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28322	----	produced from images generously made available by The Kentuckiana Digital Library) PIONEER SURGERY IN KENTUCKY: A SKETCH. BY DAVID W. YANDELL, M. D., PROFESSOR OF CLINICAL SURGERY IN THE UNIVERSITY OF LOUISVILLE, KY; PRESIDENT OF THE AMERICAN SURGICAL ASSOCIATION. LOUISVILLE: PRINTED BY JOHN P. MORTON & COMPANY. 1890 THE PRESIDENT'S ADDRESS: DELIVERED AT THE REGULAR ANNUAL MEETING OF THE AMERICAN SURGICAL ASSOCIATION, WASHINGTON, D.C., MAY 13, 1890. PIONEER SURGERY IN KENTUCKY. A SKETCH. FELLOWS OF THE ASSOCIATION: In the endeavor to chronicle the lives and achievements of Kentucky Pioneers in Surgery, I shall not attempt the resurrection of village Hampdens or mute inglorious Miltons. The men with whom I deal were men of deeds, not men of fruitless promise. It may with truth be said that from Hippocrates to Gross few in our profession who have done enduring work have lacked biographers to pay liberal tribute to their worth. In justice to the unremembered few, I turn back the records of medicine for a century, and put my finger upon two names that in the bustling march of science have been overlooked, while I try to set in fuller light two other names of workers in that day, which have and will hold an exalted place in history. The worthies to whom these names belong were pioneers in civilization as well as in surgery. I shall introduce them in the order of their work. 1806. The earliest original surgical work of any magnitude done in Kentucky, by one of her own sons, was an amputation at the hip-joint. It proved to be the first operation of the kind in the United States. The undertaking was made necessary because of extensive fracture of the thigh with great laceration of the soft parts. The subject was a mulatto boy, seventeen years of age, a slave of the monks of St. Joseph's College. The time was August, 1806; the place, Bardstown; the surgeon, Dr. Walter Brashear; the assistants, Dr. Burr Harrison and Dr. John Goodtell; the result, a complete success. The operator divided his work into two stages. The first consisted in amputating the thigh through its middle third in the usual way, and in tying all bleeding vessels. The second consisted of a long incision on the outside of the limb, exposing the remainder of the bone, which, being freed from its muscular attachments, was then disarticulated at its socket. Far-seeing as the eye of the frontiersman was, he could not have discerned that the procedure by which he executed the most formidable operation in surgery came so near perfection that it would successfully challenge improvement for more than fourscore years. Hundreds of hips have since been amputated after some forty different methods; but that which he introduced has passed into general use, and (though now known under the name of Furneaux Jordan's) remains the simplest, the least dangerous, the best. The first genuine hip-joint amputation executed on living parts was done by Kerr, of Northampton, England, 1774. The first done for shot wounds was by Larrey, in 1793. I feel safe in saying that Brashear had no knowledge of either of these operations. He therefore set about his work without help from precedent, placing his trust in himself, in the clearness of his own head, in the skill of his own hands, in the courage of his own heart. The result shows that he had not overestimated what was in him. But whether or not Brashear had ever heard or read a description of what had been accomplished in this direction by surgeons elsewhere, the young Kentuckian was the first to amputate at the hip-joint in America, and the first to do the real thing successfully in the world. Dr. Brashear seems to have set no high estimate on his achievement, and never published an account of the case. Had he done so, the art of surgery would thereby have been much advanced, his own fame have been made one of the precious heritages of his country, and, what is better, many valuable lives would have been saved. Eighteen years after the Jesuits' slave had survived the loss of his limb, the report of the much-eulogized case of Dr. Mott appeared. Dr. Brashear came of an old and wealthy Catholic family of Maryland. He was born in February, 1776. His father journeyed to Kentucky eight years later, and cleared a farm near Shepherdsville, in Bullitt County. Walter was his seventh son, and was therefore set apart for the medical profession. When a youth he was enrolled in the literary department of Transylvania University, where it is said he ranked high as a scholar in Latin. At the age of twenty he began the study of medicine, in Lexington, with Dr. Frederick Ridgely, a very cultivated physician and popular man, who had won distinction in the medical staff of the Continental Army. After two years spent in this way, he rode on horseback to Philadelphia, and attended upon a course of lectures in the University of Pennsylvania. At this time Rush, Barton, and Physick were teachers in that venerable seat of learning. His was a restless nature, and after a year spent in Philadelphia he shipped to China as surgeon of a vessel. While among the Celestials he amputated a woman's breast, probably the first exploit of the kind by one from the antipodes. Unfortunately for science, he there learned the method used by the Chinese for clarifying ginseng, and thinking, on his return home, that he saw in this an easy way to wealth, he abandoned the profession in which he had exhibited such originality, judgment, and skill, and engaged in merchandising. Twelve years of commerce and its hazards left him a bankrupt in fortune, but brought him back to the calling in which he was so well fitted to shine. He moved, in 1813, from Bardstown to Lexington, where he at once secured a large practice, especially in diseases of the bones and joints. He was thought to excel in the treatment of fractures of the skull, for the better management of which a trephine was made in Philadelphia, under his direction, which, in his judgment, was superior to any then in use. The same temper which led him to leave Philadelphia without his medical degree, sail to China, and afterward enter commerce, again asserted itself, and he forsook for the second time his vocation. With his family he now moved to St. Mary's Parish, Louisiana, and engaged in sugar-planting. During his residence in the South he served his adopted State in the Senate of the United States. He employed much time in the study of the flora of the West. "During the winter of 1843-4, when Henry Clay was on a visit to New Orleans" (says a writer in the New Orleans Medical and Surgical Journal), "we had the pleasure, together with some twenty-five physicians, of spending the evening with him at the house of a medical friend. While at the table one of the company proposed the health of the venerable Dr. Brashear, 'the first and only surgeon in Louisiana who had successfully performed amputation at the hip-joint.' Mr. Clay, who sat next to Dr. Brashear, with characteristic good humor, immediately observed, 'He has you on the hip, Doctor,' to the great amusement of Brashear and the rest of the company." Dr. Brashear was a man of fine literary taste and many and varied accomplishments. In conversation he was always entertaining, often brilliant. His voice was pleasant, his manners affable. In stature he was short; in movement, quick and nervous. But in the make-up of the man one essential of true greatness--fixedness of purpose--had been omitted. He lacked the staying qualities. He was "variable and fond of change." "His full nature, like that river of which Alexander broke the strength, spent itself in channels which led to no great name on earth." By a single exploit, at the age of thirty, he carved his name at high-water mark among the elect in surgery. Most of his life thereafter he wasted in desultory labors. As the learned Grotius said of his own life, he consumed it in levities and strenuous inanities. He died at an advanced age at his home in Louisiana. 1809. Three years after Brashear had won his unparalleled success at Bardstown, a practitioner already of wide repute as a surgeon, living in Danville, a neighboring village, did the second piece of original surgical work in Kentucky. It consisted in removing an ovarian tumor. The deed, unexampled in surgery, is destined to leave an ineffaceable imprint on the coming ages. In doing it Ephraim McDowell became a prime factor in the life of woman; in the life of the human race. By it he raised himself to a place in the world's history, alongside of Jenner, as a benefactor of his kind; nay, it may be questioned if his place be not higher than Jenner's, since he opened the way for the largest addition ever yet made to the sum total of human life. So much has been written of this, McDowell's chief work, that I feel it needless to dwell upon it. All students of our art are familiar with it as presented by abler hands than mine. What I shall say of him, therefore, will relate rather to his life and general work than to the one operation by which his name has come to be the most resounding in all surgery. This is a much more difficult task than at first it might seem to be, for McDowell made no sketch of himself, nor have his brothers or his children left us any record of his life. Even his early biographers failed to gather from his surviving friends those personal recollections of the man which would now be of such exceeding interest to us all. An authentic life-size portrait of Ephraim McDowell, as he was seen in his daily walk among men, can not now be made. The materials are too scant; the time to collect them has gone by. A profile, a mere outline drawing, is all that is possible to-day. The picture I have attempted, therefore, will be found deficient in many details which have passed into general acceptance. It is known that he came of a sturdy stock, his blood being especially rich in two of the best crosses--the Scotch-Irish. His great-grandfather rebelled against the hierarchy of his time, and enlisted as a Covenanter under the banner of James I. After honorable service, he laid down his arms, gathered his family together, and came to America. It was in honor of this ancestor that the subject of the present sketch was named. The maiden name of his mother was McClung. She was a member of a distinguished family of Virginia. McDowell was born in Rockbridge County, Virginia, on November 11, 1771. He was the ninth of twelve children. His father, Samuel McDowell, was a man of note and influence in the State, and was honored with many positions of trust. In 1773 he removed with his family to Kentucky, settling near Danville. He was made judge of the District Court of Kentucky, and took part in organizing the first court ever formed in the State. He lived to see his son confessedly the foremost surgeon south of the Blue Ridge. But it was not given to eyes of that day to see that the achievements of the village operator had illuminated all the work which has since been done in the abdominal cavity, that one had grown up and toiled in their midst, "Whose influence ineffable is borne Round the great globe to cheerless souls that yearned In darkness for this answer to their needs." Ephraim's early education was gotten at the school of the town in which he lived. He completed his school studies at an institution of somewhat higher pretentions, situated in a county near by. No anecdotes are preserved of his childhood. During his school-age he clearly preferred the out-door sports of his companions to the in-door tasks of his teachers. On quitting school he crossed the Alleghanies and became an office pupil of Dr. Humphreys, of Staunton, Va. After reading under this preceptor for two years, he repaired to the University of Edinburgh. The Scotch metropolis was then styled the "Modern Athens." It afforded opportunities at that time for acquiring a medical education the best in all the world. It was then to the medical profession what Leyden had been in the days of Sir Thomas Browne, what Paris became when Velpeau and Louis taught there. He entered the private class of John Bell, whose forceful teachings and native eloquence made a lasting impression on the mind of his youthful hearer. It has been said that McDowell conceived the thought of ovariotomy from some suggestions thrown out by this great man. The only distinction he is known to have won while in Edinburgh was that of having been chosen by his classmates to carry the colors of the college in a foot-race against a professional. In this it appears he was an easy first. He came away without a diploma. But what was of far greater value than a degree, he brought back the anatomical and surgical knowledge which was to place him in the front of his profession. He returned to Kentucky in 1795, and settled among the people who had known him from boyhood. His success was immediate, and yet Dr. Samuel Brown, who knew him in Virginia, and was his classmate in Scotland, had said, when asked of him: "Pish! he left home a gosling and came back a goose." In a little while he commanded all the surgical operations of importance for hundreds of miles around him, and this continued till, some years later, Dudley returned from Europe to share with him the empire in surgery. In 1802, fully established in his profession, and with an income which rendered him independent, he married Sarah, daughter of Governor Isaac Shelby. In 1809 he did his first ovariotomy. He believed the operation to be without precedent in the annals of surgery, yet he kept no note of it or of his subsequent work. He prepared no account of it until 1817. This appeared in the Eclectic Repertory. It was so meagre and so startling that surgeons hesitated to credit its truth. He had not mastered his mother tongue. The paper was thought to bear internal evidence of its author's having "relied upon his ledger for his dates and upon his memory for the facts." The critics from far and near fell upon him. The profession at home cast doubt upon the narrative. The profession abroad ridiculed it. For all that, McDowell kept his temper and his course, and when he finally laid down his knife he had a score of thirteen operations done for diseased ovaria, with eight recoveries, four deaths, and one failure to complete the operation because of adhesions. It would be neither fitting nor becoming on this occasion, and in this presence, to speak in detail of the technic observed by McDowell in his work. That has long since passed into history. I may, however, be permitted the remark that the procedure, in many of its features, is necessarily that of to-day. The incision was longer than that now usually made, and the ends of the pedicle ligature were left hanging from the lower angle of the wound. But the pedicle itself was dropped back into the abdomen. The patient was turned on her side to allow the blood and other fluids to drain away. The wound was closed with interrupted sutures. This marvel of work was done without the help of anesthetics or trained assistants, or the many improved instruments of to-day, which have done so much to simplify and make the operation easy. McDowell had never heard of antisepsis, nor dreamed of germicides or germs; but water, distilled from nature's unpolluted cisterns by the sun, and dropped from heaven's condensers in the clean blue sky, with air winnowed through the leaves of the primeval forest which deepened into a wilderness about him on every hand, gave him and his patients aseptic facility and environment which the most favored living laparotomist well might envy. These served him well, and six out of seven of his first cases recovered. He removed the first tumor in twenty-five minutes, a time not since much shortened by the average operator. It was not alone, however, in this hitherto unexplored field of surgery that McDowell showed himself a master. His skill was exhibited equally in other capital operations. He acquired at an early day distinction as a lithotomist, which brought to him patients from other States. He operated by the lateral method, and for many years used the gorget in opening the bladder. At a later period he employed the scalpel throughout. He performed lithotomy thirty-two times without a death. Among those who came to him to be cut for stone was a pale, slender boy, who had traveled all the way from North Carolina. This youth proved to be McDowell's most noted patient. He was James K. Polk, afterward President of the United States. Dr. McDowell's "heart was fully open to the lesson of charity, which more than all men we should feel," and he dispensed it with constant remembrance of the sacred trust imposed upon us. Yet he had a proper appreciation of what was due his guild from those whose means allowed them to make remuneration for professional services. He charged $500 for an ovariotomy that he went to Nashville, Tenn., to do. The husband of the patient gave him a check, as he supposed, for that sum. On presenting it, the doctor discovered that it was drawn for $1,500 instead of $500, whereupon he returned the check, thinking a mistake had been made. The grateful gentleman replied that it was correct, and added that the services much outweighed the sum paid. When the fact is borne in mind that the purchasable value of money was much greater in the first than in this the last decade of the century, it will be seen that the "father of ovariotomy," at least, set his successors in the field a good example. This is made conspicuous by the fact that Sir Spencer Wells has seldom charged a larger sum, and has declared £100 to be a sufficient fee for the operation. In person Dr. McDowell was commanding. He was tall, broad-shouldered, stout-limbed. His head was large, his nose prominent and full of character, his chin broad, his lips full and expressive of determination, his complexion florid, his eyes dark-black. His voice was clear and manly; he often exercised it in recitations from Scotch dialogues, when he would roll the Scotch idiom upon his tongue with the readiness of a native. He was fond of music, especially comic pieces, which he sang with fine effect, accompanying his voice sometimes with the violin. He was a man of the times, taking an active interest in the affairs of the community in which he lived. He had many books for that day. Cullen and Sydenham were his chief authorities in medicine; Burns and Scott in literature. He was fond of reading, yet he was inclined to action rather than study. He placed great reliance on surgery and its possibilities; he placed little trust in drugs. He counselled against their too liberal use. In truth, he did not like the practice of medicine, and turned over most of his non-surgical cases to his associate in business. In manner he was courteous, frank, considerate, and natural. He was a simple, ingenuous man. His great deeds had given him no arrogance. His was a clean, strong, vigorous life. His spirit remained sweet and true and modest to the last. He lived a God-fearing man, and died on June 25, 1830, in the communion of the Episcopal Church. 1813. While McDowell was so busily engaged in his special line of surgery, his colaborers elsewhere in the State were not idle. Four years after his first ovariotomy, the first complete extirpation of the clavicle ever done was accomplished by Dr. Charles McCreary, living in Hartford, Ohio County, Ky., two hundred miles, as the crow would fly, farther into the wilderness. The patient was a lad named Irvin. The disease for which the operation was done was said to be scrofulous. Recovery was slow but complete. The use of the arm remained unimpaired, and the patient lived, in good health, to be forty-nine years old. In 1829, sixteen years after the back-woods surgeon had achieved his success, Professor Mott repeated the operation, also on a youth, with a like fortunate result, and, believing he was first in the field, claimed the honor of the procedure for the United States, for New York, and for himself. He termed it his "Waterloo operation," not, however, because it surpassed, as he declared, in tediousness, difficulty, and danger any thing he had ever witnessed or performed, but because, as it appears, it fell on the 18th of June, the anniversary of the battle of Waterloo. Mott's operation required nearly four hours for its execution, and the tying of forty vessels; but after all it proved to be not a complete extirpation; for the autopsy, made many years later, showed three quarters of an inch of the bone at the acromial end still in its place. Yet the case passed quickly into the annals of surgery and added much to the already great renown of the operator. To this day it is referred to by surgical writers as "Mott's celebrated case," and the description of his procedure is often given in his own words. McCreary removed the entire collar bone, and that while a young practitioner, living in a village composed of a few scattering houses, situated in a new and sparsely settled country, where opportunities for cultivating surgical science were necessarily rare, and the means for acquiring anatomical knowledge necessarily small. The only published report of McCreary's case is from the pen of Dr. Johnson, in the New Orleans Medical and Surgical Journal for January, 1850. The account, though all too brief, clearly establishes the date of the operation, its successful issue, and the removal of the entire bone. It is greatly to be regretted that more is not known of McCreary's personal and professional character. He is said, by one who met him often, to have been a serious, thoughtful man, given to study, devoted to his calling, and fatally fond of drink, to which he fell a victim when but thirty-seven years of age. 1814. A younger man than either of those I have attempted to sketch, Dr. Benjamin Winslow Dudley, now came upon the stage. He, too, was the son of a pioneer. His early training was much like that of his contemporaries. Like Brashear, he had instruction in the office of Dr. Ridgely. Like him, he had attended lectures in the University of Pennsylvania. Unlike him, he carried away its diploma. This he did in 1806, just two weeks before he was twenty-one years old. He came home, opened an office, and offered his services to the public. The public gave him little business. He was deficient either in the knowledge or in the self-trust necessary to professional success. McDowell was located in a village hard by--was applying himself mainly to surgery, and was already in full practice. Dudley resolved to still better qualify himself for the work he was ambitious to do. He longed to go into the hospitals and follow the great teachers of Europe, but lacked the means. To get these he made a venture in trade. He purchased a flat-boat, loaded it with produce, headed it for New Orleans, and floated down the Kentucky, the Ohio, and the Mississippi rivers to the desired port. He invested the proceeds of his cargo in flour. This he billed to Gibraltar, which he reached some time in 1810; there and at Lisbon he disposed of it at a large advance. The opportunities he had sought were now near at hand. He hastened through Spain to Paris. While there he heard Baron Larrey recite his wonderful military experience. He made the acquaintance of Caulaincourt, "the Emperor's trusted minister." Through him he was present with Talma and John Howard Payne in the Chamber of Deputies when Napoleon entered the building at the close of his disastrous Russian campaign. He saw the Emperor mount the tribune. He heard him begin his report with these portentous words: "The Grand Army of the Empire has been annihilated." Remaining in Paris nearly three years, he crossed the Channel to observe surgery as practiced in London. While there he listened to Abernethy as he dwelt with all his wonted enthusiasm on his peculiar doctrine. He heard him reason it; he saw him act it, dramatize it, and came away believing him to be "the highest authority on all points relating to surgery, as at once the observant student of nature, the profound thinker, and the sound medical philosopher." He always referred to him as the greatest of surgeons. He saw Sir Astley Cooper operate, and habitually designated him as the most skilled and graceful man in his work he had ever known. He returned to Lexington in the summer of 1814, "in manners a Frenchman, but in medical doctrine and practice thoroughly English." The public was quick to detect that he had improved his time while away. "His profession had become the engrossing object of his thought, and he applied himself to it with undeviating fidelity. He made himself its slave." One who knew him well wrote of him: "He had no holidays. He sought no recreation; no sports interested him. His thoughts, he had been heard to say, were always on his cases, and not on the objects and amusements around him." He found Lexington in the midst of an epidemic of typhoid pneumonia, the same that had prevailed in the older States. This singularly fatal disease was followed by a "bilious fever, characterized, like the plague, by a tendency to local affections. Abscesses formed among the muscles of the body, legs, and arms, and were so intractable that limbs were sometimes amputated to get rid of the evil." Recalling the use he had seen made of the bandage, while abroad, in the treatment of ulcers of the leg, Dudley applied this device to the burrowing abscesses he saw so frequently in the subjects of the fever. The true position and exceeding value of the roller bandage were not so generally recognized then as now. Dr. Dudley was no doubt himself surprised at the success which followed the practice. This success probably led him to urge that wide application of the bandage with which his name came in time to be so generally associated. The tide of practice now set full toward him. He had come home a thorough anatomist. With opportunity he exhibited surpassing skill in the use of the knife. His reputation soon became national. No medical school had at that time been founded west of the Alleghanies. The need of such an institution was felt on every hand. Transylvania University, already of established reputation, was in operation. It required only a school in medicine to make it complete in its several departments. The trustees met in 1817 and added this to its organization. Dr. Dudley was made its head and appointed to fill the chairs of anatomy and surgery. A small class of students assembled in the autumn. At the commencement exercises held the following spring, W. L. Sutton was admitted to the doctorate--the first physician given that distinction by an institution in the West. Troubles arose in the faculty. Resignations were sent in and accepted. Dr. Richardson, one of the corps, challenged Dr. Dudley. A meeting followed. Richardson left the field with a pistol wound in his thigh which made him halt in his gait for the rest of his life. The year following a second organization was effected, which included the two belligerent teachers. The history of the Medical Department of Transylvania University--its rise, its success, its decline, its disappearance from the list of medical colleges--would practically cover Dr. Dudley's career, and would form a most interesting chapter in the development of medical teaching in the Southwest. But it must suffice me here to say that Dr. Dudley created the medical department of the institution and directed its policy. Its students regarded him from the beginning as the foremost man in the faculty. That he had colleagues whose mental endowments were superior to his he himself at all times freely admitted. He is said to have laid no claim to either oratorical power or professional erudition. He was not a logician, he was not brilliant, and his deliverances were spiced with neither humor nor wit. And yet, says one of his biographers, in ability to enchain the students' attention, to impress them with the value of his instructions and his greatness as a teacher, he bore off the palm from all the gifted men who, at various periods, taught by his side. A friend and once a colleague described his manner while lecturing as singularly imposing and impressive. "He was magisterial, oracular, conveying the idea always that the mind of the speaker was troubled with no doubt. His deportment before his classes was such as further to enhance his standing. He was always, in the presence of his students, not the model teacher only, but the dignified, urbane gentleman; conciliating regard by his gentleness, but repelling any approach to familiarity; and never for the sake of raising a laugh or eliciting a little momentary applause descending to coarseness in expression or thought. So that to his pupils he was always and everywhere great. As an operator they thought he had distanced competition. As a teacher they thought he gave them not what was in the books, but what the writers of the books had never understood. They were persuaded that there was much they must learn from his lips or learn not at all." His hold upon the public was as great as that upon his classes. "Patients came to him from afar because it was believed that he did better what others could do than any one else, and that he did much which no one else in reach could do." During the larger part of Dr. Dudley's life few physicians in any part of America devoted themselves exclusively to surgery. The most eminent surgeons were general practitioners--all-round men. In this class Dr. Dudley was equal to the best. In one respect, at least, he took advance ground--he condemned blood-letting. He was often heard to declare that every bleeding shortened the subject's life by a year. Admiring Abernethy more than any of his teachers, his opinions were naturally colored by the views of this eccentric Englishman. Like him he believed in the constitutional origin of local diseases, but his practice varied somewhat from that of his master. Like him he gave his patients blue pill at night but omitted the black draught in the morning. He thought an emetic better, and secured it by tartarized antimony. Between the puke and the purge his patients were fed on stale bread, skim milk, and water-gruel. And this heroic practice he pursued day after day, for weeks and months together, in spinal caries, hip caries, tuberculosis, urethral stricture and other diseases. I said that as a physician he was equal to the best. As we see things to-day this would not, perhaps, be saying much; but in fact he was better than the best. Negatively, if not positively, he improved upon the barbaric treatment of disease then in universal favor. He wholly discarded one of the most effective means by which the doctors succeeded in shortening the life of man. This was just before those biological dawnings which were soon to break into the full light of physiological medicine and the rational system of therapeutics based thereupon. And it is not improbable that as a watcher in that night of therapeutical darkness, where the doings of the best strike us with horror, his prophetic eye caught some glimpses of the coming day which in old age it was given him to see. Though engaged chiefly with the great things in surgery, he deserves a place in the list of therapeutic reformers. Much of the renown acquired for Kentucky by her surgeons was in the treatment of calculous diseases. This State is believed to have furnished almost as many cases of stone as all the rest of the Union. Dr. Dudley stands the confessed leader of American lithotomists, heading the list with two hundred and twenty-five cases. Of these he presents an unbroken series of one hundred consecutive successful operations. He used the gorget in all. He preferred the instrument invented by Mr. Cline, of London. "In one case, when his patient was on the table, he discovered that his accustomed operation was impracticable from deformity of the pelvis, and while his assistants were taking their positions resolved to make the external incision transverse, which was executed before any one else present had remarked the difficulty." Through this incision he removed a stone three and a half inches in the long diameter, two and a half inches in the short, by eleven inches in circumference. The patient recovered. In an article contributed to the Transylvania Journal of Medicine by Dr. Dudley, in 1828, he thus wrote of the trephine: "The experience which time and circumstances have afforded me in injuries of the head induced me to depart from the commonly received principles by which surgeons are governed in the use of the trephine. In skillful hands the operation, beyond the atmosphere of large cities, is neither dangerous in its consequences nor difficult in the execution." In this remark Dr. Dudley bore early testimony to the efficacy of aseptic surgery. He urged the trephine in the treatment of epilepsy and applied it in six cases--in four of which the disease was cured. The result in the two remaining cases is unknown, because the patients were lost sight of. Dr. Dudley believed himself to be the first surgeon who ever attempted to treat _fungus cerebri_ by gentle and sustained pressure made with dry sponge aided by the roller. Of the first cases in which he used it, he wrote: "By imbibing the secretions of the part, the pressure on the protruded brain regularly and insensibly increased until the sponge became completely saturated. On removing it the decisive influence and efficacy of the agent remained no longer a matter of doubt." He noted the difficulty experienced in removing the sponge because of its being extensively penetrated by blood-vessels springing from the surface of the brain. This inconvenience he afterward obviated by putting a thin piece of muslin between the fungus and the sponge. He saw in this property of the sponge what no doubt others had seen before, the phenomenon of sponge-grafting, but like them he failed to utilize it in practice. Dr. Dudley was not a student of books. He had no taste for literature. He wrote but little, and that only for the Transylvania Journal of Medicine, edited by two of his colleagues, Professors Cooke and Short. His first article did not appear until 1828, fourteen years after he had begun practice. It was on injuries of the head. It abounded in original views, and did much to shape surgical thought at the time. Today it may be consulted with profit. His second paper was on hydrocele; in this he advocated the operation by incision and removal of the sac. He read so little that he fell into the error of believing that he was the originator of the procedure. There are writers in our own day who would be able to hold their own against him in this particular. A paper on the bandage, another on fractures, and one on the nature and treatment of calculous diseases, embrace all his contributions to medical literature. Dr. Dudley was the son of Ambrose Dudley, a distinguished Baptist minister. He was born in Spottsylvania County, Va., April 25, 1785. When but a year old he was brought by his father to the then county of Kentucky. The family settled in Lexington, in which beautiful city the child became a man, and lived and wrought and died. The date of his death is January 25, 1870; his age was eighty-five years. Dr. Dudley was a man of affairs. His practice was always large and paid him well. He amassed a handsome fortune. His opinions were often sought in courts of justice on professional points, where his dignity, self-possession, and dry wit (which he seems to have suppressed at the lecturer's desk), commanded the respect of judge, juror, and advocate, while it made him the terror of the pettifogger. Once, while giving expert testimony in a case involving a wound made by bird-shot delivered at short range, he described the behavior of projectiles, and the danger of bullet wounds. The opposing counsel interrupted him: "Do you mean to say," said the lawyer, "do you mean to say, Dr. Dudley, that shot wounds are as dangerous as bullet wounds?" "Shot are but little bullets," was the unhesitating reply. Dr. Dudley had also a proper sense of the value of his professional services. He was called on one occasion to a town near Lexington to attend a patient in labor, who was the wife of a man made rich by marriage. The husband was too wise to engage a "night rider," and too purse-proud to call the village doctor. At that time most of the one hundred dollar notes in circulation in Kentucky were issued by the Northern Bank, at Lexington. On the reverse side of the bill was the letter C in Roman capital. This letter was so round in figure that it looked like a "bull's-eye," and in local slang was so called. The visit being over, and the doctor ready to leave, the young father handed him one of these notes. Eyeing it for a moment, Dr. Dudley said: "Another 'bull's-eye,' Mr. X., if you please." In person Dr. Dudley was of medium size. His features were refined, the forehead wide and high, the nose large and somewhat thick, the lips thin, the eyes bluish-gray. His hair was thin, light, and of a sandy tint. He was a graceful man. His voice was pleasing; his manners courtly; his bearing gracious. He married Miss Short, daughter of Major Peyton Short, in 1821. He delivered his last lecture in 1850, and the last entry on his ledger bears the date of April 28, 1853. * * * * * I can not give these remarks more fitting close than by describing briefly the surroundings which set their impress upon the character of the men whose lives I have attempted to portray. The picture is full of meaning, dignity, and simplicity. In this time "Canetuckee" was still a part of Virginia. The grounds on which, as boys, they played were held by their fathers under what is known as a "tomahawk claim." "Beyond lay endless leagues of shadowy forest." "The Illinois" had not been admitted into the sisterhood of the States. The vast domain west of the Mississippi River was unexplored. The city of St. Louis was but an outpost for traders. The name "Chicago" had not been coined. Fort Dearborn, occupied by two companies of United States troops, marked a roll in the prairie among the sloughs where stands to-day the queen and mistress of the lakes. Cincinnati had no place on the map, but was known as Fort Washington. General Pakenham had not attempted the rape of New Orleans, and General Jackson, who was to drive him with his myrmidons fleeing to his ships, was unknown to fame. Wars with Indians were frequent. Massacres by Indians were common. The prow of a steamboat had never cut the waters of a Western river. Railroads were unknown in the world. There were but two avenues by which Kentucky could be reached from the East. One was the water-way, furnished by the Ohio River. The other was the "Wilderness Road," "blazed" by Daniel Boone. The former was covered in keel-boats, flat-boats, and canoes. The latter was traveled on horseback or on foot. No wheel had broken it or been broken by it. The fathers of the subjects of this narrative followed this road after crossing the Alleghanies. They were a clear-eyed, a bold, an adventurous people. They wrested the land from the savage, made it secure by their arms, and by the toil of their hands fitted it for its present civilization. Among these, and such as these, these heroes in the bloody exploits of surgery were reared. From such ancestors they drew that dauntless courage which was so often tried in their achievements--achievements the fame of which will not lapse with the lapse of time. Boone had opened the way to the wilderness around them. He "blazed" a path through its unbroken depths, along which the stream of civilization quickly flowed. They blazed a path through the unexplored regions of their art along which surgeons continue to tread. His name is written in the history of his adopted State and embalmed in the traditions of its people. Their names are written in the chronicles of their beloved calling and upon the hearts of myriads of sufferers whom their beneficent labors have relieved. They may or may not have felt that their work was durable. But durable it is, and it hands down to posterity a _monumentum ære perennius_, the absolute worth of which passes computation. No present or future modification of this work can rob its authors of that glory which crowns the head of the original workman. Like their kinsmen in genius, these toilers devised measures and dealt with issues in advance of their time. Like them they enjoyed but scant recompense for labors the far-reaching significance of which they did not comprehend. Let us who are reaping in the harvest which they sowed forget not how much we are beholden to these immortal husbandmen. And as we contemplate the shining record of their deeds, let it counsel us to "bend ourselves to a better future." Not that we may hope to rival their sublime achievements, but that each in his walk, however humble it may be, may strive to enlarge the sphere of his usefulness by making surgery the better for his having practiced it. BIBLIOGRAPHY. Gross's Report on Kentucky Surgery. Gross's Medical Biography. L. P. Yandell's Report on the Medical Literature of Kentucky. L. P. Yandell's Life of Benjamin W. Dudley. Transcriber's Note: Page 27 The dot above the "i" in _fungus cerebri_ is not evident in the original publication. 
15004	----	DOCTOR AND PATIENT. BY S. WEIR MITCHELL, M.D., LL.D. HARV. MEMBER OF THE UNITED STATES NATIONAL ACADEMY OF SCIENCES, PRESIDENT OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA, PHYSICIAN TO THE ORTHOPÆDIC HOSPITAL AND INFIRMARY FOR NERVOUS DISEASES. _Introductory_. _The Physician_. _Convalescence_. _Pain and its Consequences_. _The Moral Management of Sick or Invalid Children_. _Nervousness and its Influence on Character_. _Out-Door and Camp-Life for Women_. _THIRD EDITION_. PHILADELPHIA: J.B. LIPPINCOTT COMPANY. LONDON: 36 SOUTHAMPTON STREET, COVENT GARDEN. 1901. CONTENTS. INTRODUCTORY THE PHYSICIAN CONVALESCENCE PAIN AND ITS CONSEQUENCES THE MORAL MANAGEMENT OF SICK OR INVALID CHILDREN NERVOUSNESS AND ITS INFLUENCE ON CHARACTER OUT-DOOR AND CAMP-LIFE FOR WOMEN INTRODUCTORY. The essays which compose this volume deal chiefly with a variety of subjects to which every physician must have given more or less thought. Some of them touch on matters concerning the mutual relation of physician and patient, but are meant to interest and instruct the laity rather than the medical attendant. The larger number have from their nature a closer relation to the needs of women than of men. It has been my fate of late years to have in my medical care very many women who, from one or another cause, were what is called nervous. Few of them were so happily constituted as to need from me neither counsel nor warnings. Very often such were desired, more commonly they were given unsought, as but a part of that duty which the physician feels, a duty which is but half fulfilled when we think of the body as our only province. Many times I have been asked if there were no book that helpfully dealt with some of the questions which a weak or nervous woman, or a woman who has been these, would wish to have answered. I knew of none, nor can I flatter myself that the parts of this present little volume, in which I have sought to aid this class of patients, are fully adequate to the purpose. I was tempted when I wrote these essays to call them lay sermons, so serious did some of their subjects seem to me. They touch, indeed, on matters involving certain of the most difficult problems in human life, and involve so much that goes to mar or make character, that no man could too gravely approach such a task. Not all, however, of these chapters are of this nature, and I have, therefore, contented myself with a title which does not so clearly suggest the preacher. It would be scarcely correct to state that their substance or advice was personally addressed to those still actually nervous. To them a word or two of sustaining approval, a smiling remonstrance, or a few phrases of definite explanation, are all that the wise and patient doctor should then wish to use. Constant inquiries and a too great appearance of what must be at times merely acted interest, are harmful. When I was a small boy, my father watched me one day hoeing in my little garden. In reply to a question, I said I was digging up my potatoes to see if they were growing. He laughed, and returned, "When you are a man, you will find it unwise to dig up your potatoes every day to see if they are growing." Nor has the moral of his remark been lost on me. It is as useless to be constantly digging up a person's symptoms to see if they are better, and still greater folly to preach long sermons of advice to such as are under the despotism of ungoverned emotion, or whirled on the wayward currents of hysteria. To read the riot act to a mob of emotions is valueless, and he who is wise will choose a more wholesome hour for his exhortations. Before and after are the preacher's hopeful occasions, not the moment when excitement is at its highest, and the self-control we seek to get help from at its lowest ebb. There are, as I have said, two periods when such an effort is wise,--the days of health, or of the small beginnings of nervousness, and of the uncontrol which is born of it, and the time when, after months or years of sickness, you have given back to the patient physical vigor, and with it a growing capacity to cultivate anew those lesser morals which fatally wither before the weariness of pain and bodily weakness. When you sit beside a woman you have saved from mournful years of feebleness, and set afoot to taste anew the joy of wholesome life, nothing seems easier than with hope at your side, and a chorus of gratitude in the woman's soul, to show her how she has failed, and to make clear to her how she is to regain and preserve domination over her emotions; nor is it then less easy to point out how the moral failures, which were the outcome of sickness, may be atoned for in the future, now that she has been taught to see their meaning, their evils for herself, and their sad influence on the lives of others. To preach to a mass of unseen people is quite another and a less easy matter. I approach it with a strong sense that it may have far less certain utility than the advice and exhortation addressed to the individual with such force as personal presence, backed by a knowledge of their peculiar needs, may give. I am now, then, for the first time, in the position of the higher class of teachers, who lay before a multitude what will be usefully assimilated by the few. If my power to say what is best fitted to help my readers were as large as the experience that guides my speech, I should feel more assured of its value. But sometimes the very excess of the material from which one is to deduce formulas and to draw remembrances is an embarrassment, for I think I may say without lack of modesty in statement, that perhaps scarce any one can have seen more of women who have been made by disease, disorder, outward circumstance, temperament, or some combination of these, morbid in mind, or been tormented out of just relation to the world about them. The position of the physician who deals with this class of ailments, with the nervous and feeble, the painworn, the hysterical, is one of the utmost gravity. It demands the kindliest charity. It exacts the most temperate judgments. It requires active, good temper. Patience, firmness, and discretion are among its necessities. Above all, the man who is to deal with such cases must carry with him that earnestness which wins confidence. None other can learn all that should be learned by a physician of the lives, habits, and symptoms of the different people whose cases he has to treat. From the rack of sickness sad confessions come to him, more, indeed, than he may care to hear. To confess is, for mysterious reasons, most profoundly human, and in weak and nervous women this tendency is sometimes exaggerated to the actual distortion of facts. The priest hears the crime or folly of the hour, but to the physician are oftener told the long, sad tales of a whole life, its far-away mistakes, its failures, and its faults. None may be quite foreign to his purpose or needs. The causes of breakdowns and nervous disaster, and consequent emotional disturbances and their bitter fruit, are often to be sought in the remote past. He may dislike the quest, but he cannot avoid it. If he be a student of character, it will have for him a personal interest as well as the relative value of its applicative side. The moral world of the sick-bed explains in a measure some of the things that are strange in daily life, and the man who does not know sick women does not know women. I have been often asked by ill women if my contact with the nervous weaknesses, the petty moral deformities of nervous feminine natures, had not lessened my esteem for woman. I say, surely, no! So much of these is due to educational errors, so much to false relationships with husbands, so much is born out of that which healthfully dealt with, or fortunately surrounded, goes to make all that is sincerely charming in the best of women. The largest knowledge finds the largest excuses, and therefore no group of men so truly interprets, comprehends, and sympathizes with woman as do physicians, who know how near to disorder and how close to misfortune she is brought by the very peculiarities of her nature, which evolve in health the flower and fruitage of her perfect life. With all her weakness, her unstable emotionality, her tendency to morally warp when long nervously ill, she is then far easier to deal with, far more amenable to reason, far more sure to be comfortable as a patient, than the man who is relatively in a like position. The reasons for this are too obvious to delay me here, and physicians accustomed to deal with both sexes as sick people will be apt to justify my position. It would be easy, and in some sense valuable, could a man of large experience and intelligent sympathies write a book for women, in which he would treat plainly of the normal circle of their physiological lives; but this would be a method of dealing with the whole matter which would be open to criticism, and for me, at least, a task difficult to the verge of the impossible. I propose a more superficial plan as on the whole the most useful. The man who desires to write in a popular way of nervous women and of her who is to be taught how not to become that sorrowful thing, a nervous woman, must acknowledge, like the Anglo-Saxon novelist, certain reputable limitations. The best readers are, however, in a measure co-operative authors, and may be left to interpolate the unsaid. A true book is the author, the book and the reader. And this is so not only as to what is left for the reader to fill in, but also has larger applications. All this may be commonplace enough, but naturally comes back to one who is making personal appeals without the aid of personal presence. Because what I shall write is meant for popular use rather than for my own profession, I have made my statements as simple as possible. Scarcely a fact I state, or a piece of advice I give, might not be explained or justified by physiological reasoning which would carry me far beyond the depth of those for whom I wrote. All this I have sedulously avoided. What I shall have to say in these pages will trench but little on the mooted ground of the differences between men and women. I take women as they are to my experience. For me the grave significance of sexual difference controls the whole question, and, if I say little of it in words, I cannot exclude it from my thought of them and their difficulties. The woman's desire to be on a level of competition with man and to assume his duties is, I am sure, making mischief, for it is my belief that no length of generations of change in her education and modes of activity will ever really alter her characteristics. She is physiologically other than the man. I am concerned with her now as she is, only desiring to help her in my small way to be in wiser and more healthful fashion what I believe her Maker meant her to be, and to teach her how not to be that with which her physiological construction and the strong ordeals of her sexual life threaten her as no contingencies of man's career threaten in like measure or like number the feeblest of the masculine sex. THE PHYSICIAN. I have long had in mind to write from a physician's point of view something in regard to the way in which the well-trained man of my profession does his work. My inclination to justify the labors and sentiments of an often misunderstood body of men was lately reinforced by remarks made to me by a very intelligent patient. I found him, when I entered my room, standing before an admirable copy of the famous portrait of the great William Harvey, the original of which is in the Royal College of Physicians. After asking of whom it was a likeness, he said, "I should be a little curious to know how he would have treated my case." I had to confess that of Harvey's modes of practice we know little, but I took down from a shelf those odd and most interesting letters of Howell's, clerk of council to James I., and turned to his account of having consulted Harvey on returning home from Spain. Only too briefly he tells what was done for him, but was naturally most concerned about himself and thus missed a chance for us, because it so happens that we know little of Harvey. At this page of Howelliana was a yellow paper-marker. Once the book was Walpole's, and after him was Thackeray's, and I like to fancy that Walpole left the marker, and that Thackeray saw it and left it, too, as I did. My patient, who liked books, was interested, and went on to say that he had seen several physicians in Europe and America. That in France they always advised spas and water-cure, and that at least three physicians in America and one in London had told him there was nothing the matter with him, and that finally a shrewd country doctor had remarked bluntly that he would not give him any medicine, because he was overdosed already with work and worries, which was true. At last he came back to Harvey. "He looks ill," he said, which is true. His honestly-painted knuckles make diagnosis easy. My friend thought that this great man would probably have dosed him well, and, as he added, would not have bothered him about too much sugar, nor forbidden champágne. I had to reply that whatever ills were in the England of that day,--and there was much dyspepsia and much gout,--sugar was the luxury of the rich, and anything but as abundant as it is to-day, when we consume annually fifty-six pounds per head or per stomach. I told him that in all ages the best of us would have dwelt most on diet and habits of living, and that Harvey was little likely to have been less wise than his peers, and he has had but few. Then he said it would be curious to put on paper a case, and to add just what a doctor in each century would have ordered. The idea struck me as ingenious and fertile. I could wish that some one would do this thing. It would, I think, be found that the best men of every time were most apt to consider with care the general habits of their patients as to exercise and diet, and to rely less than others on mere use of drugs. As to this matter, one learns more from men's lives than from their books, but nowadays care as to matters of hygiene has become in a valuable degree the common wisdom of a large part of my profession. Surveying our vast gains, we are a little apt to undervalue the men of older days, and no lesson is wiser than sometimes to go back and see how the best of them thought and acted amidst the embarrassments of imperfect knowledge. There is a charming life by Henry Morley, of Cardan, the great Italian physician and algebraist, which gives us in accurate detail the daily routine of a doctor's days in the sixteenth century. In it is an account of Cardan's professional visit in 1551 to John Hamilton, archbishop of St. Andrew's, Scotland, and practically the ruler of that turbulent realm. Cardan's scientific opinion as to his patient is queer enough, but, as Morley remarks, it is probably not more amusing to us than will be our opinion in a like case to the smiling brother of our guild who may chance to read it at some remote future day. The physician of whom I now write was one who already dreaded bleeding, thought less of medicines than his fellows, and was, in fact, exceptionally acute. He did some droll things for the sick prelate, and had reasons yet more droll for what he did, but his practice was, as may happen on the whole, wiser than his reasons for its use. His patient was a man once bulky, but now thin, overworked, worried, subject to asthma, troubled with a bad stomach, prone to eat largely of coarse food, but indisposed to physical exercise. Cardan advised that the full, heated head, of which his patient much complained, should be washed night and morning with hot water in a warm room, and then subjected to a cold shower-bath. Next was to come a thorough dry rubbing, and rest for two hours. As to his asthma, he forbade him to subject himself to night air or rainy weather. He must sleep on silk, not feathers, and use a dry pillow of chopped straw or sea-weed, but by no means of feathers. He forbade suppers if too late, and asked the reverend lord to sleep ten hours, and even to take time from study or business and give it to bed. He was to avoid purgatives, to breakfast lightly, and to drink slowly at intervals four pints a day of new asses' milk. As to other matters, he was to walk some time in the shade at an early hour, and, discussing the time for the fullest meal, Cardan remarks that established habits as to this point are not to be lightly considered. His directions as to diet are many, reasonable, and careful. His patient, once stout, had become perilously thin. Turtle-soup and snail-broth would help him. Cardan insisted also on the sternest rules as to hours of work, need for complete rest, daily exercise, and was lucky enough to restore his patient to health and vigor. The great churchman was grateful, and seems to have well understood the unusual mental qualities of his physician. Nothing on the whole could be better than the advice Cardan gave, and the story is well worth reading as an illustration of the way in which a man of genius rises above the level of the routine of his day. I might go farther back in time, and show by examples that the great fathers of medicine have usually possessed a like capacity, and learned much from experience of that which, emphasized by larger use and explained by scientific knowledge, has found its way into the text-books of our own day and become common property. It appears to me from a large mental survey of the gains of my profession, that the English have above all other races contributed the most towards enforcing the fact that on the whole dietetics, what a man shall eat and drink, and also how he shall live as to rest, exercise, and work, are more valuable than drugs, and do not exclude their use.[1] [Footnote 1: By this I mean that the physician, if forced to choose between absolute control of the air, diet, exercise, work, and general habits of a patient, and use of drugs without these, would choose the former, and yet there are cases where this decision would be a death-warrant to the patient.] The active physician has usually little time nowadays to give to the older books, but it is still a valuable lesson in common sense to read, not so much the generalizations as the cases of Whytt, Willis, Sydenham, and others. Nearer our own day, Sir John Forbes, Bigelow, and Flint taught us the great lesson that many diseases are self-limited, and need only the great physician, Time, and reasonable dietetic care to get well without other aid. There is a popular belief that we have learned this from homoeopathy, for the homoeopath, without knowing it, made for us on this matter ample experiments, and was as confident he was giving powerful medicines as we are that he was giving practically none. "He builded better than he knew," and certainly his results aided our ablest thinkers to reach the truth. I have named one of the most illustrious of physicians, Sydenham, as among the great Englishmen who brought to their work the clearest perception of how nature was to be best aided. He will answer admirably to exemplify my meaning. Sydenham was born in 1624, and lived in and through the wild periods of Charles I. and Cromwell, and was himself a stanch republican. He more than any other in his century decisively taught caution as to mere medication, and sedulously brought the clear light of common sense to bear upon the practice of his time. It is interesting to note, as his biographer remarks, that his theories were often as worthless as his practice was good. Experience taught him to do that for which he felt forced to find a reason, and the reason was often enough absurd. "The contrast gives a fine light and shadow effect in his biography."[2] [Footnote 2: R.G. Latham, p. xxxvi.] His systematic beliefs were ofttimes worthless, but great acuteness in observation was apt to lead him to do wisely in individual cases what was at variance with his creed. Speaking of Hippocrates, he says, "His system led him to assist nature, to support her when enfeebled and to the coercion of her when she was outrageous." As to mere drugs, Sydenham used them in what was for his day an extremely moderate fashion, and sagaciously limited in the old and young his practice as to bleeding, which was then immensely in vogue. The courage required to treat smallpox, measles, and even other fevered states by cooling methods, must have been of the highest, as it was boldly in opposition to the public and private sentiment of his day. He had, too, the intelligence to learn and teach that the Jesuit bark, cinchona, was a tonic as well as the master of the agues, so common in the England of his time. He is at his best, however, in his statement of how he treated individual cases, for then his written theories are given to the winds, or the practice is far beyond the creed in its clear common-sense value. Thus, horseback exercise he constantly speaks of. He tells you of a friend who had been much dosed by many for dyspepsia, and how he bade him ride, and abandon drugs, and how, after a thousand miles of such riding, he regained health and vigor. See how this wise man touches the matter of gout: "For years a man has feasted; has omitted his usual exercises; has grown slow and sluggish; has been overstudious or overanxious, etc." Then he reasons about "smothering the animal spirits, which are the primary instruments of concoction," and so on, but at last he says, "We must look beyond medicines. Wise men do this in gout and in all other chronic diseases." And what does he advise? Here is the substance of what he says. A gouty man must be moderate, not too abstinent, so as to get weak. One meat is best; mixtures are bad. A milk diet "has prevailed," only bread being added, but it must be rigid and has its risks. He seems to have kept a nobleman on milk a year. Also there must be total abstinence from wine and all fermented liquors. Early bed hours and early rising are for the gouty. Then there come wise words as to worry and overwork. But, above all, the gouty must ride on horseback and exercise afoot. As to the wilder passions of men, he makes this strangely interesting remark, "All such the old man should avoid, for," he says, "by their indulgence he thus denies himself the privilege of enjoying that jubilee which by the special and kind gift of nature is conceded to old men: of whom it is the natural and happy lot to be emancipated from the control of those lusts which during youth attacked them." This is a fair specimen of a master at his best. I would rather have trusted Sydenham, with all his queer theories, than many a man with the ampler resources of to-day; for his century may aid but does not make the true physician, who is not the slave, but the master, of opinions. To enforce again the fact that the greater men of my art, even in days of the most extreme theories, were more sensible in their daily practice than in their dogmatic statements, I would like to quote a letter of Rush, which for several reasons is interesting and valuable. No man was more positive in his beliefs and in the assertion of them than he. His name is still associated with bleeding and purging, and if we considered only some of his written assertions, made with the violence which opposition always aroused in his positive nature, we should pause in wonder at his great reputation. But what a man says or writes, and what he does, are often far apart. We are apt to take his most decisive statements as representative, and thus may seriously err. I have known a number of men who were really trustworthy physicians, and who yet were credited by us with a fondness for absurd ideas, which, in fact, influenced their writings far more than their practice. Rush was to some extent one of this class. His book on insanity is far in advance of his time, and his descriptions of disease one of our best tests, most admirable. Let us see how this physician who bled and dosed heavily could think and act when face to face with a hopeless case. The letter to which I have referred was given to the College of Physicians of Philadelphia at my request by one of its associate fellows, Dr. Hunter Maguire, of Richmond, Virginia. It is written to Rush's cousin, Dr. Thornton, in 1789, and has an added interest from the fact that it is a letter of advice in the case of the aged mother of Washington, who had a cancer of the breast. "PHILADELPHIA, July 6, 1789. MY DEAR KINSMAN: The respectable age and character of your venerable patient leads me to regret that it is not in my power to suggest a remedy for the cure of the disorder you have described in her breast. I know nothing of the root that you mention as found in Carolina and Georgia, but, from a variety of inquiries and experiments, I am disposed to believe that there does not exist in the vegetable kingdom an antidote to cancers. All the vegetable remedies I have heard of are composed of some mineral caustics. The arsenic is the most powerful of any of them. It is the basis of Dr. Martin's powder. I have used it in many cases with some success, but have failed in some. From your account of Mrs. Washington's breast, I am afraid no great good can be expected from the use of it. Perhaps it may cleanse it, and thereby retard its spreading. You may try it diluted in water. Continue the application of opium and camphor, and wash it frequently with a decoction of red clover. Give anodynes when necessary, and support the system with bark and wine. Under this treatment she may live comfortably many years, and finally die of old age." He had here to deal with cancer, a disease which he knew to be incurable. His experience taught him, however, that in the very old this malady is slow and measured in its march, and that he could only aid and not cure. What he says might with slight change have been penned to-day. We have gone no further in helpfulness as regards this sad disease. If what I write now is to have for the laity any value, it will be in correcting certain of their judgments as to physicians, and in suggesting to them some of the tests which will enable them to exercise a reasonable judgment as to those in whose hands they place so often without a thought the issues of life and death and the earthly fates of their dearest. I began, somewhat discursively, by showing how much care the masters of my art gave even in past days to matters of diet and modes of life. This is still to-day a test of larger applicability. There are those of my profession who have a credulity about the action of drugs, a belief in their supreme control and exactness of effect which amounts to superstition, and fills many of us with amazement. This form of idolatry is at times the dull-witted child of laziness, or it is a queer form of self-esteem, which sets the idol of self-made opinion on too firm a base to be easily shaken by the rudeness of facts. But, if you watched these men, you would find them changing their idols. Such too profound belief in mere drugs is apt, especially in the lazy thinker, to give rise to neglect of more natural aids, and these tendencies are strengthened and helped by the dislike of most patients to follow a schedule of life, and by the comfort they seem to find in substituting three pills a day for a troublesome obedience to strict rules of diet, of exercise, and of work. The doctor who gives much medicine and many medicines, who is continually changing them, and who does not insist with care on knowing all about your habits as to diet, mealtimes, sleep, modes of work, and hours of recreation, is, on the whole, one to avoid. The family doctor is most of all apt to fail as to these details, especially if he be an overworked victim of routine, and have not that habitual vigilance of duty which should be an essential part of his value. He is supposed to have some mysterious knowledge of your constitution, and yet may not have asked you a medical question in months or years. Too much is taken for granted, and inefficient opinions are the outcome of carelessness. Every new case in a household should be dealt with as if it were a stranger's, and outside familiarity should not be allowed to breed contempt of caution in study or lead to half measures. Every consultant will agree with me that this kind of social nearness of the doctor to his patient is a common cause of inert advice, and nowhere more distinctly so than when unwise physicians attempt to practise in their own households on those they love. There are very few instances of chronic ailments, however slight, which should not be met by advice as to modes of living, in the full breadth of this term; and only by a competent union of such, with reasonable use of drugs, can all be done most speedily that should be done. I have said "with use of drugs," for I am far from wishing to make any one believe that medicines are valueless. Nor do I think that the most extreme dosing employed nowadays by any one is as really hurtful as the neglect to urge efficiently the value of definite hygienic means. There are, indeed, diseases which can only be helped by heroic measures; but, in this case, were I the patient, I should like to be pretty certain as to the qualifications of my hero. The popular view of the great hurtfulness of drugs is curiously fallacious. I have spoken above more of their relative usefulness, as compared to other means of relief, than with any desire to convince my readers that they are such terrible things as some kinds of practitioners would have us to believe. The dread of their employment is a relic of the time of reaction against the senseless and excessive dosing with calomel and strong purges, and nowadays, even as regards bleeding, once wholly abandoned, it is clear that it still has at times its uses, and valuable ones, too. As medicines are now employed, even by the thoughtless, it must be rarely that they give rise to permanent injury. Let any physician who reads these lines pause and reflect how many times in his life he has seen lasting or serious evil results from drugs. Accidents happen, but they are the offspring of carelessness. Sometimes, also, unexpected and temporary extreme results surprise us, as when an opiate purges, or five grains of an iodide prove to be gravely poisonous. These occurrences are due to individual peculiarities, which we can as yet neither explain nor anticipate. One man can take opium with almost the impunity which belongs naturally to birds. Another is put to sleep by the dose you give a baby. All this teaches caution, but it is not a matter for blame when it gives rise to alarming consequences, and happily these cases of what we call idiosyncrasies are exceptionally uncommon. Physicians are often enough tempted to give a simple placebo to patients who are impatient, and ask instant treatment when we know that time is what we want, either for study of present symptoms or to enable the growing disorder to spell itself out for us, as it were, letter by letter, until its nature becomes clear. The practice is harmless, but there is, of course, a better way, if we possess the entire confidence of the patient or his friends. But sometimes it is undesirable to give explanations until they can be securely correct, or haply the sick man is too ill to receive them. Then we are apt, and wisely, to treat some dominant symptom, and to wait until the disease assumes definite shape. So it is that much of what we thus give is mild enough. The restless mother is the cause with some doctors of much of this use of mere harmless medicines. I once expressed surprise in a consultation that an aged physician, who had called me in, should be so desirous of doing something, when I as earnestly wished to wait. At last he said, "Doctor, it is not the child I want to dose; it is the mother's mind." Perhaps the anecdote may not be lost on some too solicitous woman, who naturally desires that the doctor should be doing something just when he is most anxious to be doing nothing. Men yet live who can remember when all of our knowledge of disease was acquired by the unaided use of the eye, the ear, and the touch. The physician felt the pulse, and judged of fever by the sense of warmth. He looked at the skin and tongue and the secretions, and formed conclusions, more or less just in proportion to the educated acuteness of his senses and the use he made of these accumulations of experience. The shrewdness of the judgments thus formed shows us, to our wonder, how sharply he must have trained his senses, and has led some to suspect that our easier and more exact methods and means may have led us to bestow less care in observation than did these less aided and less fortunate students. The conclusion is, I am sure, erroneous, and I am confident that the more refined the means the more do they train us to exactness in all directions, so that even what we now do with the eye, ear, or hand alone is better and more carefully done than when the senses had none of the training due to the use of instruments of precision. I may add that the results of their employment have also made it easy in many cases to dispense with them, and to interpret readily what has been won by the unassisted sense. The history of precision in medicine is worth the telling, if only to teach the lay reader something of that vast struggle to know the truths of disease, which is little understood beyond the ranks of the most scholarly of my profession. The first step was due to Galileo. In 1585 he used his pendulum to record the pulse, in a fashion at which we smile to-day, and yet what he tried to do was the birth of precision in medicine. Keeping a finger on the pulse, he set a pendulum in motion. If it went faster than the pulse, he put the weight a little lower, or as I may state it to make it clearer, he lengthened the pendulum. At last when it moved so as to beat equal time with the pulse, he measured the length of the swinging bar, and set down the pulse as, say ten inches; next day it might be set at six, and so a record was made. He was soon lost to medicine, but in 1625, Santorini, known to science as Sanctorius, published a curious book, called "Commentaries on Avicenna," in which he figured a variety of similar instruments, called "pulsilograms." We owe to him some of the first accurate studies of diet, and also the discovery of the insensible perspiration, but his pulsilogram was soon forgotten. I think that Harvey but once or twice mentions the number of the pulse even in his physiological books. In the case descriptions of his time and of Sydenham's it is rare to find it noted, and this is true as a rule all through the next century. The exceptions are interesting. In Whytte's works, _circa_ 1745, he not rarely mentions the pulse number in connection with his primary delineation of a case, but after that does not often speak of its subsequent changes in number. The force and other characters of the pulse receive, however, immense attention, and are on the whole more valuable aids than mere numeration; but that cannot nowadays be left out of our calculations, yet as early as the reign of Anne, about 1710, an English physician, Sir John Floyer, wrote an able and now half-forgotten book, quaintly called the "Pulse Watch." I am pretty sure that he was the first to put a minute-hand on a watch to enable him to time the pulse-beat, but nowhere in any English collection have I been able to find one of his watches. Thus aided, he was the first to count the minute's pulse, which is now a sort of recognized and accepted matter as standard of comparison, so that we say merely, the pulse was 60 or 90, as may chance, and do not even speak of the minute. It is as true as strange that this convenient method was practically lost to habitual use in medicine for quite a hundred years. It reappeared in the writings of the time of the great teachers who arose in France and Germany about 1825. To-day, in case of need, we have instruments which write in instructive curves the form of the pulse-wave, and enable us to settle questions which sometimes could not be settled without this delicate means. The study of the temperature of the body was, as I have said, a mere matter of the touch until our same Galileo applied a thermometer to learn more accurately its changes. Sanctorius again followed in his steps, and has left us in his works curious drawings of forms of thermometer applicable to medical uses. Our profession is, however, inapt to hold on to useless things, and our knowledge of fever, its risks and its remedies, was for many a day far behind any need for the delicate appreciations of the thermometer. Hence it is that very few physicians did more in the last three centuries as regards the temperature of the body than speak of it as high or low. Sanctorius was too far ahead of his time to teach us the true value of medical thermometry. It was forgotten for many a day. In the last century, in Dehaen and Hunter, it again receives some notice, and again drops out of use. At last we are ripe for it, and Wunderlich, in a classical book, about twenty-five years ago, puts it in a position of permanent utility. The physician of to-day knows more both of fever and of its consequences, and finds in his thermometer an indispensable ally. Within but a few years the instruments of precision have so multiplied that a well-trained consultant may be called on to know and handle as many tools as a mechanic. Their use, the exactness they teach and demand, the increasing refinement in drugs, and our ability to give them in condensed forms, all tend towards making the physician more accurate, and by overtaxing him, owing to the time all such methodical studies require, have made his work such that only the patient and the dutiful can do it justice. Primary examinations of chest, heart, and other viscera are long and troublesome, and the first study of a case which is at all difficult, demands such time as it is increasingly hard for the busy to find. A good test for laymen in acute cases is the methodical manner in which a physician of modern training goes over the case, nor is his preciseness as to doses and medicines less worthy of note. I used to watch with interest the late Professor P. at a sick-bed. The grave and tranquil interest, the pauses for thought, the swift thoroughness of examination, and then the delay, with, "Please, nurse, let me taste that last medicine," were full of good lessons. Any consultant could tell you what a rare quality is this union of precision and thoroughness. Our profession has in its work enough of true difficulties, but we still owe many of our worst errors to want of absolutely complete study of our cases, and with the careless these slips are obvious enough to enable any one who is watchful to sit in judgment on the failures. The more delicate illustrations of the fine union of qualities which attain the highest triumphs are, of course, only seen and comprehended by physicians, whose general opinion on their fellows is in the end almost always a just one. There is a potent combination of alertness in observation, with a never-satisfied desire to know even the trifles of a case, which, with sagacity, gives a medical mental character as rare as it is valuable. For such men there are no trifles, and, on entering a sick-room, they seem to absorb at a glance matters which escape others, and yet to the end are still so quietly observant and searching that they seem never to be quite content with what they have learned. Not to know surely is to them a form of unhappiness. I remember well a consultation in a case of great obscurity, into which, many years ago, the late Dr. G. was called, after three of his colleagues had failed to reach a conclusion. It was suspected that poisoning by lead was the cause of a singular and unusual train of symptoms. Now, in such cases, a blue line around the junction of the teeth and gums is a certain sign of the presence of that poisonous metal. The patient, a man of seventy-five years, was known by his own physician to wear full sets of artificial teeth, and he so said. This having been stated no one looked at the gums. At the close of the second meeting Dr. G. turned back unsatisfied. "Let me see your gums. Ah!" he said. There was the stump of one incisor left, and around it the blue line told a tale which ended all doubt. On another occasion, a young physician well known to me, fell by a chance into a consultation with Dr. P., the physician I have mentioned, and the late Professor P. The case was one of a young man who several times had been found at morning in a stupor. The attacks were rare, and what caused them was unknown. The young physician, much embarrassed, was civilly asked to examine the case, and did so with a thoroughness which rather wearied the two older men. When they retired to an adjoining room, he was asked, as our custom is, to give, as the youngest, the first opinion. He said, "It is a case of epilepsy. He has bitten his cheek in the fit." Dr. P. rose without a word and went out. Returning in a few moments, he said, "You are right. I did not look far enough back. You will reach, sir, a high rank in our profession." The case was thenceforward plain enough. These are rare illustrations of my meaning, and may suffice, with one which has a more humorous aspect. Meeting the late Professor C. D. M. on the steps of a house where, the day before, we had seen together a woman critically ill, he said to me, "Mrs. B. is better, doctor, much better." "And how do you know that?" I returned. "Her windows are open, my dear doctor. She wants more light. She must be better, much better." And so she was, as it proved. A final result of the multiplication of the means of research, and the increasing difficulty in becoming expert in the use of the many and delicate instruments they require, is the growth of what we call specialties in medicine. The best of us learn to use the ophthalmoscope to look into the eye, to use the laryngoscope for the larynx, and can at need examine the urine and the blood, but the men must be rare who are as competent to use each and all of these means as persons who devote themselves to single branches of our work. Moreover, the element of time comes in, as well as the element of such constant familiar practice as makes for one man commonplace and easy what for another, who is more generally occupied, is uncommon and unfamiliar. The specialist profits by the fact that his experience becomes enormous and his work advantaged by its definite limitations. On the other hand, and nowadays especially, he is too apt to be one who, after brief hospital work of general character, or without this, takes up, as we say, the eye, ear, throat, or uterine organs. Unless he has had at some time a larger and more varied experience, or unless he is a most unusual man, he is prone at last to lose sight in his practice of the fact that eye, ear, and womb are parts of a complicated mechanism, and suffer through its general or local disorders. Hence the too common neglect of constitutional conditions, to which are often due the apparent maladies of the organs to which he devotes himself. Moreover, in certain of the organs of sense, as the eye, are frequently seen the very first signals of spinal or other maladies, and if, as too often happens, he sees in some such sign or symptom only the evidence of a local trouble, and neglects to look or reason beyond it, he may inflict on his patient the gravest penalties, by depriving him of the chance of early treatment of some serious disease, involving lifelong, or even fatal, consequences. This is a criticism on the man and his training, not on the system of specialties which has become invaluable. A reasonable desire to seek aid from physicians of usefully limited values is another test of the good family physician. I know of men who are in the habit of saying that they dislike consultations and get little good from them. As compared to those who too commonly subject people to the expense of fresh advisers, they are the more dangerous class. Apt enough in cases of acute disease to bring into the case some one to share responsibilities which seem grave because near at hand, they continue to treat chronic cases they do not understand, because there is no crisis of pain, disability, or danger to bring them to reason. Hitherto I have dealt most with the intellectual outfit needed for the best practice of medicine, but the criticism I have just made brings me on more delicate ground. The man who feels himself so competent that his self-esteem forbids him to seek advice when he knows and must know he has come to the end of his reasonable resources, lacks the humility which belongs to larger natures, and he, too, is a man to avoid. Be sure that the physician cannot he a mere intellectual machine. None know that better than we. Through all ages we have insisted that he shall feel himself bound by a code of moral law, to which, on the whole, he has held without question, while creeds of more serious nature were shifting and changing. What the Greek fathers of medicine asked of him we still ask of him to-day. He must guard the secrets wrung from you on the rack of disease. He is more often than he likes a confessor, and while the priest hears, as I have once said, the sins and foibles of to-day, he is as like as not to have to hear the story of a life. He must be what About calls him, "Le tombeau des secrets,"--the grave of secrets. How can he be too prudent or too close-mouthed? Honor you must ask of him, for you must feel free to speak. Charity you should expect from him, for the heart is open to him as it is to no other, and knowledge, large knowledge, is the food which nourishes charity in the tender-hearted. In the tender-hearted? How can he be that? All his days he has walked amidst misery, anguish, bodily and mental suffering. Be careful when you come to test him by his ability to feel what you call sympathy. In its loftiest meaning this is the capacity to enter into, to realize, and hence to feel with and for you. There is a mystery about this matter. I know men who have never suffered gravely in mind or body, who yet have some dramatic power to enter into the griefs of others, and to comprehend, as if by intuition, just what others feel, and hence how best to say and do the things which heal or help. I know others, seemingly as tender, who, with sad experience to aid them, appear to lack the imaginative insight needed to make their education in sorrow of use to their fellows. There are times when all that men can give of sympathetic tenderness is of use. There are others when what you crave is but the outcome of morbid desires for some form of interested attention. You may ask too much, and every doctor knows how curiously this persistent claim for what you call sympathy does, as the nurses say, "take it out of a doctor." The selfishness of nervous women sometimes exceeds belief in its capacity to claim pity and constancy of expressed sympathy. In times of more serious peril and suffering, be assured that the best sympathy is that which calmly translates itself into the desire to be of practical use, and that the extreme of capacity to feel your woes would be in a measure enfeebling to energetic utility. This it is which makes a man unfit to attend those who are dear to him, or, to emphasize the illustration, to medically treat himself. He goes to extremes, loses judgment, and does too much; fears to hurt, and does too little. I once saw a very young physician burst into tears at sight of a burnt child, a charming little girl. He was practically useless for the time. And I have known men who had to abandon their profession on account of too great sensibility to suffering. There is a measure of true sympathy which comes of kindness and insight, which has its value, and but one. Does it help you over the hard places? Does it aid you to see clearly and to bear patiently? Does it truly nourish character, and tenderly but, firmly set you where you can gain a larger view of the uses of pain and distress? That is the truest sympathy. Does it leave you feebler with mere pity? Does it accentuate pain and grief by simply dwelling on it with barren words? I leave you to say what that is. We have a certain gentle disrespect among us for the doctor who is described as, oh! so sympathetic,--the man who goes about his work with a pocket-full of banal phrases calculated to soothe and comfort the cravings of the wretched. The sick and feeble take gladly these imitation crumbs cast from the full table of the strong. But sometimes people of firm character revolt at such petty and economical charity. I heard a vigorous old Quaker lady say once, after a consultation, "Thee will do me a kindness not to ask me to see that man again. Thee knows that I don't like my feelings poulticed." The question of the truthfulness of physicians is one often raised. It troubles the consultant far more than it does the family doctor, and perhaps few who are not of us understand our difficulties in this direction. Every patient has his or her standard of truth, and by it is apt to try the perplexed physician. Some of the cases which arise are curiously interesting, and perhaps nowhere better than in the physician's office or at the bedside do we see sharply developed the peculiarities of character as to this matter of truth in many of its aspects. There is the patient who asks you to tell him the whole truth as to his case. Does he really want to know? Very often he does not. If you tell him, you sentence him. You do not shorten his life, you only add to its misery. Or perhaps his wife has written to you, "On no account tell my husband that he cannot get well. He dwells now on every sign of failing health, and you will make him wretched." You parry his question and try to help him. If he is resolute, he returns on you with a query so positive that you must answer frankly. His wife was right. You have done him an injury. There is the other man who insists at the start that you must on no account tell him if he cannot get well. You inform some relative of his condition. But perhaps he ought to know. He contemplates some work or travel which he should not undertake. You say so, and he replies, "But you have not told me that I am seriously ill." Such is sick human nature. The people who really want to know if they will die of some given disease are few in number. Those who pretend they want to know are more common. Those who should not know are frequent enough, and among them one is troubled to do what seems right and to say in answer to their questions what is true. Wise women choose their doctors and trust them. The wisest ask the fewest questions. The terrible patients are nervous women with long memories, who question much where answers are difficult, and who put together one's answers from time to time and torment themselves and the physician with the apparent inconsistencies they detect. Another form of trouble arises with the woman whose standards are of unearthly altitude. This is the woman who thinks herself deceived if she does not know what you are giving her, or who, if without telling her you substitute an innocent drug for a hurtful one which she may have learned to take too largely, thinks that you are untruthful in the use of such a method. And you would indeed be wrong if you were of opinion that to tell her the whole truth, and invite her to break the habit by her own act, were available means. I certainly do not think that you have any right (indeed, I would not even discuss this) to take active means to make her think she is taking, say opium, when you are only giving her something which tastes like it. If she asks, you must answer. But she may not, or does not, and yet when she is well again and learns that the physician preferred to act without her knowledge because he distrusted her power to help, she is very likely, if she chance to be a certain kind of woman, to say that he has been untruthful. Happily, such cases must be rare, and yet I know of some which have been the source of much annoyance to sensitive men. Thorough trust and full understanding is the way to avoid such difficulties. A nervous woman should be made to comprehend at the outset that the physician means to have his way unhampered by the subtle distinctions with which bedridden women are apt to trouble those who most desire to help them. I omitted above an allusion to the most unpleasant inquirers, those who are either on the verge of insanity or are victims of that singular malady, hypochrondriasis. A patient clearly staggering to and fro on the border line of sanity consults you. Here is a wilful, terrified being, eager to know the truth. "Am I becoming insane? Will I end in an asylum?" How can you answer? You see clearly, are sure the worst is coming. What shall you do with this morbid, scared, obstinate child-man? You put aside his questions, but you have here a person quite or nearly sane to-day, resolute to hear, afraid to learn the truth he dreads. I leave my reader with this patient, and my stated knowledge and my shifted responsibility. "Doctor, if I am going to be insane, I will kill myself." Good reader, pray dispose of this case. Or take the ease of a confirmed hypochondriac. He is miserable, has a hundred ailments, watches the weather, studies the barometer, has queer delusions as to diets, clothes, and his own inability to walk. The least hint of a belief that he is not as well as he was a week ago, or even a too close examination, leaves him with a new malady, and he, too, is a sharp questioner. As a rule, he has no perceptible changes in his tissues. But if he has some real malady,--it may be a grave one on which he has built a larger sense of misery than there was need for, and the case is common enough,--how shall you answer him? It is a less difficult case than the other, and I gladly leave him also to my consultant reader's acquired knowledge and to his personal sense of the value of truth. Physicians are often blamed for not sooner warning a family of the fact that, in some case he and it are anxiously watching, death is inevitable. As to this the doctor has very mingled feelings. Sometimes he lacks courage, sometimes he is not sure enough to speak. A weak man fears that he will lose his patient and some quack be called in, and thus lessen the little chance yet left. Most of us can recall painful interviews in which a relative insisted on a definite opinion, which we were unable to give. As to cases where there is little or no doubt left, perfect frankness should be, and is, I think, our rule, but no one knows better, or as well as we, how numberless are the chances of escape for cases which seem to be at their worst. Hence a part of the reluctance the physician has to pronounce a verdict of fatal character. There is another matter of moment as to cases known to be hastening to a fatal conclusion. The responsibility of withholding this knowledge from the patient is usually shifted on to the shoulders of relatives or friends. The medical adviser reports to them his opinion and leaves with them the power to act. He is often asked if to know that death seems certain makes less the chance of recovery or shortens the lessening number of the days of life yet left. It has often fallen to my sad lot, as to that of many of my medical brothers, to have to tell a patient that he is to die. Some isolated man asks it. Some lonely hospital patient has just reasons for knowing early or late in his disease the truth as the doctor sees it. I have never been able to feel certain that in any case of acute or hopeless illness to know surely what lay before a sick man did distinctly shorten his life. I have seen many people in apparent health made ill by the shock of emotion,--by fear, grief, anger, jealousy. Diseased persons feel less, or show less in a physical way, the results we might expect to see from even the most rudely conveyed intelligence as to their probable future. It was not my wish to enter into a long discussion of all the qualities which go to make up the ideal physician. I desired chiefly to consider his principal needs, to point out in big defence certain of his embarrassments, and to leave the reader with some sense of help towards knowing whether his adviser was such as he should be in the more important qualities which go to make the true physician. There are other and minor matters which are not without their relative gravity in his life. Some are desirable but not truly essential, and yet help or hurt him much. Whether he is gentle and well-mannered, is socially agreeable, or as to this negative, influences much the choice of the woman on whom, as a rule, comes finally the decision of who her family physician shall be. Too often she is caught by the outside show of manners, and sets aside an abler and plainer man, who has more really the true manners of the heart, yet lacks the power to make himself pleasant. Desirable it is, of course, to be what so many of the best physicians have been, refined and tactful gentlemen, and also charming companions. But a man may be a most competent, clear-headed, honest, scrupulously careful doctor, and yet be plain, ill-dressed, and uninteresting, and all this it is as well to understand. The mass of professional opinion is not so easily pleased as are individual patients. It decides pretty early in any large community, and classifies its members accurately, reversing very often the verdict of the juries of matrons, who do so much to make or mar our early fates. Soon or late it sifts the mass, knows who are the thorough, trustworthy, competent, hard-headed practitioners, who are the timid, who the too daring, who ride hobbies, and who trust too much to drugs. Soon, too, it distinguishes those on whom it can call in emergencies, and the highest class of men who have the great gift of discovery and the genius of observation. From the public we can look for no such justice, and our professional manners forbid us to speak of our brethren, save among ourselves, with perfect freedom. As a profession, it is my sincere conviction that in our adherence to a high code of moral law, and in the general honesty with which we do our work, no other profession can be compared with ours. Our temptations, small and large, negative and positive, are many and constant, and yet I am quite sure that no like group of men affords as few illustrations of grave moral weaknesses. It is commonplace to say that our lives are one long training in charity, self-abandonment, all forms of self-restraint. The doctor will smile at my thinking it needful to even state the fact. He begins among the poor; all his life, in or out of hospitals, he keeps touch of them always. He sells that which men can neither weigh nor measure, and this sets him over all professions, save one, and far above all forms of mere business. He is bound in honor to profit by no patent, to disclose all he has learned, and to give freely and without reward of his best care to all others of his profession who may be sick. What such a life makes of a man is largely a question of original character, but in no other form of occupation is there such constant food useful to develop all that is best and noblest. Popular opinion has been prone to decide that the physician who is anything else than this is a person not to be trusted. The old axiom is too often quoted as concerns us, "Jack of all trades, master of none." But there are enough men who have the power to be master of many trades and passed master of one. It is a question of applicative energy. Few men in early life can do much more than is needed to learn our art and its sister sciences; but, as time goes on, there are many who can add to it other pursuits which greatly benefit them in a wide sense, and enlarge and strengthen their mental powers, or pleasantly contribute to the joys of life, and so even to the growth of a man's moral nature. The wise physician, who is fond of etching or botany, the brush, or the chisel or the pen, or who is given to science, does well to keep these things a little in the background until he is securely seated in the saddle of professional success. Then usually he may feel free to reasonably follow out his tastes, and to write, or in any other way insist on freedom to use or make public his results. If only he has the competent fund of persistent industry to draw upon, he will be not the worse, but the better, physician for such enlargement of his pursuits as I refer to, for we may feel sure that in my profession there is room for the direct or indirect use of every possible accomplishment. CONVALESCENCE. To my mind, there is nothing more pleasant than the gradual return to health after some revolutionary disease which has removed a goodly portion of the material out of which is formed our bodily frame. Nature does this happy work deftly in most cases, where, at least, no grave organic mischief has been left by the malady; and in the process we get such pleasantness as comes always from the easy exercise of healthy function. The change from good to better day by day is in itself delightful, and if you have been so happy, when well, as to have loved and served many, now is the good time when bun and biscuit come back to you,--shapely loaves of tenderness and gracious service. Flowers and books, and folks good and cheery to talk to, arrive day after day, and have for you a new zest which they had not in fuller health. Old tastes return and mild delights become luxuries, as if the new tissues in nerve and brain were not sated, like those of the older body in which they are taking their places. When you are acutely ill, the doctor is business-like and gravely kind; you want him in a way, are even anxious to see him for the relief he may bring, or the reassurance. But when you begin to feel as if you were a creature reborn, when you are safe and keenly enjoying the return of health, then it is that the morning visit is so delightful. You look for his coming and count on the daily chat. Should he chance to be what many of my medical brothers are,--educated, accomplished, with wide artistic and mental sympathies,--he brings a strong, breezy freshness of the outer world with him into the monastic life of the sick-room. One does not escape from being a patient because of being also a physician, and for my part I am glad to confess my sense of enjoyment in such visits, and how I have longed to keep my doctor at my side and to decoy him into a protracted stay. The convalescence he observes is for him, too, a pleasant thing. He has and should have pride in some distinct rescue, or in the fact that he has been able to stand by, with little interference, and see the disease run its normal course. I once watched a famous surgeon just after he had done a life-saving operation by dim candle-light. He stood smiling as the child's breath came back, and kept nodding his head with pleasant sense of his own competence. He was most like a Newfoundland dog I once had the luck to see pull out a small child from the water and on to a raft. When we came up, the dog was wagging his tail and standing beside the child with sense of self-approval in every hair. The man wagged his head; the dog wagged his tail. Each liked well what he had done. Thus it is that these half-hours by the convalescent's couch are full of subtle flattery for the doctor, and are apt to evolve the social best of him, as he notes the daily gain in strength and color, and listens, a tranquil despot, to one's pleas for this freedom or that indulgence. He turns over your books, suggests others, and, trained by a thousand such interviews, is likely enough a man interesting on many sides. You selfishly enjoy his visit, not suspecting that you, too, are ignorantly helpful. He has been in sadder homes to-day, has been sorely tried, has had to tell grim truths, is tired, mind and body. The visit he makes you is for him a pleasant oasis: not all convalescents are agreeable. He goes away refreshed. Most doctors have their share, and more, of illness, and are not, as I have seen stated, exempt from falling a prey to contagious maladies. Indeed, our records sadly show that this is not the case. Perhaps there is value for them and their future patients in the fact that they have been in turn patient and doctor and have served in both camps. Like other sick folks, the physician, as I know, looks forward, when ill, to the "morning visits" quite as anxiously as do any of those who have at times awaited his own coming. That medical poet who has the joyous art of sending a ripple of mirth across the faces of the Anglo-Saxon world recognizes this fact in a cheerful poem, called "The Morning Visit," and to which I gladly refer any of my readers who would like to know from the lips of Oliver Wendell Holmes what manner of delightful patient he must have been. I can fancy that he lost for his doctor many a pleasant hour. It has seemed to me as if this wonderful remaking and regrowing of the tissues might be likened to a swift change from the weak childhood of disease to a sudden manhood of mind and body, in which is something of mysterious development elsewhere unmatched in life. Death has been minutely busy with your tissues, and millions of dead molecules are being restored in such better condition that not only are you become new in the best sense,--renewed, as we say,--but have gotten power to grow again, and, after your terrible typhoid or yellow fever, may win a half-inch or so in the next six months,--a doubtful advantage for some of us, but a curious and sure sign of great integral change. The Greeks had a notion that once in seven years we are totally changed, the man of seven years back having in this time undergone an entire reconstruction. We know now that life is a constant death and a renewing,--that our every-day nutrition involves millions of molecular deaths and as many millions of births,--although to liken that which is so exquisitely managed, so undisturbingly done, to the coarser phenomena of death and birth is in a measure misleading. Diseases such as typhoid fever, or a sharp local lung-trouble like pneumonia, really do make these minute changes approximate in abruptness to death. You weigh, let us say, one hundred and eighty pounds, and you drop in three weeks of a fever to one hundred and thirty pounds. The rest of you is dead. You have lost, as men say, fifty pounds, but your debt to disease, or to the blunders of civilization, for it is a case of creditor behind creditor, is paid. Your capital is much diminished, but you have come out of the trial with an amazing renovation of energy. This is the happy convalescence of the wholesome man. The other, the unlucky, fellow, does not get as safely through the cleansing bankruptcy of disease. The vicious, unlucky, or gouty grandfather appears on the books of that court in mysterious ways; his sins are pathologically visited on his child's child in this time of testing strain. In the happy rush towards useful health, of a convalescence undisturbed by drawbacks, it is pleasant to think, as one lies mending, of the good day to come when my friend, recovering from typhoid or smallpox, shall send for his legal adviser and desire him as usual to bring suit against the city for damages and loss of time. A little girl coughed in my face a hideous breath of membraneous decay. I felt at once a conviction of having been hit. Two days later I was down with her malady. She herself and two more of her family owed their disease to the overflow of a neighbor's cesspool, and to them--poor, careless folk--Death dealt out a yet sterner retribution. There was a semi-civilized community beyond both. Should one go to law about it and test the matter of ultimate responsibility? The amiability of convalescence is against it. One feels at peace with all the world, and so lies still, and reflects, "like souls that balance joy and pain," as to whether, on the whole, the matter has not had its valuable side. Certainly it has brought experiences not otherwise attainable. Of the deeper and more serious insights a man gathers in the close approach of death and the swift, delicious return to safety and enlarging powers I hardly care to speak. To a physician, it is simply invaluable to have known in his own person pain, and to have been at close quarters with his constant enemy, and come off only wounded from the contest. In the anxiety about you is read anew what you look upon in other households every day, and perhaps with a too accustomed eye. And as to pain, I am almost ready to say that the physician who has not felt it is imperfectly educated. It were easy to dwell on this aspect of convalescence, but the mental state of one on the way to health is not favorable to connected thought. It is more grateful to lie in the sun, at the window, and watch the snow-birds on the ice-clad maples across the way, and now and then, day after day, to jot down the thoughts that hop about one's brain like the friendly birds on the mail-clad twigs. I make no apology for the disconnectedness of my reflections, but turn gladly to my records of the joyous and less grave observations which the passing hours brought me. Much as I have seen of disease and recoveries in all manner of men and women, the chance to observe them in my own person presented me with many little novel facts of interest. I find in my brief notes of this well-remembered time many records of the extraordinary acuteness won for a while by the senses. Not dubious, but, alas! brief, is the gain which the sensorium acquires in this delightfully instructive passage out of death's shadow into certain sunshine. In my own case there was a rapid exfoliation, as we call it, of the skin, a loss and renewal of the outer layer of the cuticle. As a result of this, the sense of touch became for a while more acute, and was at times unpleasantly delicate. This seemed to me, as I first thought of its cause, a mere mechanical result, but I incline to suspect now that it was in a measure due to a true increase in capacity to feel, because I found also that the sister sense of pain was heightened. Slight things hurt me, and a rather gentle pinch gave undue discomfort. No doubt a part of this was owing to my having taken a good deal of opium, and then abruptly laid it aside. As I have elsewhere stated, this is apt to leave the nerves oversensitive for a season. The sense of hearing seemed to me to be less wide awake. I did not hear better, but high notes were for a while most unpleasant. The sense of taste grew singularly appreciative for a time, and made every meal a joyful occasion. The simplest food had distinct flavors. As for a glass of old Madeira,--a demijohned veteran of many ripening summers,--I recall to this day with astonishment the wonderful thing it was, and how it went over the tongue in a sort of procession of tastes, and what changeful bouquets it left in my mouth,--a strange variety of varying impressions, like the play of colors. In these days of more unspiritual health and coarser sense I am almost ashamed to say what pleasure I found in a dish of terrapin. The function of smell became for me a source both of annoyance and, later on, of pleasure. I smelt things no one else could, and more things than I now can. The spring came early, and once out of doors the swiftly-flitting hours of sensory acuteness brought to me on every breeze nameless odors which have no being to the common sense,--a sweet, faint confusion of scents, some slight, some too intense,--a gamut of odors. Usually I have an imperfect capacity to apprehend smells, unless they are very positive, and it was a curious lesson to learn how intense for the time a not perfect function may become. Recent researches have shown that a drug like mercaptan may be used to test the limit of olfactory appreciation. We have thus come to know that the capacity to perceive an odor is more delicate than our ability to recognize light. Probably it is an inconceivable delicacy of the sense of smell more than anything else which enables animals to find their way in the manner which seems to us so utterly mysterious. Yet, even in human beings, and not alone in a fortunate convalescence, do we see startling illustrations of the possibilities of this form of sensorial acuteness. I know of a woman who can by the smell at once tell the worn gloves of the several people with whom she is most familiar, and I also recall a clever choreic lad of fourteen who could distinguish when blindfold the handkerchiefs of his mother, his father, or himself, just after they have been washed and ironed. This test has been made over and over, to my satisfaction and surprise. If a man could possess in the highest degree and in combination all of the possible extremes of sensory appreciativeness seen in disease, in hysteria, and in the hypnotic state, we should have a being of extraordinary capacities for observation. Taylor, in his "Physical Theory of Another World," a singular and half-forgotten book, has set this forth as conceivable of the beings of a world to come, and dwelt upon it in an ingenious and interesting way. For a long time even the inhalation of tobacco-smoke from a friend's cigar disturbed my heart, but one day, and it was, I fear, long before my physician, and he was wise, thought it prudent, I suddenly fell a prey to our lady Nicotia. I had been reading listlessly a cruel essay in the _Atlantic_ on the wickedness of smoking, and was presently seized with a desire to look at King James's famous "counterblast" against the weed. One is like a spoiled child at these times, and I sent off at once for the royal fulmination, which I found dull enough. It led to results the monarch could not have dreamed of. I got a full-flavored cigar, and had a half-hour of worshipful incense-product at the shrine of the brown-cheeked lady,--a thing to remember,--and which I had leisure enough to repent of in the sleepless night it cost me. This new keenness of perception, of taste and touch, of smell and sound, belongs also, in the splendid rally which the body makes toward health, to the intellectual and imaginative sphere of activities. Something of the lost gifts of the fairy-land of childhood returns to us in fresh aptitude for strange, sweet castle-building, as we lie open-eyed, or in power to see, as the child sees, what we will when the eyes are closed,-- Pictures of love and hate, Grim battles where no death is. Tournaments, Tall castles fair and garden terraces, Where the stiff peacock mocks the sunset light, And man and maiden whisper tenderly A shadowy love where no heart ever breaks,-- Love whose to-morrow shall be as to-day. With the increase of intellectual clearness, within a certain range, come, as with the brightened senses, certain drawbacks, arising out of the fastidiousness which belongs to the changing man just at this time. Let him, therefore, be careful what novels he chooses, for of all times this is the one for fiction, when we are away from the contradictions of the fierce outer world, and are in an atmosphere all sun and flowers, and pleasant with generous service and thankful joy. Be careful what Scheherezade you invite to your couch. By an awful rule of this world's life, in all its phases, the sharper the zest of enjoyment, the keener the possible disgusts may be. I recommend Dumas's books at this crisis, but they should be read with acceptance; as stories, their value lying largely in this, that no matter who is murdered or what horror occurs, you somehow feel no more particular call upon your compassion than is made when you read afresh the terrible catastrophes of Jack the Giant-Killer. A delightful master of style, Robert Louis Stevenson, in a recent enumeration of the books which have influenced him in life, mentions, as among the most charming of characterizations, the older Artagnan of the Vicomte de Bragelonne. I feel sure that on the sick-bed, of which he does not hesitate to speak, he must have learned, as I did, to appreciate this charming book. I made acquaintance then, also, with what seems to me, however, the most artistic of Dumas's works, and one so little known that to name it is a benefit, or may be, the Chevalier d'Harmenthal. In the long road towards working health, I must have found, as my note-books show, immense leisure, and equal capacity to absorb a quantity of fiction, good and bad, and to find in some of it things about my own art which excited amused comment, and but for that would long ago have been forgotten. Among the stuff which I more or less listlessly read was an astonishing book called "Norwood." It set me to thinking, because in this book are recounted many things concerning sick or wounded folk, and those astonishing surgeons and nurses who are supposed to have helped them on to their feet again. The ghastly amusement which came to me out of the young lady in this volume, who amputates a man's leg, made me reflect a little about the mode in which writers of fiction have dealt with sick people and doctors. I lay half awake, and thought over this in no unkindly critical mood, "With now and then a merry thought, And now and then a sad one," until I built myself a great literary hospital, such as would delight Miss Nightingale. For in it I had a Scott ward, and a Dickens ward, and a Bulwer ward, and a Thackeray ward, with a very jolly lot of doctors, such as Drs. Goodenough and Firmin, with the Little Sister (out of Philip) and Miss Evangeline to take care of the patients, besides cells for Charles Reade's heroes and heroines, and the apothecary (out of Romeo and Juliet) to mix more honest doses than he gave to luckless Romeo. Should you wander with a critical doctor through those ghostly wards, you would see some queerer results of battle and fray than ever the doctors observe nowadays,--cases I should like to report, it might be: poisonings that would have bewildered Orfila, heart-diseases that would have astounded Corvisart, and those wonderful instances of consumption which render that most painful of diseases so delightful to die of--in novels. I have no present intention to weary my readers with a clinic in those crowded wards, but it will ease my soul a little if I may say my say in a general fashion about the utter absurdities of most of these pictures of disease and death-beds. In older times the sickness of a novel was merely a feint to gain time in the story or account for a non-appearance, and the doctor made very brief show upon the stage. Since, however, the growth of realism in literary art, the temptation to delineate exactly the absolute facts of disease has led authors to dwell too freely on the details of sickness. So long as they dealt in generalities their way was clear enough. Of old a man was poisoned and done for. Today we deal in symptoms, and follow science closely in our use of poisons. Mr. Trollope's "Gemma" is an instance in point, where every one will feel that the spectacle of the heroine going seasick to death, owing to the administration of tartar emetic, is as disgusting and inartistic a method as fiction presents. Why not have made it croton oil? More and worse of this hideous realism is to be found in About's books, such, for instance, as "Germaine"; but from which censure I like to exclude the rollicking fun of "Le Nez d'un Notaire." As to the recent realistic atrocities of Zola, and even of Tolstoi, a more rare sinner, if we exclude his disgusting drama of peasant life, I prefer to say little. As to blunders in the science of poisons I say little. The novelist is a free lance, and chooses his own weapons; but I cannot help remarking that, if recent investigators are to be trusted, one unlucky female, at least, must be still alive, for a novelist relates that she was done to death by the internal taking of a dose of rattlesnake venom. I hope when I am to be poisoned this mode may be employed. She might as well have drunk a glass of milk. That book was a queer one to me after this catastrophe: the woman ought to be dead and could not be. The difficulty of the modern novelist in giving symptoms and preserving the entire decorum of his pages has amused me a little. Depend upon it, he had best fight shy of these chronic illnesses: they make queer reading to a doctor who knows what sick people are; and above all does this advice apply to death-beds. As a rule, folks get very horrible at such times, and are a long while in dying, with few of their wits about them at the last. But in novels people die marvellously possessed of their faculties; or, if they are shot, always jump into the air exactly as men never do in fact. Just here, concerning wounds, a question occurs to me: The heroes who have to lose a limb--a common thing in novels since the war--always come back with one arm, and never with a lost leg. Is it more romantic to get rid of one than of the other?--considering also that a one-armed embrace of the weeping waiting lady-love must be so utterly unsatisfactory. But enough of the patients. Among them I think I like Pendennis the best, and consider little Dombey and Nell the most delightfully absurd. And as to the doctors. Some of them have absolutely had the high promotion to be the heroes of a whole book. Had not one, nay, two, a novel to themselves? There is delightful Dr. Antonio, not enough of a doctor to call down on him my professional wrath. As to Dr. Goodenough, he has been in our family a long while,--on the shelf (God bless him!),--and attended, we remember, our friend Colonel Newcome in that death-bed matchless in art since Falstaff babbled life away. Yet, after all, he is not a doctor so much as a man charmingly drawn. There are in novels many good portraits of lawyers, from Pleydell to Tulkinghorn. Whether fair or unjust as pictures, I am scarce able to judge, although I believe that some of them have been recognized by our legal brethren as sufficiently exact. While, however, we have plenty of characters which for his purpose the novelist labels M.D., there seems to have been some insuperable difficulty in evolving for artistic use a doctor who shall seem at home, as such, among the other characters of the novel,--one, at least, who shall appear to any reasonable degree like a doctor to those who really know the genus doctor thoroughly. Save Lydgate, no doctor in fiction answers this critical demand, or seems anything to me but a very stiff lay figure from the moment he is called upon to bring his art into the story, or to figure, except as an unprofessional personage. Nor does this arise from poverty of types in the tribe of physicians. The training of a doctor's life produces the most varied effects for good or evil, as may chance, upon the human natures submitted to its discipline, so that I think any thoughtful medical man will tell you that there is a more notable individuality among his brethren in middle life than among most of the people he encounters. As for the novelist's effort--an inartistic one, it seems to me--to bring on his stage representations of some especial kind of doctor, I have only a grim smile to give, remembering Mr. Reade's grewsome medico in "Hard Cash,"--a personation meant, I suppose, to present to the public a certain irregular London doctor, but which, to the minds of most physicians, reads like an elaborate advertisement of the man in question. Sir Bulwer Lytton's renderings of a homoeopath and a water-cure specialist are open to the same charge, and could only have been successful in the hands of a master. There are at least two doctors in Balzac's novels. Rastignac, man of fashion and science, is drawn with the master's usual skill, but he is not a doctor. His art has no prominence. It is not shown how his peculiarities influenced his work, nor how his art, and its use, altered or modified the man. "The Country Doctor," by the same strong hand, is far more near my ideal of what this portraiture should be than any other known to me in French literature. The humorous aspects of a medical life in the provinces of France are nicely handled in Jules Sandeau's "Doctor Herbeau," but the study, however neat and pleasing, is slight. Wander where you may, in the drama or the novel, you will still find, I think, that the character of the physician awaits in its interesting varieties competent portrayal. Shakespeare has left us no finished portrait of a doctor. Molière caricatured him. Thackeray failed to draw him, and generally in novels he is merely a man who is labelled "Doctor." The sole exception known to me is the marvellous delineation of Lydgate in "Middlemarch." He is all over the physician, his manner, his sentiments, his modes of thought, but he stands alone in fiction. How did that great mistress of her art learn all of physicians which enabled her to leave us this amazingly truthful picture? Her life gives us no clue, and when I asked her husband, George Lewes, to explain the matter, he said that he did not know, and that she knew no more of this than of how she had acquired her strangely complete knowledge of the low turf people she has drawn in the same book, and with an almost equal skill and truth to nature. It were easy, I fancy, to point out how the doctor's life and training differ from those of all the other professions, and how this must act on peculiar individualities for the deepening of some lines and the erasure of others; but this were too elaborate a study for my present gossiping essay, and may await another day and a less lazy mood. If any one should be curious to see what are the modifying circumstances in a physician's life which strongly tend to weaken or to reinforce character, I recommend a delightful little address, quite too brief, by Dr. Emerson, the son of the great essayist. It is unluckily out of print and difficult to obtain. If you would see in real lives what sturdy forms of personal distinctness the doctor may assume, there is no better way than to glance over some half-dozen medical biographies. Read, for instance, delightful John Brown's sketch of Sydenham and of his own father, or George Wilson's life of John Reid, the physiologist, whom community of suffering must have made dear to that gentle intelligence, and whose days ended in tragic horror such as sensational fiction may scarcely match; or, for an individuality as well defined and more pleasing, read Pichot's life of Sir Charles Bell, or one of the most remarkable of biographies, Mr. Morley's life of Jerome Cardan. I am reminded as I write how rare are the really good medical biographies. The autobiographies are better. Ambrose Paré's sketches of his own life, which was both eventful and varied, are scattered through his treatise on surgery, and he does not gain added interest in the hands of Malgaigne. Our own Sims's book about himself is worth reading, but is too realistic for the library table, yet what a strangely valuable story it is of the struggle of genius up to eminent success. But these are the heroes of a not unheroic profession, and I had almost forgotten to set among them, as a study of character, the life of the tranquil, high-minded Jenner, the country doctor who swept the scars of smallpox from the faces of the world of men, and beside him John Hunter, his friend, impulsive, quick of temper, enthusiastic, an intensely practical man of science. These are illustrations of men of the most varied types, whose works show their characteristics, and who would, in the end, I fancy, have been very different had fate set them other tasks in life, for if the sculptor makes the statue, we may rest quite sure that the statue he makes influences the man who made it. These, I have said, are our heroes, but I still think there remains to be written the simple, honest, dutiful story of an intelligent, thoughtful, every-day doctor, such as will pleasantly and fitly open to laymen some true conception of the life he leads, its cares, its trials, its influences on himself and others and its varied rewards. John Brown got closest to it in that sketch of his father, and in her delicately-drawn "Country Doctor" Miss Jewett has done us gentle service. But my doctor would differ somewhat in all lands, because nationality and social conventions have their influence on us as on other men, as any one may observe who compares the clergymen of the Episcopal Church in America with those of England. The man who deals with the physician in fiction would have to consider this class of facts, for social conventions have assigned to the physician in England, at least, a very different position from that which he holds with us, where he has no social superior, and is usually in all small communities, and in some larger ones, the most eminent personage and the man of largest influence. In the rage for novel characters the lady doctor has of late assumed her place in fiction. Lots of wives have been picked up among hospital nurses, especially since the Crimean war, and since other women than Sisters of Charity got into the business, and so made to seem probable this pleasing termination of an illness. There was a case well known to me where a young officer simulated delirium tremens in order to get near to a Sister of Charity. If ever you had seen the lady, you would not have wondered at his madness; and should any author desire to utilize this incident, let him comprehend that the order of Sisters of Charity admits of its members leaving the ranks by marriage, theirs being a secular order; so that here are the chances for a story of the freshest kind. As for the lady doctor in fiction, her advantages would be awful to contemplate in sickness, when we are weak and fevered, and absurdly grateful for a newly-beaten pillow or a morsel of ice. But imagine the awful temptation of having your heart auscultated. Let us dismiss the subject while the vision of Béranger's Ange Gardienne flits before us as De Grandville drew her. I have not now beside me Howells's "Doctor Breen's Practice." It is a remarkable attempt to do justice to a very difficult subject, for there are two physicians to handle, male and female, not, I think, after their kind. "Doctor Zay," by Miss Phelps, makes absurd a book which is otherwise very attractive. This young woman doctor, a homoeopath, sets a young man's leg, and falls in love with him after a therapeutic courtship, in which he wooes and she prescribes. The woman doctor is, I suspect, still available as material for the ambitious novelist, but let him beware how he deals with her. PAIN AND ITS CONSEQUENCES. As I look from my window, on the lawn below are girls at play,--gay, vigorous, wholesome; they laugh, they run, and are never weary. How far from them and their abounding health seem the possibilities of such torment as nature somewhere in life reserves for most of us. As women, their lives are likely, nay, certain, to bring them a variety of physical discomforts, and perhaps pain in its gravest forms. For man, pain is accidental, and depends much on the chances of life. Certainly, many men go through existence here with but little pain. With women it is incidental, and a far more probable possibility. The most healthy will have least of it. Vigor of body is its foe. Thin blood is its ally. Speaking now, not of the physiological pain, which few escape, but of the torments of neuralgia and the like, Romberg says, "Pain is the prayer of the nerves for healthy blood." As the woman is normally less full-blooded than the man, she is relatively in more danger of becoming thin-blooded than he. Moreover, the disturbances which come from the nature of her physiological processes subject her to larger risks of lessened blood than man, and hence, for all reasons, she is more likely than he to become anæmic, and out of this to evolve pain in some shape. If we see that our girls are not overtasked at the age of sexual evolution, that the brain is not overtrained at bitter cost of other developments as essential, we escape a part of this peril. To discuss the question here is not my intention. To secure in our artificial life what is desirable is difficult. It involves matters of dress, exercise, proportion of lessons, diet, and other matters, of which I shall yet say something, and as to which I have elsewhere said a good deal. But no matter how careful we may be, how thoughtful as to the true needs of these young lives, we may be sure that our daughters will be more likely to have to face at some time the grim question of pain than the lads who grow up beside them. For both there are always the little ailments of childhood,--the hurts, the accidents, and the disorders or the diseases of youthful years. All come in for a share. Let us be careful how we deal with them. I have often watched with interest a mother beside the girl or boy in temporary pain. As a rule, she assumes from the beginning that the hurt boy is to be taught silent, patient endurance. What! you, a boy, to cry! Be a man! Among his comrades he is a "cry-baby" if he whimpers, "a regular girl," "a girl-boy." He is taught early that from him endurance is expected; the self-conquest of restrained emotion is his constant lesson. If it be a girl who suffers, she is assumed to be weak, and it is felt that for her tears are natural and not to be sternly repressed; nor are her little aches and complaints dismissed as lightly as are her brother's. She is trained to expect sympathy, and learns that to weep is her prerogative. The first gush of tears after a hurt of body or mind is in some mysterious way a relief, and not rudely to be chidden; but, on the whole, it is wise and right to teach patience and unemotional endurance to the sex which in life is sure to have the larger share of suffering. To be of use, this education must begin reasonably early, and we may leave to the mother to make sure that it is not too severe. As a girl grows older, we ask and expect some measure of restraint in emotional expression as regards any of the physical or moral troubles which call out tears in the child; for the woman who is wise understands that unrestrained emotion and outward expressions of pain or distress are the beginnings of that loss of self-rule which leads to habitual unrestraint, and this to more and more enfeeblement of endurance, and this, again, to worse things, of which more in the future. We are dealing now with pain. My simple practical thesis is that pain comes to all soon or late, that the indirect consequences are most to be feared, and that endurance in the adult, rational endurance, must be won by a gradual education, which can hardly begin too early. But of what use are these stern lessonings in the bearing of what none can quite escape? Do they enable us to diminish pain or to feel it less? Indirectly, yes. One woman cries out for instant easement if in pain or distress, unschooled to endure. She claims immediate relief. Another, more resolute, submits with patience, does not give way, as we put it, tries to distract her attention, knowing that even as distinct suffering as toothache may be less felt in the presence of something which interests the mind and secures the attention. Nothing, indeed, is more instructive than to watch how women bear pain,--the tremendous calamity it is to one, the far slighter thing in life it is to another. I speak now of transient torments. When we come to consider those years of torture which cruel nature holds in store for some, no one blames the sight of the moral wreck it is apt to make of the sufferer. On the other hand, there is nothing I ever see in my profession so splendid as the way in which a few, a rare few, triumph over pain, which we know must often rise to the grade of anguish, and from which scarce a day is ever free. I recall well one woman who for years, under my eyes, was the subject of what, with due sense of the force of the word, I call torture. At times she shut herself up in her room, and, as she said, "wrestled with it." This happened every day or two for an hour or more. The rest of the time she was out, or busy with her duties, but always in some pain. Meanwhile, although failing slowly, she was the life and joy of many, the true and gentle counsellor, the sure support of all who leaned on her for aid. At her dinner-table, in chat with friends, or over a book, no one who did not know her well could have dreamed that she was in such pain as consigns lower natures to disability. Her safeguard from utter wreck was a clear and resolute faith, a profound and unfailing interest in men and things and books, which gave strange vigor to her whole range of intellectual activities. But above all she possessed that happiest of gifts, the keen, undying sense of the humorous, the absurd, the witty. As she once said, "All life laughs for me." It followed her to death, as it has certain others as noble. When dying, she said some gay thing which disturbed a dear friend. The sufferer, well knowing her own state, looked up. "I must laugh, dear," she said; "I would not feel that the other world was the good place I think it if I did not believe I could laugh there too." She once said to me, in the midst of a storm of acute suffering, that pain seemed to her a strange sort of a joke. I hardly knew what she meant, but it shows the reigning mood of one who used to better ends a life half pain than most of us use the untroubled health of existence. Very irritable in youth, her clear brain and strong sense of duty overcame it in proportion to the growth of what in others creates it. All opiates she disliked, and could rarely be induced to take them. "If my mind gets weaker, I shall go to pieces----;" and, laughing always, "the bits would be worthless as the scattered bricks of a sound house." Surely such a life is a fruitful lesson in the uses of endurance, for be sure that both she and all around her were the better and happier, yes, and she the less a sufferer, for her mode of dealing with a life of pain. The illustration I have given saves me from dwelling at great length on the values of all the means within a woman's control for lessening the evil consequences of suffering, and if to few is given the largest moral and mental outfit for such a struggle, none are without the power to cultivate what they have, and, in the lesser ills of life, to make use of the lesson we may hope and know few will be called on to apply to an existence such as hers. Pain of body, hurt of mind, all the sad gamut from discomfort to anguish, depend for their influence on her life upon how nature and training enable the woman to meet them. To endure without excess of emotion saves her from consequent nervousness, and from that feebleness of mind and body which craves at all cost instant relief. It is the spoiled child, untaught to endure, who becomes the self-pampered woman. Endurance of pain has also its side-values, and is the handmaid of courage and of a large range of duties. Tranquil endurance enables the sufferer to seek and to use all the means of distraction which this woman I have described did use. It leaves the mind free, as it never can be otherwise in the storm of unrestraint, to reason on her troubles, and to decide whether or not her pain justifies the use of drugs, for on her the physician must measurably rely for this knowledge, and as she is morally strong or weak the decision will be. There are those, indeed, who suffer and grow strong; there are those who suffer and grow weak. This mystery of pain is still for me the saddest of earth's disabilities. After all is said that can be said on its values as a safeguard, an indicator of the locality of disease, after the moralist has considered it from the disciplinary view, and the theologian cracked his teeth on this bitter nut, and the evolutionist accounted for its existence, it comes at last to the doctor to say what shall be done with it. I wish it came to him alone. Civilized man has ceased to torture, but nature, relentless still, has in store possibilities of utmost anguish, which seem to fall alike on the guilty and the innocent, the poor and the rich, and in largest proportion on the gentler sex. But while pain is still here with its ever-ready presence, the direct means of lessening it have multiplied so that hardly a month goes by without some new method being added of destroying for a time the power to suffer. For, bear in mind that it is not usually the cause which can be at once destroyed by drugs, but only the bodily capacity to react to it in the fashion we call pain. Ether, chloroform, cocaine, and many other drugs enable us to-day to feel sure that the mass of real pain in the world is vastly less than it was. It is, indeed, possible to prevent all pain, and pain has no real value which we need respect and desire to preserve; at least this is so from the physician's stand-point. The temptation which comes to us out of the accumulation of anæsthetic agents is one which every tender-hearted man can understand. The temptations which it presents to the suffering they only know who have suffered. To this all that I have said leads up. To most women, even to strong women, there comes a time when pain is a grim presence in their lives. If brief, the wise physician calls upon them for that endurance, of the value of which I have spoken. On some he calls in vain. Even if it recur at intervals, as in the shape of neuralgic headaches, in the name of reason let him be the sole judge of your need to be relieved by drugs. He well knows, as you cannot know, that the frequent use of morphia seems in the end to increase, not to lessen, the whole amount of probable future pain, and that what eases for a time is a devil in angelic disguise. If you are urgent, weak of will, unable through unrestraint to comprehend him, the fault will be only half his, if you plead too eagerly for help and too constantly claim the relief he holds. But suppose that the woman I address is a long and true sufferer, and that the physician desires to use such help often, then comes her time of peril and his day of largest responsibility. If he be weak, or too tender, or too prone to escape trouble by the easy help of some pain-lulling agent, she is soon on the evil path of the opium, chloral, or chloroform habit. Nor is prevention easy. With constant or inconstant suffering comes weakness of mind as well as body, and none but the strongest natures pass through this ordeal of character unhurt. If the woman be unenduring and unthoughtful, if the doctor fail to command her faith, and be too sympathetic, at last she gets possession herself of the drug, or the drug and the hypodermatic needle. Then there is before her one of the saddest of the many downward paths which lead to destruction of body and soul. More often, in my experience, the opium habit is learned during an illness of limited duration, and for the consequences of which there is always some one to be blamed. As I remember these patients, and I have seen them by the score, far on in their evil ways, such women are most often those who lack the power, even in health, to endure pain. Some defect of training or of nature has made pain, or even distress or insomnia, ills to be relieved at once regardless of cost. Let them but feel that relief for the time is possible, and self-restraint is over. They will have the thing they crave. You cure them of the vile opium habit at awful cost of suffering, and they relapse on the first new trial of endurance, and men of their type more surely than women. I see a good many cases of opium, morphia, or chloral habit, and I am sure that these forms of intoxication are becoming more prevalent than they were a generation ago. Is this due to an increase in the disorders which are eased by such drugs? Is it not rather due to the softening influence of luxury, and the fact that we are all being constantly trained to feel that it is both easy and our right to escape pain, however brief? I am sure, too, that a part of it lies in the readiness with which many physicians give sedatives, and their failure to feel the vast moral responsibilities of their position. But, whatever be the cause or causes, it is well in the hour of ease to learn beforehand the risks which come of too easy and too frequent appeals to agents which benumb the nerves. When people are first given opium, it is apt to be the friend of the night and the foe of the morrow. Repeated often enough, it loses power to constipate and distress. It still soothes pain. It still gives sleep. At last it seems to be in a measure a tonic for those who take it. But after a while it does some other things less agreeable. The mind and memory suffer, but far more surely the moral nature is altered. The woman becomes indifferent, her affections dull, her sense of duty hopelessly weakened. Watchful, cunning, suspicious, deceitful,--a thief, if need be, to get the valued opiate,--she stops at nothing. It would seem as if it were a drug which directly affected the conscience. At last, before this one craving, all ties in life are slight and bind her not. Insensible to shame and dead to affection, she is happy if the alcohol habit be not added to her disorder, for if she cannot get the one drug she longs for, the other will serve her at need. There is a popular idea that opium gives pleasant dreams, and that it takes us away into the land of poetry, to which it is supposed to have conducted Coleridge and De Quincey. As a matter of fact, there are but few persons who get more out of opium than relief of pain, sense of comfort, and next day's remorses. The opium dream is not for all. I have known only four or five cases of habitual and distinct opium dreamers. There was more of Coleridge than of opium in "Kubla Khan," and more of De Quincey than of the juice of poppies in the "Vision of Sudden Death." When it came to the telling of these immortal dreams, we may well suspect that the narrative gained in the literary appeal from the poet opium-drunk to the poet sober. It is, I fancy, well known to physicians that opium may act on an individual differently at different times. In the case of one well known to me it usually causes sleep, and no longer gives rise to nausea the next day, as it once did. Although it leaves him sufficiently wretched, and he has taken it but rarely, the drug occasionally keeps him wide awake and delightfully indifferent to the passage of time. The striking hours are heard, and that is all. There is none of the ennui of insomnia. This effect of morphia is rare with him. He may have taken morphia a dozen times in his life to ease acute pain, but only twice has it made him thus wakeful. On these nights he saw an endless succession of visions, which he did not forget, as one does common dreams. Nearly all of the hallucinations were of the most amusing character, and were often long and connected series of ludicrous situations, over which he wondered, as he lay next day, a victim to the secondary miseries due to the soothing dose of the night before. This is one of the tricks which drugs play, and is not a thing to be anticipated. The drug is the same; the man varies, and with his variations arise peculiarities in the effects of remedies. The excess sometimes attained in the use of opiates is almost past belief. I have seen a mere girl of seventeen years take at one dose thirty grains of morphia, and I know of a woman who took for years ninety grains a day, and ruined a weak husband, a man of small means, by the costliness of her habit. The causes of the torment, which the cessation of the use of morphia brings about, are interesting. Agonizing pains show that the nerves, long muffled, have become more acutely sensitive than they were before the fatal drug was first employed. A host of lesser troubles--insomnia, pain, and indigestion--attend the cure. I know nothing more pitiful than such an ordeal, and, despite the most watchful care, I have seen it end more than once in suicide. When one has watched a woman from whom opium has been taken away, even with skilful tenderness, roll in agony on the floor, rend her garments, tear out her hair, or pass into a state of hysterical mania, the physician is made to feel that no suffering for which she took the drug can have been as bad as the results to which it leads. The capacity to suffer, which comes on as we remove the poison, is almost inconceivable. It lasts long, and is the true difficulty in the way of forming anew habits of wholesome endurance. The physician who imagines that his case is well, because he has enabled an opium-taker to eat, sleep, and be comfortable without use of the sedative, can have seen little of the future of such people. The oversensitiveness to pain persists for months, and is a constant temptation. The moral and mental habits formed under opium--the irresolution, the recklessness, the want of shame, in a word, the general failure of all that is womanly--need something more than time to cure. But I am not preaching to the woman just set free from this bondage to sin, and speak of her only to emphasize the horror with which I would wish to inspire the well, who yet may come some day to be the suffering. If there be one set of women more liable than another to become victims of morphia or chloral, it is the wives of physicians. Every winter I see four or five, and always it is true that the habit has arisen out of the effort of the husband to attend medically on his wife. Physicians make good husbands, and this is in part due to the fact that their knowledge of the difficulties of feminine life causes them to be more thoughtfully tender, and more charitable as concerns the effects upon women of certain inevitable conditions as to which the layman is ignorant or indifferent. But the very fulness of the husband's appreciation of a woman's drawbacks and little moral ailments, the outcome of her womanhood, becomes dangerous when he ventures to be her medical caretaker. What he coolly decides in another's case, he cannot in hers. How can he see her suffer and not give her of the abundance of relief in his hands? She is quick to know and to profit by this, and so the worst comes of it. "It is easy for you to sit by in your strength and see me suffer," said a woman once to me. She was on the verge of the morphia habit, and I was trying to break it off abruptly. I felt, as any gentle-hearted man must feel, the sting and hurt of her words. Next day she said to me, "Of course you were right. I used to talk that way to B----, and he never could stand it." He was her husband and a physician. She got well easily. I do not believe that most women who sin in this way slip into it either quite so ignorantly and so unwarned as they would have you to suppose. Nearly always there is a time when some one--the physician, a friend, or their own reason--bids them pause, reflect, and choose. "Alas I for thee, if thou from thine own soul dost turn and flee. Better the house and company of pain; Better distress; Better the stones of strife, the bread with tears; Humiliation and despair and fears; All, all the heart can suffer, the soul know, Rather than with the bestial train to go, With base rejoicings, ignorant of woe."[3] [Footnote 3: "Sylvian, and Other Poems," by Philip Varley.] THE MORAL MANAGEMENT OF SICK OR INVALID CHILDREN. Not long ago a pretty little girl of ten was brought to me from a long distance to get my advice as to a slight paralysis of one leg. The trouble had existed for several years. I soon saw that the child was irritable, sensitive, and positive, and I was, therefore, careful to approach her gently. The moment it was proposed to show me the leg, she broke into a fury of rage, and no inducement I could offer enabled me to effect my purpose. An appeal to the parents, and from them to force, ended in a distressing battle. She bit, scratched, kicked, and at last won a victory, and was left sullen and sobbing on the floor. Next day the same scene was repeated. It is true that at length they were able to undress her, but neither threats nor persuasion would keep her quiet long enough to enable me to apply the simplest tests. The case was obscure, and demanded the most careful study. Their time was limited, so that at length they were obliged to take her home in despair, without any guiding opinion from me, and with no advice, except as to her moral education, concerning which I was sufficiently explicit. I have seen many such illustrations of a common evil, and have watched the growth to adult life of some of these cases of wrecked character, and observed the unpleasant results which came as they grew older. I have used an extreme case as a text, because I desire to fix attention on the error which parents and some doctors are apt to commit in cases of chronic ailments in children. As to the miserable sufferers who pass through long illness to death I have little to say. We naturally yield to their whims, pet and indulge them, moved by pitiful desire to give them all they want of the little which life affords them. In acute illness, with long convalescence, I am pretty sure that the tender mother does no real good by over-indulgence; but the subject is difficult, and hard to handle with justice and charity without calling down upon me the indignation of the unthoughtful. It is so easy and pleasant to yield to the caprices of those we love, when they are in pain or helpless from illness,--so doubly hard at such times to say no. Yet, if in the case of a long convalescence, such as follows, perhaps, a typhoid or scarlet fever, we balance for the little one the too-easily yielded joy of to-day against the inevitable stringency of discipline, which, with recovered health, must teach the then doubly difficult lesson of self-restraint, we shall see, I think, that, on the whole, we do not add to the sum of happiness to which the child is entitled. The mother at the sick-bed of her young child is, however, a being quite often as difficult to manage as her child. All her instinctive maternity is up in arms. Deep in the heart of many mothers there is an unconfessed and half-smothered sense of wrath at the attack which sickness has made on her dear one. Then nothing is too much to give; no sacrifice of herself or others too great to grant or demand. The irritability and feebleness of convalescence makes claims upon her love of self-sacrifice, and her prodigality of tenderness as positive and yet more baneful. That in most cases she may and does go too far, and loses for her child what it is hard to recover in health, is a thing likely enough, yet to talk to her at such times of the wrong she does the child is almost to insult her. Nevertheless the unwisdom of a course of reckless yielding to all a child's whims is plain enough, for if the little one be long ill or weak, it learns with sad swiftness to exact more and more, and to yield less and less, so that it becomes increasingly hard to do for it the many little unpleasant things which sickness demands. Character comes strongly out in the maladies of the child, as it does even less distinctly in the sickness of the adult. The spoiled, over-indulged child is a doubly unmanageable invalid, and when in illness the foolish petting of the mother continues, the doctor, at least, is to be pitied. The ductility of childhood has its dangerous side. This is seen very well in cases which, fortunately, are rather rare, and, for some reason, are less frequent in girls than in boys. These little ones observe sharply the faces and obvious motives of those about their sick-beds, and more readily than adults are led to humor the doubts they hear expressed by the doctor or their elders as to their capacity to do this or that. Too frequent queries as to their feelings are perilously suggestive, and out of it all arises, in children of nervous or imaginative temperaments, an inexplicable tendency to fulfil the predictions they have heard, or actively to humor the ideas they acquire as to their own ailments and disabilities. There is something profoundly human in this. With careless, unthoughtful people, who have trained a child to know that illness means absolute indulgence, and who pour out unguardedly their own fears and expectations at the bedside, the result for the child is in some cases past belief. The little one gets worse and worse. It accepts automatically the situation, with all the bribes to do so made larger by feebleness, and at last gains that extreme belief in its own inability to rise or move about which absolute convictions of this nature impose on child or man. There is a further and worse stage possible. The child's claims increase. Its complaints gather force, and alarm those about it. Gratified in all its whims, it develops perverted tastes, or refuses all food but what it fancies. At last it becomes violent if opposed, and rules at will a scared circle of over-affectionate relatives. When all else fails, it exaggerates or invents symptoms, and so goes on, until some resolute physician sees the truth and opens the eyes of an amazed family. Certain physicians explain these cases as due to hysteria, and in a small number of instances there are signs which justify such an explanation. But in the larger proportion the mode of origin is complex, and depends on the coincidence of a variety of evils, none of which are of hysterical character. I am not here concerned so much with the exact nature of these troubles as I am with the avoidable errors in the management of sick childhood. If I can make the mother more thoughtfully alert, less disposed to terror and exaggeration, less liable to be led by her emotions, I shall have fulfilled my purpose without such discussion as is out of place in essays like these. To make clear, however, the possibility of the disasters I have briefly described, an illustration may answer better than any length of generalized statements. A little fellow of nine once came under my care, and was said to have inflammation of the coverings of the brain. There was a long story, which I may sum up in a few sentences. An only child; feeble in youth; indulgence to almost any degree; at the age of eight, a fall, not at all grave, but followed by some days of headache; long rest in bed, by order of a physician; much pity; many questions; half-whispered, anxious discussions at the bedside; yet more excessive indulgence, because every denial seemed to increase or cause headache. At last the slightest annoyance became cause for tears, and finally for blame, all of which a gentle, fearful mother bore as if it were part of the natural trials of disease. It took but a few months of complete non-restraint to make of a shrewd, bright, half-educated, spoiled boy a little brute, as to whose sanity there seemed to be some doubt. He was easily made well, and has lived to thank the sternness which won back the health of mind and body his parents had so foolishly helped to lose for him. A single example may suffice, nor have I any fear that it may lead any one, least of all nature's gentlest creation, a mother, to be more severe than is reasonable. She it is who is really most responsible. She is ever beside the child when the little actor is off guard. She may have the cleverness to see through the deceit or she may not. The physician comes and goes, and must take for granted much that he has no chance to see, and for which he has to trust the more constant attendant. Moreover, the rarity of these cases is apt to help to deceive him quite as much as does the mother's affectionate trust. Nevertheless, it is his fault if soon or late he fail to see the truth; but he may well be careful how he states his doubt. The mother at the sick-bed but too often resents as a wrong any hint at the true state of the case. Children are singularly imitative, and more or less prone to suffer from this tendency. Hence the curious cases in which a child simulates, I do not say dissimulates, the malady it sees constantly before it, as when one child has attacks of false epilepsy, owing to having seen the real attack in a sister or brother, or when St. Vitus's dance runs through a school or an asylum. To sum up, we credit these little ones with a simplicity of moral organization which forbids us to believe that the causes which are active for mischief in their elders are not as potent for evil in them. The popular and reasonable creed of moral education, which teaches us to ask from a well child self-control, self-restraint, truth of statement, reasonable endurance of the unavoidable, good temper, is not too lightly or too entirely to be laid aside when sickness softens the rule of health and all our hearts go out in pity to the little sufferer. Certain of the nervous and other maladies of children sometimes keep them a long while under treatments which are annoying, painful, or disabling. They often end by leaving them as strong as their fellows, but crippled, lame, disfigured, or with troubles that attract remark, or, at least, notice. Thus, a child may have hip-disease, and, after years of treatment, get well, and although vigorous enough to do all that is required in life, be more or less lame. In another case, there is disease of the bones of the spine. After a wearying treatment, it is well, but the little one has a distorted spine,--is humpbacked. Again, we have the common malady, palsy of childhood, and here, too, most probably, there is left a residue of disability, or, at all events, some loss of power. In each case there are years of troublesome treatment, all sorts of unpleasant limitations, pain it may be, and certainly, at the best, a variety of discomforts. The joy and little pleasures of youth are gone. It makes one sorrowful to think of such cases, even when all that competent means can do to help them is at their disposal, and still more to reflect on those who have to battle for health with no more resource than is left to the needy. What shall we not do for them! The woman's whole tendency is to give them all of herself and all else that she can control. Indulgence becomes inevitable, or seems to become so, and the mother is rare who does not insist that they shall have what they desire, and that her other children shall yield to them in all things. Her answer to herself and others is, "They have so little; let them at least have what they can." As rare as the reasonable mother is the sick child who can stand this treatment and survive with those traits of character which it above all others requires to make its crippled life happy, not to say useful. The child thus unrestrained and foolishly indulged must needs become ill-tempered. It loses self-control, and yet no one will need it more. It learns to expect no disappointments, and life is to hold for it less than for others. Disease has crippled its body and the mother has crippled its character. I have no belief that long illness is good for the mass of people, but the character of the adult sufferer is in his or her own hands to make, mar, or mend. In childhood the mother is in large measure responsible for the ductile being in her care. If she believes that unrestraint is her duty, she is laying up for the invalid a retribution which soon or late will bitterly visit on the child the sin or, if you like, the mistakes of the parent. It is her business and duty, no matter how hard may be to her the trial, to see that this child, above all others, shall be taught patience, gentleness, good temper, and self-control in all its varieties, nor should she fail to point out, as health returns and years go by, that it is not all of life to be straight and uncrippled. I need not dwell on this. Every wise woman will understand me, and be able to put in practice better than I can here state what I might more fully say. I do not wish, however, to be understood as urging that all children long ill or crippled grow to be unamiable and spoiled. I do not quite know why it is, but, after all, children are less apt to suffer morally from long illness than adults, and very often, despite careless or thoughtless usage, these young sufferers come out as wholesome in mind and heart as if they had known no trial, or, perhaps, because of it. It is in a measure a matter of original temperament. In other words, what the sick child was as to character modified results, and this is especially true as concerns the peculiarities which attract unpleasant notice. One person who has twitching of the muscles of the face is made miserable by the attention it invites; another is indifferent. The cases of Lord Byron and Walter Scott are to the point. The former was sensitive and morbid about his deformity. I cannot help thinking that had his mother been other than she was, he would have been brought up to more wholesome views as to what was after all no very great calamity. Walter Scott suffered from a like trouble, but healthy moral surroundings and a cheerful nature saved him from the consequences which fell so heavily upon his brother poet. Epilepsy is a malady but too common in childhood, and as to which a few words apart are needed. Usually a child epileptic for some years will carry the disease with it for a time, the length of which no man can set. The disease may be such as to ruin mind and body, or the attacks may be rare, and not prevent courageous and resolute natures from leading useful lives. All intermediate degrees are possible. As a rule, no children need so inflexible a discipline as epileptics. Indulgence as regards them is only another name for ruin. Do as we may, they are apt to become morally perverted, and require the utmost firmness, and the most matured and educated intelligence, to train them wisely. Difficult epileptics and most idiots are best looked after, and certainly happiest, in some one of the competent training-schools for feeble-minded children. Even the milder epileptic cases are hard to manage. I rarely see one which has been intelligently dealt with. Few mothers are able or willing to use a rule as stern, as enduring, as unyielding as they require. As to education, I am satisfied that these children are the better for it, and yet almost invariably I find that in the cases referred to me some physician has, with too little thought, recommended entire abandonment or avoidance of mental training. I have neither space nor desire to go into my reasons for a different belief. I am, however, sure that education limited as to time, education of mind, and especially of the hands, has for these cases distinct utility, while to them also, as to the other children crippled in mind or body, all that I have already urged applies with equal force. As to the management of sick or crippled childhood, I have said far more than I had at first meant to say, and chiefly because I have been made to feel, as I thought the matter over, how far more difficult it is in practice than in theory. But this applies to all moral lessons, and the moralist must be credited by the thoughtful mother with a full perception of the embarrassments which lie in her path. NERVOUSNESS AND ITS INFLUENCE ON CHARACTER. There are two questions often put to me which I desire to use as texts for the brief essay or advice of which nervousness[4] is the heading. As concerns this matter, I shall here deal with women alone, and with women as I see and know them. I have elsewhere written at some length as to nervousness in the male, for he, too, in a minor degree, and less frequently, may become the victim of this form of disability. [Footnote 4: Neither _nerves_ nor _nervousness_ are words to be found in the Bible or Shakespeare. The latter uses the word nerve at least seven times in the sense of sinewy. _Nervy_, which is obsolete, he employs as full of nerves, sinewy, strong. It is still heard in America, but I am sure would be classed as slang. Writers, of course, still employ nerve and nervous in the old sense, as a nervous style. Bailey's dictionary, 1734, has nervous,--sinewy, strongly made. Robt. Whytte, Edin., in the preface to his work on certain maladies, 1765, says, "Of late these have also got the name of nervous," and this is the earliest use of the word in the modern meaning I have found. Richardson has it in both its modern meanings, "vigorous," or "sensitive in nerves, and consequently weak, diseased." Hysteria is not in the Bible, and is found once in Shakespeare; as, "Hysterica passio, down," Lear ii. 4. It was common in Sydenham's day,--_i.e._, Charles II. and Cromwell's time,--but he classified under hysteria many disorders no longer considered as of this nature.] So much has been written on this subject by myself and others, that I should hesitate to treat it anew from a mere didactic point of view. But, perhaps, if I can bring home to the sufferer some more individualized advice, if I can speak here in a friendly and familiar way, I may be of more service than if I were to repeat, even in the fullest manner, all that is to be said or has been said of nervousness from a scientific point of view. The two questions referred to above are these: The woman who consults you says, "I am nervous. I did not use to be. What can I do to overcome it?" Once well again, she asks you,--and the query is common enough from the thoughtful,--"What can I do to keep my girls from being nervous?" Observe, now, that this woman has other distresses, in the way of aches and feebleness. The prominent thing in her mind, nervousness, is but one of the symptomatic results of her condition. She feels that to be the greatest evil, and that it is which she puts forward. What does she mean by nervousness, and what does it do with her which makes it so unpleasant? Remark also that this is not one of the feebler sisters who accept this ill as a natural result, and who condone for themselves the moral and social consequences as things over which they have little or no reasonable control. The person who asks this fertile question has once been well, and resents as unnatural the weaknesses and incapacities which now she feels. She wants to be helped, and will help you to help her. You have an active ally, not a passive fool who, too, desires to be made well, but can give you no potent aid. There are many kinds of fool, from the mindless fool to the fiend-fool, but for the most entire capacity to make a household wretched there is no more complete human receipt than a silly woman who is to a high degree nervous and feeble, and who craves pity and likes power. But to go back to the more helpful case. If you are wise, you ask what she means by nervousness. You soon learn that she suffers in one of two, or probably in both of two, ways. The parentage is always mental in a large sense, the results either mental or physical or both. She has become doubtful and fearful, where formerly she was ready-minded and courageous. Once decisive, she is now indecisive. When well, unemotional, she is now too readily disturbed by a sad tale or a startling newspaper-paragraph. A telegram alarms her; even an unopened letter makes her hesitate and conjure up dreams of disaster. Very likely she is irritable and recognizes the unreasonableness of her temper. Her daily tasks distress her sorely. She can no longer sit still and sew or read. Conversation no longer interests, or it even troubles her. Noises, especially sudden noises, startle her, and the cries and laughter of children have become distresses of which she is ashamed, and of which she complains or not, as her nature is weak or enduring. Perhaps, too, she is so restless as to want to be in constant motion, but that seems to tire her as it once did not. Her sense of moral proportion becomes impaired. Trifles grow large to her; the grasshopper is a burden. With all this, and in a measure out of all this, come certain bodily disabilities. The telegram or any cause of emotion sets her to shaking. She cries for no cause; the least alarm makes her hand shake, and even her writing, if she should chance to become the subject of observation when at the desk, betrays her state of tremor. What caused all this trouble? What made her, as she says, good for nothing? I have, of course, put an extreme case. We may, as a rule, be pretty sure, as to this condition, that the woman has had some sudden shock, some severe domestic trial, some long strain, or that it is the outcome of acute illness or of one of the forms of chronic disturbance of nutrition which result in what we now call general neurasthenia or nervous weakness,--a condition which has a most varied parentage. With the ultimate medical causation of these disorderly states of body I do not mean to concern myself here, except to add also that the great physiological revolutions of a woman's life are often responsible for the physical failures which create nervousness. If she is at the worst she becomes a ready victim of hysteria. The emotions so easily called into activity give rise to tears. Too weak for wholesome restraint, she yields. The little convulsive act we call crying brings uncontrollable, or what seems to her to be uncontrollable, twitching of the face. The jaw and hands get rigid, and she has a hysterical convulsion, and is on the way to worse perils. The intelligent despotism of self-control is at an end, and every new attack upon its normal prerogatives leaves her less and less able to resist. Let us return to the causes of this sad condition. It is a common mistake to suppose that the well and strong are not liable to onsets which cause nervousness. As a rule, they rarely suffer; but we are neatly ballasted, and some well people are nearer to the chance of being so overturned than it is pleasant to believe. Thus it is that what for lack of a better name we call "shock" is at times and in some people capable of inflicting very lasting evil in the way of nervousness. We see this illustrated in war in the effects of even slight injuries on certain people. I have known a trivial wound to make a brave man suddenly timid and tremulous for months, or to disorder remote organs and functions in a fashion hard to understand. In the same way, a moral wound for which we are not prepared may bring about abrupt and prolonged consequences, from which the most robust health does not always protect us; and which is in proportion disastrous if the person on whom it falls is by temperament excitable or nervous. I have over and over seen such shocks cause lasting nervousness. I knew a stout young clerk who was made tremulous, cowardly, sleepless, and, in the end, feeble, from having at a funeral fallen by mishap into an open grave. I have seen a strong woman made exquisitely nervous owing to the fall of a wall which did her no material damage. Earthquakes cause many such cases, and bad ones, as we have had of late sad occasion to know. The sudden news of calamity, as of a death or financial disaster, has in my experience made vigorous people nervous for months. A friend of mine once received a telegram which rather brutally announced the disgrace of one dear to him. He had a sense of explosion in his head, and for weeks was in a state of nervousness from which he but slowly recovered. There is something in cases like his to think about. The least preparation would have saved him, and we may be sure that there is wisdom in the popular idea that ill news should be gently and guardedly broken to such as must bear it. To be forewarned is to be forearmed we say with true wisdom. Prolonged strain of mind and body, or of both, is another cause apt to result in health failures and in nervousness as one attendant evil. The worst one I know is to nurse some person through a long disease. Women are apt to think that no one can so well care for their sick as they. Intrusion on this duty is resented as a wrong done to their sense of right. The friend who would help is thrust aside. The trained nurse excites jealous indignation. The volunteer gives herself soul and body to the hardest of tasks, and is rather proud of the folly of self-sacrifice. How often do we hear a woman say with pride, "I have not slept nor had my clothes off for a week." She does not see that her very affection unfits her for the calm control of the sick-room, and that her inevitable anxiety is incompatible with tranquil judgment. If you tell her that nursing is a profession, and that the amateur can never truly fill the place of the regular, she smiles proudly, and thinks that affection is capable of all things, and that what may be lost in skill will be made up in thoroughness and compensated by watchfulness, such as she believes fondly only love can command. It is hard to convince such a woman. It rarely chances that women are called upon to suffer in their common lives emotional strains through very long periods, and at the same time to sustain an excess of mental and physical labor. In days of financial trouble this combination is sometimes fatal to the health of the strongest men. When a loving relative undertakes to nurse one dear to her through a protracted illness, she subjects herself to just such conditions of peril as fall upon the man staggering under financial adversity. The analogy to which I have referred is curiously complete. In both there is the combination of anxiety with physical and mental overwork, and in both alike the hurtfulness of the trial is masked by the excitement which furnishes for a while the means of waging unequal battle, and prevents the sufferer from knowing or feeling the extent of the too constant effort he or she is making. This is one of the evils of all work done under excessive moral stimulus, and when the excitation comes from the emotions the expenditure of nerve-force becomes doubly dangerous, because in this case not only is the governing power taken away from the group of faculties which make up what we call common sense, but also because in women overtaxing the emotional centres is apt to result in the development of some form of breakdown, and in the secondary production of nervousness or hysteria. If she cannot afford a nurse, or will not, let her at least share her duties with some one. Above all, let her know that every competent doctor watches even the best of his trained nurses, and insists that they shall be in the open air daily. Your good wife or mother thinks in her heart that when she has sickness at home she should not be seen out of doors, and that to eat, sleep, or care for herself is then wicked or something like that. If you can make a woman change her dress, eat often, bathe as usual, and take the air, even if it must be so at night, she can stand a great deal, especially if you insist that she shall sleep her usual length of time. If she will not listen or obey, she runs a large risk, and is very apt to collapse as the patient recovers, and to furnish her family with a new case of illness, and the doctor and herself with some variety of disorder of mind or body arising out of this terrible strain on both. If physical tire, without chance for rest, with anxiety and incessant vigilance, is thus apt to cause wrecks in the nurse of ordinary illness, far more apt is it to involve breakdowns when a loving mother or sister endeavors to care for a protracted case of insanity. Unless the man of the house interferes, this effort is sure to bring disaster. And the more sensitive, imaginative, and loving is the self-appointed nurse, the more certain is she to suffer. There are no cases in which it is so hard to advise, none in which it is so difficult to get people to follow your advice. The morbid view of insanity, the vague sense of its being a stain, the horror of the hospital, all combine to perplex and trouble us. Yet here, if at any time, it is wise to cast the whole weight on the physician and to abide by his decision. Families see this peril, and can be often made to understand the unwisdom of this sacrifice; but, in cases of prolonged disease, such as hysteria in a bedridden sister or mother, it is hard to make them hear reason, and still more hard to make the nursing relation understand that she is of necessity the worst of nurses, and may share the wreck she helps to make. These old and happily rare cases of chronic nervous invalids are simply fatal to loving nurses. I have said, perhaps too often, that invalidism is for most of us a moral poison. Given a nervous, hysterical, feeble woman, shut out from the world, and if she does not in time become irritable, exacting, hungry for sympathy and petty power, she is one of nature's noblest. A mother or sister gives herself up to caring for her. She is in the grip of an octopus. Every fine quality of her nature helps to hurt her, and at last she breaks down utterly and can do no more. She, too, is become nervous, unhappy, and feeble. Then every one wonders that nobody had the sense to see what was going on. I can count many examples of nervousness which have arisen in this fashion. Perhaps my warning may not be without good results. Over and over I have made like statements in one or another form, and the increasing experience of added years only contributes force to my belief that, in still urging the matter, I am doing a serious duty. I ought to say also that the care of these invalids is, even to the well-trained and thoughtful nurse, one of the most severe of moral and physical trials, and that, in the effort to satisfy the cravings of these sick people, I have seen the best nurses crumble as it were in health, and at last give up, worn out and disheartened. A part of the responsibility of such disasters falls on the physician who forgets that it should be a portion of his duty to look sharply after the health of too devoted nurses as well as that of selfish patients. I have now said all that I need to say of the causes which, directly or indirectly, evoke the condition we call nervousness. Many of these are insidious in their growth. Too often the husband, if she be married, is immersed in his own cares, and fails to see what is going on. "I am not ill enough to see a doctor," she says, and waits until she has needlessly increased the difficulties of his task. Let us suppose, however, that, soon or late, she is doing, in a merely medical way, all that he insists upon, what more can she do for herself? She has before her very likely a long trial, severe in its exactions in proportion to her previous activity of mind and body. She most probably needs rest, and now that physicians have learned its value, and that not all ills are curable by exertion, she is told to lie down some hours each day. If she cannot get rid of her home duties, let her try at least to secure to herself despotically her times of real and true rest. To lie down is not enough. What she needs is undisturbed repose, and not to have to expect every few minutes to hear at her door the knocks and voices of servants or children. It is difficult to secure these most needful times of silent security even in health, as most women too well know. Very often the after-meal hours are the most available and the more desirable as times of repose, because in the weak digestion goes on better when they are at rest. She will find, too, that some light food between meals and at bedtime is useful, but this is within the doctor's province, and I am either desirous to avoid that or to merely help him. Air, too, she wants rather than any such great exertion as wearies; and, as regards this latter, let her understand that letter-writing, of which many women are fond, must be altogether set aside. It is, however, the moral aspects of life which will trouble her most. The cares which once were easily shaken off stick to her like burrs, and she carries them to bed with her. I have heard women say that men little know the moral value to women of sewing. It becomes difficult when people are nervous, but this or some other light handiwork is then invaluable. By this time she has learned that her minor, every-day duties trouble her, and when about to meet them, if wise, she will put herself, as we all can do, in an attitude of calmness. This applies still more forcibly to the larger decisions she must so often have to make as to children, house, and servants. Worry, as I have elsewhere said, is as sand in the mental and moral machinery, and easily becomes a mischievous habit. We can stand an immense deal of work, and can, even if weak, bear much, if only we learn to dismiss small questions without worry or unreasonable reconsiderations. As concerns temper, we constantly prepare ourselves to meet even just causes of anger, and thus by degrees learn more and more easily, and with less and less preparation, to encounter tranquilly even the most serious vexations. In health, when not nervous, a woman well knows that there are seasons when she must predetermine not to be nervous; and when ill-health has made her emotional, she must learn to be still, more constantly on guard. Above all, it is the small beginnings of nervousness which she has to fear. Tears are, for the nervous woman, the seed of trouble. Let her resolutely shun this commencement of disaster. The presence of others is apt to insure failure of self-control. A word of pity, the touch of affection, the face of sympathy, double her danger. When at her worst, let her seek to be alone and in silence and solitude to fight her battle. Fresh air, a bath (if she can bear that), even the act of undressing, will often help her. I once quoted a valued friend as saying that "we never take out of a cold bath the thoughts we take into it," and the phrase is useful and true. Above all, let such a woman avoid all forms of emotion. Her former standards of resistance apply no longer, and what once did not disturb will now shake her to the centre. A time comes, however, when she will do well to meet and relearn to bear calmly all the little emotional trials of life. I know a nervous woman--and no coward, either--who for months, and wisely, read no newspapers, and who asked another to open and read all her letters and telegrams. The day came when she was able to resume the habits of health, but for a long time the telegram at least was a sore distress, and she could only meet it by a resolute putting of herself in the attitude of tranquillity of which I have spoken. To say more should be needless. For the nervous strong emotions are bad or risky, and from violent mirth to anger all are to be sedulously set aside. Calm of mind and quiet of body are what she most needs to aid the more potent measures of the physician. The woman in the situation I have described has probably a variety of symptoms on which her condition causes her to dwell. A great many of them are of little practical moment. If she is irresolute and weak, she yields where she should not, and finds for inactivity or for fears ample excuses in the state of her own feelings. An unwholesome crop of disabilities grows out of these conditions. It then becomes the business of her physician to tell her what is real, what is unreal, what must be respected, what must be overcome or fought. She has acquired within herself a host of enemies. Some are strong, some are feeble. The hour for absolute trust has arrived, and she must now believe in her adviser, or, if she cannot, she must acquire one in whom her belief will be entire and unquestioning. Let us take an illustration. Such a woman is apt enough to suffer from vertigo or giddiness. "If I walk out," she says, "I become giddy. I am rarely free from this unless I am in bed, and it terrifies me." You know in this case that she is still strong enough to exercise in moderation. You say, "Walk so much daily. When you fall we will think about stopping. Talk to some one when you go out; have a friend with you, but walk." She must believe you to succeed. This is a form of faith-cure which has other illustrations. You tell her that she must disregard her own feelings. She credits you with knowing, and so wins her fight. There is a sense of fatigue which at some time she should learn to treat with disrespect, especially when disuse of her powers has made their exercise difficult, and yet when returning health makes it wise to employ them. To think, and at last to feel sure that she cannot walk is fatal. And above all, and at all times, close attention to her own motions is a great evil. We cannot swallow a pill because we think of what, as regards the larger morsels of food, we do automatically. Moreover, attention intensifies fatigue. Walk a mile, carefully willing each leg-motion, and you will be tired. The same evil results of attention are observed in disease as regards other functions over which we seem in health to be without direct power of control. "Mind-cure," so called, has, in some shape, its legitimate sphere in the hands of men who know their profession. It is not rare to find among nervous women a few in whom you can cause a variety of odd symptoms by pressing on a tender spine and suggesting to the woman that now she is going to feel certain pains in breast, head, or limbs. Nervous women have, more or less, a like capacity to create or intensify pains and aches, but when a woman is assured that she only seems to have such ailments she is apt, if she be one kind of woman, to be vexed. These dreamed pains--I hardly know what else to call them--are, to her, real enough. If she be another kind of woman, if she believes you, she sets herself to disregard these aches and to escape their results by ceasing to attend to them. You may call this mind-cure or what you will, but it succeeds. Now and then you meet with cases in which, from sudden shock or accident, a woman is led to manufacture a whole train of disabling symptoms, and if in these instances you can convince her that she is well and can walk, eat, etc., like others, you make one of those singular cures which at times fall to the luck of mind-or faith-cures when the patient has not had the happy fortune to meet with a physician who is intelligent, sagacious as to character, and has the courage of his opinions. I could relate many such cases if this were the place to do so, but all I desire here is to win the well woman and the nervously-sick woman to the side of the physician. If she flies from him to seek aid from the ignorant fanatic, she may, in rare cases, get what her trained adviser ought to give her and she be willing to use, while in unskilful hands she runs sad risks of having her too morbid attention riveted to her many symptoms; for to think too much about their disorders is, on the whole, one of the worst things which can happen to man or woman, and wholesome self-attention is difficult, nay, impossible, to command without help from a personally-uninterested mind outside of oneself. I cannot leave this subject without a further word of solemn warning. In my youth we had mesmerism with its cures, then we had and have spiritualism with its like pretensions. From time to time we have had faith-cures. They come and they go, and have no stable life. The evil they do lives after them in the many mental wrecks they leave. When the charlatan Newton was ordering every class of the sick to get well, I was called upon to see case after case of the most calamitous results on mind and body. Now and then he had the luck to meet some one who was merely idea-sick,--a class of cases we know well. Then he made a cure which would have been as easy to me as to him. I made much inquiry, but could never find a case of organic disease with distinct tissue-changes which he had cured. A man with hopeless rheumatic alterations of joints was made to walk a few steps without crutches. This he did at sore cost of pain, and then came to me to tell me his tale with a new set of crutches, the healer having kept the old set as evidence of the cure. And now we have the mind-cure, Christian science and the like,--a muddle of mystical statements, backed by a medley of the many half-examined facts, which show the influence of mental and moral states over certain forms of disorder. The rarity of these makes them to be suspected. Hardly any have the solid base of a thorough medical study, and we lose sight of them at the moment of cure and learn nothing as to their future. The books on mind-cure are calculated to make much and serious evil. I have read them with care, and have always risen from them with the sense of confusion which one would have if desired to study a pattern from the back of a piece of embroidery. There is, however, a class of minds which delight in the fogs of mystery, and, when a book puzzles them, accept this as evidence of depth of thought. I have been bewildered at times by the positiveness and reasoning folly of the insane, and I think most trained intelligences will feel that books like these mystical volumes require an amount of care and thinking to avoid bewilderment of which the mass of men and women are not possessed. In a few years they will be the rarely read and dusty volumes, hid away in libraries, and consulted only by those who undertake the sad task of writing the history of credulity. Their creed will die with them, and what is best of it and true will continue to be used by the thoughtful physician, as it has been in all ages. But, meanwhile, it is doing much harm and little good. Every neurologist sees already some of its consequences, and I, myself, have over and over had to undo some of the evil it had done. Our nervous woman is well. Slowly, very slowly, she has won flesh and color, which means gain in quality and quantity of blood. By degrees, too, she has been able to return to the habits and endurances of health. And now she asks that other question, "I have daughters who are yet young, but how shall I guard them against nervousness?" and again puts forward this single complex symptom in disregard of the states of body which usually accompany it, and are to us matters quite as grave. She knows well that the mass of women are by physiological nature more liable to be nervous than are men. It is a sad drawback in the face of the duties of life, that a very little emotional disturbance will suffice to overcome the woman as it does not do the man, and that the same disease which makes him irritable makes her nervous. Says Romanes, in an admirable and impartial article on the mental differences of men and women, "She is pre-eminent for affection, sympathy, devotion, self-denial, modesty, long-suffering or patience under pain, disappointment, and adversity, for reverence, veneration, religious feeling, and general morality." I accept his statement to add that these very virtues do many of them lead to the automatic development of emotion, which, in its excesses and its uncontrolled states, is the parent of much of the nervousness not due to the enfeeblement of disease.[5] [Footnote 5: _Journal of Popular Science_, July, 1887.] With the intellectual differences between man and woman I have here little to do. That there is difference, both quantitative and in a measure qualitative, I believe, nor do I think any educational change in generations of women will ever set her, as to certain mental and moral qualifications, as an equal beside the man. It would be as impossible as to make him morally and physically, by any educational or other training, what the woman now is, his true superior in much that is as high, and as valuable as any mental capacities he may possess; nor does my creed involve for woman any refusal of the loftiest educational attainments. I would only insist on selection and certain limitations as to age of training and methods of work, concerning which I shall by and by have something more to say. Neither would I forbid to her any profession or mode of livelihood. This is a human right. I do not mean to discuss it here either as citizen or physician; but, as man, I like to state for my fellow-man that there are careers now sought and won and followed by her which for him inevitably lessen her true attractiveness, and to my mind make her less fit to be the "friendly lover and the loving friend."[7] Æsthetic and other sacrifices in this direction are, however, her business, not mine, and do not influence my practical judgments as to what freedom to act is or should be hers in common with men. For most men, when she seizes the apple, she drops the rose. I am a little afraid that Mrs. Lynn Linton is right as to this, but it took some courage to say what she said,[6] and she looks at the matter from a more practical point of view, and deserves to be read at length rather than quoted in fragments. [Footnote 6: One would like to know how many women truly want the suffrage, and how, when it was won, the earnest anti-tariff wife would construe the marriage service in the face of the husband's belief in high tariff. The indirect influence of women in politics is worth a thought. We felt it sorely in 1861, and thence on to the war's end, and to-day it is the woman who is making the general prohibition laws probable. For ill or good she is still a power in the state.] [Footnote 7: _Fortnightly_, 1886.] I return to the subject. We want our young girl to be all that Romanes says she is. We desire, too, that she shall be as thoroughly educated in relation to her needs as her brothers, and that in so training her we shall not forget that my ideal young person is to marry or not, and, at all events, is to have a good deal of her life in her home with others, and should have some resources for minor or self-culture and occupation besides the larger ones which come of more distinctively intellectual acquirements. I turn now to the mother who asks this question, and say, "What of your boys? Why are you not concerned as to them?" "Oh, boys are never nervous. One couldn't stand that; but they never are. Girls are so different." My answer is a long one. I wish I could think that it might be so fresh and so attractive as to secure a hearing; but the preacher goes on, Sunday after Sunday, saying over and over the same old truths, and, like him, with some urgency within me to speak, I can only hope that I may be able so to restate certain ancient verities as to win for them a novel respect and a generous acceptation. The strong animal is, as a rule, the least liable to damaging emotion and its consequences. Train your girls physically, and, up to the age of adolescence, as you train your boys. Too many mothers make haste to recognize the sexual difference. To run, to climb, to swim, to ride, to play violent games, ought to be as natural to the girl as to the boy. All this is fast changing for us, and for the better. When I see young girls sweating from a good row or the tennis-field, I know that it is preventive medicine. I wish I saw how to widen these useful habits so as to give like chances to the poor, and I trust the time will come when the mechanic and the laborer shall insist on public play-grounds as the right of his little ones.[8] [Footnote 8: The demagogue urges his rights to much that he cannot have in any conceivable form of society. Let him ask for free libraries, free baths, free music, and, above all, free and ample play-grounds within easy reach. I wonder that the rich who endow colleges do not ever think of creating play-grounds. I wish I could open some large pockets by an appeal to hearts at large.] The tender mother, who hates dirt and loves neatness, and does not like to hear her girls called tom-boys, may and does find it hard to cultivate this free out-door life for her girls even when easy means make the matter less difficult than it is for the caged dweller in cities during a large portion or the whole of a year. I may leave her to see that delicacy and modesty find place enough in her educational trainings, but let her also make sure that her girls have whatever chance she can afford to live out of doors, and to use the sports which develop the muscles and give tone and vigor. Even in our winters and in-doors, she can try to encourage active games such as shuttlecock and graces. I know of homes where the girls put on the gloves, and stand up with their brothers, and take gallantly the harmless blows which are so valuable a training in endurance and self-control. I am reminded as I write that what I say applies and must apply chiefly to the leisure class; but in others there is a good deal of manual work done of necessity, and, after all, the leisure class is one which is rapidly increasing in America, and which needs, especially among its new recruits, the very kind of advice I am now giving. Severer games, such as cricket, which I see girls playing with their brothers, tennis, fencing, and even boxing, have for both sexes moral values. They teach, or some of them teach, endurance, contempt of little hurts, obedience to laws, control of temper, in a word, much that under ordinary circumstances growing girls do not get out of their gentler games. These are worth some risks, and such as they are need not trouble seriously the most careful mother. Neither need she fear for girls up to the age of puberty that they are any more liable to serious damage than are her boys. When for her young daughters this time of change comes near, she may rest assured that their thorough physical training will have good results. Beyond this point it is hard to generalize, and, of course, the more violent games, in which girl and boy are or may be as one, must cease But each case must stand alone, and so be judged. There are plenty of healthy girls who may continue to row, to ride, to swim, to walk as before, but there are individual cases as to which advice is needed, although, as to all girls, it should be the rule that at certain times temperate exercise, lessened walks, and no dancing, riding, rowing, skating, or swimming should be allowed. Girls feel these restrictions less if they are so stringently taught from the outset as to become habits, and this is all I care to say. Once past the critical years, and there is no reason why the mass of women should not live their own lives as men live theirs, except that always, in my opinion, the prudent woman will at certain times save herself. It is still true that even healthy women exercise too little. Our climate makes walking unpleasant, and to get in a good sweat in summer, or to wade through slush in winter, is hateful to the female soul. The English reproach us with this defect, and rightly, but do not estimate the difficulties of climate. Australian women walk little, and the English dame who comes to this country to live soon succumbs to the despotism of climate and abandons her habits of ample exercise afoot. The in-door resources of women for chest and arm exertion are sadly few, and I think it fortunate when they are so situated as to have to do things in the household which exact vigorous use of the upper extremities. Nothing is a better ally against nervousness or irritability in any one than either out-door exercise or pretty violent use of the muscles. I knew a nervously-inclined woman who told me that when she was losing self-control she was accustomed to seek her own room, and see how long she could keep up a shuttlecock without a failure. As to weather, again, I should say the worse the weather the better the exercise of a brisk walk; and my wise mother shall see that her girls do not dawdle about in-doors, but get a good tramp under all skies as a part of the habits of life. A sturdy struggle with a rough day blows the irritability and nervousness of the hour out of any but the truly sick, and I know as to some folks that the more they are out of doors the better they are morally as well as physically. My ideal mother has looked on and seen her daughters grow up to be strong and vigorous. When the time came, she has not forgotten that she has had and has to deal with one of her own sex. During the years of their childhood she should understand, as concerns her girls, that to differentiate too largely their moral lessons from those of their brothers is unwise. Something as to this I have said in a former chapter as concerns the training of invalid children. It applies also to the well. The boy is taught self-control, repression of emotion, not to cry when hurt. Teach your girls these things, and you will in the end assure to them that habitual capacity to suffer moral and physical ill without exterior show of emotion, which is so true an aid to the deeper interior control which subdues emotion at its sources, or robs it of its power to harm. Physical strength and an out-door life will make this lesson easy and natural. Be certain that weakness of body fosters and excuses emotional non-restraint, and that under long illness the most hardy man may become as nervously foolish as a spoiled child. Crave, then, for your girls strength and bodily power of endurance, and with this insist that the boy's code of emotional control shall be also theirs. But to do all this you must begin with them young, and not have to make each year undo the failure of the last. A dog-trainer once told me that it was a good thing to whip the smallest pups with a straw, and to teach them good habits, or try to do so, from birth. He put it strongly; but be sure that if we wish to build habits thoroughly into the mental and physical structure of childhood, we shall do well to begin early. As regards the out-door life, I shall have something more to say in another place, for much is within the reach of the thoughtful, which, with reasonable means, they can get for girls and women, and which yet they do not get; and there are many ways in which also we can so train our girls as to create for them constant and lasting bribes to be in the air. The question of education is a more difficult one to handle. In childhood I do not see that our wise mother need be anxious; but there comes a day when her girl is entering womanhood, when she will have to think of it. I have dealt with this question so fully of late that I have little here to add.[9] Our public schools are so organized that there is small place or excuse for indulgence, although, under wise management, this has been shown to be possible.[10] But there is a vast and growing class which is so situated that the mother can more largely control the studies and hours of her girls than can the parents of those who frequent our municipal schools. [Footnote 9: "Wear and Tear," 6th ed., 1887.] [Footnote 10: Ibid., p. 54.] A great change is on her child. Let her watch its evolution, and not with such apparent watchfulness as shall suggest the perils she is to look out for. We are all organized with a certain capital of nerve-force, and we cannot spend it with equal recklessness in all directions. If the girl bears well her gathering work,--that is, as one could wish,--we may let her alone, except that the wise mother will insist on lighter tasks and some rest of body at the time when nature is making her largest claim upon the vital powers. The least sign of physical failure should ring a graver alarm, and make the mother insist, at every cost, upon absence of lessons and reasonable repose. The matter is simple, and I have no more to say. I am dealing now so entirely with the moral and physical aspects of a woman's life, and so distinctly from the medical point of view, that I do not feel called upon to discuss, in all its aspects, the mooted question of the values and the perils of the higher education. At one time it was not open to women at all. Now it is within her reach. Our girl is well, and has passed, happily, over her time of development. Will the larger education which she so often craves subject her to risks such as are not present to the man,--risks of broken health and of its consequences? I wish to speak with care to the mother called upon to decide this grave question. I most honestly believe that the woman is the better in mind and morals for the larger training, better if she marries, and far better and happier if it chances that she does not. If we take the mass of girls, even of mature age, and give them the training commonly given to men, they run, I think, grave risks of being injured by it, and in larger proportion than do their brothers. Where it seems for other reasons desirable, it should be, I think, a question of individual selection. The majority of healthy young women ought to be able to bear the strain. Once in a female college, the woman goes on, and it is my own experience that, on the whole, she exhibits a far larger list of disastrous results from such work than do young men. If she be in the least degree nervous or not well, I, for one, should resolutely say no to all such claims; for let us bear in mind that the higher education is rarely to be used as men use it, to some definite end, and is therefore not, on the whole, so essential to her as to him. Few women mean it as a way towards medicine, or even the upper ranks of teaching; and if they do, the least doubt as to health ought to make us especially unwilling to start an unseaworthy or uninsurable vessel upon an ocean of perilous possibilities. I wish that every woman could attain to the best that men have. I wish for her whatever in the loftiest training helps to make her as mother more capable, as wife more helpful; but I would on no account let the healthiest woman thus task her brain until she is at least nineteen. If she is to marry, and this puts it off until twenty-three, I consider that a gain not counted by the advocates of the higher education. I leave to others to survey the broad question of whether or not it will be well for the community that the mass of women should have a collegiate training. It is a wide and wrathful question, and has of late been very well discussed in Romanes's paper, and by Mrs. Lynn Linton. I think the conclusions of the former, on the whole, are just; but now, whatever be my views as to the larger interests of the commonwealth and the future mothers of our race, I must not forget that I am giving, or trying to give, what I may call individualized advice, from the physician's view, as to what is wisest. Let us suppose that circumstances make it seem proper to consider an ambitious young woman's wish, and to let her go to a college for women. We presume that she has average health. But let no prudent mother suppose that in these collections of persons of one sex her child will be watched as she has been at home. At no time will she more need the vigilant insight of a mother, and yet this can only be had through letters and in the holiday seasons. Nor can the mother always rely upon the girl to put forward what may cause doubt as to her power to go on with her work. I utterly distrust the statistics of these schools and their graduates as to health, and my want of reliance arises out of the fact that this whole question is in a condition which makes the teachers, scholars, and graduates of such colleges antagonistic to masculine disbelievers in a way and to a degree fatal to truth. I trust far more what I hear from the women who have broken down under the effort to do more than they were fit to do, for always, say what you may, it is the man's standard of endurance which is set before them, and up to which they try to live with all the energy which a woman's higher sense of duty imposes upon the ambitious ones of her sex. I have often asked myself what should be done to make sure that these schools shall produce the minimum amount of evil; what can be done to avoid the penalties inflicted by over-study and class competitions, and by the emotional stimulus which women carry into all forms of work. Even if the doctor says this girl is sound and strong, her early months of college labor should be carefully watched. Above all, her eyes should be seen to, because in my experience some unsuspected disorder of vision has been fruitful of headaches and overstrain of brain, nor is it enough to know that at the beginning her eyes are good. Extreme use often evolves practical evils from visual difficulties at first so slight as to need or seem to need no correction. The period of examinations is, too, of all others, the time of danger, and I know of many sad breakdowns due to the exaction and emotional anxieties of these days of competition and excitement. Let me once for all admit that many girls improve in health at these colleges, and that in some of them the machinery of organization for care of the mental and physical health of their students seems to be all that is desirable. That it does not work satisfactorily I am sure, from the many cases I have seen of women who have told me their histories of defeat and broken health. The reason is clear. The general feeling (shall I say prejudices?) of such groups of women is bitterly opposed to conceding the belief held by physicians, that there are in the woman's physiological life disqualifications for such continuous labor of mind as is easy and natural to man. The public sentiment of these great schools is against any such creed, and every girl feels called upon to sustain the general view, so that this acts as a constant goad for such as are at times unfit to use their fullest possibility of energy. Modest girls, caught in the stern mechanism of a system, hesitate to admit reasons for lessened work or to exhibit signals of failure, and this I know to be the case. The practical outcome of it all is that the eyes of home can never be too thoughtfully busy with those of their girls who have won consent to pursue, away from maternal care, the higher education of female colleges. I must have wearied that wise mother by this time, but, perhaps, I have given her more than enough to make her dread these trials. I should say something as to the home-life of girls who go through the ordinary curriculum of city day schools were it not that I have of late so very fully reconsidered and rewritten my views as to this interesting question. I beg to refer my unsatisfied reader to a little book which, I am glad to know, has been helpful to many people in the last few years.[11] [Footnote 11: "Wear and Tear," pp. 30 to 60. J.B. Lippincott Company, Philadelphia, 1887.] OUT-DOOR AND CAMP-LIFE FOR WOMEN. A good many years ago I wrote a short paper, meant to capture popular attention, under the title of "Camp Cure." I have reason to think that it was of use, but I have been led to regret that I did not see when it was written that what I therein urged as desirable for men was not also in a measure attainable by many women. I wish now to correct my error of omission, and to show not only that in our climate camp-life in some shape can be readily had, but also what are its joys and what its peculiar advantages.[12] My inclination to write anew on this subject is made stronger by two illustrations which recur to my mind, and which show how valuable may be an entire out-door life, and how free from risks even for the invalid. The lessons of the great war were not lost upon some of us, who remember the ease with which recoveries were made in tents, but single cases convince more than any statement of these large and generalized remembrances. [Footnote 12: "Nurse and Patient," and "Camp Cure," by S. Weir Mitchell. J.B. Lippincott Company Philadelphia.] I knew a sick and very nervous woman who had failed in many hands to regain health of mind. I had been able to restore to her all she needed in the way of blood and tissue, but she remained, as before, almost helplessly nervous. Wealth made all resources easy, and yet I had been unable to help her. At last I said to her, "If you were a man I think I could cure you." I then told her how in that case I would ask a man to live. "I will do anything you desire," she said, and this was what she did. With an intelligent companion, she secured two well-known, trusty guides, and pitched her camp by the lonely waters of a Western lake in May, as soon as the weather allowed of the venture. With two good wall-tents for sleeping-and sitting-rooms, with a log hut for her men a hundred yards away and connected by a wire telephone, she began to make her experiment. A little stove warmed her sitting-room at need, and once a fortnight a man went to the nearest town and brought her books. Letters she avoided, and her family agreed to notify her at once of any real occasion for her presence. Even newspapers were shut out, and thus she began her new life. Her men shot birds and deer, and the lake gave her black bass, and with these and well-chosen canned vegetables and other stores she did well enough as to food. The changing seasons brought her strange varieties of flowers, and she and her friend took industriously to botany, and puzzled out their problems unaided save by books. Very soon rowing, fishing, and, at last, shooting were added to her resources. Before August came she could walk for miles with a light gun, and could stand for hours in wait for a deer. Then she learned to swim, and found also refined pleasure in what I call word-sketching, as to which I shall by and by speak. Photography was a further gain, taken up at my suggestion. In a word, she led a man's life until the snow fell in the fall and she came back to report, a thoroughly well woman. A more notable case was that of a New England lady, who was sentenced to die of consumption by at least two competent physicians. Her husband, himself a doctor, made for her exactly the same effort at relief which was made in the case I have detailed, except that when snow fell he had built a warm log cabin, and actually spent the winter in the woods, teaching her to live out in the air and to walk on snow-shoes. She has survived at least one of her doctors, and is, I believe, to this day a wholesome and vigorous wife and mother. What large wealth did to help in these two cases may be managed with much smaller means. All through the White Mountains, in summer, you may see people, a whole family often, with a wagon, going from place to place, pitching their tents, eating at farm-houses or hotels, or managing to cook at less cost the food they buy. Our sea-coast presents like chances. With a good tent or two, which costs little, you may go to unoccupied beaches, or by inlet or creek, and live for little. I very often counsel young people to hire a safe open or decked boat, and, with a good tent, to live in the sounds along the Jersey coast, going hither and thither, and camping where it is pleasant, for, with our easy freedom as to land, none object. When once a woman--and I speak now of the healthy--has faced and overcome her dread of sun and mosquitoes, the life becomes delightful. The Adirondacks, the Alleghanies, and the Virginia mountains afford like chances, for which, as these are in a measure remote, there must be a somewhat more costly organization. I knew well a physician who every summer deserted his house and pitched tents on an island not over three miles from home, and there spent the summer with his family, so that there are many ways of doing the same thing. As to the question of expense, there is no need to say much. All over our sparsely-inhabited land places wild enough are within easy reach, and the journey to reach them need not be long. Beyond this, tent-life is, of course, less costly than the hotel or boarding-house, in which such numbers of people swelter through their summers. As to food, it is often needful to be within reach of farm-houses or hotels, and all kind of modifications of the life I advise are possible. As to inconveniences, they are, of course, many, but, with a little ingenuity, it is easy to make tent-life comfortable, and none need dread them. Any book on camp-life will tell how to meet or avoid them, and to such treatises I beg to refer the reader who wishes to experiment on this delightful mode of gypsying. The class of persons who find it easy to reach the most charming sites and to secure the help of competent guides is, as I have said in another place, increasing rapidly. The desire also for such a life is also healthfully growing, so that this peculiarly American mode of getting an outing is becoming more and more familiar. It leads to our young folks indulging in all sorts of strengthening pursuits. It takes them away from less profitable places, and the good it does need not be confined to the boys. Young women may swim, fish, and row like their brothers, but the life has gains and possibilities, as to which I would like to say something more. In a well-ordered camp you may be sure of good food and fair cooking. To sleep and live in the air is an insurance against what we call taking cold. Where nature makes the atmospheric changes, they are always more gradual and kindly than those we make at any season when we go from street to house or house to street. My brothers during the war always got colds when at home on leave, and those who sleep in a chinky cabin or tent soon find that they do not suffer and that they have an increasing desire for air and openness. To live out of doors seems to be a little matter in the way of change, and that it should have remarkable moral and intellectual values does not appear credible to such as have not had this experience. Yet, in fact, nothing so dismisses the host of little nervousnesses with which house-caged women suffer as this free life. Cares, frets, worries, and social annoyances disappear, and in the woods and by the waters we lose, as if they were charmed away, our dislikes or jealousies, all the base, little results of the struggle for bread or place. At home, in cities, they seem so large; here, in the gentle company of constant sky and lake and stream, they seem trivial, and we cast them away as easily as we throw aside some piece of worn-out and useless raiment. The man who lives out of doors awhile acquires better sense of moral proportions, and thinks patiently and not under stress, making tranquil companions of his worthy thoughts. This is a great thing, not to be hurried. There seems to me always more time out of doors than in houses, and if you have intellectual problems to settle, the cool quiet of the woods or the lounging comfort of the canoe, or to be out under "the huge and thoughtful night," has many times seemed to me helpful. One gets near realities out of doors. Thought is more sober; one becomes a better friend to one's self. As to the effect of out-door life on the imaginative side of us, much may be said. Certainly some books get fresh flavors out of doors, and you see men or women greedily turn to reading and talking over verse who never dream of it when at home. I am tempted to mention the poets, and even the other authors who gain a kindly rubric for their work from the gentle company of lake and wood and stream. I should frankly name Walt Whitman and Thoreau, and pause pretty soon in wonder at the small number of poets who suggest out-door life as their source of inspiration. A good many of them--read as you lie in a birch canoe or seated on a stump in the woods--shrink to well-bred, comfortable parlor bards, who seem to you to have gotten their nature-lessons through plate-glass windows. The test is a sharp one, and will leave out some great names and let in some hardly known, or almost forgotten. Books to be read out of doors would make a curious catalogue, and would vary, as such lists must, with every thoughtful reader, while some would smile, perhaps with reason, at the idea of any such classification. Certainly all would name Wordsworth, and a few would add Clough, whilst the out-door plays of Shakespeare would come in, and we should soon be called on to feel that for this sort of congenial open-air poetic company we have still to fall back on the vast resources of English verse. Somehow, as yet, our own poets have not gotten fully into imaginative relation with what is peculiar in our own flowers, trees, and skies. This does not lessen our joy in the masters of English verse, because, of course, much of what they have sung has liberal application in all lands; yet is there something which we lose in them for lack of familiar knowledge of English lanes and woods, of English flowers and trees. A book of the essentially American nature--poems found here and there in many volumes--would be pleasant, for surely we have had no one poet as to whom it is felt that he is absolutely desirable as the interpretive poetic observer who has positive claims to go with us as a friendly bookmate in our wood or water wanderings. I have shrunk, as will have been seen, from the dangerous venture of enlarging my brief catalogue. What I have just now spoken of as one's bookmates will appear in very different lights according to the surroundings in which we seek to enjoy their society. If, as to this matter, any one doubts me, and has the good luck to camp out long, and to have a variety of books of verse and prose, very soon, if dainty of taste, he will find that the artificial flavoring of some books is unpleasantly felt; but, after all, one does not read very much when living thus outside of houses. Books are then, of course, well to have, but rather as giving one texts for thoughts and talk than as preachers, counsellors, jesters, or friends. In my own wood-life or canoe journeys I used to wonder how little I read or cared to read. One has nowadays many resources. If you sketch, no matter how badly, it teaches and even exacts that close observation of nature which brings in its train much that is to be desired. Photography is a means of record, now so cheaply available as to be at the disposal of all, and there is a great charm of a winter evening in turning over sketch or photograph to recall anew the pleasant summer days. Beyond all this, there is botany. I knew a lady who combined it happily and ingeniously with photography, and so preserved pictures of plants in their flowering state. When you are out under starry skies with breadth of heaven in view, astronomy with an opera-glass--and Galileo's telescope was no better--is an agreeable temptation which the cheap and neat charts of the skies now to be readily obtained make very interesting. I should advise any young woman, indeed, any one who has the good chance to live a camp-life, or to be much in the country, to keep a diary, not of events but of things. I find myself that I go back to my old note-books with increasing pleasure. To make this resource available something more than the will to do it is necessary. Take any nice young girl, who is reasonably educated, afloat in your canoe with you, and ask her what she sees. As a rule she has a general sense that yonder yellow bank, tree-crowned above the rippled water, is pleasant. The sky is blue, the sun falling behind you. She says it is beautiful and has a vague sense of enjoyment, and will carry away with her little more than this. Point out to her that the trees above are some of them deciduous poplars, or maples, and others sombre groups of pines and silky tamarack with a wonder of delicate tracery. Show her that the sun against the sloped yellow bank has covered the water with a shining changeful orange light, through which gleam the mottled stones below, and that the concave curve of every wave which faces us concentrates for the eye an unearthly sapphire the reflex of the darkening blue above us. Or a storm is on us at the same place. She is fearless as to the ducking from which even her waterproof will hardly protect. The clouds gather, the mists trail on the hills, ragged mosses on the trees hang in wet festoons of gray, and look in the misty distance like numberless cascades. It rains at last, a solid down-pour; certain tree-trunks grow black, and the shining beech and birch and poplar get a more vivid silver on their wet boles. The water is black like ink. It is no longer even translucent, and overhead the red scourges of the lightning fly, and the great thunder-roar of smitten clouds rolls over us from hill to hill. All these details you teach her and more, and paddle home with a mental cargo of fresh joys and delicious memories. My young friend is intelligent and clever, but she has never learned to observe. If she wants to know how, there is a book will help her. Let her take with her Ruskin's "Modern Painters." It will teach her much, not all. Nor do I know of any other volume which will tell her more.[13] Despite its faults, it has so many lessons in the modes of minute study of outside nature that it becomes a valuable friend. Although ostensibly written to aid artistic criticism, it does far more than this and yet not all. Other books which might seem desirable are less so because they are still more distinctly meant to teach or assist artists or amateurs. What is yet wanted is a little treatise on the methods of observing exterior nature. Above all it should be adapted to our own woods, skies, and waters. What to look for as a matter of pleasure, and how to see and record it, is a thing apart from such observation as leads to classification, and is scientific in its aims. It is somewhat remote also from the artist's study, which is a more complex business, and tends to learn what can be rendered by pencil or brush and what cannot. Its object at first is merely to give intelligent joy to the senses, to cultivate them into acuteness, and to impress on the mind such records as they ought to give us at their best. [Footnote 13: "Frondes Agrestes," Ruskin, is a more handy book than "Modern Painters," but is only selections from the greater volumes recommended. "Deucalion" is yet harder reading, but will repay the careful reader.] Presuming the pupil to be like myself, powerless to use the pencil, she is to learn how to put on paper in words what she sees. The result will be what I may call _word-sketches_. Observe these are not to be for other eyes. They make her diary of things seen and worthy of note. Neither are they to be efforts to give elaborate descriptions. In the hands of a master, such use of words makes a picture in which often he sacrifices something, as the artist does, to get something else, and strives chiefly to leave on the mind one dominant emotion just as did the scene thus portrayed. A few words may do this or it may be an elaborate work. The gift is a rare and great one. The word-paintings of Ruskin hang forever in one's mental gallery, strong, true, poetical, and capable of stirring you as the scenes described would have done, nay, even more, for a great word-master has stood interpretative between you and nature. Miss Brontë was mistress of this art. Blackmore has it also. In some writers it is so lightly managed as to approach the sketch, and is more suggestive than fully descriptive. To see what I mean read the first few chapters of "Miss Angel," by Anna Thackeray. But a sketch by a trained and poetical observer is one thing; a sketch by a less gifted person is quite another. My pupil must be content with the simplest, most honest, unadorned record of things seen. Her training must look to this only. What she should first seek to do is to be methodical and accurate and by and by fuller. If wise she will first limit herself to small scenes, and try to get notes of them somewhat in this fashion. She is, we suppose, on the bank of a stream. Her notes run as follows: Date, time of day, place. Hills to either side and their character; a guess at their height; a river below, swift, broken, or placid; the place of the sun, behind, in front, or overhead. Then the nature of the trees and how the light falls on them or in them, according to their kind. Next come color of wave and bank and sky, with questions as to water-tints and their causes. Last of all, and here she must be simple and natural, what mood of mind does it all bring to her, for every landscape has its capacity to leave you with some general sense of its awe, its beauty, its sadness, or its joyfulness. Try this place again at some other hour, or in a storm, or under early morning light, and make like notes. If she should go on at this pleasant work, and one day return to the same spot, she will wonder how much more she has now learned to see. Trees she will find an enchanting study. Let her take a group of them and endeavor to say on paper what makes each species so peculiar. The form, color, and expression of the boles are to be noted. A reader may smile at the phrase "expression," but look at a tattered old birch, or a silvery young beech-hole, "modest and maidenly, clean of limb," or a lightning-scarred pine. Tree-study has advantages because it is always within reach. The axe has been so ruthlessly wielded that you must go far into the woods to get the best specimens of the pine, and the forests about our Maine lakes and in the Adirondacks have been sadly despoiled of their aristocrats. To see trees at their savage best one must go South, and seek the white-oaks of Carolina, the cypress of Florida, but the parks of Philadelphia and Baltimore afford splendid studies, and so also do the mountains of Virginia. Private taste and enterprise is saving already much that will be a joy to our children. A noble instance is the great wild park with which Colonel Parsons has protected the Natural Bridge in Virginia. I saw there an arbor-vitæ said by botanists to be not less than nine hundred years old, a chestnut twenty-six feet in girth at the height of my shoulders, and oaks past praise. But trees are everywhere, and if my observant pupil likes them, let her next note the mode in which the branches spread and their proportion to the trunk. State it all in the fewest words. It is to be only a help to memory. Then she comes to the leaf forms and the mode in which they are massed, their dulness or translucency, how sunshine affects their brilliancy, as it is above or falls laterally at morn or eve. Perhaps she will note, too, on which the gray moss grows, and just in what forms, and how the mosses or lichens gather on the north side of trees and on what trees. I may help my pupil if, like an artist teacher, I give one or two illustrations, copied _verbatim_ from my note-books. The first was written next morning, as it is a brief record of a night scene. Time, July 21, 1887, 9 P.M. Ristigouche River, New Brunswick, Canada. Black darkness. Hill outlines nearly lost in sky. River black, with flashing bits of white rapid; banks have grayish rocks, and so seem to be nearer than the dark stream limits. Sky looks level with hill-tops. Water seems to come up close. Effect of being in a concave valley of water, and all things draw in on me. Sense of awe. Camp-fire's red glare on water. Sudden opening lift of sky. Hills recede. Water-level falls. This is a barren, unadorned sketch, but it seems to tell the thing. Or this, for a change. Newport. A beach. Time, August 1, 1887; 4 P.M. About me cleft rocks, cleavage straight through the embedded pebbles. Tones ruddy browns and grays. Gray beach. Sea-weed in heaps, deep pinks and purples. Boisterous waves, loaded with reddish seaweed, blue, with white crests, torn off in long ribbons by wind. Curious reds and blues as waves break, carrying sea-weed. Fierce gale off land. Dense fog, sun above it and to right. Everywhere yellow light. Sea strange dingy yellow. Leaves an unnatural green. Effect weird. Sense of unusualness. Of course, such study of nature leads the intelligent to desire to know why the cleaved rock shows its sharp divisions as if cut by a knife, why yellow light gives such strangeness of tints, and thus draws on my pupil to larger explanatory studies. So much the better. If when she bends over a foot-square area of mouldered tree-trunk, deep in the silence of a Maine wood, she has a craving to know the names and ways of the dozen mosses she notes, of the minute palm-like growths, of the odd toadstools, it will not lessen the joy this liliputian representation of a tropical jungle gives to her. Nor will she like less the splendor of sunset tints on water to know the secrets of the pleasant tricks of refraction and reflection. I do not want to make too much of a small matter. No doubt many people do this kind of thing, but in most volumes of travel it is easy to see that the descriptions lack method, and show such want of training in observation as would not be noticeable had their authors gone through the modest studies I am now inviting my pupil to make. Her temptation will be to note most the large, the grotesque, or the startling aspects of nature. In time these will be desirable as studies, but at first she must try smaller and limited sketches. They are as difficult, but do not change as do the grander scenes and objects. I knew a sick girl, who, bedfast for years, used to amuse herself with what her windows and an opera-glass commanded in the way of sky and foliage. The buds in spring-time, especially the horse-chestnuts, were the subject of quite curious notes, and cloud-forms an endless source of joy and puzzle to describe. One summer a great effort was made, and she was taken to the country, and a day or two later carried down near a brook, where they swung her hammock. I found her quite busy a week later, and happy in having discovered that the wave-curves over a rock were like the curves of some shells. My pupil will soon learn, as she did, that a good opera-glass is indispensable. Let any one who has not tried it look with such a glass at sunset-decked water in motion. I am sure they will be startled by its beauty, and this especially if the surface be seen from a boat, because merely to look down on water is to make no acquaintance with its loveliness. A scroll of paper to limit the view and cut out side-lights also intensifies color. The materials my pupil is to use are words, and words only. Constant dissatisfaction with the little they can tell us is the fate of all who use them. The sketcher, the great word-painter, and even the poet feels this when, like Browning, he seems so to suffer from their weakness as to be troubled into audacious employment of the words that will not obey his will, torment them as he may. Yet, as my pupil goes on, she will find her vocabulary growing, and will become more and more accurate in her use and more ingenious in her combination of words to give her meaning. As she learns to feel strongly--for she will in time--her love will give her increasing power both to see and to state what she sees, because this gentle passion for nature in all her moods is like a true-love affair, and grows by what it feeds upon. When we come to sketch in words the rare and weird effects, the storm, the sunsets that seem not of earth, the cascade, or the ravage of the "windfall," it is wise not to be lured into fanciful word-painting, and the temptation is large. Yet the simplest expression of facts is then and for such rare occasions the best, and often by far the most forceful. I venture, yet again, to give from a note-book of last year a few lines as to a sunset. I was on a steam-yacht awaiting the yachts which were racing for the Newport cup. August 6, time, sunset; level sea; light breeze; fire-red sun on horizon; vast masses of intensely-lighted scarlet clouds; a broad track of fiery red on water; three yachts, with all sail set, coming over this sea of red towards us. Their sails are a vivid green. The vast mass of reds and scarlets give one a strange sense of terror as if something would happen. I could go on to expand upon "this color such as shall be in heaven," and on the sails which seemed to be green, but for the purpose of a sketch and to refresh the traitor memory in the future, the lines I wrote are enough and are yet baldly simple. Out of this practice grow, as I have said, love of accuracy, larger insights, careful valuation of words, and also an increasing and more intelligent love of art in all its forms; nor will all these gains in the power to observe be without practical value in life. I trust that I have said enough to tempt others to try each in their way to do what has been for me since boyhood a constant summer amusement. THE END. 
16155	----	page images generously made available by Internet Archive and Canadian Libraries (http://www.archive.org/details/toronto) Note: Images of the original pages are available through the Internet Archive and Canadian Libraries. See http://www.archive.org/details/gilbertusanglicu00handuoft GILBERTUS ANGLICUS Medicine of the Thirteenth Century by HENRY E. HANDERSON, A.M., M.D. With a Biography of the Author Published Posthumously for Private Distribution by the Cleveland Medical Library Association Cleveland, Ohio 1918 CONTENTS Page Frontispiece 5 Explanatory Foreword 7 Biography 9-14 Resolutions of the Cleveland Medical Library Ass'n 15 Gilbertus Anglicus--A Study of Medicine in the Thirteenth Century 17-78 [Illustration: HENRY E. HANDERSON] EXPLANATORY FOREWORD In the summer of 1916 the librarian of the Cleveland Medical Library received a manuscript from Dr. Henry E. Handerson with the request that it be filed for reference in the archives of the library. The librarian at once recognized the value of the paper and referred it to the editorial board of the Cleveland Medical Journal, who sought the privilege of publishing it. Dr. Handerson's consent was secured and the article was set in type. However, when the time came for its publication the author was reluctant to have it appear since he was unable then to read the proof, and because he felt that the material present might not be suitable for publication in a clinical journal. To those who knew him, this painstaking attention to detail and desire for accuracy presents itself as a familiar characteristic. Though actual publication was postponed, the type forms were held, and when the Cleveland Medical Journal suspended publication, its editorial board informed the Council of the Cleveland Medical Library Association of the valuable material which it had been unable to give to the medical world. In the meantime Dr. Handerson's death had occurred, but the Council obtained the generous consent of the author's family to make this posthumous publication. It is hoped that those who read will bear this fact in mind and will be lenient in the consideration of typographical errors, of which the author was so fearful. The Cleveland Medical Library Association feels that it is fortunate in being enabled to present to its members and to others of the profession this work of Dr. Handerson's and to create from his own labors a memorial to him who was once its president. SAMUEL W. KELLEY. CLYDE L. CUMMER. Committee on Publication. BIOGRAPHY HENRY EBENEZER HANDERSON Owing to Dr. Handerson's modesty, even we who were for years associated with him in medical college, in organization, and professional work, knew but little of him. He would much rather discuss some fact or theory of medical science or some ancient worthy of the profession than his own life. Seeing this tall venerable gentleman, sedate in manner and philosophical in mind, presiding over the Cuyahoga County Medical Society or the Cleveland Medical Library Association, few of the members ever pictured him as a fiery, youthful Confederate officer, leading a charge at a run up-hill over fallen logs and brush, sounding the "Rebel yell," leaping a hedge and alighting in a ten-foot ditch among Federal troopers who surrendered to him and his comrades. Yet this is history. We could perhaps more easily have recognized him even though in a military prison-pen, on finding him dispelling the tedium by teaching his fellow prisoners Latin and Greek, or perusing a precious volume of Herodotus. Henry Ebenezer Handerson was born on March 21, 1837, here in Cuyahoga county, in the township of Orange, near the point now known as "Handerson's Cross-Roads," on the Chagrin river. His mother's maiden name was Catharine Potts. His father was Thomas Handerson, son of Ira Handerson. The family immigrated to Ohio from Columbia county, New York, in 1834. Thos. Handerson died as the result of an accident in 1839, leaving the widow with five children, the eldest thirteen years of age, to support. Henry and a sister were adopted by an uncle, Lewis Handerson, a druggist, of Cleveland. In spite of a sickly childhood the boy went to school a part of the time and at the age of fourteen was sent to a boarding school, Sanger Hall, at New-Hartford, Oneida county, New York. Henry's poor health compelled him to withdraw from school. No one at that time would have predicted that the delicate youth would live to be the sage of four score years and one. With his foster father and family he moved to Beersheba Springs, Grundy county, Tennessee. In 1854, in good health, the boy returned to Cleveland, prepared for college, and entered Hobart College, Geneva, New York, where he graduated as A.B. in 1858. Returning to Tennessee, he occupied himself for about a year with surveying land and in other work and then became private tutor in the family of Mr. Washington Compton on a cotton plantation near Alexandria, Louisiana. There he remained a year or more, then in the autumn of 1860 matriculated in the Medical Department of the University of Louisiana (now Tulane University), where he studied through the winter, and also heard much of the political oratory of that exciting period. The bombardment of Fort Sumter, April 12, 1861, followed by the call of President Lincoln for 75,000 troops to suppress the rebellion, found young Handerson again employed as tutor, this time in the family of General G. Mason Graham, a veteran of the Mexican war. With his friends and acquaintances, Handerson joined a company of "homeguards" consisting mostly of planters and their sons, formed for the purpose of maintaining "order among the negroes and other suspicious characters of the vicinity." Many years afterward Dr. Handerson wrote, in a narrative for his family, concerning this period of his life: "Without any disposition to violent partisanship, I had favored the party of which the standard-bearers were Bell and Everett and the battle cry 'The Constitution and the Union,' and I had grieved sincerely over the defeat by the Radicals of the North, aided by the 'fire-eaters' of the South." And again: "Born and educated in the North, I did not share in any degree the fears of the Southerners over the election to the Presidency of Mr. Lincoln. I could not but think the action of the seceding States unwise and dangerous to their future prosperity. On the other hand, this action had already been taken, and without any prospect of its revocation. Indeed, in the present frame of mind of the North, any steps toward recession seemed likely to precipitate the very evils which the secession of the states had been designed to anticipate. I believed slavery a disadvantage to the South, but no sin, and, in any event, an institution for which the Southerners of the present day were not responsible. An inheritance from their fore-fathers, properly administered, it was by no means an unmitigated evil, and it was one, moreover, in which the North but a few years before had shared. All my interests, present and future, apparently lay in the South and with Southerners, and if the seceding States, in one of which I resided, chose deliberately to try the experiment of self-government, I felt quite willing to give them such aid as lay in my feeble power. When I add to this that I was 24 years of age, and naturally affected largely by the ideas, the enthusiasm and the excitement of my surroundings, it is easy to understand to what conclusions I was led." So on June 17, 1861, he volunteered in the Stafford Guards under Capt. (afterward Brigadier General) L.A. Stafford. The Guards became company B of the 9th Regiment of Louisiana Volunteers, Confederate States of America, Colonel (later Brigadier General) "Dick" Taylor (son of "Old Zach," the President of the U.S.), in command. During the year that followed until the close of the war, Handerson experienced the adventures and trials of a soldier's life. He knew picket, scouting, and skirmishing duty, the bivouac, the attack and defense in battle formation, the charge, the retreat, hunger and thirst, the wearisome march in heat and dust, in cold, in rain, through swamps and stony wildernesses. He was shot through the hat and clothing and once through the muscles of the shoulder and neck within half inch of the carotid artery, lay in a hospital, and had secondary hemorrhage. At another time he survived weeks of typhoid fever. He was successively private soldier and accountant for his company, quarter-master, 2nd Lieutenant of the line, Captain of the line, and finally Adjutant General of the 2nd Louisiana Brigade, A. N. Va., under Lee and Jackson, with rank of Major. On May 4, 1864, Adjutant General Handerson was taken prisoner, and from May 17th until August 20th he was imprisoned at Fort Delaware in the Delaware river. He was then confined in a stockade enclosure on the beach between Forts Wagner and Gregg on Morris Island, until about the end of October, when he was transferred to Fort Pulaski at the mouth of the Savannah river, and in March, 1865, back to Fort Delaware. In April, after Lee's surrender, many of the prisoners were liberated on taking the oath of allegiance to the Federal Government. But Handerson did not consider his allegiance to the Southern Confederacy ended until after the capture of President Davis, and it was not until June 17, 1865, that he signed the oath of allegiance and was liberated in Philadelphia. Since that time, with that spirit of tolerance and openness to truth which characterized the man, he has said, "in the triumph of the Union, the war ended as it should have ended." Mr. Handerson then resumed his medical studies, this time in the College of Physicians and Surgeons of New York, Medical Department of Columbia University, taking the degree of M.D. in 1867. Hobart College conferred the A.M. in 1868. On October 16, 1872, he married Juliet Alice Root, who died leaving him a daughter. February 25, 1878, Dr. Handerson read before the Medical Society of the County of New York an article entitled, "The School of Salernum, an Historical Sketch of Mediæval Medicine." This essay attracted wide attention to his scholarly attainments and love of laborious research. For example, Professor Edward Schaer of the chair of Pharmacology and Pharmaceutical Chemistry, of Neumünster-Zürich, pronounces this pamphlet "a valuable gift ... a remarkable addition to other historical materials ... in connection with the history of pharmacy and of pharmaceutical drugs"; that he found in it "a great deal of information which will be sought for in vain in many even renowned literary works." Dr. Handerson practiced medicine in New York City, from 1867 to 1885, removing to Cleveland in 1885. On June 12, 1888, he married Clara Corlett of Cleveland. Then in 1889 appeared the American edition of the "History of Medicine and the Medical Profession, by Joh. Hermann Baas, M.D.," which was translated, revised and enlarged by Dr. Handerson, to whom, in the words of Dr. Baas, "we are indebted for considerable amplification, particularly in the section on English and American medicine, with which he was, of course, better acquainted than the author, and for numerous corrections." ... As a matter of fact, the learning and judgment, and the conscientious industry of the translator and American editor of this work are evident throughout the book. Concerning Dr. Handerson's writings, Dr. Fielding H. Garrison writes (Medical Pickwick, March, 1915, P. 118): "The earliest of Dr. Handerson's papers recorded in the Index Medicus is 'An unusual case of intussusception' (1880). Most of his other medical papers, few in number, have dealt with the sanitation, vital statistics, diseases and medical history of Cleveland, and have the accuracy which characterizes slow and careful work. This is especially true of his historical essays of which that on 'The School of Salernum' (1883) is a solid piece of original investigation, worthy to be placed beside such things as Holmes on homoeopathy, Weir Mitchell on instrumental precision, or Kelly on American gynecology. "To the cognoscenti, Dr. Handerson's translation of 'Baas' History of Medicine' (1889) is known as 'Handerson's Book.' He modestly describes himself as its 'editor,' but he is more than that. As the witty and effective translator of a witty and effective work, he has added sections in brackets on English and American history which are based on original investigation and of permanent value to all future historians. Handerson's Baas is thus more complete and valuable than the Rhinelander's original text." As listed in the Index Medicus, the publications and writings of Dr. Handerson appear as follows: An unusual case of intussusception. Medical Record, 1880, xviii, 698. The School of Salernum. An historical sketch of mediæval medicine. 1883. Outlines of the history of medicine (Baas). Translated, and in conjunction with the author, revised and enlarged, 1887. Clinical history of a case of abdominal cancer. Cleveland Medical Gazette, 1891-2, vii, 315-321. The Sanitary topography of Cleveland. Cleveland Medical Gazette, 1895-6, xi, 651-659. Cleveland in the Census Reports. Cleveland Medical Gazette, 1896-7, xii, 257-264. The earliest contribution to medical literature in the United States. Janus, 1899, p. 540. A review of the Vital Statistics of Cleveland during the last decennium. Cleveland Medical Journal, 1902, i, 71-76. Epidemics of typhoid fever in Cleveland. Cleveland Medical Journal, 1904, iii, 208-210. The mortality statistics of the twelfth census. Cleveland Medical Journal, 1905, iv, 425-431. Co-operative sanitation. Ohio Medical Journal, 1905, i, 278-281. The medical code of Hammurabi, King of Babylon. Cleveland Medical Journal, 1908, vii, 72-75. Carcinoma in high life. Cleveland Medical Journal, 1908, vii, 472-476. Medical Cleveland in the nineteenth (19th) Century. Cleveland Medical Journal, 1909, viii, 59, 146, 208. Gilbert of England and his "Compendium Medicine." Medical Pickwick, 1915, i, 118-120. Dr. Handerson was Professor of Hygiene and Sanitary Science in the Medical Department of the University of Wooster, 1894-96, and the same in the Cleveland College of Physicians and Surgeons (Medical Department of Ohio Wesleyan University), 1896 to 1907, and filled that chair with eminent ability. Thus it came about that the ex-Confederate officer taught sanitary science in a college standing upon ground donated by the survivors of an organization of abolitionists. Dr. Handerson was a member of the Cuyahoga County Medical Society, and its President in 1895; also a member of the Cleveland Academy of Medicine, of the Ohio State Medical Society, and of the American Medical Association. He was one of the founders and an active worker in the Cleveland Medical Library Association and its President from 1896 to 1902. He was all his life devoted to the Episcopal Church, was Warden of Grace Episcopal Church, Cleveland, for many years, and Treasurer of the Diocese of Ohio during fourteen years. During his later years Dr. Handerson withdrew entirely from active practice and spent a great deal of time in his library. His papers abound in carefully prepared manuscripts, some of them running into hundreds of pages. Two years before his death Dr. Handerson became totally blind. This grievous affliction was borne with unvarying patience and cheerfulness. He still loved to recite from memory the classic authors, to relate and discuss episodes of world history and events of the present, to solve difficult mathematical problems, and to have his data on all subjects verified. He retained his faculties perfectly until April 23, 1918, when he died from cerebral hemorrhage. He is survived by a daughter, two sons by the second marriage, and his devoted wife. Among numerous letters received from prominent physicians and authors appreciative of Dr. Handerson's medico-historical labors, one from Dr. Oliver Wendell Holmes expresses high praise and requests to have sent to him everything which Dr. Handerson might in future write. It seems eminently appropriate that the essay on "Gilbertus Anglicus." the last from the pen of Dr. Handerson, should be put in book form, together with a sketch, however brief, of its author's earnest life, his sterling character, his geniality and imperturbable equanimity, and thus preserved in testimony of the high esteem in which he was held by his contemporaries. SAMUEL WALTER KELLEY. * * * * * RESOLUTIONS At a meeting of the Council of the Cleveland Medical Library Association, held on May 14, the following resolutions were adopted: _Resolved_, That in the death of Dr. Henry E. Handerson the Cleveland Medical Library Association has sustained the loss of one of its most honored and devoted members. His scholarly acquirements were notable, and his eminence as a medical historian generally recognized. His deep interest in the welfare of the Library and his thorough attention to every detail of his official duties were always evident, while his lovable personal qualities endeared him to all. The Association desires to express its high appreciation of his long and valued services, and extends to his bereaved family its heartfelt and sincere sympathy. C.A. HAMANN, WM. EVANS BRUNER, J.B. McGEE. * * * * * GILBERTUS ANGLICUS (GILBERT OF ENGLAND) A STUDY OF ENGLISH MEDICINE IN THE THIRTEENTH CENTURY. BY H.E. HANDERSON, A.M., M.D. CLEVELAND * * * * * "Nothing in the past is dead to the man who would learn how the present came to be what it is."--Stubbs--_Constitutional Hist. of England_. * * * * * Among the literary monuments of early English medicine the "Compendium Medicinae" of Gilbertus Anglicus merits a prominent position as the earliest complete treatise on general medicine by an English author which has been preserved to our day, and equally because it forms in itself a very complete mirror of the medical science of its age and its country. Gilbert was undoubtedly one of the most famous physicians of his time. His reputation is recognized in those well-known lines of Chaucer which catalogue the "authorities" of his Doctor of Phisik: "Wel knew he the olde Esculapius And Deyscorides and eek Rufus, Olde Ypocras, Haly and Galyen, Serapion, Razis and Avycen, Averrois, Damascien and Constantyn, Bernard and Gatesden and Gilbertyn." He is also quoted with frequency and respect by the medical writers of many succeeding ages, and the Compendium, first printed in 1510, enjoyed the honor of a second edition as late as the seventeenth century (1608). The surname "Anglicus" in itself testifies to the European reputation of our author, for as Dr. Payne sensibly remarks, no one in England would speak of an English writer as "the Englishman." Yet, in spite of his reputation, we know almost no details of the life of Gilbert, and are forced to content ourselves with the few facts to be gleaned from the scanty biographies of early writers and the inferences drawn from the pages of the Compendium itself. The date and place of his birth and death, and even the field of his medical activities are equally unknown. Bale, Pits and Leland, the earliest English biographers, tell us that Gilbert, after the completion of his studies in England, proceeded to the Continent to enlarge his education, and finally became physician to the great Justiciar, Hubert Walter, archbishop of Canterbury, who died in the year 1205. This would place him under the reign of King John, in the early part of the thirteenth century. Dr. John Freind, however, the famous English physician and medical historian (1725), observing that Gilbert quotes the Arabian philosopher Averroës (who died in 1198), and believing that he also quotes a work of Roger Bacon and the surgical writings of Theodorius (Borgognoni) of Cervia (1266), was inclined to fix his period in the latter half of the thirteenth century, probably under the reign of Edward I. Most of the later historians of medicine have followed the views of Freind. Thus Eloy adopts the date 1272, Sprengel gives 1290, Haeser the same date, Hirsch says Gilbert lived towards the close of the thirteenth century, Baas adopts the figures 1290, etc. The most recent biographers of Gilbert, however, Mr. C.L. Kingsford[1], and the late Dr. Joseph Frank Payne[2], after an apparently careful and independent investigation of his life, have reached conclusions which vary materially from each other and from those of the historians mentioned. Mr. Kingsford fixes the date of Gilbert at about 1250, while Dr. Payne reverts to the views of Bale and Pits and suggests as approximate figures for the birth and death of Gilbert the years 1170-80 to 1230. This discrepancy of twenty-five or thirty years between the views of two competent and unprejudiced investigators, as a mere question of erudition and interpretation, is perhaps scarcely worthy of prolonged discussion. But as both biographers argue from substantially the same data, the arguments reveal so many interesting and pertinent facts, and the numerous difficulties attending the interpretation of these facts, that some comparison of the different views of the biographers and some criticism of their varying conclusions may not be unwelcome. [Footnote 1: In Leslie Stephen's "Dictionary of Biography."] [Footnote 2: _British Medical Journal_, Nov. 12, 1904, p. 1282.] In the first place then we must say that, as Gilbert is frequently quoted in the "Thesaurus Pauperum," a work ascribed to Petrus Hispanus, who (under the title Pope John XXI) died in 1277, this date determines definitely the _latest_ period to which the Compendium can be referred. If, as held by some historians, the "Thesaurus" is the work of Julian, the father of Petrus, the Compendium can be referred to an earlier date only. Now Gilbert in his Compendium (f. 259a) refers to the writings of Averroës (Ibn Roschd) regarding the color of the iris of the eye. Averroës died in the year 1198. There is no pretense that Gilbert was familiar with the Arabic tongue, and the earliest translations into Latin of the writings of Averroës are ascribed by Bacon to the famous Michael Scot, though Bacon says they were chiefly the work of a certain Jew named Andrew, who made the translations for Scot. Bacon also says that these translations were made "_nostris temporibus_," in our time, a loose expression, which may, perhaps, be fairly interpreted to include the period 1230-1250. But if, as Dr. Payne believes, Gilbert died about 1230, it seems improbable that he could have been familiar with the translations of Michael Scot. Accordingly Dr. Payne suggests that, after the death of his patron in 1205, Gilbert returned to the Continent, and, perhaps in Paris or at Montpellier, met with earlier Latin versions of the writings of the Arabian physician and philosopher. This is, of course, possible, but there is no historical warrant for the hypothesis, which must, for the present at least, be regarded as merely a happy conjecture of Dr. Payne. The presence of Gilbert upon the Continent, probably as a teacher of reputation, seems, however, quite probable. Littre has even unearthed the fact that during the 14th century a street in Paris near the medical schools, bore the name of the Rue Gilbert l'Anglois. A MS. in the Bibliotheque Nationale entitled "_Experimenta Magistri Gilliberti, Cancellarii Montepessulani_" has suggested also the idea that Gilbert may have been at one time chancellor of the University of Montpellier. Dr. P. Pansier, of Avignon, however, who has carefully examined and published this manuscript[3], reports that while it contains some formulae found also in the Compendium of Gilbert, it contains many others from apparently other sources, and he was unable to convince himself that the compilation was in fact the work of Gilbertus Anglicus. Dr. Pansier also furnishes us with a list of the chancellors of Montpellier, which contains the name of a certain "Gillibertus," chancellor of the university in 1250. He could find, however, no evidence that this Gillibertus was Gilbertus Anglicus, author of the Compendium Medicinae. On the whole then the visit of Gilbert to France early in the 13th century, and his access in this way to early translations of Averroës, while a convenient and plausible conjecture on the part of Dr. Payne, does not seem supported by any trustworthy historical evidence. [Footnote 3: Janus, 1903, p. 20.] The "_Liber de speculis_" mentioned by Gilbert (f. 126 c), and since the time of Freind generally accepted as the work of Bacon, is almost certainly not from the pen of that eminent philosopher. In addition to the fact that Bacon himself says he had (for obvious reasons) written nothing except a few tracts (_capitula quaedam_) prior to the composition of his Opus Magnum in 1267, the real author of the Liber de speculis is probably mentioned by Bacon in the following passage from the Opus Tertium: "_Nam in hoc ostenditur specialiter bonitas naturae, ut dicit auctor libri de speculis comburentibus._"[4] [Footnote 4: Cap. XXXVI, p. 116, edition of Brewer.] We must therefore agree with Dr. Payne that the _Liber de speculis_ of Gilbert was at least not the work of Roger Bacon. Dr. Freind regards the chapters of Gilbert on the subject of leprosy as borrowed substantially from the "Chirurgia" of Theodorius of Cervia, who wrote about the year 1266. This view has also been generally accepted by later writers. But Dr. Payne boldly challenges the view of Freind, declares that Theodorius copied _his_ chapters from Gilbert, and asserts that Theodorius was a notorious plagiarist. Now, while the bold assertion of Dr. Payne cannot, of course, be accepted as _proof_ of Gilbert's precedence in chronological order, if that precedence is otherwise established, it will explain the similarity of the chapters of the two writers very satisfactorily. For the present, however, this similarity can be adduced as evidence on neither side. Again, Gilbert, with the enthusiasm of a loyal pupil, speaks (f. 47 b) of a certain Magister Ricardus, "_omnium doctorum doctissimus_," whose views on uroscopy certainly indicate a mind superior to his age. Now there were about this period at least two eminent physicians who bore the name of Ricardus. Of these the senior, a Frenchman, known also as Ricardus Salednitanus, is highly praised by Aegidius of Corbeil (Gilles de Corbeil, Aegidius Corboliensis), physician to King Philip Augustus of France (1180-1223). This Ricardus was a famous teacher at Salernum when Aegidius was in attendance at that famous university, therefore probably about the close of the 12th century. The second Ricardus, called Parisiensis, has been recently identified by Toply with Richard of Wendover, an English canon of St. Paul's, and at one time physician to Pope Gregory IX, who died in 1241. Toply believes him to have been also the author of the "_Anatomia Ricardi_," recently published. This Ricardus died in 1252. Now to which of these Ricardi does the eulogistic language of Gilbert refer? Dr. Payne believes it to be the senior, Ricardus Salernitanus. Mr. Kingsford, on the other hand, thinks it to be Ricardus Parisiensis, who died in 1252. A _Liber de urinis_ has been ascribed to each of them, but, it seems to me, with greater probability to Ricardus Salernitanus. If too the author of the "_Anatomia Ricardi_" was a contemporary of Gilbert, we might reasonably expect to find in the Compendium some evidences of Gilbert's acquaintance with that work. But Gilbert's discussion of anatomical questions is totally unlike that of the author of the "_Anatomia_," and betrays not the slightest evidence of knowledge of such a treatise. On the whole then I am inclined to agree in this question with Dr. Payne, and to consider the Ricardus of Gilbert identical with Ricardus Salernitanus, the famous professor of the School of Salernum. This conclusion is further justified by the fact, generally accepted by all modern writers, that Gilbert was himself a pupil of Salernum. Singularly enough, both Dr. Payne and Mr. Kingsford profess to find in the Compendium some evidence that Gilbert sojourned in Syria for a certain period, though the circumstances of this sojourn are viewed differently by the two biographers. Dr. Payne thinks that the physician, after completing his education in England, proceeded to the Continent and extended his travels as far as Syrian Tripoli, where he met Archbishop Walter and became attached to his staff. As the prelate returned to England in 1192, this sojourn of Gilbert in Syria must have been about 1190-91, when, according to Dr. Payne's chronology, Gilbert could have been not more than about twenty years of age. Dr. Payne bases his story upon a certain passage in the Compendium, in which Gilbert says that he met in Syrian Tripoli "a _canonicus_ suffering from rheumatic symptoms." I have been entirely unable to find the passage referred to in this story, in spite of a careful search of the text of the edition of 1510. But, admitting the existence of the passage in question, it proves nothing as to the _date_ of this alleged Syrian sojourn. Tripoli was captured by the Crusaders in 1109, and continued under their control until its recapture by the Saracens in 1289, a period of nearly two hundred years. Gilbert's travels in Syria may then have occurred at almost any time during this long period, and his fortuitous meeting with Archbishop Walter has very much the appearance of a story evolved entirely from the consciousness of the biographer. On the other hand, Mr. Kingsford bases his theory of Gilbert's sojourn in Syria upon a story adopted, I think, from Littré and found in the Histoire litéraire de la France. The Compendium of Gilbert contains (f. 137a) a chapter giving the composition of a complex collyrium with which he professes to have cured the almost total blindness of Bertram, son of Hugo de Jubilet, after the disease had baffled the skill of the Saracen and Christian-Syrian physicians of his day. Now Littré avers that a certain Hugo de Jubilet was involved in an ambuscade in Syria in the year 1227, and that he had a son named Bertram. It is very natural, of course, to conclude that this Bertram was the patient recorded in the book of Gilbert. Kingsford says that Gilbert "met" Bertram in Syria, but the text of the Compendium says nothing of the locality of their meeting, which might have taken place almost anywhere in Europe, perhaps even at Salernum, a favorite resort of the invalided Crusaders in these times. Finally, Dr. Payne disposes effectually of the authenticity of the entire story by calling attention to the fact that the chapter referred to in the Compendium is marked plainly "_Additio_," without indicating whether this addition is from the pen of Gilbert or some later glossator. Finally, I may suggest another line of argument, which, so far as I know, has not yet been advanced for the determination of the period of Gilbert. The Compendium Medicinae of Gilbert is, of course, a compendium of internal medicine. But the book is also something more. Not less than fifty chapters are devoted to a comparatively full discussion of wounds, fractures and dislocations, lithotomy, herniotomy, fistulae and the various diseases on the border line between medicine and surgery. Not a single surgical writer, however, is quoted by name. Nevertheless the major part of these surgical chapters are either literal copies, or very close paraphrases, of the similar chapters of the "_Chirurgia_" of Roger of Parma, a distinguished professor in Salernum and the pioneer of modern surgery. The precise period of Roger is not definitely settled by the unanimous agreement of modern historians, but in the "_Epilogus_" of the "_Glosulae Quatuor Magistrorum_" it is said that Roger's "_Chirurgia_" was "_in lucem et ordinem redactum_" by Guido Arietinus, in the year of our Lord 1230. This date, while perhaps not unquestionable, is also adopted by De Renzi, the Italian historian of Medicine. The original MS. of Roger's work is said to be still in existence in the Magliabechian Library in Florence, but it has never been published in its original form.[5] Roland of Parma, however, a pupil of Roger, published in 1264 what purports to be a copy of Roger's "_Chirurgia_" with some notes and additions of his own, and it is from this MS. of Roland that all our copies of Roger's work have been printed. Roger's "_Chirurgia_" was popularly known as the "_Rogerina_;" the edition of Roland as the "_Rolandina_." They are frequently confounded, but are not identical, though the additions of Roland are usually regarded as of little importance. In the absence of Roger's manuscript, however, they lead often to considerable confusion, as it is not always easy to determine in the printed copies of the "_Rolandina_" just what belongs to Roger and what to his pupil and editor. Now a careful comparison of the surgical chapters of Gilbert of England with the published text of the "_Rolandina_" leads me to the conviction that Gilbert had before him the text of Roger, rather than that of Roland, his pupil. If such is the fact, Gilbert's Compendium must have been written between 1230 and 1264, the dates respectively of the "_Rogerina_" and "_Rolandina_." [Footnote 5: Haeser says that this MS. of Roger's "Chirurgia," made by Guido Arenitensium, was discovered by Puccinoti in the Magliabechian library, and that an old Italian translation of the same work is also found there. The latter was the work of a certain Bartollomeo. The text used to represent Roger in the present paper is that published by De Renzi (Collectio Salernitana, tom. II, pp. 426-493) and entitled "Rogerii, Medici Celeberrimi Chirurgia." It is really the text published originally in the "Collectio Chirurgica Veneta" of 1546, of which the preface says: "_His acceserunt Rogerii ac Guil. Saliceti chirurgiae, quarum prior quibusdam decorata adnotationibus nunc primum in lucem exit, etc._," and adds further on: "_Addidimus etiam quasdam in Rogerium veluti explanationes, in antiquissimo codice inventas, et ab ipso fortasse Rolando factas._" While I may recognize gratefully the surgical enthusiasm which led the editor to the publication of these "_veluti explanationes_," for my present purpose he would have earned more grateful recognition if he had left them unprinted. As the text now stands it is merely a garbled edition of the Rolandina. However, it is the best representative of the "Chirurgia" of Roger at present available. See De Renzi, op. cit., p. 425.] From a careful review of the data thus presented we may epitomize, somewhat conjecturally, the life of Gilbert substantially as follows: He was probably born about 1180 and received his early education in England. On the completion of this education, about the close of the 12th century, he proceeded to the Continent to complete his studies, and spent some time in the school of Salernum, where it is probable that he enjoyed the instruction of Roger of Parma, Ricardus Salernitanus, and may have had among his fellow-students Aegidius of Corbeil. Probably after his return to England he served for a brief period on the staff of Archbishop Hubert Walter, after whose death in 1205, but at an unknown period, Gilbert returned once more to the Continent, where it seems probable he spent the remainder of his life. This comports best with his extensive European reputation, his surname "Anglicus" and the comparative dearth in England of any facts relating to his life. The date of the Compendium I am inclined to place about 1240, prior to the literary activity of Ricardus Parisiensis or Richard of Wendover, Roland of Parma, Roger Bacon and Theodorius of Cervia. We may place his death, conjecturally, at about 1250. The first edition of the Compendium is a small quarto of 362 folios (724 modern pages), five by seven inches in size, printed in double narrow columns, in black letter, perfectly legible and clear. The pagination shows some errors, but the text itself is remarkably accurate, though the presence of a multiplicity of contractions and ligatures renders the reading somewhat difficult to the modern student. On the last page we find the following colophon: _Explicit compendium medicine Gilberti Anglici correctum et bene emendatum per dominum Michaelem de Capella artium et medicine doctorem: ac Lugduni Impressum per Jacobum Saccon: expensis Vincentii de Portonariis. Anno Domini M.D.x. die vero vigesima mensis Novembris._ _Deo Gratias._ The second edition (which I have not seen) is said to bear the title: "Laurea anglicana, sive compendium totius medicinae, etc," Geneva, 1608. It should be noticed that the title "Laurea anglicana" is not mentioned in the original edition of 1510, but is apparently due to the exuberance of enthusiasm of the editor of the later edition, whose taste seems to have been more flamboyant. Various manuscript works of greater or less authenticity are ascribed to Gilbert by different authorities. Of these Mr. Kingsford furnishes the following list: 1. "Commentarii in Versus Aegidii de Urinis," quoted by John Gaddesden and probably authentic. 2. "Practica Medicinae," mentioned by Pits, but of doubtful authenticity. 3. "Experimenta Magistri Gilliberti, Cancellarii Montepessulani," noticed on page 2, but authenticity doubtful. 4. "Compendium super Librum Aphorismorum Hippocratis." MS. in Bodleian. 5. "Eorundem Expositio." MS. in Bodleian. 6. "Antidotarium." MS. in Caius College. To these he adds, on the authority of Bale and Pits: 7. "De Viribus Aquarum et Specierum." 8. "De Proportione Fistularum." 9. "De Judicio Patientis." 10. "De Re Herbaria." 11. "De Tuenda Valentudine." 12. "De Particularibus Morbis." 13. "Thesaurus Pauperum." All of these latter may be regarded as doubtful. The authorities named by Gilbert are Pythagoras, Hippocrates, Plato, Aristotle, Galen, Rufus, Maerobius, Boetius, Alexander of Tralles, Theodorus Priscianus, Theophilus Philaretes, Stephanon (of Athens?), the Arabians Haly Abbas, Rhazes, Isaac Judaeus, Joannitius, Janus Damascenus, Jacobus Alucindi, Avicenna and Averroës; the Salernian writers, quoted generally as Salernitani and specifically Constantino Africanus, Nicholas Praepositus, Romoaldus Ricardus and Maurus, and two otherwise unknown authors, Torror and Funcius, classed by Gilbert as "_antiqui_." The latter author is also said to have written a "_Liber de lapidibus_." Certainly this list suggests a pretty good medical library for a practitioner of the 13th century. Dr. Payne calls attention to the fact that all these writers antedate the 13th century, and thus limit the period of Gilbert in antiquity. This is undoubtedly true with reference to authorities actually named, but does not exclude from consideration other writers quoted, but not named, whom we shall have occasion to refer to hereafter. The Compendium opens with a very brief and modest foreword, couched in the following terms: "_Incipit liber morborum tam universalium quam particularium a magistro Gilberto anglico editus ab omnibus autoribus et practicis magistrorum extractus et exceptus, qui compendium medicine intitulatur._" It will be observed that no claim whatever for originality is presented by the author. He calls his book a compendium extracted from all authors and the practice of the professors, and edited only by himself. The same idea is more fully emphasized later (f. 55c), where he says: "_Sed consuetudo nostra est ex dictis meliorum meliora aggregare, et ubi dubitatio est, opiniones diversas interserere; ut quisque sibi eligat quam velit retinere._" The self-abnegation implied in these extracts must not, however, be interpreted too literally, for the editorial "_dico_" on numerous pages, and even an occasional chapter marked "_Propria opinio_," testify to the fact that Gilbert had opinions of his own, and was ready on occasion to furnish them to the profession. On the whole, however, the "Compendium" is properly classified by the author as a compilation, rather than an original work. The Compendium is divided into seven books, and the general classification of diseases is from head to foot--the usual method of that day. The modern reader will probably be surprised at the comprehensiveness of the work, which, besides general diseases, includes considerable portions of physiology, physiognomy, ophthalmology, laryngology, otology, gynecology, neurology, dermatology, embryology, obstetrics, dietetics, urinary and venereal diseases, therapeutics, toxicology, operative surgery, cosmetics and even the hygiene of travel and the prevention of sea-sickness. Some of these subjects too are discussed with an acuteness and a common sense quite unexpected. Of course, scholastic speculations, superstition, charms, polypharmacy and the use of popular and disgusting remedies are not wanting. Even the mind of a philosopher like Roger Bacon was unable to rise entirely above the superstition of his age. But the charms and popular specifics of Gilbert are often introduced with a sort of apology, implying his slight belief in their efficacy. Thus in his chapter on the general treatment of wounds (f. 87a) he introduces a popular charm with the following words: "_Alio modo, solo divino carmine confisi, quidam experti posse curari omnes plagas hoc._ "_Carmine._ "_Tres boni fratres per viam unam ibant, et obviavit eis noster dominus jesus christus et dixit eis, tres boni fratres quo itis_, etc." And again, in his discussion of the treatment of gout and rheumatism (f. 327b), Gilbert adds, under the title _Emperica_ "_Quamvis ego declino ad has res parum, tamen est bonum scribere in libro nostro, ut non remaneat tractatus sine eis quas dixrunt antiqui. Dico igitur quod dixit torror: Si scinderis pedem rane viridis et ligaveris supra pendem podagrici per tres dies, curatur; ita quod dextrum pedum rane ponas supra dextrum pedem patientis, et e converso. Et dixit Funcius, qui composuit librum de lapidibus, quod magnes, si ligatus fuerit in pedem podagrici, curatur. Et alius philosophus dixit. Si accipiatur calcancus asine et ponatur ligatus supra pedem egri, curatur, ita quod dexter supra dextrum, et e converso. Et juravit quod sit verum. Et dixit torror quod si ponatur pes testudinis dexter supra dextrum pedem podagrici, et e converso, curatur._" We may believe, indeed, that Gilbert would have preferred to follow in the therapeutic footsteps of Hippocrates, had he not disliked to be regarded by his colleagues as eccentric and opinionated. For he says in his treatment of thoracic diseases (f. 193c): "_Etenim eleganter dedit Ipo. (Hippocrates) modum curationis, sed ne a medicis nostri temporis videamur dissidere, secundum eos curam assignemus._" Gilbert was a scholastic-humoralistic physician _par excellence_, delighting in superfine distinctions and hair-splitting definitions, and deriving even pediculi from a superfluity of the humors (f. 81d). Of course he was also a polypharmacist, and the complexity, ingenuity, and comprehensiveness of his prescriptions would put to shame even the "accomplished therapeutist" of these modern days. In dietetics too Gilbert was careful and intelligent, and upon this branch of therapeutics he justly laid great emphasis. The first book of the Compendium, comprising no less than 75 folios, is devoted entirely to the discussion of fevers. Beginning with the definition of Joannicius (Honain ebn Ishak): "Fever is a heat unnatural and surpassing the course of nature, proceeding from the heart into the arteries and injuring the patient by its effects." Gilbert launches out with genuine scholastic finesse and verbosity into a discussion of the questions whether this definition is based upon the essentia or the differentia of fever; whether the heat of fever is natural or unnatural, and other similar subtle speculations, and finally arrives at a classification of fevers so elaborate and complex as to be practically almost unintelligible to the modern reader. The more important of these fevers or febrile conditions are: Ephemeral Hemitertian Double quartan Interpolated Synocha Causon synochides Epilala Quotidian Double tertian Quintan Continued Causon Putrid Lipparia Tertian Quartan Sextan Synochus Synochus causonides Ethica Erratica Some of these names are still preserved in our nosologies of the present day; others will be recalled by the memories of our older physicians, and a few have totally disappeared from our modern medical nomenclature. Interpolated fevers are characterized by intermissions and remissions, and thus include our intermittent and remittent fevers; synochus depended theoretically upon putrefaction of the blood in the vessels, and was a continued fever. Synocha, on the other hand, was occasioned by a mere superabundance of hot blood, hence the verse: "_Synocha de multo, sed synochus de putrefacto._" Causon was due to putrefaction of bile in the smaller vessels of the heart, diaphragm, stomach or liver, and was an acute fever characterized by furred tongue, intolerable frontal headache, tinnitus aurium, constant thirst, delirium, an olive-colored face, redness and twitching of the eyes and a full, frequent and rapid pulse. Epiala and lipparia were febrile conditions concerning which there seems to have been much difference of opinion, even in the days of Gilbert. Apparently they were distinguished by variations of external and internal temperature, or by chills combined with fever. Febris ethica is our modern hectic fever. In the discussion of this last variety we are introduced to the "_ros_" and "_cambium_" of Avicenna, apparently varieties of hypothetical humors. All these fevers are regarded from the standpoint of Humoralism, and depend upon variations in the quantity, quality, mixture or location of the four humors, blood, phlegm, bile and black-bile (_melancholia_). In the general treatment of febrile diseases, so-called preparatives and digestives are first employed to ripen the humors, after which evacuatives (emetics, cathartics, sudorifics, and occasionally even venesection) are utilized for the discharge of these peccant humors. Much emphasis is laid upon the dietetics of fevers, and this branch of treatment is highly elaborated. Complications are met by more or less appropriate treatment, and the condition of the urine is studied with great diligence. Venesection is recommended rather sparingly, and is never to be employed during the _dies caniculares_ (dog-days) or _dies Aegyptiaci_, nor during conjunctions of the moon and planets, nor upon the 5th, 15th, 17th, 25th, 26th, or 27th days thereafter, etc. Among the complications of fevers discussed by Gilbert, two seem sufficiently important to justify special attention. On folio 74b we find a section entitled "_De fluxu materie per parotidas venas_," in which he remarks that "Sometimes matter flows through the parotid veins behind the ears down to the neck and nares, and obstructs the passages for air, food and drink, so as to threaten suffocation." He cautions us against the use of repressives, "lest the matter may run to the heart," and recommends mollitives and dissolvents, such as butter, dyaltea, hyssop and especially newly shorn wool (_lana succida_), which, he says, is a strong solvent. Is this a reference to the septic parotitis not unfrequently seen in low fevers? The following section, "_De inflatione vesice et dolore ejus_," discusses the retention of urine in fevers, and its treatment. Gilbert says: "Inflation of, and pain in the bladder are sometimes symptoms of acute fevers, since the humors descend into and fill the bladder." If this occurs in an interpolated (remittent) fever, he directs the patient to be placed in a bath of a decoction of pellitory up to the umbilicus, "_et effundet urinam_." If the complication occurs in one suffering from a continued fever, the bath should be made of wormwood and a poultice should be placed over the bladder and genitals, "_et statim minget_." The same effect may be produced by poultice mixed with levisticum (lovage) or leaves of parsley. Singularly enough the catheter is not mentioned, though this instrument, under the medieval name of _argalia_ (cf. French algalie), is noticed frequently in the section devoted to vesical calculus. With the second book of the Compendium the system of the discussion of diseases _a capite ad pedes_ is commenced, and produces some curious associates. To the modern physician the sudden transition from diseases of the scalp to fractures of the cranium seems at least abrupt, if not illogical. It seems, therefore, wiser, in a hasty review like the present, to take up the various pathological conditions described by Gilbert in their modern order and relations, and to thus facilitate the orientation of the reader. The second book then opens with a consideration of the hair and scalp, and their respective disorders. The hair is a dry fume (_fumus siccus_), escaping from the body through the pores of the scalp and condensed by contact with the air into long, round cylinders. It increases rather by accretion than by internal growth, and its color depends upon the humors. Thus red hair arises from unconsumed blood or bile; white hair, from an excess of phlegm; black hair, from the abundance of black-bile (_melancholia_), etc. The use of the hair is for ornament, for protection and for the distinction of the sexes. Numerous prescriptions for dyeing the hair, for depilatories (_psilothra_), for the removal of misplaced hair and for the destruction of vermin in the hair are carefully recorded. Three varieties of soaps for medicinal use are described, and the process of their manufacture indicated. The base of each is a lixivium made from two parts of the ashes of burned bean-stalks and one of unslaked lime, mixed with water and strained. Of this base (_capitellum_), two parts mixed with one part of olive oil form the _sapo saracenicus_. In the _sapo gallicus_ the base is made with the ashes of chaff and bean-stalks with lime, and to it is added goat's fat, in place of the oil. The _sapo spatareuticus_ is made in a similar manner, except that oil replaces the goat's fat and the soap is made only during the dog days, since the necessary heat is to be supplied by the sun alone. Among the diseases of the scalp attention is given to alopecia, dandruff (_furfur_), tinea caries and various pustular affections, fanus (favus), rima, spidecia, achora, etc. Caries was a pustular disease, in which bristle-like hairs formed a prominent feature. Rima was a name applied by the physicians of Salernum to a superfluity of hair. In addition to these diseases of the scalp, we find also descriptions of gutta rosacea, morphoea and scabies, a fairly extensive dermatology for this early day. In favus, Gilbert tells us that, after the removal of the pustules, there remain foramina, from which exudes a poisonous substance, resembling honey. Of course his system of treatment is rich in variety and comprehensiveness. We may notice here too a few chapters on Toilet or Decorative Medicine, a branch of art to which modern physicians have devoted perhaps too little attention, with the natural result that it has fallen largely into the hands of charlatans of both sexes. Gilbert's chapter "_De ornatu capillorum_" offers the following sensible introduction: "The adornment of the hair affords to women the important advantages of beauty and convenience; and as women desire to please their husbands, they devote themselves to adornment and protect themselves from the charge of carelessness. In order, therefore, that our ministry may not be depreciated, and that we may not render ourselves liable to the accusation of ignorance, let us add a few words on the subject of the dressing of the hair and the general care of the person". Accordingly Gilbert advises ladies who desire to retain or renew the charms of youth to soften the skin and open its pores by the use of steam baths and careful washing in warm water, followed by drying the surface with the finest cloths (_panno mundissimo_). If necessary, superfluous hair is to be removed by suitable depilatories, color to be restored to the pale cheeks by a lotion of chips of Brazil-wood[6] soaked in rose-water and applied with pads of cotton; or, if the face is too red, it may be blanched by the root of the cyclamen (_panis porcinus_, sowbread) dried in an oven and powdered. A wealth of remedies for freckles, moles, warts, wrinkles, discolorations and other facial blemishes, with foul breath and fetidity of the armpits, is carefully recorded, and would suffice to establish the fortune of any of our modern specialists in female beauty. Finally a long chapter entitled "_De sophisticatione vulvae_" introduces us to a phase of decoration and sophistication which I would fain believe little known or studied in the development of modern civilization, in which we are prone at least to follow the advice of Hamlet, to "Assume a virtue, if you have it not." At all events, we may congratulate ourselves that the details of these disgusting cess-pools of medical art have disappeared entirely from the pages of our modern text-books. Even Gilbert considers it advisable to preface this gruesome chapter with a sort of "_Caveat emptor_" apology to the reader: "_Ut tamen secundum ordinem procedamus, in primis cognosactur cognoscere desiderantibus, ne dolus dolo patrocinetur, vel simplex dolose muscipula claudatur._" [Footnote 6: This apparent anachronism carries us back to the history of the mythical Island of Brazil, which appeared upon our charts as late as the middle of the 19th century.] In the department of neurology Gilbert, after a philosophical discussion of the nature and variety of pain, devotes considerable chapters to the causes, symptoms, diagnosis and treatment of headache, hemicrania, epilepsy, catalepsy, analepsy, cerebral congestion, apoplexy and paralysis, phrenitis, mania and melancholia, incubus or nightmare, lethargy and stupor, lippothomia or syncope, sciatica, spasm, tremor, tetanus, vertigo, wakefulness, and jectigation (jactitation, formication, twitching). The third book of the Compendium opens with several chapters on the anatomy and physiology of the eye and the phenomena of vision. According to Gilbert, the eye consists of three humors, the albugineous (aqueous), the crystalline lens and the vitreous humor, and seven tunics, apparently 1. The conjunctiva 2. The albuginea or sclerotic 3. The cornea 4. The secundina (choroid) 5. The rethilea (retina) 6. The aranea (iris) 7. The uvea perforata (posterior layer of iris), though the definitions are not in all cases quite clear and definite. The tela aranea is said to take its origin from the retina, the retina from the optic nerve, and the latter from the rethi (rete, network) involving the substance of the brain. The cornea arises from the sclerotic tunic, the uvea and secundina take their origin from the pia mater, and the conjunctiva from a thin pellicle or membrane which covers the exterior of the cranium and is nourished by a transudation of the blood through the coronal suture. This pellicle is also said to have a connection with the heart, which arrangement furnishes a decidedly curious explanation of the mechanism of sympathetic and maudlin lachrymation. For, as Gilbert tells us, when the heart is compressed this pellicle is also compressed, and if any moisture is found beneath the pellicle it is expressed into the substance of the lachrymal gland by the constriction of the heart, and men in sorrow therefore shed tears. And again, if the heart is much dilated or elevated (by joy), this pellicle is also dilated or elevated, and if any moisture is found beneath it, it is expressed in the form of tears. Accordingly, men who are too joyful shed tears. Still further, drunken men, who are notoriously "moist," and have a superfluity of fluid between the pellicle and the skin of the cranium, are prone to weeping on slight provocation, and their tears are nothing more than an expression of this moisture, which makes its exit, not through the substance of the eye, but through the "lachrymal angle." Q.E.D. This odd demonstration is followed by a succession of optical questions, which are discussed and answered in true scholastic style, with no little acuteness of observation. Thus: "_Utrum visus fiat intus suscipiendo?_" Is vision accomplished by something received into the eye? "_Utrum color fit de nocte?_" Does color exist at night? To the latter question Gilbert replies that in the darkness color exists in posse, but not in esse. Again: "Why do some animals see at night, some in the day only and some only in the twilight?" This phenomenon he ascribes to "the clearness and subtilty of the visual spirits, or to the strength, weakness, grossness or turbidity of the organs of vision." Some animals, he says, have (visual) spirits, subtle and clear as fire, and these animals see perfectly at night because the visual spirits (_spiritus visibilis_) are sufficient to illuminate the external air. "Why do objects in water seem nearer than those in air?" Gilbert explains this as follows: "Nothing appears distant, except as perceived through an extensive intervening medium. But our judgment is largely guided by the transparency of this medium, since the medium itself is not perceived with much accuracy, except when it is transparent. Accordingly, as the lucidity of air is greater than that of water, an object looks more distant through air than through water." "Why does not a single object appear double, inasmuch as we have two eyes?" To this he replies: "From the anterior part of the brain two optic nerves pass to the two eyes. But these two nerves unite at a certain point into one. Now, since the two nerves are of equal length, two images proceeding from a single object do not make the object seem double, but single, since the two images are united into one, and accordingly one object is seen as one image." Other physiological speculations are introduced by the questions: "May one see an object not actually present?" "Why do some animals see best objects at a distance, others those near at hand?" "Why are objects seen in their proper position?" All these questions are answered in accordance with the scholastic formulae, and, not infrequently, with considerable acuteness. A chapter entitled "_De signis oculorum_" also introduces us to a curious discussion of ocular physiognomy. Thus: "When we see a man with large eyes, we argue that he is indolent." "If his eyes are deeply situated in his head, we say that he is crafty and a deceiver." "If his eyes are prominent, we say that he is immodest, loquacious and stupid." "He whose eyes are mobile and sharp is a deceiver, crafty and a thief." "He whose eyes are large and tremulous is lazy and a braggart (_spaciosus?_), and fond of women." and so forth for an entire page of the Compendium. Actual diseases of the eye are discussed in chapters on pain in the eyes, ophthalmia, pannus (including ungula, egilops and cataract), tumors of the conjunctiva, itching of the eyes, lachrymation, cancer, diseases of the cornea and uvea, diseases of the eyelids, lachrymal fistula and entropion. The treatment consists generally in ointments and collyria in abundance, but in fistula lachrymalis incision and tents of alder-pith, mandragora (_malum terrae_), briony, gentian, etc., are recommended, and entropion is referred directly to the surgeon. The Latin term cataracta (also catarracta and catarractes) is applied to a disease of the eyes by Gregory of Tours (Hist. Franc., v. 6) as early as A.D. 650, and again by Constantine Africanus, of the school of Salernum, in 1075 (De Chirurg., cap. XXX). Singularly the word is not found in the "Chirurgia" of Roger of Parma, from whom Gilbert seems to have borrowed most of his surgical knowledge. Nor is it employed by Roland, Roger's pupil and editor. It recurs, however, in the _Glossulae Quatuor Magistrorum_ (about 1270). But in all these writers cataracta seems to be included under the general term pannus, meaning opacities of every kind. Indeed Gilbert says, "Ungula, egilops, cataracta and macula are species of pannus, all arising from the same causes and cured by the same treatment." A few lines later, however, in distinguishing these various species, he adds: "Cataract arises from a humor collected between the tunics of the eye": and again it is said to be blood filling the veins of the eyes, and especially those of the conjunctiva, and derives its name _a caracteribus_ (?). The truth is none of these writers seem to have any very definite knowledge of the distinction between the various opacities of the media of the eye, all of which were included under the general term pannus. But, what is more remarkable, Roger, Roland and The Four Masters make no mention of the possibility of surgical interference in these cases, but content themselves with elaborate collyria and ointments, or simply with internal treatment. Gilbert, on the other hand, while recommending these collyria and ointments, and even the internal remedies, adds the following: "_Interior autem macula, quae tela vocatur, subcornea situata, si vl'e (?) purgatione precendente et colliriis et pulveribus non removetur, acu torta immissa per caprinum angulum extrahatur aut inferius replicetur_" (f. 137a). And again (f. 141d): "_In uvea sunt largitas et constrictio et aqua sive cataracta.... Aqua quandoque per medium pupille descendit, inferius stans, subuvea apparens, quae perfecte curatur secundum quosdam immisso acus aculeo per pupillam, ut extra fluat aqua._" Chapters on the physiology of hearing, smelling and the sensation of touch are followed by a discussion of the symptoms and treatment of earache, abscess of the ear, discharges (bloody and sanious) from the ear, worms and other foreign bodies in the ear, tinnitus aurium, deafness, coryza, epistaxis, nasal polypi, ozaena, cancer of the nose, fissures and ulcers of the lips, foul breath, diseases of the tongue, toothache, etc. Physiognomy, a favorite theme with our author, appears again in a considerable chapter on the physiognomy of the nose, mouth, face and the teeth. "He who laughs frequently is kind and genial in all things and is not worried over trifles." "He who laughs rarely is contrary and critical." "He who has large ears is stolid and long-lived." "He who has a large mouth is gluttonous and daring." "He whose teeth are defective and small is weak in his whole body." "He whose canine teeth are long and straight is a glutton and a rascal." The department of genito-urinary diseases is introduced by a long chapter entitled "_De approximeron_," a formidable Latin word defined by Gilbert as sexual impotence. An elaborate discussion of the physiology of generation and the phenomena of impotence is followed by a collection of remedies for the condition, of which the best that can be said is that they are probably no less effective than most of the modern drugs recommended for the same purpose. Concerning a function over which so many fond superstitions still linger in the public mind we may, perhaps, charitably forgive Gilbert for the introduction of an empirical remedy for sterility, which, he assures us, he has often tried and with invariable success, and which enjoys the double advantage of applicability to either sex. "Let a man, twenty years of age or more, before the third hour of the vigil of St. John the Baptist, pull up by the roots a specimen of consolida major (comfrey) and another of consolida minor (healall), repeating thrice the Lord's prayer (_oratio dominica_). Let him speak to no one while either going or returning, say nothing whatever, but in deep silence let him extract the juice from the herbs and with this juice write on as many cards as may be required the following charm: "_Dixit dominus crescite._ [symbol: dagger]. _Uthihoth._ [symbol: dagger]. _multiplicamini._ [symbol: dagger]. _thahechay._ [symbol: dagger]. _et replete terram._ [symbol: dagger]. _amath._ "If a man wears about his neck a card inscribed with these identical words written in this juice, he will beget a male. Conversely, if a woman, she will conceive a female" (f. 287b). Gilbert, however, cautions the bearer of this potent charm of the possible dangers of satyriasis incurred thereby, and offers suitable remedies for so alarming a condition. Chapters on satyriasis, gomorrhea (gonorrhea in its etymological sense, seminal emissions), with a third entitled "_De pustulis et_ *_apostematibus virgae_" complete this department of medical art. The last chapter recognizes the venereal origin of the pustules and ulcers discussed, but furnishes no direct evidence of Gilbert's belief in the existence of a specific venereal poison. While Gilbert is very scrupulous in his examination of the gross appearances of the urine in most diseases, his discussion of the diseases of the kidneys and bladder includes only pain in the kidneys, abscess of the kidneys, renal and vesical calculus, hematuria, incontinence of urine, dysuria and strangury. The chapter on hematuria presents a very curious specimen of medieval pathology. Gilbert says: "The escape of blood in the urine is due sometimes to the liver, sometimes to the bile,[7] sometimes to the kidneys and loins, sometimes to the bladder. If the blood is pure and clear, in large quantity, mixed perfectly with the urine and accompanied by pain in the right hypochondrium, it comes from the liver. Such urine presents scarcely any sediment. If the blood comes from the lrili vein, it is also rather pure, but less pure than in the former case, nor is the quantity so great, while pain is felt over the region of the seventh vertebra, counting from below. If it comes from the kidneys, it is scanty and pure as it leaves the bladder, but soon coagulates and forms a dark deposit in the vessel, while pain is felt in the pubes and peritoneum.... If pus, blood and epithelium (_squamae_) are passed, and the odor is strong, it signifies ulceration of the bladder" (f. 275b). [Footnote 7: In his chapter on embryology (f. 304c) Gilbert describes the lrili vein as follows: "The embryo is nourished by means of the lrili or lrineli vein, which does not exist in man. This vein has its origin in the liver and divides into two branches. Of these the superior branch bifurcates, and one of its branches goes to the right breast, the other to the left, conveying blood from the liver. This blood in the breast is bleached white (_dealbatur_) like milk, and forms the nourishment of the infant. The inferior branch of the lrili vein also bifurcates, sending one of its branches to the right cornu of the uterus, the other to the left. These vessels carry blood into the cotyledons, whence it is transmitted to the fetus and digested by its digestive faculty."] Diabetes is defined as "An immoderate passage or attraction of urine from the liver to the kidneys and its passage through the kidneys, as the result of a warm or dry distemperature of these organs." The idea of some association of the liver and kidneys in the production of diabetes is at least as old as the eleventh century, and Gilbert's definition of the disease is undoubtedly borrowed from the "Practica" of John Platearius (A.D. 1075), of the school of Salernum. The symptoms, continual thirst, dryness of the mouth, emaciation, in spite of an inordinate appetite, frequent and profuse urination, are correctly given, but no knowledge of the presence of sugar in the urine is indicated. Dyampnes (involuntary micturition) claims a page or more of explanation and treatment, and its frequent occurrence in old men and children is noticed. In the department of the diseases of women chapters are devoted to amenorrhea, menorrhagia, hysteria (_suffocatio matricis_), prolapse, ulceration, abscess, cancer, dropsy and "ventosity" of the uterus (physometra). In the allied department of obstetrics we find chapters on the signs of conception, on the urine in pregnant women, on difficult labor, prolapsus uteri, retention of the placenta, post partum hemorrhage, afterpains, and the oedema of pregnancy. The causes of difficult labor, according to Gilbert, are malposition, dropsy, immoderate size and death of the fetus, debility of the uterus and obstruction of the maternal passages. Malpositions are to be corrected by the hand of the midwife (_obstetrix_). Adjuvant measures are hot baths, poultices, inunctions, fumigations and sternutatories, and the use of certain herbs. In the departments of general medicine not as yet entirely appropriated by specialists it will suffice to mention scrofula, pleurisy and pneumonia, hemoptysis, empyema, phthisis, cardiac affections, diseases of the stomach, liver and spleen, diarrhoea and dysentery, intestinal worms, dropsy, jaundice, cancer, rheumatism and gout, small-pox, measles, leprosy and hydrophobia, all of which claim more or less attention. Peripneumonia and pleurisy are both inflammations of the chest, the former affecting the lungs, the latter the diaphragm and the pellicle which lines the ribs. The prominent symptoms of both diseases are pain in the chest or side, cough and fever and dyspnoea. Accidents or sequelae are hemoptysis, empyema and phthisis. Empima (empyema) is the hawking-up of sanies, with infection of the lung and a sanious habit. Hence persons laboring under pneumonia or pleurisy are not necessarily empyemics, but when these diseases progress to such a point that blood and sanies are expectorated and the lung is infected, that is when the ulceration of the lungs fails to heal and corruption and infection occur, the disease becomes empima, and is with difficulty, or never cured. Ptisis is a substantial consumption of the humidity of the body, due to ulceration of the lungs. For when a solution of continuity occurs in the lungs, the inspiratory and expiratory forces fail. Hence the lungs do not inspire sufficient air to mitigate the innate heat of the heart, and the heart fails to purify itself of the fumosity or fumous vapors generated in itself. Accordingly, deprived of the means of mitigating its heat or ventilating its fumosities, the spirits within it become unduly heated, and a consuming fire is generated in the entire body. The symptoms of ptisis are a continued fever, greater or less, detected in the palms of the hands and the soles of the feet, thirst, a roughness of the tongue, slenderness of the neck, wasting of the entire body, constipation, wasting and shrinking of the finger-nails and fingers, hollowness of the eyes, pain in the left scapula extending to the shoulder, pharyngeal catarrh with abundant and mucilaginous sputum and a tendency to lachrymation. If the sputum thrown upon the coals emits a fetid odor, it is a sign of confirmed ptisis, which is incurable. The disease when it occurs in youths and young persons rarely lasts longer than a year, often terminates in less time, and may sometimes, by the aid of medicine, be prolonged for a greater period. If the sputum received during the night in a vessel is flushed in the morning with warm water, while some impurities remain upon the surface, the putrid matter will sink to the bottom (_sputum fundum petens_), and the indications are fatal. Likewise sharpness of the nose, hollow eyes, slender nails, falling hair, flattened temples and diarrhoea are of evil omen. These patients converse while dying, and die conversing (_moriendo loquentur, sed loquendo moriuntur_). Gilbert, of course, supplies a formidable array of remedies for the disease, but tells us that the "very latest" is cauterization over the clavicles (_Novissimum autem consilium est cauterium in furcula pectoris_). The varieties of difficulty of breathing are classified under the titles of asma, dispnea, orthomia, hanelitus and sansugium. The last title is given to a condition in which, as Gilbert says, "A superfluous humor is abundant in the superficies of the lung, which compresses that organ and renders it unable to dilate in inspiration. Hence it labors in inspiration like a leech, from which the dyspnea derives its name." Under the single title of "_cardiaca passio_" are included all possible diseases of the heart. The symptoms of this disease are said to be "palpitation, twitching of the limbs (_saltus membrorum_), perspiration, weakness of the nerves, facial pallor, weakness of the body as in hectic fever or phthisis, excessive pain and faintness over the precordia, a disposition to sleep and often constipation." The treatment is, of course, entirely symptomatic. Diseases of the digestive apparatus are discussed under the headings of difficulties of deglutition, canine appetite, bolismus (boulimia), disturbances of thirst, eructations, hiccup, nausea and anorexia, vomiting, anathimiasis (gastric debility), anatropha and catatropha (varieties of obstinate vomiting), pain in the stomach, abscess of the stomach, salivation, colic, dysentery and diarrhoea, intestinal worms, hemorrhoids, rectal tenesmus, prolapsus ani, fistula in ano, diseases of the liver, dropsy, jaundice and diseases of the spleen. Abscess of the stomach sometimes manifests a circumscribed tumor, and accordingly, probably includes cancer of that organ. Approved remedies are the Al'mirabile, the stomatichon frigidum, calidum or laxativumvum, etc., stereotyped formulae, of which the composition is carefully recorded. Dysentery is a flux of the bowels with a sanguinolent discharge and excoriation of the intestines. A variety called hepatic dysentery, however, lacks the intestinal excoriation. Diarrhoea is a simple flux of the bowels, without either the sanguinolent discharges or the intestinal excoriation. Lientery is a flux of the bowels with the discharge of undigested food, occasioned by irritability (_levitas_) of the stomach or intestines. Colical passion and iliac passion derive their names from the supposed origin of the pain in the colon or ileum, a remark which furnishes occasion for the statement that Gilbert divides the bowels into six sections, viz., the duodenum jejunum and ileum, and the orobus, colon and longaon (rectum). Intestinal worms are not generated in the stomach, as Gilbert says, because of the great heat produced by the process of digestion. In the intestines they originate chiefly from the varieties of phlegm, e.g., saline, sweet, acid, natural, etc. The species mentioned specifically are lumbrici and ascarides or cucubitini, though the terms long, round, short and broad are also employed, and probably include the tape worm or taenia lata. The treatment of these parasites consists generally in the use of aromatic, bitter or acid mixtures, among which gentian, serpentaria, tithymal and cucumis agrestis are especially commended for lumbrici, and enemata of wormwood, lupinus, scammony, salt, aloes, etc., for ascarides. The diseases of the liver, though not numerous, are allotted considerable space most of which is occupied by scholastic speculations and the usual rich supply of therapeutical suggestions. Discrasia of the liver has several varieties, warm, cold, moist and dry, and seems nearly equivalent to our somewhat overworked term of "biliousness." Gilbert's favorite compounds for the relief of this condition are the Trifera sarracenica, the Electuarium psilliticum and above all the Dyantos Besonis. Obstruction (_oppilatio_) of the liver or enfraxis is defined as a disease of the canals (_pori_), of which four are enumerated, to-wit, the meseraic, that of the convexity of the organ (_gibbus--ubi sunt exitus capillarium venarum_), the duct leading to the gall-bladder and that leading to the spleen. With an abundance of symptoms, it is singular that this comprehensive disease does not seem characterized by any constant or severe pain, as we might reasonably expect. Abscess of the liver depends upon some vice of the blood, the bile, the phlegm or the black-bile. The general treatment is poultices and other maturatives, but, as the author adds rather sadly at the close, _ultima cura est per incisionem_. Dropsy is discussed as an independent disease through the exhaustive speculations of thirty-two pages. Gilbert tells us it depends upon some fault of the digestive faculty of the liver, and he divides it into four species, to-wit, leucoflantia, yposarcha, alchitis and tympanitis, each of which has its special and appropriate treatment. In the dreary waste of speculative discussion it is cheering, however, to observe Gilbert's positive recognition of the sphere of percussion indicated in the passage: "_Et venter percussus sonat ad modum utris semipleni aqua et venta._" (f. 250b.) Ycteritia or jaundice receives equally thorough discussion through eight weary pages, including the usual polypharmacal treatment. The spleen, Gilbert says, is sometimes the name of an organ, sometimes of a disease. As an organ it is spongy and loose in texture, and attracts and retains the superfluities of the black-bile, expelled from the liver for its own cleansing. Hence it is a servile and insensitive organ, and accordingly suffers different diseases, such as obstruction, tumors, hardening, softening, abscess, and sometimes flatulence or repletion. The symptoms and treatment of each of these morbid conditions, arising from either heat or cold, are discussed with exasperating thoroughness, and the chapter concludes with the composition and use of various specific remedies of compound character, bearing the impressive titles of Dyasene, Dyacapparis, Dyaceraseos (a mixture of cherry juice, honey, cinnamon, mastic and scammony) and Agrippa. Scrofulous swellings are carefully considered in a chapter entitled "_De scrophulis et glandulis._" "Scrophulae and glandulae are hard swellings developing in the soft parts, as in the emunctory localities of the veins and arteries, particularly in the neck, armpits and groins, and sometimes in other places. They spring from the superfluities of the principal organs, which nature expels, as it were, to the emunctories and localities designed to receive this flux." ... "Hence they are often found the cause of scabies, tinea, malum mortuum, cancer, fistula, etc., and are called glandes. Sometimes, however, a dryer matter is finely divided and falls into several minute portions, from which arise many hard and globular swellings, called scrofulae from the multiplicity of their progeny, like that of the sow (_scrofa_). The disease is also called _morbus regius_, because it is cured by kings." Gilbert advises that these swellings should not be "driven in" (_repercutienda_), but brought to suppuration generally by emollients and poultices. When softened they may be opened with a lancet and the pus allowed to escape gradually, but as this process is tedious, he prefers the entire removal of the glands with the knife, premissing, however, that no gland should be cut into which cannot be well grasped by the hand and pulled from its seat. This surgical manipulation is fully described, and is undoubtedly taken from the similar chapter of Roger. It is worthy of notice also that just at the close of this chapter, Gilbert mentions a swelling called "testudo," a gland-like, gaseous (_ventosa_) tumor, usually solitary and found in "nervous" localities, like the joints of the wrist and hand. He says it often occurs from fracture (_cassatura_?) of the nerves, is cured by pressure, friction or incision, but is not entirely free from danger. Possibly this may refer to ganglion. Now, Roger makes no mention whatever of "testudo," while Roland says: "_Nota quod quamvis Rogerius non designat inter glandulum et testudinem, scias igitur quod testudo fit ex majori parte flegmatica, minori melancholie, glandula vero a contrario_," a statement which might readily suggest the suspicion that Gilbert had before his eyes the text of Roland, or that, at least, he had not acquired his knowledge of testudo from Roger, his usual surgical authority. Gilbert's sections on goitre (_bocium gulae_)[8] are interesting in themselves, and characteristic of the method adopted by him in his discussion of surgical or semi-surgical subjects. An introduction relative to the pathology of the disease and which seems to be original, is followed by a treatment, medical and surgical, adopted almost literally from the Chirurgia of Roger. Thus he says: "Goiter occurs most commonly among the inhabitants of mountainous regions, and is due to an amplification and dilatation of the veins, arteries and nerves, together with the soft tissues, occasioned by the north wind (_ventum boreale_), or some other confined wind, which during childhood has accumulated in (_coadunabatur_) and enlarged the part to the size of the goiter." After suggesting an analogy between the disease and the redness and turgidity of the neck produced by passion or in singing, he adds that some cases are due to an accumulation of spongy tissue between the veins and arteries, or to the use of flatulent food, and he even tells us that some old women know how to produce and remove goitrous swellings by means of certain suitable herbs known to them. [Footnote 8: Cf. the French _bosse de la gorge_.] Under medical treatment we find the following: "Dig out of the ground while chanting a pater noster, a nut which has never borne fruit. The roots and other parts pound well with two hundred grains of pepper, and boil down in the best wine until reduced in volume to one-half. Let the patient take this freely on an empty stomach until cured." Another more elaborate prescription consists of a long list of ingredients, including burnt sponge, saponaria, the milk of a sow raising her first litter, with numerous simple herbs, and the sole object for which this nonsensical farrago is introduced here is to add that both these prescriptions are copied from the surgery of Roger. It is important too to remark here that we owe to Roger the introduction of iodine, under the form of burnt sponge, into the treatment of goiter. In the failure of medical treatment, Gilbert directs the employment of surgical means, e.g., the use of setons, or, in suitable cases, extirpation of the goiter with the knife. If, however, the tumor is very vascular, he prefers to leave the case to nature rather than expose the patient to the dangers of a bloody operation. The whole discussion of goiter is manifestly a paraphrase of the similar chapter of Roger, who also introduced into surgical practice the use of the seton. In Gilbert's chapter entitled "_De arthretica passione et ejus speciebus_," we are introduced to the earliest discussion by an English physician of that preeminently English disease--gout. We may infer, too, from the length of the discussion (thirty or more pages) that this was a disease with which Gilbert was not only familiar, but upon the knowledge of which he prided himself greatly. Indeed, it is one of the few diseases of the Compendium in which the author assumes the position of a clinician and introduces examples of the disease and its treatment taken from his own clientele. We shall, therefore, follow our author here rather more carefully and literally than usual, that we may learn the views of an English physician of the thirteenth century on, perhaps, the most characteristic disease of his countrymen. Gilbert says: "Arthetica is a disease of the joints arising from a flux of humors descending into their continuity (_concathenationem_). The name is derived from the Latin _artus_, a joint, and the disease comprehends three species, viz., _sciatica_, disease of the scia, or the ligaments uniting the spine with the hip; _cyragra_, disease of the joints of the hands; and _podagra_, disease of the bones and joints of the foot, due to the descent of humors into their continuity. Sometimes, too, the disease affects other organs, occasioning pain in sensitive members, as, e.g., the head, and then derives its name from the part affected, as _cephalea_, _emigranea_ or _monopagia_. Occasionally likewise some humor runs down (_reumatizat_) into the chest, spreading over the nerves of the breast or those of the spine between the vertebrae, and sometimes to other places. Hence the disease derives the general name gout (_gutta_), from its resemblance to a drop (_gutta_) trickling or falling downward and flowing over the weaker organs, which receive the humor. For gout arises particularly from rheumatic causes. Now, as the humors are rather uncontrollable (_male terminabiles_) fluids, they flow towards the exterior and softer parts, like the flesh and skin, which receive their moisture and being soft, dilatable and extensible, there results some swelling. But if the humors are hard and dry, they are confined within the interior of the organs, such as bones, nerves and membranes: and these, being hard in themselves, do not receive the moisture, nor suffer extension or dilatation, and thus no swelling results. Since, therefore, the material of this variety of arthetica, in which no swelling is present, is formed of grosser and harder substance and is found in the vicinity of hard and cold localities, it is dissolved slowly and the disease is not cured until this solution takes place. That form of the disease, however, in which there is swelling from a subtile and liquid material deposited in the soft parts is the more quickly cured. Hence swelling is the best sign of curability. This is most evidently true in podagra, unless the _materies morbi_, by reason of its scarcity, produces no enlargement of the affected part." Quoting the words of Rhazes, Gilbert tells us that the _materies morbi_ of gout is, for the most part, crude and bloody phlegm. Rarely is it bilious, and still more rarely, melancholic. If, however, it is compounded, it consists chiefly of bile mixed with a subtile phlegm, and more rarely, of phlegm mixed with black bile (_melancholia_), occasionally of black bile mixed with blood. The mixture of black bile and blood or bile is very rare, and still rarer a mixture of all the humors according to their proportion in the body. If the color of the affected part is red, it indicates that the _materies morbi_ is sanguineous; if greenish-yellow (_citrinus_), that it is bilious; if whiter than the general color of the body, that the materies is a subtile phlegm. If the color shades away into black, it does not signify necessarily that the materies is simply black bile, for such a color occurs at the close of acute abscesses, or from strangulation of the blood. But if, together with the black color, we find the tissues cold and no increase of heat in the affected part, this indicates that the _materies_ is black bile. By touching the diseased part we determine its heat or coldness, hardness or softness, roughness or smoothness, fullness, distention or evacuation, all of which signs possess special significance. The antecedent causes of gout, Gilbert tells us, are a heat too solvent, cold too constringent (f. 311 c), sometimes a strong bath or a severe journey in a plethoric person (_in plectorico_), again excessive coitus after a full meal (_satietatem_), or even habitual excess, by which the joints are weakened and deprived of their natural heat and subtile moisture. Hence boys and eunuchs are not commonly affected by gout--at least boys under the age of puberty. Women, too, do not usually suffer from this disease, because in coitus they are passive, unless their menstrual discharge is suspended. Again gout sometimes arises from infection of the primary semen; for a chronic disease may be inherited by the offspring and affect the material causes, i.e., the humors. Flatulence (_ventositas_) is likewise a cause of gout, as we have already hinted. In gout of the sanguineous type the favorite remedy of Gilbert was venesection, pushed to extremes which suggest the bloody theories of his later confrere Bouillaud. This bloodletting, however, was always to be practiced on the side opposite to that affected by the disease, as he tells us, for two reasons: First to solicit the peccant material to the opposite side; and, second, to retard its course toward the seat of the swelling. If, therefore, the disease is in the right foot, he bleeds from the basilic vein, or some of its branches, in the right hand. No other vein should be taken, but if neither the basilic vein nor one of its branches can be found, the bleeding may be performed upon the median vein, for certain branches of the basilic and cephalic veins unite to form the median. If the disease is in the hand, the material may be diverted in two ways, either to the other hand or to the opposite foot. Indeed, blood may be taken from both these parts in succession. The quantity of blood withdrawn should be in accordance with the strength of the patient, the character of the swelling, the pulsation, distention, heat and redness of the affected part. But it should be repeated frequently, and this bloodletting then frequently suffices, in itself, to cure the disease. Gilbert continues: "I will tell you also what I myself saw in a woman suffering and screaming with pain in her right wrist (_assuere_?), which was greatly swollen, hot, red and much distended. She was fat, full-blooded, and before the attack had lived freely on milk and flesh. Accordingly she was robust, and I bled her from the basilic vein of the left hand and the saphena of the right foot, both within an hour. Each hour I withdrew a half-pound of blood, then I fed her and for three hours I drew half a pound of blood from the saphena. In the last hour the pain and throbbing (_percussio_) ceased entirely, and the woman begged me to bleed her again from the hand, for she had experienced great relief. I wished, however, to divert the material to the lower extremities for two reasons, one of which I ought not to mention in this place, while the other is useful, and indeed necessary in such cases. You should know that this woman was suffering pain in her left hand also, though this pain was of a less severe character than in the right. For this reason I desired to divert the peccant matter downward, a point which the physician should consider and observe. Once, while treating a man suffering from sanguineous gout, the pain of which involved the joints between the assuerus and the racheta (?) of the right hand, I asked him whether any pain was felt in the other hand or in the feet. He replied that similar pain was felt in the left hand or its joints, and that hitherto it had been more severe, but that no pain had ever been experienced in the feet. Hence I was unwilling to bleed him at all from the left hand, but I bled him from the right foot. A physician who had treated him before, and had bled him from the right hand for acute swelling of the joints of the left, quieted, indeed, the pain in the left hand, but diverted the disease to the right, where a swelling developed larger than in the left. And when I asked him about this, he understood that I knew more about medicine than the other doctor did. And this is one of the reasons why one ought to divert the material to another part, especially when the pain is so located that it may be increased at the beginning. For under such conditions we ought to refrain from bleeding, frictions and other treatment which may attract the _materies morbi_ to the part. Indeed we ought to require derivation of the materies to another part whenever the affected locality contains one of the nobler organs, towards which the material is directing, or may direct its course. For instance: A person is suffering pain in the joints of the right hand, but has also an acute swelling in the bladder, the kidneys or the womb. Now, I say that in such a case we ought not to bleed from the hand, because if we do we shall injure the organ affected by the swelling. Perhaps, however, we may bleed from the right foot, provided we understand that there is on the right side a sanguineous tumor, the danger of which is greater than that of the swelling on the right hand. Again, suppose in the liver or in the right kidney an acute tumor, and in the joints of the right hand there is present a moderate pain. I say that we ought first to medicate the more dangerous lesion, and, possibly, two results may be obtained by the attraction of the peccant material. Or suppose a woman has gout in her hand, and with this a suppression of the menstrual flow. I say she ought to be bled from the foot and not from the hand for two objects, to solicit the material from the diseased hand, and to provoke a return of the menstrual discharge. "But to return to our original patient. I may say that after the third venesection, with an interval of two hours, I withdrew a half-pound of blood from the saphena vein, and that night she slept, although she had not slept for many nights. And I did nothing more, except to prescribe a light and cool diet. The third day after the bleeding she was entirely free from any trouble in her hand. Hence I say that we ought in such cases to begin our treatment by venesection." After this sanguinary introduction, Gilbert soothes the diseased part with cooling and astringent ointments, unless these occasion pain, in which event he omits them entirely and trusts the case to nature, "_quoniam natura per se curabit_." The vigorous plan of treatment thus outlined Gilbert seems to regard as original and peculiar to himself, for the next chapter bears the title, "The treatment of gout according to the authorities (_secundum magistros_)." Here he says he quotes the opinions of the modern teachers and writers, who lay down definite rules for the guidance of the physicians. Among these he mentions, as primary and of general application, the rule that, before all things, the body must be purified, either by venesection in cases where the material is sanguineous, or by purgation in other varieties of the disease. If the cause is rheumatic in its nature, fomentations should never be employed, for fear of increasing the flux. That the peccant material is to be eliminated gradually by mild remedies, just as it accumulated by degrees. In all cases of gout, and in all chronic diseases generally, much attention must be devoted to the stomach, since if this organ rejects the medicine, the latter must be at once abandoned, lest the stomach becomes weakened and even other organs, and thus the humors flow more readily (_magis reumatizarent_) to the joints, etc. These general medical rules are succeeded by some twenty pages devoted largely to special formulae for the different forms of gout, with remarks as to their applicability to the different varieties of the disease. Most of the formulae bear special titles, apparently to lend the weight of a famous name to the virtues of the prescription itself, something as in these modern days we speak of "Coxe's Hive Syrup," "Dover's Powder," "Tully's Powder," etc. Thus we read of the "_Pilulae artheticae Salernitorum_," the "_Cathapcie Alexandrine_," the "_Oxymel Juliani_" the "_Pilulae Arabice_," the "_Pulvis Petrocelli_," the "_Oleum benedictum_," the "_Pilulae Johannicii_," etc. It is important, too, to remark that the active ingredient of very many of these formulae is the root called hermodactyl, believed by the majority of our botanists to be the _colchicum autumnale_. Gilbert's discussion of gout closes with a short and characteristic chapter entitled "_Emperica_," in which he remarks: "Although I perhaps demean myself somewhat in making any reference to empirical remedies, yet it is well to write them in a new book, that the work may not be lacking in what the ancients (_antiqui_) have said on the subject. Accordingly I quote the words of Torror. If you cut off the foot of a green frog and bind it upon the foot of a gouty patient for three days, he will be cured, provided you place the right foot of the frog upon the right foot of the patient, and vice versa. Funcius, also, who wrote a book on stones, said that if a magnet was bound upon the foot of a gouty patient, he is cured. Another philosopher also declared that if you take the heel-bone of an ass and bind it upon the foot of the patient, he is cured, provided that you take the right bone for the right foot, and conversely, and he swore this was true. Torror also said that if the right foot of a turtle is placed upon the right foot of a patient suffering from the gout, and conversely, he will be cured." Gilbert's discussion of leprosy (_De lepra_, f. 336 d) covers twenty pages and, according to Sprengel, is "almost the first correct description of this disease in the Christian West." Freind says this chapter is copied chiefly _from_ Theodorius of Cervia. See page 3 ante. If, however, I am correct in my conjecture that the Compendium was written about the year 1240, the copying must have been done _by_ Theodorius, whose "Chirurgia" did not appear until 1266. Leprosy is defined as a malignant disease due to the dispersion of black bile throughout the whole body, corrupting both the constitution (_complexionem_) and the form of its members. Sometimes, too, it occasions a solution of continuity and the loss of members. The disease is sometimes congenital, arising from conception during the menstrual period. For the corrupt blood within the maternal body, which forms the nourishment of the fetus, leads likewise to the corruption of the latter. Sometimes the disease is the result of a corrupt diet, or of foul air, or of the breath or aspect of another leper. Avicenna tells us that eating fish and milk at the same meal will occasion the same result. Infected pork and similar articles of diet may likewise produce the disease. Cohabitation with a woman who has previously had commerce with a leper may also produce infection. Among the general symptoms of leprosy Gilbert enumerates a permanent loss of sensation proceeding from within (_insensibilitas mansive ad intrinseco veniens_) and affecting particularly the fingers and toes, more especially the first and the little finger, and extending to the forearm, the arm or the knees; coldness and formication in the affected parts; transparency (_luciditas_) of the skin, with the loss of its natural folds (_crispitudines_), and a look as if tightly stretched or polished; distortion of the joints of the hands and feet, the mouth or the nose, and a kind of tickling sensation as if some living thing were fluttering within the body, the thorax, the arms or the lips. There is felt also a sensation of motion, which is even visible also by inspection. Fetor of the breath, the perspiration and the skin are likewise noticeable. The localities affected lose their natural hair and are re-covered with very fine hairs, invisible except when held between the eye and the sun. The hair of the eyebrows and the eyelashes are lost--one of the worst of symptoms. There are present also hoarseness and an obstruction of the nostrils, without any visible cause. When the patient takes a bath the water runs off the affected localities as if they had been greased--another sign of evil omen. The angles of the eyes are rounded and shining. The skin, even when unaffected by cold, or other similar cause, is raised into very minute pimples, like the skin of a plucked goose. The blood in venesection has an oily appearance, and displays small particles like sand. Small tumors accompany the depilation of the eyebrows. Lepers are unusually and unduly devoted to sexual pleasures, and suffer unusual depression after sexual indulgence. The skin is tormented with a constant itching, and is alternately unduly hot or cold. Small grains are found under the tongue, as in leprous hogs. Gilbert divides leprosy into four varieties, _elephantia_, _leonina_, _tyria_ and _allopicia_, the pathology, symptoms and treatment of each of which are presented with wearisome minuteness and completeness. A long chapter, entitled "_De infectione post coitum leprosi_," discusses the transmission of the disease by means of sexual intercourse, and suggests the possible confusion of lepra and syphilis. The usual catalogue of specific remedies terminates the discussion. An interesting chapter on small-pox[9] and measles, "_De variolis et morbillis_," gives us the prevailing ideas relative to these diseases in England during the thirteenth century. Premising his remarks with a classification of diseases as follows: Diseases universal and infectious--like _morphoea_, _serpigo_, _lepra_, _variolae et morbilli_. Diseases universal but not infectious. Diseases infectious but not universal--like _noli me tangere_. Diseases neither infectious nor universal. Gilbert classifies _variolae et morbilli_ among the universal and infectious diseases, and in the species _apostemata_. To this latter species belong also _ignis Persicus_, _carbunculus_ and _antrax_. [Footnote 9: It is at least interesting to know that small-pox is said to have made its first appearance in England in 1241.] _Variolae et morbilli_ arise from moist matter confined in the body and turbid, like turbid blood. Hence the disease occurs most commonly in boys and in those who are careless about cleanliness and neglect venesection. It is the result of a disposition of the blood resembling putrescence, in which there occurs an external ebullition in the efforts of nature to purify the interior of the body and to expel to the surface the virulent material within. Accordingly the common people declare that persons who have suffered from _variolae et morbilli_ never acquire leprosy. Occasionally, too, the disease arises from excessive corruption of matter in repletion of blood, and hence it is more frequent in sanguineous diseases, like synocha, and during the prevalence of south winds or the shifting of winds to the south, and in infancy--the age characterized particularly by heat and moisture. The eruptions vary in color in accordance with the mixture of the different humors with the corrupt blood. Hence some are light colored, some the color of saffron, some red, some green, some livid, some black, and the virulence of the disease is the greater, the nearer the color approaches to black. There are, too, four varieties of the eruption, distinguished by special names. When the eruption is light colored and tends to suppuration, it is called _scora_. When it is very fine and red, it is called _morbilli_ or _veterana_. The distinction between _variolae_ and _morbilli_ is in the form and matter of the disease, for in _variolae_ the pustules are large and the matter bilious (_colerica_), while in morbilli the eruption is smaller and does not penetrate the skin (_non-pertransit cutem_). _Variolae_, on the contrary, forms a prominent pustule (_facit eminentiam_). A third form of the disease displays only four or five large, black pustules on the whole body, and this form is the most dangerous, since it is due to an unnatural black bile, or to acute fevers, in which the humors are consumed. This variety bears the name of _pustula_. A fourth form is called _lenticula_. This latter form occurs sometimes with fever, like synocha, sometimes without fever, and it arises from pestilential air or corrupt food, or from sitting near a patient suffering from the disease, the exhalations of which are infectious. The premonitory symptoms of _variolae_ are a high fever, redness of the eyes, pain in the throat and chest, cough, itching of the nose, sneezing and pricking sensations over the surface of the body. _Morbilli_ is a mild disease, but requires protection from cold, which confines and coagulates the peccant matter. Attention is directed to the not infrequent ulcers of the eyes, which occur in _variolae_ and may destroy the sight; also to ulcerations of the nose, throat, oesophagus, lungs and intestines, the latter of which often produce a dangerous diarrhoea. When _variolae_ occurs in boys, it is recommended to tie the hands of the patient to prevent scratching. Whey is said to be an excellent drink for developing the eruption of _variolae_, and the time-honored saffron (_crocus_) appears in several of Gilbert's prescriptions for this disease. Here, too, we find the earliest mention of the use of red colors in the treatment of _variolae_ (f. 348 c): "_Vetule provinciales dant purpuram combustam in potu, habet enim occultam naturam curandi variolas. Similiter pannus tinctus de grano._" Acid and saline articles of food should be avoided, sweets used freely, and the patients should be carefully guarded from cold. Not the least interesting pages of the Compendium are those (there are about twenty of them) devoted to the discussion of poisons, poisoned wounds and hydrophobia. An introductory chapter on the general subject of the character of poisonous matters, illustrated by some gruesome and Munchausen-like tales, borrowed mainly from Avicenna and Ruffus, on the wonders of acquired immunity to poisons, the horrors of the basilisk, the _armaria_ (_?_), the deaf adder (_aspis surda_) and the red-hot _regulus_ of Nubia, leads naturally to the consideration of some special poisons derived from the three kingdoms of nature. Very characteristically Gilbert displays his caution in the discussion of a dangerous subject by the following preface: _Abstineamus a venesis occultis quae non sunt manifesta, ne virus in angues adjiciamus, aut doctrinam perniciosam tradere videamur_ (f. 351 a). Beginning then with metallic mercury (_argentum vivum_), he considers the poisonous effects of various salts of lead and copper, the vegetable poisons hellebore, anacardium (_anacardis?_), castoreum, opium and cassilago (_semina hyoscyami_), and then proceeds to the bites or rabid men and animals, hydrophobia, and the bites of scorpions, serpents and the _animalia annulosa_, that is, worms, wasps, bees, ants and spiders. Space does not permit a careful review of this interesting subject, but a novel form of poisoning by the use of quicksilver is startling enough to claim our attention. Gilbert tells us that pouring metallic mercury into the ear produces the most distressing symptoms, severe pain, delirium, convulsions, epilepsy, apoplexy and, if the metal penetrates to the brain, ultimate death. In the treatment of this condition certain physicians had recommended the insertion into the ear of a thin lamina of lead, upon which it was believed that the mercury would fasten itself and might thus be drawn out. Avicenna objected to this that the mercury was liable to speedily pass into the ear so deeply as to be beyond the reach of the lead. Gilbert suggests as an improvement of the treatment that a thin lamina of gold be substituted for the lead, "because mercury thirsts after gold as animals do after water, as it is held in the books on alchemy" (_in libris allzinimicis_). This fact, too, he tells us can be easily demonstrated externally by placing upon a plate a portion of gold, and near, but not in contact with it, a little quicksilver, when the silver, he says, will at once "leap" upon the gold. Avicenna suggests that the patient stand upon the foot of the side affected, lean his head over to the same side, steady it in that position with the hands, and then leap suddenly over upon the other foot--demonstrating thereby his knowledge of both gravity and inertia. Manifestly our "laboratory physicians" of the present day can assume no airs of priority! The Compendium closes with two very sensible chapters on the hygiene of travel, entitled "_De regimine iter agentium_" and "_De regimine transfretantium_." In the hygiene of travel by land Gilbert commends a preliminary catharsis, frequent bathing, the avoidance of repletion of all kinds, an abundance of sleep and careful protection from the extremes of both heat and cold. The strange waters may be corrected by a dash of vinegar. Some travelers, he tells us, carry with them a package of their native soil, a few grains of which are added to the foreign waters, as a matter of precaution, before drinking. The breakfast of the traveler should be light, and a short period of rest after a day's travel should precede the hearty evening meal. Leavened bread two or three days old should be preferred. Of meats, the flesh of goats or swine, particularly the feet and neighboring parts, which, Gilbert tells us, the French call _gambones_, the flesh of domestic fowls and of the game fowls whose habitat is in dry places, is to be preferred to that of ducks and geese. Of fish, only those provided with scales should be eaten, and all forms of milk should be avoided, except whey, "which purifies the body of superfluities." Fruits are to be eschewed, except acid pomegranates, whose juice cools the stomach and relieves thirst. Boiled meats, seasoned with herbs like sage, parsley, mint, saffron, etc., are better than roasted meats, and onion and garlic are to be avoided. The primitive conditions of land travel in the days of Gilbert are emphasized by his minute directions for the care of the feet, which he directs to be rubbed briskly with salt and vinegar and then anointed with an ointment of nettle-juice (_urtica_) and mutton-fat, or with a mixture of garlic, soap and oil. If badly swollen, they should be bathed, before inunction, with a decoction of elder-bark and other emollients. In travel by sea, Gilbert tells us the four chief indications are to prevent nausea, to allay vomiting, to palliate the foul odor of the ship and to quiet thirst. For the prevention of nausea he recommends the juice of acid pomegranates, lemons, etc., or a decoction of parsley or sweet cicely (_cerfolium_). The traveler should endeavor to sit with his head erect, should avoid looking around, but maintain his head as immovable as possible, and support himself by a firm grasp upon some beam of the ship. Some sweets may be sucked, or he may chew a few aromatic seeds. If vomiting ensues, acid or sweet pomegranates, figs or barley-sugar (_penides_) may be taken sparingly, but no food should be ingested until the stomach is thoroughly quieted. Then the patient may take a little _stomatichon_ or _dyantos_, and a small portion of digestible food. As the diet must necessarily consist largely of salty food and vegetables, these should be cooked in three or four different waters, and then soaked in fresh water. A little aromatic wine will also benefit the patient, and a few aromatic seeds chewed in the morning are also of service. The effect of the foul odors of the ship may be combatted by the use of aromatic electuaries, "which comfort the heart, the brain and the stomach." The patient should be removed to some quiet portion of the ship, as distant as possible from the channels for the discharge of the bilge-water, and short walks upon the upper deck will contribute to convalescence. Frequent changes of clothing will palliate the annoyance of fleas and pediculi. Drinking water may be purified by aëration, or by straining, boiling and subsequent sedimentation and removal of the sediment by filtration through fresh and clean sand. For the wealthy, the water may be distilled in an alembic, if such an apparatus is obtainable. Avicenna says that bad water may be corrected by the addition of vinegar. Exposure to the midday sun and to the nocturnal cold, constipation and diarrhoea should be avoided, and prompt attention should be given to all disorders of the health. To these wise counsels Gilbert courteously adds a medieval _bon voyage_ in these words: "_Dominus autem omnia dirigat in tranquilitate. Amen._" It has been already remarked upon a preceding page that Gilbert of England was not a surgeon. Nevertheless it is only fair to say that the surgical chapters of the Compendium present a more scientific and complete view of surgical art, as then known, than any contemporaneous writings of the Christian West, outside of Italy. It is well known that during the Middle Ages the practice of surgery in western Europe was generally regarded as disreputable, and operative surgery was for the most part relegated to butchers, barbers, bath-keepers, executioners, itinerant herniotomists and oculists, _et id omne genus_, whose pernicious activity continued to make life precarious far down into the modern period. In Italy alone did surgery vindicate for itself an equality with medicine, and the pioneer of this advance was Roger of Parma, who, as we have seen, flourished early in the thirteenth century. Roger and his pupil Roland, with the somewhat mythical "Four Masters" (_Quatuor Magistri_), were the surgical representatives of the School of Salernum, while Hugo (Borgognoni) di Lucca and his more famous son Theodorius represented the rival school of Bologna. Equally famous Italian surgeons of this century were Bruno of Logoburgo (in Calabria) and Gulielmus of Saliceto (1275), the master of Lanfranchi (1296). Gilbert of England, as a pupil of Salernum, naturally followed the surgical teachings of that school, and we have already noticed that his chapters on surgery are taken chiefly from the writings of Roger of Parma, though the name of neither Roger, nor indeed of any other distinctly surgical writer, is mentioned in the Compendium. How closely in some cases Gilbert followed his masters may best be seen by a comparison of their respective chapters upon the same subject. I accordingly introduce here for such comparison Roger's chapter on wounds of the neck, and the corresponding chapter of Gilbert. Roger says: "_De vulnere quod fit in cervice._ "_Si vero cum ense vel alio simili in cervice vulnus fiat, ita quod vena organica incidatur, sic est subveniendum. Vena tota sumatur (suatur) cum acu, ita quod vena non perforetur, et ex alia parte acus cum filo ei inhaerente ducatur, et cum ipso filo nectatur atque stringatur, quod sanguinem non emittat: et ita facias ex superiori parte et inferiori. In vulnere autem pannus infusus mittatur, non tamen de ipso vulnus multum impleatur. Embrocha, si fuerit in myeme, superponatur quosque (quousque) vulnus faciat saniem. Si vero fuerit in aestate vitellus avi semper superponatur. Quum autem saniem fecerit, cum panno sicco, unguento fusco et caeteris bonam carnem generantibus, adhibeatur cura, ut in caeteris vulneribus. Quum vero extremitatem venae superioris partis putruisse cognoveris, fila praedicta dissolvas, et a loco illo removeas: et deinde procedas ut dictum est superius. A. Si vero nervus incidatur in longum aut ex obliquo, sed non ex toto, hac cura potest consolidari. Terrestres enim vermes, idest qui sub terra nascuntur, qui in longitudine et rotunditate lumbricis assimilantur, et apud quondam terrestres lumbrici dicuntur, accipiantur et aliquantulum conterantur et in oleo infusi ad ignem calefiant: et nullo alio mediante, ter vel quater, vel etiam pluries, si opportunum videbis, plagae impone. Si vero incidatur ex obliquo totus, minime consolidatur: praedicto tamen remedio non coadjuvante saepe conglutinatur. Potest etiam cuticula, quae supra nervum est, sui, pulvisque rubens, qui jam dictus est, superaspergi, quae cura non est inutilis, aliquos enim non solum conglutinatas, sed etiam consolidatas, nostra cura prospeximus. Si vero locus tumet, embrocham illam, quam in prima particula ad tumorem removendum, qui ex percussura contigit, praediximus, ponatur, quousque talis tumor recesserit._" Gilbert, after premising two short chapters entitled "_De vulneribus colli_" and "_De perforatione colli ex utraque parte_," continues as follows: "_De vena organica incisa._ "_Si vena organica in cervice incidatur: tota vena suatur cum acu, ita quod vena non perforetur, et ux alia parte acus cum filo ei adherente ita nectatur atque stringatur quod (non) emittat sanguinem, et ita fiat ex superiori parte et inferiore vene. In vulnere autem pannus infusus in albumine ovi mittatur, nec tamen de ipso panno vulnus multum impleatur. Embroca vero superius dicta, si in hyeme fuerit, superponatur, donec vulnus saniem emittat. Si vere in estate, vitellum ovi tum super ponatur, et cum saniem fecerit, panno sicco, et unguento fusco et ceteris regenerantibus carnem, curetur. Cum vero extremitatem vene superioris et inferioris putruisse cognoveris, fila dissolvantur et a loco removeantur, et deinde ut dictum est procedatur._ "_De incisione nervi secundum longum aut secundum obliquum._ "_Si vero secundum longum aut obliquum vervi incidantur, et non ex toto, ita consolidamus. Terrestres vermes, qui sub terra nascuntur, similes in longitudine et rotunditate lumbricis, qui etaim lumbrici terre appellantur: hi aliquantulum conterantur et in oleo infusi ad ignem calefiant, et nullo aliomediante, ter vel quater vel pluries, si opportunum fuerit, plagelle impone. Si vero ex oblique nervus incidatur, eodem remedio curatur, et natura cooperante saepe conglutinatur. Potest quoque cuticula quae supra nervum est sui, et pulvis ruber superaspergatur. Nervos enim conglutinari et consolidari hoc modo sepius videmus. Si vero locus tumeat, embroca, praedicta in vulnere capitis quae prima est ad tumorem removendum, superponatur, quousque tumor recesserit. Si vena organica non inciditur, pannus albumine ovi infusus in vulnere ponatur. Embroca vero post desuperponatur_" (f. 179 c). The selection and collection of words and phrases in these two passages leaves little doubt that one was copied from the other. Indeed, so close is their resemblance that it is quite possible from the one text to secure the emendation of the other. Numerous similar passages, with others in which the text of Gilbert is rather a paraphrase than a copy of the text of Roger, serve to confirm the conclusion that the surgical writings of the English physician are borrowed mainly from the "Chirurgia" of the Italian surgeon. Some few surgical chapters of the Compendium appear to be either original or borrowed from some other authority, but their number is not sufficient to disturb the conclusion at which we have already arrived. Now, as Roger's "Chirurgia" was probably committed to writing in the year 1230, when the surgeon was an old man, these facts lead us to the conclusion that Gilbert must have written his Compendium at least after the date mentioned. Another criticism of these chapters suggests certain interesting chronological data. It will be observed that Roger, in the passage quoted above, recommends a dressing of egg-albumen for wounds of the neck, and expresses considerable doubt whether nerves, when totally divided, can be regenerated (_consolidari_), though they may undoubtedly be reunited (_conglutinari_). Now Roland, in his edition of Roger's "Chirurgia," criticises both of these statements of his master, as follows: _Nota quod quamvis Rogerius dicat quod apponatur albumen ovi, non approbo, quia frigidum est naturaliter, et vena et nervus et arteria frigida sunt naturaliter, et propter frigiditatem utrorumque non potest perfecte fieri consolidatio._ And again: _Nota quod secundum Rogerium nervus omnino incisus non potest consolidari, vel conjungi nec sui. Nos autem dicimus quod potest consolidari et iterum ad motum reddi habillis, cum hac cautela: Cauterizetur utrumque caput nervi incisi peroptime cum ferro candenti, sed cave vulneris lobia cum ferro calido tangantur. Deinde apponantur vermes contusi et pulveres consolidativi, etc._ It will be observed that Gilbert, in spite of the rejection by Roland of the egg-albumen dressing of Roger, still recommends its use in wounds of the neck, and although he professes to have seen many nerves regenerated (_consolidari_) under the simple angle-worm treatment of his master, he still makes no mention of the painful treatment of divided nerves by the actual cautery, so highly praised by Roland. It would seem, therefore, that Gilbert was not familiar with the writings of Roland when his Compendium was written, or he would, doubtless, not have omitted so peculiar a plan of treatment in an injury of such gravity. As Roland's edition of Roger's "Chirurgia" is said to have been written in 1264, the comparison of these passages would seem to indicate that Gilbert must have written the Compendium after 1230 and prior to the year 1264. Gilbert's surgical chapters discuss the general treatment of wounds and their complications, and more specifically that of wounds of the head, neck, throat, wounds of nerves, of the oesophagus, scapula, clavicle, of the arm, the stomach, intestines and the spleen; fractures of the clavicle, arm, forearm and ribs; compound fractures; dislocations of the atlas, jaw, shoulder and elbows; fistulae in various localities, and the operations on the tonsils and uvula, on goitre, hernia and stone in the bladder, etc.--certainly a surgical compendium of no despicable comprehensiveness for a physician of his age and country. In the general treatment of wounds (f. 86 c) Gilbert tells us the surgeon must consider the time, the age of the patient, his temperament (_complexio_) and the locality, and be prepared to temper the hot with the cold and the dry with the moist. Measures for healing, cleansing and consolidation are required in all wounds, and these objects may, not infrequently, be accomplished by a single agent. The general dressing of most wounds is a piece of linen moistened with the white of egg (_pecia panni in albumine ovi infusa_), and, as a rule, the primary dressing should not be changed for two days in summer, and for three days in the winter. In moist wounds _vitreolum_ reduces the flesh; in dry wounds it repairs and consolidates. _Flos aeris_, in dry wounds, reduces but does not consolidate, but rather corrodes the tissues. Excessive suppuration is sometimes the result of too stimulating applications, sometimes of those which are too weak. In the former case the wound enlarges, assumes a concave form, is red, hot, hard and painful, and the pus is thin and watery (_subtilis_). If the application is too weak, the pus is thick and viscous, and the other signs mentioned are wanting. In either case the dressings are to be reversed. If any dyscrasia, such as excessive heat, coldness, dryness or moisture appears in the wound and delays its healing, it is to be met by its contrary. If fistula or cancer develops, this complication is to be first cured and then the primary wound. The signs of a hot dyscrasia are heat, burning and pain in the wound; of a cold dyscrasia, lividity of the wound; the moist dyscrasia occasions flabbiness (_mollicies_) and profuse suppuration, and the dry produces dryness and induration. Wounds of the head (f. 84 c) occur with or without fracture of the cranium, but always require careful examination and exact diagnosis. The wound is to be carefully explored with the finger, and, if necessary, should be enlarged for this purpose. Large, but simple, wounds of the scalp should be stitched with silk in three or four places, leaving the most dependent angle open for escape of the discharges, and in this opening should be inserted a tent (_tuellus_), to facilitate drainage. The wound is then sprinkled with the _pulvis rubeus_ and covered with a plantain or other leaf. On the ninth to the eleventh day, if the wound seems practically healed, the stitches are to be removed and the cure completed with simple dressings. The signs and symptoms of fracture of the cranium are: Loss of appetite and failure of digestion, insomnia, difficulty in micturition, constipation, a febrile dyscrasia, difficulty in cracking nuts or crusts of bread with the jaws, or severe pain when a string is attached to the teeth and pulled sharply. If the meninges are injured we have further: headache, a slow and irregular but increasing fever, alternating with chills, distortion of the angles of the eyes, redness of the cheeks, mental disturbances, dimness of vision, a weak voice and bleeding from the ears or the nose. In the presence of such symptoms the death of the patient may be expected within at most a hundred days. If the fracture of the cranium is accompanied by a large scalp wound, any fragments of bone or other foreign body are to be extracted at once, unless haemorrhage or the weakness of the patient are feared, and then a piece of linen is to be cautiously worked in with a feather between the cranium and the dura mater. In the fracture itself a piece of linen, or better of silk, is inserted, the apparent purpose of this double dressing being to protect the dura mater from the discharges and to solicit their flow to the exterior. A piece of sponge, carefully washed, dried and placed in the wound, Gilbert tells us, absorbs the discharges satisfactorily and prevents their penetration internally. Over the wound is placed a bit of linen moistened with egg-albumen, then a dressing of lint, and the whole is maintained in place by a suitable bandage. Finally the patient is to be laid in bed and maintained in such a position that the wound will be dependent, so as to favor the ready escape of the discharges. This dressing is to be renewed three times a day in summer, and twice in winter. Proud flesh upon the dura mater is to be repressed by the application of a sponge, well-washed and dried, and if it appears upon the surface of the wound after the healing of the fracture, it is to be destroyed by the use of the hermodactyl. When the external wound is healed, the cicatrix is to be dressed with the _apostolicon cyrurgicum_, an ointment very valuable for the consolidation of bones, the leveling (_adaequatio?_) of wounds, etc. When the wound of the scalp is small, so as to render difficult the determination of the extent of the fracture by exploration with the finger, it should be enlarged by crucial incisions, the flaps loosened from the cranium by a suitable scraper (_rugine_) and folded back out of the way, and any fragments of bone removed by the forceps (_pinceolis_). If, however, haemorrhage prevents the immediate removal of the fragments, this interference may be deferred for a day or two, until the bleeding has stopped or has been checked by suitable remedies. Then, after their removal, the piece of linen described above is to be inserted between the cranium and dura mater. Upon the cranium and over the flaps of the scalp, as well as in their angles, the ordinary dressing of albumen is to be applied, covered by a pledget of lint and a suitable bandage. No ointment, nor anything greasy, should be applied until after the healing of the wound, lest some of it may accidentally run down into the fracture and irritate the dura matter. Some surgeons, Gilbert tells us, insert in the place of the fragments of the cranium removed a piece of a cup (_ciphi_) or bowl (_mazer_), or a plate of gold, but this plan, he says, has been generally abandoned (_dimittitur_.) Sometimes the cranium is simply cracked without any depression of the bone, and such fractures are not easily detected. Gilbert tells us, however, that if the patient will close firmly his mouth and nose and blow hard, the escape of air through the fissured bone will reveal the presence of the fracture (f. 88a). In the treatment of such fissures he directs that the scalp wound be enlarged, the cranium perforated very cautiously with a trepan (_trepano_) at each extremity of the fissure and the two openings then connected by a chisel (_spata_?), in order to enable the surgeon to remove the discharges by a delicate bit of silk or linen introduced with a feather. If a portion of the cranium is depressed so that it cannot be easily raised into position, suitable openings are to be made through the depressed bone in order to facilitate the free escape of the discharges. Gunshot wounds were, of course, unknown in Gilbert's day. In a chapter entitled "_De craneo perforato_" he gives us, however, the treatment of wounds of the head produced by the transfixion of that member by an arrow. If the arrow passes entirely through the head, and the results are not immediately fatal, he directs the surgeon to enlarge the wound of exit with a trephine, remove the arrowhead through this opening, and withdraw the shaft of the arrow through the wound of entrance. The wounds of the cranium are then to be treated like ordinary fractures of that organ (f. 88c). In wounds of the neck involving the jugular vein (_vena organica_), Gilbert directs ligation of both extremities of the wounded vessel, after which the wound is to be dressed (but not packed) with the ordinary dressing of egg-albumen. Wounds of nerves are treated with a novel dressing of earthworms lightly beaten in a mortar and mixed with warm oil, and he professes to have seen nerves not only healed (_conglutinari_), but even the divided nerve fibres regenerated (_consolidari_) under this treatment. In puncture of a nerve Gilbert surprises us (f. 179d) by the advice to divide completely the wounded nerve, in order to relieve pain and prevent tetanus (_spasmus_). Goitre, not too vascular in character, is removed by a longitudinal incision over the tumor, after which the gland is to be dragged out, with its entire capsule, by means of a blunt hook. A large goitre in a feeble patient, however, is better left alone, as it is difficult to remove all the intricate roots of the tumor, and if any portion is left it is prone to return. In such cases Gilbert says we shrink from the application of the actual cautery, for fear of injury to the surrounding vessels and nerves. Whatever method of operation is selected, the patient is to be tied to a table and firmly held in position. Wounds of the trachea and oesophagus, according to Gilbert, are invariably mortal. In wounds of the thorax the ordinary dressing of albumen is to be applied, but if blood or pus enters the cavity of the thorax, the patient is directed to bend his body over a dish, twisting himself from one side to another (_supra discum[10] flectat se modo hac modo ilac vergendo_) until he expels the sanies through the wound, and to always lie with the wound dependent until it is completely healed (f. 182d). [Footnote 10: It is interesting to observe how the Latin discus developed dichotomously into the English "dish" and the German "Tisch." The former is doubtless the meaning of the word in this place.] In case an arrow is lodged within the cavity of the thorax, the surgeon is directed to trepan the sternum (_os pectoris_), remove the head of the arrow gently from the shaft, and withdraw the shaft itself through the original wound of entrance. If the head is lodged beneath or between the ribs, an opening is to be made into the nearest intercostal space, the ribs forced apart by a suitable wedge and the head thus extracted. The wound through the soft parts is to be kept open by a tent greased with lard and provided with a suitable prolongation (_cauda aliqua_) to facilitate its extraction and prevent its falling into the cavity of the chest. Wounds of the heart, lungs, liver, stomach and diaphragm are regarded as hopelessly mortal (f. 233d), and the physician is advised to have nothing to do with them. Wounds of the heart are recognized by the profuse haemorrhage and the black color of the blood; those of the lung by the foamy character of the blood and the dyspnoea; wounds of the diaphragm occasion similar dyspnoea and are speedily fatal; those of the liver are known by the disturbance of the hepatic functions, and wounds of the stomach by the escape of its contents. Wounds of the intestine are either incurable, or at least are cured only with the utmost difficulty. Longitudinal wounds of the spine which do not penetrate the cord may be repaired, but transverse wounds involving the cord, so that the latter escapes from the wound, are rarely, if ever, cured by surgery. Wounds of the kidneys are also beyond the art of the surgeon. Wounds of the penis are curable, and if the wound is transverse and divides the nerve, they are likewise painless. _Si vene titillares in coxis abscidantur homo moritur ridendo._ A passage which I can refer only to the erudition and risibility of our modern surgeons and anatomists. The ticklish _vene titillares_ are to me entirely unknown. Modern abdominal surgeons will probably be interested in reading Gilbert's chapter on the treatment of wounds of the intestines in the thirteenth century. He says (f. 234c): If some portion of the intestine has escaped from a wound of the abdomen and is cut either longitudinally or transversely, while the major portion remains uninjured; if the wound has existed for some time and the exposed intestine is cold, some living animal, like a puppy (_catulus_), is to be killed, split longitudinally and placed over the intestine, until the latter is warmed, vivified by the natural heat and softened. Then a small tube of alder is prepared, an inch longer than the wound of the intestine, carefully thinned down (_subtilietur_) and introduced into the gut through the wound and stitched in position with a very fine square-pointed needle, threaded with silk. This tube or canula should be so placed as to readily transmit the contents of the intestine, and yet form no impediment to the stitches of the wound. When this has been done, a sponge moistened in warm water and well washed should be employed to gently cleanse the intestines from all foreign matters, and the gut, thus cleansed, is to be returned to the abdominal cavity through the wound of the abdominal wall. The patient is then to be laid upon a table and gently shaken, in order that the intestines may resume their normal position in the abdomen. If necessary the primary wound should be enlarged for this purpose. When the intestines have been thus replaced, the wound in the abdominal wall is to be kept open until the wound of the intestine seems healed. Over the intestinal suture a little _pulvis ruber_ should be sprinkled every day, and when the wound of the intestine is entirely healed (_consolidatur_), the wound of the abdominal wall is to be sewed up and treated in the manner of ordinary flesh wounds. If, however, the wound is large, a pledget (_pecia_) of lint, long enough to extend from one end to the other and project a little, is placed in the wound, and over this the exterior portion of the wound is to be carefully sewed, and sprinkled daily with the _pulvis ruber_. Every day the pledget which remains in the wound is to be drawn towards the most dependent part, so that the dressing in the wound may be daily renewed. When the intestinal wound is found to be healed, the entire pledget is to be removed and the unhealed openings dressed as in other simple wounds. The diet of the patient should be also of the most digestible sort. Thus far Gilbert has followed Roger almost literally. But he now adds, apparently upon his own responsibility, the following paragraph: _Quod si placuerit, extrahe canellum: factis punctis in sutura ubi debent fieri antequan stringantur, inter duo puncta canellus extrahatur, et post puncta stringantur. Hoc dico si vulnus intestini sic (sit) ex transverso._ Apparently Gilbert feels some compunctions of conscience relative to the ultimate disposition of the canula of alder-wood, and permits, if he does not advise, its removal from the intestine before the tightening of the last stitches. Roland adds nothing to the text of Roger. But The Four Masters (_Quatuor Magistri_, about A.D. 1270) suggest that the canula be made of the trachea of some animal, and add: _Canellus autem per processum temporis putrefit et emittur per egestionem, et iterum per concavitatem canelli transibit egestio._ In his further discussion of wounds of the intestine and their treatment Gilbert also volunteers the information that: "Mummy (shade of Lord Lister!) is very valuable in the healing of wounds of the intestine, if applied with some astringent powder upon the suture." In amends for the mummy, however, we are also introduced to the practice of mediaeval anaesthesia by means of what Gilbert calls the _Confectio soporifera_ (f. 234d), composed as follows: _R._ _Opii, Succi Jusquiami (hyoscyami), Succi papaveris nigri, vel ejus seminis, Sacci mandragorae, vel ejus corticis, vel pomorunt ipsius si succo carueris, Foliorum hederae arborae (ivy), Succi mororum rubi maturorum, Seminis lactucae, Succi cuseutae (dodder)_, aa. ounce I. Mix together in a brazen vessel and place this in the sun during the dog-days. Put in a sponge to absorb the mixture, and then place the sponge in the sun until all the moisture has evaporated. When an operation is necessary, let the patient hold the sponge over his nose and mouth until he goes to sleep, when the operation may be begun. To awaken the patient after the operation, fill another sponge with vinegar and rub the teeth and nostrils with the sponge, and put some vinegar in the nostrils. An anaesthetic drink may also be prepared as follows: _R._ _Seminis papaveris albi et nigri, Seminis lactucae, aa. ounce I. Opii, Misconis ( , poppy juice?)_, aa. scruples I-II, as required. The patient is to be aroused as before. On folio 180d we find a chapter entitled "_De cathena gulae incisa vel fracta_," and copied almost literally from the chapter "_De catena gulae_" of Roger. In neither writer do I find any precise definition of what the _cathena gulae_ is, though Roger says, _Si es gulae, quod est catena, fractum fuerit_, etc., nor do I find the terms used explained in any dictionary at present available. The description of the treatment of this fracture seems, however, to indicate that the _catena gulae_ of Roger and Gilbert is what we call the clavicle, though the more common Latin names of this bone are _claviculus_, _furcula_, _juglum_ or _os juguli_. Gilbert says: "But if the bone which is the _cathena gulae_ is broken or in any way displaced (_recesserit_), let the physician with one hand raise the forearm (_brachium_) or arm (_humerum_) of the patient, and with the other hand press down upon the projecting portion of the bone. Then apply a pledget moistened with albumen, a pad and a splint in form of a cross, and over all a long bandage embracing both the arm and the neck and suspending the arm. A pad (_cervical_) should also be placed in the axilla to prevent the dropping of the arm, and should not be removed until the fracture is repaired. If the fracture is compound, the wound of the soft parts is to be left open and uncovered by the bandage, so that a tent (_stuellus_) may be inserted, and the wound is then to be dressed in the ordinary manner." Simple fracture of the humerus, Gilbert tells us, is to be reduced (_ad proprium locum reducator_) at once by grasping the arm above and below the seat of fracture and exercising gentle and gradual extension and compression. Then four pieces of lint wet in egg-albumen are to be placed around the arm on all sides, a bandage, four fingers wide, also moistened in albumen is to be snugly applied, another dry bandage placed above this, and finally splints fastened in position by cords. This dressing is to remain undisturbed for three days, and then renewed every third day for nine days. After the ninth day a _strictura_ (cast, apparatus immobile?) is to be prepared and firmly applied with splints and a bandage, and the patient is to be cautioned not to bear any weight upon the injured arm (_ne infirmus se super illud appodiet_?). The fracture is then left until it is believed that consolidation has occurred. If, however, it is found that swelling is occasioned by the cast (_ex strictorio_?), the latter should be removed, and the arm well bathed in warm water containing mallowae and other emollients and thoroughly cleansed. If the bone seems to be well consolidated, it should be rubbed with an ointment of _dialthea_ or the _unguentum marciation_, after which the splints and bandage are to be reapplied. If, however, it is found that the bone is not well consolidated, the cast should be replaced in the original manner, until consolidation is accomplished. If erysipelas results from the dressings, it is to be treated in the ordinary manner. During the entire treatment potions of nasturtium seeds, _pes columbini_ (crowfoot) and other "consolidatives" are to be administered diligently. If the fracture is compound, any loose fragments of bone are to be removed, the fracture reduced as before, and similar dressings applied, perforated, however, over the wound in the soft parts. In fracture of the ribs (_flexura costi_) Gilbert recommends a somewhat novel plan for the replacement of the displaced bone. Having put the patient in a bath, the physician rubs his hands well with honey, turpentine, pitch or bird-lime (_visco_), applies his sticky palms over the displaced ribs, and gradually raises them to their normal position. He also says (f. 183a), the application of a dry cup (_cuffa vero cum igne_?) over the displaced rib is a convenient method for raising it into position. Of fractures of the forearm Gilbert simply says that they are to be recognized by the touch and a comparison of the injured with the sound arm. They should be diligently fomented, extension made if necessary, and then treated like other fractures. Dislocation of the atlo-axoid articulation (_os juguli_) he tells us threatens speedy death. The mouth of the patient is to be kept open by a wooden gag, a bandage passed beneath the jaw and held by the physician, who places his feet upon the shoulders of the patient and pressing down upon them while he elevates the head by the bandage, endeavors to restore the displaced bone to its normal position. Inunctions of various mollitives are then useful. Dislocations of the lower jaw are recognized by the failure of the teeth to fit their fellows of the upper jaw, and by the detection of the condyles of the jaw beneath the ears. The bone is to be grasped by the rami and dragged down until the teeth resume and retain their natural position, and the jaw is then to be kept in place by a suitable bandage. In dislocation of the humerus the patient is to be bound in the supine position, a wedge-shaped stone wrapped with yarn placed in the axilla, and the surgeon, pressing against the padded stone with his foot and raising the humerus with his hands, reduces the head of the bone to its natural position. If this method fails, a long crutch-like stick is prepared to receive at one end the axillary pad, the patient is placed standing upon a box or bench, the pad and crutch adjusted in the axilla, and while the surgeon stands ready to guide the dislocated bone to its place, his assistants remove the bench, leaving the patient suspended by his shoulder upon the rude crutch. In boys, Gilbert tells us, no special apparatus is required. The surgeon merely places his doubled fist in the axilla, with the other hand grasps the humerus and lifts the boy off the ground, and the head of the bone slips readily back into place. After we are assured that the reduction is complete, a strictorium is prepared, consisting of the _pulvis ruber_, egg-albumen and a little wheat flour, with which the shoulder is to be rubbed. Finally, when all seems to be going on well, warm _spata drapum_ (sparadrap) is to be applied upon a bandage, and if necessary the apostolicon ointment. Dislocation of the elbow is reduced by passing a bandage around the bend of the arm, forming in this a loop (_scapham_) into which the foot of the surgeon is to be placed for counter-extension, while with the hands extension is to be made upon the forearm until the bones are drawn into their normal position. Flexion and extension of the joint are then to be practised three or four times (to assure complete reduction?), and the forearm flexed and supported by a bandage from the neck. After a few days, Gilbert tells us, the patient will himself often try to flex and extend the arm, and the bandage should be so applied as not to interfere with these movements. Dislocation of the wrist is reduced by gentle extension from the hand and counter-extension from the forearm, and dislocation of the fingers by a similar manipulation. After so full a consideration of the surgical injuries of the head, trunk and upper extremities, we are somewhat surprised to find Gilbert's discussion of the similar injuries of the lower extremities condensed into a single very moderate chapter entitled "De vulneribus cruris et tybie" (f. 358a b). In this, Gilbert, emphasizing the importance of wounds of the patella and knee-joint and the necessity for their careful treatment, also declares that wounds of both the leg and thigh within three inches of the joints, or in the fleshy portion of the thigh _ubi organum est_ (?), involve considerable danger. He then speaks of a blackish, hard and very painful tumor of the thigh, which, when it ascends the thigh (_ad superiora ascendit_) is mortal, but if it descends is less dangerous. Separation of the sacrum (_vertebrum_) from the ilium (_scia_), either by accident or from the corrosion of humors, leaves the patient permanently lame, though suitable fomentations and inunctions may produce some improvement. Sprains of the ankle are to be treated by placing the joint immediately in very cold water _ad repercussionem spiritus et sanguinis_, and the joint is to be kept thus refrigerated until it even becomes numb (_stupefactionem_); after which stupes of salt water and urine are to be applied, followed by a plaster of galbanum, opoponax, the apostolicon, etc. Fractures of the femur are to be treated like those of the humerus, except that the ends of the fractured bone are to be separated by the space of an inch, and a bandage six fingers in width carefully applied. Such fractures within three inches of the hip or knee-joint are regarded as specially dangerous. Dislocations of the ankle, after reduction of proper manipulation, should be bound with suitable splints. If of a less severe character, the dislocation may be dressed with stupes of canabina (Indian hemp), urine and salt water, which greatly mitigate the pain and swelling. Afterwards the joint should be strapped for four or five inches above the ankle with plaster, _ut prohibeatur fluxus_. It should be said that the brevity of this chapter of Gilbert is modeled after the manner of Roger of Parma, who refers the treatment of injuries of the lower extremities very largely to that of similar injuries of the upper, merely adding thereto such explanations as may be demanded by the differences of location and function of the members involved. Thus in his discussion of dislocation of the femur Roger says: _Si crus a coxa sit disjunctum, eadem sit cura quam et in disjuncturam brachii et cubiti diximus, etc._ The general subject of fistulae is treated at considerable length on folio 205b, and fistula lachrymalis and fistulae of the jaw receive special attention in their appropriate places. As a rule, the fistula is dilated by a tent of alder-pith, mandragora, briony or gentian, the lining membrane destroyed by an ointment of quick-lime or even the actual cautery, and the wound then dressed with egg-albumen followed by the _unguentum viride_. Necrosed bone is to be removed, if necessary, by deep incisions, and decayed teeth are to be extracted. The elongated uvula is to be snipped off, and abscesses of the tonsils opened _tout comme chez nous_. An elaborate discussion of the subject of hernia is given under the title "_De relaxatione siphac et ruptura_" (f. 280c)--siphac being the Arabian name for the peritoneum. Gilbert tells us the siphac is sometimes relaxed, sometimes ruptured (_crepatur_?) and sometimes inflated. He had seen a large rupture (_crepatura_) in which it was impossible to restore the intestines to the cavity of the abdomen in consequence of the presence in them of large hard masses of fecal matter, which no treatment proved adequate to remove, and which finally occasioned the death of the patient. Rupture of the siphac is most frequently the result of accident, jumping, straining in lifting or carrying heavy weights, or in efforts at defecation, or of shouting in boys or persons of advanced age, or even in excessive weeping, etc. It is distinguished from hernia by the fact that in hernia pain is felt in the testicle, radiating to the kidneys, while in rupture of the siphac a swelling on one side of the pubes extends into the scrotum, where it produces a tumor not involving the testicle. Rupture of the siphac, he says, is a lesion of the organs of nutrition, hernia a disease of the organs of generation. Accordingly, in the pathology of Gilbert, the term hernia is applied to hydrocele, orchitis and other diseases of the testicle, and not, as with us to protrusions of the viscera through the walls of their cavities. In young persons, he tells us, recent ruptures of the siphac may be cured by appropriate treatment. The patient is to be laid upon his back, the hips raised, the intestines restored to the abdominal cavity and the opening of exit dressed with a plaster of exsiccative and consolidating remedies, of which he furnishes a long and diversified catalogue. He is also to avoid religiously all exercise or motion, all anger, clamor, coughing, sneezing, equitation, cohabitation, etc., and to lie with his feet elevated for forty days, until the rupture (_crepatura_) is consolidated. The bowels are to be kept soluble by enemata or appropriate medicines, and the diet should be selected so as to avoid constipation and flatulence. A bandage or truss (_bracale vel colligar_) made of silk and well fitted to the patient is also highly recommended. If the patient is a boy, cakes (_crispelle_?) of _consolida major_ mixed with the yolk of eggs should be administered, one each day for nine days before the wane of the moon. If, however, the rupture is large in either a boy or an adult, and of long standing, whether the intestine descends into the scrotum or not, operation, either by incision or by the cautery offers the only hope of relief. Singularly enough too, while Roger devotes to the operation for the cure of hernia nearly half a page of his text, Gilbert dismisses the whole subject in a single sentence, as follows: _Scindatur igitur totus exitus super hac cute exteriori cum carne fissa, et uatur y fac cum file serice et acu quadrata. Deinde persequere ut in exitu intestini per vulnus superius demonstratum est_ (f. 281d). Turning now to the title "_De hernia_" (f. 289b), Gilbert tells us "Swelling (_inflatio_) of the testicles is due sometimes to humors trickling down upon them (_rheumatizantibus_), sometimes to abscess, or to gaseous collections (_ventositate_), and sometimes to escape of the intestines through rupture of the siphac." He adds also: "Some doubt the propriety of using the term hernia for an inflation. On this point magister Rn says: There is a certain chronic and inveterate tumor of the testicles, which is never cured except by means of surgery, as e.g., hernia. For hernia is an affection common to the scrotum and the testicles." The apparent confusion between these two passages is easily relieved by the explanation that inguinal or other herniae not extending into the scrotum are called by Gilbert ruptures of the siphac, but scrotal hernia is classed with other troubles located in the scrotum as hernia. Accordingly hernia, with Gilbert, includes not only scrotal hernia, but also hydrocele, orchitis, tumors of the testicles, etc. This is apparent, too, in his treatment of hernia, which consists usually in the employment of various poultices and ointments, bleeding from the saphena, cups over the kidneys, etc., though hydrocele is tapped and a seton inserted. If the testicle itself is "putrid," it should be removed; otherwise it is left. It may be remarked _en passant_ that the surgeons of medieval times, in their desire for thoroughness, often displayed very little respect to what Baas calls "the root of humanity." We will terminate our hasty review of diseases discussed in the Compendium by an abstract of Gilbert's views on vesical calculus and its treatment, which cover more than fifteen pages of his work. Stone and gravel arise from various viscous superfluities in the kidneys and bladder, which occasion difficulty in micturition. Stone is produced by the action of heat upon viscous moisture, sublimating the volatile elements and condensing the denser portions. Putrefication of stone in the bladder is the result of three causes, viz., consuming heat, viscous matter and stricture of the meatus. For consuming heat acting on viscous material retained by reason of stricture of the meatus, by long action dries up, coagulates and hardens the moisture. This is particularly manifest in boys who have a constricted meatus. Stones are thus generated not only in the kidneys and bladder, but also even in the stomach and the intestines, whence they are ejected by vomiting or in the stools. Indeed they may also be found occasionally in the lungs, the joints and other places. They are comparatively rare in women, in consequence of the shortness of the urethra and the size of their meatus. Sometimes calculi occur in the bladder, sometimes in one kidney and occasionally in both kidneys. The symptoms produced by their presence vary in accordance with the situation of the concretion. If the stone is in the kidney, the foot of the side affected is numb (_stupidus_), the spine on the affected side is sore and there is difficulty of micturition and considerable gravelly sediment in the urine. If the stone is increasing in size, the quantity of sediment also increases, but if the stone is fully formed and confirmed, the amount of sediment decreases daily, and the urine becomes milky both in the kidneys and the bladder. A stone in the bladder occasions very similar symptoms, together with pain in the peritoneum and pubes, dysuria and strangury, and sometimes the appearance of blood and flocculi (_trumbos_?) in the urine. Patients suffering from vesical calculus are always constipated, and the dysuria may increase to the degree called furia, a condition not without some danger. Three things are necessary in the cure of stone, viz., a spare and simple diet, the use of diuretics and a moderate amount of exercise. It should, however, be remarked that confirmed stone is rarely or never cured, except by a surgical operation.... If a boy has a clear and watery urine after it has been sandy, if he frequently scratches his foot, has involuntary erections and finally obstruction in micturition, I say that he has a stone in the neck of his bladder. If now he be laid upon his back with his feet well elevated, and his whole body be well shaken, if there is a stone present it is possible that it may fall to the fundus of the bladder. Afterwards direct the boy to bear down (_ut exprimat se_) and try to make water. If this treatment turns out in accordance with your theory, the urine necessarily escapes and your idea and treatment are confirmed. If, however, the urine not escape, let the boy be shaken vigorously a second time. If this too fails and strangury ensues, it will be necessary to resort to the use of a sound or catheter (_argaliam_), so that when the stone is pushed away from the neck of the bladder the passage may be opened and the urine may flow out. It may be possible too that no stone exists, but the urethra is obstructed or closed by pure coagulated blood. Perhaps there may have been a wound of the bladder, although no external haemorrhage has appeared, but the blood coagulating gradually in the bladder has occasioned an obstruction or narrowing of the urinary passage. Or possibly the blood from a renal haemorrhage has descended into the bladder and obstructs the urethra. Hence I say that the sound is useful in these cases where the urethra is obstructed by blood or gross humors. Examination should also be made as to whether a fleshy body exists in the bladder, as the result of some wound. This condition is manifest if, on the introduction of the sound, the urine flows out promptly. I once saw a man suffering from this condition, who complained of severe pain in the urinary passage as I was introducing the sound, and I recognized that there were wounds in the same part, for as soon as these were touched by the sound the urine began to flow, followed soon after by a little blood and fleshy particles.... So far as the operation of physicians is concerned, it is necessary only to be certain of the fact that obstruction to the passage of urine depends upon no other cause than stone or the presence of coagulated blood (f. 271). Gilbert's medical treatment of vesical calculus consists generally in the administration of diuretics and lithontriptics and the local application of poultices, plasters and inunctions of various kinds. Of the lithontriptics, certain combinations, characterized by famous names or notable historical origin, are evident favorites. Among this class we read of the _Philoantropos major_ and _minor_, the _Justinum_, the _Usina_ "approved by many wise men of Babylon and Constantinople," the _Lithontripon_ and the "_Pulvis Eugenii pape_," with numerous others. Rather curiously and suggestively no mention is made in this immediate connection of the technique of lithotomy. On a later page, however (f. 309a), we find a chapter entitled "_De cura lapidis per cyrurgiam_," in which Gilbert writes: "Mark here a chapter on the cure of stone in the bladder by means of surgery, which we have omitted above. Accordingly, to determine whether a stone exists in the bladder, let the patient take a warm bath. Then let him be placed with his buttocks elevated, and, having inserted into the anus two fingers of the right hand, press the fist of the left hand deeply above the pubes and lift and draw the entire bladder upward. If you find anything hard and heavy, it is manifest that there is a stone in the bladder. If the body feels soft and fleshy, it is a fleshy excrescence (_carnositas_), which impedes the flow of urine. Now, if the stone is located in the neck of the bladder and you wish to force it to the fundus: after the use of fomentations and inunctions, inject through a syringe (_siringa_) some petroleum, and after a short interval pass the syringe again up to the neck of the bladder and cautiously and gently push the stone away from the neck to the fundus. Or, which is safer and better, having used the preceding fomentations and inunctions, and having assured yourself that there is a stone in the bladder, introduce your fingers into the anus and compress the neck of the bladder with the fist of the left hand above the pubes, and cautiously remove the stone and guide it to the fundus. But if you wish to extract the stone, let a spare diet precede the operation, and let the patient lie abed for a couple of days with very little food. On the third day introduce the fingers into the anus as before, and draw down the stone into the neck of the bladder. Then make your incision lengthwise in the fontanel, the width of two fingers above the anus, and extract the stone. For nine days after the operation let the patient use, morning and evening, fomentations of _branca_ (_acanthus mollis_), _paritaria_ (pellitery) and _malva_ (mallows). A bit of tow (_stupa_) moistened with the yolk of egg in winter, and with both the yolk and white of egg in summer, is to be placed over the wound. Proud flesh, which often springs up near a wound in the neck of the bladder, should be removed by the knife (_rasorio_), and two or three sutures inserted. The wound is then to be treated like other wounds. It should be remarked, however, that if the stone is very large, it should be simply pushed up to the fundus of the bladder and left there, and no effort should be made to extract it." This description of the diagnosis of stone and of the operation of lithotomy is copied almost literally from Roger of Parma. Sufficient (perhaps more than enough) has been written to give the reader a fair idea of the general character of Gilbert's "Compendium Medicine." A few words may be added with reference to the proper place of the work in our medical literature. It is not difficult, of course, to select from the Compendium a charm or two, a few impossible etymologies and a few silly statements, to display these with a witty emphasis and to draw therefrom the easy conclusion that the book is a mass of crass superstition and absurd nonsense. This, however, is not criticism. It is mere caricature. To compare the work with the teachings of modern medicine is not only to expect of the writer a miraculous prescience, but to minimize the advances of medical science within the last seven hundred years. Even Freind and Sprengel, admirable historians, though more thoughtful and judicious in their criticisms, seem for the moment to have forgotten or overlooked the true character of the Compendium. Freind says: "I believe we may even say with justice that he (Gilbert) has written as well as any of his contemporaries of other nations, and has merely followed their example in borrowing very largely from the Arabians," and Sprengel writes: "Here and there, though only very rarely, the author offers some remarks of his own, which merit special attention." Now, what precisely is Gilbert's Compendium designed to be? In the words of its author it is "A book of general and special diseases, selected and extracted from the writings of all authors and the practice of the professors (_magistrorum_), edited by Gilbert of England and entitled a Compendium of Medicine." and a few pages later he adds: "It is our habit to select the best sayings of the best authorities, and where any doubt exists, to insert the different opinions, so that each reader may choose for himself what he prefers to maintain." The author does not claim for his work any considerable originality, but presents it as a compendium proper of the teachings of other writers. Naturally his own part in the book is not obtruded upon our notice. Now the desiderata of such a compendium are: 1. That it shall be based upon the best attainable authorities. 2. That these authorities shall be accurately represented. 3. That the compendium shall be reasonably comprehensive. In neither of these respects is the compendium of Gilbert liable, I think, to adverse criticism. The book is, undoubtedly, the work of a famous and strictly orthodox physician, possessed of exceptional education in the science of his day, a man of wide reading, broadened by extensive travel and endowed with the knowledge acquired by a long experience, honest, truthful and simple minded, yet not uncritical in regard to novelties, firm in his own opinions but not arrogant, sympathetic, possessed of a high sense of professional honor, a firm believer in authority and therefore credulous, superstitious after the manner of his age, yet harboring, too, a germ of that healthy skepticism which Roger Bacon, his great contemporary, developed and illustrated. I believe, therefore, that we may justly award to the medical pages of the Compendium not only the rather negative praise of being written as well as the work of any of Gilbert's contemporaries, but the more positive credit of being thoroughly abreast of the medical science of its age and country, an "Abstract and brief chronicle of the time." The surgical chapters of the work are unique in a compendium of medicine, and merit even more favorable criticism. The discouragement of the practice of medicine and surgery on the part of ecclesiastics by the popes and church councils of the twelfth century, culminating in the decree of Pope Innocent III in 1215, which forbade the participation of the higher clergy in any operation involving the shedding of blood (_Ecclesia abhorret a sanguine_); the relatively scanty supply of educated lay physicians and surgeons, and finally the pride and inertia of the lay physicians themselves; all these combined to relegate surgery in the thirteenth century to the hands of a class of ignorant and unconscionable empirics, whose rash activity shed a baleful light upon the art of surgery itself. As a natural result the practice of this art drifted into an _impasse_, from which the organization of the barber-surgeons seemed the only logical means of escape. The earliest evidence of the public surgical activity of the barbers, as a class, is found, I believe, in Joinville's Chronicle of the Crusade of St. Louis (Louis IX) in the year 1250. According to Malgaigne, no trustworthy evidence of any organization of the barbers of Paris is available before 1301, and the fraternity was not chartered until 1427, under Charles VII. The barbers of London are noticed in 1308, and they received their charter from Edward IV in 1462. The parallel lines upon which the confraternities of the two cities developed is very noticeable--making due allowance for Gallic enthusiasm and bitterness. Lanfranchi, the great surgeon of Paris, about the year 1300 is moved to write as follows: "Why, in God's name, in our days is there such a great difference between the physician and the surgeon? The physicians have abandoned operative procedures to the laity, either, as some say, because they disdain to operate with their hands, or rather, as I think, because they do not know how to perform operations. Indeed, this abuse is so inveterate that the common people look upon it as impossible for the same person to understand both surgery and medicine. It ought, however, to be understood that no one can be a good physician who has no idea of surgical operations, and that a surgeon is nothing if ignorant of medicine. In a word, one must be familiar with both departments of medicine." Now Gilbert by the incorporation of many chapters on surgery in his Compendium inculcates practically the same idea more than fifty years before Lanfranchi, and may claim to be the earliest representative of surgical teaching in England. Malgaigne, indeed, does not include his name in the admirable sketch of medieval surgery with which he introduces his edition of the works of Ambroise Pare, and says Gilbert was no more a surgeon than Bernard Gordon. This is in a certain sense true. Gilbert was certainly not an operative surgeon. But it needs only a very superficial comparison of the Compendium of Gilbert with the Lilium Medicinae of Gordon to establish the fact that the books are entirely unlike. Indeed, it may be truthfully said that Gordon's work does not contain a single chapter on surgery proper. His cases involving surgical assistance are turned over at once, and with little or no discussion, to those whom he calls "restauratores" or "chirurgi," and his own responsibility thereupon ends. We have no historical facts which demonstrate that Gilbert's Compendium exercised any considerable influence upon the development of surgery in England, but when we consider the depressed condition of both medicine and surgery in his day, we should certainly emphasize the clearness of vision which led our author to indicate the natural association of these two departments of the healing art, and the assistance which each lends to the other. 
28390	----	MEDICINE IN VIRGINIA, 1607-1699 By THOMAS P. HUGHES Assistant Professor of History, Washington and Lee University VIRGINIA 350TH ANNIVERSARY CELEBRATION CORPORATION WILLIAMSBURG, VIRGINIA 1957 COPYRIGHT©, 1957 BY VIRGINIA 350TH ANNIVERSARY CELEBRATION CORPORATION, WILLIAMSBURG, VIRGINIA Second Printing, 1958 Third Printing, 1963 Jamestown 350th Anniversary Historical Booklet, Number 21 [Transcriber's Notes: Research indicates the copyright on this book was not renewed. The Table of Contents was not printed in the original text but has been added here for the convenience of the reader.] CONTENTS CHAPTER ONE European Background and Indian Counterpart to Virginia Medicine 1 CHAPTER TWO Disease and The Critical Years At Jamestown 12 CHAPTER THREE Prevalent Ills and Common Treatments 31 CHAPTER FOUR Education, Women, Churchmen, and The Law 60 CHAPTER FIVE Conclusion 73 Acknowledgements and Bibliographical Note 77 CHAPTER ONE European Background and Indian Counterpart to Virginia Medicine EUROPEAN BACKGROUND The origins of medical theory and practice in this nation extend further than the settlement at Jamestown in 1607. Jamestown was a seed carried from the Old World and planted in the New; medicine was one of the European characteristics transmitted with the seed across the Atlantic. In the process of transmission changes took place, and in the New World medicine adapted itself to some circumstances unknown to Europe; but the contact with European developments in theory and practice was never--and is not--broken. Because of this relationship between European and American medicine, an acquaintance with seventeenth-century European medicine makes it possible to give additional support to some of the information in the early sources about medicine in colonial Virginia. In addition, knowledge of the European background allows reasonable speculation as to what happened in Virginia when the early sources are silent. In discussing the background for American medicine it is not necessary to make a firm distinction between England and the rest of Europe. As today, science--in this case, medical science--frequently ignored national boundaries. The same theories relative to the structure of the body (anatomy), to the functions of the organs and parts of the body (physiology), and to other branches of medical science were common to England and Europe. Medical practice, like theory, varied but in detail from nation to nation in Western Europe. Seventeenth-century Europe relied heavily upon ancient authority in the realm of medical theory. The European and colonial Virginia physician, surgeon, and even barber (when functioning as a medical man) consciously or unconsciously drew upon, or practiced according to, theories originated or developed by Hippocrates (460-377 B.C.) and Galen (131-201 A.D.). Hippocrates is remembered not only for his emphasis upon ethical practices but also for his inquiring and scientific spirit, and Galen as the founder of experimental physiology and as the formulator of ingenious medical theories. Most often Hippocrates was studied in Galen's commentaries. No longer do scholars or physicians scoff at the ancient authorities who dominated medical thinking for so many centuries. The seventeenth-century physician striving to reduce the frightful inroads that disease made into the colony at Jamestown may have been handicapped by the erroneous doctrines of the gossamer-fine _a priori_ speculation of Galen, but the physicians to a large extent practiced according to a science rather than to superstition and magic--because the voluminous writings of Galen survived the centuries. Nor would the European physician, or his Virginia counterpart, have demonstrated the same appreciation for close observation if Hippocrates had not still been an influence. In the realm of pathology (the nature, causes, and manifestations of disease) the humoral theory, with its many variations, was extremely popular. The humoral doctrines stemming largely from Hippocrates were made elaborate by Galen but were founded upon ideas even more ancient than either thinker and practitioner. As understood by the seventeenth-century man of medicine, the basic ideas of the humoral theory were the four elements, the four qualities, and the four humors. The elements were fire, air, earth, and water; the four qualities were hot, cold, moist, and dry; and the four humors were phlegm, black bile, yellow bile, and blood. From these ideological building stones a highly complex system of pathology developed; from it an involved system of treatment originated. In essence the practitioner of the humoral school attempted to restore the naturally harmonious balance of elements, qualities, and humors that had broken down and caused disease or pain. The seventeenth-century, however, witnessed in medicine the trend, manifest then in so many fields of thought, away from an uncritical acceptance of the authority of the past. It also saw a defiant denial of ancient authority among those more radically inclined, such as the disciples of the sixteenth-century alchemist and physician, Paracelsus. Although some of his practices and teachings were based on the supernatural, Paracelsus stressed observation and the avoidance of a mere system of book-learning. Practice lagged behind new scientific theory in medicine but Virginia must have felt at least the reverberations caused by the clash of the ancient and the new. An important new school of medical theory was the iatrophysical or iatromathematical (_iatros_ from the Greek--physician). This medical theory--as is the case with many scientific theories-was borrowed from another branch of science. The seventeenth century, the age of Isaac Newton, Galileo Galilei, Gottfried Wilhelm von Leibnitz, René Descartes, and other giants of physical science, was a period of remarkable progress in the field of physics. It is not surprising then that theorists in the field of medicine, noting the truths discovered by conceiving of nature as a great machine functioning according to laws that could be expressed in mathematical terms, should have attempted to explain the human body as a machine. William Harvey (1578-1657), whose name looms great in the history of seventeenth-century medicine, explained the circulation of the blood in mechanical terminology. To Harvey, working under the influence of the great physicists, the heart was a mechanical force pump and the blood was analogous to other fluids in motion. How many physicians, practicing in the same intellectual environment as this Englishman, must have carried the mechanical analogy to the extent of thinking of the teeth as scissors, the lungs as bellows, the stomach as a flask, and the viscera as a sieve? The iatrochemical school existed alongside the iatrophysical. Whereas the iatrophysical thought primarily in terms of matter, forces, and motions, the iatrochemical thought chemical relationships were fundamental. One of the founders of this school, the Dutch scientist Sylvius (1614-72), explained diseases chemically (an approach not completely unlike the humoral of Galen) and treated them on the basis of a supposed chemical reaction between drug and disease. Another leading figure in the iatrochemical school, Thomas Willis (1621-75), was an Englishman. These two advocated the use of drugs at a time when their respective nations were developing great colonial empires rich with the raw materials of pharmacology. However, it would be an error to think of the medicine of the period, either European or Virginian, only in terms of rational or scientific theories. Treatment was too often based on magic, folklore, and superstition. There were physicians relying upon alchemy and astrology; the Royal Touch was held efficacious; and in the _materia medica_ of the period were such substances as foxes' lungs, oils of wolves, and Irish whiskey. Nor should it be forgotten that many of the sick never saw a medical man but relied upon self-treatment. With theories from the ancient authorities and from experimenting scientists to draw upon, the practicing physicians could deduce therapeutic techniques or justify curative measures, but the emphasis on theory brought with it the danger of ignoring experience and abandoning empirical solutions. Aware that many of his fellow physicians tended to overemphasize theory Thomas Sydenham (1624-89), who received his doctorate of medicine from Cambridge University, recommended personal experience drawn from close observation. He scoffed at physicians who learned medicine in books or laboratory, and never at the bedside. His study of epidemics, his emphasis on geography and climate as casual factors in the genesis of disease, make this Englishman's views and practices especially relevant to the medical history of Virginia where geography and climate did play such important roles in the life of the colony. The history of surgeons and surgery during the century is less distinguished than that of the physician and his practice. Surgery produced no individuals of the stature and significance of Sydenham nor any revolutionary theories as important as Harvey's. Dissections were made but the knowledge acquired was not applied; amputation was common but not always necessary or effective. Battle wounds and injuries lay in the province of the surgeon. While the surgeon was primarily concerned with the military, using mechanical force (cutting, tying, setting, and puncturing) in his treatment of body wounds and injuries, physicians on the Continent and in England also filled these functions. For example, physicians in Italy sometimes performed surgical operations they considered worthy of their dignified positions, and in England the licensed physician could practice surgery. On the other hand, surgeons licensed by Oxford University were bound not to practice medicine. Both in France and in England surgeons and barbers held membership in the same guild or corporation, and physicians considered them of inferior social status. The American frontier tended to reduce such professional and social distinctions. In Europe and England, where medical education was institutionalized to a far greater extent than in colonial Virginia, education explains much of the difference in social status between physician and surgeon. The surgeon learned by apprenticeship to an experienced member of his guild while the physician had to meet certain educational and professional requirements, depending upon local or national law. The best medical education of the period could be had at the great centers of Leyden, Paris, and Montpellier. Cambridge and Oxford also offered a degree in medicine. Englishmen preferred to study medicine abroad--according to a recent study made by Phyllis Allen and printed in the _Journal of the History of Medicine and Allied Sciences_--because a better education could be obtained there in the same number of years. The Doctorate of Medicine required fourteen years of undergraduate and post-graduate study at Oxford; the Cambridge requirement was similar. Despite reforms during the seventeenth century, education at these universities remained dogmatic and classical. Students usually found their studies dull and their social life stimulating. The more enterprising students could find the new ideas of the period in books not required in their course of study. Cambridge, Oxford, and the Royal College of Physicians all licensed physicians who had survived their education, met certain professional requirements, and passed an examination. That physicians in England did possess a high social status as well as more extensive formal education is evidenced by a precaution taken by the Virginia Company, to avoid causing displeasure among men of rank, in preparing letters patent. The Company requested of the College of Heralds, in 1609, the setting "in order" of the names of noblemen, knights, and Doctors of Divinity, Law, and Medicine so that their "several worths and degrees" might be recognized when their names were inserted on the patents. Surgeons received no mention. On the other hand, physicians and surgeons in England might well have come from similar social backgrounds and even on occasions from the same families. When there were three or four sons in the family of a country gentleman, he might have followed the custom of keeping the eldest at home to manage and eventually inherit the estate. The second, then, would be sent to one of the universities in order to follow a profession such as that of physician, lawyer, or clergyman. The third might be apprenticed to an apothecary, surgeon, or a skilled craftsman. This practice should be borne in mind when former medical apprentices are found in high offices in Virginia; their origins were not always humble. Although the physician enjoyed the greatest social and professional prestige, he received the most verbal abuse and criticism. Perhaps the most damaging and galling satire of the century flowed from the pen of the French dramatist, Molière, who had a medical student--not completely fictitious--swear always to accept the pronouncements of his oldest physician-colleague, and always to treat by purgation, using clysters (enemas), phlebotomy (bloodletting), and emetics (vomitives). These three curative measures followed the best Galenic technique: releasing corrupting humors from the body. Molière's _Le Malade Imaginaire_ confronted the audience with constant purgings and bleedings, and the caricature was not excessive. The diseases of the century did not allow for the inadequacies of the physician, and imparted a grim note of realism to the satire of the dramatist. Infant mortality was high and the life expectancy low. Hardly a household escaped the tragedy of death of the young and the robust; historians have sensed the influence omnipresent death had upon the attitudes and aspirations of the European and American of earlier centuries. School children today learn of such a dramatic killer as the bubonic plague, but even its terrible ravages do not dwarf the toll of ague (malaria), smallpox, typhoid and typhus, diphtheria, respiratory disorders, scurvy, beriberi, and flux (dysentery) in the colonial period. England, and especially London with its surrounding marshes, suffered acutely with the ague during the century. Englishmen arriving in the New World were well aware of the dangers of this disease and made some effort to avoid the bad air, and the low and damp places. In 1658 the ague took such a toll that a contemporary described the whole island of Britain as a monstrous public hospital. Unfortunately, Thomas Sydenham, whose prestige in England was great and whose works on fevers were influential, paid scant tribute to cinchona bark (quinine) which was known but thought of, even by Sydenham, as only an alleged curative offering too radical a challenge to current techniques. According to humoral doctrine, fever demanded a purging, not the intake of additional substances. Unfortunately, public hygiene and sanitation enlisted few adherents. Epidemics of the seventeenth century have been judged the most severe in history. In Italy physicians ahead of their times proposed the draining of marshes and pools of stagnant water, and recommended the isolation of persons with contagious diseases. But it was the great London fire of 1666 that rid that city of its infested and infected places, not an enlightened municipality. Therefore Virginia, a colony of seventeenth-century Europe, started life burdened with a heritage of deadly and widespread disease and inadequate medicine. Not only did the ships that brought the settlers to Jamestown Island bring surgeons and medical supplies but also medical problems frequently more serious than the men and supplies could cope with. The European or Englishman, however, did not originate the practice of medicine in Virginia for the Indian had had to struggle with the problems of disease and injury long before the seventeenth century. INDIANS AND THEIR MEDICINE Seventeenth-century Americans found the medical practices of the Indians interesting enough to include descriptions of them in their accounts of the New World. The attitude of the authors of these early observations is a mixture of curiosity, wonder, and--on occasion--admiration. Henry Spelman, one of the early colonists, wrote of Jamestown and Virginia as they were in 1609 and 1610. He described the manner of visiting with the sick among the Indians. According to Spelman, the "preest" laid the sick Indian upon a mat and, sitting down beside him, placed a bowl of water and a rattle between them. Taking the water into his mouth and spraying it over the Indian, the priest then began to beat his chest and make noises with the rattle. Rising, he shook the rattle over all of his patient's body, rubbed the distressed parts with his hands, and then sprinkled water over him again. Like the colonist, the Indian tried to draw out blood or other matter from the sick or wounded person. The method often used for releasing the ill humor from a painful joint or limb must have caused considerable suffering but may have offered certain advantages in preventing fatal infection. If the affected part could bear it, the Indian thrust a smoldering pointed stick deep into the sore place and kept it there until the excess matter could drain off. Another technique for burning and opening had a small cone of slowly burning wood inserted in the distressed place, "letting it burn out upon the part, which makes a running sore effectually." Still another method for treating a wound was for the priest to gash open the wound with a small bit of flint, suck the blood and other matter from it, and finally apply to it the powder of a root. A colonist in describing the practice wrote that "they have many professed phisitions, who with their charmes and rattels, with an infernall rowt of words and actions, will seeme to sucke their inwarde griefe from their navels or their grieved places." Judging by other accounts written during the century concerning Indian medicine, the powdered root may well have been sassafras, of which there was an abundance in the Jamestown area. The priest dried the root in the embers of a fire, scraped off the outer bark, powdered it, and bound the wound after applying the powder. Not only did the native American resort to a crude form of bloodletting but he practiced sweating as well--which was also common to seventeenth-century European medical practice. In Captain John Smith's description of Virginia it was noted that when troubled with "dropsies, swellings, aches, and such like diseases" the cure was to build a stove "in the form of a dovehouse with mats, so close that a fewe coales therein covered with a pot, will make the pacient sweate extreamely." Before lighting his stove, the Indian covered his sweating place with bark so close that no air could enter. When he began to sweat profusely, the sick Indian dashed out from his heated shelter and into a nearby creek, sea, or river. An Englishman commented that after returning to his hut again he "either recover[s] or give[s] up the ghost." The Indians, like Molière's stage physician, believed in the value of the purge. Every spring they deliberately made themselves sick with drinking the juices of a medicinal root. The dosage purged them so thoroughly that they did not recover until three or four days later. The Indians also ate green corn in the spring to work the same effect. The Indian medicine man, like his European counterpart, frequently dispensed medicines or drugs. As has been the custom among many men in the medical profession, the medicine man would not reveal the secrets of his medicines. "Made very knowing in the hidden qualities of plants and other natural things," he considered it a part of the obligations of his priesthood to conceal the information from all but those who were to succeed him. On the other hand, the Indian priest showed his concern for the health of his people--and the similarity of his attitude to that of present day practices--by making an exception to his canon of secrecy in the case of drugs needed in emergencies arising on a hunting trip and during travel. According to one early eighteenth-century history of Virginia, the Indian in choosing raw materials for drugs preferred roots and barks of trees to the leaves of plants or trees. If the drug were to be taken internally it was mixed with water; when juices were to be applied externally they were left natural unless water was necessary for moistening. Whatever the drug and however utilized, the Indian called it _wisoccan_ or _wighsacan_, for this term was not a specific herb, as some of the earlier settlers thought, but a general term. Besides sassafras, medicinal roots and barks, the Indian believed in beneficial effects of a kind of clay called _wapeig_. The clay, in the opinion of the Indians, cured sores and wounds; an English settler marvelled to find in use "a strange kind of earth, the vertue whereof I know not; but the Indians eate it for physicke, alleaging that it cureth the sicknesse and paine of the belly." Insomuch as the Indian priest preferred to keep his professional secrets, the colonist was unlikely ever to learn the "vertue" of the clay. If the Indian medicine man had not believed that his gods would be displeased--or his prestige lowered--by revealing the nature of the _wisoccan_ he prescribed, it would have been possible for the early Virginians to have drawn upon the Indian knowledge of, and experience with, the simples and therapies of the New World. (Perhaps the "vertues" of the clay would have cured the "paines" of the Jamestown bellies.) As it was, the settlers make little mention of a reliance upon the Indians for medical assistance. CHAPTER TWO Disease and The Critical Years At Jamestown MOTIVES AND PROVISIONS FOR COLONIZATION In 1606 King James of England granted a charter to Sir Thomas Gates and others authorizing settlements in the New World. In 1609 this charter was revised and enlarged, granting the privileges to a joint-stock company. Among the merchants, knights, and gentlemen holding shares in the company and among those particularly interested in the more southerly areas of North America, including Virginia, were a number of physicians. The instructions given to the first settlers reflect the general concern of the London Company for the health of the colony and perhaps the particular interest of the physicians. One of the physicians, John Woodall, took especial care to urge that cattle be sent to provide the settlers with the milk he considered essential to their health. Not only did the Company wish to lessen the dangers of disease in the New World, but it also urged colonization as a means of reducing the plague in England. In 1609 the Company advised municipal authorities in London to remove the excess population of that great city to Virginia as the surplus was thought to be a cause of the plague. There was little danger of a surplus population during the initial years in Virginia. Before the colonists, or the Company, however, had to be concerned with dangers from disease in Virginia, the colonists had to undertake an extremely difficult and unhealthy voyage across the Atlantic. DISEASE AND THE OCEAN VOYAGE Ships plying the Atlantic at the beginning of the seventeenth century were small and the voyage was lengthy. Four months passed before the _Godspeed_, the _Discovery_, and the _Susan Constant_, carrying the first permanent settlers to Jamestown, sighted the two capes at the mouth of Chesapeake Bay in April, 1607. Although these small ships carrying the first permanent settlers had a stopover in the West Indies for rest and replenishment, there had been debilitating months at sea and more than 100 emigrants to provide for in addition to the crews. With limited cargo and passenger space, water and food supplies could hardly satisfy the demand created by a hundred persons at sea for hundreds of days. Several of the emigrants died on the first voyage and the remainder disembarked poorly prepared for the new tests their constitutions would soon endure. The sea voyage of these first settlers probably exacted no heavier a death toll and caused no more suffering because the ships went by way of the Canaries and the West Indies instead of by the more northerly route by-passing the islands. A contemporary described the advantages thought to be had from the stopover in the West Indies (at the island of Nevis): We came to a bath standing in a valley betwixt two hills, where wee bathed ourselves.... Finding this place to be so convenient for our men to avoid diseases which will breed in so long a voyage, wee incamped our selves on this ile sixe dayes, and spent none of our ships victuall. Anchoring off other West Indian islands the ships were able to replenish their stores with fresh meat and fish and to replace the evil-smelling and foul water in their casks with fresh. By these measures the colonists demonstrated a concern not only for comfort but also for hygienic precautions. Later voyages during the century took anywhere from two to three months. Despite the precautions taken by some, of a rest, in the West Indies to bring about "restitution of our sick people into health by the helpes of fresh ayre, diet and the baths," the trip aboard the pestered ships continued to exact a heavy death toll and to discharge disease and diseased persons. Benefits resulting from the stopover in the Indies were countered by the considerable exposure to tropical infections. One convoy carrying colonists to Virginia in 1609 and running a southerly course through "fervent heat and loomes breezes" had many of the crew and passengers fall ill from calenture (tropical or yellow fever). Out of two ships so afflicted, thirty-two persons died and were thrown overboard. Another of these ships reported the plague raging in her. Irritated by frequent references to the unhealthy climate of Virginia and fearful that the bad publicity would increase the difficulties in obtaining colonists, officials of the London Company took pains to expose the part that the ocean voyage played in bringing about the deaths of newcomers. Musty bread and stinking beer aboard the pestered ships, according to a contemporary, worked as a chief cause of the mortality attributed falsely to the Virginia climate and conditions at Jamestown. In 1624 Governor Wyatt and his associates recommended to commissioners from England that "care must be had that the ships come not over pestered and that they may be well used at sea with that plenty and goodness of dyet as is promised in England but seldom performed." Others complained of the crowding of men in their own "aires," uncleanliness of the ships, and the presence of fatal "infexion." Insomuch as seventeenth-century medical theory paid scant attention to sanitation and hygiene in the study of the causes of disease, it is surprising to find the early Virginian rightly recognizing the ships as sources of sickness. On the other hand, observation could not help but lead passengers to conclude that sickness, such as flux or dysentery, with which they had to suffer aboard ship, might have a causal relationship to the ship. To have related the transmission of the plague from epidemic centers in England via infected shipboard rats, and transmission of tropical fevers, as well, by the medium of shipboard water buckets infected with mosquito larvae from the tropics, was beyond the capacity of both medical theory and of first-hand observation. Physicians or surgeons did ship aboard the seventeenth-century ocean-going vessels, but Doctor Wyndham B. Blanton, the chief authority on seventeenth-century Virginia medicine, concludes that most of them probably had poor educations and little more to recommend them than "a smattering of drugs, a little practice in opening abscesses and a liking for the sea." A seventeenth-century contemporary recommended that a ship's surgeon--surgeons went to sea far more often than physicians--be the possessor of a certificate from a barber-surgeon guild and be freed from all ship's duties except the attending of the sick and the cure of the wounded. The ship's surgeon, then, crossed the professional line between surgeon and physician, a line that necessity would soon force so many medical men to cross in America. Throughout the century ship's surgeons abandoned their shipboard duties to settle in the Virginia colony, and there seems little reason to doubt that those remaining aboard ship took advantage of the opportunity when in port to help meet the medical needs of the colonists, thus supplementing the medical talent which had taken up residence in Virginia. The labors of the ship's surgeon at sea, no matter how valiant, could not offset the miseries of the long sea voyage, and the sight of Virginia's coast greatly cheered all hands. After the foul air, crowded quarters, and inadequate provisions of the ship, many settlers must have reacted to the Virginia land as Captain John Smith did: "heaven and earth never agree better to frame a place for man's habitation." It is not surprising then that the first permanent settlers were somewhat less than careful when evaluating, against standards of health, the possible sites for settlement. THE SELECTION OF SITES FOR SETTLEMENT In a fairly extensive set of instructions "by way of advice, for the intended voyage to Virginia," the London Company, in 1606, took into account the part that disease and famine could play in the life--or death--of the colony. Probably knowing that the chances for survival of the Spanish conquistadors had been enhanced by their superhuman qualities in the eyes of the Indians, the Company urged that no information on deaths or sicknesses among the whites be allowed to the natives. More important, as the course of events was to demonstrate, was the advice not to: plant in a low or moist place, because it will prove unhealthfull. You shall judge of the good air by the people; for some part of that coast where the lands are low, have their people blear eyed, and with swollen bellies and legs: but if the naturals be strong and clean made, it is a true sign of wholesome soil. The idea that climate had an influence upon human physiognomy did not originate with the London Company. In an essay dating back to the fifth century B.C. and preserved among the works of the Hippocratic school the ancient--but in the seventeenth century still influential--authorities argued that human physiognomies could be classified into the well-wooded and well-watered mountain type; the thin-soiled waterless type; the well-cleared and well-drained lowland type; and the meadowy, marshy type. The London Company's instructions to the first permanent settlers to avoid low-lying, marshy land, if followed, might have saved the colonists from some of the sicknesses they were to endure, but other considerations dictated the choice of the Jamestown site; the peninsular, about thirty miles upstream, provided natural protection and a good view up and down the river. The danger from the ships of other European peoples seemed more immediate and formidable than those from the mosquito, with its breeding place in the nearby swamp, and from the foul and brackish drinking water. As the century progressed, the settlers pushed inland from Jamestown and the low-lying coastal region, up onto the drier land. The danger from typhoid, dysentery, and malaria grew steadily less. In choosing home sites--once the confines of the peninsula were left behind and the fear of attack from Indian or European was less--the early planters took into consideration the dangers of the fetid swamp and muggy lowland. That the promotion of health did play a part in the selection of sites for settlement is borne out by the re-location of the seat of government from the languishing village of Jamestown to Middle Plantation or Williamsburg. After an accidental fire destroyed a large part of Jamestown at the end of the century, the people indicated a desire to move away from an environment, recognized as unhealthful, to Middle Plantation, known for its temperate, healthy climate as well as for its wholesome springs. The inhabitants had contemplated a move earlier in the century for health reasons but authorities in England and governors in Virginia acted to prevent the abandonment of the only community even approaching the status of a town. The move away from Jamestown would probably appear a wise measure even to the twentieth-century physician; to the seventeenth-century physician, who often saw a close relationship between climatic conditions and disease, the move seemed imperative. A man well-versed in science and medicine, living in Jamestown a decade or so before the town was abandoned, exemplified this medical theory when he wrote that an area was unhealthy according to its nearness to salt water. He had observed that salt air, especially when stagnant, had "fatal effects" on human bodies. In contrast, clear air (such as would be enjoyed at Middle Plantation) had beneficial effects. Considerations of health and the effects of disease not only influenced the settlers in their choice of living sites but also in many of their other activities. Political, economic, and social history in seventeenth-century Virginia was determined in part by health and disease. DISEASE AS A DETERMINING FACTOR IN THE EARLY YEARS OF THE COLONY Death from disease and incapacitation from disease are challenges to which every civilization--and human community--must successfully respond in order to survive. Historian Arnold J. Toynbee has emphasized the vital character of the challenge and response relationship in the history of all communities. A particular challenge to which early Jamestown almost succumbed was disease. The actions--or inactions--of the settlers under the London Company, 1607-1624, demonstrated especially well the influence of the challenge of disease upon the early history of Virginia. During the first year of the settlement at Jamestown, disease worked as an important factor in the realm of politics. In this connection, Edward Maria Wingfield, chosen first president of the governing council in Virginia, found himself removed from office, imprisoned, and sent home by the spring of 1608, all as a result of charges brought against him that for the most part were petty and contradictory. Pettiness and contradictions, in this instance, were rooted in the miserable conditions which the colonists had to endure their first summer: famine and sickness not only demoralized the colonists but were killing them faster than they could be buried. Wingfield left office as president of the council after the first summer spent in Jamestown. The sickness that caused much tension during his tenure was probably the malady loosely described by early Virginians as the "seasoning." The complex of symptoms ascribed to the seasoning bothered the settlers throughout the seventeenth century. Even as late as 1723 a recent arrival in Virginia wrote that "all that come to this country have ordinarily sickness at first which they call a seasoning of which I shall assure you I had a most severe one." During the first two summers, 1607 and 1608, however, this seasoning inflicted the most distress, judging by the seriousness with which contemporaries described it. One of these contemporary accounts, written by George Percy who sailed to Virginia with the first settlers in 1606-07, described the distress caused by seasoning and famine during the summer of 1607. The awfulness of that summer is made more dramatic by the manner in which Percy introduced the subject. Having described the voyage over, which was relatively pleasant with the stopover in the beautiful West Indian islands, and having entertained the reader with startling accounts of the habits of the savages in Virginia ("making many devillish gestures with a hellish noise, foming at the mouth, staring with their eyes, wagging their heads and hands in such a fashion and deformitie as it was monstrous to behold"), Percy abruptly began listing the names of the dead as his narrative moved into the late summer months: The sixt of August there died John Asbie of the bloudie flixe. The ninth day died George Flowre of the swelling.... The fifteenth day, their died Edward Browne and Stephen Galthorpe. The sixteenth day, their died Thomas Gower Gentleman. The seventeenth day, their died Thomas Mounslic.... The remainder of the description of the significant events of the month of August is given over entirely to the listing of the deaths. Seldom did Percy give the cause of individual deaths, but as the narrative moved into September and near the end of the seasoning period, Percy stopped his grim listing to comment in general terms upon the unhappy experience. According to his diagnosis--and perhaps he was enlightened by Thomas Wotton and Will Wilkinson, the two surgeons who arrived with the first settlers--the heavy death toll of August resulted from such ailments as fluxes, swellings, and burning fevers as well as from famine and attacks by the Indians. Percy was of the opinion that the colonists at Jamestown suffered more during the summer and winter of 1607 than any other Englishmen have during a colonization venture. Weakened by the debilitating summer and unable during that period to make the necessary provisions for the winter, the settlers, their ranks depleted, also fared poorly during the next five months. In describing their distress, he revealed the conditions that bred the diseases and illnesses to which the colonists fell prey. They lay on the bare ground through weather cold and hot, dry and wet, and their ration of food consisted of a small can of barley sod in water--one can for five men. Drinking water came from the river which in turn was salt at high tide, and slimy and filthy at low. With such food and drink, the small contingent within the fort lay about for weeks "night and day groaning in every corner ... most pittifull to heare." Fortunately during the course of the winter the Indians did come to the relief of the colonists with provisions, but before this help was substantial, Percy observed: If there were any conscience in men, it would make their harts to bleed to heare the pitifull murmurings and out-cries of our sick men without reliefe, every night and day, for the space of sixe weekes, some departing out the world, many times three or foure in a night; in the morning, their bodies trailed out of their cabines like dogges to be buried. Over one-half (approximately 60) of the original settlers perished during the summer of 1607 and the seasoning was to prove a hazard throughout the remainder of the century. Its effects became less serious, however, as the Company and the colonists, profiting from the earlier experiences began to plan departures from England so that the immigrants would arrive in Virginia in the fall: another example of the influence of disease. Governor Yeardley, writing some years later--in 1620--reminded the Company's officials in England of the advantages of a fall arrival. He had just witnessed the distress of immigrants from three ships that had arrived in May: had they arrived at a seasonable time of the year I would not have doubted of their lives and healths, but this season is most unfit for people to arrive here ... some [came] very weak and sick, some crazy and tainted ashore, and now this great heat of weather striketh many more but for life. At least twenty more immigrants died during the second summer (1608) and the misery and discontent of the survivors of the summer's sicknesses account--in part, at least--for the disposal of another council president, John Ratcliffe. Returning to Jamestown after an exploratory trip up Chesapeake Bay, Doctor Walter Russell, one of the company, found the latest arrivals to Virginia "al sicke, the rest, some lame, some bruised, al unable to do any thing but complain of the pride and unreasonable needlesse cruelty of their sillie President." The wrath of these sick--and doubtless somewhat querulous and irrational men--was appeased by the removal of the "sillie" president. The ability of Captain John Smith, who succeeded to the presidency of the council in the fall of 1608, to impose his strong will upon the inhabitants of the peninsula, and to exert such a great influence upon the course of events is explained, in part, by the depletion of ranks and the demoralization of spirit caused among them by the dreadful toll of disease. When other members of the council died, Smith did not replace them and, rid of strong opposition, he ruled as a benevolent despot. Smith's departure from the colony in October, 1609, had as its immediate cause--according to Smith--the impossibility of his obtaining proper medical attention in Virginia for burns acquired from a gunpowder explosion. When Smith sailed, his enemies, of which there were a considerable number, breathed freer air, but the colony subsequently suffered without his strong, authoritative voice. Supporters of Smith argued that if that "unhappy" accident had not occurred, he could have stayed on and solved the many problems that were to beset the colony. On the other hand, it is pointed out that the wound would have been better treated at Jamestown than on board ship, and that Smith used the wound, which was not too serious, as an excuse to escape from the administrative troubles that plagued him. The powder blast was described by friends of Smith as tearing a nine or ten-inch square of flesh from his body and thighs, and as causing him such torment that he could not carry out the duties of his position. The wound was probably complicated by the fact that the accident had occurred when Smith was in a boat many miles from Jamestown. He had had to cover the great return distance after having plunged into the water to ease his agony, and without having the assistance of either medicines or medical treatment. Whatever the seriousness of the wound, supporters of Smith maintained that he was near death and had to leave Jamestown in order to secure the services of "chirurgian and chirurgery... [to] cure his hurt." Twice in 1608, Captain Newport had brought immigrants and supplies to the colony and, in the summer of 1609 about 400 passengers had landed at Jamestown. These new arrivals, some of them already afflicted with the plague, others victims of various fevers, and all suffering from malnutrition, needed strong leadership to force them to plant busily and to lay in food supplies for the winter ahead. Supplies brought over aboard the ships could not possibly furnish nourishment for the coming months. Malnutrition as a factor contributing to sickness, and sickness as a factor preventing the labor necessary to circumvent starvation, constituted a vicious relationship. The winter of 1609-10 after Smith's departure is remembered as the "Starving Time." During this period the number of colonists dropped from 500 to about sixty. Men, women, and children lived--or died--eating roots, herbs, acorns, walnuts, berries, and an occasional fish. They ate horses, dogs, mice, and snakes without hesitation after Indians drove off hogs and deer belonging to the colonists. The Indians also kept the settlers from leaving the protection of Jamestown to go out and hunt for food. When hunting was not made impossible by Indians, the settlers' own physical weaknesses often precluded energetic action. The notorious, and possibly untrue, incident of the man whom hunger drove to kill and to eat the salted remains of his wife, is from the accounts of the Starving Time. Although this story had the support of a number of colonists, others maintain that it, and the entire episode of the famine, came out of the exaggeration of colonists who abandoned the venture and returned to England. Yet the verdict of historians establishes a Starving Time, and the high mortality of the winter must have an explanation. To argue that all those who died, died of starvation would, on the other hand, be a distortion. Food deficiencies did not always lead directly to death but in many cases to dietary disease. These dietary diseases often terminated in death, but their courses might well not have been fatal if proper medical attention could have been given. In other cases food deficiency resulted in so weakened a physical condition that the body fell prey to infectious diseases which, again, could not be cured with the limited medical help available. The Starving Time did not stand out as a time of want to be contrasted with a normal time of plenty. For many the winter of 1609-10 only brought to a crisis dietary disorders of long standing. One account of the early years describes the daily ration as eight ounces of meal and a half-pint of peas, both "the one and the other being mouldy, rotten, full of cobwebs and maggots loathsome to man and not fytt for beasts...." Nor was the Starving Time the last time that the colonists would have to endure famine and privation. Although written to discredit the administration of Sir Thomas Smith as head of the Company during the years from 1607-19, an account of the hunger of these twelve years should be accepted as having some basis in fact. The account, written in 1624, reported as common occurrences the stealing of food by the starving and the cruel punishments meted out to them (one for "steelinge of 2 or 3 pints of oatemeal had a bodkinge thrust through his tounge and was tyed with a chaine to a tree untill he starved"); and the denial of an allowance of food to men who were too sick to work ("soe consequently perished"). The starving colonists during these twelve years, according to the report, often resorted to dogs, cats, rats, snakes, horsehides, and other extremes for nourishment. Many, in those hungry times, weary of life, dug holes in the earth and remained there hidden from the authorities until dead from starvation. Although the report maintained that these events occurred throughout the twelve-year period, it is likely that many were concentrated during the Starving Time. Famished, disease-ridden, demoralized, with many mentally unbalanced, the settlement at Jamestown languished in a distressful condition after the winter of 1609-10. Jamestown, in May, 1610 appeared: as the ruins of some auntient [for]tification then that any people living might now inhabit it: the pallisadoes... tourne downe, the portes open, the gates from the hinges, the church ruined and unfrequented, empty howses (whose owners untimely death had taken newly from them) rent up and burnt, the living not hable, as they pretended, to step into the woodes to gather other fire-wood; and, it is true, the _Indian as fast killing without as the famine and pestilence within_. The Indians, however, would not make a direct assault on the fort; they waited on disease and famine to destroy the remaining whites. How many of the graves now at Jamestown must have been dug during that terrible winter? The Starving Time has been characterized by historian Oliver Chitwood as "the most tragic experience endured by any group of pioneers who had a part in laying the foundations of the present United States." By spring of 1610 the challenge of famine, pestilence, and disease had proven too great; the warfare of Europeans and savages, for which the settlers had made provisions in the selection of the Jamestown site, had not proven as great a threat as disease and famine. Under the command of Sir Thomas Gates and Sir George Somers, who had only just arrived with plans for the future of the settlement, the small band of survivors boarded ship to abandon an abortive experiment in European colonization. Before leaving, the survivors of the winter had had a consultation with Gates and Somers about future prospects for the colony. Chiefly fear of starvation determined the decision to abandon the settlement: the provisions brought by Gates and Somers would have lasted only sixteen days. The colonists could hold out no hope of obtaining food from the Indians. ("It soone then appeared most fitt, by general approbation, that to preserve and save all from starving, there could be no readier course thought on then to abandon the countrie.") After embarking, the settlers, with Gates, Somers, and the new arrivals, had reached the mouth of the river when they met Lord De la Warr, the new governor of the colony, coming from England with fresh supplies and settlers. Heartened, the survivors of the Starving Time turned back to try the New World again. In Lord De la Warr's company was Dr. Lawrence Bohun, a physician of good reputation, who subsequently distinguished himself serving the medical needs of the settlement. He could not, however, even in his capacity of personal physician, prevent Lord De la Warr from falling victim to the common ailments. In 1610, Lord De la Warr wrote: "presently after my arrival in Jamestowne, I was welcomed by a hot and violent ague, which held mee a time, till by the advice of my physician, Doctor Lawrence Bohun I was recovered." Bohun, in the seventeenth-century tradition of treatment by clysters, vomitives, and phlebotomy, resorted to bloodletting. The letting, believed to free the body of fermented blood and malignant humors, probably gave the governor a psychological lift, if only a temporary one. De la Warr, who blamed the distress of the colony upon the failures of the settlers, soon had another taste of the illnesses which so many of the colonists endured during their first months in the New World. In his report to the Company explaining his early departure from the colony, he included one of the fullest surviving accounts of sickness at Jamestown during the first few years of settlement: That disease [the hot and violent ague] had not long left me, til (within three weekes after I had gotten a little strength) I began to be distempered with other greevous sicknesses, which successively and severally assailed me: for besides a relapse into the former disease, which with much more violence held me more than a moneth, and brought me to great weakenesse, the flux surprised me, and kept me many daies: then the crampe assaulted my weak body, with strong paines; and afterwards the gout (with which I had heeretofore beene sometime troubled) afflicted mee in such sort, that making my body through weakenesse unable to stirre, or to use any maner of exercies, drew upon me the disease called the scurvy; which though in others it be a sicknesse of slothfulnesse, yet was in me an effect of weaknesse, which never left me, till I was upon the point to leave the world. When a person of strong constitution, living under the best conditions the colony could provide, and accompanied by a well-trained physician, found himself thus incapacitated, it is no wonder that the rank and file of the colony failed to pursue energetically by hard work and exemplary conduct their own best interests. The firmness of De la Warr, who was much more indulgent of his own than of others' disorders, brought additional stability to the colony, but the attack of scurvy, which current opinion believed could be relieved only by the citrous fruits of the West Indies, caused him, accompanied by Dr. Bohun, to set sail from Virginia in the spring of 1611 for the same island of Nevis praised so highly for its baths by the first settlers of 1607. Disease had robbed the colony of another outstanding leader during a period when strong leadership on the scene was imperative. Although the colony had experienced its worst years of hardship before De la Warr departed and the worst years in the New World had been caused by famine and disease, sickness and starvation were still to have a noteworthy effect. Disease no longer threatened the colony's life, but it shaped its history. In 1624 the charter of the Company was annulled and, in explaining this major development, account must be taken of the cumulative effects of sickness and hunger upon the Company's fortunes; the first summer's seasoning and the Starving Time, for example, had long-term economic repercussions as well as short-term results in human suffering. The Company had been in financial difficulties for some years and by 1624 the treasury was empty and the indebtedness heavy. If the mortality rate had not been so high and the level of energy of the colonists so reduced, the Company might have prospered. For example, local trade with the Indians necessitated small ships for the effective transportation of cargo, but several attempts by the Company to send to America boatwrights to construct such ships failed because of the deaths of the boatwrights. The Company had hoped in 1620 to better its financial condition by developing an iron industry in the colony, but this project suffered from the effects of disease, too, as the chief men for the iron works died during the ocean voyage. The remainder of the officers and men sent to establish the works died in Virginia either from disease or at the hands of the Indians. The high cost to the Company of the labor and services lost because of the early deaths of persons still indentured for a period of years cannot be estimated. Nor can the number of goals set by the colonists and the Company but never fulfilled because of sickness be tabulated. As late as 1623 a colonist wrote that "these slow supplies, which hardly rebuild every year the decays of the former, retain us only in a languishing state and curb us from the carrying of enterprise of moment." In suggesting the part that famine and disease played in the annulment of the Company's charter, the effects of one more period of intense suffering must also be considered. In March, 1622, a bloody Indian massacre occurred in which more than 350 white men, women, and children died. Not only did the massacre cause a subsequent period of disease, famine, and death among the survivors, but the heavy casualties inflicted directly by the Indians can be explained, partially, by the weakened condition and depleted ranks of the colonists before the massacre. So tenuous was the colony's ability to maintain an adequate and healthful living standard, that the destructive and disrupting impact of the massacre brought a period of severe famine and sickness. After the raid the surviving colonists had to abandon many of the outlying plantations with their arable fields, livestock, and supplies. And having had the routine of life interrupted, the settlers--their numbers unfortunately increased by a large supply of new immigrants, sent by ambitious planners in England--came to the winter of 1622-23 poorly provisioned. Toward the end of this winter, famine reduced the settlers to such conditions that one wrote to his parents that he had often eaten more at home in a day than in Virginia in a week. The beggar in England without his limbs seemed fortunate to the Virginian who had to live day after day on a scant ration of peas, water-gruel, and a small portion of bread. Another wrote that the settlers died like rotten sheep and "full of maggots as he can hold. They rot above ground." As in 1609-10, inadequate diet weakened the body and made it easy prey to infection. During this winter the colonists--in addition to suffering from want of food--had to endure a "pestilent fever" of epidemic proportions matched only by the seasoning of 1607. About 500 persons died in the course of the winter. The origin of the winter's epidemic, according to contemporaries, lay in the infectious conditions of numbers of the immigrants who had been poisoned during the ocean voyage "with stinking beer" supplied to the ships by Mr. Dupper of London. It is more likely that the pestilent fever of the winter was a respiratory disease rather than a disorder resulting from "stinking beer." Another commentator on the winter called attention to the continued "wadinge and wettinge" the colonists had to endure, bringing them cold upon cold until "they leave to live." Whether continual wadings and wettings brought on respiratory diseases, or bad beer dietary, is debatable, but the critics of the Company used the dreadful winter of 1622-23 to discredit its administration. They pointed out that the Company had sent large numbers of immigrants to Virginia without proper provisions, and to a colony without adequate means of providing food and shelter for them. Many of these persons had subsequently died during the winter of 1622-23. The Company, embarrassed by failures in Virginia--many of which resulted directly from unhappy combinations of famine and disease--and plagued by political dissension and economic difficulties, had its charter annulled in May, 1624. One of the most adversely critical--and somewhat prejudiced--tracts written against the Company summed up conditions in the colony after fifteen years under its direction: There havinge been as it is thought not fewer than tenn thousand soules transported thither ther are not through the aforenamed abuses and neglects above two thousand of them at the present to be found alive, many of them alsoe in a sickly and desperate estate. Soe that itt may undoubtedly [be expected that unless the defects of administration be remedied] that in steed of a plantacion it will shortly gett the name of a slaughterhouse.... The Company did not live on after 1624 to acquire such a name, but during its short--and unhealthy--existence the effects of disease on history were manifest. Company instructions gave attention to health requirements; ocean sailings depended upon health conditions; famine and disease almost caused the early abandonment of the colony; strong administrators left, for reasons of health, a Virginia sorely in need of leadership; poor health conditions resulting in lowered morale undermined local leaders; and the over-all economic welfare of the colony suffered from the long-term and short-term effects of famine and disease. The intimate or personal hardships endured by the individual settlers because of disease and famine cannot be enumerated, but the persistent influence that the summation of all the individual suffering had on the general spirit and ethics of early Virginia cannot be overlooked. Disease and famine did not cease to influence Virginia history in 1624, but their great importance during the first two decades has been emphasized because they were then a factor exerting a major influence, perhaps the predominant one. CHAPTER THREE Prevalent Ills and Common Treatments COMMON AND UNCOMMON DISEASES As has been noted, the seasoning caused great distress and a high mortality among the new arrivals to the colony throughout the seventeenth century. These Virginians--authorities on medicine or not--had, for the origins of this malady, their own explanations which furnish clues for more recent analysis. The general term "seasoning" is of little assistance to the medical historian attempting to understand three hundred year-old illnesses in twentieth-century terms. According to seventeenth-century contemporaries, the pathology of seasoning might be described as follows. The immigrants disembarked from their ships tired and underfed--generally in poor health. From their ships they took up residence in a Jamestown without adequate food supplies of its own, and without shelter for the new arrivals. Many of the new settlers had to sleep outside, regardless of the weather, for a number of days after arrival. Then they exposed themselves to the burning rays of the sun, the "gross and vaporous aire and soyle" of Jamestown, and drank its foul and brackish water. The foul and brackish drinking water would seem to be the most probable casual agent in the opinion of more recent medical authority. In this water, Dr. Blanton believes, lurked the deadly typhoid bacillus--the killer behind the mask of the seasoning. Typhoid is not the only possibility, but burning fever, the flux (diarrhea), and the bellyache--symptoms listed in the early accounts--indicate typhoid. Other diseases that may have caused the seasoning were dysentery, influenza, and malaria; and these may have been the seasoning during some of the later summers of the century. Whatever diseases may have caused the seasoning, it plagued the colony summer after summer. A Dutch ship captain wrote of it as it was in Virginia in the summer of 1633: There is an objection which the English make. They say that during the months of June, July, and August it is very unhealthy; that their people, who have then lately arrived from England, die during these months like cats and dogs, ... when they have the sickness, they want to sleep all the time, but they must be prevented from sleeping by force, as they die if they get asleep. Sir Francis Wyatt, twice governor of Virginia wrote, "but certaine it is new comers seldome passe July and August without a burning fever--this requires a skilful phisitian, convenient diett and lodging with diligent attendance." The skillful physician could not limit himself, however, to the curing of the seasoning; he had many other maladies in Virginia with which to contend: dietary disorders, malaria, plague, yellow fever, smallpox, respiratory disorders, and a host of other diseases. Beriberi and scurvy, both dietary diseases, handicapped the colony throughout the century, and probably had acute manifestations during the Starving Time of 1609-10. The colonists during the early years at Jamestown often boiled their limited rations in a common kettle, thus destroying what little valuable vitamin content the food may have had; eggs, vegetables, and fruits which would have countered the disease were not available. The swellings and the deaths without obvious cause described by the early commentators may have resulted from beriberi (the disease did not have a name until the eighteenth century). Another dietary disease troubling the colonists but, unlike beriberi, known by name and at times properly treated, was scurvy. Mention has been made of the outbreak of this disease aboard the ships, and of the stops made in the West Indies to eat the health-restoring citrus fruits, but in the case of the colonists at Jamestown the fruit was non-existent. A belief, also held, that idleness caused the disease did little to bring about measures to promote proper treatment. Because the incapacitating aspects of the disease could produce the appearance of idleness, numerous ill persons must have been innocently stigmatized. Their situation became hopeless when denied rations because the authorities wished to discipline the apparently lazy. Insomuch as the ague (or malaria) exacted a high toll in seventeenth-century Europe--especially in England--it would be reasonable to assume that, with typhoid and dietary disorders, this disease caused most of the illness in Virginia. When emphasis has been placed, by authorities, upon the location of Jamestown as a disease-producing factor, the implication has often been that the swampy area was a mosquito and malaria breeding place. A number of historians have asserted that malaria produced the highest mortality figures at Jamestown. Much is also made of the tragic circumstance that the arresting agent for the disease, cinchona bark or quinine, was known on the European continent by mid-seventeenth century but that little use was made of it. Dr. Blanton, the authority on seventeenth-century Virginia medicine, in contrast argues that "there is not evidence ... that malaria was responsible for a preponderating part of the great mortalities of the Seventeenth Century in Virginia." He bases this conclusion on a number of facts: he has been able to find only five or six references to the ague (malaria) in the records of the century; because the ague was well-known he does not believe its symptoms, such as the racking chill, would have escaped notice. On the other hand, he does not doubt the presence of the ague in Virginia throughout the century even though it did not cause the most distress. As in the case of the ague, a reasonable assumption would be that the plague existed in seventeenth-century Virginia. The Great Plague of London (1665) carried away 69,000 persons, and other cities of Europe had even more disastrous epidemics. During the two years before the first settlers arrived at Jamestown, over 2000 victims were buried in London. The accounts of the ocean voyage indicate rat-infested ships. Ships of the London Company reported plague and death aboard. Virginians took pains to describe their illnesses, and there would have been little difficulty in recognizing this well-known killer. Yet little evidence of the presence of the plague appears in the seventeenth-century Virginia record; cases are reported but the number is small. Why Virginia should have been spared--especially in view of the known rat-infestation aboard ship--remains a question. The evidence relative to yellow fever, or calenture, during this period in Virginia is contradictory. Early sources do make reference to numerous deaths from it at sea and even to an epidemic of it at Jamestown before 1610, but subsequent notices are infrequent and of questionable validity. Prevalence of the disease in the earlier years and its comparative infrequency in later is not a likely circumstance because with the increase of commerce, especially from tropical ports, an increase of the disease should have followed. Smallpox, the mark of which is seen in early portraits, emerges from the colonial record with a more reasonable history. Its incidence in Virginia during the first half of the seventeenth century was small, and this might be expected in view of the fact that there were few children in the colony and that most of the adults had been infected before they left the Old World. The number of smallpox epidemics in Virginia did increase--again, as might be expected--later in the century as the number of children and of native-born unimmunized adults multiplied. Smallpox caused such a scare in 1696 that the assembly, in session at Jamestown, asked for a recess--another example of the influence of disease upon political history. Earlier, in 1667, a sailor with smallpox, if the contemporary account can be accepted, landed at Accomack and was solely responsible for the outbreak of a terrible epidemic on the Eastern Shore of Virginia. A measles epidemic during the last decade of the century may actually have been smallpox as the two diseases were often confused by contemporaries. Respiratory disorders, as has been noted, caused much distress for great numbers of early Virginians during the winter months. Influenza, pneumonia, and pleurisy must have reached epidemic proportions on numerous occasions in Virginia as elsewhere in America (influenza epidemics are recorded for New England in 1647 and in 1697-99). One note from a Virginia source for the year 1688 describes "a fast for the great mortality (the first time the winter distemper was soe very fatal... the people dyed, 1688, as in a plague... bleeding the remedy, Ld Howard had 80 ounces taken from him...)." (If "Ld Howard" gave eighty ounces, it means that he lost five pints of blood from a body that contained approximately ten--perhaps the "letting" was over an extended period.) In a century in which numerous diseases had not been identified, many, known today, must have occurred that were diagnosed in general terms. Appendicitis, unrecognized until later, must have been common, and heart disease probably went undiagnosed. Distemper, a general term, often was used when the physician could not be more specific ("curing Eliza Mayberry and her daughter of the distemper"). Other prevalent disorders were over-eating ("hee died of a surfeit"); epilepsy ("desperately afflicted with the falling sicknesse soe that he requires continuall attendance"); and the winter cold ("our little boy & Molly have been both sicke with fever & colds, but are I thanke God now somewhat better"). The continued presence of deadly disease throughout the century shows itself in the population figures for the period. Over 100,000 persons migrated to Virginia before 1700 and numerous children were born, but only 75,000 people lived in Virginia in 1700. Many returned to Europe, many emigrated to other parts of America, and Indians accounted for some deaths, but the chief reason for the decline in population was the high mortality prevailing throughout the century. Health conditions, however, did not deteriorate as the century passed. By 1671 Governor Berkeley could report generally improved health conditions; for example, newcomers rarely failed to survive the first few months, or seasoning period, which had formerly exacted such an awful toll. How much these improved conditions were due to better provisioned ships, to a better diet in Virginia, and to the movement of the settlers out from Jamestown is open to question, but in any consideration of the explanations for the promotion of health, prevention of illness, the restoration of health, and the rehabilitation of the sick, the seventeenth-century Virginia physician or surgeon must be considered. PHYSICIANS AND SURGEONS IN SEVENTEENTH-CENTURY VIRGINIA The first English medical man to set foot on Virginia soil visited the Chesapeake Bay area in 1603. Henry Kenton, a surgeon attached to a fleet exploring Virginia waters, joined the landing party that perished to a man at the hands of the Indians. Next to arrive in Virginia were the two surgeons who accompanied the first settlers in 1607 and attended their medical needs. One of these, Thomas Wotton, was classed as a gentleman, while the other, Will Wilkinson, was listed with the laborers and craftsmen, a reminder of the varied social backgrounds of surgeons. Captain John Smith complimented Wotton in the summer of 1607 for skillful diligence in treating the sick; but Edward Maria Wingfield, when council president at Jamestown, criticized him for remaining aboard ship when the need for him ashore was so great. Because of this reputed slothfulness, Wingfield would not authorize funds for Wotton to purchase drugs and other necessaries. The colony could only have suffered from such a misunderstanding. Further activities of Wotton and Wilkinson have faded into the mist of time past, but Captain John Smith recorded for posterity the names and deeds of other surgeons and physicians who came to Virginia before 1609. Dr. Walter Russell, the first physician--as distinguished from surgeon--to arrive, came with a contingent of new settlers and supplies in January, 1608. Post Ginnat, a surgeon, and two apothecaries, Thomas Field and John Harford, accompanied the physician. Also in Smith's record is the name, Anthony Bagnall, who has been identified as a surgeon and who came with the first supply. Unfortunately, neither contemporaries of Russell, Ginnat, Field, and Harford--nor the men themselves--found reason to record the medical assistance they rendered during a time of great need. Russell is remembered only for the assistance he gave Smith when the Captain was severely wounded by a stingray, Post Ginnat and the apothecaries leave their names only, and Bagnall is remembered for his part in the adventures encountered on one of Captain Smith's exploratory journeys. Russell's services to Smith deserved note because the Captain was expected to die from the stingray wound. It is an interesting comment on the medicine of the time that Smith's companions prepared his grave within four hours after the accident. "Yet by the helpe of a precious oile, Doctour Russel applyed, ere night his tormenting paine was so wel asswaged that he eate the fish to his supper." The same stingray also assured the surgeon Bagnall a place in history. Mention of Bagnall by Captain Smith followed the surgeon's exploits on another expedition when he went along to treat the Captain's same stingray wound. The party, attacked by savages, shot one Indian in the knee and "our chirurgian ... so dressed this salvage that within an hour he looked somewhat chearfully and did eate and speake." How unfortunate that other exploits of these physicians and surgeons, not involving Captain Smith--or the stingray--did not cause him to make a record. Dr. Lawrence Bohun, however, who accompanied Lord De la Warr to the colony in 1610, evoked comments of a more general nature in the accounts of contemporaries. Dr. Bohun ministered to the settlers who had been ready to abandon Jamestown in 1610. A letter from the governor and council to the London Company, July 7, 1610, describes his problems and his efforts to meet them. Insomuch as the letter gives one of the fullest accounts of early Jamestown medical practices and because Bohun is one of the most renowned of seventeenth-century Virginia physicians, it deserves a lengthy quotation: Mr. Dr. Boone [Bohun] whose care and industrie for the preservation of our men's lives (assaulted with strange fluxes and agues), we have just cause to commend unto your noble favours; nor let it, I beseech yee, be passed over as a motion slight and of no moment to furnish us with these things ... since we have true experience how many men's lives these physicke helpes have preserved since our coming, God so blessing the practise and diligence of our doctor, whose store has nowe growne thereby to so low an ebb, as we have not above 3 weekes phisicall provisions; if our men continew still thus visited with the sicknesses of the countrie, of the which every season hath his particular infirmities reigning in it, as we have it related unto us by the old inhabitants; and since our owne arrivall, have cause to feare it to be true, who have had 150 at a time much afflicted, and I am perswaded had lost the greatest part of them, if we had not brought these helpes with us. Dr. Bohun sought medical supplies from abroad, but he also experimented with indigenous natural matter such as plants and earths in an effort to replenish his dwindling supplies and to discover natural products of value in the New World. Judging by a contemporary account, Bohun, professionally trained in the Netherlands, used drugs therapeutically according to the conventional theories of the humoral school. Despite the disfavor in which frequent purgings are held today, it must be allowed that those being treated then sounded a plaintive call for more of Bohun's "physicke." The colony lost his services when he left to accompany Lord De la Warr to the West Indies. His connection with the London Company and its colony did not lapse, however, for Bohun received an appointment as physician-general for the colony in December, 1620. At sea, on the way to fill his post, the physician-general found his ship engaged with two Spanish men-of-war. In the course of battle, an enemy shot mortally wounded the man who had survived great hazards at Jamestown. After the departure of Bohun with Lord De la Warr, no physician or surgeon of equal stature or reputation took up residence in Virginia until Dr. John Pott arrived almost ten years later. It is likely that there was a shortage not only of outstanding medical men during these years, but also of medical assistance in general. Sir Thomas Dale, acting as deputy governor in the absence of De la Warr, wrote in the spring of 1611 that "our wante likewise of able chirurgions is not a little." Other requests for physicians and for apothecaries were dispatched to the London Company during this period. However, despite the seeming shortage of medical assistance, the colonists survived such disorders as the summer seasoning much more frequently than in the first years at Jamestown. An account of Virginia written between 1616 and 1618 noted of the settlers that: They have fallen sick, yet have recovered agayne, by very small meanes, without helpe of fresh diet, or comfort of wholsome phisique, there being at the first but few phisique helpes, or skilful surgeons, who knew how to apply the right medecine in a new country, or to search the quality and constitution of the patient, and his distemper, or that knew how to councell, when to lett blood, or not, or in necessity to use a launce in that office at all. Bohun died in March, 1621, and the Company named his successor as physician to the colony in July. The conditions under which Dr. John Pott accepted the post reveal the qualifications and needs of the seventeenth-century medical man on his way to the New World, and the inducements offered by the Company. He was a Cambridge Master of Arts and claimed much experience in the practice of surgery and "phisique." In addition, he made much of his expertness in the distilling of water. The company allowed Pott a chest of medical supplies, a small library of medical books, and provisions for the free passage of one or more surgeons if they could be secured. Additional economic inducements helped persuade Pott--and other physicians--to make the arduous journey to America. In the eyes of the Company, physicians could render especially valuable services to the colony, and ranked with other persons of extraordinary talent such as ministers, governors, state officers, officers of justice, and knights. These individuals received special compensations in the form of land and profits, in accord with the estimated value of services to be rendered. In 1620, Dr. Bohun had had a promise--for taking the position of physician-general for the colony--of an allotment of 500 acres of land and ten servants; Pott accepted the job under about the same conditions as had Bohun. These inducements offered physicians to persuade them to go to Virginia indicate the great need for, and the high value attached to, their assistance in the seventeenth century. With the population in the colony growing so great Dr. Pott's services were in considerable demand; several years after his arrival a certain William Bennett built the doctor a boat as he by then had a relatively large area to cover and most of the outlying plantations stood on the rivers and creeks. In the colony, Pott won recognition for his professional proficiency. Even a political enemy, Governor Harvey, described him as skilled in the diagnosis and therapy of epidemic diseases. Because he alone in the colony was considered capable of treating epidemic diseases, a court sentence against him for cattle theft stood suspended early in the 1630's and clemency was sought on his behalf. Pott had become involved in other legal difficulties before 1630. In 1625, a case having medical and humorous implications brought him into court. A Mrs. Blany maintained that Doctor Pott had denied her a piece of hog flesh, and that his refusal had caused her to miscarry. The court accepted Mrs. Blany's contention that she believed the denial of the hog flesh caused her distress, but did not hold Pott guilty of willful neglect. Since the biographical material on Pott's non-professional life reveals so many intellectual and political interests, it would be surprising if he had not occasionally neglected his medical practice. He gave considerable time to the colony's administration and he served in 1629 as the elected temporary governor of the colony after having previously been on the governor's council. His activities in politics and affairs brought him political enemies and explain, in part, the cattle theft charge and the court's finding of "guilty" (although this was later found "rigorous if not erroneous"). He died in 1642, having been intimately involved in the life of the colony for twenty years. Pott was the last of the outstanding figures who practiced medicine under the direction of the Company, but Dr. Wyndham B. Blanton has found mention of over 200 persons who served as physicians or surgeons during some portion of the century. With only one exception, however, none of these achieved as prominent a place in history as Bohun, Russell, or Pott. Not only is the number of outstanding individuals in the field of medicine less, but the general quality of medical practice, in the opinion of Dr. Blanton, was not as high again during the last three-quarters of the seventeenth century as it had been during the administration of the Company (1607-1624) when Virginia medicine included a representative cross-section of English medicine. Any survey--no matter how brief--of the medical profession during the century, however, should include mention of a man who, although not a full-time professional physician, proves to be the exception to Dr. Blanton's generalization about the prominence of individual medical men and the quality of medical practice during the late 1600's. This man, the Reverend John Clayton, is a noteworthy example of the intellectual level an individual could attain and maintain while living in an area that was still remote from European civilization. Clayton, who is known to have been at Jamestown between 1684 and 1686 as a clergyman, also practiced medicine in addition to pursuing his scientific interests. As a prolific writer he has left some of the fullest and most interesting accounts of contemporary treatment and diagnosis. His knowledge and methods cannot be taken as typical, however, because his intellectual level was considerably above the average in the colony. This minister-scientist-physician wrote an account of his treatment of a case of hydrophobia resulting from the bite of a rabid dog. With its accomplished style, Clayton's account of his treatment of hydrophobia is worthy of attention as an example of contemporary theory and practice of the more learned kind. He wrote: It was a relapse of its former distemper, that is, of the bite of the mad-dog. I told them, if any thing in the world would save his life, I judged it might be the former vomit of volatile salts; they could not tell what to do, nevertheless such is the malignancy of the world, that as soon as it was given, they ran away and left me, saying, he was now certainly a dead man, to have a vomit given in that condition. Nevertheless it pleased God that he shortly after cried, _this fellow in the black has done me good_, and after the first vomit, came so to himself, as to know us all. Subsequently, Clayton "vomited him" every other day and made him take volatile salt of amber between vomitings. The patient also drank "posset-drink" with "sage and rue," and washed his hands and sores in a strong salt brine. Cured by the "fellow in the black," the patient had no relapse. Clayton reveals more of his medical theory in another passage from his writings. He observed: In September the weather usually breaks suddenly, and there falls generally very considerable rains. When the weather breaks many fall sick, this being the time of an endemical sickness, for seasonings, cachexes, fluxes, scorbutical dropsies, gripes, or the like which I have attributed to this reason. That by the extraordinary heat, the ferment of the blood being raised too high, and the tone of the stomach relaxed, when the weather breaks the blood palls, and like overfermented liquors is depauperated, or turns eager and sharp, and there's a crude digestion, whence the name distempers may be supposed to ensue. In this passage Clayton's medical theory resembles closely the orthodox medical beliefs of the century. The great English practitioner Sydenham, for example, emphasized the relationship between the weather and disease. Also the analogy between the behavior of blood and wine was then conventional, and the supposed connection between the "sour" blood and indigestion with the resulting acid humors is in accord with Galenism. The remedy--and a most logical one--was medicine to combat the acidity and to restore the tone or balance to the stomach. Acid stomach has a long history. The reasonableness of Clayton's pathology is impressive, but reason did lead to some bizarre--in the light of present-day medical knowledge--conclusions. Aware of the value to the scientist of close observation and of the necessity to reason about these observations, Clayton was in the finest seventeenth-century scientific tradition. Observing a lady--for example--suffering from lead poisoning, he noted that her distress, judging by her behavior, varied directly with the nearness and bigness of the passing clouds; the nearer the clouds, the more anguished her groans. Reason dictated to Clayton that such a phenomenon stemmed from a cause-effect relationship. Although the twentieth-century physician would deny the cloud-suffering association, he would not deny Clayton's propensity for observation and his attempts to discern relationships. The approach of the better seventeenth-century Virginia physician can be labeled scientific even if his facts were few. DRUGS AND OTHER REMEDIES No seventeenth-century physician could function without a variety of drugs (medicines) to dispense. Dr. Pott made special arrangements--for example--to have a chest of drugs transported with him from England to America, and the effectiveness of Dr. Bohun's "physicke" drew the praise of the colonists. Drugs were essential to the physician and a valuable commodity for export, as well. The subject of drugs must then include a discussion of their use as medicines and their importance as items of trade. A study of the drugs in use and the occasions of their utilization makes manifest the great part that freeing the body from corrupting matter played in the treatment of disease. The theorists and clinical physicians of the century placed such faith in the humoral doctrine that, on the basis of this predilection, much of the opposition to cinchona, or quinine, in a period greatly troubled by malaria, can be explained. Cinchona, discovered in Spanish America and known in seventeenth-century Europe, had demonstrable effects in the treatment of malaria but, because it was an additive rather than a purgative, physicians rejected it on theoretical grounds. Its eventual acceptance later revolutionized drug therapeutics, but this revolution did not affect seventeenth-century Virginia. The emphasis that the contemporary medical men placed upon the purging of the body--the vomiting, sweating, purgings of the bowels, the draining, and the bleeding--cannot be considered irrational or quaint. In the light of observation and common sense, to purge seemed not only reasonable and natural but in accord with orthodox doctrine as well. Observation revealed that illness was frequently accompanied by an excess of fluid or matter in the body, as in the case of colds, respiratory disorders, swollen joints, diarrheas, or the skin eruptions that accompanied such epidemic diseases as the plague or smallpox. Common sense dictated a freeing of the body of the corrupt or corrupting matter; drugs were a means to this end. The use of drugs for vomiting, sweating, and other forms of purging seems excessive in the light of present-day medical knowledge, and at least one seventeenth-century Virginia student of medicine also found such use of drugs by his contemporaries open to criticism. In the opinion of the Reverend John Clayton, Virginia doctors were so prone to associate all drugs with vomiting or other forms of purging that they even thought of aromatic spirits as an inferior "vomitive." He concluded that these physicians would purge violently even for an aching finger: "they immediately [upon examining the patients] give three or four spoonfuls [of _crocus metallorum_] ... then perhaps purge them with fifteen or twenty grains of the rosin of jalap, afterwards sweat them with Venice treacle, powder of snakeroot, or Gascoin's Powder; and when these fail _conclamatum est_." The list of drugs used was extensive and each drug had a considerable literature written about it explaining the various sicknesses and disorders for which it was a curative. Libraries of the Virginia physicians and of the well-to-do laymen usually included a volume or two on the use of drugs. Among the most popular plants, roots, and other natural products were snakeroot, dittany, senna, alum, sweet gums, and tobacco. Dittany drove worms out of the body and would also produce sweat (sweating being another popular method of purging the body of disease-producing matter). The juices of the fever or ague-root in beer or water "purgeth downward with some violence ... in powder ... it only moveth sweat." (Following Galen's system of classifying by taste, this root was bitter, therefore thought dry. The physician would administer such a drying agent when attempting to reduce excess moistness in the body--and thus restore normal body balance, in accord with contemporary humoral theory.) Snakeroot, another of the popular therapeutics, increased the output of urine and of perspiration; black snakeroot, remedying rheumatism, gout, and amenorrhea, found such wide usage during the last half of the seventeenth century that its price per pound in Virginia on one occasion rose from ten shillings to three pounds sterling. Although King James I of England saw much danger in tobacco, others among his subjects attributed phenomenal curative properties to it. One late sixteenth-century commentator on America recommended it as a purge for superfluous phlegm; and smokers believed it functioned as an antidote for poisons, as an expellant for "sour" humors, and as a healer of wounds. Some doctors maintained that it would heal gout and the ague, act as a stimulant and appetite depressant, and counteract drunkenness. The full significance of these drugs in the medicine of the period can be better appreciated by reference to a prescription for their use, in this instance a remedy for rickets, thought typical by historian Thomas Jefferson Wertenbaker: Dip the child in the morning, head foremost in cold water, don't dress it immediately, but let it be made warm in the cradle & sweat at least half an hour moderately. Do this 3 mornings ... & if one or both feet are cold while other parts sweat let a little blood be taken out of the feet the 2nd morning.... Before the dips of the child give it some snakeroot and saffern steep'd in rum & water, give this immediately before diping and after you have dipt the child 3 mornings. Give it several times a day the following syrup made of comfry, hartshorn, red roses, hog-brake roots, knot-grass, petty-moral roots; sweeten the syrup with melosses. But drug therapy was not always as simple as that recommended for rickets, although the evidence is that in Virginia the high cost of importing the rarer substances inclined local physicians toward the less elaborate compounds. Venice treacle, recommended by the Reverend Clayton's imaginary purge enthusiast consisted of vipers, white wine, opium, licorice, red roses, St. John's wort, and at least a half-dozen other ingredients. Because their use was so extensive in Europe and because many brought a good price, any discussion of drugs in seventeenth-century Virginia should take note of the efforts in the colony to find locally the raw materials for the drugs both for use in Virginia and for export. The London Company actively supported a program to develop the drug resources of the New World, and the hope of finding them had originally been one of the incentives for the colonization of Virginia. Even as early as the sixteenth century, authors and promoters in England of the American venture had held up the promise of a profitable trade in drugs--sassafras, for example--as a stimulus for exploration and colonization. Sassafras had market value as it was widely used in cases of dysentery, skin diseases, and as a stimulant and astringent; French warships searching for loot off the shores of the New World had often made it the cargo when richer prizes were not to be had. Like gold, sassafras diverted labor during the crucial early period at Jamestown from the tasks of building and provisioning. Sailors and settlers, both, took time off to load the ships with the drug which would bring a good price in England. The belief that the exporting of drugs would prove profitable for the colony in Virginia and for the Company may explain why two apothecaries accompanied the second group of immigrants who arrived in 1608. Someone had to search out and identify possible drugs, and a layman could not be expected to perform a task requiring such specialized knowledge. The apothecaries could further serve the new settlement by helping to supply its medicinal needs. Before the drug trade in Virginia could be developed, and at the same time adapted to the over-all needs of the colony, attention had to be given to the use of drugs to meet the immediate needs of the settlers. Dr. Bohun, who had brought medical supplies in 1610 and soon found them exhausted, turned resourcefully to an investigation of indigenous minerals and plants. He investigated earths, gums, plants, and fruits. A white clay proved useful in treating the fevers (the clay of the Indians used for "sicknesse and paine of the belly"?); the fruits of a tree similar to the "mirtle" helped the doctor to face the epidemics of dysentery. The colonists also needed a wine which could be produced cheaply and locally. Many of them, accustomed to beer and wine regularly, complained of having to rely upon water as a liquid refresher. According to one of their number, more died in Virginia of the "disease of their minds than of their body ... and by not knowing they shall drink water here." One enterprising alchemist and chemist offered to sell the London Company a solution for this problem: the formula of an artificial wine to be made from Virginia vegetables. After the colony seemed no longer in danger of perishing from its own sicknesses--or going mad from having to drink water--the Company urged the settlers to develop an active trade in medicinal plants, in order to help cure the diseases of England and the financial ills of the Company. The London Company, in a carefully organized memorandum, advised the colonists what plants had export value and how these plants should be prepared for export: 1. Small sassafras rootes to be drawen in the winter and dryed and none to be medled with in the sommer, and it is worthe 50 lb. and better per tonne. 2. Poccone to be gotten from the Indians and put up in caske is worthe per tonne 11 lb. 4. Galbrand groweth like fennell in fashion, and there is greatest stoare of it in Warriscoes Country, where they cut walnut trees leaste. You must cut it downe in Maye or June, and beinge downe it is to be cut into small peeces, and brused and pressed in your small presses, the juice thereof is to be saved and put into casks, which wilbe worthe here per tonne, 100 lb. at leasts. 5. Sarsapilla is a roote that runneth within the grounds like unto licoras, which beareth a small rounde leafe close by the grounds, which being founde the roote is to be pulled up and dryed and bounde up in bundles like faggotts, this is to be done towards the ende of sommer before the leafe fall from the stalk; and it is worthe here per tonne, 200 lb. 6. Wallnutt oyle is worth here 30 lb. per tonne, and the like is chestnutt oyle and chechinkamyne oyle. The Company's plan for the gathering, storing, and shipping of drugs was supplemented by a project indicating foresight and an early form of experimental research for the development of new products. In 1621 it planned thorough tests of an earth sent from Virginia in order to determine its value as a cure for the flux. In addition, the Company planned to test all sweet gums, roots, woods, and berries submitted by the colonists in order to ascertain their medicinal values. In regard to the sale and dispensing of drugs in Virginia, whether found locally or imported, frequent references to the apothecary supplies and utensils in the possession of Virginia physicians lead to the conclusion that they were usually their own druggists. As has been noted, the sale and dispensing of drugs usually culminated in their use--in accordance with the theory of the period--as means of purging the body. Drugs, however, did not have a monopoly in this greatly emphasized aspect of medical practice because the clyster (purging of the bowels, or enema) and phlebotomy (bleeding of the vein) could be used as well. These two methods might be classified as mechanical in nature as contrasted with the essentially chemical action of the drugs. Molière, in his seventeenth-century satires on the European medical profession, ridicules the excessive use of the clyster. The popularity of the phlebotomy then is attested to by the notoriety of this technique today. (Rare is the schoolboy who does not think that George Washington was bled to death.) There is no reason to doubt that the clyster and phlebotomy enjoyed as wide usage in colonial Virginia as in Europe, but the evidence surviving to prove this assumption is slight. Dr. Blanton, the historian of medicine, could find only meager references to the use of clyster (or glyster) and he sums them up as follows: Among the effects of Nathaniel Hill was '1 old syringe.' In York County records we find that Thomas Whitehead in 1660 paid Edmond Smith for '2 glysters.' George Wale's account to the estate of Thomas Baxter in 1658 included a similar charge. George Light in 1657 paid Dr. Modè fifty pounds of tobacco for 'a glister and administering.' John Clulo, Francis Haddon and William Lee each presented bills for similar services. The survival of such meager evidence for what was probably a common practice indicates the difficulties confronting the historian of medicine. Nor has Dr. Blanton been able to find, as a result of his research, any more evidence of phlebotomy although, again, its utilization must have been widespread. Blanton sums up his evidence for bleeding as follows: Dr. Modé's bill to George Light includes 'a phlebothany to Jno Simonds' and 'a phlebothany to yr mayd.' Dr. Henry Power twice bled Thomas Cowell of York County in 1680, and Patrick Napier twice phlebotomized 'Allen Jarves, deceased, in the cure of a cancer of his mouth.' Colonel Daniel Parke in 1665 rendered John Horsington a bill for 'lettinge blood' from his servant; and we find Dr. Jeremiah Rawlins and Francis Haddon engaging in the same practice. The horoscope often determined the proper time for bleeding and notations have been found in an early American Bible recommending the days to, and not to, bleed. Although medicine today looks askance at astrological medicine and bloodletting, it remains difficult to explain the widespread popularity of such practices unless the patients enjoyed some beneficial results, psychological or physical. Drug therapeutics, clysters, and bloodletting did by no means exhaust the seventeenth-century physician's treatments and remedies. The works of European painters of the century remind us of uroscopy or urine examination. One of the outstanding paintings illustrating the technique is by artist Gerard Dou who has the young doctor intently examining the urine flask while taking the pulse of a pretty young lady. Unfortunately, such revealing pictorial representations of life and medicine in colonial Virginia do not exist. On the other hand, in Virginia, the Reverend John Clayton displayed a distinct flair for the scientific method in his analysis of urine. It is safe to assume that his techniques were of a higher order than those usually associated with uroscopy. Clayton, not satisfied to practice just the art of observation, utilized the science of comparative weights hoping to find diseases distinguished by minute variations in the specific gravity of the liquid. He thought he could find manifestations of "affections in the head" by his careful weighing and study; manifestations not uncovered by visual observations alone. In Gerard Dou's painting, it is to be remembered, the doctor not only examined the urine but also took the pulse--another common practice. This is not surprising insomuch as Galen--the great and ancient authority--had written enough to fill sixteen books on the subject of "pulse lore." Despite the facts that physicians centuries later continue to take the pulse, they would not find the theories behind the seventeenth-century practice acceptable. Galen's deductions have since been described as fantastic, and his attempt to associate a specific type of pulse rate with every disease futile. Yet the Virginia physician, when he did take his patient's pulses, certainly did not lose his or her confidence by gravely considering the mysterious palpitation. The physician with his many techniques and remedies did not restrict himself solely to the illnesses of the sane for--contrary to popular belief today--some effort was made to treat and cure the mentally ill. America's first insane asylum was not established until 1769, but the insane had received, even before this, medical attention. If the case did not respond to treatment and took a turn toward violence, confinement under conditions that would now be considered barbarous often resulted. Before this extreme solution of an extreme problem recommended itself, however, the mentally ill might be purged. The intent was to relieve the patient of insanity-producing yellow and black bile. The belief that this type of sickness would respond to conventional treatment, however, did not completely dominate the theories on insanity; some seventeenth-century authorities considered insanity not an illness but an incurable, disgraceful condition. One of the fullest accounts of a case of insanity in seventeenth-century Virginia describes the plight of poor John Stock of York who kept "running about the neighborhood day and night in a sad distracted condition to the great disturbance of the people." The court authorities ordered that Stock be confined but provided such "helps as may be convenient to looke after him." The court, in a sanguine mood, anticipated the day when Stock would be in a better condition to govern himself. HOUSING OF THE SICK If the doctor, surgeon, or nursing persons could come to the patient's home, little advantage could have been obtained in the seventeenth century by moving the patient. The need did arise, however, to care for persons outside the home. For example, an individual without family or close friends might find it more convenient to move in with those who would care for him on a professional basis, or newly arrived immigrants and transients might need housing. Quite in harmony with the needs of the period were the men and women willing to take in a sick person in order to supplement their incomes. Illness forced one colonial Virginian to offer in 1686 to grant his plantation and his home to the person who would provide a wholesome diet, washing, and lodging for him and his two daughters. The beneficiary was also to carry the sick man to a doctor and to pay all of his debts. It is probable that the man provided these services only on this particular occasion, but by such special arrangements the century housed its sick. The number of ill persons provided for by relatives under similar arrangements or even without any compensation, must have been even greater in a period without hospitals and nursing homes. On occasions, in the seventeenth century, the physician took the patient into his own home, but not always without some reluctance. Dr. Wyndham B. Blanton, in his search of the Virginia records for this century, found an interesting account of Dr. George Lee of Surry County, Virginia, who in 1676 had an unfortunate experience in letting accommodations to a pregnant woman. Living in a house she considered open and unavoidably cold, and having only one old sow for food, the sick and feverish woman pleaded with the doctor to take her to his home for the lying-in period. The doctor argued that the house could be made warmer, suggested that neighbors bring in food, and protested that he had only one room fit for such occupancy and that he and his wife used it. Dr. Lee said he would not give up the room for anyone in Virginia. Offering the opinion that the room was large enough for her, Dr. Lee, and his wife, the expectant mother had her servant take her by boat to Lee's where she remained, taking great quantities of medicine, until she delivered. The doctor then had to bring suit to collect his fees. Another example of a medical man's housing the sick, is that of a surgeon promised 2,000 pounds of tobacco and "cask" if he cured the blindness of a person he had housed--but only modest compensation if he failed. The same surgeon received 1,000 pounds of tobacco in 1681 by order of the vestry of Christ Church parish for keeping "one Mary Teston, poore impotent person." Much earlier, Virginia had what some authorities consider to be the first hospital built in America. While the colony was still under the administration of the London Company (1612), a structure was erected near the present site of Dutch Gap on the James river to house the sick. The hospital, which had provisions for medical and surgical patients, stood opposite Henrico, a thriving outpost of the settlement of Jamestown. Evidence that the building was primarily designed for the sick and was not simply a public guest house is to be found in the statements of contemporaries. One described it as a "retreat or guest house for sicke people, a high seat and wholesome air," while another wrote that "here they were building also an hospitall with fourscore lodgings (and beds alreadie sent to furnish them) for the sicke and lame, with keepers to attend them for their comfort and recoverie." The use of the word "hospital," which had then a general sense, does not indicate any similarity to a present-day hospital as does the other information. Nothing more appears about this establishment for the sick and wounded, and it may well have been destroyed during the Indian uprising of 1622. Plans for similar institutions in each of the major political and geographical subdivisions of the colony came from the London Company. Unlike the Henrico structure, these buildings bore the name "guest house" and were to harbor the sick and to receive strangers. Specifications called for twenty-five beds for fifty persons (which was in accord with custom in public institutions); board partitions between the beds; five conveniently placed chimneys; and windows enough to provide ample fresh air. The Company repeatedly recommended and urged the construction of these guest houses not only as a retreat for the sick but also as a measure to prevent illness among the newcomers. In addition, the guest houses, if they had been built, would have saved the old settlers from being exposed to the diseases of the new arrivals who were taken into private homes. The colonists always had some excuse for delaying construction, and the Company in 1621 entreated to the effect that it could not "but apprehend with great grief the sufferings of these multitudes at their first landing for want of guest houses where in they might have a while sheltered themselves from the injuries of the air in the cold season." That the London Company should have had the Henrico hospital built during its administration and made plans for the guest houses can be explained by the situation existing during the earlier days of the colony. The Company, engaged in a commercial venture and realizing by its own statement that "in the health of the people consisteth the very life, strength, increase and prosperity of the whole general colony," had sufficient reason to shelter and care for the colonists. Also, during the early days the number of incoming colonists was high relative to the number settled and with lodging to give or to let. The Company, in addition, knew that new arrivals fell victim most easily to seasoning and other maladies, and needed protection from the elements. Finally, the Company had to fill the void created by the absence of religious orders which, during prior European colonization and occupation of distant lands, had provided shelter and care. These hospitals are no longer mentioned after the dissolution of the London Company, nor were any other comparable measures taken during the century to institutionalize care for the sick. SURGICAL PRACTICE Much has been made of the lower status held by the surgeon as compared with that of the physician--during the seventeenth century. On the continent and in England, at this period, membership in separate guilds in part distinguished doctor and surgeon; in England, after 1540 and until 1745, surgeons held common membership with barbers in one corporate organization. In America, historians agree, the differences based on specialization of practice between surgeons and physicians soon tended to disappear, a superior education often being the only attribute or function of a physician not shared by the surgeon. Barbers held a unique position, but in performing phlebotomies, a minor operation, they retained associations with health and disease. Both barber and surgeon shared a certain expertness with tools, as they do today. Evidence abounds in the earlier records that the scarcity of medical men may have compelled surgeons in Virginia to practice internal medicine: surgeons prescribed medicine with the same frequency as doctors. The surgeons, however, did not abandon the treatment of wounds, fractures, and dislocations; notes on amputations during the century also exist. Nor is it reasonable to assume that the isolated physician of the Virginia countryside would always insist upon referring a patient to a surgeon. Dr. Francis Haddon, who had a large practice in York County, Virginia, and who is not identified as a surgeon, left recorded the course of treatment for an amputation--cordials, a purge, ointments, and bloodletting--and a dismembering saw, as well. Other recorded surgical treatments include care of dislocated shoulders; wounds in various parts of the body; sores of the feet and legs; cancerous ulcers in the instep; ulcers of the throat, and dueling wounds. One of the most unusual surgical measures of the period was the application of weapon salve for battle wounds; the salve was applied to weapon, not wound. Surgery has long been associated with the military, and much of the outstanding surgical work done in Europe during the fifteenth and sixteenth centuries was performed by military surgeons. Ambroise Paré (c. 1510-1590), remembered especially for the use of the ligature in amputations and the abandonment of the burning-oil treatment of wounds, held a position as a surgeon for the French army. Other surgeons of the period contributed to the improvement of medical practice by enlightened measures of quarantine to prevent contagious diseases from decimating armies. Insomuch as the first settlers at Jamestown greatly feared attack from Indians and Spaniards and because the initial landings had the character of a military expedition, it is not surprising that the first two medical men to arrive, Will Wilkinson and Thomas Wotton, were surgeons. Captain John Smith on three occasions, it is to be remembered, emphasized the importance of the surgeon to pioneer settlers and explorers in the New World. When injured by the stingray in 1608, Smith's first thought was of his need for a surgeon and "chirurgery"; so the success of physician Russell's soothing oils came as a pleasant surprise. On a subsequent expedition he included the surgeon, Anthony Bagnall, rather than Dr. Russell, to treat the stingray wound; and in 1609 when he received the powder burn, he left Virginia "seeing there was neither chirurgeon nor chirurgery in the fort to cure his hurt." Throughout the century surgeons rendered services to colonists engaged in fighting with, or defending themselves against, the Indians. When the Indian massacre of 1622 occurred, costing the lives of more than 350 colonists in the settlements, it is possible that the two surgeons who sailed to Virginia with Dr. Pott in 1621 gave assistance to the wounded. In 1644, when a retaliatory attack on the Indians was made by the settlers because of a recent massacre, the General Assembly provided for a surgeon-general to accompany the militia, at public expense. Again, later in the century, the General Assembly gave evidence of recognizing the importance of surgical care for soldiers when it voted for supplying a surgeon with "a convenient supply of medicines & salves, etc. to the value of five pounds sterling for every hundred men" to each of eight forts planned to protect the settlements against Indian attacks. Throughout the last half of the century references were made to surgeons ministering to companies of soldiers or to various garrisons and forts. Judging by the consistent employment of surgeons for military duties, it would appear that the profession of surgeon during the century was much more intimately associated with the military than was that of physician. The relationship between the surgeon and the military is similar to the early one between civil engineer and the army in Europe. HYGIENE The restoration of the patient to health is not the only important aspect of medical practice; the prevention of illness is also vital to the health of a community. Much more attention is given to preventive medicine in the twentieth century than in the seventeenth, but the value of cleanliness, fresh air, and quarantine was known. Hygienic measures taken, or recommendations made, by public authorities make clear the fact that the cause of disease was not commonly thought to be supernatural by the educated and responsible. Contemporary accounts make known the widespread disapproval of foul ships, crowded quarters, marshy land, stagnant air, bad food and drink, excessive eating, and exposure to a hot sun. Lord De la Warr laid down regulations for Jamestown designed to eliminate the dangers of dirty wash water ("no ... water or suds of fowle cloathes or kettle, pot, or pan ... within twenty foote of the olde well"); and of contamination from sewage ("nor shall any one aforesaid, within lesse than a quarter of one mile from the pallisadoes, dare to doe the necessities of nature"). The order argued that if the inhabitants did not separate themselves at least a quarter of one mile from the palisaded living area that "the whole fort may be choaked, and poisoned with ill aires and so corrupt." The colonists by the same order had to keep their own houses and the street before both sweet and clean. Any doubt that an awareness existed of the dangers of infection by contact, at least from diseases with observable bodily symptoms, should be dispelled by the quarantine measures taken by the colonel and commander of Northampton County in 1667 during an epidemic of smallpox. He ordered that no member of a family inflicted with the disease should leave his house until thirty days after the outbreak lest the disease be spread by infection "like the plague of leprosy." Enlightened authorities in Europe took similar precautions. CHAPTER FOUR Education, Women, Churchmen, and The Law THE PLACE OF WOMEN IN MEDICINE Women played a part in treating and caring for the ill and distressed in a number of ways during the century. A few women dispensed medicine and enjoyed reputations as doctors, but it was in the field of obstetrics and as midwives that they made their most important contributions. Although women did what might be described generally as nursing, their contribution in this area was relatively insignificant when compared with the importance of the female nurse today. Any discussion of the place of women in seventeenth-century medicine should note the relationship between women, witchcraft, and medicine. Although the references leave no doubt of the existence of female doctors and dispensers of medicines, the mention of them is infrequent. Mrs. Mary Seal, the widow of a Dr. Power, for example, administered medicine to Richard Dunbar in 1700. The wife of Edward Good was sought out in 1678 to cure a head sore and another "doctress" impressed the Reverend John Clayton, who had some insights into medical science himself, with her ability to cure the bite of a rattlesnake by using the drug dittany. In the same year that Good's wife was sought to treat the head sore, a Mrs. Grendon dispensed medicine to an individual who had injured his eyes in a fight. The exact status of these women, however, is unknown; it is highly unlikely that the female practicing medicine enjoyed the professional standing of a Dr. Pott or a Dr. Bohun--an old female slave also appears in the record as a doctor. With medical knowledge limited and antisepsis unknown, the expectant mother of the seventeenth century fared better with a midwife than she would have with a physician. The midwife, whose training consisted of experience and apprenticeship at best, allowed the birth to be as free from human interference as possible and did not do a pre-delivery infection-producing examination. Both the fees and the prestige of the midwife, judging by contemporary records from other colonies, were high. Unfortunately, the early Virginia sources throw little light on the activities of the midwife in this colony. Among the scattered references from Virginia records are found charges of 100 pounds of tobacco for the service of a midwife; the presence of two midwives assisted by two nurses and other women at a single birth; the payment of twelve hens for obstetrical services; and the delivery of a bastard child by a midwife. Nursing duties were probably taken on by both men and women in addition to their regular occupations. The duties consisted not only of tending the sick--and there is no reason to believe this was done under the supervision of a physician--but also of burying the dead and arranging the funerals. While the patient lived, the nurse prepared food, washed linen, and did other chores to make the patient comfortable. When death came, the nurse was "the good woman who shall dress me and put me in my coffin," and who provided "entertainment of those that came to bury him with 3 vollys of shott & diging his grave with the trouble of his funeral included." The medical ramifications of witchcraft have been suggested. One of the most interesting Virginia court cases of the century had as its principal subject a woman accused of the power to cause sickness. In an age when weapon salve was wiped on the weapon and not the wound, and when astrology was intimately associated with the practice of medicine, it is not surprising to find, also, the witch and her power to cause disease. Goodwife Wright stood accused of such powers in the colony's general court on September 11, 1626. Goodwife Wright had caused, according to her accusers, the illness of a husband, wife, and child out of a spirit of revenge; and she was able to prophesy deaths as well. The details of the case brought against this woman accused of witchcraft reveal the more bizarre medical practices of the time. Goodwife Wright expected to serve as the midwife but the expectant mother refused to employ her upon learning that Wright was left-handed. Soon after affronting Wright in such a manner, the mother complained that her breast "grew dangerouslie sore" and her husband and child both fell sick within a few weeks. With circumstantial evidence of this kind, suspicion had little difficulty in linking the midwife with the sicknesses. Testimony revealed that on another occasion she had used her powers to counter the actions of another suspected witch. Having been informed that the other witch was causing the sickness, Wright had the ill person throw a red-hot horseshoe into her own urine. The result, according to witnesses was that the offending witch was "sick at harte" as long as the horseshoe was hot, and the sick person well when it had cooled. CHURCHMEN AND MEDICINE Medicine was associated in many minds not only with the powers of evil but also with the forces for good. The clergyman in colonial America often practiced medicine, and the layman in some localities of Virginia could turn to the local parson for medical assistance. Throughout the early Christian era and the medieval period, medicine and religion had had a close relationship. The New Testament had numerous references to the healing of the sick by spiritual means, and a casual relationship between sin and physical affliction had been assumed by many persons for centuries before the seventeenth. The hand of God was still seen by many in physical phenomena, whether disease or the flight of a comet. Not only was there a supernatural relationship seen between the God of the church and disease, but also a natural one between medicine and the church clergy, for they had staffed the medical schools for centuries. It is not surprising, then, that the parson-physician was no stranger to the Virginia colony. As early as 1619, Robert Pawlett, known to be a preacher, surgeon, and physician, came to Virginia. He was followed by other parson-physicians in Virginia and in other colonies. As late as the end of the eighteenth century, the wife of George Washington called on the Reverend Greene, M.D., for medical advice. Among the most interesting in this long tradition of ministers who practiced medicine is the Reverend John Clayton whose activities have been noted. Other persons residing in Virginia and combining the role of clergyman with a considerable interest in medicine were Nathaniel Eaton, who had a degree in medicine, and John Banister who was an active naturalist. As a naturalist, he made an important study of the plants of Virginia (_Catalogue of Virginia Plants_) which added to the literature available for the dispenser of medicinal drugs. One of the founders of Presbyterianism in America, the Reverend Francis Makemie, who came to America in 1681 and died in Accomack County, Virginia, was described as a preacher, a doctor of medicine, a merchant, an attorney--and a disturber of government by the governor of New York. LAW AND MEDICINE Although the Crown did not follow the lead of the Company in providing care for the sick and unsheltered, the authorities after 1624 did have the state take an interest in medicine to the extent of passing laws dealing with medical problems and situations. These laws were primarily concerned with the collection and charging of fees, but also provided for the censure of the physician or surgeon neglecting his patient. On four occasions during the century the Assembly attempted to regulate the excessive and immoderate rates of physicians and surgeons. The chief example used to convey the injustice of fees for visits and drugs was that many colonists preferred to allow their servants to hazard a recovery than to call a medical man. Although an inhumane attitude, the colonists reasoned that the physician or surgeon would charge more than the purchase price of the servant. The act of 1657-58 reveals this attitude and throws some light on the medical practice of the century. (Similar acts had been passed in 1639 and in 1645 and would be passed in 1661-62.) By the will of the Assembly, the layman had the right to bring the physician or surgeon into court if the charge for "paines, druggs or medicines" was thought to be unreasonable. The surgeon or physician had in court to declare under oath the true value of drugs and medicines administered, and then the court decided the just compensation. The law went on to declare that: Where it shall be sufficiently proved in any of the said courts that a phisitian or chirurgeon hath neglected his patient, or that he hath refused (being thereunto required) his helpe and assistance to any person or persons in sicknes or extremitie, that the said phisitian or chirurgeon shall be censured by the court for such his neglect or refusall. The legislators also gave the physician or surgeon protection by providing that their accounts could be pleaded against and recovered from the estate of a deceased patient--suggesting that patients were not prompt enough in paying their bills (or perhaps did not survive treatment long enough to do so). Court records show that the medical men often took advantage of this provision for collection. A measure enacted in 1692 indicated a more sympathetic attitude on the part of the legislators toward the physicians and surgeons. While in the earlier acts preventing exorbitant fees the court had been ordered to decide upon just compensation, the later act allowed the physician or surgeon to charge whatever he declared under oath in court to be just for medicines. Nor did the act of 1692 make reference to "rigorous though unskilful" or "griping and avaricious" physicians and surgeons as had the earlier laws. References by the colonial Assembly to exorbitant fees were not without a basis in fact. The conventional charge for the physician's visit, according to Dr. Wyndham Blanton, was thirty-five to fifty pounds of tobacco and on occasions the physician, or surgeon, must have exceeded this fee. An approximate estimate of the value of these visits in present-day terms would be between twenty and twenty-five dollars. The cost of medical care was even greater when an unusually large amount of drugs was dispensed. It is not surprising that many masters did not provide the services of a physician or surgeon for their servants; nor that medical attention was given by persons without professional status. Although these charges seem high, it must be taken into account that because of the great distances between communities and even between homes, the physician or surgeon could make only a small number of visits each week. County records give many examples of the fees of physicians and surgeons. Of 145 medical bills entered in the York County records between 1637 and 1700, the average bill was for 752 pounds of tobacco, or a little less than one laborer could produce in a year. Other fees were: 400 pounds of tobacco for six visits; 300 pounds of tobacco for three visits and five days attendance; 1,000 pounds of tobacco for twenty days of attendance "going ounce a weeke ... being fourteen miles"; and 600 pounds for twelve daily visits. At the time these charges were made, tobacco brought between two and three cents per pound, or the equivalent of approximately fifty cents today. The surgeon administering the clyster or phlebotomy, those commonly resorted to "remedies," could be expected to charge thirty pounds of tobacco for the first and twenty pounds for the second. The surgeon, and the physician, often charged from twenty to fifty pounds of tobacco for a drug prescription. In 1658, Dr. John Clulo presented a bill to John Gosling in York County which he itemized as follows (in pounds of tobacco): For 2 glisters [clysters] 040 For a glister 030 For a potion cord.[ial] 036 For an astringent potion 035 For my visitts paines & attendance ... For a glistere 030 For an astringent potion 035 For a cord. astringent bole 036 For a bole as before 036 For a purging potion 050 For a [cordial julep] 120 For a potion as before 036 Not only does Dr. Clulo's bill give examples of fees charged, but it supports the contention that the substance of medical treatment during the century was bloodletting, purging, and prescribing drugs. Although the physicians of colonial Virginia did charge well for their services, it should be noted that they were in demand. Their patients, this would indicate, considered their services of great value, any subsequent protests notwithstanding. THE EDUCATION OF PHYSICIANS AND SURGEONS Since the physicians and surgeons did make substantial charges and since the educated layman could buy his own books on medicine and practice what he read or since the uneducated could turn to a neighbor with medical knowledge or to a quack, the question arises as to why the services of professional surgeons and physicians were in such demand. Part of the answer lies in the professional's experience, but even in a colony without a medical school it also lies in the education and training received by the professional. There were several ways in which a seventeenth-century Virginia physician could acquire his education or training. He could have received a medical degree in England or on the continent and then gone to America. On the other hand, he might have learned without formal education--perhaps by attending lectures and by experience--and then established himself in Virginia where he was accorded professional status. A man born in Virginia could return to the Old World for training or formal education and then practice in Virginia. Also, a common manner of becoming a physician or surgeon in Virginia, which was without medical schools, was by apprenticeship. Finally, the importance of books--imported from Europe--as a means to medical education should not be minimized. To be officially licensed for practice, the requirements in England were high--those in London especially so. The following excerpt from the statutes of the College of Physicians of London demonstrates how demanding the educational standards for seventeenth-century English physicians could be: First, let them be examined in the physiologick part, and the very rudiments of medicine, and in this examination let questions be propounded out of the books concerning elements, temperaments, the use of parts, anatomy, natural powers and faculties, and other parts of natural medicine. Secondly let him be examined in the pathologick part, or concerning the causes, differences, symptoms and signs of diseases, which physicians make use of to know the essence of diseases; and in this examination let questions be proposed out of books concerning the art of physick, of the places affected, of the differences of diseases and symptoms, of feavers, of the pubes, of the books of prognosticks of Hippocrates, &c. Thirdly let him be examined concerning the use and exercise of medicine, or the reason of healing; and let that be done out of the books concerning preservation of health, of the method of healing, of the reason of diet in acute diseases, of simple medicines, of crises, of the aphorisms of Hyppocrates, and other things of that kind, which relate to the use of healing; for example sake, what caution to be observed in purging? in what persons? with what medicine? and in what vein, those things ought to be done? Likewise, what is the use of narcoticks and sleeping medicines? and what caution is to be observed in them? what is the position and site of the internal places? and by what passages medicines come to there? what is the use of clysters, what kind of vomits, the danger, kind and measure? Under the London Company, the physicians and surgeons in Virginia had the same education, training, and met the same standards as their counterparts in England. This was, in part, because the Company had good reason to supply adequate medical service, and because the men sent were but Englishmen transplanted to America. Walter Russell, who came to Virginia in 1608 was a "Doctour of Physicke" and Lawrence Bohun, De la Warr's physician, had the same degree. Pott, who succeeded Bohun as physician-general of Virginia in 1621, came recommended as a Master of Arts well-practiced in surgery and physics. After the Company's charter was annulled, few physicians or surgeons with the advanced medical degrees came to Virginia. Some of the persons, however, who practiced medicine in Virginia without medical degrees had acquired skills and knowledge in Europe or England before coming to the New World. Patrick Napier who came to Virginia about 1655 as an indentured servant and subsequently had a large medical practice, probably learned his profession in England or on the Continent, as might have Francis Haddon, another who came under terms of indenture and who later, also, had a considerable medical practice. To these two examples of persons with training and experience acquired prior to their arrival in America might be added the similar experiences of John Williams and John Inman. Medical knowledge and practices brought over from England were cross-fertilized with the European even in the New World. While the majority of newcomers were Englishmen, French, German, and other European physicians and surgeons came to Virginia. These European medical men appear, in general, to have prospered in Virginia and were anxious to become naturalized "denizens to this country." George Hacke, born in Cologne, Germany, settled in Northampton County, Virginia, in 1653 and was known as a doctor and practitioner of medicine. He was typical of the European-trained medical man settling in Virginia in becoming naturalized and in leaving a considerable estate, including thousands of acres of land. Little is known of his medical activities and interests except that he was summoned to treat the victim of a duel and that he left a large library which probably included volumes on medicine. Paul Micou, a young French physician who seems to have acquired his education abroad, settled on the shores of the Rappahannock river, near a place afterward called Port Micou, during the last decade of the seventeenth century. Cultured and educated, he soon won prominence and wealth as a physician (and surgeon), attorney, and merchant. County records in Virginia make numerous references to suits brought by him for nonpayment of fees, suggesting an extensive practice. Because so many of the doctors and surgeons of seventeenth-century Virginia are given only slight mention in the records, it is impossible to know whether, in most cases, they had acquired their skills and educations before coming to Virginia, or even whether they were born in the New World. Nor is it known how many young men born in Virginia went back to England or Europe to study medicine; a reference made by the famous English surgeon, John Woodall, indicates that a Virginian named Wake may have studied under him in London. Within the Virginia county records, however, can be found evidence indicating that a common method of learning the profession was by apprenticeship. One interesting example of the contract between apprentice and surgeon survives in the records of Surry County, Virginia; made in 1657, it bound Charles Clay to Stephen Tickner, surgeon, for a term of seven years. Clay swore to serve his master in whatever surgical or medical duties he was assigned, and Tickner promised to use his best skill and judgment to teach his apprentice whatever he knew of the art. Another contract for apprenticeship was made between Richard Townshend and the London Company's well-known Dr. Pott. This relationship included a breach of contract that occurred not infrequently between master and apprentice: Townshend argued in court that Pott was not teaching him the "art & misterye" for which he was bound. As an apprentice, the would-be physician or surgeon could gather herbs for his master and assist him in treating the sick. If the apprentice could read, or if the master would teach him, then the novice could study the medical books in the doctor's library. Not only were volumes on medicine available, but in the libraries of the better-educated medical men, the apprentice could also familiarize himself with other fields of learning. Dr. Pott had a reputation for knowing Latin, Greek, and Hebrew, and must have imparted much of his learning to Richard Townshend, his apprentice. Such would seem to be the case in view of the facts of Townshend's life. He became an apprentice to Pott in 1621 and by 1636 he was a member of the colony's highest political body, the council, and at the time of his death he possessed a considerable amount of land. In a day when schooling was hard to come by, apprenticeship to an educated man held great advantages. Unfortunately catalogues of the libraries of medical men have not survived. There is proof, however, that physicians and surgeons did not neglect opportunities to collect volumes on medicine published in England and Europe. If utilized, these books could have helped offset the lack of a formal education in a university or medical school. Dr. Henry Willoughby of Rappahannock County, Virginia, left forty-four books on "phisick" in his estate. Dr. John Holloway, a leading physician of Accomack County, Virginia, from 1633 until his death in 1643, left thirteen books on surgery and medicine, all in English or Latin. Dr. Henry Andrews of York County had twenty books in Latin on medicine. A great number of Virginians--some of them prominent--who did not practice medicine had, nonetheless, large collections of books on the subject. This would indicate that many persons resorted to medical treatment without the help of a professional. With fees high, distances great, and well-trained doctors scarce, self-reliance is not surprising. Many planters and their wives must have made a superficial study of medicine; certainly the mistress of the house visiting sick servants and slaves is a familiar historical picture. Among the medical books in such libraries were volumes on the general subjects of medicine (physick) and surgery, anatomy, gout, scurvy, distillation, and natural magic. Common in the libraries of the laymen were books recommending specific drugs for various symptoms of diseases. The long title of one volume in a Virginia library read, "Method of physick, containing the causes, signes, and cures of inward diseases in man's body from the head to the foote. Whereunto is added the forme and rule of making remedies and medicines, which our physitions commonly use at this day, with the proportion, quantity, and names of each medicine." The importance of medical volumes to the lay library is indicated by the inclusion of two in the supplies provided by a London agent for a Virginia plantation in 1620-21. William S. Powell, in a recent study of books in Virginia before 1624, found that the agent chose _The French Chirurgerye_, published in English in 1597, and the _Enchiridion Medicinae_, first published in 1573. In spite of medical books, the apprenticeships, training in Europe or England, and the demand for medical services despite a high fee, it is possible to overestimate the competence of the seventeenth-century Virginia doctor even by the standards of his own century. An observation made by William Byrd II early in the next century tends to reduce the stature of the medical man. "Here be some men," Byrd wrote, "indeed that are call'd doctors; but they are generally discarded surgeons of ships, that know nothing above very common remedys. They are not acquainted enough with plants or other parts of natural history, to do any service to the world...." Byrd may have been prejudiced by his father who, although believing himself facing death, still did not call a physician. CHAPTER FIVE Conclusion PORTRAIT OF A SEVENTEENTH-CENTURY VIRGINIA PHYSICIAN Historical evidence does not support Byrd's description of the typical physician as a discarded ship's surgeon. In contrast, the physician, whatever his competence may have been, emerges from the sources as a respected member of the colony who, besides his medical practice, engaged in farming sizable holdings of land and took part in the civic life of the colony. His private life was not unlike that of the other planters who enjoyed some wealth and professional standing. The reputable surgeon, who could also supplement his income from farming, probably enjoyed an existence not unlike that of the physicians, considering that the distinction between them in the New World was slight. Dr. Blanton, in his volume on medicine in Virginia, created a lively portrait of what he imagines from his researches to be the seventeenth-century Virginia doctor. The doctor is seen: dressed in knee breeches and jerkin, perhaps adorned with periwig and cap; not given to church-going, but fond of ale, horse-racing and cuss words; husband of a multiparous wife; owner of a log cabin home or at best a frame cottage which he guarded with gun, pistol and scimitar; his road a bridle path and his means of conveyance a horse or boat ... reading ... by candle light, without spectacles; writing with a goose quill pen; sitting on a rough stool or bench; eating at a crude table from pewter dishes, without fork or table knife; having no knowledge of bath tubs; keeping his clothes in trunk or chest; sleeping, night-capped, on a flock bed in a bedroom shared by others; dividing his time, which he measured with hour-glass and sundial, among medicine, politics and farming; often in court, often a justice, member of Council or Burgesses, and subject, like his neighbors, to military service. SUMMARY Englishmen and Europeans planted Virginia in the New World and brought the Old World's medical knowledge and medical practices with them. In Europe and England, the seventeenth century witnessed the perfection of new and scientific theories in medicine--it was the century of Harvey--but little original and fruitful in the field of practice--Dr. Sydenham might be considered an exception. In Virginia, the prior occupants had accumulated medical knowledge, too, and the Indians practiced in a manner not completely unlike that of the whites: bloodletting, purging, and sweating (all to the end of relieving the body of ill humors or morbid matter). The Indians, however, did not believe it right or good to impart their knowledge to the layman, Indian or European; therefore, cross-fertilization between the two schools of medicine was limited. In planning for the colony, the London Company took into account that health would influence the fortunes of the new settlement. The Company warned the original settlers to choose a site in a healthful location, but the colonists elected Jamestown Island which was low and moist. Provided two surgeons by the Company, the original settlers needed not only more surgeons but physicians as well: the surgeons could treat the wounds, sprains, and breaks of a military-colonizing expedition, but physicians were needed to meet conditions that developed in Jamestown. In subsequent boatloads of settlers, physicians did come--and some were well-trained and experienced--but the small number that arrived during the period when the London Company administered the colony (1606-24) could not meet the demands of disease and famine. During the first summer more than one-half the original settlers perished: during the Starving Time (1609-10) the population dropped from 500 to 60 and in the spring these 60 almost abandoned Virginia. A deadly combination of new environment, famine, and epidemic disease, such as typhoid, played a major part in determining the course of events during the first two decades of the colony's life, and near death. After Virginia became a Crown colony, famine and disease no longer influenced affairs so greatly, not because of the wise administration of the Crown, but because the colonists had better learned what was necessary to cope with health conditions in the New World. No longer did they consider disease and famine minor threats compared to those from the Indians and Spaniards. They planned their ocean voyages so as to arrive in the fall and thus avoid the dread summer sickness while still too weak from the voyage to resist it; they located their outer settlements on higher and drier land, at the end of the century even moving their capital to Williamsburg, known for its temperate and healthful climate. The physicians and surgeons, however, who came later in the century were not as distinguished as their earlier counterparts. As the century passed, many men trained by apprenticing themselves in Virginia. Whether immigrant or indigenous, the medical men used orthodox European techniques: they bled and purged, sweated and dispensed drugs, to obtain these ends. Some of the drugs were native to Virginia and the colonists exported them for a profit, but the more expensive--and efficacious--had to be imported. There is evidence that the level of medical excellence in Virginia lowered during the century; many of the planters avoided the expensive visits and drugs, even passing laws to regulate fees and chastise lax and inadequate practitioners. Women, clergymen, and laymen all treated the sick and wounded of the period, with the women especially active as midwives; with the clergy producing such an outstanding medical man as the Reverend John Clayton; and with the laymen acquiring enough information, perhaps from a few medical books, in order to practice, themselves, in case a doctor were unavailable or undesired. ACKNOWLEDGEMENTS AND BIBLIOGRAPHICAL NOTE Dr. Wyndham B. Blanton kindly gave permission for the use, in the preparation of this booklet, of his definitive and authoritative volume on the history of seventeenth-century Virginia medicine. Dr. Blanton's work--based on extensive research in the sources--has proved of great value, but he should not be held responible for any weaknesses in this essay, as the author assumes full responsibility. The author also wishes to take this opportunity to express his appreciation for the numerous suggestions and improvements made by his wife who spent many hours assisting in the preparation of the manuscript. The books and articles that proved most helpful were: Allen, Phyllis, "Medical Education in 17th Century England," _Journal of the History of Medicine and Allied Sciences_, I (January, 1946), 115-143. _American History Told by Contemporaries_. Edited by Albert B. Hart. New York and London, 1908-1909. 4 vols. Beverley, Robert, _The History of Virginia_.... (Reprinted from the author's 2d rev. ed., London, 1722.) Richmond, 1855. Blanton, Wyndham B., _Medicine in Virginia in the Seventeenth Century_. Richmond, 1930. Brown, Alexander, _Genesis of the United States_. Boston and New York, 1890. 2 vols. Castiglioni, Arturo, _A History of Medicine_. Translated from the Italian and edited by E. B. Krumbhaar. New York, 1941. Chitwood, Oliver P., _A History of Colonial America_. New York, 1948. Craven, Wesley F., _Dissolution of the Virginia Company: the Failure of a Colonial Experiment_. New York, 1932. _Southern Colonies in the Seventeenth Century_, 1607-1689. Baton Rouge, 1949. Duran-Reynals, Marie Louise, _The Fever Bark Tree_. New York, 1946. Garrison, Fielding H., _An Introduction to the History of Medicine_.... Philadelphia, 1929. _Narratives of Early Virginia_, 1606-1625. Edited by Lyon G. Tyler. New York, 1907. Packard, Francis R., _History of Medicine in the United States_. New York, 1931. 2 vols. Sigerist, Henry E., _American Medicine_. Translated by Hildegard Nagel. New York, 1934. Smith, John, _Travels and Works_. Edited by Edward Arber. Edinburgh, 1910. 2 vols. Tyler, Lyon G., "The Medical Men of Virginia," _William and Mary College Quarterly_, XIX (January, 1911), 145-162. Wertenbaker, Thomas J., _The First Americans, 1607-1690_. New York, 1944. 
33155	----	generously made available by The Internet Archive/American Libraries.) _Medicina Flagellata_: OR, THE DOCTOR SCARIFY'D. ----_Ægrescitque medendo._ Virg. _Si tibi deficiant Medici, Medici, tibi fiant: Hæc tria, Mens læta, requies, moderata dieta._ _LONDON:_ Printed for J. BATEMAN, at the _Hat_ and _Star_; and J. NICKS, at the _Dolphin_ and _Crown_, both in St. _Paul's Church-yard_. 1721. _Medicina Flagellata_: OR, THE Doctor Scarify'd. Laying open the VICES of the Faculty, the Insignificancy of a great Part of their _Materia Medica_; with certain RULES to discern the true Physician from the Emperick, and the Useful Medicine from the Noxious and Trading Physick. WITH An ESSAY on HEALTH, Or the POWER of a REGIMEN. To which is added, A Discovery of some Remarkable Errors in the late Writings on the PLAGUE, by Dr. _Mead_, _Quincey_, _Bradley_, &c. With some useful and necessary RULES to be observed in the Time of that Contagious Distemper. _LONDON_: Printed for J. BATEMAN, and J. NICKS. M. DCC. XXI. PREFACE. _It being usual for Authors, in Prefaces, to render an Account of the Occasion which gave Birth to their Writings, and to acquaint the Reader with the Design and Scope of their Discourses; I thought it convenient to continue a Custom approved by many illustrious Examples._ _The Motive of publishing this Tract, is not the Intercession of Friends, for none had ever the View of any Part of it; and that it is not Design of Applause that has engaged me in this Undertaking, the Care I have had to conceal my Name will, I suppose, free me from such Suspicion: the chief Inducement proceeds from an Inclination to Mankind, to instruct them to preserve and prolong their Lives, thereby to prevent them from using fraudulent Quack Medicines (which are now become so universally vendible amongst them) or advising with such as are wholly ignorant; and I should think my self sufficiently rewarded for my Pains, if I could arrive to the Point of reforming the Abuses of the present, and restoring the Simplicity of the ancient Practice, by laying open to the World my Observations of the pretended and fallacious =Methodus Medendi=, and the Insignificancy of a great Part of their =Materia Medica=._ _And here I will particularly address my self to all those Persons concern'd with me, who are the People or Patients; and the Physicians with their Followers, the Chirurgeons and Apothecaries: This Discourse is chiefly intended for the first, it being they who are most highly injured by the unwarrantable Practices of those we have therein accused; for although many understanding Persons among the People are sufficiently satisfied of the Abuses we have mentioned; and that it is of absolute Necessity some Reformation should be made: Yet all are not thus perswaded; for we may daily observe, that many who are less discerning, being deceiv'd by an imaginary Good, covet their own Ruin; and unless they be given to understand which is the Evil, and which is the Good, by Persons they have Reason to confide in, they must necessarily run much Hazard._ _I have here endeavoured to undeceive them; which I should dispair of, did I only foresee Inconveniencies afar off (the Vulgar being led by Sense, and not by probable Conjectures); but since they do now actually labour under many, and those obvious, Inconveniencies, how short sover their sight be, the Senses of Feeling being no less acute in them than in others, I persuade my self, they will readily assent to those Truths I have largely discovered._ _And here must I venture through all the Barricadoes and the Fortifications of popular Resentment; but Satires, like Incision, become necessary when the Humour rankles, and the Wound threatens Mortification; when Advice ceases to work; when Loss, Experience, and Disaster will not convince, then Satire reforms, by making the Error we embrace ridiculous: Shame works to make us forsake a Thing, which Instruction augments, or Persuasion could have no Effect upon._ _Many and great Abuses, and of the last Importance to the People, have urged my Duty and demanded my Assistance; and if in my Essay on Health, I do persuade my Reader to the =Regimen= I have here laid down, he may assure himself of that =Golden Panacea=, that =Elixir Salutis=, at no other Charge but in =cura seipsum=._ _It would by many be expected, that I should make an Apology for the great Liberties I have taken in my general Treatment of the whole Faculty; in which I claim the allow'd Exception, that there are some few very Eminent, and worthy of the first Honours and Dignity of Physick, and who by their unwearied Labour of Body and Application of Mind, have run through the Courses of =Anatomy, Botany, Chymistry=, and =Galenick Pharmacy=, and no less acquainted with the Virtues, Faults, and Preparations, Compositions and Doses of Vegetables, Animals, Minerals, and all the Shop Medicines._ _And yet nevertheless, the Profession of Physick (though arrived to much greater Improvement than before) it's Dignity and Degrees are so despicably fallen, that the very lowest of People, as well Women as Men, usurp the Title; and how monstrous it is to see that Mob of Empericks, as Barbers, Farriers, and Mountebanks, over-reach and bubble the People both of their Lives and Money._ _As I would not arrogate to my self the Performance of another, I must not here forget to acknowledge that I have borrowed from the judicious Author of a late excellent Discourse concerning some few Passages of the State of Physick, and the Regulation of it's Practice. I suppose it will be easily imagined, that I could have spoken the same Things in other Words; but my Respect to the Memory of that worthy Person, disposes me to believe, they will sound better, and be more effectual in his own Language._ _The following Appendix receiv'd it's Birth in Answer to some the most formidable of the many Pamphlets that were crowded upon the People at the first Report we had of the miserable State of the =Marseillians= by the Plague; which had not been but for the same plausible End, of being serviceable to the Nation, by detecting their Errors, and setting aside the clashing Opinions of those =Literati=, which has rather given Alarm, than a Security to the People._ _To conclude: If in speaking the Truth there is no Blame, but rather Commendation, I then need not Apologise for the Freedom I've used, in exploding the great Varieties and Abuses in both the Theory and Practice of Physick. And although the Attempt should not answer equal to the good Intention I've had for the Publick; yet I shall demand that Justice of the World, and with =Horace=,_ Quod Verum atque decens, curo, & rogo, & omnis in hoc sum. _Medicina Flagellata_: OR, The Doctor Scarify'd. It is most certain that all Nations, even the most barbarous, have in all Ages made use of Medicines, to ease their Pains, to regain or preserve Health, the greatest among earthly Felicities; in the Absence whereof, we cannot relish any of those numerous Enjoyments, which the bountiful Creator hath plentifully bestow'd on us; so that the most sublime ancient Philosophers who excluded all other external Good from being necessary, to the well being of Man, placing Happiness only in the things whereof we cannot be depriv'd; yet out of them they excepted Health, knowing there was so near a Connexion between the Soul and Body, that the one could not be disorder'd in its Functions, but the other would be disturb'd in its Operations. Hence it is that no Part of human Knowledge can be of greater Moment than what directs to Remedies, and Means of Relief under those Infirmities to which the whole Race of Man is Heir to; so that even amongst the wisest, that Science or Art whereby those Defects we call Diseases were repair'd, was always accounted Divine; for that God is the first and chief Physician, hath been the constant Faith of all Ages, and that Physicians were accounted the Sons of Gods, was commendably asserted by _Galen_, and therefore it was truly spoken, that Medicines were the Hand of God, there meriting only such Names, as related to their divine Original; thus a certain Antidote was called [Greek: Isytheo], equal to God, another [Greek: Theodotos], given by God, another divine; several Compositions had the Inscription [Greek: Iera], or Sacred; and 'twas the common Belief among the Heathens, that so great a Knowledge in Physick came by Inspiration: And St. _Austin_ is of the same Opinion in his _Civi. Dei_, who saith, _Corporis Medicina (si altius rerum origines repetas) non invenitur unde ad homines manare potuerit, nisi à Deo_. It cannot be conceived whence Physick should come to Man but from God himself. It is well known how great a Name _Hippocrates_ obtain'd, not only in _Greece_ (which he deliver'd from the greatest Plague) but in remote Parts; so that the greatest Monarchs of the _East_, and their Vice-Roys, were Suitors to him, to free their Country from that devouring Disease, which threatned to exhaust those populous Regions of their Inhabitants, unless the same Person who freed _Greece_ interpos'd, whom they esteem'd divine, and sent from the Gods, because successful in so great Undertakings. Very certain it is, so Noble and Useful a Study were encouraged, yea and practised by Kings, Princes, and Philosophers, by the highest, wisest, and best of Men, whereof some were honour'd by Statues erected to perpetuate their Memoirs, and by many other Instances of the publick Gratitude. So that when I consider what Reverence has been paid to this Profession, and the Professors thereof in all times whereof we have any particular Account, I am amaz'd that in this latter Age wherein it hath received greater Improvements than in Two thousand Years before, and that nevertheless it should be by many neglected, by others slighted, and by some even contemned. After a diligent Enquiry into the Causes of so strange and sudden an Alteration, I could not, in my Opinion, so justly ascribe it to Defects in the Profession, as to those of its Professors; not that I deny that Physick may be capable of greater Improvements, notwithstanding it might to this Day have been maintain'd at least in the same Degree of Honour and Esteem which all Ages have justly had for it, if the Avarice and Imprudence of the Real, the Ignorance and Baseness of the pretended Artists had not interpos'd: Under the former I comprize the Vulgar Physicians; under the latter, their Dependants the Apothecaries, who, I am confident, have caused many of the great Inconveniences under which the Practice of Physick now labours. That the Sick are in all Cases oppressed with too many Medicines, and made to loath, and complain of the very Cordials; that the Expence is made greater, and more extravagant by the often Confederacy and Artifices visible in the new Modes of prescribing: And the Deaths of the Patient I would not say is frequently the Effect not of the Disease, but of the numerous Doses obtruded in the same Proportions in every Sickness and Age, pushing on declining, and even departing Life; which after its Exit makes Pots and Glasses observed, with the same Passions and Concern, as the bloody Sword is viewed as the Instrument of Death and Mischief. By whom, or by what Means the Purity of Physick has sunk into this Degeneracy, let us farther examine, and trace it from the first Steps of entring into this great Abuse; let us then usher in the young Physician now come from the University, and having spent a great Part of his Money (if not all) in his Education, very wisely for himself considers, which are the most obvious and practis'd Ways of making himself known, and by what Methods he may more easily insinuate himself, and that he may recover the Fortune he has lent the Publick in his Education, which he is resolved they shall now pay him with Interest. He is inform'd, or presently observes, that most, or all the Families are under the Directions of the Apothecary, who gives his Physick 'till he fears the Patient will die, and then appoints a Physician, who before is prepared to acquit him, by bearing the Reproach with the most perfect Resignation. And to support this good Temper, he is bid to cast his Eyes around the Kingdom, and consider how they flourish in the common Fame, who had the good Luck to follow those Instructions at their first Arrival. Or if he has found out any more effectual Medicines, or more compendious or grateful Methods of Cure, or would imitate the applauded Practice of some few of the most eminent of that Profession, whose Prescriptions were only to assist, not to overload, or suppress Nature; this is too bold a Stroke, a too dangerous Reform in Physick; he must previously consider, that the Number of Apothecaries are increas'd, and that their Dependance lieth more on the Quantities of Medicines in suitable Proportions, and notwithstanding a generous and liberal Education, by which he has learn'd to explode the malevolent and useless Practice, from a great many Prescriptions that are now in vogue; he must not dare to refute them, he must obey that great Principle of Nature, to preserve himself; he must conform to the Manners of the Age, and the general Practice; he must dispence with his not knowing whether the Medicines are made up according to his Prescription; he must wink at the Design, Ignorance, Carelessness, or Unfaithfulness of the Apothecary; whom he must not any ways disgust, tho' he in Revenge, as well in executing his own Interest, may make his Dose up with worm-eaten superannuated Drugs, wherewith most of 'em are well stor'd, which will not work according to the Physician's Promise, and the Patient's Expectation: The Apothecary who here outwits the Doctor, and assumes the Character, is here ready at hand to tell his Patient that this was no ways accommodated to his Temper; nay, perhaps, he presages to him that it will not work sufficiently, (as he may without Conjuring or Astrology) by which he obtains a Reputation of a Person more judicious than the Physician making way for his own Advantage, by telling the Patient that he will prepare a Purge that shall work more effectually than the former: This you need not doubt is the same the Physician before prescrib'd, but assuredly made up of better Drugs, and so the Apothecary executes his Design, which is to exclude the Physician, and prefer himself. The young Physician, tho' he has learn'd the Abuse, yet he has that Regard to himself, to make use of that old Maxim, _Of the two Evils, to choose the least_; and finding it best suiting his Interest, which otherwise might be endanger'd by the clandestine and underhand Dealings of the other, and now finds it necessary to close in with him, and such a one as will join in a mutual Application and Advancement of each other: Now are their Engines set at work, and the Doctor not to be behind-hand, gives a new Form to his Bills, which he prescribes in Terms so obscure, that he forces all chance Patients to repair to his own Apothecary, pretending a particular Secret, which only they have a Key to unlock; whereas in effect it is no other than the commonest of Medicines disguised under an unusual Name, on design to direct you to that Apothecary, between whom and the Physician there is a private Compact of going Snips out of the most unreasonable Rates of the said Medicines; wherein if you seek a Redress, by shewing the Bill to the Doctor, he shall most religiously aver it to be the cheapest he ever read. The Consequence whereof, as to your Particular, is a double Fraud; and as the Apothecaries in general, their Numbers bearing the Proportion at least ten to one of noted Physicians; to whom allowing his Covenant Apothecary, who constituting one Part of the ten, the remaining nine Parts are compell'd either to sit still, or to quack for a Livelihood, or at least eight of them, for we'll suppose one Part of the nine a Possibility of acquiring competent Estates, in a Way more honest than that of the Covenanters, by their wholsome Trade of fitting out Chirurgeons Chests for Sea, and supplying Country Apothecaries with Compositions: Lastly, all accomplish'd Physicians are likewise expos'd to manifest Injuries from the Covenant Apothecaries, who being sent for by Patients, after a short Essay of a Cordial, will overpower them by Perswasions to call in a Doctor, who shall be no other than his Covenant Physician; by which Means the former Physician, who by his extraordinary Care and Skill had oblig'd the Family before, shall be passed by, and lose the Practice of that Patient: And should it happen, the Sense of Gratitude of the forementioned Patient, should engage him to continue the Use of his former Physician, yet this Covenant Apothecary shall privately cavil at every Bill, and impute the Appearance of every small Pain, or Symptom (which necessarily in the Course of a Disease will happen) to his ill Address in the Art of Physick, and shall not give over before he has introduc'd his Covenanter, whose Authority in the Fraud of Physick he supposes to be most necessary. But least you should think me overbalanc'd with a Prejudice to those that so much abuse that noble Profession, I'll conduct you into their usual Road and Method of examining their Patients, and making Enquiry into their Diseases, wherewith being acquainted, you may, without any farther Conviction, pronounce a Verdict. This Knack doth chiefly consist in three Notions; _viz._ _First_, That a Patient's Grievance is either a discernible evident Disease, which his own Confession makes known to you, what it is; or, _Secondly_, an inward Pain; or, _Thirdly_, one of those two Endemic Diseases, a Scurvy, or Consumption; or, a _Fourth_, the Pox. This is their Theory, which is so deeply ingrafted on their _Dura Mater_, and may be acquired with less Industry than fourteen Years Study at one of our Universities; for so much Time is requir'd to make a Man grow up a Doctor, the Formality whereof in most Places consists in this Elogy; _Accipiamus pecuniam, & dimittamus asinùm_. If a sick Man makes his Address to a vulgar Physician, he demands his Complaint; t'other replies, he is troubled either with a Vomiting, Looseness, want of Stomach, Cough, bad Digesture, difficulty of Breathing, a Phtisick, Faintness, Jaundice, Green-Sickness, Dropsy, Gout, Convulsion-Fits, Palsy, Diziness, or Swimming in the Brain, Spitting of Blood, an Ague, a continual great Heat or Fever, _&c._ These are all evident Diseases the Party himself expresses he is troubled with; but his Sickness not being an evident Disease, which he himself can explain, the Vulgar Doctor concludes, it must be either an inward Pain, or an Endemick Disease: The Patient then making complaint of an inward Pain, to his old way of guessing t'other goes, enquiring first in what Part? If he answers, he feels a Pain in the right Side, or under the short Ribs, he tells him it is an Obstruction, or Stoppage in the Liver; if in the left Side, in the opposite Part, then 'tis a Stoppage of the Spleen; if in the Belly, he it may be calls it a Cholick, or Wind in the Guts; if in the Back, or Loins, he perswades him it's Gravel, Stone, or some other Obstruction in the Kidneys; if a Stitch in the Breast, he terms it Wind, or other times a Pleurisy: Lastly, if the Party be reduc'd to a very lean Carcass, by reason of a long tedious Cough, Spitting of Blood, or want of Stomach, or Feebleness, or almost any other Disease, or Pain, then besure he tells him he's in a Consumption, or at least falling into one: But being troubled with several Diseases and Pains at once, as running Pains, Faintness, want of Stomach, change of Complexion, so as to look a little yellowish, duskish, or greenish; then t'other whispers him, he is troubled with the Scurvy. If diseased with Ulcers or running Sores, red, yellow, blue, or dark Spots, Pimples, or Blotches in the Face, Arms, Legs, or any other Part of the Body, that's determin'd to be the Scurvy likewise, supposing the Party to be a sober discreet Person: But if appearing inclined to Wantonness by reason of his Youth, or sly Countenance, then the fore-mention'd Disease is to be call'd the Pox. In most Diseases of Women, they accuse the Mother. In Children, their Guess seems far more fallible; for a Child within the six Months being taken ill, restless, and froward, if there appear no evident Disease, he ever affirms it's troubled with Gripes; upon which he prognosticates, that if not speedily remedied, the Child will fall into Convulsion-Fits; but this not happening according to his Prediction, to prevent the Forfeiture of his Skill and Repute, endeavours to possess the Mother, and rest of the Gossips, it had inward Fits. The Child being past six Months, and falling indispos'd, then instead of Gripes, it is discompos'd by breeding of Teeth; but having bred all his Teeth, and being surpriz'd with any kind of Illness, the Doctor then avouches it is troubled with Worms: In short, take away these three Words, Obstruction, Consumption, and Scurvy, and there will remain three dumb Doctors, the Hackney Physician, the Prescribing Surgeon, and the Practicing Apothecary. Hitherto we have only discovered to you the Ordinary Physicians conjecturing Compass, whereby he steers his Course, to arrive to the Knowledge of his Patients Diseases: There yet remains we should unlock the other Ventricle of his Brain, to behold the Subtilty of his Fancy in groaping at the Causes of Diseases, which, tho' the Poet declares (_Felix qui potuit rerum cognoscere causas_) to be cloathed with the darkest Clouds, yet by the Virtue of this following Principle, aims at this Mark immediately, _viz._ That most Diseases are caus'd by Choler, Phlegm, Melancholy, or abundance of Blood: Of these, two are suppos'd to be hot, namely, Choler, and abundance of Blood, and the other two cold, to wit, Phlegm, and Melancholy, and consequently Causes of hot and cold Diseases: These four Universals being reduced to two general Categories; under the Notion of hot and cold, any one having but the Sense of distinguishing Winter from Summer, may, in the Time of an _Hixius Doxius_, instantly appoint a Cause for almost every Disease: So that a Patient discovering his Trouble, it may be a want of Stomach, bad Digesture, Fainting, Cough, Difficulty of breathing, Giddiness, Palsy, _&c._ his Vulgar Physician has no more to do, but take him by the Fist, to feel whether he be hot or cold; if he finds him cold, then summons in his old Causes, Phlegm, and Melancholy; which ready, and quick pronouncing of the Cause upon a meer Touch, doth almost stupify your Patient, thro' Admiration of _Æsculapian_ Oracle, hitting him in the right Vein to a hair's breadth: For, quoth he, indeed, Mr. Doctor, I think you understand my Distemper exceedingly well, and have infallibly found out the Cause; for every Morning as soon as I awake, I spit such a deal of Phlegm, and moreover, I must confess my self extreamly given to Melancholy. This jumping in Opinions between them, makes Mr. Doctor swell with Expectation of a large Fee, which the Patient most freely forces on him, and so the Fool and his Monies are soon parted. Now it's two to one but both are disappointed, the one in his unexperienced Judgment, t'other in his fond Belief; for, state the Case, the Disease takes its Growth from Choler, or abundance of Blood, or any other internal Cause; there is scarce one in a hundred that are indispos'd, who is not subject to hauk and spit in the Morning, and being reduc'd to Weakness, by reason of his Trouble, must necessarily be heavy in the Passions of the Mind, and incident to melancholy Thoughts, through the Memory of his Mortality, occasion'd by this Infirmity: So that, seldom Mirth and Cheerfulness are housed in indispos'd Bodies, because they are deficient of that abundance of Light, and clear Spirits, required to produce them. No Wonder the Vulgar is so opinionated in the Affair of their Temperament, when belabour'd with a Disease; since in their healthful State, it's impossible for a Physician to engage their Opinion otherwise, than to believe themselves phlegmatick and melancholy. To return to the Point of declaring how the Vulgar strives even with Violence to be cheated, not in their Purses only, but in their Fancies and Opinion; and in this Particular, our Women are so violent eager, that if the Vulgar Physician can but make a true Sound upon the Treble of their Fancy, will produce such a Harmony as shall sound his Praise through City and Country; and without those Female-Instruments, or She-Trumpets, it's almost impossible for a Vulgarist to arrive to a famous Report, who having once by his Tongue-Harmony inchanted the Woman, doth by the same Cheat subject the Opinion of Man to his Advantage, Women generally usurping, and impropriating the Affair of their Husbands Health to their own Management; for if a Man chance to be surpriz'd with Sickness, he presently asks his Wife what Doctor he shall send to, who instantly gives her Direction to him that had her by the Nose last. In this Piece of Subtilty, the Doctor shews him self no less cunning than the Serpent in _Genesis_, who, to cheat _Adam_, thought it expedient first to deceive _Eve_. Now without any further Preamble, I must tell you the Humour many a sick Woman delights to be coaks'd in by the Ordinary Physician, _viz._ She loves to be told she is very melancholy, tho' of never so merry a Composure, and in that Part of the Litany, Mr. Doctor is a perfect Reader; for a Woman making Complaint she is troubled with Drowsiness, want of Stomach, Cough, or any other Distemper; he answers her, she is in an ill State, and troubled with great and dangerous Diseases, and all engender'd by Melancholy; and then tells her over again, she is very melancholy, and, saith he, probably occasion'd by coarse Treats at Home, or some Unkindness of Friends, which makes the poor Heart put Fingers in her Eye, and force a deep Sigh or two; and all this possibly for being deny'd the extravagant Charge of a Tea-Equipage, or a new Gown on a _May_-Day; which being refresh'd in her Memory, doth certainly assure her, the Impression of that Melancholy to be the Original of her Trouble, tho' some Months or Years past, especially since her Physician discovers to her so much: And for so doing, admires him no less, intending withal to give him an ample Testimony to the World of the Doctor's great Skill: But this is not all, he pursues his Business, looks into her Eyes, where 'spying a small Wrinkle or two in the inward or lesser Angle, he tells her, she has had a Child or two, namely, a Boy, or a Girl, according to the Place of the aforesaid Wrinkle in the right or left inward Angle; thence perswades her, that at her last lying in, her Midwife did not perform her Office skilfully, or did not lay her well, whereby she receiv'd a great deal of Prejudice, as Cold, Wrenching, displacing of the _Matrix_, &c. Which Instance squaring with the premeditated Sense and Opinion of his She-Patient, (most Women, though never so well accommodated in their Labour, being prone to call the Behaviour of their Midwife in Question) he hath now produced a far greater Confidence than before: And last of all, to compleat his Work now at the going off of his gull'd Patient, of rendring her Thoughts, Opinion, and Confidence, Vassals to his Service, Fame, and Advantage, makes one Overture more, of a great Cause of some of her Symptoms, declaring to her, she is much subject to Fits of the Mother, occasioning a Choaking in her Throat, and herein they also jump in their Sentiments; scarce one Woman in an hundred but one time or other is assaulted by those Uterin Steams, especially upon a Tempest of any of the Passions of Fright, Fret, Anger, Love, _&c._ If I have reproached the Vulgar Physician for executing his Employ with so little Ingenuity, far greater Reason may move me to condemn the Water-gazer, who by the Steams of the Urine, pretends to gratify his Patient's nice Curiosity, of being resolv'd what was, what is, and what Disease is to come; and what is more, some by their great Cunning aiming to discover as much by the Urinal, as the Astrologer by the Globe. The Fame unto which the _English_ Doctor, who some Years ago residing at _Leyden_, promoted himself by his wonderful Sagacity in Urins, is not unworthy of your Note, hundreds, or rather thousands repairing to this stupendious Oracle, to have the State of their Bodies describ'd by Urine. But when I relate to you the first Means that gave Birth to our Countryman's Repute, I shall soon remove your Passion of admiring him. Upon his Arrival at the Place aforemention'd, he had in his Company a bold Fellow, that haunted the most noted Taverns and Tap-houses, who by way of Discourse divulg'd the good Fortune that was happened to the Town, by the Arrival of an _English_ Doctor, whose great Learning, and particular Skill in Urins, would soon render him famous to all the Inhabitants. This being pronounced with a Confidence suitable to the Subject, occasion'd three sick Scholars (two Hecticks, one Hydropical) then present, to make Trial of the Truth of his Words; the next Morning, agreeing to mix all their Urins in one Urinal, and commit the Carriage of it to him that was dropsical. In the Interim, the Doctor advertis'd of it by his Companion, which made him so skilful, that when the Hydropical Scholar presented him with the Urinal, to know the State of his diseased Body, he soon gravely reply'd, that he observed three Urins in this one Urinal, whereof the two lowermost Parts of the Urin, appear'd to him to be consumptive, and the third that floated at top dropsical, and with all, that their Conditions were desperate, and at the Expiration of six Months they should be all lodg'd in their Graves. This admirable Dexterity of discerning Diseases by the Urinal, was soon proclaim'd by the Scholars themselves, who all having finish'd the Course of their Lives, within the Time prefix'd, proved an undoubted Argument of his unparallel'd Parts in the Art of Physick, which immediately procur'd him an incredible Concourse of People for many Years together. Another Instance of a Woman whose Husband had a Bruise by a Fall down Stairs, carry'd his Urin to the Urin casting Doctor in _Moor-fields_, who pretended likewise to be a Conjurer; he (after shaking) seeing little Specks of Blood float in it, had so much Understanding to tell her, that the Party had receiv'd some internal Hurt; the Woman agreed to this as Truth, but demanding by what Means he came by it: Upon this he erected a Scheme, and in the mean time asked her so many Questions, that by the Drift of her Discourse, he gather'd that he had tumbled down Stairs: The Woman not minding well what she had said, (in the Consternation she was in at the hard Words he had utter'd) suppossing he was conjuring up the Devil, to be resolv'd in the Matter, told her own Words in a different Title; the Woman acknowledged it true, with some Admiration, but desir'd to know how many Pair of Stairs he might fall down? She had told him before where she liv'd (and he considering the Place chiefly consisted of low Buildings) answer'd, two Pair. Nay, now said she, you are out in your Art, he fell three Story I'll promise. This put our Doctor to his Trumps, when having mused a while for an Excuse, he shook the Urinal again, and asked her if there was all the Water her Husband had made? No, reply'd she, I spilt a little in pouring it in. O ho, did you so? said he: Why that, Woman, was the Business that made me mistake, for there went away the other Pair of Stairs in the Urin you spilt. I shall but trouble you with another Instance, which explodes this Cheat, of what happened in the early Practice of the fam'd Dr. _Radcliff_ when at _Oxford_; of a Country Woman that brought to him her Husband's Urin in a Glass-Bottle, very carefully cork'd up; and after a low Courtesy, presented the Bottle, desiring the Doctor to send a Remedy for her Husband, who then lay very ill: The Doctor observing the Simplicity of this Woman, put no other Question, but of what Profession or Trade her Husband was of? Who reply'd, a Shoemaker: At which he pours forth the Urin in a Basin then by him, and after he had supply'd it with a like Quantity of his own, he gives it her, and says, Good Woman, carry this to your Husband, and bid him fit me with a Pair of Boots: but she replying, Her Husband must first take Measure; to which he return'd, The Shoemaker might as well judge by the Urinal the fitting of his Leg, as he in that of his Distemper. That the Effects of Confederacy in promoting a Physician to a popular Vogue, are as powerful as sinister and disingenuous, may not only be deduced from the aforesaid Naratives, but from the common Design of vulgar Empericks, who to raise their Fame as high as a Pyramid, send forth several prating Fellows into all publick Places, Taverns, Coffee-houses, and Ale-houses, to publish their vast Abilities, expecting with that Bait to hook in as many Patients as will swallow it. Others are no less skill'd in counterfeiting their great Practice, by causing their Apothecaries, or others, to call them out of the Church at an Afternoon Sermon, to hasten Post to a suborn'd Patient, to the Intent the World be advertis'd of the weighty Business this Doctor is concern'd in. Others by their Equipage, eminent Houses, and occasioning one and the same Patient, to repair needlesly to them twenty or thirty times, manifest a Decoy even taken Notice of by the Vulgar. These few disingenuous Ways, do here purposely bring on Board, omitting many others, to convince the Publick, that the only Means for a Physician to advance himself honourably to Practice, is by discovering his real Abilities in curing Diseases, by quick, certain, and pleasant Medicines; and therefore nothing should render his Parts more suspicious than by attempting their Discovery by such fallacious and ignoble Devices; for certainly the Conclusion is most sophistical, that because this Doctor is drawn in his Coach, t'other rides on Horseback, or another hath his Lacquey at his Heels, therefore he must be excellently qualify'd in his Profession, but _Vulgus vult decipi_. If I now describe, by way of Advice to those that are entering upon the Study of this divine Art, the Method of attaining to a Point of Excellency in it, and that may serve our Vulgar for a better Rule to distinguish their Qualifications by the Course they have passed through; for it is most necessarily requisite, our young Student should be perfectly instructed in the _Latin_ and _Greek_ Tongues, being the Universal Keys to unlock all those Arts and Sciences, and no less a Grace to the future Physicians. In this Particular, many of our Embryonated Physicians, that have of late Years transported themselves to _Leyden_, and _Utrecht_, to purchase a Degree, have been found very defective; insomuch, that I have heard the Professors condemn several of them for their shameful Imperfection in that which is so great an Ornament, and of so absolute an Use in the Study of Physick: Neither can less be suspected of some of the more aged Vulgar Physicians, making Choice to manage their Consultations in the Vulgar Tongue. _Secondly_, Being thus qualify'd for a Student, he ought to apply himself close to the Study of Phylosophy, for which, _Oxford_ and _Cambridge_ may justly challenge a Pre-eminence above other Universities: Here it is our Student learns to speak like a Scholar, and is inform'd in the Principles of Nature, and the Constitutions of Natural Bodies; and so receiving a rough Draught in his Mind, is to be accomplish'd by that excellent Science of Human Bodies. But because, according to the first Aphorism of the first Master _Hippocrates_, Art is long, and Life short, he ought to engage his Diligence to absolve his Philosophical Course in two Years at longest, and in the interim, for his Recreation and Divertisement, enter himself Scholar to the Gardiner of the Physick-Garden, to be acquainted with the Foetures of Plants, but particularly with those that are familiarly prescrib'd by Practitioners, to prevent being outwitted by Herb-women in the Markets, and to enable him to give a better Answer, than is said once of a Physician, who having prescrib'd _Maiden-hair_ in his Bill, the Apothecary asked which Sort he meant; t'other reply'd, some of the Locks of a Virgin. _Thirdly_, Supposing our Student having made sufficient Progress in Philosophy, may now pass to _Leyden_, and may enter himself into a _Collegium Anatomicum_, Anatomy being the Basis and Foundation whereon the weighty Structure of Physick is to be raised; and unless he acquires more than ordinary Knowledge and Dexterity in this, will certainly be deceiv'd in the Expectation of ever arriving to the Honour of an accomplish'd Physician: A Proficiency in that Part fits him for a _Collegium Medicum Institutionum_, and afterward for a _Collegium Practicum_, and then 'tis requisite he should embrace the Opportunity of visiting the Sick in the Hospital twice a Week with the Physick-Professor, where he shall examine those Patients with all the Exactness imaginable, and point at every Disease, its Symptoms, as it were, with his Fingers, and afterward propose several Cases upon those Distempers, demanding from every young Student his Opinion, and his Grounds, and his Reasons for it; withal requiring of him what Course of Physick is best to be prescrib'd: This is the only Way for a young Physician to attain a Habit of knowing Diseases when he seeth them; and a confident Method of curing those that may repair to him, without running the Hazard of being censured by Apothecaries, or derided by them for his Bills, as too many are, that at _Oxford_ or _Cambridge_ have only imbib'd a Part of _Senuert_'s Institutions, and overlook'd _Riverius_'s Practice, and thence attaining an imperfect and unhappy Skill, by enlarging the Church-yards in the City or Country; but what is more, he shall escape the Danger a young Student I formerly knew at _Oxford_ precipitated himself into, by imagining every Disease he read was his own. I must likewise advise our Student to take his Lodgings there at an able Apothecary's House, to contract the Knowledge of Drugs, and of preparing, dispensing, and mixing them in Compositions, and then by Means of his own Qualifications, may boldly pretend to inform, correct, and improve those Apothecaries which the Chance of his Practice shall conduct him to; for it would be judged ridiculous, should a Physician undertake to reprehend, and afterwards bend his Force to suppress and decry Apothecaries privately or publickly, without having first acquired a particular Experience in their Art. Hence it is again the Vulgar Physician is wrapped up in a Cloud, and the Apothecaries dance round about him; he prescribes Medicines he never saw; they prepare them according to their own Will and Pleasure. Neither is it over these alone the Physician claims a Superintendance, but over Chirurgeons likewise; and therefore in this his Course of Study, would contribute to his future Qualifications, in sojourning a Year with some experienc'd manual Operator, without a Hindrance to his other Affair, and there by an ocular Inspection, and handling of his Instruments, demanding their Names, Uses, and Manner of using, withal by Insinuations to visit the Chirurgical Patients, and see him dress them, would render his Study in Chirurgery, so plain and easy, which otherwise might be thought difficult, that it should enable him to give Laws to Chirurgeons also, especially to those that execute their Office with that Rashness, Indiscretion and Dishonesty as I have sometime discover'd amongst them. These two Years giving occasion to our Student to acquire a System, or a brief Comprehension of the Theory of Physick, and of the Practice likewise: Nothing now remains than to amplify his commenc'd Knowledge and Experience by his farther Travels; to which End, takes his Journey to _Paris_, to be acquainted with the most famous Physicians, and to be inform'd of their Way of Practice, by surveying their Prescripts at the most frequented Apothecaries, to visit for a Year every Day the Hospitals of _l'Hostel Dieù_, and _la Charitè_; in which latter, it is customary, for any three or four young Physicians to examine and overlook the new enter'd Patients, to name the Distempers among themselves, and propose their Cures, for to compare their Opinions afterwards with the Physicians that are appointed for the Hospital, and where he may see most difficult Operations perform'd in Chirurgery, as Trypaning, Amputating, Cutting for the Stone, Tapping of the Belly and Breast with the greatest Dexterity. Here he may also observe Wounds and Ulcers cured by Virtue of those famed Waters, _viz._ the White Water, and the Yellow Water; the former being _Aqua Calcis_, the latter the same, with an Addition of _Sublimate_. The Art of preparing Medicines chymically, having merited a great Esteem for its stupendious and admirable Effects in the most despair'd Diseases, shews a Necessity of being instructed in it, in which he can not fail of prying into, in the Course of his Travels. Having attained his Scope in this Place, his Curiosity ought to direct him to _Montpellier_, where he will meet with a Concourse of the greatest Proficients in Physick in _Europe_, converse with the Professors and Physicians of that Place, and out of 'em all, extract choice Observations, Secrets, and most subtle Opinions upon several Diseases, which Design can scarce be compassed in less than another Year. Now we must suppose our Student to merit the Title of an experienc'd Physician, and raised far above the Vulgar ones, that never felt the Cold beyond the Chimneys of their own Homes: He is now render'd capable of understanding the greatest Mysteries, and most acute Opinions in Physick, which he is chiefly to expect from those reputed Professors of the _Albò_ at _Padua_, where he is likewise to continue his Diligence in visiting the famed Hospital of _San Lorenzo_, and observe the _Italian_ Method of curing Diseases by alterative Broths, without purging or bleeding, that Climate seldom suffering Plethories in those dry Bodies: He cannot but be wonderfully pleased with the Variety and excellent Order of the Plants of their Physick Garden, by them call'd _Horto di Sempleci_. Neither will he receive less Satisfaction from the curious and most dextrous Dissections perform'd by the artificial Hand of the Anatomy Professor. Having here made his Abode for six Months, may justly aspire to a Degree of a Doctor in Physick, which the Fame of the Place should persuade him to take here, being the Imperial University for Physick of all others in the World, and where Physicians do pass a very exact Scrutiny, and severe Test. Hence may he transport himself to _Bologn_, and in three Months time add to his Improvements what is possible by the Advantage of the Hospital, and the Professors. Last of all, in the Imitation of the diligent Bee sucking Honey out of all sweet Flowers, our Doctor must not neglect to extract something that his Knowledge did not partake of before, out of the eminentest Practitioners at _Rome_, examine the chief Apothecaries Files, and still frequent those three renown'd Hospitals of _San Spirito_ in the _Vatican_, _San Giovanni Laterano_ on the Mount _Celio_, and that of _San Giacomo di Augusta_ in the Valley _Martia_, besides many others of less Note. Here may he see the Rarities and Antiquities of this once renowned Empress of the World, from whence he may visit the renowned City of _Naples_, and take a Survey of the Antiquities of the Nature of _Pazzoli_. Having thus in all Particulars satisfied his Curiosity, may consult about the most advantageous Ways homeward, which is to embark for _Leghorn_, or _Genoa_, where he cannot fail of _English_ Shipping. Or else may take a Tour by Land to _Milan_, where he will see the finest Hospital, and the strongest Citadel in _Europe_. Hence passes the _Alpes_, and that stupendous Mount St. _Godart_, through _Altorph_, and _Lucern_, and thence to _Bazil_, the chief of the Protestant _Cantons_, so by Boat down the River _Rhine_ to _Strasburgh_, and _Heydelbergh_, _Manheim_, and so down the _Rhine_ to _Coblentz_, _Audernach_ and _Collen_, then by Land to _Brussels_, _Ghant_, _Ostend_, _Newport_, and _Dunkirk_, _Gravelin_, and _Calais_: And thence to the Place of his Inclinations for his future Settlement, where, by his vast Experience and Knowledge, being render'd conspicuous in the secure and certain Method of his Cures, will soon give Occasion to the People to discern the Difference between him and the ordinary vulgar Physicians, who by their sordid Deports, and dangerous Practice, make it their Business to ease the blind People of the Weight in their Pockets, and plague them in worse Diseases. How very few go through this Course of Improvement, we too readily discover, and may be reproved by the first beginning of the Practice among the Ancients, where we find the Method then in use, to train up Youth to the Profession, was to place them Apprentices with able Physicians, who adjudged it necessary to take their Beginning from Surgery, the Subject whereof being external Diseases, as Wounds, Swellings, Members out of joint, and others that were visible, proved more facile and easy to their inmate Capacities, and wherein they might suddenly become serviceable to their Masters, in easing them of the Trouble of dressing and cleansing stinking Ulcers, and applying Ointments and Plaisters, a nauseous Employ, which they ever endeavour'd to abandon to their Scholars with what Expedition possible: This as it was the easiest, so it was the first, and ancientest Part of Physick, and from which those that exercised it were anciently not called Surgeons, but Physicians, tho' they attempted no other Diseases but what were external; according to which Sense _Æsculapius_ the first Physician, or Inventor of Physick, and his Sons _Podalyrius_ and _Machaon_, are by History asserted to have undertaken only those that wanted external Help; internal Diseases being in those Days unknown, and by Temperance in their Diet, wholly debarr'd; and if accidentally an internal Distemper did surprize them, they apply'd a general Remedy (having no other) of poisoning or killing themselves with a Dagger or Sword, thereby chusing rather to die once, and finish their Misery, than to survive the Objects of Peoples Pity, or to endure the Shocks of Death by every Pain or Languor, especially since the sage Judgment of that Age did esteem it a signal Virtue to despise and scorn the vain World, by hurrying out of it in a Fury, a Maxim most of the Philosophers were very eminent in observing; and was likewise extended to Children that brought any Diseases external or internal with them into the World, their Cure being perform'd immediately by strangling, or drowning them; neither was this Art of external Physick of short Continuance; _Pliny_ writing that Six hundred Years after the building of _Rome_, the _Romans_ entertain'd Chyrurgical Physicians from _Peloponesus_: Idleness and Gluttony at last exchang'd their Ease into a Disease, which soon put them into a Necessity of experimenting such Remedies as might re-establish them into that healthful Condition, which Exercise in War, and Temperance in Diet had for so many Ages preserved their Ancestors in. Upon a competent Improvement of their Scholars in this external Practice of Physick, and their deserving Deportment, they thought them worthy of giving them Entrance into their Closets, to be instructed in such Matters as the most retir'd Places of their Cabinets contained; which were their Remedies and Medicines, and the Manner of preparing them: And then bending his Endeavours to arrive to the Art of discerning the Disease by its Signs, and making Observations upon the Prognosticks, all critical and preternatural Changes: The Dose, Constitution, and all other Circumstances of giving the Medicines which he did gradually accomplish, by his sedulous Attendance on his Master, and his practical Discourses and Lectures from him on every Patient he visited: Lastly, upon his Attainment to a Degree of Perfection in the Art, discovered by his Master by his private Examination, all the Physicians and Commonalty of the Place were summoned to be present at the taking of his Oath in the publick Physick-School, which served in lieu of making Free to Practise, or taking his Degree; the Form of which, as remarkable as it is ancient, the Oath was as followeth. "I Swear by [1]_Apollo_ the Physician, and [2]_Æsculapius_, and by [3]_Hygea_, and [3]_Panacea_, and I do call to witness all the Gods, and likewise all the Goddesses, that according to my Power and Judgment I will entirely keep this Oath and this Covenant; That I will esteem this Master that taught me this Art, give him his Diet, and with a thankful Spirit, impart to him whatever he wants; and those that are born of him I will esteem them as my Male Brethren, and teach them this Art, if they will learn it, without Hire or Agreement; I will make Partakers of the Teaching, Hearing, and of all the whole Discipline, my own and my Master's Sons, and the rest of the Disciples, if they were bound before by Writing, and were obliged by the Physicians Oath, no other besides; I will, according to my Capacity and Judgment, prescribe a Manner of Diet suitable to the Sick, free from all Hurt or Injury; neither will I, through any bodies Intercession, offer Poison to any, neither will I give Counsel to any such Thing; neither will I give a Woman a Pessary to destroy her Conception: Moreover, I will exercise my Art, and lead the rest of my Life chastly and holily; neither will I cut those that are troubled with the Stone, but give them over to Artists that profess this Art; and whatever Houses I shall come into, I will enter for the Benefit of the Sick; and I will abstain from doing any voluntary Injury, from all Corruption, and chiefly from that which is venereal, whether I should happen to have in Cure the Bodies either of Women or of Men, or of free-born Men or Servants; and whatever I shall chance to see or hear in curing, or to know in the common Life of Men; if it be better not to utter it, I will conceal, and keep by me as Secrets: That as I entirely keep and do not confound this Oath, it may happen to me to enjoy my Life and my Art happily, and celebrate my Glory among all Men to all Perpetuity; but if transgressing and forswearing, that the contrary may happen." Between those Bounds of Secresy, Veneration, Honesty and Gratitude, the Art was for many hundred Years maintained; for in the Time of _Galen_, and many Ages after him, Medicines for their greater Secresie were used to be prepared and composed by Physicians, as you may read, _Libr. de Virt. Centaur._ where is observable, their Men were wont to carry their Physick ready prepar'd in Boxes after them, which they themselves, according to the Exigency, did dispense. This Custom was continued until Wars ceasing, People began to be as intent upon the Propagation of Mankind, as the Cruelty of the former martial Ages had been upon its Destruction; where the World growing numerous, and through Idelness and want of those Diversions of their military Employ, addicting themselves to Gluttony, Drunkenness, and Whoredom, did contract so great a Number of all inward Diseases, that their Multiplicity imposed a Necessity upon Physicians (being unable to attend them all as formerly) to dismember their Act into three Parts, whereof two were servile, Chirurgery and Pharmacy; and the other imperial and applicative or methodical. The servile Part being now committed to such as are now called Surgeons and Apothecaries, the former were employed in applying external Medicines to external Diseases; the latter in preparing all ordinary internal and external Medicines, according to the Prescription and Directions of the Physicians, whose Servants were ordered to fetch the prescrib'd Medicines at the Apothecaries, and thence to convey them to their Patients; by which Means the Apothecary was kept in Ignorance: As to the Application and Use of the said Medicines, not being suffered to be acquainted with the Patients or their Diseases, to prevent their Insinuation into their Acquaintance, which otherwise might endanger the diverting the said Patients to other Physicians, or at least their presuming themselves to venture at their Distempers. Neither were the Physicians Servants in the least Probability of undermining or imitating their Masters in the Practice, not knowing their Medicines or Prescriptions. Besides all this, those Remedies from which the chief Efficacy and Operation against the Disease was expected, still remain'd secret with the Physicians, who thought it no Trouble to prepare them with their own Hands. Thus you may remark the Physician's necessary Jealousy of their Underlings, and their small Pains prov'd the sole Means of impropriating their Art to themselves: And yet by the Advantage of their Chirurgeons and Apothecaries, were capacitated to visit and cure ten times greater Numbers of Sick than before; which in a short Time improved their Fame and Estate to a vast Treasure, whence it was well rhimed, ----_dat Galenus Opes, dat Justinianus Honores_. But at length, their Honour and vast Riches in the Eye of Apothecaries and Surgeons, proved Seeds sown in their Minds, that budded into Ambition of becoming Masters, and into Covetousness of Equality, and shareing with them in their Wealth; both which they thought themselves capable of aspiring to by an Emperical Skill the Neglect and Sloath of their Masters had given them occasion to attain, since they did not begin to scruple to make them Porters of their Medicines to their Patients, to intrust them with the Preparation of their greatest Secrets. This Trust they soon betray'd, for having insinuated into a familiar Acquaintance with their Masters Patients, it was a Task not difficult to perswade them, that those that had made and dispensed the Medicines, were as able to apply them to the like Distempers, as they that had prescrib'd them, who had either forgot, or were wholly ignorant how to prepare them; so that now they were as good as arrived to a Copartnership with their Masters in Reputation and Title, the best being call'd Doctors alike, and there being no other Difference between them, than that the Master Doctor comes at the Heells of his Man Doctor, to take in Hand the Work which he or his Brother Doctor (the Chirurgeon) had either spoiled, or could not farther go on with; a very fine Case the Art of Physick and its Professors are reduc'd to, and that not only of late Days, but of almost Seven hundred Years, for before that time Apothecaries had scarce a Being, only there were those they call'd _Seplasiarij_ from their selling of Ointments on the Market of _Capua_, call'd _Seplasia_, _Armatarij_, and _Speciarij_, or such as sold Drugs and Spices; tho' I confess Apothecaries may offer a just Objection in pretending to a far greater Antiquity, since the Original and Necessity of their Employ was deriv'd from the _Egyptian_ Bird _Isis_, spouting Water into its Breech for a Glyster: But 'tis no Matter, the Doctor must truckle to this powerful Engineer, he must conform to the Manner of the Age; and were I to enumerate the many Abuses that are practised by this lower Profession, I mean the Generality of them, you would be more careful in making Choice of your Apothecary, or making a better Choice in having least to do with them; and how dangerous is their Ignorance in the _Latin_ Tongue, which is of very ill Consequence, as their Prescriptions sent 'em by the Physicians are writ in _Latin_, and which not being rightly understood, hath often occasioned not only innocent but fatal Mistakes. _Homine semi docto quid iniquius?_ and that a great Part of the Apothecaries are very illiterate! is so evident, that they themselves dare not deny it; among many Instances of this Kind, that most unfortunate one recorded by an eminent Physician is notorious, who instead of a Dose of _Mercurius sublimatus dulcis_, exhibited so much common Sublimate, a mortal Poison, which was scarce ever given inwardly, instead of an innocent Medicine approved by all Physicians. Yet those worthy Sons of Bombast must disgust your Palate with the Relation of the nauseous and choaking Terms, their Ends of _Latin_ and stifling Phrases, driving to confound and amaze the simple Vulgar. An Instance of this Kind may afford you some little Diversion: A practical Apothecary coming to see his Customer, a Cobler, that lay indisposed of the Cholick, observed him to crack a Fart (for so it is express'd in the Original) upon which, said the Apothecary, Sir, that's nothing but the Tonitruation of Flatuosities in your Intestines; this was no sooner out of his Mouth, but the Cobler crack'd another, and reply'd to his Doctor, Sir, that is nothing but your Hobgoblin Notes thundring Wind out of my Guts; which literal Return of his Terms of Art in plain _English_, though by chance, obliged the Apothecary to this Expression; I beg your Pardon, Sir, I suppose you have study'd the Art of Physick as well as my self, and want not my Help: So away went Doctor Pestle, imagining the Cobler to be as great a Master in the Faculty as himself. Another Complaint against the Apothecaries is, That they are not well acquainted with the _Materia Medica_; the Knowledge of which is an essential Part of their Profession, but must take the Words of Druggists, who themselves are sometimes mistaken, and differ about the Names of several Drugs; and which is worse, their trusting to Herb-women, who obtrude almost any thing upon the greatest Part of them; and that those Women do often mistake one Thing for another, sometimes ignorantly, sometimes designedly, is well known to many Physicians, who have seen them sell the Apothecaries Herbs, Roots and Seeds, under other Names than those they do really bear, for many among them cannot distinguish between Ingredients noxious and salutary: So that we have not Patients daily poisoned is rather from the Care of Herb-women than Apothecaries. Another just Cause of Complaint against the Apothecaries are, their old Medicines; for suppose them as faithfully prepared as they can pretend or we desire, yet Length of Time will make some Changes in them, which are not often Improvements: The Syrups grow acid, and Waters full of Mother, Electuaries and Pills dry and deprived of their most active Parts, Powders themselves are not free from this Fate, whose Virtues in Time we find marvelously diminished. But were they to be told of this, you may with as good Success preach to a Wall, for not a Dram of any other Medicine will the Apothecaries part with but for Sale: So that many times they sell their Preparations five or six Years after they were made, and whether their Medicinal Properties are not much impaired, if they have any left, we leave to others to determine. And indeed the Apothecary has many Things in his Shop which are not called for in many Months, yet these must be vended with the rest; all which, when they have lost their Virtues, should they be rejected, it would be much to their Prejudice, and they have a fundamental Practice that no such Thing should be allow'd of: For 'tis much better the Patient should suffer somewhat in his Body than the Apothecary in his Estate; and if he has injured by his bad Physick, perhaps he will take Pity of him, and the next Prescription shall be better prepared; whereby he makes him abundance of Recompence for the Hurt he receiv'd by that which was bad: And he himself makes an Advantage of both, although perhaps if he had consulted the Patient, he would rather have chosen to keep his Head sound than have it broken, that a proper Plaister might be applied for the Cure. This is so notorious a Truth, that all the World, even their best Friends, exclaim against them for it, and 'till they amend this among many other Peccadillo's, it behoves the Patient to take care how seldom he employs them. Another, that the Apothecaries and their Servants are so careless, slovingly and slight in preparing of dispensatory, or prescribed Medicines, that neither the Physicians, or the Diseased, have Reason to repose that Trust in them which they challeng'd as their Due. As for Slovenliness, they may, I confess, plead the old Proverb, _That what the Eyes see not, the Heart rues not_. Indeed of all the rest it may be dispensed with; but should Patients but once behold how their Physick was prepared in some Shops, they would nauseate it: But least I should offend some nice Stomachs, I shall dismiss this Subject, and proceed to another, which is the Carelessness of Apothecaries and their Apprentices; on which I can never reflect without Fear and Indignation, to think what Numbers have been destroy'd and injur'd by such Proceedings: That this is not a groundless Apprehension many Families can witness, and you can converse with few Persons who are not able to give an Account of some such Miscarriages. Another thing of great Blame with the Apothecaries is, their enhancing the Prices of Medicines so much above what they might in Reason expect; about which the Physician must no ways concern himself, because it has a bad Influence on him, as on the Account of his Patient; though certainly, if the Apothecaries were more modest in the prising of their Physick, the Patient would be more liberal to the Physician: Whereas on the contrary, the Apothecary holds them at such unreasonable Rates, that in most Courses of Physick he gains more than the Doctor, how deservedly let others determine, though in my Opinion, were their Pay proportion'd to their Care and Honesty, I doubt they would gain little besides Shame and Reproaches: But their Bills must be paid without Abatement; and with how much Regret they are discharg'd, I shall refer it to those who have suffered by them. Now several Things contribute to, or are the occasional Causes of this Universal Grievance. The Physician's Silence, and the Number, Pride, or Covetousness of the Apothecaries, and that Prices are not set upon their Medicines: the Apothecaries being reduc'd into a Company, were at first few; and therefore having full Employment, could afford their Medicines at moderate Prices; but being since that time increased to a great Number, each Person bringing up two or three, or more, that Imployment which was before in a few Hands, became more dispers'd, so that very small Portion thereof falls to the Share of some, and indeed very few of them have more than they can manage. Now the Sick must maintain all these, for although there be no occasion for a sixth Part, yet they must all live handsomely; to supply which Expence, they have no other Way than to exalt the Prices of their Medicines, and still the less they are employ'd, the higher they must prize them, otherwise they could not possibly subsist, unless they became Physicians, and prescribe as well as prepare; to which Practices they are not only propense, but more arrogantly assume, which is no less fatal to their Patients, than by the impudent Prescription of your common Quacksalver, Emperic, or Mountebank. Now would it not be much better, if it were with us as in some Parts of _Europe_, where the Magistrates of many Cities agree upon a certain Number of Apothecaries, so many as they can apprehend are necessary, all the rest are excluded, and must either seek other Seats, or be content for a small Salary to work under those that are allow'd; their Apothecaries not being permitted to multiply by Apprentices, but one out of the Shop is by the publick Authority appointed to succeed in the Employment. _Hamburgh_ has but one, _Stockholm_ and _Copenhagen_ four or Five, _Paris_ (which rivals _London_ in its Inhabitants) has but one or two and fifty; they are from the due Regard to the Safety of the People exempted from Offices, either troublesome or profitable, that they may always be inspecting the Preparations, or compounding of the Doses, to prevent the deadly Consequences of sophisticated Medicines, or the fatal Errors of one Composition for another, not easily to be distinguished: They are not permitted to visit the Sick, that they may not be wanting from the Duties of the Shop, or be tempted to gratify themselves as they please for the Trouble, by introducing the Custom of taking too often of the Bolus and Cordials. The Physicians Fees are settled according to the various Conditions and Abilities of the Patient; 'tis not allow'd them to make any Advantage by the arbitrary Rates of Physick, when prepared by themselves, that the Patient and the Bill may not be too much inflam'd by a Profit on that side, not easily to be limited or confined. I would not be suspected to design any Prejudice to the careful and industrious Apothecary, (if such there be) his Business requires the greatest Diligence and Fidelity in selecting the Drugs, and preparing them faithfully according to the Appointment of the Faculty, and in making up the Doses with that just Regard to the Life of the Sick, that all Suspicion of the least Mistake may be prevented, in the Weight and Measure, or the Number of Drops, _&c._ But when the Apothecary deserts his Station, is always abroad, and leaves the compounding Part to his unexperienc'd Apprentice, who cannot avoid sometimes infusing one thing for another, by which Errors many are known to have lost their Lives; when 'tis known that the Prescripts are made up of Medicines bought by Wholesale of the Chymist, and not made up by the Apothecary himself, as is too much the present Practice, and consequently can't be known to be made of all, and best Ingredients, but are suspected, because bought at low Prices; you will doubt whether the Character of an Apothecary can be given to this new, and till lately unknown Employment: When he neglects the Business of his Trade, neither prepares himself the Compositions, nor forms the Doses for them, to be deliver'd at the most urgent Occasions, but daringly undertakes to advise in all Distempers, he becomes an Emperic, and invades a Profession which he cannot be supposed to understand. And here give me Leave to be serious, in examining their general Practice in all Diseases. Suppose your self to be troubled with any Distemper, it matters not which, for all is one to him you send to; upon his Arrival he feels your Pulse, and with a fix'd Eye upon your Countenance, tells you your Spirits are low, and therefore it's high time for a Cordial; the next Interogatory he puts gravely to you is, When was you at Stool, Sir? if not to Day, he promises to send you a laxative Clyster by and by; and if you complain you have a Looseness, then instead of one laxative, he will send you two healing Clysters: If besides you intimate a Pain in your Stomach, Back and Sides, then, responding to each Pain, you shall have a Stomach Plaister, another for the right Side, another for the left, and one for the Back, and so you are like to have a large Patch and well fortified round the Middle. Now before we go farther, let's compute the Charge of the first Day. There is the Cordial, composed by the Direction of some old dusty Bill on his File, out of two or three musty Waters (especially if it be towards the latter End of the Year, and that his Glasses have been stopt with Corks) _viz._ it may be a Citron, a Borrage and a Baum Water, all very full of Spirits, if River Water may be so accounted; to these is to be added one Ounce of that miraculous Treakle Water, then to be dissolved a Dram of _Confectio Alkermes_, and one Ounce of nauseous Syrup of July-Flowers; this being well shaked in the Vial, you shall spy a great Quantity of Gold swimming in Leaves up and down, for which your Conscience would be burthened should you give him less than Five Shillings; for from the meanest Tradesman he expects, without Abatement, Three and Six pence, the ordinary and general Price of all Cordials, tho' consisting only of Baum Water and half an Ounce of Syrup of July-Flowers. Your Clyster shall be prepared out of two or three Handsful of Mallow Leaves and one Ounce of common Fennil Seeds, boiled in Water to a Pint, which strained, shall be thickned with the common Electuary lenitive, Rape Oil and brown Sugar, and so seasoned with Salt; this shall be convey'd into your Guts by the young Doctor, his Man, through an Engine he commonly carries about with him, and makes him smell so wholsome; for which Piece of Service if you present your Engineer with less than Half a Crown, he will think himself worse dealt with than those who empty your necessary Closets in the Night; the Master places to Account for the Gut-Medicine (though it were no more than Water and Salt) and for the Use of his Man, which he calls Porteridge, Eight Groats. _Item_, For a Stomatick, Hepatick, Splenetick, and a Nephretick Plaister, for each Half a Crown: What the Total of this Day's Physick does amount to you may reckon. The next Afternoon or Evening the Apothecary returns himself to give you a Visit, (for should he appear in the Morning, it would argue he had little to do) and finding, upon Examination, you are rather worse than better, by Reason those Plaisters caused a melting of the gross Humours about the Bowels, and dissolved them into Winds and Vapours, which fuming to the Head, occasion a great Head-ach, Dulness and Drowsiness, and Part of 'em being dispersed through the Guts and Belly, discompose you with a Cholick, a Swelling of your Belly, and an universal Pain or Lassitude over all your Limbs. Thus you see one Day makes Work for another; however, he hath the Wit to assure you, they are Signs of the Operations of Yesterday's Means, beginning to move and dissolve the Humours; which successful Work is to be promoted by a Cordial Apozem, the Repetition of a carminative Clyster, another Cordial to take by Spoonfuls, and because your Sleep has been interrupted by the Unquietness of swelling Humours, he will endeavour to procure you for this next Night a Truce with your Disease, by an Hypnotick Potion that shall occasion Rest: Neither will he give you any other Cause than to imagine him a most careful Man, and so circumspect, that scarce a Symptom shall pass his particular Regard; and therefore to remove your Head-ach by retracting the Humours, or rather, as you are like to discern best, by attracting Humours and Vapours, he will order his young Mercury to apply a Vesicatory to the Nape of your Neck, and with a warm Hand to besmear your Belly and all your Joints with a good comfortable Ointment for to appease your Pains: The Cordial Apozem is a Decoction that shall derive its Virtue from two or three unsavoury Roots, and as many Herbs and Seeds, with a little Syrup of July-Flowers, for three or four Times taking; which because you shall not undervalue by having it brought to you all in one Glass, you shall have it sent you in so many Vials and Draughts, and for every one of them shall be placed Three Shillings to your own Account, which is five Parts more than the Whole stands him in; for the Cordial Potion as much; for the Hypnotick Potion the same Price; for your Carminative Clyster no less; and for the Epispastick Plaister a Shilling: Thus with the Increase of your Disease you may perceive the Increase of your Bill; and therefore it's no improper Observation, That the Apothecaries Practice follow the Course of the Moon. The third Day produces an Addition of new Symptoms, and an Augmentation of the old ones; the Patient stands in need of new Comfort from his Apothecary, who tells him, that Nature begins now to work more strong, and therefore all Things go well (and never ill;) but because Nature requires all possible Assistance from Cordials and small Evacuations, he must expect to have the same Cordials over again, but with the Addition of greater Ingredients, it may be Magistery of Pearl, or Oriental Bezoar in Powder, besides the Repetition of a Clyster, and the renewing of your Plaisters, for the Profit of your Physician, you must be persuaded to accept of a comfortable Electuary for the Stomach, to promote Digestion; of a Collution to wash your Gums to secure you from the Scurvy, serving at the same Time to wash the Slime and Filth from your Tongue; of a Melilot Plaister to apply to the Blister that was drawn the Night fore; of some Spirits of Salt to drop into your Beer at Meals; of three Pills of Ruffi to be swallowed down that Night, and three next Morning, which possibly may pleasure you with three Stools, but are to be computed at two Doses, each at a Shilling; the Spirit of Salt a Crown the Ounce; for the Stomach Electuary as much, for the Clysters as before; for your Cordial in relation to the Pearl and Bezoar, their Weight in Gold, which is Two-pence a Grain, the greatest Cheat of my whole Discourse; for dressing your Blister a Shilling; for the Plaister as formerly. Here I presume that Candour in you, as not to believe me so disingenuous, as to take the Advantage of Apothecaries in producing any other than the best Methods of their Practice, and that which favours the least of their Frauds, for in Comparison with others (though these are very palpable, in regard there is not a valuable Consideration regarded as a _quid pro quo_) they are such as may be judged passable; yet when you are to reflect upon the Total that shall arise on the Arithmetical Progression of Charge of a Fortnights Physick, modestly computed at about Fifteen Shillings a Day, without the Inclusion of what you please to present him for his Care, Trouble, and Attendance, I will not harbour so ill an Opinion of him, or give so rigid a Censure as your self shall upon the following Oration your Clysterpipe Doctor delivers to you with a melancholy Accent, in these Terms: Sir, I have made use of my best Skill and Endeavours, I have been an Apothecary these twenty Years, and upwards, and have seen the best Practice of our best _London_ Physicians; my Master was such a one, Mr. ------ one of the ablest Apothecaries of the City; I have given you the best Cordials that can be prescrib'd; 'tis at your Instance I did it, I can do no more, and indeed it is more properly the Work of a Physician; your Case is dangerous, and I think, if you sent for such a one, Dr. ---- he is a very pretty Man; if you please I will get him to come down. Now, Sir, how beats your Pulse? The Loss of your Monies your Bills import, give Addition to your Pain, through the Remembrance it is due to one that hath fool'd you out of it, and deserv'd it no other way, than by adding Wings to your gross Humours that before lay dormant, and now fly rampant up and down, raking, and raging; which had you not been Penny wise and Pound foolish, you would have prevented by sending for a Physician, who for the small Merit of a City-Fee (for which you might also have expected two Visits) would have struck at the Root of the Distemper, without tampering at its Symptoms, or Branches, and by Virtue of one Medicine, restor'd you to your former Condition of Health from which you are now so remote, being necessitated, considering your doubtful State, to be at the Charge of a Physician or two, to whom, upon Examination of what hath been done before, the Apothecary shall humbly declare, he hath given you nothing but Cordials; which Word Cordial, he supposes to be a sufficient Protection for his erroneous Practice; and I must tell you, that had his Cordial Method been continu'd in a Fever, or any other acute Distemper, for eight or ten Days, your Heirs would have been particularly obliged to him for giving you a Cordial Remove out of your Possession, and that through Omission of those two great Remedies, Purging and Bleeding, the exact Use whereof, in respect of Time and Quantity, and other Circumstances, can only be determined by accomplish'd Physicians. I cannot better describe their Unaptness for so great a Work, nor express the great Difficulties that must be conquer'd to deserve the first Character of a compleat Physician, than in the Words of that eminent and learned Physician Dr. _Fuller_; 'It requires (says he) to understand the learned Languages, Natural Philosophy, all the Parts of the Body, and the Animal Oeconomy, the Nature, Causes, Times, Tendencies, Symptoms, Diognosticks, and Prognosticks of Diseases, the Indications of Cure, and contra Indications, the Rules of Errors of living as to the Six Non-naturals; we must have the Skill to judge to whom, for what, when, how much, how often to prescribe Bleeding, Vomiting, Purging, Sweating, and other Evacuations; as also to Opiates, Calybiates, Cortex, and the numberless other Alteratives: We must be very well acquainted with the Virtues, Faults, Preparations, Compositions, and Doses of Vegetables, Animals, Minerals, and all Shop Medicines; and lastly, to compleat all, must be able, upon every emergent Occasion, to write a Bill for a Patient, readily, pertinently, and in Form according to Art. Now to accomplish all this, a Man had need be rightly born, and set out by Nature, with a peculiar Genius, and particular Fitness, and with a strong prevailing Inclination to this Study and Practice above all others. 'He must endeavour with Diligence, Sagacity and Gravity, Integrity, and such a convenient Briskness and Courage as will bear him up, and carry him through Difficulties, without presumptuous Rashness or barbarous Hard-heartedness; and then 'tis necessary he should be a Man of a competent Estate, to answer the great Expence of Education and Expectation; for he must be brought up directly in it from the Beginning of his Studies in the University; he must lay out all his Time and Talents upon Reading, Advising, Observing, Experimenting, Reasoning, Remembering, with an unwearied Labour of Body and Application of Mind; he must run through Courses of Anatomy, Botany, Chymistry and _Galenick_ Pharmacy: And when he hath done all this, cannot handsomely compleat himself, except he see good Variety of others practise, which (by the by) it's probable he will have more Time for than he could wish, before he can get any of his own.' Now each of those singly will require a great deal of Pains, Expence and Time to be attained; and yet all these and much more that can be in short summed up, ought to be done and in some measure accomplished, before a Man can be rightly and duly qualified even to begin Practice. And as to Matter of Fact, few (very few, God knows) there have been, or now are, who tho' they spared not for Education or Diligence, ever work themselves up to a tolerable Sufficiency: Nay, _Hippocrates_ himself, that great Genius, is not ashamed to confess, in an Epistle to _Democritus_, That though he was now got to Old Age and to the End of Life, yet he was not got to the End of Physick; no, nor was _Æsculapius_ neither, the Inventor of it. By all which, it's undeniably evident, that the Science and Practice of Physick is one of the largest Studies, and most difficult Undertakings in the World; and consequently, not any the best Collection of Prescripts that ever was, will, or can be writ or printed, can alone make a compleat Physician, any more than good Colours and Pencils alone can make a fine Painter. And yet every illiterate Fellow and paltry Gossip that can make shift to patch up a Parcel of pitiful Receipts, have the Impudence and Villainy to venture at it; and in hopes of a good Pig, Goose or Basket of Chickens, shall boldly stake their Skill (forsooth) against Mens Lives, and lose them; and at the same Time scandalize and keep out true Physicians, that might probably save them. And this leads me to the third Consideration, The great Danger and Damage occasioned by the rash tampering of such as are not educated rightly and qualified for it. You that enter not by the Door into the Profession, but climb up some other Way, ought to take it into your most serious Thoughts, that Mistakes and Mismanagement in so difficult a Business easily happen; often the Mischiefs occasioned thereby are impossible to be retrieved; and being upon the Body, perhaps Mind of Man, sometimes produce such undoing Misery, such deplorable Ruin, as would make even an Heart of Stone break and bleed, and Death to think of it. Suppose one should lose his Limbs or Health, and live unhappily in Pain, Sick or Bedrid all his Days through your improper Applications or ignorant Omissions; Would it not turn your very Bowels within you, and make you wish a thousand times you had never been that unadvis'd Busie-body to act thus foolishly and unfortunately? But put the Case again: You behold a dead Man (which to me is the most lamentable of all lamentable Spectacles Upon Earth) I say, put Case a poor dead Man were laid before your Eyes, that your Heart tells you might probably have lived many a fair Year, had it not been for your physicking of him: Such a Sight, such a Thought, (if you have the least Humanity left) cannot fail to pierce your very Soul; and ever after the Remembrance, yea, the evil Conscience of it must haunt you and give you Horror and Terror, and a sort of Hell to your dying Hour. Perhaps it may be an only and hopeful Son, in whose Life his aged Parents Lives were bound up; and they die too, or linger out a miserable Life in Sorrow and Anguish worse than Death. Perhaps the good Father of a many little Orphans, who being poor and now helpless, must pitiously perish, or being fallen into bad Hands, and cheated of what was left them, may suffer Poverty, Contempt, Injury and Misery all their Life long. Perhaps a Wife, who might have brought forth an useful eminent Man, a Hero of his Generation, and the Head of splendid Families; and so the Mischief you do may fall upon not only the present but future Ages. But Possibilities and putting of Cases are endless, the Upshot of all this, if you take upon you to cure the Sick, and be not licensed and otherwise qualified for it, if you presumptuously thrust in your self, and bar out another that is authorized and able, though no ill Event chance thereupon, yet well it might, and was likely to do so for all you; and therefore good Providence that protected your Patient, and fenced off the Evils, is alone to be thanked, and you nevertheless to be blamed. But if Death ensue your arrogant Intermeddling and pernicious Quackery, be assured of it, 'tis a sort of Murder in the Court of Conscience, and probably will be adjudged so in the last Great Court. This is not my private Opinion only, but the Judgment and Decision of the Legislature of our Land; for the _Present State of_ England tells us, That by the Law of _England_, if one who is no Physician or Surgeon, and not expresly allow'd to practise, shall take upon him a Cure, and his Patient die under his Hands, this is Felony in the Person presuming so to do. 'Tis not enough for you to say, If I can do no Good, I'll do no Hurt, (which you may as well invert, and say, If I do no Hurt I'll do no Good) no, you interlope, you injure the Faculty, you discourage Education, you keep out better Advice, you trifle with Mens Lives, you lose the golden Opportunity, you prolong the Case 'till it gets head, and grows incurable and mortal, or else extremely hazardous and almost helpless; and this is doing Hurt with a Vengeance. To bring this home to you, and make it more plain. If an House be on Fire, and you come and pretend to put it out your self, and absolutely keep off others, and then fling in Dust instead of Water, and so the Flame gets Mastery; in this Case, though you did not directly intend any positive Hurt, though you did not actually pour in Oil, nor stir and blow up the Coals; yet forasmuch as you would needs be an Undertaker, and could not extinguish it your self, and suffered not others, used to and skill'd in the Business, who coming with Water and proper Engines, might have done it, you are really and truly the Cause of it being burnt. Think not to excuse your self by pretending you did it out of Charity, and meant well, though it fell out ill; no, no, be it known to you, such a Charity as did not appertain to you, and proved murderous, was unpardonable Presumption, and therefore will not cover the multitude of Sins. If you are not sufficient for those Things, you'll do well and wisely to desist from this difficult and dangerous Practice, and fall into such a Trade of Life as you well understand and rightly can manage. And then like the Men who used curious Arts (_Acts_ xix. 19.) you may burn all your Receipt-Books; so shall you keep your Innocence, save your Conscience, secure your Quiet, and yet reserve Room enough to exercise your Charity. For if at any Time your Heart move you to pity and succour a poor sick Neighbour that can't pay for Advice, there will be no Necessity that you should try your Skill upon him, 'till you mischief or murder him by way of Charity. Do but you send him a Physician, Medicines and Necessaries without Hope of Requital; and trust me, that will be an handsome Assistance, most nobly becoming a generous Mind and a charitable Man. Now that not one of our Apothecaries, or indeed very few of our modern Traders in Physick, have these requisite Endowments, I shall leave it to any considerate Person to judge of; and how far they stretch beyond their Knowledge, we have a many miserable Objects in our daily View, woful Instances of their great Rashness, Folly and Ignorance. That the Profession has sunk into the Craft of deceiving, and amusing, and making Profit by new Medicines, or useless Preparations brought into fashion, and highly esteem'd, as long as the Mode of crying them up shall last, and the Fallacy which imposes them can support it, the unhappy People suffer themselves to be deluded, and cheated of their Lives, and their Money. The Rich please themselves that they can purchase the Alexipharmic, which has Power to controul the Disease, and have not any Doubt within themselves, that by the often Use, their Lives become almost immortal; they look down with some small Pity on the Vulgar, who they think must die before them, being not able to pay the Ransom. They please themselves, because Health and Life are of the highest Demands for these Rarities peculiar to them. The Gentlemen of both the higher and lower Faculty have not been wanting to make use of the Credulity and Weakness of the richer Patients; and I shall now lay open to your great Surprize, that the most despicable and useless Stuff have been brought into the highest Esteem to be rely'd on in the most difficult and dangerous Distempers. And _First_, of the _Bezoar_-Stone, an obvious Instance of our _English_ Practice, from whence you may concur with the Physicians abroad, with what Skill, and Art, and Integrity the Profession continues to be practised here. _Bezoar_ (which has neither Smell nor Taste, and upon taking into the Stomach gives no Sensation perceivable) has held its Name and Reputation almost sacred with us, though exploded long since in almost all Parts of _Europe_. The _French_ are well convinced that they have been impos'd upon by the trading Physicians returning from the _Indies_, to take off the pretty Trifle at a very great Price; they had made it to be admired, by asserting that it was able to encounter Poisons, that no malignant Distempers were able to resist its soveraign Virtues; but their overdoing, spoilt their Market, the more curious and wiser Part of the Nation discerning the Abuse, had the Opportunity of promoting the Experiment, which they procured by the King's Command, two Criminals who had Poison given them, with Promise of Life, if _Bezoar_ could procure their Pardon. They lost their Lives, and the Physicians and the Stone their Reputations. The greatest and most learned abroad have freely own'd that they have been deceiv'd by it, but their Patients much more, who had used it without Success, and any observable Effect. Doctor _Pauli_ tells you, he has left the Use of it many Years, and had given to better Purpose, the more powerful and certain Cordials taken from Plants; and supports his Opinion with the Suffrages of _Casper_, _Bauhinus_, _Casp. Hofmanus_, _Rectius_, _Fabriciùs_; The learned and judicious _Deemoebreck_ in his Treatise of the Pestilence, declares he had no Regard to it, that he gave it often _absque ullo fructu, movebat aliquo modo exiguum duntaxit sudorem_. It did, says he, no good to those who used it; scarcely mov'd so much as a little Sweat: It was of the best Parcel chosen of any coming from the _Indies_, or ever was sent to _Europe_, but gave them not the least Relief, though they had promised themselves the greatest from it: To confirm his Opinion that it is worth nothing, he produces the Opinion of _Hercules Saxonias_, and _Crato_ Physician to three Emperors, and refers you to many others. Doctor _Patin_, late Royal Professor of Physick in _Paris_, decides the Pretences to its being of any kind of Use: He says it neither stirs the Blood, nor puts the Spirits in any Motion; besides, some of the above-nam'd Physicians, he appeals to the Judgment of many others, and his own Experience of more than thirty Years. The lately corrected _Leewarden_'s Dispensatory leaves it out of their _Gascoins Powder_, condemning it as a useless and frivolous Ingredient. _Bontius_ tells you, that if we must give Stones, we ought to put a greater Value upon those cut out of the Bladders of Man, a more noble Creature, fed with Meat of the highest Nourishment, and his Spirits warm'd with Wine, than that of a Goat starving upon the Mountains. He assures you that he has given the _Bezoar_, from the Gall or the Bladder, with better Effect than he ever observ'd of those from the _Indies_. The Physicians who first began the Amusement and Cheat, made themselves ridiculous by dreading to give for a Dose more than five, or six, or seven Grains: You may take forty or fifty with no other Advantage or Alteration than your Imagination shall raise; and with the same Effect, ten times as much more. It may, with modern Observers, pass for a Sweater, and a Cordial, when they have given it with good Cordials, and Sweaters, but the most visible Operation it has, is seen when the Bill is paid. Our Physicians in their private Conversations, talk of it as a thing altogether worthless; but because the People are willing to be cheated with _Bezoar_ and _Pearl_, they dare not entertain a Thought of undeceiving them, fearing the Consequence to their own Disadvantage: And I pray with what Art can the high Rate of Medicines be maintain'd, if the World could not be amused with the Imagination of being kept alive in all the Distempers, by the Force of these two? _Pearl_ is a Disease in a Shell-Fish, as _Bezoar_ is in the _Quadruped_: They are very different in Shape and Bulk, the whitest and most glittering are most in Esteem; the sickly Fancy conceits it will revive the Blood as it pleases the Eye; and that it will brisk up the Spirits and Mind, when it reflects on its being dear and fashionable. But this has been despis'd by the honest Physicians, who prescribe for the Cure of their Patients. The famous _Plater_, after the Experience of a many Years Practice, rejects the pretended Virtues of Pearl, or Metals, which have no Taste or Smell, to give the least Pretence to rank them with the Vegetable Alexipharmicks. Most of our Writers are of his Sentiment, and give it only a common Place with the others usually prescrib'd in the Heart-burning, or windy sour Humour offending the upper Orifice of the Stomach: But the Shell of the Fish that breeds them, pretends to, and is allow'd by all our best Authors to have the same Virtues. Nature has been very liberal in this Sort of _Alkali_; all the Shell-fish, all the Claws of Crabs, or the Tips, if you please to value them most, the two Stones of the Craw-fish, and the Shells of Eggs are directed frequently with the Pearl: The two Corals, _&c._ and the numerous Earths of the absorbing Kind, the Chalk, the Marles, are judged by many preferable to it, or are used with the same Success: So that we have the greatest Reason to believe, that the debauched Practice of the _English_ Preservers of Health have made use of it, with Design to extract Sums out of the Purse, rather than of making the Crasis of the Blood better, or the Spirits more vivacious; and if you have Oyster-Shells or Crabs-Eyes in its Stead, which are generally made use of under that Name, they will have the same, if not a better Effect. Gold is by our Chymical Writers stil'd the Sun, and the King of Metals. The Kings and Princes of the last Age were amus'd and defrauded, their Lives made less durable than their Subjects, who were beneath the Use of Gold; the Chicken they eat had the Happiness to be fed with it, that they might extract the Sulphur and prepare it by their Circulation, and volatize it for their Use. But the Physicians were contented to collect all the Gold which past unaltered and undiminished thro' the Poultry, into their Pockets. This, with many other Artifices of this Stamp, are by many laid aside, because the Publick begin to be sensible that the Gold, as the _Bezoar_ and the Pearl, were of more Cordial Virtue to the Adviser and Confederates than to the Subject of their Care and Attendance. The _Aurum potabile_ is sometime the Entertainment of Conversation, when the poor Alcymists or their vain Pretensions are considered; there being no Humour in any Animal which can alter or dissolve it, no Effect or Operation can be expected from it, it deludes the Eye and Fancy in the Cordial Waters, and on the Bolus and Electuaries, but must pass away sooner or later as it adheres more or less to the Stomach or Bowels, without acting or being acted on in any Part of the Body; the Pills, either purgative or cordial, are as often dismist entire, having been covered with Leaf-Gold, which is able, though thin, to dismiss the most subtil and penetrating Parts of all Humours. The Value of the Leaf is not worth your Enquiry, the Book being sold at a low Price. The Fulminating Powder is a rough violent Medicine, and has been lately neglected, and given Place to others more useful and less dangerous. Silver and Lunar Pills are as vile and disregardless as Gold, when they are considered with relation to the Cure of Diseases. The precious Stones have constantly been put into the old Receipts by that Sort of Writers who prescribe every Medicine very faithfully, and design to please and amuse the Readers with the Bulk and Length of the Prescription; but they have been neglected by the practical Authors, who had the Trouble of considering, that no Manner of Vertue could be expected from so hard and therefore impenetrable Bodies; as the Diamond, Ruby, Hyacinth, the Sapphire, the Smargad and Topaz, _&c._ who are not capable of a Dissolution, and of altering or acting upon the Fluids, and as it is most certain that many very cheap Medicines have greater and more observable Effects, it's ridiculous to give a hard gritty Powder, which may for many Reasons corrode and offend the Stomach and Bowels in their Passage. Among the many Foreign Vegetables imported here, I must take Notice of Sarsaparilla, as it has had the Preference before many others, especially of our own Growth, in many difficult and chronical Cases, will have obtain'd its Credit and Reputation by being in good Company, and by being prescrib'd with the cheapest Drugs, but of the greatest Virtues, _viz._ Guiacum, Sasaphras, China, and the Seeds of many most useful Plants. If it has been by it self beneficial, in the Practice of the _West-Indies_, it has lost its Qualities in the Passage into the colder Climates, being a soft and thin Root, it may evaporate and exhale its most active Parts; many of the late Writers have given this Judgment of it, that it is _nullius Saporis vel Odoris_, of no Smell or Taste. The Physicians have not yet done, but contrive to thrust into the Stomachs of their Patients, not only the most loathsome, but the Parts of Animals, which after their Death, are void of all Spirits or Oils, and are a dry and unactive Earth. Of the first Sort, Mummy claims the Precedence; this has had the Honour to be worn in the Bosom next to the Heart, by the Kings and Princes, and all those who could then bear the Price the last Age in all the Courts of _Europe_; 'twas presented with the greatest Assurance, that it was able to preserve from the most deadly Infections, and that the Heart was secured by it from all the Kinds of Malignity: They expected long Life from the decay'd, or dead, Spices, and Balsams, and Gums, and the Piece of the dead Body of an _Egyptian_ Prince, or of a Slave preferred by him: If taken inwardly, it was avow'd to be able to dissolve the Blood coagulated, to give new Life and Motion to all the Spirits. The dry'd Hearts of many Animals, the Livers, the Spleens burnt to a Powder; the Skins of the Stomachs, or Guts of Cocks, and Worms, and the dry'd Lungs of Foxes, ought to be rejected as loathsome and offensive without any Qualities to amend, by the Expectation of any Advantage. The Powder of Vipers by it self, and in the Troches, will deserve a more strict Examination, because it is not only depended on in many Chronical Diseases, but the Life of the Patient in the Acute and Pestilential is betray'd and lost, if it has no alexiterial Powers to expel the Malignity, or support the natural Vigour. But as the Flesh of all Animals, and Fish, when dry'd, have exhal'd the Volatile Spirits with the Moisture, and nothing remains but the Skins and Fibres, and are capable of giving very little Nourishment to the Blood, and are very difficult to be dissolv'd, or digested in the Stomach: You may conclude, by trying when in Health, if Vipers will support your Strength, or if eating of the Flesh in all the Kinds of Cookery, will please the Palate more than the common Food, what you may hope from the dry Powder, or the Cake of it with Salt and Meal, (and the Troches of Vipers are no more) when your Fever calls for the best Alexipharmick. You may to this compare the Skulls of dead Men, now presum'd to command the Epilepsies, and other violent Diseases, if the Skull has been long in Powder, or has long surviv'd the Criminal, the Spirits distill'd from it, are not stronger than those from the Horn of a Stag, or the Spirits of Urin by it self, or from Sal Armoniack: the Shell of the Head preserves the Brains, and the Powder shall not fail to preserve the Spirits of all the Brains which can be perswaded to use it. What can you think will be the Success, from the Use of the Nest of the Swallow, or the Cast off Skin of a Serpent; your Thoughts will naturally reflect on the perfidious Fourbery of making great Gain from the Bubbles put on the Sick, or the vile Negligence of the rest who have suffer'd the fatal Amusements to be at last confirm'd by Custom. After these it may seem needless to speak of the gainful Industry, which has brought the Horns of the Elk, the Bufalo, Rhinoceros, and of the Unicorn's Horn, which is no other than the Bone of a Fish, and has been thought sufficient alone to expel all Poisons; or the Hoofs of the Elk and the Ounce, or the Bone of the Hart of a Stag, the Effect of his old Age; or the Jaw-bones of the Pyke, _&c._ or the Ancle-bones of the Hares and Boars, _&c._ with the Eagle-Stone, and those for the Cramp, and Convulsions, and Cholicks, the great Assistance from your Amulets, and abounding Nostrums, cannot sufficiently be derided. Of the simple distill'd Waters, one hundred and fifty are appointed to be made, the greatest Part of them are not now prepar'd; and indeed they are found of no Use, but to increase the Bulk of the Julep, with the hot and compound Waters; the Milk Water is now order'd for that Design, and because as much Money can be procur'd from it, as from all the vast Variety of the other, this in the usual Practice almost supplies the Place of all the rest. You may run over the vast Number of the _Galenical_ Preparations and Compositions, as they are improperly stiled; they are almost seven hundred, to be kept till they be corrupt, and be viewed as the old rusty and rotten Weapons of an ancient Armory; they are now reduc'd to, and the Shop is supposed to be made up with about One hundred and fifty: But if the insipid Simple Waters, and the fiery ungrateful Compound Waters shall be thrown aside, and the Simple Milk Water, with five or six Cordial Tinctures, shall be kept for Use, and the other Tincture appointed by the Physician, with respect to the Circumstances of the Patient: If only three or four Syrups and Conserves, and Powders, and Pills, and Oils, and Ointments, and Plaisters in that Number, in Imitation of the Prudence and Integrity of the Foreign Physicians who have contracted their Dispensatories, shall be order'd, in the most rational, and efficacious Forms, to receive the Addition of all the natural Powders, Balsams, Gums, or the Chymical Medicines, the Apothecary will have his Trouble very much lessened, and with less Expence; the Patient will have his Disease much sooner cured, and his Life much better preserved. By this time we presume the Reader is convinc'd, that private Interest too often influences many of our Modern Physicians, and makes them prescribe such Medicines as tend most to the Apothecaries Gain, because the People give the Apothecary Power of appointing the Physician; we have shewn that those costly pretended Medicines, which so much raise the Sum in the Bill, have no real Virtue; that the greatest Part of the most senative grow in our own Gardens; that if some few are fetch'd from foreign Parts, they are used in so small Quantities, that the Doses are of the lowest Price: And consequently you will very plainly see, that the long and high charg'd Bill after a Fit of Sickness, is more the Effect of the Collusion betwixt the Doctor and Apothecary, together with your own Folly of desiring of it, than either the Prices of the Medicine, or the Necessity of so many Doses. I dare say, my Reader now thinks it high time to take Care of himself, to believe that the seldomer the Physician or Apothecary are employ'd, the less Risque he runs in his Health or Fortune, that he is not upon every slight Indisposition, or ordinary Sickness to call upon their Help, whereby very often the Remedy proves worse than the Disease; that your Constitution will endeavour to preserve it self, and will effect it in most of the common Distempers, but with ill Medicines those will become dangerous, and will be made every Day more malignant. Take the Counsel of your most observing and experienced Friend, who has no Byass to divert him from the only Care of your Health; but avoid the Emperick, who will, instead of procuring the Ease of your Thoughts and Repose, and prescribing the Rules of your Diet, and permitting Nature to subdue the Disease, affright you with the greatest Danger, disturb you, and fill your Chamber, or both, with the inflaming and pernicious Cordials, the Bolus's and Draughts, till he has cured his own Distemper by the Number of Articles he shall enter into the Bill. That it is in the Power of every Man to become his own Physician, who needs no other Helps of supporting a good, and correcting a bad Constitution, than by observing a sober and regular Life; there is nothing more certain, than that Custom becomes a second Nature, and has a great Influence upon our Bodies, and has too often more Power over the Mind than Reason it self? The honestest Man alive, in keeping Company with Libertines, by degrees forgets the Maxims of Probity he before was used to, and naturally falls into those Vices with his Companions; and if he be so happy as to acquit himself, and to meet with better Company, then Virtue reassumes its first Lustre, and will triumph in its Turn, and he insensibly regains the Wisdom that he had abandoned. In a Word, all the Alterations that we perceive in the Temper, Carriage, and Manners of most Men, have scarce any other Foundation, but the Force and Prevalency of Custom. 'Tis an Unhappiness in which the Men of this Age are fall'n, that Variety of Dishes is now the Fashion, and become so far preferable to Frugality; and yet the one is the Product of Temperance, whilst Pride and unrestrain'd Appetite is the Parent of the other. Notwithstanding the Difference of their Origin, yet Prodigality is at present stiled Magnificence, Generosity and Grandeur, and is commonly esteem'd of in the World, whilst Frugality passes for Avarice and Sordidness in the Eyes and Acceptation of most Men: Here is a visible Error which Custom and Habit have established. The Error has so far seduc'd us, that it has prevail'd upon us, to renounce a frugal Way of living, though taught us by Nature, even from the first Age of the World, as being that which would prolong our Days, and has cast us into those Excesses, which serve only to abridge the Number of them. We become old before we have been able to taste the Pleasures of being young; and the time which ought to be the Summer of our Lives, is often the beginning of their Winter, we soon perceive our Strength to fail, and Weakness to come on apace, and decline even before we come to Perfection. On the contrary, Sobriety maintains us in the natural State wherein we ought to be. Our Youth is lasting, our Manhood attended with a Vigour that does not begin to decay 'till after a many Years. A whole Century must be run out before Wrinkles can be form'd on the Face, or Grey-hairs grow on the Head: This is so true, that when Men were not addicted to Voluptuousness, they had more Strength and Vivacity at Fourscore, than we have at present at Forty. It cannot indeed be expected, that every Man should tie himself strictly to the Observations of the same Rules in his Diet, since the Variety of Climates, Constitution, Age, and other Circumstances may admit of Variations. But this we may assert as a reasonable, general, and undeniable Maxim, founded upon Reason and the Nature of Things; that for the Preservation of Health and prolonging a Man's Life, it is necessary that he eat and drink no more than is sufficient to support his natural Constitution; and on the contrary, whatsoever he eats and drinks beyond, that is superfluous, and tends to the feeding of the corrupt and vicious Humours, which will at last, though they may be stifled for a Time, break out into a Flame and burn the Man quite down, or else leave him like a ruinated or shattered Building. This general Maxim which we have laid down, will hold good with respect to Men of all Ages and Constitutions, and under whatsoever Climate they live, if they have but the Courage to make a due Application of it, and to lay a Restraint upon their unreasonable Appetites. After all, we will not, we dare not warrant, that the most strict and sober Life will secure a Man from all Diseases, or prolong his Days to the greatest old Age. Natural Infirmities and Weaknesses, which a Man brings along with him into the World, which he deriv'd from his Parents and could not avoid, may make him sickly and unhealthful, notwithstanding all his Care and Precaution: And outward Accidents (from which no Man is free) may cut off the Thread of Life before it is half spun out. There is no fencing against the latter of those, but as to the former, a Man may in some Measure correct and amend them by a sober and regular Life. In fine, let a Man's Life be longer or shorter, yet Sobriety and Temperance renders it pleasant and delightful. One that is sober, though he lives but thirty or forty Years, yet lives long, and enjoys all his Days, having a free and clear Use of all his Faculties; whilst the Man that gives himself to Excess, and lays no Restraint to his Appetites, though he prolongs his Life to Threescore or Fourscore Years (which is next to a Miracle) yet is his Life but one continu'd doseing Slumber, his Head being always full of Fumes, the Pores of his Soul cloudy and dark, the Organs of his Body weak and worn out, and very unfit to discharge the proper Offices of a rational Creature. And indeed Reason, if we hearken to it, will tell us, that a good Regimen is necessary for the prolonging our Days, and that it consists in two Things, first in takeing Care of the Quality, and secondly of the Quantity, so as to eat and drink nothing that offends the Stomach, nor any more than we can easily digest. And in this, Experience ought to be our Guide in those two Principles, when we arrive to Forty, Fifty, or Sixty Years of Age. He who puts in Practice that Knowledge which he has of what is good for him, and goes on in a frugal Way of Living, keeps the Humours in a just Temperature, and prevents them from being altered, though he suffer Heat and Cold, though he be fatigued, though his Sleep be broke, provided there be no Excess in any of them. This being so, what an Obligation does Man lie under of living soberly, and ought he not to free himself from the Fears of sinking under the least Intemperature of the Air, and under the least Fatigue, which makes us sick upon every slight Occasion? 'Tis true, the most sober Man may sometimes be indisposed, when they are unavoidably obliged to transgress the Rule which they have been used to observe; but then they are certain, their Indisposition will not last above two or three Days at most, nor can they fall into a Fever: Weariness and Faintness are easily remedied by Rest and good Diet. There are some who feed high, and maintain, that whatsoever they eat is so little a Disturbance to them, that they cannot perceive in what Part of the Body the Stomach lies; but I averr, they do not speak as they think, nor is it natural? 'Tis impossible that any created Being should be of so perfect a Composition, as that neither Heat nor Cold, Dry nor Moist should have any Influence over it, and that the Variety of Food which they make use of, of different Qualities, should be equally agreeable to them. Those Men cannot but acknowledge, that they are sometimes out of Order; if it is not owing to a sensible Indigestion, yet they are troubled with Head-achs, Want of Sleep, and Fevers, of which they are cured by a Diet, and taking such Medicines as are proper for Evacuations. It is therefore certain, that their Distempers proceed from Repletion, or from their having eat or drank something which did not agree with their Stomachs. Most old People excuse their high Feeding by saying, that it is necessary to eat a great deal, to keep up their natural Heat, which diminishes proportionably as they grow into Years; and to create an Appetite, 'tis necessary to find out proper Sauces, and to eat whatsoever they have a Fancy for, and that without thus humouring their Palates, they would be soon in their Graves. To this I reply: That Nature, for the Preservation of a Man in Years, has so composed him, that he may live with a little Food; that his Stomach cannot digest a great Quantity, and that he has no need of being afraid of dying for want of eating; since when he is sick, he is forced to have recourse to a regular Sort of Diet, which is the first and main Thing prescrib'd him by his Physician, that if this Remedy is of such Efficacy to snatch us out of the Arms of Death, 'tis a Mistake to suppose that a Man may not by eating a little more than he does when he is sick, live a long Time without ever being sick. Others had rather be disturb'd twice or thrice a Year with the Gout, the Sciatica, and their Epidemical Distempers, than to be always put to the Torment and Mortification of laying a Restraint upon their Appetites, being sure, that when they are indisposed, a regular Diet will be an infallible Remedy and Cure. But let them be informed by me, that as they grow up in Years their natural Heat abates; that as regular Diet, despised as a Precaution, and only look'd upon as Physick, cannot always have the same Effect nor Force, to draw off the Crudities, nor repair the Disorders that are caused by Repletion; and lastly, that they run the Hazard of being cheated by their Hope and by their Intemperance. Others say, That it is more eligible to feed high and enjoy themselves, though a Man live the less while. It is no surprizing Matter that Fools and Mad-men should contemn and despise Life; the World will be no Loser whenever they go out of it; but 'tis a considerable Loss, when wise, virtuous, and holy Men drop into the Grave, who might have done more Honour to their Country and to themselves. In Youth this Excess is more frequent; necessary therefore it is to moderate his Apetite; for if the Stomach be stretch'd beyond its due Extent, it will require to be fill'd, but never well digest what it receives. Besides, it is much better to prevent Diseases, by Temperance, Sobriety, Chastity, and Exercise, than cure them by Physick. _Quid enim se Medicis dederit, seipsum sibi eripit. Summa Medicinarum ad sanitatem corporis & animæ, abstinentiæ est._ He that lives abstemiously, or but temperately, need not study the Wholesomeness of his Meat, nor the Pleasantness of that Sawce, the Moments and Punctillio's of Air, Heat, Cold, Exercise, Lodging, Diet; nor is critical in Cookery or in his Liquors, but takes thankfully what God gives him. Especially, let all young Men forbear Wines and Strong Drinks, as well as spiced and hot Meats; for they introduce a preternatural Heat in the Body, and at least hinder and obstruct, if not at length exhaust the natural. But if overtaken by Excess, (it's difficult to be always upon our Guard) the last Remedy is vomiting, or fasting it out, neither go to bed on a full Stomach; let Physick be always the last Remedy, that Nature may not trust to it; for though a sick Man leaves all for Nature to do, he hazards much; but when he leaves all for the Doctor to do, he hazards more: And since there is a Hazard both ways, I would sooner rely upon Nature; for this at least we may be sure of, that she is as honest as she can, and that she does not find the Account in prolonging the Disease. Others there are, who perceiving themselves to grow old, tho' their Stomach be less capable of digesting well every day less than another, yet will not upon that Account abate any thing of their Diet; they only abridge themselves in the Number of their Meals; and because they find two or three Meals a Day is troublesome, they think their Health is sufficiently provided for, by making only one Meal; that so the time between one Repast and another, may (as they say) facilitate the Digestion of those Aliments which they might have taken at twice: For this Reason they eat as much at one Meal, that their Stomach is over-charged and out of Order, and converts the Superfluities of its Nourishment into bad Humours, which engender Diseases and Death. I never knew a Man live long by this Conduct. These Men would doubtless have prolong'd their Days, had they abridg'd the Quantity of their ordinary Food proportionally as they grew in Years; and had they eat a great deal less a little oftner. Some again are of Opinion, that Sobriety may indeed preserve a Man in Health, but does not prolong his Life. To this we say, that there have been Persons in past Ages, who have prolong'd their Lives by this Means; and some there are at present who still do it; for as Infirmities contracted by Repletion shorten our Days, a Man of an ordinary Reach may perceive, that if he desires to live long, it is better to be well than sick, and that consequently Temperance contributes more to long Life, than excessive Feeding. Whatsoever Sensualists may say, Temperance is of infinite Benefit to Mankind: To it he owes his Preservation; it banishes from his Mind the dismal Apprehensions of dying; 'tis by its Means he becomes wise, and arrives to an Age wherein Reason and Experience furnish him with Assistance to free himself from the Tyranny of his Passions, which have lorded it over him for almost the whole Course of his Life. A very notable Instance of this we have in the Life of _Lewis Cornaro_, a noble _Venetian_, who though of a weakly Constitution, increas'd by a voluptuous Life, yet at the Age of thirty five or forty Years, he was resolv'd to practice in all the Rules of Sobriety and Temperance, and to withdraw from those Excesses that had brought upon him those usual Ills the Gout and the Cholick, fatal Attendants to an indolent and luxurious Life, and which reduc'd him to so low a State, that his Recovery was despair'd of by the wisest Physician: And here he tells you that he was born very cholerick and hasty, and flew out into a Passion for the least Trifle, that he huffed all Mankind, and was so intolerable, that a great many Persons of Repute avoided his Company: He apprehended the Injury which he did to himself, he knew that Anger is a real Frenzy, that it disturbs our Judgment, that it transports us beyond our selves, and that the Difference between a passionate and a mad Man is only this, that the latter has lost his Reason, and the former is only depriv'd of it by fits. A sober Life cured him of his Frenzy; by its Assistance he became so moderate, and so much a Master of his Passions, that no body could perceive it was born with him. How great and valuable must Temperance then be, which carries that soveraign Aid, and can relieve the Passions of the Mind, and not only to expel the bad Humours of the Body, but also to restore it to a due Tone, and a full State of Health. Now let any one upon a serious Reflection consider which is most eligible, a sober and regular, or an intemperate, and disorderly Course of Life: This is certain, that if all Men would live regularly and frugally, there would be so few sick Persons, that there would hardly be any Occasion for Remedies, _Si tibi deficiant Medici, Medici tibi fiant. Hæc tria, Mens læta, requies moderata dieta._ _The best and safest Physician is Doctor Diet, Doctor Merryman, and Doctor Quiet._ every one would become his own Physician, and would be convinced that he never met with a better. It would be to little Purpose to study the Constitution of other Men; every one, if he would but apply himself to it, would always be better acquainted with his own than that of another; every one would be capable of making those Experiments for himself which another could not do for him, and would be the best Judge of the Strength of his own Stomach, and of the Food which is agreeable thereto; for in one Word, 'tis next to impossible to know exactly the Constitution of another, their Constitutions being as different as their Complexions. Since no Man therefore can have a better Physician than himself, nor a more soveraign Antidote than a Regimen, that is to study his own Constitution, and to regulate his Life according to the Rules of right Reason. I own, indeed, the disinterested Physician may be some time necessary, since there are some Distempers, which all human Prudence cannot provide against, there happen some unavoidable Accidents which seize us after such a Manner, as to deprive our Judgment of the Liberty it ought to have to be a Comfort to us; it may then be a Mistake wholly to rely upon Nature, it must be assisted, and Recourse must be had to some one or another for it; and in this we have much the Advantage of the irregular Man, his Vices having heaped Fewel to the Distemper; but on the contrary, by a regular Course of Life, the very Cause is not to be found, and the Disease retreats from you. And here the fam'd _Cornaro_, who being at Seventy Years of Age, had another Experiment of the Usefulness of a Regimen, and 'twas this; A Business of extraordinary Consequence drawing him into the Country, and being in the Coach, the Horses ran away with him, and was overthrown, and dragg'd a long away before they could stay the Horses; they took him out of the Coach with his Head broke, a Leg and Arm out of joint, and in a Word, in a very lamentable Condition. As soon as they brought him Home again, they sent for the Physicians, who did not expect he should live three Days to an end: However, they resolv'd upon letting of him Blood, to prevent the coming of a Fever, which usually happens upon such Cases. He was so confident that the regular Life which he had led, had prevented the contracting of any ill Humours, of which he might be afraid, that he rejected their Prescription, and ordered them to dress his Head, to set his Leg and Arm, and to rub him with some Specifick Oils proper for Bruises, and without any other Remedies he was soon cured, to the Amazement of the Physicians and of all those that knew him. From hence he did infer, that a regular Life is an excellent Preservative against all natural Ills; and that Intemperance produces quite contrary Effects. What a Difference then between a sober and an intemperate Life? the one shortens and the other prolongs our Days, and makes us enjoy a perfect Health, and with _Juvenal_, _Mens sana in Corpore sano_. I cannot understand how it comes to pass, that so many People, otherwise prudent and rational, cannot resolve upon laying a Restraint upon their insatiable Appetites at fifty or sixty Years of Age, or at least when they begin to feel the Infirmities of old Age coming upon them they might rid themselves of them by a strict Diet and a due Regimen. I do not wonder so much that young People are so hardly brought to such a Resolution; they are not capable enough of reflecting; and their Judgment is not solid enough to resist the Charms of Sense: But at Fifty a Man ought to be govern'd by his Reason, which would convince us if we would hearken to it, that to gratify all our Appetites without any Rule or Measure, is the Way to become infirm and die young. Nor does the Pleasure of Taste last long, it hardly begins but 'tis gone and past; the more one eats, the more one may, and the Distempers which it brings along with it, last us to our Graves. Now should not a sober Man be very well satisfied when he is at Table, upon the Assurance, that as often as he rises from it, what he eats will do him no harm: Who then would not perfectly enjoy the Pleasures of this mortal Life so perfectly? Who will not court and win Sobriety, which is so grateful to God, as being the Guardian to Virtue, and irreconcileable Enemy to Vice. Surely the Example of this wise and good Man deserves our Imitation, that since old Age may be made so useful and pleasant to Men, I should have fail'd in Point of Charity to inform Mankind by what Methods they might prolong their Days. A great Assistant to that of Sobriety, and which is highly conducive to the Preservation of the whole Man, is to renew with us that habitual and beneficial Custom of the Antients in promoting _Exercise_, as one great Instrument to the Conservation of Health, and which no one can deny who has given himself the Experience of a Trial. That it promotes the Digestion, raises the Spirits, refreshes the Mind, and that it strengthens and relieves the whole Man, is scarce disputed by any; but that it should prove curative in some particular Distempers, and that too when scarce any thing else will prevail, seems to obtain little Credit with most People, who though they will give the Physician the hearing when he recommends the Use of Rideing, or any other Sort of Exercise, yet at the Bottom, look upon it as a forlorn Method, and rather the Effects of his Inability to relieve them, than a Belief that there is any great Matter in what he advises: Thus by a negligent Diffidence they deceive themselves and let slip the golden Opportunities of recovering by a diligent Struggle what could not be cur'd by the Use of Medicine alone. But to give you a just and rational Idea of its Power of moving and actuating upon the Body, let us consider the whole human System as a Compound of Tubes and Glands, or to use a more rustick Phrase, a Bundle of Pipes and Strainers, fitted to one another after so wonderful a Manner as to make a proper Engine for the Soul to work with. This Description does not only comprehend the Bowels, Bones, Tendons, Veins, Nerves, and Arteries, but every Muscle and every Ligature, which is a Composition of Fibres, that are so many imperceptable Tubes or Pipes interwoven on all Sides with invisible Glands and Strainers. This general Idea of a human Body, without considering it in the Niceties of Anatomy; let us see how absolutely necessary Labour is for the right Preservation of it. There must be frequent Motions and Agitations to mix, digest, and separate the Juices contained in it, as well as to clear and cleanse that Infinitude of Pipes and Strainers of which it is composed, and to give their solid Parts a more firm and lasting Tone; Exercise ferments the Humours, casts them into their proper Channels, throws off Redundancies, and helps Nature in those secret Distributions, without which the Body cannot subsist in Vigour, nor act with Chearfulness. I might here mention the Effects which this has upon the Soul, upon all the Faculties of the Mind, by keeping the Understanding clear, the Imagination untroubled, and refining those Spirits that are necessary for the proper Execution of our intellectual Faculties, during the present Laws of Union between Soul and Body. It is a Neglect in this Particular, that we must ascribe the Spleen, which is so frequent in Men of studious and sedentary Tempers; as well as the Vapours, to which those of the other Sex are so often subject. Had not Exercise been absolutely necessary for our Well-being, Nature would not have made the Body so proper for it, by giving such an Activity to the Limbs, and such a Pliancy to every Part, as necessarily produce those Compressions, Extensions, Contortions, Dilatations, and all other Kind of Motions that are necessary for the Preservation of such a System of Tubes and Glands as has been before mentioned. And that we might not want Inducements to engage us in such an Exercise of the Body as is proper for its Welfare, it is so ordered, that nothing valuable can be procur'd without it. Not to mention Riches and Honour, even Food and Raiment are not to be come at without the Toil of the Hands, and Sweat of the Brows. Providence furnishes us with Materials, but expects we should work them up ourselves. The Earth must be labour'd before it gives Encrease; and when it is forced into its several Products, how many Hands must they pass thro' before they are fit for Use? Manufactures, Trade, and Agriculture naturally employ more than nineteen Parts of the Species in twenty; and as for those who are not obliged to labour, by the Condition in which they are born, they are more miserable than the rest of Mankind, unless they indulge themselves in that voluntary Labour call'd Exercise, of which there is no Kind I would so recommend to both Sexes, as that of Rideing; as there is none that conduces so much to Health, and is every Way accommodated to the Body. Dr. _Sydenham_ is very lavish in its Praises, and if you would learn the mechanical Effects of it described at length, you may find it learnedly treated of by Dr. _Fuller_, in a late Treatise, intituled, _Medicina Gymnastica_, or, _The Power of Exercise_. And here Mr. _Dryden_: _The first Physicians by Debauch were made; Excess began, and Sloth sustain'd the Trade. By Chase our long-liv'd Fathers earn'd their Food, Toil strung the Nerves, and purified the Blood; But we their Sons, a pamper'd Race of Men, Are dwindled down to threescore Years and ten. Better to hunt in Fields for Health unbought, Than fee the Doctor for a nauseous Draught. The Wise for Cure on Exercise depend; God never made his Work for Man to mend._ General MAXIMS FOR HEALTH: OR, _RULES to preserve the Body to a good old Age_. I. It is not good to eat too much, or fast too long, or do any thing else that is preternatural. II. Whoever eats or drinks too much, will be sick. III. If thou art dull and heavy after Meat, it's a Sign thou hast exceeded the due Measure, for Meat and Drink ought to refresh the Body, and make it chearful, not to dull and oppress it. IV. If thou findest those ill Symptoms, consider whether too much Meat or Drink occasions it, or both, and abate by little and little, 'till thou findest the Inconveniency remov'd. V. Pass not immediately from a disorder'd Life, to a strict and precise Life, but by degrees abate the Excess, for ill Customs arrive by degrees, and so must be wore off. VI. As to the Quality of the Food, if the Body be of a healthful Constitution, and the Meat does thee no Harm, it matters little what it is; but all Sorts must be avoided that does Prejudice, though it please the Taste never so much. VII. After Diet is obtain'd, the Appetite will require no more than Nature hath need of, it will desire as Nature desires. VIII. Old Men can fast easily; Men of ripe Age can fast almost as much, but young People and Children can hardly fast at all. IX. Let ancient People eat Panada, made of Bread, and Flesh Broth, which is of light Digestion; an Egg now and then will do well. X. Growing Persons have a great deal of Natural Heat, which requires a great deal of Nourishment, else the Body will pine. XI. It must be examin'd what Sort of Persons ought to feed once or twice a Day, more or less; Allowance being always made to the Person, to the Season of the Year, to the Place where one lives, and to Custom. XII. The more you feed foul Bodies, the more you hurt your selves. XIII. He that studies much, ought not to eat so much as those that work hard, his Digestion being not so good. XIV. The near Quantity and Quality being found out, it is safest to be kept to. XV. Excess in all other things whatever, as well as in Meat and drink, are to be avoided; excessive Heats and Colds, violent Exercises, late Hours, and Women, unwholsome Air, violent Winds, the Passions, _&c._ XVI. Youth, Age, and Sick require a different Quantity. XVII. And so do those of different Complexions, for that which is too much for a Phlegmatick Man, is not sufficient for the Cholerick. XVIII. The Measure of the Food ought to be proportionable to the Quality and Condition of the Stomach, because the Stomach is to digest it. XIX. The Quantity that is sufficient, the Stomach can perfectly concoct, and answers to the due Nourishment of the Body. XX. Hence it appears we may eat a greater Quantity of some Viands than of others of a more hard Digestion. XXI. The Difficulty lies in finding out an exact Measure; but eat for Necessity not Pleasure; for Lust knows not where Necessity ends. XXII. Wouldst thou enjoy a long Life, a healthy Body, and a vigorous Mind, and be acquainted also with the wonderful Works of God, labour in the first Place to bring thy Appetite to Reason. XXIII. Beware of Variety of Meats, and such as are curiously and daintily drest, which destroy a multitude of People; they prolong Appetite four times beyond what Nature requires, and different Meats are of different Natures, some are sooner digested than others, whence Crudities proceed, and the whole Digestion depraved. XXIV. Keep out of the Sight of Feasts and Banquets as much as may be, for it is more difficult to retain good Cheer, when in Presence, than from the Desire of it when it is away; the like you may observe in all the other Senses. XXV. Fancy that Gluttony is not good and pleasant, but filthy, evil, and detestable; as it really is. XXVI. The richest Food, when concocted, yields the most noisom Smells; and he that works and fares hard, hath a sweeter and pleasanter Body than the other. XXVII. Winter requires somewhat a larger Quantity than Summer; hot and dry Meats agree best with Winter, cold and moist with Summer; in Summer abate a little of your Meat and add to your Drink, and in Winter substract from your Drink and add to your Meat. XXVIII. If a Man casually exceeds, let him fast the next Meal and all may be well again, provided it be not often done; or if he exceed at Dinner, let him rest from, or make a slight Supper. XXIX. Use now and then a little Exercise a Quarter of an Hour before Meals, or swing your Arms about with a small Weight in each Hand, to leap, and the like, for that stirs the Muscles of the Breast. XXX. Shooting in the long Bow, for the Breast and Arms. XXXI. Bowling, for the Reins, Stone and Gravel, _&c._ XXXII. Walking, for the Stomach: And the great _Drusus_ having weak and small Thighs and Legs, strengthened them by Riding, and especially after Dinner. XXXIII. Squinting and a dull Sight are amended by Shooting. XXXIV. Crookedness, by Swinging and hanging upon the Arms. XXXV. A temperate Diet frees from Diseases; such are seldom ill, but if they are surprized with Sickness, they bear it better, and recover it sooner, for all Distempers have their Original from Repletion. XXXVI. A temperate Diet arms the Body against all external Accidents, so that they are not so easily hurt by Heat, Cold, or Labour; if they at any Time should be prejudiced, they are more easily cured, either of Wounds, Dislocations, or Bruises; it also resists Epidemical Diseases. XXXVII. It makes Mens Bodies fitter for any Employments; it makes Men to live long; _Galen_, with many others, lived by it a Hundred Years. XXXVIII. _Galen_ saith, That those that are weak-complexioned from their Mothers Womb, may (by the Help of this Art, which prescribes the coarse Diet) attain to extreme old Age, and that without Diminution of Senses or Sickness of Body; and he saith, that though he never had a healthful Constitution of Body from his Birth, yet by using a good Diet after the Twenty-seventh Year of his Age, he never fell into Sickness, unless now and then into a One Days Fever, taken by One Days Weariness. XXXIX. A sober Diet makes a Man die without Pain; it maintains the Senses in Vigour; it mitigates the Violence of Passions and Affections. XL. It preserves the Memory; it helps the Understanding; it allays the Heat of Lust; it brings a Man to that weighty Consideration of his latter End. A DISCOVERY Of some Remarkable ERRORS In the late WRITINGS of Dr. _Mead_, _Quincey_, _Bradley_, &c. on the Plague. The great Apprehensions that all _Europe_ has received from the dreadful and raging Plague which has lately destroyed the greatest Part of the Inhabitants of _Marseilles_, has given that just Alarm to our Ministry, who under the Direction of His Majesty, by their wise and prudent Management, to the Duty of Publick Prayers, with that of a General and Solemn Fast throughout the Kingdom, have not been wanting, as much as possible, to prevent that direful Contagion which now threatens, and might be brought amongst us by the Sailors, or by Merchandize comeing from Places that are infected; and have ordered a strict Quarentine to be observed by all Ships in all the Maritime Ports liable to that Invasion. And to be Assistant to so great a Work, the Neglect of which the Lives of the Nation being at stake, we have some the most eminent of the Physicians now in Vogue, who from that Duty to their Profession, and their Zeal to the Publick Good, have publish'd some Essays, not only of the Nature, Cause, Symptoms, Prognosticks, and Affections of this fatal Distemper; but likewise of the proper Means to be used in preventing, and fortifying against, with the proper Applications of recovering those that are seiz'd by this fatal Enemy to Mankind. Books of this kind lately published are, a short Discourse concerning Pestilential Contagion, by Dr. _Mead_. The Plague of _Marseilles_ consider'd by Dr. _Bradley_. Dr. _Hodges_'s Loimologia of the Plague in _London_, _Anno_ 1665; reprinted by Dr. _Quincy_: To which is added, an Essay of his own, with Remarks of the Infection now in _France_. To those worthy Gentlemen are we indebted for their ready Help, to their philosophical Enquiries, their learned and analytical Explanations in all the Stages of this raging Ill; and farther, by what physical Power it corrupts the Blood, destroys the Spirits, and is follow'd by Death at the last. The Apologies that are made in their Preface, _viz._ of a short Warning, of their little Leisure, the Uncorrectness of Style, and the Typographical Errors should be favourably construed from so great an Aim of doing the Publick so great a Good; and it would be esteemed a base Ingratitude, meerly for the sake of Contradiction, to quarrel with the Hand that directs, and may support us in the greatest Extremity. But where there may be a sufficient Reason to undeceive, or amend such Errors, as might otherwise be prejudicial to their intended Purpose of preserving the Common Weal, or advancing some other necessary Instructions which they have omitted; I can't but perswade myself that I shall have their Approbation, if not their Thanks in prosecuting the Advancement of that good End they so greatly have desired in their Publications. It is very certain, that Essay of Doctor _Hodges de Peste_, is the best of any hitherto publish'd of that Kind; and if the Gentleman who has annex'd his Treatise to that of his own, has taken Care to remove the most affected Peculiarities, and Luxuriances of his Enthusiastick Strain, he should have avoided that Contagion himself, which are discover'd in his crabbed and dogmatical Terms of _Formulæ_, _Miasms_, _Miasmata_, _Nexus_, _Moleculæ_, _Spicula_, _Pabulum_, &c. Such Terms being too abstruse and difficult to be understood by the People in general, for whose Instruction and Benefit we have the Charity to believe he undertook his Publication. Nay, it cannot be doubted, and will need no Confirmation by those that carefully peruse Dr. _Hodges_, but will find that there is scarcely any advanced Method in what they have writ, or but what may be found in his Treatise, unless in this one Hint of _Quincy_, from the Use of _Pulvis Fluminans_ in dispersing the stagnate Air instead of the fucing of great Guns, _&c._ And he is no ways out in his Policy by tacking his own Remarks with those of the good old Doctors, which are the best Recommendations of their passing to his own Advantage. _Hodges_ in his Introduction tells you, "That the first Discoveries of the late Plague began in _Westminster_, about the Close of the Year 1664, for at that Season two or three Persons died there, attended with like Symptoms as manifestly declar'd their Origin; that in the Months of _August_ and _September_, the Contagion chang'd its former slow and languid Pace, having, as it were, got Master of all, made a most terrible Slaughter, so that three, four or five thousand died in a Week, and once eight thousand: Who can express the Calamities of those Times! None surely in more pathetick and bewailing Accents than himself, who gives us so melancholly a Description of their dismal Misery, as affects the Mind with the same Passions and despairing Sorrow they were then overloaded with; and as _Virgil_ has it, _Horror ubique Animos, simul ipsa silentia terrent. Hærent in fixi pectore Vultus._ The _British_ Nation wept for the Miseries of her Metropolis. In some Houses Carcases lay waiting for Burial; and in others, Persons in their last Agonies; in one Room might be heard dying Groans, in another the Raveings of a Delirium, and not far off Relations and Friends bewailing both their Loss and the dismal Prospect of their own sudden Departure; Death was the sure Midwife to all Children, and Infants passed immediately from the Womb to the Grave; Who would not burst with Grief to see the Stock of a future Generation hang upon the Breasts of a dead Mother? or the Marriage-Bed changed the first Night into a Sepulchre, and the unhappy Pair meet with Death in the first Embraces? Some of the Infected run about staggering like drunken Men, and fall and expire in the Streets; while others lie half dead and comatous, but never to be waked but by the last Trumpet; some lie vomiting, as if they had drank Poison; and others fall dead in the Market while they are buying Necessaries for the Support of Life. Not much unlike was it in the following Conflagration; where the Altars themselves became so many Victims, and the finest Churches in the whole World carried up to Heaven Supplications in Flames, while their marble Pillars, wet with Tears, melted like Wax; nor were Monuments secure from the inexorable Flames, where many of their venerable Remains passed a second Martyrdom; the most august Palaces were soon laid waste, and the Flames seem'd to be in a fatal Engagement to destroy the great Ornament of Commerce; and the burning of all the Commodities of the World together, seem'd a proper Epitome of this Conflagration: Neither confederate Crowns, nor the drawn Swords of Kings could restrain its phanatick and rebellious Rage; large Halls, stately Houses, and the Sheds of the Poor, were together reduced to Ashes; the Sun blush'd to see himself set, and envied those Flames the Government of the Night which had rivall'd him so many Days: As the City, I say, was afterwards burnt without any Distinction, in like Manner did this Plague spare no Order, Age, or Sex; the Divine was taken in the very Exercise of his priestly Office, to be inroll'd amongst the Saints above; and some Physicians, as before intimated, could not find Assistance in their own Antidotes, but died in the Administration of them to others; and although the Soldiery retreated from the Field of Death, and encamped out of the City, the Contagion followed and vanquished them; many in their old Age, others in their Prime, sunk under its Cruelties; of the female Sex, most died; and hardly any Children escaped; and it was not uncommon to see an Inheritance pass successively to three or four Heirs in as many Days; the Number of Sextons were not sufficient to bury the Dead; the Bells seem'd hoarse with continual tolling, until at last they quite ceased; the Burying-places would not hold the Dead, but they were thrown into large Pits dug in waste Grounds in Heaps, thirty or forty together; and it often happened, that those who attended the Funerals of their Friends one Evening, were carried the next to their own long Home." ------_Quis talia fundo temperet à lacrymis?_---- About the Beginning of _September_ the Disease was at the Height, in the Course of which Month more than Twelve thousand died in a Week[4] but from this Time its Force began to relax; and about the Close of the Year, that is, at the Beginning of _November_, People grew more healthful, and such a different Face was put upon the Publick, that although the Funerals were yet frequent, yet many who had made most haste in retiring, made the most to return, and came into the City without Fear; insomuch that in _December_ they crowded back as thick as they fled; and although the Contagion had carried off, as some computed, about One hundred thousand People; after a few Months this Loss was hardly discernable. The Doctor himself comes to no determinate Number of those that died of this Distemper, but in the Table that he has writ of the Funerals in the several Parishes within the Bills of Mortality of the Cities of _London_ and _Westminster_ for the Year 1665, he tells you, 68596 died of the Plague. Dr. _Mead_ in the same Year 1665, that it continued in this City about ten Months, and swept away 97306 Persons. Dr. _Bradley_, in his Table from the 27th of _December_, 1664/5, takes no notice of any buried of that Distemper, but of one on the 14th of _February_ following, and two on _April_ the 25th, and in all, to the 7th of _June_, 89. The next following Months, to _October_ the 3d, there were buried 49932, in all 50021. Why he should here break up from giving any further Account may be from the Weakness of his Intelligence, which so widely differs from all other Accounts; and in this one, with Dr. _Hodges_, who tells you, that about the Beginning of _September_, at which Time the Disease was at the Height, in the Course of which Month, more than 12000 Persons died in a Week: Whereas in _Bradley_, the most that were buried in one Week, _i. e._ from the 12th of _September_ to the 19th, amounted to no more than 7165. But computing after the Manner of Dr. _Hodges_, we find (taking one Week with another, from _August_ the 29th to the 27th of _September_, the Time of its greatest Fury) the exact Number of 6555; which falls short very near to one half of the Number accounted to be buried of that Distemper by Dr. _Hodges_; and we have abundant Reason to believe, that the greatest Account hitherto mentioned, may be short of the Number dying of that Distemper. If we do but observe the strict Order then published to shut up all infected Houses, to keep a Guard upon them Day and Night, to withhold from them all Manner of Correspondence from without; and that after their Recovery, to perform a Quarentine of 40 Days, in which Space if anyone else of the Family should be taken with that Distemper, the Work to be renewed again; by which tedious Confinement of the Sick and Well together, it often proved the Cause of the Loss of the Whole. These, besides many other great Inconveniencies, were sufficient to affright the People from making the Discovery, and we may be certain, that many died of the Plague which were returned to the Magistracy under another Denomination, which might easily be obtained from the Nurses and Searchers, whether from their Ignorance, Respect, Love of Money, _&c._ And if they vary so much in their Computation of those that died; we shall find them as widely different in the Time when 'tis said the Plague first began. The great Dr. _Mead_ on this important Subject, may establish by his Name whatever he lays down, with the same Force and Authority as the Ancients held of that _ipse dixit_ of Aristotle; but as that great Master of Nature was not exempt from slipping into some Errors, _& humanum est errare_, it can be no Shock to the Reputation of this Gentleman, if we shall find him no less fallible than of some others of the Faculty who has treated on this Subject; and to this part of the time when 'tis said the Plague first began. Doctor _Mead_, by what Information he has not thought fit to tell us, does affirm, That its Beginning was in _Autumn_ before the Year 1664/5; whereas Dr. _Hodges_ says, in the very first Page of his _Liomologia_, that it was not till the Close of the Year 1664; at that Season two or three Persons died suddenly in one Family at _Westminster_, of which he gives a further Light from his visiting the first Patient in the _Christmas_ Holidays, and fully confirmed by the Weekly Bills of Mortality, whose first Account of those who died of the Plague were from _December_ the 27th, 1664/5. As those Gentlemen have forfeited their Infallibility by what I have proved hitherto against them, we have further Reason to suspect, whether or not the late Plague in 1665 was occasioned by that Bale of Cotton imported from _Turkey_ to _Holland_, and thence to _England_, as Dr. _Hodges_ makes irrefregable, and Dr. _Mead_'s Authority indisputable; which is no less a Subject of Wonder and Admiration how many Years we have escaped from the Plagues that have happened and are frequent in so many Parts of _Turkey_; as at _Grand Cairo_, which is seldome or never free from that Distemper, at _Alexandria_, _Rosetta_, _Constantinople_, _Smyrna_, _Scanderoon_, and _Aleppo_, from which Places we have the most considerable Import of any of our Neighbours, and of such Goods as are most receptive of those infectious Seeds, such as Cotton, Raw Silk, Mohair, _&c._ And though Coffee may seem less dangerous, from its Quality of being more able to resist its pestilential Effluvia, yet from the many Coverings the Bales are wrapped in, it is not hard to conceive the contagious Power might be latent in some Part of the Packidge; which Escape is the more surprising and to be wondred at from the great Encrease of our Trade and Shipping which yearly arrive from those Countries; and yet to be preserved from the like Misfortune near to this 60 Years. _Gockelius_ informs us, [5]"That the Contagion in the same Year 1665 was brought into _Germany_ by a Body of Soldiers returning from the Wars in _Hungary_ against the _Turks_, spread the Infection about _Ulm_ and _Ausburgh_, where he then lived, and besides the Plague, they brought along with them the _Hungarian_ and other malignant Fevers, which diffused themselves about the Neighbourhood, whereof many died.[6] And with Submission to the wise Judgment and Opinion of these learned _Triumviri_, who have cited no fuller Authority for this Assertion than a bare Relation of it from _Hodges de Peste_; it may be no unreasonable Conjecture to have its first Progress from _Hungary_, _Germany_, and to _Holland_, from which last Place they all have agreed we certainly received the Contagion; and that we have had the Plague convey'd to us by the like Means may be found in the _Bibliotheca Anotomica_, being brought to us by some Troops from _Hungary_ sent thither against the _Turks_ by _Henry_ VI. King of _England_. Dr. _Mead_, who thinks it necessary to premise somewhat in general concerning the Propagation of the Plague, might, to the three Causes he has laid down, of a bad Air, diseased Persons, and Goods transported from Abroad, have added the Aliment or Diet, because affording Matter to the Juices it does not less contribute to the Generation of Diseases: And it may be observed, that in the Year before the pestilential Sickness, there was a great Mortality amongst the Cattel from a very wet Autumn, and their Carcasses being sold amongst the ordinary People at a very mean Price, a great many putred Humours might proceed from thence; and this, in the Opinion of many, was the Source of our late Calamities, when it was observed this fatal Destroyer raged with greater Triumph over the common People: And the feeding on unripened and unsound Fruits are frequently charged with a Share in Mischiefs of this Kind. _Galen_[7] is very positive in this Matter, and in one Place accuses[8] his great Master to _Hippocrates_ with neglecting the Consequence of too mean a Diet: From this 'tis generally observed, that a Dearth or Famine is the Harbinger to a following Plague. And we have an Account from our Merchants trading to _Surat_, _Bencoli_, and some other Parts of the _East-Indies_, that the Natives are never free from that Distemper, which is imputed to their low and pitiful Fare. The _Europeans_, especially the _English_, escaping by their better Diet, by feeding on good Flesh, and drinking of strong generous Wine, which secures them from the Power of that Malignancy. Their Hypotheses as widely differ in the very Substance or Nature of the Pestilence; and Dr. [9]_Hodges_, [10]_Mead_, and [11]_Quincey_, have asserted, that it proceeds from a Corruption of the Volatile Salts, or the Nitrous Spirit in the Air. Dr. [12]_Bradley_, from the Number of poisonous Animals, Insects, or Maggots which at that Time are swimming or driving in the circumambient Air; and being sucked into our Bodies along with our Breath, are sufficiently capable of causing those direful Depredations on Mankind called the Plague. Both these Opinions are supported by the Authorities of Learned Men. And if _Hodges_, _&c._ have the Suffrages of the greatest of the ancient Physicians, with those of _Wolfius_, _Agricola_, _Forestus_, _Fernelius_, _Belini_, _Carolus de là Font_, _&c._ _Bradley_ may challenge to him the famed _Kirchir_, _Malhigius_, _Leeuwenhooch_, _Morgagni_, _Redi_, and _Mangetus_. It is almost endless as well as altogether needless, to cite all the Authorities for the different Opinions, that might be collected from the most remote Antiquity down to the present Age. And although it is yet to be contested, and might be held an occult Quality with those learned Gentlemen, we shall find, each Doctor passes his favourite Opinion upon the World with as much Infallibility as a Demonstration in _Euclid_. [13]And for that Opinion of the famous _Kirchir_, about animated Worms, (says _Hodges_) 'I must confess I could never come at any such Discovery with the Help of the best Glasses, nor ever found the same discovered by any other; but perhaps in our cloudy Island we are not so sharp-sighted as in the serene Air of _Italy_; and with Submission to so great a Name, it seems to me very disconsonant to Reason, that such a pestilential Seminium, which is both of a nitrous and poisonous Nature, should produce a living Creature.' And he is well assured, that he is in the right, when he says, '[14]Every one of those Particulars are as clear as the Light at Noon-Day; and those Explications are so obvious to be met with in the Writings of the Learned, that it would be lost Labour to insist upon any such Thing here.' [15]Dr. _Mead_ chimes in here very tuneably with _Hodges_, and is pleased to say, 'That some Authors have imagined Infection to be performed by the Means of Insects, the Eggs of which may be conveyed from Place to Place, and make the Disease when it comes to be hatch'd. As this is a Supposition grounded upon no Manner of Observation, so I think there is no need to have Recourse to it.' Dr. _Bradley_, who hatches this Distemper by the smaller Kind of Insects floating in the Air, is greatly jealous of his favourite Egg, from which that fatal Cockatrice breaks forth and disperses Death in every Quarter: He may be seen to promote this Hypothesis in that Discourse of his new Improvement of Planting, _&c._ and with no less Pursuit in his late Pamphlet on the Plague at _Marseilles_; where in his Preface, _p._ 13, he tells you, 'That to suppose this malignant Distemper is occasioned by Vapours only arising from the Earth, is to lay aside our Reason, _&c._' And it may be farther observed, That they are as remote from their Consent to one another, as in the distant Place from whence they would trace its Origin. [16]Dr. _Mead_, from a bare Transcription of _Matthæus Villanus_, does affirm, That the Plague in the Year 1346, had its first Rise in _China_, advancing through the _East-Indies_, _Syria_, _Turkey_, _&c._ and by Shipping from the _Levant_, brought into _Europe_, which in the Year 1349. seized _England_. This is directly against Dr. _Bradley_,[17] who suggests the Plague is no where to be found in _India_, _China_, the South Parts of _Africa_ and _America_, and has taken the Pains in filling up three Pages in the Defence of this Assertion. It would be well if their Opposition ended here; but when it affects us more near, when their Difference becomes more wide in the very Means of our Preservation, and what by one is laid down as a soveraign and real Good, to be returned by another as the most fatal and destructive, is a Weight of no small Consequence, nor a less melancholly Reflection, if it should please God to inflict us with the same Calamities. And as to those preservative Means which the Government have only a Power to direct, the making of large Fires in the Streets, as has been practised in the Times of Contagion, is a Point largely contested. Dr. _Hodges_[18] seems inveterate against this Custom, and tells us, 'That before three Days were expired after the Fires made in 1665, the most fatal Night ensued, wherein more than 4000 expired; the Heavens both mourn'd so many Funerals, and wept for the fatal Mistake, so as to extinguish even the Fires with their Showers. May Posterity, (says he) be warned by this Mistake, and not like Empericks, apply a Remedy where they are ignorant of the Cause.' And Dr. _Mead_[19] has an Eye to this Remark, when he tells us, 'The fatal Success of the Trials in the last Plague is more than sufficient to discourage any farther Attempts of this Nature.' Whereas on the contrary, the making of Fires in the Streets were practised from the greatest Antiquity, and supported by _Mayerne_, _Butler_, and _Harvey_ in the two great Plagues before the Year 1665, and recommended by Dr. _Quincey_[20] for the Dissipation of Pestilential Vapours, _&c._ And without all manner of Dispute, Dr. _Bradley_[21] must be wholly on his Side, when he tells us, 'That the Year 1665, was the last that we can say raged in _London_, which might happen from the Destruction of the City by Fire the following Year 1666, and besides the destroying of the Eggs or Seeds of those poisonous Animals that were then in the stagnating Air, might likewise purifie the Air in such a Manner as to make it unfit for the Nourishment of others of the same kind, which were swimming or driving in the circumambient Air.' What has been said of Fires is likewise to be understood of firing of Guns, which some have too rashly advised. Says Dr. _Mead_[22], 'The proper Correction of the Air would be to make it fresh and cool.' And here quotes from the Practice of the _Arabians_ out of _Rhazes de re Medica_, &c. Dr. _Quincey_[23] 'That as the Air being still and as it were stagnate at such Times, and as it favours the Collection of poisonous Effluvia, and aggravates Infection, thinks it more effectual to let off small Parcels of the common _Pulvis Fulminans_, which must afford a greater Shock to the Air by its Explosion than by the largest Pieces of Ordnance.' In favour of which last Assertion, the Experience both of Soldiers, will justifie the firing of great Guns and Ordnance, which is frequently used in Camps, for the Dissipation of the collected pestilential Atoms, which by Concussion as well as its constituent Parts of Nitre and Sulphur, tend greatly to the Purification of the grosser Atmosphere within the Compass of their Activity; and by the Seamen in their Voyages in the Southern Parts of the World, when sometimes the Air is so gross, and hangs so low upon them, as to be almost suffocated. And in the late Plague at _Marseilles_ the constant firing of great Guns at Morning and Evening, by the Appointment of _Monsieur le Marquis de Langeron_ their Governour, was esteemed of great Relief to the Inhabitants. Nay, their Contest will not end in a Pipe of Tobacco, against which Dr. _Hodges_[24] declares himself a profess'd Enemy: 'But whether (says he) we regard the narcotick Quality of this _American_ Henbane; or the poisonous Oil which exhales from it in Smoaking, or that prodigious Discharge of Spittle which it occasions, and which Nature wants for many other important Occasions, besides the Aptitude of the pestilential Poison to be taken down along with it; he chose rather to supply its Place with Sack.' Dr. _Bradley_[25] redeems it from this low Character, and represents it as a great Antidote in the last Plague _Anno_ 1665. 'The Distemper did not reach those who smoak'd Tobacco every Day, but particularly it was judged best to smoak in a Morning: He farther gives you an Account of a famous Physician, who in the pestilential Time took every Morning a Cordial to guard his Stomach, and after that a Pipe or two, before he went to visit his Patients; at the same time he had an Issue in his Arm, by which, when it begun to smart, he knew he had received some Infection (as he says) and then had recourse to his Cordial and his Pipe.' By this Means only he preserved himself, as several others did at that Time by the same Method. I could heartily wish those worthy Gentlemen had struck in with greater Harmony to the Satisfaction and Security of the People, whose Expectations were greatly raised by the Hopes of their Assistance, by gaining a greater Light into the Nature, Quality, Symptoms, and Affections of this definitive Ill, to have promoted their Safety, by giving the necessary Indications relating to the Cure, as well as the necessary Precautions in order to guard us from that secret Attack which may approach us by very minute and unheeded Causes; the which, from their different Notions and positive Contradictions, lay too deep from the narrow Re-searches of those Philosophizing and Learned Gentlemen, and for the Manner whereby it kills, its Approaches are generally so secret, that Persons seiz'd with it seem to be fallen into an Ambuscade or a Snare, of which there was no Manner of Suspicion. And there are very few Discourses relating to the Pestilence but what abound in many Instances of this kind: And the Learned _Boccace_, in his Admirable Description of the Plague at _Florence_ (quoted by Dr. _Mead_[26] _Anno_ 1348) relates what himself saw, 'That two Hogs finding in the Streets some Rags which had been thrown off from a poor Man dead of the Disease, after snuffling upon them, and tearing them with their Teeth, fell into Convulsions, and died in less than an Hour.' The Misfortune which happened in the Island of _Bermudas_ about 25 Years since, which Account is from Dr. _Halley_; A Sack of Cotton put ashore by Stealth, lay above a Month without any Prejudice to the People of the House where it was hid; but when it came to be distributed among the Inhabitants, it carried such a Contagion along with it, that the Living scarce sufficed to bury the Dead. And Dr. _Quincey_[27] has somewhere read a strange Story in _Baker_'s Chronicle, 'of a great Rot amongst Sheep, which was not quite rooted out until about Fourteen Years time, that was brought into _England_ by a Sheep bought for its uncommon Largeness, in a Country then infected with the same Distemper.' _Fracastorius_[28], an eminent _Italian_ Physician, tells us, 'That in the Year 1511, when the _Germans_ were in Possession of _Verona_, there arose a deadly Disease amongst the Soldiers, from the wearing only of a Coat purchased for a small Value; for it was observed, that every Owner of it soon sickned and died; until at last the Cause of it was so manifestly known from some Infection in the Coat, that it was ordered to be burned.' Ten thousand Persons, he says, were computed to fall by this Plague before it ceased. And _Kephale_, in his _Medela Pestilentiæ_, printed _Anno_ 1665, acquaints us, That the following Plagues were produced from the following Causes. That in the Year 1603, the contagious Seeds were brought to _England_ amongst Seamens Clothes in _White-Chappel_; and in that Year there died of the Plague 30561. That in the Year 1625, was bred and produced by rotten Mutton at _Stepney_; of which died 35403 Persons. That in the Year 1630, was brought to us by a Bale of Carpets from _Turkey_, of which died 1317 Persons. That in the Year 1636, was brought over to us by a Dog from _Amsterdam_; of which died 10400 Persons. That in the Year 1665, was brought from _Turkey_ in a Bale of Cotton to _Holland_, thence to _England_; in this great Plague died no less than 100,000 People. And at _Marseilles_, in this present Year 1720, the Plague has swept away more than 70000 Persons, which was brought in Goods from _Sidon_, a fam'd and ancient City and Sea-port in _Phoenicia_, and the same which sometimes is mentioned in Holy Writ. From the Neighbourhood of this last Contagion, the frightful Apprehensions of the People are rais'd to the greatest Height; and when every one is consulting his own Security, how to guard and preserve himself from that dreadful Enemy, nothing can come more seasonably to their Relief, than to lay before them a _Compendium_ of the best and approved Rules for their Conduct; to which End I have carefully collected, from the successful Practice of Dr. _Glisson_, Sir _Thomas Millington_, Dr. _Charlton_, and other Learned Physicians in the last Plague, with what only may be of Use from the abounding Prescripts of those who have lately published, and as this Evil is supported throughout the general Practice, it appears to be the Result of the Reasoning of some of the Learned Sons of _Æsculapius_, to marshal into the Field as many Compositions as if only by their Number they might be able to pull down the Tyranny of this fatal Destroyer. It would be a Work insuperable, and altogether foreign to the Method I have gone by, to extract all the Medicines which some Writers abound with for this End; it is our Business here chiefly to take Notice of that saving _Regimen_, that Rule of Self-governing, which proved more successful in the Preservation of the People in the late Plague, than all the abounding _Nostrums_ that have been crouded into the Practice, the which has become a due Reproach to the Faculty. _Turpe est Doctori, quem culpa redarguit ipsum._ And it is here worthy of our first Remark, That the last Plague, in the Year 1665, as well from the late Accounts we have of that at _Marseilles_, the poorer Sort of People were those that mostly suffered, which can only be attributed to their mean and low Fare, whereas the most nutritive and generous Diet should be promoted, and such as generate a warm and rich Blood, Plenty of Spirits, and what easily perspires, which otherwise would be apt to ferment and generate Corruption. Your greatest Care is, to have your Meat sweet and good, neither too moist nor flashy, having a certain Regard to such as may create an easy Digestion, and observing that roasted Meats on those Occasions should be preferred; as Beef, Mutton, Lamb, Venison, Turkey, Capon, Pullet, Chicken, Pheasant, and Partridge: But Pidgeon, and most Sort of Wild and Sea Fowl to be rejected: Salt Meats to be cautiously used; all hot, dry, and spicey Seasonings to be avoided; most Pickles and rich Sauces to be encouraged, with the often Use of Garlick, Onion, and Shallot; the cool, acid, and acrid Herbs and Roots, as Lettuce, Spinnage, Cresses, Sorrel, Endive, and Sellery; all windy Things, which are subject to Putrefaction, to be refrained, as all kind of Pulse, Cabbage, Colliflower, Sprouts, Melons, Cucumbers, _&c._ as also most Summer Fruits, excepting Mulberries, Quinces, Pomegranates, Raspers, Cherries, Currants, and Strawberries, which are of Service when moderately eat of. All light and viscid Substances to be avoided, as Pork, most Sorts of Fish, of the latter that may be eat, are Soles, Plaise, Flounder, Trout, Gudgeon, Lobster, Cray-fish, and Shrimps, no Sort of Pond-Fish being good; and for your Sauce, fresh melted Butter, or Oil mixed with Vinegar or Verjuice, the Juice of Sorrel, Pomegranates, Barberries, of Lemon or _Seville_ Orange, which two last are to be preferred, from their Power of resisting all Manner of Putrefaction, as well to cool the violent Heat of the Stomach, Liver, _&c._ For your Bread, to be light, and rather stale than new, not to drink much of Malt Liquors, avoiding that which is greatly Hopped, or too much on the ferment, Mead and Metheglin are of excellent Use, and good Wines taken moderately are a strong Preservative, Sack especially being accounted the most Soveraign and the greatest Alexipharmick: Excess is dangerous to the most healthy Constitution, which may beget Inflammations of fatal Consequence in pestilential Cases. Let none go Home fasting, every one, as they can procure, to take something as may resist Putrefaction; some may take Garlick with Bread and Butter, a Clove two or three, or with Rue, Sage, Sorrel, dipt in Vinegar, the Spirit of Oil of Turpentine frequently drank in small Doses is of great Use; as also to lay in steep over-Night, of Sage well bruis'd two Handfuls, of Wormwood one Handful, of Rue half a Handful, put to them in an Earthen Vessel four Quarts of Mild Beer; which in the Morning to be drank fasting. The Custom that prevails now of drinking Coffee, Bohea-Tea, or Chocolate, with Bread and Butter, is very good; at their going abroad 'tis proper to carry Rue, Angelica, Masterwort, Myrtle, _Scordianum_ or Water-Germander, Wormwood, Valerian or Setwal-Root, _Virginian_ Snake-Root, or Zedoary in their Hands to smell to, or of Rue one Handful stampt in a Mortar, put thereto Vinegar enough to moisten it, mix them well, then strain out the Juice, wet a Piece of Sponge or a Toast of brown Bread therein, tie it in a Bit of thin Cloth to smell to. But there is nothing more grateful and efficacious than the volatile _Sal Armoniac_, well impregnated with the essential Oils of aromatick Ingredients, which may be procured dry, and kept in small Bottles, from a careful Distillation of the common _Sal Volatile Oleosum_. Sometimes more foetid Substances agree better with some Persons than the more grateful Scents, of which the most useful Compositions may be made of Rue, Featherfew, _Galbanum_, _Assafoetida_, and the like, with the Oil of Wormwood, the Spirit or Oil drawn and dropt upon Cotton, so kept in a close Ivory Box, though with Caution to be used, the often smelling to, dilating the Pores of the Olfactory Organs, which may give greater Liberty for the pestilential Air to go along with it. A Piece of Orris Root kept in the Mouth in passing along the Streets, or of Garlick, Orange or Lemon Peel, or Clove, are of very great Service. As also Lozenges of the following Composition, which are always profitable to be used fasting; of Citron Peel two Drams, Zedoary, Angelica, of each, prepar'd in Rose Vinegar, half a Dram, Citron Seeds, Wood of Aloes, Orris, of each two Scruples, Saffron, Cloves, Nutmeg, one Scruple, Myrrh, Ambergrease, of each six Grains, Sugarcandy one Ounce; make into Lozenges with Gum Traganth and Rose-water. I know not indeed a greater Neglect than not keeping the Body clean, and the keeping at a distance any thing superfluous and offensive, to keep the House airy and fresh, and moderately cool, and to strew it with Herbs, Rushes, and Boughs, which yield refreshing Scents, and contribute much to the purifying of the Air, and resisting the Infection; of this kind all Sorts of Rushes and Water Flags, Mint, Balm, Camomil Grass, Hyssop, Thyme, Pennyroyal, Rue, Wormwood, Southernwood, Tansy, Costmary, Lime-tree, Oak, Beech, Walnut, Poplar, Ash, Willow, _&c._ A frequent Change of Clothes, and a careful drying or airing them abroad, with whisking and cleaning of them from all Manner of Filth and Dust, which may harbour Infection, as it is likewise to keep the Windows open at Sun-Rise till the Setting, especially to the North and East, for the cold Blasts from those Quarters temper the Malignity of pestilential Airs. Preservative Fumigations are largely talked of by all on those Occasions, and they with good Reason deserve to be practised. And of the great Number of Aromatick Roots and Woods, I should chiefly prefer Storax, Benjamin, Frankinsense, Myrrh, and Amber, the Wood of Juniper, Cypress and Cedar, the Leaves of Bays and Rosemary, and the Smell of Tarr and Pitch is no ways inferior to any of the rest, where its Scent is not particularly offensive, observing the burning of any or more of those Ingredients at such proper Distances of Time from each other, that the Air may always be sensibly impregnated therewith. Amongst the Simples of the Vegitable Kind, _Virginian_ Snake-Root cannot be too much admired, and is deservedly accounted the most Diaphoretick and Alexipharmick for expelling the pestilential Poison; its Dose, finely powder'd, is from four or six Grains to two Scruples, in a proper Vehicle; due Regard being had to the Strength and Age of the Patient. The next is generally given to the Contrayerva Root, (from which also a Compound Medicine is admirably contrived, and made famous by its Success in the last Plague;) the Dose of this in fine Powder is from one Scruple to a Dram, in Angelica or Scordium Water, or in Wine, _&c._ There are other Roots likewise of which many valuable Compounds are form'd in order to effect that with an united Force which they could not do singly; in this Class are the Roots of Angelica, Scorzonera, Butterbur, Masterwort, Tormentil, Zedoary, Garlick, Elicampane, Valerian, Birthwort, Gentian, Bitany, and many others, which may be found in other Writings. Ginger, whether in the Root, powder'd, and candy'd deserve our Regard; for it is very powerful both to raise a breathing Sweat and defend the Spirits against the pestilential Impression. From these Roots may be made Extracts, either with Spirit of Wine or Vinegar, for it is agreed by all, that the most subtil Particles collected together, and divested of their grosser and unprofitable Parts, become more efficacious in Medicinal Cases. The Leaves of Vegetables most us'd in Practice are Scordiam, Rue, Sage, Veronica, the lesser Cataury, Scabious, Pimpinel, Marygolds, and Baum, from which, on Occasion, several _Formulæ_ are contrived. Good Vehicles to wash down and to facilitate the taking of many other Medicines, should be made of the Waters distilled from those Herbs while they are fresh and fragrant (having not yet lost their volatile Salt) for those which are commonly kept in the Shop, are insipid and of little Use. _FINIS._ Footnotes: [1] _An_ Ægyptian, _and the first Inventor of Physick_; [2] _The Son of_ Apollo, _begotten upon_ Coronis, _the Daughter of_ Phlegia. [3] _The two eldest Daughters of_ Æsculapius. [4] _See_ _Hodges of the Plague_, _reprinted_ per Qincey, p. 19. [5] _Vid._ Gockelius de peste, p. 25. [6] _Vid._ Gockelius de peste, p. 25. [7] Lib. 1. de differ. Feb. Cap. 3. & de cibis mali & boni succi. [8] Lib. 6. Obser. 9. 26. [9] _Liomologia_, p. 32, 33, 34, 35, 37, 42, 44, 52, 53, 54, 75. [10] _Short Discourse_, p. 11, 17. [11] _Different Causes_, p. 266. [12] _Plague_, Marseilles, p. 17, 30, 31, 36, 41. [13] Hodges'_s Limologia_, p. 64. [14] Hodges'_s Limilogia_, p. 32. [15] _Short Discourse_, p. 16. [16] _Short Discourse_, p. 10. [17] _Plague_, Marseilles, p. 31, 32, 33. [18] _Loimologia_, p. 20. [19] _Short Discourse_, p. 46. [20] _Liomologia Causes and Cures_, p. 281. [21] _Plague_, Marseilles, p. 9. [22] _Short Discourse_, p, 46. [23] _Loimologia_, p. 283. [24] _Loimologia_, p. 218. [25] _Plague_, Marseilles, p. 40. [26] _Short Discourse_, p. 24. [27] _Loimologia, Causes and Cures_, p. 255. [28] De Morbis Contag. Lib. II. Cap. 7. Transcriber's Notes: Passages in italics are indicated by _italics_. In the Preface, non-italicized words are indicated by =not italics=. The original text includes Greek characters. For this text version these letters have been replaced with transliterations. The following misprints have been corrected: "Gratiude" corrected to "Gratitude" (page 5) "togegether" corrected to "together" (page 31) "Phsick" corrected to "Physick" (page 63) "Apothecacaries" corrected to "Apothecaries" (page 64) "Medicince" corrected to "Medicine" (page 65) "Strengh" corrected to "Strength" (page 120) "Humous" corrected to "Humours" (page 131) "snch" corrected to "such" (page 157) "nnless" corrected to "unless" (page 158) "Weeek" corrected to "Week" (page 187) "Aristole" corrected to "Aristotle" (page 189) Other than the corrections listed above, printing is retained from the original. 
36926	----	MAN'S REDEMPTION OF MAN _A Lay Sermon, McEwan Hall Edinburgh, Sunday July_ 2_nd_ 1910 BY WILLIAM OSLER LONDON CONSTABLE & CO. LTD 1913 {4} Note.--This address was delivered at a service held for the students of the University of Edinburgh, in connection with the Edinburgh meeting of the National Association for the Prevention of Tuberculosis. {5} And a man shall be as an hiding-place from the wind, and a covert from the tempest; as rivers of water in a dry place; as the shadow of a great rock in a weary land. And the voice of weeping shall be no more heard in her, nor the voice of crying. There shall be no more thence an infant of days, nor an old man that has not filled his days. (Isaiah.) To man there has been published a triple gospel--of his soul, of his goods, of his body. Growing with his growth, preached and professed in a hundred different ways in various ages of the world, these gospels represent the unceasing purpose of his widening thoughts. The gospel of his relation to the powers unseen has brought sometimes hope, too often despair. In a wide outlook on the immediate and remote effects of the attempts to establish this relation, one event discredits the great counsel of Confucius (who realized what a heavy yoke religion might be) to keep aloof from spiritual beings. Surviving the accretions of twenty centuries, the life and immortality brought to light by the gospel of Christ, remain the earnest desire of the best portion of the race. The gospel of his goods--of man's relation to his fellow men, is written in blood on every page of history. Quietly and slowly the righteousness that exalteth a nation, the principles of eternal justice, have won acquiescence, at any rate in theory, though as nations and individuals we are still far from carrying them into practice. And the third gospel, the gospel of his body, which brings man into relation with nature,--a true _evangelion_, the glad tidings of a conquest beside which all others sink into insignificance--is the final conquest of nature, out of which has come man's redemption of man, the subject to which I am desirous of directing your attention. In the struggle for existence in which all life is engaged, disease and pain loom large as fundamental facts. The whole creation groaneth and travaileth, and so red in tooth and claw with ravin is Nature, that, it is said, no animal in a wild state dies a natural death. The history of man is the story of a great martyrdom--plague, pestilence and famine, battle and murder, crimes unspeakable, tortures inconceivable, and the inhumanity of man to man has even outdone what appear to be atrocities in nature. In the _Grammar of Assent_ (chap. x) Cardinal Newman has an interesting paragraph on this great mystery of the physical world. Speaking of the amount of suffering bodily and mental which is our lot and heritage, he says: "Not only is the Creator far off, but some being of malignant nature seems to have got hold of us, and to be making us his sport. Let us say that there are a thousand millions of men on the earth at this time; who can weigh and measure the aggregate of pain which this one generation has endured, and will endure from birth to death? Then add to this all the pain which has fallen and will fall upon our race through generations past and to come. Is there not then some great gulf fixed between us and the good God?" Dwelling too exclusively on this aspect of life, who does not echo the wish of Euripides: "Not to be born is the best, and next to die as soon as possible." Some of you may remember Edwin Markham's poem, "The Man with the Hoe," based on Millet's famous picture. Bowed by the weight of centuries he leans Upon his hoe and gazes on the ground, The emptiness of ages in his face, And on his back the burden of the world. Who made him dead to rapture and despair, A thing that grieves not and that never hopes, Stolid and stunned, a brother to the ox? It is a world-old tale, this of the trembling heart, the failing eyes, the desponding mind of the natural man. "And thy life shall hang in doubt before thee; and thou shalt fear day and night, and shalt have none assurance of thy life: In the morning thou shalt say, Would God it were even! and at even thou shalt say, Would God it were morning! for the fear of thine heart wherewith thou shalt fear, and for the sight of thine eyes which thou shalt see" (Deut. xxviii.). The condition of Hopeful and Christian put by Giant Despair into "a very dark dungeon, nasty and stinking to their spirits," and beaten with stripes, and made to feel that the bitterness of death was as nothing to the bitterness of life, illustrates in allegory the state of man for countless centuries. In darkness and in the shadow of death he lay helpless, singing like the prisoners vain hymns of hope, and praying vain prayers of patience, yet having all the while in his bosom, like Christian, a key called Promise, capable of unlocking the doors of his dungeon. Groping between what Sir Thomas Browne so finely calls "the night of our forebeing" and the unknown future--the dark before and after, he at last came to himself, and with the help of this key unlocked the mysteries of Nature, and found a way of physical salvation. Man's redemption of man is the great triumph of Greek thought. The tap-root of modern science sinks deep in Greek soil, the astounding fertility of which is one of the out-standing facts of history. As Sir Henry Maine says: "To one small people ... it was given to create the principle of progress. That people was the Greek. Except the blind forces of Nature nothing moves in this world which is not Greek in its origin." Though not always recognized, the controlling principles of our art, literature and philosophy, as well as those of science, are Hellenic. We still think in certain levels only with the help of Plato, and there is not a lecture room of this university[1] in which the trained ear may not catch echoes of the Lyceum. In his introductory chapter of his _Rise of the Greek Epic_, Professor Murray dwells on the keen desire of the Greeks to make life a better thing than it is, and to help in the service of man, a thought that pervades Greek life like an aroma. From Homer to Lucian there is one refrain--the pride in the body as a whole; and in the strong conviction that "our soul in its rose-mesh" is quite as much helped by flesh as flesh is by soul, the Greek sang his song "For pleasant is this flesh." The beautiful soul harmonizing with a beautiful body is as much the glorious ideal of Plato as it is the end of the education of Aristotle. What a splendid picture in Book III of the _Republic_, of the day when "our youth will dwell in a land of health, amid fair sights and sounds and receive the good in everything; and beauty, the effluence of fair works, shall flow into the eye and ear like a health-giving breeze from a purer region, and insensibly draw the soul from earliest years into likeness and sympathy with the beauty of reason." The glory of this zeal for the enrichment of the present life was revealed to the Greeks as to no other people, but in respect to care for the body of the common man, we have only seen its fulfilment in our own day, but as a direct result of methods of research initiated by them. Philosophy, as Plato tells us, begins with wonder; and, staring open-eyed at the starry heavens on the plains of Mesopotamia, man took a first step in the careful observation of Nature, which carried him a long way in his career. But he was very slow to learn the second step--how to interrogate Nature, to search out her secrets, as Harvey puts it, by way of experiment. The Chaldeans, who invented gnomons, and predicted eclipses, made a good beginning. The Greeks did not get much beyond trained observation, though Pythagoras made one fundamental experiment when he determined the dependence of the pitch of sound on the length of the vibrating cord. So far did unaided observation and brilliant generalization carry Greek thinkers, that there is scarcely a modern discovery which by anticipation cannot be found in their writings. Indeed one is staggered at their grasp of great principles. Man can do a great deal by observation and thinking, but with them alone he cannot unravel the mysteries of Nature. Had it been possible the Greeks would have done it; and could Plato and Aristotle have grasped the value of experiment in the progress of human knowledge, the course of European history might have been very different. This organon was absent, and even in the art of medicine Hippocrates with all his genius did not get beyond highly trained observation, and a conception of disease as a process of Nature. The great Pergamite, Galen, did indeed realize that the bare fact was only preliminary to the scientific study of disease by experiment, and to the collecting of data, from which principles and laws could be derived. On the dark horizon of the ancient world shone the brightness of the Grecian dawn so clearly that the emancipated mind had an open way. Then something happened--how, who can tell? The light failed or flickered almost to extinction: Greece died into a mediaevalism that for centuries enthralled man in chains, the weary length of which still hampers his progress. The revival of learning awakened at first a suspicion and then a conviction that salvation lay in a return to the old Greek fathers who had set man's feet in the right path, and so it came about that in the study of chemistry, and in the inventions of Copernicus, Kepler and Galileo, modern science took its origin. The growth of the experimental method changed the outlook of mankind, and led directly to the development of the physical and biological sciences by which the modern world has been transformed. A slow, painful progress, through three centuries, science crept on from point to point, with many mistakes and many failures, a progress often marked and flecked with the stains of human effort, but all the same the most revolutionary and far-reaching advance ever made by man's intellect. We are too close to the events to appreciate fully the changes which it has wrought in man's relation to the world; and the marvellous thing is that the most important of these changes have been effected within the memory of those living. Three stand out as of the first importance. My generation was brought up in the belief that "Man was in his original state a very noble and exalted creature, being placed as the head and lord of this world, having all the creatures in subjection to him. The powers and operations of his mind were extensive, capacious and perfect"--to quote the words of one of my old Sunday-school lessons. It is not too much to say that Charles Darwin has so turned man right-about-face that, no longer looking back with regret upon a Paradise Lost, he feels already within the gates of a Paradise Regained. Secondly, Chemistry and Physics have at last given him control of the four elements, and he has harnessed the forces of Nature. As usual Kipling touches the very heart of the matter in his poem on "The Four Angels," who in succession offered to Adam fire, air, earth and water. Happy in the garden, watching the apple tree in bud, in leaf, in blossom and in fruit, he had no use for them; but when the apple tree was cut down, and he had to work outside of Eden wall,--then-- out of black disaster He arose to be the master Of Earth and Water, Air and Fire. And this mastery, won in our day, has made the man with the hoe look up. But the third and greatest glory is that the leaves of the tree of science have availed for the healing of the nations. Measure as we may the progress of the world--intellectually in the growth and spread of education, materially in the application to life of all mechanical appliances, and morally in a higher standard of ethics between nation and nation, and between individuals, there is no one measure which can compare with the decrease of disease and suffering in man, woman and child. The Psalmist will have it that no man may redeem his brother, but this redemption of his body has been bought at a price of the lives of those who have sought out Nature's processes by study and experiment. Silent workers, often unknown and neglected by their generation, these men have kept alive the fires on the altars of science, and have so opened the doors of knowledge that we now know the laws of health and disease. Time will only permit me to refer to a few of the more important of the measures of man's physical redemption. Within the life-time of some of us a strange and wonderful thing happened on the earth--something of which no prophet foretold, of which no seer dreamt, nor is it among the beatitudes of Christ Himself; only St. John seems to have had an inkling of it in that splendid chapter in which he describes the new heaven and the new earth, when the former things should pass away, when all tears should be wiped away, and there should be no more crying nor sorrow. On October 16, 1846, in the amphitheatre of the Massachusetts General Hospital, Boston, a new Prometheus gave a gift as rich as that of fire, the greatest single gift ever made to suffering humanity. The prophecy was fulfilled--_neither shall there be any more pain_; a mystery of the ages had been solved by a daring experiment by man on man in the introduction of anæsthesia. As Weir Mitchell sings in his poem, "The Death of Pain"-- Whatever triumphs still shall hold the mind, Whatever gifts shall yet enrich mankind, Ah! here, no hour shall strike through all the years, No hour so sweet as when hope, doubt and fears, 'Mid deepening silence watched one eager brain With Godlike will decree the Death of Pain. At a stroke the curse of Eve was removed, that multiplied sorrow of sorrows, representing in all ages the very apotheosis of pain. The knife has been robbed of its terrors, and the hospitals are no longer the scenes of those appalling tragedies that made the stoutest quail. To-day we take for granted the silence of the operating-room, but to reach this Elysium we had to travel the slow road of laborious research, which gave us first the chemical agents; and then brave hearts had to risk reputation, and even life itself in experiments, the issue of which was for long doubtful. More widespread in its benediction, as embracing all races and all classes of society, is the relief of suffering, and the prevention of disease through the growth of modern sanitary science in which has been fought out the greatest victory in history. I can only refer to three subjects which illustrate and lead up to the question which is in the minds of all of us to-day. You have in Scotland the merit of the practical introduction of a method which has revolutionized the treatment of wounds, and changed the whole aspect of modern surgery. I am old enough to have been a dresser in a large general hospital in the pre-Listerian days, when it was the rule for wounds to suppurate, and when cases of severe pyæmia and septicæmia were so common that surgeons dreaded to make even a simple amputation. In the wards of the Edinburgh Royal Infirmary and of the Glasgow Royal Infirmary, Lord Lister's experimental work on the healing of wounds led to results of the deepest moment to every individual subject to an accident, or who has to submit to an operation. It is not simply that the prospect of recovery is enormously enhanced, but Listerian surgery has diminished suffering to an extraordinary degree. In the old days every wound which suppurated had to be dressed, and there was the daily distress and pain, felt particularly by young children. Now, even after operations of the first magnitude, the wound may have but a single dressing, and the after-pain is reduced to a minimum. How well the older ones of us realize that anæsthetics and asepsis between them have wrought a complete revolution in hospital life. I asked the Superintendent of Nurses at the Royal Infirmary to let me know how many patients last night in the wards had actual suffering, and she has sent word that about one in eight had pain, not all of them acute pain. But man's redemption of man is nowhere so well known as in the abolition and prevention of the group of diseases which we speak of as the fevers, or the acute infections. This is the glory of the science of medicine, and nowhere in the world have its lessons been so thoroughly carried out as in this country. It is too old a story to retell in detail, but I may remind you that in this city within fifty years there has been an annual saving of from four to five thousand lives, by measures which have directly prevented and limited the spread of infectious diseases. The man is still alive, Sir Henry Little-John, who made the first sanitary survey of the city. When one reads the account of the condition of the densely crowded districts on the south side of the High Street, one is not surprised that the rate of mortality was 40 and over per thousand. That you now enjoy one of the lowest death rates in Europe--15.3 per thousand for last year--is due to the thoroughness with which measures of recognized efficiency have been carried out. When we learn that last year there were no deaths from smallpox, not one from typhus, and only 21 from fevers of the zymotic group, it is scarcely credible that all this has been brought about within the memory of living men. It is not too much to say that the abolition of small-pox, typhus and typhoid fevers have changed the character of the medical practice in our hospitals. In this country typhoid fever is in its last ditch, and though a more subtle and difficult enemy to conquer than typhus, we may confidently hope that before long it will be as rare. Here I would like to say a word or two upon one of the most terrible of all acute infections, the one of which we first learned the control through the work of Jenner. A great deal of literature has been distributed, casting discredit upon the value of vaccination in the prevention of small-pox. I do not see how any one who has gone through epidemics as I have, or who is familiar with the history of the subject, and who has any capacity left for clear judgment, can doubt its value. Some months ago I was twitted by the Editor of the Journal of the Anti-Vaccination League for maintaining a curious silence on the subject. I would like to issue a Mount Carmel-like challenge to any ten unvaccinated priests of Baal. I will take ten selected vaccinated persons, and help in the next severe epidemic, with ten selected unvaccinated persons (if available!). I should choose three members of Parliament, three anti-vaccination doctors, if they could be found, and four anti-vaccination propagandists. And I will make this promise--neither to jeer nor to jibe when they catch the disease, but to look after them as brothers; and for the three or four who are certain to die I will try to arrange the funerals with all the pomp and ceremony of an anti-vaccination demonstration. A blundering art until thirty or forty years ago, preventative medicine was made a science by the discovery of the causes of many of the serious epidemic diseases. To any one of you who wishes to know this side of science, what it is, what it has done, what it may do, let me commend Radot's _Life of Pasteur_, which reads like a fairy tale. It is more particularly in connection with the great plagues of the world that man's redemption of man may be in the future effected; I say in the future because we have only touched the fringe of the subject. How little do we appreciate what even a generation has done. The man is only just dead, Robert Koch, who gave to his fellow-men the control of cholera. Read the history of yellow fever in Havana and in Brazil if you wish to get an idea of the powers of experimental medicine; there is nothing to match it in the history of human achievement. Before our eyes to-day the most striking experiment ever made in sanitation is in progress. The digging of the Panama Canal was acknowledged to be a question of the health of the workers. For four centuries the Isthmus had been a white man's grave, and during the French control of the Canal the mortality once reached the appalling figure of 170 per thousand. Even under the most favourable circumstances it was extraordinarily high. Month by month I get the _Reports_ which form by far the most interesting sanitary reading of the present day. Of more than 54,000 employés (about 13,000 of whom are white), the death rate per thousand for the month of March was 8.91, a lower percentage, I believe, than any city in the United States. It has been brought about in great part by researches into the life history of the parasite which produces malaria, and by the effectual measures taken for its destruction. Here again is a chapter in human achievement for which it would be hard to find a parallel. But let us not forget that these are but illustrations of wide-spread possibilities of organization on modern lines. These are sanitary blessings. To make them available in the Tropics is the heaviest burden of the white man; how heavy you may know from the startling figures which have just been issued from British India. Exclusive of the native states for the year 1908, the total deaths from fever and cholera exceeded 5,000,000, out of a population of 226,000,000. The bright spot in the picture is the diminution of the mortality from plague--not fewer than a million fatal cases as compared with 1907. These are brief indications of the lines along which effective progress is being made in man's redemption by man. And all this has a direct bearing upon the disease, the fight against which brings us together. Tuberculosis is one of the great infections of the world, and it has been one of the triumphs of our generation to determine its cause. With the improvement of sanitation there has been a reduction in its mortality, amounting since 1850 to above 40 per cent. But it still remains the most formidable single foe, killing a larger number of people than any other disease--some 60,000 in Great Britain and Ireland in 1908, and 589 of this city. Practically between 10 and 11 per cent. of all deaths are due to it. A plain proposition is before the people. We know the disease--how it is caused, how it is spread, how it should be prevented, how in suitable cases it may be cured. How to make this knowledge effective is the prime reason of this conference. It is a campaign for the public; past history shows that it is a campaign of hope. The measures for its stamping out, though simple on paper, present difficulties interwoven with the very fabric of society, but they are not insuperable, and are gradually disappearing. It is for this reason we urge you to join with enthusiasm in the crusade; remembering, however, that only the prolonged and united efforts, carried through several generations, can place the disease in the same category with typhus fever, typhoid and small-pox. In the comedies and tragedies of life our immutable human nature reacts very much as in the dawn of science, and yet, with a widening of knowledge, the lights and shadows of the landscape have shifted, and the picture is brighter. Nothing can bring back the hour when sin and disease were correlated as confidently as night and day; and how shall we assess the enormous gain of a new criterion, a new estimate of the value of man's life! There are tones in human sentiment to-day which the ancients never heard, which our fathers indeed heard but faintly, and that without recognizing their significance. The human heart by which we live has been touched as with the wand of a Prospero. What availed the sceptred race! what the glory that was Greece, or the grandeur that was Rome! of what avail even has been the message of the gospel, while the people at large were haunted by fear and anxiety, stricken by the pestilence of the darkness and the sickness of the noon-day? The new socialism of Science with its definite mission cares not a rap for the theories of Karl Marx, of Ferdinand Lassalle, or of Henry George; still less for the dreams of Plato or of Sir Thomas More--or at least only so far as they help to realize the well-being of the citizen. Nor is there need to fear that in weighing the world in our balance we may drain the sap of its life, so long as we materialize in the service of man those eternal principles on which life rests--moral fervour, liberty and justice. The outlook for the world as represented by Mary and John, and Jennie and Tom has never been so hopeful. There is no place for despondency or despair. As for the dour dyspeptics in mind and morals who sit idly croaking like ravens,--let them come into the arena, let them wrestle for their flesh and blood against the principalities and powers represented by bad air and worse houses, by drink and disease, by needless pain, and by the loss annually to the state of thousands of valuable lives--let them fight for the day when a man's life shall be more precious than gold. Now, alas! the cheapness of life is every day's tragedy! If in the memorable phrase of the Greek philosopher Prodicus, "That which benefits human life is God," we may see in this new gospel a link betwixt us and the crowning race of those who eye to eye shall look on knowledge, and in whose hand Nature shall be an open book, an approach to the glorious day of which Shelley sings so gloriously: Happiness And Science dawn though late upon the earth; Peace cheers the mind, health renovates the frame; Disease and pleasure cease to mingle here, Reason and passion cease to combat there, Whilst mind unfettered o'er the earth extends Its all-subduing energies, and wields The sceptre of a vast dominion there. [1] See note on page 4. RICHARD CLAY & SONS, LIMITED, BRUNSWICK STREET, STAMFORD STREET, S.E., AND BUNGAY, SUFFOLK. 
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1566	----	THE EVOLUTION OF MODERN MEDICINE A SERIES OF LECTURES DELIVERED AT YALE UNIVERSITY ON THE SILLIMAN FOUNDATION IN APRIL, 1913 by William Osler THE SILLIMAN FOUNDATION IN the year 1883 a legacy of eighty thousand dollars was left to the President and Fellows of Yale College in the city of New Haven, to be held in trust, as a gift from her children, in memory of their beloved and honored mother, Mrs. Hepsa Ely Silliman. On this foundation Yale College was requested and directed to establish an annual course of lectures designed to illustrate the presence and providence, the wisdom and goodness of God, as manifested in the natural and moral world. These were to be designated as the Mrs. Hepsa Ely Silliman Memorial Lectures. It was the belief of the testator that any orderly presentation of the facts of nature or history contributed to the end of this foundation more effectively than any attempt to emphasize the elements of doctrine or of creed; and he therefore provided that lectures on dogmatic or polemical theology should be excluded from the scope of this foundation, and that the subjects should be selected rather from the domains of natural science and history, giving special prominence to astronomy, chemistry, geology and anatomy. It was further directed that each annual course should be made the basis of a volume to form part of a series constituting a memorial to Mrs. Silliman. The memorial fund came into the possession of the Corporation of Yale University in the year 1901; and the present volume constitutes the tenth of the series of memorial lectures. CONTENTS Chapter I. Origin Of Medicine Chapter II. Greek Medicine Chapter III. Mediaeval Medicine Chapter IV. The Renaissance and the Rise of Anatomy and Physiology Chapter V. The Rise and Development of Modern Medicine Chapter VI. The Rise of Preventive Medicine PREFACE THE manuscript of Sir William Osler's lectures on the "Evolution of Modern Medicine," delivered at Yale University in April, 1913, on the Silliman Foundation, was immediately turned in to the Yale University Press for publication. Duly set in type, proofs in galley form had been submitted to him and despite countless interruptions he had already corrected and revised a number of the galleys when the great war came. But with the war on, he threw himself with energy and devotion into the military and public duties which devolved upon him and so never completed his proof-reading and intended alterations. The careful corrections which Sir William made in the earlier galleys show that the lectures were dictated, in the first instance, as loose memoranda for oral delivery rather than as finished compositions for the eye, while maintaining throughout the logical continuity and the engaging con moto which were so characteristic of his literary style. In revising the lectures for publication, therefore, the editors have merely endeavored to carry out, with care and befitting reverence, the indications supplied in the earlier galleys by Sir William himself. In supplying dates and references which were lacking, his preferences as to editions and readings have been borne in mind. The slight alterations made, the adaptation of the text to the eye, detract nothing from the original freshness of the work. In a letter to one of the editors, Osler described these lectures as "an aeroplane flight over the progress of medicine through the ages." They are, in effect, a sweeping panoramic survey of the whole vast field, covering wide areas at a rapid pace, yet with an extraordinary variety of detail. The slow, painful character of the evolution of medicine from the fearsome, superstitious mental complex of primitive man, with his amulets, healing gods and disease demons, to the ideal of a clear-eyed rationalism is traced with faith and a serene sense of continuity. The author saw clearly and felt deeply that the men who have made an idea or discovery viable and valuable to humanity are the deserving men; he has made the great names shine out, without any depreciation of the important work of lesser men and without cluttering up his narrative with the tedious prehistory of great discoveries or with shrill claims to priority. Of his skill in differentiating the sundry "strains" of medicine, there is specific witness in each section. Osler's wide culture and control of the best available literature of his subject permitted him to range the ampler aether of Greek medicine or the earth-fettered schools of today with equal mastery; there is no quickset of pedantry between the author and the reader. The illustrations (which he had doubtless planned as fully for the last as for the earlier chapters) are as he left them; save that, lacking legends, these have been supplied and a few which could not be identified have with regret been omitted. The original galley proofs have been revised and corrected from different viewpoints by Fielding H. Garrison, Harvey Cushing, Edward C. Streeter and latterly by Leonard L. Mackall (Savannah, Ga.), whose zeal and persistence in the painstaking verification of citations and references cannot be too highly commended. In the present revision, a number of important corrections, most of them based upon the original MS., have been made by Dr. W.W. Francis (Oxford), Dr. Charles Singer (London), Dr. E.C. Streeter, Mr. L.L. Mackall and others. This work, composed originally for a lay audience and for popular consumption, will be to the aspiring medical student and the hardworking practitioner a lift into the blue, an inspiring vista or "Pisgah-sight" of the evolution of medicine, a realization of what devotion, perseverance, valor and ability on the part of physicians have contributed to this progress, and of the creditable part which our profession has played in the general development of science. The editors have no hesitation in presenting these lectures to the profession and to the reading public as one of the most characteristic productions of the best-balanced, best-equipped, most sagacious and most lovable of all modern physicians. F.H.G. BUT on that account, I say, we ought not to reject the ancient Art, as if it were not, and had not been properly founded, because it did not attain accuracy in all things, but rather, since it is capable of reaching to the greatest exactitude by reasoning, to receive it and admire its discoveries, made from a state of great ignorance, and as having been well and properly made, and not from chance. (Hippocrates, On Ancient Medicine, Adams edition, Vol. 1, 1849, p. 168.) THE true and lawful goal of the sciences is none other than this: that human life be endowed with new discoveries and powers. (Francis Bacon, Novum Organum, Aphorisms, LXXXI, Spedding's translation.) A GOLDEN thread has run throughout the history of the world, consecutive and continuous, the work of the best men in successive ages. From point to point it still runs, and when near you feel it as the clear and bright and searchingly irresistible light which Truth throws forth when great minds conceive it. (Walter Moxon, Pilocereus Senilis and Other Papers, 1887, p. 4.) FOR the mind depends so much on the temperament and disposition of the bodily organs that, if it is possible to find a means of rendering men wiser and cleverer than they have hitherto been, I believe that it is in medicine that it must be sought. It is true that the medicine which is now in vogue contains little of which the utility is remarkable; but, without having any intention of decrying it, I am sure that there is no one, even among those who make its study a profession, who does not confess that all that men know is almost nothing in comparison with what remains to be known; and that we could be free of an infinitude of maladies both of body and mind, and even also possibly of the infirmities of age, if we had sufficient knowledge of their causes, and of all the remedies with which nature has provided us. (Descartes: Discourse on the Method, Philosophical Works. Translated by E. S. Haldane and G. R. T. Ross. Vol. I, Cam. Univ. Press, 1911, p. 120.) CHAPTER I -- ORIGIN OF MEDICINE INTRODUCTION SAIL to the Pacific with some Ancient Mariner, and traverse day by day that silent sea until you reach a region never before furrowed by keel where a tiny island, a mere speck on the vast ocean, has just risen from the depths, a little coral reef capped with green, an atoll, a mimic earth, fringed with life, built up through countless ages by life on the remains of life that has passed away. And now, with wings of fancy, join Ianthe in the magic car of Shelley, pass the eternal gates of the flaming ramparts of the world and see his vision: Below lay stretched the boundless Universe! There, far as the remotest line That limits swift imagination's flight, Unending orbs mingled in mazy motion, Immutably fulfilling Eternal Nature's law. Above, below, around, The circling systems formed A wilderness of harmony. (Daemon of the World, Pt. I.) And somewhere, "as fast and far the chariot flew," amid the mighty globes would be seen a tiny speck, "earth's distant orb," one of "the smallest lights that twinkle in the heavens." Alighting, Ianthe would find something she had probably not seen elsewhere in her magic flight--life, everywhere encircling the sphere. And as the little coral reef out of a vast depth had been built up by generations of polyzoa, so she would see that on the earth, through illimitable ages, successive generations of animals and plants had left in stone their imperishable records: and at the top of the series she would meet the thinking, breathing creature known as man. Infinitely little as is the architect of the atoll in proportion to the earth on which it rests, the polyzoon, I doubt not, is much larger relatively than is man in proportion to the vast systems of the Universe, in which he represents an ultra-microscopic atom less ten thousand times than the tiniest of the "gay motes that people the sunbeams." Yet, with colossal audacity, this thinking atom regards himself as the anthropocentric pivot around which revolve the eternal purposes of the Universe. Knowing not whence he came, why he is here, or whither he is going, man feels himself of supreme importance, and certainly is of interest--to himself. Let us hope that he has indeed a potency and importance out of all proportion to his somatic insignificance. We know of toxins of such strength that an amount too infinitesimal to be gauged may kill; and we know that "the unit adopted in certain scientific work is the amount of emanation produced by one million-millionth of a grain of radium, a quantity which itself has a volume of less than a million-millionth of a cubic millimetre and weighs a million million times less than an exceptionally delicate chemical balance will turn to" (Soddy, 1912). May not man be the radium of the Universe? At any rate let us not worry about his size. For us he is a very potent creature, full of interest, whose mundane story we are only beginning to unravel. Civilization is but a filmy fringe on the history of man. Go back as far as his records carry us and the story written on stone is of yesterday in comparison with the vast epochs of time which modern studies demand for his life on the earth. For two millions (some hold even three millions) of years man lived and moved and had his being in a world very different from that upon which we look out. There appear, indeed, to have been various types of man, some as different from us as we are from the anthropoid apes. What upstarts of yesterday are the Pharaohs in comparison with the men who survived the tragedy of the glacial period! The ancient history of man--only now beginning to be studied--dates from the Pliocene or Miocene period; the modern history, as we know it, embraces that brief space of time that has elapsed since the earliest Egyptian and Babylonian records were made. This has to be borne in mind in connection with the present mental status of man, particularly in his outlook upon nature. In his thoughts and in his attributes, mankind at large is controlled by inherited beliefs and impulses, which countless thousands of years have ingrained like instinct. Over vast regions of the earth today, magic, amulets, charms, incantations are the chief weapons of defense against a malignant nature; and in disease, the practice of Asa(*) is comparatively novel and unusual; in days of illness many millions more still seek their gods rather than the physicians. In an upward path man has had to work out for himself a relationship with his fellows and with nature. He sought in the supernatural an explanation of the pressing phenomena of life, peopling the world with spiritual beings, deifying objects of nature, and assigning to them benign or malign influences, which might be invoked or propitiated. Primitive priest, physician and philosopher were one, and struggled, on the one hand, for the recognition of certain practices forced on him by experience, and on the other, for the recognition of mystical agencies which control the dark, "uncharted region" about him--to use Prof. Gilbert Murray's phrase--and were responsible for everything he could not understand, and particularly for the mysteries of disease. Pliny remarks that physic "was early fathered upon the gods"; and to the ordinary non-medical mind, there is still something mysterious about sickness, something outside the ordinary standard. (*) II Chronicles xvi, 12. Modern anthropologists claim that both religion and medicine took origin in magic, "that spiritual protoplasm," as Miss Jane Harrison calls it. To primitive man, magic was the setting in motion of a spiritual power to help or to hurt the individual, and early forms may still be studied in the native races. This power, or "mana," as it is called, while possessed in a certain degree by all, may be increased by practice. Certain individuals come to possess it very strongly: among native Australians today it is still deliberately cultivated. Magic in healing seeks to control the demons, or forces; causing disease; and in a way it may be thus regarded as a "lineal ancestor of modern science" (Whetham), which, too, seeks to control certain forces, no longer, however, regarded as supernatural. Primitive man recognized many of these superhuman agencies relating to disease, such as the spirits of the dead, either human or animal, independent disease demons, or individuals who might act by controlling the spirits or agencies of disease. We see this today among the negroes of the Southern States. A Hoodoo put upon a negro may, if he knows of it, work upon him so powerfully through the imagination that he becomes very ill indeed, and only through a more powerful magic exercised by someone else can the Hoodoo be taken off. To primitive man life seemed "full of sacred presences" (Walter Pater) connected with objects in nature, or with incidents and epochs in life, which he began early to deify, so that, until a quite recent period, his story is largely associated with a pantheon of greater and lesser gods, which he has manufactured wholesale. Xenophanes was the earliest philosopher to recognize man's practice of making gods in his own image and endowing them with human faculties and attributes; the Thracians, he said, made their gods blue-eyed and red-haired, the Ethiopians, snub-nosed and black, while, if oxen and lions and horses had hands and could draw, they would represent their gods as oxen and lions and horses. In relation to nature and to disease, all through early history we find a pantheon full to repletion, bearing testimony no less to the fertility of man's imagination than to the hopes and fears which led him, in his exodus from barbarism, to regard his gods as "pillars of fire by night, and pillars of cloud by day." Even so late a religion as that of Numa was full of little gods to be invoked on special occasions--Vatican, who causes the infant to utter his first cry, Fabulinus, who prompts his first word, Cuba, who keeps him quiet in his cot, Domiduca, who watches over one's safe home-coming (Walter Pater); and Numa believed that all diseases came from the gods and were to be averted by prayer and sacrifice. Besides the major gods, representatives of Apollo, AEsculapius and Minerva, there were scores of lesser ones who could be invoked for special diseases. It is said that the young Roman mother might appeal to no less than fourteen goddesses, from Juno Lucina to Prosa and Portvorta (Withington). Temples were erected to the Goddess of Fever, and she was much invoked. There is extant a touching tablet erected by a mourning mother and inscribed: Febri divae, Febri Sancte, Febri magnae Camillo amato pro Filio meld effecto. Posuit. It is marvellous what a long line of superhuman powers, major and minor, man has invoked against sickness. In Swinburne's words: God by God flits past in thunder till his glories turn to shades, God by God bears wondering witness how his Gospel flames and fades; More was each of these, while yet they were, than man their servant seemed; Dead are all of these, and man survives who made them while he dreamed. Most of them have been benign and helpful gods. Into the dark chapters relating to demonical possession and to witchcraft we cannot here enter. They make one cry out with Lucretius (Bk. V): O genus infelix humanum, talia divis Cum tribuit facta atque iras adjunxit acerbas! Quantos tum gemitus ipsi sibi, quantaque nobis Vulnera, quas lacrimas peperere minoribu' nostris. In every age, and in every religion there has been justification for his bitter words, "tantum religio potuit suadere malorum"--"Such wrongs Religion in her train doth bring"--yet, one outcome of "a belief in spiritual beings"--as Tylor defines religion--has been that man has built an altar of righteousness in his heart. The comparative method applied to the study of his religious growth has shown how man's thoughts have widened in the unceasing purpose which runs through his spiritual no less than his physical evolution. Out of the spiritual protoplasm of magic have evolved philosopher and physician, as well as priest. Magic and religion control the uncharted sphere--the supernatural, the superhuman: science seeks to know the world, and through knowing, to control it. Ray Lankester remarks that Man is Nature's rebel, and goes on to say: "The mental qualities which have developed in Man, though traceable in a vague and rudimentary condition in some of his animal associates, are of such an unprecedented power and so far dominate everything else in his activities as a living organism, that they have to a very large extent, if not entirely, cut him off from the general operation of that process of Natural Selection and survival of the fittest which up to their appearance had been the law of the living world. They justify the view that Man forms a new departure in the gradual unfolding of Nature's predestined scheme. Knowledge, reason, self-consciousness, will, are the attributes of Man."(1) It has been a slow and gradual growth, and not until within the past century has science organized knowledge--so searched out the secrets of Nature, as to control her powers, limit her scope and transform her energies. The victory is so recent that the mental attitude of the race is not yet adapted to the change. A large proportion of our fellow creatures still regard nature as a playground for demons and spirits to be exorcised or invoked. (1) Sir E. Ray Lankester: Romanes Lecture, "Nature and Man," Oxford Univ. Press, 1905, p. 21. Side by side, as substance and shadow--"in the dark backward and abysm of time," in the dawn of the great civilizations of Egypt and Babylon, in the bright morning of Greece, and in the full noontide of modern life, together have grown up these two diametrically opposite views of man's relation to nature, and more particularly of his personal relation to the agencies of disease. The purpose of this course of lectures is to sketch the main features of the growth of these two dominant ideas, to show how they have influenced man at the different periods of his evolution, how the lamp of reason, so early lighted in his soul, burning now bright, now dim, has never, even in his darkest period, been wholly extinguished, but retrimmed and refurnished by his indomitable energies, now shines more and more towards the perfect day. It is a glorious chapter in history, in which those who have eyes to see may read the fulfilment of the promise of Eden, that one day man should not only possess the earth, but that he should have dominion over it! I propose to take an aeroplane flight through the centuries, touching only on the tall peaks from which may be had a panoramic view of the epochs through which we pass. ORIGIN OF MEDICINE MEDICINE arose out of the primal sympathy of man with man; out of the desire to help those in sorrow, need and sickness. In the primal sympathy Which having been must ever be; In the soothing thoughts that spring Out of human suffering. The instinct of self-preservation, the longing to relieve a loved one, and above all, the maternal passion--for such it is--gradually softened the hard race of man--tum genus humanum primum mollescere coepit. In his marvellous sketch of the evolution of man, nothing illustrates more forcibly the prescience of Lucretius than the picture of the growth of sympathy: "When with cries and gestures they taught with broken words that 'tis right for all men to have pity on the weak." I heard the well-known medical historian, the late Dr. Payne, remark that "the basis of medicine is sympathy and the desire to help others, and whatever is done with this end must be called medicine." The first lessons came to primitive man by injuries, accidents, bites of beasts and serpents, perhaps for long ages not appreciated by his childlike mind, but, little by little, such experiences crystallized into useful knowledge. The experiments of nature made clear to him the relation of cause and effect, but it is not likely, as Pliny suggests, that he picked up his earliest knowledge from the observation of certain practices in animals, as the natural phlebotomy of the plethoric hippopotamus, or the use of emetics from the dog, or the use of enemata from the ibis. On the other hand, Celsus is probably right in his account of the origin of rational medicine. "Some of the sick on account of their eagerness took food on the first day, some on account of loathing abstained; and the disease in those who refrained was more relieved. Some ate during a fever, some a little before it, others after it had subsided, and those who had waited to the end did best. For the same reason some at the beginning of an illness used a full diet, others a spare, and the former were made worse. Occurring daily, such things impressed careful men, who noted what had best helped the sick, then began to prescribe them. In this way medicine had its rise from the experience of the recovery of some, of the death of others, distinguishing the hurtful from the salutary things" (Book I). The association of ideas was suggestive--the plant eyebright was used for centuries in diseases of the eye because a black speck in the flower suggested the pupil of the eye. The old herbals are full of similar illustrations upon which, indeed, the so-called doctrine of signatures depends. Observation came, and with it an ever widening experience. No society so primitive without some evidence of the existence of a healing art, which grew with its growth, and became part of the fabric of its organization. With primitive medicine, as such, I cannot deal, but I must refer to the oldest existing evidence of a very extraordinary practice, that of trephining. Neolithic skulls with disks of bone removed have been found in nearly all parts of the world. Many careful studies have been made of this procedure, particularly by the great anatomist and surgeon, Paul Broca, and M. Lucas-Championniere has covered the subject in a monograph.(2) Broca suggests that the trephining was done by scratching or scraping, but, as Lucas-Championniere holds, it was also done by a series of perforations made in a circle with flint instruments, and a round piece of skull in this way removed; traces of these drill-holes have been found. The operation was done for epilepsy, infantile convulsions, headache, and various cerebral diseases believed to be caused by confined demons, to whom the hole gave a ready method of escape. (2) Lucas-Championniere: Trepanation neolithique, Paris, 1912. The practice is still extant. Lucas-Championniere saw a Kabyle thoubib who told him that it was quite common among his tribe; he was the son of a family of trephiners, and had undergone the operation four times, his father twelve times; he had three brothers also experts; he did not consider it a dangerous operation. He did it most frequently for pain in the head, and occasionally for fracture. The operation was sometimes performed upon animals. Shepherds trephined sheep for the staggers. We may say that the modern decompression operation, so much in vogue, is the oldest known surgical procedure. EGYPTIAN MEDICINE OUT of the ocean of oblivion, man emerges in history in a highly civilized state on the banks of the Nile, some sixty centuries ago. After millenniums of a gradual upward progress, which can be traced in the records of the stone age, civilization springs forth Minerva-like, complete, and highly developed, in the Nile Valley. In this sheltered, fertile spot, neolithic man first raised himself above his kindred races of the Mediterranean basin, and it is suggested that by the accidental discovery of copper Egypt "forged the instruments that raised civilization out of the slough of the Stone Age" (Elliot Smith). Of special interest to us is the fact that one of the best-known names of this earliest period is that of a physician--guide, philosopher and friend of the king--a man in a position of wide trust and importance. On leaving Cairo, to go up the Nile, one sees on the right in the desert behind Memphis a terraced pyramid 190 feet in height, "the first large structure of stone known in history." It is the royal tomb of Zoser, the first of a long series with which the Egyptian monarchy sought "to adorn the coming bulk of death." The design of this is attributed to Imhotep, the first figure of a physician to stand out clearly from the mists of antiquity. "In priestly wisdom, in magic, in the formulation of wise proverbs, in medicine and architecture, this remarkable figure of Zoser's reign left so notable a reputation that his name was never forgotten, and 2500 years after his death he had become a God of Medicine, in whom the Greeks, who called him Imouthes, recognized their own AEsculapius."(3) He became a popular god, not only healing men when alive, but taking good care of them in the journeys after death. The facts about this medicinae primus inventor, as he has been called, may be gathered from Kurt Sethe's study.(4) He seems to have corresponded very much to the Greek Asklepios. As a god he is met with comparatively late, between 700 and 332 B.C. Numerous bronze figures of him remain. The oldest memorial mentioning him is a statue of one of his priests, Amasis (No. 14765 in the British Museum). Ptolemy V dedicated to him a temple on the island of Philae. His cult increased much in later days, and a special temple was dedicated to him near Memphis Sethe suggests that the cult of Imhotep gave the inspiration to the Hermetic literature. The association of Imhotep with the famous temple at Edfu is of special interest. (3) Breasted: A History of the Ancient Egyptians, Scribner, New York, 1908, p. 104. (4) K. Sethe: Imhotep, der Asklepios der Aegypter, Leipzig, 1909 (Untersuchungen, etc., ed. Sethe, Vol. II, No. 4). Egypt became a centre from which civilization spread to the other peoples of the Mediterranean. For long centuries, to be learned in all the wisdom of the Egyptians meant the possession of all knowledge. We must come to the land of the Nile for the origin of many of man's most distinctive and highly cherished beliefs. Not only is there a magnificent material civilization, but in records so marvellously preserved in stone we may see, as in a glass, here clearly, there darkly, the picture of man's search after righteousness, the earliest impressions of his moral awakening, the beginnings of the strife in which he has always been engaged for social justice and for the recognition of the rights of the individual. But above all, earlier and more strongly than in any other people, was developed the faith that looked through death, to which, to this day, the noblest of their monuments bear an enduring testimony. With all this, it is not surprising to find a growth in the knowledge of practical medicine; but Egyptian civilization illustrates how crude and primitive may remain a knowledge of disease when conditioned by erroneous views of its nature. At first, the priest and physician were identified, and medicine never became fully dissociated from religion. Only in the later periods did a special group of physicians arise who were not members of priestly colleges.(6) Maspero states that the Egyptians believed that disease and death were not natural and inevitable, but caused by some malign influence which could use any agency, natural or invisible, and very often belonged to the invisible world. "Often, though, it belongs to the invisible world, and only reveals itself by the malignity of its attacks: it is a god, a spirit, the soul of a dead man, that has cunningly entered a living person, or that throws itself upon him with irresistible violence. Once in possession of the body, the evil influence breaks the bones, sucks out the marrow, drinks the blood, gnaws the intestines and the heart and devours the flesh. The invalid perishes according to the progress of this destructive work; and death speedily ensues, unless the evil genius can be driven out of it before it has committed irreparable damage. Whoever treats a sick person has therefore two equally important duties to perform. He must first discover the nature of the spirit in possession, and, if necessary, its name, and then attack it, drive it out, or even destroy it. He can only succeed by powerful magic, so he must be an expert in reciting incantations, and skilful in making amulets. He must then use medicine (drugs and diet) to contend with the disorders which the presence of the strange being has produced in the body."(6) (5) Maspero: Life in Ancient Egypt and Assyria, London, 1891, p. 119. (6) Maspero: Life in Ancient Egypt and Assyria, London, 1891, p. 118. (7) W. Wreszinski: Die Medizin der alten Aegypter, Leipzig, J. C. Hinrichs, 1909-1912. In this way it came about that diseases were believed to be due to hostile spirits, or caused by the anger of a god, so that medicines, no matter how powerful, could only be expected to assuage the pain; but magic alone, incantations, spells and prayers, could remove the disease. Experience brought much of the wisdom we call empirical, and the records, extending for thousands of years, show that the Egyptians employed emetics, purgatives, enemata, diuretics, diaphoretics and even bleeding. They had a rich pharmacopoeia derived from the animal, vegetable and mineral kingdoms. In the later periods, specialism reached a remarkable development, and Herodotus remarks that the country was full of physicians;--"One treats only the diseases of the eye, another those of the head, the teeth, the abdomen, or the internal organs." Our knowledge of Egyptian medicine is derived largely from the remarkable papyri dealing specially with this subject. Of these, six or seven are of the first importance. The most famous is that discovered by Ebers, dating from about 1500 B.C. A superb document, one of the great treasures of the Leipzig Library, it is 20.23 metres long and 30 centimetres high and in a state of wonderful preservation. Others are the Kahun, Berlin, Hearst and British Museum papyri. All these have now been published--the last three quite recently, edited by Wreszinski.(7) I show here a reproduction from which an idea may be had of these remarkable documents. They are motley collections, filled with incantations, charms, magical formulae, symbols, prayers and prescriptions for all sorts of ailments. One is impressed by the richness of the pharmacopoeia, and the high development which the art of pharmacy must have attained. There were gargles, salves, snuffs, inhalations, suppositories, fumigations, enemata, poultices and plasters; and they knew the use of opium, hemlock, the copper salts, squills and castor oil. Surgery was not very highly developed, but the knife and actual cautery were freely used. Ophthalmic surgery was practiced by specialists, and there are many prescriptions in the papyri for ophthalmia. One department of Egyptian medicine reached a high stage of development, vis., hygiene. Cleanliness of the dwellings, of the cities and of the person was regulated by law, and the priests set a splendid example in their frequent ablutions, shaving of the entire body, and the spotless cleanliness of their clothing. As Diodorus remarks, so evenly ordered was their whole manner of life that it was as if arranged by a learned physician rather than by a lawgiver. Two world-wide modes of practice found their earliest illustration in ancient Egypt. Magic, the first of these, represented the attitude of primitive man to nature, and really was his religion. He had no idea of immutable laws, but regarded the world about him as changeable and fickle like himself, and "to make life go as he wished, he must be able to please and propitiate or to coerce these forces outside himself."(8) (8) L. Thorndike: The Place of Magic in the Intellectual History of Europe, New York, 1905, p. 29. The point of interest to us is that in the Pyramid Texts--"the oldest chapter in human thinking preserved to us, the remotest reach in the intellectual history of man which we are now able to discern"(9)--one of their six-fold contents relates to the practice of magic. A deep belief existed as to its efficacy, particularly in guiding the dead, who were said to be glorious by reason of mouths equipped with the charms, prayers and ritual of the Pyramid Texts, armed with which alone could the soul escape the innumerable dangers and ordeals of the passage through another world. Man has never lost his belief in the efficacy of magic, in the widest sense of the term. Only a very few of the most intellectual nations have escaped from its shackles. Nobody else has so clearly expressed the origins and relations of magic as Pliny in his "Natural History."(10) "Now, if a man consider the thing well, no marvaile it is that it hath continued thus in so great request and authoritie; for it is the onely Science which seemeth to comprise in itselfe three possessions besides, which have the command and rule of mans mind above any other whatsoever. For to begin withall, no man doubteth but that Magicke tooke root first, and proceeded from Physicke, under the presence of maintaining health, curing, and preventing diseases: things plausible to the world, crept and insinuated farther into the heart of man, with a deepe conceit of some high and divine matter therein more than ordinarie, and in comparison whereof, all other Physicke was but basely accounted. And having thus made way and entrance, the better to fortifie it selfe, and to give a goodly colour and lustre to those fair and flattering promises of things, which our nature is most given to hearken after, on goeth the habite also and cloake of religion: a point, I may tell you, that even in these daies holdeth captivate the spirit of man, and draweth away with it a greater part of the world, and nothing so much. But not content with this successe and good proceeding, to gather more strength and win a greater name, shee entermingled with medicinable receipts and religious ceremonies, the skill of Astrologie and arts Mathematicall; presuming upon this, That all men by nature are very curious and desirous to know their future fortunes, and what shall betide them hereafter, persuading themselves, that all such foreknowledge dependeth upon the course and influence of the starres, which give the truest and most certain light of things to come. Being thus wholly possessed of men, and having their senses and understanding by this meanes fast ynough bound with three sure chains, no marvell if this art grew in processe of time to such an head, that it was and is at this day reputed by most nations of the earth for the paragon and cheefe of all sciences: insomuch as the mightie kings and monarchs of the Levant are altogether ruled and governed thereby." (9) Breasted: Development of Religion and Thought in Ancient Egypt, New York, 1912, p. 84. (10) The Historie of the World, commonly called the Naturall Historie of C. Plinius Secundus, translated into English by Philemon Holland, Doctor in Physieke, London, 1601, Vol. II, p. 371, Bk. XXX, Chap. I, Sect. 1. The second world-wide practice which finds its earliest record among the Egyptians is the use secretions and parts of the animal body as medicine. The practice was one of great antiquity with primitive man, but the papyri already mentioned contain the earliest known records. Saliva, urine, bile, faeces, various parts of the body, dried and powdered, worms, insects, snakes were important ingredients in the pharmacopoeia. The practice became very widespread throughout the ancient world. Its extent and importance may be best gathered from chapters VII and VIII in the 28th book of Pliny's "Natural History." Several remedies are mentioned as derived from man; others from the elephant, lion, camel, crocodile, and some seventy-nine are prepared from the hyaena. The practice was widely prevalent throughout the Middle Ages, and the pharmacopoeia of the seventeenth and even of the eighteenth century contains many extraordinary ingredients. "The Royal Pharmacopoeia" of Moses Charras (London ed., 1678), the most scientific work of the day, is full of organotherapy and directions for the preparation of medicines from the most loathsome excretions. A curious thing is that with the discoveries of the mummies a belief arose as to the great efficacy of powdered mummy in various maladies. As Sir Thomas Browne remarks in his "Urn Burial": "Mummy has become merchandize. Mizraim cures wounds, and Pharaoh is sold for balsams." One formula in everyday use has come to us in a curious way from the Egyptians. In the Osiris myth, the youthful Horus loses an eye in his battle with Set. This eye, the symbol of sacrifice, became, next to the sacred beetle, the most common talisman of the country, and all museums are rich in models of the Horus eye in glass or stone. "When alchemy or chemistry, which had its cradle in Egypt, and derived its name from Khami, an old title for this country, passed to the hands of the Greeks, and later of the Arabs, this sign passed with it. It was also adopted to some extent by the Gnostics of the early Christian church in Egypt. In a cursive form it is found in mediaeval translations of the works of Ptolemy the astrologer, as the sign of the planet Jupiter. As such it was placed upon horoscopes and upon formula containing drugs made for administration to the body, so that the harmful properties of these drugs might be removed under the influence of the lucky planet. At present, in a slightly modified form, it still figures at the top of prescriptions written daily in Great Britain (Rx)."(11) (11) John D. Comrie: Medicine among the Assyrians and Egyptians in 1500 B.C., Edinburgh Medical Journal, 1909, n. s., II, 119. For centuries Egyptian physicians had a great reputation, and in the Odyssey (Bk. IV), Polydamna, the wife of Thonis, gives medicinal plants to Helen in Egypt--"a country producing an infinite number of drugs . . . where each physician possesses knowledge above all other men." Jeremiah (xlvi, 11) refers to the virgin daughter of Egypt, who should in vain use many medicines. Herodotus tells that Darius had at his court certain Egyptians, whom he reckoned the best skilled physicians in all the world, and he makes the interesting statement that: "Medicine is practiced among them on a plan of separation; each physician treats a single disorder, and no more: thus the country swarms with medical practitioners, some under taking to cure diseases of the eye, others of the head, others again of the teeth, others of the intestines, and some those which are not local."(12) (12) The History of Herodotus, Blakesley's ed., Bk. II, 84. A remarkable statement is made by Pliny, in the discussion upon the use of radishes, which are said to cure a "Phthisicke," or ulcer of the lungs--"proofe whereof was found and seen in AEgypt by occasion that the KK. there, caused dead bodies to be cut up, and anatomies to be made, for to search out the maladies whereof men died."(13) (13) Pliny, Holland's translation, Bk. XIX, Chap. V, Sect. 26. The study of the anatomy of mummies has thrown a very interesting light upon the diseases of the ancient Egyptians, one of the most prevalent of which appears to have been osteo-arthritis. This has been studied by Elliot Smith, Wood Jones, Ruffer and Rietti. The majority of the lesions appear to have been the common osteo-arthritis, which involved not only the men, but many of the pet animals kept in the temples. In a much higher proportion apparently than in modern days, the spinal column was involved. It is interesting to note that the "determinative" of old age in hieroglyphic writing is the picture of a man afflicted with arthritis deformans. Evidences of tuberculosis, rickets and syphilis, according to these authors, have not been found. A study of the internal organs has been made by Ruffer, who has shown that arterio-sclerosis with calcification was a common disease 8500 years ago; and he holds that it could not have been associated with hard work or alcohol, for the ancient Egyptians did not drink spirits, and they had practically the same hours of work as modern Egyptians, with every seventh day free. ASSYRIAN AND BABYLONIAN MEDICINE OF equally great importance in the evolution of medicine was the practically contemporary civilization in Mesopotamia. Science here reached a much higher stage then in the valley of the Nile. An elaborate scheme of the universe was devised, a system growing out of the Divine Will, and a recognition for the first time of a law guiding and controlling heaven and earth alike. Here, too, we find medicine ancillary to religion. Disease was due to evil spirits or demons. "These 'demons'--invisible to the naked eye were the precursors of the modern 'germs' and 'microbes,' while the incantations recited by the priests are the early equivalents of the physician's prescriptions. There were different incantations for different diseases; and they were as mysterious to the masses as are the mystic formulas of the modern physician to the bewildered, yet trusting, patient. Indeed, their mysterious character added to the power supposed to reside in the incantations for driving the demons away. Medicinal remedies accompanied the recital of the incantations, but despite the considerable progress made by such nations of hoary antiquity as the Egyptians and Babylonians in the diagnosis and treatment of common diseases, leading in time to the development of an extensive pharmacology, so long as the cure of disease rested with the priests, the recital of sacred formulas, together with rites that may be conveniently grouped under the head of sympathetic magic, was regarded as equally essential with the taking of the prescribed remedies."(14) (14) Morris Jastrow: The Liver in Antiquity and the Beginnings of Anatomy. Transactions College of Physicians, Philadelphia, 1907, 3. s., XXIX, 117-138. Three points of interest may be referred to in connection with Babylonian medicine. Our first recorded observations on anatomy are in connection with the art of divination--the study of the future by the interpretation of certain signs. The student recognized two divisions of divination--the involuntary, dealing with the interpretation of signs forced upon our attention, such as the phenomena of the heavens, dreams, etc., and voluntary divination, the seeking of signs, more particularly through the inspection of sacrificial animals. This method reached an extraordinary development among the Babylonians, and the cult spread to the Etruscans, Hebrews, and later to the Greeks and Romans. Of all the organs inspected in a sacrificial animal the liver, from its size, position and richness in blood, impressed the early observers as the most important of the body. Probably on account of the richness in blood it came to be regarded as the seat of life--indeed, the seat of the soul. From this important position the liver was not dislodged for many centuries, and in the Galenic physiology it shared with the heart and the brain in the triple control of the natural, animal and vital spirits. Many expressions in literature indicate how persistent was this belief. Among the Babylonians, the word "liver" was used in hymns and other compositions precisely as we use the word "heart," and Jastrow gives a number of illustrations from Hebrew, Greek and Latin sources illustrating this usage. The belief arose that through the inspection of this important organ in the sacrificial animal the course of future events could be predicted. "The life or soul, as the seat of life, in the sacrificial animal is, therefore, the divine element in the animal, and the god in accepting the animal, which is involved in the act of bringing it as an offering to a god, identifies himself with the animal--becomes, as it were, one with it. The life in the animal is a reflection of his own life, and since the fate of men rests with the gods, if one can succeed in entering into the mind of a god, and thus ascertain what he purposes to do, the key for the solution of the problem as to what the future has in store will have been found. The liver being the centre of vitality--the seat of the mind, therefore, as well as of the emotions--it becomes in the case of the sacrificial animal, either directly identical with the mind of the god who accepts the animal, or, at all events, a mirror in which the god's mind is reflected; or, to use another figure, a watch regulated to be in sympathetic and perfect accord with a second watch. If, therefore, one can read the liver of the sacrificial animal, one enters, as it were, into the workshop of the divine will."(15) (15) Morris Jastrow: loc. cit., p. 122. Hepatoscopy thus became, among the Babylonians, of extraordinary complexity, and the organ of the sheep was studied and figured as early as 3000 B.C. In the divination rites, the lobes, the gall-bladder, the appendages of the upper lobe and the markings were all inspected with unusual care. The earliest known anatomical model, which is here shown, is the clay model of a sheep's liver with the divination text dating from about 2000 B.C., from which Jastrow has worked out the modern anatomical equivalents of the Babylonian terms. To reach a decision on any point, the phenomena of the inspection of the liver were carefully recorded, and the interpretations rested on a more or less natural and original association of ideas. Thus, if the gall-bladder were swollen on the right side, it pointed to an increase in the strength of the King's army, and was favorable; if on the left side, it indicated rather success of the enemy, and was unfavorable. If the bile duct was long, it pointed to a long life. Gallstones are not infrequently mentioned in the divination texts and might be favorable, or unfavorable. Various interpretations were gathered by the scribes in the reference note-books which serve as guides for the interpretation of the omens and for text-books of instructions in the temple schools (Jastrow). The art of divination spread widely among the neighboring nations. There are many references in the Bible to the practice. The elders of Moab and Midian came to Balaam "with the rewards of divination in their hand" (Numbers xxii, 7). Joseph's cup of divination was found in Benjamin's sack (Genesis xliv, 5, 12); and in Ezekiel (xxi, 21) the King of Babylon stood at the parting of the way and looked in the liver. Hepatoscopy was also practiced by the Etruscans, and from them it passed to the Greeks and the Romans, among whom it degenerated into a more or less meaningless form. But Jastrow states that in Babylonia and Assyria, where for several thousand years the liver was consistently employed as the sole organ of divination, there are no traces of the rite having fallen into decay, or having been abused by the priests. In Roman times, Philostratus gives an account of the trial of Apollonius of Tyana,(16) accused of human hepatoscopy by sacrificing a boy in the practice of magic arts against the Emperor. "The liver, which the experts say is the very tripod of their art, does not consist of pure blood; for the heart retains all the uncontaminated blood, and irrigates the whole body with it by the conduits of the arteries; whereas the gall, which is situated next the liver, is stimulated by anger and depressed by fear into the hollows of the liver." We have seen how early and how widespread was the belief in amulets and charms against the occult powers of darkness. One that has persisted with extraordinary tenacity is the belief in the Evil Eye the power of certain individuals to injure with a look. Of general belief in the older civilizations, and referred to in several places in the Bible, it passed to Greece and Rome, and today is still held fervently in many parts of Europe. The sign of "le corna,"--the first and fourth fingers extended, the others turned down and the thumb closed over them,--still used against the Evil Eye in Italy, was a mystic sign used by the Romans in the festival of Lemuralia. And we meet with the belief also in this country. A child with hemiplegia, at the Infirmary for Diseases of the Nervous System, Philadelphia, from the central part of Pennsylvania, was believed by its parents to have had the Evil Eye cast upon it. The second contribution of Babylonia and Assyria to medicine--one that affected mankind profoundly--relates to the supposed influence of the heavenly bodies upon man's welfare. A belief that the stars in their courses fought for or against him arose early in their civilizations, and directly out of their studies on astrology and mathematics. The Macrocosm, the heavens that "declare the glory of God," reflect, as in a mirror, the Microcosm, the daily life of man on earth. The first step was the identification of the sun, moon and stars with the gods of the pantheon. Assyrian astronomical observations show an extraordinary development of practical knowledge. The movements of the sun and moon and of the planets were studied; the Assyrians knew the precession of the equinoxes and many of the fundamental laws of astronomy, and the modern nomenclature dates from their findings. In their days the signs of the zodiac corresponded practically with the twelve constellations whose names they still bear, each division being represented by the symbol of some god, as the Scorpion, the Ram, the Twins, etc. "Changes in the heavens . . . portended changes on earth. The Biblical expression 'hosts of heaven' for the starry universe admirably reflects the conception held by the Babylonian astrologers. Moon, planets and stars constituted an army in constant activity, executing military manoeuvres which were the result of deliberation and which had in view a fixed purpose. It was the function of the priest--the barqu, or 'inspector,' as the astrologer as well as the 'inspector' of the liver was called--to discover this purpose. In order to do so, a system of interpretation was evolved, less logical and less elaborate than the system of hepatoscopy, which was analyzed in the preceding chapter, but nevertheless meriting attention both as an example of the pathetic yearning of men to peer into the minds of the gods, and of the influence that Babylonian-Assyrian astrology exerted throughout the ancient world" (Jastrow).(17) (16) Philostratus: Apollonius of Tyana, Bk. VIII, Chap. VII, Phillimore's transl., Oxford, 1912, II, 233. See, also, Justin: Apologies, edited by Louis Pautigny, Paris, 1904, p. 39. (17) M. Jastrow: Aspects of Religious Belief and Practice in Babylonia and Assyria, New York, 1911, p. 210. With the rationalizing influence of the Persians the hold of astrology weakened, and according to Jastrow it was this, in combination with Hebrew and Greek modes of thought, that led the priests in the three centuries following the Persian occupation, to exchange their profession of diviners for that of astronomers; and this, he says, marks the beginning of the conflict between religion and science. At first an expression of primitive "science," astrology became a superstition, from which the human mind has not yet escaped. In contrast to divination, astrology does not seem to have made much impression on the Hebrews and definite references in the Bible are scanty. From Babylonia it passed to Greece (without, however, exerting any particular influence upon Greek medicine). Our own language is rich in words of astral significance derived from the Greek, e.g., disaster. The introduction of astrology into Europe has a passing interest. Apparently the Greeks had made important advances in astronomy before coming in contact with the Babylonians,--who, in all probability, received from the former a scientific conception of the universe. "In Babylonia and Assyria we have astrology first and astronomy afterwards, in Greece we have the sequence reversed--astronomy first and astrology afterwards" (Jastrow).(18) (18) M. Jastrow: Aspects of Religious Belief and Practice in Babylonia and Assyria, New York, 1911, p. 256. It is surprising to learn that, previous to their contact with the Greeks, astrology as relating to the individual--that is to say, the reading of the stars to determine the conditions under which the individual was born--had no place in the cult of the Babylonians and Assyrians. The individualistic spirit led the Greek to make his gods take note of every action in his life, and his preordained fate might be read in the stars.--"A connecting link between the individual and the movements in the heavens was found in an element which they shared in common. Both man and stars moved in obedience to forces from which there was no escape. An inexorable law controlling the planets corresponded to an equally inexorable fate ordained for every individual from his birth. Man was a part of nature and subject to its laws. The thought could therefore arise that, if the conditions in the heavens were studied under which a man was born, that man's future could be determined in accord with the beliefs associated with the position of the planets rising or visible at the time of birth or, according to other views, at the time of conception. These views take us back directly to the system of astrology developed by Babylonian baru priests. The basis on which the modified Greek system rests is likewise the same that we have observed in Babylonia--a correspondence between heaven and earth, but with this important difference, that instead of the caprice of the gods we have the unalterable fate controlling the entire universe--the movements of the heavens and the life of the individual alike" (Jastrow).(19) (19) Ibid., pp. 257-258. From this time on until the Renaissance, like a shadow, astrology follows astronomy. Regarded as two aspects of the same subject, the one, natural astrology, the equivalent of astronomy, was concerned with the study of the heavens, the other, judicial astrology, was concerned with the casting of horoscopes, and reading in the stars the fate of the individual. As I mentioned, Greek science in its palmy days seems to have been very free from the bad features of astrology. Gilbert Murray remarks that "astrology fell upon the Hellenistic mind as a new disease falls upon some remote island people." But in the Greek conquest of the Roman mind, astrology took a prominent role. It came to Rome as part of the great Hellenizing movement, and the strength of its growth may be gauged from the edicts issued against astrologers as early as the middle of the second century B.C. In his introduction to his recent edition of Book II of the Astronomicon of Manilius, Garrod traces the growth of the cult, which under the Empire had an extraordinary vogue. "Though these (heavenly) signs be far removed from us, yet does he (the god) so make their influences felt, that they give to nations their life and their fate and to each man his own character."(20) Oracles were sought on all occasions, from the planting of a tree to the mating of a horse, and the doctrine of the stars influenced deeply all phases of popular thought and religion. The professional astrologers, as Pliny(21) says, were Chaldeans, Egyptians and Greeks. The Etruscans, too, the professional diviners of Rome, cultivated the science. Many of these "Isiaci conjectores" and "astrologi de circo" were worthless charlatans, but on the whole the science seems to have attracted the attention of thoughtful men of the period. Garrod quotes the following remarkable passage from Tacitus: "My judgment wavers," he says, "I dare not say whether it be fate and necessity immutable which governs the changing course of human affairs--or just chance. Among the wisest of the ancients, as well as among their apes, you will find a conflict of opinion. Many hold fixedly the idea that our beginning and our end--that man himself--is nothing to the Gods at all. The wicked are in prosperity and the good meet tribulation. Others believe that Fate and the facts of this world work together. But this connection they trace not to planetary influences but to a concatenation of natural causes. We choose our life that is free: but the choice once made, what awaits us is fixed and ordered. Good and evil are different from the vulgar opinion of them. Often those who seem to battle with adversity are to be accounted blessed; but the many, even in their prosperity, are miserable. It needs only to bear misfortune bravely, while the fool perishes in his wealth. Outside these rival schools stands the man in the street. No one will take from him his conviction that at our birth are fixed for us the things that shall be. If some things fall out differently from what was foretold, that is due to the deceit of men that speak what they know not: calling into contempt a science to which past and present alike bear a glorious testimony" (Ann. vi, 22). (20) Manili Astronomicon Liber II, ed. H. W. Garrod, Oxford, 1911, p. lxix, and II, ll. 84-86. (21) Pliny: Natural History, Bk. XVIII, Chap. XXV, Sect. 57. Cato waged war on the Greek physicians and forbade "his uilicus all resort to haruspicem, augurem, hariolum Chaldaeum," but in vain; so widespread became the belief that the great philosopher, Panaetius (who died about 111 B.C.), and two of his friends alone among the stoics, rejected the claims of astrology as a science (Garrod). So closely related was the subject of mathematics that it, too, fell into disfavor, and in the Theodosian code sentence of death was passed upon mathematicians. Long into the Middle Ages, the same unholy alliance with astrology and divination caused mathematics to be regarded with suspicion, and even Abelard calls it a nefarious study. The third important feature in Babylonian medicine is the evidence afforded by the famous Hammurabi Code (circa 2000 B.C.)--a body of laws, civil and religious, many of which relate to the medical profession. This extraordinary document is a black diorite block 8 feet high, once containing 21 columns on the obverse, 16 and 28 columns on the reverse, with 2540 lines of writing of which now 1114 remain, and surmounted by the figure of the king receiving the law from the Sun-god. Copies of this were set up in Babylon "that anyone oppressed or injured, who had a tale of woe to tell, might come and stand before his image, that of a king of righteousness, and there read the priceless orders of the King, and from the written monument solve his problem" (Jastrow). From the enactments of the code we gather that the medical profession must have been in a highly organized state, for not only was practice regulated in detail, but a scale of fees was laid down, and penalties exacted for malpraxis. Operations were performed, and the veterinary art was recognized. An interesting feature, from which it is lucky that we have in these days escaped, is the application of the "lex talionis"--an eye for an eye, bone for a bone, and tooth for a tooth, which is a striking feature of the code. Some of the laws of the code may be quoted: Paragraph 215. If a doctor has treated a gentleman for a severe wound with a bronze lances and has cured the man, or has opened an abscess of the eye for a gentleman with the bronze lances and has cured the eye of the gentleman, he shall take ten shekels of silver. 218. If the doctor has treated a gentleman for a severe wound with a lances of bronze and has caused the gentleman to die, or has opened an abscess of the eye for a gentleman and has caused the loss of the gentleman's eye, one shall cut off his hands. 219. If a doctor has treated the severe wound of a slave of a poor man with a bronze lances and has caused his death, he shall render slave for slave. 220. If he has opened his abscess with a bronze lances and has made him lose his eye, he shall pay money, half his price. 221. If a doctor has cured the shattered limb of a gentleman, or has cured the diseased bowel, the patient shall give five shekels of silver to the doctor. 224. If a cow doctor or a sheep doctor has treated a cow or a sheep for a severe wound and cured it, the owner of the cow or sheep shall give one-sixth of a shekel of silver to the doctor as his fee.(22) (22) The Oldest Code of Laws in the World; translated by C. H. W. Johns, Edinburgh, 1903. HEBREW MEDICINE THE medicine of the Old Testament betrays both Egyptian and Babylonian influences; the social hygiene is a reflex of regulations the origin of which may be traced in the Pyramid Texts and in the papyri. The regulations in the Pentateuch codes revert in part to primitive times, in part represent advanced views of hygiene. There are doubts if the Pentateuch code really goes back to the days of Moses, but certainly someone "learned in the wisdom of the Egyptians" drew it up. As Neuburger briefly summarizes: "The commands concern prophylaxis and suppression of epidemics, suppression of venereal disease and prostitution, care of the skin, baths, food, housing and clothing, regulation of labour, sexual life, discipline of the people, etc. Many of these commands, such as Sabbath rest, circumcision, laws concerning food (interdiction of blood and pork), measures concerning menstruating and lying-in women and those suffering from gonorrhoea, isolation of lepers, and hygiene of the camp, are, in view of the conditions of the climate, surprisingly rational."(23) (23) Neuburger: History of Medicine, Oxford University Press, 1910, Vol. I, p. 38. Divination, not very widely practiced, was borrowed, no doubt, from Babylonia. Joseph's cup was used for the purpose, and in Numbers, the elders of Balak went to Balaam with the rewards of divination in their hands. The belief in enchantments and witchcraft was universal, and the strong enactments against witches in the Old Testament made a belief in them almost imperative until more rational beliefs came into vogue in the eighteenth and nineteenth centuries. Whatever view we may take of it, the medicine of the New Testament is full of interest. Divination is only referred to once in the Acts (xvi, 16), where a damsel is said to be possessed of a spirit of divination "which brought her masters much gain by soothsaying." There is only one mention of astrology (Acts vii, 43); there are no witches, neither are there charms or incantations. The diseases mentioned are numerous: demoniac possession, convulsions, paralysis, skin diseases,--as leprosy,--dropsy, haemorrhages, fever, fluxes, blindness and deafness. And the cure is simple usually a fiat of the Lord, rarely with a prayer, or with the use of means such as spittle. They are all miraculous, and the same power was granted to the apostles--"power against unclean spirits, to cast them out, to heal all manner of sickness and all manner of disease." And more than this, not only the blind received their sight, the lame walked, the lepers were cleansed, the deaf heard, but even the dead were raised up. No question of the mandate. He who went about doing good was a physician of the body as well as of the soul, and could the rich promises of the Gospel have been fulfilled, there would have been no need of a new dispensation of science. It may be because the children of this world have never been able to accept its hard sayings--the insistence upon poverty, upon humility, upon peace that Christianity has lost touch no less with the practice than with the principles of its Founder. Yet, all through the centuries, the Church has never wholly abandoned the claim to apostolic healing; nor is there any reason why she should. To the miraculous there should be no time limit--only conditions have changed and nowadays to have a mountain-moving faith is not easy. Still, the possession is cherished, and it adds enormously to the spice and variety of life to know that men of great intelligence, for example, my good friend, Dr. James J. Walsh of New York, believe in the miracles of Lourdes.(24) Only a few weeks ago, the Bishop of London followed with great success, it is said, the practice of St. James. It does not really concern us much--as Oriental views of disease and its cure have had very little influence on the evolution of scientific medicine--except in illustration of the persistence of an attitude towards disease always widely prevalent, and, indeed, increasing. Nor can we say that the medicine of our great colleague, St. Luke, the Beloved Physician, whose praise is in the Gospels, differs so fundamentally from that of the other writings of the New Testament that we can claim for it a scientific quality. The stories of the miracles have technical terms and are in a language adorned by medical phraseology, but the mental attitude towards disease is certainly not that of a follower of Hippocrates, nor even of a scientifically trained contemporary of Dioscorides.(25) (24) Psychotherapy, New York, 1919, p. 79, "I am convinced that miracles happen there. There is more than natural power manifest." (25) See Luke the Physician, by Harnack, English ed., 1907, and W. K. Hobart, The Medical Language of St. Luke, 1882. CHINESE AND JAPANESE MEDICINE CHINESE medicine illustrates the condition at which a highly intellectual people may arrive, among whom thought and speculation were restricted by religious prohibitions. Perhaps the chief interest in its study lies in the fact that we may see today the persistence of views about disease similar to those which prevailed in ancient Egypt and Babylonia. The Chinese believe in a universal animism, all parts being animated by gods and spectres, and devils swarm everywhere in numbers incalculable. The universe was spontaneously created by the operation of its Tao, "composed of two souls, the Yang and the Yin; the Yang represents light, warmth, production, and life, as also the celestial sphere from which all those blessings emanate; the Yin is darkness, cold, death, and the earth, which, unless animated by the Yang or heaven, is dark, cold, dead. The Yang and the Yin are divided into an infinite number of spirits respectively good and bad, called shen and kwei; every man and every living being contains a shen and a kwei, infused at birth, and departing at death, to return to the Yang and the Yin. Thus man with his dualistic soul is a microcosmos, born from the Macrocosmos spontaneously. Even every object is animated, as well as the Universe of which it is a part."(26) (26) J. J. M. de Groot: Religious System of China, Vol. VI, Leyden, 1910, p. 929. In the animistic religion of China, the Wu represented a group of persons of both sexes, who wielded, with respect to the world of spirits, capacities and powers not possessed by the rest of men. Many practitioners of Wu were physicians who, in addition to charms and enchantments, used death-banishing medicinal herbs. Of great antiquity, Wu-ism has changed in some ways its outward aspect, but has not altered its fundamental characters. The Wu, as exorcising physicians and practitioners of the medical art, may be traced in classical literature to the time of Confucius. In addition to charms and spells, there were certain famous poems which were repeated, one of which, by Han Yu, of the T'ang epoch, had an extraordinary vogue. De Groot says that the "Ling," or magical power of this poem must have been enormous, seeing that its author was a powerful mandarin, and also one of the loftiest intellects China has produced. This poetic febrifuge is translated in full by de Groot (VI, 1054-1055), and the demon of fever, potent chiefly in the autumn, is admonished to begone to the clear and limpid waters of the deep river. In the High Medical College at Court, in the T'ang Dynasty, there were four classes of Masters, attached to its two High Medical Chiefs: Masters of Medicine, of Acupuncture, of Manipulation, and two Masters for Frustration by means of Spells. Soothsaying and exorcism may be traced far back to the fifth and sixth centuries B.C. In times of epidemic the specialists of Wu-ism, who act as seers, soothsayers and exorcists, engage in processions, stripped to the waist, dancing in a frantic, delirious state, covering themselves with blood by means of prick-balls, or with needles thrust through their tongues, or sitting or stretching themselves on nail points or rows of sword edges. In this way they frighten the spectres of disease. They are nearly all young, and are spoken of as "divining youths," and they use an exorcising magic based on the principle that legions of spectres prone to evil live in the machine of the world. (De Groot, VI, 983-985.) The Chinese believe that it is the Tao, or "Order of the Universe," which affords immunity from evil, and according to whether or no the birth occurred in a beneficent year, dominated by four double cyclical characters, the horoscope is "heavy" or "light." Those with light horoscopes are specially prone to incurable complaints, but much harm can be averted if such an individual be surrounded with exorcising objects, if he be given proper amulets to wear and proper medicines to swallow, and by selecting for him auspicious days and hours. Two or three special points may be referred to. The doctrine of the pulse reached such extraordinary development that the whole practice of the art centred round its different characters. There were scores of varieties, which in complication and detail put to confusion the complicated system of some of the old Graeco-Roman writers. The basic idea seems to have been that each part and organ had its own proper pulse, and just as in a stringed instrument each chord has its own tone, so in the human body, if the pulses were in harmony, it meant health; if there was discord, it meant disease. These Chinese views reached Europe in the seventeenth and eighteenth centuries, and there is a very elaborate description of them in Floyer's well-known book.(27) And the idea of harmony in the pulse is met with into the eighteenth century. (27) Sir John Floyer: The Physician's Pulse Watch, etc., London, 1707. Organotherapy was as extensively practiced in China as in Egypt. Parts of organs, various secretions and excretions are very commonly used. One useful method of practice reached a remarkable development, viz., the art of acupuncture--the thrusting of fine needles more or less deeply into the affected part. There are some 388 spots on the body in which acupuncture could be performed, and so well had long experience taught them as to the points of danger, that the course of the arteries may be traced by the tracts that are avoided. The Chinese practiced inoculation for smallpox as early as the eleventh century. Even the briefest sketch of the condition of Chinese medicine leaves the impression of the appalling stagnation and sterility that may afflict a really intelligent people for thousands of years. It is doubtful if they are today in a very much more advanced condition than were the Egyptians at the time when the Ebers Papyrus was written. From one point of view it is an interesting experiment, as illustrating the state in which a people may remain who have no knowledge of anatomy, physiology or pathology. Early Japanese medicine has not much to distinguish it from the Chinese. At first purely theurgic, the practice was later characterized by acupuncture and a refined study of the pulse. It has an extensive literature, largely based upon the Chinese, and extending as far back as the beginning of the Christian era. European medicine was introduced by the Portuguese and the Dutch, whose "factory" or "company" physicians were not without influence upon practice. An extraordinary stimulus was given to the belief in European medicine by a dissection made by Mayeno in 1771 demonstrating the position of the organs as shown in the European anatomical tables, and proving the Chinese figures to be incorrect. The next day a translation into Japanese of the anatomical work of Kulmus was begun, and from its appearance in 1773 may be dated the commencement of reforms in medicine. In 1793, the work of de Gorter on internal medicine was translated, and it is interesting to know that before the so-called "opening of Japan" many European works on medicine had been published. In 1857, a Dutch medical school was started in Yedo. Since the political upheaval in 1868, Japan has made rapid progress in scientific medicine, and its institutions and teachers are now among the best known in the world.(28) (28) See Y. Fujikawa, Geschichte der Medizin in Japan, Tokyo, 1911. CHAPTER II -- GREEK MEDICINE OGRAIAE gentis decus! let us sing with Lucretius, one of the great interpreters of Greek thought. How grand and how true is his paean! Out of the night, out of the blinding night Thy beacon flashes;--hail, beloved light Of Greece and Grecian; hail, for in the mirk Thou cost reveal each valley and each height. Thou art my leader, and the footprints shine, Wherein I plant my own.... * * * * * The world was shine to read, and having read, Before thy children's eyes thou didst outspread The fruitful page of knowledge, all the wealth Of wisdom, all her plenty for their bread. (Bk. III.--Translated by D. A. Slater.) Let us come out of the murky night of the East, heavy with phantoms, into the bright daylight of the West, into the company of men whose thoughts made our thoughts, and whose ways made our ways--the men who first dared to look on nature with the clear eyes of the mind. Browning's famous poem, "Childe Roland to the Dark Tower Came," is an allegory of the pilgrimage of man through the dark places of the earth, on a dismal path beset with demons, and strewn with the wreckage of generations of failures. In his ear tolled the knell of all the lost adventurers, his peers, all lost, lost within sight of the dark Tower itself-- The round squat turret, blind as the fool's heart, Built of brown stone, without a counterpart In the whole world. lost in despair at an all-encircling mystery. Not so the Greek Childe Roland who set the slug-horn to his lips and blew a challenge. Neither Shakespeare nor Browning tells us what happened, and the old legend, Childe Roland, is the incarnation of the Greek spirit, the young, light-hearted master of the modern world, at whose trumpet blast the dark towers of ignorance, superstition and deceit have vanished into thin air, as the baseless fabric of a dream. Not that the jeering phantoms have flown! They still beset, in varied form, the path of each generation; but the Achaian Childe Roland gave to man self-confidence, and taught him the lesson that nature's mysteries, to be solved, must be challenged. On a portal of one of the temples of Isis in Egypt was carved: "I am whatever hath been, is, or ever will be, and my veil no man has yet lifted." The veil of nature the Greek lifted and herein lies his value to us. What of this Genius? How did it arise among the peoples of the AEgean Sea? Those who wish to know the rock whence science was hewn may read the story told in vivid language by Professor Gomperz in his "Greek Thinkers," the fourth volume of which has recently been published (Murray, 1912; Scribner, 1912). In 1912, there was published a book by one of the younger Oxford teachers, "The Greek Genius and Its Meaning to Us,"(1) from which those who shrink from the serious study of Gomperz' four volumes may learn something of the spirit of Greece. Let me quote a few lines from his introduction: (1) By R. W. Livingstone, Clarendon Press, Oxford, 1912 (2d ed., revised, 1915). "Europe has nearly four million square miles; Lancashire has 1,700; Attica has 700. Yet this tiny country has given us an art which we, with it and all that the world has done since it for our models, have equalled perhaps, but not surpassed. It has given us the staple of our vocabulary in every domain of thought and knowledge. Politics, tyranny, democracy, anarchism, philosophy, physiology, geology, history--these are all Greek words. It has seized and up to the present day kept hold of our higher education. It has exercised an unfailing fascination, even on minds alien or hostile. Rome took her culture thence. Young Romans completed their education in the Greek schools.... And so it was with natures less akin to Greece than the Roman. St. Paul, a Hebrew of the Hebrews, who called the wisdom of the Greeks foolishness, was drawn to their Areopagus, and found himself accommodating his gospel to the style, and quoting verses from the poets of this alien race. After him, the Church, which was born to protest against Hellenism, translated its dogmas into the language of Greek thought and finally crystallized them in the philosophy of Aristotle." Whether a plaything of the gods or a cog in the wheels of the universe this was the problem which life offered to the thinking Greek; and in undertaking its solution, he set in motion the forces that have made our modern civilization. That the problem remains unsolved is nothing in comparison with the supreme fact that in wrestling with it, and in studying the laws of the machine, man is learning to control the small section of it with which he is specially concerned. The veil of thaumaturgy which shrouded the Orient, while not removed, was rent in twain, and for the first time in history, man had a clear vision of the world about him--"had gazed on Nature's naked loveliness" ("Adonais") unabashed and unaffrighted by the supernatural powers about him. Not that the Greek got rid of his gods--far from it!--but he made them so like himself, and lived on terms of such familiarity with them that they inspired no terror.(2) (2) "They made deities in their own image, in the likeness of an image of corruptible man. Sua cuique deu fit dira cupido. 'Each man's fearful passion becomes his god.' Yes, and not passions only, but every impulse, every aspiration, every humour, every virtue, every whim. In each of his activities the Greek found something wonderful, and called it God: the hearth at which he warmed himself and cooked his food, the street in which his house stood, the horse he rode, the cattle he pastured, the wife he married, the child that was born to him, the plague of which he died or from which he recovered, each suggested a deity, and he made one to preside over each. So too with qualities and powers more abstract." R.W. Livingstone: The Greek Genius and Its Meaning to Us, pp. 51-52. Livingstone discusses the Greek Genius as displayed to us in certain "notes"--the Note of Beauty--the Desire for Freedom--the Note of Directness--the Note of Humanism--the Note of Sanity and of Many-sidedness. Upon some of these characteristics we shall have occasion to dwell in the brief sketch of the rise of scientific medicine among this wonderful people. We have seen that the primitive man and in the great civilizations of Egypt and Babylonia, the physician evolved from the priest--in Greece he had a dual origin, philosophy and religion. Let us first trace the origins in the philosophers, particularly in the group known as the Ionian Physiologists, whether at home or as colonists in the south of Italy, in whose work the beginnings of scientific medicine may be found. Let me quote a statement from Gomperz: "We can trace the springs of Greek success achieved and maintained by the great men of Hellas on the field of scientific inquiry to a remarkable conjunction of natural gifts and conditions. There was the teeming wealth of constructive imagination united with the sleepless critical spirit which shrank from no test of audacity; there was the most powerful impulse to generalization coupled with the sharpest faculty for descrying and distinguishing the finest shades of phenomenal peculiarity; there was the religion of Hellas, which afforded complete satisfaction to the requirements of sentiment, and yet left the intelligence free to perform its destructive work; there were the political conditions of a number of rival centres of intellect, of a friction of forces, excluding the possibility of stagnation, and, finally, of an order of state and society strict enough to curb the excesses of 'children crying for the moon,' and elastic enough not to hamper the soaring flight of superior minds.... We have already made acquaintance with two of the sources from which the spirit of criticism derived its nourishment--the metaphysical and dialectical discussions practiced by the Eleatic philosophers, and the semi-historical method which was applied to the myths by Hecataeus and Herodotus. A third source is to be traced to the schools of the physicians. These aimed at eliminating the arbitrary element from the view and knowledge of nature, the beginnings of which were bound up with it in a greater or less degree, though practically without exception and by the force of an inner necessity. A knowledge of medicine was destined to correct that defect, and we shall mark the growth of its most precious fruits in the increased power of observation and the counterpoise it offered to hasty generalizations, as well as in the confidence which learnt to reject untenable fictions, whether produced by luxuriant imagination or by a priori speculations, on the similar ground of self-reliant sense-perception."(3) (3) Gomperz: Greek Thinkers, Vol. I, p. 276. The nature philosophers of the Ionian days did not contribute much to medicine proper, but their spirit and their outlook upon nature influenced its students profoundly. Their bold generalizations on the nature of matter and of the elements are still the wonder of chemists. We may trace to one of them, Anaximenes, who regarded air as the primary principle, the doctrine of the "pneuma," or the breath of life--the psychic force which animates the body and leaves it at death--"Our soul being air, holds us together." Of another, the famous Heraclitus, possibly a physician, the existing fragments do not relate specially to medicine; but to the philosopher of fire may be traced the doctrine of heat and moisture, and their antitheses, which influenced practice for many centuries. There is evidence in the Hippocratic treatise peri sarkwn of an attempt to apply this doctrine to the human body. The famous expression, panta rhei,--"all things are flowing,"--expresses the incessant flux in which he believed and in which we know all matter exists. No one has said a ruder thing of the profession, for an extant fragment reads: ". . . physicians, who cut, burn, stab, and rack the sick, then complain that they do not get any adequate recompense for it."(4) (4) J. Burnet: Early Greek Philosophy, 1892, p. 137, Bywater's no. LVIII. The South Italian nature philosophers contributed much more to the science of medicine, and in certain of the colonial towns there were medical schools as early as the fifth century B.C. The most famous of these physician philosophers was Pythagoras, whose life and work had an extraordinary influence upon medicine, particularly in connection with his theory of numbers, and the importance of critical days. His discovery of the dependence of the pitch of sound on the length of the vibrating chord is one of the most fundamental in acoustics. Among the members of the school which he founded at Crotona were many physicians. who carried his views far and wide throughout Magna Graecia. Nothing in his teaching dominated medicine so much as the doctrine of numbers, the sacredness of which seems to have had an enduring fascination for the medical mind. Many of the common diseases, such as malaria, or typhus, terminating abruptly on special days, favored this belief. How dominant it became and how persistent you may judge from the literature upon critical days, which is rich to the middle of the eighteenth century. One member of the Crotonian school, Alcmaeon, achieved great distinction in both anatomy and physiology. He first recognized the brain as the organ of the mind, and made careful dissections of the nerves, which he traced to the brain. He described the optic nerves and the Eustachian tubes, made correct observations upon vision, and refuted the common view that the sperma came from the spinal cord. He suggested the definition of health as the maintenance of equilibrium, or an "isonomy" in the material qualities of the body. Of all the South Italian physicians of this period, the personality of none stands out in stronger outlines than that of Empedocles of Agrigentum--physician, physiologist, religious teacher, politician and poet. A wonder-worker, also, and magician, he was acclaimed in the cities as an immortal god by countless thousands desiring oracles or begging the word of healing. That he was a keen student of nature is witnessed by many recorded observations in anatomy and physiology; he reasoned that sensations travel by definite paths to the brain. But our attention must be confined to his introduction of the theory of the four elements--fire, air, earth and water--of which, in varying quantities, all bodies were made up. Health depended upon the due equilibrium of these primitive substances; disease was their disturbance. Corresponding to those were the four essential qualities of heat and cold, moisture and dryness, and upon this four-fold division was engrafted by the later physicians the doctrine of the humors which, from the days of Hippocrates almost to our own, dominated medicine. All sorts of magical powers were attributed to Empedocles. The story of Pantheia whom he called back to life after a thirty days' trance has long clung in the imagination. You remember how Matthew Arnold describes him in the well-known poem, "Empedocles on Etna"-- But his power Swells with the swelling evil of this time, And holds men mute to see where it will rise. He could stay swift diseases in old days, Chain madmen by the music of his lyre, Cleanse to sweet airs the breath of poisonous streams, And in the mountain-chinks inter the winds. This he could do of old--(5) a quotation which will give you an idea of some of the powers attributed to this wonder-working physician. (5) Poetical Works of Matthew Arnold, Macmillan & Co., 1898, p. 440. But of no one of the men of this remarkable circle have we such definite information as of the Crotonian physician Democedes, whose story is given at length by Herodotus; and his story has also the great importance of showing that, even at this early period, a well-devised scheme of public medical service existed in the Greek cities. It dates from the second half of the sixth century B.C.--fully two generations before Hippocrates. A Crotonian, Democedes by name, was found among the slaves of Oroetes. Of his fame as a physician someone had heard and he was called in to treat the dislocated ankle of King Darius. The wily Greek, longing for his home, feared that if he confessed to a knowledge of medicine there would be no chance of escape, but under threat of torture he undertook a treatment which proved successful. Then Herodotus tells his story--how, ill treated at home in Crotona, Democedes went to AEgina, where he set up as a physician and in the second year the State of AEgina hired his services at the price of a talent. In the third year, the Athenians engaged him at 100 minae; and in the fourth, Polycrates of Samos at two talents. Democedes shared the misfortunes of Polycrates and was taken prisoner by Oroetes. Then Herodotus tells how he cured Atossa, the daughter of Cyrus and wife of Darius, of a severe abscess of the breast, but on condition that she help him to escape, and she induced her husband to send an expedition of exploration to Greece under the guidance of Democedes, but with the instructions at all costs to bring back the much prized physician. From Tarentum, Democedes escaped to his native city, but the Persians followed him, and it was with the greatest difficulty that he escaped from their hands. Deprived of their guide, the Persians gave up the expedition and sailed for Asia. In palliation of his flight, Democedes sent a message to Darius that he was engaged to the daughter of Milo, the wrestler, who was in high repute with the King.(6) (6) The well-known editor of Herodotus, R. W. Macan, Master of University College, Oxford, in his Hellenikon. A Sheaf of Sonnets after Herodotus (Oxford, 1898) has included a poem which may be quoted in connection with this incident: NOSTALGY Atossa, child of Cyrus king of kings, healed by Greek science of a morbid breast, gave lord Dareios neither love nor rest till he fulfilled her vain imaginings. "Sir, show our Persian folk your sceptre's wings! Enlarge my sire's and brother's large bequest. This learned Greek shall guide your galleys west, and Dorian slave-girls grace our banquetings." So said she, taught of that o'er-artful man, the Italiote captive, Kroton's Demokede, who recked not what of maladies began, nor who in Asia and in Greece might bleed, if he--so writes the guileless Thurian-- regained his home, and freedom of the Mede. Plato has several references to these state physicians, who were evidently elected by a public assembly: "When the assembly meets to elect a physician," and the office was yearly, for in "The Statesman" we find the following:(7) "When the year of office has expired, the pilot, or physician has to come before a court of review" to answer any charges. The physician must have been in practice for some time and attained eminence, before he was deemed worthy of the post of state physician. (7) Jowett: Dialogues of Plato, 3d ed., Statesman, Vol. IV, p. 502 (Stephanus, II, 298 E) "If you and I were physicians, and were advising one another that we were competent to practice as state-physicians, should I not ask about you, and would you not ask about me, Well, but how about Socrates himself, has he good health? and was anyone else ever known to be cured by him whether slave or freeman?"(7a) (7a) Jowett: Dialogues of Plato, 3d ed., Gorgias, Vol. II, p. 407 (Stephanus, I, 514 D). All that is known of these state physicians has been collected by Pohl,(8) who has traced their evolution into Roman times. That they were secular, independent of the AEsculapian temples, that they were well paid, that there was keen competition to get the most distinguished men, that they were paid by a special tax and that they were much esteemed--are facts to be gleaned from Herodotus and from the inscriptions. The lapidary records, extending over 1000 years, collected by Professor Oehler(8a) of Reina, throw an important light on the state of medicine in Greece and Rome. Greek vases give representations of these state doctors at work. Dr. E. Pottier has published one showing the treatment of a patient in the clinic.(8b) (8) R. Pohl: De Graecorum medicis publicis, Berolini, Reimer, 1905; also Janus, Harlem, 1905, X, 491-494. (8a) J Oehler: Janus, Harlem, 1909, XIV, 4; 111. (8b) E. Pottier: Une clinique grecque au Ve siecle, Monuments et Memoires, XIII, p. 149. Paris, 1906 (Fondation Eugene Piot). That dissections were practiced by this group of nature philosophers is shown not only by the studies of Alcmaeon, but we have evidence that one of the latest of them, Diogenes of Apollonia, must have made elaborate dissections. In the "Historia Animalium"(9) of Aristotle occurs his account of the blood vessels, which is by far the most elaborate met with in the literature until the writings of Galen. It has, too, the great merit of accuracy (if we bear in mind the fact that it was not until after Aristotle that arteries and veins were differentiated), and indications are given as to the vessels from which blood may be drawn. (9) The Works of Aristotle, Oxford, Clarendon Press, Vol. IV, 1910, Bk. III, Chaps. II-IV, pp. 511b-515b. ASKLEPIOS No god made with hands, to use the scriptural phrase, had a more successful "run" than Asklepios--for more than a thousand years the consoler and healer of the sons of men. Shorn of his divine attributes he remains our patron saint, our emblematic God of Healing, whose figure with the serpents appears in our seals and charters. He was originally a Thessalian chieftain, whose sons, Machaon and Podalirius, became famous physicians and fought in the Trojan War. Nestor, you may remember, carried off the former, declaring, in the oft-quoted phrase, that a doctor was better worth saving than many warriors unskilled in the treatment of wounds. Later genealogies trace his origin to Apollo,(10) as whose son he is usually regarded. "In the wake of northern tribes this god Aesculapius--a more majestic figure than the blameless leech of Homer's song--came by land to Epidaurus and was carried by sea to the east-ward island of Cos.... Aesculapius grew in importance with the growth of Greece, but may not have attained his greatest power until Greece and Rome were one."(11) (10) W. H. Roscher: Lexikon der griechischen und romischen Mythologie, Leipzig, 1886, I, p. 624. (11) Louis Dyer: Studies of the Gods in Greece, 1891, p. 221. A word on the idea of the serpent as an emblem of the healing art which goes far back into antiquity. The mystical character of the snake, and the natural dread and awe inspired by it, early made it a symbol of supernatural power. There is a libation vase of Gudea, c. 2350 B.C., found at Telloh, now in the Louvre (probably the earliest representation of the symbol), with two serpents entwined round a staff (Jastrow, Pl. 4). From the earliest times the snake has been associated with mystic and magic power, and even today, among native races, it plays a part in the initiation of medicine men. In Greece, the serpent became a symbol of Apollo, and prophetic serpents were kept and fed at his shrine, as well as at that of his son, Asklepios. There was an idea, too, that snakes had a knowledge of herbs, which is referred to in the famous poem of Nikander on Theriaka.(12) You may remember that when Alexander, the famous quack and oracle monger, depicted by Lucian, started out "for revenue," the first thing he did was to provide himself with two of the large, harmless, yellow snakes of Asia Minor. (12) Lines 31, etc., and Scholia; cf. W. R. Halliday: Greek Divination, London, 1913, p. 88. The exact date of the introduction of the cult into Greece is not known, but its great centres were at Epidaurus, Cos, Pergamos and Tricca. It throve with wonderful rapidity. Asklepios became one of the most popular of the gods. By the time of Alexander it is estimated that there were between three and four hundred temples dedicated to him. His worship was introduced into Rome at the time of the Great Plague at the beginning of the third century B.C. (as told by Livy in Book XI), and the temple on the island of Tiber became a famous resort. If you can transfer in imagination the Hot Springs of Virginia to the neighborhood of Washington, and put there a group of buildings such as are represented in these outlines of Caton's(13) (p. 52), add a sumptuous theatre with seating capacity for 20,000, a stadium 600 feet long with a seating capacity of 12,000, and all possible accessories of art and science, you will have an idea of what the temple at Epidaurus, a few miles from Athens, was. "The cult flourished mostly in places which, through climatic or hygienic advantages, were natural health resorts. Those favoured spots on hill or mountain, in the shelter of forests, by rivers or springs of pure flowing water, were conducive to health. The vivifying air, the well cultivated gardens surrounding the shrine, the magnificent view, all tended to cheer the heart with new hope of cure. Many of these temples owed their fame to mineral or merely hot springs. To the homely altars, erected originally by sacred fountains in the neighbourhood of health-giving mineral springs, were later added magnificent temples, pleasure-grounds for festivals, gymnasia in which bodily ailments were treated by physical exercises, baths and inunctions, also, as is proved by excavations, living rooms for the patients. Access to the shrine was forbidden to the unclean and the impure, pregnant women and the mortally afflicted were kept away; no dead body could find a resting-place within the holy precincts, the shelter and the cure of the sick being undertaken by the keepers of inns and boarding-houses in the neighbourhood. The suppliants for aid had to submit to careful purification, to bathe in sea, river or spring, to fast for a prescribed time, to abjure wine and certain articles of diet, and they were only permitted to enter the temple when they were adequately prepared by cleansing, inunction and fumigation. This lengthy and exhausting preparation, partly dietetic, partly suggestive, was accompanied by a solemn service of prayer and sacrifice, whose symbolism tended highly to excite the imagination."(14) (13) Caton: Temples and Ritual of Asklepios, 2d ed., London, 1900. (14) Max Neuburger: History of Medicine, English translation, Oxford, 1910, p. 94. The temples were in charge of members of the guild or fraternity, the head of which was often, though not necessarily, a physician. The Chief was appointed annually. From Caton's excellent sketch(15) you can get a good idea of the ritual, but still better is the delightful description given in the "Plutus" of Aristophanes. After offering honey-cakes and baked meats on the altar, the suppliants arranged themselves on the pallets. (15) Caton: Temples and Ritual of Asklepios, 2d ed., London, 1900. Soon the Temple servitor Put out the lights and bade us fall asleep, Nor stir, nor speak, whatever noise we heard. So down we lay in orderly repose. And I could catch no slumber, not one wink, Struck by a nice tureen of broth which stood A little distance from an old wife's head, Whereto I marvellously longed to creep. Then, glancing upwards, I beheld the priest Whipping the cheese-cakes and figs from off The holy table; thence he coasted round To every altar spying what was left. And everything he found he consecrated Into a sort of sack--(16) a procedure which reminds one of the story of "Bel and the Dragon." Then the god came, in the person of the priest, and scanned each patient. He did not neglect physical measures, as he brayed in a mortar cloves, Tenian garlic, verjuice, squills and Sphettian vinegar, with which he made application to the eyes of the patient. (16) Aristophanes: B. B. Roger's translation, London, Bell & Sons, 1907, Vol. VI, ll. 668, etc., 732 ff. Then the God clucked, And out there issued from the holy shrine Two great, enormous serpents.... And underneath the scarlet cloth they crept, And licked his eyelids, as it seemed to me; And, mistress dear, before you could have drunk Of wine ten goblets, Wealth arose and saw.(17) (17) Ibid. The incubation sleep, in which indications of cure were divinely sent, formed an important part of the ritual. The Asklepieion, or Health Temple of Cos, recently excavated, is of special interest, as being at the birthplace of Hippocrates, who was himself an Asklepiad. It is known that Cos was a great medical school. The investigations of Professor Rudolf Hertzog have shown that this temple was very nearly the counterpart of the temple at Epidaurus. The AEsculapian temples may have furnished a rare field for empirical enquiry. As with our modern hospitals, the larger temple had rich libraries, full of valuable manuscripts and records of cases. That there may have been secular Asklepiads connected with the temple, who were freed entirely from its superstitious practices and theurgic rites, is regarded as doubtful; yet is perhaps not so doubtful as one might think. How often have we physicians to bow ourselves in the house of Rimmon! It is very much the same today at Lourdes, where lay physicians have to look after scores of patients whose faith is too weak or whose maladies are too strong to be relieved by Our Lady of this famous shrine. Even in the Christian era, there is evidence of the association of distinguished physicians with AEsculapian temples. I notice that in one of his anatomical treatises, Galen speaks with affection of a citizen of Pergamos who has been a great benefactor of the AEsculapian temple of that city. In "Marius, the Epicurean," Pater gives a delightful sketch of one of those temple health resorts, and brings in Galen, stating that he had himself undergone the temple sleep; but to this I can find no reference in the general index of Galen's works. From the votive tablets found at Epidaurus, we get a very good idea of the nature of the cases and of the cures. A large number of them have now been deciphered. There are evidences of various forms of diseases of the joints, affections of women, wounds, baldness, gout; but we are again in the world of miracles, as you may judge from the following: "Heraicus of Mytilene is bald and entreats the God to make his hair grow. An ointment is applied over night and the next morning he has a thick crop of hair." There are indications that operations were performed and abscesses opened. From one we gather that dropsy was treated in a novel way: Asklepios cuts off the patient's head, holds him up by the heels, lets the water run out, claps on the patient's head again. Here is one of the invocations: "Oh, blessed Asklepios, God of Healing, it is thanks to thy skill that Diophantes hopes to be relieved from his incurable and horrible gout, no longer to move like a crab, no longer to walk upon thorns, but to have sound feet as thou hast decreed." The priests did not neglect the natural means of healing. The inscriptions show that great attention was paid to diet, exercise, massage and bathing, and that when necessary, drugs were used. Birth and death were believed to defile the sacred precincts, and it was not until the time of the Antonines that provision was made at Epidaurus for these contingencies. One practice of the temple was of special interest, viz., the incubation sleep, in which dreams were suggested to the patients. In the religion of Babylonia, an important part was played by the mystery of sleep, and the interpretation of dreams; and no doubt from the East the Greeks took over the practice of divination in sleep, for in the AEsculapian cult also, the incubation sleep played a most important role. That it continued in later times is well indicated in the orations of Aristides, the arch-neurasthenic of ancient history, who was a great dreamer of dreams. The oracle of Amphiaraus in Attica sent dreams into the hearts of his consultants. "The priests take the inquirer, and keep him fasting from food for one day, and from wine for three days, to give him perfect spiritual lucidity to absorb the divine communication" (Phillimore's "Apollonius of Tyana," Bk. II, Ch. XXXVII). How incubation sleep was carried into the Christian Church, its association with St. Cosmas and St. Damian and other saints, its practice throughout the Middle Ages, and its continuation to our own time may be read in the careful study of the subject made by Miss Hamilton (now Mrs. Dickens).(18) There are still in parts of Greece and in Asia Minor shrines at which incubation is practiced regularly, and if one may judge from the reports, with as great success as in Epidaurus. At one place in Britain, Christchurch in Monmouthshire, incubation was carried on till the early part of the nineteenth century. Now the profession has come back to the study of dreams,(19) and there are professors as ready to give suggestive interpretations to them, as in the days of Aristides. As usual, Aristotle seems to have said the last word on the subject: "Even scientific physicians tell us that one should pay diligent attention to dreams, and to hold this view is reasonable also for those who are not practitioners but speculative philosophers,"(20) but it is asking too much to think that the Deity would trouble to send dreams to very simple people and to animals, if they were designed in any way to reveal the future. In its struggle with Christianity, Paganism made its last stand in the temples of Asklepios. The miraculous healing of the saints superseded the cures of the heathen god, and it was wise to adopt the useful practice of his temple. (18) Mary Hamilton: Incubation, or the Cure of Disease in Pagan Temples and Christian Churches, London, 1906. (19) Freud: The Interpretation of Dreams, translation of third edition by A. A. Brill, 1913. (20) Aristotle: Parva Naturalia, De divinatione per somnium, Ch. I, Oxford ed., Vol. III, 463 a. HIPPOCRATES AND THE HIPPOCRATIC WRITINGS DESERVEDLY the foundation of Greek Medicine is associated with the name of Hippocrates, a native of the island of Cos; and yet he is a shadowy personality, about whom we have little accurate first-hand information. This is in strong contrast to some of his distinguished contemporaries and successors, for example, Plato and Aristotle, about whom we have such full and accurate knowledge. You will, perhaps, be surprised to hear that the only contemporary mention of Hippocrates is made by Plato. In the "Protagoras," the young Hippocrates, son of Apollodorus has come to Protagoras, "that mighty wise man," to learn the science and knowledge of human life. Socrates asked him: "If . . . you had thought of going to Hippocrates of Cos, the Asclepiad, and were about to give him your money, and some one had said to you, 'You are paying money to your namesake Hippocrates, O Hippocrates; tell me, what is he that you give him money?' how would you have answered?" "I should say," he replied, "that I gave money to him as a physician." "And what will he make of you?" "A physician," he said. And in the Phaedrus, in reply to a question of Socrates whether the nature of the soul could be known intelligently without knowing the nature of the whole, Phaedrus replies: "Hippocrates, the Asclepiad, says that the nature, even of the body, can only be understood as a whole." (Plato, I, 311; III, 270--Jowett, I, 131, 479.) Several lives of Hippocrates have been written. The one most frequently quoted is that of Soranus of Ephesus (not the famous physician of the time of Trajan), and the statements which he gives are usually accepted, viz., that he was born in the island of Cos in the year 460 B.C.; that he belonged to an Asklepiad family of distinction, that he travelled extensively, visiting Thrace, Thessaly, and various other parts of Greece; that he returned to Cos, where he became the most renowned physician of his period, and died about 375 B.C. Aristotle mentions him but once, calling him "the great Hippocrates." Busts of him are common; one of the earliest of which, and I am told the best, dating from Roman days and now in the British Museum, is here represented. Of the numerous writings attributed to Hippocrates it cannot easily be determined which are really the work of the Father of Medicine himself. They were collected at the time of the Alexandrian School, and it became customary to write commentaries upon them; much of the most important information we have about them, we derive from Galen. The earliest manuscript is the "Codex Laurentianus" of Florence, dating from the ninth century, a specimen page of which (thanks to Commendatore Biagi) is annexed. Those of you who are interested, and wish to have full references to the various works attributed to Hippocrates, will find them in "Die Handschriften der antiken Aerzte" of the Prussian Academy, edited by Diels (Berlin, 1905). The Prussian Academy has undertaken the editorship of the "Corpus Medicorum Graecorum." There is no complete edition of them in English. In 1849 the Deeside physician, Adams, published (for the Old Sydenham Society) a translation of the most important works, a valuable edition and easily obtained. Littre's ten-volume edition "OEuvres completes d'Hippocrate," Paris, 1839-1861, is the most important for reference. Those of you who want a brief but very satisfactory account of the Hippocratic writings, with numerous extracts, will find the volume of Theodor Beck (Jena, 1907) very useful. I can only indicate, in a very brief way, the special features of the Hippocratic writings that have influenced the evolution of the science and art of medicine. The first is undoubtedly the note of humanity. In his introduction to, "The Rise of the Greek Epic,"(21) Gilbert Murray emphasizes the idea of service to the community as more deeply rooted in the Greeks than in us. The question they asked about each writer was, "Does he help to make better men?" or "Does he make life a better thing?" Their aim was to be useful, to be helpful, to make better men in the cities, to correct life, "to make gentle the life of the world." In this brief phrase were summed up the aspirations of the Athenians, likewise illuminated in that remarkable saying of Prodicus (fifth century B.C.), "That which benefits human life is God." The Greek view of man was the very antithesis of that which St. Paul enforced upon the Christian world. One idea pervades thought from Homer to Lucian-like an aroma--pride in the body as a whole. In the strong conviction that "our soul in its rose mesh" is quite as much helped by flesh as flesh by the soul the Greek sang his song--"For pleasant is this flesh." Just so far as we appreciate the value of the fair mind in the fair body, so far do we apprehend ideals expressed by the Greek in every department of life. The beautiful soul harmonizing with the beautiful body was as much the glorious ideal of Plato as it was the end of the education of Aristotle. What a splendid picture in Book III of the "Republic," of the day when ". . . our youth will dwell in a land of health, amid fair sights and sounds and receive the good in everything; and beauty, the effluence of fair works, shall flow into the eye and ear like a health-giving breeze from a purer region, and insensibly draw the soul from earliest years into likeness and sympathy with the beauty of reason." The glory of this zeal for the enrichment of this present life was revealed to the Greeks as to no other people, but in respect to care for the body of the common man, we have only seen its fulfilment in our own day, as a direct result of the methods of research initiated by them. Everywhere throughout the Hippocratic writings we find this attitude towards life, which has never been better expressed than in the fine phrase, "Where there is love of humanity there will be love of the profession." This is well brought out in the qualifications laid down by Hippocrates for the study of medicine. "Whoever is to acquire a competent knowledge of medicine ought to be possessed of the following advantages: a natural disposition; instruction; a favourable position for the study; early tuition; love of labour; leisure. First of all, a natural talent is required, for when nature opposes, everything else is vain; but when nature leads the way to what is most excellent, instruction in the art takes place, which the student must try to appropriate to himself by reflection, becoming a nearly pupil in a place well adapted for instruction. He must also bring to the task a love of labour and perseverance, so that the instruction taking root may bring forth proper and abundant fruits." And the directions given for the conduct of life and for the relation which the physician should have with the public are those of our code of ethics today. Consultations in doubtful cases are advised, touting for fees is discouraged. "If two or more ways of medical treatment were possible, the physician was recommended to choose the least imposing or sensational; it was an act of 'deceit' to dazzle the patient's eye by brilliant exhibitions of skill which might very well be dispensed with. The practice of holding public lectures in order to increase his reputation was discouraged in the physician, and he was especially warned against lectures tricked out with quotations from the poets. Physicians who pretended to infallibility in detecting even the minutest departure from their prescriptions were laughed at; and finally, there were precise by-laws to regulate the personal behaviour of the physician. He was enjoined to observe the most scrupulous cleanliness, and was advised to cultivate an elegance removed from all signs of luxury, even down to the detail that he might use perfumes, but not in an immoderate degree."(22) But the high-water mark of professional morality is reached in the famous Hippocratic oath, which Gomperz calls "a monument of the highest rank in the history of civilization." It is of small matter whether this is of Hippocratic date or not, or whether it has in it Egyptian or Indian elements: its importance lies in the accuracy with which it represents the Greek spirit. For twenty-five centuries it has been the "credo" of the profession, and in many universities it is still the formula with which men are admitted to the doctorate. (21) Oxford. Clarendon Press, 2d ed., 1911. (22) Gomperz: Greek Thinkers, Vol. I, p. 281. I swear by Apollo the physician and AEsculapius and Health (Hygieia) and All-Heal (Panacea) and all the gods and goddesses, that, according to my ability and judgment, I will keep this oath and this stipulation--to reckon him who taught me this art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of my art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my art. (I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work.) Into whatsoever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption, and, further, from the abduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot! (Adams, II, 779, cf. Littre, IV, 628.) In his ideal republic, Plato put the physician low enough, in the last stratum, indeed, but he has never been more honorably placed than in the picture of Athenian society given by this author in the "Symposium." Here the physician is shown as a cultivated gentleman, mixing in the best, if not always the most sober, society. Eryximachus, the son of Acumenus, himself a physician, plays in this famous scene a typical Greek part(22a)--a strong advocate of temperance in mind and body, deprecating, as a physician, excess in drink, he urged that conversation should be the order of the day and he had the honor of naming the subject--"Praise of the God of Love." Incidentally Eryximachus gives his view of the nature of disease, and shows how deeply he was influenced by the views of Empedocles:". . . so too in the body the good and healthy elements are to be indulged, and the bad elements and the elements of disease are not to be indulged, but discouraged. And this is what the physician has to do, and in this the art of medicine consists: for medicine may be regarded generally as the knowledge of the loves and desires of the body and how to satisfy them or not; and the best physician is he who is able to separate fair love from foul, or to convert one into the other; and he who knows how to eradicate and how to implant love, whichever is required, and can reconcile the most hostile elements in the constitution and make them loving friends, is a skilful practitioner." (22a) Professor Gildersleeve's view of Eryximachus is less favorable (Johns Hopkins University Circular, Baltimore, January, 1887). Plato, III, 186--Jowett, I, 556. The second great note in Greek medicine illustrates the directness with which they went to the very heart of the matter. Out of mysticism, superstition and religious ritual the Greek went directly to nature and was the first to grasp the conception of medicine as an art based on accurate observation, and an integral part of the science of man. What could be more striking than the phrase in "The Law," "There are, in effect, two things, to know and to believe one knows; to know is science; to believe one knows is ignorance"?(23) But no single phrase in the writings can compare for directness with the famous aphorism which has gone into the literature of all lands: "Life is short and Art is long; the Occasion fleeting, Experience fallacious, and Judgment difficult." (23) Littre: OEuvres d'Hippocrate, Vol. IV, pp. 641-642. Everywhere one finds a strong, clear common sense, which refuses to be entangled either in theological or philosophical speculations. What Socrates did for philosophy Hippocrates may be said to have done for medicine. As Socrates devoted himself to ethics, and the application of right thinking to good conduct, so Hippocrates insisted upon the practical nature of the art, and in placing its highest good in the benefit of the patient. Empiricism, experience, the collection of facts, the evidence of the senses, the avoidance of philosophical speculations, were the distinguishing features of Hippocratic medicine. One of the most striking contributions of Hippocrates is the recognition that diseases are only part of the processes of nature, that there is nothing divine or sacred about them. With reference to epilepsy, which was regarded as a sacred disease, he says, "It appears to me to be no wise more divine nor more sacred than other diseases, but has a natural cause from which it originates like other affections; men regard its nature and cause as divine from ignorance." And in another place he remarks that each disease has its own nature, and that no one arises without a natural cause. He seems to have been the first to grasp the conception of the great healing powers of nature. In his long experience with the cures in the temples, he must have seen scores of instances in which the god had worked the miracle through the vis medicatrix naturae; and to the shrewd wisdom of his practical suggestions in treatment may be attributed in large part the extraordinary vogue which the great Coan has enjoyed for twenty-five centuries. One may appreciate the veneration with which the Father of Medicine was regarded by the attribute "divine" which was usually attached to his name. Listen to this for directness and honesty of speech taken from the work on the joints characterized by Littre as "the great surgical monument of antiquity": "I have written this down deliberately, believing it is valuable to learn of unsuccessful experiments, and to know the causes of their non-success." The note of freedom is not less remarkable throughout the Hippocratic writings, and it is not easy to understand how a man brought up and practicing within the precincts of a famous AEsculapian temple could have divorced himself so wholly from the superstitions and vagaries of the cult. There are probably grounds for Pliny's suggestion that he benefited by the receipts written in the temple, registered by the sick cured of any disease. "Afterwards," Pliny goes on to remark in his characteristic way, "hee professed that course of Physicke which is called Clinice Wherby physicians found such sweetnesse that afterwards there was no measure nor end of fees," ('Natural History,' XXIX, 1). There is no reference in the Hippocratic writings to divination; incubation sleep is not often mentioned, and charms, incantations or the practice of astrology but rarely. Here and there we do find practices which jar upon modern feeling, but on the whole we feel in reading the Hippocratic writings nearer to their spirit than to that of the Arabians or of the many writers of the fifteenth and sixteenth centuries A. D. And it is not only against the thaumaturgic powers that the Hippocratic writings protested, but they express an equally active reaction against the excesses and defects of the new philosophy, a point brought out very clearly by Gomperz.(24) He regards it as an undying glory of the school of Cos that after years of vague, restless speculation it introduces "steady sedentary habits into the intellectual life of mankind." 'Fiction to the right! Reality to the left!' was the battle-cry of this school in the war they were the first to wage against the excesses and defects of the nature-philosophy. Though the protest was effective in certain directions, we shall see that the authors of the Hippocratic writings could not entirely escape from the hypotheses of the older philosophers. (24) Gomperz: Greek Thinkers, Vol. I, p. 296. I can do no more than indicate in the briefest possible way some of the more important views ascribed to Hippocrates. We cannot touch upon the disputes between the Coan and Cnidian schools.(25) You must bear in mind that the Greeks at this time had no human anatomy. Dissections were impossible; their physiology was of the crudest character, strongly dominated by the philosophies. Empedocles regarded the four elements, fire, air, earth and water, as "the roots of all things," and this became the corner stone in the humoral pathology of Hippocrates. As in the Macrocosm--the world at large there were four elements, fire, air, earth, and water, so in the Microcosm--the world of man's body--there were four humors (elements), viz.,blood, phlegm, yellow bile (or choler) and black bile (or melancholy), and they corresponded to the four qualities of matter, heat, cold, dryness and moisture. For more than two thousand years these views prevailed. In his "Regiment of Life" (1546) Thomas Phaer says:". . . which humours are called ye sones of the Elements because they be complexioned like the foure Elements, for like as the Ayre is hot and moyst: so is the blooud, hote and moyste. And as Fyer is hote and dry: so is Cholere hote and dry. And as water is colde and moyst: so is fleume colde and moyste. And as the Earth is colde and dry: so Melancholy is colde and dry."(26) (25) The student who wishes a fuller account is referred to the histories of (a) Neuburger, Vol. 1, Oxford, 1910; (b) Withington, London, 1894. (26) Thomas Phaer: Regiment of Life, London, 1546. As the famous Regimen Sanitatis of Salernum, the popular family hand-book of the Middle Ages, says: Foure Humours raigne within our bodies wholly, And these compared to foure elements.(27) (27) The Englishman's Doctor, or the Schoole of Salerne, Sir John Harington's translation, London, 1608, p. 2. Edited by Francis R. Packard, New York, 1920, p. 132. Harington's book originally appeared dated: London 1607. (Hoe copy in the Henry E. Huntington Library.) According to Littre, there is nowhere so strong a statement of these views in the genuine works of Hippocrates, but they are found at large in the Hippocratic writings, and nothing can be clearer than the following statement from the work "The Nature of Man": "The body of man contains in itself blood and phlegm and yellow bile and black bile, which things are in the natural constitution of his body, and the cause of sickness and of health. He is healthy when they are in proper proportion between one another as regards mixture and force and quantity, and when they are well mingled together; he becomes sick when one of these is diminished or increased in amount, or is separated in the body from its proper mixture, and not properly mingled with all the others." No words could more clearly express the views of disease which, as I mentioned, prevailed until quite recent years. The black bile, melancholy, has given us a great word in the language, and that we have not yet escaped from the humoral pathology of Hippocrates is witnessed by the common expression of biliousness--"too much bile"--or "he has a touch of the liver." The humors, imperfectly mingled, prove irritant in the body. They are kept in due proportion by the innate heat which, by a sort of internal coction gradually changes the humors to their proper proportion. Whatever may be the primary cause of the change in the humors manifesting itself in disease, the innate heat, or as Hippocrates terms it, the nature of the body itself, tends to restore conditions to the norm; and this change occurring suddenly, or abruptly, he calls the "crisis," which is accomplished on some special day of the disease, and is often accompanied by a critical discharge, or by a drop in the body temperature. The evil, or superabundant, humors were discharged and this view of a special materies morbi, to be got rid of by a natural processor a crisis, dominated pathology until quite recently. Hippocrates had a great belief in the power of nature, the vis medicatrix naturae, to restore the normal state. A keen observer and an active practitioner, his views of disease, thus hastily sketched, dominated the profession for twenty-five centuries; indeed, echoes of his theories are still heard in the schools, and his very words are daily on our lips. If asked what was the great contribution to medicine of Hippocrates and his school we could answer--the art of careful observation. In the Hippocratic writings is summed up the experience of Greece to the Golden Age of Pericles. Out of philosophy, out of abstract speculation, had come a way of looking at nature for which the physicians were mainly responsible, and which has changed forever men's views on disease. Medicine broke its leading strings to religion and philosophy--a tottering, though lusty, child whose fortunes we are to follow in these lectures. I have a feeling that, could we know more of the medical history of the older races of which I spoke in the first lecture, we might find that this was not the first-born of Asklepios, that there had been many premature births, many still-born offspring, even live-births--the products of the fertilization of nature by the human mind; but the record is dark, and the infant was cast out like Israel in the chapter of Isaiah. But the high-water mark of mental achievement had not been reached by the great generation in which Hippocrates had labored. Socrates had been dead sixteen years, and Plato was a man of forty-five, when far away in the north in the little town of Stagira, on the peninsula of Mount Athos in Macedoniawas, in 384 B.C., born a "man of men," the one above all others to whom the phrase of Milton may be applied. The child of an Asklepiad, Nicomachus, physician to the father of Philip, there must have been a rare conjunction of the planets at the birth of the great Stagirite. In the first circle of the "Inferno," Virgil leads Dante into a wonderful company, "star-seated" on the verdure (he says)--the philosophic family looking with reverence on "the Master of those who know"--il maestro di color che sanno.(28) And with justice has Aristotle been so regarded for these twenty-three centuries. No man has ever swayed such an intellectual empire--in logic, metaphysics, rhetoric, psychology, ethics, poetry, politics and natural history, in all a creator, and in all still a master. The history of the human mind--offers no parallel to his career. As the creator of the sciences of comparative anatomy, systematic zoology, embryology, teratology, botany and physiology, his writings have an eternal interest. They present an extraordinary accumulation of facts relating to the structure and functions of various parts of the body. It is an unceasing wonder how one man, even with a school of devoted students, could have done so much. (28) The "Good collector of qualities," Dioscorides, Hippocrates, Avicenna, Galen and Averroes were the medical members of the group. Dante, Inferno, canto iv. Dissection--already practiced by Alcmaeon, Democritus, Diogenes and others--was conducted on a large scale, but the human body was still taboo. Aristotle confesses that the "inward parts of man are known least of all," and he had never seen the human kidneys or uterus. In his physiology, I can refer to but one point--the pivotal question of the heart and blood vessels. To Aristotle the heart was the central organ controlling the circulation, the seat of vitality, the source of the blood, the place in which it received its final elaboration and impregnation with animal heat. The blood was contained in the heart and vessels as in a vase--hence the use of the term "vessel." "From the heart the blood-vessels extend throughout the body as in the anatomical diagrams which are represented on the walls, for the parts lie round these because they are formed out of them."(29) The nutriment oozes through the blood vessels and the passages in each of the parts "like water in unbaked pottery." He did not recognize any distinction between arteries and veins, calling both plebes (Littre); the vena cave is the great vessel, and the aorta the smaller; but both contain blood. He did not use the word "arteria" (arthria) for either of them. There was no movement from the heart to the vessels but the blood was incessantly drawn upon by the substance of the body and as unceasingly renewed by absorption of the products of digestion, the mesenteric vessels taking up nutriment very much as the plants take theirs by the roots from the soil. From the lungs was absorbed the pneuma, or spiritus, which was conveyed to the heart by the pulmonary vessels--one to the right, and one to the left side. These vessels in the lungs, "through mutual contact" with the branches of the trachea, took in the pneuma. A point of interest is that the windpipe, or trachea, is called "arteria," both by Aristotle and by Hippocrates ("Anatomy," Littre, VIII, 539). It was the air-tube, disseminating the breath through the lungs. We shall see in a few minutes how the term came to be applied to the arteries, as we know them. The pulsation of the heart and arteries was regarded by Aristotle as a sort of ebullition in which the liquids were inflated by the vital or innate heat, the fires of which were cooled by the pneuma taken in by the lungs and carried to the heart by the pulmonary vessels. (29) De Generatione Animalium, Oxford translation, Bk. II, Chap. 6, Works V, 743 a. In Vol. IV of Gomperz' "Greek Thinkers," you will find an admirable discussion on Aristotle as an investigator of nature, and those of you who wish to study his natural history works more closely may do so easily--in the new translation which is in process of publication by the Clarendon Press, Oxford. At the end of the chapter "De Respiratione" in the "Parva Naturalia" (Oxford edition, 1908), we have Aristotle's attitude towards medicine expressed in a way worthy of a son of the profession: "But health and disease also claim the attention of the scientist, and not merely of the physician, in so far as an account of their causes is concerned. The extent to which these two differ and investigate diverse provinces must not escape us, since facts show that their inquiries are, at least to a certain extent, conterminous. For physicians of culture and refinement make some mention of natural science, and claim to derive their principles from it, while the most accomplished investigators into nature generally push their studies so far as to conclude with an account of medical principles." (Works, III,480 b.) Theophrastus, a student of Aristotle and his successor, created the science of botany and made possible the pharmacologists of a few centuries later. Some of you doubtless know him in another guise--as the author of the golden booklet on "Characters," in which "the most eminent botanist of antiquity observes the doings of men with the keen and unerring vision of a natural historian" (Gomperz). In the Hippocratic writings, there are mentioned 236 plants; in the botany of Theophrastus, 455. To one trait of master and pupil I must refer--the human feeling, not alone of man for man, but a sympathy that even claims kinship with the animal world. "The spirit with which he (Theophrastus) regarded the animal world found no second expression till the present age" (Gomperz). Halliday, however, makes the statement that Porphyry(30) goes as far as any modern humanitarian in preaching our duty towards animals. (30) W. R. Halliday: Greek Divination, London, Macmillan & Co., 1913. ALEXANDRIAN SCHOOL FROM the death of Hippocrates about the year 375 B.C. till the founding of the Alexandrian School, the physicians were engrossed largely in speculative views, and not much real progress was made, except in the matter of elaborating the humoral pathology. Only three or four men of the first rank stand out in this period: Diocles the Carystian, "both in time and reputation next and second to Hippocrates" (Pliny), a keen anatomist and an encyclopaedic writer; but only scanty fragments of his work remain. In some ways the most important member of this group was Praxagoras, a native of Cos, about 340 B.C. Aristotle, you remember, made no essential distinction between arteries and veins, both of which he held to contain blood: Praxagoras recognized that the pulsation was only in the arteries, and maintained that only the veins contained blood, and the arteries air. As a rule the arteries are empty after death, and Praxagoras believed that they were filled with an aeriform fluid, a sort of pneuma, which was responsible for their pulsation. The word arteria, which had already been applied to the trachea, as an air-containing tube, was then attached to the arteries; on account of the rough and uneven character of its walls the trachea was then called the arteria tracheia, or the rough air-tube.(31a) We call it simply the trachea, but in French the word trachee-artere is still used. (31a) Galen: De usu partium, VII, Chaps. 8-9. Praxagoras was one of the first to make an exhaustive study of the pulse, and he must have been a man of considerable clinical acumen, as well as boldness, to recommend in obstruction of the bowels the opening of the abdomen, removal of the obstructed portion and uniting the ends of the intestine by sutures. After the death of Alexander, Egypt fell into the hands of his famous general, Ptolemy, under whose care the city became one of the most important on the Mediterranean. He founded and maintained a museum, an establishment that corresponded very much to a modern university, for the study of literature, science and the arts. Under his successors, particularly the third Ptolemy, the museum developed, more especially the library, which contained more than half a million volumes. The teachers were drawn from all centres, and the names of the great Alexandrians are among the most famous in the history of human knowledge, including such men as Archimedes, Euclid, Strabo and Ptolemy. In mechanics and physics, astronomy, mathematics and optics, the work of the Alexandrians constitutes the basis of a large part of our modern knowledge. The school-boy of today--or at any rate of my day--studies the identical problems that were set by Euclid 300 B.C., and the student of physics still turns to Archimedes and Heron, and the astronomer to Eratosthenes and Hipparchus. To those of you who wish to get a brief review of the state of science in the Alexandrian School I would recommend the chapter in Vol. I of Dannemann's history.(31) (31) Friedrich Dannemann: Grundriss einer Geschichte der Naturwissenschaften, Vol. I, 3d ed., Leipzig, 1908. Of special interest to us in Alexandria is the growth of the first great medical school of antiquity. Could we have visited the famous museum about 300 B.C., we should have found a medical school in full operation, with extensive laboratories, libraries and clinics. Here for the first time the study of the structure of the human body reached its full development, till then barred everywhere by religious prejudice; but full permission was given by the Ptolemies to perform human dissection and, if we may credit some authors, even vivisection. The original writings of the chief men of this school have not been preserved, but there is a possibility that any day a papyrus maybe found which will supplement the scrappy and imperfect knowledge afforded us by Pliny, Celsus and Galen. The two most distinguished names are Herophilus--who, Pliny says, has the honor of being the first physician "who searched into the causes of disease"--and Erasistratus. Herophilus, ille anatomicorum coryphaeus, as Vesalius calls him, was a pupil of Praxagoras, and his name is still in everyday use by medical students, attached to the torcular Herophili. Anatomy practically dates from these Alexandrines, who described the valves of the heart, the duodenum, and many of the important parts of the brain; they recognized the true significance of the nerves (which before their day had been confounded with the tendons), distinguished between motor and sensory nerves, and regarded the brain as the seat of the perceptive faculties and voluntary action. Herophilus counted the pulse, using the water-clock for the purpose, and made many subtle analyses of its rate and rhythm; and, influenced by the musical theories of the period, he built up a rhythmical pulse lore which continued in medicine until recent times. He was a skilful practitioner and to him is ascribed the statement that drugs are the hands of the gods. There is a very modern flavor to his oft-quoted expression that the best physician was the man who was able to distinguish between the possible and the impossible. Erasistratus elaborated the view of the pneuma, one form of which he believed came from the inspired air, and passed to the left side of the heart and to the arteries of the body. It was the cause of the heart-beat and the source of the innate heat of the body, and it maintained the processes of digestion and nutrition. This was the vital spirit; the animal spirit was elaborated in the brain, chiefly in the ventricles, and sent by the nerves to all parts of the body, endowing the individual with life and perception and motion. In this way a great division was made between the two functions of the body, and two sets of organs: in the vascular system, the heart and arteries and abdominal organs, life was controlled by the vital spirits; on the other hand, in the nervous system were elaborated the animal spirits, controlling motion, sensation and the various special senses. These views on the vital and animal spirits held unquestioned sway until well into the eighteenth century, and we still, in a measure, express the views of the great Alexandrian when we speak of "high" or "low" spirits. GALEN PERGAMON has become little more than a name associated in our memory with the fulminations of St. John against the seven churches of Asia; and on hearing the chapter read, we wondered what was "Satan's seat" and who were the "Nicolaitanes" whose doctrine he so hated. Renewed interest has been aroused in the story of its growth and of its intellectual rivalry with Alexandria since the wonderful discoveries by German archaeologists which have enabled us actually to see this great Ionian capital, and even the "seat of Satan." The illustration here shown is of the famous city, in which you can see the Temple of Athena Polis on the rock, and the amphitheatre. Its interest for us is connected with the greatest name, after Hippocrates, in Greek medicine, that of Galen, born at Pergamon A. D. 130, in whom was united as never before--and indeed one may say, never since--the treble combination of observer, experimenter and philosopher. His father, Nikon, a prosperous architect, was urged in a dream to devote his son to the profession of medicine, upon which study the lad entered in his seventeenth year under Satyrus. In his writings, Galen gives many details of his life, mentioning the names of his teachers, and many incidents in his Wanderjahre, during which he studied at the best medical schools, including Alexandria. Returning to his native city he was put in charge of the gladiators, whose wounds he said he treated with wine. In the year 162, he paid his first visit to Rome, the scene of his greatest labors. Here he gave public lectures on anatomy, and became "the fashion." He mentions many of his successes; one of them is the well-worn story told also of Erasistratus and Stratonice, but Galen's story is worth telling, and it is figured as a miniature in the manuscripts of his works. Called to see a lady he found her suffering from general malaise without any fever or increased action of the pulse. He saw at once that her trouble was mental and, like a wise physician, engaged her in general conversation. Quite possibly he knew her story, for the name of a certain actor, Pylades, was mentioned, and he noticed that her pulse at once increased in rapidity and became irregular. On the next day he arranged that the name of another actor, Morphus, should be mentioned, and on the third day the experiment was repeated but without effect. Then on the fourth evening it was again mentioned that Pylades was dancing, and the pulse quickened and became irregular, so he concluded that she was in love with Pylades. He tells how he was first called to treat the Emperor Marcus Aurelius, who had a stomach-ache after eating too much cheese. He treated the case so successfully that the Emperor remarked, "I have but one physician, and he is a gentleman." He seems to have had good fees, as he received 400 aurei (about 2000) for a fortnight's attendance upon the wife of Boethus. He left Rome for a time in 168 A. D. and returned to Pergamon, but was recalled to Rome by the Emperor, whom he accompanied on an expedition to Germany. There are records in his writings of many journeys, and busy with his practice in dissections and experiments he passed a long and energetic life, dying, according to most authorities, in the year 200 A.D. A sketch of the state of medicine in Rome is given by Celsus in the first of his eight books, and he mentions the names of many of the leading practitioners, particularly Asclepiades, the Bithynian, a man of great ability, and a follower of the Alexandrians, who regarded all disease as due to a disturbed movement of the atoms. Diet, exercise, massage and bathing were his great remedies, and his motto--tuto, cito et jucunde--has been the emulation of all physicians. How important a role he and his successors played until the time of Galen may be gathered from the learned lectures of Sir Clifford Allbutt(32) on "Greek Medicine in Rome" and from Meyer-Steineg's "Theodorus Priscianus und die romische Medizin."(33) From certain lay writers we learn that it was the custom for popular physicians to be followed on their rounds by crowds of students. Martial's epigram (V, ix) is often referred to: Languebam: sed tu comitatus protinus ad me Venisti centum, Symmache, discipulis. Centum me tegigere manus Aquilone gelatae Non habui febrem, Symmache, nunc habeo. (32) Allbutt: British Medical Journal, London, 1909, ii, 1449; 1515; 1598. (33) Fischer, Jena, 1909. And in the "Apollonius of Tyana" by Philostratus, when Apollonius wishes to prove an alibi, he calls to witness the physicians of his sick friend, Seleucus and Straloctes, who were accompanied by their clinical class to the number of about thirty students.(34) But for a first-hand sketch of the condition of the profession we must go to Pliny, whose account in the twenty-ninth book of the "Natural History" is one of the most interesting and amusing chapters in that delightful work. He quotes Cato's tirade against Greek physicians,--corrupters of the race, whom he would have banished from the city,--then he sketches the career of some of the more famous of the physicians under the Empire, some of whom must have had incomes never approached at any other period in the history of medicine. The chapter gives a good picture of the stage on which Galen (practically a contemporary of Pliny) was to play so important a role. Pliny seems himself to have been rather disgusted with the devious paths of the doctors of his day, and there is no one who has touched with stronger language upon the weak points of the art of physic. In one place he says that it alone has this peculiar art and privilege, "That whosoever professeth himself a physician, is straightwaies beleeved, say what he will: and yet to speake a truth, there are no lies dearer sold or more daungerous than those which proceed out of a Physician's mouth. Howbeit, we never once regard or look to that, so blind we are in our deepe persuasion of them, and feed our selves each one in a sweet hope and plausible conceit of our health by them. Moreover, this mischief there is besides, That there is no law or statute to punish the ignorance of blind Physicians, though a man lost his life by them: neither was there ever any man knowne, who had revenge of recompence for the evill intreating or misusage under their hands. They learne their skill by endaungering our lives: and to make proofe and experiments of their medicines, they care not to kill us."(35) He says it is hard that, while the judges are carefully chosen and selected, physicians are practically their own judges, and that of the men who may give us a quick despatch and send us to Heaven or Hell, no enquiry or examination is made of their quality and worthiness. It is interesting to read so early a bitter criticism of the famous "Theriaca," a great compound medicine invented by Antiochus III, which had a vogue for fifteen hundred years. (34) Bk. VIII, Chap. VII. (35) Pliny: Natural History (XXIX, 1), Philemon Holland's version, London, 1601, II, 347. But we must return to Galen and his works, which comprise the most voluminous body of writings left by any of the ancients. The great edition is that in twenty-two volumes by Kuhn (1821-1833). The most useful editions are the "Juntines" of Venice, which were issued in thirteen editions. In the fourth and subsequent editions a very useful index by Brassavola is included. A critical study of the writings is at present being made by German scholars for the Prussian Academy, which will issue a definitive edition of his works. Galen had an eclectic mind and could not identify himself with any of the prevailing schools, but regarded himself as a disciple of Hippocrates. For our purpose, both his philosophy and his practice are of minor interest in comparison with his great labors in anatomy and physiology. In anatomy, he was a pupil of the Alexandrians to whom he constantly refers. Times must have changed since the days of Herophilus, as Galen does not seem ever to have had an opportunity of dissecting the human body, and he laments the prejudice which prevents it. In the study of osteology, he urges the student to be on the lookout for an occasional human bone exposed in a graveyard, and on one occasion he tells of finding the carcass of a robber with the bones picked bare by birds and beasts. Failing this source, he advises the student to go to Alexandria, where there were still two skeletons. He himself dissected chiefly apes and pigs. His osteology was admirable, and his little tractate "De Ossibus" could, with very few changes, be used today by a hygiene class as a manual. His description of the muscles and of the organs is very full, covering, of course, many sins of omission and of commission, but it was the culmination of the study of the subject by Greek physicians. His work as a physiologist was even more important, for, so far as we know, he was the first to carry out experiments on a large scale. In the first place, he was within an ace of discovering the circulation of the blood. You may remember that through the errors of Praxagoras and Erasistratus, the arteries were believed to contain air and got their name on that account: Galen showed by experiment that the arteries contain blood and not air. He studied particularly the movements of the heart, the action of the valves, and the pulsatile forces in the arteries. Of the two kinds of blood, the one, contained in the venous system, was dark and thick and rich in grosser elements, and served for the general nutrition of the body. This system took its origin, as is clearly shown in the figure, in the liver, the central organ of nutrition and of sanguification. From the portal system were absorbed, through the stomach and intestines, the products of digestion. From the liver extend the venae cavae, one to supply the head and arms, the other the lower extremities: extending from the right heart was a branch, corresponding to the pulmonary artery, the arterial vein which distributed blood to the lungs. This was the closed venous system. The arterial system, shown, as you see, quite separate in Figure 31, was full of a thinner, brighter, warmer blood, characterized by the presence of an abundance of the vital spirits. Warmed in the ventricle, it distributed vital heat to all parts of the body. The two systems were closed and communicated with each other only through certain pores or perforations in the septum separating the ventricles. At the periphery, however, Galen recognized (as had been done already by the Alexandrians) that the arteries anastomose with the veins, ". . . and they mutually receive from each other blood and spirits through certain invisible and extremely small vessels." It is difficult to understand how Galen missed the circulation of the blood. He knew that the valves of the heart determined the direction of the blood that entered and left the organ, but he did not appreciate that it was a pump for distributing the blood, regarding it rather as a fireplace from which the innate heat of the body was derived. He knew that the pulsatile force was resident in the walls of the heart and in the arteries, and he knew that the expansion, or diastole, drew blood into its cavities, and that the systole forced blood out. Apparently his view was that there was a sort of ebb and flow in both systems--and yet, he uses language just such as we would, speaking of the venous system as ". . . a conduit full of blood with a multitude of canals large and small running out from it and distributing blood to all parts of the body." He compares the mode of nutrition to irrigating canals and gardens, with a wonderful dispensation by nature that they should "neither lack a sufficient quantity of blood for absorption nor be overloaded at any time with excessive supply." The function of respiration was the introduction of the pneuma, the spirits which passed from the lungs to the heart through the pulmonary vessels. Galen went a good deal beyond the idea of Aristotle, reaching our modern conception that the function is to maintain the animal heat, and that the smoky matters derived from combustion of the blood are discharged by expiration. I have dwelt on these points in Galen's physiology, as they are fundamental in the history of the circulation; and they are sufficient to illustrate his position. Among his other brilliant experiments were the demonstration of the function of the laryngeal nerves, of the motor and sensory functions of the spinal nerve roots, of the effect of transverse incision of the spinal cord, and of the effect of hemisection. Altogether there is no ancient physician in whose writings are contained so many indications of modern methods of research. Galen's views of disease in general are those of Hippocrates, but he introduces many refinements and subdivisions according to the predominance of the four humors, the harmonious combination of which means health, or eucrasia, while their perversion or improper combination leads to dyscrasia, or ill health. In treatment he had not the simplicity of Hippocrates: he had great faith in drugs and collected plants from all parts of the known world, for the sale of which he is said to have had a shop in the neighborhood of the Forum. As I mentioned, he was an eclectic, held himself aloof from the various schools of the day, calling no man master save Hippocrates. He might be called a rational empiricist. He made war on the theoretical practitioners of the day, particularly the Methodists, who, like some of their modern followers, held that their business was with the disease and not with the conditions out of which it arose. No other physician has ever occupied the commanding position of "Clarissimus" Galenus. For fifteen centuries he dominated medical thought as powerfully as did Aristotle in the schools. Not until the Renaissance did daring spirits begin to question the infallibility of this medical pope. But here we must part with the last and, in many ways, the greatest of the Greeks--a man very much of our own type, who, could he visit this country today, might teach us many lessons. He would smile in scorn at the water supply of many of our cities, thinking of the magnificent aqueducts of Rome and of many of the colonial towns--some still in use--which in lightness of structure and in durability testify to the astonishing skill of their engineers. There are country districts in which he would find imperfect drainage and could tell of the wonderful system by which Rome was kept sweet and clean. Nothing would delight him more than a visit to Panama to see what the organization of knowledge has been able to accomplish. Everywhere he could tour the country as a sanitary expert, preaching the gospel of good water supply and good drainage, two of the great elements in civilization, in which in many places we have not yet reached the Roman standard. CHAPTER III -- MEDIAEVAL MEDICINE THERE are waste places of the earth which fill one with terror--not simply because they are waste; one has not such feelings in the desert nor in the vast solitude of the ocean. Very different is it where the desolation has overtaken a brilliant and flourishing product of man's head and hand. To know that . . . the Lion and the Lizard keep The Courts where Jamshyd gloried and drank deep sends a chill to the heart, and one trembles with a sense of human instability. With this feeling we enter the Middle Ages. Following the glory that was Greece and the grandeur that was Rome, a desolation came upon the civilized world, in which the light of learning burned low, flickering almost to extinction. How came it possible that the gifts of Athens and of Alexandria were deliberately thrown away? For three causes. The barbarians shattered the Roman Empire to its foundations. When Alaric entered Rome in 410 A. D., ghastly was the impression made on the contemporaries; the Roman world shuddered in a titanic spasm (Lindner). The land was a garden of Eden before them, behind a howling wilderness, as is so graphically told in Gibbon's great history. Many of the most important centres of learning were destroyed, and for centuries Minerva and Apollo forsook the haunts of men. The other equally important cause was the change wrought by Christianity. The brotherhood of man, the care of the body, the gospel of practical virtues formed the essence of the teaching of the Founder--in these the Kingdom of Heaven was to be sought; in these lay salvation. But the world was very evil, all thought that the times were waxing late, and into men's minds entered as never before a conviction of the importance of the four last things--death, judgment, heaven and hell. One obstacle alone stood between man and his redemption, the vile body, "this muddy vesture of decay," that so grossly wrapped his soul. To find methods of bringing it into subjection was the task of the Christian Church for centuries. In the Vatican Gallery of Inscriptions is a stone slab with the single word "Stercoriae," and below, the Christian symbol. It might serve as a motto for the Middle Ages, during which, to quote St. Paul, all things were "counted dung but to win Christ." In this attitude of mind the wisdom of the Greeks was not simply foolishness, but a stumbling-block in the path. Knowledge other than that which made a man "wise unto salvation" was useless. All that was necessary was contained in the Bible or taught by the Church. This simple creed brought consolation to thousands and illumined the lives of some of the noblest of men. But, "in seeking a heavenly home man lost his bearings upon earth." Let me commend for your reading Taylor's "Mediaeval Mind."(1) I cannot judge of its scholarship, which I am told by scholars is ripe and good, but I can judge of its usefulness for anyone who wishes to know the story of the mind of man in Europe at this period. Into the content of mediaeval thought only a mystic can enter with full sympathy. It was a needful change in the evolution of the race. Christianity brought new ideals and new motives into the lives of men. The world's desire was changed, a desire for the Kingdom of Heaven, in the search for which the lust of the flesh, the lust of the eye and the pride of life were as dross. A master-motive swayed the minds of sinful men and a zeal to save other souls occupied the moments not devoted to the perfection of their own. The new dispensation made any other superfluous. As Tertullian said: Investigation since the Gospel is no longer necessary. (Dannemann, Die Naturw., I, p. 214.) The attitude of the early Fathers toward the body is well expressed by Jerome. "Does your skin roughen without baths? Who is once washed in the blood of Christ needs not wash again." In this unfavorable medium for its growth, science was simply disregarded, not in any hostile spirit, but as unnecessary.(2) And a third contributing factor was the plague of the sixth century, which desolated the whole Roman world. On the top of the grand mausoleum of Hadrian, visitors at Rome see the figure of a gilded angel with a drawn sword, from which the present name of the Castle of St. Angelo takes its origin. On the twenty-fifth of April, 590, there set out from the Church of SS. Cosmas and Damian, already the Roman patron saints of medicine, a vast procession, led by St. Gregory the Great, chanting a seven-fold litany of intercession against the plague. The legend relates that Gregory saw on the top of Hadrian's tomb an angel with a drawn sword, which he sheathed as the plague abated. (1) H. O. Taylor: The Mediaeval Mind, 2 vols., Macmillan Co., New York, 1911. (New edition, 1920.) (2) Ibid., Vol. 1, p. 13: "Under their action (the Christian Fathers) the peoples of Western Europe, from the eighth to the thirteenth century, passed through a homogeneous growth, and evolved a spirit different from that of any other period of history--a spirit which stood in awe before its monitors divine and human, and deemed that knowledge was to be drawn from the storehouse of the past; which seemed to rely on everything except its sin-crushed self, and trusted everything except its senses; which in the actual looked for the ideal, in the concrete saw the symbol, in the earthly Church beheld the heavenly, and in fleshly joys discerned the devil's lures; which lived in the unreconciled opposition between the lust and vain-glory of earth and the attainment of salvation; which felt life's terror and its pitifulness, and its eternal hope; around which waved concrete infinitudes, and over which flamed the terror of darkness and the Judgment Day." Galen died about 200 A.D.; the high-water mark of the Renaissance, so far as medicine is concerned, was reached in the year 1542. In order to traverse this long interval intelligently, I will sketch certain great movements, tracing the currents of Greek thought, setting forth in their works the lives of certain great leaders, until we greet the dawn of our own day. After flowing for more than a thousand years through the broad plain of Greek civilization, the stream of scientific medicine which we have been following is apparently lost in the morass of the Middle Ages; but, checked and blocked like the White Nile in the Soudan, three channels may be followed through the weeds of theological and philosophical speculation. SOUTH ITALIAN SCHOOL A WIDE stream is in Italy, where the "antique education never stopped, antique reminiscence and tradition never passed away, and the literary matter of the pagan past never faded from the consciousness of the more educated among the laity and clergy."(3) Greek was the language of South Italy and was spoken in some of its eastern towns until the thirteenth century. The cathedral and monastic schools served to keep alive the ancient learning. Monte Casino stands pre-eminent as a great hive of students, and to the famous Regula of St. Benedict(4) we are indebted for the preservation of many precious manuscripts. (3) H. O. Taylor: The Mediaeval Mind, Vol. I, p. 251. (4) De Renzi: Storia Documentata della Scuola Medica di Salerno, 2d ed., Napoli, 1867, Chap. V. The Norman Kingdom of South Italy and Sicily was a meeting ground of Saracens, Greeks and Lombards. Greek, Arabic and Latin were in constant use among the people of the capital, and Sicilian scholars of the twelfth century translated directly from the Greek. The famous "Almagest" of Ptolemy, the most important work of ancient astronomy, was translated from a Greek manuscript, as early as 1160, by a medical student of Salerno.(5) (5) Haskins and Lockwood: Harvard Studies in Classical Philology, 1910, XXI, pp. 75-102. About thirty miles southeast of Naples lay Salernum, which for centuries kept alight the lamp of the old learning, and became the centre of medical studies in the Middle Ages; well deserving its name of "Civitas Hippocratica." The date of foundation is uncertain, but Salernitan physicians are mentioned as early as the middle of the ninth century, and from this date until the rise of the universities it was not only a great medical school, but a popular resort for the sick and wounded. As the scholar says in Longfellow's "Golden Legend": Then at every season of the year There are crowds of guests and travellers here; Pilgrims and mendicant friars and traders From the Levant, with figs and wine, And bands of wounded and sick Crusaders, Coming back from Palestine. There were medical and surgical clinics, foundling hospitals, Sisters of Charity, men and women professors--among the latter the famous Trotula--and apothecaries. Dissections were carried out, chiefly upon animals, and human subjects were occasionally used. In the eleventh and twelfth centuries, the school reached its height, and that remarkable genius, Frederick II, laid down regulations for a preliminary study extending over three years, and a course in medicine for five years, including surgery. Fee tables and strict regulations as to practice were made; and it is specifically stated that the masters were to teach in the schools, theoretically and practically, under the authority of Hippocrates and Galen. The literature from the school had a far-reaching influence. One book on the anatomy of the pig illustrates the popular subject for dissection at that time.(6) The writings, which are numerous, have been collected by De Renzi.(7) (6) "And dissections of the bodies of swine As likest the human form divine."--Golden Legend. (7) S. de Renzi: Collectio Salernitana, 5 vols., Naples, 1852-1859; P. Giacosa: Magistri Salernitani, Turin, 1901. The "Antidotarium" of Nicolaus Salernitanus, about 1100, became the popular pharmacopoeia of the Middle Ages, and many modern preparations may be traced to it. The most prominent man of the school is Constantinus Africanus, a native of Carthage, who, after numerous journeys, reached Salernum about the middle of the eleventh century. He was familiar with the works both of the Greeks and of the Arabs, and it was largely through his translations that the works of Rhazes and Avicenna became known in the West. One work above all others spread the fame of the school--the Regimen Sanitatis, or Flos Medicinae as it is sometimes called, a poem on popular medicine. It is dedicated to Robert of Normandy, who had been treated at Salernum, and the lines begin: "Anglorum regi scripsit schola tota Salerni . . . " It is a hand-book of diet and household medicine, with many shrewd and taking sayings which have passed into popular use, such as "Joy, temperance and repose Slam the door on the doctor's nose." A full account of the work and the various editions of it is given by Sir Alexander Croke,(8) and the Finlayson lecture (Glasgow Medical Journal, 1908) by Dr. Norman Moore gives an account of its introduction into the British Isles. (8) Regimen Sanitutis Salernitanum; a Poem on the Preservation of Health in Rhyming Latin Verse, Oxford, D.A. Talboys, 1830. BYZANTINE MEDICINE THE second great stream which carried Greek medicine to modern days runs through the Eastern Empire. Between the third century and the fall of Constantinople there was a continuous series of Byzantine physicians whose inspiration was largely derived from the old Greek sources. The most distinguished of these was Oribasius, a voluminous compiler, a native of Pergamon and so close a follower of his great townsman that he has been called "Galen's ape." He left many works, an edition of which was edited by Bussemaker and Daremberg. Many facts relating to the older writers are recorded in his writings. He was a contemporary, friend as well as the physician, of the Emperor Julian, for whom he prepared an encyclopaedia of the medical sciences. Other important Byzantine writers were Aetius and Alexander of Tralles, both of whom were strongly under the influence of Galen and Hippocrates. Their materia medica was based largely upon Dioscorides. From Byzantium we have the earliest known complete medical manuscript, dating from the fifth century--a work of Dioscorides--one of the most beautiful in existence. It was prepared for Anicia Juliana, daughter of the Emperor of the East, and is now one of the great treasures of the Imperial Library at Vienna.(9) From those early centuries till the fall of Constantinople there is very little of interest medically. A few names stand out prominently, but it is mainly a blank period in our records. Perhaps one man may be mentioned, as he had a great influence on later ages--Actuarius, who lived about 1300, and whose book on the urine laid the foundation of much of the popular uroscopy and water-casting that had such a vogue in the sixteenth and seventeenth centuries. His work on the subject passed through a dozen Latin editions, but is best studied in Ideler's "Physici et medici Graeci minores" (Berlin, 1841). (9) It has been reproduced by Seatone de Vries, Leyden, 1905, Codices graeci et latini photographice depicti, Vol. X. The Byzantine stream of Greek medicine had dwindled to a very tiny rill when the fall of Constantinople (1453) dispersed to the West many Greek scholars and many precious manuscripts. ARABIAN MEDICINE THE third and by far the strongest branch of the Greek river reached the West after a remarkable and meandering course. The map before you shows the distribution of the Graeco-Roman Christian world at the beginning of the seventh century. You will notice that Christianity had extended far eastwards, almost to China. Most of those eastern Christians were Nestorians and one of their important centres was Edessa, whose school of learning became so celebrated. Here in the fifth century was built one of the most celebrated hospitals of antiquity. Now look at another map showing the same countries about a century later. No such phenomenal change ever was made within so short space of time as that which thus altered the map of Asia and Europe at this period. Within a century, the Crescent had swept from Arabia through the Eastern Empire, over Egypt, North Africa and over Spain in the West, and the fate of Western Europe hung in the balance before the gates of Tours in 732. This time the barbaric horde that laid waste a large part of Christendom were a people that became deeply appreciative of all that was best in Graeco-Roman civilization and of nothing more than of its sciences. The cultivation of medicine was encouraged by the Arabs in a very special way. Anyone wishing to follow the history of the medical profession among this remarkable people will find it admirably presented in Lucien Leclerc's "Histoire de la medecine arabe" (Paris, 1876). An excellent account is also given in Freind's well-known "History of Medicine" (London, 1725-1726). Here I can only indicate very briefly the course of the stream and its freightage. With the rise of Christianity, Alexandria became a centre of bitter theological and political factions, the story of which haunts the memory of anyone who was so fortunate as to read in his youth Kingsley's "Hypatia." These centuries, with their potent influence of neoplatonism on Christianity, appear to have been sterile enough in medicine. I have already referred to the late Greeks, Aetius and Alexander of Tralles. The last of the Alexandrians was a remarkable man, Paul of AEgina, a great name in medicine and in surgery, who lived in the early part of the seventh century. He also, like Oribasius, was a great compiler. In the year 640, the Arabs took Alexandria, and for the third time a great library was destroyed in the "first city of the West." Shortly after the conquest of Egypt, Greek works were translated into Arabic, often through the medium of Syriac, particularly certain of Galen's books on medicine, and chemical writings, which appear to have laid the foundation of Arabian knowledge on this subject. Through Alexandria then was one source: but the special development of the Greek science and of medicine took place in the ninth century under the Eastern Caliphates. Let me quote here a couple of sentences from Leclerc (Tome I, pp. 91-92): "The world has but once witnessed so marvellous a spectacle as that presented by the Arabs in the ninth century. This pastoral people, whose fanaticism had suddenly made them masters of half of the world, having once founded their empire, immediately set themselves to acquire that knowledge of the sciences which alone was lacking to their greatness. Of all the invaders who competed for the last remains of the Roman Empire they alone pursued such studies; while the Germanic hordes, glorying in their brutality and ignorance, took a thousand years to re-unite the broken chain of tradition, the Arabs accomplished this in less than a century. They provoked the competition of the conquered Christians--a healthy competition which secured the harmony of the races. "At the end of the eighth century, their whole scientific possessions consisted of a translation of one medical treatise and some books on alchemy. Before the ninth century had run to its close, the Arabs were in possession of all the science of the Greeks; they had produced from their own ranks students of the first order, and had raised among their initiators men who, without them, would have been groping in the dark; and they showed from this time an aptitude for the exact sciences, which was lacking in their instructors, whom they henceforward surpassed." It was chiefly through the Nestorians that the Arabs became acquainted with Greek medicine, and there were two famous families of translators, the Bakhtishuas and the Mesues, both Syrians, and probably not very thoroughly versed in either Greek or Arabic. But the prince of translators, one of the finest figures of the century, was Honein, a Christian Arab, born in 809, whose name was Latinized as Joannitius. "The marvellous extent of his works, their excellence, their importance, the trials he bore nobly at the beginning of his career, everything about him arouses our interest and sympathy. If he did not actually create the Oriental renaissance movement, certainly no one played in it a more active, decided and fruitful part."(10) His industry was colossal. He translated most of the works of Hippocrates and Galen, Aristotle and many others. His famous "Introduction" or "Isagoge," a very popular book in the Middle Ages, is a translation of the "Microtegni" of Galen, a small hand-book, of which a translation is appended to Cholmeley's "John of Gaddesden."(11) The first printed edition of it appeared in 1475 (see Chapter IV) at Padua. (10) Leclerc: Histoire de la medecine arabe, Tome I, p. 139. (11) Oxford, Clarendon Press, 1912, pp. 136-166. The Mesues also did great work, and translations of their compilations, particularly those of the younger Mesue, were widely distributed in manuscript and were early printed (Venice, 1471) and frequently reprinted, even as late as the seventeenth century. Leclerc gives the names of more than one hundred known translators who not only dealt with the physicians but with the Greek philosophers, mathematicians and astronomers. The writings of the physicians of India and of Persia were also translated into Arabic. But close upon the crowd of translators who introduced the learning of Greece to the Arabians came original observers of the first rank, to a few only of whom time will allow me to refer. Rhazes, so called from the name of the town (Rai) in which he was born, was educated at the great hospital at Bagdad in the second half of the ninth century. With a true Hippocratic spirit he made many careful observations on disease, and to him we owe the first accurate account of smallpox, which he differentiated from measles. This work was translated for the old Sydenham Society by W.A. Greenhill (1848), and the description given of the disease is well worth reading. He was a man of strong powers of observation, good sense and excellent judgment. His works were very popular, particularly the gigantic "Continens," one of the bulkiest of incunabula. The Brescia edition, 1486, a magnificent volume, extends over 588 pages and it must weigh more than seventeen pounds. It is an encyclopaedia filled with extracts from the Greek and other writers, interspersed with memoranda of his own experiences. His "Almansor" was a very popular text-book, and one of the first to be printed. Book IX of "Almansor" (the name of the prince to whom it was addressed) with the title "De aegritudinibus a capite usque ad pedes," was a very favorite mediaeval text-book. On account of his zeal for study Rhazes was known as the "Experimentator." The first of the Arabians, known throughout the Middle Ages as the Prince, the rival, indeed, of Galen, was the Persian Ibn Sina, better known as Avicenna, one of the greatest names in the history of medicine. Born about 980 A. D. in the province of Khorasan, near Bokhara, he has left a brief autobiography from which we learn something of his early years. He could repeat the Koran by heart when ten years old, and at twelve he had disputed in law and in logic. So that he found medicine was an easy subject, not hard and thorny like mathematics and metaphysics! He worked night and day, and could solve problems in his dreams. "When I found a difficulty," he says, "I referred to my notes and prayed to the Creator. At night, when weak or sleepy, I strengthened myself with a glass of wine."(12) He was a voluminous writer to whom scores of books are attributed, and he is the author of the most famous medical text-book ever written. It is safe to say that the "Canon" was a medical bible for a longer period than any other work. It "stands for the epitome of all precedent development, the final codification of all Graeco-Arabic medicine. It is a hierarchy of laws liberally illustrated by facts which so ingeniously rule and are subject to one another, stay and uphold one another, that admiration is compelled for the sagacity of the great organiser who, with unparalleled power of systematisation, collecting his material from all sources, constructed so imposing an edifice of fallacy. Avicenna, according to his lights, imparted to contemporary medical science the appearance of almost mathematical accuracy, whilst the art of therapeutics, although empiricism did not wholly lack recognition, was deduced as a logical sequence from theoretical (Galenic and Aristotelian) premises. Is it, therefore, matter for surprise that the majority of investigators and practitioners should have fallen under the spell of this consummation of formalism and should have regarded the 'Canon' as an infallible oracle, the more so in that the logical construction was impeccable and the premises, in the light of contemporary conceptions, passed for incontrovertible axioms?"(13) (12) Withington: Medical History, London, 1894, pp. 151-152. (13) Neuburger: History of Medicine, Vol. I, pp. 368-369. Innumerable manuscripts of it exist: of one of the most beautiful, a Hebrew version (Bologna Library), I give an illustration. A Latin version was printed in 1472 and there are many later editions, the last in 1663. Avicenna was not only a successful writer, but the prototype of the successful physician who was at the same time statesman, teacher, philosopher and literary man. Rumor has it that he became dissipated, and a contemporary saying was that all his philosophy could not make him moral, nor all his physic teach him to preserve his health. He enjoyed a great reputation as a poet. I reproduce a page of a manuscript of one of his poems, which we have in the Bodleian Library. Prof. A.V.W. Jackson says that some of his verse is peculiarly Khayyamesque, though he antedated Omar by a century. That "large Infidel" might well have written such a stanza as From Earth's dark centre unto Saturn's Gate I've solved all problems of this world's Estate, From every snare of Plot and Guile set free, Each bond resolved, saving alone Death's Fate. His hymn to the Deity might have been written by Plato and rivals the famous one of Cleanthes.(14) A casual reader gets a very favorable impression of Avicenna. The story of his dominion over the schools in the Middle Ages is one of the most striking in our history. Perhaps we feel that Leclerc exaggerates when he says: "Avicenna is an intellectual phenomenon. Never perhaps has an example been seen of so precocious, quick and wide an intellect extending and asserting itself with so strange and indefatigable an activity." The touch of the man never reached me until I read some of his mystical and philosophical writings translated by Mehren.(15) It is Plato over again. The beautiful allegory in which men are likened to birds snared and caged until set free by the Angel of Death might be met with anywhere in the immortal Dialogues. The tractate on Love is a commentary on the Symposium; and the essay on Destiny is Greek in spirit without a trace of Oriental fatalism, as you may judge from the concluding sentence, which I leave you as his special message: "Take heed to the limits of your capacity and you will arrive at a knowledge of the truth! How true is the saying:--Work ever and to each will come that measure of success for which Nature has designed him." Avicenna died in his fifty-eighth year. When he saw that physic was of no avail, resigning himself to the inevitable, he sold his goods, distributed the money to the poor, read the Koran through once every three days, and died in the holy month of Ramadan. His tomb at Hamadan, the ancient Ecbatana, still exists, a simple brickwork building, rectangular in shape, and surrounded by an unpretentious court. It was restored in 1877, but is again in need of repair. The illustration here shown is from a photograph sent by Dr. Neligan of Teheran. Though dead, the great Persian has still a large practice, as his tomb is much visited by pilgrims, among whom cures are said to be not uncommon. (14) "L'hymne d'Avicenne" in: L'Elegie du Tograi, etc., par P. Vattier, Paris, 1660. (15) Traites mystiques d'Abou Ali al-Hosain b. Abdallah b. Sina ou d'Avicenne par M. A. F. Mehren, Leyden, E. J. Brill, Fasc. I-IV, 1889-1899. The Western Caliphate produced physicians and philosophers almost as brilliant as those of the East. Remarkable schools of medicine were founded at Seville, Toledo and Cordova. The most famous of the professors were Averroes, Albucasis and Avenzoar. Albucasis was "the Arabian restorer of surgery." Averroes, called in the Middle Ages "the Soul of Aristotle" or "the Commentator," is better known today among philosophers than physicians. On the revival of Moslem orthodoxy he fell upon evil days, was persecuted as a free-thinker, and the saying is attributed to him--"Sit anima mea cum philosophic." Arabian medicine had certain very definite characteristics: the basis was Greek, derived from translations of the works of Hippocrates and Galen. No contributions were made to anatomy, as dissections were prohibited, nor to physiology, and the pathology was practically that of Galen. Certain new and important diseases were described; a number of new and active remedies were introduced, chiefly from the vegetable kingdom. The Arabian hospitals were well organized and were deservedly famous. No such hospital exists today in Cairo as that which was built by al-Mansur Gilafun in 1283. The description of it by Makrizi, quoted by Neuburger,(16) reads like that of a twentieth century institution with hospital units. (16) "I have founded this institution for my equals and for those beneath me, it is intended for rulers and subjects, for soldiers and for the emir, for great and small, freemen and slaves, men and women." "He ordered medicaments, physicians and everything else that could be required by anyone in any form of sickness; placed male and female attendants at the disposal of the patients, determined their pay, provided beds for patients and supplied them with every kind of covering that could be required in any complaint. Every class of patient was accorded separate accommodation: the four halls of the hospital were set apart for those with fever and similar complaints; one part of the building was reserved for eye-patients, one for the wounded, one for those suffering from diarrhoea, one for women; a room for convalescents was divided into two parts, one for men and one for women. Water was laid on to all these departments. One room was set apart for cooking food, preparing medicine and cooking syrups, another for the compounding of confections, balsams, eye-salves, etc. The head-physician had an apartment to himself wherein he delivered medical lectures. The number of patients was unlimited, every sick or poor person who came found admittance, nor was the duration of his stay restricted, and even those who were sick at home were supplied with every necessity."--Makrizi. "In later times this hospital was much extended and improved. The nursing was admirable and no stint was made of drugs and appliances; each patient was provided with means upon leaving so that he should not require immediately to undertake heavy work." Neuburger: History of Medicine, Vol. 1, p. 378. It was in the domain of chemistry that the Arabs made the greatest advances. You may remember that, in Egypt, chemistry had already made considerable strides, and I alluded to Prof. Elliot Smith's view that one of the great leaps in civilization was the discovery in the Nile Valley of the metallurgy of copper. In the brilliant period of the Ptolemies, both chemistry and pharmacology were studied, and it seems not improbable that, when the Arabs took Alexandria in the year 640, there were still many workers in these subjects. The most famous of those early Arabic writers is the somewhat mythical Geber, who lived in the first half of the eighth century, and whose writings had an extraordinary influence throughout the Middle Ages. The whole story of Geber is discussed by Berthelot in his "La chimie au moyen age" (Paris, 1896). The transmission of Arabian science to the Occident began with the Crusades, though earlier a filtering of important knowledge in mathematics and astronomy had reached Southern and Middle Europe through Spain. Among the translators several names stand out prominently. Gerbert, who became later Pope Sylvester II, is said to have given us our present Arabic figures. You may read the story of his remarkable life in Taylor,(17) who says he was "the first mind of his time, its greatest teacher, its most eager learner, and most universal scholar." But he does not seem to have done much directly for medicine. (17) The Mediaeval Mind, Vol. I, p. 280. The Graeco-Arabic learning passed into Europe through two sources. As I have already mentioned, Constantinus Africanus, a North African Christian monk, widely travelled and learned in languages, came to Salernum and translated many works from Arabic into Latin, particularly those of Hippocrates and Galen. The "Pantegni" of the latter became one of the most popular text-books of the Middle Ages. A long list of other works which he translated is given by Steinschneider.(17a) It is not unlikely that Arabic medicine had already found its way to Salernum before the time of Constantine, but the influence of his translations upon the later Middle Ages was very great. (17a) Steinschneider: Virchow's Arch., Berl., 1867, xxxvii, 351. The second was a more important source through the Latin translators in Spain, particularly in Toledo, where, from the middle of the twelfth till the middle of the thirteenth century, an extraordinary number of Arabic works in philosophy, mathematics and astronomy were translated. Among the translators, Gerard of Cremona is prominent, and has been called the "Father of Translators." He was one of the brightest intelligences of the Middle Ages, and did a work of the first importance to science, through the extraordinary variety of material he put in circulation. Translations, not only of the medical writers, but of an indiscriminate crowd of authors in philosophy and general literature, came from his pen. He furnished one of the first translations of the famous "Almagest" of Ptolemy, which opened the eyes of his contemporaries to the value of the Alexandrian astronomy.(18) Leclerc gives a list of seventy-one works from his hand. (18) For an account of that remarkable work see German translation by Manitius, Leipzig, 1912. Many of the translators of the period were Jews, and many of the works were translated from Hebrew into Latin. For years Arabic had been the learned language of the Jews, and in a large measure it was through them that the Arabic knowledge and the translations passed into South and Central Europe. The Arab writer whose influence on mediaeval thought was the most profound was Averroes, the great commentator on Aristotle. THE RISE OF THE UNIVERSITIES THE most striking intellectual phenomenon of the thirteenth century is the rise of the universities. The story of their foundation is fully stated in Rashdall's great work (Universities of Europe in the Middle Ages, Oxford, 1895). Monastic and collegiate schools, seats of learning like Salernum, student guilds as at Bologna, had tried to meet the educational needs of the age. The word "university" literally means an association, and was not at first restricted to learned bodies. The origin appears to have been in certain guilds of students formed for mutual protection associated at some place specially favorable for study--the attraction generally being a famous teacher. The University of Bologna grew up about guilds formed by students of law, and at Paris, early in the twelfth century, there were communities of teachers, chiefly in philosophy and theology. In this way arose two different types of mediaeval university. The universities of Northern Italy were largely controlled by students, who were grouped in different "nations." They arranged the lectures and had control of the appointment of teachers. On the other hand, in the universities founded on the Paris model the masters had control of the studies, though the students, also in nations, managed their own affairs. Two universities have a special interest at this period in connection with the development of medical studies, Bologna and Montpellier. At the former the study of anatomy was revived. In the knowledge of the structure of the human body no advance had been made for more than a thousand years--since Galen's day. In the process of translation from Greek to Syriac, from Syriac to Arabic, from Arabic to Hebrew, and from Hebrew or Arabic to Latin, both the form and thought of the old Greek writers were not infrequently confused and often even perverted, and Galen's anatomy had suffered severely in the transmission. Our earliest knowledge of the teaching of medicine at Bologna is connected with a contemporary of Dante, Taddeo Alderotti, who combined Arabian erudition with the Greek spirit. He occupied a position of extraordinary prominence, was regarded as the first citizen of Bologna and a public benefactor exempt from the payment of taxes. That he should have acquired wealth is not surprising if his usual fees were at the rate at which he charged Pope Honorius IV, i.e., two hundred florins a day, besides a "gratification" of six thousand florins. The man who most powerfully influenced the study of medicine in Bologna was Mundinus, the first modern student of anatomy. We have seen that at the school of Salernum it was decreed that the human body should be dissected at least once every five years, but it was with the greatest difficulty that permission was obtained for this purpose. It seems probable that under the strong influence of Taddeo there was an occasional dissection at Bologna, but it was not until Mundinus (professor from 1306 to 1326) took the chair that the study of anatomy became popular. The bodies were usually those of condemned criminals, but in the year 1319 there is a record of a legal procedure against four medical students for body-snatching--the first record, as far as I know, of this gruesome practice. In 1316, Mundinus issued his work on anatomy, which served as a text-book for more than two hundred years. He quotes from Galen the amusing reasons why a man should write a book: "Firstly, to satisfy his own friends; secondly, to exercise his best mental powers; and thirdly, to be saved from the oblivion incident to old age." Scores of manuscripts of his work must have existed, but they are now excessively rare in Italy. The book was first printed at Pavia in 1478, in a small folio without figures. It was very often reprinted in the fifteenth and sixteenth centuries. The quaint illustration shows us the mediaeval method of teaching anatomy: the lecturer sitting on a chair reading from Galen, while a barber surgeon, or an "Ostensor," opens the cavities of the body. I have already referred to the study of medicine by women at Salernum. Their names are also early met with in the school of Bologna. Mundinus is said to have had a valuable assistant, a young girl, Alessandra Giliani, an enthusiastic dissector, who was the first to practice the injection of the blood vessels with colored liquids. She died, consumed by her labors, at the early age of nineteen, and her monument is still to be seen. Bologna honored its distinguished professors with magnificent tombs, sixteen or seventeen of which, in a wonderful state of preservation, may still be seen in the Civic Museum. That of Mundinus also exists--a sepulchral bas-relief on the wall of the Church of San Vitale at Bologna.(19) (19) For these figures and for points relating to the old school at Bologna see F. G. Cavezza: Le Scuole dell' antico Studio Bolognese, Milano, 1896. The other early mediaeval university of special interest in medicine is that of Montpellier. With it are connected three teachers who have left great names in our story--Arnold of Villanova, Henri de Mondeville and Guy de Chauliac. The city was very favorably situated not far from the Spanish border, and the receding tide of the Arab invasion in the eighth century had left a strong Arabic influence in that province. The date of the origin of the university is uncertain, but there were teachers of medicine there in the twelfth century, though it was not until 1289 that it was formally founded by a papal bull. Arnold of Villanova was one of the most prolific writers of the Middle Ages. He had travelled much, was deeply read in Arabic medicine and was also a student of law and of philosophy. He was an early editor of the Regimen Sanitatis, and a strong advocate of diet and hygiene. His views on disease were largely those of the Arabian physicians, and we cannot see that he himself made any very important contribution to our knowledge; but he was a man of strong individuality and left an enduring mark on mediaeval medicine, as one may judge from the fact that among the first hundred medical books printed there were many associated with his name. He was constantly in trouble with the Church, though befriended by the Popes on account of his medical knowledge. There is a Bull of Clement V asking the bishops to search for a medical book by Arnold dedicated to himself, but not many years later his writings were condemned as heretical. In Henri de Mondeville we have the typical mediaeval surgeon, and we know his work now very thoroughly from the editions of his "Anatomy" and "Surgery" edited by Pagel (Berlin, 1889-1892), and the fine French edition by Nicaise (Paris, 1893). The dominant Arabic influence is seen in that he quotes so large a proportion of these authors, but he was an independent observer and a practical surgeon of the first rank. He had a sharp wit and employed a bitter tongue against the medical abuses of his day. How the Hippocratic humors dominated practice at this time you may see at a glance from the table prepared by Nicaise from the works of de Mondeville. We have here the whole pathology of the period. =============================================================== TABLEAU DES HUMEURS D'APRES H. DE MONDEVILLE Flegme naturel. F. aqueux. Flegme F. mucilagineux. F. vitreux. Flegme non naturel F sale. F. doux. F. pontique, 2 especes. F. acide, 2 especes. Bile naturelle. Bile B. citrine. B. vitelline Bile non naturelle B. praline. B. aerugineuse. B. brulee, 3 especes. Sang naturel. non naturel, 5 especes. Melancolie naturelle. non naturelle, 5 especes. =============================================================== A still greater name in the history of this school is Guy de Chauliac, whose works have also been edited by Nicaise (Paris, 1890). His "Surgery" was one of the most important text-books of the late Middle Ages. There are many manuscripts of it, some fourteen editions in the fifteenth century and thirty-eight in the sixteenth, and it continued to be reprinted far into the seventeenth century. He too was dominated by the surgery of the Arabs, and on nearly every page one reads of the sages Avicenna, Albucasis or Rhazes. He lays down four conditions necessary for the making of a surgeon--the first is that he must be learned, the second, expert, the third that he should be clever, and the fourth that he should be well disciplined. You will find a very discerning sketch of the relation of these two men to the history of surgery in the address given at the St. Louis Congress in 1904 by Sir Clifford Allbutt.(20) They were strong men with practical minds and good hands, whose experience taught them wisdom. In both there was the blunt honesty that so often characterizes a good surgeon, and I commend to modern surgeons de Mondeville's saying: "If you have operated conscientiously on the rich for a proper fee, and on the poor for charity, you need not play the monk, nor make pilgrimages for your soul." (20) Allbutt: Historical Relations of Medicine and Surgery, London, Macmillan Co., 1905. One other great mediaeval physician may be mentioned, Peter of Abano (a small town near Padua, famous for its baths). He is the first in a long line of distinguished physicians connected with the great school of Padua. Known as "the Conciliator," from his attempt to reconcile the diverse views on philosophy and medicine, he had an extraordinary reputation as a practitioner and author, the persistence of which is well illustrated by the fact that eight of the one hundred and eighty-two medical books printed before 1481 were from his pen. He seems to have taught medicine in Paris, Bologna and Padua. He was a devoted astrologer, had a reputation among the people as a magician and, like his contemporary, Arnold of Villanova, came into conflict with the Church and appears to have been several times before the Inquisition; indeed it is said that he escaped the stake only by a timely death. He was a prolific commentator on Aristotle, and his exposition of the "problems" had a great vogue. The early editions of his texts are among the most superb works ever printed. He outlived his reputation as a magician, and more than a century after his death Frederick, Duke of Urbino, caused his effigies to be set up over the gate of the palace at Padua with this inscription: PETRUS APONUS PATAVINUS PHILOSOPHIAE MEDICINAEQUE SCIENTISSIMUS, OB IDQUE, CONCILIATORIS NOMEN ADEPTUS, ASTROLOGIAE VERO ADEO PERITUS, UT IN MAGIAE SUSPICIONEM INCIDERIT, FALSOQUE DE HAERESI POSTULATUS, ABSOLUTUS FUERIT.(21) (21) Naude: History of Magick, London, 1657, p. 182, or the original: Apologie pour les grands hommes soupconnez de magic, e.g., ed. Amst., 1719, p. 275. It is said that Abano caused to be painted the astronomical figures in the great hall of the palace at Padua. One characteristic of mediaeval medicine is its union with theology, which is not remarkable, as the learning of the time was chiefly in the hands of the clergy. One of the most popular works, the "Thesaurus Pauperum," was written by Petrus Hispanus, afterwards Pope John XXI. We may judge of the pontifical practice from the page here reproduced, which probably includes, under the term "iliac passion," all varieties of appendicitis. For our purpose two beacons illuminate the spirit of the thirteenth century in its outlook on man and nature. Better than Abelard or St. Thomas Aquinas, and much better than any physicians, Albertus Magnus and Roger Bacon represent the men who were awake to greet the rising of the sun of science. What a contrast in their lives and in their works! The great Dominican's long life was an uninterrupted triumph of fruitful accomplishment--the titanic task he set himself was not only completed but was appreciated to the full by his own generation--a life not only of study and teaching, but of practical piety. As head of the order in Germany and Bishop of Regensburg, he had wide ecclesiastical influence; and in death he left a memory equalled only by one or two of his century, and excelled only by his great pupil, Thomas Aquinas. There are many Alberts in history--the Good, the Just, the Faithful--but there is only one we call "Magnus" and he richly deserved the name. What is his record? Why do we hold his name in reverence today? Albertus Magnus was an encyclopaedic student and author, who took all knowledge for his province. His great work and his great ambition was to interpret Aristotle to his generation. Before his day, the Stagirite was known only in part, but he put within the reach of his contemporaries the whole science of Aristotle, and imbibed no small part of his spirit. He recognized the importance of the study of nature, even of testing it by way of experiment, and in the long years that had elapsed since Theophrastus no one else, except Dioscorides, had made so thorough a study of botany. His paraphrases of the natural history books of Aristotle were immensely popular, and served as a basis for all subsequent studies. Some of his medical works had an extraordinary vogue, particularly the "De Secretis Mulierum" and the "De Virtutibus Herbarum," but there is some doubt as to the authorship of the first named, although Jammy and Borgnet include it in the collected editions of his works. So fabulous was his learning that he was suspected of magic and comes in Naude's list of the wise men who have unjustly been reputed magicians. Ferguson tells(22) that "there is in actual circulation at the present time a chapbook . . . containing charms, receipts, sympathetical and magicalcures for man and animals, . . . which passes under the name of Albertus." But perhaps the greatest claim of Albertus to immortality is that he was the teacher and inspirer of Thomas Aquinas, the man who undertook the colossal task of fusing Aristotelian philosophy with Christian theology, and with such success that the "angelic doctor" remains today the supreme human authority of the Roman Catholic Church. (22) Bibliotheca Chemica, 1906, Vol. I, p. 15. A man of much greater interest to us from the medical point of view is Roger Bacon and for two reasons. More than any other mediaeval mind he saw the need of the study of nature by a new method. The man who could write such a sentence as this: "Experimental science has three great prerogatives over other sciences; it verifies conclusions by direct experiment; it discovers truth which they never otherwise would reach; it investigates the course of nature and opens to us a knowledge of the past and of the future," is mentally of our day and generation. Bacon was born out of due time, and his contemporaries had little sympathy with his philosophy, and still less with his mechanical schemes and inventions. From the days of the Greeks, no one had had so keen an appreciation of what experiment meant in the development of human knowledge, and he was obsessed with the idea, so commonplace to us, that knowledge should have its utility and its practical bearing. "His chief merit is that he was one of the first to point the way to original research--as opposed to the acceptance of an authority--though he himself still lacked the means of pursuing this path consistently. His inability to satisfy this impulse led to a sort of longing, which is expressed in the numerous passages in his works where he anticipates man's greater mastery over nature."(23) (23) Dannemann: Die Naturwissenschaften in ihrer Entwicklung und in ibrem Zusammenhange, Leipzig, 1910, Vol. I, pp. 278-279. Bacon wrote a number of medical treatises, most of which remain in manuscript. His treatise on the "Cure of Old Age and the Preservation of Youth" was printed in English in 1683.(24) His authorities were largely Arabian. One of his manuscripts is "On the Bad Practices of Physicians." On June 10, 1914, the eve of his birth, the septencentenary of Roger Bacon will be celebrated by Oxford, the university of which he is the most distinguished ornament. His unpublished MSS. in the Bodleian will be issued by the Clarendon Press (1915-1920), and it is hoped that his unpublished medical writings will be included. (24) It may be interesting to note the three causes to which he attributes old age: "As the World waxeth old, Men grow old with it: not by reason of the Age of the World, but because of the great Increase of living Creatures, which infect the very Air, that every way encompasseth us, and Through our Negligence in ordering our Lives, and That great Ignorance of the Properties which are in things conducing to Health, which might help a disordered way of Living, and might supply the defect of due Government." What would have been its fate if the mind of Europe had been ready for Roger Bacon's ferment, and if men had turned to the profitable studies of physics, astronomy and chemistry instead of wasting centuries over the scholastic philosophy and the subtleties of Duns Scotus, Abelard and Thomas Aquinas? Who can say? Make no mistake about the quality of these men--giants in intellect, who have had their place in the evolution of the race; but from the standpoint of man struggling for the mastery of this world they are like the members of Swift's famous college "busy distilling sunshine from cucumbers." I speak, of course, from the position of the natural man, who sees for his fellows more hope from the experiments of Roger Bacon than from the disputations of philosophy on the "Instants, Familiarities, Quiddities and Relations," which so roused the scorn of Erasmus. MEDIAEVAL MEDICAL STUDIES IT will be of interest to know what studies were followed at a mediaeval university. At Oxford, as at most of the continental universities, there were three degrees, those of Bachelor, Licentiate and Doctor. The books read were the "Tegni" of Galen, the "Aphorisms" of Hippocrates, the "De Febribus" of Isaac and the "Antidotarium" of Nicolaus Salernitanus: if a graduate in arts, six years' study in all was required, in other faculties, eight. One gets very full information on such matters from a most interesting book, "Une Chaire de Medecine au XVe Siecle," by Dr. Ferrari (Paris, 1899). The University of Pavia was founded in 1361, and like most of those in Italy was largely frequented by foreigners, who were arranged, as usual, according to their nationalities; but the students do not appear to have controlled the university quite so much as at Bologna. The documents of the Ferrari family, on which the work is based, tell the story of one of its members, who was professor at Pavia from 1432 to 1472. One is surprised at the range of studies in certain directions, and still more at the absence of other subjects. A list is given of the teachers in medicine for the year 1433, twenty in all, and there were special lectures for the morning, afternoon and evening. The subjects are medicine, practical medicine, physics, metaphysics, logic, astrology, surgery and rhetoric: very striking is the omission of anatomy, which does not appear in the list even in 1467. The salaries paid were not large, so that most of the teachers must have been in practice: four hundred and five hundred florins was the maximum. The dominance of the Arabians is striking. In 1467, special lectures were given on the "Almansor" of Rhazes, and in the catalogue of the Ferrari's library more than one half of the books are Arabian commentaries on Greek medicine. Still more striking evidence of their influence is found in the text-book of Ferrari, which was printed in 1471 and had been circulated earlier in MS. In it Avicenna is quoted more than 3000 times, Rhazes and Galen 1000, Hippocrates only 140 times. Professor Ferrari was a man who played an important role in the university, and had a large consultation practice. You will be interested to know what sort of advice he gave in special cases. I have the record of an elaborate consultation written in his own hand, from which one may gather what a formidable thing it was to fall into the hands of a mediaeval physician. Signor John de Calabria had a digestive weakness of the stomach, and rheumatic cerebral disease, combined with superfluous heat and dryness of the liver and multiplication of choler. There is first an elaborate discussion on diet and general mode of life; then he proceeds to draw up certain light medicines as a supplement, but it must have taken an extensive apothecary's shop to turn out the twenty-two prescriptions designed to meet every possible contingency. One of the difficulties in the early days of the universities was to procure good MSS. In the Paris Faculty, the records of which are the most complete in Europe, there is an inventory for the year 1395 which gives a list of twelve volumes, nearly all by Arabian authors.(25) Franklin gives an interesting incident illustrating the rarity of medical MSS. at this period. Louis XI, always worried about his health, was anxious to have in his library the works of Rhazes. The only copy available was in the library of the medical school. The manuscript was lent, but on excellent security, and it is nice to know that it was returned. (25) Franklin: Recherches sur la Bibliotheque de la Faculte de Medecine de Paris, 1864. It is said that one of the special advantages that Montpellier had over Paris was its possession of so many important MSS., particularly those of the Arabian writers. Many "Compendia" were written containing extracts from various writers, and no doubt these were extensively copied and lent or sold to students. At Bologna and Padua, there were regulations as to the price of these MSS. The university controlled the production of them, and stationers were liable to fines for inaccurate copies. The trade must have been extensive in those early days, as Rashdall mentions that in 1323 there were twenty-eight sworn booksellers in Paris, besides keepers of bookstalls in the open air. MEDIAEVAL PRACTICE THE Greek doctrine of the four humors colored all the conceptions of disease; upon their harmony alone it was thought that health depended. The four temperaments, sanguine, phlegmatic, bilious and melancholic, corresponded with the prevalence of these humors. The body was composed of certain so-called "naturals," seven in number--the elements, the temperaments, the humors, the members or parts, the virtues or faculties, the operations or functions and the spirits. Certain "non-naturals," nine in number, preserved the health of the body, viz. air, food and drink, movement and repose, sleeping and waking, excretion and retention, and the passions. Disease was due usually to alterations in the composition of the humors, and the indications for treatment were in accordance with these doctrines. They were to be evacuated, tenuated, cooled, heated, purged or strengthened. This humoral doctrine prevailed throughout the Middle Ages, and reached far into modern times--indeed, echoes of it are still to be heard in popular conversations on the nature of disease. The Arabians were famous for their vigor and resource in matters of treatment. Bleeding was the first resort in a large majority of all diseases. In the "Practice" of Ferrari there is scarcely a malady for which it is not recommended. All remedies were directed to the regulation of the six non-naturals, and they either preserved health, cured the disease or did the opposite. The most popular medicines were derived from the vegetable kingdom, and as they were chiefly those recommended by Galen, they were, and still are, called by his name. Many important mineral medicines were introduced by the Arabians, particularly mercury, antimony, iron, etc. There were in addition scores of substances, the parts or products of animals, some harmless, others salutary, others again useless and disgusting. Minor surgery was in the hands of the barbers, who performed all the minor operations, such as bleeding; the more important operations, few in number, were performed by surgeons. ASTROLOGY AND DIVINATION AT this period astrology, which included astronomy, was everywhere taught. In the "Gouernaunce of Prynces, or Pryvete of Pryveties," translated by James Yonge, 1422,(26) there occurs the statement: "As Galian the lull wies leche Saith and Isoder the Gode clerk, hit witnessith that a man may not perfitely can the sciens and craft of Medissin but yef he be an astronomoure." (26) Early English Text Society, Extra Series, No. LXXIV, p. 195, 1898; Secreta Secretorum, Rawl. MS. B., 490. We have seen how the practice of astrology spread from Babylonia and Greece throughout the Roman Empire. It was carried on into the Middle Ages as an active and aggressive cult, looked upon askance at times by the Church, but countenanced by the courts, encouraged at the universities, and always by the public. In the curriculum of the mediaeval university, astronomy made up with music, arithmetic and geometry the Quadrivium. In the early faculties, astronomy and astrology were not separate, and at Bologna, in the early fourteenth century, we meet with a professorship of astrology.(27) One of the duties of this salaried professor, was to supply "judgements" gratis for the benefit of enquiring students, a treacherous and delicate assignment, as that most distinguished occupant of the chair at Bologna, Cecco d'Ascoli, found when he was burned at the stake in 1357, a victim of the Florentine Inquisition.(28) (27) Rashdall: Universities of Europe in the Middle Ages, Vol. I, p. 240. (28) Rashdall, l.c., Vol. I, p. 244.--Rashdall also mentions that in the sixteenth century at Oxford there is an instance of a scholar admitted to practice astrology. l.c., Vol. II, p. 458. Roger Bacon himself was a warm believer in judicial astrology and in the influence of the planets, stars and comets on generation, disease and death. Many of the stronger minds of the Renaissance broke away from the follies of the subject. Thus Cornelius Agrippa in reply to the request of a friar to consult the stars on his behalf says:(29) "Judicial astrology is nothing more than the fallacious guess of superstitious men, who have founded a science on uncertain things and are deceived by it: so think nearly all the wise; as such it is ridiculed by some most noble philosophers; Christian theologians reject it, and it is condemned by sacred councils of the Church. Yet you, whose office it is to dissuade others from these vanities, oppressed, or rather blinded by I know not what distress of mind, flee to this as to a sacred augur, and as if there were no God in Israel, that you send to inquire of the god of Ekron." (29) H. Morley: The Life of Henry Cornelius Agrippa, London, 1856, Vol. II, p. 138. In spite of the opposition of the Church astrology held its own; many of the universities at the end of the fifteenth century published almanacs, usually known as "Prognosticons," and the practice was continued far into the sixteenth century. I show you here an illustration. Rabelais, you may remember, when physician to the Hotel Dieu in Lyons, published almanacs for the years 1533, 1535, 1541, 1546. In the title-page he called himself "Doctor of Medicine and Professor of Astrology," and they continued to be printed under his name until 1556. In the preparation of these he must have had his tongue in his cheek, as in his famous "Pantagrueline Prognostication," in which, to satisfy the curiosity of all good companions, he had turned over all the archives of the heavens, calculated the quadratures of the moon, hooked out all that has ever been thought by all the Astrophils, Hypernephilists, Anemophylakes, Uranopets and Ombrophori, and felt on every point with Empedocles.(30) (30) Pantagrueline Prognostication, Rabelais, W. F. Smith's translation, 1893, Vol. II, p. 460. Even physicians of the most distinguished reputation practised judicial astrology. Jerome Cardan was not above earning money by casting horoscopes, and on this subject he wrote one of his most popular books (De Supplemento Almanach, etc., 1543), in which astronomy and astrology are mixed in the truly mediaeval fashion. He gives in it some sixty-seven nativities, remarkable for the events they foretell, with an exposition. One of the accusations brought against him was that he had "attempted to subject to the stars the Lord of the stars and cast our Saviour's horoscope."(31) Cardan professed to have abandoned a practice looked upon with disfavor both by the Church and by the universities, but he returned to it again and again. I show here his own horoscope. That remarkable character, Michael Servetus, the discoverer of the lesser circulation, when a fellow student with Vesalius at Paris, gave lectures upon judicial astrology, which brought him into conflict with the faculty; and the rarest of the Servetus works, rarer even than the "Christianismi Restitutio," is the "Apologetica disceptatio pro astrologia," one copy of which is in the Bibliotheque Nationale. Nor could the new astronomy and the acceptance of the heliocentric views dislocate the popular belief. The literature of the seventeenth century is rich in astrological treatises dealing with medicine. (31) De Thou, Lib. LXII, quoted by Morley in Life of Jerome Cardan, Vol. II, p. 294. No one has ever poured such satire upon the mantic arts as did Rabelais in chapter twenty-five of the third book of "Pantagruel." Panurge goes to consult Her Trippa--the famous Cornelius Agrippa, whose opinion of astrology has already been quoted, but who nevertheless, as court astrologer to Louise of Savoy, had a great contemporary reputation. After looking Panurge in the face and making conclusions by metoposcopy and physiognomy, he casts his horoscope secundum artem, then, taking a branch of tamarisk, a favorite tree from which to get the divining rod, he names some twenty-nine or thirty mantic arts, from pyromancy to necromancy, by which he offers to predict his future. While full of rare humor, this chapter throws an interesting light on the extraordinary number of modes of divination that have been employed. Small wonder that Panurge repented of his visit! I show here the title-page of a popular book by one of the most famous of the English astrological physicians, Nicholas Culpeper. Never was the opinion of sensible men on this subject better expressed than by Sir Thomas Browne:(32) "Nor do we hereby reject or condemn a sober and regulated Astrology; we hold there is more truth therein than in ASTROLOGERS; in some more than many allow, yet in none so much as some pretend. We deny not the influence of the Starres, but often suspect the due application thereof; for though we should affirm that all things were in all things; that Heaven were but Earth Celestified, and earth but Heaven terrestrified, or that each part above had an influence upon its divided affinity below; yet how to single out these relations, and duly to apply their actions, is a work ofttimes to be effected by some revelation, and Cabala from above, rather than any Philosophy, or speculation here below." (32) Sir Thomas Browne: Pseudodoxia Epidemica, Bk. IV, Chap. XIII. (Wilkin's ed., Vol. III, p. 84.) As late as 1699, a thesis was discussed at the Paris Faculty, "Whether comets were harbingers of disease," and in 1707 the Faculty negatived the question propounded in a thesis, "Whether the moon had any sway on the human body." The eighteenth and nineteenth centuries saw, among intelligent men, a progressive weakening of the belief in the subject; but not even the satire of Swift, with his practical joke in predicting and announcing the death of the famous almanac maker, nor contemptuous neglect of the subject of late years sufficed to dispel the belief from the minds of the public. Garth in the Dispensary (1699) satirizes the astrological practitioners of his day: The Sage in Velvet Chair, here lolls at Ease To promise future Health for present Fees Then as from Tripod solemn Sham reveals And what the Stars know nothing of foretell. (Canto ii.) The almanacs of Moore and Zadkiel continue to be published, and remain popular. In London, sandwich men are to be met with carrying advertisements of Chaldeans and Egyptians who offer to tell your fortune by the stars. Even in this country, astrology is still practiced to a surprising extent if one may judge from advertisements in certain papers, and from publications which must have a considerable sale. Many years ago, I had as a patient an estimable astrologer, whose lucrative income was derived from giving people astral information as to the rise and fall of stocks. It is a chapter in the vagaries of the human mind that is worth careful study.(33) Let me commend to your reading the sympathetic story called "A Doctor of Medicine" in the "Rewards and Fairies" of Kipling. The hero is Nicholas Culpeper, Gent., whose picture is here given. One stanza of the poem at the end of the story, "Our Fathers of Old," may be quoted: Wonderful tales had our fathers of old-- Wonderful tales of the herbs and the stars-- The Sun was Lord of the Marigold, Basil and Rocket belonged to Mars. Pat as a sum in division it goes-- (Every plant had a star bespoke)-- Who but Venus should govern the Rose? Who but Jupiter own the Oak? Simply and gravely the facts are told In the wonderful books of our fathers of old. (33) It is not generally known that Stonewall Jackson practiced astrology. Col. J. W. Revere in "Keel and Saddle" (Boston, 1872) tells of meeting Jackson in 1852 on a Mississippi steamer and talking with him on the subject. Some months later, Revere received a letter from Jackson enclosing his (Revere's) horoscope. There was a "culmination of the malign aspect during the first days of May, 1863--both will be exposed to a common danger at the time indicated." At the battle of Chancellorsville, May 9, 1863, Revere saw Jackson mortally wounded! James J. Walsh of New York has written a book of extraordinary interest called "The Thirteenth, Greatest of Centuries." I have not the necessary knowledge to say whether he has made out his case or not for art and for literature. There was certainly a great awakening and, inspired by high ideals, men turned with a true instinct to the belief that there was more in life than could be got out of barren scholastic studies. With many of the strong men of the period one feels the keenest mental sympathy. Grosseteste, the great Clerk of Lincoln, as a scholar, a teacher and a reformer, represents a type of mind that could grow only in fruitful soil. Roger Bacon may be called the first of the moderns--certainly the first to appreciate the extraordinary possibilities which lay in a free and untrammelled study of nature. A century which could produce men capable of building the Gothic cathedrals may well be called one of the great epochs in history, and the age that produced Dante is a golden one in literature. Humanity has been the richer for St. Francis; and Abelard, Albertus and Aquinas form a trio not easy to match, in their special departments, either before or after. But in science, and particularly in medicine, and in the advance of an outlook upon nature, the thirteenth century did not help man very much. Roger Bacon was "a voice crying in the wilderness," and not one of the men I have picked out as specially typical of the period instituted any new departure either in practice or in science. They were servile followers, when not of the Greeks, of the Arabians. This is attested by the barrenness of the century and a half that followed. One would have thought that the stimulus given by Mundinus to the study of anatomy would have borne fruit, but little was done in science during the two and a half centuries that followed the delivery of his lectures and still less in the art. While William of Wykeham was building Winchester Cathedral and Chaucer was writing the Canterbury Tales, John of Gaddesden in practice was blindly following blind leaders whose authority no one dared question. The truth is, from the modern standpoint the thirteenth was not the true dawn brightening more and more unto the perfect day, but a glorious aurora which flickered down again into the arctic night of mediaevalism. To sum up--in medicine the Middle Ages represent a restatement from century to century of the facts and theories of the Greeks modified here and there by Arabian practice. There was, in Francis Bacon's phrase, much iteration, small addition. The schools bowed in humble, slavish submission to Galen and Hippocrates, taking everything from them but their spirit and there was no advance in our knowledge of the structure or function of the body. The Arabians lit a brilliant torch from Grecian lamps and from the eighth to the eleventh centuries the profession reached among them a position of dignity and importance to which it is hard to find a parallel in history. CHAPTER IV -- THE RENAISSANCE AND THE RISE OF ANATOMY AND PHYSIOLOGY THE "reconquest of the classic world of thought was by far the most important achievement of the fifteenth and sixteenth centuries. It absorbed nearly the whole mental energy of the Italians.... The revelation of what men were and what they wrought under the influence of other faiths and other impulses, in distant ages with a different ideal for their aim, not only widened the narrow horizon of the Middle Ages, but it also restored self-confidence to the reason of humanity."(1) (1) J. A. Symonds: The Renaissance in Italy; the Revival of Learning, 1877, p. 52. Everywhere throughout the Middle Ages learning was the handmaid of theology. Even Roger Bacon with his strong appeal for a new method accepted the dominant mediaeval conviction--that all the sciences did but minister to their queen, Theology. A new spirit entered man's heart as he came to look upon learning as a guide to the conduct of life. A revolution was slowly effected in the intellectual world. It is a mistake to think of the Renaissance as a brief period of sudden fruitfulness in the North Italian cities. So far as science is concerned, the thirteenth century was an aurora followed by a long period of darkness, but the fifteenth was a true dawn that brightened more and more unto the perfect day. Always a reflex of its period, medicine joined heartily though slowly in the revolt against mediaevalism. How slowly I did not appreciate until recently. Studying the earliest printed medical works to catch the point of view of the men who were in the thick of the movement up to 1480--which may be taken to include the first quarter of a century of printing--one gets a startling record. The mediaeval mind still dominates: of the sixty-seven authors of one hundred and eighty-two editions of early medical books, twenty-three were men of the thirteenth and fourteenth centuries, thirty men of the fifteenth century, eight wrote in Arabic, several were of the School of Salernum, and only six were of classical antiquity, viz., Pliny (first 1469), Hippocrates (1473) (Hain (*)7247), Galen (1475) (Hain 7237), Aristotle (1476), Celsus (1478), and Dioscorides (1478).(**) (*) This asterisk is used by Hain to indicate that he had seen a copy.--Ed. (**) Data added to a manuscript taken from the author's summary on "Printed Medical Books to 1480" in Transactions of the Bibliographical Society, London, 1916, XIII, 5-8, revised from its "News-Sheet" (February, 1914). "Of neither Hippocrates nor Galen is there an early edition; but in 1473 at Pavia appeared an exposition of the Aphorisms of Hippoerates, and in 1475 at Padua an edition of the Tegni or Notes of Galen." Ibid., p. 6. Osler's unfinished Illustrated Monograph on this subject is now being printed for the Society of which he was President.--Ed. The medical profession gradually caught the new spirit. It has been well said that Greece arose from the dead with the New Testament in the one hand and Aristotle in the other. There was awakened a perfect passion for the old Greek writers, and with it a study of the original sources, which had now become available in many manuscripts. Gradually Hippocrates and Galen came to their own again. Almost every professor of medicine became a student of the MSS. of Aristotle and of the Greek physicians, and before 1530 the presses had poured out a stream of editions. A wave of enthusiasm swept over the profession, and the best energies of its best minds were devoted to a study of the Fathers. Galen became the idol of the schools. A strong revulsion of feeling arose against the Arabians, and Avicenna, the Prince, who had been clothed with an authority only a little less than divine, became anathema. Under the leadership of the Montpellier School, the Arabians made a strong fight, but it was a losing battle all along the line. This group of medical humanists--men who were devoted to the study of the old humanities, as Latin and Greek were called--has had a great and beneficial influence upon the profession. They were for the most part cultivated gentlemen with a triple interest--literature, medicine and natural history. How important is the part they played may be gathered from a glance at the "Lives" given by Bayle in his "Biographic Medicale" (Paris, 1855) between the years 1500 and 1575. More than one half of them had translated or edited works of Hippocrates or Galen; many of them had made important contributions to general literature, and a large proportion of them were naturalists: Leonicenus, Linacre, Champier, Fernel, Fracastorius, Gonthier, Caius, J. Sylvius, Brasavola, Fuchsius, Matthiolus, Conrad Gesner, to mention only those I know best, form a great group. Linacre edited Greek works for Aldus, translated works of Galen, taught Greek at Oxford, wrote Latin grammars and founded the Royal College of Physicians.(*) Caius was a keen Greek scholar, an ardent student of natural history, and his name is enshrined as co-founder of one of the most important of the Cambridge colleges. Gonthier, Fernel, Fuchs and Mattioli were great scholars and greater physicians. Champier, one of the most remarkable of the group, was the founder of the Hotel Dieu at Lyons, and author of books of a characteristic Renaissance type and of singular bibliographical interest. In many ways greatest of all was Conrad Gesner, whose mors inopinata at forty-nine, bravely fighting the plague, is so touchingly and tenderly mourned by his friend Caius.(2) Physician, botanist, mineralogist, geologist, chemist, the first great modern bibliographer, he is the very embodiment of the spirit of the age.(2a) On the flyleaf of my copy of the "Bibliotheca Universalis" (1545), is written a fine tribute to his memory. I do not know by whom it is, but I do know from my reading that it is true: (*) Cf. Osler: Thomas Linacre, Cambridge University Press, 1908.--Ed. (2) Joannis Caii Britanni de libris suis, etc., 1570. (2a) See J. C. Bay: Papers Bibliog. Soc. of America, 1916, X, No. 2, 53-86. "Conrad Gesner, who kept open house there for all learned men who came into his neighborhood. Gesner was not only the best naturalist among the scholars of his day, but of all men of that century he was the pattern man of letters. He was faultless in private life, assiduous in study, diligent in maintaining correspondence and good-will with learned men in all countries, hospitable--though his means were small--to every scholar that came into Zurich. Prompt to serve all, he was an editor of other men's volumes, a writer of prefaces for friends, a suggestor to young writers of books on which they might engage themselves, and a great helper to them in the progress of their work. But still, while finding time for services to other men, he could produce as much out of his own study as though he had no part in the life beyond its walls." A large majority of these early naturalists and botanists were physicians.(3) The Greek art of observation was revived in a study of the scientific writings of Aristotle, Theophrastus and Dioscorides and in medicine, of Hippocrates and of Galen, all in the Greek originals. That progress was at first slow was due in part to the fact that the leaders were too busy scraping the Arabian tarnish from the pure gold of Greek medicine and correcting the anatomical mistakes of Galen to bother much about his physiology or pathology. Here and there among the great anatomists of the period we read of an experiment, but it was the art of observation, the art of Hippocrates, not the science of Galen, not the carefully devised experiment to determine function, that characterized their work. There was indeed every reason why men should have been content with the physiology and pathology of that day, as, from a theoretical standpoint, it was excellent. The doctrine of the four humors and of the natural, animal and vital spirits afforded a ready explanation for the symptoms of all diseases, and the practice of the day was admirably adapted to the theories. There was no thought of, no desire for, change. But the revival of learning awakened in men at first a suspicion and at last a conviction that the ancients had left something which could be reached by independent research, and gradually the paralytic-like torpor passed away. (3) Miall: The Early Naturalists, London, 1912. The sixteenth and seventeenth centuries did three things in medicine--shattered authority, laid the foundation of an accurate knowledge of the structure of the human body and demonstrated how its functions should be studied intelligently--with which advances, as illustrating this period, may be associated the names of Paracelsus, Vesalius and Harvey. PARACELSUS PARACELSUS is "der Geist der stets verneint." He roused men against the dogmatism of the schools, and he stimulated enormously the practical study of chemistry. These are his great merits, against which must be placed a flood of hermetical and transcendental medicine, some his own, some foisted in his name, the influence of which is still with us. "With what judgment ye judge it shall be judged to you again" is the verdict of three centuries on Paracelsus. In return for unmeasured abuse of his predecessors and contemporaries he has been held up to obloquy as the arch-charlatan of history. We have taken a cheap estimate of him from Fuller and Bacon, and from a host of scurrilous scribblers who debased or perverted his writings. Fuller(4) picked him out as exemplifying the drunken quack, whose body was a sea wherein the tide of drunkenness was ever ebbing and flowing--"He boasted that shortly he would order Luther and the Pope, as well as he had done Galen and Hippocrates. He was never seen to pray, and seldome came to Church. He was not onely skilled in naturall Magick (the utmost bounds whereof border on the suburbs of hell) but is charged to converse constantly with familiars. Guilty he was of all vices but wantonnesse: . . . " (4) Fuller: The Holy and Profane State, Cambridge, 1642, p. 56. Francis Bacon, too, says many hard things of him.(5) (5) Bacon: Of the Proficience and Advancement of Learning, Bk. II, Pickering ed., London, 1840, p. 181. Works, Spedding ed., III, 381. To the mystics, on the other hand, he is Paracelsus the Great, the divine, the most supreme of the Christian magi, whose writings are too precious for science, the monarch of secrets, who has discovered the Universal Medicine. This is illustrated in Browning's well-known poem "Paracelsus," published when he was only twenty-one; than which there is no more pleasant picture in literature of the man and of his aspirations. His was a "searching and impetuous soul" that sought to win from nature some startling secret--". . . a tincture of force to flush old age with youth, or breed gold, or imprison moonbeams till they change to opal shafts!" At the same time with that capacity for self-deception which characterizes the true mystic he sought to cast Light on a darkling race; save for that doubt, I stood at first where all aspire at last To stand: the secret of the world was mine. I knew, I felt (perception unexpressed, Uncomprehended by our narrow thought, But somehow felt and known in every shift And change in the spirit,--nay, in every pore Of the body, even)--what God is, what we are, What life is--. . .(6) (6) Robert Browning: Paracelsus, closing speech. Much has been done of late to clear up his story and his character. Professor Sudhoff, of Leipzig, has made an exhaustive bibliographical study of his writings,(7) there have been recent monographs by Julius Hartmann, and Professors Franz and Karl Strunz,(8) and a sympathetic summary of his life and writings has been published by the late Miss Stoddart.(9) Indeed there is at present a cult of Paracelsus. The hermetic and alchemical writings are available in English in the edition of A. E. Waite, London, 1894. The main facts of his life you can find in all the biographies. Suffice it here to say that he was born at Einsiedeln, near Zurich, in 1493, the son of a physician, from whom he appears to have had his early training both in medicine and in chemistry. Under the famous abbot and alchemist, Trithemiusof Wurzburg, he studied chemistry and occultism. After working in the mines at Schwatz he began his wanderings, during which he professes to have visited nearly all the countries in Europe and to have reached India and China. Returning to Germany he began a triumphal tour of practice through the German cities, always in opposition to the medical faculty, and constantly in trouble. He undoubtedly performed many important cures, and was thought to have found the supreme secret of alchemistry. In the pommel of his sword he was believed to carry a familiar spirit. So dominant was his reputation that in 1527 he was called to the chair of physic in the University of Basel. Embroiled in quarrels after his first year he was forced to leave secretly, and again began his wanderings through German cities, working, quarrelling, curing, and dying prematurely at Saltzburg in 1541--one of the most tragic figures in the history of medicine. (7) Professor Sudhoff: Bibliographia Paracelsica, Berlin, 1894, 1899. (8) R. Julius Hartmann: Theophrast von Hohenheim, Berlin, 1904; ditto, Franz Strunz, Leipzig, 1903. (9) Anna M. Stoddart: The Life of Paracelsus, London, John Murray, 1911. Paracelsus is the Luther of medicine, the very incarnation of the spirit of revolt. At a period when authority was paramount, and men blindly followed old leaders, when to stray from the beaten track in any field of knowledge was a damnable heresy, he stood out boldly for independent study and the right of private judgment. After election to the chair at Basel he at once introduced a startling novelty by lecturing in German. He had caught the new spirit and was ready to burst all bonds both in medicine and in theology. He must have startled the old teachers and practitioners by his novel methods. "On June 5, 1527, he attached a programme of his lectures to the black-board of the University inviting all to come to them. It began by greeting all students of the art of healing. He proclaimed its lofty and serious nature, a gift of God to man, and the need of developing it to new importance and to new renown. This he undertook to do, not retrogressing to the teaching of the ancients, but progressing whither nature pointed, through research into nature, where he himself had discovered and had verified by prolonged experiment and experience. He was ready to oppose obedience to old lights as if they were oracles from which one did not dare to differ. Illustrious doctor smight be graduated from books, but books made not a single physician.(10) Neither graduation, nor fluency, nor the knowledge of old languages, nor the reading of many books made a physician, but the knowledge of things themselves and their properties. The business of a doctor was to know the different kinds of sicknesses, their causes, their symptoms and their right remedies. This he would teach, for he had won this knowledge through experience, the greatest teacher, and with much toil. He would teach it as he had learned it, and his lectures would be founded on works which he had composed concerning inward and external treatment, physic and surgery."(11) Shortly afterwards, at the Feast of St. John, the students had a bonfire in front of the university. Paracelsus came out holding in his hands the "Bible of medicine," Avicenna's "Canon," which he flung into the flames saying: "Into St. John's fire so that all misfortune may go into the air with the smoke." It was, as he explained afterwards, a symbolic act: "What has perished must go to the fire; it is no longer fit for use: what is true and living, that the fire cannot burn." With abundant confidence in his own capacity he proclaimed himself the legitimate monarch, the very Christ of medicine. "You shall follow me," cried he, "you, Avicenna, Galen, Rhasis, Montagnana, Mesues; you, Gentlemen of Paris, Montpellier, Germany, Cologne, Vienna, and whomsoever the Rhine and Danube nourish; you who inhabit the isles of the sea; you, likewise, Dalmatians, Athenians; thou, Arab; thou, Greek; thou, Jew; all shall follow me, and the monarchy shall be mine."(12) (10) And men have oft grown old among their books To die case hardened in their ignorance. --Paracelsus, Browning. (11) Anna M. Stoddart: Life of Paracelsus, London, 1911, pp. 95-96. (12) Browning's Paracelsus, London, 1835, p. 206 (note). This first great revolt against the slavish authority of the schools had little immediate effect, largely on account of the personal vagaries of the reformer--but it made men think. Paracelsus stirred the pool as had not been done for fifteen centuries. Much more important is the relation of Paracelsus to the new chemical studies, and their relation to practical medicine. Alchemy, he held, "is to make neither gold nor silver: its use is to make the supreme sciences and to direct them against disease." He recognized three basic substances, sulphur, mercury and salt, which were the necessary ingredients of all bodies organic or inorganic. They were the basis of the three principles out of which the Archaeus, the spirit of nature, formed all bodies. He made important discoveries in chemistry; zinc, the various compounds of mercury, calomel, flowers of sulphur, among others, and he was a strong advocate of the use of preparations of iron and antimony. In practical pharmacy he has perhaps had a greater reputation for the introduction of a tincture of opium--labdanum or laudanum--with which he effected miraculous cures, and the use of which he had probably learned in the East. Through Paracelsus a great stimulus was given to the study of chemistry and pharmacy, and he is the first of the modern iatro-chemists. In contradistinction to Galenic medicines, which were largely derived from the vegetable kingdom, from this time on we find in the literature references to spagyric medicines and a "spagyrist" was a Paracelsian who regarded chemistry as the basis of all medical knowledge. One cannot speak very warmly of the practical medical writings of Paracelsus. Gout, which may be taken as the disease upon which he had the greatest reputation, is very badly described, and yet he has one or two fruitful ideas singularly mixed with mediaeval astrology; but he has here and there very happy insights, as where he remarks "nec praeter synoviam locqum alium ullum podagra occupat."(13) In the tract on phlebotomy I see nothing modern, and here again he is everywhere dominated by astrological ideas--"Sapiens dominatur astris." (13) Geneva ed., 1658, Vol. I, p. 613. As a protagonist of occult philosophy, Paracelsus has had a more enduring reputation than as a physician. In estimating his position there is the great difficulty referred to by Sudhoff in determining which of the extant treatises are genuine. In the two volumes issued in English by Waite in 1894, there is much that is difficult to read and to appreciate from our modern standpoint. In the book "Concerning Long Life" he confesses that his method and practice will not be intelligible to common persons and that he writes only for those whose intelligence is above the average. To those fond of transcendental studies they appeal and are perhaps intelligible. Everywhere one comes across shrewd remarks which prove that Paracelsus had a keen belief in the all-controlling powers of nature and of man's capacity to make those powers operate for his own good: "the wise man rules Nature, not Nature the wise man." "The difference between the Saint and the Magus is that the one operates by means of God, and the other by means of Nature." He had great faith in nature and the light of nature, holding that man obtains from nature according as he believes. His theory of the three principles appears to have controlled his conception of everything relating to man, spiritually, mentally and bodily; and his threefold genera of disease corresponded in some mysterious way with the three primary substances, salt, sulphur and mercury. How far he was a believer in astrology, charms and divination it is not easy to say. From many of the writings in his collected works one would gather, as I have already quoted, that he was a strong believer. On the other hand, in the "Paramirum," he says: "Stars control nothing in us, suggest nothing, incline to nothing, own nothing; they are free from us and we are free from them" (Stoddart, p. 185). The Archaeus, not the stars, controls man's destiny. "Good fortune comes from ability, and ability comes from the spirit" (Archaeus). No one has held more firmly the dualistic conception of the healing art. There are two kinds of doctors; those who heal miraculously and those who heal through medicine. Only he who believes can work miracles. The physician has to accomplish that which God would have done miraculously, had there been faith enough in the sick man (Stoddart, p. 194). He had the Hippocratic conception of the "vis medicatrix naturae"--no one keener since the days of the Greeks. Man is his own doctor and finds proper healing herbs in his own garden: the physician is in ourselves, in our own nature are all things that we need: and speaking of wounds, with singular prescience he says that the treatment should be defensive so that no contingency from without could hinder Nature in her work (Stoddart, p. 213). Paracelsus expresses the healing powers of nature by the word "mumia," which he regarded as a sort of magnetic influence or force, and he believed that anyone possessing this could arrest or heal disease in others. As the lily breaks forth in invisible perfume, so healing influences may pass from an invisible body. Upon these views of Paracelsus was based the theory of the sympathetic cure of disease which had an extraordinary vogue in the late sixteenth and seventeenth centuries, and which is not without its modern counterpart. In the next century, in Van Helmont we meet with the Archaeus everywhere presiding, controlling and regulating the animate and inanimate bodies, working this time through agents, local ferments. The Rosicrucians had their direct inspiration from his writings, and such mystics as the English Rosicrucian Fludd were strong Paracelsians.(14) (14) Robert Fludd, the Mystical Physician, British Medical Journal, London, 1897, ii, 408. The doctrine of contraries drawn from the old Greek philosophy, upon which a good deal of the treatment of Hippocrates and Galen was based--dryness expelled by moisture, cold by heat, etc.--was opposed by Paracelsus in favor of a theory of similars, upon which the practice of homeopathy is based. This really arose from the primitive beliefs, to which I have already referred as leading to the use of eyebright in diseases of the eye, and cyclamen in diseases of the ear because of its resemblance to that part; and the Egyptian organotherapy had the same basis,--spleen would cure spleen, heart, heart, etc. In the sixteenth and seventeenth centuries these doctrines of sympathies and antipathies were much in vogue. A Scotchman, Sylvester Rattray, edited in the "Theatrum Sympatheticum"(15) all the writings upon the sympathies and antipathies of man with animal, vegetable and mineral substances, and the whole art of physics was based on this principle. (15) Rattray: Theatrum Sympatheticum, Norimberge, MDCLXII. Upon this theory of "mumia," or magnetic force, the sympathetic cure of disease was based. The weapon salve, the sympathetic ointment, and the famous powder of sympathy were the instruments through which it acted. The magnetic cure of wounds became the vogue. Van Helmont adopted these views in his famous treatise "De Magnetica Vulnerum Curatione,"(16) in which he asserted that cures were wrought through magnetic influence. How close they came to modern views of wound infection may be judged from the following: "Upon the solution of Unity in any part the ambient air . . . repleted with various evaporations or aporrhoeas of mixt bodies, especially such as are then suffering the act of putrefaction, violently invadeth the part and thereupon impresseth an exotic miasm or noxious diathesis, which disposeth the blood successively arriving at the wound, to putrefaction, by the intervention of fermentation." With his magnetic sympathy, Van Helmont expressed clearly the doctrine of immunity and the cure of disease by immune sera: "For he who has once recovered from that disease hath not only obtained a pure balsaamical blood, whereby for the future he is rendered free from any recidivation of the same evil, but also infallibly cures the same affection in his neighbour . . . and by the mysterious power of Magnetism transplants that balsaam and conserving quality into the blood of another." He was rash enough to go further and say that the cures effected by the relics of the saints were also due to the same cause--a statement which led to a great discussion with the theologians and to Van Helmont's arrest for heresy, and small wonder, when he makes such bold statements as "Let the Divine enquire only concerning God, the Naturalist concerning Nature," and "God in the production of miracles does for the most part walk hand in hand with Nature." (16) An English translation by Walter Charleton appeared in 1650, entitled "A Ternary of Paradoxes." That wandering genius, Sir Kenelm Digby, did much to popularize this method of treatment by his lecture on the "Powder of Sympathy."(17) His powder was composed of copperas alone or mixed with gum tragacanth. He regarded the cure as effected through the subtle influence of the sympathetic spirits or, as Highmore says, by "atomicall energy wrought at a distance," and the remedy could be applied to the wound itself, or to a cloth soaked in the blood or secretions, or to the weapon that caused the wound. One factor leading to success may have been that in the directions which Digby gave for treating the wound (in the celebrated case of James Howell, for instance), it was to be let alone and kept clean. The practice is alluded to very frequently by the poets. In the "Lay of the Last Minstrel" we find the following: (17) French edition, 1668, English translation, same year. For a discussion on the author of the weapon salve see Van Helmont, who gives the various formulas. Highmore (1651) says the "powder is a Zaphyrian salt calcined by a celestial fire operating in Leo and Cancer into a Lunar complexion." But she has ta'en the broken lance, And wash'd it from the clotted gore, And salved the splinter o'er and o'er. William of Deloraine, in trance, Whene'er she turn'd it round and round, Twisted, as if she gall'd his wound, Then to her maidens she did say, That he should be whole man and sound, (Canto iii, xxiii.) and in Dryden's "Tempest" (V, 1) Ariel says: Anoint the Sword which pierc'd him with the Weapon-Salve, And wrap it close from Air till I have time To visit him again. From Van Helmont comes the famous story of the new nose that dropped off in sympathy with the dead arm from which it was taken, and the source of the famous lines of Hudibras. As I have not seen the original story quoted of late years it may be worth while to give it: "A certain inhabitant of Bruxels, in a combat had his nose mowed off, addressed himself to Tagliacozzus, a famous Chirurgein, living at Bononia, that he might procure a new one; and when he feared the incision of his own arm, he hired a Porter to admit it, out of whose arm, having first given the reward agreed upon, at length he dig'd a new nose. About thirteen moneths after his return to his own Countrey, on a sudden the ingrafted nose grew cold, putrified, and within few days drops off. To those of his friends that were curious in the exploration of the cause of this unexpected misfortune, it was discovered, that the Porter expired, neer about the same punctilio of time, wherein the nose grew frigid and cadaverous. There are at Bruxels yet surviving, some of good repute, that were eye-witnesses of these occurrences."(18) (18) Charleton: Of the Magnetic Cure of Wounds, London, 1650, p. 13. Equally in the history of science and of medicine, 1542 is a starred year, marked by a revolution in our knowledge alike of Macrocosm and Microcosm. In Frauenburg, the town physician and a canon, now nearing the Psalmist limit and his end, had sent to the press the studies of a lifetime--"De revolutionibus orbium coelestium." It was no new thought, no new demonstration that Copernicus thus gave to his generation. Centuries before, men of the keenest scientific minds from Pythagoras on had worked out a heliocentric theory, fully promulgated by Aristarchus, and very generally accepted by the brilliant investigators of the Alexandrian school; but in the long interval, lapped in Oriental lethargy, man had been content to acknowledge that the heavens declare the glory of God and that the firmament sheweth his handiwork. There had been great astronomers before Copernicus. In the fifteenth century Nicholas of Cusa and Regiomontanus had hinted at the heliocentric theory; but 1512 marks an epoch in the history of science, since for all time Copernicus put the problem in a way that compelled acquiescence. Nor did Copernicus announce a truth perfect and complete, not to be modified, but there were many contradictions and lacunae which the work of subsequent observers had to reconcile and fill up. For long years Copernicus had brooded over the great thoughts which his careful observation had compelled. We can imagine the touching scene in the little town when his friend Osiander brought the first copy of the precious volume hot from the press, a well enough printed book. Already on his deathbed, stricken with a long illness, the old man must have had doubts how his work would be received, though years before Pope Clement VII had sent him encouraging words. Fortunately death saved him from the "rending" which is the portion of so many innovators and discoverers. His great contemporary reformer, Luther, expressed the view of the day when he said the fool will turn topsy-turvy the whole art of astronomy; but the Bible says that Joshua commanded the Sun to stand still, not the Earth. The scholarly Melanchthon, himself an astronomer, thought the book so godless that he recommended its suppression (Dannemann, Grundriss). The church was too much involved in the Ptolemaic system to accept any change and it was not until 1822 that the works of Copernicus were removed from the Index. VESALIUS THE same year, 1542, saw a very different picture in the far-famed city of Padua, "nursery of the arts." The central figure was a man not yet in the prime of life, and justly full of its pride, as you may see from his portrait. Like Aristotle and Hippocrates cradled and nurtured in an AEsculapian family, Vesalius was from his childhood a student of nature, and was now a wandering scholar, far from his Belgian home. But in Italy he had found what neither Louvain nor Paris could give, freedom in his studies and golden opportunities for research in anatomy. What an impression he must have made on the student body at Padua may be judged from the fact that shortly after his graduation in December, 1537, at the age of twenty-four, he was elected to the chair of anatomy and surgery. Two things favored him--an insatiate desire to see and handle for himself the parts of the human frame, and an opportunity, such as had never before been offered to the teacher, to obtain material for the study of human anatomy. Learned with all the learning of the Grecians and of the Arabians, Vesalius grasped, as no modern before him had done, the cardinal fact that to know the human machine and its working, it is necessary first to know its parts--its fabric. To appreciate the work of this great man we must go back in a brief review of the growth of the study of anatomy. Among the Greeks only the Alexandrians knew human anatomy. What their knowledge was we know at second hand, but the evidence is plain that they knew a great deal. Galen's anatomy was first-class and was based on the Alexandrians and on his studies of the ape and the pig. We have already noted how much superior was his osteology to that of Mundinus. Between the Alexandrians and the early days of the School of Salernum we have no record of systematic dissections of the human body. It is even doubtful if these were permitted at Salernum. Neuburger states that the instructions of Frederick II as to dissections were merely nominal. How atrocious was the anatomy of the early Middle Ages may be gathered from the cuts in the works of Henri de Mondeville. In the Bodleian Library is a remarkable Latin anatomical treatise of the late thirteenth century, of English provenance, one illustration from which will suffice to show the ignorance of the author. Mundinus of Bologna, one of the first men in the Middle Ages to study anatomy from the subject, was under the strong domination of the Arabians, from whom he appears to have received a very imperfect Galenic anatomy. From this date we meet with occasional dissections at various schools, but we have seen that in the elaborate curriculum of the University of Padua in the middle of the fifteenth century there was no provision for the study of the subject. Even well into the sixteenth century dissections were not common, and the old practice was followed of holding a professorial discourse, while the butcher, or barber surgeon, opened the cavities of the body. A member of a famous Basel family of physicians, Felix Plater, has left us in his autobiography(19) details of the dissections he witnessed at Montpellier between November 14, 1552, and January 10, 1557, only eleven in number. How difficult it was at that time to get subjects is shown by the risks they ran in "body-snatching" expeditions, of which he records three. (19) There is no work from which we can get a better idea of the life of the sixteenth-century medical student and of the style of education and of the degree ceremonies, etc. Cumston has given an excellent summary of it (Johns Hopkins Hospital Bulletin, 1912, XXIII, 105-113). And now came the real maker of modern anatomy. Andreas Vesalius had a good start in life. Of a family long associated with the profession, his father occupied the position of apothecary to Charles V, whom he accompanied on his journeys and campaigns. Trained at Louvain, he had, from his earliest youth, an ardent desire to dissect, and cut up mice and rats, and even cats and dogs. To Paris, the strong school of the period, he went in 1533, and studied under two men of great renown, Jacob Sylvius and Guinterius. Both were strong Galenists and regarded the Master as an infallible authority. He had as a fellow prosector, under the latter, the unfortunate Servetus. The story of his troubles and trials in getting bones and subjects you may read in Roth's "Life."(20) Many interesting biographical details are also to be found in his own writings. He returned for a time to Louvain, and here he published his first book, a commentary on the "Almansor" of Rhazes, in 1537. (20) M. Roth: Andreas Vesalius Bruxellensis, Berlin, 1892. An excellent account of Vesalius and his contemporaries is given by James Moores Ball in his superbly printed Andreas Vesalius, the Reformer of Anatomy, St. Louis, 1910. Finding it difficult, either in Paris or Louvain, to pursue his anatomical studies, he decided to go to Italy where, at Venice and Padua, the opportunities were greater. At Venice, he attended the practice of a hospital (now a barracks) which was in charge of the Theatiner Order. I show you a photograph of the building taken last year. And here a strange destiny brought two men together. In 1537, another pilgrim was working in Venice waiting to be joined by his six disciples. After long years of probation, Ignatius Loyola was ready to start on the conquest of a very different world. Devoted to the sick and to the poor, he attached himself to the Theatiner Order, and in the wards of the hospital and the quadrangle, the fiery, dark-eyed, little Basque must frequently have come into contact with the sturdy young Belgian, busy with his clinical studies and his anatomy. Both were to achieve phenomenal success--the one in a few years to revolutionize anatomy, the other within twenty years to be the controller of universities, the counsellor of kings, and the founder of the most famous order in the Roman Catholic Church. It was in this hospital that Vesalius made observations on the China-root, on which he published a monograph in 1546. The Paduan School was close to Venice and associated with it, so that the young student had probably many opportunities of going to and fro. On the sixth of December, 1537, before he had reached his twenty-fourth year and shortly after taking his degree, he was elected to the chair of surgery and anatomy at Padua. The task Vesalius set himself to accomplish was to give an accurate description of all the parts of the human body, with proper illustrations. He must have had abundant material, more, probably, than any teacher before him had ever had at his disposal. We do not know where he conducted his dissections, as the old amphitheatre has disappeared, but it must have been very different from the tiny one put up by his successor, Fabricius, in 1594. Possibly it was only a temporary building, for he says in the second edition of the "Fabrica" that he had a splendid lecture theatre which accommodated more than five hundred spectators (p. 681). With Vesalius disappeared the old didactic method of teaching anatomy. He did his own dissections, made his own preparations, and, when human subjects were scarce, employed dogs, pigs or cats, and occasionally a monkey. For five years he taught and worked at Padua. He is known to have given public demonstrations in Bologna and elsewhere. In the "China-root" he remarks that he once taught in three universities in one year. The first fruit of his work is of great importance in connection with the evolution of his knowledge. In 1538, he published six anatomical tables issued apparently in single leaves. Of the famous "Tabulae Anatomicae" only two copies are known, one in the San Marco Library, Venice, and the other in the possession of Sir John Stirling-Maxwell, whose father had it reproduced in facsimile (thirty copies only) in 1874. Some of the figures were drawn by Vesalius himself, and some are from the pencil of his friend and countryman, Stephan van Calcar. Those plates were extensively pirated. About this time he also edited for the Giunti some of the anatomical works of Galen.(21) (21) De anatomicis administrationibus, De venarum arterinrumque dissectione, included in the various Juntine editions of Galen. We know very little of his private life at Padua. His most important colleague in the faculty was the famous Montanus, professor of medicine. Among his students and associates was the Englishman Caius, who lived in the same house with him. When the output is considered, he cannot have had much spare time at Padua. He did not create human anatomy--that had been done by the Alexandrians--but he studied it in so orderly and thorough a manner that for the first time in history it could be presented in a way that explained the entire structure of the human body. Early in 1542 the MS. was ready; the drawings had been made with infinite care, the blocks for the figures had been cut, and in September, he wrote to Oporinus urging that the greatest pains should be taken with the book, that the paper should be strong and of equal thickness, the workmen chosen for their skill, and that every detail of the pictures must be distinctly visible. He writes with the confidence of a man who realized the significance of the work he had done. It is difficult to speak in terms of moderation of the "Fabrica." To appreciate its relative value one must compare it with the other anatomical works of the period, and for this purpose I put before you two figures from a text-book on the subject that was available for students during the first half of the sixteenth century. In the figures and text of the "Fabrica" we have anatomy as we know it; and let us be honest and say, too, largely as Galen knew it. Time will not allow me to go into the question of the relations of these two great anatomists, but we must remember that at this period Galen ruled supreme, and was regarded in the schools as infallible. And now, after five years of incessant labor, Vesalius was prepared to leave his much loved Padua and his devoted students. He had accomplished an extraordinary work. He knew, I feel sure, what he had done. He knew that the MSS. contained something that the world had not seen since the great Pergamenian sent the rolls of his "Manual of Anatomy" among his friends. Too precious to entrust to any printer but the best--and the best in the middle of the sixteenth century was Transalpine--he was preparing to go north with the precious burden. We can picture the youthful teacher--he was but twenty-eight--among students in a university which they themselves controlled--some of them perhaps the very men who five years before had elected him--at the last meeting with his class, perhaps giving a final demonstration of the woodcuts, which were of an accuracy and beauty never seen before by students' eyes, and reading his introduction. There would be sad hearts at the parting, for never had anyone taught anatomy as he had taught it--no one had ever known anatomy as he knew it. But the strong, confident look was on his face and with the courage of youth and sure of the future, he would picture a happy return to attack new and untried problems. Little did he dream that his happy days as student and teacher were finished, that his work as an anatomist was over, that the most brilliant and epoch-making part of his career as a professor was a thing of the past. A year or more was spent at Basel with his friend Oporinus supervising the printing of the great work, which appeared in 1543 with the title "De Humani Corporis Fabrica." The worth of a book, as of a man, must be judged by results, and, so judged, the "Fabrica" is one of the great books of the world, and would come in any century of volumes which embraced the richest harvest of the human mind. In medicine, it represents the full flower of the Renaissance. As a book it is a sumptuous tome a worthy setting of his jewel--paper, type and illustration to match, as you may see for yourselves in this folio--the chef d'oeuvre of any medical library. In every section, Vesalius enlarged and corrected the work of Galen. Into the details we need not enter: they are all given in Roth's monograph, and it is a chapter of ancient history not specially illuminating. Never did a great piece of literary work have a better setting. Vesalius must have had a keen appreciation of the artistic side of the art of printing, and he must also have realized the fact that the masters of the art had by this time moved north of the Alps. While superintending the printing of the precious work in the winter of 1542-1543 in Basel, Vesalius prepared for the medical school a skeleton from the body of an executed man, which is probably the earliest preparation of the kind in Europe. How little anatomy had been studied at the period may be judged from that fact that there had been no dissection at Basel since 1531.(22) The specimen is now in the Vesalianum, Basel, of which I show you a picture taken by Dr. Harvey Cushing. From the typographical standpoint no more superb volume on anatomy has been issued from any press, except indeed the second edition, issued in 1555. The paper is, as Vesalius directed, strong and good, but it is not, as he asked, always of equal thickness; as a rule it is thick and heavy, but there are copies on a good paper of a much lighter quality. The illustrations drawn by his friend and fellow countryman, van Calcar, are very much in advance of anything previously seen, except those of Leonardo. The title-page, one of the most celebrated pictures in the history of medicine, shows Vesalius in a large amphitheatre (an imaginary one of the artist, I am afraid) dissecting a female subject. He is demonstrating the abdomen to a group of students about the table, but standing in the auditorium are elderly citizens and even women. One student is reading from an open book. There is a monkey on one side of the picture and a dog on the other. Above the picture on a shield are the three weasels, the arms of Vesal. The reproduction which I show you here is from the "Epitome"--a smaller work issued before (?) the "Fabrica," with rather larger plates, two of which represent nude human bodies and are not reproduced in the great work. The freshest and most beautiful copy is the one on vellum which formerly belonged to Dr. Mead, now in the British Museum, and from it this picture was taken. One of the most interesting features of the book are the full-page illustrations of the anatomy of the arteries, veins and nerves. They had not in those days the art of making corrosion preparations, but they could in some way dissect to their finest ramifications the arteries, veins and nerves, which were then spread on boards and dried. Several such preparations are now at the College of Physicians in London, brought from Padua by Harvey. The plates of the muscles are remarkably good, more correct, though not better perhaps, on the whole, than some of Leonardo's. (22) The next, in 1559, is recorded by Plater in his autobiography, who gave a public dissection during three days in the Church of St. Elizabeth. Vesalius had no idea of a general circulation. Though he had escaped from the domination of the great Pergamenian in anatomy, he was still his follower in physiology. The two figures annexed, taken from one of the two existing copies of the "Tabulae Anatomica," are unique in anatomical illustration, and are of special value as illustrating the notion of the vascular system that prevailed until Harvey's day. I have already called your attention to Galen's view of the two separate systems, one containing the coarse, venous blood for the general nutrition of the body, the other the arterial, full of a thinner, warmer blood with which were distributed the vital spirits and the vital heat. The veins had their origin in the liver; the superior vena cava communicated with the right heart, and, as Galen taught, some blood was distributed to the lungs; but the two systems were closed, though Galen believed there was a communication at the periphery between the arteries and veins. Vesalius accepted Galen's view that there is some communication between the venous and arterial systems through pores in the septum of the ventricles, though he had his doubts, and in the second edition of his book (1555) says that inspite of the authority of the Prince of Physicians he cannot see how the smallest quantity of blood could be transmitted through so dense a muscular septum. Two years before this (1553),(*) his old fellow student, Michael Servetus, had in his "Christianismi Restitutio" annatomical touch with one another! (*) See the Servetus Notes in the Osler Anniversary Volumes, New York, 1919, Vol. II.--Ed. The publication of the "Fabrica" shook the medical world to its foundations. Galen ruled supreme in the schools: to doubt him in the least particular roused the same kind of feeling as did doubts on the verbal inspiration of the Scriptures fifty years ago! His old teachers in Paris were up in arms: Sylvius, nostrae aetatis medicorum decus, as Vesalius calls him, wrote furious letters, and later spoke of him as a madman (vaesanus). The younger men were with him and he had many friends, but he had aroused a roaring tide of detraction against which he protested a few years later in his work on the "China-root," which is full of details about the "Fabrica." In a fit of temper he threw his notes on Galen and other MSS. in the fire. No sadder page exists in medical writings than the one in which Vesalius tells of the burning of his books and MSS. It is here reproduced and translated.(23) His life for a couple of years is not easy to follow, but we know that in 1546 he took service with Charles V as his body physician, and the greatest anatomist of his age was lost in the wanderings of court and campaigns. He became an active practitioner, a distinguished surgeon, much consulted by his colleagues, and there are references to many of his cases, the most important of which are to internal aneurysms, which he was one of the first to recognize. In 1555 he brought out the second edition of the "Fabrica," an even more sumptuous volume than the first. (23) Epistle on China-root, 1546, p. 196. Vesalius may be quoted in explanation--in palliation: "All these impediments I made light of; for I was too young to seek gain by my art, and I was sustained by my eager desire to learn and to promote the studies in which I shared. I say nothing of my diligence in anatomizing--those who attended my lectures in Italy know how I spent three whole weeks over a single public dissection. But consider that in one year I once taught in three different universities. If I had put off the task of writing till this time; if I were now just beginning to digest my materials; students would not have had the use of my anatomical labours, which posterity may or may not judge superior to the rechauffes formerly in use, whether of Mesua, of Gatinaria, of some Stephanus or other on the differences, causes and symptoms of diseases, or, lastly, of a part of Servitor's pharmacopoeia. As to my notes, which had grown into a huge volume, they were all destroyed by me; and on the same day there similarly perished the whole of my paraphrase on the ten books of Rhazes to King Almansor, which had been composed by me with far more care than the one which is prefaced to the ninth book. With these also went the books of some author or other on the formulae and preparation of medicines, to which I had added much matter of my own which I judged to be not without utility; and the same fate overtook all the books of Galen which I had used in learning anatomy, and which I had liberally disfigured in the usual fashion. I was on the point of leaving Italy and going to Court; those physicians you know of had made to the Emperor and to the nobles a most unfavourable report of my books and of all that is published nowadays for the promotion of study; I therefore burnt all these works that I have mentioned, thinking at the same time that it would be an easy matter to abstain from writing for the future. I must show that I have since repented more than once of my impatience, and regretted that I did not take the advice of the friends who were then with me." There is no such pathetic tragedy in the history of our profession. Before the age of thirty Vesalius had effected a revolution in anatomy; he became the valued physician of the greatest court of Europe; but call no man happy till he is dead! A mystery surrounds his last days. The story is that he had obtained permission to perform a post-mortem examination on the body of a young Spanish nobleman, whom he had attended. When the body was opened, the spectators to their horror saw the heart beating, and there were signs of life! Accused, so it is said, by the Inquisition of murder and also of general impiety he only escaped through the intervention of the King, with the condition that he make a pilgrimage to the Holy Land. In carrying this out in 1564 he was wrecked on the island of Zante, where he died of a fever or of exhaustion, in the fiftieth year of his age. To the North American Review, November, 1902, Edith Wharton contributed a poem on "Vesalius in Zante," in which she pictures his life, so full of accomplishment, so full of regrets--regrets accentuated by the receipt of an anatomical treatise by Fallopius, the successor to the chair in Padua! She makes him say: There are two ways of spreading light; to be The candle or the mirror that reflects it. I let my wick burn out--there yet remains To spread an answering surface to the flame That others kindle. But between Mundinus and Vesalius, anatomy had been studied by a group of men to whom I must, in passing, pay a tribute. The great artists Raphael, Michael Angelo and Albrecht Durer were keen students of the human form. There is an anatomical sketch by Michael Angelo in the Ashmolean Museum, Oxford, which I here reproduce.(*) Durer's famous work on "Human Proportion," published in 1528, contains excellent figures, but no sketches of dissections. But greater than any of these, and antedating them, is Leonardo da Vinci, the one universal genius in whom the new spirit was incarnate--the Moses who alone among his contemporaries saw the promised land. How far Leonardo was indebted to his friend and fellow student, della Torre, at Pavia we do not know, nor does it matter in face of the indubitable fact that in the many anatomical sketches from his hand we have the first accurate representation of the structure of the body. Glance at the three figures of the spine which I have had photographed side by side, one from Leonardo, one from Vesalius and the other from Vandyke Carter, who did the drawings in Gray's "Anatomy" (1st ed., 1856). They are all of the same type, scientific, anatomical drawings, and that of Leonardo was done fifty years before Vesalius! Compare, too, this figure of the bones of the foot with a similar one from Vesalius.(24) Insatiate in experiment, intellectually as greedy as Aristotle, painter, poet, sculptor, engineer, architect, mathematician, chemist, botanist, aeronaut, musician and withal a dreamer and mystic, full accomplishment in any one department was not for him! A passionate desire for a mastery of nature's secrets made him a fierce thing, replete with too much rage! But for us a record remains--Leonardo was the first of modern anatomists, and fifty years later, into the breach he made, Vesalius entered.(25) (*) This plate was lacking among the author's illustrations, but the Keeper of the Ashmolean Museum remembers his repeatedly showing special interest in the sketch reproduced in John Addington Symonds's Life of Michelangelo, London, 1893, Vol. I, p. 44, and in Charles Singer's Studies in the History and Method of Science, Oxford, 1917, Vol. I, p. 97, representing Michael Angelo and a friend dissecting the body of a man, by the light of a candle fixed in the body itself.--Ed. (24) He was the first to make and represent anatomical cross sections. See Leonardo: Quaderni d'Anatomia, Jacob Dybwad, Kristiania, 1911-1916, Vol. V. (25) See Knox: Great Artists and Great Anatomists, London, 1862, and Mathias Duval in Les Manuserits de Leonard de Vince: De l'Anatomie, Feuillets A, Edouard Rouveyre, Paris, 1898. For a good account of Leonardo da Vinci see Merejkovsky's novel, The Forerunner, London, 1902, also New York, Putnam. HARVEY LET us return to Padua about the year 1600. Vesalius, who made the school the most famous anatomical centre in Europe, was succeeded by Fallopius, one of the best-known names in anatomy, at whose death an unsuccessful attempt was made to get Vesalius back. He was succeeded in 1565 by a remarkable man, Fabricius (who usually bears the added name of Aquapendente, from the town of his birth), a worthy follower of Vesalius. In 1594, in the thirtieth year of his professoriate, he built at his own expense a new anatomical amphitheatre, which still exists in the university buildings. It is a small, high-pitched room with six standing-rows for auditors rising abruptly one above the other. The arena is not much more than large enough for the dissecting table which, by a lift, could be brought up from a preparing room below. The study of anatomy at Padua must have declined since the days of Vesalius if this tiny amphitheatre held all its students; none the less, it is probably the oldest existing anatomical lecture room, and for us it has a very special significance. Early in his anatomical studies Fabricius had demonstrated the valves in the veins. I show you here two figures, the first, as far as I know, in which these structures are depicted. It does not concern us who first discovered them; they had doubtless been seen before, but Fabricius first recognized them as general structures in the venous system, and he called them little doors--"ostiola." The quadrangle of the university building at Padua is surrounded by beautiful arcades, the walls and ceilings of which are everywhere covered with the stemmata, or shields, of former students, many of them brilliantly painted. Standing in the arcade on the side of the "quad" opposite the entrance, if one looks on the ceiling immediately above the capital of the second column to the left there is seen the stemma which appears as tailpiece to this chapter, put up by a young Englishman, William Harvey, who had been a student at Padua for four years. He belonged to the "Natio Anglica," of which he was Conciliarius, and took his degree in 1602. Doubtless he had repeatedly seen Fabricius demonstrate the valves of the veins, and he may indeed, as a senior student, have helped in making the very dissections from which the drawings were taken for Fabricius' work, "De Venarum Osteolis," 1603. If one may judge from the character of the teacher's work the sort of instruction the student receives, Harvey must have had splendid training in anatomy. While he was at Padua, the great work of Fabricius, "De Visione, Voce et Auditu" (1600) was published, then the "Tractatus de Oculo Visusque Organo" (1601), and in the last year of his residence Fabricius must have been busy with his studies on the valves of the veins and with his embryology, which appeared in 1604. Late in life, Harvey told Boyle that it was the position of the valves of the veins that induced him to think of a circulation. Harvey returned to England trained by the best anatomist of his day. In London, he became attached to the College of Physicans, and taking his degree at Cambridge, he began the practice of medicine. He was elected a fellow of the college in 1607 and physician to St. Bartholomew's Hospital in 1609. In 1615 he was appointed Lumleian lecturer to the College of Physicians, and his duties were to hold certain "public anatomies," as they were called, or lectures. We know little or nothing of what Harvey had been doing other than his routine work in the care of the patients at St. Bartholomew's. It was not until April, 1616, that his lectures began. Chance has preserved to us the notes of this first course; the MS. is now in the British Museum and was published in facsimile by the college in 1886.(26) (26) William Harvey: Prelectiones Anatomiae Universalis, London, J. & A. Churchill, 1886. The second day lecture, April 17, was concerned with a description of the organs of the thorax, and after a discussion on the structure and action of the heart come the lines: W. H. constat per fabricam cordis sanguinem per pulmones in Aortam perpetuo transferri, as by two clacks of a water bellows to rayse water constat per ligaturam transitum sanguinis ab arteriis ad venas unde perpetuum sanguinis motum in circulo fieri pulsu cordis. The illustration will give one an idea of the extraordinarily crabbed hand in which the notes are written, but it is worth while to see the original, for here is the first occasion upon which is laid down in clear and unequivocal words that the blood CIRCULATES. The lecture gave evidence of a skilled anatomist, well versed in the literature from Aristotle to Fabricius. In the MS. of the thorax, or, as he calls it, the "parlour" lecture, there are about a hundred references to some twenty authors. The remarkable thing is that although those lectures were repeated year by year, we have no evidence that they made any impression upon Harvey's contemporaries, so far, at least, as to excite discussions that led to publication. It was not until twelve years later, 1628, that Harvey published in Frankfurt a small quarto volume of seventy-four pages,(27) "De Motu Cordis." In comparison with the sumptuous "Fabrica" of Vesalius this is a trifling booklet; but if not its equal in bulk or typographical beauty (it is in fact very poorly printed), it is its counterpart in physiology, and did for that science what Vesalius had done for anatomy, though not in the same way. The experimental spirit was abroad in the land, and as a student at Padua, Harvey must have had many opportunities of learning the technique of vivisection; but no one before his day had attempted an elaborate piece of experimental work deliberately planned to solve a problem relating to the most important single function of the body. Herein lies the special merit of his work, from every page of which there breathes the modern spirit. To him, as to Vesalius before him, the current views of the movements of the blood were unsatisfactory, more particularly the movements of the heart and arteries, which were regarded as an active expansion by which they were filled with blood, like bellows with air. The question of the transmission of blood through the thick septum and the transference of air and blood from the lungs to the heart were secrets which he was desirous of searching out by means of experiment. (27) Harvey: Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus, Francofurti, 1628. One or two special points in the work may be referred to as illustrating his method. He undertook first the movements of the heart, a task so truly arduous and so full of difficulties that he was almost tempted to think with Fracastorius that "the movement of the heart was only to be comprehended by God." But after many difficulties he made the following statements: first, that the heart is erected and raises itself up into an apex, and at this time strikes against the breast and the pulse is felt externally; secondly, that it is contracted every-way, but more so at the sides; and thirdly, that grasped in the hand it was felt to become harder at the time of its motion; from all of which actions Harvey drew the very natural conclusion that the activity of the heart consisted in a contraction of its fibres by which it expelled the blood from the ventricles. These were the first four fundamental facts which really opened the way for the discovery of the circulation, as it did away with the belief that the heart in its motion attracts blood into the ventricles, stating on the contrary that by its contraction it expelled the blood and only received it during its period of repose or relaxation. Then he proceeded to study the action of the arteries and showed that their period of diastole, or expansion, corresponded with the systole, or contraction, of the heart, and that the arterial pulse follows the force, frequency and rhythm of the ventricle and is, in fact, dependent upon it. Here was another new fact: that the pulsation in the arteries was nothing else than the impulse of the blood within them. Chapter IV, in which he describes the movements of the auricles and ventricles, is a model of accurate description, to which little has since been added. It is interesting to note that he mentions what is probably auricular fibrillation. He says: "After the heart had ceased pulsating an undulation or palpitation remained in the blood itself which was contained in the right auricle, this being observed so long as it was imbued with heat and spirit." He recognized too the importance of the auricles as the first to move and the last to die. The accuracy and vividness of Harvey's description of the motion of the heart have been appreciated by generations of physiologists. Having grasped this first essential fact, that the heart was an organ for the propulsion of blood, he takes up in Chapters VI and VII the question of the conveyance of the blood from the right side of the heart to the left. Galen had already insisted that some blood passed from the right ventricle to the lungs--enough for their nutrition; but Harvey points out, with Colombo, that from the arrangement of the valves there could be no other view than that with each impulse of the heart blood passes from the right ventricle to the lungs and so to the left side of the heart. How it passed through the lungs was a problem: probably by a continuous transudation. In Chapters VIII and IX he deals with the amount of blood passing through the heart from the veins to the arteries. Let me quote here what he says, as it is of cardinal import: "But what remains to be said upon the quantity and source of the blood which thus passes, is of a character so novel and unheard of that I not only fear injury to myself from the envy of a few, but I tremble lest I have mankind at large for my enemies, so much doth wont and custom become a second nature. Doctrine once sown strikes deeply its root, and respect for antiquity influences all men. Still the die is cast, and my trust is in my love of truth, and the candour of cultivated minds."(28) Then he goes on to say: (28) William Harvey: Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus, Francofurti, 1628, G. Moreton's facsimile reprint and translation, Canterbury, 1894, p. 48. "I began to think whether there might not be A MOVEMENT, AS IT WERE, IN A CIRCLE. Now this I afterwards found to be true; and I finally saw that the blood, forced by the action of the left ventricle into the arteries, was distributed to the body at large, and its several parts, in the same manner as it is sent through the lungs, impelled by the right ventricle into the pulmonary artery, and that it then passed through the veins and along the vena cava, and so round to the left ventricle in the manner already indicated."(29) (29) Ibid. p. 49. The experiments dealing with the transmission of blood in the veins are very accurate, and he uses the old experiment that Fabricius had employed to show the valves, to demonstrate that the blood in the veins flows towards the heart. For the first time a proper explanation of the action of the valves is given. Harvey had no appreciation of how the arteries and veins communicated with each other. Galen, you may remember, recognized that there were anastomoses, but Harvey preferred the idea of filtration. The "De Motu Cordis" constitutes a unique piece of work in the history of medicine. Nothing of the same type had appeared before. It is a thoroughly sensible, scientific study of a definite problem, the solution of which was arrived at through the combination of accurate observation and ingenious experiment. Much misunderstanding has arisen in connection with Harvey's discovery of the circulation of the blood. He did not discover that the blood moved,--that was known to Aristotle and to Galen, from both of whom I have given quotations which indicate clearly that they knew of its movement,--but at the time of Harvey not a single anatomist had escaped from the domination of Galen's views. Both Servetus and Colombo knew of the pulmonary circulation, which was described by the former in very accurate terms. Cesalpinus, a great name in anatomy and botany, for whom is claimed the discovery of the circulation, only expressed the accepted doctrines in the following oft-quoted phrase: "We will now consider how the attraction of aliment and the process of nutrition takes place in plants; for in animals we see the aliment brought through the veins to the heart, as to a laboratory of innate heat, and, after receiving there its final perfection, distributed through the arteries to the body at large, by the agency of the spirits produced from this same aliment in the heart."(30) There is nothing in this but Galen's view, and Cesalpinus believed, as did all his contemporaries, that the blood was distributed through the body by the vena cava and its branches for the nourishment of all its parts.(*) To those who have any doubts as to Harvey's position in this matter I would recommend the reading of the "De Motu Cordis" itself, then the various passages relating to the circulation from Aristotle to Vesalius. Many of these can be found in the admirable works of Dalton, Flourens, Richet and Curtis.(31) In my Harveian Oration for 1906(32) I have dealt specially with the reception of the new views, and have shown how long it was before the reverence for Galen allowed of their acceptance. The University of Paris opposed the circulation of the blood for more than half a century after the appearance of the "De Motu Cordis." (30) De Plantis, Lib I, cap. 2. (*) Cesalpinus has also a definite statement of the circlewise process.--Ed. (31) J. C. Dalton Doctrines of the Circulation, Philadelphia, 1884; Flourens Histoire de la decouverte de la circulation du sang, 2d ed., Paris, 1857; Charles Richet Harvey, la circulation du sang, Paris, 1879; John G. Curtis Harvey's views on the use of Circulation, etc., New York, 1916. (32) Osler An Alabama Student and Other Biographical Essays, Oxford, 1908, p. 295. To summarize--until the seventeenth century there were believed to be two closed systems in the circulation, (1) the natural, containing venous blood, had its origin in the liver from which, as from a fountain, the blood continually ebbed and flowed for the nourishment of the body; (2) the vital, containing another blood and the spirits, ebbed and flowed from the heart, distributing heat and life to all parts. Like a bellows the lungs fanned and cooled this vital blood. Here and there we find glimmering conceptions of a communication between these systems, but practically all teachers believed that the only one of importance was through small pores in the wall separating the two sides of the heart. Observation--merely looking at and thinking about things--had done all that was possible, and further progress had to await the introduction of a new method, viz., experiment. Galen, it is true, had used this means to show that the arteries of the body contained blood and not air. The day had come when men were no longer content with accurate description and with finely spun theories and dreams. It was reserved for the immortal Harvey to put into practice the experimental method by which he demonstrated conclusively that the blood moved in a circle. The "De Motu Cordis" marks the final break of the modern spirit with the old traditions. It took long for men to realize the value of this "inventum mirabile" used so effectively by the Alexandrians--by Galen--indeed, its full value has only been appreciated within the past century. Let me quote a paragraph from my Harveian Oration.(33) "To the age of the hearer, in which men had heard and heard only, had succeeded the age of the eye in which men had seen and had been content only to see. But at last came the age of the hand--the thinking, devising, planning hand, the hand as an instrument of the mind, now re-introduced into the world in a modest little monograph from which we may date the beginning of experimental medicine." (33) Osler: An Alabama Student, etc., pp. 329-330. Harvey caught the experimental spirit in Italy, with brain, eye and hand as his only aids, but now an era opened in which medicine was to derive an enormous impetus from the discovery of instruments of precision. "The new period in the development of the natural sciences, which reached its height in the work of such men as Galileo, Gilbert and Kepler, is chiefly characterized by the invention of very important instruments for aiding and intensifying the perceptions of the senses, by means of which was gained a much deeper insight into the phenomena than had hitherto been possible. Such instruments as the earlier ages possessed were little more than primitive hand-made tools. Now we find a considerable number of scientifically made instruments deliberately planned for purposes of special research, and as it were, on the threshold of the period stand two of the most important, the compound microscope and the telescope. The former was invented about 1590 and the latter about 1608."(34) It was a fellow professor of the great genius Galileo who attempted to put into practice the experimental science of his friend. With Sanctorius began the studies of temperature, respiration and the physics of the circulation. The memory of this great investigator has not been helped by the English edition of his "De Statica Medicina," not his best work, with a frontispiece showing the author in his dietetic balance. Full justice has been done to him by Dr. Weir Mitchell in an address as president of the Congress of Physicians and Surgeons, 1891.(35) Sanctorius worked with a pulsilogue devised for him by Galileo, with which he made observations on the pulse. He is said to have been the first to put in use the clinical thermometer. His experiments on insensible perspiration mark him as one of the first modern physiologists. (34) Dannemann: Die Naturwissenschaften in ihrer Entwickelung..., Vol. II, p. 7, Leipzig, 1911. (35) See Transactions Congress Physicians and Surgeons, 1891, New Haven, 1892, II, 159-181. But neither Sanctorius nor Harvey had the immediate influence upon their contemporaries which the novel and stimulating character of their work justified. Harvey's great contemporary, Bacon, although he lost his life in making a cold storage experiment, did not really appreciate the enormous importance of experimental science. He looked very coldly upon Harvey's work. It was a philosopher of another kidney, Rene Descartes, who did more than anyone else to help men to realize the value of the better way which Harvey had pointed out. That the beginning of wisdom was in doubt, not in authority, was a novel doctrine in the world, but Descartes was no armchair philosopher, and his strong advocacy and practice of experimentation had a profound influence in directing men to "la nouvelle methode." He brought the human body, the earthly machine, as he calls it, into the sphere of mechanics and physics, and he wrote the first text-book of physiology, "De l'Homme." Locke, too, became the spokesman of the new questioning spirit, and before the close of the seventeenth century, experimental research became all the mode. Richard Lower, Hooke and Hales were probably more influenced by Descartes than by Harvey, and they made notable contributions to experimental physiology in England. Borelli, author of the famous work on "The Motion of Animals" (Rome, 1680-1681), brought to the study of the action of muscles a profound knowledge of physics and mathematics and really founded the mechanical, or iatromechanical school. The literature and the language of medicine became that of physics and mechanics: wheels and pulleys, wedges, levers, screws, cords, canals, cisterns, sieves and strainers, with angles, cylinders, celerity, percussion and resistance, were among the words that now came into use in medical literature. Withington quotes a good example in a description by Pitcairne, the Scot who was professor of medicine at Leyden at the end of the seventeenth century. "Life is the circulation of the blood. Health is its free and painless circulation. Disease is an abnormal motion of the blood, either general or local. Like the English school generally, he is far more exclusively mechanical than are the Italians, and will hear nothing of ferments or acids, even in digestion. This, he declares, is a purely mechanical process due to heat and pressure, the wonderful effects of which may be seen in Papin's recently invented 'digester.' That the stomach is fully able to comminute the food may be proved by the following calculation. Borelli estimates the power of the flexors of the thumb at 3720 pounds, their average weight being 122 grains. Now, the average weight of the stomach is eight ounces, therefore it can develop a force of 117,088 pounds, and this may be further assisted by the diaphragm and abdominal muscles the power of which, estimated in the same way, equals 461,219 pounds! Well may Pitcairne add that this force is not inferior to that of any millstone."(36) Paracelsus gave an extraordinary stimulus to the study of chemistry and more than anyone else he put the old alchemy on modern lines. I have already quoted his sane remark that its chief service is in seeking remedies. But there is another side to this question. If, as seems fairly certain, the Basil Valentine whose writings were supposed to have inspired Paracelsus was a hoax and his works were made up in great part from the writings of Paracelsus, then to our medical Luther, and not to the mythical Benedictine monk, must be attributed a great revival in the search for the Philosopher's Stone, for the Elixir of Life, for a universal medicine, for the perpetuum mobile and for an aurum potabile.(37) I reproduce, almost at random, a page from the fifth and last part of the last will and testament of Basil Valentine (London, 1657), from which you may judge the chemical spirit of the time. (36) Withington: Medical History from the Earliest Times, London, 1891, Scientific Press, p. 317. (37) See Professor Stillman on the Basil Valentine hoax, Popular Science Monthly, New York, 1919, LXXXI, 591-600. Out of the mystic doctrines of Paracelsus arose the famous "Brothers of the Rosy Cross." "The brotherhood was possessed of the deepest knowledge and science, the transmutation of metals, the perpetuum mobile and the universal medicine were among their secrets; they were free from sickness and suffering during their lifetime, though subject finally to death."(38) (38) Ferguson: Bibliotheca Chemica, Vol. II, p. 290. For an account of Fludd and the English Rosicrucians see Craven's Life of Fludd, Kirkwall, 1902. A school of a more rational kind followed directly upon the work of Paracelsus, in which the first man of any importance was Van Helmont. The Paracelsian Archeus was the presiding spirit in living creatures, and worked through special local ferments, by which the functions of the organs are controlled. Disease of any part represents a strike on the part of the local Archeus, who refuses to work. Though full of fanciful ideas, Van Helmont had the experimental spirit and was the first chemist to discover the diversity of gases. Like his teacher, he was in revolt against the faculty, and he has bitter things to say of physicians. He got into trouble with the Church about the magnetic cure of wounds, as no fewer than twenty-seven propositions incompatible with the Catholic faith were found in his pamphlet (Ferguson). The Philosophus per ignem, Toparcha in Merode, Royenborch, as he is styled in certain of his writings, is not an easy man to tackle. I show the title-page of the "Ortus Medicinae," the collection of his works by his son. As with the pages of Paracelsus, there are many gems to be dug out. The counterblast against bleeding was a useful protest, and to deny in toto its utility in fever required courage--a quality never lacking in the Father of Modern Chemistry, as he has been called. A man of a very different type, a learned academic, a professor of European renown, was Daniel Sennert of Wittenberg, the first to introduce the systematic teaching of chemistry into the curriculum, and who tried to harmonize the Galenists and Paracelsians. Franciscus Sylvius, a disciple of Van Helmont, established the first chemical laboratory in Europe at Leyden, and to him is due the introduction of modern clinical teaching. In 1664 he writes: "I have led my pupils by the hand to medical practice, using a method unknown at Leyden, or perhaps elsewhere, i.e., taking them daily to visit the sick at the public hospital. There I have put the symptoms of disease before their eyes; have let them hear the complaints of the patients, and have asked them their opinions as to the causes and rational treatment of each case, and the reasons for those opinions. Then I have given my own judgment on every point. Together with me they have seen the happy results of treatment when God has granted to our cares a restoration of health; or they have assisted in examining the body when the patient has paid the inevitable tribute to death."(39) (39) Withington: Medical History from the Earliest Times, London, 1894, pp. 312-313. Glauber, Willis, Mayow, Lemery, Agricola and Stahl led up to Robert Boyle, with whom modern chemistry may be said to begin. Even as late as 1716, Lady Mary Wortley Montagu in Vienna found that all had transferred their superstitions from religion to chemistry; "scarcely a man of opulence or fashion that has not an alchemist in his service." To one scientific man of the period I must refer as the author of the first scientific book published in England. Dryden sings: Gilbert shall live till load-stones cease to draw Or British fleets the boundless ocean awe. And the verse is true, for by the publication in 1600 of the "De Magnete" the science of electricity was founded. William Gilbert was a fine type of the sixteenth-century physician, a Colchester man, educated at St. John's College, Cambridge. Silvanus Thompson says: "He is beyond question rightfully regarded as the Father of Electric Science. He founded the entire subject of Terrestrial Magnetism. He also made notable contributions to Astronomy, being the earliest English expounder of Copernicus. In an age given over to metaphysical obscurities and dogmatic sophistry, he cultivated the method of experiment and of reasoning from observation, with an insight and success which entitles him to be regarded as the father of the inductive method. That method, so often accredited to Bacon, Gilbert was practicing years before him."(40) (40) Silvanus P. Thompson: Gilbert of Colchester, Father of Electrical Science, London, Chiswick Press, 1903, p. 3. CHAPTER V -- THE RISE AND DEVELOPMENT OF MODERN MEDICINE THE middle of the seventeenth century saw the profession thus far on its way--certain objective features of disease were known, the art of careful observation had been cultivated, many empirical remedies had been discovered, the coarser structure of man's body had been well worked out, and a good beginning had been made in the knowledge of how the machinery worked--nothing more. What disease really was, where it was, how it was caused, had not even begun to be discussed intelligently. An empirical discovery of the first importance marks the middle of the century. The story of cinchona is of special interest, as it was the first great specific in disease to be discovered. In 1638, the wife of the Viceroy of Peru, the Countess of Chinchon, lay sick of an intermittent fever in the Palace of Lima. A friend of her husband's, who had become acquainted with the virtues, in fever, of the bark of a certain tree, sent a parcel of it to the Viceroy, and the remedy administered by her physician, Don Juan del Vego, rapidly effected a cure. In 1640, the Countess returned to Spain, bringing with her a supply of quina bark, which thus became known in Europe as "the Countess's Powder" (pulvis Comitissae). A little later, her doctor followed, bringing additional quantities. Later in the century, the Jesuit Fathers sent parcels of the bark to Rome, whence it was distributed to the priests of the community and used for the cure of ague; hence the name of "Jesuits' bark." Its value was early recognized by Sydenham and by Locke. At first there was a great deal of opposition, and the Protestants did not like it because of its introduction by the Jesuits. The famous quack, Robert Talbor, sold the secret of preparing quinquina to Louis XIV in 1679 for two thousand louis d'or, a pension and a title. That the profession was divided in opinion on the subject was probably due to sophistication, or to the importation of other and inert barks. It was well into the eighteenth century before its virtues were universally acknowledged. The tree itself was not described until 1738, and Linnaeus established the genus "Chinchona" in honor of the Countess.(1) (1) Clements R. Markham: Peruvian Bark, John Murray, London, 1880; Memoir of the Lady Anna di Osoria, Countess of Chinchona and Vice-Queen of Peru, 1874. A step in advance followed the objective study of the changes wrought in the body by disease. To a few of these the anatomists had already called attention. Vesalius, always keen in his description of aberrations from the normal, was one of the first to describe internal aneurysm. The truth is, even the best of men had little or no appreciation of the importance of the study of these changes. Sydenham scoffs at the value of post-mortems. Again we have to go back to Italy for the beginning of these studies, this time to Florence, in the glorious days of Lorenzo the Magnificent. The pioneer now is not a professor but a general practitioner, Antonio Benivieni, of whom we know very little save that he was a friend of Marsilio Ficino and of Angelo Poliziano, and that he practiced in Florence during the last third of the fifteenth century, dying in 1502. Through associations with the scholars of the day, he had become a student of Greek medicine and he was not only a shrewd and accurate observer of nature but a bold and successful practitioner. He had formed the good habit of making brief notes of his more important cases, and after his death these were found by his brother Jerome and published in 1507.(2) This book has a rare value as the record of the experience of an unusually intelligent practitioner of the period. There are in all 111 observations, most of them commendably brief. The only one of any length deals with the new "Morbus Gallicus," of which, in the short period between its appearance and Benivieni's death, he had seen enough to leave a very accurate description; and it is interesting to note that even in those early days mercury was employed for its cure. The surgical cases are of exceptional interest, and No. 38 refers to a case of angina for which he performed a successful operation. This is supposed to have been a tracheotomy, and if so, it is the first in the fourteen centuries that had elapsed since the days of Antyllus.(3) There are other important cases which show that he was a dexterous and fearless surgeon. But the special interest of the work for us is that, for the first time in modern literature, we have reports of post-mortem examinations made specifically with a view to finding out the exact cause of death. Among the 111 cases, there are post-mortem records of cases of gallstones, abscess of the mesentery, thrombosis of the mesenteric veins, several cases of heart disease, senile gangrene and one of cor villosum. From no other book do we get so good an idea of a practitioner's experience at this period; the notes are plain and straightforward, and singularly free from all theoretical and therapeutic vagaries. He gives several remarkable instances of faith healing. (2) De abditis nonnullis ac mirandis morborum et sanationum causis. 8th, Florence, Gandhi, 1507. (3) Possibly it was only a case of angina Ludovici, or retro-pharyngeal abscess. To know accurately the anatomical changes that take place in disease is of importance both for diagnosis and for treatment. The man who created the science, who taught us to think anatomically of disease, was Morgagni, whose "De sedibus et causis morborum per anatomen indagatis"(4) is one of the great books in our literature. During the seventeenth century, the practice of making post-mortem examinations had extended greatly, and in the "Sepulchretum anatomicum" of Bonetus (1679), these scattered fragments are collected.(5) But the work of Morgagni is of a different type, for in it are the clinical and anatomical observations of an able physician during a long and active life. The work had an interesting origin. A young friend interested in science and in medicine was fond of discoursing with Morgagni about his preceptors, particularly Valsalva and Albertini, and sometimes the young man inquired about Morgagni's own observations and thoughts. Yielding to a strong wish, Morgagni consented to write his young friend familiar letters describing his experiences. I am sorry that Morgagni does not mention the name of the man to whom we are so much indebted, and who, he states, was so pleased with the letters that he continually solicited him to send more and more "till he drew me on so far as the seventieth; . . . when I begged them of him in order to revise their contents; he did not return them, till he had made me solemnly promise, that I would not abridge any part thereof" (Preface). (4) Venice, 1761. (5) Boerhaave remarked that if a man wished to deserve or get a medical degree from ONE medical author let it be this. (James Atkinson: Medical Bibliography, 1834, 268.) Born in 1682, Morgagni studied at Bologna under Valsalva and Albertini. In 1711, he was elected professor of medicine at Padua. He published numerous anatomical observations and several smaller works of less importance. The great work which has made his name immortal in the profession, appeared in his eightieth year, and represents the accumulated experience of a long life. Though written in the form of letters, the work is arranged systematically and has an index of exceptional value. From no section does one get a better idea of the character and scope of the work than from that relating to the heart and arteries--affections of the pericardium, diseases of the valves, ulceration, rupture, dilation and hypertrophy and affections of the aorta are very fully described. The section on aneurysm of the aorta remains one of the best ever written. It is not the anatomical observations alone that make the work of unusual value, but the combination of clinical with anatomical records. What could be more correct than this account of angina pectoris--probably the first in the literature? "A lady forty-two years of age, who for a long time, had been a valetudinarian, and within the same period, on using pretty quick exercise of body, she was subject to attacks of violent anguish in the upper part of the chest on the left side, accompanied with a difficulty of breathing, and numbness of the left arm; but these paroxysms soon subsided when she ceased from exertion. In these circumstances, but with cheerfulness of mind, she undertook a journey from Venice, purposing to travel along the continent, when she was seized with a paroxysm, and died on the spot. I examined the body on the following day.... The aorta was considerably dilated at its curvature; and, in places, through its whole tract, the inner surface was unequal and ossified. These appearances were propagated into the arteria innominata. The aortic valves were indurated...." He remarks, "The delay of blood in the aorta, in the heart, in the pulmonary vessels, and in the vena cave, would occasion the symptoms of which the woman complained during life; namely, the violent uneasiness, the difficulty of breathing, and the numbness of the arm."(6) (6) Cooke's Morgagni, Vol. 1, pp. 417-418. I cannot too warmly commend to young clinicians the reading of Morgagni. English editions are available--Alexander's three-volume translation of 1769 and Cooke's Abridgement (London, 1822), of which there was an American edition published in Boston in 1824. Morgagni's life had as much influence as his work. In close correspondence with the leading men of the day, with the young and rising teachers and workers, his methods must have been a great inspiration; and he came just at the right time. The profession was literally ravaged by theories, schools and systems--iatromechanics, iatrochemistry, humoralism, the animism of Stahl, the vitalistic doctrines of Van Helmont and his followers--and into this metaphysical confusion Morgagni came like an old Greek with his clear observation, sensible thinking and ripe scholarship. Sprengel well remarks that "it is hard to say whether one should admire most his rare dexterity and quickness in dissection, his unimpeachable love of truth and justice in his estimation of the work of others, his extensive scholarship and rich classical style or his downright common sense and manly speech." Upon this solid foundation the morbid anatomy of modern clinical medicine was built. Many of Morgagni's contemporaries did not fully appreciate the change that was in progress, and the value of the new method of correlating the clinical symptoms and the morbid appearances. After all, it was only the extension of the Hippocratic method of careful observation--the study of facts from which reasonable conclusions could be drawn. In every generation there had been men of this type--I dare say many more than we realize--men of the Benivieni character, thoroughly practical, clear-headed physicians. A model of this sort arose in England in the middle of the seventeenth century, Thomas Sydenham (1624-1689), who took men back to Hippocrates, just as Harvey had led them back to Galen. Sydenham broke with authority and went to nature. It is extraordinary how he could have been so emancipated from dogmas and theories of all sorts. He laid down the fundamental proposition, and acted upon it, that "all disease could be described as natural history." To do him justice we must remember, as Dr. John Brown says, "in the midst of what a mass of errors and prejudices, of theories actively mischievous, he was placed, at a time when the mania of hypothesis was at its height, and when the practical part of his art was overrun and stultified by vile and silly nostrums" ("Horae Subsecivae," Vol. I, 4th ed., Edinburgh, 1882, p. 40). Listen to what he says upon the method of the study of medicine: "In writing therefore, such a natural history of diseases, every merely philosophical hypothesis should be set aside, and the manifest and natural phenomena, however minute, should be noted with the utmost exactness. The usefulness of this procedure cannot be easily overrated, as compared with the subtle inquiries and trifling notions of modern writers, for can there be a shorter, or indeed any other way of coming at the morbific causes, or discovering the curative indications than by a certain perception of the peculiar symptoms? By these steps and helps it was that the father of physic, the great Hippocrates, came to excel, his theory being no more than an exact description or view of nature. He found that nature alone often terminates diseases, and works a cure with a few simple medicines, and often enough with no medicines at all." Towards the end of the century many great clinical teachers arose, of whom perhaps the most famous was Boerhaave, often spoken of as the Dutch Hippocrates, who inspired a group of distinguished students. I have already referred to the fact that Franciscus Sylvius at Leyden was the first among the moderns to organize systematic clinical teaching. Under Boerhaave, this was so developed that to this Dutch university students flocked from all parts of Europe. After teaching botany and chemistry, Boerhaave succeeded to the chair of physic in 1714. With an unusually wide general training, a profound knowledge of the chemistry of the day and an accurate acquaintance with all aspects of the history of the profession, he had a strongly objective attitude of mind towards disease, following closely the methods of Hippocrates and Sydenham. He adopted no special system, but studied disease as one of the phenomena of nature. His clinical lectures, held bi-weekly, became exceedingly popular and were made attractive not less by the accuracy and care with which the cases were studied than by the freedom from fanciful doctrines and the frank honesty of the man. He was much greater than his published work would indicate, and, as is the case with many teachers of the first rank, his greatest contributions were his pupils. No other teacher of modern times has had such a following. Among his favorite pupils may be mentioned Haller, the physiologist, and van Swieten and de Haen, the founders of the Vienna school. In Italy, too, there were men who caught the new spirit, and appreciated the value of combining morbid anatomy with clinical medicine. Lancisi, one of the early students of disease of the heart, left an excellent monograph on the subject, and was the first to call special attention to the association of syphilis with cardio-vascular disease. A younger contemporary of his at Rome, Baglivi, was unceasing in his call to the profession to return to Hippocratic methods, to stop reading philosophical theories and to give up what he calls the "fatal itch" to make systems. The Leyden methods of instruction were carried far and wide throughout Europe; into Edinburgh by John Rutherford, who began to teach at the Royal Infirmary in 1747, and was followed by Whytt and by Cullen; into England by William Saunders of Guy's Hospital. Unfortunately the great majority of clinicians could not get away from the theoretical conceptions of disease, and Cullen's theory of spasm and atony exercised a profound influence on practice, particularly in this country, where it had the warm advocacy of Benjamin Rush. Even more widespread became the theories of a pupil of Cullen's, John Brown, who regarded excitability as the fundamental property of all living creatures: too much of this excitability produced what were known as sthenic maladies, too little, asthenic; on which principles practice was plain enough. Few systems of medicine have ever stirred such bitter controversy, particularly on the Continent, and in Charles Creighton's account of Brown(7) we read that as late as 1802 the University of Gottingen was so convulsed by controversies as to the merits of the Brunonian system that contending factions of students in enormous numbers, not unaided by the professors, met in combat in the streets on two consecutive days and had to be dispersed by a troop of Hanoverian horse. (7) Dictionary of National Biography, London, 1886, VII, 14-17. But the man who combined the qualities of Vesalius, Harvey and Morgagni in an extraordinary personality was John Hunter. He was, in the first place, a naturalist to whom pathological processes were only a small part of a stupendous whole, governed by law, which, however, could never be understood until the facts had been accumulated, tabulated and systematized. By his example, by his prodigious industry, and by his suggestive experiments he led men again into the old paths of Aristotle, Galen and Harvey. He made all thinking physicians naturalists, and he lent a dignity to the study of organic life, and re-established a close union between medicine and the natural sciences. Both in Britain and Greater Britain, he laid the foundation of the great collections and museums, particularly those connected with the medical schools. The Wistar-Horner and the Warren Museums in this country originated with men greatly influenced by Hunter. He was, moreover, the intellectual father of that interesting group of men on this side of the Atlantic who, while practising as physicians, devoted much time and labor to the study of natural history; such men as Benjamin Smith Barton, David Hossack, Jacob Bigelow, Richard Harlan, John D. Godman, Samuel George Morton, John Collins Warren, Samuel L. Mitchill and J. Ailken Meigs. He gave an immense impetus in Great Britain to the study of morbid anatomy, and his nephew, Matthew Baillie, published the first important book on the subject in the English language. Before the eighteenth century closed practical medicine had made great advance. Smallpox, though not one of the great scourges like plague or cholera, was a prevalent and much dreaded disease, and in civilized countries few reached adult life without an attack. Edward Jenner, a practitioner in Gloucestershire, and the pupil to whom John Hunter gave the famous advice: "Don't think, try!" had noticed that milkmaids who had been infected with cowpox from the udder of the cow were insusceptible to smallpox. I show you here the hand of Sarah Nelmes with cowpox, 1796. A vague notion had prevailed among the dairies from time immemorial that this disease was a preventive of the smallpox. Jenner put the matter to the test of experiment. Let me quote here his own words: "The first experiment was made upon a lad of the name of Phipps, in whose arm a little vaccine virus was inserted, taken from the hand of a young woman who had been accidentally infected by a cow. Notwithstanding the resemblance which the pustule, thus excited on the boy's arm, bore to variolous inoculation, yet as the indisposition attending it was barely perceptible, I could scarcely persuade myself the patient was secure from the Small Pox. However, on his being inoculated some months afterwards, it proved that he was secure."(8) The results of his experiments were published in a famous small quarto volume in 1798.(*) From this date, smallpox has been under control. Thanks to Jenner, not a single person in this audience is pockmarked! A hundred and twenty-five years ago, the faces of more than half of you would have been scarred. We now know the principle upon which protection is secured: an active acquired immunity follows upon an attack of a disease of a similar nature. Smallpox and cowpox are closely allied and the substances formed in the blood by the one are resistant to the virus of the other. I do not see how any reasonable person can oppose vaccination or decry its benefits. I show you the mortality figures(9) of the Prussian Army and of the German Empire. A comparison with the statistics of the armies of other European countries in which revaccination is not so thoroughly carried out is most convincing of its efficacy. (8) Edward Jenner: The Origin of the Vaccine Inoculation, London, 1801. (*) Reprinted by Camac: Epoch-making Contributions to Medicine, etc., 1909.--Ed. (9) Jockmann: Pocken und Vaccinationlehre, 1913. The early years of the century saw the rise of modern clinical medicine in Paris. In the art of observation men had come to a standstill. I doubt very much whether Corvisart in 1800 was any more skilful in recognizing a case of pneumonia than was Aretaeus in the second century A. D. But disease had come to be more systematically studied; special clinics were organized, and teaching became much more thorough. Anyone who wishes to have a picture of the medical schools in Europe in the first few years of the century, should read the account of the travels of Joseph Frank of Vienna.(10) The description of Corvisart is of a pioneer in clinical teaching whose method remains in vogue today in France--the ward visit, followed by a systematic lecture in the amphitheatre. There were still lectures on Hippocrates three times a week, and bleeding was the principal plan of treatment: one morning Frank saw thirty patients, out of one hundred and twelve, bled! Corvisart was the strong clinician of his generation, and his accurate studies on the heart were among the first that had concentrated attention upon a special organ. To him, too, is due the reintroduction of the art of percussion in internal disease discovered by Auenbrugger in 1761. (10) Joseph Frank: Reise nach Paris (etc.), Wien, 1804-05. The man who gave the greatest impetus to the study of scientific medicine at this time was Bichat, who pointed out that the pathological changes in disease were not so much in organs as in tissues. His studies laid the foundation of modern histology. He separated the chief constituent elements of the body into various tissues possessing definite physical and vital qualities. "Sensibility and contractability are the fundamental qualities of living matter and of the life of our tissues. Thus Bichat substituted for vital forces 'vital properties,' that is to say, a series of vital forces inherent in the different tissues."(11) His "Anatomic Generale," published in 1802, gave an extraordinary stimulus to the study of the finer processes of disease, and his famous "Recherches sur la Vie et sur la Mort" (1800) dealt a death-blow to old iatromechanical and iatrochemical views. His celebrated definition may be quoted: "La vie est l'ensemble des proprietes vitales qui resistent aux proprietes physiques, ou bien la vie est l'ensemble des fonctions qui resistent a la mort." (Life is the sum of the vital properties that withstand the physical properties, or, life is the sum of the functions that withstand death.) Bichat is another pathetic figure in medical history. His meteoric career ended in his thirty-first year: he died a victim of a post-mortem wound infection. At his death, Corvisart wrote Napoleon: "Bichat has just died at the age of thirty. That battlefield on which he fell is one which demands courage and claims many victims. He has advanced the science of medicine. No one at his age has done so much so well." (11) E. Boinet: Les doctrines medicules, leur evolution, Paris, 1907, pp. 85-86. It was a pupil of Corvisart, Rene Theophile Laennec, who laid the foundation of modern clinical medicine. The story of his life is well known. A Breton by birth, he had a hard, up-hill struggle as a young man--a struggle of which we have only recently been made aware by the publication of a charming book by Professor Rouxeau of Nantes--"Laennec avant 1806." Influenced by Corvisart, he began to combine the accurate study of cases in the wards with anatomical investigations in the dead-house. Before Laennec, the examination of a patient had been largely by sense of sight, supplemented by that of touch, as in estimating the degree of fever, or the character of the pulse. Auenbrugger's "Inventum novum" of percussion, recognized by Corvisart, extended the field; but the discovery of auscultation by Laennec, and the publication of his work--"De l'Auscultation Mediate," 1819,--marked an era in the study of medicine. The clinical recognition of individual diseases had made really very little progress; with the stethoscope begins the day of physical diagnosis. The clinical pathology of the heart, lungs and abdomen was revolutionized. Laennec's book is in the category of the eight or ten greatest contributions to the science of medicine.(*) His description of tuberculosis is perhaps the most masterly chapter in clinical medicine. This revolution was effected by a simple extension of the Hippocratic method from the bed to the dead-house, and by correlating the signs and symptoms of a disease with its anatomical appearances. (*) John Forbes's translation of Auenbrugger and part of his translation of Lacnnec are reprinted in Camac's Epoch-making Contributions, etc., 1909.--Ed. The pupils and successors of Corvisart--Bayle, Andral, Bouillaud, Chomel, Piorry, Bretonneau, Rayer, Cruveilhier and Trousseau--brought a new spirit into the profession. Everywhere the investigation of disease by clinical-pathological methods widened enormously the diagnostic powers of the physician. By this method Richard Bright, in 1836, opened a new chapter on the relation of disease of the kidney to dropsy, and to albuminous urine. It had already been shown by Blackwell and by Wells, the celebrated Charleston (S.C.) physician, in 1811, that the urine contained albumin in many cases of dropsy, but it was not until Bright began a careful investigation of the bodies of patients who had presented these symptoms, that he discovered the association of various forms of disease of the kidney with anasarca and albuminous urine. In no direction was the harvest of this combined study more abundant than in the complicated and confused subject of fever. The work of Louis and of his pupils, W.W. Gerhard and others, revealed the distinction between typhus and typhoid fever, and so cleared up one of the most obscure problems in pathology. By Morgagni's method of "anatomical thinking," Skoda in Vienna, Schonlein in Berlin, Graves and Stokes in Dublin, Marshall Hall, C. J. B. Williams and many others introduced the new and exact methods of the French and created a new clinical medicine. A very strong impetus was given by the researches of Virchow on cellular pathology, which removed the seats of disease from the tissues, as taught by Bichat, to the individual elements, the cells. The introduction of the use of the microscope in clinical work widened greatly our powers of diagnosis, and we obtained thereby a very much clearer conception of the actual processes of disease. In another way, too, medicine was greatly helped by the rise of experimental pathology, which had been introduced by John Hunter, was carried along by Magendie and others, and reached its culmination in the epoch-making researches of Claude Bernard. Not only were valuable studies made on the action of drugs, but also our knowledge of cardiac pathology was revolutionized by the work of Traube, Cohnheim and others. In no direction did the experimental method effect such a revolution as in our knowledge of the functions of the brain. Clinical neurology, which had received a great impetus by the studies of Todd, Romberg, Lockhart Clarke, Duchenne and Weir Mitchell, was completely revolutionized by the experimental work of Hitzig, Fritsch and Ferrier on the localization of functions in the brain. Under Charcot, the school of French neurologists gave great accuracy to the diagnosis of obscure affections of the brain and spinal cord, and the combined results of the new anatomical, physiological and experimental work have rendered clear and definite what was formerly the most obscure and complicated section of internal medicine. The end of the fifth decade of the century is marked by a discovery of supreme importance. Humphry Davy had noted the effects of nitrous oxide. The exhilarating influence of sulphuric ether had been casually studied, and Long of Georgia had made patients inhale the vapor until anaesthetic and had performed operations upon them when in this state; but it was not until October 16, 1846, in the Massachusetts General Hospital, that Morton, in a public operating room, rendered a patient insensible with ether and demonstrated the utility of surgical anaesthesia. The rival claims of priority no longer interest us, but the occasion is one of the most memorable in the history of the race. It is well that our colleagues celebrate Ether Day in Boston--no more precious boon has ever been granted to suffering humanity.(*) (*) Cf. Osler: Proc. Roy. Soc. Med., XI, Sect. Hist. Med., pp. 65-69, 1918, or, Annals Med. Hist., N.Y., I, 329-332. Cf. also Morton's publications reprinted in Camac's book cited above.--Ed. In 1857, a young man, Louis Pasteur, sent to the Lille Scientific Society a paper on "Lactic Acid Fermentation" and in December of the same year presented to the Academy of Sciences in Paris a paper on "Alcoholic Fermentation" in which he concluded that "the deduplication of sugar into alcohol and carbonic acid is correlative to a phenomenon of life." A new era in medicine dates from those two publications. The story of Pasteur's life should be read by every student.(*) It is one of the glories of human literature, and, as a record of achievement and of nobility of character, is almost without an equal. (*) Osler wrote a preface for the 1911 English edition of the Life by Vallery-Radot.--Ed. At the middle of the last century we did not know much more of the actual causes of the great scourges of the race, the plagues, the fevers and the pestilences, than did the Greeks. Here comes Pasteur's great work. Before him Egyptian darkness; with his advent a light that brightens more and more as the years give us ever fuller knowledge. The facts that fevers were catching, that epidemics spread, that infection could remain attached to articles of clothing, etc., all gave support to the view that the actual cause was something alive, a contagium vivum. It was really a very old view, the germs of which may be found in the Fathers, but which was first clearly expressed--so far as I know--by Fracastorius, the Veronese physician, in the sixteenth century, who spoke of the seeds of contagion passing from one person to another;(12) and he first drew a parallel between the processes of contagion and the fermentation of wine. This was more than one hundred years before Kircher, Leeuwenhoek and others began to use the microscope and to see animalcula, etc., in water, and so give a basis for the "infinitely little" view of the nature of disease germs. And it was a study of the processes of fermentation that led Pasteur to the sure ground on which we now stand. (12) Varro, in De Re Rustica, Bk. I, 12 (circa 40 B.C.), speaks of minute organisms which the eye cannot see and which enter the body and cause disease. Out of these researches arose a famous battle which kept Pasteur hard at work for four or five years--the struggle over spontaneous generation. It was an old warfare, but the microscope had revealed a new world, and the experiments on fermentation had lent great weight to the omne vivum ex ovo doctrine. The famous Italians, Redi and Spallanzani, had led the way in their experiments, and the latter had reached the conclusion that there is no vegetable and no animal that has not its own germ. But heterogenesis became the burning question, and Pouchet in France, and Bastian in England, led the opposition to Pasteur. The many famous experiments carried conviction to the minds of scientific men, and destroyed forever the old belief in spontaneous generation. All along, the analogy between disease and fermentation must have been in Pasteur's mind; and then came the suggestion, "What would be most desirable is to push those studies far enough to prepare the road for a serious research into the origin of various diseases." If the changes in lactic, alcoholic and butyric fermentations are due to minute living organisms, why should not the same tiny creatures make the changes which occur in the body in the putrid and suppurative diseases? With an accurate training as a chemist, having been diverted in his studies upon fermentation into the realm of biology, and nourishing a strong conviction of the identity between putrefactive changes of the body and fermentation, Pasteur was well prepared to undertake investigations which had hitherto been confined to physicians alone. So impressed was he with the analogy between fermentation and the infectious diseases that, in 1863, he assured the French Emperor of his ambition "to arrive at the knowledge of the causes of putrid and contagious diseases." After a study upon the diseases of wines, which has had most important practical bearings, an opportunity arose which changed the whole course of his career, and profoundly influenced the development of medical science. A disease of the silkworm had, for some years, ruined one of the most important industries in France, and in 1865 the Government asked Pasteur to give up his laboratory work and teaching, and to devote his whole energies to the task of investigating it. The story of the brilliant success which followed years of application to the problem will be read with deep interest by every student of science. It was the first of his victories in the application of the experimental methods of a trained chemist to the problems of biology, and it placed his name high in the group of the most illustrious benefactors of practical industries. In a series of studies on the diseases of beer, and on the mode of production of vinegar, he became more and more convinced that these studies on fermentation had given him the key to the nature of the infectious diseases. It is a remarkable fact that the distinguished English philosopher of the seventeenth century, the man who more than anyone else of his century appreciated the importance of the experimental method, Robert Boyle, had said that he who could discover the nature of ferments and fermentation, would be more capable than anyone else of explaining the nature of certain diseases. In 1876 there appeared in Cohn's "Beitrage zur Morphologie der Pflanzen" (II, 277-310), a paper on the "AEtiology of Anthrax" by a German district physician in Wollstein, Robert Koch, which is memorable in our literature as the starting point of a new method of research into the causation of infectious diseases. Koch demonstrated the constant presence of germs in the blood of animals dying from the disease. Years before, those organisms had been seen by Pollender and Davaine, but the epoch-making advance of Koch was to grow those organisms in a pure culture outside the body, and to produce the disease artificially by inoculating animals with the cultures Koch is really our medical Galileo, who, by means of a new technique,--pure cultures and isolated staining,--introduced us to a new world. In 1878, followed his study on the "AEtiology of Wound Infections," in which he was able to demonstrate conclusively the association of micro-organisms with the disease. Upon those two memorable researches made by a country doctor rests the modern science of bacteriology. The next great advance was the discovery by Pasteur of the possibility of so attenuating, or weakening, the poison that an animal inoculated had a slight attack, recovered and was then protected against the disease. More than eighty years had passed since on May 14, 1796, Jenner had vaccinated a child with cowpox and proved that a slight attack of one disease protected the body from a disease of an allied nature. An occasion equally famous in the history of medicine was a day in 1881, when Pasteur determined that a flock of sheep vaccinated with the attenuated virus of anthrax remained well, when every one of the unvaccinated infected from the same material had died. Meanwhile, from Pasteur's researches on fermentation and spontaneous generation, a transformation had been initiated in the practice of surgery, which, it is not too much to say, has proved one of the greatest boons ever conferred upon humanity. It had long been recognized that, now and again, a wound healed without the formation of pus, that is, without suppuration, but both spontaneous and operative wounds were almost invariably associated with that process; and, moreover, they frequently became putrid, as it was then called,--infected, as we should say,--the general system became involved and the patient died of blood poisoning. So common was this, particularly in old, ill-equipped hospitals, that many surgeons feared to operate, and the general mortality in all surgical cases was very high. Believing that it was from outside that the germs came which caused the decomposition of wounds, just as from the atmosphere the sugar solution got the germs which caused the fermentation, a young surgeon in Glasgow, Joseph Lister, applied the principles of Pasteur's experiments to their treatment. From Lister's original paper(*) I quote the following: "Turning now to the question how the atmosphere produces decomposition of organic substances, we find that a flood of light has been thrown upon this most important subject by the philosophic researches of M. Pasteur, who has demonstrated by thoroughly convincing evidence that it is not to its oxygen or to any of its gaseous constituents that the air owes this property, but to minute particles suspended in it, which are the germs of various low forms of life, long since revealed by the microscope, and regarded as merely accidental concomitants of putrescence, but now shown by Pasteur to be its essential cause, resolving the complex organic compounds into substances of simpler chemical constitution, just as the yeast-plant converts sugar into alcohol and carbonic acid." From these beginnings modern surgery took its rise, and the whole subject of wound infection, not only in relation to surgical diseases, but to child-bed fever, forms now one of the most brilliant chapters in the history of preventive medicine. (*) Lancet, March 16, 1867. (Cf. Camac: Epoch-making Contributions, etc., 1909, p. 7.--Ed.) With the new technique and experimental methods, the discovery of the specific germs of many of the more important acute infections followed each other with bewildering rapidity: typhoid fever, diphtheria, cholera, tetanus, plague, pneumonia, gonorrhoea and, most important of all, tuberculosis. It is not too much to say that the demonstration by Koch of the "bacillus tuberculosis" (1882) is, in its far-reaching results, one of the most momentous discoveries ever made. Of almost equal value have been the researches upon the protozoan forms of animal life, as causes of disease. As early as 1873, spirilla were demonstrated in relapsing fever. Laveran proved the association of haematozoa with malaria in 1880. In the same year, Griffith Evans discovered trypanosomes in a disease of horses and cattle in India, and the same type of parasite was found in the sleeping sickness. Amoebae were demonstrated in one form of dysentery, and in other tropical diseases protozoa were discovered, so that we were really prepared for the announcement in 1905, by Schaudinn, of the discovery of a protozoan parasite in syphilis. Just fifty years had passed since Pasteur had sent in his paper on "Lactic Acid Fermentation" to the Lille Scientific Society--half a century in which more had been done to determine the true nature of disease than in all the time that had passed since Hippocrates. Celsus makes the oft-quoted remark that to determine the cause of a disease often leads to the remedy,(*) and it is the possibility of removing the cause that gives such importance to the new researches on disease. (*) "Et causae quoque estimatio saepe morbum solvit," Celsus, Lib. I, Prefatio.--Ed. INTERNAL SECRETIONS ONE of the greatest contributions of the nineteenth century to scientific medicine was the discovery of the internal secretions of organs. The basic work on the subject was done by Claude Bernard, a pupil of the great Magendie, whose saying it is well to remember--"When entering a laboratory one should leave theories in the cloakroom." More than any other man of his generation, Claude Bernard appreciated the importance of experiment in practical medicine. For him the experimental physician was the physician of the future--a view well borne out by the influence his epoch-making work has had on the treatment of disease. His studies on the glycogenic functions of the liver opened the way for the modern fruitful researches on the internal secretions of the various glands. About the same time that Bernard was developing the laboratory side of the problem, Addison, a physician to Guy's Hospital, in 1855, pointed out the relation of a remarkable group of symptoms to disease of the suprarenal glands, small bodies situated above the kidneys, the importance of which had not been previously recognized. With the loss of the function of these glands by disease, the body was deprived of something formed by them which was essential to its proper working. Then, in the last third of the century, came in rapid succession the demonstration of the relations of the pancreas to diabetes, of the vital importance of the thyroid gland and of the pituitary body. Perhaps no more striking illustration of the value of experimental medicine has ever been given than that afforded by the studies upon those glands. The thyroid body, situated in the neck and the enlargement of which is called goitre, secretes substances which pass into the blood, and which are necessary for the growth of the body in childhood, for the development of the mind and for the nutrition of the tissues of the skin. If, following an infectious disease, a child has wasting of this gland, or if, living in a certain district, it has a large goitre, normal development does not take place, and the child does not grow in mind or body and becomes what is called a cretin. More than this--if in adult life the gland is completely removed, or if it wastes, a somewhat similar condition is produced, and the patient in time loses his mental powers and becomes fat and flabby--myxedematous. It has been shown experimentally in various ways that the necessary elements of the secretion can be furnished by feeding with the gland or its extracts, and that the cretinoid or myxedematous conditions could thus be cured or prevented. Experimental work has also demonstrated the functions of the suprarenal glands and explained the symptoms of Addison's disease, and chemists have even succeeded in making synthetically the active principle adrenalin. There is perhaps no more fascinating story in the history of science than that of the discovery of these so-called ductless glands. Part of its special interest is due to the fact that clinicians, surgeons, experimental physiologists, pathologists and chemists have all combined in splendid teamwork to win the victory. No such miracles have ever before been wrought by physicians as those which we see in connection with the internal secretion of the thyroid gland. The myth of bringing the dead back to life has been associated with the names of many great healers since the incident of Empedocles and Pantheia, but nowadays the dead in mind and the deformed in body may be restored by the touch of the magic wand of science. The study of the interaction of these internal secretions, their influence upon development, upon mental process and upon disorders of metabolism is likely to prove in the future of a benefit scarcely less remarkable than that which we have traced in the infectious diseases. CHEMISTRY IT is not making too strong a statement to say that the chemistry and chemical physics of the nineteenth century have revolutionized the world. It is difficult to realize that Liebig's famous Giessen laboratory, the first to be opened to students for practical study, was founded in the year 1825. Boyle, Cavendish, Priestley, Lavoisier, Black, Dalton and others had laid a broad foundation, and Young, Frauenhofer, Rumford, Davy, Joule, Faraday, Clerk-Maxwell, Helmholtz and others built upon that and gave us the new physics and made possible our age of electricity. New technique and new methods have given a powerful stimulus to the study of the chemical changes that take place in the body, which, only a few years ago, were matters largely of speculation. "Now," in the words of Professor Lee, "we recognize that, with its living and its non-living substances inextricably intermingled, the body constitutes an intensive chemical laboratory in which there is ever occurring a vast congeries of chemical reactions; both constructive and destructive processes go on; new protoplasm takes the place of old. We can analyze the income of the body and we can analyze its output, and from these data we can learn much concerning the body's chemistry. A great improvement in the method of such work has recently been secured by the device of inclosing the person who is the subject of the experiment in a respiration calorimeter. This is an air-tight chamber, artificially supplied with a constant stream of pure air, and from which the expired air, laden with the products of respiration, is withdrawn for purposes of analysis. The subject may remain in the chamber for days, the composition of all food and all excrete being determined, and all heat that is given off being measured. Favorable conditions are thus established for an exact study of many problems of nutrition. The difficulties increase when we attempt to trace the successive steps in the corporeal pathway of molecule and atom. Yet these secrets of the vital process are also gradually being revealed. When we remember that it is in this very field of nutrition that there exist great popular ignorance and a special proneness to fad and prejudice, we realize how practically helpful are such exact studies of metabolism."(13) (13) Frederick S. Lee, Ph.D.: Scientific Features of Modern Medicine, New York, 1911. I would like to call attention to this work of Professor Lee's as presenting all the scientific features of modern medicine in a way admirably adapted for anyone, lay or medical, who wishes to get a clear sketch of them. CHAPTER VI -- THE RISE OF PREVENTIVE MEDICINE THE story so far has been of men and of movements--of men who have, consciously or unconsciously, initiated great movements, and of movements by which, nolens volens, the men of the time were moulded and controlled. Hippocrates, in the tractate on "Ancient Medicine," has a splendid paragraph on the attitude of mind towards the men of the past. My attention was called to it one day in the Roman Forum by Commendatore Boni, who quoted it as one of the great sayings of antiquity. Here it is: "But on that account, I say, we ought not to reject the ancient Art, as if it were not, and had not been properly founded, because it did not attain accuracy in all things, but rather, since it is capable of reaching to the greatest exactitude by reasoning, to receive it and admire its discoveries, made from a state of great ignorance, and as having been well and properly made, and not from chance."(1) (1) The Works of Hippocrates, Adams, Vol. I, p. 168, London, 1849 (Sydenham Society). I have tried to tell you what the best of these men in successive ages knew, to show you their point of outlook on the things that interest us. To understand the old writers one must see as they saw, feel as they felt, believe as they believed--and this is hard, indeed impossible! We may get near them by asking the Spirit of the Age in which they lived to enter in and dwell with us, but it does not always come. Literary criticism is not literary history--we have no use here for the former, but to analyze his writings is to get as far as we can behind the doors of a man's mind, to know and appraise his knowledge, not from our standpoint, but from that of his contemporaries, his predecessors and his immediate successors. Each generation has its own problems to face, looks at truth from a special focus and does not see quite the same outlines as any other. For example, men of the present generation grow up under influences very different from those which surrounded my generation in the seventies of the last century, when Virchow and his great contemporaries laid the sure and deep foundations of modern pathology. Which of you now knows the "Cellular Pathology" as we did? To many of you it is a closed book,--to many more Virchow may be thought a spent force. But no, he has only taken his place in a great galaxy. We do not forget the magnitude of his labors, but a new generation has new problems--his message was not for you--but that medicine today runs in larger moulds and turns out finer castings is due to his life and work. It is one of the values of lectures on the history of medicine to keep alive the good influences of great men even after their positive teaching is antiquated. Let no man be so foolish as to think that he has exhausted any subject for his generation. Virchow was not happy when he saw the young men pour into the old bottle of cellular pathology the new wine of bacteriology. Lister could never understand how aseptic surgery arose out of his work. Ehrlich would not recognize his epoch-making views on immunity when this generation has finished with them. I believe it was Hegel who said that progress is a series of negations--the denial today of what was accepted yesterday, the contradiction by each generation of some part at least of the philosophy of the last; but all is not lost, the germ plasm remains, a nucleus of truth to be fertilized by men often ignorant even of the body from which it has come. Knowledge evolves, but in such a way that its possessors are never in sure possession. "It is because science is sure of nothing that it is always advancing" (Duclaux). History is the biography of the mind of man, and its educational value is in direct proportion to the completeness of our study of the individuals through whom this mind has been manifested. I have tried to take you back to the beginnings of science, and to trace its gradual development, which is conditioned by three laws. In the first place, like a living organism, truth grows, and its gradual evolution may be traced from the tiny germ to the mature product. Never springing, Minerva-like, to full stature at once, truth may suffer all the hazards incident to generation and gestation. Much of history is a record of the mishaps of truths which have struggled to the birth, only to die or else to wither in premature decay. Or the germ may be dormant for centuries, awaiting the fullness of time. Secondly, all scientific truth is conditioned by the state of knowledge at the time of its announcement. Thus, at the beginning of the seventeenth century, the science of optics and mechanical appliances had not made possible (so far as the human mind was concerned) the existence of blood capillaries and blood corpuscles. Jenner could not have added to his "Inquiry" a study on immunity; Sir William Perkin and the chemists made Koch technique possible; Pasteur gave the conditions that produced Lister; Davy and others furnished the preliminaries necessary for anaesthesia. Everywhere we find this filiation, one event following the other in orderly sequence--"Mind begets mind," as Harvey (De Generatione) says; "opinion is the source of opinion. Democritus with his atoms, and Eudoxus with his chief good which he placed in pleasure, impregnated Epicurus; the four elements of Empedocles, Aristotle; the doctrines of the ancient Thebans, Pythagoras and Plato; geometry, Euclid."(2) (2) Works of William Harvey, translated by Robert Willis, London, 1847, p. 532. And, thirdly, to scientific truth alone may the homo mensura principle be applied, since of all mental treasures of the race it alone compels general acquiescence. That this general acquiescence, this aspect of certainty, is not reached per saltum, but is of slow, often of difficult growth,--marked by failures and frailties, but crowned at last with an acceptance accorded to no other product of mental activity,--is illustrated by every important discovery from Copernicus to Darwin. The difficulty is to get men to the thinking level which compels the application of scientific truths. Protagoras, that "mighty-wise man," as Socrates called him, who was responsible for the aphorism that man is the measure of all things, would have been the first to recognize the folly of this standard for the people at large. But we have gradually reached a stage in which knowledge is translated into action, made helpful for suffering humanity, just as the great discoveries in physics and chemistry have been made useful in the advance of civilization. We have traced medicine through a series of upward steps--a primitive stage, in which it emerged from magic and religion into an empirical art, as seen among the Egyptians and Babylonians; a stage in which the natural character of disease was recognized and the importance of its study as a phenomenon of nature was announced; a stage in which the structure and functions of the human body were worked out; a stage in which the clinical and anatomical features of disease were determined; a stage in which the causes of disorders were profitably studied, and a final stage, into which we have just entered, the application of the knowledge for their prevention. Science has completely changed man's attitude towards disease. Take a recent concrete illustration. A couple of years ago in Philadelphia and in some other parts of the United States, a very peculiar disease appeared, characterized by a rash upon the skin and moderate fever, and a constitutional disturbance proportionate to the extent and severity of the eruption. The malady first broke out in the members of a crew of a private yacht; then in the crews of other boats, and among persons living in the boarding-houses along the docks. It was the cause of a great deal of suffering and disability. There were three courses open: to accept the disease as a visitation of God, a chastening affliction sent from above, and to call to aid the spiritual arm of the church. Except the "Peculiar People" few now take this view or adopt this practice. The Christian Scientist would probably deny the existence of the rash and of the fever, refuse to recognize the itching and get himself into harmony with the Infinite. Thirdly, the method of experimental medicine. First, the conditions were studied under which the individual cases occurred. The only common factor seemed to be certain straw mattresses manufactured by four different firms, all of which obtained the straw from the same source. The second point was to determine the relation of the straw to the rash. One of the investigators exposed a bare arm and shoulder for an hour between two mattresses. Three people voluntarily slept on the mattresses for one night. Siftings from the straw were applied to the arm, under all of which circumstances the rash quickly developed, showing conclusively the relation of the straw to the disease. Thirdly, siftings from the straw and mattresses which had been thoroughly disinfected failed to produce the rash. And fourthly, careful inspection of the siftings of the straw disclosed living parasites, small mites, which when applied to the skin quickly produced the characteristic eruption. SANITATION WHEN the thoughtful historian gets far enough away from the nineteenth century to see it as a whole, no single feature will stand out with greater distinctness than the fulfilment of the prophecy of Descartes that we could be freed from an infinity of maladies both of body and mind if we had sufficient knowledge of their causes and of all the remedies with which nature has provided us. Sanitation takes its place among the great modern revolutions--political, social and intellectual. Great Britain deserves the credit for the first practical recognition of the maxim salus populi suprema lex. In the middle and latter part of the century a remarkable group of men, Southwood Smith, Chadwick, Budd, Murchison, Simon, Acland, Buchanan, J.W. Russell and Benjamin Ward Richardson, put practical sanitation on a scientific basis. Even before the full demonstration of the germ theory, they had grasped the conception that the battle had to be fought against a living contagion which found in poverty, filth and wretched homes the conditions for its existence. One terrible disease was practically wiped out in twenty-five years of hard work. It is difficult to realize that within the memory of men now living, typhus fever was one of the great scourges of our large cities, and broke out in terrible epidemics--the most fatal of all to the medical profession. In the severe epidemic in Ireland in the forties of the last century, one fifth of all the doctors in the island died of typhus. A better idea of the new crusade, made possible by new knowledge, is to be had from a consideration of certain diseases against which the fight is in active progress. Nothing illustrates more clearly the interdependence of the sciences than the reciprocal impulse given to new researches in pathology and entomology by the discovery of the part played by insects in the transmission of disease. The flea, the louse, the bedbug, the house fly, the mosquito, the tick, have all within a few years taken their places as important transmitters of disease. The fly population may be taken as the sanitary index of a place. The discovery, too, that insects are porters of disease has led to a great extension of our knowledge of their life history. Early in the nineties, when Dr. Thayer and I were busy with the study of malaria in Baltimore, we began experiments on the possible transmission of the parasites, and a tramp, who had been a medical student, offered himself as a subject. Before we began, Dr. Thayer sought information as to the varieties of mosquitoes known in America, but sought in vain: there had at that time been no systematic study. The fundamental study which set us on the track was a demonstration by Patrick Manson,(3) in 1879, of the association of filarian disease with the mosquito. Many observations had already been made, and were made subsequently, on the importance of insects as intermediary hosts in the animal parasites, but the first really great scientific demonstration of a widespread infection through insects was by Theobald Smith, now of Harvard University, in 1889, in a study of Texas fever of cattle.(4) I well remember the deep impression made upon me by his original communication, which in completeness, in accuracy of detail, in Harveian precision and in practical results remains one of the most brilliant pieces of experimental work ever undertaken. It is difficult to draw comparisons in pathology; but I think, if a census were taken among the world's workers on disease, the judgment to be based on the damage to health and direct mortality, the votes would be given to malaria as the greatest single destroyer of the human race. Cholera kills its thousands, plague, in its bad years, its hundreds of thousands, yellow fever, hookworm disease, pneumonia, tuberculosis, are all terribly destructive, some only in the tropics, others in more temperate regions: but malaria is today, as it ever was, a disease to which the word pandemic is specially applicable. In this country and in Europe, its ravages have lessened enormously during the past century, but in the tropics it is everywhere and always present, the greatest single foe of the white man, and at times and places it assumes the proportions of a terrible epidemic. In one district of India alone, during the last four months of 1908, one quarter of the total population suffered from the disease and there were 400,000 deaths--practically all from malaria. Today, the control of this terrible scourge is in our hands, and, as I shall tell you in a few minutes, largely because of this control, the Panama Canal is being built. No disease illustrates better the progressive evolution of scientific medicine. It is one of the oldest of known diseases. The Greeks and Graeco-Romans knew it well. It seems highly probable, as brought out by the studies of W.H.S. Jones of Cambridge, that, in part at least, the physical degeneration in Greece and Rome may have been due to the great increase of this disease. Its clinical manifestations were well known and admirably described by the older writers. In the seventeenth century, as I have already told you, the remarkable discovery was made that the bark of the cinchona tree was a specific. Between the date of the Countess's recovery in Lima and the year 1880 a colossal literature on the disease had accumulated. Literally thousands of workers had studied the various aspects of its many problems; the literature of this country, particularly of the Southern States, in the first half of the last century may be said to be predominantly malarial. Ordinary observation carried on for long centuries had done as much as was possible. In 1880, a young French army surgeon, Laveran by name, working in Algiers, found in the microscopic examination of the blood that there were little bodies in the red blood corpuscles, amoeboid in character, which he believed to be the germs of the disease. Very little attention at first was paid to his work, and it is not surprising. It was the old story of "Wolf, wolf"; there had been so many supposed "germs" that the profession had become suspicious. Several years elapsed before Surgeon-General Sternberg called the attention of the English-speaking world to Laveran's work: it was taken up actively in Italy, and in America by Councilman, Abbott and by others among us in Baltimore. The result of these widespread observations was the confirmation in every respect of Laveran's discovery of the association with malaria of a protozoan parasite. This was step number three. Clinical observation, empirical discovery of the cure, determination of the presence of a parasite. Two other steps followed rapidly. Another army surgeon, Ronald Ross, working in India, influenced by the work of Manson, proved that the disease was transmitted by certain varieties of mosquitoes. Experiments came in to support the studies in etiology; two of those may be quoted. Mosquitoes which had bitten malarial patients in Italy were sent to London and there allowed to bite Mr. Manson, son of Dr. Manson. This gentleman had not lived out of England, where there is now no acute malaria. He had been a perfectly healthy, strong man. In a few days following the bites of the infected mosquitoes, he had a typical attack of malarial fever. (3) Journal Linnaean Society, London, 1879, XIV, 304-311. (4) Medical News, Philadelphia, 1889, LV, 689-693, and monograph with Kilborne, Washington, 1893. The other experiment, though of a different character, is quite as convincing. In certain regions about Rome, in the Campania, malaria is so prevalent that, in the autumn, almost everyone in the district is attacked, particularly if he is a newcomer. Dr. Sambon and a friend lived in this district from June 1 to September 1, 1900. The test was whether they could live in this exceedingly dangerous climate for the three months without catching malaria, if they used stringent precautions against the bites of mosquitoes. For this purpose the hut in which they lived was thoroughly wired, and they slept under netting. Both of these gentlemen, at the end of the period, had escaped the disease. Then came the fifth and final triumph--the prevention of the disease. The anti-malarial crusade which has been preached by Sir Ronald Ross and has been carried out successfully on a wholesale scale in Italy and in parts of India and Africa, has reduced enormously the incidence of the disease. Professor Celli of Rome, in his lecture room, has an interesting chart which shows the reduction in the mortality from malaria in Italy since the preventive measures have been adopted--the deaths have fallen from above 28,000 in 1888 to below 2000 in 1910. There is needed a stirring campaign against the disease throughout the Southern States of this country. The story of yellow fever illustrates one of the greatest practical triumphs of scientific medicine; indeed, in view of its far-reaching commercial consequences, it may range as one of the first achievements of the race. Ever since the discovery of America, the disease has been one of its great scourges, permanently endemic in the Spanish Main, often extending to the Southern States, occasionally into the North, and not infrequently it has crossed the Atlantic. The records of the British Army in the West Indies show an appalling death rate, chiefly from this disease. At Jamaica, for the twenty years ending in 1836, the average mortality was 101 per thousand, and in certain instances as high as 178. One of the most dreaded of all infections, the periods of epidemics in the Southern States have been the occasions of a widespread panic with complete paralysis of commerce. How appalling the mortality is may be judged from the outbreak in Philadelphia in 1793, when ten thousand people died in three months.(5) The epidemics in Spain in the early part of the nineteenth century were of great severity. A glance through La Roche's great book(6) on the subject soon gives one an idea of the enormous importance of the disease in the history of the Southern States. Havana, ever since its foundation, had been a hotbed of yellow fever. The best minds of the profession had been attracted to a solution of the problem, but all in vain. Commission after commission had been appointed, with negative results; various organisms had been described as the cause, and there were sad illustrations of the tragedy associated with investigations undertaken without proper training or proper technique. By the year 1900, not only had the ground been cleared, but the work on insect-borne disease by Manson and by Ross had given observers an important clue. It had repeatedly been suggested that some relation existed between the bites of mosquitoes and the tropical fevers, particularly by that remarkable student, Nott of Mobile, and the French physician, Beauperthuy. But the first to announce clearly the mosquito theory of the disease was Carlos Finlay of Havana. Early in the spring of 1900, during the occupation of Cuba by the United States, a commission appointed by Surgeon-General Sternberg (himself one of the most energetic students of the disease) undertook fresh investigations. Dr. Walter Reed, Professor of Bacteriology in the Army Medical School, was placed in charge: Dr. Carroll of the United States Army, Dr. Agramonte of Havana and Dr. Jesse W. Lazear were the other members. At the Johns Hopkins Hospital, we were deeply interested in the work, as Dr. Walter Reed was a favorite pupil of Professor Welch, a warm friend of all of us, and a frequent visitor to our laboratories. Dr. Jesse Lazear, who had been my house physician, had worked with Dr. Thayer and myself at malaria, and gave up the charge of my clinical laboratory to join the commission. (5) Matthew Carey: A Short Account of the Malignant Fever, Philadelphia, 1793. (6) R. La Roche: Yellow Fever, 2 vols., Philadelphia, 1855. Many scientific discoveries have afforded brilliant illustrations of method in research, but in the work of these men one is at a loss to know which to admire more--the remarkable accuracy and precision of the experiments, or the heroism of the men--officers and rank and file of the United States Army; they knew all the time that they were playing with death, and some of them had to pay the penalty! The demonstration was successful--beyond peradventure--that yellow fever could be transmitted by mosquitoes, and equally the negative proposition--that it could not be transmitted by fomites. An interval of twelve or more days was found to be necessary after the mosquito has bitten a yellow fever patient before it is capable of transmitting the infection. Lazear permitted himself to be bitten by a stray mosquito while conducting his experiments in the yellow fever hospital. Bitten on the thirteenth, he sickened on the eighteenth and died on the twenty-fifth of September, but not until he had succeeded in showing in two instances that mosquitoes could convey the infection. He added another to the long list of members of the profession who have laid down their lives in search of the causes of disease. Of such men as Lazear and of Myers of the Liverpool Yellow-Fever Commission, Dutton and young Manson, may fitly be sung from the noblest of American poems the tribute which Lowell paid to Harvard's sons who fell in the War of Secession: Many in sad faith sought for her, Many with crossed hands sighed for her; But these, our brothers, fought for her, At life's dear peril wrought for her, So loved her that they died for her. Fortunately, the commander-in-chief at the time in Cuba was General Leonard Wood, who had been an army surgeon, and he was the first to appreciate the importance of the discovery. The sanitation of Havana was placed in the hands of Dr. Gorgas, and within nine months the city was cleared of yellow fever, and, with the exception of a slight outbreak after the withdrawal of the American troops, has since remained free from a disease which had been its scourge for centuries. As General Wood remarked, "Reed's discovery has resulted in the saving of more lives annually than were lost in the Cuban War, and saves the commercial interest of the world a greater financial loss each year than the cost of the Cuban War. He came to Cuba at a time when one third of the officers of my staff died of yellow fever, and we were discouraged at the failure of our efforts to control it." Following the example of Havana other centres were attacked, at Vera Cruz and in Brazil, with the same success, and it is safe to say that now, thanks to the researches of Reed and his colleagues, with proper measures, no country need fear a paralyzing outbreak of this once dreaded disease. The scientific researches in the last two decades of the nineteenth century made possible the completion of the Panama Canal. The narrow isthmus separating the two great oceans and joining the two great continents, has borne for four centuries an evil repute as the White Man's Grave. Silent upon a peak of Darien, stout Cortez with eagle eye had gazed on the Pacific. As early as 1520, Saavedra proposed to cut a canal through the Isthmus. There the first city was founded by the conquerors of the new world, which still bears the name of Panama. Spaniards, English and French fought along its coasts; to it the founder of the Bank of England took his ill-fated colony; Raleigh, Drake, Morgan the buccaneer, and scores of adventurers seeking gold, found in fever an enemy stronger than the Spaniard. For years the plague-stricken Isthmus was abandoned to the negroes and the half-breeds, until in 1849, stimulated by the gold fever of California, a railway was begun by the American engineers, Totten and Trautwine, and completed in 1855, a railway every tie of which cost the life of a man. The dream of navigators and practical engineers was taken in hand by Ferdinand de Lesseps in January, 1881. The story of the French Canal Company is a tragedy unparalleled in the history of finance, and, one may add, in the ravages of tropical disease. Yellow fever, malaria, dysentery, typhus, carried off in nine years nearly twenty thousand employees. The mortality frequently rose above 100, sometimes to 130, 140 and in September, 1885, it reached the appalling figure of 176.97 per thousand work people. This was about the maximum death rate of the British Army in the West Indies in the nineteenth century. When, in 1904, the United States undertook to complete the Canal, everyone felt that the success or failure was largely a matter of sanitary control. The necessary knowledge existed, but under the circumstances could it be made effective? Many were doubtful. Fortunately, there was at the time in the United States Army a man who had already served an apprenticeship in Cuba, and to whom more than to anyone else was due the disappearance of yellow fever from that island. To a man, the profession in the United States felt that could Dr. Gorgas be given full control of the sanitary affairs of the Panama Zone, the health problem, which meant the Canal problem, could be solved. There was at first a serious difficulty relating to the necessary administrative control by a sanitary officer. In an interview which Dr. Welch and I had with President Roosevelt, he keenly felt this difficulty and promised to do his best to have it rectified. It is an open secret that at first, as was perhaps only natural, matters did not go very smoothly, and it took a year or more to get properly organized. Yellow fever recurred on the Isthmus in 1904 and in the early part of 1905. It was really a colossal task in itself to undertake the cleaning of the city of Panama, which had been for centuries a pest-house, the mortality in which, even after the American occupation, reached during one month the rate of 71 per thousand living. There have been a great many brilliant illustrations of the practical application of science in preserving the health of a community and in saving life, but it is safe to say that, considering the circumstances, the past history, and the extraordinary difficulties to be overcome, the work accomplished by the Isthmian Canal Commission is unique. The year 1905 was devoted to organization; yellow fever was got rid of, and at the end of the year the total mortality among the whites had fallen to 8 per thousand, but among the blacks it was still high, 44. For three years, with a progressively increasing staff which had risen to above 40,000, of whom more than 12,000 were white, the death rate progressively fell. Of the six important tropical diseases, plague, which reached the Isthmus one year, was quickly held in check. Yellow fever, the most dreaded of them all, never recurred. Beri-beri, which in 1906 caused sixty-eight deaths, has gradually disappeared. The hookworm disease, ankylostomiasis, has steadily decreased. From the very outset, malaria has been taken as the measure of sanitary efficiency. Throughout the French occupation it was the chief enemy to be considered, not only because of its fatality, but on account of the prolonged incapacity following infection. In 1906, out of every 1000 employees there were admitted to the hospital from malaria 821; in 1907, 424; in 1908, 282; in 1912, 110; in 1915, 51; in 1917, 14. The fatalities from the disease have fallen from 233 in 1906 to 154 in 1907, to 73 in 1908 and to 7 in 1914. The death rate for malarial fever per 1000 population sank from 8.49 in 1906 to 0.11 in 1918. Dysentery, next to malaria the most serious of the tropical diseases in the Zone, caused 69 deaths in 1906; 48 in 1907; in 1908, with nearly 44,000, only 16 deaths, and in 1914, 4.(*) But it is when the general figures are taken that we see the extraordinary reduction that has taken place. Out of every 1000 engaged in 1908 only a third of the number died that died in 1906, and half the number that died in 1907. (*) Figures for recent years supplied by editors. In 1914, the death rate from disease among white males had fallen to 3.13 per thousand. The rate among the 2674 American women and children connected with the Commission was only 9.72 per thousand. But by far the most gratifying reduction is among the blacks, among whom the rate from disease had fallen to the surprisingly low figure in 1912 of 8.77 per thousand; in 1906 it was 47 per thousand. A remarkable result is that in 1908 the combined tropical diseases--malaria, dysentery and beri-beri--killed fewer than the two great killing diseases of the temperate zone, pneumonia and tuberculosis--127 in one group and 137 in the other. The whole story is expressed in two words, EFFECTIVE ORGANIZATION, and the special value of this experiment in sanitation is that it has been made, and made successfully, in one of the great plague spots of the world. Month by month a little, gray-covered pamphlet was published by Colonel Gorgas, a "Report of the Department of Sanitation of the Isthmian Canal Commission." I have been one of the favored to whom it has been sent year by year, and, keenly interested as I have always been in infectious diseases, and particularly in malaria and dysentery, I doubt if anyone has read it more faithfully. In evidence of the extraordinary advance made in sanitation by Gorgas, I give a random example from one of his monthly reports (1912): In a population of more than 52,000, the death rate from disease had fallen to 7.31 per thousand; among the whites it was 2.80 and among the colored people 8.77. Not only is the profession indebted to Colonel Gorgas and his staff for this remarkable demonstration, but they have offered an example of thoroughness and efficiency which has won the admiration of the whole world. As J. B. Bishop, secretary of the Isthmian Canal Commission, has recently said: "The Americans arrived on the Isthmus in the full light of these two invaluable discoveries (the insect transmission of yellow fever and malaria). Scarcely had they begun active work when an outbreak of yellow fever occurred which caused such a panic throughout their force that nothing except the lack of steamship accommodation prevented the flight of the entire body from the Isthmus. Prompt, intelligent and vigorous application of the remedies shown to be effective by the mosquito discoveries not only checked the progress of the pest, but banished it forever from the Isthmus. In this way, and in this alone, was the building of the canal made possible. The supreme credit for its construction therefore belongs to the brave men, surgeons of the United States Army, who by their high devotion to duty and to humanity risked their lives in Havana in 1900-1901 to demonstrate the truth of the mosquito theory."(7) (7) Bishop: The French at Panama, Scribner's Magazine, January, 1913, p. 42. One disease has still a special claim upon the public in this country. Some fourteen or fifteen years ago, in an address on the problem of typhoid fever in the United States, I contended that the question was no longer in the hands of the profession. In season and out of season we had preached salvation from it in volumes which fill state reports, public health journals and the medical periodicals. Though much has been done, typhoid fever remains a question of grave national concern. You lost in this state(7a) in 1911 from typhoid fever 154 lives, every one sacrificed needlessly, every one a victim of neglect and incapacity. Between 1200 and 1500 persons had a slow, lingering illness. A nation of contradictions and paradoxes--a clean people, by whom personal hygiene is carefully cultivated, but it has displayed in matters of public sanitation a carelessness simply criminal: a sensible people, among whom education is more widely diffused than in any other country, supinely acquiesces in conditions often shameful beyond expression. The solution of the problem is not very difficult. What has been done elsewhere can be done here. It is not so much in the cities, though here too the death rate is still high, but in the smaller towns and rural districts, in many of which the sanitary conditions are still those of the Middle Ages. How Galen would have turned up his nose with contempt at the water supply of the capital of the Dominion of Canada, scourged so disgracefully by typhoid fever of late! There is no question that the public is awakening, but many State Boards of Health need more efficient organization, and larger appropriations. Others are models, and it is not for lack of example that many lag behind. The health officers should have special training in sanitary science and special courses leading to diplomas in public health should be given in the medical schools. Were the health of the people made a question of public and not of party policy, only a skilled expert could possibly be appointed as a public health officer, not, as is now so often the case, the man with the political pull. (7a) Connecticut. It is a long and tragic story in the annals of this country. That distinguished man, the first professor of physic in this University in the early years of last century, Dr. Nathan Smith, in that notable monograph on "Typhus Fever" (1824), tells how the disease had followed him in his various migrations, from 1787, when he began to practice, all through his career, and could he return this year, in some hundred and forty or one hundred and fifty families of the state he would find the same miserable tragedy which he had witnessed so often in the same heedless sacrifice of the young on the altar of ignorance and incapacity. TUBERCULOSIS IN a population of about one million, seventeen hundred persons died of tuberculosis in this state in the year 1911--a reduction in thirty years of nearly 50 per cent. A generation has changed completely our outlook on one of the most terrible scourges of the race. It is simply appalling to think of the ravages of this disease in civilized communities. Before the discovery by Robert Koch of the bacillus, we were helpless and hopeless; in an Oriental fatalism we accepted with folded hands a state of affairs which use and wont had made bearable. Today, look at the contrast! We are both helpful and hopeful. Knowing the cause of the disease, knowing how it is distributed, better able to recognize the early symptoms, better able to cure a very considerable portion of all early cases, we have gradually organized an enthusiastic campaign which is certain to lead to victory. The figures I have quoted indicate how progressively the mortality is falling. Only, do not let us be disappointed if this comparatively rapid fall is not steadily maintained in the country at large. It is a long fight against a strong enemy, and at the lowest estimate it will take several generations before tuberculosis is placed at last, with leprosy and typhus, among the vanquished diseases. Education, organization, cooperation--these are the weapons of our warfare. Into details I need not enter. The work done by the National Association under the strong guidance of its secretary, Mr. Farrand, the pioneer studies of Trudeau and the optimism which he has brought into the campaign, the splendid demonstration by the New York Board of Health of what organization can do, have helped immensely in this world-wide conflict. SOME years ago, in an address at Edinburgh, I spoke of the triple gospel which man has published--of his soul, of his goods, of his body. This third gospel, the gospel of his body, which brings man into relation with nature, has been a true evangelion, the glad tidings of the final conquest of nature by which man has redeemed thousands of his fellow men from sickness and from death. If, in the memorable phrase of the Greek philosopher, Prodicus, "That which benefits human life is God," we may see in this new gospel a link betwixt us and the crowning race of those who eye to eye shall look on knowledge, and in whose hand nature shall be an open book--an approach to the glorious day of which Shelley sings so gloriously: Happiness And Science dawn though late upon the earth; Peace cheers the mind, health renovates the frame; Disease and pleasure cease to mingle here, Reason and passion cease to combat there, Whilst mind unfettered o'er the earth extends Its all-subduing energies, and wields The sceptre of a vast dominion there. (Daemon of the World, Pt. II.) 
18530	----	ELSIE INGLIS [Illustration: _Photo by Bassano_ ELSIE INGLIS AFTER HER RETURN FROM SERBIA IN 1916 _Frontispiece_] PIONEERS OF PROGRESS WOMEN EDITED BY ETHEL M. BARTON ELSIE INGLIS THE WOMAN WITH THE TORCH BY EVA SHAW McLAREN WITH A PREFACE BY LENA ASHWELL LONDON SOCIETY FOR PROMOTING CHRISTIAN KNOWLEDGE NEW YORK: THE MACMILLAN COMPANY 1920 _Great souls who sailed uncharted seas, Battling with hostile winds and tide, Strong hands that forged forbidden keys, And left the door behind them, wide_. _Diggers for gold where most had failed, Smiling at deeds that brought them Fame,-- Lighters of Lamps that have not failed,-- Lend us your oil and share your flame._ TO AMY SIMSON PREFACE "To light a path for men to come" is the privilege of the pioneer; and the life of a pioneer, the hewer of a new path, is always encouraging, whether he who goes before to open the way be a voyager to the Poles or the uttermost parts of the earth, in imminent danger of physical death, or whether he be an adventurer, cutting a path to a new race consciousness, revealing the power of service in new vocations, evoking new powers, and living in hourly danger of mental suffocation by prejudices and inhibitions of race tradition. The women's irresistible movement, which has so suddenly flooded all departments of work previously considered the monopoly of men, required from the leaders indomitable courage, selflessness, and faith, qualities of imperishable splendour; and to read the life of Elsie Inglis is to recognize instantly that she was one of these ruthless adventurers, hewing her way through all perils and difficulties to bring to pass the dreams of thousands of women. The world's standard of success may appear to give the prize to those who collect things, but in reality the crown of victory, the laurel wreath, the tribute beyond all material value, is always reserved for those invisible, intangible qualities which are evinced in character. It is wonderful to read how slowly and surely that character was formed through twenty years of monotonous routine. The establishing of a Hospice for women and children, run entirely by women, was not a popular movement, and through long years of dull, arduous work, patient, silent, honest, dedicated unconsciously to the service of others, she laid the foundations which led to her great achievement, and so, full of courage and growing in power, like Nelson she developed a blind eye, to which she put her telescope in times of bewilderment; she could never see the difficulties which loomed large in her way--sex prejudices and mountains of race convictions to be moved--and so she moved them! In founding The Hospice she gave herself first to the women and children round her; later, in the urgent call of the Suffrage movement, she devoted herself whole-heartedly to the service of the women of the country, and so she was ready when the war came. Her own country refused her services; but Providence has a strange way of turning what appears to be evil into great good. The refusal of the British Government to accept the services of medically trained women caused them to offer their services elsewhere; and so she went first to help the French, and then to encourage and serve Serbia in her dire need. And so from the first she was a pioneer: in doing medical work among women and children; in achieving the rights of citizenship for women; and in the further great adventure of establishing the true League of Nations which lies in the will to serve mankind. LENA ASHWELL (MRS. HENRY SIMSON) INTRODUCTION A most interesting _Life_ of Elsie Inglis, written a short time ago by the Lady Frances Balfour, has had a wide circulation which has proved the appreciation of the public. This second _Life_ appears at the request of The Society for Promoting Christian Knowledge that I should write a short memoir of my sister, to be included in the "Pioneers of Progress" Series which it is publishing. I undertake the duty with joy. In accordance with the series in which it appears, the _Life_ is a short one, but it has been possible to incorporate in it some fresh material. Not the least interesting is what has been taken from the manuscript of a novel by Dr. Inglis, found amongst her papers some time after her death. It is called _The Story of a Modern Woman_. It was probably written between the years 1906 and 1914; the outbreak of the war may have prevented its publication. The date given in the first chapter of the story is 1904. Very evidently the book expresses Elsie Inglis's views on life. Quotations have been made from it, as it gives an insight into her own character and experiences. The endeavour has been made to draw a picture of her as she appeared to those who knew her best. She was certainly a fine character, full of life and movement, ever growing and developing, ever glorying in new adventure. There was no stagnation about Elsie Inglis. Independent, strong, keen (if sometimes impatient), and generous, from her childhood she was ever a great giver. Alongside all the energy and force in her character there were great depths of tenderness. "Nothing like sitting on the floor for half an hour playing with little children to prepare you for a strenuous bit of work," was one of her sayings. Not to many women, perhaps, have other women given such a wealth of love as they gave to Elsie Inglis. In innumerable letters received after her death is traceable the idea expressed by one woman: "In all your sorrow, remember, I loved her too." Those who worked with her point again and again to a characteristic that distinguished her all her life--her complete disregard of the opinion of others about herself personally, while she pursued the course her conscience dictated, and yet she drew to herself the affectionate regard of many who knew her for the first time during the last three years of her life. What her own countrymen thought of her will be found in the pages of this book, but the touching testimony of a Serb and a Russian may be given here. A Serb orderly expressed his devotion in a way that Dr. Inglis used to recall with a smile: "Missis Doctor, I love you better than my mother, and my wife, and my family. Missis Doctor, I will never leave you." And a soldier from Russia said of her: "She was loved amongst us as a queen, and respected as a saint." "In her _Life_ you want the testimony of those who saw _her_. Dr. Inglis's work before and during the war will find its place in any enduring record; what you want to impress on the minds of the succeeding generation is _the quality of the woman_ of which that work was the final expression." Something of what that quality was appears, it is hoped, in the pages of this memoir. I am grateful to men and women of varied outlook, who knew her at different periods of her life, for memories which have been drawn upon in this effort to picture Elsie Inglis. EVA SHAW McLAREN SYLLABUS OF CHAPTERS PAGES PREFACE vii INTRODUCTION ix CHAPTER I ELSIE INGLIS Tributes from various sources--A woman of solved problems 1-2 CHAPTER II THE ROCK FROM WHICH SHE WAS HEWN Elsie Inglis the central figure on the stage--Men and women of the past, the people of her race, crowd round her--Their influence on her--Their spirit seen in hers 3-6 CHAPTER III 1864-1894 Childhood in India--Friendship with her father--Schooldays in Edinburgh--Death of her mother--Study of Medicine--Death of her father--Practice started in Edinburgh in 1894--Twenty years of professional life: interests, friendships--Varied Descriptions of Dr. Inglis by Miss S. E. S. Mair and Dr. Beatrice Russell 7-12 CHAPTER IV HER MEDICAL CAREER Fellow-students' and doctors' reminiscences--The New School of Medicine for Women in Edinburgh--The growth of her practice--Her sympathy with her poor patients--The founding of The Hospice--Some characteristics 13-19 CHAPTER V THE SOLVED PROBLEMS The problems of the unmarried woman--Dr. Inglis's unpublished novel, _The Story of a Modern Woman_--Quotations from the novel--Many parts of novel evidently autobiographical--Heroine in novel solves the problem of "the lonely woman" 20-24 CHAPTER VI "HER CHILDREN" Dr. Inglis a child-lover--Her writings full of the descriptions of children--Quotations from the novel 25-27 CHAPTER VII THE HOSPICE Founded 1901--Description of premises in the High Street amongst the poor of Edinburgh--Dr. Inglis's love for The Hospice 28-31 CHAPTER VIII THE SUFFRAGE CAMPAIGN Justice of claim appealed to Dr. Inglis--Worked from constitutional point of view--Founding of Scottish Federation of Suffrage Societies--Dr. Inglis's activities for the cause--Tributes from women who worked with her--Description of meeting addressed by her 32-41 CHAPTER IX SCOTTISH WOMEN'S HOSPITALS Dr. Inglis at the outbreak of war: Full of vigour and enthusiasm--Idea mooted at Federation Committee Meeting--Rapid growth--Hospitals in the field in December 42-44 CHAPTER X SERBIA Dreadful condition of country--Arrival of Dr. Soltau and Dr. Hutchison and Unit--Dr. Inglis's arrival in May, 1915--Fountain at Mladanovatz--Letter from officer who designed fountain--Dr. Inglis and her Unit taken prisoners in November--Account of work at Krushevatz--Release in February, 1916--Tributes from Miss Christitch and Lieut.-Colonel Popovitch 45-58 CHAPTER XI RUSSIA Dr. Inglis's start for Russia in August, 1916--Unit attached to Serb Division near Odessa--Three weeks' work at Medjidia--Retreat to Braila--Order of three retreats--Work at Reni--Description of Dr. Inglis by one of her Unit--Account of her last Communion 59-71 CHAPTER XII "IF YOU WANT US HOME, GET _THEM_ OUT" Serb Division in unenviable position--Dr. Inglis's determination to save them from wholesale slaughter--Hard work through summer months to achieve their safety--Efforts crowned with success--Left for England in October, bringing her Unit and the Division with her 72-74 CHAPTER XIII "THE NEW WORK" AND MEMORIES Landed at Newcastle on November 23, 1917--Illness on voyage--Dr. Ethel Williams's testimony to her fearlessness in facing death--Triumph in passing--Scenes at funeral in Edinburgh--Memories 75-78 BIBLIOGRAPHY 79-80 LIST OF ILLUSTRATIONS DR. ELSIE INGLIS IN 1916, AFTER HER RETURN FROM SERBIA _Frontispiece_ FACING PAGE THE THREE MISS FENDALLS 4 From a picture in the possession of Brigadier-General C. Fendall ELSIE INGLIS AT THE AGE OF TWO YEARS 7 JOHN FORBES DAVID INGLIS, ELSIE INGLIS'S FATHER 10 THE HOSPICE, HIGH STREET, EDINBURGH 28 ELSIE INGLIS, BY IVAN MESTROVICH 45 In the Scottish National Gallery ELSIE INGLIS IN AUGUST, 1916, BEFORE LEAVING FOR RUSSIA 58 THE HIGH STREET, LOOKING TOWARDS ST. GILES'S 76 ELSIE INGLIS CHAPTER I ELSIE INGLIS The War. "Elsie Inglis was one of the heroic figures of the war."[1] Suffrage. "During the whole years of the Suffrage struggle, while the National Union of Women's Suffrage Societies was growing and developing, Dr. Elsie Inglis stood as a tower of strength, and her unbounded energy and unfailing courage helped the cause forward in more ways than she knew. To the London Society she stood out as a supporter of wise councils and bold measures; time after time, in the decisions of the Union, they found themselves by her side, and from England to Scotland they learned to look to her as to a staunch friend. "Later, when the war transformed the work of the Societies of the Union, they trusted and followed her still, and it is their comfort now to think that in all her time of need it was their privilege to support her."[2] Medical. "We medical women in Scotland will miss her very much, for she was indeed a strong rock amongst us all."[3] Scottish Women's Hospitals. "Those who work in the hospitals she founded and for the Units she commanded, and all who witnessed her labours, feel inspired by her dauntless example. The character of the Happy Warrior was in some measure her character. We reverence her calm fearlessness and forceful energies, her genius for overcoming obstacles, her common sense, her largeness of mind and purpose, and we rejoice in the splendour of her achievements."[4] Home. "It is not of her great qualities that I think now, but rather that she was such a darling."[5] Serbia. "By her knowledge she cured the physical wounds of the Serb soldiers. By her shining face she cured their souls. Silent, busy, smiling--that was her method. She strengthened the faith of her patients in _knowledge_ and in _Christianity_. Scotland hardly could send to Serbia a better Christian missionary."[6] As the days pass, bringing the figure of Elsie Inglis into perspective, these true and beautiful pictures of her fall quietly into the background, and one idea begins slowly to emerge and to expand, and to become the most real fact about her. As we follow her outward life and read the writings she left behind her, we come to realize that her greatness lay not so much in the things she achieved as in the hidden power of her spirit. _She was a woman of solved problems._ The far-reaching qualities of her mind and character are but the outcome of this inward condition. All men and women have problems; few solve them. The solved problem in any life is the expression of genius, and is the cause of strength and peace in the character. "It is amazing how sometimes a name begins to shine like a star, and then to glow and glow until it fills the firmament. Such a name is Elsie Inglis."[7] FOOTNOTES: [1] Dr. Seton-Watson. [2] The London Committee of the N.U.W.S.S. [3] A medical colleague. [4] Mrs. Flinders Petrie. [5] I. A. W., niece. [6] Bishop Nicolai Velimirovic. [7] Rev. Norman Maclean, D.D. CHAPTER II THE ROCK FROM WHICH SHE WAS HEWN _"It is not the weariness of mortality, but the Strength of Divinity which we have to recognize in all mighty things."_ In the centre stands Elsie Inglis, the "woman of gentle breeding, short of stature, alert, and with the eyes of a seer," and "a smile like sunshine"; and on either side and behind this central figure the stage is crowded with men and women of long ago, the people of her race. One by one they catch our eye, and we note their connection with the central figure. Far back in the group (for it is near two hundred years ago) stands Hugh Inglis, hailing from Inverness-shire. He was a loyal supporter of Prince Charlie, and the owner of a yacht, which he used in gun-running in the service of the Prince. A little nearer are two of Elsie's great-grandfathers, John Fendall and Alexander Inglis. John Fendall was Governor of Java at the time when the island was restored to the Dutch. The Dutch fleet arrived to take it over before Fendall had received his instructions from the Government, and he refused to give it up till they reached him--a gesture not without a parallel in the later years of the life of his descendant. Alexander Inglis, leaving Inverness-shire, emigrated to South Carolina, and was there killed in a duel fought on some point of honour. Through his wife, Mary Deas, Elsie's descent runs up to Robert the Bruce on the one hand, and, on the other, to a family who left France after the revocation of the Edict of Nantes, and settled in Scotland. As we thread our way through the various figures on the stage we are attracted by a group of three women. They are the daughters of the Governor of Java, "the three Miss Fendalls." One of them, Harriet, is Elsie's grandmother. All three married, and their descendants in the second generation numbered well over a hundred! Harriet Fendall married George Powney Thompson, whose father was at one time secretary to Warren Hastings. George Thompson himself was a member of the East India Company, and ruled over large provinces in India. One of their nine daughters, Harriet Thompson, was Elsie's mother. On the other side of the stage, in the same generation as the Miss Fendalls, is another group of women. These are the three sisters of Elsie's grandfather, David Inglis, son of Alexander, who fared forth to South Carolina, and counted honour more dear than life. David was evidently a restless, keen, adventurous man; many years of his life were spent in India in the service of the East India Company. Of his three sisters--Katherine, painted by Raeburn; Mary, gentle and quiet; and Elizabeth--we linger longest near Elizabeth. She never married, and was an outstanding personality in the little family. She was evidently conversant with all the questions of the day, and commented on them in the long, closely written letters which have been preserved. After David's return from India he must have intended at one time to stand for Parliament. Elizabeth writes to him from her "far corner" in Inverness-shire, giving him stirring advice, and demanding from him an uncompromising, high standard. She tells him to "unfurl his banner"; she knows "he will carry his religion into his politics." "Separate religion from politics!" cries Elizabeth; "as well talk of separating our every duty from religion!" Needless anxiety, one would think, on the part of the good Highland lady, for the temptation to leave religion out of any of his activities can scarcely have assailed David. We read that when Elsie's grandfather had returned from the East to England he used to give missionary addresses, not, one would think, a common form of activity in a retired servant of the East India Company. One hears this note of genuine religion in the lives of those forebears of Elsie's. [Illustration: Lady D'Oyly Mrs. Lowis Mrs. Thompson (Elsie's Grandmother) THE MISSES FENDALL FROM A DRAWING IN THE POSSESSION OF BRIGADIER-GENERAL C. FENDALL, C.B., C.M.G., D.S.O., ETC.] "The extraordinary thing in all the letters, whether they were written by an Inglis, a Deas, or a Money, is the pervading note of strong religious faith. They not only refer to religion, but often, in truly Scottish fashion, they enter on long theological dissertations." David married Martha Money. Close to Martha on the stage stands her brother, William Taylor Money, Elsie's great-uncle. We greet him gladly, for he was a man of character. He was a friend of Wilberforce, and a Member of Parliament when the Anti-Slavery Bill was passed. Afterwards "he owned a merchant vessel, and gained great honour by his capture of several of the Dutch fleet, who mistook him for a British man-of-war, the smart appearance of his vessel with its manned guns deceiving them." There is a picture in Trinity House of his vessel bringing in the Dutch ships. Later, he was Consul-General at Venice and the north of Italy, where he died, in 1834, in his gondola! He had strong religious convictions, and would never infringe the sacredness of the Sabbath-day by any "secular work." In a short biography of him, written in 1835, the weight of his religious beliefs, which made themselves felt both in Parliament and when Consul, is dwelt on at length. A son of David and Martha Inglis, John Forbes David Inglis, was Elsie's father. John went to India in 1840, following his father's footsteps in the service of the East India Company. Thirty-six years of his life were spent there, with only one short furlough home. He rose to distinction in the service, and gained the love and trust of the Indian peoples. After he retired in 1876 one of his Indian friends addressed a letter to him, "John Inglis, England, Tasmania, or wherever else he may be, this shall be delivered to him," and through the ingenuity of the British Post Office it was delivered in Tasmania. Elsie's mother, Harriet Thompson, went out to India when she was seventeen to her father, George Powney Thompson. She married when she was eighteen. She met her future husband, John Inglis, at a dance in her father's house. Her children were often told by their father of the white muslin dress, with large purple flowers all over it, worn by her that evening, and how he and several of his friends, young men in the district, drove fifty miles to have the chance of dancing with her! "She must have had a steady nerve, for her letters are full of various adventures in camp and tiger-haunted jungles, and most of them narrate the presence of one of her infants, who was accompanying the parents on their routine of Indian official life." In 1858, when John Inglis was coming home on his one short furlough, she trekked down from Lahore to Calcutta with the six children in country conveyances. The journey took four months; then came the voyage round the Cape, another four months. Of course she had the help of ayahs and bearers on the journeys, but even with such help it was no easy task. John Inglis saw his family settled in Southampton, and almost immediately had to return to India, on the outbreak of the Mutiny. His wife stayed at home with the children, until India was again a safe place for English women, when she rejoined her husband in 1863. They crowd round Elsie Inglis, these men and women in their quaint and attractive costumes of long ago; we feel their influence on her; we see their spirit mingling with hers. As we run our eye over the crowded stage, we see the dim outline of the rock from which she was hewn, we feel the spirit which was hers, and we hail it again as it drives her forth to play her part in the great drama of the last three years of her life. The members of every family, every group of blood relations, are held together by the unseen spirit of their generations. It matters little whether they can trace their descent or not; the peculiar spirit of that race which is theirs fashions them for particular purposes and work. And what are they all but the varied expressions of the One Divine Mind, of the Endless Life of God? [Illustration: ELSIE INGLIS AT THE AGE OF 2 YEARS] CHAPTER III 1864-1894 Elsie Inglis was born on August 16, 1864, in India. The wide plains of India, the "huddled hills" and valleys of the Himalayas, were the environment with which Nature surrounded her for the first twelve years of her life. Her childhood was a happy one, and the most perfect friendship existed between her and her father from her earliest days. "All our childhood is full of remembrances of father.[8] He never forgot our birthdays; however hot it was down in the scorched plains, when the day came round, if we were up in the hills, a large parcel would arrive from him. His very presence was joy and strength when he came to us at Naini Tal. What a remembrance there is of early breakfasts and early walks with him--the father and the three children! The table was spread in the verandah between six and seven. Father made three cups of cocoa, one for each of us, and then the glorious walk! The ponies followed behind, each with their attendant grooms, and two or three red-coated chaprassies, father stopping all along the road to talk to every native who wished to speak to him, while we three ran about, laughing and interested in everything. Then, at night, the shouting for him after we were in bed, and father's step bounding up the stair in Calcutta, or coming along the matted floor of our hill home. All order and quietness were flung to the winds while he said good-night to us. "It was always understood that Elsie and he were special chums, but that never made any jealousy. Father was always just. The three cups of cocoa were always the same in quantity and quality. We got equal shares of his right and his left hand in our walks; but Elsie and he were comrades, inseparables from the day of her birth. "In the background of our lives there was always the quiet, strong mother, whose eyes and smile live on through the years. Every morning before the breakfast and walk there were five minutes when we sat in front of her in a row on little chairs in her room and read the Scripture verses in turn, and then knelt in a straight, quiet row and repeated the prayers after her. Only once can I remember father being angry with any of us, and that was when one of us ventured to hesitate in instant obedience to some wish of hers. I still see the room in which it happened, and the thunder in his voice is with me still." There was a constant change of scene during these years in India--Allahabad, Naini Tal, Calcutta, Simla, and Lucknow. After her father retired, two years in Australia visiting older brothers who had settled there, and then in 1878 home to the land of her fathers. On the voyage home, when Elsie was about fourteen, her mother writes of her: "Elsie has found occupation for herself in helping to nurse sick children and look after turbulent boys who trouble everybody on board, and a baby of seven months old is an especial favourite with her." But through the changing scenes there was always growing and deepening the beautiful comradeship between father and daughter. The family settled in Edinburgh, and Elsie went to school to the Charlotte Square Institution, perhaps in those days the best school for girls in Edinburgh. In the history class taught by Mr. Hossack she was nearly always at the top. Of her school life in Edinburgh a companion writes: "I remember quite distinctly when the girls of 23, Charlotte Square were told that two girls from Tasmania were coming to the school, and a certain feeling of surprise that the said girls were just like ordinary mortals, though the big, earnest brows and the hair quaintly parted in the middle and done up in plaits fastened up at the back of the head were certainly not ordinary. "A friend has the story of a question going round the class; she thinks Clive or Warren Hastings was the subject of the lesson, and the question was what one would do if a calumny were spread about one. 'Deny it,' one girl answered. 'Fight it,' another. Still the teacher went on asking. 'Live it down,' said Elsie. 'Right, Miss Inglis.' My friend writes: 'The question I cannot remember; it was the bright, confident smile with the answer, and Mr. Hossack's delighted wave to the top of the class that abides in my memory.' "I always think a very characteristic story of Elsie is her asking that the school might have permission to play in Charlotte Square Gardens. In those days no one thought of providing fresh-air exercise for girls except by walks, and tennis was just coming in. Elsie had the courage (to us schoolgirls it seemed extraordinary courage) to confront the three Directors of the school, and ask if we might be allowed to play in the gardens of the Square. The three Directors together were to us the most formidable and awe-inspiring body, though separately they were amiable and estimable men! "The answer was, we might play in the gardens if the residents of the Square would give their consent, and the heroic Elsie, with, I think, one other girl, actually went round to each house in the Square and asked consent of the owner. In those days the inhabitants of Charlotte Square were very select and exclusive indeed, and we all felt it was a brave thing to do. Elsie gained her point, and the girls played at certain hours in the Square till a regular playing-field was arranged.... Elsie's companion or companions in this first adventure to influence those in authority have been spoken of as 'her first Unit.'"[9] When she was eighteen she went for a year to Paris with six other girls, in charge of Miss Gordon Brown. She came home again shortly before her mother's death in January, 1885. Henceforth she was her father's constant companion. They took long walks together, talked on every subject, and enjoyed many humorous episodes together. On one point only they disagreed--Home Rule for Ireland: she for it, he against. During the nine years from 1885 to her father's death in 1894, she began and completed her medical studies with his full approval. The great fight for the opening of the door for women to study medicine had been fought and won earlier by Dr. Sophia Jex-Blake, Dr. Garrett Anderson, and others. But though the door was open, there was still much opposition to be encountered and a certain amount of persecution to be borne when the women of Dr. Inglis's time ventured to enter the halls of medical learning. Along the pathway made easy for them by these women of the past, hundreds of young women are to-day entering the medical profession. As we look at them we realize that in their hands, to a very large extent, lies the solving of the acutest problem of our race--the relation of the sexes. Will they fail us? Will they be content with a solution along lines that can only be called a second best? When we remember the clear-brained women in whose steps they follow, who opened the medical world for them, and whose spirits will for ever overshadow the women who walk in it, we know they will not fail us. Elsie Inglis pursued her medical studies in Edinburgh and Glasgow. After she qualified she was for six months House-Surgeon in the New Hospital for Women and Children in London, and then went to the Rotunda in Dublin for a few months' special study in midwifery. She returned home in March, 1894, in time to be with her father during his last illness. Daily letters had passed between them whenever she was away from home. His outlook on life was so broad and tolerant, his judgment on men and affairs so sane and generous, his religion so vital, that with perfect truth she could say, as she did, at one of the biggest meetings she addressed after her return from Serbia: "If I have been able to do anything, I owe it all to my father." After his death she started practice with Dr. Jessie Macgregor at 8, Walker Street, Edinburgh. It was a happy partnership for the few years it lasted, until for family reasons Dr. Macgregor left Scotland for America. Dr. Inglis stayed on in Walker Street, taking over Dr. Macgregor's practice. Then followed years of hard work and interests in many directions. [Illustration: JOHN FORBES DAVID INGLIS ELSIE INGLIS' FATHER "If I have been able to do anything--whatever I am, whatever I have done--I owe it all to my Father." _Elsie Inglis, at a meeting held in the Criterion Theatre, London, April 5th, 1916_] The Hospice for Women and Children in the High Street of Edinburgh was started. Her practice grew, and she became a keen suffragist. During these years also she evidently faced and solved her problems. She was a woman capable of great friendships. During the twenty years of her professional life perhaps the three people who stood nearest to her were her sister, Mrs. Simson, and the Very Rev. Dr. and Mrs. Wallace Williamson. These friendships were a source of great strength and comfort to her. We may fitly close this chapter by quoting descriptions of Dr. Inglis by two of her friends--Miss S. E. S. Mair, of Edinburgh, and Dr. Beatrice Russell: "In outward appearance Dr. Inglis was no Amazon, but just a woman of gentle breeding, courteous, sweet-voiced, somewhat short of stature, alert, and with the eyes of a seer, blue-grey and clear, looking forth from under a brow wide and high, with soft brown hair brushed loosely back; with lips often parted in a radiant smile, discovering small white teeth and regular, but lips which were at times firmly closed with a fixity of purpose such as would warn off unwarrantable opposition or objections from less bold workers. Those clear eyes had a peculiar power of withdrawing on rare occasions, as it were, behind a curtain when their owner desired to absent herself from discussion of points on which she preferred to give no opinion. It was no mere expression such as absent-mindedness might produce, but was, as she herself was aware, a voluntary action of withdrawal from all participation in what was going on. The discussion over, in a moment the blinds would be up and the soul looked forth through its clear windows with steady gaze. Whether the aural doors had been closed also there is no knowing." "She was a keen politician--in the pre-war days a staunch supporter of the Liberal party, and in the years immediately preceding the war she devoted much of her time to work in connection with the Women's Suffrage movement. She was instrumental in organizing the Scottish Federation of Women's Suffrage Societies, and was Honorary Secretary of the Federation up to the time of her death. But the factor which most greatly contributed to her influence was the unselfishness of her work. She truly 'set the cause above renown' and loved 'the game beyond the prize.' She was always above the suspicion of working for ulterior motives or grinding a personal axe. It was ever the work, and not her own share in it, which concerned her, and no one was more generous in recognizing the work of others. "To her friends Elsie Inglis is a vivid memory, yet it is not easy clearly to put in words the many sides of her character. In the care of her patients she was sympathetic, strong, and unsparing of herself; in public life she was a good speaker and a keen fighter; while as a woman and a friend she was a delightful mixture of sound good sense, quick temper, and warm-hearted impulsiveness--a combination of qualities which won her many devoted friends. A very marked feature of her character was an unusual degree of optimism which never failed her. Difficulties never existed for Dr. Inglis, and were barely so much as thought of in connection with any cause she might have at heart. This, with her clear head and strong common sense, made her a real driving power, and any scheme which had her interest always owed much to her ability to push things through." In the following chapters the principal events in her life during these twenty years--1894 to 1914--will be dealt with in detail, before we arrive at the story of the last three years and of the "Going Forth." FOOTNOTES: [8] From contributions to _Dr. Elsie Inglis_, by Lady Frances Balfour. [9] _Dr. Elsie Inglis_, by Lady Frances Balfour. CHAPTER IV HER MEDICAL CAREER 1894-1914 During the years from 1894 to 1914 the main stream in Elsie Inglis's life was her medical work. This was her profession, her means of livelihood; it was also the source from which she drew conclusions in various directions, which influenced her conduct in after-years, and it supplied the foundation and the scaffolding for the structure of her achievements at home and abroad. The pursuit of her profession for twenty years in Edinburgh brought to her many experiences which roused new and wide interests, and which left their impress on her mind. One who was a fellow-student writes of her classmate: "She impressed one immediately with her mental and physical sturdiness. She had an extremely pleasant face, with a finely moulded forehead, soft, kind, fearless, blue eyes, and a smile, when it came, like sunshine; with this her mouth and chin were firm and determined." She was a student of the School of Medicine for Women in Edinburgh of which Dr. Jex-Blake was Dean--a fine woman of strong character, to whom, and to a small group of fellow-workers in England, women owe the opening of the door of the medical profession. As Dean, however, she may have erred in attempting an undue control over the students. To Elsie Inglis and some of her fellow-students this seemed to prejudice their liberty, and to frustrate an aim she always had in view, the recognition by the public of an equal footing on all grounds with men students. The difficulties became so great that Elsie Inglis at length left the Edinburgh school and continued her education at Glasgow, where at St. Margaret's College classes in medicine had recently been opened. A fellow-student writes: "Never very keenly interested in the purely scientific side of the curriculum, she had a masterly grasp of what was practical." She took her qualifying medical diploma in 1902. After her return to Edinburgh she started a scheme and brought it to fruition with that fearlessness and ability which at a later period came to be expected from her, both by her friends and by the public. With the help of sympathetic lecturers and friends of The Women's Movement, she succeeded in establishing a second School of Medicine for Women in Edinburgh, with its headquarters at Minto House, a building which had been associated with the study of medicine since the days of Syme. It proved a successful venture. After the close of Dr. Jex-Blake's school a few years later, it was the only school for women students in Edinburgh, and continued to be so till the University opened its doors to them. It was mainly due to Dr. Inglis's exertions that The Hospice was opened in the High Street of Edinburgh as a nursing home and maternity centre staffed by medical women. An account of it and of Dr. Inglis's work in connection with it is given in a later chapter. She was appointed Joint-Surgeon to the Edinburgh Bruntsfield Hospital and Dispensary for Women and Children, also staffed by women and one of the fruits of Dr. Jex-Blake's exertions. Here, again, Elsie Inglis's courage and energy made themselves felt. She desired a larger field for the usefulness of the institution, and proposed to enlarge the hospital to such an extent that its accommodation for patients should be doubled. A colleague writes: "Once again the number must be doubled, always with the same idea in view--_i.e._, to insure the possibilities for gaining experience for women doctors. Once again the committee was carried along on a wave of unprecedented effort to raise money. An eager band of volunteers was organized, among them some of her own students. Bazaars and entertainments were arranged, special appeals were issued, and the necessary money was found, and the alterations carried out. It was never part of Dr. Inglis's policy to wait till the money came in. She always played a bold game, and took risks which left the average person aghast, and in the end she invariably justified her action by accomplishing the task which she set herself, and, at times it must be owned, which she set an all too unwilling committee! But for that breezy and invincible faith and optimism the Scottish Women's Hospitals would never have taken shape in 1914." Dr. Inglis's plea for the Units of the Scottish Women's Hospital was always that they might be sent "where the need was greatest." In these years of work before the war the same motive, to supply help where it was most needed, seems to have guided her private practice, for we read: "Dr. Inglis was perhaps seen at her best in her dispensary work, for she was truly the friend and the champion of the working woman, and especially of the mother in poor circumstances and struggling to bring up a large family. Morrison Street Dispensary and St. Anne's Dispensary were the centre of this work, and for years to come mothers will be found in this district who will relate how Dr. Inglis put at their service the best of her professional skill and, more than that, gave them unstintedly of her sympathy and understanding." Dr. Wallace Williamson, of St. Giles's Cathedral, writing of her after her death, is conscious also of this impulse always manifesting itself in her to work where difficulties abounded. He points out: "Of her strictly professional career it may be truly said that her real attraction had been to work among the suffering poor.... She was seen at her best in hospice and dispensary, and in homes where poverty added keenness to pain. There she gave herself without reserve. Questions of professional rivalry or status of women slipped away in her large sympathy and helpfulness. Like a truly 'good physician,' she gave them from her own courage an uplift of spirit even more valuable than physical cure. She understood them and was their friend. To her they were not merely patients, but fellow-women. It was one of her great rewards that the poor folk to whom she gave of her best rose to her faith in them, whatever their privations or temptations. Her relations with them were remote from mere routine, and so distinctively human and real that her name is everywhere spoken with the note of personal loss. Had not the wider call come, this side of her work awaited the fulfilment of ever nobler dreams." She was loved and appreciated as a doctor not only by her poorer patients, but by those whom she attended in all ranks of society. Of her work as an operator and lecturer two of her colleagues say: "It was a pleasure to see Dr. Inglis in the operating-theatre. She was quiet, calm, and collected, and never at a loss, skilful in her manipulations, and able to cope with any emergency." "As a lecturer she proved herself clear and concise, and the level of her lectures never fell below that of the best established standards. Students were often heard to say that they owed to her a clear and a practical grasp of a subject which is inevitably one of the most important for women doctors." Should it be asked what was the secret of her success in her work, the answer would not be difficult to find. A clear brain she had, but she had more. She had vision, for her life was based on a profound trust in God, and her vision was that of a follower of Christ, the vision of the kingdom of heaven upon earth. This was the true source of that remarkable optimism which carried her over difficulties deemed by others insurmountable. Once started in pursuit of an object, she was most reluctant to abandon it, and her gaze was so keenly fixed on the end in view that it must be admitted she was found by some to be "ruthless" in the way in which she pushed on one side any who seemed to her to be delaying or obstructing the fulfilment of her project. There was, however, never any selfish motive prompting her; the end was always a noble one, for she had an unselfish, generous nature. An intimate friend, well qualified to judge, herself at first prejudiced against her, writes: "In everything she did that was always to me her most outstanding characteristic, her self-effacing and abounding generosity. Indeed, it was so characteristic of her that it was often misunderstood and her action was imputed to a desire for self-advertisement. A fellow-doctor told me that when she was working in one of the Edinburgh laboratories she heard men discussing something Dr. Inglis had undertaken, and, evidently finding her action quite incomprehensible, they concluded it was dictated by personal ambition. My friend turned on them in the most emphatic way: 'You were never more mistaken. The thought of self or self-interest never even entered Elsie Inglis's mind in anything she did or said.'" Again, another writes: "One recalls her generous appreciation of any good work done by other women, especially by younger women. Any attempt to strike out in a new line, any attempt to fill a post not previously occupied by a woman, received her unstinted admiration and warm support." It was her delight to show hospitality to her friends, many of whom, especially women doctors and friends made in the Suffrage movement, stayed with her at her house in Walker Street, Edinburgh. But her hospitality did not end there. One doctor, whom we have already quoted, on arrival on a visit, found that only the day before Dr. Inglis had said good-bye to a party of guests, a woman with five children, a patient badly in need of rest, who had the misfortune to have an unhappy home, and was without any relatives to help her. Dr. Inglis's relations with her poor patients have been already referred to. Not only did she give them all she could in the way of professional attention and skill, but her generosity to them was unbounded. "I had a patient," writes a doctor, "very ill with pulmonary tuberculosis. She was to go to a sanatorium, and her widowed mother was quite unable to provide the rather ample outfit demanded. Dr. Inglis gave me everything for her, down to umbrella and goloshes." Naturally her devotion was returned, though in one case which is recorded Dr. Inglis's care met with resentment at first. A woman who was expecting a baby--her ninth--applied at a dispensary where Dr. Inglis happened to be in charge. Her advice was distasteful to the patient, who tried another dispensary, only to meet again with the same advice, again from a woman member of the profession. A third dispensary brought her the same fortune! Eventually, when the need for professional skill came, she was attended by the two latter doctors she had seen, for the case proved to be a difficult one. Requiring the aid of greater experience--for they were juniors--they sent for Dr. Inglis, with whose help the lives of mother and child were saved. Thus the patient was attended in the end by all the three women physicians whose advice she had scorned. The child was the first boy in the large family, and the mother's gratitude and delight after her recovery knew no bounds. It found, however, Scotch expression, shall we say? in her tribute, "Weel, I've had the hale three o' ye efter a', and ye canna say I hae'na likit ye--_at the hinder en' at ony rate_!" "That woman kept us busy with patients for many a day," writes one of the three. The bulky mother-in-law of one patient expressed her admiration of the doctor and her lack of faith in the justice of things by saying: "It's no fair Dr. Inglis is a woman; if she'd been a man, she'd ha' been a millionaire!" The doctor in whose memory these incidents live says of her friend: "No item was too trivial, no trouble too great to take, if she could help a human being, or if she could push forward or help a younger doctor." If Elsie Inglis's intrepidity, determination, and invincible optimism were well known to the public, the circle of her friends was warmed by the truly loving heart with which they came in contact. The following incident may show in some degree what a tender heart it was. A friend whose brother died, after an operation, in a nursing home in Edinburgh was staying at Dr. Inglis's house when the death occurred. The body had to be taken to the Highland home in the North. The sister writes: "My younger brother called for me in the early morning, as we had to leave by the 3 a.m. train to accompany the body to Inverness. When Dr. Inglis had said good-bye to us and we drove away in the cab, my brother--he is just an ordinary keen business man--turned to me with his eyes filled with tears, and said: 'I should have liked to kiss her like my mother.' (We had never known our mother.)" In the fourteenth century, in that wonderful and most lovable woman, Catherine of Siena, we find the same union of strength and tenderness which was so noticeable in Dr. Inglis. In the _Life_ of St. Catherine it is said: "Everybody loves Catherine Benincasa because she was always and everywhere a woman in every fibre of her being. By nature and temperament she was fitted to be what she succeeded in remaining to the end--a strong, noble woman, whose greatest strength lay in her tenderness, and whose nobility sprung from her tender femininity." In her political sagacity, her optimism, and cheerfulness also, she reminds us of Elsie Inglis. During St. Catherine's Mission to Tuscany the following story is told of her by her biographer: "The other case" (of healing) "was that of Messer Matteo, her friend, the Rector of Misericordia, who had been one of the most active of the heretic priests in Siena. To this good man, lying _in extremis_ after terrible agony, Catherine entered, crying cheerfully: 'Rise up, rise up, Ser Matteo! This is not the time to be taking your ease in bed!' Immediately the disease left him, and he, who could so ill be spared at such a time, arose whole and sound to minister to others."[10] We smile as we read of Catherine's "cheerful" entrance into this sick-chamber, and those who knew Dr. Inglis can recall many such a breezy entrance into the depressing atmosphere of some of her patients' sickrooms. FOOTNOTE: [10] _Catherine of Siena_, by C. M. Antony. CHAPTER V THE SOLVED PROBLEMS "_It is the solution worked out in the life, not merely in words, that brings home to other lives the fact that the problem is not insoluble_." It may be truly said that special types of problems come before the unmarried woman for solution--problems as to her connection with society and with the race, which confront her as they do not others. Though few signs of a mental struggle were visible on the surface, there is no doubt that Elsie Inglis met these problems and settled them in the silence of her heart. It is a fact of much interest in connection with the subject of this memoir that amongst the papers found after she had died is the MS. of a novel written by herself, entitled _The Story of a Modern Woman_, and one turns the pages with eager interest to see if they furnish a key to the path along which she travelled in solving her problems. The expectation is realized, and in reading the pages of the novel we find the secret of the assurance and happy courage which characterized her. Whether she intended it or not, many parts of the book are without doubt autobiographical. In this chapter we propose to give some extracts from the novel which we consider justify the belief that the authoress is describing her own experiences. The first extract refers to her "discovery" that she was almost entirely without fear. The heroine is Hildeguard Forrest, a woman of thirty-seven, a High School teacher. During a boating accident, which might have resulted fatally, the fact reveals itself to Hildeguard that she does not know what fear is. The story of the accident closes with these words: "Self-revelation is not usually a pleasant process. Not often do we find ourselves better than we expected. Usually the sudden flash that shows us ourselves makes us blush with shame at the sight we see. But very rarely, and for the most part for the people who are not self-conscious, the flash may, in a moment, reveal unknown powers or unsuspected strength. "And Hildeguard, sitting back in the boat, suddenly realized she wasn't a coward. She looked back in surprise over her life, and remembered that the terror which as a child would seize her in a sudden emergency was the fear of being parted from her mother, not any personal fear for herself, or her own safety. "Such a pleasurable glow swept over her as she sat there in the rocking boat. 'Why, no,' she thought; 'I wasn't frightened.'" A similar accident befell Elsie Inglis when a young woman. Whether the absence of fear disclosed itself to her then or not cannot be said, but she is known to have said to a friend after her return from Serbia: "It was a great day in my life when I discovered that I did not know what fear was." Benjamin Kidd in _The Science of Power_ gives (unintentionally) an indication where to look for the secret of the childless woman's feeling of loneliness--_she has no link with the future_. He affirms that woman because of her very nature has her roots in the future. "To women," he says, "the race is always more than the individual; the future greater than the present." As we follow Hildeguard through the pages of the novel, she is shown to us as faced with the problem of becoming "a lonely woman," the problem that meets the unmarried and the childless woman. And the claims and the meaning of religion are confronting her too. The story traces the workings of Hildeguard's mind and the events of her life for a year. Christmas Day in the novel finds Hildeguard a lonely and dissatisfied woman with no "sure anchor." She has had a happy childhood, with many relations and friends around her. One by one these are taken from her--some are dead, others are married--and she sees herself, at the age of thirty-seven, a forlorn figure with no great interest in the future, and her thoughts dwelling mostly on the joyous past. Two or three of Hildeguard's friends are conversing together in her rooms. None of them has had a happy day. Each in her own way is feeling the depression of the lonely woman. Frances, a little Quaker lady, enters the room, as someone remarks on the sadness of Christmas-time. "'Yes,' at last said the Quaker lady; 'I heard what you said as I came in, dear. Christmas is a hard time with all its memories. _I think I have found out what we lonely women want. It is a future_. Our thoughts are always turning to the past. There is not anything to link us on to the next generation. You see other women with their families--it is the future to which they look. However good the past has been, they expect more to come, for their sons and their daughters. Their life goes on in other lives.' Hildeguard clasped her hands round her knees and stared into the fire." "Their life goes on in other lives"--the thought finds a home in Hildeguard's mind. When, soon after, the little Quakeress dies, Hildeguard, looking at the quiet face, says to herself: "_Dear little woman! So you have got your future._" But in her own case she does not wait for death to bring it to her; she faces her problems, and, refusing to be swamped by them, makes the currents carry her bark along to the free, open sea. She flings herself whole-heartedly into causes whose hopes rest in the future. She draws around her children, who need her love and care, and makes them her hostages for the future. In all this we see Elsie Inglis describing a stage in her own life. But before the story brings us round again to Christmas, something else has helped to change the outlook for Hildeguard; she has found herself in relation to God. Her religion is no merely inherited thing--not hers at second-hand, this "link with God." It is a real thing to her, found for herself, made part of herself, and so her sure foundation. It has come to her in a flash, a never-to-be-forgotten illumination of the words: "_The Power of an Endless Life_." She faces life now glad and free. In her "den" on that Christmas Eve she is described thus to us by Elsie Inglis: "Ann had put holly berries over the pictures, and the mantelpiece, too, was covered with it. Between the masses of green and the red berries stood the solid, old-fashioned, gilt frames of long ago, the photographs in them becoming yellow with age. Hildeguard turned to them from the portraits on the walls. She stood, her hands resting on the edge of the mantelpiece. Then suddenly it came to her that her whole attitude towards life and death had altered. For long these old photographs had stood to her as symbols of a past glowing with happiness. Though the pain still lingered even after time had dulled the edge, yet the old pictures typified all that was best in life, and the dim mist of the years rose up between the good days and her. "But now, as she looked, her thoughts did not turn to the past. In some unexplained way the loves of long ago seemed to be entwined with a future so wonderful and so enticing that her heart bounded as she thought of it. "'Grow old along with me; The best is yet to be.' "Only last Christmas those words would have meant nothing to her. Then her bark seemed to be stranded among shallows. She felt that she was an old woman, and 'second bests' her lot in the coming years. There could never be any life equal to the old life, in the back-water into which she had drifted. "But to-day how different the outlook! Her ship was flying over a sunlit sea, the good wind bulging out the canvas. She felt the thrill of excitement and adventure in her veins as she stood at the helm and gazed across the dancing water. It seemed to her as if she had been asleep and the "Celestial Surgeon" had come and 'stabbed her spirit broad awake.' Joy had done its work, and sorrow; responsibility had come with its stimulating spur, and the ardent delight of battle in a great crusade. New powers she had discovered in herself, new possibilities in the world around her. She was ready for her 'adventure brave and new.' Rabbi Ben Ezra had waited for death to open the gate to it, but to Hildeguard it seemed that she was in the midst of it now, that 'adventure brave and new' in which death itself was also an adventure. "'The Power of an Endless Life'--the words seemed to hover around her, just eluding her grasp, just beyond her comprehension, yet something of their significance she seemed to catch. She remembered the flash of intuition as she stood beside Frances' newly-made grave, but she realized, her eyes on the old pictures, that it would take æons to understand all it meant, to exhaust all the wonder of the idea. She could only bring to it her undeveloped powers of thought and of imagination, but she knew that stretching away, hid in an inexpressible light, lay depths undreamt of. To her nineteenth-century intellect life could only mean evolution--life ever taking to itself new forms, developing itself in new ways. At the bed-rock of all her thought lay the consciousness of 'the Power not ourselves, which makes for Righteousness.' "No mystic she, to whom an ineffable union with the Highest was the goal of all. Never even distantly did she reach to that idea. Rather she was one of God's simple-hearted soldiers, who took her orders and stood to her post. The words thrilled her, not with the prospect of rest, but with the excitement of advance, 'an Endless Life' with ever new possibilities of growth and of achievement, ever greater battles to be fought for the right, and always new hopes of happiness. Doubtingly and hesitatingly she committed herself to the thought, conscious that it had been forming slowly and unregarded in the strenuous months that lay behind her, through the long years, ever since the first seemingly hopeless 'good-bye' had wrung her heart. She began dimly to feel the 'power' of the idea, the life of which she was the holder, only 'part of a greater whole.' Earth itself only a step in a great progression. Ever upward, ever onward, marching towards some 'Divine far-off event, to which the whole creation moves.'" If another pen than Elsie Inglis's had drawn the picture we should have said it was one of herself. Surely she was able to weave around her heroine, from the depth of her own inner experiences of solved problems, the mantle of joy and freedom with which she herself was clothed. The causes to which Elsie Inglis became a tower of strength; the "nation she twice saved from despair"; the many children, not only those in her own connection, on whom she lavished love and care, are the witnesses to-day of the completeness and the splendour of her power to mould each adverse circumstance in her life and make it yield a great advantage. CHAPTER VI "HER CHILDREN" "Wonderful courage," "intrepidity of action," "strength of purpose," "no weakening pity"--these are terms that are often used in describing Elsie Inglis. But there is another side to her character, not so well known, from its very nature bound to be less known, which it is the purpose of this chapter to discover. Elsie Inglis was a very loving woman, and she was a child-lover. From every source that touched her life, and, touching it, brought her into contact with child-life, she, by her interest in children, drew to herself this healing link with the future. The children of her poorer patients knew well the place they held in her heart. "They would watch from the windows, on her dispensary days, for her, and she would wave to them across the street. She would often stop them in the street, and ask after their mother, and even after she had been to Serbia and had returned to Edinburgh she remembered them and their home affairs."[11] The daily letters to her father, written from Glasgow and London and Dublin, are full of stories about the children of her patients. Who but a genuine child-lover could have found time to write to a little niece, under twelve, letters from Serbia and Russia--one in August, 1915, during "The Long, Peaceful Summer," and the other in an ambulance train near Odessa? Her book, _The Story of a Modern Woman_, contains many descriptions which reveal a mind to whom the ways of children are of deep interest. We draw once more from the pages of the novel, as in no other way can we show so well the mother-heart that was hers. One of Hildeguard's friends, dying in India, leaves three small children, whom she commends to her pity. Hildeguard's heart responds at once, and the orphans find their home with her. Her first meeting with the frightened children and their black nurse is described in detail: "'Just let's wait a minute or two,' said Hildeguard. 'Let them get used to me. Well, Baby,' she said, turning to the ayah, and holding out her arms. "With a great leap and a gurgle Baby precipitated himself towards her, his strong little hands clutching uncertainly at the brooch at her throat. Then the buttons distracted him, and then, after a serious look at her face, his eyes suddenly caught sight of the hat above it, and the irresistible gleam of some ornament on it. With wildly working hands he pulled himself to his feet, and, with one fat little hand on her face, grabbed at the shining jet. "Hildeguard, laughing, and submitting herself half resistingly to the onslaught, felt her hat dragged sideways by the uncertain little hand. "She held the little one close to her, still laughing, kissing the firm little arms and hands, and talking baby nonsense as if it had been her mother-tongue for years. "The brooch again caught Baby's eye, and he made another determined raid on it. He seized it and pricked his finger. Down went the corners of his mouth. "'There now,' said Hildeguard, 'I knew you'd do that, you duckie boy,' kissing the pricked hand over and over again. 'And good little sonnie is not to cry. A watch is much safer than a brooch: now let's see if we can get at it,' feeling in her belt. "The watch was grabbed at and went straight to his mouth. "'Does your watch blow open?' asked Rex. "'Come and see,' said Hildeguard. "Rex came without a moment's hesitation. Eileen was forgotten in the interest of a new investigation. The watch did blow open. How exceedingly exciting! He leaned both arms on Hildeguard's knee while he defended the watch from Baby's greedy attacks. Then he suddenly remembered something of more importance. "'I've got a watch too.' He wriggled wildly with excitement, and pulled out a Waterbury. "'Well, you are a lucky boy!' said Hildeguard. "Eileen had come forward too, but Hildeguard waited for her to speak before noticing the advance. Rex was standing near to her, pointing out the beauties of the watch, the hands, etc. "'And--and--bigger like that'--stretching his arms wide--'bigger like that than your watch.' "'Your watch,' said Eileen, 'is little and tiny, like Mummy's watch. But Mummy's watch pins on here,' dabbing at Hildeguard's blouse. Then suddenly she raised swimming eyes to Hildeguard's: 'I do want Mummy,' she said. "'Darling,' cried Hildeguard, catching Baby with her right arm, so as to free the other to draw Eileen to her--'Darling, so we all do.'" It is a simple account of the little ways of shy children. Many a mother could have written it equally well. But the interest of Elsie Inglis's descriptions of children lies in the fact that they come from the pen of a woman of action, a woman of iron nerve, and they give us the other side of her character. And then--she was a woman whom no child called mother! But thank God the instinct is not one that can be dammed up or lost, and in these writings we get a glimpse of that motherhood which was hers, and which her life showed to be deep enough and wide enough to sweep under its wing the human souls, men, women, and children, who, passing near it, and being in need, cried out for help, and never cried in vain. To quote a fellow-woman: "The emotions which are the strongest force in a woman must not live in the past; they must not be used introspectively, nor for personal pleasure and gratification. Used thus, they destroy the woman and weaken the race. But _flung forward_, flung into interests outside of the woman herself, and thus transmuted into power, they become to her her salvation, and to the race a constructive element." FOOTNOTE: [11] _Dr. Elsie Inglis_, by Lady Frances Balfour. CHAPTER VII THE HOSPICE During her medical career Dr. Inglis never lost sight of one aim, equal opportunity for the woman with the man in all branches of education and practical training and responsibility. She recognized that young women doctors in Edinburgh suffered under a serious disadvantage in being ineligible for the post of resident medical officer in the Royal Infirmary and the chief maternity hospital. "But," writes a friend, "it was characteristic of her and her inherent inability to visualize obstacles except as incentive to greater effort that she set herself to remedy this disadvantage instead of accepting it as an insurmountable difficulty. _Women doctors must found a maternity hospital of their own._ That was her first decision. A committee was formed, and the public responded generously to an appeal for funds." Through the kindness of Dr. Hugh Barbour, a house in George Square was put at the committee's disposal. But Dr. Inglis felt that it must be near the homes of the poor women who needed its shelter, and after four years a site was chosen in the historic High Street. Three stories in a huge "tenement," reached by a narrow winding stair, were adapted, and The Hospice opened its doors. It was opened in 1901 as a hospital for women, with a dispensary and out-patient department, admitting cases of accident and general illness as well as maternity patients. After nine years, it was decided to draft the general cases from the district to the Edinburgh Hospital for Women and Children, and The Hospice devoted all its beds to maternity cases. [Illustration: _Photo by D. Scott_ THE HOSPICE, HIGH STREET, EDINBURGH] As soon as the admission book showed a steady intake of patients, Dr. Inglis applied for and secured recognition as a lecturer for the Central Midwifery Board, in order to be in a position to admit resident pupils (nurses and students) to The Hospice for practical instruction in midwifery. She at the same time applied to the University of Edinburgh for recognition as an extramural lecturer on gynæcology. Recognition was granted, and for some years she lectured, using The Hospice or the Edinburgh Hospital for Women and Children at Bruntsfield Place for her practical instruction. A woman doctor writes: "In thus starting a maternity hospital in the heart of this poor district she showed the understanding born of her long experience in the High Street and her great sympathy for all women in their hour of need. Single-handed she developed a maternity indoor and district service, training her nurses herself in anticipation of the extension of the Midwives Act to Scotland. Never too tired to turn out at night as well as by day, cheerfully taking on the necessary lecturing, she always worked to lay such a foundation that a properly equipped maternity hospital would be the natural outcome." Though hampered by lack of money and suitable assistance, she was never daunted, and in a characteristic way insisted that all necessary medical requirements should be met, whatever the expense. She worked at The Hospice with devotion. Though cherishing always her aim of an institution which, while serving the poor, should provide a training for women doctors, she threw herself heart and soul into the work because she loved it for its own sake, and she loved her poor patients. In 1913 Dr. Inglis went to America, and her letters were full of her plans for further development on her return. At Muskegon, Michigan, she found a small memorial hospital, of which she wrote enthusiastically as the exact thing she wanted for midwifery in Edinburgh. On returning from America, for a time she was far from well, and one of her colleagues, in September, 1913, urged her to forgo her hard work at The Hospice, begging her to take things more easily. Her reply, in a moment of curious concentration and earnestness, was characteristic: "Give me one more year; I know there is a future there, and someone will be found to take it on." A year later, when it seemed inevitable that it must come to an end with her departure for Serbia, those interested in The Hospice passed through deep waters in saving it, but the unanswerable argument against closing its doors was always that big circle of patients, often pleading her name, flocking up its stair, certain of help. "Three things foreseen by Dr. Inglis have happened since her departure: "1. The extension of the Midwives Act to Scotland, establishing recognized training centres for midwifery nursing. "2. The extension of Notification of Births Act, making State co-operation in maternity service possible. "3. The admission of women medical students to the University, making an opportunity for midwifery training in Edinburgh of immediate and paramount importance. "The relation of The Hospice to these three events is as follows: "1. It is now fourth on the list of recognized training centres in Scotland, following the three large maternity hospitals. "2. It is incorporated in the Maternity and Child Welfare scheme of Edinburgh, which assists in out-patient work, though not in the provision of beds. "3. It has full scope under the Ordinances of the Scottish Universities to train women medical students in Clinical Midwifery if it had a sufficient number of beds. "The Hospice has the distinction of being the only maternity training centre run by women in Scotland. From this point of view it is of great value to women students, affording them opportunities of study denied to them in other maternity hospitals. "To those of her friends who knew her Edinburgh life intimately, Elsie Inglis's love of The Hospice was the love of a mother for her child. She was never too tired or too busy to respond to any demand its patients made upon her time and energy, always ready to go anywhere in crowded close, or remote tenement, if it was to see a mother who had once been an in-patient there or a baby born within its walls. True, Dr. Inglis saw The Hospice with romantic eyes, with that vision of future perfection which is the seal of pure romance in motherhood. Because of this she cheerfully accepted those cramped and inconvenient flats, reached by the narrow common stair which vanishes past The Hospice door in a corkscrew flight to regions under the roof. Inconvenience and straitened quarters were as nothing, for was not her Nursing Home exactly where she wished it, with the ebb and flow of the High Street at its feet? Dr. Inglis always rejoiced greatly in the High Street, in the charm of the precincts of St. Giles, that ineffable Heart of Midlothian, serenely catholic, brooding upon the motley life that has surged for centuries about its doors. Here, where she loved to be, The Hospice is finding a new home, an adequate building, modern equipment, and endowed beds, and it will stand a living memorial, communicating to all who pass in and out of its doors, to women in need, to women strong to help, the inspiration of Dr. Elsie Inglis's ideal of service." CHAPTER VIII THE SUFFRAGE CAMPAIGN The question of Woman's Suffrage had always interested Dr. Inglis, for the justice of the claim had from the first appealed to her. But it was not until after 1900 that the Women's Movement took possession of her. From that time onward, till the Scottish Women's Hospitals claimed her in the war, the cause of Woman's Suffrage demanded and was granted a place in her life beside that occupied by her profession. Indeed, the very practice of her profession added fuel to the flame that the longing for the Suffrage had kindled in her heart. A doctor sees much of the intimate life of her patients, and as Dr. Inglis went from patient to patient, conditions amongst both the poor and the rich--intolerable conditions--would raise haunting thoughts that followed her about in her work, and questions again and again start up to which only the Suffrage could give the answer. The Suffrage flame with her, as with many other women and men, was really one which religion tended; it was religious conviction which mastered her and made her eager and dauntless in the fight. She always worked from the constitutional point of view, and was an admirer and follower of Mrs. Fawcett throughout the campaign. "As she threw herself into this new interest she found a gale of fresh air blowing through her life. It was almost as if she had awakened on a new morning. The sunshine flooded every nook and corner of her dwelling, and even old things looked different in the new light. Not the least of these impressions was due to the new friendships; women whose life-work was farthest from her own, whose point of view was diametrically opposite to hers, suddenly drew up beside her in the march as comrades. She felt as if she had got a wider outlook over the world, as if in her upward climb she had reached a spur on the hillside, and a new view of the landscape spread itself at her feet. "As she had once said, fate had placed her in the van of a great movement, but she herself clung to old forms and old ways--a new thing she instinctively avoided. It took her long to adjust herself to a new point of view. But here, in this absorbing interest, she forgot everything but the object. Her eyes had suddenly been opened to what it meant to be a citizen of Britain, and in the overpowering sense of responsibility that came with the revelation her timorous clinging to old ways had slackened. "Not the least part of the interest of the new life was the feeling of being at the centre of things. People whose names had been household words since babyhood became living entities. She not only saw the men and women who were moulding our generation: she met them at tea, she talked intimately with them at dinners, and she actually argued with them at Council meetings." Thus Elsie Inglis describes in her writings her heroine Hildeguard's entrance into "the great crusade." The description may be taken as true of her own feelings when caught by the ideal of the movement. The following words which she puts into the mouth of a Suffrage speaker are evidently her own reflections on the subject of the Suffrage: "'I don't think for a moment that the millennium will come in with the vote,' she smiled, after a little pause. 'But our faces, the faces of the human race, have always been set towards the millennium, haven't they? And this will be one great step towards it. It is always difficult to make a move forward, for it implies criticism of the past, and of the good men and true who have brought the people up to that especial point. However gently the change is made, that element must be there, for there is always a sense of struggle in changing from the old to the new. I do not think we are nearly careful enough to make it quite clear that we do not hold that we women _alone_ could have done a bit better--that we are proud of the great work our men have done. We speak only of the mistakes, not of the great achievements; only I do think the mistakes need not have been there if we had worked at it together!' "The salvation of the world was wrapped up in the gospel she preached. Many of the audience were caught in the swirl as she spoke. Love and amity, the common cause of healthier homes and happier people and a stronger Empire, the righting of all wrongs, and the strengthening of all right--all this was wrapped up in the vote." In the early years of this century Suffrage societies were scattered all over Scotland, and it began to be felt that much of their work was lost from want of co-operation; it was therefore decided in 1906 that all the societies should form a federation, to be called the Scottish Federation of Women's Suffrage Societies. During the preliminary work Mrs. James T. Hunter acted as Hon. Secretary, but after the headquarters were established in Edinburgh Dr. Inglis was asked and consented to be Hon. Secretary, with Miss Lamont as Organizing Secretary. There is no doubt that after its formation the success of the Federation was largely due to Dr. Inglis's power of leadership. She cheered the faithful--if sometimes despondent--suffragists in widely scattered centres; she despised the difficulties of travel in the north, and over moor, mountain, and sea she went, till she had planted the Suffrage flag in far-off Shetland. In her many journeys all over Scotland, speaking for the Suffrage cause, Dr. Inglis herself penetrated to the islands of Orkney and Shetland. A very flourishing Society existed in the Orkneys. The following letter from Dr. Inglis to the Honorary Secretary there is characteristic, and will recall her vividly to those who knew her. The arrival for the meeting by the last train; the early start back next morning; the endeavour to see her friend's daughter, who she remembers is in Dollar; the light-heartedness over "disasters in the House" (evidently the setback to some Suffrage Bill in the House of Commons)--these are all like Elsie Inglis. So, too, are her praise of the Federation secretaries, her eager looking forward to the procession, and the request for the "beautiful banner"! 1913. "DEAR MRS. CURSITER, "Yes, I had remembered your daughter is at Dollar, and I shall certainly look out for her at the meeting. Unfortunately, I never have time to stay in a place, at one of these meetings, and see people. It would often be so pleasant. This time I arrive in Dollar at 6 p.m. and leave about 8 the next morning. I have to leave by these early trains for my work. "It was delightful getting your offer of an organizer's salary for some work in Orkney. Our secretaries have been most extraordinarily unconcerned over disasters in the House! Not one of you has suggested depression, and most of you have promptly proposed new work! That is the sort of spirit that wins. "I shall let you know definitely about an organizer soon. "At the Executive on Saturday it was decided to have a procession in Edinburgh during the Assembly week. We shall want you and your beautiful banner! You'll get full particulars soon. "Yours very sincerely, "ELSIE MAUD INGLIS." One of the Federation organizers who worked under Dr. Inglis for years gives us some indication of her qualities as a leader: "Though it was not unknown that Dr. Inglis had an extraordinary influence over young people, it was amazing to find how many letters were received after her death from young women in various parts of the kingdom, who wrote to express what they owed to her sympathy and encouragement. "To be a leader one must be able not only to inspire confidence in the leader, but to give to those who follow confidence in themselves, and this, I think, was one of Dr. Inglis's most outstanding qualities. She would select one of her workers, and after unfolding her plans to her, would quietly say, 'Now, my dear, I want you to undertake that piece of work for me.' As often as not the novice's breath was completely taken away; she would demur, and remark that she was afraid she was not quite the right person to be entrusted with that special piece of work. Then the Chief would give her one of those winning smiles which none could resist, and tell her she was quite confident she would not fail. The desired result was usually attained, and the young worker gained more confidence in herself. If, on the other hand, the worker failed to complete her task satisfactorily, Dr. Inglis would discuss the matter with her. She might condemn, but never unjustly, and would then arrange another opportunity for the worker in a different department of the work. "From those with whom she worked daily she expected great things. She was herself an unceasing worker, well-nigh indefatigable. It was no easy matter to work under 'the Chief's' direction; the possibility of failure never entered into her calculations." One of the finest speakers in the Suffrage cause, who with her husband worked hard in the campaign, frequently stayed with Dr. Inglis. She writes thus of her: "With me it is always most difficult to speak about the things upon which I feel the most deeply. Elsie Inglis is a case in point. She was dearer to me than she ever knew and than I can make you believe. She is one of the most precious memories I possess, the mere thought of her and her tireless devotion to her fellows being the strongest inspiration to effort and achievement. "She was the Edinburgh hostess for most of the Woman Suffrage propagandists, and we all have the same story to tell. Doubtless you have already had it from others. Every comfort she denied herself she scrupulously provided for her guests, whom she treated as though they were more tired than herself. Usually she was at her medical work till within a few minutes of the evening meal, would rush home and eat it with us, take us to the meeting afterwards, frequently take a part in it, and bring her guests home to the rest she was not always permitted to take herself. And through it all there was no variation in her wonderful manner--all brightness, affection, and warm energy. "The last time I saw her was in the Waverley station. She was returning shortly to her work abroad, while I was on my way to address a public meeting in Dundee on the need for attempting to negotiate peace. It was the time when everybody who dared to breathe the word 'peace,' much more those who tried to stop the slaughter of men, were denounced as traitors and pro-Germans. It was the time when one's nearest and dearest failed to understand. But _she_ understood. And she broke into a busy morning's work to come down to the train to shake my hand. What we said was very little; but the look and the hand-clasp were sufficient. We knew ourselves to be serving the same God of Love and Mercy, and that knowledge made the bonds between us indissoluble. I never saw nor had word with her again. "It is easy to say, what is true, that the world's women owe to Dr. Elsie Inglis a debt of gratitude they can never repay. But I am convinced in my own soul that the reward she would have chosen, if compelled to make the choice, would have been that all who feel that her work was of worth should join hands in an effort to rid the world of those evils which make men and women hate and kill one another." Dr. Inglis did not see with the pacifists of the last five years. But in this tribute to her is shown her open-mindedness and tolerance of another's views, even on this cleaving difference of opinion. A woman of great distinction--and not only in the Suffrage movement--says: "When I was working for the Suffrage movement in the years before the war, one of the most impressive personalities that I came into touch with was that of Dr. Elsie Inglis. She was then the leading spirit in our movement in Edinburgh, and when I went to speak there, or in the neighbourhood, she always used to put me up. I have never met anyone who seemed to me more absolutely single-minded and single-hearted in her devotion to a cause which appealed to her. She was eminently a feminist, and to her feminism she subordinated everything else. No consideration for her health, for her position, for her practice, ever stood in the way of any call that came to her. She was untiring, and that at a time when our cause was not popular everywhere, and when her position as a medical woman might easily have been affected by its unpopularity. "I remember one night especially, when we were going out in a motor-car to some rather remote place, in very stormy weather. It howled and rained and was pitch dark. Suddenly we ran, or nearly ran, into a great tree which had been blown down across the road. It had brought with it a mass of telegraph wire, and altogether afforded an apparently complete 'barrage.' We were still some six or seven miles from our destination, and were wearing evening frocks and thin shoes. We got out and wrestled with the obstacle, and when at one time it seemed quite hopeless to get the car through, and I suggested that she and I would have to walk, I shall never forget the look of approval that she turned on me. As a matter of fact, I doubt very much whether I really _could_ have walked. I am a little lame, and the circumstances made it almost an impossibility. But the determination of Dr. Inglis that somehow we _should_ get to our meeting infected me, and, like many others who have followed her since, I felt able to achieve the impossible. "It is true that Dr. Inglis seemed to me--since, after all, she was human--to have the faults of her qualities. No consideration of herself prevented her complete devotion to her work. I sometimes felt that there was an element of relentlessness in this devotion, which would have allowed her to sacrifice not only other people, but even perhaps considerations which it is not easy to believe ought to be sacrificed. It is extraordinarily difficult to judge how far any end may justify any given means. It is, of course, a shallow judgment which dismisses this dilemma as one easily solved. Rather, I have always felt it exceedingly difficult, at any rate to an intellect that is subtle as well as powerful. I am reminded, in thinking of Dr. Inglis, of the controversy between Kingsley and Newman, from which it appears that Charles Kingsley thought it a very easy matter to tell the truth, and Newman found it a very difficult one. One's judgment of the two will, of course, vary, but I personally have always felt that Newman understood the truth more perfectly than Kingsley; understood, for instance, that it takes two people to tell it (one to speak and one to hear aright), and that this was why he realized its difficulty. So with Dr. Inglis; I do not suppose she ever hesitated when once convinced of the goodness of her cause, but I confess that I have sometimes wished that she could have hesitated. "It is a graceless task to suggest spots in so excellent a sun, and we feminists who worked with her and loved her can never be glad enough or proud enough that the world now knows the greatness of her quality." Again, an organizer who worked constantly with Dr. Inglis before the war, and who later raised large sums for the Scottish Women's Hospitals in India and Australia, writes: "You have asked me for some personal memories of my dear Dr. Elsie Inglis, for some of those little incidents that often reveal a character more vividly than much description and explanation. And to me, at least, it is in some of those little memories that the Dr. Inglis I loved lives most vividly. What I mean is that her splendid public work, in medicine, in Suffrage, in that magnificent triumph of the Scottish Women's Hospitals--they were _her_ hospitals--is there for all the world to see and honour. But the things behind all that, the character that conquered, the spirit that aspired, the incredible courage, optimism, indomitability of that individuality, the very self from which the work sprang--all that, it seems to me, had to be gathered in and understood from the tiny incident, the word, the glance. "There stands out in my mind my first meeting with Dr. Inglis. The scene was dismal and depressing enough. It was an empty shop in an Edinburgh Street turned into a Suffrage committee-room during an election. Outside the rain drizzled; inside the meagre fire smoked; there was a general air of lifelessness over everything. I wondered, ignorant and uninitiated in organizing and election work, when something definite would happen. Giving away sodden handbills in the street did not seem a very vigorous or practical piece of work. "Suddenly the doors swung open and Dr. Inglis came into that dull place, and with her there came the very feeling of movement, vitality, action. She had come to arrange speakers for the various schoolroom election meetings to be held that night. The list of meeting-places was arranged; then came the choice and disposal of the speakers. Without hesitation, Dr. Inglis grouped them; with just one look round at those present, and another, well into her own mind, at those not present who could be press-ganged! At last she turned to me and said, 'And you will speak with Miss X. at ----' I was horrified. 'But I must explain,' I said; 'I am quite "new." I don't speak at all. I have never spoken.' I can imagine a hundred people answering my very decided utterance in a hundred different ways. But I cannot imagine anyone but Dr. Inglis answering as she answered. There was just the jolliest, cheeriest laugh and, 'Oh, but you _must_ speak.' That was all. And the remarkable thing was that, though I had sworn to myself that I would never utter a word in public without proper training, I did speak that night. It never occurred to me to refuse. Confidence begat confidence. It was during this time of work with Dr. Inglis that I began really to understand and appreciate that wonderful character. "Another incident runs into my memory, of desperate, agonizing days in Glasgow, when Suffrage was unpopular and the funds in our exchequer were very low. How well I remember writing to Dr. Inglis at the ridiculous hour of two in the morning, that we must get some money, and that I should get certain introductions and do a lecturing tour in New York and try to make Suffrage 'fashionable.' The answer came by return of post, and was deliciously typical. 'My dear, your idea is so absolutely mad that it must be thoroughly sane. Come and talk it over.' "It was a happiness to work with Dr. Inglis, for her confidence, once given, was complete. There were no petty inquiries or pedantic regulations. 'Do it your own way,' was the one comment on a plan of organization once it was settled. "Dr. Inglis was one to whom the words 'can't' and 'impossible' really and literally had no meaning; and those who worked with her had to 'unlearn' them, and they did. It did, indeed, seem 'impossible' to leave for India at ten days' notice to carry on negotiations for the Scottish Women's Hospitals and raise an Indian fund, especially when one had been in no way officially or intimately connected with the Hospitals' work. And to be told on the telephone, too, that one 'must' go. That was adorably Dr. Inglis-ish. I laughed with glee at the very ridiculous, fantastic impossibility of the whole thing--and promptly went! And how I looked forward to seeing Dr. Inglis on my return! When she saw me off at Waterloo in 1916, and, still fearfully ignorant of what awaited one, I wailed at the eleventh hour (literally, for we were in the railway carriage), 'But where am I to stay and where am I to go?' 'Don't worry,' said Dr. Inglis, with that sublime faith and optimism of hers; 'they'll put you up and pass you on. Good-bye, my dear. _It will be all right_.' And so it was. But one has missed the telling of it all to her; the hard things and the good things and the dreadfully funny things. For she would have appreciated every bit of it, and entered into every detail." During the years of that great campaign, Dr. Inglis spoke, pleading the cause of Suffrage, at hundreds of meetings all over the United Kingdom. At one large meeting she had occasion to deal with the problem of the "outcast woman." She referred to the statement once made that no woman would be safe unless this class existed. Then she said: "If this were true, the price of safety is too high. I, for one, would choose to go down with the minority." It is difficult to declare which was the more impressive, the silence--one that could be felt--which followed the words, or the burst of applause which came a moment later. But to one onlooker, from the platform, the predominant feeling was wonder at the amazing power of the woman. Without raising her voice, or putting into it any emotion beyond the involuntary momentary break at the beginning of the sentence, she had, by the transparent sincerity of her feeling, conveyed such an impression to that large audience as few there would forget. The subtle response drawn from those hundreds of women to the woman herself, to the personality of the speaker, was for the moment even more real than the outward response given to the idea. More than one woman there that day could have said in the words of the British Tommy, who had heard for the first time the story of Serbia, "It would not be difficult to follow her!" CHAPTER IX THE SCOTTISH WOMEN'S HOSPITALS "_From the first the personality of Dr. Inglis was the main asset in this splendid venture. She continued to be its inspiration to the end._" August, 1914, found many a man and woman unconsciously prepared and ready for the testing time ahead. Elsie Inglis was one of these. It is interesting to note that Dr. Inglis completed her fiftieth year in the August that war broke out. She started on her great work of the next years with all the vigour and freshness of youth. In her own words, already quoted, we can describe her at the beginning of the war: "Her ship was flying over a sunlit sea, the good wind bulging out the canvas. She felt the thrill and excitement of adventure in her veins as she stood at the helm and gazed across the dancing waters.... Joy had done its work, and sorrow and responsibility had come with its stimulating spur, and the ardent delight of battle in a great crusade.... "New powers she had discovered in herself, new responsibilities in the life around her.... She was ready for her 'adventure brave and new.' Rabbi Ben Ezra waited for death to open the gate to it, but to her it seemed that she was in the midst of it now, that 'adventure brave and new' _in which death itself was also to be an adventure_.... 'The Power of an Endless Life.' The words thrilled her, not with the prospects of rest, but with the excitement of advance...." War was declared on August 4. On the 10th the idea of the Scottish Women's Hospitals--hospitals staffed entirely by women--had been mooted at the committee meeting of the Scottish Federation of Women's Suffrage Societies. Once the idea was given expression to, nothing was able to stop its growth. A special Scottish Women's Hospital committee was formed out of members of the Federation and Dr. Inglis's personal friends. Meetings were organized all over the country; an appeal for funds was sent broadcast over Scotland; money began to flow in; the scheme was taken up by the whole body of the N.U.W.S.S.[12] Mrs. Fawcett wrote approvingly. The Scottish Women's Hospitals Committee at their headquarters in Edinburgh divided up into subcommittees: equipment, uniforms, cars, personnel, and so on. Offers for service came in every day, until soon over 400 names were waiting the choice of the personnel committee. The headquarters offices in 2, St. Andrew Square became a busy hive. Enthusiasm was written on the face of every worker. By the end of November the first fully equipped Unit, under Miss Ivens of Liverpool was on its way to the old Abbey of Royaumont in France. Dr. Alice Hutchison with ten nurses was in Calais working under the Belgian surgeon, Dr. de Page. A second Unit as well equipped as the first was almost ready to start for Serbia. It sailed in the beginning of January, under Dr. Eleanor Soltau, Dr. Inglis herself following in the April of 1915. But even with all this dispatch, the S.W.H. were not the first Women's Hospital in the field. As early as September, 1914, Dr. Flora Murray and Dr. Louisa Garrett Anderson had taken a Unit, staffed entirely by women, to Paris, where they did excellent work. Until Dr. Inglis's departure for Serbia, her whole time and strength and boundless energy had been thrown into the building up of the organization of the Scottish Women's Hospitals. She addressed countless meetings all over the Kingdom, making the scheme known and appealing for money, and at the same time her insight and enthusiasm never ceased to be the mainspring of the activity at the office in Edinburgh, where the heart of the Scottish Women's Hospitals was to be found. Miss Mair describes Dr. Inglis during these months thus: "A certain stir of feeling might be perceptible in the busy hive at the office of organization when a specially energetic visit of the Chief had been paid. Had the impossible been accomplished? If not, why? Who had failed in performance? Take the task from her; give it to another. No excuses in war-time, no weakness to be tolerated--onward, ever onward. "To those inclined to hesitate, or at least to draw breath occasionally in the course of their heavy work of organizing, raising money, gathering equipment, securing transport, passports, and attending to the other innumerable secretarial affairs connected with so big a task, she showed no weakening pity; the one invariable goad applied was ever, 'it is war-time.' No one must pause, no one must waver; things must simply be done, whether possible or not, and somehow by her inspiration they generally were done. In these days of agonizing stress she appeared as in herself the very embodiment of wireless telegraphy, aeronautic locomotion, with telepathy and divination thrown in--neither time nor space was of account. Puck alone could quite have reached her standard with his engirdling of the earth in forty minutes. Poor limited mortals could but do their best with the terrestrial means at their disposal. Possibly at times their make-weight steadied the brilliant work of their leader." In a letter to Mrs. Fawcett dated October 4, 1914, she says: "I can think of nothing except those Units just now; and when one hears of the awful need, one can hardly sit still till they are ready." [Illustration: ELSIE INGLIS FROM A BUST BY THE SERBIAN SCULPTOR IVAN M�STROVIC] FOOTNOTE: [12] National Union of Women's Suffrage Societies. CHAPTER X SERBIA Serbia in January, 1915, was in a pitiable condition. Three wars following in quick succession had devastated the land. The Austrians, after their defeat at the Battle of the Ridges in October, 1914, had retreated out of the country, leaving behind them filthy hospitals crowded with wounded, Austrian and Serb alike. The whole land has been spoken of as one vast hospital. From this condition of things sprang the scourge of typhus which started in January, 1915, and swept the land. Dr. Soltau and her Unit, arriving in the early part of January, were able to take their place in the battle against this scourge. Their work lay in Kraguevatz, in the north of Serbia, where Dr. Soltau soon had three hospitals under her command. In April Dr. Soltau contracted diphtheria. Dr. Inglis was wired for, and left for Serbia in the end of April, 1915. She went gaily. There seems no other word to describe her attitude of mind--she was so glad to go. The sufferings of the wounded and dying touched her keenly. It was not want of sympathy with all the awful misery on every hand that made her go with such joy of heart, but rather she was glad from the sense that at last she, personally, would be "where the need was greatest." This had always been her objective. THE �GEAN SEA, "_May 2nd, 1915._ "DEAREST EVA, "We have had a perfectly glorious voyage from Brindisi to Athens, all yesterday between the coast and the Greek Islands, and then in the Gulf of Corinth. I never remember such a day--all day the sunshine and the beautiful hills, with the clouds capping them, or lying on their slopes, and the blue sky above, and blue sea all round. Then came the most glorious sunset, and when we came up from dinner the sky blazing with stars. We put our chairs back to the last notches, and lay looking at them, till a great yellow moon came up and flooded the place with light and put the stars out. It was glorious.... "Your loving sister, "ELSIE INGLIS." She landed in Serbia when the epidemic of fever had been almost overcome, and with the long, peaceful summer ahead of her. It is a joy to think of Dr. Inglis all that summer. Her letters are full of buoyancy of spirit. She was keen about everything. She had left behind her a magnificent organization, enthusiastic women in every department, the money flowing in, and the scheme meeting with more and more approval throughout the country. In Serbia she was to find her power of organizing given full scope. She had splendid material in the personnel of the Scottish Women's Hospitals Units under her command. She made many friends--Sir Ralph Paget, Colonel Hunter, Dr. Curcin, Colonel Gentitch, and many others. She was in close touch with, was herself part of, big schemes, a fact which was exhilarating to her. Everything combined to make her happy. The scheme that eventually took shape was Colonel Hunter's. His idea was to have three "blocking hospitals" in the north of Serbia, which, when the planned autumn offensive of the Serbs took place, would keep all infectious diseases from spreading throughout the country. Innumerable journeys up and down Serbia were taken by Dr. Inglis before the three Scottish Women's Hospitals which were to form this blocking line had been settled, and were working at Valjevo, Lazaravatz, and Mladanovatz. Dr. Alice Hutchison and her Unit, with "the finest canvas hospital ever sent to the Balkans," arrived in Serbia shortly after Dr. Inglis. Dr. Hutchison was sent to Valjevo; Lazaravatz and Mladanovatz were respectively under Dr. Hollway and Dr. McGregor. Dr. Inglis herself took over charge of the fever hospitals in Kraguevatz, working them as one, so that soon there were four efficient Scottish Women's Hospitals in Serbia. The Serbian Government gave Dr. Inglis a free pass over all the railways. She calls herself "extraordinarily lucky" in getting this pass, and writes how greatly she enjoys these journeys, how much of the country she sees during them, and of the interesting people she meets. For the first time in her life she had work to do that needed almost the full stretch of her powers. And deep at the heart of her joy at this time lay her growing love of the Serbs. Something in them appealed to her, something in their heroic weakness satisfied the yearning of her strength to help and protect. She writes glowingly of their soldiers streaming past the Scottish Women's Hospitals at Mladanovatz, massing on the Danube, "their heads held high." Every letter is full of enthusiasm of the country and the people. "God bless her," writes a friend; "it was the last really joyous time she knew." Later on the Serbs erected a fountain at Mladanovatz in memory of the work done by the Scottish Women's Hospitals in Serbia, and in particular by Dr. Inglis. The opening ceremony took place in the beginning of September. Many people, English and Serbs, were present, and a long letter by Dr. Inglis describes the dedication service. "A table covered with a white cloth stood in front of the fountain, and on it a silver crucifix, a bowl of water, a long brown candle lighted and stuck in a tumbler full of sand, and two bunches of basil, one fresh and one dried." At the end of the service the priest gave the bunches of basil to Dr. Inglis. "These are some of the few things," she writes, "which I shall certainly keep always." The Serbian officer who designed the fountain has contributed to this _Life_ the following account of his impressions of Dr. Inglis: "Already five sad and painful years have gone by since the time that I had the chance and honour of knowing Dr. Elsie Inglis. It is already five years since we erected to her--still in the plenitude of life--a monument. What a prediction! Whence came the inspiration of the great soul who was founder of this monument? "Oh, great and noble soul, there is yet another monument created in the hearts of the soldiers and Serbian people! And if the pitiless wheel of time crushes the first, the second will survive all that is visible and material. "One did not need to be long with Dr. Elsie Inglis to see all the grandeur of her soul, her long vision, and her attachment to the Serbs. I was not among those who chanced to pass some months in her company, but even in a few days I soon learnt to recognize her divine nature, and to see her relief in all colours. "After the second big offensive of Germano-Austrian forces against Serbia in the autumn of 1914, Dr. Elsie Inglis took a great part in working against the various epidemics spread by the invasion in Western Serbia. The significance and tenacity of this time of epidemic was such that only those who witnessed it can understand the great usefulness, devotion, and attachment of its co-workers. A great number of Dr. Inglis's personnel were occupied in coping with it, and with what results! "The Serbian counter-offensive terminated, provisional peace reigned in Serbia. Six months went by before the last soldier of the enemy left our sacred soil; the second enemy--the great epidemic--has also been arrested and vanquished. The terrors that these two allies brought in their train gradually disappeared, and the sun shone once again for the Little Armed People. Men breathed again, and tired bodies slept. One had the time to think of the great soldiers of the front, as well as those who worked behind the lines. And, indeed, in those great days we knew not who were the more courageous, the more daring, the greater heroes. "General Headquarters decided to give a tangible recognition to all those who had taken part in this epoch. Among the first thus distinguished were Dr. Elsie Inglis and her hospitals. "On the proposal of the Director of Sanitation, it was decided to erect a monumental fountain to the memory of Dr. Elsie Inglis and her Scottish Women's Hospitals. This was to be at Mladanovatz, quite close to one of these hospitals, at a few yards' distance from the main railway-line running from Belgrade to Nish, in sight of all the travellers who passed through Serbia. "It was erected, and bears the inscription: "IN MEMORY OF THE SCOTTISH WOMEN'S HOSPITALS AND THEIR FOUNDER, DR. ELSIE INGLIS." "The object of my letter is not to make known what I have told you; what follows is more important. "Dr. Inglis was present in person at the unveiling and benediction of the fountain. The idea was to give her a proof of the people's gratitude by erecting an original monument which, in recalling those strenuous days, would combine a value practical and real, solving the question of a pure drinking-water, and cutting off the danger of an epidemic at the root; and also, the impression that she had after visiting a number of fountains in the environs of Mladanovatz and its villages left her no rest (as she said later), and produced in her an idea, long thought over, and eventually expressed in the following conversation: "'Look here, Captain P----, I have a scheme which absorbs me more and more, and becomes in me a fixed idea. You suffer in Serbia, and are often subject to epidemics, through nothing else but bad water. I have been thinking it over, and would like to ameliorate as much as possible this deplorable state of affairs. I have the intention of addressing an appeal to the people of Great Britain, and asking them to inaugurate a fund which would create the opportunity of constructing in each Serbian village a fountain of good drinking-water. And then, I should return to Serbia, and with you--I hope that you are willing, since you have already built so many of these fountains round about--should go from village to village erecting these fountains. It will be, after the war, my unique and greatest desire to do this for the Serbs.' "Oh, great friend of Serbia! Thy clear-sighted spirit was to have but a glimpse of one of the most essential necessities of the Serbian people. Thy frail and fragile body has not permitted thee to enjoy the pleasure to which thou hast devoted so much love. For the well-being of this dear people thou hast given thyself entirely, even thy noble life. What a misfortune indeed for us! "May Heaven send thee eternal peace, so much merited, and so much desired by all those who knew thee, and above all and especially by all those Serbian hearts who have found in thee a great human friend." Dr. Inglis wrote every week to the committee. In the letters written towards the end of September we are aware of the anxiety about the future which is beginning to make itself felt. "Last week Austrian aeroplanes were 'announced,' and the authorities evidently believed the report; for the Arsenal was emptied of workmen--and they don't stop work willingly just now. So--as a Serbian officer said to me yesterday--'Serbia is exactly where she was a year ago.' It does seem hard lines on our little Ally.... "Well, as to how this affects us. Sir Ralph was talking about the various possibilities. _As long as the Serbians fight we'll stick to them--retreat if necessary, burning all our stores._ If they are overwhelmed we must escape, probably via Montenegro. Don't worry about us. We won't do anything rash or foolish; and if you will trust us to decide, as we must know most about the situation out here, we'll act rationally." At last, in November, 1915, the storm broke. Serbia was overrun by Germans, Austrians, and Bulgarians. All her big Allies failed her, "so when her bitter hour of trial came, Serbia stood alone." The Scottish Women's Hospitals at Mladanovatz, Lazaravatz, and Valjevo had to be evacuated in an incredibly short time. The women from Mladanovatz and Lazaravatz came down to Kraguevatz, where Dr. Inglis was. After a few days they had again to move further south to Krushevatz. From here they broke into two parties, some joining the great retreat and coming home through Albania. The rest stayed behind with Dr. Inglis and Dr. Hollway to nurse the Serbian wounded and prisoners in Krushevatz. "If the committee could have seen Colonel Gentitch's face when I said to him that we were not going to move again, but that they could count on us just where we stood, I think they would have been touched." writes Dr. Inglis. At Krushevatz both Units, Dr. Inglis's and Dr. Hollway's, worked together at the Czar Lazar Hospital under the Serbian Director, Major Nicolitch. It was here they were taken prisoners by the Germans in November. "These months at Krushevatz were a strange mixture of sorrow and happiness. Was the country really so very beautiful, or was it the contrast to all the misery that made it evident? There was a curious exhilaration in working for those grateful, patient men, and in helping the Director, so loyal to his country and so conscientious in his work, to bring order out of chaos; and yet the unhappiness in the Serbian houses, and the physical wretchedness of those cold, hungry prisoners, lay always like a dead weight on our spirits. Never shall we forget the beauty of the sunrises or the glory of the sunsets, with clear, cold, sunlit days between, and the wonderful starlit nights. But we shall never forget 'the Zoo,'[13] either, or the groans outside when we hid our heads in the blankets to shut out the sound. Nor shall we ever forget the cheeriness or trustfulness of all that hospital, and especially of the officers' ward. We got no news, and we made it a point of honour not to believe a word of the German telegrams posted up in the town. So we lived on rumour--and what rumour! The English at Skoplje, the Italians at Poshega, and the Russians over the Carpathians--we could not believe that Serbia had been sacrificed for nothing. We were convinced it was some deep-laid scheme for weakening the other fronts, and so it was quite natural to hear that the British had taken Belgium and the French were in Metz!" During this time in Krushevatz Dr. Inglis and the women in her Unit lived and slept in one room. One night an excited message was brought to the door that enemy aircraft was expected soon; everyone was taking refuge in places that were considered safe; would they not come too? For a moment there was a feeling of panic in the room; then Dr. Inglis said, without raising her head from her pillow: "Everyone will do as they like, of course; _I_ shall not go anywhere. I am very tired, and bed is a comfortable place to die in." The suspicion of panic subsided; every woman lay down and slept quietly till morning. The Hon. Mrs. Haverfield was one of the "Scottish women" who stayed behind at Krushevatz. She gives us some memories of Dr. Inglis. "I think the most abiding recollection I have of our dear Doctor is the expression in her face in the middle of a heavy bombardment by German guns of our hospital at Krushevatz during the autumn of 1915. I was coming across some swampy ground which separated our building from the large barracks called after the good and gentle Czar Lazar of Kosovofanee, when a shell flew over our heads, and burst close by with a deafening roar. The Doctor was coming from the opposite direction; we stood a moment to comment upon the perilous position we were all in. She looked up into my face, and with that smile that nobody who ever knew her could forget, and such a quizzical expression in her blue eyes, said: 'Eve, we are having some experiences now, aren't we?' She and I had often compared notes, and said how we would like to be in the thick of everything--at last we were. I have never seen anyone with greater courage, or anyone who was more unmoved under all circumstances. "Under our little Doctor bricks had to be made, whether there was straw or not! "In this same hospital at Krushevatz she had ordered me to get up bathing arrangements for the sick and wounded. There was not a corner in which to make a bath-room, or a can, and only a broken pump 150 yards away across mud and swamp. There was no wood to heat the water, and nothing to heat it in even if we had the wood. I admit I could not achieve the desired arrangement. Elsie took the matter in hand herself, finding I was no use, and in one day had a regular supply of hot water, and baths for the big Magazine, where lay our sick, screened off with sheets, and regular baths were the order of the day from that time forth. "One never ceased to admire the tireless energy, the resourcefulness, and the complete unselfishness of that little woman who spent herself until the last moment, always in the service of others." "At last, on the 9th of February, our hospital was emptied.[14] The chronic invalids had been 'put on commission' and sent to their homes. The vast majority of the men had been removed to Hungary, and the few remaining, badly wounded men who would not be fit for months, taken over to the Austrian hospitals. "On the 11th we were sent north under an Austrian guard with fixed bayonets. Great care was taken that we should not communicate with anyone _en route_. At Belgrade, however, we were put into a waiting-room for the night, and after we had crept into our sleeping-bags we were suddenly roused to speak to a Serbian woman. The kindly Austrian officer in charge of us said she was the wife of a Serbian officer in Krushevatz, and that if we would use only German we might speak to her. She wanted news of her husband. We were able to reassure her. He was getting better--he was in the Gymnasium. 'Vrylo dobra' ('Very well'), she said, holding both our hands. 'Vrylo, vrylo dobra,' we said, looking apprehensively at the officer. But he only laughed. Probably his Serbian, too, was equal to that. That was the last Serbian we spoke to in Serbia, and we left her a little happier. And thus we came to Vienna, where the American Embassy took us over.... When we reached Zurich and found everything much the same as when we disappeared into the silence, our hearts were sick for the people we had left behind us, still waiting and trusting." Referring to this year of work done for Serbia, Mr. Seton-Watson wrote of Dr. Inglis: "History will record the name of Elsie Inglis, like that of Lady Paget, as pre-eminent among that band of women who have redeemed for all time the honour of Britain in the Balkans." We close this chapter on her work in Serbia with tributes to her memory from two of her Serbian friends, Miss Christitch, a well-known journalist, and Lieutenant-Colonel D. C. Popovitch, Professor at the Military Academy in Belgrade. "Through Dr. Inglis Serbia has come to know Scotland, for I must confess that formerly it was not recognized by our people as a distinctive part of the British Isles. Her name, as that of the Serbian mother from Scotland (Srpska majka iz 'Skotske'), has become legendary throughout the land, and it is not excluded that at a future date popular opinion will claim her as of Serbian descent, although born on foreign soil. "What appealed to all those with whom Elsie Inglis came in contact in Serbia was her extraordinary sympathy and understanding for the people whose language she could not speak and whose ways and customs must certainly have seemed strange to her. Yet there is no record of misunderstanding between any Serb and Dr. Inglis. Everyone loved her, from the tired peasant women who tramped miles to ask the 'Scottish Doctoress' for advice about their babies to the wounded soldiers whose pain she had alleviated. "Here I must mention that Dr. Inglis won universal respect in the Serbian medical profession for her skill as a surgeon. During a great number of years past we have had women physicians, and very capable they are too; but, for some reason or other, Serbian women had never specialized in surgery. Hence it was not without scepticism that the male members of the profession received the news that the organizer of the Scottish hospitals was a skilled surgeon. Until Dr. Inglis actually reached Serbia and had performed successfully in their presence, they refused to believe this 'amiable fable,' but from the moment that they had seen her work they altered their opinion, and, to the great joy of our Serbian women, they no longer proclaimed the fact that surgery was not a woman's sphere. This is but one of the services Dr. Inglis has rendered our woman movement in Serbia. To-day we have several active societies working for the enfranchisement of women, and there is no doubt that the record of the Scottish Women's Hospital, organized and equipped by a Suffrage society and entirely run by women, is helping us greatly towards the realization of our goal. It was a cause of delight to our women and of no small surprise to our men that the Scottish Units that came out never had male administrators. "It is very difficult to say all one would wish about Dr. Inglis's beneficial influence in Serbia in the few lines which I am asked to write. But before I conclude I may be allowed to give my own impression of that remarkable woman. What struck me most in her was her grip of facts in Serbia. I had a long conversation with her at Valjevo in the summer of 1915, before the disaster of the triple enemy onslaught, and while we still believed that the land was safe from a fresh invasion. She spoke of her hopes and plans for the future of Serbia. 'When the war is over,' she said, 'I want to do something lasting for your country. I want to help the women and children; so little has been done for them, and they need so much. I should like to see Serbian qualified nurses and up-to-date women's and children's hospitals. When you will have won your victories you will require all this in order to have a really great and prosperous Serbia.' She certainly meant to return and help us in our reconstruction. "I saw Dr. Inglis once again several weeks later, at Krushevatz, where she had remained with her Unit to care for the Serbian wounded, notwithstanding the invitation issued her by Army Headquarters to abandon her hospital and return to England. But Dr. Inglis never knew a higher authority than her own conscience. The fact that she remained to face the enemy, although she had no duty to this, her adopted country, was both an inspiration and a consolation to those numerous families who could not leave, and to those of us who, being Serbian, had a duty to remain. "She left in the spring of 1916, and we never heard of her again in Serbia until the year 1917, when we, in occupied territory, learnt from a German paper that she had died in harness working for the people of her adoption. There was a short and appreciative obituary telling of her movements since she had left us. "For Serbian women she will remain a model of devotion and self-sacrifice for all time, and we feel that the highest tribute we can pay her is to endeavour, however humbly, to follow in the footsteps of this unassuming, valiant woman." "MY RECOLLECTIONS OF DR. ELSIE INGLIS. "I made her acquaintance towards the close of October, 1915, when, as a heavily wounded patient in the Military Hospital of Krushevatz, I became a prisoner, first of the Germans and then of the Austrians. "The Scottish Women's Hospital Mission, with Dr. Inglis as Head and Mrs. Haverfield as Administrator, had voluntarily become prisoners of the Austrians and Germans, rather than abandon the Serbian sick and wounded they had hitherto cared for. The Mission undertook a most difficult task--that is, the healing of and ministration to the typhus patients, which had already cost the lives of many doctors. But the Scottish women, whose spirit was typified in their leader, Miss Inglis, did not restrict themselves to this department, hastening to assist whenever they could in other departments. In particular, Dr. Elsie Inglis gave help in the surgical ward, and undertook single-handed the charge of a great number of wounded, among whom I was included, and to her devoted sisterly care I am a grateful debtor for my life. She visited me hourly, and not only performed a doctor's duties, but those of a simple nurse, without the slightest reluctance. "The conditions of Serbian hospitals under the Austrians rendered provisioning one of the most difficult tasks. At the withdrawal of the Serbian Army only the barest necessaries were left behind, and the Austrians gave hardly anything beyond bread, and at times a little meat. The typhus patients were thus dependent almost entirely on the aliments which the Scottish Mission could furnish out of their own means. It was edifying to see how they solved the problem. Every day, their Chief, Dr. Inglis, and Mrs. Haverfield at the head, the nurses off duty, with empty sacks and baskets slung over their shoulders, tramped for miles to the villages around Krushevatz, and after several hours' march through the narrow, muddy paths, returned loaded with cabbages, potatoes, or other vegetables in baskets and sacks, their pockets filled with eggs and apples. Instead of fatigue, joy and satisfaction were evident in their faces, because they were able to do something for their Serbian brothers. I am ever in admiration of these rare women, and never can I forget their watchword: 'Not one of our patients is to be without at least one egg a day, however far we may have to tramp for it.' Such labour, such love towards an almost totally strange nation, is something more than mere humanity; it is the summit of understanding, and the application of real and solid Christian teaching. "Dr. Inglis cured not only the physical but the moral ills of her wounded patients. Every word she spoke was about the return of our army, and she assured us of final victory. She did not speak thus merely to soothe, for one felt the fire of her indignation against the oppressor, and her love for us and her confidence that our just cause would triumph. I could mention a host of great and small facts in connection with her, enough to fill a book; but, in one word, every move, every thought of the late Dr. Inglis and the members of her Mission breathed affection towards the Serbian soldier and the Serbian nation. The Serbian soldier himself is the best witness to this. One has only to inquire about the Scottish Women's Mission in order to get a short and eloquent comment, which resumes all, and expresses astonishment that he should be asked: 'Of course I know of our sisters from Scotland.' ... "But the enemy could not succeed in shaking these noble women in their determination and their love for us Serbians. They at last obtained their release, and reached their own country, but, without taking time to rest properly, they at once started to collect fresh stores, and hastened to the assistance of the Serbian Volunteer Corps in the Dobrudja. They returned with the same corps to the Macedonian front, and thence to Serbia once more at the close of last year, in order to come to the aid of the impoverished Serbian people. The fact that Dr. Inglis lost her life after the retreat from Russia is a fresh proof of her devotion to Serbia. The Serbian soldiers mourn her death as that of a mother or sister. The memory of her goodness, self-sacrifice, and unbounded charity, will never leave them as long as they live, and will be handed down as a sacred heritage to their children. The entire Serbian Army and the entire Serbian people weep over the dear departed Dr. Inglis, while erecting a memorial to her in their hearts greater than any of the world's monuments. Glory be to her and the land that gave her birth! "(_Signed_) LIEUT.-COL. DRAG. C. POPOVITCH, "_Professor at the Military Academy._ "BELGRADE. "_December 24th, 1919._" Dr. Inglis was at home from February to August, 1916. Besides her work as chairman of the committee for Kossovo Day, she was occupied in many other ways. She paid a visit of inspection for the Scottish Women's Hospitals Committee to their Unit in Corsica, reporting in person to them on her return in her usual clear and masterly way on the work being done there. She worked hard to get permission for the Scottish Women's Hospitals to send a Unit to Mesopotamia, where certainly the need was great. It has been said of her that, "like Douglas of old, she flung herself where the battle raged most fiercely, always claiming and at last obtaining permission to set up her hospitals where the obstacles were greatest and the dangers most acute." It was not the fault of the Scottish Women's Hospitals that their standard was not found flying in Mesopotamia. During the time she was at home, in the intervals of her other activities, she spoke at many meetings, telling of the work of the Scottish Women's Hospitals. At these meetings she would speak for an hour or more of the year's work in Serbia without mentioning herself. She had the delightful power of telling a story without bringing in the personal note. Often at the end of a meeting her friends would be asked by members of the audience if Dr. Inglis had not been in Serbia herself. On being assured that she had, they would reply incredulously, "But she never mentioned herself at all!" The Honorary Secretary of the Clapham High School Old Girls' Society wrote, after Dr. Inglis's death, describing one of these meetings: "In June, 1916, Dr. Inglis came to our annual commemoration meeting and spoke to us of Serbia. None of those who were present will, I think, ever forget that afternoon, and the almost magical inspiration of her personality. Behind her simple narrative (from which her own part in the great deeds of which she told seemed so small that to many of us it was a revelation to learn later what that part had been) lay a spiritual force which left no one in the audience untouched. We feel that we should like to express our gratitude for that afternoon in our lives, as well as our admiration of her gallant life and death." The door to Mesopotamia being still kept closed, Dr. Inglis, in August, 1916, went to Russia as C.M.O. of a magnificently equipped Unit which was being sent to the help of the Jugo-Slavs by the Scottish Women's Hospitals. A few days before she left Dr. Inglis went to Leven, on the Fifeshire coast of Scotland, where many of her relatives were gathered, to say farewell. The photograph given here was taken at this time. [Illustration: ELSIE INGLIS TAKEN IN AUGUST, 1916, JUST BEFORE SHE LEFT FOR RUSSIA] FOOTNOTES: [13] The name the nurses gave the huge building they had converted into a hospital. [14] Dr. Inglis's report. CHAPTER XI RUSSIA "For a clear understanding and appreciation of subsequent events affecting the relations between Dr. Inglis and the Serb division, a brief account of its genesis may be given here. "The division consisted mainly of Serbo-Croats and Slovenes--namely, Serbs who, as subjects of Austria-Hungary, were obliged to serve in the Austrian Army. Nearly all of these men had been taken prisoners by the Russians, or, perhaps more correctly, had voluntarily surrendered to the Russians rather than fight for the enemies of their co-nationals. In May, 1915, a considerable number of these Austro-Serbs volunteered for service with the Serbian Army, and by arrangement with the Russian Government, who gave them their freedom, they were transported to Serbia. After the entry of Bulgaria into the war it was no longer possible to send them to Serbia, and 2,000 were left behind at Odessa. The number of these volunteers increased, however, to such an extent that, by permission of the Serbian Government, Serbian officers from Corfu were sent over to organize them into a military unit for service with the Russian Army. By May, 1916, a first division was formed under the command of the Serb Colonel, Colonel Hadjitch, and later a second division under General Zivkovitch. It was to the first division that the Scottish Women's Hospitals and Transport were to be attached. "The Unit mustered at Liverpool on August 29, and left for Archangel on the following day. It consisted of a personnel of seventy-five and three doctors, with Dr. Elsie Inglis C.M.O."[15] A member of the staff describes the journey: "Our Unit left Liverpool for Russia on August 31, 1916; like the Israelites of old, we went out not knowing exactly where we were bound for. We knew only that we had to join the Serbian division of the Russian Army, but where that Division was or how we were to get there we could not tell. We were seventy-five all told, with 50 tons of equipment and sixteen automobiles. We had a special transport, and after nine days over the North Sea we arrived at Archangel. "From Archangel we were entrained for Russia, and sent down via Moscow to Odessa, receiving there further instructions to proceed to the Roumanian front, where our Serbs were in action. "We were fourteen days altogether in the train. I remember Dr. Inglis, during those long days on the journey, playing patience, calm and serene, or losing her own patience when the train was stopped and _would_ not go on. Out she would go, and address the Russian officials in strenuous, nervous British--it was often effective. One of our interpreters heard one stationmaster saying: 'There is a great row going on here, and there will be trouble to-morrow if this train isn't got through.' "At Reni we were embarked on a steamer and barges, and sent down the Danube to a place called Cernavoda, where once more we were disembarked, and proceeded by train and motor to Medjidia, where our first hospital was established in a large barracks on the top of a hill above the town, an excellent mark for enemy aeroplanes. The hospital was ready for wounded two days after our arrival; until then it was a dirty empty building, yet the wounded were received in it some forty-eight hours after our arrival. It was a notable achievement, but for Dr. Inglis obstacles and difficulties were placed in her path for the purpose of being overcome; if the mountains of Mahomet _would_ not move, she _removed_ them! "In connection with the establishment of these field hospitals I have vivid recollections of her. The great empty upper floor of the barracks at Medjidia, seventy-five of us all in the one room. The lines of camp beds. Dr. Inglis and her officers in one corner; and how quietly in all the noise and hubbub she went to bed and slept. I remember how I had to waken her when certain officials came on the night of our arrival to ask when we would be ready for the wounded. 'Say to-morrow,' she said, and slept again! "'It's a wonder she did not say _now_,' one of my fellow-officers remarked! "We were equipped for two field hospitals of 100 beds each, and our second hospital was established close to the firing-line at Bulbulmic. We were at Bulbulmic and Medjidia only some three weeks when we had to retreat." Three weeks of strenuous work at these two places ended in a sudden evacuation and retreat--Hospital B and the Transport got separated from Hospital A. We can only, of course, follow the fortunes of Hospital A, which was directly under Dr. Inglis. The night of the retreat is made vivid for us by Dr. Inglis: "The station was a curious sight that night. The flight was beginning. A crowd of people was collected at one end with boxes and bundles and children. One little boy was lying on a doorstep asleep, and against the wall farther on lay a row of soldiers. On the bench to the right, under the light, was a doctor in his white overall, stretched out sound asleep between the two rushes of work at the station dressing-room; and a Roumanian officer talked to me of Glasgow, where he had once been invited out to dinner, so he had seen the British 'custims.' It was good to feel those British customs were still going quietly on, whatever was happening here--breakfasts coming regularly, hot water for baths, and everything as it should be. It was probably absurd, but it came like a great wave of comfort to feel that Britain was there, quiet, strong, and invincible, behind everything and everybody." A member of the Unit also gives us details:[16] "I went twice down to the station with baggage in the evening, a perilous journey in rickety carts through pitch darkness over roads (?) crammed with troops and refugees, which were lit up periodically by the most amazing green lightning I have ever seen, and the roar and flash of the guns was incessant. At the station no lights were allowed because of enemy aircraft, but the place was illuminated here and there by the camp fires of a new Siberian division which had just arrived. Picked troops these, and magnificent men. "We wrestled with the baggage until 2 a.m., and went back to the hospital in one of our own cars. Our orderly came in almost in tears. Her cart had twice turned over completely on its way to the station; so on arrival she had hastened to Dr. Inglis with a tale of woe and a scratched face. Dr. Inglis said: 'That's right, dear child, that's right, _stick_ to the equipment,' which may very well be described as the motto of the Unit these days!... "The majority of the Unit are to go to Galatz by train with Dr. Corbett; the rest (self included) are to go by road with Dr. Inglis, and work with the army as a clearing station. "On the morning of October 22 the train party got off as quick as possible, and about 4 p.m. a big lorry came for our equipment. We loaded it, seven of us mounted on the top, and the rest went in two of our own cars. The scene was really intensely comic. Seven Scottish women balanced precariously on the pile of luggage; a Serbian doctor with whom Dr. Inglis is to travel standing alongside in an hysterical condition, imploring us to hurry, telling us the Bulgarians were as good as in the town already; Dr. Inglis, quite unmoved, demanding the whereabouts of the Ludgate boiler; somebody arriving at the last minute with a huge open barrel of treacle, which, of course, could not possibly be left to a German. Oh dear! how we laughed!" Dr. Inglis would never allow the Sunday service to be missed if it was at all possible to hold it.[17] Miss Onslow tells us how she seized a seeming opportunity even on this Sunday of so many dangers to make ready for the service. "_Medjidia._--Sunday was the day on which we began our retreat from the Dobrudja. We spent most of the morning going to and from the station--a place almost impossible to enter or leave on account of the refugees, their carts and animals, and the army, which was on the move, blocking all the approaches--transporting sick members of the Unit and some equipment which had still to be put on the train, and only my touring car and one ambulance with which to do the work. Dr. Inglis had been at the station until the early hours of the morning, but nevertheless superintended everything that was being done both at the train and up at the hospital. "Towards noon a Serbian officer brought in a report that things were not as bad for the moment as they expected. Whereupon the Doctor immediately gave orders to prepare the room for service at 4 o'clock that afternoon! And she began revolving plans for immediate work in Medjidia. But, alas! the good news was a false report--the enemy was rushing onwards. The Russian lorry came for the personal baggage and any remaining equipment which had not gone by train; and it, piled high with luggage and some of the staff, left at 3, the remainder of us going in the ambulance and my car. Dr. Inglis came in my car, and I had the honour of driving our dear Doctor nearly all the time, and am the only member of the Unit who was with her the whole time of the retreat from Medjidia until we reached the Danube at Harshova." The four days of the Dobrudja retreat from October 22nd to 26th were days of horror for all who took part in it, not least for Dr. Inglis and the members of her Units. "At first we passed a few carts, then at some distance more and more, till we found ourselves in an unending procession of peasants with all their worldly goods piled on those vehicles.... This procession seemed difficult to pass, but as time went on, added to it, came the Roumanian army retreating--hundreds of guns, cavalry, infantry, ambulances, Red Cross carts, motor-kitchens, and wounded on foot--a most extraordinary scene. The night was inky black; the only lights were our own head-lights and those of the ambulance behind us, but they revealed a sad and never-to-be-forgotten picture. Our driver was quite wonderful; she sat unmoved, often for half an hour at a time. There was a block, and we had to wait while the yelling, frantic mob did what they could to get into some sort of order; then we would move on for ten minutes, and then stop again; it was like a dream or a play; it certainly was a tragedy. No one spoke; we just waited and watched it all; to us it was a spectacle, to these poor homeless people it was a terrible reality."[18] At 11.30 that Sunday night Dr. Inglis and the party with her arrived at Caramarat. The straw beds and the fairytale dinner, and the cheery voice of Dr. Inglis calling them to partake of it, will never be forgotten by these Scottish women. On arrival at Caramarat Dr. Inglis had asked for a room for her Unit and "a good meat meal." She was told a room was waiting for them, but a good meal was an impossibility; the town had been evacuated; there had been no food to be got for days. "Though it was only a bare room with straw in heaps on the floor and green blankets to wrap ourselves in, to cold, shivering beings like ourselves it seemed all that heart could desire.... Never shall I forget the delight of lying down on the straw, the dry warm blanket rolled round me. Then a most wonderful thing happened--the door opened and several soldiers entered with the most beautiful meal I ever ate. It was like a fairytale. Where did it come from? The lovely soup--the real Russian _borsh_--and roast turkey and plenty of bread and _chi_. We ate like wolves, and I can remember so distinctly sitting up in my straw nest, with my blanket round me, and hearing Dr. Inglis's cheery voice saying, 'Isn't this better than having to start and cook a meal?' She was the most extraordinary person; when she said she must have a thing, she got it, and it was never for herself, always for others."[19] They started again early on Monday morning, and after another day of adventures slept that night in the open air beside a river. "Cushions were brought from the cars and all the rugs we could find, and soon we were sitting round the fire waiting for the water to boil for our tea, and a more delightful merry meal could not be imagined. We all told our experiences of the day, and Dr. Inglis said: 'But this is the best of all; it is just like a fairytale.' And so it was; for as we looked there were groups of soldiers holding their horses, standing motionless, staring at us; we saw them only through the wood-smoke. The fire attracted them, and they came to see what it could mean. Seeing nine women laughing and chatting, alone and within earshot of the guns, the distant sky-line red with the enemy's doings, was more than they could understand. They did not speak, but quietly went away as they had come.... Rolled in our blankets, with the warmth of the fire making us feel drowsy, our chatter gradually ceased, and we slept as only a day in the open air can make one sleep." Another two days of continued retreat, and the different parties of Scottish women arrived at places of safety. "Thus we all came through the Dobrudja retreat. We had only been one month in Roumania, but we seemed to have lived a lifetime between the 22nd and 26th of October, 1916." In a letter to the Committee Dr. Inglis says of the Unit: "They worked magnificently at Medjidia, and took the retreat in a very joyous, indomitable way. One cannot say they were plucky, because I don't think it ever entered their heads to be afraid." Finally the scattered members of the Unit joined forces again at Braila, where Dr. Inglis opened a hospital. During the time at Braila Dr. Inglis wrote to her relations. The letter is dated Reni, where she had gone for a few days. "RENI, "_October 28th, 1916._ "DEAREST AMY, "Just a line to say I am all right. Four weeks to-morrow since we reached Medjidia and began our hospital. We evacuated it in three weeks, and here we are all back on the frontier.... Such a time it has been, Amy dear; you cannot imagine what war is just behind the lines. And in a retreat.... "Our second retreat--and almost to the same day. We evacuated Kraguevatz on the 25th of October last year. We evacuated Medjidia on the 22nd this year. On the 25th this year we were working in a Russian dressing-station at Harshova, and were moved on in the evening. We arrived at Braila to find 11,000 wounded and seven doctors, only one of them a surgeon. "Boat come--must stop--am going back to Braila to do surgery. Have sent every trained person there. "Ever, you dear, dear people, "Your loving sister, "ELSIE. "We have had lots of exciting things too--and amusing things--and _good_ things." Two further retreats had, however, to be experienced by Dr. Inglis and her Unit before they could settle down to steady work. The three retreats took place in the following order: _Sunday, October 22nd._--Retreated from Medjidia. _October 25th._--Arrived at Braila. Worked there till December 3rd. _December 3rd._--Retreated to Galatz, where very strenuous work awaited them. _January 4th._--Retreated to Reni. _August, 1917._--Left Reni, and rejoined the Serb division at Hadji Abdul. The work during the above period, from October 25th, 1916, to August, 1917, was done for the Russians and Roumanians. As soon as it was possible, Dr. Inglis joined the Serb division in the end of August, 1917. "Dr. Inglis was still working in Reni when the Russian Revolution broke out in March.[20] The spirit of unrest and indiscipline, which manifested itself among the troops, spread also to the hospitals, and a Russian doctor reported that in the other hospitals the patients had their own committees, which fixed the hours for meals and doctors' visits and made hospital discipline impossible. But there was no sign of this under Dr. Inglis's kindly but firm rule. Without relaxing disciplinary measures, she did all in her power to keep the patients happy and contented; and as the Russian Easter drew near, she bought four ikons to be put up in the wards, that the men might feel more at home. The result of this kindly thought was a charming Easter letter written by the patients-- "_To the Much-honoured Elsie Maud, the Daughter of John._ "The wounded and sick soldiers from all parts of the army and fleet of great free Russia, who are now for healing in the hospital which you command, penetrated with a feeling of sincere respect, feel it their much-desired duty, to-day, on the day of the feast of Holy Easter, to express to you our deep reverence to you, the doctor warmly loved by all, and also to your honoured personnel of women. We wish also to express our sincere gratitude for all the care and attention bestowed on us, and we bow low before the tireless and wonderful work of yourself and your personnel, which we see every day directed towards the good of the soldiers allied to your country.... May England live! "(_Signed_) THE RUSSIAN CITIZEN SOLDIERS." We cannot be too grateful to one member of the Unit who, in her impressions of Dr. Inglis, has given us a picture of her during these months in Russia that will live: "I think so much stress has been laid, by those who worked under her, on the leader who said there was no such word as 'can't' in the dictionary, that the extraordinarily lovable personality that lay at the root of her leadership is in danger of being obscured. I do not mean by this that we all had a romantic affection for her. Her influence was of a much finer quality just because she never dragged in the personal element. She was the embodiment of so much, and achieved more in her subordinates, just because she had never to depend for their loyalty on the limits of an admired personality. "There is no one I should less like to hear described as 'popular.' No one had less an easy power of endearing herself at first sight to those with whom she came in contact--at least, in the relations of the Unit. The first impression, as has been repeated over and over again, was always one of great strength and singleness of purpose, but all those fine qualities with which the general public is, quite rightly, ready to credit her had their roots in a serenity and gentleness of spirit which that same public has had all too little opportunity to realize. Her Unit itself realized it slowly enough. They obeyed at first because she was stronger than they, only later because she was finer and better. "You know it was not, at least, an easy job to win the best kind of service from a mixed lot of women, the trained members of which had never worked under a woman before, and were ready with their very narrow outlook to seize on any and every opportunity for criticism. There was much opposition, more or less grumblingly expressed at first. No one hesitated to do what she was told--impossible with Dr. Inglis as a chief--but it was grudgingly done. In the end it was all for the best. If she had been the kind of person who took trouble to rouse an easy personal enthusiasm, the whole thing would have fallen to pieces at the first stress of work; on the other hand, if she had never inspired more than respect, she would never have won the quality of service she succeeded in winning. The really mean-spirited were loyal just so long as she was present because she daunted them, and Dr. Inglis's disapproval was most certainly a thing to be avoided. But the great majority, whatever their personal views, were quickly ready to recognize her authority as springing from no hasty impulse, but from a finely consistent discipline of thought. "We were really lucky in having the retreat at the beginning of the work. It helped the Unit to realize how complete was the radical confidence they felt in her. I think her extraordinary love of justice was next impressed upon them. It took the sting out of every personal grievance, and was so almost passionately sincere it hardly seemed to matter if the verdict went against you. Her selflessness was an example, and often enough a reproach, to every one of us, and to go to her in any personal difficulty was such a revelation of sympathy and understanding as shed a light on those less obvious qualities that really made all she achieved possible. "People have often come to me and said casually, 'Oh yes, Dr. Inglis was a very charming woman, wasn't she?' And I have felt sorely tempted to say rather snappishly, 'No, she wasn't.' Only they wouldn't have understood. It is because their 'charming' goes into the same category as my 'popular.' "I am afraid you will hardly have anticipated such an outburst; the difficulty is, indeed, to know where to stop. For what could I not say of the way her patients adored her--the countless little unerring things she did and said which just kept us going, when things were unusually depressing, or the Unit unusually weary and homesick; the really good moments when one won the generous appreciation that was so well worth the winning; and last--if I may strike this note--her endless personal kindness to me." The following letter to her sister, Mrs. Simson, reveals something of the lovable personality of Elsie Inglis. The nephew to whom it refers was wounded in the eye at the battle of Gaza, and died a fortnight before she did. "ODESSA, "_June 24th, 1917._ "DEAREST, DEAREST AMY, "Eve's letter came yesterday about Jim, and though I start at seven to-morrow morning for Reni, I must write to you, dear, before I go. Though what one can say I don't know. One sees these awful doings all round one, but it strikes right home when one thinks of _Jim_. Thank God he is still with us. The dear, dear boy! I suppose he is home by now. And anyhow he won't be going out again for some time. We are all learning much from this war, and I know ---- will say it is all our own faults, but I am not sure that the theory that it is part of the long struggle between good and evil does not appeal more to my mind. We are just here in it, and whatever we suffer and whatever we lose, it is for the right we are standing.... It is all terrible and awful, and I don't believe we can disentangle it all in our minds just now. The only thing is just to go on doing one's bit.... Miss Henderson is taking home with her to-day a Serb officer, quite blind, shot right through behind his eyes, to place him somewhere where he can be trained. I heard of him just after I had read Eve's letter, and I nearly cried. He wasn't just a case at that minute, with my thoughts full of Jim. Dear old Jim! Give him my love, and tell him I'm _proud of him_. And how splendidly the regiment did, and how they suffered! "Ever your loving sister, "ELSIE MAUD INGLIS." Another of her Unit, who worked with Dr. Inglis not only during the year in Russia, but through much of the strenuous campaign for the Suffrage, gives us these remembrances: "OUR LAST COMMUNION. "'He that dwelleth in the secret place of the Most High shall abide under the shadow of the Almighty.' "Dearer to me even than the memory of those outstanding qualities of great-hearted initiative, courage, and determination which helped to make Dr. Elsie Inglis one of the great personalities of her age is the remembrance of certain moments when, in the intimacy of close fellowship during my term of office with her on active service, I caught glimpses of that simple, sublime faith by which she lived and in which she died. "One of my most precious possessions is the Bible Dr. Inglis read from when conducting the service held on Sunday in the saloon of the transport which took our Unit out to Archangel. The whole scene comes back so vividly! The silent, listening lines of the girls on either hand--Hospital grey and Transport khaki; in the centre, standing before the Union Jack-covered desk, the figure of our dear Chief, and her clear, calm voice--'He that dwelleth in the secret place of the Most High.' One felt that such a 'secret place' was indeed the abode of her serene spirit, and that there she found that steadfastness of purpose which never wavered, and the strength by which she exercised, not only the gracious qualities of love, but those sterner ones of ruthlessness and implacability which are among the essentials of leadership. "Dr. Inglis was a philosopher in the calm way in which she took the vicissitudes of life. It was only when her judgment, in regard to the work she was engaged in, was crossed that you became aware of her ruthlessness--her _wonderful_ ruthlessness! I can find no better adjective. This quality of hers, perhaps more than any other, drew out my admiration and respect. Slowly it was borne in on those who worked with her that under no circumstances whatever would she fail the cause for which she was working, or those who had chosen to follow her. "Another remembrance! By the banks of the Danube at Reni, where at night the searchlight of the enemy used to play upon our camp, in the tent erected by the girls for the service, with the little altar simply and beautifully decorated by the nurses' loving hands, I see her kneeling beside me wrapt in a deep meditation, from which I ventured to rouse her, as the Chaplain came towards her with the sacred Bread and Wine. Looking back, it seems to me that even then her soul was reaching out beyond this present consciousness: "'Here in the body pent, Absent from Him I roam.' The look on her face was the look of those who hold high Communion. So 'in remembrance' we ate and drank of the same Bread and the same Cup. Even as I write these words remembrance comes again, and I know that, although her bodily presence is removed, her spirit is in communion still." FOOTNOTES: [15] _A History of the Scottish Women's Hospitals._ Hodder and Stoughton. 7s. 6d. [16] _With the Scottish Nurses in Roumania_, by Yvonne Fitzroy. [17] We recall her great-uncle William Money's strict observance of the Sabbath. [18] "The Dobrudja Retreat," _Blackwood_, March, 1918. [19] _Blackwood_, March, 1918. [20] _A History of the Scottish Women's Hospitals._ CHAPTER XII "IF YOU WANT US HOME, GET _THEM_ OUT" Through the summer months of 1917 Dr. Inglis had been working to get the Serbian division to which her Unit was attached out of Russia. They were in an unenviable position. The disorganization of the Russian Army made the authorities anxious to keep the Serbian division there "to stiffen the Russians." The Serb Command realized, on the other hand, that no effective stand at that time would be made by the Russians, and that to send the Serbs into action would be to expose them to another disaster such as had overtaken them in the Dobrudja. In the battle of the Dobrudja the Serb division had gone into the fight 14,000 strong; they were in the centre, with the Roumanians on the left and the Russians on the right. The Roumanians and Russians broke, and the Serbs, who had fought for twenty-four hours on two fronts, came out with only 4,000 men. Further slaughter such as this would have been the fate of the Serbian division if left in Russia. "The men want to fight," said General Zivkovitch to Dr. Inglis; "they are not cowards, but it goes to my heart to send them to their death like this." In July there had seemed to be a hope of the division being liberated and sent via Archangel to another front; however, later the decision of the Russian Headquarters was definitely stated. The Serbs were to be kept on the Roumanian front. "The Serb Staff were powerless in the matter, and entirely dependent on the good offices of the British Government for effecting their release." Into this difficult situation Dr. Inglis descended, and brought to bear on it all the force of which she was capable. The whole story of her achievement is told in _A History of the Scottish Women's Hospitals_, in those chapters that are written by Miss Edith Palliser. Here we can only refer to the message Dr. Inglis sent to the Foreign Office through Sir George Buchanan, British Ambassador at Petrograd, giving her own clear views on the position and affirming that "In any event the Scottish Women's Hospitals will stand by the Serbian division, and will accompany them if they go to Roumania." At the end of the month of August the Unit, leaving Reni, rejoined the Serb division at Hadji-Abdul, a little village midway between Reni and Belgrade. Dr. Inglis described it as a "lovely place ... and we have a perfectly lovely camping-ground among the trees. The division is hidden away wonderfully under the trees, and at first they were very loath to let us pitch our big tents, that could not be so thoroughly hidden; but I was quite bent on letting them see what a nice hospital you had sent out, so I managed to get it pitched, and they are so pleased with us. They bring everybody--Russian Generals, Roumanian Military Attachés and Ministers--to see it, and they are quite content because our painted canvas looks like the roofs of ordinary houses." "There was a constant rumour of a 'grand offensive' to be undertaken on the Roumanian front, which Dr. Inglis, though extremely sceptical of any offensive on a large scale, made every preparation to meet. "The London Committee had cabled to Dr. Inglis in the month of August advising the withdrawal of the Unit, but leaving the decision in her hands, to which she replied: "'I am grateful to you for leaving decision in my hands. I will come with the division.' "Following upon this cable came a letter, in which she emphasized her reasons for remaining: "'If there were a disaster we should none of us ever forgive ourselves if we had left. We _must_ stand by. If you want us home, get _them_ out.'" Orders and counter-orders for the release of the division were incessant, and on their release depended, as we have seen, the home-coming of the Unit. "The London Units Committee had feared greatly for the fate of the Unit if, as seemed probable, the Serb division was not able to leave Russia, and on November 9 approached the Hon. H. Nicholson at the War Department of the Foreign Office, who assured them that the Unit would be quite safe with the Serbs, who were well disciplined and devoted to Dr. Inglis. At that moment he thought it would be most unsafe for the Unit to leave the Serbs and to try to come home overland. "Mr. Nicholson expressed the opinion that the Committee would never persuade Dr. Inglis to leave her Serbs, and added: 'I cannot express to you our admiration here for Dr. Inglis and the work your Units have done.'"[21] At last the release of the division was effected, and on November 14 a cable was received by the Committee from Dr. Inglis from Archangel announcing her departure: "On our way home. Everything satisfactory, and all well except me." This was the first intimation the London Committee had received that Dr. Inglis was ill. She arrived at Newcastle on Friday, November 23, bringing her Unit and the Serbian division with her. A great gale was blowing in the river, and they were unable to land until Sunday. Dr. Inglis had been very ill during the whole voyage, but on the Sunday afternoon she came on deck, and stood for half an hour whilst the officers of the Serbian division took leave of her. "It was a wonderful example of her courage and fortitude. She stood unsupported--a splendid figure of quiet dignity, her face ashen and drawn like a mask, dressed in her worn uniform coat, with the faded ribbons, that had seen such good service. As the officers kissed her hand, she said to each of them a few words, accompanied with her wonderful smile." She had stood through the summer months in Russia, an indomitable little figure, refusing to leave, until she had got ships for the remnant of the Serbian division, and then, with her Serbs and her Unit around her, she landed on the shores of England, to die. FOOTNOTE: [21] _A History of The Scottish Women's Hospitals._ CHAPTER XIII "THE NEW WORK" AND MEMORIES "Never knew I a braver going Never read I of one.... "You faced the shadow with all tenderest words of love for all of us, but with not one selfish syllable on your lips."[22] Dr. Inglis was brought on shore on Sunday evening, and a room was taken for her in the Station Hotel at Newcastle. "The victory over Death has begun when the fear of death is destroyed." She had been dying by inches for months. She had fought Death in Russia; she had fought him through all the long voyage. It was a strange warfare. For he was not to be stayed. Irresistible, majestic, wonderful, he took his toll--and yet she remained untouched by him! With unclouded vision, undimmed faith, and undaunted courage, serene and triumphant, in the last, _she passed him by_. There was no fear in that room on the evening that Elsie Inglis "went forth." Dr. Ethel Williams writes of her in November, 1919: "The demonstration of serenity of spirit and courage during Dr. Inglis's last illness was so wonderful that it has dwelt with me ever since. At first one felt that she did not in the least grasp the seriousness of her condition, but very soon one realized that she was just meeting fresh events with the same fearlessness and serenity of spirit as she had met the uncertainties and difficulties of life." One of her nieces was with her the whole of that last day. After Dr. Ethel Williams's visit, when for the first time Elsie Inglis realized that the last circle of her work on earth was complete, she said to her niece, "It is grand to think of beginning a new work over there!" By the evening her sisters were with her. To the very last her mind was clear, her spirit dominant. Her confident "I know," in response to every thought and word of comfort offered to her, was the outward expression of her inward State of Faith. What made her passing so mighty and full of triumph? Surely it was the "Power of an Endless Life," that idea to which she had committed herself years ago as she had stood at the open grave where the first seemingly hopeless good-bye had been said. The Power of that Endless Life, the Life of Christ, carried her forward on its mighty current into the New Region shut out from our view, but where the Life is still the same. We have watched through these pages the widening circles of Elsie Inglis's life. Her medical profession, The Hospice, the Women's Movement, the Scottish Women's Hospitals, Serbia, her achievements in Russia--these we know of; the work which has been given to her now is beyond our knowledge; but "we look after her with love and admiration, and know that somewhere, just out of sight, she is still working in her own keen way," circle after circle of service widening out in endless joyousness. On Thursday, November 29, St. Giles's Cathedral in Edinburgh was filled with a great congregation, assembled to do honour to the memory of Elsie Inglis. She was buried with military honours. At the end of the service the Hallelujah Chorus was played, and after the Last Post the buglers of the Royal Scots rang out the Réveillé. From the door of the Cathedral to the Dean Cemetery the streets were lined with people waiting to see her pass. "Dr. Inglis was buried with marks of respect and recognition which make that passing stand alone in the history of the last rites of any of her fellow-citizens." It was not a funeral, but a triumph. "What a triumphal home-coming she had!" said one friend. And another wrote: "How glorious the service was yesterday! I don't know if you intended it, but one impression was uppermost in my mind, which became more distinct after I left, until by evening it stood out clear and strong. The note of _Victory_. I had a curious impression that her spirit was there, just before it passed on to larger spheres, and that it was glad. I felt I must tell you. I wonder if you felt it too. The note of Victory was bigger than the war. The Soul triumphant passing on. The Réveillé expressed it." [Illustration: _Photo by D. Scott_ THE HIGH STREET, EDINBURGH, LOOKING TOWARDS ST. GILES] In the two Memorial Services held to commemorate Dr. Inglis, one in St. Giles's Cathedral and the other in St. Margaret's, Westminster, a week later, the whole nation and all the interests of her life were represented. Royalty was represented, the Foreign Office, the War Office, the Admiralty, different bodies of women workers, the Suffrage cause, the Medical world, the Serbians, and--the children. Scores of "her children" were in St. Giles's, scattered through the congregation; in the crowds who lined the streets, they were seen hanging on to their mothers' skirts; and they were round the open grave in the Dean Cemetery. These were the children of the wynds and closes of the High Street, some of them bearing her name, "Elsie Maud," to whom she had never been too tired or too busy to respond when they needed her medical help or when "they waved to her across the street." "The estimate of a life of such throbbing energy, the summing up of achievement and influence in due proportion--these belong to a future day. But we are wholly justified in doing honour to the memory of a woman whose personality won the heart of an entire brave nation, and of whom one of the gallant Serbian officers who bore her body to the grave said, with simple earnestness: 'We would almost rather have lost a battle than lost her!'"[23] "Alongside the wider public loss, the full and noble public recognition, there stands in the shadow the unspoken sorrow of her Unit. The price has been paid, and paid as Dr. Inglis herself would have wished it, on the high completion of a chapter in her work, but we stand bowed before the knowledge of how profound and how selfless was that surrender. Month after month her courage and her endurance never flagged. Daily and hourly, in the very agony of suffering and death, she gave her life by inches. Sad and more difficult though the road must seem to us now, our privilege has been a proud one: to have served and worked with her, to have known the unfailing support of her strength and sympathy, and, best of all, to be permitted to preserve through life the memory and the stimulus of a supreme ideal."[24] "So passes the soul of a very gallant woman. Living, she spent herself lavishly for humanity. Dying, she joins the great unseen army of Happy Warriors, who as they pass on fling to the ranks behind a torch which, pray God, may never become a cold and lifeless thing."[25] FOOTNOTES: [22] In a letter written to his son after his death: see _Life beyond Death_, by Minot Judson Savage. [23] The Very Rev. Wallace Williamson. [24] Miss Yvonne Fitzroy in _With the Scottish Nurses in Roumania_. [25] A writer in the _Sunday Times_. BIBLIOGRAPHY [The following books will be found of value by those whose interest may have been awakened by these pages to desire to know more of the career chosen by Elsie Inglis, and to gain an entrance into the lives of other men and women who have followed the medical profession both at home and abroad.--ED.] The Problem of Creation. By J. E. Mercer, Bp. S.P.C.K. Pioneers of Progress (Men of Science). Edited by S. Chapman, M.A., D.Sc. S.P.C.K. God and the World. By Canon A. W. Robinson. S.P.C.K. The Natural and Supernatural in Science and Religion. By J. M. Wilson. S.P.C.K. The Mystery of Life. By J. E. Mercer, Bp. S.P.C.K. Where Science and Religion Meet. By Scott Palmer. S.P.C.K. The Natural Law in the Spiritual World. By Henry Drummond. Hodder and Stoughton. Introduction to Science. By Prof. J. A. Thomson. Williams and Norgate. The Warder of Life. By Prof. J. A. Thomson. Melrose and Sons. Secrets of Animal Life. By Prof. J. A. Thomson. Melrose and Sons. Darwinism and Human Life. By Prof. J. A. Thomson. Melrose and Sons. A History of the Scottish Women's Hospitals. By Eva Shaw McLaren. Hodder and Stoughton. Vikings of To-day. By W. T. Grenfell. Marshall Bros. Father Damien. By Edward Clifford. Macmillan. The Life of David Livingstone. By W. G. Blakie, D.D., LL.D. John Murray. Among the Wild Tribes of the Afghan Frontier. By Dr. Pennell. Seeley, Service. Pennell of the Afghan Frontier. By A. M. Pennell. Seeley, Service. Memoirs and Letters of Sir James Paget. By Stephen Paget. Longmans, Green. Lord Lister: His Life and Work. By G. T. Wrench. Longmans, Green. The Life of Pasteur. By René Vallery-Radot. Constable. A Woman Doctor--Mary Murdoch of Hull. By Hope Malleson. Sidgwick and Jackson. The Life of Sophia Jex-Blake. By Margaret Todd. Macmillan. Sir Victor Horsley. By Stephen Paget. Constable. At Work: Letters of Maria Elizabeth Hayes, M.D. Edited by Mrs. Hayes. S.P.G. Pioneer Work for Women (see Bibliography, page xiv.). By Dr. Elizabeth Blackwell. Dent. Dr. Jackson of Manchuria. By Rev. A. J. Costain, B.A. Hodder and Stoughton. Dr. Isabel Mitchell of Manchuria. By Rev. F. W. S. O'Neill. J. Clarke. The Way of the Good Physician. By Henry Hodgkin. L.M.S. The Claim of Suffering. By Elma Paget. S.P.G. Companions of My Solitude. By Sir A. Helps. George Routledge. Friends in Council (2 vols.). By Sir A. Helps. John Murray. Confessio Medici. Macmillan. I Wonder. By Stephen Paget. Macmillan. I Sometimes Think. By Stephen Paget. Macmillan. The Corner of Harley Street: Being Some Familiar Correspondence of Peter Harding, M.D. Constable. Living Water. By Harold Begbie. Headley Bros. Essays on Vocation. Edited by Basil Mathews. (A second series is in course of preparation.) Oxford University Press. Body and Soul. By Dr. Dearmer. Isaac Pitman. Common Sense. By Dr. Jane Walker. Privately printed. BILLING AND SONS, LTD., PRINTERS, GUILDFORD, ENGLAND 
31816	----	file was produced from images from The Internet Archive: American Libraries) FILSON CLUB PUBLICATIONS No. 20 THE HISTORY OF The Medical Department OF Transylvania University BY DOCTOR ROBERT PETER Prepared for Publication by his Daughter, MISS JOHANNA PETER Member of The Filson Club Illustrated [Illustration: Publisher's Symbol.] LOUISVILLE, KENTUCKY JOHN P. MORTON & COMPANY PRINTERS TO THE FILSON CLUB 1905 COPYRIGHTED BY THE FILSON CLUB and All Rights Reserved 1905 [Illustration: DOCTOR ROBERT PETER.] PREFACE In preparing for publication the following sketch of the famous Transylvania Medical Department and its professors, I have placed in foot-notes, as far as practicable, my own additions to the text, so as to avoid making any radical change in my father's manuscript. Portions of the history may seem fragmentary; some of the lives of the professors may be incomplete; some, no doubt, are insufficiently noticed, but this is easily understood when it is considered that my father wrote this narrative at irregular intervals of leisure in the years from 1873 to 1878, when some of the professors were still living; and that the writing was left by him in a yet uncompleted state and lacking those finishing touches which no other hand could so well give. In what I have done I have striven for accuracy. My father's reminiscences will have due weight as coming from one most intimately associated with Transylvania and her medical teachers--from the one colleague of all the brilliant company who could best transcribe them. The notice of Doctor Eberle I have copied from the _Transylvania Journal of Medicine_ of 1838, as the nearest I could get to the estimation in which he was held in the Transylvania School. The sketch of Doctor Bruce is gathered mainly from obituaries by his colleagues. That of Doctor Chipley--oftenest described, by those who knew him, as nature's nobleman--was written by his daughter, Mrs. Boykin Jones, in answer to my letter to her. I have added a few words about Doctor Marshall, and Doctor Skillman, "the beloved physician," the last survivor of the Transylvania Medical Faculty. And I have given as best I could a description of the last declining years of Transylvania, with some account of the Medical Hall and its ultimate fate. Any biography of Doctor Peter, I fear, must be unsatisfactory unless written at length. The brief summary of his life introductory to _The History of Transylvania University_, published by The Filson Club in 1896, was called "insufficient," "far too modest," etc. Such the story of a life so long, so full, and so many-sided must ever be unless a volume be devoted to it. In what I now say of my father I feel, even more than I did then, that I can not do justice. It is a mere itinerary of a life-journey. The same thing is true in varying degree of all the Transylvania professors, and I repeat here what I said of the former _History of Transylvania_--that all errors or faults must be ascribed to my own insufficiency to cope with the subject. Nevertheless, with all its shortcomings, this is a record not unworthy of preservation, and while biographers point us to the fact that in the United States Senate there sat at one and the same time no fewer than _eight_ graduates of Transylvania University, including Jefferson Davis, afterward President of the Southern Confederacy, the student of these pages will remark that Transylvania's Medical Department had already won as abundant laurels in the field of science. My grateful acknowledgments are due, first and for many kindnesses, to our invaluable President, Colonel Reuben T. Durrett, through whose unfailing interest, literary judgment, and tactful encouragement so many gems of Kentucky history have been preserved which otherwise had perished, and to the many friends of old Transylvania who have bid me Godspeed in my undertaking. I am indebted to Mrs. Thomas H. Clay for letters and documents bearing upon my subject; to Miss Mary Mason Brown for a copy of Jouett's admirable portrait of Doctor Brown which hangs in the old Brown homestead at Frankfort; to Mrs. Lawrence Dade Fitzhugh for data and the permission to use the beautiful portrait by Jouett of her ancestor, Doctor Richardson; to Mrs. Sallie Overton Bullock for the picture of Doctor Overton; to Mrs. Anderson Berry for the picture of Doctor Cooke; to Mr. William Short, of Louisville, for valuable suggestions and the fine likeness of Doctor Short; and to Doctor A. M. Peter for some of the illustrations. The several descendants of Doctor Ridgely to whom I applied have, without exception, aided me most courteously and patiently in my search for a picture of Doctor Ridgely: a search which I abandoned with the utmost reluctance and with the feeling that his portrait, could I have found it, must have adorned this history as his life had adorned the times to which it belonged, and therefore be sadly missed from its place with Doctor Brown. To Doctor John W. Whitney, who was prosector of Surgery and Anatomy in the Transylvania Medical School in 1854-55, and is now the sole surviving representative of that school, I am indebted for a number of facts and suggestions. JOHANNA PETER. INTRODUCTION The late Doctor Robert Peter, one of the most distinguished analytical chemists of his times, was a member of the Medical Faculty of Transylvania University from 1833 to the time of the dissolution of that institution, and afterward occupied chairs in the different colleges into which Transylvania was merged. He was one of the most active of the professors, and did as much as any one else to raise the university to the lofty heights it attained as a school of literature, law, and medicine. It occurred to him after the merger of the Transylvania into the Kentucky University that an institution which had led the way and done so much for literature, law, and medicine should not be permitted to vanish and leave nothing but a name and memory behind. He, therefore, went to work, after the weight of years was gathering fast upon him, to write the history of Transylvania University, and got his work almost finished in 1894, when death, which alone could have arrested him in his undertaking, relieved him of the task at the age of eighty-nine. His daughter, Miss Johanna Peter, with filial affection worthy of so excellent a father, and public spirit equal to the occasion, rightly estimating so good a work if it should be published and put into the hands of the public, undertook to prepare his manuscripts for publication. One of these manuscripts prepared by her embraced the literary department of Transylvania, and was published by The Filson Club in 1896 as its eleventh publication. When this publication was made, it was intimated, if not promised, that it would be followed in the near future by one of the medical department. Miss Peter, therefore, prepared this second manuscript of her father for publication, and The Filson Club now presents it in the pages which follow as the twentieth number in its regular annual series. The medical department of the Transylvania University no longer exists. Indeed, nothing of the Transylvania University exists except its name. Its learned professors have gone the way of all flesh. The last one of them recently went down to his grave. Its buildings have been swept away by fire or have passed to other institutions with its library and apparatus. Yet all of this renowned University has not passed away. Its fame yet lives, and will not perish while the memory of the living holds sacred the good deeds of predecessors. The distinguished professors made Transylvania University famous, and made history at the same time, and they themselves are now entitled to a place in history. It is the purpose of The Filson Club, by this publication, to assist in securing for them the place they deserve in the memory of mankind. Doctor Peter, the author, was the fittest of men to sketch these professors and to present life pictures of them. His work, however, if it had remained in manuscript, as he left it, would have been seen but by few, and could have done but little good. In this twentieth publication of The Filson Club, the manuscript will make its way to many and present them with likenesses of those who devoted their lives to instructing the young of our land in the art of administering to the sick and afflicted. The author knew all of his contemporary professors, and the likeness which he has given of some of them will be the ones by which they will be known in after years. Pen pictures are sometimes as efficient as likenesses in oil, and the characteristic of Doctor Peter's pictures is fidelity so executed that they seem to be the originals standing in life before us. In a work like this the essence of its history is biographic, and Doctor Peter has made his work to consist chiefly of biographical sketches of those who made Transylvania University what it was. He gives the leading facts in the life of each of the professors he sketches, and enumerates the other colleges in which they occupied chairs, and gives the titles of the works they published either in book form or magazine articles. He omits nothing in the sketch that is necessary in forming a just idea of the character portrayed. In the long career of Transylvania University she did not fail to make enemies, but she made more friends than enemies to remember her. A few of the living students and the many descendants of the deceased professors and graduates now scattered broadcast over the land will be glad to read what is here said of old Transylvania, and the work will thus be widely known and read. All who see it will be thankful to Doctor Peter for his manuscript, and to Miss Johanna Peter for preparing it for the press, and to The Filson Club for publishing it. There is in our nature something like the love of the relic which makes us revere the memory of Transylvania University. Early in the year 1799 a medical department was attached to this University which was the first medical college in the great Mississippi Valley and the second in the whole United States. The medical department of the University of Pennsylvania antedated it, but it antedated all others afterward established in any part of our vast domain. We can not, like our English cousins, go back along the pathway of centuries to the colleges of Oxford and Cambridge and revere them for their age; we have nothing in our new country that partakes of such age. We are a young people in a young country, and our Transylvania Medical College was old enough from our standpoint to be crowned with hoary years. We revere it as the first medical college on this side of the Alleghanies. We revere it for the efforts it made to prepare our young physicians to cope with the diseases that afflicted our people. We revere it for the good name it gave our State in the fame it acquired. We revere it for the success of Professor Brown in introducing vaccination in advance of its discoverer, for the brilliant and numerous operations in lithotomy by Professor Dudley, and for the noble efforts of others of its professors in prolonging human life and mitigating its pains. What it did in the day of its glory is set forth in the pages which follow, and he who reads them will hardly doubt that the medical department of Transylvania University is worthy of the record here made for it. R. T. DURRETT, _President of The Filson Club_. ILLUSTRATIONS PAGE Doctor Robert Peter _Frontispiece_ Doctor Samuel Brown 8 Doctor Benjamin W. Dudley 16 Doctor James Overton 28 Doctor William H. Richardson 32 Daniel Drake, M. D. 40 Charles Caldwell, M. D. 48 Doctor John Esten Cooke 64 Doctor Charles Wilkins Short 80 Doctor Lunsford P. Yandell, Senior 84 Doctor James M. Bush 116 Doctor Ethelbert L. Dudley 132 Doctor Henry Martyn Skillman 144 Transylvania University--Medical Hall 156 Absolom Driver 162 MEDICAL DEPARTMENT OF TRANSYLVANIA UNIVERSITY The history of medicine and of the earliest medical men in Kentucky clusters around the name of TRANSYLVANIA UNIVERSITY. The State of Virginia, in 1780--when "Kan-tuck-ee" or "Kentuckee," as this country was then called, was only a little-explored portion of that State--placed eight thousand acres of escheated lands within that county into the hands of thirteen trustees "for the purposes of a public school or _seminary of learning_," that they "might at a future day be a valuable fund for the maintenance and education of youth; it being the interest of this Commonwealth always to promote and encourage every design which might tend to the improvement of the mind and the diffusion of knowledge, even amongst the most remote citizens, whose situation a barbarous neighborhood and a savage intercourse might otherwise render unfriendly to science." Three years thereafter (1783), when Kentucky had become a _district_ of Virginia, the General Assembly, by a new amendatory Act, re-endowed this "public school" with twelve thousand acres more of escheated lands and gave to it all the privileges, powers, and immunities of "any college or university in the State," under the name of "_Transylvania Seminary_." In the wild and sparsely settled country this seminary began a feeble existence under the special fostering care and patronage of the Presbyterians, who were then a leading religious body, aided by individual subscriptions and by additional State endowments. The Reverend James Mitchel, a Presbyterian minister, was its first "_Grammar Master_," in 1785. In 1789 it was placed under the charge of Mr. Isaac Wilson and located in Lexington, with no more than thirteen pupils all told. The Reverend James Moore, educated for the Presbyterian ministry but subsequently an Episcopalian and first Rector of Christ Church, Lexington, was appointed "Director," or the first acting President of the Transylvania Seminary, in 1791.[1] He taught in his own house for want of a proper seminary building, with the aid of a small library and collection of philosophical apparatus. This library and apparatus had been donated by the Reverend John Todd, of Virginia, who, with other influential Presbyterians, had been mainly instrumental in procuring the charters and endowments from the General Assembly of Virginia. The offer of a lot of ground in the town of Lexington[2] to the trustees of _Transylvania Seminary_, by a company of gentlemen calling themselves the "_Transylvania Land Company_," induced the trustees to permanently locate the seminary in that place in 1793. On that lot the first school and college buildings were placed, and on it was afterward erected the more commodious _University_ edifice in which taught the learned and celebrated President, Doctor Horace Holley. This first _University_ building was destroyed by fire May 9, 1829. In later years (1879) this old "College lot" was beautified and improved by tree-planting and otherwise by liberal citizens of Lexington, moved by the efforts of Mr. H. H. Gratz, and designated first "Centennial Park,"[3] and afterward "Gratz Park," in honor of Benjamin Gratz, being not now utilized for special educational purposes. With limited success the first "_Director_ of Transylvania Seminary" taught in Lexington until 1794, when he was superseded by the election by the Board of Trustees of Mr. Harry Toulmin as first President of the Seminary. This gentleman, a learned Unitarian minister of the school of Doctor Priestly, and a native of England, resigned the Presidency in 1796, and was Secretary of State of Kentucky under Governor Garrard. (See _Collins' History of Kentucky_, volume 2, page 184.) Intense feeling at the election of Mr. Toulmin on the part of the leading Presbyterians, who claimed the Seminary as their own peculiar institution, caused them to obtain in 1796 a charter from the Legislature of Kentucky--now a State--for a new institution of learning which they could more exclusively control. This was the "Kentucky Academy," of which the Reverend James Blythe, of their communion, was made President.[4] On the establishment of the _Kentucky Academy_ by the dissatisfied Presbyterians in 1796, an active rivalry between that school and Transylvania Seminary operated to the injury of both institutions as well as to the cause of education in general. Therefore, after two years of separate existence these two institutions, with the consent of the trustees of both, were united in 1798 by Act of the General Assembly of Kentucky into one, "for the promotion of public good and learning," under the title of _Transylvania University_. The consolidation was made under the original laws which governed the Transylvania Seminary as enacted by the General Assembly of Virginia. TRANSYLVANIA UNIVERSITY. Under the act of consolidation of December 22, 1798, this University was organized by the appointment of Reverend James Moore, of the Episcopal Church, as first acting President, with a corps of professors. And now, _for the first time_ in the Mississippi Valley, was the effort made to establish a _medical college_. Early in 1799, at the first meeting of the trustees of the new Transylvania University,[5] they instituted "The _Medical Department_" or _College_ of Transylvania--which subsequently became so prosperous and so celebrated--by the appointment of Doctor Samuel Brown as Professor of Chemistry, Anatomy, and Surgery, and Doctor Frederick Ridgely as Professor of Materia Medica, Midwifery, and Practice of Physic. Doctor Brown qualified as Professor October 26, 1799, and Doctor Ridgely the following November. Doctor Brown was authorized by the Board to import books and other means of instruction for the use of the medical professors to the amount of five hundred dollars[6]--a considerable sum in those days--and he and his colleague were made salaried officers of the University. A Law College was also organized at this time in the University by the appointment of Colonel George Nicholas, soldier of the Revolution and member of the Virginia Convention, as Professor of Law and Politics. DOCTOR SAMUEL BROWN, The first Medical Professor of Transylvania University and of the great Western country, was born in Augusta, or Rockbridge County, Virginia, January 30, 1769, and died near Huntsville, Alabama, at the residence of Colonel Thomas G. Percy, January 12, 1830. He was the son of Reverend John Brown, a Presbyterian minister of great learning and piety, and Margaret Preston--a woman of remarkable energy of character and vigor of mind--second daughter of John Preston and Elizabeth Patton.[7] He was the third of four distinguished brothers--Honorable John Brown, Honorable James Brown, Doctor Samuel Brown, and Doctor Preston Brown. After graduating at Carlisle College, Pennsylvania, where he had been sent by his elder brother, he studied medicine for two years in Edinburgh, Scotland. Doctor Hosack, of New York, and Doctor E. McDowell, of Danville, Kentucky, were of the same class. Returning to the United States, he commenced practice in Bladensburg, but soon removed to Lexington, Kentucky, where he was made Professor of Chemistry, Anatomy, and Surgery in Transylvania University in 1799, as above stated. In 1806, he removed to Fort Adams, Mississippi, where he married Miss Percy, of Alabama.[8] Afterward returning to Lexington he was re-appointed in 1819 to a chair in the Medical Department of Transylvania, that of Theory and Practice. Here he was a distinguished colleague of Professors B. W. Dudley, Charles Caldwell, Daniel Drake, William Richardson, and James Blythe until 1825, when he finally left Kentucky. Doctor Brown was a man of fine personal appearance and manners; an accomplished scholar, gifted with a natural eloquence and humor that made him one of the most fascinating lecturers of his day. Learned in many branches, he was an enthusiast in his own profession, scrupulous in regard to etiquette and exceedingly benevolent and liberal of his time and services to the poor. Although active in scientific pursuits he left no extensive work, and but a few detached writings to perpetuate his fame. [Illustration: DOCTOR SAMUEL BROWN. From Jouett's Portrait at Frankfort.] His name appears among those of the contributors to the _American Philosophical Transactions_, and to the medical and scientific periodicals of the day, both in this country and in Europe. In those _Transactions_ and in _Bruce's Journal of Mineralogy_, etc., he described a remarkably large nitre cavern on Crooked Creek in Madison County (now Rockcastle County), Kentucky. In this and in a subsequent communication in Volume I of _Silliman's Journal_ he described the process of nitre manufacture in caves, and gave the best theory of its formation, according to the science of the day. In various other journals he described several interesting cases which occurred in his own practice, and in the renowned _Medical Logic_, by the distinguished Gilbert Blane, of London, Doctor Samuel Brown, of Lexington, is quoted as authority for a certain scientific fact. "To him we are indebted for the first introduction in the West of the prophylactic use of the cow-pox. As early as 1802 he had vaccinated upwards of five hundred persons, when in New York and Philadelphia physicians were only just making their first experimental attempts. The virus he used was taken from its original source, the teats of the cow, and used in Lexington even before Jenner could gain the confidence of the people of his own country."[9] A curious anecdote, illustrating _progress_, was told of Doctor Samuel Brown by his nephew, the late Orlando Brown, Esquire, of Frankfort, in a letter to the present writer: "I remember once when talking of calomel, he said he never would forget the first dose of it he gave a patient. It was looked upon as 'the Hercules,' and he used it accordingly. The case was desperate and he resolved to venture upon calomel and give a _strong dose_. He accordingly weighed out with scrupulous accuracy _four grains_--gave it to his patient, _and sat up all night to watch its effects_. The man got well and the Doctor afterwards used calomel more freely." What would he have thought of the heaping tablespoonful doses--quickly repeated _pro re nata_--or the _pound of calomel_ taken in a day--and survived--which characterized the cholera treatment of one of the later Professors of Transylvania Medical School? DOCTOR FREDERICK RIDGELY, Of a well-known family in Maryland,[10] and one of the most celebrated of the early physicians of the West, studied medicine in Delaware, and attended medical lectures in Philadelphia. He was appointed Surgeon to a rifle corps in Virginia when only nineteen years of age, and served in different positions as Surgeon throughout the Revolutionary War. He came to Kentucky in 1790, was Surgeon-General in General Wayne's army in 1794, and after that decisive campaign was ended returned to Kentucky in 1799 and was made Professor of Materia Medica, Midwifery, and the Practice of Physic in the same year in the Medical Department of Transylvania University at the first organization of this department. Widely known as a successful practitioner and a gentleman of great benevolence, disinterestedness, and affability, he was also one of the medical preceptors of Kentucky's distinguished surgeon, Benjamin W. Dudley, and for many years gave active support to Transylvania University as a member of the Board of Trustees. In 1799-1800, he delivered to the small class of medical students then in attendance a course of public instruction which did him much credit--a fact of peculiar interest, "as it proves him to have been," with his able colleague, Doctor Samuel Brown, "_the first who taught medicine by lecture in Western America_." He died at the age of sixty-eight at Dayton, Ohio, December 21, 1824. These first medical professors in Transylvania University were no doubt the first in the promotion of medical education in the West. Medical and Law societies were soon established and were in active operation--as we learn from the columns of the _Kentucky Gazette_, published at the time. How many pupils they attracted and taught we can not now definitely ascertain. In 1801, the meager existing records of the University show a reorganization, in which the Reverend James Moore--who had been replaced in 1799 by a Presbyterian clergyman, the Reverend James Welsh--was restored to the Presidency. "Doctor Frederick Ridgely was made Professor of Medicine, and Doctor Walter Warfield was made Professor of Midwifery, in addition to Doctor Samuel Brown." Doctor Warfield, a physician of Lexington, did not long occupy this chair, and appears not to have lectured in it. In 1804, the Reverend James Blythe, D. D., of the Presbyterian church, who had been President of _Kentucky Academy_, was made acting President of _Transylvania University_, which position he held until 1816. He was subsequently, in 1817, under Doctor Holley's administration, appointed Professor of Chemistry, etc., in the Medical Department. This position he retained until, in 1831, he accepted the Presidency of Hanover College, Indiana. Doctor Blythe died in 1842, aged seventy-seven, having devoted his life mainly to religion; having been one of the pioneers of the Presbyterian church in Kentucky. He made no distinguished reputation as a chemical professor in the Medical School, for chemistry in those days had few advocates, but he did good service in the University as a teacher of what was called "Natural Philosophy" in early times. _The Medical College of Transylvania University_ seems not to have attracted many students in this early period of its history, nor were its means of instruction or its organization complete. In 1805, Doctor James Fishback, D. D., was made Professor of the Theory and Practice of Physic in this department.[11] He was characterized as an eloquent, learned, though erratic divine; an able writer; a physician in good practice; an influential lawyer, and an upright man. He was the son of Jacob Fishback,[12] who came to Kentucky from Virginia in 1783. He resigned this chair in 1806, having given lectures to such small medical classes as were present. In 1808, he was elected Representative to the General Assembly of Kentucky. In 1813, he published _The Philosophy of the Mind in Respect to Religion_, and, in 1834, _Essays and Dialogues on the Powers and Susceptibilities of the Human Mind to Religion_. He was also preceptor in medicine, and for a time partner in the practice, of the celebrated surgeon, Benjamin W. Dudley. He died at an advanced age in 1854. An effort was again made to organize a full Faculty and establish a medical school in Transylvania University in the year 1809, when Doctor Benjamin W. Dudley was appointed to the chair of Anatomy and Physiology, Doctor Elisha Warfield to Surgery and Obstetrics, Joseph Buchanan, A. M., to the Institutes of Medicine, and Doctor James Overton to Materia Medica and Botany.[13] But Doctor Warfield resigned in the same year, and Doctor Buchanan in 1810. The late Lewis Rogers, M. D., of Louisville, thus mentioned Doctor Buchanan in his inaugural address as President of the Kentucky State Medical Society in 1873: "He died in Louisville in 1829: and I call up from the memories of my boyhood with great distinctness his slender form, massive head, and thoughtful, intellectual face. He was a man of great and varied powers of mind. He was a mechanical, medical, and political philosopher. His 'spiral' steam-boiler--the prototype of the exploding and exploded tubular boiler--and his steam land-carriage were among the wonders of the day. As a physician his papers attracted distinguished notice from the medical _savants_ of Philadelphia, then the center of medical science." As a political writer he ably discussed the most weighty problems of the times, he being editor of the _Louisville Focus_. Want of concentration of his wonderful mind prevented him from becoming eminent in medicine as in other pursuits which divided his mental powers.[14] No systematic medical instruction seems to have resulted from this imperfect organization of the Medical School in 1809, although occasional lectures may have been delivered and private instruction given. Doctor Dudley, after having graduated in medicine in the University of Pennsylvania, visited Europe in 1810, spending four years in Paris and London in the arduous pursuit of medical and surgical information and experience under the celebrated teachers of that day. Returning then to Lexington he began a career as a practical surgeon and teacher, in which his name became distinguished throughout the civilized world. DOCTOR BENJAMIN WINSLOW DUDLEY Was born in Spottsylvania County, Virginia, April 12, 1785. His father, a leading Baptist minister in Kentucky, Ambrose Dudley, had commanded a company in the Revolutionary War, and removed to the neighborhood of Lexington, Kentucky, when his son Benjamin was little more than a year old, and to that city in 1797. Here, reared with such tuition as the schools of the day and the country afforded, Benjamin was placed while yet very young under the medical tutelage of Doctor Frederick Ridgely, then an eminent physician in large practice in Lexington, under whose instruction his ardent taste for medical knowledge was largely gratified. In the autumn of 1804 he went to the Medical Department of the University of Pennsylvania, and was there fellow-student with Daniel Drake, John Esten Cooke, and William H. Richardson, his subsequent colleagues in the Medical Department of Transylvania University. Returning to Lexington at the close of the medical lectures at Philadelphia, he engaged in the practice of physic and surgery with Doctor Fishback during the spring and summer months of 1805. He returned to the Medical Department of the University of Pennsylvania in the fall, receiving the degree of Doctor of Medicine from that institution March, 1806, just two weeks before he was twenty-one years of age. Desirous of perfecting his medical education in Europe, after a few years' further practice in Lexington he descended the Ohio River on a flatboat to New Orleans in 1810, just one year before the first experimental steamboat was launched upon those waters. At New Orleans he purchased a cargo of flour and sailed on a prosperous voyage to Gibraltar, and after advantageously disposing of his cargo at that place and at Lisbon, he made his way through Spain to Paris. After four years spent in Europe zealously and industriously employing all the great facilities of the hospitals, dissecting-rooms, and eminent instructors of Paris and London, and after traveling six months in Italy and Switzerland, he finally returned to Lexington in the summer of 1814, conscious of innate powers and ardently devoted to his profession. [Illustration: DOCTOR BENJAMIN W. DUDLEY. From a Portrait by Jouett owned by Mrs. Robert Peter.] Professor Dudley continued to lecture until 1850, when he resigned and was appointed Professor Emeritus. Doctor James M. Bush succeeded him in the chair of Anatomy, and Dudley's nephew, Ethelbert L. Dudley, took that of Surgery, which he filled with great success. A schedule of the succession of the Professors of this Medical School will best illustrate the changes which occurred since 1819. (See Schedule A.) Professor B. W. Dudley remained in the regular performance of the duties of his double chair--Anatomy and Surgery[15]--with the able assistance of Doctor J. M. Bush, until 1844, when Doctor Bush was regularly appointed Professor of Anatomy. Doctor Dudley, as above mentioned, retained the chair of Surgery until 1850. In that year the Medical Faculty intermitted the winter session in Lexington, with the consent of the Trustees, in order to establish the "_Kentucky School of Medicine_" in Louisville as a winter school, retaining the Transylvania Medical College as a summer school. Doctor Dudley's last course of lectures was delivered in the session of 1849-50. Simultaneously with the resignation of his professorship, he withdrew from his extensive practice and retired to his beautiful suburban residence, "Fairlawn," in the vicinity of Lexington.[16] His death occurred in Lexington on the twentieth of January, 1870, in the eighty-fifth year of his age. Doctor Dudley was an earnest and laborious practical man. His whole time and energies were devoted to his profession, in which, like the celebrated John Hunter--the one of his early preceptors Dudley most admired--he sought instruction in the book of nature--in his practice--rather than in the written archives of science. As a teacher and lecturer he was admirably clear and impressive. While no attempt at eloquence was ever made by him, and no early training or later readings in the classics gave ornament to his style, his terse and impressive sentences, as they were delivered apparently without the slightest effort or premeditation as also without hesitation or interruption, were the embodiment of the ideas to be conveyed, in the most lucid and concise language. It seemed impossible to use fewer or more appropriate words to convey to the least appreciative student the subject to be taught. This, with his great practical skill as a surgeon, his minute and ready knowledge, his great experience, his unequaled success in his numerous operations, his suavity and dignity of manner, the magnanimity and liberality of his character, and his eminent devotedness to his profession, made his students most earnest admirers and followers and aided greatly in the establishment and maintenance of our Medical College. Although possessed of the firmest nerves, so that his hand never faltered in the severest operation,[17] his sensibility was so keen that he sometimes suffered from nervous prostration after the strain was over. Many of his pupils no doubt recollect with what feeling--manifested even by tears--he recited the sufferings and dangers of a patient of his who was the subject of obstinate secondary hemorrhage. It was as a practical surgeon that Doctor Dudley justly attained a world-wide reputation, and especially as a successful operator in lithotomy. This operation he performed two hundred and twenty-five times, without losing a single patient until after his one hundredth operation, losing in the whole of his operations only about two per cent. So celebrated had he become for this operation as early as 1827 that the _Kentucky Gazette_ for April 11, of that year, records that he operated three times for stone in one day. He always performed the lateral operation with the gorget, and never until by previous preparation--by diet and medicine--he had brought the system of his patient to a proper state.[18] Then, with good nursing under his immediate direction in wholesome private lodging, the incision healed up by the first intention. Although the stone may have been so large that much effort was required to withdraw it through the incision--sometimes even attended with laceration--the patient was on his feet again in a surprisingly short period of time. The Doctor justly attached great importance to the preliminary constitutional preparation of his surgical patients. A notice of two of his earliest operations of this kind is given in the _Kentucky Gazette_ for Saturday, November 19, 1817. The one--the first he performed in Lexington--on Mr. S. Owen, of that place, and the other, "some time ago," on a little boy in Paris, Kentucky, which, according to Doctor C. C. Graham--who was his pupil at that time--was the first operation for stone performed by Doctor Dudley. He never used lithotrity or seemed to approve of that operation. Another surgical specialty was his great use of judicious and regulated pressure by means of the roller bandage in the cure of abscesses, in the control of inflammation, in the treatment of fractures, aneurisms, etc. No surgeon probably ever used it so extensively or so successfully. Few, even of his pupils, seemed to be able to apply it with the skill and judgment which characterized their preceptor. He was also an earnest advocate of the patient use of hot water--as hot as could be borne--in the control of inflammation. Where other surgeons resorted to poultices he applied hot water. He was not ready with his pen; because, probably, of early neglect in the practice of composition. What he wrote was mostly at the urgent solicitation of his colleagues, and for the columns of _The Transylvania Journal of Medicine_, a quarterly which first appeared in Lexington February, 1828.[19] It was then edited by his colleagues, Professors Cooke and Short; subsequently by Professor Yandell, then by Professor Peter, more lately by Professor T. D. Mitchell, and lastly by Professor Ethelbert L. Dudley. In the first volume of this Journal appeared Doctor Dudley's first paper, a most remarkable article, showing by cases in his practice that epilepsy may be caused by pressure on the brain, the consequence of fracture of the skull, and, as demonstrated by five successive operations, might be cured by trephining, a fact and experience in surgery then entirely new, for which Doctor Dudley is entitled to the honor of discovery and demonstration. In the same paper is communicated a novel and successful method of treatment of _fungus cerebri_, by means of dried sponge compresses. Doctor Dudley stated that by this means he had cured _fungus cerebri_ within the space of five days. In a second paper, in the next number of this volume, he gives an original and successful operation for hydrocele. In the fourth number he began an extensive article on his peculiar uses of the roller bandage in gunshot wounds, fractures, etc., which he continued through several volumes of the Journal. In the second volume he had given an interesting article on the use of the roller bandage in the treatment of ulcers, contusions, lacerations, effusions, etc. In the fifth volume he continued his remarks on epilepsy as treated by the trephine. In volume sixth he published a record of his experience in the treatment of Asiatic cholera in Lexington. In the ninth he continued his observations on the bandage and its very successful application in the treatment of fractures. A most interesting and valuable article on _Calculous Diseases_ from his pen appeared in the same volume, illustrating not only his great practical skill but his courage and quick and clear judgment in cases of emergency. Volumes ten and twelve contained reports of his operations in lithotomy; volume eleven, a paper on _Fractures and Calculous Diseases_. In the elegant and generally correct Memoir of Doctor Benjamin W. Dudley, published by the late Lunsford P. Yandell, M. D., in the _American Practitioner_, 1870, these are stated to be the only writings of our late distinguished surgeon; but Doctor Dudley subsequently published three elaborate and highly valuable surgical papers, to wit: 1. _On the Treatment of Aneurism_, published in the _Transylvania Journal of Medicine_, edited by Professor Ethelbert L. Dudley, July, 1849. 2. _On the Treatment of Gunshot Wounds._ Ibid., December, 1849. 3. _On the Treatment of Fractures by the Roller Bandage._ Ibid., 1850. This journal was a bi-weekly publication, the successor of the old _Transylvania Medical Journal_ above mentioned. These were the latest productions of Doctor B. W. Dudley. Engaged as he continually was in a daily round of engrossing surgical and medical practice, lecturing twice a day in the Medical School during its sessions, there was left to him but little time for the record or promulgation of his ample experience by his pen. As a medical practitioner also he was original. He was among the first to discard the lancet in his treatment of disease. He used instead small doses of tartar emetic, or more recently, of ipecacuanha frequently repeated, with low diet; or cholagogue purgatives combined with ipecacuanha, etc. He confined himself to but few medicines, but in the application of these, and of diet and regimen, his clear and correct judgment was usually apparent. Polypharmacy he despised. New remedies were looked upon by him with incredulity and suspicion. Quinine, iodine, and other novelties in his time never were accorded approbation by him. As a man and a citizen he was eminently liberal, charitable, magnanimous, public-spirited, and energetic. He bound his friends to him with the strongest ties and treated his hostile enemies--who were few--with a cordial hatred. His sense of honor and personal dignity was very delicate and high. No one so deeply despised a mean action. No one so readily forgave an injury which was confessed. An exemplification of his character was given in 1817-18. A difficulty having originated between himself and Doctor Drake, in relation to the resignation of the latter and some matters connected with a post-mortem examination of an Irishman who had been killed in a quarrel, sharp pamphlets passed between them and a challenge to mortal combat from Dudley to Drake, which the latter declined, but which was vicariously accepted by his next friend, Doctor William H. Richardson. A duel resulted in which, at the first fire, Richardson was seriously wounded in the groin by the ball of Dudley, severing the inguinal artery. Richardson would have speedily bled to death--as it could not be controlled by the tourniquet--but for the ready skill and magnanimity of Dudley. He immediately asked permission of his adversary to arrest the hemorrhage, and by the pressure with his thumb over the ilium gave time for the application of the ligature by the surgeon of Richardson--thus converting his deadly antagonist into a lifelong friend. Notwithstanding Doctor Dudley had contributed tens of thousands to public improvement and to private charities, and never regularly kept accounts against his patients, he acquired a considerable fortune. His latter days were passed in the society of his children and grandchildren in the household of his son, the late William A. Dudley, surrounded by all the comforts which a large competency and a devoted family could provide. Thus, in the quiet of domestic retirement, passed away the last days of a most active and eminently useful and distinguished life.[20] * * * * * The annals of the earlier efforts to establish medical education and a medical college in connection with Transylvania University--the first in the whole West and the second in the United States--are meager and unsatisfactory. As already stated, the first Medical Professors in this University--Doctors Samuel Brown and Frederick Ridgely (1799)--no doubt taught and lectured occasionally to such students as were present. The files of the old _Kentucky Gazette_ show that Doctor James Fishback, who was unanimously appointed to the chair of Theory and Practice of Medicine in Transylvania in 1805, advertised to lecture, and did probably lecture on these subjects. But he resigned in 1806. Doctor James Overton, who had been appointed to the chair of Materia Medica and Botany in 1809, said in his letter of acceptance (on the occasion of his reappointment in the reorganization of the Medical Faculty in 1817) that he "had engaged for some time in giving lectures on Theory and Practice in this town," etc. According to the best recollection of the late Doctor Coleman Rogers--for a long time before his death a resident in Louisville--the Medical College of Transylvania University was reorganized in 1815 by the appointment of the following Faculty: Doctor Benjamin W. Dudley, Professor of Anatomy and Surgery. Doctor Coleman Rogers, adjunct to this chair. Doctor James Overton, Theory and Practice. Doctor William H. Richardson, Obstetrics, etc. Doctor Thomas Cooper (Judge Cooper), of Pennsylvania, to the chair of Chemistry, Mineralogy, etc. Doctor James Blythe, then acting President of the University, was to give chemical instruction. Doctor Cooper and Doctor Rogers did not accept this appointment. According to Doctor Rogers' recollection a regular course of lectures was not delivered by this Faculty, although Doctors Dudley and Overton probably both lectured or taught "as they previously had done."[21] Doctor Dudley's own recollection, as detailed to the present writer, was also that he and Doctor Overton, as well as Doctor Blythe, lectured in 1815-16 to about twenty students, of whom the late Doctor Ayres and the yet surviving Nestor of Transylvania graduates, Doctor Christopher C. Graham, of Louisville--now almost a centenarian[22]--were in attendance as pupils. Very little can now be ascertained, from existing records, of the character of Professor James Overton, M. D. Doctor Christopher C. Graham, in a recent letter to the writer, gives some of his reminiscences of him in the following language: "Doctor Overton was a small, black-eyed man, very hypochondrical and sarcastic (notoriously so), and yet quite chatty, humorous, and agreeable; telling his class many funny things.... He was well educated for his day and plumed himself especially on his Greek." Doctor Overton removed from Lexington to Nashville, Tennessee, in 1818.[23] [Illustration: DOCTOR JAMES OVERTON. From a Portrait made in Philadelphia before 1815.] The late Doctor Ayres, of Danville, and latterly of Lexington, informed the writer that, in 1815, Doctor Dudley, having recently returned from Europe, was invited by himself and other medical students to demonstrate to them in anatomy and surgery. Learning _that he would lecture to them if a class were formed_, they made up one of from twenty to twenty-five, and Doctor Dudley lectured to them on anatomy and surgery in "Trotter's Warehouse,"[24] a house situated on the south-east corner of Main and Mill streets, opposite the site[25] of the old original Lexington block-house. In the next winter, he recounts, he lectured to about fifty or sixty students, some of whom were from Ohio. Doctors Overton and Blythe, one or both, also lectured in both winters. This may be said to be the real beginning of the successful career of the Medical Department of Transylvania University, and of that of Doctor Dudley as a medical professor. The _Kentucky Gazette_ of March 10, 1817, contains a card published by a committee of the medical students of Transylvania, signed David J. Ayres, Thomas J. Garden, and Charles H. Warfield (committee of the medical class), headed a "Tribute of Gratitude," in which they return grateful thanks to their professors, Doctors B. W. Dudley, James Overton, and the Reverend Doctor Blythe, for the ability, fidelity, and perseverance with which they had taught. A further proof that a medical session was held in the Transylvania School in 1816-17. Many circumstances in these early times favored the establishment of a medical college in Lexington. Not only had that city been recognized for many years as a great center of public education for the whole State--made so by the location in it of the State's University, "Transylvania"--but it was also at that time the great metropolis of the West. The country around it, though fast becoming settled and improved by enterprising pioneers, had not as yet been provided with roads, or good means of communication with older settlements. To ascend the Ohio River and cross the Alleghany Mountains to Philadelphia, where the only other medical school then existed, was a tedious and laborious undertaking, not devoid of danger. The celebrated French botanist, F. A. Michaux, who visited this country in 1802, was obliged to walk most of the way over the mountains to Pittsburg. Descending the Ohio River in a canoe and landing at Limestone (now Maysville), he consumed two days and a half on horseback on his journey from that place to Lexington, having been obliged to leave his baggage behind. The late Professor Charles Caldwell records, in his remarkable _Autobiography_, that as late as 1820, when he set out from Lexington for Europe to purchase books and apparatus for the Medical Department of Transylvania, he was compelled to travel from Lexington to Maysville on horseback, with his baggage on a pack-horse conducted by a servant on a third horse. "The animals were all powerful and active," but "so deep and adhesive was the mud that they did not reach Maysville--only sixty miles distant--until an early hour on the fourth day," although diligence on his part was not wanting. Students of this region had to overcome very great difficulties when they set out in search of instruction in the medical schools of Philadelphia. On March 2, 1816, one thousand dollars were appropriated by the Trustees of Transylvania and placed in the hands of Doctor Blythe and John D. Clifford for the immediate purchase of chemical apparatus. Doctor Blythe, who had been acting President of the University up to this time, resigned and accepted the position of Professor of Chemistry in the Medical Department. In 1817 the Medical Faculty was further reorganized by the appointment of the late celebrated, talented Doctor Daniel Drake to the chair of Materia Medica and Medical Botany. The organization was then as follows: Doctor Benjamin W. Dudley, Professor of Anatomy and Surgery. Doctor James Overton, Professor of Theory and Practice. Doctor Daniel Drake, Professor of Materia Medica and Medical Botany. Doctor William H. Richardson, Professor of Obstetrics, etc. Doctor James Blythe, Professor of Chemistry, etc. Doctor Drake has stated that twenty pupils attended this course of lectures, and the degree of M. D. was--for the first time in Lexington--conferred on John Lawson McCullough of this city. [Illustration: DOCTOR WILLIAM H. RICHARDSON. From a Portrait by Jouett.] Each professor lectured three times a week, and his ticket was fifteen dollars. During this session ill feelings arose between Doctors Dudley and Drake, leading to the duel between Doctors Dudley and Richardson already described.[26] Doctor Drake resigned his professorship and returned to Cincinnati at the end of this session, returning subsequently in 1823 to occupy the same chair, to resign it again in 1827. Professor Richardson did not lecture this session. He, not having yet received the degree of M. D., was allowed to be absent.[27] PROFESSOR WILLIAM HALL RICHARDSON Taught in the Medical Department of Transylvania until the time of his death in 1844, and was highly respected by his pupils as a practical teacher in his especial chair, notwithstanding he had not the advantage of early educational training. He was a man of great energy and of many admirable traits of character. His pupil, the late Lewis Rogers, M. D., in his address as President of the Kentucky State Medical Society in 1873, thus spoke of his old preceptor and friend: "Few men ever had nobler traits of character. He was warm-hearted, brave, and a sincere friend. I knew him from my earliest boyhood, and have passed away many happy and instructive hours at his magnificent home in Fayette County.[28] His hospitality was profuse and elegant. I listened to his public teachings as a professor with interest and care, because I knew he taught the truth as far as he possessed it. He was not scholarly or graceful and fluent as a lecturer, but he was ardent and impressive, sufficiently learned in his special branch, and had at his command a large stock of ripe experience. I honor his memory beyond most men I have known." In 1819, a new and brilliant era for the University, and for the Medical Department of Transylvania, was inaugurated by the appointment of Reverend Horace Holley, LL. D., to the Presidency of the University. Doctor Samuel Brown was recalled to the chair of the Theory and Practice of Medicine, which he retained until 1825. Doctor Charles Caldwell was induced to remove from Philadelphia, where he had an official connection with the University of Pennsylvania, and to accept the chair of the Institutes of Medicine and Materia Medica here, thus completing the organization with the existing professors, Benjamin W. Dudley and William H. Richardson, and the election of Reverend James Blythe to the chair of Chemistry. The celebrated naturalist, C. S. Rafinesque, was advertised to lecture on Botany and Natural History in this and the following year.[29] CONSTANTINE SAMUEL RAFINESQUE,[30] A naturalist, antiquarian, etc., who stated in 1836 "that in knowledge he had been a botanist, naturalist, conchologist, zoologist, geographer, esentographer, physiologist, historian, antiquary, poet, philosopher, economist, and philanthropist; and by profession a traveler, merchant, manufacturer, collector, improver, professor, teacher, surveyor, draftsman, architect, engineer, author, editor, bookseller, librarian, secretary, chancellor, etc."--and believed he could have been any thing, as he "always succeeded in whatever he undertook." This statement gives a key to his life, which was one of great and untiring activity, as well as to his mental character, which enabled him to acquire the reputation of being one of the most learned men of his day. Born in Galata, Constantinople, the son of a merchant, in 1784, after living in France and Italy he came to America in 1802, returning to France in 1805, with a very large botanical collection. Spending ten years in Sicily in making natural history collections and writing various essays, he published in 1815 his _Analysis of Nature_. The same year he sailed for America, but was wrecked on Long Island, losing most of his collections and effects. Induced to come West from Philadelphia by John D. Clifford, of Lexington, in 1818, he was elected Professor of Botany and Natural History in Transylvania University in 1819, lectured to the students in the Medical College, was librarian, and taught French, Spanish, and Italian.[31] He also traveled and made collections in botany, natural history, etc., publishing various papers and pamphlets and preparing materials for his proposed great work, _Tellus, or the History of the Earth and Mankind, Chiefly in America_, of which in ten years he had, he said, prepared five thousand pages of manuscript and five hundred maps and figures. An idea of what this work might have been may be gathered from a remarkable essay--_Ancient History or Annals of Kentucky_--which was published in 1824 as an introduction to _Marshall's History of Kentucky_, in which, in twenty-eight small octavo pages, he professes to give not only the migrations, changes, filiations, annals, and descriptions of all the various tribes and peoples which inhabited Kentucky since the creation of man, but gives also a history of all the changes of geology and natural history, according to his views and in accordance with Mosaic cosmogony, substituting epochs for days, however. An essay which may be characterized as a very terse and dry recital of numerous doubtful statements, woven in a web of very audacious speculation. His success as a teacher in Transylvania was not great. He died in Philadelphia September 18, 1840, having published in 1836 his life, travels, and researches in North America and Europe from 1802 to 1835, and several small works on natural history, botany, etc. A project inaugurated by Rafinesque while professor in Transylvania was that of a botanic garden at Lexington called "The Botanical Garden of Transylvania University." A company was chartered by Act of Legislature January 7, 1824, with a capital stock of twenty-five thousand dollars, five hundred shares of fifty dollars each. William H. Richardson, President; Thomas Smith, Joseph Ficklin, John M. McCalla, Thomas L. Caldwell, Directors; William A. Leavy, Treasurer; C. S. Rafinesque, Secretary. Other members were William Leavy, senior, Elisha Warfield, J. Harper, James W. Palmer, Horace Holley, Charles Caldwell, Benjamin W. Dudley, Charles Humphreys, Gabriel Slaughter, Thomas Wallace, John Roche, Charles Wilkins, Benjamin Gratz, Richard Higgins, John W. Hunt, B. R. McIlvaine, Joseph Boswell, Samuel Brown, and Daniel Drake. We gather from the prospectus (1824) that this garden was intended to be a charming resort for the elite of Lexington, who were expected to stroll at eve, perchance, through sylvan bowers; it was also to benefit farmers and "the whole Western country" by supplying "the best kinds of fruit trees and grape vines, mountain rice, madder, senna, opium, ginseng, rhubarb, castor oil, new kinds of grain and pulse, etc." It was to be valuable especially to the medical students of Transylvania by affording opportunity to study the plants used in medicine. The single product of opium, it was judged, could be made to cover the annual expense of the garden. There was to be "a small but elegant building, with a portico, green-house, aviaries, bowers, museum, library, and many other suitable ornaments." Lectures and "practical demonstrations" were to be given there in Botany, Agriculture, Horticulture, Domestic Economy, etc. "Every individual admitted in the garden to hear a course of lectures" to pay "at least one dollar." To these ends a lot was procured on the south side of East Main Street,[32] within the city limits, and gardening operations commenced; but the garden was not a success. Though patronized for a time, as in duty bound, by its influential shareholders and diligently strolled in by the friends, principally, of the medical students, it was, after the departure from Lexington of Rafinesque, finally pronounced to be nothing more than a weed-patch and abandoned before any building was erected on it. In fact, from the testimony of old citizens, it would appear that no improvements were ever made there except the laying out of wide walks and the planting of various shrubs and wild flowers, chiefly such as were common upon the highways in Kentucky, but which unquestionably seemed remarkable to Rafinesque, who viewed them with the eye of a botanist exclusively. The organization of the Medical Faculty of 1819, already described, remained unchanged until 1823, when Doctor Daniel Drake was recalled to the chair of Materia Medica and Medical Botany, Doctor Caldwell retaining that of the Institutes of Medicine. The chair of Chemistry was also strengthened by the appointment of Doctor Robert Best[33] as adjunct professor, who resigned, however, at the end of two years. Doctor Drake was transferred in 1825 to the chair of Theory and Practice on the resignation of Doctor Samuel Brown, and Doctor Charles Wilkins Short was called to that vacated by Doctor Drake. Doctor Drake resigned finally in 1826, to be replaced by Doctor John Esten Cooke. We will not in this place note all the changes which occurred in the Faculty up to the time of its dissolution, but will append them in the form of a schedule. (See Schedule A.) DANIEL DRAKE, M. D. Born at Plainfield, New Jersey, October 20, 1785, and brought to Mason County, Kentucky, in 1788, was, in 1800, the first medical student in Cincinnati. He began to practice in 1804, when he was only nineteen years old. He spent the winter of 1805-6 as a student in Philadelphia, and the succeeding year in practice at his old home in Mayslick, removing for life to Cincinnati in 1807. [Illustration: DANIEL DRAKE, M. D.] He was made Professor of Materia Medica and Medical Botany in Transylvania University in 1817, but returned to Cincinnati to found the Medical College of Ohio in 1818, from which, however, his connection was suddenly severed, after a bitter controversy, May, 1822. He resumed a professorship at Lexington 1823-27, being Dean of the Faculty, and declined a chair in the University of Virginia in 1830. He accepted one in the Jefferson Medical College, Philadelphia, 1830-31, and again in the Medical College of Ohio in 1831-32. He founded a new school as a department of Cincinnati College and taught in it 1835-39; was professor in the Louisville Medical Institute 1839-49, and afterward accepted a chair in the Medical College again in 1849-50. In 1827 he was editor of the _Western Medical and Physical Journal_, etc., but his chief work is his _Treatise on the Principal Diseases of the Interior Valley of America_, published in 1850--a wonderful tribute to American medical science. His contributions to scientific journals were numerous, and many of his medical lectures and scientific and historical addresses have been published.[34] He died at Cincinnati November 5, 1852, aged sixty-seven years.[35] Doctor David W. Yandell says: "As a lecturer Doctor Drake had few equals. He was never dull. His was an alert and masculine mind. His words are full of vitality. His manner was earnest and impressive. His eloquence was fervid." Soon after Doctor Yandell had entered the practice of medicine Doctor Drake told him: "I have never seen a great and permanent practice the foundations of which were not laid in the hearts of the poor. Therefore cultivate the poor. If you need another though sordid reason, the poor of to-day are the rich of to-morrow in this country. The poor will be the most grateful of all your patients. Lend a willing ear to all their calls." * * * * * Such enthusiasm in the establishment of the Medical Department of Transylvania existed at this time (1819) that liberal citizens of Lexington freely subscribed money to the amount of more than three thousand dollars to guarantee to Professors Caldwell and Brown each an annual sum of a thousand dollars for three years, and this salary was paid to them accordingly. Professor Caldwell visiting the Legislature of Kentucky in 1820, induced that body to give five thousand dollars for the express purpose of the purchase of books and apparatus for the Medical College in Transylvania University, which, as declared in the Act, was to remain "the property of the State of Kentucky." Moreover, the city of Lexington at the same time loaned to the college, for the same specified purpose, six thousand dollars, reserving a lien on the books. This loan subsequently became a donation. In addition many physicians of the South, of Kentucky, and of Lexington made further subscriptions, making altogether a gross sum of about thirteen thousand dollars, with which Professor Caldwell was enabled to purchase in Europe, in 1820, the foundation of the library, apparatus, and museum of the Medical Department.[36] Again, in 1827, certain citizens of Lexington and medical professors, forming a joint-stock company, furnished the means to build the first Medical Hall for the special uses of this department, on which, until 1839, when a new Medical Hall was erected, the medical professors paid an annual interest of six per cent on the cost. This old hall stood, before it was destroyed by fire (in 1854, while being used as a City Hall, etc.), on the site of the Lexington City Library, corner of Market and Church streets. It is thus described in the _Transylvania Journal of Medicine_, Volume I, 1828: "This building, a vignette view of which is seen on the cover of this Journal, was erected by the private munificence of citizens of Lexington during the last season. The corner-stone was laid with Masonic ceremonies on the fifteenth day of April, and the edifice was complete and in readiness for the reception of the medical class at the commencement of the session the first of November. "In an excavation made in the corner-stone was deposited a glass bottle enclosing a parchment roll on which were written the name of the President of the United States, those of the heads of departments, the Trustees of Transylvania University, the medical professors, trustees of the town, officers of the Grand Lodge who assisted at the ceremony, building committee, architect, etc. On a marble tablet over the front door of the house is the following inscription: COLL. TRANSYL. MEDIC. FUND. A. D. MDCCCXVII. "Though plain and unostentatious, the style of its architecture is chaste and neat, its execution is solid and substantial, and its interior arrangements are of the most convenient, comfortable, and commodious kind. "The basement story of the building is chiefly appropriated to the chemical professorship and contains a lecture-room forty-five by fifty feet in dimensions, in which the seats and lecturing stand are arranged in the best manner for perfect vision, a lobby, an anti-room, a chemical laboratory well supplied with all necessary apparatus, and a dormitory for a resident pupil who acts as librarian. "These in connection with the very handsome and commodious anatomical amphitheater which was built during the preceding season, together with its preparing- and dissecting-rooms, present a suit of lecture-rooms, apartments, etc., not surpassed in point of excellence of light for demonstration, or in ease, comfort, and convenience to the pupil by any similar institution in America. The whole is situated in a pleasant and central part of the town, easily accessible from the chief boarding-houses in the worst weather."[37][38] From the time of the reorganization in 1819, the classes in the Medical College increased rapidly--from only twenty, with a single graduate in 1817-18, to two hundred students and fifty-six graduates in the session of 1823-24. A rapid increase in patronage almost unparalleled in the history of medical schools, owing, no doubt, largely to the great increasing demand for medical instruction in this fast improving country and to the temporary extreme difficulty of the journey to the great medical school of Philadelphia, but also to the _eclat_ of the University under the administration of Doctor Holley,[39] to the just fame of Doctor Dudley as a surgeon and medical teacher, to the reputation of Doctor Samuel Brown as a popular and cultivated physician and professor, and to the brilliant and popular talents of Doctor Charles Caldwell. DOCTOR CHARLES CALDWELL. The association of this distinguished professor with the fortunes of the Medical Department of Transylvania, which extended from 1819 to 1837, marked the era of its most rapid development, and embraced a large portion of the time of its greatest prosperity. The life, character, and writings of Doctor Caldwell are no doubt now well known to the medical profession through the numerous biographical notices which have appeared, especially those by the late Professor Lunsford P. Yandell, M. D., in Lindley's _Medical Annals of Tennessee_, and as amplified in the _Transactions_ of the Kentucky State Medical Society in its twenty-first annual session in 1876, and other published sketches. But it may also be studied in his somewhat unfortunate _Autobiography_, which was published in Philadelphia in 1855, two years after his death, edited by the sister of his widow, Miss Harriet W. Warner. It is said of Titian, that when in his old age he took it into his head to _improve_ some of his best pictures by retouching them, his judicious pupils mixed his paints with olive oil so they would not dry and could be easily washed off again, thus restraining him from marring or destroying his finest works and his fame together. Fortunate would it have been for the venerable Doctor Caldwell had much of this senile production--written only seven or eight years before his death--been canceled by a friendly hand. The too harsh criticisms in which he indulged, which placed some of his late colleagues sharply on the defensive and which also gave them powerful weapons of offense, as well as defense, had then been suppressed! On Page 315 of this autobiography he characterized the time-honored maxim, "_De mortuis nil nisi bonum_," as "an ill-founded and dangerous precept." Hence Doctor Yandell, whom he had denounced in this work in the most opprobrious terms, felt justified in his notice of this autobiography in his paper on the _Medical Literature of Kentucky_, published in the _Transactions of the Kentucky State Medical Society_, 1876, Page 62, in the following terms: "It is not only egotistical and vainglorious beyond anything, I believe, to be found in the English language, but it is at the same time defamatory. The author holds himself up to admiration on all occasions and everywhere from boyhood to old age a very hero of romance." And literal quotations from the unfortunate volume give support to these allegations. [Illustration: CHARLES CALDWELL, M. D.] Under the provocation of Doctor Caldwell's posthumous attack, Doctor Yandell defended himself and retorted with the weapons which Doctor Caldwell himself had supplied. But, in later years, not long before his death, Doctor Yandell expressed to the writer, in a friendly letter, something like regret that he had not in this case adhered more closely to that maxim in relation to the dead, above quoted, which Doctor Caldwell had condemned as "ill-founded and dangerous." It must be admitted, however, that the provocation was great.[40] Doctor Caldwell was born, the youngest son of a large family, May 14, 1772, in Caswell County, North Carolina, and died in Louisville July 9, 1853, in his eighty-third year. His parents had emigrated from Ireland. His father--who was described by Doctor James Blythe, who knew him, as "very poor, and very, very pious"--destined Charles for the Presbyterian ministry. Accordingly he was measurably released from the labor of the farm on which the family lived and was allowed to pursue his studies in a solitary log hut which he had built for himself for the purpose--"his books his chief companions." He says he commenced to learn the ancient languages at twelve, and was already principal of a literary academy at eighteen. He says further of himself: "From an early period of my life I was actuated by a form of ambition and a love of disquisition and mental contest, which not only marked in me somewhat of a peculiarity of native mind and spirit, but tended also to strengthen them." In his subsequent life he delighted in debates, discussions, and mental contests. He acknowledges (Page 53) an early propensity to array himself in argument "on the wrong side of the question under consideration, in order the more certainly to produce discussion by my advocacy of a paradox, and to make a show of my ingenuity and ability in defense of error." But, as he acknowledged, "this kind of gladiatorship began to blunt his appreciation of truth as distinguished from error, and hence he endeavored to restrain this impulse"--not always successfully, perhaps. Although his taste and talents inclined him to the legal profession he was induced to study medicine, somewhat against his own judgment. His medical education was obtained in Philadelphia, in the Medical Department of the University of Pennsylvania, then the only medical college in America, which he entered in 1792, and from which he graduated. While there he industriously employed his time and faculties in study, debate, and discussion, and his pen in numerous publications, the principal of which was a translation of Blumenbach's _Elements of Physiology_--which he completed before graduation. He managed to antagonize, amongst many others, his medical preceptor, the celebrated Doctor Rush, much to his own detriment, as he in his autobiography acknowledges. In the following year, 1793, on the outbreak of the yellow fever in Philadelphia, he distinguished himself by his courage and self-sacrifice in voluntarily attending and nursing the sick. And again, by his pen and otherwise, in theoretical discussions on the origin of the pestilence. According to his own representations and the testimony of his friends, he was exceedingly methodical in his habits, dividing his time with rigorous system; but we may well feel a little skeptical as to his assertion that he "rarely slept more than four hours," and at one time but three hours and a half. His mental activity and labor, however, in his youth, must have been very great. Apart from his necessary studies and his active and constant participation in the discussions of the Medical Society, he delivered more public addresses, for the Society and on other occasions, "than all the other members of the institution united" (Page 254), besides employing his pen in numerous ephemeral productions for the press. In speaking of his early life in Philadelphia (Page 330) he says: "I was a young man for the scenes in which I had acted; proud and ambitious certainly, and probably not altogether untinctured with vanity.... In truth it is hardly to be denied that, for a time at least, I was somewhat spoiled [by the compliments paid him] on account of my attributes and performances, both mental and corporal.... No wonder, therefore, that I felt, or conceited I felt, a decided superiority to most medical pupils, as well as the ordinary cast of young physicians.... I certainly did both indulge and manifest it to the extent, at times, of giving serious offense." This was not the worst. His bold self-confidence and assertion having placed him in a position of antagonism toward his friend and preceptor, Doctor Rush, as well as toward other influential medical men of Philadelphia, defeated the great ambition of his life--that of occupying the chair of the Institutes of Medicine in the Medical College of the University of Pennsylvania. When informed by Doctor Rush (Page 290, autobiography) that although his friends spoke in flattering terms of "your talents, attainments, and powers in lecturing and instruction ... they are reluctant to recommend you to the Board of Trustees in the light of a professor," he indignantly declared that "if the door of the University of Pennsylvania was thus closed to him he would soon occupy a chair equally honorable with that of Doctor Rush in some other school." And he shortly thereafter was induced to push his fortunes in the great and growing West. Coming to Lexington with his shining and commanding talents, his determination to conquer success, and the brilliant reputation he then had as an independent writer and lecturer; to become associated with the yet more brilliant President Holley, and the already well-known and appreciated medical teachers, Doctors Dudley and Brown; at an auspicious time when the rapidly improving country felt the want of medical instruction at home--the rapid success of the Medical Department of Transylvania (to which he materially contributed by his able efforts before the public) might well excuse him in his belief[41] that he had come to Lexington to be the "_premier of the school_,"[42] that he had come to train and induct his colleagues ("a most miserable Faculty," he calls them) into efficiency and fame, and that the success of medical education in Lexington was due mainly to his individual efforts. Candor obliges us to admit, however, that there is some truth in the statement of the late Professor Yandell, in the memoir above quoted. Doctor Yandell was a student in the Medical Department of Transylvania in 1823, and a most ardent admirer of the brilliant talents of Professor Caldwell, yet he found that both Professors Dudley and Drake were more popular with the students, as teachers, than he. He says (Page 56): "Students, in truth, generally turned listlessly away from his polished discourses on Sympathy, Phrenology,[43] the Vital Principle, and other kindred themes, and hurried off to the lectures on Materia Medica and Anatomy."[44] In short, Doctor Caldwell excelled in the brilliant discussion of speculative and theoretical subjects. The extent of his positive knowledge, as remarked by Doctor Yandell, was greater in superficial area than in depth; whilst in the terse and lucid exposition of definite facts, which characterized the instruction of Professor Dudley, the student felt he was acquiring knowledge which not only was real but was of practical utility. The history of the _rise and fall_ of this school of medicine is illustrated in the detailed list of its classes and graduates as shown in the annexed _Schedule B_. The total number of students in the Medical School of Transylvania during the term of its existence was, as far as can now be ascertained, more than six thousand four hundred (6,456); the total number of its medical graduates eighteen hundred and eighty-one (1,881).[45] During the late civil war the commodious Medical Hall of Transylvania, built in 1839 by the munificence of the city of Lexington, and which had been seized by the United States Government for use as a United States General Hospital, was destroyed by fire while occupied for that purpose.[46] But the medical library,[47] apparatus and museum, etc., were mainly preserved, and are now in the custody of the Curators of Kentucky University, with which institution old Transylvania University was consolidated in 1865, "all the trusts and conditions" of her property being preserved in the Act of Consolidation. The Medical Department may yet be resuscitated when in the course of events our city again becomes an eligible site for modern medical instruction, and when special means can be obtained properly to equip and re-establish it on a basis suited to the existing times. The gradual decline of this school, like its rapid rise, was due greatly to the changing conditions of the country. When, shortly after 1812, steamboat navigation began to manifest its superiority and influence on the channels of commerce, population and business deserted measurably the interior routes and locations and transferred themselves to the river valleys and neighborhoods. Gradually during this change--notwithstanding the talents, ability, and fame of our Brown, Dudley, Caldwell, Cooke, Short, Yandell, Bartlett, Mitchell, Smith, and others, and the generous support of the city--the school declined; more especially because of the establishment of rival colleges at more eligible points, in growing and populous cities. Lexington lost its pre-eminence as the "_Metropolis of the Western Country_," and Cincinnati, Louisville, St. Louis, and other places which had been villages supplied with her manufactures, rapidly became great cities; while she declined from a population of about eight thousand in 1814, down to a little over four thousand in 1820, with an immense loss to her citizens in the value of her property and the destruction of her industries. In this year (1820) the population of Cincinnati, which in 1810 had been only two thousand, three hundred and twenty, had risen to nine thousand, six hundred and forty-four; and in 1830, when the population of Lexington was yet only five thousand, six hundred and sixty-two, that of Cincinnati was twenty-four thousand, eight hundred and thirty-one. When the present writer came to Lexington in 1832 the population had remained nearly the same, and an era of decrepitude and decline of all her industries still prevailed. Lexington had not yet finished her first railroad. This railroad, the "Lexington & Ohio," was begun in 1831 and completed as far as Frankfort--twenty-eight miles--in 1835. It was composed of stone sills laid side by side, with a dressed surface on the portion upon which the wheels were to run. The cars resembled an old pattern of street car and were drawn by horses. The imposing ceremony of laying the first "stone sill" took place on Water Street, October 21, 1831, "amid a vast throng of people." Indeed, it was made a very great occasion, which might have been marked with still greater pomp and circumstance, as the newspapers inform us, had "more notice been given beforehand." As it was, a large procession, civic and military, was formed, marshaled by General Leslie Combs, the renowned "boy-captain of 1812," assisted by handsome James B. Coleman. Three military companies, including "Hunt's Artillery" and "Captain Neet's Rifle Guards," were on parade with a fine military band playing "Yankee Doodle," "Hail, Columbia," and other patriotic airs. Major-General Pendleton and staff, on horseback, led the march. Governor Metcalfe and Reverend Nathan H. Hall supported the orator of the day. The Trustees of the town, the President and Directors of the railroad, the President and all the officers and Trustees of Transylvania University, and all the societies of the University and of the town, were in line. "At eleven o'clock," says the _Lexington Reporter_, "the three military companies which formed the escort marched from the place of rendezvous to the college lawn, where they were met by the various societies and individuals. For many years we have not witnessed such a pageant, and never a more interesting. "The procession first moved in a circle around the lawn where it was formed, at which time the bells in the various churches in town commenced a merry peal which continued till the procession reached the place where the ceremony was performed. The military escort then formed a hollow square, within which the whole civic procession was enclosed. Thousands of anxious and delighted spectators were on the outside, among whom we were gratified to see a large concourse of ladies, for whose accommodation the marshal had directed the adjacent market-house to be appropriated. "Doctor Caldwell then delivered a highly interesting and appropriate address. "A Federal salute was fired at sunrise, and seven guns when the first stone sill was laid, indicating the seven sections of the road under contract." Doctor Caldwell spoke in polished and eloquent phrase of the advantages accruing to Lexington and the whole adjacent country from the establishment of this road. He prophesied also great benefit to Louisville therefrom. We learn from the same old newspaper that Doctor Caldwell was announced to deliver a lecture, a few evenings later, at the first meeting of the "Lexington Lyceum," at the court house. The subject of the lecture was "The Moral and Incidental Influences of Railroads." "Ladies and strangers" were invited to attend. But in later days, in competition with the steamboat, the newer and swifter mode of transportation--the railroad--has been gradually but surely restoring to the inland regions, and to Lexington, their lost prosperity. Our city has steadily risen to about seventeen thousand (1873), with a good prospect of a further increase of prosperity and population as railroads centering here may be extended. Then may we hope to put into active operation once more our time-honored Medical College, and to attract to it a creditable number of students. More particularly if, with the co-operation of the more enlightened members of our profession, an effort be faithfully made in the renovated college to bring about the much-needed reform in medical education, the necessity for which is now generally recognized. So that the mere fact of a student attending two courses of lectures, with other somewhat easy requisitions, may not entitle him to the degree of Doctor of Medicine, as has been too frequently the case amongst competing medical colleges. That full preparation and training, in a sufficient period of time, shall be required of the candidates into whose hands the health and lives of communities are to be committed. On such a basis--when our city may have acquired increased facilities for clinical instruction, and when anatomical studies will not be cramped for want of means of demonstration--the old Medical College of Transylvania may revive under the wing of a people's educational institution such as Transylvania is and always was--a "_State University_." Difficulties in the procurement of a sufficient supply of material for anatomical instruction, coupled with the demand for clinical teaching which was beginning to be urged by the profession, forced themselves on the attention of the Medical Faculty of Transylvania before the year 1836-37. But in that year a determined effort was made, engineered and led by Professor Caldwell, to remove the Medical College to Louisville, that city having been induced by the earnest and eloquent appeals of Caldwell to offer it a large bonus. But for the early withdrawal of Doctor Dudley from this promising scheme, toward which he was at first inclined--because mainly of his difficulties in the supply of anatomical material--it would have been successful. But Doctor Dudley finally declined to remove, much to the mortification of Doctor Caldwell, who, in his last valedictory to the graduates of 1837, indulged in a very bitter impersonal-personal tirade against deception and mendacity, aimed at Doctor Dudley--not saying openly to his colleague "thou art the man"--but hoping "the cap would fit him" and find its place. The Trustees of the University, of course, and influential citizens, violently opposed the proposed change. Doctor Caldwell was arraigned before the Board on charges preferred by Doctor Dudley, the principal of which was that he had been engaged in the enterprise of originating a rival medical college in Louisville while he was yet a professor in the Transylvania College and under oath to support it. Doctor Caldwell, disdaining to answer the summons of the Board, was, after a long and full investigation of the evidence, dismissed from his chair in Transylvania. The Medical Faculty was then dissolved and reorganized.[48] Doctors Cooke and Yandell, and finally Doctor Short, joined Doctor Caldwell to aid in the establishment of the _Louisville Medical Institute_. Professors Dudley and Richardson and the assistant professors, Bush and Peter, remained in Lexington. The celebrated Professor John Eberle was called to the chair of Theory and Practice, but he died shortly after the delivery of his introductory lecture. Professor Thomas D. Mitchell was appointed to the chair of Chemistry, etc., and Doctor James C. Cross to that of the Institutes of Medicine.[49] DOCTOR JOHN ESTEN COOKE Removed from Virginia in 1827 to fill the chair of the Theory and Practice of Medicine in Transylvania University, which had just been vacated by Doctor Drake. He had already acquired a high reputation as a practitioner of medicine; he had published an able essay on autumnal fever in the _Medical Recorder_ for 1824, and had in the same year produced the first volume of his very remarkable _Treatise on Pathology and Therapeutics_, the second volume of which he published in Lexington in 1828. The promised third volume, which was to complete the work, never appeared. He remained in Transylvania Medical School until 1837, when, under the leadership of Doctor Caldwell, he with Doctor Yandell, removed to Louisville to engage in originating a new medical college, the "_Louisville Medical Institute_." In this and in its successor, the "_Medical Department of the Louisville University_," he remained until a few years before his death, which occurred on his farm on the Ohio River above Louisville, October 19, 1853, in the seventy-first year of his age. [Illustration: DOCTOR JOHN ESTEN COOKE. From a Photograph.] Doctor Cooke was in many respects a remarkable man, who acquired a widespread reputation in this country, especially in the Mississippi Valley. His fame was mainly built on his celebrated theory of the universal origin of disease, which was, that disease was caused by cold or malaria. That especially it commenced in weakened action of the heart, resulting in _congestion of the vena cava_, its branches and capillary distribution, and that fever was but the reaction of the vital force to overcome this condition, which unrelieved would result in death. According to him, all autumnal and malarial fevers were but variations of one diseased condition, and even those fearful scourges the plague, cholera, yellow fever, dysentery, etc., were simply varied forms and conditions of congestion of the _vena cava_. To destroy this many-headed hydra--while he would use cold water to reduce too great febrile excitement and even sometimes give antimonial wine[50]--his main reliance was on blood-letting and cholagogue purgatives, as he believed it was by increasing the secretion of the liver and causing it to pour out consistent "black bile" that the venous congestion was to be relieved and the patient cured. Amongst all these remedies calomel was his chief reliance, and was given by him in doses not measured by the balance but by the effect they produced; so that in the latter days of practice--notably during the epidemic of cholera in Lexington in 1833--he absolutely resorted to tablespoonful doses of this mercurial, repeated _pro re nata_; actually giving about _one pound_ in one day to a young patient, without fatal result. Two cases may be quoted from his own paper in the _Transylvania Medical Journal_, and from Doctor Yandell's _Memoir of Doctor Cooke_ in the _American Practitioner_ for July, 1875. "William Douglass, a student of theology, nineteen years of age, took a tablespoonful (about two ounces) every six hours for three days in succession, having taken the same quantity the evening before; in all, thirteen tablespoonfuls. He was in collapse when he took the first dose. On the third morning after beginning this treatment his discharges were found to have become thick and green, and Doctor Cooke thought he would have recovered but for the indiscretion of his attendant, who had him to walk across a large room from one bed to another more than once. Hiccough came on, the patient became delirious, and died on the sixth day. But another patient recovered about this time under similar treatment, and still lives, I believe--a useful Episcopal clergyman, and an illustration of the extent to which calomel may be employed in some diseases without injury to health. Mr. Brittan, a young theological student, took a tablespoonful of calomel soon after having had several copious watery discharges. He was advised to repeat the dose every six hours, until the watery discharges ceased. He took, that day, four and on the next, three of these doses; the discharges not ceasing until some time after the seventh dose had been taken. He took, moreover, three similar doses during the same time--having thrown up three. The _repeated doses_ were given immediately after the regular ones were thrown up. Bilious discharges appeared on the evening of the second day, and were kept up by tincture of aloes and occasionally pills of aloes and rhubarb for a week. The patient was somewhat salivated, but recovered. I saw him a number of years afterwards in perfect health." Doctor Yandell asserts in this memoir that in this "extraordinary practice, Doctor Cooke was not less successful in the treatment of cholera than his medical brethren in Lexington." But the fact was that none were very successful and that as many as fifty died in a day of a population of a little over six thousand.[51] The writer recollects that Doctor Cooke only practiced in the earlier period of this famous epidemic, having been disabled by a fall in attempting, in his hurry to attend a professional call, to put on his coat while running down stairs. In another case of cholera which occurred at this time, as the present writer was informed by the intelligent and truthful brother of the young lady patient of Doctor Cooke, these large tablespoonful doses passed through the bowels apparently unchanged, being discharged in lumps as large as pullets' eggs, without being even dissolved. This patient did not recover. Calomel is well known to be practically insoluble in pure water at the common temperature. It is decomposed to a certain extent by the action of light, or by a moderate heat in the presence of water, and especially by the aid of acids of various kinds, and by certain salts such as alkaline and other soluble chlorides--especially potassium, sodium, and ammonium chlorides. In all these cases of partial decomposition some of the mercurous chloride--the calomel--is changed into soluble mercuric chloride and metallic mercury. This decomposition is supposed to result from the action of the alkaline chlorides and the chloro-hydric and other acids of the gastric juice when calomel is taken into the stomach under ordinary circumstances. It is believed that the activity of the calomel depends mainly on the amount of this decomposition which takes place in the body. Especially does this partial decomposition of calomel into corrosive sublimate occur, to a great extent, when it is mixed in water with sal-ammoniac (ammonium chloride), as has been experienced in cases of poisoning by the administration of even moderate doses of calomel which had been mixed with this salt. In an experiment by the present writer in which three tenths of a gram of calomel and one and two tenths of a gram of sal-ammoniac with ten grams of water were allowed to react at the common temperature for twenty-four hours, as much as 0.019 of a gram of corrosive sublimate was found. No doubt these facts throw much light on the very irregular action of calomel in different persons and under various conditions, in doses which may be very small or very large. We can easily understand how, when the stomach secretes no gastric juice and when the salts of the blood have been greatly reduced in quantity by watery purging as in cholera, the calomel may pass through the alimentary canal unchanged, insoluble and inactive, or exert a doubtful topical action only. The present writer's own experience--when he was a medical student, and when fully impressed by the sincere and logical teachings of Doctor Cooke, who, however halting and hesitating may have been his manner or unadorned his style of lecturing, always commanded the fixed attention and highest respect of his pupils--soon opened his eyes to the faults in the theory of the professor. On one occasion, having been brought into a somewhat febrile condition by fatigue in a botanical excursion in hot weather, and having full faith in the statements of Doctor Cooke to the effect that calomel was of all antifebrile remedies the best, and that while a small dose of calomel might prove irritating _a good large dose_ "would sometimes act like an opiate," he took a one drachm dose in full confidence. But instead of the soothing, curative effect he had been led to expect, vomiting and severe irritation of the stomach resulted, so much so that no food but boiled milk could be tolerated for a week or so afterward. Shaken in his faith by his first experience, but not yet convinced of the error of the doctrine of his respected preceptor, the second trial of a drachm dose on a similar occasion completely satisfied him that something wrong had crept into the theory and practice of the honored professor. Doctor Cooke's only fear in his heroic use of calomel was that it would salivate. But for this untoward influence, he said, one might do almost anything with it. That this substance which, in cases of cholera, he administered so largely with no signs of irritation or salivation, until the patient was in a convalescent state, should sometimes in much smaller doses prove an irritant poison, he did not understand. A quotation from Doctor Yandell's _Memoir_, Page 7, illustrates this: "In some cases of fever Doctor Cooke administered a drachm of calomel at a dose, and repeated it until the patient had taken in twenty-four hours as much as two hundred and forty grains. A young lady was thus treated in 1826. After this quantity had been given she seemed much relieved, but to avert the danger of salivation he thought it prudent to administer jalap and cream of tartar. At night they were thrown up, without producing any purgative effect. She then took a drachm of calomel, and repeated it until she had taken five doses in the course of the night and morning, with the same fine effect in producing abundant bilious discharges, and a remarkably good effect on the symptoms generally." Still uneasy about ptyalism, he gave her cream of tartar all day, but at night it was thrown up as before, without moving the bowels. "My fears of the consequence of giving the only medicine which offered any prospect of saving her," he adds, "held my hand, and she continued to vomit till death relieved her. I reproached myself on her account afterward, and felt conscious that fear of a remote and uncertain evil had induced me to stand and see her die without doing all I might have done. I was convinced she would not have died had the calomel been continued." After she had thus taken more than an ounce of calomel he honestly believed that he had not given her enough of this medicine! Entirely ignoring the action of the cream of tartar in bringing this substance partly into the condition of a soluble irritant poison! To convince myself of this decomposing action of cream of tartar on calomel, I placed about a drachm of calomel in each of two small beaker glasses. In the one I put pure distilled water, in the other I added to the water about a drachm of cream of tartar. Heating them to about blood heat and allowing them to stand for a few hours, I filtered both liquids from the undissolved calomel. Ammonium sulphide, added to the filtered fluids, threw down from that which contained the cream of tartar a sensible amount of dark mercurial sulphide, while that which contained pure water gave no notable reaction. Evidently the cream of tartar had caused the decomposition of some of the insoluble calomel and had produced a soluble mercurial compound. All soluble compounds of mercury are active poisons in small doses, while, as was fully proven by Doctor Cooke's extraordinary practice with this substance, pure unchanged calomel is one of the most insoluble substances. Consequently it sometimes proved harmless in very large doses, as was the case when the copious watery discharges of cholera had removed most of the salts of the blood. The Doctor took no note of possible agencies which might make his master remedy occasionally poisonous, and scouted the careful practice of some of the older physicians in causing their patients to abstain from the use of common salt while taking calomel, a recommendation based upon valid experience, no doubt, which science has verified. The Doctor rose to two ounces, or tablespoonful doses, during the prevalence of Asiatic cholera in Lexington, but he did not confine this treatment to that fearful disease. The present writer has preserved one of the last of his mammoth doses--one of a dozen of the same weight (about an ounce)--which he prescribed for a medical student of the session of 1836-37, the subject of pneumonia, and who took eleven such doses in regular succession before he died. In Doctor Cooke's earlier practice, and in the treatment of less severe cases, he relied greatly on his famous pills--well known in the region of Lexington as "Cooke's Pills"--composed of equal parts of calomel, aloes, and rhubarb; or on tincture of aloes and the lancet, with the occasional use of a few other remedies. These constituted his sole armament with which to encounter disease. For he was a man of the strictest and most earnest honesty, sincerity, and zeal, and withal so wedded to his logical convictions that he would at any time have died a martyr to his well-matured beliefs. Indeed, according to the testimony of his friend, the late Lunsford P. Yandell, he seems thus to have been to some extent a martyr to his own theory and practice. On Page 22 of Doctor Yandell's _Memoir of Doctor Cooke_, we are informed that "his practice on himself was of the same heroic character that he pursued with his patients. He bled himself at once copiously and repeated the operation again and again as symptoms appeared to him to demand it, at the same time keeping up purgation with calomel. Exposed as he was on his farm, these attacks became frequent and his constitution, naturally enfeebled by increasing years, at length gave way under them." Again, on Page 27 of the same _Memoir_, Doctor Yandell says: "The perfect sincerity with which he held his opinions was evinced by his carrying out his practice in his own case. On one occasion this was near costing him his life. He was seized with intermittent fever, on his farm near Louisville in the fall of 1844, and for several days took his pills--composed of calomel, rhubarb, and aloes--in the confident belief that they would arrest the disease; but the chills continued to recur with an increasing tendency to congestion until at last his case became alarming. His old friend, General Mercer, of Virginia, who happened to be on a visit to him at the time, called on me and gave me an account of his situation, asking me to visit him. Doctor Cooke was reluctant to take quinine, but finally consented and was relieved, and afterward, I believe, used the remedy in his practice." A characteristic anecdote is recorded of him in _Collins' History of Kentucky_. "One Sunday morning, waiting on some of his family to get ready for church--the Methodist church, of which he and they were members--he picked up a discourse by the Reverend Doctor Chapman, then Episcopal clergyman of Lexington. The argument for the Old Church of England attracted his attention. He perused and studied it fully, sent for all the available authorities on the subject; studied them with such effect that at once he changed his communion to the Episcopal Church and was ever after a rigid and zealous pillar to that church, and an industrious student of the writings of the theological fathers." His logic, on which he based his medical theory and practice, is most elaborately set forth in his only large work, already mentioned--_A Treatise of Pathology and Therapeutics_--and was tersely summed up by a most zealous believer and pupil of his[52] as follows: "If all diseases result from congestion of the _vena cava_, and if calomel is the best and most reliable remedy, what is the use of applying to any other means?" Because of its simplicity and its apparently logical basis, the system of Doctor Cooke was very attractive to students of medicine. If true--and they could not doubt it--it was a great new discovery of a royal road to medical practice which avoided all the drudgery over pathology, chemistry, the materia medica and therapeutics of the old school. All ordinary diseases were a unit produced by a common cause, and calomel was the principal panacea! But alas! the logical system of Doctor Cooke, like many other beautiful and well-laid superstructures, failed in this essential thing--_the foundation on which it was raised was not true_. Logical minds too often willingly lay down or accept assumptions, or uncertain facts, as axioms, and are satisfied if the deductions from these are logically accurate and perfect. Doctor Cooke, in a slow and laborious way, took infinite pains to build up his logical superstructure. The writer recollects his illustration of logical connections, by means of certain pieces of wood united by strings; and, notwithstanding his unadorned style and slow and hesitating manner, his students--carried away by his well-known truthfulness, sincerity, and earnest zeal, and incapable of judging for themselves of the validity of his premises--accepted his doctrine as a new revelation and were almost unanimously his ardent followers until experience or more ample knowledge opened their eyes to its faults. Before he removed from Transylvania School to the new one in Louisville in 1837, severe criticisms of his teachings had been published. Indeed it had begun to be believed by some that these teachings were marring the prosperity of that old college. Soon after his removal to Louisville, we are told by Doctor Yandell, "the current which from the first had set in against his theory and practice grew every year more formidable" until "assailed on all sides, and from within as well as from without, his theory steadily lost ground, his practice grew more unpopular and his influence as a teacher visibly declined from the day he began to lecture in Louisville."[53] So that in 1843 he was, on petition of the students, retired on a three years' pension of two thousand dollars per annum. Besides the two volumes of his _Pathology and Therapeutics_ he published a small work on _Autumnal Diseases_, and a number of medical papers in _The Transylvania Journal of Medicine_, of which he was one of the original editors. The congestive theory of disease had its short day, like many others which have floated like bubbles on the stream of medical progress. We remember it as one of the curiosities of medical literature.[54] DOCTOR CHARLES WILKINS SHORT Was born in Woodford County, Kentucky, at "Greenfields," October 6, 1794. He connected himself with the Medical Department of Transylvania University in 1825. He had been called by the Trustees in a previous year to the chair of Materia Medica and Medical Botany, but did not at once accept. Doctor Short was a most upright, conscientious, modest, undemonstrative gentleman of great delicacy of feeling. He was a most zealous and industrious botanist, and was possessed of artistic tastes and ability. One of his greatest pleasures was in his extensive herbarium, rich with the native plants of Kentucky collected by himself, as well as with those from other regions obtained by the exchange of specimens with the various botanists of the world, with whom he corresponded individually and extensively. He, in conjunction with Professors H. H. Eaton, H. A. Griswold, and R. Peter, contributed to the _Transylvania Journal of Medicine_ several papers on the plants of Kentucky,[55] and wrote for that periodical several papers on this subject and on medical topics, as well as numerous obituary notices of medical men. He was not the author of any large treatise. In addition to his notices and catalogues of Kentucky plants he published in the _Transylvania Medical Journal_: "Instructions for Gathering and Preservation of Plants in Herbaria." "Botanical Bibliography." 1835. "A Brief Historical Sketch of the Origin and Progress of Cholera Asphyxia." 1835. "A Sketch of the Progress of Botany in Western America." In 1845, he wrote "Observations of the Botany of Illinois," published in the _Western Journal of Medicine and Surgery_. In the early volumes of the _Transylvania Journal_ also appeared his notices of two remarkable cases which occurred in Lexington. One, of supposed _spontaneous combustion of the human body_, and the other of _paralysis of the kidneys_. At his death his vast collection of botanical specimens, in the formation of which he took such delight, and to which he had devoted so great a portion of his life, was bequeathed to the Smithsonian Institution at Washington, but there was no appropriate place there in which to display so large a collection. It is now in possession of the Academy of Natural Sciences at Philadelphia. During his life no less than five of the distinguished botanists of the age honored his name by attaching it to six new genera and species of plants. [Illustration: DOCTOR CHARLES WILKINS SHORT.] His lectures to the medical students on Materia Medica and Medical Botany he always read from his manuscript, which detracted somewhat from his impressiveness. He was too modest to trust himself to oral discourses.[56] Yet his pupils were always closely attentive and respectful, holding him and his teachings in high esteem.[57] He was Dean of the Medical Faculty in Transylvania for about ten years. For some years he was co-editor of the _Transylvania Journal of Medicine_ with Doctor Cooke. This quarterly they founded in Lexington in 1828. Doctor Short severed his connection with the Transylvania Medical School in 1838 to be allied with Doctors Caldwell, Cooke, and Yandell in the Medical Institute of Louisville,[58] in which he remained until 1849, when his colleagues elected him Emeritus Professor of Materia Medica and Botany. He died at his beautiful country residence, "Hayfield," near Louisville, on March 7, 1863, aged sixty-nine years. Doctor Short's father was Peyton Short, who came to Kentucky from Surry County, Virginia, and whose mother was Elizabeth, daughter of Sir William Skipwith, Baronet. His mother was Mary, daughter of John Cleves Symmes, formerly of Long Island, who filled various offices of honor and trust in Cincinnati. His sister was the wife of Doctor Benjamin Winslow Dudley. His brother was the late Judge John Cleves Short, of North Bend, Ohio. He married Mary Henry Churchill, only daughter of Armistead and Jane Henry Churchill. Of his six children--one son and five daughters--all were prosperous in life. The early education of Doctor Short was in the school of the celebrated Joshua Fry, and, in 1810, he graduated with honor in the Academical Department of Transylvania University, beginning soon afterward the study of medicine with his uncle, Professor Frederick Ridgely. He repaired to Philadelphia in 1813 and became a private pupil of Doctor Casper Wistar, Professor of Anatomy in the University of Pennsylvania, in which university Doctor Short received the degree of Doctor of Medicine in the spring of 1815, returning shortly after to Kentucky. Doctor Short was a consistent member of the Presbyterian church.[59] PROFESSOR LUNSFORD PITTS YANDELL, SENIOR, M. D. Was called to the chair of Chemistry and Pharmacy in the Medical Department of Transylvania University, March 16, 1831.[60] He had attended the course of lectures in that school in 1822-23, having previously acquired a good general and classical education in the Bradley Academy, Murfreesboro, Tennessee, and having studied medicine some time with his father, Doctor Wilson Yandell, a physician of high standing. While attending the lectures in the Transylvania Medical College he became favorably known as a young man of industry, good attainments, and ability, and of popular manners. Especially was he a favorite pupil of Professor Charles Caldwell, who became his ardent friend, and through whose active influence, mainly, he was called in 1831--after he had received the degree of M. D. from the University of Maryland--to occupy the Chemical chair in the Transylvania School. Although he had been a good and apt scholar in his preliminary education, he had never devoted especial attention to chemistry, which at that time, notwithstanding the neglect or opposition of the older medical teachers--notably the ridicule of Professor Caldwell and others--was beginning to be recognized as an essential element of a good medical education. This want of special training and experience in this branch of science on his part naturally caused opposition to his appointment to this chair, which was allayed by making the late Hezekiah Hulbert Eaton, A. M., professor adjunct to the Chemical chair, and giving him one third of the tuition fees. Professor Eaton was a young man of fine attainments and thorough practical training in chemistry and natural science generally; a graduate of Rensselaer Institute of Troy, New York, under the administration of his father, the celebrated Amos Eaton.[61] Adjunct Professor Eaton died of consumption at the age of twenty-three, before the end of the first year; but during the short term of his service he had, by his industry and practical knowledge, greatly improved the means of instruction in the Chemical Department by a complete reorganization of the laboratory and the procurement of much new apparatus, etc.[62] [Illustration: DOCTOR LUNSFORD P. YANDELL, SENIOR.] After the death of Professor Eaton, August 16, 1832, the present writer, then residing in Pittsburg, Pennsylvania, who had also been a student in the Rensselaer Institute and consequently known to Professor Eaton, was persuaded by the late Reverend Benjamin Orr Peers to visit Lexington, Kentucky, to deliver a course of chemical lectures in the Eclectic Institute, of which Mr. Peers was principal and of which young Professor Eaton had been a professor. During this course, in 1832, the writer was induced by Professor Yandell, by private arrangement, to assist him in his next course of lectures to the medical students of Transylvania and to commence the regular study of medicine with a view to graduation. Under this arrangement, which continued until the disruption of the Medical Faculty in 1837, Doctor Yandell, in his usual able and brilliant manner, delivered the chemical lectures to the students, while to the writer was committed the preparation and performance of the demonstrative experimental part. On his removal to Louisville in 1837, to join in the establishment of the rival school, the Louisville Medical Institute, Doctor Yandell taught in the combined chairs of Chemistry and Materia Medica, never failing ably and impressively to perform this arduous duty. Not having any particular taste for so severe a study as practical chemistry, although no one was more impressed with the philosophical beauty and wide practical value of the science, he naturally sought a transfer to a chair more congenial with his tastes and the character of his mind than that of chemistry. This, circumstances prevented until, in 1849, the Trustees of the school--having come to the conclusion that Professor Caldwell had become superannuated--placed Doctor Yandell in the chair of Physiology, for which subject he had a decided taste. This change procured him the animosity of his whilom friend, Doctor Caldwell, who, in his rather unfortunate _Autobiography_ written in his last declining years, indulged in much bitter denunciation of his late colleague. It is much to the credit of Doctor Yandell that, although when this angry publication was fresh from the press he retaliated by showing in ample quotations from the _Autobiography_ some of the weak points in Doctor Caldwell's character, he was disposed in following years, as the writer knows, to extend over these weaknesses the mantle of kindness. Doctor Yandell occupied this chair of Physiology with great credit until he resigned, in 1859, to accept a chair in the Medical School of Memphis, Tennessee. During the Civil War he devoted himself to hospital service. In 1862, he was licensed to preach by the Presbytery of Memphis, and in 1864 was ordained pastor of the Dancyville Presbyterian church. He resigned his pastorship in 1867, and returned to Louisville to resume the practice of medicine, which he had never entirely abandoned during the whole of his professional life. While resident in Lexington he was for some years sole editor of the _Transylvania Journal of Medicine_, to which he contributed several able papers. In Louisville he was editor for some time of the _Western Journal of Medicine and Surgery_, in both cases filling the editorial chair with characteristic activity and ability. He was always a contributor to the medical literature of his day in numerous papers, especially in biographical sketches and obituary memoirs of medical men of Kentucky and Tennessee, a more complete collection of which he was said to be preparing at the time of his last illness. He held a facile pen; few writers of our times have produced more classical and graceful essays. As a public speaker and lecturer he was ever impressive, graceful, and chaste. His social qualities made him always welcome and prominent in all public assemblies of his medical brethren. In 1872, he was elected President of the College of Physicians and Surgeons of Louisville, and at the time of his death he was President of the Medical Society of Kentucky. His decease occurred February 4, 1878, in the seventy-third year of his age. DOCTOR ROBERT PETER, Though of foreign birth, came of that same class of British ancestry which has given the United States her representative Americans, Virginia her great men, our own State her typical Kentuckians. Born at Launceston, Cornwall, January 21, 1805, he was a member of the Peter family of Devon and Essex, which produced in former times the remarkable Sir William Peter or Petre, to which has been ascribed the noted Hugh Peter or Peters, and from which collaterally are descended the present Lords Bathurst and Petre. Robert Peter came to America with his parents, Robert and Johanna Dawe Peter, and their six other children, when twelve years old, landing at Baltimore and later settling at Pittsburg, Pennsylvania. The father, it seems, succeeded in none of his money-making enterprises in the new country, and Robert had early to support himself and to contribute something to the maintenance of the family. He was placed in Charles Avery's wholesale drug store at Pittsburg and there received a first-rate business education, while diligently cultivating his decided taste for chemistry. In 1828, he became a naturalized citizen of the United States. The same year, after attending one session (by especial request) at the Rensselaer Institute Scientific School at Troy, New York, he acquired the title of "Lecturer on the Natural Sciences,"[63] and delivered a course of chemical lectures to a small class in Pittsburg, was a member of the Hesperian Society and contributed to its organ, _The Hesperus_, numerous papers, scientific, literary, and poetical. In 1829, as member of the Pittsburg Philosophical Society, he gave a course of lectures on the Natural Sciences before that Society. In 1830-31, he lectured on Chemistry in the Western University of Pennsylvania. In 1832, he came to Lexington, Kentucky, somewhat reluctantly, at the urgent insistence of Reverend Benjamin O. Peers, to be associated with him in the proprietorship of his "Eclectic Institute," at that place, and to deliver a course of lectures in the Institute.[64] While thus engaged, Professor Peter was induced by Doctor Yandell, Professor of Chemistry, to accept the duties of adjunct to the chair of Chemistry, a position made vacant by the death of Professor H. H. Eaton, August 16, 1832. On March 16, 1833, he was unanimously elected to the chair of Chemistry in Morrison College, Transylvania University, being installed on the occasion of the dedication of that college, November 4, 1833, when the oath of office was administered to Mr. Peers as Proctor of Morrison College and President _pro tem._ of the University. Professor Peter then studied medicine in Transylvania, receiving his diploma March 18, 1834. He was present during the terrible epidemic of cholera in Lexington in 1833, and with Doctor Yandell attended the first case--that of a Mr. Henry. Though a successful practitioner, Doctor Peter, like Doctor Short, had a distaste for the life of a physician, and soon retired to more congenial scientific labors. On October 6, 1835, he married Frances Paca, eldest daughter of Major William S. Dallam. In 1838,[65] he was elected to the chair of Chemistry and Pharmacy in Transylvania Medical Department, and, until the close of the school in 1857, was honorably connected with it. From 1847 to the end, in 1857, he was chosen Dean of the Faculty, being Librarian as well. In 1839, with Doctor James M. Bush, Doctor Peter spent most of the summer in London and Paris purchasing books, apparatus, and other means of instruction for the Medical Department.[66] After hearing numerous lectures by famous doctors, and after visiting the model hospitals, etc., of the day, he writes to his wife (Paris, June 27, 1839): "We can have as great men [in Lexington] as either of those cities [London and Paris], and neither of them contains a man as eminent in surgery as Doctor Dudley"; and from London, August 11, 1839: "We have bought a great many fine books and a great deal of excellent apparatus and anatomical and other models. Transylvania will shine. No other institution in our part of the world will be able to compare with her in the means of instruction. In fact, I have seen none in Europe that is more completely prepared to teach _modern_ medicine."[67] Daguerre, in 1839, had just published the process of his wonderful art, and it constituted perhaps the greatest novelty in Paris at the time of the sojourn there of Doctor Bush and Doctor Peter; so along with the apparatus for Transylvania was brought to Lexington a daguerreotype outfit which surely must have been the first ever seen in that city, if not the first ever used in the West. This primitive camera and its accompaniments, which Doctor Peter showed to his classes many years after, can still be found, it is supposed, among the old Transylvania possessions preserved at the Kentucky University. On his return from Europe Doctor Peter engaged in much valuable chemical research for the benefit of medical science, notably his examinations of calculi, published in 1846.[68] He also, in 1846, experimented with the then newly discovered explosive, gun-cotton, and with pyroxyline made from paper and other materials. His chemical research and teachings all were now and invariably along practical lines. Leaving theory to others, his own endeavors were in anticipation of useful results in practice. Quick to adopt new views when properly sustained by facts, he was highly appreciative of improved methods, a trait strikingly displayed when, in his old age, the most radical changes revolutionized the methods of chemical work. Laying aside the long-familiar doctrines, practiced since his far-distant youth, he took up the new with an ease--even alacrity--hardly excelled by contemporary chemists of a younger generation. In his early days he experimented much with electricity--then little understood. He gave much attention to geology, mineralogy, zoology, and botany. Associated with Doctor Charles W. Short and Professor Henry A. Griswold, he made important botanical explorations.[69] His fine herbarium, including specimens exchanged for with leading European botanists, he gave in after years to the Kentucky State Agricultural and Mechanical College. Doctor Lewis Rogers, in his address as President to the Kentucky State Medical Society, 1878, says: "In the interesting departments of Botany and Chemistry, Doctor Charles Wilkins Short and Doctor Peter are known throughout the scientific world. As teachers, the modest, almost shrinking manner, the seemingly acerb dignity, and Addisonian style of the one and the lucid expositions and brilliant illustrations of the other, must be remembered by all who ever listened to them." In 1850-53, Doctor Peter filled with distinction the chair of Chemistry in the newly founded Kentucky School of Medicine at Louisville, since so successful. On October 19, 1853, at the third meeting of the Kentucky Medical Society at Lexington, he proposed to memorialize the legislature in regard to the establishment of a Geological Survey of Kentucky. Accordingly, he prepared such a memorial (in connection with his "Report on the Relation of Forms of Disease to the Geological Formation of a Region"), accompanied by a geological map, colored by himself.[70] In consequence of this memorial, which was unanimously sanctioned by the several agricultural societies of the State, the first Geological Survey of Kentucky--which was also the first large State enterprise of the kind undertaken in the West--was begun in 1854, under the able and experienced direction of Doctor David Dale Owen. While chemist to this survey, Doctor Peter demonstrated what previously he had sturdily maintained and ably argued--that by soil analysis could be determined the elements necessary to increase and preserve the fertility of soils.[71] He was probably the first in America to apply quantitative and qualitative analysis in this manner--certainly the first to apply it to any great extent. He proved by numerous analyses that chemical analysis as practiced by him was capable of showing the deterioration of soils by long cultivation. He did this by comparing the composition of the virgin soil with that of soil taken from a near-by old field.[72] The amount of chemical work accomplished by Doctor Peter in the Kentucky Survey seems wellnigh impossible when it is considered that at the same time he lectured daily six times a week in two colleges--never omitting to prepare experiments in illustration of his subject. Some Eastern chemists were actually disposed to dispute the facts. One of these asserted that "no chemist could make more than one soil analysis in less than a month." Doctor Owen says in this regard: "Without a knowledge of the peculiar circumstances under which the work was performed, the amount of Doctor Peter's chemical labor during the last six years, as chemical assistant to the Survey of Kentucky, might appear incredible, for he has, in fact, performed a greater number of _reliable_, _detailed_, _practically useful_ analyses of soils than any living chemist"[73]--which comes with authority, for Doctor Owen, a man not given to exaggeration, was in position to view the whole field, and as Director fully and faithfully informed himself as to what was going on all over the world in matters relating to his department. Doctor Owen said no chemists in this country had thought proper to turn their special attention to soil analysis, but that Doctor Peter, with the help of only one assistant to do the more mechanical part of the work, had in six years of the survey made one thousand, one hundred and twenty-six quantitative analyses, three hundred and seventy-five of which were of soils in which, on an average, twelve different substances were determined. In addition to this and the preparation of his own chemical report, Doctor Peter personally supervised the publication of the four royal 8vo volumes of this Survey, reading and correcting all proof and adding an obituary biographical sketch of his friend Doctor Owen, whose death, November 13, 1860, had terminated the survey. Before arrangements could be made to continue this important public work the Civil War intervened, putting a stop to all such beneficent pursuits. Doctor Peter unhesitatingly and warmly upheld his adopted country against secession. Unable to take the field with his friend, Ethelbert Dudley, he promptly fell into the ranks of Dudley's Home Guards, shoulder to shoulder with Benjamin Gratz, Madison C. Johnson, David A. Sayre, and other such fellow-citizens.[74] He was appointed Acting Assistant Surgeon in charge of Military Hospitals at Lexington, Kentucky, being most of the time senior surgeon in charge, quickly bringing his hospitals to a high state of order and efficiency. It was this gift of reducing to system, combined with untiring energy and diligence, which in his long life tended to make all his work both rapid and successful. Thus he carried on simultaneously numbers of analyses with immense saving of time, while other chemists went through each operation separately--making his results almost beyond belief. When, after the war, the survey was resumed under Professor N. S. Shaler, Doctor Peter prepared three chemical reports of his analytical work, 1873-78. A total of four hundred and seventy-seven pages, containing eight hundred and seventy-one analyses. In the survey continued under the late John R. Procter, he prepared six reports, five of which were published, covering five hundred and eighty-eight pages, describing nine hundred and seventy-seven analyses--a total of one thousand, eight hundred and forty-eight published analyses. The sixth report--the ninth of the new survey--made to Procter, was not published for the lack of funds, and the manuscript seems to have been lost. The analyses, of which there are about four hundred, will be published, however, by the present able director of the newly resumed Geological Survey, Professor C. J. Norwood, in as nearly the original form as can be restored from the records. Thus, with the one assistant, Doctor Peter made for the new survey about two thousand, two hundred and fifty analyses. Besides which, during his active life in Lexington, he had at all times considerable practice as consulting and analytical chemist, making for individuals many analyses not included in the above. As a toxicologist he had a high reputation, and his expert testimony usually carried the day in cases wherein he was called. At the time of the First Kentucky Survey, under Doctor Owen, Doctor Peter had also contributed to the second report of a Geological Reconnoissance of the Southern and Middle Counties of Arkansas, made during the years 1859 and 1860, an octavo volume of four hundred and thirty-three pages, in which he gives the history of two hundred and seventy-one chemical analyses made by himself of soils, subsoils, under-clays, nitre-earths, etc., of Arkansas, with remarks in one hundred and twenty-five pages of report. At the same time he made chemical analyses of thirty-three soils, subsoils, etc., of the State of Indiana for the survey of that State begun by Doctor D. D. Owen and continued, on Doctor Owen's death, by his brother, Colonel Richard Owen. It will be seen by reference to the Kentucky Geological Reports that Doctor Peter was the first, or among the first, to point out the fact that the lower Silurian limestones always contain a notable quantity of phosphates, and that this circumstance in part accounts for the richness of our bluegrass soils[75]--facts which he brought to the attention of the agricultural public as early as April, 1849, in the _Albany Cultivator_, of New York. He was apparently the first to show that some of the upper layers of the Trenton limestone are remarkably rich in phosphates, as shown by his analyses published in the reports cited. In 1865, when in accordance with Honorable John B. Bowman's lofty educational plans Kentucky University was removed to Lexington, was united with Transylvania, and included the State Agricultural and Mechanical College, Doctor Peter occupied the chair of Chemistry and Experimental Philosophy in the new University, lecturing daily in two colleges, having declined the Presidency of the Agricultural and Mechanical College, which was offered him by Regent Bowman. At this period he devoted his every energy of mind and body to assist in the upbuilding of what he fondly hoped would be the great educational institution of the West and South; for the training especially of Kentucky's youth of every rank and creed, and for the benefit of all men of all nations who sought knowledge.[76] He accepted and accomplished, it was said at the time, the work of three average men. On the separation of the State College from the Kentucky University, after a bitter sectarian controversy in which he manfully defended the Transylvania trusts--little understood by some of the controversialists--he remained with the State College at the head of the Chemical Department.[77] In 1887, Doctor Peter was made Emeritus Professor of Chemistry in the State College. It would be of interest to give a detailed account of Doctor Peter's writings, but this must of necessity be reserved for a more extended biography. He was an easy, practical, and prolific writer on a large range of subjects. Deeply interested in agriculture and horticulture, he prepared many able treatises for journals of these branches. He experimented for himself in the culture of fruits and flowers--notably in grape-culture and wine-making. In 1867-68, he assisted in editing the _Farmer's Home Journal_, a weekly published at Lexington, Kentucky, and until its discontinuance--well in the seventies--he contributed many articles. He was sole editor of the tenth volume of the _Transylvania Journal of Medicine_, and in the preceding and following volumes published a number of contributions on medical and scientific themes. He took an active part with his pen in the controversy which arose on the attempted removal to Louisville of the Transylvania Medical School by some of the Transylvania professors and the establishment at Louisville of the "Medical Institute" as a rival school.[78] Like Doctor B. W. Dudley, Doctor Peter, under a misapprehension of the facts, was at first inclined to sanction the removal of the medical school to Louisville, for he says in a "Narrative" of the controversy published in the _Lexington Intelligencer_, July 7, 1837: "I was in favor of the removal of the Transylvania Medical School when I believed it was to be done with the consent of its legal guardians, and with the certainty of very liberal endowments, which would increase its means of instruction; but when the bubble burst--when it was found that the name of Transylvania, the oath of office--_principle_, in fact, were all to be sacrificed to the splendid scheme--I drew back." And from listening to Doctor Caldwell's flattering offers of emoluments in Louisville--even to the promise that Doctor Peter should have the superintendence of the erection of the chemical laboratory--he joined Dudley in maintaining the Transylvania School at Lexington, vigorously defending Dudley, and himself also, against the attacks of the Caldwell faction. In the midst of the general hostility, Doctor Peter became antagonistic to his former friend, Doctor Yandell--indeed, bitter was the strife on all hands. But in after years, when the better part of half a century had rolled between, Doctor Peter, on the friendly advance of Doctor Yandell, forgot the vindictive feeling of the past and a correspondence both pleasant and profitable sprung up between the two old men, which was maintained until the death of Doctor Yandell. Doctor Yandell confessed that in the heat of contention he had said much which afterward he fain would recall. And it is readily to be credited that others felt the same when time was given for calm and dispassionate reflection. Doctor Peter at all times wrote much on education, much on politics and the questions of the day. Beside lectures to his classes, he gave by request many public lectures on various topics. Possessing no especial gift of voice or enunciation, he was not an orator, though as a lecturer uniformly popular; never dry, though full of information; sometimes humorous, but ever dignified. He never neglected, where appropriate, to illustrate his subject with experiments, frequently new and always skillfully performed. His rapidity and sureness of manipulation were nearly that of the prestidigitator, and were the boast and admiration of his pupils. But with this complete mastery of science there was no corresponding lack of business ability. More than once he was offered civic honors--vainly, however. Once he agreed to act as City Councilman, but summarily resigned because the Council unjustly denied to respectable colored citizens the right to establish a public school for negroes in Lexington--a refusal we can not understand to-day. He was ever ready to give time, labor, and money to public education and improvement; ready instantly to take up his pen on all questions affecting the welfare of the community in which he lived, regardless of applause, yet valuing the approval of the wise and good. His modesty was inherent. He utterly abhorred ostentation. Yet no citizen was better known, or could more surely rely upon the love and respect of his fellows--respect secured by thorough truthfulness and honesty of purpose--the "courage of his convictions" which never left him. He retained his activity of mind and body, his youthful appearance, his cheerfulness of spirit, up to a very short time before his death, which took place at "Winton," eight miles from Lexington, in the eighty-ninth year of his age, April 26, 1894. He had, as he had often wished, "worn out rather than rusted out." Perhaps the words of his colleague of more than twenty years make the best summary of his life and character: "Intense devotion to physical science and work of the laboratory, purity of speech and modesty of manner, fidelity to all duties, domestic, professional, and civic, fidelity to settled convictions and principles; above all, his long and illustrious career in educating so many thousands of the young, and in setting before them a model so worthy of their imitation and remembrance; these were the traits, this was the service that crowned his busy life of nearly ninety years with honor, admiration, and renown." PROFESSOR JAMES CONQUEST CROSS, M. D. Born in the vicinity of Lexington, Kentucky, was early distinguished for superior natural energy and mental ability. He was a graduate of Transylvania and most ambitious to take place as member of its Faculty. Appointed to the chair of Institutes of Medicine in 1837, having been called from the Medical College of Ohio, at Cincinnati, where he held a professorship, he occupied the position in Lexington until 1843-44, and died a few years thereafter. He was Dean of the Medical Faculty in 1838. Doctor Cross contributed several papers to the medical journals, but wrote no large work. He was distinguished for readiness and brilliancy rather than for solidity. His strong ambition and self-confidence, with his considerable abilities and extensive reading, gave promise of a most distinguished career, which unhappily a certain want of mental ballast measurably prevented.[79] DOCTOR JOHN EBERLE[80] Was a native of Lancaster County, Pennsylvania, and was a little over fifty years of age at the time of his decease. Born and educated among the Germans of Lancaster, he retained the peculiar accent and idiom of that people to the day of his death, as also their habits of industry and perseverance in favorite pursuits. At an early period of his history, Doctor Eberle was deeply involved in politics and for some time conducted a German political paper. Prior to his removal to Philadelphia, which occurred about the year 1818, he published several interesting papers in the _New York Medical Repository_ and other journals. Shortly after his settlement in Philadelphia, he became the editor of the _American Medical Recorder_, known throughout the country as one of our ablest periodicals. In 1822, his work on _Therapeutics and Materia Medica_ first appeared, after having encountered many obstacles that for a time seemed to preclude its publication. The author assured the writer of this notice that he failed in all his attempts to procure a publisher, who would give him anything for the copyright, until the person who finally became its proprietor offered two hundred and fifty dollars for the work. Being the first book of the author, he accepted the offer in the hope of being more successful in his subsequent undertakings. In 1824, on the establishment of Jefferson Medical College, Doctor Eberle constituted one of its Faculty, and continued in the school until his removal to Cincinnati in 1831. While in Jefferson he taught the Theory and Practice, Materia Medica, and Obstetrics at different periods, and was also engaged as editor of the _American Medical Review_, a journal devoted especially to the interests of that school. While in the Jefferson Faculty he published the first edition of his work on _Practice_, which, it is well known, has passed through several editions, and unlike its predecessor yielded a handsome compensation to its author. In 1831, Doctor Eberle was invited (in connection with Doctors Thomas D. Mitchell and George McClellan) by Doctor Drake, to unite in the formation of a new medical school at Cincinnati. In the winter of 1831-32, the deceased gave his first course of lectures in the West as Professor of Materia Medica and Medical Botany in the Medical College of Ohio, in which school he remained until the fall of 1837, when he became connected with the Medical Department of Transylvania. While in Cincinnati, he prepared his work on the _Diseases of Children_, for which the publishers gave him a fair compensation, and it is understood that he was engaged a year ago in getting ready for the press _A System of Midwifery_. That he was importuned by his publishers in Ohio to prepare such a work is known to the writer of this notice. In addition to the publications of Doctor Eberle above named, there were others of less magnitude. Among these we name a small work of a botanical character, for young students; and it may be noticed here that botany was a favorite study with the deceased. Doctor Eberle was not fond of the practice of his profession, or he might have become rich in its pursuit. He was devoted especially to books, and as a journalist he has not perhaps been equaled in the United States of America. In his deportment he was plain, unassuming, unostentatious; and his whole aspect was indicative of one who had long been a companion of the midnight lamp. Few there are in our profession whose labors have given them such extensive celebrity as fell to the lot of Professor Eberle. His _Practice of Physic_ is in almost every medical library in the West, and has been noticed with high commendation by foreign journalists. His death has left a chasm in the profession, and especially in the school of the West, that is greatly lamented. * * * * * Doctor Eberle died at Lexington, Kentucky, February 2, 1838, while filling the chair of the Theory and Practice of Medicine. PROFESSOR THOMAS DUCHE MITCHELL, M. D., Was appointed from the Medical College of Ohio to the chair of Chemistry and Pharmacy in the Medical Department of Transylvania in 1837. He was transferred to that of Materia Medica and Medical Botany in the following year, Doctor Peter having been called to the chair of Chemistry, etc. In consequence of the death of Professor John Eberle early in the session of 1837-38, Doctor Mitchell was required to fill both this and his own chair during the session, an arduous duty which he performed faithfully and to the satisfaction of all parties.[81] With equal ability and success he performed a similar double duty to the full satisfaction of his classes in the winter of 1844-45, when, in consequence of the death of Professor William H. Richardson, the chair of Obstetrics and Diseases of Women and Children became vacant. He was appointed to that chair. He was also Dean of the Faculty in the Transylvania School from 1839 to 1846. Doctor Mitchell was born in Philadelphia in 1791, in which city for three generations his ancestors resided. He died in the same city May 13, 1865, in his seventy-fourth year, having heroically performed his duties as Professor almost up to the time of his death, although he was a constant sufferer from painful neuralgic disease of the stomach, at times almost unendurable. His early education was in Quaker schools, the best in those times in that city, and in the University of Pennsylvania. After a year spent in a drug store and chemical laboratory he became office pupil of the late Doctor Parrish, and, after attendance on three full courses of medical lectures in the Medical Department of the University, he graduated in medicine. His thesis "On Acidification and Combustion" was published in the Memoirs of the Columbian Medical Society. His mind and pen always in active operation, he published papers in _Coxe's Medical Museum_, _New York Medical Repository_, _Duane's Portfolio_, and other periodicals. Early in 1812, he was appointed Professor of Vegetable and Animal Physiology in Saint John's Lutheran College, and, in the following year, as Lazaretto Physician, which office he held for three years. In 1819, he published a duodecimo volume on Medical Chemistry. From 1822 to 1831, he was actively engaged in medical practice at Frankford, near Philadelphia. In 1826, he founded a Total Abstinence Temperance Society, to the tenets of which he rigidly adhered during the whole of his life, deprecating the use of alcohol, even in the preparation of the tinctures of the apothecary. He was also a strict Presbyterian. In 1826, the honorary degree of A. M. was conferred on him by the Trustees of Princeton College, New Jersey. In the winter of 1830-31, he was called to the chair of Chemistry in the Miami University, and in the following summer to the same chair in the Medical College of Ohio, at Cincinnati, which was soon thereafter amalgamated with the Miami School, where he remained until called to the same chair in the Medical Department of Transylvania University in 1837. He was transferred, as before mentioned, in the following year to the chair of Materia Medica, Doctor Peter having been called to that of Chemistry, etc. Here Doctor Mitchell continued until the end of the session of 1848-49. In the summer of 1847, the Philadelphia College of Medicine held its first session, and Doctor Mitchell filled in it the chair of Theory and Practice, Obstetrics, and Medical Jurisprudence. In March, 1849, resigning his chair in the Transylvania School, he joined himself with the Philadelphia College with a view to a permanent connection. Declining tempting offers from medical schools in Missouri and Tennessee, he, in 1852, resigned his chair in Philadelphia and accepted that of Theory and Practice of Medicine in the Kentucky School of Medicine at Louisville. He performed the duties of that professorship to the satisfaction of all parties until 1854, when he resigned on account of ill health and returned to his native city. Recovering, in a measure, his health, he was chosen, without any movement on his part, to fill the chair of Materia Medica and General Therapeutics in Jefferson Medical School of Philadelphia. This chair he occupied up to the year of his death. Doctor Mitchell was an able and indefatigable writer and author. Without recurring to his earlier writings, he published in 1832 an octavo volume of five hundred and fifty-three pages, _On Chemical Philosophy_, on the basis of _The Elements of Chemistry_, by Doctor Reid, of Edinburgh. In the same year he produced his _Hints to Students_, and acted as co-editor of the _Western Medical Gazette_ with Professors Eberle and Staughton; contributed papers to the _New York Repository_, _Philadelphia Museum_, _Western Journal of Medicine and Surgery_, _Western Medical Recorder_, _Western Lancet_, _American Medical Recorder_, _American Review_, _North American Medical and Surgical Journal_, _Transylvania Medical Journal_,[82] _New Orleans Medical and Surgical Journal_, _Esculapian Register_, etc. In 1850, he published an octavo volume of seven hundred and fifty pages _On Materia Medica_, also an edition of _Eberle on the Diseases of Children_, to which he added notes and a sequel of some two hundred pages. He also wrote a volume of six hundred pages _On the Fevers of the United States_, which he did not publish. Doctor Mitchell was a clear and impressive lecturer, a most industrious student even in his latter days, a learned, classical, and scientific scholar and a most rigidly upright and conscientious gentleman.[83] JAMES MILLS BUSH, M. D., A native of Kentucky,[84] born in Frankfort May, 1808, graduated as A. B. in Centre College, Danville, Kentucky, and began the study of medicine and surgery in the office of the celebrated Doctor Alban Goldsmith, Louisville, Kentucky. He removed to Lexington in 1830-31, to attend the medical lectures in Transylvania University, and to become a private pupil of its renowned surgeon, Professor Benjamin W. Dudley. To Doctor Dudley he became personally attached by sentiments of affection and esteem, which were warmly returned by his eminent preceptor; so that, when young Bush received the honor of the degree of Doctor of Medicine in 1833, Doctor Dudley immediately appointed him his demonstrator and prosector in Anatomy and Surgery, to which branches of medical science and art Doctor Bush was ardently devoted. This responsible office he filled with eminent ability and success until 1837, when he was officially made Adjunct Professor of Anatomy and Surgery to his distinguished colleague and friend, Doctor Dudley. He occupied this honorable position to the great satisfaction of all concerned until the year 1844, when he became the Professor of Anatomy, Doctor Dudley retaining the chair of Surgery. In the chair of Anatomy he continued until the dissolution of the Transylvania Medical School in 1857. In the meanwhile this school, in 1850, had been changed from a winter to a summer school; Doctor Bush, with some of his colleagues and some physicians of Louisville, having thought proper to establish the Kentucky School of Medicine[85] in Louisville as a winter school. In this latter college Doctor Bush remained for three sessions--giving thus two full courses of lectures per annum--when he and his Lexington colleagues, resigning from the Louisville school, returned to that of Lexington, re-establishing a winter session.[86] Doctor Bush was ever a most conscientious and ardent laborer in his profession, and, during the lifetime of his preceptor, Doctor Dudley, was his constant associate and assistant as well in the medical school as in his medical and surgical practice. On the retirement of that distinguished surgeon and professor, his mantle fell upon Doctor Bush. In the language of his friend, the late Doctor Lewis Rogers, in 1873: "When Doctor Dudley retired from teaching, Doctor Bush was appointed to the vacant chair. When Doctor Dudley retired from the field of his brilliant achievements as a surgeon Doctor Bush had the rare courage to take possession of it. No higher tribute can be paid to him than to say that he has since held possession without a successful rival." [Illustration: DOCTOR JAMES M. BUSH. From a Photograph by Mullen.] Most ably and successfully did he thus maintain himself as one fit to follow in the footsteps of our great surgeon. His sterling qualities as a man, his most kind and endearing manners as a physician, his great skill and experience in anatomy and surgery, which had been as well the pleasure as the devoted labor of his life; his remarkable accuracy of eye, the more acute because of congenital myopia, his delicacy of hand and unswerving nerve in the use of instruments in the most difficult operations, endeared him to his patients and won the respect and admiration of his medical brethren. Doctor Bush was a lucid and impressive teacher of his peculiar branch of medical art and science, and always attached his pupils strongly to him as an honored preceptor and friend. During his active lifetime, spent chiefly in acquiring and putting in practice the rare professional skill which distinguished him, he gave but little time to the use of his pen. Hence he left no large book as the record of his experience. His principal writings were published, in 1837, in the tenth volume of the _Transylvania Journal of Medicine_, and these were written for that journal on the solicitation of the present writer, who edited that volume. They consist of: 1. A short report of a case of epilepsy, produced in a negro girl by blows of the windlass of a well on the parietal bone, which was entirely and speedily cured under the preliminary treatment by Doctor Dudley of mercurial purgatives and low diet, preparatory to the use of the trephine, which, as is well known, had been used with great success by Doctor Dudley in such cases. 2. Report of a case of insidious inflammation of the pia mater, complicated with pleuritis--with the autopsy. 3. A more extended paper, entitled "Remarks on Mechanical Pressure Applied by Means of the Bandage; Illustrated by a Variety of Cases." In which the mode of application and _modus operandi_ are most clearly given, and illustrated by many interesting cases, mostly from the surgical practice of Doctor Dudley. 4. "Dissection of an Idiot's Brain." The subject--a female twenty-five years of age--had been born idiotic, blind, deaf, and dumb; the head was very small, and the brain on dissection was found to weigh only twenty ounces, and to have large serous cavities in the coronal portions of the cerebral hemispheres. The anatomy of the eyes was perfect, but there was no nervous connection between the optic nerve and the _thalami nervorum opticorum_. 5. A short notice of three operations of lithotomy, performed on May 31, 1837, by Doctor Dudley, with his assistance. 6. "Interesting Autopsy." On the body of a negro man who had been the subject of sudden falling fits, and was under treatment for disease of the chest. The autopsy disclosed hypertrophy of the right side of the heart, and a most remarkable course and lengthening of the colon. 7. "Observations on the Operation of Lithotomy, Illustrated by Cases from the Practice of Professor B. W. Dudley." An extensive and lucid description of the method of operation and the remarkably successful experience of Doctor Dudley in this part of his practice, giving report of one hundred and fifty-two successful cases up to that time. In addition, the Doctor contributed an occasional bibliographical review or notice. And these seem to be the whole of his published professional writings. Doctor Bush was married, in 1835, to Miss Charlotte James, of Chillicothe. Of their three children the eldest, Benjamin Dudley, was a young man of remarkable promise as a surgeon and physician when he was cut off, an event which cast a gloom over the remaining days of the life of his father. Few young men of his age had ever attained such proficiency or developed such sterling qualities.[87] The death of Doctor Bush, which took place on February 14, 1875, was followed by general and unusual manifestations of respect and regret, not only on the part of the members of the profession, but by the people of the city at large. Few citizens were more extensively known, loved, and honored in life or followed to the grave by a greater concourse of mourning friends. NATHAN RYNO SMITH, M. D., Was called from his residence in Baltimore, Maryland, to the chair of Theory and Practice of Medicine in Transylvania in the year 1838. He resigned the chair and returned to that city in 1840, having delivered three annual courses of lectures here. He was succeeded in this chair by Doctor Elisha Bartlett. Doctor Smith was born May 21, 1797, in the town of Cornish, New Hampshire, where his father, Nathan Smith--afterward Professor of Physic and Surgery in Yale College--had been for ten years in the practice of his profession. In a brief sketch of his father, Doctor Smith unconsciously drew the outlines of his own character. "In the practice of surgery," he said, "Professor Smith displayed an original and inventive mind. His friends claim for him the establishment of scientific principles and the invention of resources in practice which will stand as lasting monuments of a mind fertile in expedients and unshackled by the dogmas of the schools." The father, at the age of twenty-four, after an early life of industry and adventure in the then new country, had been so impressed and attracted by witnessing a surgical operation that he at once devoted himself to surgery and medicine, and with such ardor and success that for forty years succeeding he was a distinguished member and teacher in his profession. The son, with much the same natural bent of mind, after receiving his early education at Dartmouth and graduating at Yale in 1817--spending a year and a half in Virginia as a classical tutor--began the study of medicine in Yale, where his father was Professor of Physic and Surgery. He there received the degree of Doctor of Medicine, in 1823. He began practice in Burlington, Vermont, in 1824. In 1825, he was appointed Professor of Surgery and Anatomy in the University of Vermont, the Medical Department of which was organized principally by his exertions, aided by his father. In the winter of 1825-26, he attended the medical lectures in the University of Pennsylvania, with a view to improvement in his profession and in the art of teaching in it. While there he was invited by the late celebrated surgeon, George McClellan--to whom he had become favorably known--to take the chair of Anatomy in the new Jefferson Medical College, which McClellan and other members of the profession were engaged in organizing. This situation he occupied with success for two years, leaving it then to accept the chair of Anatomy in the School of Medicine of the University of Maryland in Baltimore, which had been vacated by Professor Granville Sharpe Pattison, in 1827. In Baltimore he soon acquired an extensive medical and surgical practice. On the death of Professor John B. Davidge he was transferred to the chair of Surgery. In the language of his biographer and colleague, Samuel C. Chew, M. D.: "In Baltimore he found a congenial home and when, at the age of fourscore, he was laid to rest among us, his name had been for a whole lifetime a household word throughout our State." When, in 1838, he accepted the inducement offered him by the Medical Faculty of Transylvania University to occupy the chair of the Theory and Practice of Medicine in their college at Lexington, Kentucky,[88] during the four months of the winter course of lectures, he did not abandon his residence in Baltimore, but at the close of each session returned to his professional work in that city. It was there especially, as a professor and practitioner of surgery, that his life-work was done. Doctor Smith was a man of remarkable mental activity, "acuteness of perception and extraordinary power of adaptation to circumstances as they might arise, promptness of action and untiring industry.... And yet with his great gifts there was about him a remarkable simplicity of character and a transparent ingenuousness which was as incapable of affectation as of falsehood." His forte was Surgery, yet his lectures here on the Theory and Practice of Medicine were exceedingly clear and instructive. One little peculiarity of his may be noticed. He never lectured without a small whalebone rod or pointer. Without this in his hand he seemed to fear the loss of continuity of his ideas. As remarked by his biographer, "his wand must always be at hand, for, like the magician's divining-rod, it seemed to have some mystic connection with the exercise of his powers." Early in his professional life he published his work on the _Anatomy of the Arteries_, and, in his later days, his work on _Fractures of the Lower Extremities_. He was engaged in the preparation of a work on surgery at the time of his death. His inventive genius, which was remarkable, was exhibited in several improvements of the instruments and apparatus of surgery, especially in his lithotome. In the practice of his son--Professor Alan P. Smith--in a series of fifty-two consecutive cases, without a single death, he used his father's lithotome in all but six cases. This great success he attributed mainly to the instrument. Another valuable improvement was his "anterior splint." Doctor Smith died on the third of July, 1877, a few weeks after the completion of his eightieth year, full of honors. "He has left behind him a record of a great surgeon, a brave and true citizen and magnanimous gentleman." ELISHA BARTLETT, M. D., ETC. Born in Smithfield, Rhode Island, October 6, 1804. His parents, Otis and Waite Bartlett, were highly respectable members of the "Society of Friends." Their son, whose early education was under the auspices of this Society, possessed all the unostentatious virtues which characterized that sect. At the "Friends' Institution" in New York, under the celebrated teacher, Jacob Willett, he obtained a highly finished classical education. He subsequently attended medical lectures in Boston and Providence and graduated as M. D. at Brown University, Providence, in 1826. Soon after graduation he spent a year pursuing medical studies under distinguished professors in Paris, France, and in classical Italy. In 1836, he was elected as the first mayor of the town of Lowell; was re-elected at the end of his first term, and afterward, in 1840, was honored by election to the Legislature of Massachusetts. A _statesman_ and not a _politician_, he soon abandoned political life for the more congenial one of a medical teacher. [89]"In 1828, he was offered the chair of Anatomy in the Medical School at Woodstock, Vermont, which honor he declined. "In 1832, he was appointed to a Professorship in the Medical School at Pittsfield, Massachusetts, which he held for several years. He also held a chair one year in the Medical Department of Dartmouth College, and for one year in Baltimore. "In 1841, he was called to the chair of Theory and Practice of Medicine in the Medical Department of Transylvania University, which he occupied for three years with ability and success."[90] After a visit to Europe he again returned, in 1846,[91] to the Transylvania Medical College, teaching in the same chair for another three years. "He subsequently delivered a course of medical lectures in the Medical School at Louisville, giving also summer lectures at Woodstock, Vermont, and other places--his instruction being highly appreciated by his colleagues and most acceptable to his students. "At length he was called to an important professorship in the College of Physicians and Surgeons of New York. Here he continued for three years, when, compelled by failing health, he abandoned the position to retire to his paternal acres in Smithfield--to die, after a long and lingering illness, on July 19, 1855." His disease--partial paralysis of the lower extremities, with torturing neuralgia and finally softening of the brain, the result of lead poisoning, caused--as he believed, and as he informed the writer--by the use of water which had passed for a considerable distance through leaden pipes. The beautiful and sterling traits of the character of Doctor Bartlett are most happily portrayed by the distinguished medical professor and poet, Oliver Wendell Holmes, in the _Boston Medical and Surgical Journal_, August 16, 1855, from which we make a few extracts, viz: "Hardly any American physician was more widely known to his countrymen, or more favorably considered abroad, where his writings had carried his name. His personal graces were known to a less extensive circle of admiring friends.... To them it is easy to recall his ever-welcome and gracious presence. On his expanded forehead no one could fail to trace the impress of a large and calm intelligence.... A man so full of life will rarely be found so gentle and quiet in all his ways.... The same qualities which fitted him for a public speaker naturally gave him signal success as a teacher. Had he possessed nothing but his clearness and eloquence of language and elocution, he could hardly have failed to find a popular welcome.... He had a manner at once impressive and pleasing, a lucid order which kept the attention and intelligence of the slowest hearer, and attractions of a personal character always esteemed and beloved by students.... Yet few suspected him of giving utterance in rhythmical shape to his thoughts or feelings. It was only when his failing limbs could bear him no longer, as conscious existence slowly retreated from the palsied nerves, that he revealed himself freely in truest and tenderest form of expression. We knew he was dying by slow degrees, and we heard from him from time to time, or saw him always serene and always hopeful while hope could have a place in his earthly future ... when to the friends he loved there came, as a farewell gift, ... a little book with a few songs in it--songs with his whole warm heart in them--they knew that his hour was come, and their tears fell fast as they read the loving thoughts that he had clothed in words of beauty and melody. "Among the memorials of departed friendships we treasure the little book of 'songs,' entitled _Simple Settings in Verse for Six Portraits from Mr. Dickens' Gallery_, Boston, 1855--his last present, as it was his last production." DOCTOR LOTAN G. WATSON, Of North Carolina, filled the chair of Theory and Practice in Transylvania in the sessions of 1844 and 1845 only. He came highly recommended as a physician of extensive practice of not less than twenty years. "A gentleman of undoubted talents. He has the reputation of bringing to his cases a great affluence of resource and fertility of expedient, regulated by a judgment discriminative and safe. He writes with facility and elegance, and converses with fluency, animation, and impressiveness. He thinks clearly and communicates his ideas with facility and a corresponding clearness." Extract from letter of Senator W. P. Mangum, of North Carolina. LEONIDAS M. LAWSON, M. D., Who filled the chair of General and Pathological Anatomy and Physiology in the Medical Department of Transylvania University from 1843 to 1846, inclusive, was born in Nicholas County, Kentucky, September 10, 1812. He had received his medical degree from this same department of Transylvania in 1837. He was engaged in Cincinnati in private practice, giving clinical instruction in the hospital and editing his recently established medical periodical, _The Western Lancet_--of which he was sole originator and proprietor--when he was called to the newly established chair of General and Pathological Anatomy and Physiology in the Transylvania Medical Department, in which he had graduated. Here he taught with great success until called to the chair of Materia Medica and General Pathology in the Ohio Medical College at Cincinnati in 1847. During the vacation months of 1845, he spent seven months in a visit to Europe, and especially in clinical studies in Guy's Hospital, London, with great advantage to himself. Doctor Lawson continued to teach from this chair until the death of Professor J. P. Harrison, whom he succeeded in that of the Principles and Practice of Medicine and Clinical Medicine, in the same college in 1852. He was appointed Professor of the Theory and Practice of Medicine in the Kentucky School of Medicine in Louisville in 1854, but accepted a call to the same chair in the Medical College of Ohio, Cincinnati, in 1857. He filled the chair of Clinical Medicine in the University of Louisiana, New Orleans, in 1860, but returned in consequence of the Civil War to the Medical College of Ohio the following year, in which college he remained until his death, January 21, 1864. He founded the _Western Lancet_, and was its sole editor and proprietor from 1842 up to the time of his decease. He also edited _Hope's Morbid Anatomy_, 1844, and published a treatise on the _Practical Treatment of Phthisis Pulmonalis_ in 1861. Doctor Lawson was a lover of his profession and a most indefatigable worker and student. Remarkably lucid and impressive in his oral teachings, and methodical in his laborious professional and editorial occupations, he was a modest but self-possessed, undemonstrative gentleman of high probity and personal merit. The world at large did not fully appreciate his value, or that of his labors. His daughter, Miss Louisa Lawson, studied sculpture as a profession, and as an artist is well known. ETHELBERT LUDLOW DUDLEY, M. D., Nephew of the late distinguished surgeon, Benjamin W. Dudley, was his private pupil for many years. He graduated in the Medical Department of Transylvania University with distinguished honor in 1842, after having attended three full courses of instruction in that department. His first course of medical lectures was in the winter of 1838-39. It was the first session in which the present writer occupied the chair of Chemistry and Pharmacy, and well he remembers the assiduous attention of his pupil; his avidity in the acquisition of knowledge and his unusual ability to retain it. Distrusting yet his own attainments and desirous of more thorough training before taking upon himself the responsible and arduous offices of a practitioner, he, under the immediate charge of his uncle, then in active practice, attended two other full courses of medical lectures (sessions 1842-43 and 1843-44) as resident graduate. During this period he sometimes officiated as prosector to his distinguished kinsman.[92] [Illustration: DOCTOR ETHELBERT L. DUDLEY. From a Photograph.] Before the next following session, Doctor Ethelbert L. Dudley was appointed Demonstrator of Anatomy in the place of Doctor James M. Bush, who had been promoted to the chair of Anatomy. This responsible office he filled until called to the chair of General and Pathological Anatomy in 1847-48. From the origin of this medical school Professor Benjamin W. Dudley had taught in the combined chair of Anatomy and Surgery, blending the two in a manner most instructive and practical.[93] In 1837, he accepted Doctor James M. Bush as adjunct to the combined professorship, and in 1844, Doctor Bush having been appointed Professor of Anatomy, the elder Dudley restricted himself to the chair of the Principles of Surgery. In the summer of 1846, Doctor Ethelbert L. Dudley was appointed to deliver a course of lectures on Comparative Anatomy. This duty he performed to the highest satisfaction of all concerned; and when, almost at the beginning of the next regular session (1847-48), he was called to the chair of Anatomy and Physiology, he successfully encountered the great labor of preparing and delivering a new course of lectures on these subjects. At the same time he also discharged the arduous duties of Demonstrator of Anatomy--duties more onerous in this school, in our small inland city, than in most other medical colleges. No one in the whole school accomplished half the work which he mastered. No task seemed too great for his young and ardent energies. In 1849, he originated and took upon himself the sole charge as editor of the _Transylvania Medical Journal_, a new series of the old _Transylvania Journal of Medicine_. He published three volumes in three successive years, aided only occasionally by some of his colleagues. In the spring of 1850, he visited Europe for professional improvement, making many friends; amongst the distinguished medical men of England particularly. Immediately on his return from Europe, in the autumn of that year, the present writer announced to him, in the city of New York, his appointment to the chair of Descriptive Anatomy and Histology in the Kentucky School of Medicine. This was a new school which some of the physicians of Louisville and professors of the Lexington school were about to establish in the former city, to which place students of medicine from the South and West were beginning to flock, to the neglect somewhat of the time-honored Transylvania school, in which it was proposed to continue medical instruction in summer sessions. This appointment he accepted, joining in the preliminary October course of lectures and aiding greatly by his talents and energy in building up that institution. Transferred in the following year to the chair of Surgery in the Transylvania summer school, on the retirement of his uncle from active professional life, he continued to teach with distinguished ability in the position made illustrious by his predecessor, until the close of the school shortly before the outbreak of our Civil War. In the second year of the Kentucky School of Medicine, he was transferred to the chair of Surgical Anatomy and Operative Surgery, and accordingly gave the surgical-clinical instruction in the Marine Hospital of Louisville to the combined classes of the two medical schools of that city during the session of 1851-52. A course which was a decided success for the young professor and surgeon, and which helped to place him at once on the elevated position as a professional man and a gentleman which he maintained to the day of his death and to which few men, of his age especially, ever are fortunate enough to attain.[94] After another successful session in this school he, with the other Transylvania professors, resigned and returned permanently to Lexington, resuming his practice there and his duties in the renewed winter sessions of the Transylvania Medical Department. As a practitioner, especially of surgery, Doctor E. L. Dudley always commanded the highest respect and admiration of his colleagues as well as the confidence and affections of his patients. Singularly unselfish and always willing to devote himself fully to his profession, his patients and his friends, few men had the power so quickly and so firmly to bind others to him with the ties of affection. With nerves as of steel, clear eye, quick judgment and answering hand, combined with the kind feelings of a woman and a fullness of professional knowledge rarely surpassed, his short career as a surgeon--all too brief!--was yet a brilliant one. Had his life been spared to him the name of Dudley had achieved a yet higher distinction in the annals of surgery. At the outbreak of our Civil War, Doctor Dudley's loyal attachment to the nation and his love of country caused him to take an active part against the rebellion. While the fate of Kentucky hung yet in the balance of a professed neutrality, he was actively instrumental in organizing a battalion of "Home Guards," of which he was at once appointed Commandant--an organization which greatly helped to prevent the precipitation of our State into the war for secession.[95] Obtaining authority to organize a regiment of volunteers for active service, of which he was Colonel, preferring this active position to the less belligerent one of Medical Director which was proffered him, he left Lexington with his command for the southern part of the State. There, exhausted by the continued labors and exposures of his combined offices of colonel, surgeon and physician to his men (which he would not commit to another), he fell a victim to typhoid fever on February 20, 1862, at the age of forty-four. His remains, brought to Lexington, were received with public honors and were followed to the cemetery by a long procession of sorrowing friends. SAMUEL ANNAN, M. D., Was born at Philadelphia, Pa., in the year 1800--a descendant of Scotch ancestors. He graduated as M. D. at the Edinburgh University in 1820. His thesis, entitled _De Appoplexia Sanguinia_, is in the library of the Medical and Surgical Faculty of Maryland. He was licentiate of the Medical and Chirurgical Faculty of Maryland in 1822, being then ex-President of the Royal Physical Society of Edinburgh. From 1827 to 1834, he ably occupied the chair of Anatomy and Physiology in the Medical Department of Washington University at Baltimore, Maryland. From 1838 to 1845, he was physician to the Baltimore Alms-house. In 1846, he was called to the chair of Obstetrics and Diseases of Women and Children in the Medical Department of Transylvania University, a position which he occupied with great ability until, in 1849, he was transferred to the chair of Theory and Practice of Medicine in the same institution, in which he gave general satisfaction until 1854, when he resigned that position. During the years 1853-57, he was Superintendent to the Insane Asylum at Hopkinsville, Kentucky. He became surgeon to the Confederate States Army at the outbreak of our Civil War in 1861, maintaining that position until 1864. In 1866, he was surgeon to the steamship "Carroll" of the Liverpool line, from April to November. He died at Baltimore, January 19, 1868. Doctor Annan was a person of great activity of mind and body, of high intelligence and probity of character. In the course of his active life and practice in his profession he found time to contribute many valuable articles to the medical journals, of which we quote the following, viz: "Cases of Bronchotomy." Maryland Medical Recorder, Vol. VII, p. 42. 1823. "On the Surgical Anatomy of Hernia." Ibid., Vol. III, p. 529. 1829. "On Polypus Nasi." Ibid., No. 3, p. 655. 1830. "On the Use of Wine in Fevers." Ibid., p. 279. 1831. "Address to the Graduates of Washington University." 1834. "New Views of Certain Dislocations." American Journal of Medical Science, Vol. XVIII, p. 376. 1836. "On the Treatment of Prolapsus Ani." Ibid., p. 334. 1836. "On Spinal Irritation and Inflammation." Ibid., Vol. XX, p. 85. 1837. "On Cases in the Baltimore Alms-house." Ibid., Vol. XXII, p. 378. 1838. "On Wind Contusions." American Medical Journal, Vol. II, pp. 3, 133, and 213. 1838. "On Cases in the Baltimore Alms-house." Journal of Medical Science, Vol. XXIV, p. 316; and Journal of Medical Science, Vol. XXV, p. 32. 1839. "On Cases in the Baltimore Alms-house." Medical and Surgical Journal, pp. 322 and 338. 1840. "Lecture at Opening of Kentucky School of Medicine." 1850. "On Fracture of the Skull." American Medical Record, No. 3, Vol. II, p. 449. "Case of Laceration of the Ileum from External Injury." American Journal of Medical Science, p. 287. 1838. For most of the facts contained in this brief sketch of the active life of Doctor Annan we are indebted to the kindness of Doctor Oscar J. Coskery, of Baltimore. NOTE.--In 1850, Doctor Annan accepted the chair of Pathology and Practice of Medicine in the new Kentucky School of Medicine in Louisville, which position he occupied for two years with great ability, when he resigned to return to his native city. In 1849, when Doctor Annan was transferred to the chair of Theory and Practice, the chair of Obstetrics was filled by Doctor William M. Boling, of Montgomery, Alabama, for one session. Doctor Boling had taught in the Memphis Medical School of Tennessee, and was "favorably known in the South as a good practitioner, an able medical writer, and an excellent teacher." PROFESSOR HENRY M. BULLITT Occupied the chair of Materia Medica and Medical Botany with ability during the session of 1849-50, after which, with the aid of some of his Transylvania associates, he established the "Kentucky School of Medicine," which still maintains a prosperous condition. "Doctor Bullitt commenced the study of medicine at seventeen years of age, in the office of Doctor Coleman Rogers, senior, of Louisville, entering the Medical Department of the University of Pennsylvania as a pupil, and graduating with high honor in 1838. Returning to Louisville, he began the practice of medicine in partnership with Doctor Joshua B. Flint, thus continuing for many years, their office being the headquarters of the prominent physicians of this city. "Doctor Bullitt passed the year 1845 in Europe, where he took advantage of every opportunity of advancing in medical knowledge. He returned liberally equipped with the good fruits of his sojourn abroad. In 1846, he was elected a professor in the St. Louis Medical College and lectured there in 1846-47 and 1847-48. In 1849, he was elected to the chair of Materia Medica, etc., in Transylvania University.... In 1850, he was mainly instrumental in the establishment of the Kentucky School of Medicine in Louisville, aided by 'prominent members of the Faculty of Transylvania.' "In 1866, he was elected to the chair of Theory and Practice in the University of Louisville, and, in 1867, was transferred to that of Physiology. In 1868, he established the Louisville Medical College, with which he remained during the several years of his professional life, his increasing deafness greatly marring his social and professional enjoyments. "Doctor Bullitt was an able writer on professional subjects.... He held, successively, chairs in five medical schools," in all with great ability. "In 1866, he was elected Health Officer of the city of Louisville," which office he most ably filled.... "Doctor Bullitt was one of the ablest Health Officers the city ever possessed," and was author of many papers of "great merit in numerous medical journals. His great affliction, deafness, was all that prevented him from taking the foremost position among medical practitioners, teachers, and writers. But he bore the misfortune with singular equanimity and fortitude." Doctor Bullitt died on the seventh of January, 1880, after a number of weeks' confinement to his bed with Bright's disease. * * * * * The greater part of this brief sketch of the life of Doctor Bullitt is copied from an able obituary notice published in the _Louisville Journal_ at the time of his death. HENRY MARTYN SKILLMAN, M. D., Youngest child of Thomas T. and Elizabeth Farrar Skillman, born September 4, 1824, at Lexington, Kentucky, was educated in Transylvania University. He spent two or three years in the drug and apothecary business in Lexington, and commenced the study of medicine and surgery in 1844, graduating as Doctor of Medicine, etc., in 1847. He was appointed Demonstrator of Anatomy in the Medical Department of Transylvania University in 1848. In 1851, he was appointed Professor of General and Pathological Anatomy and Physiology, which position he occupied with skill and success until the close of the Medical College in 1857. Since that time he has devoted himself to the duties of his profession in medicine and surgery, being "one of the most skillful, successful, and accomplished physicians in Kentucky," and "having inherited the admirable qualities of his parents, is one of the most honorable and useful citizens of Lexington."[96] Since the above was written, the gentle and busy life of this last surviving member of the Transylvania Medical Faculty came suddenly to a close at his home in Lexington, March 21, 1902, at a quarter past four o'clock in the afternoon, apparently without warning. Only two hours previously, handsome and smiling and dignified as usual, he had visited a patient, and he expected in a few hours to resume his professional rounds when the last summons came. [Illustration: DOCTOR HENRY MARTYN SKILLMAN. From a Photograph by Mullen.] It is hardly possible for a man to depart this life without leaving an enemy, but if Doctor Skillman, in his fifty-four years of active professional life, had made even a few enemies they hesitated to declare themselves. His own nature was to see good in others; their defects were not made prominent by him. As he spoke no evil, so nothing but good was said of him. But with his amiable, benevolent, compromising disposition there was no trace of weakness. Strict in professional etiquette, immovable in principle, he repelled with gentle but irresistible firmness every effort to shake his integrity. The loveliness of his character and personality is best portrayed in "Luke, the Beloved Physician," a tribute paid, on his death, editorially in the _Lexington Herald_ by Kentucky's favorite orator and statesman, every word of which is as true as it is well-chosen and beautiful. Doctor Skillman held numerous offices of trust; was elected, in 1869, President of Kentucky State Medical Society and, in 1889, the first President of Lexington and Fayette County Medical Society, and was at the time of his death the oldest practicing physician in Lexington, having seen that city grow from eight thousand to thirty thousand inhabitants. It is claimed that he was the first physician to administer chloroform there. For two years during the Civil War he was contract surgeon for the Government. Doctor Skillman's father, Thomas T. Skillman, a native of New Jersey, came to Lexington in 1809, and soon founded there the largest publishing house in the Mississippi Valley, the name of T. T. Skillman on the title page of a work being a guarantee of its excellence and fitness for the family circle. In 1823, an edition of several thousand copies of the entire Bible was published by Mr. Skillman from stereotype plates sent from New York by the American Bible Society. He founded the _Evangelical Recorder and Western Review_, afterward edited by Reverend John Breckinridge, the young and talented pastor of "the McChord Church"; also the _Western Luminary_, in 1824, the first religious paper issued in the West. Doctor Skillman married, October 30, 1851, Margaret, daughter of Matthew T. Scott, President of the Northern Bank of Kentucky. Of their children only one is living, Henry Martyn Skillman, of the Lexington Security Trust and Safety Vault Company. SAMUEL M. LETCHER, M. D., Of a prominent Kentucky family, also a graduate of the Medical Department of Transylvania University who had won distinction in his profession in Lexington, was called to the chair of Professor of Obstetrics and Diseases of Women and Children in that school in 1851, and performed the duties of that chair with ability and success until the close of the Medical College in Lexington in 1857. During the Civil War he was placed in charge of a United States General Hospital in Lexington, a position which he held for some time, giving great satisfaction. He died February 1, 1863, in Lexington, Kentucky. JOHN ROWAN ALLEN, M. D., Who was Superintendent of the Eastern Lunatic Asylum at Lexington,[97] Kentucky, and who first introduced there the moral treatment of the insane instead of forcible means, was appointed Professor of Materia Medica and Botany in 1851, and performed the duties of this chair with great ability until the end of the session of 1855, when he resigned that position. DOCTOR WILLIAM STOUT CHIPLEY Was born in Lexington, Kentucky, October 18, 1810, the only son of Reverend Stephen and Amelia Stout Chipley, the forefathers of both of whom were pioneers of Lexington. Doctor Chipley was graduated at Transylvania in 1832, with marked honor. Not a great while after his graduation he took issue with Doctor Benjamin Dudley, the oldest and most renowned practitioner of the State--or indeed of the whole country. Doctor Dudley had published a treatise upon the treatment of a special disease. Doctor Chipley took an opposite view, expressing himself most boldly and brilliantly. His article was published in an advanced medical journal and copied widely. Chipley received widespread encomiums. Indeed, he came off with raised banner, and his colors have never since been furled. His success was progressive this article exemplifying his determination when convinced he was right. Later he went to Columbus, Georgia, feeling assured it was a fine opening for a young practitioner, and so it proved. He was soon launched into an almost phenomenal practice, extending across the Chattahoochee River into Alabama to the Indian nation, where his wonderful magnetism was felt to such a degree that he won the confidence--even friendship--of these savages. He would be detained days at a time ministering to them--a tribe, too, by no means regarded as friendly to the whites. In April, 1837, he married in Columbus, Georgia, Elizabeth Fanning, niece and adopted daughter of Colonel James Fanning, of Alamo fame. Doctor Chipley was at one time Mayor of Columbus, and made a brilliant reputation as an executive officer. At the entreaties of his mother and father, who were quite advanced in age, he turned a deaf ear to the opposition of his legion of friends in Columbus and returned to Lexington, Kentucky, where it seemed a flourishing practice did but await him. He was a very successful Professor of Transylvania in the chair of Theory and Practice of Medicine, from 1854 to 1857, inclusive. As a lecturer he had a wonderful flow of language. The possessor of a perfect voice and delivery, he chained the attention of all listeners. Often have I heard his patients say his sunshiny presence, his gentle, sympathetic touch in the sick-room, dulled pain and was better than drugs. He was a brilliant and forceful writer, the author of many medical works and the writer of numerous articles published in medical journals of the highest note. One small book of his gave him much notoriety. Chief Justice George Robertson, of Lexington, regarded it of such high worth that he gave fifteen hundred dollars to have it published and placed as a healthful guide in certain schools for boys. It was in 1855 that he took charge of the Eastern Kentucky Lunatic Asylum at Lexington. This proved a wide field for the development of the most astonishing tact and management of individuals. The attendants greatly admired him and yielded without question to his dictation. Gentle as a woman, adamantine after a decision, never acting hastily, maturing a subject before deciding--these characteristics were shown on all occasions where it pertained to the comfort of the poor creatures under his care. During his fifteen or sixteen years of most successful management of this institution, he made many radical changes for the amelioration of the condition of these unfortunates. Winter after winter he haunted the legislative halls in behalf of the Asylum, spending his own personal means most lavishly to meet this end--presenting one bill after another, which sooner or later were always honored. His enthusiasm and faithfulness carried conviction with them. When he took charge of the Asylum he found it a conglomerate mass--many from other States there--incurables, epileptics, idiots--all huddled together. He went carefully over the records and proceeded to institute a thorough weeding. First he notified the governors of the respective States to send for their own insane, giving them a stated time of grace, and telling them that if the call was not honored he would send the patients to their doors by one of his own attendants, which he did in several instances. This systematizing was a great step forward. The next thing he did was to induce the State to erect an institution for idiots, believing there were few born who were not capable of receiving some degree of cultivation. In time a home was built at Frankfort, the result proving his great wisdom. It was a matter of wonderment to see these poor creatures developing from a driveling state of nonentity into some capacity for the enjoyment of life, and even to a degree of usefulness. There were but few incapable of being taught some employment which rendered their life more than a mere existence, akin alone to the lower animals. To have succeeded in this was enough to mark any man's life. His philanthropy never slept. Then, through his direct intervention, the Asylum at Anchorage for incurables was erected; all these changes making room for those who stood a chance of being cured instead of their being turned, for the lack of room, from the sheltering care which might restore them. I think his influence was brought to bear upon the advisability of an institution for the deaf and dumb, which culminated in the home made for them in Danville. I think it was in or about the year 1857 he went to Europe, absolutely for the purpose of gaining an insight into better ways and means of the treatment of the insane and the construction of the buildings which were their homes. Though there was such an emptying of the old Eastern Kentucky Lunatic Asylum building, it soon became altogether insufficient to meet the demands. Applications poured in, and soon, after a hard-fought battle, the legislature made an appropriation to add to the old building, and promptly there was under construction a building which, when finished, for comfort and in a sanitary way was unequaled. This, years after his death, was destroyed by fire, and when rebuilt, I understand, was modeled after the old plan. He was his own architect, his whole heart and being merged in a desire to have all as nearly perfect as possible, developing thus a new talent. He always had in view a private asylum of his own. This purpose was crystallized when it became apparent that politics would govern the State institutions, though in opposition to all that was humane. He resigned December, 1869. He purchased "Duncannon," the beautiful Duncan home near Lexington. The site selected, lumber on the place, all plans formulated, having gained such advanced ideas from his long and successful experience he hoped to have an ideal shelter for those who preferred private treatment. On December 9, 1871, at eleven o'clock at night, snow on the ground, standing with his family and several whom even then he had under his charge around him, after barely escaping with their lives, he saw the "Duncannon" mansion reduced to ashes. This disaster crippled his efforts to the degree that he was forced to forego that which if carried through would have proven a monument to his memory of no small magnitude. He then rented a house in Lexington, where he had some patients under his charge, with a private attendant who had won many laurels in this capacity. Doctor Chipley was frequently called upon, even in other States, to decide in the courts as a specialist in insanity. He had a great number under his private treatment in their own homes, of whom the world never knew. He had innumerable offers of positions, but none seemed to appeal to him so much as one at College Hill, near Cincinnati, Ohio. He accepted this offer. His success here proved a very decided one, redeeming the institution from great financial stress and opening up astonishing possibilities. He had four sons--only one now living (1903)--and one daughter (the present writer). He left many friends in Lexington who were ever beckoning him back, and to the last he hoped to return where his heart was. But after only a few years of service at College Hill he contracted a cold from which he never recovered. He died February 11, 1880. Invitations had been issued for a reunion in honor of his aged mother, who was ninety-seven the day he died. A train was to be chartered and Lexington friends were to come. He has left a memory of his gathered laurels and honored name more precious than the gems of the universe. EMILY CHIPLEY JONES. DOCTOR JAMES MORRISON BRUCE Was a son[98] of John Bruce, a Scottish gentleman associated with Colonel James Morrison and Benjamin Gratz in the manufacture of hemp at Lexington, Kentucky, and was born at that place in 1822. After completing a collegiate education, he studied medicine with Doctor Benjamin W. Dudley, taking the degree of M. D. in Transylvania in 1843. He then spent three years in France, studying in the principal hospitals at Paris under the most eminent instructors. In 1846, he returned to Lexington to begin the practice of his profession. He was elected to the chair of Demonstrator of Anatomy in Transylvania Medical Department in 1850, continuing therein until the cessation of the school in 1857. Doctor Bruce's intrinsic merit was fully appreciated by his colleagues, who had great affection for him, but his excessively shrinking nature withheld him from taking the prominent position with the public to which his ability and learning entitled him. In truth, his chief characteristic was his modest, amiable, and retiring disposition. His specialty in medicine was eruptive disease. In the treatment of smallpox his professional brethren conceded him the highest place. For many years he was continuously elected City Physician, and holding this office he died, January 31, 1881, the sudden ending of his useful and kindly life being largely due to the exposure he so constantly and bravely encountered in his visits to the suffering poor during an unusually severe and trying winter. Says a fellow-physician,[99] "It was then that the great and good qualities of our friend and co-laborer, Doctor Bruce, shone pre-eminently. It was at a time when poverty and distress appealed to him that his great-heartedness, his forgetfulness of self, and his proficient medical skill forced itself before that public attention from which at all other times it timidly shrunk." Doctor Bruce married, in 1847, Miss Elizabeth Norton. Of his children Miss Elizabeth Bruce and Mrs. Charlotte B. Davis, of Lexington, survive him. DOCTOR ALEXANDER KEITH MARSHALL, Born February 11, 1808, performed the duties of the chair of Materia Medica in 1856. He had received a classical education from his father, the celebrated Doctor Louis Marshall, of "Buck Pond"; studied medicine with Doctor Ephraim McDowell, and completed his medical course at Transylvania. He was a handsome man, a forcible speaker, a prominent politician and Odd Fellow, and a member of Congress in 1855. He died at the home of his son, Louis, near Lexington, April, 28, 1884.[100] BENJAMIN P. DRAKE, M. D., A graduate of Transylvania Medical Department in 1830, occupied the chair of Materia Medica in the last year of the school in 1857. * * * * * During the last two years of the Medical Department of Transylvania University the Faculty were: Ethelbert L. Dudley, Surgery. James M. Bush, Anatomy. William S. Chipley, Theory and Practice. Samuel M. Letcher, Obstetrics, etc. Henry M. Skillman, Physiology and Institutes of Medicine. Alexander K. Marshall, Materia Medica and Botany, 1856. Benjamin P. Drake, Materia Medica and Botany, 1857. Robert Peter, Chemistry and Pharmacy; Dean. [Illustration: TRANSYLVANIA UNIVERSITY--MEDICAL HALL. Built in 1839--Burned in 1863.] From 1850 until the end in 1857, the existence of the school seems to have been an heroic struggle against fate. In spite of the fine Medical Hall, alluded to on the day of its dedication (November 2, 1840) by President Robert Davidson,[101] as "colossal in size and surpassing in architectural beauty," in spite of liberal endowments and "costly and complete apparatus, superior to any in the valley of the Mississippi, and not surpassed, if equaled, by any on the continent,"[102] the school languished. Notwithstanding the efforts of zealous Trustees and generous citizens, notwithstanding the diligence of an able Faculty, the classes steadily decreased from year to year until, in 1857, with only nine graduates, the Faculty in despair disbanded, and the time-honored Medical Department of Transylvania University was no more. Two factors more than all else (except as before mentioned, the impossibility of securing sufficient material for clinical instruction) had contributed to its demise--the retirement of Doctor Dudley in 1850, and the difficulty that existed in establishing the needed railroads throughout the State. The latter cause had been operating unfavorably and with increasing effect almost ever since the introduction of steam transportation. Enlightened thinkers had early recognized and urged the vital importance of railroads for Kentucky, and especially for Lexington and Transylvania, and had bravely advanced to conquer the difficulties of the situation, but with only discouragement and pecuniary loss for many years. The peculiar topography of the State, the constant alternation of hill and valley, the numerous streams, the hardness of the rock to be penetrated, made the building of railways very expensive, and capital was wanting. The wealth of Central Kentucky was in the soil, not in the purse, and without communication with the markets of the world this wealth was unavailable. In this manner enterprise was checked and Lexington sank into an apathetic state. It is true she had secured the distinction of having the first railroad in the West and the second in the United States,[103] but for years it only led to Frankfort, an interior town but twenty-eight miles distant. It was not until 1851 that it connected with Louisville. Of Doctor Dudley's influence upon the medical school Doctor David W. Yandell truly says:[104] "The history of the Medical Department of Transylvania University--its rise, its success, its decline, its disappearance from the list of medical colleges--would practically cover Doctor Dudley's career, and would form a most interesting chapter in the development of medical teaching in the Southwest. But it must suffice me here to say that Doctor Dudley created the medical department of the institution and directed its policy. Its students regarded him from the beginning as the foremost man in the Faculty. That he had colleagues whose mental endowments were superior to his he himself at all times freely admitted. He is said to have laid no claim to either oratorical power or professional erudition. He was not a logician, he was not brilliant, and his deliverances were spiced with neither humor nor wit. And yet, says one of his biographers, in ability to enchain the students' attention, to impress them with the value of his instructions and his greatness as a teacher, he bore off the palm from all the gifted men who at various periods taught at his side." But although these two would appear to be the more obvious reasons for the decline of the Medical Department of Transylvania, we can by no means ignore the injurious effect of rival medical colleges growing up at points more accessible and more progressive than Lexington could possibly be without rapid transit of some sort to make her own peculiar advantages available. Nor can we overlook the evil consequences of the opposition systematically shown to the Transylvania Medical School by the faction originating in the attempt to disorganize the institution in 1837. However, in reviewing all these influences, the prosperity of Lexington to-day (1904), her rapid growth, her increasing enterprise, her vigorous trade, the flourishing condition of her colleges and seminaries--all of which has come to her since the completion of the railroads centering in her--abundantly prove that this communication, above everything else, was her indispensable requirement. While the medical school was closed in 1857, the Academical Department of Transylvania University continued to be conducted at the Morrison College as a State Normal School,[105] under the Presidency of the distinguished Doctor Lewis W. Green, D. D., but was soon to be disorganized, after only two years of usefulness, on account of a supposed unconstitutionality. Thus Transylvania was again humbled to a low estate in educational distinction. Lexington herself was suffering an era of banishment, as we may say, for without proper railroad connections she was excluded from progress and rendered inaccessible to both labor and capital. The financial prosperity of her citizens was not such as to warrant the lavish hospitality formerly shown to strangers within her gates, and especially to the students in Transylvania. The enterprising individuals who remained to her were not sufficient in numbers to dispel by their most strenuous exertions the lethargy which had fallen upon the place. Such was the state of affairs immediately preceding the Civil War. The immense Medical Hall had reverted to the city and was deserted, save the laboratory in which was still being busily conducted the chemical work of the first Geological Survey of Kentucky; and save perhaps one of the smaller rooms, rented to a lodger. The survey had just received a sudden check in the death of the lamented Doctor Owen when the war still further darkened the prospect, during which, as a matter of course, the resumption of the survey was out of the question. The Morrison College was almost immediately appropriated by the United States Government for a general hospital, and, some time after, the Medical Hall, which as before mentioned was utterly destroyed by fire[106] during its occupation by the sick soldiers. The conflagration originated, it appeared, from a defective flue of a temporary frame kitchen, built adjoining.[107] The corner-stone of this Medical Hall had been laid July 4, 1839; Robert Wickliffe, junior, the well-beloved, making the address. It was dedicated November 2, 1840. Of Grecian architecture, massive and without ornamentation, it contained three great lecture rooms, with ample provision for light and ventilation. The amphitheatre was immediately below the cupola, being by this means lighted from above. There were three other large apartments--for the library, the anatomical museum, and for other medical teaching. Smaller rooms accommodated the laboratory, Faculty room, janitor's room, etc. Besides which were long halls or galleries utilized for natural history collections, museums of zoology, ornithology, geology, etc., as also for apparatus of divers sorts. The costly and complete chemical apparatus was well displayed and conveniently arranged in the immense lecture room for that department. [Illustration: ABSOLOM DRIVER. For many years Janitor at the Medical Hall of Transylvania University.] In the spacious lecture-room in the front of the building many fashionable and distinguished audiences had assembled on various occasions, not only to hear the gifted incumbent professors in due discourse of introductory or valedictory, but to be charmed with concerts by Ole Bull, Strakosch, Adelina Patti--who sang there on her first tour in this country--and other celebrities of the period. There the learned Guyot had instructed in geology; there unique "Tom Marshall" had uniquely delivered a unique course of lectures on History. Over the rostrum hung the portrait of Doctor Samuel Brown--the first medical professor. This lecture hall was lighted for evening assemblages, from the sides mostly, by "scounches," as they were called by the "ole Virginny" negro janitor. This factotum, "Absolom Driver," is unforgotten by any whose path some time ran parallel with his. For many years the keeper of the Medical Hall, his zeal and vigilance were unimpeachable, his dignified solemnity on state occasions unsurpassed. Contemptuous of letters--except for doctors--and with unshakable prejudice against "book learnin' for niggers," he was faithful in trusts with the matchless fidelity of the dog. "Bad boys"--the problem of philosophers and ordinary folk in all ages--was one of easy solution by "Uncle Absolom" with a bent nail at the end of a long pole. Charged upon with _elan_ with this unprecedented weapon, accompanied by an ominous war-cry, no truant could withstand, even though the artfully strewn broken bottles on the high back fence had been successfully outflanked. "Robbers" had their everlasting antidote at hand in the peculiarly uncanny, long, "one-barreled shotgun" with curious lock, which stood in the corner of the Faculty room. Nobody ever heard it "go off," but the mystery of it was what appalled one. Happily "Uncle Absolom's" death was nearly coeval with the closing of the medical school. To have witnessed the burning of his sacred temple, the Medical Hall, after all his "keer," would have broken his heart indeed. And now, bidding adieu to the shades of the grand old Transylvania Medical Department, conjured from the past by one now numbered with them, may the earnest wish be permitted with hope of realization, that some other hand with cunning in such craft will unveil to us the portraits of that bygone throng of brilliant men which constituted and which were the exponents of the honored Transylvania Law School. APPENDIX SCHEDULE A. SUCCESSION OF THE MEDICAL PROFESSORS IN THE MEDICAL DEPARTMENT OF TRANSYLVANIA UNIVERSITY, FROM 1799 TO 1857, INCLUSIVE. ------------------------------------------------------------------- -----+--------------------+-------------+------------+------------+ | | |Theory and |Institutes, | | Year.|Surgery.| Anatomy. |Practice of |Physiology, |Obstretics, | | | |Medicine. | etc. | etc. | -----+--------------------+-------------+------------+------------+ 1799 | Samuel | Samuel | Fred'ck | | Fred'ck | | Brown | Brown | Ridgely | | Ridgely | 1805 | | | James | | | | | | Fishback | | | 1809 | B. W. | B. W. | James |J. Buchanan | | | Dudley | Dudley | Overton | | | 1815 | " | " | " | | W. H. | | | | | |Richardson | 1817 | " | " | | | " | 1818 | " | " | " | | " | 1819 | " | " |Saumel Brown | Chas. | " | | | | | Caldwell | | 1820 | " | " | " | " | " | 1821 | " | " | " | " | " | 1822 | " | " | " | " | " | 1823 | " | " | " | " | " | 1824 | " | " | " | " | " | 1825 | " | " |Daniel Drake | " | " | 1826 | " | " | " | " | " | 1827 | " | " | J. E. Cooke | " | " | 1828 | " | " | " | " | " | 1829 | " | " | " | " | " | 1830 | " | " | " | " | " | 1831 | " | " | " | " | " | | | | | | | 1832 | " | " | " | " | " | 1833 | " | " | " | " | " | 1834 | " | " | " | " | " | 1835 | " | " | " | " | " | 1836 | " | " | " | " | " | 1837 | " | " |John Eberle |J. C. Cross | " | | | | | | | 1838 |[A]" | " |N. R. Smith | " | " | | | | | | | 1839 |[A]" | " | " | " | " | 1840 |[A]" | " | " | " | " | 1841 |[A]" | " | Elisha | " | " | | | | Bartlett | | | 1842 |[A]" | " | " | " | " | 1843 |[A]" | " | " |L. M. Lawson| " | 1844 | " |J. M. Bush | L. Watson | " | " | 1845 | " | " | " | " | T. D. | | | | | | Mitchell | 1846 | " | " | Elisha | " | Samuel | | | | Bartlett | " | Annan | 1847 | " | " | " |E. L. Dudley| " | 1848 | " | " | " | " | " | 1849 | " | " |Samuel Annan | " |W. M. Boling| 1850 |No winte|r session | of the Medi |cal College.| | 1851 | E. L. |J. M. Bush |Samuel Annan | H. M. | S. M. | | Dudley | | | Skillman | Letcher | 1852 | " | " | " | " | " | 1853 | " | " | " | " | " | 1854 | " | " |W. S. Chipley| " | " | 1855 | " | " | " | " | " | 1856 | " | " | " | " | " | | | | | | | 1857 | " | " | " | " | " | ------------------------------------------------------------------- [Footnote A: J. M. Bush, adjunct.] [Footnote B: R. Best, adjunct.] [Footnote C: H. H. Eaton, adjunct.] [Footnote D: R. Peter, assistant.] SCHEDULE A. (Continued) SUCCESSION OF THE MEDICAL PROFESSORS IN THE MEDICAL DEPARTMENT OF TRANSYLVANIA UNIVERSITY, FROM 1799 TO 1857, INCLUSIVE. ----------------------------------------- -----+------------+---------+------------ | Materia |Chemistry|Demonstrator Year.| Medica, | and | of |Botany, etc.|Pharmacy.| Anatomy. -----+------------+---------+------------ 1799 | | Samuel | | | Brown | 1805 | | | | | | 1809 | | | | | | 1815 | | James | | | Blythe | 1817 |Daniel Drake| " | 1818 | | " | 1819 | Chas. | " | | Caldwell | | 1820 | " | " | 1821 | " | " | 1822 | " | " | 1823 |Daniel Drake|[B] " | 1824 | " |[B] " | 1825 | " |[B] " | 1826 | C. W. Short| | 1827 | " | | 1828 | " | | 1829 | " | | 1830 | " | | 1831 | " |[C] L. P.| | | Yandell | 1832 | " |[D] " | 1833 | " |[D] " | 1834 | " |[D] " | 1835 | " |[D] " | 1836 | " |[D] " | 1837 | " | T. D. | | | Mitchell| 1838 | T. D. | Robert | | Mitchell | Peter | 1839 | " | " | 1840 | " | " | 1841 | " | " | | | | 1842 | " | " | 1843 | " | " | 1844 | " | " | 1845 | " | " | | | | 1846 | " | " | | | | 1847 | " | " | 1848 | " | " | 1849 |H.M. Bullitt| " | 1850 | | | 1851 |J. R. Allen | Robert |J. M. Bruce | | Peter | " 1852 | " | " | " 1853 | " | " | " 1854 | " | " | " 1855 | " | " | " 1856 | A. K. | " | " | Marshall | | 1857 | B. P. Drake| " | " ----------------------------------------- [Footnote A: J. M. Bush, adjunct.] [Footnote B: R. Best, adjunct.] [Footnote C: H. H. Eaton, adjunct.] [Footnote D: R. Peter, assistant.] SCHEDULE B OF THE MEDICAL DEPARTMENT OF TRANSYLVANIA UNIVERSITY FOR THIRTY-NINE YEARS. ----------------------------------- -----------+-----------+----------- Year. | Pupils. | Graduates. 1817-18 | 20 | 1 1819-20 | 37 | 7 1820-21 | 93 | 14 1821-22 | 138 | 37 1822-23 | 171 | 51 1823-24 | 200 | 46 1824-25 | 234 | 56 1825-26 | 281 | 65 1826-27 | 190 | 53 1827-28 | 152 | 53 1828-29 | 206 | 40 1829-30 | 199 | 72 1830-31 | 210 | 54 1831-32 | 215 | 74 1832-33 | 222 | 69 1833-34 | 262 | 66 1834-35 | 259 | 83 1835-36 | 262 | 75 1836-37 | 242 | 78 1837-38 | 227 | 84 1838-39 | 211 | 51 1839-40 | 257 | 62 1840-41 | 254 | 64 1841-42 | 271 | 57 1842-43 | 204 | 60 1843-44 | 214 | 59 1844-45 | 156 | 38 1845-46 | 171 | 64 1846-47 | 205 | 68 1847-48 | 169 | 53 1848-49 | 120 | 49 1849-50 | 92 | 35 1850-[E]51 | 50 | 21 [F]1851-52 | 50 | 23 [F]1853 | 51 | 19 [F]1854 | 53 | 31 [G]1855 | 38 | 29 [H]1855-56 | 38 | 11 [H]1856-57 | 32 | 9 +-----------+----------- Totals | 6,456 | 1,881 ----------------------------------- [Footnote E: Doctor Dudley resigned at the end of this session.] [Footnote F: Spring and summer session.] [Footnote G: Summer and winter session.] [Footnote H: Winter session.] Thus the records show that in thirty-nine years of the existence of the Medical Department of Transylvania University it taught six thousand four hundred and fifty-six pupils and conferred the degree of Doctor of Medicine on one thousand eight hundred and eighty-one of that number. The late Professor Thomas D. Mitchell, in speaking of its record, made the following remark: "That for its vigorous prosperity and the rapid increase of its classes, the medical school of Transylvania is without a parallel. Certainly in the United States there is nothing comparable to it. This is the highest eulogy the institution can receive. The most eloquent and forcible language in praise of it would be spiritless and feeble contrasted with the power of the foregoing figures." SCHEDULE OF THE SEVERAL ENDOWMENTS OF TRANSYLVANIA UNIVERSITY. ======================================================================== Date of | | | Donation| |Character of | Conditions Under or | |Donations or | Which they Grant. |Donors. |Grants. | were Given. --------+------------------+----------------------+--------------------- | | | 1780 |State of Virginia |8,000 acres escheated |For the purposes | | lands in Kentucky, | of a "Public | | value unknown | School" or seminary | | | of learning in | | | Kentucky. | | | 1783 |State of Virginia |12,000 acres escheated|For the purposes | | lands in Kentucky, | of a "Public | | value unknown | School" or seminary | | | of learning in | | | Kentucky. | | | 1783 |Individuals |Books, etc., value not|For the purposes | | known | of a "Public | | | School" or seminary | | | of learning in | | | Kentucky. | | | 1784 |Reverend John Todd|Small library and |"As an encouragement | | apparatus | to science." | | | 1787 |State of Virginia |One sixth surveyors' |For the public | | fees in Kentucky | school, etc. | | | 1791 |State of Virginia |A lottery grant to |To establish | | raise money | the school. | | | 1792-3 |Transylvania Land |Lot in Lexington |For the permanent | Co. | (5 acres) | site of the | | | Seminary. | | | 1795-8 |State of Kentucky |12,000 acres of land, | | | 6,000 acres to | | | Kentucky Academy and| | | 6,000 acres to the | | | Seminary | | | | 1794-5 |Individuals in |$14,000 in money and |Promotion of science, | various parts | books and apparatus | learning, and | and States | | virtue. | | | 1804 |State of Kentucky |A lottery grant |To build a Medical | | | College. | | | 1819 |State of Kentucky |Bonus of F. & M. Bank,|To aid the | | $3,000 | University. | | | 1820 |State of Kentucky |$5,000 in paper |To Medical College | | | for library, etc. | | | 1820 |City of Lexington |$6,000 in paper |To Medical College | | | for library, etc. | | | 1820 |State of Kentucky |Half profits of | | | Commercial Bank, | | | $20,000 in paper, 2 | | | per cent on auction |To aid the | | sales to law library| University. | | | 1822 |Citizens of |$4,832 |To aid the Medical | Lexington | | Department. | | | 1823 |Colonel James |$20,000 in money |To found a "Morrison" | Morrison | | professorship or | | | library. | | | 1823 |Colonel James |$50,000 residuary |To erect a "Morrison | Morrison | estate | College." | | | 1823 |State of Kentucky |A lottery grant |To build a medical | | |college at Lexington. | | | 1827 |Citizens and city |$3,000 per annum, the |To pay salaries of to 1829 | of Lexington | city giving $500 | President and | | | professors of the | | | University. | | | 1827 |Citizens and city |Insurance policy for | | to 1829 | of Lexington | $10,000 on the | | | burned University | | | edifice | | | | 1830 |W. C. C. Claiborne|$50 |To help build the | | | above. | | | 1839 |City of Lexington |$70,000 to build new |On condition to elect | | medical college, | Trustees and send | | enlarge library, | free scholarships. | | etc. | | | | 1839 |Transylvania |About $35,000 |To endow Morrison | Institute | | College, etc. | | | 1839 |Citizens of |$3000 |To purchase a lot | Lexington | | for the site of the | | | Medical College. | | | 1839 | | | to 1850 |Medical professors|Residuary debt on new | | | Medical College in | | | lieu of rent | | | | 1855-6 |State of Kentucky |$12,000 per annum for |Support of Normal | | two years | College in | | | Transylvania | | | University. | | | 1834 |His Britannic |Numerous old legal | | majesty | record books | --------+------------------+----------------------+--------------------- Many other persons, as Honorable Edward Everett, Mr. Swan, of France, etc., have at various times made valuable contributions to the Library. INDEX * Before figures means that the reference is to a foot-note on the pages indicated. PAGE Academical Department of Transylvania in 1857 160 Account rendered of books, etc., purchased by Doctors Bush and Peter *91 Act endowing Transylvania University 1 Allen, Doctor John Rowan *147 Allen, Doctor John R., notice of 147 Allen, Doctor John R., in Transylvania Medical School 147 Allen, Reverend R. T. P. *133 Anderson, Reverend W. H. *133 Anecdote of Doctor Samuel Brown 9 Anecdote of Doctor E. L. Dudley *137 Anecdote of Doctor John Esten Cooke 75 Anecdote illustrating progress 9 Anecdote of Titian 47 Annan, Doctor Samuel *115 Biographical sketch of 138 At Baltimore Alms-house 138 At Hopkinsville Asylum 139 At Washington University 138 Born 138 Character of 139 Degree of M. D. 138 Honors conferred upon 138 In the Civil War 139 In Kentucky School of Medicine 141 Professor in Transylvania 138, 139 Resigns from Transylvania 139 Surgeon on steamship 139 Writings of 139, 140 Apparatus, purchase of by Doctors Peter and Bush 90, 91 Appropriation for purchase of apparatus 31 Attractive logic of Doctor Cooke 76 Avery, Charles 88 Ayres, David J., M. D. 29, 30 Bartlett, Doctor Elisha 57, 120, *132 Biographical sketch of 125 As a poet 129 At Baltimore 126 At Dartmouth 126 At Transylvania 126 At Woodstock Medical School 126 Beautiful character of 127, 128, 129 Born 125 Death of 128 Degree of M. D. 125 Early education of 125 Goes to the Legislature 125 In College of Physicians and Surgeons, New York 127 In Medical School at Louisville 126 Letter of resignation *126 Mayor of Lowell 125 Poisoned by lead 127 Studies in Europe 125 Bartlett, Doctor John *115 Bartlett, Otis 125 Bartlett, Waite 125 Barry, Honorable William T. *35 Bascom, Reverend H. B. *132 Beginning of success of the Medical Department 29 Best, Doctor Robert 40 Best, Doctor Robert, died *40 Biographical sketch of Doctor Samuel Annan 138 Doctor Elisha Bartlett 125 Doctor Samuel Brown 6 Doctor J. M. Bruce 154 Doctor H. M. Bullitt 141 Doctor Joseph Buchanan 14 Doctor J. M. Bush 114 Doctor Charles Caldwell 47 Doctor W. S. Chipley 147 Doctor J. E. Cooke 64 Doctor James C. Cross 105 Doctor B. W. Dudley 15 Doctor E. L. Dudley 132 Doctor Daniel Drake 40 Doctor John Eberle 106 Doctor Leonidas Lawson 130 Doctor S. M. Letcher 146 Doctor A. K. Marshall 155 Doctor T. D. Mitchell 109 Doctor Robert Peter 88 Doctor William H. Richardson 33 Doctor Frederick Ridgely 10 Doctor Charles W. Short 78 Doctor H. M. Skillman 143 Doctor Nathan R. Smith 120 Doctor Lunsford P. Yandell 83 Bishop, Reverend Robert H. *35 Blane, Gilbert 8 Blythe, Reverend James 4, 7, 27, 28, 29, 30, 31, 32, 35 Acting President of Transylvania University 12 Appointed Professor of Chemistry in Medical Department 12 Died 12 President of Kentucky Academy 4 Resigns 12 Bodley, Thomas *46 Boling, Doctor William M. 141 Boswell, Joseph 38 Botanic Garden Company, stockholders 38 Bowman, Honorable John B. 99, 100, *100 Bradford, John 4, *46 Breckinridge, Lieutenant Ethelbert D. *137 Breckinridge, Reverend John 146 Breckinridge, Ensign J. Cabell *137 Breckinridge, General Joseph C. *137 Breckinridge, Doctor Robert J. *160 Brilliant era for Transylvania Medical School 34 Brittan, Mr., case of 67 Bronston, Honorable C. J. *160 Brown, Honorable John 7 Brown, Reverend John 6 Brown, John Mason *7 Brown, Orlando 9 Brown, Doctor Preston 7 Brown, Doctor Samuel 4, 7, 26, 34, 35, 38, 43, 46, 57, 163 Biographical sketch of 6 Anecdote of 9 Born 6 Died 6 Introduces cow-pox 9 Imports books, etc., for Transylvania 6 Personal appearance 8 Vaccination introduced by 4 Writings of 8 Bruce, Benjamin Gratz *154 Bruce, James M., biographical sketch of 154 Character of 154, 155 Children of 155 Degree of M. D. 155 Demonstrator of Anatomy in Transylvania 154 Education of 154 Parentage of 154 Studies in Europe 154 Bruce, Colonel Saunders D. *154 Bruce, William Wallace *154 Bull, Ole 163 Bullitt, Doctor Henry M. *115 Biographical sketch of 141 As Health Officer 143 As writer 142 Death of 143 Education of 141, 142 Establishes Kentucky School of Medicine 141, 142 Goes to Europe 142 Founds Louisville Medical College 142 In University of Louisville 142 In St. Louis Medical College 142 In Transylvania Medical School 141, 142 Bullock, Mrs. Waller O. *28 Buchanan, Doctor Joseph 13 In politics 14 Sketch of 14 Resigns 14 Burning of first University building 3 Burning of New Medical Hall 55, 161 Burning of Old Medical Hall 44 Bush, Benjamin Dudley 119 Bush, Doctor James M. 17, 63, 90, *91, 92, *115, 163 Biographical sketch of 114 As a teacher 117 Born 114 Character in his profession 116 Children of 119 Death of 119, 120 Degree of A. B. 114 Degree of M. D. 114 In Kentucky School of Medicine 115 Parentage of *114 Married 119 Opinion of Doctor Rogers on 116 Professor of Anatomy 17 Professor Adjunct in Transylvania 115 Removed to Lexington 114 Writings of 117, 118, 119 Bush, Miss Nannie M. *119 Bush, Captain Thomas J. *119 Caldwell, Doctor Charles 7, 31, 34, 35, 38, 40, 43, 46, 57, 64, 81, *82, 83, 84, 86, 87, 102 Biographical sketch of 47 Address on the L. & O. R. R. 60 Address at Lexington Lyceum 60 Antagonizes Doctor Rush 50, 51 At University of Pennsylvania 50 Born 49 Compares Transylvania with Philadelphia school 55 Dean of Faculty 53 Described by Doctor Gross *54 Died 49 Dismissed from Transylvania 62, 53 Early life in Philadelphia 51, 52 Effort to remove school to Louisville 61, 62 Extracts from autobiography of 49, 50, 51, 52, 53 Induces Legislature to give money 43 Mental activity of 51 Parentage of 49 Sets out for Europe 31 Yellow fever in Philadelphia 51 Caldwell, Thomas L. 38 Calomel, experience of Doctor Peter 69, 70 Experiment with, by Doctor Peter 72, 73 Irregular action of 69 Mammoth dose of Doctor Cooke 73 Properties of 68, 69 Calvert, Doctor William Jeptha *123 Causes of the decline of the Medical Department 57, 157 "Captain Neet's Rifle Guards" 58 Centenary of Lexington *3 Centennial Park 3 Ceremonies on laying the first "stone sill" of L. & O. R. R. 58, 59, 60 Chapman, George T. *46 Chapman, Reverend Doctor 75 Chemical work of Doctor Peter 95, 96 Chew, Doctor Samuel C. 122 Chipley, Amelia Stout 147 Chipley, Doctor William S. 156 Biographical sketch of 147 Advocates Deaf and Dumb Asylum 151 As a lecturer 149 As a specialist 153 As a writer 149 Asylum burnt 152 At College Hill 153 Burning of "Duncannon" 152 Death of 153 Establishes asylum at Anchorage 151 Goes to Columbus, Georgia 148 Goes to Europe 151 Graduates in Transylvania 147, 148 Marries 148 Mayor of Columbus 148, 149 Parentage of 147 Practices among Indians 148 Private asylum at Lexington 153 Professor in Transylvania 149 Purchases "Duncannon" 152 Return to Lexington 149 Takes charge of Lunatic Asylum 149 Takes issue with Doctor Dudley 148 Work for idiots 150, 151 Work for Lunatic Asylum 149, 150 Chipley, Reverend Stephen 147 Cholera of 1833 66, 67, *67, 73 Cholera of 1833, number of deaths *67 Churchill, Armistead 82 Churchill, Jane Henry 82 Churchill, Mary Henry 82 Citizens of Lexington subscribe to Medical Department 42 Clifford, John D. 31 Coit, Reverend Thomas W. *83 Coleman, James B. 58 Coleman, Nicholas D. *35 Combs, General Leslie 58 Completion of Lexington & Ohio Railroad 58 Consolidation of the Transylvania and Kentucky Universities 56 Consolidation of the Transylvania Seminary and Kentucky Academy 5 Cooke, Doctor John Esten 15, 21, 40, 57 Biographical sketch of 64 As a lecturer 77 Cases from the practice of 66, 67, 68, 71 Character, by Doctor Yandell *78 Characteristic anecdote of 75 "Cooke's pills" 73, 74 Died 64, 65 In cholera of 1833 66, 67 In Louisville 77, 78 In Transylvania Medical School 64 Fame of 64 Logic of 76 Mammoth doses of calomel 73 Method of making antimonial wine *65 Only fear of calomel 70, 71 Removed to Louisville 64 Removal from Virginia 64 Retired on pension 78 Sincerity of opinions 74, 75 Universal theory of disease 76 Use of calomel 65, 66 Writings of 64, 78 Cooper, Doctor Thomas 27 Cow-pox introduced 9 Criticism of Doctor Caldwell by Doctor Yandell 48 Cross, Doctor James Conquest 106, *132 Biographical sketch of 105 Born 105 Character of 106 Dean of the Faculty 105 Dismissed from Transylvania 105 Made medical professor 63 Professor in Transylvania 105 Writings of 105 Daguerre's wonderful discovery 91 Dallam, Major William S. 90 Dallam, Frances Paca 90 Davidge, Professor John B. 122 Davidson, Reverend Robert 157 Decline of the Transylvania Medical Department 157 Causes of 57 Dedication of Morrison College 90 Description of New Medical Hall 162, 163 Description of Old Medical Hall 44 Difficulty of travel in early times 31 Difficulty of procuring anatomical material 61 Director, first, of Transylvania Seminary 3 Donation of Reverend John Todd 2, 3 Donations of physicians of Lexington, etc. 43 Douglass, William, case of 66 Driver, Absolom 163, 164 Drake, Doctor B. P. 156 Drake, Doctor Daniel 7, 15, 32, 38, 107 Biographical sketch of 40 Advice to young practitioners 42 Born 40 Died 42 Founds school in Cincinnati 41 Gross's description of *42, 54 In Louisville Medical Institute 41 In Medical College of Ohio 41 In Philadelphia 41 Professor in Transylvania 41 Resigns 33 Resigns from Transylvania 41 Writings of 41 Yandell's description of 42 Dudley, Ambrose 15 Dudley, Doctor Benjamin W. 7, 11, 13, 27, 29, 30, 32, 35, *35, 38, 46, 53, 54, 57, 82, *82, 91, 102, 114, 115, *115, 117, 118, 119, *132, *133, 156, 157, 158, 159 Biographical sketch of 15 Appointed Professor of Anatomy and Physiology 13 As citizen 24 As medical practitioner 24 As surgeon 19 As a teacher 18 As a writer 21 Born 15 Character of 18 Contracts poison *26 Death of 18, *26 Duel with Richardson 25 Elected President _pro tem._ of Transylvania University 21 Exemplification of character 24 Influence on Medical Department 158, 159 First papers of 21 Last lectures of 17 Last productions of 23 Liberality of 25 Made Emeritus 17 Memoir of, by Yandell 23 Notice of two operations 20 Operations for lithotomy 19 Papers in _Journal of Medicine_ 22 Preparation of patients 20 Receives degree of M. D. 16 Recollections of school of 1815 27 Removal of Medical Department to Louisville 62 Removes to Lexington 15 Resigns 17 Roller bandage 20 Sensibility of 19 Studies in Europe 15, 16 Treatment for _fungus cerebri_ 22 Use of hot water 21 Withdraws from practice 17 Dudley, Ethelbert L. 17, 21, 23, 96, *115 Biographical sketch of 132 As editor 134 As medical student 132 As practitioner 136 Death of 138 Degree of M. D. 132 Demonstrator of Anatomy 133 Endearing attributes of 136 Energy of 133, 134 In the Civil War 137 Incident of Civil War *137 In Kentucky School of Medicine 134, 135 Raises regiment 137 Resigns from Kentucky School of Medicine 136 Teaches at Marine Hospital 135 Visits Europe 134 Dudley, Scott *137 Dudley, Reverend Thomas P. *26 Dudley, William A. 25 Duncan, General *110 Early advantages of Lexington 30 Eaton, Amos 84 Eaton, A. M., Hezekiah Hulbert 79, *79, 84, 89, *89 Character of 84 Death of 85 Eaton, General William *84 Eberle, Doctor John 109, *110, 113 Biographical sketch of 106 Appearance and character of 108 As practitioner 108 Botanical work of 108 Called to Transylvania 63 Death of 63, 109 Difficulties as author 106, 107 Early education and birth 106 Founds Medical School in Cincinnati, Ohio 107 Professor in Jefferson Medical College 107 Professor in Medical College of Ohio 108 Professor in Transylvania Medical Department 108 Writings of 106, 107, 108 Eclectic Institute 89, *89 Editors of _Transylvania Journal of Medicine_ 21 Effort to remove Medical School to Louisville 61, 62 End of Transylvania Medical Department 157 Epilepsy, cause of 21 Epilepsy, cure by Doctor Dudley 21, 22 Era of depression in Lexington 160, 161 Everett, Edward *46, 168 Faculty, first, of Kentucky School of Medicine *115 Faculty of Transylvania University in 1821 *35 Faculty of Transylvania University under the Methodists, 1842 *132 Fanning, Elizabeth 148 Fanning, Colonel James 148 Ficklin, Joseph 38 Final dispersion of Medical Faculty 157 First acting President of Transylvania Seminary 2 First Faculty of Kentucky School of Medicine *115 First Medical College in the Mississippi Valley 5 First meeting of Trustees of Transylvania University 5 First "Director" of Transylvania Seminary 3 First effort to establish a Medical College 5 First geological survey of Kentucky 94 First Grammar Master of Transylvania Seminary 2 First lecture room of Medical Department 29 First medical graduate 32 First medical lectures 29 First Medical Professors in Transylvania University 6, 26 First newspaper in the West 4 First operation of lithotomy by Doctor Dudley 20 First President of Transylvania Seminary 4 First railroad in United States *158 First Rector of Christ Church 2 First site of Transylvania University *97 First University building burned 3 Fishback, Jacob 13 Fishback, Doctor James 16, 26, 46 Appointed Professor in Medical Department 12 Character of 13 Death of 13 Legislator 13 Trustee in Transylvania *13 Writings of 13 Flint, Doctor Joshua B. *115, 142 Fry, Joshua 82 Garden, botanic 38 Garden, Thomas J. 30 Garrard, Governor 4 Geological survey of Kentucky begun 94 Geological survey resumed 98 Goldsmith, Doctor Alban 114 Government appropriation for rents and destruction of Transylvania University property *162 Graham, Doctor Christopher C. *17, 20, *27, 28, *133 Adventures as medical student *33 Reminiscences of 28 Gratz, Benjamin 3, 38, 46, 97, *109 Gratz, H. H. 3 Gratz Park 3 Green, Doctor Lewis W. 160 Griswold, Henry A. 79, *89, 93 Gross, Doctor S. D. *42, *54, *81 Guyot, Professor 163 Hall, Reverend Nathan H. 59, *106 Hall, Doctor William *76 Harkness, L. V. *34 Harper, J. 38 Harrison, Professor J. P. 130 Hesperian Society 89 Higgins, Richard 38 Holley, Doctor Horace 3, 34, *35, 38, 46, *46, 53, 97 Holmes, Doctor Oliver Wendell, on Doctor Bartlett 127 Home Guard 96, 97, *97, 137 Hosack, Doctor 7 Humphreys, Charles 38, *46 Hunt's Artillery 58 Hunt, John W. 38, 46 Hunter, John 18 Huntingdon, Doctor, extracts from address of 126 Influence of rival schools on Transylvania Medical Department 159 Influence of Doctor Dudley on Transylvania Medical Department 158, 159 Inoculation for smallpox 4 Great hazard in 4 Ill feeling between Doctors Dudley and Richardson 32 Jackson, President 29 James, Miss Charlotte 119 Janitor of Medical Hall 163 Jenkins, John F. *35 Jenner, Doctor 9 Johnson, Honorable Madison C. 97, *97 Joint stock company to build first Medical Hall 43 Journey to Philadelphia, difficulty of 31 Kemp, Reverend J. L. *133 Kentucky Academy 4, 12 Rivalry with Transylvania Seminary 5 United with Transylvania Seminary 5 _Kentucky Gazette_ *4, 11, 19, 20, 26, 30 Kentucky School of Medicine 17, 134, 135 Kentucky School of Medicine as winter school 115 Kentucky School of Medicine, first Faculty of *115 Kentucky University controversy 100 Kentucky University removed to Lexington 99 Kentucky University united with Transylvania University 99, 100 Law College established 6 Lawrence, Mr. Byrem *94 Lawson, Doctor Leonidas, biographical sketch of 130 As practitioner 131 Graduate in Transylvania 130 In Kentucky School of Medicine 131 In University of Louisiana 131 Practice in Cincinnati 130 Professor in Ohio Medical College 130, 131 Professor in Transylvania 130 Writings of 130, 131 Lawson, Miss Louisa 131 Leavy, William 38, *46 Leavy, William A. 38 Letcher, Doctor Samuel M. 156 Biographical sketch of 146 Death of 147 In Civil War 147 Professor in Transylvania Medical Department 146 Letter of Doctor Mitchell to Benjamin Gratz 109, *110 Lexington & Ohio Railroad begun 58 Lexington & Ohio Railroad completed 58 Lexington, early advantages of 30 Lexington endows Transylvania University with $70,000 *56 Lexington, population of 57, 58 _Lexington Reporter_ *43, 59 Light, George C. *46 Loan, city of Lexington to Medical College 43 Location of Botanic Garden *39 Lofty aims of John B. Bowman *100 Lynch, Reverend Thomas H. *133 Mangum, Senator W. P. 129 Marshall, Doctor Alexander K., biographical sketch of 155 Education of 155 Death of 156 Marshall, Honorable Thomas A. *133 "Marshall, Tom" 163 Marshall, Doctor Louis 155 McCalla, John M. 38 McClellan, Doctor George 107, 121, 122 McCoun, Reverend B. H. *133 McCullough, John Lawson 32 McDowell, Doctor Ephraim 7, 155 McIlvaine, B. R. 38 Medical Class of 1815 29 Medical College established 5 Medical Department of Transylvania University, Causes of decline 57, 157 Medical Department of Transylvania University first instituted 5 Medical Faculty of Transylvania University intermits winter session in Lexington 17 Medical Faculty of Transylvania University of 1815 27 Medical Faculty of Transylvania University in 1856-57 156 Medical Hall, New, burned 55, 161 Medical Hall, Old, burned 44 Medical Hall deserted 161 Medical Hall taken for United States Hospital 161 Medical Institute 102 Medical School of Transylvania University as a summer school 115 Medical School of Transylvania University in 1809 13 Megowan, Joseph *29 Memorial of Doctor Peter to Legislature *94 Mercer, General 75 Merrick, Reverend Wright *133 Metcalfe, Governor 59 Michaux, F. A. 31 Mitchel, Reverend James 2 Mitchell, Doctor Thomas D. 21, 57, 63, 107, *133, 167 Biographical sketch of 109 As a lecturer 114, *114 At Frankford, Pa. 111 Born 110 Called to Transylvania 112 Dean of Faculty 110 Death of 110 Degree of A. M. 111 Degree of M. D. 109 Describes Medical School *63 Early education of 110 Fills two chairs 109, 110 Fortitude of 110 Founds total abstinence society 111 Lazaretto physician *109 Leaves Transylvania 112 Letter to Benjamin Gratz 109 Professor in Jefferson Medical School 113 Professor in Kentucky School of Medicine 112 Professor in Medical College of Ohio 112 Professor in Philadelphia College of Medicine 112 Professor in St. John's Lutheran College 111 Professor in Transylvania Medical Department 109 Resigns from Kentucky School of Medicine 112 Writings of 111 Yellow fever *109 Moore, Reverend James 2 Appointed president of Transylvania University 5 Restored to presidency of Transylvania University 11 Morehead, Charles D. *35 "Morgan's Rifles" *97 Morrison College, dedication of 90 Taken for United States Hospital 161 Morrison, Colonel James 154 New Medical Hall burned 55, 161 Corner-stone laid 162 Dedicated 162 Description of 162, 163 Erected 44 Purchase of lot for *56 Reverts to city *56 Used as United States Hospital 55 Nicholas, Colonel George 6 Norwood, C. J. 98 Old Medical Hall burned 44 Corner-stone laid 44 44 Description of 44 Opposition to Transylvania Medical Department 160 Organization of Medical Faculty in 1809 13 In 1817 32 Origin of Transylvania Seminary 2 Origin of Transylvania University 1 Owen, Doctor David Dale 94, 99, 161 Death of 96 Describes Doctor Peter's laboratory *95 On Doctor Peter's chemical work 95 Owen, Colonel Richard 99 Overton, Doctor James 26, 27, 29, 30, 32 Education of *28 Professor of Materia Medica and Botany 13 Removed from Lexington 28 Sketch of, by Mrs. Bullock *28 Palmer, James W. 38 Parrish, Doctor 111 Patti, Adelina 163 Pattison, Professor Granville Sharpe 122 Patton, Elizabeth 7 Paxton, W. M. *156 Peers, Reverend B. O. *83, 85, 89, *89 Pendleton, Major-General 59 Percy, Thomas G. 6 Permanent location of Transylvania Seminary 3 Peter, Doctor Robert 21, 63, 79, 109, 112, *115, *133, 156 Biographical sketch of 88 Ancestry 88 Analyses in new geological survey 98 Analyses in survey of Arkansas 99 Analyses in survey of Indiana 99 Analyses of Trenton limestone 99 Antagonistic to Doctor Yandell 102, 103 Appearance of 104 As army surgeon 97 As botanist 93 As city councilman 104 As editor 101 As experimental chemist 103, 104 As lecturer 103 As practitioner 90 As teacher 93 As toxicologist 98 As writer 101 Assists Doctor Yandell 89 At Rensselaer School 89, *89 Attacked by Louisville controversialists *102 Born 88 Brings first daguerreotype outfit to Lexington 92 Comes to America 88 Comes to Lexington 89 Character, by a colleague 104 Character of his teachings 92 Cholera of 1833 90 Controversy on the removal of the school to Louisville 101, 102 Dean of the Faculty 90 Degree of M. D. 90 Death of 104 Discovery of phosphates 99 Donates apparatus *90 Early education 88 Emeritus Professor 101 Examination of calculi 92 Experiments with gun-cotton, etc. 92 Extracts from letters of 91 Herbarium 93 In agriculture and horticulture 101 In Arkansas geological survey 98, 99 Inaugurates the Kentucky Geological Survey 94 In Civil War 96, 97 In the Eclectic Institute 89 In the Kentucky Geological Survey 94, 95, 96, 97, 98, 99 Lectures at Pittsburg 89 Marries 90 Naturalized 88, 89 Professor in Kentucky University 100 Professor in Kentucky School of Medicine 93 Professor in Transylvania Medical Department 90 Proves the importance of soil analysis 94, 95 Purchases apparatus in Europe 90, 91 Reconciliation with Doctor Yandell 103 Religious views 100, *101 Retires from medical practice 90 Unanimously elected to chair in Morrison College 90 Views on Louisville controversy 102 Petre, Sir William 88 Population of Lexington, fluctuation in 57, 58 Powell, Doctor Llewellyn *115 Preliminary preparation of patients by Doctor Dudley 19, 20 Present prosperity of Lexington 160 Present whereabouts of medical library and apparatus 56 Presbyterian patronage of Transylvania Seminary 2 President of Kentucky Academy 4 Preston family, memoranda of *7 Preston, John 7 Preston, Margaret 7 Priestly, Doctor 4 Primitive daguerreotype apparatus 91, 92 Procter, John R. 97, 98 Purchase of lot for New Medical Hall *56 Qualifications of medical students of 1838 63 Rafinesque, Professor C. S. *35, 38 Biographical sketch of 35 Born 36 Botanic Garden 37 Comes to Lexington 36 His estimation of himself 35 Professor in Transylvania University 36 Writings of 37 Railroads in Kentucky, difficulty in obtaining 158 Railroads, effect on Lexington 61, 62 Railroad, first in the West 158 Ranck, G. W. *29 Rapid increase of classes 46 Remains of the medical library *56 Reid, Doctor, of Edinburgh 113 Reorganization of Medical Faculty in 1815 27 In 1817 27 In 1823 40 In 1837 63 Richardson, Doctor William H. 7, 16, 27, 32, 35, *35, 38, 63, 110, 132 Biographical sketch of 33 Character of 33, 34 Death of 33 Duel with Doctor Dudley 25 Home of 34 Ridgely, Doctor Frederick 15, 26, 82 Biographical sketch 10 As army surgeon 10 Born *10 Character of 10 Death of 11 First lectures 11 First professor in Transylvania Medical Department 6 Made Professor in Transylvania Medical Department 11 Robertson, Honorable George *133, 149 Roche, John P. *35, 38 Rogers, Doctor Coleman 27, 141 Rogers, Doctor Lewis 14, 33, 116 On Doctors Short and Peter 93 Roller bandage, use of by Dudley 20 Rush, Doctor 51, 52, 53, *110 Sayre, David A. 97, *97 Scott, Sir Walter *46 Second geological survey of Kentucky 97 Shaler, Professor N. S. 97 Short, Doctor Charles W. 21, 40, 57, *79, 93 Biographical sketch of 78 As church member 82 As a lecturer 80, 81 As a teacher 93 Born 78 Character of 78, 79 Dean of Faculty 81 Death of 81 Description of, by Doctor Gross *81 Description of, by Professor Miller *80 Early education of 82 Editor of _Transylvania Journal of Medicine_ 81 Emeritus Professor 81 His herbarium 79, 80 Honored by botanists 80 Influence on Kentucky Medical Institute *81 Leaves Transylvania 81 Marries 82 Parentage of 81, 82 President _pro tem._ of Transylvania *82 Professor in Medical Institute 81, *82 Professor in Transylvania 78 Received degree of M. D. 82 Two remarkable cases 80 Writings of 79, 80 Short, John Cleves 82 Short, Peyton 81 Skillman, Doctor Henry M. 156 Biographical sketch of 143 Character of 144, 145 Death of 144 Degree of M. D. 143, 144 Early education 143 In Civil War 145 Marries 146 Offices of trust 145 Professor in Transylvania 144 Skillman, Elizabeth Farrar 143 Skillman, Thomas T. 143 Sketch of 145, 146 Skipwith, Sir William, baronet 82 Slaughter, Gabriel 38 Smallpox, notice of inoculation for 4 Smith, Doctor Alan P. 124 Smith, Doctor Nathan R. 57 Biographical sketch of 120 As a lecturer 124 As a surgeon 124 As a teacher 124 At University of Pennsylvania 121, 122 Born 120 Called to Transylvania 120 Early education 121 Estimation in which he was held 122 Letter of resignation *122, *123 Letter of Transylvania Faculty *123 Mental gifts 123 Professor in Transylvania Medical Department 122, 123 Professor in University of Maryland 122 Professor in University of Vermont 121 Resigned 120 Sketch of his father 120, 121 Writings and inventions 124 Smith, Thomas 38 Staughton, Professor 113 Stockholders of the Botanic Garden 38 Strakosch, Maurice 163 Students in Medical Department, total number of 55 Superior apparatus of Transylvania Medical Department 157 Superiority of library of Transylvania Medical Department *91 Swan, Mr. 168 Symmes, John Cleves 82 Table of students, graduates of Medical Department (1819-34) *55 "The Botanical Garden" of Transylvania University 38 Theobalds, Doctor Samuel *147 Thomas, Doctor Philip *10 Thornbury, Doctor Philip *115 Titian, anecdote of 47 Todd, Reverend John 3 Todd, Doctor L. B. *136, 155 Total number of students in Medical Department 55 Total number of graduates in Medical Department 55 Toulmin, Mr. Harry, first President of Transylvania University 4 Opposition to 4 Transylvania the best-endowed medical school in America *122 Transylvania Faculty in 1842 *132 Transylvania Institute *56 Transylvania _Journal of Medicine_, editors of 21 Transylvania _Journal of Medicine_, first appearance of 21 Transylvania Land Company 3 Transylvania Medical Library *91 Transylvania Medical School in 1809 13 Transylvania merged into Kentucky University 99, 100 Transylvania Seminary 2 First "Director" 3 First President 4 Presbyterian patronage of 2 Rivalry with Kentucky Academy 5 United with Kentucky Academy 5 Transylvania University 5 First meeting of Trustees of 5 Medical department established 5 Origin of 1 Tribute of thanks, 1817 30 Trotter, James *46 "Trotter's Warehouse" 29 Trustees of Transylvania University in 1828 *46 Unparalleled growth of Transylvania University Medical School 167 Vaccination introduced by Doctor Brown 9 Wallace, Thomas 38 Warfield, Charles H. 30 Warfield, Doctor Elisha 13, 38, *46 Resigns 14 Warfield, Doctor Walter 11 Warner, Miss Harriot 47 Watson, Doctor Lotan G. *126 Sketch of 129 Character of 129 Professor in Transylvania Medical Department 129 Welsh, Reverend James 11 Wickliffe, Robert, junior 162 Wilkins, Charles 38, *46 Willett, Jacob 125 Wilson, Mr. Isaac 2 Winter, Elisha I. *46 Wistar, Doctor Caspar 82 Woods, Reverend Alva, D. D. 21 Installed as President 46 Woolley, Honorable A. K. *133 Yandell, Doctor Lunsford P. 21, 23, 47, 48, 53, 57, 63, 64, 66, 77, 89, 90, 158 Biographical sketch of 83 As editor and writer 87 Called to Chemical Chair in Transylvania 83 Character of 83 Character of Doctor Cooke, by *78 Criticises Doctor Caldwell 48 Death of 88 During Civil War 86 Early education 83 Forgives Doctor Caldwell 49 Goes to Memphis 86 Ordained Presbyterian minister 87 President of College Physicians and Surgeons 87 President of Medical Society 87, 88 Professor in Medical Institute 85, 86 Professor in Transylvania 83 Removes to Louisville 85 Succeeds Doctor Caldwell 86 Resigns from Louisville school 86 Yandell, Doctor Wilson 83 Footnotes [Footnote 1: April 11, 1791. See Records of Transylvania University.] [Footnote 2: Out lot No. 6.] [Footnote 3: In honor of the Centenary of Lexington, celebrated April 2, 1879.] [Footnote 4: An interesting notice of "_Inoculation for Smallpox_," in 1794, is to be found in the files of the old _Kentucky Gazette_, a paper published by John Bradford, in Lexington, August 11, 1787--the first newspaper published west of the Alleghany mountains. This notice appeared in that paper January 4, 1794, as follows: "On Thursday last the inhabitants of this place began the inoculation of smallpox and have agreed to continue until the fifteenth, after which they are determined to cease. They have appointed a committee to draw up a remonstrance to the court of Fayette County requesting that the order of that court granting liberty to the inhabitants of said county to inoculate may be rescinded, so far as respects the town of Lexington, after that date." The _Gazette_ for the first of February following has this significant statement, illustrating the great hazard of this primitive operation, viz: "That the smallpox had been very fatal within the three weeks past in the town and vicinity under inoculation, that at least _one out of fifteen died_ who had been inoculated, and very few children had recovered." Vaccination was introduced here by Professor Samuel Brown, M. D., at quite an early period, as we shall see further on.] [Footnote 5: Lexington, January 8, 1799. (See Records of Transylvania University, Volume 1.)] [Footnote 6: December 11, 1799. (See Records of Transylvania University.)] [Footnote 7: "Memoranda of the Preston Family," by John Mason Brown, Page 20.] [Footnote 8: See "Memoranda of the Preston Family," Page 37, for his descendants.] [Footnote 9: Quoted from an introductory lecture to the winter course in the Medical Department of Transylvania University, delivered by the present writer (Doctor Robert Peter) November 5, 1854.] [Footnote 10: Doctor Ridgely was born on Elkridge, Anne Arundel County, Maryland, May 25, 1757, and studied medicine under Doctor Philip Thomas, of almost unrivaled reputation. (Doctor C. W. Short.)] [Footnote 11: Doctor James Fishback resigned as Trustee and qualified as Medical Professor November 4, 1805. (See Records.)] [Footnote 12: Jacob Fishback was a Trustee of Transylvania in 1801 and up to 1807. (See Records.)] [Footnote 13: See Records of Transylvania University, 1809.] [Footnote 14: An able biographical sketch of him by his son, Joseph Buchanan, also celebrated, was published in _Collins' History of Kentucky_, first edition.] [Footnote 15: According to Doctor C. C. Graham he held that these two chairs should be inseparable.] [Footnote 16: Now the site of the golf links at the termination of North Broadway.] [Footnote 17: This was before the use of anesthetics in surgery, it must be remembered.] [Footnote 18: Did he not, in this preliminary preparation of his surgical patients, unwittingly render them safe from the microbes of disease, thus practically securing for them the benefits of more modern scientific discovery?] [Footnote 19: March 28, 1828, Doctor Dudley was elected President, _pro tem._, in the interval between the unanimous election of Reverend Alva Woods, D. D., February 7, 1828, and his installation October 13, 1828.] [Footnote 20: "He contracted poison in performing a surgical operation, from which he suffered greatly and never recovered. He died suddenly after about two hours of illness, at a quarter to one on Thursday morning, January 20, 1870, of apoplexy. In his relations of son, husband, father, master and friend it is believed he has left no better man." (Extract from a short obituary by his brother, Reverend Thomas P. Dudley.)] [Footnote 21: Doctor C. C. Graham says: "What few private students there were in Lexington went from shop to shop (at that day so called) and got three only, Dudley, Richardson, and eccentric Overton to give us a talk." (Letter to Doctor Peter.)] [Footnote 22: Since dead as more than a centenarian.] [Footnote 23: His great niece, Mrs. Waller O. Bullock, in speaking of the portrait of Doctor Overton, the only one extant, says: "It was done in Philadelphia just as he was completing his medical course, and I think it must have been soon after that he entered upon his work at Transylvania. He took a post-graduate course at Paris, France, and was considered one of the most brilliant men of his day. He had great command of language and his conversation sparkled with wit and humor, nor was he less happy with his pen. On one occasion the city of Nashville offered a handsome prize for the best essay on some disputed medical point; no one was barred; doctors of all ages entered the lists, and Uncle James--though an old man--bore off the honors. In cultivated elegant society he was at his best, and when distinguished foreigners visited President Jackson at the Hermitage it always devolved on Doctor Overton to do the agreeable, his command of French peculiarly fitting him for this post. He early left Kentucky to make his home in Tennessee, where he practiced his profession for many years, dying at an advanced age."] [Footnote 24: "When the first medical lectures were delivered in our city a room was rented for the purpose on Main Street. At the time of the reorganization in 1819 a commodious apartment in the upper story of the large building (on Short Street) now occupied (1854) by the Branch Bank of Kentucky, then as a tavern, was temporarily fitted up as a lecture-room, and Doctor Dudley lectured in his own rooms back of his office ... (on Mill Street, east side, a little above Church Street). The rapid increase of the class soon induced Doctor Dudley to enlarge his accommodation by the erection of a very commodious amphitheatre, in which he lectured until 1839-40, when the new hall was built (corner of Broadway and Second)." (Lecture of Doctor Peter to Medical Department, November 6, 1854.)] [Footnote 25: According to G. W. Ranck's _History of Lexington_.] [Footnote 26: Doctor C. C. Graham relates, in reference to student life about this time: "Dead bodies at that day were not articles of commerce, so we, the students, had to disinter them; and we once had a battle, so published in the newspapers, at the old Baptist graveyard--the Battle of the Graveyard, so-called--when taking up the Irishman that caused the duel (between Dudley and Richardson). We were taken prisoners by an armed guard and hauled up to the court-house for trial, but there was no law to make the dead private property, so the declaration of Scripture that from dust we came and unto dust we must return let us off by paying one cent damages for taking that much clay or soil. At another time, near Nicholasville, we were pursued when making our way to our horses hitched outside an orchard fence, and one ball of several fired lodged in the subject, on my back." (Letter of Doctor Graham.)] [Footnote 27: It seems Doctor Drake had obtained an honorary degree for Richardson.] [Footnote 28: "Caneland," which now forms a beautiful portion of L. V. Harkness' Walnut Hall Stock Farm, where the old house still stands, with Richardson's name on the brass knocker of the front door.] [Footnote 29: The full Faculty of Transylvania, published 1821, was: President, Reverend Horace Holley, A. M., A. A. S.; Honorable William T. Barry, LL. D., Professor of Law; Charles Caldwell, M. D., Dean, Professor of the Institutes of Medicine and teacher of Materia Medica, with a private class in Medical Jurisprudence; Samuel Brown, M. D., Theory and Practice; Benjamin W. Dudley, M. D., Anatomy and Surgery; William H. Richardson, M. D., Obstetrics and Diseases of Women and Children; Reverend James Blythe, D. D., Professor of Chemistry; Reverend Robert H. Bishop, A. M., Natural Philosophy, Geography, Chronology, and History, giving with the President instruction in the voluntary theological class; John Roche, A. M., Ancient Languages and secretary of Faculty; John F. Jenkins, A. B., Professor of Mathematics and Librarian; Constantine S. Rafinesque, Professor of Natural History and Botany and teacher of the Modern Languages; Nicholas D. Coleman, A. B., and Charles S. Morehead, A. B., tutors of the Preparatory Department.] [Footnote 30: For Rafinesque see _Life of Rafinesque_, by R. Ellsworth Call, published by The Filson Club, 1895.] [Footnote 31: We find the announcement in a local newspaper of November 19, 1819, that the inauguration of the medical professors and Professors Rafinesque and Bradford took place "at the Episcopal Meeting House on yesterday" with music, etc.] [Footnote 32: "A fine lot of nine and three quarters acres belonging to Mr. Joseph Megowan, at the rate of one hundred dollars in specie per acre, with a small rent of two dollars and fifty cents per acre until paid."] [Footnote 33: Doctor Best, a graduate of Transylvania Medical Department in 1826, died at Lexington, Kentucky, September, 1830, aged about forty-five years.] [Footnote 34: Of Doctor Drake, Doctor S. D. Gross says: "Emphatically a self-made man, he possessed genius of a superior order and successfully coped with his colleagues for the highest place in the school (Transylvania). Of all the medical teachers I have ever known he was, all things considered, one of the most able, captivating, and impressive. There was an earnestness, a fiery zeal about him in the lecture-room which encircled him, as it were, with a halo of glory." (Autobiographical sketch of Doctor Short, Page 10.)] [Footnote 35: Mostly from _Collins' History of Kentucky_, second edition.] [Footnote 36: _Lexington Reporter_, March 5, 1821: "$17,000 are to be expended in Europe this year for the Medical Department. Doctor Caldwell (the agent) is already on his way. $5,000 only is the gift of the Legislature, while $6,000 rest upon the responsibility of Lexington alone and $6,000 upon that of _six individuals_ in the town who have generously stepped forward in this manner to anticipate the too cautious bounty of the Legislature."] [Footnote 37: The oration at the laying of the corner-stone was made by William T. Barry. The Trustees of Transylvania at that time were John Bradford, Thomas Bodley, Charles Humphreys, Benjamin Gratz, Elisha Warfield, James Fishback, John W. Hunt, James Trotter, Elisha I. Winter, George T. Chapman, William Leavy, Charles Wilkins, and George C. Light.] [Footnote 38: The same year, October 13, 1828: "The Board joined in a procession to the Episcopal Church, where the Reverend Alva Woods, D. D., was publicly installed as President of the Transylvania University." One thousand copies of his inaugural address to be printed for the Board.] [Footnote 39: Edward Everett, in a letter of introduction to Sir Walter Scott presented to Mr. Holley when intending to visit Europe, says of him: "As a philosopher, a scholar, and a gentleman he has left no superior in America."] [Footnote 40: See Pages 405-7, Autobiography of Doctor Charles Caldwell.] [Footnote 41: See Autobiography.] [Footnote 42: He was Dean of the Faculty.] [Footnote 43: It has been said that Doctor Caldwell was the first person of note to take up the study of Phrenology in this country.] [Footnote 44: Of Doctor Caldwell, Doctor Gross says: "A more majestic figure on the rostrum could hardly be imagined. Tall and erect in person, with a noble head and a piercing black eye, he was the _beau ideal_ of an elegant, entertaining, and accomplished lecturer. He was eloquent, but too artificial, for he had cultivated elocution too much before the mirror." (Autobiographical sketch of Doctor C. W. Short, Page 10.)] [Footnote 45: Doctor Caldwell says (1834): "This institution has been in operation _fourteen_ years.... According to its record book its classes and the degrees conferred by it have been as follows: Years. Number of Number of Pupils. Degrees. 1819-20 37 7 1820-1 93 13 1821-2 138 37 1822-3 171 51 1823-4 200 47 1824-5 234 57 1825-6 281 65 1826-7 190 53 1827-8 152 53 1828-9 206 40 1829-30 199 81 1830-1 210 52 1831-2 215 74 1832-3 222 69 1833-4 262 ----- --- Total 2,810 699 "It is believed from this view of it that for its vigorous prosperity and the rapid increase of its classes, the Medical School of Transylvania is without a parallel. Certainly in the United States there is nothing comparable to it. At the commencement of the present century, when the Medical School of Philadelphia had been in operation about forty years, it did not number more, we believe, than 200 pupils. It now contains about 400--rumor says a few more. In _thirty-three_ years, then, that school has added about 200 to its classes, while _in less than half that time_ the school of Transylvania has _formed_ a class of 262. This is the highest eulogy the institution can receive." (Doctor Caldwell to Lexington Medical Society, 1834, "On the Impolicy of Multiplying Schools of Medicine.")] [Footnote 46: At the time of the formation of the "Transylvania Institute" (February 20, 1839), under articles of agreement between the city of Lexington and the Trustees of Transylvania University (see Deed Book No. 17, Page 42, office Fayette County Court), the city endowed the University with seventy thousand dollars; forty-five thousand dollars was to build a new medical hall and provide additional library and apparatus for the same, five thousand dollars for the Law Department, and twenty thousand dollars for Morrison College, securing permanent scholarships in each college. In consequence of a want of harmony in the Board of Trustees as to the location of the proposed medical hall, the medical professors and their friends felt obliged to purchase a lot (corner of Broadway and Second Street, where Doctor Bush's residence was afterward built) at a cost of five thousand dollars, although there was abundant space on the University grounds. This lot, to purchase which citizens contributed three thousand dollars of the five thousand, was given in trust to the University--but, by an unauthorized clause in the deed of conveyance, the lot and the medical hall erected on it at a cost of about thirty-five thousand dollars reverted to the city about 1860. On this building, which was burned during the Civil War, the medical professors also paid out of their own incomes the surplus cost over thirty thousand dollars which had been provided by the city. The medical professors also each contributed annually to the medical library, etc., ten dollars.] [Footnote 47: There remain of this library five thousand, six hundred and eighty-four volumes; pamphlets and medical journals, seven hundred and fifty-four; bound volumes of theses, one hundred and thirty-eight, at Kentucky University.] [Footnote 48: In the session following this disintegration of the school Doctor Thomas D. Mitchell says, in his Historical Catalogue of the Medical School, 1838: "Notwithstanding the great pecuniary embarrassments of the country and the peculiar circumstances accompanying the late disorganization, the number of pupils fell short but fifteen of the previous session."] [Footnote 49: Doctor Mitchell at this time says: "The entire course of lectures in this school costs the sum of _one hundred and five dollars_. In addition the matriculation fee, which entitles the pupil to use of the very extensive library, is _five dollars_. The dissecting ticket is _ten dollars_, and may be taken or omitted at pleasure." The qualifications for candidates for the degree of Doctor of Medicine: "The persons offering must be 21 years of age and must have been engaged in the study of medicine during three years. Two full courses of lectures in a chartered medical school (the last of which in this institution) are also requisite. But persons who exhibit satisfactory proof of having been engaged in reputable practice for the space of four years may be candidates by attending one course of lectures, which must be in this school. Each candidate is required to exhibit all his tickets to the Dean before his name can be enrolled. The fee for graduation is $20." (See Doctor Mitchell's Historical Catalogue, 1838.)] [Footnote 50: This, with a strange prejudice against novelties, he recommended to be made by putting an indefinite quantity of glass of antimony in a bottle with wine, to digest for an uncertain period, adding more wine as the contents were withdrawn for use.] [Footnote 51: "From June 1 to August 1, 502 died." (_Collins' History of Kentucky._)] [Footnote 52: The late William Hall, M. D., for a long time editor of _Hall's Journal of Health_, of New York.] [Footnote 53: Memoir, Page 21.] [Footnote 54: Doctor L. P. Yandell, senior, says of Doctor Cooke in his biography: "Dr. Cooke was one of the few men who might have been safely trusted to write his autobiography. He would have reviewed his career with a truthfulness, a modesty, a candor that would have exalted his character in the eyes of men. His works will be read by the curious for a long time to come, and will always be read with advantage by the earnest student."] [Footnote 55: _Notices of Western Botany and Conchology_, by Doctor C. W. Short and H. H. Eaton, A. M., published in _Transylvania Journal of Medicine_, 1831.] [Footnote 56: Professor Henry Miller, of Louisville, says of Doctor Short: "As a lecturer Dr. Short's style was chaste, concise, and classical, and his manner always grave and dignified. His lectures were always carefully and fully written and read in the lecture room with a good voice and correct emphasis. He never made the least attempt at display nor set a clap-trap in all his life."] [Footnote 57: Doctor Gross says: "In stature Dr. Short was of medium height, well proportioned, with light hair and complexion, blue eyes, and an ample forehead. His features when lighted up by a smile were radiant with goodness and beneficence. In manner he was graceful, calm, and dignified; so much so that one coming into his presence for the first time might have supposed him to be haughty and ascetic; such, however, was not the case."] [Footnote 58: Doctor David W. Yandell thus writes of Doctor Short as connected with the Medical Institute of Louisville: "Dr. Short was a most valuable officer. His high scientific attainment, the soundness of his judgment, high dignity and urbanity of manner, his amiable temper and blameless life added character and weight to the institution. Botany was his favorite pursuit. He found the flora of this region (Louisville) virgin and unknown, and so collected, arranged, and classified it that his successors in this field have been able to change nothing and to add but little to his work."] [Footnote 59: We see in the records of the Trustees of Transylvania University that on March 17, 1832, Doctor Short was elected President _pro tem._ of Transylvania University "during the pleasure of the Board," but there is no mention of his acceptance. The fact is, Professors Short, Caldwell, and Dudley acted alternately as President _pro tem._ on public occasions and in signing diplomas, etc., until a President could be elected. The Reverend B. O. Peers was inaugurated President _pro tem._, 1833, and the Reverend Thomas W. Coit, an eminent Episcopalian divine from New England, was installed as President in 1835.] [Footnote 60: The resignation of his predecessor, Doctor Blythe, took place March 16, 1831. (See Records of Transylvania University.)] [Footnote 61: One of his ancestors was General William Eaton, the hero of Derne.] [Footnote 62: In the chemical course of lectures the subject of Electricity was given up to him entirely. He lectured on it as well as performed the experiments.] [Footnote 63: In the catalogue of the Rensselaer School, 1828, appears in the list of undergraduates, "Robert Peter, Pittsburg, Pa., Lecturer on the Experimental and Demonstrative Sciences, Druggist."] [Footnote 64: This "Eclectic Institute" occupied the "colonial" residence on Second Street, now forming a part of the Hagerman Female College. Mr. Peers, H. A. Griswold, and H. H. Eaton were already associated.] [Footnote 65: Doctor Mitchell says (1838): "Dr. Peter added to the Chemical Department several powerful galvanic batteries and a fine collection of apparatus recently procured from the East, making the laboratory more complete than it ever has been before." (Historical Catalogue, 1838.)] [Footnote 66: Of the books, apparatus, etc., purchased in Europe by Doctor Peter we find the following account rendered on March 25, 1839: "Books and plates, six thousand dollars; chemical apparatus, two thousand five hundred dollars; preparations for anatomy and surgery, one thousand five hundred dollars; models for obstetrics, five hundred dollars; specimens for materia medica and therapeutics and drawing, five hundred dollars. A total of eleven thousand dollars."] [Footnote 67: "A very large addition was made to library, museum, and apparatus by extensive purchases in Europe (selected by Dr. Bush and myself), bringing the former collection up to 8,000 volumes and making the latter equal, if not superior, to any in the United States." (Introductory lecture of Doctor Peter to Medical Department, 1854.)] [Footnote 68: See _Western Lancet_, Volume V, 1846.] [Footnote 69: See _Transylvania Journal of Medicine_, Volumes VI and VII.] [Footnote 70: The memorial was written entirely by Doctor Peter, the map was mostly copied from one published about that time by a Mr. Byrem Lawrence, who traveled and lectured on Geology in Kentucky and who subsequently went to Arkansas and made observations on its Geology, etc., and, as the writer believes, died there.] [Footnote 71: See _Kentucky Geological Survey_, Volume I, N. S., Page 143.] [Footnote 72: See Volume I, N. S., Page 143.] [Footnote 73: Doctor Owen says: "The principal operating room in which Dr. P. made his analyses is 15 feet square, the working and balance tables stand within three feet of each other, and the furnace, sand, and water baths three feet from the former, so that one or two steps suffice to reach all important parts of the different operations in their various stages of progression. The reagents constantly in use ... in a case resting on the working table within arm's reach of the operator, and his recording desk in a drawer of the same table." This laboratory was in the north-west corner of the Medical Hall, corner of Broadway and Second Street. Doctor Owen, zealous to defend Doctor Peter, explains further that the latter was aided by a more than common physical as well as mental aptitude. Doctor Peter took no part in this defense save to extend to the skeptics an invitation to visit his laboratory and examine his manner of working.] [Footnote 74: I must acknowledge that the expression "shoulder to shoulder" is a mere figure of speech as regards "Uncle Davy" Sayre, for he usually attended the drills in a buggy in subservience to his gout, being thereby rendered immune from the consequences suffered by his dignified compatriots of sundry knots tied, by youthful humorists, in the long grass of the classic "little college lot," the favorite drill ground of the Home Guard, as it had been of Morgan's Rifles and other military companies. This "college lot" was none other than the original "out lot No. 6," the first seat of Transylvania, and was the identical spot whereon had taught the immortal Holley. Madison C. Johnson was "conspicuous" for his sky-blue blouse of fine material, which stood forth in the ranks of common dark blue cotton, and must have been a mark for the enemy had the celebrated battle for the arms hereinafter mentioned ever taken place.] [Footnote 75: See _Kentucky Geological Survey_, Volume IV, N. S., Pages 18, 65, and 66; also Volume III, N. S., Page 391.] [Footnote 76: Mr. Bowman says, in a letter to Doctor Peter, April 20, 1876: "If my life is spared I will work on until by national and State aid, if not denominational, I will lay broad and deep the _foundations_ of a great, free, liberal, unsectarian university for all classes and professions of this people and abreast with the advanced curriculum of the best institutions of our century."] [Footnote 77: In the heat of contest Doctor Peter's adversaries did not hesitate to call him an infidel and an atheist. It was the worst they could say, but not strictly in conformity with the facts. He was not a church member. He had been baptized in the Church of England, always kept a pew in the Episcopal Church, and as a young man taught in the Episcopal Sunday-school. The spectacle, in so many instances, of the impediment to educational progress by narrowness and bigotry in churches had given him an indifference--not disguised--to _sectarian_ religion. He never molested the religious tenets of others. He constantly declared that education should be free to _all_ men, irrespective of creed.] [Footnote 78: Antagonists in this controversy, powerless to assail him as a scientist and teacher, characterized him as a person of low origin and brutal manners. He ignored this attack, it being his custom never to lean upon ancestors--to look forward rather than back, holding to the homely but truly American saying that "every tub must stand on its own bottom." But in truth he was of excellent English family and a descendant of that powerful "Arundel" who in the days of the Conquest was master of twenty-eight lordships. His manners passed muster among old-fashioned Kentucky gentlemen.] [Footnote 79: Doctor Cross was appointed to a chair in the Transylvania Medical Faculty by the influence of Reverend Nathan H. Hall, a trustee, and against the judgment of other members of the Board.] [Footnote 80: From the _Transylvania Journal of Medicine_, Volume XI, 1838.] [Footnote 81: Letter of Doctor Mitchell to Benjamin Gratz, February 7, 1838: " ... I graduated in 1812. In 1813 was appointed by the Governor of Pa. to the office of Lazaretto Physician of the Port of Phila, which post I held until 1816, when indisposition compelled me to resign. I then had opportunity of becoming acquainted with the Southern fevers, particularly the yellow fever of N. Orleans and the West Indies. For 17 years after I was actively engaged in practice, and may refer to Eberle's _Therapeutics_ for his opinion of me as a medical man, at a time when I was not personally acquainted with him. The journals of those times contain many medical papers furnished by me, as examination will show. In 1831 my name was before the Trustees of Jefferson Medical College for the chair of Materia Medica vacated by the resignation of Dr. Eberle, and I would have been appointed, as I have since been informed by Gen. Duncan, one of the Trustees, if I had not agreed to join with Dr. Eberle a new faculty at Cincinnati. If any object that a Prof'r of Chemistry can not make a good Prof'r of Theory and Practice, I have only to refer to the case of the celebrated Dr. Rush, who passed directly from Chemistry to Theory and Practice, as the published records of the University of Penna. will show."] [Footnote 82: He was sole editor of this journal in the latter years of its existence.] [Footnote 83: Doctor Mitchell was an exceedingly rapid speaker. With difficulty could those unused to this peculiarity follow his swift flow of language and ideas. But once accustomed, his pupils liked this better than the more deliberate speech of other professors. He never failed to impress upon students the importance of a not too hasty diagnosis, the _premonitory_ symptoms of widely differing diseases being nearly identical; whereas treatment proper for one disease might result fatally if applied to another.] [Footnote 84: Doctor Bush's mother was Miss Palmer, sister of the wife of Governor Adair. His grandparents, Philip and Mary Bush, came to America from Germany and settled at Winchester, Virginia, 1750.] [Footnote 85: The first Faculty of the Kentucky School of Medicine at Louisville: Benjamin W. Dudley, M. D., Emeritus Professor of Anatomy and Surgery; Robert Peter, M. D., Medical Chemistry and Toxicology; Samuel Annan, M. D., Pathology and Practice of Medicine; Joshua B. Flint, M. D., Principles and Practice of Surgery; Ethelbert L. Dudley, M. D., Descriptive Anatomy and Histology; Llewellyn Powell, Obstetrics and Diseases of Women and Children; James M. Bush, M. D., Surgical Anatomy and Operative Surgery; Henry M. Bullitt, Physiology and Materia Medica; Philip Thornbury, M. D., and John Bartlett, M. D., Demonstrators of Anatomy.] [Footnote 86: That this arrangement met with much opposition among citizens of Lexington will be seen by a perusal of the _Kentucky Statesman_ and other Lexington newspapers of the day. A hand-bill was also issued February 1, 1850, calling a "public meeting" in order to discuss more "fairly" the various aspects of the question.] [Footnote 87: Doctor Bush's other children are Captain Thomas J. Bush and Miss Nannie M. Bush, of Lexington, Kentucky.] [Footnote 88: Extract from Doctor Smith's letter of resignation, January 7, 1841: " ... By the influence of the reputation and efficient exertions of the present Faculty and by the munificence of the citizens of Lexington, the Medical Department of Transylvania is now placed upon a foundation which renders its position perfectly secure. Its friends may, without fear of contradiction, pronounce it to be decidedly the best endowed medical school in America. Its patronage and the emoluments of its chairs are second to those of but one, and there are none to be associated with which I should consider it a higher honor. Under these circumstances my resignation can not exercise the least injurious influence upon its prosperity. The chair will immediately command the services of some one whose labors will be more efficient than mine. You will please, dear sir, convey to the members of the Faculty assurance of my great respect and affectionate consideration. "Yours most truly, N. R. SMITH." Letter to Doctor Smith from the Faculty: "Dear Sir: The receipt of your communication informing us that circumstances beyond your control would oblige you to resign the chair of the Theory and Practice of Medicine in the Medical Department of Transylvania University at the end of the present session, renders some expression of sentiment on our part both just and appropriate. Permit us, therefore, to assure you that we receive the information of your intended resignation with regret, and that nothing would have afforded us more gratification than the certainty of your continuance among us as a fellow-citizen and colleague. The intercourse which has existed between us for the three years during which we have been associated has been of the most harmonious and pleasant character, and the ability with which you have performed the duties of your chair increases the reluctance with which we give up the expectations of a longer co-operation with you under the auspices of Transylvania University. With the most sincere wishes for your continued increase in fame and prosperity, we remain your friends and colleagues. THE MEDICAL FACULTY OF TRANSYLVANIA UNIVERSITY. "ROBERT PETER, _Dean_." (From _History of Medical Department of Transylvania University and its Faculty_, by William Jeptha Calvert, M. D.)] [Footnote 89: Extracts from Doctor Huntington's address to the Middlesex North District Medical Society, 1856.] [Footnote 90: Extract from the letter of resignation of Professor Bartlett, Lowell, Massachusetts, April 5, 1844: "It is unnecessary for me to go now into the considerations which lead me to this step any further than to say that they are connected _wholly_ with motives of a domestic character and with the strong desire which I have long cherished and expressed of being settled in one of the Eastern cities. The only pain which the step costs me being occasioned by my separation from my present colleagues which it involves, and the dissolution of the professional and social relationship, to myself of the most amicable and agreeable character."] [Footnote 91: During the absence of Doctor Bartlett his chair was filled by Doctor Lotan G. Watson, of North Carolina.] [Footnote 92: In 1842 the Transylvania University had been placed under the patronage of the Methodist Episcopal Church, with a Faculty as follows: Reverend H. B. Bascom, D. D., Acting President and Morrison Professor of Intellectual and Moral Philosophy; Benjamin W. Dudley, M. D., Professor of Anatomy and Surgery; James C. Cross, M. D., Professor of Institutes and Medical Jurisprudence; Elisha Bartlett, M. D., Professor of Theory and Practice; William H. Richardson, M. D., Professor of Obstetrics and Diseases of Women and Children; Thomas D. Mitchell, M. D., Professor of Materia Medica and Therapeutics; Robert Peter, M. D., Professor of Chemistry and Pharmacy; James M. Bush, M. D., Adjunct Professor of Anatomy and Surgery; Honorable George Robertson, LL. D., Professor of Constitutional Law, Equity, and the Law of Comity; Honorable Thomas A. Marshall, LL. D., Law of Pleading, Evidence, and Contract; Honorable A. K. Woolley, LL. D., Professor of Elementary Principles of Common Law, National and Commercial Law; Reverend R. T. P. Allen, A. M., Professor of Mathematics, Natural Philosophy, and Civil Engineering; Reverend B. H. McCoun, A. M., Professor of Ancient Languages and Literature; Reverend W. H. Anderson, A. M., Professor of English Literature; Reverend J. L. Kemp, A. M., Adjunct Professor of Mathematics, Preparatory Department; Reverend Thomas H. Lynch, A. M., Adjunct Professor of Languages, Preparatory Department; ----, Principal of the Junior Section of the Preparatory Department. N. B.--The Reverend Wright Merrick was appointed to the above vacancy.] [Footnote 93: Doctor C. C. Graham said that Doctor Dudley tenaciously held that these two chairs should always be combined.] [Footnote 94: Doctor L. B. Todd calls him "that knightly Bayard of Kentucky Surgery."] [Footnote 95: An incident well told by his son-in-law, General Joseph C. Breckinridge, is characteristic of Dudley. When, during the Civil War, a struggle was imminent between the secessionists and the Home Guard for possession of a large shipment of arms and ammunition sent into Kentucky by the United States Government for the arming of Union soldiers and citizens, Dudley, fearing the Home Guard at Lexington would be overpowered and the munitions captured on arrival, sent as a trusty messenger to General Nelson, at Camp Dick Robinson, to ask for troops--a midnight journey of twenty miles through a hostile country--his only son, Scott Dudley, a youth scarcely seventeen. He saddled the horse and armed the boy himself, at dead of night, the better to insure secrecy, for in his own household were foes. This mission was successful. (See speech of General Joseph C. Breckinridge, United States Army, at the reunion of the Army of the Cumberland, Chattanooga, October 10, 1900.) Ensign J. Cabell Breckinridge, United States Navy, the first life lost on the threshold of the Spanish War, and Lieutenant Ethelbert D. Breckinridge, seriously wounded almost at the very instant that his General, the well-beloved Lawton, fell beside him in the Philippines, were grandsons of Doctor Dudley.] [Footnote 96: Quoted from the _Biographical Encyclopedia of Kentucky_, etc., of 1878.] [Footnote 97: We learn from old announcements, etc., that, as early as 1830, the Medical Faculty of Transylvania University offered their services gratuitously to the Eastern Kentucky Lunatic Asylum, through Samuel Theobalds, M. D., and that, in 1845, Doctor John R. Allen was to deliver clinical lectures to the medical class, at the Lunatic Asylum every Saturday.] [Footnote 98: Other sons were William Wallace, Benjamin Gratz, and Colonel Saunders D. Bruce.] [Footnote 99: Doctor L. B. Todd.] [Footnote 100: See _The Marshall Family_, by W. M. Paxton, 1885.] [Footnote 101: Address at Morrison College on being inaugurated President of Transylvania University.] [Footnote 102: Doctor Peter's introductory lecture to the Medical Class, November, 1842.] [Footnote 103: The first railroad was the Baltimore & Ohio, chartered March, 1827, but not completed to the Ohio until 1853--twenty-six years.] [Footnote 104: _Pioneer Surgery in Kentucky._] [Footnote 105: "In 1856, the Trustees of Morrison College came to the legislature of Kentucky and offered all the buildings, the library, the apparatus, and grounds, which were valued at over two hundred thousand dollars, if the State would take it and establish a Normal School." ... Speech of Honorable C. J. Bronston on the Agricultural and Mechanical College tax. The idea of a Normal School originated with Doctor Robert J. Breckinridge several years before.] [Footnote 106: May 22, 1863. _Collins' History of Kentucky._] [Footnote 107: From the report of the Treasurer of the University, 1871, it is gathered that after long and persistent effort on his part while in Washington there was secured from the Government the sum of twenty-five thousand dollars "for the rents and damages to the medical college and other Transylvania property during the war," nearly one half of which was claimed and recovered from the University by the city of Lexington on the plea that the Medical Hall had been abandoned.] [Transcriber's Note: * The footnotes have been moved to the end of the book with the exception of the footnotes for tables. * Footnote 19: Added period after "_tem_" in "elected President, _pro tem_". * Footnote 88: Added period after "prosperity" in "influence upon its prosperity". * Pg 148 "His success was progressive this article exemplifying" retained as printed. * Pg 173 Added comma after "117" in "Writings of 117". * Pg 173 Removed comma after "Charles," in "Caldwell, Doctor Charles,". * Pg 174 Added comma after "51" in "autobiography of 49, 50, 51". * Pg 174 Added comma after "69" in "experience of Doctor Peter 69 70". * Pg 177 Removed comma after "W," in "Dudley, Doctor Benjamin W,". * Pg 180 Removed comma after "1842," in "University under the Methodists, 1842,". * Pg 184 Removed comma after "instituted," in "Transylvania University first instituted,". * Pg 186 Added comma after "94" in "Owen, Doctor David Dale 94". * Pg 193 Added comma after "Winter" in "Winter Elisha I". * Pg 193 Removed comma after "P.," in "Yandell, Doctor Lunsford P.,". * Otherwise, archaic and inconsistent spelling and hyphenation retained.] 
38929	----	generously made available by The Internet Archive.) QUACKS AND GRAFTERS BY EX-OSTEOPATH _BEING AN EXPOSÉ OF THE STATE OF THERAPEUTICS AT THE PRESENT TIME, WITH SOME REASONS WHY SUCH GRAFTERS FLOURISH, AND SUGGESTIONS TO REMEDY THE DEPLORABLE MUDDLE_ PUBLISHED IN THE YEAR 1908 BY THE CINCINNATI MEDICAL BOOK COMPANY CINCINNATI OHIO COPYRIGHTED, 1908, BY THE CINCINNATI MEDICAL BOOK CO. THE LANCET-CLINIC PRESS, CINCINNATI, OHIO. TO THE GREAT AMERICAN PUBLIC IS DEDICATED THIS BOOK, WITH EVERY CONFIDENCE IN ITS PROVERBIAL COMMON SENSE AND DISCRIMINATION, AND WITH THE HOPE OF HAVING ADDED A MITE TOWARD GREATER AND BETTER THINGS IN THE ART OF AESCULAPIUS. PREFACE. There has been but one other period in the history of medicine when so many systems of the healing art were in vogue. In the seventeenth century, during the Reform Period, following the many epoch-making discoveries, as the blood and lymph circulation; when alchemy was abandoned and chemistry became a science; when Galileo regenerated physics, and zoology and botany were largely extended; when Newton enunciated the laws of gravitation; when cinchona bark, the great febrifuge, was introduced into Europe, and the cell doctrine was founded by Hooke, Malpighi and Grew, the old Hippocratic, Galenic and Arabic systems of medicine were undermined. In that transition period, when the medical profession was trying to adjust its practice with the many new theories, its authoritative voice was lost, and in the struggle for something tangible, innumerable new systems sprang up. Four systems stood out most prominently--the pietistically colored Paracelsism of Von Helmont, with its sal, sulphur and mercury; the chemical system of Sylvius and Willis, with its acid and alkali theory of cause and cure of disease; the iatro-chemical system, with its fermentation theory; and the iatro-physical system, which contended that health was dependent upon proper adjustment of physical and mechanical arrangements of the body. The old humoral theory of Galen had its adherents, influencing all of the newer systems. And suggestive therapeutics was rampant in most grotesque and fanciful forms. Witchcraft, superstition and cabalism were fostered even at the various European courts. As Roswell Park says in his History of Medicine: "With delightful satire Harvey divided the physicians of the day into six classes--the Ferrea, Asinaria, Jesuitica, Aquaria, Laniaria and Stercoraria--according as their favorite systems of treatment were the administration of iron, asses' milk, cinchona, mineral water, venesection or purgatives." That history repeats itself is a truism well illustrated in medicine to-day. The new cellular pathology, founded by Virchow and Cohnheim and elaborated by innumerable men since; the discovery of parasitism and the germ theory by Davaine, Pasteur and Koch; antisepsis by Lister; the introduction of anesthesia by Morton, Simpson and Koller; the application of more exact methods in diagnosis by Skoda and others, and many other innovations and discoveries have revolutionized medicine in the nineteenth century. The transition period of to-day is very analogous to that of the seventeenth century. Suggestive therapeutics has its advocates in the Emmanuel movement, Lourdes water, Christian Science, New Thought, faith cure and psycho-therapy. The uric acid theory is a curious survival of the old chemical system. The iatro-chemical system is the prototype of Metchnikoff's theory of longevity. And, strange to relate, despite the claims of wonderful discovery by A. T. Still and D. D. Palmer, the iatro-physical system of the seventeenth century was more complete as a guide to healing than is Osteopathy and Chiropractics to-day. Verily, there is nothing novel under the solar rays. That graft in surgery and shystering in internal medicine exists no one in the medical profession denies. It has come so insidiously that the profession itself was taken unawares. However, that sweeping denunciation of the entire profession should follow is unwarranted. Every other profession and calling has its black sheep, and it is the duty of the leaders in each to eliminate them. Elimination, however, cannot come entirely from within. The public has its share of responsibility and duty to perform, and the sooner this is realized, the better for all concerned. To aid in the work of obtaining better things in therapeutics, the establishment and extension of a national bureau or department of health is imperative. Any effort along this line will hasten the day of rational healing. Preventive medicine will then gradually supplant the present haphazard system of palliation and cure. And education is the watchword of the day! G. STROHBACH, M.D. Cincinnati, Ohio, 1908. PUBLISHERS' NOTE. Though written in a satirical vein, this book is intended as a warning to the medical profession and the public alike. And, while amusing, the wealth of information and comment on certain abuses in the healing art should lead to serious consideration. This book is published without bias or prejudice toward any school of medicine or system of therapeutics as such. But that quackery and graft are rampant among those who pose as healers has become so apparent that we believe every influence to expose and weed out the pretenders is timely. The author is an Osteopath who abandoned the practice of Osteopathy after a few years' earnest endeavor, convinced of the untenable position of those professing the practice of this art. He returned to the more congenial profession of teaching. For obvious reasons he publishes this book under a _nom de plume_. He is abundantly fortified with facts to substantiate his criticism. That his effort may be of some service in clarifying the situation and lead to better therapeutics in the near future, is the sincere hope of THE PUBLISHERS. CONTENTS. PART I--IN GENERAL. CHAPTER I--BY WAY OF INTRODUCTION 17 The Augean Stables of Therapeutics--The Remedy--Reason for Absence of Dignified Literary Style--Diploma Mills--"All but Holy"--Dr. Geo. H. Simmons' Opinion--American Medical Association Not Tyrannical--Therapeutics a Deplorable Muddle. CHAPTER II--GRAFT AND FAILUREPHOBIA 25 The Commercial Spirit--Commercialism in Medicine--Stock Company Medical Colleges--Graft in Medicines, Drugs and Nostrums--Encyclopedia Graft--"Get-Rich-Quick" Propositions--Paradoxes in Character of Shysters--Money Madness--Professional Failurephobia--The Fortunate Few and the Unfortunate Many--A Cause of Quackery--The Grafter's Herald--The World's Standard--Solitary Confinement--The Prisoner's Dream--Working up a Cough--Situation Appalling Among St. Louis Physicians--A Moral Pointed. CHAPTER III--WHY QUACKS FLOURISH 37 American Public Generally Intelligent--But Densely Ignorant in Important Particulars--Cotton Mather and Witchcraft--A.B.s, A.M.s, M.D.s and Ph.D.s Espousing Christian Science, Chiropractics and Osteopathy-- Gullibility of the College Bred--The Ignorant Suspicious of New Things--The Educated Man's Creed--Dearth of Therapeutic Knowledge by the Laity--Is the Medical Profession to Blame?--Physician's Arguments Controvertible--Host of Incompetents Among the Regular Physicians--Report of Committee on Medical Colleges--The "Big Doctors"--Doc Booze--The "Leading Doctor"--Osler's Drug Nihilism--The X-Ray Graft. CHAPTER IV--TURBID THERAPEUTICS 51 An Astounding Array of Therapeutic Systems--Diet--Water--Optics--Hemotherapy--Consumption Cures--Placebos--Inconsistencies and Contradictions-- Osler's Opinion of Appendicitis--Fair Statement of Limitations in Medicine Desirable. CHAPTER V--THE EXPERT WITNESS AND PROPRIETARY MEDICINES 57 The "Great Nerve Specialist"--The Professional Witness a Jonah--The "Railway Spine"--Is it Lack of Fairness and Honesty or Lack of Skill and Learning?--Destruction of Fine Herds of Cattle Without Compensation--Koch's Dictum and Denial--Koch's Tuberculin--The Serum Tribe--Stupendous Sale of Nostrums--Druggist's Arguments--Use of Proprietary Medicines Stimulates Sale of Nostrums. CHAPTER VI--FAITH CURE AND GRAFT IN SURGERY 62 Suggestive Therapeutics Chief Stock in Trade--Advice of a Medical College President--Disease Prevention Rather than Cure--Hygienic Living--The Medical Pretender--"Dangerous Diagnosis" Graft--Great Flourish of Trumpets--No "Starving Time" for Him--"Big Operations"--Mutilating the Human Body--Dr. C. W. Oviatt's Views--Dr. Maurice H. Richardson's Incisive Statements--Crying Need for Reform--Surgery that is Useless, Conscienceless and for Purely Commercial Ends--Spirit of Surgical Graft Especially in the West--Fee-Splitting and Commissions--A Nation of "Dollar-Chasers"--The Public's Share of Responsibility--Senn's Advice--The "Surgical Conscience." PART II--OSTEOPATHY. CHAPTER VII--SOME DEFINITIONS AND HISTORIES 79 Romantic Story of Osteopathy's Origin--An Asthma Cure--Headache Cured by Plowlines--Log Rolling to Relieve Dysentery--Osteopathy is Drugless Healing--Osteopathy is Manual Treatment--Liberty of Blood, Nerves and Arteries--Perfect Skeletal Alignment and Tonic, Ligamentous, Muscular and Facial Relaxation--Andrew T. Still in 1874--Kirksville, Mo., as a Mecca--American School of Osteopathy--The Promised Golden Stream of Prosperity--The "Mossbacks"--"Who's Who in Osteopathy." CHAPTER VIII--THE OSTEOPATHIC PROPAGANDA 88 Wonderful Growth Claimed to Prove Merit--Osteopathy is Rational Physio-Therapy--Growth is in Exact Proportion to Advertising Received--Booklets and Journals for Gratuitous Distribution--Osteopathy Languishes or Flourishes by Patent Medicine Devices--Circular Letter from Secretary of American Osteopathic Association--Boosts by Governors and Senators--The Especial Protege of Authors--Mark Twain--Opie Reed--Emerson Hough--Sam Jones--The Orificial Surgeon--The M.D. Seeking Job as "Professor"--The Lure of "Honored Doctor" with "Big Income"--No Competition. CHAPTER IX--THE PRINCIPLES AND PRACTICE OF OSTEOPATHY 97 Infallible, Touch-the-Button System that Always Cured--Indefinite Movements and Manipulations--Wealth of Undeveloped Scientific Facts--Osteopaths Taking M.D. Course--The Standpatter and the Drifter--The "Lesionist"--"Bone Setting"--"Inhibiting a Center"--Chiropractics--"Finest Anatomists in the World"--How to Cure Torticollis, Goitre and Enteric Troubles--A Successful Osteopath--Timid Old Maids--Osteopathic Philanthropy. CHAPTER X--OSTEOPATHY AS RELATED TO SOME NOTORIOUS FAKES 111 Sure Shot Rheumatism Cure--Regular Practitioner's Discomfiture--Medicines Alone Failed to Cure Rheumatism--Osteopathy Relieves Rheumatic and Neuralgic Pains--"Move Things"--"Pop" Stray Cervical Vertebræ--Find Something Wrong and Put it Right--Terrible Neck-Wrenching, Bone-Twisting Ordeal. CHAPTER XI--TAPEWORMS AND GALLSTONES 119 Plug-hatted Faker--Frequency of Tapeworms--Some Tricks Exposed--How the Defunct Worm was Passed--Rubber Near-Worm--New Gallstone Cure--Relation to Osteopathy--Perfect, Self-Oiling, "Autotherapeutic" Machine--Touch the Button--The Truth About the Consumption and Insanity Cures. THE MORAL TO THE TALE 125 Honesty--Plain Dealing--Education. PART ONE IN GENERAL Quacks and Grafters By EX-OSTEOPATH CHAPTER I. BY WAY OF INTRODUCTION. The Augean Stables of Therapeutics--The Remedy--Reason for Absence of Dignified Literary Style--Diploma Mills--"All but Holy"--Dr. Geo. H. Simmons' Opinion--American Medical Association Not Tyrannical--Therapeutics of To-day a Deplorable Muddle. In writing this booklet I do not pose as a Hercules come to cleanse the Augean stables of therapeutics. No power but that of a public conscience awakened to the prevalence of quackery and grafting in connection with doctoring can clear away the accumulated filth. Like Marc Antony, I claim neither wit, wisdom nor eloquence; but as a plain, blunt man I shall "speak right on of the things I do know" about quacks and grafters. In writing of Osteopathy I claim the right to speak as "one having authority," for I have been on the "inside." As to grafting in connection with the practice of medicine I take the viewpoint of a layman, who for years has carefully read the medical literature of the popular press, and of late years a number of representative professional journals, in an effort to get an intelligent conception of the theory and practice of therapeutics. I have not tried to write in a professional style. I have been reading professional literature steadily for some time, and need a rest from the dignified ponderosity of some of the stuff I had to flounder through. I have just read an exposition of the beautiful and rational simplicity of Osteopathy. This exposition is found in a so-called great American encyclopedia that has been put into our schools as an authoritative source of knowledge for the making of intelligent citizens of our children. It is written by a man whose name, like that of the scholar James Whitcomb Riley describes, is "set plumb at the dash-board of the whole indurin' alphabet," so many are his scholarly degrees. How impressive it is to look through an Osteopathic journal, and see exhaustive (and exhausting) dissertations under mighty names followed by such proof of profound wisdom as, A.M., M.S., D.O., or A.B., A.M., M.D., D.O. Who could believe that a man with all the wisdom testified to by such an array of degrees (no doubt there were more, but the modesty that goes with great learning forbade their display) could be imposed upon by a fad or fake? Or would espouse and proclaim anything that was not born of truth, and filled with blessing and benefaction for mankind? Scholarly degrees should be accepted as proof of wisdom, but after reading such expositions as that in the cyclopedia, or some of those in the journals, one sometimes wonders if all the above degrees might not be condensed into the one--D.F. As for dignified style in discussing the subject before me, I believe my readers will agree that dignity fits such subjects about as appropriately as a ten-dollar silk hat fits a ten-cent corn doctor, or a hod-carrier converted into a first-class Osteopath. While speaking of dignity, I want to commend an utterance of the editor of the _Journal of the American Medical Association_, made in a recent issue of that journal. It was in reply to a correspondent who had "jumped onto" the editor of a popular magazine because in exposing graft and quackery he had necessarily implicated a certain brand of medical practitioners. The man who criticised the editor of the popular magazine impresses a layman as one of that class of physicians that has done so much to destroy the respect and confidence of intelligent students of social conditions for medical men as a class, and in the efficacy of their therapeutic agencies. Although the committee appointed by the great society, of which he is presumably a member, reported that more than half of the medical colleges in this country are utterly unfit by equipment to turn out properly qualified physicians; that a large per cent of these unworthy schools are little better than diploma mills conducted for revenue only, and in spite of the incompetency and shystering that reputable physicians, in self-defense and in duty to the public must expose, this man proclaims that the medical profession is "all but holy" in its care for the souls and minds as well as the bodies of the people. With all respect for the devoted gentlemen among physicians we ask, Is it any wonder that the intelligent laity smile at such gush? And this man goes on to say that "99 per cent. of the practicing physicians of the country belong to this genuine class." Members of the American Medical Association may think that such discussions are for the profession, and should be kept "in the family." Perhaps they should, and no doubt it would be much better for the profession if many of the things said by leading medical men never reached the thinking public. But the fact remains that the contradictory and inconsistent things said do reach the public, and usually in garbled and distorted form. The better and safer way is, if possible, to see to it that there is no cause to say such things, or if criticisms must be made let physicians be fair and frank with the people, and treat the public as a party deeply concerned in all therapeutic discussions and investigations. And here applies the utterance of the editor of the _Journal of the American Medical Association_ that I wanted to commend: "The time has passed when we can wrap ourselves in a cloak of professional dignity and assume an attitude of infallibility toward the public. The more intelligent of the laity have opinions on medical subjects, often _bizarre_, it must be admitted, but frequently well grounded, and a fair discussion of such opinions can result only in a greater measure of confidence in and respect for the medical profession." Such honest, fair-minded declarations, together with expressions of similar import from scores of brainy physicians and surgeons in active practice, are the anchors that hold the medical ship from being dashed to wreckage upon the rocks of public opinion by the currents, cross-currents and counter-currents of the turbid stream of therapeutics. The people have strongly suspected graft in surgery, many of them know it, and nearly all have been taught by journals of the new schools that such grafting is a characteristic of medical schools, and is asserted to be condoned and encouraged by the profession as a whole. How refreshing, then, to hear a representative surgeon of the American Medical Association say: "The moral standards set for professional men are going to be higher in the future, and with the limelight of public opinion turned on the medical and surgical grafter, the evil will cease to exist." Contrast such frankness with the gush of the writer who, in the same organ, said 99 per cent. of the medical men were "all but holy" soul guardians, and judge which is most likely to inspire confidence in the intelligent laity. Right here I want to say that since I have been studying through a cartload of miscellaneous medical journals, I have changed my opinion of the American Medical Association. It is a matter of little consequence to medical men, of course, what my individual opinion may be. It may, however, be of some consequence and interest to them to know that the opinion of multitudes are being formed by the same distorting agencies that formed the opinion I held until I studied copies of the _Journal of the American Medical Association_ in comparison with the "riff-raff, rag-tag and bob-tail" of the representative organs of the myriad cults, isms, fads and fancies that "swarm like half-formed insects on the banks of the Nile." As portrayed by the numerous new school journals I receive, the American Medical Association is a tyrannical monster, conceived in greed and bigotry, born of selfishness and arrogance, cradled in iniquity and general cussedness, improved by man-slaughter, forced upon the people at the point of the bayonet and maintained by ignorance and superstition. Most magazines representing various "drugless" therapies, I found, spoke of the American Medical Association in about the same way. And not only these, but a number of so-called regular medical journals, as well as independent journals and booklets circulated to boost some individual, all added their modicum of vituperation. When you consider that thousands of Osteopaths (yes, there are several thousand of them in the field treating the people) are buying some one of the various Osteopathic journals by the hundreds every month and distributing them gratis to the people until the whole country is literally saturated, and that other cults are almost as busy disseminating their literature, do you wonder that the people are getting biased notions of the medical profession in general and the American Medical Association in particular? While my faith in the integrity and efficacy of the "new school" remained intact and at a fanatical pitch, my sympathy was with the "independent" journals. The doctrine of "therapeutic liberty" seemed a fair one, and one that was only American. After studying both sides, and comparing the journals, I have commenced to wonder if the man who preaches universal liberty so strenuously is not, in most cases, only working for _individual license_. I wrote a paper some time ago, out of which this booklet has grown, and sent it to the editor of the _Journal of the American Medical Association_. He was kind enough to say it was full of "severe truth" that should be published to the laity. In that paper I diagnosed the therapeutic situation of to-day as a "deplorable muddle," and I am glad to have my diagnosis confirmed by a prominent writer in the _Journal_ of the Association. He says: "Therapeutics to-day cannot be called a science, it can only be called a confusion. With a dozen dissenting opinions as to the most essential and efficacious therapeutic agents inside the school, and a horde of new school pretenders outside, each with his own little system that he heralds as the best and _only_ right way, and all these separated in everything but their attack on the regulars, there certainly is a 'turbidity of therapeutics!'" And this therapeutic stream is the one that flows for the "healing of nations!" Should not its waters be pure and uncontaminated, so that the invalid who thirsts for health may drink with confidence in their healing virtues? If the stream shows turbid to the physician, how must it appear to his patient as he stands upon the shore and sees conflicting currents boil and swirl in fierce contention, forming eddies that are continually stranding poor devils on the drifts of discarded remedies, while streams of murky waters (new schools) pour in from every side and add their filth. To the patient it becomes "confusion, worse confounded." CHAPTER II. GRAFT AND FAILUREPHOBIA. The Commercial Spirit--Commercialism in Medicine--Stock Company Medical Colleges--Graft in Medicines, Drugs and Nostrums--Encyclopedia Graft--"Get-Rich-Quick" Propositions--Paradoxes in Character of Shysters--Money Madness--Professional Failurephobia--The Fortunate Few and the Unfortunate Many--A Cause of Quackery--The Grafter's Herald--The World's Standard--Solitary Confinement--The Prisoner's Dream--Working up a Cough--Situation Appalling Among St. Louis Physicians--A Moral Pointed. This chapter is not written because I possess a hammer that must be used. My liver is sound, and I have a pretty good job. Neither palpation nor "osculation" (as one of our bright Osteopathic students once said in giving means used in physical diagnosis) reveals any "lesion" in my domestic affairs. However, it doesn't take the jaundiced eye of a pessimist to see the graft that abounds to-day. The grafter is abroad in the land like a wolf seeking whom he may devour, and the sheep-skin (sometimes a diploma) that once disguised his wolfish character has become so tattered by much use that it now deceives only the most foolish sheep. Once a sheep-skin of patriotism disguised the politician, and people fancied that a public office was a public trust. The revelations of the last few years have taught us that too often a public office is but a public steal. The commercial spirit dominates the age. Nothing is too sacred for its defiling hands to touch. The church does not escape. Preachers accuse each other of following their Lord for the loaves and fishes. Lawyers accuse each other of taking fees from both sides. Leading physicians unhesitatingly say that commercialism is the bane of the medical profession. They say hundreds are rushing into medicine because they have heard of the large earnings of a few fortunate city physicians, and think they are going into something that will bring them plenty of "easy money." Stock company medical colleges have been organized by men whose main object was to get a share of the money these hosts of would-be doctors had to spend. Even the new systems of therapeutics such as Osteopathy, that have boomed themselves into a kind of popularity, have their schools that, to believe what some of them say of each other, are dominated by the rankest commercialism, being, in fact, nothing but Osteopathic diploma mills. Not alone has graft pervaded the schools whose business it is supposed to be to make capable physicians. The graft that has been uncovered lately in connection with the preparation and sale of medicines, drugs and nostrums is almost incredible when we think of the danger to health and human life involved. The same brand of ghouls who tamper with and juggle medicines for gain, do not hesitate to adulterate and poison food. With their inferior, filthy and "preserved" milk they slaughter the innocents to make a paltry profit. The story Sinclair wrote of the nauseating horrors of slaughter-houses was enough to drive us all to the ranks of vegetarians forever. Only recently I chanced to learn that even in the business of publishing there is a little world of graft peculiar to itself. I was told by a responsible book man that the encyclopedia containing a learned (?) exposition of the science of Osteopathy is the product of grafters, who took old material and worked in a little new matter, such as the exposition of Osteopathy, to make their work appear up to date to the casual observer. Then, to make the graft worse, for a consideration, it was alleged, a popular publisher let his name be used, and thus thousands were caught who bought the work relying on the reputation of the publisher, who, it appears, had nothing whatever to do with the encyclopedia. Physicians, school teachers and preachers, all supposedly poor financiers, know about the swarms of grafters who hound them with "get-rich-quick" propositions into which they want them to put their scant surplus of salary or income as they get it. A physician told me he would have been $2,000 better off if a year or two before he had been a subscriber to a certain medical journal that poses as a sort of "watch dog" of the physician's treasury. Pessimistic as this review may seem, there is yet room for optimism, and, paradoxical as it may sound, men are not always as bad as their business. I know of a lawyer who in his profession has the reputation of being the worst shyster that ever argued a case. No scheme is too dishonest for his use if it will win his case. Yet this man outside of his profession, in his home, and in his society, is as fine a gentleman as you would wish to meet--a model husband and father, a kind and obliging neighbor, a generous supporter of all that is for the upbuilding and bettering of society. Strong case, do you say? I believe our country is full of such cases. And I believe the medical profession has thousands of just such men, men whose instincts are for nobility of character and whose moral ideals are high, but whose business standards are groveling. They live a sort of "Dr. Jekyll and Mr. Hyde" life, and why? Are they not to blame? And are they not to be classed as scoundrels? Yes--and no. These men are diseased. Their contact with the world has inoculated them with the world's contagion. What is this disease? The diagnosis has been considered simple. So simple that the world has called it commercialism, or money madness, and treated the disease according to this diagnosis without studying it further. May it not be true that, for many cases at least, the diagnosis is wrong? Do men choose the strenuous, money-grabbing life because they really love it, or love the money? I believe thousands of men in professional life to-day, who are known as dollar-chasers, really long for a more simple life, but the disease they have has robbed them of the power to choose "that better part." And that disease is not money madness, but _failurephobia_. The fear of failing, or of being called a failure, dominates the professional world as no other power could. It claims thousands of poor fellows who were brought up to the active, worth-while life of the farm or of a trade, and chains them to a miserable, sham, death-in-life sort of existence, that they come to loathe, but dare not leave because of their disease, failurephobia. Success is the world's standard. Succeed in your business or profession, by honest means if you can, but _succeed_! At least, keep up the appearance of succeeding, and you may keep your place in society. It may be known that your business is poor, and that you go to your office and sit in solitude day in and day out, and that you starve and skimp at home, but so long as you keep up the _show_, you are a "professional man!" What mighty courage it takes to acknowledge what everybody else knows, and _quit_! A writer in a medical journal told of a young physician in Boston who put an ad. in a daily paper asking for a job in which a strong man could use the strength a manly man ought to be proud of, to earn an honest living. If men only had the courage, I wonder how many such ads. would appear in the columns of our papers! An old schoolmate, who is a lawyer in a Western city, told me that of the more than two hundred lawyers of that city, twenty had practically all the law business, and of that twenty a half dozen got the big cases in which there was most money. It is largely so in every city and town. And what applies to the lawyer applies to the physician, though perhaps not to so great an extent. And while the fortunate few get most of the practice, and make most of the money, what are the unfortunate many doing? Holding on, starving, skimping, keeping up appearances, and, while young, hoping against hope for better days. But when hope long deferred has made the soul sick, and hope itself dies, what then? Keep up appearances, you are a professional man. You can't be a quitter. It would be humorous, were it not so pathetic, to see the old doctor who has dragged along for years, barely eking out a living, put on the silk hat of his more ambitious days and wear it with dignity along with his shiny threadbare trousers and short coat, making a desperate spurt to keep up with the dashing young fellow just out of school. _Failurephobia!_ Among professional men what a terrible disease it is! I have known it to drive a young man, who might have been happy and useful as a farmer or mechanic, into a suicide's grave. Such cases are not uncommon. Who are the M.D.s whose pictures and glaring ads. appear in those 15-cent papers published in Augusta, Me., and in many daily and even religious papers? Are they men who took to graft and disgraced their profession because they loved that kind of life, and the stigma it brings? Not in many cases. Most of them perhaps come from the ranks of ambitious fellows who lost out in the strife for legitimate practice, but who would not acknowledge failure, so launched into quackery, and became _notorious_ if they could not become noted. Strange as it may seem, the fact that a professional man is a notorious grafter abroad does not necessarily deprive him of social standing at home. I have in mind a man whose smug face appears in connection with a page of loud and lurid literature in almost every 15-cent _Grafters Herald_ from Maine to California; yet this man at home was pointed to with pride as an eminently successful man. He wore his silk hat to church, and the church of which he was a valued member was proud of the distinction he gave it. A Western city has an industry to which it "points with pride," and the pictures of the huge plant appear conspicuously placed in illustrated boom editions of the city's enterprising papers. This octopus reaches out its slimy tentacles to every corner of the United States, feeling for poor wretches smitten by disease, real or fancied. When once it gets hold of them it spews its inky fluids around them until they "cough up" their hard-earned dollars that go to perpetuate this "pride of the West." The most popular themes of the preacher, lecturer and magazine writer to-day are Honesty, Anti-graft, Tainted Money, True Success, etc. You have heard and read them all, and have been thrilled with the stirring words "An honest man is the noblest work of God." The preacher and the people think they are sincere, and go home congratulating themselves that they are capable of entertaining such sentiment. When we observe their social lives we are led to wonder how much of that noble sentiment is only cant after all. THE WORLD'S STANDARD. The world will say that goodness is the only thing worth while, But the man who's been successful is the man who gets the smile. If the "good" man is a failure, a fellow who is down, He's a fellow "up against it," and gets nothing but a frown. The fellow who is frosted is the fellow who is down, No matter how he came there, how honest he has been, They find him just the same when being there's a sin. A man is scarce insulted if you tell him he is bad, To tell him he is tricky will never make him mad; If you say that he's a schemer the world will say he's smart, But say that he's a failure if you want to break his heart. If you want to be "respected" and "pointed to with pride," "Air" yourselves in "autos" when you go to take a ride; No matter how you get them, with the world that "cuts no ice," Your neighbors know you have them and know they're new and nice. The preacher in the pulpit will tell you, with a sigh, That rich men go with Dives when they come at last to die; And men who've been like Lazarus, failures here on earth, Will find their home in Heaven where the angels know their worth. But the preacher goes with Dives when the dinner hour comes; He prefers a groaning table to grabbing after crumbs. Yes; he'll take Dives' "tainted money" just to lighten up his load. Enough to let him travel in the little camel road. That may sound like the wail of a pessimistic knocker, but every observing man knows it's mostly truth. The successful man is the man who gets the world's smile, and he gets the smile with little regard to the methods employed to achieve his "success." This deplorable social condition is largely responsible for the multitudinous forms of graft that exist to-day. To "cut any ice" in "society" you must be somebody or keep up the appearance of being somebody. Even if the world knows you are going mainly on pretensions, it will "wink the other eye" and give you the place your pretensions claim. Most of the folk who make up "society" are slow to engage in stone slinging, for they are wise enough to consider the material of which their own domiciles are constructed. To make an application of all this, let us not be too hard on the quack and the shyster. He is largely a product of our social system. Society has placed temptations before him to get money, and he must keep up the appearances of success at any cost of honesty and independent manhood. The poor professional man who is a victim of that fearful disease, failurephobia, in his weakness has become a slave to public opinion. He is made to "tread the mill" daily in the monotonous round to and from his office where he is serving a life sentence of solitary confinement, while his wife sews or makes lace or gives music lessons to support the family. I say solitary confinement advisedly, for now a professional man is even denied the solid comfort of the old-time village doctor or lawyer who could sit with his cronies and fellow-loafers in the shade of the tavern elm, or around the grocer's stove, and maintain his professional standing (or rather sitting). In the large towns and cities that will not do to-day. If the professional man is not busy, he must _seem_ busy. A physician changed his office to get a south front, as he felt he _must_ have sunshine, and he dared not do like Dr. Jones, get it loafing on the streets. Not that a doctor would not enjoy spending some of his long, lonely hours talking with his friends in the glorious sunshine, but it would not do. People would say: "Doctor Blank must not get much to do now. I see him loafing on the street like old Doc Jones. I guess Doctor Newcomer has made a 'has been' of him, too." I know a young lawyer who sat in his office for two long years without a single case. Yet every day he passed through the street with the brisk walk of one in a hurry to get back to pressing business. He was so busy (?) that he had to read the paper as he walked to save time to--wait! Did you ever sit in the office with one of these prisoners and watch him looking out of his window upon prosperous farmers as they untied fine teams and drove away in comfortable carriages? Did you know how to translate that look in his eye, and the sad abstraction of manner into which he momentarily sank, in spite of his creed, which taught him to always seem prosperous and contented? The translation was not hard. His mind was following that farmer out of town and along the green lanes, bordered by meadows and clover bloom, and on down the road through the cool twilight of the quiet summer evening, to where the ribbon of dark green forest, whose cool cadence had called to him so often, changed to groves of whispering trees that bordered the winding stream that spoke of the swimming holes and fishing pools of his boyhood. And on up the road again, across the fertile prairie lands, until he turns in at the gate of an orchard-embowered home. And do you think the picture is less attractive to this exile because it has not the stately front and the glistening paint of the smart house in town? Not at all. The smart house with glistening paint is the one he must aspire to in town, but his ideal home is that snug farmhouse to which his fancy has followed the prosperous farmer. That picture is not altogether a product of poetic fancy. We get glimpses of such pictures in confidential talks with lawyers and doctors in almost every town. These poor fellows may fret and sigh for change, "and spend their lives for naught," but the hunger never leaves them. Not long ago a professional man who has spent twenty-five years of his life imprisoned in an office, most of the time just waiting, spoke to me of his longing to "get out." His longing had become almost a madness. He forgot the creed, to always appear prosperous, and spoke in bitterness of his life of sham. He said he was like the general of the old rhyme who "marched up the hill and--marched down again." He went up to his office and--went home again, day in and day out, year in and year out, and for what? But _failurephobia_ held him there, and he is there yet. What schemes such unfortunates sometimes concoct to escape their fate! I was told of a physician who was "working up a cough," to have an excuse to go west "for his health." How often we hear or read of some bright doctor or lawyer who had a "growing" practice and a "bright future" before him, having to change his occupation on account of his health failing! This is not an overdrawn picture. I believe old and observing professional men will bear me out in it. Statistics of the conditions in the professions are unobtainable, but I feel sure would only corroborate my statement. In a recent medical journal was an article by a St. Louis physician, which said the situation among medical men of that city was "appalling." Of the 1,100 doctors there, dozens of them were living on ten-cent lunches at the saloons, and with shiny clothes and unkempt persons were holding on in despair, waiting for something better, or sinking out of sight of the profession in hopeless defeat. This is a discouraging outlook, but it is time some such pictures were held up before the multitude of young people of both sexes who are entering medical and other schools, aspiring to professional life. And it is time for society to recognize some of the responsibility for graft that rests on it, for setting standards that cause commercialism to dominate the age. CHAPTER III. WHY QUACKS FLOURISH. American Public Generally Intelligent, but Densely Ignorant in Important Particulars--Cotton Mather and Witchcraft--A.B.'s, A.M.'s, M.D.'s and Ph.D.'s Espousing Christian Science, Chiropractics and Osteopathy--Gullibility of the College Bred--The Ignorant Suspicious of New Things--The Educated Man's Creed--Dearth of Therapeutic Knowledge by the Laity--Is the Medical Profession to Blame?--Physicians' Arguments Controvertible--Host of Incompetents Among the Regular Physicians--Report of Committee on Medical Colleges--The "Big Doctors"--Doc Booze--The "Leading Doctor"--Osler's Drug Nihilism--The X-Ray Graft. In spite of the apparent prevalence of graft and the seemingly unprecedented dishonesty of those who serve the public, there are not wanting signs of the coming of better things. The eminent physician who spoke of the turbidity of therapeutics thought it was only that agitation that precedes crystallization and clarification that brings purity, and not greater pollution. May the seeming bad condition not be due in part also to the fact that a larger number of our American people are becoming intelligent enough to know the sham from the genuine, and to know when they are being imposed upon? That our American people are generally intelligent we know; but that a people may be generally intelligent and yet densely ignorant in important particulars has been demonstrated in all ages, and in no age more clearly than in our own. We wonder how the great scholar, Cotton Mather, could have believed in and taught witchcraft. What shall we think, in this enlightened age, of judges pleading for the healing (?) virtues of Christian Science, or of college professors taking treatment from a Chiropractor or magnetic healer; or of the scores of A.B.s, A.M.s, M.D.s, Ph.D.s, who espouse Osteopathy and use the powers of their supposedly superior intellect in its propagation? We can only come to this conclusion: The college education of to-day does not necessarily make one proof against graft. In fact, it seems that when it comes to belief in "new scientific discoveries," the educated are even more easily imposed upon than the ignorant. The ignorant man is apt to be suspicious of new things, especially things that are supposed to require scientific knowledge to comprehend. On the other hand, the man who prides himself on his learning is sure he can take care of himself, and often thinks it a proof of his superior intelligence to be one of the charter members of every scientific fad that is sprung on the people by some college professor who is striving for a medal for work done in original research. Whatever the reason may be, the fact remains that frauds and grafts are perpetrated upon educated people to-day. In the preceding chapter I tried to tell in a general way what some of the grafts are, and something of the social conditions that help to produce the grafters. I shall now give some of the reasons why shysters find so many easy victims for their grafts. When it comes to grafting in connection with therapeutics, the layman's educational armor, which affords him protection against most forms of graft in business, seems utterly useless. True, it affords protection against the more vulgar nostrum grafting that claims its millions of victims among the masses; but when the educated man meets the "new discovery," "new method" grafter he bares his bosom and welcomes him as a friend and fellow-scientist. It is the educated man's creed to-day to accept everything that comes to him in the name of science. The average educated man knows nothing whatever of the theory and _modus operandi_ of therapeutics. He is perhaps possessed of some knowledge of everything on the earth, in the heaven above, and in the waters beneath. He is, however, densely ignorant of one of the most important things of all--therapeutics--the matter of possessing an intelligent conception of what are rational and competent means of caring for his body when it is attacked by disease. A man who writes A.M., D.D., or LL.D. after his name will send for a physician of "any old school," and put his life or the life of a member of his family into his hands with no intelligent idea whatever as to whether the right thing is being done to save that life. Is this ignorance of therapeutics on the part of the otherwise educated the result of a studied policy of physicians to mystify the public and keep their theories from the laity? I don't know. Such accusations are often made. I read in a medical magazine recently a question the editor put to his patrons. He told them he had returned money sent by a layman for a year's subscription to his journal, and asked if such action met their approval. If the majority of the physicians who read his journal do approve his action, their motives _may_ be based on considerations that are for the public good, for aught I know, but as a representative layman I see much more to commend in the attitude of the editor of the _Journal of the A. M. A._ on the question of admitting the public to the confidence of the physician. As I have quoted before, he says: "The time has passed when we can wrap ourselves in a cloak of professional dignity and assume an attitude of infallibility toward the public." Such sentiment freely expressed would, I believe, soon change the attitude of the laity toward physicians from one which is either suspicion or open hostility to one of respect and sympathy. The argument has been made by physicians that it would not do for the public to read all their discussions and descriptions of diseases, as their imagination would reproduce all the symptoms in themselves. Others have urged that it will not do to let the public read professional literature, for they might draw conclusions from the varied opinions they read that would not be for the good of the profession. Both arguments remind one of the arguments parents make as an excuse for not teaching their children the mysteries of reproduction. They did not want to put thoughts into the minds of their children that might do them harm. At the same time they should know that the thoughts would be, and were being, put into their children's minds from the most harmful and corrupting sources. So in therapeutics. Are not all symptoms of disease put before the people anyway, and from the worst possible sources? If medical men do not know this, let them read some of the ads. in the _Grafter's Herald_. And are the contradictions and inconsistencies in discussions in medical journals kept from the public? If medical men think so, let them read the Osteopathic and "independent" journals. The public knows too much already, considering the sources from which the knowledge comes. Since people will be informed, why not let them get information that is authentic? Before I studied the literature of leading medical journals I believed that the biggest and brainiest physicians were in favor of fair and frank dealing with the public. I had learned this much from observation and contact with medical men. After a careful study of the organ of the American Medical Association my respect for that organization is greatly increased by finding expressions in numbers of articles which show that my opinion was correct. In spite of all the vituperation that is heaped upon it, and in spite of the narrowness of individual members, the American Medical Association does seem to exist for the good of humanity. The strongest recommendation I have found for it lies in the character of the schools and individuals who are most bitter against it. It is usually complimentary to a man to have rascals array themselves against him. There are many able men among physicians who feel keenly their limitations, when they have done their best, and this class would gladly have their patients understand the limitations as well as the powers of the physician. In sorrow and disgust sometimes the conscientious physician realizes that he is handicapped in his work to either prevent or cure disease, because he has to work with people who have wrong notions of his power and of the potency of agencies he employs. With shame he must acknowledge that the people hold such erroneous ideas of medicine, not because of general ignorance, but because they have been intentionally taught them by the army of quacks outside and the host of grafters and incompetents _inside_ the regular medical profession. Incompetent physicians, to succeed financially (and that is the only idea of success incompetents are capable of appreciating), must practice as shysters. They fully understand how necessary it is to the successful working of their grafts to keep the people in ignorance of what a physician may legitimately and conscientiously do. Our medical brethren who preach the "all but holy" doctrine, and want to maintain the "attitude of infallibility toward the public," will disagree with me about there being "a host" of incompetents in the regular school of medical practice. I shall not ask that they take the possibly biased opinion of an ex-Osteopath, but refer them to the report of the committee appointed by the American Medical Association to examine the medical colleges of the United States as to their ability to make competent physicians. "One-half of all the medical schools of our country are utterly unfit to turn out properly qualified physicians, and many of them are so dominated by commercialism that they are but little better than diploma mills"! That's what the committee said. It has been argued that the capable physician need not fear the incompetent pretender, for, like dregs, he must "settle to the bottom" and find his place. This might be true if the people had correct notions of the true theory of therapeutics. As it is, the scholarly, competent physician knows (and intelligent laymen often know) that the pretenders too often are the fellows who get the reputations of being the "big doctors." Why? I think mainly because, being ignorant, they practice largely as quacks, and by curing (?) all kinds of dangerous (on their own diagnosis) diseases quickly, "breaking up" this and "aborting" that unbreakable and unabortable disease (by "hot air" treatment mainly), they place the whole system upon such a basis of quackery that the deluded masses often pronounce the best equipped and most conscientious physician a "poor doctor," because he will not pretend to do all that the wind-jamming grafter claims _he has_ done and _can_ do. Here is a case in point which I know to be true. The farce began some years ago in a small college in Oregon. A big, awkward, harmless-looking fellow came to the college one fall and entered the preparatory department. At the end of the year, after he had failed in every examination and shown conclusively that he had no capacity to learn anything, he was told that it was a waste of time for him to go to school, and they could not admit him for another year. Was he squelched? Not he. The fires of ambition yet burned in his breast, and the next year he turned up at a medical college. I presume it had the same high educational requirements for admission that some other medical colleges have, and enforced them in about the same way. At any rate he met the requirements ($$$), and pursued his medical researches with bright visions of being a doctor to lure him on. But his inability to learn anything manifested itself again, and, presumably, his money gave out. At any rate he was sent away without a diploma. Still the fire of ambition was not extinguished in his manly bosom. Regulations were not strict in those days, so he went to a small town, wore fine clothes, a silk hat and a pompous air, and--within a short time was being called for forty miles around to "counsel little doctors" in their desperate cases. Such cases are all too common, as honest physicians know. How humiliating to the conscientiously equipped doctor to hear people say of a man who never had more brains than he needed, and had hopelessly muddled what he had by using his own dope and stimulants: "I tell you Doc Booze is the best doctor in town yet when he's half sober!" Strange, isn't it, that in many communities people have an idea that an inclination on the part of a physician toward whisky or dope indicates some peculiar mental fitness for a doctor? "Poor fellow, he formed the habit of taking stimulants to keep up when he had to go night and day during the big typhoid epidemic, you know." For what per cent. of cases of medical dipsomaniacs this constitutes a stock excuse, only medical men know. As an Osteopathic physician I was never rushed so that I felt the necessity for "keeping up on stimulants." If I had been, to be consistent, I should have had to stimulate (?) mechanically, of course. Not only do shysters and pretenders abuse the confidence of the masses in matters of diagnosis and medication, but of late years they are working another species of graft that is beginning to react against the profession. This graft consists in the over-use of therapeutic appliances that are all right in their place when legitimately used. By what standard is the physician judged by the people who enter his office? It used to be the display of medical literature. Sometimes some of it was pseudo-medical literature. Did you ever know a shyster to pad his library with Congressional reports? I have. The literature used to be conspicuously placed in the waiting-room, with a ponderous volume lying open on the desk. Have you a "leading doctor" in your town? Often he is not only in the lead but has flagged all the others at the quarter post--put them all into the "has been" class. What an elegant office he has! Plush rugs and luxurious couches in the waiting-room. Double doors into the private and operating-rooms, left open when not in actual use to give impressive glimpses of glass cases filled with glittering instruments, any one of which would give the lie to Solomon's declaration that "there is nothing new under the sun." An X-ray machine fills a conspicuous corner. In the same room are tanks, tubes, inhalers, hot-air appliances, vibrators, etc. One full side of the room is filled with shelves that groan under a load of the medicines he "keeps and dispenses." What are all of these hundreds of bottles for if it is true, as many of our greatest physicians say, that a comparatively few people are benefited by drugs? These numerous bottles may contain placebos. I do not know as to that, but I do know something of the impression such a display makes on the mind of an intelligent layman. The query in his mind is how much of that entire display is for its legitimate effect on the minds of the patients, and how much of it is to impress the people with the powers of this physician, with his "wonderful equipment" to cope with all manner of disease? If there is any doubt in the minds of physicians that laymen do know and think well over the sayings of drug nihilists, let them talk with intelligent people and hear them quote from the editorial page of a great daily such sentiments as this (from the Chicago _Record-Herald_): "Prof. William Osier, the distinguished teacher of medicine, who was taken from this country a few years ago to occupy the most important medical chair in Great Britain, has shocked his profession repeatedly by his pronouncements against the use of drugs and medicines of almost every kind. Only a few days ago he made an address in which he declared that even though most physicians will be deprived of their livelihood, the time must soon come when sound hygienic advice for the prevention of disease will take the place of the present system of prescription and _pretense of cure_. The most able physicians agree with him, even when they are not frank enough to express themselves to the same effect." Medical men need not think, either, that the people who happened to read the editorial pages referred to are the only ones who know of that declaration from Osier. Osteopathic journals, Christian Science journals, health culture journals, and all the riff-raff of journals published as individual boosters, are ever on the watch for just such things, and when they find them they "roll them under their tongue as sweet morsels." They chew them, as Carleton says, with "the cud of fancy," and hand them along as latest news to tens of thousands of people who are quick to believe them. Going back to the physician who has the well-equipped office, is he a grafter in any sense? I shall not give my opinion. Perhaps every thing he has in the office is legitimate. In the opinion of the masses of that community he is the greatest doctor that ever prescribed a pill or purloined an appendix. Taking the word of the physicians whom he has put into the "has been" class for it, he is the greatest fake that ever fooled the people. Most of those outclassed doctors will talk at any time, in any place, to any one, of the pretensions of this type of physician. They will tell how he dazzles the people with his display of apparatus "kept for show;" how he diagnoses malarial fever as typhoid, and thus gets the reputation of curing a larger per cent. of typhoid than any other doctor in town; how he gets the reputation of being a big surgeon by cutting out healthy ovaries and appendices, and how he assists with his knife women who do not desire Rooseveltian families. They point to the number of appendectomies he has performed, and recall how rare such cases were before his advent, and yet how few people died with appendicitis. Is it to be wondered that intelligent laymen sometimes lose faith in and respect for the profession of medicine and surgery? To show that people may be imposed upon by illegitimate use of legitimate agencies I call attention to an article published recently in the _Iowa Health Bulletin_. The Iowa Medical Board is winning admiration from many by conducting a campaign to educate the people of the State in matters pertaining to hygienic living. In line with this work they published an article to correct the erroneous idea the laity have of the X-ray. They say: "The people think that with the X-ray the doctor can look right into the body and examine any part or organ and tell just what is the matter with it, when the fact is all that is ever seen is a lot of dim shadows that even the expert often fails to understand or recognize." Why do the people have such erroneous conceptions of the X-ray? Is it accidental, or the result of their innate stupidity? Certainly it is not. The people have just such conceptions of the X-ray as they receive from the faker who uses it as he uses his opiates and stimulants--to get an effect and give the people wrong ideas of his power. A lady of a small town who was far advanced in consumption was taken to a city to be examined by a "big doctor" who possessed an X-ray. He "examined" her thoroughly by the aid of the penetrating light made by his machine, and sent them home delighted with the assurance that his wonderful instrument revealed no tuberculosis. He assured her that if she would avail herself of his superior skill she might yet be restored to health. She died within a year from the ravages of tuberculosis. A boy of four had an aggravated attack of bronchitis. His symptoms were such that his parents thought some object might have lodged in his trachea. A noted surgeon who had come one hundred miles from a hospital to see another case was consulted. He told the parents that the boy had sucked something down his windpipe, and advised them to bring him to the hospital for an operation. They did so, and a $100 incision was made after the X-ray had located (?) an object lodged at the bifurcation of the trachea. The knife found nothing, however, and the boy still had his bronchitis, and the parents had their hospital and surgeon's bills, and, incidentally, their faith in the X-ray somewhat shattered. The X-rays, Finsen rays, electric light and sunlight have their place in therapy. Informed people do not doubt their efficacy. However, the history of the use of these agents is a common one. A scientist, after possibly a lifetime of research, develops a new therapeutic agent or a new application of some old agent. He gives his findings to the world. Immediately a lot of half-baked professional men seize upon it, more with the object of self-laudation and advertisement than in a true scientific spirit. Serious study in the application of the new agent is not thought of. The object is rather to have the reputation of being an up-to-snuff man. The results obtained are not what the originator claimed, which is not to be wondered at. The abuse of the remedy leads to abuse of the originator, which is entirely unfair to both. This state of affairs has grown so bad that scientists now are beginning to restrict the application of their discoveries to their own pupils. A Berlin _savant_, assistant to Koch, has developed the use of tuberculin to such a point as to make it one of the most valuable remedies in tuberculosis. It is manufactured under his personal supervision, and sold only to such physicians as will study in his laboratory and show themselves competent to grasp the principles involved. CHAPTER IV. TURBID THERAPEUTICS. An Astounding Array of Therapeutic Systems--Diet--Water--Optics--Hemotherapy--Consumption Cures--Placebos--Inconsistencies and Contradictions--Osler's Opinion of Appendicitis--Fair Statement of Limitations in Medicine Desirable. To be convinced that therapeutics are turbid, note the increasing numbers of diametrically opposed schools springing up and claiming to advocate the only true system of healing. Look at the astounding array: Allopathy, Homeopathy, Eclecticism, Osteopathy, Electrotherapy, Christian Science, Emmanuel movement, Hydrotherapy, Chiropractics, Viteopathy, Magnetic Healing, Suggestive Therapeutics, Naturopathy, Massotherapy, Physio-Therapy, and a host of minor fads that are rainbow-hued bubbles for a day. They come and go as Byron said some therapeutic fads came and went in his day. He spoke of the new things that astounded the people for a day, and then, as it has been with "Cowpox, tractors, galvanism and gas, The bubble bursts and all is air at last." One says he has found that fasting is a panacea. Another says: "He is a fool; you must feed the body if you expect it to be built up." One says drinking floods of water is a cure-all. Another says the water is all right, but you must use it for the "internal bath." Still another agrees that water is the thing, but it must be used in hot and cold applications. One faker says _he_ has found that most diseases are caused by defective eyes, and proposes to cure anything from consumption to ingrown toe-nails with glasses. Another agrees that the predisposing cause of diseases is eye strain, but the first fellow is irrational in his treatment. Glasses are unnatural and therefore all wrong. To cure the eyes use his wonderful nature-assisting ointment; that goes right to the optic nerve and makes old eyes young, weak eyes strong, relieves nerve strain and thereby makes sick people well. Another has found that "infused" blood is the real elixir of life. He reports 100 per cent. of twenty cases of tuberculosis cured by his beneficent discovery. I wonder why we have a "Great White Plague" at all; or why we have international conventions to discuss means of staying the ravages of this terrible disease; or why State medical boards are devoting so much space in their bulletins to warn and educate the people against the awful fatality of consumption, when to cure it is so easy if doctors will only use blood? Even if the hemotherapist does claim a little too much, there is yet no cause for terror. A leading Osteopathic journal proclaims in large letters that the Osteopath can remove the obstruction so that nature will cure consumption. Christian Scientists and Magnetic Healers have not yet admitted their defeat, and there are many regulars who have not surrendered to the plague. So the poor consumptive may hope on (while his money lasts). Our most conscientious physicians not only admit limitations in curing tuberculosis, but try to teach the people that they must not rely on being "cured" if they are attacked, but must work with the physician to prevent its contagion. The intelligent layman can say "Amen" to that doctrine. The question may be fairly put: "Why not have more of such frankness from the physician?" The manner in which the admissions of doctors that they are unable to control tuberculosis with medicine or surgery alone has been received by intelligent people should encourage the profession. It would seem more fair to take the stand of Professor Osler when he says that sound hygienic advice for the prevention of diseases must largely take the place of present medication and pretence of cure. As a member of the American Medical Association recently said, "The placebo will not fool intelligent people always." And when it is generally known that most of a physician's medicines are given as placebos, do you wonder that the claims of "drugless healers" receive such serious consideration? The absurd, conflicting claims of quack pretenders are bad enough to muddle the situation and add to the turbidity of therapeutics; but all this is not doing the medical profession nearly as much harm, nor driving as many people into the ranks of fad followers, as the inconsistencies and contradictions among the so-called regulars. This was my opinion before I made any special study of therapeutics, and while studying I found numbers of prominent medical men who agree with me. One of them says that the "criticisms," quarrels, contradictions, and inconsistencies of medical men are doing more to lower the profession in the estimation of the intelligent laity and to cause people to follow the fads of "new schools" than all else combined. Think for a moment of some of these inconsistencies and contradictions. One doctor in a town tells the people that he "breaks up" typhoid fever. His rival, perhaps from the same college, tells the people that typhoid must "run its course" and cannot be broken up, and that any man who claims the contrary is a liar and a shyster. One surgeon makes a portion of the people believe he has saved dozens of lives in that community by surgical operations; the other physicians of the town tell the people openly, or at least hint, that there has been a great deal of needless butchery performed in that community in the name of surgery. And then the people see editorials in the daily press about the fad of having operations performed, and read in their health culture or Osteopathic journals from articles by the greatest M.D.s, in which it is admitted that surgery is practiced too largely as a graft. Professor Osler is quoted as saying: "Surgeons are finding altogether too many cases of appendicitis these days. Appendicitis is becoming so common and so easily detected that the physician's wife can diagnose a case of it over the telephone." One leading physician says medical treatment has little beneficial effect on pneumonia; another claims to be able to cure it, and lets the friends of his patient rely entirely on his medicine in the most desperate cases. Another says the main reliance should be heat. Another says ice-packs. Another says Antiphlogistine. Another says, "All those clay preparations are frauds, and the only safe way to treat pneumonia is by blood letting." Thus it goes, and this is only a sample of contradictions that arise in the treatment of diseases. Nor is the above an overdrawn picture. Most of it was from the journal of the editor who said he refused to send it to a layman who had sent his money in advance. But all that same stuff has been hashed and rehashed to the people through the sources I have already mentioned. There are not only these evidences of inconsistencies to edify (?) the people, but constantly recurring examples of incompetency and pretensions. There is no doubt a middle ground in all this, but it is not evident to the casual observer. If the true physician would honestly admit his limitations to the intelligent laity, much of this muddle would be avoided. While by such a course he may occasionally temporarily lose a patient, in the end both the public and profession would gain. The time has gone by to "assume an air of infallibility toward the public." CHAPTER V. THE EXPERT WITNESS AND PROPRIETARY MEDICINES. The "Great Nerve Specialist"--The Professional Witness a Jonah--The "Railway Spine"--Is it Lack of Fairness and Honesty or Lack of Skill and Learning?--Destruction of Fine Herds of Cattle Without Compensation--Koch's Dictum and Denial--Koch's Tuberculin--The Serum Tribe--Stupendous Sale of Nostrums--Druggist's Arguments--Use of Proprietary Medicines Stimulates Sale of Nostrums. I wonder what the patrons of the sanitarium of the "great nerve specialist" thought of his display of knowledge of the nervous system when he was on the witness stand in a recent notorious case? A lawyer tangled him up completely, and showed that the doctor had no accurate knowledge of the anatomy of the nervous system. When asked the origin of the all-important pneumogastric nerve, he _thought_ it originated in a certain segment of the spinal cord! This noted "specialist" was made perfectly contemptible, and the whole profession must have blushed in shame at the spectacle presented. And that spectacle was not unnoticed by the intelligent laity. The professional witness has in most cases been a Jonah to the profession. It is about as easy to get the kind of testimony you want from a professional witness in a suit for damages for personal injuries as it is to get a doctor's certificate to get out of working your poll-tax, or a certificate of physical soundness to carry fraternal life insurance. Let me recall the substance of a paper read a few years ago by perhaps the greatest lawyer in Iowa (afterward governor of that State). He told of a trial in which he had examined and cross-examined ten physicians. It was a trial in which suit was brought to recover damages for personal injury, a good illustration of the "railway spine." One physician testified that the patient was afflicted with sclerosis of the spinal cord; another said it was a plain case of congestion of the cord; another diagnosed degeneration of the cord; yet another said it was a true combination of all the conditions named by the first three. They all said there was atrophy of the muscles of the left leg, and predicted that complete paralysis would surely supervene. On the other side five noted physicians testified as positively that neither the spinal cord nor any nerve was injured; that there was no sign of atrophy or loss of power in the leg; and they seemed to think the disease afflicting the patient was due to a fixed desire to secure a verdict for large damages from the railway company. One eminent specialist made oath that the electrical test showed the partial reaction of degeneration; another as famous challenged him to make the test again in the presence of both. After it was made this second specialist went before the jury and positively declared that there was no trace whatever of the reaction of degeneration, and that the muscles responded to the current precisely as healthy muscles should. Then this eminent attorney adds: "If the instances of such diversity were rare they might pass unnoticed, but they occur and re-occur as often as physicians are called to the temple of justice for the expression of opinions." The lay mind imputes this clash of opinions either to lack of fairness and honesty or lack of skill and learning. In either case the profession suffers great injury in the estimation of those who should have for it only the profoundest admiration and the most implicit faith. Again I ask, Is it any wonder people have lost implicit faith when they read many reports of similar cases rehashed in the various yellow journals put into their hands? Farmers submitted with all possible grace to the decrees of science when, by the authority of such a great man as Koch, their fine herds of cattle were condemned as breeders and disseminators of the great white plague and destroyed without compensation. But how do you think these same farmers feel when they read in yellow journals that Koch has changed his mind about bovine and human tuberculosis being identical, and has serious doubts about the one contracting in any way the disease of the other. People read with renewed hope the glowing accounts of the wonderful achievements of Dr. Koch in finding a destroyer for the germ of consumption. Somehow time has slipped by since that renowned discovery, with consumption still claiming its victims, and many physicians are saying "Koch's great discovery is proving only a great disappointment." Drugless therapy journals are continually pouring out the vials of their wrath upon vaccination, antitoxin and all the serum tribe, and their vituperation is even excelled by vindictive denunciations of the same things by the individual boomer journals that flood the land. Another bitter contention that is confusing some, and disgusting others, is the acrimonious strife between users and non-users of proprietary medicines. This usually develops into a sort of "rough house" affair, the druggist mixing up as savagely as the doctors before the fight is finished. I know nothing of the rights or wrongs of the case nor of the merits or demerits of proprietary medicines, but I do know this, however: The stupendous sale of nostrums that in 1907 represented a sum of money sufficient to have provided every practitioner of medicine in the United States with a two thousand dollar salary, has been helped by the use of proprietary medicines. I am aware that my position is likely to be called in question by many physicians. But they should hear druggists arguing with people who hesitate about buying patent medicines because their physicians tell them they should seldom take medicine unless prescribed by a doctor. They would hear him say: "Your doctor gives you medicines that are put up in quantities for him just as these patent medicines are put up for us." He then produces literature and proves it--at least beyond the refutation of the patient. Physicians would then realize, perhaps, how the use of proprietary medicines stimulates the sale of nostrums. CHAPTER VI. FAITH CURE AND GRAFT IN SURGERY. Suggestive Therapeutics Chief Stock in Trade--Advice of a Medical College President--Disease Prevention Rather than Cure--Hygienic Living--The Medical Pretender--"Dangerous Diagnosis" Graft--Great Flourish of Trumpets--No "Starving Time" for Him--"Big Operations"--Mutilating the Human Body--Dr. C. W. Oviatt's Views--Dr. Maurice H. Richardson's Incisive Statements--Crying Need for Reform--Surgery that is Useless, Conscienceless and for Purely Commercial Ends--Spirit of Surgical Graft, Especially in the West--Fee-Splitting and Commissions--A Nation of "Dollar-Chasers"--The Public's Share of Responsibility--Senn's Advice--The "Surgical Conscience." I think we have enough before us to show why intelligent people become followers of fads. Seeing so many impositions and frauds, they forget all the patient research and beneficent discoveries of noble men who have devoted their lives to the work of giving humanity better health and longer life. They are ready at once to denounce the whole medical system as a fraud, and become victims of the first "new system" or healing fad that is plausibly presented to them. And here a question arises that is puzzling to many. If these systems are fads and frauds, why do they so rapidly get and retain so large a following among intelligent people? The answer is not hard to find. The quacks of these fad schools get their cures, as every intelligent doctor of the old schools knows, in the same way and upon the same principle that is so important a factor in medical practice, _i. e._, _faith cure_--the psychic effect of the thing done, whether it be the giving of a dose of medicine, a Christian Science pow-wow, the laying on of hands, the "removal of a lesion" by an Osteopath, the "adjustment" of the spine by a Chiropractor, or what not. The principles of mind or faith cure are legitimately used by the honest physician. Suggestive therapeutics is being systematically studied by many who want to use it with honesty and intelligence. They realize fully that abuse of this principle figures largely in the maintenance of the shysters in their own school, and it is the very foundation of all new schools and healing fads. The people must be made to know this, or fads will continue to flourish. The honest physician would be glad to have the people know more than this. He would be glad to have them know enough about symptoms of diseases to have some idea when they really need the help of a physician. For he knows that if the people knew this much all quacks would be speedily put out of business. I wonder how many doctors know that observing people are beginning to suspect that many physicians regulate the number of calls they make on a patient by motives other than the condition of the patient--size of pocketbook and the condition of the roads, for instance. I am aware that such imputation is an insult to any physician worthy of the name, but the sad fact is that there are so many, when we count the quacks of all schools, unworthy of the name. The president of a St. Louis medical college once said to a large graduating class: "Young men, don't go to your work with timidity and doubts of your ability to succeed. Look and act your part as physicians, and when you have doubts concerning your power over disease _remember this_, ninety-five out of every hundred people who send for you would get well just the same if they never took a drop of your medicine." I have never mentioned this to a doctor who did not admit that it is perhaps true. If so, is there not enough in it alone to explain the apparent success of quacks? Again I say there are many noble and brainy physicians, and these have made practically all the great discoveries, invented all the useful appliances, written all the great books for other schools to study, and they should have credit from the people for all this, and not be misrepresented by little pretenders. Their teachings should be applied as they gave them. The best of them to-day would have the people taught that a physician's greatest work may be done in preventing rather than in curing disease. Physicians of the Osler type would like to have the people understand how little potency drugs have to cure many dangerous diseases when they have a firm hold on the system. They would have some of the responsibility removed from the shoulders of the physician by having the people understand how much they may do by hygienic living and common-sense use of natural remedies. But the conscientious doctor too often has to compete with the pretender who wants the people to believe that _he_ is their hope and their salvation, and in him they must trust. He wants them to believe that he has a specific remedy for every disease that will go "right to the spot" and have the desired effect. People who believe this, and believe that without doctoring the patient could never get well, will sometimes try, or see their neighbors try, a doctor of a "new school." When they see about the same proportion of sick recover, they conclude, of course, that the doctor of the "new school" cured them, and is worthy to be forever after intrusted with every case of disease that may arise in their families. This is often brought about by the shyster M.D. overreaching himself by diagnosing some simple affection as something very dangerous, in order to have the greater credit in curing it. But he at times overestimates the confidence of the family in his ability. They are ready to believe that the patient's condition is critical, and in terror, wanting the help of everything that promises help, call in a doctor of some "new school" because neighbors told how he performed wonderful cures in their families. When the patient recovers speedily, as he would have done with no treatment of any kind, and just as the shyster M.D. thought he would, the glory and credit of curing a "bad case" of a "dangerous disease" go to the new system instead of redounding to the glory of Dr. Shyster, as he planned it would. Is it any wonder true physicians sometimes get disgusted with their profession when they see a shyster come into the town where they have worked for years, patiently and conscientiously building up a legitimate practice that begins to promise a decent living, and by such quack methods as diagnosing cases of simple fever, such as might come from acute indigestion or too much play in children, as something dangerous, typhoid or "threatened typhoid," or cases of congestion of the lungs as "lung fever," and by "aborting" or "curing" these terrible diseases in short order and having his patients out in a few days, jumps into fame and (financial) success at a bound? Because the typhoid (real typhoid) patients of the honest doctor lingered for weeks and sometimes died, and because frequently he lost a case of real pneumonia, he made but a poor showing in comparison with the new doctor. "He's just fresh from school, you know, from a post-graduate course in the East." Or, "He's been to the old country and _knows_ something." Just as if any physician, though he may have been out of school for many years, does not, or may not, know of all the curative agencies of demonstrated merit! Would a medical journal fail to keep its readers posted concerning any new discovery in medicine, or helpful appliance that promises real good to the profession? Yet people speak of one doctor's superior knowledge of the best treatment of a particular disease as if that doctor had access to some mysterious source of therapeutic knowledge unknown to other physicians. It is becoming less easy to work the "dangerous diagnosis" graft than formerly, for many people are learning that certain diseases must "run their course," and that there are no medicines that have specific curative effects on them. There is another graft now that is taking the place of the one just mentioned, to some extent at least. In the hands of a fellow with lots of nerve and little conscience it is the greatest of them all. This is the graft of the smart young fellow direct from a post-graduate course in the clinics of some great surgeon. He comes to town with a great flourish of trumpets. Of course, he observes the ethics of the profession! The long accounts of his superior education and unusual experience with operative surgery are only legitimate items of news for the local papers. Certainly! It is only right that such an unusual doctor should have so much attention. There is no "starving time" for him. No weary wait of years for patients to come. At one bound he leaps into fame and fortune by performing "big operations" right and left, when before his coming such cases were only occasionally found, and then taken to surgeons of known ability and experience. The reputable physician respects surgery, and would respect the bright young fellow fresh from contact with the latest approved methods who has nerve to undertake the responsibility of a dangerous operation when such an operation is really indicated. But when it comes to mutilating the human body by cutting away an appendix or an ovary because it is known that to remove them when neither they nor the victim are much diseased is a comparatively safe and very _quick_ way to get a big reputation--that is the limit of quackery. And no wonder such a man is so cordially hated by his brethren. He not always hated because he mutilates humanity so much, as because his spectacular graft in surgery is sure to be taken as proof conclusive that he is superior in all other departments of therapeutics. And it puzzles observing laymen sometimes to know why all the successful (?) operations are considered such desirable items of news, while the cases that are not flattering in their outcome pass unmentioned. I find most complete corroboration of my contention in the president's address, delivered before the Western Surgical and Gynecological Association at St. Louis, in 1907, by Charles W. Oviatt, M.D. This address was published in the _Journal of the American Medical Association_, and I herewith reprint it in part: "The ambitious medical student does not usually get far into college work before he aspires to become a surgeon. He sees in the surgical clinics more definite and striking results than are discernible in other branches. Without being able to judge of his own relative fitness or whether he possesses the special aptitude so essential to success, he decides to become a surgeon. There will always be room for the young surgeon who, fitted by nature for the work, takes the time and opportunity to properly prepare himself. There is more good surgery being done to-day than ever before, and there are more good surgeons being educated to do the work. If, however, the surgeon of the future is to hold the high and honorable position our leaders have held in the past, there must be some standard of qualification established that shall protect the people against incompetency and dishonesty in surgeons. "That there is much that passes under the name of surgery being done by ill-trained, incompetent men, will not be denied. What standard, then, should be established, and what requirement should be made before one should be permitted to do surgery? In his address as chairman of the Section on Surgery and Anatomy of the American Medical Association, at the Portland (1905) meeting, Dr. Maurice H. Richardson deals with this subject in such a forceful, clear-cut way, that I take the liberty to quote him at some length: "'The burden of the following remarks is that those only should practice surgery who by education in the laboratory, in the dissecting-room, by the bedside, and at the operating-table, are qualified, first, to make reasonably correct deductions from subjective and objective signs; secondly, to give sound advice for or against operations; thirdly, to perform operations skillfully and quickly, and, fourthly, to conduct wisely the after-treatment. "'The task before me is a serious criticism of what is going on in every community. I do not single out any community or any man. There is in my mind no doubt whatever that surgery is being practiced by those who are incompetent to practice it--by those whose education is imperfect, who lack natural aptitude, whose environment is such that they never can gain that personal experience which alone will really fit them for what surgery means to-day. They are unable to make correct deductions from histories; to predict probable events; to perform operations skillfully, or to manage after-treatment. "'All surgeons are liable to error, not only in diagnosis, but in the performance of operations based on diagnosis. Such errors must always be expected and included in the contingencies of the practice of medicine and surgery. Doubtless many of my hearers can recall cases of their own in which useless--or worse than useless--operations have been performed. If, however, serious operations are in the hands of men of large experience, such errors will be reduced to a minimum. "'Many physicians send patients for diagnosis and opinion as to the advisability of operation without telling the consultant that they themselves are to perform the operation. The diagnosis is made and the operation perhaps recommended, when it appears that the operation is to be in incompetent hands. His advice should be conditional that it be carried out only by the competent. Many operations, like the removal of the vermiform appendix in the period of health, the removal of fibroids which are not seriously offending, the removal of gall-stones that are not causing symptoms, are operations of choice rather than of necessity; they are operations which should never be advised unless they are to be performed by men of the greatest skill. Furthermore, many emergency operations, such as the removal of an inflamed appendix and other operations for lesions which are not necessarily fatal--should be forbidden and the patient left to the chances of spontaneous recovery, if the operation proposed is to be performed by an incompetent. "'And is not the surgeon, appreciating his own unfitness in spite of years of devotion, in the position to condemn those who lightly take up such burdens without preparation and too often without conscience? "'In view of these facts, who should perform surgery? How shall the surgeon be best fitted for these grave duties? As a matter of right and wrong, who shall, in the opinion of the medical profession, advise and perform these responsible acts and who shall not? Surgical operations should be performed only by those who are educated for that special purpose. "'I have no hesitation in saying that the proper fitting of a man for surgical practice requires a much longer experience as a student and assistant than the most exacting schools demand. A man should serve four, five or six years as assistant to an active surgeon. During this period of preparation, as it were, as much time as possible should be given to observing the work of the masters of surgery throughout the world.' "While Dr. Richardson's ideal may seem almost utopian, there being so wide a difference between the standard he would erect and the one generally established, we must all agree that however impossible of attainment under present conditions, such an ideal is none too high and its future realization not too much to hope for. "While there is being done enough poor surgery that is honest and well intended, there is much being done that is useless, conscienceless, and done for purely commercial ends. This is truly a disagreeable and painful topic and one that I would gladly pass by, did I not feel that its importance demands some word of condemnation coming through such representative surgical organizations as this. "The spirit of graft that has pervaded our ranks, especially here in the West, is doing much to lower the standard and undermine the morals and ethics of the profession. When fee-splitting and the paying of commissions for surgical work began to be heard of something like a decade ago, it seemed so palpably dishonest and wrong that it was believed that it would soon die out, or be at least confined to the few in whom the inherited commercial instinct was so strong that they could not get away from it. But it did not die; on the other hand, it has grown and flourished. "In looking for an explanation for the existence of this evil, I think several factors must be taken into account, among them being certain changes in our social and economic conditions. This is an age of commercialism. We are known to the world as a nation of "dollar chasers," where nearly everything that should contribute to right living is sacrificed to the Moloch of money. The mad rush for wealth which has characterized the business world, has in a way induced some medical men, whether rightfully or wrongfully, to adopt the same measures in self-protection. The patient or his friends too often insist on measuring the value of our services with a commercial yard-stick, the fee to be paid being the chief consideration. In this way the public must come in for its share of responsibility for existing conditions. So long as there are people who care so little who operates on them, just so long will there be cheap surgeons, cheap in every respect, to supply the demand. The demand for better physicians and surgeons must come in part from those who employ their services. "Another source of the graft evil is the existence of low-grade, irregular and stock-company medical schools. In many of these schools the entrance requirements are not in evidence outside of their catalogues. With no standard of character or ethics, these schools turn out men who have gotten the little learning they possess in the very atmosphere of graft. The existence of these schools seems less excusable when we consider that our leading medical colleges rank with the best in the world and are ample for the needs of all who should enter the profession. Their constant aim is to still further elevate the standard and to admit as students only those who give unmistakable evidence of being morally and intellectually fit to become members of the profession. "Enough men of character, however, are entering the field through these better schools to ensure the upholding of those lofty ideals that have characterized the profession in the past and which are essential to our continued progress. I think, therefore, that we may take a hopeful view of the future. The demand for better prepared physicians will eventually close many avenues that are now open to students, greatly to the benefit of all. With the curtailing of the number of students and a less fierce competition which this will bring, there will be less temptation, less necessity, if you will, on the part of general practitioners to ask for a division of fees. He will come to see that honest dealing on his part with the patient requiring special skill will in the long run be the best policy. He will make a just, open charge for the services he has rendered and not attempt to collect a surreptitious fee through a dishonest surgeon for services he has not rendered and could not render. Then, too, there will be less inducement and less opportunity for incompetent and conscienceless men to disgrace the art of surgery. "The public mind is becoming especially active just at this time in combating graft in all forms, and is ready to aid in its destruction. The intelligent portion of the laity is becoming alive to the patent medicine evil. It is only a question of time when the people will demand that the secular papers which go into our homes shall not contain the vile, disgusting and suggestive quack advertisements that are found to-day. A campaign of reform is being instituted against dishonest politicians, financiers, railroad and insurance magnates, showing that their methods will be no longer tolerated. The moral standards set for professional men and men in public life are going to be higher in the future, and with the limelight of public opinion turned on the medical and surgical grafter, the evil will cease to exist. Hand in hand with this reform let us hope that there will come to be established a legal and moral standard of qualification for those who assume to do surgery. "I feel sure that it is the wish of every member of this association to do everything possible to hasten the coming of this day and to aid in the uplifting of the art of surgery. Our individual effort in this direction must lie largely through the influence we exert over those who seek our advice before beginning the study of medicine, and over those who, having entered the work, are to follow in our immediate footsteps. To the young man who seeks our counsel as to the advisability of commencing the study of medicine, it is our duty to make a plain statement of what would be expected of him, of the cost in time and money, and an estimate of what he might reasonably expect as a reward for a life devoted to ceaseless study, toil and responsibility. If, from our knowledge of the character, attainments and qualifications of the young man we feel that at best he could make but a modicum of success in the work, we should endeavor to divert his ambition into some other channel. "We should advise the 'expectant surgeon' in his preparation to follow as nearly as possible the line of study suggested by Richardson. Then I would add the advice of Senn, viz: 'To do general practice for several years, return to laboratory work and surgical anatomy, attend the clinics of different operators, and never cease to be a physician. If this advice is followed there will be less unnecessary operating done in the future than has been the case in the past.' The young man who enters special work without having had experience as a general practitioner, is seriously handicapped. In this age, when we have so frequently to deal with the so-called border-line cases, it is especially well never to cease being a physician. "We would next have the young man assure himself that he is the possessor of a well-developed, healthy, working 'surgical conscience.' No matter how well qualified he may be, his enthusiasm in the earlier years of his work will lead him to do operations that he would refrain from in later life. This will be especially true of malignant disease. He knows that early and thorough radical measures alone hold out hope, and only by repeated unsuccessful efforts will he learn to temper his ambition by the judgment that comes of experience. Pirogoff, the noted surgeon, suffered from a malignant growth. Billroth refused to operate or advise operation. In writing to another surgeon friend he said: 'I am not the bold operator whom you knew years ago in Zurich. Before deciding on the necessity of an operation, I always propose to myself this question: Would you permit such an operation as you intend performing on your patient to be done on yourself? Years and experience bring in their train a certain degree of hesitancy.' This, coming from one who in his day was the most brilliant operator in the world, should be remembered by every surgeon, young and old." Oh, surgery! Modern aseptic surgery! In the hands of the skilled, conscientious surgeon how great are thy powers for good to suffering humanity! In the hands of shysters "what crimes are committed in thy name!" With his own school full of shysters and incompetents, and grafters of "new schools" and "systems" to compete with on every hand, the conscientious physician seems to be "between the devil and the deep sea!" With quacks to the right of him, quacks to the left of him, quacks in front of him, all volleying and thundering with their literature to prove that the old schools, and all schools other than theirs, are frauds, impostors and poisoners, about all that is left for the layman to do when sick is to take to the woods. PART TWO OSTEOPATHY CHAPTER VII. SOME DEFINITIONS AND HISTORIES. Romantic Story of Osteopathy's Origin--An Asthma Cure--Headache Cured by Plowlines--Log Rolling to Relieve Dysentery--Osteopathy is Drugless Healing--Osteopathy is Manual Treatment--Liberty of Blood, Nerves and Arteries--Perfect Skeletal Alignment and Tonic, Ligamentous, Muscular and Facial Relaxation--Andrew T. Still in 1874--Kirksville, Mo., as a Mecca--American School of Osteopathy--The Promised Golden Stream of Prosperity--Shams and Pretenses--The "Mossbacks"--"Who's Who in Osteopathy." The story of the origin of Osteopathy is romantic enough to appeal to the fancy of impressionists. It is almost as romantic as the finding of the mysterious stones by the immortal Joe Smith. In this story is embodied the life history of an old-time doctor and pioneer hero in his restless migrations about the frontiers of Kansas and Missouri. His thrilling experiences in the days of border wars and through the Civil War are narrated, and how the germ of the idea of the true cause and cure of disease was planted in his mind by the remark of a comrade as the two lay concealed in a thicket for days to escape border ruffians. Then, later, how the almost simultaneous death of two or three beloved children, whom all his medical learning and that of other doctors he had summoned had been powerless to save, had caused him to renounce forever the belief that drugs could cure disease. He believed Nature had a true system, and for this he began a patient search. He wandered here and there, almost in the condition of the religious reformers of old, who "wandered up and down clad in sheep-skins and goat-hides, of whom the world was not worthy." In the name of suffering humanity he desecrated the grave of poor Lo, that he might read from his red bones some clue to the secret. One Osteopathic journal claims to tell authentically how Still was led to the discovery of the "great truth." It states that by accidentally curing a case of asthma by "fooling with the bones of the chest," he was led to the belief that bones out of normal position cause disease. Still himself tells a rather different story in a popular magazine posing of late years as a public educator in matters of therapeutics. In this magazine Still tells how he discovered the principles of Osteopathy by curing a terrible headache resting the back of his neck across a swing made of his father's plowlines, and next by writhing on his back across a log to relieve the pain of dysentery. Accidentally the "lesion" was corrected, or the proper center "inhibited," and his headache and flux immediately cured. You can take your choice of these various versions of the wonderful discovery. Ever since Osteopathy began to attract attention, and people began to inquire "What is it?" its leading promoters have vied with each other in trying to construct a good definition for their "great new science." Here are some of the definitions: "Osteopathy is the science of drugless healing." For a genuine "lesion" Osteopath that would not do at all. It is too broad and gives too much scope to the physicians who would do more than "pull bones." "Osteopathy is practical anatomy and physiology skillfully and scientifically applied as _manual_ treatment of disease." That definition suits better, because of the "manual treatment." If you are a true Osteopath you must do it _all_ with your hands. It will not do to use any mechanical appliances, for if you do you cannot keep up the impression that you are "handling the body with the skilled touch of a master who knows every part of his machine." "The human body is a machine run by the unseen force called life, and that it may run harmoniously it is necessary that there be liberty of blood, nerves, and arteries from the generating point to destination." This definition may be impressive to the popular mind, but, upon analysis, we wonder if any other string of big words might not have had the same effect. "Liberty of blood" is a proposition even a stupid medical man must admit. Of course, there must be free circulation of blood, and massage, or hot and cold applications, or exercise, or anything that will stimulate circulation, is rational. But when "liberty of blood" is mentioned, what is meant by "liberty of arteries"? "Osteopathy seeks to obtain perfect skeletal alignment and tonic ligamentous, muscular and facial relaxation." Some Osteopaths and other therapeutic reformers (?) have contended that medical men purposely used "big words" and Latin names to confound the laity. What must we think of the one just given as a popular definition? A good many Osteopaths are becoming disgusted with the big words, technical terms and "high-sounding nothings" used by so many Osteopathic writers. The limit of this was never reached, however, until an A.B., Ph.D., D.O. wrote an article to elucidate Osteopathy for the general public in an American encyclopedia. It takes scholarly wisdom to simplify great truths and bring them to the comprehension of ordinary minds. If writers for the medical profession want a lesson in the art of simplifying and popularizing therapeutic science, they should study this article on Osteopathy in the encyclopedia. A brief history of Osteopathy is perhaps in place. The following summary is taken from leading Osteopathic journals. As to the personality and motives of its founders I know but little; of the motives of its leading promoters a candid public must be the judge. But judgment should be withheld until all the truth is known. The principles of Osteopathy were discovered by Dr. Andrew T. Still in 1874. He was at that time a physician of the old school practicing in Kansas. His father, brothers and uncles were all medical practitioners. He was at one time scout surgeon under General Fremont. During the Civil War he was surgeon in the Union army in a volunteer corps. It was during the war that he began to lose faith in drugs, and to search for something natural in combating disease. Then began a long struggle with poverty and abuse. He was obstructed by his profession and ridiculed by his friends. Fifteen years after the discovery of Osteopathy found Dr. Still located in the little town of Kirksville, Mo., where he had gradually attracted a following who had implicit faith in his power to heal by what to them seemed mysterious movements. His fame spread beyond the town, and chronic sufferers began to turn toward Kirksville as a Mecca of healing. Others began to desire Still's healing powers. In 1892 the American School of Osteopathy was founded, which from a small beginning has grown until the present buildings and equipment cost more than $100,000. Hundreds of students are graduated yearly from this school, and large, well-equipped schools have been founded in Des Moines, Philadelphia, Boston and California, with a number of schools of greater or less magnitude scattered in other parts of the country. More than four thousand Osteopaths were in the field in 1907, and this number is being augmented every year by a larger number of physicians than are graduated from Homeopathic colleges, according to Osteopathic reports. About thirty-five States have given Osteopathy more or less favorable legal recognition. The discussion of the subject of Osteopathy is of very grave importance. Important to practitioners of the old schools of medicine for reasons I shall give further on, and of vital importance to the thousands of men and women who have chosen Osteopathy as their life work. It is even of greater importance in another sense to the people who are called upon to decide which system is right, and which school they ought to rely upon when their lives are at stake. I shall try to speak advisedly and conservatively, as I wish to do no one injustice. I should be sorry indeed to speak a word that might hinder the cause of truth and progress. I started out to tell of all that prevents the sway of truth and honesty in therapeutics. I should come far short of telling all if I omitted the inconsistencies of this "new science" of healing that dares to assume the responsibility for human life, and makes bold to charge that time-tried systems, with their tens of thousands of practitioners, are wrong, and that the right remedy, or the best remedy for disease has been unknown through all these years until the coming of Osteopathy. And further dares to make the still more serious charge that since the truth has been brought to light, the majority of medical men are so blinded by prejudice or ignorance that they _will_ not see. This is not the first time I have spoken about inconsistencies in the practice of Osteopathy. I saw so much of it in a leading Osteopathic college that when I had finished I could not conscientiously proclaim myself as an exponent of a "complete and well-rounded system of healing, adequate for every emergency," as Osteopathy is heralded to be by the journals published for "Osteopathic physicians" to scatter broadcast among the people. I practiced Osteopathy for three years, but only as an Osteopathic specialist. I never during that time accepted responsibility for human life when I did not feel sure that I could do as much for the case as any other might do with other means or some other system. Because I practiced as a specialist and would not claim that Osteopathy would cure everything that any other means might cure, I have never been called a good disciple of the new science by my brethren. I would not practice as a grafter, find bones dislocated and "subluxated," and tell people that they must take two or three months' treatment at twenty-five dollars per month, to have one or two "subluxations" corrected. In consequence I was never overwhelmed by the golden stream of prosperity the literature that made me a convert had assured me would be forthcoming to all "Osteopathic physicians" of even ordinary ability. As I said, this is not the first time I have spoken of the inconsistencies of Osteopathy. While yet in active practice I became so disgusted with some of the shams and pretences that I wrote a long letter to the editor of an Osteopathic journal published for the good of the profession. This editor, a bright and capable man, wrote me a nice letter in reply, in which he agreed with me about quackery and incompetency in our profession. He did not publish the letter I wrote, or express his honest sentiments, as I had hoped he might. If what I wrote to that editor was the truth, as he acknowledged in private, it is time the public knew something of it. I believe, also, that many of the large number of Osteopaths who have been discouraged or disgusted, and quit the practice, will approve what I am writing. There is another class of Osteopathic practitioners who, I believe, will welcome the truth I have to tell. This consists of the large number of men and women who are practicing Osteopathy as standing for all that makes up rational physio-therapy. Speaking of those who have quit the practice of Osteopathy, I will say that they are known by the Osteopathic faculties to be a large and growing number. Yet Osteopathic literature sent to prospective students tells of the small per cent. of those who take the course who fail. It may not be known how many fail, but it is known that many have quit. A journey half across one of our Western States disclosed one Osteopath in the meat business, one in the real estate business, one clerking in a store, and two, a blind man and his wife, fairly prosperous Osteopathic physicians. This was along one short line of railroad, and there is no reason why it may not be taken as a sample of the percentage of those who have quit in the entire country. I heard three years ago from a bright young man who graduated with honors, started out with luxurious office rooms in a flourishing city, and was pointed to as an example of the prosperity that comes to the Osteopath from the very start. When I heard from him last he was advance bill-poster for a cheap show. Another bright classmate was carrying a chain for surveyors in California. I received an Osteopathic journal recently containing a list of names, about eight hundred of them, of "mossbacks," as we were politely called. I say "we," for my name was on the list. The journal said these were the names of Osteopaths whose addresses were lost and no communication could be had with them. They were wanted badly, it seemed. Just for what, aside from the annual fee to the American Osteopathic Association, was not clear. I do know what the silence of a good many of them meant. They have quit, and do not care to read the abuse that some of the Osteopathic journals are continually heaping upon those who do not keep their names on the "Who's Who in Osteopathy" list. There is a large percentage of failures in other professions, and it is not strange that there should be some in Osteopathy. But when Osteopathic journals dwell upon the large chances of success and prosperity for those who choose Osteopathy as a profession, those who might become students should know the other side. CHAPTER VIII. THE OSTEOPATHIC PROPAGANDA. Wonderful Growth Claimed to Prove Merit--Osteopathy is Rational Physio-Therapy--Growth is in Exact Proportion to Advertising Received--Booklets and Journals for Gratuitous Distribution--Osteopathy Languishes or Flourishes by Patent Medicine Devices--Circular Letter from Secretary of American Osteopathic Association--Boosts by Governors and Senators--The Especial Protege of Authors--Mark Twain--Opie Reed--Emerson Hough--Sam Jones--The Orificial Surgeon--The M.D. Seeking Job as "Professor"--The Lure of "Honored Doctor" with "Big Income"--No Competition. But what about Osteopathy? Why has it had such a wonderful growth in popularity? Why have nearly four thousand men and women, most of them intelligent and some of them educated, espoused it as a profession to follow as a life work? These are questions I shall now try to answer. Osteopathic promoters and enthusiasts claim that the wonderful growth and popularity of Osteopathy prove beyond question its merits as a healing system. I have already dealt at length with reasons why intelligent people are so ready to fall victims to new systems of healing. The "perfect adjustment," "perfect functioning" theory of Osteopathy is especially attractive to people made ripe for some "drugless healing" system by causes already mentioned. When Osteopathy is practiced as a combination of all manipulations and other natural aids to the inherent recuperative powers of the body, it will appeal to reason in such a way and bring such good results as to make and keep friends. I am fully persuaded, and I believe the facts when presented will establish it, that it is the physio-therapy in Osteopathy that wins and holds the favor of intelligent people. But Osteopathy in its own name, taught as "a well-rounded system of healing adequate for every emergency," has grown and spread largely as a "patent medicine" flourishes, _i. e._, in exact proportion to the advertising it has received. I would not presume to make this statement as merely my opinion. The question at issue is too important to be treated as a matter of opinion. I will present facts, and let my readers settle the point in their own minds. Every week I get booklets or "sample copies" of journals heralding the wonderful curative powers of Osteopathy. These are published not as journals for professional reading, but to be sold to the practitioners by the hundreds or thousands, to be given to their patients for distribution by these patients to their friends. The publishers of these "boosters" say, and present testimonials to prove it, that Osteopaths find their practice languishes or flourishes just in proportion to the numbers of these journals and booklets they keep circulating in their communities. Here is a sample testimonial I received some time since on a postal card: "Gentlemen: Since using your journals more patients have come to me than I could treat, many of them coming from neighboring towns. Quite a number have had to go home without being treated, leaving their names so that they could be notified later, as I can get to them. Your booklets bring them O. K." The boast is often made that Osteopathy is growing in spite of bitter opposition and persecution, and is doing it on its merits--doing it because "Truth is mighty and will prevail." At one time I honestly believed this to be true, but I have been convinced by highest Osteopathic authority that it is not true. As some of that proof here is an extract from a circular letter from the secretary of the American Osteopathic Association: "Now, Doctor, we feel that you have the success of Osteopathy at heart, and if you realize the activity and complete organization of the American Medical Association and their efforts to curb our limitations, and do not become a member of this Association, which stands opposed to the efforts of the big monopoly, we must believe that you are not familiar with the earnestness of the A. O. A. and its efforts. We must work in harmonious accord and with an organized purpose. _When we rest on our oars the death knell begins to sound._ Can you not see that unless you co-operate with your fellow-practitioners in this national effort you are _sounding your own limitations_?" This from the _secretary_ of the American Osteopathic Association, when we have boasted of superior equipment for intelligent physicians. Incidentally we pause to make excuse for the expressions: "Curbing our limitations" and "sounding your own limitations." But does the idea that when we quit working as an organized body "_our death knell begins to sound_," indicate that Osteopathic leaders are content to trust the future of Osteopathy to its merits? If Osteopathic promoters do not feel that the life of their science depends on boosting, what did the secretary of the A.O.A. mean when he said, "Upon the success of these efforts depends the weal or woe of Osteopathy as an independent system"? If truth always grows under persecution, how can the American Medical Association kill Osteopathy when it is so well known by the people? Nearly four thousand Osteopaths are scattered in thirty-six States where they have some legal recognition, and they are treating thousands of invalids every day. If they are performing the wonderful cures Osteopathic journals tell of, why are we told that the welfare of the system depends upon the noise that is made and the boosting that is done? Has it required advertising to keep people using anesthetics since it was demonstrated that they would prevent pain? Has it required boosting to keep the people resorting to surgery since the benefits of modern operations have been proved? Does it look as if Osteopathy has been standing or advancing on its merits? Does it not seem that Osteopathy, as a complete system, is mostly a _name_, and "lives, moves, and has its being" in boosting? It seems to have been about the best boosted fad ever fancied by a foolish people. Governors and senators have boosted for it. Osteopathic journals have published again and again the nice things a number of governors said when they signed the bills investing Osteopathy with the dignity of State authority. A certain United States senator from Ohio has won more notoriety as a champion of Osteopathy than he has lasting fame as a statesman. Osteopathy has been the especial protégé of authors. Mark Twain once went up to Albany and routed an army of medical lobbyists who were there to resist the passage of a bill favorable to Osteopathy. For this heroic deed Mark is better known to Osteopaths to-day than even for his renowned history of Huckleberry Finn. He is in danger of losing his reputation as a champion of the "under dog in the fight." Lately he has gone on the warpath again. This time to annihilate poor Mother Eddy and her fond delusion. Opie Reed is a delightful writer while he sticks to the portrayal of droll Southern character. Ella Wheeler Wilcox is admirable for the beauty and boldness with which she portrays the passions and emotions of humanity. But they are both better known to Osteopaths for the bouquets they have tossed at Osteopathy than for their profound human philosophy that used to be promulgated by the _Chicago American_. Emerson Hough gave a little free advertising in his "Heart's Desire." There may have been "method in his madness," for that Osteopathic horse doctoring scene no doubt sold many a book for the author. Sam Jones also helped along with some of his striking originality. Sam said, "There is as much difference between Osteopathy and massage as between playing a piano and currying a horse." The idea of comparing the Osteopath's manipulations of the human body to the skilled touch of the pianist upon his instrument was especially pleasing to Osteopaths. However, Sam displayed about the same comprehension of his subject that preachers usually exhibit who try to say nice things about the doctors when they get their doctoring gratis or at reduced rates. These champions of Osteopathy no doubt mean well. They can be excused on the ground that they got out of place to aid in the cause of "struggling truth." But what shall we say of medical men, some of them of reputation and great influence, who uphold and champion new systems under such conditions that it is questionable whether they do it from principle or policy? Osteopathic journals have made much of an article written by a famous "orificial surgeon." The article appears on the first page of a leading Osteopath journal, and is headed, "An Expert Opinion on Osteopathy." Among the many good things he says of the "new science" is this: "The full benefit of a single sitting can be secured in from three to ten minutes instead of an hour or more, as required by massage." I shall discuss the time of an average Osteopathic treatment further on, but I should like to see how long this brother would hold his practice if he were an Osteopath and treated from three to ten minutes. He also says that "Osteopathy is so beneficial to cases of insanity that it seems quite probable that this large class of terrible sufferers may be almost emancipated from their hell." I shall also say more further on of what I know of Osteopathy's record as an insanity cure. There is this significant thing in connection with this noted specialist's boost for Osteopathy. The journal printing this article comments on it in another number; tells what a great man the specialist is, and incidentally lets Osteopaths know that if any of them want to add a knowledge of "orificial surgery" to their "complete science," this doctor is the man from whom to get it, as he is the "great and only" in his specialty, and is big and broad enough to appreciate Osteopathy. The most despicable booster of any new system of therapeutics is the physician who becomes its champion to get a job as "professor" in one of its colleges. Of course it is a strong temptation to a medical man who has never made much of a reputation in his own profession. You may ask, "Have there been many such medical men?" Consult the faculty rolls of the colleges of these new sciences, and you will be surprised, no doubt, to find how many put M.D. after their names. Why are they there? Some of these were honest converts to the system, perhaps. Some wanted the honor of being "Professor Doctor," maybe, and some may have been lured by the same bait that attracts so many students into Osteopathic colleges. That is, the positive assurance of "plenty of easy money" in it. One who has studied the real situation in an effort to learn why Osteopathy has grown so fast as a profession, can hardly miss the conclusion that advertising keeps the grist of students pouring into Osteopathic mills. There is scarcely a corner of the United States that their seductive literature does not reach. Practitioners in the field are continually reminded by the schools from which they graduated that their alma mater looks largely to their solicitations to keep up the supply of recruits. Their advertising, the tales of wonderful cures and big money made, appeal to all classes. It seems that none are too scholarly and none too ignorant to become infatuated with the idea of becoming an "honored doctor" with a "big income." College professors and preachers have been lured from comfortable positions to become Osteopaths. Shrewd traveling men, seduced by the picture of a permanent home, have left the road to become Osteopathic physicians and be "rich and honored." Other classes come also. To me, when a student of Osteopathy, it was pathetic and almost tragic to observe the crowds of men and women who had been seduced from spheres of drudging usefulness, such as clerking, teaching, barbering, etc., to become money-making doctors. In their old callings they had lost all hope of gratifying ambition for fame and fortune, but were making an honest living. The rosy pictures of honor, fame and twenty dollars per day, that the numerous Osteopathic circulars and journals painted, were not to be withstood. These circulars told them that the fields into which they might go and reap that $20 per day were unlimited. They said: "There are dozens of ministers ready to occupy each vacant pulpit, and as many applicants for each vacancy in the schools. Each hamlet has four or five doctors, where it can support but one. The legal profession is filled to the starving point. Young licentiates in the older professions all have to pass through a starving time. Not so in Osteopathy. There is no competition." The picture was a rosy dream of triumphant success! When they had mastered the great science and become "Doctors of Osteopathy," the world was waiting with open arms and pocketbooks to receive them. CHAPTER IX. THEORY AND PRACTICE OF OSTEOPATHY. Infallible, Touch-the-Button System that Always Cured--Indefinite Movements and Manipulations--Wealth of Undeveloped Scientific Facts--Osteopaths Taking M.D. Course--The Standpatter and the Drifter--The "Lesionist"--"Bone Setting"--"Inhibiting a Center"--Chiropractics--"Finest Anatomists in the World"--How to Cure Torticollis, Goitre and Enteric Troubles--A Successful Osteopath--Timid Old Maids--Osteopathic Philanthropy. How desperately those students worked. Many of them were men and women with gray heads, who had found themselves stranded at a time of life when they should have been able to retire on a competency. They had staked their little all on this last venture, and what was before them if they should fail heaven only knew. How eagerly they looked forward to the time when they should have struggled through the lessons in anatomy, chemistry, physiology, symptomatology and all the rest, and should be ready to receive the wonderful principles of Osteopathy they were to apply in performing the miraculous cures that were to make them wealthy and famous. Need I tell the physician who was a conscientious student of anatomy in his school days, that there was disappointment when the time came to enter the class in "theory and practice" of Osteopathy? There had been vague ideas of a systematized, infallible, touch-the-button system that _always_ cured. Instead, we were instructed in a lot of indefinite movements and manipulations that somehow left us speculating as to just how much of it all was done for effect. We had heard so often that Osteopathy was a complete satisfying science _that did things specifically_! Now it began to dawn upon us that there was indeed a "wealth of undeveloped scientific facts" in Osteopathy, as those glittering circulars had said when they thought to attract young men ambitious for original research. They had said, "Much yet remains to be discovered." Some of us wondered if the "undeveloped" and "undiscovered" scientific facts were not the main constituents of the "science." The students expected something exact and tangible, and how eagerly they grasped at anything in the way of bringing quick results in curing the sick. If Osteopathy is so complete, why did so many students, after they had received everything the learned (?) professors had to impart, procure Juettner's "Modern Physio-Therapy" and Ling's "Manual Therapy" and Rosse's "Cures Without Drugs" and Kellogg's work on "Hydrotherapy"? They felt that they needed all they could get. It was customary for the students to begin "treating" after they had been in school a few months, and medical men will hardly be surprised to know that they worked with more faith in their healing powers and performed more wonderful (?) cures in their freshman year than they ever did afterward. I have in mind a student, one of the brightest I ever met, who read a cheap book on Osteopathic practice, went into a community where he was unknown, and practiced as an Osteopathic physician. In a few months he had made enough money to pay his way through an Osteopathic college, which he entered professing to believe that Osteopathy would cure all the ills flesh is heir to, but which he left two years later to take a medical course. He secured his D.O. degree, but I notice that it is his M.D. degree he flourishes with pride. Can students be blamed for getting a little weak in faith when men who told them that the great principles of Osteopathy were sufficient to cure _everything_, have been known to backslide so far as to go and take medical courses themselves? How do you suppose it affects students of an Osteopathic college to read in a representative journal that the secretary of their school, and the greatest of all its boosters, calls medical men into his own family when there is sickness in it? There are many men and women practicing to-day who try to be honest and conscientious, and by using all the good in Osteopathy, massage, Swedish movements, hydrotherapy, and all the rest of the adjuncts of physio-therapy, do a great deal of good. The practitioner who does use these agencies, however, is denounced by the stand-patters as a "drifter." They say he is not a true Osteopath, but a mongrel who is belittling the great science. That circular letter from the secretary of the American Osteopathic Association said that one of the greatest needs of organization was to preserve Osteopathy in its primal purity as it came from its founder, A. T. Still. If our medical brethren and the laity could read some of the acrimonious discussions on the question of using adjuncts, they would certainly be impressed with the exactness (?) of Osteopathic science. There is one idea of Osteopathy that even the popular mind has grasped, and that is that it is essentially finding "lesions" and correcting them. Yet the question has been very prominent and pertinent among Osteopaths: "Are you a lesion Osteopath?" Think of it, gentlemen, asking an Osteopath if he is a "lesionist"! Yet there are plenty of Osteopaths who are stupid enough (or honest enough) not to be able to find bones "subluxed" every time they look at a patient. Practitioners who really want to do their patrons good will use adjuncts even if they are denounced by the stand-patters. I believe every conscientious Osteopath must sometimes feel that it is safer to use rational remedies than to rely on "bone setting," or "inhibiting a center," but for the grafter it is not so spectacular and involves more hard work. The stand-patters of the American Osteopathic Association have not eliminated all trouble when they get Osteopaths to stick to the "bone setting, inhibiting" idea. The chiropractic man threatens to steal their thunder here. The Chiropractor has found that when it comes to using mysterious maneuvers and manipulations as bases for mind cure, one thing is about as good as another, except that the more mysterious a thing looks the better it works. So the Chiropractor simply gives his healing "thrusts" or his wonderful "adjustments," touches the buttons along the spine as it were, when--presto! disease has flown before his healing touch and blessed health has come to reign instead! The Osteopath denounces the Chiropractor as a brazen fraud who has stolen all that is good in Chiropractics (if there _is_ anything good) from Osteopathy. But Chiropractics follows so closely what the "old liner" calls the true theory of Osteopathy that, between him and the drifter who gives an hour of crude massage, or uses the forbidden accessories, the true Osteopath has a hard time maintaining the dignity (?) of Osteopathy and keeping its practitioners from drifting. Some of the most ardent supporters of true Osteopathy I have ever known have drifted entirely away from it. After practicing two or three years, abusing medicine and medical men all the time, and proclaiming to the people continually that they had in Osteopathy all that a sick world could ever need, it is suddenly learned that the "Osteopath is gone." He has "silently folded his tent and stolen away," and where has he gone? He has gone to a medical college to study that same medicine he has so industriously abused while he was gathering in the shekels as an Osteopath. Going to learn and practice the science he has so persistently denounced as a fraud and a curse to humanity. The intelligent, conscientious Osteopath who dares to brave the scorn of the stand-patter and use all the legitimate adjuncts of Osteopathy found in physio-therapy, may do a great deal of good as a physician. I have found many physicians willing to acknowledge this, and even recommend the services of such an Osteopath when physio-therapy was indicated. When a physician, however, meets a fellow who claims to have in his Osteopathy a wonderful system, complete and all-sufficient to cope with any and all diseases, and that his system is founded on a knowledge of the relation and function of the various parts and organs of the body such as no other school of therapeutics has ever been able to discover, then he knows that he has met a man of the same mental and moral calibre as the shyster in his own school. He knows he has met a fellow who is exploiting a thing, that may be good in its way and place, as a graft. And he knows that this grafter gets his wonderful cures largely as any other quack gets his; the primary effects of his "scientific manipulations" are on the minds of those treated. The intelligent physician knows that the Osteopath got his boastedly superior knowledge of anatomy mostly from the same text-books and same class of cadavers that other physicians had to master if they graduated from a reputable school. All that talk we have heard so much about the Osteopaths being the "finest anatomists in the world" sounds plausible, and is believed by the laity generally. The quotation I gave above has been much used in Osteopathic literature as coming from an eminent medical man. What foundation is there for such a belief? The Osteopath _may_ be a good anatomist. He has about the same opportunities to learn anatomy the medical student has. If he is a good and conscientious student he may consider his anatomy of more importance than does the medical student who is not expecting to do much surgery. If he is a natural shyster and shirk he can get through a course in Osteopathy and get his diploma, and this diploma may be about the only proof he could ever give that he is a "superior anatomist." Great stress has always been laid by Osteopaths upon the amount of study and research done by their students on the cadaver. I want to give you some specimens of the learning of the man (an M.D.) who presided over the dissecting-room when I pursued my "profound research" on the "lateral half." This great man, whose superior knowledge of anatomy, I presume, induced by the wise management of the college to employ him as a demonstrator, in an article written for the organ of the school expresses himself thus: "It is needless to say that the first impression of an M. D. would not be favorable to Osteopathy, because he has spent years fixing in his mind that if you had a bad case of torticollis not to touch it, but give a man morphine or something of the same character with an external blister or hot application and in a week or ten days he would be all right. In the meanwhile watch the patient's general health, relieve the induced constipation by suitable means and rearrange what he has disarranged in his treatment. On the other hand, let the Osteopath get hold of this patient, and with his _vast_ and we might say _perfect_ knowledge of anatomy, he at once, with no other tools than his hands, inhibits the nerves supplying the affected parts, and in five minutes the patient can freely move his head and shoulders, entirely relieved from pain. Would not the medical man be angry? Would he not feel like wiping off the earth with all the Osteopaths? Doctor, with your medical education a course in Osteopathy would teach you that it is not necessary to subject your patients to myxedema by removing the thyroid gland to cure goitre. You would not have to lie awake nights studying means to stop one of those troublesome bowel complaints in children, nor to insist upon the enforced diet in chronic diarrhea, and a thousand other things which are purely physiological and are not done by any magical presto change, but by methods which are perfectly rational if you will only listen long enough to have them explained to you. I will agree that at first impression all methods look alike to the medical man, but when explained by an intelligent teacher they will bring their just reward." Gentlemen of the medical profession, study the above carefully--punctuation, composition, profound wisdom and all. Surely you did not read it when it was given to the world a few years ago, or you would all have been converted to Osteopathy then, and the medical profession left desolate. We have heard many bad things of medical men, but never (until we learned it from one who was big-brained enough to accept Osteopathy when its great truths dawned upon him) did we know that you are so dull of intellect that it takes you "years to fix in your minds that if you had a bad case of torticollis not to touch it but to give a man morphine." And how pleased Osteopaths are to learn from this scholar that the Osteopath can "take hold" of a case of torticollis, "and with his vast and we might say perfect knowledge of anatomy" inhibit the nerves and have the man cured in five minutes. We were glad to learn this great truth from this learned ex-M.D., as we never should have known, otherwise, that Osteopathy is so potent. I have had cases of torticollis in my practice, and thought I had done well if after a half hour of hard work massaging contracted muscles I had benefited the case. And note the relevancy of these questions, "Would not the medical man be angry? Would he not feel like wiping off the earth all the Osteopaths?" Gentlemen, can you explain your ex-brother's meaning here? Surely you are not all so hard-hearted that you would be angry because a poor wry-necked fellow had been cured in five minutes. To be serious, I ask you to think of "the finest anatomists in the world" doing their "original research" work in the dissecting-room under the direction of a man of the scholarly attainments indicated by the composition and thought of the above article. Do you see now how Osteopaths get a "vast and perfect knowledge of anatomy"? Do you suppose that the law of "the survival of the fittest" determines who continues in the practice of Osteopathy and succeeds? Is it true worth and scholarly ability that get a big reputation of success among medical men? I know, and many medical men know from competition with him (if they would admit that such a fellow may be a competitor), that the ignoramus who as a physician is the product of a diploma mill often has a bigger reputation and performs more wonderful cures (?) than the educated Osteopath who really mastered the prescribed course but is too conscientious to assume responsibility for human life when he is not sure that he can do all that might be done to save life. I once met an Osteopath whose literary attainments had never reached the rudiments of an education. He had never really comprehended a single lesson of his entire course. He told me that he was then on a vacation to get much-needed rest. He had such a large practice that the physical labor of it was wearing him out. I knew of this fellow's qualifications, but I thought he might be one of those happy mortals who have the faculty of "doing things," even if they cannot learn the theory. To learn the secret of this fellow's success, if I could, I let him treat me. I had some contracted muscles that were irritating nerves and holding joints in tense condition, a typical case, if there are any, for an Osteopathic treatment. The fellow began his "treatment." I expected him to do some of that "expert Osteopathic diagnosing" that you have heard of, but he began in an aimless desultory way, worked almost an hour, found nothing specific, did nothing but give me a poor unsystematic massage. He was giving me a "popular treatment." In many towns people have come to estimate the value of an Osteopathic treatment by its duration. People used to say to me, "You don't treat as long as Dr. ----, who was here before you," and say it in a way indicating that they were hardly satisfied they had gotten their money's worth. Some of them would say: "He treated me an hour for seventy-five cents." Does it seem funny to talk of adjusting lesions on one person for an hour at a time, three times a week? My picture of incompetency and apparent success of incompetents, is not overdrawn. The other day I had a marked copy of a local paper from a town in California. It was a flattering write-up of an old classmate. The doctor's automobile was mentioned, and he had marked with a cross a fine auto shown in a picture of the city garage. This fellow had been considered by all the Simple Simon of the class, inferior in almost every attribute of true manliness, yet now he flourishes as one of those of our class to whose success the school can "point with pride." It is interesting to read the long list of "changes of location" among Osteopaths, yet between the lines there is a sad story that may be read. How often I have followed these changes. First, "Doctor Blank has located in Philadelphia, with twenty-five patients for the first month and rapidly growing practice." A year or so after another item tells that "Doctor Blank has located in San Francisco with bright prospects." Then "Doctor Blank has returned to Missouri on account of his wife's health, and located in ----, where he has our best wishes for success." Their career reminds us of Goldsmith's lines: "As the hare whom horn and hounds pursue Pants to the place from whence at first he flew." There has been many a tragic scene enacted upon the Osteopathic stage, but the curtain has not been raised for the public to behold them. How many timid old maids, after saving a few hundred dollars from wages received for teaching school, have been persuaded that they could learn Osteopathy while their shattered nerves were repaired and they were made young and beautiful once more by a course of treatment in the clinics of the school. Then they would be ready to go out to occupy a place of dignity and honor, and treat ten to thirty patients per month at twenty-five dollars per patient. Gentlemen of the medical profession, from what you know of the aggressive spirit that it takes to succeed in professional life to-day (to say nothing of the physical strength required in the practice of Osteopathy), what per cent. of these timid old maids do you suppose have "panted to the place from whence at first they flew," after leaving their pitiful little savings with the benefactors of humanity who were devoting their splendid talents to the cause of Osteopathy? If any one doubts that some Osteopathic schools are conducted from other than philanthropic motives, let him read what the _Osteopathic Physician_ said of a new school founded in California. Of all the fraud, bare-faced shystering, and flagrant rascality ever exposed in any profession, the circumstances of the founding of this school, as depicted by the editor of the _Osteopathic Physician_, furnishes the most disgusting instance. Men to whom we had clung when the anchor of our faith in Osteopathy seemed about to drag were held up before us as sneaking, cringing, incompetent rascals, whose motives in founding the school were commercial in the worst sense. And how do you suppose Osteopaths out in the field of practice feel when they receive catalogues from the leading colleges that teach their system, and these catalogues tell of the superior education the colleges are equipped to give, and among the pictures of learned members of the faculty they recognize the faces of old schoolmates, with glasses, pointed beards and white ties, silk hats maybe, but the same old classmate of--sometimes not ordinary ability. I spoke a moment ago of old maids being induced to believe that they would be made over in the clinics of an Osteopathic college. That was not an exaggeration. An Osteopathic journal before me says: "If it were generally known that Osteopathy has a wonderfully rejuvenating effect upon fading beauty, Osteopathic physicians would be overworked as beauty doctors." Another journal says: "If the aged could know how many years might be added to their lives by Osteopathy, they would not hesitate to avail themselves of treatment." A leading D. O. discusses consumption as treated Osteopathically, and closes his discussion with the statement in big letters: "CONSUMPTION CAN BE CURED." Another Osteopathic doctor says the curse that was placed upon Mother Eve in connection with the propagation of the race has been removed by Osteopathy, and childbirth "positively painless" is a consummated fact. The old made young! The homely made beautiful! The insane emancipated from their hell! Consumption cured! Childbirth robbed of its terrors! Asthma cured by moving a bone! What more in therapeutics is left to be desired? O grave, where is thy victory? CHAPTER X. OSTEOPATHY AS RELATED TO SOME OTHER FAKES. Sure Shot Rheumatism Cure--Regular Practitioner's Discomfiture--Medicines Alone Failed to Cure Rheumatism--Osteopathy Relieves Rheumatic and Neuralgic Pains--"Move Things"--"Pop" Stray Cervical Vertebræ--Find Something Wrong and Put it Right--Terrible Neck-Wrenching, Bone-Twisting Ordeal. A discussion of graft in connection with doctoring would not be complete if nothing were said about the traveling medicine faker. Every summer our towns are visited by smooth-tongued frauds who give free shows on the streets. They harangue the people by the hour with borrowed spiels, full of big medical terms, and usually full of abuse of regular practitioners, which local physicians must note with humiliation is too often received by people without resentment and often with applause. Only last summer I was standing by while one of these grafters was making his spiel, and gathering dollars by the pocketful for a "sure shot" rheumatism cure. His was a _sure_ cure, doubly guaranteed; no cure, money all refunded (if you could get it). A physician standing near laughed rather a mirthless laugh, and remarked that Barnum was right when he said, "The American people like to be humbugged." When the medical man left, a man who had just become the happy possessor of enough of the wonderful herb to make a quart of the rheumatism router, remarked: "He couldn't be a worse humbug than that old duffer. He doctored me for six weeks, and told me all the time that his medicine would cure me in a few days. I got worse all the time until I went to Dr. ----, who told me to use a sack of hot bran mash on my back, and I was able to get around in two days." In this man's remarks there is an explanation of the reason the crowd laughed when they heard the quack abusing the regular practitioner, and of the reason the people handed their hard-earned dollars to the grafter at the rate of forty in ten minutes, by actual count. If all doctors were honest and told the people what all authorities have agreed upon about rheumatism, _i. e._, that internal medication does it little good, and the main reliance must be on external application, traveling and patent medicine fakers who make a specialty of rheumatism cure would be "put out of business," and there would be eliminated one source of much loss of faith in medicine. I learned by experience as an Osteopath that many people lose faith in medicine and in the honesty of physicians because of the failure of medicine to cure rheumatism where the physician had promised a cure. Patients afflicted with other diseases get well anyway, or the sexton puts them where they cannot tell people of the physician's failure to cure them. The rheumatic patient lives on, and talks on of "Doc's" failure to stop his rheumatic pains. All doctors know that rheumatism is the universal disease of our fickle climate. If it were not for rheumatic pains, and neuralgic pains that often come from nerves irritated by contracted muscles, the Osteopath in the average country town would get more lonesome than he does. People who are otherwise skeptical concerning the merits of Osteopathy will admit that it seems rational treatment for rheumatism. Yet this is a disease that Osteopathy of the specific-adjustment, bone-setting, nerve-inhibiting brand has little beneficial effect upon. All the Osteopathic treatments I ever gave or saw given in cases of rheumatism that really did any good, were long, laborious massages. The medical man who as "professor" in an Osteopathic college said, "When the Osteopath with his _vast_ knowledge of anatomy gets hold of a case of torticollis he inhibits the nerves and cures it in five minutes," was talking driveling rot. I have seen some of the best Osteopaths treat wry-neck, and the work they did was to knead and stretch and pull, which by starting circulation and working out soreness, gradually relieved the patient. A hot application, by expanding tissues and stimulating circulation, would have had the same effect, perhaps more slowly manifested. To call any Osteopathic treatment massage is always resented as an insult by the guardians of the science. What is the Osteopath doing, who rolls and twists and pulls and kneads for a full hour, if he isn't giving a massage treatment? Of course, it sounds more dignified, and perhaps helps to "preserve the purity of Osteopathy as a separate system," to call it "reducing subluxations," "correcting lesions," "inhibiting and stimulating" nerves. The treatment also acts better as a placebo to call it by these names. As students we were taught that all Osteopathic movements were primarily to adjust something. Some of us worried for fear we wouldn't know when the adjusting was complete. We were told that all the movements we were taught to make were potent to "move things," so we worried again for fear we might move something in the wrong direction. We were assured, however, that since the tendency was always toward the normal, all we had to do was to agitate, stir things up a bit, and the thing out of place would find its place. How _specific_! How scientific! We were told that when in the midst of our "agitation" we heard something "pop," we could be sure the thing out of place had gone back. When a student had so mastered the great bone-setting science as to be able to "pop" stray cervical vertebræ he was looked upon with envy by the fellows who had not joined the association for protection against suits for malpractice, and did not know just how much of an owl they could make of a man and not break his neck. The fellow who lacked clairvoyant powers to locate straying things, and could not always find the "missing link" of the spine, could go through the prescribed motions just the same. If he could do it with sufficient facial contortions to indicate supreme physical exertion, and at the same time preserve the look of serious gravity and professional importance of a quack medical doctor giving _particular_ directions for the dosing of the placebo he is leaving, he might manage to make a sound vertebra "pop." This, with his big show of doing something, has its effect on the patient's mind anyway. We were taught that Osteopathy was applied common sense, that it was all reasonable and rational, and simply meant "finding something wrong and putting it right." Some of us thought it only fair to tell our patients what we were trying to do, and what we did it for. There is where we made our big mistake. To say we were relaxing muscles, or trying to lift and tone up a rickety chest wall, or straighten a warped spine, was altogether too simple. It was like telling a man that you were going to give him a dose of oil for the bellyache when he wanted an operation for appendicitis. It was too common, and some would go to an Osteopath who could find vertebra and ribs and hips displaced, something that would make the community "sit up and take notice." If one has to be sick, why not have something worth while? Where Osteopathy has always been so administered that people have the idea that it means to find things out of place and put them back, it is a gentleman's job, professional, scientific and genteel. Men have been known to give twenty to forty treatments a day at two dollars per treatment. In many communities, however, the adjustment idea has so degenerated that to give an Osteopathic treatment is no job for a high collar on a hot day. To strip a hard-muscled, two-hundred-pound laborer down to a perspiration-soaked and scented undershirt, and manipulate him for an hour while he has every one of his five hundred work-hardened muscles rigidly set to protect himself from the terrible neck-wrenching, bone-twisting ordeal he has been told an Osteopathic treatment would subject him to--I say when you have tried that sort of a thing for an hour you will conclude that an Osteopathic treatment is no job for a kid-gloved dandy nor for a lily-fingered lady, as it has been so glowingly pictured. I know the brethren will say that true Osteopathy does not give an hour's shotgun treatment, but finds the lesion, corrects it, collects its two dollars, and quits until "day after to-morrow," when it "corrects" and _collects_ again as long as there is anything to co--llect! I practiced for three years in a town where people made their first acquaintance with Osteopathy through the treatments of a man who afterwards held the position of demonstrator of Osteopathic "movements" and "manipulations" in one of the largest and boastedly superior schools of Osteopathy. The people certainly should have received correct ideas of Osteopathy from him. He was followed in the town by a bright young fellow from "Pap's" school, where the genuine "lesion," blown-in-the-bottle brand of Osteopathy has always been taught. This fellow was such an excellent Osteopath that he made enough money in two years to enable him to quit Osteopathy forever. This he did, using the money he had gathered as an Osteopath to take him through a medical college. I followed these two shining lights who I supposed had established Osteopathy on a correct basis. I started in to give specific treatments as I had been taught to do; that is, to hunt for the lesion, correct it if I found it, and quit, even if I had not been more than fifteen or twenty minutes at it. I found that in many cases my patients were not satisfied. I did not know just what was the matter at first, and lost some desirable patients (lost their patronage, I mean--they were not in much danger of dying when they came to me). I was soon enlightened, however, by some more outspoken than the rest. They said I did not "treat as long as that other doctor," and when I had done what I thought was indicated at times a patient would say, "You didn't give me that neck-twisting movement," or that "leg-pulling treatment." No matter what I thought was indicated, I had to give all the movements each time that had ever been given before. A physician who has had to dose out something he knew would do no good, just to satisfy the patient and keep him from sending for another doctor who he feared might give something worse, can appreciate the violence done a fellow's conscience as he administers those wonderfully curative movements. He cannot, however, appreciate the emotions that come from the strenuous exertion over a sweaty body in a close room on a July day. Incidentally, this difference in the physical exertion necessary to get the same results has determined a good many to quit Osteopathy and take up medicine. A young man who had almost completed a course in Osteopathy told me he was going to study medicine when he had finished Osteopathy, as he had found that giving "treatments was too d----d hard work." CHAPTER XI. TAPEWORMS AND GALLSTONES. Plug-hatted Faker--Frequency of Tapeworms--Some Tricks Exposed--How the Defunct Worm was Passed--Rubber Near-Worm--New Gallstone Cure--Relation to Osteopathy--Perfect, Self-Oiling, "Autotherapeutic" Machine--Touch the Button--The Truth About the Consumption and Insanity Cures. There is another trump card the traveling medical grafter plays, which wins about as well as the guaranteed rheumatism cure, namely, the tapeworm fraud. Last summer I heard a plug-hatted faker delivering a lecture to a street crowd, in which he said that every mother's son or daughter of them who didn't have the rosy cheek, the sparkling eye and buoyancy of youth might be sure that a tapeworm of monstrous size was, "like a worm in the bud," feeding on their "damask cheeks." To prove his assertion and lend terror to his tale, he held aloft a glass jar containing one of the monsters that had been driven from its feast on the vitals of its victim by his never-failing remedy. The person, "saved from a living death," stood at the "doctor's" side to corroborate the story, while his voluptuous wife was kept busy handing out the magical remedy and "pursing the ducats" given in return. How about the worm exhibited? How this one was secured I do not know; but intelligent people ought to know that cases of tapeworm are not so common that eight people out of every ten have one, as this grafter positively asserted. An acquaintance once traveled with one of these tapeworm specialists to furnish the song and dance performances that are so attractive to the class of people who furnish the ready victims for grafters. This is how the game was worked. The "specialist" would pick out an emaciated, credulous individual from his crowd, and tell him that he bore the unmistakable marks of being the prey of a terrible tapeworm. If he couldn't sell him a bottle of his worm eradicator, he would give him a bottle, telling him to take it according to directions and report to him at his hotel or tent the next day. The man would report that no dead or dying worm had been sighted. This was when Dr. Grafter got in his expert work. The man was told that if he had taken the medicine as directed the worm was dead beyond a doubt, but sometimes the "fangs" were fastened so firmly to the walls of the intestines, in their death agony, that they would not come away until he had injected a certain preparation that _always_ "produced the goods." The man was taken into a darkened room for privacy (?), the injection given, and the defunct worm always came away. At least a worm was always found in the evacuated material, and how was the deluded one to know that it was in the vessel or matter injected? Of course, the patient felt wondrous relief, and was glad to stand up that night and testify that Dr. Grafter was an angel of mercy sent to deliver him from the awful fate of living where "the worm dieth not and the fire is not quenched." I was told recently of a new tapeworm graft that makes the old one look crude and unscientific. This one actually brings a tapeworm from the intestines in _every_ case, whether the person had one before the magic remedy was given or not. The graft is to have a near-worm manufactured of delicate rubber and compressed into a capsule. The patient swallows the capsule supposed to contain the worm destroyer. The rubber worm is not digested, and a strong physic soon produces it, to the great relief of the "patient" and the greater glory and profit of the shyster. What a wonderful age of invention and scientific discoveries! Another journal tells of a new gallstone cure that never fails to cause the stones to be passed even if they are big as walnuts. The graft in this is that the medicine consists of paraffine dissolved in colored oil. The paraffine does not digest, but collects in colored balls, which are passed by handfuls and are excellent imitations of the real things. How about tapeworms, gallstones and Osteopathy, do you ask? We heard about tapeworms and gallstones when we were in Osteopathic college. The one thing that was ground into us early and thoroughly was that Osteopathy was a complete system. No matter what any other system had done, we were to remember that Osteopathy could do that thing more surely and more scientifically. Students soon learned that they were never to ask, "_Can_ we treat this?" That indicated skepticism, which was intolerable in the atmosphere of optimistic faith that surrounded the freshman and sophomore classes especially. The question was to be put, "_How_ do we treat this?" In the treatment of worms the question was, "How do we treat worms?" That was easy. Had not nature made a machine, perfect in all its parts, self-oiling, "autotherapeutic," and all that? And would nature allow it to choke up or slip a cog just because a little thing like a worm got tangled in its gearing? Not much. Nature knew that worms would intrude, and had provided her own vermifuge. The cause of worms is insufficient bile, and behold, all the Osteopath had to do when he wished to serve notice on the aforesaid worms to vacate the premises was to touch the button controlling the stop-cock to the bile-duct, and they left. It was so simple and easy we wondered how the world could have been so long finding it out. Osteopathy was complete. That was the proposition on which we were to stand. If anything had to be removed, or brought back, or put in place, all that was necessary was to open the floodgates, release the pent-up forces of nature, and the thing was done! What a happy condition, to have _perfect_ faith! I remember a report came to our school of an Osteopathic physician who read a paper before a convention of his brethren, in which he recorded marvelous cures performed in cases of tuberculosis. The paper was startling, even revolutionary, yet it was not too much for our faith. We were almost indignant at some who ventured to suggest that curing consumption by manipulation might be claiming too much. These wonderful cures were performed in a town which I afterward visited. I could find no one who knew of a single case that had been cured. There were those who knew of cases of tuberculosis he had treated, that had gone as most other bad cases of that disease go. There was another world-startling case. It is one of the main cases, from all that I can learn, upon which all the bold claims of Osteopathy as an insanity cure are based. I remember an article under scare headlines big enough for a bloody murder, flared out in the local paper. It was yet more wonderfully heralded in the papers at the county seat. The metropolitan dailies caught up the echo, which reverberated through Canada and was finally heard across the seas! Osteopathic journals took it up and made much of it. Those in school read it with eager satisfaction, and plunged into their studies with fiercer enthusiasm. Many who had been "almost persuaded" were induced by it to "cross the Rubicon," and take up the study of this wonderful new science that could take a raving maniac, condemned to a mad house by medical men, and with a few scientific twists of the neck cause raging insanity to give place to gentle sleep that should wake in sanity and health. Was it any wonder that students flocked to schools that professed to teach how common plodding mortals could work such miracles? Was it strange that anxious friends brought dear ones, over whom the black cloud of insanity cast its shadows, hundreds of miles to be treated by this man? Or to the Osteopathic colleges, from which, in all cases of which I ever knew, they returned sadly disappointed? The report of that wonderful cure caused many intelligent laymen (and even Dr. Pratt) to indulge a hope that insanity might be only a disturbance of the blood supply to the brain caused by pressure from distorted "neck bones," or other lesions, and that Osteopaths were to empty our overcrowded madhouses. Where is that hope now? What was its foundation? I was told by an intimate friend of this great Osteopath that all these startling reports we had supposed were published as news the papers were glad to get because of their important truths, were but shrewd advertising. I afterward talked with the man, and his friends who were at the bedside when the miracle was performed, and while they believed that there had been good done by the treatment, it was all so tame and commonplace at home compared with its fame abroad that I have wondered ever since if anything much was really done after all. THE MORAL TO THE TALE. Honesty--Plain Dealing--Education. But I must close. I could multiply incidents, but it would grow monotonous. I believe I have told enough that is disgusting to the intelligent laity and medical men, and enough that is humiliating to the capable, honest Osteopath, who practices his "new science" as standing for all that is good in physio-therapy. I hope I have told, or recalled, something that will help physicians to see that the way to clear up the turbidity existing in therapeutics to-day is by open, honest dealing with the laity, and by a campaign of education that shall impart to them enough of the scientific principles of medicine so that they may know when they are being imposed upon by quacks and grafters. I am encouraged to believe I am on the right track. After I had written this booklet I read, in a report of the convention of the American Medical Association held in Chicago, that one of the leaders of the Association told his brethren that the most important work before them as physicians was to conduct a campaign of education for the masses. It must be done not only to protect the people, but as well to protect the honest physician. There is another fact that faces the medical profession, and I believe I have called attention to conditions that prove it. That is, that the hope of the profession of "doctoring" being placed on an honest rational basis lies in a broader and more thorough education of the physician. A broad, liberal general education to begin with, then all that can be known about medicine and surgery. Is that enough? No. Then all that there is in physio-therapy, under whatsoever name, that promises to aid in curing or preventing disease. If this humble production aids but a little in any of this great work, then my object in writing will have been achieved. 
34128	----	Sir James Young Simpson and Chloroform (1811-1870) BY H. LAING GORDON LONDON T. FISHER UNWIN PATERNOSTER SQUARE MDCCCXCVII Copyright by T. Fisher Unwin, 1897, for Great Britain and Longmans Green & Co. for the United States of America MASTERS OF MEDICINE EDITED BY ERNEST HART, D.C.L "HOMINES AD DEOS NULLA IN RE PROPIUS ACCEDUNT QUAM SALUTEM HOMINIBUS DANDO." CICERO. Title. Author. JOHN HUNTER _Stephen Paget_ WILLIAM HARVEY _D'arcy Power_ SIR JAMES SIMPSON _H. Laing Gordon_ EDWARD JENNER _Ernest Hart_ HERMANN VON HELMHOLTZ _John G. McKendrick_ WILLIAM STOKES _Sir William Stokes_ CLAUDE BERNARD _Michael Foster_ SIR BENJAMIN BRODIE _Timothy Holmes_ THOMAS SYDENHAM _J. F. Payne_ VESALIUS _C. Louis Taylor_ [Illustration: J. Simpson] To PROFESSOR ALEXANDER RUSSELL SIMPSON "Him by the hand dear Nature took, Dearest Nature, strong and kind." RALPH WALDO EMERSON. "When Nature has work to be done, she creates a genius to do it." _Id._ PREFACE I have endeavoured to condense the vast amount of matter which has been written concerning this Master of Medicine and his work into the form of a readable narrative, and to represent him in his social and intellectual environment in accordance with the object of this Series. The selections from his own writings illustrate as far as possible his versatility and many-sided character. I have chosen for quotation out of the numerous sketches and memoirs of him those written from undoubted knowledge of the man. I am indebted especially to Professor A. R. Simpson for kind advice, to Mr. Cuthbertson of the Edinburgh University Library for useful help, to Mr. C. Louis Taylor for valuable criticism, and to my wife for assistance in research and compilation. I have also to thank those friends who from time to time have favoured me with personal reminiscences of Sir James. The following are the chief works, in addition to Simpson's own writings, from which my information has been drawn:--(1) "The Jubilee of Anæsthetic Midwifery"; (2) "Keiller and Credé"; (3) "History of the Chair of Midwifery in the University of Edinburgh," being addresses by Professor A. R. Simpson; (4) Miss Eve B. Simpson's "Sir James Simpson"; and her (5) "Dogs of other Days;" (6) "Twenty Years and their Lesson; a Retrospect and Review" (_Scots Observer_, 1891); (7) Dr. Duns's "Memoir of Sir J. Y. Simpson"; (8) Professor Gusserow's "Zur Erinnerung an Sir J. Y. Simpson"; (9) Mr. Cuthbertson's "Student's Pilgrimage"; (10) "The Story of Edinburgh University," by Sir A. Grant; (11) "The Life of Sir Robert Christison"; (12) "The Life of Robert Knox"; and numerous back numbers of the _Century Magazine_, the _Lancet_, the _British Medical Journal_, the _Medical Times and Gazette_, the _Edinburgh Medical Journal_, &c., &c. FOREST HILL, _October, 1897_. CONTENTS CHAP. PAGE. I. Birth and Childhood. (1811-1825) 1 II. Student Days. (1825-1830) 17 III Further Studies. (1830-1835) 36 IV. Early Practice and Professorship. (1835-1840) 52 V. Professor and Physician. (1840-1847) 66 VI. The Discovery of Anæsthetics. (1844-1847) 88 VII. The Fight for Anæsthesia. 1847 onwards 111 VIII. Home Life--Controversies 133 IX. Archæology--Practice 152 X. Personal--Professorial--Professional 164 XI. Further Reforms--Honours 186 XII. Failing Health--Death 202 Appendix 223 Index 227 SIR JAMES SIMPSON CHAPTER I BIRTH AND CHILDHOOD. 1811-1825 The state of the healing art at Simpson's birth--Birthplace--Family superstitions--His father's bakery--His mother's Huguenot descent--Commencement of schooldays--Natural and antiquarian features of Bathgate district--The village hand-loom weavers as antiquarians and naturalists--His interest in Nature and craving for knowledge--Brothers' and sister's care for him--Size of his head--Village doctor's record of his birth--Schooldays cease at age of fourteen--Influence of his environment in developing his character. James Young Simpson, who will ever be remembered as the discoverer of the pain-annulling power of chloroform, was born in the year 1811, at a period when there was room for a hero in the practice of the healing art in the British Islands. It is true that in the seventeenth century Harvey had laid bare the great fact of the circulation of the blood and the practical Thomas Sydenham had swept aside the highly empirical systems and theories of medicine which had successively supplanted each other since Hippocrates first taught, and urged men to found their knowledge upon what they actually saw--on observation and experiment; and that in the eighteenth century men like Cheyne, Heberden, Cullen, and the wonderful Jenner had appreciably assisted in developing medicine at the same time that Hunter was raising surgery nearer to the level of a science. But even while Simpson was growing out of childhood all the powers of such professional giants as Bright, Addison, Abernethy, Astley Cooper, and Charles Bell, were insufficient to dispel the massive cloud of mystery and superstition which enveloped the practice of both medicine and surgery in this country and obscured whatever there was of truth in the teaching of these men. In the first decade or two of this century the medical profession had not yet entirely abandoned the use of the golden-headed cane, nor had what Oliver Wendell Holmes calls the solemn farce of overdrugging yet ceased. "Humours," "impostumes," "iliac passions," and such like were still spoken of--terms now heard only amongst country-folks in remote districts and that rarely, or encountered in curious old medical publications. Messes and abominations, prepared by the apothecaries according to more or less secret recipes handed down through the Middle Ages, were swallowed in good faith; blood-letting was still a panacea; and such remedies as that of holding a live puppy to the body for the relief of colic still had their professional advocates, but happily a decreasing number; whilst those pains "... In the hour, When the veil of the body we feel Rent round us--while torments reveal The motherhood's advent in power" --pains which Simpson was the first truly to relieve by his application of anæsthetics, were gravely said to be alleviated by the swallowing of a concoction of white onions and oil. Surgery was no doubt ahead of medicine; but the early surgical records of this century have little more than a curious interest to modern practitioners. Operations entirely unknown to our professional forefathers less than a century ago are now performed in safety daily. Such mysterious diseases as "icteric irritative fever" and "acute sinking" after operations, dreaded then with the fear that is always inspired by unseen or ill-understood dangers, have vanished before the progress of modern science in which the introduction of anæsthesia was the first great step. The practice of the branch of medicine which Simpson made so peculiarly his own--that of obstetrics--originally in the hands of women only, had been fiercely contested for by the two sexes during two centuries, and such was the feeling against man-midwives in Scotland that the dispute had scarcely ceased at Simpson's birth. The stronger sex, however, was then at last asserting its superiority, and to be an accoucheur was beginning to be considered after all as worthy of a gentleman. The despised art was preparing for its renaissance. Simpson grew to manhood whilst science, aided by precise methods of accurate observation, was shedding new light upon physic, surgery, and obstetrics. In fulfilling his great part in establishing the healing art on a firm scientific basis, Simpson encountered the full force of the ignorance and prejudice of his day both within and without his profession. It was, perhaps, fortunate that he was brought up in a small village and in a rank of life where he would meet from his earliest days with many superstitious beliefs and practices, strange and utterly irrational. A mind such as his would meet, reason, and experiment these out of existence. Probably through these circumstances he conceived the taste for archæology and antiquarian research which were his recreation in later years; but, what was more important, he gained also some training for the struggle with ignorance, untruth, and irrationalism, into which he threw with his eager vigour the whole strength of his manhood. Simpson was born in the village of Bathgate, in Linlithgowshire, where his father, David Simpson, was the local baker. David's father, who died at the ripe age of ninety-one a few years after James's birth, was the descendant of a line of small hard-working farmers, who added to his work and his profit the practice of farriery. Although modern science has, by the aid of bacteriology, proved such practitioners of the rough veterinary medicine of the day to have been right in ascribing to unseen influences many of the diseases of animals which they found themselves powerless to check, the methods they employed for treatment when what they called witchcraft was at work scarcely have the support of present-day practitioners. In one of his addresses upon archæology Simpson records how his grandfather ordered and his own father took part in the burial alive of a cow in order to appease the evil spirit which was spreading the plague of murrain with fatal effect. And the older gentleman was known to have had more than one serious encounter with a witch. On one occasion an old beggar woman, who plied her calling in quite an original method--that of being wheeled in a barrow from farm to farm--hurled curses at old Simpson for ordering a servant to wheel her from his house on to her next calling-place, and vowed an awful vengeance on his family if he did not replace the servant with one of his stalwart sons. The farmer recollected that an ill event had followed the old woman's last visit, and quickly drew a sharp flint from his pocket and made a gash across her forehead with it. "Ah," he exclaimed, "I see what ye're noo, ye auld witch; but I've scored ye aboon the braith and my house is safe." Simpson noted these and many other curious practices and beliefs, and afterwards pointed out in one of his addresses that they were probably, for the most part, relics of the pagan creeds and customs of our ancestors. He urged the making of a collection of the folk-lore of Scotland, ere it utterly disappeared before the march of modern civilisation, and suggested that, perhaps, some archæological Cuvier might one day be able to re-construct from these mythological fragments distinct pictures of the heathen practices, rites, and faiths of our forefathers. In his early boyhood he listened to many stories of local and family superstitions told to him with all the earnestness of a firm believer by his father. He himself was the object of superstitious admiration to the simple villagers all through his boyhood, and they freely foretold great deeds from him in later years; for he was a seventh son, and the good luck which seventh sons were supposed to bring had appeared in the family soon after his birth. Up to the day on which James first saw the light, June 7, 1811, the baker's business had been going steadily from bad to worse, and the shop books showed that on that very day the lowest depths were reached. The baker, David Simpson, seems to have been curiously lacking in business method, although he was a hard-working man. But after James's birth he wisely interested his wife in his affairs, with the result that she energetically and successfully bestirred herself to recoup their fallen fortunes. Mrs. Simpson was directly descended from a fugitive Huguenot family, settled for many years on a farm near Bathgate, and intermarried with well-known families. Through her, indeed, Simpson claimed a distant relationship with the national hero, Sir William Wallace. The cares of her family and the strain of managing the increasing baker's business proved too much for her always delicate constitution, and she died when James was only nine years old. There is no doubt that the youngest child and favourite son had an unusually large share of his mother's society during those years; he was a peculiarly attractive child, "a rosy bairn wi' laughin' mou' and dimpled cheeks," and his manner, even when he was little more than an infant, was quiet and affectionate. When physical sufferings overtook the mother, the child's quiet sympathy and engaging manner helped and comforted her. Her own nature was bright, vivacious, and energetic, quick to think and prompt to act; and she was full of love, sympathy, and piety. These maternal traits influenced the youth, and added a soft, refined--delicately refined--tone to the paternal influence, whence he received self-reliance and habits of persevering industry. The boy's school-life began at the age of four years. The orthodox learning came very easily to him; he entered into both work and play so whole-heartedly that he at once became known as the "wise wean," and was at the same time ever sought after by his school-mates as a companion in out-door sports. The parish schoolmaster was one James Taylor, who had considerable ability for the post, and encouraged his pupils by kindly personal interest to develop affection for learning. But for Simpson there were other teachers and greater subjects for study in the countryside around Bathgate. The district was full of rich treasures for the field naturalist and for the antiquarian. Bathgate lies between the Firth of Forth and the Pentland Hills, in a geologically varied district, with a varied and abundant flora and fauna--more so in those days when Bathgate was a small village of hand-loom weavers than latterly, when it was a thriving little town, the centre of a coal, shale, and ironstone mining industry. The archæological features of the neighbourhood were full of interest. There was the famous "Catstane," of Kirkliston, which had puzzled antiquarians even before the establishment of the Scots Society in 1780, and at Kipps was one of the few remaining cromlechs--and that a ruined one--in Scotland; whilst the line of the Roman wall between the Firth of Forth and the Clyde was not far distant. There were traces of a Cistercian monastery founded by David I., and various hills and fields and caves were associated with the names of Sir William Wallace, Robert Bruce, and King Edward I. Simpson thoroughly familiarised himself in boyhood with the natural features, as well as with the antiquarian objects in the district. He continued to investigate them during his vacations when a student at Edinburgh University, and rendered the neighbourhood famous archæologically by masterly monographs written when he was at the height of his fame. Amongst the village hand-loom weavers, a race of peculiarly observant and intelligent men, there were some who studied both the antiquarian objects and the natural history of Linlithgowshire. Simpson used to speak of one man, a daily labourer at the loom, who was able to write, in correct Latin, an accurate description of any plant or animal brought before him, although his earnings at the loom never amounted to fifty pounds a year. These men thoroughly enjoyed the evident interest of the "young philosopher" in their discussions and demonstrations, at the same time kindly directing his mind towards the simple, painstaking, true methods of observing and reflecting upon nature. There was no lack of change in his environment for him; his interest in natural phenomena was roused and kept alive during his drives round the countryside delivering bread to the farmers and cottagers, or in occasional visits to his parents' relations. He daily took his turn behind the shop counter, reading, writing, or drawing in the interval of waiting for customers. He trained himself to read or do his school lessons as readily in a roomful of romping children as in the quiet of the bedroom. It has been said that he never knew an idle moment from the day of his birth onwards, and his was such an indomitable and persevering energy that the remark is no exaggeration. But the pathway to greatness was made specially smooth for James Simpson. He was set upon it, and protected in his childhood, and guided in his youth, with the one definite object always in view. The Simpson family as well as the whole Bathgate community, took it for granted that eminence was to be his in whatever walk of life he entered seriously upon. His sister Mary and his brother Alexander looked upon him as a special care; the former watched over him as a mother, and the latter helped him in the ups and downs of boyhood, just as he constantly stood by him throughout the difficult days of his later career. It had always been a custom in Scots families of humble rank that one child, either from the exhibition of a natural aptitude, or through the ambition of the parents, was singled out to receive the advantages of a fuller education such as is within the reach of every able lad in Scotland. Honour and glory would thus be brought to the family, greatest of all if from the pulpit, while the less favoured members of the family would plod on in the same sphere of life as their parents. The world owes a great deal to the Simpsons, and particularly to Alexander, who cheerfully seconded their father's efforts to help forward their young brother, without a suspicion of jealousy. They knew he would be great some day, and therein they looked for their reward. Happily there were ample means for all their requirements derived from the now prosperous bakery. The money was kept in one drawer, the till where the shop earnings were placed. All the household were free to draw thence supplies for their ordinary wants, James without stint; and he alone was exempted from the condition that he who profited must also contribute by the sweat of his brow. The boy took very full advantage of his fortunate circumstances and drank deeply of all the knowledge that came near and ever hunted for more. With each succeeding year the craving to know, and to know thoroughly, became more and more his ruling passion; by the time his schooldays were over it had gained complete mastery over him; happily for the human race Providence had so endowed him that when knowledge had come wisdom did not linger. He was never in any way led away by the temptations that no doubt beset every boy in a village of hard-drinkers such as Bathgate was in his youth. Alexander took pains to warn him--"Others may do this, Jamie, but it would break all our hearts and blast all your prospects were you to do it," he said. It was not necessary to make appeals to James to work and fulfil the family predictions; he was as firmly determined to be great as they were sure he would be: He never forgot how much he owed to the loving help of his family, and to the fact that he was the youngest son growing up at a time when the family struggles were fairly over; when instead of its being an effort for the parents to provide the necessary funds for his education, the shop-till was well filled and the elder brothers and the loving sister were at hand eagerly willing to help. In student days when struggles came and the path seemed dark and beset with dangers, the knowledge of the firm faith in his powers of the family at home and of the scarcely smaller faith of the weavers, was a powerful incentive in the moments when he required any other than that of the spirit within him. We cannot feel otherwise than thankful that up to the age of fourteen, when his schooldays ended, he had access to but a limited stock of literature wherewith to gratify his hunger for knowledge. To satisfy his appetite he was driven into the fields and the forests; every sense was stimulated, and became developed through repeated use. Thus he laid the foundation of his phenomenal faculty of rapid and accurate observation, and of his no less phenomenal memory. His imagination was fed with the legends of the district and tales of his remote moss-trooper ancestors told to him of an evening by his father. Though happily saved from being a bookworm to the exclusion of sounder means for acquiring knowledge, he devoured and digested every scrap of literature which came in his way. Like all Scots children of his class he learnt his Bible thoroughly from end to end--a knowledge which served him well in later years. Shakespeare followed the Bible in his own review of his favourite reading as a boy; but a gazetteer or an almanac was quite as acceptable. His taste was for solid fact--fact which he could learn and put to the test; thus the great open book of Nature was the attraction he most readily yielded to. But nothing in book form ever came amiss to him; if between the covers there was useful information to be had, Simpson extracted it and stored it away in his capacious brain. The unusually large size of his head, a source of admiration in manhood, was in childhood an object of wonder to observers. In manhood he wore his hair in long locks, and this was apparently his habit in boyhood. Once a strange barber cut his hair so close that his brother took upon himself to go and rebuke the man. "The callant had suck a muckle head," was the retort, "I was doin' my best to mak' it look respectable." A close-cropped head gave altogether a too sportive appearance to the "young philosopher" in the eyes of the watchful elder brother. There is no evidence that Simpson displayed in his schooldays any special leaning towards the medical profession; it cannot be reasonably urged that his grandfather's rough skill in the treatment of animals fostered any medical tendency in him, for James was but five years old when the old man died. Even had he been of an age to understand them, the methods employed would have scarcely recommended themselves to a youth of Simpson's nature, sufficiently to raise a spirit of emulation within him. It is also not recorded that the village doctor took any special interest in the boy or brought any influence to bear upon him; although his note-book thus gives the earliest record of the future prince of obstetricians:-- 275.--June 7. Simpson, David, baker, Bathgate. Wife, Mary Jarvie. Æ. 40. 8th child, son. _Natus_ 8 o'clock. _Uti veniebam natus._ Paid 10s. 6d. James displayed his superiority so decidedly in the village school that when he reached the age of fourteen it was decided to send him to Edinburgh University without further waste of time. It was no unusual age for boys to commence their University career in Scotland. There was no secondary education in the Scots provinces, but instruction intermediate between that of the parish school and what is ordinarily known as University education was given within the walls of the University itself. Boys of humble rank who aspired to a profession were sent up, as indeed many still are, at the age of fourteen or fifteen, to attend these junior Arts classes in which this instruction was, and still is, imparted. The University was crowded with schoolboys of all ranks of life gathered together from town and country, and consisted of nothing more than a collection of class-rooms devoted to the giving of instruction in lecture form. This stepping-stone of junior classes threw open the higher education to hundreds of youths whose equals in England had no such advantage at that time. Scots University education besides being thorough was decidedly cheap, so that the church, law, and medicine received many recruits from the class out of which Simpson was drawn. His environment up to the age of fourteen was well calculated to train him for the great work that lay before him. The legends of the district, and the sight of the objects of archæological interest which he came across in his rambles out of school hours, were powerful stimuli to his sensations; whilst the accurate observation of natural phenomena in field and hedge which the kindly interested weavers helped him to, was also a valuable educative influence. It is probable that his senses received much of the training which was to lead to his ultimately being the greatest physician of his day by these means, rather than from the instruction imparted to him in the village school, or derived by him independently from the books that came in his way. It was undoubtedly a fortunate circumstance that he was born and bred in an out-of-the-way country district, where he drew his lessons from Nature and the phenomena which lay round him, rather than in a great city where he would have been educated on the stereotyped orthodox system. When we look further back, asking why he saw sermons in stones and books in the running brooks, to which the bulk of his schoolfellows were entirely blind, we are bound to confess that we find no satisfactory answer in his family history, to which it is customary to look for an explanation of such tendencies. Heredity played no great part in making Simpson great; from the paternal side there was imparted to him a vigorous physique; from his mother he received the bright, happy, sympathetic, and alert disposition, which descended through her from his French ancestors. He was provided with a brain of marvellous quality and phenomenal size. But it was the environment which acted upon this brain and brought out the capacities born in him without any apparent hereditary bias, and which might have remained entirely latent under less favourable circumstances. No small part of the development was due to the people among whom he lived; a race of men accustomed to rely upon their senses which were always with them, rather than upon books which they seldom saw, even if they were able to read them; and to observe not only all that lay around them, but also the characteristics of their fellowmen with whom they were brought into contact--the close contact of different classes which obtains in village and rural life. Simpson was taught to study Nature whether in field or fellow-creature first, and the knowledge and opinions of men as expressed in books afterwards. CHAPTER II. STUDENT DAYS. 1825-1830. Visit to Edinburgh--Sent to the University--Takes the Arts classes--Gains a bursary--Influence of MacArthur and Reid--Robert Knox the anatomist--The Burke and Hare murders--Superiority of the extra-mural teachers of the day--Edinburgh an intellectual centre--University life--His mode of living as a student--Apprenticed to a chemist--Studies surgery under Liston--Regularly falls asleep in the obstetric class--Influence of his teachers--Verse writing--Description of the medical student of the day--Vacation work--Death of his father--Obtains qualification to practice at the age of eighteen. Although Edinburgh was only eighteen miles from Bathgate, Simpson visited it only once as a schoolboy; probably he walked all the way, for railroads were as yet unknown and it was not a long walk for a country-bred vigorous youth. He exercised his already formed habit of noting objects of interest during this great event in his boyhood, and in his journal there are copies of old inscriptions from tombs in the famous Greyfriars' Churchyard to which he made his pilgrimage. The boy's nearest and dearest ambition was to become a student at "the College," as Edinburgh University was familiarly termed. It received encouragement in the periodical return to the village of elder boys who had gone up before him. He was specially struck, and afterwards stimulated, by the appearance of one John Reid, his senior by two years, and his former companion in many a country ramble, who came back for the vacations smartened up both physically and mentally by the new life. Although the collegiate life characteristic of Oxford was unknown in Scots Universities, there was social intercourse amongst the boys very different from that of the village. The ancient Edinburgh University attracted students from all parts of the world, mostly for the medical curriculum, but many preceded the professional course with a year or two's attendance on the Arts classes; and it was usual for young Englishmen of good family to spend a session at Edinburgh before going to Oxford or Cambridge. Probably before he entered the medical classes, Simpson rubbed shoulders with lads of all ranks from home and abroad. Pillans was at this time the Professor of Humanity, Wallace held the chair of Mathematics, John Wilson--better known as Christopher North--that of Moral Philosophy, and Dunbar was Professor of Greek. Wallace had begun life as a bookbinder's apprentice, and Dunbar had risen from being a gardener; the example of these men under whose influence he was brought encouraged the baker's son to go and do likewise. The family had sent him off to the College with the mission to be famous, and he was beginning only in an orthodox fashion when he entered himself for the curriculum in Arts. It had been easy for him, with his magnificent brain power, to stand _dux_ of the village school over the ordinary village youth; but here, in Edinburgh, he was brought into competition with the picked boys from other country schools, and intellectually eager youths from town schools where the course of instruction was such as more easily to lead to early University success than that of the Bathgate parish school. At first he found difficulty and desponded. The keen observer with senses all alert was dashed to find so much of the College life to which he had so eagerly looked forward only a magnified repetition of the dull school routine. But he was too intent on ultimate success to be repulsed by his initial disappointment, and soon brought his mind into adjustment with the circumstances he found himself in, reserving leisure time and vacations for the exercise of his faculties as he most loved to exercise them. He did not persevere in the Arts course after he found his tastes led him to other studies; he did not trouble to obtain the Master of Arts degree, which was then conferred in a very lax manner; probably he saw its worthlessness, for it was not until the passing of the Scots Universities Act in 1858 that this degree became really valuable. He recognised, however, the value of laying a good foundation of general knowledge; without straining after any distinction he acquitted himself creditably in all his classes. In the second year of the curriculum he won one of the numerous small bursaries of the value of £10 a year, for which logic was one of the chief subjects of examination; but as candidates were restricted to those who possessed either the name of the founder, Stewart, or that of his wife, Simpson, the competition was not particularly severe. His individuality and natural straightforwardness attracted the attention of some of his professors. The boldness of his original essays provided them with food for comment in a manner dear to the professorial heart. The Arts curriculum served him usefully in helping to develop a literary style and in teaching him how best to express his vigorous thoughts, as well as in strengthening his knowledge of Latin and Greek. According to the record preserved on his class certificates he worked attentively and diligently; but the mere fact that he did not excel is sufficient proof that he did not make an attempt. During his Arts course Simpson lodged at No. 1, Adam Street, along with the John Reid already mentioned, who was now a medical student, and with a Mr. MacArthur, who had been a junior master at the Bathgate school, but had now also commenced to study medicine. MacArthur was a man of dogged determination; he urged Simpson to persist with his Arts course when his spirit seemed to rebel against it, and so long as they were together seems to have maintained some of the authority of the usher over both of the youths. The spirit of work was strong within him. Soon after Simpson joined him he related that he could then do with four hours' sleep, John Reid with six, but he had not been able to break in James yet. What MacArthur and the Arts course could not do, however, the attraction of medicine accomplished without effort, and Simpson soon formed the habit of early rising. It seems remarkable that so much study should have been required when, compared with to-day, the science of the healing art was in but a rudimentary condition. The teachers of the day had, in spite of Sydenham, a great regard for authority, and burdened their students with much that is utterly unknown to the present generation, and, if known, would be regarded as worthless. A very large part of the curriculum consisted of practical and bedside work, so that book study was necessarily left to the evening or early morning. All three students, moreover, were fired with ambition, and thirsted for something more than mere professional knowledge. MacArthur constantly urged on his two young friends, and foretold great things for them if only they would work. When he afterwards heard of their successes he used to say, "Yes, but _how_ they worked." Simpson became the greatest living obstetrician, and Reid rose to be Professor of Physiology in St. Andrew's University. MacArthur never became famous; his name is known only because of the initial impetus which his influence gave to the professional careers of his two young friends. In his close association with two such men as MacArthur and Reid, Simpson was again fortunate in his environment. The art of medicine was also fortunate inasmuch as at the right moment the right influences were at work to direct his mind towards it. While occupied in mastering the laws of hexameter and iambic or in assimilating the prescribed portion of Virgil and Tacitus, he happily now and then, living with two such enthusiastic medical students, got a taste of the more stimulating study of things scientific--food which was more agreeable to his mental palate, more suited to his mental digestion. By peeps into anatomical books, by little demonstrations of specimens in their lodgings, and by occasional visits to some of the lecture rooms or the wards of the Infirmary, his appetite was whetted for that great study of nature which his youthful training at Bathgate had prepared him for, and for which his mental constitution was specially adapted. One can picture the eagerness with which he would cast aside the finished Greek or Latin essay and urge the not unwilling embryo professor to demonstrate a bone or lecture on an anatomical preparation. Sometimes as a special favour he was taken by Reid to hear one of the lectures of the notorious Robert Knox, the extra-academical teacher of anatomy, whose strong personality and unrivalled powers as a lecturer were at that time attracting to Surgeon's Square hundreds of students, while Munro (Tertius) was mechanically repeating his grandfather's lectures from the University chair. It was towards the end of 1828, when Simpson was just about commencing his medical studies that Edinburgh, and in fact the whole of civilised Europe, was horrified by the revelation of the doings of Burke and Hare, when they were at last brought to justice for the long series of crimes perpetrated for the purpose of selling the bodies of their victims to the anatomical schools. Knox having a class of some four hundred students had special difficulty in meeting the demand for "subjects," and it was brought to light at the trial of Burke that the majority of the bodies were disposed of to Knox. As was only natural, a fierce indignation against Knox sprang up in the city. His residence was assailed and his effigy burnt. His life was in danger at the hands of the mob on more than one occasion. Lord Cockburn in his "Memorials of His Time" says that all the Edinburgh anatomists incurred an unjust and very alarming though not an unnatural odium--Dr. Knox in particular, against whom not only the anger of the populace but the condemnation of more intelligent persons was directed. "But," he says, "tried in reference to the invariable and the necessary practice of the profession our anatomists were spotlessly correct and Knox the most correct of them all." These were stirring times in Edinburgh medical circles. The strong, cool demeanour of Knox under the persecutions to which he was subjected, must have made an indelible impression on Simpson's mind, and the memory of it may have served to strengthen him in later years when himself subjected to the unjust accusations of thoughtless and ignorant people. One night when Knox had attracted a large class to hear him on a favourite subject, the crowd in the street mustered in unusual force; the yells and howls from outside were heard distinctly in the class-room. The students got alarmed, and kept looking to the doors of egress. Knox perceiving the restlessness and alarm of his audience paused, and then addressed to them reassuring words, expressing his contempt for the cowardly mob, and reminding them of the great men who at different times had suffered persecution for the cause of their science. His statement was received with such cheers as resounded beyond the class-room walls and actually cowed the uproarious mob, so loudly did the students applaud the words of the man who, they knew, daily placed his life in danger in order to lecture to them, and whose last hour seemed to have come, so great and threatening was the crowd on this particular evening. If Simpson did not actually witness such a scene as the foregoing--he was not a member of Knox's class until the session 1830-31--he must at least have known full well about it at the time, and shared with the whole body of students the worship of the man as a hero. His fellow lodger, Reid, was not only a distinguished pupil in Knox's class, but became one of Knox's demonstrators in 1833, and was always a prominent Knoxite. We know also that Knox went down to Bathgate to visit Reid's relations there, so that it is justifiable to conclude that Simpson came closely in contact with this remarkable teacher. That the relationship between Reid and Simpson was most intimate we have the former's own words for. At a public dinner given to him when appointed to his professorship in 1841, he said, "In the croupier (Simpson) I recognise my earliest friend, a native of the same village. We were rivals at school and at college. We stood to each other from boyhood upwards in every possible relation, whether of an educational, warlike, delicate, or social character, which the warm and fitful feelings peculiar to boyhood and youth can produce." In the end Knox and Reid quarrelled over a scientific matter. Knox never recovered from the effect of the Burke and Hare incident; in spite of the favourable report of an influential committee appointed to inquire into his share in the proceedings, and his own explicit statements, the public never acquitted him of at least a wilful shutting of his eyes to much that ought to have aroused his suspicions. His crowded class-room gradually became empty during the next few years, and the once brilliant, talented, and determined man became demoralised and left Edinburgh. Christison says that Knox finally died almost destitute in London, and that one of his last occupations was that of showman to a party of travelling Ojibbeway Indians. However the strong personality and attractive lecturing of Knox may have influenced him, it is undoubted that to the personal influence of MacArthur and Reid, acting upon his constant hunger to know nature and truth, stimulated as it was by what he saw of anatomy and physiology, we owe the fact that Simpson decided to enter the medical profession. Although the number of medical students in Edinburgh University reached one of its highest points during the years that Simpson was a student, it is remarkable that with one, or perhaps two, exceptions, the University professors were men of no marked eminence in their various subjects. On the other hand, the extra-mural teachers included men of such wide reputation as Knox, Lizars, and Liston. Syme, who reached the height of his fame as a surgeon about the same time that Simpson became renowned, had just resigned the teaching of anatomy to take up surgery; shut out at first from the wards of the Royal Infirmary by jealous colleagues, he was boldly establishing for himself the little Minto House Hospital, which became the successful nursery of his own unsurpassed system of clinical teaching, and remains in the recollection to this day as the principal scene of Dr. John Brown's pathetic story, "Rab and his Friends." It was chiefly these extra-academical teachers who at that time made the medical school famous, and were raising for it a reputation in surgery such as it had acquired in physic in the days of Cullen. In certain subjects the students would, according to the regulations for the degree, take out their tickets of attendance on the professor's course of lectures, but would put in only a sufficient number of appearances to entitle them to the necessary certificates; the real study of the subject being made under the more accomplished teacher outside the University walls. Edinburgh was at this period much more than the scene of the foremost medical and surgical teaching of the day in the world. It was a striking centre of intellectual activity. Sir Walter Scott, Cockburn, and Jeffrey were famous in literature and politics; Chalmers and Moncrieff in Church affairs; and Aytoun, John Wilson, Sir William Hamilton, and Sir David Brewster were names that attracted men from far and wide to the modern Athens. English and foreign advocates, scholars, artists, squires, and noblemen mingled together to hear or see some of these men. Lord John Russell, Henry Temple--subsequently Lord Palmerston--and Lord Melbourne were amongst the young Englishmen who attended university classes for a session or two; and H.R.H. the Prince of Wales, and his brother the Duke of Edinburgh, each matriculated in later days. When Simpson began his studies Knox was the great lion, without a visit to whose class-room no sojourn in Edinburgh was complete; just as in later years Simpson's house in Queen Street was the resort of all sorts and conditions of distinguished people. The University had little control over her students once they were outside the gates of the quadrangle. There were no residential colleges; each youth found lodgings for himself suitable to his means, and led a perfectly independent life. So long as he conducted himself with propriety within her walls his Alma Mater cared little how he conducted himself or how he fared outside. Before 1858, when the Town Council controlled University affairs, there were sometimes attempts to order the comings and goings of students. It is recorded that in 1635 the Town Council discovered that the scholars of the College were much withdrawn from their studies by "invitations to burials," which "prejudiced their advancement in learning," and they enacted that no student was to be permitted to attend burials except those of University or city worthies. This was at a time when some of the students were provided with residences inside the University, but by the beginning of the eighteenth century College residence had ceased. From time to time attempts have been made to render the students conspicuous in the city by the wearing of red gowns, but without success; and those of all faculties continue to be their own masters, in marked contrast to the mode of government in force at Oxford and Cambridge. Recently, in the eighties, a batch of students who had figured in the police-court after a riot in the gallery of a theatre were surprised to find themselves summoned before the Senatus Academicus and rusticated for varying periods; this, however, was but a spasmodic exercise of power. The chief advantage claimed for this custom of leaving the student to his own devices is that it encourages independence and develops each man's individuality better than a system of discipline and control. In men of Simpson's calibre it certainly has had a good effect. Although the family in Bathgate strained every nerve to keep James well supplied with the necessary funds as a student, they were not able to place him in such a pecuniary position as to make it unnecessary for him to exercise economy: He appears to have been very careful indeed of the money which he had; much more careful than when he reckoned his income by thousands. He kept methodical accounts of his expenses down to the most trivial items, and regularly submitted them to his family. His cash-book opened with the following quotation from a small book called the "Economy of Life," which figures at a cost of ninepence:--"Let not thy recreations be expensive lest the pain of purchasing them exceed the pleasure thou hast in their enjoyment"; and to this he added:-- "No trivial gain nor trivial loss despise; Mole-hills, if often heaped, to mountains rise. Weigh every small expense and nothing waste; Farthings long saved amount to pounds at last." It is easy to see here the imprint of a well-known national characteristic, from which, however, he completely shook himself free when prosperity came to him. His share of the rent of the Adam Street lodging amounted to only three shillings a week. The entries in the cash-book show how frugally he lived and how every spare sum was devoted to the purchase of books. His library, the foundation of much of his encyclopedic knowledge, was a curious mixture. Adam's "Antiquities," Milton's Poems, Byron's "Giaour" and "Childe Harold," a Church Bible, Paley's "Natural Theology," Fife's "Anatomy," and "The Fortunes of Nigel," were amongst those entered as purchased. The daily entries were such as the following:--"Subject (anatomical), £2; spoon, 6d.; bread and tart, 1s. 8d. Duncan's Therapeutics, 9d.; snuff; 1-1/2d.; Early Rising, 9-1/2d." He followed out the usual student's custom of the day of learning dispensing by serving for a time in a chemist's shop. The late Dr. Keiller, of Edinburgh, used to relate how, while he himself was so employed in a chemist's shop in Dundas Street, one day "a little fellow with a big head" was brought in and entered as a pupil by a relative. The little fellow was Simpson, and no sooner was he left in the shop than he sat down with a book upon drugs, and turning to the shelves took down drug after drug to read up. The prompt industry of the big-headed fellow deeply impressed Keiller. James attended most of the University classes, but studied surgery under the great Robert Liston, the foremost extra-mural surgeon, daring and skilful as an operator and of great repute as a lecturer, who afterwards filled the post of Professor of Clinical Surgery in University College Hospital, London. Liston was an abrupt-mannered but sincere man, and a keen lover of truth. He was a warm advocate of hospital reform, and was successful in introducing several needed improvements into the Royal Infirmary after a fierce fight. Here again Simpson was brought under the influence of a strong, self-reliant man with a distinct tendency towards controversy; to whom he was also attracted by the fact that Liston was a native of Linlithgowshire. Liston and Syme, after being close colleagues, quarrelled most fiercely, and were bitter rivals until Liston removed to London in 1835. Simpson attended Liston's lectures during three sessions. There is no record of his having obtained great distinction in any of the medical classes, but his certificates show that he worked with pre-eminent diligence in them all, and obtained a characteristic mastery of each subject. If any exception occurred it was in the very subject in which he afterwards earned his greatest scientific fame--that of obstetrics. He attended Professor James Hamilton's course of lectures on that subject early in his career, and apparently felt so little interest--the subject only became a compulsory one for examination for qualification in 1830--that he regularly went to sleep during the lecture. The excuse urged was that the lecture being a late one, three to four in the afternoon, it found him tired out after a long morning of study, lectures, and practical work. But had he been keenly interested he would have been wide awake, for Hamilton was a forcible, if plain, lecturer. Hamilton was another of Simpson's teachers who exhibited the same uncompromising fighting characteristics--eager and strenuous in his efforts to obtain some object--which Simpson himself afterwards displayed. He fought hard for fifteen years to gain recognition for the subject which he taught, and to have it included in those necessary for qualification. He succeeded in the end, but in the course of the struggle had to bring two actions at law against professional brethren. In one the defendant was Dr. Gregory, whose teaching was mainly responsible for the British system of medical practice in the early part of this century, viz., free purging, free bleeding, and frequent blistering, and who was the inventor of that well known household remedy, Gregory's powder. Gregory was also a pugnacious man and could not abide the pretensions of the representative of the despised art of midwifery; he administered a public caning to him, and had to pay £100 in damages which, it is said, he offered to pay over again for another opportunity of thrashing the little obstetrician. This encounter occurred before Simpson became a student, but the memory of it was frequently revived in the subsequent disputes which Hamilton carried on. The notes which Simpson took of the curriculum lectures were concisely made and full of comments, criticisms, and queries. He by no means bowed down to authority; he allowed nothing to pass which he did not understand at the time, and specially noted points which it seemed to him his teachers themselves did not understand. Like most young men of his abilities and temperament, Simpson took pleasure in rhyming, and some of his verses are preserved. They indicate something of the rollicking spirit of the medical student's life seventy years ago. The medical student at that date has been described in a recent interesting sketch of Edinburgh student life as wearing a white great-coat and talking loud; his hat was inclined knowingly to one side of his head, and the bright hues of an Oriental handkerchief decorated his neck. There was a great deal of acting in his motions. He was first at the door of the theatre on a Saturday night, and regardless of the damages sustained by the skirts of his coat, secured the very middle seat of the fifth row of benches in the pit. Simpson, however, hardly conformed to this description. He enjoyed recreation as much as any man, and had a keen sense of humour which made him popular among his fellow students, but he was saturated with the love of study and was not led into extravagances of the Bob Sawyer type, or the harmless inanities of Albert Smith's immortal Medical Student. During the long summer vacation he noted carefully his observations on the botany, zoology, geology, and even the meteorology of the Bathgate district. Dr. Duns, in his memoir, points out that he was much more at home with the phenomena of organic than with those of inorganic forms. His highest powers came into play when he had to do with the presence of life and its varied manifestations. Even his antiquarian notes illustrated this. He passed at once from the things to the thoughts and feelings of the men associated with them. In the holidays he also assisted the village doctor in visiting and dispensing, and lent a willing hand in his father's shop when he was wanted, often enough driving the baker's cart on the daily round of bread delivery. In January of the year 1830 his father was taken seriously ill, and James hastily left Edinburgh and tended him till his death. On his return he presented himself for the final examination at the College of Surgeons. This he passed with ease and credit in April, and found himself a fully qualified medical practitioner at the age of eighteen. CHAPTER III FURTHER STUDIES. 1830-1835 Applies for a village appointment--Disappointment--Brother's help to further studies--Dispensary assistant--Obtains University M.D., 1832--Thesis--Assistant to the Professor of Pathology--Turns to obstetrics--Attends Professor Hamilton's lectures again--Royal Medical and Royal Physical Societies--Edward Forbes--The Oineromathic Society--Foreign tour--Visits Liverpool and meets Miss Jessie Grindlay--His characteristics, principles, and methods, with extracts from addresses. There now came the first crisis in Simpson's medical career. After his father's death he felt that having obtained his qualification to practise it was his duty to relieve his family of the burden of supporting him through more extended studies. After due deliberation he applied for a small appointment which would have served as a nucleus for private practice, that of parish surgeon to a small village on the banks of the Clyde. Those in whose hands the appointment lay were not impressed with his fitness for the post, and he was not elected, "I felt," he afterwards said, "a deeper amount of chagrin and disappointment than I have ever experienced since that date. If chosen, I would probably have been working there as a village doctor still." Although such a commencement might have delayed his ultimate rise to eminence, it cannot be agreed that it could possibly have prevented it. It was at this crisis that what he tenderly referred to as "the ceaseless love and kindness of a dear elder brother" came to his rescue, and by Alexander's or, as he affectionately called him, "Sandy's" help, he returned to Edinburgh to resume his studies in the winter session, 1830-31. His other brother, David, had started in business as a baker at Stockbridge, close to Edinburgh, and James boarded with him there for a time. His qualification enabled him to become assistant to a Dr. Gairdner in dispensary practice, a class of work he had had some experience of in the previous year while staying with Dr. Girdwood at Falkirk during the summer. Dr. Gairdner was much struck with Simpson's abilities, which he stated, "promised the most flattering expectations." In the course of his first experiences of actual practice he became impressed with the necessity for a knowledge of obstetrics, and therefore attended lectures on the subject by Dr. Thatcher, an extra-mural teacher of repute, who subsequently applied for the University chair of midwifery when Simpson was the successful candidate. His chief object, however, was to qualify for the degree of Doctor of Medicine of the University, and this he succeeded in doing in 1832. The regulations for this coveted degree were, for the times, wonderfully complete; it was held in such high estimation and such large numbers qualified annually--in 1827 there were one hundred and sixty graduates--that the authorities felt justified in being stringent. The length of the course of study necessary for graduation had been fixed at four years, and required the candidate to have attended classes in Anatomy, Surgery, Materia Medica, and Pharmacy, the Theory and Practice of Medicine, Clinical Medicine, Midwifery, Chemistry, and Botany, as well as a three months' course in any two of the following:--Practical Anatomy, Natural History, Medical Jurisprudence, Clinical Surgery, and Military Surgery. The first step in examination took place at the house of one of the professors where the candidate was questioned in literary subjects, chiefly Latin, and in the different branches of Medicine and Surgery. If he passed this satisfactorily he was examined more minutely by two professors in the presence of the others, and was subsequently given two Aphorisms of Hippocrates to explain and illustrate in writing and to defend before the faculty, as well as two cases with questions attached. The last step was the presenting of a thesis which was read by one of the faculty and was publicly defended by the candidate on the day of graduation. All this examination was conducted in Latin. Simpson's thesis was entitled: "_De causa mortis in quibusdam inflammationibus proxima_." He was amongst the last graduates who were examined through the medium of Latin, for after 1833 the language was optional, and English soon became the only one used; at the same time the examinations were differently arranged, and made to consist of more thorough and prolonged written and oral stages. Being on a pathological subject, Simpson's thesis was allotted to Thomson, the professor of Pathology, to examine, who not only recommended the author for the degree, but was so impressed by the ability displayed in the dissertation that he sought him out and promptly offered him the post of assistant, which Simpson as promptly accepted. This appointment was most welcome. Not only did it give him a much desired opportunity for pathological work, but the salary of £50 a year enabled him to free his family from the immediate necessity of supporting him. If to MacArthur and John Reid was due the credit of first directing Simpson's thoughts to the study of medicine, to Professor John Thomson belongs the credit of having made him an obstetrician. "At Dr. Thomson's earnest suggestion and advice," says Simpson, "I first turned more especially to the study of midwifery with the view of becoming a teacher of this department of medical science." He lost no time in throwing himself heartily into the work that was nearest to him, and became almost indispensable to his chief. Most of his time was spent in the Pathological Museum, busily engaged in arranging, classifying, and describing the preparations, but he also assisted in preparing the professor's lectures. He took up more readily than Thomson the then new mode of study by the microscope, and it is related that once he composed a lecture for his chief on this subject which Thomson delivered without previous perusal. Several times as Thompson read the lecture to the class he looked up to glare at his assistant, and when they returned to the side room he shook his fist in his face, saying, "I don't believe one d--d word of it." Although Simpson was now earning enough by his salary as assistant to meet his expenses at the time, his family maintained their loving interest in his welfare. His sister told him he was working too hard and hurting his health. "Well," he replied, "I am sure it is just to please you all." Sandy, who had married in 1832, watched his career carefully, and when the cholera made its appearance in Scotland he made a will with a provision for "my dear James" in the event of his death. "I daresay," he addressed his family therein, "every one of you has a pleasure in doing him good by stealth as I have had myself." By Thomson's advice Simpson attended Hamilton's lectures in the winter session 1833-4, and this time with awakened interest. With the definite object of devoting himself to Midwifery clearly in view Simpson worked with all his phenomenal energy during the years from 1832 to 1835, studying the subject while he was helping Thomson. He entered the front rank of the young graduates of his day, and was elected a member of the Royal Medical and Royal Physical Societies in the same year, 1833. Both these societies were for the encouragement of scientific study and discussion among students and young graduates, and to obtain the Presidential chair of either was a high honour. The Royal Medical Society was the oldest Society in the University, having been established in 1737 by the great Cullen and others; it had always been of great account in the University, and the originality of the utterances on professional matters which emanated from it made it then a power to be reckoned with not only in Edinburgh, but throughout European professional circles. For membership of the Royal Physical Society he was proposed by Edward Forbes, a brilliant youth, who subsequently distinguished himself in Natural History, and held the University Chair in that subject for a brief period until cut down prematurely at the age of thirty-nine. Forbes was the leader of a set of able young students who have left a distinct mark in the history of the University. John Reid was an intimate friend of Forbes, and Simpson was probably as intimate with him. Forbes was the founder and editor of the best of all the shortlived literary ventures of Edinburgh undergraduates--_The University Maga_, which was issued weekly in 1834; and he was also one of the founders of the Oineromathic Society, "The brotherhood of the friends of Truth." Forbes thus described the nature of this Society in song:-- "Some love to stray through lands far away, Some love to roam on the sea, But an antique cell and a college bell, And a student's life for me. For palace or cot, for mead or grot I never would care or pine, But spend my days in twining lays To Learning, Love, and Wine." "Wine, Love, and Learning" was the motto of this curious brotherhood, and it numbered in its membership many men of the day, who afterwards became eminent, such as Forbes himself, Reid, George Wilson, Goodsir, and Bennet. Simpson must have been quite cognisant of this Society's doings; he was closely associated with its leaders, but his name does not appear in any of the lists of members still preserved. His whole-hearted devotion to the ~MATHÊSIS~ probably prevented his uniting with the brotherhood to worship the ~ERÔS~ and ~OINOS~. The brotherhood was conspicuously united. In the great snowball riot of 1837, which was quelled only by the reading of the Riot Act and the marching down at the double from the Castle of the Cameron Highlanders into the University gates, they fought shoulder to shoulder. In 1835 Simpson felt that the time had come to enter into serious practice and turn his acquired knowledge to account. Fifty pounds a year was no large income on which to satisfy his craving for learning, and there was no surplus from which by any means to repay his family for their assistance. Before taking any decided step, however, he desired to pay a visit to the Continental centres of medical science and teaching. The funds for the proposed tour were promptly found by his brothers Alexander and John; by their assistance he was enabled to visit Paris, Liége, and Brussels, as well as London and Oxford. He was accompanied by Dr. (now Sir Douglas) Maclagan, and kept a journal of the tour, which is an interesting example of his lively powers of observation. In London he visited the leading hospitals, and made the acquaintance of the leading physicians and surgeons, amongst whom were many _alumni_ of his own _alma mater_. In the journal he freely and concisely criticised the men, their methods, and their hospitals. In Paris he followed the same plan, going the round of all the hospitals, and searching for and grasping the principle which guided each distinguished man's thought and teaching. He took more than a medical interest in all that he saw, and noted the appearance and habits of the people of each place that he visited. At the end of his coach ride from London to Southampton, on the way to Paris, he sat down to write:--"The ride as far as Windsor Park was delightful, and from the top of the coach we had two or three most lovely glimpses of English scenery. After passing Windsor the soil was rather inferior in many parts, and we passed every now and then large tracts of heath.... The neatness and cleanliness of the English cottages is greatly superior to all that we have in Scotland; the little patches of garden ground before, behind, and around them set them off amazingly. I wish the Scottish peasantry could by some means or other be excited to a little more love of cleanliness and horticulture. I did not see above two or three dirty windows, men or women along the whole line of road. The snow-white smock-frocks of the Hampshire peasantry do actually look well in my opinion." At Liége on June 13th he wrote:--"And is it possible that I here begin a second volume of a journal?... I began my journal chiefly with some distant prospect of teaching myself the important lesson of daily notation. I am vain enough to flatter myself now that I have partly at least succeeded. At all events that which was at first a sort of task, at times rather an annoying task, has now become to me a pleasure. If I had my first volume to write over again I think I would now write it twenty times better. In writing a journal 'tis needless to think of making no blunders in the way of blots and bad grammar or of crooked sentences. We, or at least I, have occasionally felt so confoundedly tired at night that if I had been obliged to attend to such minutiæ I certainly would not have been able to advance above two sentences. "This morning rose by half-past seven--dressed and breakfasted on coffee and rolls, read the _Liége Courier_, and by nine o'clock called on Professor Fohman with a copy of Dr. Reid's paper on the glands of the whale, which I had promised him yesterday. The Professor kept us until five minutes to ten, lecturing us on his discoveries upon the original elementary tubular structure of animal tissues. Somebody has remarked that no person ever entered into or at least came out of the study of the Book of Revelation without being either mad before or mad after it. I would not choose to say that Dr. F.'s case is perfectly analogous, but has it not some analogy? He seems to run wild on elementary tubular texture; ... he hates Lippi and his researches with a perfect hatred. Lippi has been preferred to him by the Parisian Academy. Is he not working against Lippi, and it may be against truth, if they happen to go together, which I do not believe? "We have taken our seats in the diligence to-morrow for Louvain, and on leaving Liége I must confess that I leave one of the most lovely places I have seen on the Continent. 'Tis rich, populous, busy; the town in itself is old and good, though not so neat and clean as Mons; its environs wild and romantic. Besides it seems full of good-natured _gash_ old wives, and sonsy, laughing-faced, good-looking, nay, some of them very good-looking girls." The homeward journey was made _viâ_ Birmingham, Liverpool, and Glasgow. In Liverpool he called upon a distant relative named Grindlay, established there as a shipper, and laid the foundation of a life-long friendship with the family. He also then for the first time met Miss Jessie Grindlay who afterwards became his wife. With the end of this tour, Simpson brought to a close the more strictly student part of his career, although it remained true of him, as of all eminent scientific men, that he was a student to the end of his days. He felt himself now fully equipped to enter into the professional battle, and he stepped into the arena, not only full of vigorous life and hope, but possessed of highly trained faculties, keen senses, and lofty ideals. It was his strong, personal characteristics, apart from his accomplishments, which at once placed him head and shoulders above his fellows. "He had a great heart," says a recent writer, "and a marvellous personal influence, calling forth, not only the sympathy and love of his fellowmen, but capable of kindling enthusiasm in others almost at first sight." It is impossible to overestimate this personal influence in analysing the elements of his ultimate success, and it is more impossible for those who did not feel it to realise its nature; but that he became the beloved as well as the trusted physician is due to this influence. "He had no acquaintances," says the writer already quoted; "none could come into contact with him and stop short of friendship." This was a powerful trait to possess; it cannot be denied that he was fully aware of it and its value; and used it with good effect in establishing himself as the greatest physician of his day. As a scientist he started with an eager desire for knowledge and reverence for truth, to which was added the highly developed power of mental concentration born of early self-training. When most men would be waiting in what they would term enforced idleness, Simpson would be busy with book or pen, deeply attentive to his occupation despite surrounding distractions or temptations to frivolous idleness. He took the full measure of the value of Time and handled his moments as another would a precious metal. "At all times," he said himself, "on all occasions, and amidst the numerous disturbing influences to which the medical man is so constantly subjected, he should be able to control and command his undivided mental attention to the case or object that he may have before him.... In the power of concentrating and keeping concentrated all the energies of attention and thought upon any given subject, consists the power of thinking strongly and successfully upon that subject. The possession or the want of this quality of the mind constitutes the main distinction between the possession or the want of what the world designates 'mental abilities and talents.'" His high ideals, his conception of the functions of the physician, and the strivings of the scientist are best shown in his own words:--"Other pursuits become insignificant in their objects when placed in contrast with ours. The agriculturist bestows all his professional care and study on the rearing of crops and cattle; the merchant spends his energies and attention on his goods and his commissions; the engineer upon his iron-wheels and rails; the sailor upon his ships and freights; the banker upon his bills and his bonds; and the manufacturer upon his spindles and their products. But what after all are machinery and merchandise, shares and stocks, consols and prices-current, or the rates of cargoes and cattle, of corns and cottons, in comparison with the inestimable value and importance of the very lives of these fellowmen who everywhere move and breath and speak and act around us? What are any, or what are all these objects when contrasted with the most precious and valued gift of God--human life? And what would not the greatest and most successful followers of such varied callings give out of their own professional stores for the restoration of health and for the prolongation of life--if the first were once lost to them, or if the other were merely menaced by the dreaded and blighting finger of disease?" In one of his addresses of later years he urged upon his students the objects and motives which had been his in early professional life:--"The objects and powers of your art are alike great and elevated," he said. "Your aim is as far as possible to alleviate human suffering and lengthen out human existence. Your ambition is to gladden as well as to prolong the course of human life by warding off disease as the greatest of mortal evils; and restoring health, and even at times reason itself, as the greatest of mortal blessings.... If you follow these, the noble objects of your profession, in a proper spirit of love and kindness to your race, the pure light of benevolence will shed around the path of your toils and labours the brightness and beauty that will ever cheer you onwards and keep your steps from being weary in well-doing; ... while if you practise the art that you profess with a cold-hearted view to its results, merely as a matter of lucre and trade, your course will be as dark and miserable as that low and grovelling love that dictates it." Simpson's method of study was simple, at the same time that it involved immense labour. In entering upon a new work his first proceeding was to ascertain conscientiously all that had already been said or written by others upon the subject. He traced knowledge from its earliest sources and was able, as he followed the mental workings of those who had preceded him, to estimate the value of every vaunted addition to the sum of knowledge; and to weigh the theories and new opinions of men which had been evolved with the progress of time, and which had sometimes obscured, instead of casting greater light upon the truth. His antiquarian tastes added to his knowledge of Latin helped him in this work and turned a tedious task into a real pleasure. This preliminary accomplished, he plunged into the work of adding to the knowledge of the subject by thought, research, experiment, or invention. In writing upon an abstract subject he would disentangle the confused thoughts of his predecessors and restate their opinions in direct and simplified language. But matters of opinion never had such an attraction for him as matters of fact; in dealing with these latter he would test by experiment the statements of authorities and correct or add to them by his own researches. Most of his professional writings, as well as his archæological works, are valuable for the historical _résumé_ of the knowledge on the subject as well as for his additions. His later writings show as careful an attention to the inductive method with which he started, as those produced in the days of his more youthful enthusiasm; when fame was attained and fortune secured, when excessive work was sapping his physical strength, he never sank into lazy or slovenly methods in scientific work, but ever threw his whole vigour into the self-imposed task. When studying Nature directly he was constantly asking her "why?"--just as in his notes of his teacher's lectures the query was ever recurring. He never felt himself beaten by an initial failure, but returned again and again with his questions with renewed energy each time. He was not to be denied, and in this manner he wrested from Nature some of those precious secrets the knowledge of which has relieved suffering and prolonged human life in every corner of the globe. "He never kept anything secret," says his nephew and successor, Professor A. R. Simpson, "that he thought could help his fellows, and it is hard to say whether his delight was greater in finding some new means to cure disease, or in demonstrating to others his methods of treatment." He was indeed clothed in well-nigh impenetrable armour, and provided with powerful weapons, when in the autumn of 1835 he returned from his foreign tour to commence the serious fight in which his avowed object was not only to obtain professional eminence, but to stand forth a proud benefactor of the human race. Although he appealed always directly to Nature and used his own well-trained eyes and ears in preference to those of others, he did not completely brush aside authority as Sydenham had done; he hesitated neither to extract all that was valuable, nor to discard what appeared worthless from the writings of past masters. CHAPTER IV EARLY PRACTICE AND PROFESSORSHIP. 1835-1840 President of Royal Medical Society--Personal appearance--Practice among the poor--Corresponds with Miss Grindlay--Lecturer on obstetrics--Resignation of Professor Hamilton--Applies for vacancy--Active candidature--Strong opposition--Marriage--Account of the midwifery Chair--The medical professors at the time--Their opposition--Cost of candidature--Triumphant election. In November, 1835, Simpson was elected one of the annual Presidents of the Royal Medical Society; a position which has been occupied by many young Edinburgh graduates, who have subsequently risen to fame. He took pains to make his inaugural address worthy of the occasion, and chose a subject connected with the pathology of obstetrics. It was a great success, and contributed largely towards giving him a recognised position as an authority in that branch of study. After appearing in the _Edinburgh Medical and Surgical Journal_ for January, 1836, it was translated into French, Italian, and German. It also obtained for him his first foreign honour--one of a long list that was made up through his lifetime--that of corresponding member of the Ghent Medical Society; indeed, his early works received more attention and appreciation abroad than at home. In 1836, in order to widen his experience in his chosen subject, he filled the post of house-surgeon to the Lying-in Hospital, and held it for twelve months. He was also elected a Fellow of the Edinburgh College of Physicians. From this time he became a profuse writer on professional subjects, and developed an easy and convincing style; he carried on this work _pari passu_ with practice amongst the poorer classes of the city and in addition to his work in connection with the Pathology Chair, always keeping in view his great object of becoming an obstetrician. It was not until 1838 that he became an independent lecturer on Midwifery. He had intended to do so earlier, but owing to Professor Thomson's ill-health, he had been called upon to act as Deputy-Professor of Pathology, a most valuable and useful employment. Simpson's personal appearance at this time has been described by one who visited a meeting of the Royal Medical Society on an evening when he was in the chair:--"The chair was occupied," says the narrator, "by a young man whose appearance was striking and peculiar. As we entered the room his head was bent down, and little was seen but a mass of long tangled hair, partially concealing what appeared to be a head of very large size. He raised his head, and his countenance at once impressed us. A pale, rather flattish face, massive brent brows, from under which shone eyes now piercing as it were to your inmost soul, now melting into almost feminine tenderness; a coarsish nose with dilated nostrils, finely chiselled mouth which seemed the most expressive feature of the face ... Then his peculiar rounded soft body and limbs, as if he had retained the infantine form in adolescence, presented a _tout ensemble_, which even if we had never seen it again would have remained indelibly impressed on our memory." In Simpson's youth physicians and surgeons made a habit of cultivating peculiarities of appearances and behaviour, but he was so shaped by nature as to attract attention without artificial aid. The growth of long hair seemed a natural accompaniment to his massive head and broad expressive countenance. His practice at this time was scattered over the city, and he took long tramps in the course of the day. In one of his letters to his brothers, who were still loyally supporting him in his increasingly successful endeavours to establish himself after his heart's desire, he says:--"The patients are mostly poor it is true, but still they are patients; ... if my health is spared me, I do hope I may get into practice sufficient to keep me respectable after the lapse of years; but I know years must pass before that. At present I enjoy the best possible spirits and health, and with all my toils was never happier or healthier." _Tout vient à point à qui sait attendre._ Simpson knew how to wait; he knew that waiting did not mean inactivity. Every opportunity that arose for advancement found him prepared to take full advantage of it. That his lectures on pathology were acceptable was made manifest by the address presented to him by the students of the class at the end of his temporary term of office, testifying to his zeal, fidelity, and success, their admiration of his high talents, of the varied and extensive research which he displayed, and of his uniform and kind affability which, while it exalted him in the eyes of all as a teacher, endeared him to each as a friend. During this period he kept up a correspondence with the Miss Grindlay, of Liverpool, whose appearance he had been struck with when he visited the family, and towards the end of 1837 he found time to visit there again accompanied by Dr. John Reid. The way for his appearance as an extra-academical lecturer on midwifery was made clear at the end of 1837 by the death of Dr. Macintosh, a successful teacher of that subject. He had been in negotiation, without success, with this Dr. Macintosh for the taking over of the part or whole of his lectures, and found it easy to step at once into his place at his death. He was firmly determined to succeed ultimately to the University Chair of Midwifery. On one occasion he pointed out to some friends the then holder of the Chair, Professor Hamilton, thus:--"Do you see that old gentleman? Well, that's my gown!" The good luck which had been his during his boyhood did not desert him when he began his course of lectures; for not only did he speedily attain a reputation for teaching, science, and practical skill, wonderful for one so young, but he had not two years to wait after thus establishing himself before the chair of his ambition fell vacant owing to the resignation in 1839 of Professor Hamilton, who died soon afterwards at the age of seventy-two. It was a bold step for so young a man--for Simpson was only twenty-eight--to apply for the professorship. He was, however, not without his precedent. The second Monro obtained the Anatomy Chair at twenty-five, Alison filled that of Physic at thirty, and Thomas Hope and Alexander Christison were Professors of Chemistry and Medical Jurisprudence respectively each at the age of twenty-four. But this subject was one which was popularly thought to require a man of experience and especially a married man. Simpson had devoted his energies but partially to midwifery for only four or five years, and except for his short hospital appointment and recent experience as a lecturer on the subject had in the eyes of many no greater claim to the post than any other general practitioner, except in the fact that he had obtained a wide reputation in the science of the subject by his contribution to its literature and his researches. This last was the point on which he himself most relied; for his age he had done more scientifically than any of his opponents. Those who had watched his career knew that he possessed in addition to zeal and ability, brilliant teaching and practical powers. The objection of his youth was less easily got over than that of his unmarried state. With characteristic promptness, as soon as he had determined to apply for the Chair and found that as a bachelor his chances would be small, he disappeared for a time from Edinburgh, and returned triumphantly with Miss Jessie Grindlay, of Liverpool, as his wife. It was a bold stroke which delighted his supporters, discomfited his opponents, who saw therein the removal of a barrier to his success and a weapon from their hands, and astonished the worthy town councillors in whose gift the appointment lay. The Edinburgh Chair of Midwifery was established in 1726, and was indisputably the first Chair of its kind in the British Islands, and probably in the world. It was in that year that the Town Council first established the medical faculty, by appointing two Professors of the Theory and Practice of Medicine and two of Medicine and Chemistry. A Chair of Anatomy had been instituted six years earlier through the instrumentality of the first Monro who became its first occupant. These five chairs were considered sufficient wherewith to teach all the medical knowledge of the day, and although appointed _ad vitam aut culpam_ the professors received no remuneration out of the city revenues. The Chair was not reckoned at first as a faculty Chair, but was termed a city professorship. The newly created medical faculty would have no midwifery within the precincts of the University; and this is scarcely surprising when we remember that at first the only persons lectured to by the city professor were women of an inferior class in whose hands the practice of the art almost entirely lay. Along with this appointment the Town Council established a system of regulation for midwifery practice within the city. It ordered that all midwives already in practice should at once be registered, and that no persons should thereafter enter on the practice within the city until they had presented to the magistrate a certificate under the hands of at least one doctor and one surgeon who were at the same time members of the College of Physicians or of the Incorporation of Chirurgeons, bearing that they had so much of the knowledge and principles of this art as warranted their entering on the practice of it; whereupon a licence should be given them signed by four magistrates at least entitling them to practise. It was further enacted that certain pains and penalties were to be inflicted upon ignorant persons for practising without this licence whereby their "want of skill might be of such dangerous consequences to the lives of so many people." It is to be presumed that as qualified medical men granted them these certificates and that these women had extensive practices, they possessed also a fair amount of skill. But slowly and gradually they had to give way and retire to the rank of nurses before the rise and growing public tolerance of the qualified male practitioner of obstetrics. The second occupant of the chair, appointed in 1739, was elevated to a place in the medical faculty, but Professor Thomas Young, who occupied it in 1756, was the first to teach the subject to medical students by means of lectures and clinical instruction. As already noted, it was left for James Hamilton to obtain the recognition of midwifery as a subject, a knowledge of which was necessary for the obtaining of the University medical degree. At the time when Simpson was straining every nerve to gain the post he coveted, the medical faculty of the University comprised the following professors of the following subjects:--Botany, Robert Graham, who established the Edinburgh and Glasgow Botanical Gardens; Anatomy, Monro the third; Chemistry, Hope, who discovered strontium in the lead mines of Argyleshire; Institutes of Medicine, Alison, an eminent physician and philanthropist who first pointed out the connection between destitution and epidemics of disease, and secured improved Poor Laws for his country; Practice of Physic, James Home; Materia Medica, Christison, the world-reputed toxicologist; Natural History, Robert Jameson; Clinical Surgery, James Syme, the wonderful operator and teacher, and inventor of the "macintosh" waterproof; Military Surgery, Ballingall; Medical Jurisprudence, Traill; Pathology, Thomson; and Surgery, Charles Bell, the discoverer of the double function of the nerves, who was ranked in his day on the Continent as greater than Harvey. It was thus not an undistinguished body that Simpson strove to enter; several of the best-known members were comparatively young men, recently appointed to their posts, and full of the rising scientific spirit. It is little to their credit that they were practically unanimous in opposing the candidature of this young and enthusiastic scientist, who afterwards shed such lustre on the University from the chair which they would have denied him for no reasons other than his youth and his humble origin. Fortunately for Simpson and for the University, the appointment did not lie in the gift of the professors, but was entirely in the hands of the Town Council, comprising thirty-three citizens. Such an election was always a matter of keen interest to the inhabitants of Edinburgh, and each candidate brought all the direct and indirect influence within his power to bear on every councillor whom he could reach. The Professors in the various faculties had no doubt great influence; they openly canvassed for the candidate they favoured, and did not hesitate to decry those they did not approve of. Shortsighted as this professorial opposition was, it proved no small difficulty in Simpson's way. Foremost amongst his opponents was Syme, who commenced a long feud with him by supporting his chief rival, Dr. Kennedy; "I feel no hesitation in stating," he wrote purposely for publication, "that of all the candidates in the field, he (Kennedy) is out of all question, according to my judgment, the one that ought to be elected." Sir Charles Bell was equally emphatic, and characterised Simpson's testimonials, in a note which Kennedy circulated, as given by "good-natured people merely to do a civil thing to a friend"--which was his mode of describing the declarations of some of the most eminent men of the day. Each candidate also brought political influence to bear, and Whig and Tory grew agitated as the contest became keener. Simpson seems to have thought that both political parties were in opposition to him, but he certainly had the strong support of Ritchie of _Scotsman_ fame, and the no less important influence of Mr. Duncan Maclaren. When writing to ask Mr. Grindlay for his daughter's hand, Simpson candidly confessed his pecuniary position at the time. He referred to a debt of £200 already owing to his brother Sandy, and added:--"Again he gave me a bill for £120 to assist me in furnishing my house. This has been renewed and becomes due in January. He hopes to be able to pay it, and I fondly imagined I would have paid the half, but this canvass has involved me in new difficulties, and besides, I have endeavoured to assist my sister to go out to Van Diemen's Land. As it is now I am self-sufficient enough to think that I am as well off as regards station in my profession as any who started here in the race of life with me. They have all, I believe, been aided by friends or by private wealth. They have almost all been fortunate enough to have the protection of a father's roof during the first years of practice. I have had no such advantages, but have worked and stood alone. I have accumulated for myself a library and museum, worth £200 at least, amidst these difficulties. These I have won by my pen and my lancet, and these are my only fortune. And now could you trust her future happiness to me under such circumstances? I did not intend to ask her hand at present. I fondly hoped I might have _first_ cleared myself of my debts." Grindlay did not hesitate, but willingly gave his daughter, as she was willingly given, for better or worse. The expenses of the canvass amounted to about £500, an amazingly large sum; he spared no expense in printing and posting his testimonials and letters to every one who had any influence with the Council, however small; but taking into consideration the cost of printing and postage in 1839, it is difficult to realise how the money was expended. His aim was to make known his scientific attainments, powers as a teacher, and personal qualifications which he felt, if duly realised, would outweigh the disadvantages of his youth and comparative inexperience. His testimonials spoke in strong terms of his abilities and characteristics; they were a good deal more numerous and elaborate than is customary to-day, but Kennedy's also made a fat volume of 150 octavo pages. As the day of election drew near the excitement amongst citizens, professors, and students grew intense. Of the five candidates in the field, three, including his former teacher Thatcher, speedily fell out of the running. Dr. Evory Kennedy, of Dublin, and Simpson stood face to face as rivals. Kennedy was no mean opponent, and his supporters honestly considered him the better man of the two; his attainments certainly merited warm support. The prophets foretold a close struggle, and the event proved them correct. So keen was public interest that when a report was circulated that Kennedy was a bad lecturer, his friends brought him over from Dublin a few days before the election, hired a public room, and made him lecture to a crowded and enthusiastic audience to dispel that illusion. In spite of this the popular vote was decidedly in Simpson's favour; if the citizens had had votes Simpson would have been returned at the head of the poll by a large majority. On Tuesday, February 4, 1840, at a Council meeting, at which all thirty-three members were present, the Provost himself proposed Kennedy, while Baillie Ramsay proposed Simpson. The result was awaited with breathless suspense, the chamber being crowded by anxious spectators. Simpson's enthusiasm had infected his supporters; he had kindled the first sparks of that enthusiastic affection with which the citizens of Edinburgh ever after regarded him; when his triumph, by the narrowest majority, was announced, the cheers resounded loud and long. The same evening he was able to write to Liverpool:-- "1, DEAN TERRACE. "I was this day elected Professor. My opponent had sixteen and I had seventeen votes. All the political influence of both the leading Whigs and Tories here was employed against me; but never mind, I have got the chair in despite of them, Professors and all. Jessie's honeymoon and mine is to commence to-morrow." It was the man's strong individuality which carried the day. The town councillors threw aside the political and academic bias of those who endeavoured to lead them, and elected the man who had boldly said, "Did I not feel I am the best man for the Chair I would not go in for it"; and had more boldly gone on showing them how thoroughly he felt what he said until they themselves came to believe it. The gift of this Chair, as of many others in the University, has now passed from the hands of the Town Council into those of a body of curators, seven in number, three nominated by the University Court and four by the Town Council; such a body might have made a more cautious choice, but never a more fortunate one both for the city and the University than this of their long-headed and far-sighted predecessors. CHAPTER V PROFESSOR AND PHYSICIAN. 1840-1847 Success as a lecturer--Increased practice--Generosity--Fashionable patients--Memoir on Leprosy--Controversy concerning the Pathology Chair--Address to the Graduates, 1842--Squabbles--Purchases 52, Queen Street--A great and good physician--Called to London--Visit to Erskine House--The daily scene at 52, Queen Street--Rangoon petroleum and Christison--The disruption--His family--Appointed Physician-Accoucheur to the Queen for Scotland. Simpson had not long been engaged upon his new duties before the town councillors gladly saw, and his brother professors were obliged to admit, that the baker's son was bringing a mighty genius to bear upon the subject of his choice from the chair of his ambition. He cherished no ill-feeling against those _confrères_ who had actively opposed his candidature, but set to work amidst his new surroundings conscious that the best way to obliterate bitter feelings was by gradually creating a stronger feeling--that of respect for him as a man and a worker. He had dealt heavy blows himself during the conflict--blows not easily forgotten. The position demanded tact and patience, and he was not found wanting in either. He converted many who had worked against him into adherents, admirers, and even friends. His lectures speedily attracted students. Besides those who were entering the profession, grey-headed and grey-bearded men, whose student days had long since passed away, came to sit at the feet of this remarkable young man and hear the so recently despised subject dealt with in his own masterly, scientific manner. Conciseness, clearness, and directness characterised his delivery; while with illustration and anecdote he made his dull subject fascinatingly interesting. It was his custom to write out on a black-board notes of the subject on which he was about to speak--concise, pithy headings, which were hung up in the theatre and which he proceeded methodically to explain and enlarge upon. So successful were his efforts that even in the first session he was able to make the proud boast that his class was for the first time in its history the largest in the University, and this in spite of the fact that one of the leading professors altered his lecture hour to the same hour as Simpson's, with the purpose of injuring the attendance at Simpson's class. A direct result of the reputation obtained through his course of lectures and improved professional position was the rapid increase of his practice and the improvement of the class of his patients, so that pecuniary profit came within his reach. He continued to be a general practitioner, however, attending to all classes of cases that came to him; but his zeal for midwifery and the diseases of women, together with his renown in those subjects, brought mostly patients of the female sex to his consulting-room. With the improved position there came necessarily increased expenditure, which at first exceeded the income; he never stopped to consider the patients' circumstances or whether he was likely to be paid for his services. "I prefer to have my reward in the gratitude of my patients," he said. He treated all that came to him, and his generous nature was oftentimes taken advantage of by persons very well able to remunerate him; moreover, at this time, when his pecuniary profit did not equal his professional reputation, he cheerfully helped many who appealed to him with amounts he could ill spare. His father-in-law generously and willingly stood by him until the fees began to come in more freely--his brother Sandy, who had supported him hitherto, having now other claims upon his purse. He found two ordinary but costly steps advisable--first, to move into a better and more centrally situated house; and, secondly, to obtain a carriage, "both to support my rank among my wealthier compeers and to save my body from excess of work." The outlay was justified in the result; the fees from students and from his private practice very soon enabled him to repay the debts to his brothers and his father-in-law without inconvenience and with grateful pleasure. Once and for ever within the first few years of his professorship he placed himself in a safe position, free from all pecuniary anxiety. If he had laboured hard to fit himself for the front rank of his profession, his work on attaining that position showed increase rather than abatement. His private practice alone was the work of more than one ordinary individual, and his professorial duties took up some of the best hours of his day. In the evenings and at all odd times he busied himself with absorbing current or ancient literature, or in preparing his own contributions to both professional and general knowledge either with the pen or by experiment. "Oh that there were double twenty-four hours in the day," he sighed at a time when he was working at highest pressure, practising amongst peers, commoners, and cottagers alike, who all flocked to his residence or sent long distances for him. When Princess Marie of Baden, wife of the Duke of Hamilton, came under his special care in 1843 he felt that he was placed at the top of his profession in Scotland, and must have smilingly recalled the words of old Dr. Dawson, of Bathgate, when he heard of the successful contest for the Chair. "It's all very well," he had said, "to have got the Chair! But he can never have such a practice as Professor Hamilton. Why, ladies have been known to come from England to consult him!" They came from the furthest parts of Greater Britain to consult Hamilton's successor, in spite of the old doctor's prognostication! The energy as well as the versatility of the man is well shown in the works which he found time to carry on while he was thus establishing himself as a teacher and as a practitioner, during the years from 1840 to 1845. One of his first literary efforts, not wholly professional, the Memoir on "Leprosy and Leper-Houses," was produced at that time. It was a work of relaxation and pleasure, for it carried him deeply into his favourite archæology. The fascination which this subject always had for him sprang from his love of nature, and of the greatest work of nature--man. "The leading object and intent of all the antiquarian's pursuit is MAN," he said, "and man's ways and works, his habits and thoughts, from the earliest dates at which we can find his traces and tracks upon the earth, onwards and forwards along the journey of past time. During this long journey he has everywhere left scattered behind him and around him innumerable relics forming so many permanent impressions and evidences of his march and progress." The quantity and quality of the information concerning leper hospitals which he collected and embodied in his memoir, contributed to the Edinburgh Medico-Chirurgical Society in March, 1841, was phenomenal. He had consulted old manuscripts and registers, monastic chronicles, burgh records, and Acts of Parliament, as well as works of antiquity, travel, and history. He gave close upon five hundred references, as well as a list of one hundred and nineteen leper-houses, whose existence in Britain and whose history he had traced. The work illustrates the objects and proper methods of antiquarian research, which twenty years afterwards he dilated upon in his address from the Chair of the Scottish Society of Antiquaries. In the course of it he pointed out how vigorously our ancestors had set to work to stamp out the disease when it spread through Europe during the period from the tenth to the sixteenth century. The method adopted was that still employed--segregation; about the twelfth century scarcely a town or burgh in France and Britain was without its leper-hospital. Although we in Britain are happily now freed from its ravages, other parts of the world are not so fortunate. It is still regarded popularly as an incurable disease, as it was in 1597, when one Catherine Livingstone was gravely brought to trial for witchcraft, one instance of which had been that she dared to state her ability to cure "leprosie, which the maist expert men in medicine are not abil to do." The indictment set forth that she "took a reid cock, slew it, baked a bannock with the blude of it, and gaf the samyn to the leper to eat." The witch's remedy is scarcely more curious and certainly no less useful than those recommended two centuries later by John Wesley in his "Primitive Physic," where, moreover, he cheerfully, if somewhat too briefly to satisfy the modern inquirer, reports the cure "of a most desperate case" by the drinking of a half-pint of celery-whey morning and evening. Scotland was severely smitten by leprosy in the centuries when it overspread Europe; Robert Bruce fell a victim to it in 1339, and the disease seems to have lingered in the North after it had almost vanished from England. Simpson's paper was published in the _Edinburgh Medical and Surgical Journal_ in three parts in 1841 and 1842, and to this day is the most valuable contribution to the interesting and important history of the disease. Some of the information had been collected in his student days. In his antiquarian researches he had frequently met with references to the dirty and unwholesome habits and surroundings of Scots towns in early days. The thought that dirt and disease were directly connected--a new thought even so recently as fifty years ago--led to his investigations. He found that leprosy was most prevalent at the time when his country was most dirty; but he was not able to establish his supposition that the cause of the disease lay in the insanitary surroundings of the people; indeed his researches proved that, on the contrary, leprosy had declined and practically disappeared from the country long before any material improvement in sanitary conditions took place. Simpson's conduct when Professor Thomson resigned the Chair of Pathology illustrates the vigour with which he entered into quite casually arising incidents where he saw that strength and a fight were necessary to conquer an evil or prevent an abuse. Thomson resigned in 1841 owing to ill-health. The Chair had been established by William IV. in 1831 on the representations of Thomson himself, who succeeded in satisfying Lord Melbourne that the subject was worthy of the dignity of a separate Chair, in spite of the protests of the Senatus Academicus, who throughout the history of the medical faculty generally appear to have been actuated more by personal considerations and professional jealousies, where new developments were in process, than by zeal for their _Alma Mater_. Professors Syme and Alison actively led an agitation that with Thomson's resignation the separate teaching of pathology should be brought to an end. Without a moment's hesitation, in the midst of his hard work, and suffering from indifferent health, Simpson plunged into a controversy with these colleagues, in which he silenced at once and for ever the detractors who had sneered at him as an ignorant, uncultured man-midwife. The controversy as usual was followed with intense interest by Edinburgh folks, and Simpson received a first taste of that popular approval which undoubtedly was one of the enjoyments of his life. The Crown avoided the difficulty of deciding between the rival petitioners for and against the Chair by transferring its patronage to the Town Council, who showed the same foresight which had led them to appoint Simpson, in deciding to maintain its existence. Unfortunately their wisdom failed when they elected as Thomson's successor a man who, although of brilliant attainments, subsequently brought discredit upon his University and himself by becoming a convert to homoeopathy. Simpson, who was indirectly instrumental in securing the Chair of Pathology for this man became his bitterest opponent when he declared himself a follower of Hahnemann's unorthodox and mistaken doctrines. In 1842 it fell to Simpson's lot to deliver the customary address to the medical graduates after they had received their degrees at the annual ceremonial on the 1st of August. He treated his listeners to a discourse on the duties of young physicians. When we remember that he had attained to his then high professional position while he was no more than a young physician himself, we recognise that he was but setting forth the ideals and principles which had been and still were his guides in life and conduct. After warning his audience against regarding the gaining of the coveted degree as the end of their student career, instead of as in reality the opening up of a lifetime of observation and study, he pointed out that self-patronage was the best of all patronage. "Place from the first," he said, "all your hopes of advancement upon the breadth and extent of your medical abilities alone.... Rather walk by the steady light of your own lamp than by the more dazzling, but to you more uncertain, lustre borrowed from that of others ... Young physicians often dream that by extending the circle of their private acquaintances they thus afford themselves the best chance of extending the circle of their private patients.... No man will in any case of doubt and danger entrust to your professional care the guardianship of his own life or of the life of those who are near and dear to his heart, merely because you happen to be on terms of intimacy with him. The self-interest of human nature forbids it.... The accomplishments which render you acceptable in the drawing-room are not always those that would make your visits longed for or valued in the chamber of sickness and sorrow.... Give therefore your whole energies to medicine; and in its multiplied departments you will find 'ample room and verge enough' for the most energetic as well as the most comprehensive mind. Place your faith in no extrinsic influences. Let your own professional character be the one great patron to whom you ever look for your professional advancement." He exhorted the young practitioners above all to save and economise their time, and to regard it as a property to be avaricious of and of every item of which they were to render a proper account to themselves. "It is by carefully preserving, confirming, and making diligent use of these broken and disjointed portions of it, which others thoughtlessly waste and destroy, that almost all the highest reputations in the medical profession have been formed." He strongly urged the value of a "proper covetousness of time." "Look around, and you will find that those who have the most to do in the way of business as practitioners have also apparently the most time to spare as observers and writers.... And why? Because they have all their daily duties perfectly assorted and arrayed; they save from loss and destruction every possible fragment of time and this very industry and precision procures them more true leisure than indolence can boast of." In referring to the relation of practitioner to patient, he spoke on a subject which has been much discussed in recent years without altering the principle originally laid down in the oath of Hippocrates:--"Whatever," said Simpson, "is communicated to you as a matter of professional confidence, must ever remain buried within your own breasts in all the silence and secrecy of the grave." He concluded his address with well-judged remarks on the relation of the physician to his professional brethren, counselling his hearers to observe the Golden Rule, and, moreover, "if it be possible, as much as lieth in you, live peaceably with all men; never allow the darker part of your nature to persuade you to the attempt of over-taking him who has distanced you in the race of life by any unjust efforts to lame the character, and thus diminish the speed, of your adversary. And if such attempts are made upon you by others, have no dread of them--if you are armed strong in honesty, if you have pursued a line of irreproachable truth and unbending rectitude of conduct. 'Be thou as pure as snow thou shalt not escape calumny.'... Your future career is a matter of your own selection, and will be regulated by the conduct which you choose to follow. That career may be one of happiness or self-regret, one of honour or of obscurity, one of wealth or of poverty. The one or other result is not a matter of _chance_, but a matter of choice on your part. Your diligence and industry for the next few years will almost inevitably secure for you the one; your apathy and indolence will almost inevitably entail upon you the other. May God, in His infinite goodness, enable you to select the wiser and the better path." In this address, as in that previously quoted, we hear him exhorting his young listeners to a line of conduct which we know to have been broadly his own in practice as well as in ideal. During these early years as professor, Simpson had to ward off many ill-disposed adversaries, and he met their attack with the determination and powerful preparedness that characterised his attitude in later years, when he experienced the hostility so constantly opposed to genuine reformers, and men who have lived ahead of their times. He sometimes regarded these encounters regretfully himself; but none the less remembered to "Bear't that the opposed may beware." The correspondence pertaining to some of these disputes was filed and ticketed, with brief contempt, "Squabbles." His controversy with Professor Syme over a personal matter in 1845 was not to the credit of either of these great men, and, as Simpson himself confessed, was equally discreditable to their profession. Simpson had seen, as has been pointed out, several of his teachers fighting long and strongly for their own cherished objects; and he doubtless then, in his student days, learnt the lesson that vigorous persistence had the power to gain much that at first seemed hopeless; he fought with such energy, that he accomplished in his own lifetime what the example of others might have led him to think would have been accomplished only by his successors. The growth of his practice up to 1847 was little short of phenomenal. In 1845 he purchased No. 52, Queen-street, the house which he inhabited up to his death, and which became the Mecca of hundreds upon hundreds of pilgrims from all quarters of the globe. Here, in those years, he was sought and consulted by unceasing crowds; in the public mind he was undoubtedly endowed with more than human powers, and regarded as a magician, at the wave of whose wand pain and disease would vanish. This caused him much embarrassment, and brought upon him the abuse of ignorant persons, irritated to find that, after all, even in Simpson's person, there was a limit to human powers; or of others with unimportant ailments who were disappointed to find that, once having made his diagnosis of their condition, he would have no more of them, preferring to place his time at the disposal of those whose sufferings were real and capable of relief, or whose cases were complicated and interesting. The question of remuneration was always secondary, and so careless was he in pecuniary matters that it is related that he would wrap up interesting specimens, professional or antiquarian, in bank notes; and his trusted valet was in the habit of emptying his pockets at night of the money earned in the day, to prevent its being lost, mislaid, or given away to undeserving persons. With him work was first and fee second. Like a great modern teacher he was able to say, "Work first--you are God's servant; fee first--you are the fiend's." To Simpson "work was master and the Lord of Work, who is God." The personal power and attractiveness of the man were large factors in gaining the practice which he now enjoyed. But he did not depend for success on these alone, by any means. His professional reputation was fully won by great work in obstetrics and gynæcology, and by the introduction of methods and instruments which contributed to the saving of countless lives. It has been said that he gave a new life to the obstetric art, and presided at the birth of gynæcology. He had done this before the great deed was dreamt of which hands his name down to posterity, before his discovery of the anæsthetic power of chloroform. Simpson was a great physician, the leading practitioner of the art and exponent of the science with which his name will always be connected. But many great physicians have failed to fulfil as Simpson did, Robert Louis Stevenson's description of the physician:-- "Generosity he has such as is possible to those who practise an art, never to those who drive a trade; discretion tested by a hundred secrets; tact tried in a thousand embarrassments; and what are more Heraclean cheerfulness and courage. So it is that he brings air and cheer into the sick room, and often enough, though not so often as he wishes, brings healing." Great as a man and great as a physician, Simpson was actually run after by the greatest in the land. In 1845 he was summoned professionally to London, and gave an interesting description of his kindly reception by the Duchess of Sutherland and her family in a letter written from Stafford House. His advent to London was a matter of notoriety, and he noted that he bought in the street a life of himself which mightily diverted him and made him laugh until he was sore. A year or more later he was invited for rest and change to Erskine House by Lord Blantyre, where he says, "the Duchess of Sutherland, the Marquis and Marchioness of Lorne, and two Ladies Gower have made up with myself all the strangers." "Tell Janet," he wrote to his brother, "I think now artificial flowers very ungenteel. The ladies here wear nothing but real flowers in their hair, and every day they come down with something new and for us males to guess at. Often the Duchess wears a simple chaplet of ivy leaves, sometimes a bracken leaf is all she sports in her head ornaments, and beautiful it looks. Rowans and 'haws' are often worn beaded into crowns or flowers or chaplets. Heather is also a favourite. On Thursday Lady Lorne came down with a most beautiful chaplet tying round and keeping down her braided hair. It was a long bunch of bramble leaves and half-ripe bramble berries--actual true brambles. They have been all exceedingly kind to me, and I really feel quite at home among them though the only untitled personage at table." The daily scene at 52, Queen Street was now unique. Those who had the fortune to lunch or breakfast in that hospitable house never forgot it. Statesmen, noblemen, artists, scientists, clergymen, and politicians from various countries sat down together and entertained each other or attempted to do so in their different languages. The host guided the conversation while he still glanced over the newspaper or some newly published book, and never failed by skilful leading to entice out of every one the best knowledge that they possessed. With his quick insight he rarely failed in his estimate of character, but rapidly perceived even in a stranger where the conventional ceased and the real man began. No stranger to Edinburgh omitted to bring or obtain an introduction to the genial professor; all were welcome, and an open table was kept. The scene has been described from intimate knowledge in the columns of the _Scots Observer_ as follows:--"Luncheon is set on the table, and some ten, twenty, or even fifty people wait the appearance of their host, who is on his rounds maybe, or in another room ministers to an urgent case. A stranger who has not learnt that the great Simpson was only in the broadest sense a punctual man--of minutes, hours, he knew nothing, but none more reliably punctual, few so unsparingly regular in working while 'tis called to-day--might be prompted by hungry discontent to suggest that none but the wealthiest can keep the doctor from his guests. The mere suggestion would be infamous, for rich and ragged alike pay fees or not exactly as it pleases them. Whatever the cause, the host still lingers, and the impatient stranger has time to wonder how it is that so odd an assortment of human beings should be met together in one room. Lords and Commons rub shoulders at his table; the salt of the earth sit down side by side with the savourless; tweed jostles broadcloth; the town-bred Briton looks askance at his country-bred compatriot, and both unconsciously shudder at the Briton with no breeding at all. In one room are assembled together the American of bluest blood; the Yankee bagman; the slave-owning Southerner, and even the man of colour hateful to both alike. The atmosphere is chill like the grave, each guest, eyeing his neighbour suspiciously, shrinks into his own social shell; on each face the meanness and snobbery of humankind is, if not aggressively expressed, at least clearly legible; when all at once Simpson bustles in. In a few minutes, under the genial influence of his presence, all tongues are set a-wagging, and well may you ask whether the men who leave his house after luncheon are those who half-an-hour ago regarded each other with cold disdain. For now they are cordial, kindly, sympathetic; each has been induced to show whatever was attractive in his nature, or to give the fruits of his experience. If in one short hour Simpson could thus transform a crowd of frigid, haughty strangers into an assemblage of decent, amiable human beings, what could he not achieve in a day, a year, or a life?" His reception of members of his own profession was specially cordial, and if those from any one country were more welcome than others, it was the many who crossed the Atlantic to see and hear him. America had the greatest share in the birth of anæsthetics, and Simpson's intimacy with so many of the profession in the United States made it easy for them to welcome his assistance in that great event. Gynæcology, too, was eagerly taken up in America, and many were Simpson's admirers from that country who returned home fired by his influence to work out for themselves valuable additions to that science. Simpson paid close attention to current events in other branches of science, in politics, and in religion. Sir Robert Christison and he were at one time associated in an enterprise which narrowly escaped being the source of a fortune to him. Rangoon petroleum which was obtained from pits dug on the banks of the Irawaddy had been chemically investigated by Christison, and he had isolated from it a substance which he named petroline; unfortunately, unknown to him, a German chemist had independently made the same discovery a few months earlier, and christened the substance paraffin. When, a few years later, it occurred to Simpson that the crude Rangoon petroleum might serve as a lubricant for machinery and prove cheaper than those in general use, he applied to Christison. He met with willing assistance, but a refusal on principle to have anything to do with a patent, which Christison laughingly suggested, might be called "Simpson's incomparable antifriction lubricant!" "When I called for Simpson," says Christison, in his Recollections, "his two reception rooms were as usual full of patients, more were seated in the lobby, female faces stared from all the windows in vacant expectancy, and a lady was ringing the door bell. But the doctor brushed through the crowd to join me, and left them all kicking their heels for the next two hours." Their experiments proved that petroleum was vastly superior to sperm oil, the best known and most commonly used lubricant. Simpson proceeded to take out a patent, having no such scruples as Christison; but to his chagrin found that he had been forestalled by others, and had to abandon the subject. About the period now referred to Scotland was stirred from end to end by the ecclesiastical movement which culminated in the crisis known as the Disruption, when, for reasons connected with the jurisdiction of the National Church, a majority of its members severed their connection therewith in a public and dramatic fashion, and "came out" to found the now strong and vigorous Free Kirk. Simpson at first steered clear of all the squabbles and discussions which the movement gave rise to, but when affairs approached a crisis he threw his lot in with the leaders of the new movement, and became a staunch Free Churchman. Busy as he was, Simpson fully enjoyed his home and all the inner domestic life. He was a cheery and hearty host to his intimate friends, and took a pleasure in impromptu entertainments got up by himself in his own house, when he found time at his disposal for such amusement. His first child--a daughter--of whom he was mightily proud, was born in 1840; his first son, David, in 1842; and the second, Walter, in 1843. In 1844 the young couple, in the midst of their rising prosperity, suffered the loss of their daughter, who died after a brief illness. Simpson felt the loss keenly, and wrote pathetically on the subject to his relations; long afterwards he loved to talk of her and her winning ways. By 1846 the vast majority of his work lay in obstetrics and gynæcology, although he himself would no doubt have indignantly repelled the suggestion that he was a specialist; his mind recognised the interdependence of all the great branches of the healing art, and the necessity for any who wished to excel or be useful practitioners to be _au courant_ with each and every branch. He had early shown that as a pathologist alone he was worthy of a niche in the temple of fame; and in later days he was urged to apply for the vacant chair of Physic in his own University; while Professor A. R. Simpson tells us that foreigners working in the sphere of surgery sometimes spoke of him as a surgeon. Early in 1847 his good friend, the Duchess of Sutherland, wrote to inform him that the Queen had much pleasure in conferring upon him the vacant post of Physician to Her Majesty. In the Queen's own words, "His high character and abilities made him very fit for the post." He held this post until his death, under the title of Physician Accoucheur to the Queen for Scotland. Thus in his thirty-sixth year, to the pride of his family and of the whole village community in which he had been born and received his early training, to the admiration of patients and friends, as well as to his own conscious satisfaction, the Bathgate baker's son had risen by his own efforts to the highest attainable position in his native land. But the work which was to make him one of the most conspicuous figures in the history of medicine, and raise him to a place of honour in the grateful estimation of humanity, was scarcely begun. CHAPTER VI THE DISCOVERY OF ANÆSTHETICS. 1844-1847 His early sympathy for suffering--Surgical methods before the discovery of anæsthetics--His mental struggle caused by the sickening sights of the operating theatre--His researches into the history of anæsthesia--Indian hemp--Mandrake--Alcohol--Hypnotism and other methods--Inhalation of drugs--Sir Humphry Davy--Anæsthetics discovered in America--Horace Wells and laughing-gas--Morton and ether--Ether in Great Britain--He uses it in midwifery practice--Search for a better-anæsthetic--Discovery of anæsthetic power of chloroform. From his earliest student days the desire had ever been present in Simpson's mind to see some means devised for preventing the sufferings endured by patients on the operating table, without, as he put it, "interfering with the free and healthy play of the natural functions." It is difficult for us at the close of the nineteenth century to understand, without an effort of the imagination, the strong incentives which he had for such a wish. Even to-day, when operations are conducted without the infliction of pain, young students are not unfrequently overcome by the sight and the thought of what is in front of them. At the commencement of a winter session the theatre is crowded with those students who are entering upon surgical study, and with others, not so far advanced, who have come to get a preliminary peep at the practice of this fascinatingly interesting art. Many of these at first succumb and faint even before the surgeon has begun his work, and sometimes are only persuaded to pursue their studies by the encouragement of kindly teachers. Simpson also went through this trying experience, but it must have been a greater struggle to him to persist. The surroundings of the surgeon at the commencement of the century were vastly more repugnant to a youth of sensitive nature than to-day. The operating theatre then has been compared to a butcher's shambles; cleanliness was not considered necessary, and little attention was paid to the feelings of the patient. He was held down by three or four pairs of powerful arms as the surgeon boldly and rapidly did his work, despite the screams, stopping, perhaps, only to roughly abuse the patient for some agonised movement which had interfered with the course of action. The poor wretch saw the instruments handed one by one by the assistant, and heard the surgeon's calm directions and his remarks on the case. The barbarous practice of arresting bleeding by the application of red-hot irons to the surface of the wound had indeed ceased three centuries before, when that humane reformer, Paré, displaced it with the method of tying the open blood-vessel, but the patient's blood gushed forth before him until arrested, into the sawdust spread to receive it, and the sight and the hot odour of it oftentimes mercifully caused him to faint. The spirit of Paré who, when relating a successful operation, would humbly add at the end, "I dressed him; God healed him," had not descended to those who practised in Simpson's day the art for which Paré did so much. It had grown to be necessary for a surgeon to be rough and callous; it was expected of him by the public; he was a man to be pointed at in the street, and shuddered at when he passed, by all who devoutly prayed they might escape his clutches. Much of this conduct was mere mannerism; it had become the custom, and had to be maintained in order to preserve the dignity and stamp the identity of the surgeon. Much of it arose from the haste with which the surgeon had to work; the quicker the operation the better chance had the patient; it was no uncommon thing to see a bystander timing the surgeon's work, as the professional time-keeper carefully times a race; and the rapidity of each surgeon's performances was a subject of comparison and admiration amongst the students of his day. Much of it also arose from the effect of the hideous scenes in the operating room upon the surgeon himself; his nerve had to become of iron if he desired to succeed, and with the nerve the face and the manner, but not necessarily always the heart hardened also. Tennyson possibly recollected these days, when he wrote of the surgeon who "Sent a chill to my heart when I saw him come in at the door, Fresh from the surgery schools of France, and of other lands; Harsh red hair, big voice, big chest, big merciless hands." When Simpson first saw Liston raise his knife to operate on a poor Highland woman, he actually felt so repelled that he contemplated abandoning his studies, and made a serious attempt to enter upon legal work instead. But the mental struggle with which medical men of all countries, and in all times, can sympathise out of their own knowledge, ended in a victory for medicine, and a triumphant return to his studies with the question permanently engraved on the tablets of his mind, "Can nothing be done to prevent this suffering?" It is necessary and it is certainly beneficial that we should thus remind ourselves of the horrors which surrounded the surgeon so recently as sixty years ago. "Before the days of anæsthetics," wrote an old patient to Simpson, in a letter which he treasured with pride--the writer was himself a medical man--"a patient preparing for an operation was like a condemned criminal preparing for execution. He counted the days till the appointed day came. He counted the hours of that day till the appointed hour came. He listened for the echo in the street of the surgeon's carriage. He watched for his pull at the door bell; for his foot on the stair; for his step in the room; for the production of his dreaded instruments; for his few grave words, and his last preparations before beginning. And then he surrendered his liberty and, revolting at the necessity, submitted to be held or bound, and helplessly gave himself up to the cruel knife.". It was, indeed, a monstrous ogre this giant Pain, holding the poor weak human creature in its merciless clutches, which Simpson even in his youthful days bethought himself to attack. It is well that we who are the heirs, should know how Simpson and those others whose names are ever associated with his, slew the monster, won the victory, and championed the human race forward into a land where further victories undreamt of by themselves are now being daily won. Simpson searched into ancient history in order to ascertain the methods, if any, by which in remote and mediæval times surgeons sought to prevent the pain of operations. The most time-honoured method seems to have been by the internal administration of drugs, the chief one used being Indian hemp, which was well known in the East, and under one of its names _haschish_ gave origin to the term assassin (strictly eater of haschish). A certain Arab Sheikh got together a band of followers to whom he administered haschish, which produced in them its usual effect--beautiful dreams of a delightful paradise. He induced them to believe so thoroughly in his power to gain for them at death permanent entrance to this paradise that they obeyed all his ferocious and bloodthirsty behests. Thus these assassins became known as men obedient to their leader in any murderous enterprise. Indian hemp was, and still is, used as a luxury all over the East, as well as to annul pain, and was used by criminals doomed to torture or execution. Simpson thought the _nepenthe_ of Homer was a preparation of this drug; he also refers to the fact that Herodotus relates that the Massagetæ inhaled the vapour of burning hemp to produce intoxication and pleasurable excitement. Mandrake was used in a similar manner and for similar purposes as Indian hemp in the Middle Ages, but it fell into disuse on account of the fatal results that often followed. It is frequently referred to by Shakspeare both for its narcotic properties and for its fabulous power of uttering a scream when torn up by the roots, to hear which meant death or madness. Simpson cited also well-known passages from Shakspeare to prove that the practice of "locking up the spirits a time" was known to that poet. In later days the intoxication produced by alcohol was taken advantage of, and instances of its use have been known in quite recent years in the Colonies, where both a surgeon and chloroform were out of reach. No drug, however, was known to be of such value in producing anæsthesia as to be constantly used, and many trials were made of other means, notably that of compressing the nerves supplying the part to be operated upon, but this was found to be too painful in itself. The stupor produced by compressing the carotid arteries--a method taken advantage of by the ruffians known as garotters--was also put in practice for a time during the sixteenth and seventeenth centuries, but it was found too barbarous a method even for those days. Hypnotism was known to the Indians, Egyptians, and Persians at a very remote period, and may possibly have been used by them sometimes to produce anæsthesia for surgical purposes. Simpson was attracted by the words of the poet Middleton in his tragedy "Women, beware Women" (1617) where he says-- "I'll imitate the pities of old surgeons To this lost limb--who ere they show their art Cast me asleep, then cut the diseased part." When hypnotism made one of its periodic re-appearances in 1837, this time under the name of mesmerism, after that extraordinary exponent of its powers Mesmer, Simpson recognised in it a possible method for "casting the patient asleep" before operation and set to work to investigate its phenomena. A Frenchman named Du Potet, disheartened by the prejudice against mesmerism in his own country, came to London in 1837, and was fortunate enough to receive the support of Dr. John Elliotson, physician to University College Hospital. Elliotson's advocacy of the new practice was received with ridicule by the profession, and was treated with such scathing contempt by the _Lancet_ and other journals, that he was completely ruined. Simpson was very successful in his experiments with mesmerism, conducted on the lines suggested by Elliotson, but he recognised that, after all, it was not the agent for which he was seeking, and dropped his researches. He did not resume them even when Liston, a few years later, stimulated by the advocacy of the Manchester surgeon Braid, who met with a better reception than Elliotson, and by the relation of a long series of successful cases by a surgeon named Esdaile, in Calcutta, actually performed operations with success on patients brought under its influence. The first suggestion to produce anæsthesia by the _inhalation_ of drugs was made by Sir Humphry Davy in 1800. He discovered by experiment upon himself that the inhalation of _nitrous oxide_ gas--commonly known as a _laughing gas_--had the power of relieving toothache and other pains; he described the effect as that of "uneasiness being swallowed up for a few minutes by pleasures." Although he stopped short at this stage, and does not seem to have used the inhalation to produce actual loss of consciousness, he, nevertheless, forecast the future by suggesting that nitrous oxide might be used as an inhalation in the performance of surgical operations, in which "no great effusion of blood" took place. Some thirty years later Faraday pointed out that _ether_ had effects upon the nervous system when inhaled, similar to those of laughing-gas. These two drugs came to be inhaled more in jest than in earnest; more as an amusing scientific experiment for the sake of the pleasure-giving excitement they set up, than for the purpose Davy had suggested. Ether, it is true, was recommended even before Davy's day for the relief of the suffering in asthma, but until the fifth decade of the century no one had attempted to prevent suffering as inflicted by the surgeon or the dentist, by producing the state of unconsciousness brought about by the inhalation of such drugs as ether--a process now known to the world as anæsthesia. The persons who first made the bold experiments which resulted in the discovery of how to produce anæsthesia were Americans; and two men were prominently concerned in the discovery. Several others made isolated and successful efforts with both ether and nitrous oxide, but they lacked the confidence and the courage to make their success public and to persist in their experiments. Of these, Dr. Long, of Athens, Georgia, was one of the earliest; he is said to have successfully removed a tumour from a patient under the influence of ether in 1842, and in the Southern States he is regarded as the discoverer of anæsthesia. Dr. Jackson, of Boston--a scientific chemist--laid claim to the honour of the discovery after others had fought the fight and established the practice of anæsthesia. Neither of these men, for the reason already given, deserves the honour which is now universally attributed to their fellow-countrymen, Wells and Morton. Horace Wells was born at Hartford, Connecticut, in 1815, and was educated to the profession of dental surgeon. He gave much attention to the desire present in the minds of many men at that time to render dental operations painless. On December 10, 1844, he witnessed at a popular lecture the experiment of administering laughing-gas, and noticed that a Mr. Cooley, while still under the influence of the gas, struck and injured his limb against a bench without suffering pain. The idea at once occurred to Wells that here was the agent he was in search of, and the very next day he experimented upon himself. If it has ever been fortunate to have toothache it was so for Wells that day; he was troubled by an aching molar which was removed by a colleague named Rigg, whilst he was fully under the influence of nitrous oxide; and thus he began what he himself at once called on recovering consciousness, "a new era in tooth-pulling." He proceeded promptly to test the experiment upon others and with complete success; and then making his success known, he proceeded with his former pupil Morton to Boston, and gave a public demonstration of his method which unfortunately was so imperfectly carried out that he was laughed at for his pains and stigmatised an impostor. Wells himself stated that the failure was due to the premature withdrawal of the bag containing the gas, so that the patient was but partially under its influence when the tooth was extracted. Wells and Morton were ignominiously hissed by the crowd of practitioners and students gathered to see the operation. Wells never recovered from the disappointment and the illness which resulted, and although he was able to explain his discovery to the French Academy of Science in 1846, he unfortunately died insane in New York two years later. Undoubtedly he was the first to discover the practicability of nitrous oxide anæsthesia, and to proclaim the discovery with a discoverer's zeal. Although his career ended so sadly, his efforts had, nevertheless, inspired to greater endeavour his colleague Morton, who had not only been associated in his experiments, but had been deeply interested in the subject for many years. William Thomas Green Morton was born in 1819; his father was a farmer at Charlton, Massachusetts. He qualified as a dentist at Baltimore, and entered into successful practice at Boston. Fired with the same ambition as Wells, he made attempts to extract teeth painlessly with the assistance of drugs administered, or sometimes of hypnotism. In December, 1844, after Wells's failure with nitrous oxide gas, he wisely abandoned that agent and investigated another which promised better results. He experimented first with a drug known as _chloric ether_, but failing to get the desired effect, and at the suggestion of the aforementioned Dr. Jackson, he proceeded to investigate the effect of ordinary ether. The first experiments were made on animals, and were so encouraging that he believed he had at last found the desired agent, provided the effect on human beings corresponded with that upon dumb creatures. Boldly and heroically he made the necessary experiment upon himself, and on September 30, 1846, inhaled ether from a handkerchief while shut up in his room and seated in his own operating-chair. He speedily lost consciousness, and in seven or eight minutes awoke in possession of the greatest discovery that had ever been revealed to suffering humanity. We can picture the man gradually awakening in his chair first, to the consciousness of his surroundings and then to the consciousness of his great achievement; sitting with his physical frame excited by the influence of the drug which he had inhaled, and his soul stirred to its deepest depth by the expanding thought of the far-reaching effects of what he had done. "Twilight came on," he said, in subsequently relating the event. "The hour had long passed when it was usual for patients to call. I had just resolved to inhale the ether again and have a tooth extracted under its influence, when a feeble ring was heard at the door. Making a motion to one of my assistants who started to answer the bell, I hastened myself to the door, where I found a man with his face bound up, who seemed to be suffering extremely. 'Doctor,' said he, 'I have a dreadful tooth, but it is so sore I cannot summon courage to have it pulled; can't you mesmerise me?' I need not say that my heart bounded at this question, and that I found it difficult to control my feelings, but putting a great constraint upon myself I expressed my sympathy, and invited him to walk into the office. I examined the tooth, and in the most encouraging manner told the poor sufferer that I had something better than mesmerism, by means of which I could take out his tooth, without giving him pain. He gladly consented, and saturating my handkerchief with ether I gave it to him to inhale. He became unconscious almost immediately. It was dark. Dr. Haydon held the lamp. My assistants were trembling with excitement, apprehending the usual prolonged scream from the patient, while I extracted the firmly-rooted bicuspid tooth. I was so much agitated that I came near throwing the instrument out of the window. But now came a terrible reaction. The wrenching of the tooth had failed to rouse him in the slightest degree; he remained still and motionless as if already in the embrace of death. The terrible thought flashed through my mind that he might be dead--that in my zeal to test my new theory, I might have gone too far, and sacrificed a human life. I trembled under the sense of my responsibility to my Maker, and to my fellowmen. I seized a glass of water and dashed it in the man's face. The result proved most happy. He recovered in a minute, and knew nothing of what had occurred. Seeing us all stand around he appeared bewildered. I instantly, in as calm a tone as I could command, asked, 'Are you ready to have your tooth extracted?' 'Yes,' he answered, in a hesitating voice. 'It is all over,' I said, pointing to a decayed tooth on the floor. 'No,' he shouted, leaping from his chair. The name of the man who thus for the first time underwent an operation under anæsthesia induced by ether was Eben Frost." The nature of the agent used by Morton was kept secret only a short period; the steps he took to bring his discovery before the medical profession would have rendered it difficult if not impossible, even if ether had not a penetrating tell-tale odour. Morton laid his method before one of the surgical staff of the Massachusetts General Hospital, Boston, the same institution where Wells's ill-managed demonstration had taken place two years before; he requested, with complete confidence, to be allowed to exhibit the powers of his agent. The surgeon was sceptical, but wisely consented, after having satisfied himself that there was no risk to life. A patient suffering from a tumour was chosen, and readily consented to act as a subject for demonstration. A large crowd of professional men and students assembled in the surgical theatre on the morning of October 16, 1846, the day chosen for the trial. The senior hospital surgeon, Dr. J. Collins Warren, was to perform the operation. The spectators, many of whom no doubt recollected the failure with laughing-gas, were disposed to deride when the appointed hour passed and Morton did not appear; but the delay was due only to the desire of the dentist to bring a proper inhaler, and although the crowd received him with a chilling reserve, and the occasion was one fit to try the nerve of the strongest, Morton did not lose his presence of mind. He promptly anæsthetised the patient, and as unconcernedly as does the modern administrator, nodded to the surgeon that the patient was ready. From the first moment that the knife touched the patient, until the operation was concluded, no sound, no movement indicated that he was suffering. The men who had scoffed once and had come, even the surgeon himself, prepared to scoff again, realised the success and the wonder of it, and remained to admire. "Gentlemen, this is no humbug," exclaimed Dr. Warren, as he finished his handiwork. When the patient recovered he was questioned again and again, but stoutly maintained that he had felt no pain--absolutely none. "Gilbert Abbott, aged twenty, painter, single," was the description of the man on whom was performed the first surgical operation under the influence of ether. News of the great success rapidly spread, and the experiment was repeated by Morton and others in America, and similar work was taken up throughout Europe. It cannot be said that Morton derived much benefit from his discovery. Although the greatness of it was recognised in his lifetime, and he received several honours and presents, he entered into prolonged squabbles concerning the discovery which worried him into a state of ill-health, ending in his death in 1868. A monument was erected over his grave by the citizens of Boston, bearing the following concise description of his achievement:-- "WILLIAM T. G. MORTON, "Inventor and revealer of anæsthetic inhalation, By whom pain in surgery was averted and annulled; Before whom in all time surgery was agony, Since whom Science has control of Pain." Whilst the discoverer of nitrous-oxide anæsthesia was dying from chagrin and inaction, and the revealer of anæsthetic inhalation by ether was wasting time in unworthy disputes concerning priority, and fruitless endeavours to gain pecuniary reward, a bolder than either had taken up the work where they had left it, with the high object of pursuing it until he had for ever established the benefit to humanity which he recognised in it. He went straight forwards and onwards, strong in his endeavour; undeterred by the jeers of the ignorant, the opposition of the prejudiced or the attacks of the jealous, with no thought of or wish for reward except that which was to come daily from the depth of sufferers' hearts. During the Christmas holidays of 1846 Simpson was in London, and discussed the new discovery with Liston, who was one of the first to operate under ether in Great Britain at University College Hospital. The great surgeon thought that the chief application of the process would be in the practice of rapidly operating surgeons; it was at first generally believed that the inhalation could be borne for only a brief period. Simpson speedily showed that no evil resulted if the patient remained under the influence of the vapour for hours. In the month of January, 1847, he gained for the Edinburgh Medical School the proud honour of being the scene of the first use of anæsthetics in obstetric practice. In March of the same year he published a record of cases of parturition in which he had used ether with success; and had a large number of copies of his paper printed and distributed far and wide at home and abroad, so eager was he to popularise amongst the members of his profession the revolutionary practice which he introduced. From the day on which he first used ether in midwifery until the end of his career he constantly used anæsthetics in his practice. He quickly perceived, however, the short-comings of ether, and having satisfied himself that they were unavoidable, he set about his next great step, namely, to discover some substance possessing the advantages without the disadvantages of ether. In the midst of his now immense daily work he gave all his spare time, often only the midnight hours, to testing upon himself the effect of numerous drugs. With the same courage that had filled Morton he sat down alone, or with Dr. George Keith and Dr. Matthews Duncan, his assistants, to inhale substance after substance, often to the real alarm of the household at 52, Queen Street. Appeal was made to scientific chemists to provide drugs hitherto known only as curiosities of the laboratory, and for others that their special knowledge might be able to suggest. The experiments usually took place in the dining-room in the quiet of the evening or the dead of night. The enthusiasts sat at the table and inhaled the particular substance under trial from tumblers or saucers; but the summer of 1847 passed away, and the autumn was commenced before he succeeded in finding any substance which at all fulfilled his requirements. All this time he was battling for anæsthesia, which, particularly in its application to midwifery, was meeting with what appears now as an astonishing amount of opposition, on varying grounds from all sorts and conditions of persons; but the vigour and power of his advocacy and defence of the practice in the days when laughing-gas and ether were the only known agents, were as nothing to that which he exerted after his own discovery at the end of 1847. The suggestion to try chloroform first came from a Mr. Waldie, a native of Linlithgowshire, settled in Liverpool as a chemist. It was a "curious liquid," discovered and described in 1831 by two chemists, Soubeiran and Liebig, simultaneously but independently. In 1835 its chemical composition was first accurately ascertained by Dumas, the famous French chemist. Simpson was apparently not aware that early in 1847 another French chemist, Flourens, had drawn attention to the effect of chloroform upon animals, or he would probably have hastened to use it upon himself experimentally, instead of putting away the first specimen obtained as unlikely; it was heavy and not volatile looking, and less attractive to him than other substances. How it finally came to be tried is best described in the words of Simpson's colleague and neighbour, Professor Miller, who used to look in every morning at nine o'clock to see how the enthusiasts had fared in the experiments of the previous evening. "Late one evening, it was the 4th of November, 1847, on returning home after a weary day's labour, Dr. Simpson with his two friends and assistants, Drs. Keith and Duncan, sat down to their somewhat hazardous work in Dr. Simpson's dining-room. Having inhaled several substances, but without much effect, it occurred to Dr. Simpson to try a ponderous material which he had formerly set aside on a lumber-table, and which on account of its great weight he had hitherto regarded as of no likelihood whatever; that happened to be a small bottle of chloroform. It was searched for and recovered from beneath a heap of waste paper. And with each tumbler newly charged, the inhalers resumed their vocation. Immediately an unwonted hilarity seized the party--they became brighteyed, very happy, and very loquacious--expatiating on the delicious aroma of the new fluid. The conversation was of unusual intelligence, and quite charmed the listeners--some ladies of the family and a naval officer, brother-in-law of Dr. Simpson. But suddenly there was a talk of sounds being heard like those of a cotton mill louder and louder; a moment more and then all was quiet--and then crash! On awakening Dr. Simpson's first perception was mental--'This is far stronger and better than ether,' said he to himself. His second was to note that he was prostrate on the floor, and that among the friends about him there was both confusion and alarm. Hearing a noise he turned round and saw Dr. Duncan beneath a chair--his jaw dropped, his eyes staring, his head bent half under him; quite unconscious, and snoring in a most determined and alarming manner. More noise still and much motion. And then his eyes overtook Dr. Keith's feet and legs making valorous attempts to overturn the supper table, or more probably to annihilate everything that was on it. By and by Dr. Simpson having regained his seat, Dr. Duncan having finished his uncomfortable and unrefreshing slumber, and Dr. Keith having come to an arrangement with the table and its contents, the _sederunt_ was resumed. Each expressed himself delighted with this new agent, and its inhalation was repeated many times that night--one of the ladies gallantly taking her place and turn at the table--until the supply of chloroform was fairly exhausted." The lady was Miss Petrie, a niece of Mrs. Simpson's; she folded her arms across her breast as she inhaled the vapour, and fell asleep crying, "I'm an angel! Oh, I'm an angel"! The party sat discussing their sensations, and the merits of the substance long after it was finished; they were unanimous in considering that at last something had been found to surpass ether. The following morning a manufacturing chemist was pressed into service, and had to burn the midnight oil to meet Simpson's demand for the new substance. So great was Simpson's midwifery practice that he was able to make immediate trial of chloroform, and on November 10th he read a paper to the Medico-Chirurgical Society, describing the nature of his agent, and narrating cases in which he had already successfully used it. "I have never had the pleasure," he said, "of watching over a series of better and more rapid recoveries; nor once witnessed any disagreeable results follow to either mother or child; whilst I have now seen an immense amount of maternal pain and agony saved by its employment. And I most conscientiously believe that the proud mission of the physician is distinctly twofold--namely to alleviate human suffering as well as preserve human life." In a postscript to the same paper he states on November 15th that he had already administered chloroform to about fifty individuals without the slightest bad result, and gives an account of the first surgical cases in which he gave the agent to patients of his friends, Professor Miller and Dr. Duncan, in the Edinburgh Royal Infirmary. "A great collection," he says, "of professional gentlemen and students witnessed the results, and amongst them Professor Dumas, of Paris, the chemist who first ascertained and established the chemical composition of chloroform. He happened to be passing through Edinburgh, and was in no small degree rejoiced to witness the wonderful physiological effects of a substance with whose chemical history his own name was so intimately connected." Four thousand copies of this paper were sold in a few days, and many thousands afterwards. It is worthy of mention that, according to a promise, Professor Miller had sent for Simpson a few days after the discovery to give chloroform to a patient on whom he was about to perform a major operation; Simpson, however, was unavoidably prevented from attending, and Miller began the operation without him--at the first cut of the knife the patient fainted and died. It is easy to imagine what a blow to Simpson, and to the cause of anæsthesia this would have been had it happened while the patient was under chloroform. Thus in little more than a year from the date of Morton's discovery of the powers of ether, Simpson had crowned the achievement by the discovery of the equally wonderful and beneficial powers of chloroform. Already he had made two satisfactory answers to the question he had early set himself--first, the application of anæsthesia to midwifery practice; and, second, the discovery of the properties of the more portable and manageable chloroform; the third, and perhaps the greatest, the defence of the practice, and the beating down of the powerful opposition to anæsthesia was yet required to render his reply complete. CHAPTER VII THE FIGHT FOR ANÆSTHESIA. 1847 ONWARDS His faith in chloroform--Confused public opinion on the subject--Personal attacks--Opposition on professional grounds--His reply--Opposition on moral grounds--His reply--Opposition on religious grounds--His reply--Her Majesty the Queen anæsthetised--Indiscrete supporters--The Edinburgh teaching of anæsthesia administration--The far-reaching effects of the successful introduction of anæsthesia. Professor Simpson firmly believed that he possessed now in chloroform an anæsthetic agent "more portable, more manageable and powerful, more agreeable to inhale, and less exciting" than ether, and one giving him "greater control and command over the superinduction of the anæsthetic state." Fortified by this belief, full of facts relating to the subject, and fired with zeal and enthusiasm, he was prepared to meet the opposition which from his knowledge of human nature he must have anticipated. So bravely and so emphatically did he champion the cause that he became identified with it in the public mind. The revelation of anæsthesia, the discovery of chloroform, and the application of anæsthetics to surgery as well as to midwifery were attributed to him by all classes of the community, not even excepting many of his own profession. Chloroform was spoken of as if ether had never existed; and chloroform and chloroforming displaced the terms anæsthetic and anæsthetising in ordinary talk--such unwieldy terms were naturally abandoned when there was the excuse that chloroform was universally considered the best substance of its class. Simpson made no attempt as Morton had done to patent his discovery under a fanciful name for his own pecuniary profit; but widely spread abroad every particle of knowledge concerning it that he possessed, so that every practitioner was forthwith enabled to avail himself thereof for the benefit of his patients. Partly owing to his own enthusiasm and his strong belief in the superiority of chloroform over ether, and partly owing to the confusion prevailing in general circles as to the history of anæsthesia, no small number of attacks were directed against Simpson personally by those who either were jealous of his achievements, or who considered that the part taken by themselves or their friends in the establishment of this new era in medical science had been slighted or overlooked. Simpson took all these as part of the fight into which he had entered. His nature was not sensitive to such personal attacks; he replied to them, cast them off, and went on his way unaffected. He handled some of these opponents somewhat severely when they accused him of encouraging the public belief in him as the discoverer of anæsthesia. It is clear to us to-day after anæsthesia has been on its trial for fifty years that Simpson magnified the superiority of chloroform over ether, and was led by that feeling to look on the history of ether as but a stage in the history of the greater chloroform. He regarded chloroform as the only anæsthetic; his utterances betrayed this feeling, and offence was naturally taken by the introducers and advocates of ether. His opinion of chloroform was shared by the leading European surgeons to such an extent in his day that shortly after his death Professor Gusserow, of Berlin, stated that with a few exceptions almost all over the earth nothing else was used to produce anæsthesia but chloroform. The real fight for anæsthesia was against those who found in the practice something which ran contrary to their beliefs or principles. There were first those who objected on purely _medical_ grounds; secondly, those who took exception to it from a _moral_ point of view; and thirdly, those who found their _religious_ convictions seriously offended by the new practice. The _medical_ opponents were, perhaps, the most powerful; certainly it was they who had first to be won over, for without the support of the profession the cause was in danger. It was urged first of all that the use of anæsthetics would increase the mortality, then very great, of surgical operations, and those who took their stand upon this ground were men who had at first denied the possibility of making operations painless, and had been driven to abandon that opinion only by a clear demonstration of the fact. To meet this form of opposition he instituted a laborious and extensive statistical investigation in order to compare the results obtained in hospitals where anæsthetics were used with those where the operations were performed on patients in the waking state. He took care that the reports dealt with the same operations under, as nearly as possible, similar conditions in each case. He obtained returns from close upon fifty hospitals in London, Edinburgh, Dublin, and various provincial towns. One of the most fatal operations in those days, and one dreaded by patient and surgeon alike, was amputation of the thigh. In 1845 Professor Syme said that the stern evidence of hospital statistics showed that the average frequency of death after that operation was not less than 60 to 70 per cent., or above one in every two operated upon. Simpson fearlessly collated statistics of this operation amongst the others, and proved that when performed under anæsthetics amputation of the thigh had its mortality reduced to 25 per cent. His figures were as follows:-- TABLE OF THE MORTALITY OF AMPUTATIONS OF THE THIGH. Reporter. Cases. Deaths. % of Deaths. Not anæsthetised. Parisian hospitals--Malgaigne 201 126 62 in 100 Edinburgh " --Peacock 43 21 49 " General collection--Phillips 987 435 44 " Glasgow hospitals --Lawrie 127 46 36 " British " --Simpson 284 107 38 " Cases on patients in an anæsthetised state 145 37 25 " He pointed to the above table as a proof that far from increasing the mortality of this operation the introduction of anæsthetics had already led to a saving of from eleven to twenty lives out of every hundred cases. He acknowledged that the number of cases he had collected (145) was somewhat small from a statistical point of view; but he confidently asserted that future figures would show greater triumphs. The tables of other operations showed similar results, and he entered exhaustively into the subject in a paper published in 1848. The paper was entitled, "Does Anæsthesia increase or decrease the mortality attendant upon surgical operations?" According to his wont, he headed it with a quotation from Shakspeare: "Why doest thou whet thy knife so earnestly? ... Shylock must be merciful. On what compulsion must I? Tell me that!" Victorious in this encounter, he turned to those who urged that anæsthetics were responsible for various kinds of ills such as a tendency to hæmorrhage, convulsions, paralysis, pneumonia, and various kinds of inflammatory mischief as well as mental derangement. He combated these contentions until the end of his career; and not only proved that the objections were visionary, but showed that for one of the alleged evils formerly often seen after operations, viz., convulsions, chloroform, far from being a cause, was one of our most powerful remedies. But the professional opponents of anæsthesia were most emphatic in the denunciation of its use in midwifery. Pain in the process of parturition was, they said, "a desirable, salutary, and conservative manifestation of life-force": neither its violence nor its continuance was productive of injury to the constitution. Strong opposition on these grounds came from the Dublin School, and with characteristic boldness Simpson turned to the statistics of their own lying-in hospital to prove his contention that to abolish parturient pain was to diminish the peril of the process. Again the statistics stood him in good stead; he flourished them triumphantly before his opponents, and proceeded to deal with those who asserted that the use of anæsthetics was accompanied by danger to life. He pointed out that, although unquestionably there were some dangers connected therewith, they were insignificant compared with the dangers in both surgery and midwifery which their use averted. Pain itself was a danger; shock in surgery was responsible for many untimely deaths upon the operating table; by preventing these chloroform saved countless lives. His arguments were characterised by painstaking thoroughness and evidenced wide reading. In addressing Professor Meigs, of Philadelphia, he said:-- "First, I do believe that if improperly and incautiously given, and in some rare idiosyncrasies, ether and chloroform may prove injurious or even fatal--just as opium, calomel, and every other powerful remedy and strong drug will occasionally do. Drinking cold water itself will sometimes produce death. 'It is well known,' says Dr. Taylor, in his excellent work on Medical Jurisprudence, 'that there are _many_ cases on record in which cold water, swallowed in large quantity and in an excited state of the system, has led to the destruction of life.' Should we therefore never allay our thirst with cold water? What would the disciples of Father Mathew say to this? But, secondly, you and others have very unnecessary and aggravated fears about the dangers of ether and chloroform, and in the course of experience you will find these fears to be, in a great measure, perfectly ideal and imaginary. But the same fears have, in the first instance, been conjured up against almost all other innovations in medicine and in the common luxuries of life. Cavendish, the secretary to Cardinal Wolsey, tells us in his life of that prelate, that when the cardinal was banished from London to York by his master--that regal Robespierre, Henry the Eighth--_many_ of the cardinal's servants refused to go such an enormous journey--'for they were loath to abandon their native country, their parents, wives, and children.' The journey which can _now_ be accomplished in six hours was considered then a perfect banishment.... In his Life of Lord Loughborough, John Lord Campbell tells us that when he (the biographer) first travelled from Edinburgh to London in the mail-coach the time had been reduced (from the former twelve or fourteen days) to three nights and two days; 'but,' he adds, 'this new and swift travelling from the Scots to the English capital was wonderful, and I was gravely advised to stop a day at York as several passengers who had gone through without stopping had died of apoplexy from the rapidity of the motion' ('Lives of the Lord Chancellors'). Be assured that many of the cases of apoplexy, &c., &c., alleged to arise from ether and chloroform, have as veritable an etiology as this apoplexy from rapid locomotion, and that a few years hence they will stand in the same light in which we now look back upon the apoplexy from travelling ten miles an hour. And as to the supposed great moral and physical evils and injuries arising from the use of ether and chloroform, they will by and by, I believe, sound much in the same way as the supposed great moral and physical evils and injuries arising from using hackney coaches, which were seriously described by Taylor, the water-poet, two or three centuries ago when these coaches were introduced. Taylor warned his fellow-creatures to avoid them, otherwise 'they would find their bodies tossed, tumbled, rumbled, and jumbled' without mercy. 'The coach,' says he, 'is a close hypocrite, for it hath a cover for knavery; they (the passengers) are carried back to back in it like people surprised by pirates, and moreover it maketh men imitate sea-crabs in being drawn sideways, and altogether it is a dangerous carriage for the commonwealth.' Then he proceeds to call them 'hell-carts,' &c., and vents upon them a great deal of other abuse very much of the same kind and character as that lavished against anæsthetics in our own day." Following out the same line of reasoning he brought to the minds of medical opponents how the introducers of such useful drugs as mercury, antimony, and cinchona bark had met with now long-forgotten but stubborn opposition; and he reminded surgeons of the stern obstinacy with which the introduction of the ligature of arteries had been long objected to and the barbarous method of arresting bleeding with red-hot irons had been preferred. But in the history of the discovery and introduction of vaccination by Jenner he found a strong parallel; and he wrote a pregnant article to prove that mere opinion and prejudgments were not sufficient to settle the question of the propriety or impropriety of anæsthetic agents, illustrating it from the story of vaccination. The result of vaccination had been to save during the half century since its introduction a number of lives in England alone equal to the whole existing population of Wales; and in Europe during the same period it had preserved a number of lives greater than the whole existing population of Great Britain. And yet Jenner, when he first announced his discovery, had encountered the most determined opposition on the part of many of his professional brethren, who ridiculed and bitterly denounced both him and his discovery; whilst ignorant laymen announced that smallpox was ordained by heaven and vaccination was a daring and profane violation of holy religion. He pointed out that these objections had been slowly and surely crushed out of existence by accumulated facts, and predicted that the ultimate decision concerning anæsthesia would come to be based, not upon impressions, opinions, and prejudices, but upon the evidence of "a sufficient body of accurate and well-ascertained facts." To these facts, as has been indicated, he subsequently successfully appealed. Those who objected to anæsthesia on _moral_ grounds directed their attacks chiefly against its use in midwifery. They not only condemned that application as iniquitous, but went the length of asserting that the birth of past myriads without it proved how unnecessary it was, and that Nature conducted the whole process of birth unaided in a greatly superior manner. The pains associated with parturition were actually beneficial, they said. Simpson answered this by showing that the proper use of anæsthetics shortened parturition, and by diminishing the amount of pain led to more rapid and more perfect recoveries. The leading exponent of the Dublin School of Midwifery at that time foolishly wrote that he did not think any one in Dublin had as yet used anæesthetics in midwifery; that the feeling was very strong against its use in ordinary cases, merely to avert the ordinary amount of pain, which the Almighty had seen fit--and most wisely, no doubt--to allot to natural labour; and in this feeling he (the writer) most heartily concurred. Simpson's private comment on this remarkable epistle at once showed his opinion of it, and ridiculed the objection out of existence. He skilfully parodied the letter thus:--"I do not believe that any one in Dublin has as yet used a carriage in locomotion; the feeling is very strong against its use in ordinary progression, merely to avert the ordinary amount of fatigue which the Almighty has seen fit--and most wisely, no doubt--to allot to natural walking; and in this feeling I heartily and entirely concur." He twitted the surgeons who opposed him with their sudden discovery, now that anæsthetics were introduced, that there was something really beneficial in the pain and agony caused by their dreaded knife. Such a contention contraverted his cherished principle that the function of the medical man was not only to prolong life, but also to alleviate human sufferings. He quoted authorities of all times to show that pain had been always abhorred by physicians and surgeons, commencing with a reference to Galen's aphorism--"_Dolor dolentibus inutile est_" ("pain is useless to the pained"); citing Ambroise Paré, who said that pain ought to be assuaged because nothing so much dejected the powers of the patient; and, finally, reproducing the words of modern authors, who asserted that, far from being conducive to well-being, pain exhausted the principle of life, and in itself was frequently both dangerous and destructive. He brought forward a collection of cases where in former days patients had died on the operating-table, even before the surgeon had begun his work, so great was the influence of the mere fear of pain; and reminded those who attributed occasional deaths on the operating-table to the influence of the anæsthetic of the numerous cases in bygone days where death occurred whilst the surgeon was at work. He recalled also how the great surgeon of St. Thomas's Hospital, Cheselden, had abhorred the pain which he caused in the process of his work, and longed for some means for its prevention. "No one," said Cheselden, "ever endured more anxiety and sickness before an operation" than himself. Simpson did not forget to look at the subject from the patient's point of view, and reproduced the letter from an old patient, which has been already quoted (Chapter VI.). The soldier and sailor, brave unto heroism in facing the enemy, never fearing the death which stared them in the face in its most horrible form whilst answering the call of duty, would quail like children at the mere thought of submitting to the deliberate knife of the surgeon. Were quibbles about the efficacy of pain to stand in the way of the merciful prevention of such suffering by the process of anæsthetisation? Those who opposed him with this curious idea, that pain after all was beneficial, were some of them men of no mean standing in the profession. Gull, Bransby Cooper, and Nunn were amongst those whom he had to silence. After replying to their arguments _seriatim_ with all his polemic power, he referred them once more to the evidence of facts and of facts alone as set forth by his statistics. Had he lived but a twelvemonth longer than he did he would have been able to conjure up a picture of the incalculable amount of suffering prevented by the eighteen hundred pounds of chloroform which were forwarded to the rival armies from one firm of chemists alone during the Franco-Prussian war; happily for the wounded within and around Paris, there was then no longer any doubt as to the propriety of employing anæsthetics. The _religious_ objections to the use of anæsthetics could scarcely be met with statistics. Foolish as they now appear to us after the lapse of time, and with the practice they attempted to repel universally adopted, they were nevertheless urged in good faith by clergy and laity of various denominations. The same kind of bigotry had met the introduction of vaccination, and Simpson himself remembered how many people had opposed the emancipation of the negroes on the ground that they were the lineal descendants of Ham, of whom it was said "a servant of servants shall he be unto his brethren." Sir Walter Scott reminds us, in "Old Mortality," of the spirit which met the introduction of fanners to separate the chaff from the corn, which displaced the ancient method of tossing the corn in the air upon broad shovels. Headrigg reproved Lady Bellenden for allowing the new process to be used on her farm, "thus impiously thwarting the will of Divine Providence by raising a wind for your leddyship's ain particular use by human art, instead of soliciting it by prayer or waiting patiently for whatever dispensation of wind Providence was pleased to send upon the sheeling hill." To-day in South Africa the same spirit is seen. Honest countryfolk of European descent are earnestly counselled by their spiritual advisers to submit patiently to the plague of locusts on the ground that it comes as a punishment from Providence. These worthy men stolidly witness their cornfields and their grass lands being eaten bare before their eyes in a few hours, whilst their more enlightened neighbours, brought up in another faith, resort with success to all sorts of artifices to ward off the destructive little invaders. It is pleasant to be able to record that Dr. Chalmers, one of the heroes of Scots religious history, not only countenanced chloroform by witnessing operations performed under it in the Royal Infirmary, but when requested to deal in a magazine article with the theological aspect of anæesthesia refused on the ground that the question had no theological aspect, and advised Simpson and his friends to take no heed of the "small theologians" who advocated such views. This was futile advice to give to one of Professor Simpson's controversial propensities; he entered with keen enjoyment into the fray with these "religious" opponents. His famous pamphlet, entitled, "Answer to the Religious Objections advanced against the employment of Anæesthetic Agents in Midwifery and Surgery," fought his enemies with their own weapons by appealing with consummate skill to Scripture for authority for the practice. The paper was headed with two scriptural verses:--"For every creature of God is good, and nothing to be refused if it be received with thanksgiving" (1 Timothy iv. 4). "Therefore to him that knoweth to do good and doeth it not to him it is sin" (James iv. 17). The principal standpoint of the religious opponents was the primeval curse upon womanhood to be found in Genesis. Simpson swept the ground from under his opponents' feet by reference to and study of the original Hebrew text. The word translated--"sorrow" ("I will greatly multiply thy sorrow ... in sorrow shalt thou bring forth")--was the same as that rendered as "sorrow" in the curse applied to man ("in sorrow shalt thou eat of it all the days of thy life"). Not only did the Hebrew word thus translated sorrow really mean labour, toil, or physical exertion; but in other parts of the Bible an entirely different Hebrew word was used to express the actual pain incident to parturition. The contention, then, that sorrow in the curse meant pain was valueless. Chloroform relieved the real pain not referred to in the curse, whereas it had no effect upon the sorrow or physical exertion. If, however, the curse was to be taken literally in its application to woman as these persons averred, and granting for the moment that sorrow did mean pain, their position was entirely illogical. If one part of the curse was to be interpreted literally, so must be the other parts, and this would have a serious effect of a revolutionary nature upon man and the human race all over the face of the earth. Literally speaking, the curse condemned the farmer who pulled up his thorns and thistles, as well as the man who used horses or oxen, water-power, or steam-traction to perform the work by which he earned his bread; for was he not thereby saving the sweat of his face? Pushed further, the same argument rendered these contentions more absurd and untenable. Man was condemned to die--"dust thou art and unto dust thou shalt return." What right had the physician or surgeon to use his skill to prolong life, at the same time that he conscientiously abstained from the use of anæsthetics on the ground that they obviated pain sent by the Deity? Nay, more; sin itself was the result of the Fall; was not the Church herself erroneously labouring to turn mankind from sin? In a truer and more serious religious spirit he reminded his foolish opponents of the Christian dispensation, and pointed out how the employment of anæsthesia was in strict consonance with the glorious spirit thereof. Some persons broadly stated that the new process was unnatural; even these he condescended to answer. "How unnatural," exclaimed an Irish lady, "for you doctors in Edinburgh to take away the pains of your patients." "How unnatural," said he, "it is for you to have swam over from Ireland to Scotland against wind and tide in a steam-boat." A son of De Quincey in his graduation thesis humorously supported Professor Simpson. He argued that the unmarried woman who opposed anæsthetics on the ground that her sex was condemned by the curse to suffer pains, broke the command herself "in four several ways, according to the following tabular statement":-- "1. She has no conception. 2. She brings forth no children. 3. Her desire is not to her husband. 4. The husband does not rule over her." De Quincey himself supported his son in a letter appended to the thesis thus:--"If pain when carried to the stage which we call agony or intense struggle amongst vital functions brings with it some danger to life, then it will follow that knowingly to reject a means of mitigating or wholly cancelling the danger now that such means has been discovered and tested, travels on the road towards suicide. It is even worse than an ordinary movement in that direction, because it makes God an accomplice, through the Scriptures, in this suicidal movement, nay, the primal instigator to it, by means of a supposed curse interdicting the use of any means whatever (though revealed by Himself) for annulling that curse." But the Bible furnished Simpson with the most powerful argument of all in Genesis ii. 21, where it is written: "And the Lord God caused a deep sleep to fall upon Adam; and he slept; and He took one of his ribs and closed up the flesh instead thereof." He strengthened his position by explaining that the word rendered "deep sleep" might more correctly be translated "coma" or "lethargy." He had taken the full measure of his opponents when he answered them with this quotation; it was a reply characteristic of the man, and completely defeated these self-constituted theologians with their own weapons. They had attacked him as a man of science, and found that his knowledge of the Scriptures excelled their own. He did not fail to read these people a lesson, and point out the harm done to true religion by such conduct and arguments as theirs, reminding them that if God had willed pain to be irremovable no possible device of man could ever have removed it. Such was the great fight--the fight for anæsthesia--which Simpson fought and won. He was the one man who by his own individual effort established the practice of anæsthesia, while Morton has the honour of being the one man without whom anæsthesia might have remained unknown. Such was the opposition encountered, and such was the timidity of his professional brethren, that but for Simpson's courageous efforts it would have been the work of years to bring about what it was granted to him to accomplish in a brief period; if fear, ridicule, contempt, and bigotry had not perhaps sunk the new practice into oblivion. Of the hundreds who are daily mercifully brought under the influence of chloroform and ether, few are aware what they owe to Simpson, even if they know how great is the suffering which they are spared. Simpson felt that the victory was indeed complete when in April, 1853, he received a letter from Sir James Clark, physician in ordinary to Her Majesty, informing him that the Queen had been brought under the influence of chloroform, and had expressed herself as greatly pleased with the result. It was at the birth of the late Prince Leopold that Her Majesty set her subjects this judicious example. Much trouble to the cause was occasioned by enthusiasts who administered chloroform with more zeal than discretion, and without any study of the principles laid down by Simpson. As a result of imperfect trials, some persons went the length of saying that there were people whom it was impossible to anæsthetise at all, and others who could be only partially anæsthetised. Wrong methods of administration were used. Simpson patiently corrected these, and carefully instructed his students, so that the young graduates of Edinburgh University carried his teaching and practice into all parts of the world. Syme also took up the cause, and valuable work was done in London by Snow, and later by Clover. The teaching of Simpson and Syme led to such successful results that their methods are followed by the Edinburgh School to this day practically unaltered. So satisfactory an agent is chloroform in Edinburgh hands, that other anæsthetics are in that city but rarely called into requisition. All the world over it is the anæsthetic in which the general practitioner places his trust. Having seen what Simpson did for anæsthesia, we may briefly review what anæsthesia has done for humanity. That it has entirely abolished the pain attendant upon surgery is easily recognised by the profession and patients alike. The patient never begs for mercy nowadays; he dreads the anæsthetic more than the knife; he has no anxiety as to whether he will feel pain or not, but rather as to whether he will come round when the operation is over; happily after one experience he realises that his fears were unfounded, and, if need be, will submit cheerfully to a second administration. The horrors of the operating-room referred to in the preceding chapter were vanquished with the pain; the surgeon has no longer to steel himself for the task as formerly, to wear a stern aspect and adopt a harsh manner. The patient has no longer to be held down by assistants; instead of having to be dragged unwillingly to the operating-table--a daily occurrence sickening to the hearts of fellow-patients and students, while it served only to harden the surgeon and the experienced old nurse of those days--he will walk quietly to the room, or submit patiently to be carried there, and at a word from the surgeon prepare "... to storm The thick, sweet mystery of chloroform, The drunken dark, the little death-in-life." The operation is no longer a race against time; order, method, cleanliness, and silence prevail, where there was formerly disorder, bustle, confusion, dirt, and long-drawn shrieks. Nothing illustrates better the progress of surgery than a picture of the operating-room in the first decade placed beside that of an operating theatre in one of our leading hospitals in this the last decade of the nineteenth century. In the quiet of the patient, in the painlessness of the operation, in the calm deliberation of the operator, and the methodical order of all around him, in the respectful silence that prevails in the room so soon as the patient is laid on the table, we see the direct results of the introduction of anæsthetics. But there are other great, if less direct, results, each making its presence known to the professional spectator. By anæsthesia successful operations previously unheard of and unthought of were made possible after the principle of antiseptic surgery had been established; by anæsthesia experimental research, which has led to numerous beneficent results in practical surgery and medicine, was made possible. Its introduction is an achievement of which the Anglo-Saxon race may well be proud. Wells, Morton, and Simpson are its heroes. The United States has by far the greater share of the honour of its discovery; but to Scotland is due the glory which comes from the victorious fight. No event in surgery up to 1847 had had such far-reaching effects. Simpson himself looked forward to the discovery of some agent, better than both chloroform and ether; and it is still possible that there may be an even greater future in store for anæsthesia than was ever dreamt of in his philosophy. CHAPTER VIII HOME LIFE--CONTROVERSIES The foundations of his fame; Comparison with Boerhaave--Family letters--Home amusements--Affection for children--And for animals--Puck--Holidays--Wide area of practice--"The arrows of malignancy"--Squabbles--Homoeopathy--Mesmerism--Refuses to leave Edinburgh. Great as was Simpson's contemporary fame, the chief part of it had its origin in his indescribable personal power over his fellows, and in his inexhaustible energy. When to these was added the reputation won by the discovery of chloroform's anæsthetic properties, he stood not only as the most famous physician of his day, but also as a man marked out for posthumous fame. The personal characteristics of the man were speedily forgotten after his death, save by those who had been brought under their influence; the marked prominence given to Simpson and the "discovery of chloroform" in the numerous recent reviews of Queen Victoria's reign on the occasion of the Diamond Jubilee, indicates that it is by chloroform that Simpson will ever be remembered. His lasting reputation depends on this work, not upon the characteristics which made him famous in the judgment of his contemporaries. The only physician in comparatively modern times, whose reputation approached Simpson's in magnitude was Hermann Boerhaave (1668 to 1738), the Dutch physician, whose fame and influence during his own lifetime were immense. Boerhaave's leading characteristics greatly resembled Simpson's: he had an enormous capacity for acquiring information, and a wonderful facility for imparting instruction to others; his energy and industry were indefatigable, and his memory prodigious. He taught from separate chairs in Leyden the Theory of Medicine, the Practice of Medicine, Botany, Chemistry, and Clinical Medicine, and at the same time carried on his large practice. Patients of both sexes flocked to him from all quarters of the globe, and he is said to have accumulated from his practice a fortune of £200,000 in five and thirty years. Although his treatment and method were, according to our modern knowledge, unscientific, his success in practice was as great as Simpson's; it sprang from the same cause; a wonderful magnetic personal influence, which commanded confidence and faith, so that he succeeded with the same possibly quite simple means which were fruitless in the hands of others. In his day all Europe rang with Boerhaave's name. To-day he is practically unknown. His books are antiquated, and if known, are neglected by modern physicians. He achieved nothing of lasting benefit to humanity. His fate, at least so far as the public is concerned, would undoubtedly have been Simpson's, in spite of his obstetric and gynæcological work, had it not been for the discovery of chloroform. The increased fame and greatly increased professional income which followed the successful struggle for anæsthesia did not affect Simpson's homely characteristics. He found time in the midst of it all to enjoy the pleasures of home in the society of those he loved best, and of intimate friends. He took a keen delight in quite the smallest enjoyments of the home circle. A characteristic letter was written to his wife in the summer of 1849; she had gone with the children to the Isle of Man; he told her the great and small events of his daily life:-- "Delighted to hear from you that all were so well. Everything goes on nicely here. I have been looking out for a headache (but keep excellently well), for I have been working very busily, and scarcely with enough of sleep. Yesterday _beat_ (as Clark writes it) any day I ever yet saw in the house. Did not get out till half-past four, and the drawing-room actually filled beyond the number of chairs and seats! Have had a capital sleep, and got up to look at the ducks; but none laying this morning, so I write instead. To-day I have a fancy to run out to Bathgate, and I think I will.... Yesterday dined with Miller, and Williamson, the Duke of Buccleuch's huntsman, enlightened us about dogs. Miller and I go to Hamilton Palace on Saturday.... My ducks won't lay any more eggs, at which I feel very chagrined.... Two salmon came as presents last week. I gave one to Mrs. Bennet. We are beginning a new batch of examinations at the college. _Such_ a sleep as I had yesterday morning! I came home by the last Glasgow train, _very_ tired. Tom came to waken me at eight, but I snored so that he didn't. He called me at half-past nine. I don't think I had stirred from the moment I lay down. This morning I have been reading in bed since six. I did not rise till now (half-past seven), because there was no duck laying." In another letter written on the same occasion he says:-- "... Tell Davie I expect a letter from him. Say to Walter that yesterday Carlo jumped into the carriage after me and saw with me several patients. He usually mounted a chair at the side of each bed and looked in. But Mrs. S. gave him too much encouragement. He leaped into bed altogether and tramped upon a blister! which was very painful." It was his custom to keep open house at breakfast and luncheon time; but the evening meal was, as a rule, reserved so that he might see and enjoy his own family and intimates. He lived exceedingly plainly himself; he did not smoke; his drink was water: but he delighted in setting a goodly repast before his guests. He loved a romp with his children, and spared an occasional hour from the afternoon for that enjoyment. The same energy entered into his play that was seen in his work. A craze ran through fashionable circles in the fifties for _tableaux vivants_, and was taken up by the Simpson household. He entered with spirit into the new amusement, perhaps more keenly because he saw an opportunity of combining in such representations instruction with amusement. Historical personages and scenes were represented, as well as illustrations of poetry and fiction. With his infective enthusiasm he pressed poets and painters, grave and gay, into service, and there is a record of one highly successful entertainment at 52, Queen Street, in 1854, to which young and old alike were invited. On this occasion most of the scenes represented serious events in Scots history, but Simpson himself seems to have supplied a little comedy. Sandwiched between a scene of "Flora Macdonald watching Prince Charlie" and one of "Rebecca and Eleazar at the Well" came that of "The Babes in the Wood." Simpson and a professional colleague disported themselves as the Babes, and appeared sucking oranges and dressed as children--short dresses, pinafores, frilled drawers, white socks, and children's shoes. They wandered about a while, and then lay weeping down to die to an accompaniment of roars of laughter and to the great delight of the juveniles. It is but a small incident to chronicle, but it shows in his home life the great physician who was beloved by thousands. His deep sympathies made him delight in the society of children. As years increased, and with them work became overwhelming and worries and troubles persistent, he appreciated more and more the refreshment of a frolic with his children. He echoed Longfellow's pure words:-- "Come to me, oh ye children, For I hear you at your play, And the questions that perplexed me Have vanished quite away. . . . . . . . . . . For what are all our contrivings, And the wisdom of our books, When compared with your caresses And the gladness of your looks." His affectionate disposition and kindly manner gained the devotion of his many child patients; and his own family bereavements made him a sympathetic physician and friend to many a sorrowing mother. There was no cant or affectation in his sympathy; it grew out of his large heart. Animals also he was fond of and gentle to, as we know from the history of the dogs who successively reigned in the household, so charmingly given to us by his daughter. One episode in the life of Puck, a black and tan terrier more intelligent than "breedy," deserves repetition. The dog had accompanied the Professor and some of his children into the country one afternoon on an expedition to dig for antiquarian relics. "After tea Puck, seeing every one carrying something to the station, demanded the honour of relieving his master of a _Lancet_, and went off with his small burden looking very important.... At the station the dog was missing. All got into their places but Puck. 'I will follow in the next train,' said the Professor; 'Puck is too dear a little friend to lose....' All he found of Puck was a muddy _Lancet_, and the last that had been seen of the old dog was that he was pushing his way through a crowd of idle colliers, where it was supposed his energies had been so engrossed in guarding the _Lancet_ that he had lost sight of his party.... His master stayed there until next morning, and some remembered afterwards how Puck's loss gave them another evening's talk with one they loved, though he broke in on the reminiscences with 'I wonder where little Puck is,' or 'Is that his bark?' No Puck came to demand entrance, and hope of his return was given up after three days passing without news of him. His master was thinking of the sorrowful letter he would have to write to Puck's companions when late one night, as he paced wearily up and down the room, he thought he heard a faint bark. There had been a great deal of listening of late for the little dog's bark; but it seemed vain to think of Puck's retracing his steps through an unknown country for so many miles. Still the Professor opened the door and called. Up the area steps something did limp into the hall. That it was Puck seemed doubtful at first, for he was quick and bright, and this animal was a lame ball of mud hardly able to crawl. The bright eyes, however, were Puck's; and he confirmed his identity by exerting his remaining energies to give one leap gratefully to kiss the friendly face that bent over him.... His truant play-fellows received a long letter from their father telling them of Puck's adventure and imagining Puck's feelings and trials through his long wanderings.... That letter always recalls Puck and his never-resting master bending over his desk, despite press of business, to send the news to Puck's companions." Simpson looked no further than his own nursery and circle of close friends for the refreshment and recreation which nature demanded in the course of his busy daily life. But holidays were necessary sometimes. He exhibited all the aversion of an enthusiastically busy man to leaving his work, but would yield sometimes to the solicitations of friends and would more readily leave his patients for a time if a prospect was held out of some interesting archæological research to be indulged in. In 1850 he suffered from an abscess, caused by blood-poisoning contracted during professional work. At the request of his friends Professor Syme was called in, somewhat to the chagrin of Simpson's old friend and colleague, Miller. It is interesting to note that in spite of the recent controversy on anæsthetics, Montgomery of Dublin, who had keenly opposed him, was amongst the first to write a sympathetic note on hearing of his illness; although dissenting from some of Simpson's professional utterances, Montgomery was influenced by the Professor's personality to respect him as a man and a worker. After this illness Simpson took a rapid run round the Continent, visiting those cities where anything professional was to be picked up. As he expressed it himself he "scampered" round the Universities, Museums, and Hospitals, seeing and hearing all that was to be seen and heard. He stowed away the newly acquired knowledge in the recesses of his mighty brain, and hastened on to the next place of interest before his companions had gained their breath sufficiently to regard with intelligent interest the objects he had already left behind. In Paris, on the occasion of one of his flying visits into a hospital, he was present at an operation, unknown to the surgeon, in which chloroform was used not only as a preventive of pain, but also for its remedial effect; after the operation the surgeon addressed his students upon the subject of chloroform, and Simpson had the pleasure of listening to a hearty eulogy of it. When, at the end, he handed in his card, the operator's delight was genuine and effusive, and the students enthusiastically appreciated the somewhat dramatic scene. On such occasions when he had to submit to the embraces of delighted foreign scientists, the exuberant manner in which they kissed him was not to his liking; even the remote strain of French blood in his own veins did not help him to enjoy the Continental mode of salutation. All over Europe his name was honoured and revered. It is said that when in later years an Edinburgh citizen was presented at the Court of Denmark the King remarked, "You come from Edinburgh? Ah! Sir Simpson was of Edinburgh!" The last trip to the Continent, indeed his last real holiday, was taken in 1868, when he ran over to Rome. So public was the life he led, such matters of interest to his fellow-countrymen were his comings and goings, that the _Scotsman_ newspaper chronicled his doings, relating the sights and places of interest which he visited, and noting that his professional services were taken advantage of by many Roman citizens during the few days that he was there; and that if time had permitted a public reception would have been given to him. In all his foreign trips his object was to learn, not to teach; he followed Sir Isaac Newton's advice to Ashton, and let his discourse be more in queries than in assertions or disputings. He took care neither to seem much wiser nor much more ignorant than his company. Sometimes feeling the need of rest himself he would take one or perhaps three days for a rapid run to the Lakes, or would spend another in the country unearthing some antiquarian object. It was always a pleasure to him to visit Bathgate, where his uncle and friend Alexander had latterly resigned the baker's business and taken up the _rôle_ of banker. One of his favourite resorts was a small house called Viewbank which he had taken, situated on the shores of the Firth of Forth. Here he was close to the fishing village of Newhaven; the fisher folks--the men and the picturesquely attired "fish-wives"--a sturdy and original set of people, were a great interest to him. They knew him well both as an occasional visitor and as the good physician. One of his letters written in 1856 gives an indication of the wide area over which his services were requisitioned and rendered. "_Sunday._ "I write this at Viewbank, which is very pretty this afternoon, but where I have not been for a week or more. This year I have not yet had one single holiday, and scarcely expect one now. I have had many long runs during the past few months. I have been often up in England, professionally, during the summer; once as far as Brighton seeing a consumptive case; once at Scarboro' where my wife went with me; once or twice in London where I saw the Queen; once at Ambleside. I long and weary for a _real_ jaunt without a sick patient lying at the end of it. And I had a great fancy to run from Manchester to Douglas and send all the patients far enough; I have been too hard worked to write, but I _must_ write one or two papers now. Queen Street has been a little hotel during the summer--always some sick lady or another sleeping in it, sometimes several at night." Even on these professional journeys he found time to examine objects of interest in the neighbourhood; or if he was unable to leave the immediate proximity of his patient, he brought pen and paper to the bedside and worked while he waited; thus he economised time as he advised his students always to do. It is doubtful if any one less great than Simpson would have ever been allowed to labour thus by a sufferer's bedside; indeed even he was not always permitted to do so. It is recorded that, at least, one lady rose hastily and seized his pen so that he was obliged to desist. The striking form with which Nature had endowed him, became more remarkable when affected by years, work, and domestic afflictions. Though of medium height his presence, even beside typically large-built and large-boned fellow-countrymen, was never insignificant. His features, overhung by his massive forehead, surrounded by the long and thick hair, spoke his character. Firm, concentrated mouth and piercing eyes, when his mind was fixed on a scientific or practical object. A soft, womanly tenderness about the lips, and a genial, sympathetic emotion in his deep-set eyes when aroused by an object of pity or pleasure. His hand was "broad and powerful, but the fingers were pointed and specially sensitive of touch." To see him was to see one of the sights of the modern Athens. His features are familiar to us to-day as one of the ring of brilliant, intellectual faces forming a frame to the picture of Queen Victoria in this the year of her Diamond Jubilee--a year of triumphant retrospection, unprecedented in the history of nations. It was impossible that a man holding Simpson's position, engaged in his work, and possessed of distinct fighting characteristics, should not make enemies. He could say, as Jenner said before him, "As for fame, what is it? A gilded butt for ever pierced by the arrows of malignancy. The name of John Hunter stamps this observation with the signature of truth." The arrows of malignancy did not hurt Simpson. He was very little, if at all, affected by them; but he paid, perhaps, more attention to them than we might have expected him to pay; certainly more than they deserved. His love of the fray led him oftentimes to answer what had better have been left unnoticed, and dragged him into prolonged, sometimes bitter, and, it is to be regretted, often unworthy, controversies. There was so much valuable work to be done, and his efforts were always so fruitful in result that we grudge the time spent in these squabbles; there arises an instinctive feeling that had he devoted the energy wasted in these contests to furthering some single branch of science, he would have made distinct advances therein. There was nothing superficial about his work; whatever the object it was thoroughly entered into; his writings convey to one a sense of the power he had of seeing all round and through a question, and of weighing and judging evidence. There was likewise no scamping in his mode of treating his opponents in these squabbles; he used his weapons fearlessly and administered many a trouncing to weak opponents. It was a time of upheaval in things medical. The microscope and stethoscope had been introduced into the science and practice of the healing art. Scientific experiment and research were beginning to lay the foundations of rational medicine and surgery. Edinburgh was in the front rank of modern progress, as she has ever been. Men like Simpson, Syme, Miller, Alison, and Christison, were not likely to lag behind. But, unfortunately, it was equally unlikely that such great minds could all think alike in matters concerning the principles of the science and art which they taught and practised. Thus it happened that the Edinburgh School became notorious for its internal quarrels, and in these Simpson was, as a rule, to be found busy. Quite apart from these professional differences were the disputes arising from attacks made upon Simpson by professional brethren and laymen, who accused him of wrong treatment or neglect of patients. His fame endowed him with almost superhuman powers in the minds of patients and their friends. When all other means had failed Simpson was hastened to as a last but sure resource; bitter the disappointment, bitter was the grief, and also sometimes bitter the things said of him when the anxious friends of a sufferer found that even Simpson's powers of healing were limited. These attacks were some of the "arrows of malignancy," which naturally fell about the over-busy man. He thought it necessary to stop, pick up these arrows, and challenge the assailants; we may regret that he stooped so often to this action, but we feel that it sprang as much from the love of truth and justice as from the dictates of a disposition inclined towards quarrel. It is impossible to pass over the great controversy which raged in Edinburgh about 1850 on the merits of homoeopathy, in which Simpson, of course, took a leading part. About the beginning of the century the practice of medicine by the apothecaries, as the general practitioners were then called, consisted in the most unscientific, nay, haphazard administration of drugs in large quantities and combinations. It was an age of drugging doctors, and the custom had become so thoroughly established that it is doubtful whether any less completely opposite system than that introduced by Hahnemann would have convinced the public that after all so many drugs were not required, nor such large quantities of them. Homoeopathic practice was founded on facts improperly interpreted, and laid down for general use a procedure that was applicable in only a limited number of cases. As Dr. Lauder Brunton has recently pointed out, it is in many instances only a method of faith-cure, and as such has its value. The success which its practitioners certainly obtained in many cases where the ordinary wholesale drugging of the day had proved futile, at once made men pause ere allowing their bodies to be made receptacles for the complicated preparations of the physician. In Edinburgh at this time the influence of homoeopathy had been felt. Alison, a physician of great renown, was to the end a pronounced polypharmacist, and was said scarcely ever to leave a patient without a new bottle or prescription. Graham, another university professor, was also a thorough-going old school therapeutist. On the other hand, Syme treated all medicine except rhubarb and soda with disdain; and Henderson, the professor of Pathology, and also a practising physician, after professing to consider no medicine of very much value, became a pronounced sceptic, and finally horrified his colleagues by making trials of homoeopathy, and gradually becoming enamoured of it until he confessed himself a full follower of Hahnemann's doctrines. Christison was leading the school which urged that the action of medicines should be studied experimentally if their administration was to be founded on scientific grounds. The behaviour of Henderson, who so greatly owed his position as professor to Simpson, stirred the wrath of the latter. He examined and condemned the irrational system of Hahnemann, and threw himself into an attitude of strong opposition. Syme and Christison ably seconded him in strong public action. Henderson was obliged to resign his chair owing to "loss of health." Homoeopathy was thoroughly crushed in Edinburgh. The contest between the old system of drugging with large complicated doses of powerful remedies, and the new one of giving on principle infinitesimal doses of the same medicines, served a good purpose. It gave an opportunity for establishing rational therapeutics, a science which is making daily progress, and in the presence of which neither the old system nor homoeopathy can stand. About this same period mesmerism was again coming to the front, this time cloaked as a science termed electro-biology. Simpson acknowledged that there was a great deal in mesmerism demanding scientific investigation; but with his reasoning powers he could not realise the existence of the mystically-termed higher phenomena of animal magnetism, _e.g._, lucidity, transference of the senses, and, above all, clairvoyance. It happened that a professional mesmerist gave a performance in Edinburgh; learning that the "professor's" daughter was stated to be able to read anything written on paper, or to divine any object enclosed in a sealed box while under her father's mesmeric power, Simpson attended the performance. He took with him a specially-prepared test--a sealed box with certain unknown contents; this he presented at a suitable opportunity. Against their own wishes, but on the insistence of the audience, the performers made an attempt by their methods to detect the nature of the contents of this test-box. They pronounced it to be money; on opening it millet seed was found, and a piece of paper, on which was written, "humbug." An accusation, couched in bitter terms, that Simpson was really a supporter of mesmerism as it was then known, was published in one of the leading professional journals in London. He indignantly repudiated the suggestion and proposed to settle the matter finally by a simple expedient. He offered to place five sealed boxes each containing a line from Shakspeare written by himself on paper, in the hands of the editor of the journal who had permitted the attack to appear in his columns. To any clairvoyant who read these lines according to the professed method, and to the satisfaction of a committee of eminent medical men, he promised the sum of five hundred pounds. The offer, however, was not accepted. The brilliant attainments of many of its teachers at this period not only placed the Edinburgh school at the head of the British schools of medicine, but also led to tempting offers being made to individual professors by rival schools anxious to secure their services. London was a much more lucrative field for practice than the Scots metropolis, and several of the most eminent Edinburgh men had from time to time yielded to the temptation to migrate southwards. Indeed, London as a medical school owes a great deal to the Scotsmen whom she imported. Liston had left for London in 1834, and Syme followed, for a brief period, on Liston's death. In 1848 a strong effort was made to secure Simpson as a lecturer on midwifery at St. Bartholomew's Hospital; without any hesitation he decided to remain in the city where he had fought his way to fame, and where he enjoyed popularity, and a practice sufficiently lucrative to satisfy the most ambitious man. Every patriotic Scot applauded the decision. During these years of fame and prosperity Simpson concerned himself in schemes for the improvement of the surroundings of the working classes, and helped with speech and purse those who worked among the poor. He strongly supported the establishment of improved dwellings for workpeople and gave much attention to the subject of Cottage Hospitals. He did not neglect the poor amongst whom he had laboured in his early days. He loved old Edinburgh, and the poor inhabitants of it were near his heart. "The Professor" was known in many a "wynd" and "stair," where his services were rendered willingly and without reward. CHAPTER IX ARCHÆOLOGY--PRACTICE His versatility--The Lycium of the Muses--The Catstane--Was the Roman Army provided with medical officers?--Weems--His lack of business method--Fees and no fees--Generosity often imposed upon--His unusual method of conducting private practice--The ten-pound note--Simpson and the hotel proprietors. Professor Simpson's versatility was remarkable. He turned from one subject to another and displayed a mastery over each; it was not merely the knowledge of principles which astonished but the intimate familiarity with details. He was able to discuss almost any subject in literature, science, politics, or theology with its leading exponent on equal terms. He had the power of patient listening as well as the gift of speech; more than that he had the ability to charm speech from others, of making each man reveal his inmost thoughts, betray his most cherished theories, or narrate his most stirring experiences; the most reticent man would not realise until he had left Simpson's presence, that in a brief interview, perhaps the first, he had told his greatest adventures, or laid bare his wildest aspirations before this student of mankind who was summarising his life and character as he spoke. Simpson built up his knowledge not so much from books as by the exercise of his highly developed faculty of observation aided by his memory. He enjoyed the study of his fellowmen and extracted all that was worth knowing from those with whom he came into contact. He never undertook work without a definite object in view, and rarely abandoned his task before that object was accomplished. Quite small researches would lead to considerable and unexpected labour. He preserved his scientific method, his desire to appeal only to the evidence of facts--not to other men's fancies--through his archæological work as well as in more professional lines of study. He laboured long and carefully over such an object as the study of old skulls dug up in antiquarian excursions; setting before himself the object of finding out by the condition and wear of the teeth what kind of food had been consumed by the owners, probably primeval inhabitants of some district. He impressed his methods upon those who worked for him or with him. We find him writing to his nephew, who was about to visit Egypt, telling him when there to gather information as to the suitability of the country for invalids, and directing him how to employ his leisure in furthering this object. He was to study German on the voyage thither, and to take with him as models Clarke's book on Climate and Mitchell's on Algiers, and any French or German books on the subject he might hear of. He would require to collect (1) The average daily temperature; (2) The hygrometric and barometric states daily; (3) The temperature of the Nile; (4) The temperature of any mineral springs; (5) The general character of the geology; (6) The general character of the botany of the country. He asked him to inquire specially as to the effect of the climate on consumption, and pointed out that Pliny described Egypt seventeen centuries ago as the best climate for phthisical patients. For amusement he was to take some good general book on Egypt and Egyptian hieroglyphics. The serious study of a succession of inquirers was to be the young man's holiday amusement! Simpson's most notable contributions to archæology were made when his time was most occupied professionally. The researches on Leprosy were first enlarged and improved. In 1852, when in the British Museum, his eye was attracted by a small leaden vase bearing a Greek inscription signifying the _Lycium of the Muses_. By a painstaking inquiry he established that this lycium was the _Lykion indikon_ of Dioscorides, drug used by ancient Greeks as an application to the eyes in various kinds of ophthalmia. It was obtained from India, and is still used for these purposes in that country. He discovered that there were three other examples of this ancient receptable for the valued eye-medicine in modern museums. He had correspondents in different parts of Scotland engaged in making researches into antiquities, which he encouraged and directed. Among such were inquiries into the whereabouts of a church said to possess holy earth brought from Rome; and a hunt for ancient cupping-vessels. The work on the Catstane of Kirkliston was elaborate, and a perfect example of his method. Probably this stone, a massive unhewn block of greenstone-trap, had been a familiar object to him in his youth, for it lay alone in a field close to the Linlithgow road. In his monograph he endeavoured to show by close reasoning, with profuse references to forgotten authorities and ancient history, that the stone was the tomb of one Vetta, the grandfather of Hengist and Horsa. His argument ran as follows: The surname Vetta, which figured on the inscription carved upon the stone, was the name of the grandfather of Hengist and Horsa, as given by the oldest genealogists, who described him as the son of Victa. The inscription ran thus: VETTA F(ilius) VICTI. Vetta was an uncommon Saxon name, and no other Vetta, son of Victa, was known in history. Two generations before Hengist and Horsa arrived in England a Saxon host was leagued with the Picts, Scots, and Attacots in fighting a Roman army, and these Saxons were probably commanded by an ancestor of Hengist and Horsa. The battlefield was situated between the two Roman walls, and consequently included the tract where the stone is now placed. The palæographic characters of the inscription indicated that it was carved about the end of the fourth century. Latin (with a very few exceptions in Greek) was the only language known to have been used at that time by Romanised Britons and foreign conquerors for the purpose of inscriptions. The occasional erection of monuments to Saxon leaders is proved by the fact mentioned by Bede that in his time, the eighth century, there stood in Kent a monument commemorating the death of Horsa. In 1659 a writer had described this tomb of Horsa as having been destroyed by "storms and tempests under the conduct of time." In 1861 Simpson was president of the Society of Antiquaries of Scotland, and delivered an address on the past and present work of archæology which greatly stimulated antiquarian study in his country. Amongst the honours which his antiquarian achievements brought upon him was that of being appointed Professor of Antiquities to the Royal Academy of Scotland; he was also elected a member of the Archæological Societies of Athens, Nassau, and Copenhagen. He made researches into the subjects of lake dwellings, primeval pottery, and burial urns. One of his most valuable writings was upon the subject, "Was the Roman Army provided with Medical Officers?" He answered the question in the affirmative after a laborious hunt amongst votive and mortuary tablets; no Roman historians had left clear indications of the existence of any army medical department. He found that several tablets were preserved bearing inscriptions referring to army surgeons, which suggested that although they were all known as _medicus_ there were degrees of rank amongst them, notably the _medicus legionis_ and the _medicus cohortis_. There is a well-preserved tablet in the Newcastle Museum found in that neighbourhood, commemorating a surgeon of the first Tungrian cohort, and one in Dresden, referring to a _medicus duplicatorius_, a term which indicates that the surgeon had been fortunate enough by his attainments to merit, and, we hope, receive double fees for his services. All his antiquarian study was looked upon by Simpson himself as no more than a relaxation. Fatigued by days and nights of anxious consecutive professional work, he would suddenly dash off for a day into some part of the country where he knew there was a likely "find," leaving patients and students to the care of his assistants. Here he would press into service and infect with his spirit all sorts of local worthies from the squire or laird down to the labourer, who woke up at his stimulation to find that what had been of no concern to them and their fathers before them--perhaps objects of vituperation or superstitious dread--were objects of keen delight and interest, and actually valuable to this astonishing man. Once on a professional visit to Fifeshire he quite casually discovered some remarkable though rough carvings in caves, representing various animals and curious emblems, and he was able to show that they presented features hitherto unnoticed. Fifeshire was famous for its underground dwellings, or, as they are locally called, "weems"--a term which gave origin to the title of the Earldom of Wemyss. After such an excursion he would return to Queen Street full of boyish spirits, eager to narrate his discoveries to interested friends, and refreshed ready to resume the daily round of work. Archæology was his hobby--the hobby on which he rode away for refreshment and relief from the monotony of his life's work; not only did the hobby constantly restore his flagging energies, but as it is given to few men to do, he put new life into his hobby whenever he bestrode it. In the conduct of his practice he was somewhat negligent. He was one of the old school in these matters; he trusted his head rather than paper, and his head had had such a careful self-imposed training since childhood that it was a good servant. But where the brain has such enormous duties to perform, those which appear to it unimportant must of necessity be comparatively neglected. Had he been more careful of pounds, shillings, and pence, he would have been more attentive to the details of practice. To Simpson, provided he had sufficient money for all his wants--and his wants were wide, for they included those of many others--pecuniary and business matters were of secondary consideration. In his student days he had lived carefully, accounting, as has been seen, for every trivial expenditure to those to whom he was indebted. But now he was free from the harassing necessity of exercising rigid economy, he cast aside the drudgery of business methods and disdained commercial considerations. He certainly received some very large fees, but the curious mixture of human beings who crowded his waiting-rooms were treated all alike whether they paid princely fees or no fee at all; lots were drawn daily for precedence, and they entered his presence according as they drew. His valet seems to have attained considerable skill in estimating the probable remunerative value of a roomful of waiting patients, and would grumble at night if on emptying the professor's pockets, as was his duty, the result fell short of his calculated anticipations. The man did not approve of the master's habit of giving gratuitous service. There were many who were never asked for a fee, and many others whose proffered guineas were refused. Simpson would not ask for money from those to whom he thought it was a struggle to pay him; the magnitude of his profit-yielding practice rendered this form of charity possible for him; from the really poor he always refused remuneration. His house was filled with all sorts of presents from patients, grateful for benefit conferred, grateful for generosity and consideration. He was also a free giver, and besides supporting orthodox charities made many gifts of goodly sums to persons who appeared to him to be in want, or who succeeded in impressing on him their need for help. He was imposed upon often enough; not seldom by pseudo-scientists full of some great discovery which a little more capital might enable them to complete. Once he corresponded with an enthusiast of this description who confessed that he had been breakfasting on a waistcoat, dining on a shirt, and supping on a pair of tough old leather boots, with the object of finding a solid substance, which combined with lead or tin would form gold--nothing more or less than the time-honoured philosopher's stone! To such a man Simpson gave freely not only once. To young students entering upon professional life with no other capital than their newly acquired qualifications to practice, he was ever generous. The Scots Universities sent forth many such youths, sturdy and independent, and with feelings that would be easily wounded by any attempt to patronise. But his gentleness, and the sympathy born of his own early experiences and shining in his eyes, made help from him something to be proud of. It could never be urged against Simpson that he was avaricious. Just as when honours were showered upon him he accepted them with less thought of the personal honour than of the appreciation of his friends and the public, and rejoiced that they were pleased; so he rejoiced in the acquisition of ample means chiefly because of the pleasure he might derive therefrom by helping others. His method of seeing patients was boldly haphazard; we learn with astonishment that he kept no list of his visits to be made, and started a day's round with only his prodigious memory to guide him as to where he should go. Such a method must have had the result that only cases of interest or urgency were seen. No doubt the able staff of assistants attended to the others, but these comprised not only sufferers from trivial complaints but those afflicted with imaginary ills who had come to see Simpson, not his assistant. Possibly they had already suffered many things of many physicians and were none the better. Such persons blamed Simpson with some reason. In the case of neurotic persons only was his method not reprehensible; continued attendance might have undone the benefit of the one application, if we may so term it, of his strong personality, which sometimes was all that was required, so superstitious was the reverence for his powers. A precise system of registration of engagements and visits ought certainly to have been adopted. We can sympathise with those who felt aggrieved that they could not obtain more attention from the great man, but it must be remembered that by his own method he saw a great number of difficult and dangerous cases, and was able to originate out of his wide and unprecedented experience, modes of treatment which are to-day valued highly and successfully made use of by his professional successors. He never wittingly left a fellow-creature's life in danger, but would hasten at all hours to cases of real urgency. As is usual where large numbers are striving after the same object some were highly careless in their communications with him. Fees were sent to him with a request for a receipt, but no address was given. Engagements were asked for by persons who neglected to say at what hotel they were staying; and others worried him for letters on quite trivial subjects. On one occasion, it is authentically related, a ten-pound note was forwarded to him by a man who might more reasonably have paid one hundred pounds. The note was somewhat carelessly not acknowledged, and the sender kept writing letters demanding an answer in increasing severity of tone. But he was left to rage in vain. A few nights later Simpson's sleep was disturbed by a rattling window; in the dark he rose and groped for a piece of paper wherewith to stuff the chink and stop the irritating noise. His only comment next morning when his wife, having removed the paper and discovered its nature came to him with it, was, "Oh! it's _that_ ten pounds!" There was a great want of method in all his arrangements, and Dr. Duns confesses to having had considerable difficulty in arranging Simpson's letters and papers, so carelessly were they kept. The leading hotels in the city benefited by Simpson's reputation. Patients and pilgrims filled their rooms long before tourists began to crowd Scotland as they do to-day. When Simpson was elected to the Chair of Midwifery loud complaints were uttered by the hotel proprietors. His predecessor, Professor Hamilton, had been a man of such wide reputation that they derived much profit from the patients sent in from the surrounding country to be attended by him. How could a young man like Simpson equal this? And yet when he died there was more than one hotel proprietor who could attribute no small measure of his own success to the patients and visitors who crowded not only from the country districts of Scotland but from the most remote parts of the British Empire, as well as from the great cities of Europe and America, to gain help or speech from or perhaps only to see this same Simpson. And his fame had reached the high point it ever after maintained when he was but a young man--before he was forty years of age. It was estimated that no less than eighty thousand pounds per annum was lost to the hotel, lodging, and boarding-house keepers of Edinburgh when he died. CHAPTER X PERSONAL--PROFESSORIAL--PROFESSIONAL His genius--Fertility of resource--Personal influence--Work in obstetrics and gynæcology and surgery--His lecturing and teaching--The healing of wounds--Acupressure--Hospitalism--Proposal to stamp out infectious diseases. Professor A. R. Simpson has said that his uncle Sir James Simpson's genius showed itself in his power of seeing things, in his power of adapting means to ends, and in his power of making others see what he had seen and do what he had done. We have seen these characteristics displayed in his work upon anæsthesia; it is literally true that he left no stone unturned to gain his end and to make others look upon anæsthesia in the same light as he regarded it. He declared all the while that if he found the opposition to the administration of chloroform in midwifery practice too powerful to conquer alone, he would finally overcome it by bringing about such a state of public opinion on the subject as would compel the profession to adopt his methods. Whether we regard Simpson as a physician or as a surgeon, as a gynæcologist or as an accoucheur, we find that his success was always due to the same causes. He possessed no secret remedies such as an ignorant and imaginative section of the public often credit to successful medical men. He performed no operations with which other surgeons were not equally familiar and equally capable of performing; indeed he frequently sent his surgical cases to operators in whose hands he considered they would be more skilfully treated than in his. In obstetrics and gynæcology his skill arose not only from his unrivalled experience, but also from his power of rapid diagnosis, and his promptness and boldness in treatment. His readiness in resource was unfailing. On one occasion, it is related, during an operation the bottle of chloroform was knocked over and its contents were spilled upon the carpet before the surgeon had completed his work; whilst his colleagues were wondering what was to be done or how a further supply of the anæsthetic could be obtained with sufficient speed, Simpson was on his knees hacking out with his knife the portion of carpet on which the chloroform had just fallen; and by means of this extemporised inhaler the operation proceeded uninterrupted to the end. He carried his distinguishing energy and thoroughness into every branch of his work; even in extempore speeches made at meetings of professional societies, he placed facts before his listeners in so convincing and lucid a manner out of the extensive variety of his knowledge, and aided by his great memory, that if he did not in reality gain the point he argued in favour of he generally appeared to do so. On such occasions too his imperturbable temper was a valuable weapon. There is no doubt that the genial professor availed himself fully of the unbounded confidence placed in him by his patients. Those of us who did not know him cannot appreciate what we have already said, that the charm of his personality was one of the greatest factors of his success in practice, and of his social success; there is the risk of the appearance of exaggeration in any description of this personal influence. The sympathy of his heart, a real sympathy, not a thin professional veneer, was made manifest by deed as well as word. It aroused in his patient, quite unconsciously to both, a feeling that this man, above all other men, understood his complaint; that he, the sufferer was the chief, if not the only object of his thought and care. It was said over and over again of him that his words and look did more good than all his physic, so able a wielder was he of that healing power which reaches the body through the mind. Those who knew him not, but falling sick hastened to Edinburgh to be healed by him, were oftentimes cured simply because they felt beforehand that he would cure them. They followed unconsciously the ancient command of the Talmud, where it says, "Honour your physician before you have need of him," and went to him full of respect and fired by faith. Wise men have striven through all ages to take advantage of this influence of the mind over the body, and the necessity of possessing a healthy mind if the body is also to be healthy. A striking proof of the antiquity of the thought has been recently furnished in a fashion that would have delighted Simpson. On a papyrus, dated A.D. 200, brought to light by Egyptian explorers, it is written that Christ said: "A prophet is not acceptable in his own country, neither doth a physician work cures upon them that know him." The advances which Simpson made in the science and practice of both midwifery and gynæcology were due to the magnitude of his experience and the readiness of his genius to profit by experience. His one thought being the relief of suffering and the prolongation of life, he approached the bedside as a man with less high aspirations would fail to do. He considered only the patient's interest, and gave his genius free play. He took midwifery and gynæcology by storm, and urged them on to great developments; he believed in observing, helping, or imitating nature rather than acting, as his predecessors had done, upon preconceived ideas which oftener than not ran contrary to nature's commands. He avoided meddlesomeness, and stepped in only as the ally of nature. He took numerous hints from bygone practitioners and writers, and developed them. To-day we are profiting by his teaching, and the instruments which he devised or perfected. To mention all his suggestions and all his contributions to the arts which he specially practised would here be obviously impossible as well as out of place; but to medical readers the mention of one instrument associated with his name, and known as _the sound_, will give a small indication of how much we are in his debt. The principle of this instrument had been known long before he took it in hand, but it was left for him to introduce it into practice, perfect it, and preach its value in diagnosis and treatment. So thorough was his work, so farseeing his science, that our knowledge of its utility has scarcely been added to since he first drew attention to it in 1843. Towards operative work his attitude was characteristically conscientious. We are told that he habitually put the following question to himself when contemplating a serious operation: "Am I conscientiously entitled to inflict deliberately upon my fellow-creature with my own hands the imminent and immediate chance of death for the problematic and prospective chance of his future improved health and prolonged life?" The fact that he habitually thus questioned himself is an evidence of the state of surgery at that time. Operations were undertaken only as a last resource to save life; the surgeon knew full well that he placed his patient in further peril merely by cutting through the skin, in a manner which has now happily become a thing of the past. His work was so pre-eminently practical that he never stopped to collect together his experiences into a scientific treatise. Although he revivified midwifery, and was one of the original founders of gynæcology, he left to aftercomers the labour of studying what he had done, and drawing the conclusions on which to strengthen the fabric of the science. His pamphlets, papers, and reports are very numerous. It would be wrong to say that modern thought has approved all that he wrote; but however much time and increased knowledge may have modified his teaching, they have not detracted from the value of his researches, discoveries, and suggestions, or from the stimulating influence of his work upon contemporary practice and thought. As a lecturer and teacher Simpson succeeded as in the other branches of his work. His brilliant exposition of his subjects and his careful practical manner of teaching his young listeners doubled the fame which had begun with his predecessor, Professor Hamilton, and has ever since belonged to the Edinburgh school of obstetricians. But here again his personal attractiveness and power gained for him the greater part of his success. In the words of the _Lancet_, written when reviewing a posthumous collection of some of his writings, his lectures used to brighten the gloomy days of the Edinburgh winter; in perusing the publication under review, Edinburgh men would "almost think they saw the big head and face of the great obstetrician, as they used to see him beaming with satisfaction or twinkling with genial humour as he told a good story, or related a happy case, illustrative of his own bold and original practice." Both as a lecturer and as a bedside teacher he captured his students by the charm of his diction, the wide range of his knowledge, and as Professor Gusserow has pointed out in his masterly memoir, by his peculiar talent of having his knowledge at his fingers' ends, and that often in very remote details. Year by year he never failed to obtain the affection of his students; scarcely a man that had been taught by him but would proudly boast that he was his friend as well as his teacher. He treated his large class in a confiding spirit--not as the superior person delivering _ex cathedrâ_ utterances, but as the friend rejoicing in his function of admitting those around him into the knowledge in which he seemed to revel. He had a happy method of getting on good terms with his audience before proceeding to the serious business of the lecture. When his health began to fail he was sometimes unwillingly laid aside, and the lectures were delivered by a substitute. On one occasion he re-appeared pale, weak, and lame, after such an enforced holiday, and was greeted enthusiastically by a crowded class. He told them that his servant had said to him that a rumour was abroad that he was in Morningside Asylum. He had asked what answer he had made, and heard that he had replied that so far from being wrong in his mind his master was writing a book in bed. While he did not say that this answer was strictly correct, he was happy to assure them, his pupils, that he was quite right in his mind, although a friend had hinted that morning that he was rather weak in his _understanding_! Old fellow-students meeting each other in after life as staid practitioners take pleasure in recalling the idiosyncrasies and peculiarities of their teachers; it is probable that no professor has ever been talked over with the appreciation which breathes through the reminiscences of Simpson conjured up by those whom he taught. Simpson left his mark in other departments besides those of the subject of his professorial chair and of anæsthesia. About ten years after the introduction of chloroform he turned his attention to the process of wound-healing--the repair of necessary wounds inflicted by surgeons in the course of their work--and although he was promptly told to go back to his midwifery, he worked persistently at the subject. In those days the subject was the most burning one in surgery and the methods employed to bring about successful results varied in different schools. The object of all methods was the same, viz., to obtain a healthy, clean, and sightly result after an operation; to leave the part which had been of necessity cut in a condition as nearly as possible approaching that in which it had been found, without the incidence of any of the too frequent grave complications. Surgeons did not recognise at first the power of nature to effect for them what they strove after; they thought to attain their object by compelling the tissues to heal as they desired by complicated applications, and many were the layers of ointments and masses of dressings heaped on wounds for this purpose. For a long time all efforts were directed to the discovery of some specific substance, the application of which would give the necessary impulse towards healing in the desired manner. Before Simpson's day it had been generally recognised that the cause--but its nature was quite undreamt of--of the trouble lay in the air surrounding the wound, and more dressings were piled on to keep out the air. But at the same time bleeding was arrested by tying the cut arteries with ligatures--chiefly silken--and these were left with long ends hanging out of the wound to work their way out by a process of ulceration, or irritation of the tissues until liberty was obtained. This process was practically incompatible with the ideal form of healing, known as healing by _first intention_, _i.e._, union without appreciable loss of substance or the formation of _pus_ or matter. So-called "surgical fever," secondary hæmorrhage, and blood-poisoning were the frequent fatal results of operation wounds treated in this manner. Simpson and others thought to prevent these alarming diseases by devising other means of closing the arteries; thinking that if some method or material were used, which nature resented less, the wound would more readily close by first intention. In 1858 Simpson stated that he had for some time past been experimenting with substitutes for the ordinary silk and thread ligatures, and in the course of his experiments had made use of iron, silver, and platinum wires. In his usual way he hunted up old authorities, and found a record of both silver and gold threads having been experimentally used by bygone practitioners. He seems to have been pleased with his results, stating that he found the tissues much more tolerant of these metallic ligatures than they were of the ordinary organic ones; that only "adhesive inflammation," not ulcerative suppurative inflammation, was excited. This success, however, was probably due to the superior cleanliness of the metal, but this he did not recognise; had he done so he might have been led to strive after surgical cleanliness, and have partly anticipated the great work done subsequently by others. He went off, however, on a different line, and searched for some readier method of using metallic means of closing the blood vessels, being stimulated by the desire to abolish ligatures altogether. Thus he was led, after ten years' careful research, to the introduction of a method entirely original--that of _Acupressure_. This consisted in the introduction of a fine needle through the tissues across the course of the artery, so that while the needle pressed upon one side of the artery the resisting tissues of the body exerted counter-pressure on the opposite side. He claimed for his method the merits of simplicity, elegance, and cleanliness, and urged that not only did the tissues tolerate the needle as they did not tolerate silk or hemp, but that unlike the ligature the needle could be withdrawn as soon as nature had closed the blood vessel by the process of coagulation of the blood within it set up by the pressure; thus the prolonged irritating presence of a body within the wound which delayed healing until it had ulcerated its way out was rendered unnecessary, and a better and more rapid result was attained. He verified his theoretical considerations by experiments on animals and in one or two operations on the human subject, and in 1859 read a communication on the subject to the Royal Society of Edinburgh. The paper was written under great pressure of work, indeed he stated that at that time he was hardly ever able to write except when himself "confined"; it was hastily prepared to take the place of that of another Fellow which had failed to be forthcoming a few days before the appointed meeting. It was composed at a country house where he had to sleep for two or three nights watching a case of diphtheria. It was headed as usual by a Shakspearian quotation, this time briefly in Justice Shallow's words, thus:--"Tut, a pin!" On the evening of its delivery an abstract of the paper was forwarded to the leading surgeons in England, Europe, and America, and diverse were the opinions expressed. In Scotland the new method met with the greatest favour and the strongest opposition at one and the same time. Throughout Europe and America it was everywhere received with applause and support. Excellent results were obtained when the method was properly applied, but technical considerations, particularly the difficulty of using it upon blood vessels far removed from the surface, rendered it unsuitable for universal application. Professor Syme met the innovation with vehement opposition; possibly he resented this intrusion of the gynæcologist into the regions of general surgery. He took into his class-room one pamphlet on the subject by Simpson, which had especially aroused his wrath; he stormed at the author before his students for "his vulgar insolence," and then, in a dramatic scene, expressed the violence of his contempt by savagely tearing the pamphlet into pieces and casting it away. In a subsequent controversy between these two old opponents, who had been temporarily united by Simpson's conduct in consulting Syme professionally, by their joint action against homoeopathy, and by Simpson's defence of Syme when publicly attacked by an English surgeon, the feud was renewed. Simpson persisted for years in collecting reports of operations in which acupressure was employed, and published them from time to time in the _British Medical Journal_ and elsewhere. In 1864 his work on the subject took the form of a volume containing 580 quarto pages. His friends endeavoured to rank acupressure with chloroform as one of the blessings to humanity made manifest by him. He himself recognised that he had failed to gain for acupressure a place in practice such as he had gained for chloroform, but he looked forward to a time, perhaps a quarter of a century distant, when his method would be beginning to be thought about. In this he was mistaken for, on the contrary, acupressure was beginning to be forgotten long before twenty-five years had elapsed. Another worker on more strictly scientific lines had by that time made healing by first intention, without complications, the rule instead of the exception, and conferred a benefit on humanity as great if not greater than that of anæsthesia. In 1867, while Simpson was still alive, Mr. (now Lord) Lister (then a hospital surgeon in Glasgow, and subsequently Syme's successor in Edinburgh) enunciated the new principle of "antiseptic surgery," which recognised the living infective micro-organisms of the air as the cause of the trouble in wounds. He directed that as these invisible organisms (known only by means of the microscope) were present everywhere in the air, found their way into all sorts of wounds, and set up the decomposition which led to disastrous results, they were to be destroyed or excluded from wounds; and he suggested effective means of accomplishing this end. He further abolished the long ligatures which irritated by their presence, and by the organisms they conveyed into the wound when imperfectly cleansed as they usually were; and substituted non-irritating ligatures which nature herself was able to remove by the process of absorption. The recognition of this antiseptic principle effected a much needed revolution in surgery, and in this revolution acupressure was practically annihilated. Simpson did not live long enough to see the complete establishment of the Listerian principle; at first he vigorously opposed what he considered to be an attempt to retain the old-fashioned ligatures in preference to his new acupressure; but with his penetrative eye he must have foreseen that should the new practice prevail and short absorbable ligatures be made possible, acupressure would be completely superseded. In the estimation of the writer of the obituary notice of Professor Simpson in the _British Medical Journal_, the greatest of all his works was that undertaken in the subject of Hospitalism. As early as 1847 he had been horrified to read in a report of the work done in the Edinburgh Infirmary, that out of eighteen cases of primary amputation performed during a period of four years only two survived. He faced this fact with the courage of the reformer, and sought far and near for other facts to support the theory which he gradually evolved, that this melancholy failure of surgeons to save their patients' lives was due not so much to the operation or the operator as to the environment of the patient. In later years he himself often shrank, on account of unfortunate experiences, from performing capital operations which he had formerly unhesitatingly undertaken. The unhealthiness of hospitals had long been recognised; and was especially observed at times when they were overcrowded, as happened during war time. When the public had thoroughly grasped the utility of anæsthetics, and recognised that operations could be performed painlessly, there were fewer refusals to submit to the knife; there was a rush to the hospitals, and the surgical wards throughout the length and breadth of the land became crowded with men and women actually longing for operation. Amongst these all the dreaded sequelæ of surgical interference, which no power seemed able to check, ravaged with alarming severity. It is to Simpson's credit that he perceived how the introduction of anæsthesia had taxed the hospitals and bewildered the operators, who sought diligently but unsuccessfully in every direction for some means of reducing hospital mortality. He was one of the first to set to work with method to investigate this question of Hospitalism. It was towards the end of his career, when the old Edinburgh Infirmary stood condemned, and various proposals for rebuilding it on a new site and improved plan were under discussion, that his voice was most loudly heard. For many years he had thought and taught that the great mortality after operations in hospitals was due to the impure state of the air therein, derived from the congregation of a large number of sick persons under one roof. He picturesquely stated that the man laid on a hospital operating table was exposed to more chances of death than the English soldier was on the field of Waterloo. His original suggestion was that hospitals might be changed from being crowded palaces, with a layer of sick on each floor, into villages or cottages, with one, or at most two, patients in each room; the building to be of iron, so that it could be periodically taken down and reconstructed, and presumably thoroughly renovated. This drastic proposal brings nowadays a smile to the lips, for we see now how he was groping in the dark; but the magnitude of it is but the shadow of the evil it was designed to cure. The change was so great as to be impracticable in the eyes of most men; he, on the other hand, contended that it was to be of incalculable benefit to humanity, and, therefore, no difficulty, however great, should be allowed to stand in the way. He did not understand that the evils arose not from the air itself but from what was in the air, known to us now as the micro-organisms. His remedy was a proposal to run away from the evils without receiving any guarantee that they could not and would not successfully pursue. Had Lister not arisen, Simpson's proposals might have possibly prevailed, for he laboured with all his persistent energy. The general belief of the profession--but it was no more than a belief--was that operations performed in country practice were not so frightfully fatal as those performed in town hospitals. This was Simpson's opinion, and he determined to test its truth by appeal to facts. He drew up a circular with a schedule for the insertion of results in a statistical form, and sent it far and wide amongst country practitioners. He awaited the result with anxious expectation; the circular asked for a plain statement of facts only, and for all he knew the facts might be against his theory; but they were not. From all over England and Scotland, particularly from mining districts, where severe operations after accidents were common, the filled-up schedules flowed in, to the number of 374. These were collected, carefully classified and summarised. The operations selected were amputations, and the result briefly was this:-- Total number of cases 2,098 } Mortality, " " deaths 226 } 10.8 per cent. The relative mortality of the different amputations was also shown:-- 669 Thigh cases; deaths, 123; mortality, 18.3 per cent. 618 Leg " ; " 82; " 13.2 " 433 Arm " ; " 19; " 4.3 " 378 Forearm " ; " 2; " 0.5 " The table on the next page compared the results of operations for injury with those performed for disease. FOR INJURY. Cases. Deaths. Mortality. per cent. Thigh 313 80 25.5 Leg 409 57 13.4 Arm 344 14 4.0 Forearm 313 2 0.6 FOR DISEASE. Cases. Deaths. Mortality. per cent. Thigh 356 43 12.0 Leg 209 25 12.0 Arm 89 5 5.6 Forearm 60 0 -- These statistics were accompanied by an exhaustive detailed examination and explanation; every possible point of attack was considered and protected. "I doubt not," he said, "that the segregation of the sick from the sick--every diseased man being a focus of more or less danger to the diseased around him--is a principle of no small moment and value." He attributed the comparative brilliancy of these statistical results to the _isolation_ of the patients only; he endeavoured to show that the operations were often performed amidst dirty and squalid surroundings, on dirty and squalid persons. He did not attribute sufficient importance to the fact urged by many of his correspondents, who supported his general contentions almost to a man out of their own experience, that where fresh air, ventilation, and cleanliness prevailed, the results were always the most satisfactory. The next step was to take hospital statistics of similar operations, and the general result appears in the table on page 183. This testimony to the truth of Simpson's opinion was more pronounced than even he himself had anticipated. "Shall this pitiless and deliberate sacrifice of human life to conditions which are more or less preventable be continued, or arrested? Do not these terrible figures plead eloquently and clamantly for a revision and reform of our existing hospital system?" This was his cry until at length breath failed him. The opposition was not strong, but the support was weak. Although there was much criticism, his conclusions were scarcely called in question at all; trifling holes were picked in his statistics, but his contentions were universally acknowledged to be correct; a few reformers only, persuaded as he was of the evils of hospitalism and working at the subject, lent him their advocacy. But he alone stood unperturbed at the extent of the evils and the magnitude of the change which he proposed in order to uproot them; death laid him low as he stood, but not before he had modified his proposals by suggesting that existing hospitals might be reconstructed, and new hospitals built on the now almost universally adopted pavilion system on which the new Edinburgh Royal Infirmary was one of the first to be built. Column Headings-- C: Cases. D: Deaths. _______________________________________________________________________ | | | | HOSPITAL. | FOR INJURY. | |_______________________|_______________________________________________| | | | | | | | | Thigh. | Leg. | Arm. | Forearm. | | |___________|___________|___________|___________| | | | | | | | | | | | | [C] | [D] | [C] | [D] | [C] | [D] | [C] | [D] | |_______________________|_____|_____|_____|_____|_____|_____|_____|_____| | | | | | | | | | | | Edinburgh Infirmary | 134 | 48 | 28 | 9 | 7 | 3 | 19 | 7 | | Glasgow " | 100 | 60 | 93 | 50 | 101 | 38 | 66 | 9 | | Nine London Hospitals | 320 | 123 | 173 | 53 | 48 | 13 | 37 | 7 | |_______________________|_____|_____|_____|_____|_____|_____|_____|_____| | | | | | | | | | | | Total | 631 | 239 | 283 | 89 | 78 | 22 | 75 | 15 | |_______________________|_____|_____|_____|_____|_____|_____|_____|_____| | | | | | | | Mortality per cent. | 64.4 | 54.8 | 40.1 | 14.8 | |_______________________|___________|___________|___________|___________| _______________________________________________________________________ | | | | HOSPITAL. | FOR DISEASE. | |_______________________|_______________________________________________| | | | | | | | | Thigh. | Leg. | Arm. | Forearm. | | |___________|___________|___________|___________| | | | | | | | | | | | | [C] | [D] | [C] | [D] | [C] | [D] | [C] | [D] | |_______________________|_____|_____|_____|_____|_____|_____|_____|_____| | | | | | | | | | | | Edinburgh Infirmary | 65 | 48 | 58 | 29 | 21 | 12 | 39 | 5 | | Glasgow " | 177 | 68 | 82 | 27 | 23 | 6 | 19 | 1 | | Nine London Hospitals | 139 | 88 | 179 | 102 | 97 | 33 | 64 | 11 | |_______________________|_____|_____|_____|_____|_____|_____|_____|_____| | | | | | | | | | | | Total | 304 | 196 | 330 | 181 | 219 | 88 | 169| 25 | |_______________________|_____|_____|_____|_____|_____|_____|_____|_____| | | | | | | | Mortality per cent. | 37.8 | 31.4 | 28.2 | 2.0 | |_______________________|___________|___________|___________|___________| The total number of cases 2,089 } mortality 41 per cent. The total number of deaths 855 } Placed side by side the Town (hospital only) and Country (private practice only) figures compared as follows:-- _Hospital_ cases 2,089; deaths 855; mortality 41 per cent. or 1 in 2.4 _Country_ " 2,098; " 226; " 10.8 " 1 in 9.2 The steady advance of aseptic surgery has slowly but surely brought about the results which Simpson strove to attain by a radical measure. The enemy which had baffled surgeons for centuries was revealed by Lister. He sent surgeons smiling into the operating-room practically certain of success instead of dreading the terrible onslaught upon their own handiwork of the formerly unseen and unknown destroyer. The death rate of operations is being daily brought nearer and nearer to vanishing point. In his review of the progress of wound treatment during the Victorian Era published in the Diamond Jubilee number of _The Practitioner_, Mr. Watson Cheyne says the mortality of major operations does not now exceed in hospitals more than three or four per cent., and this is made up practically entirely by cases admitted almost moribund and operated on _in extremis_ with faint hope of survival. The field of surgery, too, has been vastly enlarged, and the term "major operation" includes not merely operations of necessity, undertaken through ages past as the only possible means of saving life, but also operations which have become possible only in recent years--some of them performed merely to make the patient "more comfortable," or even only "more beautiful." And this glorious result is due, as Mr. Cheyne truly says, to the immortal genius of Lister. In 1867 Simpson propounded in the _Medical Times and Gazette_ a proposal for stamping out smallpox and other infectious diseases such as scarlet fever and measles. In spite of vaccination, which, however, was imperfectly carried out, smallpox alone carried off five thousand lives annually in Great Britain. A serious outbreak of rinderpest in the British Islands amongst cattle had recently been arrested and exterminated by the slaughter of all affected animals. The disease spread as smallpox did by contagion, and Simpson fell to wondering why smallpox could not also be exterminated. His paper was a noteworthy contribution to the then infant science of Public Health, and his proposal, which was, however, universally regarded as impracticable, sprang from his courageous enthusiasm as did that concerning hospitals. He suggested that the place of the pole-axe in the extermination of rinderpest might in the arrest of smallpox be taken by complete isolation, and he laid down simple but rigid rules for its enforcement. An attempt was made to utilise these a few years after when an epidemic of fatal violence broke out in Edinburgh. He was in no way an anti-vaccinationist, but his isolation measures were too strong for the people in those days. We are not surprised that he boldly proposed this measure, for he related glaring instances of neglect of the simplest precautions. Beggars held up infants with faces encrusted with active smallpox into the very faces of passers-by in the streets of Edinburgh; and on one occasion a woman was found in Glasgow serving out sweetmeats to the children of a school with her hands and face covered by the disease. He cried aloud for legislation to prevent such gross abuses, which he did not hesitate to stigmatise as little short of criminal. CHAPTER XI FURTHER REFORMS--HONOURS Professional and University Reform--Medical women--Honours--The Imperial Academy of Medicine of France--Baronetcy--Domestic bereavement--The University Principalship--Freedom of the City of Edinburgh--Bigelow of Boston--Views on education--Graduation addresses. Professor Simpson took a warm interest in medical politics, and made himself heard as a member of the Senatus of the University. That body was not renowned for any spirit of harmony prevailing in its midst; it included the medical professors many of whom were in professional opposition to each other and were actuated by conflicting interests. The rivalry prevailing amongst the leaders of the profession in the Scots capital was amusingly shown in one of Sir James's letters, where he related how Professor Miller had just given a capital address to the young graduates and recommended them to marry chiefly because Mr. Syme had advised the reverse two years before. "At least," he said, "so Mr. Syme whispered to me, and so, indeed, did Miller himself state to Dr. Laycock!" On the principles of Medical Reform and University Reform the professors were, however, practically unanimous, but their interests came into conflict with those of the extra-academical school. The two opposing bodies worked hard to gain their own ends when a Parliamentary Committee was appointed in 1852 to inquire into medical reform. The modern Athens became once more disturbed by wordy warfare. The general ends aimed at by the reformers were the obtaining of a proper standing for qualified practitioners; some satisfactory means of enabling the public to distinguish between regular and irregular, quack, practitioners; and to define the amount of general and professional knowledge necessary for degrees and qualifications. It was also desired to remove the absurd anomaly whereby, although Scots medical education was then ahead of English, Scots graduates had no legal standing in England. The Medical Act which was passed in 1858 carried out many of the best suggestions made before the Committee, and effected desirable improvements both in the status of practitioners and in medical education; but it was inadequate, as time has shown, and the question of reform still burns. Simpson took an active interest in the proceedings before the Committee, and made several dashes up to London to further the projects which he had at heart. The annual meeting of the British Medical Association was held in Edinburgh in July, 1858, at the moment when the fate of the Bill hung in the balance. As the journal of the Association said at the time the fruit of a quarter of a century's growth was plucked in the midst of the rejoicings. Sir Robert Christison publicly stated that owing to Simpson's energetic efforts certain far-reaching and objectionable clauses, which had been allowed to creep into the Bill, were expunged at the last moment. Simpson went up to London by the night train, employed the following day in effecting his purpose, and returned the next night; this was when the journey took nearly twice as many hours as now. The Universities (Scotland) Act was also passed in 1858; by it the complete control of the University, and with it the patronage of many of the Chairs, was lost to its original founders, the Town Council, who had so carefully and successfully guided it through nearly three centuries. The Council did not part from their charge without a struggle; in urging their cause they proudly pointed to the fact that they had appointed Simpson to the Chair of Midwifery against the opposition of the medical faculty. To have elected him, they thought, under such circumstances displayed their discernment, vindicated their existence, and pleaded for the perpetuation of their elective office. When the question of the admission of women to the study of medicine came up in Edinburgh and divided the ancient city once more into two hostile camps, Simpson's sympathies appear to have gone with the sex to which he was already a benefactor. He recognised that there was a place, if a small one, within the ranks of the profession for women; and when the question came to the vote he cast his in their favour. The proposal, however, was rejected, and has only quite recently become law in the University. Numerous honours were heaped upon him during the last five-and-twenty years of his life. In 1847 he filled the office of President of the Edinburgh College of Physicians, and in 1852 held the corresponding post in the Medico-Chirurgical Society. In the following year the Imperial Academy of Medicine of France--a body which lacks an analogue in this country--conferred upon him the title of Foreign Associate. This was a jealously guarded honour awarded only to the most highly distinguished men of the day, and it was conferred upon Simpson in an altogether unprecedented manner which doubled its value. According to custom a commission of members prepared a list of renowned men whom they advised the Academy to elect; in the list no British name appeared although Owen, Faraday, and Bright were entered as "reserves." On the day of election the members accepted all the candidates named in the original list until the last was reached. When the president asked for the vote for this individual a sensational and truly Gallic scene was enacted. Almost to a man the members rose, and loud and long proclaimed Simpson's name. Excited speeches were made, and amidst great enthusiasm he was elected to the one remaining vacancy by an overwhelming majority. It had remained for Simpson to prove, as the President courteously pointed out at the time, that there existed a greater honour than that of being elected by the Academy--viz., that of being chosen in _spite_ of the will of the Academy itself. This was by no means the only honour awarded to him by France. In 1856 the French Academy of Sciences voted him the Monthyon Prize of two thousand francs for "the most important benefits done to humanity." Other foreign societies added their compliments, and he was elected Foreign Associate of the Belgian Royal Academy of Medicine, of the Parisian Surgical and Biological Societies, and of the Medical Societies of Norway, Stockholm, Copenhagen, New York, Massachusetts, Leipsic, and other places. In 1866 his own country made an acknowledgment of his eminent attainments when the Queen offered him a baronetcy on the advice of Lord John Russell. Twice before he had refused a title, but this time he wrote to his brother that he feared he _must_ accept although it appeared so absurd to take a title. This honour was the first of its kind ever conferred upon a doctor, or even upon a professor, in Scotland. It was entirely unsought, and scarcely welcomed by its recipient for its own sake; he regarded it not merely as a personal honour but also as a tardy recognition of the services of the Edinburgh school in the cause of medicine. He enjoyed the congratulations which showered upon him, and felt glad when the citizens flocked to Queen Street to express their feelings, much to Lady Simpson's delight. The medical papers unanimously approved of the honour, the _Lancet_ remarking that apart from his connection with chloroform, Simpson was distinguished as an obstetric practitioner, as a physiologist, as an operator, and as a pathologist of great research and originality. Domestic bereavement quenched the rejoicings over the baronetcy, and condolences displaced congratulations. He fell ill for a time himself, and in a condition of unusual mental depression spoke of the baronetcy as appearing even more of a bauble in sickness than in health. In less than a fortnight after the offer of the title his eldest son David died after a short illness. He had been educated for the medical profession, and was a youth of considerable promise and of an earnest temperament; his death fell as a severe blow, and Simpson even contemplated abandoning the baronetcy which had not yet been formally conferred. The words of his friends, however, and the thought that his dead son had particularly insisted on its acceptance, persuaded him. A coat of arms had to be drafted for the new Baronet, and this was a pleasant interest for one of his tastes. The family history was searchingly entered into, and the arms of his father's family were differenced on the most correct lines with those of the Jervays from whom his mother had sprung. In the matter of a crest he was able to be boldly original, and adopted the rod of Æsculapius over the motto _Victo dolore_, and thus handed down to his family the memory of his great victory over pain. In June of the same year, 1866, the University of Oxford conferred upon him one of the few honours which reached him from England in awarding him the honorary degree of Doctor of Civil Law. The University of Dublin made him an honorary Doctor of Medicine, and he was created an honorary Fellow of the King's and Queen's College of Physicians of Ireland. By the death of the veteran Sir David Brewster, in February, 1868, the office of Principal of Edinburgh University fell vacant. This post is a survival from the earliest days. The College out of which the University grew was established in 1583 by the Town Council under a charter granted by James VI. Only one regent or tutor was necessary at first to teach the "bairns," as the students were termed in the contract entered into between Rollock, the first regent, and the city fathers. Rollock was promised that as the college increased "in policy and learning" he should be advanced to the highest post created. By his own efforts the number of students increased so greatly that within the first few years several other regents were appointed, and the Council, remembering their promise, dignified him with the title of Principal or First Master in 1586. This office was held during the succeeding two centuries by a series of more or less worthy men, prominent among whom were Leighton, afterwards Archbishop of Glasgow, and William Carstares, better known as a statesman and for his connection with the Rye House Plot in 1684. During Carstares's tenure the tutors were turned into professors, and the college became more strictly speaking a university, although from the first it had assumed without any right by charter the function of degree-granting. Although the utility of the post quite vanished when the college became a university, and the principal had no place in the constitution of a university, nevertheless the principalship was not abolished. The Universities Act of 1858 recognised the office, but only as that of an ornamental head, acting as president of the assembly of professors constituting the Senatus Academicus. The salary is a thousand pounds a year with an official residence, not within the precincts or the University. The former head master of the college, known by and knowing every student, became a sinecurist of whose existence it is no exaggeration to say many of the students are, through no fault of their own, unaware. Brewster had been a distinguished occupant of the post--distinguished not as a principal, for he received the appointment only at the age of seventy-eight, but as a scientist. To the public he was best known as the author of the "Life of Sir Isaac Newton," and as the inventor of the kaleidoscope. It is said that Brewster never spoke as much as five lines at the meetings of the Senatus Academicus without having previously written them down; and it is probable that this lack of spontaneous utterance from the Chairman gave the tone to the assembly. The rival professors doubtless nursed their animosities for some less dignified meeting-place, differing there only on the most correct academic lines. It is not surprising that Simpson at first refused to be a candidate for the vacant post. He would undoubtedly have made an unrivalled figure-head for his _Alma Mater_; he was the leading figure in Scotland already and "did the hospitalities" of Edinburgh to distinguished visitors of all classes. But he would probably have been obliged to resign his professorship and have thus been cut off from his sphere of greatest usefulness; and although he would have grasped with ease the details of university affairs it is open to question whether he would have suitably filled the post of president over men to many of whom he was in professional opposition. The most that the suggestion that he should be a candidate conveyed was a well-meant compliment, but it would have been a greater compliment on his part if he had really ended his life as the ornamental head of the University he had already done so much to adorn. He would certainly have turned his position to good account, and perhaps might have earned the gratitude of all succeeding students by improving their position in the University and bettering their relationship with their teachers--a much needed reform at that time. But he was a man for more active occupation, and it was more fitting that he should persevere to the end in the work of his life. Simpson expressed his opinion that the most suitable man for the post was the one already named by Brewster and desired by a majority of the Senatus; but that man, Professor Christison, then over seventy years of age, generously said that Sir Alexander Grant, an active candidate, would better fill the post. A strong section of Edinburgh folks persisted in pushing Simpson, and in deference to their wishes he consented to enter the lists. It cannot be said that he displayed any of the eager energy which had marked his candidature for the midwifery chair; but his friends made up for his comparative apathy. They were met by a strong opposition, not instigated by his rivals for the post, but offered by insignificant persons who cherished ill-will against him and spread untrue statements with the object of damaging his character. Greatly owing to the reports spread in this manner he was not elected. Sir Alexander Grant became the new Principal. The fact that he could not gain the post was communicated to him in a letter which reached him one morning before prayers. He conducted the worship as usual after reading the letter, and when the family had afterwards all assembled at the breakfast table he intimated the fact to them and dismissed the subject from his mind with the quiet remark, "I have lost the Principalship." An interesting episode pertaining to this period was narrated by the Free Church minister of Newhaven. "The election," he wrote to Dr. Duns, "took place on a Monday, and it was on the Sabbath preceding, between sermons, that one of my people, a fisherman, called on me stating that his wife was apparently dying, but that she and all her friends were longing most intensely for a consultation with Sir James. I did not know well what to do, for I knew that his mind was likely to be very much harassed, and I shrank from adding to his troubles. But in the urgency of the case I wrote him a note simply stating that one of the best women in the town was at the point of death and longed for his help, leaving the matter without another word to himself. The result was that he came down immediately, spent three hours beside his patient, performed, I am told, miracles of skill, and did not leave her till the crisis was over. She would, I am assured, have died that evening, but she was one of the sincerest mourners at his funeral, and she still lives to bless his memory. After all was over he went into a friend's house and threw himself down on a sofa in a state of utter exhaustion. This was the way in which, without hope of fee or reward, and while others were waiting for him able to give him both, Sir James spent the evening preceding the election. Some will say it was no great matter after all. Why, for that part of it, neither was the cup of cold water which the dying Sir Philip Sidney passed from his own lips to those of a wounded soldier in greater agony than himself. But the incident is recalled whenever his name is mentioned as adding to the glory of the knight _sans peur et sans reproche_, and the incident I have mentioned in the Newhaven fisherman's house surely gives to Sir James a place beside him in the glorious order of chivalrous generosity." Among the last of the honours offered to Simpson was the Freedom of the City of Edinburgh; a fitting tribute from the City in which and for which he had so nobly and untiringly laboured. It was proposed to present him with the burgess-ticket at the same time that it was publicly presented to another hero in a different sphere, Lord Napier of Magdala; but by his own desire the ceremony was postponed so far as he was concerned in order that full honour might be paid to Lord Napier. At the eventual presentation the Lord Provost made a short speech recapitulating the achievements for which they desired to honour him, and referring to his reputation as being great on the banks of the Thames and the Seine, as well as on the shores of the Firth of Forth; he likewise expressed the pride of his fellow-citizens that Sir James had remained amongst them and had not been drawn away like other men of genius before him by the attractions of the greater metropolis of the south. Simpson's reply took the form of an impromptu review of his career from the time he first entered the City as a wonderstruck boy. "I came," he proudly said, "to settle down and fight amongst you a hard and up-hill battle of life for bread and name and fame, and the fact that I stand here before you this day so far testifies that in the arduous struggle I have--won." The accounts of the speeches delivered on this occasion which reached America raised the indignation of Dr. Bigelow, of Boston. Reference had been made to chloroform in a manner which appeared to slight Morton's work in introducing ether as an anæsthetic before chloroform was heard of. In Bigelow's estimation Simpson posed as a hero at the expense of Morton. Simpson had certainly been far from liberal in his allusions to Morton and others in his article upon Anæsthesia in the _Encyclopædia Britannica_, and had written almost entirely about his own discovery. A controversy was excited, and on his deathbed Simpson wrote a letter to Bigelow to prove that he had duly considered the priority and the value of Morton's and Wells's work. In his concluding sentences he expressed regret at having taken up so much of his own and his correspondent's time in such a petty discussion, but blamed his illness which prevented him from writing with the force and brevity required. "With many of our profession in America," he said, "I have the honour of being personally acquainted, and regard their friendship so very highly that I shall not regret this attempt--my last, perhaps--at professional writing as altogether useless on my part if it tend to fix my name and memory duly in their love and esteem." The widespread national expression of the sense of loss and of sympathy which reached Edinburgh from the United States after Sir James's death testified to the regard in which he was held from one end to the other of that country. In Boston itself the Gynæcological Society, of which he had been the first honorary member, convened a special memorial meeting, which was solemn and impressive. He had not been mistaken in presuming with his last breath that he held the regard of his American _confrères_. On the subject of education Simpson held what were considered advanced opinions, but which had already been expressed by Mr. Lowe. A few years before his death he delivered a lecture on Modern and Ancient Languages at Granton, in which he lamented the common neglect of modern languages in the education of the day. He had personally felt the want of a mastery over French and German, both in the course of his studies and during his travels; nor did he feel the want compensated for by his ability to write and talk in Latin. He strongly advocated the paying of more attention to the modern and less to the dead languages, and he urged that natural science should take its place in the ordinary curriculum of the great public schools. These views were used as an argument against his fitness for the post of Principal of the ancient University. On three separate occasions it fell to Simpson's lot to deliver the annual address to the newly-fledged graduates, which is the duty of the professors of the medical faculty in rotation. This ceremony remains deeply impressed in the memory of Edinburgh men, simple and dull as it undoubtedly is. The homily delivered by the orator of the day contains excellent counsels appropriate to the occasion, but the young man eager to rise and confidently try his wings pays little attention to the words of wisdom; unless it be to feel wonder that just as he is about to leave them, probably for ever, his _Alma Mater_ and her priests have discovered an affectionate regard for him and his welfare. A few years later the struggling young practitioner may perhaps turn to the copy of this graduation address, forwarded to him by post with the author's compliments, and find in such an one as Simpson delivered much to strengthen and encourage him. In 1842 and 1855 he delivered addresses from which quotations have already been made; and in the third one, spoken in 1868, he made a forecast of the future of medical science, predicting _inter alia_ that by concentration of electric or other lights we should yet be enabled to make many parts of the body sufficiently diaphanous for inspection by the practised eye of the physician. It was his habit to commit such lectures to memory and to deliver them without notes. He was a ready public speaker on any subject in which he was interested; speeches made on the spur of the moment teemed with pleasantly-put facts and apt anecdotes from the vast storehouse of his memory. A speech from Sir James was one of the treats in which Edinburgh folks delighted. CHAPTER XII FAILING HEALTH--DEATH Poetical instincts--Religious views--Religious and emotional influences in his life--Doubts--Revivalism--Health--Overwork tells--Bed--Gradual failure--Death on May 6, 1870--Grave offered in Westminster Abbey--Buried at Warriston--Obituary notices--Bust in the Abbey--His greatness. The emotional part of Sir James Simpson's nature found some small expression in versifying both, as we have seen, in early years and in later days. We know that he was a close student of Shakspeare, but Miss Simpson states that her father probably never entered a theatre, so that he can never have seen a representation. He was familiar with modern poets, especially with Burns. It is related that he once tested a lady friend's insight into the vernacular by quoting from memory for explanation the following lines from the national bard:-- "Baudrons sit by the ingle-neuk, An' wi' her loof her face she's washin', Willie's wife it nae sae trig, She dichts her grunzie wi' a hooschen." His own verses were neither better nor worse than those written by other men whose abilities have led them to excel in more practical pursuits. In youth they celebrated student life, or were, as usual, dedicated to Celia's eyebrows; in mature life they were of a more serious, and latterly of a strong religious description. At all times he delighted in writing little doggerel verses to his children or friends; valueless as such efforts are, they served a useful purpose; their composition was a recreation and pleasant relief to his over-taxed brain, while it was an amusement to him to watch their effect upon the recipients, and perhaps to receive a reply clothed also in the garb of rhyme. Sir James's example so influenced the people amongst whom he lived that it is impossible to omit reference to his attitude throughout life towards religion and an account of what is one of the most interesting phases in his history. Up to Christmas, 1861, he had been, in the eyes of the religious public, an ordinary citizen; as regular in church-going as his professional engagements permitted; thoroughly interested in Church affairs, and a strong supporter of his own Church; possessing to the full the national characteristic of intimate acquaintance with the letter of the Old and New Testaments; and something of a theologian as well, as his answer to the religious objections to anæsthesia showed. At that period, to the delight of many, and the genuine astonishment of others among his fellow-citizens, he became a leading spirit in the strong Evangelical movement which was then spreading through the country, "Simpson is converted," cried the enthusiastic revivalist. "Simpson is converted now," laughed those who had opposed every action of his. "If Professor Simpson is converted, it is time some of the rest of us were seeing if we do not need to be converted," wisely answered one of his friends. In the ordinary sense of the word Simpson was not converted. Had he passed away without developing this latter-day Evangelical enthusiasm, all sects would still have united in thankfulness that such a man had lived. Why this religious revival during the sixties affected him as it did becomes evident in looking at the religious, moral, and emotional influences which affected him throughout his career. The simple-minded, devout mother, strong in faith and strong in works, who passed out of his life when he was but nine years old, left a vivid impression on the boy's mind. In after years he would call up the picture of the good woman retiring from the shop and the worries and troubles of daily life into which she had so vigorously thrown herself and so bravely faced even with failing health, into the quiet little room behind, to kneel down in prayer; and would describe how at other times she went about her work chanting to herself one of the old Scots metrical psalms: "Jehovah hear thee in the day, when trouble He did send And let the name of Jacob's God thee from all ill defend. Let Him remember all thy gifts, accept thy sacrifice, Grant thee thine heart's wish and fulfil thy thoughts and counsel wise." He used to relate one memory of her, touching in its simplicity: how one day he entered the house with a big hole in his stocking which she perceived and drew him on to her knee to darn. As she pulled the repaired garment on she said, "My Jamie, when your mother's away, you will mind that she was a grand darner." He remembered the words as if they had been spoken but yesterday, and subsequently offered to a lady who had established a girls' Industrial School in his native village a prize for the best darning. The simple faith which beat in the life of the Bathgate baker's household was ingrained into James Simpson; he went forth into the world full of it, and full of the determination that by his fruits he should be known. The tender, loving care for his welfare of his sisters and brothers, particularly of Sandy, who never faltered in his inspired belief in James's great future, kept alive in Simpson something of his mother's affectionate nature, and kindled the sympathies and emotions which bulked so large in his character. His goodness was displayed in his kindly treatment of the poor, who formed at first the whole and afterwards no small part of his patients. When name and fame and bread were his, he did not turn his back on the poor, but as we have seen, ever placed his skill at their disposal for no reward, as readily as he yielded it to the greatest in the land. As in his daily practice, so in his greatest professional efforts, the revelation of chloroform, the fight for anæsthesia, the introduction of acupressure, the crusade against hospitalism, one thought breathed through his work--that he might do something to better the condition of suffering humanity. He never attempted to keep discoveries in his own hands, to profit by the monopoly, but scattered wide the knowledge which had come to him that it might benefit mankind and grow stronger and wider in the hands of other workers. In his domestic life he was a tender, loving, and companionable husband and father, a charming host, and a warm-hearted friend. "In this Edinburgh of ours," says a recent writer, "there are familiar faces whose expression changes greatly at the mention of his name; there are men whose speech from formal and precise turns headlong and extravagant, as if it came from a new and inspired vocabulary." In Scotland his personal influence was immense. As was afterwards written of him, "Great in his art, and peerless in resource, yet greater was he in his own great soul;" such a man stood in no need of the violent revolution in mode of life implied in conversion. A gradual process of development led to his feeling that although to labour was to pray, there was a need for more attention to the spiritual, even in his self-sacrificing life. There is evidence that during a brief period of his career Simpson became affected by speculative doubts; indeed it would have been surprising if his mind had not been affected by some of the new schools of thought which sprang up in the footsteps of Charles Darwin, and appeared for a time to threaten a mortal antagonism to all that was dear to orthodox Christians. But these did not influence him long; true to his character he examined every new thought and finding it wanting remained firm in his old and tried faith, and ranged himself on the side of those who perceived nothing seriously incompatible between religion and modern science. In his bearing, when the angel of sorrow afflicted his household with no unsparing hand, we find him always a religious-minded man. The first trial was the loss of the eldest child, his daughter Maggie, in 1844. Another daughter, Mary, was lost in early infancy. In 1848 his friend of boyhood and student days, Professor John Reid, was smitten with a painful malady and died after a prolonged period of suffering during which, knowing that the shadow of death was hanging over him, he devoted himself in retirement to religious thoughts. Experiences such as these made Simpson pause and question himself. Brimful of life and vigour, however much he came in contact with death in his professional rounds, the sight of it in his own inner circle powerfully stirred his emotional nature. His friend the Rev. Dr. Duns noticed in him after these sad events a gradually increasing earnestness in his spiritual life, and a closer inquiry into the meanings of the Scriptures. He sought out the company, and placed himself under the influence of those among his patients whom he knew to possess fervid religious temperaments. The last mental stumbling-block was the question of prayer; he had seriously doubted in examining the question intellectually that human prayer could influence the purpose of the Deity. It is difficult, if not presumptuous, to inquire into the process whereby, under the guidance of spiritually minded friends, his doubts were satisfied. "... One indeed I knew In many a subtle question versed." * * * * * "He fought his doubts and gathered strength, He would not make his judgment blind, He faced the spectres of the mind, And laid them--thus he came at length" * * * * * "To find a stronger faith his own." The simple earnest faith of his fathers in which he had commenced life, ran all through his mature years and prompted his strong purposeful energies. After the combat with the only seriously perplexing doubt he re-embraced his faith with the simplicity of a child and the strength of a giant. For one accustomed to apply to every subject taken in hand the rigid process of careful scientific investigation, it required no small effort to lay aside his usual methods and suffer himself to be led wholly by faith. It was impossible for Simpson to enter into any movement without taking a prominent part in it. That Christmas Day on which all doubts left him was followed by days of extraordinarily zealous work, such as would have been expected of him after he had convinced himself that he had a mission to spread abroad this, the latest, and, in his opinion, the greatest, of his discoveries. He plunged at once into the midst of Evangelical societies, missions, and prayer-meetings, amongst the upper and lower classes of Edinburgh, and made excursions into the mining districts of his native county to deliver addresses. He interested himself in the education of theological students, and in foreign missions, and added to his literary work the writing of religious addresses, tracts and hymns. His example had a powerful influence in Edinburgh. It is said that he frequently addressed on a Sunday evening Evangelical assemblies of two thousand persons. The news of his so-called conversion was gleefully spread by well-meaning folks, who had given credence to statements published by his enemies, and imagined that here was a bad if a great man turned aside from the broad to the narrow path. This enthusiastic revival movement died down in time, and Simpson returned to his ordinary everyday life. More sorrow soon fell to his lot. In 1862 his fifth child, James, who had always been an invalid, was taken from him at the age of fifteen. In 1866 the sad death of Dr. David Simpson, the eldest son, which has already been referred to, was followed in about a month's time by that of the eldest surviving daughter, Jessie, at the age of seventeen. The death of James, a sweet-natured child, stimulated him in the revival work. Pious friends had surrounded the little sufferer and led him to add his innocent influence in exciting his father's religious emotions. There is reason to believe that Simpson perceived much insincerity in the revival movement, and attempted to dissociate himself from active participation in it, on account of finding it impossible to work in harmony with some who, though loud in profession, flagrantly failed in practice. The subject of Simpson's health has been little referred to in these pages, because throughout his life he paid little attention to it. The chief remedy for the feeling of indisposition was change of work. He found it impossible to be idle, and sought as recreation occupations such as archæological research, or a scamper round foreign hospitals, which to most people would have savoured more of labour. The part of his body which was most worked, his nervous system, was naturally the one which most often troubled him with disorder; like other great men of high mental development he suffered from time to time with severe attacks of megrim, which necessitated a few hours of rest. The blood-poisoning, for which he availed himself of Professor Syme's services, was soon recovered from with prompt treatment ending in a foreign tour; but after it little illnesses became more frequent, and he was perforce occasionally confined to the house. During these times he busied himself, for the sake of occupation and to distract his attention from his sufferings, in professional reading or the preparation of literary papers. Rheumatic troubles became frequent, and soon after his eldest son's death he had to run over to the Isle of Man to free himself from a severe attack of sciatica. Long, weary nights spent at the bedside of patients or in tiresome railway journeys, and exposure to all varieties of weather, had a serious effect upon him. Travelling was slow, according to modern ideas, and long waits at wayside stations in winter-time helped to play havoc with his constitution. He was well known to the railway officials in Scotland. The figure of the great Edinburgh professor was familiar at many a station, striding up and down the platform with the stationmaster, chaffing the porter, or cheerily chatting to the driver and stoker leaning out of the engine. After his death many of these men would proudly produce little mementoes of their services to him, which he never forgot to send. The little rest house, Viewbank, on the Forth, had to be more frequently sought refuge in, if only to get away from the harassing night-bell and secure a full night's sleep. In the last year or two of his existence he found the work of his practice and chair hard to carry on, not because of any defined illness, but on account of the loss of that buoyant elasticity of constitution which had enabled him to bear without apparent effort or injury the fatigue which would have been sufficient to prostrate more than one ordinary man. He had early trained himself to do with a minimum of sleep; to snatch what he could and when he could, if it were only on a sofa, a bare board, or in one of the comfortless railway carriages of the day. He took full advantage during his career of the modern facilities for travelling which he had seen introduced and developed. Many a night was spent in the train, going to or returning from a far-distant patient, or after a combined professional and archæological excursion; the next morning would find him busy in his usual routine. On the day after receiving the degree of D.C.L. at Oxford in 1866, he started for Devizes, which was reached the same evening; here he had a hasty meal and drove on to Avebury to see the standing stones there. He returned at midnight, and at five o'clock next morning set off for Stonehenge, a place he had long desired to see, thoroughly examined the remarkable remains, and on his return took train to Bath, where he found time to examine more antiquities. At midnight a telegram reached him calling him professionally to Northumberland. He snatched a few hours' sleep, and taking the four a.m. train to London set out for Northumberland, where he saw his patient, and then proceeded to Edinburgh. This is no solitary instance of his journeyings, but an example of many. When the year 1870 had been entered upon, he awoke to the fact that his flesh was too weak for his eager spirit; despite this, he held on his course, and worked without ceasing, never refusing an urgent call, although he now suffered from angina pectoris. On February 12th he hastened to London to give evidence in a notorious divorce case. He arrived only to find that the trial had been postponed for four days. He returned to Edinburgh on the 14th, spent the next day in professional visits in the country, and arrived again in London in time to appear in the witness-box on the 16th, although chilled to the bone by the coldness of the long journey. On the following day he stopped at York on his way home, dined with Lord Houghton, and visited, at 11 p.m., his friend Dr. Williams, in Micklegate. During the remainder of the journey from York to Edinburgh he suffered severely, and "was glad to rest for awhile upon the floor of the railway carriage." A few days after this last run to London he was summoned to see a patient in Perth, but was this time so fatigued by the effort, that after his return on February 25th he was obliged to take to bed. The news sped to all quarters of the globe that Simpson was gravely ill, for nothing but grave illness could compel that vigorous man to completely lay down his work. His symptoms improved at first under appropriate treatment sufficiently to allow him to be placed on a bed in the drawing-room; and he even once more took up his favourite archæology, revising some of his work in that subject. Patients also were not to be denied; many were seen and prescribed for in his sick room, some even being carried up to his presence. But the fatal disease regained ascendancy, and the fact became apparent to all, not excepting himself, that the last chapter of the closely written book of his life had been entered upon. Towards the end of March, by his own request, his eldest surviving son was telegraphed for to be near him, and he wrote a touching letter to his youngest son, then a student in Geneva, encouraging him in his studies, asking him to look for cup-markings cut in the curious islet rock in Lake Geneva, and ending with an expression of his feeling of impending death, for which he felt perfectly and happily prepared. In these last days he loved to have his nearest and dearest around him; Lady Simpson and others read to him, and his daughter tells us how she daily prepared her school lessons in the sick room with his help; to the last he interested himself in the work of his relations and friends. He answered the attack of Bigelow, of Boston, conscious that it was his last effort on behalf of chloroform, and wrote to all his old opponents asking their forgiveness if at any time words of his had wounded their feelings. He might well have spared himself the regrets--such as they were--which troubled him. "I would have liked to have completed hospitalism," he said, "but I hope some good man will take it up." On another occasion he asked, "How old am I? Fifty-nine? Well, I have done some work. I wish I had been busier." He expressed a desire that his nephew should succeed him in the Chair of Midwifery--he would, he thought, help to perpetuate his treatment. There was much communing with himself on his future, and all his sayings on the subject breathed the simple faith first inculcated in him in the Bathgate cottage. His great sufferings, sometimes allayed by opiates and his own chloroform, were bravely borne, but the days dragged sadly on. On the evening of May 5th Sandy took his place at his side, and the last conscious moments of the great physician were spent with his head in the arms of him who had helped and guided him through the difficult days of his career. At sunset on May 6th he passed peacefully away. The extent of the feeling evoked by the tidings of his death was represented in Mr. Gladstone's remark that it was a grievous loss to the nation and was truly a national concern. There was a universally expressed opinion that he merited without a shadow of doubt the rare national honour of public interment in Westminster Abbey. A committee was formed out of the leading medical men in London to carry out this suggestion. Their task was light, for the Dean acceded to the request at once. Much as his family and the Scots people valued this tribute to his greatness, they decided otherwise. Scotland has no counterpart of Westminster in which to lay to rest those whom she feels to have been her greatest; but Edinburgh felt that she could not part with him who in life had been her possession and her pride. He had long ago chosen a piece of ground in the Warriston cemetery, and Lady Simpson decided, to the gratification of his fellow-citizens, that he should be buried there beside the five children who had preceded him. His resting place was well chosen; it nestled into the side of the beautiful city, and from it could be viewed some of the chief objects of the scene he knew so well--on the south the stately rock crowned with the ancient castle, and the towering flats of the old town stretching away to Arthur's Seat; on the north the long stretch of the Firth of Forth and in the distance on the one hand the Ochills; on the other the Bass Rock. The funeral was one of the most remarkable ever witnessed in Scotland. It took place on May 13th in the presence of a crowd estimated to consist of thirty thousand persons. The hearse was followed by a representative procession comprising close upon two thousand persons. His own relatives assembled at 52, Queen Street, the general public and the Town Council in the Free Church of St. Luke, and the representatives of the University, the Colleges of Physicians and Surgeons, and the Royal Society and many other public bodies, in the Hall of the College of Physicians. At each of these meeting-places religious services were held. The whole city ceased to labour that afternoon in order to pay the last tribute to its dearly loved professor. The poor mourned in the crowd as deeply and genuinely as those with whom he had been closely associated in life mourned as they followed his remains in the procession. Every mourner grieved from a sense of personal loss, so deeply had his influence sunk down into the hearts of the people. The companion of his troubles and his triumphs, who had bravely joined him to help him to the fame he strove after, was soon laid beside him. Lady Simpson died on June 17th of the same year. But two notes were struck in the countless obituary notices and letters of condolence which appeared from far and near--those of appreciation of his great nature, and sorrow for the terrible loss sustained by science and humanity. The Queen caused the Duke of Argyle to express to the family her own personal sorrow at the loss of "so great and good a man." A largely attended meeting was held in Washington to express the feeling of his own profession in the United States, at which Dr. Storer moved, "that in Dr. Simpson, American physicians recognise not merely an eminent and learned Scots practitioner, but a philanthropist whose love encircled the world; a discoverer who sought and found for suffering humanity in its sorest need a foretaste of the peace of heaven, and a devoted disciple of the only true physician, our Saviour Jesus Christ." The following original verses from the pen of a well-known scholar in the profession, were given prominence in the columns of the _Lancet_:-- PROMETHEUS. (Our lamented Sir James Simpson was the subject of angina pectoris.) 1 "Alas! alas! pain, pain, ever forever!" So groaned upon his rock that Titan good Who by his brave and loving hardihood Was to weak man of priceless boons the giver, Which e'en the supreme tyrant could not sever From us, once given; we own him in our food And in our blazing hearth's beatitude; Yet still his cry was "Pain, ever forever!" Shall we a later, harder doom rehearse? One came whose art men's dread of are repressed: Mangled and writhing limb he lulled to rest, And stingless left the old Semitic curse; Him, too, for these blest gifts did Zeus amerce? He, too, had vultures tearing at his breast. 2 Hush, Pagan plaints! our Titan is unbound; The cruel beak and talons scared away; As once upon his mother's lap he lay So rests his head august on holy ground; Spells stronger than his own his pangs have found; He hears no clamour of polemic fray, Nor reeks he what unthankful men may say; Nothing can vex him in that peace profound. And where his loving soul, his genius bold? In slumber? or already sent abroad On angels' wings and works, as some men hold? Or waiting Evolution's change, unawed? All is a mystery, as Saint Paul has told, Saying, "Your life is hid with Christ in God." In a peaceful corner of the St. Andrew Chapel in Westminster Abbey, alongside memorials of Sir Humphry Davy and a few other scientists of note, stands a speaking image in marble--perhaps the most expressive representation that exists--of this wonderful man, "To whose genius and benevolence The world owes the blessings derived From the use of chloroform for The relief of suffering. LAUS DEO." Mr. Jonathan Hutchinson, when writing to the medical journals in support of the proposal to secure Simpson's burial in Westminster Abbey, foretold that his reputation would ripen with years, that jealousies would be forgotten, and antagonism would be buried. Twenty-seven years have elapsed since then, and few remain with whom he came in conflict; those who do remain exchanged, along with others of his opponents, friendly words of reconciliation in the end, and took the hand which he held out from his deathbed. As a man, Simpson had his faults; but they were exaggerated in his lifetime by some, just as his capabilities and achievements were magnified by those who worshipped him as inspired. He was full of sympathy for mankind, benevolent and honest to a fault, and forbearing to his enemies. He rushed eagerly into the combat and oftentimes wounded sorely, and perhaps unnecessarily. His genius was essentially a reforming genius, and impelled him to fight for his ends, for genius is always the "master of man." We can forgive him if sometimes it caused him to fight too vigorously, where the heart of a man of mere talent might have failed and lost. His social charms were excelled only by his marvellous energy, his prodigious memory, and his keenness of insight; but he was regrettably inattentive to the details of ordinary everyday life and practice. He approached the study of medicine when the darkness of the Middle Ages was still upon it, and was one of the first to point out that although many diseases appeared incurable, they were nevertheless preventable. Although no brilliant operator himself, he so transformed the surgical theatre by his revelation of the power of chloroform, and by his powerful advocacy of the use of anæsthetics, that pain was shut out and vast scientific possibilities opened up; many of which have been brilliantly realised by subsequent workers. He devoted himself specially to the despised obstetric art, fighting for what he recognised as the most lowly and neglected branch of his profession, ranging his powerful forces on the side of the weak, and left it the most nearly perfect of medical sciences. He was enthusiastic in his belief in progress, and in the power of steady, honest work to effect great ends. With the exception of the time of that temporary burst into revivalism in 1861, his motto throughout life might very well have been _laborare est orare_. He was no believer in speculations, but curiously enough kept for recreation only the subject of archæology, in which he entered into many intricate speculative studies. In his professional work he avoided speculation, and never adopted a theory which was not built upon firm fact. If we are asked for what we are most to honour Simpson, we answer, not so much for the discoveries he made, not for the instruments he invented, not for his exposure of numerous evils, not for the introduction of reforms, not for any particular contribution to science, literature, or archæology; but rather for the inspiring life of the man looked at both in outline and in detail. He was guided by high ideals, and a joyous unhesitating belief that all good things were possible--that right must prevail. He was stimulated by a genius which, as has been pointed out, gave him the energy to fight for his ends with herculean strength. The fact that chloroform was by his efforts alone accepted as _the_ anæsthetic, and ether, which from the first was generally thought to be safer in ordinary hands, was deliberately put on one side practically all over the world, testified to his forcible and convincing method, and to his power of making others see as he saw. As a man of science alone, as a philanthropist alone, as a worker alone, as a reformer alone, he was great. But although to the popular mind he is known chiefly because of his introduction of chloroform, medical history will record him as greater because of his reforming genius, and will point to the fight for anæsthesia, and his crusade against hospitalism as the best of all that he accomplished or initiated. And he who, while making allowances for the weaknesses of human nature which were Simpson's, studies the life which was brought all too soon to a close, will recognise the great spirit which breathed through all his life. THE END. APPENDIX I. The following is a list of Sir James Simpson's contributions to _Archæology_. His professional writings, in the form of contributions to the medical journals, or of papers read to various societies or meetings, number close upon two hundred. 1. "Antiquarian Notices of Leprosy and Leper Hospitals in Scotland and England." (Three papers read before the Medico-Chirurgical Society, March 3, 1841.) _Edinburgh Medical and Surgical Journal_, October, 1841, and January and April, 1842. 2. "Notice of Roman Practitioner's Medicine Stamp found near Tranent." Royal Society of Edinburgh; Dec. 16, 1850. 3. "Ancient Roman Medical Stamps." _Edinburgh Journal of Medical Science_, Jan., March, April, 1851. 4. "Was the Roman Army provided with any Medical Officers?" Edinburgh, 1851, private circulation. 5. "Notes on some Ancient Greek Medical Vases for containing Lykion; and on the modern use of the same in India." Edinburgh, 1856. 6. "Notice of the appearance of Syphilis in Scotland in the last years of the fifteenth century." 1860. 7. "Note on a Pictish Inscription in the Churchyard of St. Vigeans." Royal Society, April 6, 1863. 8. "Notes on some Scottish Magical Charm-Stones or Curing Stones." _Proceedings of Antiquarian Society of Scotland_, vol iv., 1868. 9. "An Account of two Barrows at Spottiswoode, Berwickshire, opened by the Lady John Scott." _Proceedings of Antiquarian Society of Scotland_, vol iv., 1868. 10. "Did John de Vigo describe Acupressure in the Sixteenth Century?" _British Medical Journal_, Aug. 24, 1867; _Medical Times and Gazette_, 1867, vol. ii., p. 187. 11. "Account of some Ancient Sculptures on the Walls of Caves in Fife." 1867. 12. "Notices of some Ancient Sculptures on the Walls of Caves." _Proceedings of the Royal Society_; Edinburgh, 1867. 13. "Cup-cuttings and Ring-cuttings on the Calder Stones, near Liverpool." 1866. _Transactions of the Historical Society of Lancashire and Cheshire._ 14. "Archæology--its past and its future work." Annual Address to the Society of Antiquarians of Scotland, January 28, 1861. 15. "The Cat Stane, Edinburghshire." _Proceedings of the Society of Antiquaries, Scotland_, 1861. 16. "Archaic Sculpturings of Cups, Circles, &c., upon Stones and Rocks in Scotland, England, and other countries." 1867. 17. "Is the Pyramid at Gizeh a Meteorological Monument?" _Proceedings of the Royal Society_; Edinburgh, 1868. 18. "Pyramidal Structures in Egypt and elsewhere." _Proceedings of the Royal Society_; Edinburgh, 1868. 19. "Cell at Inchcolm." The above list is founded on that given by Professor Gusscrow in his "Zur Erinnerung an Sir James Y. Simpson." Berlin, 1871. II. On _post mortem_ examination the following observations on Sir James Simpson's head were made:-- Skull--circumference round by occipital protuberance and below frontal eminences, 22-1/2 inches. --from ear to ear, 13 inches. --from occipital protuberance to point between superciliary ridges, 13 inches. Brain--weight of entire brain (cerebrum and cerebellum) was 54 ounces; the cerebellum, pons, and medulla oblongata weighed 5-1/4 ounces. The convolutions of the cerebrum were remarkable for their number, depth, and intricate foldings. This was noticed more particularly in the anterior lobes and the islands of Reil. Extract from _British Medical Journal_, May 14, 1870. INDEX A Academy of Sciences (France), 194 Acupressure, 173 Adam Street, Simpson's lodgings in, 20, 30 Addresses, Graduation, 74-77, 200 Alcohol as an anæsthetic, 93 Alison, Professor, 56, 59, 73, 148 America, United States of, and anæsthesia, 83, 96, 199 Anæsthesia, 88, 178 opposition to: (1) medical, 113 (2) moral, 120 (3) religious, 123. Discovery of, 88 results of, 130 Antiquarians, Scots Society of, 8, 71, 156 Appendix, 223 Archæological works, Simpson's, 223 Archæology, 4, 8, 152, 223 Argyle, Duke of, 217 Arts, curriculum of, 14, 19, 20 Aytoun, 27 B Baden, Princess Marie of, 69 Ballingall, Professor, 60 Baronetcy, Simpson's, 190 Bathgate, 4, 7, 8, 34, 142 Bell, Sir Charles, 60, 61 Bennet, 42 Bigelow, Dr., of Boston, 198, 214 Blantyre, Lord, 80 Boerhaave, 134 Boston, U.S.A., 97, 98, 199 Braid, Dr., 95 Brewster, Sir David, 27, 192 British Medical Association, 188 _British Medical Journal_, 176, 177, 188, 225 Bruce, Robert, 72 Brunton, Dr. Lauder, 148 Burke and Hare, 23 Bursary won by Simpson, 20 C Carstares, William, 192 Catstane, the, of Kirkliston, 8, 155 Chalmers, Dr., 27, 125 Cheselden, 122 Cheyne, Mr. Watson, 184 Children, Simpson's, 85, 207 Chirurgeons, incorporation of, 58 Chloric ether, 99 Chloroform, 215, 221, 219 discovery of, 105 composition described by Dumas, 106 Flouren's experiments, 106 discovery of properties, 106 used in obstetrics, 108 Simpson's opinion of, 111 administration, teaching of, 130 Christison, Professor, 56, 59, 84, 148, 188, 195 Clark, Sir James, 129 Clover, 130 Cockburn, Lord, 23, 27 College of Physicians, Edinburgh, 53, 58, 189 Cooley, Mr., 97 Cooper, Bransby, 123 Crest, Simpson's, 192 Cullen, 2, 27, 41 D Davy, Sir Humphry, 95, 96, 219 Dawson, Dr., 69 De Quincey, 127, 128 Disruption, the, 85 Doctor of Medicine, degree of, 38 Dumas, 106 Dunbar, Professor, 18 Duncan, Dr. Matthews, 105 Duns, Dr., 34, 162, 196, 207 Du Potet, 94 E Edinburgh, 17, 27, 197 _Edinburgh Medical and Surgical Journal_, 52, 72 Education, Simpson on, 199 Elliotson, Dr. John, 94, 95 _Encyclopædia Britannica_, 198 Erskine House, Simpson's visit to, 80 Esdaile, Dr., 95 Ether, 99, 104, 112 Evangelical work, Simpson's, 209 Extra-mural Medical School, Edinburgh, 26, 31 F Faraday, 96 Fohman, Professor, 45 Forbes, Edward, 41 Foreign tour, Simpson's, 43-46 Free Church, 85 Freedom of Edinburgh city, 197 Funeral, Simpson's, 216 G Gairdner, Dr., 37 Girdwood, Dr., 37 Gladstone, Mr., 215 Goodsir, Professor, 42 Graduation addresses, 74-77, 200 Graham, Professor R., 59, 148 Grant, Sir Alexander, 195 Gregory, Dr., 32, 33 Grindlay, Miss Jessie, 46, 55, 57 Grindlay, Mr., 46, 61, 68 Gusserow, Professor, 113, 170, 225 Gynæcological Society of Boston, 199 Gynæcology, 86 H Hahnemann, 147 Hamilton, Duchess of, 69 Hamilton, Professor James, 32, 40, 56, 59, 69, 163, 169 Hamilton, Sir William, 27 Health, Simpson's, 210 Henderson, Professor, 148 Home, Professor James, 59 Homoeopathy, 74, 147 Hope, Thomas, 56, 59 Hospitalism, 177-184 Hospitality, Simpson's, 81-83 Hotels, the Edinburgh, and Simpson, 163 Houghton, Lord, 213 Hutchinson, Mr. Jonathan, 219 Hypnotism, 94, 149 I Imperial Academy of Medicine (France), 189 Indian hemp, 92 Infirmary, Royal, of Edinburgh, 31, 109, 177, 178, 187 J Jackson, Dr., of Boston, U.S.A., 96 James VI., 192 Jameson, Professor R., 59 Jeffery, Lord, 27 Jenner, 119, 145 K Keiller, Dr., 30 Keith, Dr. George, 105 Kennedy, Dr. Evory, 61, 63 Knox, Robert, 23, 24, 25, 26, 28 L _Lancet_, the, 95, 169, 191, 218 Laughing-gas, _vide_ nitrous oxide Laycock, Professor, 186 Leighton, Archbishop, 193 Leprosy and leper-houses, 70 Lippi, 45 Lister, Lord, 176, 179, 184, 188 Liston, Professor, 26, 31, 91, 95, 104, 151 Lizars, John, 26 London, Simpson's journeys to, 80, 187, 213 Long, Dr., of Athens, U.S.A., 96 Lycium, the, of the Muses, 154 M MacArthur, Mr., 20, 21, 22, 26, 39 Macintosh, Dr., 55 Maclagan, Sir Douglas, 43 Maclaren, Mr. Duncan, 61 _Maga_, the university, 41 Mandrake, 93 Master of Arts, the degree of, 19 Medical faculty, the, 57, 59, 60, 187 Medical Reform Act, the, 187 Medical student, the Edinburgh, 33 _Medical Times and Gazette_, the, 184 Medicine, condition of, at Simpson's birth, 1-3 Medico-Chirurgical Society, the Edinburgh, 189 Meigs, Professor, 117 Melbourne, Lord, 28, 73 Mesmerism, 94, 149 Midwifery, 3, 32, 39, 40, 53, 86, 104 Midwifery Chair, 55-65, 188, 215 Midwifery class, Simpson's, 67 Miller, Professor, 106, 109, 186 Moncrieff, Lord, 27 Monro (Primus), 57 Monro (Secundus), 56 Monro (Tertius), 23, 59 Montgomery, Dr., 140 Monthyon Prize, the, 190 Morton, W. T. G., 97, 98, 129, 132, 198 N Napier, Lord, of Magdala, 197 _Nepenthe_, 93 Newhaven, 143, 196 Nitrous oxide gas, 97 North, Christopher, 18 Nunn, Mr., 123 O Oineromathic, the Society, 42 Oxford, D.C.L., degree of, 192, 212 P Paré, Ambroise, 90 Pathology, 39, 53, 55, 73, 74 Petroleum, 84 Physician-Accoucheur to the Queen, Simpson appointed, 86 Pillans, Professor, 18 _Post mortem_, 225 _Practitioner_, the, 184 Principalship, the, of Edinburgh University, 192 "Prometheus," 218 "Puck," 138 Q Queen Street, No. 52, 78, 81, 105, 137 Queen, the, 17, 86, 129, 190 R Reform, medical, 187 Reform, university, 187 Regents, the, of Edinburgh University, 192 Reid, Professor John, 18, 20, 21, 22, 25, 26, 39, 41, 42, 55, 207 Religious views, Simpson's, 203 Rinderpest, epidemic of, 185 Rollock, the Regent, 192 Roman army, the, 156 Royal Medical Society, 41, 52, 53 Royal Physical Society, 41 Russell, Lord John, 27, 190 S _Scots Observer_, the, 82 _Scotsman_, the, 61, 142 Scott, Sir Walter, 27, 124 Senatus Academicus, the, of Edinburgh University, 29, 186, 194. Simpson, Alexander, 10, 37, 40, 61, 205, 215 Simpson, David, 5 Simpson, David (secundus), 37 Simpson, David (tertius), 191, 210 Simpson, Lady, 191, 216, 217 Simpson, Mary, 10 Simpson, Miss E. B., 138, 202, 214 Simpson, Mrs., 5, 6, 204 Simpson, Professor A. R., 51, 86, 164, 219 Smallpox, 184 Snow, Dr., 130 Snowball riot, the, 42 Sound, the, 168 Squabbles, Simpson's, 78 Stafford House, Simpson's visit to, 80 St. Bartholomew's Hospital, 151 Stevenson, R. L., 80 Storer, Dr., 217 Student, the Edinburgh medical, 33 Superstitions, 4, 5, 12 Surgery at Simpson's birth, 3 before anæsthesia, 88-91 after anæsthesia, 131 Sutherland, the Duchess of, 80, 86 Syme, Professor, 26, 31, 60, 61, 73, 114, 175, 130, 140, 148, 151, 186 T Thatcher, Dr., 37, 63 Thesis, Simpson's, for M.D. degree, 39 Thomson, Professor, 39, 60, 72 Town council of Edinburgh, the, 28, 58, 60, 63, 65, 73, 188, 192 Traill, Professor, 60 U Universities (Scots) Act, 188, 193 University of Edinburgh, 14, 18, 26, 28, 31, 130 V Verses, Simpson's, 33, 202 Viewbank, 143, 211 W Waldie, Mr., 105 Wallace, Professor, 18 Warren, Dr. J. Collins, 102 Warriston cemetery, 216 Weavers, the, of Bathgate, 8, 9 Wells, Horace, 97, 132, 198 Wesley, John, 71 Westminster Abbey, 215, 219 Williams, Dr., of York, 213 Wilson, George, 42 Wilson, Professor John, 18, 27 Women, medical, 188 Wound-healing, 176 Y York, Simpson's visit to, 213 Young, Professor Thomas, 59 The Gresham Press, UNWIN BROTHERS, WOKING AND LONDON. 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Full of delightful sketches of men and things."--W. L. COURTNEY in _The Daily Telegraph_. "A work which adds many a fresh page to English, and one may say to European history.... From first to last the volume is excellent reading, while the entertaining style in which the matter is presented and the undeniable authority of the writer ... render the book of special interest and permanent value."--_The Morning Post._ "Quite as good as a novel--and a good dead better, too. The book is so bright and vivid that readers with the common dislike of history may venture on its pages unafraid."--ANDREW LANG in _Cosmopolis_. * * * * * SIR WALTER RALEGH Being Vol. I. of the series entitled "Builders of Greater Britain," each vol. with photogravure frontispiece and map. _Large crown 8vo., cloth, =5s.= each_. "There is not a dull page in it, and, with his skilful telling of it, the story of Raleigh's life and of his times reads like a romance."--_Pall Mall Gazette._ * * * * * Transcriber Notes Archaic and variable spelling is preserved, including 'receptable'. Passages in italics indicated by _underscores_. Passages in bold indicated by =equal signs=. Greek transliterations are surrounded by ~tildes~. 
38752	----	[ Transcriber's Notes: Every effort has been made to replicate this text as faithfully as possible, including inconsistencies in spelling and hyphenation. Some corrections of spelling and punctuation have been made. They are listed at the end of the text. Italic text has been marked with _underscores_. ] THE STORY OF A DOCTOR'S TELEPHONE--TOLD BY HIS WIFE BY ELLEN M. FIREBAUGH Author of "The Physician's Wife" BOSTON, MASS.: THE ROXBURGH PUBLISHING COMPANY (Incorporated) Copyrighted, 1912 By Ellen M. Firebaugh All rights reserved TO MY HUSBAND TO THE READER. The telephone has revolutionized the doctor's life. In the old days when a horse's galloping hoofs were heard people looked out of their windows and wondered if that wasn't someone after a doctor! The steed that Franklin harnessed bears the message now, and comments and curiosity are stilled. In the old days thunderous knocks came often to the doctor's door at night; they are never heard now, or so rarely as to need no mention. Neighbors have been awakened by these importunate raps: they sleep on undisturbed now. The doctor's household enjoys nothing of this sweet immunity. A disturbing factor is within it that makes the thunderous knocks of old pale into insignificance. When the telephone first came into the town where our doctor lived he had one put in his office of course, for if anyone in the world needs a 'phone it is the doctor and the people who want him. By and by he bethought him that since his office was several blocks from his residence he had better put one in there, too, because of calls that come in the night. So it was promptly installed. The doctor and his wife found their sleep disturbed far oftener than before. People will not dress and go out into the night to the doctor's house unless it is necessary. But it is an easy thing to step to the 'phone and call him from his sleep to answer questions--often needless--and when several people do the same thing in the same night, as frequently happens, it is not hard to see what the effect may be. One day the doctor had an idea! He would connect the two 'phones. It would be a handy thing for Mary to be able to talk to him about the numberless little things that come up in a household without the trouble of ringing central every time, and it would be a handy thing for him, too. When he had to leave the office he could just 'phone Mary and she could keep an ear on the 'phone till he got back. About this time another telephone system was established in the town--the Farmers'. Now a doctor's clientele includes many farmers, so he put one of the new 'phones into his office. By and by he reflected that farmers are apt to need to consult a physician at night--he must put in a Farmers' 'phone at home, too. And he did. Then he connected it with the office. When the first 'phone went up Mary soon accustomed herself to its call--three rings. When her husband connected it with the office the rings were multiplied by three. One ring meant someone at the office calling central. Two rings meant someone calling the office. Three rings meant someone calling the residence, as before. Mary found the three calls confusing. When the Farmers' 'phone was installed and the same order of rings set up, she found the original ring multiplied by six. This was confusion worse confounded. To be sure the bell on the Farmers' had a somewhat hoarser sound than that on the Citizens' 'phone, but Mary's ear was the only one in the household that could tell the difference with certainty. The clock in the same room struck the half hours which did not tend to simplify matters. When a new door-bell was put on the front door Mary found she had eight different rings to contend with. But it is the bells of the Telephone with which we are concerned and something of their story will unfold as we proceed. When the doctor was at home and the 'phone would ring he would start toward the adjoining room where the two hung and stop at the first. Mary would call "Farmers'!" and he would move on to the next. Perhaps at the same instant the tall boy of the household whose ear was no more accurate than that of his father would shout "Citizens'!" and the doctor would stop between the two. "_Farmers'!_" the wife would call a second time, with accrued emphasis. Then she would laugh heartily and declare: "Any one coming in might think this a sort of forum where orations were being delivered," and sometimes she would go on and declaim: "Friends, Romans, countrymen, lend me your ears--my husband has borrowed mine." So the telephone in the doctor's house--so great a necessity that we cannot conceive of life without it, so great a blessing that we are hourly grateful for it, is yet a very great tyrant whose dominion is absolute. I had a pleasing picture in my mind in the writing of this chronicle, of sitting serene and undisturbed in a cosy den upstairs, with all the doors between me and the 'phone shut tight where no sound might intrude. In vain. Without climbing to the attic I could not get so far away that the tintinnabulation that so mercilessly wells from those bells, bells, bells did not penetrate. I hope my readers have not got so far away from their Poe as to imagine that ringing sentence to be mine. And I wonder if a still greater glory might not crown his brow if there had been telephone bells to celebrate in Poe's day. So I gave up the pleasant dream, abandoned the cosy den and came down stairs to the dining room where I can scatter my manuscript about on the big table, and look the tyrants in the face and answer the queries that arise, and can sandwich in a good many little odd jobs besides. Through a doctor's telephone how many glimpses of human nature and how many peeps into the great Story of Life have been mine; and if, while the reader is peeping too, the scene suddenly closes, why that is the way of telephones and not the fault of the writer. And knowing how restful a thing it has been to me to get away from the ringing of the bell at times, I have devised a rest for the reader also and have sent him with the doctor and his wife on an occasional country drive where no telephone intrudes. E. M. F. Robinson, Ill. The Story of a Doctor's Telephone CHAPTER I. The hands of the clock were climbing around toward eleven and the doctor had not returned. Mary, a drowsiness beginning to steal over her, looked up with a yawn. Then she fell into a soliloquy: To bed, or not to bed--that is the question: Whether 'tis wiser in the wife to wait for a belated spouse, Or to wrap the drapery of her couch about her And lie down to pleasant dreams? To dream! perchance to sleep! And by that sleep to end the headache And the thousand other ills that flesh is heir to, The restoration of a wilted frame,-- Wilted by loss of sleep on previous nights-- A consummation devoutly to be wished. To dream! perchance to sleep!--aye, there's the rub; For in that somnolence what peals may come Must give her pause. There is the telephone That makes calamity of her repose. Her spouse may not have come to answer it, Which means that she, his wife, must issue forth All dazed and breathless from delicious sleep, And knock her knees on intervening chairs, And bump her head on a half open door, And get there finally all out of breath, And take the receiver down and say: "Hello?" The old, old question: "Is the doctor there?" Comes clearly now to her awakened ear. Then, tentatively, she must make reply: "The doctor was called out an hour ago, But I expect him now at any time." Good patrons should be held and not escape To other doctors that may lie in wait; For in this voice so brusque and straight and clear She recognizes an old friend and true, Whose purse is ever ready to make good, And she hath need of many, many things. But then, again, the message of the 'phone May be that of some stricken little child Whose mother's voice trembles with love and fear. Then must the listener earnestly advise: "Don't wait for him! Get someone else to-night." Perchance again the message may be that Of colics dire and death so imminent That she who listens, tho' with 'customed ear, Shrinks back dismayed and knows not what to say, Lacking the knowledge and profanity Of him who, were he there, would settle quick This much ado about much nothingness. And so these anticipatory peals Reverberate through fancy as she sits, And make her rather choose to bear the ills She has than fly to others she may meet; To wait a little longer for her spouse, That, when at last she does retire to rest, She may be somewhat surer of her sleep. And so she sits there waiting for the step And the accompanying clearing of the throat Which she would know were she in Zanzibar. And by-and-by he comes and fate is kind And lets them slumber till the early dawn. CHAPTER II. Ten P.M. The 'phone is ringing and the sleepy doctor gets out of bed and goes to answer it. "Hello." No response. "Hello!" Silence. "Hello!!" "Is this Doctor Blank?" "Yes." "I want you to come out to my house--my wife's sick." "Who is it?" "Jim Warner. Come just as--" A click in the receiver. The doctor waits a minute. Then he says "Hello." No answer. He waits another minute. "_Hell-o!!_" Silence. "Damn that girl--she's cut us off." He hangs up the receiver and rings the bell sharply. He takes it down and hears a voice say leisurely, "D'ye get them?" "Yes! What in h-ll did you cut us off for?" "Wait a minute--I'll ring 'em again," says the voice, hasty and obliging, so potent a thing is a man's unveiled wrath. She rings 'em again. Soon the same voice says, "Are you there yet, Doctor?" "Yes, _now_ what is it!" The voice proceeds and the doctor listens putting in an occasional "Yes" or "No." Then he says, "All right--I'll be out there in a little bit." He hangs up the receiver and his wife falls asleep again. The doctor dresses and goes out. The house is in darkness. All is still. In about five minutes Mary is suddenly, sharply awake. A slight noise in the adjoining room! She listens with accelerated heart-beats. The doctor has failed to put on the night latch. Some thief has been lying in wait watching for his opportunity, and now he has entered. What can she do. Muffled footsteps! she pulls the sheet over her head, her heart beating to suffocation. The footsteps grope their way toward her room! Great Heaven! A hand fumbles at the door knob. She shrieks aloud. "What on earth is the matter!" O, brusque and blessed is that voice! "John, you have nearly scared me to death," she says, sitting up in bed, half laughing and half crying. "But I heard you tell that man you were coming out there." "Yes. I told him I was." "Well, why didn't you go?" "I _did_ go." "You don't mean to tell me you have been a mile and back in five minutes." The doctor flashed on the light and looked at his watch,--"Just an hour since I left home," he said. Mary gasped. "Well, it only proves how soundly I can sleep when I get a chance," she said. * * * * * Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. It is the office ring but Mary hurries at once to answer it. "Is this Dr. Blank's office?" "This is Mrs. Blank. But the doctor telephoned me about twenty minutes ago that he would be out for half an hour. Call him again in ten or fifteen minutes and I think you will find him." In about fifteen minutes the call is repeated. Mary would feel better satisfied to know that the doctor received the message so she goes to the 'phone and listens. Silence. She waits a minute. Shall she speak? She hesitates. Struggle as she will against the feeling, she can't quite overcome it--it seems like "butting in." But that long silence with the listening ear at the other end of it is too much for her. Very pleasantly, almost apologetically she asks, "What is it?" "The doctor hasn't come yet?" says a plainly disappointed voice. "No--not yet. There are often unexpected things to delay him--if you will give me your number or your name I will have him call _you_." "No, I'll just wait and call him again." The inflection says plainly, "I don't care to admit the doctor's wife into my confidences." "Very well. I am sure it can't be long now till he returns." Mary goes back to her chair and ponders a little. Of what avail to multiply words. No use to tell the woman 'phoning that she was willing to take the waiting and the watching, the seeing that the doctor received the message upon herself rather than that the other should be again troubled by it. No use to let her gently understand that she doesn't care for any confidences which belong only to her husband, but Fate has placed her in a position where she has oftentimes to seem unduly interested. That these messages which are only occasional with the one calling are constant with her and that she is only mindful of them when she must be. * * * * * "Watch the 'phone." How thoroughly instilled into Mary's consciousness that admonition was! She did not heed the office ring when it came, but if it came a second time she always went to explain that the doctor had just stepped over to the drug store probably and would be back in a very few minutes. Often, as she stood explaining, the doctor himself would break into the conversation, having been in another room when the first call came, and getting there a little tardily for the second. But occasions sometimes arose which made Mary feel very thankful that she had been at the 'phone. One winter morning as she stood explaining to some woman that the doctor would be in in a few minutes, her husband's "Hello" was heard. "There he is now," she said. Usually after this announcement she would hang up the receiver and go about her work. Today a friendly interest in this pleasant voice kept it in her hand a moment. Mary would not have admitted idle curiosity, and perhaps she had as little of it as falls to the lot of women, but sometimes she lingered a moment for the message, to know if the doctor was to be called away, so that she might make her plans for dinner accordingly. The pleasant voice spoke again, "This is Dr. Blank, is it?" "Yes." "We want you to come out to Henry Ogden's." "That's about five miles out, isn't it. Who's sick out there?" "Mrs. Ogden." "What's the matter?" No reply. "How long has she been sick?" "She began complaining last night." "All right--I'll be out some time today." "Come right away, please, if you can." This is an old, old plea. The doctor is thoroughly inured to it. He would have to be twenty men instead of one to respond to it at all times. He answers cheerfully, "All right," and Mary takes alarm. That tone means sometime in the next few hours. She feels sure he ought to go _now_. Somebody else can wait better than this patient. There was a kind of hesitancy in that voice that Mary had heard before. A woman's intuitions are much safer guides than a man's slow reasoning. She must speak to John. She rings the office. "Hello." "Say, John," she says in a low voice, "I came to the 'phone thinking you were out and heard that message. I think you ought to go out there right _away_." "Well, I'm going after a little." "But I don't think you ought to wait. I'm sure it's--_you_ know." "Well,--maybe I had better go right out." "I wish you would. I know they'll be looking for you every minute." A few minutes later Mary saw him drive past and was glad. Half an hour later the office ring sounded. She did not wait for the second peal. True, John had not said, "Watch the 'phone," today, but that was understood. Occasionally he got an old man who lived next door to the office to come in and stay during his absence. Possibly he might have done so today. But even if he were there the telephone and its ways were a dark mystery to him and besides, his deafness made him of little use in that direction. Mary took down the receiver and put it to her ear. A lady's voice was asking, "Who _is_ this?" Mary knew from her inflection that she had asked something before and was not satisfied with the reply. "_This_ is Dr. Blank's office?" announced the old man in a sort of interrogative. "Well, where is the _doctor_?" "The doctor," said the old man meditatively, as if wondering that anybody should be calling for him--"the doctor--you mean Dr. Blank, I reckon?" "I certainly do." "Good Heavens," thought Mary, "why _don't_ he go on!" "Why, he's out." "Where _is_ he?" "He went to the country." Mary shut her lips tight. "_Well_, when will he be back?" "He 'lowed he'd be back in about an hour or so." "How long has he been _gone_? Maybe I'll get some information after a while." Mary longed to speak. Why hadn't she done so at first. If she thrust herself in now it would make her out an eavesdropper. But this was unbearable. She opened her mouth to speak when the old man answered. "He's been gone over an hour now, I reckon." "Then he'll soon be back. Will you be there when he comes?" "Yes ma'am." "Then tell him to come up to Mrs. Dorlan's." "To Mrs. Who's?" "Mrs. _Dorlan's_." "I didn't ketch the name." "_Mrs. Dorlan's_, on Brownson street." "Mrs. Torren's?" "MISS-ES--DOR-LAN'S!" shouted the voice. Mary sighed fiercely and clinched her teeth unconsciously. "I _will_ speak," she thought, when the old voice ventured doubtingly, "Mrs. Dorlan's?" "That's it. Mrs. Dorlan's on Brownson street, will you remember it?" "Mrs. Dorlan's, on Brownson street." "That's right. Please tell him just as soon as he comes to come right up." "All right--I'll tell him." "Poor old fellow!" said Mary as she turned from the 'phone, "but I don't want to go through any more ordeals like that. It was a good deal harder for me than for the other woman." The doctor came down late to dinner. "You got Mrs. Dorlan's message did you?" "Yes, I'll go up there right after dinner." He looked at his wife with peculiar admiration. "How did you know what was wanted with me out in the country?" he asked. With a little pardonable pride she replied: "Oh, I just felt it. Women have ways of understanding each other that men never attain to. Is it a boy or a girl added to the world today?" "Neither," said the doctor placidly, helping himself to a roll. Chagrin overspread her face. "Well," she said with an embarrassed smile, "I erred on mercy's side, and it _might_ have happened in just that way, John, and you know it." The doctor laughed. "There was mighty little the matter out there--they didn't need a doctor." "Are they good pay?" "Good as old wheat." "Then there are compensations." * * * * * Some hours later when the 'phone rang, Mary went to explain that the doctor had 'phoned her he would be out about twenty minutes. But she found no chance to speak. A spirited dialogue was taking place between a young man and a maid: "Where _are_ you, Jack?" "I'm right here." "Smarty! Where _are_ you!" "In Dr. Blank's office." "What are you there for?" "I'm waiting for the doctor and to while away the time thought I'd call you up." Then it was his ring that Mary had answered. "I ought to hang this receiver right up," thought she, but instead she held it, her face beaming with a sympathetic smile. "Are you feeling better today, Dolly?" "Yes, I'm better." "Able to go to the show then, tonight?" "_Yes_, I'm able to go." Here a thin small voice put in, "No, you're not able! You're not going." "Mamma says,--" began a pouting voice. "I heard what she said," said Jack, laughing. "Have you been up all day?" "Most of the day." "Can you eat anything?" "I ate an egg, some toast and some fruit for dinner." "That's fine. I'll bring you a box of candy then pretty soon--I'm coming down in a little bit." "That will be lovely." "Which, the candy or the coming down?" "The candy, goose, of course." A laugh at both ends of the wire. Then Jack's voice. "Well, here comes the doctor. I've got to have my neck amputated now. Goodbye." "Good-bye." "All's fair in love and war," said Mary, "and it's plain to see what this is." Then she hung up the receiver without a qualm. * * * * * There were other times when the doctor's wife was glad she had gone to the 'phone, as in this instance. She had taken down the receiver when a man's voice said, "The doctor just stepped out for a few minutes. If you will tell me your name, madam, I'll have him call you when he comes in." Disinterested courtesy spoke in his voice, but Mary was not in the least surprised to hear the curt reply, "It won't be necessary. I'll call _him_ when he comes." "I dare say that gentleman, whoever he may be, is wondering what he has done," thought Mary. But it was not altogether unpleasant to her to hear somebody else squelched, too! * * * * * There came a day when the doctor's wife rebelled. When her husband came home and ate his supper hastily and then rose to depart, she said, "You'd better wait at home a few minutes, John." "Why?" He put the question brusquely, his hat in his hand. "Because I think someone will ring here for you in a minute or two. Some man rang the office twice so I went to the 'phone to explain that you must be on your way to supper and he could find you here." "Who was it?" "I do not know." "Thunder! Why didn't you find out?" Mary looked straight at her husband. "How many times have I told you, John, that many people decline to give their names or their messages to any one but you. I think I should feel that way about it myself. For a long time I have dutifully done your bidding in the matter, but now I vow I will not trample my pride under my feet any longer--especially when it is all in vain. I will watch the 'phone as faithfully as in the past, but I will not ask for any name or any message. They will be given voluntarily if at all." "All right, Mary," said the doctor, gently, seeing that she was quite serious. "I do not mean to say that most of the people who 'phone are grouchy and disagreeable--far from it. Indeed the majority are pleasant and courteous. But it is those who are not who have routed me, and made me vow my vow. Don't ask me to break it, John, for I will not." And having delivered this declaration, Mary felt almost as free and independent as in ante-telephone days. The doctor had seated himself and leaning forward was swinging his hat restlessly between his knees. He waited five minutes. "I'll have to get back to the office," he exclaimed, starting up. "I'm expecting a man to pay me some money. Waiting for the 'phone to ring is like watching for the pot to boil." When he had been gone a minute or two, the ring came. With a new step Mary advanced to it. "Has the doctor got there yet?" the voice had lost none of its grouch. "He has. And he waited for your message which did not come. He could not wait longer. He has just gone to the office. If you will 'phone him there in two or three minutes, instead of waiting till he is called out again, you will find him." "Thank you, Mrs. Blank." The man was surprised into courtesy. The clear-cut, distinct sentences were very different from the faltering, apologetic ones, when she had asked for his name or his message twenty minutes before. Mary's receiver clicked with no uncertain sound and a smile illumined her face. * * * * * One day when the snow was flying and the wind was blowing a gale the doctor came hurrying in. "Where is the soapstone?" he asked, with small amenity. His wife flew to get it and laid it on the hearth very close to the coals. "Oh dear! How terrible to go out in such a storm. Do you _have_ to?" she asked. "I certainly do. Do you think I'd choose a day like this for a pleasure trip?" "Aren't you glad you got that galloway?" she asked, hurrying to bring the big, hairy garment from its hook in the closet. She helped her husband into it, turned the broad collar up--then, when the soapstone was hot, she wrapped it up and gave it to him. "This ought to keep your feet from freezing," she said. The doctor took it, hurried out to the buggy, pulled the robes up around him and was gone. "Eight miles in this blizzard!" thought Mary shivering, "and eight miles back--sixteen miles. It will take most of the day." Two hours after the doctor had gone the telephone rang. "Is Dr. Blank there?" "No, he is in the country, about eight miles southwest." "This is Drayton. We want him at John Small's as soon as possible. How soon do you think he will be back?" "Not for several hours, I am afraid." "Well, will you send him down as soon as he comes? We want him _bad_." Mary assured him she would do so. "Poor John," she thought as she put up the receiver. In a few minutes she went hurriedly back. When she had called central, she said, "I am very anxious to get Dr. Blank, central. He is eight miles southwest of here--at the home of Thomas Calhoun. Is there a 'phone there?" Silence for a few seconds then a voice, "No, there is no 'phone at Thomas Calhoun's." Disappointed, Mary stood irresolute, thinking. Then she asked, "Is there a 'phone at Mr. William Huntley's?" "Yes, William Huntley has a 'phone." "Thank you. Please call that house for me." In a minute a man's voice said, "Hello." "Is this Mr. Huntley?" "Yes." "Mr. Huntley, this is Mrs. Blank. You live not far from Thomas Calhoun's, do you not?" "About half a mile." "Dr. Blank is there, or will be very soon, and there is an urgent call for him to go on to Drayton. I want to save him the long drive home first. I find there is no 'phone at Mr. Calhoun's so I have called you hoping you might be able to help me out. Perhaps someone of your family will be going down that way and will stop in." "I'll go, myself." "It's too bad to ask any one to go out on a day like this--" "That's all right, Mrs. Blank. Doc's been pretty clever to me." "Tell him, please, to go to John Small's at Drayton. I am very deeply obliged to you for your kindness, Mr. Huntley," she said, hanging the receiver in its place. "Eight miles back home, six miles from here to Drayton, six miles back--twenty miles in all. Four miles from Calhoun's to Drayton, six miles from Drayton home--ten miles saved on a blizzardy day," she thought in the thankfulness of her heart. A few minutes later she was again at the 'phone. "Please give me John Small's at Drayton." When the voice came she said, "I wanted to tell you that the doctor will be there perhaps in about an hour now. I got your message to him so that he will go directly to your house." "I'm mighty glad to know it. Thank you, Mrs. Blank, for finding him and for letting us know." A terrible drive saved and some anxious hearts relieved. That dear 'phone! How thankful she was for it and for the country drives she had taken with her husband which had made her familiar with the homes and names of many farmers. Otherwise she could not have located her husband this morning. One day like this covered a multitude of tyrannies from the little instrument on the wall. * * * * * It was about half past seven. The doctor had thought it probable that he could get off early this evening and then he and Mary and the boys would have a game of whist. He had been called in consultation to W., a little town in an adjoining county, but he would be home in a little bit--in just ten minutes the train would be due. "O, there goes that 'phone," said the small boy wrathfully. "Now, I s'pose papa can't get here!" His mother was already there with the receiver at her ear. "This is Dr. Blank's residence." "No, but he will be here in fifteen or twenty minutes." "To Drayton?" "Very well. I will give him your message as soon as he gets home. I'm afraid that ends the game for tonight, boys," putting the receiver up. "Why, does papa have to go away?" "Yes, he has to drive six miles." "Gee-mi-nee--this dark night in the mud!" Here a thought flashed into Mary's mind--Drayton was on the same railroad on which the doctor was rapidly nearing home--the next station beyond. She flew to the telephone and rang with nervous haste. "Hello." "Is this the Big Four?" "Yes." "This is Mrs. Blank. Dr. Blank is on the train which is due now. He is wanted at Drayton. When he gets off, will you please tell him?" "To go on to Drayton?" "Yes, to Alfred Walton's." "All right. I'll watch for him and see that he gets aboard again." "Thank you very much." The train whistled. "Just in time," said Mary. "But how'll papa get back?" asked the smaller boy. "He's got a tie-ticket," said his brother. "Yes, papa would rather walk back on the railroad than drive both ways through this deep mud," said their mother. "I have heard him say so." Another ring. "Is the doctor there?" "He has just gone on the train to Drayton." "How soon will he be back?" "In an hour and a half, I should think." Mary heard the 'phoner say in an aside, "He won't be back for an hour and a half. Do you want to wait that long?" Another voice replied, "Yes, I'll wait. Tell 'em to tell him to come just as quick as he gets back, though." This message was transmitted. "And where is he to go?" "To Henry Smith's, down by the Big Four depot." A few minutes later Mary had another idea. She went to the 'phone and asked central to give her Drayton, Mr. Walton's house. In a minute a voice said, "What is it?" It was restful to Mary to have the usual opening varied. Perhaps eight out of ten began with, "Hello!" The other two began, "Yes," "Well," "What is it?" and very rarely, "Good morning," or "Good evening." "Is this the home of Mr. Walton at Drayton?" "Yes." "Dr. Blank is there just now, isn't he?" "Yes, but he's just going away." "Will you please ask him to come to the 'phone?" In a minute her husband's voice was heard asking what was wanted. "I want to save you a long walk when you get home, John. You're wanted at Henry Smith's down by the Big Four depot." "All right. I'll go in to see him when I get there. Much obliged." "A mile walk saved there," mused the doctor's wife, as she joined the two boys, mildly grumbling because they couldn't have their game, and never could have it just when they wanted it. But a few chapters from Ivanhoe read to them by their mother made all serene again. * * * * * The Citizens' 'phone was ringing persistently. The doctor's wife had been upstairs and could not get to it in less than no time! But she got there. "Do you know where Dr. Blank is?" the words hurled themselves against her ear. "I don't know just at this minute--but he's here in town. I'm sure of that." "Why don't he _come_ then!" The sentence came as from a catapult. "I don't know anything about it. Where was he to go?" A scornful "_Huh!_" came over the wire--"I guess you forgot to tell 'im." "I have not been asked to tell him anything this morning." There was heated silence for an instant, then a voice big with wrath: "You told me not fifteen minutes ago that you would send him right down." "You are mistaken," said Mary gently but firmly. "This is the first time I have been at the 'phone this morning." "Well, what do you think of that!" This was addressed to someone at the other end of the line, but it came clearly to Mary's ear and its intonation said volumes. "You're the very identical woman that told me when I 'phoned awhile ago that you'd send him right down. It's the very same voice." "There is a mistake somewhere," reiterated Mary, patiently, "but I'll send the doctor as soon as he gets in if you will give me your name." "I'll tell ye agin, then, that he's to come to Lige Thornton's." "Very well. I'll send him," and Mary left the 'phone much mystified. "She was in dead earnest--and so was I. I can't understand it." Glancing out of the window she saw her tall, young daughter coming up the walk. The solution came with lightning quickness--strange she didn't think of that, Gertrude had answered. She remembered now that others had thought their voices very much alike, especially over the 'phone. "If the woman had not talked in such a cyclonic way I would have thought of it," she reflected. When the young girl entered the room her mother said, "Gertrude, you answered the 'phone awhile ago, didn't you?" "About twenty minutes ago. Some woman was so anxious for father to come right away that I just ran down to the office to see that he _went_." "That was very thoughtful of you, dear, but it's little credit we're getting for it." She related the dialogue that had just taken place and mother and daughter laughed in sympathy. "Why, Mamma, we couldn't forget if we wanted to. That telephone is an Old Man of the Sea to both of us--is now and ever shall be, world without end." "But did you find your father at the office?" "Yes, and waited till he fixed up some medicine for two patients already waiting, then shooed him out before some more came in. I wanted to get it off _my_ mind." "I'm glad he is on his way. Now stay within hearing of the 'phone, dearie, till I finish my work up-stairs." "All right, Mamma, I'm going to make a cake now, but I can hear the 'phone plainly from the kitchen." It wasn't long till a ring was heard. Gertrude dusted the flour from her hands and started. "Which 'phone was it?" she asked the maid. "I think it was the Farmers'," said Mollie, hesitating. So to the Farmers' 'phone went Gertrude. "Hello." No answer. "Hello." Silence. She clapped the receiver up and hurried to the Citizens' 'phone. "Hello." "Is this Dr. Blank's?" "Yes." "Is he there?" "No, he was called--" Here a loud ring from the other 'phone sounded. "He was called down to--" said Gertrude rapidly, then paused, unable to think of the name at the instant. "If you will tell me where he went, I'll just 'phone down there for him," said the voice. A second peal from the other 'phone. "_Yes, yes!_" said Gertrude impatiently. "O, I didn't mean that for you," she hurried apologetically. "The other 'phone is calling, and I'm so confused I can't think. Will you excuse me just an instant till I see what is wanted?" "Certainly." She flew to the Farmers' 'phone. "Is this Dr. Blank's?" "Yes." "Good while a-answerin'," grumbled a voice. "I did answer but no one answered _me_." "Where's the doctor?" "He's down in the east part of town--will be back in a little bit." "Well, when he comes tell him--just hold the 'phone a minute, will you, till I speak to my wife." "All right." But she put the receiver swiftly up and rushed back to the waiting man. She could answer him and get back by the time the other was ready for her. "Hello, still there?" "Yes." "I've thought of the name--father went to Elijah Thornton's." "Thornton's--let's see--have you a telephone directory handy--could you give me their number?" "Wait a minute, I'll see." She raced through the pages,--"yes, here it is." A violent peal from the Farmers' 'phone. "He'll think I'm still hunting for the number," she thought, letting the receiver hang and rushing to the other 'phone. "Hello." "Thought you was a-goin' to hold the 'phone. I've had a turrible time gittin' any answer." "I've had a turrible time, too," thought poor Gertrude. "Tell the doctor to call me up," and he gave his name and his number. "All right, I'll tell him." She clapped the receiver up lest there might be more to follow and sped back. "Here it is," she announced calmly, "Elijah Thornton, number 101." "Thank you, I'm afraid I've put you to a good deal of trouble." "Not at all." As she went back to her cake she said to herself, "Two telephones ringing at once can certainly make things interesting." * * * * * One day in mid winter Mary sat half dreaming before the glowing coals. Snow had fallen all through the previous night and today there had been good coasting for the boys and girls. Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. She started up and went to answer it. "Is this you, Mary?" "Yes." "I'll be out of the office about twenty minutes." "Very well." Sometimes Mary wished her husband would be a little more explicit. She had a vague sort of feeling that central, or whoever should chance to hear him make this announcement to her so often, might think she requested or perhaps demanded it; might think she wanted to know every place her husband went. In about half an hour the 'phone rang again, two rings. John ought to be back. Should she take it for granted? It would be safer to put the receiver to her ear and listen for her husband's voice. "Hello." "Hello." "Is this you Dr. Blank?" "Looks like it." "We want ye to come down to our house right away." "Who is this?" "W'y, this is Mrs. Peters." "Mrs. Peters? Oh yes," said the doctor, recognizing the voice now. "What's the matter down there, grandmother?" "W'y--my little grandson, Johnny, was slidin' down hill on a board and got a splinter in his setter." "He did, eh?" "Yes, he did, and a big one, too." "Well, I'll be down there right away. Have some boiled water." Mary turned away from the telephone that it might not register her low laughter as she put the receiver in its place. The next instant she took it down again with twinkling eyes and listened. Yes, the voices were silent, it would be safe. She rang two rings. "Hello," said her husband's voice. "John," said Mary, almost in a whisper, "for English free and unadorned, commend me to a little boy's grandmother!" Two laughs met over the wire, then two receivers clicked. * * * * * One day Mary came in from a walk and noticed at once, a vacant place on the wall where the Farmers' 'phone had hung. She had heard rumors of a merger of the two systems and had fervently hoped that they might merge soon and forever. "Look! Mamma," said Gertrude, pointing to the wall. "Oh frabjous day! Callooh! Callay! One telephone is taken away!" she chortled in her joy. (The small boy of the household had been reading "Alice" and consequently declaiming the Jabberwock from morning till night, till its weird strains had become fixed in the various minds of the household and notably in Gertrude's.) "It will simplify matters," said her mother, smiling, "but liberty is not for us. _That_ tuneful peal will still ring on," and as she looked at the Citizens' 'phone the peal came. CHAPTER III. One Monday evening the doctor and his wife sat chatting cosily before the fire. In the midst of their conversation, Mary looked up suddenly. "I had a queer little experience this morning, John, I want to tell you about it." "Tell ahead," said John, propping his slippered feet up on the fender. "Well, I got my pen and paper ready to write a letter to Mrs. E. I wanted to write it yesterday afternoon and tell her some little household incidents just while they were taking place, as she is fond of the doings and sayings of boys and they are more realistic if reported in the present tense. But I couldn't get at it yesterday afternoon. When I started to write it this morning it occurred to me to date the letter Sunday afternoon and write it just as I would have done yesterday--so I did. When I had got it half done or more I heard the door-bell and going to open it I saw through the large glass--" Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. The doctor went to the 'phone. "Yes." "Yes." "Where do you live?" "I'll be right down." He went back, hastily removed his slippers and began putting on his shoes. Mary saw that he had clean forgotten her story. Very well. It wouldn't take more than a minute to finish it--there would be plenty of time while he was getting into his shoes--but if he was not enough interested to refer to it again she certainly would not. In a few minutes the doctor was gone and Mary went to bed. An hour or two later his voice broke in upon her slumber. "Back again," he said as he settled down upon his pillow. In a minute he exclaimed, "Say, Mary, what was the rest of that story?" "O, don't get me roused up. I'm _so_ sleepy," she said drowsily. "Well, I'd like to hear it." The interest in her little story which had not been exhibited at the proper time was being exhibited now with a vengeance. She sighed and said, "I can't think of it now--tell you in the morning. Good night," and turned away. When morning came and they were both awake, the doctor again referred to the unfinished story. "It's lost interest for me. It wasn't a story to start with, just a little incident that seemed odd--" "Well, let's have it." "Well, then," said Mary, "I was writing away when the door-bell rang. I went to open it and saw through the glass the laundry man--" Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. "Go on!" exclaimed her husband, hurriedly, "I'll wait till you finish." "I'll not _race_ through a story in any such John Gilpin style," said Mary, tartly. "Go, John!" The doctor arose and went. "No." "I think not." "Has she any fever?" "All right, I'll be down in a little bit." Then he went back. "Now you can finish," he said. "Finis is written _here_," said Mary. "Don't say story to me again!" So Mary's story remained unfinished. But a few days later, when she was in the buggy with her husband she relented. "Now that the 'phone can't cut me short, John, I will finish about the odd incident just because you wanted to know. But it will fall pretty flat now, as all things do with too many preliminary flourishes." "Go on," said the doctor. "Well, you know I told you I dated my letter back to Sunday afternoon, and was writing away when I heard the door-bell ring. As I started toward the door I saw the laundry man standing there. I was conscious of looking at him in astonishment and in a dazed sort of way as I walked across the large room to open the door. I am sure he must have noticed the expression on my face. When I opened the door he asked as he always does, 'Any laundry?'" "'Any laundry _today_?' The words were on my tongue's end but I stopped them in time. You see it was really Sunday to me, so deep into the spirit of it had I got, and it was with a little shock that I came back to Monday again in time to answer the man in a rational way. And now my story's done." "Not a bad one, either," said John, "I'm glad you condescended to finish it." * * * * * The doctor came home at ten o'clock and went straight to bed and to sleep. At eleven he was called. "What is it?" he asked gruffly. "It's time for Silas to take his medicine and he won't do it." "Won't, eh?" "No, he vows he won't." "Well, let him alone for a while and then try again." About one came another ring. "We've both been asleep, Doctor, but I've been up fifteen minutes trying to get him to take his medicine and he won't do it. He says it's too damned nasty and that he don't need it anyhow." "Tell him I say he's a mighty good farmer, but a devilish poor doctor." "I don't know what to do. I can't make him take it." "You'll have to let him alone for awhile I guess, maybe he'll change his mind after awhile." At three o'clock the doctor was again at the telephone. "Doctor, he just will _not_ take it," the voice was now quite distressed. "I can't manage him at all." "You _ought_ to manage him. What's a wife for? Well, go to bed and don't bother him or me any more tonight." But early next morning Silas' wife telephoned again. "I thought I ought to tell you that he hasn't taken it yet." "He'll get well anyway. Don't be a bit uneasy about _him_," said the doctor, laughing, as he rung off. * * * * * "It's time to go, John." Mary was drawing on her gloves. She looked at her moveless husband as he sat before the crackling blaze in the big fireplace. "This is better than church," he made reply. "But you promised you would go tonight. Come on." "It isn't time yet, is it?" "The last bell will ring before we get there." "Well, let's wait till all that singing's over. That just about breaks my back." Mary sat down resignedly. If they missed the singing perhaps John would not look at his watch and sigh so loud during the sermon. And it might not be a bad idea to miss the singing for another reason. The last time John had gone to church he had astonished her by sliding up beside her, taking hold of the hymn-book and singing! It happened to be his old favorite, "Sweet fields beyond the swelling flood." Of course it was lovely that he should want to sing it with her--but the _way_ he sang it! He was in the wrong key and he came out two or three syllables behind on most of the lines, but undismayed by the sudden curtailment went boldly ahead on the next. And Mary had been much relieved when the hymn was ended and the book was closed. So now she waited very patiently for her husband to make some move toward starting. By and by he got up and they went out. No sooner was the door closed behind them than the "ting-a-ling-ling-ling" was heard. The doctor threw open the door and went back. Mary, waiting at the threshold, heard one side of the dialogue. "Yes." "Down where?" "Shake up your 'phone. I can't hear you." "That's better. Now what is it?" "Swallowed benzine, did she? How much?... That won't kill her. Give her some warm water to drink. And give her a spoonful of mustard--anything to produce vomiting...... She has? That's all right. Tell her to put her finger down her throat and vomit some more..... No, I think it won't be necessary for me to come down..... You would? Well, let me hear again in the next hour or two, and if you still want me I'll come. Good-bye." They walked down the street and as they drew near the office they saw the figure of the office boy in the doorway silhouetted against the light within. He was looking anxiously in their direction. Suddenly he disappeared and the faint sound of a bell came to their ears. They quickened their pace and as they came up the boy came hurriedly to the door again. "Is that you, Doctor?" he asked, peering out. "Yes." "I told a lady at the 'phone to wait a minute, she's 'phoned twice." Mary waited at the door while her husband went into the office and over to the 'phone. "Yes. What is it?.... No. No. _No!_.... Listen to me..... Be _still_ and listen to _me_! She's in no more danger of dying than _you_ are. She couldn't die if she tried..... Be still, I say, and listen to me!" He stamped his foot mightily. Mary laughed softly to herself. "Now don't hang over her and _sympathize_ with her; that's exactly what she don't need. And don't let the neighbors hang around her either. Shut the whole tea-party out..... Well, tell 'em _I_ said so..... I don't care a damn _what_ they think. Your duty and mine is to do the very best we can for that girl. Now remember..... Yes, I'll be down on the nine o'clock train tomorrow morning. Good-bye." He joined his wife at the door. "If anybody wants me, come to the church," he said, turning to the boy. Mary laid her hand within her husband's arm and they started on. They met a man who stopped and asked the doctor how soon he would be at the office, as he was on his way there to get some medicine. "I'd better go back," said the doctor and back they went. It seemed to Mary that her husband might move with more celerity in fixing up the medicine. He was deliberation itself as he cut and arranged the little squares of paper. Still more deliberately he heaped the little mounds of white powder upon them. She looked on anxiously. At last he was ready to fold them up! No, he reached for another bottle. He took out the cork, but his spatula was not in sight. Nowise disturbed, he shifted bottles and little boxes about on the table. "Can't you use your knife, Doctor?" asked Mary. "O, I'll find it--it's around here somewhere." In a minute or two the missing spatula was discovered under a paper, and then the doctor slowly, _so_ slowly, dished out little additions to the little mounds. Then he laid the spatula up, put the cork carefully back in the bottle, turned in his chair and put two questions to the waiting man, turned back and folded the mounds in the squares with the most painstaking care. In spite of herself Mary fidgeted and when the powders with instructions were delivered and the man had gone, she rose hastily. "_Do_ come now before somebody else wants something." The singing was over and the sermon just beginning when they reached the church. It progressed satisfactorily to the end. The doctor usually made an important unit in producing that "brisk and lively air which a sermon inspires when it is quite finished." But tonight, a few minutes before the finale came, Mary saw the usher advancing down the aisle. He stopped at their seat and bending down whispered something to the doctor, who turned and whispered something to his wife. "No, I'll stay and walk home with the Rands. I see they're here," she whispered back. The doctor rose and went out. "Who's at the office?" he asked, as he walked away with the boy. "She's not there yet, she telephoned. I told her you was at church." "Did she say she couldn't wait?" "She said she had been at church too, but a bug flew in her ear and she had to leave, and she guessed you'd have to leave too, because she couldn't stand it. She said it felt _awful_." "Where is she?" "She was at a house by the Methodist church, she said, when she 'phoned to see if you was at the office. When I told her I'd get you from the other church, she said she'd be at the office by the time you got there." And she was, sitting uneasily in a big chair. "Doctor, I've had a flea in my ear sometimes, but this is a different proposition. Ugh! Please get this creature out _now_. It feels as big as a bat. Ugh! It's crawling further in, hurry!" "Maybe we'd better wait a minute and see if it won't be like some other things, in at one ear and out at the other." "O, hurry, it'll get so far in you can't reach it." "Turn more to the light," commanded the doctor, and in a few seconds he held up the offending insect. "O, you only got a little of it!" "I got it all." "Well, it certainly felt a million times bigger than that," and she departed radiantly happy. CHAPTER IV. One day in early spring the doctor surprised his wife by asking her if she would like to take a drive. "In March? The roads are not passable yet, surely." But the doctor assured her that the roads were getting pretty good except in spots. "I have such a long journey ahead of me today that I want you to ride out as far as Centerville and I can pick you up as I come back." "That's seven or eight miles. I'll go. I can stop at Dr. Parkin's and chat with Mrs. Parkin till you come." Accordingly a few minutes later the doctor and Mary were speeding along through the town which they soon left far behind them. About two miles out they saw a buggy down the road ahead of them which seemed to be at a stand-still. When they drew near they found a woman at the horses' heads with a broken strap in her hand. She was gazing helplessly at the buggy which stood hub-deep in mud. She recognized the doctor and called out, "Dr. Blank, if ever I needed a doctor in my life, it's now." "Stuck fast, eh?" The doctor handed the reins to his wife and got out. "I see--a broken single-tree. Well, I always unload when I get stuck, so the first thing we do we'll take this big lummox out of here," he said picking his way to the buggy. The lummox rose to her feet with a broad grin and permitted herself to be taken out. She was a fat girl about fourteen years old. "My! I'll bet she weighs three hundred pounds," observed the doctor when she was landed, which was immediately resented. Then he took the hitching-rein and tied the tug to the broken end of the single-tree; after which he went to the horses' heads and commanded them to "Come on." They started and the next instant the vehicle was on terra firma. Mother and daughter gave the doctor warm thanks and each buggy went its separate way. Mary was looking about her. "The elms have a faint suspicion that spring is coming; the willows only are quite sure of it," she said, noting their tender greenth which formed a soft blur of color, the only color in all the gray landscape. No, there is a swift dash of blue, for a jay has settled down on the top of a rail just at our travelers' right. Soon they were crossing a long and high bridge spanning a creek which only a week before had been a raging torrent; the drift, caught and held by the trunks of the trees, and the weeds and grasses all bending in one direction, told the story. But the waters had subsided and now lay in deep, placid pools. "Stop, John, quick!" commanded Mary when they were about half way across. The doctor obeyed wondering what could be the matter. He looked at his wife, who was gazing down into the pool beneath. "I suppose I'm to stop while you count all the fish you can see." "I was looking at that lovely concave sky down there. See those two white clouds floating so serenely across the blue far, far below the tip-tops of the elm trees." The doctor drove relentlessly on. "Another mudhole," said Mary after a while, "but this time the travelers tremble on the brink and fear to launch away." When they came up they found a little girl standing by the side of the horse holding up over its back a piece of the harness. She held it in a very aimless and helpless way. "See," said Mary, "she doesn't know what to do a bit more than I should. I wonder if she can be alone." The doctor got out and went forward to help her and discovered a young man sitting cozily in the carriage. He glanced at him contemptuously. "Your harness is broken, have you got a string?" he asked abruptly. "N-n-o, I haven't," said the youth feeling about his pockets. "Take your shoe-string. If you haven't got one I'll give you mine," and he set his foot energetically on the hub of the wheel to unlace his shoe. "Why, I've got one here, I guess," and the young man lifted a reluctant foot. The doctor saw and understood. The little sister was to fix the harness in order to save her brother's brand new shoes from the mud. "You'd better fix that harness yourself, my friend, and fix it strong," was the doctor's parting injunction as he climbed into the buggy and started on. "I don't like the looks of this slough of despond," said Mary. The next minute the horses were floundering through it, tugging with might and main. Now the wheels have sunk to the hubs and the horses are straining every muscle. "Merciful heaven!" gasped Mary. At last they were safely through, and the doctor looking back said, "That is the last great blot on our civilization--bad roads." After a while there came from across the prairie the ascending, interrogative _boo-oo-m_ of a prairie chicken not far distant, while from far away came the faint notes of another. And now a different note, soft, melodious and mournful is heard. "How far away do you think that dove is?" asked the doctor. "It sounds as if it might be half a mile." "It is right up here in this tree in the field." "Is it," said Mary, looking up. "Yes, I see, it's as pretty and soft as its voice. But I'm getting sunburned, John. How hot a March day can get!" "Only two more miles and good road all the way." A few minutes more and Mary was set down at Centerville, "I'll be back about sunset," announced her husband as he drove off. A very pleasant-faced woman answered the knock at the door. She had a shingle in her hand and several long strips of muslin over her arm. She smilingly explained that she didn't often meet people at the door with a shingle but that she was standing near the door when the knock came. Mary, standing by the bed and removing hat and gloves, looked about her. "What are you doing with that shingle and all this cotton and stuff, Mrs. Parkin?" she asked. "Haven't you ever made a splint?" "A splint? No indeed, I'm not equal to that." "That's what I'm doing now. There's a boy with a broken arm in the office in the next room." "Oh, your husband has his office here at the house." "Yes, and it's a nuisance sometimes, too, but one gets used to it." "I'll watch you and learn something new about the work of a doctor's wife." "You'll learn then to have a lot of pillow slips and sheets on hand. Old or new, Dr. Parkin just tears them up when he gets in a hurry--it doesn't matter to him what goes." The doctor's wife put cotton over the whole length of the shingle and wound the strips of muslin around it; then taking a needle and thread she stitched it securely. Mary sat in her chair watching the process with much interest. "You have made it thicker in some places than in others," she said. "Yes; that is to fit the inequalities of the arm." Mary looked at her admiringly. "You are something of an artist," she observed. Just as Mrs. Parkin finished it her husband appeared in the doorway. "Is it done?" he asked. "It's just finished." "May I see you put it on, Doctor?" asked Mary, rising and coming forward. "Why, good afternoon, Mrs. Blank. I'm glad to see you out here. Yes, come right in. How's the doctor?" "Oh, he is well and happy--I think he expects to cut off a foot this afternoon." A boy with a frightened look on his face stood in the doctor's office with one sleeve rolled up. The doctor adjusted the fracture, then applied the splint while his wife held it steady until he had made it secure. When the splint was in place and the boy had gone a messenger came to tell the doctor he was wanted six miles away. About half an hour afterward a little black-eyed woman came in and said she wanted some more medicine like the last she took. "The doctor's gone," said Mrs. Parkin, "and will not be back for several hours." "Well, you can get it for me, can't you?" "Do you know the name of it?" "No, but I believe I could tell it if I saw it," said the patient, going to the doctor's shelves and looking closely at the bottles and phials with their contents of many colors. She took up a three-ounce bottle. "This is like the other bottle and I believe the medicine is just the same color. Yes, I'm sure it is," she said, holding it up to the light. Mary looked at her and then at Mrs. Parkin. "I wouldn't like to risk it," said the latter lady. "Oh, I'm not afraid. I don't want to wait until the doctor comes and I know this must be like the other. It's exactly the same color." "My good woman," said Mary, "you _certainly_ will not risk that. It might kill you." "No, Mrs. Dawson, you must either wait till the doctor comes or come again," said Mrs. Parkin. The patient grumbled a little about having to make an extra trip and took her leave. When the door had closed behind her Mary asked the other doctor's wife if she often had patients like that. "Oh, yes. People come here when the doctor is away and either want me to prescribe for them or to prescribe for themselves." "You don't do it, do you?" "Sometimes I do, when I am perfectly sure what I am doing. Having the office here in the house so many years I couldn't help learning a few things." "I wouldn't prescribe for anything or anybody. I'd be afraid of killing somebody." About an hour later Mary, looking out of the window, saw a wagon stopping at the gate. It contained a man and a woman and two well-grown girls. "Hello!" called the man. "People call you out instead of coming in. That is less trouble," observed Mary. The doctor's wife went to the door. "Is Doc at home?" "No, he has gone to the country." "How soon will he be back?" "Not before supper time, probably." The man whistled, then looked at his wife and the two girls. "Well, Sally," he said, "I guess we'd better git out and wait fur 'im." "W'y, Pa, it'll be dark long before we git home, if we do." "I can't help that. I'm not agoin' to drive eight miles tomorry or next day nuther." "If ye'd 'a started two hour ago like I wanted ye to do, maybe Doc'd 'a been here and we c'd 'a been purty nigh home by this time." "Shet up! I told ye I wasn't done tradin' then." "It don't take _me_ all day to trade a few aigs for a jug o' m'lasses an' a plug o' terbacker." For answer the head of the house told his family to "jist roll out now." They rolled out and in a few minutes they had all rolled in. Mrs. Parkin made a heroic effort not to look inhospitable which made Mary's heroic effort not to look amused still more heroic. When at last the afternoon was drawing to a close Mary went out into the yard to rest. She wished John would come. Hark! There is the ring of horses' hoofs down the quiet road. But these are white horses, John's are bays. She turns her head and looks into the west. Out in the meadow a giant oak-tree stands between her and the setting sun. Its upper branches are outlined against the grey cloud which belts the entire western horizon, while its lower branches are sharply etched against the yellow sky beneath the grey. What a calm, beautiful sky it was! She thought of some lines she had read more than once that morning ... a bit from George Eliot's Journal: "How lovely to look into that brilliant distance and see the ship on the horizon seeming to sail away from the cold and dim world behind it right into the golden glory! I have always that sort of feeling when I look at sunset. It always seems to me that there in the west lies a land of light and warmth and love." A carriage was now coming down the road at great speed. Mary saw it was her husband and went in to put on her things. In a few minutes more she was in the buggy and they were bound for home. It was almost ten o'clock when they got there. The trip had been so hard on the horses that all the spirit was taken out of them. The doctor, too, was exceedingly tired. "Forty-two miles is a long trip to make in an afternoon," he said. "I hope Jack and Maggie are not up so late." "It would be just like them to sit up till we came." The buggy stopped; the door flew open and Jack and Maggie stood framed in the doorway with the leaping yellow firelight for a background. CHAPTER V. Once in a while sympathy for a fellow mortal kept the doctor's wife an interested listener at the 'phone. Going, one morning, to speak to a friend about some little matter she heard her husband say: "What is it, doctor?" A physician in a little town some ten or twelve miles distant, who had called Dr. Blank in consultation a few days before, was calling him. "I think our patient is doing very well, but her heart keeps getting a little faster." "How fast is it now?" "About 120." "But the disease is pretty well advanced now--that doesn't mean as much as it would earlier. But you might push a little on the brandy, or the strychnine--how much brandy have you given her since I saw her?" "I have given her four ounces." "Four ounces!" "Yes." "Four ounces in three days? I think you must mean four drachms." "_Yes._ It _is_ drachms. Four ounces _would_ be fixing things up. I've been giving her digitalis; what do you think about that?" "That's all right, but I think that strychnine would be a little better." "Would you give her any aromatic spirits of ammonia?" "Does she rattle?" "A little." "Then you might give her a little of that. And keep the room open and stick right to her and she ought to get along. Don't give her much to eat." "Is milk all right?" "Yes. You bet it is." "All right then, doctor, I believe that's all. Good-bye." On another occasion, Mary caught this fragment: "She's so everlastin' sore that she just hollers and yells every time I go near her. Would you give her any more morphine?" "Morphine's a thing you can't monkey with you know, Doctor. You want to be mighty careful about that." "Yes. I know. How long will that morphine last?" "That depends on how you use it. It won't last long if you use too much and neither will she." "I mean how long will it last in the system?" "O! Why, three or four hours." "Well, I think she don't need no more medicine." Mary smiled at the double negative and when she laughingly spoke of it that night her husband assured her that that doctor's singleness of purpose more than offset his doubleness of negative. That he was a fine fellow and a good physician just the same. * * * * * One morning in March just as the doctor arose from the breakfast table he was called to the 'phone. "Is this Dr. Blank?" "Yes." "Doctor, will it hurt the baby to bathe it every morning? I've been doing that but some of the folks around here say I oughtn't to do it; they say it isn't good for a baby to bathe it so often." The doctor answered solemnly, "The baby's fat and healthy isn't it?" "Yes, sir." "And pretty?" "Yes, _sir_." "Likes to see its mamma?" "You _know_ it." "Likes to see its papa?" "He does that!" said the young mother. "Then ask me next fall if it will hurt to bathe the baby every morning." "All right, Doctor," laughed the baby's mamma. "The fools are not all dead yet," said John, as he took his hat and departed. On the step he turned back and put his head in at the door. "Keep an ear out, Mary. I'm likely to be away from the office a good bit this morning." An hour later a call came. Mary put the ear that was "out" to the receiver: "It's on North Adams street." "All right. I'll be out there after awhile," said her husband's placid voice. "Don't wait too long. He may die before you git here." "No, he won't. I'll be along pretty soon." "Well, come just as quick as you can." "All right," and the listener knew that it might be along toward noon before he got there. About eleven o'clock the 'phone rang sharply. "Is this Dr. Blank's house?" "Yes." "Is he there?" "I saw him pass here about twenty minutes ago. I'm sure he'll be back to the office in a little bit." "My land! I've been here three or four times. Looks like I'd ketch him _some_ time." "You are at the office then? If you will sit down and wait just a little while, he will be in." "I come six miles to see him. I supposed of course he'd be in _some_ time," grumbled the voice (of course a woman's). "But when he is called to visit a patient he must go, you know," explained Mary. "Y-e-s," admitted the voice reluctantly. "Well, I'll wait here a little while longer." Ten minutes later Mary rang the office. Her husband replied. "How long have you been back, John?" "O, five or ten minutes." "Did you find a woman waiting for you?" "No." "Well, I assured her you'd be there in a few minutes and she said she'd wait." "Do you know who she was?" "No. Some one from the country. She said she came six miles to see you and she supposed you'd be in your office _some_ time, and that sometime was mightily emphatic." "O, yes, I know now. She'll be in again," laughed the doctor and Mary felt relieved, for in the querulous tones of the disappointed woman she had read disapproval of the doctor and of herself too, as the partner not only of his joys and sorrows, but of his laggard gait as well. The people who wait for a doctor are not apt to consider that a good many more may be waiting for him also at that particular moment of time. CHAPTER VI. One of the most discouraging things I have encountered is a great blank silence. The doctor asks his wife to keep a close watch on the telephone for a little while, and leaves the office. Pretty soon it rings and she goes to answer it. "Hello?" Silence. "What is it?" More silence. She knows that "unseen hands or spirits" did not ring that bell. She knows perfectly well that there is a listening ear at the other end of the line. But you cannot converse with silence any more than you can speak to a man you meet on the street if he purposely looks the other way. Mary knew that the listening ear belonged to someone who recognized that it was the wife who answered instead of the doctor, and therefore kept silent. She smiled and hung up the receiver--sorry not to be able to help her husband and to give the needed information to the patient. But when this had happened several times she thought of a more satisfactory way of dealing with the situation. She would take down the receiver and ask, "What is it?" She would wait a perceptible instant and then say distinctly and pleasantly, "Doctor Blank will be out of the office for about twenty minutes. He asked me to tell you." That never failed to bring an answer, a hasty, shame-voiced, "Oh, I--well--thank you, Mrs. Blank, I'll call again, then." * * * * * The doctor's absence from town has its telephonic puzzles. One day during Dr. Blank's absence his wife was called to the 'phone. "Mrs. Blank, a telegram has just come for the doctor. What must I do with it?" It was the man at the office who put the question. "Do you know what it is, or where it's from?" "I asked the operator and he says it's from Mr. Slocum, who is in Cincinnati. He telegraphed the doctor to go and see his wife who is sick." "Well, take it over to Dr. Brown's office and ask him to go and see her." About half an hour later the thought of the telegram came into her mind. "I wonder if he found Dr. Brown in. I'd better find out." She rang the office. "Did you find Dr. Brown in?" "Yes, he was there." "And you gave the message to him?" "Yes, he took it." "I hope he went right down?" "No, he said he wouldn't go." "Wouldn't go!" exclaimed Mary, much astonished. "He said he knew Slocum and he was in all probability drunk when he sent the message." "Why, what a queer conclusion to arrive at. The doctor may be right but I think we ought to know." "I called up their house after I came back from Dr. Brown's office, but nobody answered. So she can't be very sick or she'd be at home." Mary put up the receiver hesitatingly. She was not satisfied about this matter. She went about her work, but her thoughts were on the message and the sick wife. Suddenly she thought of something--the Slocum children were in school. The mother had not been able to get to the 'phone to answer it. The thought of her lying there alone and helpless was too much. Mary went swiftly to the telephone and called the office. "Johnson, you have to pass Mrs. Slocum's on your way to dinner. I think she may have been too ill to go to the 'phone. Please stop and find out something definite." "All right." "And let me know as soon as you can. If she isn't sick don't tell her anything about the telegram. Think up some excuse as you go along for coming in, in case all is well." In about twenty minutes the expected summons came. "Well, I stopped, Mrs. Blank." "What did you find?" "Well, I found a hatchet close to Slocum's gate." "How lucky!" "I took it in to ask if it was theirs." "Was it?" "No, it wasn't." "Who told you so?" "Mrs. Slocum, herself, and she's about the healthiest looking invalid I've seen lately." "I'm much relieved. Thank you, Johnson." And as she left the 'phone she meditated within herself, "Verily, the tender thoughtfulness of the husband drunk exceedeth that of the husband sober." When night came and Mary was preparing for bed she thought, "It will be very unpleasant to be called up only to tell people the doctor is not here." She rose, went to the 'phone and called central. "This is Mrs. Blank, central. If anyone should want the doctor tonight, or for the next two nights, please say he is out of town and will not be home until Saturday." Then with a delicious sense of freedom she went to bed and slept as sweetly as in the long-ago when the telephone was a thing undreamed of. * * * * * The ting-a-ling-ling-ling--came as Mary was pouring boiling water into the teapot, just before six on a cool July evening. The maid was temporarily absent and Mary had been getting supper in a very leisurely way when she saw her husband step up on the porch. Then her leisure was exchanged for hurry. The doctor's appearance before meal time was the signal to which she responded automatically--he had to catch a train--someone must have him right away, or what not? She must not keep him waiting a minute. She pushed the teapot back on the stove and went swiftly to the 'phone. "Is this Dr. Blank's office?" asked a disturbed feminine voice. "No, his residence. He is here. Wait a minute, please, and I will call him." She hurried out to the porch, "Isn't papa here?" she asked of her small boy sitting there. "He _was_." "Well, where is he now?" "I don't know where he is." Provoking! She hurried back. He must be in the garden. An occasional impulse to hoe sometimes came over him (especially if the day happened to be Sunday). In the kitchen her daughter stood at a table cutting the bread for supper. "Go quick, and see if papa's in the garden. Tell him to come to the 'phone at once." Then she hurried back to re-assure the waiting one. But what could she tell her? Perhaps the doctor was not in the garden. She rushed out and beat her daughter in the race toward it. She sent her voice ahead, "John!" she called. "Yes." "Come to the 'phone this minute." Back she ran. Would she still be waiting? "Hello." "Hello." "Yes, the doctor's here. He's in the garden but will be in in just a minute. Hold the 'phone please." "Very well, thank you." It was a minute and a half before the doctor got there. "Hello." No answer. "Hello!" Silence. "_Hello!_" Still no reply. The doctor rang sharply for central. "Who was calling me a minute ago." "I don't know--we can't keep track of everybody who calls." The doctor hung up the receiver with an explosive monosyllable. Mary's patience was giving out too. "She couldn't wait one half minute. I told her you would be here in a minute and it took you a minute and a half." "She may be waiting at the office, I'll go down there." "I wouldn't do it," said Mary, warmly. "It's much easier for her to stay a half minute at the 'phone than for you to tramp back to the office." But he went. As his wife went back to the kitchen her daughter called, "Mother, did you take the loaf of bread in there with you?" "Why, no." "Well, it's not on the table where I was cutting it when you sent me after father." "It's on the floor!" shouted the small boy, peering through the window. "_I_ won't eat any of it!" "Don't, exquisite child," said his sister, stooping over to recover the loaf, dropped in her haste. Ting-a-ling-ling-ling. Mary went. "Isn't the doctor coming?" "He came. He called repeatedly, but got no reply." "I was right here with my ear to the 'phone the whole time." "He concluded it might be someone waiting for him at the office, so he has gone down there." "I'm not there. I'm here at home." "Hello," broke in the doctor's voice. "O, here you are!" "Doctor, I've been taking calomel today and then I took some salts and I thoughtlessly dissolved them in some lemonade I had handy!" A solemn voice asked, "Have you made your will?" A little giggle before the patient said "No." "You'll have plenty of time. You needn't hurry about it." "You don't think it will hurt me then?" "No. Not a bit." "I was afraid the acid might salivate me." "Yes, that's an old and popular idea. But it won't." "That sounds good, Doctor. I was awfully scared. Much obliged. Good-bye." * * * * * A week or two after the above incident the doctor was seated at his dinner, a leisurely Sunday dinner. The telephone called and he rose and went to it. The usual hush fell upon the table in order that he might hear. "Is this Dr. Blank?" "Yes." "Well, Doctor, this is Mrs. Abner. Would it be too much trouble for you to step into Hall's and ask them to send me up a quart of ice-cream for dinner?" "Certainly not. A quart?" "Yes, please. I'm sorry to bother you with it. They ought to have a 'phone." "No trouble." The doctor hung up the receiver and reached for his hat. "Why, John, you surely can finish your dinner before you go!" exclaimed Mary. "Then I'd spoil Mrs. Abner's dinner." "Mrs. Abner!" "Yes, she wants a quart of ice-cream for dinner." "I'd like to know what _you've_ got to do with it," said Mary tartly. "She thinks I'm at the office." "And the office is next door to Hall's and Hall's have no 'phone," said Mary smiling. "Of course you must go. Wouldn't Mrs. Abner feel mortified though if she knew you had to leave your home in the midst of dinner to order her ice-cream. But do hurry back, John." "Maybe I'd better stay there till the dinner hour is well over," laughed John. "Every now and then someone wants me to step into Hall's and order up something." He went good-naturedly away and his wife looked after him marveling, but withal admiring. * * * * * The doctor and his wife had been slumbering peacefully for an hour or two. Then came a loud ring and they were wide awake at once. "That wasn't the telephone, John, it was the door-bell." The doctor got into his dressing-gown and went to the door. His wife heard a man's voice, then her husband reply, then the door shut. She lay back on her pillow but it was evident John was not coming back. She must have dozed, for it seemed to her a long time had gone by when she started to hear a noise in the other room. John had not yet got off. "You have to go some place, do you?" she called. "Yes,--just a little way. Look out for the 'phone, Mary. I think I'll have to go down to Hanson's tonight, to meet the stork." "But how can I get word to you? They have no 'phone or that man wouldn't have come after you." "Well, I have promised Hanson and I'll have to go there. If he 'phones before I get back tell him he'll have to come down to Stetson's after me. Or, you might wake one of the boys and send him over." "I'd rather try to wake Rip Van Winkle," said Mary, in a tone that settled it. In about an hour the doctor was back and snuggling down under the covers. "They've got a fine boy over to Stetson's," he announced to his sleepy wife. "They have!" she exclaimed, almost getting awake. Again they slept. Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. "That's Hanson," exclaimed the doctor springing up and groping his way to the 'phone. "Yes." "Out where?" "Smith's on Parks avenue?.... _Not_ Smith's?.... I understand--a little house farther down that street..... Yes, I'll come..... O, as soon as I can dress and get there." Mary heard, but when he had gone, was soon in a deep sleep. By and by she found herself flinging off the covers and hurrying guiltily toward the summoning tyrant, her subconscious self telling her that this was the third peal. "Hello." "Is the doctor there, Mrs. Blank?" "No, he is over at Stetson's. He said if you 'phoned to tell you you would have to come there as they have no 'phone." "Wait a minute, Mrs. Blank," said the voice of central, "some one is trying to speak--" "What have I said!" thought Mary suddenly, thoroughly awake. "He got back from Stetson's and went to another place. But I don't know what place nor where it is." The kindly voice of central went on: "It's the doctor who is talking, Mrs. Blank. I understand now. He says if that message comes you are to 'phone him at James Smith's on Parks avenue." Mary looked at the clock. "So he's been there all this time. That stork is a little too busy tonight," she thought as she went shivering back to bed. Toward daylight she was roused by the return of her husband, who announced a new daughter in the world and then they went to sleep. The next morning she said, "John, I've just thought of something. Why didn't you have central 'phone you at Smith's if Hanson called and save me all that bother?" "I guess it's because I'm so used to bothering you Mary, that I didn't think of it." * * * * * Mary was upstairs cleaning house most vigorously when the ring came. She stopped and listened. It came again--three. She set the dust pan down and went. "I'll have to be out for an hour or more, Mary," said the doctor. "I heard that sigh," he laughed, "but it won't be very hard to sort of keep an ear on the 'phone, will it? Johnson may get in soon and then it won't be necessary." "Very well, then, John," and she went upstairs, leaving the doors open behind her. She had just reached the top when she had to turn about and retrace her steps. "Hello." No answer. "Is someone calling Dr. Blank's house or office?" "I rang your 'phone by mistake," said central. Mary trudged up the stairs again. "This is more tiresome than cleaning house," she said to herself as she went along. In twenty minutes the summons came. She leaned her broom against the wall and went down. "O, this is Mrs. Blank. I'm very sorry to have put you to this trouble--I wanted the doctor." She recognized the voice of her old pastor for whom she had a most kindly regard. "He is out, but will be back within half an hour now, Mr. Rutledge." "Thank you, I'll call again, but I wonder that you knew my voice." Mary laughed. "I haven't heard it for awhile, but maybe I'll be at church next Sunday, if minding the telephone doesn't make me feel too wicked." "It's the wicked that church is for--come by all means." "I didn't mean to detain you, Mr. Rutledge. It is restful, though, after dragging one's weary feet down to the 'phone to hear something beside all the ills that flesh is heir to. Come to see us soon--one day next week." Once more she wended her way upstairs and in about fifteen minutes came the ting-a-ling-a-ling-a-ling. "I surrender!" she declared. When she had gone down and put the receiver to her ear her husband's voice spoke kindly, "I'm back, Mary, you're released." "Thank you, John, you are very thoughtful," and she smiled as she took off her sun-bonnet and sat herself down. "Not another time will I climb those stairs this morning." * * * * * Mary sat one evening dreamily thinking about them--these messages that came every day, every day! Doctor, will it hurt Jennie to eat some tomatoes this morning--she craves them so? Will is a great deal better. Can he have some ice-cream for dinner? I can hardly manage Henry any longer, Doctor, he's determined he _will_ have more to eat. Can I begin giving him a little more today? Lemonade won't hurt Helen, will it? She wants some. Doctor, I forget how many drops of that clear medicine I am to give..... Ten, you say? Thank you. Dr. Blank, is it after meals or before that the dark medicine is to be given..... I thought so, but I wanted to be sure. We are out of those powders you left. Do you think we will need any more?.... Then I'll send down for them. How long will you be in the office this morning, Doctor?...... Very well, I'll be down in about an hour. I want you to see my throat. You wanted me to let you know how Johnny is this morning. I don't think he has any fever now and he slept all night, so I guess you won't need to come down today. Dr. Blank, I've got something coming on my finger. Do you suppose it's a felon?.... You can tell better when you see it?.... Well, I suppose you can. I'll be down at the office pretty soon and then I want you to tell me it's _not_ a felon. Mary seems a good deal better this morning, but she still has that pain in her side. Doctor, I don't believe Joe is as well as he was last night. I think you had better come down. As these old, old stories came leisurely into Mary's thoughts the telephone rang three times. She rose from her chair before the fire and went to answer it. "Is this Dr. Blank's office?" "No, his residence." "Is the doctor there?" "No, but he will be down on the seven o'clock train." "And it's now not quite six. This is Mr. Andrews." Mary knew the name and the man. "My wife is sick and I want to get a pint of alcohol for her." "An old subterfuge," thought Mary, "I'm afraid he wants it for himself." She knew that he was often under its influence. "I can't get it without a prescription from a physician, you know. She needs it right away." "The thirst is on him," thought our listener, pityingly. The voice went on, "Mrs. Blank, couldn't you just speak to the druggist about it so I could get it right away?" "Mr. Andrews," she said hastily, "the druggist would pay no attention to me. I'm not a physician, you know. The doctor will be here in an hour--see him," and she hurried the receiver into its place, anxious to get away from it. This was a story that was entirely new to her. Never before had she been asked to procure a prescription for alcohol or any of its attendant spirits. She liked the old stories best. * * * * * The doctor had been to the city and had got home at four o'clock in the morning. He had had to change cars in the night and consequently had had little sleep. When the door-bell rang his wife awakened instantly at the expected summons and rose to admit him. In a little while both were fast asleep. The wife, about a half hour later, found herself struggling to speak to somebody about something, she did not know what. But when the second long peal came from the 'phone she was fully awakened. How she hated to rouse the slumberer at her side. "John," she called softly. He did not move. "John!" a little louder. He stirred slightly, but slept on. "John, _John_!" "Huh-h?" "The telephone." He threw back the covers, and rising, stumbled to the 'phone. "Hello." The voice of a little boy came to his half-awakened ear. "_Say_, Pa, _I_ can't sell these papers an' git through in time fer school." "Yes, you _can_!" roared a voice. "You jist want to fool around." The doctor went back to bed. "Wasn't the message for you?" inquired his wife. "What a shame to rouse you from your sleep for nothing." The doctor told her what the message was and was back in slumberland in an incredibly short space of time. Not so his wife. She was too thoroughly awake at last and dawn was beginning to peep around the edges of the window shades. She would not court slumber now but would lie awake with her own thoughts which were very pleasant thoughts this morning. By and by she rose softly, dressed and went out onto the veranda and looked long into the reddening eastern sky. Ever since she could remember she had felt this keen delight at the aspect of the sky in the very early morning. She stood for awhile, drinking in the beauty and the peacefulness of it all. Then she went in to her awakening household, glad that the little boy had 'phoned his "Pa" and by some means had got her too. * * * * * One midsummer night a tiny ringing came faintly and pleasantly into Mary's dreams. Not till it came the second or third time did she awaken to what it was. Then she sat up in bed calling her husband, who had just awakened too and sprung out of bed. Dazed, he stumbled about and could not find his way. With Mary's help he got his bearings and the next minute his thunderous "Hello" greeted her ears. "Yes." "Worse tonight? In what way?" An instant's silence. "Mrs. Brownson?" Silence. "Mrs. Brownson!" Silence. "Damn that woman! She's rung off." "Well, don't swear into the 'phone, John. It's against the rules. Besides, she might hear you." The doctor was growling his way to his clothes. "I suppose I've got to go down there," was all the answer he made. When he was dressed and the screen had banged behind him after the manner of screens, Mary settled herself to sleep which came very soon. But she was soon routed out of it. She went to the 'phone, expecting to hear a querulous woman's voice asking, "Has the doctor started yet?" and her lips were framing the old and satisfactory reply, "Yes, he must be nearly there now," when a man's voice asked, "Is this Dr. Blank's residence?" "Yes." "Is the doctor there?" "No, but he will be back in about twenty minutes." "Will you please tell him to come to J. H. Twitchell's?" "Yes, I'll send him right down." "Thank you." She went back to her bed room then, turning, retraced her steps. The doctor could come home by way of Twitchell's as their home was not a great distance from the Brownson's. She rang the Brownson's and after a little while a voice answered. "Is this Mrs. Brownson?" "Yes." "May I speak to Dr. Blank. I think he must be there now." "He's been here. He's gone home." Mary knew by the voice that its owner had not enjoyed getting out of bed. "I wonder how she would like to be in my place," she thought, smiling. She dared not trust herself to her pillow. She might fall asleep and not waken when her husband came in. She wondered what time it was. Up there on the wall the clock was ticking serenely away--she had only to turn the button beside her to find out. But she did not turn it. In the sweet security of the dark she felt safe. In one brief flash of light some prowling burglar might discover her. She sat down by the open window and looked up into the starlit sky. They were out tonight in countless numbers. Over there toward the northwest, lying along the tops of the trees was the Great Dipper. Wasn't it? Surely that particular curve in the handle was not to be found in any other constellation. She tried to see the Dipper itself but a cherry tree near her window blotted it out. Bend and peer as she might the branches intervened. It was tantalizing. She rose irresolute. Should she step out doors where the cherry tree would not be in the way? Not for a thousand dippers! She walked to another window. That view shut even the handle out. She looked for the Pleiades. They were not in the section of sky visible from the window where she stood. She turned and listened. Did she hear footsteps down the walk? She ought to be hearing her husband's by this time. He could not be walking at his usual gait. There he came! She went to the door looked through the screen and halted him as he drew near the steps. "John, you'll have to take another trip. Mr. Twitchell has 'phoned for you." He turned and was soon out of sight. "Now! I can go to bed with a clear conscience," and Mary sought her pillow. But she had better stay awake until he had time to get there lest Mr. Twitchell should 'phone again. In five or ten minutes the danger would be over. She waited. At last she closed her eyes to sleep. But what would be the use? In twenty minutes more her husband would come in and rouse her out of it. She had better just keep awake till he got back. And the next thing Mary heard was a snore. She opened her eyes to find it was broad daylight and her husband was sleeping soundly beside her. CHAPTER VII. One afternoon in June Mary went into her husband's office. "Has _The Record_ come?" she asked. "Yes, it's on the table in the next room." She went into the adjoining room and seated herself by the table. Taking up _The Record_, she turned to the editorial page, but before she could begin reading she heard a voice in the office say, "How do you do, Doctor?" "How do you do, Mr. Jenkins. Take a seat." "No, I guess I'll not sit down. I just wanted to get--a prescription." "The baby's better, isn't it?" "Oh, the baby's all right, but I want a prescription for myself." "What sort of prescription?" "I have to take a long ride in the morning, driving cattle, and I want a prescription for a pint of whiskey." Mary listened for her husband's reply. It came. "Jenkins, I have taken many a long ride through dust and heat, through rain and snow and storm, and I never yet have had to take any whiskey along." "Well, I have a little trouble with my heart and--" "The trouble's in your head. If you'd throw away that infernal pipe--" "Oh, it's no use to lecture me on that any more." "Very well, your tobacco may be worth more to you than your heart." "Well, will you give me that prescription?" "Certainly I won't. You don't need whiskey and you'll not get it from me." "Go to h-ll!" "All right, I'll meet _you_ there." At which warm farewell between these two good friends, Mary leaned back in her chair and laughed silently. Then she mused: "People will not be saved from themselves. If only they would be, how much less of sin and sickness and sorrow there would be in the world." Presently the doctor came in. "I have a trip to make tonight, Mary. How would you like a star-light drive?" Mary said she would like it very much indeed. Accordingly, at sunset the doctor drove up and soon they were out in the open country. Chatting of many things they drove along and by and by Mary's eyes were attracted to a beautiful castle up in the clouds in the west, on a great golden rock jutting out into the blue. Far below was a grand woman's form in yellow floating robes. She stood with face upturned and arms extended in an attitude of sorrow as if she had been banished from her father's house. There comes the father now. Slowly, majestically, an old man with flowing beard of gold moves toward the edge of the great rock. Now he has reached it. He bends his head and looks below. The attitude of the majestic woman has changed to that of supplication. And now the father stretches down forgiving arms and the queenly daughter bows her head against the mighty wall and weeps in gladness. Now castle and rock, father and daughter slowly interchange places and vanish from her sight. The gold turns to crimson, then fades to gray. Just before her up there in the clouds is a huge lion, couchant. See! he is going to spring across the pale blue chasm to the opposite bank. If he fails he will come right down into the road--"Oh!" "What is it?" asked the doctor, looking around, and Mary told him with a rather foolish smile. The twilight deepened into dusk and the notes of a whippoorwill came to them from a distance. "You and I must have nothing but sweet thoughts right now, John, because then we'll get to keep them for a year." She quoted: "'Tis said that whatever sweet feeling May be throbbing within the fond heart, When listening to a whippoorwill s-pieling, For a twelvemonth will never depart." "Spieling doesn't seem specially in the whippoorwill's line." "It's _exactly_ in his line. Years ago when I was a little girl he proved it. One evening at dusk I was sitting in an arbor when he, not suspecting my presence, alighted within a few feet of me and began his song. It was wonderfully interesting to watch his little throat puff and puff with the notes as they poured forth, but the thing that astounded me was the length of time he sang without ever pausing for breath. And so he is a genuine spieler. I will add, however, that the line is 'When listening to a whippoorwill _singing_.' But my literary conscience will never let me rhyme _singing_ with _feeling_, hence the sudden change." "Now I'll speak _my_ piece," announced the doctor: "De frogs in de pon' am a singin' all de night; Wid de hallelujah campmeetin' tune; An' dey all seem to try wid deir heart, soul and might To tell us ob de comin' of de June." "_Aren't_ they having a hallelujah chorus over in that meadow, though!" Darkness settled over the earth. The willow trees, skirting the road for a little distance, lifted themselves in ghostly tracery against the starlit sky. A soft breeze stirred their branches like the breath of a gentle spirit abiding there. They passed a cozy farmhouse nestled down among tall trees. Through the open door they could see a little white-robed figure being carried to bed in its father's arms, while the mother crooned a lullaby over the cradle near. For a long time they drove in silence. Mary knew that her husband was in deep thought. Of what was he thinking? The pretty home scene in the farm house had sent him into a reverie. He went back five or six years to a bright spring day. He was sitting alone in his office when an old man, a much respected farmer, came in slowly, closed the door behind him and sat down. The doctor who knew him quite well saw that he was troubled and asked if there was anything he could do for him. The old man leaned his head on his hand but did not reply. It seemed that no words would come in which to tell his errand. Puzzled and sympathetic the doctor sat silent and waited. In a little while the farmer drew his chair very near to that of the doctor's and said in a low voice, "Doctor, I'm in deep trouble. I come to you because you are one of my best friends. You have a chance to prove it now such as you never had before in all the years you've been our doctor." "Tell me your trouble and if I can help you, I will certainly do so." "It's Mary. She's gone wrong, and the disgrace will kill her mother if she finds it out." For an instant the doctor did not speak; then he asked, "Are you sure that this is true?" "Yes. She came to me last night and nestled down in my arms, just as she's done every night since she was a baby. She cried like her heart would break and then she said, 'Father, I _must_ tell you, but don't tell mother'; and then she told me." The old man, white and trembling, looked beseechingly at the doctor. "Doctor, this must not be. You must stop it before there is any breath of scandal. Oh, for a minute last night I wanted to kill her." The doctor's face was stern. "If you had killed her your crime would have been far less hellish than the one you ask me to commit." The old man bowed his head upon his hands. "You will not help me," he groaned. The doctor rose and walked the floor. "No, sir," he said, "I will not stain my soul with murder for you or any other man." He went to the window and stood looking out upon the street below. Presently he said, "Mr. Stirling, will you come here a minute?" The old man rose and went. "Do you see that little boy skipping along down there?" "Yes, I see him." "If I should go down these stairs, seize him and dash his brains out against that building, what would you think of me?" "I'd think you were a devil." "Yet he would have a chance for his life. He could cry out, or the passersby might see me and interpose, while that you ask me to destroy is--" "There's one thing I'll do," said the old man fiercely. "I'll kill Ben Morely before this day is over!" He seized his hat and started toward the door. "Wait a minute!" said the doctor quickly. "It's Ben Morely is it? I know him. I would not have thought him capable of this." "He's been coming to see Mary steady for more than a year and they were to have been married three months ago but they quarreled and Mary told me last night that he was going away the last of this week. She is as good and sweet a girl as ever lived. She never kept company with anybody else and she thought the world of him. The damned villain has got around her with his honey words and now he proposes to leave her to face it alone. But I'll kill him as sure as the sun shines." "Sit down," said the doctor, laying a hand on the excited man's arm and forcing him into a chair. "Let me tell you what to do. Young Morely's father is a good and sensible man and will take the right view of it. Go straight to him and tell him all about it and my word for it, he will see that they are married right away. He is able to help them along and will make it to his son's advantage to stay here rather than go away. He will advise him right. Have no fear." The old man wrung the doctor's hand in silence and went out. Several days later the doctor was looking over the papers published in the town and read in the list of marriage licenses the names, "Benjamin Morely, aged twenty-four, Mary Stirling, aged eighteen." And that is why the scene in the farmhouse this summer night had sent him back into the past, for it was the home of Benjamin and Mary Morely, and it was a happy home. These two lives had come together and flowed on in such harmony and helpfulness and rectitude before the world that the stain had been wiped out. For a merciless world can be merciful sometimes if it will only stop to remember that long ago a compassionate Voice said, Go and sin no more. The doctor's reverie came to an end for he had reached his destination--a large white house standing very close to the road. "Don't talk to me while you are hitching the horse," Mary whispered, "then they won't know there is anyone with you. I don't want to go in--I want to see the moon come up." The doctor took his case and went inside. Mary sat in the buggy and listened. The neighing of a horse far down the road and the barking of a dog in the distance were the only sounds she heard. How still and cool it was after the heat of the day. A wandering breeze brought the sweet perfume of dewy clover fields. She looked across the intervening knoll to the east. The tree that crowned its summit stood outlined against the brightening sky. She was sitting very near the open kitchen window and now saw the family taking their places around the supper table. She felt a little uncomfortable and as if she were trespassing on their privacy. But they did not know of her proximity and she could only sit still in the friendly cover of the darkness. How good the ham smelled and the potatoes and the coffee. A pretty home-scene! The father at the head of the table, the mother opposite with four sturdy boys between them, two on each side. The father looked around the board. Stillness settled down upon them, and then he bowed his head. The mother, too, bowed her head. The boys looked down. "Our heavenly Father, we thank Thee for these evening blessings--" the boys looked up and four forks started simultaneously for the meat platter. Every fork impaled its slice. Mary gasped. She crammed her handkerchief into her mouth to shut off the laughter that almost shouted itself before she could stop it. The oldest boy, a burly fellow of fifteen, looked astonished and then sheepish. The other three looked defiance at him. Each sat erect in perfect silence and held his slice to the platter with a firm hand. Mary, almost suffocating with laughter which _must_ be suppressed, watched anxiously for the denouement. The blessing went on. The boys evidently knew all its stages. As it advanced there was a tightening of the tension and at the welcome "amen" there was a grand rake-off. At the commotion of the sudden swipe the father and mother looked up in amazement. "Boys, boys! what do you mean!" exclaimed the mother. "We got even with Mr. Jake that time." It was the second boy who spoke. "We got _ahead_ of him," said the third. "He didn't get the biggest piece this time." "No, _I_ got it myself," said the fourth. "Well, I'm scandalized," said the mother, looking across the table at her husband. "Well, Mother, I'll tell you how it was," said the second boy. "Last night I looked up before Father was through with the blessing and I saw Jake with his fork in the biggest piece of ham. You and Father didn't notice and so he was _it_. I'll bet he's been at it a good while, too." "I've not, either," said the accused. "I told Bob and Jim about it and we concluded _we'd_ take a hand in it tonight." "Well, let this be the last of it," said the father with mild sternness. "We'll try to have ham enough for all of you without sneaking it. If not, Jacob can have his mother's share and mine." The trio of boys grinned triumphantly at the discomfited Jake, then, the little flurry over, all fell to eating with a will. The doctor's voice came to Mary from the room of the patient. "You're worth a dozen dead women yet," it said. Then a high pitched woman's voice, "I'll tell you what Mary Ann says she thinks about it." "Has she been here today?" If Mary Ann had been there the unfavorable condition of the patient was explained. "Yes, she just went away. She says she believes you're just keepin' Ellen down so you can get a big bill out of her." The doctor was fixing up powders and went placidly on till he got through, then he said "Mary Ann has a better opinion of me than I thought she had. It takes a mighty good doctor to do that. That's a very old song but there are a few people in the world that like to sing it yet. They don't know that there isn't a doctor in the world that knows enough to do a thing like that even if he wanted to. Nature would beat him every time if they gave her a chance." Mary heard the doctor give his instructions and then he came out. As they drove off she asked, "You came pretty near catching a tartar, didn't you?" "Oh, that one is all right. It's her sister that's always raising the devil." "Look! isn't she lovely, John?" "Isn't who lovely?" asked the doctor, looking back at the house in some surprise. "The gentle Shepherdess of Night," Mary answered, her eyes on the moon just rising over the distant treetops. "She's getting ready to 'lead her flocks through the fields of blue.'" "How very poetical we are." "Only an echo from a little song I used to sing when I was a little girl." "Get up, my steeds," urged the doctor, "we must be getting back"; and they sped swiftly homeward through the soft summer night. CHAPTER VIII. Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. "Hello." "Is this the doctor's office?" "This is his residence." "Pshaw! I wanted his _office_." "The doctor 'phoned me about ten minutes ago that he would be out for half an hour and asked me to answer the 'phone in his absence," Mary explained, pleasantly. "Oh," said the voice, somewhat mollified, "I'll just call him up when he gets back. You say he'll be back in half an hour?" "In about that time." She went back to her work, which happened to be upstairs this morning, leaving the doors ajar behind her that she might hear the 'phone. In two minutes she was summoned down. "What is it?" "Is this the doctor's office?" "No, the residence." "I rang for the office, sorry to have troubled you, Mrs. Blank," said a man's voice. "We are connected and when the doctor is out he expects me to be bell-boy," said Mary, recognizing the voice. "I see. Will you please tell the doctor when he comes that my little boy is sick this morning and I want him to come down. Will he be back soon?" "In a few minutes, I think." She sat down by the fire. No use to go back upstairs till she had delivered the message. This was a pleasing contrast to the other; Mr. Owen had volunteered his message as if she really had a right to know and deliver it. Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. Mary felt reluctant to answer it--it sounded so like the first. And it was not the house call this time, but two rings which undeniably meant the office. But she must be true to the trust reposed in her. She went to the 'phone and softly taking down the receiver, listened; perhaps the doctor had got back and would answer it himself. Fervently she hoped so. But there was only silence at her ear, and the ever present far-off clack of attenuated voices. The silence seemed to bristle. But there was nothing for our listener to do but thrust herself into it. "Hello," she said, very gently. "O, I've got _you_ again, have I! I _know_ I rung the office this time, for I looked in the book to see. How does it happen I get the house?" Ill temper was manifest in every word. "The office and residence are connected," explained Mary, patiently, "and when the 'phone rings while the doctor is out, he asks me to answer it for him." "I don't see what good _that_ does." "It doesn't do any good when people do not care to leave a message," said Mary quietly. "Well, I'd ruther deliver my message to _him_." "Certainly. And I would much rather you would. I can at least say about what time he expects to return." "You said awhile ago he'd be back in half an hour and he's not back _yet_." The doctor's wife knew that she was held responsible for the delay. She smiled and glanced at the clock. "It is just three minutes past the half hour," she said. "Well, we're in an awful hurry for him. I'll ring agin d'reckly." In five minutes a ring came again. Surely he would be there now, thought his wife, but she must go to the 'phone. She listened. Silence. Then the bell pealed sharply forth again. She decided to change her tactics and put the other woman on the defensive: "Well!" she said impatiently, "I'm _very_ sorry to have to answer you again but--" "Is the doctor there?" asked a sweet, new voice. "Pardon me for interrupting you, but I'm very anxious." "He will be at the office in just a few minutes," Mary answered, very gently indeed. She realized now that one cannot "monkey" with the telephone. "Will you please tell him to come at once?" and she gave the street and number. "I shall send him at once." "Thank you, good-bye." Before Mary could seat herself, the expected ring came in earnest. She answered it meekly. "O, good gracious! hain't he got there yet--?" "Not yet," said Mary, offering nothing further. "Well, I've jist _got_ to have a doctor. I'll git some one else." The threat in the tone made our listener smile. "I think it would be a good thing to do," she said. A pause. Then a voice with softening accents. "But I'd lots ruther have Dr. Blank." No reply. "Are ye there yit, Mrs. Blank?" "Yes. I am here." "He'll surely be back in a little bit now, won't he?" "I think so." "Won't _you_ tell 'im to come down to Sairey Tucker's? I'm her sister and she's bad sick." "If you will tell me where you live I will send him." "He knows--he's been here." "Very well," and she rang off. With three messages hanging over her head and her conscience, she could not go upstairs to her work. She must dawdle about at this or that 'till the doctor returned. After awhile she went to the 'phone and called the office. No reply. How she longed to deliver those messages. She dreaded any more calls from the waiting ones. She waited a few minutes then rang again. Thank fortune! Her husband's response is in her ear, the messages are delivered and she goes singing up the stairs. * * * * * Ting-a-ling-ling-ling-ling-ling. It was the telephone on the Doctor's office table and a tall young fellow was ringing it. When he got the number and asked, "Is this you, Fanny?" his face took on an expression good to see. It was Fanny, and he settled back on one elbow and asked, "What you doing, Fanny?" "Nothing, just now. What _you_ doing?" "Something a good deal better than that." "What is it?" "It's talking to _you_." "Oh!" "Is that all you have to say about it?" his voice was growing tender. "Now, Tom, don't go to making love to me over the 'phone." "How can I help it, sweetheart?" "Where are you, anyway?" "I'm in Dr. Blank's office." "Good gracious! is _he_ there? I'll ring off--good-bye." "Wait! Fanny--Fanny!" Fanny was waiting, but how could a mere man know that. He rang the number again with vehemence. "Now, Tom Laurence, I want you to quit going into people's offices and talking to me this way." "Don't you think my way is nicer than yours--huh?" The circumflexes were irresistible. "Well, tell me, Tom, is Dr. Blank there?" "No, honey. He's away in the back room busy with another patient. He can't hear." "_Another_ patient? Why, Tom, you're not _sick_, are you--huh?" Fanny's circumflexes were quite as circumflexible as Tom's and a thrill went down the young giant's spine. "No, but I wish I was!" At this juncture the man who could not hear came in with a face as grave and non-committal as the Sphinx, and the young man asked through the 'phone in brisk, cheery tones, "How are you this morning?" then added in a whisper, "He's here now." "Is he? Don't talk foolish then. Why, I'm not very well." "What's the matter?" "I burned my eye." "Burned your eye! Confound it! How did you _do_ it?" "With a curling iron." "Throw the darned thing away." He turned from the telephone and said, "Doctor, a young lady has burned her eye. I want you to go out there right away." "Where shall I go?" asked the grave doctor. "I guess you know," and he grinned. "All right. I'll go pretty soon." "Don't be too long. Charge it to me." "Fanny," he said, turning back to the 'phone, but Fanny had gone. And soon with a smile that had memories in it the doctor took his case and left the office, the young man at his side. * * * * * Ting-a-ling-ling-ling-ling-ling. Mary, from the living room, heard her husband's voice: "What is it?" "Yes." "They won't? O, I suppose so if nobody else will. I'll be up there in a little bit." He muttered something, took his hat and went. When he came back, he said, "This time I had to help the dead." "To help the dead!" exclaimed Mary. "Yes. To help a dead woman into her coffin. Everybody was afraid to touch her." "Why?" "The report got out that she died of smallpox. I only saw her once and could not be sure, but to be on the safe side I insisted that every precaution be taken--hence the scare." "But how could you lift the body without help?" "Oh, I managed it somehow. Just the same I'd rather minister to the living," said John, to which Mary gave vigorous assent. * * * * * "Old Mr. Vintner has just been 'phoning for you in a most imperious way," announced Mary as the doctor came in at the door. "Yes, old skinflint! The maid at his house is very sick and he's so afraid they'll have to take care of her that he's determined to send her home when she can't go. She has pneumonia. She lives miles out in the country--" Ting-a-ling-ling-ling-ling. "Yes." "Now see here, Vintner. Listen to me." "Yes, I know. But a man's got to be _human_. I tell you you can't send her out in this cold. It's outrageous to--" "Yes, I know all that, too. But it won't be long--the crisis will come in a day or two now and--" "Damn it! Listen. Now stop that and listen. Don't you attempt it! That girl will be to drag off if you do, I tell you--" "All right then. That sounds more like it," and he hung up the receiver. Mary looked up. "You are not very elegant in your discourse at times, John, but I'm glad you beat," she said. * * * * * One evening the doctor came in and walked hurriedly into the dining-room. As he was passing the telephone it rang sharply in his ear. "What is it?" he asked, hastily putting up the receiver. An agitated voice said, "Oh, Doctor, I've just given my little girl a teaspoonful of carbolic acid! Quick! What must I do!" "Give her some whiskey at once; then a teaspoonful of mustard in hot water. I'll be right down," and turning he went swiftly out. When he came back an hour or two later he said: "The mother got the wrong bottle. A very few minutes would have done the work. The telephone saved the child's life. This is a glorious age in which we are living, Mary." "And to think that some little children playing with tin cans with a string stretched between them, gave to the world its first telephone message." "Yes, I've heard that. It may or may not be true. Now let's have supper." "Supper awaits Mr. Non-Committal-Here-As-Ever," said Mary as she laid her arm in her husband's and they went toward the dining-room together. * * * * * One evening the doctor and Mary sat chatting with a neighbor who had dropped in. "I want to use your 'phone a minute, please," said a voice. "Very well," said Mary, and Mrs. X. stepped in, nodded to the trio, walked to the telephone as one quite accustomed, and rang. "I want Dr. Brown's office," she said. In a minute came the hello. "Is this Dr. Brown? My little boy is sick. I want you to come out to see him this evening. This is Mrs. X. Will you be right out?" "All right. Good-bye." And she departed. The eyes of the visitor twinkled. "Our neighbor hath need of two great blessings," she said, "a telephone and a sense of humor." Mary laughed merrily, "O, we're so used to it we paid no attention," she said, "but I suppose it did strike you as rather funny." "It's a heap better than it used to be when we didn't have telephones," said the doctor, with the hearty laugh that had helped many a downcast man and woman to look on the bright side. "When I was a young fellow and first hung up my shingle it was a surprising thing--the number of people who could get along without me. I used to long for some poor fellow to put his head in at the door and say he needed me. At last one dark, rainy night came the quick, importunate knock of someone after a doctor. No mistaking that knock. I opened the door and an elderly woman who lived near me, asked breathlessly, 'Mr. Blank, will you do me a great favor?' 'Certainly,' I answered promptly. 'My husband is very sick and I came to see if you would go down and ask Dr. Smithson to come and see him.' I swallowed my astonishment and wrath, put on my rubber coat and went for the doctor." "But she had the grace to come in next day," said Mary, "and tell me in much confusion that she was greatly embarrassed and ashamed. It had not entered her head until that morning that my husband was a physician." "You see," put in the doctor, "she had not taken me seriously; in fact had not taken me at all." "Tell us about the old man who had you come in to see if he needed a doctor," said Mary. The doctor smiled, "_That_ was when I didn't count, too," he said. "This old fellow got sick one day and wanted to send for old Dr. Brown, but being of a thrifty turn of mind he didn't want to unless he had to. He knew me pretty well so he sent for me to come and see if he _needed_ a doctor. If I thought he did he'd send for Brown. I chatted with him awhile and he felt better. Next day he sent word to me again that he wished I'd stop as I went by and I did. This kept up several days and he got better and better, and finally got well _without_ any doctor, as he said." The visitor laughed, "You doctors could unfold many a tale--" "If the telephone would permit," said Mary, as the doctor answered the old summons, took his hat and left. * * * * * "John," said Mary one day, "I wish you would disconnect the house from the office." "No! You're a lot of help to me," protested the doctor. "Well, I heard someone wrangling with central today because the house answered when it was the office that was wanted." She laughed. "I know there are people who fancy the doctor's wife enjoying to the utmost her 'sweet privilege' of answering the 'phone in her husband's absence. Poor, innocent souls! If they could only know the deadly weariness of it all--but they can't." "Why, I didn't know you felt quite that way about it, Mary. I suppose I can disconnect it but--" "But you don't see how you can? Never mind, then. We'll go on, and some sweet day you'll retire from practice. Then hully-gee! won't I be free! You didn't choose the right sort of helpmeet, John. You surely could have selected one who would enjoy thrusting herself into the reluctant confidences of people far more than this one." "I'm resigned to my lot," laughed John, as he kissed his wife and departed. * * * * * Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. "Is this you, Doctor?" "Yes." "What am I ever to do with Jane?" "Keep her in bed! That's what to do with her." "Well, I've got a mighty hard job. She's feeling so much better, she just _will_ get up." "Keep her down for awhile yet." "Well, maybe I can today, but I won't answer for tomorrow. She says she feels like she can jump over the house." "She can't, though." Laughter. "I'll do the best I can, Doctor, but that won't be much. Keeping her in bed is easier said than done," and the doctor grinned a very ready assent as he hung up the receiver. * * * * * The doctor's family was seated at dinner. Ting-a-ling-ling-ling. John rose, napkin in hand, and went while the clatter of knives and forks instantly ceased. "Yes." "Why didn't you do as I told you, yesterday?" "I _told_ you what to do." "Well, did you put them in hot water?" "Then do it. Do it right away. Have the water _hot_, now." He came back and went on with his dinner. Mary admitted to herself a little curiosity as to what was to be put into hot water. In a few minutes the dinner was finished and the doctor was gone. "I bet I know what that was," spoke up the small boy. "What?" asked his sister. "Diphtheria clothes. There's a family in town that's got the diphtheria." Mary was relieved--not that there should be diphtheria in town, but that the answer for which her mind was vaguely groping had probably been found. * * * * * Ting-a-ling-ling-ling. When the doctor had answered the summons he told Mary he would have to go down to a little house at the edge of town about a mile away. When he came back an hour later he sat down before the fire with his wife. "I remember a night nineteen years ago when I was called to that house--a little boy was born. I used to see the little fellow occasionally as he grew up and pity him because he had no show at all. Tonight I saw him, a great strapping fellow with a good position and no bad habits. He'll make it all right now." The doctor paused for a moment, then went on. "They didn't pay me then. I remember that. I mentioned it tonight in the young fellow's presence." "John, you surely didn't!" "Yes, I did. His mother said she guessed Jake could pay the bill himself." Mary looked at this husband of hers with a quizzical smile. "Doesn't it strike you that you are going pretty far back for your bill?" "There's no good reason why this boy should not pay the bill if he wants to." "No, I suppose not. But I don't believe he was so keen to get into the world as all that." "Well, it wouldn't surprise me much if that young fellow should come into my office one of these days and offer to settle that old score now that he knows about it." "Don't you take it if he does!" and Mary left the room quite unconscious that her pronoun was without an antecedent. * * * * * Ting-a-ling-ling-ling-ling-ling. "Is this you, Doctor?" "It is." "I expect you will have to come out to our house." "Who is it?" "This is Mary Milton." "What's the matter out there, Mrs. Milton?" "Polly's gone and hurt her shoulder. I guess she run it into the ground." "Was she thrown from a horse or a vehicle?" "No." "Then how could she run it into the ground?" "Polly Milton can run _everything_ into the ground!" and the tone was exasperation itself. "I come purty near havin' to send for you yesterday, but I managed to get 'er out." "Out of _what_?" "The clothes-wringer. She caught her stomach fast between the rollers and nearly took a piece out of it. Nobody wanted her to turn it but she would do it." "Well, what has she done _today_?" asked the doctor, getting impatient. "I'm plum ashamed to tell ye. She was a-playin' leap-frog." "Good! I'd like to play it myself once more." "I thought you'd be scandalized. Some of the girls come over to see 'er and the first thing I knowed they was out in the yard playin' leap-frog like a passel o' boys." "That's good for 'em," announced the doctor. "It wasn't very good for Polly." "The shoulder is probably dislocated. I'll be out in a little while and we'll soon fix it." "But a great big girl nearly fourteen years old oughtn't--" "She's all right. Don't you scold her too much." He laughed as he hung up the receiver, then ordered his horse brought round and in a few minutes was on his way to the luckless maiden. * * * * * Ting-a-ling-ling-ling--three rings. "Is this Dr. Blank?" "Yes." "Can you come down to James Curtis's right away?" "Yes--I guess so. What's the matter?" James Curtis stated the matter and the doctor put up the receiver, went to the door and looked out. "Gee-mi-nee! It's as dark as a stack of black cats," he said. In a little while he was off. He had to go horseback and as the horse he usually rode was lame he took Billy who was little more than a colt. Before Mary retired she went to the door and opened it. It was fearfully dark but John had said it was only a few miles. His faithful steed could find the way if he could not. John always got through somehow. With this comforting assurance she went to bed. By and by the 'phone was ringing and she was springing up and hastening to answer it. To the hurried inquiry she replied, "He is in the country." "How soon will he be back?" She looked at the clock. Nearly three hours since he left home. "I expected him before this; he will surely be here soon." A message was left for him to come at once to a certain street and number, and Mary went back to bed. But she could not sleep. Soon she was at the 'phone again, asking central to give her the residence of James Curtis. "Hello." "Is this Mr. Curtis?" "Yes, ma'am." "Is Dr. Blank there?" "He was, but he started home about an hour ago. He ought to be there by this time." "Thank you," said Mary, reassured. He would be home in a little bit then and she went back to her pillow. It was well she could not know that her husband was lost in the woods. The young horse, not well broken to the roads, had strayed from the beaten path. The doctor had first become aware of it when his hat was brushed off by low branches. He dismounted, and holding the bridle on one arm, got down on hands and knees and began feeling about with both hands in the blackness. It seemed a fruitless search, but at last he found it and put it securely on his head. He did not remount, but tried to find his way back into the path. After awhile the colt stopped suddenly. He urged it on. Snap! A big something was hurled through the bushes and landed at the doctor's feet with a heavy thud. The pommel of the saddle had caught on a grape vine and the girths had snapped with the strain. John made a few remarks while he was picking it up and a few more while he was getting it on the back of the shying colt. But he finally landed it and managed to get it half-fastened. He stood still, not knowing which way to turn. A dog was barking somewhere--he would go in that direction. Still keeping the bridle over his arm he spread his hands before him and slowly moved on. At last he stopped. He seemed to be getting no nearer to the dog. All at once, and not a great way off, he saw a fine sight. It was a lighted doorway with the figure of a man in it. He shouted lustily, "Bring a lantern out here, my friend, if you please. I guess I'm lost." "All right," the man shouted back and in a few minutes the lantern was bobbing along among the trees. "Why, Doctor!" exclaimed James Curtis, "have you been floundering around all this time in these woods so close to the house? Why didn't you holler before?" "There didn't seem to be anything to 'holler' at. Until that door opened I thought I was in the middle of these woods." "Your wife just telephoned to know if you were at our house and I told her you started home an hour ago." "She'll be uneasy. Put me into the main road, will you, and we'll make tracks for home." When he got there and had told Mary about it, she vowed she would not let him go to the country again when the night was so pitch dark, realizing as she made it, the futility of her vow. Then she told him of the message that had come in his absence and straightway sent him out again into the darkness. * * * * * It was midnight. The doctor was snoring so loudly that he had awakened Mary. Just in time. Ting-a-ling-ling-ling-ling. By hard work she got him awake. He floundered out and along toward the little tyrant. He reached it. "Hello. What is it?" "O! I got the wrong number." "Damnation!" Slumber again. After some time Mary was awakened by her husband's voice asking, "What is it?" "It's time for George to take his medicine. We've been having a dispute about it. I said it was the powder he was to take at two o'clock and he said it was the medicine in the bottle. Now he's mad and won't take either." "It was the powder. Tell him I say for him to take it now." The answering voice sank to a whisper, but the words came very distinctly, "I'm afraid he won't do it--he's so stubborn. I wish it was the bottle medicine because I believe he would take that." The doctor chuckled. "Give him that," he said. "It won't make a great deal of difference in this case, and thinking he was in the right will do him more good than the powder. Good night and report in the morning." The report in the morning was that George was better! * * * * * It was a lovely Sabbath in May. The doctor's wife had been out on the veranda, looking about her. Everywhere was bloom and beauty, fragrance and song. Long she sat in silent contemplation of the scene. At last a drowsiness stole over her and she went in and settled herself for a doze in the big easy chair. Soon a tinkling fell upon her drowsy ear. "Oh! that must have been the telephone. I wonder if it was two rings or three--I'd better listen," she said with a sigh as she pulled herself up. "Is this Dr. Blank?" The voice was faint and indistinct. "Hello?" said Mary's husband's voice, with the rising inflection. "Hello?" A more pronounced rise. No answer. "Hello!" falling inflection. Here Mary interposed. "It's some lady, Doctor, I heard her." "Hello!" with a fiercely falling inflection. "Dr. Blank," said the faint voice, "I forgot how you said to take those red tablets." Mary caught all the sentence though only the last three words came distinctly. "Yes?" Her husband's 'yes' was plainly an interrogation waiting for what was to follow. She understood. He had heard only the words "those red tablets." Again she must interpose. "Doctor, she says she forgot how you told her to take those red tablets." "O! Why, take one every--" Mary hung up the receiver and went back to resume her interrupted nap. She settled back on the cushions and by and by became oblivious to all about her. Sweetly she slept for awhile then started up rubbing her eyes. She went hurriedly to the 'phone and put the receiver to her ear. Silence. "Hello?" she said. No answer. Smiling a little foolishly she went back to her chair. "It isn't surprising that I dreamed it." For a few minutes she lay looking out into the snow flakes of the cherry blooms. Then came the bell--three rings. "I hope it's John asking me to drive to the country," she thought as she hurried to the 'phone. It was not. It was a woman's voice asking, "How much of that gargle must I use at a time?" "Oh dear," thought Mary, "what questions people do ask! When a gargler is a-gargling, I should think she could _tell_ how much to use." The doctor evidently thought so too for he answered with quick impatience, "Aw-enough to _gargle_ with." Then he added, "If it's too strong weaken it a little." "How much water must I put in it?" Mary sighed hopelessly and stayed to hear no more. Again she sank back in her chair hoping fervently that no more foolish questions were to rouse her from it. When she was dozing off the bell rang so sharply she was on her feet and at the 'phone almost before she knew it. "Doctor, the whole outfit's drunk again down here." A woman's voice was making the announcement. "Is that so?" The doctor's voice was calm and undisturbed. "Yes. The woman's out here in the street just jumpin' up and down. I think _she's_ about crazy." "She hasn't far to go." "Her father's drunk too and so's her husband. Will you come down?" "No, I don't think I'll come down this time." "Well, then will you send an officer?" "No-o--I don't--" "I wish you _would_." "Well, I'll try to send someone." * * * * * Mary was at last too wide awake to think of dozing. This blot on the sweet May Sabbath drove away all thought of day dreams. Poor, miserable human creatures! Poor, long-suffering neighbors, and poor John! "All sorts of people appeal to him in all sorts of cases, and often in cases which do not come within a doctor's province at all--he is guide, counsellor and friend," she thought as she put on her hat and went out for a walk. CHAPTER IX. One Sunday morning at the beginning of August, Mary stood in the church--as it chanced, in the back row--and sang with her next neighbor from the same hymn book, John Newton's good old hymn, "Amazing grace, how sweet the sound That saved a wretch like me!" It was the opening hymn and they were in the midst of the third verse. "Thro' many dangers, toils and snares, I have already come"; sang Mary. She did not dream that another danger, toil and snare was approaching her at that instant from the rear and so her clear soprano rang out unfaltering on the next line-- "'Tis grace that brought me safe thus far--" Then a hand was laid upon her shoulder. She turned and started as she saw her husband's face bending to her. What had happened at home? "Wouldn't you like to go to the country?" whispered the doctor. "Why--I don't like to leave church to go," Mary whispered back. "The carriage is right here at the door." The next instant she had taken her parasol from behind the hymn-books in front of her, where she had propped it a few minutes before, with some misgiving lest it fall to the floor during prayer, and just as the congregation sang the last line, "And grace will lead me home," she glided from the church by the side of the doctor, thankful that in the bustle of sitting down the congregation would not notice her departure. They descended the steps, entered the waiting carriage and off they sped. "I feel guilty," said Mary, a little dazed over the swift transfer. The doctor did not reply. In another minute she turned to him with energy. "John, what possessed you to come to _the church_?" "Why, I couldn't get you at home. I drove around there and Mollie said you had gone to church so I just drove there." "You ought to have gone without me." The doctor smiled. "You didn't _have_ to go. But you are better off out here than sitting in the church." The horse switched his tail over the reins and the doctor, failing in his effort to release them, gave vent to a vigorous expletive. "Yes, I certainly do hear some things out here that I wouldn't be apt to hear in there," she said. Then the reins being released and serenity restored, they went on. "Isn't that a pretty sight?" The doctor nodded his head toward two little girls in fresh white dresses who stood on the side-walk anxiously watching his approach. There was earnest interest in the blue eyes and the black. Near the little girls stood a white-headed toddler of about two years and by his side a boy seven or eight years old. "Mr. Blank," called the blue-eyed little girl--all men with or without titles are _Mr._ to little folks;--the doctor stopped his horse. "Well, what is it, Mamie?" "I want you to bring my mamma a baby." "You do!" "Yes, sir, a boy baby. Mamie and me wants a little brother," chimed in the little black-eyed girl. The boy looked down at the toddler beside him and then at the two little girls with weary contempt. "You don't know what you're a-gittin' into," he said. "If this one hadn't never learned to walk it wouldn't be so bad, but he jist learns _everything_ and he jist bothers me _all the time_." The doctor and Mary laughed with great enjoyment. "Now! what'd I tell you!" said the boy, as he ran to pick up the toddler who at that instant fell off the sidewalk. He gave him a vigorous shake as he set him on his feet and a roar went up. "Don't you _git_ any baby at your house," he said, warningly. "Yes, bring us one, Mr. Blank, please do, a little _bit_ of a one," said Mamie, and the black eyes pleaded too. "Well, I'll tell you. If you'll be good and do whatever your mamma tells you, maybe I _will_ find a baby one of these days and if I do I'll bring it to your house." He drove on. "If they knew what I know their little hearts would almost burst for joy. Their father is just as anxious for a boy as they are, too," he added. They were soon out in the open country. It was one of those lovely days which sometimes come at this season of the year which seem to belong to early autumn; neither too warm nor too cool for comfort. A soft haze lay upon the landscape and over all the Sunday calm. They turned into a broad, dusty road. Mary's eyes wandered across the meadow on the right with its background of woods in the distance. A solitary cow stood contentedly in the shade of a solitary tree, while far above a vulture sailed on slumbrous wings. The old rail fence and the blackberry briars hugging it here and there in clumps; small clusters of the golden-rod, even now a pale yellow, which by and by would glorify all the country lanes; the hazel bushes laden with their delightful promise for the autumn--Mary noted them all. They passed unchallenged those wayside sentinels, the tall mullein-stalks. The Venus Looking-Glass nodded its blue head ever so gently as the brown eyes fell upon it and then they went a little way ahead to where the blossoms of the elderberry were turning into tiny globules of green. Mary asked the doctor if he thought the corn in the field would ever straighten up again. A wind storm had passed over it and many of the large stalks were almost flat upon the earth. The doctor answered cheerfully that the sun would pull it up again if Aesop wasn't a fraud. After a while they stopped at a big gate opening into a field. "Hold the reins, please, till I see if I can get the combination of that gate," and the doctor got out. Mary took a rein in each hand as he opened the gate. She clucked to the horse and he started. "Whoa! John, come and get my mite. It's about to slip out of my glove." The doctor glanced at the coin Mary deposited in his palm. "They didn't lose much." "The universal collection coin, my dear. Now open the gate wider and I'll drive through." "Don't hit the gate post!" She looked at him with disdain. "I never drove through a gate in my life that somebody didn't yell, 'Don't hit the gate post' and yet I never _have_ hit a gate post." At this retort the doctor had much ado to get the gate fastened and pull himself into the buggy, and his laughter had hardly subsided before they drew up to the large farm house in the field. Mary did not go in. In about twenty minutes the doctor came out. The door-step turned, almost causing him to fall. "Here's a fine chance for a broken bone and some of you will get it if you don't fix this step," he growled. "I'll fix that tomorrow," said the farmer, "but I should think you'd be the last one to complain about it, Doctor." "Some people seem to think that doctors and their wives are filled with mercenary malice," said Mary laughing. "Yesterday I was walking along with a lady when I stopped to remove a banana skin from the sidewalk. She said she would think a doctor's wife wouldn't take the trouble to remove banana skins from the walk." "I believe in preventive medicine," said the doctor, "and mending broken steps and removing banana peeling belong to it." "Do you think it will ever be an established fact?" asked Mary as they drove away. "I do indeed. It will be the medicine of the future." "I'm glad I'm not a woman of the future, then, for I really don't want to starve to death." "I have to visit a patient a few miles farther on," said the doctor when they came out on the highway. Soon they were driving across a knoll and fields of tasseled corn lay before them. A little farther and they entered the woods. "Ah, Mary, I would not worry about leaving church. The groves were God's first temples." After a little he said, "I was trying to think what Beecher said about trees--it was something like this: 'Without doubt better trees there might be than even the most noble and beautiful now. Perhaps God has in his thoughts much better ones than he has ever planted on this globe. They are reserved for the glorious land.'" "See this, John!" and Mary pointed to a group of trees they were passing, "a ring cut around every one of them!" "Yes, the fool's idea of things is to go out and kill a tree by the roadside--often standing where it can't possibly do any harm. How often in my drives I have seen this and it always makes me mad." They drove for a while in silence, then Mary said, "Nature seems partial to gold." She had been noting the Spanish needles and Black-eyed Susans which starred the dusty roadside and filled the field on the left with purest yellow, while golden-rod and wild sunflowers bloomed profusely on all sides. "Yes, that seems to be the prevailing color in the wild-flowers of this region." "That reminds me of something. A few months ago a little girl said to me, 'Mrs. Blank, don't you think red is God's favorite color?' 'Why, dear, I don't think I ever thought about it,' I answered, quite surprised. 'Well, I think he likes _red_ better than any color.' 'Why I don't know, but when we look around and see the grass and the trees and the vines growing everywhere, it seems to me that _green_ might be his favorite color. But what makes you think it is red?' 'Because he put _blood_ into everybody in the world.' Quite staggered by this reasoning and making an effort to keep from smiling, I said, 'But we can't see that. If red is his favorite color why should he put it where it can't be seen?' The child looked at me in amazement. '_God_ can see it. He can see clear _through_ anybody.' The little reasoner had vanquished me and I fled the field." A little way ahead lay a large snake stretched out across the road. "The boy that put it there couldn't help it," said the doctor, "it's born in him. When I was a lad every snake I killed was promptly brought to the road and stretched across it to scare the passers-by." "And yet I don't suppose it ever did scare anyone." "Occasionally a girl or woman uttered a shriek and I felt repaid. I remember one big girl walking along barefooted; before she knew it she had set her foot on the cold, slimy thing. The way she yelled and made the dust fly filled my soul with a frenzy of delight. I rolled over and over in the weeds by the roadside and yelled too." A sudden turn in the road brought the doctor and his wife face to face with a young man and his sweetheart. Mary knew at a glance they were sweethearts. They were emerging into the highway from a grassy woods-road which led down to a little church. The young man was leading two saddled horses. "Why do you suppose they walk instead of riding?" asked the doctor. "Hush! they'll hear you. Isn't she pretty?" The young man assisted his companion to her seat in the saddle. She started off in one direction, while he sprang on his horse and galloped away in the other. "Here! you rascal," the doctor called, as he passed, "why didn't you go all the way with her?" "I'll go back tonight," the young fellow called back, dashing on at so mad a pace that the broad rim of his hat stood straight up. "Do you know him?" "I know them both." After another mile our travelers went down one long hill and up another and stopped at a house on the hilltop where lived the patient. Here, too, Mary chose to remain in the buggy. A wagon had stopped before a big gate opening into the barnyard and an old man in it was evidently waiting for someone. He looked at Mary and she looked at him; but he did not speak and just as she was about to say good morning, he turned and looked in another direction. When he finally looked around it seemed to Mary it would be a little awkward to bid him good morning now, so she tried to think what to say instead, by way of friendly greeting; it would be a little embarrassing to sit facing a human being for some time with not a word to break the constraint. But the more she cudgeled her brain the farther away flew every idea. She might ask him if he thought we were going to have a good corn crop, but it was so evident that we were, since the crop was already made that that remark seemed inane. The silence was beginning to be oppressive. Her eye wandered over the yard and she noticed some peach trees near the house with some of the delicious fruit hanging from the boughs. She remarked pleasantly, "I see they have some peaches here." Her companion looked at her and said, "Hey?" "I said, 'I see they have some peaches here,'" she rejoined, raising her voice. He curved one hand around his ear and said again, "Hey?" "O, good gracious," thought Mary, "I wish I had let him alone." She shrieked this time, "I only said, '_I see they have some peaches here._'" When the old man said, "I didn't hear ye yet, mum," she leaned back in the carriage, fanning herself vigorously, and gave it up. She had screamed as loud as she intended to scream over so trivial a matter. Looking toward the house she saw a tall young girl coming down the walk with something in her hand. She came timidly through the little gate and handed a plate of peaches up to the lady in the carriage, looking somewhat frightened as she did so. "I didn't hear ye," she explained, "but Jim came in and said you was a-wantin' some peaches." Mary's face was a study. Jim and his sister had not seen the deaf old man in the wagon, as a low-branched pine stood between the wagon and the house. And this was the way her politeness was interpreted! The comicality of the situation was too much. She laughed merrily and explained things to the tall girl who seemed much relieved. "I ought to 'a' brought a knife, but I was in such a hurry I forgot it." Eating peaches with the fuzz on was quite too much for Mary so she said, "Thank you, but we'll be starting home in a moment, I'll not have time to eat them. But I am very thirsty, might I have a glass of water?" The girl went up the walk and disappeared into the house. Mary did so want her to come out and draw the water, dripping and cool, from the old well yonder. She came out, went to the well, stooped and filled the glass from the bucket sitting inside the curb. Mary sighed. The tall girl took a step. Then, to the watcher's delight, she threw the water out, pulled the bucket up and emptied it into the trough, and one end of the creaking well-sweep started downward while the other started upward. The bucket was on its way to the cool depths and Mary grew thirstier every second. The doctor appeared at the door and looked out. Then he came, case in hand, with swift strides down the walk. The gate banged behind him and he untied the horse in hot haste, looking savagely at his wife as he did so. "I suppose you've asked that girl to bring you a drink." "Yes, I did. I'm very thirsty." "You ought to have more sense than to want to drink where people have typhoid fever." The girl started down the walk with the brimming glass. The doctor climbed into the buggy and turned around. "For pity's sake! what will she think?" A vigorous cut from the whip and the horse dashed off down the road. Mary cast a longing, lingering look behind. The girl stood looking after them with open mouth. "That girl has had enough today to astonish her out of a year's growth," thought Mary as the buggy bumped against a projecting plank and tore over the bridge at the foot of the hill. "John, one of the rules of good driving is never to drive fast down hill." Her spouse answered never a word. After a little he said, "I didn't mean to be cross, Mary, but I didn't want you to drink there." "You should have warned me beforehand, then," she said chillingly. "I couldn't sit in the buggy and _divine_ there was typhoid fever there," she continued. "'A woman's intuitions are safe guides' but she has to have _something_ to go on before she can _have_ intuitions." "Hadn't you better put your ulster on, dear?" inquired the doctor in such meaning tones, that Mary turned quickly and looked off across the fields. A Black-eyed Susan by the roadside caught the smile in her eyes and nodded its yellow head and smiled mischievously back at her. It was a feminine flower and they understood each other. When they had driven three or four miles Mary asked the doctor if there was any typhoid fever in the house they were approaching. "How do I know?" "I thought you might be able to divine whether there is or not." "We'll suppose there isn't. We'll stop and get a drink," he answered indulgently. They stopped, Mary took the reins and the doctor went to reconnoiter. "Nobody at home and not a vessel of any kind in sight," he announced coming back. Of course her thirst was now raging. "Maybe there's a gourd hanging inside the curb. If there is do break it loose and bring it to me heaping full." "I looked inside the curb--nothing there." Here Mary's anxious eyes saw a glass fruit jar turned upside down on a fence paling. Blessings on the woman who put it there! The doctor filled and brought it to her. After a long draught she uttered a sigh of rich content. "Now," she said, "I'm ready to go home." CHAPTER X. Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. "Hello." "Is this the doctor?" "It's one of 'em," said John, recognizing the voice of a patient. "Well, doctor, the _other_ side of my throat is sore _now_!" "Is it? Well, I told your husband it might be." "Why?" "Why? Well, because I'm running short of coffee and a few things like that." A little laugh. "_I_ don't want to keep you in coffee and things like that." "Nobody does. But the poor doctors have to live and you must contribute your share." Laughter. "All right, Doctor, but I don't want to have to contribute too much." "Don't be alarmed about your throat, Mrs. Channing. When I looked at it yesterday, I saw indications that the other side might be affected, but it will soon be well." "That sounds better. Thank you, good-bye." When he came back to the table his wife said, "John, I shouldn't think you'd say things like that to people." "Why?" "Well, they might believe 'em." The doctor laughed, swallowed his cup of tea and departed. Ting-a-ling-ling-ling. Three times. "Hello." "Is Dr. Blank at home?" "He has just this minute left for the office. 'Phone him there in two minutes and you will get him." Mary went back, took two bites and when the third was suspended on her fork the 'phone rang. "Somebody else," she thought, laying the fork down and rising. "Oh! I've got you again, Mrs. Blank. You said to ring in two minutes and I'd get the doctor." "But you didn't wait _one_ minute." "It seemed lots longer. All right, I'll wait." "People expect a doctor to get there in less than no time," thought Mary. "John walks so fast I felt safe in telling her to 'phone him in two minutes." _Buzz-z-z-z-z_, as if all the machinery of the universe were let loose in her ear. She had held the receiver till her husband could reach the office so she might feel assured the anxious one had found him. Yes, that was his voice. "Dr. Blank, you're president of the board of health, ain't ye?" "Yes--guess so." "This is Jack Johnson's. There's a dead horse down here by our house an' I want you to come down here an' bury it." Our listener heard the woman's teeth snap together. "All right. I'll get a spade and come right along." "What do they take my husband for," thought Mary. Buzz-z-z-z at her ear again. Now it was her husband's voice saying, "Give me number forty-five." In a minute a gentlemanly voice said, "Hello." "Is this you, Warner?" "Yes." "There's a dead horse down by Jack Johnson's. Go down there and bury it." "All right, Doc. I'll be right along." A burst of laughter from the doctor was echoed by Warner. Mary knew that Warner was the newly elected alderman and she smiled as she pictured the new officer leaving his elegant home and going down to perform the obsequies. Nevertheless her heart leaned toward Jack Johnson's wife, for it was plain to be seen that neither the new president of the board of health nor the new alderman had a realizing sense of his duties. Half an hour later three rings sounded. "Is this Dr. Blank's office?" "No, his residence." "Well, I see by the paper he's on the board of health and we want this manure-pile taken away from here." "Please 'phone your complaints to the doctor," said Mary, calmly replacing the receiver and shutting off the flood. "John's existence will be made miserable by this new honor thrust upon him," she thought. When he came home that evening she asked if the second complainant had found him. "Yes, she found me all right." "They're going to make day hideous and night lamented, aren't they?" "O, no. I'll just have a little fun and then send someone to look after their complaints." Just before bed-time the doctor was called to the 'phone. "Doctor, this is the nurse at the hotel. What had I better do with this Polish girl's hand?" "Doesn't it look all right?" "Yes, it's doing fine." "Just let it alone, then." "She won't be satisfied. She thinks we ought to be doing something to it. And I've got to do something or she'll go off upstairs and wash it in dirty water." "Tell her not to do anything of the kind." "She can't understand a word I say and I don't know what to do with her. She's had the bandage off once already." "The devil she has! Well, then you'll have to unwrap it, I guess, and pretend to do something. But it would be better to let it alone." "I know that." "How is the other patient tonight?" "Doing fine, Doctor." "Good! Good-bye." * * * * * There was a spacious, airy, upper chamber opening out on a balcony at the doctor's house which the doctor and Mary claimed for theirs. Not now; O no! But in the beautiful golden sometime when the telephone ceased from troubling and the weary ones might rest. This meant when the doctor should retire from night practice. Until that happy time they occupied a smaller room on the first floor as it was near the telephone. Mary had steadfastly refused to have the privacy of her upper rooms invaded by the tyrant. One warm summer night when bed-time came she made the announcement that she was going upstairs to sleep in the big room. "But what if I should be called out in the night?" asked her husband, with protest in his voice. "Then I'd be safer up there than down here," said Mary, calmly. "But I mean you couldn't hear the 'phone." "That is a consummation devoutly to be wished." "Now don't go off up there," expostulated John. "You always hear it and I sort of depend on you to get me awake." "Exactly. But it's a good thing for a man to depend on himself once in awhile. I was awake so often last night that I'm too tired and sleepy to argue. But I'm going. Good night." "Thunder!" "It doesn't ring _every_ night," said Mary, comfortingly from the landing. "Let us retire in the fond belief that curfew will not ring tonight." When she retired she fell at once into deep sleep. For two hours she slept sweetly on. Then she was instantly aroused. The figure of a man stood by her side. In the moonlight she saw him plainly, clad in black. Her heart was coming up into her throat when a voice said, "Mary, I have to go two miles into the country." "Why didn't you call me, John, instead of standing there and scaring me to death?" "I did call you but I couldn't get you awake." "Then you ought to have let me be. If a woman hasn't a right to a night's sleep once in awhile what _is_ she entitled to?" This petulance was unusual with his wife. "Well, come on down now, Mary," he said, kindly. "I'm not going down there this night." "But you can't hear the 'phone up here and I'm expecting a message any minute that must be answered." "I'll--hear--that--'phone," said Mary. "I'll sleep with one ear and one eye open." "Have it your own way," said the doctor as he started down the stairs. "I intend to. But when I tell you I'll watch the 'phone, John, you know I'll do it." He was gone and she lay wide awake. It seemed very hard to be ruthlessly pulled from a sleep so deep and delicious and so much needed. By and by her eye-lids began to feel heavy and her thoughts went wandering into queer places. "This won't do," she said aloud, sitting up in bed. Then she rose and went out on to the balcony. Seating herself in an arm chair, she looked about her on the silvery loveliness. The cricket's chirr and the occasional affirmations of the katy-did were the only sounds she heard. "I didn't say you didn't. Don't be so spiteful about it." The moon, shining through the branches of the big oak tree made faintly-flickering shadows at her feet. The white hammock, stirring occasionally as a breeze touched it, invited her. She went over to it and lay for many minutes looking up, noting how fast the moon glided from one branch of the tree to another. Now it neared the trunk. Now a slice was cut off its western rim. Now it was only a half moon--"a bweak-moon on the sky," as her little boy had called it. Now there was a total eclipse. When it began peeping out on the other side of the trunk our watcher's dreamful eyes took no note of it. A dog barked. She sprang up and seated herself in the chair again. She dare not trust herself to the hammock. It was too seductive and too delightful. So she sat erect and waited for the ring which might not come but which must be watched for just the same. Her promise had gone forth. Far up the street she heard horses' hoofs--it must be John returning. The buggy-top shining in the moonlight came into view. No, it was a white horse. Her vigil was not yet ended. A quarter of an hour later she discerned a figure far down the walk. She followed it with her eyes. It moved swiftly on. Would it turn at the corner and come up toward their house? Yes, it was turning. Then it turned into the yard. It was John. She went forward and leaning over the railing called down to him, "A good chance to play Romeo now, John." John only grunted--after the manner of husbands. "Nobody rang. I'm going to bed again. Good night--I mean good morning." * * * * * The next night was hotter than ever and Mary made up her mind she would sleep up in the hammock. She had had a delicious taste of it which made her wish for more. To avoid useless discussion she would wait till John retired and was asleep, then she would quietly steal away. But when this was accomplished and she had settled herself comfortably to sleep she found herself wide awake. She closed her eyes and gently wooed slumber, but it came not. Ah, now she knew! The night before she had shaken off all responsibility for the 'phone. Therefore she could sleep. Tonight her husband lay unconscious of her absence and the burden of it was upon her shoulders again. Well, she must try to sleep anyway, this was too good a chance to lose. She fell asleep. After awhile dinner was ready. Mollie had rung the little bell for the boys. Now she was ringing it again. Where can the boys have got to? Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. Mary sat up in the hammock and rubbed her eyes. "Oh!" she sprang out and rushed to the stairs. "Doctor!" "John!" The snores continued. Ting-a-ling-ling-ling-ling-ling! "Oh, dear!" gasped Mary, hurrying down as fast as her feet could take her. Straight to the 'phone she went. It must be appeased first. "Hello?" "Hell-_o_! Where's the doctor?" "He is very fast asleep." "I've found that out. Can you get him awake?" Sharp impatience was in the man's voice. "Hold the 'phone a minute, please, and I'll rouse him." She went into the bedroom and calling, "John! John!" shook him soundly by the shoulders. He sat up in bed with a wild look. "Go to the 'phone, quick!" commanded Mary. "Eh?" "Go to the _'phone_. It's been ringing like fury. Hurry." At last he was there and his wife knew by his questions and answers that he would be out for the rest of the night. She crept into bed. After he was gone she would go upstairs. When he was dressed he came to the door and peered in. "That's right, Mary," he said, with such hearty satisfaction in his tones that she answered cheerfully, "All right--I'll stay this time." And when he was gone she turned her face from the moonlit window and slept till morning, oblivious to the thieves and murderers that did not come. * * * * * Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. "Is the doctor there?" "He was called out awhile ago; will be back in perhaps twenty minutes." "This is Mr. Cowan. I only wanted to ask if my wife could have some lemonade this morning. She is very thirsty and craves it--but I can call again after awhile." How discouraging to the feverish, thirsty wife to have her husband come back and tell her he would 'phone again after awhile. And if, after waiting, he still failed to find the doctor? Mary knew the Cowans quite well so she made bold to say, hastily, "I think the doctor would say _yes_." "You think he would?" asked Mr. Cowan, hopefully. "I think he would, but don't let her have too much, of course." "All right. Thank you, Mrs. Blank." An uneasy feeling came into Mary's mind and would not depart as she went about her work. Really, what right had she to prescribe for a sick woman even so harmless a thing as lemonade. How did she know that it was harmless. Perhaps in this case there was some combination of symptoms which would make that very thing the thing the patient ought not to have. In about fifteen minutes there came a ring--three. Mary started guiltily. It sounded like the doctor's ring. Was he going to reprimand her? But it was the voice of a friend and it surprised Mary with this question: "Mrs. Blank, if you were me would you have your daughter operated upon?" "Operated upon for what?" "For appendicitis." "Nettie, let me tell you something: if I had no more sense than to give you advice on such a question as that, I certainly hope you would have more sense than to take it. Advice about a thing with no sort of knowledge of that thing is as worthless as it is common." "Why--I thought since you are a doctor's wife you would know about it." "Can you draw up a legal will because you happen to be the wife of a lawyer?" "No-o, but--" "But me no buts," quoth Mary. "We're even now." "Well, I've heard it said a doctor's wife knows even less than many others about ills and their remedies because she is so used to depending on her husband that she never has to think of them herself. I guess I'd better talk to the doctor. I just thought I'd see what you said first. Good-bye." "My skirts are clear of any advice in that direction," thought Mary, her mind reverting again to the lemonade. "Nettie couldn't have 'phoned me at a more opportune minute to get the right answer. But I wonder if John is back. I'll see." She rang. "Hello." "Say, John, Mr. Cowan 'phoned awhile ago, and his wife was very thirsty and craved lemonade and--don't scold--I took the liberty of saying--it's awful for a thirsty person to have to wait and wait you know--and so I said I thought _you_ would say she might have it." "I hope you weren't this long about it," laughed her husband. "Then it was all right?" "Certainly." Much relieved Mary hung up the receiver. "What needless apprehension assails us sometimes," she thought, as she went singing to her broom. "Just the same, I won't prescribe very often." CHAPTER XI. It was five o'clock in the morning when the doctor heard the call and made his way to it. His wife was roused too and was a passive listener. "Yes." "Yes." "Down where? I don't understand you." "On what street?.... Down near Dyre's? I don't know any such family." Here Mary called out, "Maybe they mean Dye's." "Dye's? Yes, I know where that is..... Galliver--that's the name is it? Very well, Mrs. Galliver, I'll be down in a little while.... Yes, just as soon as I can dress and get there." He proceeded to clothe himself very deliberately, but years of repression had taught Mary resignation. Ting-a-ling-ling-ling. Three rings. The doctor went with shoe in hand and again his wife was a listener. "Yes..... Yes..... I'm just getting ready to go to see a patient...... It's a hurry call, is it? All right then, I'll come there first...... Yes, right away." As he put up the receiver he said to his wife, "Somebody else was trying to get me then, too, but couldn't make it." Mary thought it well he couldn't since her husband was only one and indivisible. "But he will probably try again after a little," she thought, "and John will be gone and I won't know just where to find him." Ting-a-ling-ling-ling-ling-ling. Collar in hand the doctor went. "Yes..... Who is this?.... Come where?.... Jackson street. Right next to Wilson's mill?.... On which side? I say on which side of Wilson's mill?.... West? All right, I'll be down there after awhile...... No, not right away; I have to make two other visits first, but as soon as I can get there." When at last he was dressed and his hand was on the door-knob the 'phone called him back. "You say I needn't come..... Very well. I'll come if you want me to though, Mrs. Galliver. I'm just starting now. I have to see another patient first."-- "Why John," interposed Mary from the bedroom, "She called you first." "It will be about half an hour before I can get there..... All right, I'll be there." Then Mary remembered that No. 2 was the hurry call and was silent. When the doctor was gone she fell asleep but only for two minutes. She went to answer the call. "Has the doctor started yet?" "Yes, he is on his way." "All right then," and the relief in the tone was a pleasant thing to hear. "Now, if I go to sleep again I can feel no security from No. 1 or No. 3 or both." Nevertheless she did go to sleep and neither No. 1 nor No. 3 called her out of it. * * * * * "I must be going," said Mary, rising from her chair in a neighbor's house. "Have you something special on hand?" asked her neighbor. "Yes, it's clock-winding day at our house, for one thing." "Why, how many clocks do you have to wind?" inquired the little old lady with mild surprise. "Only one, thank heaven!" ejaculated Mary as she departed. When she had sped across the yard and entered her own door she threw off her shawl and made ready to wind the clock. First, she turned off the gas in the grate so that her skirts would not catch fire. Second, she brought a chair and set it on the hearth in front of the grate. Third, she went into the next room and got the big unabridged dictionary, brought it out and put it on the chair. Fourth, she went back and got the oldest and thickest Family Bible and the fat Bible Dictionary, brought them out and deposited them on the unabridged. Fifth, she mounted the chair. Sixth, she mounted the volumes--which brought her up to the height she was seeking to attain. Seventh, she wound the clock; that is, she usually did. Today, when she had inserted the key and turned it twice round--the 'phone rang. Oh, dear! Thank goodness it stopped at two rings. She would take it for granted the doctor was in the office. She wound on. Then she took the key out and inserted it on the opposite side. A second peal. That settled it. If it were a lawyer's or a merchant's or any other man's 'phone she could wind the other side first--but the doctor's is in the imperative mood and the present tense. She must descend. Slowly and cautiously she did so, went to the 'phone and put the receiver to her ear. "Hello, is this Dr. Blank's office?" "This is his--" "Hello, what is it?" said her husband's voice. "Now why couldn't he have come a minute sooner," thought Mary, provoked. "Doctor," said an agitated voice, "my little boy has swallowed a penny." "Was it a good one?" inquired the doctor, calmly. "Why--ye-es," said the voice, broken with a laugh, "guess it was." "Just let him alone. It will be all right after awhile." "It was worth getting down to hear so comforting an assurance," said Mary as she ascended again the chair and the volumes. She finished her weekly task, then slowly and cautiously descended, carried the big books back to their places, set the chair in its corner and lighted the gas. She stood for a moment looking up at this clock. The space over the mantel-piece was just the place for it and it was only after it had been firmly anchored to the wall that the thought had arisen, "How can I ever get up there to wind it?" She smiled as she thought of a social gathering a few days before, when a lady had called to her across the room, "Mrs. Blank, tell us that clock story again." And she had answered: "It isn't much of a story, but it serves to show the manner in which we computed the time. One night the doctor woke me up. 'Mary,' he said in a helpless sort of way, 'It struck _seven_--what _time_ is it?' 'Well--let me see,' I said. 'If it struck seven it meant to strike three, for it strikes four ahead of time. And if it meant to strike three it's just a quarter past two, for it's three quarters of an hour too fast.'" Ting-a-ling-ling. Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. Mary recognized her husband's ring. "Yes, what is it John?" "I'm going out for twenty minutes, watch the 'phone, please." She laughed in answer to this most superfluous request, then sat her down near by. * * * * * "John, Mrs. B. said a pretty good thing last night." "That's good." "I've a notion not to tell you, now that the good thing was about you." "That's better still. But are good things about me so rare that you made a note of it?" "I don't know but what they are," said Mary, reflectively. "There was Mrs. C., you know, who said she didn't see how in the world Doc Blank's wife ever lived with him--he was so mean." "I wonder about that myself, sometimes." "The way I manage it is to assert myself when it becomes necessary--and it does. You're a physician to your patients but to me you're a mere man." "I feel myself shrivelling. But how about Mrs. B.'s compliment?" "I was over at the church where a social program of some sort was being given and 'between acts' everybody was moving about chatting. An elderly woman near me asked, 'Mrs. Blank, do you know who the Hammell's are?' I told her that I did not, and she went on, 'I see by the paper that a member of their family died today, and I thought you, being a doctor's wife, might know something about it.' "Mrs. B. spoke up promptly, 'Why, Mrs. Blank wouldn't know anything about the _dead_ people--her husband gets 'em _well_.'" The doctor laughed, "And she believes it too," he said. "No doubt of it. So a compliment like that offsets one of Mrs. C.'s kind." "O, no. The C.'s have it by a big majority. Don't you know I have the reputation of being the meanest man in the county?" "No, I don't." "Well, I have. Do you remember that drive we took a week or two ago up north?" "That long drive?" "Yes. When I went in the man who was a stranger to me, said, 'I'll tell you why I sent for you. I've had two or three doctors out here, recommended as _good_ doctors, and they haven't done me a darned bit of good. Yesterday I heard you was the meanest doctor in this county and I said to myself, "He's the man I want."'" "I heard you laughing and wondered what it was about. The man's wife came out to the buggy and talked to me. She said they were strangers and didn't know anything about the doctors around here--they had thought of sending down to this town for a doctor but she had spoken to a woman--a neighbor--and she had said there wasn't _any_ of 'em any account down there. But her husband kept getting worse so they finally sent for Dr. Blank and she hoped he'd cure 'im. Are you doing it? I hope so for I assured her that the physicians of this town are recognized throughout the State as being men of exceptional ability, and she went in, comforted." "Yes, he got better as soon as he struck the road to health," laughed John. He took out his watch. "Jove! I haven't any time to spare if I catch that train." For several days he had been taking the train to a little station some miles out of town, where he would get off and walk a mile to the home of his patient, make his visit and walk back in time to catch the train for home. Just after the doctor left the house the telephone rang twice. His wife answered it, knowing he had not yet reached the office. "Is the doctor there?" "He left the house just a minute ago." "Well, he's coming down today isn't he?" "Is this Mrs. Shortridge?" "Yes." "Yes, he just said he must make that train." "He'll go to the office first won't he?" "Yes, to get his case, I think." "Will you please telephone him there to bring a roast with him?" "To bring what?" "A roast." Mary was nonplussed. Her husband had the reputation of "roasting" his patients and their attendants on occasion. Had an occasion arisen now? "Why, ye-es," she began, uncertainly, when the voice spoke again. "I mean a roast of beef, Mrs. Blank. I thought as the doctor was coming he wouldn't mind stopping at the butcher's and bringing me a roast--tell him a good-sized one." The receiver clicked. Mary still held hers. Then she rang the office. "What _is_ it?" Great haste spoke in the voice. "John, Mrs. Shortridge wants you to bring her a roast of beef when you go down." "The devil she does!" "The market is right on your way. Hurry. Don't miss the train!" She put up the receiver, then she snatched it and rang again violently. "_Now_ what!" thundered John's voice. "She said to get a good-sized one." Standing with the receiver in her hand and shaking with laughter she heard the office-door shut with a bang and knew that he was off. She knew that if he had been going in the buggy he would have been glad to do Mrs. S.'s bidding. He often carried ice and other needful things to homes where he visited. Mary pictured her husband picking his way along a muddy country road, his case in one hand and the "roast" in the other, and thought within herself, "He'll be in a better mood for a roast when he arrives than when he started." * * * * * Mary was out in the kitchen making jelly. At the critical moment when the beaded bubbles were "winking at the brim" came the ring. She lifted the kettle to one side, wiped her hands and went. "Is this you, Mary?" "Yes." "Watch the 'phone a little bit, please. I have to be out about half an hour." "I'm always watching the 'phone, John, always, _always_!" She went back to her jelly. She put it back on the fire, an inert mass with all the bubbles died out of it. Scarcely had she done so when the 'phone rang--two rings. Surely the doctor had not got beyond hearing distance. He would answer. But perhaps he had--he was a very swift walker. The only way to be sure of it was to go to the telephone and listen. She went hastily back and as she put the receiver to her ear there came a buzz against it which made her jump. "Hello," she said. "I wanted the doctor, Mrs. Blank, do you know where he is?" "He just 'phoned me that he--" an unmistakable sound arose from the kitchen stove. The jelly was boiling over! Instinct is older than the telephone. The receiver dangled in air while Mary rushed madly to the rescue. "I might have known it," she said to herself, as she pushed the kettle aside and rushed back to the 'phone. "I guess they cut us off," said the voice. "I was just saying," said Mary, "that the doctor 'phoned me a few minutes ago he would be out for half an hour." "Will you please tell him when he comes in to call up 83?" The man goes on his way, relieved of further responsibility in the matter. It will be a very easy thing for the doctor's wife to call up her husband and give him the message. Let us see. When the jelly was done, and Mary had begun to fill the waiting glasses she thought, "I'd better see if John is back. He may go out again before I can deliver that message." So she set the kettle on the back of the stove and went to ascertain if her husband had returned. No answer to her ring. She had better ring again to be sure of it. No answer. She went back to the kitchen. When the glasses were all filled and she had held first one and then another up to get the sunlight through the clear beautiful redness of them, she began setting them back to cool. The telephone! She hurried in and rang again to see if John had got back. Silence. She sighed and hung up the receiver. "I'd like to get it off my mind." As she started toward the kitchen again the door-bell rang. She went to open the door, and wonder of wonders--an old friend she had not seen for years! "I am passing through town, Mary, and have just three quarters of an hour till my train goes. Now sit down and _talk_." And the pair of them did talk, oblivious to everything about them. How the minutes did fly and the questions too! The 'phone rang in the next room--two rings. On Mary's accustomed ear it fell unheeded. She talked on. Again two rings. She did not notice. "Isn't that your 'phone?" asked the visitor. "O, _yes_! You knocked it clean out of my head, Alice. Excuse me a minute," and she vanished. "Did you give that message to the doctor?" "He is not back yet." "I saw him go into the office not ten minutes ago." "I have 'phoned twice and failed to find him." "I hoped when I saw him leave the office that he had started down to see my little boy, but of course he hasn't if he didn't get the message." "I am sorry. An old friend I had not seen for years came in and of course it went out of my mind for a few minutes, though I 'phoned twice before she came. I am sure he will be back in a few minutes and I will send him right down, Mr. Nelson." "Why do you do that?" asked her friend, pointedly as she came in. "Why take upon yourself the responsibility of people's messages being delivered." "It _is_ an awful responsibility. I don't know why I do it--so many people seem to expect it as a matter of course--" "It's a great deal easier for each person to deliver his own message than for you to have a half dozen on your mind at once. I wouldn't do it. You'll be a raving lunatic by the next time I see you." "At least I'll have ample time in which to become one," laughed Mary. "I'm going," announced her friend, suddenly rising. "I could spare five or ten minutes more but if I sit here you'll forget that 'phone again. But take my advice, Mary, and institute a change in the order of things." When she had gone Mary sat for a few minutes lost in thought. Then, remembering, she sprang up and went to the 'phone. No answer to her ring. "Dear me! Will I _never_ get that message delivered and off my mind." Soon a ring came. "Isn't he back _yet_?" "I 'phoned about three minutes ago and failed to get him. By the way, Mr. Nelson, will you just 'phone the doctor at the office, please? That will be a more direct way to get him as I seem to fail altogether this morning. I am sure that he can't be gone much longer," she said very pleasantly and hung up the receiver. The responsibility had been gracefully shifted and she was free for a while. Other occasions would arise when she could not be free, but in cases of this kind her friend's clear insight had helped her out. * * * * * Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. "Hello." "Is this Dr. Blank?" "Yes." "My husband has just started for your office. He says he's going to send you down. I don't need a doctor. Will you tell him that?" "I'll tell him you _said_ so." "Well, I don't. So don't you come!" "All right. I haven't got time to be bothered with you anyway. The sick people take my time." In a few minutes the 'phone rang again. "Dr. Blank, can you come over to the Woolson Hotel?" "Right away?" "Yes, if you can. There's a case here I've treated a little that I'm not satisfied about." "All right, Doctor, I'll be there in a few minutes." When he reached the hotel and had examined the patient he said, "He has smallpox." "I began to suspect that." "Not a bit of doubt of it." "The hotel is full of people--I'm afraid there'll be a panic." "We must get him out of here. We'll have to improvise a pest-house at once. I'll go and see about it." That evening about an hour after supper the doctor's daughter came hurriedly into the room where her mother was sitting. "Mother," she exclaimed, "there's an awful lot of people in the office, a regular mob and they're as mad as fury." "What about?" exclaimed her mother, startled. "They're mad at father for putting the tent for a smallpox patient down in their neighborhood." "Is he in the office now?" "He was there when I first went in but he isn't there just now. Father wasn't a bit disturbed, but I am. I got out of there. The mayor went into the office just as I came out." Uneasy, in spite of herself, Mary waited her husband's return. Ten o'clock, and he had not come. She went to the 'phone and called the office. The office man answered. "Where is the doctor?" "He was in here a few minutes ago, but there's a big fuss down at the smallpox tent and I think he's gone down there." Mary rang off and with nervous haste called the mayor's residence. "Is this Mr. Felton?" "Yes." "This is Mrs. Blank. I am very uneasy about the doctor, Mr. Felton. I hear he has just started down to the smallpox tent. Won't you please see that someone goes down at once?" "Yes, Mrs. Blank. I came from there a little while ago but they're mad at the doctor and I'll go right back. I'm not going to bed until I know everything's quieted down." "And you'll take others with you?" she pleaded, but the mayor was gone. Again she waited in great anxiety. The tent was too far away for her to go out into the night in search of him. Between eleven and twelve o'clock she heard footsteps. She rose and went to the door. Almost she expected to see her husband brought home on a stretcher. But there he came, walking with buoyant step. When he came in he kissed his anxious wife and then broke into a laugh. "My! how good that sounds! I heard of the mob and have been frightened out of my wits." "They've quieted down now. There wasn't a bit of sense in what they did." "Well, I don't know that one can really blame them for not wanting smallpox brought into the neighborhood. Couldn't you have taken the tent farther out?" "Yes, if we had had time. But we had a sick man on our hands--he had to be got out of the hotel and he had to be taken care of right away. He had to have a nurse. There must be water in the tent and the nurse can't be running out of a pest-house to get it. Neither can anyone carry it to such a place. So we couldn't put it beyond the water- and gas-pipes--there must be heat, too, you know. We have done the very best we could without more time. The nearest house is fifty yards away and there's absolutely no danger if the people down there will just get vaccinated and then keep away from the tent." "They surely will do that." "Some of them may. One fool said to me awhile ago when I told them that, 'Oh, yes! we see your game. You want to get a lot of money out of us.'" "What did you say to that ancient charge," asked Mary, smiling. "I said, 'My man, I'll pay for the virus, and I'll vaccinate everyone of you, and everyone in that neighborhood and it won't cost you a cent'." "Did he look ashamed?" "I didn't wait to see. I had urgent business out just then." "Is the patient in the tent now?" "Yes, all snug and comfortable with a nurse to take care of him. That was my urgent business. I went into the back room of the office in the midst of their jabber, slipped out the door, got into the buggy hitched back there, drove to the hotel and with Dr. Collins' help, got the patient down the ladder waiting for us, into the buggy, then got the nurse down the ladder and in, too, then away we drove lickety-cut for the tent while the mob was away from there. Then I went back to the office and attended the meeting," added the doctor, laughing heartily. His wife laughed too, but rather uneasily. "Were they still there when you got back?" "Every mother's son of 'em. They didn't stay long though. I advised them to go home, that the patient was in the tent and would stay there. They broke for the tent--vowed they'd set fire to it with him in it and I think they intended to hang _me_," and the doctor laughed again. "John, don't _ever_ get into such a scrape again. I 'phoned Mr. Felton and begged him to go down there and take someone with him." "You did? Well, he came, and it happened there was a member of the State Board of Health in town who had got on to the racket. He came, too, and you ought to have heard him read the riot act to those fellows: "'We've got a sick man here--a stranger, far from his home. You are in no danger whatever. Every doctor in town has told you so. We're going to take care of this man _and don't you forget it_. We have the whole State of Illinois behind us, and if this damned foolishness don't stop right here, I'll have the militia here in a few hours' time and arrest every one of you.' That quieted them. They slunk off home and won't bother us any more." * * * * * Three or four days after the above conversation Mary stood at the window looking out at the storm which was raging. The wind was blowing fearfully and the rain coming down in torrents. "I do hope John will not be called to the country today," she thought. Ting-a-ling-ling-ling--three rings. "Is this Dr. Blank's office?" asked a feminine voice. "No, his residence." "Mrs. Blank, this is the nurse at the smallpox tent. Will you 'phone the office and tell the doctor it's raining in down here terribly. I'm in a hurry, must spread things over the patient." "Very well, I'll 'phone him," and she rang twice. No reply. Again. No reply. "Too bad he isn't in. I'll have to wait a few minutes." In five minutes she rang again, but got no reply. In another minute she was called to the 'phone. "Didn't you get word to the doctor, Mrs. Blank?" asked a voice, full of anxiety. "I'm afraid we'll drown before he gets here." "I have been anxiously watching for him, but he must be visiting a patient. Hold the 'phone please till I ring again." This time her husband answered. "Doctor, here's the nurse at the tent to speak to you." She waited to hear what he would say. "Doctor, please come down here and help us. The roof is leaking awfully and we are about to drown." "All right, I'll be down after a little." "Don't wait too long." Mary's practised ear caught something beginning with a capital D as the receiver clicked. "Poor old John," she murmured, "it's awful--the things you have to do." The doctor got into his rubber coat and set out for his improvised pest-house. When he came home Mary asked, "Did you stop the leak?" "I did. But I had a devil of a time doing it." "I'm curious to know how you would go about it." "The roof was double and I had to straighten out and stretch the upper canvas with the wind blowing it out of my hands and nobody to help me hold it." "Was there nobody in sight?" "That infernal coward of a watchman, but I couldn't get him near the tent--he's _had_ smallpox, too." "I should think the nurse could have helped a little, that is if she knew where to take hold of it, and what to do with it when she got hold." "O, she sputtered around some and imagined she was helping." "Poor thing," said Mary, laughing, "I know just how bewildered she was with you storming commands at her which she couldn't understand--women can't." Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. The doctor helloed gruffly. "Is this you, Doc?" "Looks like it." "We want ye to come down here an' diagnosis these cases." "_What_ cases!" "There's two down here." "Down _where_?" "Down here at my house." "Well, who the devil _are_ you?" "Bill Masters. We're afraid maybe it's smallpox." "Yes, _yes_!" snarled the doctor, "every _pimple_ around here for the next three months will be smallpox." "Well, we want ye to diagnosis it, Doc." "All right. I'll 'diagnosis' it the first time I'm down that way--maybe this evening or tomorrow," and he slammed the receiver up and went to bed. * * * * * One evening the doctor was waiting for the stork at a farmhouse some miles from home. He concluded to telephone his wife as it might be several hours before he got in. He rang and put the receiver to his ear: "Did you put your washin' out today?" "No, did you?" "No, I thought it looked too rainy." "So did I. I hope it'll clear up by mornin'." "Have you got your baby to sleep yet?" "Land! yes. He goes to sleep right after supper." "Mine's not that kind of a kid. He's wider awake than any of us this minute." "Got your dress cut out?" "No, maybe I'll git around to it tomorrow afternoon, if I don't have forty other things to do." "Did ye hear about--" Seeing no chance to get in the doctor retreated. Half an hour later he rang again. A giggle and a loud girlish voice in his ear asking, "Is this you, Nettie?" "This is me." "Do you know who this is?" "Course I do." "Bet ye don't." "Bet I do." "Who?" "It's Mollie, of course." "You've guessed it. I tried to change my voice so you wouldn't know me." "What fer?" "Oh, cat-fur to make kitten breeches." Mild laughter. "I heard that you gave Jake the mitten last night." "Who told ye?" "Oh, a little bird." "Say! Who _did_ tell ye?" "You'll never, never tell if I do?" The clock near the patiently waiting doctor struck nine quick short strokes. "Did you hear that?" asked the first voice, startled. "Whose clock _is_ that?" "Johnson's haven't got one like that." "Miller's haven't neither." "I'll tell you--it's Gray's--their clock strikes quick like that." "Then there's somebody at their 'phone listenin'!" "Goodness! Maybe it's Jake, just like him!" "Jake Gray, if that's you, you're a mean eavesdroppin' sneak an' that's what I think of _you_! Good-bye, Nettie." And as the receiver slammed into its place the doctor shook with laughter. "This seems to be my opportunity," he thought, then rang and delivered the message to his wife. Often these dialogues kept him from hearing or delivering some important message and then he fumed inwardly, but tonight he had time to spare and to laugh. * * * * * After a little the 'phone rang. "It's someone wanting you, Doctor," said the man of the house who answered it. The doctor went. "Is this you, Doctor Blank?" "Yes." "I want you--" The doctor heard no more. This was a party line and every receiver on it came down. A dozen people were listening to find out who wanted the doctor and what for. All on the line knew that Doctor Blank had been at the Gray farmhouse for hours. The message being private, there was silence. The doctor waited a minute then his wrath burst forth. "Damn it! Hang up your receivers, all you eavesdroppers, so I can get this message!" Click, click, click, click, and lots of people mad, but the doctor got the message. * * * * * Ting-a-ling-ling-ling. "Is this Mrs. Blank?" "Yes." "I telephoned the office and couldn't get the doctor so I'll tell you what I wanted and you can tell him. His patient down here in the country, Mrs. Miller, is out of powders and she wants him to send some down by Mrs. Richards, if he can find her." "Where is Mrs. Richards?" "She's up there in town somewhere." "Does she know that the powders are to be sent by her and will she call at the office?" "No, I don't think she knows anything about it. Mrs. Miller didn't know she was out till after she left. That's all," and she was gone. "All!" echoed Mary. In a few minutes when she thought her husband had had time to return she went to the 'phone and told him he must go out and hunt up Mrs. Richards. "What for?" "Because Mrs. Miller wants you to find her and send some powders down by her." An explosion came and Mary retired laughing and marvelling to what strange uses telephones--and doctors--are put. CHAPTER XII. It was a lovely morning in late September. The sun almost shone through the film of light gray clouds which lay serenely over all the heavens. There was a golden gleam in the atmosphere, "And a tender touch upon everything As if Autumn remembered the days of Spring." The doctor and his wife were keenly alive to the beauty of the day. After they had driven several miles they stopped before a little brown house. The doctor said he would like Mary to go in and she followed him into the low-ceiled room. "Here, you youngsters, go out into the yard," said the mother of the children. "There ain't room to turn around when you all get in." They went. A baby seven or eight months old sat on the floor and stared up at Mary as she seated herself near it. Two women of the neighborhood sat solemnly near by. The doctor approached the bed on which a young woman of eighteen or twenty years was lying. "My heart hain't beat for five minutes," she said. "Is that so?" said the doctor, quite calm in the face of an announcement so startling. "Well, we'll have to start it up again." "That's the first time she has spoke since yesterday morning," said one of the solemn women in a low tone to the doctor. "It didn't hurt her to keep still. She could have spoken if she had wanted to." The two women looked at each other. "No, she couldn't speak, Doctor," said one of them. "Oh, yes she could," replied the doctor with great nonchalance. "I _couldn't_!" said the patient with much vigor. This was just what he wanted. He examined her carefully but said not a word. "How long do you think I'll live?" she asked after a little. "Well, that's a hard question to answer--but you ought to be good for forty or fifty years yet." The patient sniffed contemptuously. "Huh, I guess you don't know it all if you _are_ a doctor." "I know enough to know there's mighty little the matter with _you_." He turned to one of the women. "I would like to see her mother," he said. The mother had left the room on an errand; the woman rose and went out. There was a pause which Mary broke by asking the baby's name. "We think we'll call her Orient." "Why not Occident?" thought Mary, but she kept still. Not so the doctor. "_That's_ no name. Give her a good sensible _name_--one she won't be ashamed of when she's a woman." Here Mary caught sight of a red string around the baby's neck, and asked if it was a charm of some sort. The mother took hold of the string and drew up the charm. "It's a blind hog's tooth," she said simply, "to make her cut her teeth easy." The mother of the patient came into the room. "How do you think she is, Doctor?" "Oh, she's not so sick as you thought she was, not near." The mother looked relieved. "She had an awful bad spell last night. Do you think she won't have any more?" "No, she won't have any more." The look on the patient's face said plainly, "We'll see about that." It did not escape the doctor. "But in case you should see any signs of a spell coming on, and if she gets so she can't speak again, then you must--but come into the next room," he said in a low voice. They went into an adjoining room, the doctor taking care to leave the door ajar. Then in a voice ostensibly low enough that the patient might not hear and yet so distinct that she could hear every word, he delivered his instructions: "Now, if she has any more spells she must be blistered all the way from her neck down to the end of her spine." The mother looked terrified. "And if she gets so she can't speak again, it will be necessary to put a seton through the back of her neck." "What _is_ a seton?" faltered the woman. "Oh, it's nothing but a big needle six or eight inches long, threaded with coarse cord. It must be drawn through the flesh and left there for a while." Then in a tone so low that only the mother could hear, he said, "Don't pay much attention to her. She'll never have those spells unless there is somebody around to see her." He walked into the other room and took up his hat and case. "I left some powders on the table," he said to the mother. "You may give her one just before dinner and another tonight." "Will it make any difference if she doesn't take it till tonight?" "Not a bit." "Pa's gone and I didn't 'low to git any dinner today." At this announcement Mary heard something between a sigh and a groan and turning, saw a rosy-cheeked boy in the doorway. There was a look of resigned despair on his face and Mary smiled sympathetically at him as she went out. How many lads and lassies could have sympathized with him too, having been victims to that widespread feeling among housewives that when "Pa" is gone no dinner need be got and sometimes not much supper. As the doctor and his wife started down the walk they heard a voice say, "Ma, don't you ever send for that smart-aleck doctor agin. I won't _have_ him." The doctor shook with laughter as he untied the horse. "They won't need to send for me 'agin.' I like to get hold of a fine case of hysterics once in a while--it makes things lively." "The treatment you prescribed was certainly heroic enough," said Mary. They had driven about a mile, when, in passing a house a young man signaled the doctor to stop. "Mother has been bleeding at the nose a good deal," he said, coming down to the gate. "I wish you would stop and see her. She'll be glad to see you, too, Mrs. Blank." They were met at the door by a little old woman in a rather short dress and in rather large ear-rings. Her husband, two grown daughters and three children sat and stood in the room. "So you've been bleeding at the nose, Mrs. Haig?" said the doctor, looking at his patient who now sat down. "Yes, sir, and it's a-gittin' me down. I've been in bed part of the day." "It's been bleedin' off and on for two days and nights," said the husband. "Did you try pretty hard to stop it?" "Yes, sir, I tried everything I ever heerd tell of, and everything the neighbors wanted me to try, but it didn't do no good." "Open the door and sit here where I can have a good light to examine your nose by," the doctor said to the patient. She brought her chair and the young man opened the door. As he did so there was a mad rush between the old man and his two daughters for the door opposite. "Shet that door, quick!" the old man shouted, and it was instantly done. Mary looked around with frightened eyes. Had some wild beast escaped from a passing menagerie and was it coming in to devour the household? There was a swirl of ashes and sparks from the big fireplace. "This is the blamedest house that ever was built," said Mr. Haig. "Who built it?" queried the doctor. "I built it myself and like a derned fool went an' put the fireplace right between these two outside doors, so if you open one an' the other happens to be open the fire and ashes just flies." The doctor took an instrument from his pocket and proceeded with his examination. "But there's a house back here on the hill about a mile that beats this," said the old man. "That is a queer-looking house," said Mary. "It has no front door at all." "No side door, neither. When a feller wants to get in _that_ house there's just one of three ways: he has to go around and through the kitchen, or through a winder, or down the chimney." "If he was little enough he might go through the cat-hole," suggested the young man, at which they all laughed. "And what may that be?" asked the mystified Mary. "It's a square hole cut in the bottom of the door for the cat to go in and out at. The man that owns the place said he believed in having things handy." "Now, let me see your throat," said the doctor. The patient opened her mouth to such an amazing extent that the doctor said, "No, I will stand on the outside!" which made Mary ashamed of him, but the old couple laughed heartily. They had known this doctor a good many years. "What have you been doing to stop the bleeding?" he asked. "I've been a-tryin' charms and conjurin', mostly." Mary saw that there was no smile on her face or on any other face in the room. She spoke in a sincere and matter-of-fact way. "Old Uncle Peter, down here a piece, has cured many a case of nose-bleed but he hain't 'peared to help mine." "How does he go about it?" asked Mary. "W'y, don't you know nothin' 'bout conjurin'?" "Nothing at all." "I thought you bein' a doctor's wife would know things like that." "I don't believe my husband practises conjuring much." "Well, Uncle Peter takes the Bible, and opens it, and says some words over it, and pretty soon the bleedin' stops." "Which stops it, the Bible or the words?" "W'y--both I reckon, but the words does the most of it. They're the charm and nobody knows 'em but him." "Where did he learn them?" "His father was a conjurer and when he died he tol' the words to Uncle Peter an' give the power to him." "Did he come up here to conjure you?" asked the doctor. "No, he says he can do it just as well at home." "He can. But I think we can stop the bleeding without bothering Uncle Peter any more. I'd like a pair of scissors," he said, meaning to cut some papers for powders. "They won't do no good. I've tried 'em." "What do you think I want with them?" "I 'lowed you wanted to put 'em under the piller. That'll cure nose-bleed lots of times. Maybe you don't believe it, but it's so." "Can Uncle Peter cure other things?" asked Mary. "He can _that_. My nephew had the chills last year and shook and shook. At last he went to Uncle Peter an' he cured _him_." "He shot 'em," said Mr. Haig. "Yes, he told him to take sixteen shot every mornin' for sixteen days and by the time he got through he didn't shake a bit." "By jings! he was so heavy he couldn't," said Mr. Haig, and in the laugh that followed the doctor and his wife rose to go. A neighboring woman with a baby in her arms had come in and seated herself near the door. As he passed out the doctor stopped to inquire, "How's that sore breast? You haven't been back again." "It's about well. William found a mole at last and when I put the skin of it on my breast it cured it. I knowed it would, but when we wanted a mole there wasn't none to be found, so I had to go and see _you_ about it." "I thought it would soon be well. Good for the mole-skin," laughed the doctor, as they took their leave. When they had started homeward they looked at each other, the doctor with a smile in his eyes--he had encountered this sort of thing so often in his professional life that he was quite accustomed to it. But Mary's brown eyes were serious. "John," she said, "when will the reign of ignorance and superstition end?" "When Time shall be no more, my dear." "So it seems. Those people, while lacking education, seem to be fairly intelligent and yet their lives are dominated by things like these." "Yes, and not only people of fair intelligence but of fair education too. While they would laugh at what we saw and heard back there they are holding fast to things equally senseless and ridiculous. Then there are thoroughly educated and cultured people holding fast to little superstitions which had their birth in ignorance away back in the past somewhere. How many people do you know who want to see the new moon over the left shoulder? And didn't I hear you commanding Jack just the other day to take the hoe right out of the house and to go out the same door he came in?" "O, ye-es, but then _nobody_ wants to have a _hoe_ carried through the house, John. It's such a bad sign--" The doctor laughed. "This thing is so widespread there seems to be no hope of eliminating it entirely though I believe physicians are doing more than anybody else toward crushing it out." "Can they reason and argue people out of these things?" "Not often. Good-natured ridicule is an effective shaft and one I like to turn upon them sometimes. They get so they don't want to say those things to me, and so perhaps they get to see after a while that it is just as well not to say them too often to other people, too." "Don't drive so fast, John, the day is too glorious." Yellow butterflies flitted hither and thither down the road; the corn in the fields was turning brown and out from among it peeped here and there a pumpkin; the trees in apple orchards were bending low with their rosy and golden treasures. They passed a pool of water and saw reflected there the purple asters blooming above it. By and by the doctor turned down a grassy road leading up to a farmhouse a short distance away. "Are you to make another call today?" asked his wife. "Yes, there is a very sick child here." When he had gone inside three or four children came out. A curly-headed little girl edged close and looked up into Mary's face. "Miss' Blank, _you_ know where Mr. Blank got our baby, _don't_ you?" Mary, smiling down at the little questioner, said, "The doctor didn't tell me anything about it." The little faces looked surprised and disappointed. "We thought you'd know an' we come out to ask you," said another little girl. "You make all the babies' dresses, don't you?" "Dear me, no indeed!" laughed the doctor's wife. "Does he keep all the babies at your house?" asked the little boy. "I think not. I never see them there." "Didn't he ever bring any to your house?" "Oh, yes, five of them." "I'd watch and see where he _gets_ 'em," said the little fellow stoutly. "Jimmie Brown said Mr. Blank found their baby down in the woods in an old holler log." The doctor came out, and the little boy looking up at him asked, "Is they any more babies down in the woods?" "Yes, yes, 'the woods is full of 'em,'" laughed the doctor as he drove off leaving the little group quite unsatisfied. When they had gone some distance two wagons appeared on the brow of the hill in front of them. "Hold on, Doctor," shouted the first driver, as the doctor was driving rapidly by, "I want to sell you a watermelon." "Will you take your pay in pills?" "Don't b'lieve I have any use for pills." "Don't want one then, I'm broke this morning," and he passed the second wagon and pulled his horse into the road again. "Wait a minute! _I'll_ trade you a melon for some pills," called the driver. He spread the reins over the dashboard and clambered down; the man in front looked back at him with a grin. "I've got two kinds here, the Cyclone and the Monarch, which would you rather have?" "Oh, I don't care," said the doctor. "Let us have a Monarch, please," said Mary. Monarch was a prettier name than Cyclone, and besides there was no sense in giving so violent a name to so peaceful a thing as a watermelon. So the Monarch was brought and deposited in the back of the buggy. The doctor opened his case. "Take your choice." "What do you call this kind?" "I call that kind Little Devils." "How many of 'em would a feller dare take at once?" "Well, I wouldn't take more than three unless you have a lawyer handy to make your will." "Why, will they hurt me?" "They'll bring the answer if you take enough of 'em." The man eyed the pills dubiously,--"I believe I'll let that kind alone. What kind is this?" "These are podophyllin pills." "Gee, the _name's_ enough to kill a feller." "Well, Morning-Glories is a good name. If you take too many you'll be wafted straight to glory in the morning, and the road will be a little rough in places." "Confound it, Jake," called the first driver, "don't you take _none_ of 'em. Don't monkey with 'em." But Jake had agreed to trade a melon for pills. He held out his big hand. "Pour me out some of them Little Devils. I'll risk 'em." The doctor emptied the small bottle into Jake's hand, replaced it in the case and drove off. "John, why in the world didn't you give him some instructions as to how to take them?" asked Mary, energetically. "He didn't ask me to prescribe for him, my dear. He wanted to trade a watermelon for pills and we traded." "For pity's sake," said Mary indignantly, "and you're going to let that man kill himself while you strain at a point of professional etiquette!" She was gazing back at the unfortunate man. "Don't you worry, he'll be too much afraid of them to hurt himself with them," said the doctor, laughing. "I sincerely hope he will." As they came in sight of home the doctor, who had been silent for some time, sighed heavily. "I am thinking of that little child out there. I tell you, Mary, a case of meningitis makes a man feel his limitations." CHAPTER XIII. A long, importunate peal. The doctor rose and went swiftly. Mary listened with interest to what was to come: "?" "Yes." "?" "Yes." "?" "Yes." "?" "Yes." "?" "Yes." He rang off. "That was decided in the affirmative," said Mary. * * * * * Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. "Doctor, do you think the baby will cut any more teeth this summer?" "You'd better ring up Solomon and ask that." "Well--if he gets through teething--don't you think he'll be all right?" "If he gets through with the way you _feed_ him he'll be all right." "Well, his teething has lots to do with it." "No, it don't--not a darned bit. If you'll take care of his stomach his teeth will take care of themselves. It's what goes _between_ the teeth that does the mischief. I keep telling people that every day, and once in a while I find someone with sense enough to believe it. But a lot of 'em know too much--then the baby has to pay for it." "Well, I'll be awful careful, Doctor." "All right then. And stick right to the baby through the hot months. Let me hear from it. Good-bye." * * * * * Ting-a-ling-ling-ling--three times. Mary rose and went. An agitated voice said, "Come and see the baby!" and was gone. "She is terribly frightened," thought Mary, as she rang central. "Some one rang Dr. Blank. Can you find out who it was?" "I'm afraid not." "Will you please try?" "Yes, but people ought to do their own talking and not bother us so much." "I know," said Mary gently, "but this is a mother badly frightened about her baby--she did not think what she was doing and left the 'phone without giving me her name." Central tried with such good result that Mary was soon in possession of the name and number. She telephoned that she would send the doctor down as soon as she could find him, which she thought would be in a few minutes. Then she telephoned a house where he had been for several days making evening visits. "Is Dr. Blank there?" "He _was_ here. He's just gone." "Is he too far away for you to call him?" "Run and see, Tommy." Silence. Then, "Yes, he's got too far to hear. I'm sorry." "Very well. Thank you." "Let me see," she meditated, "yes, I think he goes there." She got the house. "Is Dr. Blank there?" "He's just coming through the gate." "Please ask him to come to the 'phone." After a minute his voice asked what was wanted and Mary delivered her message. When her husband came home that night, she said, "John, there's one more place you're to go and you're to be there at nine o'clock." "The deuce!" he looked at his watch, "ten minutes to nine now. Where is it?" "I don't know." "Don't know?" "No. I haven't the slightest idea." "Why didn't you find out," he asked, sharply. Mary arched her brows. "Suppose _you_ find out." John rang central. With twinkling eyes his wife listened. "Hello, central. Who was calling Dr. Blank a while ago?" "A good many people call, Dr. Blank. I really cannot say." The voice was icily regular, splendidly null. It nettled the doctor. "Suppose you try to find out." "People who need a doctor ought to be as much interested as we are. I don't know who it was." And the receiver went up. "Damned impudence!" said the doctor, slamming up his receiver and facing about. "Wait, John. That girl has had to run down the woman with the sick baby. She didn't give _her_ name either. Central had lots of trouble in finding her. It's small wonder she rebelled when I came at her the second time. So all I could do was to deliver the message just as it came, 'Tell the doctor to come down to our house and to be here at nine o'clock.'" "Consultation, I suppose. They'll ring again pretty soon, I dare say, and want to know why I don't hurry up." But nothing further was heard from the message or the messenger that night or ever after. * * * * * Ting-a-ling-ling-ling. Can we move Henry out into the yard? It's so hot inside. * * * * * Ting-a-ling-ling-ling. Can we move Jennie into the house? It gets pretty cold along toward morning. * * * * * Ting-a-ling-ling-ling. Doctor, you know those pink tablets you left? I forget just how you said to take 'em. * * * * * Ting-a-ling-ling-ling. The baby's throwing up like everything. * * * * * Ting-a-ling-ling-ling. Johnny's swallowed a nickel!.... You say it won't?.... And not give him anything at all? Well, I needn't have been so scared, then. * * * * * Ting-a-ling-ling-ling. The baby pulled the cat's tail and she scratched her in the face. I'm afraid she's put her eye out..... No, the _baby's_ eye. I'm afraid she can't see..... No, she's not crying. She's going to sleep..... Well, I guess she _can't_ see very well with her eyes shut..... Then you won't come down?.... All right, Doctor, you know best. * * * * * Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. "Is this the doctor?" "Yes." "The baby has a cold and I rubbed her chest with vaseline and greased her nose. Is that all right?" "All right." "And I am going to make her some onion syrup, if I can remember how it's made. How do you make it?" "Why--O, _you_ remember how to make it." The truth is the doctor was not profoundly learned in some of the "home remedies" and was more helpless than the little mother herself, which she did not suspect. "You slice the onions and put sugar on them, don't you?" "Yes, that'll be all right," he said, hastily putting up the receiver. * * * * * Ting-a-ling-ling-ling. "Doctor, when you come down, bring something for my fever--" "Yes, I will!" "And for my nervousness--" "Yes, yes." The doctor turned quickly from the 'phone, but it rang again. "And for my back, Doctor--" "Yes. _Yes!_" He put the receiver up with a bang and seizing his hat rushed away before there should be any more. * * * * * Three rings. "Is this Dr. Blank's?" "Yes." "Is he there?" "No, but I expect him very soon." "When he comes will you tell him to come out to Frank Tiller's?" "Does he know where that is?" "He was here once." "Lately?" "No, some time ago." "Please tell me what street you live on, so the doctor will know where to go." Mary heard a consultation of a minute. "It's on Oak street." "East Oak or West?" Another consultation. "North." "Very well. I'll tell the doctor as soon as he comes." "Tell him to come as quick as he possibly can." Five minutes later the office ring came. Mary went obediently lest her husband might not be in. She heard the same voice ask, "Is this you, Doctor?" "Yes." "We want you to come out to Frank Tiller's as quick as you possibly can." "Where is that?" "_You've_ been here." "_Where do you live?_" "We live on Oak street." "East or West?" "North." "That street runs east and west!" "Ma, he says the street runs east and west." "Well, maybe it does. I've not got my directions here yet--then it must be west." "It's on West Oak street, Doctor." The doctor was not quite able to locate the place yet. "Is it the house where the girl had the sore throat?" "Ma, he says, is it the place where the girl had the sore throat?" "It's just in front of that house." "She says it's just in front of that house and come just as quick as you possibly can." "What does she mean by 'in front of it'?" "Why, it's just across the street, and come just as quick as you possibly--" "Yes. I'll _run_." Mary smiled, but she was glad to hear her husband add a little more pleasantly, "I'll be out there after a little." When he came home he said, laughing, "That girl up there took the medicine I gave her and pounded the bottle to flinders before my eyes." "What for?" "O, she was mad." "What did you do then?" "Reached down in my pocket and took out another one just like it and told them to give it according to directions." "Nothing like being prepared." "I knew pretty well what I was up against before I went. The old complaint," said John, drawing on his slippers as he spoke. CHAPTER XIV. Mary had been down the street, shopping. "I'll drop in and visit with John a few minutes," she thought, as she drew near the office. When she entered her husband was at the telephone with his back toward her. "Hello. What is it?" "Shake up your 'phone, I can't hear a word you're saying." "Who?" "Oh, yes, _I_ know." Exasperation was in every letter of every word. "Take one every six months and let me hear from you when they're all gone." Slam! "There's always _some_ damned thing," he muttered, and turning faced his wife. "A surprising prescription, John. What does it mean?" "It means that she's one of these everlasting complainers and that I'm tired of hearing her. She's been to Chicago and St. Louis and Cincinnati. She's had three or four laparotomies and every time she comes back to me with a longer story and a worse one. They've got about everything but her appendix and they'll get that if she don't watch out." "Why, I thought they always got that the first thing." "You have no idea how it tires a man to have people come to him and complain, complain, _complain_. The story is ever new to them but it gets mighty old to the doctor. Then they go away to the city and some surgeon with a great name does what may seem to him to be best. Sometimes they come back improved, sometimes not, and sometimes they come back worse than when they went. In all probability the operator never sees the patient again and so the last chapters of the story must be told to the home doctor over and over again." Mary gave a little sigh. The doctor went on: "In many cases it isn't treatment of any kind that is needed. It is occupation--occupation for the mind and for the hands. Something that will make people forget themselves in their work or in their play." Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. "Is this you, Doctor?" "Yes." "I wanted to see if you were at the office. I'll be over there right away." In a few minutes the door opened and a gentleman about thirty-five years of age entered. His manner was greatly agitated and he did not notice Mrs. Blank at the window near the corner of the room. "Good morning, Mr. Blake," said the doctor, shaking hands with him, "back again, are you?" Mr. Blake had been to C--, his native city. He had not been well for some time and had evinced a desire to go back and consult his old physician there, in which Dr. Blank had heartily concurred. "How long do you think I can live?" Mr. Blake asked now. "What do you mean?" replied the doctor, regarding him closely. "I want to know how much time I have. I want to get my business fixed up before--" "Blake, you couldn't die if you wanted to. You're not a sick enough man for that." The patient took a letter from his pocket and handed it in silence to the doctor. The latter took it, looked carefully at the superscription, read it slowly through, then folded it with cool deliberation and put it back into the envelope. "I thought you were going to your old physician," he said. "Dr. Kenton was out of the city so I went to the great specialist." "Did he tell you what was in this letter he sent to me?" "No, but the letter was not sealed and I read it. I was so anxious to know his opinion that I couldn't help it. Tuberculosis of the larynx--" his voice faltered. "Yes," said the doctor, calmly, "that is a thing a man may well be frightened about. But listen to me, Blake. You've not got tuberculosis of the larynx." "Do you think a great physician like Dr. Wentworth doesn't know what he is talking about?" "Dr. Wentworth is a great physician; I know him well. But he is only a man like the rest of us and therefore liable to err in judgment sometimes. He knew you half an hour, perhaps, before he pronounced upon your case. I have known you and watched you for fifteen years. I say you have not got tuberculosis _and I know I am right_." Mary saw Mr. Blake grasp her husband's hand with a look in his face that made her think within herself, "Blessings on the country doctor wherever he may be, who has experience and knowledge and wisdom enough to draw just and true conclusions of his own and bravely state them when occasion demands." When the patient had gone Mary said to her husband, "One gets a kaleidoscopic view of life in a doctor's office. What comes through the ear at home comes before the eye here. The kaleidoscope turned a bright-colored bit into the place of a dark one this time, John. I am glad I was here to see." As she spoke footsteps were heard on the stairs. Slow and feeble steps they were, but at last they reached the landing and paused at the open door. Looking out Mary saw a poorly clad woman perhaps forty years of age, carrying in her hands a speckled hen. She was pale and trembling violently, and sank down exhausted into the chair the doctor set for her. He took the hen from her hands and set it on the floor. Its feet were securely tied and it made no effort to escape. The doctor had never seen the woman before but noting the emaciated form and the hectic flush on the cheek he saw that consumption was fast doing its work. Mary took the palm leaf fan lying on the table and stood beside her, fanning her gently. When the woman could speak she said, "I oughtn't to 'a' tried to walk, Doctor, but there didn't seem to be anyone passin' an' this cough is killin' me. I want something for it." "How far did you walk?" asked Mary, kindly. "Four mile." "Four miles!" she looked down at the trembling form with deep pity in her brown eyes. "I didn't have any money, Doctor, but will the hen pay for the medicine?" her eyes were raised anxiously to his face and Mary's eyes met the look in the eyes of her husband. "I don't want the hen. We haven't any place to keep her. Besides my wife, here, is afraid of hens." A little smile flitted across the wan face. He told her how to take the medicine and then said, "Whenever you need any more let me know and I'll send it to you. You needn't worry about the pay." "I'm very much obleeged to you, Doctor." "Just take the hen back home with you." "I wonder if I couldn't sell her at the store," she said, looking at the doctor with a bright, expectant face. "Wait here and rest awhile and then we'll see about it. I'll go down and perhaps I can find some one in town from out your way that you can ride home with. Where do you live?" She told him and he went down the stairs. In a little while he came back. "One of your neighbors is down here now waiting for you. He's just starting home," he said. He took the hen and as they started down the stairs Mary came out and joined them. At the foot of the stairway he said to the grocer standing in front of his establishment, "Here, Keller, I want you to give me a dollar for this hen." "She ain't worth it." "She _is_ worth it," said the doctor so emphatically that Keller put his hand in his pocket and handed out the dollar. The poor woman did not see the half dollar that passed from the doctor's hand to the grocer's, but Mary saw and was glad. The doctor laid the dollar in the trembling palm, helped the feeble woman into the wagon and they drove off. Mary turned to her husband and said with a little break in her voice, "I'm going home, John. I want to get away from your kaleidoscope." Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. "And I must go for another peep into it. Good-bye. Come again." * * * * * "Is this Dr. Blank?" "Yes." "This is Jim Sampson, Doctor, out at Sampson's mill. My boy fell out of a tree a while ago and broke his leg, and I'm sort o' worried about it." "It don't have to _stay_ broke, you know." "That's just the point. I'm afraid it will--for a while at least." "What do you mean?" "Why, my wife says she won't have it set unless the signs are right for setting a broken bone. She's great on the almanac signs." "The devil! You have that bone _set_--_today_! Do you understand?" "Yes, but Mary's awful set in her way." "I'm a darned sight more set. That boy's not going to lie there and suffer because of a fool whim of his mother's. Where is she? Send her to the 'phone and I'll talk to _her_." "She couldn't find her almanac and ran across to the neighbor's to get one." "Call me when she gets back." Ten minutes passed and the call came. "It's all right, Doctor, the signs says so." A note of humor but of unmistakable relief vibrated in the voice. "Come right out." "All right, Jim, I'll be out as soon as I make my round here in town. Tell your wife to have that almanac handy. I may learn something from it." An hour or two later he was starting out to get into the buggy, with splints and other needful things when the 'phone called him back. Hastily cramming them under the seat he went. "Hello." "Is this Dr. Blank?" "This is Millie Hastings. Do you remember me?" "No-o--I don't believe I do." "You doctored me." "Yes, I've 'doctored' several people." "I had typhoid fever two years ago up in the country at my uncle's." "What's your uncle's name?" "Henry Peters." "Yes, I remember now." "I wanted to find out what my bill is." "Wait here a moment till I look at the book." In a minute he had found it: Millie Hastings--so many visits at such and such a date, amounting to thirty-six dollars. He went back to the 'phone. "Do you make your money by working by the week?" "Yes, sir." "Have you learned how to save it?" "Yes, sir, I had to. I have to help mother." "Your bill is eighteen dollars." He heard a little gasp, then a delighted voice said: "I was afraid it would be a good deal more. And now Dr. Blank, I want to ask a favor of you." "Ask away." "I brought four dollars to town with me today to pay on my bill, but I want a rocking chair _so_ bad--I'm over here at the furniture store now--and there's such a nice one here that just costs four dollars and I thought maybe you'd wait a----" "_Certainly_ I will. Get the rocking chair by all means," and he laughed heartily as he went out to the buggy. He climbed in and drove away, the smile still lingering on his face. At the outskirts of the town a tall girl hailed him from the sidewalk. He stopped. "I was just going to your office to get my medicine," she said. "I left it with the man there. He'll give it to you." "Must I take it just like the other?" "Yes. Laugh some, though, just before you take it." "Why?" "Because you won't feel like it afterward." The girl looked after him as he drove on. "He's laughing," she said to herself and a grin overspread her face as she pursued her leisurely way. * * * * * Ting-a-ling-ling-ling-ling-ling-ling!!! "Must be something unusual," thought Mary as the doctor went to the 'phone. "Doctor, is this you?" "Yes." "Come out to John Lansing's quick!" "What's the matter?" "My wife swallowed poison. Hurry, Doctor, for God's sake!" In a few minutes the doctor was on his horse (the roads being too bad for a buggy) and was off. We will follow him as he plunges along through the darkness. Because of the mud the horse's progress was so slow that the doctor pulled him to one side, urged him on to the board walk, much against his inclination, and went clattering on at such a pace that the doors began to fly open on both sides of the street and heads, turned wonderingly after the fleeting horseman, were framed in rectangles of light. "What _is_ the matter out there?" The angle of the heads said it so plainly that the doctor laughed within himself as he thundered on. Now it chanced that one of the heads belonged to a Meddlesome Matty who, next day, stirred the matter up, and that evening two officers of the law presented themselves at Dr. Blank's office and arrested him. "I don't care anything about the fine. All I wanted was to get there," he said, handing out the three dollars. After the horse left the board walk the road became more solid and in about ten minutes the doctor arrived at his destination. Before he could knock the door was opened. The patient sat reclining in a chair, motionless, rigid, her eyes closed. "What has she taken?" asked the doctor of the woman's husband. "Laudanum." "How much?" "She told me she took this bottle full," and he held up a two ounce bottle. "I think she's lying," thought the doctor as he laid his fingers upon her pulse. Then he raised the lids and looked carefully at the pupils of the eyes. "Not much contraction here," he thought. Turning to the husband who stood pale and trembling beside him, he said, "Don't be alarmed--she's in no more danger than you are." He watched the patient's face as he spoke and saw what he expected--a faint facial movement. "To be on the safe side we'll treat the case as if she had taken two ounces." He gave her a hypodermic emetic then called for warm water. "How much?" asked the husband. "O, a half gallon will do." A big fat woman came panting through the doorway. "I got here as quick as I could," she gasped. "We don't need you at all," said the doctor quietly. "Better go back home to your children, Mrs. Johnson." Mrs. Johnson, not liking to be cheated out of a sensation which she dearly loved, stood still. Mr. Lansing came back with the warm water. A faint slit appeared under the eyelids of the patient. The doctor took the big cup and said abruptly, "Here! drink this!" No response. "Mrs. Lansing!" he said so sharply that her eyes opened. "Drink this water." "I ca-an't," she murmured feebly. "Yes, you can." "I won't," the voice was getting stronger. "You will." "You'll see." "Yes, I'll see." He held the big vessel to her mouth. When the water began to pour down her neck she sprang to her feet fighting it off. He held the cup in his left hand while with his right he reached around her neck and took her firmly by the nose. Then he held the cup against her mouth and when it opened for breath he poured the life-saving fluid forcefully down. Great gulps of it were swallowed while a wide sheet of water poured down her neck and over her night-dress to the floor. "That was very well done. Better sit down now." The husband stood in awed silence. The fat woman shook her fist at the doctor's back which he beheld, nothing daunted, in the looking-glass on the wall. The patient herself sat down in absolute quiet. In a minute she began retching and vomited some of the water. The doctor inspected it carefully. Then he went to his overcoat on a chair, felt in the pocket and drew out a coil of something. It looked like red rubber and was about half an inch in diameter. He slowly unwound it. It was five or six feet in length. A subdued voice asked, "What are you going to do now, Doctor?" "I am going to turn on the hose." "Wha-a-t?" "I am going to put this tube down into your stomach. You haven't thrown up much of that laudanum yet." She opened her mouth to speak and the doctor inserted one end of the tube and began ramming it down. "Unfasten a button or two here," he said to her husband and rammed some more. She gagged and gurgled and tried to push his hands away. "Hold on, we're not down yet--we're only about to the third button." He began ramming the tube again when she looked up at her husband so imploringly that he said, "Hold on a minute, Doctor, she wants to say something." The doctor withdrew the tube and waited. "I'm sure I threw it all up." "Oh no," he said beginning to lift it again. "I--only--took--two--or three drops." "Why the devil didn't you say so at the start?" "I wish I had. I just told _Jim_ that." "To get even with him for something," announced the doctor quietly. "How can he know so much," mused Jim's wife. "Now I advise you not to try this game again," said the doctor as he wound up the stomach tube and put it into his pocket. "You can't fool Jim all the time, and you can't fool me any of the time. Good night." And he rode home and found Mary asleep in her chair. * * * * * Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. "Is this you, Dr. Blank?" "Yes." "I wanted to ask you about an electric vibrator." "About what?" "An electric vibrator." "An electric something--I didn't get the last word." A little laugh, then "v-i-b-r-a-t-o-r." "Oh! vibrator." "Yes. Do you think it would help my aunt?" "Not a durned bit." Another little laugh, "You don't think it would?" "No!" "I had a letter today from my cousin and she said she knew a lady who had had a stroke and this vibrator helped her more than anything." "It didn't. She imagined it." "Well, I didn't know anything about it and I knew you would, so I thought I'd 'phone you before going any further. Much obliged, Doctor." It would save much time and money and disappointment if all those who don't know would pause to put a question or two to those who do. But so it is _not_, and the maker of worthless devices and the concocter of nostrums galore cometh oft to fortune by leaps and bounds, while the poor, conscientious physician who sticks to the truth of things, arriveth betimes at starvation's gate. (I was startled a few days ago to learn that the average income of physicians in the United States does not exceed six hundred dollars.) * * * * * Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. "Tell papa he's wanted at the 'phone," said Mary. "Where is he?" "Isn't he there in the dining room?" "No, he isn't here." "He must be in the kitchen then; go to the door and call him." The small boy obeyed. "He's not out here either," he announced from the door-way. "Why, where can he be!" cried Mary, springing up and going swiftly to the 'phone. "Hello." "Is the doctor there?" "Yes. Wait just a minute and I will call him." She hurried through the dining room, then through the kitchen and out into the yard. No doctor to be seen. "He passed through the house not three minutes ago," she said to herself. "John!" "Doctor!" "Doc-_tor_!" "O, dear! I don't see how he could disappear from the face of the earth in three minutes' time!" She hurried around a projecting corner through a little gate and called again. "What is it?" asked a placid voice as its owner emerged from his new auto garage. "Hurry to the 'phone for pity's sake!" and he hurried. Mary, following, all out of breath, heard this: "Two teaspoonfuls." Then the doctor hung up the receiver. He turned to Mary and laughed as he quoted Emerson on the mountain and the mouse. "I chased you all over the place this afternoon, John, when the 'phone was calling you, and couldn't find you at all. Some people have days to 'appear' but this seems to be your day to disappear. Where were you then?" "Out in the garage." "Fascinating spot! I'll know where to look next time. Now come to supper." CHAPTER XV. It was October--the carnival time of the year, When on the ground red apples lie In piles like jewels shining, And redder still on old stone walls Are leaves of woodbine twining. When comrades seek sweet country haunts, By twos and twos together, And count like misers, hour by hour, October's bright blue weather. On a lovely afternoon our travelers were driving leisurely along through partially cleared woodland. The doctor had proposed that they take this trip in the new automobile. But Mary had declined with great firmness. "I will not be hurled along the road in October of all months. What fools these mortals be," she went on. "Last year while driving slowly through the glorious Austrian Tyrol fairly holding my breath with delight, one machine after another whizzed by, the occupants fancying they were 'doing' the Tyrol, I dare say." Mary looked about her, drinking in deep draughts of the delicious air. The beautifully-tinted leaves upon every tree and bush, the blue haze in the distance and the dreamful melancholy over all, were delightful to her. The fragrance of wild grapes came to them as they emerged from the woods and Mary said, "Couldn't you wait a minute, John, until I go back and find them? I'll bring you some." "If you were sick and had sent for a doctor would you like to have him fool around gathering grapes and everything else on his way?" "No, I wouldn't. I really wouldn't." They laughed as they sped along the open country road, skirted on either side by a rail fence. From a fence corner here and there arose tall sumac, like candelabra bearing aloft their burning tapers. The poke-weed flung out its royal purple banners while golden-rod and asters were blooming everywhere. Suddenly Mary exclaimed, "I'm going to get out of the buggy this minute." "What for?" "To gather those brown bunches of hazelnuts." "Mary, I positively will not wait for you." "John, I positively don't want you to wait for me," said Mary, putting her foot on the step, "I'm going to stay here and gather nuts till you come back. See how many there are?" and she sprang lightly to the ground. "It will be an hour or more before I can get back. I've got to take up that pesky artery." "It won't seem long. You know I like to be alone." "Good-bye, then," and the doctor started off. "Wait! John," his wife called after him. "I haven't a thing to put the nuts in, please throw me the laprobe." The doctor crushed the robe into a sort of bundle and threw it to her. She spread the robe upon the ground and began plucking the bunches. Her fingers flew nimbly over the bushes and soon she had a pile of the brown treasures. Dear old times came trooping back. She thought of far-off autumn days when she had taken her little wagon and gone out to the hazel bushes growing near her father's house, and filled it to the top and tramped it down and filled it yet again. Then a gray October day came back when three or four girls and boys, all busy in the bushes, talked in awed tones of the great fire--Chicago was burning up! Big, big Chicago, which they had never seen or dreamed of seeing--all because a cow kicked over a lamp. Mary moved to another clump of bushes. As she worked she thought if she had never known the joy of gathering nuts and wild grapes and persimmons, of wandering through woods and meadows, her childhood would have lost much that is beautiful and best, and her womanhood many of its dearest recollections. "You're the doctor's wife, ain't ye?" Mary looked around quite startled. A tall woman in a blue calico dress and a brown gingham sunbonnet was standing there. "I didn't want to scare ye, I guess you didn't see me comin'." "I didn't know you were coming--yes, I am the doctor's wife." "We saw ye from the house and supposed he'd gone on to see old man Benning and that you had stopped to pick nuts." "You guessed it exactly," said Mary with a smile. "We live about a quarter mile back from the road so I didn't see the doctor in time to stop him." "Is some one sick at your house, then?" "Well, my man ain't a doin' right, somehow. He's been ailin' for some time and his left foot and leg is a turnin' blue. I come to see if you could tell me somethin' I could do for it. I'm afraid it's mortifyin'." Mary's brown eyes opened wide. "Why, my dear woman, I couldn't tell you anything to do. I don't know anything at all about such things." "I supposed bein' a doctor's wife you'd learnt everything like that." "I have learned many things by being a doctor's wife, very many things, but what to do with a leg and foot that are mortifying I really could not tell you." Mary turned her face away to hide a laugh that was getting near the surface. "I will have the doctor drive up to the house when he gets back if you wish," she said, turning to her companion. "Maybe that would be best. Your husband cured me once when I thought nothing would ever get me well again. I think more of him than any other man in the world." "Thank you. So do I." She started off and Mary went on gathering nuts, her face breaking into smiles at the queer errand and the restorative power imputed to herself. "If it is as serious as she thinks, all the doctors in the world can't do much for it, much less one meek and humble doctor's wife. But they could amputate, I suppose, and I'm sure I couldn't, not in a scientific way." Thus soliloquizing, she went from clump to clump of the low bushes till they were bereft of their fruitage. She looked down well-pleased at the robe with the nuts piled upon it. She drew the corners up and tied her bundle securely. This done she looked down the road where the doctor had disappeared. "I'll just walk on and meet him," she thought. She went leisurely along, stopping now and then to pluck a spray of goldenrod. When she had gathered quite a bunch she looked at it closely. "You are like some people in this world--you have a pretty name and at a little distance _you_ are pretty: but seen too close you are a disappointment, and more than that you are coarse. I don't want you," and she flung them away. She saw dust rising far down the road and hoped it might be the doctor. Yes, it was he, and Bucephalus seemed to know that he was traveling toward home. When her husband came up and she was seated beside him, she said, "You are wanted at that little house over yonder," and she told him what had taken place in the hazel bushes. "You're second choice though, they came for me first," she said laughing. "I wish to thunder you'd gone. They owe me a lot now they'll never pay." "At any rate, they hold you in very high esteem, John." "Oh, yes, but esteem butters no bread." "Well, you'll go, won't you? I told the woman you would." "Yes, I'll go." He turned into a narrow lane and in a few minutes they were at the gate. The doctor handed the reins to Mary and went inside. A girl fourteen or fifteen years old with a bald-headed baby on her arm came out of the house and down the path. "Won't you come in?" "No, thank you. We will be going home in a minute." The girl set the baby on the gate-post. "She's the smartest baby I ever saw," she said. "She's got a whole mouthful of teeth already." "And how old is she?" "She was ten months old three weeks ago last Saturday." As today was Thursday, Mary was on the point of saying, "She will be eleven months old in a few days then," but checked herself--she understood. It would detract from the baby's smartness to give her eleven months instead of only ten in which to accomplish such wonders in the way of teeth. The doctor came out and they started. Just before they came out to the main road they passed an old deserted house. No signs of life were about it except the very luxuriant life in the tall jimsons and ragweeds growing about it and reaching almost to the top of the low doorway, yawning blackly behind them. "I think the longest night of my life was spent in that house about sixteen years ago. It's the only house I was ever in where there was nothing at all to read. There wasn't even an almanac." Mary laughed. "An almanac is a great deal better than nothing, my dear. I found that out once upon a time when I had to stay in a house for several hours where there was just one almanac and not another printed page. I read the jokes two or three times till they began to pall and then set to work on the signs. I'll always have a regard for them because they gave me a lift through those tedious hours." They were not far from the western edge of the piece of woodland they were traversing and all about them was the soft red light of the setting sun. They could see the sun himself away off through the straight and solemn trunks of the trees. A mile farther on Mary uttered a sudden exclamation of delight. "See that lovely bittersweet!" "I see, but don't ask me to stop and get you some." "I won't, but I'll ask you to stop and let _me_ get some." "I wouldn't bother about it. You'll have to scramble over that ditch and up the bank--" "I've scrambled over worse things in my life," she said, springing from the buggy and picking her way down the intervening ditch. The bright red berries in their flaring yellow hoods were beautiful. She began breaking off the branches. When she had gathered a large bunch and was turning toward the buggy she saw a vehicle containing two women approaching from the opposite direction. There was a ditch on either side of the road which, being narrow at this point, made passing a delicate piece of work. The doctor drew his horse to one side so that the wheels of the buggy rested on the very brink and waited for them to pass; he saw that there was room with perhaps a foot or two to spare. On came the travelers and--the front wheels of the two vehicles were locked in a close embrace. For a minute the doctor did some vigorous thinking and then he climbed out of the buggy. It was a trying position. He could not say all of the things he wanted to--it would not be polite; neither did he want to act as if it were nothing because Mary might not understand the extent of the mischief she had caused and how much out of humor he was with her. It would be easier if she were only out of hearing instead of looking at him across the ditch with apologetic eyes. The doctor's horse began to move uneasily but the other stood perfectly still. "He's used to this sort of thing, perhaps," said the doctor with as little sarcasm as possible. "Yes, we have run into a good many buggies and things," said one of the women, cheerfully. "Women beat the devil when it comes to driving," thought the doctor within himself. "They'll drive right over you and never seem to think they ought to give part of the road. And they do it everywhere, not only where there are ditches." He restrained his speech, backed the offending vehicle and started the travelers on. While he was doing so his own steed started on and he had a lively run to catch him. Mary had thought of turning back to break off another spray of the bittersweet but John's profanity was rising to heaven. Diplomacy required her to get to the buggy and into it at once. This she did and the doctor plunged in after her. "Forgive me for keeping you waiting," she said gently. She held the bittersweet out before her. "Isn't it lovely, John?" A soft observation turneth away wrath. The doctor's was oozing away sooner than he wished. They drove on for a while in silence. The soft, still landscape dotted here and there with farm houses and with graceful elm and willow trees, was lit up and glorified by the after-glow. The evening sky arching serenely over a quiet world, how beautiful it was! And as Mary's eyes caught a glittering point of light in the blue vault above them, she sang softly to herself: "O, thou sublime, sweet evening star, Joyful I greet thee from afar." For a while she watched the stars as one by one they twinkled into view, then drawing her wraps more closely about her, she leaned back in the carriage and gave herself up to pleasant reflection, and before she realized it the lights of home were twinkling cheerily ahead. CHAPTER XVI. "You are not going out tonight, John, no matter how often the 'phone rings. I positively will not let you." Mary spoke with strong emphasis. All the night before he had been up and today had been a hard day for him. She had seldom seen him so utterly weary as he was tonight. He had come home earlier than usual and now sat before the fire, his head sunk on his breast, half asleep. "Go right to bed, dear, then you can really rest." The doctor, too tired to offer any resistance, rose and went to the bedroom. In a few minutes his wife heard regular sonorous sounds from the bed. (When she spoke of these sounds to John, Mary pronounced it without the first _o_.) Glad that he had so soon fallen into deep sleep she settled back in her chair. "I'll protect him tonight," she thought, "though fiery darts be hurled." She thought of many things. The fire-light gleamed red upon the hearth. All was still. The sounds from the adjoining room had ceased. Something stirred within her and she rose and went softly to the bedside of her sleeping husband. In the half-light she could see the strong, good face. Dear John so profane yet so patient, so severe yet so tender, what would it be to face life without him. She laid her hand very lightly on the hand which lay on the counterpane, then took it away lest it disturb the sleeper. She went back to her chair and opening a little volume took from it a folded sheet. Twice before today had she read the words written within it. A dear friend whose husband had recently died had written her, inclosing them. She read them again now: IN MEMORIAM,--A PRAYER. "O God! The Father of the spirits of all flesh, in whatsoever world or condition they be,--I beseech Thee for him whose name, and dwelling place, and every need Thou knowest. Lord, vouchsafe him peace and light, rest and refreshment, joy and consolation in Paradise, in the ample folds of Thy great love. Grant that his life, so troubled here, may unfold itself in Thy sight, and find employment in the spacious fields of Eternity.--If he hath ever been hurt or maimed by any unhappy word or deed of mine, I pray Thee, of Thy great pity, to heal and restore him, that he may serve Thee without hindrance. "Tell him, O gracious Father, if it may be,--how much I love him and miss him, and long to see him again; and if there may be ways in which he may come, vouchsafe him to me as guide and guard, and grant me such sense of his nearness as Thy laws permit. If in aught I can minister to his peace, be pleased of Thy love to let this be; and mercifully keep me from every act which may deprive me of the sight of him, as soon as our trial time is over, or mar the fullness of our joy when the end of the days hath come." Mary brushed away a tear from her cheek. "This letter has awakened unusual thoughts. I will--" A sharp peal from the telephone. "What is it?" "Is the doctor at home?" "Yes. He has gone to bed and is fast asleep." "Oh! We wanted him to come down to see my sister." "He was up all last night and is not able to come--" "Can I just talk to him about her?" Mary sighed. To rouse him from his sorely needed sleep was too cruel. Then she spoke. "I must not disturb him unless it is absolutely necessary. I shall be sitting here awake--call me again in a little while if you think it necessary." "A--l--l r--i--g--h--t--" and a sob came distinctly to the listener's ear. This was too much for Mary. "I'll call him," she said hurriedly and went to the bedroom. With much difficulty she roused him. He threw back the covers, got up and stumbled to the 'phone. "Hello..... Yes..... They didn't? Is she suffering much?.... All right, I'll be down in a little bit." Mary groaned aloud. She had vowed to protect him though fiery darts be hurled. But the sob in the voice of a frightened young girl was more potent than any fiery dart could have been and had melted her at once. Slowly but surely the doctor got himself into his clothes. "I don't think there's any use of my going down there again, but I suppose I'll have it to do." When he returned an hour later, he said, "Just as I thought--they were badly scared over nothing. I shouldn't wonder if they'd rout me out again before morning." "No, they won't," said Mary to herself, and when her husband was safe in bed again, she walked quietly to the telephone, took down the receiver and _left_ it down. "Extreme cases require extreme measures," she thought as she, too, prepared for her night's rest. But there was a haunting feeling in her mind about the receiver hanging there. Suppose some one who really did need the doctor should call and call in vain. She would not think of it. She turned over and fell asleep and they both slept till morning and rose refreshed for another day. * * * * * A few weeks later circumstances much like those narrated above arose, and the doctor's wife for the second and last time left the receiver down. About two o'clock there came a tragic pounding at the door and when the doctor went to open it a voice asked, "What's the matter down here?" "Why?" "Central's been ringing you to beat the band and couldn't get you awake." "Strange we didn't hear. What's wanted?" He had recognized the messenger as the night clerk at the hotel not far from his home. "A man hurt at the railroad--they're afraid he'll bleed to death. Central called me and asked me to run over here and rouse you." When the doctor was gone Mary rose tremblingly and hung up the receiver. She would not tell John what she had done. He would be angry. She had felt that the end justified the means--that he was tired out and half sick and sorely needed a night's unbroken rest--but if the end should be the bleeding to death of this poor man-- She dared not think of it. She went back to bed but not to sleep. She lay wide awake keenly anxious for her husband's return. And when at last he came her lips could hardly frame the question, "How is he, John?" "Pretty badly hurt, but not fatally." "Thank heaven!" Mary whispered, and formed a quick resolve which she never broke. This belonged to her husband's life--it must remain a part of it to the end. CHAPTER XVII. One lovely morning in April, Mary was called to the telephone. "I want you to drive to the country with me this morning," said her husband. "I'll be delighted. I have a little errand down town and I'll come to the office--we can start from there." Accordingly half an hour later she walked into the office and seated herself in a big chair to wait till John was ready. The door opened and a small freckle-faced boy entered. "Good morning, Governor," said the doctor. The governor grinned. "What can I do for you today?" "How much will ye charge to pull a tooth?" "Well, I'll pull the tooth and if it don't hurt I won't charge anything. Sit down." The boy sat down and the doctor got out his forceps. The tooth came hard but he got it. The boy clapped his hand over his mouth but not a sound escaped him. "There it is," said the doctor, holding out the offending member. "Do you want it?" A boy's tooth is a treasure to be exhibited to all one's friends. He took it and put it securely in his pocket. "How much do I have to pay?" "Did it hurt?" "Nope." "Nothing at all." The boy slid from the chair and out of the door, ecstasy overspreading all the freckles. "That boy has a future," said Mary looking after him with a smile. "I see they have brought the horse. We must be starting." Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. "They want ye down at Pete Jansen's agin." "What's the matter there now?" "O, that youngun's been _drinkin'_ somethin' agin." "Into the lye this time, too?" "No, it's coal oil and bluin' this time and I don't know what else." "I'll be down right away," said the doctor, taking up his hat. "Get into the buggy and drive down with me, Mary, it's just at the edge of town and then we can drive on into the country." When they stopped at the house, an unpainted little frame structure, Mary held the horse while her husband went in. "Where's the boy?" he asked, looking around. "He's out in the back yard a-playin' now, I guess," his mother replied from the bed. "Then what in thunder did you send for me for?" "Why, I was scared for fear it would kill him." The doctor turned to go then paused to ask, "How's the baby?" "She's doin' fine." "She's just about a week old now, isn't she?" "A week yesterday. Don't you want to see how much she's growed?" The doctor went to the bed and looked down at the wee little maiden. "Great God!" he exclaimed, so fiercely that the woman was frightened. "Why haven't you let me know about this baby's eyes?" "W'y, we didn't think it'd 'mount to anything. We thought they'd git well in a day or two." "She'll be blind in less than a week if something isn't done for them." "Grandmother's been a doctorin' 'em some." "Well, there's going to be a change of doctors right straight. I'm going to treat this baby's eyes myself." "We don't want any strong medicine put in a baby's eyes." "It don't make a bit of difference what you want. I'm going to the drug store now to get what I need and I want you to have warm water and clean cloths ready by the time I get back. Is there anyone here to do it?" "There's a piece of a girl out there in the kitchen. She ain't much 'count." The doctor went to the kitchen door and gave his orders. "I'd ruther you'd let the baby's eyes alone. I'm afraid to have strong medicine put in 'em." For answer he went out, got into the buggy and drove rapidly back to town where he procured what he needed and in a few minutes was back. "You'd better come in this time, Mary, you'll get tired of waiting and besides I want you to see this baby. I want you to know something about what every father and mother ought to understand." They went in and the doctor took the baby up and seated himself by the chair on which stood a basin of water. The mother, with very ungracious demeanor, looked on. Mary, shocked and filled with pity, looked down into the baby's face. The inflammation in the eyes was terrible. The secretion constantly exuded and hung in great globules to the tiny lids. Never in her life had she seen anything like it. "Let me hold it for you," she said, sitting down and taking the baby in her lap. The doctor turned the little head toward him and held it gently between his knees. He took a pair of goggles from his pocket and put them over his eyes to protect them from the poison, then tenderly as any mother could have done, he bathed and cleansed the poor little eyes opening so inauspiciously upon the world. He thought as he worked of this terrible scourge of infancy, producing one-third of all the blindness in the world. He thought too, that almost all of this blindness was preventable by prompt and proper treatment. Statistics had proven these two things beyond all doubt. He thought of the earnest physicians who had labored long to have some laws enacted in regard to this stupendous evil but with little result.[1] [1] 1. Ophthalmia Neonatorum 2. There has been legislation for the prevention of blindness in the States of New York, Maine, Rhode Island and Illinois. When they were in the buggy again Mary said, "But what if the baby goes blind after all? Of course they would say that you did it with your 'strong medicine.'" "Of course they would, but that would not disturb me in the least. But it will not go blind now. I'll see to that." Soon they had left the town behind them and were fairly on their way. The soft, yet bracing, air of the April morning was delightful. The sun shone warm. Birds carolled everywhere. The buds on the oak trees were swelling, while those on the maples were bursting into red and furzy bloom. Far off to the left a tall sycamore held out white arms in welcome to the Springtime and perfect stillness lay upon the landscape. "I am so glad the long reign of winter and bad roads is ended, John, so I can get out with you again into the blessed country." "And I am glad to have good company." "Thanks for that gallant little speech. Ask me often, but I won't go every time because you might get tired of me and I'd be sure to get tired of you." "Thanks for that gracious little speech." * * * * * That evening when the doctor and Mary were sitting alone, she said, "John, that baby's eyes have haunted me all day long. And you say one-third of the blindness of the world is due to this disease." "Yes." "That seems to me a terrific accusation against you doctors. What have you been doing to prevent it?" "Everything that has been done--not very much, I'm afraid. Speaking for myself, I can say that I have long been deeply interested. I have written several papers on the subject--one for our State Medical Society." "So far so good. But I'd like to know more about it." "Write to the secretary of the State Board of Health for all the information that he can give you." The next day Mary wrote. Three days later she received the following letter: SPRINGFIELD, NOV. 16, 1909. My dear Mrs. Blank: Several states of the Union have laws in relation to the prevention of blindness, some good, some bad, and some indifferent, and I fear that the last applies to the manner in which the laws are enforced in the majority of the States. In the December, 1908, _Bulletin_ of this Board, a copy of which I send you under separate cover, you will find the Illinois law, which, as you can readily see, is very difficult of enforcement. But, as I said, much can be done in its enforcement if the State Board of Health can secure the co-operation of the physicians of the State. However, in this connection you will note that I have made an appeal to physicians, on page 757. Yet, to the best of my knowledge, the Board has not received one inquiry in regard to the enforcement of this law, except from the Committee on the Prevention of Ophthalmia Neonatorum. In regard to the other States, it will take me some time to look up the laws, but I will advise you in a few days. Sincerely yours, J. A. EGAN. After reading it carefully through, Mary's eye went back to the sentence, "Much can be done if the State Board of Health can secure the co-operation of the physicians of the State." She rose and walked the floor. "If I were a Voice--a persuasive voice," she thought, "I would fly to the office of every physician in our great State and then to every physician in the land and would whisper in his ear, 'It is your glorious privilege to give light to sightless eyes. It is more: it is your sacred duty. O, be up and doing!'" "To think, John," she said, turning impetuously toward her husband, "that I, all these years the wife of a man who knows this terrible truth, should just be finding it out. Then think of the thousands of men and women who know nothing about it. How are they to know? Who is to tell them? Who is to blame for the blindness in the first place? Who can--" Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. "Is this Dr. Blank?" "Yes." "This is Mr. Ardmore. Can you come up to my house right away?" "Right away." When he arrived at his destination he was met at the door by a well-dressed, handsome young man. "Just come into this room for a few minutes, Doctor. My wife says they are not quite ready for you in there." "Who is the patient?" asked the doctor as he walked into the room indicated. "The baby boy." "The baby boy!" exclaimed the doctor. "I didn't know the little rascal had got here." "Yes, you were out of town. My wife and I thought that ended the matter but he got here just the same." "Mighty glad to hear it. How old is he?" "Just ten days." "Pretty fine, isn't he?" "You bet! I wouldn't take all the farms in these United States for him." "To be sure. To be sure," laughed the doctor. He picked up a little volume lying open on the table. "Do you like Omar?" he asked, aimlessly turning the pages. "Very much. I don't always get the old Persian's meaning exactly. Take this verse," he reached for the book and turning back a few pages read: "The moving finger writes; and having writ, Moves on; nor all your piety nor wit Shall lure it back to cancel half a line, Nor all your tears wash out a word of it. That sounds pretty but it has something in it that almost scares a fellow--he doesn't know why." The nurse appeared in the doorway and announced that the doctor might come in now. Both men rose and went across the hall into the bedroom. The doctor shook hands with the baby's mother. "Where did you get this?" he asked, laying his hand on the downy little head. "He came out of the everywhere into the here," she quoted, smiling. "Nurse, turn the baby's face up so the doctor can see his eyes. They're greatly inflamed, Doctor," she said. The doctor started. "Bring a light closer," he said sharply. While the light was being brought he asked, "Did this inflammation begin when the baby was about three days old?" "He was exactly three days old." "And been growing worse ever since?" "Yes. Dr. Brown was with me when he was born. He came in the next day and everything was all right. Then he was called to Chicago and I didn't know enough about babies to know that this might be serious." "_You_ ought to have known," said the doctor sternly, turning to the nurse. "I am not a professional nurse. I have never seen anything like this before." The light was brought and the nurse took the baby in her arms. The doctor, bending over it, lifted the swollen little lids and earnestly scrutinized the eyes. _The cornea was entirely destroyed!_ "O God!" The words came near escaping him. Sick at heart he turned his face away that the mother might not see. She must not know the awful truth until she was stronger. He gave some instructions to the nurse, then left the room followed by the baby's father. "Stop for a few minutes, Doctor, if you please. I'd like to ask you something about this," and both resumed their seats, after Mr. Ardmore had closed the door. "Do you think the baby's eyes have been hurt by too much light?" "No by darkness--Egyptian darkness." The young man looked at him in wonder. "What is the disease?" "It is Ophthalmia Neonatorum, or infantile sore eyes." "What is the nature of it?" "It is always an infection." "How can that be? There has been nobody at all in the room except Dr. Brown and the nurse." The doctor did not speak. There came into his mind the image of Mary as she had asked so earnestly, "How are they to know? Who is to tell them?" Leaning slightly forward and looking the young man in the face he said, "I do not know absolutely, but _you_ know!" "Know what?" "Whether or not your child's eyes have had a chance to be infected by certain germs." "What do you mean, Doctor?" asked the young father in vague alarm. Slowly, deliberately, and with keen eyes searching the other's face the doctor made reply: "I mean that the sins of the fathers are visited upon the children." There was bewildered silence for an instant then a wave of crimson surged over neck, cheek and brow. It was impossible to meet the doctor's eyes. The young man looked down and made no attempt to speak. By and by he said in a low voice, "It's no use for me to deny to you, Doctor, that I have been a fool and have let my base passions master me. But if I had dreamed of any such result as this they wouldn't have mastered me--I know that." "The man that scorns these vile things because of the eternal wrong in them will never have any fearful results rising up to confront him." "All that has been put behind me forever, Doctor; I feel the truth and wisdom of what you say. Just get my boy's eyes well and he shall never be ashamed of his father." The doctor looked away from the handsome, intelligent face so full at that moment of love and tenderness for this new son which had been given into his care and keeping, and a wave of pity surged over him. But he must go on to the bitter end. "You have not understood this old Persian's verse," he said, taking up the little book again. "Tonight his meaning is to be made plain to you." Slowly he read: "The Moving Finger writes; and, having writ, Moves on; nor all your Piety nor Wit Shall lure it back to cancel half a Line, Nor all your Tears wash out a Word of it." He laid the volume gently down and turning, faced the younger man. "Listen: In those licentious days the Moving Finger was writing a word for the future to reveal. It wrote BLIND in the eyes of your helpless child." "My God! You don't mean it!" "It is true. The cornea is destroyed." A deathly pallor overspread the young man's face. He bowed his head in his hands and great sobs shook his frame. "My God! My God!" he gasped over and over again. Accustomed as the doctor was to suffering and sorrow this man's anguish was too much for him. The tears rolled down his cheeks and he made no effort to restrain them. After a long time the younger man raised his head and spoke in broken words, "Doctor, I must not keep you here. You are needed elsewhere. Leave me to Remorse. I am young and you are growing old, Doctor, but will you take this word from me? You and all in your profession should long ago have told us these things. The world should not lie in ignorance of this tremendous evil. If men will not be saved from themselves they will save their unborn children, if they only know. God help them." The doctor went slowly homeward, his mind filled with the awful calamity in the household he had left. "It is time the world is waking," he thought. "We must arouse it." * * * * * Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. "Is this Mrs. Blank?" It was a manly voice vibrating with youth and joy. "I want to tell you that your husband has just left a sweet little daughter at our house." "Oh, has he! I'm very glad, Mr. Farwell. Thank you for telephoning. Father, mother and baby all doing well?" "Fine as silk. I had to tell _somebody_ right away. Now I'm off to send some telegrams to the folks at home. Goodbye." Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. Ting-a-ling-ling-ling. "This is Mrs. Blank is it not?" "Yes." "Will you please tell the doctor that father is dead. He died twenty minutes ago." "The doctor was expecting the message, Mr. Jameson," said Mary gently. This, too, was the voice of a young man, but quiet, subdued, bringing tidings of death instead of life. And Mary, going back to her seat in the twilight, thought of the words of one--Life is a narrow vale between the cold and barren peaks of two eternities. The eternity before the baby came, the eternity after the old man went, were solemnly in her thoughts. But they were not cold and barren peaks to her. They were crowned with light and warmth and love. And into her thoughts came, too, the never-ending story of the 'phone as it was unfolding itself to her throughout the years. Humor and pathos, folly and wisdom, tragedy and comedy, pain, anguish, love, joy, sorrow--all had spoken and had poured their brief story into the listening ear of the helper. And when he was not there, into the ear of one who must help in her own poor way. O countless, countless messages stored in her memory to await his coming! Only she could know how faithfully she had guarded and delivered them. Only she could-- Ting-a-ling. Ting-a-ling. Ting-a-ling-ling-ling. [ Transcriber's Note: The following is a list of corrections made to the original. The first line is the original line, the second the corrected one. "That's about five miles out, isn't it. Whose sick out there?" "That's about five miles out, isn't it. Who's sick out there?" Well, where is the _doctor_?" "Well, where is the _doctor_?" Small's at Drayton. When the voice came she said, "I wanted to tell you Small's at Drayton." When the voice came she said, "I wanted to tell you "Mary heard the 'phoner say in an aside, "He won't be back for an hour Mary heard the 'phoner say in an aside, "He won't be back for an hour asked central to give her Drayton, Mr. Walton's house." asked central to give her Drayton, Mr. Walton's house. She flew to the Farmers' phone. She flew to the Farmers' 'phone. "Wait a minute, I'll see." She raced through the pages,--yes, here it "Wait a minute, I'll see." She raced through the pages,--"yes, here it "Thought you was a-goin' to hold the' phone. I've had a turrible time "Thought you was a-goin' to hold the 'phone. I've had a turrible time "Shake up your 'phone. I can't hear you. "Shake up your 'phone. I can't hear you." interested listener at the phone. Going, one morning, to speak to a interested listener at the 'phone. Going, one morning, to speak to a "Doctor, will it hurt the baby to bathe it every morning?" I've been "Doctor, will it hurt the baby to bathe it every morning? I've been "Likes to see it's mamma?" "Likes to see its mamma?" My land! I've been here three or four times. Looks like I'd ketch him "My land! I've been here three or four times. Looks like I'd ketch him was mightly emphatic." was mightily emphatic." That sounds good, Doctor. I was awfully scared. Much obliged. "That sounds good, Doctor. I was awfully scared. Much obliged. "Wait a minute, Mrs. Blank," said the voice of central, some one is "Wait a minute, Mrs. Blank," said the voice of central, "some one is "Yes, you _can_!" roared a voice. You jist want to fool around." The "Yes, you _can_!" roared a voice. "You jist want to fool around." The It's _exactly_ in his line. Years ago when I was a little girl he "It's _exactly_ in his line. Years ago when I was a little girl he would break and then she said, "Father, I _must_ tell you, but don't would break and then she said, 'Father, I _must_ tell you, but don't tell mother; and then she told me." tell mother'; and then she told me." "The doctor was fixing up powders and went placidly on till he got The doctor was fixing up powders and went placidly on till he got "Oh," said the voice, somewhat mollified, I'll just call him up when he "Oh," said the voice, somewhat mollified, "I'll just call him up when he number again with vehemence." number again with vehemence. The circumflexes were irresistible." The circumflexes were irresistible. him this evening. This is Mrs. X. Will you be right out? him this evening. This is Mrs. X. Will you be right out?" "When I yas a young fellow and first hung up my shingle it was a "When I was a young fellow and first hung up my shingle it was a "Certainly," I answered promptly. 'Certainly,' I answered promptly. "My husband is very sick and I came to see if you would go down and ask 'My husband is very sick and I came to see if you would go down and ask Dr. Smithson to come and see him." I swallowed my astonishment and Dr. Smithson to come and see him.' I swallowed my astonishment and sweet day you'll retire from practise. Then hully-gee! won't I be free! sweet day you'll retire from practice. Then hully-gee! won't I be free! "Then do it. Do it right away. Have the water _hot_, now. "Then do it. Do it right away. Have the water _hot_, now." If they knew what I know their little hearts would almost burst for "If they knew what I know their little hearts would almost burst for there," she continued. "A woman's intuitions are safe guides' but she there," she continued. "'A woman's intuitions are safe guides' but she table his wife, said, "John, I shouldn't think you'd say things like that table his wife said, "John, I shouldn't think you'd say things like that "Hell-_o_!" Where's the doctor?" "Hell-_o_! Where's the doctor?" "Yes. When I went in the man who was a stranger to me, said, "I'll tell "Yes. When I went in the man who was a stranger to me, said, 'I'll tell said to myself, "He's the man I want." said to myself, "He's the man I want."'" "Very well Thank you." "Very well. Thank you." The voice was icily regular, spendidly null. It nettled the doctor. The voice was icily regular, splendidly null. It nettled the doctor. "_Where do you live!_" "_Where do you live?_" "Well maybe it does. I've not got my directions here yet--then it must "Well, maybe it does. I've not got my directions here yet--then it must "My wife swallowed poison. Hurry, Doctor, for God's sake! "My wife swallowed poison. Hurry, Doctor, for God's sake!" CHAPTER XVI. CHAPTER XVII. "I'll be down right away," said the doctor, taking up his hat." "I'll be down right away," said the doctor, taking up his hat. "Why haven't you let me know about this baby's eyes." "Why haven't you let me know about this baby's eyes?" inauspiciously upon the world. He thought as he worked of this terribe inauspiciously upon the world. He thought as he worked of this terrible "Thanks for that gracious little speech. "Thanks for that gracious little speech." Nor all your Tears wash out a Word of it. Nor all your Tears wash out a Word of it." ] 
48343	----	Transcriber's note: Text enclosed by underscores is in italics (_italics_). Text enclosed by equal marks is in bold face (=bold=). Small capital text has been replaced with all capitals. Minor typographical and punctuation errors have been corrected without note. Irregularities and inconsistencies in the text have been retained as printed. Mismatched quotes are not fixed if it's not sufficiently clear where the missing quote should be placed. The cover for the eBook version of this book was created by the transcriber and is placed in the public domain. * * * * * NIMMO'S SERIES OF COMMONPLACE BOOKS. CLERGYMEN AND DOCTORS. CLERGYMEN AND DOCTORS: Curious Facts and Characteristic Sketches. Edinburgh: W. P. Nimmo. CLERGYMEN AND DOCTORS: Curious Facts and Characteristic Sketches. [Illustration: decoration] EDINBURGH: WILLIAM P. NIMMO. MURRAY AND GIBB, EDINBURGH, PRINTERS TO HER MAJESTY'S STATIONERY OFFICE. CONTENTS. PAGE Abernethy and the Duke of York, 61; Anecdotes of, 83; Conquered by Curran, 151 Abstinence, Precept and Example of, 21 Agricultural Defence of Bigotry, An, 138 André Boulanger, Father, 70 Angel-Worship, 110 Antics of the Fanatics, 66 Application, A Too Personal, 124 Archbishop's Installation Feast, An, 76 Archdeacon? What is an, 99 "Atterbury's Pad", 16 Awkward Association, An, 81 Baptism, A Sanitary View of, 40 Barrow, The Exhaustive, 15; his Rhymes with Reason, 63 Barrowby, Dr., Anecdotes of, 126 Baxter, Addison's Introduction to, 13; Cromwell and, 131 Berkeley's (Bishop) Bermuda Scheme, 33 Bishops and the Poor, 150 Blomfield's Rebuke to Non-Resident Rectors, 85 Blood-Jewels, Queen Elizabeth's, 22 Bloodletters, Blunders of, 149 Bottle-Blind, 104 Bourdaloue, Bold Application of, 146 "Breaking-up" before the Holidays, 104 Bunyan's Successful and Persistent Preaching, 111 Burgess, Daniel, Pulpit Jokes of, 86 Burnet, Bishop, Against Pluralities, 151 Capacity of an Abbé, The, 100 Charles II. and his Chaplain, 30 Christian Names among the Puritans, 98 Civil to the Prince of Evil, 113 Clergy, Benefit of, 101 Commonwealth Preachers, South on the, 45 Cooper's (Sir Astley) Night-Cap Fee, 11 Crabbe, George, The Apothecary Poet, 144 Cucumber, How to Dress a, 18 Curate and the Duke, The, 23 Cure of Souls, A Desirable, 127 Dangers of Too Good Company, The, 82 Da Vinci a Great Anatomist, 77 Devotion of a Catholic Priest, 85 Diffidence in the Pulpit, 97 Donne's (Dr.) Prayerful Pun, 143 Drubbing-in Religious Feeling, 121 Fees, Ancient, of Magnitude, 89; Early English, 89; in the Reign of Henry VIII. and Elizabeth, 90; After the Revolution, 91; Large Royal, in Later Times, 92; For a Political Consultation, 94; Generous Refusal of, 95; Sticklers for, 95; Collectively Irresistible, 96 Flavel's "Day of Heaven", 24 Footscrapers Reproved, The, 17 Garrick's Precepts for Preachers, 147 George II. as an Amateur Surgeon, 148 Gibbon's Retort on the Physician, 51 Gilpin and the Northumbrian Brawlers, 19 Gospel, The, A Novelty, 34 Gregory, Dr., Generosity of, 73 Harvey and the Circulation of the Blood, 35 Herrnhuters, the, Extravagances of, 78 Hill, The Rev. Rowland, 157 Hour-Glasses in Church, 49 How to be Kept in Health, 64 Hunter (William) and Cullen, The Partnership of, 14 Hunter, John, the Anatomist, 139; Routing the Rout, 65 Iconoclastic Zeal in the North, 137 Indian Commerce, Origin of our, 122 Intercessor for Himself, An, 71 Interpolation, A Significant, 27 Jebb, Sir Richard, 40 Jenner, the Discoverer of Vaccination, 107 Kennet, Bishop, on Late Repentance, 42 Kirwan, Dr., Dean of Killala, 55 Knox, John, Fearlessness of, 105 Leighton, Archbishop, on Time and Eternity, 159 Lettsom's Liberation of his Slaves, 112 Licenced Lay Preaching, 62 "Make the Most of Him", 158 Mal-apropos Quotation, A, 43 Masses Transferred, 21 Massillon, Eloquence of, 12 Mathews on his Deathbed, 32 Mayerne, Sir Theodore, 92 Medicine, A Royal, 25 Methodist Dog, The, 50 Mild Criticism, A, 48 Monsey, Messenger, his Dying Jests, 132 Nash's (Beau) Treatment of a Prescription, 128 Pacific She, A, 158 Paley's Career, Turning Point in, 81; Economy of Conscience, 97 Perkins' "Tractors" Exposed, 113 Perversion of Scripture, A Clever, 136 Peter the Great as Dentist, 47 Physicians and their Fees, 86; and Clergymen, 159 Playing-Cards, Puritan Re-Christening of, 139 Pope's Last Epigram, 68 Prayer, A Loyal and Fata, 124 Preacher, A Popular, 16; A Witty French, 130 Preaching for a Crown, 54 Preaching to Purpose, Latimer's, 124 Preparing for the Worst and Best, 143 Prescription in Disguise, A, 18; Prescription for Long Life, A, 61 Promotion, The Way to, 145 Pulteney's Cure by Small Beer, 128 Radcliffe's Enmity to Hannes, 30 Radcliffe and Kneller, 58 Revival of "Prophesying," Lord Bacon on the, 141 Revolution, The French, and the Bible, 107 Rude Truth for a Queen, 75 Saint's Bell, The, 39 Seaman Bishop, The, 27 Sermon Reading, Charles II. on, 44 Servant and Master, 126 Shedding his Blood for his Country, 54 Slaps for Sleepers in Church, 59 Sloane, Sir Hans, 154 Smith, Sydney, Bon-Mots of, 121 Sterne, A Home Thrust at, 34 Stillingfleet, Charles II. and Bishop, 123 Sunday Sports, James I. on, 37 Swift's (Dean) Contributory Dinner, 102 "Tapping" a Toper, 100 Tar-water, The Power of, 22 Taylor, Jeremy, on Marriage, 57 Tillotson, Archbishop, Charity of, 120 Transfusion of Blood, 68 Trump Cards, 52 Two-Edged Accusation, A, 58 Two Gates of Heaven, The, 51 Unconcern in Presence of Death, 137 Unlucky Coincidence, An, 61 Unmistakeable Identity, 134 Unpreaching Prelates, 28 Wasdale's (Dr.) Long Ride, 136 Wesley and Beau Nash, 106 Whately, Witticisms of Archbishop, 152 Whitfield, Persuasiveness of, 52; his Influence on the Church, 72; "Improving" an Execution in Edinburgh, 117; Dr. Johnson's Opinion of, 118; and the New York Sailors, 135; and the Kingswood Colliers, 153 Wolcot, Dr. ("Peter Pindar") in Jamaica, 119 NOTE. Clergymen and Doctors are so frequently associated, in connection with the most pleasant and the most grave necessities and occurrences of actual life, that if any apology is needed for uniting them on the present occasion, it is only because the abundant fund of anecdote and interest relating to both professions can therefore be drawn upon to the smaller extent. In this, as in the other volumes of this little series, the only plan followed has been that of striving to be brief and interesting in each selection or summary. Much of the charm and value of a collection of this kind consists in the large admixture of personal incident, and liberal display of individual character--which the nature and duties of the clerical and medical professions render so easy. But it has also been sought to present, not of course in order or in complete series, a number of such curious facts as throw a side-light at once on professional and social history; and it is confidently hoped that thus the collection will not only amuse, but inform. CLERGYMEN AND DOCTORS. _CURIOUS FACTS AND CHARACTERISTIC SKETCHES._ SIR ASTLEY COOPER'S NIGHTCAP FEE. Living as he long did in the City,--in Broad Street,--Sir Astley Cooper, the most distinguished surgeon of his time, made a very large income; which, however, naturally enough rose and fell somewhat in sympathy with the state of the markets. In one year he made 20,000 guineas; and for many years his income was over £15,000. From one Mincing Lane merchant, whom he usually visited at Croydon, Sir Astley derived for a long period an annual revenue of £600. Large individual fees, of course, were also paid by the wealthy traders and financiers on special occasions; and once, and once only, Sir Astley received--and received in a very whimsical fashion--the splendid _honorarium_ of a thousand guineas. A West Indian millionaire, of the name of Hyatt, during a painful and critical operation which he had to undergo, was attended by Drs. Lettsom and Nelson as physicians, and by Sir Astley Cooper as surgeon. The operation was successful, and the patient speedily felt in himself the promise of recovered health and spirits. He did not wait for his complete recovery to evince his sense of gratitude and joy; but promptly rewarded his physicians with a fee of 300 guineas each. "As for you, Sir," the millionaire said, sitting up in bed and addressing himself to Sir Astley,--"you, Sir, shall have something better than that; there, Sir, take that!"--and he flung his nightcap at the great surgeon. Sir Astley picked up the nightcap, saying, "Sir, I pocket the affront;" and on reaching home he found in the cap a cheque for 1000 guineas. In his younger days, however, Sir Astley Cooper had sowed, by anxious and ill-rewarded waiting, the seeds of his subsequent great renown and revenue: in his first year of practice his profits were but five guineas; in his second, twenty-six pounds; in his third, thirty-four; and only in the ninth year did his income mount above a thousand pounds. ELOQUENCE OF MASSILLON. Jean Baptiste Massillon, born in 1663 at Hyères, was one of the greatest pulpit orators of France. At the age of seventeen he entered the congregation of the Oratory, at Paris, and won very high favour; but, being enviously accused of some amours, he went into retirement for a short time. The eloquence by which his funeral sermon, at his retirement at St. Fonds, on the Archbishop de Villars was characterized, led to his reluctant but triumphant return to Paris. The applause with which his oratory met there, even at the Court, was almost unparalleled. When he preached the first Advent sermon at Versailles, Louis XIV. paid the following most happy and expressive testimony to the power of his preaching: "Father, when I hear other preachers, I am very well satisfied with them; when I hear you, I am dissatisfied with myself." The effect of his first delivery of the sermon "On the small number of the Elect," has been described as almost miraculous. At a certain powerful passage in it, the entire auditory was seized with such violent emotion, that almost every person half rose from his seat, as if to endeavour to shake off the horror of being one of those cast out into everlasting darkness. He spoke with that strong, earnest simplicity which is the surest key to the hearts of all but the utterly devoid of feeling. When asked once where a man like him, whose life was dedicated to retirement, could borrow his admirable descriptions of real life, he answered, "From the human heart; let us examine it ever so slightly, we find in it the seeds of every passion. When I compose a sermon, I imagine myself consulted upon some difficult piece of business. I give my whole application to determine the person who has recourse to me to act the good and proper part. I exhort him, I urge him, and I quit him not until he has yielded to my persuasions." ADDISON'S INTRODUCTION TO BAXTER. Addison says that he once met with a page of Mr. Baxter under a Christmas pie. "Whether or no the pastry-cook had made use of it through chance or waggery, for the defence of that superstitious _viande_, I know not; but, upon the perusal of it, I conceived so good an idea of the author's piety that I bought the whole book." THE PARTNERSHIP OF HUNTER AND CULLEN. Dr. William Cullen, the celebrated physician and medical writer, and Dr. William Hunter, the brother of the great anatomist, when young men formed a copartnery of as singular and noble a nature as any to be found in the records of their profession. They were both natives of the neighbourhood of Glasgow, and Hunter studied for the church at that university. But he accidentally became acquainted with Cullen, who was some years his senior, and had settled in a medical practice at Hamilton; and this friendship, strengthening his natural inclination, drew Hunter away from the study of theology to that of medicine. He went to reside with Cullen, and entered into partnership with him--neither of the young men being well to do, and both stimulated by the impulse of genius to take this step in order that they might the better overcome the obstacles presented by the narrowness of their fortunes to the prosecution of their studies. It was stipulated that each partner alternately should be allowed to study during the winter at what college he pleased, the other meantime conducting the joint business for the common advantage. Cullen, as the senior partner, had the first winter, and he went to Edinburgh. But next winter Hunter's turn came: he preferred London to Edinburgh, went thither, and did not return to Scotland. His excellence as a dissector, singular dexterity in making anatomical preparations, assiduity in study, and agreeable manners, won him the warm regard of Dr. Douglas, to whom he had an introduction from Foulis the printer; and in two or three years Hunter became a lecturer on anatomy, and laid the foundations of a great fame and fortune. The scientific partnership was of course dissolved by Hunter's success in London; but Cullen freely consented to renounce his claim on his junior, and ever afterwards maintained a very cordial and friendly correspondence with Hunter--though the two friends are believed never afterwards to have seen each other. THE EXHAUSTIVE BARROW. Charles II., in his humorous fashion, was wont to say about his chaplain--that distinguished philosopher and divine, Dr. Isaac Barrow--that he was the most unfair preacher in England, because he exhausted every subject, and left no room for others to come after him. This was indeed too much the doctor's characteristic; when he had once got hold of a topic, he knew not how to leave anything unsaid upon it. One of his best discourses, on the duty and reward of bounty to the poor, actually occupied between three and four hours in the delivery. Although, however, his sermons are unusually long, they so abound in matter, that his language sometimes labours in the utterance of his thought; hence his style is at times involved and parenthetical, though passages of sublime and simple eloquence frequently occur. It is related that, in preaching the Spital sermon before the Lord Mayor and Corporation, he consumed three hours and a half. Being asked, after he came down from the pulpit, if he was not tired, he replied, "Yes, indeed, I begin to be weary in standing so long." A POPULAR PREACHER. When Father Thomas Conecte, who was afterwards burnt at Rome, preached in the great towns of Flanders and Artois, the churches were so filled that he used to be hoisted in the middle of the church by a cord, in order to be heard! "ATTERBURY'S PAD." During the debates on the Occasional Conformity and Schism Bills, in the House of Lords, in December 1718, these measures were very warmly opposed by Atterbury, Bishop of Rochester; who said "he had prophesied last winter that this bill would be attempted in the next session, and he was very sorry to find that he had turned out a true prophet." Lord Coningsby, who always spoke in a passion, rose immediately after Atterbury, and remarked that "one of the right reverends had set himself forth as a prophet; but, for his part, he did not know what prophet to liken him to, unless to that famous prophet Balaam, who was reproved by his own ass." The Bishop, in reply, with great calmness and wit met the attack of Lord Coningsby, thus concluding: "Since the noble Lord has discovered in our manners such a similitude, I am well content to be compared to the prophet Balaam; but, my Lords, I am at a loss to make out the other part of the parallel. I am sure that I have been _reproved by nobody but his Lordship_." From that day forward, Lord Coningsby was known by the sobriquet of "Atterbury's Pad." THE FOOT-SCRAPERS REPROVED. When a preacher was very obnoxious to the students at Cambridge, it was the custom for them to express disapprobation by scraping with their feet on the floor. A very eloquent but intriguing preacher, Dr. James Scott--known as a political partisan by the pamphleteer and newspaper signatures of "Anti-Sejanus" and "Old Slyboots"--being one day saluted thus, signified his intention to preach against the practice of scraping; and fulfilled his promise very shortly afterwards, taking for his text, "Keep thy foot when thou goest to the house of God, and be more ready to hear than to give the sacrifice of fools; for they consider not that they do evil." On the text being read out, the galleries became one scene of confusion and uproar; but Dr. Scott called to the proctors to preserve silence. This being effected, he delivered a discourse so eloquent, as to extort universal approbation, even from those at whom the text was aimed. A PRESCRIPTION IN DISGUISE. General D---- was more distinguished for gallantry in the field than for the care he lavished upon his person. Complaining, on a certain occasion, to Chief Justice Bushe, of Ireland, of the sufferings he endured from rheumatism, that learned and humorous judge undertook to prescribe a remedy. "You must desire your servant," he said to the General, "to place every morning by your bedside a tub three-parts filled with warm water. You will then get into the tub, and having previously provided yourself with a pound of yellow soap, you must rub your whole body with it, immersing yourself occasionally in the water, and at the end of a quarter of an hour, the process concludes by wiping yourself dry with towels, and scrubbing your person with a flesh-brush." "Why," said the General, after reflecting for a minute or two, "this seems to be neither more nor less than washing one's self." "Well, I must confess," rejoined the judge, "_it is open to that objection_." HOW TO DRESS A CUCUMBER. Dr. Glynn, of Cambridge, being one day in attendance on a lady, in the quality of her physician, took occasion to lecture her on the impropriety of eating cucumbers, of which she was immoderately fond; and gave her the following humorous receipt for dressing them: "Peel the cucumber with great care; then cut it into very thin slices; pepper and salt it well--and then throw it away." GILPIN AND THE NORTHUMBRIAN BRAWLERS. Bernard Gilpin, the great Northern apostle, did not confine his labours to the church of Houghton-le-Spring, of which he was minister; but at his own expense, and with great risk and hardship, visited the then desolate churches of Northumberland once every year, usually about Christmas, to preach the gospel. The Northumbrians about that time retained so much of the customs of our Saxon ancestors, as to decide every dispute by the sword; they even went beyond them, and, not content with a duel, each contending party used to muster what adherents he could, and began a kind of petty war, so that a private grudge would often occasion much bloodshed. In one of his annual tours, Mr. Gilpin found a quarrel of this kind raging at Rothbury. During the first two or three days of his preaching, the contending parties observed some decorum, and never came to church both at the same time. At last, however, they met; one party had come early, and just as Mr. Gilpin began the sermon the other entered. They did not stand long quiet, but, mutually enraged at the sight of each other, began to clash their arms. Awed, however, by the sacredness of the place, the tumult somewhat fell, and Mr. Gilpin could proceed with his sermon. In a short time, however, the combatants anew brandished their weapons, and approached each other. Mr. Gilpin now came down from the pulpit, went between the two parties, and, appealing to the chiefs, stayed the quarrel for the time, though he could not perfectly reconcile them. They promised that until the sermon was over there should be no further disturbance. Mr. Gilpin then remounted the pulpit, and devoted the rest of the time to endeavour to make the combatants ashamed of their behaviour; and his courage and earnestness so much affected them, that at his further entreaty they agreed to abstain from all acts of hostility while he continued in the country. Another time, when he entered the church, Mr. Gilpin saw a glove hanging up, and was told by the sexton that it was as a challenge to any one that should take it down. The sexton refusing to take it down, because he "dared not," Mr. Gilpin procured a long staff, took it down himself, and put it in his breast. When the congregation assembled, he went into the pulpit, and took occasion severely to rebuke these inhuman challenges, and especially this fashion of hanging up the glove in church. "I hear," said he, "that there is one among you who even in this sacred place hath hanged up a glove to this purpose, and threateneth to enter into combat with whosoever shall take it down. Behold, I have taken it down myself!" and, plucking the glove out of his breast, he held it up before them all, and again proceeded to condemn such barbarous fashions, and to commend the practice of love and charity. So much did his faithfulness win for him respect, and soften the stern mood of the country folk, that so often as he came into the parts where he had administered these rebukes, if any man was in fear of a deadly foe, he resorted usually where Mr. Gilpin was, supposing himself to be more safe in his company than under an armed guard. MASSES TRANSFERRED. Bernal Diaz relates, that while Cortes was absent on his expedition against Christoval d'Oli, his death was reported by men who assumed the government at Mexico; they ordered ceremonies and masses for his soul, and paid for them with his effects. When he returned in safety, Juan de Caceres, "the rich," bought all these acts of devotion for his own benefit--like some modern buyer of shares, expecting a regular entry of the transfer to be made in the books of the concern in which he invested. PRECEPT AND EXAMPLE OF ABSTINENCE. John Wesley having learned that a wealthy tradesman of his neighbourhood indulged to excess in the pleasures of the table, paid him a visit, and, discussing the subject with him, urged every argument and every passage of Scripture he could against the sin of gluttony. Observing the tradesman silent and thoughtful, Wesley flattered himself that he had gained his point and produced the desired reformation. The dinner cloth was by this time spread, and sumptuous elegance decorated the board. Mr. Wesley was asked to dine; and having consented, was thus addressed by his host: "Sir, your conversation has made such an impression on me, that henceforward I shall live only on bread and water; and to show you that I am in good earnest, I will begin immediately." The dinner was then ordered to be removed, and bread and water introduced; to the disappointment of the preacher, who, although an abstemious man, wished for something better than an anchorite's fare. QUEEN ELIZABETH'S BLOOD JEWELS. In the _Parliamentary History_, under date of 1601, the Lord Keeper is reported to say: "I have seen her Majesty wear at her girdle the price of her blood; I mean, jewels which have been given to her physicians to have done that unto her which I hope God will ever keep from her. But she hath rather worn them in triumph, than for the price, which hath not been greatly valuable." THE POWER OF TAR-WATER. Doctor Hill, a notorious wit, physician, and man of letters, having quarrelled with the members of the Royal Society, who had refused to admit him as an associate, resolved to avenge himself. At the time that Bishop Berkeley had issued his work on the marvellous virtues of tar-water, Hill addressed to their secretary a letter, purporting to be from a country surgeon, and reciting the particulars of a cure which he had effected. "A sailor," he wrote, "broke his leg, and applied to me for help. I bound together the broken portions, and washed them with the celebrated tar-water. Almost immediately the sailor felt the beneficial effects of this remedy, and it was not long before his leg was completely healed!" The letter was read and discussed at the meetings of the Royal Society, and caused considerable difference of opinion. Papers were written for and against the tar-water and the restored leg, when a second letter arrived from the (pretended) country practitioner: "In my last I omitted to mention that the broken limb of the sailor was a wooden leg!" THE CURATE AND THE DUKE. The Duke of Grafton, when hunting, was thrown into a ditch; at the same time a young curate, calling out, "Lie still, your Grace," leaped over him, and pursued his sport. On being assisted to remount by his attendants, the duke said, "That young man shall have the first good living that falls to my disposal; had he stopped to have taken care of me, I never would have patronised him"--being delighted with an ardour similar to his own, and with a spirit that would not stoop to flatter. A LOYAL AND FATAL PRAYER. It is related by Thoresby that Mr. John Jackson, a good old Puritan, and a member of the Assembly of Divines at Westminster, "was yet so zealously affected for King Charles I., when he heard of his being brought before a pretended high court of justice, that he prayed earnestly that God would please to prevent that horrid act, which would be a perpetual shame to the nation, and a reproach to the Protestant religion; or, at least, would be pleased to remove him, that he might not see the woful day. His prayer was heard and answered as to himself, for he was buried the week before" the execution of Charles took place. FLAVEL'S "DAY OF HEAVEN." This distinguished Nonconformist divine, who lived about the end of the seventeenth century, in his _Treatise on the Soul of Man_ relates of himself--so at least it is understood, though he speaks in the third person--that for a day he was wrapt in such intimate spiritual communion with heaven, as exhausted the powers of physical nature, and for a time appeared to leave him on the brink of the grave. This singular season of trance he used to style "one of the days of heaven;" and he affirmed, that in that time there came to him more insight into the heavenly life, than he had all his days gained from books or sermons. "Being on a journey, he set himself to improve his time by meditation; when his mind grew intent, till at length he had such ravishing tastes of heavenly joys, and such full assurance of his interest therein, that he utterly lost the sight and sense of this world and all its concerns, so that for hours he knew not where he was. At last, perceiving himself faint through a great loss of blood from his nose, he alighted from his horse, and sat down at a spring, where he washed and refreshed himself, earnestly desiring, if it were the will of God, that he might then leave the world. His spirits reviving, he finished his journey in the same delightful frame. He passed all that night without a wink of sleep, the joy of the Lord still overflowing him, so that he seemed an inhabitant of the other world." It was taken by his religious friends as a special promise of heavenly favour, that at the birth of Flavel a pair of nightingales made their nest close to the chamber of his mother, and welcomed him into the world with their delightful warble. A ROYAL MEDICINE. Even so late as the days of Queen Elizabeth, ignorance and superstition continued prime regulating powers in the practice of physic; accomplished as some of the physicians of the day were, it was, as Lord Bacon has affirmed, in every department excepting those that immediately touched their own profession. Sir William Bulleyn was not one of the least prominent and enlightened; but some of the prescriptions which he has left on record, attest a very deplorable state of things, existing little more than half a century before Harvey achieved his great discovery. Take for example this recipe for an "_Electuarium de Gemmis._" "Take two drachms of white perles; two little peeces of saphyre; jacinth, corneline, emerauldes, granettes, of each an ounce; setwal, the sweate roote doronike, the rind of pomecitron, mace, basel seede, of each two drachms; of redde corall, amber, shaving of ivory, of each two drachms; rootes both of white and red behen, ginger, long peper, spicknard, folium indicum, saffron, cardamon, of each one drachm; of troch. diarodon, lignum aloes, of each half a small handful; cinnamon, galinga, zurubeth, which is a kind of setwal, of each one drachm and a half; thin pieces of gold and sylver, of each half a scruple; of musk, half a drachm. Make your electuary with honey emblici, which is the fourth kind of mirobalans with roses, strained in equall partes, as much as will suffice. This healeth cold diseases of ye braine, harte, stomack. It is a medicine proved against the tremblynge of the harte, faynting and souning, the weaknes of the stomacke, pensivenes, solitarines. Kings and noble men have used this for their comfort. It causeth them to be bold-spirited, the body to smell wel, and ingendreth to the face good coloure." A SIGNIFICANT INTERPOLATION. The most celebrated wits and _bon vivants_ of the day graced the dinner table of Dr. Kitchener, and _inter aliis_ George Colman, who was an especial favourite. His interpolation of a little monosyllable in a written admonition, which the Doctor caused to be placed on the mantlepiece of the dining parlour, will never be forgotten, and was the origin of such a drinking bout as was seldom permitted under his roof. The caution ran thus: "Come at seven, go at eleven." Colman briefly altered the sense of it; for, upon the Doctor's attention being directed to the card, he read, to his astonishment, "Come at seven, _go it_ at eleven!" which the guests did, and the claret was punished accordingly. THE SEAMAN-BISHOP. Dr. Lyons, who was appointed to the Bishopric of Cork, Cloyne, and Ross, towards the end of the reign of Queen Elizabeth, held the See for twenty years, but only preached once--on the death of the Queen. His aversion to preaching is ascribed to the fact that he was not educated for the church. He was, indeed, captain of a ship, and distinguished himself so gallantly in several actions with the Spaniards, that, on his being introduced to the Queen, she told him that he should have the first vacancy that offered. The simple captain understood the Queen literally; and soon after, hearing of a vacancy in the See of Cork, he immediately set out for Court, and claimed the fulfilment of the royal promise. The Queen, astonished at the request, for a time remonstrated against the impropriety of it, and said that she could never think it a suitable office for him. It was, however, in vain; he pleaded the royal promise, and relied on it. The Queen then said she would take a few days to consider the matter; when, examining into his character, and finding that he was a sober, moral man, as well as an intrepid commander, she sent for him, and gave him the Bishopric, saying that she "hoped he would take as good care of the Church, as he had done of the State." UNPREACHING PRELATES. The appointment of bishops and other ecclesiastics to lay offices, and more especially to places in the Mint, during the reign of Edward VI., was severely censured from the pulpit by the intrepid and venerable Bishop Latimer. In his "Sermon of the Plough," he says, with equal humour and vigour: "But now for the fault of unpreaching prelates, methinks I could guess what might be said for excusing them. They are so troubled with lordly living, they be so placed in palaces, couched in courts, ruffling in their rents, dancing in their _dominions_, burdened with embassages, pampering of their paunches, like a monk that maketh his jubilee, munching in their mangers, and moiling in their gay manors and mansions, and so troubled with loitering in their lordships, that they cannot attend it. They are otherwise occupied, some in King's matters, some are ambassadors, some of the Privy Council, some to furnish the Court, some are lords of the Parliament, some are presidents, comptrollers of Mints. Well, well, is this their duty? Is this their office? Is this their calling? Should we have ministers of the Church to be comptrollers of Mints? Is this a meet office for a priest that hath the cure of souls? Is this his charge? I would here ask one question: I would fain know who comptrolleth the devil at home at his parish, while he comptrolleth the Mint? If the apostles might not leave the office of preaching to be deacons, shall one leave it for minting? I cannot tell you; but the saying is, that since priests have been minters, money hath been worse than it was before." In another part of this discourse the Bishop proceeds to ask, "Is there never a nobleman to be a Lord President, but it must be a prelate? Is there never a wise man in the realm to be a comptroller of the Mint? I speak it to your shame, I speak it to your shame. If there be never a wise man, make a water-bearer, a tinker, a cobbler, a slave, a page, the comptrollers of the Mint. Make a mean gentleman, a groom, a yeoman; make a poor beggar, Lord President. Thus I speak, not that I would have it so, but to your shame, if there be never a gentleman meet nor able to be Lord President. For why are not the noblemen and young gentlemen of England so brought up in knowledge of God and in learning, that they might be able to execute offices in the commonweal?" CHARLES II. AND HIS CHAPLAIN. Dr. Hickringal, who was one of King Charles the Second's chaplains, whenever he preached before his Majesty, was sure to tell him of his faults from the pulpit. One day his Majesty met the Doctor in the Mall, and said to him, "Doctor, what have I done to you that you are always quarrelling with me?" "I hope your Majesty is not angry with me," quoth the Doctor, "for telling the truth." "No, no," says the king; "but I would have us for the future be friends." "Well, well," quoth the Doctor, "I will make it up with your Majesty on these terms: _as you mend I'll mend_." RADCLIFFE'S ENMITY TO HANNES. John Radcliffe, the eccentric, niggardly, self-indulgent, ill-educated, and intensely Jacobitish physician, who, at the end of the seventeenth century, rose to an eminent place in the capital and at Court, was the son of a comfortable Yorkshire yeoman. He resided for some years at Oxford University, and afterwards practised there; but in 1684 he went up to London, and speedily made himself a great name and income. As, however, at Oxford he had found enemies who, as was the fashion of these days, spoke very openly and bitterly against their rising rival--so was it also in London: Gibbons, Blackmore, and others, were hostile to the new-comer--the first expending his sarcasm on Radcliffe's defects of scholarship. Radcliffe replied, by fixing on Gibbons, as is well known the epithet of "_Nurse_;" ridiculing his mode of treatment by slops and gruels, and so forth,--Radcliffe's faith being placed in fresh air and exercise, generous nourishment, and the use of cordials. Sir Edward Hannes was, like Radcliffe, an Oxford man; and hence, perhaps, the peculiar jealousy and hatred with which he regarded Radcliffe. Hannes started in London, whither he followed Radcliffe, a splendid carriage and four, that drew upon it the eyes of all the town, and provoked Radcliffe, when told by a friend that the horses were the finest he had ever seen, to the savage reply, "Then he'll be able to sell them for all the more!" Hannes employed a stratagem that, in sundry shapes, has since been not quite unfamiliar in medical practice. He instructed his livery servants to run about the streets, and, putting their heads into every coach they met, to inquire in tones of anxiety and alarm, whether Dr. Hannes was there. Once one of these servants entered on this advertising errand Garraway's Coffeehouse, in Exchange Alley--a great resort of the medical profession; and called out, all breathless with haste, "Gentlemen, can any of your honours tell me if Dr. Hannes is here?" "Who wants Dr. Hannes, fellow?" asked Radcliffe, who was in the room. "Lord A----, and Lord B----," was the assurance of the servant. "No, no, my man," said Radcliffe, in a voice deliberate and full of enjoyment of the irony; "no, no, you are mistaken; it isn't the Lords that want your master, but he that wants them." Hannes was reputed the son of a basket-maker; Blackmore had been a schoolmaster--circumstances which furnished Radcliffe with material for a savage attack on both, when called in to attend the young Duke of Gloucester, for whom they had prescribed until the illness took a fatal turn. He accused them to their faces, and with no particular gentleness of language, for having abominably mismanaged a mere attack of rash; and said, "It would have been happy for this nation had you, Sir, been bred up a basket-maker, and you, Sir, remained a country schoolmaster, rather than have ventured out of your reach, in the practice of an art to which you are an utter stranger, and for your blunders in which you ought to be whipped with one of your own rods." MATHEWS OH HIS DEATHBED. A friend attending on Charles Mathews the Elder, the celebrated comedian, in his last illness, intending to give him his medicine, gave in mistake some ink from a phial on a shelf. On discovering the error, his friend exclaimed, "Good heavens! Mathews, I have given you ink." "Never--never mind, my boy--never mind," said Mathews, faintly, "I'll swallow a bit of _blotting-paper_." BISHOP BERKELEY'S BERMUDA SCHEME. Dr. George Berkeley, the Bishop of Cloyne--celebrated for his ideal theory, and by the praise of Pope, his stedfast friend, who ascribes "to Berkeley every virtue under heaven," as others ascribed to him all learning--in 1824 conceived and published his benevolent proposal for converting the American savages to Christianity, by means of a colony to be established in the Bermudas. The proposal was published in 1723, the year after he had been appointed Dean of Derry; and he offered to resign that opulent preferment, worth £1100 a year, and to dedicate the remainder of his life to the instruction of the Indians, on the moderate allowance of £100 a-year. The project was very favourably received, and persons of the highest rank raised considerable sums by subscription in aid of it. Berkeley having resigned his preferment, set sail for Rhode Island, to make arrangements for carrying out his views. Such was the influence of his distinguished example, that three of the junior Fellows of Trinity College, Dublin, abandoned with him all their flattering prospects in life in their own country, for a settlement in the Atlantic Ocean at £40 a-year. The Dean, not meeting with the support the ministry had promised him, and after spending nearly all his private property and seven of the best years of his life in the prosecution of his scheme, returned to Europe. This, however, he did not do, until the Bishop of London had informed him, that on application for funds to Sir Robert Walpole, he had received the following honest answer: "If you put this question to me as a minister, I must and I can assure you, that the money shall most undoubtedly be paid as soon as suits with the public convenience; but if you ask me as a friend, whether Dean Berkeley should continue in America, expecting the payment of £10,000, advise him, by all means, to return home to Europe, and give up his present expectations." A HOME-THRUST AT STERNE. Sterne, the reverend author of the _Sentimental Journey_, had the credit of treating his wife very ill. He was one day talking to Garrick, in a fine sentimental strain, in laudation of conjugal love and fidelity. "The husband," said he, "who behaves unkindly to his wife, deserves to have his house burnt over his head." "If you think so," replied Garrick, "I hope _your_ house is insured." THE GOSPEL A NOVELTY. When Le Torneau preached the Lent sermon at St. Benoit, at Paris, Louis XIV. inquired of Boileau, "if he knew anything of a preacher called Le Tourneau, whom everybody was running after?" "Sire," replied the poet, "your Majesty knows that people always run after novelties; this man preaches the gospel." The King pressing him to speak seriously, Boileau added: "When M. Le Tourneau first ascends the pulpit, his ugliness so disgusts the congregation that they wish he would go down again; but when he begins to speak, they dread the time of his descending." Boileau's remark as to the "novelty" of preaching the gospel in his time, brings to mind the candid confession of a Flemish preacher, who, in a sermon delivered before an audience wholly of his own order, said: "We are worse than Judas; he sold and delivered his Master; we sell Him too, but deliver Him not." Somewhat akin was the remark, in an earlier age, of Father Fulgentio, the friend and biographer of Paul Sarpi, and, like him, a secret friend to the progress of religious reformation. Preaching on Pilate's question, "What is truth?" he told the audience that he had at last, after many searches, found it out; and, holding forth the New Testament, said, "Here it is, my friends; but," he added sorrowfully, as he returned it to his pocket, "it is _a sealed book_." HARVEY AND THE CIRCULATION OF THE BLOOD. The discovery of the circulation of the blood was the most important ever made in the science of physiology, and led to a complete revolution throughout the whole circle of medical knowledge and practice. The renown of this splendid discovery, by all but universal consent, has been attributed to William Harvey, an English physician, who was born at Folkestone in 1578, and in 1593 went to Caius College, Cambridge, where he remained four years. He then went abroad for several years, studying in the most famous medical schools; and in 1604, having passed M.D. at Cambridge, he set up in practice in London. In 1615 he was appointed Lecturer at the College of Physicians, on Anatomy and Surgery; and it was in the performance of these duties that he arrived at the important discovery that is inseparably associated with his name. "The merit of Harvey," it has been justly observed, "is enhanced by considering the degraded state of medical knowledge at that time in England. While anatomical schools had been long established in Italy, France, and Germany, and several teachers had rendered their names illustrious by the successful pursuit of the science, anatomy was still unknown in England, and dissection had hitherto hardly begun; yet at this inauspicious period did Harvey make a discovery, which amply justifies Haller in ranking him as only second to Hippocrates." In 1620 he promulgated his new doctrine of the circulation of the blood, in a treatise entitled _Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus_; in the preface to which, addressed to the College of Physicians, he states that frequently in his lectures he had declared his opinion touching the motion of the heart and the circulation of the blood, and had for more than nine years confirmed and illustrated that discovery by reasons and arguments grounded on ocular demonstration. The attention of all Europe, and the keen opposition of many of its medical scholars, were at once aroused by Harvey's publication; but his doctrine triumphed over all objections, and before he died he had the happiness of seeing it fully established. Harvey was physician to James I. and Charles I., the latter of whom had a high regard for him; and at the outbreak of the civil war he adhered to the royal side, and quitted London with the king, attending him at the battle of Edgehill, and afterwards at Oxford. He died in 1658, it is said from the effects of opium which he had taken with suicidal intent, while suffering under the acute pangs of gout. Posterity has been more faithful and grateful than his own age to the greatest modern discoverer in medical science; for his discovery rather tended to push him back than to advance him in professional position. It has been said that "perhaps his researches took him out of the common road to popular eminence, and they seem to have exposed him to the prejudice so commonly prevailing against an innovator; for we find him complaining to a friend, that his practice considerably declined after the publication of his discovery." SUNDAY SPORTS. Rushworth relates that King James, in 1618, in his _Declaration concerning Lawful Sports_, said that in his progress through Lancashire he did justly rebuke some Puritans and precise people for the prohibiting and unlawful punishment of his good people for using their lawful recreations and honest exercises upon Sundays and other holidays, after the afternoon sermon or service. "With his own ears he heard the general complaint of his people, that they were barred from all lawful recreations and exercise upon the Sundays after noon;" which must produce two great evils,--the first, the hindering the conversion of many whom the clergy caused to believe that religion, and honest mirth and recreation, were incompatible. "The other inconvenience is, that this prohibition barreth the common and meaner sort of people from using such exercises as may make their bodies more able for war when his Majesty, or his successors, shall have occasion to use them; and in place thereof, sets up tippling and filthy drunkenness, and breeds a number of idle and discontented speeches in alehouses. For when shall the common people have leave to exercise, if not upon the Sundays and holidays, seeing they must apply their labour, and win their living, on all working days? Therefore, the King said, his express pleasure was that no lawful recreation should be barred to his good people which did not tend to the breach of the laws of this kingdom and the canons of the Church: that after the end of divine service his people be not disturbed, letted, or discouraged from any lawful recreation, such as dancing, either men or women; archery for men, leaping, vaulting, or any other such harmless recreation; nor from having of May-games, Whitson-ales, and Morice-dances; and the setting up of Maypoles, and other sports therewith used, so as the same be had in due and convenient time, without impediment or neglect of divine service. And that women should have leave to carry rushes to the church for the decoring of it, according to their old custom." But bull and bear baiting, "interludes," and bowling (at all times prohibited to the meaner sort), were forbidden; all known recusants who abstained from coming to service were barred the liberty of recreation, "being unworthy of any lawful recreation after the service, that would not first come to the church and serve God;" as were also all who, though conforming in religion, had not been present in church. Each person was to go to church, and join the sports, in his own parish; and no weapons of offence were to be carried or used. Charles I., in 1633, gave command for the reading of the _Book of Sports_ in the churches, which had not been done even by his father, and which gave great offence and stirred up much display of bad feeling. In London, after the reading, one clergyman went on immediately to read the Ten Commandments, and said, "Dearly beloved brethren, you have now heard the commandments of God and man; obey which you please." Another minister followed up the reading of the obnoxious ordinance by the delivery of a sermon on the Fourth Commandment. THE SAINT'S BELL. In their description of Westmoreland, Nicholson and Burn relate, that "in the old church at Ravenstonedale there was a small bell, called the Saint's Bell, which was wont to be rung after the Nicene creed, to call in the Dissenters to sermon. And to this day the Dissenters, besides frequenting the meeting-house, oftentimes attend the sermon in church." SIR RICHARD JEBB. Sir Richard Jebb, the famous physician, who was very rough and harsh in his manner, once observed to a patient to whom he had been extremely rude, "Sir, it is my way." "Then," returned his indignant patient, pointing to the door, "I beg you will make _that_ your way!" Sir Richard being called to see a patient who fancied himself very ill, told him ingenuously what he thought, and declined prescribing for him. "Now you are here," said the patient, "I shall be obliged to you, Sir Richard, if you will tell me how I must live--what I may eat, and what I may not." "My directions as to that point," replied Sir Richard, "will be few and simple! You must not eat the poker, shovel, or tongs, for they are hard of digestion; nor the bellows, because they are windy; but eat anything else you please!" A SANITARY VIEW OF BAPTISM. Crosby's _History of the English Baptists_ preserves the opinion of Sir John Floyer, the physician, that immersion at baptism was of great value in a sanitary point of view, and that its discontinuance, about the year 1600, had been attended with ill effects on the physical condition of the population. Dealing with the question purely in a professional sense, he declared his belief that the English would return to the practice of immersion, when the medical faculty or the science of physic had plainly proved to them by experiment the safety and utility of cold bathing. "They did great injury to their own children and all posterity, who first introduced the alteration of this truly ancient ceremony of immersion, and were the occasion of a degenerate, sickly, tender race ever since. Instead of prejudicing the health of their children, immersion would prevent many hereditary diseases if it were still practised." He tells, in support of his belief, that he had been assured by a man, eighty years old, whose father lived while immersion was still the practice, that parents at the baptism would ask the priest to dip well in the water that part of the child in which any disease used to afflict themselves, to prevent its descending to their posterity. And it had long been a proverbial saying among old people, if any one complained of pain in their limbs, that "surely that limb had not been dipt in the font." Immersion, however, was far otherwise regarded in quarters where professional animus of another kind militated against its revival by the powerful dissenting body of the Baptists. Baxter vehemently and exaggeratedly denounced it as a breach of the Sixth Commandment, which says, "Thou shalt not kill;" and called on the civil magistrate to interfere for its prevention, to save the lives of the lieges. "Covetous physicians," he thought, should not be much against the Anabaptists; for "catarrhs and obstructions, which are the two great fountains of most mortal diseases in man's body, could scarce have a more notable means to produce them where they are not, or to increase them where they are. Apoplexies, lethargies, palsies, and all comatous diseases, would be promoted by it"--and then comes a long string of terrible maladies that would follow on the dipping. "In a word, it is good for nothing but to despatch men out of the world that are troublesome, and to ranken churchyards." Again: "If murder be a sin, then dipping ordinarily in cold water over head in England is a sin. And if those that would make it men's religion to murder themselves, and urge it on their consciences as their duty, are not to be suffered in a commonwealth, any more than highway murderers; then judge how these Anabaptists, that teach the necessity of such dippings, are to be suffered." Had Baxter lived in these cold water days, tubbing would probably have taught him a little more toleration. BISHOP KENNET ON LATE REPENTANCE. Doctor, afterwards Bishop, Kennet preached the funeral sermon of the first Duke of Devonshire in 1707. The sentiments of the sermon gave much umbrage; people complained that the preacher "had built a bridge to heaven for men of wit and parts, but excluded the duller part of mankind from any chance of passing it." The complaint was founded on this passage, in speaking of a late repentance: "This rarely happens but in men of distinguished sense and judgment. Ordinary abilities may be altogether sunk by a long vicious course of life; the duller flame is easily extinguished. The meaner sinful wretches are commonly given up to a reprobate mind, and die as stupidly as they lived; while the nobler and brighter parts have an advantage of understanding the worth of their souls before they resign them. If they are allowed the benefit of sickness, they commonly awake out of their dream of sin, and reflect, and look upwards. They acknowledge an infinite being; they feel their own immortal part; they recollect and relish the Holy Scriptures; they call for the elders of the church; they think what to answer at a judgment-seat. Not that God is a respecter of persons; but the difference is in men; and the more intelligent the nature is, the more susceptible of divine grace." The successor to the deceased Duke did not think ill of the sermon; and recommended Kennet to the Deanery of Peterborough, which he obtained in 1707. A MAL APROPOS QUOTATION. In one of the debates in the House of Lords, on the war with France in 1794, a speaker quoted the following lines from Bishop Porteous' _Poem on War_:-- "One murder makes a villain, Millions a hero! Princes are privileged To kill, and numbers sanctify the crime. Ah! why will kings forget that they are men, And men that they are brethren? Why delight In human sacrifice? Why burst the ties Of nature, that should knit their souls together In one soft bond of amity and love? They yet still breathe destruction, still go on, Inhumanly ingenious to find out New pains for life; new terrors for the grave; Artifices of Death! Still monarchs dream Of universal empire growing up From universal ruin. Blast the design, Great God of Hosts! nor let Thy creatures fall Unpitied victims at Ambition's shrine." The Bishop, who was present, and who generally voted with the Ministry, was asked by an independent nobleman, if he were really the author of the lines that had been quoted. The Bishop replied, "Yes, my Lord; but--they were not composed for the present war." CHARLES II. ON SERMON-READING. The practice of reading sermons, now so prevalent, was reproved by Charles II., in the following ordinance on the subject, issued by the Chancellor of the University of Cambridge:-- "_Vice-Chancellor and Gentlemen_,--Whereas his Majesty is informed, that the practice of reading sermons is generally taken up by the preachers before the University, and therefore continues even before himself; his Majesty hath commanded me to signify to you his pleasure, that the said practice, which took its beginning from the disorders of the late times, be wholly laid aside; and that the said preachers deliver their sermons, both in Latin and English, by memory without book; as being a way of preaching which his Majesty judgeth most agreeable to the use of foreign Churches, to the custom of the University heretofore, and to the nature of that holy exercise. And that his Majesty's command in these premises may be duly regarded and observed, his further pleasure is, that the names of all such ecclesiastical persons as shall continue the present supine and slothful way of preaching, be from time to time signified to me by the Vice-Chancellor for the time being, on pain of his Majesty's displeasure. October 8, 1674. "MONMOUTH." SOUTH ON THE COMMONWEALTH PREACHERS. Dr. South, in one of his sermons, thus reflected on the untrained and fanatical preachers of the time of the Commonwealth--many of whom but too well deserved the strictures:--"It may not be amiss to take occasion to utter a great truth, as both worthy to be now considered, and never to be forgot,--namely, that if we reflect upon the late times of confusion which passed upon the ministry, we shall find that the grand design of the fanatic crew was to persuade the world that a standing settled ministry was wholly useless. This, I say, was the main point which they then drove at. And the great engine to effect this was by engaging men of several callings (and those the meaner still the better) to hold forth and harangue the multitude, sometimes in the streets, sometimes in churches, sometimes in barns, and sometimes from pulpits, and sometimes from tubs, and, in a word, wheresoever and howsoever they could clock the senseless and unthinking babble about them. And with this practice well followed, they (and their friends the Jesuits) concluded, that in some time it would be no hard matter to persuade the people, that if men of other professions were able to teach and preach the word, then to what purpose should there be a company of men brought up to it and maintained in it at the charge of a public allowance? especially when at the same time the truly godly so greedily gaped and grasped at it for their self-denying selves. So that preaching, we see, was their prime engine. But now what was it, which encouraged those men to set up for a work, which (if duly managed) was so difficult in itself, and which they were never bred to? Why, no doubt it was, that low, cheap, illiterate way, then commonly used, and cried up for the only gospel soul-searching way (as the word then went), and which the craftier set of them saw well enough, that with a little exercise and much confidence, they might in a short time come to equal, if not exceed; as it cannot be denied, but that some few of them (with the help of a few friends in masquerade) accordingly did. But, on the contrary, had preaching been made and reckoned a matter of solid and true learning, of theological knowledge and long and severe study (as the nature of it required it to be), assuredly no preaching cobbler amongst them all would ever have ventured so far beyond his last, as to undertake it. And consequently this their most powerful engine for supplanting the church and clergy had never been attempted, nor perhaps so much as thought on; and therefore of most singular benefit, no question, would it be to the public, if those who have authority to second their advice, would counsel the ignorant and the forward to consider what divinity is, and what they themselves are, and so to put up their preaching tools, their Medulla's note-books, their melleficiums, concordances, and all, and betake themselves to some useful trade, which nature had most particularly fitted them for." PETER THE GREAT AS DENTIST. The Czar Peter, impelled by natural curiosity and love of science, was very fond of witnessing dissections and operations. He first made these known in Russia, and gave orders to be informed when anything of the kind was going on at the hospitals, that he might, if possible, be present to gratify his love for such spectacles. He frequently aided the operator, and was able to dissect properly, to bleed, draw teeth, and perform other operations as well as one of the faculty. Along with a case of mathematical instruments, he always carried about with him a pouch furnished with surgical instruments. The wife of one of his valets had once a disagreeable experience of his skill. She was suspected of gallantry, and her husband vowed revenge. He sat in the ante-chamber with a sad and pensive face, provoking the Czar to inquire the occasion of his gloom. The valet said that nothing was wrong, except that his wife refused to have a tooth drawn that caused her great pain. The Czar desired that he should be allowed to cure her, and was at once taken to her apartment, where he made her sit down that he might examine her mouth, in spite of her earnest protestations that she had no toothache. The husband, however, alleging that she always said so when the physician was present, and renewed her lamentations when he departed, the Czar ordered him to hold her head and arms; and, pulling forth his instruments, promptly extracted the tooth which he supposed to be the cause of the pain, disregarding the piteous cries of the persecuted lady. But in a few days the Czar learned that the whole affair was a trick of the valet to torment his wife; and his Majesty thereupon, as his manner was, administered to him a very severe chastisement with his own hands. A MILD CRITICISM. While Sir Busick Harwood was Professor of Anatomy at Cambridge, he was called in, in a case of some difficulty, by the friends of a patient, who were anxious for his opinion of the malady. Being told the name of the medical man who had previously prescribed, Sir Busick exclaimed, "He! if he were to descend into the patient's stomach with a candle and lantern, when he ascended he would not be able to name the complaint!" HOUR-GLASSES IN CHURCH. To restrain over-eloquent or over-zealous preachers in the length of their discourses, hour-glasses were introduced in churches about the period of the Reformation. In the frontispiece prefixed to the Bible of the Bishops' Translation, printed in 1569, Archbishop Parker is represented with an hour-glass standing on his right hand. Clocks and watches being then but rarely in use, the hour-glass was had recourse to as the only convenient public remembrancer which the state of the arts could then supply. The practice of using them became generally prevalent, and continued till the period of the Revolution. The hour-glass was placed either on the side of the pulpit, or on a stand in front. "One whole houre-glasse," "one halfe houre-glasse," occur in an inventory taken about 1632 of the properties of the church of All Saints at Newcastle-on-Tyne. Daniel Burgess, a Nonconformist preacher at the commencement of last century, alike famous for the length of his pulpit harangues and the quaintness of his illustrations, was once vehemently declaiming against the sin of drunkenness. Having exhausted the customary time, he turned the hour-glass, and said, "Brethren, I have somewhat more to say on the nature and consequences of drunkenness; so let's have _the other glass and then_--" The jest, however, seems to have been borrowed from the frontispiece of a small book, entitled _England's Shame, or a Relation of the Life and Death of Hugh Peters_, published in 1663; where Peters is represented preaching, and holding an hour-glass in his left hand, in the act of saying, "I know you are good fellows; so let's have another glass." THE METHODIST DOG. In the early days of Methodism, meetings for preaching and prayer were held regularly about Bristol, and usually well attended. The people who had frequented these meetings had repeatedly observed a dog that came from a distance; and as at the house to which he belonged the Methodists were not respected, he always came alone. At that time, the preaching on Sunday began immediately after the church service ended; and this singular animal, invariably attending on those occasions, received the name of the "Methodist Dog." He was generally met by the congregation returning from the church, and abused and pelted by the boys belonging to that party. His regular attendance had often been the subject of public debate; and, merely to prove the sagacity of the animal, the meeting, for one evening, was removed to another house. Surprising as it may seem, at the proper and exact time he made his appearance. A few weeks after, his owner returning intoxicated from Leeds market, was drowned in a narrow shallow stream; and from that day the "Methodist Dog" ceased to attend the preaching. Concerning this odd fact, a good Methodist (John Nelson) used to say, "The frequent attendance of this dog at the meeting was designed to attract his master's curiosity, and engage him thereby to visit the place; where, hearing the gospel, he might have been enlightened, converted, and eternally saved. But the end to be answered being frustrated by the master's death, the means to secure it were no longer needful on the dog's part." THE TWO GATES OF HEAVEN. "God," says St. Pierre, in his _Harmonies of Nature_, "God has placed upon earth two gates that lead to heaven; He has set them at the two extremities of life--one at the entrance, the other at the issue. The first is that of innocence; the second, that of repentance." GIBBON'S RETORT ON THE PHYSICIAN. A good story of Gibbon the historian is told in Moore's Memoirs. Gibbon and an eminent French physician were rivals in courting the favour of Lady Elizabeth Foster. Impatient at Gibbon's occupying so much of her attention by his conversation, the doctor said crossly to him, "_Quand milady Elizabeth Foster sera malade de vos fadaises, je la guérirai_." [When my Lady Elizabeth Foster is made ill by your twaddle, I will cure her.] On which Gibbon, drawing himself up grandly, and looking disdainfully at the physician, replied, "_Quand milady Elizabeth Foster sera morte de vos recettes, je l'immortaliserai_." [When my Lady Elizabeth Foster is dead from your prescriptions, I will immortalize her.] TRUMP CARDS. Mrs. Bray relates the following instance of the power of a ruling passion or habit, concerning a Devonshire physician, boasting the not untradesmanlike name of Vial, who was a desperate lover of whist. One evening, in the midst of a deal, the doctor fell off his chair in a fit. Consternation seized on the company, who knew not whether he was alive or dead. At length he showed signs of returning life; and, retaining the last fond idea that had possessed him at the moment he fell into the fit, he exclaimed, "_What is trumps?_" A _bon-vivant_, brought to his deathbed by an immoderate use of wine, after having been told that he could not in all human probability survive many hours, and would die before eight o'clock next morning, summoned the small remnants of his strength to call the doctor back, and said, with the true recklessness of a gambler, "Doctor, I'll bet you a bottle that I live till nine!" PERSUASIVENESS OF WHITFIELD. Benjamin Franklin, in his memoirs, bears witness to the extraordinary effect that was produced by Whitfield's preaching in America, and tells an anecdote equally characteristic of the preacher and of himself. "I happened," says Franklin, "to attend one of his sermons, in the course of which I perceived that he intended to finish with a collection, and I silently resolved he should get nothing from me. I had in my pocket a handful of copper money, three or four silver dollars, and five pistoles in gold. As he proceeded, I began to soften, and concluded to give the copper. Another stroke of his oratory made me ashamed of that, and determined me to give the silver; and he finished so admirably, that I emptied my pocket wholly into the collector's dish, gold and all. At this sermon there was also one of our club, who, being of my sentiments regarding the building in Georgia (the subject of Whitfield's appeal), and suspecting a collection might be intended, had by precaution emptied his pockets before he came from home. Towards the conclusion of the discourse, however, he felt a strong inclination to give, and applied to a neighbour who stood near him to lend him some money for the purpose. The request was fortunately made to perhaps the only man in the company who had the firmness not to be affected by the preacher. His answer was: 'At any other time, friend Hodgkinson, I would lend to thee freely; but not now, for thee seems to be out of thy right senses.'" "PREACHING FOR A CROWN." Howell Davies, who was Whitfield's Welsh coadjutor, walking one Sunday morning to preach, was accosted by a clergyman on horseback, who was bound on the same errand, and who complained of the unprofitable drudgery of his profession, saying that he could never get more than half-a-guinea for preaching. The Welshman replied that he for his part was content to preach _for a crown_. This so offended the mounted priest, that he upbraided the pedestrian for disgracing his cloth. "Perhaps," said Davies, "you will hold me still cheaper when I inform you that I am going nine miles to preach, and have only seven-pence in my pocket to bear my expenses out and in. But the crown for which I preach is a crown of glory." SHEDDING HIS BLOOD FOR HIS COUNTRY. Lord Radnor, who lived in the middle of last century, had a singular liking for the amateur employment of the lancet on the veins of his friends, or of persons whom he induced by gifts of money to allow him to display his skill upon them. It is told of Lord Chesterfield, that, desiring the vote of Lord Radnor in some division impending in the House of Lords, he went to him, and by and by, in the course of indifferent conversation, complained that he was suffering from a bad headache. Lord Radnor leaped at the opportunity of indulging his predilection for phlebotomy on such a _corpus nobile_; he told Lord Chesterfield that he ought to lose blood at once. "Do you indeed think so, my dear Lord? Then do me the favour to add to the service of your advice that of your skill. I know that you are a clever surgeon." In a moment Lord Radnor had pulled out his lancet case, and opened a vein in his visitor's arm; who subsequently, when the bandage was being put on, as if casually, asked the operator, "By the by, does your Lordship go down to the House to-day?" Lord Radnor answered that he had not intended going, not having information enough as to the question that was to be debated; "But on what side will you, that have considered the matter, vote?" Lord Chesterfield stated his views to his amateur surgeon, whose vanity he had so cleverly flattered; and left the house with the promise of Lord Radnor's vote--having literally, as he told an intensely amused party of his friends the same evening, "shed his blood for the good of his country." DR. KIRWAN, DEAN OF KILLALA. Towards the end of last century, there arose in Ireland an eminent preacher, who, to use the emphatic language of Grattan, "broke through the slumbers of the pulpit." This was Walter Blake Kirwan, originally a Catholic priest and Professor of Philosophy at Louvain, and afterwards chaplain to the Neapolitan embassy at London. In 1787 he resolved to conform to the Establishment, and preached for the first time to a Protestant congregation in St. Peter's Church at Dublin. He subsequently became Prebend of Howth, Rector of St. Nicholas, Dublin, and ultimately Dean of Killala. Wonders have been recorded of his attractiveness as a preacher. That he was a great orator, the manner in which he was attended abundantly proved. People crowded to hear him, who on no other occasion appeared within the walls of a church: men of the world, who had other pursuits, men of professions, physicians, lawyers, actors--in short, all to whom clergymen of the highest order had any charms. The pressure of the crowds was immense; guards were obliged to be stationed, and even palisades erected, to keep off from the largest churches the overflowing curiosity, which could not contribute adequately to the great charities for which he generally preached. The sums collected on these occasions exceeded anything ever before known. In one instance, such was the magical impression he produced, that many persons, ladies particularly, after contributing all the money they had about them, threw their watches, rings, and other valuable ornaments into the plate, and next day redeemed them with money. The produce of this triumph of pulpit oratory was indeed magnificent; it was no less than £1200--a much larger sum at that day than the figures represent in ours. Worn out by his labours, Dr. Kirwan died in 1805; and a book of sermons printed in 1814 is his sole literary memorial. JEREMY TAYLOR. Jeremy Taylor, Bishop of Down, from the fertility of his mind and the extent of his imagination, has been styled "the Shakespeare of English divines." His sermons abound with some of the most brilliant passages; and embrace such a variety of matter, and such a mass of knowledge and of learning, that even the acute Bishop Warburton said of him: "I can fathom the understandings of most men, yet I am not certain that I can fathom the understanding of Jeremy Taylor." His comparison between a married and a single life, in his sermon on the Blessedness of Marriage, is rich in tender sentiments and exquisitely elegant imagery. "Marriage," says the Bishop, "is the mother of the world, and preserves kingdoms, and fills cities, churches, and even heaven itself. Celibacy, like the fly in the heart of an apple, dwells in a perpetual sweetness; yet sits alone, and is confined, and dies in singularity. But marriage, like the useful bee, builds a house, and gathers sweetness from every flower, and labours and unites into societies and republics, and sends out colonies, and fills the world with delicacies, and obeys the king, keeps order, and exercises many virtues, and promotes the interest of mankind; and is that state of things to which God hath designed the present constitution of the world. Marriage hath in it the labour of love, and the delicacies of friendship; the blessings of society, and the union of hands and hearts. It hath in it less of beauty, but more of safety, than a single life; it is more merry and more sad; is fuller of joy and fuller of sorrow; it lies under more burthens, but is supported by the strength of love and charity; and these burthens are delightful." A TWO-EDGED ACCUSATION. Dr. Freind, like too many of the physicians of his time--under Queen Anne--was not very careful to keep his head clear and hand steady by moderation in tavern potations; and more often than not he was tipsy when he visited his patients. Once he entered the chamber of a lady of high rank in such a state of intoxicated confusion, that he could do nothing more than mutter to himself, "Drunk--drunk--drunk, by ----!" Happily, or unhappily, the lady, from the same cause, was not in any better case than the physician; and when she came to herself, she was informed by her maid that the doctor had briefly and gruffly described _her_ condition, and then abruptly taken his leave. Freind next day was puzzling as to the apology he should offer to his patient for his unfitness to deal with her ailment, when to his great joy there came a note from the lady, enclosing a handsome fee, and entreating him to keep his own counsel as to what he had seen. RADCLIFFE AND KNELLER. Sir Godfrey Kneller and Dr. Radcliffe lived next door to each other in Bow Street, just after the latter had come up to town, and were extremely intimate. Kneller had a very fine garden, and as the doctor was fond of flowers, he permitted him to have a door into it. Radcliffe's servants, however, gathering and destroying the flowers, Kneller sent to inform him that he would nail up the door; to which Radcliffe, in his rough manner, replied, "Tell him he may do anything but paint it."--"Well," retorted Kneller, "he may say what he will; for tell him, I will take anything from him, except physic." SLAPS FOR SLEEPERS IN CHURCH. A Methodist preacher once, observing that several of his congregation had fallen asleep, exclaimed with a loud voice, "A fire! a fire!" "Where? where?" cried his auditors, whom the alarm had thoroughly aroused from their slumbers. "In the place of judgment," said the preacher, "for those who sleep under the ministry of the holy gospel." Another preacher, of a different persuasion, more remarkable for drowsy hearers, finding himself in a like unpleasant situation with his auditory, or rather _dormitory_, suddenly stopped in his discourse, and, addressing himself in a whispering tone to a number of noisy children in the gallery, said, "Silence! silence! children; if you keep up such a noise, you will waken all the old folks below." Dr. South, chaplain of Charles II., once when preaching before the Court--then composed, as every one knows, of the most profligate and dissolute men in the nation--saw, in the middle of his discourse, that sleep had gradually made a conquest of his hearers. He immediately stopped short, and, changing his tone, called out to Lord Lauderdale three times. His Lordship standing up, Dr. South said, with great composure, "My Lord, I am sorry to interrupt your repose; but I must beg of you that you will not snore quite so loud, lest you awaken his Majesty." Lassenius, chaplain to the Danish Court in the end of the seventeenth century, for a long time, to his vexation, had seen that during his sermon the greater part of the congregation fell asleep. One day he suddenly stopped, and, pulling shuttlecock and battledore from his pocket, began to play with them in the pulpit. This odd behaviour naturally attracted the attention of the hearers who were still awake; they jogged the sleepers, and in a very short time everybody was lively, and looking to the pulpit with the greatest astonishment. Then Lassenius began a very severe castigatory discourse, saying, "When I announce to you sacred and important truths, you are not ashamed to go to sleep; but when I play the fool, you are all eye and ear." When Fenelon, as almoner, attended Louis XIV. to a sermon preached by a Capuchin, he fell asleep. The Capuchin perceived it, and breaking off his discourse, cried out, "Awake that sleeping Abbé, who comes here only to pay his court to the King;" a reproof which Fenelon himself often related with pleasure after he became Archbishop of Cambray. A PRESCRIPTION FOR LONG LIFE. In the reign of Francis I. of France, the saying went-- "_Lever à cinq, diner à neuf, Souper à cinq, coucher à neuf, Fait vivre d'ans nonante et neuf_;" which we thus translate-- "Rising at five, and dining at nine, Supping at five, and bedding at nine, Brings the years of a man to ninety and nine." ABERNETHY AND THE DUKE OF YORK. The Duke of York once consulted Abernethy. During the time his Highness was in the room, the doctor stood before him with his hands in his pockets, waiting to be addressed, and whistling with great coolness. The Duke, naturally astonished at his conduct, said, "I suppose you know who I am?"--"Suppose I do; what of that? If your Highness of York wishes to be well, let me tell you," added the surgeon, "you must do as the Duke of Wellington often did in his campaigns,--_cut off the supplies_, and the enemy will quickly leave the citadel." AN UNLUCKY COINCIDENCE. Dean Ramsay "remembers in the parish church of Fettercairn, though it must be sixty years ago, a custom, still lingering in some parts of the country, of the precentor reading out each single line before it was sung by the congregation. This practice gave rise to a somewhat unlucky introduction of a line from the first Psalm. In most churches in Scotland the communion tables are placed in the centre of the church. After sermon and prayer, the seats round these tables are occupied by the communicants while a psalm is being sung. One communion Sunday, the precentor observed the noble family of Eglantine approaching the tables, and likely to be kept out by those who pressed in before them. Being very zealous for their accommodation, he called out to an individual whom he considered to be the principal obstacle in clearing the passage, 'Come back, Jock, and let in the noble family of Eglantine;' and then, turning to his psalm-book, he took up his duty, and went on to read the line, '_Nor stand in sinners' way_.'" LICENSED LAY PREACHING. In 1555, Mr. Tavernier, of Bresley, in Norfolk, had a special licence signed by Edward VI., authorizing him to preach in any part of his Majesty's dominions, though he was a layman; and he is said to have preached before the King at court, wearing a velvet bonnet or round cap, a damask gown, and a gold chain about his neck. In the reign of Mary he appeared in the pulpit of St. Mary's at Oxford, with a sword by his side and a gold chain about his neck, and preached to the scholars, opening his discourse in this wise: "Arriving at the mount of St. Mary's, in the stony stage where I now stand, I have brought you some fine biscuits, baked in the oven of charity, carefully conserved for the chickens of the church." This sort of style, especially the alliteration, was much admired in those days, even by the most accomplished scholars; and was long afterwards in high favour both with speakers and hearers. At the time Mr. Tavernier first received commission as a preacher, good preaching was so very scarce, that not only the King's chaplains were obliged to make circuits round the country to instruct the people, and to fortify them against Popery, but even laymen, who were scholars, were, as we have seen, employed for that purpose. DR. BARROW'S RHYMES WITH REASON. In the days of Charles II., candidates for holy orders were expected to respond in Latin to the various interrogatories put to them by the bishop or his examining chaplain. When the celebrated Barrow (who was fellow of Trinity College, and tutor to the immortal Newton) had taken his bachelor's degree, he presented himself before the bishop's chaplain, who, with the stiff stern visage of the times, said to Barrow-- "_Quid est fides?_" (What is faith?) "_Quod non vides_" (What thou dost not see), answered Barrow with the utmost promptitude. The chaplain, a little annoyed at Barrow's laconic answer, continued-- "_Quid est spes?_" (What is hope?) "_Magna res_" (A great thing), replied the young candidate in the same breath. "_Quid est caritas?_" (What is charity?) was the next question. "_Magna raritas_" (A great rarity), was again the prompt reply of Barrow, blending truth and rhyme with a precision that staggered the reverend examiner, who went direct to the bishop and told him that a young Cantab had thought proper to give rhyming answers to three several moral questions, and added that he believed his name was Isaac Barrow, of Trinity College, Cambridge. "Barrow! Barrow!" said the bishop, who well knew the literary and moral worth of the young bachelor; "if that's the case, ask him no more questions, for he is much better qualified to examine us than we are to examine him." Barrow received his letters of orders forthwith. HOW TO BE KEPT IN HEALTH. Sir G. Staunton related a curious anecdote of old Kien Long, Emperor of China. He was inquiring of Sir George the manner in which physicians were paid in England. When, after some difficulty, his Majesty was made to comprehend the system, he exclaimed, "Is any man well in England, that can afford to be ill? Now, I will inform you," said he, "how I manage my physicians. I have four, to whom the care of my health is committed: a certain weekly salary is allowed them, but the moment I am ill, the salary stops till I am well again. I need not inform you that my illnesses are usually short." JOHN HUNTER ROUTING THE ROUT. Mr. Jeaffreson, in his amusing _Book about Doctors_, tells a good story about the great anatomist, John Hunter. "His wife, though devoted in her attachment to him, and in every respect a lady worthy of esteem, caused her husband at times no little vexation by her fondness for society. She was in the habit of giving enormous routs, at which authors and artists, of all shades of merit and demerit, used to assemble to render homage to her literary powers, which were very far from commonplace. Hunter had no sympathy with his wife's poetical aspirations, still less with the society which those aspirations led her to cultivate. Grudging the time which the labours of practice prevented him from devoting to the pursuits of his museum and laboratory, he could not restrain his too irritable temper when Mrs. Hunter's frivolous amusements deprived him of the quiet requisite for study.... Imagine the wrath of such a man, finding, on his return from a long day's work, his house full of musical professors, connoisseurs, and fashionable idlers--in fact, all the confusion and hubbub and heat of a grand party, which his lady had forgotten to inform him was that evening to come off! Walking straight into the middle of the principal reception-room, he faced round and surveyed his unwelcome guests, who were not a little surprised to see him--dusty, toil-worn, and grim--so unlike what 'the man of the house' ought to be on such an occasion. 'I knew nothing,' was his brief address to the astounded crowd--'I knew nothing of this kick-up, and I ought to have been informed of it beforehand; but, as I have now returned home to study, I hope the present company will retire.' Mrs. Hunter's drawing-rooms were speedily empty." ANTICS OF THE FANATICS. In concord, yet in contrast, with Dr. South's censure on the fanatics of the Commonwealth, noticed on a former page, we take this from the _Loyal Satirist, or Hudibras in Prose_, published among _Somers' Tracts_:--"Well, who's for Aldermanbury? You would think a phoenix preached there; but the birds will flock after an owl as fast; and a foot-ball in cold weather is as much followed as Calama (Calamy) by all his rampant dog-day zealots. But 'tis worth the crouding to hear the baboon expound like the ape taught to play on the cittern. You would think the church, as well as religion, were inversed, and the anticks which were used to be without were removed into the pulpit. Yet these apish tricks must be the motions of the spirit, his whimsie-meagrim must be an ecstatie, and Dr. G----, his palsy make him the father of the sanctified shakers. Thus, among Turks, dizziness is a divine trance, changlings and idiots are the chiefest saints, and 'tis the greatest sign of revelation to be out of one's wits. "Instead of a dumb-shew, enter the sermon dawbers. O what a gracious sight is a silver inkhorn! How blessed a gift is it to write shorthand! What necessary implements for a saint are cotton wool and blotting-paper! These dablers turn the church into a scrivener's shop. A country fellow last term mistook it for the Six Clerks' Office. The parson looks like an offender upon the scaffold, and they penning his confession; or a spirit conjured up by their uncouth characters. By his cloak you would take him for the prologue to a play; but his sermon, by the length of it, should be a taylor's bill; and what treats it of but such buckram, fustian stuff? What a desperate green-sickness is the land fallen into, thus to doat on coals and dirt, and such rubbish divinity! Must the French cook our sermons too! and are frogs, fungos, and toadstools the chiefest dish in a spiritual collation? Strange Israelites! that cannot distinguish betwixt mildew and manna. Certainly in the brightest sunshine of the gospel clouds are the best guides; and woodcocks are the only birds of paradise. I wonder how the ignorant rabbies should differ so much, since most of their libraries consist only of a concordance. The wise men's star doubtless was an _ignis fatuus_ in a churchyard; and it was some such Will-o'-th'-Whisp steered prophetical Saltmarsh, when, riding post to heaven, he lost his way in so much of revelation as not to be understood; like the musick of the spheres, which never was heard." POPE'S LAST EPIGRAM. During Pope's last illness, it is said, a squabble happened in his chamber between his two physicians, Dr. Burton and Dr. Thomson, who mutually charged each other with hastening the death of the patient by improper treatment. Pope at length silenced them by saying, "Gentlemen, I only learn by your discourse that I am in a dangerous way; therefore, all I now ask is, that the following epigram may be added after my death to the next edition of the Dunciad, by way of postscript:-- 'Dunces rejoice, forgive all censures past, The greatest dunce has kill'd your foe at last.'" TRANSFUSION OF BLOOD. The experiment of transferring the blood of one animal into the vascular system of another, by means of a tube connected with a vein of the receiving animal and an artery of the other--which had been unsuccessfully attempted in 1492 in the hope of saving the life of Pope Innocent VIII.--was first tried in England in the year 1657 by Clarke, who failed in his attempts. Lower, of Oxford, succeeded in 1665, and communicated his success to the Royal Society. This was on dogs. Coxe did it on pigeons; and Coxe and King afterwards exhibited the experiment on dogs before the Society, transfusing the blood from vein to vein. It was again performed from a sheep to a dog, and the experiment was frequently repeated. The first attempts at transfusion appear to have been instigated merely by curiosity, or by a disposition to inquire into the powers of animal economy. But higher views soon opened themselves; it was conceived that inveterate diseases, such as epilepsy, gout, and others, supposed to reside in the blood, might be expelled with that fluid; while with the blood of a sheep or calf the health and strength of the animal might be transferred to the patient. The most sanguine anticipations were indulged, and the new process was almost expected to realize the alchemical reveries of an elixir of life and immortality. The experiment was first tried in France, where the blood of a sheep, the most stupid of all animals, according to Buffon, was transfused into the veins of an idiotic youth, with the effect, as was asserted, of sharpening his wits; and a similar experiment was made without injury on a healthy man. Lower and King transferred blood from a sheep into the system of a literary man, who had offered himself for the experiment, at first without inconvenience, but afterwards with a less favourable result; the Royal Society still recommending perseverance in the trials. These events were not calculated to maintain the expectation of brilliant results that had been raised; and other occurrences produced still more severe disappointment. The French youth first mentioned died lethargic soon after the second transfusion; the physicians incurred great disgrace, and were judicially prosecuted by the relations. Not, however, discouraged by this unlucky event, they soon after transfused the blood of a calf into a youth related to the royal family, who died soon after of a local inflammation. The Parliament of Paris now interfered, and proscribed the practice; and two persons having died after transfusion at Rome, the Pope also issued a prohibitory edict. Since the publication in 1824, however, of Dr. Blundell's _Physiological and Pathological Researches_, transfusion has been recognised as a legitimate operation in obstetric surgery--the object being to obviate the effects of exhaustion from extreme loss of blood by hæmorrhage. FATHER ANDRE BOULANGER. France has produced several entertaining preachers, among whom was André Boulanger, better known as "little Father André," who died about the middle of the seventeenth century. His character has been variously drawn. He is by some represented as a buffoon in the pulpit; but others more judiciously observe, that he only indulged his natural genius, and uttered humorous and lively things to keep the attention of his audience awake. "He told many a bold truth," says the author of _Guerre des Auteurs, Anciens et Modernes_, "that sent bishops to their dioceses, and made many a coquette blush. He possessed the art of biting while he smiled; and more ably combated vice by his ingenious satire, than by those vague apostrophes which no one takes to himself. While others were straining their minds to catch at sublime thoughts which no one understood, he lowered his talents to the most humble situations, and to the minutest things." In fact, Father André seems to have been a sort of seventeenth century Spurgeon, as two samples may serve to show. In one of his sermons he compared the four doctors of the Latin Church to the four kings of cards. "St. Augustine," said he, "is the King of Hearts, for his great charity; St. Ambrose is the King of Clubs (_treflé_), by the flowers of his eloquence; St. Gregory is the King of Diamonds, for his strict regularity; and St. Jerome is the King of Spades (_pique_), for his piquant style." The Duke of Orleans once dared Father André to employ any ridiculous expression about him. This, however, the good father did, very adroitly. He addressed the Duke thus: "_Foin de vous, Monseigneur; foin de moi; foin de tous les auditeurs_." He saved himself from the consequences of his jest, by taking for his text the seventh verse of the tenth chapter of Isaiah, where it is said, "All the people are grass"--_Foin_ in French signifying hay, and being also an interjection, "Fie upon!" AN INTERCESSOR FOR HIMSELF. A Protestant renting a little farm under the second Duke of Gordon, a Catholic, fell behind in his payments; and the steward, in his master's absence, seized the farmer's stock and advertised it to be rouped on a certain day. In the interval, the Duke returned home, and the tenant went to him to entreat indulgence. "What is the matter, Donald?" said the Duke, seeing him enter with sad and downcast looks. Donald told his sorrowful tale concisely and naturally: it touched the Duke's heart, and produced a formal quittance of the debt. Donald, as he cheerily withdrew, was seen staring at the pictures and images he saw in the Duke's hall, and expressed to his Grace, in a homely way, a wish to know who they were. "These," said the Duke, "are the saints who intercede with God for me." "My Lord Duke," said the tenant, "would it not be better to apply yourself directly to God? I went to mickle Sandy Gordon, and to little Sandy Gordon; but if I had not come to your good Grace's self, I could not have got my discharge, and baith I and my bairns had been harried out of house and hame." WHITFIELD'S INFLUENCE ON THE CHURCH. Toplady speaks thus, in a sermon, of the Establishment to which he belonged, and the effect on its ministers of the work of Whitfield beyond its pale:--"I believe no denomination of professing Christians (the Church of Rome excepted) were so generally void of the light and life of godliness, so generally destitute of the doctrine and of the grace of the gospel, as was the Church of England, considered as a body, about fifty years ago. At that period, a _converted_ minister in the Establishment was as great a wonder as a comet; but now, blessed be God, since that precious, that great apostle of the English empire, the late dear Mr. Whitfield, was raised up in the spirit and power of Elias, the word of God has run and been glorified; many have believed and been added to the Lord all over the three kingdoms; and still, blessed be His name, the great Shepherd and Bishop of souls continues to issue His word; and great is the company of preachers, greater and greater every year." This was indeed a liberality far in advance of Toplady's time. GENEROSITY OF DR. GREGORY. It was the custom of the Professors of Edinburgh University, in the time of this amiable and learned man--as it is partly still--to receive at their own residences the fees from students intending to attend their lectures; some old students yet remembering that, when other material for the class-tickets failed, and sometimes even when it did not, the necessary formula was written on the back of a playing-card. While Dr. Gregory was one day at the receipt of fees, he left his room, in which was a single student, and went into an adjoining apartment for more admission cards. In this room there was a mirror, in which the doctor saw the student lift and pocket a portion of a pile of guineas that lay on the table. Dr. Gregory took no notice of what he had seen till he was showing the student out; but on the threshold he said, with a voice marked with deep emotion, "Young man, I saw what you did just now. Keep the money; I know what distress you must be in. But for God's sake never do it again; it can never succeed." The remorseful student sought in vain to persuade the Professor to take back the money: "No, this must be your punishment, that you must keep it now that you have taken it." The kind warning was not lost; the student, we are assured, turned out a good and honest man. At another time Gregory attended a poor medical student, ill of typhus fever, who offered him the customary fee of a guinea. The doctor refused it in silence, and with signs of annoyance and anger at the offer; whereupon the student hastily said, "I beg your pardon, Dr. Gregory; I did not know your rule. Dr. A. has always taken a fee." "Oh, he has, has he?" said Gregory; "then, my young friend, ask him to meet me here in consultation--and offer me the fee first." The consultation took place, and the student offered the fee; whereupon the good Gregory broke out: "Sir, do you mean to insult me? Is there a Professor in this University who would so far degrade himself, as to take payment from one of his brotherhood, and a junior?" Dr. A. did not enjoy the little scene that had been prepared for him; and that very day he returned the fees he had taken of the sick student. RUDE TRUTH FOR A QUEEN. It is well known to how great an extent Queen Elizabeth, with all her strength of mind, was beset by the weakness of her sex in what concerned her age and her personal appearance. "The majesty and gravity of a sceptre," says one of her contemporaries, "could not alter the nature of a woman in her. When Bishop Rudd was appointed to preach before her, he, wishing in a godly zeal, as well became him, that she should think sometimes of mortality, being then sixty-three years of age--he took his text fit for that purpose out of the Psalms, xc. 12: 'Teach us to _number_ our days, that we may incline our hearts unto wisdom;' which text he handled most learnedly. But when he spoke of some sacred and mystical numbers, as three for the Trinity, three times three for the heavenly hierarchy, seven for the Sabbath, and seven times seven for a jubilee; and lastly, nine times seven for the grand climacterical year (her age), she, perceiving whereto it tended, began to be troubled by it. The Bishop, discovering that all was not well, for the pulpit stood opposite her Majesty, he fell to treat of some more plausible (pleasing) numbers, as of the number 666, making _Latinus_, with which, he said, he could prove Pope to be Antichrist, etc. He still, however, interlarded his sermon with Scripture passages, touching the infirmities of age, as that in Ecclesiastes: 'When the grinders shall be few in number, and they wax dark that look out of the windows,' etc.; 'and the daughters of singing shall be abased;' and more to that purpose. The Queen, as the manner was, opened the window; but she was so far from giving him thanks or good countenance, that she said plainly: 'He might have kept his arithmetic for himself; but I see the greatest clerks are not the wisest men;' and so she went away discontented." AN ARCHBISHOP'S INSTALLATION FEAST. Fuller, in his _Church History_, relates that "George Nevill, brother to the great Earl of Warwick, at his instalment into the Archbishoprick of York, gave a prodigious feast to all the nobility, most of the prime clergy, and many of the great gentry, wherein, by his bill of fare, three hundred quarters of wheat, three hundred and thirty tuns of ale, one hundred and four tuns of wine, one pipe of spiced wine, eighty fat oxen, six wild bulls, one thousand and four wethers, three hundred hogs, three hundred calves, three thousand geese, three thousand capons, three hundred pigs, one hundred peacocks, two hundred cranes, two hundred kids, two thousand chickens, four thousand pigeons, four thousand rabbits, two hundred and four bitterns, four thousand ducks, two hundred pheasants, five hundred partridges, four thousand woodcocks, four hundred plovers, one hundred curlews, one hundred quails, one thousand egrets, two hundred roes, above four hundred bucks, does, and roebucks, one thousand five hundred and six hot venison pasties, four thousand cold venison pasties, one thousand dishes of jelly parted, four thousand dishes of plain jelly, four thousand cold custards, two thousand hot custards, three hundred pike, three hundred bream, eight seals, four porpoises, and four hundred tarts. At this feast the Earl of Warwick was steward, the Earl of Bedford, treasurer, the Lord of Hastings, comptroller, with many more noble officers; servitors, one thousand; cooks, sixty-two; kitcheners, five hundred and fifteen.... But," continues honest Fuller, "seven years after, the King seized on all the estate of this archbishop, and sent him over prisoner to Calais in France, where _vinctus jacuit in summa inopia_, he was kept bound in extreme poverty. Justice thus punished his former prodigality." DA VINCI A GREAT ANATOMIST. Leonardo Da Vinci, to his talents as a painter, added that of being the best anatomist and physiologist of his time, and was the first person who introduced the practice of making anatomical drawings. Vassari, in his _Lives of the Painters_, says that Leonardo made a book of studies, drawn with red chalk, and touched with a pen with great diligence, of such subjects as Marc Antonio de la Torre, an excellent philosopher of that day, had dissected. "And concerning those from part to part, he wrote remarks in letters of an ugly form, which are written by the left hand backwards, and not to be understood but by those who knew the method of reading them; for they are not to be read without a looking-glass." Those very drawings and writings alluded to by Vassari, were happily found to be preserved in the royal collection of original drawings, where Dr. Hunter was permitted to examine them. The Doctor, in noticing them, says: "I expected to see little more than such designs in anatomy as might be useful to the painter in his own profession; but I saw, and, indeed, with astonishment, that Leonardo had been a general and a deep student. When I consider what pains he has taken upon every part of the body, the superiority of his universal genius, his particular excellence in mechanics and hydraulics, and the attention with which such a man would examine and see objects which he was to draw, I am fully persuaded that Leonardo was the best anatomist at that time in the world." EXTRAVAGANCES OF THE HERRNHUTERS. In a letter to Count Zinzendorf--the founder of the community of Moravian Brethren at Herrnhut, in Upper Lusatia--who visited England about 1745, Whitfield thus describes and rebukes some of the extravagant flummeries then practised by the Moravians: "Pray, my Lord, what instances have we of the first Christians walking round the graves of their deceased friends on Easter day, attended with hautboys, trumpets, French horns, violins, and other kinds of musical instruments? Or where have we the least mention made of pictures of particular persons being brought into the Christian assemblies, and of candles being placed behind them in order to give a transparent view of the figures? Where was it ever known that the picture of the Apostle Paul, representing him handing a gentleman and lady up to the side of Jesus Christ, was ever introduced into the primitive love-feasts?... Again, my Lord, I beg leave to inquire whether we hear anything in Scripture of eldresses or deaconesses of the apostolical churches seating themselves before a table covered with artificial flowers, and against that a little altar surrounded with wax tapers, on which stood a cross, composed either of mock or real diamonds, or other glittering stones? And yet your Lordship must be sensible this was done in Fetter Lane Chapel, for Mrs. Hannah Nitschman, the present general eldress of your congregation; with this addition, that all the sisters were seated, clothed in white, and with German caps; the organ also illuminated with three pyramids of wax tapers, each of which was tied with a red ribbon; and over the head of the general eldress was placed her own picture, and over that (_horresco referens_) the picture of the Son of God. A goodly sight this, my Lord, for a company of English Protestants to behold!... A like scene to this was exhibited by the single brethren in a room of their house at Hatton Garden. The floor was covered with sand and moss, and in the middle of it was paved a star of different-coloured pebbles; upon that was placed a gilded dove, which spouted water out of its mouth into a vessel prepared for its reception, which was curiously decked with artificial leaves and flags; the room was hung with moss and shell; the Count, his son, and son-in-law, in honour of whom all this was done, with Mrs. Hannah Nitschman, and Mr. Peter Boehlen, and some other labourers, were also present. These were seated under an alcove, supported by columns made of pasteboard, and over their heads was painted an oval in imitation of marble, containing cyphers of Count Zinzendorf's family. Upon a side-table was a little altar covered with shells, and on each side of the altar was a bloody heart, out of, or near which, proceeded flames. The room was illuminated with wax tapers, and musicians played in an adjoining apartment, while the company performed their devotions, and regaled themselves with sweetmeats, coffee, tea, and wine." Mr. Whitfield also mentions a "singular expedient" made use of to raise the drooping spirits of one Mr. Bell, who had been induced to join the Brethren. On his birthday, he was sent for by Mr. Peter Boehlen, one of the bishops, and "was introduced into a hall, where was placed an artificial mountain, which, upon singing a particular verse, was made to fall down, and then behind it was discovered an illumination, representing Jesus Christ and Mr. Bell sitting very near, or embracing each other; and out of the clouds was also represented plenty of money falling round Mr. Bell and the Saviour." Towards the close of his career, Count Zinzendorf applied himself, and not without success, to undo a good deal of the extravagant and unseemly work of former years, both in his devotional hymns and forms. AN AWKWARD ASSOCIATION. In his _Jest-book_, Mr. Lemon tells the following capital story of awkward association:--"In a cause tried in the Court of Queen's Bench, the plaintiff being a widow, and the defendants two medical men who had treated her for delirium tremens, and put her under restraint as a lunatic, witnesses were called on the part of the plaintiff to prove that she was not addicted to drinking. The last witness called by Mr. Montagu Chambers, the leading counsel, on the part of the plaintiff, was Dr. Tunstal, who closed his evidence by describing a case of delirium tremens treated by him, in which the patient recovered in a single night. 'It was,' said the witness, 'a case of gradual drinking, sipping all day, from morning till night.' These words were scarcely uttered, than Mr. Chambers, turning to the Bench, said, 'My Lord, that is my case.'" TURNING-POINT IN PALEY'S CAREER. When Paley first went to Cambridge, he fell into a society of young men far richer than himself, to whom his talents and conviviality made him an acceptable companion, and he was in a fair way for ruin. One morning one of these comrades came into his bedroom before he was up, and he, as usual, thought it was to propose some plan of pleasure for the day. His friend, however, said, "Paley, I have not slept a wink this night for thinking of you. I am, as you know, heir to such and such a fortune, and whether I ever look in a book at Cambridge does not signify a farthing. But this is not the case with you. You have only your abilities to look to; and no man has better, if you do but make the proper use of them. But if you go on in this way, you are ruined; and from this time forward I am determined not to associate with you, for your own sake. You know I like your company, and it is a great sacrifice to give it up; but give it up I will, as a matter of conscience." Paley lay in bed the whole day, ruminating upon this. In the evening he rose and took his tea, ordered his bed-maker to make his fire overnight, and call him at five in the morning; and from that day forward he rose always at that hour. He went out first wrangler, and became the fortunate man he was. This story was told to Southey in 1808, by Mr. Brome, who had it from an intimate friend of Paley. THE DANGERS OF TOO GOOD COMPANY. George I. liked to temper the cares of royalty with the pleasures of private life, and commonly invited six or eight friends to pass the evening with him. His Majesty seeing Dr. Lockier one day at court, desired the Duchess of Ancaster, who was almost always of the party, to ask the Doctor to come that evening. When the company met in the evening, Dr. Lockier was not there; and the King inquired of the Duchess if she had invited him. "Yes," she said; "but the Doctor presents his humble duty to your Majesty, and hopes your Majesty will have the goodness to excuse him at present; he is soliciting some preferment from your Majesty's Ministers, and fears it may be some obstacle to him, if it should be known that he had the honour of keeping such good company." The King laughed very heartily, and said he believed he was in the right. Not many weeks after, Dr. Lockier kissed the King's hand as Dean of Peterborough; and as he was rising from kneeling, the King inclined forwards, and with great good-humour whispered in his ear, "Well, now, Doctor, you will not be afraid to come in an evening; I would have you come this evening;" an invitation which was very readily accepted. ANECDOTES OF ABERNETHY. John Abernethy, the pupil and friend of John Hunter, was remarkable for eccentricity and _brusquerie_ in his dealings with patients. But there are many instances to show that his roughness was only external, and that a very soft and gentle heart beat in his bosom. He was sometimes successfully combated with his own weapons. A lady on one occasion entered his consulting-room, and showed him an injured finger, without saying a word. In silence Abernethy dressed the wound; silently the lady put the usual fee on the table, and retired. In a few days she came again, and offered the finger for inspection. "Better?" asked the surgeon. "Better," answered the lady, speaking for the first time. Not another word followed during the interview. Three or four visits were made, in the last of which the patient held out her finger perfectly healed. "Well?" was Abernethy's inquiry. "Well," was the lady's answer. "Upon my soul, madam," exclaimed the delighted surgeon, "_you are the most rational woman I ever met with_!" "I had heard of your rudeness before I came, Sir," another and less fortunate lady said, taking his prescription; "but I was not prepared for such treatment. What am I to do with this?" "Anything you like," the surgeon roughly answered. "Put it on the fire if you please." Taking him at his word, the lady put her fee on the table, and the prescription on the fire, and, making a bow, left the room. Abernethy followed her, apologizing, and begging her to take back the fee or let him write another prescription; but the lady would not relent. When the bubble schemes were flourishing in 1825, Mr. Abernethy met some friends who had risked large sums of money in one of those speculations; they informed him that they were going to partake of a most sumptuous dinner, the expenses of which would be defrayed by the company. "If I am not very much deceived," replied he, "you will have nothing but bubble and squeak in a short time." BLOMFIELD'S REBUKE TO NON-RESIDENT RECTORS. Dr. Blomfield, Bishop of London, had occasion to call the attention of the Essex incumbents to the necessity of residing in their parishes; and he reminded them that curates were, after all, of the same flesh and blood as rectors, and that the residence which was possible for the one, could not be quite impossible for the other. "Besides," added he, "there are two well-known preservatives against ague: the one is, a good deal of care and a little port wine; the other, a little care and a good deal of port wine. I prefer the former; but if any of the clergy prefer the latter, it is at all events a remedy which incumbents can afford better than curates." DEVOTION OF A CATHOLIC PRIEST. In a parish close to Dublin, it is on record that a Catholic priest was called on to administer the solemn rites of his religion to a family in the last stage of typhus fever. The family, six or seven in number, were found lying in a wretched hovel, on a little straw scattered on the damp earthen floor. The agonies of death were fast coming upon them. The confession of each one of them had to be heard. Lest any should overhear the confession of another, the priest stretched himself on the straw, while the miserable sufferer breathed his or her confession into his ear. Thus, inhaling the poison of their respiration, and separating them from each other successively, at the risk of his own life, he completed his sacred functions. PULPIT JOKES OF DANIEL BURGESS. Daniel Burgess, the noted Nonconformist minister, was by no means of Puritan strictness, for he was the most facetious person of his day, and carried his wit so far as to retail it from the pulpit with more levity than decency. Speaking of Job's "robe of righteousness," he once said, "If any of you would have a suit for a twelvemonth, let him repair to Monmouth Street; if for his lifetime, let him apply to the Court of Chancery; but if for all eternity, let him put on the robe of righteousness." The sermons of Burgess were adapted to the prejudices as well as the opinions of his hearers--wit and Whiggism went hand in hand with Scripture. He was strongly attached to the House of Brunswick, and would not uphold the Pretender's cause from the pulpit. He once preached a sermon, about that time, on the reason why the Jews were called Jacobites, in which he said, "God ever hated Jacobites, and therefore Jacob's sons were not so called, but Israelites!" PHYSICIANS AND THEIR FEES. Perhaps regarding nothing connected with the science and practice of medicine, or the lives of its professors, are there more stories told, more curious facts on record, more interesting exhibitions of character and touching displays of generosity to relate, than about the giving and taking--or not taking--of fees. In stringing together some memoranda and anecdotes on this head, it needs only to be said that they are but a few out of a crowd. At the outset, it may be explained that from very early times the fee of the physician (like that of the advocate or the university professor) was regarded in the light of a voluntary recognition or reward for services rendered out of pure love of science or humanity. Dr. Doran alleges, indeed, that "there is a religious reason why fees are supposed not to be taken by physicians. Amongst the Christian martyrs are reckoned the two eastern brothers, Damian and Cosmas. They practised as physicians in Cilicia, and they were the first mortal practitioners who refused to take recompense for their work. Hence they were called Anargyri, or 'without money.' All physicians are pleasantly supposed to follow this example. They never take fees, like Damian and Cosmas; but they meekly receive what they know will be given out of Christian humility, and with a certain or uncertain reluctance, which is the nearest approach that can be made in these times to the two brothers who were in partnership at Egea in Cilicia." It has very naturally, however, been objected that physicians act from no such lofty motives, but merely because they prefer that the gratitude or the fears of the patient should be the measure of their reward. And yet, as Mr. Wadd forcibly remarks, "it is a fact, not less singular than true, that the advancement of surgical science is a benefit conferred on society at the expense of the scientific practitioner, since in proportion as the mode of cure is _tuto et celeriter_, safe and speedy, remuneration is diminished. Perhaps in no instance is this better exemplified than in the operation of the hydrocele, introduced by my late friend and master, Sir James Earle. Compare the simplicity, safety, and celerity of this, with the bustle and bloody brutality of the old system; the business of six weeks reduced to so many days! But mark the consequence, _quâ honorarium_: does the patient increase the fee for the pain and misery he is spared? Not a bit of it. Here is little or no work done; no trouble to the doctor; no pain to the patient; therefore, nothing to pay for.... Selden, who understood these failings in mankind vastly well, gives them a sly hit in his _Table Talk_:--'If a man had a sore leg, and he should go to an honest, judicious chirurgeon, and he should only bid him keep it warm, and anoint it with such an oil (an oil well known) that would do the cure, haply he would not much regard him, because he knows the medicine beforehand, an ordinary medicine. But if he should go to a surgeon that should tell him, your leg will gangrene within three days and it must be cut off, and you will die unless you do something that I could tell you, what listening there would be to this man! Oh, for the Lord's sake, tell me what this is, I will give you any content for your pains!'" Not only has this loss of reward through the devising of new appliances for preventing human suffering, not made medical men, as a rule, one whit less anxious to devise them, or adopt them when devised; but it is in the experience of all, that in many cases physicians can render services gratuitously, which they would never have had the opportunity of rendering if it was not understood, both by themselves and the suffering, that they gave their skill cheerfully for God's sake as for gold's sake, to those who were unable to appeal to the latter power. _Ancient Fees of Magnitude._--Seleucus--the one of Alexander's generals to whom the kingdom of Syria fell at the break-up of the empire of Macedonian conquest--gave to Erasistratus 60,000 crowns "for discovering the disorder of his son Antiochus." Alcon, whose dexterity is celebrated in Martial's _Epigrams_, was repaid by the public, in the course of a few years' practice, the sum of 10,000,000 sesterces (£80,000) which he had lost by a law-suit. Four Roman physicians, Aruntius, Calpetanus, Rubrius, and Albutius, for their attendance on Augustus and his two immediate successors, enjoyed each an annual salary of 250,000 sesterces, equal to £2000 sterling. _Early English Fees._--In 1345, Edward III. granted to his apothecary, Coursus de Gungeland, a pension of sixpence a-day; and "Ricardus Wye, chirurgicus," had twelve pence per day, and eight marks per year, for his services. Under the same king, "Willielmus Holme, chirurgicus Regis," is rewarded with the permission, during his lifetime, "to hunt, take, and carry off wild animals of all kinds, in any of the royal forests, chases, parks, and warrens." In the Courts of the kings of Wales, the physician or surgeon was the twelfth person in rank, and his fees seem to have been fixed by law. For a flesh wound, not of a dangerous character, he got nothing but such of the wounded man's garments as the blood had stained; but for any of the three classes of dangerous wounds, he had in addition 180 pence, and his maintenance so long as his services might be in requisition. _Fees in the reign of Henry VIII. and Elizabeth._--In the record of expenses of the Earl of Cumberland, it is stated that he paid to a physician of Cambridge £1; but this fee was evidently, as shown by other entries, an exceptionally liberal one, even perhaps for a noble to pay. In the 18th year of Henry VIII., as is mentioned in Burn's _History of Westmoreland_, Sir Walter Strickland made a bargain with a physician to cure him of an asthma for £20. Stow, in the same reign, complimenting British physicians on their skill and learning, mentions "as the great grievance that the inferior people are undone by the exorbitance of their fees." Half-a-crown, he avers, is in Holland looked on as a large fee; whereas in England "a physician scorns to touch any metal but gold; and our surgeons are still more unreasonable." Queen Elizabeth's physician in ordinary received £100 per annum, besides his sustenance, wine, wax, and other necessaries or perquisites. Her apothecary, Hugo Morgan, for one quarter's bill had £83, 7s. 8d.; but this was not all for medicines, as such entries as this will show:--eleven shillings for a confection shaped like a _manus Christi_, with bezoar stone and unicorn's horn; sixteenpence for a royal sweetmeat with incised rhubarb; six shillings for "a conserve of barberries, with preserved damascene plums, and other things for Mr. Ralegh;" two shillings and sixpence for sweet scent to be used at the christening of Sir Richard Knightley's son; and so on. _Fees after the Revolution._--At the close of the sixteenth and opening of the seventeenth century, the fee of the physician had tended towards fixity, as regards the _minimum_ at least, which was ten shillings. This appears from several incidental contemporary statements, as in the satirical dialogue of "Physick lies a-bleeding; or the Apothecary turned Doctor" (published in 1697, during the war of the "Dispensary"), in which one of the characters, called on to pay eighteen shillings for medicine for his wife and a crown by way of gratuity to the apothecary, says: "I wish you had called a doctor; perhaps he would have advised her to have forbore taking anything, at least as yet, so I had saved 13s. in my pocket." In 1700, as appears from the _Levamen Infirmi_, the existence of _minimum_ and _maximum_ fees appears to have been quite recognised:--"To a graduate in physick, his due is about ten shillings, though he commonly expects or demands twenty. Those that are only licensed physicians, their due is no more than six shillings and eightpence, though they commonly demand ten shillings. A surgeon's fee is twelve-pence a mile, be his journey far or near; ten groats to set a bone broke, or out of joint; and for letting blood, one shilling; the cutting off or amputation of any limb is five pounds, but there is no settled price for the cure." _Sir Theodore Mayerne._--This eminent physician, who was a native of Geneva, and attended James I. and the two Charleses, once very neatly and deservedly rebuked a mean and ostentatious friend, who, after consulting him, laid on the table two broad pieces of gold (of the value of 36s. each). Sir Theodore quietly pocketed the fee; and, on his friend expressing or showing himself hurt at thus being taken at his money, said to him: "I made my will this morning; and if it should appear that I had refused a fee, I might be deemed _non compos_." Mr. Wadd caps this anecdote with another about Dr. Meyer Schomberg, who was much in vogue about the middle of last century. Mr. Martin, the surgeon, used now and then to visit him; and was once shown in when a patient was with him. After the patient was gone, Martin noticed two guineas lying on the table, and asked the doctor how it came that he left his money about in that way? Said Dr. Schomberg: "I always have a couple of guineas before me, as an example, or broad hint, what they (the patients who consulted him) ought to give." _Large Royal Fees in Later Times._--Henry Atkins was sent for to Scotland by James the First (of England), to attend to the Prince Charles--afterwards Charles I., but then in his infancy--who lay dangerously sick. For this journey and duty the King gave Atkins the splendid fee of £6000, which he invested in the purchase of the manor of Clapham. In 1685 a very handsome fee was ordered to be paid--but it was never paid--to Dr. King, for a brave breach of Court etiquette that saved the life of Charles II. for a time. Evelyn thus relates the incident, under date 4th February 1685:--"I went to London, hearing his Majesty had been, the Monday before (2 Feb.), surprised in his bed-chamber with an apoplectic fit; so that if, by God's providence, Dr. King (that excellent chirurgeon as well as physician) had not been actually present, to let him blood (having his lancet in his pocket), his Majesty had certainly died that moment, which might have been of direful consequence, there being nobody else present with the king save this doctor and one more, as I am assured. It was a mark of the extraordinary dexterity, resolution, and presence of mind in the Dr. to let him blood in the very paroxysm, without staying the coming of other physicians; which regularly should have been done, and for want of which he must have a regular pardon, as they tell me." The Privy Council ordered £1000 to be given to Dr. King; but he never obtained the money. The physicians who attended Queen Caroline in 1737 had 500 guineas, and the surgeons 300 guineas, apiece. Dr. Willis, for his success in dealing with the malady of George III., received £1500 a-year for twenty years, and £650 was settled on his son for life; the subordinate physicians had thirty guineas for each visit to Windsor, and ten for each visit to Kew. The Empress Catherine of Russia made Dr. Dimsdale--a Hertfordshire physician--who, in 1768, travelled to St. Petersburg to inoculate her and her son, a Baron of the Empire; and presented him with a fee of £12,000, and a life pension of £500. This sum of £12,000 is about the largest ever paid, in ancient times or modern, to one physician for one operation; although there are living surgeons who from private individuals have received fees that dwarf this imperial largess into comparative insignificance. Perhaps even more remarkable, however, than Catherine's liberal payment for good work, was the Emperor Joseph of Austria's reward for bad news. On his deathbed his Majesty asked Quarin his opinion of his case, and was frankly assured, in reply, that he could not expect to live other forty-eight hours. For this uncourtly but really kind affirmation of the truth, the Emperor created Quarin a Baron, and conferred on him an income of £2000. Louis XIV. gave his physician and surgeon 75,000 crowns each, after the successful performance of a painful, and at that time novel, operation. Beside this, the fees paid by Napoleon I. to the Faculty who attended Marie Louise in March 1811, when the Emperor's son was born, are trifling. Dubois, Corvisart, Bourdier, and Ivan, had amongst them a remuneration of £4000, £2000 being the portion assigned to Dubois. _Fee for a Political Consultation._--At the outbreak of the American war, Grenville was desirous to ascertain what was the state of feeling that prevailed among the Quaker colonists in America; and he could hit, as he thought, on no more effectual means of doing this, than by a conversation with Dr. Fothergill, who was a Quaker, and enjoyed the hearty confidence of his brethren of that sect. Fothergill was accordingly summoned to prescribe for the statesman--who, in reality, wanted to feel, through him, the pulse of transatlantic Quakerism; and the visit, of course, was made to take the turn of a vivacious controversy on American politics. At the end, Grenville put five guineas into the doctor's hand, and said to him, "Really, I feel so much better, that I don't think it is necessary for you to prescribe." With a shrewd smile, Fothergill, keeping a good hold of the money, said, "Well, at this rate, friend, I can spare thee an hour now and then." _Generous Refusal of Fees._--There are many anecdotes of refusal of physicians to take fees from persons whom the payment of them would have distressed; but they are all so nobly alike, that we need not quote any here. The benevolent and eccentric Dr. Smith, when established in a practice equal to that of any physician in London, did what perhaps few physicians in great practice would have done. He set apart _two days for the poor in each week_. From those who were really poor, he never took a fee; and from those who were of the middling ranks in life, he never would take above half a guinea! Yet so great was the resort to him, that he has in one day received fifty guineas, at the rate of half a guinea only from each patient. _Sticklers for Fees._--Sir Richard Jebb was once paid three guineas by a nobleman from whom he had a right to expect five. Sir Richard dropped the coins on the carpet, when a servant picked them up and restored them. Sir Richard continued his search. "Are all the guineas found?" asked his Lordship, looking round. "There must be two still on the floor," was Jebb's answer; "for I have only three." The hint was taken, and the right sum put down. An eminent Bristol doctor coming into his patient's bedroom immediately after death, found the right hand of the deceased tightly clenched. Opening the fingers, he discovered within them a guinea. "Ah! that was for me, clearly," said the doctor, putting the piece into his pocket. A physician, receiving two guineas when he expected three, from an old lady who used to give him the latter fee, had recourse to one part of Sir Richard Jebb's artifice, and, assuming that the third guinea had been dropt through his carelessness on the floor, looked about for it. "Nay, nay," said the lady, "you are not in fault. It is I who dropt it." _Fees collectively Irresistible._--Radcliffe attended a friend for a twelvemonth gratuitously. On his last visit his friend said, "Doctor, here is a purse in which I have put every day's fee; and your goodness must not get the better of my gratitude. Take your money." Radcliffe steeled himself to persevere in benevolence, just touched the purse to reject it, heard the chink of the gold, and put it into his pocket, saying "Singly, Sir, I could have refused them for a twelvemonth; but, all together, they are _irresistible_." PALEY'S ECONOMY OF CONSCIENCE. The great controversy on the propriety of requiring a subscription to articles of faith, as practised by the Church of England, excited in 1772 a very strong sensation amongst the members of the two universities. Paley, when pressed to sign the clerical petition which was presented to the House of Commons for relief, excused himself, saying, "He could not _afford_ to keep a conscience." DIFFIDENCE IN THE PULPIT. Izaak Walton relates about Bishop Sanderson, that once "his dear and most intimate friend, the learned Dr. Hammond, came to enjoy a quiet rest and conversation with him for some days at Boothby Pannel, and did so, and having formerly persuaded him to trust his excellent memory, and not read, but try to speak a sermon as he had writ it; Dr. Sanderson became so compliant as to promise that he would. And to that end they two went early the Sunday following to a neighbour minister, and requested to exchange a sermon; and they did so. And at Dr. Sanderson's going into the pulpit, he gave his sermon (which was a very short one) into the hands of Dr. Hammond, intending to preach it as it was writ; but before he had preached a third part, Dr. Hammond (looking on his sermon as written) observed him to be out, and so lost as to the matter, especially the method, that he also became afraid for him; for it was discernible to many of that plain auditory. But when he had ended this short sermon, as they two walked homeward, Dr. Sanderson said with much earnestness, 'Good Doctor, give me my sermon, and know that neither you, nor any man living, shall ever persuade me to preach again without my books.' To which the reply was, 'Good Doctor, be not angry; for if ever I persuade you to preach again without book, I will give you leave to burn all the books that I am master of.'" Elsewhere Walton says:--"Though they were much esteemed by them that procured and were fit to judge them, yet (Dr. Sanderson's sermons) were the less valued because he read them, which he was forced to do; for though he had an extraordinary memory (even the art of it), yet he was punished with such an innate, invincible fear and bashfulness, that his memory was wholly useless as to the repetition of his sermons, so as he had writ them; which gave occasion to say, when some of them were first printed and exposed to censure (which was in the year 1632), that the best sermons that ever were read were never preached." Aubrey says, that when he was a freshman at college, and heard Dr. Sanderson read his first lecture, he was out in the Lord's Prayer. CHRISTIAN NAMES AMONG THE PURITANS. In his _Church History_, Collins says:--"Under the article of Baptism, the Book of Discipline runs thus: 'Let persuasions be used that such names that do savour either of Paganism or Popery be not given to children at their baptism, but principally those whereof there are examples in the Scriptures.' The Puritans were strict in keeping close to this rule, as may be collected from the odd names they gave their children; such as, 'The Lord is Near,' 'More Trial,' 'Reformation,' 'Discipline,' 'Joy Again,' 'Sufficient from Above,' 'Free-Gifts,' 'More Fruit,' 'Dust,' etc. And here Snape was remarkably scrupulous; for this minister refused to baptize one Christopher Hodgkinson's child, because he would have it christened Richard. Snape acquainted Hodgkinson with his opinion beforehand. He told him he must change the name, and look out for one in the Scripture; but the father, not thinking this fancy would be so strongly insisted on, brought his son to church. Snape proceeded in the solemnity till he came to naming the child; but not being able to prevail for any other name than Richard, refused to administer the sacrament, and thus the child was carried away, and afterwards baptized by a conforming clergyman." "WHAT IS AN ARCHDEACON?" Lord Althorp, when Chancellor of the Exchequer, having to propose to the House of Commons a vote of £400 a year for the salary of the Archdeacon of Bengal, was puzzled by a question from Mr. Hume, "What are the duties of an archdeacon?" So he sent one of the subordinate occupants of the Treasury Bench to the other House to obtain an answer to the question from one of the bishops. To Dr. Blomfield accordingly the messenger went, and repeated the question, "What is an archdeacon?" "An archdeacon," replied the bishop, in his quick way, "an archdeacon is an ecclesiastical officer, who performs archidiaconal functions;" and with this reply Lord Althorp and the House were perfectly satisfied. "TAPPING" A TOPER. A man who had never drunk water enough to warrant the disease, was reduced to such a state by dropsy, that the physicians decided that tapping was necessary; and the poor patient was invited to submit to the operation, which he seemed inclined to do, in spite of the entreaties of his son. "Oh! father, father, do not let them _tap_ you," screamed the boy, in an agony of tears; "do anything, but do not let them tap you!" "Why, my dear?" inquired the afflicted parent. "It will do me good, and I shall live long in health to make you happy." "No, father, no, you will not: there never was anything _tapped_ in our house that lasted longer than a week!" THE CAPACITY OF AN ABBE. When the diminutive Abbé de Voisenon was ordered by his physician to drink a quart of ptisan per hour, he was horrified. On his next visit the doctor asked, "What effect has the ptisan produced?" "Not any," answered the little Abbé. "Have you taken it all?" "I could not take more than half of it." The physician was angry that his directions had not been carried out, and frankly said so. "Ah! my friend," pleaded the Abbé, "how could you desire me to swallow a quart an hour? I hold but a pint!" BENEFIT OF CLERGY. In Burnet's _History of the Reformation_, we find it stated that "a law of Henry VII. for burning in the hand clerks convicted of felony, did not prove a sufficient restraint. And when, in the fourth year of the following reign, it was enacted that all murderers and robbers should be denied the benefit of their clergy, two provisos were added to make the bill pass through the House of Lords, the one for excepting all such as were within the holy orders of bishop, priest, or deacon, and the other, that the Act should only be in force till the next Parliament. Pursuant to this Act many murderers and felons were denied their clergy, and the law passed on them to the great satisfaction of the nation; but this gave great offence to the clergy, and the Abbot of Winchelcont said, in a sermon at Paul's Cross, that the Act was contrary to the law of God, and to the liberties of the holy Church, and that all who assented to it had by so doing incurred the censures of the Church." DEAN SWIFT'S CONTRIBUTORY DINNER. Dean Swift once invited to dinner several of the first noblemen and gentlemen in Dublin. A servant announced the dinner, and the Dean led the way to the dining-room. To each chair was a servant, a bottle of wine, a roll, and an inverted plate. On taking his seat, the Dean desired the guests to arrange themselves according to their own ideas of precedence, and fall to. The company were astonished to find the table without a dish, or any provisions. The Lord Chancellor, who was present, said, "Mr. Dean, we do not see the joke." "Then I will show it you," answered the Dean, turning up his plate, under which was half-a-crown, and a bill of fare from a neighbouring tavern. "Here, sir," said he, to his servant, "bring me a plate of goose." The company caught the idea, and each man sent his plate and half-a-crown. Covers, with everything that the appetites of the moment dictated, soon appeared. The novelty, the peculiarity of the manner, and the unexpected circumstances, altogether excited the plaudits of the noble guests, who declared themselves particularly gratified by the Dean's entertainment. "Well," said the Dean, "gentlemen, if you have dined, I will order the _dessert_." A large roll of paper, presenting the particulars of a splendid dinner, was produced, with an estimate of the expense. The Dean requested the accountant-general to deduct the half-crowns from the amount, observing, "that as his noble guests were pleased to express their satisfaction with the dinner, he begged their advice and assistance in disposing of the _fragments_ and _crumbs_," as he termed the balance mentioned by the accountant-general--which was two hundred and fifty pounds. The company said, that no person was capable of instructing the Dean in things of that nature. After the circulation of the finest wines, the most judicious remarks on charity and its abuse were introduced, and it was agreed that the proper objects of liberal relief were well-educated families, who from affluence, or the expectation of it, were reduced through misfortune to silent despair. The Dean then divided the sum by the number of his guests, and addressed them according to their respective private characters, with which no one was perhaps better acquainted. "You, my Lords," said the Dean to several young noblemen, "I wish to introduce to some new acquaintance, who will at least make their acknowledgment for your favours with sincerity." "You, my reverend Lords," addressing the bishops present, "adhere so closely to the spirit of the Scriptures, that your left hands are literally ignorant of the beneficence of your right. You, my Lord of Kildare, and the two noble lords near you, I will not entrust with any part of this money, as you have been long in the _usurious_ habits of lending your own on such occasions; but your assistance, my Lord of Kerry, I must entreat, as charity covereth a multitude of sins." "BREAKING UP" BEFORE THE HOLIDAYS. It is related that Dr. Harrington of Bath, the Editor of _Nugæ Antiquæ_, for many years attended the Dowager Lady Trevor, relict of Lord Trevor, and last surviving daughter of Sir Richard Steele. "He spoke of this lady as possessing all the wit, humour, and gaiety of her father, together with most of his faults. She was extravagant, and always in debt; but she was generous, charitable, and humane. She was particularly partial to young people, whom she frequently entertained most liberally, and delighted them with the pleasantry and volubility of her discourse. Her person was like that which her pleasant father described himself in the _Spectator_, with his short face, etc. A little before her death (which was in the month of December) she sent for her doctor, and, on his entering her chamber, he said, 'How fares your Ladyship?' She replied, 'Oh, my dear Doctor, ill fare! I am going to break up before the holidays!'" BOTTLE BLIND. Dean Cowper, of Durham, was very economical of his wine. One day at table he was descanting on the extraordinary performance of a man who was blind, and remarked that the poor fellow could see no more than "that bottle." "I do not wonder at that at all, Sir," replied a minor canon; "for we have seen no more than _that bottle_ all the afternoon." FEARLESSNESS OF JOHN KNOX. When Lord Darnley, in 1565, had married Mary Queen of Scots, he was prevailed on by his friends to go and hear Knox preach, in the hope that thereby he might conciliate the stem moralist and outspoken minister. But Knox seized the occasion to declaim even more vehemently against the government of wicked princes, who, for the sins of the people, are sent as tyrants and scourges to torment them. Darnley complained to the Council of the insult; and the bold preacher was forbidden the use of his pulpit for several days. Robertson thus remarks on his character:--"Rigid and uncomplying himself, he showed no regard to the infirmities of others. Regardless of the distinctions of rank and character, he uttered his admonitions with acrimony and vehemence, more apt to irritate than to reclaim. Those very qualities, however, which now render his character less amiable, fitted him to be the instrument of Providence for advancing the Reformation among a fierce people, and enabled him to face dangers, and to surmount opposition, from which a person of a more gentle spirit would have been apt to shrink back." The shortest and perhaps the best funeral oration extant, is that pronounced by the Earl of Morton over the grave of Knox: "Here lies he who never feared the face of man." WESLEY AND BEAU NASH. Wesley once preaching at Bath, Beau Nash entered the room, came close up to the preacher, and demanded by what authority he was acting? Wesley answered, "By the authority of Jesus Christ, conveyed to me by the present Archbishop of Canterbury, when he laid his hands upon me and said, 'Take thou authority to preach the gospel.'" Nash then affirmed that he was acting contrary to the law. "Besides," said he, "your preaching frightens people out of their wits." "Sir," replied Wesley, "did you ever hear me preach?" "No," said the master of the ceremonies. "How, then, can you judge of what you have never heard?" "By common report," said Nash. "Sir," retorted Wesley, "is not your name Nash? I dare not judge of you by common report; I think it not enough to judge by." Nash, right or wrong as to the extravagances of the Methodists, was certainly proclaiming his opinions in the wrong place; and when he desired to know what the people came there for, one of the company cried out: "Let an old woman answer him. You, Mr. Nash, take care of your body, we take care of our souls, and for the food of our souls we come here." Nash found himself so different a man in the meeting-house, to what he was in the pump-room or the assembly, that he thought it best to withdraw. THE FRENCH REVOLUTION AND THE BIBLE. In Silliman's _Travels_ it is related that during the Peace of Amiens, in 1801-2, a committee of English gentlemen went over to Paris for the purpose of taking measures to supply the French with the Bible in their own language. One of these gentlemen, Mr. Hardcastle, subsequently gave the assurance that the fact which was published was literally true--that they searched Paris for several days before a single Bible could be found. EDWARD JENNER, THE DISCOVERER OF VACCINATION. It is to a "country doctor" that England and the world owe one of the greatest benefits that modern medical science has conferred on the race, in the practice of vaccination. The youngest son of a Gloucestershire clergyman, Edward Jenner was placed, about 1763, as apprentice to a surgeon at Sodbury; and it was there, it is stated, that first the possibility of arresting the then dreaded and dreadful ravages of small-pox entered his mind. He accidentally learned, from the conversation of a young serving woman--who boasted that she was safe from that disease because she had had "cow-pox"--that among servants in the country there prevailed a belief that the small-pox could not attack any one into whose system had been absorbed the virus from a diseased cow. From that time Jenner never lost sight of the idea. He spent some time in London finishing his studies, under the prelections of John Hunter; and then he settled, for life as it proved, at Berkeley, in Gloucestershire. Pursuing inquiries and experiments on the subject of vaccination, he established the efficacy of the rural system of inducing "cow-pox" as a preventive against small-pox; which had originated by inoculation, accidental or designed, with some of the matter afforded by a peculiar disease of the udder of a cow, and which could be communicated by inoculation from one human being to another with the same preventive efficacy. In 1796, a friend of Jenner's, to whom he had communicated the results of his inquiry--Mr. Cline, surgeon to St. Thomas's Hospital--first employed vaccination in London; and the practice was speedily adopted in the army and navy, the Government bestowing on Jenner honours and rewards, and the University of Oxford conferring on him the diploma of Doctor of Medicine. Just, however, as Blackmore and Tanner had vehemently opposed inoculation, so did many members of the Faculty, foremost among them Moseley, Birch, and Woodville, oppose the new system of vaccination. The London mob were asked and induced to believe that if they submitted to vaccination they were in jeopardy of being converted into members of the canine species, and that the operation would infallibly be followed by the development of horns, and tail, and "thick natural fell" of hair. A child was said to have never ceased, since he received the matter into his system, to run about on all fours and imitate the lowing of a bull! In a caricature Jenner was mounted on a cow. Moseley indited verses, of which this is a sample:-- "O Jenner! thy book, nightly phantasies rousing, Full oft makes me quake for my heart's dearest treasure; For fancy, in dreams, oft presents them all browsing On commons, just like little Nebuchadnezzar. _There_, nibbling at thistle, stand Jem, Joe, and Mary, On their foreheads, oh, horrible! crumpled horns bud; There Tom with his tail, and poor William all hairy, Reclined in a corner, are chewing the cud." Even in Berkeley, Jenner was pursued with ridicule and suspicion; but he went quietly on his rounds, waiting confidently till the storm was laid, plashing through the Gloucestershire lanes in the garb that an acquaintance has thus described:--"He was dressed in a blue coat and yellow buttons, buckskins, well-polished jockey-boots, with handsome silver spurs, and he carried a smart whip with a silver handle. His hair, after the fashion, was done up in a club, and he wore a broad-brimmed hat." But Jenner, says Mr. Jeaffreson, found also compensation for all the ridicule and opposition "in the enthusiastic support of Rowland Hill, who not only advocated vaccination in his ordinary conversation, but from the pulpit used to say, after his sermon to his congregation, wherever he preached, 'I am ready to vaccinate to-morrow morning as many children as you choose; and if you wish them to escape that horrid disease, the small-pox, you will bring them.' A Vaccine Board was also established at the Surrey Chapel--_i.e._ the Octagon Chapel, in Blackfriars Road. 'My Lord,' said Rowland Hill once to a nobleman, 'allow me to present to your Lordship my friend, Dr. Jenner, who has been the means of saving more lives than any other man.' 'Ah!' observed Jenner, 'would that I, like you, could say--souls.' There was no cant in this. Jenner was a simple, unaffected, and devout man. His last words were, 'I do not marvel that men are grateful to me; but I am surprised that they do not feel gratitude to God for making me a medium of good.'" ANGEL-WORSHIP. A now obsolete ecclesiastical custom in Scotland was, Dean Ramsay says, that the minister should bow in succession to the heritors or proprietors in the parish, who occupied the front gallery seats; a custom, when the position of the heritors was tolerably well matched, that led to an unpleasant contest at times as to who was entitled to the precedence of getting the first bow. A clever and complimentary reply was made by Dr. Wightman of Kirkmahoe, when rallied on one occasion for neglecting this usual act of courtesy one Sunday. The heritor who was entitled to, and always received, this token of respect, was Miller of Dalswinton. One Sunday, the Dalswinton pew was filled by a bevy of ladies, but no gentleman was present; and the Doctor--perhaps because he was a bachelor, and felt a delicacy in the circumstances--omitted the usual salaam in that direction. A few days after, meeting Miss Miller (who was widely famed for her beauty, and afterwards became Countess of Mar), she rallied him, in presence of her companions, for not bowing to her on the Sunday. The Doctor immediately replied, "I beg your pardon, Miss Miller; but you know, surely, that angel-worship is not allowed by the Church of Scotland;" and, lifting his hat, he bowed low and passed on. BUNYAN'S SUCCESSFUL AND PRESISTENT PREACHING. A student of Cambridge observing a multitude flock to a village church on a working day, inquired what was the cause. On being informed that "one Bunyan, a tinker," was to preach there, he gave a boy a few halfpence to hold his horse, resolved, as he said, "to hear the tinker prate." The tinker _prated_ to such effect, that for some time the scholar wished to hear no other preacher; and, through his future life, gave proofs of the advantages he had received from the humble ministry of the author of the _Pilgrim's Progress_. Bunyan, with rude but irresistible zeal, preached throughout the country, and formed the greater part of the Baptist churches in Bedfordshire; until, at the Restoration, he was thrown into prison, where he remained twelve years. During his confinement he preached to all to whom he could gain access; and when liberty was offered to him on condition of promising to abstain from preaching, he constantly replied, "If you let me out to-day, I shall preach again to-morrow." Bunyan, on being liberated, became pastor of the Baptist Church at Bedford; and when the kingdom enjoyed more religious liberty, he enlarged the sphere of his usefulness by preaching every year in London, where he excited great attention. On one day's notice, such multitudes would assemble, that the places of worship could not hold them. "At a lecture at seven o'clock in the dark mornings of winter," says one of his contemporaries, "I have seen about twelve hundred; and I computed about three thousand that came to hear him on a Lord's day, so that one-half of them were obliged to return for want of room." LETTSOM'S LIBERATION OF HIS SLAVES. Dr. Lettsom, the founder of the Sea-Bathing Infirmary at Margate, and of the General Dispensary, was left by his father a property, which happened to consist almost entirely of a number of slaves on an estate in Jamaica. When the benevolent doctor went out to the West Indies to take possession of his inheritance, he is said to have emancipated every one of the slaves on his arrival; so that, in the words of his biographer, "he became a voluntary beggar at the age of twenty-three." The doctor went afterwards to Tortola, where, by his practice as a physician, he amassed a considerable sum of money, with which he returned to England in 1768, and attained a distinguished position among the Metropolitan practitioners. CIVIL TO THE PRINCE OF EVIL. The devil, in his malignant wrestlings with the spirits of the righteous, has not always been so energetically and uncivilly received as by Luther and his ink-bottle. It is related in all seriousness, that a minister who "used often to preach for Mr. Huntington, was talking one Lord's day morning, at Providence Chapel, about a trial he underwent in his own parlour, wherein the devil had 'set in' with his unbelief to dispute him out of some truth that was essential to salvation. He said he was determined that the devil should not have his way, and he therefore 'drew a chair for him, and desired him to sit down that they might have it out together.' According to his own account, he gained a great victory over the empty chair." He did better in his confidence than Barcena the Jesuit did in the opposite spirit; who told another of his order that when the devil appeared to him one night, out of his profound humility he rose up to meet him, and prayed him to sit down in his chair, for he was more worthy to sit there than he! "PERKINS' TRACTORS" EXPOSED. Faith in the medicinal potency of the properties of the loadstone was, for centuries after its discovery, a regular part of many physicians' mental stock-in-trade; and pulverized magnet was administered in the form of pills, and potions, and salves, even after Dr. Gilbert, of Colchester, had in 1660 scientifically ascertained and published the fact, that when reduced to powder the loadstone ceases totally to possess its magnetic properties. The belief in the efficacy of magnets held its ground much later. Even in 1779 and 1780, the Royal Society of Medicine at Paris made experiments with the view of precisely ascertaining the influence of magnets on the human system; and the conclusion reached was, that they exerted a healing potency of no contemptible character. It was about this time that the instruments called "Perkins' Tractors," which were supposed to be endowed with magnetic power, came into vogue. Perkins was an American citizen, from the shrewd State of Connecticut; and only he could make, and only he sell, the painted nails, composed of an alloy of various metals, that were in great demand among the credulous and the wealthy. For a considerable time the wonderful tractors attracted and perplexed everybody; until Dr. Haygarth of Bath, in the following manner, made it apparent that the efficacy of the tractors lay not in themselves, but in the mental condition of the person upon whom they were used:--"Robert Thomas, aged forty-three, who had been for some time under the care of Dr. Lovell, in the Bristol Infirmary, with a rheumatic affection of the shoulder, which rendered his arm perfectly useless, was pointed out as a proper object of trial by Mr. J. W. Dyer, apothecary to the house. Tuesday, April 19th, having everything in readiness, I passed through the ward, and, in a way that he might suspect nothing, questioned him respecting his complaint. I then told him that I had an instrument in my pocket which had been very serviceable to many in his state; and when I had explained to him how simple it was, he consented to undergo the operation. In six minutes no other effect was produced than a warmth upon the skin, and I feared that this _coup d'essai_ had failed. The next day, however, he told me that 'he had received so much benefit that it had enabled him to lift his hand from his knee, which he had in vain several times attempted on Monday evening, as the whole ward witnessed.' The tractors I used being made of lead, I thought it advisable to lay them aside, lest, being metallic points, the proof against the fraud might be less complete. Thus much, however, was proved, that the patent tractors possessed no specific power independent of simple metals. Two pieces of wood, properly shaped and painted, were next made use of; and in order to add solemnity to the farce, Mr. Barton held in his hand a stop-watch, whilst Mr. Lax minuted the effects produced. In four minutes the man raised his hand several inches, and he had lost also the pain in his shoulder, usually experienced when attempting to lift anything. He continued to undergo the operation daily, and with progressive good effect; for, on the twenty-fifth, he could touch the mantelpiece. On the twenty-seventh, in the presence of Dr. Lovell and Mr. J. P. Noble, two common iron nails, disguised with sealing-wax, were substituted for the pieces of mahogany before used. In three minutes he felt something moving from his arm to his hand, and soon after he touched the board of rules which hung a foot above the fire-place. This patient at length so far recovered that he could carry coals and use his arm sufficiently to help the nurse; yet, previous to the use of the spurious tractors, he could no more lift his hand from his knee than if a hundredweight were upon it, or a nail driven through it, as he declared in the presence of several gentlemen. The fame of this case brought applications in abundance; indeed, it must be confessed, that it was more than sufficient to act upon weak minds, and induce a belief that these pieces of wood and iron were endowed with some peculiar virtues." The prosecution and publication of the result of Haygarth's experiments, led to the downfall of Perkins and the discredit of the tractors; but it was not very long before Mesmerism had established a yet stronger hold on the public credulity, which seems never to be content, if it is not fooled to the top of its bent. WHITFIELD "IMPROVING" AN EXECUTION IN EDINBURGH. When Whitfield first went to Scotland, he was received in Edinburgh with a kind of frantic joy by many of the citizens. The day after his arrival, an unhappy man, who had forfeited his life to the offended laws of his country, was to be executed. Mr. Whitfield mingled in the crowd on the occasion, and seemed highly pleased with the solemnity and decorum with which the awful scene was conducted. His appearance, however, drew the eyes of all around him, and raised a variety of opinions as to his motives. The next day being Sunday, he preached to a very large congregation in a field near the city. In the course of his sermon, he adverted to the execution which had taken place on the preceding day. "I know," said he, "that many of you will find it difficult to reconcile my appearance yesterday with my character. Many of you, I know, will say that my moments would have been better employed in praying for the unhappy man than in attending him to the fatal tree, and that perhaps curiosity was the only cause that converted me into a spectator on that occasion. But those who ascribe that uncharitable motive to me, are under a mistake. I went as an observer of human nature, and to see the effect that such an example would have on those who witnessed it. I watched the conduct of almost every one present on that awful occasion, and I was highly pleased with their demeanour, which has given me a very favourable opinion of the Scottish nation. Your sympathy was visible on your countenances, and reflected the goodness of your hearts, particularly when the moment arrived that your unhappy fellow-creature was to close his eyes on this world for ever; then you all, as if moved by one impulse, turned your heads aside, and wept. Those tears were precious, and will be held in remembrance. How different was it when the Saviour of mankind was extended on the cross! The Jews, instead of sympathizing in His sorrows, triumphed in them. They reviled Him with bitter expressions, with words even more bitter than the gall and vinegar which they handed Him to drink. Not one of all that witnessed His pains turned His head aside, even in the last pang. Yes, my friends, there was one; that glorious luminary (pointing to the sun) veiled his brightness, and travelled on his course in tenfold night." DR. JOHNSON'S OPINION OF WHITFIELD. Boswell informs us that Dr. Johnson would not allow much merit to Whitfield's oratory. "His popularity, Sir," said he, "is chiefly owing to the peculiarity of his manner. He would be followed by crowds were he to wear a nightcap in the pulpit, or were he to preach from a tree." And again: "Whitfield never drew as much attention as a mountebank does; he did not draw attention by doing better than others, but by doing what was strange. Were Astley to preach a sermon standing upon his head on a horse's back, he would collect a multitude to hear him; but no wise man would say he had made a better sermon for that. I never treated Whitfield's ministry with contempt; I believe he did good. He had devoted himself to the lower classes of mankind, and among them he was of use. But when familiarity and noise claim the praise due to knowledge, art, and elegance, we must beat down such pretensions." DR. WOLCOT ("PETER PINDAR") IN JAMAICA. Dr. Wolcot, the patron of Opie, and better known to fame as "Peter Pindar," practised medicine--descending from a family, members of which in several generations had followed the same profession in Devon and Cornwall. Sir William Trelawny, when he went as Governor to Jamaica, took Wolcot out as surgeon to his household; and there he figured in several characters--as grand master of the ceremonies, private secretary, and chaplain. Whether or not he ever received regular ordination, it is certain that Wolcot acted as rector in the colony for some time; and odd stories of his behaviour as a parish priest were current among his friends as well as his enemies. He read prayers and preached when a congregation presented itself; but that was not oftener than about every fourth Sunday. He was a capital shot, and, with his clerk, used to amuse himself with shooting pigeons. Having shot their way to the church, the pair were wont to wait ten minutes in the porch for the arrival of the congregation; at the end of which time, if nobody appeared, the reverend sportsmen returned to their amusement. If a few negroes only presented themselves at the church, the rector bought them off with a little money; and one old negro, finding out Wolcot's weakness, after a time attended every Sunday, when the rector would address him: "What do you come here for, blackee?" "Why, Massa, for to hear your good sermon and all the prayer ob de church." "Would not a _bit_ or two do you more good?" "Yes, massa doctor; me lub prayer much, but me lub money too." The little transaction would then take place, and the darky retire grinning; and it is said that this man drew thus an income from Wolcot for a whole year. When he returned to England, Wolcot did not succeed in obtaining a practice, and abandoned both physic and divinity for satire--which yielded him a good income while he lived, and won him fame both with his own generation and with posterity. CHARITY OF ARCHBISHOP TILLOTSON. In 1685, Archbishop Tillotson avowed himself a warm advocate for affording charitable relief to the French refugees, on the recall of the Edict of Nantes. Dr. Beveridge, the prebendary of Canterbury, having objected to reading a brief for this purpose, as contrary to the rubric, the Archbishop observed to him roughly, "Doctor, Doctor, charity is above all rubrics." While Tillotson was in a private station, he always laid aside two-tenths of his income for charitable uses; and after his elevation to the mitre, he so constantly expended all that he could spare of his annual revenues in acts of beneficence, that the only legacy which he was able to leave to his family consisted of two volumes of sermons, the value of which, however, was such, that the copyright brought not less than £2500. Of Tillotson it is told that once, when King William III. complained of the shortness of his sermon, he replied, "Sire, could I have bestowed more time upon it, it would not have been so long." DRUBBING-IN RELIGIOUS FEELING. Pietro della Valle, "who," says Southey, "could be amused at the superstition of others," reports that when the _Ecce Homo_ was displayed during a sermon in the Jesuit church at Goa, the women used to beat their servants if they did not cry enough to please them. BON-MOTS OF SYDNEY SMITH. Sydney Smith was once dining in company with a French gentleman, who had before dinner indulged in a number of free-thinking speculations, and ended by avowing himself a materialist. "Very good soup, this," said Mr. Smith. "Yes, Sir, it is excellent," was the reply. "Pray, Sir, do you _believe_ in a _cook_?" inquired Mr. Smith.--"Do you believe in the apostolical succession?" inquired one of Smith. "I do," he replied; "and my faith in that dogma dates from the moment I became acquainted with the Bishop of ----, _who is so like Judas!_"--In preaching a charity sermon, Sydney Smith frequently repeated the assertion that, of all nations, Englishmen were most distinguished for their generosity, and the love of their _species_. The collection happening to be inferior to his expectation, provoked him to say, that he had evidently made a great mistake; for that his expression should have been, that they were distinguished for the love of their _specie_.--On the departure of Bishop Selwyn for his diocese, New Zealand, Smith, when taking his leave of him, said: "Good-bye, my dear Selwyn; I hope you will not _disagree_ with the man who eats you!"--A friend of Smith inquired, "What is Puseyism?" To which the witty canon replied: "Puseyism, Sir, is inflexion and genuflexion; posture and imposture; bowing to the east, and curtseying to the west." THE ORIGIN OF OUR INDIAN COMMERCE. It is perhaps not generally known, says Wadd, in his _Memoirs_, that it was an English surgeon of the name of Broughton whose good fortune it was to open the commerce of India to his countrymen, by the following accident. Having been sent from Surat to Agra in the year 1636, to treat one of the daughters of the Emperor Shah Jehan, he had the good fortune to cure the Princess. By way of recompense, the Emperor, among other favours, gave him the privilege of a free commerce throughout the whole extent of his dominions. Broughton immediately returned to Bengal, to purchase goods, and transmit them by sea to Surat. Scarcely had he returned when he was requested to attend the favourite of the Nabob of the province, labouring under a very dangerous disease. Having fortunately restored his patient to health, the Nabob settled a pension upon him, confirmed the privilege of the Emperor, and promised to allow the same to all the English who should come to Bengal. Broughton communicated all this to the English Governor at Surat, and it was by the advice of the latter that the company sent from England, in 1640, two ships to Bengal. Such was the origin of a commerce that has since been carried to so great an extent--and made the foundation of a vast empire. CHARLES II. AND BISHOP STILLINGFLEET. Charles the Second once demanded of Dr. Stillingfleet, who was a preacher to the Court, "Why he read his sermons before him, when on every other occasion his sermons were delivered extempore?" The Bishop answered, that, overawed by so many great and noble personages, and in the presence of his Sovereign, he dared not to trust his powers. "And now," said the divine, "will your Majesty permit me to ask a question?" "Certainly," said the condescending monarch. "Why, then, does your Majesty read your speeches, when it may be presumed that _you_ can have no such reason?" "Why, truly," said the King, "I have asked my subjects so often for money, that I am ashamed to look them in the face." A TOO PERSONAL APPLICATION. When Dr. Beadon was rector of Eltham, in Kent, his text one day was, "Who art thou?" After reading the text, he made a pause, for the congregation to reflect upon the words; when a gentleman, in a military dress, who at the instant was marching very sedately up the middle aisle of the church, supposing it a question addressed to him, to the surprise of all present replied, "I am, Sir, an officer of the sixteenth regiment of foot, on a recruiting party here; and having brought my wife and family with me, I wish to be acquainted with the neighbouring clergy and gentry." This so deranged the divine, and astonished the congregation, that though they attempted to listen with decorum, the service was not continued without considerable difficulty. PREACHING TO PURPOSE. Burnet records that "two entries made in the Council Books, show the good effects of Latimer's zealous preaching. On the 10th of March he brought in £104 recovered of one who had concealed it from the King, and a little after, £363 of the King's money." The amount of this conscience-money must of course be multiplied manifold, to estimate aright the penetrating and persuading power of the preacher. Latimer's style of preaching is said to have been extremely captivating; simple and familiar, often enlivened with anecdote, irony, and humour; and still oftener swelling into strains of most impassioned and awakening eloquence. Of the earnestness of his manner, which could lead to the disgorgement of great plunder by unscrupulous men, the following, from a sermon against the corruptions of the age, may be taken as a sample:--"Take heed and beware of covetousness; take heed and beware of covetousness; take heed and beware of covetousness. And what if I should say nothing else these three or four hours but these words? Great complaints there are of it, and much crying out, and much preaching, but little amendment that I can see; Covetousness is the root of all evil. Then have at the root; out with your swords, ye preachers, and strike at the root. Stand not ticking and toying at the branches, for new branches will spring out again, but strike at the root; and fear not these great men, these men of power, these oppressors of the needy--fear them not, but strike at the root." In another sermon, Latimer himself gives some account of the restitutions he brought about:--"At my first preaching of restitution, one man took remorse of conscience, and acknowledged himself to me that he had deceived the King, and willing he was to make restitution; and so the first Lent came to my hands £20 to be restored to the King's use. I was promised £20 more the same Lent; but it could not be made, so that it came not. Well, the next Lent came £320 more. I received it myself and paid it to the King's council. So I was asked what he was that made this restitution. But should I have named him? Nay, they should as soon have this weasand of mine. Well, now, this Lent came £180, 10s. which I was paid, and delivered this present day to the King's council; and so this man hath made a godly restitution. And so, quoth I to a certain nobleman that is one of the King's council, if every man that hath beguiled the King should make restitution after this sort, it would cough the King £20,000 I think, said I. Yea, that it would, quoth the other, a whole £100,000. Alack! alack! make restitution for God's sake; ye will cough in hell else, that all the devils there will laugh at your coughing. There is no remedy but restitution, open or secret, or else hell." SERVANT AND MASTER. A preacher who differed in opinion with Adolphus Gunn, called upon him, and being known, was denied admittance, "Mr. Gunn being busy in his study." "Tell him," said the importunate visitor, "that a servant of the Lord wishes to speak to him." Gunn sent back this answer: "Tell the servant of the Lord that I am engaged with his Master." DR. BARROWBY, Who lived about the middle of last century, when canvassing for a post in St. Bartholomew's Hospital, called upon a grocer in Snow Hill, one of the governors. The grocer was sitting in his counting-house, and thence saw the Doctor enter the shop. Knowing his person, and having little doubt that the object of his visit was to solicit his vote at the approaching election, the grocer immediately donned his hat and spectacles, and greatest parochial consequence, and, strutting into the shop with an insolent air of patronage, addressed the Doctor with--"Well, friend, and what is your business?" Barrowby promptly and quietly said, "I want a pound of plums;" and after the abashed and mortified grocer had weighed them out and put them up, Barrowby paid for them and walked off without saying a word. (This story has been erroneously told of Abernethy.) Of the same Dr. Barrowby, it is related that an Irish gentleman, whom the College of Physicians had declined to pass, called next day on him, and insisted upon fighting him, as being one of the Censors who had been the authors of the rejection. Barrowby, who was small of stature, declined to fight. "I am only the third Censor," he said, "in point of age; you must first call out your countryman, Sir Hans Sloane, our President, and when you have fought him and the two senior Censors, then I shall be ready to meet you." A DESIRABLE CURE OF SOULS. Southey copied the following from Jackson's _Oxford Journal_:-- "NEXT PRESENTATION. "To be sold by auction, by Hoggart and Philips, at the Auction Mart, opposite the Bank of England, on Thursday next, the 11th day of April 1811, the next presentation to a most valuable living, in one of the first sporting counties. The vicinity affords the best coursing in England, also excellent fishing, an extensive cover for game, and numerous packs of fox-hounds, harriers, etc.; it is half-an-hour's ride from one of the first cities, and not far distant from several most fashionable watering-places; the surrounding country is beautiful and healthful, and the society elegant and fashionable. The incumbent is about fifty years of age. Particulars may be had," etc. etc. BEAU NASH'S TREATMENT OF A PRESCRIPTION. When Beau Nash was ill, Dr. Cheyne wrote a prescription for him. Next day the Doctor, coming to see his patient, asked him if he had followed the prescription. "No, truly, Doctor," was the answer of Nash; "if I had I should have broken my neck, for I threw it out of a two pair of stairs' window." PULTENEY'S CURE BY SMALL BEER. Mr. Pulteney, afterwards the Earl of Bath, lay (about 1730) for a long time at Lord Chetwynd's house of Ingestre, in Staffordshire, sick, very dangerously, of a pleuritic fever. This illness cost him an expense of 750 guineas for physicians; and, after all, his cure was accomplished merely by a draught of small beer. Dr. Hope, Dr. Swynsen, and other physicians from Stafford, Lichfield, and Derby, were called in, and carried off about 250 guineas of the patient's money, leaving the malady just where they found it. Dr. Freind went down post from London, with Mrs. Pulteney, and received 300 guineas for the journey. Dr. Broxholm went from Oxford, and received 200 guineas. When these two physicians, who were Pulteney's particular friends, arrived, they found his case to be quite desperate, and gave him over, saying that everything had been done that could be done. They prescribed some few medicines, but without the least effect. He was still alive, and was heard to mutter, in a low voice, "Small beer, small beer." They said, "Give him small beer, or anything." Accordingly, a great silver cup was brought, which held two quarts of small beer; they ordered an orange to be squeezed into it, and gave it to him. Pulteney drank off the whole at a draught, and demanded another. Another cupful was administered to him; and soon after that he fell into a profuse perspiration and a profound slumber for nearly twenty-four hours. In his case the saying was eminently verified, "If he sleep he shall do well." From that time forth, he recovered wonderfully, insomuch that in a few days the physicians took their leave. The joy over his recovery was diffused over the whole country; for he was then in the height of that popularity which, after his elevation to the peerage, he completely forfeited. A WITTY FRENCH PREACHER. A French preacher, called Father André, was nicknamed by his Bishop _le petit fallot_ (the little lantern). Having to preach before the prelate, André determined to notice this, and took for his text, "Ye are the light of the world." Addressing himself to the Bishop, he said, "Vous etês, monseigneur, le grand fallot de l'église, nous ne sommes que de petits fallots." Father André, preaching before an Archbishop, perceived him to be asleep during the sermon, and thought of the following method to awake him. Turning to the beadle of the church, he said in a loud voice, "Shut the doors, the shepherd is asleep, and the sheep are going out, to whom I am announcing the word of God." This sally caused a stir in the audience, which awoke the Archbishop. Being once to announce a collection for a young lady, to enable her to take the veil, he said, before the commencement of his sermon, "Friends, I recommend to your charity a young lady, who has not enough to enable her to make a vow of poverty." Preaching during the whole of Lent in a town where he was never invited to dine, he said, in his farewell sermon, "I have preached against every vice except that of good living--which, I believe, is not to be found among you, and therefore needed not my reproach." CROMWELL AND RICHARD BAXTER. After Cromwell had seized on the government, Richard Baxter, the celebrated Nonconformist divine, once preached before the Protector, when he made use of the following text: "Now, I beseech you, brethren, by the name of our Lord Jesus the Christ, that ye all speak the same thing, and that there be no division amongst you; but that ye be perfectly joined together in the same mind, and in the same judgment." The discourse on these words was levelled against the divisions and distractions which then prevailed, especially in the Church. After the sermon, Cromwell sent for Mr. Baxter, and made a long and serious speech to him, about God's providence in the change of the government, and the great things which had been done at home and abroad. Mr. Baxter answered, that it was too condescending in his Highness to acquaint him so fully with all these matters, which were above his understanding; but that the honest people of the land took their ancient monarchy to be a blessing, and not an evil, and humbly craved his patience, that he might ask how they had forfeited that blessing? At this question Cromwell became angry; he said, "There was no forfeiture; but God had changed things as it pleased Him;" and after reviling the Parliament which thwarted him, and especially by name four or five members who were particular friends of Mr. Baxter, he dismissed the worthy divine with signs of great displeasure. MESSENGER MONSEY'S DYING JESTS. Dr. Messenger Monsey, the great grandfather of Lord Cranworth (so at least Mr. Jeafferson affirms), was appointed physician to Chelsea Hospital through the influence of Godolphin, and, after holding that office for about half a century, died in his rooms at Chelsea in 1788, in his ninety-fifth year. The eccentricities that had characterized his prime continued to distinguish him to the last. In consequence of his great age, many intending candidates for the office went down to Chelsea, in order to contemplate the various advantages and _agrémens_ of the situation, and observe the progress of the tenacious incumbent towards final recumbency. Monsey, who was at once a humorist, and possessed of a sharp eye for a visitor of this order, one day espied in the College walks a reconnoitring doctor, whom he thus accosted: "So, Sir, I find you are one of the candidates to succeed me." The physician bowed. Monsey proceeded: "But you will be confoundedly disappointed." "Disappointed!" exclaimed the physician, with quivering lips. "Yes," returned Monsey; "you expect to outlive me; but I can discern from your countenance, and other concomitant circumstances, that you are deceiving yourself--you will certainly die first; though, as I have nothing to expect from that event, I shall not rejoice at your death, as I am persuaded you would at mine." It actually fell out as Monsey (possibly only by way of a ghastly jest) had foretold; the candidate lived but a short time. The Doctor was so diverted with checking the aspiring hopes of his brethren of the faculty, that whenever he saw a physician on the look-out, he was not content till he had gone down to comfort him in the same manner. He did so to several; and it is very remarkable--if it be true, as it is alleged--that his predictions were in every case verified. At last the medical speculators shrank in superstitious alarm from Chelsea, and left Monsey to die in peace; indeed, when his death happened, the Minister of the day was not engaged by a single promise, nor had he had for some time a single application for the place of physician to the College. Monsey got out of his own death as much grim fun as he had out of the poor prying place-hunters. A few days before he died, he wrote to Mr. Cruickshanks, the anatomist, begging to know whether it would suit his convenience to undertake the dissection of his body, as he felt that he could not live many hours, and Mr. Forster, his surgeon, was then out of town. The dissection was one of the instructions of his eccentric and rather brutal will; his body was not to be subjected to the insult of any funeral ceremony, but, after the surgeon had finished with it, "the remainder of my carcase may be put into a hole, or crammed into a box with holes, and thrown into the Thames." His will was, so far as regards the dissection, faithfully carried out; Mr. Forster dissected the body, and delivered a lecture upon it to the medical students in the theatre of Guy's Hospital. Before he had disposed of his body by will in the manner described, and when he meant to be buried in his garden, he had written an epitaph eminently characteristic of his violent cynicism and contempt of things sacred:-- MONSEY'S EPITAPH, WRITTEN BY HIMSELF. "Here lie my old bones; my vexation now ends; I have lived much too long for myself and my friends. As to churches and churchyards, which men may call holy, 'Tis a rank piece of priestcraft, and founded on folly. What the next world may be, never troubled my pate; And be what it may, I beseech you, O fate! When the bodies of millions rise up in a riot, To let the old carcase of Monsey be quiet." UNMISTAKEABLE IDENTITY. A Reverend Doctor in London was what is usually termed a popular preacher. His reputation, however, had been gained not by his drawing largely on his own stores of knowledge or eloquence, but by the skill with which he appropriated the thoughts and language of the great divines who had gone before him. With fashionable audiences, lightly versed in pulpit lore, he passed for a miracle of erudition and pathos. It did, for all that, once happen to him to be detected in his larcenies. One Sunday, as he was beginning to amaze and delight his admirers, a grave old gentleman seated himself close to the pulpit, and listened with close attention. The preacher had hardly finished his third sentence, before the old gentleman muttered, loud enough to be heard by those near, "That's Sherlock!" The Doctor frowned, but went on. He had not proceeded much further, when his tormentor broke out with, "That's Tillotson!" The Doctor bit his lips and paused, but, considering discretion the better part of valour, again proceeded. A third exclamation of "That's Blair!" however, was too much, and fairly deprived him of patience. Leaning over the pulpit, he cried, "Fellow, if you do not hold your tongue, you shall be turned out!" Without moving a muscle of his face, the grave old gentleman raised his head, and, looking the Doctor full in the face, retorted, "_That's his own!_" WHITFIELD AND THE NEW YORK SAILORS. When Whitfield preached before the seamen at New York, he had the following bold apostrophe in his sermon:--"Well, my boys, we have a clear sky, and are making fine headway over a smooth sea, before a light breeze, and we shall soon lose sight of land. But what means this sudden lowering of the heavens, and that dark cloud arising from beneath the western horizon? Hark! Don't you hear distant thunder? Don't you see those flashes of lightning? There is a storm gathering! Every man to his duty! How the waves rise, and dash against the ship! The air is dark! The tempest rages! Our masts are gone! The ship is on her beam ends! What next?" It is said that the unsuspecting tars, reminded of former perils on the deep, as if struck by the power of magic, arose with united voices and minds, and shouted, "_Take to the long boat._." CLEVER PERVERSION OF SCRIPTURE. Dr. Williamson, Vicar of Moulton, in Lincolnshire, had a violent quarrel with one of his parishioners of the name of Hardy, who showed considerable resentment. On the succeeding Sunday the Doctor preached from the following text, which he pronounced with much emphasis, and with a significant look at Mr. Hardy, who was present: "There is no fool like the fool _Hardy_." DR. WASDALE'S LONG RIDE. Dr. Wasdale, who originally was an apothecary, resided at Carlisle when George III. came to the throne; and as he had some business to transact in London, he was desirous to see the pageant of the coronation at the same time. As he was very busy in his professional engagements at Carlisle, he set out on a Saturday after the market was over, about one in the afternoon, and got to London the next day, Sunday, in the evening, having ridden 301 miles in twenty-eight hours. He left London again on the following Thursday about noon, and got home on Friday in the evening. This is perhaps the greatest equestrian feat in medical annals; and, for the information of possible rivals, the Doctor left the memorandum "that he made use of his own saddle the whole journey." Dr. Wasdale, in the later part of his life, resided in Spring Gardens, but did not engage in practice, acting as private secretary to the Duke of Norfolk. ICONOCLASTIC ZEAL IN THE NORTH. "The high altar at Aberdeen"--so we read in Douglas's _East Coast of Scotland_, published at the end of last century--"a piece of the finest workmanship of anything of the kind in Europe, was hewn to pieces in 1649, by order of the parish minister. The carpenter employed for this infamous purpose, struck with the noble workmanship, refused to lay a tool on it; till the more than Gothic priest took the hatchet from his hand, and struck the first blow." Elsewhere Douglas, who displays a heart hatred of the image-breakers, remarks that, "so violent was the zeal of that reforming period against all monuments of idolatry, that perhaps the sun and moon, very ancient objects of false worship, _owed their safety to their distance_." UNCONCERN IN PRESENCE OF DEATH. Dr. Woodville, the author of a work on medical botany, lived in lodgings at a carpenter's house in Ely Place, London; and a few days before he died, Dr. Adams brought about his removal, for better attendance, to the Small-pox Hospital. The carpenter with whom he lodged had not been always on the best terms with him. Woodville said he should like to let the man see that he died at peace with him, and, as he never had had much occasion to employ him, desired that he might be sent for to come and measure him for his coffin. This was done; the carpenter came, and took measure of the Doctor, who begged him not to be more than two days about it, "for," said he, "I shall not live beyond that time;" and he actually did die just before the end of the next day. A contemporary and friend of his, Dr. George Fordyce, also expired under similar circumstances. He desired his youngest daughter, who was sitting by his bedside, to take up a book and read to him; she read for about twenty minutes, when the Doctor said, "Stop, go out of the room; I am going to die." She put down the book, and went out of the room to call the attendant, who immediately went into the bedroom and found that Fordyce had breathed his last. AN AGRICULTURAL DEFENCE OF BIGOTRY. In Ryder's _History of England_, a singular reason is stated to have been alleged by the Interlocutor, in support of a motion he had made in Convocation against permitting the printing of Cranmer's translation of the Bible. "If," said the mover, "we give them the Scriptures in their vernacular tongue, what ploughman who has read that 'no man having set his hand to the plough, and looking back, is fit for the kingdom of heaven,' will thenceforth make a straight furrow?" PURITAN RECHRISTENING OF PLAYING CARDS. The Puritans objected to the use of "heathen" names, not only for children, but for the "court" cards of the pack. They complained, according to Collier, of the appellations of Hercules, Alexander, Julius Cæsar, Hector, and such like; and they wanted to have the Kings called David, Solomon, Isaiah, and Hezekiah; the Queens, Sarah, Rachel, Esther, and Susannah; the Knaves, Balak, Achitophel, Tobit, and Bel. There was, however, it must be confessed, considerable toleration in their permitting the use of cards at all. JOHN HUNTER THE ANATOMIST. Wadd, in his interesting collection of medical _Mems., Maxims, and Memoirs_, says of John Hunter:--"When Hunter began practice, the town was in possession of Hawkins, Bromfield, Sharpe, and Pott; whilst Adair and Tomkins had the chief practice derived from the army. He remained in unenvied obscurity for many years; and so little was he considered, that some time after he began lecturing his class consisted of less than twenty. Dr. Denman used to say that William Hunter was a man of order, and John Hunter a man of genius; and, in truth, with all his cleverness, which was more than ordinary, the Doctor always felt John's superiority. 'In this I am only my brother's interpreter.' 'I am simply the demonstrator of this discovery; it was my brother's'--were his constant expressions. Hunter was a philosopher in more senses than one: he had philosophy enough to bear prosperity as well as adversity, and with a rough exterior was a very kind man. The poor could command his services more than the rich. He would see an industrious tradesman before a duke, when his house was full of grandees. 'You have no time to spare,' he would say; 'you live by it: most of these can wait; they have nothing to do when they go home.' No man cared less for the profits of the profession, or more for the honour of it. He cared not for money himself, and wished the Doctor to estimate it by the same scale, when he sent a poor man with this laconic note:-- 'DEAR BROTHER,--The bearer wants your advice. I do not know the nature of the case. He has no money, and you have plenty, so you are well met.--Yours, 'J. HUNTER.' He was once applied to, to perform a serious operation on a tradesman's wife; the fee agreed upon was twenty guineas. He heard no more of the case for two months, at the end of which time he was called upon to perform it. In the course of his attendance he found out that the cause of the delay had been the difficulty under which the patient's husband had laboured to raise the money; and that they were worthy people, who had been unfortunate, and were by no means able to support the expense of such an affliction. 'I sent back to the husband nineteen guineas, and kept the twentieth,' said he, 'that they might not be hurt with an idea of too great an obligation. It somewhat more than paid me for the expense I had been at in the business.' He held the operative part of surgery in the lowest estimation. 'To perform an operation,' said he, 'is to mutilate the patient whom we are unable to cure; it should therefore be considered as an acknowledgment of the imperfection of our art.' Among other characteristics of genius, was his simplicity of character and singleness of mind. His works were announced as the works of _John Hunter_; and _John Hunter_ on a plain brass plate announced his residence. His honour and his pride made him look with contempt on the unworthy arts by which ignorant and greedy men advance their fortunes. He contemplated the hallowed duties of his art with the feelings of a philanthropist and a philosopher; and although surgery had been cultivated more than 2000 years, this single individual did more towards establishing it as a _science_, than all who preceded him." LORD BACON ON THE REVIVAL OF "PROPHESYING." Lord Bacon, in his _Inquiry on the Pacification of the Church_, asks whether it might not be advantageous to renew the good service that was practised in the Church of England for some years, and afterwards put down, against the advice and opinion of one of the greatest and gravest prelates of the land. The service in question was commonly called "prophesying;" and from this description of it by Bacon it may be seen that it might have benefits of its own, not in the Church of England alone or especially, if it were resumed at the present day:--"The ministers within a precinct did meet upon a week-day in some principal town, where there was some ancient grave minister that was president, and an auditory admitted of gentlemen, or other persons of leisure. Then every minister successively, beginning with the youngest, did handle one and the same part of Scripture, spending severally some quarter of an hour or better, and in the whole, some two hours; and so the exercise being begun and concluded with prayer, and the president giving a text for the next meeting, the assembly was dissolved; and this was, as I take it, a fortnight's exercise, which in my opinion was the best way to frame and train up preachers to handle the word of God as it ought to be handled, that hath been practised. For we see orators have their declamations; lawyers have their merits; logicians their sophisms; and every practice of science hath an exercise of erudition and imitation before men come to the life; only preaching, which is the worthiest, and wherein it is most dangerous to do amiss, wanteth an introduction, and is ventured and rushed upon at first." DR. DONNE'S PRAYERFUL PUN. Dr. Donne, the Dean of St. Paul's, having married a lady of a rich and noble family without the consent of the parents, was treated with great asperity. Having been told by the father that he was to expect no money from him, the Doctor went home and wrote the following note to him: "John Donne, Anne Donne, _undone_." This quibble had the desired effect, and the distressed couple were restored to favour. PREPARING FOR THE WORST AND BEST. The historians of dissent record with pride the sedulous preparation of Dr. Marryat, a tutor who belonged to the Independent body, to make the best of either of the worlds to come. He was accustomed, we are told, to sit up at his studies two or three nights in the week, the whole year over. He learned by heart, at these times, the poets and prophets of the Old Testament, the Epistles and Apocalypse of the New; and what he had thus acquired, he sought to retain by careful recitation of them annually. He had begun to do this while he was yet a young man; when, "deeply convinced of his sinfulness and misery, he was afraid of falling into hell, and formed the resolution that if that should be the case, he would treasure up in his mind as much of the word of God as he possibly could, and carry it with him to the place of torment. When faith in his Redeemer afterwards communicated to his soul the peace and consolations of the gospel, he still continued the practice, that he might have a larger measure to carry to a better place." GEORGE CRABBE, THE APOTHECARY POET. Not the least distinguished among the names of doctors who have distinguished themselves in the world of literature, is that of George Crabbe. He was the son of the collector of salt dues at Aldborough, in Suffolk, where he was born on Christmas Eve, 1754. His father strove to give his children an education somewhat above their station in life; and George was kept at school at Bungay and Stowmarket till his fourteenth year--his comparative delicacy of constitution inducing his father to destine him to a gentler pursuit than those followed by his brothers. Leaving school, he was apprenticed to a country doctor, half farmer half physician, at Wickham Brook, near Bury St. Edmunds, where he shared the bed of his master's stable-boy. This and other _désagrémens_ of the situation, however, did not suit Crabbe's likings or his father's honest pride; and in a couple of years he was removed, and placed with Mr. Page, a surgeon at Woodbridge, and a gentleman of family and taste. Here he found time and circumstances favouring to make his first essays in poetry; and in 1775 published his first work of consequence, _Inebriety, a Poem: in three parts_. At the expiry of his apprenticeship, Crabbe vainly tried to raise funds for a regular course of study in London, and had to content himself with settling down in his native village in a small practice as surgeon and apothecary; but this proving an insufficient source of income, he resolved to venture his fortunes in London, in dependence on his poetic talent. "With this view he proceeded to London; and after a year spent in that most trying of all situations, that of a literary adventurer without money and without friends--a situation from the miseries of which the unfortunate Chatterton, 'the wondrous boy,' escaped by suicide--when on the point of being thrown into jail for the little debts which he had unavoidably contracted, as a last resource, in an auspicious moment, he had applied to Edmund Burke for assistance, transmitting to him at the same time some verses as a specimen of his abilities. In these sketches Burke at once recognised the hand of a master. He invited the poet to Beaconsfield; installed him in a convenient apartment; opened up to him the stores of his library; watched over his progress, and afforded him the benefit of his taste and literary skill." "The Library" soon appeared, and Crabbe was famous. By Burke's advice he went into holy orders; he was appointed chaplain to the household of the Duke of Rutland, obtained ample Church preferment, and pursued his path to fame. THE WAY TO PROMOTION. Speed relates that Guymond, chaplain to Henry I., observing that for the most part ignorant men were advanced to the best dignities of the Church, one day, as he was celebrating divine service before the King, and was about to read these words out of St. James, "It rained not upon the earth iii years and vi months," read it thus: "It rained not upon the earth one-one-one years and five-one months." The king noticed the singularity, and afterwards took occasion to blame the chaplain for it. "Sire," answered Guymond, "I did it on purpose, for such readers, I find, are sooner advanced by your Majesty." The King smiled; and in a short time thereafter presented Guymond to the benefice of St. Frideswid's, in Oxford. BOLD APPLICATION OF BOURDALOUE. Louis Bourdaloue--who claims the proud distinction of being "the reformer of the pulpit and the founder of genuine pulpit eloquence in France"--was sent for by Louis XIV. to preach the Advent Sermon in 1670. Bourdaloue, at that time at the age of thirty-eight, acquitted himself before the Court with so much success, that he was for many years afterwards retained as a preacher at Court. He was called the King of Preachers, and the Preacher to Kings; and Louis himself said, that he would rather hear the repetitions of Bourdaloue, than the novelties of another. With a collected air, he had little action; he kept his eyes generally half closed, and penetrated the hearts of his hearers by the tones of a voice uniform and solemn. On one occasion he turned the peculiarity of his external aspect to account in a very memorable fashion. After depicting in soul-awakening terms a sinner of the first magnitude, he suddenly opened his eyes, and, casting them full on the King, who sat opposite to him, he cried in a voice of thunder, "Thou art the man!" The effect was magical, confounding. When Bourdaloue had made an end of his discourse, he immediately went, and, throwing himself at the feet of his Sovereign, said, "Sire, behold at your feet one who is the most devoted of your servants; but punish him not, that in the pulpit he can own no other master than the King of kings!" This incident was characteristic of Bourdaloue's style of preaching, for he gave his powers to attacking the vices, passions, and errors of mankind. In his later days he renounced the pulpit, and devoted himself to the care of hospitals, prisons, and religious institutions. He died in 1704; and his sermons have been translated into several tongues. GARRICK'S PRECEPTS FOR PREACHERS. The celebrated actor Garrick having been requested by Dr. Stonehouse to favour him with his opinion as to the manner in which a sermon ought to be delivered, sent him the following judicious answer:-- "MY DEAR PUPIL,--You know how you would feel and speak in a parlour concerning a friend who was in imminent danger of his life, and with what energetic pathos of diction and countenance you would enforce the observance of that which you really thought would be for his preservation. You could not think of playing the orator, of studying your emphases, cadences, and gestures; you would be yourself; and the interesting nature of your subject impressing your heart would furnish you with the most natural tone of voice, the most proper language, the most engaging features, and the most suitable and graceful gestures. What you would thus be in the parlour, be in the pulpit, and you will not fail to please, to affect, and to profit. Adieu, my dear friend." GEORGE II. AS AN AMATEUR SURGEON. It is related in the _Percy Anecdotes_, that a gentleman, after taking tea with a friend who lived in St. James's Palace, took his leave, and stepping back, immediately fell down a whole flight of stairs, and with his head broke open a closet door. The unlucky visitor was completely stunned by the fall; and on his recovery, found himself sitting on the floor of a small room, and most kindly attended by a neat little old gentleman, who was carefully washing his head with a towel, and fitting with great exactness pieces of sticking plaster to the variegated cuts which the accident had occasioned. For some time his surprise kept him silent; but finding that the kind physician had completed his task, and had even picked up his wig, and replaced it on his head, he rose from the floor, and limping towards his benefactor, was going to utter a profusion of thanks for the attention he had received. These were, however, instantly checked by an intelligent frown, and significant motion of the hand towards the door. The patient understood the hint, but did not then know that for the kind assistance he had received he was indebted to George II., King of England. BLUNDERS OF BLOOD-LETTERS. A noble fee, in the interests of humanity, was given by a French lady to a surgeon, who used his lancet so clumsily that he cut an artery instead of a vein, in consequence of which the lady died. On her deathbed she made a will, bequeathing the operator a life annuity of eight hundred livres, on condition "that he never again bled anybody so long as he lived." In the _Journal Encyclopédique_ of May 1773, a somewhat similar story is told of a Polish princess, who lost her life in the same way. In her will, made _in extremis_, there was the following clause:--"Convinced of the injury that my unfortunate accident will occasion to the unhappy surgeon who is the cause of my death, I bequeath to him a life annuity of two hundred ducats, secured by my estate, and forgive his mistake from my heart. I wish this may indemnify him for the discredit which my sorrowful catastrophe will bring upon him." A famous French Maréchal reproved the awkwardness of a phlebotomist less agreeably. Drawing himself away from the operator, just as the incision was about to be made, he displayed an unwillingness to put himself further in the power of a practitioner who, in affixing the fillet, had given him a blow with the elbow in the face. "My Lord," said the surgeon, "it seems that you are afraid of the bleeding." "No," returned the Maréchal, "not of the bleeding--but the bleeder." BISHOPS AND THE POOR. A nobleman once advising a French bishop to add to his house a new wing in modern style, received this answer:--"The difference, my Lord, between your advice and that which the devil gave to our Saviour is, that Satan advised Jesus to change the stones into bread, that the poor might be fed--and you desire me to turn the bread of the poor into stones!" Ethelwold, Bishop of Winchester in the time of King Edgar, sold the sacred gold and silver vessels belonging to the Church, to relieve the poor during a famine,--saying that there was no reason that the senseless temples of God should abound in riches, while his living temples were perishing of hunger. Butler, Bishop of Durham, being asked for a charitable subscription, asked his steward what money he had in the house. The steward informed him that there were five hundred pounds. "Five hundred pounds!" cried the bishop; "it is a shame for a bishop to have so much in his possession!" and he ordered the whole sum to be immediately given to the poor. BISHOP BURNET AGAINST PLURALITIES. Bishop Burnet, in his charges to the clergy of his diocese, used to be extremely vehement in his exclamations against pluralities. In his first visitation to Salisbury, he urged the authority of St. Bernard; who, being consulted by one of his followers whether he might accept of two benefices, replied, "And how will you be able to serve them both?" "I intend," answered the priest, "to officiate in one of them by a deputy." "Will your deputy suffer eternal punishment for you too?" asked the saint. "Believe me, you may serve your cure by proxy, but you must suffer the penalty in person." This anecdote made such an impression on Mr. Kelsey, a pious and worthy clergyman then present, that he immediately resigned the rectory of Bemerton, in Berkshire, worth £200 a year, which he then held with one of greater value. ABERNETHY CONQUERED BY CURRAN. To curb his tongue, out of respect to Abernethy's humour, was an impossibility to John Philpot Curran. Eight times Curran (who was personally unknown to Abernethy) had called on the great surgeon; and eight times Abernethy had looked at the orator's tongue (telling him that it was the most unclean and utterly abominable tongue in the world); had curtly advised him to drink less, and not abuse his stomach with gormandizing; had taken a guinea, and had bowed him out of the room. On the ninth visit, just as he was about to be dismissed in the same summary fashion, Curran said, "Mr. Abernethy, I have been here on eight different days, and I have paid you eight different guineas, but you have never yet listened to the symptoms of my complaint. I am resolved, sir, not to leave the room till you satisfy me by doing so." With a good-natured laugh, Abernethy leaned back in his chair and said, "Oh! very well, sir; I am ready to hear you out. Go on, give me the whole--your birth, parentage, and education. I wait your pleasure. Pray be as minute and tedious as you can." Curran gravely began:--"Sir, my name is John Philpot Curran. My parents were poor, but, I believe, honest people, of the province of Munster, where also I was born, at Newmarket, in the county of Cork, in the year one thousand seven hundred and fifty. My father being employed to collect the rents of a Protestant gentleman of small fortune, in that neighbourhood, procured my admission into one of the Protestant free schools, where I obtained the first rudiments of my education. I was next enabled to enter Trinity College, Dublin, in the humble sphere of a sizar--." And so he went steadily on, till he had thrown Abernethy into convulsions of laughter. WITTICISMS OF ARCHBISHOP WHATELY. "What is the difference," asked Archbishop Whately of a young clergyman he was examining, "between a form and a ceremony? The meaning seems nearly the same; yet there is a very nice distinction." Various answers were given. "Well," he said, "it lies in this: you sit upon a _form_, but you stand upon _ceremony_." "Morrow's Library" is the Mudie's of Dublin, and the Rev. Mr. Day a popular preacher. "How inconsistent," said Archbishop Whately, "is the piety of certain ladies here! They go to _Day_ for a sermon, and to _Morrow_ for a novel!" At a dinner-party Archbishop Whately called out suddenly to the host: "Mr. ----!" There was silence. "Mr. ----, what is the proper female companion of this John Dory?" After the usual number of guesses the answer came: "_Anne Chovy._" WHITFIELD AND THE KINGSWOOD COLLIERS. The crowds that attended the preaching of Whitfield, first suggested to him the thought of preaching in the open air. When he mentioned this to some of his friends, they judged it was mere madness; nor did he begin to practise it until he went to Bristol, when, finding the churches denied to him, he preached on a hill at Kingswood to the colliers. After he had done this three or four times, his congregation is said to have amounted to twenty thousand persons. He effected a great moral reform among these colliers by his preaching. "The first discovery," he tells us, "of their being affected, was to see the white gutters made by their tears, which plentifully fell down their black cheeks, as they came out of their coal-pits." After this he preached frequently in the open air in the vicinity of London, and in other parts of the country, to thousands of auditors. SIR HANS SLOANE. This illustrious physician, President of the Royal Society and the College of Physicians, and the founder of the British Museum, was born at Killaleagh, in the north of Ireland, in 1660. He settled in London in 1684, and was in great repute as a practitioner in the time of Radcliffe, with whom he was acquainted, though they were never friends. On his arrival in London, he waited on Sydenham with a letter of introduction, in which a friend had set forth his qualifications in glowing language, as "a ripe scholar, a good botanist, a skilful anatomist." Sydenham read the recommendation, and eyed the young man very narrowly; then he said, "All this is mighty fine, but it won't do. Anatomy--botany--nonsense! Sir, I know an old woman in Covent Garden who understands botany better; and as for anatomy, my butcher can dissect a joint just as well. No, no, young man, this is all stuff; you must go to the bedside,--it is there alone that you can learn disease." In spite of this mortifying reception, however, Sydenham afterwards took the greatest interest in Sloane, frequently making the young man accompany him in his chariot on his favourite airing. It was against the strongly expressed wish of Sydenham that Sloane went to Jamaica--where he gathered abundant materials for the book on the natural history of that island, which he published at intervals from 1707 till 1725. He neglected, when he was settled in successful practice in London, no means that could advance the interests of literature and science. He presented to the Apothecaries' Company the fee-simple of their gardens, on conditions as honourable to their fame as to his own. It was his public spirit and humanity that suggested the plan of the "Dispensary," the opposition to which gave rise to the beautiful and famous poem of Garth, which alone preserves the memory of the contest and the disputants on this much-vexed subject. Sloane was made a baronet in 1716; but his greatest glory was his succession to Sir Isaac Newton in the Presidency of the Royal Society. Sloane had previously acted as secretary; and an evidence is given of the high sense entertained by that body for his services and his virtues, by their expulsion of Dr. Woodward from the council, for affronting him by making grimaces, and by interrupting him, while reading a paper of his own composition, with a grossly insulting remark. Sir Isaac Newton was in the chair when the expulsion of Woodward came under discussion; and some one pleading in his favour that he was a good natural philosopher, Newton interfered with the remark, that "in order to belong to that Society, a man ought to be a good moral philosopher as well as a good natural one." In 1746 Sloane retired from practice; and in 1748 he was visited by the Prince of Wales, the father of George III., who went to see a collection and library that were the ornament of the nation. The Prince duly estimated the value and excellence of the collection, and at the same time remarked "how much it must conduce to the benefit of learning, and how great an honour must redound to Britain, to have it established for public use to the latest posterity." It is probable that by this time the intention of Sir Hans to bequeath his collection to the nation had transpired; at all events, when he died, in 1752, it was found by his will that his collections, which had cost £50,000, and included 50,000 books and manuscripts, had been left to the nation, on condition of the payment of £20,000 to his heirs. Parliament voted £100,000 to fulfil the bargain and increase the collection; and in 1759 the British Museum, founded on Sir Hans Sloane's bequest, was first opened at Montague House. Sir Hans had the reputation of being one of the most abstemious and parsimonious of eminent physicians--his absorbing love for his museum forbidding us to blame or sneer at a failing from which the country reaped such splendid fruit. He is said to have given up his winter soirees in Bloomsbury Square, to save the tea and bread and butter he had to dispense to the guests. At one of the latest of these entertainments, Handel was present, and gave grave offence to the scientific baronet by laying a muffin on one of his books. "To be sure it was a gareless trick," said the composer, a little brutally, when telling the story, "bud it tid no monsdrous mischief; bud it pode the old poog-vorm treadfully oud of sorts. I offered my best apologies, bud the old miser would not have done with it. If it had been a biscuit it would not have mattered; but muffin and pudder! And I said, 'Ah, mine Gotd, that is the rub!--it is the pudder!' Now, mine worthy friend, Sir Hans Sloane, you have a nodable excuse, you may save your doast and pudder, and lay it to that unfeeling gormandizing German; and den I knows it will add something to your life by sparing your burse.'" THE REV. ROWLAND HILL, While once travelling alone, was accosted by a footpad, who, by the agitation of his voice and manner, appeared to be new to his profession. After delivering to the assailant his watch and purse, curiosity prompted Mr. Hill to examine him as to the motives that had urged him to so desperate a course. The man candidly confessed, that being out of employment, with a wife and children who were perishing of want, despair had forced him to turn robber; but that this was the first act of the kind in which he had been engaged. Mr. Hill, struck with the apparent sincerity of the man, and feeling for his distress, gave his name and address, and asked him to call on him the next day. The man did so, and was immediately taken into the service of the humane divine, where he continued till his death. Nor did Mr. Hill ever divulge the circumstance, until he related it in the funeral sermon which he preached on the death of his domestic. The same clergyman being called to visit a sick man, found a poor emaciated creature in a wretched bed, without anything to alleviate his misery. Looking more narrowly, he observed that the man was actually without a shirt, on which Mr. Hill instantly stripped himself, and forced his own upon the reluctant but grateful object; then, buttoning himself up closely, he hastened homewards, sent all that was needed to relieve the destitute being he had left, provided medical aid, and had the satisfaction of restoring a fellow-creature to his family. "MAKE THE MOST OF HIM." Dr. Moore, the author of _Zeluco_, told the following little story, which suggests that physicians are not always disinclined to recoup themselves for their generosity, by making the rich and foolish pay through the nose:--"A wealthy tradesman, after drinking the Bath waters, took a fancy to try the effect of the Bristol hot wells. Armed with an introduction from a Bath physician to a professional brother at Bristol, the invalid set out on his journey. On the road he gave way to his curiosity to read the Doctor's letter of introduction, and cautiously prying into it read these instructive words: 'Dear sir, the bearer is a fat Wiltshire clothier--make the most of him.'" A PACIFIC SHE. Sir William Dawes, Archbishop of York, loved a pun very well. His clergy dining with him for the first time after he had lost his lady, he told them he feared they did not find things in so good order as they used to be in the time of poor Mary; and, looking extremely sorrowful, he added with a deep sigh, "She was, indeed, _Mare Pacificum_." A curate, who knew pretty well what the deceased lady had been in her domestic relations, said, "Aye, my Lord, but she was _Mare Mortuum_ first!" TIME AND ETERNITY. When Archbishop Leighton was minister of a parish in Scotland, the question was asked of the ministers in their Synod or provincial meeting, whether they preached the duties of the times. When it was found that Leighton did not, and he was blamed for his remissness, he made the answer and defence: "If all the brethren have preached on the _times_, may not one poor brother be suffered to preach on _eternity_?" PHYSICIANS AND CLERGYMEN. A peculiar sympathy has always existed between these two professions, when the second had need of the first; and the times were, and for some are not yet past, when the condition of the clergy gave them a very powerful claim on the generosity of the physicians. A poor clergyman, settled in London on a curacy of fifty pounds per annum, with a wife and numerous family, was known to the good Quaker, Dr. Fothergill. An epidemic disease seized upon the curate's wife and five children. In his distress he looked to the doctor for his assistance, but dared not apply to him, not being able to pay him for his attendance. A friend, who knew his situation, kindly offered to accompany him to the Doctor's house, and give him his fee. They took the advantage of his hour of audience; and, after a description of the several cases, the fee was offered, and rejected, but note was taken of the curate's place of residence. The Doctor called assiduously the next and every succeeding day, until his attendance was no longer necessary. The curate, anxious to return some mark of the sense he entertained of the Doctor's services, strained every nerve to accomplish it; but his astonishment was not to be described, when, instead of receiving the money he offered, with apologies for his situation, the Doctor put ten guineas into his hand, desiring him to apply without diffidence in future difficulties.--Dr. Wilson, of Bath, sent a present of £50 to an indigent clergyman, whom he had met in the course of practice. The gentleman who had engaged to convey the gift to the unfortunate priest, said, "Well, then, I'll take the money to him to-morrow." "Oh, my dear sir," said the Doctor, "take it to him to-night. Only think of the importance to a sick man of one good night's rest!" MURRAY AND GIBB, EDINBURGH, PRINTERS TO HER MAJESTY'S STATIONERY OFFICE. CATALOGUE OF POPULAR AND STANDARD BOOKS PUBLISHED BY WILLIAM P. NIMMO, EDINBURGH, _AND SOLD BY ALL BOOKSELLERS_. A SUPERB GIFT-BOOK. The 'Edina' Burns. _JUST READY_, Beautifully printed on the finest toned paper, and elegantly bound in cloth extra, gilt edges, price One Guinea; or Turkey morocco extra, price Two Guineas; or in clan tartan enamelled, with photograph of the Poet, price Two Guineas. _A HANDSOME DRAWING-ROOM EDITION OF_ THE POEMS AND SONGS OF ROBERT BURNS. _WITH ORIGINAL ILLUSTRATIONS BY THE MOST DISTINGUISHED SCOTTISH ARTISTS._ The 'EDINA' EDITION of BURNS contains Sixty-four entirely Original Illustrations, drawn expressly for it; and the names of the Artists who have kindly given their assistance--comprising several of the most distinguished members of the Royal Scottish Academy--are a sufficient guarantee that they are executed in the highest style of art. The engraving of the Illustrations is executed by Mr. R. PATERSON; and the volume is printed by Mr. R. CLARK, Edinburgh. OPINIONS OF THE PRESS ON THE 'EDINA BURNS.' The Times. 'The arts of the printer and engraver show to advantage in this Scotch edition of the Poems and Songs of Burns. The Artists who supply the Illustrations are all of the land of Burns, and the book owes nothing to handicraftsmen on this side the Tweed. Many of the engravings are excellent, particularly the landscape sketches. Altogether the book is a handsome one, and to the "Scot abroad" it would be difficult to make a more acceptable present.' Pall Mall Gazette. 'Mr. Nimmo's illustrated edition of the "Poems and Songs of Robert Burns" is a book upon which the publisher has evidently bestowed great care. Limiting himself to the art and industry of his own country, he has endeavoured to unite Scotland's best draughtsmen, engravers, and printers in the production of a worthy edition of Scotland's greatest and dearest poet. The result is very satisfactory. It is certainly a very meritorious production, and one which does great credit to the publisher.' The Examiner. 'Of all the handsome reprints of the works of "nature's own" bard, this "Edina" edition of the poems and songs of Burns is, perhaps, the handsomest yet produced. Beautifully printed, and profusely illustrated by some of the most distinguished of the Scotch academicians, it forms a shrine worthy of the genius of the "poet of the land of the mountain and the flood."' Court Circular. 'If we were asked what is the best and handsomest edition of Burns extant, we should answer--and we call the special attention of the reader to the distinguishing title which the publisher has affixed to this volume--the "Edina."' Saturday Review. 'This is, as it ought to be, a Scotch edition. It is of Scotland, decidedly Scottish. Scotch as to author, printer, publisher, and illustrator. The whole thing has a decidedly pretty and whiskyish look; or, rather, to speak more decorously, it recalls the land of the heather and the flood throughout.' Illustrated London News. 'The magnificent "Edina" edition of his works is a noble tribute rendered to the genius of Burns by the graphic and typographic skill and taste of Edinburgh, the city which gave him an admiring welcome in his lifetime, and where his monument has been erected.' Court Journal. 'If Burns could have lived to see himself in such a jacket of gold and red as Mr. Nimmo of Edinburgh puts upon him this year, he would, we think, have shed a tear of gratitude, for pride would have been foreign to so great a heart.' Illustrated Times. 'Many editions of the works of the immortal Scottish bard have passed under our notice within the last few years, but none equal to the "Edina Burns," just published by Mr. Nimmo.' NIMMO'S 'CARMINE' GIFT-BOOKS. _NEW AND CHEAPER EDITIONS._ Small 4to, beautifully printed within red lines on superior paper, handsomely bound in cloth extra, bevelled boards, gilt edges, price 7s. 6d., ROSES AND HOLLY: A Gift-Book for all the Year. With Original Illustrations by GOURLAY STEELL, R.S.A.; SAM. BOUGH, A.R.S.A.; JOHN M'WHIRTER; R. HERDMAN, R.S.A.; CLARK STANTON, A.R.S.A.; J. LAWSON, and other eminent Artists. 'This is really a collection of art and literary gems--the prettiest book, take it all in all, that we have seen this season.'--_Illustrated Times_. Uniform with the above, price 7s. 6d., PEN AND PENCIL PICTURES FROM THE POETS. A Series of Forty beautiful Illustrations on Wood, with descriptive selections from the Writings of the Poets, elegantly printed within red lines, on superfine paper. Uniform with the above, price 7s. 6d., GEMS OF LITERATURE: ELEGANT, RARE, AND SUGGESTIVE. A Collection of the most notable beauties of the English Language, appropriately illustrated with upwards of one hundred original engravings, drawn expressly for this work. Beautifully printed within red lines, on superfine paper. 'For really luxurious books, Nimmo's "Pen and Pencil Pictures from the Poets" and "Gems of Literature" may be well recommended. They are luxurious in the binding, in the print, in the engravings, and in the paper.'--_Morning Post._ Uniform with the above, price 7s. 6d., THE BOOK OF ELEGANT EXTRACTS. Profusely Illustrated by the most eminent Artists. Choicely printed on superfine paper, within red lines. Second Edition, imperial 16mo, cloth extra, gilt edges, price 3s. 6d., KARL-OF-THE-LOCKET AND HIS THREE WISHES. A Tale. By DAVID SMITH. 'To that portion of the public which cares about knowing such things, it has not been unknown for some time that Mr. David Smith, brother of the poet Alexander, is likewise in possession of the literary faculty, and even of the gift of song; but this beautiful little book, which will be the delight of all boys and the admiration of many men, so for as we are aware, is the first substantive work from his pen. Meant as it is for a boy's book, it presents a terseness in the style, a poetic tint in the language throughout, and a vividness in the descriptive passages, which we do not often find in such literature in England.'--_Daily Review._ Crown 4to, cloth extra, gilt edges, price 6s., THE NATIONAL MELODIST. TWO HUNDRED STANDARD SONGS, WITH SYMPHONIES AND ACCOMPANIMENTS FOR THE PIANOFORTE. Edited by J. C. KIESER. Demy 4to, cloth extra, gilt edges, price 3s. 6d., THE SCOTTISH MELODIST. FORTY-EIGHT SCOTTISH SONGS AND BALLADS, WITH SYMPHONIES AND ACCOMPANIMENTS FOR THE PIANOFORTE. Edited by J. C. KIESER. The above two volumes are very excellent Collections of First-class Music. The arrangements and accompaniments, as the name of the Editor will sufficiently testify, are admirable. They form handsome and suitable presentation volumes. Demy 8vo, cloth, price 10s. 6d., JAMIESON'S SCOTTISH DICTIONARY. Abridged from the Dictionary and Supplement (in 4 vols. 4to), by JOHN JOHNSTONE. An entirely new Edition, Revised and Enlarged, by JOHN LONGMUIR, A.M., LL.D., formerly Lecturer in King's College and University, Aberdeen. NIMMO'S LIBRARY EDITION OF STANDARD WORKS, WELL ADAPTED FOR Prizes in Upper Classes and High Schools. In large Demy 8vo, with Steel Portrait and Vignette, handsomely bound in cloth extra, in a new style, price 5s. each. THE COMPLETE WORKS OF WILLIAM SHAKESPEARE, based on the Text of Johnson, Steevens, and Reed; with a Biographical Sketch by MARY C. CLARKE; and a Copious Glossary. THE ARABIAN NIGHTS' ENTERTAINMENTS. Translated from the Arabic. An entirely New Edition. Illustrated with upwards of 100 original Engravings. THE COMPLETE POETICAL AND PROSE WORKS OF ROBERT BURNS. With Life and Variorum Notes. THE MISCELLANEOUS WORKS OF OLIVER GOLDSMITH. JOSEPHUS: The Whole Works of FLAVIUS JOSEPHUS, the Jewish Historian. Translated by WHISTON. Ten Volumes, large Crown 8vo, cloth, price £2, 14s., A HANDSOME LIBRARY EDITION OF THE HISTORY OF SCOTLAND, FROM THE ACCESSION OF ALEXANDER III. TO THE UNION. BY PATRICK FRASER TYTLER, F.R.S.E., F.A.S. Also, Four Volumes, Crown 8vo, cloth, price 18s., THE PEOPLE'S EDITION OF TYTLER'S HISTORY OF SCOTLAND. 'The most brilliant age of Scotland is fortunate in having found a historian whose sound judgment is accompanied by a graceful liveliness of imagination. We venture to predict that this book will soon become, and long remain, the standard History of Scotland.'--_Quarterly Review._ 'An accurate, well-digested, well-written History; evincing deliberation, research, judgment, and fidelity.'--_Scotsman._ 'The tenor of the work in general reflects the highest honour on Mr. Tytler's talents and industry.'--_Sir Walter Scott._ 'The want of a complete History of Scotland has been long felt; and from the specimen which the volume before us gives of the author's talents and capacity for the task he has undertaken, it may be reasonably inferred that the deficiency will be very ably supplied. The descriptions of the battles are concise, but full of spirit. The events are themselves of the most romantic kind, and are detailed in a very picturesque and forcible style.'--_Times._ *_* The LIBRARY Edition of TYTLER'S HISTORY OF SCOTLAND may be had in Ten volumes, handsomely bound in tree calf extra; and the PEOPLE'S Edition, Four volumes in Two, tree calf extra. NIMMO'S POPULAR EDITION OF THE WORKS OF THE POETS. In fcap. 8vo, printed on toned paper, elegantly bound in cloth extra, gilt edges, price 3s. 6d. each; or in morocco antique, price 6s. 6d. each. Each Volume contains a Memoir, and is illustrated with a Portrait of the Author, engraved on Steel, and numerous full-page Illustrations on Wood, from designs by eminent Artists. Longfellow's Poetical Works. Scott's Poetical Works. Byron's Poetical Works. Moore's Poetical Works. Wordsworth's Poetical Works. Cowper's Poetical Works. Milton's Poetical Works. Thomson's Poetical Works. Pope's Poetical Works. Beattie and Goldsmith's Poetical Works. Burns's Poetical Works. The Casquet of Gems. A Volume of Choice Selections from the Works of the Poets. The Book of Humorous Poetry. Ballads: Scottish and English. *_* This Series of Books, from the very superior manner in which it is produced, is at once the cheapest and handsomest edition of the Poets in the market. The volumes form elegant and appropriate presents as School Prizes and Gift-Books, either in cloth or morocco. 'They are a marvel of cheapness, some of the volumes extending to as many as 700, and even 900, pages, printed on toned paper in a beautifully clear type. Add to this, that they are profusely illustrated with wood engravings, are elegantly and tastefully bound, and that they are published at 3s. 6d. each, and our recommendation of them is complete.'--_Scotsman._ UNIFORM WITH NIMMO'S POPULAR EDITION OF THE WORKS OF THE POETS. _The Complete Works of Shakespeare._ With Biographical Sketch by MARY COWDEN CLARKE. Two Volumes, price 3s. 6d. each. _The Arabian Nights' Entertainments._ With One Hundred Illustrations on Wood. Two Volumes, price 3s. 6d. each. _Bunyan's Pilgrim's Progress & Holy War._ Complete in One Volume. _Lives of the British Poets_: Biographies of the most eminent British Poets, with Specimens of their Writings. Twelve Portraits on Steel, and Twelve Full-page Illustrations. _The Prose Works of Robert Burns._ Correspondence complete, Remarks on Scottish Song, Letters to Clarinda, Commonplace Books, etc. etc. Crown 8vo, cloth extra, price 3s. 6d., FAMILY PRAYERS FOR FIVE WEEKS, WITH PRAYERS FOR SPECIAL OCCASIONS, AND A TABLE FOR READING THE HOLY SCRIPTURES THROUGHOUT THE YEAR. BY WILLIAM WILSON, MINISTER OF KIPPEN. 'This is an excellent compendium of family prayers. It will be found invaluable to parents and heads of families. The prayers are short, well expressed, and the book as a whole does the author great credit.'--_Perth Advertiser._ 'Thoroughly evangelical and devotional in spirit, beautifully simple and scriptural in expression, and remarkably free from repetition or verbosity, these prayers are admirably adapted either for family use or for private reading.'--_Kelso Chronicle._ NIMMO'S PRESENTATION SERIES OF STANDARD WORKS. * * * * * In small Crown 8vo, printed on toned paper, bound in cloth extra, gilt edges, bevelled boards, with Portrait engraved on Steel, price 3s. 6d. each. * * * * * =WISDOM, WIT, AND ALLEGORY=. Selected from 'The Spectator.' * * * * * =BENJAMIN FRANKLIN=: A BIOGRAPHY. * * * * * =THE WORLD'S WAY=. LAYS OF LIFE AND LABOUR. * * * * * TRAVELS IN AFRICA. THE LIFE AND TRAVELS OF =MUNGO PARK=. With a Supplementary Chapter, detailing the results of recent Discovery in Africa. * * * * * =WALLACE, THE HERO OF SCOTLAND=: A BIOGRAPHY. By James Paterson. * * * * * =EPOCH MEN=, AND THE RESULTS OF THEIR LIVES. By Samuel Neil. =A BOOK OF CHARACTERS=. SELECTED FROM THE WRITINGS OF OVERBURY, EARLE, AND BUTLER. * * * * * =MEN OF HISTORY=. By Eminent Writers. * * * * * =OLD WORLD WORTHIES=; OR, CLASSICAL BIOGRAPHY. SELECTED FROM PLUTARCH'S LIVES. * * * * * =THE MAN OF BUSINESS= Considered in Six Aspects. A BOOK FOR YOUNG MEN. * * * * * =THE HAPPY LIFE=: LAYS OF LOVE AND BROTHERHOOD. * * * * * =WOMEN OF HISTORY=. By Eminent Writers. *_* This elegant and useful Series of Books has been specially prepared for School and College Prizes: they are, however, equally suitable for General Presentation. In selecting the works for this Series, the aim of the publisher has been to produce books of a permanent value, interesting in manner and instructive in matter--books that youth will read eagerly and with profit, and which will be found equally attractive in after life. =NIMMO'S HALF-CROWN REWARD BOOKS.= Extra Foolscap 8vo, cloth elegant, gilt edges, Illustrated, price 2s. 6d. each. I. =Memorable Wars of Scotland.= BY PATRICK FRASER TYTLER, F.R.S.E., Author of 'History of Scotland,' etc. * * * * * II. =Seeing the World=: =A Young Sailor's Own Story=. BY CHARLES NORDHOFF, Author of the 'Young Man-of-War's Man.' * * * * * III. =The Martyr Missionary: Five Years in China=. BY REV. CHARLES P. BUSH, M.A. IV. =My New Home: A Woman's Diary.= By the Author of 'Win and Wear,' etc. * * * * * V. =Home Heroines: Tales for Girls.= BY T. S. ARTHUR, Author of 'Life's Crosses,' 'Orange Blossoms,' etc. * * * * * VI. =Lessons from Women's Lives.= BY SARAH J. HALE. * * * * * NIMMO'S FAVOURITE GIFT-BOOKS. In small 8vo, printed on toned paper, richly bound in cloth and gold and gilt edges, with new and original Frontispiece, printed in colours by KRONHEIM, price 2s. 6d. each. =The Vicar of Wakefield=. =Poems and Essays=. BY OLIVER GOLDSMITH. * * * * * =Bunyan's Pilgrim's Progress=. * * * * * =The Life and Adventures of Robinson Crusoe=. =Æsop's Fables, With Instructive Applications.= BY DR. CROXALL. * * * * * =The History of Sandford and Merton=. * * * * * =Evenings at Home; Or, The Juvenile Budget Opened=. *_* The above are very elegant and remarkably cheap editions of these old favourite Works. NIMMO'S TWO SHILLING REWARD BOOKS. Foolscap 8vo, Illustrated, elegantly bound in cloth extra, bevelled boards, gilt back and side, gilt edges, price 2s. each. I. =The Far North=: Explorations in the Arctic Regions. BY ELISHA KENT KANE, M.D., Commander second 'Grinnell' Expedition in search of Sir John Franklin. II. =The Young Men of the Bible=: A Series of Papers, Biographical and Suggestive. BY REV. JOSEPH A. COLLIER. III. =The Blade and the Ear=: A Book for Young Men. IV. =Monarchs of Ocean=: Narratives of Maritime Discovery and Progress. V. =Life's Crosses, and How to Meet them=. BY T. S. ARTHUR, Author of 'Anna Lee,' 'Orange Blossoms,' etc. VI. =A Father's Legacy to his Daughters; etc=. A Book for Young Women. BY DR. GREGORY. * * * * * NIMMO'S EIGHTEENPENNY REWARD BOOKS. Demy 18mo, Illustrated, cloth extra, gilt edges, price 1s. 6d. each. I. =The Vicar of Wakefield=. Poems and Essays. BY OLIVER GOLDSMITH. II. =Æsop's Fables=, With Instructive Applications. BY DR. CROXALL. III. =Bunyan's Pilgrim's Progress=. IV. =The Young Man-of-War's Man=; A Boy's Voyage round the World. V. =The Treasury of Anecdote=: Moral and Religious. VI. =The Boy's Own Workshop=. BY JACOB ABBOTT. VII. =The Life and Adventures of Robinson Crusoe=. VIII. =The History of Sandford and Merton=. IX. =Evenings at Home=; Or, The Juvenile Budget Opened. *_* The above Series of elegant and useful books are specially prepared for the entertainment and instruction of young persons. NIMMO'S SUNDAY SCHOOL REWARD BOOKS. Fcap. 8vo, cloth extra, gilt edges, Illustrated, price 1s. 6d. each. I. Bible Blessings. BY REV. RICHARD NEWTON, Author of 'The Best Things,' 'The Safe Compass,' 'The King's Highway,' etc. II. One Hour a Week: Fifty-two Bible Lessons for the Young. By the Author of 'Jesus on Earth.' III. The Best Things. BY REV. RICHARD NEWTON. IV. Grace Harvey and her Cousins. By the Author of 'Douglas Farm.' V. Lessons from Rose Hill; AND Little Nannette. VI. Great and Good Women: Biographies for Girls. BY LYDIA H. SIGOURNEY. NIMMO'S ONE SHILLING JUVENILE BOOKS. Foolscap 8vo, Coloured Frontispieces, handsomely bound in cloth, Illuminated, price 1s. each. I. Four Little People and their Friends. II. Elizabeth; Or, The Exiles of Siberia. III. Paul and Virginia. IV. Little Threads: Tangle Thread, Golden Thread, Silver Thread. V. The Perils of Greatness; Or, The Story of Alexander Menzikoff. VI. Barton Todd. VII. Benjamin Franklin: A Biography for Boys. VIII. Little Crowns, and How to Win them. IX. Great Riches: Nelly Rivers' Story. X. The Right Way, and the Contrast. XI. The Daisy's First Winter, And other Stories. XII. The Man of the Mountain. NIMMO'S SIXPENNY JUVENILE BOOKS. Demy 18mo, Illustrated, handsomely bound in cloth, gilt side, gilt edges, price 6d. each. _Pearls for Little People._ _Great Lessons for Little People._ _Reason in Rhyme_: A Poetry Book for the Young. _Æsop's Little Fable Book._ _Grapes from the Great Vine._ _Ways of Doing Good._ _Story Pictures from the Bible._ _The Tables of Stone_: Illustrations of the Commandments. _The Pot of Gold._ _Stories about our Dogs._ By HARRIET BEECHER STOWE. _The Red-Winged Goose._ _The Hermit of the Hills._ NIMMO'S FOURPENNY JUVENILE BOOKS. 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5069	----	THE DOCTOR'S DILEMMA: PREFACE ON DOCTORS By Bernard Shaw 1909 It is not the fault of our doctors that the medical service of the community, as at present provided for, is a murderous absurdity. That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity. But that is precisely what we have done. And the more appalling the mutilation, the more the mutilator is paid. He who corrects the ingrowing toe-nail receives a few shillings: he who cuts your inside out receives hundreds of guineas, except when he does it to a poor person for practice. Scandalized voices murmur that these operations are necessary. They may be. It may also be necessary to hang a man or pull down a house. But we take good care not to make the hangman and the housebreaker the judges of that. If we did, no man's neck would be safe and no man's house stable. But we do make the doctor the judge, and fine him anything from sixpence to several hundred guineas if he decides in our favor. I cannot knock my shins severely without forcing on some surgeon the difficult question, "Could I not make a better use of a pocketful of guineas than this man is making of his leg? Could he not write as well--or even better--on one leg than on two? And the guineas would make all the difference in the world to me just now. My wife--my pretty ones--the leg may mortify--it is always safer to operate--he will be well in a fortnight--artificial legs are now so well made that they are really better than natural ones--evolution is towards motors and leglessness, etc., etc., etc." Now there is no calculation that an engineer can make as to the behavior of a girder under a strain, or an astronomer as to the recurrence of a comet, more certain than the calculation that under such circumstances we shall be dismembered unnecessarily in all directions by surgeons who believe the operations to be necessary solely because they want to perform them. The process metaphorically called bleeding the rich man is performed not only metaphorically but literally every day by surgeons who are quite as honest as most of us. After all, what harm is there in it? The surgeon need not take off the rich man's (or woman's) leg or arm: he can remove the appendix or the uvula, and leave the patient none the worse after a fortnight or so in bed, whilst the nurse, the general practitioner, the apothecary, and the surgeon will be the better. DOUBTFUL CHARACTER BORNE BY THE MEDICAL PROFESSION Again I hear the voices indignantly muttering old phrases about the high character of a noble profession and the honor and conscience of its members. I must reply that the medical profession has not a high character: it has an infamous character. I do not know a single thoughtful and well-informed person who does not feel that the tragedy of illness at present is that it delivers you helplessly into the hands of a profession which you deeply mistrust, because it not only advocates and practises the most revolting cruelties in the pursuit of knowledge, and justifies them on grounds which would equally justify practising the same cruelties on yourself or your children, or burning down London to test a patent fire extinguisher, but, when it has shocked the public, tries to reassure it with lies of breath-bereaving brazenness. That is the character the medical profession has got just now. It may be deserved or it may not: there it is at all events, and the doctors who have not realized this are living in a fool's paradise. As to the humor and conscience of doctors, they have as much as any other class of men, no more and no less. And what other men dare pretend to be impartial where they have a strong pecuniary interest on one side? Nobody supposes that doctors are less virtuous than judges; but a judge whose salary and reputation depended on whether the verdict was for plaintiff or defendant, prosecutor or prisoner, would be as little trusted as a general in the pay of the enemy. To offer me a doctor as my judge, and then weight his decision with a bribe of a large sum of money and a virtual guarantee that if he makes a mistake it can never be proved against him, is to go wildly beyond the ascertained strain which human nature will bear. It is simply unscientific to allege or believe that doctors do not under existing circumstances perform unnecessary operations and manufacture and prolong lucrative illnesses. The only ones who can claim to be above suspicion are those who are so much sought after that their cured patients are immediately replaced by fresh ones. And there is this curious psychological fact to be remembered: a serious illness or a death advertizes the doctor exactly as a hanging advertizes the barrister who defended the person hanged. Suppose, for example, a royal personage gets something wrong with his throat, or has a pain in his inside. If a doctor effects some trumpery cure with a wet compress or a peppermint lozenge nobody takes the least notice of him. But if he operates on the throat and kills the patient, or extirpates an internal organ and keeps the whole nation palpitating for days whilst the patient hovers in pain and fever between life and death, his fortune is made: every rich man who omits to call him in when the same symptoms appear in his household is held not to have done his utmost duty to the patient. The wonder is that there is a king or queen left alive in Europe. DOCTOR'S CONSCIENCES There is another difficulty in trusting to the honor and conscience of a doctor. Doctors are just like other Englishmen: most of them have no honor and no conscience: what they commonly mistake for these is sentimentality and an intense dread of doing anything that everybody else does not do, or omitting to do anything that everybody else does. This of course does amount to a sort of working or rule-of-thumb conscience; but it means that you will do anything, good or bad, provided you get enough people to keep you in countenance by doing it also. It is the sort of conscience that makes it possible to keep order on a pirate ship, or in a troop of brigands. It may be said that in the last analysis there is no other sort of honor or conscience in existence--that the assent of the majority is the only sanction known to ethics. No doubt this holds good in political practice. If mankind knew the facts, and agreed with the doctors, then the doctors would be in the right; and any person who thought otherwise would be a lunatic. But mankind does not agree, and does not know the facts. All that can be said for medical popularity is that until there is a practicable alternative to blind trust in the doctor, the truth about the doctor is so terrible that we dare not face it. Moliere saw through the doctors; but he had to call them in just the same. Napoleon had no illusions about them; but he had to die under their treatment just as much as the most credulous ignoramus that ever paid sixpence for a bottle of strong medicine. In this predicament most people, to save themselves from unbearable mistrust and misery, or from being driven by their conscience into actual conflict with the law, fall back on the old rule that if you cannot have what you believe in you must believe in what you have. When your child is ill or your wife dying, and you happen to be very fond of them, or even when, if you are not fond of them, you are human enough to forget every personal grudge before the spectacle of a fellow creature in pain or peril, what you want is comfort, reassurance, something to clutch at, were it but a straw. This the doctor brings you. You have a wildly urgent feeling that something must be done; and the doctor does something. Sometimes what he does kills the patient; but you do not know that; and the doctor assures you that all that human skill could do has been done. And nobody has the brutality to say to the newly bereft father, mother, husband, wife, brother, or sister, "You have killed your lost darling by your credulity." THE PECULIAR PEOPLE Besides, the calling in of the doctor is now compulsory except in cases where the patient is an adult--and not too ill to decide the steps to be taken. We are subject to prosecution for manslaughter or for criminal neglect if the patient dies without the consolations of the medical profession. This menace is kept before the public by the Peculiar People. The Peculiars, as they are called, have gained their name by believing that the Bible is infallible, and taking their belief quite seriously. The Bible is very clear as to the treatment of illness. The Epistle of James; chapter v., contains the following explicit directions: 14. Is any sick among you? let him call for the elders of the Church; and let them pray over him, anointing him with oil in the name of the Lord: 15. And the prayer of faith shall save the sick, and the Lord shall raise him up; and if he have committed sins, they shall be forgiven him. The Peculiars obey these instructions and dispense with doctors. They are therefore prosecuted for manslaughter when their children die. When I was a young man, the Peculiars were usually acquitted. The prosecution broke down when the doctor in the witness box was asked whether, if the child had had medical attendance, it would have lived. It was, of course, impossible for any man of sense and honor to assume divine omniscience by answering this in the affirmative, or indeed pretending to be able to answer it at all. And on this the judge had to instruct the jury that they must acquit the prisoner. Thus a judge with a keen sense of law (a very rare phenomenon on the Bench, by the way) was spared the possibility of leaving to sentence one prisoner (under the Blasphemy laws) for questioning the authority of Scripture, and another for ignorantly and superstitiously accepting it as a guide to conduct. To-day all this is changed. The doctor never hesitates to claim divine omniscience, nor to clamor for laws to punish any scepticism on the part of laymen. A modern doctor thinks nothing of signing the death certificate of one of his own diphtheria patients, and then going into the witness box and swearing a peculiar into prison for six months by assuring the jury, on oath, that if the prisoner's child, dead of diphtheria, had been placed under his treatment instead of that of St. James, it would not have lived. And he does so not only with impunity, but with public applause, though the logical course would be to prosecute him either for the murder of his own patient or for perjury in the case of St. James. Yet no barrister, apparently, dreams of asking for the statistics of the relative case-mortality in diphtheria among the Peculiars and among the believers in doctors, on which alone any valid opinion could be founded. The barrister is as superstitious as the doctor is infatuated; and the Peculiar goes unpitied to his cell, though nothing whatever has been proved except that his child does without the interference of a doctor as effectually as any of the hundreds of children who die every day of the same diseases in the doctor's care. RECOIL OF THE DOGMA OF MEDICAL INFALLIBILITY ON THE DOCTOR On the other hand, when the doctor is in the dock, or is the defendant in an action for malpractice, he has to struggle against the inevitable result of his former pretences to infinite knowledge and unerring skill. He has taught the jury and the judge, and even his own counsel, to believe that every doctor can, with a glance at the tongue, a touch on the pulse, and a reading of the clinical thermometer, diagnose with absolute certainty a patient's complaint, also that on dissecting a dead body he can infallibly put his finger on the cause of death, and, in cases where poisoning is suspected, the nature of the poison used. Now all this supposed exactness and infallibility is imaginary; and to treat a doctor as if his mistakes were necessarily malicious or corrupt malpractices (an inevitable deduction from the postulate that the doctor, being omniscient, cannot make mistakes) is as unjust as to blame the nearest apothecary for not being prepared to supply you with sixpenny-worth of the elixir of life, or the nearest motor garage for not having perpetual motion on sale in gallon tins. But if apothecaries and motor car makers habitually advertized elixir of life and perpetual motion, and succeeded in creating a strong general belief that they could supply it, they would find themselves in an awkward position if they were indicted for allowing a customer to die, or for burning a chauffeur by putting petrol into his car. That is the predicament the doctor finds himself in when he has to defend himself against a charge of malpractice by a plea of ignorance and fallibility. His plea is received with flat credulity; and he gets little sympathy, even from laymen who know, because he has brought the incredulity on himself. If he escapes, he can only do so by opening the eyes of the jury to the facts that medical science is as yet very imperfectly differentiated from common curemongering witchcraft; that diagnosis, though it means in many instances (including even the identification of pathogenic bacilli under the microscope) only a choice among terms so loose that they would not be accepted as definitions in any really exact science, is, even at that, an uncertain and difficult matter on which doctors often differ; and that the very best medical opinion and treatment varies widely from doctor to doctor, one practitioner prescribing six or seven scheduled poisons for so familiar a disease as enteric fever where another will not tolerate drugs at all; one starving a patient whom another would stuff; one urging an operation which another would regard as unnecessary and dangerous; one giving alcohol and meat which another would sternly forbid, etc., etc., etc.: all these discrepancies arising not between the opinion of good doctors and bad ones (the medical contention is, of course, that a bad doctor is an impossibility), but between practitioners of equal eminence and authority. Usually it is impossible to persuade the jury that these facts are facts. Juries seldom notice facts; and they have been taught to regard any doubts of the omniscience and omnipotence of doctors as blasphemy. Even the fact that doctors themselves die of the very diseases they profess to cure passes unnoticed. We do not shoot out our lips and shake our heads, saying, "They save others: themselves they cannot save": their reputation stands, like an African king's palace, on a foundation of dead bodies; and the result is that the verdict goes against the defendant when the defendant is a doctor accused of malpractice. Fortunately for the doctors, they very seldom find themselves in this position, because it is so difficult to prove anything against them. The only evidence that can decide a case of malpractice is expert evidence: that is, the evidence of other doctors; and every doctor will allow a colleague to decimate a whole countryside sooner than violate the bond of professional etiquet by giving him away. It is the nurse who gives the doctor away in private, because every nurse has some particular doctor whom she likes; and she usually assures her patients that all the others are disastrous noodles, and soothes the tedium of the sick-bed by gossip about their blunders. She will even give a doctor away for the sake of making the patient believe that she knows more than the doctor. But she dare not, for her livelihood, give the doctor away in public. And the doctors stand by one another at all costs. Now and then some doctor in an unassailable position, like the late Sir William Gull, will go into the witness box and say what he really thinks about the way a patient has been treated; but such behavior is considered little short of infamous by his colleagues. WHY DOCTORS DO NOT DIFFER The truth is, there would never be any public agreement among doctors if they did not agree to agree on the main point of the doctor being always in the right. Yet the two guinea man never thinks that the five shilling man is right: if he did, he would be understood as confessing to an overcharge of one pound seventeen shillings; and on the same ground the five shilling man cannot encourage the notion that the owner of the sixpenny surgery round the corner is quite up to his mark. Thus even the layman has to be taught that infallibility is not quite infallible, because there are two qualities of it to be had at two prices. But there is no agreement even in the same rank at the same price. During the first great epidemic of influenza towards the end of the nineteenth century a London evening paper sent round a journalist-patient to all the great consultants of that day, and published their advice and prescriptions; a proceeding passionately denounced by the medical papers as a breach of confidence of these eminent physicians. The case was the same; but the prescriptions were different, and so was the advice. Now a doctor cannot think his own treatment right and at the same time think his colleague right in prescribing a different treatment when the patient is the same. Anyone who has ever known doctors well enough to hear medical shop talked without reserve knows that they are full of stories about each other's blunders and errors, and that the theory of their omniscience and omnipotence no more holds good among themselves than it did with Moliere and Napoleon. But for this very reason no doctor dare accuse another of malpractice. He is not sure enough of his own opinion to ruin another man by it. He knows that if such conduct were tolerated in his profession no doctor's livelihood or reputation would be worth a year's purchase. I do not blame him: I would do the same myself. But the effect of this state of things is to make the medical profession a conspiracy to hide its own shortcomings. No doubt the same may be said of all professions. They are all conspiracies against the laity; and I do not suggest that the medical conspiracy is either better or worse than the military conspiracy, the legal conspiracy, the sacerdotal conspiracy, the pedagogic conspiracy, the royal and aristocratic conspiracy, the literary and artistic conspiracy, and the innumerable industrial, commercial, and financial conspiracies, from the trade unions to the great exchanges, which make up the huge conflict which we call society. But it is less suspected. The Radicals who used to advocate, as an indispensable preliminary to social reform, the strangling of the last king with the entrails of the last priest, substituted compulsory vaccination for compulsory baptism without a murmur. THE CRAZE FOR OPERATIONS Thus everything is on the side of the doctor. When men die of disease they are said to die from natural causes. When they recover (and they mostly do) the doctor gets the credit of curing them. In surgery all operations are recorded as successful if the patient can be got out of the hospital or nursing home alive, though the subsequent history of the case may be such as would make an honest surgeon vow never to recommend or perform the operation again. The large range of operations which consist of amputating limbs and extirpating organs admits of no direct verification of their necessity. There is a fashion in operations as there is in sleeves and skirts: the triumph of some surgeon who has at last found out how to make a once desperate operation fairly safe is usually followed by a rage for that operation not only among the doctors, but actually among their patients. There are men and women whom the operating table seems to fascinate; half-alive people who through vanity, or hypochondria, or a craving to be the constant objects of anxious attention or what not, lose such feeble sense as they ever had of the value of their own organs and limbs. They seem to care as little for mutilation as lobsters or lizards, which at least have the excuse that they grow new claws and new tails if they lose the old ones. Whilst this book was being prepared for the press a case was tried in the Courts, of a man who sued a railway company for damages because a train had run over him and amputated both his legs. He lost his case because it was proved that he had deliberately contrived the occurrence himself for the sake of getting an idler's pension at the expense of the railway company, being too dull to realize how much more he had to lose than to gain by the bargain even if he had won his case and received damages above his utmost hopes. Thus amazing case makes it possible to say, with some prospect of being believed, that there is in the classes who can afford to pay for fashionable operations a sprinkling of persons so incapable of appreciating the relative importance of preserving their bodily integrity, (including the capacity for parentage) and the pleasure of talking about themselves and hearing themselves talked about as the heroes and heroines of sensational operations, that they tempt surgeons to operate on them not only with large fees, but with personal solicitation. Now it cannot be too often repeated that when an operation is once performed, nobody can ever prove that it was unnecessary. If I refuse to allow my leg to be amputated, its mortification and my death may prove that I was wrong; but if I let the leg go, nobody can ever prove that it would not have mortified had I been obstinate. Operation is therefore the safe side for the surgeon as well as the lucrative side. The result is that we hear of "conservative surgeons" as a distinct class of practitioners who make it a rule not to operate if they can possibly help it, and who are sought after by the people who have vitality enough to regard an operation as a last resort. But no surgeon is bound to take the conservative view. If he believes that an organ is at best a useless survival, and that if he extirpates it the patient will be well and none the worse in a fortnight, whereas to await the natural cure would mean a month's illness, then he is clearly justified in recommending the operation even if the cure without operation is as certain as anything of the kind ever can be. Thus the conservative surgeon and the radical or extirpatory surgeon may both be right as far as the ultimate cure is concerned; so that their consciences do not help them out of their differences. CREDULITY AND CHLOROFORM There is no harder scientific fact in the world than the fact that belief can be produced in practically unlimited quantity and intensity, without observation or reasoning, and even in defiance of both, by the simple desire to believe founded on a strong interest in believing. Everybody recognizes this in the case of the amatory infatuations of the adolescents who see angels and heroes in obviously (to others) commonplace and even objectionable maidens and youths. But it holds good over the entire field of human activity. The hardest-headed materialist will become a consulter of table-rappers and slate-writers if he loses a child or a wife so beloved that the desire to revive and communicate with them becomes irresistible. The cobbler believes that there is nothing like leather. The Imperialist who regards the conquest of England by a foreign power as the worst of political misfortunes believes that the conquest of a foreign power by England would be a boon to the conquered. Doctors are no more proof against such illusions than other men. Can anyone then doubt that under existing conditions a great deal of unnecessary and mischievous operating is bound to go on, and that patients are encouraged to imagine that modern surgery and anesthesia have made operations much less serious matters than they really are? When doctors write or speak to the public about operations, they imply, and often say in so many words, that chloroform has made surgery painless. People who have been operated on know better. The patient does not feel the knife, and the operation is therefore enormously facilitated for the surgeon; but the patient pays for the anesthesia with hours of wretched sickness; and when that is over there is the pain of the wound made by the surgeon, which has to heal like any other wound. This is why operating surgeons, who are usually out of the house with their fee in their pockets before the patient has recovered consciousness, and who therefore see nothing of the suffering witnessed by the general practitioner and the nurse, occasionally talk of operations very much as the hangman in Barnaby Rudge talked of executions, as if being operated on were a luxury in sensation as well as in price. MEDICAL POVERTY To make matters worse, doctors are hideously poor. The Irish gentleman doctor of my boyhood, who took nothing less than a guinea, though he might pay you four visits for it, seems to have no equivalent nowadays in English society. Better be a railway porter than an ordinary English general practitioner. A railway porter has from eighteen to twenty-three shillings a week from the Company merely as a retainer; and his additional fees from the public, if we leave the third-class twopenny tip out of account (and I am by no means sure that even this reservation need be made), are equivalent to doctor's fees in the case of second-class passengers, and double doctor's fees in the case of first. Any class of educated men thus treated tends to become a brigand class, and doctors are no exception to the rule. They are offered disgraceful prices for advice and medicine. Their patients are for the most part so poor and so ignorant that good advice would be resented as impracticable and wounding. When you are so poor that you cannot afford to refuse eighteenpence from a man who is too poor to pay you any more, it is useless to tell him that what he or his sick child needs is not medicine, but more leisure, better clothes, better food, and a better drained and ventilated house. It is kinder to give him a bottle of something almost as cheap as water, and tell him to come again with another eighteenpence if it does not cure him. When you have done that over and over again every day for a week, how much scientific conscience have you left? If you are weak-minded enough to cling desperately to your eighteenpence as denoting a certain social superiority to the sixpenny doctor, you will be miserably poor all your life; whilst the sixpenny doctor, with his low prices and quick turnover of patients, visibly makes much more than you do and kills no more people. A doctor's character can no more stand out against such conditions than the lungs of his patients can stand out against bad ventilation. The only way in which he can preserve his self-respect is by forgetting all he ever learnt of science, and clinging to such help as he can give without cost merely by being less ignorant and more accustomed to sick-beds than his patients. Finally, he acquires a certain skill at nursing cases under poverty-stricken domestic conditions, just as women who have been trained as domestic servants in some huge institution with lifts, vacuum cleaners, electric lighting, steam heating, and machinery that turns the kitchen into a laboratory and engine house combined, manage, when they are sent out into the world to drudge as general servants, to pick up their business in a new way, learning the slatternly habits and wretched makeshifts of homes where even bundles of kindling wood are luxuries to be anxiously economized. THE SUCCESSFUL DOCTOR The doctor whose success blinds public opinion to medical poverty is almost as completely demoralized. His promotion means that his practice becomes more and more confined to the idle rich. The proper advice for most of their ailments is typified in Abernethy's "Live on sixpence a day and earn it." But here, as at the other end of the scale, the right advice is neither agreeable nor practicable. And every hypochondriacal rich lady or gentleman who can be persuaded that he or she is a lifelong invalid means anything from fifty to five hundred pounds a year for the doctor. Operations enable a surgeon to earn similar sums in a couple of hours; and if the surgeon also keeps a nursing home, he may make considerable profits at the same time by running what is the most expensive kind of hotel. These gains are so great that they undo much of the moral advantage which the absence of grinding pecuniary anxiety gives the rich doctor over the poor one. It is true that the temptation to prescribe a sham treatment because the real treatment is too dear for either patient or doctor does not exist for the rich doctor. He always has plenty of genuine cases which can afford genuine treatment; and these provide him with enough sincere scientific professional work to save him from the ignorance, obsolescence, and atrophy of scientific conscience into which his poorer colleagues sink. But on the other hand his expenses are enormous. Even as a bachelor, he must, at London west end rates, make over a thousand a year before he can afford even to insure his life. His house, his servants, and his equipage (or autopage) must be on the scale to which his patients are accustomed, though a couple of rooms with a camp bed in one of them might satisfy his own requirements. Above all, the income which provides for these outgoings stops the moment he himself stops working. Unlike the man of business, whose managers, clerks, warehousemen and laborers keep his business going whilst he is in bed or in his club, the doctor cannot earn a farthing by deputy. Though he is exceptionally exposed to infection, and has to face all weathers at all hours of the night and day, often not enjoying a complete night's rest for a week, the money stops coming in the moment he stops going out; and therefore illness has special terrors for him, and success no certain permanence. He dare not stop making hay while the sun shines; for it may set at any time. Men do not resist pressure of this intensity. When they come under it as doctors they pay unnecessary visits; they write prescriptions that are as absurd as the rub of chalk with which an Irish tailor once charmed away a wart from my father's finger; they conspire with surgeons to promote operations; they nurse the delusions of the malade imaginaire (who is always really ill because, as there is no such thing as perfect health, nobody is ever really well); they exploit human folly, vanity, and fear of death as ruthlessly as their own health, strength, and patience are exploited by selfish hypochondriacs. They must do all these things or else run pecuniary risks that no man can fairly be asked to run. And the healthier the world becomes, the more they are compelled to live by imposture and the less by that really helpful activity of which all doctors get enough to preserve them from utter corruption. For even the most hardened humbug who ever prescribed ether tonics to ladies whose need for tonics is of precisely the same character as the need of poorer women for a glass of gin, has to help a mother through child-bearing often enough to feel that he is not living wholly in vain. THE PSYCHOLOGY OF SELF-RESPECT IN SURGEONS The surgeon, though often more unscrupulous than the general practitioner, retains his self-respect more easily. The human conscience can subsist on very questionable food. No man who is occupied in doing a very difficult thing, and doing it very well, ever loses his self-respect. The shirk, the duffer, the malingerer, the coward, the weakling, may be put out of countenance by his own failures and frauds; but the man who does evil skilfully, energetically, masterfully, grows prouder and bolder at every crime. The common man may have to found his self-respect on sobriety, honesty and industry; but a Napoleon needs no such props for his sense of dignity. If Nelson's conscience whispered to him at all in the silent watches of the night, you may depend on it it whispered about the Baltic and the Nile and Cape St. Vincent, and not about his unfaithfulness to his wife. A man who robs little children when no one is looking can hardly have much self-respect or even self-esteem; but an accomplished burglar must be proud of himself. In the play to which I am at present preluding I have represented an artist who is so entirely satisfied with his artistic conscience, even to the point of dying like a saint with its support, that he is utterly selfish and unscrupulous in every other relation without feeling at the smallest disadvantage. The same thing may be observed in women who have a genius for personal attractiveness: they expend more thought, labor, skill, inventiveness, taste and endurance on making themselves lovely than would suffice to keep a dozen ugly women honest; and this enables them to maintain a high opinion of themselves, and an angry contempt for unattractive and personally careless women, whilst they lie and cheat and slander and sell themselves without a blush. The truth is, hardly any of us have ethical energy enough for more than one really inflexible point of honor. Andrea del Sarto, like Louis Dubedat in my play, must have expended on the attainment of his great mastery of design and his originality in fresco painting more conscientiousness and industry than go to the making of the reputations of a dozen ordinary mayors and churchwardens; but (if Vasari is to be believed) when the King of France entrusted him with money to buy pictures for him, he stole it to spend on his wife. Such cases are not confined to eminent artists. Unsuccessful, unskilful men are often much more scrupulous than successful ones. In the ranks of ordinary skilled labor many men are to be found who earn good wages and are never out of a job because they are strong, indefatigable, and skilful, and who therefore are bold in a high opinion of themselves; but they are selfish and tyrannical, gluttonous and drunken, as their wives and children know to their cost. Not only do these talented energetic people retain their self-respect through shameful misconduct: they do not even lose the respect of others, because their talents benefit and interest everybody, whilst their vices affect only a few. An actor, a painter, a composer, an author, may be as selfish as he likes without reproach from the public if only his art is superb; and he cannot fulfil his condition without sufficient effort and sacrifice to make him feel noble and martyred in spite of his selfishness. It may even happen that the selfishness of an artist may be a benefit to the public by enabling him to concentrate himself on their gratification with a recklessness of every other consideration that makes him highly dangerous to those about him. In sacrificing others to himself he is sacrificing them to the public he gratifies; and the public is quite content with that arrangement. The public actually has an interest in the artist's vices. It has no such interest in the surgeon's vices. The surgeon's art is exercised at its expense, not for its gratification. We do not go to the operating table as we go to the theatre, to the picture gallery, to the concert room, to be entertained and delighted: we go to be tormented and maimed, lest a worse thing should befall us. It is of the most extreme importance to us that the experts on whose assurance we face this horror and suffer this mutilation should leave no interests but our own to think of; should judge our cases scientifically; and should feel about them kindly. Let us see what guarantees we have: first for the science, and then for the kindness. ARE DOCTORS MEN OF SCIENCE? I presume nobody will question the existence of widely spread popular delusion that every doctor is a titan of science. It is escaped only in the very small class which understands by science something more than conjuring with retorts and spirit lamps, magnets and microscopes, and discovering magical cures for disease. To a sufficiently ignorant man every captain of a trading schooner is a Galileo, every organ-grinder a Beethoven, every piano-tuner a Hemholtz, every Old Bailey barrister a Solon, every Seven Dials pigeon dealer a Darwin, every scrivener a Shakespear, every locomotive engine a miracle, and its driver no less wonderful than George Stephenson. As a matter of fact, the rank and file of doctors are no more scientific than their tailors; or, if you prefer to put it the reverse way, their tailors are no less scientific than they. Doctoring is an art, not a science: any layman who is interested in science sufficiently to take in one of the scientific journals and follow the literature of the scientific movement, knows more about it than those doctors (probably a large majority) who are not interested in it, and practise only to earn their bread. Doctoring is not even the art of keeping people in health (no doctor seems able to advise you what to eat any better than his grandmother or the nearest quack): it is the art of curing illnesses. It does happen exceptionally that a practising doctor makes a contribution to science (my play describes a very notable one); but it happens much oftener that he draws disastrous conclusions from his clinical experience because he has no conception of scientific method, and believes, like any rustic, that the handling of evidence and statistics needs no expertness. The distinction between a quack doctor and a qualified one is mainly that only the qualified one is authorized to sign death certificates, for which both sorts seem to have about equal occasion. Unqualified practitioners now make large incomes as hygienists, and are resorted to as frequently by cultivated amateur scientists who understand quite well what they are doing as by ignorant people who are simply dupes. Bone-setters make fortunes under the very noses of our greatest surgeons from educated and wealthy patients; and some of the most successful doctors on the register use quite heretical methods of treating disease, and have qualified themselves solely for convenience. Leaving out of account the village witches who prescribe spells and sell charms, the humblest professional healers in this country are the herbalists. These men wander through the fields on Sunday seeking for herbs with magic properties of curing disease, preventing childbirth, and the like. Each of them believes that he is on the verge of a great discovery, in which Virginia Snake Root will be an ingredient, heaven knows why! Virginia Snake Root fascinates the imagination of the herbalist as mercury used to fascinate the alchemists. On week days he keeps a shop in which he sells packets of pennyroyal, dandelion, etc., labelled with little lists of the diseases they are supposed to cure, and apparently do cure to the satisfaction of the people who keep on buying them. I have never been able to perceive any distinction between the science of the herbalist and that of the duly registered doctor. A relative of mine recently consulted a doctor about some of the ordinary symptoms which indicate the need for a holiday and a change. The doctor satisfied himself that the patient's heart was a little depressed. Digitalis being a drug labelled as a heart specific by the profession, he promptly administered a stiff dose. Fortunately the patient was a hardy old lady who was not easily killed. She recovered with no worse result than her conversion to Christian Science, which owes its vogue quite as much to public despair of doctors as to superstition. I am not, observe, here concerned with the question as to whether the dose of digitalis was judicious or not; the point is, that a farm laborer consulting a herbalist would have been treated in exactly the same way. BACTERIOLOGY AS A SUPERSTITION The smattering of science that all--even doctors--pick up from the ordinary newspapers nowadays only makes the doctor more dangerous than he used to be. Wise men used to take care to consult doctors qualified before 1860, who were usually contemptuous of or indifferent to the germ theory and bacteriological therapeutics; but now that these veterans have mostly retired or died, we are left in the hands of the generations which, having heard of microbes much as St. Thomas Aquinas heard of angels, suddenly concluded that the whole art of healing could be summed up in the formula: Find the microbe and kill it. And even that they did not know how to do. The simplest way to kill most microbes is to throw them into an open street or river and let the sun shine on them, which explains the fact that when great cities have recklessly thrown all their sewage into the open river the water has sometimes been cleaner twenty miles below the city than thirty miles above it. But doctors instinctively avoid all facts that are reassuring, and eagerly swallow those that make it a marvel that anyone could possibly survive three days in an atmosphere consisting mainly of countless pathogenic germs. They conceive microbes as immortal until slain by a germicide administered by a duly qualified medical man. All through Europe people are adjured, by public notices and even under legal penalties, not to throw their microbes into the sunshine, but to collect them carefully in a handkerchief; shield the handkerchief from the sun in the darkness and warmth of the pocket; and send it to a laundry to be mixed up with everybody else's handkerchiefs, with results only too familiar to local health authorities. In the first frenzy of microbe killing, surgical instruments were dipped in carbolic oil, which was a great improvement on not dipping them in anything at all and simply using them dirty; but as microbes are so fond of carbolic oil that they swarm in it, it was not a success from the anti-microbe point of view. Formalin was squirted into the circulation of consumptives until it was discovered that formalin nourishes the tubercle bacillus handsomely and kills men. The popular theory of disease is the common medical theory: namely, that every disease had its microbe duly created in the garden of Eden, and has been steadily propagating itself and producing widening circles of malignant disease ever since. It was plain from the first that if this had been even approximately true, the whole human race would have been wiped out by the plague long ago, and that every epidemic, instead of fading out as mysteriously as it rushed in, would spread over the whole world. It was also evident that the characteristic microbe of a disease might be a symptom instead of a cause. An unpunctual man is always in a hurry; but it does not follow that hurry is the cause of unpunctuality: on the contrary, what is the matter with the patient is sloth. When Florence Nightingale said bluntly that if you overcrowded your soldiers in dirty quarters there would be an outbreak of smallpox among them, she was snubbed as an ignorant female who did not know that smallpox can be produced only by the importation of its specific microbe. If this was the line taken about smallpox, the microbe of which has never yet been run down and exposed under the microscope by the bacteriologist, what must have been the ardor of conviction as to tuberculosis, tetanus, enteric fever, Maltese fever, diphtheria, and the rest of the diseases in which the characteristic bacillus had been identified! When there was no bacillus it was assumed that, since no disease could exist without a bacillus, it was simply eluding observation. When the bacillus was found, as it frequently was, in persons who were not suffering from the disease, the theory was saved by simply calling the bacillus an impostor, or pseudobacillus. The same boundless credulity which the public exhibit as to a doctor's power of diagnosis was shown by the doctors themselves as to the analytic microbe hunters. These witch finders would give you a certificate of the ultimate constitution of anything from a sample of the water from your well to a scrap of your lungs, for seven-and-sixpense. I do not suggest that the analysts were dishonest. No doubt they carried the analysis as far as they could afford to carry it for the money. No doubt also they could afford to carry it far enough to be of some use. But the fact remains that just as doctors perform for half-a-crown, without the least misgiving, operations which could not be thoroughly and safely performed with due scientific rigor and the requisite apparatus by an unaided private practitioner for less than some thousands of pounds, so did they proceed on the assumption that they could get the last word of science as to the constituents of their pathological samples for a two hours cab fare. ECONOMIC DIFFICULTIES OF IMMUNIZATION I have heard doctors affirm and deny almost every possible proposition as to disease and treatment. I can remember the time when doctors no more dreamt of consumption and pneumonia being infectious than they now dream of sea-sickness being infectious, or than so great a clinical observer as Sydenham dreamt of smallpox being infectious. I have heard doctors deny that there is such a thing as infection. I have heard them deny the existence of hydrophobia as a specific disease differing from tetanus. I have heard them defend prophylactic measures and prophylactic legislation as the sole and certain salvation of mankind from zymotic disease; and I have heard them denounce both as malignant spreaders of cancer and lunacy. But the one objection I have never heard from a doctor is the objection that prophylaxis by the inoculatory methods most in vogue is an economic impossibility under our private practice system. They buy some stuff from somebody for a shilling, and inject a pennyworth of it under their patient's skin for half-a-crown, concluding that, since this primitive rite pays the somebody and pays them, the problem of prophylaxis has been satisfactorily solved. The results are sometimes no worse than the ordinary results of dirt getting into cuts; but neither the doctor nor the patient is quite satisfied unless the inoculation "takes"; that is, unless it produces perceptible illness and disablement. Sometimes both doctor and patient get more value in this direction than they bargain for. The results of ordinary private-practice-inoculation at their worst are bad enough to be indistinguishable from those of the most discreditable and dreaded disease known; and doctors, to save the credit of the inoculation, have been driven to accuse their patient or their patient's parents of having contracted this disease independently of the inoculation, an excuse which naturally does not make the family any more resigned, and leads to public recriminations in which the doctors, forgetting everything but the immediate quarrel, naively excuse themselves by admitting, and even claiming as a point in their favor, that it is often impossible to distinguish the disease produced by their inoculation and the disease they have accused the patient of contracting. And both parties assume that what is at issue is the scientific soundness of the prophylaxis. It never occurs to them that the particular pathogenic germ which they intended to introduce into the patient's system may be quite innocent of the catastrophe, and that the casual dirt introduced with it may be at fault. When, as in the case of smallpox or cowpox, the germ has not yet been detected, what you inoculate is simply undefined matter that has been scraped off an anything but chemically clean calf suffering from the disease in question. You take your chance of the germ being in the scrapings, and, lest you should kill it, you take no precautions against other germs being in it as well. Anything may happen as the result of such an inoculation. Yet this is the only stuff of the kind which is prepared and supplied even in State establishments: that is, in the only establishments free from the commercial temptation to adulterate materials and scamp precautionary processes. Even if the germ were identified, complete precautions would hardly pay. It is true that microbe farming is not expensive. The cost of breeding and housing two head of cattle would provide for the breeding and housing of enough microbes to inoculate the entire population of the globe since human life first appeared on it. But the precautions necessary to insure that the inoculation shall consist of nothing else but the required germ in the proper state of attenuation are a very different matter from the precautions necessary in the distribution and consumption of beefsteaks. Yet people expect to find vaccines and antitoxins and the like retailed at "popular prices" in private enterprise shops just as they expect to find ounces of tobacco and papers of pins. THE PERILS OF INOCULATION The trouble does not end with the matter to be inoculated. There is the question of the condition of the patient. The discoveries of Sir Almroth Wright have shown that the appalling results which led to the hasty dropping in 1894 of Koch's tuberculin were not accidents, but perfectly orderly and inevitable phenomena following the injection of dangerously strong "vaccines" at the wrong moment, and reinforcing the disease instead of stimulating the resistance to it. To ascertain the right moment a laboratory and a staff of experts are needed. The general practitioner, having no such laboratory and no such experience, has always chanced it, and insisted, when he was unlucky, that the results were not due to the inoculation, but to some other cause: a favorite and not very tactful one being the drunkenness or licentiousness of the patient. But though a few doctors have now learnt the danger of inoculating without any reference to the patient's "opsonic index" at the moment of inoculation, and though those other doctors who are denouncing the danger as imaginary and opsonin as a craze or a fad, obviously do so because it involves an operation which they have neither the means nor the knowledge to perform, there is still no grasp of the economic change in the situation. They have never been warned that the practicability of any method of extirpating disease depends not only on its efficacy, but on its cost. For example, just at present the world has run raving mad on the subject of radium, which has excited our credulity precisely as the apparitions at Lourdes excited the credulity of Roman Catholics. Suppose it were ascertained that every child in the world could be rendered absolutely immune from all disease during its entire life by taking half an ounce of radium to every pint of its milk. The world would be none the healthier, because not even a Crown Prince--no, not even the son of a Chicago Meat King, could afford the treatment. Yet it is doubtful whether doctors would refrain from prescribing it on that ground. The recklessness with which they now recommend wintering in Egypt or at Davos to people who cannot afford to go to Cornwall, and the orders given for champagne jelly and old port in households where such luxuries must obviously be acquired at the cost of stinting necessaries, often make one wonder whether it is possible for a man to go through a medical training and retain a spark of common sense. This sort of inconsiderateness gets cured only in the classes where poverty, pretentious as it is even at its worst, cannot pitch its pretences high enough to make it possible for the doctor (himself often no better off than the patient) to assume that the average income of an English family is about 2,000 pounds a year, and that it is quite easy to break up a home, sell an old family seat at a sacrifice, and retire into a foreign sanatorium devoted to some "treatment" that did not exist two years ago and probably will not exist (except as a pretext for keeping an ordinary hotel) two years hence. In a poor practice the doctor must find cheap treatments for cheap people, or humiliate and lose his patients either by prescribing beyond their means or sending them to the public hospitals. When it comes to prophylactic inoculation, the alternative lies between the complete scientific process, which can only be brought down to a reasonable cost by being very highly organized as a public service in a public institution, and such cheap, nasty, dangerous and scientifically spurious imitations as ordinary vaccination, which seems not unlikely to be ended, like its equally vaunted forerunner, XVIII. century inoculation, by a purely reactionary law making all sorts of vaccination, scientific or not, criminal offences. Naturally, the poor doctor (that is, the average doctor) defends ordinary vaccination frantically, as it means to him the bread of his children. To secure the vehement and practically unanimous support of the rank and file of the medical profession for any sort of treatment or operation, all that is necessary is that it can be easily practised by a rather shabbily dressed man in a surgically dirty room in a surgically dirty house without any assistance, and that the materials for it shall cost, say, a penny, and the charge for it to a patient with 100 pounds a year be half-a-crown. And, on the other hand, a hygienic measure has only to be one of such refinement, difficulty, precision and costliness as to be quite beyond the resources of private practice, to be ignored or angrily denounced as a fad. TRADE UNIONISM AND SCIENCE Here we have the explanation of the savage rancor that so amazes people who imagine that the controversy concerning vaccination is a scientific one. It has really nothing to do with science. The medical profession, consisting for the most part of very poor men struggling to keep up appearances beyond their means, find themselves threatened with the extinction of a considerable part of their incomes: a part, too, that is easily and regularly earned, since it is independent of disease, and brings every person born into the nation, healthy or not, to the doctors. To boot, there is the occasional windfall of an epidemic, with its panic and rush for revaccination. Under such circumstances, vaccination would be defended desperately were it twice as dirty, dangerous, and unscientific in method as it actually is. The note of fury in the defence, the feeling that the anti-vaccinator is doing a cruel, ruinous, inconsiderate thing in a mood of indignant folly: all this, so puzzling to the observer who knows nothing of the economic side of the question, and only sees that the anti-vaccinator, having nothing whatever to gain and a good deal to lose by placing himself in opposition to the law and to the outcry that adds private persecution to legal penalties, can have no interest in the matter except the interest of a reformer in abolishing a corrupt and mischievous superstition, becomes intelligible the moment the tragedy of medical poverty and the lucrativeness of cheap vaccination is taken into account. In the face of such economic pressure as this, it is silly to expect that medical teaching, any more than medical practice, can possibly be scientific. The test to which all methods of treatment are finally brought is whether they are lucrative to doctors or not. It would be difficult to cite any proposition less obnoxious to science, than that advanced by Hahnemann: to wit, that drugs which in large doses produce certain symptoms, counteract them in very small doses, just as in more modern practice it is found that a sufficiently small inoculation with typhoid rallies our powers to resist the disease instead of prostrating us with it. But Hahnemann and his followers were frantically persecuted for a century by generations of apothecary-doctors whose incomes depended on the quantity of drugs they could induce their patients to swallow. These two cases of ordinary vaccination and homeopathy are typical of all the rest. Just as the object of a trade union under existing conditions must finally be, not to improve the technical quality of the work done by its members, but to secure a living wage for them, so the object of the medical profession today is to secure an income for the private doctor; and to this consideration all concern for science and public health must give way when the two come into conflict. Fortunately they are not always in conflict. Up to a certain point doctors, like carpenters and masons, must earn their living by doing the work that the public wants from them; and as it is not in the nature of things possible that such public want should be based on unmixed disutility, it may be admitted that doctors have their uses, real as well as imaginary. But just as the best carpenter or mason will resist the introduction of a machine that is likely to throw him out of work, or the public technical education of unskilled laborers' sons to compete with him, so the doctor will resist with all his powers of persecution every advance of science that threatens his income. And as the advance of scientific hygiene tends to make the private doctor's visits rarer, and the public inspector's frequenter, whilst the advance of scientific therapeutics is in the direction of treatments that involve highly organized laboratories, hospitals, and public institutions generally, it unluckily happens that the organization of private practitioners which we call the medical profession is coming more and more to represent, not science, but desperate and embittered antiscience: a statement of things which is likely to get worse until the average doctor either depends upon or hopes for an appointment in the public health service for his livelihood. So much for our guarantees as to medical science. Let us now deal with the more painful subject of medical kindness. DOCTORS AND VIVISECTION The importance to our doctors of a reputation for the tenderest humanity is so obvious, and the quantity of benevolent work actually done by them for nothing (a great deal of it from sheer good nature) so large, that at first sight it seems unaccountable that they should not only throw all their credit away, but deliberately choose to band themselves publicly with outlaws and scoundrels by claiming that in the pursuit of their professional knowledge they should be free from the restraints of law, of honor, of pity, of remorse, of everything that distinguishes an orderly citizen from a South Sea buccaneer, or a philosopher from an inquisitor. For here we look in vain for either an economic or a sentimental motive. In every generation fools and blackguards have made this claim; and honest and reasonable men, led by the strongest contemporary minds, have repudiated it and exposed its crude rascality. From Shakespear and Dr. Johnson to Ruskin and Mark Twain, the natural abhorrence of sane mankind for the vivisector's cruelty, and the contempt of able thinkers for his imbecile casuistry, have been expressed by the most popular spokesmen of humanity. If the medical profession were to outdo the Anti-Vivisection Societies in a general professional protest against the practice and principles of the vivisectors, every doctor in the kingdom would gain substantially by the immense relief and reconciliation which would follow such a reassurance of the humanity of the doctor. Not one doctor in a thousand is a vivisector, or has any interest in vivisection, either pecuniary or intellectual, or would treat his dog cruelly or allow anyone else to do it. It is true that the doctor complies with the professional fashion of defending vivisection, and assuring you that people like Shakespear and Dr. Johnson and Ruskin and Mark Twain are ignorant sentimentalists, just as he complies with any other silly fashion: the mystery is, how it became the fashion in spite of its being so injurious to those who follow it. Making all possible allowance for the effect of the brazen lying of the few men who bring a rush of despairing patients to their doors by professing in letters to the newspapers to have learnt from vivisection how to cure certain diseases, and the assurances of the sayers of smooth things that the practice is quite painless under the law, it is still difficult to find any civilized motive for an attitude by which the medical profession has everything to lose and nothing to gain. THE PRIMITIVE SAVAGE MOTIVE I say civilized motive advisedly; for primitive tribal motives are easy enough to find. Every savage chief who is not a Mahomet learns that if he wishes to strike the imagination of his tribe--and without doing that he can rule them--he must terrify or revolt them from time to time by acts of hideous cruelty or disgusting unnaturalness. We are far from being as superior to such tribes as we imagine. It is very doubtful indeed whether Peter the Great could have effected the changes he made in Russia if he had not fascinated and intimidated his people by his monstrous cruelties and grotesque escapades. Had he been a nineteenth-century king of England, he would have had to wait for some huge accidental calamity: a cholera epidemic, a war, or an insurrection, before waking us up sufficiently to get anything done. Vivisection helps the doctor to rule us as Peter ruled the Russians. The notion that the man who does dreadful things is superhuman, and that therefore he can also do wonderful things either as ruler, avenger, healer, or what not, is by no means confined to barbarians. Just as the manifold wickednesses and stupidities of our criminal code are supported, not by any general comprehension of law or study of jurisprudence, not even by simple vindictiveness, but by the superstition that a calamity of any sort must be expiated by a human sacrifice; so the wickednesses and stupidities of our medicine men are rooted in superstitions that have no more to do with science than the traditional ceremony of christening an ironclad has to do with the effectiveness of its armament. We have only to turn to Macaulay's description of the treatment of Charles II in his last illness to see how strongly his physicians felt that their only chance of cheating death was by outraging nature in tormenting and disgusting their unfortunate patient. True, this was more than two centuries ago; but I have heard my own nineteenth-century grandfather describe the cupping and firing and nauseous medicines of his time with perfect credulity as to their beneficial effects; and some more modern treatments appear to me quite as barbarous. It is in this way that vivisection pays the doctor. It appeals to the fear and credulity of the savage in us; and without fear and credulity half the private doctor's occupation and seven-eighths of his influence would be gone. THE HIGHER MOTIVE. THE TREE OF KNOWLEDGE. But the greatest force of all on the side of vivisection is the mighty and indeed divine force of curiosity. Here we have no decaying tribal instinct which men strive to root out of themselves as they strive to root out the tiger's lust for blood. On the contrary, the curiosity of the ape, or of the child who pulls out the legs and wings of a fly to see what it will do without them, or who, on being told that a cat dropped out of the window will always fall on its legs, immediately tries the experiment on the nearest cat from the highest window in the house (I protest I did it myself from the first floor only), is as nothing compared to the thirst for knowledge of the philosopher, the poet, the biologist, and the naturalist. I have always despised Adam because he had to be tempted by the woman, as she was by the serpent, before he could be induced to pluck the apple from the tree of knowledge. I should have swallowed every apple on the tree the moment the owner's back was turned. When Gray said "Where ignorance is bliss, 'tis folly to be wise," he forgot that it is godlike to be wise; and since nobody wants bliss particularly, or could stand more than a very brief taste of it if it were attainable, and since everybody, by the deepest law of the Life Force, desires to be godlike, it is stupid, and indeed blasphemous and despairing, to hope that the thirst for knowledge will either diminish or consent to be subordinated to any other end whatsoever. We shall see later on that the claim that has arisen in this way for the unconditioned pursuit of knowledge is as idle as all dreams of unconditioned activity; but none the less the right to knowledge must be regarded as a fundamental human right. The fact that men of science have had to fight so hard to secure its recognition, and are still so vigorously persecuted when they discover anything that is not quite palatable to vulgar people, makes them sorely jealous for that right; and when they hear a popular outcry for the suppression of a method of research which has an air of being scientific, their first instinct is to rally to the defence of that method without further consideration, with the result that they sometimes, as in the case of vivisection, presently find themselves fighting on a false issue. THE FLAW IN THE ARGUMENT I may as well pause here to explain their error. The right to know is like the right to live. It is fundamental and unconditional in its assumption that knowledge, like life, is a desirable thing, though any fool can prove that ignorance is bliss, and that "a little knowledge is a dangerous thing" (a little being the most that any of us can attain), as easily as that the pains of life are more numerous and constant than its pleasures, and that therefore we should all be better dead. The logic is unimpeachable; but its only effect is to make us say that if these are the conclusions logic leads to, so much the worse for logic, after which curt dismissal of Folly, we continue living and learning by instinct: that is, as of right. We legislate on the assumption that no man may be killed on the strength of a demonstration that he would be happier in his grave, not even if he is dying slowly of cancer and begs the doctor to despatch him quickly and mercifully. To get killed lawfully he must violate somebody else's right to live by committing murder. But he is by no means free to live unconditionally. In society he can exercise his right to live only under very stiff conditions. In countries where there is compulsory military service he may even have to throw away his individual life to save the life of the community. It is just so in the case of the right to knowledge. It is a right that is as yet very imperfectly recognized in practice. But in theory it is admitted that an adult person in pursuit of knowledge must not be refused it on the ground that he would be better or happier without it. Parents and priests may forbid knowledge to those who accept their authority; and social taboo may be made effective by acts of legal persecution under cover of repressing blasphemy, obscenity, and sedition; but no government now openly forbids its subjects to pursue knowledge on the ground that knowledge is in itself a bad thing, or that it is possible for any of us to have too much of it. LIMITATIONS OF THE RIGHT TO KNOWLEDGE But neither does any government exempt the pursuit of knowledge, any more than the pursuit of life, liberty, and happiness (as the American Constitution puts it), from all social conditions. No man is allowed to put his mother into the stove because he desires to know how long an adult woman will survive at a temperature of 500 degrees Fahrenheit, no matter how important or interesting that particular addition to the store of human knowledge may be. A man who did so would have short work made not only of his right to knowledge, but of his right to live and all his other rights at the same time. The right to knowledge is not the only right; and its exercise must be limited by respect for other rights, and for its own exercise by others. When a man says to Society, "May I torture my mother in pursuit of knowledge?" Society replies, "No." If he pleads, "What! Not even if I have a chance of finding out how to cure cancer by doing it?" Society still says, "Not even then." If the scientist, making the best of his disappointment, goes on to ask may he torture a dog, the stupid and callous people who do not realize that a dog is a fellow-creature and sometimes a good friend, may say Yes, though Shakespear, Dr. Johnson and their like may say No. But even those who say "You may torture A dog" never say "You may torture MY dog." And nobody says, "Yes, because in the pursuit of knowledge you may do as you please." Just as even the stupidest people say, in effect, "If you cannot attain to knowledge without burning your mother you must do without knowledge," so the wisest people say, "If you cannot attain to knowledge without torturing a dog, you must do without knowledge." A FALSE ALTERNATIVE But in practice you cannot persuade any wise man that this alternative can ever be forced on anyone but a fool, or that a fool can be trusted to learn anything from any experiment, cruel or humane. The Chinaman who burnt down his house to roast his pig was no doubt honestly unable to conceive any less disastrous way of cooking his dinner; and the roast must have been spoiled after all (a perfect type of the average vivisectionist experiment); but this did not prove that the Chinaman was right: it only proved that the Chinaman was an incapable cook and, fundamentally, a fool. Take another celebrated experiment: one in sanitary reform. In the days of Nero Rome was in the same predicament as London to-day. If some one would burn down London, and it were rebuilt, as it would now have to be, subject to the sanitary by-laws and Building Act provisions enforced by the London County Council, it would be enormously improved; and the average lifetime of Londoners would be considerably prolonged. Nero argued in the same way about Rome. He employed incendiaries to set it on fire; and he played the harp in scientific raptures whilst it was burning. I am so far of Nero's way of thinking that I have often said, when consulted by despairing sanitary reformers, that what London needs to make her healthy is an earthquake. Why, then, it may be asked, do not I, as a public-spirited man, employ incendiaries to set it on fire, with a heroic disregard of the consequences to myself and others? Any vivisector would, if he had the courage of his opinions. The reasonable answer is that London can be made healthy without burning her down; and that as we have not enough civic virtue to make her healthy in a humane and economical way, we should not have enough to rebuild her in that way. In the old Hebrew legend, God lost patience with the world as Nero did with Rome, and drowned everybody except a single family. But the result was that the progeny of that family reproduced all the vices of their predecessors so exactly that the misery caused by the flood might just as well have been spared: things went on just as they did before. In the same way, the lists of diseases which vivisection claims to have cured is long; but the returns of the Registrar-General show that people still persist in dying of them as if vivisection had never been heard of. Any fool can burn down a city or cut an animal open; and an exceptionally foolish fool is quite likely to promise enormous benefits to the race as the result of such activities. But when the constructive, benevolent part of the business comes to be done, the same want of imagination, the same stupidity and cruelty, the same laziness and want of perseverance that prevented Nero or the vivisector from devising or pushing through humane methods, prevents him from bringing order out of the chaos and happiness out of the misery he has made. At one time it seemed reasonable enough to declare that it was impossible to find whether or not there was a stone inside a man's body except by exploring it with a knife, or to find out what the sun is made of without visiting it in a balloon. Both these impossibilities have been achieved, but not by vivisectors. The Rontgen rays need not hurt the patient; and spectrum analysis involves no destruction. After such triumphs of humane experiment and reasoning, it is useless to assure us that there is no other key to knowledge except cruelty. When the vivisector offers us that assurance, we reply simply and contemptuously, "You mean that you are not clever or humane or energetic enough to find one." CRUELTY FOR ITS OWN SAKE It will now, I hope, be clear why the attack on vivisection is not an attack on the right to knowledge: why, indeed, those who have the deepest conviction of the sacredness of that right are the leaders of the attack. No knowledge is finally impossible of human attainment; for even though it may be beyond our present capacity, the needed capacity is not unattainable. Consequently no method of investigation is the only method; and no law forbidding any particular method can cut us off from the knowledge we hope to gain by it. The only knowledge we lose by forbidding cruelty is knowledge at first hand of cruelty itself, which is precisely the knowledge humane people wish to be spared. But the question remains: Do we all really wish to be spared that knowledge? Are humane methods really to be preferred to cruel ones? Even if the experiments come to nothing, may not their cruelty be enjoyed for its own sake, as a sensational luxury? Let us face these questions boldly, not shrinking from the fact that cruelty is one of the primitive pleasures of mankind, and that the detection of its Protean disguises as law, education, medicine, discipline, sport and so forth, is one of the most difficult of the unending tasks of the legislator. OUR OWN CRUELTIES At first blush it may seem not only unnecessary, but even indecent, to discuss such a proposition as the elevation of cruelty to the rank of a human right. Unnecessary, because no vivisector confesses to a love of cruelty for its own sake or claims any general fundamental right to be cruel. Indecent, because there is an accepted convention to repudiate cruelty; and vivisection is only tolerated by the law on condition that, like judicial torture, it shall be done as mercifully as the nature of the practice allows. But the moment the controversy becomes embittered, the recriminations bandied between the opposed parties bring us face-to-face with some very ugly truths. On one occasion I was invited to speak at a large Anti-Vivisection meeting in the Queen's Hall in London. I found myself on the platform with fox hunters, tame stag hunters, men and women whose calendar was divided, not by pay days and quarter days, but by seasons for killing animals for sport: the fox, the hare, the otter, the partridge and the rest having each its appointed date for slaughter. The ladies among us wore hats and cloaks and head-dresses obtained by wholesale massacres, ruthless trappings, callous extermination of our fellow creatures. We insisted on our butchers supplying us with white veal, and were large and constant consumers of pate de foie gras; both comestibles being obtained by revolting methods. We sent our sons to public schools where indecent flogging is a recognized method of taming the young human animal. Yet we were all in hysterics of indignation at the cruelties of the vivisectors. These, if any were present, must have smiled sardonically at such inhuman humanitarians, whose daily habits and fashionable amusements cause more suffering in England in a week than all the vivisectors of Europe do in a year. I made a very effective speech, not exclusively against vivisection, but against cruelty; and I have never been asked to speak since by that Society, nor do I expect to be, as I should probably give such offence to its most affluent subscribers that its attempts to suppress vivisection would be seriously hindered. But that does not prevent the vivisectors from freely using the "youre another" retort, and using it with justice. We must therefore give ourselves no airs of superiority when denouncing the cruelties of vivisection. We all do just as horrible things, with even less excuse. But in making that admission we are also making short work of the virtuous airs with which we are sometimes referred to the humanity of the medical profession as a guarantee that vivisection is not abused--much as if our burglars should assure us that they arc too honest to abuse the practice of burgling. We are, as a matter of fact, a cruel nation; and our habit of disguising our vices by giving polite names to the offences we are determined to commit does not, unfortunately for my own comfort, impose on me. Vivisectors can hardly pretend to be better than the classes from which they are drawn, or those above them; and if these classes are capable of sacrificing animals in various cruel ways under cover of sport, fashion, education, discipline, and even, when the cruel sacrifices are human sacrifices, of political economy, it is idle for the vivisector to pretend that he is incapable of practising cruelty for pleasure or profit or both under the cloak of science. We are all tarred with the same brush; and the vivisectors are not slow to remind us of it, and to protest vehemently against being branded as exceptionally cruel and its devisors of horrible instruments of torture by people whose main notion of enjoyment is cruel sport, and whose requirements in the way of villainously cruel traps occupy pages of the catalogue of the Army and Navy Stores. THE SCIENTIFIC INVESTIGATION OF CRUELTY There is in man a specific lust for cruelty which infects even his passion of pity and makes it savage. Simple disgust at cruelty is very rare. The people who turn sick and faint and those who gloat are often alike in the pains they take to witness executions, floggings, operations or any other exhibitions of suffering, especially those involving bloodshed, blows, and laceration. A craze for cruelty can be developed just as a craze for drink can; and nobody who attempts to ignore cruelty as a possible factor in the attraction of vivisection and even of antivivisection, or in the credulity with which we accept its excuses, can be regarded as a scientific investigator of it. Those who accuse vivisectors of indulging the well-known passion of cruelty under the cloak of research are therefore putting forward a strictly scientific psychological hypothesis, which is also simple, human, obvious, and probable. It may be as wounding to the personal vanity of the vivisector as Darwin's Origin of Species was to the people who could not bear to think that they were cousins to the monkeys (remember Goldsmith's anger when he was told that he could not move his upper jaw); but science has to consider only the truth of the hypothesis, and not whether conceited people will like it or not. In vain do the sentimental champions of vivisection declare themselves the most humane of men, inflicting suffering only to relieve it, scrupulous in the use of anesthetics, and void of all passion except the passion of pity for a disease-ridden world. The really scientific investigator answers that the question cannot be settled by hysterical protestations, and that if the vivisectionist rejects deductive reasoning, he had better clear his character by his own favorite method of experiment. SUGGESTED LABORATORY TESTS OF THE VIVISECTOR'S EMOTIONS Take the hackneyed case of the Italian who tortured mice, ostensibly to find out about the effects of pain rather less than the nearest dentist could have told him, and who boasted of the ecstatic sensations (he actually used the word love) with which he carried out his experiments. Or the gentleman who starved sixty dogs to death to establish the fact that a dog deprived of food gets progressively lighter and weaker, becoming remarkably emaciated, and finally dying: an undoubted truth, but ascertainable without laboratory experiments by a simple enquiry addressed to the nearest policeman, or, failing him, to any sane person in Europe. The Italian is diagnosed as a cruel voluptuary: the dog-starver is passed over as such a hopeless fool that it is impossible to take any interest in him. Why not test the diagnosis scientifically? Why not perform a careful series of experiments on persons under the influence of voluptuous ecstasy, so as to ascertain its physiological symptoms? Then perform a second series on persons engaged in mathematical work or machine designing, so as to ascertain the symptoms of cold scientific activity? Then note the symptoms of a vivisector performing a cruel experiment; and compare them with the voluptuary symptoms and the mathematical symptoms? Such experiments would be quite as interesting and important as any yet undertaken by the vivisectors. They might open a line of investigation which would finally make, for instance, the ascertainment of the guilt or innocence of an accused person a much exacter process than the very fallible methods of our criminal courts. But instead of proposing such an investigation, our vivisectors offer us all the pious protestations and all the huffy recriminations that any common unscientific mortal offers when he is accused of unworthy conduct. ROUTINE Yet most vivisectors would probably come triumphant out of such a series of experiments, because vivisection is now a routine, like butchering or hanging or flogging; and many of the men who practise it do so only because it has been established as part of the profession they have adopted. Far from enjoying it, they have simply overcome their natural repugnance and become indifferent to it, as men inevitably become indifferent to anything they do often enough. It is this dangerous power of custom that makes it so difficult to convince the common sense of mankind that any established commercial or professional practice has its root in passion. Let a routine once spring from passion, and you will presently find thousands of routineers following it passionlessly for a livelihood. Thus it always seems strained to speak of the religious convictions of a clergyman, because nine out of ten clergymen have no religions convictions: they are ordinary officials carrying on a routine of baptizing, marrying, and churching; praying, reciting, and preaching; and, like solicitors or doctors, getting away from their duties with relief to hunt, to garden, to keep bees, to go into society, and the like. In the same way many people do cruel and vile things without being in the least cruel or vile, because the routine to which they have been brought up is superstitiously cruel and vile. To say that every man who beats his children and every schoolmaster who flogs a pupil is a conscious debauchee is absurd: thousands of dull, conscientious people beat their children conscientiously, because they were beaten themselves and think children ought to be beaten. The ill-tempered vulgarity that instinctively strikes at and hurts a thing that annoys it (and all children are annoying), and the simple stupidity that requires from a child perfection beyond the reach of the wisest and best adults (perfect truthfulness coupled with perfect obedience is quite a common condition of leaving a child unwhipped), produce a good deal of flagellation among people who not only do not lust after it, but who hit the harder because they are angry at having to perform an uncomfortable duty. These people will beat merely to assert their authority, or to carry out what they conceive to be a divine order on the strength of the precept of Solomon recorded in the Bible, which carefully adds that Solomon completely spoilt his own son and turned away from the god of his fathers to the sensuous idolatry in which he ended his days. In the same way we find men and women practising vivisection as senselessly as a humane butcher, who adores his fox terrier, will cut a calf's throat and hang it up by its heels to bleed slowly to death because it is the custom to eat veal and insist on its being white; or as a German purveyor nails a goose to a board and stuffs it with food because fashionable people eat pate de foie gras; or as the crew of a whaler breaks in on a colony of seals and clubs them to death in wholesale massacre because ladies want sealskin jackets; or as fanciers blind singing birds with hot needles, and mutilate the ears and tails of dogs and horses. Let cruelty or kindness or anything else once become customary and it will be practised by people to whom it is not at all natural, but whose rule of life is simply to do only what everybody else does, and who would lose their employment and starve if they indulged in any peculiarity. A respectable man will lie daily, in speech and in print, about the qualities of the article he lives by selling, because it is customary to do so. He will flog his boy for telling a lie, because it is customary to do so. He will also flog him for not telling a lie if the boy tells inconvenient or disrespectful truths, because it is customary to do so. He will give the same boy a present on his birthday, and buy him a spade and bucket at the seaside, because it is customary to do so, being all the time neither particularly mendacious, nor particularly cruel, nor particularly generous, but simply incapable of ethical judgment or independent action. Just so do we find a crowd of petty vivisectionists daily committing atrocities and stupidities, because it is the custom to do so. Vivisection is customary as part of the routine of preparing lectures in medical schools. For instance, there are two ways of making the action of the heart visible to students. One, a barbarous, ignorant, and thoughtless way, is to stick little flags into a rabbit's heart and let the students see the flags jump. The other, an elegant, ingenious, well-informed, and instructive way, is to put a sphygmograph on the student's wrist and let him see a record of his heart's action traced by a needle on a slip of smoked paper. But it has become the custom for lecturers to teach from the rabbit; and the lecturers are not original enough to get out of their groove. Then there are the demonstrations which are made by cutting up frogs with scissors. The most humane man, however repugnant the operation may be to him at first, cannot do it at lecture after lecture for months without finally--and that very soon--feeling no more for the frog than if he were cutting up pieces of paper. Such clumsy and lazy ways of teaching are based on the cheapness of frogs and rabbits. If machines were as cheap as frogs, engineers would not only be taught the anatomy of machines and the functions of their parts: they would also have machines misused and wrecked before them so that they might learn as much as possible by using their eyes, and as little as possible by using their brains and imaginations. Thus we have, as part of the routine of teaching, a routine of vivisection which soon produces complete indifference to it on the part even of those who are naturally humane. If they pass on from the routine of lecture preparation, not into general practice, but into research work, they carry this acquired indifference with them into the laboratory, where any atrocity is possible, because all atrocities satisfy curiosity. The routine man is in the majority in his profession always: consequently the moment his practice is tracked down to its source in human passion there is a great and quite sincere poohpoohing from himself, from the mass of the profession, and from the mass of the public, which sees that the average doctor is much too commonplace and decent a person to be capable of passionate wickedness of any kind. Here then, we have in vivisection, as in all the other tolerated and instituted cruelties, this anti-climax: that only a negligible percentage of those who practise and consequently defend it get any satisfaction out of it. As in Mr. Galsworthy's play Justice the useless and detestable torture of solitary imprisonment is shown at its worst without the introduction of a single cruel person into the drama, so it would be possible to represent all the torments of vivisection dramatically without introducing a single vivisector who had not felt sick at his first experience in the laboratory. Not that this can exonerate any vivisector from suspicion of enjoying his work (or her work: a good deal of the vivisection in medical schools is done by women). In every autobiography which records a real experience of school or prison life, we find that here and there among the routineers there is to be found the genuine amateur, the orgiastic flogging schoolmaster or the nagging warder, who has sought out a cruel profession for the sake of its cruelty. But it is the genuine routineer who is the bulwark of the practice, because, though you can excite public fury against a Sade, a Bluebeard, or a Nero, you cannot rouse any feeling against dull Mr. Smith doing his duty: that is, doing the usual thing. He is so obviously no better and no worse than anyone else that it is difficult to conceive that the things he does are abominable. If you would see public dislike surging up in a moment against an individual, you must watch one who does something unusual, no matter how sensible it may be. The name of Jonas Hanway lives as that of a brave man because he was the first who dared to appear in the streets of this rainy island with an umbrella. THE OLD LINE BETWEEN MAN AND BEAST But there is still a distinction to be clung to by those who dare not tell themselves the truth about the medical profession because they are so helplessly dependent on it when death threatens the household. That distinction is the line that separates the brute from the man in the old classification. Granted, they will plead, that we are all cruel; yet the tame-stag-hunter does not hunt men; and the sportsman who lets a leash of greyhounds loose on a hare would be horrified at the thought of letting them loose on a human child. The lady who gets her cloak by flaying a sable does not flay a negro; nor does it ever occur to her that her veal cutlet might be improved on by a slice of tender baby. Now there was a time when some trust could be placed in this distinction. The Roman Catholic Church still maintains, with what it must permit me to call a stupid obstinacy, and in spite of St. Francis and St. Anthony, that animals have no souls and no rights; so that you cannot sin against an animal, or against God by anything you may choose to do to an animal. Resisting the temptation to enter on an argument as to whether you may not sin against your own soul if you are unjust or cruel to the least of those whom St. Francis called his little brothers, I have only to point out here that nothing could be more despicably superstitious in the opinion of a vivisector than the notion that science recognizes any such step in evolution as the step from a physical organism to an immortal soul. That conceit has been taken out of all our men of science, and out of all our doctors, by the evolutionists; and when it is considered how completely obsessed biological science has become in our days, not by the full scope of evolution, but by that particular method of it which has neither sense nor purpose nor life nor anything human, much less godlike, in it: by the method, that is, of so-called Natural Selection (meaning no selection at all, but mere dead accident and luck), the folly of trusting to vivisectors to hold the human animal any more sacred than the other animals becomes so clear that it would be waste of time to insist further on it. As a matter of fact the man who once concedes to the vivisector the right to put a dog outside the laws of honor and fellowship, concedes to him also the right to put himself outside them; for he is nothing to the vivisector but a more highly developed, and consequently more interesting-to-experiment-on vertebrate than the dog. VIVISECTING THE HUMAN SUBJECT I have in my hand a printed and published account by a doctor of how he tested his remedy for pulmonary tuberculosis, which was to inject a powerful germicide directly into the circulation by stabbing a vein with a syringe. He was one of those doctors who are able to command public sympathy by saying, quite truly, that when they discovered that the proposed treatment was dangerous, they experimented thenceforth on themselves. In this case the doctor was devoted enough to carry his experiments to the point of running serious risks, and actually making himself very uncomfortable. But he did not begin with himself. His first experiment was on two hospital patients. On receiving a message from the hospital to the effect that these two martyrs to therapeutic science had all but expired in convulsions, he experimented on a rabbit, which instantly dropped dead. It was then, and not until then, that he began to experiment on himself, with the germicide modified in the direction indicated by the experiments made on the two patients and the rabbit. As a good many people countenance vivisection because they fear that if the experiments are not made on rabbits they will be made on themselves, it is worth noting that in this case, where both rabbits and men were equally available, the men, being, of course, enormously more instructive, and costing nothing, were experimented on first. Once grant the ethics of the vivisectionists and you not only sanction the experiment on the human subject, but make it the first duty of the vivisector. If a guinea pig may be sacrificed for the sake of the very little that can be learnt from it, shall not a man be sacrificed for the sake of the great deal that can be learnt from him? At all events, he is sacrificed, as this typical case shows. I may add (not that it touches the argument) that the doctor, the patients, and the rabbit all suffered in vain, as far as the hoped-for rescue of the race from pulmonary consumption is concerned. "THE LIE IS A EUROPEAN POWER" Now at the very time when the lectures describing these experiments were being circulated in print and discussed eagerly by the medical profession, the customary denials that patients are experimented on were as loud, as indignant, as high-minded as ever, in spite of the few intelligent doctors who point out rightly that all treatments are experiments on the patient. And this brings us to an obvious but mostly overlooked weakness in the vivisector's position: that is, his inevitable forfeiture of all claim to have his word believed. It is hardly to be expected that a man who does not hesitate to vivisect for the sake of science will hesitate to lie about it afterwards to protect it from what he deems the ignorant sentimentality of the laity. When the public conscience stirs uneasily and threatens suppression, there is never wanting some doctor of eminent position and high character who will sacrifice himself devotedly to the cause of science by coming forward to assure the public on his honor that all experiments on animals are completely painless; although he must know that the very experiments which first provoked the antivivisection movement by their atrocity were experiments to ascertain the physiological effects of the sensation of extreme pain (the much more interesting physiology of pleasure remains uninvestigated) and that all experiments in which sensation is a factor are voided by its suppression. Besides, vivisection may be painless in cases where the experiments are very cruel. If a person scratches me with a poisoned dagger so gently that I do not feel the scratch, he has achieved a painless vivisection; but if I presently die in torment I am not likely to consider that his humility is amply vindicated by his gentleness. A cobra's bite hurts so little that the creature is almost, legally speaking, a vivisector who inflicts no pain. By giving his victims chloroform before biting them he could comply with the law completely. Here, then, is a pretty deadlock. Public support of vivisection is founded almost wholly on the assurances of the vivisectors that great public benefits may be expected from the practice. Not for a moment do I suggest that such a defence would be valid even if proved. But when the witnesses begin by alleging that in the cause of science all the customary ethical obligations (which include the obligation to tell the truth) are suspended, what weight can any reasonable person give to their testimony? I would rather swear fifty lies than take an animal which had licked my hand in good fellowship and torture it. If I did torture the dog, I should certainly not have the face to turn round and ask how any person there suspect an honorable man like myself of telling lies. Most sensible and humane people would, I hope, reply flatly that honorable men do not behave dishonorably, even to dogs. The murderer who, when asked by the chaplain whether he had any other crimes to confess, replied indignantly, "What do you take me for?" reminds us very strongly of the vivisectors who are so deeply hurt when their evidence is set aside as worthless. AN ARGUMENT WHICH WOULD DEFEND ANY CRIME The Achilles heel of vivisection, however, is not to be found in the pain it causes, but in the line of argument by which it is justified. The medical code regarding it is simply criminal anarchism at its very worst. Indeed no criminal has yet had the impudence to argue as every vivisector argues. No burglar contends that as it is admittedly important to have money to spend, and as the object of burglary is to provide the burglar with money to spend, and as in many instances it has achieved this object, therefore the burglar is a public benefactor and the police are ignorant sentimentalists. No highway robber has yet harrowed us with denunciations of the puling moralist who allows his child to suffer all the evils of poverty because certain faddists think it dishonest to garotte an alderman. Thieves and assassins understand quite well that there are paths of acquisition, even of the best things, that are barred to all men of honor. Again, has the silliest burglar ever pretended that to put a stop to burglary is to put a stop to industry? All the vivisections that have been performed since the world began have produced nothing so important as the innocent and honorable discovery of radiography; and one of the reasons why radiography was not discovered sooner was that the men whose business it was to discover new clinical methods were coarsening and stupefying themselves with the sensual villanies and cutthroat's casuistries of vivisection. The law of the conservation of energy holds good in physiology as in other things: every vivisector is a deserter from the army of honorable investigators. But the vivisector does not see this. He not only calls his methods scientific: he contends that there are no other scientific methods. When you express your natural loathing for his cruelty and your natural contempt for his stupidity, he imagines that you are attacking science. Yet he has no inkling of the method and temper of science. The point at issue being plainly whether he is a rascal or not, he not only insists that the real point is whether some hotheaded antivivisectionist is a liar (which he proves by ridiculously unscientific assumptions as to the degree of accuracy attainable in human statement), but never dreams of offering any scientific evidence by his own methods. There are many paths to knowledge already discovered; and no enlightened man doubts that there are many more waiting to be discovered. Indeed, all paths lead to knowledge; because even the vilest and stupidest action teaches us something about vileness and stupidity, and may accidentally teach us a good deal more: for instance, a cutthroat learns (and perhaps teaches) the anatomy of the carotid artery and jugular vein; and there can be no question that the burning of St. Joan of Arc must have been a most instructive and interesting experiment to a good observer, and could have been made more so if it had been carried out by skilled physiologists under laboratory conditions. The earthquake in San Francisco proved invaluable as an experiment in the stability of giant steel buildings; and the ramming of the Victoria by the Camperdown settled doubtful points of the greatest importance in naval warfare. According to vivisectionist logic our builders would be justified in producing artificial earthquakes with dynamite, and our admirals in contriving catastrophes at naval manoeuvres, in order to follow up the line of research thus accidentally discovered. The truth is, if the acquisition of knowledge justifies every sort of conduct, it justifies any sort of conduct, from the illumination of Nero's feasts by burning human beings alive (another interesting experiment) to the simplest act of kindness. And in the light of that truth it is clear that the exemption of the pursuit of knowledge from the laws of honor is the most hideous conceivable enlargement of anarchy; worse, by far, than an exemption of the pursuit of money or political power, since there can hardly be attained without some regard for at least the appearances of human welfare, whereas a curious devil might destroy the whole race in torment, acquiring knowledge all the time from his highly interesting experiment. There is more danger in one respectable scientist countenancing such a monstrous claim than in fifty assassins or dynamitards. The man who makes it is ethically imbecile; and whoever imagines that it is a scientific claim has not the faintest conception of what science means. The paths to knowledge are countless. One of these paths is a path through darkness, secrecy, and cruelty. When a man deliberately turns from all other paths and goes down that one, it is scientific to infer that what attracts him is not knowledge, since there are other paths to that, but cruelty. With so strong and scientific a case against him, it is childish for him to stand on his honor and reputation and high character and the credit of a noble profession and so forth: he must clear himself either by reason or by experiment, unless he boldly contends that evolution has retained a passion of cruelty in man just because it is indispensable to the fulness of his knowledge. THOU ART THE MAN I shall not be at all surprised if what I have written above has induced in sympathetic readers a transport of virtuous indignation at the expense of the medical profession. I shall not damp so creditable and salutary a sentiment; but I must point out that the guilt is shared by all of us. It is not in his capacity of healer and man of science that the doctor vivisects or defends vivisection, but in his entirely vulgar lay capacity. He is made of the same clay as the ignorant, shallow, credulous, half-miseducated, pecuniarily anxious people who call him in when they have tried in vain every bottle and every pill the advertizing druggist can persuade them to buy. The real remedy for vivisection is the remedy for all the mischief that the medical profession and all the other professions are doing: namely, more knowledge. The juries which send the poor Peculiars to prison, and give vivisectionists heavy damages against humane persons who accuse them of cruelty; the editors and councillors and student-led mobs who are striving to make Vivisection one of the watchwords of our civilization, are not doctors: they are the British public, all so afraid to die that they will cling frantically to any idol which promises to cure all their diseases, and crucify anyone who tells them that they must not only die when their time comes, but die like gentlemen. In their paroxysms of cowardice and selfishness they force the doctors to humor their folly and ignorance. How complete and inconsiderate their ignorance is can only be realized by those who have some knowledge of vital statistics, and of the illusions which beset Public Health legislation. WHAT THE PUBLIC WANTS AND WILL NOT GET The demands of this poor public are not reasonable, but they are quite simple. It dreads disease and desires to be protected against it. But it is poor and wants to be protected cheaply. Scientific measures are too hard to understand, too costly, too clearly tending towards a rise in the rates and more public interference with the insanitary, because insufficiently financed, private house. What the public wants, therefore, is a cheap magic charm to prevent, and a cheap pill or potion to cure, all disease. It forces all such charms on the doctors. THE VACCINATION CRAZE Thus it was really the public and not the medical profession that took up vaccination with irresistible faith, sweeping the invention out of Jenner's hand and establishing it in a form which he himself repudiated. Jenner was not a man of science; but he was not a fool; and when he found that people who had suffered from cowpox either by contagion in the milking shed or by vaccination, were not, as he had supposed, immune from smallpox, he ascribed the cases of immunity which had formerly misled him to a disease of the horse, which, perhaps because we do not drink its milk and eat its flesh, is kept at a greater distance in our imagination than our foster mother the cow. At all events, the public, which had been boundlessly credulous about the cow, would not have the horse on any terms; and to this day the law which prescribes Jennerian vaccination is carried out with an anti-Jennerian inoculation because the public would have it so in spite of Jenner. All the grossest lies and superstitions which have disgraced the vaccination craze were taught to the doctors by the public. It was not the doctors who first began to declare that all our old men remember the time when almost every face they saw in the street was horribly pitted with smallpox, and that all this disfigurement has vanished since the introduction of vaccination. Jenner himself alluded to this imaginary phenomenon before the introduction of vaccination, and attributed it to the older practice of smallpox inoculation, by which Voltaire, Catherine II. and Lady Mary Wortley Montagu so confidently expected to see the disease made harmless. It was not Jenner who set people declaring that smallpox, if not abolished by vaccination, had at least been made much milder: on the contrary, he recorded a pre-vaccination epidemic in which none of the persons attacked went to bed or considered themselves as seriously ill. Neither Jenner, nor any other doctor ever, as far as I know, inculcated the popular notion that everybody got smallpox as a matter of course before vaccination was invented. That doctors get infected with these delusions, and are in their unprofessional capacity as members of the public subject to them like other men, is true; but if we had to decide whether vaccination was first forced on the public by the doctors or on the doctors by the public, we should have to decide against the public. STATISTICAL ILLUSIONS Public ignorance of the laws of evidence and of statistics can hardly be exaggerated. There may be a doctor here and there who in dealing with the statistics of disease has taken at least the first step towards sanity by grasping the fact that as an attack of even the commonest disease is an exceptional event, apparently over-whelming statistical evidence in favor of any prophylactic can be produced by persuading the public that everybody caught the disease formerly. Thus if a disease is one which normally attacks fifteen per cent of the population, and if the effect of a prophylactic is actually to increase the proportion to twenty per cent, the publication of this figure of twenty per cent will convince the public that the prophylactic has reduced the percentage by eighty per cent instead of increasing it by five, because the public, left to itself and to the old gentlemen who are always ready to remember, on every possible subject, that things used to be much worse than they are now (such old gentlemen greatly outnumber the laudatores tempori acti), will assume that the former percentage was about 100. The vogue of the Pasteur treatment of hydrophobia, for instance, was due to the assumption by the public that every person bitten by a rabid dog necessarily got hydrophobia. I myself heard hydrophobia discussed in my youth by doctors in Dublin before a Pasteur Institute existed, the subject having been brought forward there by the scepticism of an eminent surgeon as to whether hydrophobia is really a specific disease or only ordinary tetanus induced (as tetanus was then supposed to be induced) by a lacerated wound. There were no statistics available as to the proportion of dog bites that ended in hydrophobia; but nobody ever guessed that the cases could be more than two or three per cent of the bites. On me, therefore, the results published by the Pasteur Institute produced no such effect as they did on the ordinary man who thinks that the bite of a mad dog means certain hydrophobia. It seemed to me that the proportion of deaths among the cases treated at the Institute was rather higher, if anything, than might have been expected had there been no Institute in existence. But to the public every Pasteur patient who did not die was miraculously saved from an agonizing death by the beneficent white magic of that most trusty of all wizards, the man of science. Even trained statisticians often fail to appreciate the extent to which statistics are vitiated by the unrecorded assumptions of their interpreters. Their attention is too much occupied with the cruder tricks of those who make a corrupt use of statistics for advertizing purposes. There is, for example, the percentage dodge. In some hamlet, barely large enough to have a name, two people are attacked during a smallpox epidemic. One dies: the other recovers. One has vaccination marks: the other has none. Immediately either the vaccinists or the antivaccinists publish the triumphant news that at such and such a place not a single vaccinated person died of smallpox whilst 100 per cent of the unvaccinated perished miserably; or, as the case may be, that 100 per cent of the unvaccinated recovered whilst the vaccinated succumbed to the last man. Or, to take another common instance, comparisons which are really comparisons between two social classes with different standards of nutrition and education are palmed off as comparisons between the results of a certain medical treatment and its neglect. Thus it is easy to prove that the wearing of tall hats and the carrying of umbrellas enlarges the chest, prolongs life, and confers comparative immunity from disease; for the statistics show that the classes which use these articles are bigger, healthier, and live longer than the class which never dreams of possessing such things. It does not take much perspicacity to see that what really makes this difference is not the tall hat and the umbrella, but the wealth and nourishment of which they are evidence, and that a gold watch or membership of a club in Pall Mall might be proved in the same way to have the like sovereign virtues. A university degree, a daily bath, the owning of thirty pairs of trousers, a knowledge of Wagner's music, a pew in church, anything, in short, that implies more means and better nurture than the mass of laborers enjoy, can be statistically palmed off as a magic-spell conferring all sorts of privileges. In the case of a prophylactic enforced by law, this illusion is intensified grotesquely, because only vagrants can evade it. Now vagrants have little power of resisting any disease: their death rate and their case-mortality rate is always high relatively to that of respectable folk. Nothing is easier, therefore, than to prove that compliance with any public regulation produces the most gratifying results. It would be equally easy even if the regulation actually raised the death-rate, provided it did not raise it sufficiently to make the average householder, who cannot evade regulations, die as early as the average vagrant who can. THE SURPRISES OF ATTENTION AND NEGLECT There is another statistical illusion which is independent of class differences. A common complaint of houseowners is that the Public Health Authorities frequently compel them to instal costly sanitary appliances which are condemned a few years later as dangerous to health, and forbidden under penalties. Yet these discarded mistakes are always made in the first instance on the strength of a demonstration that their introduction has reduced the death-rate. The explanation is simple. Suppose a law were made that every child in the nation should be compelled to drink a pint of brandy per month, but that the brandy must be administered only when the child was in good health, with its digestion and so forth working normally, and its teeth either naturally or artificially sound. Probably the result would be an immediate and startling reduction in child mortality, leading to further legislation increasing the quantity of brandy to a gallon. Not until the brandy craze had been carried to a point at which the direct harm done by it would outweigh the incidental good, would an anti-brandy party be listened to. That incidental good would be the substitution of attention to the general health of children for the neglect which is now the rule so long as the child is not actually too sick to run about and play as usual. Even if this attention were confined to the children's teeth, there would be an improvement which it would take a good deal of brandy to cancel. This imaginary case explains the actual case of the sanitary appliances which our local sanitary authorities prescribe today and condemn tomorrow. No sanitary contrivance which the mind of even the very worst plumber can devize could be as disastrous as that total neglect for long periods which gets avenged by pestilences that sweep through whole continents, like the black death and the cholera. If it were proposed at this time of day to discharge all the sewage of London crude and untreated into the Thames, instead of carrying it, after elaborate treatment, far out into the North Sea, there would be a shriek of horror from all our experts. Yet if Cromwell had done that instead of doing nothing, there would probably have been no Great Plague of London. When the Local Health Authority forces every householder to have his sanitary arrangements thought about and attended to by somebody whose special business it is to attend to such things, then it matters not how erroneous or even directly mischievous may be the specific measures taken: the net result at first is sure to be an improvement. Not until attention has been effectually substituted for neglect as the general rule, will the statistics begin to show the merits of the particular methods of attention adopted. And as we are far from having arrived at this stage, being as to health legislation only at the beginning of things, we have practically no evidence yet as to the value of methods. Simple and obvious as this is, nobody seems as yet to discount the effect of substituting attention for neglect in drawing conclusions from health statistics. Everything is put to the credit of the particular method employed, although it may quite possibly be raising the death rate by five per thousand whilst the attention incidental to it is reducing the death rate fifteen per thousand. The net gain of ten per thousand is credited to the method, and made the excuse for enforcing more of it. STEALING CREDIT FROM CIVILIZATION There is yet another way in which specifics which have no merits at all, either direct or incidental, may be brought into high repute by statistics. For a century past civilization has been cleaning away the conditions which favor bacterial fevers. Typhus, once rife, has vanished: plague and cholera have been stopped at our frontiers by a sanitary blockade. We still have epidemics of smallpox and typhoid; and diphtheria and scarlet fever are endemic in the slums. Measles, which in my childhood was not regarded as a dangerous disease, has now become so mortal that notices are posted publicly urging parents to take it seriously. But even in these cases the contrast between the death and recovery rates in the rich districts and in the poor ones has led to the general conviction among experts that bacterial diseases are preventable; and they already are to a large extent prevented. The dangers of infection and the way to avoid it are better understood than they used to be. It is barely twenty years since people exposed themselves recklessly to the infection of consumption and pneumonia in the belief that these diseases were not "catching." Nowadays the troubles of consumptive patients are greatly increased by the growing disposition to treat them as lepers. No doubt there is a good deal of ignorant exaggeration and cowardly refusal to face a human and necessary share of the risk. That has always been the case. We now know that the medieval horror of leprosy was out of all proportion to the danger of infection, and was accompanied by apparent blindness to the infectiousness of smallpox, which has since been worked up by our disease terrorists into the position formerly held by leprosy. But the scare of infection, though it sets even doctors talking as if the only really scientific thing to do with a fever patient is to throw him into the nearest ditch and pump carbolic acid on him from a safe distance until he is ready to be cremated on the spot, has led to much greater care and cleanliness. And the net result has been a series of victories over disease. Now let us suppose that in the early nineteenth century somebody had come forward with a theory that typhus fever always begins in the top joint of the little finger; and that if this joint be amputated immediately after birth, typhus fever will disappear. Had such a suggestion been adopted, the theory would have been triumphantly confirmed; for as a matter of fact, typhus fever has disappeared. On the other hand cancer and madness have increased (statistically) to an appalling extent. The opponents of the little finger theory would therefore be pretty sure to allege that the amputations were spreading cancer and lunacy. The vaccination controversy is full of such contentions. So is the controversy as to the docking of horses' tails and the cropping of dogs' ears. So is the less widely known controversy as to circumcision and the declaring certain kinds of flesh unclean by the Jews. To advertize any remedy or operation, you have only to pick out all the most reassuring advances made by civilization, and boldly present the two in the relation of cause and effect: the public will swallow the fallacy without a wry face. It has no idea of the need for what is called a control experiment. In Shakespear's time and for long after it, mummy was a favorite medicament. You took a pinch of the dust of a dead Egyptian in a pint of the hottest water you could bear to drink; and it did you a great deal of good. This, you thought, proved what a sovereign healer mummy was. But if you had tried the control experiment of taking the hot water without the mummy, you might have found the effect exactly the same, and that any hot drink would have done as well. BIOMETRIKA Another difficulty about statistics is the technical difficulty of calculation. Before you can even make a mistake in drawing your conclusion from the correlations established by your statistics you must ascertain the correlations. When I turn over the pages of Biometrika, a quarterly journal in which is recorded the work done in the field of biological statistics by Professor Karl Pearson and his colleagues, I am out of my depth at the first line, because mathematics are to me only a concept: I never used a logarithm in my life, and could not undertake to extract the square root of four without misgiving. I am therefore unable to deny that the statistical ascertainment of the correlations between one thing and another must be a very complicated and difficult technical business, not to be tackled successfully except by high mathematicians; and I cannot resist Professor Karl Pearson's immense contempt for, and indignant sense of grave social danger in, the unskilled guesses of the ordinary sociologist. Now the man in the street knows nothing of Biometrika: all he knows is that "you can prove anything by figures," though he forgets this the moment figures are used to prove anything he wants to believe. If he did take in Biometrika he would probably become abjectly credulous as to all the conclusions drawn in it from the correlations so learnedly worked out; though the mathematician whose correlations would fill a Newton with admiration may, in collecting and accepting data and drawing conclusions from them, fall into quite crude errors by just such popular oversights as I have been describing. PATIENT-MADE THERAPEUTICS To all these blunders and ignorances doctors are no less subject than the rest of us. They are not trained in the use of evidence, nor in biometrics, nor in the psychology of human credulity, nor in the incidence of economic pressure. Further, they must believe, on the whole, what their patients believe, just as they must wear the sort of hat their patients wear. The doctor may lay down the law despotically enough to the patient at points where the patient's mind is simply blank; but when the patient has a prejudice the doctor must either keep it in countenance or lose his patient. If people are persuaded that night air is dangerous to health and that fresh air makes them catch cold it will not be possible for a doctor to make his living in private practice if he prescribes ventilation. We have to go back no further than the days of The Pickwick Papers to find ourselves in a world where people slept in four-post beds with curtains drawn closely round to exclude as much air as possible. Had Mr. Pickwick's doctor told him that he would be much healthier if he slept on a camp bed by an open window, Mr. Pickwick would have regarded him as a crank and called in another doctor. Had he gone on to forbid Mr. Pickwick to drink brandy and water whenever he felt chilly, and assured him that if he were deprived of meat or salt for a whole year, he would not only not die, but would be none the worse, Mr. Pickwick would have fled from his presence as from that of a dangerous madman. And in these matters the doctor cannot cheat his patient. If he has no faith in drugs or vaccination, and the patient has, he can cheat him with colored water and pass his lancet through the flame of a spirit lamp before scratching his arm. But he cannot make him change his daily habits without knowing it. THE REFORMS ALSO COME FROM THE LAITY In the main, then, the doctor learns that if he gets ahead of the superstitions of his patients he is a ruined man; and the result is that he instinctively takes care not to get ahead of them. That is why all the changes come from the laity. It was not until an agitation had been conducted for many years by laymen, including quacks and faddists of all kinds, that the public was sufficiently impressed to make it possible for the doctors to open their minds and their mouths on the subject of fresh air, cold water, temperance, and the rest of the new fashions in hygiene. At present the tables have been turned on many old prejudices. Plenty of our most popular elderly doctors believe that cold tubs in the morning are unnatural, exhausting, and rheumatic; that fresh air is a fad and that everybody is the better for a glass or two of port wine every day; but they no longer dare say as much until they know exactly where they are; for many very desirable patients in country houses have lately been persuaded that their first duty is to get up at six in the morning and begin the day by taking a walk barefoot through the dewy grass. He who shows the least scepticism as to this practice is at once suspected of being "an old-fashioned doctor," and dismissed to make room for a younger man. In short, private medical practice is governed not by science but by supply and demand; and however scientific a treatment may be, it cannot hold its place in the market if there is no demand for it; nor can the grossest quackery be kept off the market if there is a demand for it. FASHIONS AND EPIDEMICS A demand, however, can be inculcated. This is thoroughly understood by fashionable tradesmen, who find no difficulty in persuading their customers to renew articles that are not worn out and to buy things they do not want. By making doctors tradesmen, we compel them to learn the tricks of trade; consequently we find that the fashions of the year include treatments, operations, and particular drugs, as well as hats, sleeves, ballads, and games. Tonsils, vermiform appendices, uvulas, even ovaries are sacrificed because it is the fashion to get them cut out, and because the operations are highly profitable. The psychology of fashion becomes a pathology; for the cases have every air of being genuine: fashions, after all, are only induced epidemics, proving that epidemics can be induced by tradesmen, and therefore by doctors. THE DOCTOR'S VIRTUES It will be admitted that this is a pretty bad state of things. And the melodramatic instinct of the public, always demanding; that every wrong shall have, not its remedy, but its villain to be hissed, will blame, not its own apathy, superstition, and ignorance, but the depravity of the doctors. Nothing could be more unjust or mischievous. Doctors, if no better than other men, are certainly no worse. I was reproached during the performances of The Doctor's Dilemma at the Court Theatre in 1907 because I made the artist a rascal, the journalist an illiterate incapable, and all the doctors "angels." But I did not go beyond the warrant of my own experience. It has been my luck to have doctors among my friends for nearly forty years past (all perfectly aware of my freedom from the usual credulity as to the miraculous powers and knowledge attributed to them); and though I know that there are medical blackguards as well as military, legal, and clerical blackguards (one soon finds that out when one is privileged to hear doctors talking shop among themselves), the fact that I was no more at a loss for private medical advice and attendance when I had not a penny in my pocket than I was later on when I could afford fees on the highest scale, has made it impossible for me to share that hostility to the doctor as a man which exists and is growing as an inevitable result of the present condition of medical practice. Not that the interest in disease and aberrations which turns some men and women to medicine and surgery is not sometimes as morbid as the interest in misery and vice which turns some others to philanthropy and "rescue work." But the true doctor is inspired by a hatred of ill-health, and a divine impatience of any waste of vital forces. Unless a man is led to medicine or surgery through a very exceptional technical aptitude, or because doctoring is a family tradition, or because he regards it unintelligently as a lucrative and gentlemanly profession, his motives in choosing the career of a healer are clearly generous. However actual practice may disillusion and corrupt him, his selection in the first instance is not a selection of a base character. THE DOCTOR'S HARDSHIPS A review of the counts in the indictment I have brought against private medical practice will show that they arise out of the doctor's position as a competitive private tradesman: that is, out of his poverty and dependence. And it should be borne in mind that doctors are expected to treat other people specially well whilst themselves submitting to specially inconsiderate treatment. The butcher and baker are not expected to feed the hungry unless the hungry can pay; but a doctor who allows a fellow-creature to suffer or perish without aid is regarded as a monster. Even if we must dismiss hospital service as really venal, the fact remains that most doctors do a good deal of gratuitous work in private practice all through their careers. And in his paid work the doctor is on a different footing to the tradesman. Although the articles he sells, advice and treatment, are the same for all classes, his fees have to be graduated like the income tax. The successful fashionable doctor may weed his poorer patients out from time to time, and finally use the College of Physicians to place it out of his own power to accept low fees; but the ordinary general practitioner never makes out his bills without considering the taxable capacity of his patients. Then there is the disregard of his own health and comfort which results from the fact that he is, by the nature of his work, an emergency man. We are polite and considerate to the doctor when there is nothing the matter, and we meet him as a friend or entertain him as a guest; but when the baby is suffering from croup, or its mother has a temperature of 104 degrees, or its grandfather has broken his leg, nobody thinks of the doctor except as a healer and saviour. He may be hungry, weary, sleepy, run down by several successive nights disturbed by that instrument of torture, the night bell; but who ever thinks of this in the face of sudden sickness or accident? We think no more of the condition of a doctor attending a case than of the condition of a fireman at a fire. In other occupations night-work is specially recognized and provided for. The worker sleeps all day; has his breakfast in the evening; his lunch or dinner at midnight; his dinner or supper before going to bed in the morning; and he changes to day-work if he cannot stand night-work. But a doctor is expected to work day and night. In practices which consist largely of workmen's clubs, and in which the patients are therefore taken on wholesale terms and very numerous, the unfortunate assistant, or the principal if he has no assistant, often does not undress, knowing that he will be called up before he has snatched an hour's sleep. To the strain of such inhuman conditions must be added the constant risk of infection. One wonders why the impatient doctors do not become savage and unmanageable, and the patient ones imbecile. Perhaps they do, to some extent. And the pay is wretched, and so uncertain that refusal to attend without payment in advance becomes often a necessary measure of self-defence, whilst the County Court has long ago put an end to the tradition that the doctor's fee is an honorarium. Even the most eminent physicians, as such biographies as those of Paget show, are sometimes miserably, inhumanly poor until they are past their prime. In short, the doctor needs our help for the moment much more than we often need his. The ridicule of Moliere, the death of a well-informed and clever writer like the late Harold Frederic in the hands of Christian Scientists (a sort of sealing with his blood of the contemptuous disbelief in and dislike of doctors he had bitterly expressed in his books), the scathing and quite justifiable exposure of medical practice in the novel by Mr. Maarten Maartens entitled The New Religion: all these trouble the doctor very little, and are in any case well set off by the popularity of Sir Luke Fildes' famous picture, and by the verdicts in which juries from time to time express their conviction that the doctor can do no wrong. The real woes of the doctor are the shabby coat, the wolf at the door, the tyranny of ignorant patients, the work-day of 24 hours, and the uselessness of honestly prescribing what most of the patients really need: that is, not medicine, but money. THE PUBLIC DOCTOR What then is to be done? Fortunately we have not to begin absolutely from the beginning: we already have, in the Medical Officer of Health, a sort of doctor who is free from the worst hardships, and consequently from the worst vices, of the private practitioner. His position depends, not on the number of people who are ill, and whom he can keep ill, but on the number of people who are well. He is judged, as all doctors and treatments should be judged, by the vital statistics of his district. When the death rate goes up his credit goes down. As every increase in his salary depends on the issue of a public debate as to the health of the constituency under his charge, he has every inducement to strive towards the ideal of a clean bill of health. He has a safe, dignified, responsible, independent position based wholly on the public health; whereas the private practitioner has a precarious, shabby-genteel, irresponsible, servile position, based wholly on the prevalence of illness. It is true, there are grave scandals in the public medical service. The public doctor may be also a private practitioner eking out his earnings by giving a little time to public work for a mean payment. There are cases in which the position is one which no successful practitioner will accept, and where, therefore, incapables or drunkards get automatically selected for the post, faute de mieux; but even in these cases the doctor is less disastrous in his public capacity than in his private one: besides, the conditions which produce these bad cases are doomed, as the evil is now recognized and understood. A popular but unstable remedy is to enable local authorities, when they are too small to require the undivided time of such men as the Medical Officers of our great municipalities, to combine for public health purposes so that each may share the services of a highly paid official of the best class; but the right remedy is a larger area as the sanitary unit. MEDICAL ORGANIZATION Another advantage of public medical work is that it admits of organization, and consequently of the distribution of the work in such a manner as to avoid wasting the time of highly qualified experts on trivial jobs. The individualism of private practice leads to an appalling waste of time on trifles. Men whose dexterity as operators or almost divinatory skill in diagnosis are constantly needed for difficult cases, are poulticing whitlows, vaccinating, changing unimportant dressings, prescribing ether drams for ladies with timid leanings towards dipsomania, and generally wasting their time in the pursuit of private fees. In no other profession is the practitioner expected to do all the work involved in it from the first day of his professional career to the last as the doctor is. The judge passes sentence of death; but he is not expected to hang the criminal with his own hands, as he would be if the legal profession were as unorganized as the medical. The bishop is not expected to blow the organ or wash the baby he baptizes. The general is not asked to plan a campaign or conduct a battle at half-past twelve and to play the drum at half-past two. Even if they were, things would still not be as bad as in the medical profession; for in it not only is the first-class man set to do third-class work, but, what is much more terrifying, the third-class man is expected to do first-class work. Every general practitioner is supposed to be capable of the whole range of medical and surgical work at a moment's notice; and the country doctor, who has not a specialist nor a crack consultant at the end of his telephone, often has to tackle without hesitation cases which no sane practitioner in a town would take in hand without assistance. No doubt this develops the resourcefulness of the country doctor, and makes him a more capable man than his suburban colleague; but it cannot develop the second-class man into a first-class one. If the practice of law not only led to a judge having to hang, but the hangman to judge, or if in the army matters were so arranged that it would be possible for the drummer boy to be in command at Waterloo whilst the Duke of Wellington was playing the drum in Brussels, we should not be consoled by the reflection that our hangmen were thereby made a little more judicial-minded, and our drummers more responsible, than in foreign countries where the legal and military professions recognized the advantages of division of labor. Under such conditions no statistics as to the graduation of professional ability among doctors are available. Assuming that doctors are normal men and not magicians (and it is unfortunately very hard to persuade people to admit so much and thereby destroy the romance of doctoring) we may guess that the medical profession, like the other professions, consists of a small percentage of highly gifted persons at one end, and a small percentage of altogether disastrous duffers at the other. Between these extremes comes the main body of doctors (also, of course, with a weak and a strong end) who can be trusted to work under regulations with more or less aid from above according to the gravity of the case. Or, to put it in terms of the cases, there are cases that present no difficulties, and can be dealt with by a nurse or student at one end of the scale, and cases that require watching and handling by the very highest existing skill at the other; whilst between come the great mass of cases which need visits from the doctor of ordinary ability and from the chiefs of the profession in the proportion of, say, seven to none, seven to one, three to one, one to one, or, for a day or two, none to one. Such a service is organized at present only in hospitals; though in large towns the practice of calling in the consultant acts, to some extent, as a substitute for it. But in the latter case it is quite unregulated except by professional etiquet, which, as we have seen, has for its object, not the health of the patient or of the community at large, but the protection of the doctor's livelihood and the concealment of his errors. And as the consultant is an expensive luxury, he is a last resource rather, as he should be, than a matter of course, in all cases where the general practitioner is not equal to the occasion: a predicament in which a very capable man may find himself at any time through the cropping up of a case of which he has had no clinical experience. THE SOCIAL SOLUTION OF THE MEDICAL PROBLEM The social solution of the medical problem, then, depends on that large, slowly advancing, pettishly resisted integration of society called generally Socialism. Until the medical profession becomes a body of men trained and paid by the country to keep the country in health it will remain what it is at present: a conspiracy to exploit popular credulity and human suffering. Already our M.O.H.s (Medical Officers of Health) are in the new position: what is lacking is appreciation of the change, not only by the public but by the private doctors. For, as we have seen, when one of the first-rate posts becomes vacant in one of the great cities, and all the leading M.O.H.s compete for it, they must appeal to the good health of the cities of which they have been in charge, and not to the size of the incomes the local private doctors are making out of the ill-health of their patients. If a competitor can prove that he has utterly ruined every sort of medical private practice in a large city except obstetric practice and the surgery of accidents, his claims are irresistible; and this is the ideal at which every M.O.H. should aim. But the profession at large should none the less welcome him and set its house in order for the social change which will finally be its own salvation. For the M.O.H. as we know him is only the beginning of that army of Public Hygiene which will presently take the place in general interest and honor now occupied by our military and naval forces. It is silly that an Englishman should be more afraid of a German soldier than of a British disease germ, and should clamor for more barracks in the same newspapers that protest against more school clinics, and cry out that if the State fights disease for us it makes us paupers, though they never say that if the State fights the Germans for us it makes us cowards. Fortunately, when a habit of thought is silly it only needs steady treatment by ridicule from sensible and witty people to be put out of countenance and perish. Every year sees an increase in the number of persons employed in the Public Health Service, who would formerly have been mere adventurers in the Private Illness Service. To put it another way, a host of men and women who have now a strong incentive to be mischievous and even murderous rogues will have a much stronger, because a much honester, incentive to be not only good citizens but active benefactors to the community. And they will have no anxiety whatever about their incomes. THE FUTURE OF PRIVATE PRACTICE It must not be hastily concluded that this involves the extinction of the private practitioner. What it will really mean for him is release from his present degrading and scientifically corrupting slavery to his patients. As I have already shown the doctor who has to live by pleasing his patients in competition with everybody who has walked the hospitals, scraped through the examinations, and bought a brass plate, soon finds himself prescribing water to teetotallers and brandy or champagne jelly to drunkards; beefsteaks and stout in one house, and "uric acid free" vegetarian diet over the way; shut windows, big fires, and heavy overcoats to old Colonels, and open air and as much nakedness as is compatible with decency to young faddists, never once daring to say either "I don't know," or "I don't agree." For the strength of the doctor's, as of every other man's position when the evolution of social organization at last reaches his profession, will be that he will always have open to him the alternative of public employment when the private employer becomes too tyrannous. And let no one suppose that the words doctor and patient can disguise from the parties the fact that they are employer and employee. No doubt doctors who are in great demand can be as high-handed and independent as employees are in all classes when a dearth in their labor market makes them indispensable; but the average doctor is not in this position: he is struggling for life in an overcrowded profession, and knows well that "a good bedside manner" will carry him to solvency through a morass of illness, whilst the least attempt at plain dealing with people who are eating too much, or drinking too much, or frowsting too much (to go no further in the list of intemperances that make up so much of family life) would soon land him in the Bankruptcy Court. Private practice, thus protected, would itself protect individuals, as far as such protection is possible, against the errors and superstitions of State medicine, which are at worst no worse than the errors and superstitions of private practice, being, indeed, all derived from it. Such monstrosities as vaccination are, as we have seen, founded, not on science, but on half-crowns. If the Vaccination Acts, instead of being wholly repealed as they are already half repealed, were strengthened by compelling every parent to have his child vaccinated by a public officer whose salary was completely independent of the number of vaccinations performed by him, and for whom there was plenty of alternative public health work waiting, vaccination would be dead in two years, as the vaccinator would not only not gain by it, but would lose credit through the depressing effects on the vital statistics of his district of the illness and deaths it causes, whilst it would take from him all the credit of that freedom from smallpox which is the result of good sanitary administration and vigilant prevention of infection. Such absurd panic scandals as that of the last London epidemic, where a fee of half-a-crown per re-vaccination produced raids on houses during the absence of parents, and the forcible seizure and re-vaccination of children left to answer the door, can be prevented simply by abolishing the half-crown and all similar follies, paying, not for this or that ceremony of witchcraft, but for immunity from disease, and paying, too, in a rational way. The officer with a fixed salary saves himself trouble by doing his business with the least possible interference with the private citizen. The man paid by the job loses money by not forcing his job on the public as often as possible without reference to its results. THE TECHNICAL PROBLEM As to any technical medical problem specially involved, there is none. If there were, I should not be competent to deal with it, as I am not a technical expert in medicine: I deal with the subject as an economist, a politician, and a citizen exercising my common sense. Everything that I have said applies equally to all the medical techniques, and will hold good whether public hygiene be based on the poetic fancies of Christian Science, the tribal superstitions of the druggist and the vivisector, or the best we can make of our real knowledge. But I may remind those who confusedly imagine that the medical problem is also the scientific problem, that all problems are finally scientific problems. The notion that therapeutics or hygiene or surgery is any more or less scientific than making or cleaning boots is entertained only by people to whom a man of science is still a magician who can cure diseases, transmute metals, and enable us to live for ever. It may still be necessary for some time to come to practise on popular credulity, popular love and dread of the marvellous, and popular idolatry, to induce the poor to comply with the sanitary regulations they are too ignorant to understand. As I have elsewhere confessed, I have myself been responsible for ridiculous incantations with burning sulphur, experimentally proved to be quite useless, because poor people are convinced, by the mystical air of the burning and the horrible smell, that it exorcises the demons of smallpox and scarlet fever and makes it safe for them to return to their houses. To assure them that the real secret is sunshine and soap is only to convince them that you do not care whether they live or die, and wish to save money at their expense. So you perform the incantation; and back they go to their houses, satisfied. A religious ceremony--a poetic blessing of the threshold, for instance--would be much better; but unfortunately our religion is weak on the sanitary side. One of the worst misfortunes of Christendom was that reaction against the voluptuous bathing of the imperial Romans which made dirty habits a part of Christian piety, and in some unlucky places (the Sandwich Islands for example) made the introduction of Christianity also the introduction of disease, because the formulators of the superseded native religion, like Mahomet, had been enlightened enough to introduce as religious duties such sanitary measures as ablution and the most careful and reverent treatment of everything cast off by the human body, even to nail clippings and hairs; and our missionaries thoughtlessly discredited this godly doctrine without supplying its place, which was promptly taken by laziness and neglect. If the priests of Ireland could only be persuaded to teach their flocks that it is a deadly insult to the Blessed Virgin to place her image in a cottage that is not kept up to that high standard of Sunday cleanliness to which all her worshippers must believe she is accustomed, and to represent her as being especially particular about stables because her son was born in one, they might do more in one year than all the Sanitary Inspectors in Ireland could do in twenty; and they could hardly doubt that Our Lady would be delighted. Perhaps they do nowadays; for Ireland is certainly a transfigured country since my youth as far as clean faces and pinafores can transfigure it. In England, where so many of the inhabitants are too gross to believe in poetic faiths, too respectable to tolerate the notion that the stable at Bethany was a common peasant farmer's stable instead of a first-rate racing one, and too savage to believe that anything can really cast out the devil of disease unless it be some terrifying hoodoo of tortures and stinks, the M.O.H. will no doubt for a long time to come have to preach to fools according to their folly, promising miracles, and threatening hideous personal consequences of neglect of by-laws and the like; therefore it will be important that every M.O.H. shall have, with his (or her) other qualifications, a sense of humor, lest (he or she) should come at last to believe all the nonsense that must needs be talked. But he must, in his capacity of an expert advising the authorities, keep the government itself free of superstition. If Italian peasants are so ignorant that the Church can get no hold of them except by miracles, why, miracles there must be. The blood of St. Januarius must liquefy whether the Saint is in the humor or not. To trick a heathen into being a dutiful Christian is no worse than to trick a whitewasher into trusting himself in a room where a smallpox patient has lain, by pretending to exorcise the disease with burning sulphur. But woe to the Church if in deceiving the peasant it also deceives itself; for then the Church is lost, and the peasant too, unless he revolt against it. Unless the Church works the pretended miracle painfully against the grain, and is continually urged by its dislike of the imposture to strive to make the peasant susceptible to the true reasons for behaving well, the Church will become an instrument of his corruption and an exploiter of his ignorance, and will find itself launched upon that persecution of scientific truth of which all priesthoods are accused and none with more justice than the scientific priesthood. And here we come to the danger that terrifies so many of us: the danger of having a hygienic orthodoxy imposed on us. But we must face that: in such crowded and poverty ridden civilizations as ours any orthodoxy is better than laisser-faire. If our population ever comes to consist exclusively of well-to-do, highly cultivated, and thoroughly instructed free persons in a position to take care of themselves, no doubt they will make short work of a good deal of official regulation that is now of life-and-death necessity to us; but under existing circumstances, I repeat, almost any sort of attention that democracy will stand is better than neglect. Attention and activity lead to mistakes as well as to successes; but a life spent in making mistakes is not only more honorable but more useful than a life spent doing nothing. The one lesson that comes out of all our theorizing and experimenting is that there is only one really scientific progressive method; and that is the method of trial and error. If you come to that, what is laisser-faire but an orthodoxy? the most tyrannous and disastrous of all the orthodoxies, since it forbids you even to learn. THE LATEST THEORIES Medical theories are so much a matter of fashion, and the most fertile of them are modified so rapidly by medical practice and biological research, which are international activities, that the play which furnishes the pretext for this preface is already slightly outmoded, though I believe it may be taken as a faithful record for the year (1906) in which it was begun. I must not expose any professional man to ruin by connecting his name with the entire freedom of criticism which I, as a layman, enjoy; but it will be evident to all experts that my play could not have been written but for the work done by Sir Almroth Wright in the theory and practice of securing immunization from bacterial diseases by the inoculation of "vaccines" made of their own bacteria: a practice incorrectly called vaccinetherapy (there is nothing vaccine about it) apparently because it is what vaccination ought to be and is not. Until Sir Almroth Wright, following up one of Metchnikoff's most suggestive biological romances, discovered that the white corpuscles or phagocytes which attack and devour disease germs for us do their work only when we butter the disease germs appetizingly for them with a natural sauce which Sir Almroth named opsonin, and that our production of this condiment continually rises and falls rhythmically from negligibility to the highest efficiency, nobody had been able even to conjecture why the various serums that were from time to time introduced as having effected marvellous cures, presently made such direful havoc of some unfortunate patient that they had to be dropped hastily. The quantity of sturdy lying that was necessary to save the credit of inoculation in those days was prodigious; and had it not been for the devotion shown by the military authorities throughout Europe, who would order the entire disappearance of some disease from their armies, and bring it about by the simple plan of changing the name under which the cases were reported, or for our own Metropolitan Asylums Board, which carefully suppressed all the medical reports that revealed the sometimes quite appalling effects of epidemics of revaccination, there is no saying what popular reaction might not have taken place against the whole immunization movement in therapeutics. The situation was saved when Sir Almroth Wright pointed out that if you inoculated a patient with pathogenic germs at a moment when his powers of cooking them for consumption by the phagocytes was receding to its lowest point, you would certainly make him a good deal worse and perhaps kill him, whereas if you made precisely the same inoculation when the cooking power was rising to one of its periodical climaxes, you would stimulate it to still further exertions and produce just the opposite result. And he invented a technique for ascertaining in which phase the patient happened to be at any given moment. The dramatic possibilities of this discovery and invention will be found in my play. But it is one thing to invent a technique: it is quite another to persuade the medical profession to acquire it. Our general practitioners, I gather, simply declined to acquire it, being mostly unable to afford either the acquisition or the practice of it when acquired. Something simple, cheap, and ready at all times for all comers, is, as I have shown, the only thing that is economically possible in general practice, whatever may be the case in Sir Almroth's famous laboratory in St. Mary's Hospital. It would have become necessary to denounce opsonin in the trade papers as a fad and Sir Almroth as a dangerous man if his practice in the laboratory had not led him to the conclusion that the customary inoculations were very much too powerful, and that a comparatively infinitesimal dose would not precipitate a negative phase of cooking activity, and might induce a positive one. And thus it happens that the refusal of our general practitioners to acquire the new technique is no longer quite so dangerous in practice as it was when The Doctor's Dilemma was written: nay, that Sir Ralph Bloomfield Boningtons way of administering inoculations as if they were spoonfuls of squills may sometimes work fairly well. For all that, I find Sir Almroth Wright, on the 23rd May, 1910, warning the Royal Society of Medicine that "the clinician has not yet been prevailed upon to reconsider his position," which means that the general practitioner ("the doctor," as he is called in our homes) is going on just as he did before, and could not afford to learn or practice a new technique even if he had ever heard of it. To the patient who does not know about it he will say nothing. To the patient who does, he will ridicule it, and disparage Sir Almroth. What else can he do, except confess his ignorance and starve? But now please observe how "the whirligig of time brings its revenges." This latest discovery of the remedial virtue of a very, very tiny hair of the dog that bit you reminds us, not only of Arndt's law of protoplasmic reaction to stimuli, according to which weak and strong stimuli provoke opposite reactions, but of Hahnemann's homeopathy, which was founded on the fact alleged by Hahnemann that drugs which produce certain symptoms when taken in ordinary perceptible quantities, will, when taken in infinitesimally small quantities, provoke just the opposite symptoms; so that the drug that gives you a headache will also cure a headache if you take little enough of it. I have already explained that the savage opposition which homeopathy encountered from the medical profession was not a scientific opposition; for nobody seems to deny that some drugs act in the alleged manner. It was opposed simply because doctors and apothecaries lived by selling bottles and boxes of doctor's stuff to be taken in spoonfuls or in pellets as large as peas; and people would not pay as much for drops and globules no bigger than pins' heads. Nowadays, however, the more cultivated folk are beginning to be so suspicious of drugs, and the incorrigibly superstitious people so profusely supplied with patent medicines (the medical advice to take them being wrapped round the bottle and thrown in for nothing) that homeopathy has become a way of rehabilitating the trade of prescription compounding, and is consequently coming into professional credit. At which point the theory of opsonins comes very opportunely to shake hands with it. Add to the newly triumphant homeopathist and the opsonist that other remarkable innovator, the Swedish masseur, who does not theorize about you, but probes you all over with his powerful thumbs until he finds out your sore spots and rubs them away, besides cheating you into a little wholesome exercise; and you have nearly everything in medical practice to-day that is not flat witchcraft or pure commercial exploitation of human credulity and fear of death. Add to them a good deal of vegetarian and teetotal controversy raging round a clamor for scientific eating and drinking, and resulting in little so far except calling digestion Metabolism and dividing the public between the eminent doctor who tells us that we do not eat enough fish, and his equally eminent colleague who warns us that a fish diet must end in leprosy, and you have all that opposes with any sort of countenance the rise of Christian Science with its cathedrals and congregations and zealots and miracles and cures: all very silly, no doubt, but sane and sensible, poetic and hopeful, compared to the pseudo science of the commercial general practitioner, who foolishly clamors for the prosecution and even the execution of the Christian Scientists when their patients die, forgetting the long death roll of his own patients. By the time this preface is in print the kaleidoscope may have had another shake; and opsonin may have gone the way of phlogiston at the hands of its own restless discoverer. I will not say that Hahnemann may have gone the way of Diafoirus; for Diafoirus we have always with us. But we shall still pick up all our knowledge in pursuit of some Will o' the Wisp or other. What is called science has always pursued the Elixir of Life and the Philosopher's Stone, and is just as busy after them to-day as ever it was in the days of Paracelsus. We call them by different names: Immunization or Radiology or what not; but the dreams which lure us into the adventures from which we learn are always at bottom the same. Science becomes dangerous only when it imagines that it has reached its goal. What is wrong with priests and popes is that instead of being apostles and saints, they are nothing but empirics who say "I know" instead of "I am learning," and pray for credulity and inertia as wise men pray for scepticism and activity. Such abominations as the Inquisition and the Vaccination Acts are possible only in the famine years of the soul, when the great vital dogmas of honor, liberty, courage, the kinship of all life, faith that the unknown is greater than the known and is only the As Yet Unknown, and resolution to find a manly highway to it, have been forgotten in a paroxysm of littleness and terror in which nothing is active except concupiscence and the fear of death, playing on which any trader can filch a fortune, any blackguard gratify his cruelty, and any tyrant make us his slaves. Lest this should seem too rhetorical a conclusion for our professional men of science, who are mostly trained not to believe anything unless it is worded in the jargon of those writers who, because they never really understand what they are trying to say, cannot find familiar words for it, and are therefore compelled to invent a new language of nonsense for every book they write, let me sum up my conclusions as dryly as is consistent with accurate thought and live conviction. 1. Nothing is more dangerous than a poor doctor: not even a poor employer or a poor landlord. 2. Of all the anti-social vested interests the worst is the vested interest in ill-health. 3. Remember that an illness is a misdemeanor; and treat the doctor as an accessory unless he notifies every case to the Public Health authority. 4. Treat every death as a possible and under our present system a probable murder, by making it the subject of a reasonably conducted inquest; and execute the doctor, if necessary, as a doctor, by striking him off the register. 5. Make up your mind how many doctors the community needs to keep it well. Do not register more or less than this number; and let registration constitute the doctor a civil servant with a dignified living wage paid out of public funds. 6. Municipalize Harley Street. 7. Treat the private operator exactly as you would treat a private executioner. 8. Treat persons who profess to be able to cure disease as you treat fortune tellers. 9. Keep the public carefully informed, by special statistics and announcements of individual cases, of all illnesses of doctors or in their families. 10. Make it compulsory for a doctor using a brass plate to have inscribed on it, in addition to the letters indicating his qualifications, the words "Remember that I too am mortal." 11. In legislation and social organization, proceed on the principle that invalids, meaning persons who cannot keep themselves alive by their own activities, cannot, beyond reason, expect to be kept alive by the activity of others. There is a point at which the most energetic policeman or doctor, when called upon to deal with an apparently drowned person, gives up artificial respiration, although it is never possible to declare with certainty, at any point short of decomposition, that another five minutes of the exercise would not effect resuscitation. The theory that every individual alive is of infinite value is legislatively impracticable. No doubt the higher the life we secure to the individual by wise social organization, the greater his value is to the community, and the more pains we shall take to pull him through any temporary danger or disablement. But the man who costs more than he is worth is doomed by sound hygiene as inexorably as by sound economics. 12. Do not try to live for ever. You will not succeed. 13. Use your health, even to the point of wearing it out. That is what it is for. Spend all you have before you die; and do not outlive yourself. 14. Take the utmost care to get well born and well brought up. This means that your mother must have a good doctor. Be careful to go to a school where there is what they call a school clinic, where your nutrition and teeth and eyesight and other matters of importance to you will be attended to. Be particularly careful to have all this done at the expense of the nation, as otherwise it will not be done at all, the chances being about forty to one against your being able to pay for it directly yourself, even if you know how to set about it. Otherwise you will be what most people are at present: an unsound citizen of an unsound nation, without sense enough to be ashamed or unhappy about it. 
39514	----	generously made available by The Internet Archive.) THE DOCTOR. [Illustration: HENRY VIII. RECEIVING THE BARBER-SURGEONS.] THE DOCTOR IN HISTORY, LITERATURE, FOLK-LORE, ETC. EDITED BY WILLIAM ANDREWS, F.R.H.S., AUTHOR OF "BYGONE ENGLAND," "OLD CHURCH LORE," ETC. HULL: WILLIAM ANDREWS & CO., THE HULL PRESS. LONDON: SIMPKIN, MARSHALL, HAMILTON, KENT, & CO., LTD. 1896. Preface. In the following pages I have attempted to bring together from the pens of several authors who have written expressly for this book, the more interesting phases of the history, literature, folk-lore, etc., of the medical profession. If the same welcome be given to this work as was accorded to those I have previously produced, my labours will not have been in vain. WILLIAM ANDREWS. THE HULL PRESS, HULL, _November 11th, 1895_. Contents. BARBER-SURGEONS. By William Andrews, F.R.H.S. 1 TOUCHING FOR THE KING'S EVIL. By William Andrews, F.R.H.S. 8 VISITING PATIENTS 22 ASSAYING MEAT AND DRINK. By William Andrews, F.R.H.S. 24 THE GOLD-HEADED CANE. By Tom Robinson, M.D. 32 MAGIC AND MEDICINE. By Cuming Walters 42 CHAUCER'S DOCTOR OF PHYSIC. By W. H. Thompson 70 THE DOCTORS SHAKESPEARE KNEW. By A. H. Wall 76 DICKENS' DOCTORS. By Thomas Frost 90 FAMOUS LITERARY DOCTORS. By Cuming Walters 102 THE "DOCTOR" IN TIME OF PESTILENCE. By William E. A. Axon, F.R.S.L. 125 MOUNTEBANKS AND MEDICINE. By Thomas Frost 140 THE STRANGE STORY OF THE FIGHT WITH THE SMALL-POX. By Thomas Frost 153 BURKERS AND BODY-SNATCHERS. By Thomas Frost 167 REMINISCENCES OF THE CHOLERA. By Thomas Frost 181 SOME OLD DOCTORS. By Mrs. G. Linnæus Banks 192 THE LEE PENNY 209 HOW OUR FATHERS WERE PHYSICKED. By J. A. Langford, LL.D. 216 MEDICAL FOLK-LORE. By John Nicholson 234 OF PHYSICIANS AND THEIR FEES, with some Personal Reminiscences. By Andrew James Symington, F.R.S.N.A. 252 INDEX 285 THE DOCTOR IN HISTORY, LITERATURE, AND FOLK-LORE. Barber-Surgeons. BY WILLIAM ANDREWS, F.R.H.S. The calling of the barber is of great antiquity. We find in the Book of the Prophet Ezekiel (v. 1) allusions to the Jewish custom of the barber shaving the head as a sign of mourning. In the remote past the art of surgery and the trade of barber were combined. It is clear that in all parts of the civilized world, in bygone times, the barber acted as a kind of surgeon, or to state his position more precisely, he practised phlebotomy. Barbers appear to have gained their experience from the monks whom they assisted in surgical operations. The clergy up to about the twelfth century had the care of men's bodies as well as of their souls, and practised surgery and medicine. The operations of surgery involved the shedding of blood, and it was felt that this was incompatible with the functions of the clergy. After much consideration and discussion, in 1163 the council of Tours, under Pope Alexander III., forbade the clergy to act as surgeons, but they were permitted to dispense medicine. The edict of Tours must have given satisfaction to the barbers, and they were not slow to avail themselves of the opportunities the change afforded them. In London, and we presume in other places, the barbers advertised their blood-letting in a most objectionable manner. It was customary to put blood in their windows to attract the attention of the public. An ordinance was passed in 1307, directing the barbers to have the blood "privily carried into the Thames under pain of paying two shillings to the use of the Sheriffs." At an early period in London the barbers were banded together, and a gild was formed. In the first instance it seems that the chief object was the bringing together of the members at religious observances. They attended the funerals and obits of deceased members and their wives. Eventually it was transformed into a semi-social and religious gild, and subsequently became a trade gild. In 1308, Richard le Barber, the first master of the Barbers' Company, was sworn at the Guildhall, London. As time progressed, the London Company of Barbers increased in importance. In the first year of the reign of Edward IV. (1462) the barbers were incorporated by a royal charter, and it was confirmed by succeeding monarchs. A change of title occurred in 1540, and it was then named the Company of Barber-Surgeons. Holbein painted a picture of Henry VIII. and the Barber-Surgeons. The painting is still preserved, and may be seen at the Barber-Surgeons' Hall, Monkwell Street, London. We give a carefully executed wood engraving of the celebrated picture. Pepys calls this "not a pleasant though a good picture." It is the largest and last painting of Holbein. In the _Leisure Hour_ for September 1895, are some interesting details respecting it, that are well worth reproducing. "It is painted," we are told, "on vertical oak boards, being 5ft. 11in. high by 10ft. 2in. long. It seems to have been begun about 1541, and finished after Holbein's death in 1543, and it has evidently been altered since its first delivery. The tablet, for instance, was not always in the background, for the old engraving in the College of Surgeons has a window in its place, showing the old tower of St. Bride's, and thus indicating Bridewell as the site of the ceremony. The outermost figure to the left, too, is omitted, and, according to some critics, the back row of heads are all post-Holbeinic. The names over the heads appear to have been added in Charles I.'s time, and it is significant that only two portraits in the back row are so distinguished." The king is represented wearing his robes, and is seated on a chair of state, holding erect his sword of state, and about him are the leading members of the fraternity. "The men whose portraits appear in the picture," says the _Leisure Hour_, "are not nonentities. The first figure to the king's right, with his hands in his gown, is Dr. John Chambre, king's physician, Fellow and Warden of Merton, and happy in his multitudinous appointments, both clerical and lay. Behind him is the Doctor Butts of Shakespeare's 'Henry VIII.'--the Sir William Butts who was the king's and Princess Mary's physician, and whose wife is known by Holbein's splendid portrait of her. Behind Butts is Alsop, the king's apothecary. To the king's left the first figure is Thomas Vicary, surgeon to Bartholomew's Hospital, serjeant-surgeon to the king, and author of 'The Anatomie of the Bodie of Man.' Next to him is Sir John Ayleff, an exceptionally good portrait. Then come in the undernamed: Nicholas Simpson, Edmund Harman (one of the witnesses to the king's will), James Monforde (who gave the company the silver hammer still used by the Master in presiding at the courts), John Pen (another fine portrait), Nicholas Alcocke, and Richard Ferris (also serjeant-surgeon to the king). In the back row the only names given are those of Christopher Salmond and William Tilley." In the reign of Henry VIII. an enactment as follows was in force:--"No person using any shaving or barbery in London shall occupy any surgery, letting of blood, or other matter, except of drawing teeth." Laws were made, but they could not be, or at all events were not, enforced. Disputes were frequent. The barbers acted often as surgeons, and the surgeons increased their income by the use of the razor and shears. At this period vigorous attempts were made to confine each to their legitimate work. The barber's pole, it is said, owes its origin to the barber-surgeons. Much has been written on this topic, but we believe that the following are the facts of the matter. We know that in the days of old bleeding was a frequent occurrence, and during the operation the patient used to grasp a staff, stick, or pole which the barber-surgeon kept ready for use, and round it was bound a supply of bandages for tying the arm of the patient. The pole, when not in use, was hung at the door as a sign. In course of time a painted pole was displayed instead of that used in the operation. Lord Thurlow addressing the House of Lords, July 17th, 1797, stated, "by a statute, still in force, barbers and surgeons were each to use a pole [as a sign]. The barbers were to have theirs blue and white, striped, with no other appendage; but the surgeons', which was to be the same in other respects, was likewise to have a gully-pot and a red rag, to denote the particular nature of their vocations." The Rev. J. L. Saywell has a note on bleeding in his "History and Annals of Northallerton" (1885):--"Towards the early part of this century," observes Mr. Saywell, "a singular custom prevailed in the town and neighbourhood of Northallerton (Yorkshire). In the spring of the year nearly all the robust male adults, and occasionally females, repaired to a surgeon to be bled, a process which they considered essentially conduced to vigorous health." The charge for the operation was one shilling. Parliament was petitioned, in 1542, praying that surgeons might be exempt from bearing arms and serving on juries, and thus be enabled without hindrance to attend to their professional duties. The request was granted, and to the present time medical men enjoy the privileges granted so long ago. In 1745, the surgeons and the barbers separated by Act of Parliament. The barber-surgeons lingered for a long time, the last in London, named Middleditch, of Great Suffolk Street, in the Borough, only dying in 1821. Mr. John Timbs, the popular writer, left on record that he had a vivid recollection of Middleditch's dentistry. Touching for the King's Evil. BY WILLIAM ANDREWS, F.R.H.S. The practice of touching for the cure of scrofula--a disease more generally known as king's evil--prevailed for a long period in England. Edward the Confessor who reigned from 1042 to 1066, appears to be the first monarch in this country who employed this singular mode of treatment. About a century after the death of Edward the Confessor, William of Malmesbury compiled his "Chronicle of the Kings of England," and in this work is the earliest allusion to the subject. Holinshed has placed on record some interesting details respecting Edward the Confessor. "As it has been thought," says Holinshed, in writing of the king, "he was inspired with the gift of prophecy, and also to have the gift of healing infirmities and disease commonly called the king's evil, and left that virtue, as it were, a portion of inheritance to his successors, the kings of this realm." The first edition of the "Chronicle" was published in 1577, and from it Shakespeare drew much material for his historical dramas. There is an allusion to this singular superstition in _Macbeth_, which it will be interesting to reproduce. Malcolm and Macduff are in England, "in a room in the King's palace" (the palace of King Edward the Confessor):-- "_Malcolm._ Comes the King forth I pray you? _Doctor._ Aye, sir! There are a crew of wretched souls That stay his cure: their malady convinces The great assay of art; but at his touch-- Such sanctity hath heaven given his hand-- They presently amend. _Malcolm._ I thank you, Doctor. _Macduff._ What's the disease he means? _Malcolm._ 'Tis called the evil: A most miraculous work in this good King; Which often, since my here-remain in England, I've seen him do. How he solicits heaven, Himself best knows: but strangely visited people All swoln and ulcerous, pitiful to the eye, The mere despair of surgery, he cures, Hanging a golden stamp about their necks, Put on with holy prayers: and 'tis spoken, To the succeeding royalty he leaves The healing benediction. With this strange virtue, He hath a heavenly gift of prophecy, And sundry blessings hang about his throne That speak him full of grace." History does not furnish any facts respecting touching by the four kings of the House of Normandy. It is generally believed that the Norman monarchs did not practise the rite. Henry II., the first of the Plantagenet line, emulated the Confessor. We know this fact from a record made by Peter of Blois, the royal chaplain, in which it is clearly stated that the king performed certain cures by touch. John of Gaddesden, in the days of Edward II., wrote a treatise in which he gave instructions for several modes of treatment for the disease, and if they failed, recommended the sufferers to seek cure by royal touch. Bradwardine, Archbishop of Canterbury, lived in the reigns of Edward III. and Richard II., and from his statements we learn that both kings kept up the observance. Henry IV., the first king of the House of Lancaster, touched for the evil. This we learn from a "Defence to the title of House of Lancaster," written by Sir John Fortesque, Lord Chief Justice of the Court of King's Bench. He speaks of the practice as "belonging to the kings of England from time immemorial." This pamphlet is preserved among the Cottonian manuscripts in the British Museum. The earliest king of the House of Tudor, Henry VII., was the first to give a small gold piece, known as a touch-piece, to those undergoing the ceremony. During the reign of the next monarch, Henry VIII., little attention appears to have been given to the subject. It was at this period largely practised in France. Cardinal Wolsey, when at the Court of Francis I., in 1527, witnessed the king touch two hundred people. On Easter Sunday, 1686, Louis XIV. is recorded to have touched 1,600. He used these words:--"_Le Roy te touche, Dieu te guéisse._" ("The King touches thee. May God cure thee!") Coming back to the history of our own country, and dealing with the more interesting passages bearing on this theme, we find that in the reign of Queen Elizabeth, William Clowes, the Court Surgeon, believed firmly in the efficacy of the royal touch. "The king's queen's evil," he says, "is a disease repugnant to nature, which grievous malady is known to be miraculously cured and healed by the sacred hands of the Queen's most Royal Majesty, even by Divine inspiration and wonderful work and power of God, above man's will, act, and expectation." In this reign, under the title of "_Charisma; sive Donum Sanationis_," a book was published by William Fookes bearing testimony to the cures effected by royal touch on all sorts and conditions of people from various parts of the country. The Stuarts paid particular attention to the practice. No fewer than eleven proclamations published during the reign of Charles I. are preserved at the State Paper Office, and chiefly relate to the times the afflicted might attend the court to receive the royal touch. In course of time the king's pecuniary means became limited, and he was unable to present gold touch-pieces, so silver was substituted, and many received the rite of touch only. During the Commonwealth we have not any trace of Cromwell touching for the malady. During the rising in the West of England, the Duke of Monmouth, who claimed to be the rightful heir to the throne, touched several persons for the evil, and, said a newspaper of the time, with success. One of the charges made against him on his trial at Edinburgh for high treason, was, that he had "touched children of the King's Evil." Two witnesses proved the charge, having witnessed the ceremony at Taunton. No sooner had another Stuart obtained the English crown than the ceremony was again performed. During the first year of the reign of Charles II., six thousand seven hundred and twenty-five persons were brought to His Majesty to be healed. The ceremony was often performed on a Sunday. Evelyn and Pepys were witnesses of these proceedings, and in their Diaries have recorded interesting particulars. Under date of 6th July, 1660, "His Majesty," writes Evelyn, "began first to touch for ye evil, according to custome thus: Sitting under his state in the Banqueting House, the chirurgeons cause the sick to be brought or led up to the throne, where, they kneeling, ye king strokes their faces and cheeks with both his hands at once, at which instant a chaplaine in his fermalities says:--'He put his hands upon them and healed them.' This he said to every one in particular. When they have been all totched, they come up again in the same order; and the other chaplaine kneeling, and having an angel of gold strung on white ribbon on his arme, delivers them one by one to His Majestie, who puts them about the necks of the touched as they passe, while the first chaplaine repeats 'That is ye true light which came into ye world.' Then follows an epistle (as at first a gospel) with the liturgy, prayers for the sick, with some alteration, and then the Lord Chamberlain and the Comptroller of the Household bring a basin, ewer, and towel, for his Majesty to wash." Samuel Pepys witnessed the ceremony on April 13th, 1661, and refers to it in his Diary. "Went to the Banquet House, and there saw the King heal, the first time I ever saw him do it, which he did with great gravity, and it seemed to me to be an ugly office and a simple one." In Evelyn's Diary on March 28th, 1684, there is a record of a serious accident, "There was," he writes, "so great a concourse of people with their children to be touched for the evil, that six or seven were crushed to death by pressing at the chirurgeon's door for tickets." According to Macaulay, Charles II. during his reign touched nearly a hundred thousand persons. In the year 1682 he performed the rite eight thousand five hundred times. No person was allowed to enter the King's presence for the purpose of receiving the rite without first obtaining a certificate from the minister of his parish from whence he came, nor unless he had not previously been touched. A proclamation of Charles II., dated January 9th, 1683, ordered a register of the certificates to be made. Here is a record drawn from the Old Town's Book of Birmingham:-- "March 14th, 1683, Elizabeth, daughter of John and Anne Dickens, of Birmingham, in the county of Warwick, was certified for in order to obtayne his Majesty's touch for her cure. HENRY GROVE, Minister. JOHN BIRCH, } HENRY PATER, } Churchwardens." We cull from the churchwardens' accounts of Terling, Essex, the following item:-- "1683 Dec{r}. Pd. for his Majestie's order for touching 00.00.06." A page in the register book of Bisley, Surrey, is headed thus, "Certificates for the Evill commonly called the kings Evill." Two entries occur as follow:-- "Elizabeth Collier and Thomas Collier the children of Thomas Collier, Senior, had a certificate from the minister and churchwardens of Bisley, August 7th 1686." "Sarah Massey, the daughter of Richard Massey, had a certificate from the minister and churchwardens of Bisley, 1st April 1688." Old parish accounts often contain entries similar to the following, from Ecclesfield, Yorkshire:-- "1641. Given to John Parkin wife towards her trauell to London to get cure of his Matie. for the disease called Euill which her soone Thom is visited withall 0. 6. 8." "The following extracts," says a contributor to _The Reliquary_ of January, 1894, "from the Minute Books of the Corporation of the city of York, show that general belief in the virtue of the touching by the King was unshaken at the end of the seventeenth century. It must be borne in mind that these Minutes do not record the acts of individuals, but were those of the Corporation of what was at that time one of the most important cities in the country, and that it was in administering Poor Law Relief that the grants were made. In Vol. 38 of the Corporation Records, fo. 74b, under the date of February 28th, 1671, is the following:-- "Ordered that Elizabeth Trevis haue x{s} given her for charges in carrying her daughter to London to be touched for the Evill." A few years later, on March 12th, 1678 (fo. 156b), occurs the following:-- "Anne Thornton to haue x{s} for goeing to London to be touched for the euill." And again on March 3, 1687 (fo. 249b), ten shillings was granted for "carrying of Judith Gibbons & her Child & one Dorothy Browne to London to be touched by his Majestie in order to be healed of the Kings Evil." The Records of the Corporation of Preston, Lancashire, contain at least two references to this matter. In the year 1682 the bailiffs were instructed to "pay unto James Harrison, bricklayer, 10s. towards carrying his son to London, in order to the procuring of His Majesty's touch." Five years later, when James II. was at Chester, the council passed a vote that "the Bailiff pay unto the persons undermentioned each of them 5s. towards their charge in going to Chester to get his Majesty's touch:--Anne, daughter of Abel Mope; ---- daughter Richard Letmore." It is recorded that James II. touched eight hundred persons in the choir of the Cathedral of Chester. The ceremony cost, we learn from Macaulay, about £10,000 a year, and the amount would have been much greater but for the vigilance of the royal surgeons, whose business it was to examine the applicants, and to distinguish those who came for the cure, and those who came for the gold. William III. declined to have anything to do with a ceremony he regarded as an imposture. "It is a silly superstition," he said, when he heard that at the close of Lent his palace was besieged by a crowd of sick. "Give the poor creatures some money, and send them away." On one occasion only was he induced to lay his hand on a sufferer. "God give you better health," he said, "and more sense." The next to wear the crown was Queen Anne, and she revived the rite. In the _London Gazette_ of March 12th, 1712, appeared an official announcement that the queen intended to touch for the evil. In Lent of that year, Dr. Johnson, then a child, went up to London with his mother in the stage coach that he might have the benefit of the royal touch. He was then between two and three years of age. "His mother," writes Boswell, "yielding to the superstitious notion which, it is wonderful to think, prevailed so long in this country as to the virtue of regal touch (a notion to which a man of such inquiry and such judgment as Carte, the historian, could give credit), carried him to London, where he was actually touched by Queen Anne. Mrs. Johnson, indeed, as Mr. Hector informed me, acted by the advice of the celebrated Sir John Floyer, then a physician in Lichfield. Johnson used to talk of this very frankly, and Mrs. Piozzi has preserved his very picturesque description of the scene as it remained upon his fancy. Being asked if he could remember Queen Anne, 'He had,' he said, 'a confused but somehow a sort of solemn recollection of a lady in diamonds and a long black hood.' This touch, however, was without any effect." The malady remained with Dr. Johnson to his death. [Illustration: TOUCH-PIECE OF CHARLES II. (GOLD).] After the death of Queen Anne, no other English sovereign kept up the custom, although the service remained in the "Book of Common Prayer" as late as 1719. The latest instance we have found of the ceremony being performed was in October, 1745, when Charles Edward, at Holyrood House, touched a child. [Illustration: (GOLD). TOUCH-PIECES OF JAMES II. (SILVER).] In the preceding pages we have referred to "touch pieces," and it will not be without interest to direct attention to some of the more notable examples. A small sum of money was given by Edward I., and it has been suggested that it was probably presented in the form of alms. Henry VII. gave a small gold coin known as the angel noble. It was of about six shillings and eight pence in value, and was a current coin of the period, and the smallest gold coin issued. On one side of the coin was a figure of the angel Michael overcoming the dragon, and on the other a ship on the waves. During the residence of Charles II. on the continent, those who visited him to receive the royal rite had to give him gold, but after the Restoration, "touch-pieces" were made expressly for presentation at the healings. They were small gold medals resembling angels, but they were not equal in value to the angels previously given. However they met a want when gold was in great demand. James II. had two kinds of touch pieces, one of gold and the other of silver, but they were not half the size of those given by Charles II. Queen Anne gave a touch-piece a little larger than that of James II. The touch-piece presented by this Queen to Dr. Johnson may, with other specimens, be seen in the British Museum. [Illustration: TOUCH-PIECE OF ANNE (GOLD).] In a carefully-compiled article in the _Archæological Journal_, vol. x., p. 187-211, will be found some interesting particulars of touch-pieces, and to it we are indebted for the few details we have given bearing on this part of our subject. Visiting Patients. The doctor made his daily rounds, before the reign of Charles II., on horseback, sitting sideways on foot-clothes. He must have cut an undignified figure as he rode through the streets of London and our chief towns. A change came after the Restoration, and we meet with the physicians making their visits in a carriage and pair. It seems that increased fees were expected with the introduction of the carriage. A curious note appears on this subject in _Lex Talionis_. "For there must now be a little coach and two horses," says the author, "and, being thus attended, half-a-piece their usual fee is but ill taken, and popped into their left pocket, and possibly may cause the patient to send for his worship twice before he will come again in the hazard of another angel." The carriage was popular, and physicians vied with each other in making the greatest display. In the days of Queen Anne, a doctor would even drive half-a-dozen horses attached to his chariot, and not fewer than four was the general rule. In our own time the doctor's carriage and pair is to be seen in all directions. It is now driven for use and not for display as in the days of Queen Anne. We have seen the bicycle used by doctors of good standing, and we predict the time is not far distant when it will be more generally ridden by members of the medical profession. Assaying Meat and Drink. BY WILLIAM ANDREWS, F.R.H.S. From the time of our earliest Norman king down to the days of James I., the chief people of the land partook of their food in fear. Treachery was a not infrequent occurrence, and poison was much used as a means of taking life. As a precaution against murder, assayers of food, drink, etc., were appointed. Doctors usually filled the office, and by their unremitting attention to their duties crime was to a great extent prevented. In a royal household the physician acted as assayer. Let us imagine ourselves in an old English home, the palace of a king, or the stronghold of a leading nobleman. The cloth is laid by subordinate servants, but not without considerable ceremony. Next a chief officer of the household sees that every article on the table is free from poison. The bread about to be consumed is cut, and, in the presence of the "taker of assay," is tasted, and the salt is also tested. The knives, spoons, and table linen are kissed by a responsible person, so that assurance might be given that they were free from poison. Then the salt dish is covered with a lid, and the bread is wrapped in a napkin, and afterwards the whole table is covered with a fair white cloth. The coverlet remains until the head of the household comes to take his repast, and then his chief servant removes the covering of the table. If any person attempted to touch the covered bread or the covered salt after the spreading of the coverlet, they ran the risk of a severe flogging, and sometimes even death at the hands of a hangman. The time of bringing up the meats having arrived, the assayer proceeds to the kitchen, and tests the loyalty of the steward and cook by compelling them to partake of small quantities of the food prepared before it is taken to the table. Pieces of bread were cut and dipped into every mess, and were afterwards eaten by cook and steward. The crusts of closed pies were raised, and the contents tasted; small pieces of the more substantial viands were tasted, and not a single article of food was suffered to leave the kitchen without being assayed. After the ceremony had been completed, each dish was covered, no matter if hot or cold, and these were taken by servitors to the banqueting hall, a marshal with wand of office preceding the procession. The bearers on no account were permitted to linger on the way, no matter if their hands were burnt they must bear the pain, far better to suffer that than be suspected of tampering with the food. On no pretext were the covers to be removed until the proper time, and by the servants appointed for that purpose. If very hot, the bearers might perhaps protect their hands with bread, which was to be kept out of sight. We produce from the Rev. Charles Bullock's interesting volume entitled "How they Lived in the Olden Time," a picture of bringing in the dinner. It will be observed that the steward, bearing his staff of office, heads the procession. Each dish as it was brought to the table was again tasted in the presence of the personage who purposed partaking of it. This entailed considerable ceremony, and took up much time. To render the delay as little unpleasant as possible to the guests, music was usually performed. [Illustration: BRINGING IN THE DINNER.] In the stately homes of old England, as a mark of respect to the distinguished visitor, it was customary to assign to him an assayer. History furnishes a notable instance of an omission of the official. When Richard II. was at Pontefract Castle, we gather from _Hall's Chronicle_, edition 1548, folio 14, that Sir Piers Exton intended poisoning the King, and, to use the chronicler's words, forbade the "esquire whiche was accustumed to serve and take the assaye beefore Kyng Richarde, to again use that manner of service." According to Hall, the King "sat downe to dyner, and was served withoute curtesie or assaye; he much mervaylyng at the sodayne mutacion of the thynge, demanded of the esquire why he did not do his duty." He replied that Sir Piers had forbidden him performing the duties pertaining to his position. The King immediately picked up a carving-knife, struck upon the head of the assayer, and exclaimed, "The devil take Henry of Lancaster and thee together." Paul Hentzner, a German tutor, visited England in 1598, and wrote a graphic account of his travels in the country, which were translated into English by Horace Walpole. The work contains a curious account of the ceremonies of laying the cloth, etc., for Queen Elizabeth at Greenwich Palace. The notice is rather long, but is so entertaining and informing that it well merits reproduction. "A gentleman," it is stated, "entered the room bearing a rod, and along with him another who had a table-cloth, which, after they had both kneeled three times, with the utmost veneration, he spread upon the table, and after kneeling again, they both retired. Then came two others, one with the rod again, and the other with a salt-cellar and a plate of bread: when they had kneeled, as the others had done, and placed what was brought upon the table, they, too, retired with the same ceremonies performed by the first. At last came an unmarried lady (we were told she was a Countess), and along with her a married one, bearing a tasting-knife; the former was dressed in white silk, who when she prostrated herself three times in the most graceful manner, approached the table, and rubbed the plates with bread and salt with as much care as if the Queen had been present; when they had waited there a little time, the Yeomen of the Guard entered bareheaded, clothed in scarlet, with a golden rose upon their backs, bringing in at each turn a course of twenty-four dishes, served in plate, most of it gilt; these dishes were received by a gentleman in the same order they were brought, and placed upon the table, while the lady-taster gave to each guard a mouthful to eat, for fear of poison. During the time that this guard, which consists of the tallest and stoutest men that can be found in all England, being carefully selected for this service, were bringing dinner, twelve trumpets and two kettle-drums made the hall ring for half-an-hour together. At the end of the ceremonial, a number of unmarried ladies appeared, who, with particular solemnity, lifted the meat off the table and conveyed it into the Queen's inner and more private chamber, where, after she had chosen for herself, the rest goes to the ladies of the Court." [Illustration: ASSAYING WINE.] Drink as well as food had to be assayed twice, once in the buttery and again in the hall. The butler drank of the wine in the buttery, and then handed it to the cup-bearer in a covered vessel. When he arrived at the hall, he removed the lid of the cup, and poured into the inverted cover a little of the wine, and drank it under the eye of his master. We give an illustration, reproduced from an ancient manuscript, of an assayer tasting wine. The middle of the twelfth century is most probably the period represented. In the ancient assay cup, it is related on reliable authority, a charm was attached to a chain of gold, or embedded in the bottom of the vessel. This was generally a valuable carbuncle or a piece of tusk of a narwhal, usually regarded as the horn of the unicorn, and which was believed to have the power of neutralising or even detecting the presence of poison. Edward IV. presented to the ambassadors of Charles of Burgundy a costly assay cup of gold, ornamented with pearls and a great sapphire, and, to use the words of an old writer, "in the myddes of the cuppe ys a grete pece of a Vnicornes horne." The water used for washing the hands of the great had to be tasted by the yeoman who placed it on the table, to prove that no poison was contained in the fluid. This ceremony had to be performed in the presence of an assayer. The Gold-headed Cane. BY TOM ROBINSON, M.D. The stick takes many forms. It is the sceptre of kings, the club of a police constable, the baton of a field marshal. The mace is but a stick of office, being ornamental and merely symbolical. In history we may go back to the pilgrim's staff, which was four feet long, and hollow at the top to carry away relics from the Holy Land. It was also used to carry contraband goods, such as seeds, or silk-worms' eggs, which the Chinese, Turks, or Greeks forbade to be exported. It is occasionally used for eluding the customs now. Some people smuggle diamonds into the United States in that way. Prometheus' reed, or marthex, in which he conveyed fire to "wretched mortals," as Aeschylus tells us, is a well-known fable. An enormous amount of interest centres around the walking stick, and there are few families in which we do not find an old stick handed down generation after generation. Such an inheritance was at one time a common possession of those who belonged to the medical profession. [Illustration: DR. RADCLIFFE'S CANE.] The College of Physicians possesses at the present time the gold cane which Radcliffe, Mead, Askew, Pitcairn, and Baillie successively carried about with them, and which Mrs. Baillie presented to that learned body. The drawing here given is a representation of this cane, and it will be seen that it has not a gold knob, but consists of an engraved handle or crook. It is, I think, quite clear that the custom which the doctors of the last century always followed in carrying their stick about with them, even to the bed-side, was due entirely to the fact that the handle of the cane could be, and was, filled with strong smelling disinfectants, such as rosemary and camphor. The doctor held this against his nose obviously for two reasons. One, to destroy any poison which might be floating about in the air but chiefly to prevent him smelling unpleasant odours. This stick was as long as a footman's, smooth and varnished. A belief in the protective power of camphor and other pleasant-smelling herbs is still in existence, and we know quite a number of individuals who carry about with them bags of camphor during the prevalence of an epidemic. Before Howard exposed the deadly sanitary state of the prisons of this country, it was the custom to sprinkle aromatic herbs before the prisoners, so powerful was the noxious effluvium which exhaled from their filthy bodies. The bouquet which the chaplain always carried when accompanying a prisoner to Tyburn, was used for the same defensive purpose. The stick of the physician's cane was probably a relic of the legerdemain of the healer, who in superstitious times worked upon the ignorance of the credulous. The modern conjuror always uses a wand in his entertainment. These baubles die hard, because there is a strong conservative instinct in the race which clings with tremendous tenacity to anything which has the sanction of antiquity. The barber's pole is still seen even in London, and is striped blue and white, emblems of the phlebotomist, and symbolical of the blue venous blood, which was so ungrudgingly given by the sufferers from almost all maladies. The white stripe represented the bandage used to bind up the wound on the arm. The practice of the bleeders continued in fashion in England until the beginning of this century. John Coutsley Lettsom, who possessed high literary attainments, and who was President of the Philosophical Society of London, and who entertained at his house at Grove Hill, Camberwell, many of the most distinguished men of his time, including Boswell and Dr. Johnson, and whose writings shew he was an enlightened physician, was bold in his treatment of disease, and a heroic bleeder. He used to say of himself:-- "When patients sick to me apply, I physics, bleeds, and sweats 'em Then if they choose to die, What's that to me--I lets 'em." The wig also constituted an essential part of the dress of the older physicians. It was a three tailed one, and this with silk stockings, clothes well trimmed, velvet coat with stiff skirts, large cuffs and buckled shoes, made quite an imposing show, and when they rode in their gilt carriages with two running footmen, as was the custom, no one would be better recognised. It is interesting to contrast the dress and mode of practice of the modern physician with those who built up the honourable calling of medicine. It is so easy to laugh at those who practised the art of medicine before modern scientific investigation had laid naked so many of the secrets of physiology, pathology, and vital chemistry. Slowly but surely as the true nature and progress of disease has become known, so have all the adventitious and unnecessary surroundings of dress disappeared, and now we may meet the most eminent of our doctors, clad in the same garments as a man on Change. All this was inevitable, but running through the whole history of medicine is a magnificent desire on the part of those who have made a mark, and of all its humbler followers to "go about doing good." The difficulties are enormous, the labour is colossal, but there could be no convictions were there no perplexities. Credulity is the disease of a feeble intellect. Accepting all things and understanding nothing, kills a man's intellect and checks all scientific investigation. The physician has to knock at the temple of the human frame, and patiently pick up the knowledge which nature always gives to those who love her best. But the investigator must approach his subject with humility, and with the recognition that there is a limit to the human intellect, and that behind and above this big round world is a supreme being, that around the intellect is the atmosphere of spiritual convictions from which our highest and best impulses spring, that the universe not only embraces material phenomena, but it also includes the sublime and the moral attributes, which no man has, or ever will, weigh in the physical balance or distil from a retort. The union of Intellect and Piety will grow stronger as the world grows older. When men began to think, they began to doubt, but when men have thought more deeply they will cease to doubt. An idea is in the air that the study of science has a tendency to make men sceptical. This is an error. For surely the study of Nature in any of its manifold aspects has a direct tendency to lead us into the inscrutable. Amongst those who demonstrate the ennobling influence of science let us only name Boyle, Bacon, Kepler, and Newton. If we would select a few names from the number of medical celebrities of the past who have felt this elevating influence, the following will readily occur to us, Linacre, Sydenham, Brodie, Astley Cooper, Graves Watson, and Abernethy. The latter, who is chiefly remembered as a coiner of quaint sayings and personal originality, had, notwithstanding his biting wit, a deep sense of the nobility and the sacredness of his calling, as the following extract from a lecture which he delivered at the Royal College of Surgeons will prove. He says:--"When we examine our bodies we see an assemblance of organs formed of what we call matter, but when we examine our minds, we feel that there is something sensitive and intelligible which inhabits our bodies. We naturally believe in the existence of a first cause. We feel our own free agency. We distinguish right and wrong. We feel as if we were responsible for our conduct, and the belief in a future state seems indigenous to the mind of man." The noiseless tread of time will cause many doctors whose names are now household words to be forgotten, but we may rest assured that the wreath of memory will cluster round the brows of these grand, noble workers in the field of medicine who have shown by their daily life that they never flinched from the arduous duties, aye and the dangers of their profession, but steadfastly plodded on. Originality, integrity, and honesty are attributes which grace the life of any man, and although the history of medicine claims no monopoly of these virtues, for they serve all men alike, yet they are the handmaids of greatness; without them no human being will ever win that true success which enables us to look back upon such lives and say, "Here are examples which show us the possibilities of the race." Doctors ought to be great burden lifters. Their mission is to carry into the chamber of disease--and even of death itself--that calm courage, that buoyant hope, which has around it a halo of sympathy and of encouragement. The public are loyal to the profession of medicine, and seldom do we hear of any members of that calling who abuse their high privileges. Their work is an absorbing work; it says to a man:--"You have placed in your hands the lives of the human race. You are the true soldier whose business it is to give life and health and happiness to those with whom you come in contact. You must not lean upon the baubles of your calling, so as to inspire confidence, but you must night and day let the one abiding thought be concentrated upon the good of humanity," and there is no field of professional experience which has given us so many men who have as nobly done their duty as the doctors of the past and of the present day. We seem to be on the threshold of a new era in the treatment of disease, and already do we find an increase in the average lives of the race. No one need despair of the future in that direction; indiscretion and ignorance kill more human beings than plague, pestilence, or famine. The public must help to tear away the veil which hides the _Truth_, by not worshipping at the foot of Quackery, Chicanery, or Superstition. The medical profession has so far escaped the pernicious tendency of modern thought, which tendency is to hamper every institution. This is a noteworthy fact; our hospitals, medical schools, College of Physicians, and College of Surgeons are not cramped and hindered by legislative interference; but unostentatiously, silently, and with a never-failing sense of their responsibilities, do they educate and pass through their gates the doctors of the future--and no man dare point his finger at any one of these, and say he does not do his duty. Magic and Medicine. BY CUMING WALTERS. Coleridge once said that in the treatment of nervous cases "he is the best physician who is the most ingenious inspirer of hope." The great "faith cures" are worked by such physicians, and the dealers in magic at all times and in all parts achieved their successes by inspiring hope in their patients. The more credulous the invalid the more easy the cure, no matter what remedy is applied. Is it surprising, then, to find that among the more childlike races, or that among the infant civilizations, magic often supersedes medicine, or is combined with it? Ceremonies which impress the mind and act upon the imagination considerably aid the physician in his treatment of susceptible persons. Paracelsus himself combined astrology with alchemy and medicine, and his host of followers often went further than their master, and relied more upon magic than upon specific remedies. It was the crowd of charlatans, astrologers, wonder-workers, and their sort who substituted magic for medicine, and who had so great an influence in England three centuries ago, that Ben Jonson scourged with the lash of his satire in "The Alchemist," the impostor described as "A rare physician, An excellent Paracelsian, and has done Strange cures with mineral physic. He deals all With spirits, he; he will not hear a word Of Galen, or his tedious recipes." There has generally been sufficient superstition in all races to make amulets the popular means of averting calamity and preserving from sickness. The Greeks, the Romans, the Jews, the Turks, and the Arabs, to say nothing of less civilized races, have thoroughly believed that disease can be charmed away by the simple expedient of wearing a token, or carrying a talisman. The magical formula of Abracadabra, written in the form of a triangle, sufficed to cure agues and fevers; the Abraxas stones warded off epidemics; the coins of St. Helena served as talismans, and cured epilepsy. So strong was the belief in these magical protectors in the fourth century that the clergy were forbidden, under heavy penalties to make or to sell the charms, and in the eighth century the Christian Church forbade amulets to be longer worn. In this connection it may be mentioned that the custom of placing the wedding-ring upon the fourth finger of the left hand owes its origin to the ancients who resorted to magic for the cure of their ailments. The Greeks and the Romans believed that the finger in question contained a vein communicating directly with the heart, and that nothing could come in contact with it without giving instant warning to the seat of life. For this reason they were accustomed to stir up mixtures and potions with this "medicated finger," as it was called, and when the ring became the symbol of marriage that finger was chosen of all others for the wearing of it. Thus do we unknowingly keep alive the superstitions of other times. The Hindoos, whose books on the healing art date back to 1500 B.C., regarded sickness as the result of the operation of malevolent deities who were either to be propitiated by prayers, offerings, charms, and sacrifices, or to be overcome with the aid of friendly gods. The early Greeks when suffering from disease were cured, not by means of medicine, but by religious observances, and particularly by the "temple-sleep," in which they dreamt dreams which the priests interpreted, and in which were found the suggestions for remedy. It was Hippocrates, in 460 B.C., who first proclaimed that disease was not of supernatural origin, and that it could not be combated or cured by magic. But for many centuries later in Europe the Black Art had greater sway than rational treatment. In Sweden it is even now common for the lower classes to ascribe sickness to the visitation of spirits (Nisse), who must be mollified by pouring liquor into a goblet and mixing with it the filings of a bride-ring, or filings of silver, or of any metal that has been inherited. The mixture is taken to the place where the man is supposed to have caught his illness, and is poured over the left shoulder, not a syllable being uttered the while. After the performance of this ceremony the invalid may hope to recover. Consecrated grave-mould is supposed by many primitive races to have particular properties as a medicine. The Shetlander who has a "stitch in his side," cures himself by applying to the affected part, some dry mould brought from a grave, and heated, care being taken to remove the mould and to return it before the setting of the sun. In the neighbouring isles of Orkney, magic is also resorted to as a remedy for disease. Perhaps the least harmful of the rites is the washing of a cat in the water which had previously served for an invalid's ablutions, the confident belief being that the disease would by this means be transferred to the animal. This custom of "substitution" is found in many races, and is one of the most interesting subjects introduced to the student of folk-lore. In Tibet, for example, when all ordinary remedies have failed, the Lamas make a dummy to represent the sick person, and they adorn the image with trinkets. By ceremonies and prayers the sickness of the patient is laid upon the dummy, after which it is taken out and burned, the Lamas appropriating the ornaments as a reward. Sir Walter Scott tells of a similar case which occurred in Scotland. Lady Katharine Fowlis made a model in clay of a person whom she wished to afflict, and shot at the image in the hope that the wound would be transferred to the real person. We have only to turn to Scott's "Demonology and Witchcraft" to find hundreds of instances of the unshaken belief of the Highlanders in mystic potions, pills, drugs, and drops; and not even wholesale burnings of the dealers in white magic could induce the people to forsake their superstitions. Bessie Dunlop told the Court, before which she was arraigned, of the magic elixirs given to her by Thome Reid, who had been killed in battle centuries before, but had appeared to her as an apparition, and begged her to fly with him to Elf-land. By means of his medicines she cured the most stubborn diseases, obtained the reputation of a wise woman, and grew so rich that the eye of the law was drawn upon her, and, after her confession was made, she was ordered to be burnt. As Scott said, in one of his chapters, the Scottish law did not acquit those who accomplished even praiseworthy actions, and "the proprietor of a patent medicine who should in those days have attested his having wrought such miracles as we see sometimes advertised might have forfeited his life." The idea of sacrificing something, or someone, to appease the anger of the powers who bring affliction upon mankind, is extremely common, and by no means confined to savage nations or to very ancient times. At the time of the Black Plague in the fourteenth century the fanaticism of the French led them to sacrifice 12,000 Jews by torture and burning, these Israelites being deemed the cause of the affliction. In the "Ingoldsby Legends" may be read a ghastly account of a similar sacrifice in Spain, in order to secure the good-will of the over-ruling powers on behalf of the Queen. Even in comparatively modern times the practice of sacrificing in order to cure or avert disease has not been unknown, and this in civilized lands, too. The sacrifices in these cases have, of course, been of animals only, but the germ of the old and worse ritual is found in the custom. In 1767, the people of Mull, in consequence of a disease among the cattle, agreed to perform an incantation. They carried to the top of Carnmoor a wheel and nine spindles of oakwood. Every fire in the houses was extinguished; and the wheel was then turned from east to west over the nine spindles long enough to produce fire by friction. They then sacrificed a heifer, which they cut in pieces and burnt while yet alive. Finally they lighted their own hearths from the pile, while an old man repeated the words of incantation. This custom is prevalent in Ireland, in various parts of Scotland, and even in England and Wales it has been practised with variations and some modification. In Cornwall, in 1800, a calf was burnt alive to arrest the murrain. Mr. Laurence Gomme has traced the custom back to the sacrifice of animals for human sickness, for in 1678 four men were actually prosecuted for "sacrificing a bull in a heathenish manner for the recovery of the health of Custane Mackenzie." In Ireland a cure for small-pox consisted in sacrificing a sheep to a wooden image, wrapping the skin about the sick person, and then eating the sheep. In Scotland strange and weird customs linger, and Sir H. G. Reid in his entertaining volume, "'Tween Gloamin' and the Mirk," has related how he himself, during infancy, underwent a mysterious cure for the "falling sickness." He was carried secretly away to a lonely hut on the distant moor, and the party were admitted to a long, low-roofed apartment, dimly lighted from two small windows. In one corner sat an old woman, wrinkled and silent, busily knitting; a huge peat-fire blazed on the open hearth, shooting heavy sparks up through the hole in the roof, and filling the apartment with smoke. No word was spoken, and the scene must have been as eerie as the lover of mystery or the believer in witchcraft could have desired. "I was placed on a three-legged stool in the middle of the floor" (the writer continues); "the old woman rose, and with the aid of immense tongs, took deliberately from the fire seven large smooth round stones, they were planted one by one in an irregular circle about me; with her dull dark eyes closed, and open white palms outstretched, the enchantress muttered some mystic words; it was over--the tremulous patient was taken up as 'cured!'" In Scotland the belief in witches who have power both to cure and to cause maladies is so deeply founded that it would be rash to deny its continued existence. These creatures are credited with opening graves for the purpose of taking out joints of the fingers and toes of dead bodies, with some of the winding-sheet, in order to prepare powders. In Kirkwall a small portion of the human skull was taken from the graveyard and grated to a powder in order to be used in a mixture for the cure of fits; while in Caithness the patient was made to drink from a suicide's skull, and the beverage so taken was regarded as a sovereign specific for epilepsy. In 1643 one John Drugh was indicted for this despoiling of corpses for some such purpose. The Australian aborigines had a belief not altogether dissimilar to this. They rubbed weak persons with the fat of a corpse, and thought that the strength, courage, and valour of the dead man was communicated to the body subjected to the treatment. Analogies may be found among savage tribes all over the world, and the culmination is found in the devouring of enemies, not out of revenge, but because the widespread primitive idea prevails that by eating the flesh and by drinking the blood of the slain, a man absorbs the nature or the life of the deceased into his own body. In other words, cannibalism has a medical origin which the most depraved superstition suggested and fortified. The Lhoosai, a savage hill-tribe in India, teach their young warriors to eat a piece of the liver of the first man they kill in order to strengthen their hearts, and here we see the development of the magic power of the medicines which is not only efficacious for the body, but for the spirit. When Coleridge was a little boy at the Blue Coat School, he relates in his Table Talk, there was a "charm for one's foot when asleep," which he believed had been in the school since its foundation in the time of King Edward VI. Its potency lay in the words-- "Crosses three we make to ease us, Two for the thieves, and one for Christ Jesus." The same charm served for cramp in the leg, and Coleridge quaintly adds: "Really, upon getting out of bed, where the cramp most frequently occurred, pressing the sole of the foot on the cold floor, and then repeating this charm, I can safely affirm that I do not remember an instance in which the cramp did not go away in a few seconds." Charms like this, by which a simple method of cure is invested with marvel, are common enough among primitive races, and not infrequently provide the key to the solution of the mystery of the magician's triumph. The cunning leaders, priests, or medicine-men of ignorant nations maintain their ascendency by ascribing to miracle the simplest feats they perform. The superstitious red man is completely at the mercy of the medicine-man who claims to possess supernatural powers, and who assumes the ability to work marvellous cures by magic. Each North American Indian carries with him a medicine bag obtained under very curious circumstances. When he is approaching manhood he sets forth in search of the patent drug which is to shield him from all danger, and act as an all-powerful talisman. He lies down alone in the woods upon a litter of twigs, eats and drinks nothing for several days, and at last falls asleep from sheer exhaustion. Then he dreams--or should do so--and whatever bird, or beast, or reptile, forms the subject of his dream, he must seek as his medicine. He goes forth upon the quest directly his strength has returned, and when he has discovered the animal of his vision, he turns its skin into a pouch, and wears it ever afterwards round his neck. In peace or war he will never part with this talisman; it is the treasure of his life, a sacred possession, a charm against all maladies, and a protection from foes. It is scarcely necessary to add, after this, that the medicine-man of the tribe is held in highest honour, and regarded as a worker of veritable miracles. All things are possible to him. By his prayers, his rites, and his incantations he causes the sun to shine, the rain to descend, the rivers to deepen, the plants to thrive. A traveller tells us that a drought had withered the maize fields, and the medicine-man was sent for to compel the rain to fall. On the first day one Wah-ku, or the Shield, came to the front, but failed; so did Om-pah, or the Elk. On succeeding days another was tried, but without success; but at last recourse was made to Wak-a-dah-ha-Ku, or the White Buffalo Hair, who possessed a shield coloured with red lightnings, and carried an arrow in his hand. Much was expected of him, and the people were not disappointed. "Taking his station by the medicine-lodge," we are told, "he harangued the people, protesting that for the good of his tribe he was willing to sacrifice himself, and that if he did not bring the much desired rain he was content to live for the rest of his life with the old women and the dogs. He asserted that the first medicine-man had failed because his shield warded off the rain clouds; the second, who wore a head-dress made of a raven's skin, because the raven was a bird that soared above the storm, and cared not whether the rain came or stayed; and the third who wore a beaver skin, because the beaver was always wet and required no rain. But as for him, the red lightnings on his shield would attract the rain-clouds, and his arrow would pierce them, and pour the water over the thirsty fields. It chanced that as he ended his oration, a steamer fired a salute from a twelve pounder gun. To the Indians the roar of the cannon was like the voice of thunder, and their joy knew no bounds. The successful medicine-man was loaded with valuable gifts; mothers hastened to offer their daughters to him in marriage; and the elder medicine-men hastened from the lodge to enrol him in their order.... Just before sunset his quick eyes discovered a black cloud which, unobserved by the noisy multitude, swiftly came up from the horizon. At once he assumed his station on the roof of the lodge, strung his bow, and made ready his arrow; arrested the attention of his fellows by his loud and exultant speech; and as the cloud impended over the village, shot his arrow into the sky. Lo, the rain descended in torrents, wetting the rain-maker to the skin, but establishing in everybody's mind a firm and deep conviction of his power." The influence of the medicine-man in time of sickness is illustrated in the narrative of Mr. Kane, who wrote "The Wanderings of an Artist." He heard a great noise in one of the villages, and found that a handsome Indian girl was extremely ill. The medicine-man sat in the middle of the room, crossed-legged and naked; a wooden dish filled with water was before him, and he had guaranteed to rid the girl of her disease which afflicted her side. He commenced by singing and gesticulating in a violent manner, the others who surrounded him beating drums with sticks. This lasted half-an-hour. Then the medicine-man determined on a radical cure of the patient, for he darted suddenly upon the girl, dug his teeth into her side (for she was undressed), and shook her for several minutes. This increased her agony, but the medicine-man declared he had "got it," and held his hands to his mouth. After this he plunged his hands into a bowl of water, leaving the spectators to believe that he had torn out the disease with his teeth, and was now destroying it by drowning. Eventually he withdrew his hand from the bowl, and it was found that he held a piece of cartilage between the finger and thumb. This was cut in two, and half cast into the fire, half into the water. So ended the operation, and Mr. Kane records that though the doctor was perfectly satisfied, the patient seemed, if anything, to be worse for the treatment. The belief in magic was ingrained in the Egyptians, who, notwithstanding that the art of medicine was far advanced with them, preferred to trust in the workers of miracles and enchantments. In his recent collection of Egyptian Tales, Mr. Flinders-Petrie is able to supply a striking instance of this credulity. A man named Dedi was said to have such powers over life and death that he could restore the head that had been smitten from the body. He was brought before the King, who desired to put this marvellous power to the test, and the story thus proceeds:--"His Majesty said, 'Let one bring me a prisoner who is in prison that his punishment may be fulfilled.' And Dedi said, 'Let it not be a man, O King, my lord; behold we do not even thus to our cattle.' And a duck was brought unto him, and its head was cut off. And the duck was laid on the west side of the hall, and its head on the east side of the hall. And Dedi spake his magic speech. And the duck fluttered along the ground, and its head came likewise; and when it had come part to part the duck stood and quacked. And they brought likewise a goose before him, and he did even so unto it. His Majesty caused an ox to be brought, and its head cast on the ground. And Dedi spake his magic speech. And the ox stood upright behind him, and followed him with his halter trailing on the ground." This story prepares us in every way for the information that the Egyptians, despite their great knowledge of the curative powers of herbs and drugs, preferred to rely upon enchanters, soothsayers, and magicians in their time of illness and peril. Professor Douglas, in his "Society in China," devotes a very interesting and entertaining chapter to medicine as regarded and practised by the Celestials. From this we learn that while there are plenty of doctors in the land, they are one and all the merest empirics, who prey on the folly, the ignorance, and the dread of the uneducated people. The failure to cure any disease brings no odium upon the quack, though when the late Emperor "ascended on a dragon to be a guest on high," or, in other words, died of small-pox, his physicians who could not save him from that distinction were deprived of honours and rewards. The Chinese are centuries behind other nations in medicine, and they have not yet learnt that the blood circulates in the body, or that a limb may be removed with beneficial effects in case of some diseases or accidents. They believe that arteries and veins are one and the same, and that the pulses communicate with the various organs of the body. The object of the physician is to "strengthen the breath, stimulate the gate of life, restore harmony." "The heart is the husband, and the hinges are the wife," and they must be brought into agreement, or evil arises. Good results may be obtained, it is believed, by such tonics as dog-flesh, dried red-spotted lizard-skins, tortoise-shell, fresh tops of stag-horns, bones and teeth of dragons (when obtainable), shavings of rhinoceros-horns, and such like. For dyspepsia the doctor has no nostrum, but he thrusts a needle into the patient's liver and expects him to be immediately cured. When cholera or any other pestilence sweeps over the land, the Chinese feel the helplessness of their physicians, so they resort to charms, and to the offering of gifts to the gods by way of staying the plague. Hydrophobia is common among the half-starved curs which infest the streets, and the cure for it--quite unknown to Pasteur--is the curd of the black pea dried and pulverised, mixed with hemp oil, and formed into a large ball; this is to be rolled over the wound, then broken open, and kept on rolling until it has lost its hair-like appearance. To complete the cure the patient must abstain from eating "anything in a state of decomposition." He might just as well be told not to poison himself. If, by the way, the prescription does not work, but hydrophobia continues, the patient is strongly commended to try the effect of "the skull, teeth, and toes of a tiger ground up, and given in wine in doses of one-fifth of an ounce." While the tiger is being caught, however, a fatal result may occur, but of course the Chinese doctor is not to be blamed for that. He has done his best, and the fault is obviously the tiger's. The Chinese believe in astrology, the philosopher's stone, and the elixir of life. A plant known as ginseng is said to greatly prolong and sweeten existence, and sometimes as much as a thousand taels of silver are given for a pound's weight of the precious root. It will be seen, therefore, from such facts as these that a Galen in China would have a vast revolution to undertake, and that a thousand Galens at least would be required to overcome the prejudices and uproot the superstitions of the race. The great value which the Chinese attach to the bones, horns, tusks, and eyes of animals may be judged from various tonics and remedies which are in great request among all classes. A dose of tigers' bones inspires courage; an elephant's eye burnt to powder and mixed with human milk is a sovereign remedy for inflammation of the eye; pulverised elephants' bones cure indigestion; a preparation of elephants' ivory is the recognised cure for diabetes; and the same animal's teeth may be used for epilepsy. But if the patient cannot eat rice his case is abandoned as hopeless, and not even the physician who deals most extensively in magic pills, ointments, and decoctions will attempt to save the obstinate person's life. The medicine-men of the Eskimos were called angekoks, and enjoyed the unlimited confidence of the people. They were said to have equal power over heaven and earth, this world and the next. This made them useful as friends and dangerous as enemies. The Eskimo, therefore, set out upon no enterprise without consulting the angekoks, who granted blessings, exorcised demons, and gave charms against disease. These medicine-men have a profound belief in themselves, and though they resort to jugglery and ventriloquism to deceive their visitors, they appear to have no idea that they are perpetrating an imposture. Their particular powers, they think, are derived from more than human sources. Dr. Nansen, in his "Eskimo Life," points out that it has always been to the interests of the medicine-men and the priests to sustain and mature superstitions or religious ideas. "They must therefore themselves appear to believe in them; they may even discover new precepts of divinity to their own advantage, and thereby increase both their power and their revenues." The Greenlanders believe that the angekoks work with the help of ministering spirits, called _tôrnat_, who are often none other than the souls of dead persons, especially of grandfathers; but not infrequently the _tôrnat_ are supposed to be the souls of departed animals, or of fairies. The angekok is assumed to have several of these councillors always at hand. They render help in the time of danger, and may even act as avengers or destroyers. In the latter case they show themselves as ghosts, and so frighten to death the persons against whom vengeance is directed. Therefore, as Dr. Nansen reports, the angekoks are the wisest and also the craftiest of all Eskimos. They assert that they have the power of conversing with spirits, of travelling in the under-world, of conjuring up powerful spirits, and of obtaining revelations. "They influence and work upon their countrymen principally through their mystic exorcisms and _seances_, which occur as a rule in the winter, when they are living in houses. The lamps are extinguished, and skins hung before the windows. The angekok himself sits upon the floor. By dint of making a horrible noise so that the whole house shakes, changing his voice, bellowing and shrieking, ventriloquising, groaning, moaning, and whining, beating on drums, bursting forth into diabolical shrieks of laughter and all sorts of other tricks, he persuades his companions that he is visited by the various spirits he personates, and that it is they who make the disturbance." They cure diseases by reciting charms, and "give men a new soul." He demands large fees, not for himself, he explains, but for the spirits whose agent he is. Apparently these spirits have similar ideas to the London consulting physician. Mr. Theodore Bent, in his "Ruined Cities of Mashonaland," gives a specimen of the credulity excited by the medicine-men. The explorer desired to interview a chief, Mtoko by name, but permission was refused. The reason, he afterwards ascertained, was that the chief's father had died shortly after another white man's visit, and the common belief was that he had been bewitched. The chief thought that the "white lady" who ruled over the nation to which Mr. Bent belonged had sent him purposely to cast a glamour over him. It may be remembered that the ill-fated Lobengula refused to have his portrait taken because he believed that by means of the image of himself he could be magically infected with a dread disease. This idea of substitution, which has already been referred to, is akin to that of the belief in witchcraft during the middle ages--namely, that the witches could, by sticking pins into the wax image of a person, bring upon that person agonising maladies. The dreadful results of such beliefs among savage tribes is told by the two hospital nurses who a year or so ago produced a lively book, "Adventures in Mashonaland." One morning a native entered their camp, bringing a tale of horror. A chief called Maronka, whose kraal was about forty miles away, had boiled his family alive. He had been convinced by the native doctors that after death the souls of the chiefs passed into the bodies of lions. His medicine-men had "smelt out" his own family as witches, and boiling alive was the requisite punishment. Mr. Rider Haggard has told many such stories as this in his books on South Africa. The Zulu doctors were in the habit, not only of "smelling out" witches and evil spirits, but of sprinkling the soldiers with medicine, in order to "put a great heart into them," and ensure their victory in battle. Customs like these gave Charles Dickens his opportunity of writing two of his most scathing satires "The Noble Savage" and "The Medicine Man of Civilisation." He refused to subscribe to the popular and amiable sentiment that the African barbarian was an interesting survival, or that the Ojibbeway Indian was picturesque. After a severe indictment of them, Dickens instanced their customs in medicine as a proof of their irremediable depravity. "When the noble savage finds himself a little unwell," he wrote, "and mentions the circumstance to his friends, it is immediately perceived that he is under the influence of witchcraft. A learned personage, called an Imyanger, or Witch Doctor, is sent for to Nooker the Umtargartie, or smell out the witch. The male inhabitants of the kraal being seated on the ground, the learned doctor, got up like a grizzly bear, appears and administers a dance of the most terrific nature, during the exhibition of which remedy he incessantly gnashes his teeth, and howls,--'I am the original physician to Nooker the Umtargartie. Yow, yow, yow! No connection with any other establishment. Till, till, till! All other Umtargarties are feigned Umtargarties, Boroo, Boroo! but I perceive here a genuine and real Umtargartie, Hoosh, Hoosh, Hoosh! in whose blood, I, the original Imyanger and Nookerer, will wash these bear's claws of mine!' All this time the learned physician is looking out among the attentive faces for some unfortunate man who owes him a cow, or who has given him any small offence, or against whom, without offence, he has conceived a spite. Him he never fails to Nooker as the Umtargartie, and he is instantly killed." This is no burlesque, and I have given the record in Dickens's inimitable language because it most vividly sets before us the custom of the medicine-men of barbarous races. But the medicine-men of Longfellow's description, the men who came to appease and console Hiawatha, who "Walked in silent, grave procession, Bearing each a pouch of healing, Skin of beaver, lynx, or otter, Filled with magic roots and simples, Filled with very potent medicines," --these may be accepted as the milder type of magicians who, among a primitive people, claimed not only to be able to heal the living, but to restore the dead. Mr. Austine Waddell, in his exhaustive work on the Buddhism of Tibet, tells us that a very popular form of Buddha is as "the supreme physician" or Buddhist Æsculapius, the idea of whom is derived from an ancient legend of the "medicine-king" who dispensed spiritual medicine. The images of this Buddha are worshipped as fetishes, and they cure by sympathetic magic. The supplicant, after bowing and praying, rubs his finger over the eye, knee, or particular part of the image corresponding to the affected part on his own body, and then applies the finger carrying this hallowed touch to the afflicted spot. Mr. Waddell says that this constant friction is rather detrimental to the features of the god; whether it is beneficial to the man's body is of course largely a matter of faith and circumstances. As might be expected, talismans to ward off evils from malignant planets and demons, whence come all diseases, are in great request. The eating of the paper on which a charm has been written is considered by the Tibetan to be the easiest and most certain method of curing a malady, and the spells which the Lamas use in this way are called "za-yig," or edible letters. A still more mystical way of applying these remedies, according to Mr. Waddell, is by the washings of the reflection of the writing in a mirror, a habit common in other quarters of the globe. In Gambia, for instance, this treatment is relied upon by the natives. A doctor is called in, he examines the patient, and then sits down at the bedside and writes in Arabic characters on a slate some sentences from the Koran. The slate is then washed, and the dirty infusion is drunk by the patient. In Tibet, Chinese ink is smeared on wood, and every twenty-nine days the inscription reflected in a mirror. The face of the mirror during the reflection is washed with beer, and the drainings are collected in a cup for the patient's use. This is a special cure for the evil eye. The medicine-men of Tibet can also supply charms against bullets and weapons, charms for the clawing of animals, charms to ward off cholera, and even charms to prevent domestic broils. This is surely evidence of high civilisation. It would be hopeless to endeavour to exhaust this subject. Only a few selected instances can be given to illustrate how large a part magic has played, and still plays, in the healing art. Medicine is by no means freed of its superstitions yet, and the success of quack advertisements of the day abundantly proves that the civilised public is still prone to believe that universal remedies are obtainable, and that miracles can be wrought. Modern medical science, as one of its great exponents has pointed out, plays a waiting game when miracles are spoken of, and when magic is claimed to supersede specific remedies. "When it is asked to believe in the violent and erratic violation of laws of matter and force, science stands on an impregnable rock, fenced round by bulwarks of logical fact, and flanked by the bastions of knowledge of nature and her constitution." And as exact knowledge spreads, Prospero will have no alternative but to break his staff, and bury it fathoms deep. Chaucer's Doctor of Physic. BY W. H. THOMPSON. In the "Canterbury Tales" we have an inimitable gallery of fourteenth century portraits, drawn from life, with all a great master's delicacy of finish and touch. And in none of these pictures does Chaucer excel himself more than in that of his "Doctor of Physic." We may take it for granted that the portrait is no mere fanciful one, with its pre-Raphaelite minuteness of detail, sketched with the poet's own peculiar skill. With what mischievous and yet altogether playful and good-natured humour is the man of medicine presented to us! "With us there was a doctour of phisike In all this world ne was there none like him To speak of phisike and of surgerie." What manner of man was this paragon of medical knowledge? In personal appearance he was somewhat of an exquisite. "Clothes are unspeakably significant" saith the immortal Teufelsdrockh, and every practitioner who has his _clientele_ largely yet to make knows the importance of being well dressed. Chaucer's grave graduate was apparelled in a purple surcoat, and a blue and white furred hood. "In sanguine and in perse he clad was all Lined with taffata and with sendall," and yet no luxurious sybarite by any means was he, "Of his diet measureable was he, For it was no superfluity, But of great nourishing and digestable." A man of simple habits, even perhaps given to holding his purse strings somewhat tightly. "He was but easy of expense, He kept that he won in pestilence." For, as the poet adds with his characteristic merry sly humour, "Gold in physic is a cordial, Therefore he loved gold in special." The science of medicine since Chaucer's day has made extraordinary advances, and it is only fair to judge his doctor by contemporary standards. To-day, we fear, he would be largely regarded as little better than a charlatan and a quack. It is true, he was acquainted with all the authorities, ancient and modern, from Æsculapius and Galen down to Gaddesden, the author of the "Rosa Anglica," the great English book of fourteenth century medicine. But this last named luminary of physic would aid him very little on the road to true knowledge. This medical "Rose," which Leland calls a "large and learned work," only serves to illustrate the impotence of the professors of the healing arts at that period. This is the recipe of Gaddesden for the small-pox. "After this (the appearance of the eruption) cause the whole body of your patient to be wrapped in red scarlet cloth, and command everything about the bed to be made red. This is an excellent cure. It was in this manner I treated the son of the noble king of England when he had the small-pox, and I cured him without leaving any marks." To cure epilepsy, he orders the patient "and his parents" to fast three days, and then go to church. "The patient must first confess, and he must have mass on Friday and Saturday, and then on Sunday the priest must read over the patient's head the gospel for September, in the time of vintage after the feast of the Holy Cross. After this the priest shall write out this portion of the gospel reverently, and bind it about the patient's neck, and he shall be cured." If epilepsy was to be exorcised by such a remedy as this, we venture to assert that it must have been largely a case of faith-healing. [Illustration: GEOFFREY CHAUCER. (_From Harleian M.S.--4866 fol. 91._)] Seeing then that such was the condition of the science of medicine in Chaucer's days, we must take with a good deal of reservation his statement that his doctor "Knew the cause of every malady Were it of cold, or hot, or moist, or dry, And where engendered, and of what humour." Anyhow, some of the remedies prescribed for the "sick man," and the "drugs," which his friends the apothecaries were so ready to supply, would have seemed extraordinary enough to us. The poet tells us the doctor's study was but "little in the Bible," and that though a "perfect practitioner," the ground of his scientific knowledge was astronomy, _i.e._, astrology; the "better part of medicine," as Roger Bacon calls it. In dealing with his patients he was guided by "natural magic." To this practice Chaucer alludes in another of his poems, the "House of Fame." "And clerks eke, which con well, All this magic naturell, That craftily do her intents, To make in certain ascendents, Images--lo through which magic, To make a man be whole or sick." So that in spite of what appears to us the charlatanry in his make up, the doctor was supposed to be a person of importance in the eyes of his fellow pilgrims, with quite the standing of an accredited medical man of to-day, is evidenced by the manner in which mine host Bailly addresses him. Master Bailly was no particular respecter of persons, indeed, on the contrary, he was somewhat of a Philistine; yet he was all respect to this man of medicine. It is as "Sir" Doctor of Physic, the host addresses him; also declaring him to be a "proper man," and like a prelate. After the story of chicanery related by the Canon's Yeoman, it is to the physician he looks to tell a tale of "honest matter." Such is his bearing towards him throughout. The doctor's contribution to the "Canterbury Tales," too, is of a serious, sober kind, in keeping with his character; and concludes with some sound moral advice. Therefore, whatever foibles he may have, the "doctor of physic" is presented to us as a sterling gentleman, no unworthy predecessor of those who to-day, on more modern lines, still follow in his footsteps. The Doctors Shakespeare Knew. BY A. H. WALL. "O, mickle is the powerful grace that lies In herbs, plants, shrubs, and their true qualities. For nought so vile that on the earth doth live But to the earth some special good doth give; Nor ought so good, but, strained from that fair use Revolts from true birth, stumbling on abuse." --_Romeo and Juliet._ "By medicine life may be prolong'd."--_Cymbeline V. 5._ In Walckenaer's "Memoirs of Madame de Sévigné," and in the amusing, interesting volume which Gaston Boissier devoted to her works and letters, we have glimpses of the medical profession in France, which show us it was in her time and country, just what it was in England in the same century when it was known to Shakespeare. For one more or less genuine physician there were thousands of charlatans and quacks, and the contempt which our great dramatic poet frequently expresses in his works for medical practitioners must, in fairness, be regarded as applicable to the latter, not to the former. In 1884, an American writer on this subject (Dr. Rush Field, in his "Medical Thoughts of Shakespeare") strove to show that our great philosophic poet and playwright's opinion of all the medical practitioners was a low one. "He uses them frequently," he says, "as a tool by which deaths are produced through the means of poison, and generally treats them with contempt." That he might fairly do this, and that in doing it he rather displayed respect and regard for the genuine, more or less scientific professors of the healing art, can be very readily demonstrated by anyone at all familiar with his plays. But to return to Madame de Sévigné. At a time when she was growing old, when her letters speak so sadly of the dying condition of Cardinal de Retz at Commercy, of Madame de la Fayette's being consumed by slow fever, and La Roche confined to his armchair by gout, of Corbinelle's threatened insanity, and of his taking "potable gold" as a remedy for headache, she writes also of small-pox and other fevers having permanently settled at Versailles and Saint-Germain, where the King and Queen were attacked, and ladies and gentlemen of the Court were decimated, and cases of apoplexy and rheumatism were rapidly increasing in every direction. "Fashionable folk, used up with pleasure-making, sick through disappointed ambition, fidgetting without motive, agitating without aim, tainted with morbid fancies and suspicion," found themselves in the doctor's hands, and were far more ready to select practitioners who promised magically swift and easy cures, than those who spoke of slow and gradual recovery by means which were neither painless nor pleasurable. "Everybody," says Boissur, "women included, battled with one another to possess marvellous secrets whereby obstinate complaints should be immediately cured. Madame Fouquet applied a plaster to the dying Queen, which cured her, to the great scandal of the Faculty unable to save her; and the Princess de Tarente served out drugs to all her people at Vitre. [Illustration: WILLIAM SHAKESPEARE. (_The Stratford Portrait._)] Madame Sévigné wrote of her as "the best doctor in the upper classes; she has rare and valuable compounds of which she gives us three pinches with prodigious effect." When writing to her daughter, she begs her not to neglect taking such medicines as "cherry water," "extract of periwinkles," "viper-broth," "uric acid," and "powdered crab's-eyes." She says the extract of periwinkles "endowed Madame de Grignam with a second youth." Writing to her daughter, "If you use it, when you re-appear so fair people will cry, 'O'er what blessed flower can she have walked,' then I will answer 'On the periwinkle.'" She tells, too, how the Capuchins, who still retained their ancient medical reputation, treated the rheumatism in her leg "with plants bruised and applied twice a day; taken off while wet twice a day, and buried in the earth, so that as they rotted away her pains might in like way decrease." "It's a pity you ran and told the surgeons this," she says to her daughter, "for they roar with laughter at it, but I do not care a fig for them." In like way Madame de Scudery tells Bassy, "There is an abbé here who is making a great bother by curing by sympathy. For fever of all kinds, so they say, he takes the patient's spittle and mingles it with an egg, and gives it to a dog; the dog dies and the patient recovers.... They say he has cured a quantity of people." Turning from these illustrations of medical practice in France to see how identical it is with that adopted in England when Shakespeare lived, we recall the advice of that eminent gentleman, Andrew Rourde, who recommends people to wash their faces once a week only, using a scarlet cloth to wipe them dry upon, as a sure remedy in certain cases. In other instances we find that certain pills made from the skulls of murderers taken down from gibbets, and ground to powder for that purpose, were popular as medicine, that a draught of water drunk from a murdered man's skull had wonderful medicinal properties, and that the blood of a dragon was absolutely miraculous in the cures it effected. The touch of a dead man's hand was another ghastly remedy in common use, and the powder of mummy was a wonderful cure for certain grave complaints. Love-philtres were also regarded from a medicinal point of view, and the strange doings of quack _accoucheurs_ are not less absurdly terrible. That the seventeenth century physician himself was not always proof against these products of ancient ignorance and superstition, is abundantly apparent. Van Helmont, the son of a nobleman, born in Brussels, and very carefully educated for his profession, practised both medicine and magic medicinally. He rejected Galen, inclined to that illiterate pretender Paracelsus, and determined that the only way by which he could defy disease, and utterly destroy it, was through what he called _Archæus_. Speaking of digestion, for instance, he denied that it was either chemical or mechanical in its nature, but the result of this _Archæus_, a spiritual activity, working in a very mysteriously complicated way, for both evil and good. It has been said that he was one of Lord Bacon's disciples, but for that assertion there certainly is no sufficient foundation, for Bacon, if a mystic by inclination, was logical in reasoning. In England Van Helmont had an English follower in the person of another physician, Dr. Fludd, a disciple of the famous inventor of the camera obscura, and conjecturally the first photographer. His grand quack remedy was "the powder of sympathy," which was the "sword-salve" of Paracelsus (composed of moss taken from the skull of a gibbetted murderer, of warm human blood, human suet, linseed oil, turpentine, etc.). This was applied, not to the wound, but to the sword that inflicted it, kept "in a cool place!" Certain plants pulled up with the left hand were regarded as a sure remedy in fever cases, but the gatherer, while gathering, was not to look behind, for that deprived the plants of their medicinal value. Amongst other physicians of Shakespeare's century was Mr. Valentine Greatrake, who came to London from Ireland, where his supposed magical cures had been awakening a great sensation. He hired a large house in Lincoln's Inn Fields, to which vast crowds of patients of all kinds and conditions crowded daily, all clamouring to be cured. He received them in their order, says an eye-witness, with "a grave and simple countenence." For, as Shakespeare wrote, "Thus credulous fools are caught." ("Comedy of Errors," 1, 2.) Greatrake (afterwards executed for high treason) asserted that every diseased person was possessed by a devil, and that by his prayers and laying on of hands the devil could be cast out. Lord Conway sent for him to cure an incurable disease from which his wife was suffering, and even some of the most learned and eminent people of the time were amongst his patrons. St. Evremond wrote, "You can hardly imagine what a reputation he gained in a short time. Catholics and Protestants visited him from every part, all believing that power from heaven was in his hands." In an Act of Parliament which was passed in the year 1511, we read, in its preamble, that "the science and cunning of Physic and Surgery" was exercised by "a great multitude of ignorant persons, of whom the greater part have no manner of insight in the same, nor in any other kind of learning--some also can read no letters in the book--so far forth that common artificers, as smiths, weavers, and women, boldly and accostumably took upon them great cures, and things of great difficulty, in which they partly used sorceries and witchcraft, and partly supplied such medicines unto the diseased as are very noisome, and nothing meet therefore; to the high displeasure of God," etc. A large number of the pretended remedies thus used in medical practice are clearly traceable back to the ancient Magi, who were professors of medicine, as well as priests and astrologers. With these facts before you, turn to your Shakespeare, and see how he regarded the popular delusions thus created and fostered, with their "Distinguished cheaters, prating mountebanks, And many such libertines of sin." --_Comedy of Errors._ Do you remember the other lines from this source, in which the poet speaks of "This pernicious slave," who "forsooth took on him as a conjurer, and, gazing in mine eyes, feeling my pulse, and with no face, as't were, outfacing me, cried out I was possessed." This is not the stern, grave doctor in "Macbeth," who did not pretend to "raze out the written troubles of the brain," but said, "Therein the patient must minister unto himself." There is no depreciation of the healing art in Shakespeare's painting of Lear's physician, as there is of the "caitiff wretch" of an apothecary, who sold poison to Romeo in a very different way to that in which the physician in Cymbeline supplied a deadly drug to the Queen. "I beseech your grace," says he, speaking in solemn earnestness, "without offence (my conscience bids me ask) wherefore you have commanded of me these most poisonous compounds." In "All's well that Ends Well," you will recognize the foregoing descriptions of medicinal delusions in the interview between Helena and the King, who says, we "may not be so credulous of cure, when our most learned doctors leave us, and the congregated college have concluded that labouring art can never ransom Nature from her maid estate, I say we must not so stain our judgment, or corrupt our hope, to prostitute our past-cure malady to empirics." In this play both "Galen and Paracelsus" are mentioned, and their names then represented rival schools of medicine. How smartly and merrily Shakespeare wrote of such cures as Greatrake professed to effect, we see in Henry VI., where Simpcox, supposed to be miraculously cured of blindness, is asked to and does describe what he sees, "If thou _hadst_ been born blind, thou might'st as well have known all our names as thus to name the several colours we do wear." In the "Merry Wives of Windsor" we have "Master Caius that calls himself doctor of physic," and is called by Dame Quickly a "fool and physician." The two were in Shakespeare's time very commonly combined, and often, as we have shown, very strangely. Dr. Caius was a real name borne by a learned gentleman who was physician to Queen Elizabeth. In Cymbeline the name of the physician is Cornelius. This again was the name of a real physician, who, in the sixteenth century, gained great reputation in Europe chiefly by restoring Charles V. to health after a tediously long illness. We may presume that Shakespeare was familiar with the fact. Amongst the doctors of our poet's time it was a common custom to throw up cases when they believed them hopeless. Shakespeare's Sempronius says, "His friends, like physicians, thrice gave him o'er," and Lord Bacon in his work on "The Advancement of Learning," says of Physicians, "In the enquiry of diseases, they do abandon the cures of many, some as in their nature incurable, and others as past the period of cure, so that Sylla triumvirs never prescribed so many men to die as they do by their ignorant edicts." We have spoken of the sword-salve cure for wounds. Of dealers in poison who visited fairs and market-places, and attracted crowds by the aid of a stage fool, we get a glimpse in "Hamlet," where Laertes says:-- "I bought an unction of a mountebank, So mortal, that but dip a knife in it, Where it draws blood, no cataplasm so rare Collected from all simples that have virtue, Under the moon can save the thing from death." There is a hit at doctors who gave others remedies they had not enough faith in to adopt for themselves:-- "Thou speak'st like a physician, Helicarnus: Who minister'st a potion unto me That thou would'st tremble to receive thyself." --_Pericles._ In the same play the true physician receives full appreciation. Cerimon says of himself:-- "'Tis known, I ever Have studied physic, through which secret art, By turning o'er authorities, I have Together with my practice, made familiar To me, and to my aid, the blest infusions That dwell in vegitives, in metals, stones. And I can speake of the disturbances That nature works, and of her cures; which doth give me A more content in course of true delight Than to be thirsty after tottering honour, Or tie my treasure up in silken bags, To please the fool, and death." And one of the two listening gentlemen adds:-- "Your honour has through Ephesus pour'd forth Your charity, and hundreds call themselves Your creatures, who by you have been restored." And Pericles, with his supposed dead wife in his arms, turning to Cerimon, who has saved her from the grave, says:-- "Reverend Sir, The gods can have no mortal officer More like a god than you." And Gower, speaking the concluding lines of the play, adds:-- "In reverend Cerimon there well appears The worth that learned charity aye wears." "_Cerimon_: I hold it ever Virtue and cunning (wisdom) were endowment greater Than nobleness and riches...." There was, perhaps, when Shakespeare wrote the above lines, some thought of the Elizabethan nobleman, Edmund, Earl of Derby, who "was famous for chirurgerie, bone-setting, and hospitalite," as Ward says in his Diary; of the Marquis of Dorchester, who in his time was a Fellow of the College of Surgeons; or of the poet's son-in-law, Dr. Hall, a gentleman who resided in Stratford-on-Avon, in a fine old half timber house still standing, and known as Hall's Croft. To his wife, the poet's elder daughter, Shakespeare bequeathed his house and grounds, which Dr. Hall occupied when he died. His grave is near that of his glorious father-in-law, and on it is the following inscription:-- "HERE LYETH Y{E} BODY OF JOHN HALL, GENT: HE MARR: SVSANNA Y{E} DAUGHTER AND CO HEIRE OF WILL. SHAKESPEARE, GENT. HEE DECEASED NOVE{R} 25 A{O} 1635 AGED 60. Hallius hic situs est medica celeberrimus arte Expectans regni gaudia læta Dei Dignus erat meritis qui Nestora vinceret annis, In terris omnes, sed rapit aequa dies; Ne tumulo, quid desit adest fidissima conjux Et vitæ Comitem nunc quoque mortis habet." Dickens' Doctors. BY THOMAS FROST. Dickens, it must be admitted by even the greatest admirers of his inimitable genius, among whom the writer of this paper must be counted, was not successful in his delineations of the medical profession. Though his most humorous as well as his most pathetic pictures of human life are drawn from the humbler walks in the pilgrimage of humanity, he has given us some good touches of his skill in his presentments of other professions, and notably of lawyers and lawyers' clerks. Nothing in fiction can excel his legal characters in, for instance, "Bleak House,"--his Mr. Tulkinghorn, Mr. Guppy, the clerk, and Mr. Snagsby, the law stationer. But a life-like doctor cannot be found in his works, and the nearest approaches to such a description are the merest sketches. The most strongly marked of these are Dr. Parker Peps and Mr. Pilkins, the two members of the faculty who officiate at the closing scene in the life of Mrs. Dombey, in which a sense of humour, with difficulty suppressed by the author, mingles with the touching sadness of the death. Dr. Parker Peps, "one of the Court physicians, and a man of immense reputation for assisting at the increase of great families," is introduced "walking up and down the drawing-room with his hands behind him, to the unspeakable admiration of the family surgeon, who had regularly puffed the case for the last six weeks among all his friends and acquaintances as one to which he was in hourly expectation, day and night, of being summoned in conjunction with Dr. Parker Peps." But in this little interlude, the two actors in which do not appear again, the obsequiousness of Mr. Pilkins to the Court physician, and the manner in which the latter, with assumed obliviousness, substitutes "her grace, the duchess" or "her ladyship" for Mrs. Dombey, verge on caricature, a tendency Dickens seems to have had at all times some difficulty in resisting. Of Dr. Slammer also we have only a sketch, and that of the slightest character. Though he is described as "one of the most popular personages in his own circle," we gather from the incidents in which he appears only that he was very irascible. As we read of his furious jealousy of Jingle, and the interrupted duel with Winkle, who had received his challenge to the former by mistake, we wonder at the circle in which this "little fat man, with a ring of upright black hair round his head, and an extensive bald plain on the top of it," was one of the most popular personages. Harold Skimpole, we are told, had been educated for the medical profession; but his training seems to have left no traces of it upon his character or his conversation. He prefers to dabble in literature and music for his own amusement, and look to his friends for the means of living, too prosaic an occupation for himself. One of the best, but not quite the best, of the medical characters in Dickens' novels, is Allan Woodcourt, who "had gone out a poor ship's surgeon, and had come home nothing better,"--the young man hastily called in when the death of Nemo is discovered, in conjunction with "a testy medical man, brought from his dinner, with a broad snuffy upper lip, and a broad Scotch tongue." Allan Woodcourt has the kindness of heart which characterises the profession, and exemplifies it very pleasingly in the scene with the brickmaker's wife, and with poor Jo, the forlorn waif who is kept continually moving on by the police. How tenderly, too, he deals with Richard Carstone, the weak-minded victim of the long-drawn Chancery suit. And his head is as sound as his heart is soft. "You," says Richard to him, "can pursue your art for its own sake, and can put your hand to the plough and never turn; and can strike a purpose out of anything." What a world of difference we see in this briefly sketched trait to the want of earnestness of purpose and steadfastness of pursuit in the character of young Carstone! Even stronger testimony to the good qualities of Allan Woodcourt is borne by Mr. Jarndyce. Allan, says that gentleman, is "a man whose hopes and aims may sometimes lie (as most men's sometimes do, I dare say) above the ordinary level, but to whom the ordinary level will be high enough after all, if it should prove to be a way of usefulness and good service leading to no other. All generous spirits are ambitious, I suppose; but the ambition that calmly trusts itself to such a road, instead of spasmodically trying to fly over it, is the kind I care for. It is Woodcourt's kind." The love passages of this estimable young man with the equally estimable Esther Summerson, one of Dickens' most charming presentments of English maidenhood, are very pleasing, and none of them more so than one which occurs towards the close of the story. There is another medical character in one of the Christmas stories which, good as it is, might have been made better but for the extent to which the exigencies of space limited the author in the development of character in that class of stories. I mean Dr. Jeddler, the genial but mistaken father of Grace and Marion, in "The Battle of Life." The doctor is "a great philosopher, and the heart and mystery of his philosophy was to look upon the world as a gigantic practical joke; as something too absurd to be considered seriously by any practical man. His system of belief had been in the beginning part and parcel of the battle ground on which he lived." He is not of the cynical school, but a modern Democritus, whose inclination to laugh at everything on the surface of the ocean of life was irresistible, while there was nothing in the conditions of his existence to suggest anything that was beneath. When he hears his daughters conversing about their lovers, "his reflections as he looked after them, and heard the purport of their discourse, were limited at first to certain merry meditations on the folly of all loves and likings, and the idle imposition practised on themselves by young people who believe for a moment that there could be anything serious in such bubbles, and were always deceived--always." Dr. Jeddler is a widower; we are not told what his experiences of married life had been. Had they been unhappy, one would suppose that he would have been more disposed to be cynical and pessimistic than to regard life's incidents as provocative of merriment, yet, if they had been happy, why should he have regarded the engagement of Grace as an idle folly, a bubble on life's surface, soon to burst? Dickens' explanation is, from this point of view, scarcely satisfactory. "He was sorry," says the novelist, "for her sake--sorry for them both--that life should be such a very ridiculous business as it was. The doctor never dreamed of inquiring whether his children, or either of them, helped in any way to make the scheme a serious one. But then he was a philosopher. A kind and generous man by nature, he had stumbled by chance over that common philosopher's stone (much more easily discovered than the object of the alchemist's researches) which sometimes trips up kind and generous men, and has the fatal property of turning gold to dross, and every precious thing to poor account." But when sorrow had humbled the doctor's heart, he felt that the world in which some love, deep-anchored, is the portion of every human creature, was more serious than he had thought it, and understood "how such a trifle as the absence of a little unit in the great absurd account had stricken him to the ground." Then, when he and his daughters are again together in the old home, and his arms are about them both, we find him acknowledging that "It's a world full of hearts, and a serious world with all its folly,--even with mine, which was enough to swamp the whole world." It is to be observed, however, that while we find all the traits and incidents of professional life in the lawyers of Dickens' creation, there is little or nothing of the kind in his doctors. Such traits are abundant in his presentments of Tulkinghorn, and Kenge, and Vholes in Wickfield, and many others that might be named; but they are so completely absent from his portrayals of Allan Woodcourt and Dr. Jeddler, that the two men might as well have been of any other profession, without any loss to the stories in which they appear. If we compare them with his lawyers, or with the clergymen of Mrs. Oliphant, we are struck at once with the difference. [Illustration: CHARLES DICKENS.] This is not the case, however, when from the full-blown medical practitioner, adding to his name the initials M.D. or M.R.C.S., we descend to the "sawbones in training," as the facetious Sam Weller designates the young men qualifying themselves for the exercise of the profession by "walking the hospitals." The medical students of the novelist's early days were--it would perhaps be fairer to say that a large proportion of them were--a turbulent and disorderly element in the social life of the metropolis. The newspapers of the day record their frequent appearances at the Bow Street and Marlborough Street police-courts on charges of rowdyism in the streets at or after midnight, when they came out from their favourite places of amusement, the Coal Hole, in the Strand, the Cider Cellars, in Maiden Lane, and the Judge and Jury Club, in Leicester Square, the latter presided over by Renton Nicholson, who edited a vile publication called _The Town_. Their after-amusements were found in strolling through the streets in threes and fours, singing at the top of their voices comic songs, that often outraged propriety, ringing door bells, and chaffing the police. Dickens must often in his reporting days have witnessed the next morning appearances of these young men at Bow Street police-court. The first appearance of two specimens of this variety of the immature medico in the humorous pages of the "Pickwick Papers" is described as follows in the low cockney vernacular of Sam Weller. "One on 'em," he tells Mr. Pickwick, "has got his legs on the table, and is a-drinkin' brandy neat, vile the tother one--him in the barnacles--has got a barrel of oysters atween his knees, vich he's a-openin' like steam, and as fast as he eats 'em he takes a aim with the shells at young Dropsy, who's a-sittin' down fast asleep in the chimbley corner." The latter gentleman is Mr. Benjamin Allen, who is described by the novelist as "a coarse, stout, thick-set young man, with black hair cut rather short, and a white face cut rather long. He was embellished with spectacles, and wore a white neckerchief. Below his single-breasted black surtout, which was buttoned up to his chin, appeared the usual number of pepper-and-salt coloured legs, terminating in a pair of imperfectly polished boots. Although his coat was short in the sleeves, it disclosed no vestige of a linen wristband, and although there was quite enough of his face to admit of the encroachment of a shirt-collar, it was not graced by the smallest approach to that appendage. He presented altogether rather a mildewy appearance, and emitted a fragrant odour of full-flavoured Cubas." This gentleman's companion is Mr. Bob Sawyer, "who was habited in a coarse blue coat which, without being either a great-coat or a surtout, partook of the nature and qualities of both," and "had about him that sort of slovenly smartness and swaggering gait which is peculiar to young gentlemen who smoke in the streets by day, shout and scream in the same by night, call waiters by their Christian names, and do various other acts and deeds of an equally facetious description. He wore a pair of plaid trousers and a large rough double-breasted waistcoat: out of doors he carried a thick stick with a big top. He eschewed gloves, and looked, upon the whole, something like a dissipated Robinson Crusoe." The conversation of these budding surgeons is perfectly in harmony with their outward aspect. Their discourse, when it assumes a serious character, is of the "cases" at the hospital and the "subjects" at the time being on the dissecting tables of the anatomical lecture-rooms. When relieved from attendance at the hospitals, they lounge at tavern bars, and flirt with barmaids and waitresses, to whom their attentions are not unfrequently of an objectionable character, and less agreeable than they imagine them to be. The contrast between the graphic power displayed by Dickens in his delineation of the characters of Bob Sawyer and Ben Allen, and the indistinctiveness, as to profession, of his presentments of Allan Woodcourt and Dr. Jeddler, may help us to understand the causes which render his doctors so much less effective than his lawyers. The legal profession presents more variety than the medical, and comes before us more prominently in conjunction with incidents of a striking character, as may be seen every day in the newspaper records of the courts of law and of police. The physician and the surgeon stand as much apart, in these respects, from the busy barrister or solicitor as the clergy do. Dickens has not given us a clerical portrait, and probably for a similar reason. Mrs. Oliphant, on the other hand, excels in her delineations of every grade of the Anglican hierarchy; but her genius as a writer of fiction runs in a groove essentially different from that of Dickens. Famous Literary Doctors. BY CUMING WALTERS. Medical men have not so commonly made literature an extra pursuit, or adopted it as a serious calling, as have the members of the other liberal professions. It is quite expected that a clergyman should write poems, philosophical essays, and perhaps even a novel with a purpose; and it is usual to recruit the ranks of critics extensively from the law, and to trust to briefless barristers for a continuous supply of romances. No detail is more frequently discovered in the biographies of eminent authors than that they were called to the Bar, and either never practised or forsook practising in order to engage in literary labours. Indeed, it might almost seem that failure in law was the most important step towards success in authorship. No such rule applies, however, to medical men, and no such comment would be justified in their case. Not only do we find the writing of books--otherwise than text-books and technical treatises--rarer with them, but it curiously happens that in most instances it has been the successful practitioner, not the man walking the hospitals or waiting for calls, who has turned author. And we shall find that these medico-literati (if I may coin the phrase) have often been among the most hard-working in their profession, and the wonder is that they were able to enter upon a second pursuit and to follow it with so much zeal. For, in most of the examples I shall advance, literature was more than a pastime with these men who indulged in it. It was chosen by some for its lucrativeness, and by the majority for its capacity to enhance their reputation or to bring them enduring fame. This much may be safely said, that the names of many excellent doctors would have faded from public remembrance ere this, and would have passed away with the generation to which they belonged, had not literature given them lasting luminance. In not a few instances the fact is already forgotten or wholly ignored that certain successful writers once wrote "M.D." after their names. Who cares that the author of that classic "Religio Medici" took his degrees at Leyden and at Oxford, and dispensed medicine to the end of his life? Who cares that the author of "The Borough," "Tales in Verse," and "The Parish Register," was apprenticed to a surgeon? Who cares that the writer of such dramas as "Virginius," "William Tell," and "The Hunchback," was trained for a physician? Who cares that the author of "Roderick Random," "Peregrine Pickle," and "The Expedition of Humphrey Clinker" was a surgeon's assistant and acted as surgeon's mate in the unfortunate Carthagena expedition, before trying (unsuccessfully) to obtain a practice in London? And, above all, who cares that the author of "The Deserted Village" and "The Vicar of Wakefield" studied physic in Edinburgh and on the Continent, and, as Boswell was informed, "was enabled to pursue his travels on foot, partly by demanding at Universities to enter the lists as a disputant, by which, according to the custom of many of them, he was entitled to the premium of a crown, when luckily for him his challenge was not accepted?" Such are a few of the examples which immediately occur to the mind when the whole subject is contemplated. It would be impossible in the compass of a short article to deal systematically and comprehensively with doctors who became authors, or to make out a complete list of their names with an account of the works which entitled them to the designation. Any facts now adduced must be considered arbitrary and capricious, so far as the choice of them is concerned; and sequence is so little attempted that the reader will pardon, I trust, a possible leap from Galen to Goldsmith, from Sir Thomas Browne to Tobias Smollett, and from Sir John Blackmore to Conan Doyle. I put aside those members of the profession who have simply written on professional subjects. Their name is legion, but in the great majority of cases such work as this would not strictly justify their inclusion among the literati. And, on the other hand, we cannot find a place in the category for such men as Goethe or Sainte-Beuve, for though both studied medicine, it seems to have been purely with a view to the extension of their knowledge and not with any more practical or material object. Sainte-Beuve, it is true, for a short time in his youth entertained some thought of adopting the profession; but Goethe only dipped into the subject with the same spirit that he dipped into experimental chemistry and astrology. Let us, then, refer to a few types certain of instant recognition. The most notable of modern instances is Dr. Oliver Wendell Holmes, a specialist in his profession, a hard-working physician, and the author of valuable treatises on medical art, who nevertheless occupied the position of being among the four chief poets whom America has produced, and one of the most versatile of the littérateurs of the century. He went to the Paris Medical Schools shortly after he had graduated at Harvard; he practised as a physician at Boston; and for nearly forty years he was Professor of Physiology. Yet he had time to write the most delightful and original of philosophical essays, to publish novels of which at least one--"Elsie Venner: A Romance of Destiny"--will rank as a classic; to deliver orations and after-dinner speeches in sparkling verse, and to write exquisite poems in rich and felicitous language on a wonderful variety of themes, the complete collection of which makes a very substantial volume. In all his work Dr. Holmes showed himself to be the profound student of nature and of humanity with many varying interests; yet we can often trace the hand of the physician in the work of the essayist and poet. His novels were special studies which only the ardent physiologist and metaphysician would have cared to discuss, or, at all events, would have discussed so well. Both "Elsie Venner" and "The Guardian Angel" deal with the occult problems of heredity, and those problems are treated with the power of the specialist in certain branches of science. Still more strongly is the character of the medical man displayed in a number of the poems, some by reason of their subject, and some by the figures and imagery they contain. The well-known "Stethoscope Song" will immediately suggest itself in illustration. But, for purposes of quotation, I prefer a less popular poem of rare beauty, which more strikingly manifests the writer's power of transmuting the hard dry facts of science into light and gleaming poetry. I refer to what he called at first "The Anatomist's Hymn," but afterwards "The Living Temple." It is one of the interpolated poems in the "Autocrat" series of papers, and to my thinking invests the human body and its physical functions with unimagined charms. Take, for instance, this poetic exposition of our respiration, the scientific correctness and exactness of which need no explanation to readers of this volume:-- "The smooth, soft air with pulse-like waves Flows murmuring through its hidden caves, Whose streams of brightening purple rush Fired with a new and livelier blush, While all their burden of decay The ebbing current steals away, And red with Nature's flame they start From the warm fountains of the heart. No rest that throbbing slave may ask, For ever quivering o'er his task, While far and wide a crimson jet Leaps forth to fill the woven net Which in unnumbered crossing tides The flood of burning life divides, Then kindling each decaying part Creeps back to find the throbbing heart. But warmed with that unchanging flame Behold the outward moving frame, Its living marbles jointed strong With glistening band and silvery thong, And linked to reason's guiding reins By myriad rings in trembling chains, Each graven with the threaded zone Which claims it as the master's own." There is an almost irresistible temptation to linger over Dr. Oliver Wendell Holmes' books, so intensely interesting is his personality and so fascinating is his work. But several other eminent poets of the profession demand attention. To Crabbe's connection with surgery I have already incidentally referred, and inasmuch as he early abandoned the calling for the ministry, little need be said except that his youthful experience may have aided him in writing a scathing denunciation of the Quack, who believed wholly in the potence of "oxymel of squills," and of the Parish Doctor, who "first insults the victim whom he kills." The poet was a severe castigator, and was never less forbearing with the lash than when these impostors of his day were under his hand for flagellation. In Mark Akenside we come to a better specimen of the class which we are considering. At the age of twenty he went to Leyden, and three years later became, (as Dr. Johnson writes) "a doctor of physick, having, according to the custom of the Dutch Universities, published a thesis." In the same year he published "The Pleasures of the Imagination," his greatest work. This was followed by a collection of odes, but he still sought a livelihood as a physician. Little success attended him, however, and Dr. Johnson records that Akenside was known as a poet better than as a doctor, and would have been reduced to great exigencies but for the generosity of an ardent friend. "Thus supported, he gradually advanced in medical reputation, but never attained any great extent of practice, or eminence of popularity. A physician in a great city," his biographer continues musingly, "seems to be the mere play-thing of Fortune; his degree of reputation is, for the most part, totally casual; they that employ him, know not his excellence; they that reject him, know not his deficiency." Yet it was otherwise with Sir Samuel Garth, doctor and poet, of whom Johnson himself records that "by his conversation and accomplishments he obtained a very extensive practice." His principal poem was "The Dispensary," relating to a controversy of the time between the College of Physicians, who desired to give gratuitous advice to the poor, and the Apothecaries, who wished to keep up the high price of medicine. Garth was "on the side of charity against the intrigues of interest, and of regular learning against licentious usurpation of medical authority," as Johnson put it; and he sprang into favour, was eventually knighted, and became physician-general to the army. His last literary work, and his worst, was a crude but ostentatious preface to a translation of Ovid. As a matter of fact his writing was invariably mediocre, and Pope, in calling attention to the fact that the "Dispensary" poem had been corrected in every edition, unkindly remarked that "every change was an improvement." John Phillips, who may be ranked among the physicians, though it is doubtful whether he practised, enjoyed a better fate as a man of letters than did either Akenside or Garth. He sprang into sudden popularity by the publication of a whimsical and clever medley called "The Silver Shilling," and this he followed up by a sort of official commemoration of the victory of Blenheim. His greatest achievement was a poem in two books on "Cider," and he was meditating an epic on "The Last Day" when he died, at the early age of thirty-three. One curious fact about his writings, small as it is, is worthy of mention. He sang the praises of tobacco in every poem he wrote, except that on Blenheim. Dr. Johnson did not rate Phillips very highly; he said that what study could confer he obtained, but that "natural deficience cannot be supplied." The sturdy doctor, however, did his utmost to rehabilitate the damaged reputation of Blackmore, whom we may regard as the most remarkable of all the compounds of physician-poets with whom we can become acquainted. Blackmore obtained an undeserved success, which was followed by unmerited ridicule, and Johnson, who hated every form of injustice, constituted himself his champion. For the truth about Blackmore we must seek the medium between the extremes of Johnson's praise and of the censure of his enemies--the "malignity of contemporary wits," as Boswell termed it. When all is said and done the fact remains that Blackmore was a man of uncommon character, and a prodigious worker. His first work, a heroic poem in ten books, on Prince Arthur, was written, he related, by "such catches and starts, and in such occasional uncertain hours as his profession afforded, and for the greatest part in coffee-houses, or in passing up and down the streets." This work passed through several editions with rapidity, and two extra books were added to it. The King knighted him and gave him other advances, but the critics furiously assailed him, and his name became a by-word for all that was heavy and ridiculous in poetry. Notwithstanding this he persevered, and published successively a "Paraphrase on the Book of Job," a "Satire on Wit," "Elijah,"--an epic poem in ten books--"Creation, a Philosophical Poem," "Advice to Poets how to celebrate the Duke of Marlborough," "The Nature of Man," "Redemption," "A New Version of the Psalms," "Alfred"--an epic in twelve books--"A History of the Conspiracy against King William," and a host of others which his perverted reason or fantastic fancy suggested. Never, perhaps, was known such a voluminous author, or one so erratic in his system. What with his long heroic poems, his treatises on smallpox and other diseases, his theological controversies, his "Advices" to painters, poets, and weavers, and his prose contributions to periodical publications, "England's Arch-Poet" (as Swift described him) could never have idled away an hour. Of all that he wrote, a few passages from his "Arthur" and "Creation" are alone remembered, and but for Johnson's good-natured attempt to save him from oblivion, his name would only have lived in the satires of his remorseless critics. One saying of Blackmore's only is worth noting here. He had laid himself open to the imputation of despising learning, and Dr. Johnson himself thought him a shallow ill-read man. But Blackmore said:--"I only undervalued false or superficial learning, that signifies nothing for the service of mankind; as to physic I expressly affirmed that learning must be joined with native genius to make a physician of the first rank; but if those talents are separated, I asserted, and do still insist, that a man of native sagacity and diligence will prove a more able and useful practiser than a heavy notional scholar encumbered with a heap of confused ideas." One or two other doctors who in their time enjoyed a reputation as writers, but whose fame was transient, or, at least, is insecure, call for very brief notice before we pass on to a few of greater importance. Sir John Hill, M.D., an eighteenth century physician, was a fairly extensive litterateur, and in addition to producing treatises on botany, medicine, natural history, and philosophy, wrote half a dozen novels, and several dramas. His _chef d'oeuvre_ was "The Vegetable System," a work of such magnitude that it ran to twenty-six volumes, a copy of which was presented to the King of Sweden, and procured for the author the distinction of being included in the Order of the Polar Star. Dr. William Fullarton Cumming, a son of Burns' "Bonnie Leslie," was compelled to travel in mild climates for his health, and as a result wrote "The Notes of a Wanderer," a work abounding in poetic descriptions of the charming scenery of the East. He tells us that the real pleasure of travelling is not to boast of how many lions one may have slain in a single day, but to saunter about without an object, to inhale the moral atmosphere of places visited, to enter bazaars, not to buy, but to catch the hundred peculiarities of a new people, to stray hither and thither watching the work and the recreations of other races. John Chalmers, M.D. (not to be confused with the great divine, Dr. Thomas Chalmers), also deserves to be noted as a very graceful writer of romantic stories; and Sir Henry Thompson, under the name of "Pen Oliver," produced some years ago a strange little volume which enjoyed a season's success--"Charley Kingston's Aunt." That most diffident and most delightful of authors, Dr. John Brown, who gave us the memorable "Rab and his Friends," was in practice at Edinburgh. As long as lovers of the animal creation are to be found, the story of Rab and of Marjorie will be read; and these sketches of brutes whom he almost humanised will probably outlive the genial doctor's more ambitious "Horæ Subsecivæ" and "John Leech and other Papers." Of a very different nature was the author of "Ten Thousand a Year," Dr. Samuel Warren, physician, lawyer, politician, novelist, and office-seeker. Tittlebat Titmouse is not much studied now, for the type is out-of-date, and the society of which the novel treats, the abuses prevalent, the general corruption which prevailed in public life, were exposures intended for a past generation. Yet there are passages in the work which should save it from absolute neglect, and it has for over half a century kept its author's name alive. This is more than his "Passages from the Diary of a late Physician" could have done, or those dozen other works with the bare titles of which the present reading public is scarcely acquainted. John Abercrombie, the chief consulting physician in Scotland during the last century, sought and achieved literary fame with two volumes on "The Intellectual Powers," and "The Moral Feelings." They enjoyed a popularity scarcely commensurate with their actual merits. David Macbeth Moir, who faithfully performed the arduous duties of a medical practitioner in Edinburgh, and whose life was almost wholly devoted to the service of his fellows, was the famous "Delta" of _Blackwood's Magazine_. His poems, some four hundred of which he contributed to "Maga." alone, are out of fashion now, though their delightful vein of reflectiveness and their charm of expression should preserve them from absolute neglect. The heavy labours of his profession did not seem to check his literary productiveness. His poems fill two large volumes; his prose works are by no means meagre or unimportant, and his "Sketches of the Poetical Literature of the past Half-century," is a standard work on the poetry of his period. Medical treatises, too, came from his pen; and his "Life of Mansie Wauch, Tailor," is one of the most agreeable of genuine Scotch sketches. His biographer correctly summed up the merits of the worthy doctor as a literary worker in the words "Good sound sense, a simple healthy feeling, excited and exalted though these may be, never fail him. He draws from nature, and from himself direct." Quiet humour and simple pathos, a love of humanity, deep reverential feeling, and originality of thought--all these are found in "Delta's" writings, and serve, with his own admirable nature, to keep his memory green. Of Dr. Conan Doyle, the most conspicuous instance of the hour of the doctor turned author, no detailed notice is requisite, as the main facts of his career are sufficiently well known, and his literary work promises to bring him both fame and fortune. Undoubtedly he exemplifies the fact that the medical hand can scarcely be concealed when it takes to the pen, for his novels and stories abound in allusions which only his study, training, and experience as a doctor could suggest. His reading and observation largely provide the technique of his romances. Something of the same could be said of Smollett's work, though the medical knowledge of the author was often turned to less agreeable account. In fact, most of Smollet's references on this score were the reverse of delectable, and I refrain from a more precise examination of them. The unexpected use to which Mr. R. D. Blackmore has turned his knowledge of medicine--for he studied medicine as well as law seriously in his youth--in several of his novels, notably in the last, "Perlycross," has excited much interest and attention among the profession. So marked is this that I cannot refrain quoting from a singularly interesting criticism penned by a leading physician in the Midlands. "The medical incidents in 'Perlycross,'" he says, "are pourtrayed with an accuracy which shows an intimate knowledge of the profession and its members.... No doubt the opinions expressed by one learned doctor were those of the time represented in the story, though they could hardly be received with justice in the present day. Speaking of the illness of Sir Thomas Waldron, he says (p. 18):--'At present such a case could be dealt with best in Paris, although we have young men rising now who will make it otherwise before very long.' The key to this difficulty is found later on (p. 159) where the technical word 'introsusception' is mentioned as the disease or condition from which the patient suffered. At the time spoken of Parisian surgeons, headed by the eminent Dupuytren, excelled in the art of surgery; at the present time such a case could be treated as well by any hospital surgeon in England as in the metropolis of France.... The book contains an admirably-described case of catalepsy, which is equally well explained. The cure of the attack is described with consummate skill and power. The keystone of the whole position of medical knowledge is contained in a few words towards its close. In these days of rapid transition from one excitement to another it would be well to take the lesson to heart, and to remember what the author speaks of as two fine things--'If you wish to be sure of anything see it with your own good eyes,' and the second, 'Never scamp your work.' How these sayings may be applied in the practice of the profession may with profit be learned from a perusal of the pages of 'Perlycross.'" Perhaps I am going too far in claiming Mr. Blackmore as a medical man who has taken to literature, but the excuse of his early training, combined with this curious result of it manifested in his writing, proves irresistible. Not to stray, however, but to get our feet once more upon solid ground, we may refer to a classic example, with which this article, had it been aught else but discursive, should have begun. Galen, the Greek physician, must be counted among the first and most famous of his class who have written literary works. He was so voluminous a writer on philosophical subjects that scores of books on logic and ethics have been fathered upon him without much question arising as to the unlikelihood of his being the author of so many. As it is he is credited with eighty-three treatises, the genuineness of which is not disputed; there are nineteen suspected to bear his name unjustly, forty-five are proved to be spurious, and then there remain a further fifteen fragments and fifteen commentaries on Hippocrates, which may be accepted as his in part or whole. He made himself master of the medical, physiological, and scientific knowledge of his time. He was born in 130 A.D., and died in 201, and left a record of that period. In addition to preparing this massive work, he seems to have found time to devote himself to various branches of philosophy with such success that later writers were well pleased to trade with the talisman of his name. Were it worth while to go back to antiquity, and to the history of foreign nations for further examples of physicians whose writings were not confined to expositions of the medical system, Averrhoes, most famous of Arabian philosophers, and physician to the calif, a master of the twelfth century, would occupy a prominent position. But it is more to our purpose to draw attention to the remarkable career, and one that deserves to be held in remembrance, of Arthur Johnston, physician to King Charles the First. In the same year that he graduated at the university of Padua (1610) he was "laureated poet at Paris, and that most deservedly," as Sir Thomas Urquhart recorded. He was then only three-and-twenty years of age, and the prospect of many years being before him, he indulged in extensive travel, and visited in turn most of the principal foreign seats of learning. His journeying over, he settled in France and became equally well known as a physician and as a writer of excellent Latin verse. A courteous act, characteristic of the time, secured him the favour and patronage of the English royal family, for in 1645 he published an elegy on James I., and followed this up by dedicating a Latin rendering of the Song of Solomon to King Charles. Other specimens of his rare culture and his poetical powers were forthcoming, and he achieved a European reputation. His Latin translation of the Psalms is held to be unexcelled by any other, unless it be Buchanan's, and the fact that his translation is still in use sufficiently attests its excellence and value. He died suddenly in 1641, while on a visit to Oxford, and in the centuries which have succeeded he has not been displaced in the front rank of refined and deeply versed Latin scholars and poets. It would be a matter of considerable difficulty to make a complete list of literary doctors, but enough has perhaps been written to show that they are no small band so far as numbers go, and that their influence in the world of books has been very considerable and distinguished. We owe to them many great works of enduring repute, of value to the student, of perpetual entertainment to the general reader. When, too, we consider the willingness and the zeal with which the writing members of the medical profession have imparted their knowledge, we are led to believe that they accepted as their motto the noble utterance of Sir Thomas Browne, the chief of literary doctors:--"To be reserved and caitiff in goodness is the sordidest piece of covetousness, and more contemptible than pecuniary Avarice. To this (as calling myself a Scholar) I am obliged by the duty of my condition: I make not therefore my head a grave, but a treasure of knowledge; I intend no Monopoly, but a community, in learning; I study not for my own sake only, but for theirs that study not for themselves. I envy no man that knows more than myself, but pity them that know less. I instruct no man as an exercise of my knowledge, or with an intent rather to nourish and keep it alive in mine own head than beget and propagate it in his; and in the midst of all my endeavours there is but one thought that dejects me, that my acquired parts must perish with myself, nor can be Legacied among my honoured Friends." The "Doctor" in time of Pestilence. BY WILLIAM E. A. AXON, F.R.S.L. "I do not feel in me those sordid and unchristian desires of my profession; I do not secretly implore and wish for Plagues, rejoice at Famines, revolve Ephemerides and Almanacks in expectation of malignant Aspects, fatal Conjunctions, and Eclipses."--SIR THOMAS BROWNE'S "Religio Medici," pt. ii., sec. ix. Of the great epidemics which have from time to time devastated Europe, Great Britain has had its full share. Between 664 and 1665 there were many visitations, resulting in heavy mortality, to which the general name of plague or pestilence has been given, although they were not always identical in form. Often the dread sisters Famine and Pestilence went hand in hand in the domains of merrie England in the good old times. The Statute of Labourers declares, no doubt with perfect truth, that "a great part of the people, principally of artisans and labourers," died in the pestilence known as the Black Death of 1349, which had important consequences, socially and politically. There were many subsequent outbreaks, though they fortunately did not attain to the enormous proportions of the great mortality. We have from the graphic hand of Chaucer a life-like portrait of a medical man of the fourteenth century who had gained his money in the time of pestilence. At the end of the fifteenth and middle of the sixteenth century, we have as alternating with bubo plague, the _Sudor Anglicanus_. Its appearance coincided with the invasion by which Richard III. lost his crown, and his rival became Henry VII. Dr. Thomas Forrester, who was in London during the outbreak of 1485, gives instances of suddenness with which the "sweat" became fatal. "We saw two prestys standing togeder and speaking togeder, and we saw both of them die suddenly." The symptoms were sweating, bad odour, redness, thirst, headache, "and some had black spots as it appeared in our frere Alban, a noble leech, on whose soul God have mercy." Forrester complains of the quacks who put letters on poles and on church doors, promising to help the people in their need. He lays stress upon astrological causes, but does not overlook the defective sanitation which gave the plague some of its firm hold. The _Sudor Anglicanus_ returned in 1508, 1517, 1528, and 1551. The last visitation was the occasion of a treatise by the worthy Cambridge founder, to whom Gonville and Caius College owes so much. "The Boke of Jhon Caius aganst the sweatyng Sickness" is an interesting document. It opens with a long autobiographical passage as to his previous literary labours, which have ranged from medicine to theology. At first he wrote in English, but afterwards in Latin and Greek. The reason for this change is stated. "Sence y{t} that tyme diverse other thynges I have written, but with the entente never more to write in the Englishe tongue partly because the comodite of that which is so written, passeth not the compasse of Englande, but remaineth enclosed within the seas, and partly because I thought that labours so taken should be halfe lost among them which set not by learnyng. Thirdly, for that I thought it best to auoide the judgment of the multitude from whom in maters of lernyng a man shal be forced to dissente, in disprouyng that which they most approue, and approuyng that which they most disalowe. Fourthly for that the common settyng furthe and printig of every foolishe thyng in englishe, both of phisicke vnperfectly and other matters vndiscretly diminishe the grace of thynges learned set furth in thesame. But chiefely because I would geve none example or comfort to my countrie men (who I would to be now, as here tofore they have been, comparable in learnyng to men of other countries) to stande onely in the Englishe tongue, but to leaue the simplicitie of the same, and to procede further in many and diuerse knowledges both in tongues and sciences at home and in uniuersities, to the adornyng of the comon welthe, better service of their kyng, and great pleasure and commodite of their own selues, to what kind of life so euer they should applie them." But his resolution not to write again in the vulgar tongue was broken by considerations of utility, for he saw that it could not be very serviceable to ordinary English people to give them advice as to the treatment of the sweating sickness in a language which they did not understand. In his account of this dire malady, he lays stress upon errors and excess of diet as a strongly co-operating cause. "They which had thys sweat sore with perille or death, were either men of welthe, ease and welfare, or of the poorer sorte such as wer idls persones, good ale drinkers, and Tauerne haunters. For these, by ye great welfare of the one sorte, and large drinkyng of thother, heped up in their bodies moche evill matter: by their ease and idlenes, coulde not waste and consume it." Against the infection of bad air he recommends avoiding carrion "kepyng Canelles cleane" and other general sanitary precautions. He suggests that the midsummer bonfires were intended for purging the air, "and not onely for vigils." Rosewater and other perfumes are to be used, and he thinks it would be well to clear the house of its rushes and dust. It is to be feared that the rushes which served instead of carpets, even in great houses, were not renewed very frequently. The handkerchief was to be perfumed, and the patient was to have in his mouth "a pece either of setwel, or of the rote of _enula campana_ wel steped before in vinegre rosate, a mace, or berie of Juniper." Dr. Caius, like Dr. Forrester, did not omit to warn his readers that even with the aid of his book a medical man was still necessary, and in doing so he gives us a glimpse of the quack doctors of the sixteenth century. "Therefore seke you out a good Phisicien, and knowen to haue skille, and at the leaste be so good to your bodies, as you are to your hosen or shoes for the wel-making or mending wherof, I doubt not but you wil diligently searche out who is knowe to be the best hosier or shoemaker in the place where you dwelle: and flie the unlearned as a pestilence to the comune wealth. As simple women, carpenters, pewterers, brasiers, sope ball sellers, pulters, hostellers, painters, apotecaries (otherwise then for their drogges), auaunters theselves to come from Pole, Constantiple, Italie, Almaine, Spaine, Fraunce, Grece, and Turkie, Inde, Egipt or Jury: from y{e} seruice of Emperoures, kinges, and quienes, promisig helpe of al diseases, yea vncurable, with one or two drinckes, by waters sixe monethes in continualle distillinge, by _Aurum potabile_, or _quintessence_, by drynckes of great and hygh prices as though thei were made of the sune, moone, or sterres, by blessynges, and Blowinges, Hipocriticalle prayenges, and foolysh smokynges of shirts, smockes, and kerchieffes, wyth such other theire phantasies and mockeries, meaninge nothng els, but to abuse your light belieue, and scorne you behind your backes with their medicines, so filthie, that I am ashamed to name theim, for your single wit and simple belief, in trusting the most which you know not at al, and vnderstad least: like to them which thinke farre foules have faire fethers, although thei be never so euil fauoured & foule: as though there could not be so conning an Englishman, as a foolish running stranger (of others I speak not) or so perfect helth by honest learning, as by deceiptfull ignorance." Dr. Caius laid stress upon exercise as an aid to health, but some popular games he thought "rather a laming of legges than an exercise." We need not follow him in the details of the treatment he recommends if in spite of the adoption of his preventive _regime_, the sweating sickness should come. In 1561 there was issued "A newe booke conteyninge an exortacion to the sicke." The tract ends with the following parody on the nostrums current for the cure of the pestilence: "Take a pond of good hard penaunce, and washe it wel with the water of your eyes, and let it ly a good whyle at youre hert. Take also of the best fyne fayth, hope, charyte yt you can get, a like quantite of al mixed together, your soule even full, and use this confection every day in your lyfe, whiles the plages of God reigneth. Then, take both your handes ful of good workes commaunded of God, and kepe them close in a clene conscience from the duste of vayne glory, and ever as you are able and se necessite so to use them. This medicine was found wryten in an olde byble boke, and it hath been practised and proved true of mani, both men and women" (Collier's _Bib. Account_, i. 74). The wealthy, on an outbreak of the plague, fled from the infected city, as we may learn from Boccaccio, and from Miles Coverdale's translation of Osiander's sermon, "How and whether a Christian man ought to flye the horrible plage of the pestilence," which appeared in 1537. During the plague of London, in 1603, the physicians are asserted by Dekker to have "hid their synodical heads," but this is at all events not wholly true. Thomas Lodge, the poet, was also a graduate in medicine, and in his "Treatise on the Plague"--not the only one published in relation to this epidemic--we are told of his experiences of the plague-stricken city. He gives some good advice in relation to the sanitary measures to be taken for the prevention of the plague. The nature of the regulations devised in the Tudor times to ward off infection may be gathered from the rules laid down at Chester in November, 1574, when "the right Worshipful Sir John Sauage, Knight, maior of the City of Chester had consideracion of the present state of the said cite somewhat visited with what is called the plage, and divisinge the best meanes and orderlie waies he can, with [the advice] of his Bretheren the alderman, Justices of peace within the citie aforesaid (through the goodness of God) to avoid the same hath with such advice, sett forth ordained and appointed (amongst other) the points, articles, clauses, and orders folowing, which he willeth and commandeth all persons to observe and kepe, upon the severall pains theirin contayned: "Imprimis. That no person nor persons who are or shalbe visited with the said sickness, or any other who shall be of there company, shall go abrode out of there houses without license of the alderman of the ward such persons inhabite, And that every person soe licensed to beare openlie in their hands ... three quarters long ... ense ... shall goe abrode out of the ... upon paine that eny person doynge the contrary to be furthwith expulsed out of the said citie. "2. Item if any person doe company with any persons visited, they alsoe to beare ... upon like payne. "3. Item that none of them soe visited doe goe abroad in any part or place within the citie in the night season, upon like payne. "4. Item that the accustomed due watche to be kepte every night, within the said citie, by the inhabitants thereof. "5. Item the same watchman to apprehend and take up all night walkers and such suspect as shalbe founde within and to bring them to the Justice of peace, of that ... the gaile of the Northgate, that further order may be taken with them as shall appear.... "6. Item that no swine be kept, within the said citie nor any other place, then ... side prively nor openlie after the xiii{th} daie of this present moneth, upon paine of fyne and imprisonment of every person doing the contrary. "7. Item that no donge, muck or filth, at any tyme, hearafter be caste within the walls of the said citie, upon paine of ffyne and imprisonment at his worships direction. "8. Item that no kind or sort of ... or any wares from other place be brought in packs into the said citie of Chester, untill the same be ffirste opened and eired without the libities of the said citie, upon pain last recited. "9. Item that papers or writing containing this sence Lord haue mercie upon us, to be fixed upon euery house, dore post, or other open place, to the street of the house so infected. "10. Item that no person of the said citie doe suffer any their doggs to goe abrode out of their houses or dwellings, upon paine that euery such dogge so founde abrode shalbe presently killed. And the owners thereof ponished at his worships pleasure." It has always been found easier to make laws than to have them enforced, and we find certain inhabitants complaining of the disobedience of infected persons in the following petition:-- "To the right worshipful Sir John Savage, knight, maior of the Citie of Chester, the aldermen, sheriffs, and common counsaile of the same. "In most humble wise complayninge sheweth unto your worships, your Orators, the persons whose name are subscribed inhabiting in a certain lane within the same citie called Pepper Street, That where yt haue pleased God to infect divers persons of the same Street with the plage, and where also for the avoidinge of further infection your worships have taken order that all such so infected should observe certaine good necessarye orders by your worships made and provided. But so it is, right worships, that none of the said persons infected do observe any of the orders by your worships in that case taken, to the greate danger and perill, not only of your Orators and their famelyes being in number twenty, but also of the reste of the said citie, who by the sufferance of God and of his gracious goodness are clere and safe from any infection of the said deceas: In consideration whereof your Orators moste humbly beseche your worships for God's sake, and as your worships intend it your Orators should, by the sufferance of God, avoide the dangers of the said deceas with their family, and also for the better safty of the citie to take such directions with the said infected persons that they may clearly be avoided from thens to some other convenient for the time untill God shall restore them to their former health. And in this doing your Orators shall daily pray, &c."[1] During the visitation of the plague at Manchester in 1645, when the place suffered severely, the authorities not only provided "cabins" at Collyhurst for the reception of those whom the disease attacked, but engaged the services of "Doctor Smith," who received £4 "for his charges to London and a free guift," and £39 "for part of his wages for his service in the time of the visitation." Thos. Minshull, the apothecary, was paid £6 2s. 6d. for "stuffe for ye town's service." Some "bottles and stuffe" were unused at the end of the plague, and these were sold to "Mr. Smith, Phissition," for £1. The story of English pestilence closes with the Great Plague of London in 1665. It began about the west end of the city, Hampstead, Highgate, and Acton sharing the infection, and gradually worked eastward by way of Holborn. Out of an estimated population of 460,000 there died 97,306 persons, of whom 68,596 perished of pestilence. One week witnessed 8,297 deaths, and it has been seriously argued that the official figures very much underrate the truth, and that in this week of highest mortality the deaths really amounted to 12,000. "Almost all other diseases turned to the plague." Many of the clergy fled, and the places of some were occupied by the ejected Nonconformists. The complaint of absenteeism was also brought against the physicians, but there were certainly some who stayed in the infected and desolate city. "But Lord!" says Pepys, "what a sad time it is to all: no boats upon the river, and grass grown all up and down Whitehall Court, and nobody but poor wretches in the street." William Boghurst, who was an apothecary, and Nathaniel Hodges, who was a physician, each wrote full accounts of the plague. Hodges was the son of a vicar of Kensington, where he was born in 1629. He was a King's scholar at Westminster, and was educated both at Cambridge and Oxford, taking his M.D. degree at the latter university in 1659. When the great plague broke out he remained at his house in Walbrook, and gave advice to all who sought it. There was unfortunately no lack of patients. Hodges' writings give us a minute account of the "doctor in the time of pestilence." The first doubtful appearances of the plague were noticed by Dr. Hodges amongst some of those who sought his counsel at the Christmas of 1664-5, in May and June there were some that could not be mistaken, and in August and September he was overwhelmed with work. He was an early riser, and after taking a dose of anti-pestilential electuary, he attended to any private business that needed immediate decision, and then went to his consulting room, and for three hours received a succession of patients, some already ill of the plague, others only infected by fear. Having disposed of these anxious inquirers, the doctor breakfasted, and then began his round of visits to patients who were unable to see him at home. Disinfectants were burnt on hot coals as he entered their houses, and he also took a lozenge. Returning home, he dined off roast meat and pickles, prefaced and followed by sack and other wine. A second round of visits did not terminate until eight or nine in the evening. He was an enemy of tobacco, but his dislike of the Indian weed did not extend to sack, which he seems to have drunk plentifully, especially perhaps on the two occasions when he thought he had himself caught the plague. These proved to be false alarms. Amongst the drugs he tried and found useless were "unicorn's horn" and dried toads. The Corporation of London testified a due sense of Hodges' services by a stipend and the position of physician to the city. His "Loimologia" is an important contribution to the literature of epidemics. Hodges, who had thus been a witness of the Carnival of Death in the metropolis of England, may well have pondered on the words of one of his illustrious contemporaries, Sir Thomas Browne, who says:--"I have not those strait ligaments, or narrow obligations to the world as to dote on life, or be convulst and tremble at the name of Death. Not that I am insensible of the dread and horrour thereof; or by raking into the bowels of the deceased, continual sight of anatomies, skeletons, or cadaverous reliques, like vespilloes or grave makers, I am become stupid, or have forgot the apprehension of mortality: but that, marshalling all the horrors and contemplating the extremities thereof, I find not anything therein able to daunt the courage of a man, much less a well resolved Christian.... For a Pagan there may be some motive to be in love with life; but for a Christian to be amazed at Death, I see not how he can escape this dilemma, that he is too sensible of this life, or hopeless of the life to come." Mountebanks and Medicine. BY THOMAS FROST. Mountebanks--a name derived from the Italian words _monta in banco_, mounting a bench--were, in company with their attendant zanies, or "Merry Andrews," a popular class of public entertainers down to the earlier years of the present century. Their chief object, however, was not to provide a free entertainment, but to dispose of their nostrums to the crowds which the entertainment brought together. Andrew Borde, a medical practitioner at Winchester, who obtained a more than local reputation, enjoying the distinction of being one of the physicians of Henry VIII., is said to have been the original "Merry Andrew." The story of his life is full of interest, and furnishes some curious information concerning the manners of his age and his class. Mr. George Roberts, who supplied Lord Macaulay with much material for his "History of England," relates that Borde was a man of great learning, and had travelled on the continent. He made many astronomical calculations, which may not unfairly be supposed to have been for the purposes of astrology. He was a celibitarian and an ascetic, drinking water three times a week, wearing a hair-shirt next his skin, and keeping the sheet intended for his burial at the foot of his bed. As a mountebank, he frequented fairs, markets, and other places of public resort, and addressed those assembled in recommendation of his medicines. He was a fluent speaker, and the witticisms with which he interspersed his lectures never failed to attract, obtaining for him the name of "Merry Andrew." Mountebanks flourished on the continent as well as in England, and the _Belphegor_ of the dramatist had many prototypes in Italy and France. Coryat, a little-known writer, who made the tour of Europe at the beginning of the seventeenth century, and published a narrative of his adventures and experiences, gives a good account of the mountebanks he saw at Venice. "Twice a day," he says, "that is, in the morning and afternoon, you may see five or six several stages erected for them.... These mountebanks at one end of their stage place their trunk, which is replenished with a world of new-fangled trumperies. After the whole rabble of them has gotten up to the stage,--whereof some wear vizards like fools in a play, some that are women are attired with habits according to that person they sustain,--the music begins; sometimes vocal, sometimes instrumental, sometimes both. While the music plays, the principal mountebank opens his trunk and sets abroad his wares. Then he maketh an oration to the audience of half-an-hour long, wherein he doth most hyperbolically extol the virtue of his drugs and confections--though many of them are very counterfeit and false. I often wondered at these natural orators, for they would tell their tales with such admirable volubility and plausible grace, _extempore_, and seasoned with that singular variety of elegant jests and witty conceits, that they did often strike great admiration into strangers.... He then delivereth his commodities by little and little, the jester still playing his part, and the musicians singing and playing upon their instruments. The principal things that they sell are oils, sovereign waters, amorous songs printed, apothecary drugs, and a commonweal of other trifles. The head mountebank, every time he delivereth out anything, maketh an extemporal speech, which he doth eftsoons intermingle with such savoury jests (but spiced now and then with singular scurrility), that they minister passing mirth and laughter to the whole company, which may perhaps consist of a thousand people." The entertainment extended over two hours, when, having sold as many of their wares as they could, their properties would be removed and the stage taken down. Jonson, in his comedy of "Volpone," presents a scene showing a mountebank's stage at Venice, and the discourse of the vendor of quack medicines has a remarkable resemblance to the oratory of the "Cheap Jacks" of the present day, of which old play-goers may remember hearing a very good imitation in the drama of "The Flowers of the Forest." Says Jonson's mountebank: "You all know, honourable gentlemen, I never valued this ampulla, or vial, at less than eight crowns; but for this time I am content to be deprived of it for six: six crowns is the price, and less in courtesy I know you cannot offer me. Take it or leave it, however, both it and I am at your service! Well! I am in a humour at this time to make a present of the small quantity my coffer contains: to the rich in courtesy, and to the poor for God's sake. Wherefore, now mark: I asked you six crowns, and six crowns at other times you have paid me; you shall not give me six crowns, nor five, nor four, nor three, nor two, nor one, nor half a ducat. Sixpence it will cost you (or six hundred pounds); expect no lower price, for I will not bate." Returning to the mountebanks of our own country, we find in the accounts of the Chamberlain of the Corporation of Worcester for the year 1631 the following item:-- "They yeald account of money by them received of mountebanks to the use of the poor 58s. 9d." It is suggested by Mr. John Noake, however, that these mountebanks were riders or posturers, and that the amount was the charge made for the permission accorded them to perform in the city. Later in the century, the eccentric Earl of Rochester, on one occasion, played the mountebank on Tower Hill, and the example was followed by more than one comedian of the next century. Leveridge and Penkethman, actors well known at Bartholomew Fair for many years, appeared at country fairs as "Doctor Leverigo and his Jack-Pudding Pinkanello," as also did Haines as "Watho Van Claturbank, High German Doctor." The discourse of the latter was published as a broadside, headed with an engraving representing him addressing a crowd from a stage, with a bottle of medicine in his right hand. Beside him stands a Harlequin, and in the rear a man with a plumed hat blows a trumpet. A gouty patient occupies a high-backed arm-chair, and an array of boxes and bottles is seen at the back of the stage. "Having studied Galen, Hypocrates, Albumazar, and Paracelsus," says the discourse thus headed, "I am now become the Esculapius of the age; having been educated at twelve universities, and travelled through fifty-two kingdoms, and been counsellor to the counsellors of several monarchs. By the earnest prayers and entreaties of several lords, earls, dukes, and honourable personages, I have been at last prevailed upon to oblige the world with this notice, that all persons, young or old, blind or lame, deaf and dumb, curable or incurable, may know where to repair for cure, in all cephalalgias, paralytic paroxysms, palpitations of the pericardium, empyemas, syncopes, and nasieties; arising either from a plethory or a cachochymy, vertiginous vapours, hydrocephalus dysenteries, odontalgic or podagrical inflammations, and the entire legion of lethiferous distempers.... This is Nature's palladium, health's magazine; it works seven manner of ways, as Nature requires, for it scorns to be confined to any particular mode of operation; so that it affecteth the cure either hypnotically, hydrotically, cathartically, poppismatically, pneumatically, or synedochically; it mundifies the hypogastrium, extinguishes all supernatural fermentations and ebullitions, and, in fine, annihilates all nosotrophical morbific ideas of the whole corporeal compages. A drachm of it is worth a bushel of March dust; for, if a man chance to have his brains beat out, or his head dropped off, two drops--I say two drops! gentlemen--seasonably applied, will recall the fleeting spirit, re-enthrone the deposed archeus, cement the discontinuity of the parts, and in six minutes restore the lifeless trunk to all its pristine functions, vital, natural, and animal; so that this, believe me, gentlemen, is the only sovereign remedy in the world. _Venienti occurite morbo._--Down with your dust. _Principiis obsta._--No cure no money. _Quærendo pecunia primum._--Be not sick too late." The mountebanking quack flourished in great state in the first half of the last century. "A Tour through England," published in 1723, gives the following account of one whom the author saw at Winchester:--"As I was sitting at the George Inn, I saw a coach with six bay horses, a calash and four, a chaise and four, enter the inn, in a yellow livery, turned up with red; four gentlemen on horseback, in blue, trimmed with silver: and as yellow is the colour given by the dukes in England, I went out to see what duke it was; but there was no coronet on the coach, only a plain coat-of-arms on each, with this motto: ARGENTO LABORAT FABER. Upon enquiry, I found this great equipage belonged to a mountebank, and that his name being Smith, the motto was a pun upon his name. The footmen in yellow were his tumblers and trumpeters, and those in blue his merry-andrew, his apothecary, and his spokesman. He was dressed in black velvet, and had in his coach a woman that danced on the ropes. He cures all diseases, and sells his packets for sixpence a-piece. He erected stages in all the market towns twenty miles round; and it is a prodigy how so wise a people as the English are gulled by such pickpockets. But his amusements on the stage are worth the sixpence, without the pills. In the morning he is dressed up in a fine brocade night-gown, for his chamber practice, when he gives advice, and gets large fees." A passage in a letter written by the second Lord Lyttelton, about the year 1774, shows that this style of travelling was then still kept up by mountebanks. He says:--"As a family party of us were crossing the road on the side of Hagley Park, a chaise passed along, followed by a couple of attendants with French horns. Who can that be, said my father? Some itinerant mountebank, replied I, if one may judge from his musical followers. I really spoke with all the indifference of an innocent mind: nor did it occur to me that the Right Reverend Father in God, my uncle, had sometimes been pleased to travel with servants similarly accoutred." Nearly twenty years later, the famous quack, Katerfelto, travelled through Durham in a carriage, with a pair of horses, and attended by two negro servants in green liveries, with red collars. In the towns he visited these men were sent round to announce his lectures on electricity and the microscope, blowing trumpets, and distributing hand-bills. There seems to be good ground for believing that among what may be called the amateur mountebanks, such as Rochester, we must count the author of "Tristram Shandy." Dr. Dibdin found in the possession of Mr. James Atkinson, a medical practitioner at York, a rather roughly executed picture, in oil colours, representing a mountebank and his zany on a stage, surrounded by a crowd. An inscription described the former as Mr. T. Brydges, and the latter as the Rev. Laurence Sterne. Mr. Atkinson, who was an octogenarian, told Dr. Dibdin that his father had been acquainted with Sterne, who was a good amateur draughtsman, and that he and Brydges each painted the other's portrait in the picture. The story is a strange one, but before it is dismissed as unworthy of belief, it must be remembered that the clerical story-writer was a droll and whimsical character, and at no time much influenced by his priestly vocation. It is quite conceivable, therefore, that he may have indulged in such a freak on some occasion during the period of his life in which he developed his worst moral deficiencies. In the early years of the present century, a German quack, named Bossy, used to mount a stage on Tower Hill and Covent Garden Market alternately, in order, as he said, that both ends of London might profit by his experience and skill. It is said that on one of these occasions, when he had induced an old woman to mount his stage in the latter place, and relate the wonderful cures the doctor had performed upon her, a parrot that had learned some coarse language from the porters and costermongers frequenting the market, and sometimes used it in a manner that seemed very apt to the occasion, exclaimed, "Lying old ----!" when the old woman concluded her narrative. The roar of laughter with which this criticism was received by the rough audience disconcerted Bossy for a moment; but quickly recovering his presence of mind, he stepped forward, with his hand on his heart, and gravely replied, "It is no lie, you wicked bird!--it is all true as is de Gospel!" Bossy attained considerable reputation, and ended his days with a fair competence. The mountebank has long fallen from his former high estate. The quack may still be found vending his pills in the open-air markets of Yorkshire and Lancashire; but he does not mount a stage, and resembles his predecessors of the last century only in the fluency and volubility of his discourse on the virtues of his potions, pills, and plasters. The author of the paper on mountebanks in the "Book of Days" (edited by Robert Chambers), states that he saw one at York about 1860, who "sold medicines on a stage in the old style, but without the Merry Andrew or the music," and adds that "he presented himself in shabby black clothes, with a dirty white neck-cloth." Even the name had long before that time ceased to be connected with the vending of medicines, and had come to be applied to those itinerant circus companies who gave gratuitous performances in the open air, making their gains by the sale of lottery tickets. The present writer remembers seeing the circus company of John Clarke performing on a piece of waste ground at Lower Norwood, when the clown of the show went among the spectators selling tickets at a shilling each, entitling the holder to participate in a drawing, the prizes in which were Britannia metal tea pots and milk ewers, papier maché tea trays, cotton gown pieces, etc. That must have been about 1835, or within a year or two of that time. Only a few years later, a lottery in sixpenny shares was similarly conducted at Alfreton, in Derbyshire, and probably in many other places, though contrary to the provisions of the Lottery Act. The mountebank doctor of former times, with his carriage, his zany, and his musicians, can now only be met with in the provincial towns of France and Italy, and even there but seldom. Thirty or forty years ago, there was a man who, in a carriage drawn up behind the Louvre, used to practise dentistry and advertise his father, who had a flourishing dentist's practice in one of the narrow streets near the cathedral of Notre Dame. Another of this fraternity was seen at Marseilles by an English tourist a few years later, and in this instance some musicians accompanied the mountebank's phaeton, and drowned the cries of the suffering patients with the crash of a march. But these survivals remind us rather of _Belphegor_, in the pathetic drama of that name, than of _Dulcamara_ in the opera of _L'Elisor d'Amore_, with his gorgeous equipage and his musical attendants, as old play-goers remember the personation of the character by the famous Lablache. The Strange Story of the Fight with the Small-Pox. BY THOMAS FROST. When, at the present day, we hear of an epidemic of small-pox in some town where the practice of vaccine inoculation has been neglected, it is both instructive and consolatory to turn our thoughts back to the time, before the introduction of that practice, when that horrible disease caused ten per cent, of all the deaths in excess of those occurring in the ordinary course of nature. This statement, startling as it may seem to the present generation, may be verified by reference to the annual bills of mortality of the city of London. This fearful state of things had prevailed in England from the time of the Plantagenets, when, in the first quarter of the eighteenth century, a gleam of light was flashed upon the medical darkness of western Europe from the east. Lady Mary Wortley Montagu, writing from Adrianople to a lady friend in the spring of 1717, flashed that light in the concluding portion of her letter, as follows:-- "Apropos of distempers, I am going to tell you a thing that will make you wish yourself here. The small-pox, so fatal and so general amongst us, is here entirely harmless, by the invention of _ingrafting_, which is the term they give it. There is a set of old women who make it their business to perform the operation every autumn, in the month of September, when the great heat is abated. People send to one another to know if any of their family has a mind to have the small-pox; they make parties for this purpose, and when they are met (commonly fifteen or sixteen together), the old woman comes with a nut-shell full of the matter of the best sort of small-pox, and asks what vein you please to have opened. She immediately rips open that you offer to her with a large needle (which gives you no more pain than a common scratch), and puts into the vein as much matter as can lie upon the head of her needle, and after that binds up the little wound with a hollow bit of shell, and in this manner opens four or five veins. ... Every year thousands undergo this operation; and the French ambassador says pleasantly, that they take the small-pox here by way of diversion, as they take the waters in other countries. There is no example of any one that has died in it; and you may believe I am well satisfied of the safety of this experiment, since I intend to try it on my own little son." This intention she carried into practice, and on her return to England made great exertions to introduce inoculation into general use. The medical profession opposed it so strongly, however, that for many years the horrible distemper continued to rage unchecked. Such announcements as the following were, in consequence, not unfrequent in the newspapers:-- "WHEREAS the TOWN of BURY ST. EDMUND'S, where the GENERAL QUARTER SESSIONS of the PEACE of that Division are usually held, is now afflicted with the Small-Pox, for which reason it might be of exceeding ill consequence to the Country in General to hold the Sessions there; This is, therefore, to acquaint the PUBLIC that the next GENERAL QUARTER SESSIONS of the Peace will be held at the sign of the PICKEREL in IXWORTH, on Monday next. "COCKSEDGE, Clerk of the Peace." Later on in the same year (1744) an advertisement appeared, signed by the clergy, churchwardens, and medical practitioners of the town, stating that "there were only twenty-one persons then lying ill of the small-pox." Scarcely a week passed, in those days, without advertisements appearing of the number of cases of the disease in certain towns. Careful study of a large number of these announcements shows, however, that it was only thought desirable to advertise when the epidemic was thought to be abating, or when it had abated. Take the following, for instance:-- "Nov. 4, 1755. "Upon the strictest Inquiry made of the present state of the SMALL-POX in BECCLES, it appears to be in eleven houses, and no more, and that the truth may be constantly known, the same will be weekly advertised alternately in the Ipswich and Norwich papers by us, "THO. PAGE, Rector. "OSM. CLARKE and IS. BLOWERS, Churchwardens." In the following year we find it announced that, "upon a strict inquiry made by the clerks through their respective parishes, delivered to us, and attested by them, there is but six persons now afflicted with the small-pox in this town,"--to wit, Colchester--and this statement is signed by three ministers and six medical practitioners. In the _Ipswich Journal_ of Jan. 22nd, 1757, the following appeared:--"There will be no fair this year at Bildestone on Ash Wednesday, as usual, by reason of the small-pox being in several parishes not far off." The practice of inoculation, though still frowned upon by a large proportion of the medical profession, was growing at this time, as appears from the following advertisement:-- "COLCHESTER, May 12, 1762. "The Practice of bringing people out of the country into this town to be inoculated for the Small-pox being very prejudicial to the town in many respects, but especially to the Trade thereof, and as by this practice the distemper may be continued much longer in the town than it otherwise would, in all probability, it is thought proper by some of the principal inhabitants and traders in the town, that this public notice should be given that they are determined to prosecute any person or persons whomsoever, that shall hereafter bring into this town, or who shall receive into their houses in the town as lodgers, any person or persons for that purpose, with the utmost severity that the law will permit.... But that they might not be thought discouragers of a practice so salutary and beneficial to mankind, as inoculation is found to be, which encourages great numbers to go into the practice, the persons who have caused this public notice to be given have no objection to surgeons carrying on the practice in houses properly situated for the purpose." The "great numbers" of persons referred to in this notice as having "gone into the practice" of inoculation for the small-pox appear to have been chiefly old women, as in Turkey, and by some of these it was carried on until the passing of the Vaccination Act in 1840. Five guineas was the fee advertised in the _Ipswich Journal_ in 1761 for performing the operation by Robert Sutton, an operator in Kent, who announced that he had "only met with but one accident out of the many hundreds he has had under his cure." The prevalence of this hideous disease in the last century, and the dread which it inspired, is curiously attested by the frequency with which advertisements for servants, etc., appeared in the newspapers, in which there was an express stipulation that applicants must have had the small-pox. A housemaid or footman whose face bore the traces of this disease would not, at the present day, find their appearance much in their favour: but the following selection of advertisements, culled from the _Ipswich Journal_ and the _Salisbury and Winchester Journal_, show that in the last century the marks would increase their chances of obtaining employment very considerably. The dates range from 1755 to 1781, and such announcements might be increased to any extent. "A Three Years' APPRENTICE is wanted to use the Sea between Manningtree and London, whose age is between 18 and 25 years, and has had the Small-pox. Such a one, inquiring of MR. WM. LEACH, at Mistley Thorne, in Essex, will hear of good encouragement." "WANTED, about Michaelmas, as Coachman, in a gentleman's family, who can drive four horses, and ride postillion well. A Single Man, must have had the Small-pox, and know how to drive in London. Such an one, who can be well recommended, by giving a description of himself, his age, and abilities, in a letter directed to A. B., at MR. J. KENDALL'S, in COLCHESTER, may hear of a very good place." "WANTED, a JOURNEYMAN BAKER, that is a good workman, and has had the SMALL-POX. Such a person may hear of a good place by applying to MR. JOHN STOW, at Sudbury, or to the Printer of this paper." "Wanted an Apprentice to an eminent Surgeon in full practice in the county of Suffolk. If he has not had the Small-Pox, it is expected he will be inoculated for it, before he enters on business.--Enquire of JOHN FOX, at Dedham, Essex." "COLCHESTER, June 15th, 1762. "Wanted immediately, a Stout Lad as an Apprentice to a Currier. If he can write it will be the more agreeable. Inquire further of ELEANOR ONYON. N.B.--If he has not had the Small-pox, he need not apply." "WANTED for a gentleman that lives most part of the year in London, A Genteel Person, between 28 and 40 years of age, that has had the Small-pox, to be as Companion and Housekeeper. One that has been brought up in a genteel, frugal and handsome manner, either a Maid or Widow, so they have no incumbrances." "WANTED, a NURSEMAID. None need apply who cannot bring a good character from their last place; and has had the Small-pox." "WANTS a place in a large or small family, in town or country, a YOUNG MAN, who is well versed in the different branches of a Gardener, has had the Small-pox, and can write a good hand." "WANTED, in a large family, a STOUT WOMAN, about 30, single, or a widow without children, who has had the Small-pox, to take care of a lusty child, under a year old. Her character must be unexceptionable, and by no means a fashionable dresser, and lived in families of credit. Any person answering this description may enquire of MRS. MERCER, at the Star and Garter, Andover, and be further informed." It was about the time when the last of these advertisements appeared that Jenner commenced his inquiries concerning the prophylactic virtues of cow-pox, though nearly twenty years elapsed before they were sufficiently advanced to enable him to make the results known. His idea of using vaccine inoculation to bring about the total extinction of small pox was scouted by those of his professional brethren to whom he mentioned it, and we learn from one of his biographers that, at the outset, "both his own observation and that of other medical men of his acquaintance proved to him that what was commonly called cow-pox was not a certain preventive of small-pox. But he ascertained by assiduous inquiry and personal investigation that cows were liable to various kinds of eruption on their teats, all capable of being communicated to the hands of the milkers; and that such sores when so communicated were all called cow-pox." But when he had traced out the nature of these various diseases, and ascertained which of them possessed the protective virtue against small-pox, he was again foiled by learning that in some cases when what he now called the true cow-pox broke out among the cattle on a dairy farm, and had been communicated to the milkers, they subsequently had small-pox. These repeated failures perplexed him, but at the same time stimulated, instead of discouraging him. He conceived the idea that the virus of cow-pox might undergo some change which deprived it of its protective power, while still enabling it to communicate a disease to human beings. Following up the inquiry from this point, he at length discovered that the virus was capable of imparting protection against small-pox only in a certain condition of the pustule. He was now prepared to submit his theory to the test of experiment, but it was not until 1796 that he had the opportunity. A dairymaid, who had contracted cow-pox from one of her employer's cows, afforded the matter, and Jenner introduced it into two incisions in the arms of a boy about eight years of age. The disease thus transferred ran its ordinary course without any ill effects, and the boy was afterwards inoculated with the virus of small pox, which produced no effect. The disappearance of the cow-pox from the dairies in the neighbourhood of his country practice in Gloucestershire prevented him from making further experiments; and when he visited London for that purpose, he had the mortification of finding that no one could be found who would consent to be operated upon. It was not until 1798 that this obstacle was overcome, and then, the results of the earlier experiments having been confirmed by a series of vaccinations, followed by inoculation for small-pox several months afterwards without effect, Jenner made his discovery public. In the following year, vaccine inoculation began to spread, the practice being taken up by many of Jenner's friends, including several who were not in the medical profession. But, like inoculation for the small-pox, when introduced by Lady Mary Wortley Montagu,--like all innovations on established practices, indeed,--vaccination received for many years after its introduction the most violent opposition. Just as inoculation for small-pox had been denounced from the pulpit and in medical treatises as a "diabolical operation" and a wicked interference with the designs of Providence, so did a certain Dr. Squirrel denounce vaccination as an attempt to change "the established laws of nature." The most absurd stories were circulated of the effects alleged to have followed vaccination. "A lady," it is stated by Mr. Bettany, "complained that since her daughter had been vaccinated she coughed like a cow, and had grown hairy all over her body; and in one country district it was stated that vaccination had been discontinued there, because those who had been inoculated in that manner bellowed like bulls." There were even doctors who pretended to detect resemblances to bovine visages in the countenances of children, produced, as they did not hesitate to declare, by vaccination! Self-interest may have had as much to do as prejudice in prompting the opposition of the profession. Many practitioners derived a considerable portion of their income from fees for inoculation for small-pox. Sutton, as we have seen, charged five guineas for the operation, and advertised himself in many provincial newspapers; and the income of Dr. Woodville, at one time physician to the Small-Pox Hospital, is said to have sunk in one year from a thousand pounds to a hundred on his adopting the practice of vaccination. Notwithstanding the prejudice and interested antagonism to which the new practice was exposed, it continued to make way. The Rev. Dr. Booker, of Dudley, gave the following striking testimony to its beneficial effects:--"I have, previous to the knowledge of vaccine inoculation, frequently buried, day after day, several (and once as many as eight) victims of the small-pox. But since the parish has been blessed with this invaluable boon of Divine Providence (cow pox), introduced among us nearly four years ago, only two victims have fallen a prey to the above ravaging disorder (small pox). In the surrounding villages, like an insatiable Moloch, it has lately been devouring vast numbers, where obstinacy and prejudice have precluded the Jennerian protective blessing." In 1803, the Royal Jennerian Institution was founded under royal patronage, and with Jenner as president, to promote vaccination in London and elsewhere; and its operations were continued for a few years with much success, ceasing, however, on the establishment of the National Vaccine Institution in 1808. Two years prior to this event, Lord Henry Petty, who then held the office of Chancellor of the Exchequer, carried a motion in the House of Commons, that the Royal College of Physicians should be requested to inquire and report on the progress of vaccination. The report, which appeared in the following year, set forth that, within eight years from the discovery of vaccination, some hundreds of thousands of persons had been vaccinated in the British Islands, and upwards of eight hundred thousand in our East Indian possessions, and that the practice had been generally adopted on the continent of Europe. Considering that small-pox destroyed one-sixth of those whom it attacked, and that nearly one-tenth, and in some years more than that proportion, of the entire mortality in London was caused by it, and also the number, respectability, and extensive experience of the advocates of vaccination, compared with the feeble and imperfect testimonies of its few opponents, the value of the practice seemed firmly established. This report did much to advance vaccination in public opinion. At the next quarter sessions held at Stafford, it was taken into consideration by the county magistrates, who, from its statements and the reports and testimonials sent to Jenner, considered themselves justified in placing it on record--"That vaccine inoculation, properly conducted, appeared never to have failed as a certain preservative against small-pox; that it was unattended by fever, and perfectly free from danger; that it required neither confinement, loss of time, nor previous preparation; that it was not infectious, nor productive of other diseases; that it might be performed with safety on persons of every age and sex, and at all times and seasons of the year." It was not, however, until 1840 that the results of the labours of Jenner, the report of the Royal College of Physicians, and the opinions of nearly the entire medical profession received legislative endorsement by the passing of the Vaccination Act, since which small-pox has become a thing of the past, except in cases where it has been conserved by prejudice and ignorance. Burkers and Body-Snatchers. BY THOMAS FROST. How recollections will crowd upon the mind when a train of thought is set in motion by the association of ideas! When, many years ago, I visited Dr. Kahn's anatomical museum, then located in Tichborne Street, I there saw a human skeleton which was affirmed by the lecturer, Dr. Sexton, to be that of John Bishop, who was hanged in 1831, for the murder of an Italian boy named Carlo Ferrari, at a house in Nova Scotia Gardens, one of the slums then existing in the north-eastern quarter of London. Though nearly forty years had elapsed since the commission of the crime, and I was only ten years of age when I heard the horrible story which the sight of that ghastly relic of mortality recalled to my mind, all the incidents connected with it immediately passed before my mental vision like a hideous phantasmagoria. The vividness with which they came back to me may be accounted for by the deep impression which they made upon my mind at the time of their occurrence. Those whose memories will carry them back sixty years will readily understand this. At the time when the public mind was harrowed by the narration in the newspapers of the horrible circumstances connected with the murder, and for some time previously, a fearful excitement had been created in all parts of the country by stories of murders committed and graves robbed of their ghastly tenants for the purpose of supplying with "subjects" the dissecting tables of the London and Edinburgh schools of anatomy. In the latter city two miscreants named Burke and Hare had been convicted of murder for this purpose, and one of them hanged for their crimes; but the scare had not abated. Stories were told with appalling frequency of corpses missing from lonely graveyards and of narrow escapes from murder in little frequented places. Chloroform had not then been discovered, but the Scotch professors of the art of murder had introduced the practice, popularly named after one of them, of disabling their victims by means of a pitch plaster suddenly clapped on the mouth. Every person who was missing was thought to have been "burked," and the watching of graves to prevent the removal of newly-buried corpses became an established practice. As the dark nights of the late autumn came on, the fears of the timid and nervous were doubled, and persons who lived in lonely places, or in the ill-lighted parts of towns, became afraid to leave their houses after nightfall. I remember hearing such fears expressed by several persons at Croydon, with whom my parents were acquainted, and also of neighbours combining to assist in watching the graves of deceased members of each others' families. A few years ago, I was one day exchanging reminiscences of a long bygone generation with a brother journalist, when, on this gruesome subject being mentioned, he placed in my hands a report of the trial of the murderers of Carlo Ferrari, which appeared to have been detached from a volume of criminal trials. No feature of the horrible record impressed me so much as the cool, business-like manner in which the wretches concerned in the crime hawked the corpse of their victim from one school of anatomy to another, and the equally cool and business-like manner in which the matter was dealt with by those with whom their nefarious occupation brought them in contact. The procuring of corpses for anatomical purposes was, in fact, a regular trade, and the biographer of Sir Astley Cooper states that "the Resurrection-men were occasionally employed on expeditions into the country to obtain possession of the bodies of those who had been subjected to some important operation, and of which a _post mortem_ examination was of the greatest interest to science. Scarcely any distance from London was considered an insuperable difficulty in the attaining of this object, and as certainly as the Resurrectionist undertook the task, so certain was he of completing it. This was usually an expensive undertaking, but still it did not restrain the most zealous in their profession from occasionally engaging these men in this employment." The price of a subject ranged from seven to twelve guineas, but when the "body-snatchers" were specially employed to procure some particular corpse, the incidental expenses were often as much more. As an illustration of the times in which such horrors were possible, the story of the murder of Carlo Ferrari may, at this distance of time from the event, be worth telling. In the autumn of 1831, there lived in one of a row of small houses, known as Nova Scotia Gardens, in the poverty-stricken district of Bethnal Green, a man named John Bishop, with his wife and three children. He had formerly been a carrier at Highgate, but had long been suspected of "body-snatching," as the practice of robbing graves was termed, and had no visible means of honest living. He had the look of a man whose original rustic stolidity had been supercharged with cockney cunning. The house adjoining Bishop's was occupied by a man named Woodcock, who had succeeded in the tenancy a glass-blower named Thomas Williams, described as a little, simple-looking man, of mild and inoffensive demeanour. About two o'clock on the morning of the 4th of November, Woodcock was awakened by a noise, as of a scuffle, in Bishop's house, and afterwards heard two men leave it and return in a few minutes, when he recognised the voices as those of Bishop and Williams. At noon the same day these two men were in a neighbouring public-house, accompanied by two other men, one of whom was known as James May, who had formerly been a butcher, but for the last few years had been suspected of following the same ghastly and revolting occupation as Bishop. In the afternoon three men alighted from a cab at Nova Scotia Gardens, two of them being recognised as Bishop and Williams, and afterwards returned to the vehicle, when the former and the third man were carrying something in a sack, which they placed in the cab. The three men then entered, and it was driven off. About seven o'clock the same evening, Bishop and May presented themselves at Guy's Hospital, carrying something in a sack, and asked the porter if a "subject" was wanted. Receiving a negative reply, they asked him to allow "it" to remain there until the next morning, to which he consented. Half-an-hour later, the two traffickers in human flesh called at Grainger's anatomical theatre, in Webb Street, Southwark, and told the curator they had "a very fresh male subject, about fourteen years of age." The offer being declined, they went away, and later on they were, accompanied by Williams, in a public-house, where May was seen by a waiter to pour water on a handkerchief containing human teeth, and then rub the teeth together, remarking that they were worth two pounds to him. Next morning, May called upon a dentist named Mills, on Newington Causeway, and sold a dozen teeth to him for a guinea, observing that they were the teeth of a boy fourteen years of age. On examining them, Mills found that morsels of the gums and splinters of the jaw were adhering to them, as if much force had been used to wrench them out. Two hours later, Bishop and May called again at the anatomical theatre in Southwark, and repeated their offer of the preceding evening, which was again declined. Shortly afterwards, they went to Guy's Hospital, accompanied by Williams and a man named Shields, to remove the "subject" left there the evening before, and it was given to them in the sack, as they had left it, and placed in a large hamper, which Shields had brought for the purpose. There was a hole in the sack, through which the porter saw a small foot protruding, apparently that of a boy or a woman. About midnight, the bell of King's College was rung, and the porter, on going to the gate, found there Bishop and May, whom he had seen there before, it seems, and on similar business. May asked him if anything was wanted, and receiving an indifferent answer, added that they had a male "subject," a boy about fourteen years of age. The porter inquired the price, and was told they wanted twelve guineas for it. He then said he would ask Mr. Partridge, the demonstrator in anatomy, and they followed him to a room adjoining the dissecting room. Nine guineas were offered, which May, with an oath, refused, and went outside. Bishop then said to the porter, "Never mind May, he is drunk; it shall come in for nine in half-an-hour." They then went away, returning at the stipulated time, accompanied by Williams and Shields, the latter carrying on his head the hamper containing the corpse brought from Guy's Hospital. It was taken into a room, where it was opened, and the corpse turned out of the sack by May. The porter, observing a cut on the left temple, and that the left arm was bent and the fingers clenched, conceived suspicions of foul play, and communicated them at once to Mr. Partridge. That gentleman thereupon examined the corpse, and mentioned its condition to the secretary, who immediately gave information to the police. In order to detain the men until the arrival of the police, the demonstrator showed them a £50 note, observing that he must get it changed for gold before he could pay them. Several constables were soon on the spot, and the four men were arrested, and taken to the station-house in Vine Street, Covent Garden. On being charged on suspicion with having unlawful possession of a corpse, May said he had nothing to do with it, and had merely accompanied Bishop. A similar statement was made by Williams, and Bishop said he was only removing the corpse from St. Thomas's Hospital to King's College. Shields, who was known as a porter, said he was employed to carry the hamper, which he did in the exercise of his vocation. They were all then removed to the cells. The evidence given at the coroner's inquest by Partridge and two other surgeons left no doubt that the unfortunate lad, respecting whose identity there was no evidence, had been killed by a violent blow on the back of the neck, which had affected the spinal cord. The four accused men were present in custody during the inquiry, and Bishop, after reading a bill relating to the murder, which was displayed on the wall of the room, was heard by a constable to say, in a subdued tone, to May, "It was the blood that sold us." Volunteering to give evidence, he said he got the corpse from a grave, but declined to name the place whence he had got it, alleging that the information would get into trouble two watchmen, who had large families. May also made a voluntary statement, to the effect that he got two "subjects" from the country, which he took first to Grainger's theatre of anatomy, and afterwards to Guy's Hospital, subsequently meeting Bishop, who promised him all he could get for a "subject" above nine guineas if he would sell it for him. The inquest was adjourned, and the police proceeded with their investigation. The houses of Bishop and May had been promptly visited and searched by the police, who found at the former's a sack, a large hamper, and a brad-awl, the last showing recent bloodstains. At May's house in Dorset Street, New Kent Road, they found a pair of breeches, stained with blood at the back. On a second visit to Bishop's house the garden was dug over, and a jacket, trousers, and a shirt found in one spot, and in another a coat, trousers, a vest with blood on the collar and one shoulder, and a shirt with the front torn. When the brad-awl was produced at Bow Street police-court, May said, "That is the instrument I punched the teeth out with." Shields was eventually discharged from custody, but the other three prisoners were committed for trial on the capital charge. The identity of the victim remained a mystery until the 19th of November, a fortnight after the murder, when the corpse was recognised by a foreigner named Brun as that of a boy named Carlo Ferrari, whom he had brought from Italy two years before, but had not seen since July, 1830. The boy picked up the means of living by exhibiting a tortoise and a pair of white mice in the streets. He had been seen by several persons in or near Nova Scotia Gardens on the 3rd of November, but he had not been seen since, nor had he returned on that day to his miserable lodgings in Charles Street, Drury Lane. The clothes found in Bishop's garden corresponded with the description given of those worn by him when he was last seen, and a little boy who played with Bishop's children stated that they had, on the following day, shown him two white mice in a cage similar to the one carried by Ferrari. The incidents of the crime, as revealed from day to day, and the mystery in which the identity of the victim was for some time veiled, created so much excitement in the public mind, that when the prisoners were placed in the dock at the Old Bailey, early in December, the court was crowded, and a guinea each was paid for seats in the gallery, the occupants of which, all fashionably dressed, as might be expected of those who could afford to pay that price for the gratification of their love of the sensational, had taken their seats the day before. Though the evidence was but a recapitulation of the story told before in the police-court and the inquest-room, it was listened to with the utmost avidity. The witnesses for the defence were few, and their evidence valueless, except in the case of May, for whom an _alibi_ was established in respect of the time between the afternoon of the day preceding the murder and noon on the following day. The prisoners were sentenced to death, but in May's case the sentence was commuted into transportation for life. A sea-faring relative of mine, who was second officer of the vessel in which May was sent out to Sydney, described him as an athletic, wiry-looking man, with features expressive of sternness, and a determined will, quite a different-looking man, therefore, to his two companions in crime, who were duly hanged at Newgate. The crime of these men, and the deeds of Burke and Hare, created such a scare, and exposed so vividly the temptation to murder afforded by the prices paid by surgeons for "subjects," that the attention of parliament was directed to the matter, and a Select Committee of the House of Commons was appointed to inquire and report as to the facilities which might be given for obtaining bodies for anatomical purposes in a legitimate manner. Sir Astley Cooper, who was one of the eminent surgeons who gave evidence before this committee, was asked whether the state of the law prevented teachers of anatomy from obtaining the body of any person, which, in consequence of some peculiarity of structure, they might be desirous of procuring. He replied:--"The law does not prevent our obtaining the body of an individual if we think proper; for there is no person, let his situation in life be what it may, whom, if I were disposed to dissect, I could not obtain.... The law only enhances the price, and does not prevent the exhumation. Nobody is secured by the law; it only adds to the price of the subject." The result of this inquiry was the passing of the Anatomy Act, by which the bodies of persons dying in hospitals and workhouses, if unclaimed by the relatives, may be placed at the disposal of the schools of anatomy. Reminiscences of the Cholera. BY THOMAS FROST. It is now more than sixty years since the strange and mysterious visitation, as it was then considered, known as the cholera morbus, for which fearsome name that of Asiatic cholera has since been substituted, made its first appearance in this country, or anywhere west of the Ural Mountains. Coming first from India, from the banks of the Ganges and the Indus, the dread pestilence moved steadily westward and north-westward until, creeping along the rivers of Russia, and desolating all the most considerable towns of that country, it reached St. Petersburg. There it raged with fearful severity, mowing down as with the scythe of Death more than a thousand persons daily. So dreadful were the features of the unknown malady, and so rapidly were its victims carried off, that the ignorant populace of the capital attributed it to poison administered by the doctors. A fearful tumult was excited by this belief, and it was with great difficulty that it was suppressed. From Russia the dire disease spread rapidly into almost every country in Europe, and wherever it appeared created the profoundest awe and the most bewildering terror. In Paris it broke out with extreme malignity in March, 1832, and soon raged there with greater virulence than it had exhibited in any other city in Europe except St. Petersburg. The deaths soon reached from four to five hundred daily, and during April they rose to a total for the month of twelve thousand seven hundred. It was hinted that the ravages of this new and dreadful disease were caused by the poisoning of the meat sold in the markets and the water in the public fountains; and the dwellers in the slums became so infuriated by this horrible and absurd rumour that mobs perambulated the streets howling for vengeance on the poisoners. Many unfortunate persons were murdered in the streets on being denounced as the perpetrators of these imaginary crimes, and so paralysed was the arm of justice by the influence of terror that nothing was done to vindicate the majesty of the law. Everyone who could afford to leave Paris fled from it with precipitation, and the city was abandoned to desolation and anarchy. The legislative labours of the two Chambers were suspended, and the peers and deputies were the first to set the example of flight, though Louis Philippe and his family continued to reside at the Tuileries, with an occasional sojourn of a few days at Neuilly. I have a vivid recollection of the mingled awe and terror which this fell disease inspired when it was announced that it had crossed the sea and made its first victims in this country. It had made its way across the continent from town to town on the banks of the great rivers, but into England it was imported by sick sailors. Many generations had passed away since anything like a pestilence had been known in England, and the cholera therefore created a panic among all classes of the people, which served to augment its virulence and render those of a nervous temperament more liable to be attacked by it. Doctors were utterly unacquainted with its proper treatment, and indeed had no knowledge whatever of the disease. Hence it raged without check wherever it appeared, and the rapidity with which it carried off its victims added to the terror inspired by its approaches. The first death at Lower Norwood, where my parents then resided, was that of the pastor of the Independent Chapel, situated only two doors from my father's house. He died in a few hours from the time he experienced the premonitory symptoms, and such was the dread of infection that the corpse was buried the same night by torchlight, in the burial-ground of the chapel, wrapped in a sheet coated with pitch. Though a period of seventeen years separated the first cholera epidemic from the second, the lessons which the former should have taught had not been so well learned as they should have been, and the latter, with which these reminiscences are chiefly concerned, inspired a wild, unreasoning terror in only a little less degree than that of 1832. I remember a case at Mitcham, in which the women attending a patient were seized with a panic on the approach of death, and rushed out of the house, leaving the poor wretch, a woman, to die alone, the corpse being afterwards found rigid and distorted. The apparently erratic manner in which the disease spread, sometimes carrying off victims from one side of a street and sparing the other side, sometimes smiting every member of a family in one house, and passing over all the other houses in the same street, was a puzzle to persons who had given no attention to the causes of the disease, and were content to regard it as a sign of the wrath of God, reasoning about the matter as little as did the Israelites whose relatives were swept off at Kibroth-hattaavah. They had not given sufficient attention to the laws of health to understand that the disease found its victims where those laws were neglected, whether from carelessness or from ignorance. I remember two cases at Croydon in which all the inmates of the houses in which the disease manifested its dread presence were carried off by it. One occurred in a cottage in St. James's Road, one of a row which had originally been level with the road, but had become overshadowed by the approach to the railway bridge. There were three victims in that house, and no other case in the same row, or in the neighbourhood. The other case occurred in King Street, one of several narrow, closely-built streets in the centre of the town, and the victims were a widow and her only child, the latter dying not alone, for, like Byron's Haidee,-- "----she held within A second principle of life, which might Have dawned a fair and sinless child of sin; But closed its little being without light, And went down to the grave unborn, wherein Blossom and bough lie withered with one blight." A remarkable incident occurred while the fell disease was in the full swing of its ravages. The wife of a working man living in the Old Town, a low-lying and densely populated quarter, was attacked by it, and at once removed to a temporary hospital that had been established on Duppas Hill, a tabular eminence overlooking the town, and in the thirteenth century the scene of the tournament in which the son of Earl Warrenne was by misadventure slain. There her husband went, on his return from labour, to ascertain her condition, and heard with a shock which the reader may imagine that she was dead. When the poor fellow had in some degree recovered from the blow, he expressed a wish to see the corpse and take it to his home. He seems to have been unable to realise that his wife was really dead, though the nurses and doctors assured him that she had passed away. The idea that life yet lingered in the form that was apparently lifeless grew upon him as he gazed and though he may never have read "The Giaour," he may have felt the force of the thought so finely expressed by Byron in the lines that introduce his picture of the Greece of his day:-- "He who hath bent him o'er the dead, Ere the first day of death is fled, The first dark day of nothingness, The last of danger and distress (Before Decay's effacing fingers Have swept the lines where beauty lingers), And marked the mild angelic air, The rapture of repose that's there, The fixed yet tender traits that streak The languor of the pallid cheek, And--but for that sad shrouded eye, That fires not, wins not, weeps not, now, And but for that chill, changeless brow, Where cold Obstruction's apathy Appals the gazing mourner's heart, As if to him it could impart The doom he dreads, yet dwells upon; Yes, but for these, and these alone, Some moments, aye, one treacherous hour, He still might doubt the tyrant's power; So fair, so calm, so softly sealed, The first, last look by death revealed!" Whether it was feeling or reason that inspired the thought that life yet lingered in the apparently inanimate, but not yet rigid form, which the loving husband conveyed to his humble dwelling, it was undoubtedly to that inspiration that the woman owed her preservation from death. For she was not dead. Signs of returning animation were perceived when the supposed corpse was placed upon the bed, and the neighbour women who came in to perform the last sad offices for the dead were there to welcome her on her return to life. I will not attempt to describe the feelings with which the husband beheld the eyelids of his wife unclose, and the rose-tints return to the pallid cheeks. Like the Greek painter who, conscious of the inadequacy of his art to fully portray the grief of Agamemnon for the loss of his son, covered the countenance of the old king with a veil, I draw the curtain upon the scene, and leave it to the imagination of the reader. Among the remedies for the cholera which came into vogue during the prevalence of the epidemic of 1849, the rubbing of the stomach with brandy and salt obtained a considerable degree of repute; and the chemists vied with each other, as in the recent epidemics of influenza, in the concoction and advertising of various cholera mixtures, one of the most efficacious of which was a preparation of opium and chalk. The lessons of the cholera were not so entirely neglected on this occasion as they were after the epidemic of 1832; but it is a sad reflection on our legislation that we were indebted to the ravages of disease, or rather to the fear inspired by them, for sanitary reforms which ought to have resulted from foresight. There had been sanitary inquiries by Royal Commissions between 1842 and 1849, but little had been done towards carrying out the recommendations which resulted from them. The existence of cholera in India, and the causes which produced it, had long been known; but so long as its ravages were confined to the people of that country no one seemed to think that it concerned the people of England. It was known, too, that whatever might be the true causes of zymotic diseases, concerning which medical opinions differed, accumulations of filth, contaminated sources of water supply, and an impure condition of the atmosphere tended to produce their outbreaks, and to aggravate their virulence. But then we had been used to these evils since the days of the Plantagenets, and though they had become intensified with the increase of population and the growth of the large towns, had not Malthus taught us that epidemics of disease were one of the means used by divine providence to prevent the numbers of the human race from exceeding the means of subsistence? The cholera epidemic of 1849 roused the public mind from its lethargy, and prepared it to act upon the recommendations of the General Board of Health and to comply with the Sanitary Act of that year. The old wells of London were closed, and the like course was adopted in Croydon, where a constant supply of practically pure water was obtained by boring down to the chalk. Other towns followed the example, one of the foremost being Birmingham, which received a supply which enabled the inhabitants to dispense with the insalubrious rain-water butt. Sewerage works were undertaken where no efficient system of drainage had before existed. Attention was called to the important questions of sewage disposal and the pollution of rivers; and though much even now remains to be done in this direction, and in the improvement of the water supply of the large manufacturing towns of Yorkshire and Lancashire, sanitation has been cleared of most of its difficulties by better knowledge of the philosophy of cause and effect, so that we no longer regard the calamities resulting from our own ignorance and neglect of the laws of nature as the inflictions of Providence. Some Old Doctors. BY MRS. G. LINNÆUS BANKS. It is not my intention to go back to those Greek fathers of the healing art, Hippocrates and Galen, or to dwell on the days when every monastery held within its walls some learned brother accredited to administer to bodies as well as souls diseased, or when the mistress of every feudal castle, every baronial-hall, was trained and skilled in leechcraft, distilled herbs, concocted potions and unguents, and not only physicked her household, but was prepared to staunch and dress the gaping wounds received in siege or tournay. Nor yet have we ought to do with those pretenders to science who mingled astrology with pharmacy, ascribed to every plant its ruling planet, and held that the potency of all herbs depended on the conjunction of planets, or the phase of the moon under which they were gathered--a belief, indeed, under which old Nicholas Culpepper compiled his well-known "Herbal" early in the seventeenth century. Medicine and surgery have made rapid strides since the days, not a century agone, when in the naval cockpit, and on the open battlefield, the hatchet was the ready implement for amputation, the rough cautery that of a red hot iron applied to the fizzing flesh; and when the doctor cried, "Spit, man, spit" to the suffering soldier with a gunshot wound in his chest, and when the sputum came tinged with blood, simply plugged up the bullet-hole and left the poor fellow to his fate, while he passed on to cases less hopeless. And _en passant_ I may say that wooden legs and stumps for arms were so common in the writer's young days as scarcely to attract attention--so ready were army surgeons to amputate. These are not matters on which I have to dwell, but I think the present work would be incomplete without a record of those men of original mind, whose acute observation and unwearied investigations in the past have indissolubly linked their names with discoveries which have revolutionised the practice of both medicine and surgery. In the opinion of Solomon, "there is nothing new under the sun;" and if such was the case in his day, how much more of a verity must be the truism in ours. So the most startling and perfect revelation of any great fact in human physiology may have been dimly perceptible to earlier intelligences groping in the dark, faint adumbrations of which may fall on the sensorium of the final discoverer, until a ray of divine light dispels the mists of ages, and the man, developing his crude idea with infinite pains, realises a great truth, and cries out "Eureka" to an astonished--and too often--an unbelieving world. Thus it may have been with the renowned practitioner, WILLIAM HARVEY, who came into the world when all England was filled with alarms of an "Invincible Spanish Armada," then preparing to devastate our shores and spare neither man nor maid, babe nor mother. Yet the scare passed and peace came, and the boy grew, until his educational course at Cambridge ended, and his bias led him towards Padua, then the great seat of academical and medical lore, and there he took his doctor's degree in physic. With the prestige of Padua upon him, in 1607, when he was but twenty years of age, he was elected Fellow of the College of Physicians (founded by Dr. Linacre in the reign of Henry VII.), and in 1715, the man of twenty-eight became their Anatomical Reader. A noteworthy appointment this, since consequent study and investigation led to the grand discovery that the heart--to speak unscientifically--was a sort of muscular pumping-engine, sending the blood circulating along a series of blood-vessels to every part of the system, changing in character on its course until it returned to its centre, the seat of life, to be pumped out afresh to circulate as before and do its appointed work. In 1628, Harvey made his discovery known in a learned treatise "On the circulation of the blood," and as may be supposed, his daring assertions roused a violent spirit of opposition amongst his medical brethren, even among those who began to feel the pulses of their patients for the first time, and to comprehend _why_ there should be a fluttering or audible beating under the sick one's ribs, and wherefore the fatal hemorrhage following a sword-thrust or a gunshot wound. In spite of opposition his teaching created a revolution in medical practice. The discoverer was called before Charles I. and his Court to demonstrate the action of the heart and subsidiary organs, in support of his new doctrine. Fresh honours fell upon him even when too old to bear the burden. And when in the fulness of time, William Harvey, who had outlived three monarchs, made his own exit under Cromwellian rule, he bequeathed infinitely more to posterity in his invaluable discovery than can be summed up in the estate, library, and museum now in the proud possession of the College of Physicians. These are held by a mere body of men. The other has a world-wide significance. Yet, as in his life, even in his grave, detractors strove to dim the glory of his important revelation, ascribing to the theological physician Servetus, to Realdus Columbus, and to Andreas Cæsalpinas, the credit of prior discovery. It remained for another learned physician, a century later, to deal with these counter-claims, and whilst admitting their vague individual conceptions of an elusive mystery, to establish once and for ever William Harvey's inalienable right as sole discoverer. This notable champion was JOHN FREIND, M.D., F.R.S., distinguished as the Medical Historian, and Harveian lecturer to the College of Physicians, at a time when he and his fellows shaved their heads and mounted Ramillies wigs as outward guarantees for the profundity of wisdom they enshrined. But apart from his flowing wig, or his defence of Harvey, or his learned medical history, written in part when he was a prisoner in the Tower for supposed complicity in the Atterbury Plot, or for skill in the treatment of disease, John Freind had a pioneer's claim to distinction. The doctor, strange to say, was a Member of Parliament, and on resuming his seat on his release from incarceration, he brought before the House of Commons, in 1725, a remarkable petition from the Royal College of Physicians, to restrain "the pernicious use of spirituous liquors." And though he might speak but as the mouthpiece of his brother Fellows, it needed no small degree of courage to broach such a subject in those days of general coarse indulgence among all classes; especially if his own language was as direct and forcible as that of the petitioners. Therefore, in his triple character as the historian of medicine, as the champion of William Harvey, and as the foremost M.P. to advocate the cause of temperance before our national legislative assembly, John Freind, M.D., claims a niche in our Walhalla of notable old doctors. In the nave of Westminster Abbey on a memorial of polished granite is this inscription--"Beneath are deposited the remains of JOHN HUNTER, born at Long Calderwood, Lanarkshire, N.B., on February 14th, 1728; died in London on October 10th, 1793. His remains were removed from the Church of St. Martins-in-the-Fields to this Abbey on March 28th, 1858. The Royal College of Surgeons of England have placed this table over the grave of Hunter to record their admiration of his genius as a gifted interpreter of the Divine power and wisdom that works in the laws of organic life, and their grateful veneration for his services to mankind as the Father of scientific surgery. 'O Lord, how manifold are Thy works; in wisdom hast Thou made them all.'" Such honours are not paid to the remains of men of common stamp. And of no common stamp was the sandy-headed youth who, having spent ten years of his life learning cabinet making, resolved on striking out a better career for himself; and in his twentieth year took horse and journeyed to London to place himself under his elder brother, WILLIAM HUNTER, then rising into note as a medical practitioner and a teacher of anatomy. In October, 1748, he entered his brother's dissecting room, and whether the fitting of joints in cabinetware had been of initiatory service, or he had had access to the books of his medical relations in Glasgow, or that as a boy upon his father's farm, observation of the domestic animals and of the wild inhabitants of wood and fell, had roused the desire to master the secrets of animated nature, sure it is that William speedily foretold a successful future for his new pupil as an anatomist. At all events he used his interest to place his promising brother under the eminent surgeon of Chelsea Hospital, and later under another at St. Bartholomew's. Then, shocked by the rough speech and manners of his countrified brother, and his need of education, the classical elder packed him off to college to pick up a little refinement along with Latin and Greek. In vain. Irrepressible and hot-tempered John could not sit down quietly to study dead languages. Back he came from Oxford in haste, to study dead bodies in his brother's dissecting room, and serve as demonstrator to his course of lectures, simultaneously with his study of living bodies at St. George's Hospital, where in a comparatively short time he became house-surgeon. His appointment as staff-surgeon to our troops on foreign service marked the six intervening years before he settled down to practise in London. He had laboured ten years on human anatomy, and had dissected a number of the lower animals, laying the foundation of his collection of comparative anatomy. Even while on foreign service he had amused himself with studying the digestive faculties of snakes and lizards when in a torpid state, and many were the contributions he sent home to his brother's museum. His return to London, as a teacher of surgery and anatomy, was a marked success, though private practice had to grow. In 1776, he was appointed surgeon extraordinary to His Majesty George III., but eleven years prior to this was admitted a Fellow of the Royal Society, slightly in advance of his elder brother. Then in 1768, the bachelor, William, shifted himself and his museum from Jermyn Street to Windmill Street, and resigned the lease to John, thus securing independent action to the latter, and facilities for creating a natural-history museum of his own. Hitherto, the brothers had worked together in unison, but now John committed the unpardonable offence of bringing home to Jermyn Street "a tocherless bride," fourteen years younger than himself, endowed only with beauty and accomplishments, and a faculty for filling the house with assemblies of wit and fashion, which blunt-spoken John designated "kick-ups," no doubt with an irreverent big D as a prefix, swearing being as characteristic as hard work. And work hard he did, early and late, not merely to maintain his extensive and lucrative practice, but to provide and prepare subjects for the museum in the rear of his town house, and for the valuable and original lectures he delivered in language forcible and clear, if neither refined nor academic. His chief workshop, so to speak, was at his country "Box" at Earl's Court, the grounds of which he had converted into a zoological garden, so many wild animals were there kept for study. There is a story told of his facing an escaped lion and flicking him back to his den with his pocket handkerchief, showing his fearlessness and his knowledge of leonine nature. Another tale is told of his intervention between fighting dogs and leopards, he dragging the infuriated leopards back to their cage by their collars--and _fainting_ when the feat was accomplished, for his was not a burly frame, and his heart was in a threatening condition. An element of humour mingles with the gruesome in Sir B. W. Richardson's account of the ruse employed to cheat watchful executors, and obtain the body of O'Brien the Irish Giant,[2] so as to convert it into the skeleton now in the Hunterian Museum of the Royal College of Surgeons, Lincoln's Inn. Those were the days when surgeons were not particular where they obtained subjects for their scalpels, whether from the resurrection men or from the gallows, and John Hunter was not more dainty than his fellows. But also from travelling shows and menageries, and from animals that died in the Tower he was supplied. And so rapidly did his museum grow, absorbing the bulk of his income, that ere long he had to remove to what is now Leicester Square, and erect a building in the rear for his collection. Honours fell upon him thickly as they had fallen on his brother, alike British and foreign, of which he took little heed, absorbed as he was in the pursuit of knowledge, and its demonstration. His discoveries placed him far ahead of the science of his time, though his courtly brother, earlier in the field and first to leave it, ran him close. Indeed their final quarrel and alienation arose out of a disputed claim to a certain discovery in feminine physiology, brought before the Royal Society, a quarrel which transferred William's museum to the University of Glasgow, and excluded John from his will. The so-called "Lyceum Medicum" in Leicester Square, became the home of the "Society for the Improvement of Medical and Chirurgical Knowledge," and the "Philosophical Transactions" of the Society testify to the genius and untiring activity of its promoter. How he found time for his many written essays and discourses on topics wide apart as "Gunshot-wounds" and "Teeth" is a marvel. No wonder the frail human machine wore out so early. He had worked when he should have rested, worked regardless of premonitions and attacks John Hunter must have well understood, and died at last at sixty-two, a victim of one of those fits of passion no man with a diseased heart can indulge in safely. Setting out originally from the tablet in Westminster Abbey to describe what manner of man was the old doctor who lay beneath, it became imperatively necessary to bracket the two brothers, John and William Hunter, together, since, according to Sir B. W. Richardson, they were "twins in science," if not in birth. Had not William already come to the front when John sought him out, he could not have been his teacher, or given his younger brother his first start in life, his introduction, or his facilities for study. Then they worked together, became one in anatomical discovery, in their zeal for collecting all that illustrated their theories, all that was rare and curious, into unprecedented museums. Yet how widely the personalities of the brothers differed. They both stood out among contemporaries, yet William, with his slight form, mildly refined face, set off by an unpretentious wig, and delicate hands, under lace ruffles, and wide coat cuffs, a classical scholar, an antiquary, a numismatist, as well as a naturalist,--Queen Charlotte's medical referee, stepping out from his chariot, gold cane in hand, to visit his courtly patients, was the very _beau ideal_ of a fashionable physician of that day, one who shone in drawing-rooms as well as in the lecture-hall. Blue-eyed John, with high cheek bones, broad, slightly receding forehead, tangled red hair, and a shaggy mane of whisker that made his keen face a triangle, tender of heart, yet brusque and coarse of speech, rough in manner as in dress (with not a sign of frill or ruffle), despising dilettante coteries, not squeamish in seeking "subjects," passionate and determined, caring little for empty honours, for money only to swell his museum, and nothing for courtly circles, though created surgeon-extraordinary to George III., and owing his large practice solely to the force of his character, his science, and his skill. So far he was his brother's antithesis. John was a diamond in the rough; William the gem cut and polished. And such were the two old doctors to whom England's College of Surgeons owes its Hunterian Museum; the University of Glasgow the other. Had not the brothers quarrelled, the two would have formed one grand unrivalled collection. Space is limited, and so must be our notes of these other celebrated "old doctors," whom it would be invidious to overlook. Of these EDWARD JENNER stands prominently out, but he has been already dealt with by another hand. It is scarcely possible to pass by JOHN ABERNETHY, F.R.S., the eccentric physician, whose principle was that men should eat to live, not live to eat, who maintained that the stomach was the chief seat of health or disease, according as it was used or abused, and that water was the one natural and nutrient beverage. The practical way in which he illustrated his theories respecting overfeeding,--filling a pail with food from various dishes in correspondence with the heterogeneous mixture on his patients' plates--and his brusque replies to some other of his patients, have perpetuated his name through his oddities, rather than as a benefactor of his kind, who revolutionized the medical practice of his time, and of course excited envy and antagonism. His hair, kept together at the nape of the neck with a ribbon tie, was brushed back from his forehead, and added a degree of sharpness to his somewhat hatchet-shaped face, when he told the timorous lady who was "afraid she had swallowed a spider," "Then put a fly in your mouth, madam, and the spider will come up to catch him." Or when he threw the shilling from his fee back to a mother with a delicate daughter, "Take that, madam, and buy her a skipping-rope," an intimation that exercise was needed. It was an age of coarse feeding and strong drinking, an age of drastic purges and much blood-letting, and Abernethy's temperance principles, so much in advance of his time, provoked considerable opposition from his medical brethren, whose satirical epigrams he was not slow to cap. But contemporary squibs and satires cannot affect the real good which has made Abernethy's name a household word. Indeed it has been stamped upon a biscuit. It is stamped also on a medical society he founded at St. Bartholomew's Hospital, where his centenary has recently been celebrated. Many have been the contributions to scientific medicine and surgery since the rough days of the old doctors I have endeavoured to chronicle, but these men of wigs and ties, gold-headed canes and pouncet-boxes, breeches and buckled shoes, were the pioneers of progress, they cleared the way for the men of this day and generation, and left their mark on their own age, not to be effaced by newer and more advanced successors, to whom they have served as stepping-stones. The Lee Penny. The story of the Lee Penny is full of historic interest, and the legends respecting it furnished Sir Walter Scott with some incidents for his novel the "Talisman." This amulet is a stone of a deep red colour and triangular shape, in size about half-an-inch on each side, and is set in a silver coin. The various accounts which have come under our notice are agreed that this curious relic of antiquity has been in the Lee family since a period immediately after the death of King Robert the Bruce. The monarch was nearing his end, and as he lay on his death-bed, he was much troubled for having failed to visit in person the Holy Land to assist in the Crusade. His long war with the English had rendered it impossible for him to leave his kingdom to fight in a foreign land, even in the cause of religion. Sir James Douglas, his tried and trusty friend, stood beside the bed of his king, and was in sore distress. As a last request the king implored that as soon as possible after his soul had left his body Douglas would take his heart to Jerusalem. On the honour of a knight, Sir James faithfully promised to discharge the trust. The king died in 1329, and his heart was enclosed in a silver case. Sir James suspended it from his neck with a chain, and without delay gathered round him a suitable retinue, and made his way towards the Holy Land. He was not destined to reach that country, for on his route the intelligence reached him that Alphonso, King of Leon and Castile, was waging war with the Moorish chief, Osmyn of Granada. To assist the Christians, he felt it was his duty, and in accordance with the dying charge of his king. With courage he engaged in the fray, but was soon surrounded by horsemen, and he who had fought so long and bravely, realised that he must meet his doom far from the country he loved so well. He made a desperate effort to escape. The precious casket he took from his neck and threw it before him, saying, "Onward, as thou were wont, thou noble heart! Douglas will follow thee." He followed it and was slain. After the battle was over the brave knight was found resting on the heart of Bruce. The mortal remains of the valiant knight were carried back to his home and buried in his church of St. Bride, at Douglas. The heart of Bruce was entrusted to Sir Simon Locard, and by him borne back to Scotland, and at last found a resting-place beneath the high altar of Melrose Abbey, and its site is still pointed out. Mrs. Hemans wrote a charming poem on Bruce's heart in Melrose Abbey, commencing:-- "Heart! that did'st press forward still, Where the trumpet's note rang shrill; Where the knightly swords are crossing, And the plumes like sea-foam tossing, Leader of the charging spear, Fiery heart! and liest thou here? May this narrow spot inurn Aught that could so beat and burn?" We are told the family name of Locard was changed to Lockheart, or Lockhart, from the circumstance of Sir Simon having carried the key of the casket, and was granted as armorial insignia, heart with a fetter-lock, with the motto, "Corda serrata pando." According to a contributor to Chambers's "Book of Days," v., 2, p. 415, from the same incident, the Douglases bear a human heart, imperially crowned, and have in their possession an ancient sword, emblazoned with two hands holding a heart, and dated 1329, the year Bruce died. Lockhart was not daunted at the failure of the first attempt to reach Jerusalem, and, in company with such Scottish knights as escaped the fate of their leader, they once more proceeded, and arrived in the Holy Land, and for some time fought in the wars against the Saracens. [Illustration: THE LEE PENNY.] The following adventure is said to have befallen him. He made prisoner in battle an Emir of wealth and note. The aged mother of his captive came to the Christian camp to save her son from his captivity. Lockhart fixed the price at which his prisoner should ransom himself; and the lady, pulling out a large embroidered purse, proceeded to tell down the amount. In this operation, a pebble inserted in a coin, some say of the lower empire, fell out of the purse, and the Saracen matron testified so much haste to recover it as to give the Scottish knight a high idea of its value. "I will not consent," he said, "to grant your son's liberty unless the amulet be added to the ransom." The lady not only consented to this, but explained to Sir Simon the mode in which the talisman was to be used. The water in which it was dipped operated as a styptic, or a febrifuge, and the amulet possessed several other properties as a medical talisman. Sir Simon Lockhart, after much experience of the wonders which it wrought, brought it to his own country, and left it to his heirs, by whom, and by Clyde side in general, it was, and is still, distinguished by the name of the Lee Penny, from the name of his native seat of Lee. Its virtues were brought into operation by dropping the stone in water which was afterwards given to the diseased to drink, washing at the same time the part affected. No words were used in dipping the stone, or money permitted to be taken by the servants of Lee. People came from all parts of Scotland, and many places in England, to carry away the water to give to their cattle. Some interesting information respecting this amulet appears in an account of the Sack and Siege of Newcastle-on-Tyne in 1644. "As one of the natural sequences," says the writer, "of prolonged distress, caused by this brave but foolhardy defence against overwhelming odds, the plague broke out with fatal violence in Newcastle and Gateshead, as well as Tynemouth and Shields, during the following year. Great numbers of poor people were carried off by it; while tents were erected on Bensham Common, to which those infected were removed; and the famous Lee Penny was brought out of Scotland to be dipped in water for the diseased persons to drink, and the result said to be a perfect cure. The inhabitants (that is to say, the Corporation, we presume), gave a bond for a large sum in trust for the loan; and they thought the charm did so much good, that they offered to pay the money down, and keep the marvellous penny with a stone in which it is inserted; but the proprietor, Lockhart of Lee, would not part with it." We are told that many years ago a remarkable cure is alleged to have been performed on Lady Baird of Sauchton Hall, near Edinburgh, who, having been bitten by a mad dog, was seized with hydrophobia. The Lee Penny was sent for, and she used it for some weeks, drinking and bathing in the water it had been dipped in, and she quite recovered. "The most remarkable part of the history," as Sir Walter Scott says, "perhaps was, that it so especially escaped condemnation when the Church of Scotland chose to impeach many other cures which savoured of the miraculous, as occasioned by sorcery, and censured the appeal of them, 'excepting only the amulet called the Lee Penny, to which it pleased God to annex certain healing virtues, which the Church did not presume to condemn.'" The Lee Penny is preserved at Lee House, in Lanarkshire, the residence of the present representative of the family. How Our Fathers were Physicked. BY J. A. LANGFORD, LL.D. Delightful old Fuller tells us "Necessary and ancient their Profession ever since man's body was subject to enmity and casualty." There is no doubt of the necessity and antiquity of the doctor's calling, but there is, without doubt, no profession in which such great and beneficent advance has been made in modern times as in the medical. The tortures which our fathers endured under the old treatment are terrible to think of. It was not enough that they were afflicted by disease; the pains which they had to suffer from the supposed remedies far exceeded those which nature imposed. Cupping, blistering, and especially bleeding, were the common applications in nearly all complaints, the Bleeding was also used as a preventive, which proverb truly tells us "is better than cure"; but in this case the supposed disease could scarcely have been worse than the supposed prevention. Five times in the year--"in September, before Advent, before Lent, after Easter, and at Pentecost"--were the periods at which men in health were accustomed to "breathe a vayne." Besides letting of blood, the physician's cane and the surgeon's club were vigorously used on the unfortunate sufferers. Mr. J. C. Jeaffreson, in his very interesting "Book about Doctors," says, "For many centuries fustigation was believed in as a sovereign remedy for bodily ailments as well as moral failings, and a beating was prescribed for an ague as frequently as for picking and stealing." So what with the lancet and the stick combined, our fathers must indeed have shuddered at the approach of any of the "natural shocks that flesh is heir to." The medicines of those good old times were of a very strange and objectionable kind. Some of the concoctions were composed of many ingredients, and were formed of abominable, not to say disgusting, materials. All nature was ransacked for out-of-the-way and horrible things which could be used as drugs and nostrums for suffering and gullible sufferers. In the reign of Charles II., Dr. Thomas Sherley "recommended a clumsy and inordinate administration of violent drugs" for gout. "Calomel he habitually administered in simple doses. Sugar of lead he mixed largely in his conserves; pulverized human bones he was very fond of prescribing; and the principal ingredient in his gout-powder was 'raspings of a human skull unburied.' But his sweetest compound was his 'Balsam of Bats,' strongly recommended as an unguent for hypochondriacal persons, into which entered adders, bats, sucking-whelps, earth worms, hogs' grease, the marrow of a stag, and the thigh-bone of an ox." A good idea of the things sold to a confiding public as cures for its ills may be gathered from two verses on Colonel Dalmahoy, a well-known--shall we say quack--of the past:-- "Dalmahoy sold infusions and lotions, Decoctions, and gargles, and pills, Electuaries, powders, and potions, Spermaciti, salts, scammony, squills. Horse aloes, burnt alum, agaric, Balm, benzoine, blood-stone, and dill; Castor, camphor, and acid tartaric, With specifics for every ill." Metals and precious stones were extensively used in the prescriptions of bygone doctors. Every metal and every stone was credited with some special and peculiar virtue which it alone possessed, and it was applied as a cure for that ailment over which it had influence and power. Bacon tells us, "We know Diseases of Stoppings, and Suffocations, are the most dangerous in the body; And it is not much otherwise in the minde. You may take _Sarza_ to open the Liver; _Steele_ to open the Spleene; _Flowers of Sulphur_ for the Lungs; _Castoreum_ for the Braine," for each of which parts it was believed that the specifics named were most efficacious. The prescriptions of Dr. Bulleyn, in the reign of Elizabeth, are wonderful examples of how our fathers were physicked. Here are two of those quoted by Mr. Jeaffreson. The first is "_An Embrocation._--An embrocation is made after this manner:--Px. Of a decoction of mallowes, vyolets, barly, quince seed, lettice leaves, one pint; of barly meale, two ounces; of oyle of vyolets and roses, of each, an ounce and half; of butter, one ounce; and then seeth them all together till they be like a brouthe, puttyng thereto, at the ende, foure yolkes of eggs; and the maner of applying is with peeces of cloth, dipped in the aforesaid decoction, being actually hoate." Our second is "truly a medicine for kings and noblemen;" it is called an "_Electuarium de Gemmis._--Take two drachms of white perles; two little peeces of saphyre; jacinth, corneline, emerauldes, grannettes, of each an ounce; setwal, the sweete roote dorsnike, the rind of pomecitron, mase, basal seede, of each two drachms; of redde corrall, amber, shewing of ivory, of each two drachms; rootes both of white and red lichen, ginger, long peper, spicknard, folium indicum, saffron, cardamon, of each one drachm; of troch diarodon, lignum aloes, of each half a small handful; cinnamon, galinga, zurnbeth, which is a kind of setwal, of each one drachm and a half; thin pieces of gold and sylver, of each half a scruple; of musk, half a drachm. Make your electuary with honey emblici, which is the fourth kind of mirobulans with roses, strained in equall partes, as much as will suffice. This healeth cold diseases of ye braine, harte, stomack. It is a medicine proved against the tremblynge of the harte, faynting and swooning, the weakness of the stomacke, pensiveness, solitarines. Kings and noble men have used this for their comfort. It causeth them to be bold-spirited, the body to smell wel, and ingendreth to the face good colour." The most innocent articles used in the old medicines were fruits, and herbs, and vegetables. To some kinds special virtues are assigned, and Dr. Bulleyn's "Book of Simples," is very pleasant reading. "Pears, apples, peaches, quinces, cherries, grapes, raisins, prunes, raspberries, oranges, medlons, raspberries and strawberries, spinage, ginger, and lettuces are the good things thrown upon the board." We are told of a prune growing at Norwich, and known as the "black freere's prune," that it is "very delicious and pleasaunt, and no lesse profitable unto a hoate stomacke." "The red warden is of greate virtue, conserved, roasted or baken to quench choller." We are also informed that "Figges be good agaynst melancholy, and the falling evil, to be eaten. Figges, nuts, and herb grase do make a sufficient medicine against poison or the pestilence. Figges make a good gargarism to cleanse the throates." Some of the Doctor's prescriptions are very curious. He prescribes "a smal young mouse rosted," for a child afflicted with a nervous ailment. Nor did he disdain to use the snail in certain cases. He tells us that "Snayles broken from the shelles and sodden in whyte wyne with oyle and sugar are very holsome, because they be hoat and moist for the straightnes of the lungs and cold cough. Snails stamped with camphery, and leven will draw forth prycks in the flesh." Snail broth is not entirely unknown in some country places, even at the present time. Bezoar stone and unicorn's horn were also used in confections. Cancer has always been, and unfortunately still is, a terrible and an incurable disease, and has afforded a fine field for all kinds of nostrums and specifics which were to produce a "safe and certain cure." One of these, called a "precious water," was thus composed. "Take dove's foote, a herb so named, Arkangell ivy with the berries, young red bryer toppes, and leaves, whyte roses, theyre leaves and buds, red sage, celandyne and woodbynde, of each lyke quantity, cut or chopped and put into pure cleane whyte wyne, and clarified honey. Then breake into it alum glasse and put in a little of the pouder of aloes hepatica. Destill these together softly in a limbecke of glasse or pure tin; if not then in a limbecke wherein aqua vitæ is made. Keep this water close. It will not onely kyll the canker (cancer), if it be duly washed therewyth; but also two droppes dayly put into the eye wyll sharp the syght, and breake the pearle and spottes, specially if it be dropped in wyth a little fenell water, and close the eyes after." In 1739, the British Parliament passed an Act which is unprecedented in the annals of folly. A female quack, named Joanna Stephens, was reported to have effected some most extraordinary cures by the use of a medicine of which she only possessed the secret. She proposed to make it public for the sum of £5,000, and a vain attempt was made to raise the sum by subscription, but only £1,356 3s. was thus raised. An appeal was made to Parliament, and a commission was appointed to enquire into the subject, and a certificate signed by the Archbishop of Canterbury, Bishops, Peers, and Physicians, was presented to the House, declaring that they were "convinced by experiment of the utility, efficacy, and dissolving power," of the tested medicine, and Joanna Stephens was rewarded with the desired £5,000. The prescriptions were published, and the following extracts will suffice to show how easily sufferers from diseases may be, and sometimes are, gulled. This lucky quack says:-- "My medicines are a Powder, a Decoction, and Pills." "The Powder consists of egg-shells and snails, both calcined." "The Decoction is made by boiling some herbs (together with a ball which consists of soap, swine's-cresses burnt to a blackness, and honey), in water." "The Pills consist of snails calcined, wild carrot seeds, burdock seeds, asken keys, hips and hawes, all burnt to a blackness--soap and honey." Our readers will willingly dispense with the directions of how these dearly purchased medicines should be prepared. Surely "The pleasure is as great, In being cheated as to cheat!" In 1633, Stephen Brasnell, Physician, published a small volume entitled "Helps | for | Svddain | Accidents | Endangering Life. | By which | Those that live farre from Physitions or Chirurgions | may happily preserve the Life | of a true Friend or Neigh-| bour, till such a Man may be | had to perfect the Cure. | Collected out of the best authors | for the generall good." The following is his prescription for all kinds of poisons:--viz. "the Hoofe of an Oxe cut into parings and boyled with bruised mustard-seed in white wine and faire water. The Bloud of a Malard drunke fresh and warme: or els dryed to powder, and so drunke in a draught of white wine. The Bloud of a Stagge also in the same manner. The seeds of Rue and the leaves of Betony boyled together in white wine. Or take ij scruples (that is fortie graines) of Mithridate; of prepared Chrystall, one dram (that is three score grains), fresh Butter one ounce. Mix all well together. Swallow it down by such quantities as you can swallow at once; and drink presently upon it a quarter of a pint of the decoction of French Barley, or so much of six shillings Beere. Of this I have had happy proofe." There is a much more effective, though a somewhat revolting prescription for "those with abilitie." "Take," says our seventeenth century physician, "take a sound horse, open his belly alive, take out all his entrayles quickly, and put the poysoned partie naked into it all save his head, while the body of the horse retains his naturall heate, and there let him sweat well." Our author admits that "this may be held a strange course, but the same reason that teacheth to devide live pullets and pigeons for plague-sores approveth this way of sweating as most apt to draw to itselfe all poysons from the heart and principall parts of the patient's body. But during this time of sweating he must defend his braine by wearing on his head a quilt." The quilt is to be made by taking a number of dried herbs, which are to be made into a "grosse powder and quilt them up in sarsnet or calico, and let it be so big as to cover all the head like a cap, then binde it on fast with a kerchief." This is called "a Nightcap to preserve the Brain." There are also curious prescriptions for the stings of bees and wasps, the "bitings of spiders," of which he says "the garden ones are the worst." He tells us that the "flesh of the same beast that biteth, inwardly taken, helpeth much," and that "outwardly the best thing to be applied is the flesh of the same beast that did the hurt, pounded in a morter and applied in manner of a poultis." Here is one about that pretty little animal, the shrew-mouse: "Now the shrew-mouse is a little kind of a mouse with a long sharpe snout and a short tayle; it liveth commonly in old ruinous walls. It biteth also very venomously, and leaveth foure small perforations made by her foure foreteeth. To cure her biting, her flesh roasted and eaten is the best inward antidote if it may be had. And outwardly apply her warme liver and skin if it may be had. Otherwise _Rocket-reeds_ beaten into powder, and mixed with the bloud of a dog. Or els the teeth of a dead man made into a fine powder." The toad comes in for a good share of attention, and Mr. Bradwell gives a personal anecdote on this subject. He says:--"Myself, while I was a student at _Cambridge_, was so hurt by the spouting of a venomous humour from the body of a great toad into my face while I pashed him to death with a brickbat. Some of the moisture lighted on my right eye, which did not a little endanger it, and hath made it ever since apt to receive any flux of Rheume or Inflammation." Some of our readers may think that this was a fit punishment for having "pashed" the toad to "death with a brickbat." Among the strangest things ever used as medicine must be placed human skulls. In 1854, Mr. T. A. Trollope gave a short account in _Notes and Queries_ of a book by Dr. Cammillo Brunoni, published at Fabriano in 1726. It was entitled _Il Medico Poeta_ (the Physician a Poet), and gives an account "of the medical uses of human skulls." Dr. Brunoni informs us, says Mr. Trollope, that "all skulls are not of equal value. Indeed, those of persons who have died a natural death, are good for little or nothing. The _reason_ of this is, that the disease of which they died has consumed or dissipated the essential spirit! The skulls of murderers and bandits are particularly efficacious. And this is clearly because not only is the essential spirit of the cranium concentrated therein by the nature of their violent death, but also the force of it is increased by the long exposure to the atmosphere, occasioned by the heads of such persons being ordinarily placed on spikes over the gates of cities! Such skulls are used in various manners. Preparations of volatile salt, spirit, gelatine, essence, etc., are made from them, and are very useful in epilepsy and hoemorrhage. The notion soldiers have, that drinking out of a skull renders them invulnerable in battle, is a mere superstition, though respectable writers do maintain that such a practice is a proved preventive against scrofula." This very curious book consists of a "poem in twelve cantos, or 'Capitoli,' as from the fifteenth century downwards it was the Italian fashion to call them, on the physical poet--a sort of medical _ars poetica_; and followed by a hundred and seventy-two sonnets on all diseases, drugs, parts of the body, functions of them, and curative means. Each sonnet is printed on one page, while that opposite is occupied by a compendious account in prose of the subject in hand. We have a sonnet on the stomach-ache, a sonnet on apoplexy, a sonnet on purges, another on blisters, and many others on far less mentionable subjects. The author's poetical view of the action of a black-dose compares it to that of a tidy and active housemaid, who, having swept together all the dirt in the room, throws it out of the window. Mystic virtues are attributed to a variety of substances, animal, vegetable, and mineral." That delightful work, The Memoirs of the Verney Family, by Lady Verney, affords some very striking examples of the medical treatment of poor suffering humanity in the 17th century. Our selections are from the third volume. One of the most extraordinary medicines of this, or of any age, was without doubt that known as Venice Treacle. In 1651, Sir Ralph Verney was in Venice, and the Memoirs furnish the following graphic account of this terrible drug, which was a concoction of the most disgusting materials. Sir Ralph sends it to Mrs. Isham, for her family medicine chest, and says "hee that is most famous for Treacle is called Sig{r} Antonio Sgobis, and keepes shopp at the Strazzo, or Ostridge, sopra il ponte de'Baretteri, on the right hand going towards St. Mark's. His price is 19 livres (Venize money) a pound, and hee gives leaden Potts with the Ostridge signe uppon them, and Papers both in Italian and Lattin to show its virtue." "This celebrated and incredibly nasty compound," adds Lady Verney, "traditionally composed by Nero's physician, was made of vipers, white wine, and opium, 'spices from both the Indies,' liquorice, red roses, tops of germander, juice of rough aloes, seeds of treacle mustard, tops of St. John's wort, and some twenty other herbs, to be mixed with honey 'triple the weight of all the dry species' into an electuary." The recipe is given as late as 1739, in Dr. Quincey's "English Dispensatory," published by Thomas Longman, at the Ship in Paternoster Row. "Vipers are essential, and to get the full benefit of them 'a dozen vipers should be put alive into white wine.' The English doctor, anxious for the credit of British vipers, proves that Venice treacle may be made as well in England, 'though their country is hotter, and so may the more rarify the viperime juices'; yet the bites of our vipers at the proper time of year, which is the hottest, are as efficacious and deadly as them. But he complains that the name of Venice goes so far, that English people 'please themselves much with buying a Tin Pot at a low price of a dirty sailor ... with directions in the Italian tongue, printed in London,' and that some base druggists 'make this wretched stuff of little else than the sweepings of their shops.' Sir Ralph could pride himself that his leaden pots contained the genuine horror. It was used as 'an opiate when some stimulus is required at the same time'; an overdose was confessedly dangerous, and even its advocates allowed that Venice treacle did not suit everyone, because, forsooth, 'honey disagrees with some particular constitutions.'" For centuries this medical "horror" was taken by our drastically treated forefathers. The treatment was indeed drastic, and we might truly add cruel. Tom Verney had "a tertian ague and a feaver," and for this he had "only a vomit, glister, a cordiall, and breathed a vane"--that is, was bled. Another patient, Sir George Wheler, who had caught a chill after dancing, had all sorts of "Applications of Blisters and Laudanums," so that his Christmas dinner at Dr. Denton's cost him "the best part of 100 pounds." For an eruption in the leg, Sir Ralph Verney was advised to apply a lotion "so virulent, a drop would fech of the skin when it touched." Young Edmund Verney was ill in 1657, and writes to his father, "Truly I might compare my afflictions to Job's. I have taken purges and vomits, pills and potions, I have been blooded, and I doe not know what I have not had, I have had so many things." In 1657-58 the epidemic known as "The New Disease," proved very fatal, and created quite a panic. The treatment adopted by the doctors may be gathered from a prescription of Dr. Denton's, one of the most famous physicians of the time. He writes to Sir Ralph Verney, "I see noe danger of Wm. R., and if he had followed your advice by taking of a vomit, and if that had not done it, then to have beene blooded, I beleeved he had beene well ere this." Then he adds "It is the best thinge and the surest and the quickest he can yet doe, therefore I pray lett him have one yett. 3 full spoonfulls of the vomitage liquor in possitt drinke will doe well, and he may abide 4 the same night when he goes to rest; let him take the weight of vi{ds} of diascordium the next day or the next but one; he may be blooded in the arm about 20 ounces." Some of the ladies of the time did not, however, approve of this kind of treatment, and preferred their own remedies, or their own notions of remedies, to the doctor's prescriptions. We select two examples. Lady Fanshawe described the disease as "a very ill kind of fever, of which many died, and it ran generally through all families." While she suffered from it she ate "neither flesh, nor fish, nor bread, but sage possett drink, a pancake or eggs, or now and then a turnip or carrott." But Lady Hobart ventured to prescribe. She writes, "If you have a new dises in your town pray have a car of yourself, and goo to non of them; but drink good ale for the gretis cordall that is: I live by the strength of your malt." Few, we anticipate, would object to her ladyship's advice, and most would prefer her "good ale" to Dr. Denton's "vomitts," and the loss of 20 ounces of blood. Our illustrations might be indefinitely multiplied, but those given will amply suffice to show the way in which our fathers were physicked. Medical Folk-Lore. BY JOHN NICHOLSON. To ease pain and endeavour to effect a cure, man will try every suggested remedy, likely and unlikely, and when numberless things have been tried, each of which was alleged to be a certain cure, he reverts to some simple thing, taught him by his old grandmother, or the "wise woman" of his early days; and which, by reason of its simplicity, had been at first contemptuously rejected in favour of more complex but inefficacious compounds. There is scarcely a market but has a stall kept by a herb woman, who, in warm old-fashioned hood, with a little shawl round her shoulders, her ample waist encircled by broad tapes from which is suspended a pocket, capacious and indispensable, lays out with great care her stock of simples--roots, leaves, or flowers, studiously gathered at the proper time, when their virtue is strongest. Here may be seen poppy heads for fomentation, dandelion roots for liver complaint, ground ivy for rheumatism, celandine for weak eyes, and other herbs, all "for the service of man," to alleviate or cure some of the "ills that flesh is heir to." She can relate wondrous tales of marvellous cures wrought by her wares, of cases, long standing, and given up by the duly qualified medical fraternity, a brotherhood she holds in contempt because of their new-fangled remedies and methods. This chapter, however, deals chiefly with superstitious remedies, or at least those remedies which seem to have no scientific bearing on the case; thus, a person having a sty on the eye, will have it rubbed with a wedding ring, or the gold ring of a young maiden; or cause it to be well brushed seven times with a black cat's tail, if the cat were willing. Another cure is more efficacious if administered as a surprise. The patient is placed in front of the operator, who unexpectedly spits on the eye affected; which action often leads to angry remonstrance, met by derisive laughter, which causes, it may be, broken friendship and general unpleasantness for a time. It is a common belief, almost world-wide in its extent, that toothache is caused by a little worm which gnaws a hole in the tooth. Not long ago I was shewn a large molar, which when _in situ_ had caused its owner great pain, and he pointed to the nerve apertures, saying, "That's where the worm was!" Shakespeare, in "Much Ado About Nothing,"[3] speaks of this curious belief:-- "_D. Pedro._ What! sigh for the toothache? _Leon._ Where is but a humour or a worm." "This superstition was common some years ago in Derbyshire, where there was an odd way of extracting, as it was thought, the worm. A small quantity of a mixture, consisting of dried and powdered herbs, was placed in a tea-cup or other small vessel, and a live coke from the fire was dropped in. The patient then held his or her open mouth over the cup, and inhaled the smoke as long as it could be borne. The cup was then taken away, and a fresh cup or glass, containing water, was then put before the patient. Into this cup the patient breathed hard for a few moments, and then, it was supposed, the grub or worm could be seen in the water."[4] The following was communicated to the _Folk Lore Journal_ by Wm. Pengelly, Esq., Torquay, February 1st, 1884:-- "Upwards of sixty years ago, a woman at Looe, in south-east Cornwall, complained to a neighbouring woman that she was suffering from toothache, on which the neighbour remarked that she could give a charm of undoubted efficacy. It was to be in writing, and worn constantly about the person; but, unfortunately, it would be valueless if the giver and receiver were of the same sex. This difficulty was obviated by calling in my services, and requesting me to write from dictation the following words:-- 'Peter sat in the gate of Jerusalem. Jesus cometh unto him and saith, "Peter, what aileth thee?" He saith, "Lord, I am grievously tormented with the toothache." He saith, "Arise, Peter, and follow me." He did so, and immediately the toothache left him; and he followed him in the name of the Father, and of the Son, and of the Holy Ghost.' The charm, being found to be correctly written, was held to have been presented to me by the dictator. I at once gave it to the sufferer, who placed it in a small bag and wore it round her neck." A Roumanian charm against toothache is to sit beside an anthill, masticate a crust of bread, spit it out over the anthill, and as the ants eat the bread the toothache will cease. Some believe that if you pick the aching tooth with the nail of an old coffin, or drink the water taken from the tops of three waves, the wearying pain may be relieved or cured. In Norfolk, the toothache is called the "love pain," and the sufferer does not receive much sympathy. Some time ago, a man wished to shew me some antiquity he had found, but his jacket pocket was so filled with odds and ends ("kelterment," he called it) that he turned all out in order to better prosecute his search. Among the miscellaneous collection I noticed a potato, withered, dry, hard, and black; and was informed it was kept as a preventive and cure for rheumatism. For the same distressing, disabling disease, some people spread treacle on brown paper, and apply hot to the part affected. The following curious passages have been transcribed by my friend, Mr. George Neilson, solicitor, Glasgow, from the Kirk Session Records of the parish of Gretna, and are here inserted by his consent, most freely given:-- "GRAITNEY KIRK, _Feb. 11, 1733_. Session met after Sermon. It was represented by some of the members that the Charms and Spells used at Watshill for Francis Armstrong, Labouring under distemper of mind, gave great offence, and 'twas worth while to enquire into the affair and publickly admonish the people of the evil of such a course, that a timely stop be put to such a practice. Several of the members gave account that in Barbara Armstrang's they burned Rowantree and Salt, they took three Locks of Francis's hair, three pieces of his shirt, three roots of wormwood, three of mugwort, three pieces of Rowantree, and boiled alltogether, anointed his Legs with the water, and essayed to put three sups in his mouth, and meantime kept the door close, being told by Isabel Pott, at Cross, in Rockcliff commonly called the Wise Woman, that the person who had wronged him would come to the door, but no access was to be given. Francis, tho' distracted, told them they were using witch-craft and the Devils Charms that would do no good. It is said they carried a candle around the bed for one part of the inchantment. John Neilson, in Sarkbridge, declared before the Session this was matter of fact others then present. Mary Tate, Servant to John Neilson in Sarkbridge is to be cited as having gone to the Wise Woman for Consultation." "GRAITNEY KIRK, _Feb. 25, 1733_. Session met after Sermon Mary Tate having been summoned was called on, and compearing confessed that she had gone to Isabel Pot, in the parish of Rockcliff, and declared that the s{d} Isabell ordered South running water to be lifted in the name of the Father, Son and Holy Ghost, and to be boiled at night in the house where Francis Armstrong was, with nettle roots, wormwood, mugwort, southernwood and rowantree, and his hands, legs and temples be stroaked therewith, and three sups to be put in his mouth, and withal to keep the door close: She ordered also three locks of his hair to be burnt in the fire with three pieces clipt out of his shirt, and a Slut, _i.e._, a rag dipt in tallow to be lighted and carried round his bed, and all to be kept secret except from near friends: Mary Tate declared that the said Francis would allow none to touch him but her, and at last Helen Armestrange, Spouse to Archibald Crighton, Elder, assisted her, and after all the said Francis, tho' distracted, told them they were using witchcrafts and the Devil's Charms that would do no good: Mary Tate being admonished of the Evil of such a course was removed: Notwithstanding her acknowledgments of her fault she is to be suspended _a sacris_, and others her accomplices, and that none hereafter pretend Ignorance the Congregation is to be cautioned against such a practice from the Pulpit." Ague used to be much more prevalent than it now is. Drainage and sanitation have banished many evils, and with the evil, the exorcists' charm for the banishment of the evil. Charms, rather than medical remedies, for the cure of ague, are very prevalent. Rider's _British Merlin_ for 1715 lies before me. It is a thin 16mo. booklet of 48 printed pages and 42 blank pages, but some of the blank inter-leaves have been torn out. It is bound in parchment with gilt edges, and has had a clasp, which has disappeared. One of the interleaves bears this written charm:--"And Peter sat at the gate of Jerusalem and prayed, and Jesus called Peter, and Peter said, Lord, I am sick of an ague, and the evil ague being dismissed, Peter said, Lord, grant that whosoever weareth these lines in writing, the evil ague may depart from them, and from all evil ague good Lord deliver us." The following charm is taken from an old diary of 1751[5]:--"When Jesus came near Pilate, He trembled like a leaf, and the judge asked Him if He had the ague. He answered, He had neither the ague, nor was He afraid; and whosoever bears these words in mind shall never fear ague or anything else." A strange charm for this dreaded disease was to be spoken up the wide cavernous chimney by the eldest female of the family on St. Agnes' Eve. Thus spake she:-- "Tremble and go! First day shiver and burn; Tremble and quake! Second day shiver and learn; Tremble and die! Third day never return." A curious anecdote is related of Lord Chief Justice Holt. When a young man, he, with companions who were law students like himself, ran up a score at an inn, which they were not able to pay. Mr. Holt observed that the landlord's daughter looked very ill, and, posing as a medical student, asked what ailed her. He was informed she suffered from ague. Mr. Holt, continuing to play the doctor, gathered sundry herbs, mixed them with great ceremony, rolled them up in parchment, scrawled some characters on the same, and to the great amusement of his companions, tied it round the neck of the young woman, who straightway was cured of her ague. After the cure, the pretending doctor offered to pay the bill, but the grateful landlord and father would not consent, and allowed the party to leave the house with hearts as light as their pockets. Many years after, when on the Bench, a woman was brought before him accused of witchcraft. She denied the charge, but said she had a wonderful ball, which never failed to cure the ague. The charm was handed to the judge, who recognised it as the very ball he had made for the young woman at the inn, to help himself and his companions out of a difficult position.[6] In the west of England a live snail is sewn up in a bag and worn round the neck as an antidote for ague; though others in the same district imprison a spider in a box, and, as it pines away, so will the disease depart. It is a common belief in the north of England that a person bitten by a dog is liable to madness, if the dog which bit them goes mad. In order to secure the bitten one from such a terrible fate, the owner of the dog is often compelled to destroy it. Should he refuse to do so, the friends of the injured party would probably poison it, The condition peculiar to the morning following a night of debauchery, is said to need "a hair of the dog that bit you," which doubtless refers to the means taken to prevent ill effects following a dog bite. A wise saw from the Edda tells us that "Dog's hair heals dog's bite." The following incident recorded in the _Pall Mall Gazette_, Oct. 12th, 1866, shews most gross superstition in this Victorian age. "At an inquest, held on the 5th of October, at Bradfield, (Bucks.), on the body of a child of five years of age, which had died of hydrophobia, evidence was given of a practice almost incredible in civilised England. Sarah Mackness stated that at the request of the mother of the deceased, she had fished out of the river the body of the dog by which the child had been bitten, and had extracted its liver, a slice of which she had frizzled before the fire, and had then given it to the child to be eaten with some bread. The dog had been drowned nine days before. The child ate the liver greedily, drank some tea afterwards, but died, in spite of this strange specific." Erysipelas in Donegal is known as the "rose." It is very common, but can be cured by a stroker. The following is said to have happened. A nurse of a Rector had the "rose," and the doctor was called in. After he was gone, the woman's friends brought in a stroker, who rubbed the nurse with bog moss, and then threw a bucket of bogwater over her in bed. This treatment cured the woman, and is said to be generally in vogue, but is not efficient except the right person does it.[7] In some parts of Yorkshire, sheep's dung is applied as a poultice for the cure of erysipelas. What is more distressing, both to patient and nurse, than whooping cough, or king-cough, as it is sometimes called? A change of air is deemed beneficial to the afflicted one, so the mothers of Hull take their suffering children across the Humber to New Holland and back again. Some call it "crossing strange water." Other people procure a "hairy worm," and suspend it in a flannel cover round the neck of the sufferer, in the belief that as the creature dies and wastes away, so will the cough depart. This custom seems to be the relic of an old belief that something of the nature of a hairy caterpillar was the cause of the cough, and Mr. Tylor, in his _Primitive Culture_,[8] speaks of the ancient homoeopathic doctrine that what hurts will also cure. In Gloucestershire roasted mouse is considered a specific for whooping cough; though in Yorkshire the same diet cure is adopted for croup, while rat pie is the one to be used for whooping cough. The Norfolk peasants tie up a common house spider in a piece of muslin, and when the luckless long-legged spinner dies, the cough will soon disappear. A correspondent of _Notes and Queries_ states that when staying in a village in Oxfordshire, he was informed by an old woman that she and her brothers were cured of whooping cough in the following way. They were required to go, the first thing in the morning, to a hovel at a little distance from their house, where a fox was kept. They carried with them a large can of milk, which was set down before the fox, and when he had taken as much as he cared to drink, the children shared among them what was left. The _Aberdeen Evening Gazette_ of 24th August, 1882, tells of a curious superstition in Lochee:-- "Hooping-cough being rather prevalent in Lochee at the present time, various cures are resorted to with the view of allaying the distress. Amongst these the old 'fret' of passing a child beneath the belly of a donkey has come in for a share of patronage. A few days ago, two children living with their parents in Camperdown Street, were infected with the malady. A hawker's cart, with a donkey yoked to it, happening to pass, the mothers thought this an excellent opportunity to have their little ones relieved of their hacking cough. The donkey was accordingly stopped, the children were brought forth, and the ceremony began. The mothers, stationed at either side of the donkey, passed and repassed the little creatures underneath the animal's belly, and with evident satisfaction appeared to think that a cure would in all probability be effected. Nor was this all; a piece of bread was next given to the donkey to eat, one of the women holding her apron beneath its mouth to catch the crumbs which might fall. These were given to the children to eat, so as to make the cure effectual. Whether these strange proceedings have resulted in banishing the dreaded cough or not, has not been ascertained, and probably never will be. A few years ago, the custom was quite common in this quarter, but with the spread of education the people generally know better than to attempt to cure hooping-cough through the agency of a donkey." The _North British Mail_ for 20th March 1883, among other superstitions in Tiree, says, "On the west side of the island there is a rock with a hole in it, through which children are passed when suffering from whooping-cough or other complaints." It is a common belief that if you wash your hands in water in which eggs have been boiled, warts will make their appearance; also, that the blood of a wart will cause other warts. Anyhow, if the warts be there, they can either be cured or charmed away. The writer once had a row of warts, thirteen in number, on his left arm. He was told by an aged dame, who sat on a three-legged stool before her cottage door, smoking a short black pipe, to take thirteen bad peas, throw them over his left shoulder, never heeding where they went, all the while repeating some incantation, which has been forgotten. Cures are effected by rubbing the warts with something, which is afterwards allowed to decay. Some rub the warts with a grey snail or slug, and then impale the poor creature on a thorn; others steal a bit of beef, not so much as Taffy made off with, rub the beef on the warts, and then bury the beef. Lord Bacon, in his _Natural History_, says:--"I had from my childhood a wart upon one of my fingers; afterwards, when I was about sixteen years old, being then at Paris, there grew upon both my hands a number of warts, at the least an hundred in a month's space. The English Ambassador's lady, who was a woman far from superstitious, told me one day she would help me away with my warts: whereupon she got a piece of lard with the skin on, and rubbed the warts all over with the fat side; and among the rest, the wart which I had from my childhood; then she nailed the piece of lard, with the fat towards the sun, upon a post of her chamber window, which was to the south. The success was, that within five weeks' space all the warts went quite away; and that wart which I had so long endured, for company.... They say the like is done by the rubbing of warts with a green elder stick, and then burying the stick to rot in muck." In Withal's _Dictionary_ (1608) there is the following couplet:-- "The bone of a haire's foot closed in a ring, Will drive away the cramp whenas it doth wing," but Pepys, who tells us the whole of his experience, with comments thereon, used a hare's foot as a charm for colic. He says:--(20 Jan. 1664-5) "Homeward, in my way buying a hare and taking it home, which arose upon my discourse to-day with Mr. Batten in Westminster Hall, who showed me my mistake, that my hare's foot hath not the joynt in it, and assures me he never had the cholique since he carried it about him; and it is a strange thing how fancy works, for I no sooner handled his foot but I became very well, and so continue." (22nd.) "Now mighty well, and truly I can but impute it to my fresh hare's foot." (March 26) "Now I am at a loss to know whether it be my hare's foot which is my preservation; for I never had a fit of collique since I wore it, or whether it be my taking a pill of turpentine every morning." The following newspaper cutting from the _Boston Herald_, 7th February, 1837, is worth preserving:-- "Nothing could be more absurd than the notions regarding some of these supposed cures; a ring made of a hinge of a coffin had the power of relieving cramps, which were also mitigated by having a rusty old sword hanging up by the bedside. Nails driven in an oak tree prevented the toothache. A halter that had served in hanging a criminal was an infallible remedy for a head-ache when tied round the head; this affection was equally cured by the moss growing upon the human skull taken as cephalic snuff dried and pulverised. A dead man's hand could dissipate tumours of the glands, by stroking the part nine times; but the hand of a man who had been cut down from the gallows was the most efficacious. The chips of a gallows on which several had been hanged, when worn in a bag round the neck would cure the ague. A stone with a hole in it, suspended at the head of a bed, would effectually stop the night-mare, hence it was called a hag-stone, as it prevents the troublesome witches from sitting upon the sleeper's stomach. The same amulet, tied to the key of the stable door, deterred witches from riding horses over the country." Our forefathers firmly believed in planetary influence on the minds and bodies of men, and no operation could be performed on any part of the body unless the planet, ruling that particular part, were propitious. Rider's _British Merlin_ for 1715, places the name of some part of the body--face, neck, arms, breast, etc., opposite the days of the month, indicating that the influence of the planets on that day is favourable to that particular part or organ. An old proverb says:-- "Friday hair, Sunday horn, You'll go the devil afore Monday morn," shewing that these days were unlucky for clipping hair and cutting nails. The _York Fabric Rolls_[9] tell us that Maundy Thursday, the day before Good Friday, was termed Shere Thursday, because "in olde faders dayes the people wold that day _sheer_ theyr heddes and clype theyr berdes and poll theyr heedes and so make them honest ayenst Easter Day." The same interesting volume[10] gives the following account of charming away fevers:-- "1528. Bishopwilton. Isabel Mure presented. She took fier, and ij yong women w{t} hirr, and went to a rynnyng water, and light a wypse of straw and sett it on the water, and said thus, 'Benedicite, se ye what I see. I se the fier burne, and water rynne and the gryse grew, and see flew and nyght fevers and all unkowth evils flee, and all other, God will,' and after theis wordes said xv Pater Noster, xv Ave Maria and thre credes." The following is a reproduction of a receipt for Yellow Jonus (Jaundice) copied from an old book in my possession. "A quart of whine (wine), a penoth of Barbary barck, a penoth of Tormorch (Turmerich), a haporth of flour of Brimstone for Jonous." Of Physicians and their Fees, WITH SOME PERSONAL REMINISCENCES. BY ANDREW JAMES SYMINGTON, F.R.S.N.A. In the whole range of professional life, or in any section of the community, there is no set of men so self-denying, sympathetic, philanthropic, liable to be called at any hour, day or night, and so hard-worked, as medical practitioners. To begin with, there is first, a long and expensive course of study, and, often, several years pass, before a practice becomes even self-sustaining. Those at the head of the profession attain to large incomes, and make their £20,000 a year. Noted specialists, in particular, such as the late Dr. Mackenzie, get large fees; but the majority of the profession conscientiously perform their laborious and kindly ministrations ungrudgingly and with moderate remuneration, which, in most cases, is certainly far short of their deserts. This state of matters has prevailed for many centuries, and, taking the different value of money into account, notwithstanding the advance of medical science, there is but little change in the scale of remuneration, whether as to large fees paid by Royal or titled personages, fees by the middle classes, or by the rural or working population. It has been well said, that "the theory and practice of medicine is the noblest and most difficult science in the world; and that there is no other art for the practice of which the most thorough education is so essential." Whittier observes:--"It is the special vocation of the doctor to grow familiar with suffering--to look upon humanity disrobed of its pride and glory--robbed of all its fictitious ornaments--weak, hopeless, naked--and undergoing the last fearful metempsychosis, from its erect and god-like image, the living temple of an enshrined divinity, to the loathsome clod and the inanimate dust! Of what ghastly secrets of moral and physical disease is he the depository!" Sir Thomas Browne, in his "Religio Medici," says:--"Men, that look no further than their outsides, think health an appurtenance unto life, and quarrel with their constitutions for being sick; but I, that have examined the parts of man, and know upon what tender filaments that fabrick hangs, do wonder that we are not always so; and, considering the thousand doors that lead to death, do thank my God that we can die but once." This model physician, who said, "I cannot go to cure the body of my patient, but I forget my profession and call unto God for his soul," in the same work, finely says of charity:--"Divinity hath wisely divided the act thereof into many branches, and hath taught us, in this narrow way, many paths unto goodness; as many ways as we may do good, so many ways we may be charitable. There are infirmities not only of the body, but of soul and fortunes, which do require the merciful hand of our abilities. I cannot contemn a man for ignorance, but behold him with as much pity as I do Lazarus. It is no greater charity to clothe his body than apparel the nakedness of his soul." His distinguished position, as a physician and an author, demands very special and reverential mention in these pages. Sir Thomas Browne was born in London on the 19th of October, 1605. He died at Norwich on the 19th of October, 1682, having reached exactly the age of seventy-seven. His father was a wealthy merchant, of a good Cheshire family, but died when his more illustrious son was a boy, and his mother shortly afterwards married Sir Thomas Dutton. After travelling on the Continent, he settled as a practising physician at Shipley Hall, near Halifax, for a time, and then moved to Norwich, where the remaining forty-two years of his life were spent. His library contained vast stores of learned works on antiquities, languages, and the curiosities of erudition. He corresponded with the best men of his day, and was often able to assist them in their various investigations. His friend Evelyn, alluding to Browne's home, at Norwich, tells us "His whole house and garden being a paradise and cabinet of rarities, and that of the best collections, especially medals, books, plants, and natural things." He was knighted by Charles II. in 1671. Throughout the troublous times of the Civil War, the Commonwealth, and the Restoration, he led a quiet studious life, issuing volume after volume full of profound, penetrating, and far-reaching thought, set forth in stately, sonorous, and musical language, the perfect form or style of which, at times, is only equalled but not excelled by the best cadenced prose of Milton or Jeremy Taylor. His "Religio Medici," "Hydrotaphia or Urn Burial," and "The Garden of Cyrus," have been my favourites for more than half a century. Of the latter work, John Addington Symonds has finely and truly said, that "the rarer qualities of Sir Thomas Browne's style (are) here displayed in rich maturity and heavy-scented blossom. The opening phrase of his dedication to Sir Thomas Le Gros--'When the funeral pyre was out, and the last valediction over, men took a lasting adieu of their interred friends, little expecting the curiosity of future ages should comment on their ashes;'--this phrase strikes a key-note to the sombre harmonies which follow, connecting the ossuaries of the dead, the tears quenched in the dust of countless generations, with the vivid sympathy and scrutinizing sagacity of the living writer.... I will only call attention to the unique feeling for verbal tone, for what may be called the musical colour of words, for crumbling cadences, and the reverberation of stationary sounds in cavernous recesses, which is discernable at large throughout the dissertation. How simple, for example, seems the collocation of vocables in this phrase--'Under the drums and tramplings of three conquests!' And yet with what impeccable instinct the vowels are arranged; how naturally, how artfully, the rhythm falls! Take another, and this time a complete sentence,--'But the iniquity of oblivion blindly scattereth her poppy, and deals with the memory of men, without distinction to merit of perpetuity.' Take yet another--'The brother of death daily haunts us with dying mementoes.'" I take leave of this, the most notable of English Physicians, by transcribing the following grand, suggestive, and characteristic passage from his "Fragment on Mummies":--"Yet in these huge structures and pyramidial immensities of the builders, whereof so little is known, they seemed not so much to raise sepulchres or temples to death, as to contemn and disdain it, astonishing heaven with their audacities, and looking forward with delight to their interment in those eternal piles. Of their living habitations they made little account, conceiving of them but as _hospitia_, or inns, while they adorned the sepulchres of the dead, and planting them on lasting basis, defied the crumbling touches of time and the misty vaporousness of oblivion. Yet all were but Babel vanities. Time sadly overcometh all things, and is now dominant, and sitteth upon a sphinx, and looketh unto Memphis and old Thebes, while his sister Oblivion reclineth semisomnous on a pyramid, gloriously triumphing, making puzzles of Titanian erections, and turning old glories into dreams. History sinketh beneath her cloud. The traveller, as he paceth amazedly through those deserts, asketh of her, who builded them? and she mumbleth something, but what it is he heareth not." The medical profession is a noble and pleasant one, though laborious and often full of anxiety, straining mind and body. The good physician is the sympathizing, confidential, and comforting _friend_ of the family. He values the humble gifts and testimonials of gratitude from the poor, even more than the costly presents of the rich. The virtuous poor are always grateful. It can truly be said of the physician's kind and often gratuitous services to them, in the language of scripture:-- "When the ear heard me, then it blessed me; and when the eye saw me it gave witness to me; because I delivered the poor that cried, and the fatherless, and him that had none to help him. The blessing of him that was ready to perish came upon me; and I caused the widow's heart to sing for joy." Among savages, sorcerers, and magicians, are the medicine men; these are still represented, in civilisation, by impostors and quacks. Members of the profession, as a rule, keep themselves posted up in the medical science of the day, honestly and unselfishly do everything that can be done for their patients, and rejoice in being the means of their recovery, far more than in their fee. Burton, in his "Anatomy of Melancholy," treating of "Physician, Patient, and Physick," when astrology, ignorance, and queer nostrums, were then more in vogue than practical science, says:--"I would require Honesty in every Physician, that he be not over careless or covetous, Harpylike to make a prey of his patient, or, as an hungry Chirurgeon, often produce and wire-draw his cure, so long as there is any hope of pay. Many of them, to get a fee, will give physic to every one that comes, when there is no cause, thus, as it often falleth out, stirring up a silent disease, and making a strong body weak." Burton then quotes the following sensible Aphorism from Arnoldus:--"A wise physician will not give physick, but upon necessity, and first try medicinal diet, before he proceedeth to medicinal cure." Latimer thus severely censured the mercenary physicians of his day:--"Ye see by the example of Hezekiah that it is lawful to use physick. But now in our days physick is a remedy prepared only for rich folks, and not for the poor, for the poor man is not able to wage the Physician. God indeed hath made physick for rich and poor, but Physicians in our time seek only their own profits, how to get money, not how they might do good unto their poor neighbour. Whereby it appeareth that they be for the most part without charity, and so consequently not the children of God; and no doubt but the heavy judgment of God hangeth over their heads, for they are commonly very wealthy, and ready to purchase lands, but to help their neighbour, that they cannot do. But God will find them out one day I doubt not." "Empirics and charlatans are the excrescences of the medical profession; they have obtained in all ages, yet the healing art is not necessarily the occasion for deception; nor the operations of witchcraft, charms, amulets, astrology, alchemy, necromancy, or magic; although it has its mysteries like other branches of occult science." Paracelsus, the prince of charlatans, styled himself "King of Physic," but, though he professed to have discovered the _elixir of life_, he humbly died at the early age of forty-eight years. We are told of a patient who, instead of the medicine prescribed, swallowed the prescription! and _Punch_ records an extraordinary case of a voracious individual who bolted a door, and threw up a window! Sydney Smith, on being told by his doctor to take a walk on an empty stomach, asked--"Upon whose!" But a truce to stories suggested by the queer nostrums of quacks. Empirics, however, often believed in their nostrums, and were, sometimes, amiable and unselfish. In the year 1776, we are told, there lived a German doctor, who styled himself, or was called, "the Rain-water doctor;" all the diseases to which flesh is heir he professed to cure by this simple agent. Some wonderful cures were, it is said, achieved by means of his application of this fluid, and his reputation spread far and wide; crowds of maimed and sickly folk flocked to him, seeking relief at his hands. What is yet more remarkable still, he declined to accept any fee from his patients! Dr. Haygarth, of Bath, had a pair of wooden tractors made in precisely the same shape and appearance as Perkin's metallic ones; and the same results followed as when the others, which cost five guineas a pair, were used. The story is well known of the condemned criminal in Paris, who was laid on a dissecting table, strapped down, with his eyes bandaged, and slightly pricked, when streamlets of water set a-trickling made him think, as he had been told, that he was being bled to death. His strength gradually ebbed away, and he actually died, although he did not lose a drop of blood. I knew of a gentleman who, when pills to procure sleep were ordered to be discontinued, lay awake. The doctor made up a box of bread pills, which were administered as the others had been, and the patient slept, and recovered rapidly. A young medical man fell in love with a young lady patient, and, when he had no longer any pretext for continuing his visits, he sent her a present of a pair of spring ducks. Not reciprocating his attentions, she did not acknowledge the present, upon which he ventured to call, asking if the birds had reached her. Her reply was--"Quack, quack!" Dr. Lettsom, a quaker in the time of George III., near the close of the last century, had such an extensive practice that his receipts in some years were as much as £12,000; and this although half his services were entirely gratuitous, and rendered with unusual solicitude and care to necessitous clergymen and literary men. Generosity was the ruling feature of his life. On one occasion he attended an old American merchant whose affairs had gone wrong, and who grieved over leaving the trees he had planted. The kind hearted doctor purchased the place from the creditors, and presented it to his patient for life. Pope, a few days before his decease, bore the following cordial testimony to the urbanity and courtesy of his medical friends:--"There is no end of my kind treatment from the Faculty; they are in general the most amiable companions, and the best friends, as well as the most learned men I know." And Dryden, in the postscript to his translation of Virgil, speaks in the same way of the profession. "That I have recovered," says he, "in some measure the health which I had lost by too much application to this work, is owing, next to God's mercy, to the skill and care of Dr. Guibbons and Dr. Hobbs, the two ornaments of their profession, whom I can only pay by this acknowledgment." When Dr. Dimsdale, a Hertford physician and member of Parliament, went over to Russia to inoculate the Empress Catherine and her son, in the year 1768, he received a fee of £12,000, a pension for life of £500 per annum, and the rank of Baron of the Empire. Dr. Henry Atkins was sent for to Scotland by James the Sixth to attend Charles the First (then an infant), ill of a dangerous fever. The King gave him a fee of £6000, with which he purchased the manor of Clapham. Louis XIV. after undergoing an operation, gave his physician and his surgeon 75,000 crowns each. Dr. Glynn once attended the only son of a poor peasant woman, ministering to his wants with port wine, bark, and delicacies. After the lad's recovery, his mother waited on the doctor, bringing a large wicker basket with an enormous magpie, which was her son's pet, as a fee to show their gratitude. A thousand pounds were ordered to be paid to Sir Edmund King for promptly bleeding Charles the Second, but he never received this fee. Dr. Mead, in the time of George the First, was generous to a degree, and like many of his brethren, would not accept fees from curates, half-pay officers, and men of letters. At home his fee was a guinea. When he visited patients of means, in consultation or otherwise, he expected two guineas or more. But to the apothecaries who waited on him at his coffee houses of call he charged only half a guinea for prescriptions, written without his having seen the patient. He had an income one year of £7,000, and for several years received between £5,000 and £6,000, which, considering the value of money at that time, is as much as that of any living physician. The physicians who attended Queen Caroline had five hundred guineas, and the surgeons three hundred guineas each; Dr. Willis was rewarded for his attendance on George III. by £1,500 per annum for twenty years, and £650 per annum to his son for life. The other physicians, however, had only thirty guineas each visit to Windsor, and ten guineas each visit to Kew. Dr. Abernethy was annoyed by a lady needlessly consulting him about her tongue. One morning she came, as he was descending the steps from his door and putting on his gloves. She said:--"Doctor, I'm so glad I have caught you!" The doctor asked if it were the old trouble. On her saying "Yes," he told her to put out her tongue. She did so, and he said, "Stand there till I come," and left her so, in the street, setting out on his round of visits. Once when prescribing nutritious and expensive diet for a young man in consumption, he observed the look of despair on the young wife's face, and the evidence of straitened circumstances around; when the lady appealed to him, asking if there was really nothing else he could suggest for her husband. He replied:--"When I think of it, I'll send along a box of pills in the afternoon!" A messenger brought the box. On the lid was written "One every day," and, on being opened, it was found to contain twenty guineas! He once bluntly told a _bon-vivant_ gentleman to "Live on sixpence a day, and earn it!" Long ago, a friend told me of a lady in Devonshire, belonging to a family she knew, who read medical books, and at length imagined she had every disease under the sun. Whenever she discovered what she believed to be a new symptom, she at once went off to consult different medical men regarding it, spending several hundreds a year in this way, and all quite needlessly. At length she confided to her friends that since doctors differed so widely, and she could obtain no satisfaction as to what ailed her, she had resolved to go to town and consult one of the Queen's physicians. A consultation was held in the family, and her nephew was sent to explain matters to the physician, in the hope of his being able to cure her hypochondria. When she reached town, the street in which the physician lived was blocked with the carriages of patients. After waiting hours, her turn at last came. The physician examined her, asked a few questions, then enquired if she had any friends in town, as he would rather call to see her when under their roof, and there tell her what he had got to say. She protested that she was quite prepared to hear the worst--that she had for long years looked death in the face--that the notices of her death were lying in her desk, all written out and addressed, only requiring the date to be filled in, etc. The physician said he was busy--more than twenty patients were still waiting in the street--he was averse to scenes, and would much prefer to see her at her friend's house. She still persisted, and begged of him to tell her all, there and then, on which he said:--"Madam, it is my melancholy duty to inform you--that there is nothing whatever the matter with you!" This interview fortunately effected her cure, to the great delight of her friends, who paid the physician a handsome fee. Sir Astley Cooper one year received in fees £21,000. This sum was exceptional, but for many years his income was over £15,000. His great success was achieved very gradually. "His earnings for the first nine years of his professional career progressed thus:--In the first year he netted five guineas; in the second, twenty-six pounds; in the third, sixty-four pounds; in the fourth, ninety-six pounds; in the fifth, a hundred pounds; in the sixth, two hundred pounds; in the seventh, four hundred pounds; in the eighth, six hundred and ten pounds; and in the ninth--the year in which he secured his hospital appointment--eleven hundred pounds." On one occasion when he had performed a perilous surgical operation on a rich West Indian merchant, the two physicians who were present were paid three hundred guineas each; but the patient, addressing Sir Astley, said:--"But you, sir, shall have something better. There, sir, take _that_," upon which he flung his nightcap at the skilful operator. "Sir," replied Sir Astley, picking up the cap, "I'll pocket the affront." On reaching home, he found in the cap a draft for a thousand guineas from the grateful but eccentric old man. A cynical lawyer once advised a young doctor to collect his fees as he went along, quoting the following verse to back his recommendation:-- "God and the doctor we alike adore, But only when in danger, not before; The danger o'er, both are alike requited-- God is forgotten, and the doctor slighted." The following story illustrates the too frequent weary waiting, when hope makes the heart sick, and also shows on what curious casual incidents the success of a career may sometimes turn. It has been told in different ways, and attributed to different men, such as to Dr. Freind, and others; but, quite possibly, the same or a similar incident may have repeatedly occurred. I simply give it as it was narrated to me. A young doctor having graduated with honours, took a house at a high rent in Harley Street, London. The brass plate attracted no patients; months passed idly and drearily, and the poor fellow took to drink. One night the door-bell rang--a servant man, from a lady of title round the corner, begged him to come at once, as his mistress was dangerously ill, lying on the floor; her own doctor was out, and he was sent to fetch the first doctor he could find. The young doctor regretfully thought what a fool he was, for here was his chance, when he could not avail himself of it; but he would go, and try hard to pull himself together. When he reached the room, he had enough conscience or sense left to know that he was not in a fit state to prescribe, and exclaiming, "Drunk, by George!" took his hat and bolted from the house. Next morning he received a scented note from the lady, entreating him not to expose her, inviting him to call, and offering to introduce him professionally to her circle! Before the season was ended, his practice was yielding him at the rate of some £1500 a year! Curiously enough, it is recorded of a British doctor that he once actually took a fee from a _dead_ patient. Entering the bedroom immediately after death had taken place, he observed the right hand tightly clenched. Opening the fingers, he found in them a guinea. "Ah, that was clearly for me," said the doctor, putting the gold into his pocket. It may be remembered here, that the Royal College of Physicians, London, was founded by Thomas Linacre, physician to Henry VIII., in 1518; and that the Royal College of Physicians of Edinburgh was incorporated by Charter of Charles II., November 20th, 1681. As to the fees paid to physicians, we find that Dr. Edward Browne, the son of Sir Thomas Browne, who became a distinguished physician in London, in his Journal, under the date of February 16th, 1664, records: "I went to visit Mr. Edward Ward, an old man in a feaver, when Mrs. Anne Ward gave me my first fee, 10 shillings." In a work entitled "Levamen Infirmi," published in the year 1700, we find that the scale of remuneration to surgeons and physicians was as follows:--"To a graduate in physic, his due is about ten shillings, though he commonly expects or demands twenty. Those that are only licenced physicians, their due is no more than six shillings and eightpence, though they commonly demand ten shillings. A surgeon's fee is twelvepence a mile, be his journey far or near; ten groats to set a bone broke or out of joint; and for letting blood one shilling; the cutting off or amputation of any limb is five pounds, but there is no settled price for the cure." Till recent times neither barristers nor physicians could recover their fees by legal proceedings against their clients or patients unless a special contract had been made. In the case of lawyers this custom can be traced back to the days of ancient Rome. Their services were regarded as being gratuitously rendered in the interests of friendship and justice, and of a value no money could buy. The acknowledgment given them by clients was regarded as an _honorarium_, and paid in advance, so that all pecuniary interest in the issue of the suit was removed, thus preserving the independence and respectability of the bar. Equity draftsmen, conveyancers, and such like, however, could recover reasonable charges for work done. So in the medical profession, surgeons, dentists, cuppers, and the like were always entitled to sue for their fees; but the valuable services of a consulting physician were of a different kind, not rendered for payment but acknowledged by the gratitude and honour of his patients. But this code of honour was modified when all medical practitioners were relieved by the Act of 21 and 22 Vict. 90, which applied to the United Kingdom, and enabled them to recover in any court of law their reasonable charges as well as costs of medicines and medical appliances used. This rule applies to physicians, surgeons, and apothecaries as defined by the statute. The following information is taken from "Everybody's Pocket Cyclopædia" (Saxon & Co.). LONDON MEDICAL FEES. "Patients are charged according to their supposed income, the income being indicated by the rental of the house in which they reside. The following are the charges usually made by medical practitioners:-- ----------------------------------------------------------------------- | Rentals. |------------------------------------------------ | £10 to £25 | £25 to £50 | £50 to £100 ----------------------|----------------|----------------|-------------- Ordinary Visit | 2s 6d to 3s 6d | 3s 6d to 5s | 5s to 7s 6d Night Visit | Double an | Ordinary | Visit Mileage beyond two | | | miles from home | 1s 6d | 2s | 2s 6d Detention per hour | 2s 6d to 3s 6d | 3s 6d to 5s | 5s to 7s 6d Letters of Advice | Same charge as | for an Or- | dinary Visit Attendance on Servants| 2s 6d | 2s 6d to 3s 6d | 3s 6d to 5s Midwifery | 21s | 21s to 30s | 42s to 105s | | | CONSULTANTS. | | | | | | Advice or visit alone | 21s | 21s | 21s Advice or visit with | | | another Practitioner| 21s | 21s to 42s | 21s to 42s Mileage beyond two | | | miles from home | 10s 6d | 10s 6d | 10s 6d ----------------------------------------------------------------------- "Special visits, _i.e._, of which due notice has not been given before the practitioner starts on his daily round, are charged at the rate of a visit and a half. Patients calling on the doctor are charged at the same rate as if visited by him. "There are about 23,000 physicians and surgeons in the United Kingdom, or one to every 1,600 inhabitants." It has been my privilege to know several doctors intimately. Our family doctor when I was a boy in Paisley, was Dr. Kerr, a man far in advance of his day. He was the means of introducing a pure water supply to the town of Paisley, always strenuously urging the importance of sanitary matters and good drainage, when such things were then but little understood, and greatly neglected. Shortly after the water had been introduced to the houses, from Stanley, an old man--who had been accustomed to purchase water from a cart which went through the streets selling it from a barrel--on being asked how he liked the new water, replied indignantly, "Wha's going to pay good siller for water that has neither smell nor taste?" On one occasion, an elderly gentleman, who was slightly hypochondriac, consulted Dr. Kerr about his clothing, saying that he regulated the thickness of his flannels by the thermometer. Dr. Kerr, losing patience, said, "Can you not use the thermometer your Maker has put in your inside, and put on clothes when you are cold?" Dr. Kerr's son and assistant, whom we then called "the young doctor," died a few years ago in Canada, over eighty years of age. No man could possibly have been more considerately kind, gentle, and tender-hearted. On one occasion, in 1841, when, in typhus fever, I was struggling for my life, he sat up with me for three whole consecutive nights, and brought me through. He ever kept himself abreast of the science of the day, and devoted his abilities and energies, _con amore_, to the benefitting of men's souls as well as their bodies. Another model village and country doctor, also an intimate friend of my parents, Dr. Campbell of Largs, I knew very well. Good, genial, and accomplished, he was a perfect gentleman, and equally at home dining with Sir Thomas Brisbane, or drinking a cup of tea at some old woman's kitchen fireside. He read the _Lancet_, and tried all new medicines, and repeatedly, when going to London, at his request I procured the most recent instruments for him. He was intimate with Dr. Chalmers, Lord Jeffrey, Lord Moncrieff, Lord Cardwell, etc. In telling me of experiments with Perkin's metallic tractors, and that the same results were obtained with wooden ones, showing the power of imagination, he gave me a recent curious illustration. He had lately had the old fashioned little panes of glass taken out of the windows of his house, and plate glass inserted. His mother, who did not know of the change, calling one afternoon, sat on an easy chair, close by the gable window, knitting. On suddenly looking round she said, "Oh John, I've been sitting all this time by an _open_ window," and forthwith she began to sneeze! She actually took cold, and even afterwards could scarcely be persuaded that it had _not_ been an open window, for she said she felt the cold! The doctor told me of an old maiden lady who consulted him, and who, when he prescribed in a general way, insisted on knowing exactly what ailed her. He said she was only slightly nervous, and would soon be all right. This did not at all please her, and she at once loudly protested--"Me nervous! There is not a nerve in my whole body!" A West India merchant, one of his patients whom I knew, he also told me, one day said to him, "Doctor, for forty years I never knew I had a stomach, and now I can think of nothing else!" At the cholera time Dr. Campbell was laid down by the disease. The fact spread like wildfire over the village, and, at once, prayer-meetings for his recovery were called by the public bellman, meetings of _all_ the different denominations, including the Roman Catholics (Dr. Campbell was a Free Church Elder), and there were truly heartfelt rejoicings in the whole district over his recovery. I once asked him how he managed to get in his fees, since he never refused to visit when sent for. He said that one year, from curiosity, he kept an account of his gratuitous visits, and it ran into three figures; but he never took the trouble to note them again, as it served no purpose. Many years ago he went to his rest, and, at his request, during his last illness, I paid him a farewell visit. There are few finer descriptions of the country doctor than that contained in Ian Maclaren's "Beside the Bonnie Brier Bush," a book which speaks directly home to every true Scottish heart. Dr. Campbell, in his large-hearted and genial Christian charity, scientific research, and philosophical acquirements, always reminded me of Sir Thomas Browne, "the beloved physician" of Norwich. The following pleasing incident, relating to a medical man, came under my own notice. I often visited a country minister, an intimate friend, a learned man, and a genius, the quaint originality of whose observations often reminded me of Fuller, the Church historian, or Charles Lamb. Although of limited means, the Rev. Robert Winning, of Eaglesham, was ever hospitable; if he knew of any poor student, he would invite him to the manse for a month, on the plea that he would help to prepare him for his examination in Hebrew and Greek. The old manse servant, also an original, was paid a sum of money as compensation for refusing tips from visitors. One day, seeing an advertisement of a new book in a magazine I was reading, Mr. Winning remarked to me, "Andrew, I wish you would buy that book, _cut the leaves_, and lend it to me to read!" One evening a message reached him from the village inn, saying that a doctor had come to an urgent case, which required him to stay over night, that there was no room in the inn, and asking if the minister could give him a bed. His wife, knowing the house was full, asked her husband what they should do. His reply was, "Be not forgetful to entertain strangers, for thereby some have entertained angels unawares. Give him a room, though we have to sleep on the floor." He was accordingly hospitably entertained. Some time after, the minister took ill. The medical guest heard of it, went to see the local doctor, and, with his consent, visited the minister twice a week, from a distance of nine miles, and for a period of some four months, till his death. When the widow afterwards sent for his account, he said there was none, for it had been more than discharged on the first evening he had spent at the manse. Dr. Stark, of Glasgow, who attended my family for years, was a skilful practitioner, but eccentric. He generally made light of trifling ailments, but was most energetic when aroused by any appearance of danger. I knew of his being suddenly called in to see an old lady who was far gone in an advanced stage of cholera. He at once asked to be shown over the house, looked at the different fireplaces, but as none of them suited his purpose, he went to the kitchen, threw off his coat, took out the range, made a fire in the recess that would have roasted an ox, had the old lady carried down in blankets and placed before it, worked energetically with her the whole night, and brought her through. In a similar way he once stayed over night and saved the life of one of my boys. One day I called at his house, and, finding him with a bad cold, eyes red and watery, throat husky, said, "Doctor, if you found me so, you would prescribe placing the feet in hot water and mustard, warm gruel, medicine, and going to bed! Physician, heal thyself!" The doctor's Shakespearian reply was, "Do you think I am such a fool as to take physic?" Once when accompanying me to the coast to visit one of my children, there was a heavy sea on, and the steamer, on approaching the pier, rolled alarmingly, and was close on a lee shore. A strange lady on board, in terror, laid hold of the doctor, a tall, stalwart man, saying, "Oh! sir, are we going to the bottom?" On which he said, dryly, "Behave yourself, if you are going there, you are going in good company!" which odd answer reassured and caused her to laugh. In speaking of a Greek gem representing Cupid and Pysche, one day, when driving in Wigtonshire with the late Dr. David Easton, a medical friend, he said I had not given the correct pronunciation of the names. Always willing to learn, I asked to be put right; whereupon, the doctor gravely informed me that I ought to have said--Cupped and Physic! I have spoken of the kindness of medical men, such as Dr. Garth Wilkinson, to clergymen, artists, and literary men. I add one more expression of gratitude, which is a good modern instance:-- When at St. Helens, in Jersey, during his last illness, my friend Samuel Lover, the genial poet and artist, wrote the following lines to Dr. Dixon, his friend and physician. I first copied them some years ago from Lover's MS. note-book, kindly lent me by his widow when I was engaged in the preparation of his life. Such cordial tributes are a good physician's most highly-valued fees:-- "Whene'er your vitality Is feeble in quality, And you fear a fatality May end the strife, Then Dr. Joe Dickson Is the man I would fix on For putting new wicks on The lamp of life." From the many varied facts and incidents adduced in these pages, it will be seen that, in anxiety or sorrow, the good family doctor is a true and sympathetic friend, whose services can never be paid by gold. Next to religion, nothing is more precious or comforting than the sympathy of those who know and fully understand our sufferings, for, as my old favourite, Sir Thomas Browne, to whom I ever revert with renewed pleasure, truly and beautifully says:--"It is not the tears of our own eyes only, but of our friends also, that do exhaust the current of our sorrows, which, falling into many streams, runs more peaceably, and is contented with a narrower channel." Ye Ende Index. Abernethy, John, 206-208, 266 Advertisements, Curious, 155-159 Ague, Charms for, 240-241 Akenside, Mark, 109-111 Andrews, William, Barber-Surgeons, 1-7; Touching for King's Evil, 8-23; Assaying Meat and Drink, 24-31 Anne, Queen, 18-19 Assay Cups, 30-31 Assaying Meat and Drink, 24-31 Atkins, Dr. H., 264 Axon, W. E. A., The Doctor in the time of Pestilence, 125-139 Banks, Mrs. G. Linnæus, Some Old Doctors, 192-208 Barber-Surgeons, 1-7 Barber's Pole, 6, 35 Bicycle, 23 Birmingham town's book, 15 Bisley, 15 Bishop, hanged, 167 Bishop and Williams, body-snatchers, 171-177 Blackmore, R. D., 118 Blackmore, Dr., 111-113 Black Art, 45 Bleeding, 7, 216 Blood, Circulation of the, 195 Blood in windows, 2 Boke of Jhon Caius, 127 Booker, Rev. Dr., on small-pox, 163-164 Bossy, a quack, 149 Brown, Dr. John, 115 Brown, Sir Thomas, 123, 124, 253-258, 278, 283 Bruce, King Robert the, 209 Buddhism, 67-68 Bulleyn, Dr., quoted, 219 Burke and Hare, 168 Burkers and Body-Snatchers, 167-180 Burning for disease, 46 Burton's "Anatomy of Melancholy," 259-260 Byron quoted, 187 Campbell, Dr., 276, 278 Cancer, Curious treatment for, 222 Carriages, 22-23 Celestials and medicine, 58-61 Chalmers, John, M.D., 115 Charms, 43-44, 52 Chaucer's Doctor of Physic, 70-75 Chester in plague time, 133-135; Touching at, 17 Cholera, Reminiscences of, 181-191 Circulation of the blood, 195 Colic, Charm for, 248 Cooper, Sir Astley, 170, 179, 268 Coryat, 141 Cramp, Charm, 52; Strange cure for, 249 Croydon, Cholera at, 185-186, 190 Crusade, 209 Cumming, Dr. W. F., 114-115 Cupping, 217 Curious prescriptions, 226 Dickens, Charles, Satires by, 65-66 Dickens' Doctors, 90-101 Dimsdale, Dr., 264 Disinfectants in sticks, 33 Disputes between surgeons and barbers, 5 Doctor in the time of Pestilence, 125-139 Doctors Shakespeare Knew, 76-89 Dog bites, 242 Douglas, Sir James, 209 Doyle, Dr. Conan, 118 "Drunk by George," 270 Ecclesfield, 16 Edward the Confessor, 8-9 Egyptians and Magic, 57-58 Elizabeth, Queen, at dinner, 28-29 Erysipelas, 243 Eskimo Medicine Men, 61-63 Faith Cures, 42 Famous Literary Doctors, 102-124 Fees, London, 273-274 Food taken in fear, 24 Freind, John, 196 Frost, Thomas, Dickens' Doctors, 90-101. Mountebanks and Medicine, 140-152. The Strange Fight with the Small-pox, 153-166. Burkers and Body-Snatchers, 167-180. Reminiscences of the Cholera, 181-191 Galen, 120 Gallows, superstitions respecting, 249 Gild, Barbers', 2 Gold-headed Cane, 32-41 Grave-mould, 45 Greatrake, Valentine, 82 Great Plague of London, 136-139 Hall, Dr., 88-89 Harvey, Wm., 194-196 Heart of Bruce, 210 Hentzner in England, 28 Hill, Sir John, 114 Hodges, Dr., 137 Holbein, Picture by, 3 Holmes, Oliver Wendell, 106-108 How our Fathers were Physicked, 216-233 Hunter, John, 198 Hunter, William, 199 Hunterian Museum, 205 Jaundice, 251 Jenner, 159-162 Johnston, Arthur, 122-123 Johnson, Dr., touched for the evil, 18-19 Kerr, Dr., 275 Langford, J. A., LL.D., How our Fathers were Physicked, 216 Latimer on Mercenary Physicians, 260 Lee Penny, 209-215 Lettsom, J. C., 35, 263 Liver, eating human, 51 Lockhart, Sir Simon, 211-213 Lotteries, 151 Lover, Samuel, 282 Macbeth, quoted, 9 Mashonaland, Credulity in, 63-65 Magic and Medicine, 42-69 Manchester in plague time, 135-136 Mead, Dr., 265 Medical Folk Lore, 234-251 Medical Students, 97-98 Merry Andrew, 141-151 Mercenary Physicians, 260 Metals and precious stones used, 218 Mountebanks and Medicine, 140-152 Mouse, roasted, prescribed, 221 Moir, D. M., 116-118 Montagu, Lady May, 153-154, 162 Monks as surgeons, 1; forbidden to bleed, 2 Newcastle-on-Tyne, Siege of, 213 Nicholson, John, Medical Folk-Lore, 234-251 North American Indian medicine men, 52-56 O'Brien, Giant, 202 Of Physicians and their Fees, 252-283 Parliament, Folly of, 223 Phillips, John, 111 Pilgrim's Staff, 32 Planetary Influence, 250 Plantagenent kings touching for the evil, 10 Pontefract Castle, 27 Pole, Barber's, 6 Preston records, 17 Radcliffe's cane, 33 Rain-water doctor, 261 Reminiscences of the Cholera, 181-191 Revolting prescriptions, 225 Richardson, Sir B. W., 202, 204 Rings from hinges of coffins, 249 Robinson, Tom, M.D., The Gold-headed Cane, 32-41 Rochester, Earl of, 144 Rheumatism, 238 Sacrificing for disease, 47-49 Skull, Human, Medical uses, 227 Small-pox, Old receipt for, 72 Smith, Sydney, Witty remark, 261 Some Old Doctors, 192-208 St. Agnes' Eve, 241 Stark, Dr., 280-281 Statute of Labourers, 124-125 Strange Stories, 262 Strange Story of the Fight with the Small Pox, 153-166 Stuart kings touching for the evil, 12-14 Suicide's skull, Drinking from, 50 Symington, A. J., Of Physicians and their Fees, 252-283 Tooth-drawing, 5 Thompson, W. H., Chaucer's Doctor of Physic, 70-75 Thurlow, Lord, on Barbers and Surgeons, 6 Thompson, Sir Henry, 115 Tobacco, Poet's Praise of, 111 Tournament, 186 Toothache, Folk-lore of, 235-237, 249 Toad, 227 Touching for the King's Evil, 8-23 Touch-pieces, 11, 20-21 Terling, Essex, 15 Tudor Kings touching for the Evil, 11 Verney Family, 229-233 Visiting Patients, 22-23 Wall, A. H., Doctors Shakespeare Knew, 76-89 Walters, Cuming, Magic and Medicine, 42-69; Famous Literary Doctors, 102-124 Warren, Samuel, 116 Warts, Charms for, 247 Whooping cough, 244-246 Wig, 35 William III. refuses to touch, 18 Winchester, Mountebank at, 147-148 Witchcraft, 49-50, 242 York records, 16-17 Zulu doctors, 65 FOOTNOTES: [1] "Chester in the Plantagenet and Tudor Periods," by Rupert H. Morris, 1894, pp. 78-79. [2] The _Asclepiad_, Vol. viii. [3] Act ii., sc. 2. [4] Dyer's English Folk Lore, p. 156. [5] Dyer's English Folk Lore, p. 158. [6] _Records of York Castle_, p. 230. [7] Folk Lore Journal, v. 5. [8] Vol. i., p. 761. [9] P. 353. [10] P. 273. Transcriber's Notes: Passages in italics are indicated by _italics_. Superscripted characters are indicated by {superscript}. The original text contains letters with diacritical marks that are not represented in this text version. 
47343	----	LITTLE MASTERPIECES OF SCIENCE [Illustration: Louis Pasteur.] Little Masterpieces of Science Edited by George Iles HEALTH AND HEALING _By_ Sir James Paget, M.D. Patrick Geddes and Sir J. R. Bennett, M.D. J. Arthur Thomson T. M. Prudden, M.D. B. W. Richardson, M.D. G. M. Sternberg, M.D. Buel P. Colton Robson Roose, M.D. J. S. Billings, M.D. NEW YORK DOUBLEDAY, PAGE & COMPANY 1902 Copyright, 1902, by Doubleday, Page & Co. Copyright, 1894, by Harper & Brothers Copyright, 1901, by Popular Science Monthly Copyright, 1900, by D. C. Heath & Co. Copyright, 1901, by Evening Post Publishing Co. Copyright, 1901, by G. P. Putnam's Sons PREFACE When we remember that sound health is the foundation of every other good, of all work fruitful and enjoyed, we see that in this field new knowledge and new skill have won their most telling victories. Pain, long deemed as inevitable as winter's cold, has vanished at the chemist's bidding: the study of minutest life is resulting in measures which promise to rid the world of consumption itself. Dr. Billings's masterly review of medical progress during the nineteenth century, following upon chapters from other medical writers of the first rank, strikes Prevention as its dominant note. To-day the aim of the great physicians is not simply to restore health when lost, but the maintenance of health while still unimpaired. Worthy of remark is the co-operation in this good task which the physician receives at the hands of the inventor and the man of business. To-day the railroad, quick and cheap, disperses crowded cities into country fields: even the poorest of the poor may take a summer outing on mountain slopes, on the shores of lake or sea. As easily may the invalid escape the rigors of a Northern winter as he journeys to the Gulf of Mexico. For those who stay at home the railroad is just as faithfully at work. It exchanges the oranges of Florida for the ice of Maine, and brings figs and peaches from California to New England and New York. These, together with the cold storage warehouse and the cannery, have given the orchard and the kitchen garden all seasons for their own. Nor must we forget the mills that offer a dozen palatable cereals for the breakfast table, most of the drudgery of preparation shifted from the kitchen to the factory. Because food is thus various and wholesome as never before, the health and strength of the people steadily gains, while medicine falls into less and less request; for what is medicine three times in ten but a corrective for a poor or ill-balanced diet? But if the best health possible is to be enjoyed by everybody, the co-operation with the physician must include everybody. Already a considerable and increasing number of men and women understand this. If they have any reason to suspect organic weakness of any kind, they have recourse to the physician's advice, to the end that a suitable regimen, or a less exacting mode of livelihood, may forefend all threatened harm. A few pages of this volume set forth the due care of the eyes: the work from which those pages is taken gives hints of equal value regarding the care of the ears, the lungs and other bodily organs, so much more easily kept sound than restored to soundness after the assail of disease. GEORGE ILES. CONTENTS PAGET, SIR JAMES, M.D. ESCAPE FROM PAIN. THE HISTORY OF A DISCOVERY About 1800 Humphry Davy experimented with nitrous oxide gas and suggested its use in surgery. Horace Wells, a dentist of Hartford, Conn., uses the gas for the painless extraction of teeth. Sulphuric ether also observed to produce insensibility to pain. Dr. Crauford Long, of Jefferson, Ga., uses it in 1842 for the excision of a tumour. Wm. T. G. Morton, Boston, employs ether in dentistry, and Dr. Warren in surgery. Dr. Simpson, Edinburgh, introduces chloroform to prevent the pains of childbirth. Anæsthesia not only abolishes pain, it broadens the scope of surgery and makes operations safe which formerly were most perilous. 3 BENNETT, SIR J. R., M.D. JENNER AND PASTEUR Jenner's indebtedness to John Hunter. Jenner's early observations in natural history. He hears a countrywoman say, "I can't take small-pox for I have had cow-pox." This sets him thinking. He finds that of various forms of cow-pox but one gives protection against small-pox. In 1796 successfully vaccinates a patient. Holds that small-pox and cow-pox are modifications of the same disease and that if the system be impregnated with the milder disease, immunity from the severer is conferred. Immense saving of life by vaccination. Pasteur, a chemist, studies fermentation, which is due to the rapid multiplication of organisms. Similar organisms he detects as the cause of the silkworm disease and of anthrax in cattle. He adopts the method of Jenner, prepares an attenuated virus and protects cattle from anthrax. 25 GEDDES, PATRICK, AND J. ARTHUR THOMSON PASTEUR AND HIS WORK Distinguishes minute facets, not before observed, in certain chemical compounds. Proves that the fermentation of tartrate of lime is due to a minute organism and that a similar agency underlies many other kinds of fermentation. Protects wine from fermentation by heating it for a minute to 50° C. Disproves the theory of spontaneous generation. Discovers an antitoxin for hydrophobia. 51 PRUDDEN, T. M., M.D. TUBERCULOSIS AND ITS PREVENTION In Nature an extremely important part is played by minute organisms. Some of them take up their abode in the human body and there set up diseases of which consumption is the chief. The tubercle bacillus is the sole cause of consumption: its entrance may be prevented, mainly by destroying the spittle of patients. Susceptibility to consumption may be inherited: the disease itself is not. Any cause which lowers vitality increases susceptibility. Dust is a source of danger both out-of-doors and in. Dust in houses should be removed, not simply stirred up. Encouragement for sufferers in early stages of disease. 63 STERNBERG, G. M., M.D. MALARIA AND MOSQUITOES Malaria, long believed to be due to bad air, is really chargeable to a mosquito discovered by Dr. Laveran, 1880, and first detected in America by Dr. Sternberg, 1886. Healthy individuals inoculated with blood containing the parasite develop malarial fever. The mosquito theory of infection was advanced by Dr. A. F. A. King, Washington, 1883. Dr. Manson and Dr. Ross confirmed the theory by observation and experiment. Five individuals exposed to the July air of the Roman Campagna escape malaria by using screens on doors and windows and nets over their beds. 89 ROOSE, ROBSON, M.D. THE ART OF PROLONGING LIFE What is the natural term of life? One hundred years the extreme limit. Longevity runs in families. Clergymen are long-lived. Abstemiousness, sound digestion, capacity for sleep usually found in the long-lived. Work is healthy, especially intellectual work. Reasonable hobbies are good. Beyond middle life exercise should be judicious. Diet should be digestible and moderate. Clothing should be sensible and cleanliness habitual. 107 RICHARDSON, B. W., M.D. NATURAL LIFE AND DEATH Man should be as unconscious of death as of birth. To this end let him observe the rules of Health. RULES OF HEALTH The health of the unborn should be ensured. Many diseases usual in children may be avoided by isolation and disinfection. An equable temperature should be maintained. Regular and various mental labour is a benefit. Physical exercise should be moderate. The passions should obey the reason. Alcohol and tobacco are harmful. Opium, and other narcotics should be shunned. Not too much meat. Water the natural beverage. Air should be pure and not damp. Rest and recreation gainful. Idleness injurious. Sleep should be adequate. 137 COLTON, BUEL P. CARE OF THE EYES Light should fall from behind and above: it should be equal for both eyes. An Argand lamp is best. Reading out-of-doors is harmful. The range of the eye should not be too short. Frequent rests do good. Light should be strong enough. The easiest reading should be saved for the evening. Reading during convalescence is hurtful. How to remove foreign substances from the eye. Cleanliness essential. 155 BILLINGS, J. S., M.D. PROGRESS OF MEDICINE IN THE NINETEENTH CENTURY More medical progress in the nineteenth century than in the two thousand years preceding. The surgeon does more and better work than ever: he can locate a tumour of the brain. Deformities ameliorated. Perils of maternity reduced. Blindness in many cases prevented. Human life lengthening. The prevention of disease has made great strides. Pure water-supply, proper drainage and sewerage. Diphtheria, typhoid and consumption are largely preventable. Scientific nursing introduced. Improvements in hospital construction and management. 161 HEALTH AND HEALING ESCAPE FROM PAIN: THE HISTORY OF A DISCOVERY SIR JAMES PAGET, M.D. [Sir James Paget was one of the most eminent English surgeons of the last century: his writings on surgical themes are of the first authority. The essay, the chief portions of which follow, appeared in the _Nineteenth Century Magazine_, December, 1879. The editor's permission to reprint is thankfully acknowledged. The essay is contained in "Selected Essays and Addresses," by Sir James Paget, published by Longmans, Green & Co., 1902. The same firm publishes "Memoirs and Letters of Sir James Paget," edited by Stephen Paget, one of his sons.] The history of the discovery of methods for the prevention of pain in surgical operations deserves to be considered by all who study either the means by which knowledge is advanced or the lives of those by whom beneficial discoveries are made. And this history may best be traced in the events which led to and followed the use of nitrous oxide gas, of sulphuric ether, and of chloroform as anæsthetics--that is, as means by which complete insensibility may be safely produced and so long maintained that a surgical operation, of whatever severity and however prolonged, may be absolutely painless. In 1798, Mr. Humphry Davy, an apprentice to Mr. Borlase, a surgeon at Bodmin, had so distinguished himself by zeal and power in the study of chemistry and natural philosophy, that he was invited by Dr. Beddoes, of Bristol, to become the "superintendent of the Pneumatic Institution which had been established at Clifton for the purpose of trying the medicinal effects of different gases." He obtained release from his apprenticeship, accepted the appointment, and devoted himself to the study of gases, not only in their medicinal effects, but much more in all their chemical and physical relations. After two years' work he published his _Researches, Chemical and Philosophical, chiefly concerning Nitrous Oxide_, an essay proving a truly marvelous ingenuity, patience, and courage in experiments, and such a power of observing and of thinking as has rarely if ever been surpassed by any scientific man of Davy's age; for he was then only twenty-two. In his inhalations of the nitrous oxide gas he observed all the phenomena of mental excitement, of exalted imagination, enthusiasm, merriment, restlessness, from which it gained its popular name of "laughing gas"; and he saw people made, at least for some short time and in some measure, insensible by it. So, among other suggestions or guesses about probable medicinal uses of inhalation of gases, he wrote, near the end of his essay: "As nitrous oxide in its extensive operation appears capable of destroying physical pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place." It seems strange that no one caught at a suggestion such as this. True, the evidence on which it was founded was very slight; it was with a rare scientific power that Davy had thought out so far beyond his facts; but he had thought clearly, and as clearly told his belief. Yet no one earnestly regarded it. The nitrous oxide might have been of as little general interest as the carbonic or any other, had it not been for the strange and various excitements produced by its inhalation. These made it a favourite subject with chemical lecturers, and year after year, in nearly every chemical theatre, it was fun to inhale it after the lecture on the gaseous compounds of nitrogen; and among those who inhaled it there must have been many who, in their intoxication, received sharp and heavy blows, but, at the time, felt no pain. And this went on for more than forty years, exciting nothing worthy to be called thought or observation, till, in December, 1844, Mr. Colton, a popular itinerant lecturer on chemistry, delivered a lecture on "laughing gas" in Hartford, Connecticut. Among his auditors was Mr. Horace Wells, an enterprising dentist in that town, a man of some power in mechanical invention. After the lecture came the usual amusement of inhaling the gas, and Wells, in whom long wishing had bred a kind of belief that something might be found to make tooth-drawing painless, observed that one of the men excited by the gas was not conscious of hurting himself when he fell on the benches and bruised and cut his knees. Even when he became calm and clear-headed the man was sure that he did not feel pain at the time of his fall. Wells was at once convinced--more easily convinced than a man of more scientific mind would have been--that, during similar insensibility, in a state of intense nervous excitement, teeth might be drawn without pain, and he determined that himself and one of his own largest teeth should be the first for trial. Next morning Colton gave him the gas, and his friend Dr. Riggs extracted his tooth. He remained unconscious for a few moments, and then exclaimed, "A new era in tooth-pulling! It did not hurt me more than the prick of a pin. It is the greatest discovery ever made." In the next three weeks Wells extracted teeth from some twelve or fifteen persons under the influence of the nitrous oxide, and gave pain to only two or three. Dr. Riggs, also, used it with the same success, and the practice was well known and talked of in Hartford. Encouraged by his success Wells went to Boston, wishing to enlarge the reputation of his discovery and to have an opportunity of giving the gas to some one undergoing a surgical operation. Dr. J. C. Warren, the senior Surgeon of the Massachusetts General Hospital, to whom he applied for this purpose, asked him to show first its effects on some one from whom he would draw a tooth. He undertook to do this in the theatre of the medical college before a large class of students, to whom he had, on a previous day, explained his plan. Unluckily, the bag of gas from which the patient was inhaling was taken away too soon; he cried out when his tooth was drawn; the students hissed and hooted; and the discovery was denounced as an imposture. Wells left Boston disappointed and disheartened; he fell ill, and was for many months unable to practice his profession. Soon afterwards he gave up dentistry, and neglected the use and study of the nitrous oxide, till he was recalled to it by a discovery even more important than his own. The thread of the history of nitrous oxide may be broken here. The inhalation of sulphuric ether was often, even in the eighteenth century, used for the relief of spasmodic asthma, phthisis, and some other diseases of the chest. Dr. Beddoes and others thus wrote of it: but its utility was not great, and there is no evidence that this use of it had any influence on the discovery of its higher value, unless it were, very indirectly, in its having led to its being found useful for soothing the irritation produced by inhaling chlorine. Much more was due to its being used, like nitrous oxide, for the fun of the excitement which its diluted vapor would produce in those who freely inhaled it. The beginning of its use for this purpose is not clear. In the _Journal of Science and the Arts_, published in 1818 at the Royal Institution, there is a short anonymous statement among the "Miscellanea," in which it is said, "When the vapor of ether mixed with common air is inhaled, it produces effects very similar to those occasioned by nitrous oxide." The method of inhaling and its effects are described, and then "it is necessary to use caution in making experiments of this kind. By the imprudent inspiration of ether a gentleman was thrown into a very lethargic state, which continued with occasional periods of intermission for more than thirty hours, and a great depression of spirits; for many days the pulse was so much lowered that considerable fears were entertained for his life." The statement of these facts has been ascribed to Faraday, under whose management the journal was at that time published. But, whoever wrote or whoever may have read the statement, it was, for all useful purposes, as much neglected as was Davy's suggestion of the utility of the nitrous oxide. The last sentence, quoted as it was by Pereira and others writing on the uses of ether, excited much more fear of death than hope of ease from ether-inhalation. Such effects as are described in it are of exceeding rarity; their danger was greatly over-estimated; but the account of them was enough to discourage all useful research. But, as the sulphuric ether would "produce effects very similar to those occasioned by nitrous oxide," and was much the more easy to procure, it came to be often inhaled, for amusement, by chemists' lads and by pupils in the dispensaries of surgeons. It was often thus used by young people in many places of the United States. They had what they called "ether-frolics," in which they inhaled ether till they became merry, or in some other way absurdly excited or, sometimes, completely insensible. Among those who had joined in these ether-frolics was Dr. Wilhite of Anderson, South Carolina. In one of them, in 1839, when nearly all of the party had been inhaling and some had been laughing, some crying, some fighting--just as they might have done if they had had the nitrous oxide gas--Wilhite, then a lad of seventeen, saw a negro boy at the door and tried to persuade him to inhale. He refused and resisted all attempts to make him do it, till they seized him, held him down, and kept a handkerchief wet with ether close over his mouth. Presently his struggles ceased; he lay insensible, snoring, past all arousing; he seemed to be dying. And thus he lay for an hour, till medical help came and, with shaking, slapping, and cold splashing, he was awakened and suffered no harm. The fright at having, it was supposed, so nearly killed the boy, put an end to ether-frolics in that neighbourhood; but in 1842 Wilhite had become a pupil of Dr. Crauford Long, practising at that time at Jefferson (Jackson County, Georgia). Here he and Dr. Long and three fellow-pupils often amused themselves with the ether-inhalation, and Dr. Long observed that when he became furiously excited, as he often did, he was unconscious of the blows which he, by chance, received as he rushed or tumbled about. He observed the same in his pupils; and thinking over this, and emboldened by what Mr. Wilhite told him of the negro boy recovering after an hour's insensibility, he determined to try whether the ether-inhalation would make any one insensible of the pain of an operation. So, in March, 1842, nearly three years before Wells's observations with the nitrous oxide, he induced Mr. Venable, who had been very fond of inhaling ether, to inhale it till he was quite insensible. Then he dissected a tumour from his neck; no pain was felt, and no harm followed. Three months later, he similarly removed another tumour from him; and again, in 1842 and 1845, he operated on three other patients, and none felt pain. His operations were known and talked of in his neighbourhood; but the neighbourhood was only that of an obscure little town; and he did not publish any of his observations. The record of his first operation was only entered in his ledger: "James Venable, 1842. Ether and excising tumour, $2.00." He waited to test the ether more thoroughly in some greater operation than those in which he had yet tried it; and then he would have published his account of it. While he was waiting, others began to stir more actively in busier places, where his work was quite unknown, not even heard of. Among those with whom, in his unlucky visit to Boston, Wells talked of his use of the nitrous oxide, and of the great discovery which he believed that he had made, were Dr. Morton and Dr. Charles Jackson, men widely different in character and pursuit, but inseparable in the next chapter of the history of anæsthetics. Morton was a restless, energetic dentist, a rough man, resolute to get practice and make his fortune. Jackson was a quiet, scientific gentleman, unpractical and unselfish, in good repute as a chemist, geologist, and mineralogist. At the time of Wells's visit, Morton, who had been his pupil in 1842, and for a short time in 1843 his partner, was studying medicine and anatomy at the Massachusetts Medical College, and was living in Jackson's house. Neither Morton nor Jackson put much if any faith in Wells's story, and Morton witnessed his failure in the medical theatre. Still, Morton had it in his head that tooth-drawing might somehow be made painless, and even after Wells had retired from practice, he talked with him about it, and made some experiments, but, having no scientific skill or knowledge, they led to nothing. Still, he would not rest, and he was guided to success by Jackson, whom Wells advised him to ask to make some nitrous oxide gas for him. Jackson had long known, as many others had, of sulphuric ether being inhaled for amusement, and of its producing effects like those of nitrous oxide: he knew also of its employment as a remedy for the irritation caused by inhaling chlorine. He had himself used it for this purpose, and once, in 1842, while using it, he became completely insensible. He had thus been led to think that the pure ether might be used for the prevention of pain in surgical operations; he spoke of it with some scientific friends, and sometimes advised a trial of it; but he did not urge it or take any active steps to promote even the trial. One evening, Morton, who was now in practice as a dentist, called on him, full of some scheme which he did not divulge, and urgent for success in painless tooth-drawing. Jackson advised him to use the ether, and taught him how to use it. On that same evening, the 30th of September, 1846, Morton inhaled the ether, put himself to sleep, and, when he awoke, found that he had been asleep for eight minutes. Instantly, as he tells, he looked for an opportunity of giving it to a patient; and one just then coming in, a stout, healthy man, he induced him to inhale, made him quite insensible, and drew his tooth without his having the least consciousness of what was done. But the great step had yet to be made--the step which Wells would have tried to make if his test experiment had not failed. Clearly, operations as swift as that of tooth-drawing might be rendered painless, but could it be right to incur the risk of insensibility long enough and deep enough for a large surgical operation? It was generally believed that in such insensibility there was serious danger to life. Was it really so? Jackson advised Morton to ask Dr. J. C. Warren to let him try, and Warren dared to let him. It is hard now to think how bold the enterprise must have seemed to those who were capable of thinking accurately on the facts then known. The first trial was made on the 16th of October, 1846. Morton gave the ether to a patient in the Massachusetts General Hospital, and Dr. Warren removed a tumour from his neck. The result was not complete success; the patient hardly felt the pain of cutting, but he was aware that the operation was being performed. On the next day, in a severer operation by Dr. Hayward, the success was perfect; the patient felt nothing, and in long insensibility there was no appearance of danger to life. The discovery might already be deemed complete, for the trials of the next following days had the same success, and thence onwards the use of the ether extended over constantly widening fields. A coarse but feeble opposition was raised by some American dentists; a few surgeons were over-cautious in their warnings against suspected dangers; a few maintained that pain was very useful, necessary perhaps to sound healing; some were hindered by their dislike of the patent which Morton and Jackson took out; but as fast as the news could be carried from one continent to another, and from town to town, so fast did the use of ether spread. It might almost be said that in every place, at least in Europe, where the discovery was promoted more quickly than in America, the month might be named before which all operative surgery was agonizing, and after which it was painless. But there were other great pains yet to be prevented, the pains of childbirth. For escape from these the honour and deep gratitude are due to Sir James Simpson. No energy, or knowledge, or power of language less than his could have overcome the fears that the insensibility, which was proved to be harmless in surgical operations and their consequences, should be often fatal or very mischievous in parturition. And to these fears were added a crowd of pious protests (raised, for the most part, by men) against so gross an interference as this seemed with the ordained course of human nature. Simpson, with equal force of words and work, beat all down; and by his adoption of chloroform as a substitute for ether promoted the whole use of anæsthetics. Ether and chloroform seemed to supply all that could be wished from anæsthetics. The range of their utility extended; the only question was as to their respective advantages, a question still unsettled. Their potency was found absolute, their safety very nearly complete, and, after the death of Wells in 1848, nitrous oxide was soon neglected and almost forgotten. Thus it remained till 1862, nearly seventeen years, when Mr. Colton, who still continued lecturing and giving the gas "for fun," was at New Haven, Connecticut. He had often told what Wells had done with nitrous oxide at Hartford, and he wanted other dentists to use it, but none seemed to care for it till, at New Britain, Dr. Dunham asked him to give it to a patient to whom it was thought the ether might be dangerous. The result was excellent, and in 1863 Dr. Smith of New Haven substituted the nitrous oxide for ether in his practice and used it very frequently. In the nine months following his first use of it, he extracted without pain nearly 4,000 teeth. Colton, in the following year, associated himself with a dentist in New York and established the Colton Dental Association, where the gas was given to many thousands more. Still, its use was very slowly admitted. Some called it dangerous, others were content with chloroform and ether, others said that the short pangs of tooth-drawing had better be endured. But in 1867 Mr. Colton came to Paris and Dr. Evans at once promoted his plan. In 1868 he came to London and, after careful study of it at the Dental Hospital, the nitrous oxide was speedily adopted, both by dentists and by the administrators of anæsthetics. By this time it has saved hundreds of thousands of people from the sharp pains of all kinds of operations on the teeth and of a great number of the surgical operations that can be quickly done. Such is the history of the discovery of the use of anæsthetics. Probably, none has ever added so largely to that part of happiness which consists in the escape from pain. Past all counting is the sum of happiness enjoyed by the millions who, in the last three-and-thirty years, have escaped the pains that were inevitable in surgical operations; pains made more terrible by apprehension, more keen by close attention; sometimes awful in a swift agony, sometimes prolonged beyond even the most patient endurance, and then renewed in memory and terrible in dreams. These will never be felt again. But the value of the discovery is not limited by the abolition of these pains or the pains of childbirth. It would need a long essay to tell how it has enlarged the field of useful surgery, making many things easy that were difficult, many safe that were too perilous, many practicable that were nearly impossible. And, yet more variously, the discovery has brought happiness in the relief of some of the intensest pains of sickness, in quieting convulsion, in helping to the discrimination of obscure diseases. The tale of its utility would not end here; another essay might tell its multiform uses in the study of physiology, reaching even to that of the elemental processes in plants, for these, as Claude Bernard has shown, may be completely for a time suspended in the sleep produced by chloroform or ether. And now, what of the discoverers?[1] What did time bring to those who brought so great happiness to mankind? * * * * * Probably most people would agree that Long, Wells, Morton and Jackson deserved rewards, which none of the four received. But that which the controversy and the patent and the employment of legal advisers made it necessary to determine was, whether more than one deserved reward, and, if more than one, the proportion to be assigned to each. Here was the difficulty. The French Academy of Sciences in 1850 granted equal shares in the Monthyon Prize to Jackson and to Morton; but Long was unknown to them, and, at the time of the award, the value of nitrous oxide was so hidden by the greater value of ether that Wells's claim was set aside. A memorial column was erected at Boston, soon after Morton's death in 1868, and here the difficulty was shirked by dedicating the column to the discovery of ether, and not naming the discoverers. The difficulty could not be thus settled; and, in all probability, our supposed council of four or five would not solve it. One would prefer the claims of absolute priority; another those of suggestive science; another the courage of bold adventure; sentiment and sympathy would variously affect their judgments. And if we suppose that they, like the American Congress, had to discuss their differences within sound of such controversies as followed Morton's first use of ether, or during a war of pamphlets, or under burdens of parliamentary papers, we should expect that their clearest decision would be that a just decision could not be given, and that gratitude must die if it had to wait till distributive justice could be satisfied. The gloomy fate of the American discoverers makes one wish that gratitude could have been let flow of its own impulse; it would have done less wrong than the desire for justice did. A lesson of the whole story is that gratitude and justice are often incompatible; and that when they conflict, then, usually, "the more right the more hurt." Another lesson, which has been taught in the history of many other discoveries, is clear in this--the lesson that great truths may be very near us and yet be not discerned. Of course, the way to the discovery of anæsthetics was much more difficult than it now seems. It was very difficult to produce complete insensibility with nitrous oxide till it could be given undiluted and unmixed; this required much better apparatus than Davy or Wells had; and it was hardly possible to make such apparatus till india-rubber manufactures were improved. It was very difficult to believe that profound and long insensibility could be safe, or that the appearances of impending death were altogether fallacious. Bold as Davy was, bold even to recklessness in his experiments on himself, he would not have ventured to produce deliberately in any one a state so like a final suffocation as we now look at unmoved. It was a boldness not of knowledge that first made light of such signs of dying, and found that what looked like a sleep of death was as safe as the beginning of a night's rest. Still, with all fair allowance for these and other difficulties, we cannot but see and wonder that for more than forty years of the nineteenth century a great truth lay unobserved, though it was covered with only so thin a veil that a careful physiological research must have discovered it. The discovery ought to have been made by following the suggestion of Davy. The book in which he wrote that "nitrous oxide--capable of destroying physical pain--may probably be used with advantage during surgical operations," was widely read, and it would be hard to name a man of science more widely known and talked of than he was. Within two years of the publication of his _Researches_ he was appointed to a professorship in the Royal Institution; and in the next year he was a favourite in the fashionable as well as in the scientific world; and all his life through he was intimately associated with those among whom all the various motives for desiring to find some means "capable of destroying physical pain" would be most strongly felt. Curiosity, the love of truth, the love of marvels, the desire of ease, self-interest, benevolence,--all were alert in the minds of men and women who knew and trusted whatever Davy said or wrote, but not one mind was earnestly directed to the rare promise which his words contained. His own mind was turned with its full force to other studies; the interest in surgery which he may have felt during his apprenticeship at Bodmin was lost in his devotion to poetry, philosophy, and natural science, and there is no evidence that he urged others to undertake the study which he left. Even his biographers, his brother, Dr. John Davy, and his intimate friend, Dr. Paris, both of whom were very capable physicians and men of active intellect, say nothing of his suggestion of the use of nitrous oxide. It was overlooked and utterly forgotten till the prophecy was fulfilled by those who had never heard of it. The same may be said of what Faraday, if it were he, wrote of the influence of sulphuric ether. All was soon forgotten, and the clue to the discovery, which would have been far easier with ether than with nitrous oxide, for it needed no apparatus and even required mixture with air, was again lost. One could have wished that the honour of bringing so great a boon to men, and so great a help in the pursuit of knowledge, had been won by some of those who were giving themselves with careful cultivation to the search for truth as for its own sake. But it was not so: science was utterly at fault; and it was shown that in the search for truth there are contingencies in which men of ready belief and rough enterprise, seeking for mere utility even with selfish purposes, can achieve more than those who restrain themselves within the range of what seems reasonable. Such instances of delay in the discovery of truth are always wondered at, but they are not uncommon. Long before Jenner demonstrated the utility of vaccination it was known in Gloucestershire that they who had had cow-pox could not catch the small-pox. For some years before the invention of electric telegraphy, Professor Cumming of Cambridge, when describing to his class the then recent discovery by Oersted of the power of an electric current to deflect a magnet, used to say, "Here, then, are the elements which would excellently serve for a system of telegraphy." Yet none of his hearers, active and cultivated as they were, were moved from the routine of study. Laennec quotes a sentence from Hippocrates which, if it had been worthily studied, might have led to the full discovery of auscultation [trained listening to sounds]. Thus it often has been; and few prophecies can be safer than that our successors will wonder at us as we do at those before us; will wonder that we did not discern the great truths which they will say were all around us, within reach of any clear, earnest mind. They will wonder, too, as we may, when we study the history of the discovery of anæsthetics, at the quietude with which habitual miseries are borne; at the very faint impulse to action which is given by even great necessities when they are habitual. Thinking of the pain of surgical operations, one would think that men would have rushed after the barest chance of putting an end to it as they would have rushed to escape from starving. But it was not so; the misery was so frequent, so nearly customary, deemed so inevitable, that, though it excited horror when it was talked of, it did not excite to strenuous action. Remedies were wished for and sometimes tried, but all was done vaguely and faintly; there was neither hope enough to excite intense desire, nor desire enough to encourage hope; the misery was "put up with" just as we now put up with typhoid fever and sea-sickness, with local floods and droughts, with the waste of health and wealth in the pollution of rivers, with hideous noises and foul smells, and many other miseries. Our successors, when they have remedied or prevented them, will look back on them with horror, and on us with wonder and contempt for what they will call our idleness or blindness or indifference to suffering. FOOTNOTE: [1] Those only are here reckoned as discoverers from whose work may be traced not merely what might have been the beginning of the discovery, but the continuous history of events, consequent upon the evidence of its truth. Long, it is true, might under this rule be excluded; yet his work cannot fairly be separated from the history. Of course, in this, as in every similar case, there were some who maintained that there was nothing new in it. Before 1842 there were many instances in which persons underwent operations during insensibility. There may be very reasonable doubts about what is told of the ancient uses of Indian hemp, and mandragora; but most of those who saw much surgery before 1846 must have seen operations done on patients during insensibility produced by narcotics, dead-drunkenness, mesmerism, large losses of blood or other uncertain and often impracticable methods. Besides, there were many guesses and suggestions for making operations painless. But they were all fruitless; and they fail at that which may be a fair test for most of the claims of discoverers--the test of consequent and continuous history. When honour is claimed for the authors of such fruitless works as these, it may fairly be said that blame rather than praise is due to them. Having seen, so far as they profess, they should not have rested till they could see much further. JENNER AND PASTEUR SIR J. RISDON BENNETT, M.D. [Sir J. Risdon Bennett was a leading physician of London for many years, holding the highest offices as an educator and administrator. The article from which the following extracts have been taken appeared in the _Leisure Hour_, 1882.] No department of medical science has made greater advances in modern times than that which is termed "Preventive Medicine." Nor is there any in which the public at large is more deeply interested, and the knowledge of which it is of more importance should be diffused as widely as possible. The devoted and zealous service rendered by the medical profession in all questions relating to the maintenance of health and the prevention of disease is a sufficient answer, if any be needed, to the ignorant and prejudiced statements that are sometimes made, that in support of various scientific theories and proceedings medical men are actuated by interested and selfish motives. No name stands, or will ever stand, out more brilliant among the benefactors of mankind than that of Edward Jenner, by whose genius and labours untold multitudes of human lives have been saved, and an incalculable amount of human suffering and misery prevented. At the present time various circumstances, both social and scientific, have combined to recall attention to this illustrious man and his remarkable scientific and beneficial labours. It is not, however, our intention on the present occasion to give either a complete sketch of his life, or a detailed account of his work. But in order to show the connection between his discoveries and more recent advances in the same field of scientific investigation, it will be necessary to give a brief _resume_ of Jenner's life-work, and the benefits which he conferred on the human race throughout the world. He was born on the 17th May, 1749, at Berkeley, in Gloucestershire, of which place his father was the vicar. On leaving Dr. Washbourn's school, at Cirencester, he was apprenticed to Mr. Ludlow, a gentleman in practice as a surgeon at Sudbury, near Bristol. On the completion of his apprenticeship he came to London, and had the good fortune to be placed under the care of the celebrated John Hunter, with whom he resided for two years. The observing powers and taste for natural history which Jenner had early shown, as a boy, were quickened and fostered by the daily example and friendship of the illustrious man who, as surgeon and lecturer at St. George's Hospital, was carrying on those laborious scientific investigations, and building up that marvelous monument of his genius, which have rendered his name and fame immortal. So much skill and knowledge had been shown by Jenner in arranging the natural history collection of Sir J. Banks, to whom he had been recommended by Hunter, that he was offered the appointment of naturalist to Captain Cook's second expedition. He, however, declined this and other flattering proposals, in order to return to the rural scenes of his boyhood, and be near an elder brother who had been the guide of his orphanhood. He rapidly acquired an extensive business as a general practitioner, while his polished manners, wide culture, and kind and genial social qualifications, secured him welcome admission to the first society of his neighbourhood. His conscientious devotion to his professional duties did not, however, quell his enthusiastic love of natural history, or preclude him from gaining a distinguished reputation as a naturalist. A remarkable paper on the cuckoo, read before the Royal Society and printed in the _Transactions_, gained him the fellowship of that illustrious body. Jenner's paper established what has been properly termed the "parasitic" character of the cuckoo, _i. e._, it deposits its eggs in the nests of other birds, by whose warmth they are hatched, and by whom the young are fed. His observations have received general confirmation by subsequent observers, more especially the remarkable facts that the parent cuckoo selects the nests of those birds whose eggs require the same period of time for their incubation as its own (which are much larger), and the food of whose young is the same, viz., insects, which the young cuckoo ultimately monopolizes by ousting the young of the rightful owner of the nest. By this and similar studies was Jenner preparing his acute powers of investigation for the great purpose of his life. For this he secured more time and more extended opportunities for inquiry by abandoning general practice, and confining himself to medicine proper, having obtained, in 1792, the degree of M.D. from the University of St. Andrews. In conjunction with the "dear man," as he used to call his great master, John Hunter, he carried on his experiments illustrative of the structure and functions of animals. With great industry and ingenuity he explained some of the unaccountable problems in ornithology; he ascertained the laws which regulate the migration of birds; made considerable advances in geology and in our knowledge of organic remains; he amended various pharmaceutical processes; he was an acute anatomist and pathologist, and investigated and explained one of the most painful affections of the heart, and many of the diseases to which animals are liable. By such labours he established a just claim to distinction as a medical philosopher, apart from his claims to the gratitude and admiration of mankind by his self-denying and devoted labours in connection with his great discovery; but like other great men absorbed in the establishing of important truths, he was regardless of personal objects, and never ostentatiously promulgated his claims to public distinction. It was while still a youth, living with his master at Sudbury, that his mind first became deeply impressed on the subject of the cow-pox. A young country woman came to seek advice, when the subject of small-pox was incidentally mentioned in her presence, and she immediately observed, "I cannot take that disease, for I have had cow-pox." This was a popular notion prevalent in the district, and not unknown to Jenner, but from this time he never ceased to think on the subject. On coming to London he mentioned it to several persons, and among others to Hunter; but all thought his notion of getting rid of small-pox Utopian, and gave him little or no encouragement. Hunter, however, who never liked to daunt the enthusiasm of inquirers, said, in his characteristic way: "Don't _think_, but _try_; be patient, be accurate." About the year 1775, some time after his return to the country, he first had the opportunity of examining into the truth of the common traditions regarding cow-pox, but it was not until 1780, after much study and careful inquiry, that he was able to unravel the various obscurities and contradictions with which the subject was involved, and in that year he first disclosed his hopes and his fears to his friend, Edward Gardner. His mind seems to have caught a glimpse of the reputation awaiting him, and he felt that, in God's good providence, it "might be his lot to stand between the living and the dead, and that through him a great plague might be stayed." It would be impossible in the brief space at our disposal to recount the various difficulties and sources of error that Jenner encountered. It may, however, be mentioned that he ascertained that there was more than one form of local disease with which cows are afflicted, and which may give rise to sores on the hands of milkmaids, but that one only of these was the true cow-pox, giving origin to constitutional as well as local disease, and which proves protective against small-pox. He also found reason to believe that it was only in a particular stage of its development that the true cow-pox vesicle was capable of being transmitted so as to prove a prophylactic [preventive]. He was aware that though, as a rule, persons did not have small-pox a second time, yet there are instances where, from peculiarity of constitution or other causes, small-pox occurs a second time in the same individual. Such considerations as these cheered him to continue his inquiries when apparent exceptions occurred to the protective influence of true cow-pox. Having at length satisfied his own mind, and, indeed, succeeded in convincing others also, respecting the important protective influence exerted on the constitutions of those who had received the true cow-pox in the casual way, he sought to prove whether it was possible to propagate the disease by inoculation from one human being to another. On the 19th May, 1796, an opportunity occurred of making the experiment. Matter was taken from the hand of Sarah Nelmes, who had been infected by her master's cows, and inserted into the arm of James Phipps, a healthy boy eight years of age. He went through the disease in a regular and perfectly satisfactory way. But was he secure against the contagion of small-pox? It is needless to say how full of anxiety Jenner was, when in July following he put this to the test by inoculating the boy with matter taken from the pustule of a small-pox patient. No disease followed! This, his first crucial experiment, Jenner related to his friend Gardner, and said: "I shall now pursue my experiments with redoubled ardour." This ever-to-be-remembered day, 19th May, 1796, is commemorated by an annual festival in Berlin, where, in 1819, little more than twenty years after, it was officially reported that 307,596 persons had been vaccinated in the Prussian dominions alone. The account which Jenner has given of his own feelings at this time is deeply interesting. "While the vaccine discovery was progressing," he says, "the joy I felt at the prospect before me of being the instrument destined to take away from the world one of its greatest calamities, blended with the fond hope of enjoying independence and domestic peace and happiness, was often so excessive that in pursuing my favourite subject among the meadows I have sometimes found myself in a kind of reverie. It is pleasant to me to recollect that these reflections always ended in devout acknowledgments to that Being from whom this and all other mercies flow." Having obtained further corroboration of the truth of his conclusions by the vaccination of his own son and several others, he published in the form of a quarto pamphlet called "An Inquiry," a brief and modest but complete account of his investigations and discoveries. By this the attention of the whole medical world and general public was called to the subject. His doctrines were put to the test and abundantly confirmed, so that Mr. Clive, the celebrated surgeon of the day, urged him to come to London, and promised him an income of £10,000 a year. Jenner, however, declined the request, saying, "Admitting as a certainty that I obtain both fortune and fame, what stock should I add to my fund of little happiness? And as for fame, what is it? A gilded butt forever pierced by the arrows of malignancy." Jenner always maintained that small-pox and cow-pox were modifications of the same disease, and that in employing vaccine lymph we only make use of means to impregnate the system with the disease in its mildest form, instead of propagating it in its virulent and contagious form, as is done when small-pox is inoculated. He felt, also, that there was this objection to the latter practice, which had obtained prevalence since its introduction to this country by Lady Mary Wortley Montagu, that the disease was thus spread among the community. He had, however, at that time to contend against the prevalent notions that epidemic diseases affecting the human race are peculiar to man and have no influence on the lower animals, and that the diseases of other animals are not communicable to man. But we have now abundant evidence that both these notions are erroneous. Jenner himself, indeed, had shown what was well known in various parts of the country, that the "grease" of the heel of the horse was frequently communicated to those who had the care of horses, whether or not it was the same disease as that which affected the cow. It is sufficient only further to adduce another disease of horses, called "farcy," which is not infrequently fatal to grooms and others, not to mention the still more dreaded hydrophobia communicated by dogs and animals of the feline species. The rapid acceptance and spread of Jenner's doctrines speedily silenced all cavillers except that small minority of incredulous and fanatical opponents who are always to be found refusing to accept any truth that does not coincide with their own ignorant and prejudiced views. The frightful mortality and appalling effects of small-pox prior to the introduction of vaccination were indeed such as to impel men to grasp at any means that held out a probability of escape from the scourge. In the present day the public can form but a faint idea of the ravages of small-pox before Jenner's time. The records of historians, not only of our own country, but throughout the world, teem with the most appalling accounts. Dr. Lettsom calculated that 210,000 fell victims to it annually in Europe. Bernouilli, an Italian, believed that not less than 15,000,000 of human victims were deprived of life by it every twenty-five years, _i. e._, 600,000 annually. In Russia 2,000,000 were cut off in one year. In Asia, Africa, and South America, whole cities and districts were depopulated. Nor was it only the actual mortality which rendered it so appalling. The records of the Institution for the Indigent Blind in our own country showed that three-fourths of the objects relieved had lost their sight by small-pox, while the number of persons with pitted and scarred faces and deformed features that were met with in the streets testified to the frightful ordeal that they had passed through. Multitudes died of diseases set up by this plague, or from ruined constitutions which it entailed. And what, of all this, it may be asked, do we now see? Is it not a rare thing to meet a person whose face is scarred and his features deformed by small-pox? How few persons can cite instances among their acquaintance of those who have died of small-pox after having been properly vaccinated? Is it necessary to go into statistics and elaborate investigations of the bills of mortality of the present day in order to be convinced that, as compared with the records of anti-vaccine times, we have indeed cause to bless the memory of Jenner? We do not ignore the fact that small-pox, like other similar diseases having an epidemic character, may be absent for a length of time from certain districts and then break out again; nor that each epidemic has its period of increment and decrement, and varies in its degree of malignancy. But a full and careful review of the whole history of small-pox since the introduction of vaccination, proves to every unprejudiced mind that every recurring epidemic finds its victims, with comparatively few exceptions, among the unvaccinated, that its spread is arrested by renewed attention to vaccination and its vigorous enforcement, and that, even taking into account the countries and localities where from various causes it has been neglected, the mortality from this foul and fatal disease, small-pox, has been enormously reduced. Human lives have been saved, and human life prolonged to such an extent that it is impossible to estimate the benefits that mankind has derived from the genius and devoted patriotic labours of one man. That doubts and difficulties in connection with this subject, involving the well-being of the whole human race, have lately arisen, must be admitted. But there is good reason to believe that, by modern researches on the subject of epidemic diseases and the germ theory of disease, these doubts are already being dispelled, and that the difficulties will be speedily obviated. The grounds for this belief will be understood by the consideration of those scientific investigations to a brief detail of which we now proceed. The reader will then also be better able to judge of the propriety, and necessity of certain measures which, to the uninformed, must appear objectionable or even repulsive and arbitrary. We now, then, turn to the remarkable experiments and discoveries of M. Pasteur, which have gained for him a world-wide reputation, and the bearing of which on the science of preventive medicine is commanding the attention and admiration of the whole scientific world, and indeed we may say of mankind at large. M. Pasteur is not a medical man, nor, indeed, a physiologist. He is simply a French chemist, a modest, retiring labourer in the field of science whose sole object has been the discovery of truth, and whose chemico-physical researches gained for him the Rumford Medal of the Royal Society in 1856. Having devoted himself specially to the chemistry of organic substances, he was naturally attracted by the discovery of Cagniard de la Tour, that yeast is really a plant, a species of fungus, whose vegetative action in fermentable liquids is the true cause of their fermentation. This was so opposed to the theories of all the chemists of the day, among whom may particularly be mentioned the celebrated Liebig, that it met with their warm opposition. When, however, Helmholtz and others succeeded in showing that by preventing the passage of the minute organisms constituting the yeast plant into fermentable liquids, no fermentation took place, the doctrine soon became established that the first step in the process of alcoholic fermentation is due, not to ordinary chemical changes, but to the presence of living organisms. In like manner the putrefaction and decomposition of various liquids containing organic matter was found to be due, not to the simple action of the oxygen of the atmosphere, but to the introduction from without of microscopic germs which found material for their development in such liquids. So that if by mechanical filtration of the air the entrance of such germs can be prevented, or if by heat or other means they can be destroyed, any fluid, however readily it may undergo putrefaction in ordinary circumstances, will remain perfectly sweet, though freely exposed to the air. And the same fluid will undergo a different kind of fermentation according as it is subjected to the action of different species of germs. These and other facts of scarcely less importance, which cannot here be detailed, induced Pasteur to test the application of the doctrines deduced from them to the study of disease in living animals. His attention was first directed to the disease affecting the silkworm, and known as the _Pebrine_, which at one time seemed likely to destroy the silk cultivation both in France and Italy. It had been ascertained that the bodies of the silkworm, in all its stages of chrysalis, moth, and worm, were in this disease infested by minute corpuscles which even obtained entrance into the undeveloped eggs. After a prolonged and difficult inquiry, Pasteur found that these minute corpuscles were really independent, self-propagating organisms, introduced from without, and were not merely a sign of the disease, but its real cause. As a result of the application of these discoveries, the silkworm disease has been extinguished, or so controlled as to have saved a most important and valuable culture. Between the years 1867 and 1870 above 56,000 deaths from a disease variously designated as "anthrax," or "carbuncular disease," and "splenic fever," and in France known by the terms "charbon," or "pustule maligne," are stated to have occurred among horses, cattle, and sheep in one district of Russia, Novgorod, occasioning also the deaths of 528 among the human population. It occurs in two forms, one more malignant and rapid in its action than the other. In France the disease appears to be scarcely ever absent, and is estimated to entail on the breeders of cattle an annual loss of many millions of francs. As a milder epidemic it has prevailed in this country, and the disease which has lately broken out in Bradford and some other towns in the north among wool-sorters, has now been shown to be a modification of the same disease communicated by the wool of sheep that have been infected. On examining the blood of animals, the subjects of "splenic fever," some French pathologists had discovered the presence of certain minute transparent filaments which, by the investigations of a German physician named Koch, were proved to be a fungoid plant developed from germ particles of microscopic minuteness. By gradual extension these minute particles, termed "microbes," attain the form of small threads or rods, to which the name of "bacilli" has been given, from the Latin _bacillus_, a rod or staff. These rods were found to be in fact hollow tubes, divided at intervals by partitions, which, on attaining full growth, break up into fragments, the interiors of which are found to be full of minute germs similar to those from which the rods were at first developed. These germs were found by Koch and his collaborateurs to be capable of cultivation by being immersed in some suitable organic liquid kept at a proper temperature, and the supply could be kept up by introducing even a few drops of such impregnated fluids into other fluids, and repeating the process again and again. The next step to test the potency of these germs to generate the disease in animals whence they were originally obtained, was to vaccinate animals with a few drops of the fluid thus artificially infected. Accordingly it was found that the bodies of guinea-pigs, rabbits, and mice thus inoculated became infected, and developed all the characteristic symptoms of splenic fever or carbuncular disease. Pasteur, whose enthusiasm in the pursuit of investigations which had already been crowned with such signal success kept him awake to all that was being done by other inquirers, and made him watchful of every event that transpired relative to the epidemic diseases of cattle, was struck with the fact that some of the most fatal outbreaks of "charbon" among flocks of sheep occurred in the midst of apparently the most healthy pastures. His sagacity led him to inquire what had been done with the carcasses of animals that had died from previous outbreaks of the disease in these localities, when he found that they had been buried in the soil and often at great depths, of the same pastures. But how could the disease germs make their way to the surface from a depth of eight or ten feet? Earthworms, he guessed, might have conveyed them. And notwithstanding the incredulity with which his explanation was received, he forthwith proceeded to verify his supposition. Having collected a number of worms from the ground of the pastures in question, he made an extract of the contents of the alimentary canal of the worms, and with this he inoculated rabbits and guinea-pigs, gave them the "charbon" in its most fatal form, and proved the identity of the malady by demonstrating that the blood of the victims swarmed with the deadly "bacillus." And here we cannot but stop to notice the remarkable confirmation that is thus given to the wonderful and beautiful observations of Darwin as set forth in his last work on "The Formation of Vegetable Mould Through the Action of Worms." Darwin has shown beyond all dispute, as the result of his incomparable researches, that though "the plough is one of the most ancient and most valuable of man's inventions, long before he existed the land was in fact regularly ploughed, and still continues to be ploughed, by earthworms." He has shown us that the smoothness which we admire in a wide, turf-covered expanse "is mainly due to all the inequalities having been slowly leveled by worms," and that "the whole of the superficial mould over any such expanse has passed, and will pass again, every few years, through the bodies of worms!" It was left for Pasteur to show that these innumerable and indefatigable plowmen, whilst rendering to man such efficient service, may also be the carriers of the seeds of disease and death. In proceeding with our brief historical account of Pasteur's and allied researches, we are arrived at the point where their analogy to Jenner's becomes manifest, and where their direct bearing on the welfare of mankind comes into view. So soon as it was known that these disease germs were low forms of vegetation, and that, like other vegetables, they could be cultivated, it was natural to ask whether, like other vegetables, their characters and properties could not be so modified as to render them at least less deleterious. Every one knows the difference between the crab-apple and its cultivated variety, the sloe and the plum, the wild and the cultivated celery. It is all the difference between unwholesome and wholesome food. Two methods of cultivation, with a view to obtaining the desired modification of the power exercised by the bacilli and other similar germs, presented themselves, the one analogous to that really pursued by Jenner where small-pox, or the grease of the horse, was passed through the system of the cow, and then from one human being to another; and the second by carrying on the cultivation out of the living body. Both these plans have been adopted, with the result of proving that the potency of the germs can be so diminished as to render the disease produced by their introduction so mild as to be of no importance. Pasteur cultivated the bacillus in chicken broth or meat juice, and allowed a certain time to elapse before he made use of the mixture. After allowing only two months to elapse, the virulence of the germs seemed to be but little impaired, but after three or four months animals inoculated with the fluid, though they took the disease, had it in so mild a form that the greater number recovered. After a long period of six or eight months the engendered disease was so mild that all the animals speedily recovered and regained health and strength. And now the question will naturally arise, Did animals which had passed through the mild disease thus induced acquire a protection against the original disease, if brought in contact with it in subsequent epidemics, in the same way that Jenner's vaccinated patients were protected against small-pox? An answer in the affirmative may now be given with the utmost confidence. Experiments conducted, both in this country and abroad, by both methods of procedure, have abundantly proved that animals may be protected by inoculation so as to render them insusceptible of any form of the destructive anthrax disease. From a remarkable paper read by Pasteur before the International Medical Congress we extract the concluding paragraph. After detailing the method pursued to obtain the requisite attenuation of the virus, and stating that by certain physiological artifices it may be made again to assume its original virulence, he proceeds: "The method I have just explained, of obtaining the vaccine of splenic fever, was no sooner made known then it was very extensively employed to prevent the splenic affection. In France we lose every year by splenic fever animals to the value of 20,000,000 francs, and even, according to one of the persons in the office of the Minister of Agriculture, more than 30,000,000 francs, but exact statistics are still wanting. I was asked to give a public demonstration at Pouilly-le-Fort, near Melun, of the results already mentioned. This experiment I may relate in a few words. Fifty sheep were placed at my disposition, of which twenty-five were vaccinated, and the remaining twenty-five underwent no treatment. A fortnight afterwards the fifty sheep were inoculated with the most virulent anthracoid microbe (or germ). The twenty-five vaccinated sheep resisted the infection, the twenty-five unvaccinated died of splenic fever within fifty hours. "Since that time the capabilities of my laboratory have been inadequate to meet the demands of farmers for supplies of this vaccine. In the space of fifteen days we have vaccinated in the departments surrounding Paris, more than 20,000 sheep, and a large number of cattle and horses. This experiment was repeated last month at the Ferme de Lambert, near Chartres. It deserves special mention. "The very virulent inoculation practiced at Pouilly-le-Fort, in order to prove the immunity produced by vaccination, had been effected by the aid of anthracoid germs deposited in a culture which had been preserved in my laboratory more than four years, that is to say, from the 21st March, 1877. There was assuredly no doubt about its virulence, since in fifty hours it killed twenty-five sheep out of twenty-five. Nevertheless, a commission of doctors, surgeons, and veterinary-surgeons, of Chartres, prejudiced with the idea that virus obtained from infectious blood must have a virulence capable of defying the action of what I call cultures of virus, instituted a comparison of the effects upon vaccinated sheep and upon unvaccinated sheep of inoculation with the blood of an animal which had died of splenic fever. The result was identical with that obtained at Pouilly-le-Fort--absolute resistance of the vaccinated and deaths of the unvaccinated. If I were not pressed for time I should bring to your notice other kinds of virus attenuated by similar means. These experiments will be communicated by-and-by to the public." The bearing of these researches of Pasteur on vaccination with cow-pox, and the whole of the Jennerian doctrines, will be evident. They throw a flood of light both on the efficacy of vaccination and the many supposed failures which have given a handle to the unscrupulous fanatical detractors of Jenner and his doctrines. They go far toward establishing the correctness of the view entertained by Jenner as to the identity of small-pox and cow-pox, showing how great may be the modifications effected in the original virus by repeated transmission, either through the animal or the human system. But apart from the question of identity or diversity of small-pox and vaccinia, Pasteur's researches prove beyond all question that a disease virus may be both diminished and augmented in power by physiological devices, and that therefore the efficacy of the vaccine lymph may, in various ways, be so diminished as to lose its protective power, without shaking our faith in the principle of vaccination or detracting in the least from the inestimable value of Jenner's discovery. The attention of the scientific world will now be, and is, directed to the important inquiry, How far has the original vaccinia of Jenner lost its protective power? If so, how has this been brought about, and by what means can it be restored? Must we again revert to the cow for a new supply? Need we only be more scrupulous in the selection of the vesicles, and the particular stage of their development, and in the mode in which the operation of vaccination is performed? These and numerous other similar questions are now being discussed and investigated, but none probably is more important than the question how far the protective influence in each individual is dissipated by time, and hence the principle of re-vaccination is now being enforced. There can be no doubt that different epidemics possess different degrees of virulence, and what proves a sufficient protection in a mild epidemic of small-pox may not be sufficient in a more virulent one. In certain seasons and in certain conditions of the atmosphere, the human system is more prone to certain disease than at other times. Pasteur's experiments on cultivated virus or germs show that in the course of time, and in certain conditions of exposure to the action of oxygen or other agents, the vitality, or constitution, so to speak, of the germs may be so changed as materially to alter their action on the animal system. We have, therefore, scientific grounds for reverting from time to time to the heifer for a new stock, rather than continuing to rely on the perpetual transmission from one human body to another. This is not the place to enter on the whole question of the germ theory of disease, but who does not see how wide is the field for investigation opened up by Pasteur and others? Already the application of the principle of vaccination has been successfully applied by Pasteur to a very fatal epidemic disease attacking fowls, and known by the name of "chicken cholera." By inoculating chickens with the cultivated variety of the particular "bacillus" he has afforded to them complete protection. The economic value of this to France may in some measure be estimated by the many millions of eggs which are exported from France to this country alone. How many other diseases, such as scarlatina and diphtheria, which now carry off annually thousands of children, may not ere long be extinguished by like means who shall say? "I venture," states Mr. Simon, in his address to the Health Section of the International Congress, "to say that in the records of human industry it would be impossible to point to work of more promise to the world than these various contributions to the knowledge of disease and of its cure and prevention, and they are contributions which, from the nature of the case, have come, and could only have come, from the performance of experiments on living animals." Compulsory vaccination is, no doubt, a strong measure, and one which might, in this land of individual liberty, be expected to give rise both to question and opposition. It can only be justified by proving that it is to the interest of the individual as well as of the whole community that it should be enforced. Of its propriety and necessity we believe it needs only a calm and unprejudiced inquiry to be convinced. Most of the objections raised against it are either baseless or admit of being obviated. That some of the objections are of a character that command our respect may be admitted, but mere sentiment or prejudiced and ill-founded objections, must give place to sound arguments and well-established evidence. In this, as in many similar cases, opposition and discussion open up entrances for light by which the clouds of ignorance and darkness are sure to be dispelled. But even as this whole question of vaccination now stands, the responsibility of those who are persistently misrepresenting facts and misleading the public is great, nay, criminal, when we reflect how many lives are sacrificed by the neglect of precautionary means within the reach of all. LOUIS PASTEUR AND HIS WORK PATRICK GEDDES AND J. ARTHUR THOMSON [Professor Geddes is Professor of Botany at University College, Dundee. He has written "Chapters in Modern Botany" and many botanical articles and papers. Professor Thomson is Regius Professor of Natural History, Aberdeen University. His works include "The Study of Animal Life," "Outlines of Zoölogy," "The Natural History of the Year" and "The Science of Life." "The Evolution of Sex" was written jointly by both these authors. The article from which extracts follow was published in the _Contemporary Review_, 1895: the editor's permission to reprint is gratefully acknowledged. The Life of Louis Pasteur by M. Radot, 2 vols., were published by McClure, Phillips & Co., New York, 1901.] The course of Pasteur's scientific work is one of remarkably natural and logical sequence. As the veteran M. Chevreuil long ago said in the Academy of Sciences, "It is by first examining in their chronological order the researches of M. Pasteur, and then considering them as a whole, that we appreciate the rigor of his conclusions, and the perspicacity of a mind which, strong in the truths which it has already discovered, sweeps forward to the establishment of what is new." We shall therefore summarize the record of his greatest achievements. As was natural in a pupil of Dumas, Balard, and Delafosse, Pasteur's first important piece of work was chemical and crystallographic, and we may best understand its spirit by recalling the work of Delafosse's master in mineralogy, the Abbé Hauy, who is still remembered for that bold attempt to visualize the ultimate structure of the crystal, to penetrate the inmost secret of its architecture, which also reappears in another way in the work of Mendelejeff. Pasteur's puzzle concerned the tartrates and paratartrates of soda and ammonia. These two salts are alike in chemical composition, in crystalline form, in specific gravity, and so on, but they differ in behaviour. Thus, as Biot had shown, a solution of tartrate deflects the plane of polarized light passed through it, while a solution of the paratartrate does not. The salts are the same, yet they behave differently. A note to the Academy from the famous chemist Mitscherlich emphasized the entire similarity of the two salts, and this acted as an additional stimulus to Pasteur. He succeeded in distinguishing the minute facets which even Mitscherlich had missed; he proved that the paratartrate is a combination of a left-handed and a right-handed tartrate, and did much else which only the expert chemist could duly explain. Biot was first doubtful, then delighted; Arago, who had also busied himself with these matters, moved that Pasteur's paper be printed in the memoirs of the Academy, and Mitscherlich himself congratulated the young discoverer who had tripped him up. Already, then, in this minute and laborious piece of work, we may detect ultra-microscopic mental vision, and that rigorous accuracy so characteristic of the man. Yet it is interesting to observe that at this early stage he was sowing his wild oats of speculation. Impressed by the strange rotation of the plane of polarization exhibited by these organic salts, he deduced therefrom an hypothesis of molecular dissymmetry, and hazarded the view that this was a fundamental distinction between the organic and the inorganic. For various reasons, neither chemist nor biologist would nowadays accept this distinction; but it is hard to tell what Pasteur might have made of this inquiry had not circumstances, regretted at the time, directed his attention to very different subjects. Being thus known in connection with tartrates, Pasteur was one day consulted, so the story goes, by a German manufacturer of chemicals, who was puzzled by the fermentation of his commercial tartrate of lime, which contained some admixture of organic impurities. Pasteur undertook to look into the matter, and probably deriving some hint from the previous work of Cagniard Latour, and Schwann who had demonstrated the yeast-plant which causes alcoholic fermentation, he demonstrated the micro-organism which fermented the tartrate of lime. He extended this discovery to other tartrates, and made the neat experiment of showing how the common blue mould (_Penicillium glaucum_), sown in paratartrate of ammonia, uses up all the right-handed tartrate and leaves the left-handed salt alone, its identical chemical composition notwithstanding. These and similar inquiries led him to tackle the whole question of fermentation, but his transference to Lille had probably much to do with this. For, as one of the chief industries of the district is making alcohol from beet-root and grain, Pasteur's practical sense led him to devote some of his lectures to fermentation; here, as always, as his biographer reminds us, wishful to make himself directly useful to his hearers. The prevalent theory of fermentation, before Pasteur took the subject in hand, was that of Willis and Stahl, revised and elaborated by Liebig. According to this theory, nitrogenous substances in a state of decomposition upset the molecular equilibrium of fermentable matter with which they are in contact. What Pasteur did was to show that lactic, butyric, acetic, and some other fermentations, were due to the vital activity of micro-organisms. In spite of Liebig's prolonged opposition, Pasteur carried his point; and although some of his detailed interpretations have since been revised, it is universally admitted that he changed the whole complexion of the fermentation problem. It must, of course, be borne in mind that his theory of the vital nature of many fermentations does not apply to soluble ferments or enzymes--such as diastase and pepsin--which are chemical substances, not living organisms. Part, indeed, of the opposition to Pasteur's views was due to the fact that this distinction between organized and unorganized ferments was not at the time clearly drawn. Perhaps, indeed, we are as yet by no means out of the woods. In the course of his work on fermentation, Pasteur made an important theoretical step by distinguishing the micro-organisms which require the presence of free oxygen, from forms which are able to live apart from free oxygen, obtaining what they require by splitting up oxygen-containing compounds in the surrounding medium. These he termed ærobic and anærobic respectively. Practically, this piece of work immediately led to what is known as the Orleans process of making vinegar. Some years later, after he had returned to Paris, he followed this up by his studies on wine, in the course of which he tracked various wine-diseases to their sources, and showed how deterioration might be prevented by raising the wine for a minute to a temperature of 50°C. The wine-tasters of Paris gave their verdict in his favour. The old notion of spontaneous generation still lingered in some quarters, and in 1858 Pouchet had given new life to the question by claiming before the Academy of Sciences that he had succeeded in proving the origin of microscopic organisms apart from pre-existing germs. But Pasteur knew more than Pouchet as to the insidious ways of germs: he showed the weak point of his antagonist's experiments, and gained the prize, offered in 1860 by the Academy, for "well-contrived experiments to throw new light upon the question of spontaneous generation." As every one knows, the victory was with Pasteur, but the idea is an old and recurrent one, and dies hard. Thus, not many years afterward, Pasteur and Tyndall had to fight the battle over again with Bastian. The important result of what seems at first sight an abstract discussion has been not only an increased knowledge of the distribution and dissemination of bacteria, but the establishment of the fundamental conditions and methods of experimental bacteriology.... [Here follows substantially the same narrative as that given by Sir J. Risdon Bennett on pages 36 to 49 of this volume. It recites how Pasteur devised preventives for the disease which was destroying the silkworms; preventives for splenic fever or anthrax.] Opposition was an ever-recurrent factor in Pasteur's life. He had to fight for his crystallographic and chemical theories, and for his fermentation theory; he had to fight against the theory of spontaneous generation, and for his practice of inoculating as a preventive against splenic fever; he had to fight for each step. But no part of his work has met with so much opposition and adverse criticism as that concerning hydrophobia, though it is easy to exaggerate the importance of the discussion, in which Pasteur himself took little part. Feeling ran high in this country; hence, when it was announced that Pasteur--surely best qualified to speak--was to write the article Hydrophobia in "Chamber's Encyclopædia," a shower of letters inundated the office; hence the article in question includes an editorially demanded summary of the grounds of the opposition by one of ourselves, and to which therefore we may refer the reader. While avoiding controversy and partisanship as far as may be, the question remains, What did Pasteur do in regard to hydrophobia? His claims are to have proved, first of all, that the disease was particularly associated with the nervous system. The virus is usually spread through the saliva, but it is not found in the blood or lymph, and it has its special seat in the nerves, brain, and spinal cord. Secondly, he showed that the virus might be attenuated in its virulence. The spinal cord of a rabbit which has died of rabies, is, when fresh, powerfully virulent, but when exposed for a couple of weeks to dry air at a constant temperature of 23°-24°C. it loses its virulence. Thirdly, he showed that inoculation with the attenuated virus rendered an animal immune from infection with rabies. To make the animal immune it has first to be inoculated with infected spinal cord fourteen days old, then with that of thirteen days, and so on till inoculation with almost freshly infected spinal cord is possible. In this way the animal becomes refractory to the infection, and if it be bitten it will not die. Fourthly, he showed that even if the organism had been bitten, it was still possible to save it, unless the wounds were near the head--that is, within close reach of the central nervous system. For in the case of a superficial wound, say on hand or leg, the virus takes some considerable time to spread, and during this period of spreading and incubation it is possible to forestall the virus by inoculation with that which has been attenuated. In this case there is obvious truth in the proverb, "He gives twice who gives quickly." And the outcome was, that while out of a hundred persons bitten, nineteen or twenty will in ordinary circumstances die, "the mortality among cases treated at the Pasteur Institute has fallen to less than 1-2 per cent." According to another set of statistics, a mortality of 40 per cent. has been reduced to 1.3 per cent.; and of 1673 patients treated by Pasteur's method only thirteen died. As to the adverse criticism of Pasteur's inoculation against rabies, it consists, first and second, of the general argument of the anti-vaccinationists, and thirdly, of specific objections. To the two former the school of Pasteur, of course, replies that the value of human life answers the one, and the results of experience the other; but on these controversies we cannot enter here. The main specific objections we take to be three--that as the micro-organism of rabies has not really been seen, the theory and practice of Pasteur's anti-rabic method lack that stability which is desirable; that the statistics in favor of the Pasteur procedure have been insufficiently criticised; that there have been failures and casualties, sometimes of a tragic nature. In regard to this last point--that deaths have occurred as the result of the supposed cure, instead of from the original infection--we may note that the _possibility_ of such casualties was admitted by the English Investigation Committee (1887), while, on the other hand, Dr. Armand Ruffer, who speaks with much authority, denies with all deliberateness that there is any known case in which death followed as the result of Pasteur's treatment. Microscopic verification is, of course, most desirable, and statistics are proverbially difficult of criticism. But, on the whole, we think it likely that those who, like ourselves are not medical experts will incline to believe that Sir James Paget, Dr. Lauder Brunton, Professor George Fleming, Sir Joseph Lister, Dr. Richard Quain, Sir Henry Roscoe, and Professor Burdon Sanderson must have had grounds for saying, in the report which they presented to Parliament in 1887, "It may, hence, be deemed certain that M. Pasteur has discovered a method of protection from rabies comparable with that which vaccination affords against infection from small-pox." So far a summary of Pasteur's personal life and scientific work, but is it not possible to make a more general and rational estimate of these? So much was his life centred in Paris that most people are probably accustomed to think of him as a townsman; but it is more biologically accurate to recognize him as a rustic, sprung from a strong, thrifty stock of mountain peasants. Nor can his rustic early environment of tanyard and farm, of village and country-side, be overlooked as a factor in developing that practical sense and economic insight which were so conspicuous in his life work. The tanner's son becomes the specialist in fermentation; the country boy is never throughout his life beyond hail of the poultry-yard and the farm-steading, the wine press and the silk nursery; brought up in the rural French atmosphere of careful thrift and minute economies, all centred not round the mechanism or exchange of town industries, but round the actual maintenance of human and organic life, he becomes a great life-saver in his generation. In short, as we might almost diagrammatically sum it up, the shrewd, minutely careful, yet inquiring rustic, eager to understand and then to improve what he sees, passes in an ever-widening spiral from his rural centre upward, from tan-pit to vat and vintage, from manure-heaps, earthworms, and water-supply to the problems of civic sanitation. The rustic tragedies of the dead cow and the mad dog excite the explanation and suggest the prevention, of these disasters; from the poisoning of rats and mice he passes to suggestive experiments as to the rabbit-pest of Australia, and so in other cases from beast to man, from village to state. And on each radius on which he paused he left either a method or a clew, and set some other inquirer at work. On each radius of work he has left his disciples; for he founded not only an Institute, but a living school, or indeed whole schools of workers. We think of him, then, not only as thinking rustic, but as one of the greatest examples in science of the Rustic Thinker--a type of thinker too rare in our mechanical and urban generation, yet for whom the next generation waits. As to his actual legacy to the world, let us sum it up briefly. There is the impulse which he gave, after the successful organization of his own Institute, to the establishment in other countries of similar laboratories of preventive medicine, and, one may also say, of experimental evolution. There is his educative work at Strasburg and Lille, at the Ecole Normale and the Sorbonne, and, above all, in the smaller yet world-wide circle of his immediate disciples. To general biology his chief contribution has been the demonstration of the part which bacteria play, not only in pathological and physiological processes, but in the wider drama of evolution. To the chemist he has given a new theory of fermentation; to the physician many a suggestive lesson in the etiology [inquiry into the causes] of diseases, and a series of bold experiments in preventive and curative inoculation, of which Roux's treatment of diphtheria and Professor Fraser's new remedy for snake-bite are examples at present before the public; to the surgeon a stable foundation, as Lister acknowledged, for antiseptic treatment; to the hygienist a multitude of practical suggestions concerning water-supply and drainage, disinfection and burial. On brewer, distiller, and wine-maker he has forced the microscope and its results; and he has shown both agriculturist and stock-breeder how some, at least, of their many more than ten plagues may be either averted or alleviated. TUBERCULOSIS AND ITS PREVENTION T. MITCHELL PRUDDEN, M.D. [Dr. Prudden is Professor of Pathology in the College of Physicians and Surgeons, New York. He has bestowed especial attention upon the means of preventing disease: in that important field he has written three capital manuals, all published by G. P. Putnam's Sons, New York:--"Story of the Bacteria," "Dust and Its Dangers," "Water and Ice Supplies." His other works, intended for the professional reader, are of the highest authority. The article here given appeared in _Harper's Magazine_, March, 1894; copyright by Harper & Brothers, who have granted permission to reprint. In May, 1902, these pages were revised by Dr. Prudden.] It is commonly neither wise nor necessary for people not professionally concerned to think much about disease, or weigh anxiously the chance or mode of its acquirement. But now and then conditions arise which demand general attention and instruction regarding certain diseases in order that a great, threatening calamity may be averted. Such a condition faces the people in all lands to-day in the appalling prevalence of tuberculosis. A disease which in mild or severe form affects at least one-half of the whole human race, and which causes the death of full one-seventh of all who pass away, killing about one-third of those who perish between the ages of fifteen and forty-five--a disease which is most insidious in its onset, and often relentless in its course, and which may be largely prevented--is one about which we cannot be indifferent, and should not be longer inactive. There has long been reason for believing that tuberculosis is a communicable disease. Its prevalence in certain families and communities, its frequent occurrence in those who have personally attended upon its victims, its onset in those who have occupied apartments vacated by consumptives--such facts observed over and over again abundantly justify the belief in its communicability. Up to the commencement of the last decade the cause of the disease was altogether unknown, and no definite data were at hand which could enable us to fix upon a feasible plan for limiting its ravages. But in these later years a great light has been thrown upon this and other kindred diseases. Most intelligent people are aware that within the past decade a new field in the domain of life has been revealed and widely explored. It has been learned that in earth and air and water there exist countless myriads of living things so minute as to lie far beyond the limits of the unaided vision, and yet in the aggregate so potent in the maintenance of the cycle of life upon earth that without their activity all life would soon cease to be, and the elements which for a short span fall under the sway of the life forces in all higher animals and plants would lapse finally and irrevocably into their primal state. These tiny organisms are called germs, microbes, or micro-organisms. One great and important group of them belongs among the microscopic plants called bacteria. These bacteria as a class are important in their economy of nature, because they live for the most part on dead organic material--that is, such material as has once formed a portion of some living thing. The world's store of available oxygen, hydrogen, carbon and nitrogen, out of which all living beings are largely formed, is limited, and if after these have served their temporary uses, as the medium through which that mysterious potency called life alone can find expression, they were not speedily released, new generations of living beings could neither assume nor maintain their place in the great cycle of life. And so these tiny plants, year in, year out, by day and by night, unseen and mostly unheeded, are busy always in making possible the return of each year's visible vegetation and the maintenance of an unbroken succession of generations in man and beast. Different groups and races among the bacteria have different habitations, and vary widely in their special powers. Complex and powerful as is the aggregate result which they accomplish in the world, the performances of the individual are comparatively simple. They are most liberally endowed with the capacity for multiplication, and each germ acts as a tiny chemical laboratory, taking into itself the organic matter on which it feeds, and resolving it into new compounds. Some of the latter are used in building up and maintaining its own body, while others are given off into the surrounding media. We are but just beginning to peer at the mysterious processes which go on under the influence of the bacteria in this underworld of life, and to realize that all the lore which unwearied toilers in the past have gathered in their studies of the visible forms of animals and plants, makes but one of the many chapters in nature's story-book of life. But this new and stimulating point of view, toward which the studies of the past decade have led us, does not look so largely into the domain of the practical that it would greatly attract the majority of business and pleasure and _ennui_ ridden mankind were it not for one very practical fact which these recent studies have revealed. This is, that among the myriads of altogether beneficent bacteria which people the earth, and air, and water, there are a few forms which have chosen out of all the world as their most congenial residence the bodies of men. But even this would be of only passing interest to most people were it not still further unfortunately true that in the performance of their simple life-processes these man-loving bacteria, feeding on the tissues of their host, and setting free certain subtle poisons in his blood, each after its kind, can induce those disturbances of the body's functions and those changes in its structure which we call disease. The diseases caused by the growth of germs in the body are called infectious. The germs causing some of the infectious diseases are given off from the bodies of their victims in such form as to be readily transmitted through the air to others, in whom they may incite similar disease. Such diseases are spoken of as readily communicable, though it is not actually the disease itself, but only the germ causing it, which is transmitted. In other infectious diseases transmission but rarely occurs. Many infectious diseases are very easily communicated from the sick to the well under unsanitary and uncleanly conditions, which with proper care are very little liable to spread. I need not here put on parade the whole uncanny list of germ diseases, in which tuberculosis stands foremost, followed by pneumonia, diphtheria, typhoid fever, scarlatina, cholera, small-pox, and the rest. Nor need I call to mind the means by which our growing knowledge in this domain has been day by day laid under tribute for suggestions of hope and safety for the stricken. It is a record of brilliant conquest in nature, and already of far-reaching beneficence to man. But the great fundamental advance which signalizes the past decade is the lifting of this whole class of fateful germ diseases out of the region of the intangible and mysterious, and their establishment, on the basis of positive experimental research, in the domain of the comprehensible and definite. The things which cause them are no longer for us mysterious emanations from the sick, or incorporate expressions of malign forces against which conjurations or prayers could alone promise protection, but they are particulate beings, never self-engendered, never evolved in the body, always entering from without--things which we can see and handle and kill. Let us now glance at the germ called the tubercle bacillus, the germ which induces and which alone can induce tuberculosis. It does not exist and thrive in the body of men or animals in health. Without the entrance of this particular germ into the human body from without, tuberculosis cannot develop in it. Without the transmission of this germ in some way or other in a living condition from the sick to the well, tuberculosis cannot spread. In the life-story of this tiny germ lie both the potency for mischief which we deplore and the secret of our release from its bondage. The tubercle bacillus is a little colourless, rod-like plant, so small that even many thousands of them piled together would make a heap far too small to be visible to the naked eye. It cannot move about, nor can it grow without moisture, nor at a temperature much above or much below that of the human body. The material on which it feeds must be very nicely adapted to its requirements, and it has no lurking and growing places in nature outside of the bodies of men and a few warm-blooded animals. It can be cultivated artificially in the laboratory, and we know more about its life and peculiarities than about almost any other germ. While it can remain alive in a dried state for many weeks, it is readily killed by heat, by sunlight, and by many of those chemical substances which we call disinfectants. It does not flourish equally well in the bodies of all human beings. When once it gains lodgment in a body suited to its growth it multiplies slowly, each germ dividing and subdividing, taking from the tissues material for its growth, and returning to them certain subtle poisons which it sets free. The action of the tubercle bacillus is peculiar in that it stimulates the cells of the body, wherever it may lodge and grow, to the formation of little masses of new tissue, which we call tubercles. These tubercles are as a rule short-lived, and, if the disease progresses, tend to disintegrate. If the tubercles have grown in such situations as to make this possible, as in the intestinal canal or the lungs, the disintegrated and broken-down material, often containing myriads of the living germs, may be cast off from the body. In tuberculosis of the lungs, or consumption, this waste material is thrown off with the sputum [spittle]. While almost any part of the body may be affected, tuberculosis of the lungs is by far the most common form of the disease. It follows from what has been said that the only way in which we can acquire tuberculosis is by getting into our bodies tubercle bacilli from tuberculous men or animals. The only animals liable to convey the disease to man are tuberculous cattle, and these through the use of either meat or milk. The danger from the use of uncooked meat or the unboiled milk from tuberculous cattle is real and serious, but it will not be considered here at length, because the great and prevailing danger of infection comes from another source. Almost as soon as the significance of the tubercle bacillus was established, a series of studies was undertaken on the possibility of the spread of the disease by the breath or exhalations of the persons of consumptives. These studies at once showed that the tubercle bacillus cannot be given off into the air of the breath from the moist surfaces of the mouth and air passages, nor from any material which may come from them while this material remains moist, nor from healthy unsoiled surfaces of the body. The establishment of this fact is of far-reaching consequence, because it shows that neither the person nor the breath of the consumptive is a direct source of danger, even to the most constant and intimate attendants. While the discharges from the bowels in persons suffering from tuberculosis of the intestinal tract may contain many living bacilli, the usual mode of disposal of these discharges protects us from any considerable danger from this source. It is the sputum after its discharge from the body on which our attention must be fixed. While the sputum is moist it can, as a rule, do no harm, unless it should be directly transmitted to those who are well by violent coughing, sneezing, etc., by the use of uncleansed cooking or eating utensils, by soiled hands, or by such intimate personal contact as kissing or fondling. But if in any way the sputum becomes dried, on floors or walls or bedding, on handkerchiefs or towels, or on the person of the patient, it may soon become disseminated in the air as dust, and can thus be breathed into the lungs of exposed persons. The wide distribution of tubercle bacilli in the air of living-rooms, and in other dusty places where people go, is due partly to the frequency of the disease and the large numbers of living bacilli which are cast off in the sputum (sometimes millions in a day), and partly to the fact that many of the victims of consumption go about among their fellows for purposes of business or pleasure for months or years. So each consumptive, if not intelligently careful, may year after year be to his fellow-men a source of active and serious and continual infection. This, then, the dried, uncared-for sputum of those suffering from pulmonary tuberculosis, is the great source of danger; this the means so long concealed by which a large part of the human race prematurely perishes. Let but this discharged material be rendered harmless or destroyed before it dries in all cases, and the ravages of this scourge would largely cease. This is not a theoretic matter only, for again and again have the living and virulent germs been found clinging to the walls and furniture and bedding and handkerchiefs of consumptive persons, and in the dust of the rooms in which they dwell. A malady whose victims far outnumber those of all other infectious diseases put together, sparing neither rich nor poor, seizing upon life while it is as yet only a promise, but most inexorable in the fulness of its tide--this malady can be largely prevented by the universal and persistent practice of intelligent cleanliness. We have learned in the past few years one fact about tuberculosis which is of incalculable comfort to many, and that is that the disease is not hereditary. It is very important that we should understand this, because it seems to contradict a long-prevalent tradition, and a belief still widely and sorrowfully entertained. Bacteria, and especially most disease-producing bacteria, are very sensitive in the matter of growth and reproduction to the conditions under which they are placed, and especially to the material on which they feed. So that a germ which can induce serious disease in one species of animal is harmless in the body of a different though closely allied form. More than this, different individuals of the same species, or the same individual at different times, may have the most marked differences in susceptibility in the presence of disease-producing germs. What this subtle difference is we do not know. Whether the body at one time affords a congenial soil to the invading germs and at another does not, whether its marvelous and complex powers of resisting the virulent tendencies of disease-producing bacteria at one period or in one individual are more vigorous than in another, and vary at different times, we do not certainly know. This, however, we do know, that certain individuals are more likely than others to yield to the incursions of the tubercle bacillus. This vulnerability in the presence of invading germs we call susceptibility, and susceptibility to the action of the tubercle bacillus is hereditary. It is not the disease, tuberculosis, which comes into the world with certain individuals or with successive children of the same family, but the aptitude to contract it should external conditions favour. What subtle impress on the cells which are to develop into the new individual renders him more than another an easy prey to the tubercle bacillus should it later find lodgment in his body we do not know, and we may not hope soon to be enlightened, since all the intricate mysteries of heredity seem involved in the problem. But this we do know, that how ever much the child of tuberculous parents or a member of a tuberculous family may be predisposed to the disease, he cannot acquire tuberculosis unless by some mischance the fateful germ enters his body from without. What has been all through these years regarded as the strongest proof of the hereditary transmission of tuberculosis--namely, the occurrence of the disease in several members of the same household--is, in the new light, simply the result of household infection--the breathing of air especially liable to contain the noxious germs, or their entrance in some other way into the bodies of persons especially sensitive to their presence. I do not mean to imply that under no conditions can the tubercle bacillus be transmitted from the mother to the child before its birth. In a few instances this is believed to have happened. But its occurrence is so extremely infrequent that it may be regarded as accidental, and of no serious importance from our present point of view. But it will perhaps be said, "If the tubercle bacilli are so widely diffused, why do we not all acquire tuberculosis, and why was the world not long since depopulated?" In order to explain this matter I must ask the reader to look with me for a moment at some of the body's natural safeguards against bacterial and other invaders from the air. It has been found that a person breathing in germ and dust-laden air through the nose breathes out again air which is both dust and germ free. The air passages of the nose are tortuous, and lined with a moist membrane, against which the air impinges in its passage. On these moist surfaces most of the solid suspended particles, the germs among them, are caught and held fast, and may be thrown off again by secretion. In breathing through the mouth this safeguard is not utilized. Again, the upper passages leading to the lungs are lined with a delicate membrane of cells, whose free surfaces are thickly beset with tiny hairlike projections. These projections are constantly moving back and forth with a quick sweep, in such a way that they carry small particles which may have escaped the barriers above up into the mouth, from which they may be readily discharged. In this way much of the evil of breathing dust and germ-laden air is averted. But in spite of these natural safeguards a great deal of foreign material does, under the ordinary conditions of life indoors or in dusty places, find lodgment in the delicate recesses of the lungs. The body tolerates a good deal of the deleterious material, but its overtasked toleration fails at last, when serious disease may ensue. When ordinary forms of living bacteria get into the tissues of the body, a very complex cellular mechanism, not fully understood, usually results in their destruction and ultimate removal. In the presence of the tubercle bacillus the body cells are often able to build a dense enclosing wall around the affected region, shutting it off from the rest of the body. This is one of the modes of natural cure. The body cells are sometimes able, if sustained by nourishing food and an abundance of fresh air, to carry on, year after year, a successful struggle with the invading germs, so that the usefulness and enjoyment of life are but little interfered with. Finally, a certain proportion of human beings seem to be endowed at birth with some as yet unknown quality in the cells or fluids of the body which naturally unfits them for the life uses of the tubercle bacillus, and so renders the individual for longer or shorter periods practically immune. Others, on the contrary, are, as we have seen, from birth unusually susceptible. This inherited susceptibility to the incursions of the tubercle bacillus, should this find lodgment in the body from without, by no means always reveals itself in any apparent lack of vigour or robustness of the body. Still, any habit or mode of life which diminishes the bodily vigour, whether in those predisposed to this malady or in the apparently immune, and gives it a leaning toward disease, diminishes, as a rule, the chances of a successful contest with the bacillus. And so it is that in spite of the wide distribution of these fateful germs in frequented places, and the tendency of certain vulnerable persons to succumb to their ravages, so many people are not affected by them, and so many, although not altogether escaping their malign influence, are yet able to wrest at least a moiety of life from the hand of the great destroyer. The degree of success which may attend our crusade against tuberculosis will largely depend upon the wide diffusion of the knowledge of its communicability by means of the sputum dried and powdered and floating in the air as dust, and the intelligent persistence with which the morbid material may be safely cared for at its sources. The resolute avoidance by consumptives of the not only filthy but dangerous practice of spitting upon floors or streets, or anywhere else except into proper receptacles; the use of receptacles which may be and are frequently and thoroughly cleansed, and, best of all, of water-proof paper cups, which with their contents may be burned; or, when circumstances require, the receiving of the dangerous material on cloths or Japanese paper napkins, which may be destroyed by fire, and not on more valuable handkerchiefs on which the sputum is allowed to dry while in use or before disinfection and washing; scrupulous care by others of the sputum of those too ill to care for it themselves--these are the comparatively simple means from which we may most confidently expect relief. The details of these precautions and their adaptation to the special circumstances of those suffering from the disease can be most wisely left to the physician, and though of paramount importance, need not further engage our attention here. To the consumptive himself these measures are not without a vital significance. For his chances of recovery may be in no small degree diminished if he be more or less constantly liable to a fresh infection from material which he has once got rid of, and which should have been destroyed. The great volumes of fresh, moving air which we encounter out-of-doors in properly cleansed streets usually so greatly dilutes the dust, of whatever kind, that little apprehension need be felt from its presence. When, however, in crowded cities, the streets are, as is nearly always the case, save for a few favored localities, filthy, and but fitfully cared for; when choking dust clouds must be encountered by the citizen during the haphazard and slatternly essays at cleaning made by untrained and irresponsible sweepers; we cannot ignore a danger from street dust which may well incite grave apprehension. The citizen can, if he must, run from the presence of cloud-enwrapped machines furiously whirled along half-sprinkled pavements; he may avoid a block on which the hand-sweepers, in the absence or in disregard of rules, ply their nefarious brooms over unwet surfaces, because too indolent or indifferent to sprinkle them--these things he can do if he be not willing or ready to apply the citizen's remedy for municipal misrule. But it is in rooms either of dwelling or assembling places that the ill effects of infectious dust are most potent, because the air is here not so constantly renewed as it is out-of-doors, and is liable to be breathed over and over again. Dust which gets into houses does not readily leave them, unless special and intelligent means be directed to its removal. We do not usually realize that, though the air itself in inhabited rooms is constantly changing more or less rapidly by diffusion, by draughts, or by purposed ventilation, fine dust particles are not removed under the same influences in proportionate degree. They cling more or less tenaciously to all surfaces on which they have settled, and especially to fabrics, so that currents of abundant force and sufficient distribution to change the air may and usually do leave the lodged dust particles almost entirely undisturbed. One of the most threatening tendencies of modern times in matters of health is that of overcrowding in cities, and the great element of danger from this overcrowding is not only and not chiefly the insufficiency of air in living-rooms and the lack of ready means for its renewal, but the accumulation in this air of infectious germs floating with the dust. Abundant water supply and good sewerage have rendered possible and measurably safe, so far as the ordinary waste of life is concerned, the building of vast tenements which swarm with people. But the means of getting pure air, and especially of disposing of infectious material often floating in it when it is confined, have not at all kept pace with the demands of health and cleanliness. But when we return to larger and more liberally furnished dwellings of the well-to-do classes, we are not reassured, for in some respects the rich are sadly handicapped by the "tyranny of things." Of course, long and thick piled carpets afford persistent lurking-places for infectious as well as other dust. Certainly heavy hangings in a measure hinder the detergent action of the sunlight, shut the used air in and the fresh air out, and shelter floating matter which might otherwise escape. Without doubt, complex upholstery with roughened fabrics increases the difficulties in the maintenance of cleanliness. But the usage of the householder in these matters will, after all, depend upon whether his practical devotion be most at Fashion's or Hygeia's shrine. We may hope for the coming of a time when clean, clear, airy, simply furnished living-rooms shall replace the stuffy, fabric strewn apartments in which the fashionable citizen so much delights to-day. In one particular, however, the devotion to cleanliness may be unreservedly insistent, and that is that in the cleaning of living-rooms, whether occupied by the sick or the well, the distinct and recognized purpose of the operation shall be to remove, and not simply to stir up, the ever-gathering dust. The past few years, so beneficently signalized by the exploitation of the new germ lore, have seen marked departures from the traditional sweepings and dustings of a past era; and the emancipation of the housekeeper, and incidentally of the household, from the thrall of the pestiferous feather duster seems fairly under way. Still, some of the old barbarous travesties upon cleaning widely persist. The dry broom still seeks out in the deep recesses of the carpets not the coarser particles of dirt alone, but the hordes of living germs which were for the time safely ensconced, and among these such malignant forms as the chances of the day have gathered. These all are set awhirl in the air; some collect upon salient points of the fittings and furnishings; many stay with the operator, to vex for hours the delicate breathing passages or the deeper recesses of the lungs. Then in the lull which follows, gravity reasserts its sway, and the myriad particles, both the living and the dead, slowly settle to the horizontal surfaces, especially to the carpets. Then the feather duster comes upon the scene, and another cyclone befalls. The result of it all is that the dust has finally been forced to more or less completely abandon the smooth and shining surfaces where it would be visible, and is largely caught in the surface roughness of the carpets or upholstery or hangings, ready at the lightest footfall or the chariest touch to dance into the air again, and be taken into the lungs of the victims of the prevailing delusion--the delusion that the way to care for always obnoxious and offensive and often dangerous dust is not to get it out of the house, but to keep it stirring in the air until at last it has settled where it does not vex the eye. By the use of moist tea leaves in the sweeping of carpets, by the use of soft-textured fabrics, frequently shaken out-of-doors, or by moist cloths or chamois in dusting, much useless dust-scattering may be avoided. But no matter what the means employed, the final purpose of every household cleaning should be to get the dust, not afloat, but away. Probably the most serious source of infection which one is liable to encounter in the usual ways of life is the occupancy at hotels of bed-rooms vacated by consumptives without subsequent efficient cleansing, and travel in sleeping cars. I need not enter here into the harrowing details of desperate uncleanness which the ordinary railway travel brings to light. It is to be hoped that popular demand for reform in the routine of hotel-keepers and railroad managers in the matter of ordinary sweeping and dusting, and in the precautions against the spread of tuberculosis, may soon usher in among them a day of reasonable sanitary intelligence. A belief in the communicability of tuberculosis is becoming widely diffused, and it would seem to be desirable, on the ground of policy alone, for the managers of summer, and especially of winter resorts frequented by consumptives, to let it be known in no uncertain way that their precautions against the spread of infectious diseases are effectually in line with the demands of modern sanitary science. The members of families bearing a hereditary susceptibility to the acquirement of this disease should strive to foster those conditions which favour a healthy, vigorous life in occupation, food, exercise and amusement and remember that for them more than for others it is important to avoid such occupations and places as favour the distribution, in the air or otherwise, of the tubercle bacillus. But when the individual has done what he can in making his surroundings clean, and in thus limiting the spread of the tubercle bacillus, there still remains work for municipal and State and national authorities in diffusing the necessary knowledge of the disease and its modes of prevention; in directly caring for those unable to care for themselves; in securing for all such freedom from contact with sources of the disease as the dictates of science and humanity may require. To health boards, either national or local, must be largely entrusted the primary protection of the people against the danger from tuberculous cattle. A national bureau of health might be of incalculable service in stimulating and harmonizing measures for the suppression of tuberculosis in various parts of the land, and in fostering research in lines which promise large practical return in the saving of life. Tuberculosis has in this country been officially almost entirely ignored in those practical measures which health boards universally recognize as efficient in the suppression of this class of maladies. Physicians are not now generally required to report it to the local health boards. Systematic official measures of disinfection are not widely practised. But such official measures have been found extremely useful in the limitation of other communicable diseases. While consumption must logically be classed with diphtheria and scarlatina and small-pox as a communicable germ disease, it is, in fact, in the light of our present knowledge, when intelligently cared for, so little liable to spread that it is properly exempt from some of those summary measures which health authorities are justified in adopting with the more readily and less avoidably communicable maladies. Moreover, consumption is apt to involve such prolonged illness, and so often permits affected persons for months and years to go about their usual avocations, that general isolation would be both impracticable and inhumane. Moreover, for reasons which it is hoped are evident to the reader, isolation among those capable of caring for themselves is at present entirely unnecessary. But while extreme measures are not called for, local health boards must soon act in the prevention of tuberculosis. For the present the wisest and most humane course would seem to be to attempt to secure the desired ends rather by instruction and counsel and help than by direct and summary procedures. There is no more pitiable spectacle in this land to-day than that of hundreds of victims of advanced tuberculosis in every large town who cannot be comfortably or safely cared for in the dwellings of the poor, and yet who are always unwelcome applicants at most of our hospitals and at many are denied admission altogether. They are victims of ignorance and of vicious social and hygienic conditions for which they are not largely responsible, and States and municipalities, which are most to blame, owe them at least a shelter and a place to die. Unquestionably one of the urgent duties immediately before us in all parts of the land where tuberculosis prevails is the establishment of special hospitals in which this disease can be treated and its victims safely cared for. And now at last remains to be spoken what word of cheer and hope our new outlooks may have given us for those who are already under the shadow of this sorrowful affliction. The dreams and aspirations and strenuous labours of the students of this disease have looked steadily toward the discovery of some definite and positive means of cure, but as yet full success lingers beyond their grasp. The methods for the early detection of tuberculosis which science has pointed out make it possible for affected persons to plan such modes of life and early seek such salubrious climates as promise a hope of recovery. We have studied closely the ways in which the cells of the body often successfully resist the incursions of the already seated germs, and learned how in many ways the natural forces of cure may be sustained and strengthened. We have learned much about certain complicating occurrences which often form the most serious features in the progress of tuberculosis of the lungs, and how they may be best avoided. And so to-day the outlook for those in the earlier stages of this disease is in a considerable proportion of cases extremely encouraging. It is no longer for us the hopeless malady which it was earlier believed to be. It is not necessarily a bitter losing fight upon which one enters who becomes aware that the finger of this disease is upon him. A long and happy and useful life may still be his if the conditions which favour his cure be early and intelligently fixed upon, and patiently and faithfully persisted in. The wise physician is here the best adviser in climate and regimen, as well as in the proper selection of remedial measures, and the earlier his counsel is sought and acted on, the brighter will usually be the outlook for recovery. Research in tuberculosis and the ministration of the physician should, and generally do, go hand in hand, and no time should be lost in bringing to the aid of the stricken what light and promise the studies of the laboratory day by day may yield. The great and beneficent work which has been accomplished by Trudeau in the Adirondack woods, in at once widening the bounds of knowledge of tuberculosis and in carrying to a successful issue in so many the varied and delicate processes of cure, is a cheering example of what may be accomplished with persistent devotion, by the light of our new knowledge, in mastering a malady so long considered hopeless. MALARIA AND MOSQUITOES GEORGE M. STERNBERG, M.D., LL.D. [Dr. Sternberg, Surgeon-General of the United States Army, is an investigator and author of distinction. His works include a "Manual of Bacteriology," a "Text-Book of Bacteriology," and "Immunity, Protective Inoculations and Serum-Therapy," all published by William Wood & Co., New York. The address which follows was delivered by Dr. Sternberg as president of the Philosophical Society of Washington, December 8, 1900. It appeared in the _Popular Science Monthly_, February, 1901, copyright, and is here reprinted by the kind permission of the editor of the _Monthly_ and the author. A book well worth reading in this connection is "Mosquitoes," by Leland O. Howard, Chief of the Division of Entomology, United States Department of Agriculture, Washington, D. C., and published by McClure, Phillips & Co., New York.] In my address as President of the Biological Society, in 1896, the subject chosen was "The Malarial Parasite and Other Pathogenic Protozoa." This address was published in March, 1897, in the _Popular Science Monthly_, and I must refer you to this illustrated paper for a detailed account of the morphological character of the malarial parasite. It is my intention at the present time to speak of "Malaria" in a more general way, and of the recent experimental evidence in support of Manson's suggestion, first made in 1894, that the mosquito serves as an intermediate host for the parasite. The discovery of this parasite may justly be considered one of the greatest achievements of scientific research during the nineteenth century. Twenty-five years ago the best informed physicians entertained erroneous ideas with reference to the nature of malaria and the etiology [inquiry into the causes] of the malarial fevers. Observation has taught them that there was something in the air in the vicinity of marshes in tropical regions, and during the summer and autumn in semi-tropical and temperate regions, which gave rise to periodic fevers in those exposed in such localities, and the usual inference was that this something was of gaseous form--that it was a special kind of bad air generated in swampy localities under favourable meteorological conditions. It was recognized at the same time that there are other kinds of bad air, such as the offensive emanations from sewers and the products of respiration of man and animals, but the term malaria was reserved especially for the kind of bad air which was supposed to give rise to the so-called malarial fevers. In the light of our present knowledge it is evident that this term is a misnomer. There is no good reason for believing that the air of swamps is any more deleterious to those who breathe it than the air of the sea coast or that in the vicinity of inland lakes and ponds. Moreover, the stagnant pools, which are covered with a "green scum" and from which bubbles of gas are given off, have lost all terrors for the well-informed man, except in so far as they serve as breeding places for mosquitoes of the genus _Anopheles_. The green scum is made up of harmless algæ such as Spirogyra, Zygnema Protococcus, Euglena, etc.; and the gas which is given off from the mud at the bottom of such stagnant pools is for the most part a well-known and comparatively harmless compound of hydrogen and carbon--methane or "marsh gas." In short, we now know that the air in the vicinity of marshes is not deleterious because of any special kind of bad air present in such localities, but because it contains mosquitoes infected with a parasite known to be the specific cause of the so-called malarial fevers. This parasite was discovered in the blood of patients suffering from intermittent fevers by Laveran, a surgeon in the French army, whose investigations were conducted in Algiers. This famous discovery was made toward the end of the year 1880, but it was several years later before the profession generally began to attach much importance to the alleged discovery. It was first confirmed by Richard in 1882; then by the Italian investigators, Marchiafava, Celli, Golgi and Bignami; by Councilman, Osier and Thayer in this country, and by many other competent observers in various parts of the world. The Italian investigators named not only confirmed the presence of the parasite discovered by Laveran in the blood of those suffering from malarial fevers, but they demonstrated its etiological rôle by inoculation experiments and added greatly to our knowledge of its life history (1883-1898). The fact that the life history of the parasite includes a period of existence in the body of the mosquito, as an intermediate host, has recently been demonstrated by the English army surgeons Manson and Ross, and confirmed by numerous observers, including the famous German bacteriologist, Koch. The discoveries referred to, as is usual, have had to withstand the criticism of conservative physicians, who, having adopted the prevailing theories with reference to the etiology of periodic fevers, were naturally skeptical as to the reliability of the observations made by Laveran and those who claimed to have confirmed his discovery. The first contention was that the bodies described as present in the blood were not parasites, but deformed blood corpuscles. This objection was soon set at rest by the demonstration, repeatedly made, that the intra-corpuscular forms underwent distinct amoeboid movements [resembling those of the amoeba, a jelly-like organism of simple type]. No one witnessing these movements could doubt that he was observing a living micro-organism. The same was true of the extra-corpuscular flagellate bodies [resembling a whip-lash], which may be seen to undergo very active movements, as a result of which the red blood corpuscles are violently displaced and the flagellate body itself dashes about in the field of view. The first confirmation in this country of Laveran's discovery of amoeboid parasites in the blood of malarial fever patients was made by myself in the pathological laboratory of the Johns Hopkins University in March, 1886. In May, 1885, I had visited Rome as a delegate to the International Sanitary Conference, convened in that city under the auspices of the Italian Government, and while there I visited the Santo Spirito Hospital for the purpose of witnessing a demonstration, by Drs. Marchiafava and Celli, of that city, of the presence of the _plasmodium malariæ_ in the blood of persons suffering from intermittent fever. Blood was drawn from the finger during the febrile [feverish] attack and from individuals to whom quinine had not been administered. The demonstration was entirely satisfactory, and no doubt was left in my mind that I saw living parasitic micro-organisms in the interior of red blood corpuscles obtained from the circulation of malarial fever patients. The motions were quite slow, and were manifested by a gradual change of outline rather than by visible movement. After a period of amoeboid activity of greater or less duration, the body again assumed an oval or spherical form and remained quiescent for a time. While in this form it was easily recognized, as the spherical shape caused the light passing through it to be refracted and gave the impression of a body having a dark contour and a central vacuole [minute cavity]; but when it was flattened out and undergoing amoeboid changes in form, it was necessary to focus very carefully and to have a good illumination in order to see it. The objective used was a Zeiss's one-twelfth inch homogeneous oil immersion. But, very properly, skepticism with reference to the causal relation of these bodies to the disease with which they are associated was not removed by the demonstration that they are in fact blood parasites, that they are present in considerable numbers during the febrile paroxysms. These facts, however, give strong support to the inference that they are indeed the cause of the disease. This inference is further supported by the evident destruction of red blood corpuscles by the parasite, as shown by the presence of grains of black pigment in the amoeba-like micro-organisms observed in these corpuscles and the accumulation of this insoluble blood pigment in the liver and spleen of those who have suffered repeated attacks of intermittent fever. The enormous loss of red blood corpuscles as a result of such attacks is shown by the anæmic condition of the patient and also by actual enumeration. According to Kelsch, a patient of vigorous constitution in the first four days of a quotidian [daily recurrent] intermittent fever, or a remittent of first invasion, may suffer a loss of 2,000,000 red blood corpuscles per cubic millimeter of blood, and in certain cases a loss of 1,000,000 has been verified at the end of twenty-four hours. In cases of intermittent fever having a duration of twenty to thirty days the number of red blood cells may be reduced from the normal, which is about 5,000,000 per cubic millimeter, to 1,000,000 or even less. In view of this destruction of the red blood cells and the demonstrated fact that a certain number, at least, are destroyed during the febrile paroxysms by a blood parasite, which invades the cells and grows at the expense of the continued hæmoglobin [the red substance in the blood], it may be thought that the etiological rôle of the parasite should be conceded. But scientific conservatism demands more than this, and the final proof has been afforded by the experiments of Gerhardt and of Marchiafava and Celli--since confirmed by many others. This proof consists in the experimental inoculation of healthy individuals with blood containing the parasite and the development of a typical attack of periodic fever as a result of such inoculation. Marchiafava and Bignami, in their elaborate article upon "Malaria," published in the _Twentieth Century Practice of Medicine_, say: "The transmission of the disease occurs equally whether the blood is taken during the apyretic [aguish] period or during a febrile [feverish] paroxysm, whether it contains young parasites or those in process of development, or whether it contains sporulation [minute spore-like] forms. Only the crescent forms, when injected alone, do not transmit the infection, as has been demonstrated by Bastianelli, Bignami and Thayer, and as can be readily understood when we remember the biological significance of these forms. "In order that the disease be reproduced in the inoculated subject it is not necessary to inject the malarial blood into a vein of the recipient, as has been done in most of the experiments; a subcutaneous injection is all-sufficient. Nor is it necessary to inject several cubic centimeters, as was done especially in the earlier experiments; a fraction of a cubic centimeter will suffice, and even less than one drop, as Bignami has shown." After the inoculation of a healthy individual with blood containing the parasite a period varying from four to twenty-one days elapses before the occurrence of a febrile paroxysm. This is the so-called period of incubation, during which, no doubt, the parasite is undergoing multiplication in the blood of the inoculated individual. The duration of this period depends to some extent upon the quantity of blood used for the inoculation and its richness in parasites. It also depends upon the particular variety of the parasite present, for it has been ascertained that there are at least three distinct varieties of the malarial parasite--one which produces the quartan type of fever, in which there is a paroxysm every third day and in which, in experimental inoculations made, the period of incubation has varied from eleven to eighteen days; in the tertian type, or second day fever, the period of incubation noted has been from nine to twelve days; and in the æstivo-autumnal type the duration has usually not exceeded five days. The parasite associated with each of these types of fever may be recognized by an expert, and there is no longer any doubt that the difference in type is due to the fact that different varieties or "species" of the malarial parasite exist, each having a different period of development. Blood drawn during a febrile paroxysm shows the parasite in its different stages of intra-corpuscular development. The final result of this development is a segmenting body, having pigment granules at its center, which occupies the greater part of the interior of the red corpuscle. The number of segments into which this body divides differs in the different types of fever, and there are other points of difference by which the several varieties may be distinguished one from the other, but which it is not necessary to mention at the present time. The important point is that the result of the segmentation of the adult parasites contained in the red corpuscles is the formation of a large number of spore-like bodies, which are set free by the disintegration of the remains of the blood corpuscles and which constitute a new brood of reproductive elements, which in their turn invade healthy blood corpuscles and effect their destruction. This cycle of development without doubt accounts for the periodicity of the characteristic febrile paroxysms; and, as stated, the different varieties complete their cycle of development in different period of time, thus accounting for the recurrence of the paroxysms at intervals of forty-eight hours, in one type of fever, and of three days in another type. When a daily paroxysm occurs, this is believed to be due to the alternate development of two groups of parasites of the tertian variety, as it has not been possible to distinguish the parasite found in the blood of persons suffering from a quotidian form of intermittent fever from that of the tertian form. Very often, also, the daily paroxysm occurs on succeeding days at a different hour, while the paroxysm every alternate day at the same hour is a fact which sustains the view that we have to deal, in such cases, with two broods of the tertian parasite which mature on alternate days. In other cases there may be two distinct paroxysms on the same day, and none on the following day, indicating the presence of two broods of tertian parasites maturing at different hours every second day. The hypothesis that malarial infection results from the bites of mosquitoes was advanced and ably supported by Dr. A. F. A. King, of Washington, D. C., in a paper read before the Philosophical Society on February 10, 1883, and published in the _Popular Science Monthly_ in September of the same year. In 1894, Manson supported the same hypothesis in a paper published in the _British Medical Journal_ (December 8), and the following year (1895) Ross made the important discovery that when blood containing the crescentic bodies was ingested by the mosquito, these crescents rapidly underwent changes similar to those heretofore described, resulting in the formation of motile [spontaneously moving] filaments, which become detached from the parent body and continue to exhibit active movements. In 1897, Ross ascertained, further, that when blood containing crescents was fed to a particular species of mosquito, living pigmented parasites could be found in the stomach walls of the insect. Continuing his researches with a parasite of the same class which is found in birds, and in which the mosquito also serves as an intermediate host, Ross found that this parasite enters the stomach wall of the insect, and, as a result of its development in that locality, forms reproductive bodies (sporozoites), which subsequently find their way to the venenosalivary [poisonous salivary] glands of the insect which is now capable of infecting other birds of the same species as that from which the blood was obtained in the first instance. Ross further showed that the mosquito which served as an intermediate host for this parasite could not transmit the malarial parasite of man or another similar parasite of birds (halteridium). These discoveries of Ross have been confirmed by Grassi, Koch and others, and it has been shown that the mosquitoes which serve as intermediate host for the malarial parasites of man belong to the genus _Anopheles_, and especially to the species known as _Anopheles claviger_. The question whether mosquitoes infected with the malarial parasite invariably become infected as a result of the ingestion [taking in] of human blood containing this parasite has not been settled in a definite manner, but certain facts indicate that this is not the case. Thus there are localities noted for being extremely dangerous on account of the malarial fevers contracted by those who visit them, which on this very account are rarely visited by man. Yet there must be a great abundance of infected mosquitoes in these localities, and especially in low swampy regions in the tropics. If man and the mosquitoes are alone concerned in the propagation of this parasite, how shall we account for the abundance of infected mosquitoes in uninhabited marshes? It appears probable that some other vertebrate animal serves in place of man to maintain the life cycle of the parasite, or that it may be propagated through successive generations of mosquitoes. It is well known that persons engaged in digging canals, railroad cuts, etc., in malarious regions are especially liable to be attacked with one or the other of the forms of malarial fever. This may be due to the fact that the digging operations result in the formation of little pools suitable for the development of the eggs of _Anopheles_, but another explanation has been offered. Ross and others have found in infected mosquitoes certain bodies, described by Ross as "black spores," which resist decomposition and which may be resting spores capable of retaining their vitality for a long time. The suggestion is that these "black spores" or other incysted [enclosed in a small vessel] reproductive bodies may have been deposited in the soil by mosquitoes long since defunct, "and that in moving the soil these dormant parasites are set at liberty, and so, in air, in water or otherwise, gain access to the workmen engaged" (Manson). This hypothesis is not supported by recent observations, which indicate that infection in man occurs only as a result of inoculation through the bite of an infected mosquito. The question is whether malarial fevers can be contracted in marshy localities independently of the mosquito, which has been demonstrated to be an intermediate host of the malarial parasite? Is this parasite present in the air or water in such localities as well as in the bodies of infected mosquitoes? Its presence has never been demonstrated by the microscope; but this fact has little value in view of the great variety of micro-organisms present in marsh water or suspended in the air everywhere near the surface of the ground, and the difficulty of recognizing the elementary reproductive bodies by which the various species are maintained through successive generations. It would appear that a crucial experiment for the determination of this question would be to expose healthy individuals in a malarious region and to exclude the mosquito by some appropriate means. This experiment has been made during the past summer, and the result up to the present time has been reported by Manson in the London _Lancet_ of September 29, 1900. Five healthy individuals have lived in a hut on the Roman Campagna since early in the month of July. They have been protected against mosquito bites by mosquito-netting screens in the doors and windows and by mosquito bars over the beds. They go about freely during the daytime, but remain in their protected hut from sunset to sunrise. At the time Manson made his report all these individuals remained in perfect health. It has long been known that labourers could come from the villages in the mountainous region near the Roman Campagna and work during the day, returning to their homes at night, without great danger of contracting the fever, while those who remained on the Campagna at night ran great risk of falling sick with fever, as a result of "exposure to the night air." What has already been said makes it appear extremely probable that the "night air," by itself, is no more dangerous than the day air, but that the real danger consists in the presence of infected mosquitoes of a species which seeks its food at night. As pointed out by King, in his paper already referred to, it has repeatedly been claimed by travelers in malarious regions that sleeping under a mosquito bar is an effectual method of prophylaxis [prevention] against intermittent fevers. That malarial fevers may be transmitted by mosquitoes of the genus _Anopheles_ was first demonstrated by the Italian physician Bignami, whose experiments were made in the Santo Spirito Hospital in Rome. The subjects of the experiment, with their full consent, were placed in a suitable room and exposed to the bites of mosquitoes brought from Maccarese, "a marshy place with an evil but deserved reputation for the intensity of its fevers." It has been objected to these experiments that they were made in Rome, at a season of the year when malarial fevers prevail to a greater or less extent in that city, but Marchiafava and Bignami say: "It is well known to all physicians here that, although there are some centers of malaria in certain portions of the suburbs, the city proper is entirely free from malaria, as long experience has demonstrated, and at no season of the year does one acquire the disease in Rome." In view of the objection made, a crucial experiment has recently been made in the city of London. The result is reported by Manson, as follows: "Mosquitoes infected with the parasite of benign tertian malarial fever were sent from Rome to England, and were allowed to feed upon the blood of a perfectly healthy individual (Dr. Manson's son, who had never had malarial disease). Forty mosquitoes, in all, were allowed to bite him between August 29 and September 12. On September 14 he had a rise of temperature, with headache and slight chilliness, but no organisms were found in his blood. A febrile paroxysm occurred daily thereafter, but the parasites did not appear in the blood until September 17, when large numbers of typical tertian parasites were found. They soon disappeared under the influence of quinine." We have still to consider the question of the transmission of malarial fevers by the ingestion of water from malarious localities. Numerous medical authors have recorded facts which they deemed convincing as showing that malarial fevers may be contracted in this way. I have long been of the opinion that while the observed facts may, for the most part, be authentic, the inference is based upon a mistake in diagnosis [determination]. That, in truth, the fevers which can justly be ascribed to the ingestion [taking into the body] of a contaminated water supply are not true malarial fevers--_i. e._, they are not due to the presence of the malarial parasite in the blood. This view was sustained by me, in my work on "Malaria and Malarial Diseases," published in 1883. The fevers supposed to have been contracted in this way are, as a rule, continued or remittent in character, and they are known under a variety of names. Thus we have "Roman fever," "Naples fever," "remittent fever," "mountain fever," "typhomalarial fever," etc. The leading physicians and pathologists, in regions where these fevers prevail, are now convinced that they are not malarial fevers, but are simply more or less typical varieties of typhoid fever, a disease due to a specific bacillus [minute comma-shaped plant], and which is commonly contracted as a result of the ingestion of contaminated water or food. The error in diagnosis, upon which the inference has been based that malarial fevers may be contracted through drinking water, has been widespread in this country, in Europe and in the British possessions in India. It vitiated our medical statistics of the Civil War and of the recent war with Spain. In my work already referred to, I say: "Probably one of the most common mistakes in diagnosis, made in all parts of the world where malarial and enteric [intestinal] fevers are endemic [characteristic of the locality], is that of calling an attack of fever, belonging to the last mentioned category, malarial remittent. This arises from the difficulties attending a differential diagnosis at the outset, and from the fact that having once made a diagnosis of malarial fever, the physician, even if convinced later that a mistake has been made, does not always feel willing to confess it. The case therefore appears in the mortality returns, if it prove fatal, or in the statistical reports of disease, if made by an army or navy surgeon, as at first diagnosed." THE ART OF PROLONGING LIFE ROBSON ROOSE, M.D. [Dr. Robson Roose, an eminent physician of London, is the author of standard works on Gout on Nerve Prostration, on Waste and Repair in Modern Life. The _Fortnightly Review_, 1889, contained the admirable article which follows: it is reprinted with the kind permission of the author and the editor.] The doctrine that a short life is a sign of divine favour has never been accepted by the majority of mankind. Philosophers have vied with each other in depicting the evils and miseries incidental to existence, and the truth of their descriptions has often been sorrowfully admitted, but they have failed to dislodge, or even seriously diminish, that desire for long life which has been deeply implanted within the hearts of men. The question whether life be worth living has been decided by a majority far too great to admit of any doubt upon the subject, and the voices of those who would fain reply in the negative are drowned amid the chorus of assent. Longevity, indeed, has come to be regarded as one of the grand prizes of human existence, and reason has again and again suggested the inquiry whether care or skill can increase the chances of acquiring it, and can make old age, when granted, as comfortable and happy as any other stage of our existence. From very early times the art of prolonging life, and the subject of longevity, have engaged the attention of thinkers and essayists; and some may perhaps contend that these topics, admittedly full of interest, have been thoroughly exhausted. It is true that the art in question has long been recognized and practiced, but the science upon which it really depends is of quite modern origin. New facts connected with longevity have, moreover, been collected within the last few years, and some of these I propose to examine, and further to inquire whether they teach us any fresh means whereby life may be maintained and prolonged. But, before entering upon the immediate subject, there are several preliminary questions which demand a brief examination, and the first that suggests itself is, What is the natural duration of human life? This oft-repeated question has received many different answers; and inquiry has been stimulated by skepticism as to their truth. The late Sir George Cornewall Lewis expressed the opinion that one hundred years must be regarded as a limit which very few, if indeed any, human beings succeed in reaching, and he supported this view by several cogent reasons. He pointed out that almost all the alleged instances of abnormal longevity occurred among the humbler classes, and that it was difficult, if not impossible, to obtain any exact information as to the date of birth, and to identify the individuals with any written statements that might be forthcoming. He laid particular stress upon the fact that similar instances were altogether absent among the higher classes, with regard to whom trustworthy documentary evidence was almost always obtainable. He thought that the higher the rank the more favourable would the conditions be for the attainment of a long life. In this latter supposition, however, Sir George Lewis was probably mistaken: the comforts and luxuries appertaining to wealth and high social rank are too often counterbalanced by cares and anxieties, and by modes of living inconsistent with the maintenance of health, and therefore with the prolongation of life. In the introduction to his work on "Human Longevity," Easton says, "It is not the rich or great ... that become old, but such as use much exercise, are exposed to the fresh air, and whose food is plain and moderate--as farmers, gardeners, fishermen, labourers, soldiers, and such men as perhaps never employed their thoughts on the means used to promote longevity." The French naturalist, Buffon, believed that if accidental causes could be excluded, the normal duration of human life would be between ninety and one hundred years, and he suggested that it might be measured (in animal as well as in man) by the period of growth, to which it stood in a certain proportion. He imagined that every animal might live for six or seven times as many years as were requisite for the completion of its growth. But this calculation is not in harmony with facts, so far, at least, as man is concerned. His period of growth cannot be estimated at less than twenty years; and if we take the lower of the two multipliers, we get a number which, in the light of modern evidence, can not be accepted as attainable. If the period of growth be multiplied by five, the result will in all probability not be far from the truth. If we seek historical evidence, and from it attempt to discover the extreme limit of human life, we are puzzled at the differences in the ages said to have been attained. The longevity of the antediluvian patriarchs when contrasted with our modern experience seems incredible. When we look at an individual, say ninety years of age, taking even the most favourable specimen, a prolongation of life to ten times that number of years would appear too absurd even to dream about. There is certainly no physiological reason why the ages assigned to the patriarchs should not have been attained, and it is useless to discuss the subject, for we know very little of the conditions under which they lived. It is interesting to notice that after the Flood there was a gradual decrease in the duration of life. Abraham is recorded to have died at one hundred and seventy-five; Joshua, some five hundred years later, "waxed old and stricken in age" shortly before his death at one hundred and ten years; and his predecessor, Moses, to whom one hundred and twenty years are assigned, is believed to have estimated the life of man at threescore years and ten--a measure nowadays pretty generally accepted. There is no reason for believing that the extreme limit of human life in the time of the Greeks and Romans differed materially from that which agrees with modern experience. Stories of the attainment of such ages as one hundred and twenty years and upward may be placed in the same category as the reputed longevity of Henry Jenkins, Thomas Parr, Lady Desmond, and a host of others. With regard to later times, such as the middle ages, there are no precise data upon which any statements can be based, but there is every reason to believe that the _average_ duration of life was decidedly less than it is at present. The extreme limit, indeed, three or four centuries ago, would appear to have been much lower than in the nineteenth century. At the request of Mr. Thoms, Sir J. Duffus Hardy investigated the subject of the longevity of man in the thirteenth, fourteenth, fifteenth, and sixteenth centuries, and his researches led him to believe that persons seldom reached the age of eighty. He never met with a trustworthy record of a person who exceeded that age. To bring the investigation down to quite recent times, I can not do better than utilize the researches of Dr. Humphry, Professor of Surgery at Cambridge. In 1886 he obtained particulars relating to fifty-two individuals then living and said to be one hundred years old and upward. The oldest among them claimed to be one hundred and eight, the next one hundred and six, while the average amounted to a little more than one hundred and two years. Many interesting facts connected with the habits and mode of life of these individuals were obtained by Dr. Humphry, and will be referred to in subsequent paragraphs. A short account of the experience of a few life-assurance companies will conclude this part of my subject. Mr. Thoms tells us that down to 1872 the records of the companies showed that one death among the assured had occurred at one hundred and three, one in the one hundredth, and three in the ninety-ninth year. The experience of the National Debt Office, according to the same authority, gave two cases in which the evidence could be regarded as perfect; one of these died in the one hundred and second year, and the other had just completed that number. In the tables published by the Institute of Actuaries, and giving the mortality experience down to 1863 of twenty life-assurance companies, the highest age at death is recorded as ninety-nine; and I am informed by the secretary of the Edinburgh Life Office that from 1863 onward that age had not been exceeded in his experience. In the valuation schedules, which show the highest ages of existing lives in various offices, the ages range from ninety-two to ninety-five. It is true that one office which has a large business among the industrial classes reports lives at one hundred and three, and in one instance at one hundred and seven; but it must be remembered that among those classes the ages are not nearly so well authenticated as among those who assure for substantial sums. There is, moreover, another source of error connected with the valuation schedules. When a given life is not considered to be equal to the average, a certain number of years is added to the age, and the premium is charged at the age which results from this addition. It follows, therefore, that in some cases the age given in the schedules are greater by some years than they really are. Taking into consideration the facts thus rapidly passed under review, it must, I think, be admitted that the natural limit of human existence is that assigned to it in the book of Ecclesiasticus, "The number of a man's days at the most are an hundred years" (chapter xviii. 9). In a very small number of cases this limit is exceeded, but only by a very few years. Mr. Thoms's investigations conclusively show that trustworthy evidence of one hundred and ten years having been reached is altogether absent. Future generations will be able to verify or reject statements in all alleged cases of longevity. It must be remembered that previous to the year 1836 there was no registration of births, but only of baptisms, and that the registers were kept in the churches, and contained only the names of those therein baptized. Whatever number of years may be taken as representing the natural term of human life, whether threescore and ten or a century be regarded as such, we are confronted by the fact that only one-fourth of our population attains the former age, and that only about fifteen in one hundred thousand become centenarians. It is beyond the scope of this article to discuss the causes of premature mortality, but the conditions favourable to longevity, and the causes to which length of days has been assigned, are closely connected with its subject. A capability of attaining old age is very often handed down from one generation to another, and heredity is probably the most powerful factor in connection with longevity. A necessary condition of reaching advanced age is the possession of sound bodily organs, and such an endowment is eminently capable of transmission. Instances of longevity characterizing several generations are frequently brought to notice. A recent and most interesting example of transmitted longevity is that of the veteran guardian of the public health, Sir Edwin Chadwick, who was entertained at a public dinner a few weeks ago on the occasion of his reaching his ninetieth year. He informed his entertainers that his father died at the age of eighty-four, one of his grandfathers at ninety-five, and that two more remote ancestors were centenarians. It is difficult to estimate the influence of other contingencies which affect longevity. With regard to sex, Hufeland's opinion was that women were more likely than men to become old, but that instances of extreme longevity were more frequent among men. This opinion is to some extent borne out by Dr. Humphry's statistics: of fifty-two centenarians, thirty-six were women. Marriage would appear to be conducive to longevity. A well-known French _savant_, Dr. Bertillon, states that a bachelor of twenty-five is not a better life than a married man of forty-five, and he attributes the difference in favour of married people to the fact that they take more care of themselves, and lead more regular lives than those who have no such tie. It must, however, be remembered that the mere fact of marrying indicates superior vitality and vigour, and the ranks of the unmarried are largely filled by the physically unfit. In considering occupations as they are likely to effect longevity, those which obviously tend to shorten life need not be considered. With respect to the learned professions, it would appear that among the clergy the average of life is beyond that of any similar class. It is improbable that this average will be maintained for the future; the duties and anxieties imposed upon the clergy of the present generation place them in a very different position from that of their predecessors. Among lawyers there have been several eminent judges who attained a great age, and the rank and file of the profession are also characterized by a decided tendency to longevity. The medical profession supplies but few instances of extreme old age, and the average duration of life among its members is decidedly low, a fact which can be easily accounted for. Broken rest, hard work, anxieties, exposure to weather and to the risks of infection can not fail to exert an injurious influence upon health. No definite conclusions can be arrived at with regard to the average longevity of literary and scientific men, but it might be supposed that those among them who are not harassed by anxieties and enjoy fair health would probably reach old age. As a general rule, the duration of life is not shortened by literary pursuits. A man may worry himself to death over his books, or, when tired of them, may seek recreation in pursuits destructive to health; but application to literary work tends to produce cheerfulness, and to prolong rather than shorten the life even of an infirm man. In Prof. Humphry's "Report on Aged Persons," containing an account of eight hundred and twenty-four individuals of both sexes, and between the ages of eighty and one hundred, it is stated that forty-eight per cent. were poor, forty-two per cent. were in comfortable circumstances, and only ten per cent. were described as being in affluent circumstances. Dr. Humphry points out that these ratios "must not be regarded as representing the relations of poverty and affluence to longevity, because, in the first place, the poor at all ages and in all districts bear a large proportion to the affluent; and, secondly, the returns are largely made from the lower and middle classes, and in many instances from the inmates of union work-houses, where a good number of aged people are found." It must also be noticed that the "past life-history" of these individuals showed that the greater proportion (fifty-five per cent.) "had lived in comfortable circumstances," and that only thirty-five per cent. had been poor. Merely to enumerate the causes to which longevity has been attributed in attempting to account for individual cases would be a task of some magnitude; it will be sufficient to mention a few somewhat probable theories. Moderation in eating and drinking is often declared to be a cause of longevity, and the assertion is fully corroborated by Dr. Humphry's inquiries. Of his fifty-two centenarians, twelve were recorded as total abstainers from alcoholic drinks throughout life, or for long periods; twenty had taken very little alcohol; eight were reported as moderate in their use of it; and only three habitually indulged in it. It is quite true that a few persons who must be classified as drunkards live to be very old; but these are exceptions to the general rule, and such cases appear to be more frequent than they really are, because they are often brought to notice by those who find encouragement from such examples. The habit of temperance in food, good powers of digestion, and soundness of sleep are other main characteristics of most of those who attain advanced years, and may be regarded as causes of longevity. Not a few old persons are found on inquiry to take credit to themselves for their own condition, and to attribute it to some remarkable peculiarity in their habits or mode of life. It is said that Lord Mansfield, who reached the age of eighty-nine, was wont to inquire into the habits of life of all aged witnesses who appeared before him, and that only in one habit, namely, that of early rising, was there any general concurrence. Health is doubtless often promoted by early rising, but the habit is not necessarily conducive to longevity. It is, as Sir H. Holland points out, more probable that the vigour of the individuals maintains the habit than that the latter alone maintains the vitality. If we pass from probable to improbable causes of longevity we are confronted by many extravagant assumptions. Thus, to take only a few examples, the immoderate use of sugar has been regarded not only as a panacea, but as decidedly conducive to length of days. Dr. Slare, a physician of the last century, has recorded the case of a centenarian who used to mix sugar with all his food, and the doctor himself was so convinced of the "balsamic virtue" of this substance that he adopted the practice, and boasted of his health and strength in his old age. Another member of the same profession used to take daily doses of tannin (the substance employed to harden and preserve leather), under the impression that the tissues of the body would be thereby protected from decay. His life was protracted beyond the ordinary span, but it is questionable whether the tannin acted in the desired direction. Lord Combermere thought that his good health and advanced years were due, in part at least, to the fact that he always wore a tight belt round his waist. His lordship's appetite was doubtless thereby kept within bounds; we are further told that he was very moderate in the use of all fluids as drink. Cleanliness might be supposed to aid in prolonging life, yet a Mrs. Lewson, who died in the early part of this century, aged one hundred and six, must have been a singularly dirty person. We are told that instead of washing she smeared her face with lard, and asserted that "people who washed always caught cold." This lady, no doubt, was fully persuaded that she had discovered the universal medicine. Many of the alchemists attributed the power of prolonging life to certain preparations of gold, probably under the idea that the permanence of the metal might be imparted to the human system. Descartes is said to have favoured such opinions; he told Sir Kenelm Digby that, although he would not venture to promise immortality, he was certain that his life might be lengthened to the period of that enjoyed by the patriarchs. His plan, however, seems to have been the very rational and simple one of checking all excesses and enjoining punctual and frugal meals. Having thus endeavoured to show the extent to which human life may be prolonged, and having examined some of the causes or antecedents of longevity, the last subject for inquiry is the means by which it may be attained. Certain preliminary conditions are obviously requisite; in the first place there must be a sound constitution derived from healthy ancestors, and in the second there must be a freedom from organic disease of important organs. Given an individual who has reached the grand climacteric, or threescore and ten, and in whom these two conditions are fulfilled, the means best adapted to maintain and prolong his life constitute the question to be solved. It has been said that "he who would long to be an old man must begin early to be one," but very few persons designedly take measures in early life in order that they may live longer than their fellows. The whole term of life may be divided into the three main periods of growth and development, of maturity, and of decline. No hard and fast line can be drawn between these two latter phases of existence: the one should pass gradually into the other until the entire picture is changed. Diminished conservative power and the consequent triumph of disintegrating forces are the prominent features of the third period, which begins at different times in different individuals, its advent being mainly controlled by the general course of the preceding years. The "turning period," also known as the "climacteric" or "middle age," lies between forty-five and sixty; the period beyond may be considered as belonging to advanced life or old age. The majority of the changes characteristic of these last stages are easily recognizable. It is hardly necessary to mention the wrinkled skin, the furrowed face, the "crow's feet" beneath the eyes, the stooping gait, and the wasting of the frame. The senses, notably vision and hearing, become less acute; the power of digestion is lessened; the force of the heart is diminished; the lungs are less permeable; many of the air-cells lose their elasticity and merge into each other, so that there is less breathing surface as well as less power. Simultaneously with these changes the mind may present signs of enfeeblement; but in many instances its powers long remain in marked contrast with those of the body. One fact connected with advanced life is too often neglected. It should never be forgotten that while the "forces in use" at that period are easily exhausted, the "forces in reserve" are often so slight as to be unable to meet the smallest demand. In youth, the reserve powers are superabundant; in advanced life, they are reduced to a minimum, and in some instances are practically non-existent. The recognition of this difference is an all-important guide in laying down rules for conduct in old age. In order to prolong life and at the same time to enjoy it, occupation of some kind is absolutely necessary; it is a great mistake to suppose that idleness is conducive to longevity. It is at all times better to wear out than to rust out, and the latter process is apt to be speedily accomplished. Every one must have met with individuals who, while fully occupied till sixty or even seventy years of age, remained hale and strong, but aged with marvelous rapidity after relinquishing work, a change in their mental condition becoming especially prominent. There is an obvious lesson to be learned from such instances, but certain qualifications are necessary in order to apply it properly. With regard to mental activity, there is abundant evidence that the more the intellectual faculties are exercised the greater the probability of their lasting. They often become stronger after the vital force has passed its culminating point; and this retention of mental power is the true compensation for the decline in bodily strength. Did space permit, many illustrations could be adduced to show that the power of the mind can be preserved almost unimpaired to the most advanced age. Even memory, the failure of which is sometimes regarded as a necessary concomitant of old age, is not infrequently preserved almost up to the end of life. All persons of middle age should take special pains to keep the faculties and energies of the mind in a vigorous condition; they should not simply drift on in a haphazard fashion, but should seek and find pleasure in the attainment of definite objects. Even if the mind has not been especially cultivated, or received any decided bent, there is at the present day no lack of subjects on which it can be agreeably and profitably exercised. Many sciences which, twenty or thirty years ago, were accessible only to the few, and wore at best a somewhat uninviting garb, have been rendered not merely intelligible but even attractive to the many; and in the domain of general literature the difficulty of making a choice among the host of allurements is the only ground for complaint. To increase the taste for these and kindred subjects is worth a considerable effort, if such be necessary; but the appetite will generally come with the eating. The possession of some reasonable hobby which can be cultivated indoors is a great advantage in old age, and there are many pursuits of this character besides those connected with literature and science. Talleyrand laid great stress on a knowledge of whist as indispensable to a happy old age, and doubtless to many old people that particular game affords not only recreation but a pleasant exercise to the mind. It is, however, an unworthy substitute for higher objects, and should be regarded only as an amusement and not as an occupation. Whatever be the sphere of mental activity, no kind of strain must be put upon the mind by a person who has reached sixty-five or seventy years. The feeling that mental power is less than it once was not infrequently stimulates a man to increased exertions which may provoke structural changes in the brain, and will certainly accelerate the progress of any that may exist in that organ. When a man finds that a great effort is required to accomplish any mental task that was once easy, he should desist from the attempt, and regulate his work according to his power. With this limitation, it may be taken for granted that the mental faculties will be far better preserved by their exercise than by their disuse. Somewhat different advice must be given with regard to bodily exercises in their reference to longevity. Exercise is essential to the preservation of health; inactivity is a potent cause of wasting and degeneration. The vigour and equality of the circulation, the functions of the skin, and the aeration of the blood, are all promoted by muscular activity, which thus keeps up a proper balance and relation between the important organs of the body. In youth, the vigour of the system is often so great that if one organ be sluggish another part will make amends for the deficiency by acting vicariously, and without any consequent damage to itself. In old age, the tasks can not be thus shifted from one organ to another; the work allotted to each sufficiently taxes its strength, and vicarious action can not be performed without mischief. Hence the importance of maintaining, as far as possible, the equable action of all the bodily organs, so that the share of the vital processes assigned to each shall be properly accomplished. For this reason exercise is an important part of the conduct of life in old age; but discretion is absolutely necessary. An old man should discover by experience how much exercise he can take without exhausting his powers, and should be careful never to exceed the limit. Old persons are apt to forget that their staying powers are much less than they once were, and that, while a walk of two or three miles may prove easy and pleasurable, the addition of a return journey of similar length will seriously overtax the strength. Above all things, sudden and rapid exertion should be scrupulously avoided by persons of advanced age. The machine which might go on working for years at a gentle pace often breaks down altogether when its movements are suddenly accelerated. These cautions may appear superfluous, but instances in which their disregard is followed by very serious consequences are by no means infrequent. No fixed rule can be laid down as to the kind of exercise most suitable for advanced age. Much must depend upon individual circumstances and peculiarities; but walking in the open air should always be kept up and practiced daily, except in unfavourable weather. Walking is a natural form of exercise and subserves many important purposes: not a few old people owe the maintenance of their health and vigour to their daily "constitutional." Riding is an excellent form of exercise, but available only by a few; the habit, if acquired in early life, should be kept up as long as possible, subject to the caution already given as to violent exercise. Old persons of both sexes fond of gardening, and so situated that they may gratify their tastes, are much to be envied. Body and mind are alike exercised by what Lord Bacon justly termed "the purest of human pleasures." Dr. Parkes goes so far as to say that light garden or agricultural work is a very good exercise for men past seventy: "It calls into play the muscles of the abdomen and back, which in old men are often but little used, and the work is so varied that no muscle is kept long in action." A few remarks must be made, in conclusion, with regard to a new form of exercise sometimes indulged in even by elderly men. I allude to so-called "tricycling." Exhilarating and pleasant as it may be to glide over the ground with comparatively little effort, the exercise is fraught with danger for men who have passed the grand climacteric. The temptation to make a spurt must be often irresistible; hills must be encountered, some perhaps so smooth and gradual as to require no special exertion, none, at least, that is noticed in the triumph of surmounting them. Now, if the heart and lungs be perfectly sound, such exercises may be practiced for some time with _apparent_ impunity; but if (as is very likely to be the case) these organs be not quite structurally perfect, even the slightest changes will, under such excitement, rapidly progress and lead to very serious results. Exercise unsuited to the state of the system will assuredly not tend to the prolongation of life. With regard to food, we find from Dr. Humphry's report that ninety per cent. of the aged persons were either "moderate" or "small" eaters, and such moderation is quite in accord with the teachings of physiology. In old age the changes in the bodily tissues gradually become less and less active, and less food is required to make up for the daily waste. The appetite and the power of digestion are correspondingly diminished, and although for the attainment of a great age a considerable amount of digestive power is absolutely necessary, its perfection, when exercised upon proper articles of diet, is the most important characteristic. Indulgence in the pleasures of the table is one of the common errors of advanced life, and is not infrequent in persons who, up to that period, were moderate or even small eaters. Luxuries in the way of food are apt to be regarded as rewards that have been fully earned by a life of labour, and may, therefore, be lawfully enjoyed. Hence arise many of the evils and troubles of old age, and notably indigestion and gouty symptoms in various forms, besides mental discomfort. No hard and fast rules can be laid down, but strict moderation should be the guiding maxim. The diet suitable for most aged persons is that which contains much nutritive material in a small bulk, and its quantity should be in proportion to the appetite and power of digestion. Animal food, well cooked, should be taken sparingly and not more often than twice a day, except under special circumstances. Dr. Parkes advocates rice as a partial substitute for meat when the latter is found to disagree with old persons. "Its starch-grains are very digestible, and it supplies nitrogen in moderate amount, well fitted to the worn and slowly repaired tissues of the aged." Its bulk, however, is sometimes a disadvantage; in small quantities it is a valuable addition to milk and to stewed fruits. The amount of food taken should be divided between three or four meals at fairly regular intervals. A sense of fullness or oppression after eating ought not to be disregarded. It indicates that the food taken has been either too abundant or of improper quality. For many elderly people the most suitable time for the principal meal is between 1 and 2 P. M. As the day advances the digestive powers become less, and even a moderately substantial meal taken in the evening may seriously overtask them. Undigested food is a potent cause of disturbed sleep, an evil often very troublesome to old people, and one which ought to be carefully guarded against. It is an easier task to lay down rules with regard to the use of alcoholic liquors by elderly people. The Collective Investigation Committee of the British Medical Association has lately issued a "Report on the Connection of Disease with Habits of Intemperance," and two at least of the conclusions arrived at are worth quoting: "Habitual indulgence in alcoholic liquors, beyond the most moderate amount, has a distinct tendency to shorten life, the average shortening being roughly proportional to the degree of indulgence. Total abstinence and habitual temperance augment considerably the chance of death from old age or natural decay, without special pathological lesion." Subject, however, to a few exceptions, it is not advisable that a man sixty-five or seventy years of age, who has taken alcohol in moderation all his life, should suddenly become an abstainer. Old age can not readily accommodate itself to changes of any kind, and to many old people a little good wine with their meals is a source of great comfort. To quote again from Ecclesiasticus, "Wine is as good as life to a man, if it be drunk moderately, for it was made to make men glad." Elderly persons, particularly at the close of the day, often find that their nervous energy is exhausted, and require a little stimulant to induce them to take a necessary supply of proper nourishment, and perhaps to aid the digestive powers to convert their food to a useful purpose. In the debility of old age, and especially when sleeplessness is accompanied by slow and imperfect digestion, a small quantity of a generous and potent wine, containing much ether, often does good service. Even a little beer improves digestion in some old people; others find that spirits, largely diluted, fulfill the same purpose. Individual peculiarities must be allowed for; the only general rule is that which prescribes strict moderation. It is not to be inferred from the hints given in the preceding paragraphs that the preservation of health should be the predominant thought in the minds of elderly persons who desire that their lives should be prolonged. To be always guarding against disease, and to live in a state of constant fear and watchfulness, would make existence miserable and hasten the progress of decay. Selfish and undue solicitude with regard to health not only fails to attain its object, but is apt to induce that diseased condition of mind known as hypochondriasis, ["the blues,"] the victims of which are always a burden and a nuisance, if not to themselves, at least to all connected with them. Addison, in the _Spectator_, after describing the valetudinarian who constantly weighed himself and his food, and yet became sick and languishing, aptly remarks, "A continual anxiety for life vitiates all the relishes of it, and casts a gloom over the whole face of nature, as it is impossible that we should take delight in anything that we are every moment afraid of losing." Sleep is closely connected with the question of diet; "good sleeping" was a noticeable feature in the large majority of Dr. Humphry's cases. Sound, refreshing sleep is of the utmost consequence to the health of the body, and no substitute can be found for it as a restorer of vital energy. Sleeplessness is, however, often a source of great trouble to elderly people, and one which is not easily relieved. Narcotic remedies are generally mischievous; their first effects may be pleasant, but the habit of depending upon them rapidly grows until they become indispensable. When this stage has been reached, the sufferer is in a far worse plight than before. In all cases the endeavour should be made to discover whether the sleeplessness be due to any removable cause--such as indigestion, cold, want of exercise, and the like. In regard to sleeping in the daytime, there is something to be said both for and against that practice. A nap of "forty winks" in the afternoon enables many aged people to get through the rest of the day in comfort, whereas they feel tired and weak when deprived of this refreshment. If they rest well at night there can be no objection to the afternoon nap; but if sleeplessness be complained of, the latter should be discontinued for a time. Most old people find that a reclining posture, with the feet and legs raised, is better than the horizontal position for the afternoon nap. Digestion proceeds with more ease than when the body is recumbent. Warmth is very important for the aged; exposure to chills should be scrupulously avoided. Bronchitis is the malady most to be feared, and its attacks are very easily provoked. Many old people suffer from more or less cough during the winter months, and this symptom may recur year after year, and be almost unheeded. At last, perhaps a few minutes' exposure to a cold wind increases the irritation in the lungs, the cough becomes worse, and the difficulty of breathing increases until suffocation terminates in death. To obviate such risk the skin should be carefully protected by warm flannel clothes, the outdoor thermometer should be noticed and winter garments should always be at hand. In cold weather the lungs should be protected by breathing through the nose as much as possible, and by wearing a light woolen or silken muffler over the mouth. The temperature of the sitting and bed-rooms is another point which requires attention. Some old people pride themselves on never requiring a fire in their bed-rooms. It is, however, a risky practice to exchange a temperature of 65° or 70° for one fifteen or twenty degrees lower. As a general rule, for persons sixty-five years of age and upward, the temperature of the bed-room should not be below 60°, and when there are any symptoms of bronchitis it should be raised from five to ten degrees higher. Careful cleansing of the skin is the last point which needs to be mentioned in an article like the present. Attention to cleanliness is decidedly conducive to longevity, and we may congratulate ourselves on the general improvement in our habits in this respect. Frequent washing with warm water is very advantageous for old people, in whom the skin is only too apt to become hard and dry; and the benefit will be increased if the ablutions be succeeded by friction with coarse flannel or linen gloves, or with a flesh-brush. Every part of the skin should be thus washed and rubbed daily. The friction removes worn-out particles of the skin, and the exercise promotes warmth and excites perspiration. Too much attention can hardly be paid to the state of the skin; the comfort of the aged is greatly dependent upon the proper discharge of its functions. Such, then, are the principal measures by which life may be prolonged and health maintained down to the closing scene. It remains to be seen whether, as a result of progress of knowledge and civilization, life will ever be protracted beyond the limit assigned to it in a preceding paragraph. There is no doubt that the _average duration_ of human life is capable of very great extension, and that the same causes which serve to prolong life materially contribute toward the happiness of mankind. The experience of the last few decades abundantly testifies to the marked improvement which has taken place in the public health. Statistics show that at the end of the septennial period, 1881-'87, 400,000 persons were alive in England and Wales whose death would have taken place had the mortality been in the same proportion as during the previous decade. It may be reasonably expected that as time goes on there will be an increase in the proportion of centenarians to the population as a whole. The question whether long life is, after all, desirable does not admit of any general answer. Much depends upon the previous history of the individual, and his bodily and mental condition. The last stages of a well spent life may be the happiest, the shuffling-off of the mortal coil, though calmly expected, need not be wished for. The picture afforded by cheerful and mellow old age is a lesson to younger generations. Elderly people may, if they choose, become centers of improving and refining influence. On the other hand, old age can not be regarded as a blessing when it is accompanied by profound decrepitude and disorder of mind and body. Senile dementia, or second childishness, is, of all conditions, perhaps the most miserable, though not so painful to the sufferer as to those who surround him. Its advent may be accelerated by ignorance and neglect, and almost assuredly retarded or prevented by such simple measures as have been suggested. No one who has had opportunities of studying old people can shut his eyes to the fact that many of the incapabilities of age may be prevented by attention to a few simple rules, the observance of which will not only prolong life and make it happier and more comfortable, but will reduce to a minimum the period of decrepitude. Old age may be an incurable disease, admitting of but one termination, but the manner of that end, and the condition which precedes it, are, though not altogether, certainly to a very great extent, within our own power. NATURAL LIFE AND DEATH: AND RULES FOR HEALTH BENJAMIN WARD RICHARDSON, M.D. [Dr. Richardson was an English physician of uncommon originality and ability. He founded and for some years edited the _Journal of Public Health_, chiefly directed toward the prevention of disease. In 1875 he created widespread interest by sketching an imaginary "Model City of Health" to be called Hygeia. He wrote several important books; from "The Diseases of Modern Life," published by D. Appleton & Co., New York, are taken the extracts which follow.] By the strict law of Nature a man should die as unconscious of his death as of his birth. Subjected at birth to what would be, in the after-conscious state, an ordeal to which the most cruel of deaths were not possibly more severe, he sleeps through the process, and only upon the subsequent awakening feels the impressions, painful or pleasant, of the world into which he is delivered. In this instance the perfect law is fulfilled because the carrying of it out is retained by Nature herself: human free-will and the caprice that springs from it have no influence. By the hand of Nature death were equally a painless portion. The cycle of life completed, the living being sleeps into death when Nature has her way. This purely painless process, this descent by oblivious trance into oblivion, this natural physical death, is the true Euthanasia; and it is the duty of those we call physicians to secure for man such good health as shall bear him in activity and happiness onward in his course to this goal. For Euthanasia, though it be open to every one born of every race, is not to be had by any save through obedience to those laws which it is the mission of the physician to learn, to teach, and to enforce. Euthanasia is the sequel of health, the happy death engrafted on the perfect life. When the physician has taught the world how this benign process of Nature may be secured, and the world has accepted the lesson, death itself will be practically banished; it will be divested equally of fear, of sorrow, of suffering. It will come as a sleep. If you ask me what proof there is of the possibility of such a consummation, I point to our knowledge of the natural phenomena of one form of dissolution revealed to us even now in perfect, though exceptional, illustration. We have all seen Nature, in rare instances, vindicating herself despite the social opposition to her, and showing how tenderly, how soothingly, how like a mother with her foot on the cradle, she would, if she were permitted, rock us all gently out of the world. How, if the free-will with which she has armed us were brought into accord with her designs, she would give us the riches, the beauties, the wonders of the Universe for our portion so long as we could receive and enjoy them; and at last would gently withdraw us from them, sense by sense, with such imperception that the pain of the withdrawal would be unfelt and indeed unknown. Ten times in my own observation I remember witnessing, with attentive mind, these phenomena of natural Euthanasia. Without pain, anger, or sorrow, the intellectual faculties of the fated man lose their brightness. Ambition ceases, or sinks into desire for repose. Idea of time, of space, of duty, lingeringly pass away. To sleep and not to dream is the pressing and, step by step, still pressing need; until at length it whiles away nearly all the hours. The awakenings are shorter and shorter; painless, careless, happy awakenings to the hum of a busy world, to the merry sounds of children at play, to the sound of voices offering aid; to the effort of talking on simple topics and recalling events that have dwelt longest on the memory; and then again the overpowering sleep. Thus on and on, until at length, the intellectual nature lost, the instinctive and merely animal functions, now no longer required to sustain the higher faculties, in their turn succumb and fall into inertia. This is death by Nature, and when mankind has learned the truth, when the time shall come--as come it will--that "there shall be no more an infant of days, nor an old man who hath not filled his days," this act of death, now, as a rule, so dreaded because so premature, shall, arriving only at its appointed hour, suggest no terror, inflict no agony. The sharpness of death removed from those who die, the poignancy of grief would be almost equally removed from those who survive, were natural Euthanasia the prevailing fact. Our sensibilities are governed by the observance of natural law and the breach of it. It is only when nature is vehemently interrupted that we either wonder or weep. Thus the old Greeks, fathers of true mirth, who looked upon prolonged grief as an offence, and attached the word madness to melancholy,--even they were so far imbued with sorrow when the child or the youth died, that they bore the lifeless body to the pyre in the break of the morning, lest the sun should behold so sad a sight as the young dead; while we, who court rather than seek to dismiss melancholy, who find poetry and piety in melancholic reverie, and who indulge too often in what, after a time, becomes the luxury of woe, experience a gradation of suffering as we witness the work of death. For the loss of the child and the youth we mourn in the perfect purity of sorrow; for the loss of the man in his activity we feel grief mingled with selfish regret that so much that was useful has ceased to be. In the loss of the aged, in their days of second childishness and mere oblivion, we sympathize for something that has passed away, and for a moment recall events saddening to the memory; but how soon this consoling thought succeeds and conquers--that the race of the life that has gone was run, and that for its own sake the dispensation of its removal was most merciful and most wise. To the rule of natural death there are a few exceptions. Unswerving in her great purpose for the universal good, Nature has imposed on the world of life her storms, earthquakes, lightnings, and all those sublime manifestations of her supreme power which, in the infant days of the universe, cowed the boldest and implanted in the human heart fears and superstitions which in hereditary progression have passed down even to the present generations. Thus she has exposed us all to accidents of premature death, but, with infinite wisdom, and as if to tell us that her design is to provide for these inevitable calamities, she has given a preponderance of number at birth to those of her children who by reason of masculine strength and courage shall have most frequently to face her elements of destruction. Further, she has provided that death by her, by accidental collision with herself shall, from its very quickness, be freed of pain. For pain is a product of time. To experience pain the impression producing it must be transmitted from the injured part of the living body to the conscious centre, must be received at the conscious centre, and must be recognized by the mind as a reception; the last act in truth being the conscious act. In the great majority of deaths from natural accidents there is not sufficient time for the accomplishment of these progressive steps by which the consciousness is reached. The unconsciousness of existence is the first and last fact inflicted upon the stricken organism: the destruction is so mighty, that the sense of it is not revealed. The duration of time intended by Nature to extend between the birth of the individual and his natural Euthanasia is undetermined, except in an approximate degree. From the first, the steady, stealthy attraction of the earth is ever telling upon the living body. Some force liberated from the body during life enables it, by self-controlled resistance, to overcome its own weight. For a given part of its cycle the force produced is so efficient, that the body grows as well as moves by its agency against weight; but this special stage is limited to an extreme, say, of thirty years. There is then another period, limited probably also to thirty years, during which the living structure in its full development maintains its resistance to its weight. Finally, there comes a time when this resistance begins to fail, so that the earth, which never for a moment loses her grasp, commences and continues to prevail, and after a struggle, extended from twenty to thirty years, conquers, bringing the exhausted organism which has daily approached nearer and nearer to her dead self, into her dead bosom. Why the excess of power developed during growth or ascent of life should be limited as to time; why the power that maintains the developed body on the level plain should be limited as to time; why the power should decline so that the earth should be allowed to prevail and bring descent of life, are problems as yet unsolved. We call the force that resists the earth Vital. We say it resists death; we speak of it as stronger in the young than in the old; but we know nothing more of it really, from a physical point of view, than that while it exists it opposes terrestrial weight sufficiently to enable the body to move with freedom on the surface of the earth. These facts we accept as ultimate facts. To say that the animal is at birth endowed with some reserve force, something over and above what it obtains from food and air, would seem a reasonable conclusion; but we have no proofs that it is true, save that the young resist better than the old. We must therefore rest content with our knowledge in its simple form, gathering from it the lesson that death, a part of the scheme of life, is ordained upon a natural term of life, is beneficially planned, "is rounded with a sleep." [Then follow chapters on disease, leading up to rules for health.] RULES FOR HEALTH I The first step towards the reduction of disease is, beginning at the beginning, to provide for the health of the unborn. The error, commonly entertained, that marriageable men and women have nothing to consider except wealth, station, or social relationships, demands correction. The offspring of marriage, the most precious of all fortunes, deserves surely as much forethought as is bestowed on the offspring of the lower animals. If the intermarriage of disease were considered in the same light as the intermarriage of poverty, the hereditary transmission of disease, the basis of so much misery in the world, would be at an end in three or at most four generations. II Greater care than is at present manifested ought to be taken with women who are about to become mothers. Wealthy women in this condition are often too much indulged in rest and are too richly fed. Poor women in this condition are commonly underfed and made to toil too severely. The poor, as we have seen, fare the best, but both, practically, are badly cared for. Nothing that is extraordinary is required for the woman during this condition named. She needs only to live by natural rule. She should retire to rest early; take nine hours' sleep; perform walking or similar exercise, to an extent short of actual fatigue, during the day; partake moderately of food, and of animal food not oftener than twice in the day; avoid all alcoholic drinks; take tea in limited quantities; forego all scenes that excite the passions; hear no violence of languages, be clothed in warm, light, loose garments; and shun, with scrupulous care, every exposure to infectious disease. III In meeting the uncontrollable causes of disease the special influence of season deserves particular regard. It should always be remembered that, other things being equal, during winter the body loses, during summer gains in weight. Further, it should be remembered that these changes are abrupt: that usually the loss commences, sharply, in September and lasts until April, and that the gain commences in April and lasts until September. In September, though the weather even be warm, it is right, therefore, to add to the clothing and to commence a little excess of food. In summer it is right not only to reduce the clothing, but to eat less food than in winter. IV The best means of preventing the spread of the communicable diseases is perfect and instant isolation of the affected, and removal and thorough purifying of all clothing and bedding with which the affected have come in contact. It is a vulgar error to suppose that every child must necessarily suffer from the contagious maladies, and that the risk of exposure to infection is, therefore, of little moment. The chance of infection lessens with advance of life, and that person is strongest who has never passed through a contagious malady. Against small-pox vaccination is the grand safeguard, but even vaccination ought never to prevent the isolation of those who suffer from small-pox. V The mortality from the uncontrollable causes of disease amongst persons of advanced life is best prevented by providing against sudden vicissitudes of heat and cold. The primary care is to guard against sudden change of vascular tension from exposure to heat when the blood-vessels are weakened by cold. Such exposure is the cause of nearly all the congestions which occur during winter, and which carry off the enfeebled. The sound practice is to maintain the body, at all hours and seasons, but especially during the hours of sleep, at an equable temperature. The temperature of 60° Fah. may be considered a safe standard. VI The true danger of every form of mental exercise is the addition of worry. Laborious mental exercise is healthy unless it be made anxious by necessary or unnecessary difficulties. Regular mental labour is best carried on by introducing into it some variety. New work gives time for repair better than attempt at complete rest, since the active mind finds it impossible to evade its particular work unless its activity be diverted into some new channel. During the new work a fresh portion of the brain comes into play and the overwrought seat of mental faculty is secured repose and recovery. Excessive competition in mental labour is ruinous at all ages of life. VII The idea that excessive physical exercise is a sound means of promoting health is erroneous. Man is not constructed to be a running or a leaping animal like a deer or a cat, and to raise the physical above the mental culture were to return to the shortness and misery of savage life. Physical training, while it should be moderately encouraged, should be refined and made secondary to mental training. Every rash and violent feat of competitive prowess should be discountenanced. VIII The combination of mental and physical fatigue, as it is practised in many pursuits at this time, are exceedingly dangerous. Long journeys each day, to and from the sphere of profession or business, are hurtful. The idea that mental labour may be advantageously supplemented by violent muscular exercise, such as is implied in long and fatiguing walks or laborious exercise on horseback, is an error. Moderate and regular exercise, at the same time, favours mental work. The practical point is to regulate the physical labour that it shall not induce fatigue. IX One of the surest means for keeping the body and mind in perfect health consists in learning to hold the passions in subservience to the reasoning faculties. This rule applies to every passion. Man, distinguished from all other animals by the peculiarity of his reason, is placed above his passions to be the director of his will, can protect himself from every mere animal degradation resulting from passionate excitement. The education of the man should be directed, not to suppress such passions as are ennobling, but to bring under governance, and especially to subdue, those most destructive passions, anger, hate, and fear. X To escape the evils arising from the use of alcohol there is only one perfect course, namely, to abstain from alcohol altogether. No fear need be entertained of any physical or mental harm from such abstinence. Every good may be expected from it. True, a certain very qualified temperance, a temperance that keeps the adult to a strict allowance of one ounce and a half of alcohol in each twenty-four hours, may possibly be compatible with a healthy life; but such indulgence is unnecessary and encourages the dangerous desire to further indulgence. A man or woman who abstains is healthy and safe. A man or woman who indulges at all is unsafe. A man or woman who relies on alcohol for support is lost. XI Smoking tobacco, and the use of tobacco in every form, is a habit better not acquired, and when acquired is better abandoned. The young should especially avoid the habit. It gives a doubtful pleasure for a certain penalty. Less destructive than alcohol, it induces various nervous changes, some of which pass into organic modifications of function. So long as the practice of smoking is continued the smoker is temporarily out of health. When the odour of tobacco hangs long on the breath and other secretions of the smoker, that smoker is in danger. Excessive smoking has proved directly fatal. XII Indulgence in narcotics, opium, chloral, chlorodyne, ether, absinthe, and all others of the class, is an entire departure from natural law. Except under the direction of skilled opinion and for the cure of disease, the use of these agents is subversive of the animal functions, and is a certain means of embittering and shortening life. It is doubtful whether the freedom of the subject ought to be permitted to extend to the uncontrolled self-indulgence in these poisons. The indulgence indicates an unsound reason which requires to be governed by sound reason, temperately enforced. XIII The food on which the man who would be healthy should live should be selected so as to ensure variety without excess. Animal food should not be taken oftener than twice daily. The amount of animal and vegetable food combined should not exceed thirty ounces in the twenty-four hours, and for the majority of persons an average of twenty-four ounces of mixed solid food, a third only of which should be animal, is sufficient. All animal foods should be eaten while they are fresh and after they are well cooked. The habit of eating underdone flesh is an almost certain cause of parasitic disease. The amount of fluid taken, in any form, should not exceed an average of twenty-four ounces daily. Water is the only natural beverage. XIV To escape the injuries arising from impure air it is necessary to attend to the following rules: To avoid the admission into closed apartments of air charged with any substance that offends the sense of smell. To avoid surcharging the air with vapour of water. To keep the temperature in every room as nearly as possible at the safe standard of 60° Fah. To take ample means of allowing air to escape from the room by every available outward draught, by the chimney flue especially. To admit air freely at all times, and, when a room is not in use and the external air is not charged with moisture, to allow the entrance of air from without through every window and door. XV Occupations of every kind, however varied they may be, require to be alternated, fairly, with rest and recreation. It is the worst mistake to suppose that most and best work can be done when these aids are omitted. Strictly, no occupation that calls forth special mental and physical work should fill more than one-third of the daily life. The minds of men of all classes ought now to be devoted to the promotion of a systematic method by which the productive labour of every life should be carried on within the limited term of eight hours in the twenty-four. The body of man is not constructed to run its completed circle under a heavier burden of labour. XVI Enforced idleness, by those who have acquired wealth, is always an error so long as the health is good. Men of business should never actually retire while they retain fair bodily and physical faculty. It is one of the gravest of errors to attempt to enforce idleness on others from the mistaken sentiment of wishing to place them beyond the necessity for work. This is against nature. The earth, which is itself ever in motion, demands ever the motion of cultivation from its inhabitants that it may be a garden properly arranged from age to age. Those, therefore, who have idleness thrust upon them, by their progenitors, should throw it off as if some necessity for work were equally theirs. By this plan they will live longest to enjoy the greatest happiness. XVII The natural duration of sleep is eight hours out of the twenty-four, and those who can secure this lead the soundest lives. It is best taken from ten o'clock till six, and it is most readily obtained by cultivating it as an automatic procedure. All stimulants, all excitements, all excessive fatigues, all exhaustions pervert sleep even if they do not prevent it. The room in which sleep is taken should be the best ventilated and the most equably warmed room in the house. The air of the room should be maintained at the natural standard of 60° Fah., and the body of the sleeper should always be kept completely warm. The bed should be soft and yielding. A regular tendency to sleep at other hours than the natural is a sure sign of error of habit or of nervous derangement. XVIII Dress, to be perfectly compatible with healthy life, should fit loosely, should be light, warm, and porous, should be adapted to the season as to colour, should be throughout every part of the clothing, upper as well as under, frequently changed, and should be, at all times, scrupulously clean. The wearing of clothes until they are threadbare, is an invariable error in all that respects the health, to say nothing of the comfort of the wearer. All bands or corsets which in any way restrict the course of the blood in any part of the body are directly injurious. Dresses dyed with irritating dyestuffs ought to be carefully avoided. XIX Connected with cleanliness of clothing, as a means of health, is personal cleanliness. Perfected action of the skin, so essential to the perfect life, can only be obtained by thorough ablution of the whole body. The ablution ought, strictly, to be performed once in every twenty-four hours. It is best to train the body to the use of cold water through all seasons, so that the requirement for water of raised temperature may not become a necessity. The simplest and best bath is the ordinary sponge-bath. Plungings, splashings, showers, and the like are mere pastimes. The occasional use of the hot air or Turkish bath is an important adjunct to the means of maintaining health. CARE OF THE EYES BUEL P. COLTON ["Physiology, Experimental and Descriptive," by Buel P. Colton, Professor of Natural Science in the Illinois State Normal University, is a capital text-book which may be read as gainfully at home as in school or at college. Throughout its chapters are excellent directions for the care of health and strength. It is published by D. C. Heath & Co. Boston. 1898. The following extract was revised by Dr. Casey A. Wood, an eminent oculist of Chicago] In reading we wish light from the printed page. Hence we should avoid light entering the eye from any other source at this time. While reading, then, do not face a window, another light, a mirror, or white wall, if it can be avoided. In a room, white walls are likely to injure the eyes. Choose a dark colour for a covering for a reading table. Sewing against the background of a white apron has worked serious mischief. Direct sunshine near the book or on the table is likely to do harm. Preferably have the light from behind and above. Many authors say "from the left" or "over the left shoulder." In writing with the usual slant of the letters this may be desirable. But vertical writing is now strongly advocated, as it enables one to sit erect, and have the light from above and equally to the two eyes. Having stronger light for one eye than for the other is bad. Sitting under and a little forward of a hanging lamp will give the light equally to the two eyes and send no light direct into the face. In reading by daylight avoid cross-lights as much as possible. The incandescent electric light has an advantage in being readily lighted without matches, and in giving out little heat, thus making it valuable for house-lighting; but owing to its irregular illumination (due to the shadow cast by the wire or filament), it is not well suited for study or other near work. For this purpose an Argand gas or kerosene burner is much to be preferred, since it throws a soft, uniform, and agreeable light upon the work. Reading out-of-doors is likely to injure the eyes, especially when lying down. To try to read while lying in a hammock is bad in many ways. Too much light directly enters the eye, and often too little falls upon the printed page. Do not hold the book or work nearer the eyes than is necessary. So far as possible avoid continuous reading in large or heavy books by artificial light. Such books being hard to hold, the elbows gradually settle down against the sides of the body, and thus, without thinking about it, the book is held too close to the eyes, or at a bad angle, or the body assumes a bad position. Frequently rest the eyes by looking up and away from the work, especially at some distant object. One may rest the eyes while thinking over each page or paragraph, and thus really gain time instead of losing it. Have light that is strong enough. Remember that the law of the intensity of light as affected by distance is that at twice the distance from the source of light the light is only one-fourth as strong. Reading just before sunset is risky. One is tempted to go on, not noticing the gradual diminution of light. Save the easiest reading for the evening. Newspapers, as a rule, have neither good print nor good paper. If the eyes have much work to do, finish this kind of reading by daylight if possible, and by artificial light read books, which usually have better type and better paper. In all ways endeavour to favour the eyes by doing the most difficult reading by daylight, and saving the better print and the books that are easier to hold for work by artificial light. Writing is usually much more trying to the eyes than reading. By carefully planning his work the student may economize eyesight, and it is desirable that persons blessed with good eyes should be careful, as well as those who have a natural weakness in the eyes; for it often results that those inheriting weak organs, by taking proper care, may outlast and do more and better work than those naturally stronger, but who through carelessness injure organs by improper use or wrong use. Reading before breakfast by artificial light is usually bad. Many eyes are ruined during convalescence. At this time the whole system is often weak, including the eyes. Still, there is a strong temptation to read, perhaps to while away the time, perhaps to make up for lost time in school work. This is a time when a friend may show his friendship by reading aloud to the convalescent. If one finds himself rubbing his eyes, it is a clear sign that they are irritated. It may be time to stop reading. At any rate, one should find the cause, and not proceed with the work until the irritation ceases. If any foreign object gets into the eye, as a cinder, it is better not to rub the eye, but to draw the lid away from the eyeball and wink repeatedly; the increased flow of tears may dissolve and wash the matter out. If you must rub, rub the other eye. If it be a sharp-cornered cinder, rubbing may merely serve to fix it more firmly in the cornea or the mucous membrane of the inner surface of the eyelid. If it does not soon come out, the lid may be rolled over a pencil, taking hold of the lashes or the edge of the lid. The point of a blunt lead pencil is a convenient and safe instrument with which to remove the particle. Sometimes being out in the wind (especially if unused to it), together with bright sunlight, may irritate the eyes. If after such exposure one finds lamplight irritating, he will do well to go to bed early, or to remain in a dark room. Be careful to keep the eyes clean. Do not rub the eyes with the fingers. Aside from considerations of etiquette, there is danger of introducing foreign matter that may be harmful. It is very desirable that each person have his individual face towel. By not observing this rule, certain contagious diseases of the eye often spread rapidly. If there is any continuous trouble with the eyes, consult a reliable oculist. Many persons injure the eyes by not wearing suitable glasses. On the other hand, do not buy glasses of peddlers or of any but reliable specialists. One may ruin the eyes by wearing glasses when they are not needed. Sight is priceless. THE PROGRESS OF MEDICINE IN THE NINETEENTH CENTURY JOHN SHAW BILLINGS, M.D. [Dr. Billings is a surgeon and administrator of the first rank. He is now a director of the New York Public Library. Among his many published works are "Principles of Ventilation and Heating," issued by the _Engineering Record_, New York. The essay which follows appeared in the _Evening Post_, New York. January 12, 1901, copyrighted. It is reprinted in a volume entitled "The Nineteenth Century: a Review of Progress During the Past One Hundred Years," published by G. P. Putnam's Sons, New York, 1901, copyrighted. It is presented here by the kind permission of Dr. Billings, the publisher of the _Evening Post_, and G. P. Putnam's Sons.] The word "medicine," as used in the title of this paper, includes all branches of the art of prevention and treatment of disease and injuries; all discoveries of methods of diminishing physical pain and of prolonging life, and also that part of modern science which is concerned with accurate knowledge of the structure and functions, normal and abnormal, of the human body, and of the causes of diseases. In other words, it includes not only therapeutics, medical and surgical, but also physiology, pathology, and hygiene. In all these branches of medicine greater progress has been made during the last century than had been made during the previous two thousand years. This progress has been largely due to improvements in methods of investigation and diagnosis, resulting from increase of knowledge in chemistry and physics; to better microscopes and new instruments of precision; to experimental work in laboratories and to the application of scientific method and system in the observation and recording of cases of disease and of the results of different modes of treatment. The introduction of statistical methods in the study of cases of disease and of causes of death; the discovery of general anæsthetics; the adoption of antiseptic [excluding microbes] and aseptic [uninfective] methods in surgery, and the development of modern bacteriology--each marks a point in the history of medicine in the nineteenth century. The scientific demonstration that some diseases are due to the growth and development of certain specific micro-organisms in the human body dates from about twenty years ago, although the theory of such causal relation is much older. Since 1880 it has been proved that anthrax, Asiatic cholera, cerebro-spinal meningitis, diphtheria, one form of dysentery, erysipelas, glanders, gonorrhoea, influenza, certain epidemics of meat-poisoning, pyæmia and suppuration in general, pneumonia, tetanus, relapsing fever, tuberculosis, bubonic plague, and typhoid fever are due to minute vegetable organisms known as bacteria; that malarial fevers, Texas cattle fever, and certain forms of dysentery are due to forms of microscopic animal organisms known as microzoa; and for most of these diseases the mode of development and means of introduction of the micro-organism into the body are fairly well understood. To the information thus obtained we owe the triumphs of antiseptic and aseptic surgery, a great increase of precision in diagnosis, the use of specific antitoxins [antidotes to organic infection] as remedies and as preventives, and some of the best practical work in public hygiene. The evidence as to the increased powers of medicine to give relief from suffering and to prolong life is most clear and direct in the records of modern surgery--particularly in some of its special branches. In a large proportion of certain cases in which the surgeon now operates with a fair chance of success, such as calculus in the kidney or gall-bladder, shot-wounds of the abdomen, and tumours of various kinds, there was no hope in the year 1800, and the unhappy sufferer could only expect a certain, though often a lingering and painful, death. In cases of cancer of the face, tongue, breast, or uterus, the persistent pain, extreme disfigurement, and offensive odors which attended them made death a boon to be prayed for, if not deliberately sought, while now such cases, if brought in time to the surgeon, can often be entirely relieved. The knowledge of this fact has become general with the public, and patients no longer defer an operation as long as possible, as was their custom in days of old. Instead of having to look forward to the torture of incisions, manipulations, and stitching, with but small hope of surviving the exhausting suppuration and blood-poisoning which were such common results, the patient now knows that he will inhale a little sweet vapour, and sleep unconscious of the strokes of the surgeon's knife or the pricks of his needle. He may dream wondrous dreams, but he will soon awake to find himself in his bed staring at the trained nurse standing by his side, and wondering vaguely why the operation has not begun. He does not have to look forward to weeks and even months of daily dressings. The surgeon will glance at his temperature record and at the outside of his bandages, but will probably not touch them for a week; and when he does remove them nothing will be seen but a narrow red line without a trace of suppuration. These improved methods not only preserve the mother for her children, and the bread-winner for the family, but they greatly contribute to the public good by shortening the period of enforced idleness and unproductivity after operations. Some of the greatest triumphs of modern surgery are obtained in cases of disease or injury of the abdominal organs. The removal of ovarian and uterine tumours is now so common and successful that it is not easy to realize that a hundred years ago there was practically no help or hope for such cases. In former days, the lists of deaths contained many cases reported as inflammation or obstruction of the bowels, or as peritonitis. It is now well understood that most of these cases are due to disease of a little worm-like appendix connected with the large intestine on the right side of the lower part of the abdomen, inflammation of which, known as appendicitis, causes excruciating pain, and often produces internal abscesses and death. An operation for the removal of such a diseased appendix is now common, and in most cases successful. The operation for the removal of calculus, or stone, from the urinary bladder dates from over twenty-five hundred years ago, and no one knows who first performed it. Within the last century it has been largely superseded by an operation which crushes the stone to powder within the bladder, and removes this powder without the use of the knife. The removal of calculi from the kidney or from the gall bladder, and the removal of a diseased kidney, are new operations, made possible by improved means of diagnosis, anæsthesia, and antisepsis [determining disease, causing insensibility, and excluding microbes]. Wounds of the intestines were formerly thought to be almost necessarily fatal, and nothing was done for them except to stupify the patient with opium. Now in such cases the abdomen is opened, the lacerations of the bowel are closed, the effused blood and other matters are removed, and in many cases life has thus been preserved. By increase of knowledge of the anatomy of the brain, and of the distribution of nerves connected with it, it has become possible in a certain number of cases to determine what part of the brain is suffering from irritation or pressure, and to operate for the removal of the tumour or other substance causing the trouble, with considerable hope of giving permanent relief. A branch of surgery which has developed into an important specialty during the last century is that known as plastic and orthopædic surgery [ameliorating deformities]. The replacing of a lost nose by engrafting other tissue in its place is a very old triumph of surgical art, but operations of this kind have been greatly extended and perfected within the last hundred years, and much can now be done to mitigate the deformity and weakness due to club feet, bandy legs, contracted joints, etc., which formerly were considered to be beyond remedy. Many of the diseases peculiar to women have been deprived of much of their terrors within a hundred years. In 1800, for every thousand children born, from ten to twenty mothers died. Puerperal fever occurred in epidemics, following certain physicians and nurses, but nothing was known as to its causes or nature. To-day puerperal fever is almost unknown in the hospitals or in the practice of a skilled physician. The death-rate of mothers is less than five per thousand births, and the mechanical obstructions which a century ago would almost certainly have brought about the death of both mother and child, are now so dealt with that more than half of both mothers and children are saved. The study of the diseases of the eye has greatly developed another specialty during the century, viz., ophthalmology. The investigations of Helmholtz in physiological optics, with his invention of the ophthalmoscope in 1852, effected a revolution in this branch of medical science and art, and have added greatly to human comfort and happiness. A hundred years ago, when the physician saw the eyelids of a new-born babe redden, and swell, and yellow matter ooze from between them, he knew that in a few days or weeks the child would be partially or wholly blind, but he knew nothing of the simple means by which the skilled physician can now prevent such a calamity. It is unfortunately true that this knowledge is not even now sufficiently widely diffused, and that our blind asylums must, for some time to come, continue to receive those that have been deprived of sight during the first months of their life through the ignorance or neglect of those who should have properly cared for them. While it is certain that the death-rates in the last century were greater than those of the present day, it is not possible to make precise comparisons. The record of deaths in the city of New York begins with 1804, and was necessarily very imperfect until the law of 1851, which required the registration of all deaths; but it shows a death-rate of 30.2 per 1,000 in 1805, which means that the true death-rate must have been between 35 and 40. At present, for a series of five years, it would be about 20, having been below 19 in 1899, so that the death-rate has been diminished by at least one-third. How much of this is due to improved sanitary conditions it is impossible to say. A comparison of the list of causes of death in 1805 with the list of causes for 1900 shows great differences, but much of this is due to changes in name and to more accurate diagnosis. "Malignant sore throat" and "croup" were well known to anxious parents in 1800, but "diphtheria" caused no anxiety. "Inflammation of the bowels" was common and fatal, but "appendicitis" had not been heard of. "Nervous fever," "continued fever," and "low fever" were on the lists, but not typhoid, which was not clearly distinguished as a special form of disease until 1837, when Dr. Gerhard, an American physician, pointed out the differences between it and typhus, which also prevailed at the commencement of the century. One hundred years ago the great topic of discussion in our cities on the North Atlantic coast was the means of preventing yellow fever, which had been epidemic in New York and Philadelphia for two years. Physicians were disputing as to whether the disease was contagious and imported, and, therefore, perhaps, preventable by quarantine and disinfection, or was due to some occult condition of the atmosphere (which was the view taken by Noah Webster in his "History of Epidemic and Pestilential Diseases," a work which appeared about the middle of the year 1800, although it is dated 1789). The discussions remind one of the remark that a certain patented form of electric light was surrounded by a cloud of non-luminous verbosity. For example, the Committee of the Medical Society of the State of New York reported that yellow fever may be produced in any country by pestilential effluvia; and Webster concluded that typhus and nervous fevers were due to a "conversion of the perspirable fluids of the body into septic [poisonous] matter"--all of which means that they knew nothing about it. Even now we do not know the cause of yellow fever, or the precise mode of its spread; but we are sufficiently certain that it is due to a specific micro-organism to be confident that its spread can be checked by isolation and disinfection properly applied--and Memphis and New Orleans are witnesses to the truth of this. In the year 1800, the majority of persons over twenty years old were more or less pitted by small-pox, being the survivors of a much greater number who had suffered from this disease. Dr. Miller in New York had just received from England a thread which had been steeped in the newly discovered vaccine matter, and was about to begin vaccination in this city. To-day there are many physicians who have never seen a case of small-pox, and a face pitted with the marks of this disease is rarely seen. During the century there have appeared in civilized countries two strange and unfamiliar forms of epidemic disease, namely, Asiatic cholera and the plague, the first coming from the valley of the Ganges, the second from the valley of the Euphrates, and each having a long history. A really new disease was the outbreak in Paris in 1892 of a specific contagious disease transmitted from sick parrots, and known as psittacosis. This little epidemic affected forty-nine persons, and caused sixteen deaths. Typhus fever has almost disappeared, while some diseases have increased in relative frequency, in part, at least, because of medical progress. The children who would have died of small-pox in the eighteenth century now live to be affected with diphtheria or scarlet fever, and the increase in the number of deaths reported as due to cancer is partly due to the fact that a greater proportion of people live to the age most subject to this disease. A large part of modern progress in medicine is due to improved methods of diagnosis, and to the use of instruments of precision for recording the results of examinations. The use of the clinical thermometer has effected a revolution in medical practice. Our knowledge of diseases of the heart and lungs has been greatly expanded during the century by auscultation [trained listening to sounds] and percussion, and especially by the use of the stethoscope. The test-tube and the microscope warn us of kidney troubles which formerly would not have been suspected, and the mysterious Röntgen rays are called in to aid the surgeon in locating foreign bodies and in determining the precise nature of certain injuries of the bones. Bacteriological examination has become a necessary part of the examination in cases of suspected diphtheria, tuberculosis, or typhoid, and a minute drop of blood under the microscope may furnish data which will enable the skilled physician to predict the result in certain cases of anæmia [bloodlessness], or to make a positive diagnosis as between malaria and other obscure forms of periodic fever. The means at the command of the physician for the relief of pain now include, not only the general anæsthetics,--chloroform, ether, and nitrous oxide,--but also the hypodermic use of the concentrated alkaloids of opium, belladonna, and other narcotics, and the local use of cocaine; and restful sleep for the weary brain may be obtained by sulphonal, chloral, etc. Some agonizing forms of neuralgic pain are now promptly relieved by the section or excision of a portion of the affected nerve; or it may be forcibly stretched into a condition of innocuous desuetude. Relief to the sufferings of thousands of neurotic women, and of their families and friends, has been produced by the systematic scientific application of the rest cure of Dr. Weir Mitchell. A hundred years ago the medical advertisement which was most prominent in New York and Philadelphia newspapers was one of a remedy for worms. Many symptoms of nervous and digestive troubles in children were in those days wrongly attributed to worms. Nevertheless, there is good reason to believe that parasitic diseases derived from animals were in those days much more prevalent in this country than they are to-day. Our knowledge of the mode of origin and development of the tapeworm, the _trichina spiralis_, the liver fluke, and the itch insect has been gained during the nineteenth century. Much the same may be said with regard to the peculiar worm known as _anchylostum_, the cause of Egyptian chlorosis, and of the St. Gothard tunnel disease, although prescriptions for this parasite are found in the Papyrus Ebers, written before the time of Pharaoh. The limits of this article permit of but a brief reference to the progress in preventive medicine during the century. The studies made in England of the results of the cholera epidemic of 1849, and the experience gained in the English army during the Crimean war, led to some of the most important advances in sanitary science, more especially to the demonstration of the importance of pure water supplies, and of proper drainage and sewerage. During our Revolutionary War, and the Napoleonic wars, the losses to the armies from disease greatly exceeded those from wounds; and hospital fever--in other words, typhus--was dreaded by a general almost more than the opposing forces. During the wars of the last twenty-five years, typhus and hospital gangrene have been unknown, but some extensive outbreaks of typhoid fever have occurred, showing that our knowledge of the causes and mode of transmission of this disease has not been practically applied to the extent to which it should have been; this remark applies also to some of the most fatal diseases in civil life. In the United States diphtheria and typhoid fever each causes from twenty to thirty thousand deaths a year, while more than one hundred thousand deaths are annually due to consumption. Yet for each of these diseases we know the specific germ, the channels through which it is usually conveyed, and the means by which this conveyance can be to a great extent prevented. The ravages of these diseases are, therefore, largely due to the fact that the great mass of the people are still ignorant of these subjects. Antitoxin is not yet used for either prevention or treatment in diphtheria to anything like the extent which our knowledge of its powers demands. Our better knowledge of the causes of certain infectious and contagious diseases, and of the mode of their spread, has been of great importance to the world from a purely commercial point of view, since it has led to the doing away with many unnecessary obstructions to traffic and travel which were connected with the old systems of quarantine, while the security which has been gained from the modern method of cleansing and disinfection is decidedly greater than that secured by the old methods. A striking illustration of the effect of these improvements is seen in the manner in which the news of the recent outbreak of plague in Glasgow was received in England and throughout Europe. One hundred years ago the city would have been almost deserted, and terror would have reigned in all England. To-day it is well understood that the disease spreads by a bacillus which is not conveyed through the air. No one fears a repetition of the ghastly scenes of the Black Death in the fourteenth century. In like manner, and for the same reasons, Asiatic cholera has lost most of its terrors. The benefits to the public of modern progress in medicine have been greatly enlarged by the establishment of many small hospitals, and by the steady increase in the employment of specially trained nurses in private practice, even in rural districts. The results of a case of typhoid or of pneumonia often depend as much upon the nurse as upon the doctor; and affection cannot take the place of skill in either. For the great mass of the people, cases of severe illness or injury, or those requiring major surgical operations, can be treated more successfully in well-appointed hospitals than in private houses, and as this is becoming generally understood the old feeling against entering a hospital for treatment is rapidly disappearing. Improvement in hospital construction and management has kept pace with progress in medical knowledge; and in future such institutions seem destined to play an increasingly important part in municipal and village life. All progress in civilization is attended with injury to some individuals. Trained nurses have deprived some unskilled labour of employment; hospitals have injured the business of some physicians; pure-water supplies, good sewers, food inspection, vaccination,--in short, all effective measures in public hygiene,--interfere with the trade side of medical practice; but upon the whole the public at large benefits by all these things. In one sense they seem opposed to the general law of evolution, in that they prolong the life of the unfit; but in a broader sense they work in accordance with this law by increasing the power of the strong to protect and care for the weak. All told, the most important feature in the progress of medicine during the century has been the discovery of new methods of scientific investigation, more especially in the fields of bacteriology and pathology. These methods have been as yet only partially applied, and great results are to be hoped from their extension in the near future. They will not lead to the discovery of an elixir of life, and the increasing feebleness of old age will continue to be the certain result of living a long time, for the tissues and organs of each man have a definitely limited term of duration peculiar to himself; but many of the disorders which make life a burden in advancing years can now be palliated, or so dealt with as to secure comparative comfort to the patient, so that "if by reason of strength" life can be prolonged beyond threescore years and ten it no longer necessarily involves labour and sorrow. Transcriber's Notes: Punctuation and hyphenated and accented words have been standardized. All else remains as in the original. 
29307	----	Note: Project Gutenberg also has an HTML version of this file which includes the original illustration. See 29307-h.htm or 29307-h.zip: (http://www.gutenberg.org/files/29307/29307-h/29307-h.htm) or (http://www.gutenberg.org/files/29307/29307-h.zip) THE NORTH AMERICAN MEDICAL AND SURGICAL JOURNAL. CONDUCTED BY HUGH L. HODGE, M.D. | CHAS. D. MEIGS, M.D. FRANKLIN BACHE, M.D. | B. H. COATES, M.D. AND R. LA ROCHE, M.D. NON DOCTIOR, SED MELIORE IMBUTUS DOCTRINA. VOL. II. PHILADELPHIA: PUBLISHED BY J. DOBSON, AGENT. JESPER HARDING, PRINTER. 1826. _Eastern District of Pennsylvania, to wit_ BE IT REMEMBERED, that on the 31st day of March, in the 50th year of the Independence of the United States of America, A. D. 1826, Hugh L. Hodge, Franklin Bache, Charles D. Meigs, Benjamin H. Coates, and René La Roche, of the said District, have deposited in this office the Title of a Book, the right whereof they claim as Proprietors, in the words following, to wit: "_The North American Medical and Surgical Journal. Conducted by Hugh L. Hodge, M. D., Franklin Bache, M. D., Chas. D. Meigs, M. D., B. H. Coates, M. D., and R. La Roche, M. D. Non doctior, sed meliore imbutus doctrina. Vol. II._" In conformity to the act of Congress of the United States, intituled, "An act for the encouragement of learning, by securing the copies of maps, charts, and books, to the authors and proprietors of such copies, during the times therein mentioned;"--and also to the act, entitled, "An act supplementary to an act, entitled, "An act for the encouragement of learning, by securing the copies of maps, charts, and books, to the authors and proprietors of such copies, during the times therein mentioned," and extending the benefits thereof to the arts of designing, engraving, and etching historical and other prints." D. CALDWELL, Clerk of the Eastern District of Pennsylvania. CONTENTS OF VOL. II. No. III. ORIGINAL COMMUNICATIONS. ART. PAGE. I. Description of the Gangrenous Ulcer of the mouths of children. By B. H. Coates, M. D., one of the Physicians to the Philadelphia Children's Asylum, &c. 1 II. Case of Purpura in an Infant, attended with extraordinary symptoms. By R. M. Huston, M. D. 24 III. History of the Natural and Modified Small Pox, or of the Variolous and Varioloid Diseases, as they prevailed in Philadelphia, in the years 1823 and 1824. By John K. Mitchell, M. D., and John Bell, M. D., attending physicians at the then Small Pox Hospital. With a plate. 27 IV. Remarks on the Pathology and Treatment of Yellow Fever. Arranged from the notes of Dr. J. A. Monges, of Philadelphia. 53 V. Remarks on the Prophylactic Treatment of Cholera Infantum. By Joseph Parrish, M. D., one of the Surgeons to the Pennsylvania Hospital. 68 VI. Case of Neuralgia cured by Acupuncturation. Communicated by J. Hunter Ewing, M. D. 77 ANALYTICAL REVIEWS. VII. Researches into the Nature and Treatment of Dropsy in the Brain, Chest, Abdomen, Ovarium, and Skin. By Joseph Ayre, M. D., &c. 79 VIII. An Essay on Venereal Diseases, and the Uses and Abuses of Mercury in their Treatment. By Richard Carmichael, M. R. I. A. With Practical Notes, &c. By G. Emerson, M. D. 109 IX. Remarks on some Means employed to destroy Tænia, and expel them from the Human Body. By Louis Frank, M. D. Privy Counsellor of her Majesty, Maria Louisa, Duchess of Parma. 114 X. Researches, Physiological and Pathological, instituted principally with a View to the Improvement of Medical and Surgical Practice. By James Blundell, M. D., Lecturer on Physiology and Midwifery at the United Hospitals of St. Thomas and Guy. 119 XI. An Inquiry into the Nature and Treatment of Diabetes, Calculus and other Affections of the Urinary Organs. By William Prout, M. D., F. R. S. With Notes and Additions, by S. Colhoun, M. D. 125 MEDICAL LITERATURE.--RETROSPECTIVE REVIEW. XII. Tractatus de Ventriculo et Intestinis, cui præmittitur alius, de Partibus continentibus in Genere, et in Specie de iis Abdominis. Authore Francisco Glissonio. Lond. 1677, 4to. 138 QUARTERLY SUMMARY OF MEDICAL AND SURGICAL INTELLIGENCE. ANATOMY, 155 1, Papillæ of the Tongue. 2, Villi of the Stomach and Intestines. 3, Minute distribution of the Vessels of the Liver. 4, Trachea perforating the Aorta. 5, Monsters. 6, Malformation of the Heart. 7, Acephalous Mummy. 8, New Anatomical Plates. 9, A Manual of Osteology. 10, Soemmering's Work on the Anatomy of the Ear. 11, Does the conjunctiva run over the Cornea? PHYSIOLOGY, 158 12, Electro-Galvanic phenomena of Acupuncturation. 13, Variations in Milk. 14, Hyoscyamus dilates the Pupils of the Eyes. 15, Worms in the Eye. 16, Digestion. PATHOLOGY, 161 17, Dothinenteria--Pustules of the small Intestines. 18, Dr. Broussais. 19, Whooping Cough. 20, Antiperistaltic Globus--Globus Hystericus. 21, Non-contagion of Yellow Fever. THERAPEUTICS, MATERIA MEDICA, AND THE PRACTICE OF MEDICINE, 166 22, Iodine. 23, Non-mercurial Treatment of Syphilis. 24, Cancer treated by Antiphlogistics. 25, Essential Oil of Male Fern as a remedy in Cases of Tænia. 26, Tincture of Bastard Saffron for the expulsion of Tænia. 27, Oil of Turpentine in Tænia. 28, Action of the Oil of the Euphorbia Lathyris. 29, Medicinal Properties of the Apocynum Cannabinum or Indian Hemp. 30, Remarkable Effects from the external application of the Acetate of Morphia. 31, Cure of Urinary Calculi, by means of the internal use of the Bicarbonate of Soda. 32, Attempt to cure Abdominal Dropsy by exciting Peritoneal Inflammation. 33, Artificial Respiration. 34, Secale Cornutum. 35, Animal Magnetism. 36, Sketch of the Medical Literature of Denmark, Sweden, and Norway. 37, Erysipelatous Mumps or Angina Parotidiana. 38, Tænia. 39, Scrophula. 40, Digitalis. SURGERY, 192 41, Dr. Physick's Operation for Artificial Anus denied to have been performed. 42, Gangrenous Sore Mouth of Children. 43, Operation for Phymosis. 44, Lunar Caustic on Wounds and Ulcers. 45, Hæmorrhage from Lithotomy. 46, Extirpation of the Parotid Gland. 47, Aneurism from a Wound, cured by Valsaiva's method. 48, Protrusion and Wound of the Stomach. 49, Oesophagotomy. 50, Retention of Urine, caused by a Stricture of the Urethra, relieved by a forcible but gradual Injection. 51, Tracheotomy. 52, Fistula Lachrymalis. 53, Aneurisma Herniosum. 54, Extirpation of the Two Dental Arches affected with Osteo-sarcoma. 55, Traumatic Erysipelas. 56, Obliteration of a portion of the Urethra, remedied by an Operation. 57, Artificial Joint cured by Caustic. 58, Epilepsy cured by Trephining. MIDWIFERY, 205 59, Gastrotomy. 60, Cæsarian Operation, performed with safety to the Mother and Foetus. 61, Extirpation of the Uterus. 62, Uterine Hæmorrhage. CHEMISTRY AND PHARMACY, 208 63, State in which Morphia exists in Opium. 64, Peculiar Principles of Narcotic Plants. 65, Relative quantities of Cinchonia and Quinia with indention in the most esteemed Varieties of Peruvian Bark. 66, Sulphate of Quinia, extracted from the Cinchona Bark, exhausted by Decoction. 67, Analysis of Rhubarb. 68, Alkaline Lozenges of Bicarbonate of Soda. 69, Presence of Mercury in Samples of Medicinal Prussic Acid. 70, Proposed Method of preparing Protoxide of Mercury by precipitation, for Medical Employment. 71, Goulard's Extract of Lead. QUARTERLY LIST OF AMERICAN MEDICAL PUBLICATIONS, 214-16 No. IV. ORIGINAL COMMUNICATIONS. ART. I. On the Epidemic of 1825 in Natchez, Miss. By Ayres P. Merrill, M. D. 217 II. History of the Natural and Modified Small Pox, or of the Variolous and Varioloid Diseases, as they prevailed in Philadelphia, in the years 1823 and 1824. By John K. Mitchell, M. D., and John Bell, M. D., Physicians at the then Small Pox Hospital. (Concluded from page 53.) 238 III. Cases of Nervous Irritation, exhibiting the Efficacy of Cold as a Remedy. By S. Jackson, M. D. 250 IV. Remarks on the Pathology of Jaundice. By G. B. Wood, M. D. 260 V. Account of a Case in which a New and Peculiar Operation for Artificial Anus was performed in 1809. By Philip Syng Physick, M. D., Professor of Surgery in the University of Pennsylvania, &c. Drawn up for publication by B. H. Coates, M. D. 269 VI. Observations on Asphyxia from Drowning, to which is added a Case of Resuscitation. By Edward Jenner Coxe, M. D. 276 ANALYTICAL REVIEWS. VII. Traité Zoologique et Physiologique, Sur les Vers Intestinaux de l'Homme. Par M. Bremser, D. M. Traduit de l'Allemande par M. Grundler, D. M. P. Revue et Augmentée de Notes. Par M. de Blainville, D. M., &c. Avec un Atlas. Paris, 1824. Anatomie des Vers Intestinaux, Ascaride, Lombricoide, et Echynorhynque Geant. Memoire Couronné par l'Academie Royale des Sciences, qui en avoit mit le sujet au Concours, pour l'année 1818. Avec 8 Planches. Par Jules Cloquet, &c. &c. A Paris, 1824 297 VIII. Precis Theorique et Pratique, sur les Maladies de la Peau. Par M. S. L. Alibert. 2 Tomes. 8vo. Paris, 1810-1820. 322 IX. Thoughts on Medical Education, and a Plan for its Improvement; addressed to the Council of the University of London. Dictu Necessaria. Plin. London, 1826. Projet de Loi, presenté aux Chambres dans la Séance du 14 Fevrier 1825, par S. E. le Ministre de l'Intérieur, Sur les Ecoles Secondaries de Medécine, les Chambres de Discipline, et les Eaux Minerales Artificielles. 344 MEDICAL LITERATURE--RETROSPECTIVE REVIEWS. X. Recherches sur le Tissu Muqueux, ou l'Organe Cellulaire, et Sur Quelques Maladies de la Poitrine. Par Théophile Bordeu, Docteur en Medécine des Facultés de Paris, et de Montpélier. Paris, 1767, 12mo. 376 QUARTERLY SUMMARY OF IMPROVEMENTS IN MEDICINE AND SURGERY ANATOMY, 395 1, Notice of a Double Male Foetus, by W. E. Horner, M. D., &c. 2, Imperfect Development of the Cerebral Organs in Monsters. 3, Imperforate Vagina. 4, Fallopian Tubes. 5, Monsters. 6, Foetus grafted into the Chest of another. 7, Foetus without a Stomach, Head or Anus. 8, Congenital Hydrocephalus, with Transposition of the Viscera. 9, Unusual Arrangement of the Aortic Branches. PHYSIOLOGY, 403 10, Influence of the Great Sympathetic Nerve on the Functions of Sense. 11, Cutaneous Absorption. 12, Abstinence. 13, Hippomane Mancinella. 14, Cutaneous Absorption. 15, Regeneration of Divided Arteries. 16, Mineral Poisons. PATHOLOGY, 406 17, Are we followers of Dr. Broussais? 18, Influenza. 19, Diarrhoea Infantum. 20, Tetanus. 21, Small Pox. THERAPEUTICS, MATERIA MEDICA, AND THE PRACTICE OF MEDICINE. 411 22, Tincture of Iodine in Gonorrhoea, Bubo, Scrofula, &c. 23, Acetate of Lead and Tincture of Opium in Dysentery. 24, Powers of Digitalis in Palpitatio Cordis. 25, Tartar-Emetic Ointment in Epilepsy. 26, Antiphlogistics in Recent Cases of Epilepsy. 27, On the Efficacy of Nitrate of Silver in the Treatment of Zona or Shingles. 28, On the Remedial Effects of Camphor in Acute and Chronic Rheumatism. 29, Examination of the Question, whether the Medical Use of Phosphorus internally, is useful, injurious, or equivocal. 30, Nitrous Acid and Opium in Dysentery, Cholera and Diarrhoea. 31, Tartar Emetic in Pneumonia Biliosa. 32, Bark of the Ampelopsis in Catarrhal Consumption. 33, Obstinate Vomiting cured with Extract of Marigold. 34, Vomiting of Fat and Blood. 35, Rupture of the Spleen. 36, Chilblains cured with Chloride of Lime. 37, Local Spontaneous Combustion. 38, Dr. Painchaud on Tic Douloureux. 39, Duration of Life among the Romans. 40, Difference of Mortality from 1775, to 1825. 41, New Method of Percussion of the Thorax. 42, Acid Nitrate of Mercury. 43, Effects of Ardent Spirits. 44, Colombo Root. 45, Poison of Mushrooms. 46, Antisyphilitic Decoction of Zittmann. 47, Acetate of Ammonia, a Remedy for Drunkenness. 48, Mortality of Leeches. 49, Black Drop. 50, Doses of Calomel in days of yore. 51, Buying a good Practice. 52, Sore Nipples. 53, Anderson's Quarterly. 54, Antiquity of Cow Pox and Origin of Small Pox from it. SURGERY, 431 55, Lithotritie, on Breaking the Stone in the Bladder. 56, The High Operation. 57, Sutures in Wounds of the Bladder. 58, Paracentesis Thoracis. 59, Stricture of the Oesophagus. 60, Wound of the Brain. 61, Luxation of the Metatarsus; the history drawn up by M. Dusol, D. M. MIDWIFERY, 438 62, Uterine Hæmorrhage. 63, Polypi of the Uterus. 64, Cæsarian Section. 65, Case of Difficult Parturition. 66, Case of the Pelvis becoming enlarged. CHEMISTRY AND PHARMACY, 440 67, L'Artigue's Process of preparing the Watery Extract of Opium. 68, Berzelius' Method of Detecting Arsenic in the bodies of Persons poisoned by it. 69, Action of Certain Metallic Substances on the Animal Economy. QUARTERLY LIST OF AMERICAN MEDICAL PUBLICATIONS, 444-48 CONTENTS ORIGINAL COMMUNICATIONS. PAGE ART. I. Description of the Gangrenous Ulcer of the Mouths of Children. By B. H. Coates, M. D. one of the Physicians to the Philadelphia Children's Asylum, &c. 1 II. Case of Purpura in an Infant, attended with extraordinary Symptoms. By R. M. Huston, M. D. 24 III. History of the Natural and Modified Small-pox, or of the Variolous and Varioloid Diseases, as they prevailed in Philadelphia in the years 1823 and 1824. By John K. Mitchell, M. D., and John Bell, M. D., attending Physicians at the then Small-pox Hospital.--With a plate. 27 IV. Remarks on the Pathology and Treatment of Yellow Fever. Arranged from the Notes of Dr. J. A. Monges, of Philadelphia. 53 V. Remarks on the Prophylactic Treatment of Cholera Infantum. By Joseph Parrish, M. D., one of the Surgeons to the Pennsylvania Hospital. 68 VI. Case of Neuralgia, cured by Acupuncturation. Communicated by J. Hunter Ewing, M. D. 77 ANALYTICAL REVIEWS. VII. Researches into the Nature and Treatment of Dropsy in the Brain, Chest, Abdomen, Ovarium, and Skin. By Joseph Ayre, M. D., &c. 79 VIII. An Essay on Venereal Diseases, and the Uses and Abuses of Mercury in their Treatment. By Richard Carmichael, M. R. I. A., with Practical Notes, &c. by G. Emerson, M. D. 109 IX. Remarks on some means employed to destroy Tænia, and expel them from the Human Body. By Louis Frank, M. D., Privy Counsellor of her Majesty, Maria Louisa, Duchess of Parma. 114 X. Researches Physiological and Pathological, instituted principally with a View to the Improvement of Medical and Surgical Practice. By James Blundell, M. D., Lecturer on Physiology and Midwifery, at the United Hospitals of St. Thomas and Guy. 119 XI. An Inquiry into the Nature and Treatment of Diabetes, Calculus, and other Affections of the Urinary Organs. By William Prout, M.D. F.R.S. With Notes and Additions, by S. Colhoun, M. D. 125 MEDICAL LITERATURE. XII. Retrospective Review.--Tractatus de Ventriculo et Intestinis, cui præmittitur alius, de Partibus continentibus in Genere, et in Specie de iis Abdominis. Authore Francisco Glissonio. Lond. 1677, 4to. 138 QUARTERLY SUMMARY OF MEDICAL AND SURGICAL INTELLIGENCE. I. Anatomy. 155 II. Physiology. 158 III. Pathology. 161 IV. Therapeutics, Materia Medica, and the Practice of Medicine. 166 V. Surgery. 192 VI. Midwifery. 205 VII. Chemistry and Pharmacy. 208 QUARTERLY LIST OF AMERICAN MEDICAL PUBLICATIONS. 214 FOOTNOTES: THE NORTH AMERICAN Medical and Surgical Journal. JULY, 1826. ORIGINAL COMMUNICATIONS. FOOTNOTES: ARTICLE I.--_Description of the Gangrenous Ulcer of the Mouths of Children._ By B. H. Coates, M. D. one of the Physicians to the Philadelphia Children's Asylum, &c. Having had opportunities of witnessing the ravages and unmanageable character of this destructive disease, I have long and deeply felt the want of some written account, both of the malady, and of a proper mode of treatment. Some research and observation, made in consequence of this feeling, have terminated in the acquisition of more fixed ideas, and of a practice hitherto successful. This convinced me, that it became my duty to lay the result of these inquiries before the public, for the benefit of others. There is, perhaps, no stronger and more peculiar reason for wishing American physicians to write, than the opportunities they possess, of describing and recording many important varieties of morbid affection, which were either unknown to our predecessors, or the descriptions of which, uncombined and uncompared, are only to be found by searching among the more neglected tomes of a public library. Of this, the present case will afford a fair example; as well as an instance of an American physician, who had described the disease from nature, having, from want of encouragement, false modesty, or some other cause, kept it back from publication. Ever since the establishment of the Children's Asylum, under the care of a committee of the guardians of the poor, of the city and liberties of Philadelphia, in the spring of 1819, this useful institution has been annually visited by the new and distressing scourge of which we are treating. It has here prevailed in a considerable number of cases, forming the principal source of anxiety and trouble during the winter season, and annually sweeping off its little victims, in a manner rendered peculiarly awful by its insidious approach, its loathsome effects, and its apparently uncontrollable progress. Various scattered cases of a similar affection have come within my knowledge, during the last few years; occurring in the practice of several physicians, as well as in my own. In no place, however, near Philadelphia, other than the above, has there existed, so far as I know, a sufficient number of cases at the same time, to enable a physician to examine it in much detail, or to make comparative trials of different modes of treatment, so as clearly to determine the most successful. _References to Authors._--The notices of this complaint given by authors, to which I have been enabled to refer, are few, and generally too scanty to supply much means of forming a satisfactory judgment, or a practice in which confidence can be reposed. They consist, principally, of the mere mention of an affection resembling that of which we treat; and, in some instances, it is even doubtful whether they are describing the same disease. No notice is taken of this affection in any of our common books; with the exception of the last edition of COOPER'S Surgical Dictionary,[1] and of UNDERWOOD'S work on diseases of children. It is there described under the erroneous title of _cancrum oris_. A reference is given to PEARSON'S Surgery; and the article in the Dictionary is taken exclusively from that work. As this is the only authority with which I am acquainted, that gives a tolerably full account of a disease somewhat similar to that of which we are treating, I have concluded to extract the whole passage, in the words of the author. "The canker of the mouth is a deep, foul, irregular, foetid ulcer, with jagged edges, which appears upon the inside of the lips and cheeks; and is attended with a copious flow of diseased saliva. "This disease is seldom seen in adults; but it most commonly attacks children, from the age of 18 months, to that of 6 or 7 years. When the ulceration begins at the inner part of the lip, it exhibits a deep, narrow, sulcated appearance, and quickly spreads along the inside of the cheek; which becomes hard, and tumefied externally. The gums are very frequently interested in this complaint, and, in such cases, the teeth are generally found in a loose and diseased state; matter is often found in their sockets, and abscesses sometimes burst externally through the cheek, the lip, or a little below the maxilla inferior: and it is not uncommon to see an exfoliation of the alveolar processes, or even of the greater part of the lower jaw. Among the children of poor people, where this disease is neglected or mismanaged at the beginning, a dreadful gangrene will sometimes supervene. "The remote causes that give origin to this disease are not very obvious. I think it occurs most frequently among children that live in a marshy situation; that are sustained by unwholesome food; and where a due attention to cleanliness has been wanting. The cancrum oris has been described by some writers, as a complaint very common in England and Ireland, where it is sometimes epidemical among infants. It, however, is commonly seen in other kingdoms, and prevails more especially in those houses where a great number of children are crowded together. I am not able to determine whether it is or is not contagious. "But adults are not wholly exempted from this morbid affection, and it is not easy in all cases, to distinguish the cancrum oris from a cancerous or venereal ulcer in the mouth; since the uvula, tonsils or fauces may be the seat of each disease. I have seen ulcerations on the uvula and tonsils, with all the marks of a venereal sore, in patients where the presence of such a virus could not be suspected; and by treating them as canker of the mouth, they have been speedily cured. "The canker of the mouth ought to be distinguished from aphthæ, the epulis and parulis, scurvy, cancerous ulcers, venereal ulcers and exulceration from the use of mercury. "_The mode of treatment._--It will be proper, "1. To remove the diseased teeth, bone, &c. if possible. "2. To prescribe a milk and vegetable diet, and to allow a prudent use of fermented liquors. "3. It will be adviseable to exhibit such remedies as, Peruvian bark; sarsaparilla; elm bark; mineral acids. "The external applications that I have generally found successful have consisted of such as the following: "_Preparations of copper_; a diluted mineral acid; burnt alum; decoction of bark with white vitriol; tincture of myrrh, &c."[2] Of the above articles, those which we have indicated by italics are omitted in the last edition of COOPER'S Dictionary; and, in a former one, they are directly prohibited with strong reprobation. Nevertheless, it is among these that we have found, beyond comparison, the most successful one. Mr. PEARSON prefixes to the preceding article a list of synonymes, with references to authors, in the manner of writers on natural history. They are as follow: _Aphthæ Serpentes._--SENNERTUS; Medicinâ Practicâ. _Labrosulcium, seu Cheilocace._--ARNOLDUS BOOTIUS. _Oris Cancrum._--MUYS. STALPAART VANDER WIEL. _Gangræna Oris._--VAN SWEITEN. _Gangrene scorbutique des Gencives._--Auctores Gallici. Of these, SENNERTUS[3] merely mentions, under the article aphthæ, that the latter sometimes spread around the frænum and tongue, occasionally corroding the subjacent parts. He is so far from giving a clear description, under the head of Aphthæ Serpentes, of any affection analogous to that we are about to record, that he quotes GALEN as remarking, very properly, that these are not aphthæ at all, but putrid ulcers. ARNOLD BOOTIUS, in his little treatise "de morbis omissis," of diseases omitted in the books, published in London, in 1649,[4] gives, from his own observation, an account of a disease, to which he applies the names above attributed to him. It differs from the cases which have attracted our attention, chiefly in its situation. He describes it as an ulcer, soon becoming black and foetid, corroding the inside of both lips, separating them widely from the gums and allowing them to fall outwards upon the face; thus producing a horrible deformity. Besides this, the author states, that a deep fissure usually extended down each half of the inside of each lip; thus adding four deep and ghastly ramifications to the ulcer. This shocking affection is stated to have prevailed extensively, both in England and Ireland; in which latter country the author practised and held several important offices. It occasionally became epidemic, and then destroyed great numbers of children. It principally prevailed between 2 and 4 years of age; though it was occasionally met with both earlier and later in life. It was frequently, but not always, accompanied with aphthæ. This disease was, in general, successfully treated by our author, with a decoction of "Chærephyllum, Quinquefolium, Myrrhis, Rosæ et Salvia;" in which was dissolved a "sat magna copia" of white vitriol.--A combination about as precise as some of the prescriptions which have been recommended to me, for the present disease, in this country. With this mixture, he touched the ulcers several times a day; and then washed them with a liniment of acetate of lead, aqua plantaginis, and oleum rosaceum. He also used _issues_ in both arms; and confined the patient, in more obstinate cases, for drink, to a decoction of sarsaparilla, china, and several other articles, which we will spare our readers. To this disease, BOOTIUS devotes about five small 18mo. pages, forming his tenth chapter. VANDER WIEL cites BOOTIUS, and expresses his belief, that the disease described by the latter was identical with one which he saw himself. This last, however, though described in a cursory manner, appears to resemble much more nearly the disease of the Children's Asylum; beginning in the gums, and extending to the adjacent parts. He treats it by the following lotion: R. Mel. Rosar. [Symbol: ounce]i ---- Ægyptiaci, [Symbol: dram]ij Olei Vitrioli, gtt. _aliquot._ misce. Under this treatment, and by removing the teeth, when loose, the small number of cases he saw recovered in a few days. VANDER WIEL was a practitioner in Holland; and, though he does not specify the fact, his cases were probably in a marshy country.[5] MUYS, in a little treatise entitled "Chirurgia Rationalis,"[6] published in 1684, has an account of a disease, which is evidently supposed by PEARSON to be that which he describes. This also, however, appears to have been a "labrosulcium;" an ulcer between the lips and the incisor teeth. There is but little to be gathered from his paper; as it is principally occupied with an attempt to prove, that this ulcer is owing to an accumulation of _acidity_ in the blood, increased, at this point, by the putrescence of particles of food which collect there. He illustrates this doctrine by an examination of a _burnt rag_ under a microscope; and this he considers as in a state analogous to the gangrene. "Opinionum commenta delet dies," &c. We give his treatment; which is aimed at acidity. R. Theriaci, [Symbol: dram]ijss Ung. Egypt. [Symbol: dram]iss Gum. Laccæ, et Spirit. Sal. _Armon._ aa [Symbol: scruple]ij ---- Cochleariæ, [Symbol: dram]ij _m._ ft. ung. To be softened with a little alcohol, the part washed with the mixture six times a day, and a rag moistened with the same compound left in the ulcer. Here we take leave of the Chirurgia _Rationalis_. In the 14th volume of the Memoirs of the French Royal Academy of Surgery, are papers containing accounts of two cases, which have some points in common with the disease of which we treat; but the identity of at least one of which it is hard to establish. The first piece is entitled, "_Sur la gangrene scorbutique des gencives dans les enfans. Par feu M. Berthe._"[7] The author is described, in a note, as a young surgeon of great promise, who was carried off by an early death. M. BERTHE commences by quoting FABRICIUS HILDANUS; who describes a gangrene of the gums, occuring principally at about 4 years of age, and of which all the patients died. FABRICIUS takes the occasion to give a caution to young surgeons, to avoid being too sanguine in predicting recovery from gangrenes. Next a case is given us, drawn from M. SAVIARD, in which death was the result. This author seems, subsequently, to have had somewhat better success, but at the expense of horrible disfigurements; such as great holes through the cheek, and the loss of a large piece of the jaw; which, indeed, are described as having been worse than death. In another case, recorded by M. POUPART, in the "Histoire de l'Academie des Sciences," this affection terminated in death; preceded, however, and in the opinion of the author, caused, by the production of two tumours, one by the side of the tongue, the other inside of the cheek. This is not at all unlike the progress, which will be hereafter mentioned to have taken place in many of the Asylum cases. M. BERTHE then remarks, that the greater number of instances of gangrene of the gums had terminated unfavourably. His own patient was ill from April to September, 1753; and exhibited swelled and bleeding gums, frequently projecting beyond the teeth,--black and foetid stools, foetid urine, and ecchymoses over the surface of the body. He treated it with antiscorbutics, internally and externally, and apparently with success. The patient, however, relapsed in January, 1754; when M. BERTHE proceeded to a very different, and far more severe treatment. The gums were pared away, in many successive operations; and the wounds were washed with aluminous water. A roll of linen was, during the intervals, kept fastened in the patient's mouth, for the purpose of allowing the escape of the fluids of the part; which he apprehended to possess a putrid character, and to aggravate the original disease, whenever they passed into the stomach. At length, his patient recovered, and continued well. It appears to the writer of these notes to be hardly necessary to state, that M. BERTHE evidently mistook the disease; the latter being in reality scorbutic, and not a single symptom of gangrene being described during its whole history. The same, however, cannot be said of M. CAPDEVILLE; whose "_Observations sur les effets rapides de la pourriture des gencives_" appear in the same volume with the foregoing, and immediately subsequent to it.[8] This writer's case took place after a fever, and no tumefaction of the gums nor ecchymoses of the skin are mentioned as occurring in it. M. CAPDEVILLE attended this case in consultation, in 1764; and complains of too feeble means being employed, as the case was trusted to antiscorbutics. This treatment ended in death. M. C. refers to VAN SWEITEN, whose correct account we shall mention; and it is evident that it was the disease of the Children's Asylum: though he manifests a strong propensity to connect it with scorbutus, and the "blanchet," or a species of aphthæ, which destroyed a great number of children in the Foundling Hospital, in 1746. Reference is also made to cases which occurred in "La Pitié," under the care of CHOPART. Of these, a very scanty account is given. They terminated in death; after a treatment by lotions of honey of roses and spirit of vitriol, with emollient and resolvent cataplasms. VAN SWEITEN, in the article devoted to the consideration of gangrene,[9] has left us a far more exact description of the disease, into which we are inquiring. Practising in a marshy country, he had frequent opportunities of meeting with it; and his account of it, and his mode of treatment, though brief, are every way worthy of the close, practical inquirer into nature, and the sound medical philosopher. His description is not unmixed with strong expressions of horror and commiseration at its ravages. He describes it in a manner so similar to that in which it now prevails, that no doubt can exist of the identity of the diseases. He acknowledges, however, "rubedo, calor, dolor," among its symptoms. Cochlearia, theriaca and similar articles, according to him, are almost always injurious. If no foetor exist, (and, of coarse, no actual mortification,) he applies a solution of sal ammoniac or nitre, with some vinegar or lemon juice; sometimes as a lotion, sometimes by keeping a rag imbued with it always in the ulcer. Hard rubbing he reprobates. If the disease have made progress, and foetor exist, muriatic acid is used: in the less aggravated stages, diluted with honey of roses and water; in the worst cases, pure. This practice he states never to have failed him, unless where the bone was affected. In an early edition of Dr. UNDERWOOD'S Treatise on Diseases of Children, in the library of the Pennsylvania Hospital, no mention is made of this disease; although an article is devoted to "_gangrenous erosion of the cheek_." The account is wholly borrowed from a work by Mr. DEASE, of Dublin, "on the diseases of lying-in women," &c. also in the library. Mr. DEASE describes this affection as occurring from 2 to 6 or 8 years of age; especially in unhealthy children, including such as have been subject to worms. The whole body often appeared cold upon the approach of the disease. A black spot then occurred, but _without marks of inflammation_, on one of the cheeks or lips. The whole cheek was sometimes destroyed, and the lower jaw fell down upon the breast. Muriatic acid, infusion of roses, the effervescing draught, and, in the decline of the disease, bark, broths, jellies, and wine, besides magnesia or rhubarb, to remove the putrid matters swallowed, were the internal remedies employed. The parts were washed and injected with muriatic acid, diluted with chamomile or sage tea; and afterwards dressed with the acid, mixed with honey of roses, and, over this, a carrot poultice. By this practice, Mr. DEASE lays claim to almost total success. In the Philadelphia republication of Dr. UNDERWOOD'S book, taken from the sixth London edition, there is an article entitled Cancrum Oris. The author appears to have read PEARSON'S account; but as his description does not at all agree with the disease of which we are treating, nor with that of Mr. PEARSON, we shall not stop longer to analyse it. I have no doubt, from views that will be hereafter developed, that many of the above writers have had cases similar to those which we are about to describe; but have mistaken them, from the want of a sufficiently early and close inspection of the ulcers. In the second stage, this disease much resembles an inflamed sore between the lips and gums, extending to the latter; although I hope to prove that this state of things is secondary. _Locality of the Disease._--The Philadelphia Children's Asylum is situated in South Fifth street, between Prime and Federal streets, in the district of Southwark. The soil is what is called alluvial, or rather diluvial; as is well known to be the case with all that district, lying south of Philadelphia, as well as the southern part of the city itself. The house was built, and for many years occupied, as a mansion, by the head of a most respectable and wealthy family. Its situation possesses some of the qualities usually selected in choosing the site of a country seat. The buildings stand on a swell of ground, leaving an open lawn, now interrupted by several unoccupied streets, and extending, on the right hand, to the banks of the Delaware, and, on the left, to the Navy Yard and part of the suburb of Southwark. Towards the north, it is not far from the edge of a thickly built appendage of the city. The district immediately south of the Asylum is marshy, and has long been noted for the prevalence of intermittent fevers; but the slightly elevated site of the building had been generally healthy, and continued so, till the universal and distressing epidemic, which infested all the outskirts of Philadelphia, in 1822 and 1823. Even at this period, the persons resident at the Asylum, were far from suffering so severely as the adjacent neighbourhood; and, since those years, it has again become, in general, tolerably healthy. In 1819, 1820, 1821, and 1822, a lot, situated at a short distance, on which were deposited the contents of a number of privies, proved a source of great inconvenience, and some disease, at the Asylum. This focus of effluvia, together with the general and copious use of similar materials in manuring the adjacent fields, occasioned an intolerable stench, and generated diarrhoeas, in the early part of the spring. When the grass and weeds, however, were grown sufficiently to protect the surface of the soil from the sun and wind, this effect entirely ceased; and I know not that any other inconvenience was experienced from the same source, unless we attribute to this, as may fairly be done, the destruction of the purity of the well. This formerly afforded very good water; and, since that period, it has much improved. When the corporations of Southwark and Moyamensing shall introduce, as it is to be hoped they will, the Fairmount water into their streets, one remaining cause of inconvenience and ill health, will be removed from the Children's Asylum. _Prevalent Diseases._--Ophthalmias and furuncular eruptions, the latter principally on the face, are epidemic every year; generally in the spring and early summer months. When prevalent in the city, the measles, small pox, and varioloid disease have reached the Asylum; the scarlatina has, at no period, I believe, been peculiarly troublesome there. Intermittents, which were anticipated by many, from the nature of the situation, have seldom, if ever, prevailed in the house, to any very considerable extent. One of the worst visitations which it has experienced, in this respect, was in the autumn of 1823. In many cases, it was in patients who had been labouring under disease of this description, that the ulcer we are about to describe exhibited itself; but it was by no means confined to those who were known to have so suffered. Many, perhaps, most of the children affected, were free from any apparent ailment; although it is by no means impossible that the little, uncomplaining subjects were, at the time, labouring under what has been called "febricula" or "inward fever." _Regimen._--To the impurity of the water we have already adverted. The diet of the children furnishes them with meat every day, with the exception, during a part of the existence of the institution, of two days in every week. Molasses was freely used; indian mush was greatly in demand; and the breakfast and supper were of bread and milk. During the summer months, this diet was abundantly nourishing; but in winter, it was thought that an additional quantity of animal food was desirable; and, accordingly, it was, during the two last winters, given every day. _Description of the Disease._--The ulcer of which we speak, may begin in many parts of the mouth. In by far the greater number of cases, however, it commences immediately at the edges of the gums, in contact with the necks of the teeth, and, most generally, of the two lower incisors. A separation is found here; which exhibits a slight loss of substance at the extreme edge of the gums, and, as far as I have observed, a whitishness of the diseased surface. In some instances, though not very frequently, this is preceded by a slight swelling and redness. In this state, the disease may continue for a long time; and I have reason to believe, that patients have remained thus affected, during the whole period of three months, for which I attended the Asylum. At one time, when the disease was at its height, threatening several patients with destruction, I found upwards of 70 children, out of a population amounting to about 240, more or less affected with these ulcerations. No remarkable change is at this stage observable in the functions of the little sufferer; except a general air of languor and weakness. The appetite and the muscular activity continue, but are somewhat reduced; not sufficiently, however, to disable the child from attending school, taking the air, or continuing his ordinary practices. In this state, no symptoms of irritation have been at all discovered. The skin is cool during the day, no pain is complained of; and no account has ever been given me of any nocturnal paroxysm of fever. It would appear to be purely a state of asthenia. We are, however, by no means certain, that there was no concealed irritation in the system. We were, of necessity, obliged to depend, in a great measure, upon the reports of nurses, and other females; and these were liable to overlook, or mistake for mere weakness, the signs of an obscure disease. In this manner, commencing cases were frequently not discovered, and nothing was done, till the affection had made further progress; and this continued until the ascertained existence of the epidemic in the house, combined with the recollection of its former ravages, had excited an alarm, which led to the inspection of the mouths of all the children in the institution. The disease, in this form, must be within the curative powers of nature; as, if this were not the case, we should hear of more numerous unfavourable terminations. It has seldom, however, if at all, been within my power to witness this tendency; and, when not controlled by a particular treatment, the cases have almost always either remained stationary, or increased in severity. Its first progress is, most generally, by extending to the edges of the gums round other teeth; frequently affecting a large portion of the dental arches. A very early progress is, however, mostly effected, down the length of the tooth, in the direction of the socket; and, in this way, the disease commits great and unsuspected ravages. When it reaches the edges of the bony socket, the tooth begins to be loose, and when drawn, exhibits portions of the fang, including parts which had been contained within the alveolus, entirely denuded of their periosteum. Indeed, from observation, I should say, that the latter membrane was the part, which was the most peculiarly liable to injury and death from this disease; and it is by no means clear, to my apprehension, that this is not frequently the commencement of the complaint. The injury generally proceeds with augmenting rapidity; especially when it has affected the deeper parts: and it is while in the act of rapidly spreading, that it occasions gangrene. In the production of gangrenous sloughs, it much resembles the descriptions usually given of sloughing ulcers. A portion of the parts immediately subjacent to the ulcer loses its life; this rapidly separates; and, before or after a complete removal, a fresh slough is formed in the same manner. The sloughs are generally black, with ash-coloured edges. I have not been able to discern a change of colour, the production of vesicles, or any material tumefaction, as antecedent to the gangrene. There is generally, by this time, an increased heat in the parts; with the sensation termed "calor mordens." The discharge now, for the first time, becomes acrimonious; giving pain when it comes in contact with cuts in the finger; and excoriations are produced on all parts in contact with the sloughing ulcerations; as the lips, the cheeks, the tongue, and the adjoining surface of the part where the ulcer is situated. As soon as the external gangrene has reached the level of the edge of the bony socket, and frequently much sooner, the adjacent portion of the latter is found deprived of its life; forming a necrosis. The death of the periosteum in the socket, at least that of the fang of the tooth, precedes, by some interval of time, that of any portion of the bone itself. When gangrene is formed, a fever of irritation is generally developed. In regard to the time at which this takes place, there is a great diversity in different constitutions. It has appeared to me to depend, principally, upon the inflammation of the mouth, which is secondary to the original disease, and, in most cases, to arise from the acrimony of the discharge. It is aggravated by loss of rest, want of nourishment, and, probably, by putrid matter finding its way into the stomach. To the latter cause I also refer a diarrhoea, which almost uniformly comes on, towards the close. There are accounts of a similar disease having begun on the inside of the cheeks. I have, however, never seen a well-marked instance of this; the cases which were supposed to be such having, in every instance, been also found to exhibit ulcerations at the edges of the gums. That the disease spreads from the gums to the cheek, is a fact which have often seen exemplified. It is, indeed, the most usual termination of bad cases. After producing gangrene and necrosis in the gums and alveoli, and after the discharge becomes, as above stated, acrimonious, a gangrenous spot is not unfrequently found about the opening of the Stenonian duct, on the inside of the upper or lower lip, opposite the incisors, in some other part of the inside of the lip or cheek, or in more than one of these situations at the same time. Whether this be owing to excoriation from the discharge, or to some other cause, I cannot say; it has, however, in every instance which I have seen sufficiently early to witness its rise, been subsequent to the symptoms previously described. When the gangrene reaches the cheek or lip, however, very active inflammatory symptoms are uniformly developed. In the cellular substance of these parts, they assume the well known characters which have been attributed to the _phlegmonous_ species. We have a great thickening, forming, in the cheek, a large, rounded, prominent tumour, with great heat and pain. Sometimes redness is perceived externally; but, more frequently, the great distension of the skin of the cheek seems to empty the cutaneous vessels; giving to the part, a smooth, polished, dense, white appearance, very much resembling the effect of a violent salivation. I have no doubt that this is the tumour described by POUPART, and alluded to in an earlier part of this paper. Great thickness and hardness have always occurred, in the other situations where this gangrene has approached the external cellular masses of the face; in the lip, however, they are less remarkable, perhaps from the smaller amount of cellular matter. After reaching this stage, a black spot is frequently seen on the outer surface of the swelling. This spreads rapidly; and has always been, in my own experience, the immediate harbinger of death. It is proper to state, however, that I have heard it said, that cases had recovered in this city, in which the gangrene had produced a hole through the cheek. Under what physician's care this occurred, I have never learned. In two cases it commenced in the fauces; and was marked by the same unsuspected progress. In one of these, the little patient was remarked to be languid, but had no positive external marks of disease. The mouth was examined, and found healthy; but no suspicion of the real situation of the disease was entertained, till after 3 or 4 days more, when he complained of a slight sore throat. A large gangrene of the tonsils, half-arches and pharynx, was now found; and the event need hardly be told. The closing stage of this affection is marked by large gangrenous patches in the gums; deep fissures between these and the teeth; the latter loose, or falling out; large pieces of the alveolar processes, often containing the roots of several teeth, in a state of entire necrosis; the whole lining membrane of the mouth suffering a violent excoriation; the whole adjacent external cellular substance, hard and swelled; large gangrenous spots in the inside of the cheek or lips, occasionally extending quite through to the outer surface; a total incapability to sleep, or to take the least food; fever; a swelled abdomen, and diarrhoea. _Dissection._--The inspection of the body after death had never thrown much light upon this obscure affection. Since I began to prepare materials for this paper, I have been able to dissect but one subject. The appearances were as follow: _Exterior_, emaciated. _Alimentary canal_, externally and internally, altogether in a natural state, except what appeared to me to be owing to the subsidence of blood to depending portions of the intestines. The mucous membrane was carefully examined throughout its whole length; but not being at that time aware of the importance, attached, by some pathologists, to small rednesses in this organ, it is highly probable that some such may have been overlooked. _Liver and Spleen_, enlarged, but of a natural appearance. _Heart, thoracic oesophagus, and one kidney_, (the other not examined,) natural. _Lungs_, containing much mucus in the bronchial cavities. The fore part of their substance contained much hepatization. _Pathology._--The nature and production of this disease are certainly very obscure. We may, however, as in other branches of knowledge, attempt to develop and record what knowledge we possess respecting it; carefully separating truth and reason from conjecture. We have already said, that its access was very frequently preceded by no marks of visible disease, or at least none that attracted attention. The little subjects were, apparently, in merely a drooping or enfeebled state. In other instances, the ulceration followed a common remittent or intermittent fever; insomuch that, at one time, whenever a child was brought to the nursery for fever, it was expected, as a matter of course, that his mouth would become sore. In the other cases, as we have already had occasion to say, it is quite possible that a concealed "inward fever" may have existed; and this is rendered the more probable, by the circumstance of their losing their appetites. In the instance where the body was opened, we have seen that the original disease was hepatization of the lungs; and yet it is quite probable, that this affection had caused, as it often does, that species of disease, which a rapidly spreading pathology refers to a slow inflammation of the stomach and intestines. With regard to marks of this last not having been detected by me, it is evident that I am in the same situation with a very numerous body of other observers. The local appearances, at the commencement, did not appear to be of an _inflammatory_ nature, at least generally. If the gums were really the first part affected, it was not so; as these parts when inflamed, as they frequently are in affections of the teeth, exhibit decided soreness, pain, swelling, and an increase of redness. The ulcerated part was, in about nine cases out of ten, paler than natural; and then neither soreness nor increased heat was perceptible, except in a few cases, in which the mouth was generally hotter than natural, though it was not, in a striking manner, referrible to the gums. In a few cases, distinct redness, and a slight swelling, were perceptible round the ulcer. These patients generally did better than the others. If, on the other hand, we suppose the original derangement to have taken place in the periosteum, we shall be enabled, more easily, to explain some of the phenomena. We then reason thus: The whole of the body had shrunk considerably, from disease, and, the circulation being deprived of a part of its usual vigour, the periosteum, a part possessed of little vitality, was unable to bear the additional extension, which it underwent, across the unyielding bone of the tooth. The blood ceased to circulate in it, and it died. Ulceration of the adjacent parts followed, as a matter of course; and these parts, especially the periosteum, being possessed of but little sensibility, the sympathies of the other parts of the system were but little interested, until an extensive portion of the mucous membrane of the mouth, or a mass of cellular substance, became affected. We certainly see that, in every case but two, the disease commenced in contact with the teeth. This doctrine will also explain the rapid and deep penetration of the ulcer along the roots of the teeth; and the destruction of the bone. We may recur to the statement, that a portion of the fang of every loose tooth was always found deprived of its periosteum. In the two cases excepted, we have seen it apparently begin in the mucous membrane of the fauces; and indeed the manner in which it generally spreads from the gums to the cheek and lips, seems to me, unquestionably, to indicate a greater liability than common to gangrene in more than one part of the mouth. The soreness and pain of the socket, which forms a part of most tooth-achs, might have been reasonably expected here; but neither was ever complained of, even when the teeth were loosening: and, as no fever existed at this time, the original irritation can hardly be considered as inflammatory; excepting perhaps the cases which exhibited redness, and slight swelling of the gums. _Is this disease scorbutic?_--I never observed ecchymoses, nor in more than a single instance any the minutest red specks upon the cutis, which might be thought to resemble petechiæ. The patients never fainted; the gums were never spongy, nor did they bleed more than those of any other child would have bled, under an equal degree of violence. I however requested my friend, Dr. HARRIS, who has had ample opportunities of making himself acquainted with scorbutus, to see some patients with me. He complied, with his usual kindness, and pronounced their disease not at all to resemble the scurvy. _The teeth._--But few cases occurred during the second dentition; and it is doubtful whether any one took place during the first. It should be remarked, however, that children under 2 years, were not admitted to the institution, unless by deception on the part of the parents. No child ever lost a tooth of the second set; and, indeed, the second dentition seemed often to cure the complaint. The greater number of cases occurred between 2 and 5 years of age, but some as late as 8 or 10. In several instances, the ulcer destroyed a portion of the enamel capsule; and the teeth were then cut, with _very perfect enamel_ upon the lower part, while the bone was entirely bare at the ulcerated portion of the capsule. This singular fact proves that no inflammation of the capsule, sufficient to interrupt the function of its remaining portion, took place in consequence of the opening of its cavity. _Prevalence of this disease in our own country._--Many elderly persons remember during different periods of their lives, a tradition and particular instances of a formidable disease of the mouth, by the name of "Black Canker."[10] Round Philadelphia, it appears to have been rare. Having been informed by a friend, that the disease had prevailed extensively at Salem, New Jersey, under the notice of my friend, Dr. THEOPHILUS R. BEESLEY, I addressed a letter to that gentleman, to which he furnished me with an obliging and instructive reply, which I have unfortunately mislaid. Numerous cases have occurred, in that vicinity, within the last 30 years; and were, in general, successfully treated by the women. Cases seldom came under the view of physicians, until gangrene had commenced; and of these, many died: so that the old women were generally more in vogue for its cure, than the regular practitioners. Dr. BEESLEY, Dr. VANMETER, and my friend Dr. E. Q. KEASBEY, had met with much of this complaint; and the result of many of their observations had been combined in a thesis, written, but, according to our unfortunate custom, not published, by the younger Dr. VANMETER. It was there considered as a sequela of intermittent and slow remittent fevers, and seldom occurred but in marshy districts, and among the poor. It generally prevailed between the ages of 2 and 10 years. Of the remedies employed we shall again speak. Dr. SAMUEL TUCKER has also seen it in marshy situations near Burlington. I have heard of its existence on the Schuylkill. Dr. PARRISH has for several years noticed a stage of this complaint, under the name of "a disease resembling the effects of mercury," in his private lectures. Drs. PHYSICK, HARTSHORNE, HEWSON, MEIGS, WOOD, RHEA BARTON, and REMINGTON, and several others who will pardon me for omitting their names, have also met with cases. _Prevention._--Our precautionary measures should be directed to the predisposed or commencing state already described; to the prevention and cure of fevers, to the removal of "febricula," and other internal disorders, and to the general restoration of strength. Finally, its commencing stage should be watched, and promptly met; and success, I believe, will always attend our endeavours. At the Children's Asylum, all the weakly children were made to take bitters, of different descriptions; and Dr. SYLVESTER'S antiscorbutic drink, composed of cream of tartar and juniper berries, infused in water. As the disease declined in the house, under this administration of bitters, it is highly probable that they had a preventive agency. I much question, however, whether Dr. SYLVESTER'S drink was productive of any advantage. One question of some importance yet remains. _Has mercury any agency in producing this affection?_ The salivary glands have never been observed to be affected in it. Dr. PARRISH informs me, that, after a strict examination, he has come to the conclusion that the previous use of mercury does not bring on, or aggravate this complaint, as he has noticed it. I have made the same observation; and, not being peculiarly sparing of the use of calomel in fevers, have had opportunities to verify it. I think I can add, that, in some cases, by shortening and moderating an attack of fever, calomel has been useful in preventing the ulceration. Given during the progress of one, and that a fatal case, it did not appear to aggravate it. There is no evidence whatever tending to excite the suspicion of _contagion_. _Treatment._--A variety of remedies had been tried within my knowledge; most of them with but little success, and one or two with somewhat better. Feeling much disappointed with the results of my practice, in the small number of cases which fell under my care in the spring months at the Asylum, as well as elsewhere, I wished to exchange with another physician for a period when the disease was more prevalent; for the purpose of studying it, and making comparative trials of different remedies. Dr. JOS. G. NANCREDE was so polite as to indulge me. Having then a large number of patients under my care, I was enabled to make more extensive observations, and with more precision; the results of which course gave me the first satisfaction I had ever felt relative to this disease. Trials were made of every thing that was suggested by friends, and generally upon 4 or 5 selected patients at a time. Thus, choosing them in the ulcerative stage, and having several at a time before our eyes, the result was seen in a very few days, much sooner than if patients had been successively subjected to the remedies; and no material time was lost in appealing to the article which appeared to answer best. The remedy which beyond all comparison succeeded best, was sulphate of copper. The usefulness of this substance, though known at Salem, New Jersey, was discovered, at the Asylum, by the mistake of a nurse. It had been previously used, in lotions of the strength of gr. ij or iij to the ounce of water; and with little advantage. Observing that the empirical remedies said to have succeeded, were, as I considered them, immoderately strong, I furnished the nurse with a common solution of sulphate of copper, and with a vial containing 72 grains of the sulphate in an ounce of water, for the purpose of being progressively added to the other at different periods. This stronger solution was applied, by mistake, instead of the diluted one; and it was the first remedy which had produced a rapid tendency to a cure. I finally settled down, after various trials, in the employment of the following: R. Sulph. Cupri, [Symbol: dram]ij Pulv. Cinchonæ, [Symbol: ounce]ss Aquæ, [Symbol: ounce]iv _m._ S. To be applied twice a day, very carefully, to the full extent of the ulcerations and excoriations. The cinchona here is not absolutely necessary; but operates by retaining the sulphate longer in contact with the edges of the gums. Simple ulcerations and small gangrenes, as well as the troublesome excoriation, when not in the last stage, yielded promptly to this remedy; the good effect being generally visible from the first application. Dr. FOX, my friend and fellow-labourer in the Asylum, had already taught me that it was important early to extract the teeth. I was not, however, sensible of the full extent of this rule, till after examining the fangs of some of them which were drawn. The separation of a portion of the periosteum from the fang, within the socket, which was universally found whenever the tooth was loose, among two or three hundred specimens, proved the existence of the disease in a deep, narrow crevice, into which it was impossible, by any contrivance, to insinuate the lotion. This cavity was laid open by extracting the tooth; and when the remedy was applied, the sanatory effect was surprisingly prompt. From this period, forwards, the universal rule was to extract all teeth, the moment they were discovered to be in the slightest degree loose; and "the blue wash" above described, became the standing remedy. It is at all times a dangerous boast for a physician to make, to say that, in the treatment of any complaint, he has always succeeded. He is frequently not credited; and he can never know at what moment disbelief may be borne out by his subsequent failures. A faithful adherence to fact, and justice to the medical art, oblige me to say that it was owing to the observation of these means, that I never had an opportunity of making a dissection, after the one mentioned in a preceding page. Upwards of 120 ulcerated gums came under my notice in the course of three months; of which 70 were affected at one time. Of these, by far the greater number would, unquestionably, have escaped gangrene. The experience of past winters, however, and that of the preceding autumn, justifies the belief that there would have been several gangrenous cases, and some deaths; unless interrupted by remedial means. Some 3 or 4 suffered small spots of mortification, and one, by the delay arising from the tardy report of a nurse, suffered necrosis in a portion of an alveolus; but they were speedily arrested, and the production of more such cases, I believe, prevented, by the employment of the above means. I have been once, since then, called in consultation to a case in which this remedy failed; but this was only two days previous to death, and during the existence of swelled cheek, and of a thick gangrenous eschar, and it was in fact only once imperfectly applied. The farthest advanced of all the cases which I have seen, since that time, relieved by this remedy, was in the practice of my friend, Dr. R. M. HUSTON. He aided it by the application of a poultice with lead-water to the external surface of the cheek. This was thought to be productive of much relief. Great attention and care are requisite on the part of the physician, to see that every part of the ulceration and excoriation is made visible, and brought under the influence of the applications employed. Without this entire knowledge of the extent of the evil, the result will be failure. The disgusting sloughs and discharge, and the fear of an imaginary _contagion_, make the nurses very unwilling to introduce their fingers into the reluctant little patient's mouth, and without this scrutiny all is in vain. The physician is compelled to set the example, to try the looseness of the teeth with his own fingers, and to ensure the nurse's entire knowledge of the extent of the disease. Dr. BEESLEY writes that the women in his neighbourhood, frequently used considerable _roughness_ in applying the lotions. _Certainty_ is absolutely necessary. After the remedy had been thus accidentally discovered in the Asylum, and used for a few days, I received Dr. BEESLEY'S letter mentioned above; and I then learned that the sulphate of copper was the principal dependence of the physicians at Salem. As, however, I had never seen Dr. VANMETER'S thesis, the use of it at the Asylum was new to me. An excellent remedy, and one on which the sole dependence should be placed, were we not in possession of one which possesses a decided superiority, is one which was communicated to me by Dr. PARRISH. It is as follows, including a slight correction made by the apothecary: R. Sulph. Zinci, [Symbol: dram]i Aquæ, [Symbol: dram]ij Solve. Dein adde, Mellis Despum. et Tinct. Myrrhæ, aa [Symbol: ounce]ij To be used in the manner described above. Some bad cases yielded to the following: R. Sulph. Zinci, [Symbol: dram]ij Aquæ, [Symbol: ounce]i _m._ It is useful to record failures and unsuccessful trials; as they serve to deter others from unnecessary risk. We therefore record the following as not having succeeded in our hands: R. Mellis et Tinct. Myrrhæ, aa [Symbol: ounce]i _m._ The same, with the addition of powdered bark. R. Aluminis, [Symbol: scruple]ij Tinct. Myrrhæ, et Mellis, aa [Symbol: ounce]ij _m._ R. Pulv. Cinchonæ, [Symbol: ounce]i Myrrhæ et Pulv. Carbonis. a [Symbol: ounce]ss _m._ et adde Succ. Limonum, q. s. ad massam faciendam, quâ illineantur gingivæ. Caustic potassa; and nitrate of silver. Pyroligneous acid, both pure and variously diluted with water. This had but a very limited effect, even in destroying the foetor; and I am by no means sure that it was of any use in arresting the disease. Muriatic acid, though praised by such high authorities, did not seem productive of any distinct useful effects. Nitric acid, variously diluted, and sulphuric acid, which was tried in one case, diluted with an equal quantity of water, were entirely useless. Of _constitutional_ treatment, the disease seemed to admit very little. In the early stage, the means employed, were the same mentioned above as means of prevention. It was by no means evident that any of these were useful in retarding the progress of the complaint. Towards the decline of the worst cases, aromatic sirup of rhubarb, with magnesia, were employed, to remove the putrid matters swallowed; and to relieve the diarrhoea which generally took place, by the astringent operation of the first mentioned medicine. It is extremely doubtful whether these means were productive of any benefit. * * * * * While the above was in press, I have met with the article, "_Gangrene de la bouche des enfans_," in the Dictionnaire de Medicine; written by M. MARJOLIN. The author in the Dictionnaire des Sciences Medicales, has given nothing material but references to some of the writers mentioned above; with one or two which were not within my reach. M. MARJOLIN has evidently identified the disease. He cites FABRICIUS HILDANUS, though we have not found a distinct account of it in that writer's works. He remarks that it is identical with the _necrosis infantilis_ of SAUVAGES. He also refers to SAVIARD, VAN SWEITEN, whom he justly mentions with the highest praise, UNDERWOOD, BERTHE, CAPDEVILLE, M. BARON, and the inaugural thesis of M. ISNARD. As we have no means of referring to the two last, we must judge of them by M. MARJOLIN'S statements. He observes the dissimilarity of BERTHE'S case. From the thesis of M. ISNARD, he gives us an account of the disease which corresponds very nearly, indeed, with that of VAN SWEITEN, and with the appearances observed at the Children's Asylum. "Almost all the infants affected with this disease in the hospitals of Paris," says M. MARJOLIN, "sink under it." He recommends, after VAN SWEITEN, the use of muriatic acid, which he mixes with honey in equal proportions. Thick sloughs he cuts away with a bistouri or with scissors. MM. JADELOT, GUERSENT, and BARON, have employed the actual cautery with success in several instances. M. MARJOLIN has cured three cases; one by the actual cautery, one by caustic potassa, and a third by _muriate of soda!_ which, he believes, will always destroy the foetor. It would be interesting, undoubtedly, to make repeated trials of this simple remedy; and we shall endeavour to do so in cases which admit of delay. FOOTNOTES: [1] Vol. I. p. 319, Anderson's edition. [2] Principles of Surgery; by JOHN PEARSON. Lond. 1788. p. 262, et seq. [3] Opera omnia. Vol. II. p. 271. In the Loganian Library. [4] Ibidem. [5] See CORNELII STALPAART VANDER WIEL Observationes Medico-Anatomicæ. p. 167. Note by the editor, P. STALPAART VANDER WIEL. Amsterdam, 1687. In the Loganian Library. [6] In the Loganian Library. [7] Page 193. [8] Page 217. [9] Commentaria.--Edit. Lugd. Bat. 1742. Vol. I. pp. 766, 767. [10] This name may be either from the ancient English or the low Dutch; if the one, by tradition, if the other, from the use of it by medical men. _Cancrum_ is an odd grammatical blunder; being, in reality, nothing but the accusative of Cancer, put instead of the nominative. The latter name was, as is well known, frequently applied by the older surgeons, in a vague manner, to any terrific and unmanageable ulcer; and, in particular, it was often applied to gangrene. The error appears to have been first made by Pearson, and copied by Mr. Cooper. Compare Muys and Vander Wiel, with Pearson, at the above references. ARTICLE II.--_Case of Purpura in an Infant, attended with Extraordinary Symptoms._ By R. M. HUSTON, M. D., &c. On the 28th of August last, A---- V----, after a moderate labour of four hours' continuance, was delivered of a female child. About a month previously, she had laboured under an attack of intermittent fever, which yielded, in a few days, to the ordinary treatment. She was 23 years of age, an English-woman by birth, had generally enjoyed good health, and was as well as usual at the time of her confinement. Her labour was strictly natural, and her delivery accomplished without any extraordinary assistance. At birth there was nothing remarkable about the child. Its breathing was natural, its skin of the usual colour and appearance; in short, all the common indications of a continuance of life and health were present. A few hours, however, after birth, it became uneasy, cried much, and showed signs of colic. The nurse, supposing these symptoms to arise from flatulence, administered some warm tea; but without any apparent advantage. On the following day, I saw it again, and learned, that it had evacuated a considerable quantity of urine, and some intestinal matter, of the ordinary appearance after birth. The spasms continuing at intervals, a teaspoonful of castor oil was ordered, to evacuate any remaining meconium, that might lie in the bowels, producing irritation; upon the presence of which, it was presumed the spasms depended. It operated well, but without producing the desired relief. On the next day, viz. forty-eight hours after birth, a number of bluish or purple spots were observed on different parts of the child's body, but most numerous on the extremities. They were of various sizes, from that of a mustard seed, up to that of a grain of Indian corn. Some were slightly elevated, but most of them were not in the least so. In the majority, there was a minute central spot, or little point, more red or pink coloured than the blue areola, by which it was surrounded. In many instances, these little points projected, so as to become manifest to the touch. In the course of twenty-four hours, the spots, which had first appeared, began to decline, leaving a greenish mark, very like the remains of a bruise; but much more rapidly than these declined, others of larger size appeared on different parts of the child's body. On the third day after birth, large blotches appeared, one behind each ear. These rapidly increased, until they covered the whole extent of the parietal bones, and considerably elevated the skin, giving it a puffy or tumid appearance, like that caused by a blow from a large or blunt instrument. The parts soon became hot and tender to the touch; and this tenderness extended over the greater part of the scalp. A blotch, similar to those upon the exterior surface, was likewise observed within the mouth, covering the whole extent of the palate bones. The child experienced great difficulty in swallowing after the third day; and the _nurse_ thought the spasms were often excited by attempts of this kind. But the most singular feature of the case was the appearance, on the night of the second day, of a discharge from the vagina, _resembling_ the menstrual flux. It resembled that flux in _colour_, _consistence_, _want of coagulability_, and in being, withal, accompanied by a considerable quantity of _slimy or mucous matter_. Every diaper which was used during that night, and the greater part of the next day, was stained more or less with this discharge. It was also observed, that, during the flow of this fluid, the spasms ceased; and that, whenever the discharge was suppressed, even for a very short time, they uniformly returned. In this manner they alternated at intervals of a few hours, until the occurrence of the death of the child, which happened on the eighth day after birth. As this case is related more for its singularity than from an expectation that any practical suggestions will be furnished by its perusal, but few remarks will be necessary, either upon its pathology or treatment. Although it will be perceived by the scientific reader, that the disease observed, differed materially from any of the forms of _purpura_, described by systematic writers on diseases of the skin; still I apprehend it may be justly considered as more nearly allied to that genus, than to any other. The spots were evidently caused by an effusion of blood beneath the cutis, and the presumption is strong, that it issued from the little point discoverable in the centre of each spot. Those points were, in all probability, _arterial_. That they were arterial terminations, I think is evident, from the great extent to which the cellular membrane was injected, especially over the parietal bones. The force exerted must have been very considerable to elevate so large a portion of scalp, and yet no pulsation could be discovered in any one of the points. But whence came the vaginal discharge? That it issued from the _vagina_ was most certain; but whether it was furnished by that canal, or by _the uterus_, was not ascertained. To assert that it was menstrual, would be hazarding more than a prudent regard for truth would justify. But, if not, why the pain and spasms which preceded it, and the alternation of these symptoms with each other? and, especially, why the slimy appearance, mixed with red matter, without a trace of any thing like coagula? Certainly we do not find these appearances in ordinary cases of hæmorrhage. So that there is no other way of accounting for the discharge in this case, except by considering it as having been secreted by the vessels of the parts from which it came. From the difficulty which the child experienced in swallowing, but little food could be taken; and the same difficulty precluded the administration of medicines. What caused this impediment could not be ascertained, but it was supposed to result from a spasmodic action of the muscles of the part. The only medicine attempted to be given was a weak infusion of bark, and this was soon abandoned. The spots, particularly the large ecchymosed surface on the head, exhibited no change in appearance, when _viewed superficially_, a few hours after death. No other examination was permitted. FOOTNOTES: ARTICLE III.--_History of the Natural and Modified Small-Pox, or of the Variolous and Varioloid Diseases, as they prevailed in Philadelphia in the years 1823 and 1824._ By JOHN K. MITCHELL, M. D., and JOHN BELL, M. D. attending physicians at the then Small-Pox Hospital. With a Plate. In a question of less moment, some apology might seem due for once more directing public attention to that which has been so oft discussed and described by many eminent physicians and experienced observers. But, if descriptions of any disease be valuable; if to record faithfully an evil be among the first steps for its removal and prevention; and, still more, if additional confidence, derived from enlarged experience, can be imparted to the means hitherto adopted to guaranty the human frame against a mortal and loathsome malady, our efforts at this time may claim the favourable notice of our professional brethren, and of the community at large. Sedulously abstaining from the parade of erudite research or indulgence in speculations, however ingenious, it is our intention to describe with accuracy all that we saw; and if, in so doing, we shall be found repeating what others have said before us, and proposing inferences previously drawn, the observations and deductions are to be considered as not the less our own, since we only speak from conviction, founded on the evidence presented to our senses. Our opportunities for accurate judgment were most ample, being derived as well from an attendance of nine months on the hospital for the reception of the poor, labouring under the disease, as from one of us prescribing, during a part of the time, for the Philadelphia Dispensary, added to the cases furnished us by private practice, and very many others, the records of which have been kindly placed at our disposal by professional friends. The ravages committed by the small-pox in Baltimore, and the fact of many who had been previously vaccinated having been attacked by the disease during the years 1821 and 1822 were notorious to us all, but were productive of little alarm in Philadelphia. The non-appearance of the scourge in the greater part of the period, when the former city was suffering under it, justified, to a certain extent, this feeling of security, and seemed to call more on our sympathies for our neighbours than on our fears for ourselves. In the month of September, 1823, some cases of fever, with pustular eruption, first arrested the attention of the medical faculty, some of whom were, of course, called on to render professional assistance. The residence of some of the persons, thus attacked, in Water street, and their emigration from Europe, naturally induced a suspicion of this disease being no other than the small-pox, imported by, or brought in with them. Very nearly about the same time, however, some scattered cases of a similar eruptive disease, were noticed in the upper or western portion of the city, without our being able to trace any intercourse or connexion between these and the others in the lower or eastern part, viz. Water street. The first return of death from small-pox, furnished by the Board of Health, was in the week between the 13th and 20th of September. The next was between the 4th and 11th of October. From this time to the end of the year there was a progressive increase of mortality, and the annual return for 1823, presented no fewer than one hundred and sixty deaths by small-pox. The greatest mortality in any one week was thirty-three, from December 20 to 27. During the months of January, February and March, 1824, the disease prevailed extensively, and was fatal to many. In the following months its violence subsided, and in the month of June our attendance on the temporary hospital[11] was discontinued, in consequence of a resolution of the Managers of the Alms House to close it. Though a few patients were afterwards received into it, yet the malady soon disappearing, justified its final closure. The annual return for 1824 exhibited three hundred and twenty-four deaths by small-pox. The entire mortality from this cause was four hundred and seventy-three, in a period of twelve months, from November 1, 1823, to November 1, 1824. The deaths before the first, and after the second date, were but eleven.[12] Contagious as this disease unquestionably was, we cannot, at the same time, withhold our belief of its having been in a measure subjected to epidemical influences, viz. in a particular character of the seasons and atmospherical changes. It is then within our province, as historians of events, rather than as expounders of causes, to present our readers with a summary account of the weather during the years 1823 and 1824. We do this both from a sense of duty, considering it as pertinent to our present labour, and from a wish to encourage others by our example to preserve and transmit the meteorological registers, in their respective districts, of those years, marked by new or aggravated diseases. METEOROLOGICAL REGISTER.[13] ------------------------------------------------------------------------ | | | | | |Winds--Days.| | | | | | |Snow & |------|-----| | | | | | |Rain |N. W. |N. E.| | | |Mean |Variat.|Variat.|Water. | to | to | | | 1823. |Temp. |Therm. |Barom. |Inches.|S. W. |S. E.| | |-------------|------|-------|-------|-------|------|-----| The | |January, | 31 | 44 | 0.94 | 3.38 | 22 | 8 | | |February, | 25 | 42 | 1.17 | 1.93 | 22 | 6 |temperature | |March, | 37 | 52 | 1.65 | 6.87 | 21 | 9 | | |April, | 55 | 47 | 1.08 | 1.77 | 16 | 14 | of | |May, | 61 | 52 | 0.88 | 1.60 | 19 | 8 | | |June, | 68 | 46 | 0.65 | 0.87 | 20 | 10 | the | |July, | 72 | 30 | 0.58 | 6.12 | 23 | 6 | | |August, | 72 | 35 | 0.60 | 4.68 | 21 | 8 | wells | |September, | 63 | 51 | 0.61 | 3.46 | 15 | 12 | | |October, | 53 | 42 | 0.60 | 2.02 | 21 | 9 | and | |November, | 38 | 38 | 0.81 | 2.47 | 21 | 9 | | |December, | 34 | 31 | 1.07 | 7.37 | 21 | 10 | springs, | | | | | |-------|------|-----| | |For the year,|50-3/4| 88 | 1.70 |42.54 | 242 | 109 | in | |-------------|------|-------|-------|-------|------|-----| | | 1824. | | | | | | | and | |January, | 36 | 48 | 1.25 | 3.67 | 24 | 7 | | |February, | 31 | 59 | 1.55 | 3.94 | 21 | 7 | near | |March, | 40 | 39 | 0.71 | 2.63 | 16 | 15 | | |April, | 50 | 45 | 1.08 | 4.54 | 22 | 8 |Philadelphia,| |May, | 60 | 44 | 0.88 | 1.59 | 24 | 7 | | |June, | 73 | 46 | 0.69 | 6.09 | 25 | 5 | | |July, | 74 | 30 | 0.38 | 8.80 | 19 | 8 | is | |August, | 70 | 36 | 0.45 | 6.39 | 20 | 11 | | |September, | 64 | 41 | 0.65 | 6.60 | 17 | 7 | 52° | |October, | 54 | 43 | 0.65 | 1.53 | 23 | 5 | | |November, | 42 | 38 | 0.89 | 2.49 | 24 | 6 |Fahrenheit. | |December, | 37 | 43 | 0.95 | 2.11 | 24 | 7 | | | | | | |-------|------|-----| | |For the year,|52-1/2| 85 | 1.55 |50.38 | 259 | 93 | | ------------------------------------------------------------------------ 1823. Maximum of Therm. 91, June 19. Maximum of Barom. 30.45, Nov. 29. Minimum " 3, Feb. 7. Minimum " 28.75, March 30. -- ----- Variation, 88 1.70 1824. Maximum of Therm. 90, June 8. Maximum of Barom. 30.45, Feb. 6. Minimum " 5, Feb. 2. Minimum " 28.90, Feb. 26. -- ----- Variation, 85 1.55 The amount of water which fell in rain and snow during the four years, from 1822 to 1825, inclusive, was, 1822. 1823. 1824. 1825. Inches, 35.20 | 42.54 | 50.38 | 33.26 | We next subjoin a summary of deaths by fever, erysipelas and measles, in the above period; being more desirous of narrating all the circumstances associated with the appearance and continuance of the small-pox, than of insisting on them as supporting causes or necessary connexions. It will appear from the accompanying statement, that the diseases febrile and eruptive were in number, violence and mortality unusually great, in the above mentioned years, as we discover by comparison with the returns for 1822 and 1825. Deaths by Fevers. Erysipelas. Measles. Small-pox. 1822 510 4 0 0 1823 758 24 156 160 1824 654 28 102 324 1825 375 12 38 6 In New York and Baltimore, the coincidence between increase of fevers, measles and erysipelas, and the mortality from small-pox, is not so well marked. In New York--Deaths by Fevers. Erysipelas. Measles. Small-pox. 1822 393[14] 6 1 0 1823 192[15] 13 117 18 1824 191[16] 14 100 394 1825 445 20 53 40 In Baltimore--Deaths by Fevers. Erysipelas. Measles. Small-pox. 1821 400 0 2 21 1822 430 1 4 122 1823 304 2 175 2 1824 183 3 14 2 1825 138 0 9 3 We now proceed to give a brief sketch of the disease called the natural small-pox, (occurring in persons unprotected by previous vaccination or inoculation,) and the deaths from which are given in the above statements. We must, in advance, insist on the great diversity in the appearance of the eruption in different individuals; so great, that an attempt to make an accurate picture of one case pass for a faithful representation of the many, must be deceptive and injurious. In the premonitory symptoms, constituting the characters of the fever precursory to the eruption, there was considerable uniformity: the complaint of nearly all those attacked being at first chills and rigors; pains in the loins, head and limbs, with thirst and want of appetite; with which were soon associated gastric uneasiness, and in many, soreness of throat, rendering deglutition painful, hoarseness and weeping eyes. The duration of these symptoms, aggravated by febrile exacerbations, varied from one to three days, more usually the latter, after which the eruption begins to appear. It is first seen round the forehead and temples, near the hairy scalp; then on the cheeks and breast and back; on the arms near the shoulders; the abdomen and thighs; and subsequently on the fore-arms and hands, and finally on the legs and feet. The appearance of the eruption is that of red or scarlet papulæ, presenting to the touch a sensible resistance, but not much raised, and without roughness or hardness. These papulæ, becoming more and more defined and elevated, are after a day or two converted into vesicles, with small elevated centres or bodies of a yellowish-white, and more diffused red and somewhat hard bases or margins. The redness extending as the eruption becomes copious, converts the skin, especially of the face, neck, and hands, into a red ground, from which project, in relief, the whitish vesicles. Similar appearances, but of a less marked nature, owing to the eruption being more scattered, are found on the trunk. The vesicles, containing at first a thin, semi-transparent fluid, become gradually larger, fuller and yellower, and filled with a thick, tenacious matter. This change is completed, and the pustules are entirely formed, after a lapse of time from the first eruptive effort, which varies from the fifth to the ninth day, and is occasionally longer. The mean for the beginning of maturation, or the finishing of the secretion of matter in the pustule, may be received as five days for the face, and eight or nine days for the body generally. The stages of the eruption, as regards its appearance, may be very properly called papular, vesicular, and pustular. This last having attained its height, completes what is termed the period of maturation, during which the pustules retain their fulness and spheroid figure; and exhibit the greatest proportion of whitish-yellow shining surface of their body, and diminished extent of redness at their base. A yellow dry point on the summit of the pustule, which loses thereby somewhat of its former spheroidal shape, by becoming flatter, or slightly indented, indicates beginning desiccation, at which time the body exhales that peculiar odour, so unpleasant, and so readily recognizable, after it has once been perceived. There is no uniformity in the size of the pustules on the body generally, nor any equality among them on a particular part: more usually one larger and fuller is surrounded by others less so. Nor is it to be supposed that the changes above mentioned are gone through in regular succession on all parts of the surface, uniformly. It was no uncommon thing to see the eruption papular on the legs, vesicular on the trunk and arms, and pustular on the face, at the same epoch. One part even, as the arm for instance, has exhibited to us the three forms at the same time. Maturation complete and desiccation going on, the pustules break, and have their thin coverings converted into a yellow hard coat or crust, to which adheres the pus that was not removed by absorption, and the residue, by evaporation of its watery part, is now converted into a scab of varying thickness, firm and prominent in its centre, and made up outwardly of concentric circles. The margins of the pustules, before of a distinct red, now assume a bluish-red or purplish colour, and the skin begins to desquamate. The constitutional sympathies, or the symptoms in the milder and regular variety of the disease, are not of any great violence or intensity. The premonitory pains, diminishing or disappearing, after the coming out of the eruption, leave in their place a regular fever. The action of the heart and capillaries is hurried during the papular and vesicular stages; but becomes more equable while maturation is going on. During the former period, the loaded and not unfrequently furred tongue evidences disordered stomach, the cravings of which are for cold drinks. The somewhat laborious respiration may, in some cases, depend on the swelling and soreness of the fauces and pharynx; in others, on the eruption extending along the lining membrane of the larynx; whilst in others, it may be caused by bronchial engorgement. The febrile symptoms, which abate during the process of maturation, are apt to return during desiccation; and when the skin begins to desquamate, they then constitute what is called secondary fever. The skin which had suffered so much, occasionally exhibits at this time an erysipelatous blush, accompanied by an inflammation of the subjacent cellular tissue, and the formation of troublesome boils, or infiltration of serum, especially where there is much laxity of structure, as in the eyelids, cheeks, lips, &c. The cutaneous system, during and immediately after the removal of its cuticle, and much of its rete mucosum, is of course very sensible, as well to the impression of clothes as to atmospherical extremes, and particularly cold. This is with many a critical time. It not unfrequently happened that persons, who had passed through the different stages of the disease, and were advancing rapidly to convalescence, were suddenly seized with an affection of the chest, pleurisy, bronchitis or pneumonia, and speedily carried off by the violence of the inflammation. The skin, exquisitely sensible in its denuded state to atmospherical vicissitudes, transmits with great promptness the morbid impression to the lungs, already prone to take on disease, in consequence of the active part they are compelled to play during the eruptive fever. The anomalous varieties, if we can admit any standard form of the disease, were numerous. Those which most fixed our attention were the _confluent_, the _roseate_, the _tuberculous_, and the _erysipelatous_. The _confluent_ was ushered in by symptoms of greater febrile disorder than the regular distinct variety: the throat was sorer; eyes more suffused and watery, and more intolerant of light; gastric and pulmonic uneasiness, and oppression more aggravated. In place of the papulæ being separate, or merely in clusters, they are so crowded, that on the progress of the eruption the vesicles first and then the pustules are contiguous at their bases, and often run into each other, forming at times, a large irregular bag filled with pus, and technically called blebs, or else exhibiting over a considerable space of skin the appearance of imperfect vesication. The vesicles and pustules are, in such cases, flattened, and with indented centres, which latter display at times a dark point or spot, while the edges are of a livid red. This is the appearance of the limbs and trunk. The cheeks and forehead during the process of maturation present a continuous puffy elevation of a pearly white colour. The eyes are nearly closed by the swelling of the lids, and the thick copious secretion from the borders and the conjunctiva; the lips are tumid and the angles of the mouth ulcerated. In fact the human face divine, deprived of all lineaments and expression, is now a foul, misshapen mass. Associated with this state are swelled throat, rendering deglutition very painful--salivation, cough--occasional vomiting, delirium, sometimes phrenitical, sometimes evidencing itself in low mutterings and jactation. The _roseate_ variety of small-pox might, without creating much confusion, be ranked with the confluent, which it closely resembles in its second stage. The first is characterized by the rose or pink colour of the face, which is covered with a copious eruption of papulæ, some with dry points, while from others, the bases of which are small and hard, arise minute vesicles of a pearly colour, which soon dry away. The inflammation, however, still continues, but spreads under the cuticle, which is raised in large patches of a white colour, but not vesicular, or distinctly pustular, or containing fluid: they approximate and produce the continuous puffy elevation already described. On the trunk and extremities, the eruption is either of confluent patches or of pustules dry and flat, with indented centres, the intermediate skin being of a deep red or crimson colour. The constitutional disorder runs high in these cases,--delirium and great gastric distress being very common symptoms. The tongue, especially at its border, is frequently the seat of eruption, which may be compared to the vesicular stage on the skin, with the summits cut off. The lining membrane of the mouth and fauces and pharynx, are, we presume, similarly affected, judging from the soreness of these parts, and the thick muco-purulent matter sometimes mixed with blood, which is spit out or brought up by screatus. The subjects most liable to the roseate eruption, were the intemperate and debauched of the sanguine temperament. The _tuberculous_ variety of small-pox was most frequent among the negroes. The eruption at first consisted of broad papulæ, which were converted into hard, rough, and knotted prominences, tuberculous at base and flattened in the centre. This was not unaptly called by some the seal skin eruption. Sore throat, causing the greatest difficulty in deglutition, and delirium were the almost invariable concomitants of this variety. Occasionally the patient was in a state of stupor and disinclination to motion--at other times wakeful and restless, and requiring coercive means to confine him to his bed. In many instances, the muscular strength was retained to within a few hours of death. The fatal termination in these three varieties, confluent, roseate, and tuberculous, was in the second period of the disease, that is, in the one corresponding with the completion of maturation, and the absorption and drying away of the pus in the simple distinct form of small pox. After some experience, we were enabled, from the appearance of the eruption at the outset, to presage the event, which in the above described kinds, was almost universally fatal. The _erysipelatous_ variety was more an adventitious conversion of the primary form of the disease, by hospital air and delicacy of the cutaneous tissue induced by prior irregularities of life, than a distinct kind to be met with in general practice. It was most commonly presented to us in persons who had a very copious eruption, interesting to a great degree the whole cutaneous surface, and in whom the process of maturation was complete, and the cuticle began to lose its adhesion to the subjacent tissue. In some cases, even after desquamation was almost completed, and the skin nearly dry and smooth, erysipelatous inflammation would supervene, and seem to be repeated on the pulmonary and gastric surfaces, producing great trouble in respiration and derangement in the digestive functions, accelerated pulse, and other symptoms of fever. We could readily pourtray other nicer shades of the natural small-pox, but the originals might not perhaps be so readily recognized by succeeding observers, or their nature well understood by our readers.[17] Our object being to convey practical knowledge, we pass on to a notice of the subjects, most liable to suffer from exposure to the variolous poison. The African race would seem to be peculiarly obnoxious to the small-pox: the actual number of people of colour brought to the hospital being greater than the whites, and the proportionate mortality much more considerable; being as four deaths to six cases of disease in the former, and two deaths to four cases of disease in the latter. As regards sex, the proportion of deaths among the males was three-fifths, among the females two-fifths, of the entire number under treatment in the hospital. In both, the violence of the disease, and the number of anomalous symptoms and complications, depended greatly on their prior dissolute life. Drunkards among the men, and prostitutes among the women, rarely escaped death. The former had the roseate eruption, and the latter the confluent, on which dark spots as if gangrenous were a frequent appearance. Menorrhagia, at any time in the course of the disease, was a bad augury. The better to elucidate the nature of this dire malady, we shall now give from our records some cases of fatal termination, and add an account of the appearances on _post mortem_ examination of these same subjects. CASES.--I. Wilhelmina Smith, white, aged nineteen years, of irregular habits, has a well defined circular scar, with smaller pits in it, on the left arm; but has no recollection of having been vaccinated, nor does she remember ever having heard her parents, who are now dead, speak of it. She was taken sick on Thursday night, the 11th of March, 1824, and in the morning had vomiting and pains in the back. On the 13th in the afternoon, the eruption first appeared. 15th. Admitted and visited. Eruption on face slightly prominent, is red, tuberculous and rough--small and scattered on the arms, like flea bites. Legs nearly clear: they have many cicatrices, especially on the shin and outer part. There is at present an ulcer above the inner ancle. Tongue yellow, and furred in centre, white at borders. Pulse small and threaded. 16th. Eruption rising vesicular from face and limbs; no fever; tongue greenish and loaded; coughs much. 17th. Eruption fine, dry, flat, and partly indented in centre on the face, which burns much; skin red and inflamed; on limbs same appearance, but eruption less copious; pulse small, threaded, and frequent; tongue furred and yellow in centre; complains of pain in deglutition; cough. 18th. Eruption on face dry, flat, white and small in size, and copious; rather more elevated on limbs and neck; tongue dry and furred; pulse frequent and threaded; throat sore. 19th. Eruption same as yesterday; pulse scarcely to be felt; skin cool; coughs with an appearance of choking. Dead at midnight. She retained her muscular strength and ability to sit up to the last. _Examination_ in the afternoon of March 21.--On removing the sternum and anterior portion of the ribs, the anterior mediastinum was found filled with a frothy adipo-mucous collection of a yellowish colour. The lungs on both sides adherent to the thorax, and the left lobes to each other. A sanguineo-serous effusion on both sides, probably a quart on the right, the lungs of which were changed in texture, and shrunk. The pericardium contained a large quantity of the same kind of fluid, which was found in the cavity of the thorax. The heart was highly injected. On removing the lungs and the trachea, and larynx, the lining membrane of the two last showed a brownish-red, coated with mucus, and deeply injected. Same appearances in a more marked degree in the bifurcations of the trachea. The oesophagus next examined, was found of a natural appearance, except near the stomach, where it was injected and assumed a red hue, contrasting with the whiteness of its upper part. The mucous membrane of the stomach near the cardiac orifice was in some parts of a roseate hue, in others a brownish-red; while in others it was ash-coloured, and dotted with red and yellow points. Towards the pyloric orifice, less disease. The stomach contained nothing but dark green bile and mucus. The duodenum was also highly injected. Lower down, the small intestines were in places lined with a dark red and brown, and the mesentery highly injected in the portions corresponding to these spots. Intestines much inflated, and omentum dark and injected. The uterus was not examined. The ovaria were large, white and soft; in the left was a small sac of dark blood, which readily burst on pressure. The liver was very large, of a soft texture and white colour; gall-bladder full of dark green bile, which had in part transuded through its coats. On looking at the trachea after it was washed, it exhibited in places whitish elevated spots, having all the appearance of an eruption. II. Ann Collins, white, aged 18 years, unprotected, became sick on Tuesday evening, March 23, 1824, and was taken to the Alms House, as one having the measles, on Wednesday. On Thursday evening, some eruption was visible; on Saturday evening, March 27, admitted. 28th. Visited. Face covered with a red, flat, dry eruption, particularly on the cheeks; small and vesicular on the chin and around the mouth. On the arms, it has the appearance of measles; on the hands, it is of a deep scarlet, with central vesicular elevations; on the legs is slight; tongue loaded and yellow, except at the borders, which are clean; pulse natural; complains much of pain in the back and sickness of stomach. 30th. Eruption covering the face, vesicular on a deep red ground with some tumefaction; rising vesicular on the limbs with scarlet bases. Tongue smooth and shining anteriorly, and with vesicles on it. Throat sore. Salivation. Pulse small and feeble. Has had menorrhagia since her admission into the hospital. 31st. The menorrhagia continues. Had last night epistaxis. Pulse small and slow. Tongue furred and red. Eruption confluent with indented and dark centres. Surface white and dry. Skin between, red and inflamed. Very slight eruption on legs, and none on feet. April 1. Menorrhagia continues. Pulse small and labouring. Respiration laborious and hurried. Face swelled. Surface smooth, with white spots to represent the pustules. On breast and arms the eruption is in confluent patches which are nearly continuous--some pustules flat and indented, others smooth, with appearance of radii, and some more elevated forming blebs. Skin of the feet cold, and blue in spots; no elevated eruption on lower extremities. Tongue furred and yellowish. Throat sore. Eruption very copious on body, generally with blebs. _Vespere_; pulse hardly perceptible. Anxiety and distress great. Dead at 10, P. M. _Examination_ April 2nd, in the afternoon.--On opening the thorax, the lungs and heart were found of the natural appearance and size. The larynx and trachea being divided, exhibited all the way down to the lungs an injected surface with whitish irregular spots, having nearly the same appearance as the flat smooth eruption on the face: in parts it was more evidently pointed, and showed, by the aid of the microscope, a pustular appearance. In the lungs, the inner surface was still darker. The root of the tongue was covered with large and rather hard papillæ, with open summits. The oesophagus was smooth and white. The stomach near the cardia injected, and of a brownish-red in spots: the remaining portion white, presenting no diseased appearance. The spleen was very large and covered with copious miliary points. The omentum, to appearance gangrened, was dark, and altered in texture. The peritoneum, especially in the pelvis, was injected and inflamed, being of a semi-opaque dark colour. The uterus, small and firm, contained some bloody mucus in its cavity. III. Joseph Foster, white, aged 22 years, unprotected, became sick on Monday evening 8th of March. The eruption began to show itself on Wednesday morning, 10th. 12th. Admitted and visited. Face covered with a red, dry, tubercular eruption, with some few yellow pustules. Same on arms, but no pustular appearance; partly tuberculous, partly vesicular. More sparse and scattered on breast and legs: none on feet. Slight cough. Tongue white, clammy, and loaded in middle--red at borders. Pulse rather frequent. 14th. Face covered with a pustulo-vesicular eruption, with whitish summits, red and inflamed bases. Skin between, of same colour. Eruption dry and hard; very red, copious on limbs; less so on trunk. Tongue moist and less loaded. Pulse regular. 15th. No fever. Face of a deep red colour; eruption rising from it rather flat, irregular in figure and white at summits. Eyes inflamed. On limbs the eruption is red at base, vesicular in body and summit: on trunk in clusters. Tongue yellowish and rather furred. No complaint made; rests easy; sleeps well. 16th. No fever: tongue moist and a little loaded. Pustules nearly white. Some yellow, and beginning to dry on summits. Skin between still of a deep red. Eruption filling on limbs and trunk. 17th. Pulse strong and frequent; skin hot; tongue moist and loaded. Pustules scabbing on face. Not yet entirely filled on limbs, where they are in clusters with inflamed bases. 18th. Pustules full and matured on limbs. Running into each other in places. Tongue dry, brown, and furred in centre, yellow and loaded at sides. Pulse quick and frequent. Lies easy. 19th. Blebs formed on arms; pustules running into each other, beginning to shrink; matter oozing out. Tongue covered with a dark crust. Pulse quick and frequent. Erysipelas of eyelids and ophthalmia. Throat sore. 20th. Blebs larger and more numerous on hands and arms; purulent matter oozing out from some of the pustules. Face nearly scabbed over. Some small white pustules formed on the eyelids. Pulse frequent and vibrating. Tongue as yesterday. Gums tender. 21st. Pulse weaker. Desquamation going on; pustules shrunk and drying on limbs. Tongue as yesterday. 22nd. Matter much absorbed on limbs, leaving a shrunk cuticle. Face covered with a brown and yellow scab and scurf. Tongue black and furred; clear at apex. 23d. Some erysipelatous inflammation of the skin; pustules all nearly disappeared from arms, trunk and thighs; some few, white and soft remain scattered over breast. Pulse frequent. Tongue black and incrusted. 24th. Was brought into town from Bush Hill. 30th. Desquamation nearly complete. Low frequent pulse. Respiration slow and laboured. Tongue incrusted. April 2nd. Dead at 10, A. M. Calomel had been freely given to this man in the earlier stage of his disease: and during the last week, spts. terebinth. and nutritive farinaceous food. _Examination._--The pericardium, of a greenish colour and its capillaries finely injected, was full of yellow serum. The lining membrane of the larynx and trachea was of a greenish-yellow colour throughout, and in the spaces between the cartilages ulcerated and disorganized in several spots. Beneath the membrane was a venous injection. About the bifurcation it was injected; and in the ramifications of the trachea were seen several inflamed, and in places abraded and disorganized spots. A chocolate coloured liquor with a sediment filled the bronchiæ and the larger tracheal subdivisions. The oesophagus was sound. The stomach showed clusters of bright red and brownish-red spots, in stellated and other regular figures extending along the smaller curvature. The duodenum, at its commencement and in its course, presented similar clusters. The rest of the intestine was healthy. The brain was to appearance in a natural state. IV. Peter Johnson, black man, aged 38 years, unprotected, was taken sick on Monday, 29th March, in Sandy Hook. Eruption of small-pox appeared April 3d, Saturday morning. Admitted same day. 4th. Eruption copious on face; papular and of irregular figure. Eyes suffused and red. On arms, same appearance as on face, but less tuberculous. On breast and body, eruption small and pointed; beginning to show on legs. Throat sore. Tongue yellow and loaded at sides; red in centre. Pulse full, equal, and rather frequent. Cough. 5th. Much anxiety and moaning. Eruption rough and tuberculous on face. On arms, it is in parts papillary and pointed, and in parts flat with indented centres. Pulse slow and equal. 6th. Eruption hard and tuberculous on face and arms; small and pointed on breast. Pulse slow; throat less sore; mind wandering. Is sitting up in bed, dressed. Tongue moist and yellow. 7th. Delirious through the preceding night; is now dozing. Eruption same as yesterday. Not so thick on legs, but hard and tuberculous. 8th. Tongue black and incrusted. Throat very sore. Eruption hard and flat. Pulse active. 9th. In a comatose state. Pulse slow. Skin cool. 10th. In the same condition. Drawn down in the bed, the thighs flexed on the abdomen, and lies on his side. 11th. Dead at six A. M. _Examination._--The upper surface of the tongue of a brownish yellow, full of holes and rough. At the posterior part, in place of the larger papillæ, were ulcers and cavities. The posterior nares and pharynx were covered with holes, formed by ulceration, and of a brownish hue, adjoining injected and apparent pustular parts. Tonsils ulcerated, and their investing membrane mostly destroyed. The oesophagus immediately below the glottis, smooth and sound. Yellowish matter flowing from the glottis. On opening the larynx, it was found half filled with a viscid light olive-coloured fluid; on removing which, the whole lining membrane, down to the bifurcation of the trachea, was found covered with clusters of ulcerated pustules of a yellow colour, with the intervening spaces of a brownish-red, highly injected, and destitute of its natural smooth, shining appearance. The internal surface of the glottis and epiglottis was in a similar but less marked state as the larynx and trachea. The pustular surface extends to the minute ramifications of the bronchiæ, and their cells beyond were highly injected. On opening the abdomen, the omentum was found dark and shrunk. Stomach contracted. Intestines distended, shining, and very vascular, with capillary injection when viewed externally. The peritoneal covering of the stomach showed a similarly injected appearance. The stomach being opened, displayed at its upper curvature, spaces studded with spots of a deep red or purple; apparently effusions surrounded by a vascular net-work. Same appearance towards the pyloric orifice, and in places on the duodenum, which, together with the jejunum, particularly the latter, is of a dark leaden colour, and injected. The diaphragm on its upper surface, highly injected, as was also the pleura lining the thorax. The pericardium healthy. The brain was not, unfortunately, examined. V. Jacob Fry, black man, aged 30 years, unprotected, was taken sick on Sunday, 11th April, 1824. Eruption appeared on Thursday, April 15th. 16th. Admitted and visited. Eruption copious and papular on face; smooth and flat, with dark centres, on trunk and arms. Tongue loaded. Cough. Tenderness of epigastrium on pressure. Throat sore. Pulse small and threaded. Eyes muddy. 18th. Eruption flat and rough; diffused over face. On breast red and flat; on limbs in clusters, shrunk, and hollow in centre. Pulse small. 19th. Tongue moist. Pulse small and frequent. Throat much swelled. Restless, and somewhat delirious. 20th. In a comatose state; but is roused to attention by calling him. 21st. Dead at five P. M. _Examination._ April 22nd.--On opening the thorax, the lungs were seen to appearance healthy. Both adhered to the pleura costalis. The pleura lining the diaphragm, and also the pericardium, were finely injected. Fauces inflamed, injected, and ulcerated. From the tonsils oozed out pus. The larynx contains a light olive coloured fluid, muco-serous, which likewise covered the trachea and bronchiæ. The lining membrane throughout was rough, and exhibited a net-work of a brownish-red colour, finely injected. The oesophagus about half way down, has its lining membrane removed for one-third its length, showing miliary points on its muscular coat. The stomach on its outer surface, and near its upper end, showed a black spot, like effusion of black blood, under the peritoneal coat. On examining the oesophagus near the cardia, it was found of a dark colour in lines. From the cardia, half over the inner surface of the stomach, radiates inflamed membrane of a deep red colour, and corroded at the place corresponding to the dark spot above mentioned. Red spots near the pyloric orifice. Intestines not diseased. Liver adherent by its right lobe to the ribs; this lobe was of a greenish leaden colour. No alteration of its structure. Brain injected in its arachnoid coat. Ventricles contained some serum. Tela choroides dark and gorged. VI. William Lawrence, aged 18 years, unprotected, became sick on Saturday, April 17th. On Sunday taken to the Alms House, and on Wednesday, 21st was transferred to the Hospital. 21st. Eruption fine and papillary on face; red and scarcely raised on arms. None on legs. Has cough since yesterday. Pulse slow and regular. Tongue brown, and incrusted in centre. Moist on sides. 22nd. Eruption confluent and red. Papulo-vesicular on face and arms. Flat, dry, and copious all over the trunk. Scattered and small on legs and feet. Pulse small and regular. Tongue loaded and brown in middle. Eyes sparkling. Is delirious and very restless. 23rd. Eruption very copious all over the body, rising vesicular from red margin. Pulse small and slow. Tongue loaded, furred, and yellow. Head and back easier. Has slept well. Face deeply suffused with red. 24th. Cough. Eruption flat, indented centres, dark in places. It is now coming out on legs. Pulse small and firm. Skin cool. Much uneasiness and hurried breathing. 25th. Dead at seven A. M. This man had been bled twice before his admission, and once again on the 22nd. Cold affusions had been freely used. _Examination_, on the 26th April.--Pericardium sound, but contained much sanguinolent serum. Pleura sound. Lining membrane of pharynx partly destroyed. No ulceration. Tonsils give out pus on pressure. Oesophagus of a dark red, and partly lost its inner membrane. Larynx and trachea injected; but the membrane lining them is entire, without pustules or ulceration. Some frothy effusion in bronchiæ. Liver healthy. Spleen large. Omentum sound, and of a natural white colour, traversed by some large veins. Stomach externally of a brown-red colour; and when opened, presents, spread out from the cardiac orifice, dark brown-red streaks; and towards the pyloric orifice and upper side, an extensive surface shaded over with vermillion and darker spots. Near the duodenum, the surface is white. Intestines slightly injected. Bladder dotted all over with bright red spots on its inner surface, which is covered with a fine capillary reticulated structure. VII. An infant, white, unprotected, aged three weeks, child of Clarissa Clarke, who had been inoculated twenty-one years ago. Taken sick on Sunday, 2nd May. Eruption appeared Thursday, 6th. Admitted 9th. 10th. Eruption copious, and in confluent patches, with red bases, and flat vesicular summits. Has also aphthæ. 13th. Eruption confluent, in large white patches on face. Throat very sore. 15th. Dead at eight A. M. _Examination._--The stomach of a light colour, perfectly healthy. Folds and plaits of mucous membrane strongly marked. Mucous surface of trachea nearly healthy. VIII. Infant, female, of a woman who died in the Alms House of varioloid disease, shortly after giving birth to this child. It is three weeks old; was admitted Sunday, 25th April, second day of the eruption. Dead on Thursday, 29th. The skin became livid after death.. _Examination._--Pharynx inflamed, and the eruption on it extending all the way down the oesophagus, to near the cardiac orifice; the lining membrane being also in part destroyed. Stomach of a fine clear red, and beautifully injected to the minutest capillaries all over the mucous surface. Intestines, both large and small, red and injected. The larynx has some eruption on its lining membrane. The trachea and bronchiæ nearly healthy; there being no eruption or secretion on their surface. Doctor DARRACH was present at the majority of the above detailed examinations, and kindly officiated at some of them. This gentleman, well known for his zeal in the study of comparative and morbid anatomy, made many interesting microscopical examinations of the various kinds of variolous pustules, and the corresponding changes in the cutaneous tissue, the results of which, we hope, he will make public. Having thus freely described what we saw, we wish it were in our power to lay down next, for the benefit of those who come after us, a satisfactory method of treating small-pox. The hospital returns are not of such an encouraging nature as to make our self-love predominate over observation and experience, and lead us to inferences which might seem to sanction the utility of this or that medicine, or curative plan. We had to deal, it is true, with the worst portion of the community; persons of constitutions exhausted or perverted by excess of sensual indulgences, or by poverty, or both conjoined. In private and even dispensary practice, where the subjects were of a better physical and moral nature, we often saw the disease subside, and health return, after less attention to administer medical aid, or to supply other wants, than was exhibited at the hospital. We are, notwithstanding, sanguine enough to anticipate useful results from our attentive study of the symptoms of the disease, in connexion with that of the post mortem examinations, and to consider ourselves as in possession of lights to guide us with more certainty than before. Let us see how far a cautious analysis will tend to dispel old errors, and establish useful truths. The gastric distress, and the associated uneasiness and pain in the head, back, and limbs, with evening exacerbations of fever, for the three days preceding the eruption, evince conclusively a disease to which the skin is a stranger, except by its usual sympathies of heat and coldness, moisture and dryness. The appearance of the tongue, the loss of appetite, thirst, nausea, and occasionally vomiting, are testimonies to the impeded function of the stomach in this first period, or that of precursory fever: and if to this we add the soreness of the fauces and pharynx, producing impeded deglutition, we cannot refuse our assent to the belief that the mucous surface, on which the _preparatory process_ of digestion takes place, is mainly affected. The next leading symptom is the appearance of the eruption on the skin. The character of the disease is now fixed, and the physician feels himself compelled to respect the cutaneous inflammation, throughout its entire course, naturally enough regarding it as the disease itself, rather than the last link in the chain of morbid actions. To support the circulatory system at such a degree as shall enable the skin to secrete this new matter of small-pox, is nearly as much as he proposes to himself. But here arises a question of great practical moment. To what extent, if any, is the eruption a natural or necessary sequence of the previous symptoms or condition of the system. Perhaps in the existing state of medical science, we hardly dare reply positively to this question. This much we know, that there is no correspondence in general between the intensity of the precursory fever, and the copiousness of the after eruption. We are, moreover, well apprized of the fact of very many, who had been protected in earlier life by inoculation or vaccination, being seized with all the symptoms of the precursory fever of the small-pox, and remaining seriously indisposed for a few days, yet with very little eruption in some cases, and without any in others. Next we may inquire, what control, salutary or otherwise, we can exercise over the skin in reference to its eruption, by adopting certain methods in medicine and hygeine, during the period of invasion or of precursory fever. To foster the germ of the poison, as yet only affecting the inner surfaces, into efflorescence on the outer or cutaneous one, by hot air, warm and heavy clothes, and cordial drinks, is a practice, which, though at one time advocated on what was thought very sufficient theory, is now abandoned as at war with experience. Of these means, clothing acts primarily on the skin, and we will suppose heat to do the same: the cordial drinks must however affect this organ by stimulating and irritating the gastric and intestinal surface. Against all stimulation of this surface we are then bound, from knowledge and theory, to object. The cooling regimen as it is called, was substituted for the alexipharmic, in so far as regards light clothing and cool air. Can emetics and purgatives be viewed as a part of this regimen, and exert as such a salutary influence over the second period of the disease, or that when the eruptive effort takes place? Admitting they are but local stimulants, can they as such be with advantage applied to a surface, as that of the stomach and intestines, already highly irritable, and which, as the disease advances, becomes inflamed? If our object be in this first period to diminish the violence of the second or eruptive one, we doubt whether our expectations will be at all met by any kind of stimulant to parts, which so promptly transfer their irritation to the cetaceous surface. Whatever may be thought of these suggestions; whether they are to be regarded as well-founded, or merely speculative, must be a subject of future investigation; since we are as yet compelled to deny that experience can be adduced in favour of the practice of vomiting and purging to the first period of variolous disease. On the same line with the remedies just mentioned, have been placed bleeding, general and local, though as we apprehend, very erroneously. There is not in bleeding as in purging, conflicting and alternating effects of debility from evacuation, and irritation, primary and sympathetic, from local stimulation; but a direct diminution of morbid action, more tranquil movements of the heart and capillary system, that is of the circulatory apparatus, and of the membranes, mucous, serous and cutaneous, &c. Bleeding, unlike most other remedial agents, produces a direct calmness and ease in the animal economy: it does not like them substitute one disturbance for another, or make the great appear the lesser evil. The experienced physician well knows the value of this remedy, in the first period or invasion of the phlegmasiæ, and of some fevers called general. He is fully aware, that if he cannot produce by it a decided impression on the malady in the commencement, he is but too often afterwards a prey to doubts and anxieties, wishing to relieve, but unknowing what to attempt. Conceding, however, the power of venesection, in the forming stage of the disease, now under review, so that we by this remedy may control the series of morbid actions in the second period, and diminish the extent of the eruption; it may yet be seriously asked, whether we can with safety and propriety prevent or destroy the succession of changes to which the skin is subjected, from the first papulæ on to desiccation. On this point, we believe, has turned the practice of the profession at all times, whether in the ages of humoralism, or in the reign of solidism. In addition to the reasons already assigned, which would lead us to doubt the necessity of the eruption being left uncontrolled, or even suffered to run its course, we may appeal to the practice of inoculation, which as effectually saturated the system, and indisposed to subsequent attacks, as if the skin had formed a continuous pustular surface; and yet this benefit was often gained by the trifling tax of a few days' fever, and half a dozen of pustules. Where the fever runs high and the respiration is much affected, in the first period of measles, and before there is the slightest appearance of eruption, we conceive it often so be our duty to bleed freely, without reference to the subsequent disease of the skin, or any nicety of calculation about this latter going through its regular stages. Indeed, we have usually reason to congratulate ourselves for having, by this means, rendered the subsequent disease milder and more tractable. That affection of the urethra termed gonorrhoea, the product of contagion, will, if left to itself, go through its several stages; and, if rest and regimen be enjoined, will often leave the subject healthy as before. But we can, notwithstanding, cut it short with perfect impunity, by suitable remedies, and thereby prevent numerous unpleasant symptoms and effects, which are often present when the disease is left to nature. Syphilis has its several stages, each marked by characteristic symptoms; but the skilful treatment of the first stage prevents, how beneficially we all know, the appearance of the others. We must then in small-pox, as well as in other diseases, beware how we confound a common and even natural, with a necessary and unavoidable succession of symptoms and periods. The precursory fever in small-pox is seldom marked by the same common inflammatory symptoms as that in measles; and does not seem, by its actual violence, to urge the physician to deplete with freedom, if he only have regard to the existing condition, rather than to the impending danger and complication. The diversity in the two diseases consists not so much in the greater intensity of the latter, as in the more decided gastro-enteritic derangement in the former. Experience has not yet sanctioned the benefit of copious bleeding from the arm, in incipient disease, or irritation verging to inflammation of the intestinal surface, as in small-pox; while its efficacy is admitted in measles. But conceding its doubtful character, local bleeding, as by cupping, and leeching on the abdomen, might be serviceably employed in the form of disease now under consideration; as we know it to have been in other febrile affections, where the same parts were diseased. Topical depletion does unquestionably exercise the best effect on membranous inflammation. In addition to cool air, we may with some confidence have applied at this time to the skin, cool, if not cold, affusions; while cold or cool drinks, and these of mucilaginous kind, would constitute the principal ingestæ and medicines. Our own experience was little favourable to the efficacy of cold water, applied to the surface during the eruptive stage; and we apprehend, that, if decided benefit can grow out of its use, it must be during the first or precursory fever, before the formation of vesicles has commenced, when every thing is to be attempted to sooth irritation, and prevent febrile reaction. The first period over, the eruption on the skin now appears, and constitutes a leading and exceedingly important symptom of the disease. This eruption, like many others the product of gastric derangement, acts for a time as a counter-irritant, and as such affords temporary relief to the internal organs; but when continued, as in the farther progress of the disease, it, in common with all irritants on the skin, returns with interest to the digestive tube, the irritation which it first received from this latter. We must not lose sight of the state of the lining membrane of the lungs during this time. It cannot be said so much to sympathize with the skin, as to be affected by continuous disease; since the eruption on the mucous membrane of the larynx, trachea, and its ramifications, undergoes nearly the same changes, in the same time with that on the cutaneous surface. The danger and violence of a disease in which the three surfaces, cutaneous, pulmonary, and gastric, are all organically affected at the same time, must be very apparent. Even though there be no eruption on the internal coat of the stomach, its appearance after death, of high vascularity and sanguineous injection, corresponding precisely in appearance with the circles found in the lungs, of which the pustules were the centres, justifies this belief of its being organically affected. Each of the three above mentioned surfaces is in degree ancillary to the others, and each may, on occasions, partially supply their functions; but in this period of variolous disease, our hopes of such vicarious action must be very faint indeed, and hence the hazard attending any application to any one of them. Are we from these appearances to pronounce the eruption a phlegmasia of the skin and lungs, associated with a previous one of the stomach, and recommend the free use of venesection? Life may occasionally be prolonged, or at times saved by this means; but the disease will not be thereby materially arrested in its course, or modified in its appearance. We shall find that the inflammation of the membranes, consisting as most of them do of cellular tissue and minute capillary vessels, is often not susceptible of being checked by general depletion, carried even so far as to almost empty the larger arteries, and arrest the heart's motion. Still more will this inflammation persist, if it have gone to the extent of forming new parts, whether phlegmons or pustules. The intensity of the inflammation may be somewhat moderated, but it cannot be conquered now as at the commencement, or during the first period, or that of invasion. We cannot, from our own experience, speak favourably of the remedy in the second, or eruptive stage. It did not answer our expectations, though employed in subjects apparently the best constituted to derive the good effects proposed from it. We must at the same time grant, that it was complicated with other remedies. Of topical bleeding, we are unable to speak, not having seen it tried. In this period of the disease, it must be of very difficult execution. Still less reason have we to boast of the good effects of purging. Though the skin may for a while be relieved by the watery secretions from the intestinal canal; yet the irritation of the latter, consequent on purging, is soon communicated to the cutaneous surface with the effect of aggravating the eruption. To the class of stimuli or stimulating diaphoretics, the same objections apply with increased force. As on the one hand, in cases of high fever, seeming to call for great depletion, the surfaces are often not relieved by general bleeding, but retain their own vitality; so on the other, in cases of apparent prostration, and feebleness of circulation, they often retain all their morbid activity, and will of course be materially injured by stimulation, either of hot air to the skin, or heating drinks to the gastric and intestinal surface. Of the various diaphoretics employed, we had reason to be least dissatisfied with the combination of opium and ipecacuanha in small doses. In some few cases, tartrate of antimony and cream of tartar, dissolved in rice or barley water, and the solution used as a drink, seemed to be beneficial. Several grains of the former were thus taken in the 24 hours, without its producing vomiting or purging. But in very many other instances of the disease, this medicine had no ameliorating effects. Calomel alone, or in combination with opium, was given, and in a few cases caused _ptyalism_. We did not lose persons thus affected, but we cannot speak with any confidence of the propriety of the treatment. The application of cold water to the skin, was tried by us on the strength of its alleged good effects in this disease, but in no case had we reason to be satisfied with it. The state of the cutaneous surface, during the vesicular and pustular stages, is such as to prevent its transmitting the usual impressions to the interior. Cold may deaden it, and hasten the disorganization of its tissue, but cannot arrest and suspend morbid capillary action here, as in ordinary fevers, or diseases with great local determination, as to the head, &c. If useful at all, it will, we apprehend, be in the forming stage of the disease, before the skin is altered by the eruptive effort. The same objections do not hold against the internal use of cool or cold liquids. We have in this instance to be regulated by the usual precautions, as in all febrile disease where the gastric system is the greatest sufferer. More benefit will follow the sustained use of cool, than the occasional administration of very cold draughts; since in the former case the morbid action of the mucous surface may be restrained in due bounds, without the risk and danger of reaction, and increase of heat and thirst, which are apt to ensue from the latter. The same principle will guide us in the temperature of the air to be inhaled by the lungs. The secondary diseases, erysipelas, catarrh, and pneumonia, occurring on the decline or subsidence of the variolous disease, would, we may now presume from the phenomena in life, and the autopsic examinations, bear and require a treatment, nearly similar to that used in these diseases arising under other circumstances. Perhaps leeching and cupping ought to be substituted, in such emergencies, for bleeding from the arm. The extension unavoidably given to this first branch of our subject, requires that we should defer the history of the modified small-pox, or varioloid disease, to the next quarter, when it shall appear in the corresponding number of this Journal. EXPLANATION OF THE PLATE. Figures 1, 2, 3, represent various appearances of the lining membrane of the stomach. Fig. 4, is a portion of the oesophagus; but the red bands ought to run vertically, and not horizontally, as in the plate. Fig. 13, is another appearance of the stomach. Fig. 12, indicates the eruption having gone on to ulceration in the pharynx. Fig. 6, displays the appearance of the lining membrane of the trachea, on the 6th day of the eruption, as in the case of Ann Collins. Fig. 5, is intended to represent the same part in an advanced stage of the disease, as in the case of Joseph Foster. Resembling this is the case of Peter Johnson, as far as regards the ulceration and dark colour of the intermediate surface; but differing in the disorganization of the membrane being less. Figs. 7, 8, 9, 10, and 11, represent the progress of the eruption, in a female, from its incipient to its maturated state. The same section of skin is represented from the 1st to the 5th day of the eruptive stage, on which day the patient died. On the 2nd day, (fig. 8,) the vesicles began to exhibit a central lividness, which was augmented on the subsequent days. The patient had been some years before successfully vaccinated. She was delivered of a child on the 1st day of the eruptive stage. The minutes of this case have been mislaid; but the post mortem appearances were indicative of high action, if not inflammation, of the uterus and its appendages. The infant of this woman, forming Case VIII. died of small-pox three weeks afterwards, on the sixth day of the eruption. This plate, together with some others yet unpublished, are from the accurate pencil of Mr. now Dr. HARRINGTON, of this city. (TO BE CONTINUED.) FOOTNOTES: [11] This was first at Bush Hill, and subsequently at the Sugar House, near the Alms House. [12] The largest proportion of these deaths was in the six months from the 1st of November, 1823, to 1st of May, 1824, being in that period about four hundred. [13] Kept by Reuben Haines, at Germantown, seven miles from the city. The thermometrical mean is that from daily observations made by this gentleman at sunrise and at 2 P. M. [14] Of these 165 were by yellow fever. [15] The deaths from inflammation of the different viscera, were as reported in this year, 290, and from infantile flux and cholera morbus, 177. [16] Same proportion of inflammations as last year, viz. 339. [17] Should it be hereafter necessary, we can illustrate other varieties of the disease by drawings which were taken at the same time with those, of which coloured engravings are now furnished. ARTICLE IV.--_Remarks on the Pathology and Treatment of Yellow Fever._ Arranged from the Notes of Dr. J. A. MONGES, of Philadelphia. I arrived at St. Domingo in the year 1785, and from that period to the time of my departure from thence, I had very ample opportunities of observing and treating the diseases of that island, both in the country and at the Cape. During the whole time of my residence there, the ordinary febrile diseases of hot climates were of very frequent occurrence, especially among the new comers, and those not acclimated; but the real yellow fever, or vomito negro, never prevailed. So that when I reached this city in 1793, I never had had an opportunity of observing this disease. As introductory to the subject more particularly before us, I shall offer a few remarks on the nature and treatment of the fever, which prevailed in that island. It was usually of the remittent type, of a bilious nature, and rather violent in its character; presenting very often symptoms of a typhoid, or malignant condition of the system. In almost every case, it was attended with great gastric irritability and pain; and, in very many instances, accompanied with vomiting of dark green, and even of black bilious matter,--determination to the brain producing delirium, coma, &c. &c. In general, this fever differed but little from the bilious fevers of this country; except, perhaps, in its greater severity, and in a larger quantity of bile commonly evacuated. The treatment of this disease, at the time of my arrival, was generally attended with some difficulty, owing to the great prejudice prevailing against the use of the lancet; not only among the mass of the population, but even among the old physicians of the island. Experience, however, having taught me, that venesection was essentially necessary in fevers of the same sort, which I had noticed in other places, I resorted to it, notwithstanding the existing opinion; and am now convinced, that by its means I saved many patients. Nor was I the only one to adopt this mode of practice; as it was commonly resorted to by all _new_ physicians, who were soon found to be more successful than the older practitioners. To arrest the violent vomiting, already alluded to, it was of the highest utility, and, in many instances, the only remedy that could be depended upon. Emetics were very commonly used, and sometimes with great benefit; but, in many instances, they were contraindicated by the pain and irritation of the stomach. Cooling and saline purgatives were advantageously employed, as well as the saline mixture, and nitre and camphor in small and repeated doses, a very favourite practice in the place. In a more advanced period, and when the fever assumed a typhoid type, blisters, bark, and serpentaria were resorted to. I arrived in Philadelphia on the 20th of August, 1793, and on the 22nd of the same month, began to see patients. The epidemic was then at its height, and such was the demand for physicians, and the prevalence of the idea, that, as I came from the West Indies, I must be familiar with the yellow fever, that I soon became very extensively employed. Such, indeed, was soon the extent of my engagements, that I was compelled for a time to refuse my attendance on many patients, and to limit my visits from Race to Dock streets, and from the water to Third street. From the first time I had an opportunity of seeing the yellow fever, I perceived that there existed but a very distant, if any, analogy between it and the fevers I had been in the habit of treating in the West Indies. And this opinion I have ever since entertained, in opposition to the statement of many respectable authorities; but in conjunction with some highly respectable physicians and friends, who, like myself, had had an opportunity of treating both diseases. The points of difference between these fevers will be noticed in a subsequent part of these observations. But although entertaining this sentiment, I very early came to the conclusion, that the yellow fever was the effect of a gastro-duodenic inflammation, somewhat modified by some unknown cause,--requiring the usual remedies for such a complaint, proportioned only to the strength of the patient, and the force of reaction in the system; and all my subsequent experience has only served to confirm me in this belief. Differing from many physicians respecting its bilious character, I have been led to believe, that the liver is very seldom implicated in the disease;--the secretion of bile, in the majority of cases, being very little, if at all altered. This may very readily be discovered by an attentive examination of the symptoms of the disease, as well as by the appearances noticed on dissection; the lining membrane of the stomach and duodenum presenting in almost every case, marks of inflammation, and giving passage to a large quantity of black matter, which I have always been led to regard as altered blood, mixed with mucus. The liver, on the contrary, so rarely showed marks of disease, that when it did, it was natural to regard its alteration as secondary. Such being my opinion respecting the pathology of yellow fever, I cannot view otherwise than as secondary to the gastric affection, all the morbid conditions of other organs, indicated during life by their peculiar symptoms, and revealed on dissection by the ordinary marks of inflammation; such as affections of the lungs, kidneys, &c. This view of the subject will cease to be regarded as merely hypothetical, when it is recollected, that these symptoms and morbid appearances are occasionally not found; whilst the symptoms referrible to the gastric and duodenic irritation, being the true characteristics of the disease, are always present. Indeed, what would authorize us to regard any subject as affected with yellow fever, who would not present the pain in the stomach, the redness of the tip of the tongue, the thirst, irritability of the stomach, and vomiting either of simple mucus, or black matter? And, on the other hand, how many have died with these symptoms, who were not affected with all the others we have noticed, and, on dissection, have shown no mark of disease, except in the digestive apparatus? Finally, can pain in the head, affections of the kidneys, vomiting of bile, &c. constitute yellow fever, without the concurrence of some of the gastric symptoms we have enumerated? With respect to the characteristic features of yellow fever, and the different signs, by which it may be distinguished from bilious fever, I must be very brief; as a great deal having been written on the subject, any long details in this place would occasion undue repetition of what is already known to the profession. A few words, however, may not be improper. Every one who has had frequent opportunities of seeing the yellow fever, must have noticed, among its most habitual signs, a peculiar inflamed glassy appearance of the eye, easily recognised, but difficult to describe. It is one, however, on which I should be willing to place considerable reliance, in establishing my diagnosis of this disease; as I do not recollect to have noticed it in any other form of febrile affection. Together with this, there is, in the majority of cases, an intense supra-orbitar pain, apparently unconnected with great disordered action of the brain, as the intellectual functions are generally unimpaired. These two signs, together with pain in the loins, and, in more advanced periods, the peculiar appearance of the skin, the vomiting of the coffee grounds matter, the intermission on the 4th day, the retention of muscular strength, and suppression of urine, are the only signs by which the yellow fever, so far as I am prepared to say, may be recognised. In regard to the supposed identity of this fever with the bilious, a great deal has been written; but I must confess, that I feel inclined to doubt the correctness of this opinion, for the following reasons: 1st. Bilious fever is almost always a remittent fever, presenting regular exacerbations, and, unless arrested by medical aid or some effort of nature, running its course, in a progressive manner, either to a happy or fatal termination; whereas the yellow fever is almost invariably a continued fever, presenting obscure and irregular, or even _no_ remissions. On the fourth day, it generally presents so perfect a remission, as to cause the patient, in many cases, to imagine himself perfectly free from disease, and induce him to get up, and even sometimes to walk out. This remission, which sometimes amounts to an intermission, so far as an experience of upwards of forty years can authorize me to decide, is never found to attend in bilious fever, in which, if there be any remission, and recurrence of the unpleasant symptoms, the former is always a real convalescence, and the latter an accidental relapse. 2nd. The red colour of the eye, to which I have alluded above as occurring in the early stage of the yellow fever, and its peculiar yellow tinge in the after part of the disease, are different from the redness and yellowness of the same organ in bilious fever; in the first stage of which the eye presents a more fiery redness, and in the subsequent period, a more saffron yellowness. 3d. The colour of the skin in the two diseases presents also some difference, being more constantly noticed in yellow fever, and disappearing much more rapidly than in bilious fever. In yellow fever, moreover, it assumes, most commonly, a yellowish-brown or even mahogany tinge; whereas in bilious fever, when it occurs, it does not differ from the ordinary jaundice colour, of a lighter or deeper shade. 4th. These fevers may likewise be distinguished by an attention to the state of the intellectual faculties, and of the muscular strength; these remaining often unimpaired to the last in yellow fever, whereas, in a very large majority of cases of bilious fever, the mind becomes soon involved in the disorder of the system, and the greatest muscular debility prevails, even from the very onset of the attack. 5th. The matter vomited might of itself serve to distinguish the two diseases. Independently of the difference we shall notice when speaking of the black vomit, we may mention that patients complain, even sometimes from the commencement of the attack, of the acidity of the vomited matter; whereas in bilious fever, the mouth is bitter, and the matter ejected of the same taste. 6th. As a further mark of difference, we may state, that, in yellow fever, the tongue, except at the tip, the skin, and the pulse are sometimes little altered; whereas in bilious fever they are usually pretty much so. 7th. In respect to the duration of the two diseases, we may state as a general rule, that yellow fever runs its course to death or convalescence, in a much shorter time than bilious fever. Nor is the promptness of recovery from yellow fever less different from the slowness of convalescence, noticed in most cases of bilious fever. 8th. The suppression of urine is a frequent attendant on the last stage of yellow fever, and is seldom noticed in bilious fever. 9th. I have never witnessed a second attack of yellow fever in the same individual; whilst on the contrary, so far as I have seen, there is no limitation to the number of times a person may be affected with the other form of fever. _Prognosis._--As regards the prognosis in yellow fever, I shall merely state, that I generally found, an early evacuation from the alimentary canal, and a disposition to diaphoresis during the first twenty-four or thirty-six hours, and its continuance during the course of the disease, to be favourable omens. When the disease continued beyond the 7th, 9th, or 11th day, greater hopes might be entertained. It was likewise found, that the mortality was much smaller among patients, who remained free from apprehensions as to the nature and termination of the disease. To this cause, more than any other, do I refer my greater success among Quakers; who, being generally surrounded and comforted by their friends, retained more than any other class of people, the necessary tranquillity of mind. Among the unfavourable signs may be mentioned, a discoloration of the skin before the fourth day. This symptom was, indeed, almost always a fatal one. Obstinate vomiting and costiveness, hæmorrhages from different parts of the body, unattended with an abatement of the symptoms, and vomiting of black matter, were very unfavourable; whilst a suppression of urine, agreeably to my experience, was always a fatal sign. _Black Vomit._--In a preceding part of these observations, in alluding to the black vomit, I took occasion to express my views respecting its nature,--stating that I regard it as consisting of mucous flakes, mixed with a large proportion of altered blood. That such is the true nature of this substance, on which so much has been said and written, I have had sufficient reason to be convinced. The opinion that it consists of altered bile, I deem totally untenable, for the following reasons: The matter is occasionally voided in large quantities, in cases in which the liver is not at all affected, and in which, after death, the gall bladder is discovered to be more or less filled with _natural_ bile. Independently, of this, it may be stated, that the appearance of the two substances is very dissimilar;--the black bile vomited in bilious fever being of a homogeneous nature, and of a black or deep green colour; whilst the matter of the black vomit is, in a large majority of cases, a compound of a mucous, flaky substance, and a sanguineous matter, bearing some resemblance to the grounds of coffee, and, for the most part, of a brown tinge. When mixed with water, the two substances produce very different effects,--the bile mixing with and imparting a greenish tinge to it without difficulty, whilst the grounds of the other, float on the surface of the water, without mixing with and colouring it, in the same manner as bran, deprived of all its mucilage, or rather like mahogany saw-dust. This I consider as one of the best modes of distinguishing these two substances,--serving at the same time to establish a difference between the fevers, I was in the habit of observing in the West Indies, and the yellow fever of this country. Nor are these the only reasons for rejecting the supposition of the black vomit of yellow fever being of a bilious nature; for I have known this substance (and I suppose other practitioners have observed the same fact) occasionally to exude from surfaces, from which, in all probability, bile is excluded. I allude particularly to the skin and verous membranes. Thus it has often happened, that the application of a blister, especially in the advanced stage of the disease, has been followed by a copious exudation of a fluid, resembling, in all respects, the matter ejected from the stomach; an occurrence which was strikingly exemplified in a case, which fell under my immediate observation during the last visitation of the disease in this city, in 1820. During the same epidemic, I had occasion to attend a Mrs. H. about 70 years of age, who presented a curious example of the exudation of a similar substance from the peritoneum. She had not been exposed to the causes of the yellow fever, and indeed presented none of its ordinary pathognomonic signs. She was attacked very early in the morning with violent colic, attended with fever, great tenderness of the abdomen, and high colour of the face. She was bled at 10 o'clock; at 11 vomited a large quantity of coffee ground matter, and died in about 12 or 15 hours from the commencement of the attack. The next morning her body was examined in the presence of several highly respectable and experienced physicians, who all coincided in the opinion, that the matter vomited and which continued to be discharged from the nose, was identical with that discharged in yellow fever. The stomach as well as the intestines were found to contain a large quantity of a similar substance. The cavity of the peritoneum being likewise found filled with a large portion of it, we at first suspected the existence of an opening in the intestines, by which an effusion had taken place. After a careful and minute examination, however, no such opening was discovered. Our attention was now directed to the condition of the peritoneum itself, which was highly inflamed. It was, moreover, found, that the substance in question exuded from its surface,--the membrane, in many places, especially the portion of it which covers the liver, being coated so thickly with the grounds, that they could readily be scraped off with the back of a scalpel. These cases show conclusively, that the matter of the black vomit, occurring in yellow fever, should not be regarded as altered bile; and that the supposition of its consisting of a secretion of the mucous membrane of the stomach, does not rest on a much more solid foundation. For bile can hardly be admitted to exude from the skin and serous membranes, and we cannot suppose, that fluids, similar in every respect, can be secreted from two surfaces, so very distinct in their organization, and in the nature of their ordinary products, as those of the mucous and serous membranes. From these facts I am led to regard the black vomit as a true hæmorrhage, resulting from a state of previous irritation of the surface which furnishes it. That inflammation may be cause of it, we have a sufficient proof in the fact, that a similar fluid is occasionally vomited in cases of puerperal fever, when the irritation progresses from the serous to the mucous membrane of the intestines; as well as in cases of inflammation from blows on the stomach, and the action of poisons. A case of this kind, arising from a kick of a horse, was attended by myself and two respectable physicians in consultation, a few years ago; and another case arising from a large dose of carbonate of potassa, swallowed by mistake, occurred in my practice not long since. But as it would occupy too much time to give them here in detail, I pass them by without further notice. That the matter of the black vomit is the product of a hæmorrhage, I have thought may also be inferred from the fact, often noticed by myself and others, of large portions of coagulated blood being found in the intestines; the surface having the appearance of the common black matter, whilst on cutting into them, the centre is found to consist of a red solid coagulum. I have also sometimes noticed, that the duodenum contained the coffee ground matter, and the intestines, coagulated blood. In such cases, in order to adopt the opinion of secretion, we must believe, that the same vessels, occupied in the secretory process, afforded, at the same time, passage to a portion of common blood; for we can hardly admit, that the mucous follicles are the organs secreting the black matter. Besides, is this not a mere dispute about words; and is it proved that what are called sanguineous secretions are not the result of the same action, which gives rise to hæmorrhagic exudations? and is there any other difference between the hæmorrhage of yellow fever, and of ordinary cases of hematemesis, than that arising from a difference in the _quality_ of the blood? Nor do I find much difficulty in believing, that the colour of the skin, which is more frequently brown than yellow, as well as the petechiæ, &c. are the effects of the stagnation of blood, altered by the capillaries of the surface, in the same manner as that exuding from the mucous surfaces. I believe that this opinion, suggested by some European writers, is supported by the fact, that this fluid exudes from the orifices made by the bites of leeches and the incisions of scarified cups; as well as from the raw surface occasioned by blisters; and that the vibices contain a serous fluid mixed with blood. _Analogy to Plague._--On comparing the symptoms of the yellow fever of this country with those of plague, as detailed so minutely and, I believe, accurately by authors, and especially by the physicians who accompanied Bonaparte to Egypt, I have been led to regard these diseases as bearing a closer analogy to each other than has hitherto been admitted. I do not pretend to assert that they are the same disease, but only that they are so nearly allied, as on some occasion, to lead even an experienced observer into an error of diagnosis. The great difference between them consists in the frequency of the affection of the lymphatic glands in the plague, and its comparative rareness in yellow fever; and in the greater predominance of gastric symptoms in the latter. Nevertheless, I have had, on many occasions, during our different epidemics, opportunities of noticing buboes, situated in the same parts as those mentioned by writers on the plague, running the same course, and curable by the same means. Carbuncles are frequently seen in both diseases, though not so frequently in yellow fever as in the plague. Both diseases present what are called the walking cases. Patients in both, though more frequently in yellow fever, retain their muscular strength as well as their intellectual faculties. So far as we are informed, the mortality in both is pretty nearly the same, and the treatment similar. _Contagion of Yellow Fever._--The question of the contagion or non-contagion of yellow fever has so long occupied the attention of the profession and been discussed so extensively, that I deem it unnecessary to devote much space to it here. Nevertheless, as I have had frequent opportunities of noticing the disease under all circumstances; in all parts of the city, and in the country; among the wealthy and the poor, I may without much impropriety offer, in a few words, the result of my observations and reflections on this head. I must unhesitatingly declare, that, establishing my opinion on what I have seen, I am led to the conviction, that the yellow fever is not a contagious disease; that it never has been carried hither in the way mentioned by contagionists; and that it has invariably proved an infectious disease, using this word to express a malady arising from a local source of contamination, other than a living body. It is plain, that this view of the subject does not exclude the possibility of a vessel carrying the disease to this or any other port; but, in that case, the vessel itself or its cargo, must be the source of infection, and not the individuals on board. And this may take place, when the port from whence the vessel sailed is free from the disease. That such has been the case, there cannot be any doubt; and that the idea, predicated on it, of the contagiousness of the fever is erroneous, I have not the least hesitation in believing. How else than on the principle of infection, and not of contagion, can we explain the attack of individuals frequenting those parts of the city, where the disease had originated, and which (all the inhabitants having been removed to some distant situation) had been barricaded? How could we, in any other way, account for the exemption from the fever of individuals, who, out of the infected district, nursed, touched, and even slept with their diseased relatives and friends; and not always in clean and well ventilated apartments and parts of the city; but, in very many instances, in the filthiest hovels, and alleys, and among the lowest classes of society. Striking and unanswerable facts of the sort have frequently presented themselves to my observation, during our various epidemics. Children have sucked their parents, affected with the fever, and, in one case which fell under my notice, the child continued attached to the breast after its mother's death; and in all such instances with impunity. I have constantly reprobated the practice of burning the clothes and bedding of the dead, and have never found any bad results to occur to those who followed my advice. From a consideration of all these facts, I must once more express it as my decided opinion, that the yellow fever, so far as I have had an opportunity of observing it, is not a contagious disease. _Treatment._--Whatever opinion we may entertain respecting the specific nature of yellow fever, I was early convinced that this disease was not to be treated by specific remedies, and that our curative indications should be formed on an attentive consideration of the condition of the system in general, and of particular organs, as pointed out by the symptoms during life and the morbid lesions after death. In a former part of these remarks, I suggested the opinion, that the yellow fever is a gastro-duodenic inflammation, (perhaps of a specific kind,) and that it required a mode of treatment appropriate to this morbid state; but proportioned to the strength of the patient, to the violence of the attack, and to the power of re-action. In general, however, I have not found active depletion by the lancet, as easily borne in this, as in bilious and other fevers;--the disease assuming more rapidly, under this plan, a state of prostration or adynamia. Nor can this appear surprising, since the same circumstance of a disease being of an inflammatory nature, but, under a peculiar condition of the system, contraindicating ample depletion, is a subject of frequent notice during certain epidemics; for example, of scarlatina, pneumonia, &c. With the exception of those cases, therefore, occurring in very robust and plethoric constitutions, and accompanied with much pain in the head, high febrile excitement, and hard pulse, either large or small, I have seldom resorted freely to the lancet. When, however, these symptoms presented themselves, especially the hardness of the pulse, I have not been sparing of blood-letting, and have sometimes repeated it several times with the most decided success. But even under these circumstances, I have seldom found that _large_ bleedings were as beneficial as small and repeated ones;--the system not reacting always as energetically as could have been desired, and symptoms of prostration occurring with much more rapidity. I do not recollect to have bled with advantage, patients presenting a large, full, but _compressible_ pulse, owing to the want of reaction; although the other symptoms might seem to indicate the propriety of the practice. The effect of bleeding on the vomiting was very different in this, from what I mentioned it to have been in the bilious fevers of the West Indies; owing probably to the circumstance, that, when, in yellow fever, the irritation of the stomach became sufficiently violent to give rise to this symptom, the state of the system was very often such as to contraindicate the use of the lancet. The application of scarified and dry cups to the epigastrium and head, when there existed pain in these regions, was often resorted to, and afforded much relief. And I very much regret, that, during our epidemics, it was out of my power to make use of leeches to the former part, as so warmly recommended, at the present day, by the French and Spanish physicians; as I am inclined to the opinion, from the view I have adopted respecting the pathology of the disease, that, used early and in large numbers, they would prove very serviceable. In conjunction with general and local bleeding, fomentations were had recourse to in almost every case, and applied to the epigastrium in the form of poultices, or flannels wrung out of warm emollient decoctions. In order to excite perspiration and to determine action to the surface, a tepid bath was occasionally prescribed, and in some cases afforded considerable relief; but as it was an inconvenient remedy, pediluvia, and hot bricks on which water, or water mixed with vinegar was poured, were substituted. In cases, however, in which much arterial action existed, these last means were not prescribed, until the pulse had been brought down by the lancet, and other remedies presently to be mentioned. On the subject of emetics, I shall not enlarge; as I can safely assert, that I very seldom saw a patient recover from yellow fever, to whom tartarized antimony, or any other active remedy of the same class, had been administered. Of the impropriety and danger of this practice in the present disease, I was early convinced from a careful analysis of the symptoms, indicating an acute irritation of the stomach and upper portion of the small intestines, and from the circumstance, that, of the first family in which I was called to prescribe, five members, to whom emetics had been administered, had already fallen victims to the fever, under the care of a very respectable physician, and that three succeeding ones, who were treated agreeably to my view of the pathology of the disease, recovered. From these facts and reflections, I was induced to watch the effects of these remedies in subsequent cases, in my own practice, and in the practice of other physicians, and was soon led, from this extended experience, to abandon totally the use of tartar emetic in the treatment of this malady. Ipecacuanha in emetic doses was also tried by me; but although, thus administered, it did not occasion the bad effects resulting from the exhibition of the preceding article, yet it was often productive of harm, and never of benefit. These remarks, however, apply more particularly to the use of tartar emetic during the state of excitement of the fever, and not to that of collapse which sometimes precede it, and in which it is recommended by some physicians of the southern states. In this condition of the system, I have never resorted to it, and, I must confess, could not easily be persuaded to do so; suspecting that even in such cases, the digestive organs are already too far implicated, to justify the use of so powerful and acrid a remedy. It would seem that the bad effects of emetics, and more particularly of tartarized antimony, resulted, not only from their irritating qualities, but also from the efforts of vomiting, during which the stomach is compressed by the abdominal muscles, and made to contract very forcibly. To this opinion I am naturally led from the circumstance, that purgatives, whose action is certainly primarily irritating, are very advantageously employed in yellow fever. It is not my intention to attempt here an explanation of this seeming contradiction. Leaving to others the accomplishment of this difficult task, I shall content myself with stating, that during the whole course of my long practice, I have seldom seen a patient die of this disease, whose bowels had been well evacuated, and in whom perspiration had been excited within the first twenty-four hours after the attack. I exhibited purgatives in almost every instance _every day_, until copious evacuations had been procured, and I generally found, that the mild purges were of greater service than those of a severe and irritating nature. Senna, acidulated with lemon juice or tamarinds, answered sometimes remarkably well, when the stomach could retain it. Castor oil, manna, salts, magnesia, were frequently employed by me with advantage; and although I did not make an extensive use of calomel in this disease, yet I prescribed it to children, and to adults, who, owing to great irritability of the stomach, could not retain other purgative medicines. When I resorted to it, I generally did so in doses sufficient to ensure a purgative effect, and never with a view of exciting ptyalism. In doing this, I was not guided, however, by any fear of the effects of a salivation, since I was well aware that a ptyalism occurring in malignant diseases is often a favourable crisis; but by a knowledge of the great difficulty experienced in producing it, and from the observation, that in cases in which it was obtained, much valuable time had been lost, and the patient might have recovered without. To promote the operation of the above remedies, purgative enemata were resorted to, in the early stage of the fever; and were followed by the frequent use of injections, composed of emollient decoctions, from which the patient derived considerable relief and comfort. As counter-irritants, blisters and sinapisms were used, and often with great advantage. They were found of much value when applied to the epigastric region, for the purpose of arresting the vomiting. Sinapisms were in general preferred to blisters, as being more prompt in their effects and more easily renewed. Blisters were sometimes applied to the extremities in the different stages of the disease; but so far as I can judge, from my experience, not with much real benefit. I seldom derived much advantage from the use of tonics and stimuli in yellow fever; except when the powers of life seemed to fail, and petechiæ, vibices, hæmorrhages, and other signs of malignancy had occurred. In general, under such circumstances, the Peruvian bark, either alone or combined with serpentaria, was administered in preference to any other remedy of the same class. In cases, however, unattended with reaction, tonics and diffusible stimuli internally, and revulsives of all sorts externally, were had recourse to from the commencement of the attack, and sometimes with the desired effect of arousing the powers of the system. _Opium_ was never found beneficial, on account of its tendency to aggravate or produce coma, as well as from its effect in suppressing intestinal evacuations. Whilst making use of the above remedies, the plentiful exhibition of diluent drinks was not neglected,--care being taken, however, not to load unduly the stomach, and to select such drinks as would suit the taste of the patient. In almost every case, acids did not answer so well as the bland mucilaginous infusions. The drinks were almost universally allowed cold, except when there existed a tendency to perspiration; under which circumstances they were administered slightly warm and a little aromatic. During the course of the yellow fever, some of the symptoms demanded particular attention. Influenced by the idea of prostration and dissolution, many practitioners, and myself for some time among the rest, resorted to the bark and other tonics for the purpose of arresting the black vomit, and of correcting that condition of the organs, which gave rise to this effusion; but after many unsuccessful trials, I was led to abandon this practice and to resort to other means. Of all the remedies employed to attain this effect, calcined magnesia mixed in a thick solution of gum arabic seemed to me to answer best; for whilst it succeeded, in many cases, in arresting the vomiting, it tended to keep the bowels open. Together with this, revulsive remedies were applied to the skin, and sometimes succeeded very well,--a sufficient proof, I think, that this hæmorrhage is the effect of an increased action of the mucous membrane of the digestive tube, and not of a passive condition of the capillaries of the parts. For the purpose of controlling the great irritability of the stomach, and arresting the vomiting occurring in the early stage of the disease, besides the usual remedies used in such cases, I found advantage in the use of small and frequently repeated injections with a solution of salts, an infusion of senna, or the like substances. Such a practice, however, did not seem to succeed so well in the latter stage of the disease. With the intention of promoting the secretion of urine, in cases in which it was suppressed, all the diuretics, as well as every external stimuli, were in vain employed;--this symptom, as I have already mentioned, being, in all instances which fell under my immediate observation, the forerunner of death. ARTICLE V.--_Remarks on the Prophylactic Treatment of Cholera Infantum._ By JOSEPH PARRISH, M. D., one of the Surgeons to the Pennsylvania Hospital. The great mortality of cholera infantum renders it one of the most interesting diseases, which come under the notice of the physician. Its ravages among the infant population of our large cities, are too well known, and too strongly felt, to require any comment. No disease contributes so largely to swell our bills of mortality during its prevalence; and were it not restricted to the summer season, it would prove a greater scourge to the community than consumption itself. This mortality is owing less to our ignorance of the nature of the complaint, and the proper mode of treatment, than to the continued operation of the causes by which it is produced. I have often compared our endeavours to cure cholera infantum, while these causes remain, to an attempt to relieve inflammation in a part, while a thorn is sticking in the flesh. We may resort to bleeding and leeching; we may restrict our patient to the lowest diet, and the most perfect rest; we may employ all those remedies, which are ordinarily best calculated to reduce inflammation: but so long as the thorn continues in the wound, our efforts will be fruitless. Thus it is with cholera. We may obviate the more violent symptoms; we may procure temporary relief; we may even flatter ourselves that a cure has been effected: but the original causes have not lost their power; an increased susceptibility to their operation remains; relapse upon relapse is experienced; and at last the little sufferer, worn out by the successive attacks, sinks beyond the reach of medicine, and expires. Unhappily, the nature of the causes is such, that, in very many instances, their removal is exceedingly difficult, if not altogether impossible; and, under such circumstances, the patient who has once been severely affected, seldom recovers in the end. Hence it becomes of the greatest importance to prevent the occurrence of the disease; and attention to the prophylactic treatment is no less essential than the adoption of curative measures. It is with the view of calling the attention of the profession to this subject, that I have been induced to offer the following observations. It is obvious, that, in the preventive treatment, two objects demand attention; first, to remove, as far as possible, the causes of the disease; and secondly, where their entire removal is not attainable, to fortify the system against their influence. On each of these, I shall offer a few observations. I. Excessive and continued heat is, perhaps, the most fruitful source of cholera. Thus we find, that the disease makes its first appearance in the commencement of the hot weather, increases and becomes more fatal with the rise of the thermometer, and declines with the return of cool weather in autumn. During its continuance, it may be observed to vary with every permanent change of temperature. A few very hot days in succession, in the 6th month, are sufficient to call it into action; and during the height of its prevalence, a spell of cold weather will diminish, if not suppress it. In the summer of 1806, which was remarkably cool and pleasant, there was very little of the disease; and generally in moderate summers, it is much less prevalent than in those of a contrary character. I believe that it is by a direct operation on the system, and not by the generation of miasmata, that heat proves so deleterious to the infant. In the country, where miasmata are most abundant, there is comparatively little cholera; for the heat of the sun is there moderated by the free circulation of the air; and the debilitating operation of the high temperature of the day is counteracted by the refreshing coolness of the morning and evening. It is in the close air of cities, that the complaint flourishes with greatest vigour; and the most confined situations are the most favourable to its production. Let any one take a walk, in a summer's morning, through the thickly built lanes and alleys of Philadelphia. He will be struck with the appearance of the children, reclining their heads, as if exhausted, upon the breast of their mothers, with a pale and languid countenance, a cool and clammy skin, a shrunk neck, and other signs of debility, arising from their confinement, during the night, to close and hot apartments. It will readily be believed, that such places are the very hot beds of cholera. Heat, therefore, connected with confined air, being among the most frequent causes of the complaint, it is necessary, as far as possible, to counteract them. Should a strong predisposition to cholera be suspected, the best plan will be to send the child into the country during the summer. Both as a preventive and a remedy, country air is decidedly the most effectual, to which we can resort. But in most instances, it would be exceedingly inconvenient, sometimes impossible for mothers to leave their homes and occupations in the city; and, under such circumstances, it becomes necessary to substitute measures, which may produce, as nearly as possible, the same effects. To keep the child cool, and expose him to the fresh air, are the ends to be obtained. For this purpose, he should be carried frequently into the open squares, or beyond the suburbs of the city. I am in the habit of recommending to parents, whose circumstances will not allow of a removal from the city during the summer season, to make frequent excursions across the Delaware, and into the neighbouring woods of New Jersey. The refreshing effects of the air on the river are truly surprising. The brightened eye and animated countenance of the infant, give speedy proof of their favourable influence; and when labouring under the disease, even in its lowest stage, the little patient will often exhibit immediate signs of amendment. In the prevention of cholera, much may also be expected from a proper attention to the lodging of children. Many parents have a great dread of the night air; and exclude it from their chambers, as sedulously as if it were infected with poison. But, in guarding their children from taking cold, they expose them to a much greater danger. Observe their mode of treatment. The doors and windows are carefully closed; the child is placed in a feather bed, with his parents on each side, and almost smothered with the bed-clothes. Perhaps other children are lodged in the same apartment; and thus the delicate system of the infant is exposed to the debilitating influence of great heat and stagnant air, combined with the effluvia, which, in such a situation, must be abundantly generated. Simply to enter such a room in the morning, is almost sufficient to sicken a healthy individual; how much more injurious must be its effects upon the lodgers themselves. Examine in the morning a child, who has passed the night thus confined. You will find him limber as a rag, exhausted by perspiration, wholly destitute of animation, without appetite, and on the very verge of cholera. I should recommend an entirely different plan of management. Instead of a feather bed, the child should be placed on a hard mattress, or on blankets folded and laid upon the floor. The covering should be light, but comfortable. The doors and windows should be open; so that fresh air, that _pabulum vitæ_, without which health cannot be sustained, may be freely admitted. Thus treated, instead of the feeble and sickly appearance before mentioned, he will present a lively countenance, with all that activity of motion, and enjoyment of existence, which are natural to his age, and afford the surest criterion of vigorous health. Experience has fully convinced me of the great importance of attention to the lodging of children, as a prophylactic measure; and this renders me desirous of impressing upon the profession generally, the truth of my own convictions on the subject. With the same design of obviating the injurious effects of a high temperature upon the infantile system, I advise frequent ablutions with cool water, and its free employment as a beverage. Infants, unable to make their wants known, often suffer exceedingly from the inability of their attendants to understand them. During the heat of summer, the increased evaporation from their surface is necessarily productive of increased thirst, which, if unsatisfied, renders them uneasy and restless. To quiet them, the breast or bottle is offered. Aliment is thus given, where drink only was required; and the stomach, overloaded and oppressed, is apt to become irritable, and is thus brought into a condition most favourable to the occurrence of cholera. By attention to the peculiar language of infants, expressed not by words, but by signs, I have often been able to detect their wants; and, in many instances, have afforded the most decided relief, by simply giving them a little cool water for drink. From the dread which some individuals have for cool air and cold water, it would seem that they were considered rather as destructive poisons than as absolute necessaries. I have no fear of either, when judiciously employed; and as prophylactics in cholera, I do not think their place can be supplied. But heat is not the only cause of this complaint. Dentition is well known both to predispose the system to its attack, and, after it has occurred, to increase its violence, and diminish the chances of recovery. In the employment, therefore, of preventive measures, it is highly necessary to attend to the state of the gums, and to remove or counteract this source of irritation. If at all swelled or painful, they should be lanced freely, and the operation should be repeated as often as their inflammatory condition may demand. In severe cases, much good may be expected from the application of blisters behind the ears. The irritation thus receives an external direction, and the stomach and bowels are in less danger of an attack. I was led to this practice, by observing that the eruption, which, during dentition, is apt to make its appearance behind the ears, often proves a most salutary effort of nature; and that, while it continues, the infant generally enjoys an exemption from those dangerous disorders, incident to this critical period of life. To imitate nature as closely as possible, the discharge from the blistered surface should be maintained for some time by stimulating dressings. I have witnessed the most beneficial effects from the practice, and can strongly recommend it to the attention of the profession. II. At the same time that we endeavour to remove or diminish the causes of cholera, we should not neglect to put the system of the child in such a condition, as may enable it most effectually to resist their operation. As cholera is a disease of irritation, originating generally in a debilitated state of the alimentary canal, I believe this end may be most easily attained, by preserving the natural tone of the digestive organs. For this purpose, all flatulent and indigestible food should be carefully avoided. During the first year, the mother's milk is, in general, the most appropriate nutriment. When the stomach of the infant is very delicate, the diet of the mother should be strictly regulated; and, in all cases, it would be adviseable for her to avoid articles of a flatulent nature. While the child is still at the breast, if a predisposition to cholera be suspected, I would recommend the occasional use of nutritious animal juices. The sucking of small pieces of salt meat, as ham or dried beef for example, will sometimes be found productive of advantage. After weaning, animal food should always enter into the diet of the child. Many parents, fearing to render their children gross and unhealthy, restrict them altogether to vegetable aliments; and thus, by weakening the powers of digestion, prepare the way for that very result which they are most anxious to avoid. With the same view of giving tone to the stomach, aromatics should be used habitually during the summer, in those cases, in which there is strong reason to apprehend the occurrence of cholera. While they produce a cordial impression on the stomach, and invigorate generally the digestive powers, they are liable to none of those objections which may be urged against the employment of the narcotic stimulants. Indeed, nature herself seems to have pointed them out as prophylactics against the diseases of hot weather. Our most powerful and valuable spices are the products of warm countries. Cinnamon, ginger, pepper, the clove, the nutmeg, are to be found only in tropical climates. In this arrangement, we see the hand of a beneficent Creator, who has provided, that, by the same high temperature, which renders the equatorial regions so fruitful of cholera, and other disorders of the bowels, the growth of those plants should be promoted, which are best calculated to invigorate the alimentary canal, and to fortify it against the inroads of disease. Facts are not wanting to prove the efficacy of spices in preventing intestinal complaints. We are informed by DEWAR, in his treatise on the Diarrhoea and Dysentery, by which the British army in Egypt was attacked, that among the Mamalukes of that country, it was a universal practice, when they apprehended the approach of these disorders, to make use of cinnamon or ginger, with the almost uniform effect of averting them; and where the same practice was followed by the British soldiers, equal advantages were experienced. In the French army, so highly was the prophylactic power of the aromatics estimated, that every soldier was provided with a box of spices, which he was directed to use freely with his diet of fruit and melons. When attending surgeon of the Alms-house hospital in this city, I had occasion frequently to prescribe in a syphilitic ward, which being situated directly under the roof, in a large garret, was liable, in the summer season, to become very much heated. As the patients were numerous, and the windows insufficient to admit of proper ventilation, the air became much contaminated; and the consequence was, that bowel complaints were very frequent and troublesome. I have often entered the ward on a summer's morning, and found almost every patient affected more or less with diarrhoea or cholera. It occurred to me, that the free use of some of the aromatics might be found serviceable in preventing the occurrence of these complaints. I accordingly directed, that every individual in the ward should drink a portion of strong ginger tea daily. I also ordered, that salt meat should be used twice in the week. By the steady pursuit of this plan, a very considerable change for the better was effected. The employment of aromatics as prophylactics is not less beneficial in children than in adults. I would not, however, advise, that they should be given indiscriminately to all children, during the summer. It is only to those cases, in which a predisposition to cholera infantum exists, that I consider them peculiarly applicable; and here I believe they are capable of producing much good. Before dismissing the subject of the paper, I will simply remark, in addition to what has been already said, that the occasional use of the cold bath, by the vigour it imparts to the system generally, and through it to the digestive organs, will often be found an excellent preservative against the summer complaint of children. In this short account of the preventive treatment of cholera infantum, I have been less anxious to give a dissertation, embracing all that might be said on the subject, than to communicate those particular measures, which, according to my own experience, I have found most effectual. I will conclude the paper by the relation of a case, in which a strong predisposition to the disease was successfully counteracted. It will be proper, however, to premise, that the treatment of this case is by no means held out as an example to be generally followed with every infant, which may possibly become the subject of cholera. It is applicable in all its details only to those, in which, as in the present instance, there is every reason to apprehend, that the only alternative is between almost certain death, and the most careful prophylactic treatment. CASE.--A gentleman of this city, whose wife had arrived at a period of life, when she could not expect to be the mother of many more children, consulted me respecting an infant daughter, their only surviving child. I was informed, that they had already lost eight children, all of whom, with one exception, had died of cholera. It may readily be imagined, that every feeling of parental anxiety was awakened for their babe; and that no degree of attention on their part was considered too great, which might contribute to its preservation. It was placed under my care, not to be cured, but that I might, if possible, devise some plan of management which would avert the disease they had so much reason to apprehend. I felt the responsibility of the trust, and endeavoured to find it to the best of my ability. Every opportunity which I could desire was afforded me; for the infant, from its birth was submitted to my direction; and both the disposition and ability existed, on the part of the parents, to carry implicitly into effect every measure which I might recommend. As the mother was unable to furnish sufficient nourishment, the first step was to provide a healthy wet-nurse, who might be willing to submit to the necessary regulations in respect to diet. I believed the children of these parents to possess a constitutional weakness in the alimentary canal; and, on inquiry, I was told, that they had been kept upon a vapid diet, under the impression that it would contribute to their health. In the present case, therefore, the principal object was to communicate strength to the stomach and bowels. With this view, the child was accustomed, from an early period of infancy, to a generous diet. When very young, portions of ginger tea were given to it daily; and as soon as it was old enough to suck the juice of meat, it was encouraged to do so. The nurse, during the warm season, was kept upon a nutritious diet, consisting principally of animal food, with the occasional use of ginger tea; and every description of recent fruit and fresh vegetable food was forbidden. Under this management, the first summer was passed without any symptom of the disease; but I looked forward to the second with no little anxiety, when the child would have to struggle with the irritation arising from dentition. The same plan was continued during the second summer, and still more rigidly enforced. The child was now old enough to take animal food freely in addition to the breast. It was allowed as much salt fish, ham, beef-steak, essence of beef, &c. as it desired; ginger tea was given daily; a little sound old port wine was occasionally directed; and both the child and the nurse were restricted from every species of flatulent and indigestible aliment. So anxious, indeed, were the parents, and so careful to carry my directions into full effect, that they allowed no forbidden article of food to enter the house, and denied themselves their wonted comforts, lest possibly their child might be injured. The gums were carefully attended to, and lanced whenever the operation appeared to be requisite. All those measures, which I have before mentioned as serviceable in obviating the effects of great heat, so far as they were applicable to the case, were adopted. The second summer was spent wholly in the country. Very little medicine was required, and none was administered, except of the mildest description. Frequently, when summoned to visit the babe, I have found the mother trembling with fear, and anxious that something might be done; and often, under such circumstances, have I begged it off from a dose of physic, having determined to avoid a resort to every thing of the kind, unless real necessity should demand it. By a strict adherence to the plan above detailed, the period of dentition was passed in safety; and it is with heartfelt pleasure I can say, that no symptom of cholera afterwards made its appearance. ARTICLE VI.--_Case of Neuralgia cured by Acupuncturation._ Communicated by J. HUNTER EWING, M. D. The attention of the medical public having been of late much excited on the subject of acupuncturation, I am induced to communicate the following case. For eighteen months, Miss ---- had been afflicted, at intervals, with a severely painful affection of the nerves of the right cheek, immediately below the orbit of the eye, and extending to the angle of the lower jaw. On the 14th of January 1826, she was attacked more violently than usual, and the remedies, which had previously afforded some relief, now failed. Stimulating cataplasms, warm embrocations, laudanum, internally and externally, heat applied externally to the cheek by means of very hot flannels, produced not the slightest mitigation of the pain; and she continued to suffer excessively until the afternoon of the 15th; when acupuncturation being proposed, she consented to the operation with this remark,--"any thing to relieve me from this agony." The needles were immediately procured, and three inserted about an inch from each other. Two in a line parallel with the inferior edge of the orbit of the eye, and half an inch below it; and a third below, and equidistant from the others. The first two were introduced to the depth of three-fourths of an inch; the last, a full inch. They were inserted very gradually and with a rotary motion. The second needle was scarcely introduced, before the patient exclaimed, "the pain has entirely left me." When the third was introduced, she experienced a stiffness in the muscles of the cheek, and a creeping sensation, as if a spider's web had been drawn across the face; but no painful sensation whatever. Such was the exhausted state of her system from the excessive pain she had suffered, that when thus relieved, she requested a pillow to rest her head on, and fell into a gentle slumber. About two hours after the insertion of the needles, I again visited my patient, and found her still perfectly free from pain, and seated at a table reading. She thanked me for the relief I had been the means of affording her, and requested me not to withdraw the needles, lest the pain might return. Upon being apprised of the risk that might attend their being allowed to remain, she observed, that she would rather have a servant to watch her whilst she slept. The propriety of their removal being further urged, she at last consented. There was no return of pain. The next morning, the patient remarked, that the stiffness of the cheek, and a numbness of the whole right side, continued through the night; and though she did not sleep very soundly, she was free from pain and rested well. By the third day, the stiffness and numbness had passed away, and there was no return of pain. Several weeks have now passed, and she has had no relapse; although often since exposed to causes, which, heretofore, had always excited violent attacks. Previous to the operation, she seldom passed as many days without severe suffering. Although I have performed this operation many times, and been present when others have performed it, I have never seen a case, in which its efficacy was so decided, or in which the relief afforded was more unquestionably attributable to the action of the needles. ANALYTICAL REVIEWS. ARTICLE VII.--_Researches into the Nature and Treatment of Dropsy in the Brain, Chest, Abdomen, Ovarium, and Skin, in which a more correct and consistent Pathology of these Diseases is attempted to be established, and a new and more successful method of treating them, recommended and explained._ By JOSEPH AYRE, M. D. &. London, 1825. We have read the present work with the liveliest pleasure, and we dare hope with considerable benefit, and hasten to lay a review of its contents before our readers. Dr. AYRE is already advantageously known in this country, where his Essay on Marasmus has had an extensive circulation; but we are disposed to think, that, however he might be esteemed for the talent he displayed in his former composition, he is entitled to much more credit for his able researches into the nature and treatment of dropsy. We confess that we enter upon our editorial duties on the present occasion, with the two-fold intention of offering to our readers what we regard, on the whole, as a very correct view of the pathology of dropsy, and of showing to some of our medical friends, who shudder at the mere mention of what they denominate _hunch theories_, that the English physicians, or at least some of the most intelligent among them, so far from considering these theories as dangerous and unphilosophical, are beginning to entertain similar views with their Gallic brethren, in respect to the inflammatory nature of many diseases too long regarded as resulting from a state of debility, and classed by nosologists among the Cachexiæ. By most writers upon the subject, dropsy has too long been considered as a _disease_,--constituted into a separate class, and divided into many species. Dr. AYRE entertains, however, a very different and, we believe, a much more correct view of the pathology of this complaint; regarding it as only one in a series of effects of a disease, and not always the last of that series. He remarks, that the true disease is to be sought for in that particular condition of the solids by which the effusion is produced; and that to appreciate justly the nature and treatment of dropsy, it is necessary to understand the nature of that condition, which constitutes the disease, and of which the serous and watery effusion is merely the result. Of all the hypotheses that have been advanced to account for the nature of the morbid state, which gives rise to general and local dropsy, there are only three which our author regards as entitled to our notice. According to these, all dropsical accumulations arise either, 1st, From a want of tone or energy in the absorbent vessels, giving rise to a deficient absorption. 2nd, From an increased exhalation of the natural fluid, through a similar want of tone in the exhalents; and 3d, From a mechanical obstruction to the free return of blood by the veins, produced by tumours of various kinds, &c., by which a greater portion of it is forced into the exhalents, and a greater effusion of their proper fluids thereby occasioned. With these hypotheses, however, Dr. AYRE is not satisfied, and he endeavours, in the following manner, to show their insufficiency. "1st. The opinion of a want of tone in the absorbents, as a cause of dropsy, is contradicted by the fact, that in those cases, in which it is assumed to prevail, it is found, that the adipose matter, or fat of the body, is removed by the absorbents; or, in other words, that emaciation takes place to as great an extent, and as rapidly in this, as in other diseases; and emaciation can only be effected by means of absorption. Besides, in these cases of dropsy, mercury, when rubbed upon the surface, or received internally, is absorbed as readily, and affects the system as early as under other states of the body. There is also no accumulation of the fluids in the joints, or in the _bursæ mucosæ_ in these cases, which, nevertheless would happen, if there was a general debility of the absorbent system; and _ecchymoses_ or livid spots, though easily induced in anasarcous limbs, are likewise easily removed from them by the absorbents. "2nd. The opinion of a want of tone or energy in the exhalants involves in it one of the following conditions: namely, either, 1st, that the fluid of dropsy may escape mechanically from them, and that the fluid thus _mechanically_ separated may be identified in its sensible and chemical qualities with another fluid which is confessedly secreted; or 2nd, that if the fluid of dropsy be secreted, then that an _increase_ in the quantity of a secretion may continue an indefinite period, under a _decrease_ in the energy of its secreting vessels; conclusions to which experience and analogy are alike opposed." In answer to the third hypothesis, Dr. A. remarks, that such an obstruction as contemplated, has never been shown to exist. "In the case of the liver, which is commonly considered, when in a scirrhous or enlarged state, to be the seat of these mechanical obstructions, and thus, to be the cause of abdominal dropsy, we have no satisfactory instance yet shown to us, of any such precise condition of that organ. There are, indeed, numerous instances of abdominal dropsies, in those labouring under a scirrhous or enlarged state of the liver; but there are also, numerous examples of such states of the liver, as well as of the spleen and other organs, without any such effusion; and in many cases, when such effusion has taken place, it has been carried off by the natural passages or by tapping, without any return of the dropsy; and yet, without any visible change in the structural condition of the liver." Dr. A. further remarks, that if the cause were mechanical and existed in the liver, the effect should be constant; which, however, is not the case. Besides, were this mechanical cause necessary, how could we account for the appearance of abdominal dropsy, where there is no disease of the liver, or in other cavities, where no mechanical cause is asserted to be present, and where the remedies by which the cure is effected, have no relation to such causes? Again, if the discharge depended upon a mechanical cause, the water should in every case be of a uniform fluidity, and the progress of its accumulation likewise uniform; so that the operation of tapping should have no tendency to induce a more rapid refilling of the cavity. Yet, the contrary of all this is a subject of daily observation. In addition to this, Dr. A. calls the attention to the fact, that in experiments, in which obstruction has been artificially made, by tying the vena cava for example, the experimenter has committed an error, in reasoning from the lower animal to man--assuming, that as ascites had arisen in dogs, it would in like manner have occurred in human subjects. "But there was an effect, here overlooked, which was to be expected to take place in the abdomen of the dog, from the injury done to the surrounding parts by the operation itself, and which would be quite independent of any effect arising out of the experiment. In the human subject, the effect would be the highest form of inflammation, by which coagulable lymph or pus would be poured upon the surface of the peritoneum. There would, therefore, be inflammation excited in the abdomen of the dog; but as the lower animals are less easily acted on than man, the inflammation would in this case be in a lower degree. But every degree of inflammation has its particular product. The highest occasions a discharge of pus, whilst the lowest, when seated in a serous membrane, is a larger portion of its proper serous fluid. This, therefore, might be the product of the inflammation, which was produced incidentally by the experiment in the abdomen of the dog; and it would be just as reasonable to regard the coagulable lymph in the human subject, which would result from such an experiment, as an effect of the mechanical obstruction, as to consider the fluid effusion in the dog to be so." In respect to those instances of diseases of the liver, connected with ascites, in which, in addition to its other morbid states, a partial occlusion of the vena portæ, by the effusion of coagulable lymph into it, is said to have existed, our author remarks, that they are very few in number, occurring, perhaps, in one out of several hundred cases of ascites with hepatic disease; and that we are justified, from analogy, to assume, that any obstruction given to the circulation by diseased vessels, would be quickly relieved by the enlargement of the anastomosing branches, and that no effusion of water into the abdomen would result from it. After referring to some cases, related by the late Mr. WILSON, in which the vena cava was completely obliterated, and no effusion took place; and some cases of morbid condition of the heart of an analogous kind, by which the course of the circulation became greatly obstructed, and yet, without being followed by effusion; our author concludes, that from these facts and others, to be presently noticed, it appears evident, "That the dropsical effusion, in whatever part it may be seated, does not arise from any want of tone in the exhalant or absorbent system, or from a mechanical obstruction in the liver or other viscus; but, that it proceeds from a morbid action in the cellular or serous tissues, and that this action, as we shall now proceed to show, is allied in its nature to inflammation." In support of this opinion, Dr. AYRE remarks, that all the phenomena belonging to cases of watery effusion, met with under one or other of the forms of inflammation, are common to those of dropsy. Thus the fluid, discharged under the cuticle in erysipelas or in inflammation induced by heat or a blister, or in cases of pemphigus, is a secretion, and resembles in all respects the fluid found in dropsy. In some cases of acknowledged inflammation, the fluid effused is found to vary greatly in its degree of tenuity, so as to be sometimes of quite a viscid nature. The same circumstance is met with in dropsy; the fluid of which varies sometimes in different forms of the disease, and at different periods in the same patient. With regard to the absence of pain, in ordinary cases of local or general dropsy, which, in the minds of many physicians, might seem to militate against this view of the subject,--since pain accompanies the inflammation of a blister, Dr. A. very justly says, that the difference is referrible to a different degree of sensibility of the parts affected; that, moreover, in pemphigus there is no pain, and that chronic inflammation of the serous membranes is little painful. That the morbid action producing the effusion is only a modification of inflammation, our author thinks may be further shown by the fact that it obeys the same laws--being translated occasionally, like it, from one part of the body to another. On this subject, Dr. AYRE makes the very pertinent remark, that in these cases, the fluid alone has been thought to be translated; but that the metastasis, is without doubt, exclusively of the action which produces the serous discharge. Analogous also to what occurs in inflammation, especially of the erysipelatous kind, the action occasioning the effusion, as seen in anasarca, commences at a given point, and gradually extends from thence in a continuous course. It ought also to be noticed, that the results of common inflammation vary according to the intensity of the cause; the lowest degree of it, occasioning an increase in the quantity of the proper fluids of the part,--a higher degree, yielding for its product coagulable lymph, and a still higher one producing pus. All these several products of common inflammation, are more or less remedial of their cause; or in other words, are the immediate means of the cessation or abatement of the inflammation which produces them. This same power is likewise a property, though in a much less degree, of the hydropic effusion, when the inflammation which produces it, is idiopathic; or in other words, not created by a visceral or other disease, or some particular excitement of the general system, as is seen in cases of anasarca. "And here," continues our author, "it may be proper to remark upon a common error, committed by those, who, mistaking the nature of the action which produces the serous effusion, look in the _post mortem_ examination, for some of the common signs of an inflammation having existed; and who conclude, upon not finding such, that the water was derived from some mechanical or other cause foreign to the true one. But in the higher forms of abdominal inflammation, the products are pus or lymph, and these are found upon the surface of the peritoneum, with sometimes a thickening and discoloration or ulceration of its substance; whilst in the lowest form of that increased action to which the serous membranes are subject, the only product is the serous fluid, and there can be, therefore, no visible alteration produced by it in the structure of the serous tissue." "By the hydropic or serous inflammation, obeying the same laws which govern the other degrees of common inflammation, it follows, that upon a higher excitement being superinduced upon it, the serous effusion should cease. This, therefore, is found to happen in every case, where such higher excitement is brought on. This increased inflammation is sometimes occasioned by design or accident, and at other times, it occurs in the natural and progressive course of some disease, formed within the cavity, which is the seat of the dropsical effusion." This is exemplified in the effects of the operation for the radical cure of hydrocele; or in the operation of tapping in some cases of ovarian dropsy; or even in some instances, of ascites from chronic inflammation of the liver, spleen, mesentery, &c. In all these cases, the serous membrane, which directly or indirectly was affected to a sufficient degree to occasion a serous effusion, takes on, from the extension of a visceral disease, or from some other cause, a higher degree of inflammation--lymph is thrown out, and the cavity becomes obliterated. "Now from these, and similar examples, which have fallen under my observations, I think it may be assumed, that ascites, when proceeding from some visceral disease, (and the principle applies to hydropic effusions from the pressure of disease in other cavities,) does so by the gradual extension of the chronic inflammation of the internal cellular or serous tissues of the diseased organ, to its outer external coverings; and that, commencing here as from a point, the serous or hydropic inflammation is progressively propagated through the whole of the serous membrane of the cavity. By the disease within the cellular tissue of the diseased viscous increasing, a corresponding increase, in these cases, will ensue of the disease on the surface of the membrane investing it; until at length a susceptibility to take on a higher action is induced, which only requires any slight occasional cause to establish. Under this condition of an increased excitement in the peritoneal or other serous membrane, coagulable lymph is discharged into its cellular tissue, and a thickening of it takes place; until at length the operation of paracentesis, which in the early stage of the disease was attended with only inconsiderable inconvenience, becomes an adequate cause of a still higher inflammation, which terminates perhaps in suppuration; and, in the _post mortem_ examination the serous fluid is found so mixed with coagulable lymph, and purulent matter, as to give a whey or milk-like appearance to the mass. The quantity of serous fluid, in these cases, is generally small, when compared with what was accumulated in the intervals of former tappings; for the vascular excitement which occasions the discharge of coagulable lymph, is destructive of that which pours out the serous fluid." Dr. A. remarks, that, besides the particular facts deduced from observations on dropsy as a local disease, and which prove its relation to diseases of local excitement, there is a further support to be given to these views by various proofs that are afforded from observations upon the urine, of serous inflammation producing local dropsy, being frequently connected with one of a general kind. "So that the inflammatory state of the system becomes sometimes a cause of the effusion into a cavity, and at other times an effect of this state." After giving full credit to Drs. WELLS and BLACKALL for their researches into the state of the urine in dropsy, our author remarks, that there are certain conclusions deducible, which appear not to have been contemplated by those gentlemen, but which are strictly accordant with the pathological views he has endeavoured to establish in the present work. "According to these facts, it appears, that when the disease of dropsy is under a sub-acute form, and of the anasarcous kind, it is usually idiopathic, and, often originating from cold; and in this state, as well as in the symptomatic form, though in a less degree, the urine is found to contain a portion of serum. It is nearly peculiar to this disease, and denotes, according to the quantity of it contained in the urine, the amount of that excitement in the cellular tissue, and of the general vascular system, which may be termed serous inflammation: for it is met with most considerably in those forms of the disease, in which these particular states of the body are most apparent." Serum is therefore found in greater abundance, when anasarca precedes the local dropsy, which, in Dr. A.'s opinion, denotes the operation of a general cause. This is found to be the case especially in anasarca after scarlet fever. In cases of anasarca, the skin, kidneys, and bowels are very defective in their operation. Serum is also found, though in a smaller quantity, in those cases in which the anasarca has followed the local dropsy; for the disease of the viscus, which is the cause of the inflammation in the serous membrane of the cavity, may produce an adequate degree of the vascular excitement which gives rise to a discharge in the cellular tissue. Our author sums up his observations on this subject, by remarking, that there appear to be four distinct conditions of the system by which the occurrence of serum in the urine is regulated. "1. It is in the greatest quantity, where along with a copious and continued effusion, there is a nearly corresponding quickness in the absorption of the serous fluid, and which will occur most commonly when the general excitement precedes, and is cause of the local one. "2. It is consequently, _cæteris paribus_, in a less quantity where the general hydropic excitement of the system succeeds, and is dependent on the local one. "3. It is absent, or found only in a minute proportion, in all those cases where the local increased excitement in the serous membrane is only partially extended to the rest of the system, and where the absorption from the part is inconsiderable; as particularly happens in the encysted kinds, or, "4. Where the effusion of the serous fluid has proved remedial of the inflammation producing it; in which case the disease, as it respects the presence of water in a part, may visibly resemble another example, and yet be essentially different from it, by the serous inflammation, which produced it in both, having ceased, on its occurrence, in one of them." Dr. A. discovers a further evidence of the relation which dropsy bears to diseases of local excitement, in the effects it produces on the general system. Thus, during the continued effusion of serum in anasarca, there is sometimes a large quantity absorbed and carried out of the body; by which a regular draught is made upon the nutrient principles of the blood, which must naturally create effects like those arising from the continued discharge of pus from a suppurating surface. In both cases the local disease, when extensive and of long duration, will necessarily occasion an exhaustion of the vital powers, by which that condition of the system termed cachexy will be induced. "The exhausted or cachectical state, therefore, of the system, which has been so variously accounted for, and so frequently assigned as a principal cause of both local and general dropsy, is a direct consequence of the agency of some power diminishing the vital strength at its source; and in the case of a chronic and long continued serous inflammation, it will proceed from the daily abduction from the circulation of a portion of its vital fluid: and whether it be pus or serum that is drawn from the body; or whether it be from any permanent failure in the supplies of nutriment to it, the effect will be the same, as if a certain quantity of blood was daily abstracted from the system." Dr. A. continues to remark that, under these circumstances, a suppurating surface will readily become gangrenous, from any cause temporarily exciting it, and that, in like manner, a higher inflammation may sometimes supervene upon an oedematous limb, as in the former case, and terminate in gangrene. "Hence, therefore, the tendency of dropsical parts to fall into gangrene, and which has been urged, as an argument, in proof of debility being the cause of the serous effusion, is only what is common to other forms of local inflammation, under a similar condition of the body." From the view he has adopted of the nature of dropsy, Dr. AYRE thinks that the excitement of the parts, giving rise to the effusion, may be either 1st. Sub-acute or chronic. 2nd. Symptomatic or idiopathic. In other words, that it may arise from a local disease, or from the common causes of inflammation; and that these causes may be either general or particular. 3d. That the serous inflammation may be either local or general, giving rise to a general or local effusion. After offering so copious an analysis of Dr. AYRE'S sentiments respecting the pathology of dropsy, it is unnecessary to enlarge very fully on the application of his theory to the particular forms of that disease. We shall, however, offer a rapid review, of some of his opinions, and next detail the method of treatment he proposes for the cure of these dangerous maladies. We commence with hydrocephalus, which he remarks has been divided into an acute and chronic form. This division, our author thinks, is correct in a certain sense; for the disease varies much in duration,--running its course, sometimes in a few days; and at other times continuing several weeks. Yet, he continues, the terms acute and chronic must be understood as restricted to that particular form of inflammation producing a serous effusion, and not as denoting the highest and lowest degrees of common inflammation. It is from the want of this distinction that much confusion has arisen in our speculations relative to the pathology of hydrocephalus. Dr. AYRE calls our attention to the fact, that the forms of hydrocephalus denominated by Dr. GOLIS hyperacute and acute, do not differ from the sub-acute phrenitis of nosologists, in which pus and coagulable lymph are the proper products, with sometimes a serous effusion into the ventricles as an accidental effect; all of which forms of inflammation, the serous membranes of the brain, and of other cavities are liable to take on; and adds: "Now, the true hydrocephalus internus stands distinguished from these, in the nature of the inflammation of which it consists, in the same way, precisely, that the serous inflammation of the pleura, producing simple hydrothorax, is distinct from that higher degree of vascular excitement, which occasions an effusion of pus or lymph. Relatively to these, therefore, the disease is in a chronic form; and consists, we may repeat, of that lowest degree of inflammation to which serous membranes are subject, and the effect of which is to increase the natural secretion of the part, so as to cause, in regard to the brain, an accumulation of that fluid in its cavities." Dropsy of the brain is usually divided into three stages. In the first, continues our author, vascular excitement exists, as denoted by pain in the head increasing in acuteness with the increase of the disease; and in infants by a restless movement of the head upon the pillow, moaning, occasional screamings, sickness, retching, impatience of light and noise, contractions of the pupils, delirious terrors, &c. The second stage is indicated by signs of pressure on the brain by effused fluid, and by an absence of pain, excepting upon raising or moving the head, convulsions, permanent dilatation of the pupils, squinting, blindness, slow intermitting pulse, hemiplegia, and a peculiar placid expression of the countenance, &c. The third stage is made up of some of these symptoms, together with other ulterior ones which follow the vascular reaction. On this subject, Dr. A. offers the following remarks: "With respect, however, to the division thus formed of this disease, it is, I think, somewhat questionable, whether it be pathologically correct; for strictly speaking, the true disease is comprised between the incipient beginnings of the inflammation, and its termination by the effusion; since the symptoms which follow, and compose what are called the second and third stages, are little more than the consequences of the disease, and arise from the mechanical pressure of the water upon the brain. The progress, therefore, of what may be strictly considered the disease, should perhaps be considered as terminating with the occurrence of the effusion, which is often remedial of the excitement causing it; and the whole disorder, to be thus made up of two distinct states, the first consisting of symptoms, which commencing with the excitement, terminate with the serous discharge; whilst the second is composed of those of a secondary kind, and which are wholly dependent for their origin and continuance, on a mechanical pressure from the effused fluid." Hydrocephalus may occur, either as an idiopathic or symptomatic affection. As the first, it may arise, where there exists a predisposition in the brain, from various injuries inflicted on the head by slight blows;--from all the general causes of inflammation--from the sudden drying up of long established discharges--the sudden repulsion of cutaneous eruptions, or the imperfect evolution of that or other sanative actions of the system, at the close of some febrile diseases, usually denominated defect of crisis. When, on the other hand, the disease is symptomatic, it may arise from a particular cause seated within the head, or in some distant part of the body. The former variety is not common among children, and when it does occur, it is the result of some chronic disease, as a tumour or a thickened state of the arachnoid or other membranes of the brain, resulting from a former inflammation. "Sometimes, adult patients wholly recover from chronic or sub-acute inflammation, which induced the structural disease, and this last becomes, at some future period, the occasional cause of the hydropic one." At other times, the chronic inflammation continues, and finally extends to the serous membrane, giving rise to the effusion. "The most usual cause of the disease, however, particularly in children, is an irritation which is sympathetically communicated to the brain, from a disturbance in the chylopoietic organs; and particularly from a functional disorder of the liver. The cerebral disorder, to which a derangement in the digestive functions thus gives rise, is only one of those numerous effects which arise out of sympathies, subsisting between these organs and different parts of the system. In many cases, the same sympathetic irritation is successively and variously directed to different parts of the system. It will thus leave one organ or part, and suddenly move to another; and through the operation of causes, which are not always obvious, but which have a relation to some particular predisposition, inherent or acquired. In this way, an irritation may occasion an eruption upon the skin, and thence be translated to the bronchial lining, producing a cough; and next perhaps, to the serous tissue of the brain, exciting there a turgescent or congestive state of the cerebral vessels, by which symptoms are produced, through the pressure of the congestive vessels, that simulate those of hydrocephalus; or the true disease is brought on by an arterial re-action, ensuing upon the congestion, which is resolved by a serous effusion." Dr. GOLIS, from observing the marked connexion "between the turgescent state of the brain from chylopoietic disturbance, and its serous inflammation, has concluded, that it essentially pertains to it;" consequently, that "whenever it occurs, it is a part of it;" that it should be considered as forming the first stage of the disease, and that in all instances, it precedes the excitement. He has, for the same reason, constituted all the symptoms of the chylopoietic disease into the first stage of hydrocephalus. Dr. AYRE shows, however, that this state of turgescence, is not essential to the disease, and is only a sympathetic effect, which in the majority of instances, requires no treatment, (at least a very subordinate one,) other than that of the primary affection. He concludes his remarks on hydrocephalus, with the following words. "The cerebral turgescence and disturbance, therefore, in whatever degree they may exist, are only, when sympathetically produced, to be considered as morbid causes, whose presence, where the predisposition prevails, may lead to a serous inflammation of the tissues of the brain, but which do not form, in any sense, parts of the disease itself; since, under every degree of them, they are so frequently remediable, by means which are alone available, for the removal of their distant and sympathetic cause." Of _Hydrothorax_, Dr. AYRE very justly remarks, that, as its name imports and as defined by Nosologists, it consists of symptoms, which strictly speaking, pertain only remotely to the true disease--arising, as they do, from a certain disturbance given to the lungs, by the pressure of water upon them. They are only the symptoms, therefore, of the effusion, and as the excitement sometimes terminates with the occurrence of the serous discharge, its existence, in many cases, is discoverable only by its effects--there existing no signs, which clearly point out the presence of that state, previous to the appearance of the effusion; and what are usually called, by writers on the subject, premonitory symptoms, being only those of an inferior degree of the effusion which has already commenced. Like hydrocephalus, hydrothorax may be idiopathic or symptomatic; and proceed from a local or general cause--the nature of the inflammation being the same in both cases. It may likewise be divided into an acute and chronic form. When the disease is symptomatic, and arises from a local cause, it is generally chronic. When it arises secondarily from a disease of the lungs, our author thinks, that "The mode by which this state is induced in the serous membranes, is by the chronic inflammation that exists in the diseased organ extending to them; and not by the same form of inflammation being set up in them, by a certain sympathy or consent of parts, which, from a loose analogy, has been thought to subsist between similar structures." All diseases of the thoracic organs, are not equally prone to occasion effusion; some of these also, are only dangerous to life, in proportion to their disposition in occasioning such an effusion; whilst in other cases, if it occurs at all, the effusion is only the sequel of a disease essentially fatal. "To distinguish between these two conditions, is a desideratum pathology. Modern writers on pathological anatomy have prosecuted with considerable zeal and ability, their researches into the nature of the diseases of the organs within the chest, but they have done but little towards elucidating the true relation, which subsists between the diseases of the several viscera, and the serous effusions which take place into their cavities; for, by limiting their views to the disease which the _post mortem_ examination exhibited, they have overlooked those intermediate actions or states of excitement which connect the organic disease with such effusions." Whenever the excitement, producing hydrothorax, is idiopathic and independent of an organic disease of the lungs, heart, &c. its remote causes may be either of a general or local kind; and are the same which produce, when applied in a higher degree, or under different states of the system, the other forms of inflammation. The effusion may take place in those cases in which, the individual being predisposed, the inflammation, owing to some peculiarity in the cause, does not reach beyond its lowest grade; or in those in which the inflammation being high, and treated too late, or by insufficient means, a chronic form succeeds to the acute one, which may produce a watery effusion; or some structural disease remains and eventually becomes a cause of the effusion. The occurrence of this effect, in those latter cases, is sometimes attributed to a debility, resulting from the large depletion required in consequence of the severity of the previous inflammation. "That such opinions, however, are founded in error, may be shown from this, that the effusion, thus imputed to debility, does not occur sometimes, until some weeks or months after the period when the bleeding was employed; and although the debility is confessedly of a general kind, yet the effusion is local, and is precisely in the very cavity where the disease existed, which required the unjustly condemned evacuations. The truth of the matter is, that in such cases, either the depletory means have been employed in an insufficient degree, or too late." "The imperfect recovery of such patients from their first attack, and, which is attributed to the depletion, arises from the disease which is left by it, and to the injudicious means, perhaps, that are employed by the too anxious attendants, with the view of restoring the strength." Among the ordinary predisposing and exciting causes of the inflammation which produces hydrothorax, Dr. A. mentions a certain congestive or plethoric state of the circulation, which is brought on in some persons of particular habits, by indulging in the pleasures of the table, and taking little exercise. These cases are analogous to those occurring in the brain, and giving rise, by rupture, to a sanguineous apoplexy, or, by arterial reaction, inducing an effusion of serum. Dr. A. next proceeds to the subject of _ascites_, the symptoms of which he remarks are at first so obscure, that the disease is sometimes with difficulty detected. The remote causes of ascites may be either symptomatic or idiopathic, and either local or general. When symptomatic, it may be seated in some diseased viscus, as the liver, spleen, or in the mesenteric glands, &c. "To produce, however, a dropsical effusion into the abdomen from this cause, it is necessary that the disease of this viscus should be making progress; for, in its indolent state, or, in other words, if inflammation be not present in it, it is incapable from its mere bulk, as is commonly but erroneously supposed, of producing this effect." "Nor does the serous discharge always take place into the abdomen, in every case where these organs are morbidly affected, but only where their peritoneal covering participates in the disease; for the chronic inflammation in those cases, where it occasions ascites, does so by extending from the cellular tissue of the internal structure of the organ, to the serous tissue investing in it." "When ascites is an idiopathic affection, it may proceed from all the common causes of inflammation. The most frequent cause is cold, and which may act either locally or generally. When in the latter mode, the ascites is usually combined with anasarca, and the disorder generally comes on suddenly, and has a rapid progress. The vascular system is excited, and there is more than usual thirst; the blood when drawn exhibits the buffy appearance; and the urine, when subjected to heat, is found to coagulate strongly, from the large quantity of serum contained in it. In some of the severer cases, the effusion into the abdomen takes place very suddenly, and yet, by a copious bleeding the disease may be at once arrested, and the water be afterwards absorbed." Unlike what occurs in hydrothorax and hydrocephalus, the effusion in the present form of dropsy is of inconsiderable importance, compared to the visceral disease which is its remote cause. When, however, the accumulation becomes very considerable, the pressure of the fluid may affect the organs, and more particularly the peritoneal lining, which from the irritation induced in it, may take on a higher grade of inflammation, terminating in effusion of coagulable lymph or pus, and in death. The necessity which arises of tapping, where the effusion is very considerable, proves sometimes a farther cause, perhaps, of aggravating the disease of the affected viscus, and either of renewing or extending the hydropic excitement, or of converting it into a higher or more destructive form of inflammation. By most writers on dropsy, anasarca has been maintained to originate, in all instances, in debility, and to be curable only by a tonic and invigorating plan. It is true that some writers, especially among the ancients, (for we can hardly class PORTAL among the moderns,) have spoken of the disease as arising occasionally from a plethoric state of the circulation, and enforced the necessity, under these circumstances, of venesection. This view of the pathology of anasarca, although leading in many instances to a successful practice, was, however, vague and often unsatisfactory. To the late Dr. RUSH, and to Dr. PARRY, much credit is certainly due for their labours on this subject; but so far as we are informed, it was not until within a few years, that the subject was cleared of part of the obscurity in which is was involved, and that the disease, at least the active sort, has been referred to an irritation of the cellular tissue. Following up this opinion, and generalizing still more than the French pathologists, our author asserts that anasarca invariably consists in an inflammation of the cellular membrane of the body, with a serous effusion as its result. The accumulation, he continues, may be either idiopathic or symptomatic, and either general or local; occurring only under two forms, the one being of greater intensity that the other. In general, the disease derives all its importance from the nature of the remote cause. "When it is idiopathic and proceeding from cold, it is usually unimportant, for though the progress of the swelling be rapid, and the appearance of the disease formidable, yet it readily subsides under proper treatment, as the effusion proves in these cases, either partially or fully corrective of its cause; and little more, under such circumstances, is required in its treatment, than to promote the absorption of the water. In some cases of general anasarca, however, the disease is more severe; for sometimes the action of the heart and arteries is increased, the urine becomes loaded with serum, and there is thirst and other indications of general vascular excitement, similar to the state which was noticed, as producing effusion into the brain, or the other cavities of the body." In some cases, the serous effusion appears to be translated from one part to another. Our author very justly adds, however, that this translation is not of the serous fluid, but only of the serous inflammation giving rise to the effusion. It usually takes place from one portion of the cellular membrane to another; but sometimes from this membrane to the serous tissue of the brain, chest, or abdomen. Oedema of the feet and ankles is often symptomatic of chylopoietic disturbance, and particularly in young women, in whom the menstrual function is obstructed. In these cases, as well as in the oedema following gout or rheumatism, the swelling usually commences with considerable pain and stiffness of the parts, and hardness of the swelling. "But the most common form of anasarca is that which is symptomatic of some visceral disease; and which, as it ordinarily appears, arises from a state of the system that answers to the hydropic diathesis of systematic authors." This form of the disease begins in the lower extremities, and is rarely attended with strong signs of local excitement so obvious in anasarca of the idiopathic kind. Its occurrence has been referred to various causes. When combined with ascites, it is supposed to arise from pressure of the iliac veins by the fluid accumulated in the abdomen,--an opinion which our author combats by repeating, in great measure, the arguments we have already noticed. "But here let me observe, that the denial of ascites producing an anasarcous state of the legs, from the water compressing the iliac veins, must not be understood as implying, that a mechanical compression of a vein will not in other cases produce an effect of this kind. A pressure made on the brachial vein and its branches by scirrhous glands in the axilla, is a common cause of this state. The remote cause is here, indeed, of a mechanical kind, but not so the proximate cause of the effusion. By the resistance given, in this case, to the blood's return by the principal veins of the limb, a reaction is occasioned in the extremities of the arteries leading into the corresponding extreme branches of the veins, and which reaction is in this, as in a multitude of other occasions of congestive fulness in these vessels, a sanative effort of nature to overcome the primary obstruction." The disease has often been referred, when occurring under these circumstances, to a local and general debility; and this opinion is thought to be supported by the facts that the swelling is increased by a depending position of the limb, and diminished by a horizontal one--by the occurrence of an inflammatory state of the parts being incompatible with such a degree of debility, and lastly by the absence of preternatural heat on the surface of an oedematous part. To these pretended arguments, Dr. A. opposes, that the effusion cannot be attributed purely to debility; because the effects are in no correspondence with the assigned cause,--the debility being, in some instances of chronic and acute disease, very considerable, and the effusion small, and vice versa;--because anasarcous limbs will occur in the strongest individuals when the limbs have remained a long time in an erect posture,--because there is in certain fatal chronic diseases, a tendency in the lower limbs to take on an inflammatory action, often of an erysipelatous kind,--and because the fact of oedema increasing by an erect posture and diminishing in the horizontal one is readily explained by the greater congestion of the vessels induced in the limb by such a position, as it occurs in the higher grades of inflammation. "And with respect to the temperature of the surface of oedematous parts not being preternaturally raised, the objection, if of any force, must apply to all, for all have this peculiarity, and yet some cases of oedema confessedly arise from inflammation; differing not, in this respect, from several other morbid states, as those for instance, of chronic rheumatism, and which are indubitably, as indicated by the nature of their causes and remedies, of a truly inflammatory kind." Dr. AYRE, therefore, regards all these cases as secondary to a serous inflammation seated in a cavity; and lastly as arising from some disturbance in the digestive functions, by which this and other distant irritations are produced through the operation of that law of the animal economy, denominated sympathy. Having thus offered, in the preceding pages, an analysis of Dr. AYRE'S views of the pathology of the principal forms of dropsy, we must be allowed, before proceeding to the treatment of the disease, to make a few remarks. It appears to us that Dr. A. has treated the subject in a very able manner, and contributed greatly to remove many objections, that could be adduced against the opinion of the inflammatory nature of some of the more obscure cases of dropsy. We cannot help thinking, however, that he is too exclusive in his theories, and that he has rejected too positively the idea of a passive dropsy; in other words, of a dropsy independent of inflammation. Some cases of the disease which follow extensive losses of blood, (profuse uterine hemorrhages, for example) and which are cured by tonics and an invigorating diet, without the aid of diuretics, cannot always, though they may sometimes, be accounted for by admitting the existence of inflammation. Such instances have fallen under our own observations, and could not be explained by supposing that the effusion had relieved the inflammation; since there had not existed, at least as far as we could ascertain, any local inflammation. In one case it followed abortion, attended with profuse hemorrhage, and produced, not by disease, but by an accident. In the second and fifth volumes of the _Archives Générales de Médecine_, Dr. BOUILLAUD has related many cases of partial and general dropsy, which undoubtedly originated in obstruction to the venous circulation, from adhesion of the parietes of the principal veins. It is true that Dr. A. is compelled to admit this among the causes of dropsy; but faithful to his theory, he supposed the supervention of an arterial reaction resulting in an effusion of serum. It does not appear to us, however, that this arterial reaction is admissible in all cases of the sort, and we prefer on the whole the explanation of the mechanism of the effusion, originally given, by DONALD MONRO, and lately by Drs. BOUILLAUD and BROUSSAIS, who refer it to an obstruction in the venous circulation and to a consequent deficient venous absorption. By admitting this explanation, it is readily perceived, that we admit a passive dropsy, and we think the view well exemplified by a case which occurred last summer. The individual had recently recovered from a violent attack of disease, and was left much debilitated. Induced by this circumstance to travel to the north, he had occasion to notice that when seated long in a stage with his feet depending on the veins compressed, oedema invariably came on, and that it as invariably went off the next day if he did not ride. This occurred so often as to lead us to think there could not always be an arterial reaction occasioning the effusion, and that this effect arose from the mere obstruction to the venous circulation. In making these remarks we are not actuated by the desire of detracting from the merits of Dr. A.'s views of the pathology of dropsy; convinced as we are, that the great majority of cases of the disease, which are thought by many physicians to arise from debility, do not owe their origin to this condition of the system, but to an increased excitement of the membranes or cellular tissue. Were it otherwise, how could we account for the fact, that dropsy is generally _local_, whilst the _debility_ to which it is in most instances referred, is general? But whilst maintaining the correctness of many of Dr. A.'s views, we are inclined to the opinion, that he may do some injury to the doctrine he is advocating, by invariably making use of the word _inflammation_, to express that condition of the vessels, giving rise to an excessive secretion of serous fluid. We are ready to admit, and we dare hope, that few will refuse to do so, that _inflammation_, strictly speaking, will occasion such an effect; yet, it often happens, that effusion will occur in cases, where no inflammation can be detected. In such instances, the vessels are evidently in a state of increased excitement; or in other words, in a state of irritation, but not of inflammation, which always implies congestion. This latter morbid condition, may supervene on the irritation, and occasion a suppression of the serous effusion, and the formation of coagulable lymph or pus. It is true, it may be said, that both these states (irritation and inflammation) being an increase of the life of the part, and requiring the same treatment, may be designated by the same name. Nevertheless, to prevent confusion, and the quibbling of some of the opponents of the theory of inflammation in dropsy, we are inclined to believe, that it is better to substitute the word irritation, whenever there is merely an increased secretion, and reserve the word inflammation, to designate those cases, in which there are decided marks of local excitement and congestion, attended or not with general fever. Dr. AYRE, adopting the opinion of Dr. PARRY, regards some cases of local dropsy as an effect of a general hydropic diathesis, or of a general inflammatory action of the vascular system, occasioning a local excitement, ending in dropsy. This is a natural consequence of the views, entertained by many physicians in Europe and this country, that fever produces local inflammation. We must confess, however, that all Dr. A. has said on the subject, is not calculated to carry conviction to our minds. Thus, one of his reasons for regarding some cases, as arising from this general vascular excitement is, that they are produced by what he considers as a general cause,--as cold, for example. But cold produces local diseases, occasioning, and not preceded by, a febrile excitement; and if it can, and does occasion anasarca, who will pretend to assert, from its being a _general_ cause, that this anasarca is a general disease? Does not cold occasion also ascites, which, in many cases, is regarded by every one as a local disease, sometimes terminating in anasarca? If so, why shall we regard anasarca, ending in ascites, as a general disease? The cases are analogous, and the action in both should not be explained differently. If the action of such a cause were really general, and extended to all parts of the body, then the effects should also be general, and the dropsy should be universal, which is very far from being always the case. 2nd. It is also said in support of this opinion, that where anasarca is idiopathic, it is attended with fever, but that this latter does not exist, when the disease follows ascites. This difference appears to us to be very readily explained by the fact, that the disease in the former case, is more acute, and that the heart sympathises more actively with the irritated cellular tissue, than in the second case, when the disease is milder, or more gradual in its progress. 3d. It is also maintained, that when anasarca is idiopathic, there exists a large quantity of serum in the urine; and this is brought forward in order to distinguish these cases from local dropsies. But it is also admitted, that serum is found in the urine in cases of anasarca following ascites. Consequently, if there be none in cases of simple ascites, and if it only appears when anasarca supervenes, the only conclusion that may be drawn from these facts, is, that anasarca is the only form of dropsy, in which serum is absorbed, and passed off by the kidneys; and if there be a greater quantity discharged when anasarca is primary, it is only because the disease is more violent, and generally more extensive. But, surely all this is far from proving, that primary anasarca is a general disease, and owes its origin to a primary arterial excitement of the whole system. When fever exists first, and terminates in dropsy, who has proved, that there existed no local irritation producing the fever, and that the hydropic irritation has not supervened by metastasis. This takes place in scarlatina and other eruptive diseases, which Dr. A. would surely not be justified in calling general diseases. Dropsy follows the suppression of cutaneous diseases, unattended with fever; consequently, when there happens to be a febrile excitement, we are at a loss to know, why we should call this latter to our aid, in our explanation of the dropsical effusion, and not account for it on the same principle, as we did in the former cases; namely, by metastasis. If febrile symptoms are sufficient to make us regard a disease as general, then there is no local disease, except when apyretic. We now proceed to notice the mode of treatment, recommended by our author, for the different forms of dropsy. From what we have seen, it is natural to conclude, that as Dr. AYRE regards the proximate cause of the several forms of the effusion, or in other words, the _disease_, to be the same under all its conditions, he will be of opinion, that "the same general principles of treatment, are alike applicable to all--subject only to such modifications, as arise from differences in the nature and intensity of the remote cause, and those general or local relations of the parts implicated in the serous effusion, with the diseases of the organs, which incidentally produce it." Founding upon these views the indications of cure, he states them to be; 1st. To remove the visceral, or such other disease or state, which, when present, proves a remote cause of the effusion; 2nd. To remove the morbidly increased action in the serous membrane or tissue, which is its proximate cause. 3d. To promote the absorption of the effused fluid. Agreeably to Dr. A. the treatment of hydrocephalus internus, is divisible into three general heads: "The first, consisting of means to correct, with its causes, that turgescent state of the brain, which may produce the arterial re-action and effusion; the second, of those which shall subdue the excitement, when formed; the third, to correct or relieve, as far as it is practicable, the effects of the effusion, and procure, if possible, its absorption." With respect to the general causes, tending to produce that congestive state of the brain, precursory to its inflammation, he remarks, that they are of three kinds; 1st. Those acting through the general system, and consisting of an irritation, from some obstructed or required evacuation; 2nd. A local disease, seated in the head, or a local injury inflicted on it; 3d. Chylopoietic disturbance, acting sympathetically upon the brain. When the first of these causes appears to have been instrumental, in occasioning this condition of the brain, it is plain that it must be removed, and the obstructed emunctory corrected,--the suppressed evacuation promoted, or a new and artificial one substituted. When there exists any structural disease within the head, or a relic of a former state of excitement, a serous inflammation may be reasonably apprehended, and to avert it, the most rigid and undeviating attention must be paid to regimen, whilst cupping and leeching must be employed, and a seton fixed in the neck. "For the object of the treatment, in these cases, is not to remove, but to avert the inflammation, and which, from the strong disposition to it, conferred by the organic disease, can only be effected by avoiding, not merely the causes of inflammation, but likewise, all those agents, which are calculated, in any way, to increase the momentum of the circulation." "Beyond those, the common precautions against morbid irritations, little else can be done." When the turgescent state of the brain, arises from a disturbance in the digestive organs, it will be remedied, by means directed to this cause. Our author locates the primary seat of this disturbance, in most cases, in the liver; though he admits, it may occasionally be in the stomach and intestines. He places great reliance for correcting and increasing the secretion of bile, on small doses of calomel,--purging off the contents of the intestines by aperient medicines; and recommends, at the same time, the application of cups and leeches to the temples, as a measure of precaution. He very properly lays considerable stress on the necessity of combating this secondary affection of the head; "For though the means applied, to correct the disorder in the digestive organs, may be sufficient to remove the turgescent state of the brain, which arose from it, yet, those means will have little or no control over the excitement, which that turgescent state has created; and still less can they avail in subduing an excitement, that may even survive its remote cause, and continue independently of it. By overlooking these facts, much distrust and disappointment have arisen with many, who confided in the opinion, delivered by some writers, of the uniform prevalency of chylopoietic disturbance, as a cause of this disease, and of the sufficiency of calomel to remove it." When the inflammation exists, and is a sequel of some pre-existing structural disease in the brain or membranes, all that can be reasonably expected, is to _palliate_ it by the antiphlogistic plan; but when it is idiopathic it may readily be cured, by the same remedies, graduated to the age and strength of the patient and to the violence of the attack. Dr. A. seems to rely principally on cups and leeches;--not excluding, in some cases, bleeding from the arm. Blisters to the summit of the head and afterwards a cold evaporating lotion to the temples, are also recommended. As soon as, by these means, an impression is made on the disease, mild diaphoretic medicines, assisted by the tepid bath, or the pediluvium, maybe prescribed;--the bowels are to be kept open by small doses of calomel, followed after two hours by a draught of some aperient medicine,--the antiphlogistic regimen should be rigidly enforced, and light and noise carefully excluded. "Many practitioners give the mild preparations of mercury, and particularly calomel, freely in this disease, under a notion of its having some specific power in subduing it; but it never should be so used, excepting in cases where the disease is symptomatic of some functional disturbance in the liver and other chylopoietic organs, where it is calculated, in conjunction with the local bleeding, &c. to afford the most important service." With a view of pointing out some characteristic sign, by which to distinguish those cases in which the affection of the bowels is primary from those in which it is secondary, he remarks-- "The condition of the stools at the period when a child is labouring under the disease, will afford to such persons but an imperfect notion of its true nature; for the disturbance of the brain will often create a disorder in the secretions, both of the liver and the other chylopoietic organs, producing green looking stools; and there is often a congestive state of the brain for a short time preceding the full development of the idiopathic excitement, which may, in like manner, by reacting upon the liver, create a disorder there. In cases, however, which are symptomatic of this cause, the chylopoietic disturbance will be found to have existed several days or even weeks; and the origin of the disorder, in like manner, may be commonly traced to some irregularity of diet, or other obvious causes, and frequently in infants to those which are connected with premature weaning; and sometimes even the cerebral disorder itself will have been only the last of a series of effects in the system, to which such disturbance had given rise." Agreeably to Dr. A., it is not proper to discontinue those means, immediately upon the occurrence of what appears to be symptoms of effusion, since, frequently, these symptoms, as it respects the effusion, will immediately manifest their fictitious character, and disappear under a treatment no wise adapted to such a state, and with a rapidity, too, which equally betrays their true nature. He notices, though we believe not in its proper place, a modification of the disease in which the effusion takes place in the cellular membrane of the substance of the brain, and thinks this species more likely to be recovered from than when the water accumulates in the ventricles. He concludes this section by remarking, that "Of the means to be employed to promote the absorption of the water, under these or other circumstances of its accumulation in the brain, little satisfactory can be said. The treatment must be founded on the use of such means as shall avert the risk of renewing an inflammation in the organ. To this end, occasional blistering the head will be proper; the diet must be spare, and the several secretions, particularly those of the kidneys, must be cautiously promoted." We next turn to the treatment of hydrothorax and ascites. As the existence of hydrothorax in its early stage is difficult to ascertain, and as what have been called premonitory symptoms are only those proper to the mildest forms of the disease, and not of that condition of the parts which gives rise to the effusion, the treatment is somewhat difficult, and, in too many instances, our remedies are directed, not to the disease itself, but to one of its effects. Faithful to his view of the pathology of dropsy, Dr. A. remarks, that the plan of treatment to be pursued at an early stage of symptomatic hydrothorax, must consist in the use of those means which shall subdue the chronic excitement of the serous membrane, as well as the chronic inflammation of the diseased organ. To attain this end, the antiphlogistic and revulsive plans, graduated to the age and strength of the patient, and to the violence of the disease are recommended. In general the frequent application of leeches are held by Dr. A. as preferable to venesection, unless the patient be plethoric, and the disease arise from a local congestion within the chest, which, according to him, is often a cause of serous inflammation of the thoracic tissue, independently of any previous disease. Dr. AYRE calls attention to the fact, that topical bleeding is particularly adapted to correct that chronic inflammation of the serous membranes, which causes an effusion from them, and which is neither the result of any inflammatory excitement of the general system, nor of a nature to produce it; and that when properly conducted, it has the advantage of acting only slightly on the general system, and therefore only slightly on the general strength, and very considerably on the local disease. Together with leeches, blisters are to be used, and after the chronic action existing in the serous membrane is subdued by these means, a seton fixed in the integuments of the chest will be found of great utility. The same treatment will be found equally serviceable, not only to correct the chronic excitement existing in the peritoneal membrane and giving rise to ascites, but very commonly to cure or palliate the visceral disease producing it. In respect to the very common practice of resorting to mercury in this complaint, our author makes the following judicious remarks. "With too many practitioners, it is the practice to employ mercury freely in every case of abdominal dropsy, under the vague notion of there existing some mechanical obstruction in the liver or other viscus, as a cause of it; and under the equally vague notion, that mercury so employed will remove it. The practice, however, to speak of it in the mildest terms, is founded on erroneous views of the pathology of these diseases; and employed, therefore, as it is by some, on all the occasions in which they meet with them, must be frequently very injurious. For, independently of the injury to be inflicted by it, when given freely in some of the forms of liver disease, there is an effect produced by it on the urine, when given to a person in health, resembling that which arises from the specific excitement of dropsy. Under a salivation, the urine becomes charged with serum. Any condition of the system, therefore, approaching even to a state of salivation, must be injurious, by the tendency it must have to increase that morbid state of the body, which is nearest allied to the hydropic one. Hence the mercurial salivation has been numbered amongst the remote causes of dropsy; and the resemblance between the dropsical and mercurial excitement, thus established by the common resemblance of the urine in these states, goes far to prove this connexion; and it is not improbable, that the mercurial inflammation, when considerable, may survive its specific cause, and degenerate at length into the purely hydropic state. When, however, mercury is given in minute doses, so that these its specific morbid effects are not produced, it is capable of becoming highly useful, as we shall presently have occasion to notice." In conjunction with bleeding and other means just noticed, drastic purges have an important influence in subduing the disease; not merely by removing the water, but likewise by contributing to subdue the chronic excitement which occasions its effusion. This latter effect Dr. A. very justly refers to the counteraction and irritation these medicines excite on the mucous membrane of the bowels, by which the excitement of the serous tissue or of the diseased viscus is removed. He remarks that drastic purgatives are sometimes inadmissible in ascites, when an affection of the liver or mesentery is its remote cause, and there is a tendency to a spontaneous diarrhoea, which even the mildest purgatives would increase. "In the case of the mesentery, such a mode of treating dropsy would speedily destroy the patient." Dr. A. ought, perhaps, to have explained the real cause of the danger attending the practice, and not referred it merely to the tendency to diarrhoea, which itself can only be an effect of a morbid condition of the bowels. The fact is, that most cases of hepatitis, and all cases of mesenteric disease, are attended, whether as cause or effect we care not, with inflammation of the stomach or bowels, which purgatives can only tend to aggravate. In general, the practice of administering drastic purgatives is more serviceable in hydrothorax, and especially in anasarca, or in _idiopathic_ serous inflammation of the peritoneum. Dr. A. prefers the gamboge to all other medicines of the same class, and gives it to the amount of four or five grains in a single dose, with the same quantity of some aromatic powder, and triturated with a few crystals of the supertartrate of potassa; or in urgent cases of hydrothorax, he prescribes ten or twelve grains, divided into four doses, one of which is to be given every three hours. When the strength admits of it, the purgative may be given every four or five days. Dr. A. next notices diuretics. "The sensible operation of these medicines," he says, "as is well known, is to promote the secretion of the kidneys. There appears to me, however, to be farther effects produced by them upon the system, or particular parts of the system, which is not referrible to the mere evacuation of a certain quantity of fluid from the body; and these effects, it is probable, consist in promoting the natural discharges by this and, perhaps, the other emunctories, whose partial suppression may either produce this disease, or serve materially to continue it; and likewise in occasioning a derivation of blood to the kidneys, and therefore to a part distant from the morbid one; and that thus, whilst they are contributing materially to the removal of the fluid, they are serving like the purgative, an important end, in assisting to subdue the cause of it. The medicines which I am accustomed almost entirely to rely on in this disease, are the powder of dried squill and digitalis, given in combination in the form of pills, and in doses, which, from their smallness, will probably excite no little surprise in the minds of some of my readers. The dose of the squill is something less than a grain, and of the digitalis only a sixth part of a grain, given uninterruptedly every third or fourth hour." To render these medicines more effectual, a third or half a grain of calomel may be given nightly, and an infusion of dandelion, or some other popular diuretic, may be taken _ad libitum_. Our author speaks in terms of merited disapprobation of the practice pursued by some physicians, of allowing their patients daily, potions of gin punch, with the view of aiding the operation of the diuretic medicine, and supporting their strength. He shows, that, although by these means the water may be promptly evacuated, the disease is not cured, and the effusion is soon renewed with redoubled violence and danger to the patient. In the idiopathic form of hydropic inflammation, attacking the serous membranes of the chest and abdomen, and which, agreeably to our author, may be strictly local, or consist in a general specific excitement of the system, leading to a general watery effusion, the lancet is particularly advantageous, and should be had recourse to. The pulse is generally hard, the blood exhibits a buffy appearance, and the urine coagulates when subjected to heat. Leeches, in pretty large numbers, must also be used, as well as all the remedies already enumerated. But as in these cases, which according to Dr. AYRE are more common among females than males, and among the younger than those of middle and advanced age, the disease is of a more acute nature, a greater reliance is to be placed on an active antiphlogistic plan; and if this be steadfastly persevered in, comparatively little difficulty will be experienced in effecting a discharge of the water. When hydrothorax occurs after scarlatina, and is combined with anasarca, its course is generally rapid, and the cure difficult; partaking, as it often does, of the two-fold state of debility and excitement. When detected early, the lancet must be promptly used. Cups and leaches, followed by the warm bath, blisters, and cathartics, must also be resorted to. "Diuretics, which are so beneficial in the less acute forms of dropsy, are commonly too inert and slow in this, unless given in doses to act immediately upon the vascular system, when the infusion of digitalis, as given by many practitioners in all the other states of the disease, may be resorted to; since the treatment here is not so much to remove the water, as to prevent, if possible, its farther effusion; for when a discharge suddenly takes place into the chest after scarlet fever, it will generally prove fatal, even though the quantity collected be inconsiderable, and only such as would occasion, if gradually effused, a moderate degree of inconvenience to the lungs." In respect to tapping, our author remarks, that the circumstances calling for this operation are, where, from the very considerable accumulation of water, and the consequent distension it occasions, a permanent and morbid stimulus is given to the peritoneal membrane, by which its serous inflammation is perpetuated or increased; or where so much pain and irritation are produced, as to risk inducing a similar disease in the chest, and of bringing on likewise an ulcerative form of inflammation in the peritoneal lining of the abdomen. "Whilst the objections to its employment consist in the danger which is incurred, where there is much visceral disease, of its causing a destructive form of inflammation in the peritoneum; and the probability of its occasioning, under the most favourable condition of the disease, a more rapid renewal of the serous accumulation." Our limits not allowing us to enter on the treatment of ovarian dropsy, we proceed to offer a few remarks on the means recommended by Dr. A. for the cure of anasarca. As in the treatment of every other form of dropsy, it is necessary, in attempting the cure of anasarca, to advert to the nature and causes of the disease. "If it be idiopathic, and unconnected with any dropsy of a circumscribed cavity, and the pulse at the same time be soft, and the urine free from serum, it may be treated solely with the view of procuring the absorption of the effused fluid, as in such cases, the watery discharge in all probability will have removed, in a considerable degree, the excitement which caused it." It is in such cases that recoveries take place under almost any plan of treatment, and that bark and other tonics have been found beneficial. Their utility, however, in these cases is very limited, consisting only in aiding the removal of the effects of the disease, and keeping up the strength of the system, whilst the absorbents perform their function, and remove the fluid. Dr. A. recommends, in these cases, puncturing and bandages; but he very justly adds, that they must not be employed, whenever there remains any inflammation in the parts, as they would then tend to aggravate it. "To oedematous swellings, in which the serous local inflammation, whether symptomatic or idiopathic, still subsists, I am accustomed to direct the application of leeches and cold evaporating lotions, observing not to commence the use of the latter, until twelve hours after the leeches have been used, that inflammation may not be produced in the wound." "When anasarca arises from a general excited state of the system, as denoted by the pulse, and by the serous quality of the urine, venesection becomes necessary, combined with the use of leeches, applied to the extremities, or to those parts of the body, in which the serous tissues are most affected, along with the active use of the general means already alluded to." In anasarca, an error is sometimes committed, especially by young practitioners, of estimating the degree of danger, and the necessity for active treatment, by the single consideration of the extent of the oedematous swelling. This, however, should be guarded against, as the swelling may be very considerable, and the disease subsided, or of little consequence; whilst, in other instances, the reverse may be the case. In the first instance, where the disease is not seen early, the treatment must sometimes be limited to those means which promote the absorption of the water, and neither venesection nor leeches will be required. In such cases, the practitioner must be guided by the state of the pulse and urine; the presence or absence of vascular excitement; the history given of the case up to the period when visited, and particularly by the progress of the swelling. "When the dropsy of the skin is considerable and long protracted, and symptomatic of some visceral disease, as it most commonly is in these cases, and is attended by a serous state of the urine, and a general failure of the strength, the cachetical state of the system may be considered as established, and the treatment is then beset with difficulties. For the general means, which are useful in the earlier states of the disease, and when the vital strength is entire, become injurious in this, by the tendency they have, aided by the effects of the visceral disease, to diminish farther the vigour of the system; whilst, at the same time, the treatment, which is suited to support the declining strength, can contribute nothing towards lessening the constitutional and local diseases, but will frequently increase the morbidly excited state of the circulation, which, analogous to what occurs in diabetes, will continue and increase under the most decided marks of general constitutional weakness. Pending the continuance of that inflammatory state of the system, in which the urine is charged with serum, the debility will be mainly derived from that drain of its nutrient parts, which is thus established in the body, assisted by the weakening effects of the organic disease. If blood be drawn, it will be found, in many of these cases, to exhibit the usual signs of inflammation; and the treatment of the tonic kind, when employed to support the strength, will be found to act unfavourably. "The plan to be pursued must consist in the use of such means as shall assist the powers of digestion and assimilation; so that, by a highly nourishing but plain diet, the drain from the system may be somewhat counteracted; and, at the same time, the cause of the effusion is to be corrected by the use of local depletion and blistering, and by the temperate employment of those general means, which are useful in the less aggravated forms of the disease." The diet of patients, in the symptomatic forms of dropsy, should be plain and unirritating; and in the idiopathic states, the antiphlogistic regimen should be rigidly enforced; particularly an abstinence from all fermented liquors, until the inflammatory period of the disease be removed. The clothing should be moderately warm, and selected of that kind, best suited to promote the insensible perspiration of the surface. Before taking leave of Dr. AYRE, we cannot omit adverting, in a very few words, to a circumstance noticed in his preface, and which we think of some importance. He remarks, that if, in the prosecution of his task, he has had no acknowledgments to make to any individual as his guide and authority, he is nevertheless indebted for many important facts to the writings of the late Dr. WELLS, and of Drs. BLACKALL, ABERCROMBIE, and DUNCAN, jun. and particularly to the system of pathology of Dr. PARRY. He further remarks, that he entertained and taught for many years, the views advocated in this work, and that, after the manuscript had been sent to press, he had seen a copy of an abridged edition of the elaborate Dictionnaire des Sciences Medicales, in which the doctrine of dropsy, maintained in the larger work, is relinquished; whilst others are given in their place, conformable, in the main, with those which it is the object of his treatise to establish. Now it would appear, from these expressions, that Dr. AYRE wishes to inculcate the idea, that the English writers, whom he has cited, were the only ones who had published anything valuable, and conformable to his doctrine; and that prior to 1823, the year of the publication of the Dictionary above mentioned, the French entertained very different views of the pathology of the disease. We think it our duty, however, to rectify our author in this respect, and to show to our readers, that, even allowing full credit to Drs. WELLS, BLACKALL, ABERCROMBIE, &c. for their researches into the nature and treatment of dropsy, the American, French, and Italian pathologists are entitled to a much larger share than is allowed to them in the present work. A few references will be sufficient. Many years ago, our celebrated RUSH taught, that general dropsies "depend on a certain morbid excitement of the arteries;" and that hydrocephalus, "in its first stage, is the effect of causes, which produce a less degree of that morbid action in the brain which constitutes phrenitis." In 1812, Dr. BRESCHET, of Paris, published an excellent dissertation on active dropsies. In the early writings of BROUSSAIS, though more particularly in the propositions prefixed to his _Examen_, the opinion is maintained, that all active dropsies depend on irritability, either primary or secondary, of the serous and cellular tissues,--a theory more closely allied to Dr. A.'s, than all that is contained in the writings of Drs. WELLS, PARRY, &c. But what, perhaps, is more to our purpose, Dr. GEROMINI, of Cremona, published a work, in 1816, on the origin and cure of dropsy, in which he compares the dropsical accumulation to that of serum produced by the inflammation of a blister, or by fire; and in which he also maintains, that a slight inflammation occasions a flow of limpid serous fluid, whilst a higher degree gives rise to the formation of pus. From these circumstances, he concludes, that the hydropic fluid, which contains little albumen, is the product of a lower grade of inflammation. In the same work, he finally asserts, that in more than 200 individuals who had died of dropsy, he invariably found marks of inflammation or its effects; views which our readers will readily discover to be nearly allied to those supported by Dr. A. In making these remarks, however, we do not wish to be understood as asserting, that the theory advanced by our author did not originate also with him. We have too favourable an opinion of his honesty, to accuse him of plagiarism. Our sole intention has been to render unto each the degree of praise to which he is entitled, and, by pointing out this coincidence of opinion, to derive a further proof of the correctness of most of the pathological views, so ably defended in the present work. ARTICLE VIII.--_An Essay on Venereal Diseases, and the Uses and Abuses of Mercury in their Treatment._ By RICHARD CARMICHAEL, M.R.I.A. _With Practical Notes, &c._ by G. EMERSON, M. D. Philadelphia, J. Harding, 1825; pp. 360. One of the most important improvements in practice, which modern experience has established, is the reformed method of treating venereal diseases. To the labours of several distinguished military physicians and surgeons of Great Britain, we are chiefly indebted for the facts and researches connected with this interesting subject. And although we may have much to learn in regard to the true nature of these complaints; yet the plan adopted by Mr. CARMICHAEL, of determining their distinct pathological characteristics, and applying the remedies accordingly, is the only one likely to subvert the empirical routine of prescribing mercury on all occasions, a practice which derives such strong support both from the indolence and prejudices of the profession. In this country, many eminent practitioners have contributed to restrain the abuse of mercury; and it is believed, that Professor CHAPMAN has for many years, in his lectures, disseminated the most enlightened doctrines on this point. Dr. HARRIS and other surgeons of the navy have made a fair trial of the non-mercurial treatment, and with the most satisfactory results. The great object, so desirable of attainment, is to form a correct discrimination between the diseases, which may be cured or benefited by the exhibition of mercury, and those which do not require this medicine, or become aggravated by its use; for it seldom fails to do injury, when its advantages are not very obvious. Mr. CARMICHAEL has taken the most conspicuous part in this investigation for the last fifteen years, and from the extensive theatre, in which his inquiries were conducted, has had the best opportunities of arriving at the truth. He, therefore, who undertakes the management of these affections, may be justly pronounced culpable, if he neglect to make himself acquainted with the experience of this eminent surgeon. In this enlarged and improved edition of his work, several subjects have not been treated of so copiously by the author, as was requisite to render it acceptable as a book of reference; but the judicious notes of Dr. EMERSON, whose attention has been profitably directed to the investigation of venereal diseases, have well supplied the deficiency. A brief outline is here presented of the contents. The author describes the various symptoms in plain and intelligible terms; rejecting such unmeaning appellations as syphiloidal, pseudo-syphilis, &c. as designating no particular phenomena, and therefore of no use in describing a disease. He thinks there is a plurality of venereal poisons, and has divided the disease into four classes, from their different primary and secondary symptoms; making the eruptions on the skin the most certain criterion of distinguishing them from each other. These classes are:--the papular venereal disease; the pustular; The phagedenic; and the scaly venereal disease. The latter is the true syphilis. First, the Papular. This is the most common disease, and the most easily cured. Its primary symptoms are, a simple ulcer without induration, without elevated edges, and without phagedena. Sometimes there is a patchy excoriation of the glans penis, attended with a purulent discharge. This disease and gonorrhoea are caused by the same poison. The constitutional symptoms are:--fever; pain in the head, shoulders, and larger joints, pain in the chest; dyspnoea; a papular eruption on the forehead, chest, and back, sometimes extending in a more scattered way over the extremities. It is often attended with iritis. It never gives rise to nodes. The sore throat is different from that of syphilis; the latter having deep excavated ulcers. If buboes accompany it, they are mostly of an indolent nature. The eruptions do not all appear at once; but follow each other. When on the decline, they are of a pale red or copper colour, not scaly, as in syphilis, but papular; disappearing and recurring repeatedly, and ending in desquamation. _Remedies._--Venesection; cathartics; antiphlogistic regimen; antimonials, combined with decoction of sarsaparilla. Alterative does of calomel and antimonials, when the eruption declines. The local treatment consists in astringent washes and simple dressings. Iritis is to be cured by venesection, cathartics, mercury, blisters, and belladonna. This disease will yield to the powers of the constitution. Mercury is always injurious in the early stage. Second, Pustular venereal disease. Primary ulcer of a reddish-brown colour; borders closely on the phagedenic character. The edges raised and well defined; not excavated, but on a level with or above the surrounding skin. In the commencement, a small itchy pustula; distinguished from the ulcer attending the papular disease by its well defined and elevated edges, and by the absence of the smooth fungous surface of the former; from the phagedenic by its well defined margin and its corroded-like surface, and the absence of acute pain; and from chancre by the absence of the callous edges and base. These ulcers are of a chronic nature, showing little disposition to spread. The ulcers from buboes partake of the same character, the edges being hard and the ulcer disposed to burrow. These edges Mr. C. removes with the knife. The disease is rendered extremely obstinate, where full courses of mercury have been given. The more closely the eruption approaches the papular, the more mild and manageable will be the disease. _Constitutional symptoms._--The eruption is pustular, and often exhibits simultaneously new pustules; also scabbing ulcers, the crusts of which fall off, and leave discoloured patches of skin after healing. For these ulcers of the skin, the best remedies are, sulphur fumigations, nitro-muriatic acid baths, and ointment of tar and sulphur. _Remedies._--Rest; gentle astringents; mild ointments; antimonials and sarsaparilla:--for the constitutional symptoms; venesection; cathartics; antimonials; sarsaparilla. Mercury is decidedly injurious, until the disease is on the wane, when alterative doses may accelerate the cure. Third, Phagedenic venereal disease. The primary ulcer has a corroded appearance. It exhibits neither granulations nor induration. It spreads sometimes rapidly, sometimes slowly; healing in one part, while ulcerating in another. It is mostly situated on the glans and prepuce, and often attended with hemorrhage. In this disease, buboes most frequently appear. The sloughing ulcer occurs also in this disease. Mercury is extremely pernicious, always rendering the disease more inveterate and rapid in its progress. _Constitutional symptoms._--High fever precedes the eruption, but abates afterwards. Nocturnal headachs; tenderness of the scalp; slight dyspnoea; tenderness of the sternum on pressure; soreness of the chest; an eruption of tubercles, or pustules, or spots of a pustular tendency, which quickly degenerate into ulcers, with thick crusts, that heal from the centre, while they extend from the circumference, with phagedenic borders. The crusts are often of a conical figure. The ulceration of the throat is of the most formidable nature. It commences in the form of a small white aphthous sore; which usually attacks the velum or posterior part of the pharynx, mostly the latter. It extends rapidly, destroying the parts, and at last attacks the bones. It often attacks the larynx, after which, the patient seldom recovers. The affection of the bones of the nose is never joined with the papular eruption, nor with the scaly syphilitic lepra; but in every case with the pustular description, and when scales and ulcers were present. At the time of the eruption, pains in the knees, wrists, and ankles occur, attended with swelling and redness. He has never seen nodes in the disease, except in cases where mercury had been given. Full courses of mercury introduce the disease into the deep seated parts; for the bones are seldom or never affected in this disease, unless mercury has been given. _Remedies for the primary symptoms._--Absolute rest; venesection; nauseating doses of antimonials; warm poultices and fomentations; opium; hyosciamus and cicuta in sufficient doses to lessen pain and irritation. For the sloughing ulcer, stimulating applications are often useful; such as Venice turpentine or balsam copaibæ, mixed with olive oil. _For the secondary symptoms:_--Venesection; antimonials; sarsaparilla; Dover's powder. Mercury increases the ravages of the disease, except when on the wane, when it may be given in alterative doses, with safety and advantage. For the pain in the head, a blister to the nape of the neck. If the eruption appear scaly, then mercury is likely to be useful. If the throat and skin are affected, muriate of mercury in solution, and decoction of sarsaparilla. If the ulcer in the throat be small, touch it with the oxymel æruginis, or solution of nitrate of silver, grs. v a x to an ounce of water; but if there exist extensive ulcerations, fumigations with red sulphuret of mercury ought to be employed. Fourth, Scaly Venereal Disease, or Syphilis.--Primary ulcer of a circular form, excavated, without granulations, with matter adhering to the surface, and with a thickened edge and base. The hardening is very circumscribed, not diffusing itself gradually or imperceptibly into the surrounding parts, but terminating rather abruptly. Its progress is slow, sometimes assuming a tawny appearance. _Constitutional symptoms._--Sometimes the skin, at other times the throat, is first affected. There is headach, restlessness, and fever. The scaly eruption appears, but does not relieve the fever, as in the other diseases. This eruption commences with a small hard reddish protuberance; and as it advances, the sides are raised, and centre depressed or flat, and covered with thin white scales. It terminates in ulcerated blotches. This eruption appears on the forehead, breast, back of the neck, and groin; often in large copper coloured blotches, in parts near the hair. The ulcers of the throat mostly affect the tonsils, and come on without much previous pain or swelling; although there soon appears a considerable excavation of the tonsil, attended with evident loss of substance. The ulcer is foul, with thick white matter adherent to it, which cannot be washed away. The bones then become affected, those nearest the surface being most liable to attack; such as the tibia, sternum, clavicle, and cranium. The remedies for syphilis are full courses of mercury, for both primary and secondary symptoms; except where a tendency to phthisis, or a delicate constitution forbids them. He thinks syphilis a rare disease now, compared with what it was formerly. ARTICLE IX.--_Remarks on some Means employed to destroy Tænia, and expel them from the Human Body._--By LOUIS FRANK. M. D. Privy Counsellor of her Majesty, Maria Louisa, Duchess of Parma. [Lond. Med. Rep. April 1825.] The symptoms produced by the presence of tape worm in the human body, are exceedingly distressing, and the sufferings of the patient are increased, by the obstinacy, with which these animals resist the operation of the most disgusting, and even painful and dangerous remedies. Improvements in the mode of attacking and expelling them, therefore, should be gladly received, and widely made known. The numerous reports which we have received, concerning oil of turpentine as a remedy for tænia solium, have already given to that remedy the highest character; but many cases have been only partially relieved by it. The ol. tereb. seems to be capable of causing the separation and expulsion of portions of the animal; but while the head remains unexpelled, it is supposed to be capable of reproducing the joints, to a degree not yet ascertained. If we may believe medical writers, the tænia has been observed of the enormous length of 700 feet. It is probable that the reproduction, after the loss of large numbers of joints, is often very rapidly effected; as was the case in a patient treated at the Carey Street Dispensary, mentioned in their report for Aug. 1813,[18] This person always discharged very considerable quantities of joints or fragments, after the use of oil of turpentine; after which he remained free from the complaint for a few months, until the tænia recovered a troublesome magnitude; when it was again easily reduced to less uncomfortable dimensions. We are not able to state positively, how long the oil of turpentine has been in use as a remedy for tænia. The Carey Street Report for Feb. 1810, informs us, that a mechanic in Durham, having been very successful in the treatment of tænia by means of this article, the circumstance was communicated by Dr. SOUTHEY, of that place, to Dr. LAIRD of London; and it was accordingly prescribed in doses of [Symbol: ounce]ss. to [Symbol: ounce]ij. at several of the London charities. It had been found, says the report, that ol. tereb. might be thus given, as safely as so much gin, and frequently caused the expulsion in two hours: Dr. KNOX says it has been in use in Germany for fifty years for the expulsion of tænia. The experience of Dr. KNOX, concerning tænia, at the Cape of Good Hope, is the most extraordinary that we are acquainted with. Dr. SPARMAN, the traveller, had observed, that worms were exceedingly common in the northern parts of the colony; but Dr. KNOX, who was there in 1819, did not notice any special prevalence of verminous disorders, "previous to Oct. 1819, when the _tape worm became so general among the troops, as to resemble an epidemic_."[19] Most of these troops had been employed on a short campaign to the east of the great fish river. They had been compelled to live on very bad beef and mutton, driven and starved half to death; and Dr. KNOX thinks he has proved, that the tænia in these cases did "arise from the use of unwholesome animal food; from the flesh of animals, which had been diseased." Two out of five of the troops, who had been thus employed and fed, were affected with worms. Of a detachment of 86 vigorous, healthy young men, 36 were found, on inquiry, to have _tape_ worm. Those who remained in the colony did not suffer so much, as those who had been out on the campaign, the ratio being as one to four; whereas of the others, it was two to five. Dr. KNOX had ample experience of the utility of turpentine during this singular prevalence of tænia. Concerning the 36 men above mentioned, he says, "the cure of all, who chose to adopt the means, was easily effected by small doses of the spts. of turpentine, after the failure of purgatives and various other remedies." He considers ol. tereb. as the _most efficacious remedy_. He does not approve of large doses, because of headach, vertigo, and delirium, which have been produced by them in "many patients." "I have generally found," says he, "that from one to two drachms of ol. tereb., given in a little water, morning and evening, for three successive days, were sufficient to destroy the tænia solium, (even in the most obstinate cases,) and cause it to leave the intestines, without the aid of any purgative medicine." He advises, however, to give a little castor oil each day about noon. It has been a very common observation in regard to the dose of turpentine, that the patient suffers more cephalic distress when it is given in small quantity, than in a large dose. The writer of this has been obliged to desist from the exhibition of oil turpentine, in doses of [Symbol: dram]ij twice a day, in consequence of a vertigo so considerable, as to alarm and distress his patient very much. Perhaps there might have been in this case some peculiar liability to nervous excitation, which in another patient would not have been worthy of much notice. Dr. KNOX'S opinion is of great weight. The celebrated remedy of CHABERT, Dr. KNOX thinks, owes its efficacy to the ol. terebinth. combined with it. Dr. FRANK, whose name stands at the head of this article, was informed by the celebrated helminthologist, Dr. BREMSER, at Vienna, in 1814, that he had for ten years preferred the use of CHABERT'S remedy, and with invariable success. CHABERT was a veterinary surgeon of Alfort, who used the animal oil of Dippel in many diseases of animals, as well as those of men. This oil he often gave for the purpose of removing tænia in his animals. He often combined it with spt. terebinth. and gave equal parts of these substances, in doses of [Symbol: dram]i.[20] The London Medical Repository states, that CHABERT'S remedy is prepared from Ol. Corn. Cerv. Foetid. 1 part. Ol. Terebinth, 3 parts. These are well mixed, and left at rest four days; they are then distilled in a sand bath, till three-fourths of the liquor has passed over. It must be kept tightly stopped, out of the light.[21] The great objection to CHABERT'S remedy is its disgusting flavour; which is the more obnoxious, because the remedy must be continued for a length of time. Dr. FRANK cured two persons affected with tænia solium, after considerable perseverance with it: he cured two other persons with a preparation as follows: Ol. Terebinth. [Symbol: ounce]ss Æther Sulphuric. [Symbol: dram]ij Pulv. G. Arab. [Symbol: ounce]ss Aq. Flor. Chamam. distil. [Symbol: ounce]xvj _m._ Two spoonfuls morning and evening. Four of these mixtures were sufficient to cure the patients, who remained well two years afterwards. A fifth patient, unable to take the last named medicines, was cured by the boluses subjoined: Sem. Santonic. pulv. [Symbol: ounce]ss Pulv. Jalap. Ferri Sulphat. aa [Symbol: dram]i Ol. Corn. Cervi, gtt. viij. Syrup. q.s. Make 20 boluses. One to be taken morning and evening. These 20 boluses being repeated three times, the patient found himself perfectly well. In the above 5 cases, the tænia was discharged in fragments. Dr. FRANK does not say much concerning the bark of pomegranate root, which has come into vogue lately as a remedy for tænia. He refers to the Med. Chirurg. Transact. Vol. XII. for accounts by some English physicians, and remarks, that Dr. GOMEZ, the Portuguese physician, had cured 14 cases with this bark. Dr. POLLOCK (vide Ed. Med. and Surg. Journal, Oct. 1819) treated a child, aged 14 months, with the decoction of bark of pomegranate root, so far back as the year 1811. This infant, under the use of the medicine, discharged at several times upwards of 30 feet of tænia solium, and was cured. We learn also from the Med. Repository,[22] that MM. DESLANDES, SOURYA, and BOURGEOISE, have employed pomegranate with great success; that the decoction generally expelled the worm in two hours; that it sometimes occasioned vomiting and griping pains; and that it has been a common remedy for tape worm, in the East Indies, and among the blacks of St. Domingo. From the same source we are informed, that the French pharmaceutists recommend, before boiling the bark, that it should be allowed to swell (macerate) in cold water. [Symbol: ounce]ij of bark should be boiled in lbij of water to [Symbol: ounce]xii. Of this decoction, [Symbol: ounce]ij may be taken every half hour. The worm is here said to be passed often in twelve hours instead of two. It may be necessary to continue this plan four or five days, taking care to suspend the medicine, in case any vertigo, or intestinal disease supervenes. A dose of castor oil is recommended after the 4th bottle; even though the worm be happily for the patient expelled. In the Revue Medicale is a case, in which pomegranate succeeded in discharging three ells of tænia; but the patient broke off the worm in attempting to extract it with too much violence. This circumstance recalls us to the consideration of Dr. FRANK'S communication. He recommends much caution in the extraction of those portions of tænia, which have remained partly in the intestine; and says that Dr. CAGNOLA proposed touching the extruded portion with prussic acid, in hopes of killing the whole animal by means of this violent poison. Dr. GARLEKE adopted this plan on an extruded portion of four inches in length, and in one hour afterwards the _whole animal came away dead_. Dr. F. suggests, that the electric shock might weaken the tænia, so as to cause it to let go its hold, and thus be unresistingly extracted. BRERA recommended that the worm should be tied with a piece of silk. In this manner, it is retracted into the bowel, but begins to descend again not long afterwards. He dissuades from any attempt at forcible extraction, which excites the most distressing sensations in the bowels, and causes the risk of bringing on convulsions. We are informed by Dr. FRANK, that a surgeon of St. Petersburg succeeded by passing the worm through a canula, and the canula through the sphincter ani muscle, so as to obviate the resistance caused by its contraction. In this manner, he easily succeeded in withdrawing the tænia _whole_, which is always desirable. The writer of this article succeeded in removing many pieces of tænia from a female, by means of the tincture of black hellebore, given in doses of a teaspoonful for another object. The patient has since been affected with the same symptoms, and took to-day, Oct. 19th, in doses of [Symbol: ounce]iss, repeated every hour, sixteen ounces of a decoction of the rind of pomegranate fruit, (none of the cort. rad. being procurable); after which she took a dose of castor oil. It is said, we know not on what authority, in a French journal, that this preparation possesses the same powers as the root. It may be so; but this patient had no discharge of the tape worm, after swallowing the whole of this very astringent decoction, and following up the plan by taking [Symbol: ounce]iij of ol. ricini. Perhaps the tænia had been effectually destroyed before. She has seen none of the joints for 18 months. The accounts, however, of the expulsion of tænia by the bark of the root, are so encouraging, that we have much pleasure in recommending it to the notice of the medical public in this country. FOOTNOTES: [18] Ed. Med. and Surg. Jour. [19] Ed. Med. and Surg. Jour. July, 1821. [20] Dict. des Sciences Medicales. [21] There can be no particular benefit derived from the distillation. The simple mixture of the materials, above indicated, is all that is necessary. CHABERT'S remedy is therefore easily prepared. [22] Lond. Med. Repos. April, 1825. ARTICLE X.--_Researches Physiological and Pathological, instituted principally with a View to the Improvement of Medical and Surgical Practice._ By JAMES BLUNDELL, M. D., Lecturer on Physiology and Midwifery at the United Hospitals of St. Thomas and Guy. London, 1824, pp. 146, 8vo. Dr. BLUNDELL is the author of some celebrated experiments on the physiology of generation, and the transfusion of blood. The work at present under consideration consists of physiological observations and experiments, the substance of a paper read before the Medico-Chirurgical Society of London, in the year 1823, and not heretofore published; of experiments on a few controverted points, respecting the physiology of generation; and lastly, of some remarks on the operation of transfusion. The first part seems intended to ascertain what degree of lesion, or losses by extirpation, the body may sustain without inducing death; and thus, to open a way for improvements in surgery, by rendering the surgeon not only more bold and fearless, but more frequently successful in his attempts to preserve life, or counteract the inconvenient effects of disease and accidents. We shall make a short analysis of the first paper. In four experiments, Dr. B. removed the left kidney of the rabbit, by incision on the outer edge. Ligatures were applied to prevent bleeding. Two died; one in 60 hours, the other in 4-1/2 days: both of inflammation. One recovered, and lived 5 or 6 weeks, and then died. The 4th also recovered, but died in 5 or 6 weeks. On examination, a sac was found (in place of the kidney) filled with a semi-fluid substance, resembling custard, p. 4. In seven rabbits, removed the spleen. One recovered permanently, and one lived six months. p. 5. In five rabbits, opened the abdomen, and punctured the fundus of the bladder with a lancet. Three of them recovered entirely. p. 6. In two rabbits, cut off one-fourth of the bladder with scissors, having applied a ligature first. One died in seven months; the other still lives in good health. Into the peritoneum of four rabbits, threw [Symbol: ounce]i of human urine; then washed it out by injecting tepid water. One died of collapse in less than 24 hours, and two of inflammation, in 60 and 19 hours respectively. The fourth is now (12 months) in good health. p. 7. In seven, injected [Symbol: ounce]xi decoct. quercûs into the peritoneum. Only one recovered. Dr. B.'s inferences from the foregoing experiments are: 1st. "Large apertures into the peritoneum of the rabbit, do not immediately induce a dangerous prostration, of strength." p. 9. 2ndly. "Large apertures into the peritoneal sac of the rabbit, are not necessary, nor perhaps generally, productive of fatal inflammation." 3dly. "In the rabbit, the kidney, the spleen, and a large piece of the bladder may be extirpated, without necessarily causing death; though death under the first operation is probable." p. 10. 4thly. "When the abdomen is laid open, and parts are removed from it in the rabbit, the first danger arises apparently from collapse; the second from general inflammation; and the last from chronic disease." (Vide experiments.) 5thly. "The rabbit's abdomen is very tender, probably no less so than that of man." See exper. 6thly. "Success in abdominal operations on the rabbit, furnishes a presumption in favour of success in similar operations on the human abdomen; and, therefore, from these experiments, we may infer, _presumptively_, that moderate openings into the human peritoneum will not necessarily, nor even generally prove fatal from inflammation or otherwise; and further, that certain viscera or parts of viscera, not essential to the welfare of our structure, may be removed from the belly, without necessarily, or even generally, producing death. The extirpation of the kidney must be highly dangerous; but there is a presumption in favour of the successful removal of the spleen, the ovaries, or even of large pieces of the bladder." p. 11, 12. Dr. B. having stated the foregoing results and inferences, proceeds by relating instances of severe injury sustained by the _human_ body, without being followed by death. These are confirmatory of his inferences from the experiments on rabbits. The instances given are--an os uteri torn off; extensive laceration of the uterus and rectum in labour; four uteri extirpated on account of chronic inversion, (p. 13.) One of these last under his own care. It was removed by a wire, and came off in 11 days, without one bad symptom, (p. 14.) Rupture and laceration of the abdominal coverings, four fingers' breadth, the bowels hanging out, (p. 14.) Two spleens removed; one in a soldier after the battle of Dettingen, who recovered without inconvenience afterwards; the other in a Mexican, whose case is related by Dr. O'BRIEN, in his Inaugural Essay, Edinb. 1818, (p. 15.) Three cases of rupture of the dropsical ovary. Two cases of opening into the abdomen, for the extirpation of dropsical ovaries, (p. 18.) Five cases of laceration of the uterus by natural efforts. Four of the women died, but in the fifth, Dr. BLUNDELL turned and delivered, after the child had escaped into the peritoneal sac, and the woman recovered, (p. 20.) Cesarian operation, three times by friend of Dr. HAIGHTON; once successfully, (p. 22.) Dr. B. says, "From these (facts) few as they are, I feel conscious that no certain inference can yet be drawn; though _presumptive_ inferences certainly may, and they seem to me to be the following: "1st. Small wounds, as tapping, hernia, &c. do not induce fatal peritonitis; and therefore the vulgar opinion that inflammation in a spot of the peritoneum will almost invariably diffuse itself over the greater part of it, is probably unfounded. "2nd. Extensive divisions of the peritoneum are not necessarily fatal by inflammation or otherwise, and _probably_ not generally so. "3d. That the womb, spleen, and ovaries, may be removed in the mode mentioned, without necessarily, and, _presumptively_, without generally destroying life. "4th. That the gravid uterus may be torn open; the child may escape into the peritoneal sac; the os uteri may be torn off: not indeed, so far as these cases may be relied on, without great danger, but twice, in seven instances, without death. p. 28. "5th. The peritoneum and abdominal viscera will bear more injury than the British surgeons seem disposed to admit. "6th. That the above observations on the human abdomen, are in unison with those drawn from observations on the rabbit; and that observations made on the brute have more correspondence with those on the human being, than is generally believed." Dr. BLUNDELL next remarks, that the facts related create a suspicion that a bolder abdominal surgery would not be unattended with success, and recommends the following operations to "_consideration_ merely, and not to practice, except in otherwise desperate cases." 1st. "When the Cesarian section is performed, divide or remove a small piece of Fallopian tube, so as to prevent the danger of reimpregnation, without destroying the sexual propensity. The need for a second operation might thus be certainly prevented, without scarcely increasing the danger." 2ndly. "Extirpation of healthy ovaries." 3dly. "The extirpation of the ovarian cyst in scirrhus, combined with dropsy, or in simple dropsy." He remarks, "This operation will, I am persuaded, ultimately come into general use; and if the British surgeons will not patronize and perform it, the French and American surgeons will." p. 26. 4thly. "The removal of a large circular piece of the cyst in ovarian dropsy, when the sac itself cannot be extirpated." 5thly. "The removal of the cancerous womb, when the ulceration first makes its appearance. Might not the womb be taken out above the symphysis pubis, or through the outlet of the pelvis?" &c. 27. 6thly. "Extirpation of the puerperal uterus." He suggests the removal of the whole womb after the Cesarian section, in order that the smaller might take place of the larger and more formidable wound through the uterus--but says expressly, "No operation perhaps can be more unpromising, shall I say more unjustifiable, in the _present state of our knowledge_; but I thought it proper to mention it." &c. p. 28. 7thly. "Should the bladder give way into the peritoneum," he asks, "Why should we not lay open the abdomen, tie up the bladder, discharge the urine, and wash out the peritoneum thoroughly, by the injection of warm water?" p. 28. 8thly. - - - - - 9thly. Injection of astringents into the ovarian cyst or peritoneal sac, unjustifiable. 10thly. "In cases of strongly characterized introsusception," why not make an opening into the peritoneum; and "pass the small intestines, fold by fold, through the fingers." Dr. B. has repeatedly done this in the dog and rabbit, without producing death, or extensive and dangerous inflammation. 11thly. In the rabbit, he has tied an abdominal artery, and carried the end of the ligature with a broad needle out through the back, opposite to the place of the vessel. This ligature can come away, and is a better mode than to leave it hanging out at the abdomen, or entirely among the bowels, where it forms a sac of puriform matter, and to appearance lays the foundation of chronic disease. p. 30. Dr. BLUNDELL closes this paper by saying, that since the substance of it was read before the Medico-Chirurgical Society in 1823, Dr. RITZIUS, a Swedish physician, had informed him in London, "that the complete removal of the cancerous womb had been, to his personal knowledge, performed on the Continent five times. All the patients recovered from the operation," &c. "The womb was removed through the outlet of the pelvis." p. 36. Since we read Dr. BLUNDELL'S recommendations to the new operations, we have been astonished to notice in the Ed. Med. and Surg. Journal, July, 1825, that a German surgeon had actually treated a case of ileus in the manner recommended by Dr. B. It is from Hufeland's Journal of Feb. 1825. After it was ascertained that an immoveable introsusception existed-- "The patient was placed on a convenient table. We examined accurately the situation of the hardening, (_which marked the diseased part_), and determined on opening the abdomen at the outer edge of the right rectus muscle, about two inches above the navel. After dividing the integuments with a common scalpel, and making a small opening in the peritoneum, I introduced my finger, and with a blunt pointed scalpel divided the peritoneum, so as to make it correspond with the external opening, which was between two and three inches. I then besmeared my hand with oil, and carried it into the abdomen, in order to feel for the indurated part. Scarcely had I introduced my hand, than an attack of the pain came on, and a portion of the intestines was protruded through the wound, which was immediately replaced by my assistant. On continuing the examination, I discovered in a transverse portion of the ileum, a foreign substance, just where the hardened intestine was to be felt. I drew the intestine out, in order to examine it more minutely. The intestine was neither inflamed nor expanded, but it contained in its cavity a soft coherent and compact mass, which at its upper part was somewhat compressed, and thus felt harder than the rest. So far as I could follow this part of the intestine, this contained matter was to be felt: I also here immediately detected an intus-susception, but in spite of all my efforts I could not reach the commencement of it, so as to bring it out. Two modes of proceeding were open to me, in order to remove the intus-susception; either to make a transverse incision in the integuments, from the right to the left side, or to open the intestine itself. The last mode seemed to me the most adviseable, both because the patient was already very much exhausted, and because the operation would be sooner completed. The intestine was opened at the end of the discovered intus-susceptio, and immediately a part of the strictured intestine came into view. I introduced my finger into the opening in the intestine, which was made about two inches in length, and gradually pushed the intus-suscepted part back from the right to the left side, whilst I gently drew that part of the intestine which contained the intus-susceptio towards me. By this means I fortunately succeeded in unfolding the tangled intestine, which amounted to two feet in length. There was not the slightest trace of inflammation, nor any thing unnatural to be discovered in the part; there was merely a round worm, which was situated in the upper part of the intus-susceptio. The intestine was brought together by means of six spiral stitches, after the manner of the glover's suture, and the end of the silk was allowed to hang out of the external wound in the abdomen." The sutures were removed on the 8th day. On the 14th day, the man was cured, and continues well up to the date of the account. ARTICLE XI.--_An Inquiry into the Nature and Treatment of Diabetes, Calculus, and other Affections of the Urinary Organs._ By WILLIAM PROUT, M. D., F. R. S. _From the second London Edition, published in 1825; with Notes and Additions_, by S. COLHOUN, M.D. Philadelphia, Towar & Hogan, 1826; pp. 308. A very acceptable service has been done to the medical profession in this country, by the present republication of Dr. PROUT'S work on affections of the urinary organs. The American physician will now have it in his power, at a reasonable cost, to possess one of the best treatises on this interesting subject. From the known accuracy of Dr. PROUT as a chemist, and his reputation as an accurate observer of nature, much new light was naturally expected as the result of his observations. Nor indeed have these high expectations been disappointed. After a careful perusal of his work, we have formed the highest opinion of his powers, both as an original thinker, and experimental inquirer. Dr. PROUT begins his treatise with some introductory remarks on the composition of the urine, and on urinary derangements generally. After giving a comparative tabular view of the composition of the blood, and healthy and diseased urine, he proceeds to notice in succession, their principal constituents. As albuminous urine is of frequent occurrence in dropsical complaints, and its presence regulates in some degree the practice proper to be pursued, the following characters, given to it by Dr. PROUT, should be well understood. "Albuminous urine, on being exposed to a temperature of about 150° becomes opaque, and deposites this principle in a coagulated state. The precipitate varies considerably in its appearance in different instances. Sometimes it is of a firmer character, and similar to that formed by the serum of the blood, from which, in this case, it may be supposed to be derived; at other times it is very delicate and fragile in its texture, and somewhat resembles curd, when it may be supposed to be of chylous origin. In some instances, the effects of heat upon albuminous urine are increased by the addition of nitric acid. But the most delicate test of albuminous matter in general is dilute acetic acid, and the prussiate of potash." p. 6. Dr. PROUT combats very successfully the opinion, generally entertained by chemists, that the power of healthy urine to redden litmus depends on the presence of free lithic acid.[23] That this power cannot depend upon lithic acid uncombined, is made evident to Dr. P. by its sparing solubility; it requiring, according to our author, 10,000 times its weight of water to dissolve it, or six times as much as is stated by Dr. HENRY. The reddening power of the urine is attributed by Dr. PROUT to the presence of lithate of ammonia, and superphosphate of ammonia: the former of which, contrary to what might be expected, is found capable of reddening litmus, and of remaining in solution with the latter, without decomposition. The following interesting remarks are made by Dr. PROUT on the effects of muriatic acid, in precipitating lithic acid gravel: "The muriatic acid, in combination with soda and potash, occurs both in the blood and in the urine; thus appearing to pass through the kidneys unchanged. This acid and its compounds formerly appeared to be of less importance in a pathological point of view than any other similar principles existing in the urine: but since the unexpected fact has been ascertained, that muriatic acid in a free state exists abundantly in the stomachs of animals during the process of digestion, I have attended a little more closely to the appearance of this principle in the urine, and am disposed to believe, in consequence, that it is the cause of the precipitation of lithic acid gravel from the urine more frequently than any other acid. I do not mean to say, that it is the _immediate_ cause of the precipitation of this acid; for in most instances, it acts like all powerful acids do under similar circumstances, namely, by liberating the weaker acids, which are thus enabled to act in their turn, and separate those having still weaker affinities than themselves. Thus, in the present instance, the muriatic acid may be supposed to separate the lactic, while the latter precipitates the lithic, &c. If this opinion be well founded, as I believe is the case, the muriatic acid may be considered of very great importance, not only in a pathological, but a physiological point of view; for if the muriatic acid, found in the urine in such instances, be supposed to have its origin in the digestive organs, we see at once the reason why the deposition of gravel is so liable to be influenced by the derangements in general, and more especially by the acidity, of the stomach." "The muriatic acid may be shown to exist in the urine by the white curdy precipitate insoluble in nitric acid, which is formed, when the nitrate of silver is added to it, after the sulphuric and phosphoric acids have been removed by the nitrate of barytes or lead." pp. 20 and 21. After finishing these introductory subjects, Dr. PROUT proceeds to the consideration of the diseases of the urinary organs themselves; which he divides into functional, mechanical, and organic. Under functional diseases, we have _first_, those, in which principles _soluble_ in the urine are morbidly deranged in quantity or quality, embracing three chapters; and _secondly_, those affections, in which principles _insoluble_ in the urine are morbidly deranged in quantity or quality, comprising six additional chapters. Under the first subdivision, the first chapter is on the affections, characterized by albuminous urine; the second, on diseases, in which an excess of urea is the characteristic symptom; and the third, on diabetes. The diseased derangement, consisting in an excess of urea in the urine, has not been particularly noticed by any writer before Dr. PROUT, who believes that it has probably been confounded with that form of diabetes, called diabetes _insipidus_. The state of the urine and symptoms in this species of urinary derangement are thus described by our author: "The average specific gravity of the urine seems to be a little above 1.020, and occasionally to vary from 1.015 to 1.030. Most generally it is pale, but occasionally it is high coloured, and exhibits somewhat the appearance of porter, more or less diluted with water; and this variety in appearance not unfrequently takes place in the urine of the same person. When first voided, it reddens litmus paper. For the most part, it is entirely free from sediment, except the mucous cloud of healthy urine; and the only remarkable property which it appears to possess, is that of containing abundance of urea; so that on the addition of nitric acid, crystallization speedily takes place. From the quantity of urea present, it is very prone to decomposition, and soon becomes alkaline, especially in warm weather. "There is almost constantly in these diseases, a frequent and urgent desire of passing water both by night and day. This desire is for the most part evidently excited by actual _diuresis_, or the increased quantity of urine; but frequently it cannot be ascribed to this cause, as the quantity voided at one time is often by no means considerable; though in almost every instance that has fallen under my observation, the total quantity voided during any given time has appeared to be greater than natural. The quantity appears also to be particularly liable to be increased by cold weather, and by all causes producing mental agitation. There is sometimes a sense of weight or dull pain in the back, but this is by no means a constant symptom. There is also occasional irritation about the neck of the bladder, which sometimes extends along the urethra. The functions of the skin appear to be natural; at least in every case which has come under my own observation, perspiration has been rather easily induced. The pulse is not affected. There is no remarkable thirst, nor craving for food, except in extreme cases; nor are the functions of the stomach and bowels much deranged. Hence for the most part the tongue is clean, and the dejections regular and apparently natural. "In most of the cases of this disease, which have hitherto fallen under my own immediate observation, the subjects have been middle-aged men, of thin and spare habit, with a sort of hollow-eyed anxiety of expression in their countenance, free from gout and constitutional disease in general, and, as far as could be ascertained, from any organic defect in the urinary organs. In every instance they had been induced to apply for medical advice, not so much from the pain, as from the inconvenience of the disease, and the dread of its ending in something worse; and, what may be worth remarking, in several instances confessed, that they had been addicted to masturbation from very early youth," p. 41, et seq. The remedy for this morbid derangement in the urinary secretion, most successful in the hands of Dr. PROUT, was opium, either administered alone, or in conjunction with alkaline medicines. It is rather a rare affection. When not arrested, it is liable, according to Dr. PROUT, to pass into diabetes. In his chapter on diabetes, our author makes many interesting remarks; but the space we are enabled to devote to this analysis, will permit us only to make an extract, which seems to prove a close connexion between the disease characterized by an excess of urea, and diabetes. "It has been mentioned in the preceding pages, that an excess of urea frequently precedes the appearance of saccharine matter in the urine. Now it is a remarkable fact, that in diabetes, in proportion as the saccharine matter diminishes, that of urea generally increases; and in such instances, the presence of the former principle can not only be no longer distinguished by the sensible properties of the urine, but scarcely be demonstrated by the utmost skill of the most experienced chemist, though the specific gravity of the urine may at the same time be nearly 1.040. I have recently been favoured by Dr. ELLIOTSON with the most complete and remarkable change of this description that has yet occurred to me. The patient, besides being diabetic, was in the last stage of phthisis, of which he died shortly afterwards. The quantity of urine passed daily, when I first examined it, was six or eight pints; its specific gravity was 1.038, and it contained a large proportion of very white sugar and very little urea. Dr. ELLIOTSON under these circumstances gave opium, beginning with gr. i, and increasing the dose to gr. iii, thrice a day. The opium produced stupor, and was obliged to be discontinued; but the effects produced upon the urine by its means were most remarkable. _In about 60 hours, the quantity of urine diminished to two pints, its specific gravity was reduced to 1.0174, the saccharine matter had apparently disappeared, and was superseded by urea, the quantity of which had become excessive._ This alternation of a principle containing nearly half its weight of azote, with another containing no azote at all, is perhaps, one of the most singular facts occurring in physiology." p. 74. The second subdivision of functional urinary diseases comprises six chapters: _first_, on urinary gravel and calculi; _second_, on the data, showing the comparative prevalency of different forms of urinary deposite, and the order of their succession; _third_, on the lithic acid diathesis in general; _fourth_, on the mulberry or oxalate of lime diathesis; _fifth_, on the cystic oxide diathesis, and _sixth_, on the phosphatic, or earthy diathesis. Under the first chapter, we have an account of I. Pulverulent or amorphous sediments; II. Crystallized sediments, or gravel; and III. Solid concretions, or urinary calculi. Of the latter, our author enumerates thirteen species. 1. The lithic acid calculus. 2. The lithate of ammonia calculus. 3. The oxalate of lime, or mulberry calculus. 4. The cystic oxide calculus. 5. The bone earth, or phosphate of lime calculus. 6. The triple phosphate of magnesia-and-ammonia calculus. 7. The calculus, composed of a mixture of the phosphate of lime, and triple phosphate of magnesia-and-ammonia, or fusible calculus. 8. The alternating calculus. 9. The mixed calculus. 10. The carbonate of lime calculus. 11. The xanthic oxide calculus. 12. The fibrinous calculus. 13. The prostate calculus. Of these, the 2nd, 4th, 5th, 9th, 10th, 11th, 12th, and 13th species are more or less rare, and consequently of less interest. The remaining 5 are of much more frequent occurrence, and are thus described by our author: "_The lithic acid calculus_ is generally of a brownish-red, or fawn colour; but occasionally of a colour approaching to that of mahogany. Its surface is commonly smooth, but sometimes finely tuberculated; and upon being cu t through, it is usually found to consist of concentric laminæ. Its fracture generally exhibits an imperfectly crystallized texture, sometimes an amorphous or earthy one, in which case, it usually contains a mixture of other substances. This is one of the most common species of calculi.--_Chemical characters._ Before the blow-pipe, this calculus blackens, emits a smoke having a peculiar odour, and is gradually consumed, leaving a minute quantity of white ash, which is generally alkaline. It is completely soluble in caustic potash, and precipitable again by any acid in the form of a white granular powder. Lastly, if to a small particle, a drop of nitric acid be added, and heat applied, the lithic acid is dissolved; and if the solution be evaporated to dryness, the residue assumes a beautiful pink or carmine colour." "_The oxalate of lime, or mulberry calculus_, is generally of a very dark brown colour, approaching to black. Its surface is very rough and tuberculated (hence the epithet of _mulberry_.) It is usually hard, and when cut through exhibits an imperfectly laminated texture. This species of calculus seldom surpasses the medium size, and is rather common. There is a variety of it remarkably smooth, and pale coloured. These are always of small size; and from their colour and general appearance, have been termed the _hempseed_ calculus.--_Chemical characters._ Before the blow-pipe, this species of calculus expands into a kind of white efflorescence, which, when moistened and brought into contact with turmeric paper, stains it red. This white alkaline substance is the caustic lime deprived of its oxalic acid." "_The triple phosphate of magnesia-and-ammonia calculus_ is always nearly white; its surface is commonly uneven, and covered with minute shining crystals. Its texture is not laminated, and it is easily broken and reduced to powder. In some rare instances, however, it is hard and compact, and when broken exhibits a crystallized texture, and is more or less transparent. Calculi composed entirely of the triple phosphate of magnesia-and-ammonia are rare; but specimens, in which this salt constitutes the predominant ingredient, are by no means uncommon.--_Chemical characters._ Before the heat of the blow-pipe, this calculus gives off the odour of ammonia, and at length melts with difficulty. It also gives off ammonia, when treated with caustic potash. It is much more soluble than the preceding species in dilute acids, from which it is again readily precipitated by ammonia in its original crystallized form. "_The calculus composed of a mixture of the phosphate of lime and triple phosphate of magnesia-and-ammonia, or the fusible calculus_, is commonly whiter and more friable than any other species, resembling sometimes a mass of chalk, and leaving a white dust on the fingers. This species is generally not laminated. Occasionally, however, it separates readily into laminæ, the interstices of which are often studded with sparkling crystals of the triple phosphate. The variety of this species which is not laminated often acquires a very large size, and assumes the form of a spongy friable whitish mass, evidently moulded to the contracted cavity of the bladder in which it has been formed. This species of calculus occurs very frequently.--_Chemical characters._ It may be readily distinguished by the ease with which it melts before the blow-pipe. It also dissolves readily in acids, and particularly in dilute muriatic acid; and if to the solution, oxalate of ammonia be added, the lime is precipitated alone, and the magnesium may be afterwards separated by the addition of pure ammonia. "_The alternating calculus_, as the name imports, may consist of different layers of any of the preceding species. Hence its general appearance, texture, &c. will depend entirely on the composition, and may be very varied. Most commonly it is composed of a lithic acid or mulberry nucleus, and an external crust of the fusible calculus. In some rare instances, it is composed of laminæ of all three of these substances, and sometimes of even more--the mixed phosphates still continuing to constitute the external crust. This species of calculus often acquires a very large size and is very common.--_Chemical characters._ The chemical characters must of course vary with the composition; and as the different substances of which it is composed must almost certainly be some of the preceding, the nature of the different laminæ can be readily ascertained by what has been already stated," p. 79, et seq. In the chapter on the comparative prevalency of different forms of urinary deposite; and the order of their succession, we have a number of important facts and observations. Dr. PROUT calculates, from the data collected by him, that about one-third of the urinary calculi which occur, are of the lithic acid species, and that another third are formed on a nucleus of this acid. Hence, "we may assert," says he, "that at least _two-thirds_ of the whole number of calculi originate from lithic acid; that is to say, if a lithic acid nucleus had not been formed and detained in the bladder, two persons at least out of three, who suffer from calculus, would have never been troubled with that affection. This is a most important fact, and deserves to be constantly borne in mind." The relative prevalency of the oxalate of lime calculus is very various. The average proportion, as determined by Dr. PROUT is about one in seven. Of the calculi, examined by Mr. BRANDE, 1 in 25 was of the mulberry species; while in the Norwich and Guy's Hospital collections, the proportion is about 1 in 4. In the Bristol collection, one-sixth of the whole, was composed of oxalate of lime, nearly pure; while, including all the concretions containing more or less of the oxalate, the proportion was nearly _one-half_! This great disparity in the proportional frequency of this calculus in different districts of England, clearly shows the great influence of local causes, in determining the character of urinary concretions. From a careful observation of the order of deposition of different species of calculous matter, Dr. PROUT has been enabled to deduce the following general law; "_that, in urinary calculi, a decided deposition of the mixed phosphates is not followed by other depositions_." So that it would appear, that a redundancy in the earthy phosphates is the last link in the chain of diseased alterations, to which the urinary secretion is liable. In the third chapter, under the second subdivision of functional urinary diseases, Dr. PROUT describes the lithic acid diathesis, and communicates several important original observations. After remarking that the dyspeptic are particularly predisposed to lithic acid deposites, he enumerates, as exciting causes of this species of gravel, 1st. _Errors in diet_; 2nd. _Unusual or unnatural exercise of the body or mind, particularly after eating, and the want of proper exercise at all other times_; and 3d. _Debilitating causes_. Under errors of diet, an unusually heavy meal, especially of animal food, and the use of heavy, unfermented bread, or compact, hard-boiled, fat dumplings or puddings, salted and dried meats, acescent fruits, malt liquors, and acescent wines, are enumerated as particularly hurtful in the lithic acid diathesis. The above remarks refer to the amorphous lithic deposites, consisting of lithate of ammonia. In regard to crystallized sediments, or, more properly speaking, gravel, our author makes the following remarks: "Crystallized sediments, or red gravel, consist of lithic acid, nearly pure. Lithic acid, as has been before stated, exists in a state of combination in healthy urine; and in such a proportion, as to be held in a state of solution at all ordinary temperatures. Sometimes, however, a free acid is generated by the kidneys, which precipitates the lithic acid in the pure crystallized state we see it--a phenomenon easily imitated artificially, as is well known, by the addition of a few drops of any acid to healthy urine. The precipitation of crystallized lithic acid does not, therefore, necessarily indicate an excess of lithic acid in the urine, but the presence only of some free acid in that fluid; though such an excess does, for the most part, exist in this form of disease, as will be shown hereafter. With respect to the nature of the precipitating acid, it is probably not always the same. Most generally it appears to be the _muriatic_, sometimes the _phosphoric_ or _sulphuric_, and occasionally other acids. In general, however, it is to be understood, as noticed elsewhere, that when the mineral acids are present in excess, these are the _immediate_ cause of the preternatural acidity in the urine, and consequently of the precipitation of the lithic acid. The stronger acids act by decomposing saline compounds, into which destructible acids, such as the lactic acid, &c. enter, and setting them free. Hence the _immediate_ cause of the deposition of lithic acid gravel is generally a destructible acid of very weak powers: even, perhaps, in some instances, the carbonic acid. When the urine contains a free acid, it is commonly more transparent than usual, and of a bright copper colour." p. 112. The treatment recommended by Dr. PROUT in this species of gravel is as follows: First, a strict attention to diet, avoiding the hurtful articles already enumerated. Secondly, the use of _alkaline_ remedies; but those must not be depended upon, without the aid of other means, more especially of alteratives and purgatives. Accordingly we are informed that "The pil. submur. hydrarg. comp., or a pill composed of the pil. hydrarg. and pulv. antimonialis, may be taken twice or thrice a week at bed time, and followed up the next morning by an active dose of the sub-sulphate of magnesia, or a mixture of Rochelle salts and magnesia, or carbonate of soda. A little of either of these compounds may be also taken twice or thrice in the day, so as to keep the urine constantly neutral or alkaline, and the bowels freely open; or gr. x to xx of magnesia may be taken for the same purpose in a glass of soda water, as often as it may be found necessary." In the chapter on the mulberry, or oxalate of lime diathesis, Dr. PROUT gives a number of cases, from which he draws the following conclusions: "1st. That this form of disease occurs in both sexes; that it may exist before puberty, and at all ages between that and 40 or 50, at which time it seems to occur most frequently; but that no case occurs beyond the age of sixty. Hence that it is probably not a disease of old age. "2nd. That it is not incompatible with gout, but seems occasionally to be associated with it. I have also seen it connected, as lithic acid frequently is, with a tendency to cutaneous disease. "3d. That this variety of calculous affection occurs in individuals of sound constitutions, and who ordinarily enjoy good health; and that it rarely occurs a second time, except at long intervals, during which the intermediate health is good; which latter facts, it may be proper to observe, are confirmed by other observers, and particularly by Mr. BRANDE and Dr. MARCET. "4th. That the urine is acid, and apparently but slightly deranged in this form of calculus, and remarkably free from all sorts of sediment and gravel. "5th. That as renal calculi of the oxalate of lime often subsequently acquire considerable magnitude in the bladder, it may be inferred, that the formation of this compound is connected with a distinct diathesis, excluding the existence of other diatheses, and that is not an accidental occurrence, happening in common with many others to the urine. "6th. That from the dissection of calculi, formerly mentioned, it appears that the oxalate of lime diathesis is preceded and followed by the lithic acid diathesis; a circumstance which seems to be peculiar to these two forms of deposite, and which, when taken in conjunction with the other circumstances, already related, appears to show, that they are of the same general nature; or in other words, that the oxalic acid merely takes place as it were of the lithic acid, and by combining with the lime naturally existing in the urine, forms the concretion in question. "7th. That the diathesis being of a similar nature, the principles of treatment adapted for counteracting the original tendency to it must be also similar, that is to say, of an antiphlogistic character; great attention being at the same time paid to the digestive and assimilative functions." p. 137, et seq. The diagnostic signs of the oxalate of lime diathesis are very obscure, as will appear from the following extract: "With respect to the means of determining when this diathesis is going on in the system, I am sorry that I can give but little positive information. The absence of urinary sediment, &c. are of a negative character, and lead to no inference, where other circumstances are wanting, as is most generally the case. But if there be pain in the region of the kidney, and other symptoms of gravel, without any appearance of sediment; and if the urine be acid, and of the yellow tint above alluded to, the stomach deranged, and an inflammatory diathesis, either general or local (i.e. about the urinary organs), be present; and if all these are associated with suppressed gout, or tendency to cutaneous disease,--the existence of this form of the disease may be suspected, and means immediately taken to counteract it." p. 138. We omit any analysis of the next chapter on the cystic oxide diathesis, on account of the rare occurrence of this state of the system. The next chapter of our author is on the phosphatic, or earthy diathesis. The phosphatic deposites are of two kinds; the _crystallized_, consisting almost invariably of the triple phosphate of magnesia-and-ammonia, and exhibiting the appearance of white, shining crystals; and the _amorphous_, consisting always of a mixture of the phosphate of lime, and the triple phosphate of magnesia-and-ammonia. The causes apt to produce a deposition of the triple phosphate of magnesia-and-ammonia, are thus enumerated by Dr. PROUT: "Any thing acting generally, and producing _a nervous state of the system_, such as the distressing passions, and particularly _mental anxiety_ or _fear_, will frequently produce in many people an excess of this salt in the urine. The same is also true of many articles of food or medicine that produce a hurried secretion of the urine, and act as diuretics; as the neutral salts in some cases, and particularly the Rochelle salts and other saline compounds, in which the acid is of vegetable origin. So also, a long continued use of alkaline remedies, or of mercury, in irritable habits more especially, will likewise produce a tendency to an excess of this salt, as well as of the phosphates in general, and even lead to an actual deposition of them from the urine. The same sediment also frequently abounds, or is easily induced, in the urine of those who have long been in bad health, and in whom the constitution may be considered as giving way, or, to use a common expression, breaking up. In general, it is to be understood, that the slighter causes affect only the predisposed, and those in particular who are subject to other diseases of the urinary organs or urine. It may be also remarked, that children are more subject to this form of deposition than adults; a circumstance, perhaps, to be referred to the irritability of the system at this age, and the great derangement of the digestive organs, to which they are subject." p. 151. The above mentioned causes are stated to be equally productive of amorphous phosphatic sediments. Our author next enumerates the very distressing symptoms, by which the deposition of the earthy phosphates is attended. They consist in great irritability; derangement of the chylopoietic viscera, evinced by flatulency, nausea, obstinate costiveness, or peculiarly debilitating diarrhoea; extremely unnatural stools, nearly black, or clay-coloured, and sometimes resembling yest; pain, uneasiness, or weakness in the back or loins; sallow, haggard expression of countenance; and finally, if the disease be not arrested, great languor and depression of spirits, coldness of the legs, and complete anaphrodisia, as occur in diabetes. A curious and important fact has been stated in regard to the remote causes, producing the phosphatic state of the urine. It has been observed by Dr. PROUT, that a large proportion of cases of this complaint may be traced _to some injury of the back_ from mechanical violence, such as a fall from a horse, &c. The remedies for this diseased state of the urine, found most successful by Dr. PROUT, are,--opium, in from one to five grain doses, repeated two or three times a day, until the unnatural irritability of the system is relieved,--the same remedy in more moderate doses, in conjunction with the mineral acids, cinchona, uva ursi, and the different preparations of iron,--a large pitch, soap, or galbanum plaster to the loins,--and setons or issues in the back, when the disease manifestly arises from local injury. With respect to the bowels, Dr. PROUT remarks, that they are very difficult to regulate. He has occasionally seen serious consequences to arise from the exhibition of a small dose of calomel, such as diarrhoea and debility, much aggravating the disease, and endangering the life of the patient. For the regulation of the bowels, small doses of castor oil, and laxative injections are most to be relied on; while saline purgatives, more especially Rochelle salt and Seidlitz powders, as containing vegetable and therefore destructible acid, must be avoided.[24] Mercury, in all its forms, is also inadmissible. "Alkaline remedies of every description, must be most carefully avoided, their use in every point of view being most mischievous when the phosphates are concerned. Indeed all remedies that act as diuretics should, in general, be shunned, and the patient should be prohibited from drinking too much. With respect to drinks, in general, they should be of a soothing, demulcent character, and prepared with distilled or the softest water that can be procured; as hard waters are literally poison in this form of disease." The second division of the work under review treats of the mechanical and organic diseases of the urinary organs. This portion of the subject is handled with the same ability as the first. We regret, however, that our space will not permit a further development of the author's views. We trust, nevertheless, that we have imparted to our readers adequate notions of the scope of the work, to render them sensible of its value as a manual of urinary diseases. It is illustrated by a good coloured plate, representing the principal varieties of urinary calculi. The additions of Dr. COLHOUN consist of foot notes, and paragraphs inserted in the text of the original work. We would not, however, wish to be considered as approving of the course, for the most part pursued by Dr. C., of inserting his amplifications in the text of the author, merely distinguished by brackets. Besides the absence of sufficient distinction between the matter of the author and commentator, the text of the former is thus injuriously disjointed, and dependent sentences sometimes widely separated. In regard to the execution of the present edition, we regret to say that it is wanting in typographical accuracy. FOOTNOTES: [23] The reader will bear in mind, that this acid is the same as the uric, the name by which it is generally known. [24] The reason of this exclusion of salts, containing a vegetable acid is, that they become real alkalies in the course of assimilation by the destruction of their acid, and therefore add alkaline properties to the urine, already too alkaline. MEDICAL LITERATURE. ARTICLE XII.--RETROSPECTIVE REVIEW.--_Tractatus de Ventriculo et Intestinis, cui proemittitur alius, de Partibus continentibus in Genere, et in Specie de iis Abdominis._ _Authore_ FRANCISCO GLISSONIO, &c. &c. Lond. 1677, 4to. As it is not our intention to confine our remarks to the work above mentioned, we shall deem no apology necessary for the somewhat excursive nature of this article, which would not answer our present purpose, if we were obliged to follow the costive details of the venerable FRANCIS GLISSON, whose villanous bad style, and execrable latin, are only to be excused or overlooked in consideration of the great importance of the topics which he handles, and the profound reflections which he makes on them. GLISSON is recognised as author of the physiological term _Irritability_, and as the assertor of the inherent activity of matter. HALLER says of him in his XIth book. "FRANCISCUS GLISSON, qui universis elementis corporum, vim motricem tribuit, etiam nostram vim, Irritabilitatem vocavit," &c. He was a native of Dorsetshire, and was appointed professor of physic at Oxford in 1627. This post he occupied during forty years, and is much distinguished by his treatise de vita naturæ, and by the work which forms our caption. As he is the first who used the physiological term irritability, we have thought that some researches on this subject in general, and more particularly on his peculiar sentiments, might profitably occupy our retrospective department; for it is very evident that this subject is in general but vaguely discussed, both in medical writings and conversation. The ancient philosophers did not agree among themselves as to the nature and origin of matter; some of them considering it as eternal in its essence, and others as mutable and changeable in form. The theory of atoms, published by DEMOCRITUS, and subsequently carried out so elaborately by EPICURUS and his disciples, seems to have reached even to our own times, with an increasing reputation and acceptance. According to this theory, the kinds of matter, or elements, must he regarded as infinitely various. HERACLITUS, who taught philosophy about 550 years before Christ, considered all things as derived from an elemental heat or fire;[25] a philosophy which seems to us to have formed the basis of the Hippocratic doctrines of life. Like HERACLITUS, HIPPOCRATES tells us, that the calidum was the first principle of things, and that by an expansion or extension of itself, it constitutes all the objects of the material world. He expresses himself in the following manner. That which we call warmth, or heat, seems to me to be something immortal; something which comprehends all things, which sees and knows all things, as well present as future. Thus assuming as a basis, that the calidum is an almighty, all-wise being, or in other words, a God, all in all, the cosmogony was developed as follows: Chaos he regarded as that condition of the calidum, which preceded any exertion of the Almighty faculties. In emerging from the chaotic state, the greatest part of the heat having assumed the uppermost place, formed the æther; another part having gained the lowermost place, constituted earth; a third portion, midway between earth and æther, became air; and a fourth part, establishing itself between the two latter, became water. So that by means of the extension of this all-wise, elemental calidum, we have the four elements, earth, air, fire, and water, out of which are ultimately composed all the aggregates of the material world.[26] Now, to apply this general principle to the formation of the living being man, who seems to be a sort of microcosm in himself, we are told, that that portion of heat which remained with earth, being expanded and spread abroad in divers places, in some more, in others less, the earth became dry, and something like membrane or pellicle was formed; the matters contained in which, being heated as by a sort of putrefaction, some parts became bone, some nerve, some veins and their contents, and some formed the cavities and their contents, as the urinary bladder, for example.[27] The full exposition of the opinions of HIPPOCRATES was left for GALEN, and we prefer to make reference to him on this theory, which by his genius and talent was so much embellished, that it became the glory of science, exercising an almost undisputed authority during a long lapse of ages. Indeed the gigantic intellect of this great man, still continues to shed its vast illumination over the world of science, particularly that of medicine; which, if it owes its birth to the divine old man of Cos, is not less indebted for its nurture and growth to the celebrated native of Pergamus. GALEN is the facile princeps of physicians. His astonishing industry, perseverance, and acquirements, his ingenious arguments, and persuasive eloquence, give him an unquestionable claim to the title of princeps, so long accorded to him; and those who even in the present enlightened period, will study his works, shall find themselves almost irresistibly led away by the charm of his suasion. GALIEN est le seul des anciens qui ait donné un corps complet de medecine: Quoique formé des débris de toutes les doctrines précédentes, son systeme offre cependant, malgré les contradictions ou il tombe assez souvent, une unité remarquable dans toutes ses parties; un ensemble séduisant, qu'un genie de l'ordre le plus élevé pouvoit seul imprimer à un pareil édifice. Ramenant tout à un petit nombre de principes généraux, qui s'ils ne peuvent satisfaire la raison, fournissent du moins une réponse facile a tout, ce systême dut être adopté avec empressement, et sa fortune ne peut étonner.--_Biographie Medicale, Tom. IV._ GALEN may perhaps be justly regarded as an eclectic; but it is manifest, that he mainly walked after the steps of his great predecessor, and recognised model. The following passage seems to contain ideas not much differing from those of HIPPOCRATES which we have presented above: "Who is there, says he, that judging from the origin and constitution of animated beings, doth not immediately infer the existence of a mind, possessed of wonderful energies, extending to, and pervading every portion of the universe! We every where perceive animals procreated, which are possessed of the most admirable structure, and yet what portion of the universe can be more ignoble than this earth of ours? Yet a grand intelligence is seen to have reached even it from the celestial bodies, which for their beauty are so astonishing, and which, as they are for purity far more excellent than our earth, so they are the seats of intelligences, far more pure and perfect than those which inhabit these lower regions." He proceeds to remark, that animals, worthy of the greatest admiration, are produced out of the slime and mud of ponds and ditches, and even in putrefying vegetables, which, as they indicate the miraculous properties of their author, also show us in what estimation we should hold the higher orders of being. "We may even perceive a rational nature in men, if we refer to such examples as PLATO, ARISTOTLE, HIPPARCHUS, ARCHIMEDES, and many others. If, therefore, in such a colluvies as the human body, (for by what better name can we characterize a mixture of blood, bile, and phlegm,) a mind is formed of such great and excellent faculties, what must we think of the excellence of that which exists in the superior bodies?" It may be said that GALEN expresses, in these passages, the Platonic dogma of an _anima mundi_. But they certainly agree with the sentiments of HIPPOCRATES; and whether he derived them from the former or the latter, matters not, as both of them have invested matter with certain qualities, which render it active, whether it be so essentially or by the act of the Creator. GALEN may be also regarded as partially an Epicurean; for he insists that there are several sorts of matter, or as we should say, several elements; but he differs from that sect again in affirming for it a passible quality. To show that there must be more than one element, or kind of matter, he says, that if there was only one element, or a unit, it would be impassible; it could undergo no change whatever. For there would be nothing by which it could be made to suffer any alteration, or into which it could be altered. Whatever is changed, is changed into something else, and whatever suffers, suffers from something extrinsic: therefore he affirms, that of necessity there must be several sorts of matter, or elements. He says, "there are only two theories on this subject deserving our attention; one of which affirms that sentient bodies are composed of elements possessing the faculty, (cum patiendi tum sentiendi,) both of suffering and perceiving an alteration;" while the other affirms that such bodies are formed (ex patibilibus, sed sensu expertibus) out of passible, but not sentient elements. Neither of these doctrines does he consider tenable, so long as only one element is affirmed, as earth, air, or fire alone, which could never become capable of that great variety of actions we witness in living bodies: but, admit several elements, and we suppose that the mutual interchange of powers would yield a compound body, capable of all the vital phenomena. Such, therefore, says he, as consider the human body to be composed of fire, air, earth, and water, mutually transmuted, alternated, and reduced to a given temperament, and thereby vested with a sentient faculty, speak reasonably; and it is evident that there must be more than one element, and that these elements are passible bodies. PLATO had taught, that, though all bodies are formed of matter, yet matter itself is not a body; and the same idea is conveyed by ARISTOTLE, in the Lib. de partibus animal. & earum causis, II c.i. "Prima statui potest ea quæ ex primordiis conficitur, iis quæ nonnulli elementa appellant terram dico, aquam aërem & ignem: sed melius fortasse dici potest ex virtutibus confici elementorum, iisque non omnibus sed ut ante expositum est humiditus enim, & siccitas, & caliditas, and frigiditas, materia sunt corporum compositorum." GALEN also states, that in fire there exists a perfect heat and dryness, in earth a perfect coldness and dryness, and so on of the rest of the elements. For you cannot expect to find in nature a perfectly simple and isolated element; because they are always mixed two or more together. Hence the real terram, aquam, aërem, and ignem, become rather a metaphysical abstraction, than a real entity. That is to say, matter has no real existence, but is mere quality; for earth is not the mere representation of dry or siccum; it is the representative of siccitas, or dryness: fire is not the eidolon of calidum, but of caliditas; water of humiditas, and air of frigiditas. Yet all these elements are in nature possessed of more than one property. Fire is hot and dry, earth is dry and cold, water is cold and moist, &c. If we refer, however, to his account of the soul, we perceive at once, that these inseparable qualities of the elements are the real active agents of life. He plainly declares, that the soul is the mere result of organization, and perishes with the structure in which it dwells. He thinks, "corporis temperiem censendum est." As to the active powers of the four primary qualities, he says, "At mihi quidem tam venæ, quam reliquarum particularum singulæ, ob certam quandam temperiem quam ex quatuor sunt qualitatibus nactæ, hoc vel illo modo videntur agere."--De nat. fac. I. It is plain he thinks, that the elements consist of a materia and qualitas; but they are elemental by the _qualitas_ and not by the _materia_. After establishing that there are four elements, which are the common and simple bases of all things, he goes on to show, that the proper proportion and admixture of these, constitute the healthy state of living bodies. If the calidum, for example, be unduly increased, the body is destroyed; if it be improperly diminished by excess of the frigidum, it will also perish. The business of the physician is to keep the proportions just and harmonious; but, as no pure element exists alone, the physician must employ the qualitas in conjunction with the materia. These (to make a phrase) substantive qualities, are found in medicines or food, which, like all objects of sense, are either cold, hot, dry, or moist, and available of course in the management of a cold, hot, dry, or moist derangement of the living body. The elements of the human body exist in the four humours, blood, bile, atrabilis and pituita; and these four humours correspond in quality with the elements. Blood, which is the reservoir or continent of them all, is a temperate humour. Bile, being the representative of calidum, is hot and dry. Melancholy represents, in our microcosm, the element earth or siccum, and is dry and cold. But pituita, which is moist and cold, corresponds with the humidum element. Air exists in animals nearly pure, as we learn from the phenomena of the pulse and of respiration. It answers to frigidum. He shows us in his lib. de naturalib. facultat. that, out of the humours, all the parts are formed, and these parts are either _similar_ or _dissimilar_; i. e. simple or compound. Bone is a similar part, that is, it is a simple part; so is an artery, or vein, or ligament. Each of these is so constituted, as that it has a predominance of one element in its nature; and it is therefore dry, or cold, or moist, &c. But if an adust element be, by accident or disease, accumulated in a part naturally cold, the function of such part is morbidly affected. The natural tendency, however, of similar humours to unite, causes each part to receive its regular supply; a principle which BICHAT has since characterized as, _contractilité organique insensible_. To show the wonderful simplicity of the Galenical system, which for plainness and easy attainment may be compared with the improved nomenclature of chemistry, we will cite a passage from ARGENTERIUS, who, perhaps, was as learned in this kind of lore as any man of his time. In his Tractatio de calidi significationibus, he says; "If any body would undertake to give a general enumeration of those circumstances, in which this term calidum and the others (frigidum, humidum, &c.) are applicable to the explanation of this warmth, he shall find truly, that they are the elements, the humours, the parts, the whole body, medicines, food, air, climate, the weather, the season of the year, and even ages; for these all are either temperate, or hot, or cold, or humid, or dry." The animal body is moved and governed by two principles; one of them corresponds to the _vie animale_ of BICHAT, and the other to the _vie organique_. Since the power of sensation and of voluntary or elective motion, says he, is a property of animals, and since that of growth and nutrition is common both to animals and plants; the former may be called attributes of the soul, and the latter attributes of nature. Whence we say, that animals are governed by the soul and by nature, while plants are governed by nature alone. The powers of the body are faculties; and these are either natural, vital, or animal: but they are so subdivided, that we have as many faculties as there are sorts of action. Under the class of natural faculties, we find three principal sorts; to wit, a facultas generatrix, an auctrix, and a nutrix. But if you ask, says GALEN, how many faculties there be, which result from the action of these on each other, you will find them as numerous and diverse as there are numbers and diversities of the animal parts. For example, we have an attractrix faculty, a retentrix, alteratrix, expultrix, &c. &c., all of which are variously modified, according to the nature of the similar or dissimilar parts they are exercised in, or, in other words, according to the nature of the tissues or organs, in which they reside. Need we go further to show, that GALEN, believing all matter essentially conjoined with the hypothetical caliditas, frigiditas, &c. &c., taught that it was gifted with such a degree of inherent activity, as to render it capable under certain states of combination, of exhibiting all the phenomena of organic and animal life? It is certain that he regarded these active qualities, as the causes of all the phenomena, whether of living or dead matter.--GLISSON ought not certainly then to be regarded as the author of this dogma in medical philosophy. PLATO certainly taught it. VAN HELMONT could not get along without investing matter with what he called a "seminal likeness, which is the more inward spiritual kernel of the seed," &c. But we will let him speak for himself. "Whatsoever," says V. H., "cometh into the world, must needs have the beginning of its motions, the stirrer up and inward director of generation. Therefore all things, however hard and thick they are, yet before that their soundness, they inclose in themselves an air, which representeth the inward future generation to the seed in this respect fruitful, and accompanies the thing generated, even to the end of the stage: which air, although it be in some things more plentiful, yet, in vegetables it is pressed together in the show of a juice, as also in metals it is thickened with a most thick homogeniety or sameliness of kind. Notwithstanding this gift hath happened to all things, which is called _archeus_, or chief workman, containing the fruitfulness of generations or seeds, as it were the internal efficient cause; I say that workman hath the likeness of the thing generated, unto the beginning whereof, he composeth the appointments of things to be done. But the chief workman consists of the _conjoining of the vital air_, as of the matter, with the seminal likeness, which is the more outward spiritual kernel, containing the fruitfulness of the seed; but the visible seed is only the husk of this. This image of the master workman, issuing out of the first shape or idea of its predecessor, or snatching the same to itself out of the cup or bosom of outward things, is not a certain dead image, but made famous by a full knowledge, and adorned with necessary powers of things to be done in its appointment; and so it is the first or chief instrument of life and feeling. But since every corporeal act is limited into a body, hence it comes to pass, that the archeus, the workman and governor of generations, doth clothe himself presently with a bodily clothing. For in things soulified, he walketh thorow all the dens and retiring places of his seed, and begins to transform the matter according to the perfect act of his own image; for here he placeth the heart, but there appointeth the brain, and he every where limiteth an unmoveable chief dweller, out of his whole monarchy, according to the bounds of requirance of the parts and appointments. At length that president remaineth the overseer and inward ruler of the bounds, even until death; but the other, floating about and being assigned to no member, keeps the oversight over the particular pilots of the members, being clear and never at rest or keeping holiday." Notwithstanding the affected and euphuistic jargon of the above passages, it is evident that VAN HELMONT'S idea is very similar to that of GALEN. By seminal likeness, we are to understand an aptitude in matter to take on certain determinate forms, and this may be supposed to differ not very essentially from those laws, which govern matter in crystallization. But even this seminal likeness, as we perceive, is a sort of abstraction, very analogous to the Galenical caliditas; for it is the more inward spiritual kernel of the seed, whereby the matter is enabled to enjoy a certain degree of activity, the degree of which is much increased by the union of the air, or archeus, with it. So the caliditas of GALEN, which, after all, is matter, gives to its subject the powers which it enjoys. GLISSON, speaking of the natura seminalis, says that it is a certain or specific essence, superadded to mere elementary principles, by means of which mixt bodies adopt certain determinate forms, and acquire the faculty of performing essential operations, more noble than those which belong to naked elements. We regret very much that we have been unable to procure a copy of GLISSON'S treatise de vita naturæ, which, so far as we know, can not be had in this country. We shall, therefore, furnish our readers with the following passage from the Biographie Medicale, from the pen of JOURDAIN. "The name of GLISSON occupies an honourable place in the history of medicine, because to him we are indebted for the first elements of the physiological doctrine of the present day. Instead of directing his attention to movements alone, as the iatro-mathematicians, and even, to a certain extent, the animists had done, he referred to vitality all the phenomena of nature, of whatever kind, and attempted to reduce them to one, common principle. To this end he admitted, that matter is originally endued with forces inherent in it, and that living bodies in particular, are invested in their organs with a radical force, which, put in play by stimulants, whether internal or external, gives rise to all the phenomena of life. He even went so far as to assert, that sympathy may be explained by referring to the intercommunication of this force, to which he gave the name of irritability." We shall also cite from SPRENGEL, a passage which throws some light on his theory. "When they became unwilling, like DESCARTES and STAHL, to have constant recourse in their explanations, to the soul, they tried to find a philosophic proof of the existence of material forces, to show that matter, as mere matter, is endowed with particular forces, with which they might satisfactorily explain a great many of its phenomena. No one had hitherto sought for a similar proof; for ARISTOTLE had contented himself with an axiom, that all natural things contain in themselves the sufficient cause of their movement and rest. GLISSON and LEIBNITZ set themselves in search of this proof; but it was reserved for the immortal KANT to find it in the nature of matter itself. "FRANCIS GLISSON may with propriety be considered as the precursor of LEIBNITZ. What he tried to demonstrate by scholastic subtlety, and by thousands of syllogisms, was developed by LEIBNITZ with a clearness and ability, which secured the suffrages, even of the unenlightened. Both of them went too far, in attributing life and sensation to matter, instead of claiming for it the two simple and primordial forces of attraction and repulsion. "GLISSON sets out with the idea of substance, but he does not explain it with sufficient precision. Every substance has three substantial rudiments,--_fundamental_ substance, by means of which it exists,--_energetic_ substance, by means of which it acts,--and _additional_ substance, which determines its accidental qualities. All matter, as substance, must have an energetic substance or nature, which is the internal principle of movement. Therefore whatever moves spontaneously, and in virtue of an internal force, must _feel_ this motion, _and desire it_. All matter feels that it is, and that it exists by itself. It has therefore, consciousness of its own nature. Life consists in the activity of the internal substantial energetic nature. Death is the dissolution of the triple alliance of the internal energetic substantial nature, with the vegetative and animal natures, which two last belong to the _additional_ substance."[28] In applying his theory to physiology, GLISSON'S idea is, that the fibres of the human body are endowed with a force, which he divides into three kinds; to wit, natural or inherent force, (robur insitum)--vital force, (robur vitale)--and animal force, (robur animale.) Natural or inherent force, is a part of the constitution of the fibre, and is as much a property of its organization as are its tenacity, tensibility, &c. The sum of this force varies, in proportion as the constitution of the fibre is more or less perfect. It is strongest in athletic men and strong animals, and weaker in relaxed and debilitated persons. It may be compared with the contractilité de tissu of BICHAT. The second, or vital force, is something superadded to the inherent sort. It is an _influxus_, derived to any fibre or set of fibres, from that greater sum of force, which arises out of a more elaborate, complex, and exalted organization. It varies in proportion as the vital spirits flow with more or less freedom; and in proportion as their quality is more or less perfect. The third kind, or robur animale, may be supposed to depend on the organic constitution of the brain and nerves, and varies according to the state of that organization. We cannot help adverting to the resemblance between these two latter kinds, and the contractilité organique, and contractilité animale, of BICHAT; and this robur comprises, as we shall show hereafter, both the contractilité and sensibilité of the French physiologist. GLISSON, in his chapter de Irritabilitate fibrarum, commences by remarking that a motive faculty existing in any fibre, unless it were of an irritable nature, would leave such fibre in one of the two following states: 1. It would either never cease from action, or 2ndly, being once at rest, its motion could never be reproduced; but the varieties and differences which we see in the actions of fibres, clearly demonstrate them to be possessed of irritability: i.e. if a fibre may be by turns in a state of action and repose, it is evidently possessed of a quality, whereby it can be induced to move if in a state of rest; this quality he terms irritable, or irritability. The next inference from this power of alternate activity and repose is, that the fibre is possessed of a faculty, whereby it can _perceive_ an irritation offered to it; but this perception of irritation further implies an _appetence_ for a change of its actual state, before the motion can really take place. Perception, appetence, and motion, make a triunit. "In the mean time, says he, as sensitive appetence, and sensibility, are frequently confounded with natural perception, in this irritation of the fibres," he divides it into three kinds, viz. Natural Perception, Sensitive Perception, and Perception regulated by animal appetency. Natural Perception is that principle whereby a fibre perceiving any alteration offered to it, whether pleasing or displeasing, is excited either to accept that change, or to avoid it, and moves accordingly. Sensitive Perception, is that kind, in which a fibre, perceiving a change effected in some other organ, is impelled ad aliquid appetendum, and to move conformably. The third sort, or Perception regulated by animal appetency, is that in which the brain directs from within, such movements of the muscular fibres, as are requisite for the execution of any purpose. "Some persons," says GLISSON, "may doubt whether there really exists a natural perception of irritation in the fibres; but we have elsewhere asserted in general the reality of natural perception, to wit, in my work, de Vita Naturæ; and whoever has known it, will readily admit this quality in fibres imbued with inherent, influent, and vital spirits. We do not expect, in this place, to establish it as a general principle; but if any proof, derived from a knowledge of the structure, uses, and actions of the fibres, can be adduced, it may be here attempted." "It is indubitable that the fibres are alternately at rest and in motion; for, during sleep, they are all relaxed, with the exception of such as subserve the functions of respiration and circulation, and even these are by turns quiet and active. During waking again, they are all in a state of moderate tonic motion; and moreover, during all movements of the limbs, the antagonist muscles yield spontaneously, the abductors being active, while the adductors are relaxed, and vice versa. Hence it is manifest, that the fibres are alternately quiescent and active: but, since they are not _principal_ or sui arbitrii agents, it is necessary, in order to the new movement, that they should be irritated from some source: for, it is impossible that a fibre in repose, can be set in action without an irritating cause; nor can we conceive of a part being irritated without _perceiving_ the irritation. It is like speaking to a deaf man, or trying to awaken a dead one." "If you say, fibres are possessed of sensibility, and can be excited by virtue thereof, I confess that they are sensible parts, and may thereby perceive some, not all irritating causes; but whether sensation excites them immediately, or rather, is transmitted to the brain, and irritates the animal appetency; and further, whether the animal appetence, effects a movement in them directly, and to what sort of perception this irritation may be properly and immediately ascribed, is detailed in order below, when we come to explain sensitive perception, and perception à phantasia imperata." "Let us now go on to point out those cases, in which no suspicion of _sensation_ can be entertained. The pulsation of the heart is neither effected nor affected by sensation; its fibres, in virtue of the irritation occasioned by the blood in its ventricles, are excited to contract, and thus occasion the pulsation, but when the irritation is remitted they relax, and recover the natural state. Now it cannot be denied that this is an evident case of irritation of the fibres, for according as is the irritation, so is the rythm of the pulsation, which varies at times, as in febrile and other affections: nor is it right to pretend that there is any sensation in this case; because this perception of irritation _per vices_, is exercised as well during sleep, when the senses are all locked up, as in the waking condition. The fibres do not, therefore, _perceive_ in these actions by a sensitive, _but by a natural perception_, the irritation of the vital blood, which animates them to alternate contraction and relaxation. This is corroborated by those tumultuous irregular motions which continue in animals after decapitation; so also the intestines when still warm in a recently opened animal, move and twist about; the muscles in dead animals also, excited by the perception of cold, contract with a strong tonic movement, and render the body rigid. The hearts of some animals too, when torn out of the body, and even when dissected, continue their endeavours to pulsate. Is there any further evidence wanting? We may hence infer with sufficient confidence that the fibres (without the aid of the senses) may _perceive_ irritation, and move themselves conformably." In the next place he examines the nature of sensitive perception of fibres, and goes on to show how an impression made on an external part, or a natural perception, becomes converted into sensation, and thus made known to the sensorium. But his disquisition is not only very long but very dark, and we shall therefore pass it by with the exception of the following. "Natural perception includes within itself a _rationem positivam_, and a _negationem formalem_. "The ratio positiva is the perception of the idea, or image of the object moving or changing the fibre. "The negatio formalis is a denial or refusal to communicate this image to the sensorium. In the process of transformation into sensation, the positive ratio is not changed, but remains the same, and is the first part, or basis, both of internal and external sensation. "The negatio formalis is destroyed or abolished in any case of impression communicated to the sensorium. Natural perception, in its ratio positiva, is not abolished or degraded by being converted into sensation, but is rather exalted, or gifted with a more dignified nature. By as much as public or general knowledge is preferable to private, or public advantage to that of an individual, by so much is sensation preferable to natural perception. Hence nature formed so many organs of sense, that the phantasy might have notice of what ought to be done, desired, or avoided." He does not doubt that external sensibility is inherent in the nervous parts of the external organ, whence he infers that it may readily incite the fibres of such organ ad appetendum et movendum; for, as external sensation is communicated to the brain by means of the nerves, it must of necessity be true, that these nerves and nervous parts (such as the fibres,) are the subjects of it. Since then sensibility causes its subject to feel, it consequently enables it to desire and move comformably. For perception in any subject is vain, unless it can desire, and appetence is useless, unless it can move. External sensibility, therefore, may be said to render the fibres _actu irritabiles_, for example, as often as the irritating cause is perceived; but as the irritation is perceived, not by a sensibility, but by a mere natural perception, this it is which constitutes their irritability. Thus we may perceive that the triunit consisting of perception, appetence, and motion, constitutes the celebrated irritability of our author. But he has been too latitudinarian in his application of the theory; for he did not limit it, as HALLER has subsequently done, to one sort of fibres, or indeed to fibres alone, for he says in cap. IX., "It is to be remarked that natural perception belongs to other parts of the body besides fibres; to wit, to the parenchymata, bones, marrow, fat, blood, recrementitious juices, humours of the eye, and such like, all which are irritable, and increase the irritable constitution of the parts, but these parts hardly admit of the existence of animal perception." HALLER blames GLISSON for having gone so far in his application of the theory, and it is well known that he himself restrained it to the single tissue of muscular fibres, and denominated it vis insitum, or inherent force; whereby he distinguished it from his vis mortua or elastic contraction, on the one hand, and the vis nervosum or voluntary power, on the other; the former being something less, and the latter something more than irritability. GLISSON'S theory, when fully explained, which we cannot for want of space do here, will be found to bear a very strong resemblance, in many points, to that of BICHAT, who has invested the matters of the body with vital powers, far beyond those attributed by HALLER; and as we are not furnished in the present article with sufficient space, we hope in some subsequent number, to place this matter in a plainer light before our readers. In the mean time we may remark, that GLISSON seems to be the first of those who have placed the subject fairly before the medical public; for although faint traces of a similar theory may be perceived before him, especially by translating terms into their equivalents, yet he has the merit of using a term which, in spite of all subsequent modifications, is in daily use. GLISSON'S latitudinarianism may be contrasted with HALLER'S rigid application: for the latter says, "I call that an irritable part of the human body, which on being touched by a foreign body, renders itself shorter;" thus while GLISSON attributes his triunit of perception, appetence, and motion to all the tissues and fluids, HALLER confines it to muscular fibre alone. No one can doubt that the membranes of the body are endowed with vital properties, but yet they do not shorten themselves on being touched by a foreign body. BICHAT has distinguished their vitality as organic vitality, and the contractile qualities displayed are divided into insensible organic contractility, and into contractility of tissue: but these sorts of contractility mount up by insensible gradations. He says, that "entre la contractilité obscure mais réelle, necessaire a la nutrition des ongles, des poils, &c. et celle que nous presentent les mouvements des intestins, de l'estomac, &c. il est des nuances infinies, qui servent de transition: tels sont les mouvements du dartos, des arteres, de certaines parties de l'organ cutané," &c. We will close with a comparison between GLISSON'S irritability, and BICHAT'S contractility. At page 70 of the Treatise _sur la Vie & la Mort_, BICHAT supposes that a "muscle enters into action, 1st. by the influence of the nerves which it receives from the brain, and this is a case of contractile animale," (which differs in no respect from perception regulated by animal appetency of GLISSON). 2ndly. According to BICHAT, the muscle enters into action "by the excitation of a chemical or physical stimulant applied to it, and which artificially determines a movement of the whole muscle, analogous to what is natural to the heart, and other involuntary muscles. This is sensible organic contractility or irritability," and corresponds to the sensitive perception of the old English physiologist. In the 3d place it enters into action by the stimulus of the fluids which circulate in it, and this is insensible organic contractility or tonicity of BICHAT, and is nothing different from GLISSON'S natural perception. BICHAT makes a fourth case; as for example, when a muscle is divided across, it contracts by a _contractilité de tissue_, or _par defaut d'extension_. We do not perceive how GLISSON'S natural perception can be applied to this case, but he treats of it in his fifth chapter under the head of Cessatio: it is that state to which a fibre is reduced when left to itself, and freed from all stimulus. BICHAT has attributed to some fibres the power of active elongation. On this subject GLISSON says, "Impossible enim est, ut simplex fibra, sua sola actione, se secundum longitudinem distendat, nec modus quo hæc fiat concipi nedum effari queat non negavero quin in distensione hac, aliqualis fibræ actio includatur, sed ea tota contractiva est, & distensioni ab extranea causa factæ reluctatur." A doctrine as sound as that of the 47th proposition; a doctrine too, without admitting which, we think no man can understand the theory either of simple inflammation, or of the febrile affections. We hope to resume this subject at an early period. FOOTNOTES: [25] Hæc ei generatim videbantur, ex igne omnia constare eodemque interire. Diogenes Laertius. [26] Quatuor æternus genitalia corpora mundus Continet; ex illis duo sunt onerosa, suoque Pondere in inferius, tellus atque unda, feruntur, Et totidem gravitate carent, nulloque premente Alta petunt, aer atque aere purior ignis.--OVID--_Metamorph._ [27] Lib. de Carnibus, HIPPOCRATES says: Quod Calidum vocamus, id mihi immortale esse videtur, cunctaque intelligere, videre et audire, sentireque omnia, tum præsentia tum futura: cujus pars maxima cum omnia perturbata essent in supremum ambitum secessit; quod, mihi veteres æthera appellasse videntur. Altera pars locum infimum sortita, terra quidem appellatur, frigida et sicca multas que motiones habens, et in qua multum sane calidi inest. Tertia vero pars medium aeris locum nacta est, calidum quid existens. Quarta pars terræ proximum locum obtinens humidissima et crassissima. His igitur in orbem agitatis cum turbata essent, calidi magna pars alias in terra relicta est, partim quidem magna, partim vero minor, alias etiam valde parva, sed in multas partes divisa. Et temporis successu a calido resiccata est terra, ista in ea tanquam in membranis contenta circumse putredines excitant, ac longo tempore incalescens quod quidem ea terræ putredine pinguedinem sortitum est et minimum humidi habet, id citissime exustum ossa produxit. Quæ vero naturam glutinosiorem sortita sunt et frigidi communionem habent, ea neque calefacta exuri potuerunt, neque etiam humida fieri ideo formam longe ab aliis diversam nacta sunt et nervi solidi exciterint, cum non multum in iis frigidi inesset. At venæ frigidi multum habebant cajus pars circumcirca ambiens et quod erat glutinosissimum, a calido exassatum membrana extitit. Quod vero erat frigidum, a calido superatum, dissolutum est ideoque humidum evasit. [28] K. SPRENGEL, Hist. de la Medicine. QUARTERLY SUMMARY OF MEDICAL AND SURGICAL INTELLIGENCE. I. ANATOMY. 1. _Papillæ of the Tongue._--At the upper surface of the tongue, say MM. LEURET and LASSAIGNE, in their recent work on digestion, the mucous membrane presents projections of three different species; and these are, the sensitive papillæ, the epidermoid papillæ, and the mucous cryptæ. The sensitive papillæ are numerous. They occupy the anterior four-fifths of the tongue, on which they are implanted by a narrow pedicle. The rounded head of these papillæ is much more prominent in the living subject, than after death; but injections are capable of restoring them to their pristine form. Nervous fibres from the lingual branch of the fifth pair have been distinctly traced to their roots. These papillæ are of various sizes; at the root of the tongue they form a V. They are all vascular and nervous. The sense of taste is referred by these writers almost exclusively to the above papillæ. The epidermoid papillæ are of a nature similar to those retroverted prominences so remarkable on the tongue of the cat; as well as in the lion, and some other animals. They are larger in many species than in man, and, in general, the sensibility of the tongue appears to diminish in proportion to the remoteness of the subject from the human structure. The epidermoid papillæ are separated from the tongue along with the epidermis, or rather, epithelium, by maceration for a few days in vinegar. They are pyramidal in form. They are grouped round the sensitive papillæ, except on the edges and point of the tongue, where they are rare. Their base is perforated, and always gives outlet to a crypta. In an epithelium separated from the tongue, these minute and numerous perforations are easily distinguished from the larger ones left by the sensitive papillæ. The office of the epidermoid papillæ appears purely mechanical. The only cryptæ which produce, of themselves, a visible projection on the surface of the tongue, are situated at its base. They are formed by the mucous membrane, like other cryptæ, and are scattered between the sensitive papillæ. In the tongue of birds, there is always a bone or cartilage; and the external membrane is dense. In reptiles the tongue is soft, possessed of little sensibility, and capable of great elongation. In fishes it is endowed with little motion, and is often wanting.--_Bulletin Medicale._ 2. _Villi of the Stomach and Intestines._--MM. LEURET and LASSAIGNE state that the villi can be easily injected; most conveniently from the vena portæ, though the arteries may be employed. In the latter case, the matter of injection is effused into the intestinal or gastric cavity. The villi are peculiar to these parts; they are inversely conical, adhering to the membrane by their smaller end. The best mode of exhibiting them, is to tie the vena portæ of a living animal, when they erect themselves by the afflux of blood. These diminutive organs, about 3/100 of an inch long, then exhibit distinctly, under the microscope, four red longitudinal lines, being probably vessels. Injections made retrograde from the thoracic duct, pass through the villi into the intestines. When the stomach of a man, who died of some complaint not deranging its condition, is examined, we sometimes find its lining membrane covered with a multitude of minute white points. These are the villi in a flaccid state. In those who have died during digestion, they are erected, and of a rosy colour. When the intestine of a living animal is examined under a microscope, after being carefully washed, a great number of orifices are seen, from each of which exudes a minute drop of a transparent fluid. These rapidly disappear; and then the villi attract attention. What these foraminula are, the reviewer, M. DU FERMON, does not tell us.--_Ibid._ 3. _Minute distribution of the Vessels of the Liver._--M. CRUVEILHIER gives, in his lectures, an account of the results he has obtained from a minute injection of the liver. He finds, 1. The acini surrounded with a dense, cellular texture, paler than themselves; 2. The ramifications of the hepatic artery distributed to this cellular envelope; 3. Those of the vena portæ spread around the acini, or granulations of the liver; and 4. Those of the biliary ducts, and of the hepatic veins, emerging from the cavities of these bodies. Our readers will observe a great similarity, in this, to the arrangement of the lobules of the kidneys.--_Ibid._ 4. _Trachea perforating the Aorta._--This odd distribution of parts, was observed by M. ZAGORSKY, at St. Petersburg, in 1802. The aorta divided itself, at its arch, into two branches, which received the trachea between them, and again united, exactly fitting the organ they received. They were found to have compressed the trachea, and probably produced difficulty of breathing. In another case, in 1808, the right subclavian artery, instead of its usual origin, arose from the left extremity of the arch of the aorta, and crossed behind the trachea, thus including the latter between it and the aorta. Why do we call the common trunk of the right subclavian and carotid, the arteria innominata? Is coining words so difficult a task, that we cannot find a proper and expressive name for it? The French call it _brachio-cephalic_, and this expresses its office and distribution.--_Ibid._ 5. _Monsters._--These productions, hitherto considered as mere objects of wonder, from the study of which no useful inference could be drawn, have recently attracted a good deal of attention in Paris. There seem to be some close affinities discoverable in many of them, not only with the natural and complete forms of animals of various tribes, but even with the actual condition of their own species, while in the foetal state. The views of M. GEOFFROY ST. HILAIRE seem to us rather mystical and vague. Those of BRESCHET, and the other practical anatomists, we can understand much better. 6. _Malformation of the Heart._--Drs. BAILLIE,[29] LANGSTAFF,[30] and FARRE[31] have each published cases; and M. TIEDEMANN, in his journal of Physiology, now adds a fourth, in which the aorta and pulmonary artery were found to have changed places. In professor TIEDEMANN'S case, the two circulations were entirely distinct; the systemic blood passing from venæ cavæ to right auricle, from right auricle to right ventricle, and from this, through the aorta, to the body at large; while the pulmonary blood ran through an equally simple circle, by the route of pulmonary veins, left auricle, left ventricle, and pulmonary artery. The only communications between the two circulations, were the foramen ovale, the ductus arteriosus, and, in the opinion of M. TIEDEMANN, the inosculations between the branches of the _pulmonary_ and _bronchial_ arteries. The infant is recorded to have presented _no peculiar appearances_ till the ninth day; when attacks of suffocation came on, attended with the blackish blue colour, and followed by death, at the end of twelve days. Similar histories are said to be given of the cases mentioned above, and the references to which we have copied. We have not the time to consult them.--_Ibid._ 7. _Acephalous Mummy._--M. GEOFFROY ST. HILAIRE has read a memoir of some length to the Academy of Sciences, on an acephalous mummy. It was found in a catacomb, destined, with this exception, exclusively to animals. It had an amulet suspended round its neck, being an earthen figure of a cynocephalus, for which it was very probably mistaken by the Egyptians. The collector, M. PASSALACQUA, who obtained it, showed it to M. G. ST. H. as a monkey, of which he wished to know the species. Yet the latter observes that these amulets were only put on human mummies. M. G. concludes that the monkeys, elephants, &c. said by Livy, Valerius Maximus, Pliny, and others, to have been born of women in their times, and considered as omens of public calamity, were acephala. 8. _New Anatomical Plates._--Messrs. E. W. TYSON and GEORGE SIMPSON are publishing anatomical plates, in London. They are spoken of with approbation. The labours of the latter are designed for the use of painters. 9. _A Manual of Osteology_ has been undertaken by Dr. WEBER, of Bonn, and one volume published. 10. _Soemmering's fine work on the anatomy of the ear_, has been translated into French, and his splendid folio plates copied in lithography. 11. _Does the conjunctiva run over the cornea?_ Messrs. LECOQ, LEBLANC, and ARTUS, state that they have each seen a case in which regular _skin_ and _hair_ were seen, forming a small patch on the cornea of the eye of a quadruped. This is considered as a proof of the existence there of a membrane naturally analogous to the skin; which must, of course, be the conjunctiva. An officer saw another case, in which a hair was seen in the middle of the eye of a horse.--_Bulletin._ II. PHYSIOLOGY. 12. _Electro-Galvanic phenomena of Acupuncturation._--M. POUILLET, after making a complete circuit, through a needle introduced in acupuncture, through wires, and through the patient's mouth, found, by means of a multiplier of SCHWEIGHER with a magnetic needle, that the electro-magnetic rotation could be readily produced; at least so far as to effect small vibrations backwards and forwards. On repeating it with two needles, one of them run into an artery and another into a vein, or one into the medulla spinalis, at the neck, and another into an extremity, in a rabbit, no effect whatever took place.--_Magendie's Journ. de Physiologie._ 13. _Variations in Milk._--Milk, says M. VALLOT, in his memoir read to the Academy of Dijon, may be _red_. The cause of this is unknown, though it has given rise to superstitious fears. Some have observed that the cow's teats are then tender. Whether this be cause or effect has not been ascertained. _Yellow milk_ is said to have been produced by the cow's eating the caltha palustris, (marygold.) _Blue milk_, from a cause still unknown, in the departments of Seine-inférieure and Calvados. Some have ascribed it to the hyacinthus comosus; others to butomus umbellatus. The _green milk_ of some writers is supposed to be only blue. _Milk not coagulable_ is produced by feeding on husks of green peas, and on mint. _Bitter milk_, from wormwood, sonchus alpinus, and the leaves of the artichoke; and in goats, from eating freely of elder, (sambucus nigra,) and potato-tops; _a disagreeable taste_, from turnips, in Upper Canada. _Garlicky milk_, from causes well known. _Insipid milk_, and _lead-coloured butter_, from equisetum fluviatile. _Milk unnaturally sweet and luscious_, (sucré,) from alpine clover, (trifolium alpinum;) and _red butter_, from the ripe berries of asparagus.--_Bulletin._ 14. _Hyoscyamus dilates the pupils of the eyes_, the same manner as stramonium, several Eastern species of datura, and belladonna, which the Europeans use. The strongest species was datura fastuosa.--_Oriental Magazine, apud Du Fermon._ 15. _Worms in the Eye._--Several cases of worms in the eye are mentioned in the Bulletin des Sciences Medicales, for Feb. 1826. DEGUILLEME saw several in the eye of a cow; and the case was published by GORIER, a veterinary teacher, in his memoirs. In the report of the proceedings of the veterinary school at Lyons, in 1822-3, there is the case of a mule, in which a knot of worms (crinons) was seen in one eye. _Two_ were extracted; (why no more is not said;) and another subsequently. No inflammation was produced; but a violent nervous agitation of the head, and a turning of it to the left side took place. Next follows an account of a memoir read before the Medical Society of Calcutta, but of which the name of the author is not given. He is represented as stating, that the strongylus armatus minor of RUDOLPHI, and the _filiaris_ (filaria) papillosa, are frequently found in the eyes of the horses in India, but much more so in the cellular membrane, particularly about the loins. He believes that they make their way into the blood-vessels, and, through them, into the eye. Their most ordinary seat is the cellular membrane of the loins; where they exist for years, producing emaciation, and, at length, paralysis of the hind legs. This last the Calcutta author is represented as ascribing to the penetration of the spinal marrow; but he does not appear to have verified it by dissection. TREUTTLER says, he has seen the strongylus armatus in _aneurisms_ of the mesenteric artery of the horse; but the writer in the Bulletin doubts whether any have ever been found in sound arteries. Dr. KENNEDY, in the Edinburgh Philosophical Transactions, describes a worm, which he calls _ascaris pellucidus_, (pellucida,) as being common in the eyes of horses in India. A review of BREMSER'S work on worms is expected in our next, and inferences will then be drawn from these singular facts. 16. _Digestion._--MM. LEURET and LASSAIGNE, in their very interesting and valuable experimental essay on this subject, have met with many curious results. They found no remarkable difference in the saliva of carnivorous and herbivorous animals. The purest saliva was obtained for their experiments directly from the parotid duct, in man, the horse, and dog. The composition was as follows: Water, 99 parts; mucus, traces; albumen, soda, chloride of sodium, chloride of potassium, carbonate of lime, and phosphate of lime, 1 part. Total, 100. Their experiments on the bile confirmed the results of THENARD and CREVREUIL. The pancreatic juice is of the specific gravity 1.0026; at 15° of the thermometer: (centigrade, we presume.) Its composition is: Water, 99.1 parts; animal matter soluble in alcohol, animal matter soluble in water, traces of albumen, mucus, soda, chloride of sodium, chloride of potassium, and phosphate of lime, 0.9 parts. Total, 100. This greatly confirms the analogy long observed between the pancreatic liquor and the saliva. In the _gastric liquor_, there are: Water, 98 parts; _lactic acid_, muriate of ammonia, chloride of sodium, animal matter soluble in water, mucus, and phosphate of lime, 2 parts. Total, 100. Dr. PROUT and Mr. CHILDREN have announced the gastric acid, of which so much has been said, to be the muriatic, while M. CHEVREUIL had stated it to be the lactic. MM. LEURET and LASSAIGNE confirm the results of CHEVREUIL, and that with great confidence in their own accuracy. They found the contents of all the four stomachs of ruminating animals acid. MM. PREVOST and LEROYER had stated those of the three first to be alkaline. The observations of LEURET and LASSAIGNE agree with those of MONTEGRE, (vide Dict. des Sci. Med.) who believes digestion to produce acidity as a result of the regular process. The _fæces_ become alkaline. _Substances which contain no azote, from whatever class they are obtained, cannot serve for nutrition._ We cannot understand this, especially when compared with what follows. "If, on the contrary, they are soluble, one part is absorbed and another is expelled, either by urine or by the anus; such are sugar, gum, &c." This seems to us like a contradiction. It is impossible, in the present state of science, to determine the chemical change which aliments undergo in the digestive organs; both on account of their mixture and the insufficiency of our means of analysis. "The absorption of chyle takes place by the villi." "These communicate directly with the lacteals and the vena portæ." "The transference of the chyle takes place by the lacteals; nevertheless, if they are obliterated, _this may be done through the vena portæ_." _The section of the pneumo-gastric nerves does not stop the dilution of aliments in the stomach, or chylification._ The juices secreted by the liver and pancreas, are poured into the intestines in greater quantity during digestion than at any other period; in consequence of the contact of the acid chyme with the biliary and pancreatic orifices. The pancreatic juice is analogous to the saliva. The spleen is an appendage to the liver; it swells during the absorption of liquids by the vena portæ. Liquid aliments are digested, just as much as solid; but they do not require so great a quantity of gastric and intestinal juices. Watery drinks are absorbed in the stomach and intestines, by the radicles of the vena portæ. Spirituous drinks occasion an afflux of the gastric juices, become acid, and are absorbed. Excrements owe their colour and odour to the bile, and their consistence to the absorption of a portion of the water they contain. They carry off a large amount of the nutriment. Great obscurity still remains as to the cause of hunger. Thirst is thought to be produced by the drying which the pharynx undergoes, from the passage through it of the air used in respiration, and at a time when the supply of mucous fluid is scanty. Our readers will have perceived, long ere this, that here are several propositions at war, not only with our received opinions, but with the experimental researches of some others among the modern physiologists. We do not know what Dr. WILSON PHILIP would say to his observations being so cavalierly dismissed: they seem scarcely to condescend to mention his name in France. Not having the original, we could do no better than translate, almost literally, the conclusions of these experimenters, as stated in the Bulletin; and the result of this is what we have just given our readers. From the words "the absorption of chyle," to the end, is nearly verbatim the language of the review. III. PATHOLOGY. 17. _Dothinenteria. Pustules of the small Intestines._--From [Greek: dothinê], a pustule, and [Greek: enteron], an intestine. This name is given to a disease which has been described by M. BRETONNEAU, of Tours, and, after him, by SERRES, BROUSSAIS, ANDRAL, and several others, and consists in pustules, generally situated at the lower end of the ileum. We are constantly lamenting to ourselves the contracted bounds allotted to our Quarterly Summary. Indeed, were it not for other objects, it might occupy, with advantage, half of the number, and most of the time employed in the preparation of the work. Every thing must be curtailed, though cut off at the most interesting and valuable point; and the painful exertion of the attention, necessary to condense information for our readers' use, of the amount of which they cannot possibly be aware, can only be equalled by the constant feeling of disappointment at rejecting so much important matter. We are told that this pustular disease is as common and as destructive as the _small pox_, (indeed!) the measles or the scarlatina; that few persons spend the whole of their lives without having, at some period, suffered by it; that it never affects individuals but once; and that it is suspected of being contagious. M. BRETONNEAU has prepared a set of specimens, taken from the bodies of those who have died in various stages of this complaint. He traces the malady day by day, with a precision which we will not copy here. The seat of this affection is the glands of PEYER and BRUNNER. The former are found in groups, throughout the lower half of the jejunum and the whole of the ileum, gradually increasing in the size and number of their clusters, till they reach the valve of the colon, where they cease. They have been mistaken by some dissectors of the modern school for the effects of inflammation. They are found in honey-combed patches; which are agglomerations of mucous glands. The glands of BRUNNER are thinly dispersed mucous follicles which are scattered singly throughout the whole length of the small intestines, with nearly equal frequency. These organs are well described by HALLER in the great Physiology. They are not seen well, unless in a young subject, and by cutting into the intestine very close to the mesentery. When inflamed, they swell and thicken, and, after some days, the membrane around them assumes a reddish tint. The mesenteric glands are enlarged. M. BRETONNEAU has seen one as large as a hen's egg: they generally equal in size that of a pigeon. The disease spreads and affects an additional number of glands. It reaches its acme generally on the 9th day; after which sometimes all, and always a part of the affected glands return to their natural condition, by resolution of the inflammation. Those which are to run the full course of the disease continue to augment in size and projection into the intestine. On the 13th and 14th days they are discovered tinged with bile, which penetrates their substance, and thus proves the occurrence of disorganization. On the 15th and 16th, the sloughs separate, and leave from one to six ulcers. These penetrate the gland, and with it the mucous membrane, of which it forms a part, and next, the cellular tissue of the intestine. In numerous instances they perforate the muscular coat, leaving nothing but peritoneum at the bottom; and frequently, passing this, they induce inflammation of the cavity of the belly, and death. The cases of simple resolution terminate in three weeks: those in which sloughs are formed, in from 30 to 40 days, if not fatal. If death be from peritonitis, it is of course soon after the 15th and 16th days; if from exhaustion, at periods varying according to the strength of the sufferer. Dothinenteria occurs in many of the cases commonly called typhus fever, gastro enteritis, &c. It is proper to remark that both the author and the journal are in opposition to Dr. BROUSSAIS.--_Archives._ 18. _Dr. Broussais._--While the opinions of this celebrated reformer have been gradually becoming more extensively known among our countrymen, the war has prevailed with increased heat in his native land. The most vehement attacks are made, from various quarters, upon his system of _medicine physiologique_. No one appears to deny that he has clearly proved the existence of mucous gastritis and enteritis in many or most fevers, or the propriety of directing a part of the remedies to them. Criticisms and invectives are freely emitted: but they are only levelled against the too extensive application of this doctrine, and the inconsistencies, unquestionably often real, of the system of which he has made it the foundation. Indeed, if the quotations given are correct, we think no one who has not assumed a party, can refrain from concurring in their condemnation. "Those who understand our doctrine never attack it; they speak of it only to express their admiration: above all, they never think of wishing to modify it, because they know that its fundamental dogmas are unshakeable." "Surtout ils ne s'avisent jamais de vouloir la modifier," &c. A man who assumes such ground as this, had need be very careful in assuming his positions, indeed; and should particularly avoid any thing like self-contradiction. The _Lettres a un medecin de province_, in a style of lively criticism, labour to show a great variety of inconsistencies in this immoveable doctrine. The review of this publication in the Revue Medicale, including copious extracts, coincides with, and evidently wishes to aid, the author's satire. In the same journal are a series of criticisms on some of the elementary propositions of Dr. BROUSSAIS, published in a late edition of his Examen; (nearly the same which were published here, some time since, in the American Medical Recorder, having been translated by Dr. ATKINS.) In these critiques, great severity is shown, in dealing with the new dogmas, and the doctrine is treated as one of dangerous tendency; while, at the same time, high praise is awarded to their author, for his discoveries in the diseases of the alimentary mucous membranes. In the other journals, there is a division; some favouring the new opinions, while others oppose them with more or less of vehemence. That the doctrine of gastritis has made a great impression at Paris, that almost every one believes in it, to a greater or less extent, appears undeniable; but there, as well as here, most of the more rational, and moderate minded men are evidently of the only school a physician ought to belong to, the _eclectic_. Borrowing largely from BROUSSAIS, and having had their minds powerfully stimulated by the succession of striking and novel ideas which he has introduced, they think it unmanly to "bind themselves to his chariot-wheel," but form conclusions for themselves from every resource within their power. If the great French reformer really wishes to establish as absolute a power over the minds of his followers, as MAHOMET or PYTHAGORAS did, and as the above-quoted extract seems pretty fairly to indicate, he must certainly undergo many mortifications. Notwithstanding the "inebranlable" nature of his dogmas, M. MIQUEL has furnished us with several variations from them, in the writings of Messrs. BOISSEAU, ROCHE, SANSON, REMUSAT, RICHOND, and BEGIN; and the last-named individual has had a public dispute with his preceptor. M. BEGIN has produced his promised work on surgery, according to the principles of the new school. We have not seen the volume, but have read a review of it in the Revue Medicale, by M. BELLANGER. The latter describes it as a cursory work, having for its object the adaptation of surgery to a set of general principles, rather than a detailed system of instructions how to proceed in each individual case. It contains only what is easy to be remembered, and omits those matters for which it is usual to refer to books. Thus two pages only are appropriated to fractures of the body and neck of the femur! and twenty-six for the whole subject of fractures, wounds, and six or eight of the most important diseases, of bones! Yet all this criticism is not without a compliment, well-merited at least by the former productions of the same author, to his talents and ingenuity. 19. _Whooping-cough._--"There is no disease of children, in which the resources of medicine are more manifestly serviceable than in an obstinate whooping-cough." Such, in amount, was the opinion of Dr. UNDERWOOD, and Dr. WATT uses language almost equally strong. Certainly, we are not at all times equally successful or equally sanguine in America. Dr. A. CAVENNE considers whooping-cough a true bronchitis, a pulmonary catarrh; accompanied with greatly heightened nervous symptoms, owing to the irritable period of life at which it occurs, and particularly to its frequent existence in nervous constitutions. Professor TOURTELLE calls it a pneumo-gastric, pituitous catarrh; and certainly, the pupils of a modern school will find no difficulty in recognizing symptoms of gastritis in its severer forms. The further inferences drawn by Dr. CAVENNE, are as follows: 1. That the whooping-cough, in an individual of a sanguine temperament, requires, in general, the use of bleeding, and a debilitating regimen. 2. That bleeding and a debilitating treatment are equally necessary, whatever be the temperament, in whooping-cough of the chronic form. 3. The antispasmodics are necessary in nervous constitutions. 4. That blood-letting and the debilitating treatment should be rejected, when the subject is endowed with a lymphatic temperament. This observation, says our author, is equally applicable to early infancy, in which lymph predominates over the red blood, and the fluids are more diluted. Finally, if the disease be obstinate and there be disturbance in several functions, there is certainly reason to believe that a lung, a viscus of the abdomen, or the brain, is in an unfavourable condition; (the author means of the inflammatory kind;) and this is ground for the moderate abstraction of blood.--_Journ. Univ. Feb._ 20. _Antiperistaltic globus. Globus hystericus._--Dr. TROLLIET, of Lyons, observes that hysteria cannot, with propriety, be said to exist in the male sex; that it arises, as its name imports, from derangement of the uterus, and that CULLEN and SYDENHAM have done wrong, and stand alone, in teaching the contrary. When there exists a real hysteria, the contractions are not confined to the intestinal regions, but invade the neighbouring parts; (quere, which of them contract?) they are always accompanied, when existing in a high degree, with convulsions and loss of the mental powers. In the intervals, the patients affected can satisfy their appetite. Antiperistaltic globus may occur from various causes; and either in the intestines or the oesophagus. That of the intestines is met with chiefly in advancing age; and is generally produced by daily and often-repeated pressure on the abdomen, as practised in various professions. Hard labour and bad diet also greatly aggravate it. At first pain in the intestines occurs, aggravated by labour; together with derangement of digestion. The sensation of a globe then appears on the lower and left side of the abdomen; and, after performing various circuits, finally reaches the stomach; from which is soon after discharged, with great relief, a quantity of gas, issuing from the mouth. Vomiting of an acid and burning fluid, as also of the food, is not uncommon as an accompaniment. This ball is about the size of a man's fist, and is sensible to the external touch, and even to the sight. The patients possess the power, to a certain extent, of controlling its motions, and relieving the pain, which is often extremely violent, by pressure. Indigestible food always aggravated the disease. Some could only tolerate milk, broth, and other fluids. A weaver was obliged to quit his profession, from the pressure on the abdomen which it required, occasioning the paroxysms. The treatment consisted in 1. Avoiding the original causes. 2. The use of a species of corslet, (plastron,) to prevent future pressure on the abdomen. 3. A rigid diet. We do not understand why, firstly, articles containing a great deal of fecula, and, as it is said, "requiring a great action of the intestines," are forbidden, while, in the second place, rice is recommended. "Bouillon aux herbes," (a laxative decoction,) rice-cream, and milk, were found the best. Wine was injurious. Assafoetida and camphor were useful, and were administered in boluses. Purgatives were injurious. Emolient enemas were useful. Of antiperistaltic globus in the oesophagus our author saw only two cases, which were not complicated with hysteria. The patients had both been subject to rheumatism; and, in one of them, this had been supplanted by an eruption Of tetter: on the disappearance of which last the globus appeared. These cases were cured, the latter by a severe, light diet, and some antispasmodics, the names of which are not mentioned; the other by curing the rheumatism. Dissections are somewhat difficult to obtain; unless where some other more mortal disease exists. In one, scirrhus of the pylorus was found; the stomach greatly enlarged; the small intestines contracted, _red outside and gray within_. (Where was the redness situated; in the peritoneal or the muscular coat? We must _guess_ the latter.) The stomach was pale gray, and thickened. The large intestines were dilated, and gray.--_Journ. Univ._ 21. _Non-contagion of Yellow Fever._--Dr. VALENTINE, of Nancy, has printed a pamphlet of a single sheet, in which he finds himself involved in all the turmoil, through which American physicians passed during the period which intervened between 1793 and 1805. Dr. V. gives his authority decidedly in favour of the non-existence of a contagion in this disease; and grounds his opinion upon the innumerable cases of patients affected with the disease and otherwise, who have escaped from infected districts, without communicating the malady in any instance, to the persons with whom they lived; upon the healthiness of ports, from which it has been said to have been introduced, &c. Dr. V. is not, as some of his countrymen have been, unwilling, from some unimaginable cause, to make use of the immense mass of American evidence; though he observes, and with justice, that experiments should be repeated in France, in order to set the public mind at rest in that kingdom. He proposes the employment of criminals for this purpose; and recommends every mode of the most close contact which his imagination could suggest. He mentions experiments of this kind having been made in the United States; and by M. GUYON, of Martinique, on his own person. He quotes Dr. CHERVIN's labours, with great and just applause. This indefatigable and daring physician has now spent upwards of ten years in accumulating proofs upon this single question. At the commencement of the pamphlet, the arrangement of which does not seem to us to be quite clear and easy, Dr. V. gives a sketch of the situation and localities of Leghorn. He traces the fevers of that place to putrid matters, perceptible by the sense of smell; and principally to obstructed drains. He does not give the exact degree of heat, but merely states that it was excessive, and followed by heavy rains. IV. THERAPEUTICS, MATERIA MEDICA, AND THE PRACTICE OF MEDICINE. 22. _Iodine._--In the former numbers of this journal, we offered some observations respecting the medicinal properties of iodine, intending then to present in one of our future numbers an elaborate analysis of a valuable work on this subject, by Dr. Manson, which appeared in England sometime last year.[32] Fearing, however, that the want of room and time will prevent us from fulfilling this task, as soon as soon as might be desired, we have thought that a condensed notice of its contents would be acceptable in this place. It appears that previously to the discovery of iodine as a medicinal agent, our author used the burnt sponge in bronchocele, a disease very common in the neighbourhood of Nottingham, where he practices. But when the effects of the former remedy was announced, Dr. M. prepared a tincture composed of one drachm of iodine to two ounces and a half of rectified spirit, (spec. grav. 916.) and prescribed it very extensively in doses of from 10 to 30 drops three times a day, according to the age and strength of the patient. Dr. MANSON has presented a tabular view of 116 cases of bronchocele treated by iodine, and also a detailed account of 15 more cases, with appropriate remarks. Of the former, there were, viz:-- Males--Cured, 10 Much relieved, 1 Discharged for non-attendance, 1 Improving under treatment, 3--Total 15 Females--Cured, 66 Much relieved, 9 Not relieved, 2 Discharged for non-attendance, 10 Improving under treatment, 14--101--116 Whilst using the tincture internally, Dr. MANSON occasionally had recourse externally to a liniment composed of Liniment. Sap. Comp. [Symbol: ounce]i Tinct. Iodinæ, [symbol: dram]i _m._ Some patients can bear this quantity rubbed into the tumour once, and sometimes twice a day; though in some, the skin is so tender, that the liniment cannot be so frequently used. Dr. M. prefers this liniment to the common iodine ointment, as less liable to evaporation. In France, we believe Dr. RICHOND prefers rubbing in the tincture itself. The following remarks are useful: "In some _individuals_, after the preparations of iodine have been given internally for some time, they are apt to occasion headach, giddiness, sickness of stomach, with some degree of nausea, langour, and inaptitude for exertion; when these unpleasant sensations and effects occur, the best plan to remove or obviate them is to suspend, for a time, the use of the medicine, or to reduce the dose, as may seem most expedient." A reduction of dose, from fifteen to twelve drops, was the plan adopted by our author on this occasion. 2d. _Paralysis._--Want of success with the ordinary modes of treating this disease, induced Dr. MANSON to try the effects of iodine. "The wonderful powers of iodine, which I had recently witnessed; and a long previous acquaintance with the same remedy as it exists in burnt sponge, in reducing morbid enlargements of the thyroid gland, led me from analogy, to think, that in cases of palsy, from tumours or fluids pressing on the brain or spinal cord, or from morbid thickening of the investing membrane of the cord itself, iodine might prove a useful remedy not only by stimulating the nervous system, and removing morbid tumefaction and effusion, but also by correcting the strumous state of the constitution that often gives rise to the disease." The following interesting case as abridged in the Medico-Chirurgical Review, for January 1826, we take the liberty to transcribe. "J. Watterton, aged 19, was admitted into the General Hospital of Nottingham, on the 27th of March, 1821, having been ailing since October, 1819. Stated that he had at first been attacked with pain in the bowels, which having ceased, the lower extremities became swelled and painful. "After this, his neck became stiff and painful, with shooting pains from the neck into the left side of the head. These also disappeared, and did not afterwards return. This was about nine months ago, and, at that time, he suddenly lost the power of the left arm, and in a short time afterwards, that of the left lower extremity. Some time after this, he recovered, partially, the use of the left arm; the leg remaining paralytic. About this time, the _right_ half of the body was instantaneously and completely palsied. He has continued ever since in this wretched state, getting worse rather than better, passing his stools and urine, involuntarily. He lies on his back, and, with the exception of the left arm, he is completely paralytic on both sides, from the neck downwards. The sense of feeling is very much impaired--there is no distortion of the face, nor impediment of speech. Is troubled with twitchings in the lower extremities. _Purgatives--blisters to the nape of the neck, and to be kept open._ "It appears that, about two years ago, he had a bloody purulent discharge from both ears. The left still continues to discharge a purulent looking matter. Purgatives were continued till the 6th of April, when the tincture of iodine, in doses of 15 drops, was given thrice a day. April 9, can raise the right arm nearly to the head; but the power of the lower limbs has not improved. The twitchings have decreased. Purgatives--the tincture of iodine to be increased to 20 drops ter in die. 10th. Evinces some muscular power in the lower extremities to day--feels stronger--can retain his urine for some time. 14th. Continues to improve. The left foot is become exquisitely sensible, and that extremity is often drawn up spasmodically towards the body. The iodine to be increased to 25 drops. 16th. The paralytic symptoms continue to yield to the powerful influence of the iodine. When his meat is cut, he can now feed himself with the left hand;--can raise the right hand to the chin, and draw the right upper extremity up towards the body. He continues to hold his water. The iodine is increased to 30 drops, thrice a day--from this date to the 7th of May, the medicine was occasionally obliged to be intermitted and again commenced in smaller doses. At this period, however, the patient could walk from his bed room to the day ward with very little assistance. 19th. He can walk without any assistance, except that of a stick to steady him. June 9th, can walk without a stick. He is gradually recovering the power of motion and sense of feeling. Drops agree. Appetite good, and is allowed full diet. July 3d, the patient was discharged cured." Besides this highly interesting case, 24 more of paraplegia, hemiplegia, and partial paralysis, are given in detail, in which the iodine was exhibited with various success. In his prefatory remarks to this chapter, Dr. MANSON observes, that although he has been able to cure only a proportion of the cases of palsy that have come under his care since April 1821, yet he has been much more successful in his practice since that time, than he was previously with the use of all the ordinary means. Having succeeded so well in paralysis, Dr. MANSON was induced to try the effects of iodine in chorea, which he thinks is more closely allied to palsy than is supposed, and is linked to it by that species of the disease called shaking palsy. Of chorea treated with iodine, and showing the efficacy of the remedy, Dr. MANSON details eleven cases, and concludes this section with a tabular view of 72 cases treated at the General Hospital near Nottingham, between the 6th of October, 1812, and the 5th of October, 1824. In all the cases detailed by our author, the iodine was administered after purgatives, and throughout the treatment, the bowels were carefully regulated by aperient medicines. Dr. MANSON next records the results of his experience with iodine in scrofula--detailing three cases of scrofulous enlargement of the conglobate glands--two of scrofulous ulcers, and four of scrofulous ophthalmia; in all of which, the most beneficial effects were obtained. Our author details eleven cases of fistula lachrymalis, in which iodine produced the happiest results. He was led to prescribe iodine in this disease from the circumstance, that one of the individuals to whom he gave it for paralysis, laboured under the fistula, and was promptly relieved of it, whilst under the use of the remedy. Dr. MANSON has likewise detailed nine cases of deafness cured, or greatly relieved, by iodine. In most of these cases, the disease originated from obstruction of the Eustachian tube, the consequence of swelling of the tonsils, or of the membrane of the tube itself, from previous inflammation. Seven cases of dysphagia, eleven of white swelling, four of morbus coxarius, and eleven of distortion, form the subjects of the four succeeding sections. The medicine in all these cases, manifested so very decided a power in arresting the progress, and even in curing the disease, that we think ourselves safe in recommending a trial of it in similar cases. As the iodine, however, is a powerful stimulant, we would advise it not to be prescribed when there exists any fever, and especially when there are any decided signs of gastric irritation, as it would be likely to aggravate it. 23. _Non-mercurial treatment of Syphilis._--In the first number of this Journal, we inserted an essay on this subject, by Dr. THOMAS HARRIS, of this city, in which the author confirms, by the results of his public and private practice, the statements of the British army surgeons respecting the efficacy and safety of the non-mercurial treatment. Since that period, having noticed that, by the worthy editor of a respected cotemporary, it is asserted that though mercury fails, "yet from the most ample experience in Europe, the present practice of Paris, England, Ireland, and the Continent generally, we must lean to the idea, that its use, under proper regulations, must be always adopted, as the only safe mode of cure in these diseases," we deem it but justice towards Dr. H. to call the attention of our readers to the result of the extensive experience of some physicians on the continent of Europe. Not to mention BROUSSAIS himself, who appears to have rejected mercury almost entirely in the treatment of primary or secondary symptoms, we may cite Mr. RICHOND, who reports that he treated, at the military hospital of Strasburgh, nearly 3000 cases of syphilis in all its grades, the vast majority of which were completely cured without mercury, and simply by means of antiphlogistics, emollients, and revulsives. Mr. RICHOND, besides some essays in the Archives Medicales, and a summary of his experience in the preface to his work on apoplexy, has lately published an elaborate work on the subject. In the October number of the Annales de la Médecine Physiologique, Mr. BECQUART of the military hospital of Bayonne, details twenty-six cases of gonorrhoea, inflammation of the testicles, chancres on the glans and lips, buboes, excrescences around the anus, &c., all of which were cured without mercury, and with the same remedies as were employed by Mr. RICHOND. We might adduce the testimony of other French physicians, and particularly of M. BEGIN, but we deem it unnecessary, as the above will be sufficient to show that in France the practice meets with the support of many very intelligent physicians. We annex the conclusions of Dr. OTTO of Copenhagen, drawn from an extended personal experience, and from his researches on the subject. Dr. OTTO'S essay is contained in a late number of Gräafe's and Walther's Journal, and the conclusions are published in the Edinburgh Medical and Surgical Journal. Dr. O. remarks: 1. That the cure of syphilis, without mercury, has been asserted by so many authorities, that the fact can no longer be doubted. If, then, the disease could formerly be cured without mercury, it may certainly now be much easier, as it has lost much of its violence and obstinacy. 2. Syphilis can undoubtedly be radically cured in this manner; but then the cure is of longer duration, and the diet requires considerable restriction. 3. The secondary symptoms, and a return of the complaint, are certainly more frequent; but the symptoms are not so difficult of removal; and the treatment has a much more speedy effect. 4. As the treatment without mercury requires a longer time, it appears more practicable in hospital than in private practice; and on the other hand, the patient can be better watched in a hospital, which, on account of the diet, is of great importance. 5. As ulcers on the genitals are often not syphilitic, and the use of mercury is contraindicated from a predisposition to scrofula or phthisis existing in the individual, it is consolatory to learn from the results of experience, that this medicine is not always necessary, and that a radical cure, by more simple and innocent means, can sometimes be effected. Where, however, the physician is anxious to avoid the possible evils which mercury is capable of producing, and also to prevent loss of time, there remains a middle way, namely, to employ mercury, whose specific action can scarcely be denied, in moderate doses. It results from a report of the cases of syphilis admitted into the public institutions of Sweden, that 3,574 were treated in 1822; 3,465 in 1823, and 3,355 in 1824. During the course of this last year, 55-3/10 per centum of all the patients were treated by the mercurial method, and 35-1/10 per centum by the non-mercurial method, and by low diet; 2-1/2 per centum by means of fumigations. MM. KESSLER, WURSTER, RONBERG, and SANDMARK, prefer the dietetic method, and consider it as the surest of all those hitherto employed. Relapses are rare. In 1822 they amounted in relation to the whole number of cases, to 11-2/3 per centum; in 1823 to 10-1/4, and in 1824 to 10-2/3. After the treatment by starvation, they amounted in 1822 to 7-3/4 per centum; to 7-1/3 in 1823; and to 8-1/3 in 1824. After the mercurial treatment, in 1822 to 17-1/2 per centum; in 1823 to 14-1/16; and in 1824 to 14-1/2. _Bulletin des Sci. Med._ We hope to lay before our readers at some future period, an analysis of Mr. RICHOND's work above alluded to, as well as of one on the same subject by Mr. JOURDAN of Paris, author of some essays on the origin of syphilis, translated and published here a few years ago. 24. _Cancer treated by Antiphlogistics._--Of all diseases classed among the opprobria medicorum, cancer has hitherto been justly viewed as holding the most conspicuous rank, and it is only within a short time, that it appears to have been treated on correct principles, and that cures have been detailed by individuals of undoubted veracity. The idea of the inflammatory nature of cancer, and of the propriety of treating it by means of antiphlogistics, has been held many years ago, and supported by VASALVA in Italy, FEARON in England, HUFELAND in Germany, POUTEAU and VACHER in France, not to mention other high authorities. But, notwithstanding the success attending this practice, it was too simple for the supporters of cancerous humours and specific inflammations, and seemed, in consequence, to have been abandoned by them, in their search after anti-cancerous or specific remedies; and little was heard of it, until revived by the disciples of the physiological school of France, and particularly by its founder professor BROUSSAIS, and by professor LALLEMAND of Montpellier, the result of whose experience is published in a thesis, lately defended at Montpellier by Dr. MARESCHEL. We have been led to these reflections from reading the above essay, and another on the same subject, published by Dr. J. A. PUEL, in a late number of the Archives Générales de Medecine. Dr. P. details many cases, which were treated by his father, by means of leeches, emollients, purgatives, &c. so early as 1807. In most of these cases, the practice appears to have been very successful. As it is our wish to impress our readers with the propriety of making a fair trial of this method, in cases of scirrhus and cancer, we shall select and translate a few cases from the latter essay. It is proper to premise, however, that the practice must not be viewed as completely successful in _every_ case, and that the older the complaint, the less confident we ought to be, in respect to the happy results of the case. Nor is it to be expected, that _boldness_ in the employment of the lancet and leeches, will answer as well as a perseverant, constant, but moderate use of these means. Chronic inflammations are not to be removed by storm, but by a _chronic_ use of remedies, and particularly by attention to diet. We cannot at present determine precisely the proportion of cures effected, by this method, of scirrhus or cancer, in a given number of cases, and how far it will surpass, in point of success, the common method of treatment by _specific_ narcotics and escharotics; but, even supposing that it is not more successful, (which we are disposed to deny,) it has at least the vast advantage of being more _comfortable_, and much less painful to the patient. Mrs. D. enjoying good health, and mother of three children, was brought to bed in 1823, of a healthy child, which, however, she did not suckle. With a view of suppressing the secretion of milk, irritating applications to the breast were resorted to, which brought on an inflammation of that organ. Emollient poultices were now applied; these, however, did not prevent the formation of an abscess, which was opened by means of caustic potash. The suppuration, for a few days, was abundant and the matter discharged healthy. Purgatives were prescribed, with the view of suppressing the discharge, and mercurial ointment was rubbed on the tumour, to produce its absorption. These remedies were not successful, because no means were employed to arrest the inflammation, which gave rise to the suppuration. When the patient applied for advice, she had been sick already four months, and presented the following symptoms. She was very much emaciated, and laboured under fever, resulting from a gastro-enteritic inflammation, kept up by purgatives and deostruents, (_fondans_,) which, from the commencement of the attack, were prescribed for her. The ulceration of the mamma was of the size of a five frank piece, unequal and gray, and gave issue to an ichorous and foetid purulent matter. The edges were thick and everted, and surrounded with an erysipelatous inflammation. The whole mamma was large and hard, and the seat of lancinating pain. Thirty-five leeches were applied around the tumour, and gave rise to a profuse hæmorrhage, which continued many hours. From this, the patient experienced so much relief from pain, as to be able to take some repose, of which she had been deprived for some weeks. Emollient poultices and drinks were prescribed, and a low diet enjoined. By all these means, the pain was lessened, and the swelling much diminished. Leeches were again applied, and the other remedies continued. The wound gradually improved, and in forty five days, was completely healed. Mr. P. was called on the 25th of September, 1817, to attend a lady, who had been affected for two days with uterine hæmorrhage, which he succeeded in arresting. The following history of her complaint was given to him: she had aborted about 18 months before, and since that time, had experienced every fortnight an uterine hæmorrhage, which generally lasted five or six days. During the intervals, she complained of deep seated pain, numbness and cramps, in the lower part of the abdomen, in the thighs and groins. The pain was much aggravated when she had a stool--walking, especially when long continued, was painful, and attended with a sense of dragging, which was only relieved by repose. From the same period, her disposition had changed from gay and lively, to melancholy and morose--her digestive functions were slow and painful--she was affected with leucorrhea, and during coition, felt much pain, and often lost some blood. On examination per vaginam, it was found, that the neck of the uterus was elongated--the anterior lip of the same organ was soft to the feel--the orifice somewhat enlarged, and painful when the finger was introduced into it. On the inferior lip there was a small unequal and painful spot, which was regarded as a superficial ulceration; the uterus was a little prolapsed, and somewhat enlarged; the pulse small and frequent; febrile exacerbations every evening; sleep not refreshing, and interrupted by short lancinating pain in the uterus. The disease was judged by Mr. P. to be a chronic metrites, with ulceration, and all the symptoms usually attending incipient cancer. Guided by this belief, and notwithstanding the already long duration of the disease, and the debility of the patient, the following treatment was adopted--complete repose in the horizontal posture--leeches to the vulva, repeated several times--vaginal injections, with emollient decoctions--hip baths--very low diet. After persevering in this plan twenty days, the patient appeared much better, and was allowed to sit up. General baths were substituted for the partial ones. The same treatment was continued, with the exception of the leeches, and at the end of thirty days more, all the symptoms of the disease had completely disappeared. Mrs. P. was allowed to spend the following spring in the country, from whence she returned in very excellent health. She has since continued to enjoy it, and has borne several children. Cases nearly similar, are detailed by Mr. MARESCHAL, as having occurred in the practice of professor LALLEMAND. The same gentleman, also gives the history of two cases of external cancerous sores, in which the same treatment was adopted. The patients having died during the progress of the cure, of other diseases, an opportunity was offered, of examining by dissection, the changes that had occurred in the parts. We cannot enlarge on the subject in this place, and can only remark, that these changes were such, as to lead us to hope, that less difficulty will be experienced in the treatment of sores reputed cancerous, by the local antiphlogistic plan, than is commonly supposed. At any rate, recommended by such high authorities, the practice deserves a trial. The Revue Medicale for February 1826, contains the details of a case lately cured at La Pitié, by Mr. LISFRANC. The patient, a woman, aged 36 years, of a strong and good constitution, had suffered the removal of a cancerous breast, 18 months previous to her admission into the Hospital, on the 10th October, 1825. The following symptoms were observed. On the whole surface of the cicatrix were felt a number of engorged ganglia, and an induration situated on the large and small pectoral muscles, and spreading from the clavicle to all the external and superior part of the thorax, and as far as the axilla, where other swollen ganglia were felt. The enlarged surface was elevated about half an inch above the level of the chest. Severe lancinating pains were at short intervals felt by the patient--which came on without any evident cause, and were particularly severe on the least pressure of the swollen part. This patient was treated by means of frequent and copious bleeding from the arm--the very frequent application of leeches to the inflamed part, and to the upper and interior part of the thighs, to bring on the menstrual discharge--digitalis to remedy the frequent palpitations--emollient applications, and low diet. On the 10th of January, she was considered well;--the swellings and pain having disappeared--the menstrual discharge being well established, and the movement of the arm (which during the progress of the disease had been impeded from the swelling in the axilla) perfectly free. We are happy to learn that this practice is pursued with success by the Spanish physicians, as may be readily found by a reference to a late number of the Periodico de la Sociedad Medico Quirurgica de Cadiz, which contains cases of scirrhous mamma cured by the repeated application of leeches. 25. _Essential oil of Male Fern, as, a remedy in Cases of Tænia._--The male fern has long been regarded as a valuable anthelmintic medicine; but, as every powder administered in large doses, its exhibition is difficult and disagreeable; so much so, indeed, that many patients refuse to make a sufficiently constant use of it to ensure its beneficial effects. Struck with this inconvenience, M. PERCHIER, a pharmaceutist of Geneva, has lately made some experiments with a view of discovering its active principle, and to see whether this latter may be administered with equal success with the powder or infusion of the plant. We are happy to learn that the result of his experiments are very satisfactory. We translate the following observations from a memoir on the subject, read on the 7th of October last, by Mr. GENDRIN, before the medical society of the department of the Seine. "This medicine, which is a fatty oil extracted by distillation from the æther, in which the powder of the root of the male fern has been macerated, has caused in many cases, the expulsion of the tænia, without occasioning nausea, colics, or any other morbid phenomena." "It is exhibited at bed time, either in an oily potion, in pills, or incorporated in an electuary, in doses of 18 or 20 drops. On the following morning, a similar dose is given, and two hours after, two ounces of castor oil are administered. In most cases, the tænia is expelled in the course of the day, but if this does not occur, the same doses of the oil are given in the same way, and followed by a similar quantity of the castor oil. The fatty oil of fern, has an æthereal and empyreumatic smell; its colour is brown, and its consistence rather greater than that of castor oil; it is, however, easier to separate in drops. Its taste is acrid, pungent, empyreumatic, and very disagreeable."--_Propagateur des Sciences Medicales, Janvier 1826._ 26. _Tincture of Bastard Saffron[33] for the expulsion of Tænia._--Dr. CHISHOLM, of Canterbury, has lately used with success, in a case of tænia of many years standing, the vinous tincture of bastard saffron. The patient had already undergone various plans of treatment, and had especially used the oil of turpentine in very large doses. Dr. C. was induced to try the above remedy, from having noticed, that in a case in which it had been prescribed for the cure of rheumatism, a large portion of tænia had been expelled. He consequently administered two ounces of the tincture; advising the patient to take a table spoonful more of it mixed in a little water, two or three times a day. On the third or fourth day after commencing the use of this remedy, the patient voided a large portion of the worm, and has since been free from the usual symptoms of the disease. 27. _Oil of Turpentine in Tænia._--Although the oil of turpentine is used in many parts of this country, in cases of tænia, we have good reasons for believing, that some physicians continue, notwithstanding the testimony in its favour, to hesitate exhibiting it in doses sufficiently large to destroy and promote the expulsion of the worm. Such being our opinion, we are induced to offer here a few remarks on the subject, and to notice a memoir published by Dr. DE POMMER, in a late number of Hufeland's Journal. The employment of this remedy in such cases, is not of recent origin, having been resorted to many years ago by the Swedish practitioners, and subsequently revived by the English. In Germany it has recently been used by Professor OSAN, and we believe particularly by Dr. DE POMMER, who appears to have prescribed it boldly in very many instances, and in some, after the ineffectual employment of all other anthelmintics. Dr. P. adds, that he never saw any bad effects resulting from its use, and that patients are very little liable to relapses when treated by it. Among the cases detailed by Dr. DE POMMER, we select the following, as calculated to show the manner in which the Dr. uses the remedy. "G.K..., a soldier aged 21 years, thin, tall, and who during his infancy had been subject to ascarides, has occasionally voided during more than 10 years past, portions of tænia. He had used several purgative medicines, by which several yards of this worm had been expelled; but annoyed with so many attempts at obtaining its total expulsion, he had ceased, three years before, the use of all sorts of anthelmintics. But the phenomena resulting from the presence of the animal being aggravated, the patient applied for advice to Dr. DE POMMER, who found him labouring under the following symptoms:--Frequent pain in the abdomen, and especially in the umbilical region, accompanied with a sense of burning heat, and alternate distension and depression of the abdomen. Appetite sometimes keener than in health; at others nearly lost. In the morning before breakfast, the patient was seized with extraordinary weakness, and general uneasiness, accompanied with trembling of the limbs, ineffectual attempts to vomit, a sense of constriction in the throat, and a profuse salivation. All these symptoms disappeared after K... had taken food; but reappeared two hours after. Milk and farinaceous aliments were the only articles of which he could make use without an aggravation of his disease. The pulse was febrile; sleep good, but attended with dreams. The pupils were in the natural state. From the symptoms, and from the history of the case, Dr. P. was induced to make use of the oil of turpentine in the following manner. The patient was ordered in the morning, before breakfast, three table spoonsfuls of the remedy, at half an hour's interval. The first doses produced only a few borborygma. Two more table spoonfuls occasioned a vomiting of mucous matter. Three more table spoonfuls were exhibited, and followed by a stool of solid fæces, mixed with which were five small pieces of tænia. The patient not finding himself incommoded, took in the space of an hour, three more table spoonfuls of the remedy, after which he experienced some pain in the head, and vomited about one pint of bilious liquid. An hour after, the same quantity of the medicine was taken, and followed again by vomiting, but after a repose of half an hour K... discharged, per anum, firm and greenish fæces, and with them five ells of tænia. The urine discharged had the smell of violets. He again took a few spoonfuls of the vermifuge, which were not followed, however, with any fæcal discharge, and only with some vomiting of mucus, and slight vertigo. In the afternoon the patient felt well, and experienced a great appetite, in which he indulged. From this moment he recovered, and has ever since enjoyed good health. The quantity of the remedy used was six ounces." It appears, from the observations of Dr. P., that the gastric irritation occasioned by the spirits of turpentine, has never amounted to phlogosis, and has generally subsided after the remedy had been discontinued. Nevertheless, as the spirit of turpentine is a very powerful stimulant, we would not venture to recommend its use, when there exists an inflammation in the gastro-enteritic system. We are aware that it is resorted to in burns, and highly eulogized in puerperal and yellow fever. In the first, it is certainly very useful, but on what principle we know not, except perhaps that its stimulus is different from that existing in the diseased part. But in the second case, it acts, not on the diseased surface, but by revulsion, on the mucous membrane; and as regards its virtues in yellow fever, we are rather sceptical in respect to what has been said on the subject. In this opinion we are supported by the testimony of our friend Professor RHEES, whose situation of house surgeon to the fever hospital, during the epidemic of 1820, afforded him ample opportunities of testing the propriety of the practice. In the number for March 1826, of the Revue Medicale, M. MAUDRU relates two cases in which large portions of tænia were expelled, and the patients cured, by means of a strong decoction of the bark of pomegranate. The first patient took, in one day, two pounds of the decoction made with four ounces of the remedy. The second patient took six ounces of the bark in decoction, in the course of forty-eight hours. In neither case did the medicine occasion unpleasant effects, with the exception, in the second patient, of slight colicky pains. 28. _Action of the Oil of the Euphorbia Lathyris._--At a meeting of the Academy of Medicine, (section of pharmacy) M. BALLY read the results of some clinical experiments made by him at the hospital of La Pitié, on the action of the oil of the euphorbia lathyris. The preparation used by him, had been made by means of alcohol and expression. It appears to be a little more active than the other preparations. Administered to fifteen individuals of different ages, it did not produce very various results, nor prove very active in its purgative effects. As a purgative, indeed, it is far less active than the croton oil, and requires to be given in much larger doses; as much as six or ten drops. It has also the bad property of exciting emesis, by which it is rejected from the stomach. On the other hand, however, it does not, like the croton oil, produce salivation, and is, on the whole, regarded by M. BALLY, especially when fresh, as a useful purgative in diseases of children.--_Archives Generales, Decembre, 1825._ 29. _Medicinal properties of the Apocynum Cannabinum, or Indian Hemp._--In an essay on this plant, submitted to the medical faculty of Jefferson College, by Dr. M. L. KNAPP, we are informed, that in doses of 15 or 30 grains it possesses emetic properties. It was besides, on trial, found to be cathartic, expectorant, diuretic and diaphoretic. It appears to have been generally administered in powder, and Dr. K. remarks, that "in decoction, it seems to lose some of its emetic properties, and to act more upon the bowels as a hydragogue cathartic." "The root possesses all the medicinal properties of the plant, and is active throughout, both in its cortical and ligneous portions. Water or proof spirit is its proper menstruum." This article was prescribed with success in dropsy, by Dr. KNAPP, and by Dr. PARRISH of this city. It was likewise used in intermittent fever, in bilious affections, amaurosis, hernia humoralis, dysentery, chronic rheumatism, &c. Dr. KNAPP appears to have derived benefit from its use as an alterative in a case of fever in a child, attended with disordered bowels. "The powders (gr. ii. each at intervals of three hours,) were regularly persisted in for a week, and the child's health went on gradually improving. Neither vomiting nor purging was produced, but the morbid heat and thirst were allayed, the stools became natural, the skin soft and moist, and the functions of digestion and assimilation were gradually restored, and the child is at this time fat and healthy."--_American Medical Review, &c. April_ 1826. 30. _Remarkable effects from the external application of the Acetate of Morphia._--M. DUBOURG has recently published the result of an experiment made at the hospital de la Pitié, with the acetate of morphia, which we regard as sufficiently interesting to be noticed in this place. The patient had been affected twelve months before with puerperal peritoneal inflammation, complicated with cerebral symptoms, from which, notwithstanding a most energetic antiphlogistic treatment, she never entirely recovered. When she was admitted into the hospital, she presented the following symptoms:--"considerable emaciation; skin hot and pungent to the feel; pulse small and frequent; tongue of a pale rose colour, dry at the tip and edges, brown and smooth in the centre as far as the basis; severe pain on the least pressure on the epigastrium and over the whole abdomen; cardialgia, nausea, vomiting of all solid and liquid aliments, and during the empty state of the stomach, violent efforts to vomit occurring at irregular intervals; abdomen tense and tympanitic; violent intermittent pain along the course of the intestines; constipation; sensation of fatigue and lassitude in the lumbar region and in the extremities; dragging pains in the inter-scapular region; extinction of the voice; urine red and scanty; the face animated and bearing no marks of profound suffering; agitation, and total want of sleep." The disease was regarded as a chronic gastro-entero-peritonitis, and treated accordingly, by the antiphlogistic regimen; but no benefit was derived from this plan. The patient continued to vomit almost every thing she took, with the exception of sugar and a paste made with the Iceland moss. A blister was applied to the epigastrium on the 15th of February, seven days after her admission. Called to her assistance on the 22nd of February, on account of an aggravation of the vomiting, M. LAMBERT, one of the house pupils of the hospital, endeavoured to calm the symptoms by means of the acetate of morphia in powder, applied to the raw surface of the blister. Half a grain was used in this way, and in a few minutes the vomiting disappeared, and the patient passed a better night than she had yet done. M. SERRES having authorized the continuance of this method, M. DUBOURG the next day applied half a grain in the same way; and the patient slept the whole night. The remedy was applied every day with the same effect, and was gradually increased to two grains and a half. From the first application of the remedy, the symptoms gradually subsided; aliments were retained and properly digested; the pain and swelling of the abdomen disappeared, and on the 14th of March the patient was regarded as in a fair way of recovery.--_Archives Generales, March_ 1826. In some remarks which accompany this interesting case, M. DUBOURG, seems to doubt the correctness of the first diagnosis, and to view the disease as a nervous, rather than as an inflammatory affection of the abdominal viscera. 31. _Cure of Urinary Calculi by means of the internal use of the Bicarbonate of Soda._--At a late meeting of the Academy of Medicine, Mr. ROBIQUET read a memoir on the use of this salt in cases of urinary calculi. Having learnt from Mr. DARCET, that the use of the waters of Vichy changes the quality of the urine from acid to alkaline, Mr. R. conjectured, that this effect should be attributed to the bicarbonate of soda contained in them; and from this circumstance, he was led to administer this salt internally, in cases of calculi composed of uric acid. In July last, he made the experiment on a man 74 years of age, who had laboured under symptoms of the disease since the month of February, and in whom, by means of the sound, a small and soft calculus had been detected. Mr. R. ordered him 10 grains of the bicarbonate in the course of the day, dissolved in two pounds of water--prescribing at the same time, hip baths, injections, &c. At the end of fifteen days, much benefit had already resulted from this treatment; and in a month, the patient appeared to be cured. Nevertheless, the remedy was continued until November, when the patient passed through the urethra, a small calculus composed of uric acid, which appeared to have been the nucleus of a much larger one, the exterior strata of which had been worn off. From that period, the patient has not experienced any unpleasant symptom; but the sound was not resorted to, to ascertain whether the first calculus before felt, could be detected.--_Archives Generales, February, 1826._ 32. _Attempt to cure Abdominal Dropsy, by exciting Peritoneal Inflammation._--In the number of the London Medical and Physical Journal for April, 1826, a case of ascites is related by H. R. OSWALD, Esq. in which the cure was attempted to be effected, by exciting peritoneal inflammation. The following symptoms were noticed at the time of application for advice: the abdomen measured nearly six feet in circumference, was exceedingly hard and tense; but not tender. The patient "could hardly walk across her cabin from dyspnoea and debility, and the weight and tension of the tumour; which caused her to bend the body much forward, leaning her hands on her knees. The emaciation was very considerable; the appetite good; thirst considerable; tongue clean; pulse 120, and small; skin dry, harsh, and rough; bowels habitually costive; urine scanty." "This affection commenced about twelve months ago, after an obstruction of the catamenia for nearly a year, arising, as was supposed, from exposure to cold. The swelling was preceded by lancinating pains in the abdominal and lower part of the thoracic cavities, but which, after a few months, ceased entirely; and the disease had, in a chronic manner, gradually arrived at its present oppressive form." Paracentesis was performed several times; cathartics, diuretics, the lancet, blisters, and tonics were resorted to, with relief from some of the symptoms. The tumour, however, returned several times, so that M. OSWALD despairing of effecting a cure by following the same plan, and recollecting a case of ascites, which was cured apparently by an inflammation having supervened in the peritoneum, from the orifice made by tapping remaining open, attempted to produce the same effect in the present patient, by keeping the orifice of the wound open by means of a small tent. In this he partly succeeded, for in the course of a few months, all symptoms of the effusion had disappeared; health and strength had much improved, and the patient had experienced a return of the menstrual discharge, which had been suppressed for nearly three years. About a year afterwards, however, the disease returned. Paracentesis was again performed several times, and a tumour was perceived to have formed in the lower part of the abdomen. The patient died in about five or six months from the re-appearance of the effusion. On dissection, much water was found in the abdominal cavity, which was lined by a dense, white, and rough looking membrane, of a fragile and diseased structure. The intestines behind this membrane, were unusually small, and of a dark leaden colour. The tumour above alluded to, was discovered to be situated in the region of the right ovarium; it was a tubercular, carcinomatous, and pale coloured fungus, possessing a structure not unlike that of the placenta, and was formed in the interior of the sac, which being traced further back, was found to be the cyst of a dropsy, originating in the right ovarium at the fundus of the sac, or "more properly speaking of its neck." "The foregoing statement," Mr. O. remarks, "involves four facts and questions of considerable importance in pathology. 1st. The great quantity of fluids evacuated in so short a space of time: no less than ninety-six quarts in eight months, by four operations; and fifty-nine quarts from August to December, 1824, by three. 2nd. The variety in the nature, consistence and colour of these fluids. 3d. The possibility of curing ascites and dropsy of the ovaria, by exciting inflammation in the abdominal sac, either by the admission of air into it, or mechanical irritation; and 4th. The possibility of a thickening of the parietes of the abdomen by inflammation, or by an exudation of a carcinomatous sort, being mistaken for a tumour rising out of the pelvis." 33. _Artificial Respiration._--Dr. J. WARE of Boston, relates in the New England Jour. for April last, that he was led by the experiments of the justly celebrated physiologist Mr. BRODIE, to employ artificial respiration in the case of an infant 9 weeks old, whose system was prostrated from an over dose of laudanum. "The action of the heart was reduced to an occasional throb; the pulse had entirely ceased, and the efforts at respiration, which for some time had consisted merely in an occasional gasp, became more and more unfrequent." The child had been afflicted for five or six weeks with hooping-cough, and had been very sick and feeble when the laudanum (about 15 drops) was administered. By means of the stem of a tobacco-pipe, artificial respiration was excited, and continued for several minutes: the action of the heart was immediately renewed, and the pulse could be again felt. At the end of an hour, during which the artificial respiration was repeated at intervals; "the respiration became natural, the pulse distinct and tolerably strong, and the heat began to return." A fit of coughing, preceded by a livid appearance of the forehead and face, arrested the breathing, "which did not return till assisted by the artificial process." The child, assisted by these measures, and by attention to the more usual means of recovery, struggled through the night, but died during a paroxysm of coughing in the morning. The conclusions of Mr. BRODIE are, that narcotics destroy life through the organs of respiration, and hence, if respiration can be artificially carried on until the effects of the narcotic subside, life may be preserved. Dr. WARE'S case would seem to confirm this idea; for it is _probable_ his patient would have recovered from the effects of the narcotic, if the paroxysms of coughing had not interfered. 34. _Secale Cornutum._--Mr. CHARLES WALLER has lately published (London Medical and Physical Journal, April 1826,) several cases illustrative of the action and efficacy of secale cornutum. We have not room for any of the cases, and content ourselves with transcribing Mr. W.'s inferences. These are: "That the secale cornutum is a remedy which is capable of increasing the force of the uterine contractions in a most remarkable manner, under certain circumstances; but that the effect is doubtful, unless there be some degree of action present. In other words, that, although it will increase the contractions when already present, it will not always renew them when they are suspended. "That the effect is more certain if the infusion be of greater strength than is usually recommended; two drachms of the secale to six ounces of water being barely sufficient for the purpose. "That it appears to be a stimulus peculiarly fitted for irritable, and what are generally termed _nervous_ habits. "That the fears entertained by some practitioners of its proving detrimental to the child, are groundless. "But, although it is in general necessary, not only that there should be a disposition for labour, but that this process should have actually commenced, before we can expect the secale cornutum to have any effect upon the uterus, still one solitary case has indirectly come to my knowledge (and I will vouch for the authenticity of it,) where this remedy was given for the purpose of producing abortion in a female, about the second month of utero-gestation; and this effect was accomplished in a few hours after its exhibition." 35. _Animal Magnetism._--This strange doctrine begins to acquire considerable vogue in France, and other European countries, from which it seemed to have been expelled, by the contempt and ridicule which it met with, from most of the learned of the latter part of the last century. ANTHONY MESMER, the great choroegus of the magnetic mummers, was born in 1733, and excited a vast deal of attention, by the enormous pretensions which he set forth on the subject of magnetism. MESMER came from Austria to Paris in 1778. He addressed the Academy of Sciences, and that of Medicine, but no attention was paid to him, till a commission was appointed to examine carefully into the merits of the question. This commission in 1784, so fully exposed the fallacy of MESMER'S theories and practice, that he soon afterwards quitted Paris, and retired to England under a feigned name. He subsequently went to Germany, and died in obscurity, in the year 1815. In December last, M. HUSSON (for himself, and MM. ADELON, BURDIN, MARC, and PARISET,) read a report to the Royal Academy of Medicine, on the question, whether it was fitting for the section to undertake new researches on animal magnetism, as it had been thought to be definitively settled by the decisions of 1784. The report concluded affirmatively, for several reasons; among which the principal seems to be, that magnetism has at present fallen into the hands of the learned, whereas it was formerly under the domain only of quacks and the vulgar. M. HUSSON'S report was discussed at subsequent sittings of the Academy, for the purpose of ascertaining whether a new commission should be appointed; and as this topic is certainly one of the greatest novelties of the day, we shall give some account of the discussions, making free use of the report of them, contained in the Revue Medicale, Mars. 1826. M. DESGENETTES, declared against the appointment of a commission, because he considered the magnetism of the present day, quite as much a matter of jugglery as that of 1784; and he informs us, that the publicity given to the report, had already increased the audacity of the magnetisers, who look on it as an approbation of their art. M. VIREY, regretted that the report had not spoken in strong terms, against the ridiculous practices, and shameful jugglery, which disgrace the cause of magnetism; he wished the committee had announced an intention, to make only physiological, or psychological researches, on the influence, which magnetism really appears to exercise on the nervous system; and gave his voice for the formation of a commission of experiments. M. BALLY, voted against it for several reasons, and among others, because of the fact announced by all the magnetisers, that the person who magnetises, acquires a sovereign power over the magnetisee; and he inferred from this, all the inconvenient and even dangerous consequences which may result to public morals!--Finally, he voted against it, because magnetism is ridiculed every where, because it is all darkness and confusion, and especially, because it being an inexhaustible mine of empiricism, the section ought not to lay open such a fertile field for those gentry who live by quackery. M. ORFILA, (eheu!) defended the propositions of the reporters. It is opposed, said he, on the three grounds following: 1st. Because the section has not been invited to the examination now recommended. 2nd. Because magnetism is nothing but juggling. 3d. Because commissions will not commonly do any work. The first ground is not correct: M. FOISSAC, a physician of Paris, has invited our attention to it, and offered to subject a magnetic somnambulist to its exploration; and very reputable physicians, members of the Academy, MM. ROSTAN, (the ramollissement man, is his head soft too?) and GEORGET, have in their recent publications called the attention of the learned to this subject. Secondly, if there be any jugglery, in the magnetic phenomena we are told of; it is nevertheless certain, that the whole of them are not simulated. The testimony of well taught physicians, ought to be received on this head. That the phenomena are extraordinary, is no argument; for those of electricity must have been quite as marvellous, at the period of their discovery, &c. &c. M. DOUBLE, blamed the report as being nothing more than an apology for magnetism, which is tarred with the same stick as that of 1784, and only modified a little, by the esprit de notre temps, &c. &c. He said he had made magnetism a special subject of study, and _never saw a phenomenon produced by it_.----He thinks the commission could only do injury to science, and compromit the Academy, &c. &c. He would vote against the appointment, and advised the section to wait until some scientific memoirs should be sent to it. M. LAENNEC, agreed with M. DOUBLE, because after studying the subject for twenty years, he is satisfied, that it is almost nothing but deception and juggling; although, when he commenced the study, he was prejudiced in its favour. According to M. LAENNEC, among the magnetic influences, there are several, attributable to the impressions, which one individual naturally makes on another in correlation with him; and he cited a mistake, which he saw committed by a somnambulist woman. She was magnetised by two persons, one of whom was handsome, but anaphrodisiac, the other ugly, yet possessing in integrity, the genital faculties. She received no impression, except from the first individual; so that the impression which this female had received by the organs of vision, before the experiment, superseded that, which the pretended magnetic sense ought to have made on her. He thinks, the academy ought to _observe_ the magnetisers, but what he has seen, has convinced him, that nine-tenths of the facts in magnetism are supposititious. The phenomena effected by magnetism, and the oracles uttered by the somnambulist, vary with every magnetiser. MESMER excited convulsions; DESLIN effected crises, such as are seen in diseases. The somnambulists of Mr. DELEUZE, a learned man, are much better taught than those of PUYSEGUR, who is ignorant of the sciences, and finally, Mr. LAENNEC has seen a somnambulist under the direction of a pharmacien, who was quite distinguished, by the art with which she compounded the medicines, she recommended. The discussion was now adjourned to the next sitting. On the 24th of January, it was resumed. M. CHARDEL, bears witness to a reality of the magnetic phenomena, as he has witnessed them himself, in a case of what is called somnambulism. He dares not pronounce on the question of magnetism, as a therapeutical agent; but is disposed to think it ought, if ever, to be used with great reserve. Whether it consist of nervous phenomena of a particular order, or whether it be a product of the imagination, in either case, it deserves to be studied, &c. &c. M. RONCHOUX, thought the proposed examination would be impossible; for the magnetisers assert, that if one of the parties have a will opposed to that of the magnetiser, no phenomena can be produced. Their confessed inability to surmount any opposite will, seems to Mr. RONCHOUX, an invincible obstacle to any exploration to be attempted by a commission. M. MARC, gave some explanation of the labours undertaken in Germany. According to the opposition, nothing conclusive can be derived from these labours; because Germany is the native soil of sects and of thaumaturgæ but, Mr. M. proved by citations, that they are not to be attributed to excited imaginations, as has been urged, but to the most celebrated Savans of that country, as for example, OERSTDT, KLAPROTH, and HUFELAND, to learned bodies, and to governments. The Royal Academy of Berlin, offered in 1818, a prize of 3300 francs, for an essay on this topic. The governments of Prussia, Russia, and Denmark, have founded medical commissions for the examination of it, and subjected its therapeutical application to certain regulations. He thought, therefore, that the Academy could follow without compromising its dignity, such good examples. He added, that the examination was absolutely necessary, unless they desired that every French practitioner should hereafter reject the whole subject, and for ever abandon its employment to jugglers and credulous fools. M. NACQUART thought, that as magnetic somnambulism is something wholly independent of organical, physical, or physiological laws; that as the senses here have no need of organs; as time, space, and intermediate bodies, wholly disappear; we can avail ourselves of no method of appreciating magnetical facts, and consequently, the Academy ought not to trouble their heads about it--a very good joke truly: but M. ITARD said, that jokes had nothing to do with the question, because they are meant only for the abuses and extravagancies of magnetism; but we want to get at the truth, and to eschew the folly. Magnetism, says he, is either a real or imaginary agent; it ought to be examined. To refuse this, is to despise the path of experiment, which can alone lead to truth, &c. &c. M. RECAMIER, could add nothing to the observations of MM. DESGENETTES, BALLY, and DOUBLE; but he wished the section to know, that he been a witness to the magnetic phenomena--he had been present at the oracles of the marichale of M. DE PUYSEGUR, who was represented as the most lucid of all possible somnambulists. He had reason to suspect a cheat in this case, as he was denied the means of dissipating his doubts; and heard this woman repeat what he had before said to the patient himself. How ridiculous, moreover, is it, to hear one drachm of glauber's salt prescribed as a transcendental remedy for phthisis pulmonalis! He also attended at the Hotel Dieu, at experiments made on one woman and two men. He saw the woman go to sleep (as was asserted,) at the simple will of the magnetiser, who for that purpose was concealed in a closet of the apartment. The only mode adopted, to prove that she was really asleep, consisted in some slight pinching of her ears, and some noises; yet, in the recital, these slight impressions have been transformed into most painful tortures. In the experiments made on the men, he employed a more powerful proof, which was the application of moxa; and that he did, because it was indicated by a coxalgia, with which the patient was affected: it is _a fact_, says he, that the man did not awake, or show _the slightest sensibility_. Mr. R. believes, therefore, in magnetical action; but does not think it can ever be available in the practice of physic. In Germany, said he, where magnetism is so much employed, do they cure better than elsewhere? And has magnetism been the occasion of any therapeutical discovery any where? In somnambulism there is only a disordered sensibility, and not an increase of it; and the pretended clairvoyance of the somnambulists, has no real existence, &c. &c. M. GEORGET, cited in proof of the existence of magnetic power, the names of many physicians, members of the Academy, as MM. ROSTAN and FOUQUIER--he cited the experiments made at the Hotel Dieu, by Dr. DUPORTET, in the presence of many members, who had signed the results, as MM. HUSSON, GEOFFROY, RECAMIER, DELENS, PATISSIER, MARTIN, SOLON, BRICHETEAU and KERGARADEC. If there be any analogy between magnetic and natural somnambulism, ought we to be astonished at the production of the former by certain practices? The magnetisers conceal nothing, but publish all their proceedings, and do you call these the tactics of jugglers and charlatans? M. MAGENDIE thought the examination expedient, and wished commissioners to be appointed to examine the somnambulist, offered by Dr. FOISSAC. M. GUERSENT was in the affirmative: he himself had magnetised, and witnessed several phenomena, &c. The discussion was then adjourned to the next setting, and on the 14th February, after hearing M. GASC against, and M. LHERMINER for the report, M. HUSSON the reporter was heard. The section then closed the discussion, and it was decided by a majority of ten, (35 to 25,) that a commission should be appointed to examine animal magnetism. We are indebted for the above account to the Revue Medicale for March--the No. for February, also contains a review of M. DUPAU'S Lettres Physiologiques et Morales sur le Magnetisme Animal, 8vo. Paris, 1826. In order to show our readers how they manage these matters, we shall translate the following from p. 269. "Here, says M. ROSTAN, is an experiment that I have often repeated, but which I was finally obliged to interrupt, because it fatigued my somnambulist prodigiously, who assured me, that if I continued, it would make her go mad. This experiment was made in presence of my colleague and friend, M. FERRUS. I took my watch, which I placed three or four inches from her occiput. I asked my somnambulist, if she saw any thing: "certainly, I see something that shines; it hurts me." Her countenance was expressive of pain, and ours expressed astonishment. We looked at each other, and M. FERRUS breaking silence, said, if she sees something shine, she can doubtless tell what it is. "What do you see that shines?--Oh! I don't know, I can't tell. Look at it well--Stop, it fatigues me, wait--(and after a moment of great attention) _It's a watch_." More astonishment. But, if she sees the watch, said M. FERRUS, she will doubtless see what o'clock it is. "Could you tell me what o'clock it is?--Oh! no, it is too difficult." "Look at it, try." "Wait then, I'll try; may be I can tell the hour, but I never shall be able to see the minutes;" and after the greatest attention--"It wants ten minutes of eight o'clock:" which was exact. M. FERRUS now desired to make the experiment himself, and repeated it with the same success. He made me turn the hands of his watch several times, and when presented to her (occiput we suppose,) without her having seen it, she never made any mistake." These statements we have thought fit to lay before our readers, who will observe the respectable names which are connected with them. We shall seize the first opportunity to give the report of the new commission, and if they confirm the miracles, we can still say, credat Judaeus apella. If it will make no cure, it will probably make much pay; since MESMER got upwards of 340,000 francs for his mumming exhibitions, to the _spectacle_ loving quidnuncs of Paris. The commission consists of 11 members, viz. LEROUX, BOURDOIS, DOUBLE, MAGENDIE, GUERSENT, LAENNEC, THILLAYE, MARC, ITARD, FOUQUIER and GUENEAU DE MUSSY. 36. _Sketch of the Medical Literature of Denmark, Sweden, and Norway--by_ Dr. C. OTTO, _of Copenhagen, apud Bulletin des Sci. Med. Feb. and March._--"Denmark is richer in medical literature, than the other countries which in conjunction with it, composed the ancient Scandinavia. Although it does not in this respect, bear a comparison with France, Germany, England, and Italy, nevertheless, medicine, of all the sciences, seems to be that which is most successfully cultivated, and Copenhagen contains a great number of learned, and able physicians." In proof of what Denmark has done, Dr. O. refers us to the great names of the two BARTHOLINS, of STENO, of WINSLOW, of CALLISEN, &c. "In the 16th century, Denmark possessed the anatomical works of the two BARTHOLINS: (_Instit. Anatomicæ de vasis lymphaticis, &c._) and other works of the same kind, which have been translated into all the languages of Europe. STENO, the disciple of THOMAS BARTHOLIN, followed the career of his master, with an equal success. HALLER never spoke of this anatomist, without the highest admiration. RODE enriched the literature of Germany and Denmark, with works which have made his name illustrious, wherever science is cultivated. Among these, we may chiefly distinguish his Bibliotheca, and Materia Medica." The Danes are indebted to him for several popular works on medicine, which are in the judgment of Dr. OTTO, chef d'oeuvres of this sort of writing. He published more than 13 volumes on these topics. "To the celebrated CALLISEN, who is recently deceased, we are indebted for 1st, a _Systema Chirurgiæ Hodiernæ_, a work of the highest merit, and which has reached a fourth edition. 2nd, a Medical Topography of Copenhagen, published in Danish. (2 _vols._ _8vo. Copen._ 1807.) 3d, the Director of the Academy of Surgery. He is also the author of several important memoirs, inserted in those of the _Roy. Soc. of Sciences_, of Denmark, and in some other collections. The late professor MATH. SAXTORPH, composed an excellent _manual of labours_, for the use of midwives. A second edition with plates, appeared in 1804. T. L. BANG, has given a _Praxis Medica_, an excellent guide to young physicians in their first outset in practice. HERHOLDT has shed some lustre on Danish Physiology: his dissertations on the life of the foetus, and on the question, whether vision is performed with both eyes, or with one only, bear testimony to his genius and penetration: he is also author of a memoir on penetrating wounds of the Chest, inserted, as well as the former dissertation, and many other pieces, in various medical journals. "TYSCHEN published in 1804, a _Treatise on Pharmacy_, in Danish; and professor MYNSTER, gave a work on Pharmacology, of which two volumes only had appeared, when death interrupted his useful labours. In 1794, he commenced the publication of a journal, the _Bibliothek for Physik Oeconomic og Medicin_, which was continued in 1799, by BAHN, and afterwards under several names, till 1807. We now come to the existing state of Danish medical literature. "The Royal Medical Society of Copenhagen, which, without contradiction, holds the first rank among those of Scandinavia, celebrated its 50th anniversary in 1822. It publishes at irregular periods, its memoirs, under the title of _Nova Acta Societatis Medicæ Havniensis_. The last volume appeared in 1821. Professor JACOBSEN, is ardently devoted to the study of Comparative Anatomy, and has published several works on the subject, inserted in the Mem. of the Roy. Soc. of Sciences, extracts from which have appeared also in several foreign journals. The collection we have just now cited, (for 1824, V. I.) contains a memoir of Dr. GARTNER, which confirms the opinion entertained by the ancients, as to the presence of a glandular body in the uterus of some animals. The author has added a plate to this interesting dissertation. Dr. OTTO has enriched the physiological sciences with his _Phrenology_, and is zealously occupied with all that relates to this subject. Professor WENDT, physician to the General Hospital of Copenhagen, has recently published several small medical works. We may cite his _Historical and Chemical Supplements, to the knowledge of some therapeutical agents, of the class Euphorbiæ_; some notices on _small pox_, _vaccina_, and _modified small pox_. "Denmark possesses three periodical journals of medicine, without counting those of the Royal Societies of Sciences and of Medicine of Copenhagen. The first and best of these journals, is the _Bibliothek for Læger_, published by a society instituted for the advancement of medical studies. CLASSEN, the founder of this association, bequeathed to it a sum of money, to purchase annually, some foreign medical works. This collection is composed of original memoirs, extracts, and announcements of other works, and a review of the _course_ of the faculty of medicine. It is specially consecrated to the practical department of the art--(three numbers per ann. of 70, to 100 pages each.) The 2nd collection, is the _Nye Hygæa_, the editor of which, (M. OTTO,) embraces in his plan, all the medical sciences. This journal, although specially devoted to physicians, is in reach of all those persons of education, who can be interested in a variety of important medical questions. It contains original memoirs, and extracts from foreign works, (five leaves per month.) The 3d collection, Archives for the History of Medicine in Denmark, (_Archiv. for lægevidens kabens historie in Danmark_,) does not appear periodically, but at indefinite times. Professor HERHOLDT, the editor, has only published one number, in 1823. "As to inaugural dissertations for the doctorate, the number amounts only to three or four in the space of ten years; because the title of M. D. is not requisite to the practitioner in Denmark." The above is taken from the Bulletin for February, the ensuing portion of the sketch is contained in the March number of the same journal. "The medical literature of Sweden, must have been very insignificant in past ages, if we may form an opinion, from the total want of documents in relation to it. There existed no scientific lien between the physicians of that country, or even among those of the capital. A medical society might in vain have been sought for there, at a period, when they were common in all other countries. The Royal Academy of Sciences, published some essays relating to medicine, from time to time, but until 1807, a work on this topic was regarded as a sort of rarity. However, in the course of that year, seven physicians of Stockholm, united in order to found a society, which received the royal sanction, and took the title of _Svenska Loekare Soellskapet_, (_Society of Swedish Physicians_.) This institution, seemed to communicate to the practitioners of Sweden a new existence, and then really commenced the æra of medical literature in that country. The number of works published since that period, has scarcely amounted to more than one or two per annum. Dr. RABEN is the author of three works, which, though not large, give evidence of considerable knowledge and penetration: Their titles are: 1st. De præcipuis causis mali Scrophul. ejusque remediis Commentation. Lund. 1807. 2nd. A second volume on the same subject, written in the Swedish language, Lund. 1819. 3d. Observationes in Syphilidem, ejusque curationem, ubi novæ quoque proponuntur curandi rationes. Lund. Goth. 1821. "We shall also mention among the works recently published in Sweden, 1st. A biographical and literary gallery of the physicians of that country, from the reign of Gustavus I. down to our own times, by Dr. J. F. SAKLEN. 2nd. FLORMANN'S Manual of Anatomy. Finally, a collection of the laws of the kingdom, which relate to medicine. The Medical Society of Stockholm, regularly publishes its transactions, _Svenska Loekare Soellskapets Handlingar_, the 10th vol. of which has just appeared. In it, are some remarkable cases, a table of the constitution of the atmosphere, and of the diseases which have prevailed at Stockholm, and in its environs; reports on the hospitals and baths of the whole kingdom; extracts from Medico-legal Examinations, recent discoveries, &c. M. ECKSTRÖM promises to publish a complete description of the variolous epidemic, which prevailed last year at Stockholm, and in the provinces. Besides these transactions, the secretary makes an annual report, on what passes at the sittings. To this he adds, short notices of the most interesting recent discoveries and observations, which he derives from foreign medical literature. He publishes this collection once a year, and adds some nosological articles. In closing this review, we ought not to forget to mention the collection of theses, defended at the university of Upsal, which is published yearly by Dr. ZETTERSTRÖM." 37. _Erysipelatous Mumps or Angina Parotidiana._--Dr. BEHR of Bernberg, has published in the _Journ. der Pract. Heilkund for July_, 1825, an account of this disease, which we find in the _Bulletin_ for Feb. 1826. Dr. BEHR'S "memoir is intended to pourtray the principal features of an epidemic prevalence of parotitis at Bernberg, in the months of December, 1822, and January and February, 1823. Dr. B. attributes it to the frequent and sudden variations of the atmosphere at that period." He says, "the disease is so rare in this country, that physicians of 30 years standing had never met with it before." Bernberg contains 6000 souls; it is divided into two parts by the Saale, and it is situated on the great road from Leipsic to Magdeburg, in a narrow valley, which runs from N. W. to S. E. The precursory symptoms were rigors followed by heat, heaviness of the limbs, pains in the joints, especially in the evening, sense of tension in the region of the lower jaw, and sometimes a difficulty in mastication. The appetite was usually natural, with gastric symptoms only in the most severe cases. On the evening of the 3d day, there was an increase of uneasiness with chills and heat, after which the patient commonly enjoyed sweet sleep. The next day, on awaking, he felt tolerably well, and had no more sense of heaviness in his limbs, but his face was swelled on one or both sides. Speech and mastication were effected with difficulty; the lower jaw was _comme engourdie_, and a dull pain was felt in the ligaments of the joints; the tumefaction increased and soon extended from the ear to the cheek. On a careful examination, it was found to affect the parotid gland, and the surrounding cellular tissue. The tumour was hard, diffused, and not very painful, except on pressure. The colour and temperature of the swollen part were natural. In the evening, the pulse became hard and accelerated, the tongue white, the stools more consistent than common, and the urine pale. The following night he was agitated, frequently awakened by lancinating pains in the affected part, and sometimes by a sense of tension in the head. The following day, the tumour reached its maximum of elevation, and sometimes comprised the submaxillary glands of the same side. From this time, the pains did not increase, and the skin became slightly red only in a very few examples. The disease having thus reached its acme, a gentle sweat commenced behind the ears, then extended over the whole tumour, and remained as long as the swelling lasted. This evening there was no fever, but a gentle perspiration continued throughout the night. The day following, being the 6th of the disease, the tumour was evidently diminished, and continued decreasing until its final disappearance, which occurred on the 9th, and sometimes on the 7th day. Until this period, abundant local perspirations in the day-time, less abundant, but more general ones in the night, were observable. When the disease was critical by urine with sediment, the diminution of the swelling was dated from this appearance; but the resolution was not perfected in some cases till the 14th day, and in such cases, the integuments of the part were covered with a mealy desquamation. Dr. BEHR did not observe any metastasis to the genitals, but he saw cases, in which the disappearance of the swelling, was followed by considerable fever with _augoisse_, and then an oedema, commonly situated on the head. He often saw the termination by induration, but this soon yielded to a proper treatment. As to the contagion of mumps, the author thinks, it can only occur where there is desquamation of the integuments; and remarks on the analogy of this circumstance, with what occurs in scarlatina. Dr. BEHR thinks, that antiphlogistics are rarely indicated in the treatment of parotitis. 38. _Tænia._--In several cases in which gum. gutt., salts of tin, and other medicines, were unsuccessfully used for the expulsion of tape worm, Dr. BOUGARD succeeded in expelling them with pills compounded as follows: Merc. dulc. Extr. aloes, aa. gr. iij. divided into three pills. This dose was given every evening for eight days, and gradually increased or diminished, so as to procure three stools per diem. A rigorous diet was observed during this treatment.--_Rust's Magazin fur die gesamte Heilkunde apud Bulletin des Sci. Med. March_, 1826. 39. _Scrophula._--Dr. WETZ recommends the employment of caustic potassa in scrophula. He dissolves x grs. of caustic potassa in one ounce of orange-peel water, and gives from xij to xx gtt. four times a day, in a cup of broth. A solution of caustic potassa in six ounces of distilled water, is applied as a wash to the ulcers.--_Ibid._ 40. _Digitalis._--We find in the Propagateur des Sciences Medicales for Feb. 1826, an account of the directions of Dr. NEUMANN of Berlin, for the employment of digitalis in pulmonic diseases: they are said to be the result of long experience. Digitalis is useless, says the writer, in all cases of suppuration of the lung, consequent to tubercles of that organ. It is of no avail in those suppurations, which succeed inflammatory hæmoptysis. It is employed without success in _local_ phlegmorrhagies of the lungs; but it almost invariably cures those chronic catarrhs, which depend on a state of erethism of the mucous lining of the bronchiæ. This disease is sometimes called chronic bronchitis, sometimes mucous consumption, pulmonic catarrh, and galloping consumption. If the diagnosis in this case be well made out, hopes may be entertained of a cure, one of the two following conditions being present: A. The patient must be susceptible of the stimulant action of the remedy: this is often not the case. We may be sure the digitalis will not produce its effect, where the pulse of the patient remains _uniform and frequent after he has taken it for several days_. It does not suit such persons. B. The medicine ought to be administered in a proper manner. To be good, the leaves, even in the dried state, should be perfectly green and free from any brown spots. Two ounces of the leaves, should be infused in six ounces of boiling water; and the patient may take a table spoonful every hour, until he feels nausea, or a sense of constriction in his throat, or flashing of the eyes, or irregular pulse. The use of the foxglove should then be interrupted for seven or eight days, in which interval, the full action of the medicine is developed, the pulse remaining irregular, and the mucous secretion diminishing gradually. If the first trial does not remove it entirely, a second course may be commenced after a few days. FOOTNOTES: [29] Series of Engravings to the morbid anatomy; fasc. 1. pl. 6. fig. 1, 2. [30] Lond. Med. Review; vol. 4. [31] Pathological Researches; Essay 1. [32] Medical Researches on the Effects of Iodine in Bronchocele, Paralysis, Chorea Scrofula, Fistula Lachrymalis, Deafness, Dysphagia, White Swelling, and Distortions of the Spine. By Alexander Manson, M. D., &c. London, 1825. [33] Carthamus Tinctorius. V. SURGERY. 41. _Dr. Physick's operation for artificial anus, denied to have been performed!_--We have often had occasion to remark the claiming, and, we fully hope, the actual re-invention of American operations and practices among physicians on the other side of the Atlantic. As we are not a publishing people, it is, perhaps, not very strange that the French and English should be generally unacquainted with the discoveries and inventions which have been made among us; but here comes an actual denial of the invention having ever taken place! Every American who has any pretensions to the character of a surgeon, is most probably familiar with the proposal and performance, by Dr. PHYSICK, of a peculiar operation for those cases of artificial anus, where the two ends of the divided or opened intestine adhere laterally to each other, in the manner of a double-barrelled gun. We are now told that M. RICHERAND, in his new work "On the recent progress of Surgery," "avoids giving this the least confidence." (Archives Generales, Janvier, 1826.) The reviewer in the Archives, in a paroxysm of angry jealousy for the honour of French surgery, deeply wounded, as he conceives, in the _admissions_ by M. RICHERAND of discoveries and inventions among the English and others, adds no small amount of ill-nature to this unworthy intimation, and makes the observations which we have translated below. It is certainly an easy method of erecting reputations, to deny, directly, the priority of others in operations which a favourite has repeated. No matter though the knowledge of this priority be widely diffused; if readers can, by means of national predilections, be induced to place confidence in your denial, the effect, as far as relates to them, is completely obtained. Yet one would think it an ungenerous act, to call in question, and before partial judges, the veracity of such men as are here named. Where a physician reports cases which agree too well with his preconceived theories, we doubt the correctness of his observations; and with justice: for we know that an already formed belief will greatly tinge the most honest seeings and hearings of very sensible and honourable heads. But this is a far different thing from impeaching, in a manner entirely gratuitous, the moral honesty of the record of a historical fact, made by men at the head of their profession. The reviewer, Mr. and probably Dr. L. C. ROCHE, comments as follows: "1. Dr. PHYSICK never published any thing on this subject. "2. Dr. DORSEY, who makes the claim for him, never published the work in which he does so, [the Elements of Surgery,] till 1813. "3. In the English journal (?) and in that work, he contents himself with a simple assertion, without giving either the date of the operation, the name, age, or sex of the patient, the names of his assistants, or the details of the operation; _all points which men never forget to make known, when treating of the first attempt in a new operation of this importance_." To the first of these comments we reply, that Dr. PHYSICK, to the great regret of his countrymen, has never been in the habit of publishing; but still possesses many useful improvements in medicine and surgery, which he has not committed to the press. On the other hand, however, he has taught this operation annually, to from three to four hundred pupils, in his lectures, during about twelve successive years; and this is no mean substitute for a publication in types. M. ROCHE'S memory will supply him with an instance of an eminent French surgeon, whom we shall not attempt to defraud of his laurels, who also made it his practice to leave the publication of his observations and improvements to his pupils. To the second remark, the above is also a sufficient reply; but we will add that it was recorded in the case book of the Pennsylvania Hospital in 1809. Our comment on the third observation of Mr. ROCHE may be brief. It is that we promise an account of the case for the next number of this Journal. In the mean time, the patient was well known to us and to many persons now living. The operation was performed in 1809. In reply to that portion of the last observation, which we have marked with italics, we can assure the reviewer that he is mistaken; at least with regard to this side of the ocean. We Americans are a very peculiar people, and but little affected, as yet, with the cacoethes scribendi; a malady which the present work, in its humble sphere, is designed to disseminate. We are not in the habit of frequently publishing, and above all, of publishing volumes. Books are dear, private libraries small, public ones few, and encouragement for even the best original publications but limited. Of this we have known some melancholy instances. It is impossible for either a Frenchman or an Englishman to judge correctly of a country, which, in many important respects, is in such a different situation from his own. It is a thing of by no means uncommon occurrence here, to make a valuable discovery or improvement in the healing art, and not to make it public. A striking instance of this fact, at least with the exception of the insertion of an imperfect account in the Eclectic Repertory, which very probably never reached England, is mentioned in our last number. We allude to the extirpations of diseased ovaria, by Dr. M'DOWALL, of Kentucky. Here a unique and brilliantly successful operation was performed, successful as yet beyond European imitations, and still the inventor and achiever of it did not possess vanity or industry sufficient to treat the public with a full account of it. M. ROCHE may find it hard to explain modesty of this species; but we can promise him, should these sheets ever reach his eye, and he still continue skeptical, abundance of proofs, and some more instances of the same kind. 42. _Gangrenous Sore Mouth of Children._--Dr. COATES begs permission to add the following quotation from FABRICIUS HILDANUS to the authorities quoted in his paper on gangrenous ulcer of the mouth, at the commencement of the present number. "Gingivarum inflammatio maxime in infantibus in gangrænam interdum degenerat. Morbus enim magnus, vehemens et peracutus; magna quoque requirit remedia: sed quis illa in ore adhibere ausus?"--_De Gangræna et Sphacelo, Cap. IV. p. 773. col. 2. Edit. Beyeri. Francofurt ad Mæn._ 1646. "Gangræna in partibus humidis, gingivis, palato, naribus, &c. raro sanabilis; in sphacelum autem degenerans, insanabilis."--_Cap. XI. p._ 781. _col._ 2. This is all I find in that author, relative to the subject. 43. _Operation for Phymosis._--M. J. CLOQUET, has so improved this operation that no deformity results. He recommends the incision to be made at the _inferior_ surface, near, and parallel to, the frænum præputii. The longitudinal wound thus made, becomes transverse, as soon as the prepuce is drawn behind the glans penis, and cicatrizes in a line scarcely visible; so that the prepuce acquires in breadth what it loses in length. M. CLOQUET has, in this way, perfectly cured many patients; the prepuce appearing to possess its natural conformation.--_La Propagateur des Sci. Med. for March._ 44. _Lunar Caustic on Wounds and Ulcers._--The practice of healing wounds and ulcers by natural or artificial scabs, to which the attention of the profession was first directed by Mr. J. HUNTER, has been too much neglected, and the circumstances under which it is useful, have not been accurately stated. In a small work published by Mr. HIGGINBOTTOM, in January last, at London, the practice of forming an _eschar_ by the lunar caustic over small ulcers and recent wounds, has been strongly recommended as saving the patient much pain, trouble, and danger. The whole surface is to be pencilled with the solid caustic so as to form an eschar, and where this remains _adherent_, the wound or ulcer invariably heals with comparatively little inconvenience. When effusion occurs under the eschar, whether of serum or of pus, there is more difficulty; but if this fluid be evacuated by a puncture, and the caustic applied to the orifice, the eschar will often remain adherent. Sometimes the fluid must be frequently evacuated. If the eschar does not separate favourably, a cold poultice may be applied, which not only removes the eschar, but lessens the irritation and inflammation. Should the sore not be healed, Mr. H. recommends the reapplication of the caustic. To prevent effusion under the eschar, and to preserve it adhering, he advises the whole to be covered with a piece of gold-beater's skin; but we may add, that as this effusion arises from too much inflammation, more powerful means may occasionally be employed, especially a solution of acetate of lead. LARREY recommends with the same view, after the application of moxa, the use of the aq. ammoniæ. Indeed any evaporating, cold, astringent lotion will be advantageous. The application of the caustic, of course, produces some pain, but this soon subsides, and the patient experiences more ease than under any other mode of treatment. _Particular cases in which the Caustic is useful._--In punctured wounds, it should be applied to the orifice and surrounding skin, and the eschar allowed to dry. The terrible effects of punctured wounds, are thus completely prevented, whether caused by needles, hooks, bayonets, &c. So also of wounds from saws; of bites from leeches and animals; of the stings of insects; and especially of those small scratches, and punctures, received in _anatomical dissections_. The danger of these last mentioned accidents may, according to Mr. H., be completely arrested by the prompt and free application of the lunar caustic. Even in neglected cases, when a small tumour has formed under the skin, attended with a smart stinging pain, he advises the tumour to be removed, and an adherent eschar to be formed by the caustic; and in still more neglected and advanced cases, where inflammation of the absorbents has supervened, "a free crucial incision is to be made, the caustic to be freely applied, and afterwards, the cold poultice and lotion; the usual constitutional remedies being actively enforced." In _bruises_, especially of the shin, the adherent eschar from lunar caustic, has, with Mr. H., always effected a cure; and even when a slough has been produced, the application of the caustic will moderate the inflammation. In _ulcers_, which are small, not exposed to friction or motion, and discharging little, the cure by eschar will be preferable; especially in those little irritable and painful ulcers often seen about the ancle and tendo Achillis. Apply first a cold poultice, and then form the eschar, which may be freely exposed to the air. Should the matter, nevertheless, collect, it should be evacuated by puncture as often as necessary, until the eschar remains adherent. This practice is recommended by Mr. H., in various other affections; as in inflammation of the fingers; in the fungous ulcer of the navel in infants; in _tinea capitis_, &c. In this last case, we have ourselves used it with marked advantage. In all cases, the lunar caustic has a decided effect in _diminishing the irritability_ of the parts to which it is applied; and hence should usually be preferred for the purpose of forming a "_scab_," for such the eschar really is, in a practical view; and we think that our author has hardly done justice to nature's methodus medendi by "scabbing;" while he so ably and strenuously recommends his own imitation of her process. Scabs may be formed by the coagulation of blood; by the drying of mucus or pus; and by the formation of an eschar, by the actual or potential cautery. The surgeon may frequently reduce parts to the same situation, by the use of gold-beater's skin, court-plaster, or other unirritating applications, which prevent exposure and evaporation. In all cases, care must be taken to prevent the surrounding inflammation from transcending the adhesive stage. 45. _Hæmorrhage from Lithotomy._--In the London Med. and Phys. Jour. for Jan. Mr. JOHN SHAW has published an account of a patient, who unfortunately perished from hæmorrhage, in consequence of being cut for the stone. The parts being injected after death, it was found, that the bleeding proceeded from the _unusual distribution_ of a branch of the pudic artery, which traversed the neck of the bladder, and lay directly in the way of the incision. The pudic artery was uninjured. 46. _Extirpation of the Parotid Gland._--The best surgical writers have condemned this operation, if not as absolutely impracticable, nevertheless, as too dangerous to be ever attempted. Successful cases have however been reported, and Mr. A. COOPER, in a letter to the operator in the following case, avers, that he twice removed the parotid gland in one year. Mr. KIRBY, late president of the Royal College of Surgeons in Ireland, in a work published in 1825 at Dublin, on hæmorrhoidal excrescences, has given the details of a diseased parotid, and of the operation for its removal. We condense from Johnson's Review for April, 1826. The patient was a poor female, aged 40, who had a tumour extending from above the zygoma downwards on the neck, two inches below the angle of the jaw, stretching as far forwards as the anterior edge of the masseter muscle, forcing the ear backwards, and raising it outwards from its natural position. Above the surface, it was about the size of a goose-egg; immoveable; painful when handled; irregular on the surface, and of a deep livid colour over the prominent points. Pains of a lancinating character, extended over the head and neck, producing sickness and want of sleep. The operation was performed chiefly by the fingers and the handle of the knife, after dividing the integuments by a crucial incision. The branches of the portio dura were of course divided, and great embarrassment arose from a copious hæmorrhage, caused by the bursting of the tumour, while Mr. K. was rooting it out from between the pterygoid muscles. The bleeding was restrained by the finger of an assistant, and the complete extirpation of the diseased gland was effected. Mr. KIRBY says, "the space between the pterygoid muscles was void--the auditory tube was fully exposed--the articular capsule of the jaw was brought into view--the finger could trace the length of the styloid process, and on sponging the wound of its blood, it could be seen by those who surrounded the chair." The hæmorrhage was restrained by a sponge firmly lodged at the bottom of the wound, covered by compresses of lint, and the whole secured by a double-headed roller. The patient was much exhausted, slept tolerably well the next night, complaining of thirst and inability to swallow. On the 2nd day, inflammation, swelling, and fever followed--erysipelas appeared on the neck--patient lethargic--pulse small and frequent. Fourth day, suppuration--symptoms improving--no relapse. The patient completely recovered, without any regeneration of the tumour. In FERUSSAC'S Bulletin Universel for Jan. 1826, we observe the following notice, from a German Medical Magazine, conducted by M. D. Schmidt. A female, aged 33 years, had suffered for 9 years from a diseased parotid gland, which had gradually attained a large size. It was extirpated by Dr. PRIEGER, and the patient soon returned home in good health, and little disfigured. The tumour measured 8 inches in circumference, and weighed three and a half pounds. (Livres.) Dr. PRIEGER had previously extirpated a scirrhous parotid successfully. M. WIENHOLD affirms, that he has extirpated three parotids; the details of these operations are published. M. SCHMIDT, however, suggests some doubts, as to the _nature_ and _seat_ of the tumours removed. 47. _Aneurism from a Wound, cured by Valsalva's method._--This interesting and valuable case, is condensed from Le Propagateur des Sci. Med. for March, 1826. M. Antouard, a healthy female, æt. 18, was wounded on the 18th of June, 1825, by a poniard, in the left carotid artery, below the superior extremity of the sternum; the instrument passing obliquely inwards and downwards. The anterior and lateral portions of the neck, were enormously distended with blood, and syncope supervened. Four days after the injury was received, an aneurismal tumour was observed at the edge of the sternum, the surrounding effusion being greatly diminished by absorption; and at the expiration of a month, when she was first seen by Dr. SOUCHIER, it was of the size of the two fists of the young female. The pulsations at this time, were nearly equal over the whole surface of the tumour; but rather more distinct over the orifice in the vessel. The surrounding blood was entirely absorbed. No pain was experienced, unless from the pressure of the swelling; from which cause also, resulted a troublesome and continued headach. Dr. SOUCHIER, not believing an operation adviseable, during the warm season of the year, and on a tumour, situated so much under the sternum, determined to fulfil the following indications: 1st. To lessen the quantity of blood; and thus, to diminish the stimulus to the heart, the projectile force it exercises, and consequently, the rapidity with which the blood escaped from the ruptured vessel, and the impulse hence imparted to the sides of the tumour, preventing, in some degree, the coagulation of the blood. 2nd. To increase the effect of general and local bleeding by the use of _cold_, of _pressure_, and especially, of the digitalis purpurea: that thus the force of the circulation may be lessened, the blood allowed to coagulate, and a radical cure be accomplished. Mademoiselle Antouard, determined to yield herself to this plan, and was directed: 1st. Rice-water, acidulated with lemon-juice, and an infusion of mallows, for _food_ and _drink_. 2nd. To employ frictions on the abdomen, and on the insides of the thighs, morning and evening, with eight grains of the pulverized leaves of digitalis, previously macerated for 24 hours in a sufficient quantity of saliva. 3d. To apply every day 12 leeches, near the aneurismal tumour, and after favouring the flow of blood by emollient fomentations, to cover the part with compresses, wet with a saturated solution of the acetate of lead, to be frequently renewed, so as to be kept below the temperature of the skin. 4th. The effect of these means to be augmented by pressure, made by means of the base of a glass tumbler, fixed by the hands of assistants; and 5th. To be kept at rest, and in perfect silence. _Fourth day of treatment_, being 2nd of Aug. 1825. Pulsations more central; tumour very sensibly diminished; pulse less strong and reduced from 86 to 74 in the minute; the menses, which had been suppressed for two months, appeared on the 31st ulto. and still flow. _Prescription_, V. S. [Symbol: ounce]xviij. next day, twelve leeches, on the lateral parts of the tumour; gr. xxiv. of digitalis in three applications through the day. Continue ut supra. Aug. 8th. Patient tranquil; pulse 60, full, not active; face not flushed, but preserving a delicate tinge of red; headach now slight; no nausea; menses continued until the 6th inst. _Prescription_, V. S. [Symbol: ounce]xij.--fifteen leeches to-morrow; increase digitalis to gr. xxviij. daily; the rest, ut supra. The tumour has diminished at least one-fourth. Aug. 12th. Tumour reduced to 3-5ths of its former volume; pulse at 56; her nights are comfortable; has some headach, and lately, cardialgia; complains of hunger and weakness, and from the fatigue of her assistants, the pressure was made with a bandage less effectually than before. This was allowed, as the pulsations are weakened, and more and more central, while the elevation of the tumour is trifling. For fear her health might be injured, she was permitted to rise a little from bed, and to add to her rice water, some light jellies, (crémes) made from the same grain. V. S. [Symbol: ounce]x. and every 2nd day, eight leeches around the tumour; digitalis increased to 32 grains daily; warm pediluvium for one hour, morning and evening; silence as complete as possible. Aug. 18th. No tumour visible; pulsations can yet be felt; the skin is thickened; pulse at the wrist is at 50. V. S. [Symbol: ounce]viij.--six leeches every 4th day until menstrual period; digitalis reduced to gr. xx. and still to the same parts; continue the pressure; allow some rice jelly, vermicelli soup, gentle exercise; silence to be preserved, continue pediluvium, and relieve constipation by simple enemata. In 15 days, Dr. SOUCHIER again visited his patient. It required an experienced hand to distinguish, at the spot where the artery was cicatrized, an elevation rather more evident, than over the rest of the artery. Pulse 48 per minute; hunger great, and the remedies now unpleasant. Most of them were suspended, and fruit and the white flesh of poultry added to her diet list. The digitalis reduced to 12 grains a day. Compression, silence, and moderate exercise, to be continued as before. The menses appeared at the expiration of twenty-five days, and were more abundant than at the last period. At the end of a month, no trace of the tumour was discoverable. The young lady had carefully increased her nutriment and exercise without inconvenience, and all remedial measures were now omitted. During the months of December and January last, she remained free from any inconvenience from the tumour, and the union of the parietes of the artery was therefore regarded as complete. In the above account, we have only to regret that the state of the artery above the tumour, before and after the treatment, had not been noticed. Perhaps this may be supplied by Dr. SOUCHIER, in the commentary, which he proposes publishing on the above case. 48. _Protrusion and Wound of the Stomach._--Mr. TRAVERS, in the Edin. Journ. of the Med. Sciences, for Jan. 1826, relates, that a female, aged 53, and the mother of _nineteen_ children, inflicted on herself a wound in the abdomen, three inches in length, and in a transverse direction. When admitted into St. Thomas' Hospital, at the expiration of six hours, the greater part of the large curvature of the stomach, the arch of the colon, and the entire large omentum, were protruded and strangulated in the wound. The omentum was partially detached from the stomach, which organ was wounded in two places; one, half an inch long through the peritoneal coat; the other, a perforation of all the coats, admitting the head of a large probe, and giving issue to a considerable quantity of mucus. Patient faint; pain slight; pulse 102, and irregular; some hiccup. A silk ligature was placed round the small puncture in the stomach, and the displaced viscera returned, after enlarging the external wound. This last was closed by the quill suture. Warm fomentations and abstinence from food and drink enjoined. 2nd day, some re-action; had been sick in the night from some drink given; is free from pain; pulse 120; pain on pressure; an enema ordered. _Evening_, a dose of castor oil, and twenty leeches to the abdomen. 3d, much fever; V.S. [Symbol: ounce]xviij. and 20 leeches to the abdomen; bowels not opened. 4th day, two stools; pulse 98; tension of the abdomen; three more stools during the day. 5th, sutures removed; wound united, except at its right extremity, where a serous fluid is discharged in considerable quantities. On the 6th day, was allowed food, and on the 23d of Dec., about two months after the accident, was discharged cured. 49. _Oesophagotomy._--This operation has been objected to, not only on account of the dangers attending its performance, but from the alleged difficulty of promoting the union of the wound in the oesophagus; as it is seldom at rest, the lips of the incision being often separated, and the mucous coat adhering with difficulty under any circumstances. Hence we are induced to notice the following case, in which the operation was successfully executed on an inferior animal, by M. FELIX, a veterinary surgeon of Bergelac. The account is published in the Feb. No. of Le Propagateur des Sci. Med. A _Cow_ was threatened with immediate suffocation from the lodgment of a potato in the oesophagus. It had shortness of respiration, an incapacity of swallowing even its saliva, which flowed from the mouth, was in great distress, and covered with a cold sweat. Being properly secured in a horizontal posture, an external incision was made on the inside of the sterno-mastoid muscle, and a cautious dissection practised until the tumour was completely exposed. The oesophagus was divided by "an incision extending the whole length of the foreign body, which was extracted without any force, _which is almost always fatal_. I immediately made two close sutures; and also two others in the skin, on each side, adapting to them two pieces of packthread, more easily to fix the dressings. I dressed the wound with brandy, filling the opening with hemp soaked with brandy." The animal was kept on very little food or drink. On the third day the wound was dressed for the first time, and a digestive ointment applied. In the course of the 2nd week, the cicatrization of the oesophagus occurred; the part was dressed with lint; and by the 20th day after the operation, the animal was quite restored. This case would have been more useful, if more precision had been employed in describing the dressing and subsequent treatment of the wound. It would seem that the sutures were passed through the parietes of the oesophagus only, and that the external wound was kept open by being filled with tow. Certainly, union by the adhesive inflammation ought to have been attempted in all parts of the wound; but whether sutures in the oesophagus are advantageous, or whether the uniting bandage be preferable, is not so easily determined. In the two cases described in 3d vol. of the Mem. de l'Acad. de Chirur. the uniting bandage was alone employed, and with success. 50. _Retention of Urine, caused by a Stricture of the Urethra, relieved by a forcible but gradual Injection._--The editor of Le Propagateur des Sci. Med. in the No. for Feb. 1826, introduces the following case, by observing, that it reflects great honour on M. AMUSSAT, and that his discovery merits the greatest praise. M. D... aged 70 years, of a plethoric constitution, had suffered about 30 years before from three attacks of gonorrhoea; since which period he has had a difficulty in urinating, and can never discharge more than one or two ounces of urine at a time. At eight o'clock, P. M. of the 1st of Feb. he tried to urinate, but could not succeed. He suffered great pain. Pulse agitated; face flushed; belly swelled, and globular at its inferior part; the subcutaneous abdominal veins distended, and the penis in a state of semi-erection. All attempts to urinate were painful and ineffectual. At ten o'clock, A. M., on the 2nd, M. AMUSSAT visited him, and passed a bougie. This was arrested by a contraction near the bulb of the urethra, and caused the discharge of some blood. No urine had been passed for 14 hours, while ordinarily he urinated 12 or 16 times through the night. The obstruction was so great, that none of the usual means of relief remained, except _the forcible introduction of the catheter_, or the _puncture of the bladder_. M. AMUSSAT resorted to the following plan which he had devised, and which completely succeeded. He injected warm water forcibly, but gradually, into the urethra, which, dilating the orifice of the stricture, forced backwards the thickened mucus which had obstructed it. As soon as the liquid injection met the urine, the patient cried out that he was saved, and immediately was able to urinate as formerly. At two trials, he discharged nearly two pints of thick urine. There was no return of the retention, the patient continuing well. Should subsequent experience confirm this experiment of M. AMUSSAT, this simple measure will be a most valuable substitute for those dangerous measures hitherto resorted to for retention of urine, in cases where the obstruction arises from thickened mucus, from small calculi closing the orifice of a stricture, from inflammation, or from what are termed, (justly or not,) spasmodic strictures. 51. _Tracheotomy._--In the Amer. Med. Review for April, Dr. JOHN ATLEE, of Lancaster, mentions that on Wednesday, Aug. 11th, he was consulted by a child ten years old, who had that morning, while running, put a button-mould into his mouth, which during respiration was drawn into the trachea. He complained of uneasiness in respiration, with a slight rattling, and pointed towards the upper part of the sternum, as the situation of the button. On coughing, a rattling was heard, and immediately after, a sudden check to expiration, from the lodgment of the button near the rima glottidis, requiring a sudden and violent effort of inspiration to remove the sense of suffocation. An emetic was given with no advantage. During the night, he had two or three spells of coughing, threatening suffocation. An operation was urged, to avoid immediate and subsequent dangers from the lodgment of this extraneous body, and was agreed to by the parents, and by Dr. HUMES, who was called in consultation. It was performed on the 14th of Aug.; a cathartic, and afterwards an opiate, having been given. An incision, one inch and a half long, was made through the integuments, extending downwards from above the cricoid cartilage, and exposing the sterno-hyoid and thyroid muscles, which were then separated. After exposing the trachea, a longitudinal incision, about three-quarters of an inch in length, was made through its parietes at the third ring. This was held open, and the patient requested to cough. This was ineffectual. The wound being closed, the button was, by coughing, thrown up against the rima glottidis. A probe passed into the trachea, produced a violent effort to cough, by which, as soon as the instrument was withdrawn, the button was thrown through the wound, to some distance from the patient. The wound was dressed with two sutures and adhesive strips. Most of it united by the first intention: and in a few days the patient completely recovered. 52. _Fistula Lachrymalis_--At the session of the Royal Academy, on the 15th of December, M. J. CLOQUET related the case of a female, who, three years previously, had submitted to the operation for fistul. lachrym. according to the method of M. FOUBUT. The canula which had been allowed to remain in the nasal canal, had ulcerated through the floor of the nose, and presented its inferior extremity on the inside of the mouth. A practical commentary on this mode of operating, which is still recommended by able surgeons! 53. _Aneurisma Herniosum._--This form of aneurism is supposed to consist of a dilatation of the internal and muscular coats of the artery; the external cellular having been destroyed. It is termed by ARNAUD, and by Dr. WILLIAM HUNTER, _aneurisma herniam arteriæ sistens_. Its existence in any case has, however, been denied by a large majority of surgeons; and perhaps the only cases reported are those of DUBOIS, in 1804, found in the thoracic and abdominal aorta of a dead subject. The reporter of the following case, quotes also MONRO, as having cited examples of this kind of aneurism. But what MONRO termed a "mixt aneurism," arose from the rupture of the coats of a "true aneurism," by which it was reduced to the state of a "false aneurism;" very different from that here contended for. SABATIER and BOYER, also, deny the existence of this hernia of the artery, and a good summary of facts and arguments is given by BOYER in his Surgery, in support of this opinion, (vide article Aneurism, tome i.) which it would be difficult to invalidate, especially by cases analogous to the following. The reporter, M. BONNET, of the late French army, considers this case as proving a hernia of the artery in a vessel of medium diameter; those of DUBOIS having been noticed in the largest arteries. A Prussian soldier was wounded over the femoral artery by a musket ball. No hæmorrhage ensued, and the wound cicatrized. In this state, M. BONNET visited him for a mortification of the foot of the same limb, which had been frozen. Amputation of the leg was performed, the stump healed readily, and in 12 days the ligatures came away. On the 13th day, (being six weeks since wounded in the thigh,) the patient perceived a tumour at the original cicatrix on his thigh, which had appeared during the preceding night. On the 14th, it had enlarged to three times its former size: it was painful; fluctuation was evident; but there was no pulsation, not even the thrilling noise, which is evident in the last stage of aneurism. A consultation was called, to determine whether it was an abscess or an aneurism. The question could not be satisfactorily answered, and it was determined to open it, after having made the necessary arrangements to secure the artery, should the tumour prove aneurismal. As soon as the integuments were punctured, the jet of blood evinced the nature of the complaint; and the artery was secured by ligatures above and below the tumour. The coagula were numerous, and the superficial ones, quite hard and cartilaginous. The patient did well, and there was every prospect of his recovery on the 1st day, when M. BONNET was forced by the movement of the armies to leave him at Meaux. Such are the facts, from which the Reporter infers, that the aneurism consisted of a protrusion of the internal and middle coats of the artery. The _reasoning_, founded on them, appears to us inconclusive; but we have not space to insert it, and must refer to the March No. of Le Propagateur des Sci. Med. 54. _Extirpation of the Two Dental Arches, affected with Osteo-sarcoma._--Dr. GIORGI REGNOLI, physician at Pesaro, performed this operation on a female 35 years of age, who had from infancy, been troubled with pain and diseases of the teeth and jaws. When Dr. R. visited her, both dental arches were enormously swelled; red and sanguineous tumours had formed over their whole surface, and covered the teeth. The alveolar processes were entirely softened. The diameters of the mouth were greatly lessened; but by the touch, it was evident, that the disease was confined to the alveolar processes of the two ossa maxillaria. A foetid odour exhaled from the mouth. Lancinating pains continually tormented the patient; especially on attempting to masticate. The slightest touch was very painful, and was always followed by an effusion of blood. There was also an alteration of voice; a disgusting deformity of the mouth, with emaciation, fever, &c. The operation was performed on the 18th May, 1825. The patient was seated opposite to a window; her head being supported against the breast of an assistant, who, at the same time, pressed upon the labial arteries. The inferior lip was divided perpendicularly, and detached laterally from the inferior jaw, so as to expose the whole extent of the carcinoma. Some strokes of the saw were made on the anterior and most prominent part of the bone, and into the groove thus formed, the blade of a very strong knife was inserted, by means of which, aided by some slight strokes with a mallet, all the diseased portion was removed. The soft parts had been previously detached from the internal surface of the jaw. The last left molar tooth, not being diseased, was alone left. The hæmorrhage from the dental artery was arrested by the actual cautery. The dental arch of the upper jaw, was then completely removed in the same manner. The bleeding was here more profuse, but was arrested by a hot iron. The alveolar processes thus removed, were enlarged, and of a lardaceous colour, and the fungous growths had the appearance and consistence of indurated albumen. In 25 days, the patient was discharged well. Her general health was good; the foetor had quite gone; the cicatrix over the bone was regular, white, hard, and could be pressed upon without causing pain. The patient can triturate her food with facility; the lips are slightly drawn inwards, without any sensible inconvenience; and the voice is a little altered, but this even is daily improving.--_Le Propagateur des Sci. Med._ for Jan. 1826. 55. _Traumatic Erysipelas._--In the Feb. No. of the Revue Medicale, is a clinical report of the celebrated Baron LARREY, surgeon in chief of the Hospital de la Garde Royale; in which he criticises severely the use of leeches in erysipelas, and recommends in that variety of the disease, arising from wounds, &c. the application of the actual cautery, as effectual in arresting immediately the progress of the disease. It causes, he says, but little pain; destroys the burning and tense pain of the disease, as also the redness and swelling of the part; is not followed by suppuration, and does not cause gangrene in the contiguous parts. The eschar separates, without leaving a cicatrix. Various other advantages are enumerated, all of which are confirmed by a list of cases, as treated at the hospital. We have no room for details, which would, if known universally, hardly render us Americans, whether surgeons or patients, as fond of the cautery, as our trans-atlantic brethren of the French school. 56. _Obliteration of a portion of the Urethra, remedied by an operation._--M. VANIER of Cherbourgh, relates in the Jan. No. of "Le Propagateur des Sciences Medicales," the case of a man aged 27 years, who, on the 16th of June, 1815, was wounded in the penis by a musket ball, which completely divided the urethra at its middle portion, without injuring the corpora cavernosa. The wound healed up; but by degrees, the passage contracted, so that in May, 1819, the patient could pass his urine only guttatim, with pain and difficulty, and was threatened with inflammation, &c. of the perineum. Bougies afforded no relief. An incision was then made externally, in the direction of the urethra, so as to divide the cicatrix, and open the canal above and below the contracted part. The lips of the incision were drawn together over a sound, passed into the bladder; and by the 5th day, the wound was completely cicatrized. The sound was then removed, and a short bougie inserted, so as to pass beyond the cicatrix. This was worn occasionally, and the patient completely recovered. At the end of three years, he was able to "urinate with ease, and in a full stream." 57. _Artificial Joint cured by Caustic._--Dr. J. RHEA BARTON, has applied the caustic potash to the extremities of the fragments of a broken tibia, after an artificial joint had fully formed. Exfoliation was produced, followed by bony union. In three months, the patient recovered. Dr. B. alludes to other cases, by Mr. WHITE of Manchester, and Mr. HENRY CLINE, thus treated with success; to two instances, in which the practice failed in the hands of Mr. EARLE; and finally, to one case by Mr. A. COOPER, the result of which he has not learnt. He does not recommend the operation, as usually preferable to the _seton_, for which, the profession is indebted to Dr. PHYSICK; but as an additional expedient, when other means fail.--_Med. Record. April_, 1826. 58. _Epilepsy cured by Trephining._--In the 17th No. of the New-York Medical and Physical Journal, Dr. DAVID L. ROGERS relates an interesting case of a man, aged 46, who had been subject to epileptic convulsions for 14 years, and who, of late years, had been unable to labour, and rapidly sinking into a state of idiocy, from their frequent recurrence. These fits were preceded by a fracture of the os frontis, with depression, from which he readily recovered; but soon after he was attacked with convulsions. He now suffers pain on the injured side extending down the neck and left arm--the eye of the same side is diminished--the sight much impaired, and his memory almost entirely destroyed. A cicatrix covering a slight depression was easily found, above the left superciliary ridge of the frontal bone, and over the superior orbitar foramen. Under these circumstances, the operation of trephining was performed on the 7th of July, 1825, but with some difficulty, from the irregular thickness of the bone, and from the saw having to pass through the upper part of the frontal sinus. "The dura mater was unfortunately cut through for one-half the circumference of the circle." The parts were found more vascular than usual, and the under surface had a ridge corresponding to the internal depression, but too slight to have caused compression of the brain. "Having made a section of the frontal sinus, [with a trephine?] a part of the _posterior table_ was removed with the _circular_ piece. This portion of the internal table had been fractured, and separated to some distance from its inferior attachments to the frontal plate, and driven back upon the substance of the brain. Its sharp edge was worn round and smooth." This seemed to have been the cause of all the mischief. After the operation, the patient suffered from pain in his head, with some moderate excitement, which was relieved by cathartics. He had no return of fits until the 25th day, when the wound was entirely healed. These had been brought on by overloading his stomach with food, and were followed by high arterial excitement and inflammation of the brain. He was relieved in a few days by active depletion, and was discharged cured on the 20th of August. _Nine months_ afterwards, this man continued free from fits, his memory had nearly recovered its usual strength, and he could attend to his business without any inconvenience. VI. MIDWIFERY. 59. _Gastrotomy_.--M. BULK, in Germany, has successfully performed this operation on a female, aged 36 years, of good constitution, under the following circumstances. The patient, during her pregnancy, suffered from a severe pain at the left and inferior portion of the abdomen; her menses were not suppressed, and every six or eight days, a clot of blood and mucus came from the vagina. Her general health was very good. About the middle of her 8th month, she was washing some linen, and suddenly felt as if something was tearing in her abdomen; at the same time, a swelling of the size of two fists (poings) formed on the right side, below the umbilicus. She fainted, and for six weeks suffered dull pains in the abdomen. At this time, she had _true labour pains_ for 48 hours, and was attended by a midwife. The os uteri dilated so as to admit one finger only. The tumour disappeared during these pains. The patient recovered, with the size of the abdomen undiminished. In this state she continued for two years and three months, menstruating regularly. She became again pregnant, with little inconvenience until the 7th month, when her abdomen was painfully distended, and of a bluish colour, and fluctuation was induced on the least motion. At the full period, she was delivered of a large foetus, which she suckled for 15 days. The infant then died of an aphthous affection. Her milk ceasing, she rapidly declined with hectic symptoms. The tumour reappeared below the umbilicus about the size of an egg, and soon opened, discharging from small orifices a little pus. The opening was enlarged, and some skin and hairs were removed. The patient's constitution was fast yielding, and gastrotomy was immediately performed. An incision was made, with the requisite precautions, through the linea alba into the cavity of the abdomen, from two and a half inches above the umbilicus to within nine lines of the pubis, care being taken to prevent the escape of the intestines. A foetus of full size, in which putrefaction had commenced, was found on the right side of the uterus. "I raised," says the operator, "the body with much care, and endeavoured to trace the umbilical cord. This was turned over the fundus of the uterus to the left side, and terminated in a vascular substance in a state of suppuration, (probably, the remains of the placenta,) which was situated below the great omentum. I pressed out, and dried up the pus, which covered these parts, by means of a sponge. The uterus was an inch and a half in length and an inch in breadth, of a pale rose colour, and could easily be distended (se laissait distendre aisément.) It was otherwise in a good condition." The wound in the abdomen was closed with sutures. The patient was in great danger from inflammatory symptoms for 8 days, but eventually recovered. She left her bed on the 55th day. 60. _Cæsarian operation, performed with safety to the Mother and Foetus._--We condense from JOHNSON'S Review for April last, the following summary of a case of Cæsarian section performed by GRAEFE, on the 20th of September, 1825. Carolina Bechang, was admitted into GRAEFE'S Clinicum, in an advanced stage of pregnancy; being 30 years of age, much deformed by rickets, and only four feet (Rhenish) in height. On the 20th of Sept. after having been five days in labour at the full period, pains severe, and os uteri dilated, she consented to the Cæsarian section. A little after 2 o'clock, GRAEFE placed the fore finger of his left hand, immediately below the umbilicus, and with a large scalpel, made an incision downwards in the linea alba, to within one inch of the pubis; dividing the entire parietes, and even penetrating the substance of the uterus. A second incision penetrated the uterus and exposed the placenta; which, as had been anticipated, was found on the fore part of the fundus. The assistants now compressed firmly the edges of the divided abdominal parietes upon the uterus, to prevent the protrusion of the intestines, in which they succeeded; and GRAEFE carried his hand in a moment into the uterus, separated the placenta with his finger and thumb, and then withdrew it and the child almost together. The child was very active, and cried lustily. The uterus immediately and suddenly contracted, and the bleeding was inconsiderable. Not more than twelve ounces of blood were lost, and no ligature was required. The whole operation was completed in four minutes and a half. The wound was secured by three broad sutures, and adhesive plasters, assisted by a bandage round the abdomen. The child weighed six pounds and was well formed. During the operation, the patient was sick, and once vomited slightly. In two hours had pain and fever: V.S. [Symbol: ounce]xij. Draught with ten drops of the aqua laurocerasi was given, and repeated in a few hours. The patient passed a quiet night. The symptoms of pain, inflammation, and fever, were threatening for some days, and were promptly resisted by the lancet, by enamata, by narcotics, especially the laurocerasus and hyosciamus, by fomentations, &c. By the 9th day, the wound had cicatrized, excepting near the symphisis; symptoms all favourable. The lochia were discharged regularly; and in three weeks, she was able to sit up, and in three more, quite well. Early in November, she returned home with her child, both in perfect health. In FERUSSAC'S Bulletin Universel; for February, another case, in which the Cæsarian operation was performed with safety to the mother and infant, is copied from RUST'S Magazine. 61. _Extirpation of the Uterus._--Dr. RHEINECK, of Memmingen, was consulted by a female, who in December, 1824, was attacked by fever, from which she slowly recovered. A prolapsus of the uterus, which gradually became inverted, followed, attended with frequent hæmorrhage and discharge, by which she was almost worn to the grave. The whole of the uterus was inverted, and without the labia externa; its surface loose, fungous, and in several places easily broken down upon pressure; but there was no hardening nor ulceration. The irritation was so great, as to threaten the patient's life, and after a consultation, in which it was agreed, that the swelling was really formed by the uterus, the tumour was laid hold of and drawn forwards, and a broad ligature, secured with a double surgeon's knot, was applied round its base. In about three weeks, the whole had separated, and the part above the ligature was cicatrized. During this period, the patient was dangerously ill, and was only rescued by great care and attention. The operator had before performed a similar operation, in which case, the patient died suddenly from hæmorrhage, on the separation of the ligature. OSIANDER, STRUVE, LONGENBACK, SAUTER, SIEBOLD, and ZAUG, have in late years performed the same operation, with various degrees of success.--_Johnson's Review for April_, 1826, who quotes from _Siebold's Journal fur Geburtshulfe_, 1826. 62. _Uterine Hæmorrhage._--In the Bulletin Universel for Jan. 1826, the following case is detailed from the Gazette de Santé, for Dec. 1825. A female aged 32 years, was taken with labour with her first child, on the 12th Feb. 1825. The pains soon ceased, and on the 15th of Feb. M. BEDEL, physician at Schirmack, was consulted, who speedily delivered her, by means of the forceps, of a dead child. The hæmorrhage was so considerable, as to render the immediate removal of the placenta necessary; but the uterus did not contract, and the bleeding continued, with tremblings, syncope, cold sweats, &c. Irritation on the internal surface of the uterus, the use of cold water to the abdomen, injections into the uterus of cold water and vinegar, were unavailing. Plugging the vagina, and also the _uterus_, was now resorted to, as the only means of safety remaining. The uterus was filled with pieces of rags, for fear the patient could not sustain the loss of blood necessary to fill that cavity; while a methodic compression was at the same time made to the abdomen. The hæmorrhage was immediately arrested, and soon after reaction ensued. On the 16th, M. BEDEL extracted the plugs from the uterus, cautiously and in succession; and had the pleasure of finding the uterus regularly contracting after each removal. The lochial discharge continued, and there was no secretion of milk. The patient recovered slowly. It is in such cases as the above, that the physicians of the United States have employed the Secale Cornutum (Ergot,) the judicious use of which would have probably superseded the necessity of instruments, and prevented or arrested the hæmorrhagic discharge. VII. CHEMISTRY AND PHARMACY. 63. _State in which Morphia exists in Opium._--In the 80th article of our Quarterly Summary for January, we stated that MR. ROBINET had announced the discovery of a new acid in opium, with which the morphia was combined; while the meconic acid was alleged to be united with soda. To the former salt, he gave the name of _codeate of morphia_. MR. ROBIQUET, however, has shown, that the pretended _codeate_, is a _muriate_ of morphia, formed by double decomposition between the muriate of soda, employed by MR. ROBINET in his analysis, and meconate of morphia. The same decomposition shows the source of the meconate of soda. We observe that MR. ROBINET admits his mistake.--_Archives Générales de Medicine._ 64. _Peculiar principles of Narcotic Plants._--"Dr. BRANDES of Sabzerflen, having been prevented by extreme illness, induced by investigating the peculiar principles of narcotic plants, from completing his inquiries, has announced the results of his labours in general terms. He states, that he has found a peculiar narcotic principle in all the narcotic plants; as belladonna, hyosciamus, conium, stramonium, chelidonium, digitalis, &c. The narcotic principles are readily soluble in alcohol, ether, acids, and water, and of a highly offensive odour. This odour is so great in the principle of conium, that it is almost impossible for an individual of an irritable habit, to remain in the room, where there is an etherial solution, containing only a few grains of it. The smell of such a solution is equal to the smell, arising from twenty or thirty pounds of the plants. It is also remarkable, that as this principle is neutralized by acid, the disagreeable odour disappears, or is greatly diminished; which so far agrees with the circumstance, that the plants themselves give little of their peculiar smell, because the narcotic principle is not in a free state. Dr. BRANDES has promised to communicate the manner of obtaining the principles."--_Lond. Med. Repository, Feb. 1826._ 65. _Relative quantities of Cinchonia and Quinia in the most esteemed Varieties of Peruvian Bark._--Mr. BALLY asserts, that practitioners, from observation, have classed the Peruvian barks in the following order;--first, the gray loxa bark, (_Cinchona Officinalis_;) then the red bark (_Cinchona Magnifolia_ of RUIZ and PAVON, or _Oblongifolia_ of MUTIS;) and lastly the yellow bark, or calisaya, (_Cinchona Cordifolia_ of MUTIS, or _pubescens_ of VALLI.) The _Cinchona Officinalis_ furnishes much cinchonia, and little quinia; the _Cinchona Magnifolia_ affords about equal quantities of the two salifiable principles, while the _Cordifolia_ contain much quinia. Mr. BALLY, assuming it as proved, that cinchonia is the more powerful salifiable base of the two in a medical point of view, considers, therefore, that, in regard to the above barks, chemical analysis justifies the order of their relative value, which had been previously deduced from their medical employment.--_Archives Generales de Medecine._ 66. _Sulphate of Quinia, extracted from the Cinchona Bark, exhausted by Decoction._--Mr. JULIA-FONTENELLE, from the sparing solubility of quinia and cinchonia, suspected that decoctions and aqueous extracts of Peruvian bark contained but little of those vegetable alkalies; whence it would follow, that the residuum, generally rejected as having no febrifuge power, would still contain the greater part of them. This suspicion has been in a great measure verified. The aqueous extract was found to contain but little cinchonia and quinia; while the residuum of decoctions, giving the mean results, furnished two-thirds of the sulphate of quinia, yielded by the same weight of cinchona not acted on by water. As decoctions and aqueous extracts of bark are febrifuge, though containing inconsiderable quantities of quinia, and cinchonia, Mr. JULIA-FONTENELLE is led to believe, that these salifiable bases are not the only febrifuge principles in Peruvian bark, but that the extractive matter also possesses that property. His results present a striking difference between alcoholic and aqueous extracts of bark; for while the former contain nearly the whole of the salifiable principles, the latter contain very little.--_Revue Medicale._ 67. _Analysis of Rhubarb._--It is some time since Mr. NANI, an Italian chemist, announced the discovery of a crystallizable vegetable alkali in rhubarb. Mr. CAVENTOU has repeated the experiments of Mr. N. and finds them, in many respects, inaccurate. Upon analysing the alcoholic extract of rhubarb, by the aid of alcohol and ether, employed separately and combined, Mr. C. obtained a fatty matter, containing a little odoriferous volatile oil, and a yellow colouring principle, capable of crystallization, and of being sublimed without decomposition, which may be called _rhubarbin_. He also detected in the alcoholic extract, a brown substance, insoluble in water when pure, but rendered soluble by combination with rhubarbin; when it forms a compound, constituting the _eaphopicrite_ of some chemists, and the _rhubarbin_ of Psaff.--_Archives Generales._ Mr. GEORGE W. CARPENTER, of this city, prepares the medicinal principle of rhubarb in combination with sulphuric acid, under the name of sulphate of rhubarb, by the following process: "Boil, for half an hour, six pounds of coarsely powdered Chinese rhubarb in six gallons of water, acidulated with two and a half fluid ounces of sulphuric acid; strain the decoction, and submit the residue to a second ebullition in a like quantity of acidulated water; strain as before, and submit it again to a third ebullition. Unite the three decoctions, and add, by small portions, recently powdered pure lime, constantly stirring it to facilitate its action on the acid decoction. When the decoction becomes slightly alkaline, it deposites a red flocculent precipitate, and the fluid is changed from a yellow to a crimson colour. The precipitate is then to be separated by passing it through a linen cloth, and dried; after which, reduce it to powder, and digest in three gallons of alcohol, at thirty-six degrees, in a water bath, for several hours, at a moderate heat. Separate this solution from the calcareous precipitate, and distil off three-fourths of the alcohol. There then remains a strong solution of rhubarbine, to which add as much sulphuric acid as will exactly neutralize it. Evaporate this slowly to dryness, without having access to atmospheric air. The residuum will be of a brownish-red colour, intermingled with brilliant specks, possessing a slightly pungent styptic taste, soluble in water, and its odour that of the native rhubarb." This residuum is the sulphate of rhubarb. (Sulphate of _rhubarbin._?) Mr. CARPENTER assures us, that this preparation contains the medicinal principle of the rhubarb, apart from its inert portion; and considers it as bearing the same relation to rhubarb, as the sulphate of quinia to the Peruvian bark. The Chinese rhubarb, at half the price, furnished twice as much rhubarbin as the reputed Russian, which Mr. C. considers to be spurious in the Philadelphia market, being the English prepared in imitation of the Russian.--_Philadelphia Journal of the Medical & Physical Sciences. May_, 1826. 68. _Alkaline Lozenges of Bicarbonate of Soda._--Mr. D'ARCET proposes the following formula for these lozenges:--Take of Bicarbonate of Soda, pure and dry, and in fine powder, 5 parts. Very white Sugar, in fine powder, 95 Mucilage of Gum Tragacanth, q.s. Essential oil of Mint, pure and fresh, 2 or 3 drops for about every 3 ounces of mixture of bicarbonate and sugar. Shake the bicarbonate and sugar in a well dried bottle, with the view of mixing them intimately. Withdraw the mixture from the bottle, and add the mucilage and oil of mint, blending the whole together on a marble. The mass obtained, is then to be divided into lozenges, which should weigh, when dried, about 15 grains each. As they slightly attract moisture, they ought to be kept in a dry place, or in well stopped bottles. Mr. D'ARCET praises very highly the effects of these lozenges in disordered digestion, and in preventing its occurrence, as well from experiments made on his own person, as from observations on others. He believes their operation to be purely chemical, consisting in the saturation of the morbid acid of the stomach, and, therefore, not likely to be lessened by habit. Their effects are much more prompt than magnesia, either pure or in the state of carbonate. In the phosphatic diathesis, where the urine is disposed to be alkaline, it would seem that these lozenges would do harm. But, perhaps, we have this security against their use in these cases, that the stomach would not at the same time be troubled with acidity. _Annales de Chimie et de Physique, Jan._ 1826. 69. _Presence of Mercury in Samples of medicinal Prussic Acid._--Mr. REGIMBEAU, apothecary at Montpellier, has detected this impurity in some prussic acid, prepared in Paris. Its presence was first suspected, from a portion of the acid, accidentally dropped, leaving a white stain on the copper dish of a balance. It is probable, that the impure acid, spoken of, had been made by passing sulphuretted hydrogen through a solution of cyanide of mercury, according to VANQUELIN'S process; and that an insufficiency of the decomposing gas had been employed. May not this accidental impurity explain the occasional salivating effects of prussic acid. 70. _Proposed Method for preparing Protoxide of Mercury by precipitation, for Medical Employment._--Mr. THOMAS EVANS has published some observations on this subject, and justly remarks, that the blue pill, mercurial ointment, and other mercurial preparations, are not uniform compounds, but contain variable proportions of the real protoxide, and uncombined mercury. Some blue pill, which had been carefully prepared by Mr. E. by the usual process of trituration, was found to contain on analysis 20 per cent. of unoxidized mercury; and the blue mass from Apothecaries' Hall, London, furnished about the same proportion. As it is obviously a desideratum to procure preparations of protoxide of mercury of uniform strength, Mr. EVANS has been led to seek a process, by which to obtain this oxide in a pure state. After repeated experiments, he has pitched upon the following formula: Dissolve four ounces of caustic hydrate of potassa in a pound of water, and to the clear solution, decanted from any impurities, add four ounces of calomel, and shake the mixture frequently. Pour off the liquid, and wash the precipitate formed with water, and then dry it at a gentle heat. In regard to the medical efficacy of the protoxide obtained in this way, Mr. EVANS reports the following to be the results obtained by Dr. COATES, at whose suggestion the article was prepared. As a substitute for calomel, it is more apt to vomit and purge, two grain doses operating several times. As an alterative, it was found incomparably more efficacious than the blue pill, being more certain and regular in its operation. Dr. C. thinks, that one-fourth of a grain of the precipitated protoxide, as prepared by Mr. EVANS, is equal to three or four grains of the blue mass.--_Journ. of the Philad. Col. of Pharm. May_, 1826. The method here proposed for obtaining the black oxide of mercury by Mr. EVANS, was first suggested and put in practice by Mr. PHILLIPS. See his "Experimental Examination of the last edition of the Pharmacopoeia Londinensis, London, 1811," page 114. His words are, "When solution of potash is employed, the several inconveniences attendant upon the use of lime-water are avoided, and a blackish coloured protoxide is obtained without heating the solution. As potash is much more soluble than lime, it is scarcely necessary to employ one-tenth part of the quantity of water; this not only renders the process more convenient, but the quantity of air contained in the water being less, very little of the oxide, perhaps none of it, is converted into peroxide." See also the experiments, and observations of Mr. DONOVAN, on Mercurial Ointment, &c. published in the Medical Journals, several years ago. 71. _Goulard's Extract of Lead._ Mr. DANIEL B. SMITH proposes the following formula for obtaining Goulard's extract of uniform strength: Acetate of lead, crystallized, 15 ounces, troy. Protoxide of lead, 9 ounces, troy. Distilled water, 4 pints. "Boil them together for fifteen minutes and filter. The filtered liquid will weigh about five and a quarter pounds, is transparent, colourless, and of the specific gravity of 1.267. (30° Baumé.)" We conceive that Mr. SMITH has erroneously denominated the sugar of lead, a binacetate. The best usage is to deem that the primary saline compound, which contains a single proportional of acid and base. Accordingly we call the saturated carbonate of potassa, a _bicarbonate_; and Dr. THOMSON calls borax, a biborate of soda, on account of its containing two proportionals of acid to one of base, notwithstanding the alkaline qualities of this salt. Goulard's extract is, therefore, a sub-binacetate of lead, or according to Dr. THOMSON'S recently suggested nomenclature, a _diacetate_.--_Ibid._ QUARTERLY LIST OF AMERICAN MEDICAL PUBLICATIONS Observations on the Autumnal Fevers of Savannah. By W. C. Daniell, M. D. 8vo. pp. 152.--W. T. Williams, and Collins & Hanway. Savannah, 1826. An Analysis of Fever. By Charles Caldwell, M. D., Professor of the Institutes of Medicine, and Clinical Practice in Transylvania University. 8vo. pp. 97.--Lexington, K. 1825. Medical and Physical Memoirs. By Charles Caldwell, M. D., Professor, &c. Containing, 1. An Introductory Address, intended as a Defence of the Medical Profession against the charge of Irreligion and Infidelity; with Thoughts on the Truth and Importance of Natural Religion. 2. A Dissertation in answer to certain Prize Questions, proposed by his Grace, the Duke of Holstein Oldenburg, respecting the "Origin, Contagion and general Philosophy of Yellow Fever, and the Practicability of that Disease prevailing in high Northern Latitudes;" with Thoughts on its Prevention and Treatment. 3. Thoughts on the Analogies of Disease. 8vo. pp. 224.--Lexington, K. 1826. Florula Cestrica: an Essay towards a Catalogue of the Phoenogamous Plants, native and naturalized, growing in the vicinity of the borough of West-Chester, in Chester County, Pennsylvania; with brief notices of their Properties and Uses, in Medicine, rural Economy and the Arts. To which is subjoined an Appendix of the useful cultivated Plants of the same District. By William Darlington, M. D. 8vo.--West-Chester, 1826. We are much gratified with the appearance of this little flora. It is really an uncommonly neat, useful, and convenient performance; and, we have no doubt, is by far the most elegant and creditable botanical work, if not the only one, published in any small town in America. To a country town, we would not think of looking for such a production; but in fact, the county of Chester has, of late years, made very considerable advances in science and literature. It has produced a public library, and perhaps others with the existence of which we are not acquainted, several botanical and mineralogical collections, a very respectable series of essays on its history, similar to Mr. Jefferson's notes on Virginia, schools, teaching the higher branches of the English mathematics, and one of those partly literary newspapers which have recently sprung up among us. The above title considerably explains the nature and extent of the work. Of its scientific accuracy, sufficient time has not yet elapsed to form an adequate judgment; but we observe that the author has had the frequent assistance of Baldwin, Collins, Steinhauer, Torrey, and Schweinitz: so that, if the maxim "noscitur a socio" be at all applicable in the present case, it is evident that he has been in the very best botanical company which our land affords. The work is executed with very great neatness, such as would do credit to the press of a metropolis, and is really wonderful for a moderate sized village, and for the disturbed life of a country physician, its author. There is also a great deal of that kind of popular explanation, which so agreeably relieves the repulsiveness of dry works on natural history: such as the familiar names of the plants; the derivations of the names of the genera, designed to assist the student in remembering them, by enabling him to associate some idea with them; occasional comments on their uses and injurious effects, &c. We may add, that from the close proximity of Chester County to Philadelphia, extending to a large part of the line of the Schuylkill, this little work will answer extremely well for common use around this city, with the single exception of the sands of New-Jersey. Memoir on the Topography, Weather, and Diseases of the Bahama Islands. By P. S. Townsend, M. D.--New-York, 1826. The New-England Journal of Medicine and Surgery, and Collateral Branches of Science. Conducted by Walter Channing, Jr. M. D., and John Ware, M. D. No. 2. Vol. XV.--Boston, April, 1826. The American Medical Review, and Journal of Original and Selected Papers in Medicine and Surgery. Conducted by John Eberle, M. D., Nathan Smith, M. D., George M'Clellan, M. D., and Nathan R. Smith, M. D. No. 1, Vol. III.--Philadelphia, April, 1826. The Medical Recorder of Original Papers and Intelligence in Medicine and Surgery. Conducted by Samuel Colhoun, M. D. No. 2, Vol. IX.--Philadelphia, April, 1826. The Philadelphia Journal of the Medical and Physical Sciences. Edited by N. Chapman, M. D., W. P. Dewees, M. D., and John D. Godman, M. D. No. V. New Series.--Philadelphia, May, 1826. The New-York Medical and Physical Journal. No. 17. Edited by John B. Beck, M. D., Daniel L. M. Peixotto, M. D., and John Bell, M. D.--New-York, April, 1826. Journal of the Philadelphia College of Pharmacy. No. 2, Vol. 1.--Philadelphia, May, 1826. AMERICAN EDITIONS OF FOREIGN MEDICAL BOOKS. Manual of Surgical Operations; containing the New Method of operating, devised by Lisfranc; followed by two Synoptic Tables of Natural and Instrumental Labours. By J. Coster, M. D. and Professor of the University of Turin. The Translation and Notes by John D. Godman, M. D. 12mo. pp. 265.--Carey & Lea. Philadelphia, 1825. A Treatise on Derangements of the Liver, Internal Organs, and Nervous System. By James Johnson, M. D. 12mo. pp. 223.--Carey & Lea. Philadelphia, 1826. An Inquiry into the Nature and Treatment of Diabetes, Calculus, and other Affections of the Urinary Organs. By William Prout, M.D. F.R.S. From the second London Edition, with Notes and Additions, by S. Colhoun, M. D. 8vo. pp. 308.--Towar & Hogan. Philadelphia, 1826. * * * * * We are sensible that the foregoing does not present a full list of medical publications for the last quarter; but it is as complete as our opportunities have enabled us to make it. It is obviously for the interest of authors and publishers, to send us the titles of their medical publications as soon as they appear, and we invite them to do so. 
43300	----	Medical History Manuals _General Editor_--John D. Comrie, M.A., B.SC., M.D., F.R.C.P.E. MEDIEVAL MEDICINE * * * * * * IN THE SAME SERIES PASTEUR AND AFTER PASTEUR By STEPHEN PAGET, F.R.C.S. With 8 full-page Illustrations. THE EDINBURGH SCHOOL OF SURGERY BEFORE LISTER By ALEX. MILES, M.D., F.R.C.S. With 8 full-page Illustrations. A. AND C. BLACK, LTD., 4 SOHO SQ., LONDON, W. 1 * * * * * * [Illustration: AN AMPUTATION BELOW THE KNEE This is the first picture of an amputation known _From Gerssdorff's woodcut, reproduced in Gurlt's "Geschichte der Chirurgie"_] MEDIEVAL MEDICINE by JAMES J. WALSH K.C.ST.G., M.D., PH.D., SC.D., LITT.D. Medical Director, Sociological Department Fordham University, and Professor Physiological Psychology Cathedral College, New York Fellow A.M.A., A.A.A.S., Member of the French, German, and Italian Societies for the History of Medicine, etc. Author of "Makers of Modern Medicine," and Other Volumes on Medical History "_Multum egerunt qui ante nos fuerunt, sed non peregerunt. Suspiciendi tamen sunt et ritu Deorum colendi._" SENECA: _Epist. LXIV._ A. & C. Black, Ltd. 4, 5 & 6, Soho Square, London, W.C. 1 1920 Made in Great Britain. CONTENTS CHAPTER PAGE PREFACE vii I. INTRODUCTION 1 II. EARLY MEDIEVAL MEDICINE 21 III. SALERNO AND THE BEGINNINGS OF MODERN MEDICAL EDUCATION 37 IV. MONTPELLIER AND MEDICAL EDUCATION IN THE WEST 61 V. LATER MEDIEVAL MEDICINE 74 VI. MEDIEVAL SURGEONS: ITALY 88 VII. SURGEONS OUTSIDE OF ITALY: SURGEONS OF THE WEST OF EUROPE 109 VIII. ORAL SURGERY AND THE MINOR SURGICAL SPECIALITIES 136 IX. MEDICAL EDUCATION FOR WOMEN 154 X. MEDIEVAL HOSPITALS 169 XI. MEDIEVAL CARE OF THE INSANE 183 APPENDIX I 206 APPENDIX II 212 INDEX 217 LIST OF ILLUSTRATIONS AMPUTATION BELOW THE KNEE _Frontispiece_ FACING PAGE HOLY GHOST HOSPITAL 64 SURGICAL INSTRUMENTS OF GUY DE CHAULIAC 118 BRUNSCHWIG'S SURGICAL ARMAMENTARIUM 134 SURGICAL INSTRUMENTS OF THE ARABS 138 THIRTEENTH-CENTURY HOSPITAL INTERIOR 172 LEPER HOSPITAL OF ST. BARTHOLOMEW 176 THE HARBLEDOWN HOSPITAL 180 "When we think of all the work, big with promise of the future, that went on in those centuries which modern writers in their ignorance used once to set apart and stigmatize as the 'Dark Ages'; when we consider how the seeds of what is noblest in modern life were then painfully sown upon the soil which Imperial Rome had prepared; when we think of the various work of a Gregory, a Benedict, a Boniface, an Alfred, a Charlemagne, we feel that there is a sense in which the most brilliant achievements of pagan antiquity are dwarfed in comparison with these."--FISKE: _The Beginnings of New England, or the Puritan Theocracy in its Relations to Civil and Religious Liberty_. TO MOST REVEREND P. J. HAYES ARCHBISHOP OF NEW YORK AS A SLIGHT TOKEN OF GRATITUDE FOR THE PRIVILEGE OF CO-OPERATING IN THE EDUCATIONAL FOUNDATION THAT IS A MONUMENT TO HIS PRUDENT WISDOM PREFACE "Medieval Medicine" is the story of the medical sciences in the Middle Ages. The Middle Ages are usually assumed to begin with the deposition of Romulus Augustulus, 476, and end with the fall of Constantinople, 1453. In this little volume, then, we have to outline the history of human efforts to prevent and treat the ills of mankind for nearly one thousand years. Until recently, it has been the custom to believe that there was so little of genuine interest in anything like the scientific care of ailing human beings during these centuries, that even a volume of this kind might seem large for the tale of it. Now we know how much these men of the Middle Ages, for so long called the "Dark Ages," were interested in every phase of human progress. They created a great art and literature, and above all a magnificent architecture. We have been cultivating the knowledge of these for several generations, and it would indeed be a surprise to find that the men who made such surpassing achievements in all the other lines of human effort should have failed only in medicine. As a matter of fact, we have found that the history of medicine and surgery, and of the medical education of the Middle Ages, are quite as interesting as all the other phases of their accomplishments. Hence the compression that has been necessary to bring a purview of all that we know with regard to medieval medicine within the compass of a brief book of this kind. The treatment has been necessarily fragmentary, and yet it is hoped that the details which are given here may prove suggestive for those who have sufficient interest in the subject to wish to follow it, and may provide an incentive for others to learn more of this magnificent chapter of the work of the medieval physicians. MEDIEVAL MEDICINE CHAPTER I INTRODUCTORY To understand the story of Medieval Medicine, the reader must recall briefly the course of Roman history. Rome, founded some eight centuries before Christ, was at first the home of a group of adventurers who, in the absence of women enough to supply wives for their warriors, went out and captured the maidens of a neighbouring Sabine town. The feud which broke out as a result was brought to an end by the women now become the wives of the Romans, and an alliance was made. Gradually Rome conquered the neighbouring cities, but was ever so much more interested in war and conquest than in the higher life. The Etruscan cities, which came under her domination, now reveal in their ruins art objects of exquisite beauty and the remains of a people of high artistic culture. When Rome conquered Carthage, Carthage was probably the most magnificent city in the world, and Rome was a very commonplace collection of houses. Culture did not come to Rome until after her conquest of Greece, when "captive Greece led her captor captive." Sir Henry Maine's expression that whatever lives and moves in the intellectual life is Greek in origin may not be unexceptionably true, but it represents a generalization of very wide application. Rome was stimulated in art and architecture and literature by touch with the Greeks, and her own achievements, important though they were, were little better than copies of Greek originals. The Romans themselves acknowledged this very frankly. When in the course of time the barbarian nations from the North and West of Europe came down in large numbers into Italy, and finally gained control of the Roman Empire, they had but very little interest in the Greek sources, and decadence of the intellectual life was inevitable. This was particularly true as regards scientific subjects, and above all for medicine; for the Romans had always depended on Greek physicians, and Galen in the second century, like Alexander of Tralles in the seventh, represent terms in the series of physicians who reached distinction at Rome. The key to the history of medicine in the Middle Ages, then, is always the presence of Greek influence. This persisted in the Near East, and consequently serious scientific medicine continued to flourish there, at first among the Christians and later among the Arabs. It was not for any special incentive of their own that the Arabs became the intellectual leaders of Europe during the tenth and eleventh centuries, but the fact that their geographical position in Asia Minor close to Greek sources provided them with the opportunity to know the old Greek authors, especially in philosophy and medicine, and therefore to be almost forced to become the channels through which Greek influences were carried into the West once more. Before the coming of the Arabs, however--that is, before the rise of Mohammedanism--there was an important chapter of medieval medicine which is often not appreciated at its true worth. The contributors to it deserve to be well known, and fortunately for us in the modern time were properly appreciated during the early days of the art of printing, in the Renaissance time, and accordingly their books were printed, and came to be distributed in many copies, which have rendered them readily available in the modern time. In Asia Minor, where Greek influence persisted as it did not in Italy, we have a series of distinguished contributors to medicine, or rather, medical literature--that is, men whose books represent a valuable compilation and digestion of the important medical writings from before their time, often enriched by their own experience. The first of these was Aëtios Amidenus--that is, Aëtios of Amida--born in the town of that name in Mesopotamia on the Upper Tigris (now Diarbekir), who flourished in the sixth century. Aëtios, or in the Latin form Aëtius, wrote a textbook that has often been republished in the modern time, and that shows very clearly how well the physicians of this period faced their medical and surgical problems, how thoroughly equipped they were by faithful study of the old Greek writers, and how successfully they coped with the difficulties of the cases presented to them. He is eminently conservative, a careful observer, who uses all the means at his command and who well deserves the interest that has been manifested in him at many periods during the almost millennium and a half elapsed since his death. After Aëtius came Alexander of Tralles, from another of these towns of Asia Minor that we would consider insignificant, sometimes termed Trallianus for this reason. He must be reputed one of the great independent thinkers in medicine whose writings have deservedly attracted attention not only in his own time, but long afterwards in the Renaissance period, and with whose works everyone who cares to know anything about the development of medical history must be familiar. One detail of his life has always seemed to me to correct a whole series of misapprehensions with regard to the earlier Middle Ages. Alexander was one of five brothers, all of whose names have come down to us through nearly 1,500 years because of what they accomplished at the great Capital of the East. The eldest of them was Anthemios, the architect of the great Church of Santa Sophia. A second brother was Methrodoros, a distinguished grammarian and teacher at Constantinople. A third brother was a prominent jurist in the Imperial Courts of the capital; while a fourth brother, Dioscoros, was, like Alexander, a physician of repute, but remained in his birthplace Tralles, and acquired a substantial practice there. There is sometimes the feeling that at this time in the world's history, the end of the sixth and the beginning of the seventh century, men had but little initiative, and above all very little power of achievement in the intellectual order. Anyone who knows Santa Sophia in Constantinople, however, will recognize at once that the architect who conceived and superintended the construction of that great edifice was a genius of a high order, not lacking in initiative, but on the contrary possessed of a wonderful power of original accomplishment. No greater constructive work, considering all the circumstances, has perhaps ever been successfully planned and executed. It would scarcely be expected that the brother of the man who conceived and finished Santa Sophia would, if he set out to write a textbook of medicine, make an egregious failure of it. Surely his work would not be all unworthy of his brother's reputation, and the family genius should lift him up to important accomplishment. This is literally what we find true with regard to Alexander. After years of travel which led him into Italy, Gaul, Spain, and Africa, he settled down at Rome, and practised medicine successfully until a very old age, and probably lectured there, for some of his books are in the form of lectures. Fortunately for us, he committed his knowledge and his experience to writing, which has come down to us. A third of these greater writers on medicine in the early Middle Ages was Paul of Ægina--Æginetus as he is sometimes known. There has been some question as to his date in history, but as he quotes Alexander of Tralles there seems to be no doubt now that his career must be placed in the first half of the seventh century. We shall see more of him, as also of his great contemporaries and predecessors of the early Middle Ages, Aëtios and Alexander of Tralles, in a subsequent chapter. Besides these men who were known for their writings, a series of less known Christian physicians were praised by their contemporaries for their knowledge of medicine. Among them are particularly to be noted certain members of an Arabian family with the title Bachtischua, a name which is derived from the Arabic words _Bocht Jesu_--that is, servant of Jesus--who, having studied among the Greek Christians in the cities of Asia Minor, were called to the Court of Haroun al-Raschid and introduced Greek medicine to the Mohammedans. I have pointed out in my volume "Old-Time Makers of Medicine"[1] that "it was their teaching which aroused Moslem scholars from the apathy that characterized the attitude of the Arabian people towards science at the beginning of Mohammedanism." After this preliminary period of early medieval medical development, the next important phase of medicine and surgery in the Middle Ages developed in the southern part of Italy at Salerno. Here came the real awakening from that inattention to intellectual interests which characterized Italy after the invasion of the northern barbarians. The reason for the early Renaissance in this neighbourhood is not far to seek. In the older times Sicily had been a Greek colony, and the southern portion of Italy had been settled by Greeks and came to be known as Magna Græcia. The Greek language continued to be spoken in many parts even during the earlier medieval centuries, and Greek never became the utterly unknown tongue it was in Northern Italy. With the turning of attention to education in the later Middle Ages, the Southern Italians were brought almost at once in contact with Greek sources, and the earlier Renaissance began. With this in mind, it is comparatively easy to understand the efflorescence of culture in Southern Italy, and the development of the important University of Salerno and its great accomplishment, particularly in scientific matters, though all this came almost entirely as a consequence of the opportunity for Greek influence to have its effect there. It is sometimes said that Arabian influence meant much for the development of Salerno, and that it was because the southern part of the Italian peninsula was necessarily rather closely in touch with Arabian culture that an early awakening took place down there. The Mohammedans occupied so many of the islands of the Mediterranean, as well as Spain, that their influence was felt deeply all along its shore, and hence the first university of Europe in modern times came into existence in this part of the world. Montpellier is sometimes, though not so often, said to have had the same factor in its early development. Undoubtedly there was some Arabian influence in the foundation of Salerno. The oldest traditions of the University show this rather clearly. This Arabian influence, however, has been greatly exaggerated by some modern historical writers. Led by the thought that Christianity was opposed to culture, and above all to science, they were quite willing to suggest any other influences than Christian as the source of so important a movement in the history of human progress as Salerno proved to be. The main influence at Salerno, however, was Greek, and the proof of this is, as insisted by Gurlt in his "History of Surgery," that the great surgeons of Salerno do not refer to Arabian sources, but to Greek authors, and their books do not show traces of Arabian influences, but on the contrary have many Græcisms in them. Salerno represents an especially important chapter in the history of Medieval Medicine. As we shall see, the teachers at the great medical school there set themselves in strenuous opposition to the Arabian tendency to polypharmacy, by which the Oriental mind had seriously hurt medicine, and what is still more to the credit of these Salernitan teachers, they developed surgery far beyond anything that the Arabs had attempted. Indeed, surgery in the later centuries of Arabian influence had been distinctly neglected, but enjoyed a great revival at Salerno. Besides, the Salernitan physicians used all the natural methods of cure, air, water, exercise, and diet, very successfully. If any other proof were needed that Arabian influence was not prominent at Salerno, surely it would be found in the fact that women physicians enjoyed so many privileges there. This is so entirely opposed to Mohammedan ways as to be quite convincing as a demonstration of the absence of Arabian influence. From Salerno, the tradition of medicine and surgery spread to Bologna early in the thirteenth century, and thence to the other universities of Italy and to France. Montpellier represented an independent focus of modern progress in medicine, partly due to close relationship with the Moors in Spain and the Greek influences they carried with them from Asia Minor, but not a little of it consequent upon the remnants of the older Greek culture, still not entirely dead even in the thirteenth century, because Marseilles, not far away, had been a Greek colony originally, and still retained living Greek influence, and wherever Greek got a chance to exercise its stimulant incentive modern scientific medicine began to develop. France owed most of her development in medicine and surgery at the end of the Middle Ages to the stream of influence that flowed out of Italian universities. Such men as Lanfranc, who was an Italian born but exiled; Mondeville, who studied in Italy; and Guy de Chauliac, who has so freely acknowledged his obligation to Italian teachers, were the capital sources of medical and surgical teaching in France in the later Middle Ages. It is thus easy to see how the two periods of historical import in medicine at the beginning and end of the Middle Ages may be placed in their intimate relation to Greek influences. At the beginning, Greek medicine was not yet dead in Asia Minor, and it influenced the Arabs. When the revival came, it made itself first felt in the portions of Southern Italy and Southern France where Greek influence had been strongest and still persisted. Fortunately for us, the great Renaissance printers and scholars, themselves touched by the Greek spirit of their time, put the books of the writers of these two periods into enduring printed form, and in more recent years many reprints of them have been issued. These volumes make it possible for us to understand just how thoroughly these colleagues of the Middle Ages faced their problems, and solved them with a practical genius that deserves the immortality that their works have been given. The history of medicine and surgery during the Middle Ages has been greatly obscured by the assumption that at this time scientific medicine and surgery could scarcely have developed because men were lacking in the true spirit of science. The distinction between modern and medieval education is often said to be that the old-time universities sought to increase knowledge by deduction, while the modern universities depend on induction. Inductive science is often said to be the invention of the Renaissance period, and to have had practically no existence during the Middle Ages. The medieval scholars are commonly declared to have preferred to appeal to authority, while modern investigators turn to experience. Respect for authority is often said to have gone so far in the Middle Ages that no one ventured practically to assert anything unless he could find some authority for it. On the other hand, if there was any acknowledged authority, say Aristotle or Galen, men so hesitated to contradict him that they usually followed one another like sheep, quoting their favourite author and swearing by the authority of their chosen master. Indeed, many modern writers have not hesitated to express the greatest possible wonder that the men of the Middle Ages did not think more for themselves, and above all did not trust to their own observation, rather than constantly rest under the shadow of authority. Above all, it is often asked why there was no nature study in the Middle Ages--that is, why men did not look around them and see the beauties and the wonders of the world and of nature, and becoming interested in them, endeavour to learn as much as possible about them. Anyone who thinks that there was no nature study in the Middle Ages, however, is quite ignorant of the books of the Middle Ages. Dante, for instance, is full of the knowledge of nature. What he knows about the ants, and the bees, and many other insects; about the flowers, and the birds, and the habits of animals; about the phosphorescence at sea and the cloud effects, and nearly everything else in the world of nature around him, adds greatly to the interest of his poems. He uses all these details of information as figures in his "Divine Comedy," not in order to display his erudition, but to bring home his meaning with striking concreteness by the metaphors which he employs. There is probably no poet in the modern time who knows more about the science of his time than Dante, or uses it to better advantage. It is sometimes thought that the medieval scholars did not consider that experience and observation were of any value in the search for truth, and that therefore there could have been no development of science. In an article on "Science at the Medieval Universities"[2] I made a series of quotations from the two great scientific scholars of the thirteenth century, Albertus Magnus and Roger Bacon, with regard to the question of the relative value of authority and observation in all that relates to physical science. Stronger expressions in commendation of observation and experiment as the only real sources of knowledge in such matters could scarcely be found in any modern scientist. In Albert's tenth book of his "Summa," in which he catalogues and describes all the trees, plants, and herbs known in his time, he declares: "All that is here set down is the result of our own experience, or has been borrowed from authors whom we know to have written what their personal experience has confirmed; for in these matters experience alone can be of certainty." In his impressive Latin phrase, _experimentum solum certificat in talibus_. With regard to the study of nature in general he was quite emphatic. He was a theologian as well as a scientist, yet in his treatise on "The Heavens and the Earth," he declared that: "In studying nature we have not to inquire how God the Creator may, as He freely wills, use His creatures to work miracles, and thereby show forth His power. We have rather to inquire what nature with its immanent causes can naturally bring to pass." Roger Bacon, the recent celebration of whose seven hundredth anniversary has made him ever so much better known than before, furnishes a number of quotations on this subject. One of them is so strong that it will serve our purpose completely. In praising the work done by Petrus, one of his disciples whom we have come to know as Peregrinus, Bacon could scarcely say enough in praise of the thoroughly scientific temper, in our fullest sense of the term, of Peregrinus's mind. Peregrinus wrote a letter on magnetism, which is really a monograph on the subject, and it is mainly with regard to this that Roger Bacon has words of praise. He says: "I know of only one person who deserves praise for his work in experimental philosophy, for he does not care for the discourses of men and their wordy warfare, but quietly and diligently pursues the works of wisdom. Therefore, what others grope after blindly, as bats in the evening twilight, this man contemplates in their brilliancy, _because he is a master of experiment_. Hence, he knows all of natural science, whether pertaining to medicine and alchemy, or to matters celestial or terrestrial. He has worked diligently in the smelting of ores, as also in the working of minerals; he is thoroughly acquainted with all sorts of arms and implements used in military service and in hunting, besides which he is skilled in agriculture and in the measurement of lands. It is impossible to write a useful or correct treatise in experimental philosophy without mentioning this man's name. Moreover, he pursues knowledge for its own sake; for if he wished to obtain royal favour, he could easily find sovereigns who would honour and enrich him." Roger Bacon actually wanted the Pope to forbid the study of Aristotle because his works were leading men astray from the true study of science--his authority being looked upon as so great that men did not think for themselves, but accepted his assertions. Smaller men are always prone to act thus at any period in the world's history, and we undoubtedly in our time have a very large number who do not think for themselves, but swear on the word of some master or other, and very seldom so adequate a master as Aristotle. Bacon insisted that the four great grounds of human ignorance are: "First, trust in inadequate authority; second, that force of custom which leads men to accept without properly questioning what has been accepted before their time; third, the placing of confidence in the assertions of the inexperienced; and fourth, the hiding of one's own ignorance behind the parade of superficial knowledge, so that we are afraid to say, 'I do not know.'" Prof. Henry Morley suggested that: "No part of that ground has yet been cut away from beneath the feet of students, although six centuries have passed. We still make sheepwalks of second, third, and fourth, and fifth hand references to authority; still we are the slaves of habit, still we are found following too frequently the untaught crowd, still we flinch from the righteous and wholesome phrase, 'I do not know,' and acquiesce actively in the opinion of others that we know what we appear to know." It used to be the custom to make little of the medieval scientists because of their reverence for Aristotle. Generations who knew little about Aristotle, especially those of the seventeenth and eighteenth centuries, were inclined to despise preceding generations who had thought so much of him. We have come to know more about Aristotle in our own time, however, and as a consequence have learned to appreciate better medieval respect for him. Very probably at the present moment there would be almost unanimous agreement of scholars in the opinion that Aristotle's was the greatest mind humanity has ever had. This is true not only because of his profound intellectual penetration, but above all because of the comprehensiveness of his intelligence. For depth and breadth of mental view on a multiplicity of subjects, Aristotle has never been excelled and has but very few rivals. The admiration of the Middle Ages for him, instead of being derogatory in any way to the judgment of the men of the time, or indicating any lack of critical appreciation, rather furnishes good reasons for high estimation of both these intellectual modes of the medieval mind. Proper appreciation of what is best is a much more difficult task than condemnation of what is less worthy of regard. It is the difference between constructive and destructive criticism. Medieval appreciation of Aristotle, then, constitutes rather a good reason for admiration of them than for depreciation of their critical faculty; and yet they never carried respect and reverence to unthinking worship, much less slavish adoration. Albertus Magnus, for instance, said: "Whoever believes that Aristotle was a God must also believe that he never erred; but if we believe that Aristotle was a man, then doubtless he was liable to err just as we are." We have a number of direct contradictions of Aristotle from Albert. A well-known one is that with regard to Aristotle's assertion that lunar rainbows appeared only twice in fifty years. Albert declared that he himself had seen two in a single year. Galen, after Aristotle, was the author oftenest quoted in the Middle Ages, and most revered. Anyone who wants to understand this medieval reverence needs only to read Galen. There has probably never been a greater clinical observer in all the world than this Greek from Pergamos, whose works were destined to have so much influence for a millennium and a half after his time. How well he deserved this prestige only a careful study of his writings will reveal. It is simply marvellous what he had seen and writes about. Anatomy, physiology, pathological anatomy, diagnosis, therapeutics--all these were magnificently developed under his hands, and he has left a record of accurate and detailed observation. There are many absurdities easily to be seen in his writings now, but no one has yet written on medicine in any large way who has avoided absurdities, nor can anyone hope to, until we know much more of the medical sciences than at present. The therapeutics of any generation is always absurd to the second succeeding generation, it has been said. Those in the modern time who know their Galen best have almost as much admiration for him, in spite of all our advance in the knowledge of medicine, as the medieval people had. No wonder, seeing the depth and breadth of his knowledge, that he was thought so much of, and that men hesitated to contravene anything that he said. Even in the authorities to which they turned with so much confidence, the medieval physicians are admirable. If man must depend on authority, then he could not have better than they had. As with regard to this, so in all other matters relating to the Middle Ages, the ordinarily accepted notions prove to have been founded on ignorance of actual details, and misconceptions as to the true significance of their point of view. To have contempt give way to admiration, we need only to know the realities even in such meagre details as can be given in a short manual of this kind. The thousand years of the Middle Ages are now seen to have been full of interesting and successful efforts in every mode of human activity, and medicine and surgery shared in this to the full. CHAPTER II EARLY MEDIEVAL MEDICINE There are two distinct periods in the history of Medieval Medicine. The first concerns the early centuries, from the sixth to the ninth, and is occupied mainly with the contributions to medicine made by those who were still in touch with the old Greek writers; while the second represents the early Renaissance, when the knowledge of the Greek writers was gradually filtering back again, sometimes through the uncertain channel of the Arabic. Both periods contain contributions to medicine that are well worthy of consideration, and nearly always the writings that have been preserved for us demonstrate the fact that men were thinking for themselves as well as studying the Greek writers, and were making observations and garnering significant personal experience. The later Middle Ages particularly present material in this regard of far greater interest than was presumed to exist until comparatively recent historical studies were completed. The real history of medicine in the Middle Ages--that is, of scientific medicine--is eclipsed by the story of popular medicine. So much has been said of the medical superstitions, many of which were rather striking, that comparatively little space has been left for the serious medical science and practice of the time, which contain many extremely interesting details. It is true that after the Crusades mummy was a favourite pharmacon, sometimes even in the hands of regular physicians; and _Usnea_, the moss from the skulls of the bodies of criminals that had been hanged and exposed in chains, was declared by many to be a sovereign remedy for many different ills; but it must not be forgotten that both of these substances continued to be used long after the medieval period, mummy even down to the middle of the eighteenth century, and Usnea almost as late. Indeed, it is probable that the seventeenth and eighteenth centuries present many more absurdities in therapeutics than do the later centuries of the Middle Ages. In this, as in so many other regards, the modern use of the adjective medieval has been symbolic of ignorance of the time rather than representative of realities in history. Popular medicine is always ridiculous, though its dicta are often accepted by supposedly educated people. This has always been true, however, and was never more true than in our own time, when the vagaries of medical faddism are so strikingly illustrated, and immense sums of money spent every year in the advertising of proprietary remedies, whose virtues are often sadly exaggerated, and whose tendency to work harm rather than good is thoroughly appreciated by all who know anything about medicine. The therapeutics of supposedly scientific medicine are often dubious enough. A distinguished French professor of physiology quoted, not long since, with approval, that characteristic French expression: "The therapeutics of any generation are always absurd to the second succeeding generation." When we look back on the abuse of calomel and venesection a century ago, and of the coal-tar derivatives a generation ago, and the overweening confidence in serums and vaccines almost in our own day, it is easy to understand that this law is still true. We can only hope that our generation will not be judged seven centuries from now by the remedies that were accepted for a time, and then proved to be either utterly ineffectual or even perhaps harmful to the patients to whom they were given. When we turn our attention away from this popular pseudo-history of Medieval Medicine, which has unfortunately led so many even well-informed persons into entirely wrong notions with regard to medical progress during an important period, we find much that is of enduring interest. The first documents that we have in the genuine history of Medieval Medicine, after the references to the organizations of Christian hospitals at Rome and Asia Minor in the fourth and fifth centuries (see chapter Medieval Hospitals), are to be found in the directions provided in the rules of the religious orders for the care of the ailing. St. Benedict (480-543), the founder of the monks of the West, was particularly insistent on the thorough performance of this duty. The rule he wrote to guide his religious is famous in history as a great constitution of democracy, and none of its provisions are more significant than those which relate to the care of the health of members of the community. One of the rules of St. Benedict required the Abbot to provide in the monastery an infirmary for the ailing, and to organize particular care of them as a special Christian duty. The wording of the rule in this regard is very emphatic. "The care of the sick is to be placed above and before every other duty, as if, indeed, Christ were being directly served in waiting on them. It must be the peculiar care of the Abbot that they suffer from no negligence. The Infirmarian must be thoroughly reliable, known for his piety and diligence and solicitude for his charge." The last words of the rule are characteristic of Benedict's appreciation of cleanliness as a religious duty, though doubtless also the curative effect of water was in mind. "Let baths be provided for the sick as often as they need them." As to what the religious infirmarians knew of medicine, at least as regards the sources of their knowledge and the authors they were supposed to have read, we have more definite information from the next historical document, that concerning medical matters in the religious foundation of Cassiodorus. Cassiodorus (468-560), who had been the prime minister of the Ostrogoth Emperors, when he resigned his dignities and established his monastery at Scillace in Calabria, was influenced deeply by St. Benedict, and was visited by the saint not long after the foundation. His rule was founded on that of the Benedictines. Like that, it insisted especially on the care of the sick, and the necessity for the deep study of medicine on the part of those who cared for them. Cassiodorus laid down the law in this regard as follows: "I insist, brothers, that those who treat the health of the body of the brethren who have come into the sacred places from the world should fulfil their duties with exemplary piety. Let them be sad with others' suffering, sorrowful over others' dangers, sympathetic to the grief of those whom they have to care for, and always ready zealously to help others' misfortunes. Let them serve with sincere study to help those who are ailing as becomes their knowledge of medicine, and let them look for their reward from Him who can compensate temporal work by eternal wages. Learn, therefore, the nature of herbs, and study diligently the way to combine their various species for human health; but do not place your entire hope on herbs, nor seek to restore health only by human counsels. Since medicine has been created by God, and since it is He who gives back health and restores life, turn to Him. Remember, do all that you do in word or deed in the name of the Lord Jesus, giving thanks to God the Father through Him. And if you are not capable of reading Greek, read above all the translations of the Herbarium of Dioscorides, which describes with surprising exactness the herbs of the field. After this, read translations of Hippocrates and Galen, especially the Therapeutics, and Aurelius Celsus' 'De Medicina,' and Hippocrates' 'De Herbis et Curis,' and divers other books written on the art of medicine, which by God's help I have been able to provide for you in my library." The monasteries are thus seen to have been in touch with Greek medicine from the earliest medieval time. The other important historical documents relating to Medieval Medicine which we possess concern the work of the men born and brought up in Asia Minor, for whom the Greeks were so close as to be living influences. Aëtius, Alexander of Tralles, and Paul of Ægina have each written a series of important chapters on medical subjects, full of interest because the writers knew their Greek classic medicine, and were themselves making important observations. Aëtius, for instance, had a good idea of diphtheria. He speaks of it in connection with other throat manifestations under the heading of "crusty and pestilent ulcers of the tonsils." He divides the anginas generally into four kinds. The first consists of inflammation of the fauces with the classic symptoms; the second presents no inflammation of the mouth nor of the fauces, but is complicated by a sense of suffocation--apparently our neurotic croup. The third consists of external and internal inflammation of the mouth and throat, extending towards the chin. The fourth is an affection rather of the neck, due to an inflammation of the vertebræ--retropharyngeal abscess--which may be followed by luxation, and is complicated by great difficulty of respiration. All of these have as a common symptom difficulty of swallowing. This is greater in one variety than in another at different times. In certain affections he remarks that even "drinks when taken are returned through the nose." Aëtius declares quite positively that all the tumours of the neck region, with the exception of scirrhus, are easily cured, yielding either to surgery or to remedies. The exception is noteworthy. He evidently saw a good many of the functional disturbances and the enlargements of the thyroid gland, which are often so variable in character as apparently to be quite amenable to treatment, and which have actually been "cured" in the history of medicine by all sorts of things from the touch of the hangman's rope to the wrapping of the shed skin of the snake around the neck. A few cervical tumours were beyond resource. Aëtius suggests the connection between hypertrophy of the clitoris and certain exaggerated manifestations of the sexual instinct, as well as the development of vicious sexual habits. It requires only a little study of this early medieval author to understand why Cornelius, at the time of the Renaissance, was ready to declare: "Believe me, that whoever is deeply desirous of studying things medical, if he would have the whole of Galen abbreviated and the whole of Orbiasius extended, and the whole of Paulus (of Ægina) amplified; if he would have all the special remedies of the old physicians, as well in pharmacy as in surgery, boiled down to a summa for all affections, he will find it in Aëtius." Alexander of Tralles was, as we have said, the brother of the architect of Santa Sophia of Constantinople, and his writings on medical and surgical subjects are worthy of such a relationship. His principal work is a treatise on the "Pathology and Therapeutics of Internal Diseases" in twelve books, the first eleven books of which were evidently material gathered for lectures or teaching purposes. He treats of cough as a symptom due to hot or cold, dry or wet, dyscrasias. Opium preparations judiciously used he thought the best remedies, though he recommended also the breathing in of steam impregnated with various ethereal resins. He outlines a very interesting because thoroughly modern treatment of consumption. He recommends an abundance of milk with a hearty nutritious diet, as digestible as possible. A good auxiliary to this treatment in his opinion was change of air, a sea voyage, and a stay at a watering-place. Ass's and mare's milk are much better for these patients than cow's and goat's milk. We realize now that there is not enough difference in the composition of these various milks to make their special prescription of physical importance, but it is probable that the suggestive influence of the taking of an unusual milk had a very favourable effect upon patients, and this effect was renewed with every drink taken, so that much good was ultimately accomplished. For hæmoptysis, especially when it was acute and due, as Alexander felt, to the rupture of a bloodvessel in the lungs, he recommended the opening of a vein at the elbow or the ankle--in order to divert the blood from the place of rupture to the healthy parts of the circulation. He insisted, however, that the patients must in addition rest, as well as take acid and astringent drinks, while cold compresses should be placed upon the chest [our ice-bags], and that they should take only a liquid diet, at most lukewarm, or, better, if agreeable to them, cold. When the bleeding stopped, he declared a milk cure [blood-maker] very useful for the restoration of these patients to their former strength. He paid particular attention to diseases of the nervous system, and discussed headache at some length. Chronic or recurrent headache he attributed to diseases of the brain, plethora, biliousness, digestive disturbances, insomnia, and prolonged worry. Hemicrania he thought due to the presence of toxic materials, though it was also connected with abdominal disorders, especially in women. Alexander has much to say of the paralytic and epileptic conditions, and recommended massage, rubbings, baths, and warm applications for the former, and emphasized the need for careful directions as to the mode of life, and special attention to the gastro-intestinal tract, in the latter. A plain, simple diet, with regular bowels, he considers the most important basis for any successful treatment of epilepsy. Besides, he recommended baths, sexual abstinence, and regular exercise. He rejected treatment of the condition by surgery of the head, either by trephining or by incisions or by cauterization. His teaching is that of those who have had most experience with the disease in our own time. For sore throat he prescribes gargles or light astringents at the beginning, and stronger astringents, alum and soda dissolved in water, later in the case. He particularly emphasized that trust should not be placed in any single method of treatment. Every available means of bringing relief to the patient should be tried. "The duty of the physician is to cool what is hot, to warm what is cold, to dry what is moist, and to moisten what is dry. He should look upon the patient as a besieged city, and try to rescue him with every means that art and science placed at his command. The physician should be an inventor, and think out new ways and means by which the cure of the patient's affection and the relief of his symptoms may be brought about." The most important factor in Alexander's therapeutics is his diet. Watering-places and various forms of mineral waters, as well as warm baths and sea baths, are constantly recommended by him. He took strong ground against the use of many drugs, and the rage for operating. The prophylaxis of disease is in Alexander's opinion the important part of the physician's duty. His treatment of fever shows the application of his principle: cold baths, cold compresses, and a cooling diet, were his favourite remedies. He encouraged diaphoresis nearly always, and gave wine and stimulating drugs when the patient was very weak. Some of the general principles of medical practice which Alexander lays down are very significant even from our modern standpoint. He deprecated drastic remedies of all kinds. He did not believe in severe purgation nor in profuse or sudden blood-letting. His diagnosis was thorough and careful. He insisted particularly on inspection and palpation of the whole body; on careful examination of the urine, of the fæces, and the sputum; on study of the pulse and the breathing. He dwelt on the fact that much might be learned from the patient's history taken carefully. The general constitution was the most important element, in his estimation. His therapeutics is, above all, individual. Remedies must be administered with careful reference to the constitution, the age, the sex, and the condition of the patient's strength. Special attention must always be paid to seconding nature's efforts to cure. Alexander had no sympathy at all with the idea that nature was to be disturbed, much less that remedies must work in opposition to natural tendencies to recovery. Paul of Ægina, educated at the University at Alexandria, probably flourished during the reign of the Emperor Heraclius, who died 641; his works contain more of surgical than of medical interest. The Arab writer, Abul Farag, to whose references we owe the definite placing of the time when Paul lived, said that "he had special experience in women's diseases, and had devoted himself to them with great industry and success. The midwives of the time were accustomed to go to him and ask his counsel with regard to accidents that happen during and after parturition. He willingly imparted his information, and told them what they should do. For this reason he came to be known as the Obstetrician." Perhaps the term should be translated the man-midwife, for it was rather unusual for men to have much knowledge of this subject. His knowledge of the phenomena of menstruation was wide and definite. He knew a great deal of how to treat its disturbances. He seems to have been the first one to suggest that in metrorrhagia, with severe hæmorrhage from the uterus, the bleeding might be stopped by putting ligatures around the limbs. This same method has been suggested for severe hæmorrhage from the lungs as well as from the uterus in our own time. In hysteria he also suggested ligature of the limbs, and it is easy to understand that this might be a very strongly suggestive treatment for the severer forms of hysteria. It is possible, too, that the modification of the circulation to the nervous system induced by the shutting off of the circulation in large areas of the body might very well have a favourable physical effect in this affection. Paul's description of the use of the speculum is as complete as that in any modern textbook of gynæcology. In the chapter on the medieval care of the insane, there are some clinical observations and suggestions as to treatment from Paul which make it very clear what a careful observer he was, and how rational in his application of such knowledge as he had to the treatment of patients. Probably his contributions to the difficult subject psychiatry, well above a thousand years ago, will serve to make his genius as a physician clearer than almost anything else that could be said of him. Among the great Arabian physicians who represent the transition period, from the earlier Middle Ages directly under Greek influence, still surviving to the later Middle Ages, when the earlier Renaissance brought back the Greek masters once more, were Rhazes, Ali Abbas, Avicenna--whose name had been transformed from the Arabic Ibn Sina--Abulcasis, Avenzoar, and Averroes, the last named a philosophic theorist but not a physician. The first three named were born in the East, the last three in Spain. Besides these Maimonides, the great Jewish physician, who was born and educated at Cordova in Spain, deserves a place. In this earlier period Rhazes must be mentioned, while the others who merit special attention will be considered in the chapter on Later Medieval Medicine. Rhazes (died 932) is one of the great epoch-makers in the history of medicine. He was the first to give us a clear description of smallpox. Some of his medical aphorisms are well worth noting, and make it very clear that he was a careful observer. "When you can heal by diet, prescribe no other remedy; and where simple remedies suffice, do not take complicated ones." Rhazes knew well the value of the influence of mind over body even in serious organic disease, and even though death seemed impending. One of his aphorisms is: "Physicians ought to console their patients even if the signs of impending death seem to be present." He considered the most valuable thing for the physician to do was to increase the patient's natural vitality. Hence his advice: "In treating a patient, let your first thought be to strengthen his natural vitality. If you strengthen that, you remove ever so many ills without more ado. If you weaken it, however, by the remedies that you use, you always work harm." The simpler the means by which the patient's cure can be brought about, the better in his opinion. He insists again and again on diet rather than artificial remedies. "It is good for the physician that he should be able to cure disease by means of diet, if possible, rather than by means of medicine." Another of his aphorisms seems worth while quoting: "The patient who consults a great many physicians is likely to have a very confused state of mind." During the ninth and tenth centuries the Arabs continued to be the most important contributors to medicine, until the rise of the school at Salerno gave a new impetus to clinical observation, and furnished a new focus of medical attention in the West. Constantine brought whatever of Arab influence there was in Salerno, as we have pointed out in the chapter on the Beginnings of Medical Education; but after his time there is an originality about Salernitan medicine which makes it of great value as the foster-mother of the sciences related to medicine during the later Middle Ages. CHAPTER III SALERNO AND THE BEGINNINGS OF MODERN MEDICAL EDUCATION The first medical school of modern history, and the institution which more than any other has helped us to understand the Middle Ages, is that of Salerno. Indeed, the accumulation of information with regard to this medical school, formally organized in the tenth century but founded a century earlier, and reaching a magnificent climax of development at the end of the twelfth century, has done more than anything else to revolutionize our ideas with regard to medieval education and the scientific interests of the Middle Ages. We owe this development of knowledge to De Renzi, whose researches with regard to matters Salernitan, and medical education generally in Italy in the Middle Ages, are well deserving of the prestige that has been at length accorded them. In his "Storia della Medicina in Italia," published so modestly at Naples, the patient Italian student of medical history made an epoch-making contribution to the history of medicine. Unless one has actually read his book, it is difficult to understand how deep our obligations to him are. Anyone who might be tempted to think that medicine was not taken seriously, or that careful clinical observations and serious experiments for the cure of disease were not made at Salerno, will be amply undeceived by a reading of De Renzi. Above all, he makes it very clear that medical education was taken up with rigorous attention to details and high standards maintained. Three years of college work were demanded in preparation for medical studies, and then four years at medicine, followed by a year of practice with a physician, and even an additional year of special study in anatomy, had to be taken, if surgery were to be practised. All this before the licence to practise medicine was given; though the degree of doctor, granting the privilege of teaching as the word indicates, was conferred apparently after the completion of the four years at the medical school. We have had to climb back to these medieval standards of medical education in many countries in recent years, after a period of deterioration in which often the requirements for the physician's training for practice were ever so much lower. It may seem surprising that the first medical school should have arisen in the southern part of Italy, but for those who know the historical conditions it will seem the most natural thing in the world that this development should have come in this region. As we have said, touch with Greek has always been the most important factor for modern educational and intellectual development. Salerno was situated in the heart of that Greek colony in the southern part of Italy which came to be known as Magna Græcia. Apparently at no time during the Middle Ages was Greek entirely a dead language in this part of Italy, and there were Greek travellers, Greek sailors, and many other wanderers, who made their way along the shores of the Mediterranean at this time, and carried with them everywhere the stimulus that always came from association with the Greeks of Asia Minor and of the Grecian Islands and peninsula. There were two other factors that made for the development of the medical school at Salerno. The first of these seems undoubtedly to have been the presence of the Benedictines, who had a rather important school at Salerno, and who were closely in touch with their great mother-house at Monte Cassino not far away. It was they who imparted the academic atmosphere to the town, and made it possible to gather together the elements for the university which gradually came into existence around the medical school, after that began to attract European attention. The actual foundation of the medical school, however, seems to have been due to the fortunate accident that Salerno became a health resort, a place to which invalids were attracted from many parts of Europe because the climate was salubrious, and opportunities for obtaining the medical advice of men of many different schools of thought from all over the Mediterranean, and securing the Oriental drugs which were so much valued--as drugs from a distance always are--were there afforded. It is easy to understand that, especially in the winter-time, better-class patients from all over Europe would be glad to go down to the mild temperate climate of Salerno and spend their time there. It has been pointed out that the first modern university, that of Salerno, had for a nucleus a medical school, representing man's interest in his body as his primary intellectual purpose in modern history. The second modern university, that of Bologna, gathered around a law school representing man's interest in his property--his second formal purpose in life. And the third, that of Paris, developed around a school of theology and philosophy, demonstrating that man's intellectual interests rise finally to the consideration of his relations to his fellow-man and to God. The first that we know definitely about the medical school of Salerno, the origin of which is difficult to trace, is concerned with Alphanus, usually designated "the First," because there are several of the name. He was a Benedictine monk, distinguished as a literary man and known by his contemporaries as both poet and physician, who was afterwards raised to the Bishopric of Salerno. He had taught at Salerno in the Benedictine school there before becoming Bishop, and when exercising the highest ecclesiastical authority did much to encourage the development of Salerno. He states that medicine flourished in the town even in the ninth century, and there is an old chronicle published by De Renzi in his "Collectio Salernitana" in which it is said that the medical school was founded by four doctors--a Jewish Rabbi, Elinus; a Greek, Pontus; a Saracen, Adale; and the fourth a native of Salerno--each of whom lectured in his native language. This reads like a mythical legend that has formed around some real tradition of the coming of physicians from many countries. Puschmann in his "History of Medical Education" has suggested that the names are probably as much varied as the absolute truth of the facts. Elinus, the Jew, is probably Elias or Eliseus, Adale is probably a corruption of Abdallah, and Pontus should be probably Gariopontus. There was a hospital at Salerno that was somewhat famous as early as the first quarter of the ninth century. This was placed under the control of the Benedictines; and other infirmaries and charitable institutions, similarly under the care of religious orders, sprang up in Salerno to accommodate the patients that came. The practical character of the teaching at Salerno, as preserved for us in the writings of the school, would seem to argue that probably those who came to study medicine here were brought directly in contact with the patients, though we have no definite evidence of that fact. The most interesting feature of the medical school at Salerno is undoubtedly the development of legal standards of medical education in connection with the school. Before the middle of the twelfth century Roger, King of the Two Sicilies, issued a decree according to which preliminary studies at the University were required as a preparation for the medical school, and four years of medical studies were made the minimum requirement for the degree of doctor in medicine, which was, however, as we have said, not a licence to practise, but only a certificate authorizing teaching. There seemed to have been, even thus early, some further state regulations with regard to practice. About the middle of the next century, however, there came, through a law of the Emperor Frederick II., a still further evolution of legal standards for medical education and medical practice in the Two Sicilies. This law required that the student of medicine should have spent some years, probably the equivalent of our undergraduate training, in the university before studying medicine, and that he should then devote four years to medicine, after which, on proper examination, he might be given the degree of doctor--that is, teacher of medicine; but he must spend a further year of practice with a physician before he would be allowed to practise for himself. This is such a high standard that, only that we have the actual wording of the law, it would seem almost impossible that it could have been evolved at this period in medical history. It actually represents the standard that we have climbed back to generally only during the past generation or two, and in the interval there have been many rather serious derogations from it. This law of the Emperor Frederick is, moreover, a pure drug law, regulating the sale of drugs and their purity, and inflicting condign punishment for substitution; in this regard also anticipating our most recent well-considered legislation. The penalty by which the druggist was fined all his movable goods for substitution, while the government inspector who permitted such substitution was put to death, would seem to us in the modern time to make the punishment eminently fit the crime. Almost needless to say, then, the law (see Appendix for full text) represents one of the most important documents in the history of medicine, particularly of medical education. The fee regulation included in it shows that medicine was looked upon as a profession, and was paid accordingly. From Salerno come many of the traditions of the conferring of degrees which are still used in a large number of modern medical schools. Before receiving his degree, the candidate had to take an oath, of which the following were the principal tenets: "Not to contradict the teaching of his college, not to teach what was false or lying, and not to receive fees from the poor even though they were offered; to commend the sacrament of penance to his patients, to make no dishonest agreement with the druggists, to administer no abortifacient drug to the pregnant, and to prescribe no medicament that was poisonous to human bodies." It has sometimes been said that youths of tender age were admitted to the study of medicine at Salerno, and that many of them were given their degrees at the age of twenty-one. De Renzi's discussion would seem to show that the usual age of receiving the degree was twenty-five to twenty-seven. As medical students had to have three years of preparatory studies in literature and philosophy, it would seem that they must have been rather mature on their admission to the medical schools. De Renzi tells us that the medical school of Salerno was of great importance not only for medical education, but it acquired sufficient means to extend its benefits over the entire city. Gifts were made of statues to the churches, and especially to the shrine of St. Matthew the Apostle, situated here; monuments were set up, inscriptions placed and ample donations made to the various institutions of the city. The formal name of the medical school was _Almum et Hippocraticum Medicorum Collegium_. This is the first use that I know of the word _almum_ in connection with a college, and may very well be the distant source of our term _alma mater_. The medical school was situated in the midst of an elevated valley which opened up on the mountain that dominates Salerno, and while enjoying very pure air must have been scarcely disturbed at all by the winds which can be blustery enough from the gulf. De Renzi says that in his time some of the remains could still be seen, though visitors to Salerno now come away very much disappointed because nothing of interest is left. The most famous of the teachers at Salerno was Constantine Africanus, so called because he was born near Carthage. His life runs from the early part of the eleventh century to near its close, and he lived probably well beyond eighty years of age. Having studied medicine in his native town, he wandered through the East, became familiar with a number of Oriental languages, and studied the Arabian literature of science, and above all of medicine, very diligently. The Arabs, owing to their intimate contact with the Greeks in Asia Minor, had the Greek authors constantly before them, and Hippocrates and Galen have always roused men to do good work in medicine. Constantine seems not to have learned Greek, finding enough to satisfy him in the Arabic commentaries on the Greek authors, and probably confident, as all young men have ever been, that what his own time was doing must represent an advance over the Greek. He brought back with him Arabian books and a thorough knowledge of Arabian medicine. When he settled down in Carthage he was accused of magical practices, his medical colleagues being apparently jealous of his success--at least, there is a tradition to that effect to account for his removal to Salerno, though the immediate reason seems to have been that his reputation attracted the attention of Duke Robert of Salerno, who invited him to become his physician. After Constantine's time the principal textbooks of the school became, according to De Renzi, Hippocrates, Galen, and Avicenna. To these were added the _Antidotarium_ of Mesue, and there were various compendiums of medical knowledge, quite as in our own time--one well known under the name of _Articella_. In surgery the principal textbook was the surgical works of the Four Masters of Salerno, which interestingly enough was the sort of combination work gathered from a series of masters that we are accustomed to see so frequently at the present day. De Renzi insists that there was much less Arabic influence at Salerno than is usually thought; and Gurlt more recently has emphasized, as we have said, the fact that the great textbooks of surgery which we have from Salerno contain not Arabisms, as might be expected from the traditions of Arabic influence that we hear so much of, but Græcisms, which show that here at Salerno there was a very early Renaissance, and the influence of Greek writers was felt even in the twelfth century. Probably the best way to convey in brief form a good idea of the teaching in medicine at Salerno is to quote the _Regimen Sanitatis Salernitanum_, the Code of Health of the School of Salernum, which for many centuries was popular in Europe, and was issued in many editions even after the invention of printing. Professor Ordronaux, Professor of Medical Jurisprudence in the law school of Columbia College (now Columbia University, New York), issued a translation of it in verse,[3] which gives a very good notion of the contents and the spirit and the mode of expression of the little volume. The _Regimen_ was written in the rhymed verses which were so familiar at this time. Many writers on the history of medicine have marvelled at this use of verse, but anyone who knows how many verse-makers there were in the twelfth and thirteenth centuries all over Europe will not be surprised. It used to be the custom to make little of these rhymed Latin verses of the Middle Ages, but it may be well to recall that in recent years a great change has come over the appreciation of the world of literature in their regard. The rhymed Latin hymns of the Church, especially the _Dies Iræ_, the _Stabat Mater_, and others, are now looked upon as representing some of the greatest poetry that ever was written. Professor Saintsbury of the University of Edinburgh has declared them the most wondrous wedding of sense and sound that the world has ever known. The _Regimen Sanitatis_ of Salerno is of course no such poetry, mainly because its subject was commonplace and it could not rise to poetic heights. A good deal of the deprecation of its Latinity might well be spared, for most of the mistakes are undoubtedly due to copyists and interpolation. The verses not only rhyme at the end, but often there are internal sub-rhymes. This too was a very common custom among the hymn-writers, as the great sequence of Bernard of Morlaix, so well known through its translations in our time, as "Jerusalem the Golden" attests. The _Regimen_ was not written for physicians, but for popular information. It seems to have been a compilation of maxims of health from various professors of the Salernitan School. Nothing that I know shows more clearly the genuine knowledge of medicine, and the careful following of the first rule of medical practice _non nocere_ to which Salerno had reached at this time, than the fact that this popular volume contained no recommendation of specific remedies, but only health rules for diet, air, exercise, and the like, many of which are as valuable in our time as they were in that, and very few of which have been entirely superseded--together with some general information as to simples, and a few details of medical knowledge that would give a convincing air to the compilation. The book was dedicated to the King of the English, _Anglorum regi scribit schola tota Salerni_, and in the translation made by Professor Ordonaux begins as follows: If thou to health and vigour wouldst attain, Shun weighty cares--all anger deem profane, From heavy suppers and much wine abstain. Nor trivial count it, after pompous fare, To rise from table and to take the air. Shun idle, noonday slumber, nor delay The urgent calls of Nature to obey. These rules if thou wilt follow to the end, Thy life to greater length thou mayst extend.[4] Evidently it was rather easy to commit such rhymes to memory, and this accounts for the fact that we have many different versions of the _Regimen_ and disputed readings of all kinds. These medieval hygienists believed very much in early rising, cold water, thorough cleansing, exercise in the open air, yet without sudden cooling afterwards. The lines on morning hygiene seem worth while giving in Ordonaux's translation. At early dawn, when first from bed you rise, Wash, in cold water, both your hands and eyes. With brush and comb then cleanse your teeth and hair, And thus refreshed, your limbs outstretch with care. Such things restore the weary, o'ertasked brain; And to all parts ensure a wholesome gain. Fresh from the bath, get warm. Rest after food, Or walk, as seems most suited to your mood. But in whate'er engaged, or sport, or feat, Cool not too soon the body when in heat. The Salernitan writers were not believers in noonday sleep, though one might have expected that the tradition of the _siesta_ in Italy had been already established. They insist that it makes one feel worse rather than better to break the day by a sleep at noonday. Let noontide sleep be brief, or none at all; Else stupor, headache, fever, rheums, will fall On him who yields to noontide's drowsy call. They believed in light suppers-- Great suppers will the stomach's peace impair; Wouldst lightly rest, curtail thine evening fare. With regard to the interval between meals, the Salernitan rule was, wait until your stomach is surely empty: Eat not again till thou dost certain feel Thy stomach freed of all its previous meal. This mayst thou know from hunger's teasing call, Or mouth that waters--surest sign of all. Pure air and sunlight were favourite tonics at Salerno-- Let air you breathe be sunny, clear, and light, Free from disease or cess-pool's fetted blight. Taking "a hair of the dog that bit you" was, however, a maxim with Salernitans for the cure of potation headaches. Art sick from vinous surfeiting at night? Repeat the dose at morn, 'twill set thee right. The tradition with regard to the difficulty of the digestion of pork, which we are trying to combat in the modern time, had already been established at Salerno. The digestibility of pork could, however, be improved by good wine. Inferior far to lamb is flesh of swine, Unqualified by gen'rous draughts of wine; But add the wine, and lo! you'll quickly find In them both food and medicine combined. Milk for consumptives was a favourite recommendation. The tradition had come down from very old times, and Galen insisted that fresh air and milk and eggs was the best possible treatment for consumption. The Salernitan physicians recommended various kinds of milk, goat's, camel's, ass's, and sheep's milk as well as cow's. It is probable, as I pointed out in my "Psychotherapy," that the mental influence of taking some one of the unusual forms of milk did a good deal to produce a favourable reaction in consumptives, who are so prone to be affected favourably by unusual remedies. The _Regimen_ warned, however, that milk will not be good if it produces headache or if there is fever. Apparently some patients had been seen with the idiosyncrasy for milk, and the tendency to constipation and disturbance after it which have been noted also in the modern time. Goat's milk and camel's, as by all is known, Relieve poor mortals in consumption thrown; While ass's milk is deemed far more nutritious, And e'en beyond all cow's or sheep's, officious. But should a fever in the system riot, Or headache, let the patient shun this diet. Salerno's common sense with regard to diet is very well illustrated by a number of maxims. Diet tinkering was not much in favour. We hold that men on no account should vary Their daily diet until necessary: For, as Hippocrates doth truly show, Diseases sad from all such changes flow. A stated diet, as it is well known, Of physic is the strongest cornerstone-- By means of which, if you can nought impart, Relief or cure, vain is your Healing Art. They believed firmly that many of the conditions of eating were quite as important as the diet itself, and said: Doctors should thus their patients' food revise-- _What_ is it? _When_ the meal? And what its _size_? How _often_? _Where?_ lest, by some sad mistake, Ill-sorted things should meet and trouble make. They recommended the various simples, mallow, mint, sage, rue, the violet for headache and catarrh, the nettle, mustard, hyssop, elecampane, pennyroyal, cresses, celandine, saffron, leeks--a sovereign remedy for sterility--pepper, fennel, vervaine, henbane, and others. There were certain special affections, as hoarseness, catarrh, headaches, fistula, for which specific directions for cure were given. Here for instance are the directions to be given a patient suffering from rheum or catarrh. The verses conveyed interesting information with nice long names for the various affections, as well as the directions for its management. Fast well and watch. Eat hot your daily fare, Work some, and breathe a warm and humid air; Of drink be spare; your breath at time suspend; These things observe if you your cold would end. A cold whose ill-effects extend as far As in the chest, is known as a catarrh; Bronchitis, if into the throat it flows; Coryza, if it reach alone the nose. The _Regimen_ conveyed a deal of information in compact form. It gives the number of bones in the body as 219 with 32 teeth, and the number of veins as 365, this number being chosen doubtless because of some supposed relation to the number of days in the year. It contains also a good brief account of the four humours in the human body--black bile, blood, phlegm, and yellow bile; and of the four temperaments--the sanguine, the bilious, the phlegmatic, and the melancholy. These four temperaments were discussed at considerable length by all the psychologists and most of the writers on religious life for centuries afterwards, largely on the basis of the information conveyed by the Salernitan handbook. There are descriptions of the symptoms of plethora or excess of blood, of excess of bile, of excess of phlegm, and excess of black bile. The little volume finally contains discussions as to bleeding, its indications, contraindications, as in youth--"Ere seventeen years we scarce need drawing blood"--and in old age; and then of the mode of practising it, and the place whence the blood should be drawn to relieve different symptoms.[5] Salerno impressed itself much more deeply on surgery than on medicine, for the magnificent development of medieval surgery, the knowledge of which has proved so surprising in our day, began down at Salerno. Some of the details of this phase of Salernitan accomplishment are given in the chapter on Medieval Surgeons of Italy. Roger and Roland and the Four Masters were great original founders in a phase of medical science that proved extremely important for the next three or four centuries. Undoubtedly the presence of a hospital at Salerno, where there were gathered a number of the chronic cases from all over Europe, most of them of the better-to-do classes looking for ease from their ills, gave the incentive to this development. When the natural means of cure, tried for a considerable time, failed, recourse was had to surgery for relief, and often with excellent results. This chapter on Salerno's history shows how thoroughgoing was the effort of the members of the faculty of the medical school to develop every possible means of aid for their patients, even when that required pioneer work. Pagel's appreciation of Salerno's place in the history of medicine, in his chapter on Medicine in the Middle Ages in Puschmann's "Handbuch Der Geschichte der Medicin," Berlin, 1902, gives in very brief space a summary of what was accomplished at Salerno that emphasizes what has been said here, and his authority will confirm those who might possibly continue to doubt of any institution of the Middle Ages having achieved so much. He said: "If we take up now the accomplishments of the School of Salerno in the different departments, there is one thing that is very remarkable. It is the rich, independent productivity with which Salerno advanced the banners of medical science for hundreds of years, almost as the only autochthonous centre of medical influence in the whole West. One might almost say that it was like a _versprengten Keim_--a displaced embryonic element--which, as it unfolded, rescued from destruction the ruined remains of Greek and Roman medicine. This productivity of Salerno, which may well be compared in quality and quantity with that of the best periods of our science, and in which no department of medicine was left without some advance, is one of the striking phenomena of the history of medicine. While positive progress was not made, there are many noteworthy original observations to be chronicled. It must be acknowledged that pupils and scholars set themselves faithfully to their tasks to further, as far as their strength allowed, the science and art of healing. In the medical writers of the older period of Salerno, who had not yet been disturbed by Arabian culture or scholasticism, we cannot but admire the clear, charmingly smooth, easy-flowing diction, the delicate and honest setting forth of cases, the simplicity of their method of treatment, which was to a great extent dietetic and expectant; and while we admire the carefulness and yet the copiousness of their therapy, we cannot but envy them a certain austerity in their pharmaceutic formulas, and an avoidance of medicamental polypragmasia. The work in internal medicine was especially developed. The contributions to it from a theoretic and literary standpoint, as well as from practical applications, came from ardent devotees." One very interesting contribution to medical literature that comes to us from Salerno bears the title "The Coming of a Physician to His Patient, or an Instruction for the Physician Himself." It illustrates very well the practical nature of the teaching of Salerno, and gives a rather vivid picture of the medical customs of the time. The instruction as to the conduct of the physician when he first comes into the house and is brought to the patient runs as follows: "When the doctor enters the dwelling of his patient, he should not appear haughty, nor covetous, but should greet with kindly, modest demeanour those who are present, and then seating himself near the sick man accept the drink which is offered him [_sic_], and praise in a few words the beauty of the neighbourhood, the situation of the house, and the well-known generosity of the family--if it should seem to him suitable to do so. The patient should be put at his ease before the examination begins, and the pulse should be felt deliberately and carefully. The fingers should be kept on the pulse at least until the hundredth beat in order to judge of its kind and character; the friends standing round will be all the more impressed because of the delay, and the physician's words will be received with just that much more attention." The rest of the advice smacks rather more of sophistication than we care to think of in a professional man, but its display of a profound knowledge of human nature makes it interesting. "On the way to see the sick person he (the physician) should question the messenger who has summoned him upon the circumstances and the conditions of the illness of the patient; then, if not able to make any positive diagnosis after examining the pulse and the urine, he will at least excite the patient's astonishment by his accurate knowledge of the symptoms of the disease, and thus win his confidence." Salerno taught as well as it could the science of medicine, and initiated great advances in surgery; but it also emphasized the art of medicine, and recognized very clearly that the personality of the physician counted for a great deal, and that his influence upon his patients must be fostered quite as sedulously as his knowledge of the resources of medicine for their ills. CHAPTER IV MONTPELLIER AND MEDICAL EDUCATION IN THE WEST After Salerno the next great medical school was that of Montpellier in the South of France. The conditions which brought about its original establishment are very like those which occasioned the foundation of Salerno. Montpellier, situated not far from the Mediterranean, came to be a health resort. Patients flocked to it from many countries of the West of Europe; physicians settled there because patients were numerous, and medical instruction came to be offered to students. Fame came to the school. The fundamental reason for this striking development of the intellectual life seems to have been that Montpellier was not far from Marseilles, which had been a Greek colony originally and continued to be under Greek influence for many centuries. As a consequence of this the artistic and intellectual life of the southern part of France was higher during the earlier Middle Ages than that of any other part of Europe, except certain portions of South Italy. The remains of the magnificent architecture of the Roman period are well known, and Provence has always been famous for its intellectual and literary life. Among a people who were in this environment, we might well look for an early renaissance of education. It is not surprising, then, that one of the earliest of the medical schools of modern history around which there gradually developed a university should have come into existence in this part of the world. What is even more interesting perhaps for us, is that this medical school has persisted down to our own day, and has always been, for nearly ten centuries now, a centre of excellent medical education. There gathered around the story of its origin such legends as were noted with regard to the history of Salerno, and there is no doubt that Jewish and Moorish physicians who became professors there contributed not a little to the prestige of the school and the reputation that it acquired throughout Europe. The attempt to attribute all of the stimulus for the intellectual life at Montpellier to these foreign elements is, however, simply due to that paradoxical state of mind which has so often tried to minimize the value of Christian contributions to science and the intellectual life, even by the exaggeration of the significance of what came from foreign and un-Christian sources. Proper recognition must be accorded to both Jewish and Moorish factors at Montpellier, but the one important element is that these foreign professors brought with them, even though always in rather far-fetched translations, the ideas of the great Greek masters of medicine to which the region and the people around Montpellier were particularly sensitive, because of the Greek elements in the population, and hence the development of a significant centre of education here. The date of the rise of the medical school at Montpellier is, as suggested by Puschmann, veiled in the obscurity of tradition. There seems to be no doubt that it goes back to as early as the tenth century, it was already famous in the eleventh, and it attracted students from all over Europe during the twelfth century. When Bishop Adalbert of Mainz came thither in 1137, the school possessed buildings of its own, as we learn from the words of a contemporary, Bishop Anselm of Havelberg. St. Bernard in a letter written in 1153 tells that the Archbishop of Lyons, being ill, repaired to Montpellier to be under the treatment of the physicians there. Perhaps the most interesting feature of this letter is the fact that the good Archbishop not only spent what money he had with him on physicians, but ran into debt. The two schools, Salerno and Montpellier, came to be mentioned by writers of the period as representing the twins of medical learning of the time. John of Salisbury, a writer of the early thirteenth century, declares that those who wished to devote themselves to medicine at this time went either to Salerno or Montpellier. Ægidius or Gilles de Corbeil, the well-known physician, and Hartmann von der Aue, the Meistersinger, both mention Salerno and Montpellier, usually in association, in their writings, and make it very clear that in the West at least the two names had come to be almost invariably connected as representing rival medical schools of about equal prominence. The reputation of Montpellier spread in Italy also, however, and we have the best evidence for this from an incident that took place in Rome at the beginning of the thirteenth century, which is more fully dwelt on in the chapter on Medieval Hospitals. Pope Innocent III. wanted to create a model hospital at Rome, and made inquiries as to who would be best fitted to organize such an institution. He was told of the work of Guy or Guido of Montpellier, who was a member of the Order of the Holy Ghost and had made a great hospital at Montpellier. Accordingly Guy was summoned to Rome, and the establishment of the Santo Spirito Hospital was entrusted to him. It was on the model of this that a great many hospitals were founded throughout the world, for Pope Innocent insisted that every diocese in Christianity should have a hospital, and Bishops who came on formal visits to the Holy See were asked to inspect the Santo Spirito for guidance in their own diocesan hospital establishments. Many of the hospitals throughout the world came as a result to be hospitals of the Holy Ghost and this contribution alone of Montpellier to the medical world of the time was of great significance and must have added much to her prestige. [Illustration: HOLY GHOST HOSPITAL (LÜBECK) _From "The Thirteenth: Greatest of Centuries," by J. J. Walsh_] Montpellier, like Salerno, seems to have attracted students to its medical school from all over the world. There were undoubtedly many English there, and probably also Irish and Scotch, though the journey must have been much longer and more difficult to make than is that from America to Europe at the present time. Of course there came many from Spain and from North France and the Netherlands. The fact that a number of Italians went there before the close of the Middle Ages shows how deeply interested were the men of this time in knowledge for its own sake, and indicates that something of that internationality of culture which we are priding ourselves on at the present time, because our students from all countries go far afield for postgraduate work and there is an interchange of professors, existed at this period. In spite of the fact that books were only written by hand, the teaching of distinguished professors had a wide diffusion, and students were quite ready to go through the drudgery of making these handwritten copies of a favourite master's work. They had plenty of common sense as well as powers of observation, and some of their writing is still of great practical value. A number of men who are famous in the history of medicine made their medical studies at Montpellier in the twelfth and thirteenth centuries. Among them are Mondeville, who afterwards taught surgery at Paris; and Guy de Chauliac, who was a Papal Physician at Avignon and at the same time a professor at Montpellier, probably spending a certain number of weeks, or perhaps months, each year in the university town. Sketches of these men, and of other students and teachers at Montpellier who reached distinction in surgery, will be found in the chapter on Surgeons of the West of Europe. Some other distinguished Montpellierians deserve brief mention. One of the distinguished professors at Montpellier was the well-known Arnold de Villanova, of whose name there are a number of variants, including even Rainaldus and Reginaldus. In 1285 he was already a famous physician, and was sent for to treat Peter III., King of Aragon, who was severely ill. In 1299 he was summoned on a consultation to the bedside of King Philip the Handsome (le Bel) at Paris. After this we hear of him in many places, as at the Court of Pope Benedict XI. at Rome, and in 1308 as the physician and friend of Pope Clement V. at Avignon. His writings were printed in a number of editions in the Renaissance time, Venice 1505, Lyons 1509, 1520, 1532, Basel 1585, and his medical and astronomical and chemical works in separate volumes at Lyons in 1586. His aphorisms are well known, and used to be frequently quoted during the Middle Ages and afterwards, and some of them deserve to be remembered even at the present time. For instance, he said: "Where the veins and arteries are notably large, incision and deep cauterization should be avoided." "When cauterization is to be done the direct cautery should be used; caustic applications are only suitable for very timid patients." "The lips of a wound will glue together of themselves if there is no foreign substance between them, and in this way the natural appearance of the part will be preserved." "In large wounds sutures should be used, and silk thread tied at short distances makes the best sutures." "The infection of the dura mater is followed in most cases by death." "A collection of pus is best dissolved by incision and cleaning out of the purulent material." "To put off the opening of an abscess brings many dangers with it." "In most cases of scrofula external applications are better than the use of the knife. Scrofulous patients always have other sources of infection within them, and so it does them no good to operate externally." "Tranquil and pure air is the best friend for convalescents." Villanova advised that the bite of a mad dog should not be permitted to heal at once, but the wound should be enlarged and allowed to bleed freely, leeches and cups being used to encourage bleeding, and healing should not be permitted for forty days. He believed very thoroughly in drainage, and in the dilation of narrow fistulous openings. He describes anthrax or carbuncle, and has chapters on various painful conditions for which he employs the terms arthritis, sciatica, chiragra, podagra, and gonagra. Villanova's treatment of the subject of hernia shows how thoroughly conservative he was, and how careful were his observations. In young persons in recent hernias he advised immediate complete reposition of the contents of the sac, the bringing together of the hernial opening by means of adhesive plaster, above which a bandage was placed, and the patient should be put to bed with the feet and legs elevated and the head depressed for ten to fifteen days or more if necessary. He says that "there are some--especially surgeons--who claim that they can cure hernia by incision, and some others by means of a purse-string ligature, and still others by the cautery or by some cauterizing material [they manifestly had our complete catalogue of 'fakes' in the matter]; but I prefer not to mention these procedures, since I have seen many patients perish under them, and others brought into serious danger of death, and I do not think that the surgeon will acquire glory or an increase of his friends from such perilous procedures, and I do not approve their use." One of the important writers of Montpellier was Gilbertus Anglicus (Gilbert the Englishman), who is called in one of the old translations of Mesue Doctor _Desideratissimus_, which I suppose might be Anglicized "loveliest of doctors." After his studies in England he went for graduate work to some of the famous foreign universities, and is named as a chancellor of Montpellier. His best-known work is his "Compendium Medicinæ," which bore as its full title "The Compendium of Medicine of Gilbert the Englishman; useful not only to physicians, but to clergymen for the treatment of all and every disease." Gurlt says that it contains little that is original, being a copy of Roger of Parma and Theodoric of Lucca, with a number of quotations from the Arabs, nearly all of whom Gilbert seems to have read with considerable attention. It is interesting to find that Gilbert was definitely of the opinion that cancer is incurable except by incision or cauterization. He declares that it yields to no medicine except surgery. Another of the men whose names are connected with Montpellier was John of Gaddesden, often called _Joannes Anglicus_. He was a student of Merton College, and received his degree of doctor of medicine at Oxford. He studied afterwards at Montpellier and also at Paris, and settled down to practise in London. He treated the son of King Edward II. for smallpox, and having wrapped him in red cloth and made all the hangings of his bed red, so that the patient was completely surrounded by this colour, he declared that he made "a good cure, and I cured him without any vestiges of the pocks." The treatment is interesting, as an anticipation in a certain way of Finsen's red light treatment for smallpox in our own time. Hanging the room, and especially the doors and the windows, with red when smallpox was to be treated was a favourite treatment down at Montpellier. Gaddesden's book is called by the somewhat fanciful name "Rosa Anglica." Bernard Gordon of Montpellier had written a "Lilium Medicinæ," and we have a "Flos Medicinæ" from Salerno, so that flower names for medical textbooks were evidently the fashion of the time. Gaddesden's book is almost entirely a compilation, and except in the relation of his surgical experience, contains little that is new. Guy de Chauliac was quite impatient with it, and declared that "lately there had arisen a foolish Anglican rose which was sent to me and I looked it over. I expected to find the odour of sweetness in it, but I found only some old fables." The criticism is, however, as Gurlt remarks, too severe and not quite justified, representing rather Guy's high ideal of the originality that a new textbook should possess, than a legitimate critical opinion. If our own textbooks were to be judged by any such lofty standard, most of them would suffer rather severely. Another of the well-known teachers at Montpellier was Valesco de Taranta. There are the usual variants of his name, his first name being written also Balesco, and his last name sometimes Tharanta. He was a Portuguese who studied in Lisbon, and later in Montpellier, where he taught afterwards and was considered one of the distinguished professors of his day, being for a time chancellor. He became so well known that he was summoned in consultation to the French King Charles VI., and there is some doubt as to whether he did not become his regular physician. One of his works, the "Philonium Pharmaceuticum et Chirurgicum de medendis omnibus, cum internis tum externis, humani corporis affectionibus," had the honour of being printed at Lyons in two editions in 1490, and one at Venice the same year, at Lyons 1500, Venice 1502, Lyons 1516, 1521, 1532, 1535, Venice 1589, and Lyons 1599. It has also been reprinted subsequently in a number of editions, so that it must have been a much-read book. Valesco had two favourite authors, Galen and Guy de Chauliac. The fact that he should have appreciated two such great men so thoroughly is of itself the best evidence of his own ability and critical judgment. His book, from the number of printed editions, must have been in the hands of practically all the progressive physicians of the southern part of France, at least during the fifteenth, sixteenth, and part of the seventeenth centuries. A very well-known teacher of Montpellier, who has had a reputation in English-speaking countries because his name was supposed to indicate that he was a Scotchman, was Bernard Gordon or de Gordon, whose name is, however, also written Gourdon. He was a teacher at Montpellier at the end of the thirteenth and the beginning of the fourteenth century. His textbook of medicine, in accordance with the custom of the time, is called by the flowery title "Lilium Medicinæ," the Lily of Medicine. While much of his information was derived from the Arabs, some of his teaching was an advance on theirs, and he described the acute fevers, leprosy, scabies, anthrax, as well as erysipelas, and still more strangely phthisis, as contagious. Dr. Garrison has called attention in his "History of Medicine" to the fact that the book is notable as containing the first description of a modern truss, and a very early mention of spectacles under the Latin name _oculus berellinus_. In recent years it has come to be the custom to think of Gordon or Gourdon as probably not of Scotch but of French origin--that is, born somewhere in the confines of what we now call France. There are a number of French places of the name of Gourdon from any of which he might have come. Montpellier represented for the West of Europe then very nearly what Salerno did for Italy and Eastern Europe. It very probably attracted many of the English and Scotch students of medicine, though not all the names supposed to be of British origin have proved to be so with the development of our knowledge. Montpellier has survived, however, while Salerno disappeared as a force in medical education. Its story would well deserve telling in detail, and doubtless the new national spirit of the French after the war will prove an incentive to the writing of it. CHAPTER V LATER MEDIEVAL MEDICINE Medicine in the later Middle Ages, that is, from the tenth to the middle of the fifteenth centuries, was greatly influenced by the medical schools which arose in Italy and the West of Europe during this period. These were organized mainly in connection with universities, Salerno, Montpellier, Bologna, Paris, Padua, in the order of their foundations, so far as they can be ascertained. These university medical schools represented serious scientific teaching in medicine, and certainly were not more prone to accept absurdities of therapeutics and other phases of supposed medical knowledge than have been the universities of any other corresponding period of time. Five centuries represent a very long interval in the history of humanity, and provide opportunities for a great many curious developments and ups and downs of interest, all of which must not be considered as representing any particular generation or even century in the history of that time. The absurdities came and went quite as in more modern times; but all the while there was an undercurrent of solid medical knowledge, founded on observation and definite clinical research, superadded to the information obtained from the classics of medicine. Even as early as the tenth century the thoroughly conservative teaching of Salerno in medicine made itself felt, and above all counteracted the Oriental tendencies to over-refinement of drugging, which had led to the so-called calendar prescription. This was the most noteworthy element in the medical practice of the later Middle Ages, but its significance has been dwelt on in the chapter on Salerno and the Beginnings of Medical History. While Arabic polypharmacy is the most striking feature of Mohammedan influence on medicine at this time, there were a number of Arabian and Jewish physicians who made a deep impression on the medicine of the later Middle Ages--that is, subsequent to the tenth century. Their work was felt not only in their own time, but for many subsequent centuries even down to and beyond the Renaissance, and they therefore must find a place in medieval medical history. This influence was exerted ever so much more outside of Italy than in the Italian peninsula, where the tradition of their contact with the original Greek authors still remained, and where they were making medicine and surgery for themselves quite apart from Arabian influence. The more one knows about the conditions in Italian medicine the less question is there of Arabian contributions to it. De Renzi in his History of Italian Medicine makes it very clear that the Arabs exercised no significant influence either at Salerno or elsewhere. The Benedictines and Cassiodorus afford evidence of the study of the Greek medical classics in Latin translations. Muratori cites a manuscript which he had consulted in the Medicean Library at Florence, and which, though written between the eighth and ninth centuries, says not a word of the Arabs and bears the title of "Abstracts from Hippocrates, Galen, Oribasius, Heliodorus, Asclepiades, Archigenes, Dioclis, Amyntas, Apollonius, Nymphiodorus, Ruffius, Ephesinus, Soranus, Ægineta, and Palladius." These and not the Arabs were the masters of the Italians, and it was fortunate, for the world was thus saved many Arabian mistakes and their tendency to neglect surgery. Before Salerno began to exert its real influence, some of the Arabian physicians came to occupy places of prominence in the medicine of the time. The most important of these was Avicenna, born toward the end of the tenth century in the Persian province of Chorasan, at the height of Arabian influence. He is sometimes spoken of as the Arabian Galen. His famous book, "The Canon," was the most consulted medical book throughout Europe for centuries. There are very few subjects in medicine that did not receive suggestive treatment at his hands. He has definite information with regard to Bubonic plague and the _filaria medinensis_. He has special chapters with regard to obesity, emaciation, and general constitutional conditions. He has chapters on cosmetics and on affections of the hair and nails that are interesting reading. The Renaissance scholars wrote many commentaries on his work, and for long after the introduction of printing his influence was felt widely. His Arabic colleague in the West was Avenzoar, to call him by the transformation of his Arabic family name, Ibn-Zohr. He was born near Seville, and probably died there, in 1162, well past ninety years of age. He was the teacher of Averröes, who always speaks of him with great respect. He is interesting as probably the first to suggest nutrition per rectum. His apparatus for the purpose consisted of the bladder of a goat with a silver cannula fastened into its neck. Having first carefully washed out the rectum with cleansing and purifying clysters, he injected the nutriment--eggs, milk, and gruel--into the gut. His idea was that the intestine would take this and, as he said, suck it up, carrying it back to the stomach, where it would be digested. The bladders of animals were very commonly used by these Moorish physicians and by their disciples, and the profession generally, for generations, for a great many purposes for which we now use rubber bags. Abulcasis, for instance, used a sheep's bladder introduced into the vagina and filled with air as a colpeurynter for supporting the organs in the neighbourhood, and also in fractures of the pubic arch. Avenzoar suggested feeding _per rectum_ in cases of stricture of the oesophagus, but he also treated the oesophageal stricture directly. He inserted a cannula of silver through the mouth until its head met an obstruction. This was pushed firmly, but withdrawn whenever there was a vomiting movement, until it became engaged in the stricture. Through it then _freshly milked_ milk, or gruel made from farina or barley, was to be poured. He had evidently seen cases improve this way, and therefore must have had experience with functional stricture of the oesophagus. He adds that some physicians believe that nutrition may be absorbed through the pores of the whole body, and that therefore in these cases the patient might be put in a warm milk or gruel bath; but he has not very much faith in the procedure, and says that the reasons urged for it are weak and rather frivolous. It is easy to understand that a man who could recommend manipulative modes of treatment of such kinds, and discuss questions of nutrition so sensibly, knew his medicine very practically and wrote of it judiciously. Maimonides (1135-1204) was one of these wise old Jews who quotes with approval from a Rabbi of old who had counselled his students: "Teach thy tongue to say, I do not know." Knowing thus the limitations of his own knowledge, it is not surprising that Maimonides should have left a series of practical observations for the maintenance of health which represent the common sense of all time in the matter. Maimonides anticipated the modern rule for taking fruits before meals, as we all do now at breakfast, and so often as fruit cocktails at the beginning of other meals. He thought that grapes, figs, melons, should be taken before meals, and not mixed with other food. He set down as a rule that what was easily digestible should be eaten at the beginning of the meal, to be followed by what was more difficult of digestion. He declared it to be an axiom of medicine "that so long as a man is able to be active and vigorous, does not eat until he is over full, and does not suffer from constipation, he is not liable to disease." Salerno's influence was felt much more deeply on surgery than on medicine, as can be seen very clearly from the chapter on Medieval Surgeons--Italy. These great surgeons of the period were also the leaders in medicine--for almost needless to say, there was no separation between the two modes of practice--men were as a rule both physicians and surgeons, even though for us their most important work by far was done in surgery. Certain passages from the works of these great surgeons that have come down to us deserve a place in the treatment of the more distinctly medical questions of the time. Lanfranc the great French surgeon's description of the treatment of the bite of a rabid dog is interesting. He suggests that a large cupping-glass should be applied over the wound, so as to draw out as much blood as possible. After this the wound should be dilated and thoroughly cauterized to its depths with a hot iron. It should then be covered with various substances that were supposed "to draw," in order as far as possible to remove the poison. His description of how one may recognize a rabid animal is rather striking in the light of our present knowledge, for he seems to have realized that the main diagnostic element is a change in the disposition of the animal, but above all a definite tendency to lack playfulness. Lanfranc had manifestly seen a number of cases of true rabies, and describes and suggests treatment for them, though evidently without very much confidence in the success of the treatment. The treatment of snake-bites and the bites of other animals supposed to be poisonous, or at least suspicious, followed the principles laid down for handling the bite of a mad dog. This was the case particularly as to the encouragement of free bleeding and the use of the cautery. A characteristic example of the power of clinical observation of the medieval physicians, and one which illustrates much better than many of the absurd tales told as typical of their superstitious tendencies, but really representing that tendency always present in mankind to believe wonders, is to be found in how much they learned of rabies. Even in our own time there are many absurd beliefs with regard to this disease, with some denials of its existence and many grossly exaggerated tales, widely believed; yet the medieval people seem to have reached some quite rational notions with regard to it. Bartholomæus Anglicus is the author of a popular encyclopedia which was very widely read in the medieval period. He was an English Franciscan of the thirteenth century, who gathered together a lot of information and wrote a volume that for centuries after his time, even down to Shakespeare's boyhood, was popular in England. Here is his description of rabies as he knew it. The most important element is his recognition of the uncertainty of the length of the incubation period, but it contains two other ideas that are very interesting, because medicine in subsequent centuries has come back to them over and over again. One is that free bleeding may remove the virus, and the other that the cautery may help in preventing the infection. "The biting of a wood-hound is deadly and venomous, and such venom is perilous. For it is long hidden and unknown, and increaseth and multiplieth itself, and is sometimes unknown to the year's end, and then the same day and hour of the biting it cometh to the head, and breedeth frenzy. They that are bitten of a wood-hound have in their sleep dreadful sights, and are fearful, astonished, and wroth without cause. And they dread to be seen of other men, and bark as hounds, and they dread water most of all things, and are afeared thereof, full sore and squeamous also. Against the biting of a wood-hound wise men and ready use to make the wounds bleed with fire or with iron, that the venom may come out with the blood that cometh out of the wound." A very interesting development of therapeutics in the Middle Ages was the employment of the red light treatment to shorten the course and the severity of the fever in smallpox, and above all to prevent pitting; it was employed successfully by John of Gaddesden in the case of the son of King Edward II. Recent investigation by Cholmeley has shown that both Gilbertus Anglicus (1290) and Bernard de Gordon (1305) antedated John of Gaddesden in references to the red light treatment. All of these men were professors at Montpellier, showing that the medical school of the South of France was a rival in the use of natural methods of cure to its better-known predecessor of Southern Italy. Curiously enough, the "Rosa Anglica" of Gaddesden, in which the reference to the red light is made, is deservedly characterized by Garrison as "a farrago of Arabist quackeries and countrified superstitions"; it well deserves Guy de Chauliac's bitter criticism of it as "a scentless rose." The idea included under the word autointoxication in our time--that is, that the human body has a tendency to produce poisons within itself, which act deleteriously on it and must be eliminated--was a favourite one during the Middle Ages. It became the custom in our time to have recourse to antiseptics or to surgical measures of various kinds for the relief and prevention of autointoxication. In the Middle Ages they thought to reduce its harmfulness at least by direct elimination, hence the use of drastic purgatives. It seems worth while remarking, however, that the employment of these did not come into general use until the close of the Middle Ages. Basil Valentine, if he really lived in the Middle Ages, and is not merely a name for a writer of the early sixteenth century, as modern historians seem inclined to think, suggested the use of antimony for the removal of the materies morbi from the body that has so much obsessed physicians for many generations. Antimony continued to be used down to the nineteenth century. It was gradually replaced by venesection, which was employed very strenuously during the eighteenth and early nineteenth centuries, in spite of the objection of such men as Morgagni, who refused to allow this mode of treatment to be used on him. Venesection was succeeded by large doses of calomel, and the calomel era continued on almost to our own generation. As a rule, however, the medieval physicians trusted nature much more than did their colleagues of modern history--that is, after the Renaissance until the present epoch of medical science began. It has always been difficult, however, for physicians to continue long in the persuasion that nature is a helpful auxiliary, and not a hampering factor to be combated. It is all the more to the credit of the medieval physicians to find, then, that in spite of many absurdities they continued for all the later centuries of the Middle Ages to extol the value of the natural means of cure. I shall have much to say of John of Ardern in the chapter on Medieval Surgeons of the West of Europe, but he deserves a place also in the chapter on Medicine. Ardern's advice to patients suffering from renal disease, which is contained in a separate tract of his lesser writings with the title in an old English version of "The Governaunce of Nefretykes," is extremely interesting, because it shows very clearly how long ago thoughtful physicians anticipated most of the directions that we now give such patients. Though we are inclined to think that any real knowledge of renal disease is quite modern, and above all has come since Bright's time, this paragraph of Ardern's shows how long before definite pathological knowledge had developed, careful clinical observation worked out empirically the indications of the affection. The paragraph is of special interest, because it contains the first reference to the possible danger that there may be for sufferers from kidney disease using the dark or red meats rather than the white meats. The tradition as to the distinction between the red and white meats has continued ever since his time, and though our modern chemistry does not enable us to find any such distinction between these substances as would justify the differentiation thus dwelt on, it has been maintained for no other reason that I have ever been able to find than because of the long years of tradition and clinical observation behind it.[6] "Nefretykes must putte awey ire, hyghly and moche besynesse and almanere [business and all manner of] thynge that longeth to the soule saff [save] only joye.... They schulle forbere almanere metys that ben to grete of substaunse and viscous, as olde beeff that is myghtyly pooudryd and enharded with salt and also fressch porke but yf it lye in salt iiii dayes afore.... They mowe use grete wyne and the fflessch of calvys that ben soowkynge and also of all ffowlys saff thoo that ben of the lakys and dichys [dykes?] ... and squamous ffyssches, i.e., fyssch of the rivere, of the stony waterys and rennynge ryveres and not of the standyne waterys and they schulle eschywe [eschew] almaner mete made of paast [pastries] and all bred that is dowgh bakene and all fatnesse. And they schulle use the reynes of te beeste other roste or sode. And in especiall he schall use a ffowl that is callyd Cauda tremula or Wagstertte [the wagtail, an English bird] other fressch or salte or bakene withoute drynesse ffor and it be drye it is nought woorth. And note that the use of the powdir or of the flessch of the Wagstertte avayleth gretly to breke the stone in the bladdere."[7] CHAPTER VI MEDIEVAL SURGEONS: ITALY Strange as it may seem, and quite contrary to the usual impressions in the matter, the most interesting department of the history of the medical science during the Middle Ages is that of surgery. Because of this fact we have to divide the subject into two chapters, one for the surgery of Italy, the other for the surgery of the rest of Europe. We have two series of medieval textbooks which treat largely of surgical subjects in a thoroughly scientific and professional way. The first of these comes to us from the earlier centuries of the Middle Ages, when Greek classic influence on medicine and the medical sciences was on the wane; and the other set comes to us from the later Middle Ages, when the earlier Renaissance of Greek influence was just making itself felt in Europe. Both sets of books serve to show very well that the men of these times were not only deeply interested in the affections for which surgery can provide the only relief possible, but that they had reached very definite, indeed sometimes ultimate, solutions of a large number of the constantly recurring problems of surgery. The greatest surprise of the whole range of medical history is that these medieval surgeons of both periods anticipated not a few of the surgical advances that we have been accustomed to think of as having been reserved for our time to make. Our knowledge of these details of the work of the medieval surgeons not only of the sixth and seventh centuries, but also of the thirteenth and fourteenth, is not founded on tradition, nor on a few scattered expressions which a modern medievalist might exaggerate, but on actual textbooks, which fortunately for us were reprinted as a rule during the Renaissance period, and have been preserved for us usually in a number of rather readily available copies. Most of them have been reprinted during the past generation, and have revolutionized our knowledge of the history of surgery; for these textbooks exhibit in detail a deep knowledge of surgical affections, a well-developed differential diagnosis, a thoroughly conservative treatment, and yet a distinct effort to give the patient every possible surgical opportunity for his life, compatible with reasonable assurance of successful surgical intervention. As I have pointed out, the surgical history of the old Crusades was as interesting and almost as valuable for civil surgery as that of our own Great War.[8] Three writers whom we have already mentioned (Early Medieval Medicine)--Aëtius, Alexander of Tralles, and Paul of Ægina--were, as we have seen, all of them interested in surgery, and wrote very interestingly on that subject. It is, however, from the end of the Middle Ages--that is, from the writers of the twelfth century down to the end of the fifteenth--that surprising contributions were made to surgical knowledge. This surgery of the end of the Middle Ages began its development at Salerno. The first great textbook was that of Roger--known also as Rogero and Ruggiero, with the adjective Parmensis or Salernitanus, of Parma or Salerno--who wrote his work about 1180. It is of this that Gurlt, in his "History of Surgery," vol. i., p. 701, says: "Though Arabian works on surgery had been brought over to Italy by Constantine Africanus a hundred years before Roger's time, these exercised no influence over Italian surgery in the next century, and there is scarcely a trace of the surgical knowledge of the Arabs to be found in Roger's works." He insisted, further, that Arabisms are not found in Roger's writings, while many Græcisms occur. The Salernitan School of Surgery drank, then, at the fountain-head of Greek surgery. After Roger comes Rolando, his pupil, who wrote a commentary on his master's work, and then the combined work of both of them was subsequently annotated by the Four Masters. It is this textbook, the work of many hands and the combined experience of many great teachers, that is the foundation stone of modern surgery. Some of the expressions in this volume will serve to give the best idea of how thoroughly these surgeons of the later medieval period studied their cases, how careful they were in observation, and how well they solved many problems that we are inclined to think of as having come up for serious consideration only much later than this time. After studying their chapter on Injuries of the Head, it is easy to understand why Gurlt should declare that, though there is some doubt about the names of the authors, this volume makes it very clear that these writers drew their opinions from a rich experience. They warn about the possibility of fracture of the skull even when there is no penetrating wound of the scalp, and they even suggest the advisability of exploratory incision when there is some good reason for suspicion of, though no evident sign of, fracture. In "Old-Time Makers of Medicine," I quoted some of the details of this teaching as to head surgery that may serve to illustrate what these surgeons taught on this important subject. There are many warnings of the danger of opening the skull, and of the necessity for definitely deciding beforehand that there is good reason for so doing. How carefully their observation had been made, and how well they had taken advantage of their opportunities, which were, of course, very frequent in those warlike times when firearms were unknown, hand-to-hand conflict common, and blunt weapons were often used, can be appreciated very well from some of the directions. For instance, they knew of the possibility of fracture by _contrecoup_. They say that "quite frequently, though the percussion comes in the anterior part of the cranium, the cranium is fractured on the opposite part." They even seem to have known of accidents such as we now discuss in connection with the laceration of the middle meningeal artery. They warn surgeons of the possibilities of these cases. They tell the story of "a youth who had a very small wound made by a thrown stone, and there seemed no serious results or bad signs. He died the next day, however. His cranium was opened, and a large amount of black blood was found coagulated about his dura mater." There are many interesting things said with regard to depressed fractures and the necessity for elevating the bone. If the depressed portion is wedged, then an opening should be made with the trephine, and an elevating instrument called a spatumen used to relieve the pressure. Great care should be taken, however, in carrying out this procedure, lest the bone of the cranium itself, in being lifted, should injure the soft structures within. The dura mater should be carefully protected from injury as well as the pia. Care should especially be exercised at the brow, and the rear of the head, and at the commissures (_proram et pupim et commissuras_), since at these points the dura mater is likely to be adherent. Perhaps the most striking expression, the word "infect" being italicized by Gurlt, is: "In elevating the cranium, be solicitous lest you should _infect_ or injure the dura mater." While these old-time surgeons insisted on the necessity for treating all depressed fractures, and even suggested that many fissure fractures required trephining, they deprecated meddlesome surgery of the cranium, unless there was evident necessity, quite as much as we do now. Surgeons who in every serious wound of the head have recourse to the trephine must, they said, be looked upon as fools and idiots (_idioti et stolidi_). When operations were done on the head, cold particularly was to be avoided. The operations were not to be done in cold weather, and above all not in cold places. The air of the operating-room must be warmed artificially. Hot plates should surround the patient's head while the operation was being performed. If this were not possible they were to be done by candlelight, the candle being held as close as possible in a warm room. They had many experiences with fractures at the base of the skull. Hæmorrhages from the mouth and nose and from the ears were considered a bad sign. They even suggested, for diagnostic purposes, what seems to us the rather dangerous procedure that the patient should hold his mouth and nostrils tight shut and blow strongly. One of their methods of negative diagnosis for fractures of the skull was that, if the patient were able to bring his teeth together strongly, or to crack a nut without pain, then there was no fracture present. One of the commentators, however, adds to this, as well he might, _sed hoc aliquando fallit_--"but this sign sometimes fails." Split or crack fractures were also diagnosticated by the methods suggested by Hippocrates of pouring some coloured fluid over the skull after the bone was exposed, when a linear fracture would show by coloration. The Four Masters suggest a sort of red ink for this purpose. One might well expect that, with trephining as frequent as this textbook of the Four Masters more than hints, the death-rate of these medieval surgeons must have been very high in head cases. We can scarcely understand such intervention in the conditions of operation assumed to exist in the Middle Ages without almost inevitable infection and consequent death. They seem to have come to an empiric recognition of the advantage of absolute cleanliness in such operations. Indeed, in the light of our modern asepsis and its development during our own generation, it is rather startling to note the anticipation of what is most recent in the directions that are given to a surgeon to be observed on the day when he is to do a trephining. I give it in the original Latin as it may be found in Gurlt (vol. i., p. 707): "_Et nota quod die illa cavendum est medico a coitu et malis cibis æra corrumpentibus, ut sunt allia, cepe, et hujusmodi, et colloquio mulieris menstruosæ, et manus ejus debent esse mundæ_, etc." The directions are most interesting. The surgeon's hands must be clean; he must avoid coitus and the taking of food that may corrupt the air, such as onions, leeks, and the like; must avoid menstruating women; and in general must keep himself in a state of absolute cleanliness. After the South Italian surgeons, some of whom taught at Bologna, a group of North Italian surgeons, most of whom probably were either direct or indirect pupils of the Salernitan School, must be considered. This includes such distinguished names in the history of surgery as Bruno da Longoburgo, usually called simply Bruno; Theodoric and his father Hugh of Lucca; William of Salicet; Lanfranc, the disciple of William who taught at Paris, and gave that primacy to French surgery which was maintained all the centuries down to the nineteenth (p. 1); and Mondino, the author of the first manual on dissection, which continued for two centuries to be used by practically everyone who anywhere did dissection throughout Europe. Practically all of these men did their best work between 1250 and 1300. Bruno of Longoburgo taught at Padua and Vicenza, and his textbook, the "Chirurgia Magna," was completed in Padua in January, 1252. Gurlt notes that "He is the first of the Italian surgeons who besides the Greeks quotes also the Arabian writers on surgery." Eclecticism had definitely come into vogue to replace exclusive devotion to the Greek authors, and men were taking what was good wherever they found it. Bruno begins his work by a definition of surgery, _chirurgia_, tracing it to the Greek and emphasizing that it means handwork. He then declares that it is the last instrument of medicine to be used, only when the other two instruments, diet and potions, have failed. He insists that surgeons must learn by seeing surgical operations, and watching them long and diligently. They must be neither rash nor over-bold, and should be extremely cautious about operating. While he says that he does not object to a surgeon taking a glass of wine, the followers of this specialty must not drink to such an extent as to disturb their command over themselves, and they must not be habitual drinkers. While all that is necessary for their art cannot be learned out of books, they must not despise books, however, for many things can be learned readily from books, even about the most difficult parts of surgery. Three things the surgeon has to do--"to bring together separated parts, to separate those that have become abnormally united, and to extirpate what is superfluous." While the old textbooks had emphasized the necessity for not allowing the circulation in the head to be disturbed by the cold, and insisted on the taking of special precautions in this matter, Bruno insists that wounds must be more carefully looked to in summer than in winter, because "putrefaction is greater in warm than in cold weather"--_putrefactio est major in æstate quam in hyeme_. He is particularly insistent on the necessity of drainage. In wounds of the extremities the limb must always be so placed as to encourage drainage. To secure it the wound may be enlarged; if necessary, even a counter-opening must be made to provide drainage. In order to secure proper union care must be exercised to bring the wound edges accurately together, and not allow hair or oil or dressings to come between them. In large wounds he considers stitching indispensable, and the preferable suture material in his experience is silk or linen. He discusses healing by first and second intention, and declares that with proper care the healing of a great many wounds by first intention can be secured. All his treatment of wounds is dry. Water he considered always did harm, and it is quite easy to understand that his experience taught him this, for the water generally available for surgeons in camps and battlefields and in emergency surgery was likely to do much more harm than good. Some of the details of his technique of abdominal wounds will be particularly interesting to modern surgeons. If there was difficulty in bringing about the reposition of the intestines, they were first to be pressed back with a sponge soaked in warm wine. Other manipulations are suggested, and if necessary the wound must be enlarged. If the omentum finds its way out of the wound, all of it that is black or green must be cut off. In cases where the intestines are wounded they are to be sewed with a small needle and a silk thread, and care is to be exercised in bringing about complete closure of the wound. This much will give a good idea of Bruno's thoroughness. Altogether, Gurlt, in his "History of Surgery," gives about fifteen large octavo pages of rather small type to a brief compendium of Bruno's teachings. One or two other remarks of Bruno are rather interesting in the light of modern development in medicine. For instance, he suggests the possibility of being able to feel a stone in the bladder by means of bimanual palpation. He teaches that mothers may often be able to cure hernias, both umbilical and inguinal, in children by promptly taking up the treatment of them as soon as noticed, bringing the edges of the hernial opening together by bandages, and then preventing the reopening of the hernia, by prohibiting wrestling and loud crying and violent motion. He has seen overgrowth of the mamma in men, and declares that it is due to nothing else but fat, as a rule. He suggests if it should hang down and be in the way on account of its size, it should be extirpated. He seems to have known considerable about the lipomas, and advises that they need only be removed in case they become bothersomely large. The removal is easy, and any bleeding that takes place may be stopped by means of the cautery. He divides rectal fistulæ into penetrating and non-penetrating, and suggests salves for the non-penetrating and the actual cautery for those that penetrate. He warns against the possibility of producing incontinence by the incision of deep fistulæ, for this would leave the patient in a worse state than before. The most interesting feature of the work of the North Italian surgeons of the later Middle Ages is their discovery and development of the two special advances of our modern surgery in which we are inclined to take most pride. These are, union by first intention, and anæsthesia. It is of course very startling to think that surgeons of seven centuries ago should have made advances in these important phases of surgery--which were afterwards to be forgotten; but human history is not a story of constant progress, but of ups and downs, and the mystery of human history is the decadence that almost inevitably follows any period of supremely great accomplishment by mankind. The later Middle Age enjoyed a particularly great period of efflorescence and achievement in surgery, and this, quite as with literature and other phases of human accomplishment, was followed by distinct descent of interest in surgical theory, and decadence in surgical practice, until the Renaissance came to provide another climax of surgical development. It would be perilous to say, however, that the acme of the curve of Renaissance surgical progress was higher than its predecessor, though once more there is the surprise to find that this high point was followed by another descent, until the curve ascended again in our time. What we have said already with regard to the requirement of cleanliness in operating upon the skull, insisted upon by the Salernitan School, will suggest that some of the practical value of asepsis had come home to these old-time surgeons. The North Italian surgeons went, however, much farther in their anticipations of asepsis. They insisted that if a surgeon made a wound through an unbroken surface and did not secure union by first intention, it was usually his own fault. It is to them we owe the expression "union by first intention"--_unio per primam intentionem_--which means nothing to us except through its Latin equivalent. They boasted of getting linear cicatrices which could scarcely be seen, and evidently their practice fostered the best of surgical technique and was founded on excellent principles. The North Italian surgeons replaced the use of ointments by wine, and evidently realized its cleansing--that is, antiseptic--quality. What is often not realized is, that the very old traditional treatment of wounds by the pouring of wine and oil into them represented a mild antiseptic and a soothing protective dressing. The wine inhibited the growth of ordinary germs, the oil protected the wound from dust and dirt. They were not ideal materials for the purpose, but they were much better when discreetly used than many surgical dressings of much more modern times founded on elaborate theories. Professor Clifford Allbutt, reviewing the practice of these North Italian surgeons of the thirteenth century, says:[9] "They washed the wound with wine, scrupulously removing every foreign particle; then they brought the edges together, not allowing wine nor anything else to remain within--dry adhesive surfaces were their desire. Nature, they said, produces the means of union in a viscous exudation--or natural balm, as it was afterwards called by Paracelsus, Paré, and Wurtz. In older wounds they did their best to obtain union by cleansing, desiccation, and refreshing of the edges. Upon the outer surface they laid only lint steeped in wine. Powder they regarded as too desiccating, for powder shuts in decomposing matters; wine, after washing, purifying, and drying the raw surfaces, evaporates." Theodoric wrote in 1266 on that question that so much disturbed the surgeons of the generations before ours, as to whether pus was a natural development in the healing of wounds or not. While laudable pus was for centuries after his time supposedly a scientific doctrine, Theodoric did not think so, and emphatically insisted that such teaching represented a great error. He said: "For it is not necessary, as Roger and Roland have written, as many of their disciples teach, and as all _modern_ surgeons profess, that pus should be generated in wounds. No error can be greater than this. Such a practice is indeed to hinder nature, to prolong the disease, and to prevent the conglutination and consolidation of the wound." The italics in the word modern are mine, but the whole expression might well have been used by some early advocate of antisepsis, or even by Lord Lister himself. Just six centuries almost to the year would separate the two declarations, yet they would be just as true at one time as at another. When we learn that Theodoric was proud of the beautiful cicatrices which his father had obtained without the use of any ointment--_pulcherrimas cicatrices sine unguento inducebat_--then, further, that he impugned the use of poultices and of oils in wounds, while powders were too drying, and besides had a tendency to prevent drainage (the literal meaning of the Latin words he employs, _saniem incarcerare_, is to "incarcerate sanious material"), it is easy to understand that the claim that antiseptic surgery was anticipated six centuries ago is no exaggeration and no far-fetched explanation, with modern ideas in mind, of certain clever modes of dressing hit upon accidentally by medieval surgeons. After Bruno, who brought with him the methods and principles of surgery from the South of Italy, his contemporary of the North, Hugh of Lucca--Ugo da Lucca, or Luccanus, as he is also called--deserves to be mentioned. He was called to Bologna in 1214 as City Physician, and was with the regiment of crusaders from Bologna at Damietta in 1220. He returned to Bologna in 1221 and occupied the post of legal physician. The Civic Statutes of Bologna are, according to Gurlt, the oldest monument of legal medicine in the Middle Ages. Hugh seems to have been deeply intent on chemical experiments, and especially anodyne and anæsthetic drugs. He is said to have been the first to have taught the sublimation of arsenic. Like many another distinguished practitioner of medicine and surgery, he left no writings. All that we know of him and his work, and above all his technique, we owe to the filial devotion of his son Theodoric. Anæsthesia is perhaps an even greater surprise in the Middle Ages than practical antisepsis. A great many of these surgeons of the time seem to have experimented with substances that might produce anæsthesia. Mandragora was the base of most of these anæsthetics, though a combination with opium seems to have been a favourite. They succeeded apparently, even with such crude means, in producing insensibility to pain without very serious dangers. One of these methods of Da Lucca was by inhalation, and seems to have been in use for a full century. Guy de Chauliac describes the method as it was used in his day, and a paragraph with regard to it will be found in the chapter on Surgeons of the West of Europe. It is quite clear that the extensive operations which are described in their textbooks of surgery at this time could not possibly have been performed, only that the surgeons were able to secure rather a deep and prolonged insensibility to pain. With anæsthesia combined with antisepsis, it is easy to understand how well equipped the surgeons of this time were for the development of their speciality. The fourth of these great surgeons at the North of Italy was William of Salicet. He was a pupil of Bruno of Longoburgo. Some idea of his practice as a surgeon may be obtained from even the first chapter of his first book. He begins with the treatment of hydrocephalus--or, as he calls it, "water collected in the heads of children newly born." He rejects opening of the head by incision because of the danger of it. He had successfully treated some of these difficult cases, however, by puncturing the scalp and membrane by a cautery, a very small opening being made and fluid being allowed to escape only drop by drop. William did not quote his predecessors much, but depended to a great extent on his own experience. He has many interesting details of technique with regard to the special subject of surgery of the nose, the ear, the mouth; and he did not even hesitate to treat goitre when it grows large, and says that if the sac is allowed to remain it should be thoroughly rubbed over on the inside with "green ointment." He warned "that in this affection many large bloodvessels make their appearance, and they find their way everywhere through the fleshy mass." A very interesting development of surgery along a line where it would probably be least expected was in plastic surgery. In the first half of the fifteenth century the two Brancas, father and son, performed a series of successful operations for the restoration of the nose particularly, and the son invented a series of similar procedures for the restoration of mutilated lips and ears. The father seems to have built up the nose from other portions of the face, possibly using, as Gurlt suggests, the skin of the forehead, as the Indian surgeons had done, though without any known hint of their work. Fazio, the historian of King Alphonso I. of Naples, who died in 1457, describes the favourite operation of Antonio Branca, the son, who in order not to disfigure any further the face in these cases, made the new nose from the skin of the upper arm; and in anticipation of Tagliacozzi, who attracted much attention by a similar operation in the latter half of the sixteenth century, separated the new nose from the arm sometime during the third week. There is abundance of other evidence as to the Brancas' work from contemporary writers--for instance, Bishop Peter Ranzano the annalist, the poet Calenzio, and Alexander Benedetti, the physician and anatomist--so that there can be no doubt of the fact that this wonderful invention in surgical technique was actually made before the close of the Middle Ages. It is interesting to realize that, while we hear much about the work of the Brancas, and from ecclesiastical authorities, there is no word of condemnation of the practice of restoring the nose or other facial features until much later in history. Tagliacozzi, who revived the operation of rhinoplasty just about the beginning of the seventeenth century, did not share so kind a fate. The latter Italian surgeon was roundly abused by some of his colleagues, even, it is said, by Fallopius and Paré, and bitterly satirized in Butler's "Hudibras." As late as 1788 (!) the Paris faculty interdicted face-repairing altogether. It is this sort of intolerance, on some superstitious ground or other, that is usually attributed to the Middle Ages. For such events the adjective medieval seems particularly adapted. As a matter of fact, we find comparatively little trace of such intolerance in medieval times; but it is comparatively easy to find the bitterest treatment of fellow-mortals for all sorts of foolish reasons in the seventeenth and eighteenth centuries. CHAPTER VII SURGEONS OUTSIDE OF ITALY: SURGEONS OF THE WEST OF EUROPE "Sciences are made by addition, and it is not possible that the same man should begin and finish them...." "We are like infants at the neck of a giant, for we can see all that the giant sees and something more."--(GUY DE CHAULIAC, Papal Physician to the Popes at Avignon.) The very interesting and in many ways astonishing development of surgery which occurred in Italy in the twelfth and thirteenth centuries, was followed up by similar developments in the western countries of Europe. France was the first to fall into the line of progress with important advances in surgery, and owes her teaching directly to the Italians; but in Flanders, in England, in Spain, and in Germany, we have records of some significant advances in surgery, and distinguished surgeons wrote books that fortunately for the history of surgery were preserved. The most important of the surgical writings of the time, put in type during the great nascent period of printing at the Renaissance, have come down to us. Many of these have been republished in recent years, and as the texts are now readily available they enable anyone to see for himself just what were the interests of the surgeons of the later medieval period, their technique, and their successful applications of great practical principles to the solution of important surgical problems. The beginning of French scientific surgery came with the exile from Italy of Lanfranc, as he is known, though his Italian name was Lanfranchi or Lanfranco, and he is sometimes spoken of as Alanfrancus. He had practised as physician and surgeon in Milan until banished from there by Matteo Visconti, about 1290. He made his way then to Lyons, where he attracted so much attention by his success as a surgeon that he was offered the chair of professor of surgery at the University of Paris. "He attracted an almost incredible number of scholars to his lessons in Paris, and by hundreds literally they accompanied him to the bedside of his patient and attended his operations" (Gurlt). Paris was at this time at the very height of its glory as a University. It had had a series of distinguished professors whose writings are still known and honoured, Albert the Great, Thomas Aquinas, Roger Bacon, and Duns Scotus; and during the latter half of the thirteenth century Louis IX. had encouraged the University in every way, and had helped in the foundation of the Sorbonne. There were probably more students in attendance at the University of Paris about the time that Lanfranc was there than there has ever been in attendance at any University before or since. The prestige of Lanfranc's position, then, and his opportunity to impress the world of his time, can be readily appreciated. The Dean of the medical faculty of Paris, Jean de Passavant, urged Lanfranc to write a textbook of surgery, partly for the familiar academic reason that the students were clamouring for some definite record of his teaching, but also because the Dean felt that the many copies of these lessons which the students would take away with them, and which would be consulted by others, would add greatly to the prestige of the medical school. Medical school officials are not so different after more than six and a half centuries. Lanfranc completed his textbook of surgery, called "Chirurgia Magna," in 1296, and dedicated it to Philippe le Bel, the then reigning King of France. It is from this work that we are able to judge exactly what the value of Lanfranc's surgical teaching was. In the second chapter of his textbook--the first containing the definition of surgery and a general introduction--Lanfranc devotes some paragraphs to the surgeon himself, and the qualities that a surgeon should possess if he is to be successful in his speciality. It is about the sort of advice that older surgeons are still likely to give young men who are entering on the practice of the speciality, and more or less what is said at many a commencement in the modern time when the maker of the address to the graduates is a surgeon. "It is necessary that a surgeon should have a temperate and moderate disposition. That he should have well-formed hands, long slender fingers, a strong body, not inclined to tremble, and with all his members trained to the capable fulfilment of the wishes of his mind. He should be well grounded in natural science, and should know not only medicine but every part of philosophy; should know logic well, so as to be able to understand what is written; to talk properly, and to support what he has to say by good reasons." He suggests that it would be well for the surgeon to have spent some time teaching grammar and dialectics and rhetoric, especially if he is to teach others in surgery, for this practice will add greatly to his teaching power. (What a desideratum for the modern time is thus outlined!) Some of his expressions might well be repeated to young surgeons in the modern time. "The surgeon should not love difficult cases, and should not allow himself to be tempted to undertake those that are desperate. He should help the poor as far as he can, but he should not hesitate to ask for good fees from the rich." Lanfranc was himself a scholar well read in the literature of his profession, but who had well digested his reading. He quotes altogether more than a score of writers on surgery who had preceded him, and evidently was thoroughly familiar with general surgical literature. He is a particular favourite of Gurlt, the German historian of surgery, who has devoted more than twenty-five closely printed large octavo pages to the discussion of this old Paris professor and his work. Lanfranc's discussion of wounds of nerves is of itself sufficient to show the character of his work. Many generations after his time have used the word nerves for tendons, and mistaken the function of these two structures, but Lanfranc distinguished very clearly between them. He declared that since the nerves are instruments of sense and motion, wounds of them should be carefully treated, especially as the sensitiveness of these structures is likely to cause the patient much subsequent pain if they are neglected. Longitudinal wounds of nerves are much less dangerous than those across them. When a nerve is completely divided in cross section Lanfranc was of the opinion, though Theodoric and some others were opposed to it, that the nerve ends should be stitched together. He says that the suture insures the reintegration of the nerve much better. Besides, after this operation the restoration of the usefulness of the member is more assured and is commonly more complete. After Lanfranc at Paris came Henri de Mondeville, whom Latin writers usually quote as _Henricus_. At least a dozen variants of the second portion of his name are found in literature, from Armondeville to Hermondaville. He was another of the University men of this time who wandered far for opportunities in education. Though born in the North of France and receiving his preliminary education there, he made his medical studies in the latter half of the thirteenth century under Theodoric in Italy. Afterwards he studied medicine in Montpellier and surgery in Paris. Later he gave at least one course of lectures at Montpellier, and then a series of lectures in Paris, attracting to both universities during his professorship a crowd of students from every part of Europe. One of his teachers at Paris had been his compatriot, Jean Pitard, the surgeon of Philippe le Bel, of whom he speaks as "most skilful and expert in the practice of surgery," and it was doubtless to Pitard's friendship that he owed his appointment as one of the four surgeons and three physicians who accompanied the King into Flanders. There is an historical tradition which has led many to believe that the surgery of the fourteenth century was mainly in the hands of the barber surgeons--ignorant men who plied a rude handicraft in connection with some conventional use of the lancet--and that the physicians quite despised their surgical colleagues. Mondeville is a striking contradiction of this. He was a scholarly man, who quotes not only all the distinguished contributors to medicine and surgery before his time, the Greeks and Latins, the Arabs, and his Italian masters, but who also has quotations from poets and philosophers, Aristotle, Plato, Diogenes, Cato, Horace, Ovid, Seneca, and others. The Regius Professors of Medicine at both Oxford and Cambridge in our generation are on record with the declaration that medicine and surgery have been allowed to drift too far apart, and that above all the physician should see more of surgical operations for the confirmation of diagnoses, for they are real bioscopys. It is rather interesting to find, then, that Mondeville felt the necessity in his time for close relations between physicians and surgeons, and said: "It is impossible that a surgeon should be expert who does not know not only the principles, but everything worth while knowing about medicine," and then he added, "just as it is impossible for a man to be a good physician who is entirely ignorant of the art of surgery." He says further: "This our art of surgery, which is the third part of medicine [the other two parts were diet and drugs] is, with all due deference to physicians, considered by us surgeons ourselves and by the non-medical as a more certain, nobler, securer, more perfect, more necessary, and more lucrative art than the other parts of medicine." Surgeons have always been prone to glory in their speciality. Mondeville is particularly interesting for the history of surgery because he himself ventured to trace some of the recent history of the development of his speciality. Following Galen's example, who had divided the physicians of the world into three sects, the Methodists, the Empirics, and the Rationalists, Mondeville divides modern surgery into three sects: First, that of the Salernitans, with Roger, Roland, and the Four Masters; second, that of William of Salicet, and Lanfranc; and third, that of Ugo da Lucca and his son Theodoric and their modern [_sic_] disciples. The characteristics of these three sects are in brief. The first limited patients' diet, used no stimulants, dilated all wounds and looked for union only after pus formation. The second allowed a liberal diet to weak patients, though not to the strong, but generally interfered with wounds too much. The third believed in a liberal diet, never dilated wounds, never inserted tents, and its members were extremely careful not to complicate wounds of the head by unwise interference. Almost needless to say, his critical discussion of the three schools is extremely interesting. Mondeville was himself a broadly educated scholar, who considered that the surgeon should know everything worth while knowing about medicine, for his work was greater than that of the physician. While he had high ideas, however, of the value of theoretic knowledge, he insisted above all on the value of practical training. He said, in his textbook on surgery, as to what the training of the surgeon should be: "A surgeon who wishes to operate regularly ought first for a long time to frequent places in which skilled surgeons often operate, and he ought to pay careful attention to their operations and commit their technique to memory. Then he ought to associate himself with them in doing operations. A man cannot be a good surgeon unless he knows both the art and science of medicine, and especially anatomy. The characteristics of a good surgeon are that he should be moderately bold, not given to disputations before those who do not know medicine, operate with foresight and wisdom, not beginning dangerous operations until he has provided himself with everything necessary for lessening the danger. He should have well-shaped members, especially hands with long slender fingers, mobile and not tremulous, and with all his members strong and healthy, so that he may perform all the proper operations without disturbance of mind. He must be highly moral, should care for the poor for God's sake, see that he makes himself well paid by the rich, should comfort his patients by pleasant discourse, and should always accede to their requests if these do not interfere with the cure of the disease." "It follows from this," he says, "that the perfect surgeon is more than the perfect physician, and that while he must know medicine he must in addition know his handicraft." The other great French surgeon of the fourteenth century was Guy de Chauliac, who well deserves the name of father of modern surgery. He was educated in a little town in the South of France, made his medical studies at Montpellier, and then went on a journey of hundreds of miles to Italy in order to make his postgraduate studies. While it is not generally realized, for some seven centuries before the nineteenth Italy was the home of graduate teaching in all departments. Whenever a man in any country in Europe, from the beginning of the twelfth until the end of the eighteenth century, wanted to secure opportunities for the higher education that were not available in his home country, he went down into Italy. At the beginning of the nineteenth century France usurped Italy's place for half a century, and Germany pre-empted the position to a great degree during the latter half of the nineteenth. The journey to Italy in the Middle Ages was more difficult, and involved more expense and time, than would even the voyage from America to Europe in our time; yet many a student from France, Germany, and England made it for the sake of the postgraduate opportunities, and it is matter for professional pride that this was particularly true of our medieval colleagues in medicine and surgery. [Illustration: SURGICAL INSTRUMENTS OF GUY DE CHAULIAC, NOS. 1, 2, 3, AND 4 (FOURTEENTH CENTURY); AND SURGICAL APPARATUS OF HANS VON GERSSDORFF, NOS. 5, 6 AND 7 (FIFTEENTH CENTURY) _After plates in Gurlt's "Geschichte der Chirurgie"_ 1. Trepan 2. Balista used for extraction of arrows 3. Cauterizing shears with cannula for cauterization of the uvula 4. Bistoury 5. Extension arrangement for reducing upper arm dislocations, called "The Fool" 6. Screwpiece for extending a knee contracture 7. Extension apparatus in the form of armour-arm and armour-leg plates ("harness instruments") for contractures of the elbow and knee joints] To know Guy de Chauliac's works well is to have ready contradictions at hand to practically all of the objections so frequently repeated as to the lack of scholarly work during the Middle Ages. For instance, Guy de Chauliac insisted on the value of experience rather than authority, and of original work rather than mere copying. He criticized in bitter satire John of Gaddesden's book on medicine, called after the fashion of the time by the poetical title "Rosa Anglica," of which he said: "Last of all bloomed the scentless Rose of England, which on its being sent to me I hoped to find bearing the odour of sweet originality. But instead of that I encountered only the fictions of Hispanus, of Gilbert, and of Theodoric." His mode of satirical expression is all the more interesting and significant, because it shows that the men of the time were critically minded enough as regards many of the passages in the writings of their predecessors with which fault has been found in the modern time, though we have usually been inclined to think that medieval readers accepted them quite uncritically. Chauliac's bitterest reproach for many of his predecessors was that "they follow one another like cranes, whether for love or fear I cannot say." Chauliac's description of the methods of anæsthesia practised by the surgeons of his time, especially in cases of amputation, is particularly interesting to us because the anæsthetic was administered by inhalation. Chauliac says: "Some surgeons prescribe medicaments, such as opium, the juice of the morel, hyoscyamus, mandrake, ivy, hemlock, lettuce, which send the patient to sleep, so that the incision may not be felt. A new sponge is soaked by them in the juice of these and left to dry in the sun; when they have need of it they put this sponge into warm water, and then hold it under the nostrils of the patient until he goes to sleep. Then they perform the operation."[10] Chauliac was particularly interested in the radical cure of hernia, and he discusses six different operations for this purpose. Gurlt points out that Chauliac's criticism of these operations is quite modern in its viewpoint. He declared that practically the object of radical operations for hernia is to produce a strong, firm tissue support over the ring through which the cord passes, so that the intestines cannot descend through it. It is rather interesting to find that the surgeons of this time tried to obliterate the canal by means of the cautery, or inflammation-producing agents--arsenic and the like--a practice that recalls some methods still used more or less irregularly. They also used gold wire as a support; it was to be left in the tissues, and was supposed to protect and strengthen the closure of the ring. At this time all these operations for the radical cure of hernia involved the sacrifice of the testicle, because the old surgeons wanted to obliterate the ring completely, and thought this the easiest way. Chauliac criticizes the operation in this respect, but says that he has "seen many cases in which men possessed of but one testicle have procreated, and this is a problem where the lesser of two evils is to be chosen." While he discussed hernia operations so freely, the great French surgeon did not believe that everyone who suffered from a hernia ought to be submitted to an operation. He quite agreed with Mondeville who, in the preceding generation, declared that many operations for hernia were done not for the benefit of the patient but for the benefit of the surgeon--a mode of expression that is likely to strike a sympathetic chord in some physicians' minds even at the present time. Chauliac's rule was that no operation should be attempted unless the patient's life was put in danger by the hernia, but that a truss should be worn to retain it. He emphasized that trusses should not be made according to rule, but must be adapted to each individual, and he invented several forms of trusses himself. He developed the method of taxis by which hernias might be reduced, suggested an exaggerated Trendelenburg position for operations for hernia and for the manipulations necessary for the reduction of hernia. The technique of some of these old surgeons is a never-ending source for surprise. The exaggerated Trendelenburg position in the operation for the radical cure of hernia--the patient being fastened on an inclined board, head down, so that the intestines would fall away from the site of operation--was used by Guy de Chauliac, who probably obtained a hint of it from Italy. He also employed extension in the treatment of fracture of the thigh, inventing an apparatus by which this might be continued for a long time until the muscles were relaxed from overtiredness. He made use for this purpose of a weight suspended on a cord which ran over rollers. He also adapted stiffened bandages of various kinds, especially employing white of egg for this, and sometimes moulding bandages to the limbs in cases of fracture. Yperman, the Flemish surgeon of this time, knew and used the oesophagus tube for artificial feeding, and a number of various kinds of instruments were invented for the urethra, including bougies of wax, tin, and silver. In diseases of the bladder and in gonorrhoea John Ardern employed astringent injections. Probably what ought to be considered the most important work of the French surgeons of the Middle Ages has been quite misunderstood until recent years. In his paper on "The Origin of Syphilis," at the Seventeenth International Congress of Medicine (London, 1913), Professor Karl Südhoff of Leipzig (see Transactions) reviewed the use of mercury in the form of mercurial ointment during the later Middle Ages, and the reputation that it had acquired for the cure of ulcers, skin eruptions of various kinds, and other distinctly objective lesions. It is perfectly clear now that the success of this form of therapy was due to the fact that syphilis was being treated. The French surgeons of the South of France developed the empiric discovery of the value of this remedy, the first hint of which had probably come to them from the Italians. It is one of the few specifics in the history of medicine. Needless to say, it is still with us, and still the accepted medication in spite, as Professor Südhoff notes, of the often-attempted replacement of it down the centuries by some form or other of arsenic treatment, though this has always been afterwards abandoned, and it would seem as though our generation might furnish another instance of the triumph of the medieval mercurial treatment over arsenic. The real reason then, it would seem, why syphilis came to be called the _morbus Gallicus_, or French Disease, was because when knowledge of its differential diagnosis was generalized, physicians at the same time learned of the remedy which could be so successfully employed for its treatment, the value of which had been determined as the result of the careful observations of the surgeons of South France. It is probable, as I have said, that the original idea for this form of treatment came from the Italian surgical traditions brought over from Italy by Lanfranc and his contemporaries at the end of the thirteenth century. There can be no doubt at all, however, of the power of clinical observation of the medieval surgeons who gave us this wonderful advance in therapeutics. The most distinguished pupil of Guy de Chauliac was Pietro d'Argelata, who died about 1423 as a professor at Bologna, but whose textbook, "The Cirurgia," was among the first of medical books to be printed at Venice in 1480. His teaching was still a living force at that time, and it is evident that he had attracted wide attention in his own generation. He taught the dry treatment of wounds, suggesting various powders to be employed on them, and gave his experience with sutures and drainage tubes in wounds. Ligatures are often supposed to have been invented much later. They have been attributed to Ambroise Paré and other surgeons of the Renaissance period, but were probably used at many times during the Middle Ages, and had been invented and frequently employed by the Greeks. They invariably went out of use after a time, however, and had to be reinvented. As I said in "Old-Time Makers of Medicine": "It is hard to understand how so useful an auxiliary to the surgeon as the ligature--it seems indispensable to us--could possibly be allowed to go out of use and even be forgotten. It will not be difficult, however, for anyone who recalls the conditions that obtained in old-time surgery to understand the succession of events. The ligature is a most satisfying immediate resource in stopping bleeding from an artery, but a septic ligature inevitably causes suppuration, and almost inevitably leads to secondary hæmorrhage. In the old days of septic surgery, secondary hæmorrhage was the surgeon's greatest and most dreaded bane. Some time from the fifth to the ninth day a septic ligature came away under conditions such that inflammatory disturbance had prevented sealing of the vessel. If the vessel was large, the hæmorrhage was fast and furious, and the patient died in a few minutes. After a surgeon had had a few deaths of this kind he dreaded the ligature. "Eventually he abandoned its use, and took kindly even to such methods as the actual cautery, red-hot knives for amputations and the like, that would sear the surfaces of tissues, and the bloodvessels, and not give rise to secondary hæmorrhage. A little later, however, someone not familiar with the secondary risks would reinvent the ligature. If he were cleanly in his methods, and, above all, if he were doing his work in a new hospital, the ligature worked very well for a while. If not, it soon fell into innocuous desuetude again. In any case, it was only a question of time until it would be abandoned." There was at least one, and probably a number of English surgeons who were doing excellent work in the latter part of the Middle Ages, but John of Ardern wrote a book which has come down to us, and from him we may judge the character of his contemporaries. He was educated at Montpellier, and practised surgery for a time in France. About the middle of the fourteenth century, according to Pagel, he went back to his native land and settled for some twenty years at Newark in Nottinghamshire; and for nearly thirty years longer, until near the end of the century, practised in London. Ardern's speciality was diseases of the rectum, but he made special studies in the treatment of fistulas everywhere in the body. He was an expert operator, and seems to have had excellent success in this field. He made careful statistics of his cases, and was quite as proud as any modern surgeon of the large numbers that he had operated on, which he gives very exactly. He was the inventor of some new instruments and of a clyster apparatus. We know something also about his fees, and there is no doubt that he obtained quite as good fees in proportion to the value of money as even any specialist of the modern time. Ardern gives many evidences of his power of clinical observation, and incidentally makes it very clear that the eyes of the men of his time were not so held from seeing the things that lay before them as is often assumed. Mr. D'Arcy Power, in the paper on "The Lesser Writings of John Ardern" which he read before the section on the History of Medicine at the Seventeenth International Congress (see Transactions), has quoted a series of paragraphs from Ardern which make it very clear how accurate an observer this fourteenth-century Englishman was. Here, for instance, is his description of epidemic sore throat in his time, probably diphtheria, for the death within five days through strangling would seem to point to this: "And note diligently that in the sqwynancy [quinsy] and in all the swellynges of the throte and the nekke and in all the lettynges and swolowynge as whanne the pacient thereof is oftetymys dysposyd to the deeth withinne schort time and I have seye manye deyed thereof within v dayes thorough stranglynge. To the weche it is to know that ther is nothynge more profytablere therefore thane to use glysteryes of malowys, mercurye [cheno-podium?] branne and oyle or buttre, hony and Sal gemme or comone salt. This operacione draweth the wykkyd humours to the inner partyes that causeth the syknesse and so it helpeth the sqwynnancye." Ardern's description of rabies, its fatality, and of how a mad dog acts, exemplifies still further his accuracy of clinical observation. Only one who had seen many cases and understood them, and had had many mad dogs under observation, could have given the details he does. A single paragraph confirms the idea that the medieval surgeons had very clearly recognized the disease, and knew as much about it as was known until our own generation added something of more definite knowledge of the affection than could be gained by mere clinical observation. Ardern says: "The bytynge of a wood [mad] dogge is more venemous and perilous thane it is of a serpente, ffor the venyme of a wood dogge ys hydd often tymes by the hole yere togydere and other whyle by the ii [two] yere and after some auctours it wole endure vii yere or it sle [slay] a man. And note wheyther it be longe tyme hydd or schorte or that it slee ther comene tofore to the pacient thes tokenys medlynge and chaungynge of wytte and resone and abhominacione and lothsomnesse of cold water that is clene and pure. And whane suche sygnys fallen to him that is byten of a wood hound schall unnethe or ellys [seldom or never] escape it. "The tokenys of a wood dogge ben these; the furste is he knoweth not his lord ne his mayster and he falleth into a voyd goyinge allone with boowynge of his heed and hangynge of the erys [ears] as other wyse than ne he hadde hemin his helthe and the yene [eyes] of him ben rede and the fome cometh out at the mowth and he wole berke at his oune schadowe and he hath ane hos [hoarse] berkynge, and other houndes fleene from hyme and berken towardys hyme. And yf a schyvere [slice] of breed be folden or wette in the bytynge of the sore and yoven a dogge to ete, yf that he ete it, it is a token that the dogge is not wood, for and the dogge be wood tha other dogge that the breed is yoven to wole not ete it, but that he be over moche hungry, and yf he denye to ete the seyde breed, out-take [unless on] the condicione aforeseyd, thane is the dogge wood." Ardern's description of a case of traumatic tetanus is very interesting, because it contains so many elements that are familiar in the history of this affection. The fact that it occurred in a gardener from a hook, so likely to be infected with tetanus bacilli from hay or grass, and that the wound was made where the thumb joins the hand and where, as we know now, the construction of the tissues is so favourable to that burying of the tetanus bacilli away from the free oxygen of the air, giving it a chance to grow anaerobically, all show the disease exactly as in our own time. The other details of the case probably indicate a wound of an important bloodvessel, secondary hæmorrhage after suppuration had been established, and then the development of fatal subacute tetanus. "A gardinere whyle that he wrowghte in the vynes kytte his owne hande with ane hooke uppone a ffryday after the ffeste of Seynt Thomas of Caunterbury in somere so that the thoombe was altogydere departyd from the hande saff only in the juncture that was joyned to the hande, and he myghte boowe bakward the thoombe to his arme and ther stremyd out therof moche blood. "And so touchynge to the cure. The thoombe was furst reduced in to his furste ordre and sowyd and the blood was restreyned with the reed pouder of launfrankes [Lanfranc's red powder] and with the heerys [hairs] of ane hare and it was not remevyd une-to the iiide day when it was remevyd tther apperyd no blood. Thanne was ther putte therto tho medicines that engendren blood, every day ones repeyrynge the wounde, and tho it begane to purge itselffe and to gadere mater. And in the iiiithe nyght after the blood brak out abowte mydnyght in the wheyghte of ii poundes. And whane the blod was restreyned the wounde was repeyred frome day to day as it was furste. "Also in the xithe nyght abowte the forseyd oure the blood brake owt ayene [again] in more quantyte thane it dyde afore tyme, nevertheless the blood was staunched, and by the morne the pacient was so taken with the crampe in the chekes [cheeks] and in the arme that he myght resseyve no mete in-to his mowth ne neyther opene the mowyth (lockjaw) and so vexynge the pacient in the xv day the blood brake out ayene owt of mesure and alwey the crampe endured forth and in the xx day he dyde." Another important surgeon of the West of Europe whose book has come down to us was John Yperman, who owes his name to the fact that he was a native of the town of Ypres (in Flemish Ypern) in Flanders. Yperman was sent by his fellow-townsmen to Paris in order to study surgery, apparently at the expense of the municipality, because they wanted to have a good surgeon in their town, and Paris seemed the best school at that time. Ypres, so familiar now as the scene of bloody battles, had become even before the war one of the less important cities even of Belgium, with less than 20,000 people. It was in the thirteenth century one of the greatest commercial cities of Europe, and probably had several hundred thousand inhabitants. The great hall of the Cloth Guild, one of the architectural triumphs of the time, and such an attraction for visitors to the town ever since (destroyed in the war) was built at this time, and is another tribute to the community feeling of the citizens, who determined upon the very sensible procedure of assuring the best possible surgery for themselves and fellow-citizens by having one of their townsmen specially educated for that purpose. Yperman's book on surgery was well known in his own time, but remained unprinted until about half a century ago (1854), when Carolus of Ghent issued an edition. Subsequent editions were issued by Broeckx, the Belgian historian (Antwerp, 1863), and by van Leersum (1913), who gathered some details of the great Flemish surgeon's life. After his return from Paris, Yperman obtained great renown, which maintains in the custom extant in that part of the country even yet of calling an expert surgeon "an Yperman." He is the author of two works in Flemish. One of these is a smaller compendium of internal medicine, which is very interesting, however, because it shows the many subjects that were occupying physicians' minds at that time. He treats of dropsy, rheumatism, under which occur the terms coryza and catarrh (the flowing diseases), icterus, phthisis (he calls the tuberculous, tysiken), apoplexy, epilepsy, frenzy, lethargy, fallen palate, cough, shortness of breath, lung abscess, hæmorrhage, blood-spitting, liver abscess, hardening of the spleen, affections of the kidney, bloody urine, diabetes, incontinence of urine, dysuria, strangury, gonorrhoea, and involuntary seminal emissions--all these terms are quoted directly from Pagel's account of his work. There is not much to be said of the surgery of Germany during the Middle Ages, though toward the end of this period a series of important documents for the history of surgery were written which serve to show how much was being accomplished, though the subsequent religious and political disturbances in Germany doubtless led to the destruction of many other documents that would have supplied valuable information. Heinrich von Pfolspeundt's book, which is a work on bandaging--"Bundth-Ertzney"--was published in 1460, and the experience for it was therefore all obtained in the Middle Ages. While its main purpose is bandaging, it contains many hints of the surgical knowledge of the time. There are chapters devoted to injuries and wounds, though it is distinctly stated that the book is for "wound physicians" (_Wund Aertzte_) and not for cutting physicians (_Schneide Aertzte_)--that is, for those who do operations apart from wounds. There are two operations described, however, that have particular interest. One of them involves the plastic surgery of the nose, and the other the repair of a hare-lip. Pfolspeundt suggested that stitches should be placed on the mucous surface as well as on the skin surface, after the edges of the cleft in hare-lip had been freshened in order to be brought closely together for healing with as little deformity as possible. Perhaps his most interesting surgical hint for us is a description of a silver tube with flanges to be inserted in the intestines whenever there were large wounds, or when the intestines had been divided. The ends of the gut were brought together carefully over the tube and stitched together, the tube being allowed to remain _in situ_. Pfolspeundt says that he had often seen these tubes used and the patient live for many years afterwards. While this resembles some of the mechanical aids to surgery of the intestines that have been suggested in our time, this was not the first mechanical device of this kind that had been thought of. One of the later medieval surgeons in Italy, one of the Brancas, had employed the trachea of an animal as the tube over which the wounded intestines were brought together. This had the advantage of not having to be passed, for after a time it became disintegrated in the secretions, but it remained intact until after thorough agglutination of the intestines had occurred. [Illustration: BRUNSCHWIG'S SURGICAL ARMAMENTARIUM _From Gurlt's "Geschichte der Chirurgie"_] Hans von Gerssdorff and Hieronymus Brunschwig, who flourished in the latter half of the fifteenth century in Germany, have both left early printed treatises on Surgery which give excellent woodcuts showing pictures of instruments, operations, and costumes, at the end of the medieval period. CHAPTER VIII ORAL SURGERY AND THE MINOR SURGICAL SPECIALITIES The surgical specialities, as they are called--that is, the surgery of the mouth, throat, and nose, and of the eye and ear, as well of course as of certain other portions of the body--have developed to a striking extent in our time. As a consequence of this recent development, there is an impression prevalent that this is the first time that serious attention has been paid by surgeons to these phases of their work. The feeling is probably that the minor operations usually required in the surgical specialities were either thought so trivial, or involved such delicate technique, that they never received due attention, rather than that they were deliberately neglected. Because of this very general persuasion, even among physicians, it is all the more interesting to trace the phases of attention during the Middle Ages to these special subjects in surgery, which was far from lacking at any time, and which led at various periods to some rather important developments. While specialism is considered new by most people, it must not be forgotten that at every time in the world's history, when men have had much chance to think about themselves rather than the actual necessities of the situation in which they were placed, and the things they were compelled to do for actual self-preservation, specialism has enjoyed a period of more or less intense evolution. It is rather easy to trace this in the Ebers Papyrus near the beginning of the second millennium B.C.; and Herodotus called attention to the fact that the old Egyptians had divided the practice of medicine into many specialities. His passage on the subject is well known.[11] If the surgical specialities had been neglected in the Middle Ages, then that fact would have constituted the surest evidence of that backwardness of medical and surgical progress which is usually supposed to have existed at that time. But the real story is exactly to the contrary, and has many surprises in it because of the anticipations of very recent advances which it represents.[12] It would be surprising, then, if we were to find no attention paid to dentistry during the Middle Ages. As a matter of fact, a number of the old surgeons include in their textbooks of surgery the discussion of oral surgery. Aëtius evidently knew much about the hygiene of the teeth, and discusses extraction and the cure of fistulæ of the gums as well as the surgical treatment of many other lesions of the mouth. Paul of Ægina in the century after Aëtius has even more details; and while they both quote mainly from older authors, there seems no doubt that they themselves must have had considerable practical experience in the treatment of the teeth and had made not a few observations. The Arabians took up the subject, and discussed dental diseases and their treatment rationally and in considerable detail. Abulcassis particularly has much that is of significance and interest. We have pictures of two score of dental instruments that were used by him. The Arabs not only treated and filled carious teeth, and even replaced those that were lost, but they also corrected deformities of the mouth and the dental arches. Orthodontia is usually thought of as of much later origin, yet no one who knows Abulcassis's work can speak of efforts at straightening the teeth as _invented_ after his time. [Illustration: SURGICAL INSTRUMENTS OF THE ARABS, ACCORDING TO ABULCASIM _After plates in Gurlt's "Geschichte der Chirurgie"_ 1. A pincher for extracting foreign bodies from the ear 2. An ear syringe for injections 3. A tongue depressor 4. Concave scissors for the removal of tonsils 5. Curved pinchers for foreign bodies in the throat 6 to 29. Instruments for the treatment of the teeth 19 and 20. Forceps 21 to 25. Levers and hooks for the removal of roots 26. Strong pinchers for the same 27. A tooth saw 28 and 29. Files for the teeth] The great surgeons of the later Middle Ages in their textbooks of surgery usually include remarks on oral surgery, and suggest treatment for the various diseases of the teeth. Guy de Chauliac in "La Grande Chirurgie" lays down certain rules for the preservation of the teeth, and shows that the ordinary causes of dental decay were well recognized in his time. Emphasis was laid by him on not taking foods too hot or too cold, and above all on the advisability of not having either hot or cold food followed by something very different from it in temperature. The breaking of hard things with the teeth was warned against as responsible for such fissures in the enamel as gave opportunity for the development of decay. The eating of sweets, and especially the sticky sweets, preserves, and the like, were recognized as an important source of caries. The teeth were supposed to be cleaned frequently, and not to be cleaned too roughly, for this would do more harm than good. Chauliac is particularly emphatic in his insistence on not permitting alimentary materials to remain in the cavities, and suggests that if cavities between the teeth tend to retain food material they should even be filled in such a way as to prevent these accumulations. His directions for cleansing the teeth were rather detailed. His favourite treatment for wounds was wine, and he knew that he succeeded by means of it in securing union by first intention. It is not surprising, then, to find that he recommends rinsing of the mouth with wine as a precaution against dental decay. A vinous decoction of wild mint and of pepper he considered particularly beneficial, though he thought that dentifrices, either powder or liquid, should also be used. He seems to recommend the powder dentifrices as more efficacious. His favourite prescription for a tooth-powder, while more elaborate, resembles to such an extent at least, some, if not indeed most, of those that are used at the present time, that it seems worth while giving his directions for it. He took equal parts of cuttle-bones, small white seashells, pumice-stone, burnt stag's horn, nitre, alum, rock salt, burnt roots of iris, aristolochia, and reeds. All of these substances should be carefully reduced to powder and then mixed. His favourite liquid dentifrice contained the following ingredients: Half a pound each of sal ammoniac and rock salt, and a quarter of a pound of saccharin alum. All these were to be reduced to powder and placed in a glass alembic and dissolved. The teeth should be rubbed with it, using a little scarlet cloth for the purpose. Just why this particular colour of cleansing cloth was recommended is not quite clear. He recognized, however, that cleansing of the teeth properly often became impossible by any scrubbing method, no matter what the dentifrice used, because of the presence of what he called hardened limosity or limyness (_limosité endurcie_). When that condition is present he suggests the use of rasps and spatumina and other instrumental means very similar to those we make use of for removing tartar. Guy de Chauliac was also interested in mechanical dentistry and the artificial replacement of lost teeth; and, indeed, dental prosthesis represents, as treated by him, a distinct anticipation of dental procedures usually thought quite modern. When teeth become loose he advises that they be fastened to the healthy ones with a gold chain. Guerini, in his "History of Dentistry" (Philadelphia, 1907), suggests that he evidently means a gold wire. If the teeth fall out Chauliac recommends that they be replaced by the teeth of another person, or with artificial teeth made from ox-bone, which may be fixed in place by a fine metal ligature. He says that such teeth may be serviceable for a long while. This is a rather curt way of treating so large a subject as dental prosthesis, but it contains a lot of suggestive material. He was quoting mainly the Arabian authors, and especially Abulcassis and Ali Abbas and Rhazes--and these of course, as we have said, mentioned many methods of artificially replacing teeth, as also of transplantation and of treatment of the deformities of the dental arches. Guerini called particular attention to the fact that Chauliac recognized the dentists as specialists. He observes that operations on the teeth are in a class by themselves, and belong to the _dentatores_ to whom they had been entrusted. He remarks, however, that the operations on the mouth should be performed under the direction of a surgeon. It is in order to give surgeons the general principles by means of which they may be able to judge of the advisability or necessity for dental operations, that his brief presentation of the subject is made. If their advice is to be of value, physicians should know the various methods of treatment suitable for dental diseases, including "mouth washes, gargles, masticatories and ointments, rubbings, fumigations, cauterizations, fillings, filings," as well as the various dental operations. He says that the _dentator_ must be provided with appropriate instruments, among which he named scrapers, rasps, straight and curved, spatumina, elevators, simple and with two branches, toothed tenacula, and many different forms of probes and cannulas. He should have also small scalpels, tooth trephines, and files. After Guy de Chauliac, the most important contributor to dentistry is Giovanni of Arcoli--or simply Arcolano, but sometimes better known by his Latin name Johannes Arculanus--who was Professor of Medicine and Surgery at Bologna just before and after the middle of the fifteenth century. He is sometimes treated in history as belonging rather to the Renaissance, but he owed his training to the Middle Ages and was teaching before they closed, so he has a place in Medieval Medicine. Guerini, in his "History of Dentistry," says that Arculanus treats the subject of dentistry rather fully and with great accuracy. The Italian historian makes a summary of Arculanus's rules for dental hygiene which shows how thoroughly he appreciated the care of the teeth. The medieval surgeon arranged his rules in ten distinct canons, creating in this way a kind of decalogue of dental hygiene. These rules are: (1) It is necessary to guard against the corruption of food and drink within the stomach; therefore, easily corruptible food--milk, salt fish, etc.--must not be partaken of, and after meals all excessive movement, running exercises, bathing, coitus, and other causes that impair the digestion, must also be avoided. (2) Everything must be avoided that may provoke vomiting. (3) Sweet and viscous food--such as dried figs, preserves made with honey, etc.--must not be partaken of. (4) Hard things must not be broken with the teeth. (5) All food, drink, and other substances that set the teeth on edge must be avoided, and especially the rapid succession of hot and cold, and _vice versa_. (7) Leeks must not be eaten, as such a food, by its own nature, is injurious to the teeth. (8) The teeth must be cleaned at once after every meal from the particles of food left in them; and for this purpose thin pieces of wood should be used, somewhat broad at the ends, but not sharp-pointed or edged; and preference should be given to small cypress-twigs, or the wood of aloes, or pine, rosemary, or juniper, and similar sorts of wood, which are rather bitter and styptic; care must, however, be taken not to search too long in the dental interstices, and not to injure the gums or shake the teeth. (9) After this it is necessary to rinse the mouth, using by preference a vinous decoction of sage, or one of cinnamon, mastich, gallia, moschata, cubeb, juniper seeds, root of cyperus, and rosemary leaves. (10) The teeth must be rubbed with suitable dentifrices before going to bed, or else in the morning before breakfast. Although Avicenna recommended various oils for this purpose, Giovanni of Arcoli appears very hostile to oleaginous frictions, because he considers them very injurious to the stomach. He observes, besides, that whilst moderate frictions of brief duration are helpful to the teeth, strengthen the gums, prevent the formation of tartar, and sweeten the breath, too rough or too prolonged rubbing is, on the contrary, harmful to the teeth, and makes them liable to many diseases. Shortly after Arculanus, when the Middle Ages are over--if they end with the middle of the fifteenth century, though perhaps not if the later date of the discovery of America is to be taken as the medieval terminal--John de Vigo has in a few lines a very complete description of the method of filling teeth with gold-leaf which deserves to be quoted. Only that it was a common practice he would surely have described it more in detail, though he could have added nothing to the significance of what he has to say: "By means of a drill or file the putrefied or corroded part of the teeth should be completely removed. The cavity left should then be filled with gold-leaf." Much more is known about the medieval anticipation of other specialities--those of the throat and nose, and eye and ear--and the surprise is with regard to dentistry, which is usually quite unknown. The fact, however, that dentistry developed so much more than is usually thought prepares the mind for the anticipations in other departments. Following that of dentistry should come naturally the mouth and throat, and it happens that the men whose writings in dentistry are known also touched on these subjects. The medical writers of the early Middle Ages, particularly Aëtius, Alexander of Tralles, and Paul of Ægina, have not a little to say with regard to affections of the throat and nose, and the eye and ear. Alexander's chapter on the Treatment of Affections of the Ear, Gurlt considers ample evidence of large practical experience and power of observation. Alexander describes the ordinary mode of getting water out of the external auditory canal by standing on the leg corresponding to the side in which the water is, and kicking out with the opposite leg. Foreign bodies should be removed by an ear spoon, or a small instrument wrapped in wool and dipped in sticky material. He suggests sneezing with the head leaning toward the side on which the foreign body is present. Insects or worms that find their way into the ear may be killed by injections of dilute acid and oil or other substances. Paul of Ægina has a very practical technique for the removal of fish-bones or other objects caught in the throat. He also gives the detailed technique of opening the larynx or trachea, with the indications for this operation. He also describes how wounds of the neck should be sewed after attempts at suicide. In a word, the more one knows of these old-time medieval writers of the sixth and seventh centuries the clearer it becomes that they had learned their lessons well from the ancients, and passed on an excellent tradition to their colleagues of succeeding generations. If these lessons were not properly taken, it was because the disturbance of civilization caused by the coming down of the Teutonic invaders into Italy took away interest in the things of the mind and of the body, until the coming of another upward turn in progress. Arculanus has some very interesting paragraphs with regard to the treatment of conditions in the nose. For instance, in the treatment of polyps, he says that they should be incised and cauterized. Soft polyps should be drawn out with a toothed tenaculum as far as can be without risk of breaking them off. The incision should be made at the root, so that nothing or just as little as possible of the pathological structure be allowed to remain. It should be cut off with fine scissors; or with a narrow file just small enough to permit ingress into the nostrils; or with a scalpel without cutting edges on the sides, but only at its extremity, and this cutting edge should be broad and well sharpened. If there is danger of hæmorrhage, or if there is fear of it, the instruments with which the section is made should be fired (_igniantur_)--that is, heated at least to a dull redness. Afterwards the stump, if any remains, should be touched with a hot iron or else with cauterizing agents, so that as far as possible it should be obliterated. After the operation, a pledget of cotton dipped in the green ointment described by Rhazes should be placed in the nose. This pledget should have a string fastened to it, hanging from the nose, in order that it may be easily removed. At times it may be necessary to touch the root of the polyp with a stylet, on which cotton has been placed that has been dipped in _aqua fortis_ (nitric acid). It is important that this cauterizing fluid should be rather strong, so that after a certain number of touches a rather firm eschar is produced. In all these manipulations in the nose Arculanus recommends that the nose should be held well open by means of a nasal speculum. Pictures of all these instruments occur in his extant works, and indeed this constitutes one of their most interesting and valuable features. They are to be seen in Gurlt's "History of Surgery." In some of the cases he had seen, the polyp was so difficult to get at, or was situated so far back in the nose, that it could not be reached by means of a tenaculum or scissors, or even the special knife devised for that purpose. For these patients Arculanus describes an operation that is to be found in the older writers on surgery--Paul of Ægina (Æginetas), Avicenna, and some of the other Arabian surgeons. For this, three horse-tail hairs are twisted together and knotted in three or four places, and one end is passed through the nostrils and out through the mouth. The ends of this are then pulled on backward and forward after the fashion of a saw. Arculanus remarks, evidently with the air of a man who has tried it and not been satisfied, that this operation is quite uncertain, and seems to depend a great deal on chance, and much reliance must not be placed on it. Arculanus suggests a substitute method by which latent polyps--or occult polyps, as he calls them--may be removed. Among the affections of the upper air passages mentioned by Arculanus are various forms of sore throat, which he calls Synanche or Cynanche, or angina. A milder form of the affection was called Parasynanche. The medieval teaching with regard to an angina that was causing severe difficulty of breathing was to perform tracheotomy. Arculanus goes into some detail with regard to affections of the uvula, which was made much more responsible for throat affections than at the present time. The popular tradition in our time of the uvula and its fall is evidently a remnant of the medieval teaching with regard to it. Arculanus's description of the removal of the uvula, or at least of the tip of it, gives a very good idea of how thorough the teaching of surgical technique was in his time. His directions are: "Seat the patient upon a stool in a bright light, while an assistant holds the head; after the tongue has been firmly depressed by means of a speculum, let the assistant hold this speculum in place. With the left hand then insert an instrument, a stilus, by which the uvula is pulled forward; and then remove the end of it by means of a heated knife or some other process of cauterization. The mouth should afterwards be washed out with fresh milk." The application of a cauterizing solution by means of a cotton swab wrapped round the end of a sound may be of service in patients who refuse the actual cautery. To be successful, he insists that the application must be firmly made and must be frequently repeated. With regard to ophthalmology the older history has always been thoroughly appreciated. Even as early as the time of Hammurabi (2200 B.C.) some rather extensive and interesting surgery of the eye was practised, for the fees for these operations are mentioned in the code. All of the early medieval writers on medicine and surgery--Aëtius, Alexander of Tralles, and Paul of Ægina--have paragraphs at least, and sometimes more, with regard to eye operations and the care of the eyes. Operations above all for cataract have been practised from very early times, and are mentioned also by many medieval writers on medicine and surgery. It is not surprising, then, to find that the medieval surgeons particularly discussed a number of eye diseases and the operations for them. Pope John XXI., who before he became Pope was known as _Petrus Hispanus_ (the Spaniard), and who had been a professor of surgery and a papal physician, wrote a book on eye diseases in the latter half of the thirteenth century, which has come down to us. He had much to say of cataract, dividing it into traumatic and spontaneous, and suggesting operation by needling, a gold needle being used for that purpose. Pope John describes a form of hardness of the eye which would seem to be what we now call glaucoma, and has a number of external applications for eye diseases. Most of his collyria had some bile in them, the bile of various kinds of animals and birds being supposed to be progressively more efficient for the cure of external affections of the eye. This very general use of bile, or of an extract of the livers of animals or fishes, seems to be a heritage from biblical times, when old Toby was cured of his blindness by the gall of the fish.[13] The Pope ophthalmologist (see _Opthalmology_, Milwaukee, January, 1909) recommended the urine of infants as an eye-wash, experience having evidently shown that this fluid, which is usually bland and unirritating, a solution of salts of a specific gravity such that it would not set up osmotic processes in the eye, was empirically of value. In the Middle Ages the idea of using it would be much less deterrent, because it was quite a common practice for physicians to taste urine in order to test it for pathological conditions. Spectacles were rather commonly used in the Middle Ages, probably having been invented in the second half of the thirteenth century by Salvino de Armato of Florence. Bernard de Gordon mentions them under the name _oculus berellinus_ early in the fourteenth century. They were originally made from a kind of smoky crystal, _berillus_, whence the German name _Brillen_ and the French _besicles_ (Garrison). Guy de Chauliac suggests that when collyria failed to improve the sight spectacles should be employed. Almost needless to say, this use of spectacles meant very much for the comfort and convenience of old people. Up to that time most of those who reached the age of three-score would be utterly unable to read, and would have to depend either on others or on their memory for teaching and many other purposes. External eye troubles, as those due to trichiasis and to various disturbances of the lachrymal apparatus, were treated by direct mechanical means. Some very ingenious suggestions and manipulations were made with regard to them. CHAPTER IX MEDICAL EDUCATION FOR WOMEN Among the rather startling surprises that have developed, as the growth of our knowledge of medieval history, through consultation of the documents in recent years, is constantly contradicting traditions founded on lack of information, perhaps the greatest has been to learn that women were given opportunities for the higher education at practically all of the Italian universities, and that they became not only students, but professors, at many of these institutions. No century from the twelfth down to the nineteenth was without some distinguished women professors at Italian universities, and in the later Middle Ages there was a particularly active period of feminine education. The most interesting feature of this development for us is that the application of women to medical studies from the twelfth to the fourteenth centuries was not only not discouraged, but was distinctly encouraged, and we find evidence that a number of women studied and taught medicine, wrote books on medical subjects, were consulted with regard to medico-legal questions, and in general were looked upon as medical colleagues in practically every sense of the word. The very first medical school that developed in modern times, that of Salerno, which came into European prominence in the eleventh century, was quite early in its history opened to women students, and a number of women professors were on its faculty. Considering the modern idea that ours is the first time when women have ever had any real opportunity for the higher education, and above all professional education, it is a source of no little astonishment to find that at Salerno not only an opportunity was afforded to women to study medicine, but the department of women's diseases was handed over entirely to them, and as a consequence we have a Salernitan School of Women Physicians, some of whom wrote textbooks on the subject relating to this speciality. De Renzi, in his "Storia della Scuola di Salerno," has brought to light many details of the history of this phase of medical education for women at the first important medical school that developed in modern Europe. The best known of these medieval women physicians was Trotula, to whom is attributed a series of books on medical subjects--though doubtless some of these were due rather to disciples, but became identified with the more famous master, as so often happened with medieval books. Trotula's most important book bears two sub-titles: "Trotula's Unique Book for the Curing of Diseases of Women, Before, During, and After Labour," and the other sub-title, "Trotula's Wonderful Book of Experiences (_experimentalis_) in the Diseases of Women, Before, During, and After Labour, with Other Details Likewise Relating to Labour." Probably the most interesting passage in her book for the modern time is that with regard to a torn perineum and its repair, even when prolapse of the uterus is a complication. The passage, which may be found readily in De Renzi or in Gurlt, runs: "Certain patients, from the severity of the labour, run into a rupture of the genitalia. In some even the vulva and anus become one foramen, having the same course. As a consequence, prolapse of the uterus occurs, and it becomes indurated. In order to relieve this condition, we apply to the uterus warm wine in which butter has been boiled, and these fomentations are continued until the uterus becomes soft, and then it is gently replaced. After this we sew the tear between the anus and vulva in three or four places with silk thread. The woman should then be placed in bed, with the feet elevated, and must retain that position, even for eating and drinking, and all the necessities of life, for eight or nine days. During this time, also, there must be no bathing, and care must be taken to avoid everything that might cause coughing, and all indigestible materials." There is a passage almost more interesting with regard to prophylaxis of rupture of the perineum. Trotula says: "In order to avoid the aforesaid danger, careful provision should be made, and precautions should be taken during labour after the following fashion: A cloth folded in somewhat oblong shape should be placed on the anus, and during every effort for the expulsion of the child, that should be pressed firmly, in order that there may not be any solution of the continuity of tissue." There are records of other women professors of Salerno, though none of them as famous as Trotula. A lady of the name of Mercuriade is said to have written "On Crises in Pestilent Fever," and as she occupied herself with surgery as well as medicine, there is also a work on "The Cure of Wounds." Rebecca Guarna, who belonged to the old Salernitan family of that name, a member of which in the twelfth century was Romuald, priest, physician, and historian, wrote "On Fevers," "On the Urine," and "On the Embryo." Abella acquired a great reputation with her work "On Black Bile," and curiously enough on "The Nature of Seminal Fluid." From these books it is clear that, while as professors they had charge of the department of women's diseases, they studied all branches of medicine. There are a number of licences preserved in the Archives of Naples in which women are accorded the privilege of practising medicine, and apparently these licences were without limitation as to the scope of practice. The preamble of the licence, however, suggests the eminent suitability of women treating women's diseases. It ran as follows: "Since, then, the law permits women to exercise the profession of physicians, and since, besides, due regard being had to purity of morals, women are better suited for the treatment of women's diseases, after having received the oath of fidelity, we permit," etc. The story of medical education for women with the free opportunity for practice, and above all the recognition accorded by making them professors at the University of Salerno, will seem all the more surprising to those who recall that the Benedictines largely influenced the foundation at Salerno, and were important factors in its subsequent growth and management. Ordinarily it would be presumed that monastic influence would be distinctly against permitting women to secure such opportunities for education, and, above all, encouraging their occupation with medical practice. As a matter of fact, it seems indeed to have been monastic influence which secured this special development. The Benedictines were already habituated to the idea that women were quite capable, if given the opportunity, of taking advantage of the highest education; and besides, they were accustomed to see them occupied, and successfully, with the care of the ailing. When St. Benedict established the monks of the West in retreats, where the men of the earlier Middle Ages could secure, in the midst of troubled times and with men in the cities utterly neglectful of intellectual interests, a refuge from the disturbed life around them, and an opportunity for intellectual development, his sister Scholastica afforded similar opportunities for such women as felt that they were called rather to the intellectual and spiritual life than to the taking up of the burden of domestic duties and a wife's labours. In these Benedictine convents for women, as they spread throughout Italy--and afterwards throughout Germany, and France, and England, though the fact is often ignored--the intellectual life was pursued as faithfully as the spiritual. Besides, there gathered around the convent gates as around the monasteries the farmers who worked their estates, and who found it so good "to live under the crozier," as the rule of the Abbot or Abbess was called, and who always suffered severely whenever, by confiscation or war or like disturbances, the monastic lands passed into the hands of laymen. For their own large numbers as well as for their peasantry, and for the travellers who stayed in their guest-houses, the nuns had to provide medical attendance; and the infirmarians of the convents, situated as they were so often far from cities or towns, acquired considerable medical knowledge and came to apply it with excellent success. The traditions were gathered from many quarters, and passed on for centuries from one house to another; and they gathered simples and treated the ordinary ailments, and nursed the ailing into moods of greater courage and states of mind that predisposed to recovery. Probably the most important book on medicine that we have from the twelfth century is written by a Benedictine Abbess, since known as St. Hildegarde. She was born of noble parents at Boeckelheim in the county of Sponheim, about the end of the eleventh century. She was educated at the Benedictine cloister of Disibodenberg, and when her education was finished she entered the house as a religious, and at the age of about fifty she became abbess. Her writings, reputation for sanctity, and her wise rule, eminently sympathetic as she was, attracted so many new members to the community that the convent became overcrowded. Accordingly, with eighteen of her nuns, Hildegarde withdrew to a new convent at Rupertsburg, which English and American travellers will doubtless recall because it is not far from Bingen on the Rhine, made famous in the later time by Mrs. Hemans's poem. Here she came to be a sort of centre for the intellectual life of her period. According to traditions, some of which are dubious, she was in active correspondence with nearly every important personage of her generation. She was an intimate friend of St. Bernard of Clairvaux, who was himself perhaps the most influential man of Europe in this century. Her correspondence was enormous, and she was consulted from all sides because her advice on difficult problems of any and every kind was considered so valuable. In spite of all this time-taking correspondence she found leisure to write a series of books, most of them on mystical subjects, but two of them, strange as it may seem, on medicine. The first is called "Liber Simplicis Medicinæ," and the second "Liber Compositæ Medicinæ." These books were written as a contribution of her views with regard to the medical knowledge of her time, but were evidently due, partly at least, to the Benedictine traditions of interest in medicine. Dr. Melanie Lipinska in her "Histoire des Femmes Médicins," a thesis presented for the doctorate in medicine at the University of Paris in 1900, which was subsequently awarded a special prize by the French Academy, reviews Hildegarde's work critically from the medical standpoint. She does not hesitate to declare the Abbess Hildegarde the most important medical writer of her time. Reuss, the editor of the works of Hildegarde as they are published in Migne's "Patrologia," the immense French edition of all the important works of the Fathers, Doctors, and Saints of the Church, says: "Among all the saintly religious who have practised medicine or written about it in the Middle Ages, the most important is without any doubt St. Hildegarde...." With regard to her book he says: "All those who wish to write the history of the medical and natural sciences must read this work, in which this religious woman, evidently well grounded in all that was known at that time in the secrets of nature, discusses and examines carefully all the knowledge of the time." He adds: "It is certain that St. Hildegarde knew many things that were unknown to the physicians of her time." Some of Hildegarde's expressions are startling enough because they indicate discussion of, and attempts to elucidate, problems which many people of the modern time are likely to think occurred only to the last few generations. For instance, in talking about the stars and describing their course through the firmament, she makes use of a comparison that seems strangely ahead of her time. She says: "Just as the blood moves in the veins, causing them to vibrate and pulsate, so the stars move in the firmament, and send out sparks as it were of light, like the vibrations of the veins." This is, of course, not an anticipation of the discovery of the circulation of the blood, but it shows how close were men's ideas to some such thought five centuries before Harvey's discovery. For Hildegarde the brain was the regulator of all the vital qualities, the centre of life. She connects the nerves in their passage from the brain and the spinal cord through the body with manifestations of life. She has a series of chapters with regard to psychology, normal and morbid. She talks about frenzy, insanity, despair, dread, obsession, anger, idiocy, and innocency. She says very strongly in one place that "when headache and migraine and vertigo attack a patient simultaneously, they render a man foolish and upset his reason. This makes many people think that he is possessed of a demon, but that is not true." These are the exact words of the saint as quoted in Mlle. Lipinska's thesis. With this story of St. Hildegarde in mind, and the recall of other educational developments among the Benedictine nuns, it is easy to understand the developments that took place at Salerno, where monastic influence was so prominent. Just as the medical, and above all the surgical, traditions of Salerno found their way to Bologna at the beginning of the thirteenth century, so also did the regulations regarding standards in medical education, and with them medical education for women. There are definite historical documents which show that women not only studied but taught in the medical department of Bologna. The name of one of them at least is very well known. She was Alessandra Giliani, and, strange as it might appear, was one of the prosectors in anatomy of Mondino, the founder of teaching by human dissection. According to the "Cronaca Persicetana," quoted by Medici in his "History of the Anatomical School at Bologna": "She became most valuable to Mondino because she would cleanse most skilfully the smallest vein, the arteries, all ramifications of the vessels, without lacerating or dividing them, and to prepare them for demonstration she would fill them with various coloured liquids, which, after having been driven into the vessels, would harden without destroying the vessels. Again, she would paint these same vessels to their minute branches so perfectly, and colour them so naturally, that, added to the wonderful explanations and teachings of the master, they brought him great fame and credit." This passage with its description, as coming from a woman, of a very early anticipation of our most modern anatomical technique--injection, hardening, and colouring, so as to imitate nature for the making of anatomical preparations, for class and demonstration purposes--is all the more interesting because the next great improvement in anatomical teaching, the use of wax models of dissected specimens coloured to imitate nature, came also from a woman, Madame Manzolini, also of Bologna. Feminine instinct aroused women to use their inventive ability to do away with the necessity for always recurring to the deterrent material of fresh dissections, and yet securing such preparations as would make teaching not less but more effective. Some doubt has been thrown on certain details of the story of Alessandra Giliani, but the memorial tablet erected at the time of her death in the Hospital Church of Santa Maria de Mareto in Florence gives all the important facts, and tells the story of the grief of her fiancé, who was himself Mondino's other assistant. Like her, he died young also, when there were high hopes of his ability, and there is more than the suspicion that these two untimely deaths may have been due to dissecting wound infections. She died "consumed by her labours," so that it may have been phthisis; but he was taken by "a swift and lamentable death." Nicaise, in the Introduction to his edition of Guy de Chauliac's "Grande Chirurgie" (Paris, 1893), has a brief review of the history of women in medicine, with special reference to France. He supplies practically all the information available in very short compass, as well as the references where more details can be obtained. "Women continued to practise medicine in Italy for centuries, and the names of some who attained great renown have been preserved for us. Their works are still quoted from in the fifteenth century. "There was none of them in France who became distinguished, but women could practise medicine in certain towns at least on condition of passing an examination before regularly appointed masters. An edict of 1311, at the same time that it interdicts unauthorized women from practising surgery, recognizes their rights to practise the art if they have undergone an examination before the regularly appointed master surgeons of the corporation of Paris. An edict of King John, April, 1352, contains the same expressions as the previous edict. Du Bouley, in his 'History of the University of Paris' gives another edict by the same king, also published in the year 1352, as a result of the complaints of the faculties at Paris, in which there is also question of women physicians. This responded to a petition: 'Having heard the petition of the Dean and Masters of the Faculty of Medicine at the University of Paris, who declare that there are very many of both sexes, some of the women with legal title to practise and some of them merely old pretenders to a knowledge of medicine, who come to Paris in order to practise, be it enacted,' etc. (The edict then proceeds to repeat the terms of previous legislation in this matter.) "Guy de Chauliac speaks also of women who practised surgery. They formed the fifth and last class of operators in his time. He complains that they are accustomed to too great an extent to give over patients suffering from all kinds of maladies to the will of Heaven, founding their practice on the maxim, 'The Lord has given as he has pleased; the Lord will take away when he pleases; may the name of the Lord be blessed.' "In the sixteenth century, according to Pasquier, the practice of medicine by women almost entirely disappeared. The number of women physicians becomes more and more rare in the following centuries, just in proportion as we approach our own time. Pasquier says that we find a certain number of them anxious for knowledge, and with a special penchant for the study of the natural sciences and even of medicine, but very few of them take up practice." There seems, however, to have been not nearly so much freedom or so much encouragement for women in medicine in France as in Italy. Indeed, in the whole matter of education for women, medieval France has but little to record compared to Italy's significant chapter in the history of feminine education. One reason for this was doubtless the Hélöise-Abélard incident early in the history of the University of Paris. This seems to have discouraged efforts in the direction of the securing of the higher education for women in most of the Western Universities. Oxford was a daughter university of Paris, and Cambridge of Oxford, and they and all the other universities of the West were more deeply influenced in their customs and organization by Paris than by Italy, and as a consequence we hear little of feminine education in the West generally. One result of this has been the existence of a feeling that, since women had very few opportunities for the higher education in Western Europe, they must have had them nowhere else. This presumption forms the basis of not a little misunderstanding of the Middle Ages in our time. It often takes but a little incident to set the current of history in a very different direction from that in which it might have gone, and this seems to have been the case as regards the higher education for women in France and Spain and England. CHAPTER X MEDIEVAL HOSPITALS Our recent experience makes it easy to understand that such magnificent advance in surgery as has been described in the preceding chapters would have been quite impossible unless there were excellent hospitals in the medieval period. Good surgery demands good hospitals, and indeed inevitably creates them. Whenever hospitals are in a state of neglect, surgery is hopeless. We have, however, abundant evidence of the existence of fine hospitals in the Middle Ages, quite apart from this assumption of them, because of the surprising surgery of the period. Historical traditions from the earlier as well as the later medieval times demonstrate a magnificent development of hospital organization. While there had been military hospitals and a few civic institutions for the care of citizens in Roman times, and some hospital traditions in the East and in connection with the temples in Egypt, hospital organization as we know it is Christian in origin; and particularly the erection of institutions for the care of the ailing poor came to be looked upon very early as a special duty of Christians. Even the Roman Emperor, Julian the Apostate, declared that the old Olympian religion would inevitably lose its hold on the people, unless somehow it could show such care for others in need as the Christians exhibited wherever they obtained a foothold. It was not, however, until nearly the beginning of the Middle Ages that the Christians were in sufficient numbers in the cities, and were free enough from interference by government, to take up seriously the problem of public hospital organization. The rapidity of the development, once external obstacles were removed, shows clearly how close to the heart of Christianity was the subject of care for the ailing poor. St. Basil's magnificent foundation at Cæsarea in Cappadocia, called the _Basilias_, which took on the dimensions of a city (termed Newtown) with regular streets, buildings for different classes of patients, dwellings for physicians and nurses and for the convalescent, and apparently even workshops and industrial schools for the care and instruction of foundlings and of children that had been under the care of the monastery, as well as for what we would now call reconstruction work, shows how far hospital organization, even in the latter part of the fourth century, had developed. About the year 400 Fabiola at Rome, according to St. Jerome, "established a Nosocomium to gather in the sick from the streets, and to nurse the wretched sufferers wasted from poverty and disease." A little later Pammachius, a Roman Senator, founded a Xenodochium for the care of strangers which St. Jerome praises in one of his letters. At the end of the fifth century Pope Symmachus built hospitals in connection with the three most important churches of Rome, St. Peter's, St. Paul's, and St. Lawrence's. During the Pontificate of Vigilius, Belisarius founded a Xenodochium in the _Via Lata_ at Rome, shortly after the middle of the sixth century. Christian hospitals were early established in the cities of France; and not long after the conversion of England, in that country. In connection with these hospitals, it is rather easy to understand the fine development of surgery by early Christian physicians which we have traced. The later medieval period of hospital building, however, is of particular interest in the history of medicine, because we have such details of it as show its excellent adaptation to medical and surgical needs. According to Virchow, in his article on the History of German Hospitals, which is to be found in the second volume of his collected "Essays on Public Medicine and the History of Epidemics,"[14] the story of the foundation of these hospitals of the Middle Ages, even those of Germany, centres around the name of one man, Pope Innocent III. Virchow was not at all a papistically inclined writer, so that his tribute to the great Pope who solved so finely the medico-social problems of his time undoubtedly represents a merited recognition of a great social development in history. "The beginning of the history of all these German hospitals is connected with the name of that Pope who made the boldest and farthest-reaching attempt to gather the sum of human interests into the organization of the Catholic Church. The hospitals of the Holy Ghost were one of the many means by which Innocent III. thought to hold humanity to the Holy See. And surely it was one of the most effective. Was it not calculated to create the most profound impression to see how the mighty Pope, who humbled emperors and deposed kings, who was the unrelenting adversary of the Albigenses, turned his eyes sympathetically upon the poor and the sick, sought the helpless and the neglected upon the streets, and saved the illegitimate children from death in the waters! There is something at once conciliating and fascinating in the fact that, at the very time when the fourth crusade was inaugurated through his influence, the thought of founding a great organization of an essentially humane character, which was eventually to extend throughout all Christendom, was also taking form in his soul; and that in the same year (1204) in which the new Latin Empire was founded in Constantinople, the newly erected hospital of the Holy Spirit, by the old bridge on the other side of the Tiber, was blessed and dedicated as the future centre of this organization." According to tradition, just about the beginning of the thirteenth century Pope Innocent resolved to build a hospital in Rome. On inquiry, he found that probably the best man to put in charge of hospital organization was Guy or Guido of Montpellier, of the Brothers of the Holy Ghost, who had founded a hospital at Montpellier which became famous throughout Europe for its thorough organization. Accordingly he summoned Guido to Rome, and gave into his hands the organization of the new hospital, which was erected on the other side of Tiber in the Borgo not far from St. Peter's. Indeed, Santo Spirito Hospital, as it came to be called, was probably the direct successor of the hospital which Pope Symmachus (488-514) had had built in connection with St. Peter's not long after the beginning of the Middle Ages. It is easy to understand that at the time when magnificent municipal structures, cathedrals, town halls, abbeys, and educational institutions of various kinds were being erected, with exemplary devotion to art and use, the Hospital of Santo Spirito under the special patronage of the Pope was not unworthy of its time.[15] We know very little, however, about the actual structure. [Illustration: THIRTEENTH-CENTURY HOSPITAL INTERIOR (TONERRE) _From "The Thirteenth: Greatest of Centuries," by J. J. Walsh_] Then, as now, Bishops made regular visits at intervals _ad limina_--that is, to the Pope as Chief Bishop of the Church; and according to tradition Pope Innocent called their attention particularly to this hospital of Santo Spirito, one of his favourite institutions, and suggested that every diocese in Christendom ought to have such a refuge for the ailing poor. The consequence was the erection of hospitals everywhere throughout Europe. Virchow has told the story of these hospital foundations of the Holy Ghost, as they were called, and makes it very clear that probably every town of 5,000 inhabitants everywhere throughout Europe at this time had a hospital. The traditions with regard to France are quite as complete as those that concern Germany and the great hospitals of London--St. Thomas's; St. Bartholomew's, which had been a priory with a house for the care of the poor, but was now turned into a hospital; Bethlehem, afterwards Bedlam; Bridewell, and Christ's Hospital, the first of which afterwards became a prison, while Christ's Hospital, though retaining its name, became a school. The Five Royal Hospitals, as they were called, were either founded, or received a great stimulus and thorough reorganization, during the thirteenth century. It would be easy to suppose these hospitals were rather rude structures, inexpertly built, poorly arranged, and above all badly lighted and ventilated. They might be expected to furnish protection from the elements for the poor, but scarcely more, and probably became in the course of time hotbeds of infection because of their lack of air and uncleanness. As a matter of fact, they were almost exactly the opposite of any such supposition. Those in the larger towns at least were model hospitals in many ways, and ever so much better than many hospital structures erected in post-medieval centuries. Indeed, the ordinary impression as to the medieval hospitals, and their lack of suitability to their purpose, would apply perfectly to the hospitals of the latter half of the eighteenth and the early nineteenth centuries. It is because our generation still has the memory of these hospitals of the past generation, and assumes that if these were so bad, the hospitals of an earlier time must have been worse and the hospitals of the medieval period must have been intolerable, that the derogatory tradition with regard to medieval hospitals and many other medical subjects maintained itself until the coming of real information with regard to them. The ecclesiastical architecture of the later Middle Ages was not only beautiful, but it was eminently suitable for its purpose, and above all provided light and air. The churches, the town halls, the monasteries and abbeys, were models in their kind, and it would have been quite surprising if the hospitals alone had been unworthy products of that great architectural period. As abundant remains serve to show even to the present time, they were not. The hospitals built in the thirteenth century particularly usually were of one story, had high ceilings with large windows, often were built near the water in order that there might be abundance of water for cleansing purposes, and also so that the sewage of the hospital might be carried off, had tiled floors that facilitated thorough cleansing, and many other provisions that the architects of our time are reintroducing into hospital construction. They were a complete contrast to the barrack-like hospitals with small windows, narrow corridors, cell-like rooms, which were built even two generations ago, and which represented the lowest period in hospital building for seven centuries. [Illustration: LEPER HOSPITAL OF ST. BARTHOLOMEW, OXFORD _From "Medieval Hospitals," by Miss R. M. Clay_] Viollet le Duc, in his "Dictionary of Architecture," has given a picture of the interior of one of these medieval hospitals, that of Tonnerre in France, erected by Marguerite of Bourgogne, the sister of St. Louis, in 1293, which we reproduce here. Mr. Arthur Dillon, discussing this hospital from the standpoint of an architect, says: "It was an admirable hospital in every way, and it is doubtful if we to-day surpass it. It was isolated, the ward was separated from the other buildings, it had the advantages we so often lose of being but one story high, and more space was given to each patient than we can now afford. "The ventilation by the great windows and ventilators in the ceiling was excellent; it was cheerfully lighted, and the arrangement of the gallery shielded the patients from dazzling light and from draughts from the windows, and afforded an easy means of supervision; while the division by the roofless, low partitions isolated the sick, and obviated the depression that comes from the sight of others in pain. "It was, moreover, in great contrast to the cheerless white wards of to-day. The vaulted ceiling was very beautiful; the woodwork was richly carved, and the great windows over the altars were filled with coloured glass. Altogether, it was one of the best examples of the best period of Gothic architecture." The hospital ward itself was 55 feet wide and 270 feet long and had a high arched ceiling of wood. The Princess herself lived in a separate building, connected with the hospital by a covered passage. The kitchen and storehouse for provisions were also in separate buildings. The whole hospital plant was placed between the branches of a small stream conducted around it, which served to temper the atmosphere, and was a source of water supply at one end of the grounds and helped in the disposal of sewage from the other end. A hospital of the Holy Ghost which may be taken as the type of such structures is still standing at Lübeck in Germany, and was, like the hospital at Tonnerre, also built during the thirteenth century. It was erected as the result of the movement initiated by Pope Innocent's foundation of the Santo Spirito at Rome. The picture of this, in my "Thirteenth Century," will serve to show what Holy Ghost hospitals in important cities at least were like. Lübeck was one of the rich Hansa towns in the thirteenth century, but there were many others of equal importance, or very nearly so, and all of these towns were rivals in the architectural adornment of their municipalities, and particularly in the erection of cathedrals, town halls, guild halls, and other buildings for the use of citizens. The older portion of the Hospital of St. Jean at Bruges also gives an excellent idea of a later medieval hospital as it was constructed in a populous commercial town. Bruges, almost needless to say, was one of the most important cities of Europe in the fourteenth century. The Hospital of St. Jean, then, was built, like the cathedral and churches and the town hall, so as to be worthy of the city's prestige. The older part, which is now used for a storeroom, has the characteristics of the best medieval hospitals. The ward was one story in height, the windows were large, high in the walls, and the canals that flowed around the hospital made pleasant vistas for the patient, while the gardens attached were eminently suitable for convalescents. The phases of hospital building down the centuries can be studied at St. Jean, and, strange as it may seem, the oldest portion of the hospital, that of the medieval period, provided the most light and air for the patients and the best opportunity for thorough cleansing, as well as for occupation of the patients' minds with details of the construction that were visible from any part of the ward. The hospitals of the Middle Ages are particularly interesting, because they represent a solution of the social problems other than merely the relief of pain and suffering, or the care of the needy who have none to care for them. They represent a ready, constantly near opportunity for the better-to-do classes to exercise charity toward those who needed it most. The hospitals were always in the busiest portions of the towns, and were often visited by the citizens, both men and women. Dr. John S. Billings, in his description of "The Johns Hopkins Hospital" (Baltimore, 1890), touched upon this spirit of the hospital movement of the Middle Ages in a very appropriate way when he said: "When the medieval priest established in each great city of France a Hotel Dieu, a place for God's hospitality, it was in the interest of charity as he understood it, including both the helping of the sick poor, and the affording of those who were neither sick nor poor an opportunity and a stimulus to help their fellow-men; and doubtless the cause of humanity and religion was advanced more by the effect on the givers than on the receivers." A rather significant historical detail with regard to medieval hospitals is the foundation of a special order to take care of the hospitals in which St. Anthony's Fire, or what we know as erysipelas, was treated. Apparently this indicated the recognition of the contagiousness of this disease by the medieval people. Pope Honorius III. approved the foundation of an order of nurses particularly devoted to the care of patients suffering from this affection. Other religious congregations for the same works seem to have been established. We did not recognize the contagiousness of the disease until the last generation. Undoubtedly these special foundations made it possible to control many of the epidemics of erysipelas that used to make surgical care in our hospitals in the modern time such a difficult matter. Even as late as our Civil War here in America, erysipelas was the special dread of the hospital surgeon. Oliver Wendell Holmes pointed out that erysipelas might readily be carried to the parturient woman with the production of child-bed fever. It is interesting to realize, then, the attempt of the medieval period to segregate the disease. [Illustration: THE HARBLEDOWN HOSPITAL, NEAR CANTERBURY _From "Medieval Hospitals," by Miss R. M. Clay_ "On the outskirts of a town, seven hundred years ago, the eye of the traveller would have been caught by a well-known landmark--a group of cottages, with an adjoining chapel, clustering round a green enclosure. At a glance he would recognize it as the lazar-house, and would prepare to throw an alms to the crippled and disfigured representative of the community."] Besides hospitals, a series of lazarettos--that is, of buildings for the segregation of lepers--were erected in the various countries of Europe during the medieval period. Just about the end of the Crusades it was discovered that leprosy had become very common throughout Europe. It is often said that leprosy was introduced at this time, but it had evidently been in the West for many centuries before. Gregory of Tours mentions leper hospitals as early as 560, and the disease evidently continued to progress, in spite of these special hospitals, until in the thirteenth century it became clear that strenuous efforts would have to be made to wipe out the disease. Accordingly, leproseries were erected in connection with practically every town in Europe at this time. Baas estimates that there were some 19,000 of them in Europe altogether. Virchow has listed a large number of the leper hospitals of the German cities, quite enough to show that probably no organized community was without one. As a consequence of this widespread movement of enforced segregation, leprosy gradually died out in Europe, remaining only here and there in backward localities. The disease was probably as common during the later Middle Ages as tuberculosis is among us at the present time. The recently discovered relations between the bacterial cause of the two diseases may give rise to the question as to whether we shall succeed as well with the great social and hygienic problem that confronts our generation, of lowering the death-rate from "the great white plague," as the medieval generations did with their chronic folk-disease, leprosy. It would be "a consummation devoutly to be wished." We are now beginning to have as many sanatoria for tuberculosis in proportion to the population as they had of leproseries. These leproseries, or lazarettos, as they were called, were not at all the dreadful places that the imagination has been wont to picture them in recent years; on the contrary they were, as a rule, beautifully situated on a side-hill to favour drainage, consisted of a series of dwellings with a chapel in their midst surrounded by trees, and encompassed by what was altogether a park effect. Miss Clay, in "Medieval Hospitals," has given a picture of one of them, which we reproduce, because it serves to contradict the popular false notion with regard to the bare and ugly and more or less jail-like character of these institutions. CHAPTER XI MEDIEVAL CARE OF THE INSANE Quite contrary to the usual impression, rather extensive and well-managed institutions for the care of the insane came into existence during the Middle Ages, and continued to fulfil a very necessary social and medical duty. For the unspeakable neglect of the insane which is a disgrace to civilization, we must look to the centuries much nearer our own than those of the Middle Ages. Above all, the Middle Ages did not segregate the insane entirely from other ailing patients until their affections had become so chronic as to be certainly incurable, and they took the insane into ordinary hospitals to care for them at the beginning of their affection. This mode of procedure has many advantages, mainly in getting the patients out of unfavourable environments and putting them under skilled care early in their affections, so that a definite effort is being made to restore what is called the psychopathic ward in the general hospitals in our time. Only a careful study of the details of actual historical references to the medieval care of the insane will serve to contradict unfortunate traditions which have gathered around the subject entirely without justification in real history. The traditions of medical knowledge with regard to the insane inherited by the early Middle Ages from the ancients were of the best, and the books written at this time have some interesting material on the subject. Paulus Aëgineta (Aëginetus), who wrote in the seventh century--and it must not be forgotten that already at this time some 200 years of the Middle Ages have passed--has some excellent directions with regard to the care and treatment of patients suffering from melancholia and mania. He says, in his paragraph on the cure of melancholy: "Those who are subject to melancholy from a primary affection of the brain are to be treated with frequent baths and a wholesome and humid diet, together with suitable exhilaration of mind, and without any other remedy unless, when from its long continuance, the offending humour is difficult to evacuate, in which case we must have recourse to more powerful and complicated plans of treatment." He then gives a series of directions, some of them quite absurd to us, apparently in order to satisfy those who feel that they must keep on doing something for these cases, though evidently his own opinion is expressed in the first portion of the paragraph, and in the simple laxative treatment that he outlines. "These cases are to be purged first with dodder of thyme (_epithymus_) or aloes; for if a small quantity of these be taken every day it will be of the greatest service, and open the bowels gently." His directions as to diet for those suffering from melancholia are all in the line of limiting the consumption of materials that might possibly cause digestive disturbance, for evidently his experience had taught him that the depression was deeper whenever indigestion occurs. He says: "The diet for melancholics shall be wholesome and moderately moistening; abstaining from beef, roe's flesh, dried lentils, cabbages, snails, thick and dark coloured wines, and in a word from whatever things engender black bile." Mania was to be treated very nearly like melancholia, with special warnings as to the necessity for particular care of these patients. "But above all things they must be secured in bed, so that they may not be able to injure themselves or those who approach them; or swung within a wicker basket in a small couch suspended from on high." This last suggestion would seem to be eminently practical, especially for young people who are not too heavy, and enforces the idea that the physicians of this time were thinking seriously of their problems of care for the insane and exercising their ingenuity in inventions for their benefit. Paul of Ægina seems, then, to have thought that mania and melancholia were definitely related to each other, and to have held a similar opinion in this regard to Aretæus, who declared that melancholia was an incipient mania. Both had evidently noted that in most cases there were melancholic and maniacal stages in the same patient. These early medieval students of mental disease, then, anticipated to a rather startling extent our most recent conclusions with regard to the essential insanities. They would have been much readier to agree with Kraepelin's term, manic-depressive insanity, than with the teaching of the hundred years before our time, which so absolutely separated these two conditions. All this represents an organized knowledge of insanity that could not be acquired by chance, nor by a few intermittent observations on a small number of patients, but must have been due to actual, careful, continued observation of many of them over a long period. Here is the presumptive evidence for the existence of special institutions for their care at this period in the Middle Ages. This presumption is confirmed by Ducange in his "Commentary on Byzantine History," in which he tells of the existence of a _morotrophium_, or house for lunatics, at Byzantium in the fourth century, and one is known to have existed at Jerusalem late in the fifth century. Further confirmation of the existence of special arrangements and institutions for the care of the insane even thus early in the Middle Ages is obtained from the _regula monachorum_ of St. Jerome, which enjoins upon the monks the duty of making careful provision for the isolation and proper treatment of the sick both in mind and body, whilst they were enjoined to leave nothing undone to secure appropriate care and speedy recovery of such patients.[16] Among the first Christian institutions for the care of the ailing founded by private benevolence, a refuge for the insane was undoubtedly built in England before the seventh century. Burdett says that: "How far the two institutions established in England prior to A.D. 700 were entitled to be considered asylums, we have discovered insufficient evidence to enable us to decide." He evidently inclines to the opinion, however, that provision was made in them for the care of those ailing in mind as well as in body. There is a rather well-grounded tradition that Sigibaldus, the thirty-sixth bishop of Metz during the papacy of Leo IV., about A.D. 850, erected two monasteries and paid special attention to the sick in body and mind. There are records that the insane in Metz were placed under the guardianship of persons regularly appointed. The attendants in the hospitals had to take a special oath of allegiance to the King, and that they would fulfil their duties properly. There is definite evidence of Bethlehem in London, afterwards known as Bedlam, containing lunatics during the thirteenth century, for there is the report of a Royal Commission in the next century stating that there were six lunatics there who were under duress. Burdett says that Bedlam has been devoted exclusively to the treatment of lunatics from some years prior to 1400 down to the present time, so that it takes precedence in this matter of the asylum founded in Valencia in Spain, which Desmaisons has erroneously held as the first established in Europe. Esquirol states that the Parliament of Paris ordered the general hospital, that of the Hotel Dieu, to provide a place for the confinement of lunatics centuries before this; and while definite evidence is lacking, there seems no doubt that in most places there were, as we have said, what we would call psychopathic wards in connection with medieval hospitals. Early in the fifteenth century there are a number of bequests made to Bedlam which specifically mention the care of the insane. Indeed, "the poor madmen of Bethlehem" seem to have been favourite objects of charity. The care of the insane there seems to have touched a responsive chord in many hearts. Mayor Gregory describes in his "Historical Collections" (about 1451) this London asylum and its work of mercy, and from him we have evidence of the fact that some of the patients were restored to reason after their stay in the asylum. He has words of praise for how "honestly" the patients were cared for; but recognizes, of course, that some could not be cured. In his quaint old English he emphasizes particularly the church feature of the establishment. "A chyrche of Owre Lady that ys namyde Bedlam. And yn that place ben founde many men that ben fallyn owte of hyr wytte. And fulle honestely they ben kepte in that place; and sum ben restoryde unto hyr witte and helthe a-gayne. And sum ben a-bydyng there yn for evyr, for they ben falle soo moche owte of hem selfe that hyt ys uncurerabylle unto man." In her chapter on Hospitals for the Insane in "Medieval Hospitals of England,"[17] Miss Clay gives a number of details of the care of the insane in England, and notes that the Rolls of Parliament (1414) mention "hospitals ... to maintain men and women who had lost their wits and memory"; manifestly they had some experience which differentiated cases of aphasia from those of insanity. She says that outside of London "it was customary to receive persons suffering from attacks of mania into general infirmaries. At Holy Trinity, Salisbury, not only were sick persons and women in childbirth received, but mad people were to be taken care of (_furiosi custodiantur donec sensum adipiscantur_). This was at the close of the fourteenth century. In the petition for the reformation of hospitals (1414), it is stated that they existed partly to maintain those who had lost their wits and memory (_hors de leur sennes et mémoire_)." Further evidence of the presence of the insane with other patients is to be found in the fact that in certain hospitals and almshouses it was forbidden to receive the insane, showing that in many places that must have been the custom. Miss Clay notes: "Many almshouse-statutes, however, prohibited their admission. A regulation concerning an endowed bed in St. John's, Coventry (1444), declared that a candidate must be 'not mad, quarrelsome, leprous, infected.' At Ewelme 'no wood man' [crazy person] must be received; and an inmate becoming 'madd, or woode,' was to be removed from the Croydon almshouse." Desmaisons is responsible for the tradition which declares there were no asylums for the insane until the beginning of the fifteenth century, and that then they were founded by the Spaniards under the influence of the Mohammedans. Lecky, in his "History of European Morals," has contradicted this assertion of Desmaisons', and declares that there is absolutely no proof for it. Burdett, in his "History of Hospitals," vol. i., p. 42, says with regard to this question: "Again, Desmaisons states that the 'origin of the first establishment exclusively devoted to the insane dates back to A.D. 1409. This date constitutes an historic fact, the importance of which doubtless needs no demonstration. Its importance stands out all the more clearly when we calculate the lapse of time between the period just spoken of (1409) and that in which Spain's example' (Desmaisons is here referring to the Valencia asylum as the first in Europe) 'found so many followers.' Now, as a matter of fact, an asylum exclusively for the use of the mentally infirm existed at Metz in the year A.D. 1100, and another at Elbing, near Danzic, in 1320. Again, there was an ancient asylum, according to Dugdale, known as Berking Church Hospital, near the Tower of London, for which Robert Denton, chaplain, obtained a licence from King Edward III. in A.D. 1371. Denton paid forty shillings for this licence, which empowered him to found a hospital in a house of his own, in the parish of Berking Church, London, 'for the poor priests, and for men and women in the said city who suddenly fall into a frenzy and lose their memory, who were to reside there till cured; with an oratory to the said hospital to the invocation of the Blessed Virgin Mary.'" The passages from Aëgineta at the beginning of this chapter represent a thorough understanding of mental diseases often supposed not to exist at this time. Often it is presumed that this thorough appreciation of insanity gradually disappeared during subsequent centuries, and was not revived until almost our own time. It is quite easy, however, to illustrate by quotations from the second half of the Middle Ages a like sensible treatment of the subject of insanity by scientific and even popular writers. How different was the attitude of mind of the medieval people toward lunacy from that which is usually assumed as existing at that time may be gathered very readily from the paragraph in "Bartholomeus' Encyclopædia" with regard to madness. I doubt whether in a brief discussion so much that is absolutely true could be better said in our time. Insanity, according to old Bartholomew, was due to some poison, autointoxication, or strong drink. The treatment is prevention of injury to themselves or others, quiet and peaceful retirement, music, and occupation of mind. The paragraph itself is worth while having near one, in order to show clearly the medieval attitude toward the insane of even ordinarily well-informed folk, for Bartholomew was the most read book of popular information during the Middle Ages. Bartholomew himself was only a compiler of information--a very learned man, it is true, but a clergyman-teacher, not a physician. Translations of his book were probably more widely read in England, in proportion to the number of the reading public, than any modern encyclopædia has ever been. He said: "Madness cometh sometime of passions of the soul, as of business and of great thoughts, of sorrow and of too great study, and of dread: sometime of the biting of a wood-hound [mad dog], or some other venomous beast; sometime of melancholy meats, and sometime of drink of strong wine. And as the causes be diverse, the tokens and signs be diverse. For some cry and leap and hurt and wound themselves and other men, and darken and hide themselves in privy and secret places. _The medicine of them is, that they be bound, that they hurt not themselves and other men. And namely such shall be refreshed, and comforted, and withdrawn from cause and matter of dread and busy thoughts. And they must be gladded with instruments of music and some deal be occupied._" (Italics ours.) Bartholomew recognizes the two classes of causes of mental disturbance, the mental and the physical, and, it will be noted, has nothing to say about the spiritual--that is, diabolic possession. Writing in the thirteenth century, diabolism was not a favourite thought of the men of his time, and Bartholomew omits reference to it as a cause of madness entirely. Food and drink, and especially strong spirituous liquor, are set down as prominent causes. It may seem curious in our time that the bite of a mad dog, or a "wood hound," as Bartholomew put it, should be given so important a place; but in the absence of legal regulation rabies must have been rather common, and the disease was so striking from the fact that its onset was often delayed for a prolonged interval after the bite, that it is no wonder that a popular encyclopædist should make special note of it. The effect of alcohol in producing insanity was well recognized during the Middle Ages, and many writers have alluded to it. Pagel, in the chapters on Medieval Medicine in Puschmann's "Handbook," says that Arculanus, of whom there is mention in the chapter on Oral Surgery and the Minor Surgical Specialities, has an excellent description of alcoholic insanity. The ordinary assumption that medieval physicians did not recognize the physical factors which lead up to insanity, and practically always attributed mental derangement to spiritual conditions, especially to diabolic possession, is quite unfounded so far as authoritative physicians were concerned. Their suggestions as to treatment, above all in their care for the general health of the patient and the supplying of diversion of mind, was in principle quite as good as anything that we have been able to accomplish in mental diseases down to the present time. Their insanity rate, and above all their suicide rate, was much lower than ours, for life was less strenuous and conscious, and though men and women often had to suffer from severe physical strains and stresses, their free outdoor life made them more capable of standing them. The history of human care for the insane, it is often said by those who are reviewing the whole subject briefly, may be represented by the steps in progress from the presumption of diabolical possession, and exorcism for its relief, to intelligent understanding, sympathetic treatment, and gentle surveillance, with the implication that this has all been a gradual evolution. There is no doubt that during the Middle Ages even physicians often thought of possession by the devil as the cause of irrational states of mind. Not only some of the genuinely insane--though not all, be it noted--but also sufferers from dreads and inhibitions of various kinds, the victims of tics and uncontrollable habits, especially the childish repetition of blasphemous words, and sufferers from other psychoses and neuroses, were considered to be the victims of diabolic action. Exorcism then became a favourite form of treatment of all these conditions, but its general acceptance came about because it was so often successful. The mental influence of the ceremonies of exorcism was often quite as efficient in the cure of these mental states as mesmerism, hypnotism, psycho-analysis, and other mental influences in the modern time. It may particularly be compared in this regard to psycho-analysis in our own day, for this cures patients by making them feel that they have been the victims of some very early evil impression, usually sexual in character, which has continued unconsciously to them to colour all their subsequent mental life. Some of the curious theories of secondary personality, the subliminal self and what has recently been called "our hidden guest," represent in other terms what the medieval observers and thinkers expressed in their way by an appeal to diabolic influence. They felt that there was a spirit influencing these patients quite independent of themselves in some way, and their thoroughgoing belief in a personal devil led them to think that there must be some such explanation of the phenomena. Even great scientists in the modern time who have studied psychic research have not been able to get away entirely from the feeling that there is something in such possession, and have admitted that there may be even alien influence by an evil spirit. The more one studies the question from all sides, and not merely from a narrow materialistic standpoint, the less one is ready to condemn the medievalists for their various theories of diabolic possession. The Christian Church still teaches not only its possibility but its actual occurrence. Such conservative thinkers as Sir Thomas More, one of England's greatest Lord Chancellors, the only one who ever cleared the docket of the Court of Chancery, continued to believe in it nearly a century after the Middle Ages had closed, but above all is quite frank in the expression of his opinion that some of the mutism, the tics, and bad habits, and repeated blasphemies, attributed to it, may be cured by soundly thrashing the young folks who are subject to them. Neurological experts will recall similar experiences in the modern time. Charcot's well-known story of the little boy whose _tic_ was the use of the word uttered by the corporal at Waterloo, and was cured by being soundly licked by some playmates at the Salpêtrière gate, is a classic. Some of the medieval cruelty represented unfortunate developments from the observations that had been made that a number of the impulsive neuroses and psychoneuroses could be favourably modified, or even entirely corrected, by attaching to the continuance of the habit a frequently repeated memory of distinctly unpleasant consequences that had come upon the patient because of it. Our experience in the recent war called to attention a great many cases of mutism, functional blindness, tremors, and incapacities of all kinds, some of which were cured by painful applications of electricity. The medieval use of the lash for such cases can be better understood now as the result of this very modern set of clinical observations. In the meantime it must not be forgotten that the people of the Middle Ages, even when they thought of insane and psychoneurotic persons as the subjects of diabolic possession, felt themselves under the necessity of providing proper physical care for these victims of disease or evil spirits, and as we know actually made excellent provision for them. Not only were the insane given shelter and kept from injuring themselves and others, but in many ways much better care was provided for them than has been the custom down almost to our own time. They had many fewer insane to care for; life was not so strenuous, or rather fussy, as it is in our time; large city life had not developed, and simple existence in the country was the best possible prophylactic against many of the mental afflictions that develop so frequently in the storm and stress of competitive industrial city existence. This prophylaxis was accidental, but it was part of the life of the time that needs to be appreciated, since it represents one of the helpful hints that the Middle Ages can give us for the reduction of our own alarmingly increasing insanity rate. They had no large asylums such as we have now, but neither did they have any poor-houses; yet we have come to recognize how readily they solved the social evils of poverty. The almshouses at Stratford, with their accommodations for an old man and his wife living together, are a typical, still extant example of this. Each small community cared for its own sufferers. They did not solve their social problems in the mass fashion which we have learned is so liable to abuse, but each little town cared to a great extent for its own mentally ailing. They were able to do this mainly because hospitals were rather frequent; and psychic cases were, at the beginning, cared for in hospitals, and when in milder state their near relatives were willing to take more bother in caring for them than in our time. Delirious states due to fever had not yet been definitely differentiated from the acute insanities, and all these cases then were taken in by the hospitals. This was an excellent thing for patients, because they came under hospital care early; and one of the developments that must come in our modern hospitals is a psychopathic ward in every one of them, for patients will be saved the worst developments of their affection. The better-to-do classes found refuges for their non-violent insane in certain monasteries and convents, or in parts of monastic establishments particularly set aside for this purpose. When the patient was of the higher nobility, he was often put in charge of a monk or of several religious, and confined in a portion of his own or a kinsman's castle and cared for for years. There are traditions of similar care for the peasantry who were connected with monastic establishments, and sometimes small houses were set apart for their use on the monastery grounds. As cities grew in extent, certain hospitals received mental patients as well as the physically ailing, keeping them segregated. After a time some of these hospitals were entirely set aside for this purpose. Bedlam in England, which had been the old Royal Bethlehem Hospital for the care of all forms of illness, came to be just before the end of the thirteenth century exclusively for the care of the insane. In Spain particularly the asylums for the insane were well managed, and came to be models for other countries. This development in Spain is sometimes attributed to the Moors, but there is absolutely no reason for this attribution, except the desire to minimize Christianity's influence, even though this effort should attempt the impossible feat of demonstrating Mohammedanism as an organizer of charity and social service. Some of the developments of their care for the insane in the Middle Ages are very interesting. Before this period closed, there was a custom established at Bedlam by which those who had been insane but had become much better were allowed to leave the institution. This was true, even though apparently there might be no friends to care for them particularly, or to guarantee their conduct or their return, in case of redevelopment of their symptoms. This amounted practically to the open-door system. The authorities of the hospital, however, made one requirement. Those who had been insane and were allowed to leave Bedlam were required to wear a badge or plate on the arm, indicating that they had been for some time in this hospital for the insane. These people came to be known as Bedlamites, or Bedlams, or Bedlamers, and attracted so much sympathy from the community generally that some of the ne'er-do-wells, the tramps and sturdy vagrants who have always been with the world as a problem quite as well as the insane, obtained possession of these insignia by fraud or stealth, and imposed on the charity of the people of the time. It is easy to understand that wherever these patients were recognized by their badges as having been for a time in an asylum for the insane, they were treated quite differently from ordinary people. Though allowed to leave the asylum, and left, as it were, without surveillance, they were really committed to the care of the community generally. No one who knows the history is likely to irritate a person who has been insane, nor are such people treated in the same spirit as those who are supposed to have been always normal, but out of pity and sympathy they are particularly cared for. They are not expected to live the same workaday existence as mentally healthy individuals, but their pathway in life is smoothed as much as possible. Many an unfortunate incident in modern times is due to the fact that a previous inmate of an asylum is irritated beyond his power to control himself in the ordinary affairs of life by those who know nothing of his previous mental weakness. It is not unlikely that our open-door system will have to be supplemented by some such arrangement as this medieval requirement of a badge, and that we can actually get suggestions from the medieval people with regard to the care of the insane that will be valuable for us. Another very interesting development of care for the mentally afflicted was the organization of institutions like the village of Gheel in Belgium, in which particularly children who were of low-grade mentality were cared for. This was practically the origin of what has come in our time to be called the colony system of caring for defectives. We now have colonies for imbeciles of various grades, and village systems of caring for them. At Gheel the system developed, it might be said, more or less accidentally, but really quite naturally. St. Dympna was an Irish girl-martyr whose shrine, said to be on the site of her martyrdom, existed in the village of Gheel. Her intercession was said to be very valuable in helping children of low-grade mentality. These were brought to the shrine, sometimes from a long distance, and when the prayers of relatives were not answered immediately the children were often left near the shrine in the care of some of the villagers, to have the benefit of the martyr's intercession for a prolonged period. As a consequence of this custom, many of the houses of the village came to harbour one or more of these mentally defectives, who were cared for by the family as members of it. The religious feelings, and particularly the impression that the defectives were under the special patronage of the patron saint of the village, not only kept them from being abused or taken advantage of in any way, but made them an object of special care. They were given various simple tasks to perform, and the public spirit of the community cared for them. It was only with the development of modern sophistication that the tendency to take advantage of social defectives came and special government regulations had to be made and inspectors appointed. This system of caring for these defective children, however, was eminently satisfactory. Other villages took up the work, especially in the Low Countries and in France. The village and colony system of caring for the insane, which we are now developing with so much satisfaction, was entirely anticipated under the most favourable circumstances, and with religious sanctions, during the Middle Ages. Not a few of the defectives, when they grew up, came to be attached in various humble occupations to monastic establishments. Here they were out of the current of the busy life around them, and were cared for particularly. They were not overworked but asked to do what they could, and given their board and clothes and the sympathetic attention of the religious. There are many more of such cases at the present time than are at all appreciated. They emphasize how much of this fraternal care there must have been in the Middle Ages. Between the village system of caring for defectives, and the germ of the colony idea in their recognition of the value of the country or small town as a dwelling-place for those suffering from backwardness of mind or chronic bodily ills that disturb mentality, and the "open-door system" for the insane, as practised at Bedlam and other places, the Middle Ages anticipated some of the best features of what is most modern in our care for mental patients. Their use of severe pain as a corrective for the psychoneuroses, even when they thought of them in connection with diabolic possession, is another striking instance of their very practical way of dealing with these patients in a manner likely to do them most good. We have had to make our own developments in these matters, however, before we could appreciate the true value of what they were doing in the Middle Ages. APPENDIX I Law of the Emperor Frederick II. (1194-1250) regulating the practice of Medicine.[18] "While we are bent on making regulations for the common weal of our loyal subjects we keep ever under our observation the health of the individual. In consideration of the serious damage and the irreparable suffering which may occur as a consequence of the inexperience of physicians, we decree that in future no one who claims the title of physician shall exercise the art of healing or dare to treat the ailing, except such as have beforehand in our University of Salerno passed a public examination under a regular teacher of medicine and been given a certificate, not only by the professor of medicine, but also by one of our civil officials, which declares his trustworthiness of character and sufficiency of knowledge. This document must be presented to us, or in our absence from the kingdom, to the person who remains behind in our stead in the kingdom, and must be followed by the obtaining of a licence to practise medicine either from us or from our representative aforesaid. Violation of this law is to be punished by confiscation of goods and a year in prison for all those who in future dare to practise medicine without such permission from our authority. "Since the students cannot be expected to learn medical science unless they have previously been grounded in logic, we further decree that no one be permitted to take up the study of medical science without beforehand having devoted at least three full years to the study of logic.[19] After three years devoted to these studies he (the student) may, if he will, proceed to the study of medicine, provided always that during the prescribed time he devotes himself also to surgery, which is a part of medicine. After this, and not before, will he be given the licence to practise, provided he has passed an examination, in legal form, as well as obtained a certificate from his teacher as to his studies in the preceding time. After having spent five years in study he shall not practise medicine until he has during a full year devoted himself to medical practice with advice and under the direction of an experienced physician. In the medical schools the professors shall during these five years devote themselves to the recognized books, both those of Hippocrates as well as those of Galen, and shall teach not only theoretic but also practical medicine. "We also decree as a measure intended for the furtherance of public health that no surgeon shall be allowed to practise, unless he has a written certificate, which he must present to the professor in the medical faculty, stating that he has spent at least a year at that part of medicine which is necessary as a guide to the practice of surgery, and that, above all, he has learned the anatomy of the human body at the medical school, and is fully equipped in this department of medicine, without which neither operations of any kind can be undertaken with success nor fractures be properly treated. "In every province of our kingdom which is under our legal authority, we decree that two prudent and trustworthy men, whose names must be sent to our court, shall be appointed and bound by formal oath, under whose inspection electuaries and syrups and other medicines be prepared according to law and be sold only after such inspection. In Salerno in particular we decree that this inspectorship shall be limited to those who have taken their degree as masters in physic. "We also decree by the present law that no one in the kingdom except in Salerno or in Naples [in which were the two universities of the kingdom] shall undertake to give lectures on medicine or surgery, or presume to assume the name of teacher, unless he shall have been very thoroughly examined in the presence of a government official and of a professor in the art of medicine. [No setting up of medical schools without the proper authority.] "Every physician given a licence to practise must take an oath that he shall faithfully fulfil all the requirements of the law, and in addition that whenever it comes to his knowledge that any apothecary has for sale drugs that are of less than normal strength, he shall report him to the court, and besides that he shall give his advice to the poor without asking for any compensation. A physician shall visit his patient at least twice a day and at the wish of his patient once also at night, and shall charge him, in case the visit does not require him to go out of the village or beyond the walls of the city, not more than one-half tarrene in gold for each day's service.[20] From a patient whom he visits outside of the village or the wall of the town, he has a right to demand for a day's service not more than three tarrenes, to which may be added, however, his expenses, provided that he does not demand more than four tarrenes altogether. "He (the regularly licensed physician) must not enter into any business relations with the apothecary nor must he take any of them under his protection nor incur any money obligations in their regard. Nor must any licensed physician keep an apothecary's shop himself. Apothecaries must conduct their business with a certificate from a physician according to the regulations and on their own credit and responsibility, and they shall not be permitted to sell their products without having taken an oath that all their drugs have been prepared in the prescribed form, without any fraud. The apothecary may derive the following profits from his sales: Such extracts and simples as he need not keep in stock for more than a year, before they may be employed, may be charged for at the rate of three tarrenes an ounce. Other medicines, however, which in consequence of the special conditions required for their preparation or for any other reason, the apothecary has to have in stock for more than a year, he may charge for at the rate of six tarrenes an ounce. Stations for the preparation of medicines may not be located anywhere but only in certain communities in the kingdom as we prescribe below. "We decree also that the growers of plants meant for medical purpose shall be bound by a solemn oath that they shall prepare their medicines conscientiously according to the rules of their art, and so far as it is humanly possible that they shall prepare them in the presence of the inspectors. Violations of this law shall be punished by the confiscation of their movable goods. If the inspectors, however, to whose fidelity to duty the keeping of the regulations is committed, should allow any fraud in the matters that are entrusted to them, they shall be condemned to punishment by death." APPENDIX II Bull of Pope John XXII., issued February 18, 1321, as a charter for the Medical Department of the University of Perugia.[21] "While with deep feelings of solicitous consideration we mentally revolve how precious the gift of science is and how desirable and glorious is its possession, since through it the darkness of ignorance is put to flight and the clouds of error completely done away with so that the trained intelligence of students disposes and orders their acts and modes of life in the light of truth, we are moved by a very great desire that the study of letters in which the priceless pearl of knowledge is found should everywhere make praiseworthy progress, and should especially flourish more abundantly in such places as are considered to be more suitable and fitting for the multiplication of the seeds and salutary germs of right teaching. Whereas some time ago, Pope Clement of pious memory, our predecessor, considering the purity of faith and the excelling devotion which the city of Perugia, belonging to our Papal states, is recognized to have maintained for a long period towards the Church, wishing that these might increase from good to better in the course of time, deemed it fitting and equitable that this same city, which had been endowed by Divine Grace with the prerogatives of many special favours, should be distinguished by the granting of university powers, in order that by the goodness of God men might be raised up in the city itself pre-eminent for their learning, decreed by the Apostolic authority that a university should be situated in the city and that it should flourish there for all future time with all those faculties that may be found more fully set forth in the letter of that same predecessor aforesaid. And, whereas, we subsequently, though unworthy, having been raised to the dignity of the Apostolic primacy, are desirous to reward with a still richer gift the same city of Perugia for the proofs of its devotion by which it has proven itself worthy of the favour of the Apostolic See, by our Apostolic authority and in accordance with the council of our brother bishops, we grant to our venerable brother, the Bishop of Perugia, and to those who may be his successors in that diocese, the right of conferring on persons who are worthy of it the licence to teach (the Doctorate) in canon and civil law, according to that fixed method which is more fully described and regulated more at length in this our letter. "Considering, therefore, that this same city, because of its convenience and its many favouring conditions, is altogether suitable for students and wishing on that account to amplify the educational concessions hitherto made because of the public benefits which we hope will flow from them, we decree by Apostolic authority that if there are any who in the course of time shall in that same university attain the goal of knowledge in medical science and the liberal arts and should ask for licence to teach in order that they may be able to train others with more freedom, that they may be examined in that university in the aforesaid medical sciences and in the arts and be decorated with the title of Master in these same faculties. We further decree that as often as any are to receive the decree of Doctor in medicine and arts, as aforesaid, they must be presented to the Bishop of Perugia, who rules the diocese at the time, or to him whom the bishop shall have appointed for this purpose, who having selected teachers of the same faculty in which the examinations are to be made, who are at that time present in the university to the number of at least four, they shall come together without any charge to the candidate and, every difficulty being removed, should diligently endeavour that the candidate be examined in science, in eloquence, in his mode of lecturing, and anything else which is required for promotion to the degree of doctor or master. With regard to those who are found worthy, their teachers should be further consulted privately, and any revelation of information obtained at such consultations as might redound to the disadvantage or injury of the consultors is strictly forbidden. If all is satisfactory the candidates should be approved and admitted and the licence to teach granted. Those who are found unfit must not be admitted to the degree of doctor, all leniency or prejudice or favour being set aside. "In order that the said university may in the aforesaid studies of medicine and the arts so much more fully grow in strength, according as the professors who actually begin the work and teaching there are more skilful, we have decided that until four or five years have passed some professors, two at least, who have secured their degree in the medical sciences at the University of Paris, under the auspices of the Cathedral of Paris, and who shall have taught or acted as masters in the before-mentioned University of Paris, shall be selected for the duties of the masterships and the professorial chairs in the said department in the University of Perugia, and that they shall continue their work in this last-mentioned university until noteworthy progress in the formation of good students shall have been made. "With regard to those who are to receive the degree of doctor in medical science, it must be especially observed that all those seeking the degree shall have heard lectures in all the books of this same science which are usually required to be heard by similar students at the University of Bologna or of Paris, and that this shall continue for seven years. Those, however, who have elsewhere received sufficient instruction in logic or philosophy having applied themselves to these studies for five years in the aforesaid universities, with the provision, however, that at least three years of the aforesaid five or seven year term shall have been devoted to hearing lectures in medical science in some university and according to custom, shall have been examined under duly authorized teachers and shall have, besides, read such books outside the regular course as may be required, may, with due observation of all the regulations which are demanded for the taking of degrees in Paris or Bologna, also be allowed to take the examination at Perugia." INDEX Abdallah, 41 Abdominal wounds, 98 Abella, 157 Abulcasis, 35, 78 Abul Farag, 33 Adalbert of Mainz, 63 Adale, 41 Ægidius, 64 Ægina, Paul of, 6, 27, 33, 138, 146, 149, 184, 186 Æginetus. _See_ Ægina, Paul of Ætius, 4, 28, 138, 146 Aëtius, 27 Albert the Great, 110 Albertus Magnus, 14, 18 Alcohol, 194 Alessandra Giliani, 164 Alexander of Tralles, 4, 27, 29, 146 Alexandria, 33 Ali Abbas, 35 Alphanus, 41 Anæsthesia, 100, 104, 105, 120 Anselm of Havelberg, 63 Anthemios, 5 Antiseptic surgery, 104 wine as, 101 Arabian culture, 8 surgeons, 149 Arabians, 139 Arabs, 46 Archbishop of Lyons, 63 Arculanus, 147, 150 Ardern, John, 85, 123, 127 Aretæus, 186 Argelata, Pietro d', 125 Aristotle, 18 study of, 16 Armato, Salvino de, 152 Arnold de Villanova, 66 aphorisms of, 67 Arsenic in syphilis, 124 Artificial teeth, 142 Asepsis, 95, 101 Asylums, 191 Aue, Hartmann von der, 64 Aurelius Celsus, 26 Authorities of medieval physicians, 20 Authority, influence of, 12 Autointoxication, 83 Avenzoar, 35, 77 Averroes, 35 Avicenna, 35, 47, 76, 149 Baas, 181 Bachtischua, 7 Bacon, Roger, 14, 110 Bandages, stiffened, 123 Barber surgeons, 115 Bartholomæus Anglicus, 81 Bartholomew on causes of insanity, 192 Basil Valentine, 84 Baths, 32 for melancholia, 184 Bedlam, 188 Bedlamites, 201 Belisarius, Hospital of, 171 Benedictine convents, 159 Bernard de Gordon, 70, 72, 153 Bernard of Morlaix, 49 Bile in eye diseases, 152 Bladders of animals, 78 Bleeding, 55, 84 Blood-letting, 32 Bologna, 40 Bones, number of, 54 Bougies, 123 Branca, 106 Antonio, 107 Bruno da Longoburgo, 96 Brunschwig, Hieronymus, 135 Bubonic plague, 77 Calomel, 85 Care of the insane, 34, 183, 189 Care of the sick, 24, 25 Cassiodorus, 25 Cataract, 151 Cautery, 100, 126 Celsus, Aurelius, 26 Charter of the University of Perugia, 212 Chauliac, Guy de, 11, 66, 71, 72, 105, 109, 118, 123, 139, 140, 153, 167 Christian hospitals, 24 Cleanliness, 95 Clyster apparatus, 127 Cold compresses, 30 Compilation, 3 Constantine, 36, 45 Contrecoup, 92 Convents, Benedictine, 159 Corbeil, Gilles de, 64 Cosmetics, 77 Crusades, 89, 181 Dental instruments, 143 Dentistry, 138 Depressed fractures, 93 De Renzi, 37, 41, 44, 45, 47, 76, 155, 156 Diabolic possession, 195, 196 Diet, 31, 36 for melancholies, 185 Dioscorides, 26 Dioscoros, 5 Diphtheria, 27, 128 Diseases of nervous system, 30 of women, 156 Drainage, 97 tubes, 125 Duke, Robert, 46 Duns Scotus, 110 Dura mater, infection of, 93 Ebers Papyrus, 137 Education, characters of medieval, 12 Elias, 41 Elinus, 41 English, King of the, 40 Epileptic conditions, 30 Exorcism, 195 Eye diseases, bile in, 152 wash, urine of infants as, 152 Fabiola, Hospital of, 171 Fee, law as to, 44 Fever, 32 Filaria medinensis, 77 Fistulæ, 100 Fistulas, 127 Four masters of Salerno, 47, 91 Fracture of the skull, 91 of the thigh, extension in, 123 Fractures of the skull, 94 depressed, 93 Frederick II., 42 law of, 43, 206 Gaddesden, John of, 70, 119 Galen, 18, 19, 26, 47, 72, 116 Gariopontus, 41 Gerssdorff, Hans von, 135 Gilbert, 69 Giovanni of Arcoli, 143 Glaucoma, 152 Gonorrhoea, 123 Gregory, Major, 189 of Tours, 181 Guarna, Rebecca, 157 Guerini, 142, 143 Guido of Montpellier, 64 Gurlt, 9, 47, 69, 90, 93, 95, 96, 99, 106, 110, 113, 121, 146, 156 Guy de Chauliac. _See_ Chauliac Guy of Montpellier. _See_ Montpellier Hæmoptysis, 30 Hangman's rope, 28 Hare-lip, 134 Hartmann von der Aue, 64 Headache, 30 Hemicrania, 30 Herbs, 26 Hernia, 68 operations too frequent, 122 radical cure of, 121 reduction of, 122 Hernias, 99 Herodotus, 137 Hippocrates, 26, 47 Holy Ghost Hospital, 172 Hospital, 64, 65 at Lübeck, 178 for lunatics, 187 of Bedlam, 188 of Belisarius, 171 of Fabiola, 171 of Pope Symmachus, 171 of St. Basil, 170 of St. Jean, 178 of Tonnerre, 176 Hospitals, 169 Christian, 24 for lepers, 181 of the Holy Ghost, 172 royal, 174 Hotel Dieu, 188 "Hudibras," 107 Hugh of Lucca, 96, 104 Humours, 54 Hymns, Latin, 48 Hysteria, 34 Indian surgeons, 106 Infection of dura mater, 93 Infirmaries in monasteries, 24 Inhalations, steam, 29 Insane, care of the, 34, 183, 189 Insanity, 194 lash for, 198 Intestine, suture of, 134 Intestines, wounds of, 99 Italy the postgraduate medical centre, 118 John of Salisbury, 64 of Gaddesden, 70, 119 King of the English, 49 Laceration of the middle meningeal artery, 92 Lanfranc, 11, 80, 96, 110 Lash for insanity, 198 Latin hymns, 48 Law as to fee, 44 of Frederick II., 43, 206 Lepers, hospitals for, 181 Ligatures, 125 "Lilium Medicinæ," 73 Linear cicatrices, 101 Lister, Lord, 103 Louis IX., 110 Lübeck, hospital at, 178 Lunatics, hospital for, 187 Lucca, Hugh of, 96, 104 Lyons, Archbishop of, 63 Manzolini, Madame, 165 Mad dog, 68, 80 Magnetism, 15 Maimonides, 35, 79 Medical oath, 44 schools at universities, 74 superstitions, 22 Medici, 164 Medicine and surgery, relations of, 115 popular, 22 Medieval education, characters of, 12 medicine, periods of, 21 textbooks, 88 Melancholics, diet for, 185 Mental defectives, colonies for, 202 Meningeal artery, laceration of, 92 Mercuriade, 157 Mercury, use of, 123 Mesue, 47 Methrodoros, 5 Metrorrhagia, 33 Middle Ages, limits of, vii Milk, 29, 52 bath, 78 Monasteries, infirmaries in, 24 Mondeville, Henri de, 11, 66, 114, 116 Mondino, 96, 164 Monte Cassino, 39 Montpellier, Guy de, 10, 61, 173 Moorish physicians, 62 Morbus Gallicus, 124 Morley, Henry, 17 Morgagni, 84 Muratori, 76 Nasal cautery, 148 polypi, 147 speculum, 149 Nature study, 13 Needling for cataract, 151 Nefretykes, 85 Nerve suture, 113 Nervous system, 30 Nicaise, 166 Nose, surgery of the, 106 Number of bones, 54 of veins, 54 Nurses, order of, 180 Nutrition _per rectum_, 77 Oath, medical, 44 Oesophagus tube, 123 Ophthalmology, 151 Opium, 29 Order of nurses, 180 Ordronaux, 47, 50 Oribasius, 28 Orthodontia, 139 Pagel, 56, 127, 194 Pammachius, 171 Paris, 40, 110 Passavant, Jean, 111 Paul of Ægina, 6, 27, 33, 138, 146 Peregrinus, 15 Perineum, rupture of, 157 Perugia, Charter of the University, 212 Pfolspeundt, Heinrich von, 133, 134 Physician, conduct of the, 58 Physicians, Moorish, 62 Pitard, Jean, 114 Plague, bubonic, 77 Plastic surgery, 106, 134 Polypi, nasal, 147 Pontus, 41 Pope Symmachus, Hospital of, 171 Popular medicine, 22 Power, D'Arcy, 127 Psycho-analysis, 196 Pure drug law, 43 Pus, 103 Puschmann, 56 Putrefaction, 97 Rabies, 81, 128 Rectal feeding, 78 surgery, 127 Red light treatment, 70, 82 Regimen, 48, 49 sanitatis, 47 Renal disease, 85 Rhazes, 35, 148 Roger, 42, 56, 70, 90, 103 Roland, 56, 103 Rolando, 91 Roman medicine, origin of, 2 "Rosa Anglica," 70 Rupture of the perineum, 157 St. Basil, Hospital of, 170 St. Benedict, 24 St. Bernard, 63 of Clairvaux, 161 St. Hildegarde, 160 St. Jean, Hospital of, 178 Saintsbury, Professor, 48 Salerno, 7, 37, 75, 155 curriculum at, 38 Salerno, school of, 57 Salicet, William of, 96, 105 Salisbury, John of, 64 Salvino de Armato, 152 Santa Sophia, architect of, 5 School of Salerno, 57 Scotus, Duns, 40 Sects in surgery, 116 Sick, care of the, 24, 25 Skin of the snake, 28 Skull, fractures of, 91, 94 opening the, 92 Smallpox, 35, 70 Snake, skin of, 28 Sore throat, 31 Spectacles, 73, 152 Steam inhalations, 29 Stiffened bandages, 123 Students, 65 Superstitions, medical, 22 Surgeon, training of, 117 Surgeons, Arabian, 140 barber, 11 Indian, 106 temperance in, 97 Surgery, antiseptic, 104 of the nose, 106 plastic, 106, 134 rectal, 127 sects in, 116 Surgical specialities, 136 Syphilis, 123 arsenic treatment of, 124 Tagliacozzi, 107 Taranta, Valesco de, 71 Tartar, removal of, 141 Teeth, artificial, 142 cleaning of, 140 filling of, 145 preservation of, 139, 144 straightening of, 139 Temperaments, 54 Temperance in surgeons, 97 Testicle excision in hernia operations, 121 Tetanus, 130 Textbooks, medieval, 88 Theodoric, 70, 96, 102, 113 Therapeutics, 23 Thigh, fracture of, 123 Thomas Aquinas, 110 Thyroid gland, 28 Tonnerre, Hospital of, 176 Tooth-powder, 140 Tracheotomy, 147, 150 Trallianus, 4 Trephining, 93, 94 Trichiasis, 153 Trotula, 155 Truss, 73, 122 Union by first intention, 100 Universities, medical schools at, 74 Urine of infants as eye-wash, 152 Use of mercury, 123 Uvula, affections of the, 150 Valentine, Basil, 84 Valesco de Taranta, 71 Veins, number of, 54 Vicious sexual habits, 28 Vigo, John de, 145 Viollet le Duc, 176 Virchow, 171, 174, 181 William of Salicet, 96, 105 Wine as antiseptic, 101 Women, diseases of, 156 in medicine, 10 physicians, 166 professors, 155 students, 155 Wood dogge, 129 Wood-hound, 193 Wounds, abdominal, 98 dry treatment of, 125 of intestines, 99 treatment of, 98 Yperman, 123, 131 PRINTED IN GREAT BRITAIN BY BILLING AND SONS, LTD., GUILDFORD FOOTNOTES: [1] Fordham University Press, New York, 1911. [2] _Popular Science Monthly_, May, 1911. [3] Philadelphia: Lippincott, 1871. [4] The Latin lines run thus: Si vis incolumem, si vis te reddere sanum, Cures tolle graves, iras crede profanum. Parce mero--coenato parum, non sit tibi vanum Surgere post epulas; somnum fuge meridianum; Ne mictum retine, nec comprime fortiter anum; Hæc bene si serves, tu longo tempore vives. [5] English translations of the _Regimen_ were made in 1575, 1607, and 1617. The two latter were printed; the former exists in manuscript in the Library of Corpus Christi College, Oxford. The opening lines of the edition of 1607 deserve to be noted because they are the origin of an expression that has been frequently quoted since. The Salerne Schoole doth by these lines impart All health to England's King, and doth advise From care his head to keepe, from wrath his harte. Drink not much wine, sup light, and soone arise. When meat is gone long sitting breedeth smart; And after noone still waking keepe your eies, When mou'd you find your selfe to nature's need, Forbeare them not, for that much danger breeds, _Use three physitians still--first Dr. Quiet, Next Dr. Merry-man, and third Dr. Dyet_. [6] Some of these old medical traditions come down to us from many more centuries than we have any idea of until we begin to trace them. Ordinarily it is presumed that the advice with regard to the taking of small amounts of fluid during meals comes to us from the modern physiologists. In "The Babees Book," a volume on etiquette for young folks issued in the thirteenth century, there is among other advices, as, for instance, "not to laugh or speak while the mouth is full of meat or drink," and also "not to pick the teeth with knife or straw or wand or stick at table," this warning: "While thou holdest meat in mouth beware to drink; that is an unhonest chare; and also physick forbids it quite." It was "an unhonest chare" because the drinking-cups were used in common, and drinking with meat in the mouth led to their soiling, to the disgust of succeeding drinkers. All the generations ever since have been in slavery to the expression that "physic forbids it quite," and now we know without good reason. [7] The book called "The Hundred Merry Jests" suggests that the wagtail is light of digestion because it is ever on the wing, and therefore had, as it were, an essential lightness. [8] International Clinics, vol. iii., series 28. [9] "Historical Relations of Medicine and Surgery down to the Sixteenth Century." London, 1904. [10] The subsequent disuse of anæthesia seems an almost impossible mystery to many, but the practically total oblivion into which the practice fell is incomprehensible. This is emphasized by the fact that while it dropped out of medical tradition, the memory of it remained among the poets, and especially among the dramatists. Shakespeare used the tradition in "Romeo and Juliet." Tom Middleton, in the tragedy of "Women Beware Women" (Act IV., Scene i., 1605), says: "I'll imitate the pities of old surgeons To this lost limb, who, ere they show their art, Cast one asleep, then cut the diseased part." [11] "Physicke is so studied and practised with the Egyptians that every disease hath his several physicians, who striveth to excell in healing that one disease and not to be expert in curing many. Whereof it cometh that every corner of that country is full of physicians. Some for the eyes, others for the head, many for the teeth, not a few for the stomach and the inwards." [12] The Ebers Papyrus shows that special attention was paid to diseases of the eyes, the nose, and throat, and we have traditions of operations upon these from very early times. Conservative surgery of the teeth, and the application of prosthetic dental apparatus, being rather cosmetic than absolutely necessary, might possibly be expected not to have developed until comparatively recent times; but apart from the traditions in Egypt with regard to this speciality, which are rather dubious, we have abundant evidence of the definite development of dentistry from the long ago. The old Etruscans evidently paid considerable attention to prosthetic dentistry, for we have specimens from the Etruscan tombs which show that they did bridge work in gold, supplied artificial teeth, and used many forms of dental apparatus. At Rome the Laws of the Twelve Tables (_circa_ 450 B.C.) forbade the burying of gold with a corpse except such as was fastened to the teeth, showing that the employment of gold in the mouth for dental repair must have been rather common. We have specimens of gold caps for teeth from the early Roman period; and there is even a well-confirmed tradition of the transplantation of teeth, a practice which seems to have been taken up again in the later Middle Ages, and then allowed to lapse once more until our own time. [13] Dr. Petells, discussing this use of livers (_Janus_, 1898), says that there has been some tendency to revert to the idea of biliary principles as of value in external eye diseases. [14] "Gesammelte Abhandlungen aus dem Gebiete der Oeffentliche Medizin," Hirschwald, Berlin, 1877. [15] See Walsh, "The Thirteenth, Greatest of Centuries," New York, seventh edition, 1914. [16] Burdett, "Hospitals and Asylums of the World." [17] London, 1909. [18] To be found in Huillard-Brehollis' "Diplomatic History of Frederick II. with Documents" (issued in twelve quarto volumes, Paris, 1851-1861). [19] Under logic at this time was included the study of practically all the subjects that are now included under the term the seven liberal arts. Huxley, in his address before the University of Aberdeen, on the occasion of his inauguration as rector of that university, said: "The scholars (of the early days of the universities, first half of the thirteenth century) studied grammar, rhetoric, arithmetic and geometry, astronomy, theology and music." He added: "Thus their work, however imperfect and faulty, judged by modern lights, it may have been, brought them face to face with all the leading aspects of the many-sided mind of man. For these studies did really contain, at any rate in embryo--sometimes, it may be, in caricature--what we now call philosophy, mathematical and physical science and art. And I doubt if the curriculum of any modern university shows so clear and generous a comprehension of what is meant by culture as the old trivium and quadrivium does." Science and Education Essays, p. 197. New York, D. Appleton and Co. 1896. [20] A tarrenus or tarrene in gold was equal to about thirty cents of our money. Money at that time had from ten to fifteen times the purchasing power that it has at the present time. An ordinary workman at this time in England received about four pence a day, which was just the price of a pair of shoes, while a fat goose could be bought for two and a half pence, a sheep for one shilling and two pence, a fat hog for three shillings, and a stall-fed ox for sixteen shillings (Act of Edward III. fixing prices). [21] The University of Perugia had already achieved a European reputation for its Law School, and this Papal document was evidently meant to maintain standards, and keep the new Medical School up to the best criteria of the times. The original Latin of this document, as well as of the Law of Frederick II., may be found in Walsh, "The Popes and Science," Fordham University Press, New York, 1908. 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20216	----	Old-Time Makers of Medicine THE STORY OF THE STUDENTS AND TEACHERS OF THE SCIENCES RELATED TO MEDICINE DURING THE MIDDLE AGES BY James J. Walsh, K.C.St.G., M.D. Ph.D., LL.D., Litt.D., Sc.D. DEAN AND PROFESSOR OF NERVOUS DISEASES AND OF THE HISTORY OF MEDICINE AT FORDHAM UNIVERSITY SCHOOL OF MEDICINE; PROFESSOR OF PHYSIOLOGICAL PSYCHOLOGY AT THE CATHEDRAL COLLEGE, NEW YORK NEW YORK FORDHAM UNIVERSITY PRESS 1911 COPYRIGHT 1911 JAMES J. WALSH THE QUINN & GODEN CO. PRESS RAHWAY, N.J. TO REVEREND DANIEL J. QUINN, S.J. The historical material here presented was gathered for my classes at Fordham University School of Medicine during your term as president of the University. It seems only fitting then, that when put into more permanent form it should appear under the patronage of your name and tell of my cordial appreciation of more than a quarter of a century of valued friendship. "When we have thoroughly mastered contemporary science it is time to turn to past science; nothing fortifies the judgment more than this comparative study; impartiality of mind is developed thereby, the uncertainties of any system become manifest. The authority of facts is there confirmed, and we discover in the whole picture a philosophic teaching which is in itself a lesson; in other words, we learn to know, to understand, and to judge."--LITTRÉ: _OEuvres d'Hippocrate_, T. I, p. 477. "There is not a single development, even the most advanced of contemporary medicine, which is not to be found in embryo in the medicine of the olden time."--LITTRÉ: Introduction to the Works of Hippocrates. "How true it is that in reading this history one finds modern discoveries that are anything but discoveries, unless one supposes that they have been made twice."--DUJARDIN: _Histoire de la Chirurgie_, Paris, 1774 (quoted by Gurlt on the post title-page of his _Geschichte der Chirurgie_, Berlin, 1898). PREFACE The material for this book was gathered partly for lectures on the history of medicine at Fordham University School of Medicine, and partly for articles on a number of subjects in the Catholic Encyclopedia. Some of it was developed for a series of addresses at commencements of medical schools and before medical societies, on the general topic how old the new is in surgery, medicine, dentistry, and pharmacy. The information thus presented aroused so much interest, the accomplishments of the physicians and surgeons of a period that is usually thought quite sterile in medical science proved, indeed, so astonishing, that I was tempted to connect the details for a volume in the Fordham University Press series. There is no pretence to any original investigation in the history of medicine, nor to any extended consultation of original documents. I have had most of the great books that are mentioned in the course of this volume in my hands, and have given as much time to the study of them as could be afforded in the midst of a rather busy life, but I owe my information mainly to the distinguished German and French scholars who have in recent years made deep and serious studies of these Old Makers of Medicine, and I have made my acknowledgments to them in the text as opportunity presented itself. There is just one feature of the book that may commend it to present-day readers, and that is that our medieval medical colleagues, when medicine embraced most of science, faced the problems of medicine and surgery and the allied sciences that are now interesting us, in very much the same temper of mind as we do, and very often anticipated our solutions of them--much oftener, indeed, than most of us, unless we have paid special attention to history, have any idea of. The volume does not constitute, then, a contribution to that theme that has interested the last few generations so much,--the supposed continuous progress of the race and its marvellous advance,--but rather emphasizes that puzzling question, how is it that men make important discoveries and inventions, and then, after a time, forget about them so that they have to be made over again? This is as true in medical science and in medical practice as in every other department of human effort. It does not seem possible that mankind should ever lose sight of the progress in medicine and surgery that has been made in recent years, yet the history of the past would seem to indicate that, in spite of its unlikelihood, it might well come about. Whether this is the lesson of the book or not, I shall leave readers to judge, for it was not intentionally put into it. OUR LADY'S DAY IN HARVEST, 1911. CONTENTS CHAPTER PAGE I. INTRODUCTION 1 II. GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 23 III. GREAT JEWISH PHYSICIANS 61 IV. MAIMONIDES 90 V. GREAT ARABIAN PHYSICIANS 109 VI. THE MEDICAL SCHOOL AT SALERNO 141 VII. CONSTANTINE AFRICANUS 163 VIII. MEDIEVAL WOMEN PHYSICIANS 177 IX. MONDINO AND THE MEDICAL SCHOOL OF BOLOGNA 202 X. GREAT SURGEONS OF THE MEDIEVAL UNIVERSITIES 234 XI. GUY DE CHAULIAC 282 XII. MEDIEVAL DENTISTRY--GIOVANNI OF ARCOLI 313 XIII. CUSANUS AND THE FIRST SUGGESTION OF LABORATORY METHODS IN MEDICINE 336 XIV. BASIL VALENTINE, LAST OF THE ALCHEMISTS, FIRST OF THE CHEMISTS 349 APPENDICES I. ST. LUKE THE PHYSICIAN 381 II. SCIENCE AT THE MEDIEVAL UNIVERSITIES 400 III. MEDIEVAL POPULARIZATION OF SCIENCE 427 "Of making many books there is no end."--_Eccles._ xii, 12 (circa 1000 B.C.). "The little by-play between Socrates and Euthydemus suggests an advanced condition of medical literature: 'Of course, you who have so many books are going in for being a doctor,' says Socrates, and then he adds, 'there are so many books on medicine, you know.' As Dyer remarks, whatever the quality of these books may have been, their number must have been great to give point to this chaff."--_Aequanimitas_, WILLIAM OSLER, M.D., F.R.S., Blakistons, Philadelphia, 1906. "Augescunt aliae gentes, aliae minuuntur; Inque brevi spatio mutantur saecla animantum, Et, quasi cursores vitai lampada tradunt." --OVID. One nation rises to supreme power in the world, while another declines, and, in a brief space of time, the sovereign people change, transmitting, like racers, the lamp of life to some other that is to succeed them. "There is one Science of Medicine which is concerned with the inspection of health equally in all times, present, past and future." --PLATO. I INTRODUCTION Under the term Old-Time Medicine most people probably think at once of Greek medicine, since that developed in what we have called ancient history, and is farthest away from us in date. As a matter of fact, however, much more is known about Greek medical writers than those of any other period except the last century or two. Our histories of medicine discuss Greek medicine at considerable length and practically all of the great makers of medicine in subsequent generations have been influenced by the Greeks. Greek physicians whose works have come down to us seem nearer to us than the medical writers of any but the last few centuries. As a consequence we know and appreciate very well as a rule how much Greek medicine accomplished, but in our admiration for the diligent observation and breadth of view of the Greeks, we are sometimes prone to think that most of the intervening generations down to comparatively recent times made very little progress and, indeed, scarcely retained what the Greeks had done. The Romans certainly justify this assumption of non-accomplishment in medicine, but then in everything intellectual Rome was never much better than a weak copy of Greek thought. In science the Romans did nothing at all worth while talking about. All their medicine they borrowed from the Greeks, adding nothing of their own. What food for thought there is in the fact, that in spite of all Rome's material greatness and wide empire, her world dominance and vaunted prosperity, we have not a single great original scientific thought from a Roman. Though so much nearer in time medieval medicine seems much farther away from us than is Greek medicine. Most of us are quite sure that the impression of distance is due to its almost total lack of significance. It is with the idea of showing that the medieval generations, as far as was possible in their conditions, not only preserved the old Greek medicine for us in spite of the most untoward circumstances, but also tried to do whatever they could for its development, and actually did much more than is usually thought, that this story of "Old-Time Makers of Medicine" is written. It represents a period--that of the Middle Ages--that is, or was until recently, probably more misunderstood than any other in human history. The purpose of the book is to show at least the important headlands that lie along the stream of medical thought during the somewhat more than a thousand years from the fall of the Roman Empire under Augustulus (476) until the discovery of America. After that comes modern medicine, for with the sixteenth century the names and achievements of the workers in medicine are familiar--Paracelsus, Vesalius, Columbus, Servetus, Cæsalpinus, Eustachius, Varolius, Sylvius are men whose names are attached to great discoveries with which even those who are without any pretence to knowledge of medical history are not unacquainted. In spite of nearly four centuries of distance in time these men seem very close to us. Their lives will be reserved for a subsequent volume, "Our Forefathers in Medicine." It is usually the custom to contemn the Middle Ages for their lack of interest in culture, in education, in literature, in a word, in intellectual accomplishment of any and every kind, but especially in science. There is no doubt about the occurrence of marked decadence in the intellectual life of the first half of this period. This has sometimes been attributed to what has been called the inhibitory effect of Christianity on worldly interests. Religion is said to have occupied people so much with thoughts of the other world that the beauties and wonders, as well as much of the significance, of the world around them were missed. Those who talk thus, however, forget entirely the circumstances which brought about the serious decadence of interest in culture and science at this time. The Roman Empire had been the guardian of letters and education and science. While the Romans were not original in themselves, at least they had shown intense interest in what was accomplished by the Greeks and their imitation had often risen to heights that made them worthy of consideration for themselves. They were liberal patrons of Greek art and of Greek literature, and did not neglect Greek science and Greek medicine. Galen's influence was due much more to the prominence secured by him as the result of his stay in Rome than would have been possible had he stayed in Asia. There are many other examples of Roman patronage of literature and science that might be mentioned. As we shall see, Rome drained Greece and Asia Minor of their best, and appropriated to herself the genius products of the Spanish Peninsula. Rome had a way of absorbing what was best in the provinces for herself. Just as soon as Rome was cut off from intimate relations with the provinces by the inwandering of barbarians, intellectual decadence began. The imperial city itself had never been the source of great intellectual achievement, and the men whom we think of as important contributors to Rome's literature and philosophy were usually not born within the confines of the city. It is surprising to take a list of the names of the Latin writers whom we are accustomed to set down simply as Romans and note their birthplaces. Rome herself gave birth to but a very small percentage of them. Virgil was born at Mantua, Cicero at Arpinum, Horace out on the Sabine farm, the Plinys out of the city, Terence in Africa, Persius up in Central Italy somewhere, Livy at Padua, Martial, Quintilian, the Senecas, and Lucan in Spain. When the government of the city ceased to be such as assured opportunity for those from outside who wanted to make their way, decadence came to Roman literature. Large cities have never in history been the fruitful mothers of men who did great things. Genius, and even talent, has always been born out of the cities in which it did its work. It is easy to understand, then, the decadence of the intellectual life that took place as the Empire degenerated. For the sake of all that it meant in the Roman Empire to look towards Rome at this time, however, it seemed better to the early Christians to establish the centre of their jurisdiction there. Necessarily, then, in all that related to the purely intellectual life, they came under the influences that were at work at Rome at this time. During the first centuries they suffered besides from the persecutions directed against them by the Emperors at various times, and these effectually prevented any external manifestations of the intellectual life on the part of Christians. It took much to overcome this serious handicap, but noteworthy progress was made in spite of obstacles, and by the time of Constantine many important officials of the Empire, the educated thinking classes of Rome, had become Christians. After the conversion of the Emperor opportunities began to be afforded, but political disturbances consequent upon barbarian influences still further weakened the old civilization until much of the intellectual life of it almost disappeared. Gradually the barbarians, finding the Roman Empire decadent, crept in on it, and though much more of the invasion was peaceful than we have been accustomed to think, the Romans simply disappearing because family life had been destroyed, children had become infrequent, and divorce had become extremely common, it was not long before they replaced the Romans almost entirely. These new peoples had no heritage of culture, no interest in the intellectual life, no traditions of literature or science, and they had to be gradually lifted up out of their barbarism. This was the task that Christianity had to perform. That it succeeded in accomplishing it is one of the marvels of history. The Church's first grave duty was the preservation of the old records of literature and of science. Fortunately the monasteries accomplished this task, which would have been extremely perilous for the precious treasures involved but for the favorable conditions thus afforded. Libraries up to this time were situated mainly in cities, and were subject to all the vicissitudes of fire and war and other modes of destruction that came to cities in this disturbed period. Monasteries, however, were usually situated in the country, were built very substantially and very simply, and the life in them formed the best possible safeguard against fire, which worked so much havoc in cities. As we shall see, however, not only were the old records preserved, but excerpts from them were collated and discussed and applied by means of direct observation. This led the generations to realize more and more the value of the old Greek medicine and made them take further precautions for its preservation. The decadence of the early Middle Ages was due to the natural shifting of masses of population of this time, while the salvation of scientific and literary traditions was due to the one stable element in all these centuries--the Church. Far from Christianity inhibiting culture, it was the most important factor for its preservation, and it provided the best stimulus and incentive for its renewed development just as soon as the barbarous peoples were brought to a state of mind to appreciate it. Bearing this in mind, it is easier to understand the course of medical traditions through the Middle Ages, and especially in the earlier period, with regard to which our documents are comparatively scanty, and during which the disturbed conditions made medical developments impossible, and anything more than the preservation of the old authors out of the question. The torch of medical illumination lighted at the great Greek fires passes from people to people, never quenched, though often burning low because of unfavorable conditions, but sometimes with new fuel added to its flame by the contributions of genius. The early Christians took it up and kept it lighted, and, with the Jewish physicians, carried it through the troublous times of the end of the old order, and then passed it on for a while to the Arabs. Then, when favorable conditions had developed again, Christian schools and scholars gave it the opportunity to burn brightly for several centuries at the end of the Middle Ages. This medieval age is probably the most difficult period of medical history to understand properly, but it is worth while taking the trouble to follow out the thread of medical tradition from the Greeks to the Renaissance medical writers, who practically begin modern medicine for us. It is easy to understand that Christianity's influence on medicine, instead of hampering, was most favorable. The Founder of Christianity Himself had gone about healing the sick, and care for the ailing became a prominent feature of Christian work. One of the Evangelists, St. Luke, was a physician. It was the custom a generation ago, and even later, when the Higher Criticism became popular, to impugn the tradition as to St. Luke having been a physician, but this has all been undone, and Harnack's recent book, "Luke the Physician," makes it very clear that not only the Third Gospel, but also the Acts, could only have been written by a man thoroughly familiar with the Greek medical terms of his time, and who had surely had the advantage of a training in the medical sciences at Alexandria. This makes such an important link in medical traditions that a special chapter has been devoted to it in the Appendix. Very early in Christianity care for the ailing poor was taken up, and hospitals in our modern sense of the term became common in Christian communities. There had been military hospitals before this, and places where those who could afford to pay for service were kept during illness. Our modern city hospital, however, is a Christian institution. Besides, deformed and ailing children were cared for and homes for foundlings were established. Before Christianity the power even of life and death of the parents over their children was recognized, and deformed or ailing children, or those that for some reason were not wanted, were exposed until they died. Christianity put an end to this, and in two classes of institutions, the hospitals and the asylums, abundant opportunity for observation of illness was afforded. Just as soon as Christianity came to be free to establish its institutions publicly, hospitals became very common. The Emperor Julian, usually known as the Apostate, who hoped to re-establish the old Roman Olympian religion, wrote to Oribasius, one of the great physicians of this time, who was also an important official of his household, that these Christians had established everywhere hospitals in which not only their own people, but also those who were not Christians, were received and cared for, and that it would be idle to hope to counteract the influence of Christianity until corresponding institutions could be erected by the government. From the very beginning, or, at least, just as soon as reasonable freedom from persecution gave opportunity for study, Christian interest in the medical sciences began to manifest itself. Nemesius, for instance, a Bishop of Edessa in Syria, wrote toward the end of the fourth century a little work in Greek on the nature of man, which is a striking illustration of this. Nemesius was what in modern times would be called a philosopher, that is, a speculative thinker and writer, with regard to man's nature, rather than a physical scientist. He was convinced, however, that true philosophy ought to be based on a complete knowledge of man, body and soul, and that the anatomy of his body ought to be a fundamental principle. It is in this little volume that some enthusiastic students have found a description that is to them at least much more than a hint of knowledge of the circulation of the blood. Hyrtl doubts that the passage in question should be made to signify as much as has been suggested, but the occurrence of any even distant reference to such a subject at this time shows that, far from there being neglect of physical scientific questions, men were thinking seriously about them. Just as soon as Christianity brought in a more peaceful state of affairs and had so influenced the mass of the people that its place in the intellectual life could be felt, there comes a period of cultural development represented in philosophy by the Fathers of the Church, and during which we have a series of important contributors to medical literature. The first of these was Aëtius, whose career and works are treated more fully in the chapter on "Great Physicians in Early Christian Times." He was followed by Alexander of Tralles, probably a Christian, for his brother was the architect of Santa Sophia, and by Paul of Ægina, with regard to whom we know only what is contained in his medical writings, but whose contemporaries were nearly all Christians. Their books are valuable to us, partly because they contain quotations from great Greek writers on medicine, not always otherwise available, but also because they were men who evidently knew the subject of medicine broadly and thoroughly, made observations for themselves, and controlled what they learned from the Greek forefathers in medicine by their own experience. Just at the beginning of the Middle Ages, then, under the fostering care of Christianity there is a period of considerable importance in the history of medical literature. It is one of the best proofs that we have not only that Christianity did not hamper medical development, but that, directly and indirectly, by the place that it gave to the care of the ailing in life as well as the encouragement afforded to the intellectual life, it favored medical study and writing. A very interesting chapter in the story of the early Christian physician is to be found in what we know of the existence of women physicians in the fourth and fifth centuries. Theodosia, the mother of St. Procopius the martyr, was, according to Carptzovius, looked upon as an excellent physician in Rome in the early part of the fourth century. She suffered martyrdom under Diocletian. There was also a Nicerata who practised at Constantinople under the Emperor Arcadius. It is said that to her St. John Chrysostom owed the cure of a serious illness. From the very beginning Christian women acted as nurses, and deaconesses were put in charge of hospitals. Fabiola, at Rome, is the foundress of the first important hospital in that city. The story of these early Christian women physicians has been touched upon in the chapter on "Medieval Women Physicians," as an introduction to this interesting feature of Salernitan medical education. During the early Christian centuries much was owed to the genius and the devotion to medicine of distinguished Jewish physicians. Their sacred and rabbinical writers always concerned themselves closely with medicine, and both the Old Testament and the Talmud must be considered as containing chapters important for the medical history of the periods in which they were written. At all times the Jews have been distinguished for their knowledge of medicine, and all during the Middle Ages they are to be found prominent as physicians. They were among the teachers of the Arabs in the East and of the Moors in Spain. They were probably among the first professors at Salerno as well as at Montpellier. Many prominent rulers and ecclesiastics selected Jewish physicians. Some of these made distinct contributions to medicine, and a number of them deserve a place in any account of medicine in the making during the Middle Ages. One of them, Maimonides, to whom a special chapter is devoted, deserves a place among the great makers of medicine of all time, because of the influence that he exerted on his own and succeeding generations. Any story of the preservation and development of medical teaching and medical practice during the Middle Ages would be decidedly incomplete without due consideration of the work of Jewish physicians. Western medical literature followed Roman literature in other departments, and had only the Greek traditions at second hand. During the disturbance occasioned by the invasion of the barbarians there was little opportunity for such leisure as would enable men to devote themselves with tranquillity to medical study and writing. Medical traditions were mainly preserved in the monasteries. Cassiodorus, who, after having been Imperial Prime Minister, became a monk, recommended particularly the study of medicine to the monastic brethren. With the foundation of the Benedictines, medicine became one of the favorite studies of the monks, partly for the sake of the health of the brethren themselves, and partly in order that they might be helpful to the villages that so often gathered round their monasteries. There is a well-grounded tradition that at Monte Cassino medical teaching was one of the features of the education provided there by the monks. It is generally conceded that the Benedictines had much to do with the foundation of Salerno. In the convents for women as well as the monasteries for men serious attention was given to medicine. Women studied medicine and were professors in the medical department of Salerno. Other Italian universities followed the example thus set, and so there is abundant material for the chapter on "Medieval Women Physicians." The next phase of medical history in the medieval period brings us to the Arabs. Utterly uninterested in culture, education, or science before the time of Mohammed, with the growth of their political power and the foundation of their capitals, the Arab Caliphs took up the patronage of education. They were the rulers of the cities of Asia Minor in which Greek culture had taken so firm a hold, and captive Greece has always led its captors captive. With the leisure that came for study, Arabians took up the cultivation of the Greek philosophers, especially Aristotle, and soon turned their attention also to the Greek physicians Hippocrates and Galen. For some four hundred years then they were in the best position to carry on medical traditions. Their teachers were the Christian and Jewish physicians of the cities of Asia Minor, but soon they themselves became distinguished for their attainments, and for their medical writings. Interestingly enough, more of their distinguished men flourished in Spain than in Asia Minor. We have suggested an explanation for this in the fact that Spain had been one of the most cultured provinces of the Roman Empire, providing practically all the writers of the Silver Age of Latin literature, and evidently possessing a widely cultured people. It was into this province, not yet utterly decadent from the presence of the northern Goths, that the Moors came and readily built up a magnificent structure of culture and education on what had been the highest development of Roman civilization. The influence of the Arabs on Western civilization, and especially on the development of science in Europe, has been much exaggerated by certain writers. Closely in touch with Greek thought and Greek literature during the eighth, ninth, and tenth centuries, it is easy to understand that the Arabian writers were far ahead of the Christian scholars of Europe of the same period, who were struggling up out of the practical chaos that had been created by the coming of the barbarians, and who, besides, had the chance for whatever Greek learning came to them only through the secondary channels of the Latin writers. Rome had been too occupied with politics and aggrandizement ever to become cultured. In spite of this heritage from the Greeks, decadence took place among the Arabs, and, as the centuries go on, what they do becomes more and more trivial, and their writing has less significance. Just the opposite happened in Europe. There, there was noteworthy progressive development until the magnificent climax of thirteenth century accomplishment was reached. It is often said that Europe owed much to the Arabs for this, but careful analysis of the factors in that progress shows that very little came from the Arabs that was good, while not a little that was unfortunate in its influence was borrowed from them with the translations of the Greek authors from that language, which constituted the main, indeed often the only, reason why Arabian writers were consulted. With the foundation of the medical school of Salerno in the tenth century, the modern history of medical education may be said to begin, for it had many of the features that distinguish our modern university medical schools. Its professors often came from a distance and had travelled extensively for purposes of study; they attracted patients of high rank from nearly every part of Europe, and these were generous in their patronage of the school. Students came from all over, from Africa and Asia, as well as Europe, and when abuses of medical practice began to creep in, a series of laws were made creating a standard of medical education and regulating the practice of medicine, that are interesting anticipations of modern movements of the same kind. Finally a law was passed requiring three years of preliminary work in logic and philosophy before medicine might be taken up, and then four years at medicine, with a subsequent year of practice with a physician before a license to practise for one's self was issued. In addition to this there was a still more surprising feature in the handing over of the department of women's diseases to women professors, and the consequent opening up of licensure to practise medicine to a great many women in the southern part of Italy. The surprise that all this should have taken place in the south of Italy is lessened by recalling the fact that the lower end of the Italian peninsula had been early colonized by Greeks, that its name in later times was Magna Græcia, and that the stimulus of Greek tradition has always been especially favorable to the development of scientific medicine. Salerno's influence on Bologna is not difficult to trace, and the precious tradition of surgery particularly, which was carried to the northern university, served to initiate a period of surgery lasting nearly two centuries, during which we have some of the greatest contributions to this branch of medical science that were ever made. The development of the medical school at Bologna anticipated by but a short time that of a series of schools in the north Italian universities. Padua, Piacenza, Pisa, and Vicenza had medical schools in the later Middle Ages, the works of some of whose professors have attracted attention. It was from these north Italian medical schools that the tradition of close observation in medicine and of thoroughly scientific surgery found its way to Paris. Lanfranc was the carrier of surgery, and many French students who went to Italy came back with Italian methods. In the fourteenth century Guy de Chauliac made the grand tour in Italy, and then came back to write a text-book of surgery that is one of the monuments in this department of medical science. Before his time, Montpellier had attracted attention, but now it came to be looked upon as a recognized centre of great medical teaching. The absence of the Popes from Italy and the influence of their presence at Avignon made itself felt. While culture and education declined in Italy in the midst of political disturbances, they advanced materially at the south of France. For our generation undoubtedly the most interesting chapter in the history of medieval medicine is that which tells of the marvellous development of surgery that took place in the thirteenth and fourteenth centuries. Considerable space has been devoted to this, because it represents not only an important phase of the history of medicine, and recalls the names and careers of great makers of medicine, but also because it illustrates exquisitely the possibility of important discoveries in medicine being made, applied successfully for years, and then being lost or completely forgotten, though contained in important medical books that were always available for study. The more we know of this great period in the history of surgery, the more is the surprise at how much was accomplished, and how many details of our modern surgery were anticipated. Most of us have had some inkling of the fact that anæsthesia is not new, and that at various times in the world's history men have invented methods of producing states of sensibility in which more or less painless operations were possible. Very few of us have realized, however, the perfection to which anæsthesia was developed, and the possibility this provided for the great surgeons of the later medieval centuries to do operations in all the great cavities of the body, the skull, the thorax, and the abdomen, quite as they are done in our own time and apparently with no little degree of success. Of course, any such extensive surgical intervention even for serious affections would have been worse than useless under the septic conditions that would surely have prevailed if certain principles of antisepsis were not applied. Until comparatively recent years we have been quite confident in our assurance that antisepsis and asepsis were entirely modern developments of surgery. More knowledge, however, of the history of surgery has given a serious set-back to this self-complacency, and now we know that the later medieval surgeons understood practical antisepsis very well, and applied it successfully. They used strong wine as a dressing for their wounds, insisted on keeping them clean, and not allowing any extraneous material of any kind, ointments or the like, to be used on them. As a consequence they were able to secure excellent results in the healing of wounds, and they were inclined to boast of the fact that their incisions healed by first intention and that, indeed, the scar left after them was scarcely noticeable. We know that wine would make a good antiseptic dressing, but until we actually read the reports of the results obtained by these old surgeons, we had no idea that it could be used to such excellent purpose. Antisepsis, like anæsthesia, was marvellously anticipated by the surgical forefathers of the medieval period. It has always seemed to me that the story of Medieval Dentistry presented an even better illustration of a great anticipatory development of surgery. This department represents only a small surgical specialty, but one which even at that period was given over to specialists, who were called dentatores. Guy de Chauliac's review of the dentistry of his time and the state of the specialty, as pictured by John of Arcoli, is likely to be particularly interesting, because if there is any department of medical practice that we are sure is comparatively recent in origin, it is dentistry. Here, however, we find that practically all our dental manipulations, the filling of teeth, artificial dentures, even orthodontia, were anticipated by the dentists of the Middle Ages. We have only the compressed account of it which is to be found in text-books of general surgery, and while in this they give mainly a heritage from the past, yet even this suffices to give us a picture very surprising in its detailed anticipation of much that we have been inclined to think of as quite modern in invention and discovery. Medicine developed much more slowly than surgery, or, rather, lagged behind it, as it seems nearly always prone to do. Surgical problems are simple, and their solution belongs to a great extent to a handicraft. That is, after all, what chirurgy, the old form of our word surgery, means. Medical problems are more complex and involve both art and science, so that solutions of them are often merely temporary and lack finality. During the Middle Ages, however, and especially towards the end of them, the most important branches of medicine, diagnosis and therapeutics, took definite shape on the foundations that lie at the basis of our modern medical science. We hear of percussion for abdominal conditions, and of the most careful study of the pulse and the respiration. There are charts for the varying color of the urine, and of the tints of the skin. With Nicholas of Cusa there came the definite suggestion of the need of exact methods of diagnosis. A mathematician himself, he wished to introduce mathematical methods into medical diagnosis, and suggested that the pulse should be counted in connection with the water clock, the water that passed being weighed, in order to get very definite comparative values for the pulse rate under varying conditions, and also that the specific gravity of fluids from the body should be ascertained in order to get another definite datum in the knowledge of disease. It was long before these suggestions were to bear much fruit, but it is interesting to find them so clearly expressed. At the very end of the Middle Ages came the father of modern pharmaceutical chemistry, Basil Valentine. Already the spirit that was to mean so much for scientific investigation in the Renaissance period was abroad. Valentine, however, owes little to anything except his own investigations, and they were surprisingly successful, considering the circumstances of time and place. His practical suggestions so far as drugs were concerned did not prove to have enduring value, but then this has been a fate shared by many of the masters of medicine. There were many phases of medical practice, however, that he insisted on in his works. He believed that the best agent for the cure of the disease was nature, and that the physician's main business must be to find out how nature worked, and then foster her efforts or endeavor to imitate them. He insisted, also that personal observation, both of patients and drugs, was more important than book knowledge. Indeed, he has some rather strong expressions with regard to the utter valuelessness of book information in subjects where actual experience and observation are necessary. It gives a conceit of knowledge quite unjustified by what is really known. What is interesting about all these men is that they faced the same problems in medicine that we have to, in much the same temper of mind that we do ourselves, and that, indeed, they succeeded in solving them almost as well as we have done, in spite of all that might be looked for from the accumulation of knowledge ever since. It was very fortunate for the after time that in the period now known as the Renaissance, after the invention of printing, there were a number of serious, unselfish scholars who devoted themselves to the publication in fine printed editions of the works of these old-time makers of medicine. If the neglect of them that characterized the eighteenth and early nineteenth centuries had been the rule at the end of the fifteenth and during the sixteenth century, we would almost surely have been without the possibility of ever knowing that so many serious physicians lived and studied and wrote large important tomes during the Middle Ages. For our forefathers of a few generations ago had very little knowledge, and almost less interest, as to the Middle Ages, which they dismissed simply as the Dark Ages, quite sure that nothing worth while could possibly have come out of the Nazareth of that time. What they knew about the people who had lived during the thousand years before 1500 only seemed to them to prove the ignorance and the depths of superstition in which they were sunk. That medieval scholars should have written books not only well worth preservation, but containing anticipations of modern knowledge, and, though of course they could not have known that, even significant advances over their own scientific conditions, would have seemed to them quite absurd. Fortunately for us, then, the editions of the early printed books, so many of them monuments of learning and masterpieces of editorial work with regard to medieval masters of medicine, were lying in libraries waiting to be unearthed and restudied during the nineteenth century. German and French scholars, especially during the last generation, have recovered the knowledge of this thousand years of human activity, and we know now and can sympathetically study how the men of these times faced their problems, which were very much those of our own time, in almost precisely the same spirit as we do ours at the present time, and that their solutions of them are always interesting, often thorough and practical, and more frequently than we would like to think possible, resemble our own in many ways. For the possibility of this we are largely indebted originally to the scholars of the Renaissance. Without their work that of our investigators would have been quite unavailing. It is to be hoped, however, that our recovery of this period will not be followed by any further eclipse, though that seems to be almost the rule of human history, but that we shall continue to broaden our sympathetic knowledge of this wonderful medieval period, the study of which has had so many surprises in store for us. II GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES What we know of the life of the Founder of Christianity and how much He did for the ailing poor would make us expect that the religion that He established would foster the care and the cure of suffering humanity. As we have outlined in the Introduction, the first of the works of Christian service that was organized was the care of the sick. At first a portion of the bishop's house was given over to the shelter of the ailing, and a special order of assistants to the clergy, the deaconesses, took care of them. As Christians became more numerous, special hospitals were founded, and these became public institutions just as soon as freedom from persecution allowed the Christians the liberty to give overt expression to their feelings for the poor. While hospitals of limited capacity for such special purposes as the sheltering of slaves or of soldiers and health establishments of various kinds for the wealthy had been erected before Christianity, this was the first time that anyone who was ill, no matter what the state of his pecuniary resources, could be sure to find shelter and care. The expression of the Emperor Julian the Apostate, that admission to these hospitals was not limited to Christians, is the best possible evidence of the liberal charity that inspired them. The ordinary passing student of the history of medicine or of hospital foundation and organization, can have no idea of the magnitude of some of these institutions, and their importance in the life of the time, unless it is especially pointed out. St. Basil, about the middle of the fourth century, erected what was spoken of as "a city for the sick," before the gates of Cæsarea. Gregory of Nazianzen, his friend, says "that well built and furnished houses stood on both sides of streets symmetrically laid out about the church, and contained rooms for the sick, and the infirm of every variety were intrusted to the care of doctors and nurses." There were separate buildings for strangers, for the poor, and for the ailing, and comfortable dwellings for the physicians and nurses. An important portion of the institution was set apart for the care of lepers, which constituted a prominent feature in Basil's work in which he himself took a special interest. Earlier in the same century Helena, the mother of the Emperor Constantine, had built similar institutions around Jerusalem, and during this same century nearly everywhere we have evidence of organization of hospitals and of care for the ailing poor. Not only were hospitals erected, but arrangements were made for the care of the ailing poor in their own homes and for the visitation of them, and for the bringing to places adapted for their care and treatment of such as were found on the street, or neglected in their homes. The Church evidently considered itself bound to care for men's bodies as well as their souls, and many of the expressions in common use among Christians referred to this fact. Religion itself was spoken of as a medicine of the soul and the body. Christianity was defined as the religion of healing. The word salvation had a reference to both body and soul. Baptism was spoken of as the bath of the soul, the holy Eucharist as the elixir of immortal life, and penance as the medicine of the soul. It is not surprising to find, then, that Harnack has found among the texts that illustrate the history of early Christian literature this one: "In every community there shall be at least one widow appointed to assist women who are stricken with illness, and this widow shall be trained in her duties, neat and careful in her ways, shall not be self-seeking, must not indulge too freely in wine in order that she may be able to take up her duties at night as well as by day, and shall consider it her duty to keep the Church officials informed of all that seems necessary." The saving of deformed and ailing infants or children whose parents did not care to have the trouble of rearing them, required the establishment by the Christians of another set of institutions, Foundling Asylums and Hospitals for Children. Until the coming of Christianity parents were supposed to have the right of life and death over their children, and no one questioned it. In every country in the world until the coming of Christianity this had always been the case. Besides, there were institutions for the care of the old. These are the classes of mankind who are especially liable to suffer from disease, and the opportunity to study human ailments in such institutions could scarcely help but provide facilities for clinical observation such as had not existed before. Unfortunately the work of Christianity was hampered, first by the Roman persecutions, and then later by the invasion of the barbarians, who had to be educated and lifted up to a higher plane of civilization before they could be brought to appreciate the value of medical science, much less contribute to its development. Harnack, whose writings in the higher criticism of Scripture have attracted so much attention in recent years, began his career in the study of Christian antiquities with a monograph on Medical Features of Early Christianity.[1] He mentions altogether some sixteen physicians who reached distinction in the earliest days of Christianity. Some of these were priests, some of them bishops, as Theodotos of Laodicea; Eusebius, Bishop of Rome; Basilios, Bishop of Ancyra, and at least one, Hierakas, was the founder of a religious order. The first Christian physicians came mainly from Syria, as might be expected, for here the old Greek medical traditions were active. Among them must be enumerated Cosmas and Damian, physicians who were martyred in the persecution of Diocletian, and who have been chosen as the patrons of the medical profession. Justinian erected a famous church to them. It became the scene of pilgrimages. Organizations of various kinds since, as the College of St. Come, and medical societies, have been named after them. Some idea of the interest of ecclesiastics in medical affairs may be gathered from a letter of Bishop Theodoret of Cyrus, directed to the prefect of the city, when he was about to leave the place. He wrote (see Puschmann, Vol. I., p. 494): "When I took up the Bishopric of Cyrus I made every effort to bring in from all sides the arts that would be useful to the people. I succeeded in persuading skilled physicians to take up their residence here. Among these is a very pious priest, Peter, who practises medicine with great skill, and is well known for his care for the people. Now that I am about to leave the city, some of those who came at my invitation are preparing also to go. Peter seems resolved to do this. I appeal to your highness, therefore, in order to commend him to your special care. He handles patients with great skill and brings about many cures." Distinguished Christian writers and scholars, and the Fathers of the Church in the early centuries, evidently paid much attention to medicine. Tertullian speaks of medical science as the sister of philosophy, and has many references to the medical doctrines discussed in his time. Lactantius, in his work, "De Opificio Dei," has much to say with regard to the human body as representing the necessity for design in creation. His teleological arguments have much more force now than they would have had for people generally twenty years ago. We have come back to recognize the place of teleology. Clement of Alexandria was an early Christian temperance advocate, who argued that the use of wine was only justified when it did good as a medicine. The problems of embryology and of diseases of childhood interested him as they did many other of the early Christian writers. AËTIUS The first great Christian physician whose works meant much for his own time, and whose writings have become a classic in medicine, was Aëtius Amidenus, that is, Aëtius of Amida, who was born in the town of that name in Mesopotamia, on the upper Tigris (now Diarbekir), and who flourished about the middle of the sixth century. His medical studies, as he has told us himself, were made at Alexandria. After having attracted attention by his medical learning and skill, he became physician to one of the emperors at Byzantium, very probably Justinian, (527-565). He seems to have been succeeded in the special post that was created for him at court by Alexander of Tralles, the second of the great Christian physicians. There is no doubt that Aëtius was a Christian, for he mentions Christian mysteries, and appeals to the name of the Saviour and the martyrs. He was evidently a man of wide reading, for he quotes from practically every important medical writer before his time. Indeed, he is most valuable for the history of medicine, because he gives us some idea of the mode of treatment of various subjects by predecessors whose fame we know, but none of whose works have come to us. His official career and the patronage of the Emperor, the breadth of his scholarship, and the thoroughly practical character of his teaching, show how medical science and medical art were being developed and encouraged at this time. Aëtius' work that is preserved for us is known in medical literature as his sixteen books on medical practice. In most of the manuscript it is divided into four Tetrabibloi, or four book parts, each of which consists of four sections called Logoi in Greek, Sermones in Latin. This work embraces all the departments of medicine, and has a considerable portion devoted to surgery, but most of the important operations and the chapters on fractures and dislocations are lacking. Aëtius himself announces that he had prepared a special work on surgery, but this is lost. Doubtless the important chapters that we have noted as lacking in his work would be found in this. He is much richer in pathology than most of the older writers, at least of the Christian era; for instance, Gurlt says that he treats this feature of the subject much more extensively even than Paulus Æginetus, but most of his work is devoted to therapeutics. At times those who read these old books from certain modern standpoints are surprised to find such noteworthy differences between writers on medicine, who are separated sometimes only by a generation, and sometimes by not more than a century, in what regards the comparative amount of space given to pathology, etiology, and therapeutics. Just exactly the same differences exist in our own day, however. We all know that for those who want pathology and etiology the work of one of our great teachers is to be consulted, while for therapeutics it is better to go to someone else. When we find such differences among the men of the olden time we are not so apt to look at them with sympathetic discrimination, as we do with regard to our contemporaries. We may even set them down to ignorance rather than specialization of interest. These differences depend on the attitude of mind of the physician, and are largely the result of his own personal equation. They do not reflect in any way either on his judgment or on the special knowledge of his time, but are the index of his special receptivity and teaching habit. Aëtius' first and second books are taken up entirely with drugs. The first book contains a list of drugs arranged according to the Greek alphabet. In the third book other remedial measures, dietetic, manipulative, and even operative, are suggested. In these are included venesection, the opening of an artery, cupping, leeches, and the like. The fourth and fifth books take up hygiene, special dietetics, and general pathology. In the sixth book what the Germans call special pathology and therapy begins with the diseases of the head. The first chapter treats of hydrocephalus. In this same book rabies is treated. What Aëtius has consists mainly of quotations from previous authors, many of whom he had evidently read with great care. Concerning those "bitten by a rabid dog or those who fear water," Gurlt has quoted the following expression, with regard to which most people will be quite ready to agree with him when he says that it contains a great deal of truth, usually thought to be of much later origin: "When, therefore, any one has been bitten by a rabid dog the treatment of the wound must be undertaken just as soon as possible, even though the bite should be small and only superficial. One thing is certain, that none of those who are not rightly treated escape the fatal effect. The first thing to do is to make the wound larger, the mouth of it being divided and dilated by the scalpel. Then every portion of it and the surrounding tissues must be firmly pressed upon with the definite purpose of causing a large efflux of blood from the part. Then the wound should be deeply cauterized, etc." There are special chapters devoted to eye and ear diseases, and to various affections of the face. Under this the question of tattooing and its removal comes in. It is surprising how much Aëtius has with regard to such nasal affections as polyps and ulcers and bleedings from the nose. In this book, however, he treats only of their medicinal treatment. What he has to say about affections of the teeth is so interesting that it deserves a paragraph or two by itself. He had much to say with regard to the nervous supply of the mucous membranes of the gums, tongue, and mouth, and taught that the teeth received nerves through the small hole existing at the end of every root. For children cutting teeth he advised the chewing of hard objects, and thought that the chewing of rather hard materials was good also for the teeth of adults. For fistulas leading to the roots of teeth he suggests various irritant treatments, and, if they do not succeed, recommends the removal of the teeth. He seems to have known much about affections of the gums and recognizes a benignant and malignant epulis. He thought that one form of epulis was due to inflammation of a chronic character, and suggests that if remedies do not succeed it should be removed. His work is of interest mainly as showing that even at this time, when the desire for information of this kind is usually supposed to have been in abeyance, physicians were gathering information about all sorts even of the minor ailments of mankind, gathering what had been written about them, commenting on it, adding their own observations, and in general trying to solve the problems as well as they could. Aëtius seems to have had a pretty good idea of diphtheria. He speaks of it in connection with other throat manifestations under the heading of "crusty and pestilent ulcers of the tonsils." He divides the anginas generally into four kinds. The first consists of inflammation of the fauces with the classic symptoms, the second presents no inflammation of the mouth nor of the fauces, but is complicated by a sense of suffocation--apparently our croup. The third consists of external and internal inflammation of the mouth and throat, extending towards the chin. The fourth is an affection rather of the neck, due to an inflammation of the vertebræ--retropharyngeal abscess--that may be followed by luxation and is complicated by great difficulty of respiration. All of these have as a common symptom difficulty of swallowing. This is greater in one variety than in another at different times. In certain affections even "drinks when taken are returned through the nose." Hypertrophy of the tonsils--Aëtius speaks of them as glands--is to be treated by various astringent remedies, but if these fail the structures should be excised. His description of the excision is rather clear and detailed. The patient should be put in a good full light, and the mouth should be held open and each gland pulled forward by a hook and excised. The operator should be careful, however, only to excise those portions that are beyond the natural size, for if any of the natural substance of the gland is cut into, or if the incision is made beyond the projecting portion of the tonsil, there is grave danger of serious hemorrhage. After excision a mixture of water and vinegar should be kept in the mouth for some time. This should be administered cold in order to prevent the flow of blood. After this very cold water should be taken. In this same book, Chapter L, he treats of foreign bodies in the respiratory and upper digestive tracts. If there is anything in the larynx or the bronchial tubes the attempt must be made to secure its ejection by the production of coughing or sneezing. If the foreign body can be seen it should be grasped with a pincers and removed. If it is in the esophagus, Aëtius suggests that the patient should be made to swallow a sponge dipped in grease, or a piece of fat meat, to either of which a string has been attached, in order that the foreign body may be caught and drawn out. If it seems preferable to carry the body on into the stomach, the swallowing of large mouthfuls of fresh bread or other such material is recommended. With regard to goitre, Aëtius has some interesting details. He says that "all tumors occurring in the throat region are called bronchoceles, for every tumor among the ancients was called a cele, and, though the name is common to them, they differ very much from one another." Some of them are fatty, some of them are pultaceous, some of them are cancerous, and some of them he calls honey tumors, because of a honey-like humor they contain. "Sometimes they are due to a local dilatation of the blood vessels, and this is most frequently connected with parturition, apparently being due to the drawing of the breath being prevented or repressed during the most violent pains of the patient. Such local dilatation at this point of the veins is incurable, but there are also hard tumors like scirrhus and malignant tumors, and those of great size. With the exception of these last, _all the tumors of this region are easily cured_, yielding either to surgery or to remedies. Surgery must be adapted to the special tumor, whether it be honey-like or fatty, or pultaceous." The prognosis of goitrous tumors is much better than might be expected, but evidently Aëtius saw a number of the functional disturbances and enlargements of the thyroid gland, which are so variable in character as apparently to be quite amenable to treatment. Aëtius' treatment of the subject of varicosities is quite complete in its suggestions. "The term varices," he says, "is applied to dilated veins, which occur sometimes in connection with the testes and sometimes in the limbs. Operations on testicular varices patients do not readily consent to; those on the limbs may be cured in several ways. First, simple section of the skin lying above the dilated vessel is made, and with the hook it is separated from the neighboring tissues and tied. After this the dilated portion is removed and pressure applied by means of a bandage. The patient is ordered to remain quiet, but with the legs higher than the head. Some people prefer treatment by means of the cautery." Gurlt, in his "History of Surgery," calls attention to the fact that two of our modern methods of treating varicose veins are thus discussed in Aëtius, that by ligation and that by the cautery. The cautery was applied over a space the breadth of a finger at several points along the dilated veins. Aëtius' chapters on obstetrics and gynæcology are of special interest, because, while we are prone to think that gynæcology particularly is a comparatively modern development of surgery, this surgical authority of the early Middle Ages treats it rather exhaustively. His sixteenth book is for the most part (one hundred and eleven chapters of it) devoted to these two subjects. He has a number of interesting details in the first thirty-six chapters with regard to conception, pregnancy, labor, and lactation, which show how practical were the views of the physicians of the time. Gurlt has given us some details of his chapters on diseases of the breast. Aëtius differentiates phagedenic and rodent ulcers and cancer. All the ordinary forms of phagedenic ulcer yield to treatment, while malignant growths are rendered worse by them. Where ulcers are old, he suggests the removal of their thickened edges by the cautery, for this hastens cure and prevents hemorrhage. With regard to cancer, he quotes from Archigenes and Leonides. He says that these tumors are very frequent in women, and quite rare in men. Even at this time cancer had been observed and recognized in the male breast. He emphasizes the fact that cancerous nodules become prominent and become attached to surrounding tissues. There are two forms, those with ulcer, and those without. He describes the enlargement of the veins that follows, the actual varicosities, and the dusky or livid redness of the parts which seem to be soft, but are really very hard. He says that they are often complicated by very painful conditions, and that they cause enlargement of the glands and of the arms. The pain may spread to the clavicle and the scapula, and he seems to think that it is the pain that causes the enlargement of the glands at a distance. His description of ulcerative cancer of the breast is very striking. He says that it erodes without cause, penetrating ever deeper and deeper, and cannot be stopped until it emits a secretion worse than the poison of wild beasts, copious and abominable to the smell. With these other symptoms pains are present. This form of cancer is especially made worse by drugs and by all manner of manipulation. The paragraph from Leonides quoted by Aëtius gives a description of operation for cancer of the breast, in which he insists particularly on the extensive removal of tissue and the free use of the cautery. "The cautery is used at first in order to prevent bleeding, but also because it helps to destroy the remains of diseased tissues. When the burning is deep, prognosis is much better. Even in cases where indurated tumors of the breast occur that might be removed without danger of bleeding, it is better to use the cautery freely, though the amputation of such a portion down to the healthy parts may suffice." Aëtius quotes this with approval. Others before Aëtius had suggested the connection between hypertrophy of the clitoris and certain exaggerated manifestations of the sexual instinct, and the development of vicious sexual habits. As might be expected from this first great Christian physician and surgeon, he emphasizes this etiology for certain cases, and outlines an operation for it. This operation had been suggested before, but Aëtius goes into it in detail and describes just how the operation should be done, so as to secure complete amputation of the enlarged organ, yet without injury. He warns of the danger of removing more than just the structure itself, because this may give rise to ugly and bothersome scars. After the operation a sponge wet with astringent wine should be applied, or cold water, especially if there is much tendency to bleeding, and afterwards a sponge with manna or frankincense scattered over it should be bound on. He treats of other pathological conditions of the female genitalia, varicose veins, growths of various kinds, hypertrophy of the _portio vaginalis uteri_, an operation for which is described, and of various tumors. He describes epithelioma very clearly, enumerates its most frequent locations in their order, lays down its bad prognosis, and hence the necessity for early operation with entire removal of the new growth whenever possible. He feared hemorrhage very much, however, and warns with regard to it, and evidently had had some very unfortunate experiences in the treatment of these conditions. Aëtius seems to have had as thoroughly scientific an interest in certain phases of chemistry apart from medicine as any educated physician of the modern time might have. Mr. A.P. Laurie, in his "Materials of the Printer's Craft,"[2] calls attention to the fact that the earliest reference to the use of drying oil for varnish is made by the physician Aëtius. Aëtius, or Aëtios, to use for the nonce the Greek spelling of his name, which sometimes occurs in medical literature, and should be known, has been the subject of very varied estimation at different times. About the time of the Renaissance he was one of the first of the early writers on medicine accorded the honor of printing, and then was reprinted many times, so that his estimation was very high. With the reawakening of clinical medicine in the seventeenth century his reputation waxed again, and Boerhaave declared that the works of Aëtius had as much importance for physicians as had the Pandects of Justinian for lawyers. This high estimation had survived almost from the time of the Renaissance, when Cornelius went so far as to say: "Believe me, that whoever is deeply desirous of studying things medical, if he would have the whole of Galen abbreviated and the whole of Oribasius extended, and the whole of Paulus (of Ægina) amplified, if he would have all the special remedies of the old physicians as well in pharmacy as in surgery boiled down to a summa for all affections, he will find it in Aëtius." Naturally enough, this exaggerated estimation was followed by a reaction, in which Aëtius came to be valued at much less than he deserved. After all is taken into account in the vicissitudes of his fame, it is clear, however, that he is one of the most important links in the chain of medical tradition, and himself worthy to be classed among makers of medicine for his personal observations and efforts to pass on the teachings of the old to succeeding generations. ALEXANDER OF TRALLES An even more striking example than the life and work of Aëtius as evidence for the encouragement and patronage of medicine in early Christian times, is to be found in the career of Alexander of Tralles, whose writings have been the subject of most careful attention in the Renaissance period and in our own, and who must be considered one of the great independent thinkers in medicine. While it is usually assumed that whatever there was of medical writing during the Middle Ages was mere copying and compilation, here at least is a man who could not only judiciously select, but who could critically estimate the value of medical opinions and procedure, and weighing them by his own experience and observation, turn out work that was valuable for all succeeding generations. The modern German school of medical historians have agreed in declaring him an independent thinker and physician, who represents a distinct link in medical tradition. He came of a distinguished family, in which the following of medicine as a profession might be looked upon as hereditary. His father was a physician, and it is probable that there were physicians in preceding generations, and one of his brothers, Dioscoros, was also a successful physician. Altogether four of his brothers reached such distinction in their life work that their names have come down to us through nearly fifteen hundred years. The eldest of them was Anthemios, the builder of the great church of Santa Sophia in Constantinople. As this is one of the world's great churches, and still stands for the admiration of men a millennium and a half after its completion, it is easy to understand that Anthemios' reputation is well founded. A second brother was Metrodoros, a distinguished grammarian and teacher, especially of the youthful nobility of Byzantium, as it was then called, or Constantinople, as we have come to call it. A third brother was a prominent jurist, also in Constantinople. The fourth brother, Dioscoros, like Alexander, a physician, remained in his birthplace, Tralles, and acquired there a great practice. It was with his father at Tralles that Alexander received his early medical training. The father of a friend and colleague, Cosmas, who later dedicated a book to Alexander, was also his teacher, while he was in his native city. As a young man, Alexander undertook extensive travels, which led him into Italy, Gaul, Spain, and Africa, everywhere gathering medical knowledge and medical experience. Then he settled down at Rome, probably in an official position, and practised medicine successfully until a very old age. He was probably eighty years of age when, some time during the first decade of the seventh century, he died. Puschmann, who has made a special study of Alexander's life and work, suggests that since some of his books have the form of academic lectures he was probably a teacher of medicine at Rome. As might be expected from what we know of the relations of the rest of the family to the nobility of the time, it is easy to understand, especially in connection with hints in Alexander's favorite modes of therapeutics, that costliness of remedies made no difference to his patients, that he must have had the treatment of some of the wealthiest families in Rome. His principal work is a Treatise on the Pathology and Therapeutics of Internal Diseases, in twelve books. The first eleven books were evidently material gathered for lectures or teaching of some kind. The twelfth book, in which considerable use of Aëtius' writings is made, was written, according to Puschmann, toward the end of Alexander's life, and was meant to contain supplementary matter, comprising especially his views gathered from observation as to the pathology of internal diseases. A shorter treatise of Alexander is with regard to intestinal parasites. There are many printed editions of these books, and many manuscript copies are in existence. Alexander was often quoted during the Middle Ages, and in recent years, with the growth of our knowledge of medical history, he has come to be a favorite subject of study. Alexander's first book of pathology and therapeutics treats of head and brain diseases. For baldness, the first symptom of which is falling out of the hair, he counsels cutting the hair short, washing the scalp vigorously, and the rubbing in of sulphur ointments. For grey hair he suggests certain hair dyes, as nutgalls, red wine, and so forth. For dandruff, which he described as the excessive formation of small flake-like scales, he recommends rubbing with wine, with certain salves, and washing with salt water. He gives a good deal of attention to diseases of the nervous system. He has a rather interesting chapter on headache. The affection occurs in connection with fevers, after excess in drinking, and as a consequence of injury to the skull. Besides, it develops as a result of disturbances of the natural processes in the head, the stomach, the liver, and the spleen. Headache, as the first symptom of inflammation of the brain, is often the forerunner of convulsions, delirium, and sudden death. Chronic or recurrent headache occurs in connection with plethora, diseases of the brain, biliousness, digestive disturbances, insomnia, and continued worry. Hemicrania has its origin in the brain, because of the presence of toxic materials, and specially their transformation into gaseous substances. It also occurs in connection with abdominal affections. This latter remark particularly is directed to the cases which occur in women. For apoplexy and the consequent paralysis, Alexander considered venesection the best remedy. Massage, rubbings, baths, and warm applications are recommended for the paralytic conditions. He had evidently had considerable experience with epilepsy. It develops either from injuries of the head or from disturbances of the stomach, or occasionally other parts of the body. When it occurs in nursing infants, nourishment is the best remedy, and he gives detailed directions for the selection of a wet nurse, and very careful directions as to her mode of life. He emphasizes very much the necessity for careful attention to the gastro-intestinal tract in many cases of epilepsy. Planned diet and regular bowels are very helpful. He rejects treatment of the condition by surgery of the head, either by trephining or by incisions, or cauterization. Regular exercise, baths, sexual abstinence are the foundation of any successful treatment. It is probable that we have returned to Alexander's treatment of epilepsy much more nearly than is generally thought. There are those who still think that remedies of various kinds do good, but in the large epileptic colonies regular exercise, bland diet, regulation of the bowels, and avoidance of excesses of all kinds, with occupation of mind, constitute the mainstay of their treatment. Alexander has much to say with regard to phrenitis, a febrile condition complicated by delirium, which, following Galen, he considers an affection of the brain. It is evidently the brain fever of the generations preceding the last, an important element of which was made up of the infectious meningitises. Alexander suggests its treatment by opiates after preliminary venesection, rubbings, lukewarm baths, and stimulating drinks. Every disturbance of the patient must be avoided, and visitors must be forbidden. The patient's room should rather be light than dark. His teaching crops up constantly in the centuries after his time, until the end of the nineteenth century, and while we now understand the causes of the condition better, we can do little more for it than he did. Alexander divided mental diseases into two, the maniacal and melancholic. Mania was, however, really a further development of melancholia, and represented a high grade of insanity. Under melancholy he groups not only what we denominate by that term, but also all depressed conditions, and the paranoias, as also many cases of imbecility. The cause of mental diseases was to be found in the blood. He counselled the use of venesection, of laxatives and purgatives, of baths and stimulant remedies. He insisted very much, however, on mental influence in the disease, on change of place and air, visits to the theatre, and every possible form of mental diversion, as among the best remedial measures. After his book on diseases of the head, his most important section is on diseases of the respiratory system. In this he treats first of angina, and recommends as gargles at the beginning light astringents; later stronger astringents, as alum and soda dissolved in warm water, should be employed. Warm compresses, venesection from the sublingual veins, and from the jugular, and purgatives in severe cases, are the further remedies. He treats of cough as a symptom due to hot or cold, dry or wet dyscrasias. Opium preparations carefully used are the best remedies. The breathing in of steam impregnated with various ethereal resins, was also recommended. He gives a rather interestingly modern treatment of consumption. He recommends an abundance of milk with a strong nutritious diet, as digestible as possible. A good auxiliary to this treatment was change of air, a sea voyage, and a stay at a watering-place. Asses' and mares' milk are much better for these patients than cows' and goats' milk. There is not enough difference in the composition of these various milks to make their special consumption of import, but it is probable that the suggestive influence of the taking of an unusual milk had a very favorable effect upon patients, and this effect was renewed frequently, so that much good was ultimately accomplished. For hemoptysis, especially when it was acute and due as Alexander thought to the rupture of a blood vessel in the lungs, he recommended the opening of a vein at the elbow or the ankle--in order to divert the blood from the place of rupture to the healthy parts of the circulation. He insisted that the patients must rest, that they should take acid and astringent drinks, that cold compresses should be placed upon the chest (our ice bags), and that they should take only a liquid diet at most lukewarm, or, better, if agreeable to them, cold. When the bleeding stopped, a milk cure was very useful for the restoration of these patients to strength. It is not surprising, then, to find that Alexander suggests a thoroughly rational treatment for pleurisy. He recognizes this as an inflammation of the membrane covering the ribs, and its symptoms are severe pain, disturbance of breathing, and coughing. In certain cases there is severe fever, and Alexander knows of purulent pleurisy, and the fact that when pus is present the side on which it is is warmer than the other. Pleurisy can be, he says, rather easily confounded with certain liver affections, but there is a peculiar hardness of the pulse characteristic of pleurisy, and there is no expectoration in liver cases, though it also may be absent in many cases of pleurisy. Sufferers from liver disease usually have a paler color than pleuritics. His treatment consists in venesection, purgatives, and, when pus is formed, local incision. He recommends the laying on of sponges dipped in warm water, and the internal use of honey lemonade. Opium should not be used unless the patient suffers from sleeplessness. Some of the general principles of therapeutics that Alexander lays down are very interesting, even from our modern standpoint. Trust should not be placed in any single method of treatment. Every available means of bringing relief to the patient should be tried. "The duty of the physician is to cool what is hot, to warm what is cold, to dry what is moist, and to moisten what is dry. He should look upon the patient as a besieged city, and try to rescue him with every means that art and science places at his command. The physician should be an inventor, and think out new ways and means by which the cure of the patient's affection and the relief of his symptoms may be brought about." The most important factor in his therapeutics is diet. Watering-places and various forms of mineral waters, as well as warm baths and sea baths, are constantly recommended by him. He took strong ground against the use of many drugs, and the rage for operating. The prophylaxis of disease is in Alexander's opinion the important part of the physician's duty. His treatment of fever shows the application of his principle: cold baths, cold compresses, and a cooling diet, were his favorite remedies. He encouraged diaphoresis nearly always, and gave wine and stimulating drugs only when the patient was very weak. He differentiates two kinds of quartan fever. One of these he attributes to an affection of the spleen, because he had noticed that the spleen was enlarged during it, and that, after purgation, the enlarged spleen decreased in size. Alexander was a strong opponent of drastic remedies of all kinds. He did not believe in strong purgatives, nor in profuse and sudden blood-lettings. He opposed arteriotomy for this reason, and refused to employ extensive cauterization. His diagnosis is thorough and careful. He insisted particularly on inspection and palpation of the whole body; on careful examination of the urine, of the feces, and the sputum; on study of the pulse and the breathing. He thought that a great deal might be learned from the patient's history. The general constitution is also of importance. His therapeutics is, above all, individual. Remedies must be administered with careful reference to the constitution, the age, the sex, and the condition of the patient's strength. Special attention must always be paid to nature's efforts to cure, and these must be encouraged as far as possible. Alexander had no sympathy at all with the idea that remedies must work against nature. His position in this matter places him among the dozen men whose name and writings have given them an enduring place in the favor of the profession at all times, when we were not being carried away by some therapeutic fad or imagining that some new theory solved the whole problem of the causation and cure of disease. Gurlt, in his "History of Surgery," has abstracted from Alexander particularly certain phases of what the Germans call external pathology and therapeutics. For instance, Alexander's treatment of troubles connected with the ear is very interesting. Gurlt declares that this chapter alone provides striking evidence for Alexander's practical experience and power of observation, as well as for his knowledge of the literature of medicine. He considers that only a short abstract is needed to show that. For water that has found its way into the external ear, Alexander suggests a mode of treatment that is still popularly used. The patient should stand upon the leg corresponding to the side on which there is water in his ear, and then, with head leaning to that side, should hop or kick out with the other leg. The water may be drawn out by means of suction through a reed. In order to get foreign bodies out of the external auditory canal, an ear spoon or other small instrument should be wrapped in wool and dipped in turpentine, or some other sticky material. Occasionally he has seen sneezing, especially if the mouth and nose are covered with a cloth, and the head leant toward the affected side, bring about a dislodgment of the foreign body. If these means do not succeed, gentle injections of warm oil or washing out of the canal with honey water should be tried. Foreign bodies may also be removed by means of suction. Insects or worms that find their way into the ear may be killed by injections of acid and oil, or other substances. Gurlt also calls attention to Alexander's careful differentiation of certain very dangerous forms of inflammation of the throat from others which are rather readily treated. He says, "Inflammation of the throat may, under certain circumstances, belong to the severest diseases. The patients succumb to it as a consequence of suffocation, just as if they were choked or hanged. For this reason, perhaps, the affection bears the name synanche, which means constriction." He then points out various other forms of inflammation of the throat, acute and chronic, suggesting various names and the differential diagnostic signs. One of the most surprising chapters of Alexander's knowledge of pathology and therapeutics is to be found in his treatment of the subject of intestinal worms, which is contained in a letter sent by him to his friend, Theodore, whose child was suffering from them. He describes the _oxyuris vermicularis_ with knowledge manifestly derived from personal observation. He dwells on the itching in the region of the anus, caused by the _oxyuris_, and the fact that they probably find their way into the upper part of the digestive tract because of the soiling of the hands. He knew that the tapeworms often reached great length,--he has seen one over sixteen feet long,--and also that they had a life cycle, so that they existed in two different forms. He describes the roundworms as existing in the intestines, but occasionally wandering into the stomach to be vomited. His vermifuges were the flowers and the seeds of the pomegranate, the seeds of the heliotrope, castor-oil, and certain herbs that are still used, by country people, at least, as worm medicines. For roundworms he recommended especially a decoction of _artemisia maritima_, coriander seeds, and decoctions of thyme. Our return to thymol for intestinal parasites is interesting. For the _oxyuris_ he prescribed clysters of ethereal oils. We have not advanced much in our treatment of intestinal worms in the fifteen hundred years since Alexander's time. PAUL OF ÆGINA Another extremely important writer in these early medieval times, whose opportunities for study in medicine and for the practice of it, were afforded him by Christian schools and Christian hospitals, was Paul of Ægina. He was born on the island of Ægina, hence the name Æginetus, by which he is commonly known. There used to be considerable doubt as to just when Paul lived, and dates for his career were placed as widely apart as the fifth and the seventh centuries. We know that he was educated at the University of Alexandria. As that institution was broken up at the time of the capture of the city by the Arabs, he cannot have been there later than during the first half of the seventh century. An Arabian writer, Abul Farag, in "The Story of the Reign of the Emperor Heraclius," who died 641, says that "among the celebrated physicians who flourished at this time was Paulus Æginetus." In his works Paul quotes from Alexander of Tralles, so that there seems to be no doubt now that his life must be placed in the seventh century. The most important portion of Paul's work for the modern time is contained in his sixth book on surgery. In this his personal observations are especially accumulated. Gurlt has reviewed it at considerable length, devoting altogether nearly thirty pages to it, and it well deserves this lengthy abstract. Paul quotes a great many of the writers on surgery before his time, and then adds the results of his own observation and experience. In it one finds careful detailed descriptions of many operations that are usually supposed to be modern. Very probably the description quoted by Gurlt of the method of treating fishbones that have become caught in the throat will give the best idea of how thoroughly practical Paul is in his directions. He says: "It will often happen in eating that fishbones or other objects may be swallowed and get caught in some part of the throat. If they can be seen they should be removed with the forceps designed for that purpose. Where they are deeper, some recommend that the patient should swallow large mouthfuls of bread or other such food. Others recommend that a clean soft sponge of small circumference to which a string is attached be swallowed, and then drawn out by means of the string. This should be repeated until the bone or other object gets caught in the sponge and is drawn out. If the patient is seen immediately after eating, and the swallowed object is not visible, vomiting should be brought on by means of a finger in the throat or irritation with the feather, and then not infrequently the swallowed object will be brought up with the vomit." In the chapter immediately following this, XXXIII, there is a description of the method of opening the larynx or the trachea, with the indications for this operation. The surgeon will know that he has opened the trachea when the air streams out of the wound with some force, and the voice is lost. As soon as the danger of suffocation is over, the edges of the wound should be freshened and the skin surfaces brought together with sutures. Only the skin without the cartilage should be sutured, and general treatment for encouraging union should be employed. If the wound fails to heal immediately, a treatment calculated to encourage granulations should be undertaken. This same method of treatment will be of service whenever we happen to have a patient who, in order to commit suicide, has cut his throat. Paul's exact term is, perhaps, best translated by the expression, slashed his larynx. One of the features of Paul's "Treatise on Surgery" is his description of a radical operation for hernia. He describes scrotal hernia under the name enterocele, and says that it is due either to a tearing or a stretching of the peritoneum. It may be the consequence either of injury or of violent efforts made during crying. When the scrotum contains only omentum, he calls the condition epiplocele; when it also contains intestine, an epiplo-enterocele. Hernia that does not descend into the scrotum he calls bubonocele. For operation the patient should be placed on the back, and, the skin of the inguinal region being stretched by an assistant, an oblique incision in the direction in which the blood vessels run should be made. The incision should then be stretched by means of retractors, until the contents of the sac can be lifted out. All adhesions should be broken up and the fat be removed, and the hernia replaced within the abdomen. Care should be taken that no loop of intestine is allowed to remain. Then a large needle with double thread made of ten strands should be run through the middle of the incision in the end of the peritoneum, and tied firmly in cross sutures. The outer structures should be brought together with a second ligature, and the lower end of the incision should have a wick placed in it for drainage, and the site of operation should be covered with an oil bandage. The Arab writer, Abul Farag, to whose references we owe the definite placing of the time when Paul lived, said that "he had special experience in women's diseases, and had devoted himself to them with great industry and success. The midwives of the time were accustomed to go to him and ask his counsel with regard to accidents that happen during and after parturition. He willingly imparted his information, and told them what they should do. For this reason he came to be known as the Obstetrician." Perhaps the term should be translated the man-midwife, for it was rather unusual for men to have much knowledge of this subject. His knowledge of the phenomena of menstruation was as wide and definite. He knew a great deal of how to treat its disturbances. He seems to have been the first one to suggest that in metrorrhagia, with severe hemorrhage from the uterus, the bleeding might be stopped by putting ligatures around the limbs. This same method has been suggested for severe hemorrhage from the lungs as well as from the uterus in our own time. In hysteria he also suggested ligature of the limbs, and it is easy to understand that this might be a very strongly suggestive treatment for the severer forms of hysteria. It is possible, too, that the modification of the circulation to the nervous system induced by the shutting off of the circulation in large areas of the body might very well have a favorable physical effect in this affection. Paul's description of the use of the speculum is as complete as that in any modern text-book of gynæcology. FURTHER CHRISTIAN PHYSICIANS Another distinguished Christian medical scientist was Theophilus Protosbatharius, who belonged to the court of the Greek Emperor Heraclius, in the seventh century. He seems to have had a life very full of interest and surprisingly varied duties. He was a bishop, and, at the same time, commander of the imperial bodyguard, and the author of a little work on the fabric of the human body. The most surprising chapter in the history of the book is that for some two centuries, in quite modern times, it was used as a text-book of anatomy at the University of Paris. It was printed in a number of editions early in the history of printing, at least one very probably before 1500, and several later. There are very interesting phases of medicine delightfully surprising in their modernity to be found here and there in many of these early Christian writers on medicine. For instance, in a compend of medicine written by one Leo, who, under the Emperor Theophilus, seems to have been a prominent physician of Byzantium (the compend was written for a young physician just beginning practice), we find the following classification of hydrops or abdominal dilatation: "There are three kinds; the first is ascites, due to the presence of watery fluid, for which we do paracentesis; second, tympany, when the abdomen is swollen from the presence of air or gas. This may be differentiated by percussion of the belly. When air is present the sound given forth is like that of a drum, while in the first form ascites the sound is like that from a sack [the word used is the same as for a wine sack]; the third form is called anasarca, when the whole body swells." It has often been the subject of misunderstanding as to why medicine should have developed among the Latin Christian nations so much more slowly than among the Arabs during the early Middle Ages. Anyone who knows the conditions in which Christianity came into existence in Italy will not be surprised at that. The Arabs in the East were in contact with Greek thought, and that is eminently prolific and inspiring. At the most, the Christians in Italy got their inspiration at second hand through the Romans. The Romans themselves, in spite of intimate contact with Greek physicians, never made any important contributions to medical science, nor to science of any kind. Their successors, the Christians of Rome and Italy, then could scarcely be expected to do better, hampered especially, as they were, by the trying social conditions created by the invasion of the barbarians from the North. Whenever the Christians were in contact with Greek thought and Greek medicine, above all, as at Alexandria, or in certain of the cities of the near East, we have distinguished contributions from them. ARABIAN CHRISTIAN PHYSICIANS That this is not a partial view suggested by the desire to make out a better case for Christianity in its relation to science will be very well understood, besides, from the fact that a number of the original physicians of Arab stock who attracted attention during the first period of Arabian medicine, that is, during the eighth and ninth centuries, were Christians. There are a series of physicians belonging to the Christian family Bachtischua, a name which is derived from Bocht Jesu, that is, servant of Jesus, who, from the middle of the eighth to the middle of the eleventh century, acquired great fame. The first of them, George (Dschordschis), after acquiring fame elsewhere, was called to Bagdad by the Caliph El-Mansur, where, because of his medical skill, he reached the highest honors. His son became the body-physician of Harun al-Raschid. In the third generation Gabriel (Dschibril) acquired fame and did much, as had his father and grandfather, for the medicine of the time, by translations of the Greek physicians into Arabian. These men may well be said to have introduced Greek medicine to the Mohammedans. It was their teaching that aroused Moslem scholars from the apathy that had characterized the attitude of the Arabian people toward science at the beginning of Mohammedanism. As time went on, other great Christian medical teachers distinguished themselves among the Arabs. Of these the most prominent was Messui the elder, who is also known as Janus Damascenus. Both he and his father practised medicine with great success in Bagdad, and his son became the body-physician to Harun al-Raschid either after or in conjunction with Gabriel Bachtischua. Like his colleague or predecessor in official position, he, too, made translations from the Greek into Arabic. Another distinguished Arabian Christian physician was Serapion the elder. He was born in Damascus, and flourished about the middle of the ninth century. He wrote a book on medicine called the "Aggregator," or "Breviarium," or "Practica Medicinæ," which appeared in many printed editions within the century after the invention of printing. During the ninth century, also, we have an account of Honein Ben Ischak, who is known in the West as Johannitius. After travelling much, especially in Greece and Persia, he settled in Bagdad, and, under the patronage of the Caliph Mamum, made many translations. He translated most of the old Greek medical writers, and also certain of the Greek philosophic and mathematical works. The accuracy of his translations became a proverb. His compendium of Galen was the text-book of medicine in the West for many centuries. It was known as the "Isagoge in Artem Parvam Galeni." His son, Ishac Ben Honein, and his nephew, Hobeisch, were also famous as medical practitioners and translators. Still another of these Arabian Christians, who acquired a reputation as writers in medicine, was Alkindus. He wrote with regard to nearly everything, however, and so came to be called the philosopher. He is said altogether to have written and translated about two hundred works, of which twenty-two treat of medicine. He was a contemporary of Honein Ben Ischak in the ninth century. Another of the great ninth-century Christian physicians and translators from the Greek was Kostaben Luka. He was of Greek origin, but lived in Armenia and made translations from Greek into Arabic. Nearly all of these men took not alone medical science, but the whole round of physical science, for their special subject. A typical example in the ninth century was Abuhassan Ben Korra, many of whose family during succeeding generations attracted attention as scholars. He became the astronomer and physician of the Caliph Motadhid. His translations in medical literature were mainly excerpts from Hippocrates and Galen meant for popular use. These Christian translators, thoroughly scientific as far as their times permitted them to be, were wonderfully industrious in their work as translators, great teachers in every sense of the word, and they are the men who formed the traditions on which the greater Arabian physicians from Rhazes onward were educated. It would be easy to think that these men, occupied so much with translations, and intent on the re-introduction of Greek medicine, might have depended very little on their own observations, and been very impractical. All that is needed to counteract any such false impression, however, is to know something definite about their books. Gurlt, in his "History of Surgery," has some quotations from Serapion the elder, who is often quoted by Rhazes. In the treatment of hemorrhoids Serapion advises ligature and insists that they must be tied with a silk thread or with some other strong thread, and then relief will come. He says some people burn them _medicinis acutis_ (touching with acids, as some do even yet), and some incise them with a knife. He prefers the ligature, however. He calmly discusses the removal of stones from the kidney by incision of the pelvis of the kidney through an opening in the loin. He considers the operation very dangerous, however, but seems to think the removal of a stone from the bladder a rather simple procedure. His description of the technique of the use of a catheter and of a stylet with it, and apparently also of a guide for it in difficult cases, is extremely interesting. He suggests the opening of the bladder in the median line, midway between the scrotum and the anus, and the placing of a canula therein, so as to permit drainage until healing occurs. Even this brief review of the careers and the writings of the physicians of early Christian times shows how well the tradition of old Greek medicine was being carried on. There was much to hamper the cultivation of science in the disturbances of the time, the gradual breaking up of the Roman Empire, and the replacement of the peoples of southern Europe by the northern nations, who had come in, yet in spite of all this, medical tradition was well preserved. The most prominent of the conservators were themselves men whose opinions on problems of practical medicine were often of value, and whose powers of observation frequently cannot but be admired. There is absolutely no trace of anything like opposition to the development of medical science or medical practice, but, on the contrary, everywhere among political and ecclesiastical authorities, we find encouragement and patronage. The very fact that, in the storm and stress of the succeeding centuries, manuscript copies of the writings of the physicians of this time were preserved for us in spite of the many vicissitudes to which they were subjected from fire, and war, and accidents of various kinds for hundreds of years, until the coming of printing, shows in what estimation they were held. During this time they owed their preservation to churchmen, for the libraries and the copying-rooms were all under ecclesiastical control. III GREAT JEWISH PHYSICIANS[3] Any account of Old-Time Makers of Medicine without a chapter on the Jewish Physicians would indeed be incomplete. They are among the most important factors in medieval medicine, representing one of the most significant elements of medical progress. In spite of the disadvantages under which their race labored because of the popular feeling against them on the part of the Christians in the earlier centuries and of the Mohammedans later, men of genius from the race succeeded in making their influence felt not only on their own times, but accomplished so much in making and writing medicine as to influence many subsequent generations. Living the segregated life that as a rule they had to, from the earliest times (the Ghettos have only disappeared in the nineteenth century), it would seem almost impossible for them to have done great intellectual work. It is one of the very common illusions, however, that great intellectual work is accomplished mainly in the midst of comfortable circumstances and as the result of encouraging conditions. Most of our great makers of medicine at all times, and never more so than during the past century, have been the sons of the poor, who have had to earn their own living, as a rule, before they reached manhood, and who have always had the spur of that necessity which has been so well called the mother of invention. Their hard living conditions probably rather favored than hampered their intellectual accomplishments. It is not unlikely that the difficult personal circumstances in which the Jews were placed had a good deal to do at all times with stimulating their ambitions and making them accomplish all that was in them. Certain it is that at all times we find a wonderful power in the people to rise above their conditions. With them, however, as with other peoples, luxury, riches, comfort, bring a surfeit to initiative and the race does not accomplish so much. At various times in the early Middle Ages, particularly, we find Jewish physicians doing great work and obtaining precious acknowledgment for it in spite of the most discouraging conditions. Later it is not unusual to find that there has been a degeneration into mere money-making as the result of opportunity and consequent ease and luxury. At a number of times, however, both in Christian and in Mohammedan countries, great Jewish physicians arose whose names have come to us and with whom every student of medicine who wants to know something about the details of the course of medical history must be familiar. There are men among them who must be considered among the great lights of medicine, significant makers always of the art and also in nearly all cases of the science of medicine. A little consideration of the history of the Jewish people and their great documents eliminates any surprise there may be with regard to their interest in medicine and successful pursuit of it during the Middle Ages. The two great collections of Hebrew documents, the Old Testament and the Talmud, contain an immense amount of material with reference to medical problems of many kinds. Both of these works are especially interesting because of what they have to say of preventive medicine and with regard to the recognition of disease. Our prophylaxis and diagnosis are important scientific departments of medicine dependent on observation rather than on theory. While therapeutics has wandered into all sorts of absurdities, the advances made in prophylaxis and in diagnosis have always remained valuable, and though at times they have been forgotten, re-discovery only emphasizes the value of preceding work. It is because of what they contain with regard to these two important medical subjects that the Old Testament and the Talmud are landmarks in the history of medicine as well as of religion. Baas, in his "Outlines of the History of Medicine," says: "It corresponds to the reality in both the actual and chronological point of view to consider the books of Moses as the foundation of sanitary science. The more we have learned about sanitation in the prophylaxis of disease and in the prevention of contagion in the modern time, the more have we come to appreciate highly the teachings of these old times on such subjects. Moses made a masterly exposition of the knowledge necessary to prevent contagious disease when he laid down the rules with regard to leprosy, first as to careful differentiation, then as to isolation, and finally as to disinfection after it had come to be sure that cure had taken place. The great lawgiver could insist emphatically that the keeping of the laws of God not only was good for a man's soul but also for his body." With this tradition familiarly known and deeply studied by the mass of the Hebrew people, it is no surprise to find that when the next great Hebrew development of religious writing came in the Talmud during the earlier Middle Ages, that also contains much with regard to medicine, not a little of which is so close to absolute truth as never to be out of date. Friedenwald, in his "Jewish Physicians and the Contributions of the Jews to the Science of Medicine," a lecture delivered before the Gratz College of Philadelphia fifteen years ago, summed up from Baas' "History of Medicine" the instructions in the Talmud with regard to health and disease. The summary represents so much more of genuine knowledge of medicine and surgery than might be expected at the early period at which it was written, during the first and second century of our era, that it seems well to quote it at some length. "Fever was regarded as nature's effort to expel morbific matter and restore health; which is a much safer interpretation of fever, from a practical point of view, than most of the theories bearing on this point that have been taught up to a very recent period. They attributed the halting in the hind legs of a lamb to a callosity formed around the spinal cord. This was a great advance in the knowledge of the physiology of the nervous system. An emetic was recommended as the best remedy for nausea. In many cases no better remedy is known to-day. They taught that a sudden change in diet was injurious, even if the quality brought by the change was better. That milk fresh from the udder was the best. The Talmud describes jaundice and correctly ascribes it to the retention of bile, and speaks of dropsy as due to the retention of urine. It teaches that atrophy or rupture of the kidneys is fatal. Induration of the lungs (tuberculosis) was regarded as incurable. Suppuration of the spinal cord had an early, grave meaning. Rabies was known. The following is a description given of the dog's condition: 'His mouth is open, the saliva issues from his mouth; his ears drop; his tail hangs between his legs; he runs sideways, and the dogs bark at him; others say that he barks himself, and that his voice is very weak. No man has appeared who could say that he has seen a man live who was bitten by a mad dog.' The description is good, and this prognosis as to hydrophobia in man has remained unaltered till in our day when Pasteur published his startling revelation. The anatomical knowledge of the Talmudists was derived chiefly from dissection of the animals. As a very remarkable piece of practical anatomy for its very early date is the procuring of the skeleton from the body of a prostitute by the process of boiling, by Rabbi Ishmael, a physician, at the close of the first century. He gives the number of bones as 252 instead of 232. The Talmudists knew the origin of the spinal cord at the foramen magnum and its form of termination; they described the oesophagus as being composed of two coats; they speak of the pleura as the double covering of the lungs; and mention the special coat of fat about the kidneys. They had made progress in obstetrics; described monstrosities and congenital deformities; practised version, evisceration, and Cæsarian section upon the dead and upon the living mother. A.H. Israels has clearly shown in his 'Dissertatio Historico-Medica Inauguralis' that Cæsarian section, according to the Talmud, was performed among the Jews with safety to mother and child. The surgery of the Talmud includes a knowledge of dislocation of the thigh bone, contusions of the skull, perforation of the lungs, oesophagus, stomach, small intestines, and gall bladder; wounds of the spinal cord, windpipe, of fractures of the ribs, etc. They described imperforate anus and how it was to be relieved by operation. Chanina Ben Chania inserted natural and wooden teeth as early as the second century, C.E." There is a famous summing up of the possibilities of life and happiness in the Talmud that has been often quoted--its possible wanting in gallantry being set down to the times in which it was written. "Life is compatible with any disease, provided the bowels remain open; any kind of pain, provided the heart remain unaffected; any kind of uneasiness, provided the head is not attacked; all manner of evils, except it be a bad woman." There are many other interesting suggestions in the Talmud. Sometimes they have come to be generally accepted in the modern time, sometimes they are only curious notions that have not, however, lost all their interest. The crucial incision for carbuncle is a typical example of the first class and the suggestion of the removal of superfluous fat from within the abdomen or in the abdominal wall itself by operation is another. That they had some idea of the danger of sepsis may be gathered from the fact that they suspected iron surgical instruments and advised the use of others of less enduring character. The Talmud itself was indeed a sort of encyclopedia in which was gathered knowledge of all kinds from many sources. It was not particularly a book of medicine, though it contains so many medical ideas. In many parts of it the authors' regard for science is emphatically expressed. Landau, in his "History of Jewish Physicians," closes his account of the Talmud with this paragraph: "I conclude this brief review of Talmudic medicine with some reference to how high the worth of science was valued in this much misunderstood work. In one place we have the expression 'occupation with science means more than sacrifice.' In another 'science is more than priesthood and kingly dignity.'"[4] After all this of national tradition in medicine before and after Christ, it is only what we might quite naturally expect to find, that there is scarcely a century of the Middle Ages which does not contain at least one great Jewish physician and sometimes there are more. Many of these men made distinct contributions to medical science and their names have been held in high estimation ever since. Perhaps I should say that they were held in high estimation until that neglect of historical studies which characterized the eighteenth century developed, and that there has been a reawakening of interest in our time. We forget this curious decadence of the later seventeenth and eighteenth centuries which did so much to obscure history and especially the history of the sciences. Fortunately the scholars of the sixteenth and early seventeenth centuries accomplished successfully the task of printing many of the books of these old-time physicians and secured their publication in magnificent editions. These were bought eagerly by scholars and libraries all over Europe in spite of the high price they commanded in that era of slow, laborious printing. The Renaissance exhibits some of its most admirable qualities in its reverence for these old workers in science and above all for the careful preparation by its scholars of the text of these first editions of old-time physicians. The works have often been thus literally preserved for us, for some of them at least would have disappeared among the vicissitudes of the intervening time, most of which was anything but favorable to the preservation of old-time works, no matter what their content or value. During the second and third centuries of our era, while the Talmudic writings were taking shape, three great Jewish physicians came into prominence. The first of them, Chanina, was a contemporary of Galen. According to tradition, as we have said, he inserted both natural and artificial teeth before the close of the second century. The two others were Rab or Raw and Samuel. Rab has the distinction of having studied his anatomy from the human body. According to tradition he did not hesitate to spend large sums of money in order to procure subjects for dissection. At this time it is very doubtful whether Galen, though only of the preceding generation, ever had the opportunity to study more than animals or, at most, a few human bodies. Samuel, the third of the group, was an intimate friend of Rab's, perhaps a disciple, and his fame depends rather on his practice of medicine than of research in medical science. He was noted for his practical development of two specialties that cannot but seem to us rather distant from each other. His reputation as a skilful obstetrician was only surpassed by the estimation in which he was held as an oculist. He seems to have turned to astronomy as a hobby, and was highly honored for his knowledge of this science. Probably there is nothing commoner in the story of great Jewish physicians than their successful pursuit of some scientific subject as a hobby and reaching distinction in it. Their surplus intellectual energy needed an outlet besides their vocation, and they got a rest by turning to some other interest, often accomplishing excellent results in it. Like most great students with a hobby, the majority of them were long-lived. Their lives are a lesson to a generation that fears intellectual overwork. During the fourth century we have a number of very interesting traditions with regard to a great Jewish physician, Abba Oumna, to whom patients flocked from all over the world. He seems particularly to have been anxious to make his services available to the scholars of his time. He looked upon them as brothers in spirit, fellow-laborers whose investigations were as important as his own and whose labors for mankind he hoped to extend by the helpfulness of his profession. In order that it might be easy for them to come to him without feeling abashed by their poverty, and yet so that they might pay him anything that they thought they were able to, he hung up a box in his anteroom in which each patient might deposit whatever he felt able to give. His kindliness towards men became the foundation for many legends. Needless to say he was often imposed upon, but that seems to have made no difference to him, and he went on straightforwardly doing what he thought he ought to do, regardless of the devious ways of men, even those whom he was generously assisting. While we do not know much of his scientific medicine, we do know that he was a fine example of a practitioner of medicine on the highest professional lines. With the foundation of the school at Djondisabour in Arabistan or Khusistan by the Persian monarch Chosroes, some Jewish physicians come into prominence as teachers, and this is one of the first important occasions in history when they teach side by side with Christian colleagues. Djondisabour seems distant from us now, lying as it does in the province just above the head of the Persian Gulf, and it is a little hard to understand its becoming a centre of culture and education, yet according to well-grounded historical traditions students flocked here from all parts of the world, and its medical instruction particularly became famous. According to the documents and traditions that we possess, clinical teaching was the most significant feature of the school work and made it famous. As a consequence graduates from here were deemed fully qualified to become professors in other institutions and were eagerly sought by various medical schools in the East. With the rise of the strong political power of the Mohammedans enough of peace came to the East at least to permit the cultivation of arts and sciences to some extent again, and then at once the eminence of Jewish physicians, both as teachers and practitioners of medicine, once more becomes manifest. The first of the race who comes into prominence is Maser Djawah Ebn Djeldjal, of Basra. To him we owe probably more than to anyone else the preservation of old scientific writings and the cultivation of arts and sciences by the Mohammedans. He prevailed on Caliph Moawia I, whose physician he had become, to cause many foreign works, and especially those written in Greek, to be translated into Arabic. He seems to have taken a large share of the labor of the translation on himself and prevailed upon his pupil, the son of Moawia, to translate some works on chemistry. The translation for which Maser Djawah is best known is that of the Pandects of Haroun, a physician of Alexandria. The translation of this work was made toward the end of the seventh century. Unfortunately the "Pandects" has not come down to us, either in original or translation, but we have fragments of the translation preserved by Rhazes, the distinguished Arabian medical writer and physician of the ninth century, and there seems no doubt that it contained the first good description of smallpox, a chapter in medicine that is often--though incorrectly--attributed to Rhazes himself. Rhazes quoted Maser Djawah freely and evidently trusted his declarations implicitly. The succeeding Caliphs of the first Arabian dynasty did not exhibit the same interest in education, and above all in science, that characterized Moawia. Political ambition and the desire for military glory seem to have filled up their thoughts and perhaps they had not the good fortune to fall under the influence of physicians so wise and learned as Maser Djawah. More probably, however, they themselves lacked interest. Toward the end of the seventh century they were succeeded by the Abbassides. Almansor, the second Caliph of this dynasty, was attacked by a dangerous disease and sent for a physician of the Nestorian school. After his restoration to health he became a liberal patron of science and especially medical science. The new city of Bagdad, which had become the capital of the realm of the Abbassides, was enriched by him with a large number of works on medicine, which he caused to be translated from the Greek. He did not confine himself to medicine, however, but also brought about translations of works with regard to other sciences. One of these, astronomy, was a favorite. He made it a particular point to search out and encourage the translation of such books as had not previously been translated from Greek into Arabic. While he provided a translation of Ptolemy he also had translations made of Aristotle and Galen. It is not surprising, then, that the school of Bagdad became celebrated. Jewish physicians seem to have been most prominent in its foundation, and the most distinguished product of it is Isaac Ben Emran, almost as celebrated as a philosopher as he is as a physician. One of his expressions with regard to the danger of a patient having two physicians whose opinions disagree with regard to his illness has been deservedly preserved for us. Zeid, an Emir of one of the chief cities of the Arabs in Barbary, fell ill of a tertian fever and called Isaac and another physician in consultation. Their opinions were so widely in disaccord that Isaac refused to prescribe anything, and when the Emir, who had great confidence in him, demanded the reason, he replied, "disagreement of two physicians is more deadly than a tertian fever." This Isaac, who is said to have died in 799, is the great Jewish physician, one of the most important members of the profession in the eighth century. His principal work was with regard to poisons and the symptoms caused by them. This is often quoted by medical writers in the after time. The prominent Jewish physician of the ninth century was Joshua Ben Nun. Haroun al-Raschid, whose attempts to secure justice for his people are the subject of so much legendary lore, and whose place in history may be best recalled by the fact that he is a contemporary of Charlemagne, was particularly interested in medicine. He founded the city of Tauris as a memorial of the cure of his wife. He was a generous patron of the school of Djondisabour and established a medical school also at Bagdad. He provided good salaries for the professors, insisted on careful examinations, and raised the standard of medical education for a time to a noteworthy degree. The greatest teacher of this school at Bagdad was Joshua Ben Nun, sometimes known as the Rabbi of Seleucia. His teaching attracted many students to Bagdad and his fame as one of the great practitioners of medicine of this time brought many patients. Among his disciples was John Masuée, whose Arabian name is so different, Yahia Ben Masoviah, that in order to avoid confusion in reading it is important to know both. Almost better known, perhaps, at this time was Abu Joseph Jacob Ben Isaac Kendi. Fortunately for the after time, these men devoted themselves not only to their own observations and writings but made a series of valuable translations. Joshua Ben Nun seems to have been particularly zealous in this matter, following the example of Maser Djawah of Basra. Bagdad then became a centre for Arabian culture. Mahmoud, one of Haroun's successors, provided in Bagdad a refuge for the learned men of the East who were disturbed by the wars and troubles of the time. He became a liberal patron of literature and education. When the Emperor Michael III of Constantinople was conquered in battle, one of the obligations imposed upon him was to send many camel loads of books to Bagdad, and Aristotle and Plato were studied devotedly and translated into Arabic. The era of culture affected not only the capital but all the cities, and everywhere throughout the Arabian empire schools and academies sprang up. We have records of them at Basra, Samarcand, Ispahan. From here the thirst for education spread to the other cities ruled by the Mohammedans, and each town became affected by it. Alexandria, the cities of the Barbary States, those of Sicily and Provence, where Moorish influences were prominent, and of distant Spain, Cordova, Seville, Toledo, Granada, Saragossa, all took up the rivalry for culture which made this a glorious period in the history of the intellectual life. Already, in the chapter on "Great Physicians in Early Christian Times," I have pointed out that many of the teachers of the Arabs were Christian physicians. Here it is proper to emphasize the other important factor in Arabian medicine, the Jewish physicians, who influenced the great Arabian rulers, and were the teachers of the Arabs in medicine and science generally. These Christian and Jewish physicians particularly encouraged the translation of the works of the great Greek physicians and thus kept the Greek medical tradition from dying out. It is not until the end of the ninth, or even the beginning of the tenth, century that we begin to have important contributors to medicine from among the Arabs themselves. Even at this time they have distinguished rivals among Jewish physicians. Indeed these acquired such a reputation that they became the physicians to monarchs and even high ecclesiastics, and we find them nearly everywhere throughout Europe. Their success was so great that it is not surprising that after a time the vogue of the Jewish physicians should have led to jealousy of them and to the passage of laws and decrees limiting their sphere of activity. The great Jewish physician of the ninth century was Isaac Ben Soliman, better known as Isaac el Israili, and who is sometimes spoken of as d'Israeli. He was a pupil of Isaac Ben Amram the younger, probably a grandson of another Isaac Ben Amram, who, after having become famous in Bagdad, went to Cairo and became the physician of the Emir Zijadeth III. The younger Isaac established a school, and it was with him that Israeli obtained his introduction to medicine. He practised first as an oculist and then became body-physician to the Sultan of Morocco. Because of the sympathy of his character and his unselfishness he acquired great popularity. Hyrtl refers to him respectfully as "that scholarly son of Israel." Curiously enough, considering racial feeling in the matter, he never married, and when asked why he had not, and whether he did not think that he might regret it, he replied, "I have written four books through which my memory will be better preserved than it would be by descendants." The four books are his "Treatise on Fevers," his "Treatise on Simple Medicines and Ailments," a treatise on the "Elements," and a treatise "On the Urine." Besides these, we have from him shorter works, "On the Pulse," "On Melancholy," and "On Dropsy." His hope with regard to his fame from these works was fulfilled, for they were printed as late as 1515 at Leyden, and Sprengel declared them the best compendium of simple remedies and diet that we have from the Arabian times. One of his translators into Latin has called him the monarch of physicians. Some of his maxims are extremely interesting in the light of modern notions on the same subjects. He declared emphatically that "the most important duty of the physician is to prevent illness." "Most patients get better without much help from the physician by the power of nature." He emphasized his distrust of using many medicines at the same time in the hope that some of them would do good. He laid it down as a rule: "Employ only one medicine at a time in all your cases and note its effects carefully." He was as wise with regard to medical ethics as therapeutics. He advised a young physician, "Never speak unfavorably of other physicians. Every one of us has his lucky and unlucky hours." It is pleasant to learn that the old gentleman lived to fill out a full hundred years of life, and that in his declining years he was surrounded by the good will and the affection of many who had learned to know his precious qualities of heart and mind. More than of any other class of physicians do we find the large human sympathies of the Jewish physicians of the Middle Ages praised by their contemporaries and succeeding generations. During the next centuries a number of Jewish physicians became prominent, though none of them until Maimonides impressed themselves deeply upon the medical life of their own and succeeding centuries. Very frequently they were the physicians to royal personages. Zedkias, for instance, was the physician to Louis the Pious and later to his son Charles the Bald. His reputation as a physician was great enough to give him the popular estimation of a magician, but it did not save him from the accusation of having poisoned Charles when that monarch died suddenly. There seem to be no good grounds, however, for the accusation. There were a number of schools of medicine, in Sicily and the southern part of Italy, in which Jewish, Arabian, and Christian physicians taught side by side. One of these teachers was Jude Sabatai Ben Abraham, usually known by the name of Donolo, who was famous both as a writer on medicine and on astronomy. Donolo studied and probably taught at Tarentum, and there were similar schools at Palermo, at Bari, and then later on the mainland at Salerno. The foundation of Salerno, in which Jewish physicians also took part, we shall discuss later in the special chapter devoted to that subject. One of the great translators whose work meant very much for the medical science of his own and succeeding generations was the distinguished Jewish physician, Faradj Ben Salim, sometimes spoken of as Farachi Faragut or Ferrarius, who was born at Girgenti in Sicily. He made his medical studies in Salerno and did his work under the patronage of Charles of Anjou towards the end of the thirteenth century. His greatest work is the translation of the whole of the "Continens" of Rhazes. The translation is praised as probably the best of its time made in the Middle Ages. Faradj came at the end of a great century, when the intellectual life of Europe had reached a high power of expression, and it is not surprising that he should have proved equal to his environment. This translation has also some additions made by Faradj himself, notably a glossary of Arabian names. In Spain also Jewish physicians rose to distinction. The most distinguished in the tenth century was Chasdai Ben Schaprut. Like many other of the great physicians of this time, he had studied astronomy as well as the medical sciences. He became the physician of the Caliph Abd-er-Rahman III of Cordova. He seems also to have exercised some of the functions of Prime Minister to the Caliph, and took advantage of diplomatic relations between his sovereign and the Byzantine Emperor to obtain some works of Dioscorides. These he translated into Arabian with the help of a Greek monk, whom he seems also to have secured through the diplomatic relations. Undoubtedly he did much to usher in that enthusiasm for education and study which characterized the next centuries, the eleventh and twelfth, at Cordova in Spain, when such men as Avenzoar, Avicenna, and Averroës attracted the attention of the educational world of the time. Jewish writers have sometimes claimed one of the most distinguished of these, Avenzoar himself, as a Jew, but Hyrtl and other good authorities consider him of Arabic extraction and point to the fact that his ancestors bore the name of Mohammed. This is not absolutely conclusive evidence, but because of it I have preferred to class Avenzoar among the Arabian physicians. The one historical fact of importance for us is that everywhere in Europe at that time Jews were being accorded opportunities for the study and practice of medicine. There are local incidents of persecution, but we are not so far away from the feelings that brought these about as to misunderstand them or to think that they were anything more than local, popular manifestations. The more we know about the details of the medical history of these times the deeper is the impression of academic freedom and of opportunities for liberal education. Much has been said about the intolerance of ecclesiastical authorities toward the Jews, and of Church decrees that either absolutely forbade their practice of the medical profession and their devotion to scientific study, or at least made these pursuits much more difficult for them than for others. Of course it has to be conceded, even by those who most insistently urge the existence of formal legislation in the matter, that in spite of these decrees and intolerance and opposition, Jews continued to practise medicine and to be the chosen physicians of kings and even of high ecclesiastical dignitaries, as well indeed of the Popes themselves. This, it is usually declared, must be attributed to the surpassing skill of the Jewish physicians, causing men to overcome their prejudices and override even their own legal regulations. There is no doubt at all about the skill of Jewish physicians at many times during the Middle Ages. There is no doubt also of the sentiment of opposition that often developed between the Christian peoples and the Jews. Any excuse is good enough to justify men, to themselves at least, in putting obstacles in the paths of those who are more successful than they are themselves. Religion often became a cloak for ill-will and persecution. The state of affairs that has been presumed however, according to which laws and decrees were being constantly issued forbidding the practice of medicine to Jews by the ecclesiastical authorities, while at the same time they themselves and those who were nearest to them were employing Jewish physicians, is an absurdity that on the face of it calls for investigation of the conditions and from its very appearance would indicate that the ordinary historical assumption in the matter must be wrong. I have been at some pains, then, to try to find out just what were the conditions in Europe with regard to the practice of medicine by the Jews. There is no doubt that at Salerno, where the influence of the Benedictines was very strong and where the influence of the Popes and the ecclesiastical authorities was always dominant, full liberty of studying and teaching was from the earliest days allowed to the Jews. Down at Montpellier it seems clear that Jewish physicians had a large part in the foundation of the medical school, and continued for several centuries to be most important factors in the maintenance of its reputation and the upbuilding of that fame which draw students from even distant parts of Europe to this medical school of the south of France. During the ninth, tenth, eleventh, and twelfth centuries Jewish physicians were frequently in attendance on kings and the higher nobility, on bishops and archbishops, cardinals, and even Popes. Every now and then the spirit of intolerance among the populace was aroused, and occasionally the death of some distinguished patient while in a Jewish physician's hands was made the occasion for persecution. We must not forget, after all, that even as late as Elizabeth's time, when Shakespeare wrote "The Merchant of Venice," he was taking advantage of the popular sentiment aroused by the execution of Lopez, the Queen's physician, for a real or supposed participation in a plot against her Majesty's life. Shylock was presented the next season for the sake of adventitious popularity that would thus accrue to the piece. The character was played so as to depict all the worst traits of the Jew, and was scornfully laughed at at every representation. This is an index of the popular feeling of the time. Bitter intolerance of the Jew has continued. Down almost to our own time the Ghettos have existed in Europe, and popular tumults against them continue to occur. Quite needless to say, these do not depend on Christianity, but on defective human nature. During the Middle Ages the best possible criterion of the attitude of the Church authorities towards the Jews is to be found in the legislation of Pope Innocent III. He is the greatest of the Popes of the Middle Ages; he shaped the policy of the Church more than any other; his influence was felt for many generations after his own time. His famous edict with regard to them was well known: "Let no Christian by violence compel them to come dissenting or unwilling to Baptism. Further, let no Christian venture maliciously to harm their persons without a judgment of the civil power or to carry off their property or change their good customs which they have hitherto in that district which they inhabit." Innocent himself and several of his predecessors and successors are known to have had Jewish physicians. Example speaks even louder than precept, and the example of such men must have been a wonderful advertisement for the Jewish physicians of the time. Besides Innocent III, many of the Popes of the twelfth and thirteenth centuries issued similar decrees as to the Jews. It may be recalled that this was the time when the Papacy was most powerful in Europe and when its decrees had most weight in all countries. Alexander II, Gregory IX, and Innocent IV all issued formal documents demanding the protection of the Jews, and especially insisting that they must not be forced to receive Baptism nor disturbed in the celebration of their festivals. Clement VI did the same thing in the next century, and even offered them a refuge from persecution throughout the rest of France at Avignon. Distinguished Jewish scholars, who know the whole story from careful study, have given due credit to the Popes for all that they did for their people. They have even declared that if the Jews were not exterminated in many of the European countries it was because of the protection afforded by the Church. We have come to realize in recent years that persecution of the Jews is not at all a religious matter, but is due to racial prejudice and jealousy of their success by the peoples among whom they settle. All sorts of pretexts are given for this persecution at all times. Formal Church documents and the personal activities of the responsible Church officials show that during the Middle Ages the Church was a protector and not a persecutor of the Jews. There is abundant historical authority for the statement that the Popes were uniformly beneficent in their treatment of the Jews. In order to demonstrate this there is no need to quote Catholic historians, for non-Catholics have been rather emphatic in bringing it out. Neander, the German Protestant historian, for instance, said: "It was a ruling principle with the Popes after the example of their great predecessor, Gregory the Great, to protect the Jews in the rights which had been conceded to them. When the banished Popes of the twelfth century returned to Rome, the Jews went forth in their holiday garments to meet them, bearing before them the 'thora,' and Innocent II, on an occasion of this sort, blessed them." English non-Catholic historians can be quoted to the same effect. The Anglican Dean Milman, for instance, said: "Of all European sovereigns, the Popes, with some exceptions, have pursued the most humane policy towards the Jews. In Italy, and even in Rome, they have been more rarely molested than in the other countries." Hallam has expressed himself to the same effect, especially as regards the protection afforded to the Jew by the laws of the Church from the injustice of those around him. Laws sometimes fail of their purpose and the persecuting spirit of the populace is often hard to control, but everything that the central authority could do to afford protection was done and essential justice was enshrined in the Church laws. Prominent ecclesiastics would naturally follow the lines laid down by their Papal superiors. The attitude of those whose lives mark epochs in the history of Christianity and who had more to do almost with the shaping of the policy of the Church at many times than the Popes themselves, can be quoted readily to this same effect. Neander has called particular attention to St. Bernard's declarations with regard to the evils that would follow any tolerance of such an abuse as the persecution of the Jews. "The most influential men of the Church protested against such un-Christian fanaticism. When the Abbot Bernard of Clairvaux was rousing up the spirit of the nations to embark in the second crusade, and issued for this purpose, in the year 1146, his letters to the Germans (East Franks), he at the same time warned them against the influence of those enthusiasts who strove to inflame the fanaticism of the people. He declaimed against the false zeal, without knowledge, which impelled them to murder the Jews, a people who ought to be allowed to live in peace in the country." But it has been said that there are decrees against Jewish physicians, issued especially in the south of France, by various councils and synods of the Church. Attention needs to be called at once to the fact that these are entirely local regulations and have nothing to do with the attitude of the Church as a whole, but represent what the ecclesiastical authorities of a particular part of the country deem necessary for some special reason in order to meet local conditions. Indeed at the end of the thirteenth and the early fourteenth century, when these decrees were being issued in France, full liberty was allowed in Italy, and there were no restrictions either as to medical practice or education founded on adhesion to Judaism. What need to be realized in order to understand the issuance of certain local ecclesiastical regulations forbidding Jews to practise medicine are the special conditions which developed in France at this time. Many Jews had emigrated from Spain to France, and the reputation acquired by Jewish physicians at Montpellier led to a number of the race taking up the practice of medicine without any further qualification than the fact that they were Jews. That gave them a reputation for curative powers of itself because of the fame of some Jewish doctors and their employment by the nobility and the highest ecclesiastics. It was hard to regulate these wandering physicians. As a consequence of this, the faculty at Paris, always jealous of its own rights and those of its students, at the beginning of the fourteenth century absolutely forbade Jews from practising on Christian patients within its jurisdiction. Of course the faculty of the University of Paris was dominated by ecclesiastical authorities. The medical school was, however, almost entirely independent of ecclesiastical influence, and was besides largely responsible for this decree. It was felt that something had to be done to stop the evil that had arisen and the charlatanry and quackery which was being practised. This was, however, rather an attempt to regulate the practice of medicine and keep it in the hands of medical school graduates than an example of intolerance towards the Jews. Practically no Jews had graduated at its university, Montpellier being their favorite school, and Paris was not a little jealous of its rights to provide for physicians from the northern part of France. We have not got away from manifestations of that spirit even yet, as our non-reciprocating state medical laws show. During the next quarter of a century decrees not unlike those of the University of Paris were issued in the south of France, especially in Provence and Avignon. Anyone who knows the conditions which existed in the south of France at this time with regard to medical practice will be aware that a number of attempts were made by the ecclesiastical authorities just at this time to regulate the practice of medicine. Great abuses had crept in. Almost anyone who wished could set up as a physician, and those who were least fitted were often best able to secure a large number of patients by their cleverness, their knowledge of men, and their smooth tongues. The bishops of various dioceses met, and issued decrees forbidding anyone from practising medicine unless he was a graduate of the medical school of the neighboring University of Montpellier. After a time it was found that the greatest number of violators of these decrees were Jews. Accordingly special regulations were made against them. They happen to be ecclesiastical regulations, because no other authority at that time claimed the right to regulate medical education and the practice of medicine. What is sure is that many Jewish physicians reached distinction under Christian as well as Arabian rulers at all times during the Middle Ages. It would be quite impossible in the limited space at command here to give any adequate mention of what was accomplished by these Jewish physicians, whose names we have scarcely been able to more than catalogue, nor of the place they hold in their times. As the physicians of rulers, their influence for culture and the cultivation of science was extensive, and as a rule they stood for what was best and highest in education. The story of one of them, who is generally known in the Christian world at least, Maimonides, given in some detail, may serve as a type of these Jewish physicians of the Middle Ages. He lived just before the flourishing period of university life in the thirteenth century brought about that wonderful development of medicine and surgery in the west of Europe that meant so much for the final centuries of the Middle Ages. His works influenced not a little the great thinkers and teachers whose own writings were to be the foundations of education for several centuries after their time. Maimonides was well known in the Western universities. Though his life had been mainly spent in the East, and he died there, there was scarcely a distinguished scholar of Europe who was not acquainted directly or indirectly with his works, and the greater the reputation of the scholar, as a rule, the more he knew of Maimonides, Moses Ægyptæus, as he was called, and the more frequently he referred to his writings. IV MAIMONIDES The life of one of the great Jewish physicians, who has come to be known in history as Maimonides, is of such significance in medical biography that he deserves to have a separate sketch. Born in Spain, his life was lived in the East, where his connection as royal physician with the great Sultan Saladin of Crusades fame made his influence widely felt. He is a type of the broadly educated man, conversant with the culture of his time and of the past, knowing much besides medicine, who has so often impressed himself deeply on medical practice. While the narrow specialists in each generation, the men who are quite sure that they are curing the special ills of men to which they devote themselves, have always felt that whatever of progress there was in any given time was due to them, they occupy but little space as a rule in the history of medicine. The men who loom large were the broad-minded, humanely sympathetic, deeply educated physicians, who treated men and their ills rather than their ills without due consideration of the individual, and who not only relieved the discomfort of their patients and greatly lessened human suffering, and added to the sum of human happiness in their time, but also left precious deeply significant lessons for succeeding generations of their profession. Hippocrates, Galen, Sydenham, Auenbrugger, Morgagni, these are representatives of this great class, and Maimonides must be considered one of them. Moses Ben Maimum, whose Arabic name was Abu Amran Musa Ben Maimum Obaid Alla el-Cordovi, who was called by his Jewish compatriots Ramban or Rambam, was born at Cordova in Spain, on the 30th of March in 1135 or 1139, the year is in doubt. It might not seem of much import now after nearly eight centuries, but not a little ink is spilt over it yet by devoted biographers. We are rather prone to think in our time that the conditions in which men were born and reared before what we are pleased to call modern times, and, above all, in the Middle Ages, must have made a distinct handicap for their intellectual development. Most of us are quite sure that the conditions in medieval cities were eminently unsuited for the stimulation of the intellect, for incentive to art impulse, for uplift in the intellectual life, or for any such broad interest in what has been so well called the humanities--the humanizing things that lift us above animal necessities--as would make for genuinely liberal education. We are likely to be set in the opinion that the environment of the growing youth of an old-time city, especially so early as the middle of the twelfth century, was poor and sordid. The cares of the citizens are presumed to have been mainly for material concerns, and, indeed, mostly for the wants of the body. They were only making a start on the way from barbarism to something like our glorious culmination of civilization. As "the heirs to all the ages in the foremost files of time" we are necessarily far in advance of them, and we are only sorry that they did not have the opportunity to live to see our day and enjoy the benefits of the evolution of humanity that is taking place during the eight centuries that have elapsed. As a matter of fact, there was much more of abiding profound interest in real civilization in many a medieval city, much more general appreciation of art, much more breadth of intelligence and sympathy with what we call the humanities, than in most of our large cities. The large city, as we know it, is eminently a discourager of breadth of intelligence. Specialism in the various phases of money-making obscures culture. Maimonides, born in Cordova, was brought up amid surroundings that teemed with incentives of every kind to the development of intelligence, of artistic taste, and everything that makes for cultivation of intellect rather than of interest in merely material things. It is well said that it is hard to judge the Cordova of old by its tawdry ruins of to-day. The educated visitor still stands in awe and admiration of the great mosque which expressed the high cultivation of the Moors of this time. It is a never-ending source of wonder to Americans. The city itself has many reminders of that fine era of Moorish culture and refinement of taste and of art expression, which made it in the best sense of the word a city beautiful. The Arab invaders had found a great prosperous country which had been the most cultured province of the Roman Empire, and on this foundation they made a marvellous development. "The banks of the Guadalquivir," says Mr. S. Lane-Poole in "The Moors in Spain" (London, 1887), "were bright with marble houses, mosques, and gardens, in which the rarest flowers and trees of other countries were carefully cultivated, and the Arabs introduced their system of irrigation which the Spaniards both before and since have never equalled." The greatest beauty of the city, of course, had come, and some of it had gone, before Maimonides' time. So much remains in spite of time and war, and many unfortunate influences, that we can have some idea how beautiful it must have been in his youth seven centuries ago, and how even more beautiful in the foretime. Of the great mosque writers of travel can scarcely say enough. Mr. Lane-Poole says: "Travellers stand amazed among the forest of columns which open out apparently endless vistas on all sides. The porphyry, jasper, and marbles are still in their places; the splendid glass mosaics, which artists from Byzantium came to make, still sparkle like jewels in the walls; the daring architecture of the sanctuary, with its fantastic crossed arches, is still as imposing as ever; the courtyard is still leafy with the orange trees that prolong the vistas of columns. As one stands before the loveliness of the great mosque, the thought goes back to the days of the glories of Cordova, the palmy days of the Great Khalif, which will never return." Of all the countries in which the Jews all down the centuries have lived there is probably none of which they have been more loud in praise than Spain. Their poets sang of it as if it were their own country; for centuries the people were happier here than probably they have been anywhere else for so long a period. Elsewhere in this book I have called attention to all that Spain meant in Europe during all the centuries from the beginning of the Roman Empire down to the end of the Middle Ages. Maimonides was fortunate in his birthplace, then, and while circumstances compelled the family to move away, this change did not come until a good effect had been produced on the mind of the growing youth. Even when persecution came, Maimonides clung to Spain with a tenacity born of deep affection and emphasized by admiration for all that she was and had been. Cordova was the jewel of the Spain of this time, and though much less than she had been in the long preceding time, when she was the birthplace of Lucan and the two Senecas, or even than what she had been in Abd-er-Rahman's days, or when she was the birthplace of Averroës, still she remained wonderfully beautiful and attractive, winning and holding the affections of men. Maimonides' father, Maimum Ben Joseph, was a member of the Rabbinical College of Cordova, and famous for his knowledge of the Talmud. There are some writings of his on mathematics and astronomy extant. He directed the education of his son, who, like many another distinguished scholar in later life, seems to have exhibited very little talent in his early years. There is no rule in the matter. Precocity often disappoints. Genius is often dull in childhood, but there are exceptions that prove both rules. The basis of education in Spain at that time among the Jews was the Bible, the Talmud, mathematics, and astronomy, a good rounded education in literature, the basis of law, and some exact physical science. After his preliminary education at home Maimonides studied the natural sciences and medicine with Moorish teachers. Nature-study, in spite of frequent expressions that declare it new in modern times, is as old as man. He also received a grounding in philosophy as a preparation for his scientific studies. At the age of twenty-three he began the composition of a commentary on the Talmud, which he continued to work at on his journeys in Spain and in Egypt. This is considered to be one of the most important of this class of works extant, though, almost needless to say, similar writings are very numerous. In the light of wanderings in philosophy during the centuries since, it is rather interesting to quote from that work the end of man as this Jewish philosopher of the middle of the twelfth century saw it. Recent teleological tendencies in biology add to the interest of his views. According to Maimonides, "Man is the end of the whole creation, and we have only to look to him for the reason for its existence. Every object shows the end for which it was created. The palm-trees are there to provide dates; the spider to spin her webs. All the properties of an animal or a plant are directed so as to enable it to reach its purpose in life. What is the purpose of man? It cannot lie alone in eating and drinking or yielding to passion, nor in the building of cities and the ruling of others, since these objects lie outside of him, and do not touch his essential being. Such material striving he has in common with the animal. A man is lifted from a lower to a higher condition by his reason. Only through his reason is he placed above the animals. He is the only reasonable animal. His reason enables him to understand all things, especially the Unity of God, and all knowledge and science serve only to direct man to the knowledge of God. Passions are to be subdued, since the man who yields to passion subjects his spirit to his body, and does not reveal in himself the divine power which in him lies in his reason, but is swallowed up in the ocean of matter." Not long after Maimonides passed his twentieth year the family, consisting of the father and his two sons, Moses and David, and a daughter, moved from Cordova to Fez, compelled by Jewish persecutions. Here it is said that they had to submit to wearing the mask of Islam in order to lead a peaceful existence. This has been doubted, however, and his whole life is in flagrant contradiction with any such even apparent apostasy from the faith of his fathers. Father and son took advantage of the opportunity of intercourse with Moorish physicians and philosophers to increase their store of knowledge, but could not be content in the political and religious conditions in which they were compelled to live. About 1155, then, they went to Jerusalem, but found conditions even more intolerable there, and turned back to Egypt, where they settled down in Old Cairo. In 1166 the father died, and after this we learn that the sons made a livelihood, and even laid the foundation of a fortune, by carrying on a jewelry trade. Moses still devoted most of his time to study, while his brother did most of the business, but the brother was lost in the Indian Ocean, and with him went not only a large sum of his own money, but also much that had been entrusted to him by others. Maimonides undertook to pay off these debts and at the same time had to meet the necessities not only of himself and sister, but also of the family of his dead brother. It was then that he took up the practice of medicine and succeeded in making a great name and reputation for himself. He continued to write, however, and completed his commentary on the Talmud. About the age of fifty Maimonides, as seems to be true of a good many men who live to old age, became rather discouraged and despondent about himself. He refers to himself in his letters and writings rather frequently as an old and ailing man. He had nearly twenty years of active life ahead of him, but he had the persuasion that comes to many that he was probably destined to an early death. His son was born shortly after this time, and that seems to have had not a little to do with brightening his life. While in Egypt Maimonides married the sister of one of the royal secretaries, who, in turn, wedded Maimonides' sister. Maimonides took on himself the education of his son, who also became a physician, though his father was not to have the satisfaction of watching his success in the practice of his chosen profession. This son, Abraham, became the physician of Malie Alkamen, the brother of Saladin, and, besides, was a physician to the hospital at Cairo. _His_ son, David, the grandson of Maimonides, practised medicine also at Cairo till 1300. He in turn left two sons, Abraham and Solomon, who achieved reputation in the chosen profession of their great-grandfather. Maimonides, after the birth of his son, became one of the busiest of practising physicians. Indeed, it is hard to understand how he had the time to do any writing in his busy life. Still less can we understand his time for teaching. He was the physician to Saladin, whose relations with Richard Coeur de Lion have made him known to English-speaking people. Every morning, as the Court physician, Maimonides went to the palace, situated half a mile away from his dwelling, and if any of the many officials and dependents that then, as now, were at Oriental courts, were ill, he stayed there for some time. As a rule he could only get back to his own home in the afternoon, and then he was, as he says himself, "almost dying with hunger." Knowing the scantiness of the Oriental breakfast, we are not surprised. There he found his waiting-room full of patients, "Jews and Mohammedans, prominent and unimportant, friends and enemies," he says himself, "a varied crowd, who are looking for my medical advice. There is scarcely time for me to get down from my carriage and wash myself and eat a little, and then until night I am constantly occupied, so that, from sheer exhaustion, I must lie down. Only on the Sabbath day have I the time to occupy myself with my own people and my studies, and so the day is away from me." What a picture it is of the busy medical teacher at all times in the world's history, yet it must not be forgotten that it is from these busy men that we have derived our most precious lessons in caring for patients rather than disease, in the art of medicine rather than medical science--and their practical lessons have been valuable long after the fine-spun theories of the scientist that took so long to elaborate have been placed definitely in the lumber room. His reputation as a writer on medical topics is not as great as that which has been accorded him for his writings on philosophy and in Talmudic literature, but he well deserves a place among the great practical masters of medicine, as well as high rank among the physicians of his time. There is little that is original in his writing, but his thoroughgoing common sense, his wide knowledge, and his discriminating, eclectic faculty make his writings of special value. As might have been expected, the Aphorisms of Hippocrates attracted his attention, and, besides, he wrote a series of aphorisms of his own. The most interesting of his writings, however, is a series of letters on dietetics written for the son of his patron Saladin. The young prince seems to have suffered from one of the neurotic conditions that so often develop in those who have their lives all planned for them, and little incentive to do things for themselves. The main portion of his complaints centred, as in the case of many another individual of leisure, in disturbances of digestion. Besides, he suffered from constipation and feelings of depression. Doubtless, like many a young person of the modern time, he was quite sure that these symptoms portended some insidious organic ailment that would surely bring an early death. When fathers, having done all that there is to do, just expect their sons to enjoy the fruits of the paternal accomplishments, conditions of this kind very often develop, unless the young man proceeds to occupy himself with even more dangerous distractions than he finds in unending thought about his own feelings. The rules of life and health that Maimonides laid down in these letters have become part of our popular medical tradition. Probably more of the ordinarily current maxims as to health have been derived from them than would possibly be suspected by anyone not familiar with them. In various forms his rules have been published a number of times. A good idea of them can be obtained from the following compendium of them, which I abbreviate from a biographical sketch of Maimonides by Dr. Oppler, which appeared in the "Deutsches Archiv für Geschichte der Medizin und Medicinische Geographie" (Bd. 2, Leipzig, 1879). 1. Man is bound to lead a life pleasing to God if he wants to have a healthy body, and he must hold himself far from everything that can hurt his health and accustom himself to whatever renews his strength. He should eat and drink only when hungry and thirsty and should be particularly careful of the regular evacuation of his bowels and of his bladder. He must not delay either of these operations, but as far as possible satisfy the inclination at once. 2. A man must not overload his stomach but be content always with something less than is necessary to make him feel quite satisfied. He should not drink much during the meal and only of water and wine mixed, taking somewhat more after digestion has begun and after digestion is completed, in moderation according to his needs. Before a man sits down to table he should note whether he has any tendency to evacuation and should make the body warm by movement and activity. After this exercise he should rest a little before taking food. It is very beneficial after work to take a bath and then the meal. 3. Food should be taken always in the sitting position. There should be no riding nor walking, nor movements of the body until digestion is finished. The man who takes a walk or any strenuous occupation immediately after eating subjects himself to serious dangers of disease. 4. Day and night should be divided into twenty-four hours. Men should sleep for eight hours, and so arrange their sleep that the end of it comes with the dawn, so that from the beginning of sleep until sunrise there should be an eight-hour interval. We should all leave our beds about the time that the sun rises. 5. During sleep a man should lie neither on his face nor on his back but on his side, the beginning of the night on his left and at the end on his right. He should not go to sleep for three or four hours after eating and should not sleep during the day. 6. Fruits that are laxative, as grapes, figs, melons, gourds, should be taken only before meal time and not mixed with other food. It would be better to let these get into the abdominal organs and then take other food. 7. Eat what is easily digestible before what is difficult of digestion. The flesh of birds before beef and the flesh of calves before that of cows and steers. (Birds were then thought more digestible than other flesh; we have reversed the ruling. The note shows how light and digestible their flesh was considered and the reason therefor.) 8. In summer eat cooling food, acids, and no spices. In winter, on the contrary, eat warming foods, rich in spices, mustard, and other heating substances. In cold and warm climates one should eat according to the climatic conditions. 9. There are certain harmful foods that should be avoided. Large salt fish, old cheese, old pickled meat, young new wine, evil-smelling and bitter foods are often poisonous. There are also some which are less harmful, but are not to be recommended as ordinary nutritive materials. Large fish, cheese, milk more than twenty-four hours after milking, the flesh of old oxen, beans, peas, unleavened bread, sauerkraut, onions, radishes and the like. These are to be taken only in small quantities and only in the winter time and they should be avoided in the summer. Beans and lentils are to be recommended neither in winter nor summer. 10. As a rule one should avoid the eating of tree fruits, or not eat much of them, especially when they are dry and even less when they are green. If they are unripe they may cause serious damage. Johannesbrod is very harmful at all times, as are also all the sour fruits, and only small amounts of them should be eaten in summer or in warm countries. 11. The fruits that are to be recommended dry as well as fresh, are figs, grapes, and almonds. These may be eaten as one has the appetite for them, but one should not accustom himself to eat them much, though they are healthier than all other fruits. 12. Honey and wine are not good for children, though they are beneficial for older people, especially in winter. In summer one-third less of them should be eaten than in winter. 13. Special care should be taken to have regular movements of the bowels that carry off the impurities of the body. It is an axiom in medicine, that so long as evacuations are absent, or difficult, or require strong efforts, the individual is liable to serious disease. Every medical means should be taken to overcome constipation in order to escape its dangers. For this purpose young people should be given salty food, materials that have been soaked in olive oil, salt itself, or certain vegetable soups with olive oil and salt. Older people should take honey mixed with warm water early in the morning and four hours later should take their breakfast. This proceeding should be followed up from one to four days until the constipation is overcome. 14. Another axiom of medicine is that so long as a man is able to be active and vigorous, does not eat until he is over-full, and does not suffer from constipation, he is not liable to disease. Even such men, however, are much safer if they do not take food that may disagree with them. 15. Whoever gives himself up to inactivity, or puts off evacuations of the bowels, or suffers from constipation, will be sure to suffer from many diseases and will see his strength disappear even should he eat the best food in the world and make use of all the remedies that physicians have. Immoderate eating is a poison for men and the cause of many diseases which attack them. Most diseases come from either eating too much or partaking of unsuitable food. That was what Solomon meant with his proverb: "He who puts a guard over his mouth and his tongue protects himself from many evils," that is to say, whoever protects his mouth from the overindulgence in food and his tongue from unsuitable speech protects himself from many evils. 16. Every week at least a man should take a warm bath. One should not bathe when hungry, nor after eating until the food is digested, and bathe the whole body in warm but not too hot water and the head in hot water. Afterwards the body should be washed in lukewarm and cool water until finally cold water is used. One should pour neither cold nor even lukewarm water on the head, nor bathe in cold water in the winter time, nor when the body is tired and in perspiration. At such times the bath should be put off for a while. 17. As soon as one leaves the bath one should cover oneself, and especially cover the head, so that no draught may strike it. Even in summer, care must be taken to observe this rule. After this one should rest for a while until the heat of the body passes off and then should go to table. If one could sleep a little just before a meal it is often very beneficial. Neither during the bath nor immediately after it should cold water be drunk, and if there is an inappeasable thirst a little wine and water or water and honey should be taken. In winter it is beneficial to rub the body with oil after the bath. 18. Venesection should not be practised frequently, for it is only meant for serious illness. It should not be permitted in winter or summer, nor during the months of April or September (the "r" months). After passing his fiftieth year an individual should abstain from venesection. Venesection should not be practised on the day when one takes a bath or goes on a journey or returns from it. On the day when it is practised less than usual should be eaten and drunk, and the patient should give himself to rest, undertake no work nor bothersome occupation, and take no walk. 19. Whoever observes these rules of life faithfully I guarantee him a long life without disease. He shall reach a good old age, and when he comes to die will not need a physician. His body will remain always strong and healthy, unless of course he has been born with a weak nature, or has had an unfortunate bringing up, or should be attacked by epidemic disease or by famine. 20. Only the healthy should keep these rules. Whoever is ill or a sufferer from any injuries, or has lost his health through bad habits, for him there are special rules for each disease, only to be found in the medical books. Let it be remembered that every change in a life habit is the beginning of an ailment. 21. If no physician can be secured, then ailing people may use these rules as well as the healthy. These rules are, of course, full of the common sense of medicine that endures at all times. For the tropical climate of the Eastern countries they probably represent as good advice as could be given even at the present time. With them before us it is not surprising to find that on other subjects Maimonides was just as sensible. Perhaps in nothing is this more striking than in his complete rejection of astrology. Considering how long astrology, in the sense of the doctrine of the stars influencing human health and destinies, had dominated men's minds, and how universal was the acceptance of it, Maimonides' strong expressions show how much genius lifts itself above the popular persuasions of its time, even among the educated, and how much it anticipates subsequent knowledge. It is well to remind ourselves that as late as the middle of the eighteenth century Mesmer's thesis on "The Influence of the Stars on Human Constitutions" was accepted by the faculty of the University of Vienna as a satisfactory evidence not only of his knowledge of medicine, but of his power to reason about it. At the end of the twelfth century Maimonides was trying to argue it out of existence on the best possible grounds. "Know, my masters," he writes, "that no man should believe anything that is not attested by one of these three sanctions:--rational proof as in mathematical science, the perception of the senses, or traditions from the prophets and learned men." His biographer in the monograph "Maimonides," published by the Jewish Publication Society of America[5], expresses his further views on the subject in compendious form, and then gives his final conclusion as follows: "'Works on astrology are the product of fools, who mistook vanity for wisdom. Men are inclined to believe whatever is written in a book, especially if the book be ancient; and in olden times disaster befell Israel because men devoted themselves to such idolatry instead of practising the arts of martial defence and government.' He says, that he had himself studied every extant astrological treatise, and had convinced himself that none deserved to be called scientific. Maimonides then proceeds to distinguish between astrology and astronomy, in the latter of which lies true and necessary wisdom. He ridicules the supposition that the fate of man could be dependent on the constellations, and urges that such a theory robs life of purpose, and makes man a slave of destiny. 'It is true,' he concludes, 'that you may find strange utterances in the Rabbinical literature which imply a belief in the potency of the stars at a man's nativity, but no one is justified in surrendering his own rational opinions because this or that sage erred, or because an allegorical remark is expressed literally. A man must never cast his own judgment behind him; the eyes are set in front, not in the back.'" While Maimonides could be so positive in his opinions with regard to a subject on which he felt competent to say something, he was extremely modest with regard to many of the great problems of medicine. He often uses the expression in his writings, "I do not see how to explain this matter." He quotes with approval from a Rabbi of old who had counselled his students, "teach thy tongue to say, I do not know." In this, of course, he has given the best possible evidence of his largeness of mind and his capacity for making advance in knowledge. It is when men are ready to say, "I do not know," that progress becomes possible. It is very easy to rest in a conscious or unconscious pretence of knowledge that obscures the real question at issue. A great thinker, who lived in the century in which Maimonides died, Roger Bacon, set down as one of the four principal obstacles to advance in knowledge indeed, as _the_ one of the four that hampered intellectual progress the most, the fact that men feared to say, "I do not know." One of the most interesting features of Maimonides' career for the modern time is the influence that his writings exerted over the rising intellectual life of Europe within a half century after his death. Most people would be rather inclined to think that this Jewish author of the East would have very little influence over the thinkers and teachers of Europe within a generation after his death. He died in 1204, just at the beginning of one of the great productive centuries of humanity, perhaps one of the greatest of them all. In literature, in art, in architecture, in philosophy, and in education, this century made wonderful strides. Two of its greatest teachers, Albertus Magnus and his pupil, Thomas Aquinas, quote from Moses Ægyptæus, the European name for Maimonides at that time, and evidently knew his writings very well. Maimonides was for them an important connecting link with the world of old Greek thought. Others of the writers and teachers of this time, as William of Auvergne, and the two great Franciscans, Alexander of Hales and Duns Scotus, were also influenced by Maimonides. In a word, the educational world of that time was much more closely united than we might think, and it did not take long for a great writer's thoughts to make themselves felt several thousand miles away. Maimonides was, then, in his own time one of the world teachers, and, in a certain sense, he must always remain that, as representing a special development of what is best in human nature. V GREAT ARABIAN PHYSICIANS In order to understand the place of the Arabs in medicine and in science, a few words as to the rise of this people to political power, and then to the cultivation of literature and of science, are necessary. We hear of the Arabs as hireling soldiers fighting for others during the centuries just after Christ, and especially in connection with the story of the famous Queen Zenobia at Palmyra. After the destruction of this city we hear nothing more of them until the time of Mohammed. During these six and a half centuries there is little question of education of any kind among them except that at the end of the sixth century, the Persian King Chosroes I, who was much interested in medicine, encouraged the medical school in Djondisabour, in Arabistan, founded at the end of the fifth century by the Nestorian Christians, who continued as the teachers there until it became one of the most important schools of the East. It was here that the first Arab physicians were trained, and here that the Christian physicians who practised medicine among the Arabs were educated. Among the Arabs themselves, before the time of Mohammed, there had been very little interest in medicine. Gurlt notes that even the physician of the Prophet himself was, according to tradition, a Christian. Mohammed's immediate successors were not interested in education, and their people mainly turned to Christian and Jewish physicians for whatever medical treatment they needed. When the Caliphs came to be rulers of the Mohammedan Empire, they took special pains to encourage the study of philosophy and medicine; though dissection was forbidden by the Koran, most of the other medical sciences, and especially botany and all the therapeutic arts, were seriously cultivated. Until the coming of Mohammed, the Arabs had been wandering tribes, getting some fame as hireling soldiers, but now, under the influence of a feeling of community in religion, and led by the military genius of some of Mohammed's successors, whose soldiers were inspired by the religious feelings of the sect, they made great conquests. The Mohammedan Empire extended from India to Spain within a century after Mohammed's death. Carthage was taken and destroyed, Constantinople was threatened. In 661, scarcely forty years after the _hegira_ or flight of Mohammed, from which good Mohammedans date their era, the capital was transferred from Medina to Damascus, to be transferred from here to Bagdad just about a century later, where it remained until the Mongols made an end of the Abbasside rulers about the middle of the thirteenth century. At the beginning the followers of Mohammed were opposed to knowledge and education of all kinds. Mohammed himself had but little. According to tradition, he could not read or write. The story told with regard to the Caliph Omar and the great library of Alexandria, seems to have a foundation in reality, though such legends usually are not to be taken literally. Certainly it represents the traditional view as to the attitude of the earlier Moslem rulers to education. Omar was asked what should be done with the more than two million volumes. He said that the books in it either agreed with the Koran, or they did not. If they agreed with it they were quite useless. If they did not, they were pernicious. In either case, they should be done away with, because there was an element of danger in them. Accordingly, the precious volumes that had been accumulating for nearly ten centuries, served, it is said, to heat the baths of Alexandria for some six months--probably the most precious fuel ever used. Fortunately for posterity, the edict was not quite as universal in its application as the story would indicate, and exceptions were made for books of science. In the course of their conquests, however, the Mohammedan Arabs captured the Greek cities of Asia Minor. They were brought closely in contact with Greek culture, Greek literature, and Greek thought. As has always been the case, captive Greece took its captors captive. What happened to the Romans earlier came to pass also among the Arabs. Inspired by Greek philosophy, science, and literature, they became ardent devotees of science and the arts. While not inventing or discovering anything new, like the Romans they carried on the old. Damascus, Basra, Bagdad, Bokhara, Samarcand all became centres of culture and of education. Large sums were paid for Greek manuscripts, and for translations from them. Under the famous Harun al-Raschid, at the end of the eighth century, whose name is better known to us than that of any others, because of the stories of his wandering by night among his people in order to see if justice were done, three hundred scholars were sent at the cost of the Caliph to the various parts of the world in order to bring back treasures of science, and especially of geography and medicine. It is an interesting historical reflection that the Japanese and Chinese are doing the same thing now. The Arabs were very much taken by the philosophy of Aristotle, and it became the foundation of all their education. Greek thought, as always, inspired its students to higher things. Soon everywhere in the dominions of the Caliphs, philosophy, science, art, literature, and education nourished. Medicine was taken up with the other sciences and cultivated assiduously. Freind, in his "Historia Medicinæ," says that the writings of the old Greeks which treated of medicine were saved from destruction with the other books at Alexandria, for the desire of health did not have less strength among the Arabs than among other nations. Since these books taught them how to preserve health, and were not otherwise contrary to the laws of the Prophet, that served to bring about their preservation. Freind also calls attention to the fact that grammars and books which treated of the science of language were likewise saved from destruction. Besides the library, the Arabs, after their conquest of Alexandria in the eighth century, came under the influence of the university still in existence there. In the West, in Spain, the Arabs enjoyed the same advantages as regards contact with culture and education as their conquest of the Eastern cities and Alexandria brought them in the East. While it is not generally realized, Spain was, as we have pointed out, the province of the Roman Empire in the West that advanced most in culture before the breaking up of the Empire. The Silver Age of Latin literature owes all of its geniuses to Spain. Lucan, the Senecas, Martial, Quintilian, are all Spaniards. Spain itself was a most flourishing province, and under the Spanish Cæsars, from the end of the first to about the end of the second century, increased rapidly in population. Spain was the leader in these prosperous times, and the tradition of culture maintained itself. When Spain became Christian the first great Christian poet, Prudentius, born about the middle of the fourth century, came from there. He has been called the Horace and Virgil of the Christians. The coming down of the barbarians from the North disturbed Spain's prosperity and the peace and culture of her inhabitants, but it should not be forgotten that the first medieval popularization of science, a sort of encyclopedia of knowledge, the first of its kind after that of Pliny in the classical period, came from St. Isidore of Seville, a Spanish bishop. There has been considerable tendency to insist that Spanish culture and intellectuality owe nearly all to the presence of the Moors in Spain. This can only be urged, however, by those who know nothing at all of the Spanish Cæsars, the place of Spain in the history of the Roman Empire, and the continuance of the culture that then reached a climax of expression during succeeding centuries. On the contrary, the Moors who came to Spain owe most of their tendency to devote themselves to culture and education to the state of affairs existent in Spain when they came. There is no doubt that they raised standards of education and of culture above the level to which they had sunk under the weight of the invading barbarians from the North, and Spain owes much to the wise ruling and devotion to the intellectual life of her Moorish invaders. All the factors, however, must be taken together in order to appreciate properly the conditions which developed under the Arabs in both the East and the West. The Arabs invented little that was new in science or philosophy; they merely carried on older traditions. It is for that that the modern time owes them a great debt of gratitude. RHAZES The most distinguished of the Arabian physicians was the man whose rather lengthy Arabian name, beginning with Abu Bekr Mohammed, finished with el-Razi, and who has hence been usually referred to in the history of medicine as Rhazes. He was born about 850 at Raj, in the Province of Chorasan in Persia. He seems to have had a liberal early education in philosophy and in philology and literature. He did not take up medicine until later in life, and, according to tradition, supported himself as a singer until he was thirty years of age. Then he devoted himself to medical studies with the ardor and the success so often noted in those whose opportunity to study medicine has been delayed. His studies were made at Bagdad, where Ibn Zein el-Taberi was his teacher. He returned to his native town and was for some time the head of the hospital there. Later he was called by the Sultan to Bagdad to take charge of the renovated and enlarged hospital of the capital. His medical career, then, is not unlike that of many another successful physician, especially of the modern time. At Bagdad he had abundant opportunities for study, and the ambition to make medicine as well as to make money and gain fame. His studies in science were all founded on Aristotle. Though he was called the Galen of his time, and looked up to the Greek physician as his master, even the authority of Galen did not override that of the Stagirite in his estimation. One of his aphorisms is said to have been, "If Galen and Aristotle are of one mind on a subject, then surely their opinion is true. When they differ, however, it is extremely difficult for the scholar to decide which opinion should be accepted." He drew many pupils to Bagdad, and, when one knows his teaching, this is not surprising. Some of his aphorisms are very practical. While the expressions just quoted with regard to Galen and Aristotle might seem to indicate that Rhazes was absolutely wedded to authority, there is another well-known maxim of his which shows how much he thought of the value of experience and observation. "Truth in medicine," he said, "is a goal which cannot be absolutely reached, and the art of healing, as it is described in books, is far beneath the practical experience of a skilful, thoughtful physician." Some of his other medical aphorisms are worth noting. "At the beginning of a disease choose such remedies as will not lessen the patient's strength." "When you can heal by diet, prescribe no other remedy, and, where simple remedies suffice, do not take complicated ones." Rhazes knew well the value of the influence of mind over body even in serious organic disease, and even though death seemed impending. One of his aphorisms is: "Physicians ought to console their patients even if the signs of impending death seem to be present. For the bodies of men are dependent on their spirits." He considered that the most valuable thing for the physician to do was to increase the patient's natural vitality. Hence his advice: "In treating a patient, let your first thought be to strengthen his natural vitality. If you strengthen that, you remove ever so many ills without more ado. If you weaken it, however, by the remedies that you use you always work harm." The simpler the means by which the patient's cure can be brought about, the better in his opinion. He insists again and again on diet rather than artificial remedies. "It is good for the physician that he should be able to cure disease by means of diet, if possible, rather than by means of medicine." Another of his aphorisms seems worth while quoting: "The patient who consults a great many physicians is likely to have a very confused state of mind." Some idea of Rhazes' strenuous activity as a writer on medical subjects may be obtained from the fact that thirty-six of his works are still extant, and there are nearly two hundred others of which only the titles have been preserved. Some of these are doubtless the works of pupils and students of succeeding generations, published under his name to attract attention. His principal work is "Continens," or "Comprehensor," which owes its title to the fact that it was meant to contain the whole practice of medicine and surgery. It includes references to the writings of all previous distinguished medical writers, from Hippocrates to Honein Ben Ishac, also known as Johannitius, a Christian Arabian physician, one of Rhazes' teachers. The most frequently quoted of these authorities are Galen, Oribasius, Aëtius, and Paul of Ægina. The work, however, is not made up entirely of quotations, but contains many observations made by the author himself. Gurlt says that the foundation of the theoretic medicine of Rhazes is the system of Galen, while in practice he seems to cling more to the aphorisms of Hippocrates. He has many practical points which show that he thought for himself. For instance, in wounds of the abdomen, if the intestines are extruded and cannot be replaced, he suggests the suspension of the patient by his hands and feet in a bath in order to facilitate their return. If they do not go back readily, compresses dipped in warm wine should be used. Cancer he declares to be almost incurable. He has much to say about the bites of animals and their tendency to be poisonous, knew rabies very well, and knew also that the bites of men might have similar serious consequences. It is impossible to give any adequate idea of the thoroughly practical character of Rhazes' medical writing in a few lines, but it may suffice to say that there is scarcely any feature of modern medicine and surgery that he does not touch, and oftener than not his touch is sure and rational and frequently much better than the advice of successors long after him in the same matters. An example or two will suffice to illustrate this. In the treatment of nasal polyps he says that whenever drug treatment of these is not successful, they should be removed with a snare made of hair. For fall of the uvula he suggests gargles, but when these fail he advises resection and cauterization. Among the affections of the tongue he numbers abscess, fissure, ulcer, cancer, ranula, shortening of the ligaments, hypertrophy, erythema of the mucous membrane, and inflammatory swelling. In general his treatment of the upper respiratory tract is much farther advanced than we might think possible at this time. He advises tracheotomy whenever there is great difficulty of respiration, and describes how it should be done. After the dyspnea has passed the edges of the wound should be brought together with sutures. It is not surprising, then, to find that the treatment of fractures and luxations is eminently practical, and, indeed, on any subject that he touches he throws practical light. In the introduction to his edition of the works of Ambroise Paré, Malgaigne says that the first reference to a metal band in connection with trusses is to be found in Rhazes. Hernia was, of course, one of the serious ailments that, because of its superficial character, was rather well understood, and so it is not surprising to find that much of our modern treatment of it was anticipated. The manipulations for taxis, the use of a warm bath for the relaxation of the patient by means of heat and by putting the head and feet higher than the abdomen while in the bath, and the employment of various kinds of trusses to prevent strangulation of the hernia recur over and over again, in the authors of the Middle Ages. Many of the suggestions are to be found in the early Greek authors, but subsequent writers give a certain personal expression to them which shows how much they had learned by personal observation in the employment of various methods. Pagel, in Puschmann's "Handbook of the History of Medicine," declares that Rhazes' most important work for pure medicine is his monograph on smallpox. Its principal value is due to the fact that, though he has consulted old authorities carefully, his discussion of the disease is founded almost entirely on his own experience. His description of the various stages of the disease, of the forms of the eruption, and of the differential diagnosis, is very accurate. He compares the course of the fever with that of other fevers, and brings out exactly what constitutes the disease. His suggestions as to prognosis are excellent. Those cases, he declares, are particularly serious in which the eruption takes on a dark, or greenish, or violet color. The prognosis is also unfavorable for those cases which, having considerable fever, have only a slight amount of rash. His treatment of the disease in young persons was by venesection and cool douches. Cold water and acid drinks should be administered freely, so that sweat and other excretions may carry off poisonous materials. Care must be taken to watch the pulse, the breathing, the appearance of the feet, the evacuations from the bowels, and to modify therapy in accordance with these indications. The eruption is to be encouraged by external warmth and special care must be taken with regard to complications in the eyes, the ears, the nose, the mouth, and the pharynx. A fact that will, perhaps, give the best idea to modern readers of the place of Rhazes in the history of medicine is that Vesalius considered it worth his while to make a translation of his principal work. Unfortunately that translation has not come down to us. When Vesalius, pestered by the controversies that had come upon him because of his venturing to make his observations for himself, accepted the post of physician to the Emperor Charles V, he burnt a number of his manuscripts. Among these were his translation of Rhazes and some annotations on Galen, which, as he says himself, had grown into a huge volume. The Galenists were bitterly decrying his refusal to accept Galen on many points, and both of these works would have added fuel to the flame of controversy. He deemed it wiser, then, not to give any further opportunities for rancorous criticism, and, feeling presumably that in his new and important post it was not worth while to bother further over the matter, he burnt them. He tells the reason in his letters to Joachin Roelant: "When I was about to leave Italy to go to Court, since a number of the physicians whom you know had made the worst kind of censure of my books, both to the Emperor himself, and to other rulers, I burned all the manuscripts that were left, although I had never suffered a moment under the displeasure of the Emperor because of these complaints, and in spite of the fact that a number of friends who were present urged me not to destroy them." Vesalius' translation of Rhazes was probably undertaken because he recognized in him a kindred spirit of original investigation and inquiry, whose work, because it was many centuries old, would command the weight of an authority and at the same time help in the controversy over Galenic questions. This, of itself, would be quite enough to make the reputation of Rhazes, even if we did not know from the writings themselves and from the admiration of many distinguished men as well as the incentive that his works have so often proved to original observation, that he is an important link in the chain of observers in medicine, who, though we would naturally expect them to be so frequent, are really so rare. ALI ABBAS Rhazes lived well on into the tenth century. His successor in prestige, though not his serious rival, was Ali Ben el-Abbas, usually spoken of in medical literature as Ali Abbas, a distinguished Arabian physician who died near the end of the tenth century. He wrote a book on medicine which, because of its dedication to the Sultan, to whom he was body-physician, is known as the "Liber Regius," or "Royal Book of Medicine." This became the leading text-book of medicine for the Arabs until replaced by the "Canon of Avicenna" some two centuries later. The "Liber Regius" was an extremely practical work and, like most of the Arabian books of the early times, is simple and direct, quite without many of the objectionable features that developed later in Arabian medicine. It is valuable mainly for its contributions to diet and the fact that Ali Abbas tested many of his medicines on ailing animals before applying them to men. Of course, it owes much to earlier writers on medicine, and especially to Paul of Ægina. An example of its practical value is to be found in his description of the treatment of a wound of the brachial artery, when, as happened often in venesection from the median basilic vein, it was injured through carelessness or inadvertence. If astringent or cauterizing methods do not stop the bleeding, the artery should be exposed, carefully isolated, tied in two places above and below the wound, and then cut across between them. He has many similar practical bits of technique. For instance, in pulling a back tooth he recommends that the gums be incised so as to loosen them around the roots, and then the tooth itself may be drawn with a special forceps which he calls a molar forceps. In ascites he recommends that when other means fail an opening should be made three finger-breadths below the navel with a pointed phlebotomy knife, and a portion of the fluid allowed to evacuate itself. A tube should then be inserted, but closed. The next day more of the fluid should be allowed to come away, and then the tube removed and the abdomen wrapped with a firm bandage. It is easy to understand that Ali Abbas' book should have been popular, and the more we know of it the easier it is to explain why Constantine Africanus should have selected it for translation. It contains ten theoretic and ten practical books, and gives an excellent idea of the medical knowledge and medical practice of the time. Probably the fact that Constantine had translated it led to its early printing, so that we have an edition of it published at Venice in 1492, and another at Lyons in 1523. During the Middle Ages the book was often spoken of as "Regalis Dispositio," the "Royal Disposition of Medicine." MOORISH PHYSICIANS After Rhazes, the most important contributors to medical literature from among the Arabs, with the single exception of Avicenna, were born in Spain. They are Albucasis or Abulcasis, the surgeon; Avenzoar, the physician, and Averroës, the philosophic theorist in medicine. Besides, it may be recalled here that Maimonides, the great Jewish physician, was born and educated at Cordova, in Spain. It might very well be a surprise that these distinguished men among the Arabs should have flourished in Spain, so far from the original seat of Arabian and Mohammedan dominion in the East, where, owing to conditions in the modern time, the English-speaking world particularly is not likely to assume that the environment was favorable for the development of science and philosophy. Anyone who recalls, however, the history of Spanish intellectual influence in the Roman Empire, as we have traced it at the beginning of this chapter, will appreciate how favorable conditions were in Spain for the fostering of intellectual development. With the disturbances that had come from political strife and the invasion of the barbarians in Italy, Spain had undoubtedly come to hold the primacy in the intellectual life of Europe at the time when the Arabs took possession of the peninsula. ABULCASIS The most important of the Arabian surgeons of the Middle Ages is Albucasis or Abulcasis, also Abulkasim, who was born near Cordova, in Spain. The exact year of his birth is not known, but he flourished in the second half of the tenth century. He is said to have lived to the age of 101. The name of his principal work, which embraces the whole of medicine, is "Altasrif," or "Tesrif," which has been translated "The Miscellany." Most of what he has to say about medical matters is taken from Rhazes. His work on surgery, however, in three books, represents his special contribution to the medical sciences. It contains a number of illustrations of instruments, and is the first illustrated medical book that has come to us. It was translated into Latin, and was studied very faithfully by all the surgeons of the Middle Ages. Guy de Chauliac has quoted Albucasis about two hundred times in his "Chirurgia Magna." Even as late as the beginning of the sixteenth century Fabricius de Acquapendente, the teacher of Harvey, confessed that he owed most to three great medical writers, Celsus (first century), Paul of Ægina (seventh century), and Abulcasis (tenth century). Abulcasis insisted that for successful surgery a detailed knowledge of anatomy was, above all, necessary. He said that the reason why surgery had declined in his day was that physicians did not know their anatomy. The art of medicine, he added further, required much time. Unfortunately, to quote Hippocrates, there are many who are physicians in name only, and not in fact, especially in what regards surgery. He gives some examples of surgical mistakes made by his professional brethren that were particularly called to his attention. They are the perennially familiar instances of ignorance causing death because surgeons were tempted to operate too extensively. His description of the procedure necessary to stop an artery from bleeding is an interesting example of his method of teaching the practical technique of surgery. Apply the finger promptly upon the opening of the vessel and press until the blood is arrested. Having heated a cautery of the appropriate size, take the finger away rapidly and touch the cautery at once to the end of the artery until the blood stops. If the spurting blood should cool the cautery, take another. There should be several ready for the purpose. Take care, he says, not to cauterize the nerves in the neighborhood, for this will add a new ailment to the patient's affection. There are only four ways of arresting arterial hemorrhage. First, by cautery; second, by division of the artery, when that is not complete--for then the extremities contract and the blood clots--or by a ligature, or by the application of substances which arrest blood flow, aided by a compressive bandage. Other means are inefficient, and seldom and, at most, accidentally successful. His instruction for first aid to the injured in case of hemorrhage in the absence of the physician, is to apply pressure directly upon the wound itself. The development of the surgical specialties among the Arabs is particularly interesting. Abulcasis has much to say about nasal polyps. He divided them into three classes: (1) cancerous, (2) those with a number of feet, and (3) those that are soft and not living,--these latter, he says, are neither malignant nor difficult to treat. He recommends the use of a hook for their removal, or a snare for those that cannot be removed with that instrument. His instructions for the removal of objects from the external ear are interestingly practical. He advises the use of bird lime on the end of a sound to which objects will cling, or, where they are smaller, suction through a silver or copper canula. Hooks and pincettes are also suggested. Insects should be removed with a hook, or with a canula, or, having been killed by warm oil, removed by means of a syringe. Some of his observations with regard to genito-urinary surgery are quite as interesting. He even treated congenital anomalies. He suggests cutting of the meatus when narrowed, dilatation of strictures with lead sounds, and even suggests plans of operations to improve the condition in hypospadias. He gives the signs for differentiation between epitheliomata and condylomata, and distinguishes various forms of ulceration of the penis. Abulcasis discusses varicose veins in very much the same spirit as a modern surgeon does. They occur particularly in people who work much on their feet, and especially who have to carry heavy burdens. They should not be operated on unless they produce great discomfort, and make it impossible for the sufferer to make his living. They may be operated on by means of incision or extirpation. Incision consists of cutting the veins at two or three places when they have been made prominent by means of tight bandages around the limb. The blood should be allowed to flow freely out of the cut ends, and then a bandage applied. For extirpation, the skin having been shaved beforehand, the vein should be made prominent, and then carefully laid bare. When freed from all adhesions, it should be lifted out on a hook, and either completely extirpated or several rather long pieces removed. He lays a good deal of stress on the necessity for freeing the vein thoroughly and lifting it well out of tissues before incising it. In old cases special care must be taken not to tear the vein. Minute details of technique are often found in these old authors. Abulcasis, for instance, treats of adherent fingers with up-to-date completeness. They can occur either congenitally or from injury, as, for instance, burning. They should be separated, and then separation maintained by means of bandages or by the insertion between them of a thin lead plate, which prevents their readhesion. Adhesions of the fingers with the palm of the hand, which Abulcasis has also seen, should be treated the same way. At times there is surprise at finding some rare lesion treated with modern technique, and a hint at least of our modern apparatus. Fracture of the pubic arch, for instance, is described in Abulcasis quite as if he had had definite experience with it. When this occurs in a woman, the reposition of the bone is often greatly facilitated by a cotton tampon in the vagina. This tampon must be removed at every urination. There is another way, however, of better securing the same purpose of counterpressure. One may take a sheep's bladder into the orifice of which a tube is fastened. One should introduce the bladder into the vagina, and then blow strongly through the tube, until the bladder becomes swollen and fills up the vaginal cavity. The fracture will, as a rule, then be readily reduced. Here is, of course, not alone the first hint of the colpeurynter, but a very practical form of the apparatus complete. Old-time physicians used the bladders of animals very generally for nearly all the medical purposes for which we now use rubber bags. AVICENNA Undoubtedly the most important of Abulcasis' contemporaries is the famous physician whose Arabic name, Ibn Sina, was transformed into Avicenna. He was born toward the end of the tenth century in the Persian province of Chorasan, at the height of Arabian influence, and is sometimes spoken of as the chief representative of Arabian medicine, of as much importance for it as Galen for later Greek medicine. His principal book is the so-called "Canon." It replaced the compendium "Continens" of Rhazes, and, in the East, continued until the end of the fifteenth century to be looked upon as the most complete and best system of medicine. Avicenna came to be better known in the West than any of the other Arabian writers, and his name carried great weight with it. There are very few subjects in medicine that did not receive suggestive, if not always adequate, treatment at the hands of this great Arabian medical thinker of the eleventh century. He copied freely from his predecessors, but completed their work with his own observations and conclusions. One of his chapters is devoted to leprosy alone. He has definite information with regard to bubonic plague and the _filaria medinensis_. Here and there one finds striking anticipations of what are supposed to be modern observations. Nothing was too small for his notice. One portion of the fourth book is on cosmetics, in which he treats the affections of the hair and of the nails. He has special chapters with regard to obesity, emaciation, and general constitutional conditions. His book, the "Antidotarium," is the foundation of our knowledge of the drug-giving of his time. Some idea of the popularity and influence of Avicenna, five centuries after his time, can be readily derived from the number of commentaries on him issued during the Renaissance period by the most distinguished medical scholars and writers of that time. Hyrtl, in his "Das Arabische und Hebräische in der Anatomie," quotes some of them,--Bartholomæus de Varignana, Gentilis de Fulgineis, Jacobus de Partibus, Didacus Lopez, Jacobus de Forlivio, Ugo Senesis, Dinus de Garbo, Matthæus de Gradibus, Nicolaus Leonicenus, Thaddæus Florentinus, Galeatus de Sancta Sophia. A more complete list, with the titles of the books, may be found in Haller's "Bibliotheca Anatomica." For over three centuries after the foundation of medical schools in Europe (and even after Mondino's book had been widely distributed), Avicenna was still in the hands of all those who had an enthusiasm for medical science. AVENZOAR Another of the distinguished Arabian physicians was Avenzoar--the transformation of his Arabic family name, Ibn-Zohr. He was probably born in Penaflor, not far from Seville. He died in Seville in 1162 at the age, it is said, of ninety-two years. He was the son of a physician descended from a family of scholars, jurists, physicians, and officials. He received the best education of the time not only in internal medicine, but in all the specialties, and must be counted among the greatest of the Spanish Arabian physicians. He was the teacher of Averroës, who always speaks of him with great respect. He is interesting as probably being the first to suggest nutrition _per rectum_. A few words of his description show how well he knew the technique. His apparatus for the purpose consisted of the bladder of a goat or some similar animal structure, with a silver canula fastened into its neck, to be used about as we use a fountain syringe. Having first carefully washed out the rectum with cleansing and purifying clysters, he injected the nutriment--eggs, milk, and gruels--into the gut. His idea was that the intestine would take this, and, as he said, suck it up, carrying it back to the stomach, where it would be digested. He was sure that he had seen his patients benefited by it. Some light on his studies of cases that would require such treatment may be obtained from what he has to say about the handling of a case of stricture of the esophagus. He says that this begins with some discomfort, and then some difficulty of swallowing, which is gradually and continuously increased until finally there comes complete impossibility of swallowing. It was in these cases that he suggested rectal alimentation, but he went farther than this, and treated the stricture of the esophagus itself. The first step in this treatment is that a canula of silver or tin should be inserted through the mouth and pushed down the throat till its head meets an obstruction, always being withdrawn when there is a vomiting movement, until it becomes engaged in the stricture. Then _freshly milked_ milk, or gruel made from farina or barley, should be poured through it. He says that in these cases the patient might be put in a warm milk or gruel bath, since there are some physicians who believe that through the lower parts of the body, and also through the pores of the whole body, nutrition might be taken up. While he considers that this latter method should be tried in suitable cases, he has not very much faith in it, and says that the reasons urged for it are weak and rather frivolous. It is easy to understand that a man who has reached the place in medicine where he can recommend manipulative treatments of this kind, and discuss nutritional modes so rationally, knew his practical medicine well, and wrote of it judiciously. AVERROËS Among the distinguished contributors to medicine at this time, though more a philosopher than a physician, is the famous Averroës, whose full Arabic name among his contemporaries was Abul-Welid Mohammed Ben Ahmed Ibn Roschd el-Maliki. Like Avenzoar, of whom he was the intimate personal friend, and Abulcasis and Maimonides, he was born in the south of Spain. He was in high favor with the King of Morocco and of Spain, El-Mansur Jacub, often known as Almansor, who made him one of his counsellors. His works are much more important for philosophy than for medicine, and his philosophical writings gave him a place only second to that of Aristotle in the Western world during the Middle Ages. Averroism is still a subject of at least academic interest, and Renan's monograph on it and its author was one of the popular books of the latter half of the nineteenth century in philosophic circles. In spite of his friendship with the Moorish King and with Avenzoar, he fell under the suspicion of free thinking and was brought to trial with a number of personal friends, who occupied high positions in the Moorish government. He escaped with his life, but only after great risks, and he was banished to a suburb of Cordova, in which only Jews were allowed to live. By personal influence he succeeded in securing the pardon of himself and friends, and then was summoned to the court of the son and successor of El-Mansur in Morocco. He died, not long after, in 1198. Altogether there are some thirty-three works of Averroës on philosophy and science. Only three of these are concerned with medicine. One is the "Colliget," so-called, containing seven books, on anatomy, physiology, pathology, diagnostics, materia medica, hygiene, and therapy. Then there is a commentary on the "Cantica of Avicenna," and a tractate on the "Theriac." Averroës' idea in writing about medicine was to apply his particular system of philosophy to medical science. His intimate relations with other great physicians of the time, and in particular his close friendship with Avenzoar, enabled him to get abundant medical information in faultless order so far as knowledge then went, but his theoretic speculations, instead of helping medicine, as he thought they would, and as philosophers have always been inclined to think as regards their theoretic contributions, were not only not of value, but to some extent at least hindered human progress by diverting men from the field of observation to that of speculation. It is interesting to realize that Averroës did in his time what Descartes did many centuries later, and many another brilliant thinker has done before and since. ARABIAN INFLUENCE The fame of these great thinkers and writers in philosophy and in medicine came to be known not only through the distribution of their books long after their death, but during their lifetime, and in immediately subsequent generations, ardent seekers after knowledge, who were themselves afterwards to become famous by their teaching and writing, found their way into the Arabian dominions in order to take advantage of the educational opportunities afforded. These were better than they could secure at home in Christian countries, because the process of bringing culture and devotion to literature and science into the minds of the Northern nations, who had replaced the old Romans in Europe, was not yet completed. Bagdad and Cordova were the two favorite places of educational pilgrimage. The names that are most familiar among the scholars in the Middle Ages in Europe are those of whom it is recorded that they made long journeys in order to get in touch with what the Arabs had preserved of the old Greek civilization and culture. Among them are such men as Michael Scot or Scotus, Matthew Platearius, who was afterwards a great teacher at Salerno; Daniel Morley, Adelard of Bath, Egidius, otherwise known as Gilles de Corbeil; Romoaldus, Gerbert of Auvergne, who later became Pope under the name of Sylvester II; Gerard of Cremona, and the best known of them all, at least in medicine, Constantine Africanus, whose wanderings, however, were probably not limited to Arabian lands, but who seems also to have been in Hindustan. We are rather prone to think that this great spirit of going far afield for knowledge's sake is recent, or, at least, quite modern. As a matter of fact, one finds it everywhere in history. Long before Herodotus did his wanderings there were many visitors who went to Egypt, and many more later who went to Crete, and many more a few centuries later who went to the shores of Asia Minor seeking for the precious pearl of knowledge, and sometimes finding it without finding the even more precious pearl of wisdom, "whose worth is from the farthest coasts." To the Arabs we owe the foundation of a series of institutions for the higher learning, like those which had existed around them in Asia Minor and in Egypt at the time they made their conquests. Alexandria, Pergamos, Cos, Cnidos, Tarsus, and many other Eastern cities had had what we would call at least academies, and many of them deserved the name of universities. The Arabs continued the tradition in education that they found, and established educational institutions which attracted wide attention. As we have said, the two most famous of these were at Bagdad and at Cordova. Mostanser, the predecessor of the last Caliph of the family of the Abbassides, built a handsome palace, in which the academy of Bagdad was housed. It is still in existence, and gives an excellent idea of the beneficent interest of this monarch and of other of the Abbasside rulers in education. Its fate at the present time is typical of the attitude of the Mohammedans towards education. Though the building is still standing, the institution of learning is no longer there. As Hyrtl remarks, it is not ideas that are exchanged in it now, but articles of commerce. It has become the chief office of the Turkish customs department in Bagdad. These institutions of the higher learning, founded by the Arabs, at first as rather strict imitations of the museums or academies of Egypt and Asia Minor, gradually changed their character under the Arabs. Their courses became much more formal, examinations became much more important. Scholarship was sought not so much for its own sake, as because it led to positions in the civil service, to the favor of princes, and, in general, to reputation and pecuniary reward. Formal testimonials proclaiming education, signed by the academic authorities, were introduced and came to mean much. Lawyers could not practise without a license, physicians also required a license. These formalities were adopted by the Western medieval universities to a considerable degree and have been perpetuated in the modern time. Undoubtedly they did much to hamper real education among the Arabs by setting in place of the satisfaction of learning for its own sake and the commendation of teachers the formal recognition of a certain amount of work done as recognized by the educational authorities. There was always a tendency among the Arabs to formulate and formalize, to over-systematize what they were at; to think that new knowledge could be obtained simply by speculating over what was already acquired, and developing it. There are a number of comparisons between this and later periods of education that might be suggested if comparisons were not odious. The influence of Arabian medicine on modern medicine can, perhaps, best be judged from the number of words in our modern nomenclature, which, though bearing Latin forms, often with suggestion of Greek origins, still are not derived from the old Latin or Greek authors, but represent Arabic terms translated into Latin during the Renaissance period. Hyrtl, without pretence of quoting them all, gives a list of these which is surprising in its comprehensiveness. For instance, the mediastinum, the sutura sagittalis, the scrobiculus cordis, the marsupium cordis, the chambers of the heart, the velum palati, the trochanter, the rima glottidis, the fontanelles, the alæ of the nose, all have their present names, not from original Latin expressions, but from the translation of Arabic terms. For all such words the Greeks and Romans have quite other expressions, in which the sense of our modern terms is not contained. This has given rise to many misunderstandings, and to many attempts in the modern times to return to the classic terminology rather than preserve what in many cases are the barbarisms introduced through the Arabic, but it is doubtful whether any comprehensive reform in the matter can be effected, so strongly entrenched in medical usage have these terms now become. Freind, in his "History of Medicine," already cited, calls attention to the fact that the Arabs had an unfortunate tendency to change by addition or subtraction of their own views the authors that they studied, and wished to translate to others. This seems to have been true even of some of the most distinguished of them. Of course, the idea of preserving an author's text untouched, and making it clear just where note and commentary came in, had not yet come to men's view, but quite apart from this the Arabs apparently often tried to gain acceptance for their own ideas by having them masquerade as the supposed ideas of favorite classic authors. Another unfortunate tendency among the Arabs was their liking for the discussion of many trivial questions. Hyrtl, in his volume on "Arabian and Hebrew Words in Anatomy,"[6] declares that it is almost incredible how earnestly some trivial questions in anatomy and physiology were discussed by the Arabs. He gives some examples. Why does no hair grow on the nose of men? Why does the stomach not lie behind the mouth? Why does the windpipe not lie behind the esophagus? Why are the breasts not on the abdomen? Why are not the calves on the anterior portion of the legs? Even such men as Rhazes and Avicenna discuss such questions. It was this tendency of the Arabs that passed over to the Western Europeans with Arabian commentaries on philosophy and science, and brought so many similar discussions in the scholastic period. These trivialities have usually been supposed to originate with the scholastics themselves, for they are not to be found in the Greek authors on whom the scholastics were writing commentaries, but they are typically Oriental in character, and it must be remembered that during the twelfth and early thirteenth centuries, at least, Greek philosophy found its way largely into Europe in Arab versions, and these characteristically Arabian additions of the discussion of curious trivial questions came with them and produced an imitative tendency among the Europeans. As a rule the more careful has been the study of Arabian writers in the modern time, particularly by specialists, the clearer has it become that they lacked nearly all originality. Especially were they faulty in their observations; besides, they had a definite tendency to replace observation by theory, a fatal defect in medicine. The fine development of surgery that came at the end of the Arabian period of medicine in Europe could never have come from the Arabs themselves. Gurlt has brought this out particularly, but it will not be difficult to cite many other good authorities in support of this opinion. Hyrtl, in his "Thesis on the Rarer Old Anatomists,"[7] says that "the Arabs paid very little attention to anatomy, and, of course, because of the prohibition in the Koran, added nothing to it. Whatever they knew they took from the Greeks, and especially Galen. Not only did they not add anything new to this, but they even lost sight of much that was important in the older authors. The Arabs were much more interested in physiology; they could study this by giving thought to it without soiling their hands. They delighted in theory, rather than in observation." While we thus discuss the lack of originality and the tendency to over-refinement among the Arabian medical writers, it must not be thought that we would make little of what they accomplished. They not only preserved the old medical writers for us, but they kept alive practical medicine with the principles of the great Greek thinkers as its basis. There are a large number of writers of Arabian medicine whose names have secured deservedly a high place in medical history. If this were a formal history of Arabian medicine, their careers and works would require discussion. For our purpose, however, it seems better to confine attention to a few of the most prominent Arabian writers on medicine, because they will serve to illustrate how thoroughly practical were the Arabian physicians and how many medical problems that we are prone to think of as modern they occupied themselves with, solving them not infrequently nearly as we do in the modern time. VI THE MEDICAL SCHOOL AT SALERNO The Medical School at Salerno, probably organized early in the tenth century, often spoken of as the darkest of the centuries, and reaching its highest point of influence at the end of the twelfth century, is of great interest in modern times for a number of reasons. First it brought about in the course of its development an organization of medical education, and an establishment of standards that were to be maintained whenever and wherever there was a true professional spirit down to our own time. They insisted on a preliminary education of three years of college work, on at least four years of medical training, on special study for specialist's work, as in surgery, and on practical training with a physician or in a hospital before the student was allowed to practise for himself. At Salerno, too, the department of women's diseases was given over to women professors, and we have the text-books of some of these women medical teachers. The license to practise given to women, however, seems to have been general and did not confine them merely to the care of women and children. We have records of a number of these licenses issued to women in the neighborhood of Salerno. This subject of feminine medical education at Salerno, because of its special interest in our time, will have a chapter by itself. These are the special features of medical education in our own time that we are rather prone to think of as originating with ourselves and as being indices of that evolution of humanity and progress in mankind which are culminating in our era. It is rather interesting, then, to study just how these developments came about and what the genesis of this great school was. The books of its professors were widely read, not only in their own generation but for centuries afterwards. With the invention of printing at the time of the Renaissance most of them were printed and exerted profound influence over the revival of medicine which took place at that time. Salerno became the first of the universities in the modern sense of the word. Here there gathered round the medical school, first a preparatory department representing modern college work, and then departments of theology and law, though this latter department particularly was never quite successful. The fact that the first university, that of Salerno, should have been organized round a medical school, the second, that of Bologna, around a law school, and the third, that of Paris, around a school of theology and philosophy, would seem to represent the ordinary natural process of development in human interests. First man is interested in himself and in his health, then in his property, and finally in his relations to his fellow-man and to God. Though much work has been done on the subject in recent years, it is not easy to trace the origin of the medical school at Salerno. The difficulty is emphasized by the fact that even the earliest chroniclers whose accounts we have were not sure as to its origin, and even had some doubt about the age of the school. Alphanus, usually designated Alphanus I because there are several of the name, who is one of the earliest professors whose name and fame have come down to us, gives us the only definite detail as to the age of the school. He was a Benedictine monk, distinguished as a literary man, known both as poet and physician, who was afterwards raised to the Bishopric of Salerno. As a bishop he was one of the beneficent patrons, to whom the school owed much. He lived in the tenth century, and states that medicine flourished in the town before the time of Guimarus II, who reigned in the ninth century. In the ancient chronicle of Salerno, re-discovered by De Renzi and published in his "Collectio Salernitana," it is definitely recorded that the medical school was founded by four doctors,--a Jewish Rabbi Elinus, a Greek Pontus, a Saracen Adala, an Arab, and a native of Salerno, each of whom lectured in his native language. There are many elements in this tradition, however, that would seem to indicate its mythical origin and that it was probably invented after the event to account for the presence of teachers in all these languages and the coming of students from all over the world. The names, for instance, are apparently corruptions of real names, as can be readily recognized. Elinus, the Jew, is probably Elias or Eliseus, Adala is a corruption of Abdallah, and Pontus, as pointed out by Puschmann in his "History of Medical Education," should probably be Gario-Pontus. While we do not know exactly when the medical school at Salerno was founded, we know that a hospital was established there as early as 820. It was founded by the Archdeacon Adelmus, and was placed under the control of the Benedictines after it was realized that a religious order, by its organization, was best fitted for carrying on such charitable work continuously. Other infirmaries and charitable institutions, mainly under control of the religious, sprang up in Salerno. It was the presence of these hospitals in a salubrious climate that seems first to have attracted the attention of patients and then of physicians from all over Europe and even adjacent Africa and Asia. Puschmann says that it is uncertain whether clinical instruction was imparted in these institutions or not, but the whole tenor of what we know about the practical character of the teaching at Salerno and of the fine development of professional medicine there, would seem to argue that probably those who came to study medicine here were brought directly in contact with patients. As early as the ninth century Salerno was famous for its great physicians. We know the names of at least two physicians, Joseph and Joshua, who practised there about the middle of the ninth century. Ragenifrid, a Lombard by his name, was private physician to Prince Wyamar of Salerno in the year 900. The fact that he was from North Italy indicates that already foreigners were being attracted, but more than this that they were obtaining opportunities unhampered by any Chauvinism. From early in the tenth century physicians from Salerno were frequently brought to foreign courts to become the attending physicians to rulers. Patients of the highest distinction from all over Europe began to flock to Salerno, and we have the names of many of them. In the tenth century Bishop Adalberon, when ailing, went there, though he found no cure for his ills. Abbot Desiderius, however, the great Benedictine scholar of the time, who afterwards became Pope Victor III, regained his health at Salerno under the care of the great Constantine Africanus, who was so much impressed by the gentle kindness and deep learning and the example of the saintly life of his patient that not long after he went to Monte Cassino to become a Benedictine under Desiderius, who was abbot there. Duke Guiscard sent his son Bohemund to Salerno for the cure of a wound received in battle, which had refused to heal under the ordinary surgical treatment of the time. William the Conqueror, early in the eleventh century and while still only the Duke of Normandy, is said to have passed some time at Salerno for a similar reason. The most interesting feature of the medical life at Salerno at this time is the relations between the clergy and the physicians. In the sketch of the life of Constantine Africanus, which follows this chapter, there is some account of the friendship between Abbot Desiderius of Monte Cassino and Constantine Africanus, and the latter's withdrawal from his professorship to become a Benedictine. One of the physicians of the early tenth century who stood high in favor with Prince Gisulf was raised to the Bishopric of Salerno. This was Alphanus, whom we have already mentioned as a chronicler, a monk, a poet, a physician, and finally the Bishop of Salerno. The best proof of how thorough was the medical education at Salerno and how much influence it exerted even over public opinion is to be found in the regulation of the practice of medicine, which soon began, and the insistence upon proper training before permission to practise medicine was granted. The medical school at Salerno early came to be a recognized institution in the kingdom of the Two Sicilies, representing a definite standard of medical training. It is easy to understand that the attraction which Salerno possessed for patients soon also brought to the neighborhood a number of irregular physicians, travelling quacks, and charlatans. Wealthy patients were coming from all over the world to be treated at Salerno. Many of them doubtless were sufferers from incurable diseases and nothing could be done for them. Often they would be quite unable to return to their homes and would be surely unwilling to give up all hope if anybody promised them anything of relief. There was a rich field for the irregular, and of course, as always, he came. Salerno had already shown what a good standard of medical education should be, and it is not surprising, then, that the legal authorities in this part of the country proceeded to the enforcement of legal regulations demanding the attainment of this standard, in order that unfit and unworthy physicians might not practise medicine to their own benefit but to the detriment of the patients. Accordingly, as early as the year 1140, King Ruggiero (Roger) of the Two Sicilies promulgated the law: "Whoever from this time forth desires to practise medicine must present himself before our officials and judges, and be subject to their decision. Anyone audacious enough to neglect this shall be punished by imprisonment and confiscation of goods. This decree has for its object the protection of the subjects of our kingdom from the dangers arising from the ignorance of practitioners." Just about a century later the Emperor Frederick II, the Hohenstaufen, in the year 1240, extended this law, emphasized it, and brought it particularly into connection with the great medical school of the Two Sicilies, of which territory he was the ruler. This law has often been proclaimed as due to his personality rather than to his times,--as representing his very modern spirit and his progressive way of looking at things. There is no doubt that certain personal elements for which he should be given due credit are contained in the law. To understand it properly, however, one must know the law of King Roger of the preceding century; and then it is easy to appreciate that Frederick's regulation is only such a development of the governmental attitude toward medical practice as might have been expected during the century since Roger's time. It has sometimes been suggested that this law made by the Emperor Frederick, who was so constantly in bitter opposition to the Papacy, was issued in despite of the Church authorities and represents a policy very different from any which they would have encouraged. The early history of Salerno, even briefly as we have given it, completely contradicts any such idea. The history of medical regulation at the beginning of the next century down at Montpellier moreover, where the civil authorities being weak the legal ordering of the practice of medicine was effectively taken up by the Church, and the authority for the issuance of licenses to practise was in the hands of the bishops of the neighborhood, shows clearly that it is not because of any knowledge of the real medical history of the times that such remarks are made, but from a set purpose to discredit the Church. The Emperor Frederick's law deserves profound respect and consideration because of the place that it holds in the legal regulation of the practice of medicine. Anyone who thinks that evolution must have brought us in seven centuries much farther in this matter than were the people of the later Middle Ages should read this law attentively. Everyone who is interested in medical education should have a copy of it near him, because it will have a chastening effect in demonstrating not only how little we have done in the modern time rather than how much, but above all how much of decadence there was during many periods of the interval. The law may be found in the original in "The Popes and Science" (Fordham University Press, N.Y., 1908). Three years of preliminary university education before the study of medicine might be taken up, four years of medical studies proper before a degree was given, a year of practice with a regularly licensed physician before a license to practise could be obtained, a special course in anatomy if surgery were to be practised; all this represents an ideal we are striving after at the present time in medical education. Besides this, Frederick's law also regulates medical fees, requires gratuitous attendance on the poor for the privilege of practice accorded by the license, though the general fees are of a thoroughly professional character and represent for each visit of the physician about the amount of daily wage that the ordinary laborer of that time earned. Curiously enough, this same ratio of emolument has maintained itself. This law was also a pure drug law, regulating the practice of pharmacy, and the price as well as the purity of drugs, and the relations of physicians, druggists, and the royal drug inspectors whose business it was to see that only proper drugs were prepared and sold. All this is so much more advanced than we could possibly have imagined, only that the actual documents are in our possession, that most people refuse to let themselves be persuaded in spite of the law that it could have meant very much. Especially as regards medical education are they dubious as to conditions at this time. To them it seems that it can make very little difference how much time was required for medical study or for studies preliminary to medicine, since there was so little to be learned. The age was ignorant, men knew but little, and so very little could be imparted no matter how much time was taken. This is, I fear, a common impression, but an utterly false one. The preliminary training that is the undergraduate work at the universities consisted of the Seven Liberal Arts--the trivium and quadrivium, which embraced logic, rhetoric, grammar, metaphysics, under which was included not a little of physics, cosmology in which some biology was studied, as well as psychology and mathematics, astronomy, and music. This was a thoroughly rounded course in intellectual training. No wonder that Professor Huxley said in his Inaugural Address as Rector of Aberdeen, "I doubt if the curriculum of any modern university shows so clear and generous a comprehension of what is meant by culture as this old trivium and quadrivium does." There is no doubt at all about the value of the undergraduate training, nor of the scholarship of the men who were turned out under the system, nor of their ability to concentrate their minds on difficult subjects--a faculty that we strive to cultivate in our time and do not always congratulate ourselves on securing to the degree, at least, that we would like. As to the medical teaching, Ægidius, often called Gilles of Corbeil, who was a graduate of Salerno and afterward became the physician-in-ordinary to Philip Augustus, King of France, thought that he could not say too much for the training in medicine that was given at this first of the medical schools. One thing is sure, the professors were eminently serious, the work taken up was in many ways thoroughly scientific, and some of the results of the medical investigations of that early day are interesting even now. The descriptions of diseases that we have from the Salernitan school are true to nature and are replete with many original observations. Puschmann says: "The accounts given of intermittent fever, pneumonia, phthisis, psoriasis, lupus, which they called the malum mortuum, of ulcers on the sexual organs, among which it is easy to recognize chancre, and of the disturbances of the mental faculties, especially deserve mention." They seem to have been quite expert in their knowledge of phthisis. In the treatment of it they laid great stress upon the giving up of a strenuous life, the living a rather easy existence in the open air, and a suitable diet. When the commencement of consumption was suspected, the first prescription was a good course of strengthening nourishment for the patient. On the other hand, they declared that the cases in which diarrhea supervened during consumption soon proved fatal. In general, with regard to people who were liable to respiratory diseases, they insisted upon life in an atmosphere of equable temperature. Though the custom was almost unheard of in the Salerno of that time, and indeed at the present time there is very little heating during the winter in southern Italy, they insisted that patients who were liable to pulmonary affections should have their rooms heated. On the other hand, they suggested the cooling of the air of the sick-room, as we have noted in the chapter on Constantine Africanus, and Afflacius recommended the employment of an apparatus from which water trickled continuously in drops to the ground and then evaporated. Baths and bleeding were employed according to definite indications and diet was always a special feature. They had a number of drugs and simples, and the employment of some of them is interesting. Iron was prescribed for enlargement of the spleen. The internal use of sea sponge, in which of course there is a noteworthy proportion of iodine, was recommended for relief from the symptoms of goitre by reducing its size. Iodine has been used so much ever since in this affection, even down to our own day, that this employment of one of its compounds is rather striking. Massage of the goitre was also recommended, and this mode of treatment was commonly employed for a number of ailments. Probably the best idea that can be obtained in brief space of the achievements of the University of Salerno is to be found in Pagel's appreciation of Salerno's place in the history of medicine in his chapters on "Medicine in the Middle Ages" in Puschmann's "Handbuch der Geschichte der Medizin" (Berlin, 1902). He said: "If we take up now the accomplishments of the school of Salerno in the different departments there is one thing that is very remarkable. It is the rich independent productivity with which Salerno advanced the banners of medical science for hundreds of years almost as the only autochthonous centre of medical influence in the whole West. One might almost say that it was like a _versprengten Keim_--a displaced embryonic element--which, as it unfolded, rescued from destruction the ruined remains of Greek and Roman medicine. This productivity of Salerno, which may well be compared in quality and quantity with that of the best periods of our science, and in which no department of medicine was left without some advance, is one of the striking phenomena of the history of medicine. While positive progress was not made, there are many noteworthy original observations to be chronicled. It must be acknowledged that pupils and scholars set themselves faithfully to their tasks to further as far as their strength allowed the science and art of healing. In the medical writers of the older period of Salerno who had not yet been disturbed by Arabian culture or scholasticism, we cannot but admire the clear, charmingly smooth, light-flowing diction, the delicate and honest setting forth of cases, the simplicity of their method of treatment, which was to a great extent dietetic and expectant, and while we admire the carefulness and yet the copiousness of their therapy, we cannot but envy them a certain austerity in their pharmaceutic formulas and an avoidance of medicamental polypragmasia. The work in internal medicine was especially developed. The contributions to it from a theoretic and a literary standpoint, as well as from practical applications, found ardent devotees." Less than this could scarcely have been expected from the medical school which brought such an uplift of professional dignity and advance in the standards of medical education that are to be noticed in connection with Salerno. Registration, licensure, preliminary education, adequate professional studies, clinical experience under expert guidance, even special training for surgical work, all came in connection with this great medical school. Such practical progress in medical education could not have been made but by men who faced the problems of the practice of medicine without self-deception and solved them as far as possible by common-sense, natural, and rational methods. It is usually said that at Salerno surgery occupied an inferior position. It is true that we have less record of it in the earlier years of Salerno than we would like to see. It was somewhat handicapped by the absence of human dissection. This very important defect was not due to any Church opposition to anatomy, as has often been said, but to the objection that people have to seeing the bodies of their friends or acquaintances used for anatomical purposes. In the comparatively small towns of the Middle Ages there were few strangers, and therefore very seldom were there unclaimed bodies. The difficulty was in the obtaining of dissecting material. We had the same difficulty in this country until about two generations ago, and the only way that bodies could be obtained regularly was by "resurrecting" them, as it was called, from graveyards. In the absence of human subjects, anatomy was taught at Salerno upon the pig. The principal portion of the teaching in anatomy consisted of the demonstration of the organs in the great cavities of the body and their relations, with some investigations of their form and the presumed functions of the corresponding organs in man. Copho's well-known "Anatomy of the Pig" was a text-book written for the students of Salerno. In spite of its limitations, it shows the beginnings of rather searching original inquiry and even some observations in pathological anatomy. It is simple and straightforward and does not profess to be other than it is, though it must be set down as the first reasonably complete contribution to comparative anatomy. When their surgery came to be written down, however, it gave abundant evidence of the thoroughness with which this department of medicine had been cultivated by the Salernitan faculty. We have the text-book of Roger, with the commentary of Rolando, and then the so-called commentary of the Four Masters. These writings were probably made rather for the medical school at Bologna than that of Salerno, though there is no doubt that at least Roger and Rolando received their education at Salerno and embodied in their writings the surgical traditions of that school. While I have preferred, in order to have a connected story of surgical development, to treat of their contributions to their specialty under the head of the "Great Surgeons of the Medieval Universities," it seems well to point out here that they must be considered as representing especially the surgical teaching of the older medical school of Salerno. There are many interesting features of the old teaching that they have embodied in their books. For instance, at Salerno both sutures and ligatures were employed in order to prevent bleeding. We are rather accustomed to think of such uses of thread, and especially the ligature, as being much later inventions. The fact of the matter is, however, that ligatures and sutures were reinvented over and over again and then allowed to go out of use until someone who had no idea of their dangers came to reinvent them once more.[8] Much is often said about the place of Arabian surgery and medicine at this time, and the influence that they had over the medical teaching and thinking of the period. To trust many of the shorter histories of medicine the Arabs must be given credit for more of the medical thought of this time than any other medical writers or thinkers. It is forgotten, however, apparently, that in the southern part of Italy, where Salerno was situated, Greek influence never died out. This had been a Greek colony in the olden time and continued to be known for many centuries after the Christian era as Magna Græcia. Greek medicine, then, had more influence here than anywhere else. As a matter of fact, the beginnings of Salernitan teaching are all Greek and not at all Arabian. This is as true in surgery as in medicine. I have quoted Gurlt in the chapter on "Great Surgeons of the Medieval Universities," insisting that the Salernitan school owed nothing at all to Arabian surgery. Salernitan medicine was, during the twelfth century, just as free from Arabian influence. When Arabian medicine makes itself felt, as pointed out by Pagel in his "Geschichte der Heilkunde im Mittelalter,"[9] far from exerting a beneficial influence, it had a rather unfortunate effect. It led especially to an oversophistication of medicine from the standpoint of drug therapeutics. The Arabian physicians trusted nature very little. In this they were like our forefathers of medicine one hundred years ago, of whom Rush was the typical representative--so history repeats itself. Before the introduction of Arabian medicine the Salernitan school of medicine was noted for its common-sense methods and its devotion to all the natural modes of healing. It looked quite as much to the prevention of disease as its treatment. Diet and air and water were always looked upon as significant therapeutic aids. With the coming of Arabian influence there began, says Pagel, "as the literature of the times shows very well, that rule of the apothecary in therapeutics which was an unfortunate exaggeration. Now all the above-mentioned complicated prescriptions came to be the order of the day. Apparently the more complicated a prescription the better. Dietetics especially was relegated to the background. Salerno, at the end of the twelfth century, had already reached its highest point of advance in medicine and was beginning to decline. Decadence was evident in so far as all the medical works that we have from that time are either borrowings or imitations from Arabian medicine with which eventually Salernitan medical literature became confounded. Only a few independent authors are found after this time." This is so very different from what is ordinarily presumed to have been the case and openly proclaimed by many historians of medicine because apparently they would prefer to attribute scientific advance to the Arabs than to the Christian scholars of the time, that it is worth while noting it particularly. Salerno was particularly rich in its medical literary products. Very often we have not the names of the writers. Apparently there is good reason to think that a number of the professors consulted together in writing a book, and when it was issued it was considered to be a text-book of the Salernitan school of medicine rather than of any particular professor. This represents a development of co-operation on the part of colleagues in medical teaching that we are likely to think of as reserved for much later times. The most important medical writing that comes to us from Salerno, in the sense at least of the work that has had most effect on succeeding generations, has been most frequently transcribed, most often translated and committed to memory by many generations of physicians, is the celebrated Salernitan medical poem on hygiene. The title of the original Latin was "Regimen Sanitatis Salernitanum." It was probably written about the beginning of the twelfth century. A century or so later it came to be the custom to call medical books after flowers, and so we had the "Lilium Medicinæ" and the "Flos Medicinæ" down at Montpellier, and this became the "Flos Medicinæ" of Salerno. Pagel calls it the quintessence of Salernitan therapeutics. For many centuries portions at least of this Latin medical poem were as common in the mouths of physicians all over Europe as the aphorisms of Hippocrates or the sayings of Galen. Probably this enables us to understand the great reputation that the Salernitan school enjoyed and the influence that it wielded better than anything else. The poem is divided into ten principal parts, containing altogether about 3,500 lines. The first part on hygiene has 855 lines in eight chapters. The second part on _materia medica_, though containing only four chapters, has also about 800 lines. Anatomy and physiology are crowded into about 200 lines, etiology has something over 200, semiotics has about 250, pathology has but thirty lines more or less, and therapeutics about 400; nosology has about 600 more, and finally there is something about the physician himself, and an epilogue. As Latin verses go, when written for such purposes, these are not so bad, though some of them would grate on a literary ear. The whole work makes a rather interesting compendium of medicine, with therapeutic indications and contra-indications, and whatever the physician of the medieval period needed to have ready to memory. Some of its prescriptions, both in the sense of formulæ and of directions to the patient, have quite a modern air. One very interesting contribution to medical literature that comes to us from Salerno bears the title, "The Coming of a Physician to His Patient, or An Instruction for the Physician Himself." We have had a number of such works published in recent years, but it is a little surprising to have the subject taken up thus early in the history of modern professional life. It is an extremely valuable document, as demonstrating how practical was the teaching at Salerno. The work is usually ascribed to Archimattheas, and it certainly gives a vivid picture of the medical customs of the time. The instruction for the immediate coming of the physician to his patient runs as follows: "When the doctor enters the dwelling of his patient, he should not appear haughty, nor covetous, but should greet with kindly, modest demeanor those who are present, and then seating himself near the sick man accept the drink which is offered him (_sic_) and praise in a few words the beauty of the neighborhood, the situation of the house, and the well-known generosity of the family,--if it should seem to him suitable to do so. The patient should be put at his ease before the examination begins and the pulse should be felt deliberately and carefully. The fingers should be kept on the pulse at least until the hundredth beat in order to judge its kind and character; the friends standing round will be all the more impressed because of the delay and the physician's words will be received with just that much more attention." The old physician evidently realized very well how much influence on the patient's mind meant for the course of the disease. For instance, he recommends that the patient should be asked to confess and receive the sacraments of the Church before the doctor sees him, for if mention is afterwards made of this the patient may believe that it is because the doctor thinks that there is no hope for him. For the purpose of producing an effect upon the patient's mind, the old physician does not hesitate even to suggest the taking advantage of every possible source of information, so as to seem to know all about the case. "On the way to see the sick person he [the physician] should question the messenger who has summoned him upon the circumstances and the conditions of the illness of the patient; then, if not able to make any positive diagnosis after examining the pulse and the urine, he will at least excite the patient's astonishment by his accurate knowledge of the symptoms of the disease and thus win his confidence." At the end of these preliminary instructions there is a rather diplomatic--to say the least--bit of advice that might perhaps to a puritanic conscience seem more politic than truthful. Since the old professor insists so much on not disturbing the patient's mind by a bad prognosis or any hint of it, and since even some exaggeration of what he might think to be the serious outlook of the case to friends would only lead to greater care of the patient, there is probably much more justification for his suggestion than might be thought at first glance. He says, "When the doctor quits the patient he should promise him that he will get quite well again, but he should inform his friends that he is very ill; in this way, if a cure is affected, the fame of the doctor will be so much the greater, but if the patient dies people will say that the doctor had foreseen the fatal issue." The story of the medical school of Salerno, even thus briefly and fragmentarily told, illustrates very well how old is the new in education,--even in medical education. There is scarcely a phase of modern interest in medical education that may not be traced very clearly at Salerno though the school began its career a thousand years ago, and ceased to attract much attention over six hundred years ago. We owe most of our knowledge of the details of its organization and teaching to De Renzi. Without the devotion of so ardent a scholar it would have been almost impossible for us to have attained so complete a picture of Salernitan activities. As it is, as a consequence of his work we are able to see this first of modern medical schools developing very much as do our most modern medical schools. There has been an accumulation of medical information in the thousand years, but the ways and modes of facing problems and many of the solutions of them do not differ from what they were in the distant past. The more we know about any particular period, the more is this brought home to us. It is for this that study of particular periods and institutions of the olden time, as of Salerno, grows increasingly interesting, because each new detail helps to fill in sympathetically the new-old picture of human activity as it may be seen at all times. VII CONSTANTINE AFRICANUS Probably the most important representative of the medical school at Salerno, certainly the most significant member of its faculty, if we consider the wide influence for centuries after his time that his writings had, was Constantine Africanus. He is interesting, too, for many other reasons, for he is the first representative, in modern times, that is, who, after the incentive of antiquity had passed, devoted himself to creating a medical literature by translations, by editions, and by the collation of his own and others' observations on medical subjects. He is the connecting link between Arabian medicine and Western medical studies. The fact that he was first a traveller over most of the educational world of his time, then a professor at the University of Salerno who attracted many students, and finally a Benedictine monk in the great abbey at Monte Cassino, shows how his life ran the gamut of the various phases of interest in the intellectual world of his time. It was his retirement to the famous monastery that gave him the opportunity, the leisure, the reference library for consultation that a writer feels he must have near him, and probably also the means necessary for the publication of his works. Not only did the monks of Monte Cassino itself devote themselves to the copying of his many books, but other Benedictine monasteries in various parts of the world made it a point to give wide diffusion to his writings. As a study in successful publication, that is, in the securing of wide attention to writings within a short time, the career of Constantine and the story of his books would be extremely interesting. Medieval distribution of books is usually thought to have been rather halting, but here was an exception. It was largely because Benedictines all over the world were deeply interested in what this brother Benedictine was writing that wide distribution was secured for his work within a very short time. His superiors among the Benedictines had a profound interest in what he was doing. The great Benedictine Abbot Desiderius of Monte Cassino, who afterwards became Pope, used all of his extensive influence in both positions to secure an audience for the books--hence the many manuscript copies of his writings that we have. It is probable that Constantine established a school of writers at Monte Cassino, for he could scarcely have accomplished so much by himself as has been attributed to him. Besides, his works attracted so much attention that writers of immediately succeeding generations who wanted to secure attention for their works sometimes attributed them to him in order to take advantage of his popularity. It is rather difficult, then, to determine with absolute assurance which are Constantine's genuine works. Some of those attributed to him are undoubtedly spurious. What we know with certainty, however, is that his authentic works meant much for his own and after generations. Constantine was born in the early part of the eleventh century, and died near its close, having lived probably well beyond eighty years of age, his years running nearly parallel with his century. His surname, Africanus, is derived from his having been born in Africa, his birthplace being Carthage. Early in life he seems to have taken up with ardor the study of medicine in his native town, devoting himself, however, at the same time to whatever of physical science was available. Like many another young man since his time, not satisfied with the knowledge he could secure at home, he made distant journeys, gathering medical and scientific information of all kinds wherever he went. According to a tradition that seems to be well grounded, some of these journeys took him even into the far East. During his travels he became familiar with a number of Oriental languages, and especially studied the Arabian literature of science very diligently. At this time the Arabs, having the advantage of more intimate contact with the Greek medical traditions in Asia Minor, were farther advanced in their knowledge of the medical sciences than the scholars in the West. They had better facilities for obtaining the books that were the classics of medicine, and, with any desire for knowledge, could scarcely fail to secure it. What was best in Arabian medicine was brought to Salerno by Constantine and, above all, his translation of many well-known Arabian medical authors proved eminently suggestive to seriously investigating physicians all over the world in his time. Before he was to be allowed to settle down to his literary work, however, Constantine was to have a very varied experience. Some of this doubtless was to be valuable in enabling him to set the old Arabian teachers of medicine properly before his generation. After his Oriental travels he returned to his native Carthage in order to practise medicine. It was not long, however, before his superior medical knowledge, or, at least, the many novelties of medical practice that he had derived from his contact with the East, drew upon him the professional jealousy of his colleagues. It is very probable that the reputation of his extensive travels and wide knowledge soon attracted a large clientele. This was followed quite naturally by the envy at least of his professional brethren. Feeling became so bitter, that even the possibility of serious personal consequences for him because of false accusations was not out of the question. Whenever novelties are introduced into medical science or medical practice, their authors are likely to meet with this opposition on the part of colleagues, and history is full of examples of it. Galvani was laughed at and called the frogs' dancing-master; Auenbrugger was made fun of for drumming on people; Harvey is said to have lost half of his consulting practice;--all because they were advancing ideas that their contemporaries were not ready to accept. We are rather likely to think that this intolerant attitude of mind belongs to the older times, but it is rather easy to trace it in our own. In Constantine's day men had ready to hand a very serious weapon that might be used against innovators. By craftily circulated rumors the populace was brought to accuse him of magical practices, that is, of producing his cures by association with the devil. We are rather prone to think little of a generation that could take such nonsense seriously, but it would not be hard to find analogous false notions prevalent at the present time, which sometimes make life difficult, if not dangerous, for well-meaning individuals.[10] Life seems to have been made very uncomfortable for Constantine in Carthage. Just the extent to which persecution went, however, we do not know. About this time Constantine's work attracted the attention of Duke Robert of Salerno. He invited him to become his physician. After he had filled the position for a time a personal friendship developed, and, as has often happened to the physicians of kings, he became a royal counsellor and private secretary. When the post of professor of medicine at Salerno fell vacant, it is not surprising, then, that Constantine should have been made professor, and from here his teaching soon attracted the attention of all the men of his time. Constantine seems to have greatly enhanced the reputation of the medical school, and added to the medical prestige of Salerno. After teaching for some ten years there, however, he gave up his professorship--the highest position in the medical world of the time--apparently with certain plans in mind. He wanted leisure for writing the many things in medicine that he had learned in his travels in the East, so as to pass his precious treasure of knowledge on to succeeding generations; and then, too, he seems to have longed for that peace that would enable him not only to do his writing undisturbed, but to live his life quietly far away from the strife of men and the strenuous existence of a court and of a great school. There was probably another and more intimate personal reason for his retirement. Abbot Desiderius of the Benedictine Abbey of Monte Cassino, not far away, had become a close and valued friend. Before having been made abbot, Desiderius and Constantine probably were fellow professors at Salerno, for we know that Desiderius himself and many of his fellow Benedictines taught in the undergraduate department there. Desiderius enjoyed the reputation of being one of the most learned men of the time when his election to the abbacy at Monte Cassino took him away from Salerno. His departure was a blow to Constantine, who had learned by years of friendship that to be near his intimate friend, the pious scholarly Benedictine, was a solace in life and a never failing incentive to his own intellectual work. Desiderius seems, indeed, to have been a large factor in influencing the great physician to write his books rather than devote himself to oral teaching, since the circulation of his writing would confer so much more of benefit on a greater number of people. Perhaps another element in the situation was that Desiderius was desirous of having the learned physician, the travelled scholar, at Monte Cassino, for the sake of his influence on the scholarship of the abbey, and for the incentive that he would be to the younger monks to apply themselves to the varied field of knowledge which the Benedictines had chosen for themselves at this time. Whatever hopes of mutual solace and helpfulness and of the joys of intimate close friendship may have been in the minds of these two most learned men of their time, they were destined to be grievously disappointed. Only a few years after Constantine's entrance into the monastery at Monte Cassino Desiderius was elected Pope. The humble Benedictine did not want to take the exalted position, but it was plainly shown to him that it was his duty, and that he must not shirk it. Accordingly, under the name of Pope Victor III, he became one of the great Popes of the eleventh century. One might think that he could have summoned Constantine to Rome, but perhaps he knew that his friend would prefer the quietude of the cloister, and then, too, probably he wanted to allow him the opportunity to accomplish that writing for which Constantine and himself had planned when the great physician entered the monastery. All that we know for sure is that some twenty years of Constantine's life were spent as a monk in Monte Cassino, where he devoted his time mainly to the writing of his books. One bond of union there was. Each of the works, as soon as completed, was sent off to the Pope as long as he lived. On the other hand, though busy with his Papal duties, Pope Victor constantly stimulated Constantine, even from distant Rome, to go on with his work. There were messages of brotherly interest and solicitude just as in the old days. The great African physician's best known work, the so-called "Liber Pantegni," which is really a translation of the "Khitaab el Maleki" of Ali Ben el-Abbas, is dedicated to Desiderius. Constantine wrote a number of other books, most of them original, but it is difficult now to decide just which of those that pass under his name are genuine. Many were subsequently attributed to him that are surely not his. These translators of the Middle Ages proved to be not only the channels through which information came to their generations, but they were also incentives to study and investigation. It is when men can get a certain amount of information rather easily that they are tempted to seek further in order to solve the problems that present themselves. There are three great translators whose work meant much for the Middle Ages at this time. They were, besides Constantine in the eleventh century, Gerard of Cremona, in the twelfth, and the Jewish Faradj Ben Salim, at Naples, in the thirteenth. Gerard did in Spain for the greater Arabian writers what Constantine had accomplished for those of lesser import. Under the patronage of the Emperor Frederick Barbarossa, he published translations of Rhazes, Isaac Judæus, Serapion, Abulcasis, and Avicenna. His work was done in Toledo, the city in which, during the twelfth and thirteenth centuries, so many translators were at work making books for the Western world. Constantine did much more than merely bring out his translations of Arabian works. He gave a zest to the study of the old masters, issued editions of certain, at least, of the works of Hippocrates ("Aphorisms") and Galen ("Microtechnics"), and, in general, called attention to the precious treasure of medical lore that must be used to advantage if men were to teach the rising generation out of the accumulated knowledge of the past. Pagel, in Puschmann's "Handbook," does not hesitate to say that "a farther merit of Constantine must be recognized, inasmuch as that not long after his career the second epoch of the school of Salerno begins, marked not only by a wealth of writers and writings on medicine, but, above all, because from this time on the study of Greek medicine received renewed encouragement through the Latin versions of the Arabian literature. We may think as we will of the worth of these works, but this much is sure, that in many ways they brought about a broadening and an improvement of Greek knowledge, especially from the pharmacopeia standpoint." Probably the best evidence that we have for Constantine's influence on his generation is to be found in what was accomplished by men who acknowledged with pride that he was their master, and who thought it a mark of distinction to be reckoned as his disciples. Among these especially noteworthy is Johannes Afflacius, or Saracenus (whose surname of the Saracen probably means that he, too, came from Africa, as his master did). He was the author of two treatises on "Fevers and Urines," and the so-called "Cures of Afflacius." Some of these cures he directly attributed to Constantine. Then there is a Bartholomew who wrote a "Practica," or "Manual of the Practice of Medicine," with the sub-title, "Introductions to and Experiments in the Medical Practice of Hippocrates, Constantine, and the Greek Physicians." Bartholomew represents himself as a disciple of Constantine. This "Practica" of Bartholomew was one of the most commonly used books of the twelfth and thirteenth centuries throughout Europe. There are manuscript commentaries and translations, and abstracts from it not only in the Latin tongues, but especially in the Teutonic languages. Pagel refers to manuscripts in High and Low Dutch, and even in Danish. The Middle High Dutch manuscripts of this "Practica" of Bartholomew come mainly from the thirteenth century, and have not only a special interest because of their value in the history of philology, but because they are the main sources of all the later books on drugs which appeared in very large numbers in German. They have a very great historico-literary interest, especially for pharmacology. To Afflacius we owe a description of a method of reducing fever that is not only ingenious, but, in the light of our recently introduced bathing methods for fever, is a little startling. In his book on "Fevers and Urines," Afflacius suggests that when the patient's fever makes him very restless, and especially if it is warm weather, a sort of shower bath should be given to him. He thought that rain water was the best for this purpose, and he describes its best application as in rainy fashion, _modo pluviali_. The water should be allowed to flow down over the patient from a vessel with a number of minute perforations in the bottom. A number of the practical hints for treatment given by Afflacius have been attributed to Constantine. Constantine's reputation has, in the opinion of some writers, been hurt by two features of his published works, as they have come to us, that we find it difficult to understand. One of these is that his translations from the Arabic were made mainly not of the books of the great leaders of Arabian medicine, but from certain of the less important writers. The other is that it does not seem always to have been made clear in the manuscripts that have come down to us, whether these writings were translations or original writings. Some have even gone so far as to suggest that Constantine himself would have been quite willing to receive the credit for these writings. As to the first of these objections, it may be said that very probably Constantine, in his travels, had come to realize that the books of the great Arabian physicians, Rhazes, Abulcasis, Avicenna, and others, already received so much attention that the best outlook for medicine was to call particular notice to the writings of such lesser lights as Ali Abbas, Isaac Judæus, Abu Dschafer, and others of even less note. Certainly we cannot but feel that his judgment in the matter must have been directed by reasons that we may not be able to understand at present, but that must have existed, for all that we know of the man proves his character as a practical, far-sighted scholar. Besides, it seems not unlikely that but for his interest in them we would not at the present time possess the translations of these minor Arabian writers, and that would be an unfortunate gap in medical history. The other misunderstanding with regard to Constantine refers to the fact that it is now almost impossible to decide which are his own and which are the writings of others. It has been said that he even tried to palm off some of the writings of others as his own. This seems extremely unlikely, however, knowing all that we do about his life; and the suspicion is founded entirely on manuscripts as we have them at the present time, about a thousand years after he lived. What mutilations these manuscripts underwent in the course of various copyings is hard now to estimate. Monastic copyists might very well have left out Arabian names, because they were mainly interested in the fact that they were providing for their readers works that had received the approval of Constantine, and the translation of which at least had been made under his direction. It is quite clear that he did not do all the translating himself, and that he probably must have organized a school of medical translators at Monte Cassino. Then just how the various works would be looked at is very dubious. Undoubtedly many of the translations were done after his death, or certainly finished after his time, and at last attributed to him, because he was the moving spirit and had probably selected the books that should be translated, and made suggestions with regard to them. For all of his monks he was, as masters have ever been for disciples, much more important, and rightly so, than those writers to whom he referred them. The whole question of plagiarism in these medieval times, as I have pointed out elsewhere, is entirely different from that of the present time. Now a writer may consciously or unconsciously claim another writing as his own. We have come to a time when men think much of their individual reputations. It was no uncommon thing, however, in the Middle Ages, and even later in the Renaissance, for a writer to attribute what he had written to some distinguished literary man of the preceding time, and sign that writer's name to his own work. The idea of the later author was to secure an audience for his thoughts. He seemed to be quite indifferent whether people ever knew just who the writer was, but he wanted to influence humanity by his writings. He thought much more of this than of any possible reputation that might come to him. Of course, there was no question of money. There never has been any question of money-making whenever the things written have been really worth while. Literature that has deeply influenced mankind has never paid. Publications that have paid are insignificant works that have touched superficially a whole lot of people. To think of Constantine as a plagiarist in our modern sense of the word, as trying to take the credit for someone else's writings, is to misunderstand entirely the times in which he lived, and to ignore the real problem of plagiarism at that time. With the accumulation of information with regard to the history of medicine in his time, Constantine's reputation has been constantly enhanced. It is not so long since he was considered scarcely more than a monkish chronicler, who happened to have taken medicine rather than history for his field of work. Gradually we have come to appreciate all that he did for the medicine of his time. Undoubtedly his extensive travels, his wide knowledge, and then his years of effort to make Oriental medicine available for the Western civilization that was springing up again among the peoples who had come to replace the Romans, set him among the great intellectual forces of the Middle Ages. Salerno owed much to him, and it must not be forgotten that Salerno was the first university of modern times, and, above all, the first medical school that raised the dignity of the medical profession, established standards of medical education, educated the public mind and the rulers of the time to the realization of the necessity for the regulation of the practice of medicine, and in many ways anticipated our modern professional life. That the better part of his life work should have been done as a Benedictine only serves to emphasize the place that the religious had in the preservation and the development of culture and of education during the Middle Ages. VIII MEDIEVAL WOMEN PHYSICIANS Very probably the most interesting chapter for us of the modern time in the history of the medical school at Salerno is to be found in the opportunities provided for the medical education of women and the surrender to them of a whole department in the medical school, that of Women's Diseases. While it is probable that Salerno did not owe its origin to the Benedictines, and it is even possible that there was some medical teaching there for all the centuries of the Middle Ages from the Greek times, for it must not be forgotten that this part of Italy was settled by Greeks, and was often called Magna Græcia, there is no doubt at all that the Benedictines exercised great influence in the counsels of the school, and that many of the teachers were Benedictines, as were also the Archbishops, who were its best patrons, and the great Pope Victor III, who did much for it. For several centuries the Benedictines represented the most potent influence at Salerno. For most people who are not intimately familiar with monastic life, and, above all, with the story of the Benedictines, their prestige at Salerno might seem to be enough of itself to preclude all possibility of the education of women in medicine at Salerno. For those who know the Benedictines well, however, such a departure as the accordance of opportunities for women to study medicine would seem eminently in keeping with the practical wisdom of their rules and the development of their work. From the beginning the Benedictines recognized that a monastic career should be open to women as well as to men, and Benedict's sister, Scholastica, established convents for them, as her brother did the Benedictine monasteries, thus providing a vocation for women who did not feel called upon to marry. That the members of the order should recognize the advisability of affording women the opportunity to study medicine, and of handing over to them the department of women's diseases in a medical school in which they had a considerable amount of authority, seems, then, indeed, only what might have been expected of them. We are prone in the modern time to think that our generation is the first to offer to women any facilities or opportunities for education in medicine. We are prone, however, just in the same way, to consider that a number of things that we are doing are now being done for the first time. As a matter of fact, it is extremely difficult to find any important movement or occupation that is not merely a repetition of a previous interest of mankind. The whole question of feminine education we are apt to think of as modern, forgetting that Plato insisted in his "Republic," as absolutely as any modern feminist, that women should have the same opportunities for education as men, and that at Rome, at the end of the Republic and the beginning of the Empire, the women occupied very much the same position in social life as our own at the present time. Their husbands supplied the funds, and they patronized the artists, gave receptions to the poets, lionized the musicians, and, in general, "went after culture" in a way that is a startling reminder of what we are familiar with in our own time. Just as soon as Christianity began to influence education, women were given abundant opportunities for higher education in all forms. In Ireland, the first nation completely converted to Christianity,--where, therefore, the national policy in education could be shaped by the Church without hindrance,--St. Brigid's school at Kildare was scarcely less famous than St. Patrick's at Armagh. It had several thousand students, and, to a certain extent at least, co-education existed. In Charlemagne's time, with the revival of education on the Continent, the women of the Imperial Court attended the Palace School, as well as the men. In the thirteenth century we find women professors in every branch at Italian universities. Some of them were at least assistants in anatomy. The Renaissance women were, of course, profoundly educated. In a word, we have many phases of feminine education, though with intervals of absolutely negative interest, down the centuries. There had evidently been quite a considerable amount of opportunity, if not of actual encouragement, for women in medicine, both among the Greeks and the Romans, in the early centuries of the Christian era. Galen, for instance, quotes certain prescriptions from women physicians. One Cleopatra is said to have written a book on cosmetics. This name came afterwards to be confounded with that of Queen Cleopatra, giving new prestige to the book, but neither Galen nor Aëtius, the early Christian physician, both of whom quote from her work, speak of her as anything except a medical writer. Some monuments to women physicians from these old times have escaped the tooth of time. There was the tomb of one Basila, and also of a Thecla, both of whom are said to have been physicians. Two other names of Greek women physicians we have, Origenia and Aspasia, the former mentioned by Galen, the latter by Aëtius in his "Tetrabiblion." Daremberg, the medical historian, announced in 1851 that he had found a Greek manuscript with the title, "On Women's Diseases," written by one Metrodora, a woman physician. He promised to publish it. It was unpublished at the time of his death, but could not be found among his papers. There is a manuscript on medical subjects, bearing this name, mentioned in the catalogue of the Greek Codices of the Laurentian Library at Florence, but this is said to give no indication of the time when its author lived. We have evidence enough, however, to show that Greek women physicians were not very rare. The Romans imitated the Greeks so faithfully--one might almost say copied them so closely--that it is not surprising to find a number of Roman women physicians. The first mention of them comes from Scribonius Largus, in the first century after Christ. Octavius Horatianus, whom most of us know better as Priscian, dedicated one of his books on medicine to a woman physician named Victoria. The dedication leaves no doubt that she was a woman in active practice, at least in women's diseases, and it is a book on this subject that Priscian dedicates to her. He mentions another woman physician, Leoparda. The word _medica_ for a woman physician was very commonly used at Rome. Martial, whose epigrams have been a source of so much information in medical history, especially on subjects with regard to which information was scanty, mentions a _medica_ in an epigram. Apuleius also uses the word. There are a number of inscriptions in which women physicians are mentioned. Among the Christians we find women physicians, and Theodosia, the mother of St. Procopius, the martyr, is said to have been very successful in the practice of both medicine and surgery. She is numbered among the martyrs, and occurs in the Roman Martyrology on the 29th of May. Father Bzowski, the Polish Jesuit, who compiled "Nomenclatura Sanctorum Professione Medicorum" (Rome, 1621; the book is usually catalogued under the Latin form of his name, Bzovius), has among his list of saints who were physicians by profession a woman, St. Nicerata, who lived at Constantinople in the reign of the Emperor Arcadius, and who is said to have cured St. John Chrysostom of a serious disease. The organization of the department of women's diseases at Salerno, under the care of women professors, and the granting of licenses to women to practise medicine, is not so surprising in the light of this tradition among Greeks and Romans, taken up with some enthusiasm by the Christians. We are not sure just when this development took place. The first definite evidence with regard to it comes in the life of Trotula, who seems to have been the head of the department. Some of her books are well known, and often quoted from, and she contributed to a symposium on the treatment of disease, in which there are contributions, also, from men professors of Salerno at the time. She seems to have flourished about the middle of the eleventh century. Ordericus Vitalis, a monk of Utica, who wrote an ecclesiastical history, tells of one Rudolph Malcorona, who, in 1059, came to Utica and remained there for a long time with Father Robert, his nephew. "This Rudolph had been a student all his life, devoting himself with great zeal to letters, and had become famous for his visits to the schools of France and Italy, in order to gather there the secrets of learning. As a consequence he was well informed not only in grammar and dialectics, but also in astronomy and in music. He also possessed such an extensive knowledge of the natural sciences that in the town of Salerno, where, since ancient times, the best schools of medicine had existed, there was no one to equal him with the exception of a very wise matron." This wise matron has been identified with Trotula, many of the details of whose life have been brought to light by De Renzi, in his "Story of the School of Salerno."[11] According to very old tradition, Trotula belonged to the family of Ruggiero. This was a noble family of Salerno, many of the members of which were distinguished in their native town at least, but the name is not unusual in Italy, as readers of Dante and Boccaccio are likely to know. It was, indeed, as common as our own Rogers, of which it is the Italian equivalent. De Renzi has made out a rather good case for the tradition that Trotula was the wife of John Platearius I--so called because there were probably three professors of that name. Trotula was, according to this, the mother of the second Platearius, and the grandmother of the third, all of them distinguished members of the faculty at Salerno. Her reputation extended far beyond her native town, and even Italy itself, and, in later centuries, her name was used to dignify any form of treatment for women's diseases that was being exploited. Rutebeuf, one of the _trouvères_, thirteenth-century French poets, has a description of the scene in which one of the old herbalist doctors who used to go round and collect a crowd by means of songs and music, and then talk medicine to them--just as is done even yet in many of the smaller towns of this country--is represented as saying to the crowd when he wants to make them realize that he is no ordinary quacksalver, that he is one of the disciples of the great Madame Trot of Salerno. The old-fashioned speech runs somewhat as follows: "Charming people: I am not one of these poor preachers, nor the poor herbalists, who carry little boxes and sachets, and who spread out before them a carpet. I am the disciple of a great lady, who bears the name of Madame Trot of Salerno. And I would have you know that she is the wisest woman in all the four quarters of the world." Two books are attributed to Trotula; one bears the title, "De Passionibus Mulierum," and the other has been called "Trotula Minor," or "Summula Secundum Trotulam," and is a compendium of what she wrote. This is probably due to some disciple, but seems to have existed almost in her own time. Her most important work bears two sub-titles, "Trotula's Unique Book for the Curing of Diseases of Women, Before, During, and After Labor," and the other sub-title, "Trotula's Wonderful Book of Experience (_experimentalis_) in the Diseases of Women, Before, During, and After Labor, with Other Details Likewise Relating to Labor." The book begins with a prologue on the nature of man and of woman, and an explanation of how the author, taking pity on the sufferings of women, came to devote herself to the study of their diseases. There are many interesting details in the book, all the more interesting because in many ways they anticipate modern solutions of difficult problems in women's diseases, and the care of the mother and child before, during, and after labor. For instance, there are a series of rules on the choice of the nurse, and on the diet and the régime which she should follow if the child is to be properly nourished without disturbance. Probably the most striking passage in her book is that with regard to a torn perineum and its repair. This passage may be found in De Renzi or in Gurlt. It runs as follows: "Certain patients, from the severity of the labor, run into a rupture of the genitalia. In some even the vulva and anus become one foramen, having the same course. As a consequence, prolapse of the uterus occurs, and it becomes indurated. In order to relieve this condition, we apply to the uterus warm wine in which butter has been boiled, and these fomentations are continued until the uterus becomes soft, and then it is gently replaced. After this the tear between the anus and vulva we sew in three or four places with silk thread. The woman should then be placed in bed, with the feet elevated, and must retain that position, even for eating and drinking, and all the necessities of life, for eight or nine days. During this time, also, there must be no bathing, and care must be taken to avoid everything that might cause coughing, and all indigestible materials." There is a passage, also, almost more interesting with regard to prophylaxis of rupture of the perineum. She says, "In order to avoid the aforesaid danger, careful provision should be made, and precautions should be taken during labor somewhat as follows: A cloth should be folded in somewhat oblong shape, and placed on the anus, so that, during every effort for the expulsion of the child, that should be pressed firmly, in order that there may not be any solution of the continuity of tissue." Her book contains, also, some directions for various cosmetics. How many of these are original, however, is difficult to say. Trotula's name had become a word to conjure with, and many a quack in the after time tried to make capital for his remedies in this line by attributing them to Trotula. As a consequence, many of these remedies gradually found their way into the manuscript copies of her book, and subsequent copyists incorporated them into the text, until it became practically impossible to determine which were original. There are manuscripts of Trotula's work in Florence, Vienna, and Breslau. Some of these contain chapters not in the others, undoubtedly added by subsequent hands. In one of these, that at Florence, from which the edition of Strasburg was printed in 1544, and of Venice, 1547, one of the Aldine issues, there is a mention in the last chapter of spectacles. We have no record of these until the end of the thirteenth century, when this passage was probably added. It was also printed at Basle, 1566, and at Leipzig as late as 1778, which would serve to show how much attention it has attracted even in comparatively recent times. After Trotula we have a number of women physicians of Salerno whose names have come down to us. The best known of these bear the names Constanza, Calendula, Abella, Mercuriade, Rebecca Guarna, who belonged to the old Salernitan family of that name, a member of which, in the twelfth century, was Romuald, priest, physician, and historian, Louise Trencapilli, and others. The titles of some of their books, as those of Mercuriade, who occupied herself with surgery as well as medicine, and who is said to have written on "Crises," on "Pestilent Fever," on "The Cure of Wounds," and of Abella, who acquired a great reputation with her work on "Black Bile," and on the "Nature of Seminal Fluid," have come down to us. Rebecca Guarna wrote on "Fevers," on the "Urine," and on the "Embryo." The school of Salernitan women came to have a definite place in medical literature. While, as teachers, they had charge of the department of women's diseases, their writings would seem to indicate that they studied all branches of medicine. Besides, there are a number of licenses preserved in the archives of Naples in which women are accorded the privilege of practising medicine. Apparently these licenses were without limitation. In many of these mention is made of the fact that it seems especially fitting that women should be allowed to practise in women's diseases, since they are by constitution likely to know more and to have more sympathy with feminine ills. The formula employed as the preamble of this license ran as follows: "Since, then, the law permits women to exercise the profession of physicians, and since, besides, due regard being had to purity of morals, women are better suited for the treatment of women's diseases, after having received the oath of fidelity, we permit, etc." Salerno continued to enjoy a reputation for training women physicians thoroughly, until well on in the fifteenth century, for we have the record of Constance Calenda, the daughter of Salvator Calenda, who had been dean of the faculty of medicine at Salerno about 1415, and afterwards dean of the faculty at Naples. His daughter, under the diligent instruction of her father, seems to have obtained special honors for her medical examination. Not long after this, Salerno itself lost all the prestige that it had. The Kings of Naples endeavored to create a great university in their city in the thirteenth century. They did not succeed to the extent that they hoped, but the neighboring rival institution hurt Salerno very much, and its downfall may be traced from this time. Gradually its reputation waned, and we have practically no medical writer of distinction there at the end of the fourteenth century, though the old custom of opportunities for women students of medicine was maintained. This custom seems also to have been transferred to Naples, and licenses to practise were issued to woman graduates of Naples. This never achieved anything like the reputation in this department that had been attained at Salerno. Salerno influenced Bologna and the north Italian universities profoundly in all branches of medicine and medical education, particularly in surgery, as can be seen in the chapter on "Great Surgeons of the Medieval Universities," and the practice of allowing such women as wished to study medicine to enter the university medical schools is exemplified in the case of Mondino's assistant in anatomy, Alessandra Giliani, though there are also others whose names have come down to us. The University of Salerno had developed round a medical school. It was the first of the universities, and, in connection with its medical school, feminine education obtained a strong foothold. It is not surprising, then, that with the further development of universities in Italy, feminine education came to be the rule. This rule has maintained itself all down the centuries in Italy, so that there has not been a single century since the twelfth in which there have not been one or more distinguished women teachers at the Italian universities. University life gradually spread westward, and Paris came into existence as an organized institution of learning after Bologna, and, doubtless, with some of the traditions of Salerno in the minds of its founders. Feminine education, however, did not spread to the West. This is a little bit difficult to understand, considering the reverence that the Teutonic peoples have always had for their women folk and the privileges accorded them. A single unfortunate incident, that of Abélard and Héloïse, seems to have been sufficient to discourage efforts in the direction of opportunities for feminine education in connection with the Western universities. Perhaps, in the less sophisticated countries of the North and West of Europe, women did not so ardently desire educational opportunities as in Italy, for whenever they have really wanted them, as, indeed, anything else, they have always obtained them. In spite of the absence of formal opportunities for feminine education in medicine at the Western universities, a certain amount of scientific knowledge of diseases, as well as valuable practical training in the care of the ailing, was not wanting for women outside of Italy. The medical knowledge of the women of northern France and Germany and England, however, though it did not receive the stamp of a formal degree from the university and the distinction of a license to practise, was none the less thorough and extensive. It came in connection with certain offices in their own communities, held by members of religious orders. Genuine information with regard to what the religious were doing during the Middle Ages was so much obscured by the tradition of laziness and immorality, created at the time of the so-called reformation in order to justify the confiscation of their property by those whose one object was to enrich themselves, that we have only come to know the reality of their life and accomplishments in comparatively recent years. We now know that, besides being the home of most of the book knowledge of the earlier Middle Ages, the monasteries were the constant patrons of such practical subjects as architecture, agriculture in all its phases, especially irrigation, draining, and the improvement of land and crops; of art, and even what we now know as physical science. Above all, they preserved for us the old medical books and carried on medical traditions of practice. The greatest surprise has been to find that this was true not only for the monks, but also for the nuns. One of the most important books on medicine that has come to us from the twelfth century is that of a Benedictine abbess, since known as St. Hildegarde, whose life was spent in the Rhineland. Her works serve to show very well that in the convents of the tenth, eleventh, and twelfth centuries there was much more of interest in things intellectual than we have had any idea of until recent years, and that, indeed, one of the important occupations of convent life was the serious study of books of all kinds, some of them even scientific, as well as the writing of works in all departments. The century before St. Hildegarde there is the record of Hroswitha, who wrote a series of dramas in imitation of Terence, that were meant to replace, for the monks and nuns of that period, the reading of that rather too human author. Hroswitha, like Hildegarde, was a German, and we have the record, also, of another religious writer, abbess of the Odilian Cloister, at Hohenberg, who wrote a book called "Hortus Deliciarum, the Garden of Delights," a book of information on many subjects not unlike our popular encyclopedias of the modern time, the title of which shows that the place of information in life was considered to be the giving of pleasure. While this work deals mainly with Biblical and theological and mystical questions, there are many purely scientific passages and many subjects of strictly medical interest treated. The life of the Abbess Hildegarde is worthy of consideration, because it illustrates the period and makes it very clear that, in spite of the grievous misunderstanding of their life and work, so common in the modern time, these old-time religious had most of the interests of the modern time, and pursued them with even more than modern zeal and success, very often. Her career illustrates very well what the foundation of the Benedictines had done for women. When St. Benedict founded his order for men, his sister, Scholastica, wanted to do a similar work for women. We know that the Benedictine monks saved the old classics for us, kept burning the light of the intellectual life, and gave a refuge to men who wanted to devote themselves in leisure and peace to the things of the spirit, whether of this world or the other. We have known much less of the Benedictine nuns until now the study of their books shows that they provided exactly the same opportunities for women and furnished a vocation, a home, an occupation of mind, and a satisfaction of spirit for the women who, in every generation, do not feel themselves called to be wives and mothers, but who want to live their lives for others rather than for themselves and their kin, seeking such development of mind and of spirit as may come with the leisure and peace of celibacy. Hildegarde was born of noble parents at Böckelheim, in the county of Sponheim, about the end of the eleventh century (probably 1098). In her eighth year she went for her education to the Benedictine cloister of Disibodenberg. When her education was finished, she entered the cloister, of which, at the age of about fifty, she became abbess. Her writings, reputation for sanctity, and her wise saintly rule attracted so many new members to the community that the convent became overcrowded. Accordingly, with eighteen of her nuns, Hildegarde withdrew to a new convent at Rupertsberg, which English and American travellers will remember because it is not far from Bingen on the Rhine. Here she came to be a centre of attraction for most of the world of her time. She was in active correspondence with nearly every important man of her generation. She was an intimate friend of Bernard of Clairvaux, who was himself, perhaps, the most influential man in Europe in this century. She was in correspondence with four Popes, and with the Emperors Conrad and Frederick I, and with many distinguished archbishops, abbots, and abbesses, and teachers and teaching bodies of various kinds. These correspondences were usually begun by her correspondents, who consulted her because her advice in difficult problems was considered so valuable. In spite of all this time-taking correspondence, she found leisure to write a series of books, most of them on mystical subjects, but two of them on medical subjects. The first is called "Liber Simplicis Medicinæ," and the second "Liber Compositæ Medicinæ." These books were written in order to provide information mainly for the nuns who had charge of the infirmaries of the monasteries of the Benedictines. Almost constantly someone in the large communities, which always contained aged religious, was ailing, and then, besides, there were other calls on the time and the skill of the sister infirmarians. There were no hotels at that time, and no hospitals, except in the large cities. There were always guest houses in connection with monasteries and convents, in which travellers were permitted to pass the night, and given what they needed to eat. There are many people who have had experiences of monastic hospitality even in our own time. Sometimes travellers fell ill. Not infrequently the reason for travelling was to find health in some distant and fabulously health-giving resort, or at the hands of some wonder-working physician. Such high hopes are nearly always set at a distance. This of itself must have given not a little additional need for knowledge of medicine to the infirmarians of convents and monasteries. There were around many of the monasteries, moreover, large estates; often they had been cleared and made valuable by the work of preceding generations of monks, and on these estates peasants came to live. Workingmen and workingwomen from neighboring districts came to help at harvest time, and, after a chance meeting, were married and settled down on a little plot of ground provided for them near the monastery. As these communities grew up, they looked to the monasteries and convents for aid of all kinds, and turned to them particularly in times of illness. The need for definite instruction in medicine on the part of a great many of the monks and nuns can be readily understood, and it was this need that Hildegarde tried to meet in her books. The first of her books that we have mentioned, the "Liber Simplicis Medicinæ," attracted attention rather early in the Renaissance, and was deemed worthy of print. It was edited at the beginning of the sixteenth century by Dr. Schott at Strasburg, under the title, "Physica S. Hildegardis." Another manuscript of this part was found in the library of Wolfenbuttel, in 1858, by Dr. Jessen. This gave him an interest in Hildegarde's contributions to medicine, and, in 1859, he noted in the library at Copenhagen a manuscript with the title "Hildegardi Curæ et Causæ." On examination, he was sure that it was the "Liber Compositæ Medicinæ" of the saint. The first work consists of nine books, treating of plants, elements, trees, stones, fishes, birds, quadrupeds, reptiles, and metals, and is printed in Migne's "Patrologia," under the title "Subtilitatum Diversarum Naturarum Libri Novem." The second, in five books, treats of the general diseases of created things, of the human body and its ailments, of the causes, symptoms, and treatment of diseases. It would be very easy to think that these are small volumes and that they contain very little. We are so apt to think of old-fashioned so-called books as scarcely more than chapters, that it may be interesting to give some idea of the contents and extent of the first of these works. The first book on Plants has 230 chapters, the second on the Elements has 13 chapters, the third on Trees has 36 chapters, the fourth on various kinds of Minerals, including precious stones, has 226 chapters, the fifth on Fishes has 36 chapters, the sixth on Birds has 68 chapters, the seventh on Quadrupeds has 43 chapters, the eighth on Reptiles has 18 chapters, the ninth on Metals has 8 chapters. Each chapter begins with a description of the species in question, and then defines its value for man and its therapeutic significance. Modern scientists have not hesitated to declare that the descriptions abound in observations worthy of a scientific inquiring spirit. We are, of course, not absolutely sure that all the contents of the books come from Hildegarde. Subsequent students often made notes in these manuscript books, and then other copyists copied these into the texts. Unfortunately we have not a number of codices to collate and correct such errors. Most of what Hildegarde wrote comes to us in a single copy, of none are there more than four copies, showing how near we came to missing all knowledge of her entirely. Dr. Melanie Lipinska, in her "Histoire des Femmes Médecins," a thesis presented for the doctorate in medicine at the University of Paris in 1900, subsequently awarded a special prize by the French Academy, reviews Hildegarde's work critically from the medical standpoint. She says that the saint distinguishes a double mode of action of different substances, one chemical, the other physical, or what we would very probably call magnetic. She discusses all the ailments of the various organs, the brain, the eyes, the teeth, the heart, the spleen, the stomach, the liver. She has special chapters on redness and paleness of the face, on asthma, on cough, on fetid breath, on bilious indigestion, on gout. Besides, she has other chapters on nervous affections, on icterus, on fevers, on intestinal worms, on infections due to swamp exhalations, on dysentery, and a number of forms of pulmonary diseases. Nearly all of our methods of diagnosis are to be found, hinted at at least, in her book. She discusses the redness of the blood as a sign of health, the characteristics of various excrementitious material as signs of disease, the degrees of fever, and the changes in the pulse. Of course, it was changes in the humors of the body that constituted the main causes for disease in her opinion, but it is well to remind ourselves that our frequent discussion of auto-intoxication in recent years is a distinct return to this. Some of Hildegarde's anticipations of modern ideas are, indeed, surprising enough. For instance, in talking about the stars and describing their course through the firmament, she makes use of a comparison that is rather startling. She says: "Just as the blood moves in the veins which causes them to vibrate and pulsate, so the stars move in the firmament and send out sparks as it were of light like the vibrations of the veins." This is, of course, not an anticipation of the discovery of the circulation of the blood, but it shows how close were men's ideas to some such thought five centuries before Harvey's discovery. For Hildegarde the brain was the regulator of all the vital qualities, the centre of life. She connects the nerves in their passage from the brain and the spinal cord through the body with manifestations of life. She has a series of chapters with regard to psychology normal and morbid. She talks about frenzy, insanity, despair, dread, obsession, anger, idiocy, and innocency. She says very strongly in one place that "when headache and migraine and vertigo attack a patient simultaneously they render a man foolish and upset his reason. This makes many people think that he is possessed of a demon, but that is not true." These are the exact words of the saint as quoted in Mlle. Lipinska's thesis. It is no wonder that Mlle. Lipinska thinks St. Hildegarde the most important medical writer of her time. Reuss, the editor of the edition of Hildegarde published in Migne's "Patrology," says: "Among all the saintly religious who have practised medicine or written about it in the Middle Ages, the most important is without any doubt St. Hildegarde...." With regard to her book he says: "All those who wish to write the history of the medical and natural sciences must read this work in which this religious woman, evidently well grounded in all that was known at that time in the secrets of nature, discusses and examines carefully all the knowledge of the time." He adds, "It is certain that St. Hildegarde knew many things that were unknown to the physicians of her time." When such books were read and widely copied, it shows that there was an interest in practical and scientific medicine among women in Germany much greater than is usually thought to have existed at this time. Such writers, though geniuses, and standing above their contemporaries, usually represent the spirit of their times and make it clear that definite knowledge of things medical was considered of value. The convents and monasteries of this time are often thought of by those who know least about them as little interested in anything except their own ease and certain superstitious practices. As a matter of fact, they cared for their estates, and especially for the peasantry on them, they provided lodging and food for travellers, they took care of the ailing of their neighborhood, and, besides, occupied themselves with many phases of the intellectual life. It was a well-known tradition that country people who lived in the neighborhood of convents and monasteries, and especially those who had monks and nuns for their landlords, were much happier and were much better taken care of than the tenantry of other estates. For this a cultivation of medical knowledge was necessary in certain, at least, of the members of the religious orders, and such books as Hildegarde's are the evidence that not only the knowledge existed, but that it was collected and written down, and widely disseminated. Nicaise, in the introduction to his edition of Guy de Chauliac's "Grande Chirurgie," reviews briefly the history of women in medicine, and concludes: "Women continued to practise medicine in Italy for centuries, and the names of some who attained great renown have been preserved for us. Their works are still quoted from in the fifteenth century. "There was none of them in France who became distinguished, but women could practise medicine in certain towns at least on condition of passing an examination before regularly appointed masters. An edict of 1311, at the same time that it interdicts unauthorized women from practising surgery, recognizes their right to practise the art if they have undergone an examination before the regularly appointed master surgeons of the corporation of Paris. An edict of King John, April, 1352, contains the same expressions as the previous edict. Du Bouley, in his 'History of the University of Paris,' gives another edict by the same King, also published in the year 1352, as a result of the complaints of the faculties at Paris, in which there is also question of women physicians. This responded to the petition: 'Having heard the petition of the Dean and the Masters of the Faculty of Medicine at the University of Paris, who declare that there are very many of both sexes, some of the women with legal title to practise and some of them merely old pretenders to a knowledge of medicine, who come to Paris in order to practise, be it enacted,' etc. (The edict then proceeds to repeat the terms of previous legislation in this matter.) "Guy de Chauliac speaks also of women who practised surgery. They formed the fifth and last class of operators in his time. He complains that they are accustomed to too great an extent to give over patients suffering from all kinds of maladies to the will of Heaven, founding their practice on the maxim 'The Lord has given as he has pleased; the Lord will take away when he pleases; may the name of the Lord be blessed.' "In the sixteenth century, according to Pasquier, the practice of medicine by women almost entirely disappeared. The number of women physicians becomes more and more rare in the following centuries just in proportion as we approach our own time. Pasquier says that we find a certain number of them anxious for knowledge and with a special penchant for the study of the natural sciences and even of medicine, but very few of them take up practice." Just how the lack of interest in medical education for women gradually deepened, until there was almost a negative phase of it, only a few women in Italy devoting themselves to medicine, is hard to say. It is one of the mysteries of the vicissitudes of human affairs that ups and downs of interest in things practical as well as intellectual keep constantly occurring. The number of discoveries and inventions in medicine and surgery that we have neglected until they were forgotten, and then had to make again, is so well illustrated in chapters of this book, that I need only recall them here in general. It may seem a little harder to understand that so important a manifestation of interest in human affairs as the education and licensure of women physicians should not only cease, but pass entirely out of men's memory, yet such apparently was the case. It would not be hard to illustrate, as I have shown in "Cycles of Feminine Education and Influence" in "Education, How Old the New" (Fordham University Press, 1910), that corresponding ups and downs of interest may be traced in the history of feminine education of every kind. In that chapter I have discussed the possible reasons for these vicissitudes, which have no place here, but I may refer those who are interested in the subject to that treatment of it. IX MONDINO AND THE MEDICAL SCHOOL OF BOLOGNA The most important contributions to medical science made by the Medical School of Salerno at the height of its development were in surgery. The text-books written by men trained in her halls or inspired by her teachers were to influence many succeeding generations of surgeons for centuries. Salerno's greatest legacy to Bologna was the group of distinguished surgical teachers whose text-books we have reviewed in the chapter, "Great Surgeons of the Medieval Universities." Bologna herself was to win a place in medical history, however, mainly in connection with anatomy, and it was in this department that she was to provide incentive especially for her sister universities of north Italy, though also for Western Europe generally. The first manual of dissection, that is, the first handy volume giving explicit directions for the dissection of human cadavers, was written at Bologna. This was scattered in thousands of copies in manuscript all over the medical world of the fourteenth and early fifteenth centuries. Even after the invention of printing, many editions of it were printed. Down to the sixteenth century it continued to be the most used text-book of anatomy, as well as manual of dissection, which students of every university had in hand when they made their dissection, or wished to prepare for making it, or desired to review it after the body had been taken away, for with lack of proper preservative preparation, bodies had to be removed in a comparatively short time. Probably no man more influenced the medical teaching of the fourteenth and fifteen centuries than Mundinus, or, as he was called in the Italian fashion, Mondino, who wrote this manual of dissection. _Mundinus quem omnis studentium universitas colit ut deum_ (Mundinus, whom all the world of students cultivated as a god), is the expression by which the German scholar who edited, about 1500, the Leipzig edition of Mundinus' well-known manual, the _Anathomia_, introduces it to his readers. The expression is well worth noting, because it shows what was still the reputation of Mundinus in the medical educational world nearly two centuries after his death.[12] Until the time of Vesalius, whose influence was exerted about the middle of the sixteenth century, Mondino was looked up to by all teachers as the most important contributor to the science of anatomy in European medicine since the Greeks. He owed his reputation to two things: his book, of which we have already spoken, and then, the fact that he reintroduced dissection demonstrations as a regular practice in the medical schools. His book is really a manual of making anatomical preparations for demonstration purposes. These demonstrations had to be hurried, owing to the rapid decomposition of material consequent upon the lack of preservatives. The various chapters were prepared with the idea of supplying explicit directions and practical help during the anatomical demonstrations, so that these might be made as speedily as possible. The book does not comprise much that was new at that time, but it is a good compendium of previous knowledge, and contains some original observations. It was entirely owing to its form as a handy manual of anatomical knowledge and, besides, because it was an incentive to the practice of human dissection, that it attained and maintained its popularity. Mondino followed Galen, of course, and so did every other teacher in medicine and its allied sciences, until Vesalius' time. Even Vesalius permitted himself to be influenced overmuch by Galen at points where we wonder that he did not make his observations for himself, since, apparently, they were so obvious. The more we know of Galen, however, the less surprised are we at his hold over the minds of men. Only those who are ignorant of Galen's immense knowledge, his practical common sense, and the frequent marvellous anticipations of what we think most modern, affect to despise him. His works have never been translated into any modern language except piecemeal, there is no complete translation, and one must be ready to delve into some large Latin, if not Greek, volumes to know what a marvel of medical knowledge he was, and how wise were the men who followed him closely, though, being human, there are times when necessarily he failed them. For those who know even a little at first hand of Galen, it is only what might be expected, then, that Mondino, trying to break away from the anatomy of the pig, which had been before this the basis of all anatomical teaching in the medical schools (Copho's book, used at Salerno and Bologna before Mondino's was founded on dissections of the pig), should have clung somewhat too closely to this old Greek teacher and Greek master. The incentive furnished by Mondino's book helped to break the tradition of Galen's unquestioned authority. Besides this, the group of men around Mondino, his master, Taddeo Alderotti, with his disciples and assistants, form the initial chapter in the history of the medical school of Bologna, which gradually assumed the place of Salerno at this time. There is no better way of getting a definite idea of what was being done in medicine, and how it was being done, than by knowing some of the details of the life of this group of medical workers. Mondino di Liucci, or Luzzi, is usually said to have been born about 1275. His first name is a diminutive for Raimondo. It used to be said of him that, like many of the great men of history, many cities claimed to be his birthplace. Five were particularly mentioned--Florence, Milan, Bologna, Forli, and Friuli. There is, however, another Mondino, a distinguished physician, who was born and lived at Friuli, and it is because of confusion with him that the claim for Friuli has been set up. Florence and Milan are considered out of the question. Mondino was probably born in or near Bologna. The fact that there should have been this multiple set of claims shows how much was thought of him. Indeed, his was the best known name in the medical schools of Europe for nearly two centuries and a half. He seems to have been a particularly brilliant student, for tradition records that he had obtained his degree of doctor of medicine when he was scarcely more than twenty. This seems quite out of the question for us at the present time, but we have taken to pushing back the time of graduation, and it is not sure whether this is, beyond peradventure, so beneficial as is usually thought. That his early graduation did not hamper his intellectual development, the fact that, in 1306, when he was about thirty-one years of age, he was offered the professorial chair in anatomy, which he continued to occupy with such distinction for the next twenty years, would seem to prove. His public dissections of human bodies, probably the first thus regularly made, attracted widespread attention, and students came to him not only from all over Italy, but also from Europe generally. In this, after all, Mondino was only continuing the tradition of world teaching that Bologna had acquired under her great surgeons in the preceding century. (See "Great Surgeons of the Medieval Universities.") Mondino came from a family that had already distinguished itself in medicine at Bologna. His uncle was a professor of physic at the university. His father, Albizzo di Luzzi, seems to have come from Florence not long after the middle of the thirteenth century, for the records show that, about 1270, he formed a partnership with one Bartolommeo Raineri for the establishment of a pharmacy at Bologna. Later this passed entirely under the control of the Mondino family, and came to be known as the Spezieria del Mondino. In it were sold, besides Eastern perfumes, spices, condiments, probably all sorts of toilet articles, and even rugs and silks and feminine ornaments. The stricter pharmacy of the earlier times developed into a sort of department store, something like our own. The Mondini, however, insisted always on the pharmacy feature as a specialty, and the fact was made patent to the general public by a sign with the picture of a doctor on it. This drug shop of the Mondini continued to be maintained as such, according to Dr. Pilcher, until the beginning of the nineteenth century.[13] One of the fellow students of Mondino at the University of Bologna had been Mondeville. He came from distant France to take a course in surgery with Theodoric, whose high reputation in the olden time, vague with us half a century ago, is now amply justified by what we know of him from such ardent students and admirers as Pagel and Nicaise. Not long after Mondino's death, Guy de Chauliac came from France to reap similar opportunities to these, which had proved so fruitful for Mondeville. The more that we learn about this time the more do we find to make it clear how deeply interested the generation was in education in every form, artistic, philosophic, but, also, though this is often not realized, scientific. The long distances, so much longer in that time than in ours, to which men were willing, and even anxious, to go, in order to obtain opportunities for research, and to get in touch with a special master, the associations with stimulating fellow pupils of other lands, the scientific correspondences, almost necessarily initiated by such circumstances, all indicate an enthusiasm for knowledge such as we have not been accustomed to attribute to this period. On the contrary, we have been rather inclined to think them neglectful of all education, and have, above all, listened acquiescently while men deprecated the lack of interest in things scientific displayed by these generations. Indeed, many writers have gone out of their way to find a reason for the supposed lack of interest in science at this time, and have proclaimed the Church's opposition to scientific education and study as the cause. At this time Italy was the home of the graduate teaching for all Europe. The Italian Peninsula continued to be the foster-mother of the higher education in letters and art, but also, though this is less generally known, in science, for the next five centuries. Germany has come to be the place of pilgrimage for those who want higher opportunities in science than can be afforded in their own country only during the latter half of the nineteenth century. France occupied it during the first half of the nineteenth century. Except for short intervals, when political troubles disturbed Italy, as about the middle of the fourteenth century, when the removal of the Popes to Avignon brought their influence for education over to France and a short period at the beginning of the eighteenth century, when the Netherlands for a time came into educational prominence, Italy has always been the European Mecca for advanced students. Practically all our great discoverers in medicine, until the last century, were either Italians, or else had studied in Italy. Mondino, Bertrucci, Salicet, Lanfranc, Baverius, Berengarius, John De Vigo, who first wrote on gun-shot wounds; John of Arcoli, first to mention gold filling and other anticipations of modern dentistry; Varolius, Eustachius, Cæsalpinus, Columbus, Malpighi, Lancisi, Morgagni, Spallanzani, Galvani, Volta, were all Italians. Mondeville, Guy de Chauliac, Linacre, Vesalius, Harvey, Steno, and many others who might be named, all studied in Italy, and secured their best opportunities to do their great work there. It would be amusing, if it were not amazing, to have serious writers of history in the light of this plain story of graduate teaching of science in Italy for over five centuries, write about the opposition of the Church to science during the Medieval and Renaissance periods. It is particularly surprising to have them talk of Church opposition to the medical sciences. The universities of the world all had their charters from the Popes at this time, and were all ruled by ecclesiastics, and most of the students and practically all of the professors down to the end of the sixteenth century belonged to the clerical order. The universities of Italy were all more directly under the control of ecclesiastical authority than anywhere else, and nearly all of them were dominated by papal influence. Bologna, while doing much of the best graduate work in science, especially in medicine, was, in the Papal States, absolutely under the rule of the Popes. The university was, practically, a department of the Papal government. The medical school at the University of Rome itself was for several centuries, at the end of the Middle Ages, the teaching-place where were assembled the pick of the great medical investigators, who, having reached distinction by their discoveries elsewhere, were summoned to Rome in order to add prestige to the Papal University. All of them became special friends of the Popes, dedicated their books to them, and evidently looked to them as beneficent patrons and hearty encouragers of original scientific research. While this is so strikingly true of medical science as to make contrary declarations in the matter utterly ridiculous, and to suggest at once that there must be some motive for seeing things so different to the reality, the same story can be told of graduate science in other departments. It was to Italy that men came for special higher studies in mathematics and astronomy, in botany, in mineralogy, and in applied chemistry, so far as it related to the arts of painting, illuminating, stained-glass making, and the like. No student of science felt that he had quite exhausted the opportunities for study that were possible for him until he had been down in Italy for some time. To meet the great professors in Italy was looked on as sure to be a source of special incentive in any department of science. This is coming to be generally recognized just in proportion as our own interest in the arts and crafts, and in the history of science, leads us to go carefully into the details of these subjects at first hand. The editors of the "Cambridge Modern History," in their preface, declared ten years ago that we can no longer accept with confidence the declaration of any secondary writer on history. This is particularly true of the medieval period. We must go back to the writers of those times. If it seems surprising that the University of Bologna should have come into such great prominence as an institute for higher education at this time, it would be well to recall some of the great work that is being done in this part of Italy in other departments at this time. Cimabue laid the foundation of modern art towards the end of the thirteenth century, and during Mondino's life Giotto, his pupil, raised an artistic structure that is the admiration of all generations of artists since. Dante's years are almost exactly contemporary with those of Giotto and of Mondino. If men were doing such wondrous work in literature and in art, why should not the same generation produce a man who will accomplish for the practical science of medicine what his friends and contemporaries had done in other great intellectual departments. In recent years we have come to think much more of environment as an influence in human development and accomplishment than was the custom sometime ago. The broader general environment in Italy, with genius at work in other departments, was certainly enough to arouse in younger minds all their powers of original work. The narrower environment at Bologna itself was quite as stimulating, for a great clinical teacher, Taddeo Alderotti, had come, in 1260, from Florence to Bologna, to take up there the practice and teaching of medicine. It was under him that Mondino was to be trained for his life work. To understand the place of Mondino, and of the medical school of Bologna, in his time, and the reputation that came to them as world teachers of medicine, we must know, first, this great teacher of Mondino and the atmosphere of progressive medicine that enveloped the university in the latter half of the thirteenth century. In the chapter on "Great Surgeons of the Medieval Universities" we call particular attention to the series of distinguished men, the first four of whom were educated at Salerno, and who came to Bologna to teach surgery. They were doing the best surgery in the world, much better than was done in many centuries after their time; indeed, probably better than at any period down to our own day. Besides, they seem to have been magnetic teachers who attracted and inspired pupils. We have the surgical contributions of a series of men, written at Bologna, that serve to show what fine work was accomplished. At this time, however, the field of medicine was not neglected, though we have but a single great historical name in it that has lived. This was Taddeo Alderotti, a man who lifted the medical profession as high in the estimation of his fellow citizens at Florence as the great painters and literary men of his time did their departments, and who then moved to Bologna, because of the opportunity to teach afforded him by the university. It is sometimes a little difficult for casual students of the time to understand the marvellous reputation acquired by this medieval physician. It should not be, however, when we recall the enthusiastic reception and procession of welcome accorded to Cimabue's Madonna, and the almost universal acclaim of the greatness of Dante's work, even in his own time. In something of that same spirit Bologna came to appreciate Taddeo, as he is familiarly known, looked upon him as a benefactor of the community, and voted to relieve him of the burden of paying taxes. He came to be considered as a public institution, whose presence was a blessing to his fellow citizens, and whose goodness to them should be recognized in this public way. One is not surprised to hear Villani, the well-known contemporary historian, speak of him as the greatest physician in Christendom. The feelings of the citizens of Bologna, it may well be confessed, were not entirely unselfish, or due solely to the desire to encourage a great scientific genius. Few men of his generation had done more for the city in a material way quite apart from whatever benefits he conferred upon the health of its citizens than Dr. Taddeo. It was he who organized medical teaching in the city on such a plane that it attracted students from all over the world. Bologna had had a great law school before this, founded by Irnerius, to which students had come from all over the world. With the advent of Taddeo from Florence, and his success as a medical practitioner, there began to flock to his lectures many students who spread his fame far and wide. The city council could scarcely do less than grant the same privileges to the medical students and teachers of Taddeo's school as they had previously accorded to the faculty of law and its students. The city council recognized quite as clearly as any board of aldermen in the modern time how much, even of material benefit, a great university was to the building up of a city, though their motives were probably much higher than that, and their enlightened policy had its reward in the rapid growth of Bologna until, very probably at the end of the thirteenth century, it had more students than any university of the modern time. The number was not less than fifteen thousand, and may have been twenty thousand. To this great university success Taddeo and his medical school contributed not a little. The especially attractive feature of his teaching seems to have been its eminent practicalness. He himself had made an immense success of the practice of medicine, and accumulated a great fortune, so much so that Dante, in his "Paradiso," when he wishes to find a figure that would represent exactly the opposite to what St. Dominic, the founder of the Dominicans, did for the love of wisdom and humanity, he takes that of Taddeo, who had accomplished so much for personal reputation and wealth. This might easily lead to the impression that Taddeo's teaching was unscientific, or merely empiric, or that he himself was a narrow-minded maker of money, intent only on his immediate influence, and hampered by exclusive devotion to practical medicine. Nothing could be farther from the truth than any such impression. Taddeo was not only the head of a great medical school, a great teacher whom his students almost worshipped, a physician to whom patients flocked because of his marvellous success, a fine citizen of a great city, whom his fellow citizens honored, but he was a broad-minded scholar, a philosopher, and even an author in branches apart from medicine. In that older time it was the custom to combine the study of philosophy and medicine. For centuries after that period in Italy it was the custom for men to take both degrees, the doctorate in philosophy and in medicine at the same time. Indeed, most of those whose work has made them famous, down to and including Galvani, did so. Taddeo wrote commentaries on the works of Hippocrates and Galen, but he also translated the ethics of Aristotle, and did much to make the learning of the Arabs easily available for his students. His was a broad, liberal scholarship. Dr. Lewis Pilcher, in his article on "The Mondino Myth,"[14] does not hesitate to say that "to the spirit which, from his professorial chair, Taddeo infused into the teaching and study of medicine undoubtedly is due the high position which for many generations thereafter the school of Bologna continued to maintain as a centre of medical teaching." Of course, erudition had its revenge, and carried Taddeo too far. The difficult thing in human nature is to stay in the mean and avoid exaggeration. His methods of illustrating medical truths from many literary and philosophical sources often caused the kernel of observation to be hidden beneath a blanket of speculation or, at least, to be concealed to a great extent. Even the Germans, who have insisted most on this unfortunate tendency of Taddeo, have been compelled to confess that there is much that is valuable in what he accomplished, and that even his modes of expression were not without a certain vivacity which attracted attention and doubtless added materially to his success as a teacher. Pagel, in Puschmann's "Handbuch," says: "It cannot be denied [this is just after he has quoted a passage of Taddeo with regard to dreams] that Taddeo's expressions have a certain liveliness all their own that gives us some idea why he was looked upon as so good a teacher, a teacher who, as we know now, also gave instruction by the bedside of patients." Pagel adds, "Taddeo's greatest merit and his highest significance in medical education consist in the fact that a great many (_zahlreiche_) physicians followed directly in his footsteps and were counted as his pupils. They were all men, as we know them, who as writers and practitioners of medicine succeeded in going far beyond the level of mediocrity in what they accomplished." This was the teacher who most influenced young Mondino when he came to the University of Bologna, for it seems not unlikely that as a medical student he was actually the pupil of Taddeo, then in a vigorous old age. If not, he was at least brought under the direct influence of the teaching tradition created during more than thirty years by that wonderful old man. Knowing what we do of Taddeo it is not surprising that his pupil should have accomplished work that was to influence succeeding generations more than any other of that wonderful thirteenth century. Dr. Pilcher in the article on "The Mondino Myth," so often placed under contribution in this sketch, says that "It needs no great stretch of the imagination to picture somewhat of the effect that contact with such a man as Taddeo di Alderotto[15] might have, in molding the character of his young neighbor and pupil, the chemist's son, who a few years later, by his devotion to the study of human anatomy, was to re-establish the practical pursuit of study on the human cadaver as the common privilege of the skilled physician, and was to engrave his own name deeply on the records of medicine." Under this worthy compatriot and contemporary of the great Florentines, Mondino was inspired to be the teacher that did so much for Bologna. Until recent years it has usually been the custom to give too much significance to the work of the men whose names stand out most prominently in the early history of departments of the intellectual life. Mondino's reputation has shared in this exaggerative tendency to some extent, hence the necessity for realizing what was accomplished before his time and the fact that he only stands as the culmination of a progressive period. Carlyle spoke of Dante as the man in whom "ten silent centuries found a voice." The centuries, however, were only silent because the moderns did not know how to listen to their message. We know now that every country in Europe had a great contributor to literature in the century before Dante. The Cid, the Arthur Legends, the Nibelungen, the Troubadours, naturally led up to Dante. He was only the culmination of a great period of literature. We know now that men had worked in art before Cimabue and Giotto, and had done impressive work that made for the progress of art. These names, however, have come to represent in many minds the sort of solitary phenomena that Dante has seemed sometimes even to scholars. Because Mondino did such good work in medical teaching it is sometimes declared, even in rather serious histories, that he was the first to accomplish anything in his department, and that before his time there is a blank. Some historians, for instance, have insisted that Mondino was the first to do human dissections, and that he did at most but two or three. Only those who are unacquainted with the magnificent development of surgery that took place during the preceding century, the evidence for which is so abundantly given in modern historians of medicine and especially in Gurlt's great work on the history of surgery, from which we have quoted enough to give a good idea of the extent to which the movement went, are likely to accept any such declaration. There could not have been all that successful surgery without much dissection not only of animals but also of human bodies. The teaching of dissection was not regularly organized until Mondino's time, but it seems very clear that even he must have dissected many more bodies than the number usually attributed to him. Professor Lewis Stephen Pilcher of Brooklyn, who made a special study of Mondino traditions in Bologna itself, and collected some of the early editions of his books, feels so acutely the absurdity of the ordinarily accepted tradition in this matter, that he has written a paper on the subject bearing the suggestive title, "The Mondino Myth." He says:[16] "We are accustomed to think of the practice of dissection as having been re-created by Mondino, and at once fully developed, springing into acceptance. The year 1315 is the generally accepted date for the first public anatomical demonstration upon a human body made by Mondino, and yet it is true that among the laws promulgated by Frederick II, more than seventy-five years before (A.D. 1231), was included a decree that a human body should be dissected at Salernum at least once in five years in the presence of the assembled physicians and surgeons of the kingdom, and that in the regulations established for admission to the practice of medicine and surgery in the kingdom it was decreed that no surgeon should be admitted to practise unless he should bring testimonials from the masters teaching in the medical faculty, that he was 'learned in the anatomy of human bodies, and had become perfect in that part of medicine without which neither incisions could safely be made nor fractures cured.' "Salernum was notable in its legalization of the dissection of human bodies before the first public work of Mondino, for, according to a document of the Maggiore Consiglio of Venice of 1308, it appears that there was a college of medicine at Venice which was even then authorized to dissect a body every year. Common experience tells us that the embodiment of such regulations into formal law would occur only after a considerable preceding period of discussion, and in this particular field of clandestine practice. It is too much to ask us to believe that in all this period, from the date of the promulgation of Frederick's decree of 1231 to the first public demonstration by Mondino, at Bologna in 1315, the decree had been a dead letter and no human body had been anatomized. It is true there is not, as far as I am aware, any record of any such work, and commentators and historians of a later date have, without exception, accepted the view that none was done, and thereby heightened the halo assigned to Mondino as the one who ushered in a new era. Such a view seems to me to be incredible. Be that as it may, it is undeniable that at the beginning of the 14th century the idea of dissecting the human body was not a novel one; the importance of a knowledge of the intimate structure of the body had already been appreciated by divers ruling bodies, and specific regulations prescribing its practice had been enacted. It is more reasonable to believe that in the era immediately preceding that of Mondino human bodies were being opened and after a fashion anatomized. All that we know of the work of Mondino suggests that it was not a new enterprise in which he was a pioneer, but rather that he brought to an old practice a new enthusiasm and better methods, which, caught on the rising wave of interest in medical teaching at Bologna, and preserved by his own energy as a writer in the first original systematic treatise written since the time of Galen, created for him in subsequent uncritical times the reputation of being the Restorer of the practice of anatomizing the human body, the first one to demonstrate and teach such knowledge since the time of the Ptolemaic anatomists, Erasistratus and Herophilus. "The changes have been rung by medical historians upon a casual reference in Mondino's chapter on the uterus to the bodies of two women and one sow which he had dissected, as if these were the first and the only cadavers dissected by him. The context involves no such construction. He is enforcing a statement that the size of the uterus may vary, and to illustrate it remarks that 'a woman whom I anatomized in the month of January last year, viz., 1315 Anno Christi, had a larger uterus than one whom I anatomized in the month of March of the same year.' And further, he says that 'the uterus of a sow which I dissected in 1316 (the year in which he was writing) was a hundred times greater than any I have seen in the human female, for she was pregnant and contained thirteen pigs.' These happen to be the only reference to specific bodies that he makes in his treatise. But it is a far cry to wring out of these references the conclusion that these are the only dissections he made. It is quite true that if we incline to enshroud his work in a cloud of mystery and to figure it as an unprecedented awe-inspiring feature to break down the prejudices of the ages, it is easy to think of him as having timidly profaned the human body by his anatomizing zeal in but one or two instances. His own language, however, throughout his book is that of a man who was familiar with the differing conditions of the organs found in many different bodies; a man who was habitually dissecting." (Quotations from the work of Mundinus showing his familiarity with dissections. The leaf and line references are to the Dryander edition, Marburg, 1541.) "I do not consider separately the anatomy of component parts, because their anatomy does not appear clearly in the fresh subject, but rather in those macerated in water." (Leaf 2, lines 8-13.) "... these differences are more noticeable in the cooked or perfectly dried body, and so you need not be concerned about them, and perhaps I will make an anatomy upon such a one at another time and will write what I shall observe with my own senses, as I have proposed from the beginning." (Leaf 60, lines 14-17.) "What the members are to which these nerves come cannot well be seen in such a dissection as this, but it should be liquefied with rain water, and this is not contemplated in the present body." (Leaf 60, lines 31-33.) "After the veins you will note many muscles and many large and strong cords, the complete anatomy of which you will not endeavor to find in such a body but in a body dried in the sun for three years, as I have demonstrated at another time; I also declared completely their number, and wrote the anatomy of the muscles of the arms, hands, and feet in a lecture which I gave over the first, second, third, and fourth subjects." (Leaf 61, lines 1-7.) Very probably the best evidence that we have of the comparative frequency at least of dissection at this time is to be found in the records of a trial for body-snatching that occurred in Bologna. The details would remind one very much of what we know of the difficulties with regard to dissection in America a couple of generations ago, when no bodies were provided by law for dissection purposes. In the course of some studies for the history of the New York State Medical Society (New York, 1906) I found that nearly every one of the first half dozen presidents of the New York Academy of Medicine, which is not much more than sixty years old, had had body-snatching experiences when they were younger. Dr. Samuel Francis, the medico-historical writer, tells of a personal expedition across the ferry in the winter time, bringing a body from a Long Island graveyard. In order to avoid the constables on the Long Island side and the police on the New York side, because there had been a number of cases of body-snatching recently and the authorities were on the lookout, the corpse was placed sitting beside the physician who drove the wagon, with a cloak wrapped around it, as if it were a living person specially protected against the cold. Similar experiences were not unusual. The lack of bodies for dissection is sometimes attributed to religious scruples, but they have very little to do with it, as at all times men have refused to allow the bodies of their friends to be treated as anatomical material. This is the natural feeling of abhorrence and not at all religious. It is only when there are many unclaimed bodies of strangers and the poor, as happens in large cities, that there can be an abundance of anatomical material. The details of this body-snatching case are strangely familiar to those who know the history of similar cases before the middle of the nineteenth century. The case occurred in 1319 in Bologna, just four years after Mondino's public dissections. Four students were involved in the charge of body-snatching, all of them from outside the city of Bologna itself, three from Milan and one from Piacenza. In modern experience, too, as a rule, students from outside of the town where the medical college was situated, were always a little readier than natives to violate graveyards. These four students were accused of having gone at night to the Cemetery of St. Barnabas, outside the gate of San Felice,--suburban graveyards were usually the scene of such exploits,--and to have dug up the body of a certain criminal named Pasino, who had been hanged a few days before. They carried the body to the school in the Parish of San Salvatore, where Alberto Zancari was teaching. The resurrection had been accomplished without witnesses, but there were several witnesses who testified that they recognized the body of Pasino in the school and students occupied with its dissection. If evidence for the zeal of the medical students of that time for dissection were needed, surely we have it in the testimony at this trial. At a time when body-snatching has become a criminal offence usually there have been many repeated occurrences of it before the parties are brought to trial, so that it seems not unlikely that a good many dissections of illegally secured bodies were being done at Bologna at this time. We know of a regulation of the University in force at this time, which required the teachers at the University to do an anatomy or dissection for students if they secured a body for that purpose. The students seem to have used all sorts of influence, political, monetary, diplomatic, and ecclesiastical, in order to secure the bodies of criminals. Sometimes when they failed in their purpose they waited until after burial and then took the body without leave. When we recall the awfully deterrent condition in which bodies must have been that were thus provided for dissecting purposes, it is easy to understand that the enthusiasm of the students for dissection must have been at a very high pitch. Certainly it was far higher than at the present day, when, in spite of the fact that our dissecting-rooms have very few of the old-time dangers and unpleasantnesses, dissection is only practised with assiduity if special care is exercised in requiring attendance and superintending the work of the department. In my book on "The Popes and Science" I have gathered the traditions relating to Mondino's assistants in the chair of anatomy at Bologna. They furnish abundant evidence of the fact that dissections, far from being uncommon, must have been not at all infrequent at the north Italian universities at this time. Curiously enough, one of these assistants was a young woman who, as was not infrequently the custom at this time in the Italian universities, was matriculated as a student at Bologna. She took up first philosophy, and afterwards anatomy, under Mondino. While it is not generally realized, co-education was quite common at the Italian universities of the thirteenth and fourteenth centuries, and at no time since the foundation of the universities has a century passed in Italy without distinguished women occupying professors' chairs at some of the Italian universities. This young woman, Alessandra Giliani, of Persiceto, a country district not far from Bologna, took up the study of anatomy with ardor and, strange as it may appear, became especially enthusiastic about dissection. She became so skilful that she was made the prosector of anatomy, that is, one who prepares bodies for demonstration by the professors. According to the "Cronaca Persicetana," quoted by Medici in his "History of the Anatomical School at Bologna": "She became most valuable to Mondino because she would cleanse most skilfully the smallest vein, the arteries, all ramifications of the vessels, without lacerating or dividing them, and to prepare them for demonstration she would fill them with various colored liquids, which, after having been driven into the vessels, would harden without destroying the vessels. Again, she would paint these same vessels to their minute branches so perfectly and color them so naturally that, added to the wonderful explanations and teachings of the master, they brought him great fame and credit." The whole passage shows a wonderful anticipation of our most modern methods--injection, painting, hardening--of making anatomical preparations for class and demonstration purposes. Some of the details of the story have been doubted, but her memorial tablet, erected at the time of her death in the Church of San Pietro e Marcellino of the Hospital of Santa Maria de Mareto, gives all the important facts, and tells the story of the grief of her fiancé, who was himself Mondino's other assistant.[17] This was Otto Agenius, who had made for himself a name as an assistant to the chair of anatomy in Bologna, and of whom there were great hopes entertained because he had already shown signs of genius as an investigator in anatomy. These hopes were destined to grievous disappointment, however, for Otto died suddenly, before he had reached his thirtieth year. The fact that both these assistants of Mondino died young and suddenly, would seem to point to the fact that probably dissection wounds in those early days proved even more fatal than they occasionally did a century or more ago, when the proper precautions against them were not so well understood. The death of Mondino's two prosectors in early years would seem to hint at some such unfortunate occurrence. As regards the evidence of what the young man had accomplished before his untimely death, probably the following quotation, which Medici has taken from one of the old chroniclers, will give the best idea: "What advantage indeed might not Bologna have had from Otto Agenius Lustrulanus, whom Mondino had used as an assiduous prosector, if he had not been taken away by a swift and lamentable death before he had completed the sixth lustrum of his life!" How well the tradition created by Mondino continued at the university will be best understood from what we know of Guy de Chauliac's visit to the medical school here about the middle of the century. The great French surgeon tells us that he came to Bologna to study anatomy under the direction of Mondino's successor, Bertruccius. When he wrote his preface to his great surgery he recalled this teaching of anatomy at Bologna and said, "It is necessary and useful to every physician to know, first of all, anatomy. For this purpose the study of books is indeed useful, but it is not sufficient to explain those things which can only be appreciated by the senses and which need to be seen in the dead body itself." He advises his students to consult Mundinus' treatise but to demonstrate its details for themselves on the dead body. He relates that he himself had often, _multitoties_, done this, especially under the direction of Bertruccius at Bologna. Curiously enough, as pointed out by Professor Pilcher, Mondino had used this same word _multitotiens_ (the variant spelling makes no difference in the meaning) in speaking about his own work. In describing the hypogastric lesion he mentions that he had demonstrated certain veins in it many times, _multitotiens_. Mondino was just past fifty when he finished his little book and permitted copies of it to be made. Though the book occurs so early in the history of modern book-making the author offers his excuses to the public for writing it, and quotes the authority of Galen, to whom he turns in other difficult situations, for justification. As prefaces go, Mondino's is so like that of many an author of more recent date that his words have a bibliographic, as well as a personal, interest. He said: "A work upon any science or art--as saith Galen--is issued for three reasons: first, that one may satisfy his friends. Second, that he may exercise his best mental powers. Third, that he may be saved from the oblivion incident to old age. Therefore, moved by these three causes, I have proposed to my pupils to compose a certain work on medicine. "And because a knowledge of the parts to be subjected to medicine (which is the human body, and the names of its various divisions) is a part of medical science, as saith Averrhoes in his first chapter, in the section on the definition of medicine, for this reason among others, I have set out to lay before you the knowledge of the parts of the human body which is derived from anatomy, not attempting to use a lofty style, but the rather that which is suitable to a manual of procedure." Some of the early editions of Mondinus' book are said, according to old writers, to have contained illustrations. None of these copies have come down to us, but the assertion is made so definitely that it seems likely to have been the case. The editions that we have contain wood engravings of the method of making a dissection as frontispiece, so that it would not be difficult to think of further such illustrations having been employed in the book itself. As we note in the chapter on "Great Surgeons of the Medieval Universities," Mondeville, according to Guy de Chauliac, had pictures of anatomical preparations which he used for teaching purposes. It is easy to understand that the value of such aids would be recognized at a time when the difficulty of preserving bodies made it necessary to do dissections hurriedly so as to get the rapidly decomposing material out of the way. Beyond his book and certain circumstances connected with it we know very little about Mondino. What we know, however, enables us to conclude that, like many another great teacher, he must have had the special faculty of inspiring his students with an ardent enthusiasm for the work that they were taking under him. Hence the body-snatching and other stories. Mondino continued to be held in high estimation by the Bolognese for centuries after his death. Dr. Pilcher calls attention to the fact that his sepulchral tablet, which is in the portico of the Church of San Vitari in Bologna, and a replica of which he was allowed to have made in order to bring it to America, is the only one of the sepulchral tablets in the great churches of Florence, San Domenico, San Martino, the Cathedral and the Cloister of San Giacomo degli Ermitani, which has not been removed from its original location and placed in the halls of the Civic Museum. Their removal he considers "a kind of desecration which does violence to one's sense of sanctity and propriety." "Fortunately, thus far, the Mondino Tablet has escaped the spoiler." Very probably Dr. Pilcher's replica of the tablet which he was required to deposit in the Civic Museum at the time when the copy was made to be brought to America may save the tablet to be seen in its original position for many generations. Mondino's career is of special interest because it foreshadows the life and accomplishment of many another maker of medicine of the after time. He did a great new thing in medicine in organizing regular public dissections, and then in making a manual that would facilitate the work. He waited patiently for years before completing his book in order that it might be the fruit of long experience, and so be more helpful to others. He was so modest as to require urging to secure the publication. He had the reward of his patience in the popularity of his little work for centuries after his time. The glimpse that we get of his relations to his young assistants, Agenius and Alessandra, seems to show us a teacher of distinct personal magnetism. Undoubtedly the reputation of his book did much for not only the medical school of the University of Bologna, but also for the medical schools of other north Italian universities, and helped to bring to them the crowds of students that flocked there during the fourteenth and fifteenth centuries. Taddeo and Mondino turned the attention of the medical students of their generations Bolognawards. Before that time they had mainly gone to Salerno. After their time most of the ardent students of medicine felt that they must study for a time at least at Bologna. Other important medical schools of Italian universities at Padua, at Vicenza, at Piacenza, arose and prospered. During the time when the political troubles of Italy reached a climax about the middle of the fourteenth century, while the Popes were at Avignon, there was a remission in the attendance at all the Italian universities, but with the Popes' return to Rome and the coming of even comparative peace to Italy, Bologna once more became the term of medical pilgrimages for students from all over the world. In the meantime Mondino's book went forth to be the most used text-book of its kind until Vesalius' great work came to replace it. To have ruled in the world of anatomy for two centuries as the best known of teachers is of itself a distinction that shows us at once the teaching power and the scientific ability of this professor of anatomy of Bologna in the early fourteenth century. X GREAT SURGEONS OF THE MEDIEVAL UNIVERSITIES Strange as it may appear to those who have not watched the development of our knowledge of the Middle Ages in recent years the most interesting feature in the medical departments and, indeed, of the post-graduate work generally of the medieval universities, is that in surgery. There is a very general impression that this department of medicine did not develop until quite recent years, and that particularly it failed to develop to any extent in the Middle Ages. A good many of the historians of this period, indeed, though never the special historians of medicine, have even gone far afield in order to find some reason why surgery did not develop at this time. They have insisted that the Church by its prohibition of the shedding of blood, first to monks and friars, and then to the secular clergy, prevented the normal development of surgery. Besides they add that Church opposition to anatomy completely precluded all possibility of any genuine natural evolution of surgery as a science. There is probably no more amusing feature of quite a number of supposedly respectable and presumably authoritative historical works written in English than this assumption with regard to the absence of surgery during the later Middle Ages. Only the most complete ignorance of the actual history of medicine and surgery can account for it. The writers who make such assertions must never have opened an authoritative medical history. Nothing illustrates so well the expression of the editors of the "Cambridge Modern History" referred to more than once in these pages that "in view of changes and of gains such as these [the jointing of original documents] it has become impossible for historical writers of the present day to trust without reserve even to the most respected secondary authority. The honest student finds himself continually deserted, retarded, misled by the classics of historical literature." Fortunately for us this sweeping condemnation does not hold to any great extent for the medical historical classics. All of the classic historians of medicine tell us much of the surgery of the thirteenth and fourteenth centuries, and in recent years the republication of old texts and the further study of manuscript documents of various kinds have made it very clear that there is almost no period in the history of the world when surgery was so thoroughly and successfully cultivated as during the rise and development of the universities and their medical schools in the thirteenth and fourteenth centuries. It is interesting to trace the succession of great contributors to surgery during these two centuries. We know their teaching not from tradition, but from their text-books so faithfully preserved for us by their devoted students, who must have begrudged no time and spared no labor in copying, for many of the books are large, yet exist in many manuscript copies. Modern surgery may be said to owe its origin to a school of surgeons, the leaders of whom were educated at Salerno in the early part of the thirteenth century, and who, teaching at various north Italian universities, wrote out their surgical principles and experiences in a series of important contributions to that department of medical science. The fact that the origin of the school was at Salerno, where, as is well known, Arabian influence counted for much and for which Constantine's translations of Arabian works proved such a stimulus a century before, makes most students conclude that this later medieval surgical development is simply a continuation of the Arabian surgery that, as we have seen, developed very interestingly during the earlier Middle Ages. Any such idea, however, is not founded on the realities of the situation, but on an assumption with regard to the extent of Arabian influence. Gurlt in his "History of Surgery" (Vol. I, page 701) completely contradicts this idea, and says with regard to the first of the great Italian writers on surgery, Rogero, that "though Arabian works on surgery had been brought over to Italy by Constantine Africanus a hundred years before Roger's time, these exercised no influence over Italian surgery in the next century, and there is scarcely a trace of the surgical knowledge of the Arabs to be found in Roger's works." It is in the history of medicine particularly that it is possible to trace the true influence of the Arabs on European thought in the later Middle Ages. We have already seen in the chapter on Salerno that Arabian influence did harm to Salernitan medical teaching. The school of Salerno itself had developed simple, dietetic, hygienic, and general remedial measures that included the use of only a comparatively small amount of drugs. Its teachers emphasized nature's curative powers. With Arabian influence came polypharmacy, distrust of nature, and attempts to cure disease rather than help nature. In surgery, which developed very wonderfully in the thirteenth and fourteenth centuries, Salerno must be credited with the incentive that led up to the marvellous development that came. With this, however, Arabian influence has nothing to do. Gurlt, besides calling attention to the fact that the author of the first great text-book on the subject not only did not draw his inspiration from Arab sources, insisted that "instead of any Arabisms being found in his [Roger's] writings many Græcisms occur." The Salernitan school of surgery drank at the fountain-head of Greek surgery. Apart from Greek sources Roger's book rests entirely upon his own experiences, those of his teachers and his colleagues, and the tradition in surgery that had developed at Salerno. This tradition was entirely from the Greek. Roger himself says in one place, "We have resolved to write out deliberately our methods of operation such as they have been derived from our own experience and that of our colleagues and illustrious men." ROGER, ROLAND, AND THE FOUR MASTERS Ruggero, or Rogero, who is also known as Rogerio and Rogerus with the adjective Parmensis, or Salernitanus, of Parma or of Salerno, and often in German and English history simply as Roger, lived at the end of the twelfth or the beginning of the thirteenth century and probably wrote his text-book about 1180. This text-book was, according to tradition, originally drafted for his lessons in surgery at Salerno. It attracted much attention and after being commented on by his pupil Rolando, the work of both of them being subsequently annotated by the Four Masters, this combined work became the basis of modern surgery. Roger was probably born either in Palermo or Parma. There are traditions of his having taught for a while at Paris and at the University of Montpellier, though these are not substantiated. His book was printed at Venice in 1546, and has been lately reprinted by De Renzi in his "Collectio Salernitana." Roland was a pupil of Roger's, and the two names that often occur in medieval romance became associated in a great historic reality as a consequence of Roland's commentary on his master's work, which was a favorite text-book in surgery for a good while in the thirteenth century at Salerno. Some space will be given to the consideration of their surgical teaching after a few words with regard to some disciples who made a second commentary, adding to the value of the original work. This is the well-known commentary of the Four Masters, a text-book of surgery written somewhat in the way that we now make text-books in various departments of medicine, that is, by asking men who have made specialties of certain subjects to write on that subject and then bind them all together in a single volume. It represents but another striking reminder that most of our methods are old, not new as we are likely to imagine them. The Four Masters took the works of Roger and Rolando, acknowledged their indebtedness much more completely than do our modern writers on all occasions, I fear, and added their commentaries. Gurlt says ("Geschichte der Chirurgie," Vol. I, p. 703) that "in spite of the fact that there is some doubt about the names of the authors, this volume constitutes one of the most important sources for the history of surgery of the later Middle Ages and makes it very clear that these writers drew their opinions from a rich experience." It is rather easy to illustrate from the quotations given in Gurlt or from the accounts of their teaching in Daremberg or De Renzi some features of this experience that can scarcely fail to be surprising to modern surgeons. For instance, what is to be found in this old text-book of surgery with regard to fractures of the skull is likely to be very interesting to surgeons at all times. One might be tempted to say that fewer men would die every year in prison cells who ought to be in hospitals, if the old-time teaching was taken to heart. For there are rather emphatic directions not to conclude because the scalp is unwounded that there can be no fracture of the skull. Where nothing can be felt care must be exercised in getting the history of the case. For instance, if a man is hit by a metal instrument shaped like the clapper of a bell or by a heavy key, or by a rounded instrument made of lead--this would remind one very much of the lead pipe of the modern time, so fruitful of mistakes of diagnosis in head injuries--special care must be taken to look for symptoms in spite of the lack of an external penetrating wound. Where there is good reason to suspect a fracture because of the severity of the injury, the scalp should be incised and a fracture of the cranium looked for carefully. That is carrying the exploratory incision pretty far. If a fracture is found the surgeon should trephine so as to relieve the brain of any pressure of blood that might be affecting it. There are many warnings, however, of the danger of opening the skull and of the necessity for definitely deciding beforehand that there is good reason for so doing. How carefully their observations had been made and how well they had taken advantage of their opportunities, which were, of course, very frequent in those warlike times when firearms were unknown, hand-to-hand conflict common, and blunt weapons were often used, can be appreciated very well from some of the directions. For instance, they knew of the possibility of fracture by _contrecoup_. They say that "quite frequently though the percussion comes in the anterior part of the cranium, the cranium is fractured on the opposite part."[18] They even seem to have known of accidents such as we now discuss in connection with the laceration of the middle meningeal artery. They warn surgeons of the possibilities of these cases. They tell the story of "a youth who had a very small wound made by a thrown stone and there seemed no serious results or bad signs. He died the next day, however. His cranium was opened and a large amount of black blood was found coagulated about his dura mater." There are many interesting things said with regard to depressed fractures and the necessity for elevating the bone. If the depressed portion is wedged then an opening should be made with the trephine and an elevating instrument called a spatumen used to relieve the pressure. Great care should be taken, however, in carrying out this procedure lest the bone of the cranium itself, in being lifted, should injure the soft structures within. The dura mater should be carefully protected from injury as well as the pin. Care should especially be exercised at the brow and the rear of the head and at the commissures (_proram et pupim et commissuras_), since at these points the dura mater is likely to be adherent. Perhaps the most striking expression, the word _infect_ being italicized by Gurlt, is: "In elevating the cranium be solicitous lest you should infect or injure the dura mater." For wounds of the scalp sutures of silk are recommended because this resists putrefaction and holds the wound edges together. Interrupted sutures about a finger-breadth apart are recommended. "The lower part of the wound should be left open so that the cure may proceed properly." Red powder was strewed over the wound and the leaf of a plant set above it. In the lower angle of the wound a pledget of lint for drainage purposes was inlaid. Hemorrhage was prevented by pressure, by the binding on of _burnt_ wool firmly, and by the ligature of veins and by the cautery. There are rather interesting discussions of the prognosis of wounds of the head, especially such as may be determined from general symptoms in this commentary of the Four Masters on Roger's and Rolando's treatises. If an acute febrile condition develops, the wound is mortal. If the patient loses the use of the hands and feet or if he loses his power of direction, or his sensation, the wound is mortal. If a universal paralysis comes on, the wound is mortal. For the treatment of all these wounds careful precautions are suggested. Cold was supposed to be particularly noxious to them. Operations on the head were not to be done in cold weather and, above all, not in cold places. The air where such operations were done must be warmed artificially. Hot plates should surround the patient's head while the operation was being performed. If this were not possible they were to be done by candlelight, the candle being held as close as possible in a warm room. These precautions are interesting as foreshadowing many ideas of much more modern time and especially indicating how old is the idea that cold may be taken in wounds. In popular medicine this still has its place. Whenever a wound does badly in the winter time patients are sure that they have taken cold. Such popular medical ideas are always derived from supposedly scientific medicine, and until we learned about microbes physicians used the same expressions. We have not got entirely away from them yet. These old surgeons must have had many experiences with fractures at the base of the skull. Hemorrhages from the mouth and nose, for instance, and from the ears were considered bad signs. They were inclined to suggest that openings into the skull should be discovered by efforts to demonstrate a connection between the mouth and nares and the brain cavity. For instance, in their commentary the Four Masters said: "Let the patient hold his mouth and nostrils tight shut and blow strongly." If there was any lessening of the pressure or any appearance of air in the wound in the scalp, then a connection between the mouth and nose was diagnosticated. This is ingenious but eminently dangerous because of the infectious material contained in the nasal and oral cavities, so likely to be forced by such pressure into the skull. They were particularly anxious to detect linear fractures. One of their methods of negative diagnosis for fractures of the skull was that if the patient were able to bring his teeth together strongly, or to crack a nut without pain, then there was no fracture present. One of the commentators, however, adds to this "_sed hoc aliquando fallit_--but this sign sometimes fails." Split or crack fractures were also diagnosticated by the method suggested by Hippocrates of pouring some colored fluid over the skull after the bone was exposed, when the linear fracture would show by coloration. The Four Masters suggest a sort of red ink for this purpose. While they have so much to say about fractures of the skull and insist, over and over again, that though all depressed fractures need treatment and many fissure fractures require trepanation, still great care must be exercised in the selection of cases. They say, for instance, that surgeons who in every serious wound of the head have recourse to the trephine must be looked upon as "fools and idiots" (_idioti et stolidi_). In the light of what we now know about the necessity for absolute cleanliness,--asepsis as we have come to call it,--it is rather startling to note the directions that are given to a surgeon to be observed on the day when he is to do a trepanation. For obvious reasons I prefer to quote it in the Latin: "_Et nota quod die ilia cavendum est medico a coitu et malis cibis aera corrumpentibus, ut sunt allia, cepe, et hujusmodi, et colloquio mulieris menstruosæ, et manus ejus debent esse mundæ, etc._" My quotation is from Gurlt, Vol. I, p. 707. The directions are most interesting. The surgeon's hands must be clean, he must avoid the taking of food that may corrupt the air, such as onions, leeks, and the like; must avoid menstruating and other women, and in general must keep himself in a state of absolute cleanliness. To read a passage like this separated from its context and without knowing anything about the wonderful powers of observation of the men from whom it comes, it would be very easy to think that it is merely a set of general directions which they had made on some general principle, perhaps quite foolish in itself. We know, however, that these men had by observation detected nearly every feature of importance in fractures of the skull, their indications and contra-indications for operation and their prognosis. They had anticipated nearly everything of importance that has come to be insisted on even in our own time in the handling of these difficult cases. It is not unlikely, therefore, that they had also arrived at the recognition by observations on many patients that the satisfactory after-course of these cases which were operated on by the surgeon after due regard to such meticulous cleanliness as is suggested in the paragraph I have quoted, made it very clear that these aseptic precautions, as we would call them, were extremely important for the outcome of the case and, therefore, were well worth the surgeon's attention, though they must have required very careful precautions and considerable self-denial. Indeed this whole subject, the virtual anticipation of our nineteenth-century principles of aseptic surgery in the thirteenth century, is not a dream nor a far-fetched explanation when one knows enough about the directions that were laid down in the surgical text-books of that time. THE NORTH ITALIAN SURGEONS After Roger and Rolando and the Four Masters, who owe the inspiration for their work to Salerno and the south of Italy, comes a group of north Italian surgeons: Bruno da Longoburgo, usually called simply Bruno; Theodoric and his father, Hugo of Lucca, and William of Salicet. Immediately following them come two names that belong, one almost feels, to a more modern period: Mondino, the author of the first text-book on dissection, and Lanfranc (the disciple of William of Salicet), who taught at Paris and "gave that primacy to French surgery which it maintained all the centuries down to the nineteenth" (Pagel). It might very well be thought that this group of Italian surgeons had very little in their writings that would be of any more than antiquarian interest for the modern time. It needs but a little knowledge of their writings as they have come down to us to show how utterly false any such opinion is. To Hugo da Lucca and his son Theodoric we owe the introduction and the gradual bringing into practical use of various methods of anæsthesia. They used opium and mandragora for this purpose and later employed an inhalant mixture, the composition of which is not absolutely known. They seem, however, to have been very successful in producing insensibility to pain for even rather serious and complicated and somewhat lengthy operations. Indeed it is to this that must be attributed most of their surprising success as surgeons at this early date. We are so accustomed to think that anæsthesia was discovered about the middle of the nineteenth century in America that we forget that literature is full of references in Tom Middleton's (seventeenth century) phrase to "the mercies of old surgeons who put their patients to sleep before they cut them." Anæsthetics were experimented with almost as zealously, during the latter half of the thirteenth century at least, as during the latter half of the nineteenth century. They were probably not as successful as we are, but they did succeed in producing insensibility to pain, otherwise they could never have operated to the extent they did. Moreover the traditions show that the Da Luccas particularly had invented a method that left very little to be desired in this matter of anæsthesia. A reference to the sketch of Guy de Chauliac in this volume will show how practical the method was in his time. Nearly the same story as with regard to anæsthetics has to be repeated for what are deemed so surely modern developments,--asepsis and antisepsis. I have already suggested that Roger seems to have known how extremely important it was to approach operations upon the skull with the most absolute cleanliness. There are many hints of the same kind in other writers which show that this was no mere accidental remark, but was a definite conclusion derived from experience and careful observation of results. We find much more with regard to this same subject in the writings of the group of northern Italian surgeons and especially in the group of those associated with William of Salicet. Professor Clifford Allbutt, Regius Professor of Medicine at the University of Cambridge, England, in his address before the St. Louis World's Fair Congress of Arts and Science in 1904, did not hesitate to declare that William discussed the causes for union by first intention and the modes by which it might be obtained. He, too, insisted on cleanliness as the most important factor in having good surgical results, and all of this group of men, in operating upon septic cases, used stronger wine as a dressing. This exerted, as will be readily understood, a very definite antiseptic quality. Evidently some details of the teaching of this group of great surgeons in northern Italy in the second half of the thirteenth century will make clearer to us how much the rising universities of the time were accomplishing in medicine and surgery as well as in their other departments. The dates of the origin of some of these universities should perhaps be recalled so as to remind readers how closely related they are to this great group of surgical teachers. Salerno was founded very early, probably in the tenth century, Bologna, Reggio, and Modena came into existence toward the end of the twelfth century; Vicenza, Padua, Naples, Vercelli, and Piacenza, as well as Arezzo, during the first half of the thirteenth century; Rome, Perugia, Trevizo, Pisa, Florence, Sienna, Lucca, Pavia, and Ferrara during the next century. The thirteenth century was the special flourishing period of the universities, and the medical departments, far from being behind, were leaders in accomplishment. (See my "The Thirteenth Greatest of Centuries," N.Y., 1908.) BRUNO DA LONGOBURGO The first of this important group of north Italian surgeons who taught at these universities was Bruno of Longoburgo. While he was born in Calabria, and probably studied in Salerno, his work was done at Vicenza, Padua, and Verona. His text-book, the "Chirurgia Magna," dedicated to his friend Andrew of Piacenza, was completed at Padua in January, 1252. Gurlt notes that he is the first of the Italian surgeons who quotes, besides the Greeks, the Arabian writers on surgery. Eclecticism had definitely come into vogue to replace exclusive devotion to the Greek authors, and men were taking what was good wherever they found it. Gurlt tells us that Bruno owed much of what he wrote to his own experience and observation. He begins his work by a definition of surgery, _chirurgia_, tracing it to the Greek and emphasizing that it means handwork. He then declares that it is the last instrument of medicine to be used only when the other two instruments, diet and potions, have failed. He insists that surgeons must learn by seeing surgical operations and watching them long and diligently. They must be neither rash nor over bold and should be extremely cautious about operating. While he says that he does not object to a surgeon taking a glass of wine, the followers of this specialty must not drink to such an extent as to disturb their command over themselves, and they must not be habitual drinkers. While all that is necessary for their art cannot be learned out of books, they must not despise books however, for many things can be learned readily from books, even about the most difficult parts of surgery. Three things the surgeon has to do:--"to bring together separated parts, to separate those that have become abnormally united, and to extirpate what is superfluous." In his second chapter on healing he talks about healing by first and second intention. Wounds must be more carefully looked to in summer than in winter, because _putrefactio est major in aestate quam in hyeme_, putrefaction is greater in summer than in winter. For proper union care must be exercised to bring the wound edges accurately together and not allow hair, or oil, or dressings to come between them. In large wounds he considers stitching indispensable, and recommends for this a fine, square needle. The preferable suture material in his experience was silk or linen. The end of the wound was to remain open in order that lint might be placed therein in order to draw off any objectionable material. He is particularly insistent on the necessity for drainage. In deep wounds special provision must be made, and in wounds of extremities the limb must be so placed as to encourage drainage. If drainage does not take place, then either the wound must be thoroughly opened, or if necessary a counter opening must be made to provide drainage. All his treatment of wounds is dry, however. Water, he considered, always did harm. We can readily understand that the water generally available and especially as surgeons saw it in camps and on the battlefield, was likely to do much more harm than good. In penetrating wounds of the belly cavity, if there was difficulty in bringing about the reposition of the intestines, they were first to be pressed back with a sponge soaked in warm wine. Other manipulations are suggested, and if necessary the wound must be enlarged. If the omentum finds its way out of the wound, all of it that is black or green must be cut off. In cases where the intestines are wounded they are to be sewed with a small needle and a silk thread and care is to be exercised in bringing about complete closure of the wound. This much will give a good idea of Bruno's thoroughness. Altogether, Gurlt, in his "History of Surgery," gives about fifteen large octavo pages of rather small type to a _brief_ compendium of Bruno's teachings. One or two other remarks of Bruno are rather interesting in the light of modern developments in medicine. For instance, he suggests the possibility of being able to feel a stone in the bladder by means of bimanual palpation. He teaches that mothers may often be able to cure hernias, both umbilical and inguinal, in children by promptly taking up the treatment of them as soon as noticed, bringing the edges of the hernial opening together by bandages and then preventing the reopening of the hernia by prohibiting wrestling and loud crying and violent motion. He has seen overgrowth of the mamma in men, and declares that it is due to nothing else but fat, as a rule. He suggests if it should hang down and be in the way on account of its size it should be extirpated. He seems to have known considerable about the lipomas and advises that they need only be removed in case they become bothersomely large. The removal is easy, and any bleeding that takes place may be stopped by means of the cautery. He divides rectal fistulæ into penetrating and non-penetrating, and suggests salves for the non-penetrating and the actual cautery for those that penetrate. He warns against the possibility of producing incontinence by the incision of deep fistulæ, for this would leave the patient in a worse state than before. HUGH OF LUCCA Bruno brought up with him the methods and principles of surgery from the south of Italy, but there seems to have been already in the north at least one distinguished surgeon who had made his mark. This was Ugo da Lucca or Ugo Luccanus, sometimes known in the modern times in German histories of medicine as Hugo da Lucca and in English, Hugh of Lucca. He flourished early in the thirteenth century. In 1214 he was called to Bologna to become the city physician, and joined the Bolognese volunteers in the crusade in 1218, being present at the siege of Damietta. He returned to Bologna in 1221 and was given the post of legal physician to the city. The civic statutes of Bologna are, according to Gurlt, the oldest monument of legal medicine in the Middle Ages. Ugo died not long after the middle of the century, and is said to have been nearly one hundred years old. Of his five sons, three became physicians. The most celebrated of these was Theodoric, who wrote a text-book of surgery in which are set down the traditions of surgery that had been practised in his father's life. Theodoric is especially enthusiastic in praise of his father, because he succeeded in bringing about such perfect healing of wounds with only wine and water and the ligature and without the employment of any ointments. Ugo seems to have occupied himself much with chemistry. To him we owe a series of discoveries with regard to anodyne and anæsthetizing drugs. He is said to have been the first who taught the sublimation of arsenic. Unfortunately he left no writings after him, and all that we know of him we owe to the filial devotion of his son Theodoric. THEODORIC This son, after having completed his medical studies at the age of about twenty-three, entered the Dominican Order, then only recently established, but continued his practice of medicine undisturbed. His ecclesiastical preferment was rapid. He attracted the attention of the Bishop of Valencia, and became his chaplain in Rome. At the age of about fifty he was made a bishop in South Italy and later transferred to the Bishopric of Cervia, not far from Ravenna. Most of his life seems to have been passed in Bologna however, and he continued to practise medicine, devoting his fees, however, entirely to charity. His text-book of surgery was written about 1266 and is signed with his full name and title as Bishop of Cervia. Even at this time however, he still retained the custom of designating himself as a member of the Dominican Order. The most interesting thing in the first book of his surgery is undoubtedly his declaration that all wounds should be treated only with wine and bandaging. Wine he insists on as the best possible dressing for wounds. It was the most readily available antiseptic that they had at that time, and undoubtedly both his father's recommendation of it and his own favorable experience with it were due to this quality. It must have acted as an excellent inhibitive agent of many of the simple forms of pus formation. At the conclusion of this first book he emphasizes that it is extremely important for the healing of wounds that the patient should have good blood, and this can only be obtained from suitable nutrition. It is essential therefore for the physician to be familiar with the foods which produce good blood in order that his wounded patients may be fed appropriately. He suggests, then, a number of articles of diet which are particularly useful in producing such a favorable state of the tissues as will bring about the rebirth of flesh and the adhesion of wound surfaces. Shortly before he emphasizes the necessity for not injuring nerves, though if nerves have been cut they should be brought together as carefully as possible, the wound edges being then approximated. Probably the most interesting feature for our generation of the great text-books of the surgeons of the medieval universities is the occurrence in them of definite directions for securing union in surgical wounds, at least by first intention and their insistence on keeping wounds clear. The expression union by first intention comes to us from the olden time. They even boasted that the scars left after their incisions were often so small as to be scarcely noticeable. Such expressions of course could only have come from men who had succeeded in solving some of the problems of antisepsis that were solved once more in the generation preceding our own. With regard to their treatment of wounds, Professor Clifford Allbutt says:[19] "They washed the wound with wine, scrupulously removing every foreign particle; then they brought the edges together, not allowing wine nor anything else to remain within--dry adhesive surfaces were their desire. Nature, they said, produces the means of union in a viscous exudation, or natural balm, as it was afterwards called by Paracelsus, Paré, and Wurtz. In older wounds they did their best to obtain union by cleansing, desiccation, and refreshing of the edges. Upon the outer surface they laid only lint steeped in wine. Powders they regarded as too desiccating, for powder shuts in decomposing matters wine after washing, purifying, and drying the raw surfaces evaporates." Theodoric comes nearest to us of all these old surgeons. The surgeon who in 1266 wrote: "For it is not necessary, as Roger and Roland have written, as many of their disciples teach, and as all _modern_ surgeons profess, that pus should be generated in wounds. No error can be greater than this. Such a practice is indeed to hinder nature, to prolong the disease, and to prevent the conglutination and consolidation of the wound" was more than half a millennium ahead of his time. The italics in the word modern are mine, but might well have been used by some early advocate of antisepsis or even by Lord Lister himself. Just six centuries almost to the year would separate the two declarations, yet they would be just as true at one time as at another. When we learn that Theodoric was proud of the beautiful cicatrices which he obtained without the use of any ointment, _pulcherrimas cicatrices sine unguento aliquo inducebat_, then further that he impugned the use of poultices and of oils on wounds, while powders were too drying and besides had a tendency to prevent drainage, the literal meaning of the Latin words _saniem incarcerare_ is to "incarcerate sanious material," it is easy to understand that the claim that antiseptic surgery was anticipated six centuries ago is no exaggeration and no far-fetched explanation with modern ideas in mind of certain clever modes of dressing hit upon accidentally by medieval surgeons. Theodoric's treatment of many practical problems is interesting for the modern time. For instance, in his discussion of cancer he says that there are two forms of the affection. One of them is due to a melancholy humor, a constitutional tendency as it were, and occurs especially in the breasts of women or latent in the womb. This is difficult of treatment and usually fatal. The other class consists of a deep ulcer with undermined edges, occurring particularly on the legs, difficult to cure and ready of relapse, but for which the outlook is not so bad. His description of _noli me tangere_ and of lupus is rather practical. Lupus is "eating herpes," occurs mainly on the nose, or around the mouth, slowly increases, and either follows a preceding erysipelas or comes from some internal cause. _Noli me tangere_ is a corroding ulcer, so called perhaps because irritation of it causes it to spread more rapidly. He thinks that deep cauterization of it is the best treatment. Since these are in the department of skin diseases this seems the place to mention that Theodoric describes salivation as occurring after the use of mercury for certain skin diseases. He has already shown that he knows of certain genital ulcers and sores on the genital regions and of distinctions between them. WILLIAM OF SALICET The third of the great surgeons in northern Italy was William of Salicet. He was a pupil of Bruno's and the master of Lanfranc. The first part of his life was passed at Bologna and the latter part as the municipal and hospital physician of Verona. He probably died about 1280. He was a physician as well as a surgeon and was one of those who insisted that the two modes of practising medicine should not be separated, or if they were both medicine and surgery would suffer. He thought that the physician learned much by seeing the interior of the body during life, while the surgeon was more conservative if he were a physician. It is curiously interesting to find that the Regius Professors at both Oxford and Cambridge in our time have expressed themselves somewhat similarly. Professor Clifford Allbutt is quite emphatic in this matter and Professor Osler is on record to the same effect. Following Theodoric, William of Salicet did much to get away from the Arabic abuse of the cautery and brought the knife back to its proper place again as the ideal surgical instrument. Unlike those who had written before him, William quoted very little from preceding writers. Whenever he quotes his contemporaries it is in order to criticise them. He depended on his own experience and considered that it was only what he had actually learned from experience that he should publish for the benefit of others. A very good idea of the sort of surgery that William of Salicet practised may be obtained even from the beginning of the first chapter of his first book. This is all with regard to surgery of the head. He begins with the treatment of hydrocephalus or, as he calls it, "water collected in the heads of children newly born." He rejects opening of the head by an incision because of the danger of it. In a number of cases, however, he had had success by puncturing the scalp and membranes with a cautery, though but a very small opening was made and the fluid was allowed to escape only drop by drop. He then takes up eye diseases, a department of surgery rather well developed at that time, as can be seen from our account of the work of Pope John XXI as an ophthalmologist during the thirteenth century. See _Ophthalmology_ (January, 1909), reprinted in "Catholic Churchmen in Science," Philadelphia, The Dolphin Press, 1909. William devotes six chapters to the diseases of the eyes and the eyelids. Then there are two chapters on affections of the ears. Foreign bodies and an accumulation of ear wax are removed by means of instruments. A polyp is either cut off or its pedicle bound with a ligature, and it is allowed to shrivel. The next chapter is on the nose. Nasal polyps were to be grasped with a sharp tenaculum, _cum tenacillis acutis_, and either wholly or partially extracted. Ranula was treated by being lifted well forward by means of a sharp iron hook and then split with a razor. It is evident that the tendency of these to fill up again was recognized, and accordingly it was recommended that vitriol powder, or alum with salt, be placed in the cavity for a time after evacuation in order to produce adhesive inflammation. In the same chapter on the mouth one finds that William did not hesitate to perform what cannot but be considered rather extensive operations within the oral cavity. For instance, he tells of removing a large epulis and gives an account in detail of the case. To quote his own words: "I cured a certain woman from Piacenza who was suffering from fleshy tumor on the gums of the upper jaw, the tumor having grown to such a size above the teeth and the gums that it was as large or perhaps larger than a hen's egg. I removed it at four operations by means of heated iron instruments. At the last operation I removed the teeth that were loose with certain parts of the jawbone." In the next chapter there is an account of the treatment of a remarkable case of abscess of the uvula. In the following chapter the swelling of cervical glands is taken up. In his experience expectant treatment of these was best. He advises internal medication with the building up of the general health, or suggests allowing the inflamed glands to empty themselves after pustulation. After much meddlesome surgery we are almost back to his methods again. He did not hesitate to treat goitre surgically, though he considered there were certain internal remedies that would benefit it. In obstinate cases he suggests the complete extirpation of cystic goitre, but if the sac is allowed to remain it should be thoroughly rubbed over on the inside with green ointment. He warns about the necessity for avoiding the veins and arteries in this operation, and says that "in this affection many large veins make their appearance and they find their way everywhere through the fleshy mass." What I have given here is to be found in a little more than half a page of Gurlt's abstract of the first twenty chapters of Salicet's first book. Altogether Gurlt has more than ten pages of rather small print with regard to William; most of it is as interesting and as practical and as representative of anticipations of what is done in the modern time as what I have here quoted. William, as I have said, depended much more upon his own experience than upon what was to be found in text-books. He knew the old text-books very well however, but as a rule did not quote from them unless he had tried the recommendations for himself, or unless similar cases to these mentioned had come under his own observation. He was evidently a thoroughly observant physician, a skilled surgeon who was practical enough to see the simplest way to do things, and he proceeded to do them. It is no wonder that he influenced succeeding generations so much, nor that his great pupil, Lanfranc, continuing his tradition, founded a school of surgery in Paris, the influence of which was to endure almost down to our time, and give France a primacy in surgery until the nineteenth century. LANFRANC After Salicet's lifetime the focus of interest in surgery changes from Italy to France, and what is still more complimentary to William, it is through a favorite disciple of his that the change takes place. This was Lanfranchi, or Lanfranco, sometimes spoken of as Alanfrancus, who practised as physician and surgeon in Milan until banished from there by Matteo Visconti about 1290. He then went to Lyons, where in the course of his practice he attracted so much attention that he was offered the opportunity to teach surgery in Paris. He attracted what Gurlt calls an almost incredible number of scholars to his lessons in Paris, and by hundreds they accompanied him to the bedside of his patients and attended his operations. The dean of the medical faculty, Jean de Passavant, urged him to write a text-book of surgery, not only for the benefit of his students at Paris but for the sake of the prestige which this would confer on the medical school. Deans still urge the same reasons for writing. Lanfranc completed his surgery, called "Chirurgia Magna," in 1296, and dedicated it to Philippe le Bel, the then reigning French King. Ten years later he died, but in the meantime he had transferred Italian prestige in surgery from Italy to France and laid the foundations in Paris of a thoroughly scientific as well as a practical surgery, though this department of the medical school had been in a sadly backward state when he came. In the second chapter of this text-book, the first containing the definition of surgery and general introduction, Lanfranc describes the qualities that in his opinion a surgeon should possess. He says, "It is necessary that a surgeon should have a temperate and moderate disposition. That he should have well-formed hands, long slender fingers, a strong body, not inclined to tremble and with all his members trained to the capable fulfilment of the wishes of his mind. He should be of deep intelligence and of a simple, humble, brave, but not audacious disposition. He should be well grounded in natural science, and should know not only medicine but every part of philosophy; should know logic well, so as to be able to understand what is written, to talk properly, and to support what he has to say by good reasons." He suggests that it would be well for the surgeon to have spent some time teaching grammar and dialectics and rhetoric, especially if he is to teach others in surgery, for this practice will add greatly to his teaching power. Some of his expressions might well be repeated to young surgeons in the modern time. "The surgeon should not love difficult cases and should not allow himself to be tempted to undertake those that are desperate. He should help the poor as far as he can, but he should not hesitate to ask for good fees from the rich." Many generations since Lanfranc's time have used the word nerves for tendons. Lanfranc, however, made no such mistake. He says that the wounds of nerves, since the nerve is an instrument of sense and motion, are, on account of the greater sensitiveness which these structures possess, likely to involve much pain. Wounds along the length of the nerves are less dangerous than those across them. When a nerve is completely divided by a cross wound Lanfranc is of the opinion, though Theodoric and some others are opposed to it, that the nerve ends should be stitched together. He says that this suture insures the redintegration of the nerve much better. After this operation the restoration of the usefulness of the member is more complete and assured. His description of the treatment of the bite of a rabid dog is interesting. A large cupping glass should be applied over the wound so as to draw out as much blood as possible. After this the wound should be dilated and thoroughly cauterized to its depths with a hot iron. It should then be covered with various substances that were supposed to draw, in order as far as possible to remove the poison. His description of how one may recognize a rabid animal is rather striking in the light of our present knowledge, for he seems to have realized that the main diagnostic element is a change in the disposition of the animal, but above all a definite tendency to lack playfulness. Lanfranc had seen a number of cases of true rabies, and describes and suggests treatment for them, though evidently without very much confidence in the success of the treatment. The treatment of snake bites and the bites of other poisonous animals was supposed to follow the principles laid down for the bite of a mad dog, especially as regards the encouragement of free bleeding and the use of the cautery. Lanfranc has many other expressions that one is tempted to quote, because they show a thinking surgeon of the old time, anticipating many supposedly modern ideas and conclusions. He is a particular favorite of Gurlt's, who has more than twenty-five large octavo, closely printed pages with regard to him. There is scarcely any development in our modern surgery that Lanfranc has not at least a hint of, certainly nothing in the surgery of a generation ago that does not find a mention in his book. On most subjects he has practical observations from his own experience to add to what was in surgical literature before his time. He quotes altogether more than a score of writers on surgery who had preceded him and evidently was thoroughly familiar with general surgical literature. There is scarcely an important surgical topic on which Gurlt does not find some interesting and personal remarks made by Lanfranc. All that we can do here is refer those who are interested in Lanfranc to his own works or Gurlt. MONDEVILLE The next of the important surgeons who were to bring such distinction to French surgery for five centuries was Henri de Mondeville. Writers usually quote him as Henricus. His latter name is only the place of his birth, which was probably not far from Caen in Normandy. It is spelled in so many different ways, however, by different writers that it is well to realize that almost anything that looks like Mondeville probably refers to him. Such variants as Mundeville, Hermondaville, Amondaville, Amundaville, Amandaville, Mandeville, Armandaville, Armendaville, Amandavilla occur. We owe a large amount of our information with regard to him to Professor Pagel, who issued the first edition of his book ever published (Berlin, 1892). It may seem surprising that Mondeville's work should have been left thus long without publication, but unfortunately he did not live long enough to finish it. He was one of the victims that tuberculosis claimed among physicians in the midst of their work. Though there are a great number of manuscript copies of his book, somehow Renaissance interest in it in its incompleted state was never aroused sufficiently to bring about a printed edition. Certainly it was not because of any lack of interest on the part of his contemporaries or any lack of significance in the work itself, for its printing has been one of the surprises afforded us in the modern time as showing how thoroughly a great writer on surgery did his work at the beginning of the fourteenth century. Gurlt, in his "History of Surgery," has given over forty pages, much of it small type, with regard to Mondeville, because of the special interest there is in his writing.[20] His life is of particular interest for other reasons besides his subsequent success as a surgeon. He was another of the university men of this time who wandered far for opportunities in education. Though born in the north of France and receiving his preliminary education there, he made his medical studies towards the end of the thirteenth century under Theodoric in Italy. Afterwards he studied medicine in Montpellier and surgery in Paris. Later he gave at least one course of lectures at Montpellier himself and a series of lectures in Paris, attracting to both universities during his professorship a crowd of students from every part of Europe. One of his teachers at Paris had been his compatriot, Jean Pitard, the surgeon of Philippe le Bel, of whom he speaks as "most skilful and expert in the art of surgery," and it was doubtless to Pitard's friendship that he owed his appointment as one of the four surgeons and three physicians who accompanied the King into Flanders. Besides his lectures, Mondeville had a large consultant practice and also had to accompany the King on his campaigns. This made it extremely difficult for him to keep continuously at the writing of his book. It was delayed in spite of his good intentions, and we have the picture that is so familiar in the modern time of a busy man trying to steal or make time for his writing. Unfortunately, in addition to other obstacles, Mondeville showed probably before he was forty the first symptoms of a serious pulmonary disease, presumably tuberculosis. He bravely fought it and went on with his work. As his end approached he sketched in lightly what he had hoped to treat much more formally, and then turned to what was to have been the last chapter of his book, the Antidotarium or suggestions of practical remedies against diseases of various kinds because his students and physician friends were urging him to complete this portion for them. We of the modern time are much less interested in that than we would have been in some of the portions of the work that Mondeville neglected in order to provide therapeutic hints for his disciples. But then the students and young physicians have always clamored for the practical--which so far at least in medical history has always proved of only passing interest. It is often said that at this time surgery was mainly in the hands of barbers and the ignorant. Henri de Mondeville, however, is a striking example in contradiction of this. He must have had a fine preliminary education and his book shows very wide reading. There is almost no one of any importance who seriously touched upon medicine or surgery before his time whom Mondeville does not quote. Hippocrates, Aristotle, Dioscorides, Pliny, Galen, Rhazes, Ali Abbas, Abulcasis, Avicenna, Constantine Africanus, Averroës, Maimonides, Albertus Magnus, Hugo of Lucca, Theodoric, William of Salicet, Lanfranc are all quoted, and not once or twice but many times. Besides he has quotations from the poets and philosophers, Cato, Diogenes, Horace, Ovid, Plato, Seneca, and others. He was a learned man, devoting himself to surgery. It is no wonder, then, that he thought that a surgeon should be a scholar, and that he needed to know much more than a physician. One of his characteristic passages is that in which he declares "it is impossible that a surgeon should be expert who does not know not only the principles, but everything worth while knowing about medicine," and then he added, "just as it is impossible for a man to be a good physician who is entirely ignorant of the art of surgery." He says further: "This our art of surgery, which is the third part of medicine (the other two parts were diet and drugs), is, with all due reverence to physicians, considered by us surgeons ourselves and by the non-medical as a more certain, nobler, securer, more perfect, more necessary, and more lucrative art than the other parts of medicine." Surgeons have always been prone to glory in their specialty. Mondeville had a high idea of the training that a surgeon should possess. He says: "A surgeon who wishes to operate regularly ought first for a long time to frequent places in which skilled surgeons operate often, and he ought to pay careful attention to their operations and commit their technique to memory. Then he ought to associate himself with them in doing operations. A man cannot be a good surgeon unless he knows both the art and science of medicine and especially anatomy. The characteristics of a good surgeon are that he should be moderately bold, not given to disputations before those who do not know medicine, operate with foresight and wisdom, not beginning dangerous operations until he has provided himself with everything necessary for lessening the danger. He should have well-shaped members, especially hands with long, slender fingers, mobile and not tremulous, and with all his members strong and healthy so that he may perform all the good operations without disturbance of mind. He must be highly moral, should care for the poor for God's sake, see that he makes himself well paid by the rich, should comfort his patients by pleasant discourse, and should always accede to their requests if these do not interfere with the cure of the disease." "It follows from this," he says, "that the perfect surgeon is more than the perfect physician, and that while he must know medicine he must in addition know his handicraft." Thinking thus, it is no wonder that he places his book under as noble patronage as possible. He says in the preface that he "began to write it for the honor and praise of Christ Jesus, of the Virgin Mary, of the Saints and Martyrs, Cosmas and Damian, and of King Philip of France as well as his four children, and on the proposal and request of Master William of Briscia, distinguished professor in the science of medicine and formerly physician to Pope Boniface IV and Benedict and Clement, the present Pope." His first book on anatomy he proposed to found on that of Avicenna and "on his personal experience as he has seen it." The second tractate on the treatments of wounds, contusions, and ulcers was founded on the second book of Theodoric "with whatever by recent study has been newly acquired and brought to light through the experience of modern physicians." He then confesses his obligations to his great master, John Pitard, and adds that all the experience that he has gained while operating, studying, and lecturing for many years on surgery will be made use of in order to enhance the value of the work. He hopes, however, to accomplish all this "briefly, quietly, and above all, charitably." There are many things in the preface that show us the reason for Mondeville's popularity, for they exhibit him as very sympathetically human in his interests. While Mondeville is devoted to the principle that authority is of great value, he said that there was nothing perfect in things human, and successive generations of younger men often made important additions to what their ancestors had left them. While his work is largely a compilation, nearly everywhere it shows signs of the modification of his predecessors' opinions by the results of his own experience. His method of writing is, as Pagel declares, "always interesting, lively, and often full of meat." He had a teacher's instinct, for in several of the earlier manuscripts his special teaching is put in larger letters in order to attract students' attention.... He seems to have introduced or re-introduced into practice the idea of the use of a large magnet in order to extract portions of iron from the tissues. He made several modifications in needles and thread holders and invented a kind of small derrick for the extraction of arrows with barbs. Besides, he suggested the surrounding of the barbs of the arrows with tubes, to facilitate extraction. In his treatment of wounds, Pagel considers that as a writer and teacher he is far ahead of his predecessors and even of those who came after him in immediately subsequent generations. One of his great merits undoubtedly is that Guy de Chauliac, the father of modern surgery, in his text-book turned to him with a confidence that proclaims his admiration and how much he felt that he had gained from him. One of the most interesting features of Mondeville's work is his insistence on the influence of the mind on the body and the importance of using this influence to the best advantage. It is especially important in Mondeville's opinion to keep a surgical patient from being moody. "Let the surgeon," says he, "take care to regulate the whole regimen of the patient's life for joy and happiness by promising that he will soon be well, by allowing his relatives and special friends to cheer him and by having someone to tell him jokes, and let him be solaced also by music on the viol or psaltery. The surgeon must forbid anger, hatred, and sadness in the patient, and remind him that the body grows fat from joy and thin from sadness. He must insist on the patient obeying him faithfully in all things." He repeats with approval the expression of Avicenna that "often the confidence of the patient in his physician does more for the cure of his disease than the physician with all his remedies." Obstinate and conceited patients prone to object to nearly everything that the surgeon wants to do, and who often seem to think that they surpass Galen and Hippocrates in science and wisdom, are likely to delay their cure very much, and they represent the cases with which the surgeon has much difficulty. Mondeville thought that nursing was extremely important and that without it surgery often failed of its purpose. He says, "For if the assistants are not solicitous and faithful, and obedient to the surgeons in each and every thing which may make for the cure of the disease, they put obstacles and difficulties in the way of the surgeon." It is especially important that the patient's nutrition should be cared for and that the bandages should be managed exactly as the surgeon directs. He has no use for garrulous, talkative nurses, and does not hesitate to say that sometimes near relatives are particularly likely to disturb patients. "Especially are they prone to let drop some hint of bad news which the surgeon may have revealed to them in secret, or even the reports that they may hear from others, friends or enemies, and this provokes the patient to anger or anxiety and is likely to give him fever. If the assistants quarrel among themselves, or are heard murmuring, or if they draw long faces, all of these things will disturb the patients and produce worry and anxiety or fear. The surgeon therefore must be careful in the selection of his nurses, for some of them obey very well while he is present, but do as they like and often just exactly the opposite of what he has directed when he is away." We do not know enough of the details of Mondeville's life to be sure whether he was married or not. It is probable that he was not, for all of these surgeons of the thirteenth century before Mondeville's time, Theodoric, William of Salicet, Lanfranc, and Guy de Chauliac, after him belonged to the clerical order; Theodoric was a bishop; the others, however, seem only to have been in minor orders. It is therefore from the standpoint of a man who views married life from without that Mondeville makes his remarks as to the difficulty often encountered when wives nurse their husbands. He says that the surgeon has difficulty oftener when husbands or wives care for their spouses than at other times. This is much more likely to take place when the wives are caring for the husbands. "In our days," he says, "in this Gallican part of the world, wives rule their husbands, and the men for the most part permit themselves to be ruled. Whatever a surgeon may order for the cure of a husband then will often seem to the wives to be a waste of good material, though the men seem to be quite willing to get anything that may be ordered for the cure of their wives. The whole cause of this seems to be that every woman seems to think that her husband is not as good as those of other women whom she sees around her." It would be interesting to know how Mondeville was brought to a conclusion so different from modern experience in the matter. For those who are particularly interested in medical history one of the sections of Henry's book has a special appeal, because he gives in it a sketch of the history of surgery. We are little likely to think, as a rule, that at this time, full two centuries before the close of the Middle Ages, men were interested enough in the doings of those who had gone before them to try to trace the history of the development of their specialty. It is characteristic of the way that the scholarly Mondeville views his own life work that he should have wanted to know something about his predecessors and teach others with regard to them. He begins with Galen, and as Galen divides the famous physicians of the world into three sects, the Methodists, the Empirics, and the Rationalists, so Mondeville divides modern surgery into three sects: first, that of the Salernitans, with Roger, Roland, and the Four Masters; second, that of William of Salicet and Lanfranc; and third, that of Hugo de Lucca and his brother Theodoric and their modern disciples. He states briefly the characteristics of these three sects. The first limited patients' diet, used no stimulants, dilated all wounds, and got union only after pus formation. The second allowed a liberal diet to weak patients, though not to the strong, but generally interfered with wounds too much. The third believed in a liberal diet, never dilated wounds, never inserted tents, and its members were extremely careful not to complicate wounds of the head by unwise interference. His critical discussion of the three schools is extremely interesting. Another phase of Mondeville's work that is sympathetic to the moderns is his discussion of the irregular practice of medicine and surgery as it existed in his time. Most of our modern medicine and surgery was anticipated in the olden time; but it may be said that all of the modes of the quack are as old as humanity. Galen's description of the travelling charlatan who settled down in his front yard, not knowing that it belonged to a physician, shows this very well. There were evidently as many of them and as many different kinds in Mondeville's time as in our own. In discussing the opposition that had arisen between physicians and surgeons in his time and their failure to realize that they were both members of a great profession, he enumerates the many different kinds of opponents that the medical profession had. There were "barbers, soothsayers, loan agents, falsifiers, alchemists, meretrices, midwives, old women, converted Jews, Saracens, and indeed most of those who, having wasted their substance foolishly, now proceed to make physicians or surgeons of themselves in order to make their living under the cloak of healing." What surprises Mondeville however, as it has always surprised every physician who knows the situation, is that so many educated, or at least supposedly well-informed people of the better classes, indeed even of the so-called best classes, allow themselves to be influenced by these quacks. And it is even more surprising to him that so many well-to-do, intelligent people should, for no reason, though without knowledge, presume to give advice in medical matters and especially in even dangerous surgical diseases, and in such delicate affections as diseases of the eyes. "It thus often happens that diseases in themselves curable grow to be simply incurable or are made much worse than they were before." He says that some of the clergymen of his time seemed to think that a knowledge of medicine is infused into them with the sacrament of Holy Orders. He was himself probably a clergyman, and I have in the modern time more than once known of teachers in the clerical seminaries emphasizing this same idea for the clerical students. It is very evident that the world has not changed very much, and that to know any time reasonably well is to find in it comments on the morning paper. We are in the midst of just such a series of interferences with medicine on the part of the clergy as this wise, common-sense surgeon of the thirteenth century deprecated. In every way Mondeville had the instincts of a teacher. He took advantage of every aid. He was probably the first to use illustrations in teaching anatomy. Guy de Chauliac, whose teacher in anatomy for some time Mondeville was, says in the first chapter of his "Chirurgia Magna" that pictures do not suffice for the teaching of anatomy and that actual dissection is necessary. The passage runs as follows: "In the bodies of men, of apes, and of pigs, and of many other animals, tissues should be studied by dissections and not by pictures, as did Henricus, who was seen to demonstrate anatomy with thirteen pictures."[21] What Chauliac blames is the attempt to replace dissections by pictorial demonstrations. Hyrtl, however, suggests that this invention of Mondeville's was probably very helpful, and was brought about by the impossibility of preserving bodies for long periods as well as the difficulty of obtaining them. YPERMAN One of the maxims of the old Greek philosophers was that good is diffusive of itself. As the scholastics put it, _bonum est diffusivum sui_. This proved to be eminently true of the old universities also, and especially of their training in medicine and in surgery. We have the accounts of men from many nations who went to the universities and returned to benefit their own people. Early in the thirteenth century Richard the Englishman was in Italy, having previously been in Paris and probably at Montpellier. Bernard Gordon, probably also an Englishman, was one of the great lights in medicine down at Montpellier, and his book, "Lilium De Medicina," is well known. Two distinguished surgeons whose names have come down to us, having studied in Paris after Lanfranc had created the tradition of great surgical teaching there, came to their homes to be centres of beneficent influence among their people in this matter. One was Yperman, of the town of Ypres in Belgium; the other Ardern of England. Yperman was sent by his fellow-townsmen to Paris in order to study surgery, because they wanted to have a good surgeon in their town and Paris seemed the best school at that time. Ypres was at this period one of the greatest commercial cities of Europe, and probably had a couple of hundred thousand inhabitants. The great hall of the cloth gild, which has been such an attraction for visitors ever since, was built shortly before the town determined upon the very sensible procedure of securing good surgery beyond all doubt by having a townsman specially educated for that purpose. Yperman's work was practically unknown to us until Broeck, the Belgian historian, discovered manuscript copies of his book on surgery and gathered some details of his life. After his return from Paris, Yperman obtained great renown, which maintained itself in the custom extant in that part of the country even yet of calling an expert surgeon an Yperman. He is the author of two works in Flemish. One of these is a smaller compendium of internal medicine, which is very interesting, however, because it shows the many subjects that were occupying physicians' minds at that time. He treats of dropsy, rheumatism, under which occur the terms coryza and catarrh (the flowing diseases), icterus, phthisis (he calls the tuberculosis, tysiken), apoplexy, epilepsy, frenzy, lethargy, fallen palate, cough, shortness of breath, lung abscess, hemorrhage, blood-spitting, liver abscess, hardening of the spleen, affections of the kidney, bloody urine, diabetes, incontinence of urine, dysuria, strangury, gonorrhea, and involuntary seminal emissions--all these terms are quoted directly from Pagel's account of his work; the original is not available in this country. JOHN ARDERN In English-speaking countries of course we are interested in what was done by Englishmen at this time. Fortunately we have the record of one great English surgeon of the period worthy to be placed beside even the writers already mentioned. This is John Ardern, whose name is probably a modification of the more familiar Arden, whose career well deserves attention. I have given a sketch of his work in "The Popes and Science."[22] He was educated at Montpellier, and practised surgery for a time in France. About the middle of the century however, according to Pagel, he went back to his native land and settled for some twenty years at Newark, in Nottinghamshire, and then for nearly thirty years longer, until about the end of the century, was in London. He is the chief representative of English surgery during the Middle Ages. His "Practica," as yet unprinted, contains, according to Pagel, a short sketch of internal medicine, but is mainly devoted to surgery. Contrary to the usual impression with regard to works in medicine and surgery at this time, the book abounds in references to case histories which Ardern had gathered, partly from his own and partly from others' experience. The therapeutic measures that he suggests are usually very simple, in the majority of cases quite rational, though, of course, there are many superstitions among them; but Ardern always furnished a number of suggestions from which to choose. He must have been an expert operator, and had excellent success in the treatment of diseases of the rectum. He seems to have been the first operator who made careful statistics of his cases, and was quite as proud as any modern surgeon of the large numbers that he had operated on, which he gives very exactly. He was the inventor of a new clyster apparatus. Fortunately we possess here in America, in the Surgeon General's Library at Washington, a very interesting manuscript containing Ardern's surgical writings, though it has not yet been published. Even a little study of this and of the notes on it prepared by an English bibliophile before its purchase by the Surgeon General's Library, serves to show how valuable the work is in the history of surgery. There are illustrations scarcely less interesting than the text. Some of these illustrations were inserted by the original writer or copyist, and some of them later. In general, however, they show a rather high development of the mechanics of surgery at that time. Some of the pages have spaces for illustrations left unfilled, so that evidently the copyist did not complete his work. The titles of certain of the chapters are interesting, as illustrating the fact that our medical and surgical problems were stated clearly in the olden time, and thinking physicians, even six centuries ago, met them quite rationally. There is, for instance, a chapter headed "Against Colic and the Iliac Passion," immediately followed by the subheading, "Method of Administering Clysters." The iliac passion, _passio iliaca_ of the old Latin, is usually taken to signify some obstruction of the intestines causing severe pain, vomiting, and eventually fecal vomiting. A good many different forms of severe painful conditions, especially all those complicated by peritonitis, were included under the term, and the modern student of surgery is likely to wonder whether these old observers had not noted that the right iliac region was particularly prone to be the source of fatal conditions. There is a chapter entitled "Against Pain in the Loins and the Kidneys," followed by the chapter subheading, "Against Stone in the Kidneys." There is a chapter with the title, "Against Ulceration of the Bladder or the Kidneys." Another one, with the title "Against Burning of the Urine and Excoriation of the Lower Part of the Yard." Gonorrhea is frankly treated under the name _Shawdepisse_, evidently an English alliteration of the corresponding French word. As to the instrumentation of such conditions and for probing in general, Ardern suggests the use of a lead probe, because it may readily be made to bend any way and not injure the tissues. MEDIEVAL SURGERY Even this brief account of the surgeons who taught and studied at the medieval universities demonstrates what fine work they did. It is surely not too much to say that the chapter on university education mainly concerned with them is one of the most interesting in the whole history of the universities. Their story alone is quite enough to refute most of the prevalent impressions and patronizing expressions with regard to medieval education. Their careers serve to show how interested were the men of many nations in the development of an extremely important application of science for the benefit of suffering humanity. Their work utterly contradicts the idea so frequently emphasized that the great students of the Middle Ages were lacking in practicalness. Besides, they make very clear that we have been prone to judge the Middle Ages too much from its speculative philosophies. It has been the custom to say that speculation ruled men's minds and prevented them from making observations, developing science, or applying scientific principles. There was much speculation during the Middle Ages, but probably not any more in proportion than exists at the present day. We were either not acquainted with, or failed to appreciate properly, until comparatively recent years, the other side of medieval accomplishment. Our ignorance led us into misunderstanding of what these generations really did. It was our own fault, because during the Renaissance practically all of these books were edited and printed under the direction of the great scholars of the time in fine editions, but during the eighteenth century nearly all interest was lost in them, and we are only now beginning to get back a certain amount of the precious knowledge that they had in the Renaissance period of this other side of medieval life. We have learned so much about surgery because distinguished scholars devoted themselves to this phase of the history of science. Doubtless there are many other phases of the history of science which suffered the same fate of neglect and with regard to which the future will bring us equally startling revelations. For this reason this marvellous chapter in the history of surgery is a warning as well as a startling record of a marvellous epoch of human progress. XI GUY DE CHAULIAC One of the most interesting characters in the history of medieval medicine, and undoubtedly the most important and significant of these Old-Time Makers of Medicine, is Guy de Chauliac. Most of the false notions so commonly accepted with regard to the Middle Ages at once disappear after a careful study of his career. The idea of the careful application of scientific principles in a great practical way is far removed from the ordinary notion of medieval procedure. Some observations we may concede that they did make, but we are inclined to think that these were not regularly ordered and the lessons of them not drawn so as to make them valuable as experiences. Great art men may have had, but science and, above all, applied science, is a later development of humanity. Particularly is this supposed to be true with regard to the science and practice of surgery, which is assumed to be of comparatively recent origin. Nothing could well be less true, and if the thoroughly practical development of surgery may be taken as a symbol of how capable men were of applying science and scientific principles, then it is comparatively easy to show that the men of the later Middle Ages were occupied very much as have been our recent generations with science and its practical applications. The immediate evidence of the value of old-time surgery is to be found in the fact that Guy de Chauliac, who is commonly spoken of in the history of medicine as the Father of Modern Surgery, lived his seventy-odd years of life during the fourteenth century and accomplished the best of his work, therefore, some five centuries before surgery in our modern sense of the term is supposed to have developed. A glance at his career, however, will show how old are most of the important developments of surgery, as also in what a thoroughly scientific temper of mind this subject was approached more than a century before the close of the Middle Ages. The life of this French surgeon, indeed, who was a cleric and occupied the position of chamberlain and physician-in-ordinary to three of the Avignon Popes, is not only a contradiction of many of the traditions as to the backwardness of our medieval forbears in medicine, that are readily accepted by many presumably educated people, but it is the best possible antidote for that insistent misunderstanding of the Middle Ages which attributes profound ignorance of science, almost complete failure of observation, and an absolute lack of initiative in applications of science to the men of those times. Guy de Chauliac's life is modern in nearly every phase. He was educated in a little town of the south of France, made his medical studies at Montpellier, and then went on a journey of hundreds of miles into Italy, in order to make his post-graduate studies. Italy occupied the place in science at that time that Germany has taken during the nineteenth century. A young man who wanted to get into touch with the great masters in medicine naturally went down into the Peninsula. Traditions as to the attitude of the Church to science notwithstanding, Italy where education was more completely under the influence of the Popes and ecclesiastics than in any other country in Europe, continued to be the home of post-graduate work in science for the next four centuries. Almost needless to say, the journey to Italy was more difficult of accomplishment and involved more expense and time than would even the voyage from America to Europe in our time. Chauliac realized, however, that both time and expense would be well rewarded, and his ardor for the rounding out of his education was amply recompensed by the event. Nor have we any reason for thinking that what he did was very rare, much less unique, in his time. Many a student from France, Germany, and England made the long journey to Italy for post-graduate opportunities during the later Middle Ages. Even this post-graduate experience in Italy did not satisfy Chauliac, however, for, after having studied several years with the most distinguished Italian teachers of anatomy and surgery, he spent some time in Paris, apparently so as to be sure that he would be acquainted with the best that was being done in his specialty in every part of the world. He then settled down to his own life work, carrying his Italian and French masters' teachings well beyond the point where he received them, and after years of personal experience he gathered together his masters' ideas, tested by his own observations, into his "Chirurgia Magna," a great text-book of surgery which sums up the whole subject succinctly, yet completely, for succeeding generations. When we talk about what he accomplished for surgery, we are not dependent on traditions nor vague information gleaned from contemporaries and successors, who might perhaps have been so much impressed by his personality as to be made over-enthusiastic in their critical judgment of him. We know the man in his surgical works, and they have continued to be classics in surgery ever since. It is an honorable distinction for the medicine of the later fourteenth, the fifteenth, and sixteenth centuries that Guy de Chauliac's book was the most read volume of the time in medicine. Evidently the career of such a man is of import, not alone to physicians, but to all who are interested in the history of education. Chauliac derives his name from the little town of Chauliac in the diocese of Mende, almost in the centre of what is now the department of Lozère. The records of births and deaths were not considered so important in the fourteenth century as they are now, and so we are not sure of either in the case of Chauliac. It is usually considered that he was born some time during the last decade of the thirteenth century, probably toward the end of it, and that he died about 1370. Of his early education we know nothing, but it must have been reasonably efficient, since it gave him a good working knowledge of Latin, which was the universal language of science and especially of medicine at that time; and though his own style, as must be expected, is no better than that of his contemporaries, he knew how to express his thoughts clearly in straightforward Latin, with only such a mixture of foreign terms as his studies suggested and the exigencies of a new development of science almost required. Later in life he seems to have known Arabic very well, for he is evidently familiar with Arabian books and does not depend merely on translations of them. Pagel, in the first volume of Puschmann's "Handbook of the History of Medicine," says, on the authority of Nicaise and others, that Chauliac received his early education from the village clergyman. His parents were poor, and but for ecclesiastical interest in him it would have been difficult for him to obtain his education. The Church supplied at that time to a great extent for the foundations and scholarships, home and travelling, of our day, and Chauliac was amongst the favored ones. How well he deserved the favor his subsequent career shows, as it completely justifies the judgment of his patrons. He went first to Toulouse, as we know from his affectionate mention of one of his teachers there. Toulouse was more famous for law, however, than for medicine, and after a time Chauliac sought Montpellier to complete his medical studies. For English-speaking people an added interest in Guy de Chauliac will be the fact that one of his teachers at Montpellier was Bernard Gordon, very probably a Scotchman, who taught for some thirty-five years at this famous university in the south of France, and died near the end of the first quarter of the fourteenth century. One of Chauliac's fellow-students at Montpellier was John of Gaddesden, the first English Royal Physician by official appointment of whom we have any account. John is mentioned by Chaucer in his "Doctor of Physic," and is usually looked upon as one of the fathers of English medicine. Chauliac did not think much of him, though his reason for his dislike of him will probably be somewhat startling to those who assume that the men of the Middle Ages always clung servilely to authority. Chauliac's objection to Gaddesden's book is that he merely repeats his masters and does not dare to think for himself. It is not hard to understand that such an independent thinker as Chauliac should have been utterly dissatisfied with a book that did not go beyond the forefathers in medicine that the author quotes. This is the explanation of his well-known expression, "Last of all arose the scentless rose of England ['Rosa Angliæ' was the name of John of Gaddesden's book], in which, on its being sent to me, I hoped to find the odor of sweet originality, but instead of that I encountered only the fictions of Hispanus, of Gilbert, and of Theodoric." The presence of a Scotch professor and an English fellow-student, afterwards a royal physician, at Montpellier, at the beginning of the fourteenth century, shows how much more cosmopolitan was university life in those times than we are prone to think, and what attraction a great university medical school possessed even for men from long distances. After receiving his degree of Doctor of Medicine at Montpellier Chauliac went, as we have said, to Bologna. Here he attracted the attention and received the special instruction of Bertruccio, who was attracting students from all over Europe at this time and was making some excellent demonstrations in anatomy, employing human dissections very freely. Chauliac tells of the methods that Bertruccio used in order that bodies might be in as good condition as possible for demonstration purposes, and mentions the fact that he saw him do many dissections in different ways. In Roth's life of Vesalius, which is usually considered one of our most authoritative medical historical works not only with regard to the details of Vesalius' life, but also in all that concerns anatomy about that time and for some centuries before, there is a passage quoted from Chauliac himself which shows how freely dissection was practised at the Italian universities in the fourteenth century. This passage deserves to be quoted at some length because there are even serious historians who still cite a Bull of Pope Boniface VIII, issued in 1300, forbidding the boiling and dismembering of bodies in order to transport them to long distances for burial in their own country, as being, either rightly or wrongly, interpreted as a prohibition of dissection and, therefore, preventing the development of anatomy. In the notes to his history of dissection during this period in Bologna Roth says: "Without doubt the passage in Guy de Chauliac which tells of having frequently seen dissections, must be considered as referring to Bologna. This passage runs as follows: 'My master Bertruccius conducted the dissection very often after the following manner: the dead body having been placed upon a bench, he used to make four lessons on it. In the first the nutritional portions were treated, because they are so likely to become putrefied. In the second, he demonstrated the spiritual members; in the third, the animate members; in the fourth, the extremities.'" (Roth, "Andreas Vesalius." Basel, 1896.) Bertruccio's master, Mondino, is hailed in the history of medicine as the father of dissection. His book on dissection was for the next three centuries in the hands of nearly every medical scholar in Europe who was trying to do good work in anatomy. It was not displaced until Vesalius came, the father of modern anatomy, who revolutionized the science in the Renaissance time. Mondino had devoted himself to the subject with unfailing ardor and enthusiasm, and from everywhere in Europe the students came to receive inspiration in his dissecting-room. Within a few years such was the enthusiasm for dissection aroused by him in Bologna that there were many legal prosecutions for body-snatching, the consequence doubtless of a regulation of the Medical Department of the University of Bologna, that if the students brought a body to any of their teachers he was bound to dissect it for them. Bertruccio, Mondino's disciple and successor, continued this great work, and now Chauliac, the third in the tradition, was to carry the Bolognese methods back to France, and his position as chamberlain to the Pope was to give them a wide vogue throughout the world. The great French surgeon's attitude toward anatomy and dissection can be judged from his famous expression that "the surgeon ignorant of anatomy carves the human body as a blind man carves wood." The whole subject of dissection at this time has been fully discussed in the first three chapters of my "Popes and Science," where those who are interested in the matter may follow it to their satisfaction.[23] After his Bologna experience Chauliac went to Paris. Evidently his indefatigable desire to know all that there was to be known would not be satisfied until he had spent some time at the great French university where Lanfranc, after having studied under William of Salicet in Italy, had gone to establish that tradition of French surgery which, carried on so well by Mondeville his great successor, was to maintain Frenchmen as the leading surgeons of the world until the nineteenth century (Pagel). Lanfranc, himself an Italian, had been exiled from his native country, apparently because of political troubles, but was welcomed at Paris because the faculty realized that they needed the inspiration of the Italian medical movement in surgery for the establishment of a good school of surgery in connection with the university. The teaching so well begun by Lanfranc was magnificently continued by Mondeville and Arnold of Villanova and their disciples. Chauliac was fortunate enough to come under the influence of Petrus de Argentaria, who was worthily maintaining the tradition of practical teaching in anatomy and surgery so well founded by his great predecessors of the thirteenth century. After this grand tour Chauliac was himself prepared to do work of the highest order, for he had been in touch with all that was best in the medicine and surgery of his time. Like many another distinguished member of his profession, Chauliac did not settle down in the scene of his ultimate labors at once, but was something of a wanderer. His own words are, "_Et per multa tempora operatus fui in multis partibus_." Perhaps out of gratitude to the clerical patrons of his native town to whom he owed so much, or because of the obligations he considered that he owed them for his education, he practised first in his native diocese of Mende; thence he removed to Lyons, where we know that he lived for several years, for in 1344 he took part as a canon in a chapter that met in the Church of St. Just in that city. Just when he was called to Avignon we do not know, though when the black death ravaged that city in 1348 he was the body-physician of Pope Clement VI, for he is spoken of in a Papal document as "_venerabilis et circumspectus vir, dominus Guido de Cauliaco, canonicus et præpositus ecclesiæ Sancti Justi Lugduni, medicusque domini Nostri Papæ_." All the rest of his life was passed in the Papal capital, which Avignon was for some seventy years of the fourteenth century. He served as chamberlain-physician to three Popes, Clement VI, Innocent VI, and Urban V. We do not know the exact date of his death, but when Pope Urban V went to Rome in 1367, Chauliac was putting the finishing touches on his "Chirurgia Magna," which, as he tells us, was undertaken as a _solatium senectutis_--a solace in old age. When Urban returned to Avignon for a time in 1370 Chauliac was dead. His life work is summed up for us in this great treatise on surgery, full of anticipations in surgical procedures that we are prone to think much more modern. Nicaise has emphasized the principles which guided Guy de Chauliac in the choice and interpretation of his authorities by a quotation from Guy himself, which is so different in its tone from what is usually supposed to have been the attitude of mind of the men of science of the time that it would be well for all those who want to understand the Middle Ages better to have it near them. Speaking of the surgeons of his own and immediately preceding generations, Guy says: "One thing particularly is a source of annoyance to me in what these surgeons have written, and it is that they follow one another like so many cranes. For one always says what the other says. I do not know whether it is from fear or from love that they do not deign to listen except to such things as they are accustomed to and as have been proved by authorities. They have to my mind understood very badly Aristotle's second book of metaphysics where he shows that these two things, fear and love, are the greatest obstacles on the road to the knowledge of the truth. Let them give up such friendships and fears. 'Because while Socrates or Plato may be a friend, truth is a greater friend.' Truth is a holy thing and worthy to be honored above everything else. Let them follow the doctrine of Galen, which is entirely made up of experience and reason, and in which one investigates things and despises words." After all, this is what great authorities in medicine have always insisted on. Once every hundred years or so one finds a really great observer who makes new observations and wakes the world up. He is surprised that men should not have used their powers of observation for themselves, but should have been following old-time masters. His contemporaries often refuse to listen to him at first. His observations, however, eventually make their way. We blame the Middle Ages for following authority, but what have we been always doing but following authority, except for the geniuses who come and lift us out of the rut and illuminate a new portion of the realm of medicine. After they have come, however, and done their work, their disciples proceed to see with their eyes and to think that they are making observations for themselves when they are merely following authority. When the next master in medicine comes along his discovery is neglected because men have not found it in the old books, and usually he has to suffer for daring to have opinions of his own. The fact of the matter is that at any time there is only a very limited number of men who think for themselves. The rest think other people's thoughts and think they are thinking and doing things. As for observation, John Ruskin once said, "Nothing is harder than to see something and tell it simply as you saw it." This is as true in science as in art, and only genius succeeds in doing it well. Chauliac's book is confessedly a compilation. He has taken the good wherever he found it, though he adds, modestly enough, that his work also contains whatever his own measure of intelligence enabled him to find useful (_quæ juxta modicitatem mei ingenii utilia reputavi_). Indeed it is the critical judgment displayed by Chauliac in selecting from his predecessors that best illustrates at once the practical character of his intellect and his discerning spirit. What the men of his time are said to have lacked is the critical faculty. They were encyclopedic in intellect and gathered all kinds of information without discrimination, is a very common criticism of medieval writers. No one can say this of Chauliac, however, and, above all, he was no respecter of authority, merely for the sake of authority. His criticism of John of Gaddesden's book shows that the blind following of those who had gone before was his special _bête noir_. His bitterest reproach for many of his predecessors was that "they follow one another like cranes, whether for love or fear, I cannot say." Chauliac's right to the title of father of surgery will perhaps be best appreciated from the brief account of his recommendations as to the value of surgical intervention for conditions in the three most important cavities of the body, the skull, the thorax, and the abdomen. These cavities have usually been the dread of surgeons. Chauliac not only used the trephine, but laid down very exact indications for its application. Expectant treatment was to be the rule in wounds of the head, yet when necessary, interference was counselled as of great value. His prognosis of brain injuries was much better than that of his predecessors. He says that he had seen injuries of the brain followed by some loss of brain substance, yet with complete recovery of the patient. In one case that he notes a considerable amount of brain substance was lost, yet the patient recovered with only a slight defect of memory, and even this disappeared after a time. He lays down exact indications for the opening of the thorax, that _noli me tangere_ of surgeons at all times, even our own, and points out the relations of the ribs and the diaphragm, so as to show just where the opening should be made in order to remove fluid of any kind. In abdominal conditions, however, Chauliac's anticipation of modern views is most surprising. He recognized that wounds of the intestines were surely fatal unless leakage could be prevented. Accordingly he suggested the opening of the abdomen and the sewing up of such intestinal wounds as could be located. He describes a method of suture for these cases and seems, like many another abdominal surgeon, even to have invented a special needleholder. To most people it would seem absolutely out of the question that such surgical procedures could be practised in the fourteenth century. We have the definite record of them, however, in a text-book that was the most read volume on the subject for several centuries. Most of the surprise with regard to these operations will vanish when it is recalled that in Italy during the thirteenth century, as we have already seen, methods of anæsthesia by means of opium and mandragora were in common use, having been invented in the twelfth century and perfected by Ugo da Lucca, and Chauliac must not only have known but must have frequently employed various methods of anæsthesia. In discussing amputations he has described in general certain methods of anæsthesia in use in his time, and especially the method by means of inhalation. It would not seem to us in the modern time that this method would be very successful, but there is an enthusiastic accord of authorities attesting that operations were done at this time with the help of this inhalant without the infliction of pain. Chauliac says: "Some prescribe medicaments which send the patient to sleep, so that the incision may not be felt, such as opium, the juice of the morel, hyoscyamus, mandrake, ivy, hemlock, lettuce. A new sponge is soaked by them in these juices and left to dry in the sun; and when they have need of it they put this sponge into warm water and then hold it under the nostrils of the patient until he goes to sleep. Then they perform the operation." Many people might be prone to think that the hospitals of Chauliac's time would not be suitable for such surgical work as he describes. It is, however, only another amusing assumption of this self-complacent age of ours to think that we were the first who ever made hospitals worthy of the name and of the great humanitarian purpose they subserve. As a matter of fact, the old-time hospitals were even better than ours or, as a rule, better than any we had until the present generation. In "The Popes and Science," in the chapter on "The Foundation of City Hospitals," I call attention to the fact that architects of the present day go back to the hospitals of the Middle Ages in order to find the models for hospitals for the modern times. Mr. Arthur Dillon, a well-known New York architect, writing of a hospital built at Tonnerre in France, toward the end of the thirteenth century (1292), says: "It was an admirable hospital in every way, and it is doubtful if we to-day surpass it. It was isolated; the ward was separated from the other buildings; it had the advantage we so often lose of being but one story high, and more space was given to each patient than we can now afford. "The ventilation by the great windows and ventilators in the ceiling was excellent; it was cheerfully lighted; and the arrangement of the gallery shielded the patients from dazzling light and from draughts from the windows and afforded an easy means of supervision, while the division by the roofless low partitions isolated the sick and obviated the depression that comes from sight of others in pain. "It was, moreover, in great contrast to the cheerless white wards of to-day. The vaulted ceiling was very beautiful; the woodwork was richly carved, and the great windows over the altars were filled with colored glass. Altogether it was one of the best examples of the best period of Gothic Architecture."[24] The fine hospital thus described was but one of many. Virchow, in his article on hospitals quoted in the same chapter, called attention to the fact that in the thirteenth and fourteenth centuries every town of five thousand or more inhabitants had its hospital, founded on the model of the great Santo Spirito Hospital in Rome, and all of them did good work. The surgeons of Guy de Chauliac's time would indeed find hospitals wherever they might be called in consultation, even in small towns. They were more numerous in proportion to population than our own and, as a rule, at least as well organized as ours were until the last few years. It is no wonder that with such a good hospital organization excellent surgery was accomplished. Hernia was Chauliac's specialty, and in it his surgical judgment is admirable. Mondeville before his time did not hesitate to say that many operations for hernia were done not for the benefit of the patient, but for the benefit of the surgeon,--a very striking anticipation of remarks that one sometimes hears even at the present time. Chauliac discussed operations for hernia very conservatively. His rule was that a truss should be worn, and no operation attempted unless the patient's life was endangered by the hernia. It is to him that we owe the invention of a well-developed method of taxis, or manipulation of a hernia, to bring about its reduction, which was in use until the end of the nineteenth century. He suggested that trusses could not be made according to rule, but must be adapted to each individual case. He invented several forms of truss himself, and in general it may be said that his manipulative skill and his power to apply his mechanical principles to his work are the most characteristic of his qualities. This is particularly noteworthy in his chapters on fractures and dislocations, in which he suggests various methods of reduction and realizes very practically the mechanical difficulties that were to be encountered in the correction of the deformities due to these pathological conditions. In a word, we have a picture of the skilled surgeon of the modern time in this treatise of a fourteenth-century teacher of surgery. Chauliac discusses six different operations for the radical cure of hernia. As Gurlt points out, he criticises them from the same standpoint as that of recent surgeons. The object of radical operations for hernia is to produce a strong, firm tissue support over the ring through which the cord passes, so that the intestines cannot descend through it. It is rather interesting to find that the surgeons of this time tried to obliterate the canal by means of the cautery, or inflammation producing agents, arsenic and the like, a practice that recalls some methods still used more or less irregularly. They also used gold wire, which was to be left in the tissues and is supposed to protect and strengthen the closure of the ring. At this time all these operations for the radical cure of hernia involved the sacrifice of the testicle because the old surgeons wanted to obliterate the ring completely, and thought this the easiest way. Chauliac discusses the operation in this respect and says that he has seen many cases in which men possessed of but one testicle have procreated, and this is a case where the lesser of two evils is to be chosen. Of course Guy de Chauliac would not have been able to operate so freely on hernia and suggest, following his own experience, methods of treatment of penetrating wounds of the abdomen only that he had learned the lessons of antiseptic surgery which had been gradually developed among the great surgeons of Italy during the preceding century. The use of the stronger wines as a dressing together with insistence on the most absolute cleanliness of the surgeon before the operation, and careful details of cleanliness during the operation, made possible the performance of many methods of surgical intervention that would otherwise surely have been fatal. Probably nothing is harder to understand than that after these practical discoveries men should have lost sight of their significance, and after having carefully studied the viscous exudation which produces healthy natural union, should have come to the thought of the necessity for the formation of laudable pus before union might be expected. The mystery is really no greater than that of many another similar incident in human history, but it strikes us more forcibly because the discovery and gradual development of antiseptic surgery in our own time has meant so much for us. Already even in Chauliac's practice, however, some of the finer elements of the technique that made surgery antiseptic to a marked degree, if not positively aseptic in many cases, were not being emphasized as they were by his predecessors, and there was a beginning of surgical meddlesomeness reasserting itself. It must not be thought, however, that it was only with the coarse applications of surgery that Chauliac concerned himself. He was very much interested in the surgical treatment of eye diseases and wrote a monograph on cataract, in which he gathers what was known before his time and discusses it in the light of his own experience. The writing of such a book is not so surprising at this time if we recall that in the preceding century the famous Pope John XXI, who had been a physician before he became Pope, and under the name of Peter of Spain was looked up to as one of the distinguished scientists of his time, had written a book on eye diseases that has recently been the subject of much attention. Pope John had much to say of cataract, dividing it into traumatic and spontaneous, and suggesting the needling of cataract, a gold needle being used for the purpose. Chauliac's method of treating cataract was by depression. His care in the selection of patients may be appreciated from his treatment of John of Luxembourg, King of Bavaria, blind from cataract, who consulted Chauliac in 1336 while on a visit to Avignon with the King of France. Chauliac refused to operate, however, and put off the King with dietary regulations. In the chapter on John of Arcoli and Medieval Dentistry we call attention to the fact that Chauliac discussed dental surgery briefly, yet with such practical detail as to show very clearly how much more was known about this specialty in his time than we have had any idea of until recent years. He recognized the dentists as specialists, calls them dentatores, but thinks that they should operate under the direction of a physician--hence the physician should know much about teeth and especially about their preservation. He enumerates instruments that dentists should have and shows very clearly that the specialty had reached a high state of development. A typical example of Chauliac's common sense and dependence on observation and not tradition is to be found in what he has to say with regard to methods of removing the teeth without the use of extracting instruments. It is characteristic of his method of dealing with traditional remedies, even though of long standing, that he brushes them aside with some impatience if they have not proved themselves in his experience. "The ancients mention many medicaments, which draw out the teeth without iron instruments or which make them more easy to draw out; such as the milky juice of the tithymal with pyrethrum, the roots of the mulberry and caper, citrine arsenic, aqua fortis, the fat of forest frogs. But these remedies promise much and accomplish but little--_mais ils donnent beaucoup de promesses, et peu, d'opérations_." It is no wonder that Chauliac has been enthusiastically praised. Nicaise has devoutly gathered many of these praises into a sheaf of eulogies at the end of his biography of the great French surgeon. He tells us that Fallopius compared him to Hippocrates. John Calvo of Valencia, who translated the "Great Surgery" into Spanish, looks upon him as the first law-giver of surgery. Freind, the great English physician, in 1725 called him the Prince of Surgeons. Ackermann said that Guy de Chauliac's text-book will take the place of all that has been written on the subject down to his time, so that even if all the other works had been lost his would replace them. Dezimeris, commenting on this, says that "if one should take this appreciation literally, this surgeon of the fourteenth century would be the first and, up to the present time, the only author who ever merited such an eulogy." "At least," he adds, "we cannot refuse him the distinction of having made a work infinitely superior to all those which appeared up to this time and even for a long time afterwards. Posterity rendered him this justice, for he was for three centuries the classic _par excellence_. He rendered the study easy and profitable, and all the foreign nations the tributaries of our country." Peyrihle considered Guy's "Surgery" as the most valuable and complete work of all those of the same kind that had been published since Hippocrates and added that the reading of it was still useful in his time in 1784. Bégin, in his work on Ambroise Paré, says "that Guy has written an immortal book to which are attached the destinies of French surgeons." Malgaigne, in his "History of Surgery," does not hesitate to say, "I do not fear to say that, Hippocrates alone excepted, there is not a single treatise on surgery,--Greek, Latin, or Arabic,--which I place above, or even on the same level with, this magnificent work, 'The Surgery of Guy de Chauliac.'" Daremberg said, "Guy seems to us a surgeon above all erudite, yet expert and without ever being rash. He knows, above all, how to choose what is best in everything." Verneuil, in his "Conférence sur Les Chirurgiens Érudits," says, "The services rendered by the 'Great Surgery' were immense; by it there commenced for France an era of splendor. It is with justice, then, that posterity has decreed to Guy de Chauliac the title of Father of French surgery." The more one reads of Chauliac's work the less is one surprised at the estimation in which he has been held wherever known. It would not be hard to add a further sheaf of compliments to those collected by Nicaise. Modern writers on the history of medicine have all been enthusiastic in their admiration of him, just in proportion to the thoroughness of their acquaintance with him. Portal, in his "History of Anatomy and Surgery," says, "Finally, it may be averred that Guy de Chauliac said nearly everything which modern surgeons say, and that his work is of infinite price but unfortunately too little read, too little pondered." Malgaigne declares Chauliac's "Chirurgia Magna" to be "a masterpiece of learned and luminous writing." Professor Clifford Allbutt, the Regius Professor of Physic at the University of Cambridge, says of Chauliac's treatise: "This great work I have studied carefully and not without prejudice; yet I cannot wonder that Fallopius compared the author to Hippocrates or that John Freind calls him the Prince of Surgeons. It is rich, aphoristic, orderly, and precise."[25] If to this account of his professional career it be added that Chauliac's personality is, if possible, more interesting than his surgical accomplishment, some idea of the significance of the life of the great father of modern surgery will be realized. We have already quoted the distinguished words of praise accorded him by Pope Clement VI. That they were well deserved, Chauliac's conduct during the black death which ravaged Avignon in 1348, shortly after his arrival in the Papal City, would have been sufficient of itself to attest. The occurrence of the plague in a city usually gave rise to an exhibition of the most arrant cowardice, and all who could, fled. In many of the European cities the physicians joined the fugitives, and the ailing were left to care for themselves. With a few notable exceptions, this was the case at Avignon, but Guy was among those who remained faithful to his duty and took on himself the self-sacrificing labor of caring for the sick, doubly harassing because so many of his brother physicians were absent. He denounces their conduct as shameful, yet does not boast of his own courage, but on the contrary says that he was in constant fear of the disease. Toward the end of the epidemic he was attacked by the plague and for a time his life was despaired of. Fortunately he recovered, to become the most influential among his colleagues, the most highly admired of the physicians of his generation, and the close personal friend of all the high ecclesiastics, who had witnessed his magnificent display of courage and of helpfulness for the plague-stricken during the epidemic. He wrote a very clear account of the epidemic, which leaves no doubt that it was true bubonic plague. After this fine example, Chauliac's advice to brother physicians in the specialty of surgery carried added weight. In the Introductory chapter of his "Chirurgia Magna" he said: "The surgeon should be learned, skilled, ingenious, and of good morals. Be bold in things that are sure, cautious in dangers; avoid evil cures and practices; be gracious to the sick, obliging to his colleagues, wise in his predictions. Be chaste, sober, pitiful, and merciful; not covetous nor extortionate of money; but let the recompense be moderate, according to the work, the means of the sick, the character of the issue or event, and its dignity." No wonder that Malgaigne says of him, "Never since Hippocrates has medicine heard such language filled with so much nobility and so full of matter in so few words." Chauliac was in every way worthy of his great contemporaries and the period in which his lot was cast. Ordinarily we are not apt to think of the early fourteenth century as an especially productive period in human history, but such it is. Dante's Divine Comedy was entirely written during Chauliac's life. Petrarch was born within a few years of Chauliac himself; Boccaccio in Italy, and Chaucer in England, wrote while Chauliac was still alive. Giotto did his great painting, and his pupils were laying the deep, firm foundations of modern art. Many of the great cathedrals were being finished. Most of the universities were in the first flush of their success as moulders of the human mind. There are few centuries in history that can show the existence of so many men whose work was to have an enduring influence for all the after time as this upon which Chauliac's career shed so bright a light. The preceding century had seen the origin of the universities and the rise of such supremely great men as Albertus Magnus, Roger Bacon, Thomas Aquinas, and the other famous scholars of the early days of the mendicant orders, and had made the intellectual mould of university training in which men's minds for seven centuries were to be formed, so that Chauliac, instead of being an unusual phenomenon is only a fitting expression of the interest of this time in everything, including the physical sciences and, above all, medicine and surgery. For some people it may be a source of surprise that Chauliac should have had the intellectual training to enable him to accomplish such judicious work in his specialty. Many people will be apt to assume that he accomplished what he did in spite of his training, genius succeeding even in an unfavorable environment, and notwithstanding educational disadvantages. Those who would be satisfied with any such explanation, however, know nothing of the educational opportunities provided in the period of which Chauliac was the fruit. He is a typical university man of the beginning of the fourteenth century, and the universities must be given due credit for him. It is ordinarily assumed that the universities paid very little attention to science and that scientists would find practically nothing to satisfy in their curricula. Professor Huxley in his address on "Universities, Actual and Ideal," delivered as the Rectorial Address at Aberdeen University in 1874, declared that they were probably educating in the real sense of the word better than we do now. (See quotation in "The Medical School at Salerno.") In the light of Chauliac's life it is indeed amusing to read the excursions of certain historians into the relationship of the Popes and the Church to science during the Middle Ages. Chauliac is typically representative of medieval science, a man who gave due weight to authority, yet tried everything by his own experience, and who sums up in himself such wonderful advance in surgery that during the last twenty years the students of the history of medicine have been more interested in him than in anyone who comes during the intervening six centuries. Chauliac, however, instead of meeting with any opposition, encountered encouragement, liberal patronage, generous interest, and even enjoyed the intimate friendship of the highest ecclesiastics and the Popes of his time. In every way his life may be taken as a type of what we have come to know about the Middle Ages, when we know them as we should, in the lives of the men who counted for most in them, and do not accept merely the broad generalizations which are always likely to be deceptive and which in the past have led men into the most absurd and ridiculous notions with regard to a wonderful period in human history. That Guy de Chauliac was no narrow specialist is abundantly evident from his book, for while the "Great Surgery" treats of the science and art of surgery as its principal subject, there are remarks about nearly everything else relating to medicine, and most of them show a deep interest, a thorough familiarity, and an excellent judgment. Besides we have certain expressions with regard to intellectual matters generally which serve to show Guy as a profound thinker, who thoroughly appreciated just how accumulations of knowledge came to men and how far each generation or member of a generation should go and yet how limited must, after all, be the knowledge obtained by any one person. With regard to books, for instance, he said, "for everyone cannot have all the books, and even if he did have them it would be too tiresome to read them all and completely, and it would require a godlike memory to retain them all." He realized, however, that each generation, provided it took the opportunities offered it, was able to see a little bit farther than its predecessor, and the figure that he employs to express this is rather striking. "Sciences," he said, "are made by additions. It is quite impossible that the man who begins a science should finish it. We are like infants, clinging to the neck of a giant; for we can see all the giant sees and a little more." One of the most interesting features of the history of Guy de Chauliac is the bibliography of his works which has been written by Nicaise. This is admirably complete, labored over with the devotion that characterized Nicaise's attitude of unstinted admiration for the subject. Altogether he has some sixty pages of a quarto volume with regard to the various editions of Guy's works. The first manuscript edition of Guy de Chauliac was issued in 1363, the first printed edition in 1478. Even in the fourteenth century Guy's great work was translated into all the languages generally used in Europe. Nicaise succeeded in placing 34 complete manuscripts of the "Great Surgery": 22 of these are in Latin, 4 are in French, 3 are in English, 2 only in Provençal, though that was the language spoken in the region where much of Chauliac's life was passed, and one each in Italian, in Low Dutch, and in Hebrew. Of the English manuscripts, one is number twenty-five English of the Bibliothèque Nationale, Paris; a second is number 3666 English of the Sloane collection in the British Museum, and a third is in the Library of the University of Cambridge.[26] Paulin Paris, probably one of the best of recent authorities on the age and significance of old manuscripts, says in the third volume of his "Manuscrits Français," page 346, "This manuscript [of Guy de Chauliac's "Great Surgery"] was made, if not during the life, then certainly very shortly after the death of the author. It is one of the oldest that can be cited, and the fact that an English translation was made so near to the time of the original composition of the book attests the great reputation enjoyed by Guy de Chauliac at this time, and which posterity has fully confirmed." The Sloane copy in the British Museum contains some medical recipes at the end by Francis Verney. It was probably written in the fifteenth century. Its title is: "The inventorie or the collectorie in cirurgicale parte of medicine compiled and complete in the yere of our Lord 1363, with some additions of other doctours, necessary to the foresaid arte or crapte (crafte?)."[27] What we find in the period of manuscripts, however, is as nothing compared to the prestige of Guy de Chauliac's work, once the age of printing began. Nicaise was able to find sixty different printed editions of the "Great Surgery." Nine others that are mentioned by authors have disappeared and apparently no copies of them are in existence. Besides there are sixty editions of portions of the work, of compendiums of it and commentaries on it. Altogether 129 editions are extant. Of these there are sixteen Latin editions, forty-three French, five Italian, four Low Dutch, five Catalan, and one English. Fourteen appeared in the fifteenth century, thirty-eight in the sixteenth century, and seventeen in the seventeenth century. The fourteen editions belonging to the _incunabula_ of printing, issued, that is, before the end of the fifteenth century, show what lively interest there was in the French surgeon of the preceding century, since printing presses at this precious time were occupied only with the books that were considered indispensable for scholars. The first edition of the "Great Surgery" was printed in 1478 at Lyons. Printing had only been introduced there five years before. This first edition, _primus primarius_ or _editio princeps_, was a French translation by Nicholas Panis. In 1480 an Italian edition was printed at Venice. The first Latin edition was printed also in Venice in 1490. It would be only natural to expect that the successors of Guy de Chauliac, and especially those who had come personally in contact with him, would take advantage of his thorough work to make still further advances in surgery. As matter of fact, decadence in surgery is noted immediately after his death. Three men taught at the University of Montpellier at the end of the fourteenth and the beginning of the fifteenth century, John de Tornamira, Valesco de Taranta, and John Faucon. They cannot be compared, Gurlt says, with Guy de Chauliac, though they were physicians of reputation in their time. Faucon made a compendium of Guy's work for students. Somehow there seemed to be the impression that surgery had now reached a point of development beyond which it could not advance. Unfortunate political conditions, wars, the withdrawal of the Popes from Avignon to Rome, and other disturbances, distracted men's minds, and surgery deteriorated to a considerable extent, until the new spirit at the time of the Renaissance came to inject fresh life into it. XII MEDIEVAL DENTISTRY--GIOVANNI OF ARCOLI If there is one phase of our present-day medicine and surgery that most of us are likely to be quite sure is of very recent development it is dentistry. Probably most people would declare at once that they had every reason to think that the science and art of dentistry, as we have it now, developed for the first time in the world's history during the last generation or two. It is extremely interesting to realize then, in the light of this almost universal persuasion, founded to a great extent on the conviction that man is in process of evolution and that as a consequence we must surely be doing things now that men never did before, to find that dentistry, both as an art and science, is old; that it has developed at a number of times in the world's history, and that as fortunately for history its work was done mainly in indestructible materials, the teeth themselves and metal prosthetic apparatus, we have actual specimens of what was accomplished at a number of periods in the olden times. Surprising as it will seem to those who hear of it for the first time, dentistry reached high perfection even in what we know as ancient history. It is rather easy to trace scientific and craftsmanlike interest in it during the medieval period and in the magnificent development of surgery that came just at the end of the Middle Ages, dentistry shared to such degree that some of the text-books of the writers on surgery of this time furnish abundant evidence of anticipations of many of the supposedly most modern developments of dentistry. There are a number of historical traditions with regard to dentistry and the treatment of the teeth in Egypt that can be traced back to good authorities in Egyptology of a generation or more ago, but it is rather hard to confirm the accounts we have by actual specimens; either none were found or for some reason those actually discovered are now not readily available for study. Among the Phenicians however, though we have good reasons to think that they learned their arts and crafts from the Egyptians, there is convincing evidence of a high development of dentistry. M. Ernest Renan, during an exploring expedition in Phenicia, found in the old necropolis at Sidon a set of teeth wired together, two of which were artificial. It was a striking example of bridgework, very well done, and may now be seen in the Louvre. It would be more than a little surprising, from what we know of the lack of inventiveness on the part of the Phenicians and their tendency to acquire their arts by imitation, if they had reached such a climax of invention by themselves. Since they adapted and adopted most of their arts and crafts from Egypt, with which they were in close commercial relations, it has been argued with some plausibility that the Egyptians may have had many modes of dental prosthesis, but removed all artificial teeth and dental appliances from the mouth of corpses before embalming them, in preparation for the next world, because there was some religious objection to such human handiwork being left in place for the hereafter, as they hoped for it. There is a well-authenticated tradition of intimate intercourse in a commercial way between the old Etruscans who inhabited the Italian hill country and the Phenicians, so that it is no surprise to find that the oldest of Etruscan tombs contain some fine examples of bridgework. An improvement has come over Phenician work however, and bands of gold instead of wire are used for holding artificial teeth in place. Guerini, whose "History of Dentistry" is the standard work on the subject, on a commission from the Italian government, carefully studied these specimens of Etruscan dental work in the museums of Italy, and has made some interesting observations on them. In one specimen, which is especially notable, two incisor teeth are replaced by a single tooth from a calf. This was grooved in such a way as to make it seem like two separate teeth. Guerini suggests a very interesting and quite unexpected source for this. While examining the specimen he wondered where the old Etruscan dentist had obtained a calf's tooth without a trace of wear on it. He came to the conclusion that he must have cut into the gums of a young calf before the permanent tooth was erupted in order to get this structure absolutely unworn for his purpose. A number of examples of bridgework have been found in the old Etruscan tombs. The dates of their construction are probably not later than 500 B.C., and some of them are perhaps earlier than 700 B.C. The Etruscans affected the old Romans in the matter of dentistry, so that it is easy to understand the passage in the "Laws of the Twelve Tables," issued about 450 B.C., which, while forbidding the burial of gold with corpses, made a special exception for such gold as was fastened to the teeth. Gold was rare at Rome, and care was exercised not to allow any unnecessary decrease of the visible supply almost in the same way as governments now protect their gold reserves. It may seem like comparing little things with great, but the underlying principle is the same. Hence this special law and its quite natural exception. In Pope Julius' Museum in Rome there is a specimen of a gold cap made of two plates of gold riveted together and also riveted to bands of metal which were fastened around the neighboring teeth in order to hold the cap in place. This is from later Republican times at Rome. At the end of the Republic and the beginning of the Empire there appear to have been many forms of dental appliances. Martial says that the reason why one lady's teeth--whose name he does not conceal--are white and another's--name also given--were dark, was that the first one bought hers and the second still had her own. In another satiric poem he describes an elderly woman as so much frightened that when she ran away her teeth fell out, while her friends lost their false hair. Fillings of many kinds were used, dentrifices of nearly every kind were invented, and dentistry evidently reached a high stage of development, though we have nowhere a special name for dentist, and the work seems to have been done by physicians, who took this as a specialty. While in the Middle Ages there was, owing to conditions, a loss of much of this knowledge of antiquity with regard to dentistry, or an obscuration of it, it never disappeared completely, and whenever men have written seriously about medicine, above all about surgery in relation to the face and the mouth, the teeth have come in for their share of scientific and practical consideration. Aëtius, the first important Christian writer on medicine and surgery, discusses, as we have seen in the sketch of him, the nutrition of the teeth, their nerves, "which came from the third pair and entered the teeth by a small hole existing at the end of the root," and other interesting details of anatomy and physiology. He knows much about the hygiene of the teeth, discusses extraction and the cure of fistula and other details. Paul of Ægina in the next century has much more, and while they both quote mainly from older authors there seems no doubt that they themselves had made not a few observations and had practical experience. It was from these men that the Arabian physicians and surgeons obtained their traditions of medicine, and so it is not surprising to find that they discuss dental diseases and their treatment rationally and in considerable detail. Abulcasis particularly has much that is of significance and interest. We have pictures of two score of dental instruments that were used by them. The Arabs not only treated and filled carious teeth and even replaced those that were lost, but they also corrected deformities of the mouth and of the dental arches. Orthodontia is sometimes said to be of much later origin and to begin many centuries after Abulcasis' time, yet no one who knows of his work can speak of Orthodontia as an invention after him. In this, however, as in most of the departments of medicine and surgery, the Arabs were merely imitators, though probably they expanded somewhat the practical knowledge that had come to them. When the great revival in surgery came in the twelfth and thirteenth centuries it is not surprising that there should also have been an important renewal of interest in dentistry. A detailed review of this would take us too far afield, but at least something may be said of two or three of the great representative surgical writers who touched on this specialty. About the middle of the fourteenth century that prince of surgeons, and model of surgical writers, Guy de Chauliac, wrote his great text-book of surgery, "Le Grande Chirurgie." An extremely interesting feature of this work is to be found in the chapters that treat of diseases of the teeth. These are not very comprehensive, and are evidently not so much the result of his experience, as the fruit of his reading, yet they contain many practical valuable ideas that are supposed to be ever so much later than the middle of the fourteenth century. His anatomy and physiology at least are not without many errors. His rules for the preservation of the teeth show that the ordinary causes of dental decay were well recognized even as early as this. Emphasis was laid on not taking foods too hot or too cold, and above all not to follow either hot or cold food by something very different from it in temperature. The breaking of hard things with the teeth was recognized as one of the most frequent causes of such deterioration of the enamel as gives opportunity for the development of decay. The eating of sweets, and especially the sticky sweets--preserves and the like--was recognized as an important source of caries. The teeth were supposed to be cleaned frequently, and not to be cleaned too roughly, for this would do more harm than good. We find these rules repeated by succeeding writers on general surgery, who touch upon dentistry, or at least the care of the teeth, and they were not original with Guy de Chauliac, but part of the tradition of surgery. As noted by Guerini in his "History of Dentistry," the translation of which was published under the auspices of the National Dental Association of the United States of America,[28] Chauliac recognized the dentists as specialists. Besides, it should be added, as is evident from his enumeration of the surgical instruments which he declares necessary for them, they were not as we might easily think in the modern time mere tooth pullers, but at least the best among them treated teeth as far as their limited knowledge and means at command enabled them to do so, and these means were much more elaborate than we have been led to think, and much more detailed than we have reason to know that they were at certain subsequent periods. In fact, though Guy de Chauliac frankly confesses that he touches on the subject of dentistry only in order to complete his presentation of the subject of surgery and not because he has anything of his own to say with regard to the subject, there is much that is of present-day interest in his brief paragraphs. He observes that operations on the teeth are special and belong to the _dentatores_, or dentists, to whom doctors had given them over. He considers, however, that the operations in the mouth should be performed under the direction of a physician. It is in order to give physicians the general principles with which they may be able to judge of the advisability or necessity for dental operations that his short chapters are written. If their advice is to be of value, physicians should know the various methods of treatment suitable for dental diseases, including mouth washes, gargles, masticatories, anointments, rubbings, fumigations, cauterizations, fillings, filings, and the various manual operations. He says that the _dentator_ must be provided with the appropriate instruments, among which he names scrapers, rasps, straight and curved spatumina, elevators, simple and with two branches, toothed tenacula, and many different forms of probes and canulas. He should also have small scalpels, tooth trephines, and files. Chauliac is particularly emphatic in his insistence on not permitting alimentary materials to remain in cavities, and suggests that if cavities between the teeth tend to retain food material they should even be filed in such a way as to prevent these accumulations. His directions for cleansing the teeth were rather detailed. His favorite treatment for wounds was wine, and he knew that he succeeded by means of it in securing union by first intention. It is not surprising, then, to find that he recommends rinsing of the mouth with wine as a precaution against dental decay. A vinous decoction of wild mint and of pepper he considered particularly beneficial, though he thought that dentifrices, either powder or liquid, should also be used. He seems to recommend the powder dentifrices as more efficacious. His favorite prescription for a tooth powder, while more elaborate, resembles to such an extent, at least some, if not indeed most of those, that are used at the present time, that it seems worth while giving his directions for it. He took equal parts of cuttle bone, small white sea-shells, pumice stone, burnt stag's horn, nitre, alum, rock salt, burnt roots of iris, aristolochia, and reeds. All of these substances should be carefully reduced to powder and then mixed. His favorite liquid dentifrice contained the following ingredients,--half a pound each of sal ammoniac and rock salt, and a quarter of a pound of sacharin alum. All these were to be reduced to powder and placed in a glass alembic and dissolved. The teeth should be rubbed with it, using a little scarlet cloth for the purpose. Just why this particular color of cleansing cloth was recommended is not quite clear. He recognized, however, that cleansing of the teeth properly often became impossible by any scrubbing method, no matter what the dentifrice used, because of the presence of what we call tartar and what he called hardened limosity or limyness (_limosité endurcie_). When that condition is present he suggests the use of rasps and spatumina and other instrumental means of removing the tartar. Evidently he did not believe in the removal of the teeth unless this was absolutely necessary and no other method of treatment would avail to save the patient from continuous distress. He summarizes the authorities with regard to the extraction of teeth and the removal of dental fragments and roots. He evidently knew of the many methods suggested before his time of removing teeth without recourse to instrumental extraction. There were a number of applications to the gums that were claimed by older authors to remove the teeth without the need of metal instruments. We might expect that Chauliac would detect the fallacy with regard to these and expose it. He says that while much is claimed for these methods he has never seen them work in practice and he distrusts them entirely. The most interesting phase of what Guy de Chauliac has to say with regard to dentistry is of course to be found in his paragraphs on the artificial replacement of lost teeth and the subject of dental prosthesis generally. When teeth become loose he advises that they be fastened to the healthy ones with a gold chain. Guerini suggests that he evidently means a gold wire. If the teeth fall out they may be replaced by the teeth of another person or with artificial teeth made from oxbone, which may be fixed in place by a fine metal ligature. He says that such teeth may be serviceable for a long while. This is a rather curt way of treating so large a subject as dental prosthesis, but it contains a lot of suggestive material. He was quoting mainly the Arabian authors, and especially Abulcasis and Ali Abbas and Rhazes, and these of course, as we have said, mentioned many methods of artificially replacing teeth as also of transplantation and of treatment of the deformities of the dental arches. On the whole, however, it must be confessed that we have here in the middle of the fourteenth century a rather surprising anticipation of the knowledge of a special department of medicine which is usually considered to be distinctly modern, and indeed as having only attracted attention seriously in comparatively recent times. After Guy de Chauliac the next important contributor to dentistry is Giovanni of Arcoli, often better known by his Latin name, Johannes Arculanus, who was a professor of medicine and surgery at Bologna and afterwards at Padua, just before and after the middle of the fifteenth century, and who died in 1484. He is famous principally for being the first we know who mentions the filling of teeth with gold. It might possibly be suggested that coming at this time Arculanus should rather be reckoned as a Maker of Medicine in the Renaissance than as belonging to the Middle Ages and its influences. His education, however, was entirely completed before the earliest date at which the Renaissance movement is usually said to begin, that is with the fall of Constantinople in 1452, and he was dead before the other date, that of the discovery of America in 1492, which the Germans have in recent years come to set down as the end of the Middle Ages. Besides, what he has to say about dentistry occurs in typical medieval form. It is found in a commentary on Rhazes, written just about the middle of the fifteenth century. In the later true Renaissance such a commentary would have been on a Greek author. In his commentary Arculanus touches on most of the features of medicine and surgery from the standpoint of his own experience as well as from what he knows of the writings of his predecessors and contemporaries. With the rest he has a series of chapters on diseases of the teeth. Guerini in his "History of Dentistry" says that "this subject [dentistry] is treated rather fully, and with great accuracy." Even some short references to it will, I think, demonstrate this rather readily.[29] Arculanus is particularly full in his directions for the preservation of the teeth. We are rather prone to think that prophylaxis is comparatively a modern idea, and that most of the principles of conservation of human tissues and the prevention of deterioration and disease are distinctly modern. It needs only a little consideration of Arculanus' instruction in the matter of the teeth, however, to undo any such false impression. For obvious reasons I prefer to quote Guerini's summation of this medieval student of dentistry's rules for dental hygiene: "For the preservation of teeth--considered by him, quite rightly, a matter of great importance--Giovanni of Arcoli repeats the various counsels given on the subject by preceding writers, but he gives them as ten distinct canons or rules, creating in this way a kind of decalogue of dental hygiene. These rules are: (1) It is necessary to guard against the corruption of food and drink within the stomach; therefore, easily corruptible food--milk, salt fish, etc.--must not be partaken of, and after meals all excessive movement, running exercises, bathing, coitus, and other causes that impair the digestion, must also be avoided. (2) Everything must be avoided that may provoke vomiting. (3) Sweet and viscous food--such as dried figs, preserves made with honey, etc.--must not be partaken of. (4) Hard things must not be broken with the teeth. (5) All food, drink, and other substances that set the teeth on edge must be avoided. (6) Food that is too hot or too cold must be avoided, and especially the rapid succession of hot and cold, and vice versa. (7) Leeks must not be eaten, as such a food, by its own nature, is injurious to the teeth. (8) The teeth must be cleaned at once, after every meal, from the particles of food left in them; and for this purpose thin pieces of wood should be used, somewhat broad at the ends, but not sharp-pointed or edged; and preference should be given to small cypress twigs, to the wood of aloes, or pine, rosemary, or juniper and similar sorts of wood which are rather bitter and styptic; care must, however, be taken not to search too long in the dental interstices and not to injure the gums or shake the teeth. (9) After this it is necessary to rinse the mouth by using by preference a vinous decoction of sage, or one of cinnamon, mastich, gallia, moschata, cubeb, juniper seeds, root of cyperus, and rosemary leaves. (10) The teeth must be rubbed with suitable dentrifices before going to bed, or else in the morning before breakfast. Although Avicenna recommended various oils for this purpose, Giovanni of Arcoli appears very hostile to oleaginous frictions, because he considers them very injurious to the stomach. He observes, besides, that whilst moderate frictions of brief duration are helpful to the teeth, strengthen the gums, prevent the formation of tartar, and sweeten the breath, too rough or too prolonged rubbing is, on the contrary, harmful to the teeth, and makes them liable to many diseases." All this is so modern in many ways that we might expect a detailed exact knowledge of the anatomy of the teeth and even something of their embryology from Arculanus. It must not be forgotten, however, that coming as he does before the Renaissance, the medical sciences in the true sense of the word are as yet unborn. Men are accumulating information for practical purposes but not for the classification and co-ordination that was to make possible the scientific development of their knowledge. Giovanni of Arcoli's acquaintance with the anatomy of the teeth was rather sadly lacking. He does not know even with certainty the number of roots that the teeth have. This has been attributed to the fact that he obtained most of his information from books, and had not the time to verify descriptions that he had found. It has been argued from this that he was himself probably not a practical dentist, and turned to that specialty only as a portion of his work as a general surgeon, and that consequently he was not sufficiently interested to verify his statements. His chapters on dentistry would seem to bear out this conclusion to some extent, though the very fact that one who was himself not specially interested in dental surgery should have succeeded in gathering together so much that anticipates modern ideas in dentistry, is of itself a proof of how much knowledge of the subject there was available for a serious student of that time. The anatomy of the teeth continued to be rather vague until about the middle of the next century when Eustachius, whose investigations of the anatomy of the head have deservedly brought him fame and the attachment of his name to the Eustachian canal, wrote his "Libellus de Dentibus--Manual of the Teeth," which is quite full, accurate, and detailed. Very little has been added to the microscopic anatomy of the teeth since Eustachius' time. He had the advantage, of course, of being intimately in contact with the great group of Renaissance anatomists,--Vesalius, Columbus, Varolius, Fallopius, and the others, the great fathers of anatomy. Besides, his position as Papal Physician and Professor of Anatomy at the Papal Medical School at Rome gave him opportunities for original investigation, such as were not easily obtained elsewhere. Arculanus can scarcely be blamed, therefore, for not having anticipated the Renaissance, and we must take him as merely the culmination of medieval knowledge with regard to anatomy and surgery. Medieval medical men did not have the time nor apparently the incentive to make formal medical science, though it must not be forgotten, as has been said, that they did use the knowledge they obtained by their own and others' observation to excellent advantage for the practical benefit of ailing humanity. The sciences related to medicine are conscious developments that follow the evolution of practical medicine, nor must it be forgotten that far from always serving as an auxiliary to applied medical science, often indeed in the history of medicine scientific pursuits have led men away into side issues from which they had to be brought back by some genius medical observer. As might be expected, then, it is with regard to the practical treatment and general consideration of ailments of the teeth that Giovanni of Arcoli is most interesting. In this some of his chapters contain a marvellous series of surprises. Arculanus was probably born towards the end of the fourteenth century. The date of his death is variously placed as either 1460 or 1484, with the probability in favor of the former. From 1412 to 1427 he was professor at Bologna, where in accordance with the non-specializing tendencies of the time he did not occupy a single chair but several in succession. He seems first to have taught Logic, then Moral Philosophy, and finally Medicine. His reputation in medicine drew many students to the university, and his fame spread all over Italy. The rival University of Padua then secured him, and he seems to have been for some twenty years there. Later apparently he accepted a professor's chair at Ferrara, where the D'Estes were trying to bring their university into prominence. It was at Ferrara that he died. He was a man of wide reading, of extensive experience, both of men and medicine, and one of the scholars of his time. His works are, as we have said, mainly excerpts from earlier writers and particularly the Arabians, but they contain enough of hints drawn from his own observation and experience to make his work of great value. While, as Gurlt remarks in his "History of Surgery," Arculanus' name is one of those scarcely known--he is usually considered just one of many obscure writers of the end of the Middle Ages--his writings deserve a better fate. They contain much that is interesting and a great deal that must have been of the highest practical value to his contemporaries. They attracted wide attention in his own and immediately succeeding generations. The proof of this is that they exist in a large number of manuscript copies. Just as soon as printing was introduced his books appeared in edition after edition. His "Practica" was printed in no less than seven editions in Venice. Three of them appeared before the end of the fifteenth century, which places them among the _incunabula_ of printing. Probably nothing in the history of human intellectual interest is more striking than the excellent judgment displayed by the editors who selected the works to be printed at this time. Very few of them were trivial or insignificant. Fewer still were idle speculations, and most of them were almost of classical import for literature and science. Four editions of this work were printed in Venice in the sixteenth century, one of them as late as 1560, when the work done by such men as Vesalius, Columbus, Eustachius, and Fallopius would seem to have made Arculanus out of date. The dates of the various editions are Venice, 1483, 1493, 1497, 1504, 1542, 1557, and 1560. Besides there was an edition printed at Basel in 1540. Arculanus is said to have re-introduced the use of the seton, that is the method of producing intense counter-irritation by the introduction of some foreign body into an incision in the skin. We owe to him, too, according to Pagel in the chapters on medieval medicine in Puschmann's "Handbook of the History of Medicine," an excellent description of alcoholic insanity. His directions for the treatment of conditions in the mouth and nose apart from the teeth are quite as explicit and practical, and in many ways quite as great an anticipation of some of our modern notions as what he has to say with regard to the teeth. For instance, in the treatment of polyps he says that they should be incised and cauterized. Soft polyps should be drawn out with a toothed tenaculum as far as can be without risk of breaking them off. The incision should be made at the root so that nothing or just as little as possible of the pathological structure be allowed to remain. It should be cut off with a fine scissors, or with a narrow file just small enough to permit its ingress into the nostrils, or with a scalpel without cutting edges on the sides, but only at its extremity, and this cutting edge should be broad and well sharpened. If there is danger of hemorrhage, or if there is fear of it, the instruments with which dissection is made should be fired (_igniantur_), that is, heated at least to a dull redness. Afterwards the stump, if any remains, should be touched with a hot iron or else with cauterizing agents so that as far as possible it should be obliterated. After the operation a pledget of cotton dipped in the green ointment described by Rhazes should be placed in the nose. This pledget should have a string fastened to it, hanging from the nose in order that it may be easily removed. At times it may be necessary to touch the root of the polyp with a stylet on which cotton has been placed that has been dipped in _aqua fortis_ (nitric acid). It is important that this cauterizing fluid should be rather strong so that after a certain number of touches a rather firm eschar is produced. In all these manipulations in the nose Arculanus recommends that the nose should be held well open by means of a nasal speculum. Pictures of all these instruments occur in his extant works, and indeed this constitutes one of their most interesting and valuable features. They are to be seen in Gurlt's "History of Surgery." In some cases he had seen the polyp was so difficult to get at or was situated so far back in the nose that it could not be reached by means of a tenaculum or scissors, or even the special knife devised for that purpose. For these patients Arculanus describes an operation that is to be found in the older writers on surgery, Paul of Ægina (Æginetus), Avicenna, and some of the other Arabian surgeons. For this three horse-tail hairs are twisted together and knotted in three or four places, and one end is passed through the nostrils and out through the mouth. The ends of this are then pulled on backward and forward after the fashion of a saw. Arculanus remarks evidently with the air of a man who has tried it and not been satisfied that this operation is quite uncertain, and seems to depend a great deal on chance, and much reliance must not be placed on it. Arculanus suggests a substitute method by which latent polyps or occult polyps as he calls them may be removed. There is scarcely an important disease for which Arculanus has not some interesting suggestions, and the more one reads of him the more is one surprised to find how many things that we might think of as coming into the purview of medicine long after his time or at least as having been neglected from the time of the Greeks almost down to our own time are here treated explicitly, definitely, and with excellent practical suggestions. He has a good deal to say with regard to the treatment of angina, which he calls synanche, or synanchia, or cynanche, or angina. Parasynanche is a synonymous term, but refers to a milder synanche. He distinguished four forms of it. In one called canine angina, because the patient's tongue hangs out of his mouth, somewhat the same as from an overheated dog in the summer time, while at the same time the mouth is held open and he draws his breath pantingly, Arculanus suggests an unfavorable prognosis, and would seem to refer to those cases of Ludwig's angina in which there is involvement of the tongue and in which our prognosis continues to be of the very worst even to our own day. At times the angina causes such swelling in the throat that the breathing is interfered with completely. For this Arculanus' master, Rhazes, advised tracheotomy. Arculanus himself, however, apparently hesitated about that. It is not surprising, then, to find that Arculanus is very explicit in his treatment of affections of the uvula. He divides its affections into _apostema, ulcus, putredo sive corrosio, et casus_. _Apostema_ was abscess, _ulcus_ any rather deep erosion, _putredo_ a gangrenous condition, and _casus_ the fall of the uvula. This is the notorious falling of the soft palate which has always been in popular medical literature at least. Arculanus describes it as a preternatural elongation of the uvula which sometimes goes to such an extent as to make it resemble the tail of a mouse. For shorter elongations he suggests the cautery; for longer, excision followed by the cautery so that the greater portion of the extending part may be cut off. If people fear the knife he suggests following Rhazes, the application of an astringent powder directly to the part by blowing through a tube. His directions for the removal of the uvula are very definite. Seat the patient upon a stool in a bright light while an assistant holds the head; after the tongue has been firmly depressed by means of a speculum let the assistant hold this speculum in place. With the left hand then insert an instrument, a stilus, by which the uvula is pulled forward, and then remove the end of it by means of a heated knife or some other process of cauterization. The mouth should afterwards be washed out with fresh milk. The application of a cauterizing solution by means of a cotton swab wrapped round the end of a sound may be of service in patients who refuse the actual cautery. To be successful the application must be firmly made and must be frequently repeated. After this it is not surprising to find that Arculanus has very practical chapters on all the other ordinary surgical affections. Empyema is treated very thoroughly, liver abscess, ascites, which he warns must be emptied slowly, ileus especially when it reaches stercoraceous vomiting, and the various difficulties of urination, he divides them into dysuria, ischuria, and stranguria, are all discussed in quite modern fashion. He gives seven causes for difficulty of urination. One, some injury of the bladder; two, some lesion of the urethra; three, some pathological condition in the power to make the bladder contract; four, some injury of the muscle of the neck of the bladder; five, some pathological condition of the urine; six, some kidney trouble, and seven, some pathological condition of the general system. He takes up each one of these and discusses the various phases, causes, disposition, and predispositions that bring them about. One thing these men of the Middle Ages could do, they reasoned logically, they ordered what they had to say well, and they wrote it out straightforwardly. That Arculanus' work with regard to dentistry was no mere chance and not solely theoretic can be understood very well from his predecessors, and that it formed a link in a continuous tradition which was well preserved we may judge from what is to be found in the writings of his great successor, Giovanni or John de Vigo, who is considered one of the great surgeons of the early Renaissance, and to whom we owe what is probably the earliest treatise on "Gun-shot Wounds." John of Vigo was a Papal physician and surgeon, generally considered one of the most distinguished members of the medical profession of his time. Two features of his writing on dental diseases deserve mention. He insists that abscesses of the gums shall be treated as other abscesses by being encouraged to come to maturity and then being opened. If they do not close promptly, an irritant Egyptian ointment containing verdigris and alum among other things should be applied to them. In the cure of old fistulous tracts near the teeth he employs not only this Egyptian ointment but also arsenic and corrosive sublimate. What he has to say with regard to the filling of the teeth is, however, most important. He says it with extreme brevity, but with the manner of a man thoroughly accustomed to doing it. "By means of a drill or file the putrefied or corroded part of the tooth should be completely removed. The cavity left should then be filled with gold leaf." It is evident that the members of the Papal court, the Cardinals and the Pope himself, had the advantage of rather good dentistry at John de Vigo's hands even as early as the beginning of the sixteenth century. John de Vigo, however, is not medieval. He lived on into the sixteenth century and was influenced deeply by the Renaissance. He counts among the makers of modern medicine and surgery, as his authorship of the treatise on gun-shot wounds makes clear. He comes in a period that will be treated of in a later volume of this series on "Our Forefathers in Medicine." XIII CUSANUS AND THE FIRST SUGGESTION OF LABORATORY METHODS IN MEDICINE As illustrating how, as we know more about the details of medical history, the beginnings of medical science and medical practice are pushed back farther and farther, a discussion in the _Berliner klinische Wochenschrift_ a dozen years ago is of interest. Professor Ernest von Leyden, in sketching the history of the taking of the pulse as an important aid in diagnostics, said that John Floyer was usually referred to as the man who introduced the practice of determining the pulse rate by means of the watch. His work was done about the beginning of the eighteenth century. Professor von Leyden suggested, however, that William Harvey, the English physiologist, to whom is usually attributed the discovery of the circulation of the blood, had emphasized the value of the pulse in medical diagnosis, and also suggested the use of the watch in counting the pulse. Professor Carl Binz, of the University of Bonn, commenting on these remarks of Professor von Leyden, called attention to the fact that more than a century before the birth of either of these men, even the earlier, to whom the careful measurement of the pulse rate is thus attributed as a discovery, a distinguished German churchman, who died shortly after the middle of the fifteenth century, had suggested a method of accurate estimation of the pulse that deserves a place in medical history. This suggestion is so much in accord with modern demands for greater accuracy in diagnosis that it seems not inappropriate to talk of it as the first definite attempt at laboratory methods in the department of medicine. The maker of the suggestion, curiously enough, was not a practising physician, but a mathematician and scholar, Cardinal Nicholas of Cusa, who is known in history as Cusanus from the Latin name of the town Cues on the Moselle River, some twenty-five miles south of Trèves, where he was born. His family name, Nicholas Krebs, has been entirely lost sight of in the name derived from his native town, which is the only reason why most of the world knows anything about that town. Cardinal Cusanus suggested that in various forms of disease and at various times of life, as in childhood, boyhood, manhood, and old age, the pulse was very different. It would be extremely valuable to have some method of accurately estimating, measuring, and recording these differences for medical purposes. At that time watches had not yet been invented, and it would have been very difficult to have estimated the time by the clocks, for almost the only clocks in existence were those in the towers of the cathedrals and of the public buildings. The first watches, Nuremberg eggs, as they were called, were not made by Peter Henlein until well on into the next century. The only method of measuring time with any accuracy in private houses was the clepsydra or water-clock, which measured the time intervals by the flow of a definite amount of water. Cardinal Cusanus suggested then that the water-clock should be employed for estimating the pulse frequency. His idea was that the amount of water which flowed while a hundred beats of the pulse were counted, should be weighed, and this weight compared with that of the average weight of water which flowed while a hundred beats of the normal pulse of a number of individuals of the same age and constitution were being counted. This was a very single and a very ingenious suggestion. We have no means of knowing now whether it was adopted to any extent or not. It may seem rather surprising that a cardinal should have been the one to make such a suggestion. Cusanus, however, was very much interested in mathematics and in the natural sciences, and we have many wonderful suggestions from his pen. He was the first, for instance, to suggest, more than a century before Copernicus, that the earth was not the centre of the universe, and that it would not be absolutely at rest or, as he said, devoid of all motion. His words are: "_Terra igitur, quæ centrum esse nequit, motu omni carere non potest_." He described very clearly how the earth moved round its own axis, and then he added, what cannot fail to be a surprising declaration for those in the modern times who think such an idea of much later origin, that he considered that the earth itself cannot be fixed, but moves as do the other stars in the heavens. The expression is so astonishing at that time in the world's history that it seems worth the while to give it in its original form, so that it may be seen clearly that it is not any subsequent far-fetched interpretation of his opinion, but the actual words themselves, that convey this idea. He said: "_Consideravi quod terra ista non potest esse fixa, sed movetur ut aliæ stellæ._" How clearly Cusanus anticipated another phase of our modern views may be judged from what he has to say in "De Docta Ignorantia" with regard to the constitution of the sun. It is all the more surprising that he should by some form of intuition reach such a conclusion, for the ordinary sources of information with regard to the sun would not suggest such an expression except to a genius, whose intuition outran by far the knowledge of his time. The Cardinal said: "To a spectator on the surface of the sun the splendor which appears to us would be invisible, since it contains, as it were, an earth for its central mass, with a circumferential envelope of light and heat, and between the two an atmosphere of water and clouds and of ambient air." After reading that bit of precious astronomical science announced nearly five centuries ago, it is easy to understand how Copernicus could have anticipated other phases of our knowledge, as he did in his declarations that the figure of the earth is not a sphere, but is somewhat irregular, and that the orbit of the earth is not circular. Cusanus was an extremely practical man, and was constantly looking for and devising methods of applying practical principles of science to ordinary life. As we shall see in discussing his suggestion for the estimation of the pulse rate later on, he made many other similar suggestions for diagnostic purposes in medicine, and set forth other applications of mathematics and mechanics to his generation. Many of Cusanus' books have curiously modern names. He wrote, for instance, a series of mathematical treatises, in Latin of course, on "Geometric Transmutations," on "Arithmetical Complements," on "Mathematical Complements," on "Mathematical Perfection," and on "The Correction of the Calendar." In his time the calendar was in error by more than nine days, and Cusanus was one of those who aroused sufficient interest in the subject, so that in the next century the correction was actually made by the great Jesuit mathematician, Father Clavius. Perhaps the work of Cusanus that is best known is that "On Learned Ignorance--De Docta Ignorantia," in which the Cardinal points out how many things that educated people think they know are entirely wrong. It reminds one very much of Josh Billings's remark that it is not so much the ignorance of mankind that makes them ridiculous, as the knowing so many things that ain't so. It is from this work that the astronomical quotations which we have made are taken. The book that is of special interest to physicians is his dialogue "On Static Experiments," which he wrote in 1450, and which contains the following passages: "Since the weight of the blood and the urine of a healthy and of a diseased man, of a young man and an old man, of a German and an African, is different for each individual, why would it not be a great benefit to the physician to have all of these various differences classified? For I think that a physician would make a truer judgment from the weight of the urine viewed in connection with its color than he could make from its color alone, which might be fallacious. So, also, weight might be used as a means of identifying the roots, the stems, the leaves, the fruits, the seeds, and the juice of plants if the various weights of all the plants were properly noted, together with their variety, according to locality. In this way the physician would appreciate their nature better by means of their weight than if he judged them by their taste alone. He might know, then, from a comparison of the weights of the plants and their various parts when compared with the weight of the blood and the urine, how to make an application and a dosage of drugs from the concordances and differences of the medicaments, and even might be able to make an excellent prognosis in the same way. Thus, from static experiments, he would approach by a more precise knowledge to every kind of information. "Do you not think if you would permit the water from the narrow opening of a clepsydra [water-clock] to flow into a basin for as long as was necessary to count the pulse a hundred times in a healthy young man, and then do the same thing for an ailing young man, that there would be a noticeable difference between the weights of the water that would flow during the period? From the weight of the water, therefore, one would arrive at a better knowledge of the differences in the pulse of the young and the old, the healthy and the unhealthy, and so, also, as to information with regard to various diseases, since there would be one weight and, therefore, one pulse in one disease, and another weight and another pulse in another disease. In this way a better judgment of the differences in the pulse could be obtained than from the touch of the vein, just as more can be known from the urine about its weight than from its color alone. "Just in the same way would it not be possible to make a more accurate judgment with regard to the breathing, if the inspirations and expirations were studied according to the weight of the water that passed during a certain interval? If, while water was flowing from a clepsydra, one were to count a hundred expirations in a boy, and then in an old man, of course, there would not be the same amount of water at the end of the enumeration. Then this same thing might be done for other ages and states of the body. As a consequence, when the physician once knew what the weight of water that represented the number of expirations of a healthy boy or youth, and then of an individual of the same age ill of some infirmity or other, there is no doubt that, by this observation, he will come to a knowledge of the health or illness and something about the case, and, perhaps, also with more certainty would be able to choose the remedy and the dose required. If he found in a healthy young man apparently the same weight as in an old and decrepit individual, he might readily be brought to the conclusion that the young man would surely die, and in this way have some evidence for his prognosis in the case. Besides, if in fevers, in the same way, careful studies were made of the differences in the weight of water for pulse and respiration in the warm and the cold paroxysms, would it not be possible thus to know the disease better and, perhaps, also get a more efficacious remedy?" As will be seen from this passage, Cusanus had many more ideas than merely the accurate estimation of the pulse frequency when he suggested the use of the water-clock. Evidently the thought had come to him that the specific gravity of the substances, that is, their weight in comparison to the weight of water, might be valuable information. Before his time, physicians had depended only on the color and the taste of the urine for diagnostic purposes. He proposed that they should weigh it, and even suggested that they should weigh, also, the blood, I suppose in case of venesection, for comparison's sake. He also thought that the comparative weight of various roots, stems, leaves, juices of plants might give hints for the therapeutic uses of these substances. This is the sort of idea that we are apt to think of as typically modern. Specific gravities and atomic weights have been more than once supposed to represent laws in therapeutics, which so far, however, we have not succeeded in finding, but it is interesting to realize that it is nearly five hundred years since the first thought in this line was clearly expressed by a distinguished thinker and scientific writer. There are many interesting expressions in Cusanus' writings which contradict most of the impressions commonly entertained with regard to the scholars of the Middle Ages. It is usually assumed that they did not think seriously, but speculatively, that they feared to think for themselves, neglected the study of nature around them, considered authority the important source of knowledge, and were as far as possible from the standpoint of modern scientific students and investigators. Here is a passage from Nicholas, on knowing and thinking, that might well have been written by a great intellectual man at any time in the world's history, and that could only emanate from a profound scholar at any time. "To know and to think, to see the truth with the eye of the mind, is always a joy. The older a man grows the greater is the pleasure which it affords him, and the more he devotes himself to the search after truth, the stronger grows his desire of possessing it. As love is the life of the heart, so is the endeavor after knowledge and truth the life of the mind. In the midst of the movements of time, of the daily work of life, of its perplexities and contradictions, we should lift our gaze fearlessly to the clear vault of heaven, and seek ever to obtain a firmer grasp of and a keener insight into the origin of all goodness and beauty, the capacities of our own hearts and minds, the intellectual fruits of mankind throughout the centuries, and the wondrous works of nature around us; at the same time remembering always that in humility alone lies true greatness, and that knowledge and wisdom are alone profitable in so far as our lives are governed by them." The career of Nicholas of Cusa is interesting, because it sums up so many movements, and, above all, educational currents in the fifteenth century. He was born in the first year of the century, and lived to be sixty-four. He was the son of a wine grower, and attracted the attention of his teachers because of his intellectual qualities. In spite of comparatively straitened circumstances, then, he was afforded the best opportunities of the time for education. He went first to the school of the Brethren of the Common Life at Deventer, the intellectual cradle of so many of the scholars of this century. Such men as Erasmus, Conrad Mutianus, Johann Sintheim, Hermann von dem Busche, whom Strauss calls "the missionary of human wisdom," and the teacher of most of these, Alexander Hegius, who has been termed the schoolmaster of Germany, with Nicholas of Cusa and Rudolph Agricola and others, who might readily be mentioned, are the fruits of the teaching of these schools of the Brethren of the Common Life, in one of which Thomas à Kempis, the author of "The Imitation of Christ," was, for seventy years out of his long life of ninety, a teacher. Cusanus succeeded so well at school that he was later sent to the University of Heidelberg, and subsequently to Padua, where he took up the study of Roman law, receiving his doctorate at the age of twenty-three. This series of educational opportunities will be surprising only to those who do not know educational realities at the beginning of the fifteenth century. There has never been a time when a serious seeker after knowledge could find more inspiration. On his return to Germany, Father Krebs became canon of the cathedral in Coblenz. This gave him a modest income, and leisure for intellectual work which was eagerly employed. He was scarcely more than thirty when he was chosen as a delegate to the Council at Basel. After this he was made Archdeacon of the Cathedral of Lüttich, and from this time his rise in ecclesiastical preferment was rapid. He had attracted so much attention at the Council of Basel that he was chosen as a legate of the Pope for the bringing about certain reforms in Germany. Subsequently he was sent on ecclesiastical missions to the Netherlands, and even to Constantinople. At the early age of forty he was made a Cardinal. After this he was always considered as one of the most important consultors of the Papacy in all matters relating to Germany. During the last twenty-five years of his life in all the relations of the Holy See to Germany, appeal was constantly made to the wisdom, the experience, and the thoroughly conservative, yet foreseeing, judgment of this son of the people, whose education had lifted him up to be one of the leaders of men in Europe. It was during this time that he wrote most of his books on mathematics, which have earned for him a prominent place in Cantor's "History of Mathematics," about a score of pages being devoted to his work. Much of his thinking was done while riding on horseback or in the rude vehicles of the day on the missions to which he was sent as Papal Legate. He is said to have worked out the formula for the cycloid curve while watching the path described by flies that had lighted on the wheels of his carriage, and were carried forward and around by them. His scientific books, though they included such startling anticipations of Copernicus' doctrines as we have already quoted (Copernicus did not publish the first sketch of his theory for more than a quarter of a century after Cusanus' death), far from disturbing his ecclesiastical advancement or injuring his career as a churchman, seem actually to have been considered as additional reasons for considering him worthy of confidence and consultation. As the result of his careful studies of conditions in Germany, he realized very clearly how much of unfortunate influence the political status of the German people, with their many petty rulers and the hampering of development consequent upon the trivial rivalries, the constant bickerings, and the inordinate jealousies of these numerous princelings, had upon his native country. Accordingly, towards the end of his life he sketched what he thought would be the ideal political status for the German people. As in everything that he wrote, he went straight to the heart of the matter and, without mincing words, stated just exactly what he thought ought to be done. Considering that this scheme of Cusanus for the prosperity and right government of the German people was not accomplished until more than four centuries after his death, it is interesting, indeed, to realize how this clergyman of the middle of the fifteenth century should have come to any such thought. Nothing, however, makes it clearer than this, that it is not time that fosters thinking, but that great men at any time come to great thoughts. Cusanus wrote: "The law and the kingdom should be placed under the protection of a single ruler or authority. The small separate governments of princes and counts consume a disproportionately large amount of revenue without furnishing any real security. For this reason we must have a single government, and for its support we must have a definite amount of the income from taxes and revenues yearly set aside by a representative parliament and before this parliament (reichstag) must be given every year a definite account of the money that was spent during the preceding year." Cusanus' life and work stand, then, as a type of the accomplishment, the opportunities, the power of thought, the practical scholarship, the mathematical accuracy, the fine scientific foresight of a scholar of the fifteenth century. For us, in medicine, it is interesting indeed to realize that it is from a man of this kind that a great new departure in medicine with regard to the employment of exact methods of diagnosis had its first suggestion in modern times. The origin of that suggestion is typical. It has practically always been true that it was not the man who had exhausted, or thought that he had done so, all previous medical knowledge, who made advances in medicine for us. It has nearly always been a young man early in his career, and at a time when, as yet, his mind was not overloaded with the medical theories of his own time. Cusanus was probably not more than thirty when he made the suggestion which represents the first practical hint for the use of laboratory methods in modern medicine. It came out of his thoughtful consideration of medical problems rather than from a store of garnered information as to what others thought. It is a lesson in the precious value of breadth of education and serious training of mind for real progress at all times. XIV BASIL VALENTINE, LAST OF THE ALCHEMISTS, FIRST OF THE CHEMISTS "Fieri enim potest ut operator erret et a via regia deflectat, sed ut erret natura quando recte tractatur fieri non potest." "For it is quite possible that the physician should err and be turned aside from the straight (royal) road, but that nature when she is rightly treated should err is quite impossible." This is one of the preliminary maxims of a treatise on medicine written by a physician born not later than the first half of the fifteenth century, and who may have lived even somewhat earlier. We are so prone to think of the men of that time as utterly dependent on authority, not daring to follow their own observation, suspecting nature, and almost sure to be convinced that only by going counter to her could success in the treatment of disease be obtained, that it is a surprise to most people to find how completely the attitude of mind, that is supposed to be so typically modern in this regard, was anticipated full four centuries ago. There are other expressions of this same great physician and medical writer, Basil Valentine, which serve to show how faithfully he strove with the lights that he had to work out the treatment of patients, just as we do now, by trying to find out nature's way, so as to imitate her beneficent processes and purposes. It is quite clear that he is but one of many faithful, patient observers and experimenters--true scientists in the best sense of the word--who lived in all the centuries of the Middle Ages. Speculations and experiments with regard to the elixir of life, the philosopher's stone, and the transmutation of metals, are presumed to have filled up all the serious interests of the alchemists, supposed to be almost the only scientists of those days. As a matter of fact, however, men were making original observations of profound significance, and these were considered so valuable by their contemporaries that, though printing had not yet been invented, even the immense labor involved in the manifold copying of large folio volumes by the slow hand process did not suffice to deter them from multiplying the writings of these men so numerously that they were preserved in many copies for future generations, until the printing press came to perpetuate them. Of this there is abundant evidence in the preceding pages as regards medicine, and, above all, surgery, while a summary of accomplishments of workers in other departments will be found in Appendix II, "Science at the Medieval Universities." At the beginning of the twentieth century, with some of the supposed foundations of modern chemistry crumbling to pieces under the influence of the peculiarly active light thrown upon our nineteenth century chemical theories by the discovery of radium, and our observations on radio-active elements generally, there is a reawakening of interest in some of the old-time chemical observers, whose work used to be laughed at as so unscientific, or, at most, but a caricature of real science, and whose theory of the transmutation of elements into one another was considered so absurd. It is interesting in the light of this to recall that the idea that the elementary substances were essentially distinct from each other, and that it would be impossible under any circumstances to convert one element into another, belongs entirely to the nineteenth century. Even so deeply scientific a mind as that of Newton, in the preceding century, could not bring itself to acknowledge the tradition, that came to be accepted subsequent to his time, of the absurdity of metallic transformation. On the contrary, he believed quite formally in transmutation as a basic chemical principle, and declared that it might be expected to occur at any time. He had seen specimens of gold ores in connection with metallic copper, and concluded that this was a manifestation of the natural transformation of one of these yellow metals into the other. With the discovery that radium transforms itself into helium, and that, indeed, all the so-called radioactivities of the heavy metals are probably due to a natural transmutation process constantly at work, the ideas of the older chemists cease entirely to be a subject for amusement. The physical chemists of the present day are very ready to admit that the old teaching of the absolute independence of something over seventy elements is no longer tenable, except as a working hypothesis. The doctrine of "matter and form," taught for so many centuries by the scholastic philosophers, which proclaimed that all matter is composed of two principles, an underlying material substratum, and a dynamic or informing principle, has now more acknowledged verisimilitude, or lies at least closer to the generally accepted ideas of the most progressive scientists, than it has at any time for the last two or three centuries. Not only the great physicists, but also the great chemists, are speculating along lines that suggest the existence of but one form of matter, modified according to the energies that it possesses under a varying physical and chemical environment. This is, after all, only a restatement in modern times of the teaching of St. Thomas of Aquin, in the thirteenth century. It is not surprising, then, that there should be a reawakening of interest in the lives of some of the men, who, dominated by some of the earlier scholastic ideas, by the tradition of the possibility of finding the philosopher's stone, which would transmute the baser metals into the precious metals, devoted themselves with quite as much zeal as any modern chemist to the observation of chemical phenomena. One of the most interesting of these--indeed, he might well be said to be the greatest of the alchemists--is the man whose only name that we know is that which appears on a series of manuscripts written in the High German dialect of the end of the fifteenth and the beginning of the sixteenth century. That name is Basil Valentine, and the writer, according to the best historical traditions, was a Benedictine monk. The name Basil Valentine may only have been a pseudonym, for it has been impossible to trace it among the records of the monasteries of the time. That the writer was a monk, however, there seems to be no room for doubt, for his writings give abundant evidence of it, and, besides, in printed form they began to have their vogue at a time when there was little likelihood of their being attributed to a monastic source, unless an indubitable tradition connected them with some monastery. This Basil Valentine (to accept the only name we have) did so much for the science of the composition of substances that he eminently deserves the designation that has been given him of the last of the alchemists and the first of the chemists. There is practically a universal recognition of the fact now that he deserves also the title of the Founder of Pharmaceutical Chemistry, not only because of the value of the observations contained in his writings, but also because of the fact that they proved so suggestive to certain scientific geniuses during the century succeeding Valentine's life. Almost more than to have added to the precious heritage of knowledge for mankind, it is a boon for a scientific observer to have awakened the spirit of observation in others, and to be the founder of a new school of thought. This Basil Valentine undoubtedly did, and, in the Renaissance, the incentive from his writings for such men as Paracelsus is easy to appreciate. Besides, his work furnishes evidence that the investigating spirit was abroad just when it is usually supposed not to have been, for the Thuringian monk surely did not do all his investigation alone, but must have owed, as well as given, many a suggestion to his contemporaries. Some ten years ago, when Sir Michael Foster, professor of physiology in the University of Cambridge, England, was invited to deliver the Lane Lectures at the Cooper Medical College in San Francisco, he took for his subject "The History of Physiology." In the course of his lecture on "The Rise of Chemical Physiology" he began with the name of Basil Valentine, who first attracted men's attention to the many chemical substances around them that might be used in the treatment of disease, and said of him: "He was one of the alchemists, but in addition to his inquiries into the properties of metals and his search for the philosopher's stone, he busied himself with the nature of drugs, vegetable and mineral, and with their action as remedies for disease. He was no anatomist, no physiologist, but rather what nowadays we should call a pharmacologist. He did not care for the problem of the body, all he sought to understand was how the constituents of the soil and of plants might be treated so as to be available for healing the sick and how they produced their effects. We apparently owe to him the introduction of many chemical substances, for instance of hydrochloric acid, which he prepared from oil and vitriol of salt, and of many vegetable drugs. And he was apparently the author of certain conceptions which, as we shall see, played an important part in the development of chemistry and of physiology. To him, it seems, we owe the idea of the three 'elements,' as they were and have been called, replacing the old idea of the ancients of the four elements--earth, air, fire, and water. It must be remembered, however, that both in the ancient and the new idea the word 'element' was not intended to mean that which it means to us now, a fundamental unit of matter, but a general quality or property of matter. The three elements of Valentine were: (1) sulphur, or that which is combustible, which is changed or destroyed, or which at all events disappears during burning or combustion; (2) mercury, that which temporarily disappears during burning or combustion, which is dissociated in the burning from the body burnt, but which may be recovered, that is to say, that which is volatile, and (3) salt, that which is fixed, the residue or ash which remains after burning." It is a little bit hard in our time for most people to understand just how such a development of thoroughly scientific chemical notions, with investigations for their practical application, should have come before the end of the Middle Ages. This difficulty of understanding, however, we are coming to realize in recent years, is entirely due to our ignorance of the period. We have known little or nothing about the science of the Middle Ages, because it was hidden away in rare old books, in rather difficult Latin, not easy to get at, and still less easy to understand always, and we have been prone to conclude that since we knew nothing about it, there must have been nothing. Just inasmuch as we have learned something definite about the medieval scholars, our admiration has increased. Professor Clifford Allbutt, the Regius Professor of Medicine at the University of Cambridge, in his Harveian Oration, delivered before the Royal College of Physicians in 1900, on "Science and Medieval Thought" (London, 1901), declared that "the schoolmen, in digging for treasure, cultivated the field of knowledge even for Galileo and Harvey, for Newton and Darwin." He might have added that they had laid foundations in all our modern sciences, in chemistry quite as well as in astronomy, physiology, and the medical sciences, in mathematics and botany. In chemistry the advances made during the thirteenth, fourteenth, and fifteenth centuries were, perhaps, even more noteworthy than those in any other department of science. Albertus Magnus, who taught at Paris, wrote no less than sixteen treatises on chemical subjects, and, notwithstanding the fact that he was a theologian as well as a scientist, and that his printed works fill some _fifteen folio volumes_, he somehow found the time to make many observations for himself, and performed numberless experiments in order to clear up doubts. The larger histories of chemistry accord him his proper place, and hail him as a great founder in chemistry, and a pioneer in original investigation. Even St. Thomas of Aquin, much as he was occupied with theology and philosophy, found some time to devote to chemical questions. After all, this is only what might have been expected of the favorite pupil of Albertus Magnus. Three treatises on chemical subjects from Aquinas' pen have been preserved for us, and it is to him that we are said to owe the use, in the Western world at least, of the word amalgam, which he first employed in describing various chemical methods of metallic combination with mercury that were discovered in the search for the genuine transmutation of metals. Albertus Magnus' other great scientific pupil, Roger Bacon, the English Franciscan friar, followed more closely in the scientific ways of his great master, devoting himself almost entirely to the physical sciences. Altogether he wrote some eighteen treatises on chemical subjects. For a long time it was considered that he was the inventor of gunpowder, though this is now known to have been introduced into Europe by the Arabs. Roger Bacon studied gunpowder and various other explosive combinations in considerable detail, and it is for this reason that he obtained the undeserved reputation of being an original discoverer in this line. How well he realized how much might be accomplished by means of the energy stored up in explosives, can, perhaps, be best appreciated from the fact that he suggested that boats would go along the rivers and across seas without either sails or oars, and that carriages would go along the streets without horse or man power. He considered that man would eventually invent a method of harnessing these explosive mixtures, and of utilizing their energies for his purposes without danger. It is curiously interesting to find, as we begin the twentieth century, and gasolene is so commonly used for the driving of automobiles and motor boats, and is being introduced even into heavier transportation as the most available source of energy for suburban traffic, at least, that this generation should only be fulfilling the idea of the old Franciscan friar of the thirteenth century, who prophesied that in explosives there was the secret of eventually manageable energy for transportation purposes. Succeeding centuries were not as fruitful in great scientists as the thirteenth, and yet, in the second half of the thirteenth, there was a Pope, John XXI, who had been a physician and professor of medicine before his election to the Papacy, three of whose scientific treatises--one on the transmutation of metals, which he considers an impossibility, at least as far as the manufacture of gold and silver was concerned; a treatise on diseases of the eyes, to which good authorities have not hesitated to give lavish praise for its practical value, considering the conditions in which it was written; and, finally, his treatise on the preservation of the health, written when he was himself over eighty years of age--are all considered by good authorities as worthy of the best scientific spirit of the time. During the fourteenth century, Arnold of Villanova, the inventor of nitric acid, and the two Hollanduses, kept up the tradition of original investigation in chemistry. Altogether there are some dozen treatises from these three men on chemical subjects. The Hollanduses particularly did their work in a spirit of thoroughly frank, original investigation. They were more interested in minerals than in any other class of substances, but did not waste much time on the question of transmutation of metals. Professor Thompson, the professor of chemistry at Edinburgh, said, in his "History of Chemistry," many years ago, that the Hollanduses give very clear descriptions of their processes of treating minerals in investigating their composition, and these serve to show that their knowledge was by no means entirely theoretical, or acquired only from books. It is not surprising, then, to have a great investigating pharmacologist come along sometime about the beginning of the fifteenth century, when, according to the best authorities, Basil Valentine was born. From traditions he seems to have had a rather long life, and his years run nearly parallel with his century. His career is a typical example of the personally obscure and intellectually brilliant lives which the old monks lived. Probably in nothing have recent generations been more deceived in historical matters than in their estimation of the intellectual attainments and accomplishment of the old monks. The more that we know of them, not from second-hand authorities, but from their own books and from what they accomplished in art and architecture, in agriculture, in science of all kinds, the more do we realize what busy men they were, and appreciate what genius they often brought to the solution of great problems. We have had much negative pseudo-information brought together with the definite purpose of discrediting monasticism, and now that positive information is gradually being accumulated, it is almost a shock to find how different are the realities of the story of the intellectual life during the Middle Ages from what many writers had pictured them. To those who may be surprised that a man who did great things in medicine should have lived during the fifteenth century, it may be well to recall the names and a little of the accomplishment of the men of this period, who were Basil Valentine's contemporaries, at least in the sense that some portion of their lives and influence was coeval with his. Before the end of this century Columbus had discovered America, and by no happy accident, for many men of his generation did correspondingly great work. Cardinal Nicholas of Cusa had developed mathematics and applied mathematical ideas to the heavens, so that he could announce the conclusion that the earth was a star, like the other stars, and moved in the heavens as they do. Contemporary with Cusanus was Regiomontanus, who has been proclaimed the father of modern astronomy, and a distinguished mathematician. Toscanelli, the Florentine astronomer, whose years run almost parallel with those of the fifteenth century, did fine scholarly work, which deeply influenced Columbus and the great navigators of the time. The universities in Italy were attracting students from all over Europe, and such men as Linacre and Dr. Caius went down there from England. Raphael was but a young man at the end of the century, but he had done some noteworthy painting before it closed. Leonardo da Vinci was born just about the middle of the century, and did some marvellous work before the end of that century. Michael Angelo was only twenty-five at the close of the century, but he, too, did fine work, even at this early age. Among the other great Italian painters of this century are Fra Angelico, Perugino, Raphael's master, Pinturicchio, Signorelli, the pupil of his uncle, Vasari, almost as distinguished, Botticelli, Titian, and very many others, who would have been famous leaders in art in any other but this supremely great period. It was not only in Italy, however, that there was a wonderful outburst of genius at this time, for Germany also saw the rise of a number of great men during this period. Jacob Wimpheling, the "Schoolmaster of Germany," as he has been called, whose educational work did much to determine the character of German education for two centuries, was born in 1450. Rudolph Agricola, who influenced the intellectual Europe of this time deeply, was born in 1443. Erasmus, one of the greatest of scholars, of teachers, and of controversialists, was born in 1467. Johann Reuchlin, the great linguist, who, next to Erasmus, is the most important character in the German Renaissance, was born in 1455. Then there was Sebastian Brant, the author of "The Ship of Fools," and Alexander Hegius, both of this same period. The most influential of them all, Thomas à Kempis, who died in 1471, and whose little book, "The Following of Christ," has influenced every generation deeply ever since, was probably a close contemporary of Basil Valentine. When one knows what European, and especially German scholars, were accomplishing at this time, no room is left for surprise that Basil Valentine should have lived and done work in medicine at this period that was to influence deeply the after history of medicine. Most of what Basil Valentine did was accomplished in the first half of the fifteenth century. Coming, as he did, before the invention of printing, when the spirit of tradition was more rife and dominating than it has been since, it is almost needless to say that there are many curious legends associated with his name. Two centuries before his time, Roger Bacon, doing his work in England, had succeeded in attracting so much attention even from the common people, because of his wonderful scientific discoveries, that his name became a byword, and many strange magical feats were attributed to him. Friar Bacon was the great wizard, even in the plays of the Elizabethan period. A number of the same sort of myths attached themselves to the Benedictine monk of the fifteenth century. He was proclaimed in popular story to have been a wonderful magician. Even his manuscript, it was said, had not been published directly, but had been hidden in a pillar in the church attached to his monastery, and had been discovered there after the splitting open of the pillar by a bolt of lightning from heaven. It is the extension of this tradition that has sometimes led to the assumption that Valentine lived in an earlier century, some even going so far as to say that he, too, like Roger Bacon, was a product of the thirteenth century. It seems reasonably possible, however, to separate the traditional from what is actual in his existence, and thus to obtain some idea at least of his work, if not of the details of his life. The internal evidence from his works enables the historian of science to place his writing within half a century of the discovery of America. One of the myths that have gathered around the name of Basil Valentine, because it has become a commonplace in philology, has probably made him more generally known than any of his actual discoveries. In one of the most popular of the old-fashioned text-books of chemistry in use about half a century ago, in the chapter on antimony, there was a story that students, if I may judge from my own experience, never forgot. It was said that Basil Valentine, a monk of the Middle Ages, was the discoverer of this substance. After having experimented with it in a number of ways, he threw some of it out of his laboratory one day when the swine of the monastery, finding it, proceeded to gobble it up, together with some other refuse. Just when they were finishing it, the monk discovered what they were doing. He feared the worst from it, but took the occasion to observe the effect upon the swine very carefully. He found that, after a preliminary period of digestive disturbance, these swine developed an enormous appetite, and became fatter than any of the others. This seemed a rather desirable result, and Basil Valentine, ever on the search for the practical, thought that he might use the remedy to good purpose on the members of the community. Some of the monks in the monastery were of rather frail health and delicate constitution, and most of them were rather thin, and he thought that the putting on of a little fat, provided it could be accomplished without infringement of the rule, might be a good thing for them. Accordingly, he administered, surreptitiously, some of the salts of antimony, with which he was experimenting, in the food served to these monks. The result, however, was not so favorable as in the case of the hogs. Indeed, according to one, though less authentic, version of the story, some of the poor monks, the unconscious subjects of the experiment, perished as the result of the ingestion of the antimonial compounds. According to the better version, they suffered only the usual unpleasant consequences of taking antimony, which are, however, quite enough for a fitting climax to the story. Basil Valentine called the new substance which he had discovered antimony, that is, _opposed to monks_. It might be good for hogs, but it was a form of monks' bane, as it were.[30] Unfortunately for most of the good stories of history, modern criticism has nearly always failed to find any authentic basis for them, and they have had to go the way of the legends of Washington's hatchet and Tell's apple. We are sorry to say that that seems to be true also of this particular story. Antimony, the word, is very probably derived from certain dialectic forms of the Greek word for the metal, and the name is no more derived from _anti_ and _monachus_ than it is from _anti_ and _monos_ (opposed to single existence), another fictitious derivation that has been suggested, and one whose etymological value is supposed to consist in the fact that antimony is practically never found alone in nature. Notwithstanding the apparent cloud of unfounded traditions that are associated with his name, there can be no doubt at all of the fact that Valentinus--to give him the Latin name by which he is commonly designated in foreign literatures--was one of the great geniuses, who, working in obscurity, make precious steps into the unknown that enable humanity after them to see things more clearly than ever before. There are definite historical grounds for placing Basil Valentine as the first of the series of careful observers who differentiated chemistry from the old alchemy and applied its precious treasures of information to the uses of medicine. It is said to have been because of the study of Basil Valentine's work that Paracelsus broke away from the Galenic traditions, so supreme in medicine up to his time, and began our modern pharmaceutics. Following Paracelsus came Van Helmont, the father of modern medical chemistry, and these three did more than any others to enlarge the scope of medication and to make observation rather than authority the most important criterion of truth in medicine. Indeed, the work of this trio of men of the fifteenth and sixteenth centuries--the Renaissance in medicine as in art--dominated medical treatment, or at least the department of pharmaceutics, down almost to our own day, and their influence is still felt in drug-giving. While we do not know the absolute data of either the birth or the death of Basil Valentine and are not sure of the exact period even in which he lived and did his work, we are sure that a great original observer about the time of the invention of printing studied mercury and sulphur and various salts of the metals, and above all introduced antimony to the notice of the scientific world, and especially to the favor of practitioners of medicine. His book, "The Triumphal Chariot of Antimony," is full of conclusions not quite justified by his premises nor by his observations. There is no doubt, however, that the observational method which he employed furnished an immense amount of knowledge, and formed the basis of the method of investigation by which the chemical side of medicine was to develop during the next two or three centuries. Great harm was done by the abuse of antimony, but then great harm is done by the abuse of anything, no matter how good it may be. For a time it came to be the most important drug in medicine and was only replaced by venesection. The fact of the matter is that doctors were looking for effects from their drugs, and antimony is, above all things, effective. Patients, too, wished to see the effect of the medicines they took. They do so even yet, and when antimony was administered there was no doubt about its working. The most interesting of Basil Valentine's books, and the one which has had the most enduring influence, is undoubtedly "The Triumphal Chariot of Antimony."[31] It has been translated and has had a wide vogue in every language of modern Europe. Its recommendation of antimony had such an effect upon medical practice that it continued to be the most important drug in the pharmacopoeia down almost to the middle of the nineteenth century. If any proof were needed that Basil Valentine or that the author of the books that go under the name was a monk it would be found in the introduction to this volume, which not only states that fact very clearly, but also in doing so makes use of language that shows the writer to have been deeply imbued with the old monastic spirit. I quote the first paragraph of this introduction because it emphasizes this. The quotation is taken from the English translation of the work as published in London in 1678. Curiously enough, seeing the obscurity surrounding Valentine himself, we do not know for sure who made the translation. The translator apologizes somewhat for the deeply religious spirit of the book, but considers that he was not justified in eliminating any of this. The paragraph is left in the quaint, old-fashioned form so eminently suited to the thoughts of the old master, and the spelling and use of capitals is not changed. "Basil Valentine: His Triumphant Chariot of Antimony.--Since I, Basil Valentine, by Religious Vows am bound to live according to the order of St. Benedict and that requires another manner of Spirit of Holiness than the common state of Mortals exercised in the profane business of this World; I thought it my duty before all things, in the beginning of this little book, to declare what is necessary to be known by the pious Spagyrist [old-time name for medical chemist], inflamed with an ardent desire of this Art, as what he ought to do, and whereunto to direct his striving, that he may lay such foundations of the whole matter as may be stable; lest his Building, shaken with the Winds, happen to fall, and the whole Edifice to be involved in shameful Ruine which otherwise being founded on more firm and solid principles, might have continued for a long series of time. Which Admonition I judged was, is and always will be a necessary part of my religious Office; especially since we must all die, and no one of us which are now, whether high or low, shall long be seen among the number of men. For it concerns me to recommend these Meditations of Mortality to Posterity, leaving them behind me, not only that honor may be given to the Divine Majesty, but also that men may obey him sincerely in all things. "In this my meditation I found that there were five principal heads, chiefly to be considered by the wise and prudent spectators of our Wisdom and Art. The first of which is Invocation of God. The second, Contemplation of Nature. The third, True Preparation. The fourth, the Way of Using. The fifth, Utility and Fruit. For he who regards not these, shall never obtain place among true Chymists, or fill up the number of perfect Spagyrists. Therefore, touching these five heads, we shall here following treat and so far declare them, as that the general Work may be brought to light and perfected by an intent and studious Operator." This book, though the title might seem to indicate it, is not devoted entirely to the study of antimony, but contains many important additions to the chemistry of the time. For instance, Basil Valentine explains in this work how what he calls the spirit of salt might be obtained. He succeeded in manufacturing this material by treating common salt with oil of vitriol and heat. From the description of the uses to which he put the end product of his chemical manipulation, it is evident that under the name of spirit of salt he is describing what we now know as hydrochloric acid. This is said to be the first definite mention of it in the history of science, and the method suggested for its preparation is not very different from that employed even at the present time. He also suggests in his volume how alcohol may be obtained in high strengths. He distilled the spirit obtained from wine over carbonate of potassium, and thus succeeded in depriving it of a great proportion of its water. We have said that he was deeply interested in the philosopher's stone. Naturally this turned his attention to the study of metals, and so it is not surprising to find that he succeeded in formulating a method by which metallic copper could be obtained. The material used for the purpose was copper pyrites, which was changed to an impure sulphate of copper by the action of oil of vitriol and moist air. The sulphate of copper occurred in solution, and the copper could be precipitated from it by plunging an iron bar into it. Basil Valentine recognized the presence of this peculiar yellow metal, and studied some of its qualities. He does not seem to have been quite sure, however, whether the phenomenon that he witnessed was not really a transmutation of at least some of the iron into copper as a consequence of the other chemicals present. There are some observations on chemical physiology, and especially with regard to respiration, in the book on antimony which show their author to have anticipated the true explanation of the theory of respiration. He states that animals breathe because air is needed to support their life, and that all the animals exhibit the phenomenon of respiration. He even insists that the fishes, though living in water, breathe air, and he adduces in support of this idea the fact that whenever a river is entirely frozen the fishes die. The reason for this being, according to this old-time physiological chemist, not that the fishes are frozen to death, but that they are not able to obtain air in the ice as they did in the water, and consequently perish. There are many testimonials to the practical character of all his knowledge and his desire to apply it for the benefit of humanity. The old monk could not repress the expression of his impatience with physicians who gave to patients for "diseases of which they knew little, remedies of which they knew less." For him it was an unpardonable sin for a physician not to have faithfully studied the various mixtures that he prescribed for his patients, and not to know not only their appearance and taste and effect, but also the limits of their application. Considering that at the present time it is a frequent source of complaint that physicians often prescribe remedies with even whose physical appearance they are not familiar and whose composition is often quite unknown to them, this complaint of the old-time chemist alchemist will be all the more interesting for the modern physician. It is evident that when Basil Valentine allows his ire to get the better of him it is because of his indignation over the quacks who were abusing medicine and patients in his time, as they have ever since. There is a curious bit of aspersion on mere book learning in the passage that has a distinctly modern ring, and one feels the truth of Russell Lowell's expression that to read a classic, no matter how antique, is like reading a commentary on the morning paper, so up-to-date does genius ever remain: "And whensoever I shall have occasion to contend in the School with such a Doctor, who knows not how himself to prepare his own medicines, but commits that business to another, I am sure I shall obtain the Palm from him; For indeed that good man knows not what medicines he prescribes to the sick; whether the color of them be white, black, gray, or blew (_sic_), he cannot tell; nor doth this wretched man know whether the medicine he gives be dry or hot, cold or humid; but he only knows that he found it so written in his books, and then pretends to knowledge or as it were Possession by Prescription of a very long time; yet he desires to further information. Here again let it be lawful to exclaim, Good God, to what a state is the matter brought! what Goodness of Minde is in these men! what care do they take of the sick! Wo, wo to them! in the day of Judgement they will find the fruit of their Ignorance and Rashness, then they will see him whom they pierced, when they neglected their Neighbor, sought after money and nothing else; whereas were they cordial in their profession, they would spend Nights and Days in Labour that they might become more learned in their Art, whence more certain health would accrew to the sick with their estimation and greater glory to themselves. But since Labour is tedious to them they commit the matter to chance, and being secure of their Honour, and content with their Fame, they (like Brawlers) defend themselves with a certain garrulity, without any respect had to Confidence or Truth." Perhaps one of the reasons why Valentine's book has been of such enduring interest is that it is written in an eminently human vein and out of a lively imagination. It is full of figures relating to many other things besides chemistry, which serve to show how deeply this investigating observer was attentive to all the problems of life around him. For instance, when he wants to describe the affinity that exists between many substances in chemistry, and which makes it impossible for them not to be attracted to one another, he takes a figure from the attractions that he sees exist among men and women. It is curious to find affinities discussed in our modern sense so long ago. There are some paragraphs with regard to the influence of the passion of love that one might think rather a quotation from an old-time sermon than from a great ground-breaking book in the science of chemistry. "Love leaves nothing entire or sound in man; it impedes his sleep, he cannot rest either day or night; it takes off his appetite that he hath no disposition either to meat or drink by reason of the continual torments of his heart and mind. It deprives him of all Providence, hence he neglects his affairs, vocation, and business. He minds neither study, labor, nor prayer; casts away all thoughts of anything but the body beloved; this is his study, this his most vain occupation. If to lovers the success be not answerable to their wish, or so soon and prosperously as they desire, how many melancholies henceforth arise, with griefs and sadness, with which they pine away and wax so lean as they have scarcely any flesh cleaving to the bones. Yea, at last they lose the life itself, as may be proved by many examples! for such men (which is an horrible thing to think of) slight and neglect all perils and detriments, both of the body and life, and of the soul and eternal salvation." It is evident that human nature is not different in our sophisticated twentieth century from that which this observant old monk saw around him in the fifteenth. He continues: "How many testimonies of this violence which is in love, are daily found? for it not only inflames the younger sort, but it so far exaggerates some persons far gone in years as through the burning heat thereof, they are almost mad. Natural diseases are for the most part governed by the complexion of man and therefore invade some more fiercely, others more gently; but Love, without distinction of poor or rich, young or old, seizeth all, and having seized so blinds them as forgetting all rules of reason, they neither see nor hear any snare." But then the old monk thinks that he has said enough about this rather foreign subject, and apologizes for his digression in another paragraph that should remove any lingering doubt there might be with regard to the genuineness of his monastic character. At the end of the passage he makes the application in a very few words. The personal element in his confession is so naïve and so simply straightforward that instead of seeming to be the result of conceit, which would surely have repelled the reader, it rather attracts and enhances his kindly feeling for its author. The paragraph would remind one in certain ways of that personal element that was to become more popular in literature after Montaigne in the next century made it rather the fashion. "But of these enough; for it becomes not a religious man to insist too long upon these cogitations, or to give place to such a flame in his heart. Hitherto (without boasting I speak it) I have throughout the whole course of my life kept myself safe and free from it, and I pray and invoke God to vouchsafe me his Grace that I may keep holy and inviolate the faith which I have sworn, and live contented with my spiritual spouse, the Holy Catholick Church. For no other reason have I alleged these than that I might express the love with which all tinctures ought to be moved towards metals, if ever they be admitted by them into true friendship, and by love, which permeates the inmost parts, be converted into a better state." The application of the figure at the end of his long digression is characteristic of the period in which he wrote, as also to a considerable extent of the German literary methods of the time. In this volume on the use of antimony there are in most of the editions certain biographical notes which have sometimes been accepted as authentic, but oftener rejected. According to these, Basil Valentine was born in a town in Alsace, on the southern bank of the Rhine. As a consequence of this, there are several towns that have laid claim to being his birthplace. M. Jean Reynaud, the distinguished French philosophical writer of the first half of the nineteenth century, once said that Basil Valentine, like Ossian and Homer, had many towns claim him years after his death. He also suggested that, like those old poets, it was possible that the writings sometimes attributed to Basil Valentine were really the work not of one man, but of several individuals. There are, however, many objections to this theory, the most forcible of which is the internal evidence derived from the books themselves showing similarities of style and method of treating subjects too great for us to admit non-identity in the writers. M. Reynaud lived at a time when it was all the fashion to suggest that old works that had come down to us, like the Iliad and the Odyssey, and even such national epics as the Cid and the Arthur Legends and the Nibelungenlied were to be attributed to several writers rather than to one. We have passed that period of criticism, however, and have reverted to the idea of single authorship for these works, and the same conclusion has been generally come to with regard to the writings attributed to Basil Valentine. Other biographic details contained in "The Triumphal Chariot of Antimony" are undoubtedly more correct. According to them Basil Valentine travelled in England and Holland on missions for his order, and went through France and Spain on a pilgrimage to St. James of Compostella. Besides this work, there is a number of other books of Basil Valentine's, printed during the first half of the sixteenth century, that are well known and copies of which may be found in most of the important libraries. The United States Surgeon General's Library at Washington contains not a few of the works on medical subjects, and the New York Academy of Medicine Library has some valuable editions of certain of his works. Some of his other well-known books, each of which is a good-sized octavo volume, bear the following descriptive titles (I give them in English, though as they are usually found, they are in Latin, sixteenth-century translations of the original German): "The World in Miniature: or, The Mystery of the World and of Human Medical Science," published at Mayburg, 1609; "The Chemical Apocalypse: or, The Manifestation of Artificial Chemical Compounds," published in Erfurt in 1624; "A Chemico-Philosophic Treatise Concerning Things Natural and Preternatural, Especially Relating to the Metals and the Minerals," published at Frankfurt in 1676; "Haliography: or, The Science of Salts: A Treatise on the Preparation, Use, and Chemical Properties of All the Mineral, Animal, and Vegetable Salts," published at Bologna in 1644; "The Twelve Keys of Philosophy," Leipsic, 1630. These are of interest to the chemist and physicist rather than to the physician, and it is as a Maker of Medicine that we are concerned with Valentine here. The great attention aroused in Basil Valentine's work at the Renaissance period can be best realized from the number of manuscript copies and their wide distribution. His books were not all printed at one place, but, on the contrary, in different portions of Europe. The original edition of "The Triumphal Chariot of Antimony" was published in Leipsic in the early part of the sixteenth century. The first editions of the other books, however, appeared at places so distant from Leipsic as Amsterdam and Bologna, while various cities of Germany, as Erfurt and Frankfurt, claim the original editions of still other works. Many of the manuscript copies still exist in various libraries in Europe; and while there is no doubt that some unimportant additions to the supposed works of Basil Valentine have come from the attribution to him of scientific treatises of other German writers, the style and the method of the principal works mentioned is entirely too similar not to have been the fruit of a single mind and that possessed of a distinct investigating genius, setting it far above any of its contemporaries in scientific speculation and observation. The most interesting feature of all of Basil Valentine's writings that are extant is the distinctive tendency to make his observations of special practical utility. His studies in antimony were made mainly with the idea of showing how that substance might be used in medicine. He did not neglect to point out other possible uses, however, and knew the secret of the employment of antimony in order to give sharpness and definition to the impression produced by metal types. It would seem as though he was the first scientist who discussed this subject, and there is even some question of whether printers and typefounders did not derive their ideas in this matter from our chemist. Interested though he was in the transmutation of metals, he never failed to try to find and suggest some medicinal use for all of the substances that he investigated. His was no greedy search for gold and no cumulation of investigations with the idea of benefiting only himself. Mankind was always in his mind, and perhaps there is no better demonstration of his fulfilment of the character of the monk than this constant solicitude to benefit others by every bit of investigation that he carried out. For him, with medieval nobleness of spirit, "the first part of every work must be the invocation of God, and the last, though no less important than the first, must be the utility and fruit for mankind that can be derived from it." The career of the last of the Makers of Medicine in the Middle Ages may be summed up briefly in a few sentences that show how thoroughly this old Benedictine was possessed of the spirit of modern science. He believed in observation as the most important source of medical knowledge. He valued clinical experience far above book information. He insisted on personal acquaintanceship on the part of the physician with the drugs he used, and thought nothing more unworthy of a practitioner of medicine,--indeed he sets it down as almost criminal--than to give remedies of whose composition he was not well aware and whose effect he did not thoroughly understand. He thought that nature was the most important aid to the physician, much more important than drugs, though he was the first to realize the significance of chemical affinities, and he seems to have understood rather well how individual often were the effects obtained from drugs. He was a patient student, a faithful observer, a writer who did not begrudge time and care to the composition of large books on medicine, yet withal he was no dry-as-dust scholar, but eminently human in his sympathies with ailing humanity, and a strenuous upholder of the dignity of the profession to which he belonged. Scarcely more can be said of anyone in the history of medicine, at least so far as good intentions go; though many accomplished more, none deserve more honor than the Thuringian monk whom we know as Basil Valentine. There are many other of these old-time Makers of Medicine of whom nearly the same thing can be said. Basil Valentine is only one of a number of men who worked faithfully and did much both for medical science and professional life during the thousand years from the fall of Rome to the fall of Constantinople, when, according to what used to be commonly accepted opinion, men were not animated by the spirit of research and of fine incentive to do good to men that we are so likely to think of as belonging exclusively to more modern times. A man whom he greatly influenced, Paracelsus, took up the tradition of scientific investigation where Basil Valentine had left it. His work, though more successfully revolutionary, was not done in such a fine spirit of sympathy with humanity nor with that simplicity of life and purity of intention that characterized the old monk's work. Paracelsus' birth in the year of the discovery of America places him among the makers of the foundations of our modern medicine, and he will be treated of in a volume on "The Forefathers in Medicine." APPENDIX I ST. LUKE THE PHYSICIAN[32] In the midst of what has been called the "higher criticism" of the Bible in recent times, one of the long accepted traditions that has been most strenuously assailed and, indeed, in the minds of many scholars, seemed, for a time at least, quite discredited, was that St. Luke the Evangelist, the author of the Third Gospel and the Acts of the Apostles, was a physician. Distinguished authorities in early Christian apologetics have declared that the pillars of primitive Christian history are the genuine Epistles of St. Paul, the writings of St. Luke, and the history of Eusebius. It is quite easy to understand, then, that the attack upon the authenticity of the writings usually assigned to St. Luke, which in many minds seemed successful, has been considered of great importance. In the very recent time there has been a decided reaction in this matter. This has come, not so much from Roman Catholics, who have always clung to the traditional view, and whose great Biblical students have been foremost in the support of the previously accepted opinion, but from some of the most strenuous of the German higher critics, who now appreciate that destructive, so-called higher criticism went too far, and that the traditional view not only can be maintained, but is the only opinion that will adequately respond to all the new facts that have been found, and all the recently gathered information with regard to the relations of events in the olden time. By far the most important contribution to the discussion in recent years came not long since from the pen of Professor Adolph Harnack, the professor of church history in the University of Berlin. Professor Harnack's name is usually cited as that of one of the most destructive of the higher critics. His recent book, however, "Luke the Physician,"[33] is an entire submission to the old-fashioned viewpoint that the writer of the Third Gospel and of the Acts of the Apostles was a Greek fellow-worker of St. Paul, who had been in company for years with Mark and Philip and James, and who had previously been a physician, and was evidently well versed in all the medical lore of that time. Harnack does not merely concede the old position. As might be expected, his rediscussion of the subject clinches the arguments for the traditional view, and makes it impossible ever to call it in question again. It is easy to understand how important are such admissions when we recall how much this traditional view has been assailed, and how those who have held it have been accused of old-fogyism and lack of scholarship, and unwarranted clinging to antiquated notions just because they thought they were of faith, and how, lacking in true scholarship, seriously hampering genuine investigation, such conservatism has been declared to be. The question of Luke's having been a physician is an extremely valuable one, and no one in our time is better fitted by early training and long years of study to elucidate it than Professor Harnack. He began his excursions into historical writing years ago, as I understand, as an historian of early Christian medicine. Some of his works on medical conditions just before and after Christ are quoted confidently by the distinguished German medical historians. From this department he graduated into the field of the higher criticism. He is eminently in a position, therefore, to state the case with regard to St. Luke fully, and to indicate absolutely the conclusions that should be drawn from the premises of fact, writings, and traditions that we have. He does so in a very striking way. Perhaps no better example of his thoroughly lucid and eminently logical mode of argumentation is to be found than the paragraph in which he states the question. It might well be recommended as an example of terse forcefulness and logical sequence that deserves the emulation of all those who want to write on medical subjects. If we had more of these characteristic qualities of Harnack's style, our medical literature, so called, would not need to occupy so many pages of print as it does--yet would say more. Here it is: St. Luke, according to St. Paul, was a physician. When a physician writes a historical work it does not necessarily follow that his profession shows itself in his writing; yet it is only natural for one to look for traces of the author's medical profession in such a work. These traces may be of different kinds: 1, The whole character of the narrative may be determined by points of view, aims, and ideals which are more or less medical (disease and its treatment); 2, marked preference may be shown for stories concerning the healing of diseases, which stories may be given in great number and detail; 3, the language may be colored by the language of physicians (medical technical terms, metaphors of medical character, etc.). All these three groups of characteristic signs are found, as we shall see, in the historical work which bears the name of St. Luke. Here, however, it may be objected that the subject matter itself is responsible for these traits, so that their evidence is not decisive for the medical calling of the author. Jesus appeared as a great physician and healer. All the evangelists say this of Him; hence it is not surprising that one of them has set this phase of His ministry in the foreground, and has regarded it as the most important. Our evangelist need not therefore have been a physician, especially if he were a Greek, seeing that in those days Greeks with religious interests were disposed to regard religion mainly under the category of healing and salvation. This is true, yet such a combination of characteristic signs will compel us to believe that the author was a physician if, 4, the description of the particular cases of disease shows distinct traces of medical diagnosis and scientific knowledge; 5, if the language, even where questions of medicine or of healing are not touched upon, is colored by medical phraseology; and, 6, if in those passages where the author speaks as an eye-witness medical traits are especially and prominently apparent. These three kinds of tokens are also found in the historical work of our author. It is accordingly proved that it proceeds from the pen of a physician. The importance of the concession that Luke was a physician should be properly appreciated. His whole gospel is written from that standpoint. For him the Saviour was the healer, the good physician who went about curing the ills of the body, while ministering to people's souls. He has more accounts of miracles of healing than any of the other Evangelists. He has taken certain of the stories of the other Evangelists who were eye-witnesses, and when they were told in naïve and popular language that obscured the real condition that was present, he has retold the story from the physician's standpoint, and thus the miracle becomes clearer than ever. In one case, where Mark has a slur on physicians, Luke eliminates it. In a number of cases the correction of Mark's popular language in the description of ailments is made in terms that could not have been used except by one thoroughly versed in the Greek medical terminology of the times. As a matter of fact, there seems to be no doubt now that Luke had been, before he became an Evangelist, a practising physician in Malta of considerable experience. His testimony, then, to the miracles is particularly valuable as almost a medical eye-witness. In medical science, St. Luke's time was by no means barren of knowledge. The Alexandrian school of medicine had done some fine work in its time. It was the first university medical school in the world's history, and there dissection was first practised regularly and publicly for the sake of anatomy, and even the vivisection of criminals who were supplied by the Ptolemei for human physiology, was a part of the school curriculum. A number of important discoveries in brain anatomy are attributed to Herophilus, after whom the torcular herophili within the skull is named, and who invented the term calamus scriptorius for certain appearances in the fourth ventricle. His colleague, Erasistratus, the co-founder of this school at Alexandria, did work in pathological anatomy, and laid the foundation for serious study there. For three centuries there is some good worker, at or in connection with Alexandria, whose name is preserved for us in the history of medicine. Other Greek schools of medicine in the East, as, for instance, that of Pergamos, also did excellent work. Galen is the great representative of this school, and he came in the century after St. Luke. A physician educated in Greek medicine at that time, then, would be in an excellent position to judge critically of the miracles of healing of the Christ, and it would seem to have been providential that Luke was called for this purpose. The evidence for his membership of our profession will doubtless be interesting to all physicians. Some of the distinctive passages in which Luke's familiarity with medical terms to such an extent that to express his meaning he found himself compelled to use them, will appeal at once to these, for whom such terms are part of everyday speech. The use of the word _hydropikos_, which is not to be met with anywhere else in the New Testament, nor in the non-medical Greek literature of that time, though the word is of frequent occurrence as a designation for a person suffering from dropsy (and always, as in Luke, the adjective for the substantive), in Hippocrates, Dioscorides, and Galen is a typical example. Where such vague terms as paralyzed occur Luke does not use the familiar word, but the medical term that meant stricken with paralysis, indicating not any inability to use the limbs, but such a one as was due to a stroke of apoplexy. We who, as physicians, have heard of so many cures of paralysis from our friends, the Eddyites, are prone to ask, as the first question, what sort of a paralysis it was. Luke made inquiries from men who were eye-witnesses, and then has described the scene with such details as convinced him as a physician of the reality of the miracle, and his description was meant to carry conviction to the minds of others. Occasionally St. Luke uses words which only a physician would be likely to know at all. That is to say, even a man reasonably familiar with medical terminology and medical literature would not be likely to know them unless he had been technically trained. One of these is the word _sphudron_, a word which is only medical, and is not to be found even in such large Greek lexicons of ordinary words as that of Passow. Sphudron is the anatomical term of the Græco-Alexandrian school for the condyles of the femur. Galen and other medical authors use it, and Luke, in giving the details of the story of the lame man cured, in the third chapter of the Acts, seventh verse, selects it because it exactly expresses the meaning he wished to convey. In this story there are a number of added medical details. These are all evidently arranged so as to give the full medical significance to the miracle. For instance, the man had been _lame from birth_, literally _from the womb of his mother_. At this time he was forty years of age, an age at which the spontaneous cure of such an ailment or, indeed, any cure of it, could scarcely be expected, if, during the preceding time, there had been no improvement. In the story of the cure of Saul's blindness Luke says in the Acts that his blindness fell from him like scales. The figure is a typically medical one. The word for fall that is used is, as was pointed out by Hobart ("Medical Language of St. Luke," Dublin, 1882), exactly the term that is used for the falling of scales from the body. The term for scales is the specific designation of the particles that fall from the body during certain skin diseases or after certain of the infectious fevers, as in scarlet fever. Hippocrates and Galen have used it in many places. It is distinctively a medical word. In the story of the vision of St. Peter, told also in the Acts, the word _ecstasis_, from which we derive our word ecstasy, is used. This is the only word St. Luke uses for vision and he alone uses it. This term is of constant employment in a technical sense in the medical writers of St. Luke's time and before it. When the other evangelists talk of lame people they use the popular term. This might mean anything or nothing for a physician. Luke uses one of the terms that is employed by physicians when they wish to indicate that for some definite reason there is inability to walk. In the story of the Good Samaritan there are some interesting details that indicate medical interest on the part of the writer. It is Luke's characteristic story and a typical medical instance. He employs certain words in it that are used only by medical writers. The use of oil and wine in the treatment of the wounds of the stranger traveller was at one time said to indicate that it could not have been a physician who wrote the story, since the ancients used oil for external applications in such cases but not wine. More careful search of the old masters of medicine, however, has shown that they used oil and wine not only internally but externally. Hippocrates, for instance, has a number of recommendations of this combination for wounds. It is rather interesting to realize this, and especially the wine in addition to the oil, because wine contains enough alcohol to be rather satisfactorily antiseptic. There seems no doubt that wounds that had been bathed in wine and then had oil poured over them would be likely to do better than those which were treated in other ways. The wine would cleanse and at least inhibit bacterial growth. The subsequent covering with oil would serve to protect the wound to some degree from external contamination. Sometimes there is an application of medical terms to something extraneous from medicine that makes the phrase employed quite amusing. For instance, when Luke wants to explain how they strengthened the vessel in which they were to sail he describes the process by the term which was used in medical Greek to mean the splinting of a part or at least the binding of it up in such a way as to enable it to be used. The word was quite a puzzle to the commentators until it was pointed out that it was the familiar medical term, and then it was easy to understand. Occasionally this use of a medical term gives a strikingly accurate significance to Luke's diction. For instance, where other evangelists talk of the Lord looking at a patient or turning to them, Luke uses the expression that was technically employed for a physician's examination of his patient, as if the Lord carefully looked over the ailing people to see their physical needs, and then proceeded to cure them. Manifestly in Luke's mind the most interesting phase of the Lord's life was His exhibition of curative powers, and the Saviour was for him the divine healer, the God physician of bodies as well as of souls. There are many little incidents which he relates that emphasize this. For instance, where St. Mark talks about the healing of the man with a withered hand, St. Luke adds the characteristic medical note that it was the right hand. When he tells of the cutting off of the ear of the servant of the high priest in the Garden of Olives St. Luke takes the story from St. Mark, but adds the information that would appeal to a physician that it was the right ear. Moreover, though all four evangelists record the cutting off of the ear, only St. Luke adds the information that the Lord healed it again. It is as if he were defending the kindly feelings of the Divine Physician and as if it would have been inexcusable had He not exerted His miraculous powers of healing on this occasion. It is St. Luke, too, who has constantly distinguished between natural illnesses and cases of possession. This careful distinction alone would point to the author of the third gospel and the Acts as surely a physician. As it is it confirms beyond all doubt the claim that the writer of these portions of the New Testament was a physician thoroughly familiar with all the medical writings of the time and probably a physician who had practised for a long time. Certain miracles of healing are related only by St. Luke as if he realized better than any of the other evangelists the evidential value that such instances would have for future generations as to the divinity of the personage who worked them. The beautiful story of the raising from death of the son of the widow of Nain is probably one of the oftenest quoted passages from St. Luke. It is a charming bit of literature. While it suggests the writer physician it makes one almost sure that the other tradition according to which St. Luke was also a painter must be true. The scene is as picturesque as it can be. The Lord and His Apostles and the multitudes coming to the gate of the little city just as in the evening sun the funeral cortège with the widow burying her only son came out of it. The approach of the Lord to the weeping mother, His command to the dead son to arise, and the simple words, "and he gave him back to his mother," constitute as charming a scene as a painter ever tried to visualize. Besides this, Luke alone has the story of the man suffering with dropsy and the woman suffering from weakness. The intensely picturesque quality of many of these scenes that he describes so vividly would indeed seem to place beyond all doubt the old tradition that he was an artist as well as a physician. It is interesting to realize that it is to Luke alone that we owe the account of the well-known message sent by Christ Himself to John the Baptist when John sent his disciples to inquire as to His mission. After describing His ministry He said: "Go and relate to John what you have heard and seen: the blind see, the lame walk, the deaf hear, the lepers are made clean, the dead rise again, to the poor the Gospel is preached." To no one more than to a physician would that description of His mission appeal as surely divine. To those who care to follow the subject still further, and above all, to read opinions given before the reversal of the verdict of the higher criticism on the Lucan writings, indeed before ever that trial was brought, there is much in "Horæ Lucanæ--A Biography of St. Luke," by Henry Samuel Baynes (Longmans, 1870), that will surely be of interest. He has some interesting quotations which show how thoroughly previous centuries realized all the force of modern arguments. For instance, the following paragraph from Dr. Nathaniel Robinson, a Scotch physician of the eighteenth century, will illustrate this. Dr. Robinson said: It is manifest from his Gospel, that Luke was both an acute observer, and had even given professional attention to all our Saviour's miracles of healing. Originally, among the Egyptians, divinity and physic were united in the same order of men, so that the priest had the care of souls, and was also the physician. It was much the same under the Jewish economy. But after physic came to be studied by the Greeks, they separated the two professions. That a physician should write the history of our Saviour's life was appropriate, as there were divers mysterious things to be noticed, concerning which his education enabled him to form a becoming judgment. It is even interesting to realize that St. Luke's tendency to use medical terms has been of definite value in determining the question whether both the third gospel and the Acts of the Apostles are by the same man. They have been attributed to St. Luke traditionally, but in the higher criticism some doubt has been thrown on this and an elaborate hypothesis of dual authorship set up. It has been asserted that it is very improbable on extrinsic grounds that they were both written by one hand and certain intrinsic evidence, changes in the mode of narration, especially the use of the first personal pronoun in the plural in certain passages, has been pointed to as making against single authorship. This tendency to deny old-time traditions of authorship with regard to many classical writings was a marked characteristic of the early part of the nineteenth century, but the close of the century saw practically all of these denials discredited. The nineteenth century ushered in studies of Homer, with the separatist school perfectly confident in their assertion that the Iliad and the Odyssey were not by the same person, and even that the Iliad itself was the work of several hands. At the beginning of the twentieth century we are quite as sure that both the Iliad and Odyssey were written by the same person and that the separatists were hurried into a contrary decision not a little by the feeling of the sensation that such a contradiction of previously accepted ideas would create. This is a determining factor in many a supposed novel discovery, that it is hard always to discount sufficiently. A thing may be right even though it is old, and most new discoveries, it must not be forgotten, that is, most of those announced with a great blare of trumpets, do not maintain themselves. The simple argument that the separatists would have to find another poet equal to Homer to write the other poem has done more than anything else to bring their opinion into disrepute. It is much easier to explain certain discrepancies, differences of style, and of treatment of subjects, as well as other minor variants, than to supply another great poet. Most of the works of our older literatures have gone through a similar trial during the over-hasty superficially critical nineteenth century. The Nibelungenlied has been attributed to two or three writers instead of one. The Cid, the national epic of Spain, and the Arthur Legends, the first British epic, have been at least supposed to be amenable to the same sort of criticism. In every case, scholars have gone back to the older traditional view of a single author. The phases of literary and historic criticism with regard to Luke's writings are, then, only a repetition of what all our great national classics have gone through from supercilious scholarship during the past hundred years. It is not surprising, then, that there should be dual or even triple ascriptions of authorship for various portions of the Scriptures, and Luke's writings have on this score suffered as much or more even than others, with the possible exception of Moses. It is now definitely settled, however, that the similarities of style between the Acts and the third gospel are too great for them to have come from two different minds. This is especially true, as pointed out by Harnack, in all that regards the use of medical terms. The writer of the Acts and the writer of the third gospel knew Greek from the standpoint of the physician of that time. Each used terms that we find nowhere else in Greek literature except among medical writers. What is thus true for one critical attack on Luke's reputation is also true in another phase of recent higher criticism. It has been said that certain portions of the Acts which are called the "we" portions because the narration changes in them from the third to the first person were to be attributed to another writer than the one who wrote the narrative portions. Here, once more, the test of the medical words employed has decided the case for Luke's sole authorship. It is evidently an excellent thing to be able to use medical terms properly if one wants to be recognized with certainty later on in history for just what one's business was. It has certainly saved the situation for St. Luke, though there may be some doubt as to the real force of objections thus easily overthrown. It is rather interesting to realize that many scholars of the present generation had allowed themselves to be led away by the German higher criticism from the old tradition with regard to Luke as a physician and now will doubtless be led back to former views by the leader of German biblical critics. It shows how much more distant things may influence certain people than those nearer home--how the hills are green far away. Harnack confesses that the best book ever written on the subject of Luke as a physician, the one that has proved of most value to him, and that he still recommends everyone to read, was originally written in English. It is Hobart's "Medical Language of St. Luke,"[34] written more than a quarter of a century before Harnack. The Germans generally had rather despised what the English were doing in the matter of biblical criticism, and above all in philology. Yet now the acknowledged coryphæus of them all, Harnack, not only admits the superiority of an old-time English book, but confesses that it is the best statement of the subject up to the present time, including his own. He constantly quotes from it, and it is evident that it has been the foundation of all of his arguments. It is not the first time that men have fetched from afar what they might have got just as well or better at home. Harnack has made complete the demonstration, then, that the third gospel and the Acts were written by St. Luke, who had been a practising physician. In spite of this, however, he finds many objections to the Luke narratives and considers that they add very little that is valuable to the contemporary evidence that we have with regard to Christ. He impairs with one hand the value of what he has so lavishly yielded with the other. He finds inconsistencies and discrepancies in the narrative that for him destroy their value as testimony. A lawyer would probably say that this is that very human element in the writings which demonstrates their authenticity and adds to their value as evidence, because it shows clearly the lack of any attempt to do anything more than tell a direct story as it had come to the narrator. No special effort was made to avoid critical objections founded on details. It was the general impression that was looked for. Sir William Ramsay, in his "Luke the Physician and Other Studies in the History of Religion" (New York: Armstrong and Sons, 1908), has answered Harnack from the side of the professional critic with much force. He appreciates thoroughly the value of Professor Harnack's book, and above all the reactionary tendency away from nihilistic so-called higher criticism which characterized so much of German writing on biblical themes in the nineteenth century. He says (p. 7): "This [book of Harnack's] alone carries Lukan criticism a long step forwards, and sets it on a new and higher plane. Never has the unity and character of the book been demonstrated so convincingly and conclusively. The step is made and the plane is reached by the method which is practised in other departments of literary criticism, viz., by dispassionate investigation of the work and by discarding fashionable _a priori_ theories." The distinguished English traveller and writer on biblical subjects points out, however, that in detail many of Harnack's objections to the Lukan narratives are due to insufficient consideration of the circumstances in which they were written and the comparative significance of the details criticised. He says, "Harnack lays much stress on the fact that inconsistencies and inexactnesses occur all through Acts. Some of these are undeniable; and I have argued that they are to be regarded in the same light as similar phenomena in the poem of Lucretius and in other ancient classical writers, viz., as proofs that the work never received the final form which Luke intended to give it, but was still incomplete when he died. The evident need for a third book to complete the work, together with those blemishes in expression, form the proof." Ramsay's placing of Harnack's writing in general is interesting in this connection. (P. 8) "Professor Harnack stands on the border between the nineteenth and twentieth century. His book shows that he is to a certain degree sensitive of and obedient to the new spirit; but he is only partially so. The nineteenth century critical method was false, and is already antiquated.... "The first century could find nothing real and true that was not accompanied by the marvellous and the 'supernatural.' The nineteenth century could find nothing real and true that was. Which view was right and which was wrong? Was either complete? Of these two questions, the second alone is profitable at the present. Both views were right--in a certain way of contemplating; both views were wrong--in a certain way. Neither was complete. At present, as we are struggling to throw off the fetters which impeded thought in the nineteenth century, it is most important to free ourselves from its prejudices and narrowness." He adds (pp. 26 and 27): "There are clear signs of the unfinished state in which this chapter was left by Luke; but some of the German scholar's criticisms show that he has not a right idea of the simplicity of life and equipment that evidently characterized the jailer's house and the prison. The details which he blames as inexact and inconsistent are sometimes most instructive about the circumstances of this provincial town and Roman colonia. "But it is never safe to lay much stress on small points of inexactness or inconsistency in any author. One finds such faults even in the works of modern scholarship if one examines them in the microscopic fashion in which Luke is studied here. I think I can find them in the author [Harnack] himself. His point of view sometimes varies in a puzzling way." As a matter of fact, Harnack, as pointed out by Ramsay, was evidently working himself more and more out of the old conclusion as to the lack of authenticity of the Lucan writings into an opinion ever more and more favorable to Luke. For instance, in a notice of his own book, published in the _Theologische Literaturzeitung_, "he speaks far more favorably about the trustworthiness and credibility of Luke, as being generally in a position to acquire and transmit reliable information, and as having proved himself able to take advantage of his position. Harnack was gradually working his way to a new plane of thought. His later opinion is more favorable." Ramsay also points out that Professor Giffert, one of our American biblical critics, had felt compelled by the geographical and historical evidence to abandon in part the older unfavorable criticism of Luke and to admit that the Acts is more trustworthy than previous critics allowed. Above all, "he saw that it was a living piece of literature written by one author." In a word, Luke is being vindicated in every regard. Some of the supposed inaccuracies of Luke vanish when careful investigation is made. Some of his natural history details, for instance, have been impugned and the story of the viper that "fastened" itself upon St. Paul in Malta has been cited as an example of a story that would not have been told in that way by a man who knew medicine and the related sciences in Luke's time. Because the passage illustrates a number of phases of the discussion with regard to Luke's language I make a rather long quotation from Ramsay: Take as a specimen with which to finish off this paper the passage Acts xxviii, 9 _et seq._, which is very fully discussed by Harnack twice. He argues that the true meaning of the passage was not understood until medical language was compared, when it was shown that the Greek word by which the act of the viper to Paul's hand is described, implies "bit" and not merely "fastened upon." But it is a well-assured fact that the viper, a poisonous snake, only strikes, fixes the poison fangs on the flesh for a moment, and withdraws its head instantly. Its action could never be what is attributed by Luke the eye witness to this Maltese viper; that it hung from Paul's hand and was shaken off into the fire by him. On the other hand, constrictors, which have no poison fangs, cling in the way described, but as a rule do not bite. Are we, then, to understand in spite of the medical style and the authority of Professor Blass (who translates "momordit" in his edition), that the viper fastened upon the apostle's hand? Then, the very name viper is a difficulty. Was Luke mistaken about the kind of snake which he saw? A trained medical man in ancient times was usually a good authority about serpents, to which great respect was paid in ancient medicine and custom. Mere verbal study is here utterly at fault. We can make no progress without turning to the realities and facts of Maltese natural history. A correspondent obligingly informed me some years ago that Mr. Bryan Hook, of Farnham, Surrey (who, my correspondent assures me, is a thoroughly good naturalist), had found in Malta a small snake, _Coronella austriaca_, which is rare in England, but common in many parts of Europe. It is a constrictor, without poison fangs, which would cling to the hand or arm as Luke describes. It is similar in size to the viper, and so like in markings and general appearance that Mr. Hook, when he caught his specimen, thought he was killing a viper. My friend, Prof. J.W.H. Trail, of Aberdeen, whom I consulted, replied that _Coronella lævis_ or _austriaca_, is known in Sicily and the adjoining islands; but he can find no evidence of its existence in Malta. It is known to be rather irritable, and to fix its small teeth so firmly into the human skin as to need a little force to pull it off, though the teeth are too short to do any real injury to the skin. Coronella is at a glance very much like a viper; and in the flames it would not be closely examined. While it is not reported as found in Malta except by Mr. Hook, two species are known there belonging to the same family and having similar habits (_leopardinus_ and _zamenis_ (or _coluber_) _gemonensis_). The coloring of _Coronella leopardinus_ would be the most likely to suggest a viper. The observations justify Luke entirely. We have here a snake so closely resembling a viper as to be taken for one by a good naturalist until he had caught and examined a specimen. It clings, and yet it also bites without doing harm. That the Maltese rustics should mistake this harmless snake for a venomous one is not strange. Many uneducated people have the idea that all snakes are poisonous in varying degrees, just as the vulgar often firmly believe that toads are poisonous. Every detail as related by Luke is natural, and in accordance with the facts of the country. In a word, then, the whole question as to Luke's authority as a writer, as an eye-witness of many things, and as the relator of many others with regard to which he had obtained the testimony of eye-witnesses is fully vindicated. Twenty years ago many scholars were prone to doubt this whole question. Ten years ago most of them were convinced that the Luke traditions were not justified by recent investigation. Now we have come back once more to the complete acceptance of the old traditions. Perhaps the most unfortunate characteristic of much nineteenth-century criticism in all departments, even those strictly scientific, was the marked tendency to reject previous opinions for new ones. Somehow men felt themselves so far ahead of old-time writers and thinkers that they concluded they must hold opinions different from their ancestors. In nearly every case the new ideas that they evolved by supposedly newer methods are not standing the test of time and further study. There had been a continuous belief in men's minds, having its basis very probably on a passage in one of St. Peter's Epistles, that the earth would dissolve by fire. This was openly contradicted all during the nineteenth century and the time when the earth would freeze up definitely calculated by our mathematicians. Now after having studied radioactivity and learned from the physicist that the earth is heating up and will eventually get too hot for life, we calmly go back to the old Petrine declaration. Some of the most distinguished of the German biologists of the present day, such men as Driesch and others, calmly tell us that the edifice erected by Darwin will have to come down because of newly discovered evidence, and indeed some of them go so far as to declare that Darwinism was a crude hypothesis very superficial in its philosophical aspects and therefore acceptable to a great many people who, because it was easy to understand and was very different from what our fathers had believed, hastened to accept it. Nothing shows the necessity for being conservative in the matter of new views in science or ethics or religion more than the curious transition state in which we are with regard to many opinions at the present time, with a distinct tendency toward reaction to older views that a few years ago were thought quite untenable. We are rather proud of the advance that we are supposed to be making along many lines in science and scholarship, and yet over and over again, after years of work, we prove to have been following a wrong lead and must come back to where we started. This has been the way of man from the beginning and doubtless will continue. The present generation are having this curious regression that follows supposed progress strongly emphasized for them. APPENDIX II SCIENCE AT THE MEDIEVAL UNIVERSITIES[35] With the growth of interest in science and in nature study in our own day, one of the expressions that is probably oftenest heard is surprise that the men of preceding generations and especially university men did not occupy themselves more with the world around them and with the phenomena that are so tempting to curiosity. Science is usually supposed to be comparatively new and nature study only a few generations old. Men are supposed to have been so much interested in book knowledge and in speculations and theories of many kinds, that they neglected the realities of life around them while spinning fine webs of theory. Previous generations, of course, have indulged in theory, but then our own generation is not entirely free from that amusing occupation. Nothing could well be less true, however, than that the men of preceding generations were not interested in science even in the sense of physical science, or that nature study is new, or that men were not curious and did not try to find out all they could about the phenomena of the world around them. The medieval universities and the school-men who taught in them have been particularly blamed for their failure to occupy themselves with realities instead of with speculation. We are coming to recognize their wonderful zeal for education, the large numbers of students they attracted, the enthusiasm of their students, since they made so many handwritten copies of the books of their masters, the devotion of the teachers themselves, who wrote at much greater length than do our professors even now and on the most abstruse subjects, so that it is all the more surprising to think they should have neglected science. The thought of our generation in the matter, however, is founded entirely on an assumption. Those who know anything about the writers of the Middle Ages at first hand are not likely to think of them as neglectful of science even in our sense of the term. Those who know them at second hand are, however, very sure in the matter. The assumption is due to the neglect of history that came in the seventeenth and eighteenth centuries. We have many other similar assumptions because of the neglect of many phases of mental development and applied science at this time. For instance, most of us are very proud of our modern hospital development and think of this as a great humanitarian evolution of applied medical science. We are very likely to think that this is the first time in the world's history that the building of hospitals has been brought to such a climax of development, and that the houses for the ailing in the olden time were mere refuges, prone to become death traps and at most makeshifts for the solution of the problem of the care of the ailing poor. This is true for the hospitals of the seventeenth and eighteenth centuries, but it is not true at all for the hospitals of the thirteenth and fourteenth and fifteenth centuries. Miss Nutting and Miss Dock in their "History of Nursing"[36] have called attention to the fact that the lowest period in hospital development is during the eighteenth and early nineteenth centuries. Hospitals were little better than prisons, they had narrow windows, were ill provided with light and air and hygienic arrangements, and in general were all that we should imagine old-time hospitals to be. The hospitals of the earlier time, however, had fine high ceilings, large windows, abundant light and air, excellent arrangements for the privacy of patients, and in general were as worthy of the architects of the earlier times as the municipal buildings, the cathedrals, the castles, the university buildings, and every other form of construction that the late medieval centuries devoted themselves to. The trouble with those who assume that there was no study of science and practically no attention to nature study in the Middle Ages is that they know nothing at all at first hand about the works of the men who wrote in the medieval period. They have accepted declarations with regard to the absolute dependence of the scholastics on authority, their almost divine worship of Aristotle, their utter readiness to accept authoritative assertions provided they came with the stamp of a mighty name, and then their complete lack of attention to observation and above all to experiment. Nothing could well be more ridiculous than this ignorant assumption of knowledge with regard to the great teachers at the medieval universities. Just as soon as there is definite knowledge of what these great teachers wrote and taught, not only does the previous mood of blame for them for not paying much more attention to science and nature at once disappear, but it gives place to the heartiest admiration for the work of these great thinkers. It is easy to appreciate, then, what Professor Saintsbury said in a recent volume on the thirteenth century: And there have even been in these latter days some graceless ones who have asked whether the science of the nineteenth century after an equal interval will be of any more positive value--whether it will not have even less comparative interest than that which appertains to the scholasticism of the thirteenth. Three men were the great teachers in the medieval universities at their prime. They have been read and studied with interest ever since. They wrote huge tomes, but men have pored over them in every generation. They were Albertus Magnus, the teacher of the other two, Thomas Aquinas and Roger Bacon. All three of them were together at the University of Paris shortly after the middle of the thirteenth century. Anyone who wants to know anything about the attitude of mind of the medieval universities, their professors and students, and of all the intellectual world of the time towards science and observation and experiment, should read the books of these men. Any other mode of getting at any knowledge of the real significance of the science of this time is mere pretence. These constitute the documents behind any scientific history of the development of science at this time. It is extremely interesting to see the attitude of these men with regard to authority. In Albert's tenth book (of his "Summa"), in which he catalogues and describes all the trees, plants, and herbs known in his time, he observes: "All that is here set down is the result of our own experience, or has been borrowed from authors whom we know to have written what their personal experience has confirmed; for in these matters experience alone can be of certainty." In his impressive Latin phrase "_experimentum solum certificat in talibus_." With regard to the study of nature in general he was quite as emphatic. He was a theologian as well as a scientist, yet in his treatise on "The Heavens and the Earth" he declared that "in studying nature we have not to inquire how God the Creator may, as He freely wills, use His creatures to work miracles and thereby show forth His power. We have rather to inquire what nature with its immanent causes can naturally bring to pass."[37] Just as striking quotations on this subject might be made from Roger Bacon. Indeed, Bacon was quite impatient with the scholars around him who talked over-much, did not observe enough, depended to excess on authority, and in general did as mediocre scholars always do, made much fuss on second-hand information--plus some filmy speculations of their own. Friar Bacon, however, had one great pupil whose work he thoroughly appreciated because it exhibited the opposite qualities. This was Petrus--we have come to know him as Peregrinus--whose observations on magnetism have excited so much attention in recent years with the republications of his epistle on the subject. It is really a monograph on magnetism written in the thirteenth century. Roger Bacon's opinion of it and of its author furnishes us the best possible index of his attitude of mind towards observation and experiment in science. I know of only one person who deserves praise for his work in experimental philosophy for he does not care for the discourses of men and their wordy warfare, but quietly and diligently pursues the works of wisdom. Therefore what others grope after blindly, as bats in the evening twilight, this man contemplates in their brilliancy _because he is a master of experiment_. Hence, he knows all of natural science whether pertaining to medicine and alchemy, or to matters celestial or terrestrial. He has worked diligently in the smelting of ores as also in the working of minerals; he is thoroughly acquainted with all sorts of arms and implements used in military service and in hunting, besides which he is skilled in agriculture and in the measurement of lands. It is impossible to write a useful or correct treatise in experimental philosophy without mentioning this man's name. Moreover, he pursues knowledge for its own sake; for if he wished to obtain royal favor, he could easily find sovereigns who would honor and enrich him. Similar expressions might readily be quoted from Thomas Aquinas, but his works are so easy to secure and his whole attitude of mind so well known, that it scarcely seems worth while taking space to do so. Aquinas is still studied very faithfully in many universities, and within the last few years one of his great text-books of philosophy has been replaced in the curriculum of Oxford University, in which it occupied a prominent position in the long ago, as a work that may be offered for examination in the department of philosophy. It is with regard to him particularly that there has been the greatest revulsion of feeling in recent years and a recognition of the fact that here was a great thinker familiar with all that was known in the physical sciences, and who had this knowledge constantly in his mind when he drew his conclusions with regard to philosophical and theological questions. It used to be the fashion to make little of the medieval scholars for the high estimation in which they held Aristotle. Occasionally even yet one hears narrowly educated men, I am sorry to say much more frequently scientific specialists than others, talk deprecatingly of this ardent devotion to Aristotle. No one who knows anything about Aristotle ever indulges in such an exhibition of ignorance of the realities of the history of philosophy and science. To know Aristotle well is to think of him as probably possessed of the greatest human mind that ever existed. We do not need to go back to the Middle Ages to be confirmed in that opinion. Modern scientists who know their science well, but who also know Aristotle well, and who are ardent worshippers at his shrine, are not hard to find. Romanes, the great English biologist of the end of the nineteenth century, said: "It appears to me that there can be no question that Aristotle stands forth not only as the greatest figure in antiquity but as the greatest intellect that has ever appeared upon this earth." Before Romanes, George H. Lewes, in his interesting monograph in the history of thought, "Aristotle, a Chapter in the History of Science," is quite as complimentary to the great Greek thinker. We may say that Lewes was by no means partial to Aristotle. Anything but inclined to accept authority as of value in philosophy, he had been rendered impatient by the fact that so much of the history of philosophy was dominated by Aristotle, and it was only that the panegyric was forced from him by careful study of all that the Stagirite wrote that he said: "History gazed on him with wonder. His intellect was piercing and comprehensive; his attainments surpassed those of every philosopher; his influence has been excelled only by the founders of religion ... his vast and active intelligence for twenty centuries held the world in awe." Professor Osborn, whose scholarly study of the theory of evolution down the ages "From the Greeks to Darwin" rather startled the world of science by showing not only how old was a theory of evolution, but how frequently it had been stated and how many of them anticipated phases of our own thought in the matter, pays a high compliment to the great Greek scientist. He says: "Aristotle clearly states and rejects a theory of the origin of adaptive structures in animals altogether similar to that of Darwin." He then quotes certain passages from Aristotle's "Physics," and says: "These passages seem to contain absolute evidence that Aristotle had substantially the modern conception of the evolution of life, from a primordial, soft mass of living matter to the most perfect forms, and that even in these he believed that evolution was incomplete for they were progressing to higher forms." Modern French scientists are particularly laudatory in their estimation of Aristotle. The group of biologists, Buffon, Cuvier, St. Hilaire, and others who called world attention to French science and its attainments about a century ago, are all of them on record in highest praise of Aristotle. Cuvier said: "I cannot read his work without being ravished with astonishment. It is impossible to conceive how a single man was able to collect and compare the multitude of facts implied in the rules and aphorisms contained in this book." It is possible, however, to get opinions ardently laudatory of Aristotle from the serious students of any nation, provided only they know their Aristotle. Sir William Hamilton, the Scotch philosopher, said: "Aristotle's seal is upon all the sciences, his speculations have determined those of all subsequent thinkers." Hegel, the German philosophic writer, is not less outspoken in his praise: "Aristotle penetrated the whole universe of things and subjected them to intelligence." Kant, who is often said to have influenced our modern thinking more than any other in recent generations, has his compliment for Aristotle. It relates particularly to that branch of philosophy with which Kant had most occupied himself. The Koenigsberg philosopher said: "Logic since Aristotle, like Geometry since Euclid, is a finished science." I do not want to tire you or I could quote many other authorities who proclaim Aristotle the genius of the race. They would include poets like Dante and Goethe, scholars like Cicero and Anthon, literary men like Lessing and Reich and many others. The scholars of the Middle Ages, far from condemnation for their devotion to Aristotle, deserve the highest praise for it. If they had done nothing else but appreciate Aristotle as our greatest modern scholars have done, that of itself would proclaim their profound scholarship. The medieval writers are often said to have been uncritical in their judgment, but in their lofty estimation of Aristotle they displayed the finest possible critical judgment. On the contrary, the generations who made much of the opportunity to minimize medieval scholarship because of its worship at the shrine of Aristotle, must themselves fall under the suspicion at least of either not knowing Aristotle or of not thinking deeply about the subjects with regard to which he wrote. For in all the world's history the rule has been that whenever men have thought deeply about a subject and know what Aristotle has written with regard to that subject, they have the liveliest admiration for the great Greek thinker. This is true for philosophy, logic, metaphysics, politics, ethics, dramatics, but it is also quite as true for physical science. He lacked our knowledge, though not nearly to the degree that is usually thought, and he had a marvellous accumulation of information, but he had a breadth of view and a thoroughness of appreciation with a power of penetration that make his opinions worth while knowing even on scientific subjects in our enlightened age. As for the supposed swearing by Aristotle, in the sense of literally accepting his opinions without daring to examine them critically, which is so constantly asserted to have been the habit of the medieval scholars and teachers, it is extremely difficult in the light of the expressions which we have from them, to understand how this false impression arose. Aristotle they thoroughly respected. They constantly referred to his works, but so has every thinking generation ever since. Whenever he had made a declaration they would not accept the contradiction of it without a good reason, but whenever they had good reasons, Aristotle's opinion was at once rejected without compunction. Albertus Magnus, for instance, said: "Whoever believes that Aristotle was a God must also believe that he never erred, but if we believe that Aristotle was a man, then doubtless he was liable to err just as we are." A number of direct contradictions of Aristotle we have from Albert. A well-known one is that with regard to Aristotle's assertion that lunar rainbows appeared only twice in fifty years. Albert declared that he himself had seen two in a single year. Indeed, it seems very clear that the whole trend of thought among the great teachers of the time was away from the acceptance of scientific conclusions on authority unless there was good evidence for them available. They were quite as impatient as the scientists of our time with the constant putting forward of Aristotle as if that settled a scientific question. Roger Bacon wanted the Pope to forbid the study of Aristotle because his works were leading men astray from the study of science, his authority being looked upon as so great that men did not think for themselves but accepted his assertions. Smaller men are always prone to do this, and indeed it constitutes one of the difficulties in the way of advance in scientific knowledge at all times, as Roger Bacon himself pointed out. These are the sort of expressions that are to be expected from Friar Bacon from what we know of other parts of his work. His "Opus Tertium" was written at the request of Pope Clement IV, because the Pope had heard many interesting accounts of what the great thirteenth-century teacher and experimenter was doing at the University of Oxford, and wished to learn for himself the details of his work. Bacon starts out with the principle that there are four grounds of human ignorance. These are, "first, trust in inadequate authority; second, that force of custom which leads men to accept without properly questioning what has been accepted before their time; third, the placing of confidence in the assertions of the inexperienced; and fourth, the hiding of one's own ignorance behind the parade of superficial knowledge, so that we are afraid to say I do not know." Professor Henry Morley, a careful student of Bacon's writings, said with regard to these expressions of Bacon: No part of that ground has yet been cut away from beneath the feet of students, although six centuries have passed. We still make sheep-walks of second, third and fourth, and fiftieth hand references to authority; still we are the slaves of habit, still we are found following too frequently the untaught crowd, still we flinch from the righteous and wholesome phrase "I do not know" and acquiesce actively in the opinion of others that we know what we appear to know. In his "Opus Majus" Bacon had previously given abundant evidence of his respect for the experimental method. There is a section of this work which bears the title "Scientia Experimentalis." In this Bacon affirms that "without experiment nothing can be adequately known. An argument may prove the correctness of a theory, but does not give the certitude necessary to remove all doubt, nor will the mind repose in the clear view of truth unless it finds its way by means of experiment." To this he later added in his "Opus Tertium": "The strongest argument proves nothing so long as the conclusions are not verified by experience. Experimental science is the queen of sciences, and the goal of all speculation." It is no wonder that Dr. Whewell, in his "History of the Inductive Sciences," should have been unstinted in his praise of Roger Bacon's work and writings. In a well-known passage he says of the "Opus Majus": Roger Bacon's "Opus Majus" is the encyclopedia and "Novum Organon" of the thirteenth century, a work equally wonderful with regard to its wonderful scheme and to the special treatises by which the outlines of the plans are filled up. The professed object of the work is to urge the necessity of a reform in the mode of philosophizing, to set forth the reasons why knowledge had not made greater progress, to draw back attention to the sources of knowledge which had been unwisely neglected, to discover other sources which were yet almost untouched, and to animate men in the undertaking of a prospect of the vast advantages which it offered. In the development of this plan all the leading portions of science are expanded in the most complete shape which they had at that time assumed; and improvements of a very wide and striking kind are proposed in some of the principal branches of study. Even if the work had no leading purposes it would have been highly valuable as a treasure of the most solid knowledge and soundest speculations of the time; even if it had contained no such details it would have been a work most remarkable for its general views and scope. As a matter of fact the universities of the Middle Ages, far from neglecting science, were really scientific universities. Because the universities of the early nineteenth century occupied themselves almost exclusively with languages and especially formed students' minds by means of classical studies, men in our time seem to be prone to think that such linguistic studies formed the main portion of the curriculum of the universities in all the old times and particularly in the Middle Ages. The study of the classic languages, however, came into university life only after the Renaissance. Before that the undergraduates of the universities had occupied themselves almost entirely with science. It was quite as much trouble to introduce linguistic studies into the old universities in the Renaissance time to replace science, as it was to secure room for science by pushing out the classics in the modern time. Indeed the two revolutions in education are strikingly similar when studied in detail. Men who had been brought up on science before the Renaissance were quite sure that that formed the best possible means of developing the mind. In the early nineteenth century men who had been formed on the classics were quite as sure that science could not replace them with any success. There is no pretence that this view of the medieval universities is a new idea in the history of education. Those who have known the old universities at first hand by the study of the actual books of their professors and by familiarity with their courses of study, have not been inclined to make the mistake of thinking that the medieval university neglected science. Professor Huxley in his "Inaugural Address as Rector of Aberdeen University" some thirty years ago stated very definitely his recognition of medieval devotion to science. His words are well worth remembering by all those who are accustomed to think of our time as the first in which the study of science was taken up seriously in our universities. Professor Huxley said: The scholars of the medieval universities seem to have studied grammar, logic, and rhetoric; arithmetic and geometry; astronomy, theology, and music. Thus their work, however imperfect and faulty, judged by modern lights, it may have been, brought them face to face with all the leading aspects of the many-sided mind of man. For these studies did really contain, at any rate in embryo, sometimes it may be in caricature, what we now call philosophy, mathematical and physical science, and art. _And I doubt if the curriculum of any modern university shows so clear and generous a comprehension of what is meant by culture, as this old Trivium and Quadrivium does._ It would be entirely a mistake, however, to think that these great writers and teachers who influenced the medieval universities so deeply and whose works were the text-books of the universities for centuries after, only had the principles of physical and experimental science and did not practically apply them. As a matter of fact their works are full of observation. Once more, the presumption that they wrote only nonsense with regard to science comes from those who do not know their writings at all, while great scientists who have taken the pains to study their works are enthusiastic in praise. Humboldt, for instance, says of Albertus Magnus, after reading some of his works with care: Albertus Magnus is equally active and influential in promoting the study of natural science and of the Aristotelian philosophy. His works contain some exceedingly acute remarks on the organic structure and physiology of plants. One of his works bearing the title of "Liber Cosmographicus De Natura Locorum" is a species of physical geography. I have found in it considerations on the dependence of temperature concurrently on latitude and elevation and on the effect of different angles of the sun's rays in heating the ground which have excited my surprise. It is with regard to physical geography of course that Humboldt is himself a distinguished authority. Humboldt's expression that he found some exceedingly acute remarks on the organic structure and physiology of plants in Albert the Great's writings will prove a great surprise to many people. Meyer, the German historian of botany, however, has re-echoed Humboldt's praise with emphasis. The extraordinary erudition and originality of Albert's treatise on plants drew from Meyer the comment: No botanist who lived before Albert can be compared with him unless Theophrastus, with whom he was not acquainted; and after him none has painted nature in such living colors or studied it so profoundly until the time of Conrad Gessner and Cæsalpino. These men, it may be remarked, come three centuries after Albert's time. A ready idea of Albert's contributions to physical science can be obtained from his life by Sighart, which has been translated into English by Dixon and was published in London in 1870. Pagel, in Puschmann's "History of Medicine," already referred to, gives a list of the books written by Albert on scientific matters with some comments which are eminently suggestive, and furnish solid basis for the remark that I have made, that men's minds were occupied with nearly the same problems in science in the thirteenth century as we are now, while the conclusions they came to were not very different from ours, though reached so long before us. This catalogue of Albertus Magnus' works shows very well his own interest and that of his generation in physical science of all kinds. There were eight treatises on Aristotle's physics and on the underlying principles of natural philosophy and of energy and of movement; four treatises concerning the heavens and the earth, one on physical geography which also contains, according to Pagel, numerous suggestions on ethnography and physiology. There are two treatises on generation and corruption, six books on meteors, five books on minerals, three books on the soul, two books on the intellect, a treatise on nutritives, and then a treatise on the senses and another on the memory and on the imagination. All the phases of the biological sciences were especially favorite subjects of his study. There is a treatise on the motion of animals, a treatise in six books on vegetables and plants, a treatise on breathing things, a treatise on sleep and waking, a treatise on youth and old age, and a treatise on life and death. His treatise on minerals contains, according to Pagel, a description of ninety-five different kinds of precious stones. Albert's volumes on plants were reproduced with Meyer, the German botanist, as editor (Berlin, 1867). All of Albert's books are available in modern editions. Pagel says of Albertus that His profound scholarship, his boundless industry, the almost incontrollable impulse of his mind after universality of knowledge, the many-sidedness of his literary productivity, and finally the almost universal recognition which he received from his contemporaries and succeeding generations, stamp him as one of the most imposing characters and one of the most wonderful phenomena of the Middle Ages. In another passage Pagel has said: While Albert was a Churchman and an ardent devotee of Aristotle, in matters of natural phenomena he was relatively unprejudiced and presented an open mind. He thought that he must follow Hippocrates and Galen, rather than Aristotle and Augustine, in medicine and in the natural sciences. We must concede it a special subject of praise for Albert that he distinguished very strictly between natural and supernatural phenomena. The former he considered as entirely the object of the investigation of nature. The latter he handed over to the realm of metaphysics. Roger Bacon is, however, the one of these three great teachers who shows us how thoroughly practical was the scientific knowledge of the universities and how much it led to important useful discoveries in applied science and to anticipations of what is most novel even in our present-day sciences. Some of these indeed are so startling, that only that we know them not by tradition but from his works, where they may be readily found without any doubt of their authenticity, we should be sure to think that they must be the result of later commentators' ideas. Bacon was very much interested in astronomy, and not only suggested the correction of the calendar, but also a method by which it could be kept from wandering away from the actual date thereafter. He discovered many of the properties of lenses and is said to have invented spectacles and announced very emphatically that light did not travel instantaneously but moved with a definite velocity. He is sometimes said to have invented gunpowder, but of course he did not, though he studied this substance in various forms very carefully and drew a number of conclusions in his observations. He was sure that some time or other man would learn to control the energies exhibited by explosives and that then he would be able to accomplish many things that seemed quite impossible under present conditions. He said, for instance: Art can construct instruments of navigation, such that the largest vessels governed by a single man will traverse rivers and seas more rapidly than if they were filled with oarsmen. One may also make carriages which without the aid of any animal will run with remarkable swiftness. In these days when the automobile is with us and when the principal source of energy for motor purposes is derived from explosives of various kinds, this expression of Roger Bacon represents a prophecy marvellously surprising in its fulfilment. It is no wonder that the book whence it comes bears the title "De Secretis Artis et Naturæ." Roger Bacon even went to the extent, however, of declaring that man would some time be able to fly. He was even sure that with sufficient pains he could himself construct a flying machine. He did not expect to use explosives for his motor power, however, but thought that a windlass properly arranged, worked by hand, might enable a man to make sufficient movement to carry himself aloft or at least to support himself in the air, if there were enough surface to enable him to use his lifting power to advantage. He was in intimate relations by letter with many other distinguished inventors and investigators besides Peregrinus and was a source of incentive and encouragement to them all. The more one knows of Aquinas the more surprise there is at his anticipation of many modern scientific ideas. At the conclusion of a course on cosmology delivered at the University of Paris he said that "nothing at all would ever be reduced to nothingness" (_nihil omnino in nihilum redigetur_). He was teaching the doctrine that man could not destroy matter and God would not annihilate it. In other words, he was teaching the indestructibility of matter even more emphatically than we do. He saw the many changes that take place in material substances around us, but he taught that these were only changes of form and not substantial changes and that the same amount of matter always remained in the world. At the same time he was teaching that the forms in matter by which he meant the combinations of energies which distinguish the various kinds of matter are not destroyed. In other words, he was anticipating not vaguely, but very clearly and definitely, the conservation of energy. His teaching with regard to the composition of matter was very like that now held by physicists. He declared that matter was composed of two principles, prime matter and form. By _forma_ he meant the dynamic element in matter, while by _materia prima_ he meant the underlying substratum of material, the same in every substance, but differentiated by the dynamics of matter. It used to be the custom to make fun of these medieval scientists for believing in the transmutation of metals. It may be said that all three of these greatest teachers did not hold the doctrine of the transmutation of metals in the exaggerated way in which it appealed to many of their contemporaries. The theory of matter and form, however, gave a philosophical basis for the idea that one kind of matter might be changed into another. We no longer think that notion absurd. Sir William Ramsay has actually succeeded in changing one element into another and radium and helium are seen changing into each other, until now we are quite ready to think of transmutation placidly. The Philosopher's Stone used to seem a great absurdity until our recent experience with radium, which is to some extent at least the philosopher's stone, since it brings about the change of certain supposed elements into others. A distinguished American chemist said not long ago that he would like to extract all the silver from a large body of lead ore in which it occurs so commonly, and then come back after twenty years and look for further traces of silver, for he felt sure that they would be found and that lead ore is probably always producing silver in small quantities and copper ore is producing gold. Most people will be inclined to ask where the fruits of this undergraduate teaching of science are to be found. They are inclined to presume that science was a closed book to the men and women of that time. It is not hard, however, to point the effect of the scientific training in the writings of the times. Dante is a typical university man of the period. He was at several Italian universities, was at Paris and perhaps at Oxford. His writings are full of science. Professor Kühns, of Wesleyan, in his book "The Treatment of Nature in Dante," has pointed out how much Dante knows of science and of nature. Few of the poets not only of his own but of any time have known more. There are only one or two writers of poetry in our time who go with so much confidence to nature and the scientific interpretation of her for figures for their poetry. The astronomy, the botany, the zoölogy of Albertus Magnus and Thomas Aquinas, Dante knew very well and used confidently for figurative purposes. Anyone who is inclined to think nature study a new idea in the world forgets, or has never known, his Dante. The birds and the bees, the flowers, the leaves, the varied aspects of clouds and sea, the phenomena of phosphorescence, the intimate habits of bird and beast and the ways of the plants, as well as all the appearances of the heavens, Dante knew very well and in a detail that is quite surprising when we recall how little nature study is supposed to have attracted the men of his time. Only that his readers appreciated it all, Dante would surely not have used his scientific erudition so constantly. So much for the undergraduate department of the universities of the Middle Ages, and the view is absolutely fair, for these were the men to whom the students flocked by thousands. They were teaching science, not literature. They were discussing physics as well as metaphysics, psychology in its phenomena as well as philosophy, observation and experiment as well as logic, the ethical sciences, economics, practically all the scientific ideas that were needed in their generation--and that generation saw the rise of the universities, the finishing of the cathedrals, the building of magnificent town halls and castles and beautiful municipal buildings of many kinds, including hospitals, the development of the Hansa League in commerce, and of wonderful manufacturers of all the textiles, the arts and crafts, as well as the most beautiful book-making and art and literature. We could be quite sure that the men who solved all the other problems so well could not have been absurd only in their treatment of science. Anyone who reads their books will be quite sure of that. While most people might be ready, then, to confess that possibly Huxley was not mistaken with regard to the undergraduate department of the universities, most of them would feel sure that at least the graduate departments were sadly deficient in accomplishment. Once more this is entirely an assumption. The facts are all against any such idea. There were three graduate departments in most of the universities--theology, law, and medicine. While physical scientists are usually not cognizant of it apparently, theology is a science, a department of knowledge developed scientifically, and most of these medieval universities did more for its scientific development than the schools of any other period. Quite as much may be said for philosophy, for there are many who hesitate to attribute any scientific quality to modern developments in the matter. As for law, this is the great period of the foundation of scientific law development; the English common law was formulated by Bracton, the deep foundations of basic French and Spanish law were laid, and canon law acquired a definite scientific character which it was always to retain. All this was accomplished almost entirely by the professors in the law departments of the universities. It was in medicine, however, where most people would be quite sure without any more ado that nothing worth while talking about was being done, that the great triumphs of graduate teaching at the medieval universities were secured. Here more than anywhere else is there room for supreme surprise at the quite unheard-of anticipations of our modern medicine and, stranger still, as it may seem, of our modern surgery. The law regulating the practice of medicine in the Two Sicilies about the middle of the thirteenth century shows us the high standard of medical education. Students were required to have three years of preliminary study at the university, four years in the medical department, and then practise for a year with a physician before they were allowed to practise for themselves. If they wanted to practise surgery, an extra year in the study of anatomy was required. I published the text of this law, which was issued by the Emperor Frederick II about 1241, in the _Journal of the American Medical Association_ three years ago. It also regulated the practice of pharmacy. Drugs were manufactured under the inspection of the government and there was a heavy penalty for substitution, or for the sale of old inert drugs, or improperly prepared pharmaceutical materials. If the government inspector violated his obligations as to the oversight of drug preparations the penalty was death. Nor was this law of the Emperor Frederick an exception. We have the charters of a number of medical schools issued by the Popes during the next century, all of which require seven years or more of university study, four of them in the medical department, before the doctor's degree could be obtained. When new medical schools were founded they had to have professors from certain well-recognized schools on their staff at the beginning in order to assure proper standards of teaching, and all examinations were conducted under oath-bound secrecy and with the heaviest obligations on professors to be assured of the knowledge of students before allowing them to pass. It might be easy to think, and many people are prone to do so, that in spite of the long years of study required there was really very little to study in medicine at that time. Those who think so should read Professor Clifford Allbutt's address on the "Historical Relations of Medicine and Surgery" delivered at the World's Fair at St. Louis in 1904. He has dwelt more on surgery than on medicine, but he makes it very clear that he considers that the thinking professors of medicine of the later Middle Ages were doing quite as serious work in their way as any that has been done since. They were carefully studying cases and writing case histories, they were teaching at the bedside, they were making valuable observations, and they were using the means at their command to the best advantage. Of course there are many absurdities in their therapeutics, but then we must not forget there have always been many absurdities in therapeutics and that we are not free from them in our day. Professor Richet, at the University of Paris, said not long ago: "The therapeutics of any generation is quite absurd to the second succeeding generation." We shall not blame the medieval generations for having accepted remedies that afterwards proved inert, for every generation has done that, even our own. Their study of medicine was not without lasting accomplishment, however. They laid down the indications and the dosage for opium. They used iron with success, they tried out many of the bitter tonics among the herbal medicines, and they used laxatives and purgatives to good advantage. Down at Montpellier, Gilbert, the Englishman, suggested red light for smallpox because it shortened the fever, lessened the lesions, and made the disfigurement much less. Finsen was given the Nobel prize partly for re-discovery of this. They segregated erysipelas and so prevented its spread. They recognized the contagiousness of leprosy, and though it was probably as widespread as tuberculosis is at the present time, they succeeded not only in controlling but in eventually obliterating it throughout Europe. It was in surgery, however, that the greatest triumphs of teaching of the medieval universities were secured. Most people are inclined to think that surgery developed only in our day. The great surgeons of the thirteenth and fourteenth centuries, however, anticipated most of our teaching. They investigated the causes of the failure of healing by first intention, recognized the danger of wounds of the neck, differentiated the venereal diseases, described rabies, and knew much of blood poisoning, and operated very skilfully. We have their text-books of surgery and they are a never-ending source of surprise. They operated on the brain, on the thorax, on the abdominal cavity, and did not hesitate to do most of the operations that modern surgeons do. They operated for hernia by the radical cure, though Mondeville suggested that more people were operated on for hernia for the benefit of the doctor's pocket than for the benefit of the patient. Guy de Chauliac declared that in wounds of the intestines patients would die unless the intestinal lacerations were sewed up, and he described the method of suture and invented a needle holder. We have many wonderful instruments from these early days preserved in pictures at least, that show us how much modern advance is merely re-invention. They understood the principles of aseptic surgery very well. They declared that it was not necessary "that pus should be generated in wounds." Professor Clifford Allbutt says: They washed the wound with wine, scrupulously removing every foreign particle; then they brought the edges together, not allowing wine or anything else to remain within--dry adhesive surfaces were their desire. Nature, they said, produces the means of union in a viscous exudation, or natural balm, as it was afterwards called by Paracelsus, Paré, and Wurtz. In older wounds they did their best to obtain union by cleansing, desiccation, and refreshing of the edges. Upon the outer surface they laid only lint steeped in wine. Powders they regarded as too desiccating, for powder shuts in decomposing matters; wine after washing, purifying, and drying the raw surfaces evaporates. Almost needless to say these are exactly the principles of aseptic surgery. The wine was the best antiseptic that they could use and we still use alcohol in certain cases. It would seem to many quite impossible that such operations as are described could have been done without anæsthetics, but they were not done without anæsthetics. There were two or three different forms of anæsthesia used during the thirteenth and fourteenth centuries. One method employed by Ugo da Lucca consisted of the use of an inhalant. We do not know what the material employed was. There are definite records, however, of its rather frequent employment. What a different picture of science at the medieval universities all this makes from what we have been accustomed to hear and read with regard to them. It is difficult to understand where the old false impressions came from. The picture of university work that recent historical research has given us shows us professors and students busy with science in every department, making magnificent advances, many of which were afterwards forgotten, or at least allowed to lapse into desuetude. The positive assertions with regard to old-time ignorance were all made in the course of religious controversy. In English-speaking countries particularly it became a definite purpose to represent the old Church as very much opposed to education of all kinds and above all to scientific education. There is not a trace of that to be found anywhere, but there were many documents that were appealed to to confirm the protestant view. There was a Papal bull, for instance, said to forbid dissection. When read it proves to forbid the cutting up of bodies to carry them to a distance for burial, an abuse which caused the spread of disease, and was properly prohibited. The Church prohibition was international and therefore effective. At the time the bull was issued there were twenty medical schools doing dissection in Italy and they continued to practise it quite undisturbed during succeeding centuries. The Papal physicians were among the greatest dissectors. Dissections were done at Rome and the cardinals attended them. Bologna at the height of its fame was in the Papal States. All this has been ignored and the supposed bull against anatomy emphasized as representing the keynote of medical and surgical history. Then there was a Papal decree forbidding the making of gold and silver. This was said to forbid chemistry or alchemy and so prevent scientific progress. The history of the medical schools of the time shows that it did no such thing. The great alchemists of the time doing really scientific work were all clergymen, many of them very prominent ecclesiastics. Just in the same way there were said to be decrees of the Church councils forbidding the practice of surgery. President White says in his "Warfare of Science with Theology in Christendom," that, as a consequence of these, surgery was in dishonor until the Emperor Wenceslaus, at the beginning of the fifteenth century, ordered that it should be restored to estimation. As a matter of fact, during the two centuries immediately preceding the first years of the fifteenth century, surgery developed very wonderfully, and we have probably the most successful period in all the history of surgery except possibly our own. The decrees forbade monks to practise surgery because it led to certain abuses. Those who found these decrees and wanted to believe that they prevented all surgical development simply quoted them and assumed there was no surgery. The history of surgery at this time is one of the most wonderful chapters in human progress. The more we know of the Middle Ages the more do we realize how much they accomplished in every department of intellectual effort. Their development of the arts and crafts has never been equalled in the modern time. They made very great literature, marvellous architecture, sculpture that rivals the Greeks', painting that is still the model for our artists, surpassing illuminations; everything that they touched became so beautiful as to be a model for all the after time. They accomplished as much in education as they did in all the other arts, their universities had more students than any that have existed down to our own time, and they were enthusiastic students and their professors were ardent teachers, writers, observers, investigators. While we have been accustomed to think of them as neglecting science, their minds were occupied entirely with science. They succeeded in anticipating much more of our modern thought, and even scientific progress, than we have had any idea until comparatively recent years. The work of the later Middle Ages in mathematics is particularly strong, and was the incentive for many succeeding generations. Roger Bacon insisted that, without mathematics, there was no possibility of real advance in physical science. They had the right ideas in every way. While they were occupied more with the philosophical and ethical sciences than we are, these were never pursued to the neglect of the physical sciences in the strictest sense of that term. Is it not time that we should drop the foolish notions that are very commonly held because we know nothing about the Middle Ages--and, therefore, the more easily assume great knowledge--and get back to appreciate the really marvellous details of educational and scientific development which are so interesting and of so much significance at this time? APPENDIX III MEDIEVAL POPULARIZATION OF SCIENCE The idea of collecting general information from many sources, of bringing it together into an easily available form, so as to save others labor, of writing it out in compendious fashion, so that it could readily pass from hand to hand, is likely to be considered typically modern. As a matter of fact, the Middle Ages furnish us with many examples of the popularization of science, of the writing of compendia of various kinds, of the gathering of information to save others the trouble, and, above all, of the making of what, in the modern time, we would call encyclopedias. Handbooks of various kinds were issued, manuals for students and specialists, and many men of broad scholarship in their time devoted themselves to the task of making the acquisition of knowledge easy for others. This was true not only for history and philosophy and literature, but also for science. It is not hard to find in each century of the Middle Ages some distinguished writer who devoted himself to this purpose, and for the sake of the light that it throws on these scholars, and the desire for information that must have existed very commonly since they were tempted to do the work, it seems worth while to mention here their names, and those of the books they wrote, with something of their significance, though the space will not permit us to give here much more than a brief _catalogue raisonné_ of such works. Very probably the first who should be mentioned in the list is Boëthius, who flourished in the early part of the sixth century. He owed much of his education to his adoptive father, afterwards his father-in-law, Symmachus, who, with Festus, represented scholarship at the court of the Gothic King, Theodoric of Verona. These three--Festus, Symmachus, and Boëthius--brought such a reputation for knowledge to the court that they are responsible for many of the wonderful legends of Dietrich of Bern, as Theodoric came to be called in the poems of the medieval German poets. The three distinguished and devoted scholars did much to save Greek culture at a time when its extinction was threatened, and Boëthius particularly left a series of writings that are truly encyclopedic in character. There are five books on music, two on arithmetic, one on geometry, translations of Aristotle's treatises on logic, with commentaries; of Porphyry's "Isagoge," with commentaries, and a commentary on Cicero's "Topica." Besides, he wrote several treatises in logic and rhetoric himself, one on the use of the syllogism, and one on topics, and in addition a series of theological works. His great "Consolations of Philosophy" was probably the most read book in the early Middle Ages. It was translated into Anglo-Saxon by King Alfred, into old German by Notker Teutonicus, the German monk of St. Gall, and its influence may be traced in Beowulf, in Chaucer, in High German poetry, in Anglo-Norman and Provençal popular poetry, and also in early Italian verse. Above all, the "Divine Comedy" has many references to it, while the "Convito" would seem to show that it was probably the book that most influenced Dante. Though it is impossible to confirm by documentary evidence the generally accepted idea that Boëthius died a martyr for Christianity, the tradition can be traced so far back, and it has been so generally accepted that this seems surely to have been the case. The fact is interesting, as showing the attitude of scholars towards the Church and of the Church towards scholarship thus early. The next great name in the tradition should probably be that of Cassiodorus, the Roman writer and statesman, prime minister of Theodoric, who, after a busy political life, retired to his estate at Vivarium, and, in imitation of St. Benedict, who had recently established a monastery at Monte Cassino, founded a monastery there. He is said to have lived to the age of ninety-three. His retirement favored this long life, for, after the death of Theodoric, troublous times came, and civil war, and only his monastic privileges saved him from the storm and stress of the times. He had been interested in literature and the collection of information of many kinds before his retirement, and it is not unlikely that his recognition of the fact that the monastic life offered opportunities for the pursuit of this, under favorable circumstances, led him to take it up. While still a statesman he wrote a series of works relating to history and politics and public affairs generally. These consisted mainly of chronicles and panegyrics, and twelve books of miscellanies called Variæ. After his retirement to the monastery, a period of ardent devotion to writing begins, and a great number of books were issued. He evidently gathered round him a number of men whom he inspired with his spirit, or, perhaps, selected, because he found that, while they had a taste for a quiet, peaceful spiritual life, they were also devoted to the accumulation and diffusion of knowledge. A series of commentaries on portions of the Scriptures was written, the Jewish antiquities of Josephus translated, and the ecclesiastical histories of Theodoric, Sozomen, and Socrates made available in Latin. Cassiodorus himself is said to have made a compendium of these, called the "Historia Tripartita," which was much used as a manual of history during succeeding centuries. Then there were treatises on grammar, on orthography, and a series of works on mathematics. In all of his writings Cassiodorus shows a special fondness for the symbolism of numbers. There is a well-grounded tradition that he insisted on the study of the Greek classics of medical literature, especially Hippocrates and Galen, and awakened the interest of the monks in the necessity for making copies of these fathers of medicine. The tradition that he established at Vivarium is also found to have existed at Monte Cassino among the Benedictines, and, doubtless, to this is to be attributed the foundation of the medical school of Salerno, where Benedictine influence was so strong. It is probable, therefore, that to Cassiodorus must be attributed the preservation in as perfect a state as we have them of the old Greek medical writers. His main idea was, of course, the study of Scriptures, but with just as many helps as possible. He thought that commentators, and historians, not alone Christian, but also Hebrew and Pagan, should be studied to illustrate it, and then the commentaries of the Latin fathers, so that a thoroughly rounded knowledge of it should be obtained. He thus began an "Encyclopedia Biblica," and set a host of workers at its accomplishment. Every country in Europe shared this movement for the diffusion of information during the early Middle Ages, and the works of men from each of these countries in succeeding centuries has come down to us, preserved in spite of all the vicissitudes to which they were so liable during the centuries before the invention of printing and the easy multiplication of books. To many people it will seem surprising to learn that the next evidence of deep broad interest in knowledge is to be found in the next century in the distant west of Europe, in the Spanish Peninsula. It is a long step from the semi-barbaric splendor of the Gothic court at Verona, to the bishop's palace in Seville in Andalusia. The two cities are separated by what is no inconsiderable distance in our day. In the seventh century they must have seemed almost at the other end of the world from each other. Those who recall what we have insisted on in several portions of the body of this work with regard to the high place Spanish genius won for itself in the Roman Empire, and how much of culture among the Spaniards of that time the occurrence of so many important writers of that nationality must imply, will not be surprised at the distinguished work of a great Christian Spanish writer of the seventh century. Indeed, it would be only what might be expected for evidences of early awakening of the broadest culture to be found in Spain. The important name in the popularization of science in the seventh century is St. Isidore of Seville. He made a compendium of all the scattered scientific traditions and information of his time with regard to natural phenomena in a sort of encyclopedia of science. This consisted of twenty books--chapters we would call them now--treating almost _de omni re scibili et quibusdam aliis_ (everything knowable and a few other things besides). It is possible that the work may have been written by a number of collaborators under the patronage of the bishop, though there is no sure indication of this to be found either in the volume itself or even contemporary history. All the ordinary scientific subjects are treated. Astronomy, geography, mineralogy, botany, and even man and the animals have each a special chapter. Pouchet, in his "History of the Natural Sciences During the Middle Ages," calls attention to the fact that, in grouping the animals for collective treatment in the different chapters, sometimes the most heterogeneous creatures are brought under a common heading. Among the fishes, for instance, are classed all living things that are found in water. The whale and the dolphin, as well as sponges, and oysters, and crocodiles, and sea serpents, and lobsters, and hippopotamuses, all find a place together, because of the common watery habitation. The early Spanish Churchman would seem to have had an enthusiastic zeal for complete classification that would surely have made him a strenuous modern zoölogist. The next link in the tradition of encyclopedic work is the Venerable Bede, whose character was more fully honored by the decree on November 13, 1899, by Pope Leo XIII declaring him a Doctor of the Church. Bede was the fruit of that ardent scholarship which had risen in England as a consequence of the introduction of Christianity. It had been fostered by the coming of scholar saints from Ireland, but was, unfortunately, disturbed by the incursions of the Danes. While Bede is known for his greatest work, the "Ecclesiastical History of the English People," which gives an account of Christianity in England from its beginning until his own day, he wrote many other works. His history is the foundation of all our knowledge of early British history, secular as well as religious, and has been praised by historical writers of all ages, who turned to it for help with confidence. He wrote a number of other historical works. Besides, he wrote books on grammar, orthography, the metrical art, on rhetoric, on the nature of things, the seasons, and on the calculation of the seasons. These latter books are distinctly scientific. His contributions to Gregorian Music are now of great value. After this, Alcuin and the monks, summoned by Charlemagne, take up the tradition of gathering and diffusing information, and the great monasteries of Tours, Fulda, and St. Gall carry it on. Besides these, in the ninth century Monte Cassino comes into prominence as an institution where much was done of what we would now call encyclopedic work. After his retirement from Salerno Constantine Africanus made his translations and commentaries on Arabian medicine, constituting what was really a medical encyclopedia of information not readily available at that time. After this, of course, the tradition is taken up by the universities, and it is only when, with the thirteenth century, there came the complete development of the university spirit, that encyclopedias reached their modern expression. Three great encyclopedists, Vincent of Beauvais, Thomas of Cantimprato, and Bartholomæus Anglicus, are the most famous. Vincent consulted all the authors sacred and profane that he could lay hold on, and the number was, indeed, prodigious. I have given some account of him in "The Thirteenth Greatest of Centuries" (Catholic Summer School Press, New York, third edition, 1910). It would be very easy to conclude that these encyclopedias, written by clergymen for the general information of the educated people of the times, contain very little that is scientifically valuable, and probably nothing of serious medical significance. Any such thought is, however, due entirely to unfamiliarity with the contents of these works. They undoubtedly contain absurdities, they are often full of misinformation, they repeat stories on dubious authority, and sometimes on hearsay, but usually the source of their information is stated, and especially where it is dubious, as if they did not care to state marvels without due support. Books of popular information, however, have always had many queer things,--queer, that is, to subsequent generations,--and it is rather amusing to pick up an encyclopedia of a century ago, much less a millennium ago, and see how many absurd things were accepted as true. The first edition of the "Encyclopedia Britannica," issued one hundred and fifty years ago, furnishes an easily available source of the absurdities our more recent forefathers accepted. The men of the Middle Ages, however, were much better observers as a rule, and used much more critical judgment, according to their lights, than we have given them credit for. Often the information that they have to convey is not only valuable, but well digested, thoroughly practical, and sometimes a marvellous anticipation of some of our most modern thoughts. There is one of these encyclopedias which, because it was written in my favorite thirteenth century, I have read with some care. It is simply a development of the work of preceding clerical encyclopedists, and often refers to them. Because it contains some typical examples of the better sorts of information in these works, I have thought it worth while to quote two passages from it. The author is Bartholomæus Anglicus, and the quaint English in which it is couched is quoted from "Medical Lore" (London, 1893). The book is all the more interesting because in a dear old English version, issued about 1540, the spellings of which are among the great curiosities of English orthography, it was often read and consulted by Shakespeare, who evidently quotes from it frequently, for not a little of the quaint scientific lore that he uses for his figures can be traced to expressions used in this book. The first of the paragraphs that deserves to be quoted, discusses madness, or, as we would call it, lunacy, and sums up the causes, the symptoms, and the treatment quite as well as that has ever been done in the same amount of space: Madness cometh sometime of passions of the soul, as of business and of great thoughts, of sorrow and of too great study, and of dread: sometime of the biting of a wood hound, or some other venomous beast; sometime of melancholy meats, and sometime of drink of strong wine. And as the causes be diverse, the tokens and signs be diverse. For some cry and leap and hurt and wound themselves and other men, and darken and hide themselves in privy and secret places. The medicine of them is, that they be bound, that they hurt not themselves and other men. And namely, such shall be refreshed, and comforted, and withdrawn from cause and matter of dread and busy thoughts. And they must be gladded with instruments of music, and some deal be occupied.' The second discusses in almost as thorough a way the result of the bite of a mad dog. The old English word for mad, wood, is constantly used. The causes, the symptoms, and course of the disease, and its possible prevention by early treatment, are all discussed. The old tradition was already in existence that sufferers from rabies or hydrophobia, as it is called, dreaded water, when it is really only because the spasm consequent upon the thought even of swallowing is painful that they turn from it. That tradition has continued to be very commonly accepted even by physicians down to our own day, so that Bartholomew, the Englishman, in the thirteenth century, will not be blamed much for setting it forth for popular information in his time some seven centuries ago. The idea that free bleeding would bring about the removal of the virus is interesting, because we have in recent years insisted in the case of the very similar disease, tetanus, on allowing or deliberately causing wounds in which the tetanus microbe may have gained an entrance, to bleed freely. The biting of a wood hound is deadly and venomous. And such venom is perilous. For it is long hidden and unknown, and increaseth and multiplieth itself, and is sometimes unknown to the year's end, and then the same day and hour of the biting, it cometh to the head, and breedeth frenzy. They that are bitten of a wood hound have in their sleep dreadful sights, and are fearful, astonied, and wroth without cause. And they dread to be seen of other men, and bark as hounds, and they dread water most of all things, and are afeared thereof full sore and squeamous also. Against the biting of a wood hound wise men and ready use to make the wounds bleed with fire or with iron, that the venom may come out with the blood, that cometh out of the wound. FOOTNOTES: [Footnote 1: "Medicinisches aus der Aeltesten Kirchen Geschichte." Leipzig, 1892.] [Footnote 2: Foulis, London and Edinburgh, 1910.] [Footnote 3: My attention was called to the interesting story of the Jewish physicians of the Middle Ages and their scientific accomplishment while writing the article on Joseph Hyrtl for the Catholic Encyclopedia. His "Das Arabische und Hebräische in der Anatomie" (Wien, 1879) has some interestingly suggestive material on these important chapters of the history of medicine. (I owe my opportunity to consult it to the courtesy of the Surgeon-General's library.) Biographic material has been obtained from Carmoly's "History of the Jewish Physicians," translated by Dr. Dunbar for the _Maryland Medical and Surgical Journal_, some extra copies of which were printed by John Murphy and Co., Baltimore, about the middle of the nineteenth century. Baas and Haeser's Histories of Medicine and Puschmann and Pagel's "Handbook" provided additional material, and I have found Landau's "Geschichte der Jüdischen Aerzte" (Berlin, 1895) of great service.] [Footnote 4: Of course there are many absurd things recommended in the Talmud. We cannot remind ourselves too often, however, that there have been absurd things at all times in medicine, and especially in therapeutics. It is curious how often some of these absurdities have repeated themselves. We are liable to think it very queer that men should have presumed, or somehow jumped to the conclusion, that portions of animals might possess wonderful virtue for the healing of diseases of the corresponding special parts of man. We ourselves, however, within a little more than a decade, had a phase of opotherapy--how much less absurd it seems under that high-sounding Greek term--that was apparently very learned in its scientific aspects yet quite as absurd as many phases of old-time therapy, as we look at it. We administered cardin for heart disease and nephrin for kidney trouble, cerebrin for insanity (save the mark!), and even prostate tissue for prostatism--and with reported good results! How many of us realize now that in this we were only repeating the absurdities, so often made fun of in old medicine, with regard to animal tissue and excrement therapeutics? The Talmud has many conclusions with regard to the symptoms of patients drawn from dreams; as, for instance, it is said to be a certain sign of sanguineous plethora when one dreams of the comb of a cock. One phase of our psycho-analysis in the modern time, however, has taken us back to an interpretation of dreams different of course from this, yet analogous enough to be quite striking.] [Footnote 5: "Maimonides," by David Yellin and Israel Abrahams, Philadelphia, 1903.] [Footnote 6: "Das Arabische und Hebräische in der Anatomie," Dr. Joseph Hyrtl, Wien, 1879.] [Footnote 7: "Anat. Antiq. Rariores," Vienna, 1835.] [Footnote 8: It seems hard to understand how so useful an auxiliary to the surgeon as the ligature,--it seems indispensable to us,--could possibly be allowed to go out of use and even be forgotten. It will not be difficult, however, for anyone who recalls the conditions that obtained in old-time surgery. The ligature is a most satisfying immediate resource in stopping bleeding from an artery, but a septic ligature inevitably causes suppuration and almost inevitably leads to secondary hemorrhage. In the old days of septic surgery secondary hemorrhage was the surgeon's greatest and most dreaded bane. Some time from the fifth to the ninth day a septic ligature came away under conditions such that inflammatory disturbance had prevented sealing of the vessel. If the vessel was large, then the hemorrhage was fast and furious and the patient died in a few minutes. After a surgeon had had a few deaths of this kind he dreaded the ligature. He abandoned its use and took kindly to such methods as the actual cautery, red-hot knives for amputations, and the like, that would sear the surfaces of tissues and the blood-vessels, and not give rise to secondary hemorrhage. A little later, however, someone not familiar with secondary risks would reinvent the ligature. If he were cleanly in his methods and, above all, if he were doing his work in a new hospital, the ligature worked very well for a while. If not, it soon fell into innocuous desuetude again.] [Footnote 9: Puschmann: "Handbuch der Geschichte der Medizin," Vol. I, page 652.] [Footnote 10: The first dentist who filled teeth with amalgam in New York, some eighty years ago, had to flee for his life, because of a hue and cry set up that he was poisoning his patients with mercury.] [Footnote 11: "Storia de la Scuola di Salerno."] [Footnote 12: It is probably interesting to note that the word _universitas_ as used here has no reference to our word university, but refers to the whole world of students as it were. In the Middle Ages universities were called _studia generalia_, general studies--that is, places where everything could be studied and where everyone from any part of the world could study. Our use of the word university in the special modern sense of the term comes from the formal mode of address to the faculty of a university when Popes or rulers sent them authoritative documents. Such documents began with the expression _Universitas vestra_, all of you (in the old-time English, as preserved in the Irish expression, "the whole of ye"), referring to all the members of the faculty. The transfer to our term and signification university was not difficult.] [Footnote 13: Physicians wore a particular garb consisting of a cloak and often a mask, supposed to protect them from infections at this time, so that it was not difficult to make a characteristic picture as a sign for a pharmacy. These symbolic signs were much commoner and very necessary when people generally were not able to read. It is from that period that we have the mortar and pestle as also the colored lights in the windows of the drug stores, and the many-colored barber-pole. Also the big boot, key, watch, hat, bonnet, and the like, the last symbolic sign invention apparently being the wooden Indian for the tobacco store.] [Footnote 14: _The Medical Library and Historical Journal_, Brooklyn, December, 1906.] [Footnote 15: Taddeo, who was born in 1215, according to our usually accepted traditions in the matter, would have been seventy-five years of age when Mondino as a youth of scarcely more than fifteen went to the University. It might seem that so old a man would have very little influence over the young man. Taddeo, however, had, as we have said, a very strenuous old age. Everything in life had come to him late. He was well past thirty before he began to study philosophy and medicine, having been a seller of candles from necessity because of poverty in his younger years. His great success in practice came when he was past forty. He first began to teach when he was forty-five, and he was nearly fifty-five before he began to write. According to tradition he married when he was nearly eighty--whether for the first or second time is not said--and while this might be considered, and would in some cases be, an indication of weakness of character (it would probably depend on whether he married or was married), it seems in his case to have indicated a vigor of body and character which shows very clearly how great was the possibility of his influence as a teacher having been maintained even up to this late time of life, and thus influencing a pupil who is to represent the most potent influence at the beginning of the next century.] [Footnote 16: _Medical Library and Historical Journal_, 1906.] [Footnote 17: Pilcher (_loc. cit._) tells of her tomb. I venture to change his translation of the inscription in certain unimportant particulars. He says: "We know the very place where she was buried in front of the Madonna delle Lettre in the Church of San Pietro e Marcellino of the Hospital of Santa Maria de Mareto, where her associate, Agenio, mourning and inconsolable, placed a tablet with this inscription: D . O . M . Vrceo . Contenti Alexandrae . Galinae . Pvellae . Persicetanae Penicillo . Egregiae . Ad . Anatomen . Exhibendam Et . Insignissimi . Medici . Mundini . Lucii Paucis . Comparandae . Discipulae . Cineres Carnis . Hic . Expectant . Resurrectionem Vixit . Ann . XIX . Obiit . Studio . Absunta Die XXVI Martii . A . S . MCCCXXVI Otto . Agenius . Lustrulanus . Ob . Eam . Demptam Sui . Potiori . Parte . Spoliatus . Sodali . Eximiae Ac . De . Se . Optime . Meritae . Inconsolabilis . M . P . This inscription may be translated as follows: In this urn enclosed The ashes of the body of Alexandra Giliani, a maiden of Periceto; Skilful with her brush in anatomical demonstrations And a disciple equalled by few, Of the most noted physician, Mundinus of Luzzi, Await the resurrection. She lived 19 years: she died consumed by her labors March 26, in the year of grace 1326. Otto Agenius Lustrulanus, by her taking away Deprived of his better part, his excellent companion, Deserving of the best, Has erected this tablet." ] [Footnote 18: This is so striking that I quote their actual words from Gurlt, p. 704: "_Multoties fit percussio in anteriori parte cranei et craneum in parte frangitur contraria._"] [Footnote 19: "Historical Relations of Medicine and Surgery Down to the Sixteenth Century," London, 1904.] [Footnote 20: Of course, for any extended knowledge of Mondeville, a modern reader must turn to Nicaise's translation of his "Chirurgia," which, with an introduction and a biography, was published at Paris in 1893. Nicaise's publication of this and of Guy de Chauliac's treatise has worked a revolution in medical history and, above all, has made these old authors available for those who hesitate to take up a work written entirely in Latin.] [Footnote 21: In the very first book containing some account of human anatomy, a German volume by Conradus Mengenberger, called "Puch der Natur," the date of printing of which is about 1478,--that is, less than ten years after the printing of the very first book, the "Biblia pauperum," which appeared in 1470,--there are, according to Haller in his "Bibliotheca Anatomica," a series of illustrations. This is the first illustrated medical work ever published.] [Footnote 22: Fordham University Press, New York, 1908.] [Footnote 23: Fordham University Press, New York, 1908.] [Footnote 24: See picture of the hospital ward at Tonnerre, in "The Thirteenth Greatest of Centuries," 3rd edit., New York, 1911.] [Footnote 25: "The Historical Relations of Medicine and Surgery," by T. Clifford Allbutt, M.A., M.D. London: Macmillan & Co., Ltd., 1905.] [Footnote 26: The beginning of the manuscript copy in the "Bibliothèque Nationale" is extremely interesting as an example of the English of the period, and alongside of it it seems worth while to quote the closing sentence as Nicaise reproduces them: "In godes name here bygyneth the inventarie of gadryng to gedre medecyne in the partye of cyrurgie compilede and fulfilled in the zere (yere?) of our Loord 1363 by Guide de Cauliaco cirurgene and doctor of physik in the fulclere studye of Mountpylerz. "On page 191, verso.--Here endeth the cyrurgie of Maistre Guyd' de Cauliaco dottoure of phisik." The University of Cambridge copy has the title in the colophon. It runs as follows: "Ye inventorye of Guydo de Caulhiaco Doctor of Phisyk and Cirurgien in Ye Universitie of Mount Pessulanee of Montpeleres." The fly-leaf contains the words, "Jesu Christ save ye soule of mich." It is rather interesting to note how much closer to modern English is this copy, made probably not much more than half a century later than the first one and, above all, how much more nearly the spelling has come. At this time, however, and, indeed, for more than a century later, spelling had no fixed rule, and a man might spell the same word quite differently even on the same page. The difference between doctor spelled thus in the early edition, and doctours in the later one, probably means nothing more than personal peculiarities of the original translator or copyist.] [Footnote 27: In Nicaise this last word is written _crapte_. I have ventured to suggest _crafte_, since a misreading between the two letters would be so easy. In the same way I have suggested tentatively a changing of the _z_ in the title of the Bibliothèque Nationale copy to _y_, making the word _yere_ instead of _zere_.] [Footnote 28: "A History of Dentistry from the Most Ancient Times Until the End of the Eighteenth Century," by Dr. Vincenzo Guerini, editor of the Italian Review _L'Odonto-Stomatologia_, Philadelphia and New York, Lea and Febriger, 1909.] [Footnote 29: The first printed edition of Arculanus is that of Venice, 1542, bearing the Latin title, "Joannis Arculani Commentaria in Nonum Librum Rasis," etc.] [Footnote 30: It is curious to trace how old are the traditions on which some of these old stories, that must now be rejected, are founded. I have come upon the story with regard to Basil Valentine and the antimony and the monks in an old French medical encyclopedia of biography, published in the seventeenth century, and at that time there was no doubt at all expressed as to its truth. How much older than this it may be I do not know, though it is probable that it comes from the sixteenth century, when the _kakoëthes scribendi_ attacked many people because of the facility of printing, and when most of the good stories that have so worried the modern dry-as-dust historian in his researches for their correction became a part of the body of supposed historical tradition. It is probably French in origin because in that language _antimoine_ is a tempting bait for that pseudo-philology which has so often led to false derivations.] [Footnote 31: There is in the New York Academy of Medicine a thick 24mo volume in which three of the classics of older medicine are bound together. They are Kerckringius's "Commentary on the Triumphal Chariot of Antimony," published at Amsterdam, 1671; Steno's "Dissertation on the Anatomy of the Brain," published in Leyden in 1671, and Father Kircher's "Scrutinium Physico Contagiosae Luis quae dicitur Pestis" (Physico-medical Discussions of the Contagious Disease which is called Pest). This was published at Leipzig in 1659. Just how the three works came to be bound together is hard to say. Very probably they belonged to some old-time scholar, though there is nothing about the books to tell anything of the story. The fact that all three of the authors were ecclesiastics of the Catholic Church, Valentine a Monk, Steno a Bishop, and Kircher a Jesuit, would seem to be one common bond and perhaps a reason for the binding of these rather disparate treatises together. In that case it is probable that the book came from an old monastic library dispersed after the suppression of the order by some government. It seems not unlikely that the volume belonged at some time to an old Jesuit library, for they have suffered the most in that way. That these three classics of medicine should have been republished in handy volume editions within practically ten years shows an interest in medical literature that has not existed again until our own time, for during the eighteenth and early nineteenth centuries there was almost utter neglect of them.] [Footnote 32: Paper read before the first meeting of the American Guild of St. Luke.] [Footnote 33: Published by Putnams, New York, 1909.] [Footnote 34: Dublin, 1882.] [Footnote 35: The material for this chapter was gathered for a paper read before the Medical Improvement Society of Boston in the spring of 1911. In nearly its present form it was published in _The Popular Science Monthly_ for May, 1911, and thanks are returned to the editor of that magazine for permission to reprint it here. The additions that have been made refer particularly to the estimation of Aristotle in the Middle Ages.] [Footnote 36: New York, Putnam, 1908.] [Footnote 37: "De Coelo et Mundo," 1, tr. iv., x.] INDEX =A= Abbassides, 73 Abba Oumna, 70 Abbas, 324 Abélard, 189 Abraham, 97, 98 Abu Dschafer, 173 Abulcasis, 123, 170, 226, 317, 318, 323 Abul Farag, 51 Abulkasim, 124 Academy of Bagdad, 135 Acid, hydrochloric, 369 Ackermann, 302 Adalberon, 145 Adelard of Bath, 134 Adhesions, 128 Ægidius, 150 Aëtius, 10, 117, 180, 317 Aëtius, Amidenus, 28 Afflacius, 151, 171 Affinity, 372 Agenius, Otto, 227 Agricola, 345 À Kempis, Thomas, 345, 361 Alanfrancus, 260 Albertus Magnus, 267, 306, 356, 403 Alchemist, 354 Alcuin, 432 Alderotti, 213 Alexander II, Pope, 83 Alexander of Hales, 108 Alexander of Tralles, 10, 28, 39 Alexandria, 135, 385 Allbutt, Sir Clifford, 247, 254, 257, 304, 355, 421 Ali Abbas, 121, 173, 266, 323 Ali Ben el Abbas, 170 Almansor, 132 Alphanus, 143, 145 Amandaville, 264 Anæsthesia, 17; inhalation of, 295, 296 Anæsthetics, 246 Anathomia, 203 Anatomy, ignorance of, 289; of the teeth, 326 Anatomical material, 224 Anatomical injection, 227 Anatomical preparations, 277 Andrew of Piacenza, 248 Animals, motion of, 414 Anthemios, 40 Angelico, Fra, 360 Angina, 32, 44, 332 Anthon, 407 Antimony, 362 Antiseptic, 253 Antisepsis, 17, 246 Apocalypse, the chemical, 376 Aquinas, 306, 403 Arabian lack of originality, 140 Arabian words in anatomy, 138 Arabs, 7 Arabisms, 237 Archimattheas, 160 Arcoli, John of, 208 Arculanus, 323 Arezzo, 248 Arithmetical complements, 340 Armandaville, 264 Arnold of Villanova, 290, 358 Arrows, extraction of, 270 Arpinum, 4 Arsenic, 335 _Artemisia maritima_, 50 Arterial hemorrhage, 126 Arthur Legends, 218, 375, 392 Arts, 7; liberal, 149; and crafts, 425 Asepsis, 17, 244, 246, 387 Aspasia, 180 Astrology, 105; and astronomy, 106, 418 Asylums, 8 Auenbrugger, 91, 166 Authority, 269, 292, 404 Authorship, dual, 391 Automobile, 415 Avenzoar, 80, 123, 130, 132 Averroës (Averrhoes), 80, 123, 132, 230, 267 Avicenna, 80, 128, 170, 266, 268, 331 Avignon, 16, 233 =B= Baas, 61, 63 Bachtischua, 56 Bacon, Roger, 107, 306, 356, 361, 403 Bagdad, 110, 111, 115, 134, 135 Barbarians, 5 Bartholomæus Anglicus, 433 Bartholomew, 172 Basilios, 26 Basil. St., 24 Basila, 180 Basil Valentine, 20, 180, 349 Basra, 111 Bath, 103 Bath, milk, 131; in fever, 172; of the soul, 25 Baverius, 209 Baynes, Henry Samuel, 390 Bede, 432 Benedict, St., 178 Benedictines, 12, 164 Benedictine Nuns, 191 Beowulf, 428 Berengarius, 209 Bernard of Clairvaux, 192 Bernard, St., 85 Bertruccio, 209, 287 Bertruccius, 229 Binz, Prof. Carl, 333 Birthplace, Latin writers, 4 Black Death, 304 Boccaccio, 183, 306 Body-snatching, 224 Boerhaave, 38 Boëthius, 427 Bokhara, 111 Bologna, 16, 142, 202, 206, 248 Book-learning, 371 Botany, 413; medieval, 414, 418 Botticelli, 360 Bracton, 419 Brain substance, loss of, 294 Brant, 361 Brethren of the Common Life, 344 Bridgework, dental, 315 Broeck, 277 Bronchoceles, 34 Bruno da Longoburgo, 245, 248 Bubonocele, 53 Buffon, 406 Bull, supposed against dissection, 424 Busche, 344 Bzowski, S.J., 181 =C= Cæsalpinus, 2, 209 Caius, 360 Calenda, Constance, 187 Calendar, correction of, 340 Calvo, 302 Cancer, 255 Cantor, 346 Carmoly, 61 Carthage, 165 Cases, desperate, 262 Cassiodorus, 12, 429 Cataract, 300 Cato, 267 Chanina Ben Chania, 66, 69 Charlatans, numbers of, 274 Charters, medical school, 420 Charts, 19 Chasdai Ben Schaprut, 79 Chaucer, 306, 428 Chauliac, 18, 285, 301, 319 Chauliac, bibliography, 308; editio princeps, 312 Chemical compounds, artificial, 376 Chirurgia Magna, 261, 284 Chirurgy, 19 Chosroes I, 109 Church and Jews, 80; and anatomy, 234; and surgery, 234 Cicatrices, beautiful, 255 Cicero, 4, 427 Cid, The, 218, 375, 392 Cimabue. 211 Circulation of the blood, 147 Cities, large, 5 City hospitals, 8; for the sick, 24, 296 City physician, 251 Clavius, S.J., Father, 340 Classics of Medicine, 165 Clement of Alexandria, 83; VI, Pope, 83 Cleopatra, 179 Clepsydra, 341 Clinical experience, 378 Clitoris hypertrophy, 37 Clysters, 279 Cnidos, 135 Colic, 279 Collectio Salernitana, 143, 238 College of St. Come, 26 Colpeurynter, 128 Columbus, 2, 209, 327, 329, 359 Conception, 35 Constantine Africanus, 5, 24, 123, 134, 145, 151, 163, 236, 266, 433 Constitution of the sun, 339 Consolations, 428 Consumption, 44 Conrad, 192 Conrad Mutianus, 344 _Contrecoup_, 240 _Convito_, 428 Copernicus, 346 Copho, 154, 205 Cordova, 75, 92, 134, 135 Cornelius, 38 Corrosive sublimate, 335 Cos, 135 Cosmas and Damian, 26 Criticism, higher, 7 Crown, dental, 316; cap, 316 Cusanus, 336 Cures of Afflacius, 171 Cuvier, 406 Cycloid curve, 346 =D= Da Lucca, 246 Damascus, 111 Daniel Morley, 134 Dante, 183, 211, 306, 407, 417 Daremberg, 180, 303 Darwin, 355, 399 David, 97 Decadence, 6 De Renzi, 143, 162, 182, 238, 239 Dental appliances, 316; decay, 318; hygiene, 325; surgery, 327; instruments, 320 _Dentatores_, 320 Dentrifices, 316 Descartes, 133 Desiderius, 145, 164, 168 Deventer, 344 Dezimeris, 302 Diaphoresis, 47 Diarbekir, 28 Didacus Lopez, 130 Diet, 46, 116 Dietetics, 99, 157 Di Liucci, 205 Dinus de Garbo, 130 Diogenes, 267 Dioscorides, 79, 266, 385 Diphtheria, 32 Diseases made incurable, 274; eye, 300 D'Israeli, 76 Dissecting material, 134; wounds, 227 Dissection, 224; supposed prohibition of, 424 Divine Comedy, 428 Divorce, 5 Djondisabour, 71, 109 Dock (Miss), 401 Dog, rabid, 31 Donolo, 78 Drainage, 241, 249 Dreams, 68 Driesch, 399 Dschibril, 57 Dschordschis, 56 Du Bouley, 199 Duke, Robert, 167 Duns Scotus, 108 =E= Eclecticism, 248 Eclipse, 22 _Ecstasis_, 386 Eddyites, 385 Edessa, 9 Egidius, 134 Elixir of immortal life, 25 Embryology, 28 Encyclopedia biblica, 430 Energy, Conservation of, 417 Epilepsy, 43 Epiplocele, 53 Epiplo-enterocele, 53 Epithelioma, 37 Epulis, 32 Erasistratus, 221, 385 Erasmus, 344, 361 Esophagus, 33 Ethics, medical, 77 Ethnography, 414 Etruscans, 315 Eusebius, 26 Eustachius, 2, 209 Eustachian canal, 327, 329 Examinations, 136 Experience, 403 Experiment, master of, 404 =F= Fabiola, 11 Fabricius de Acquapendente, 125 Fallopius, 302, 327 Faradj Ben Salim, 79, 170 Faragut, 79 Father of Modern Surgery, 283 Faucon, 312 Feminine education, 178, 188; cycles of, 200 Ferrara, 248, 328 Festus, 428 Filling of the teeth, 335 Finsen, 421 First intention, 18 Fish bones, 51 Florence, 206, 248 Floyer, 336 Forefathers in medicine, 380 Foreign body, 33 Foreign bodies, 48 Forli, 206 Foster, Sir Michael, 354 Foundlings, 8 Foundling asylums, 25 Founder of Pharmaceutical Chemistry, 353 Four Masters, 154, 238, 242, 243, 273 Fractures, 240; of pubic arch, 128; of base, 242; of skull, 244; split or crack, 243 Francis, Dr. Samuel, 223 Frederick I, 192; II, 147 Freind, 112, 302 Friedenwald, 64 Friuli, 206 =G= Gaddesden, 287 Galeatus de Sancta Sophia, 130 Galileo, 355 Galen, 3, 13, 35, 43, 73, 91, 115, 117, 129, 179, 266, 230, 204, 430, 385 Galenists, 120 Galvani, 166, 209 Gario Pontus, 43 Gentilis de Fulgineis, 130 Geography, physical, 413 Geometric transmutation, 340 Gerard of Cremona, 134, 170 Ghetto, 62 Giffert, Prof., 396 Gilbert, 421 Giliani, Alessandra, 188 Gilles de Corbeil, 134, 150 Giotto, 211, 306 Giovanni of Arcoli, 313, 324, 328 Glands, cervical, 259 Goitre, 33, 151; cystic, 259 Gold reserve, 316 Gordon, Bernard, 276, 286 Graduate, 208 Græcisms, 237 Granada, 75 Gratz College, 75 Gravity, specific, 342 Greeks, From the, to Darwin, 406 Gregory IX, 83; of Nazianzen, 24 Gruel, 131 Guadalquivir, 93 Guerini, 315 Guimarus II, 143 Guiscard, 145 Gurlt, 29, 48, 109, 139, 156, 219, 236, 239, 244, 248, 259, 312, 329, 331 Guy de Chauliac, 16, 208, 229, 270, 275, 232, 422 =H= Haeser, 61 Haliography, 376 Hallam, 85 Hamilton, Sir Wm., 407 Harnack, 25, 26, 382, 392 Haroun al-Raschid, 74 Harvey, 166, 209, 355 Harun al-Raschid, 56, 112 Headache, 42 Hegel, 407 _Hegira_, 170 Hegius, 345, 361 Heidelberg, 345 Helena, 24 Héloïse, 189 Hemicrania, 42 Hemoptyses, 45 Heraclius, 54 Hermondaville, 264 Hernia, 298; radical cure of, 299 Herophilus, 221, 384 Hierakas, 26 Hildegarde, 190 Hippocrates, 13, 91, 99, 117, 266, 385, 429 "Histoire des Femmes Médecins," 195 Historia Tripartita, 429 History of the Inductive Sciences, 410 Hobart, 393 Hobeisch, 58 Hollanduses, 358 Homer, 375, 391 Honein Ben Ischak, 57 Honein Ben Ishac, 117 Honey, 103 Horæ Lucanæ, 390 Horace, 267 _Hortus Deliciarum_, 191 Hospitals, 8 Hospitals for children, 25 Hroswitha, 190 Hugh of Lucca, 257 Hugo of Lucca, 245, 267, 273 Humboldt, 412 Huxley, 150, 307, 412 Hydrocephalus, 257 _Hydropikos_, 385 Hydrophobia, 435 Hysteria, 54 =I= Ibn Sina, 128 Ibn Zeinel-Taberi, 115 Ibn-Zohr, 130 Ignorance, on learned, 340; grounds of, 409 _Ignorantia, De Docta_, 339 Iliac passion, 279 Iliad, 375 Illustrations, 230; dental, 331; first medical, 275 _Incunabula_, 311, 329 Infection, 241 Innocent III, 83; IV, 83 Insanity, 434 Inspection, 47 Invasion of the barbarians, 26 Isaac Ben Amram, 76 Isaac Ben Emran, 73 Isaac Ben Soliman, 76 Isaac Judæus, 170, 173 Isagoge, 58 Ishac Ben Honein, 53 Isidore of Seville, St., 113, 431 Israels, A.H., 66 Israeli, 76 =J= Jacobus de Forlivio, 130 Jacobus de Partibus, 130 Jewish physicians, 7 Johannes Afflacius, 171 Johannesbrod, 102 Johannitius, 57 John Chrysostom, St., 11, 181 John de Vigo, 209 John Masuée, 74 John of Arcoli, 18, 209 John of Gaddesden, 286 Josephus, 29 Joshua Ben Nun, 74 Jude Sabatai, 78 Julian the Apostate, 8, 23 Justinian, 26, 23 =K= Kant, 407 Kerckringius, 366 Kircher, 366 Koran, 106, 139 Kostaben Luka, 58 Kühns, 418 =L= Lactantius, 27 Lancisi, 209 Landau, 67 Lane Lectures, 354 Lanfranc, 16, 209, 245, 260, 267 Laurentian Library, 180 Lead pipe, 239 Leo, 55 Leonardo da Vinci, 360 Leonides, 36 Leoparda, 181 Lewes, 406 Libraries, 6 Life, intellectual, 5 Ligatures, 155; around the limbs, 54 Lilium Medicinæ, 158 Linacre, 209, 360 Lipinska, Dr. Melanie, 195 Livy, 4 Lopez, 82 Love, 373 Lowell, Russell, 371 Lucan, 4, 94, 113 Lucca, 248 Lucretius, 395 Ludwig's angina, 332 Luke, St., 7; the physican, 8; supposed inaccuracies, 397 Lupus, 256 =M= Machine, Flying, 416 Madness, 434 Magna Græcia, 15, 156, 177 Magnet, 269 Magnetism, 404 Mahmoud, 75 Maimonides, 12, 88, 90; rules of life, 100 Malcorona, 182 Malgaigne, 118, 303, 306 Malpighi, 209 Malta, 97 Man, 95 Mandeville, 264 Mania, 44 Manipulation, surgical, 250 Mantua, 4 _Marsupium cordis_, 147 Martial, 4, 113, 181 Maser Djawah, 72 Matter and form, 351, 417 Matter, indestructibility of, 416 Matthæus de Gradibus, 130 Matthew Platearius, 134 Mediastinum, 137 _Medica_, 181 Medical, first illustrations, 275 Medicine, legal, 252; New York Academy of, 223 Melancholia, 44 Mengenberger, 276 Meningitis, 43 Mental influence, 44 "Merchant of Venice, The," 82 Mercuriade, 186 Mesmer, 105 Meteors, 414 Metrodora, 180 Metrorrhagia, 54 Meyer, 413 Michael Angelo, 360 Michael Scot, 134 Microtechnics, 171 Middle meningeal artery, 37 Middleton, 246 Migne, 194 Milan, 206 Milk, bath, 131; cure, 45 Milman, 84 Ministry of Christ, 390 Miscellany, 124 Modena, 248 Mohammed, 13 Monasteries, 6 Mondeville, 207, 209, 231, 264, 298, 422 Mondino, 202, 209, 245; career, 232; myth, 216 Monks' bane, 364 Montaigne, 374 Monte Cassino, 12, 145, 163, 168, 433 Montpellier, 11, 16, 87, 265 Morgagni, 91, 209 Moses, 64 Moses Ben Maimum, 91 =N= Nain, widow of, 389 Naples, 248 Nature, 47, 77, 378; in Dante, 418 Neander, 84 Needleholder, 295 Nemesius, 9 Nerve suture, 253, 262 Nestorian, 73, 109 Newton, 351, 355 Nibelungen, 218 Nibelungenlied, 375, 392 Nicaise, 198, 208, 265, 286, 292, 302, 309 Nicerata, 181 Nicholas of Cusa, 19, 337, 344 Nicolaus, Leonicenus, 130 Nobel Prize, 421 _Noli me tangere_, 256 Nosology, 159 Notker Teutonicus, 428 Novelties, medical, 166 Nuremberg eggs, 337 Nursing, 271; history of, 401 Nutrition per rectum, 130 Nutting, 401 =O= Observations, 282, 293, 378 Octavius Horatianus, 180 Odyssey, 375 Oil and wine, 387 Old Testament, 63 Omar, 110 Omentum, 250 Operation for hernia, 52 Ophthalmology, 258 Opotherapy, 68 Oppler, 100 _Opus Majus_, 410 _Opus Tertium_, 409 Ordericus Vitalis, 182 Organization of medical education, 141 Oribasius, 8, 38, 117 Origenia, 180 Orthodontia, 318 Osborn, 406 Osler, 257 Ossian, 375 Ovid, 267 Oxygen, 49 =P= Padua, 4, 16, 232, 248, 328, 345 Pagel, 61, 111, 119, 152, 156, 157, 172, 208, 216, 245, 264, 277, 286, 330 Palmyra, 109 Palpation, 47 Pandects, 38; of Haroun, 72 Paracelsus, 2, 254, 379 Paracentesis, 122, 365 Paradiso, 215 Paré, Ambroise, 254, 303 Paris, 141 Paris, Paulin, 310 Passavant, Jean de, 260 Passow, 386 Pasquier, 200 Paul of Ægina, 10, 50, 117, 122, 125, 317, 331 Paulus Æginetus, 29, 38 Pavia, 248 Percussion, 19 Peregrinus, 404 Pergamos, 135, 385 Perineum, torn, 184 Persecutions, Christian, 4; of Jews, 83 Persius, 4 Perugia, 248 Perugino, 360 Peter of Spain, 300 Petrarch, 306 Petrus de Argentaria, 290 Phagedenic ulcer, 35 Pharmacy, 207 Pharmacologist, 354 Phenicia, 314 Philip Augustus, 150 Philosopher's stone, 369, 412 Philosopher's keys, 376 Phrenitis, 43 Physicians and surgery, 267 Physiology, history of, 354, 414 Piacenza, 16, 232, 248 Pilcher, Dr. Lewis, 215, 216, 219, 229 Pinturicchio, 360 Pisa, 16, 248 Pitard, Jean, 265, 269 Plagiarism, medieval, 174 Plague, 305 Platearius I, 183 Plato, 267, 292 Pleurisy, 45 Pliny, 4, 113 Polyps, 31, 118, 258, 330; nasal, 126, 258 Pool, 93 Pope Boniface VIII, 288 Pope Clement VI, 300 Pope Innocent VI, 300 Pope John XXI, 300, 357 Pope Urban V, 300 Popes and Jews, 80; and science, 148 _Popular Science Monthly_, 400 Porphyry, 428 Portal, 304 Portio vaginalis hypertrophy, 37 Pouchet, 431 Practice, medical, 15 Preface, 230 Priscian, 180 Probe, 280 Professional spirit, 141 Professione Medicorum, 181 Prohibition of chemistry, 424 Prophylaxis, 47; perineal, 185 Prudentius, 113 Pseudo-philology, 364 Psycho-analysis, 68 Ptolemy, 73, 384 "Puch der Natur," 275 Pulse, 19, 160 Pure Drug Law, 420 Puschmann, 41, 61, 144, 150 Pus, unnecessary, 255 =Q= Quackery, 273 Quacks, 371 Quadrivium, 149 Quintilian, 4, 113 =R= Rab, 69 Rabbi Ishmael, 66 Rabies, 30; diagnosis of, 263, 435; treatment, 262 Radio-active elements, 350 Radio-activity, 399 Radium, 350 Ragenifrid, 144 Ramsay, Sir William, 394, 417 Raphael, 360 Rebecca Guarna, 186 Reggio, 248 _Regimen Sanitatis_, 158 Regiomontanus, 360 Religion of healing, 25 Religious scruples, 224 Renaissance, 20, 142 Renan, 132, 314 Respiration rate, 342 Reuchlin, 361 Reynaud, M. Jean, 375 Rhazes, 59, 114, 170, 266, 323, 331; aphorisms, 116 Richard Coeur de Lion, 98 Richard the Englishman, 276 _Rima glottidis_, 147 Robinson, Dr. Nathaniel, 390 Rodent ulcer, 35 Rogero, 237 Roland, 273 Rolando, 154, 238, 242 Romanes, 405 Roman Empire decadent, 5 Roman patronage, 2 Roman persecutions, 26 Rome, 248 Romoaldus, 134 _Rosa Angliæ_, 287 Roth, 288 Rudolph, 82 Ruggero, 237 Ruggiero, 146 Rules of life, 100 Rupertsberg, 192 Rutebeuf, 183 =S= St. Benedict, 191 St. Brigid, 179 St. Dominic, 215 St. Gall, 433 St. Luke, 381, 382 St. Patrick, 179 St. Peter's Epistle, 398 St. Thomas of Aquin, 352 Saintsbury, 402 Sacrament, 164 Saladin, 90 Salerno, 11, 13, 78, 141, 236, 273 Salicet, 209, 247 Salvation, 25 Samarcand, 111 Sanctions of belief, 105 Sanitary science, 64 Santa Sophia, 10, 40 Saracenus, 171 Saragossa, 75 Scholarship, 136 Scholastica, 178, 191 Science, biological, 413; popular medieval, 425; medieval, 400 Scientia Experimentalis, 410 Scotus, 134 Scribonius Largus, 180 _Scrobiculus cordis_, 137 Sea sponge, 151 Semiotics, 159 Seneca, 4, 94, 113, 267 Serapion, 170 Servetus, 2 Seville, 75 Shakespeare, 82 Shawdepisse, 280 Shower bath, 172 Sidon, 314 Sienna, 248 Sighart, 413 Signorelli, 360 Silver Age, 13, 113 Sintheim, 344 Small-pox, 119 Snake bites, 263 Snare, 126 Socrates, 292, 429 Solomon, 98 Sozomen, 429 Spagyrist, 369 Spallanzani, 209 Spanish peninsula, 4 Speculum, 331 _Sphudron_, 386 Sprengel, 77 Standards of medical education, 420 Static experiments, 340 Steno, 366 _Studia generalia_, 203 Studies, post-graduate, 283 Superstitions, 21 Surgeon, as teacher, 261; qualities of, 261, 305; good, 268; perfect, 268; training of, 267 Surgery, aseptic, 245; antiseptic, 255; dishonor of, 424; epoch of, 281; Genito-urinary, 126, 234; history of, 273; of the mind, 270; quality of, 305; union in, 249, 260 Surgical, meddlesomeness, 300; nursing, 271 Sydenham, 91 Sylvester II, 134 Sylvius, 2 Symmachus, 428 Synanche, 332 =T= Taddeo Alderotti, 212, 215, 232 Talmud, 11, 63, 65, 94 Tarsus, 135 Tartar, 321 Tattooing, 31 Taxes, 298 Technique, Surgical, 125 Teleology, 27, 95 Tell's apple, 364 Tenaculum, 258, 330 Terence, 4, 190 Tertullian, 27 Testament, Old, 11 Thaddæus Florentinus, 130 Thecla, 180 Theodoret, 27 Theodoric, 245, 252, 267, 273, 429 Theodosia, 10, 181 Theodotos, 26 "Theology and Science," 419 Theophilus, 54, 55 "Thirteenth Greatest of Centuries," 433 Thomas Cantimprato, 433 Thompson, 358 Thorax, 295 Thymol, 50 Titian, 360 Toledo, 76, 170 Tonnerre Hospital, 296 Tonsils, 29 Tooth powder, 321; replacement of, 322 Tornamira, 312 Toscanelli, 360 Toulouse, 286 Tours, 433 =U= Ugo da Lucca, 251, 295 Ugo Senesis, 130 Ulcer, eroding, 256 Union by first intention, 254 _Universitas_, 203 Universities, ecclesiastical, 210; medieval, 411 University of Bologna, 142; of Paris, 887, 142, 199; of Salerno, 142 University man, typical, 307 Urine, 19 Urination, difficulty of, 334 Uvula, 118, 259, 332; removal of, 333 =V= Valentine, 20, 349; bibliography, 376 Valesco de Taranta, 312 Van Helmont, 365 Varices, 34 Varicose veins, 127 Varignana, 130 Varolius, 2, 209, 327 Vasari, 360 _Velum Palati_, 137 Venerable Bede, 432 Venesection, 104 Vercelli, 248 Verneuil, 303 Verney, Francis, 311 Verona, 248 Vesalius, 2, 120, 204, 209, 233, 289, 327 Vicenza, 16, 232, 248 Victoria, 180 Vigo, John De, 334 Villani, 313 Vincent of Beauvais, 433 Virchow, 297 Virgil, 4 Vitality, natural, 116 Volta, 209 Von Leyden, 336 =W= "Warfare of Science and Religion," 434 Washington's hatchet, 364 Water clock, 341 Water in the ear, 48 Watering places, 47 Wenceslaus, Emperor, 424 Whewell, 410 White, Pres., 424 Wine for wounds, 187 William of Auvergne, 108 William of Briscia, 268 William of Salicet, 245, 256, 267 William the Conqueror, 145 Wimpheling, 361 Wives as nurses, 272 Women professors, 15 Women physicians, 177, 179 Wood hound, 435 Wounds, penetrating, 250; adhesion, 253; gunshot, 334; of intestines, 250; wine and oil, 387 Wurtz, 254 =Y= Yahia Ben Masoviah, 74 Yard, 280 Yperman, 276 Ypres, 276 =Z= Zedkias, 78 Zenobia, 109 Zoölogy, 418 * * * * * Other Books by Dr. Walsh FORDHAM UNIVERSITY PRESS SERIES =MAKERS OF MODERN MEDICINE--A series of Biographies of the men to whom we owe the important advances in the development of modern medicine. By James J. Walsh, M.D., Ph.D., LL.D., Dean and Professor of the History of Medicine at Fordham University School of Medicine, N.Y. Second Edition, 1909. 362 pp. Price, $2.00 net.= _The London Lancet_ said: "The list is well chosen, and we have to express gratitude for so convenient and agreeable a collection of biographies, for which we might otherwise have to search through many scattered books. The sketches are pleasantly written, interesting, and well adapted to convey the thoughtful members of our profession just the amount of historical knowledge that they would wish to obtain. We hope that the book will find many readers." _The New York Times_: "The book is intended primarily for students of medicine, but laymen will find it not a little interesting." _Il Morgagni_ (Italy): "Professor Walsh narrates important lives in modern medicine with an easy style that makes his book delightful reading. It certainly will give the young physician an excellent idea of who made our modern medicine." _The Lamp_: "This exceptionally interesting book is from the practiced hand of Dr. James J. Walsh. It is a suggestive thought that all of the great specialists portrayed were God-fearing men, men of faith, far removed from the shallow materialism that frequently flaunts itself as inherently worthy of extra consideration for its own sake." _The Church Standard_ (_Protestant Episcopal_): "There is perhaps no profession in which the lives of its leaders would make more fascinating reading than that of medicine, and Dr. Walsh by his clever style and sympathetic treatment by no means mars the interest which we might thus expect." _The New York Medical Journal_: "We welcome works of this kind; they are evidence of the growth of culture within the medical profession, which betokens that the time has come when our teachers have the leisure to look backward to what has been accomplished." _Science_: "The sketches are extremely entertaining and useful. Perhaps the most striking thing is that every one of the men described was of the Catholic faith, and the dominant idea is that great scientific work is not incompatible with devout adherence to the tenets of the Catholic religion." =THE POPES AND SCIENCE--The story of the Papal Relations to Science from the Middle Ages down to the Nineteenth Century. By James J. Walsh, M.D., Ph.D., LL.D. 440 pp. Price, $2.00 net.= PROF. PAGEL, Professor of History at the University of Berlin: "This book represents the most serious contribution to the history of medicine that has ever come out of America." SIR CLIFFORD ALLBUTT, Regius Professor of Physic at the University of Cambridge (England): "The book as a whole is a fair as well as a scholarly argument." _The Evening Post_ (New York) says: "However strong the reader's prejudice ... he cannot lay down Prof. Walsh's volume without at least conceding that the author has driven his pen hard and deep into the 'academic superstition' about Papal Opposition to science." In a previous issue it had said: "We venture to prophesy that all who swear by Dr. Andrew D. White's History of the Warfare of Science with Theology in Christendom will find their hands full, if they attempt to answer Dr. James J. Walsh's The Popes and Science." _The Literary Digest_ said: "The book is well worth reading for its extensive learning and the vigor of its style." _The Southern Messenger_ says: "Books like this make it clear that it is ignorance alone that makes people, even supposedly educated people, still cling to the old calumnies." _The Nation_ (New York) says: "The learned Fordham Physician has at command an enormous mass of facts, and he orders them with logic, force and literary ease. Prof. Walsh convicts his opponents of hasty generalizing if not anti-clerical zeal." _The Pittsburg Post_ says: "With the fair attitude of mind and influenced only by the student's desire to procure knowledge, this book becomes at once something to fascinate. On every page authoritative facts confute the stereotyped statement of the purely theological publications." PROF. WELCH, of Johns Hopkins, quoting Martial, said: "It is pleasant indeed to drink at the living fountain-heads of knowledge after previously having had only the stagnant pools of second-hand authority." PROF. PIERSOL, Professor of Anatomy at the University of Pennsylvania, said: "I have been reading the book with the keenest interest, for it indeed presents many subjects in what to me at least is a new light. Every man of science looks to the beacon--truth--as his guiding mark, and every opportunity to replace even time-honored misconceptions by what is really the truth must be welcomed." _The Independent_ (New York) said: "Dr. Walsh's books should be read in connection with attacks upon the Popes in the matter of science by those who want to get both sides." =MAKERS OF ELECTRICITY--By Brother Potamian, F.C.S., Sc.D. (London), Professor of Physics in Manhattan College, and James J. Walsh, M.D., Ph.D., Litt.D., Dean and Professor of the History of Medicine and of Nervous Diseases at Fordham University School of Medicine, New York. Fordham University Press, 110 West 74th Street. Illustrated. Price, $2.00 net. Postage, 15 cents extra.= _The Scientific American_: "One will find in this book very good sketches of the lives of the great pioneers in Electricity, with a clear presentation of how it was that these men came to make their fundamental experiments, and how we now reach conclusions in Science that would have been impossible until their work of revealing was done. The biographies are those of Peregrinus, Columbus, Norman and Gilbert, Franklin and some contemporaries, Galvini, Volta, Coulomb, Oersted, Ampére, Ohm, Faraday, Clerk Maxwell, and Kelvin." _The Boston Globe_: "The book is of surpassing interest." _The New York Sun_: "The researches of Brother Potamian among the pioneers in antiquity and the Middle Ages are perhaps more interesting than Dr. Walsh's admirable summaries of the accomplishment of the heroes of modern science. The book testifies to the excellence of Catholic scholarship." _The Evening Post_: "It is a matter of importance that the work and lives of men like Gilbert, Franklin, Galvini, Volta, Ampére and others should be made known to the students of Electricity, and this office has been well fulfilled by the present authors. The book is no mere compilation, but brings out many interesting and obscure facts, especially about the earlier men." _The Philadelphia Record_: "It is a glance at the whole field of Electricity by men who are noted for the thoroughness of their research, and it should be made accessible to every reader capable of taking a serious interest in the wonderful phenomena of nature." _Electrical World_: "Aside from the intrinsic interest of its matter, the book is delightful to read owing to the graceful literary style common to both authors. One not having the slightest acquaintance with electrical science will find the book of absorbing interest as treating in a human way and with literary art the life work of some of the greatest men of modern times; and, moreover, in the course of his reading he will incidentally obtain a sound knowledge of the main principles upon which almost all present-day electrical development is based. It is a shining example of how science can be popularized without the slightest twisting of facts or distortion of perspective. Electrical readers will find the book also a scholarly treatise on the evolution of electrical science, and a most refreshing change from the 'engineering English' of the typical technical writer." =EDUCATION, HOW OLD THE NEW--A Series of Lectures and Addresses on Phases of Education in the Past Which Anticipate Most of Our Modern Advances, by James J. Walsh, M.D., Ph.D., Litt. D., K.C.St.G., Dean and Professor of the History of Medicine and of Nervous Diseases at Fordham University School of Medicine. Fordham University Press, 1910. 470 pp. Price, $2.00 net. Postage, 15 cents extra.= CARDINAL MORAN (Sydney, Australia): "I have to thank you for the excellent volume 'Education, How Old the New.' The lectures are admirable, just the sort of reading we want for English readers of the present day." _New York Sun_: "It is all bright and witty and based on deep erudition." _The North American_ (Philadelphia): "Wide historical research, clear graphic statement are salient elements of this interesting and suggestive addition to the modern welter of educational literature." _Detroit Free Press_: "Full of interesting facts and parallels drawn from them that afford much material for reflection." _Chicago Inter-Ocean_: "Incidentally it does away with a number of popular misconceptions as to education in the Middle Ages and as to education in the Latin-American countries at a somewhat later time. The book is written in a straight, unpretentious and interesting style." _Wilkes-Barre Record_: "The volume is most interesting and shows deep research bearing the marks of the indefatigable student." _Pittsburg Post_: "There is no bitterness of controversy and one of the first things to strike the reader is that the dean of Fordham quotes from nearly everybody worth while, Protestant or Catholic, poetry, biography, history, science or what not." _The Wall Street News_ (New York): "The book is calculated to cause a healthy reduction in the conceit which each generation enjoys at the expense of that which preceded it." _Rochester Post Express_: "The book is well worth reading." _The New Orleans Democrat_: "The book makes very interesting reading, but there is a succession of shocks in store in it for the complacent New Englander or Bostonian and for the orthodox or perfunctory reader of American literature." =CATHOLIC SUMMER SCHOOL PRESS SERIES= The highest value attaches to historical research on the lines you so ably indicate, especially at the present time, when the enemies of Holy Church are making renewed efforts to show her antagonism to science and human progress generally. I shall have much pleasure in perusing your work entitled "The Thirteenth Greatest of Centuries." Wishing you every blessing, I am, Yours sincerely in Xt., R. Card. MERRY DEL VAL. Rome, January 18th, 1908. Jas. J. Walsh, Esq., New York. =THE THIRTEENTH GREATEST OF CENTURIES--By James J. Walsh, M.D., Ph.D., Litt.D., Dean and Professor of Nervous Diseases and of the History of Medicine at Fordham University School of Medicine; Professor of Physiological Psychology at Cathedral College, New York. Catholic Summer School Press, 110 West 74th Street, N.Y., Georgetown University Edition. Over 100 additional illustrations and twenty-six chapters that might have been, nearly 600 pages. Price, $3.50, post free.= PROF. WILLIAM OSLER, of Oxford, delivering the Linacre Lecture before the University of Cambridge, said: "That good son of the Church and of the profession, Dr. James J. Walsh, has recently published a charming book on The Thirteenth as the Greatest of Centuries. He makes a very good case for what is called the First Renaissance." _The Saturday Review_ (of London): "The volume contains a mass of interesting facts that will start a train of profitable thought in many readers' minds." _The Educational Review_ said: "The title of Dr. Walsh's book, The Thirteenth Greatest of Centuries, will startle many readers, but we respectfully commend to the open-minded his presentation of that great epoch. A century that witnessed such extraordinary achievements in architecture, in arts and crafts, in education, and in literature and law, as did the Thirteenth, is not to be lightly dismissed or unfavorably compared with periods nearer our own." _The Pittsburg Post_ said: "Dr. Walsh writes infused with all the learning of the past, enthusiastic in modern research, and sympathetic, in true scholarly style, with investigation in every line. One need only run over a few of the topical headings to feel how plausible the thesis is. The assemblage of the facts and the elucidation of their mutual relations by Dr. Walsh shows the master's skill. The work bristles on every page with facts that may be familiar to many, but which were never before so arranged in just perspective with their convincing force so clearly shown." CARDINAL MORAN, of Sydney, Australia: "Just the sort of literature we want for English readers at the present day." BY THE SAME AUTHOR FORDHAM UNIVERSITY PRESS SERIES MAKERS OF MODERN MEDICINE Lives of the men to whom nineteenth century medical science owes most. Second Edition. New York, 1910. $2.00 net. THE POPES AND SCIENCE The story of Papal patronage of the sciences and especially medicine. 45th thousand. New York, 1911. $2.00 net. MAKERS OF ELECTRICITY Lives of the men to whom important advances in electricity are due. In collaboration with Brother Potamian, F.S.C., Sc.D. (London), Professor of Physics at Manhattan College. New York, 1909. $2.00 net. EDUCATION, HOW OLD THE NEW Addresses in the history of education on various occasions. 3rd thousand. New York, 1911. $2.00 net. _IN PREPARATION_ MAKERS OF ASTRONOMY PROBLEMS OLD AND NEW IN EDUCATION THE THIRTEENTH GREATEST OF CENTURIES Georgetown University edition. 5th thousand. 116 illustrations, nearly 600 pages. Catholic Summer School Press, New York, 1911. Postpaid, $3.50. THE DOLPHIN PRESS SERIES CATHOLIC CHURCHMEN IN SCIENCE First and second series, each $1.00 net. _IN COLLABORATION_ ESSAYS IN PASTORAL MEDICINE O'MALLEY AND WALSH A manual of information on medical subjects for the clergy, religious superiors, superintendents of hospitals, nurses and charity workers. Longmans, New York, 1911. $2.50 net. TRANSCRIBER'S NOTES The list of the works by the same author has been moved from the beginning to the end of the book. 
35477	----	[Transcriber's notes] This is derived from a copy on the Internet Archive: http://www.archive.org/details/cu31924012267013 Page numbers in this book are indicated by numbers enclosed in curly braces, e.g. {99}. They have been located where page breaks occurred in the original book. Obvious spelling errors have been corrected but "inventive" and inconsistent spelling is left unchanged. Extended quotations and citations are indented. Footnotes have been renumbered to avoid ambiguity, and relocated to the end of the enclosing paragraph. There are several occurrences of square brackets used by the author. They do not begin with "Transcriber's note", "Footnote", or "Illustration". [End Transcriber's notes] _By the Same author_. Catholic Churchmen in Science. Cloth, gilt top, with portraits. The Dolphin Press, Philadelphia, 1906. $1.00, _net_. History of the Medical Society of the State of New York (appearing serially in _New York State Journal of Medicine_, beginning February, 1906). _In Press_. The Thirteenth the Greatest of Centuries. _In Preparation_. The Popes in Medical History. _In Collaboration_. Essays in Pastoral Medicine. O'Malley and Walsh. Longmans, Green & Co., New York, 1906. $2.50, _net_. [Illustration: PASTEUR] MAKERS of Modern Medicine BY JAMES J. WALSH, M.D., Ph.D., LL.D. ACTING DEAN AND PROFESSOR OF THE HISTORY OF MEDICINE AND OF NERVOUS DISEASES, FORDHAM UNIVERSITY MEDICAL SCHOOL, AND ADJUNCT PROFESSOR OF MEDICINE AT THE NEW YORK POLYCLINIC SCHOOL FOR GRADUATES IN MEDICINE; PROFESSOR OF PHYSIOLOGICAL PSYCHOLOGY AT ST. FRANCIS XAVIER'S COLLEGE IN NEW YORK. FORDHAM UNIVERSITY PRESS NEW YORK 1907 COPYRIGHT, 1907, FORDHAM UNIVERSITY PRESS, NEW YORK. TO DR. WILLIAM OSLER WHO EXEMPLIFIES FOR THIS GENERATION THE FINEST QUALITIES OF THESE MAKERS OF OUR MODERN MEDICINE, THIS VOLUME IS WITH HIS KIND PERMISSION DEDICATED AS A SLIGHT TOKEN OF THE ADMIRATION OF A DISTANT DISCIPLE. "If in some things I dissent from others, whose wit, industry, diligence and judgment I look up at and admire, let me not therefore hear presently of ingratitude and rashness. For I thank those that have taught me, and will ever; but yet dare not think the scope of their labor and inquiry was to envy their posterity what they also could add and find out. If I err, pardon me. I do not desire to be equal with those that went before; but to have my reasons examined with theirs, and so much faith to be given them, or me, as those shall evict. I am neither author or fautor of any sect. I will have no man addict himself to me; but if I have anything right, defend it as Truth's, not mine, save as it conduceth to a common good. It profits not me to have any man fence or fight for me, to follow or take my part. Stand for truth, and 'tis enough." {vii} PREFACE. The present volume is published at the solicitation of many friends who have read the articles contained in it as they appeared at various times in magazines and who deemed that they were worth preservation in a more permanent form. The only possible claim for its filling a want lies in the fact that it presents these workers in medicine not only as scientists but also and especially as men, in relation to their environment, social, religious and educational. I have to thank the editors of the _Messenger, Donahoe's Magazine, The Catholic World_ and the _Records of the American Catholic Historical Society_, for permission to reprint the articles which appeared in their periodicals. The opening chapter, The Making of Medicine, is an abstract from the introductory lecture of the course in the history of medicine at the Fordham University Medical School, New York. Much of the material for the article on the Irish School of Medicine was gathered for a lecture before the Historical Club of Johns Hopkins University and the District Medical Society of the District of Columbia. The sketch of the life of Dr. Jenner has not hitherto been published. All of the other articles have been considerably lengthened and revised. There are other makers of modern medicine who deserve a place beside those mentioned here, but as the material had reached the amount that would make a good-sized volume it {viii} was thought better to proceed with the publication of the first series of sketches, which will be followed by others if conditions conspire to encourage any further additions to our not very copious English medical biography. A subsequent volume will contain sketches of the lives of old-time makers of medicine in the fifteenth, sixteenth and seventeenth centuries, the men who laid the firm foundations of our medical science of the present day. I have to thank my friend of many years and brother alumnus of Fordham University, Dr. Austin O'Malley, of Philadelphia, for reading the proofs and for suggestions while the book was going through the press. {9} CONTENTS. PAGE The Making of Medicine 11 Morgagni, Father of Pathology 27 Auenbrugger, Inventor of Percussion 53 Jenner, Discoverer of Vaccination 87 Galvani, Founder of Animal Electricity 113 Laennec, Father of Physical Diagnosis 133 The Irish School of Medicine--Graves, Stokes, Corrigan 165 Müller, Father of German Medicine 215 Schwann, Founder of the Cell Doctrine 251 Claude Bernard, Discoverer in Physiology 269 Pasteur, Father of Preventive Medicine 291 O'Dwyer, Inventor of Intubation 323 {10} {11} THE MAKING OF MEDICINE {12} Without History a man's soul is purblind, seeing only the things which almost touch his eyes. --Fuller, _Holy and Profane State_, 1641. {13} THE MAKING OF MEDICINE. Our generation, in this no more self-concentrated than many another, has prided itself so much on the progress it has achieved in science that it has in its interest in the insistent present rather neglected the claims of the history of science. There has been the feeling that our contemporaries and immediate predecessors have accomplished so much as to put us far beyond the past and its workers, so that it would seem almost a waste of time to rehearse the crude notions with which they occupied themselves. In no one of the sciences is this truer than in medicine. Yet it seems likely that no more chastening influence on the zeal for the novel in science, which so often has led this generation astray, could possibly be exerted than that which will surely follow from adequate knowledge of scientific history. In medicine there is no doubt at all that an intimate acquaintance with the work of the great medical men of the past would save many a useless investigation into problems that have already been thoroughly investigated, or at least would help modern workers to begin at a place much farther on in their researches than is often the custom. There are other reasons why the knowledge of the history of medicine cannot but prove of great service to the present generation. We are entering upon a time when original research as the main business of selected lives, in contra-distinction to the few hours a day or even a week that the medical practitioners of a few generations ago could steal from their busy lives, is becoming more and more the rule. A consideration then of the methods by which advances in {14} medicine were made in the past, of the character of the men to whom we owe the ground-breaking discoveries, of the way in which such discoveries were accepted or rather rejected by contemporaries, for rejection was almost the rule, will serve as a mirror for reflections that will surely be helpful in this day of great institutions of research. It must not be forgotten, however, that only too often in the past it is in the large institutions that routine work has been done, while the occasional genius has sprung up in circumstances that seemed quite unlikely to be the fostering mother of originality, and there has taken for the world the precious step into the unknown which represents a new departure in medical science. Prof. Osier's declaration that the world's best work was mainly done by young men was not well received, but no one knew better than he that this is the most salient fact in the history of medical progress. There is practically not a single great discovery in medicine that was not made by a young man under thirty-five. As a rule, indeed, the new departures in medicine came from men who were well under thirty, some of them in fact only at the beginning of their third decade of life. Morgagni's great germinal idea, which made him the father of modern pathology, came to him when he was a student scarcely more than twenty. He then began to take notes on all the morbid appearances that he found in bodies, recognizing very clearly that he must trace out not only the main cause of the disease, but also the subsidiary pathological factors that were at work in the production of the various symptoms of the special case as he had studied it clinically. This idea is so obvious now as to seem impossible to be missed; yet scarcely a century ago it constituted the foundation-stone of modern pathology. {15} Auenbrugger, who laid the foundation of modern physical diagnosis by his observations upon percussion, began the work when he was under twenty-five, at the Spanish Hospital in Vienna, and carried it out to a completely successful issue absolutely without any encouragement from the great masters of the Vienna school. As a matter of fact, they rather pooh-poohed the idea that this foolish drumming, as one of them is said to have termed it, could ever amount to anything in enabling physicians to recognize pathological conditions within the chest. For twenty-five years after the publication of his little book, Auenbrugger's discovery attracted no attention. Laennec, who followed Auenbrugger in the development of physical diagnosis, set himself the much harder problem of constructing a system of auscultation when he was in his early twenties, studied the subject for twelve years and then published the book on it when he was as yet scarcely thirty-five. He accomplished the revolution in medicine that is due to him, though he was never strong and died at the early age of forty-six. These are only striking examples which show what the young man has accomplished. The same thing was true in other countries. Corrigan wrote his famous essay on the "Permanent Patency of the Aortic Valve" when he was only twenty-nine years of age, and the work for it had been done during the preceding three years, at a hospital in which there were beds for only six medical patients. Trousseau declared this the greatest medical work, from a clinical standpoint, that had ever been accomplished, and hailed young Corrigan as one of the masters of clinical medicine. He maintained that disease of the aortic valve should receive the name Corrigan's disease. Stokes, Corrigan's contemporary and friend in Dublin, wrote his little book on the stethoscope when he was not yet twenty-one, and at a time when the {16} distinguished clinicians of the day were all asking if these young men expected the old physicians to carry this toy about with them and use it for any serious purpose. Graves, also of the Irish school of medicine, made some of the clinical observations on which his reputation is founded, including a short description of characteristic cases of the affection that still bears his name, when he was well under thirty-five. Further examples might well be cited, but they will be met with in the course of this book. The history of most of the sciences is like medicine in this respect, and it is to young men that the great ground-breaking ideas come. How true this is in biology can be noted even from the lives of the physician-biologists that are included in this volume. Theodore Schwann, the father of the cell doctrine, did all the work for which he deserves the name of founder of modern biology when he was scarcely more than thirty. Part of the best of it was accomplished before he was twenty-five. Claude Bernard had shown the precious metal of his originality before he was far on in his twenties. Pasteur, the most original genius of them all, began his work when he was scarcely more than a boy, and though every five years of a long life was filled with original observations of the most precious kind, his genius had received the bent which it was to follow from the successful accomplishment of observations during his third and fourth decades. In these modern days, when the education of the young man for medicine is not supposed to be finished until he is nearly thirty, it is easy to understand that perhaps the precious years in which originality might manifest itself are already past before he gets out of the swaddling clothes of enforced instruction from others. As has been very well said, it is possible to smother whatever of the investigating {17} spirit and original initiative there may be in a young man by attempting to teach him too much of what the present generation knows. Unfortunately, it happens only too often even in this wise generation of ours that it is not so much the ignorance of mankind that makes them ridiculous as the knowing so many things that are not so. The number of things that the young man has to learn and that are taught him, often with the assurance that they are almost gospel truth in medicine, and yet that he finds before he has been long out of school or indeed sometimes before he leaves school, to be at best opinions, is entirely too great. The saving grace for the correction of this constantly recurring fault in education is undoubtedly a knowledge of the development of medicine in the past and a recognition of the fact that the accepted truth of any one generation proves after all often enough to be only apparent. After the false impression that it is to older men we owe progress in medicine, perhaps the most universally accepted apparent truth is that the investigating spirit is communicable, and that the pupils of a great master may be expected to carry on his work and add almost as much as he has done to the great body of medical knowledge during the generation immediately following his work. It would naturally be expected, for instance, that Morgagni having laid the foundations of modern pathology and connected pathological observation with clinical observation the great development in modern diagnosis would have come down in Italy. This was not true, however. The next great step connecting bedside observations with postmortem appearances was made by Auenbrugger in Vienna in distant Austria. Auenbrugger's work having been successfully accomplished it might reasonably be supposed that he himself or some of those who had seen his successful diagnosis of thoracic conditions {18} by percussion would take the next step and discover auscultation. This, however, did not happen in Germany, but in France. It is true that Laennec's work was done under the influence of Corvisart, who revived Auenbrugger's work and gave it to the world once more, and that in a way, therefore, Laennec may be considered an indirect pupil of Auenbrugger; but the fact stands that the two discoveries of percussion and auscultation were made at an interval of nearly fifty years and at a distance of more than a thousand miles from each other. On the other hand, Laennec having solved the wonderful mystery of the significance of the sounds within the chest as far as they concern pulmonary diseases might have been expected to do as much also for heart disease. Even genius, however, is able it seems to take only one step into the unknown. Auenbrugger did not discover auscultation, though it apparently lay so near at hand. Laennec did not solve the riddle of heart murmurs, though for most of us they do not present any more difficulty than the wonderfully successful recognition of the significance of _râles_ of various kinds in which Laennec never failed. The problem of heart diagnosis was to be solved by Corrigan and the Irish school of medicine hundreds of miles away, though they were doing their work about the same time that Laennec was making his observations in Paris. Curiously enough just during the same decade Richard Bright, in England, was studying out the problem of kidney disease, and, as a young man, teaching the world nearly as much about it as it has ever learned, though, in the seventy-five years that have passed since, so much of investigation has been devoted to the subject. No one nation can claim the palm of superiority in the matter of original investigation. The spirit of genius breathes where it will, and unfortunately it is incommunicable. {19} Students may think they absorb all that the master has to give them, and that they are ready to go on with his work where he left it. They do actually seem to their own generation to make distinct progress in medicine. When the situation is analyzed fifty or a hundred years afterward, however, it is found that only the master's work counts, and that much of what seems to be advance was only a skirmishing here and there along the lines laid down by him, but without any material progress for true science. This same peculiarity is manifest, also, not only in the history of sciences allied to medicine, but in that of all the physical sciences. A very striking example is to be found in the story of the rise of electrical science, which took place almost at the same period as that which saw the rise of clinical medicine. Origins in electricity date from Franklin's work here in America and Galvani and Volta's observations in Italy. It might quite naturally have been expected that the further progress of electrical science would come in either of these countries. The next great discoveries, however, were separated by long distances and a considerable interval of time. After Volta came the demonstration by Oersted, in Denmark, of the identity of magnetism with electricity. It was not in Denmark, however, that the problems connected with this principle were worked out, but by Ampere in France. In the mean time, Cavendish and Faraday, working quite independently of their Continental colleagues, were making significant strides in electricity in England. When the problem of the resistance to the passage of electricity in a conductor was to be studied, another nation supplied the man for the opportunity. Ohm had never been in contact with any of these great contemporaries and did his work entirely by himself. It is a curious confirmation of what we have stated with regard to the young man in {20} medicine and the making of great discoveries that practically all these founders in electricity were under thirty-five when their best original work was accomplished. From a series of biographies of great medical discoverers, certain salient traits stand out so as to attract attention even from the cursory reader. The essence of significant work in medicine consists of observation, not theory. It has always been the custom to theorize much and unfortunately to observe but little. Long ago John Ruskin said that the hardest thing in the world for a man to do is to see something and to tell it simply as he saw it. Certainly this has been true in medicine. The men who have had eyes, and have used them, have impressed their names upon the history of progressive scientific advance. The theorists have never contributed anything worth while to the body of medical truth. While this is readily acknowledged by every generation, with regard to the past, it is curious to note how different is the appreciation of each generation for the theorist as opposed to the observer. Medical theorists have always been honored by their contemporaries unless their theories were utterly outlandish, and even then they have had many disciples, and have seldom been without honor and never, with sorrow for the foolishness of men be it said, without emolument. The observer, however, has but rarely been in favor with his contemporaries. Not infrequently the observation that he made appeared to be so obvious that his fellows could not think that it represented a great truth. As a consequence they have usually derided him for attempting to make them see a significance in his observation that they could not think was there. Huxley once stated the phases through which a new scientific truth ordinarily passes. At first it is said to be trivial and insignificant, then as it attracts more attention {21} it is declared to be in contradiction with hitherto known truth. Finally it is declared to be after all only in other terms what the world has always believed in the matter. Certainly through these stages all the great discoveries in medicine have gone. So true is this, that if what seems to be a new truth in medicine is accepted at once, and willingly, there is more than a suspicion that it is not really a new discovery but only a modification of something hitherto well known. All the great discoverers in medicine have practically without exception met, if not with opposition, surely with neglect of their work. We smile complacently now at the generation that considered the stethoscope a toy, and asked derisively if they should be expected to carry it about with them. The next generation, however, having grown accustomed to the stethoscope, refused quite as inconsequentially to have anything to do with the thermometer. They refused to carry these glass things around with them in order to test the fever that patients might have, since they claimed they were able to accomplish this purpose quite as well by means of their educated touch. The generation of medical men is not yet passed who refused to credit the thought that the diagnosis of diphtheria would ever be made only by the microscope and culture methods, and who considered that they could tell very well what was diphtheria, and what not, from the appearance of the throat. Of course similar opposition was the fate meted out to every distinguished scientific discoverer, and so I suppose medical men cannot complain. His contemporaries said of Galvani that he had made of himself a dancing master for frogs, because he continued his observations on the legs of these animals in order to solve the problems of animal {22} electricity. Pasteur's demonstration that there was no such thing as spontaneous generation, served at first only to bring down on his devoted head the aspersions of most of the distinguished scientific men in Europe. When that genius, the physician Robert Mayer, discovered the conservation of energy as the result of his acute observation, that blood drawn by venesection in the tropics was redder than that drawn in colder climates, he found that scientific circles were not only not ready to accept his demonstration, but that he was looked upon as a visionary, somewhat as one who thought that he had solved the problem of squaring the circle or the endless puzzle of perpetual motion. Fortunately these men have as a rule had a physical and mental force that enabled them to go on in spite of the opposition or derision of their contemporaries. It is rather a curious fact that most of the great medical discoverers were born in the country and were as a rule the sons of rather poor parents. Many of them were so situated that they had to begin to make their own livelihood to some extent at least at the beginning of their third decade of life. Far from proving a hindrance to their original work, this necessity seems rather to have been one of the sources of inspiration that spurred them on to successful efforts in their investigations. Most of them were what would be called handy men, in the sense that they could use their hands to work out their ideas mechanically. This was typically true of Galvani, who had to construct his own first electrical instruments, and of Laennec, who took pride in making his own stethoscopes. So many of them made by his own hands are still extant, that a number of museums have the opportunity to hold specimens of his handiwork. Auenbrugger and Johann Müller and Pasteur are further examples of this same handiness. Claude {23} Bernard exhibited this quality very early in life and continued to exercise it all during his career. Nor was their ingenuity limited to material things. Many of them were interested in literary and artistic work of various kinds. Morgagni was considered a literary light in his generation. Auenbrugger composed a musical comedy which had a distinct success, even in music loving Vienna. The Empress Maria Theresa said that she supposed he would now continue to write musical comedies; but Auenbrugger replied, with more candor than gallantry, that he had something better to do. Claude Bernard composed a play that shows distinct evidence of literary talent. It seems fortunate indeed that he was diverted from his original intention of following literature as a career, and took up medicine. Many of the others, as, for instance, Graves and Stokes, were excellent judges of art, critics of real knowledge and genuine appreciation; and indeed it may be said that none of them was ever so absorbed in his vocation of medicine as not to have much more than a passing interest in some of the great phases of intellectual activity quite apart from his professional work, or from scientific knowledge: an avocation to which he turned for the only true recreation of mind there is--a change of work. This seems all the more worth while calling attention to in our strenuous age, because it is sometimes considered a mistake for a physician to show that he is interested in intellectual pursuits of any kind apart from his professional work. It is supposed that no one is capable of dividing his attention in this way and yet do justice to his profession and his patients. As a matter of fact it has well been said that no really great physician has ever been a narrow specialist in the sense that he knew only medicine well; there was always at least one other department of intellectual {24} attainment with which he had made himself so familiar as to be an authority in it. It is not the lopsided who make great athletes, and it is not the one-sided man who succeeds in doing really great work. Practically all the great physicians have had favorite hobbies to which they have turned for relaxation, for surely no one understands better than physicians that recreation consists not in that impossibility, the doing of nothing, but in resting the mind by doing something quite different from what it has been engaged at before. There is another phase of the lives of these great men of medicine that is so different from what is ordinarily thought to be the rule with physicians, that it seems worth while emphasizing at the end of this introduction. All these great discoverers have been men of constructive imagination, men who might have been distinguished litterateurs very probably, had they applied themselves in that field. All of them have had too much imagination to be materialists, that is, to consider that they could know nothing except what they learned from the matter with which their studies were taken up. All these great discoverers in medicine have been simple, sincere, faithful believers, ready to express their trust in an overruling Providence, and in a hereafter that they knew only by faith, it is true, but which was for that reason none the less distinctly recognized. While it is usually considered that medicine leads men's minds away from orthodox thinking in the great matter of the relationship of the creature to the Creator, all these men have been not only ready to acknowledge their personal obligations to Him, but have furnished exemplary models of what the recognition of such obligations can make of human lives. There is an old proverb that runs _Ubi tres medici ibi duo athei_,--where there are three physicians there are at least two atheists. This has made many a heartache for fond mothers {25} when they found their sons had determined on becoming physicians. If the present series of sketches is to be taken as any argument, however, it is only the small minds among physicians who become atheists. They are not able to see their way clearly from the material they work in to the higher things that prove a source of strength and consolation to the great minds while they are busy making medicine for their own and subsequent generations. Certainly no more thoroughly representative group of the makers of nineteenth century clinical medicine could have been selected than those whose sketches are here given. They are from all the nations who have contributed materially to modern medical advance, yet all of them were deeply religious men. There is another and equally important point with regard to them. It is their relations to their fellows. Without exception they were men beloved by those around them for their unselfish devotion not only to science, but also to their brother men. In the midst of their occupations the thought that has been the profoundest consolation for all of them without exception has been that they were accomplishing something by which their fellow-men would be saved suffering and by which human life would be made more happy. A study of their careers cannot fail to show the young physician the ideals he must cherish if he would have real and not apparent success and happiness in life. {26} {27} MORGAGNI, THE FATHER OF PATHOLOGY {28} Let us then blush, in this so ample and so wonderful field of nature (where performance still exceeds what is promised), to credit other men's traditions only, and thence come uncertain problems to spin out thorny and captious questions. Nature herselfe must be our adviser; the path she chalks must be our walk; for so while we confer with our own eies, and take our rise from meaner things to higher, we shall at length be received into her closet-secrets. --Preface to _Anatomical Exercitations concerning the Generation of Living Creatures_, 1653. William Harvey. {29} MORGAGNI, THE FATHER OF PATHOLOGY. "VIR INGENII, MEMORIAE, STUDII, INCOMPARABILIS." --HALLER. In 1894, when the International Medical Congress met at Rome, Prof. Virchow of Berlin, the greatest living pathologist at the time, was asked to deliver the principal address. He chose as his subject John Baptist Morgagni, the distinguished Italian physician and original investigator of the eighteenth century, whom he hailed as the Father of Pathology. No medical scientist of the nineteenth century was in a better position than Virchow to judge who had been the founder of the science for which he himself did so much. Virchow besides, through long and faithful study of the history of medicine, knew well whereof he spoke. In pathology especially modern medicine has made its sure advances, so that Morgagni's ground-breaking work may well be considered the beginning of the most recent epoch in medical science. As a matter of fact, medicine lost much of its obscurity by losing all its vagueness when Morgagni's methods came into general use. As a medical student scarcely twenty years of age, he revolutionized medical observation by studying his fatal cases with a comparative investigation of their clinical symptoms and the postmortem findings. This had been done before, but mainly with the idea of finding out the cause of death and the principal reasons for the illness which {30} preceded. Morgagni's investigations in pathology consisted in tracing side by side all the clinical symptoms to their causes as far as that might be possible. This looks so simple now as to be quite obvious, as all great discoveries are both simple and obvious once they have been made; but it takes a genius to make them, since their very nearness causes them to be overlooked by the ordinary observer so prone to seek something strange and different from the common. How much Morgagni's studies from this new viewpoint of the investigation of all the symptoms of disease has meant for modern medicine, may be best appreciated by a quotation from an address delivered before the Glasgow Pathological and Clinical Society in 1864, by Professor Gairdner, who thus tersely describes the character of the distinguished Italian pathologist's work: "In investigating the seats of disease, Morgagni is not content to record the coincidence of a lesion in an organ with the symptoms apparently due to disordered function in that organ. "For the first time almost in medical inquiry, he insists on examining every organ, as well as the one suspected to be chiefly implicated; not only so, he marshals with the utmost care, from his own experience and that of his predecessors, all the instances in which the symptoms have existed apart from the lesion, or the lesion apart from the symptoms. He discusses each of these incidents with severe exactness in the interest of truth, and only after an exhaustive investigation will he allow the inference either that the organ referred to is or is not the seat of the disease. "And in like manner in dealing with causes: a group of symptoms may be caused by certain organic changes--it may be even probable that it is so--but, according to Morgagni's method, we must first inquire into all the lesions of {31} organs which occur in connection with such symptoms; in the second place, we must know if such lesions ever occur without the symptoms; and again if such symptoms can be attributed in any cases to other causes in the absence of such lesions." During over sixty years of a long life Morgagni continued to follow out the idea that he had developed as a boy, and his works contain the first definite account of pathological lesions and clinical manifestations that attracted attention. As a proof of the striking difference between the value of observation and theory in medicine, it may be said that many hundreds of volumes containing the most elaborate medical theories were published during the eighteenth century, and that practically none of these is ever read now, except for curiosity's sake by some seeker after the quaint and distant in medicine, while Morgagni's books still contain a precious fund of information, to which pathologists at least, and not a few clinicians, turn often with interest and come away always with profit. They are not infrequently quoted from, and, as we shall see, have been highly appreciated by some of the best medical authorities of the present and the immediately preceding generations. To the modern thinker, accustomed to look rather to the northern nations or to France for great advances in science, it may prove somewhat of a surprise to have an Italian thus put forward as the founder of modern medicine, and especially of the most scientific department of it. Those who are familiar with the history of medicine since the revival of civilization after the Dark Ages will realize what a prominent place Italy has always held in the development of medical science. The first great Christian medical school was founded at Salerno, not far from Naples, in the tenth century. The first regular practical teaching of anatomy by means of {32} dissections of human bodies and demonstrations on the cadaver was done at Bologna by Mondino at the beginning of the fourteenth century. The great Father of Modern Anatomy, Vesalius, was a Belgian, but he did all the work for his epoch-making book, the _De Fabrica Humani Corporis_, at the Universities of North Italy, especially at Padua, Bologna and Pisa, during the first half of the sixteenth century. Every student of medicine in those times who was desirous to secure wider opportunities for medical education went down into Italy, and on the rosters of the Italian medical schools of the sixteenth century are to be found the names of most of the men who in all the countries of Europe became famous for their medical attainments. Morgagni only forms a final link in the chain of great Italian medical scientists, connecting medieval with modern medicine. From the time of Vesalius to that of Morgagni there was never a period when Italy did not possess the leading medical investigator of Europe. We need only mention such names as those of Fallopius, who added so much to our knowledge of abdominal anatomy; Eustachius, to whom we owe many important details of the anatomy of the head; Spigelius, whose name is forever associated with the liver, and Malpighi, to whom the whole round of the biological sciences allied most closely to medicine owes more than perhaps to any other single investigator, to show the complete justification for this claim. As a matter of fact, every encouragement to the progress of medicine was extended both by the secular and the ecclesiastical authorities in Italy during these centuries, and the Italian peninsula was from the beginning of the sixteenth to the end of the eighteenth centuries the mecca for ardent medical students desirous of exhausting the medical knowledge of their time, quite as Germany has been in our day. {33} John Baptist Morgagni was born on February 25, 1682. His birthplace was Forli in Romagna. It was the capital of a little papal state, lying at the foot of the Apennines to the southeast of Bologna. The modern American traveler is likely to know something about it, because it is one of the principal stopping places on the road from Bologna to Rimini, for at least the feminine portion of any travelling party will want to make a pilgrimage to the home of Dante's poor Francesca and to the scene of the heroic exploits of Catarina Sforza, the great woman of the Renaissance, to whom in all honor, and without any tinge of the discredit it has since come to convey, was given the proud title of the Virago of Forli. The little town is noted for the beauty of its situation, and well deserves a visit for itself, for it contains a famous palace built after designs made by Michael Angelo. The town had decreased in importance and population at the end of the seventeenth century, when Morgagni was born there, but it was favorably known for the high standard of cultivation among its inhabitants, possessed a good library, a number of schools and a well-known college. Like many another great man, Morgagni seems to have been especially fortunate in his mother. He was left an orphan at a very early age. His mother, however, whose maiden name was Maria Tornieli, not only bore her loss bravely, but devoted her life and talents to the education of her gifted son. She seems to have been a woman of uncommon good sense and remarkable understanding. Morgagni often spoke of her during the course of his life, and attributed much of his success to the training he had received from her. It is the custom sometimes to think that women have come to exert great cultural influence only in these latter days. Nothing could be more untrue. All through history are abundant traces of women exerting the {34} highest intellectual influences in their own sphere, and the North Italians in their era of highest cultural development seem to have been happier in nothing more than their recognition of the possibilities that lay in providing educational facilities for women. These times and this part of Italy are famous in history for some of the opportunities afforded women in the matter of higher education. It has been suggested that it is perhaps to the liberal culture of the mothers we owe the fact that this part of Italy furnished for one hundred and fifty years about this time the greatest men in science of the time. It is well known that women occasionally held professorships at the University of Bologna, not far from Morgagni's birthplace. The general culture of the women of this section was very high. Modern masculine historians have even been ungenerous enough to point out that Bologna was famous for two things--the opportunities provided for the higher education of women and the extensive manufacture of various forms of prepared food, the best known of which, the classical Bologna sausage, has come down as a precious heritage to hurried housekeepers in our own time. After an excellent preliminary education at Forli, always under the careful supervision and enlightened encouragement of his mother, Morgagni, as might have been expected from the place of his birth, went to the neighboring university town of Bologna for his higher studies. Bologna was at this time at the very acme of its reputation as the greatest of existent medical schools. The science of anatomy had been especially developed here as the result of important investigations and discoveries made by some of the greatest men in the history of medical science. Mondino had, very early in the fourteenth century, recreated the modern science of anatomy as we know it. He was the first to realize the importance {35} and urge the necessity for the dissection of human bodies, if any real lasting progress in human anatomy was to be made. Medical teaching before this time had been largely by lectures and disputations upon the work of Aristotle, Hippocrates and Galen, but actual observation on human tissues and organs now replaced the older method. Bologna became a papal city in 1512, and it is especially after this date that, under the fostering care of the Popes, the University of Bologna became the centre of medical teaching for the whole world for several centuries. As the result of actual observation and patient study instead of idle theorizing there came a large number of great discoveries in anatomy. From Mondino to Morgagni there is a continuous series of great men in connection with the University of Bologna such as no other institution can show. About midway between the first and last came the great Vesalius, who taught at Bologna as well as at Padua and Pisa, and whose work on anatomy was to be a treasure for anatomists of all countries for many generations. It was while teaching at Bologna that Vesalius made the famous series of dissections which formed the subjects of the illustrations for his great work on anatomy. Titian, the celebrated Venetian artist, who had come down from Venice in order to study anatomy for artistic purposes at the famous school of anatomy and under the supervision of its great teachers, is said to have executed the plates for the book. The work remains a worthy monument of the two great masters in their respective professions whose collaboration created it. During the century before Morgagni's entrance into the University of Bologna, the distinguished English physician Harvey, who was to lay the foundation of modern physiology by the discovery of the circulation of the blood, was attracted to Bologna because of the opportunities it presented for {36} advanced work in the studies in which he was so much interested. While repeating some of the dissecting work that Vesalius had done Harvey was led to suspect the existence of the circulation and had his thoughts directed in the channel which finally led to his masterly exposition of the subject. In a word, here at Bologna the study of the physical side of life, so important a characteristic of latter-day science, became a distinct and recognized branch of science. As Professor Benjamin Ward Richardson said, in his sketch of the life of Morgagni, "Since that time there has been no decline in interest in these studies and medicine has been developed in a manner as daring in project as it has been useful in application." Bologna was, at the time, certainly an excellent place for Morgagni. He went there as an inquiring youth of fifteen and began his medical studies at once. He became a student of two of the most celebrated professors of the time--Albertini, a leader in his day, though since more or less forgotten, and Valsalva, whose investigations into the anatomy of the ear assure him a permanent place in the science of anatomy for all time. When Morgagni went to the university, Valsalva was at the zenith of his brilliant career as an anatomist. He was in the midst of his great work on the organ of hearing. This extremely intricate piece of human mechanism had never been understood before his time, and the working out of its details proved a time-taking but intensely interesting investigation. It was not long before the genial insight of Valsalva picked out Morgagni as a person excellently fitted to assist him in his dissecting work. Morgagni had not only an enthusiasm for the work, but had, what is much more precious under the circumstances, untiring patience and industry and unswerving perseverance. These were the qualities that were {37} afterward to prove the foundation of his reputation. His genius consisted certainly in the faculty for hard work, and his special talent was an infinite capacity for taking pains. Nearly all of the dissections which Valsalva required for his demonstrations during lecture hours, or for the illustrations of his books, are said to have been made by Morgagni under the master's personal supervision. After four years of this precious training and study at the university, Morgagni took his degree as Doctor of Medicine and of Philosophy. The late Benjamin Ward Richardson, one of the great English medical men of the end of the nineteenth century, says that this is a happy combination of qualifications which might, with great advantage, be required of the graduate in the present day, when so much of medicine and so little of philosophy is demanded of the student, to the manifest detriment of both departments of knowledge. Some idea of the estimation in which Morgagni was held at this time may be gathered from the fact that, though scarcely more than twenty-one years of age, he was sometimes allowed to assume Valsalva's lecture obligations during the master's absence. After graduation he spent some time at the university doing special work in connection with the science of anatomy, in which he was so much interested, and as an assistant professor and tutor. Bologna at this time enjoyed as wide a European reputation as at any period of its history. Students from all countries in Europe flocked here, especially to make their legal and medical studies. Among the medical students Morgagni was always a moving spirit, a leader in the phases of thought in many lines that were occupying students' minds at the time. He was the founder and director of a society of young professors and maturer students, whose object was the discussion of scientific subjects of many kinds. The standard of the {38} new society was personal investigation and observation as a means of arriving at scientific truth. The principal maxim that guided their discussions seems to have been that nothing was to be accepted on authority, merely because it was authority. In the physical sciences thought had been frequently cramped to fit the old theories inherited from Galen and Pliny and Aristotle and Hippocrates. A quotation from one of these classic authors on a point at issue was supposed to throw light on any difficulty that might be the subject of discussion. Morgagni's society was called the Academia Inquietorum--"The Academy of the Restless"--the idea of the curious name being that the members were not satisfied to rest peacefully in the knowledge to be gleaned from the older authors, but preferred to get at science for themselves by direct observation and planned experiment. Morgagni's idea in founding the society seems to have been premature. The fate of the Academy of the Restless is involved in some obscurity, but biographers seem to hint that it failed of its purpose. Neither the university nor the times were yet ready for such freedom of thought as this. Even in our own day such a scheme would be considered radical and chimerical. The discouragement met with finally led to the abandonment of the meetings, and Morgagni gave up his attempt to inspire others with his own industry and enthusiasm for original investigation in the physical sciences. For some years after this he seems to have been absent from Bologna. His time was spent especially at the medical schools of the great universities of Pisa and of Padua. Students who wished to make some special branch of medicine such as physiology, or anatomy, or the, then as yet scarcely known, science of pathology, their prime object in life, had to visit various universities in order to find opportunity and {39} suggestion for study. Morgagni devoted himself so faithfully to his work that his eyesight failed him for a time and very probably his general health also. For some years he returned to his native town to recuperate. Here he took up the active practice of medicine. As so often happens, this period of rest after years of study proved especially broadening in its influence upon Morgagni. After his rest his contemporaries begin to realize his great possibilities as a scientist. His first publication was a series of notes on anatomy. These were published in the form of collected essays, with the title _Adversaria Anatomica_. The title has a pugnacious sound, but Morgagni did not indulge in controversy and _adversaria_ is only the Latin name for note-books. The first articles thus collected were really communications made by Morgagni to the "Academy of the Restless" during his presidency of that body. This opened his career as a writer, and it is interesting to note that his last book was to be published some sixty-three years later--a period of fecund authorship almost unprecedented. As the result of the reputation gained by this work he was offered a teaching position at the University of Padua and later was transferred to the chair of the second professorship of anatomy. After a few years he succeeded to the first professorship of anatomy at the university, at that time the most important post in the medical school. This gave him, at the age of about thirty-five, one of the greatest university professorships in the world. Opportunities for research were now amply provided. He was in a position where his communications would be received with due attention and his reputation was secure. A university professorship in those days was a position of more importance than even in our own, and Morgagni was {40} especially favored in the fact that it had come early in life, so as to enable him to round out his career. His work was eminently congenial to him, and the labor it involved was that which constituted for Morgagni the highest form of recreation. He made many friends among professors and students. The lectures which Morgagni delivered to the university became so popular that his lecture-room was overcrowded and new quarters had to be provided. Many foreign students were attracted to the university by his wide-spread reputation as a great and suggestive teacher. These students came in great numbers especially from the northern countries of Europe. At one time there were over a thousand German students at the University of Padua, and when they organized into a guild for mutual help and social purposes, Morgagni was chosen by them to act as their patron. Here at the University of Padua Morgagni was to found the new science of pathological anatomy. Normal anatomy had received its development at the hands of the other great masters in the schools of North Italy. To Morgagni was to be given to describe the changes which take place in organs as the result of disease. Needless to say, this is the most important practical branch of modern medical science. The symptoms of disease mean very little unless we know just what organs are affected and what changes have taken place. Morgagni's work on _The Seats and Causes of Disease_ contains the foundation of modern pathology. Modern advances might seem to put it out of date, but the acuity of its author's observations and the truth of his investigations make it an enduring classic. Of this work of Morgagni's, Professor Benjamin Ward Richardson, said: "To this day no medical scholar can help being delighted and instructed by the study of this wonderful book. To move into it from the midst of a body {41} of current medical literature, is like passing from the periodical flux of current general literature to the perusal of a Shakespearean drama, the _Pilgrim's Progress_, or _Paradise Lost_. It is a transition from the mediocrity of incessant repetition of well-known truths told in long and hackneyed terms, back to descriptions derived direct from nature and fresh from her treasury. It matters not where the book is opened, it is always good and instructive reading, full of suggestion and rich in original narrative." Some of Morgagni's work in clinical medicine and in pathology, as detailed in these volumes, remains of perennial interest and is often referred to. Many an after-time discovery, proclaimed loudly by its author, will be found, at times only in embryo but often enough in entirety, in its pages. There are frequent surprises to the reader in the anticipation of what are supposedly much later thoughts in medicine. Some of these passages of more general interest I venture to present here. It was Morgagni who first realized that minute connections between parts of the nervous system might very easily provide the basis for symptoms quite distant from the site of actual disease. He gives, for instance, a detailed account of a curiously interesting case in which the patient, a man somewhat beyond middle life, was annoyed on a number of occasions by violent sneezing. These attacks of sneezing became more and more frequent and finally were accompanied by difficulty of breathing and a sense of pressure over the chest. These symptoms became more and more marked, until finally, during an especially violent attack of sneezing, the man suddenly died. Up to this time anatomists generally had declared that there was no direct nervous connection between the mucous membrane of the nose and the diaphragm. Sneezing is {42} due to a violent contraction of the diaphragm and is almost invariably caused by the presence of an irritant in the nose. This is, in fact, nature's method of getting rid of irritant material on the sensitive nasal mucous membranes by an explosive expulsion of air through the nose. This expulsion of air is brought about by a convulsive contraction of the diaphragm. It had always been supposed that the sneezing was due to irritation transmitted through the brain to the diaphragm. Morgagni, in discussing the reason why the diaphragm should be excited into sympathetic reaction by the presence of an irritant in the nose, pointed out a fact that had been forgotten or the significance of which had not been appreciated. The membrane of the nose concerned in smell is supplied by the first pair of cranial nerves, the so-called olfactory nerves. Between this olfactory nerve and the nerve which supplies the diaphragm, the phrenic nerve, which is a cervical and not a cranial nerve, that is to say, comes from the central nervous system through the spinal cord in the neck and not directly from the brain, the older anatomists declared there was no connection. Morgagni pointed out that the mucous membrane of the nose is partly supplied also from the fifth pair of cranial nerves. From the fifth nerve, small branches of connection with the cervical nerves, as low even as the intercostal nerves, had been traced by Meckel. This shows the possibility of a nervous reflex; that is, of a communication of nerve impulses without the necessity for the intervention of the central nervous system. This was the first direct tracing of distant reflex nervous action in human physiology. The problem of nervous reflexes was to remain obscure for more than a century later, until light was thrown upon it by the investigation of the French physiologist, Claude Bernard. Here, however, was {43} the pregnant suggestion of the explanation of the seeming mystery. In subsequent cases Morgagni looked for the confirmation of his theory in this matter and found it. He pointed out that there was a relationship between the abdominal viscera and the olfactory mucous membrane of the nose. In one of his cases an epileptic seizure was always accompanied by a sense of discomfort in the upper abdominal region and a fetid odor. This odor was entirely subjective; that is, though extremely annoying to the patient it could not be noticed by any one else, even though the patient was close at hand and exhaled his breath at the moment of the observation. This would seem to point to the fact that Morgagni suspected there were other connections between the special senses and important organs besides those which had been discovered by anatomists up to that time. As a matter of fact the so-called sympathetic nervous system does place all the organs of special sense in direct connection with the other important organs of the body. Morgagni's suspicions were to be confirmed by the discoveries made in this sympathetic system during the succeeding century. Morgagni first of all seems to have realized what was the mechanism by which alcohol injures the human system. He pointed out that the excitation of the heart due to the action of alcohol was reflected in an overdistention of the arteries. This overdistention gradually led to degenerations in the arterial walls. The loss of elasticity thus induced brought on a disturbance of the circulation in the important organs of the body, and so gave rise to symptoms of wide-spread interference with organic functions. Morgagni's studies in aneurism, that is, in the dilatation of bloodvessels, show how thoroughly he understood the mechanism of the formation of this serious pathological {44} condition. He pointed out that the first noticeable disease change that occurs is a degeneration of the inner coat of the artery. This leads to the formation of furrows on the inner wall of the vessels and finally brings on weakness of the middle coat of the artery. He realized that the progress of these arterial changes is due to a large extent to blood pressure within the arteries. He felt, too, that blood pressure could be kept from being dangerously high by strict attention to diet limitation. If aneurisms are discovered in early stages the patient's life may well be prolonged by these simple measures. This idea contains the germ of the Tufnell treatment, which has been the most successful therapeutic measure for the treatment of aneurism in the nineteenth century. The Italian anatomist's acumen led him to appreciate better than ever before in medical history the influence of the mind on the circulation. He pointed out that emotions have a powerful influence on the circulatory system in all its parts. How much the peripheral bloodvessels are affected can be seen in the tendency to blushing during certain forms of excitement, involving shame or embarrassment; on the contrary, pallor in anger, or indignation, or fright. He pointed out, too, that the heart is affected by such emotions and is sometimes strenuously excited and sometimes very much retarded. Morgagni understood that the influence of such emotions in especially excitable individuals leads to wear and tear on the bloodvessels and so to a shortening of lives. He thought of some aneurisms, even those affecting the large bloodvessels, might be caused by sudden intense emotions, and especially by violent efforts to suppress or conceal emotions. We know now, however, that these pathological conditions are due to human passions, but quite other than those which Morgagni had in mind. It is interesting to note that comparative {45} pathology--that is, the study of the diseases of animals as illustrating corresponding conditions in human beings--had already attracted the attention of the Bolognese school of medicine. Albertini, who had been a professor of Morgagni's, pointed out that aneurisms are rarely found in animals, because brutes were not subject to emotions as are human beings. Morgagni made still further observations in this line to confirm his own conclusions in the matter. For a time in his earlier life he devoted himself to the study of fishes, because they seemed to promise to throw light on certain problems in human anatomy and pathology. How closely he studied pathological changes in tissues can be gathered from the fact that his observations led him to point out that aneurism of the aorta occurs most frequently at that part of the curvature of the aorta against which blood is constantly projected by the heart. The realization of the importance of this mechanical factor in the production of aneurism is one of the first successful results of carefully applied observation and knowledge of physical laws in the causation of changes in the tissues as opposed to elaborate theories with very little foundation in fact. Variations in the pulse attracted his attention, and he was among the first to point out that the occurrence of flatulency is liable to cause disturbance of the heart's action and to bring on noticeable cardiac palpitation in the absence of any organic affection of the heart itself. Morgagni also pointed out that intermittence of the pulse may be due to nervous conditions. He showed that severe mental shock or trying emotions may cause irregularity of the heart's action and pulse intermittency. Some of his observations in this matter show an intuition with regard to the nerve supply of the heart that is quite beyond the anatomy of his time, and seems to indicate that he suspected the existence and {46} function of the sympathetic system and also the existence of a special nerve supply to the small arteries. Perhaps Morgagni's most penetrating evidence of insight in pathology and its relations to clinical medicine is with regard to tuberculosis. Over a century and a half ago he insisted on its contagiousness. He refused to make autopsies on patients who had died of tuberculosis, and his position in the matter was undoubtedly of the greatest service in directing the attention of his contemporaries, and especially those closely in contact with him, to the important question of intimate association with tuberculous patients as a potent factor in the acquirement of the disease, more potent even than heredity which then occupied all men's minds on this subject. It might be deemed that this advanced position of Morgagni was due rather to intuitive abhorrence of the disease than to the conviction of actual observation, and that his conclusions were the result more of prejudice than of real knowledge. Any such opinion, however, is absolutely contradicted by the fact that he knew and understood better than any one of his generation the pathology of consumption. He pointed out at a time when any chronic affection of the lungs was liable to be considered consumption that there are a number of forms of chronic bronchitis that are not due to pthisis pulmonalis, but to other slow-running conditions within the lungs. He anticipated very completely the present position of surgery with regard to the treatment of cancer. He advised the operative removal of these malignant tumors whenever possible. As Benjamin Ward Richardson points out, this advice was given evidently not with the idea that the disease could be always thus completely cured, but because early operation gave speediest relief of annoying {47} symptoms and assured the greatest prolongation of life. Many other methods of removal of cancerous growths were suggested in Morgagni's time, as in our own, and many false promises made and false hopes raised by their advocates. He pointed out that the quickest, the safest, the surest and in the end, for the patient, the easiest method of removal is by the knife in the hands of the bold and skilful surgeon. After a century and a half of vauntedly great advance, especially in surgery, we are practically in the same position as when Morgagni's advice was penned, and his opinion remains practically as valuable to-day as then. In another important point of medicine Morgagni seems to have anticipated the opinion of our own time. It was the custom to practise venesection very freely. On one or two occasions in his own lifetime Morgagni fell ill and venesection was recommended. His biographer says that he constantly refused this method of treatment, adding very naively, "and he who had often cured others by venesection would never allow this remedy to be used upon himself because, as I believe, he had a natural abhorrence to it." It was an index of thoroughgoing independence of thought in those days to stand out, even for personal reasons, against the overwhelming tradition in favor of blood-letting. But Morgagni had well-grounded doubts as to the remedial efficacy of abstraction of blood, and at least avoided it in his own case. Besides his skill in practical and theoretic medicine, Morgagni was a man of cultivated taste in art, and he was conversant not only with the literature of his own language, but also of French, Latin and Greek. He was always welcomed in the literary circles of the cities of Northern Italy, and counted among his friends many of the great writers of the time. His success in winning the friendship of rulers was especially {48} noteworthy, and had not a little influence for the advantage of education and science. The patricians of Venice were proud to consider him as a personal friend, and to the Venetian Senate he owed his professorship at Padua. The King of Sardinia, Emanuel III, looked upon him as an intimate acquaintance. All the Popes, five in number, of the second half of his life were on terms of personal intimacy with him, and his advice was asked on many important questions with regard to educational matters in his own day. Some of these Popes are among the most influential pontiffs that ever occupied the Roman See. The great Benedict XIV, himself a native of Bologna and an intimate friend of the scientist, in his classic work "De Beatificatione Servorum Dei" mentions Morgagni in terms of special commendation. His scarcely less famous successor, Clement XIII, had often consulted Morgagni professionally at Padua before his elevation to the See of Rome. After his election as Pope he assures Morgagni of his continued esteem and friendship, and asks him to consider the Vatican always open to him on his visits to Rome. In an extant letter Clement praises his wisdom, his culture, his courtesy, his charity to God and men, and holds him up as an example to others, since with all his good qualities he had not aroused the enmity or envy of those around him. Morgagni's life must have been in many ways ideally happy. Rewards for his scientific success began early in life, even before his professorship, and continued all during his long career. The Royal Society of England elected him a fellow in 1724; the Academy of Sciences of Paris made him a member in 1731. In 1735 the Imperial Academy of St. Petersburg conferred a like honor upon him. In 1754 the Academy of Berlin elected him to honorary membership. His English biographer, Dr. William Cook, says quaintly {49} that all the learned and great who came into his neighborhood did not depart without a visit to Morgagni. He was in correspondence with most of the great men of his time, and the terms of intimate relationship that this correspondence reveals are the best evidence of the estimation in which Morgagni was held, especially by the prominent scientists of his time. Among them were such men as Ruysch, Boerhaave, Sir Richard Mead, Haller and Meckel. This wide acquaintanceship of itself was a great distinction at a time when the means of communication were so much more limited than at present. It is gratifying to think that Morgagni must have been enviably content in his private life, though, as usually happens when this is the case, very little is said explicitly on this subject. His untiring labor deserved the compensation of a loving domestic circle. During his retirement at Forli, after his graduation from the university and when, from overwork, his health failed him for a time, he married the descendant of a noble family of the town, Paola Vergieri by name, a companion for him who, biographers declare, could not have been surpassed in judgment or in affection. They had a family of fifteen children, eight of whom survived their father though he lived to the ripe age of eighty-seven years. There were three sons, one of whom died in childhood; another became a Jesuit and taught in the famous Jesuit school at Bologna whose magnificent building has now become the municipal museum, the Accademia delle Belle Arte. The third followed his father's profession, married and settled in Bologna, but died before his father, who assumed the care of his grandchildren. All Morgagni's daughters who grew up to womanhood, eight in number, became nuns in various religious orders. The spirit of science had not disturbed the development {50} of a homely simple faith in the family. The great Father of Pathology, far from being disturbed by the unselfish self-sacrifice of so many of his children, bore it not only with equanimity but even rejoiced at it. His relations to his children were ever most tender. After the suppression of the Jesuits, his son, who had been a member of the order, worked at science with his father at the University of Bologna and not without distinction. The estimation in which Morgagni was held by his contemporaries can be judged from the fact that twice when invading armies had entered the Emilia and laid siege to Bologna, their commanders, as in old Greek history did the Grecian generals with regard to Pindar and Archimedes, gave strict orders that special care was to be taken that no harm come to Morgagni, and that his work was not to be hampered. Having lived his long life amidst the reverent respect of all who knew him, he died full of day and honors. Succeeding generations have not been backward in acknowledging Morgagni's merits. I have already spoken of Virchow's tribute to his greatness. The Italians have long considered him as one of their most brilliant names in medicine. One of the best known of the representative Italian medical journals is _Il Morgagni_, published at Milan. To its pages the foreigner seeking to know the progress of Italian medicine turns almost as the first resort. _Il Morgagni_ was founded some fifty years ago, and continues to uphold its reputation as one of the world-known medical periodicals. The great medical scientist whose work was to prove the foundation of modern pathology, and thus be the source of more blessings to mankind than ever even he dreamed of, remained in the midst of the reverence and gratitude of his generation, one of those beautifully simple characters whom all the world delights to honor. As a teacher he was the {51} idol of his students. No great scientist who came to Italy felt that his journey had been quite complete unless he had had the privilege of an interview with Morgagni. This friend of Popes and of many of the European rulers was the happy father of a houseful of members of religious orders, and considered himself blest that so many of them had chosen the better part. He was himself all during his long life the ardent seeker after truth, who did well the work that came to his hand and followed his conscience in sincere simplicity of heart and reaped his personal reward in the peace that is beyond understanding to those who have not the gift of faith to appreciate the things that are beyond the domain of sense. {52} {53} AUENBRUGGER, THE INVENTOR OF PHYSICAL DIAGNOSIS {54} While medicine is your vocation, or calling, see to it that you have also an avocation--some intellectual pastime which may serve to keep you in touch with the world of art, of science, or of letters. Begin at once the cultivation of some interest other than the purely professional. The difficulty is in a selection and the choice will be different according to your tastes and training. --Osler, _Aequanimitas and other Addresses_. {55} AUENBRUGGER, THE INVENTOR OF PHYSICAL DIAGNOSIS. At the present time the most interesting development in medicine is the gradual reduction of the death rate from tuberculosis. This is entirely due to the fact that the disease can now be recognized very early in its course, and that, as a consequence, the treatment may be begun before serious damage has been inflicted on the lungs. Under the circumstances, the disease formerly supposed incurable has become according to all the best modern authorities one of the most tractable of infectious diseases. In their recent lectures in Philadelphia, before the Phipps Institute for the Prevention and Cure of Consumption, such distinguished medical authorities as Dr. Trudeau, of Saranac; Professor Osler, of Johns Hopkins, and Professor G. Simms Woodhead, of Cambridge, England, insist on the absolute curability of tuberculosis when it is taken in time. Professor Woodhead particularly asserts that there has been entirely too much pessimism in this matter, even among physicians. This present confidence with regard to the successful treatment of pulmonary consumption is due to the fact that the diagnosis can be made early. The glory of this early recognition depends entirely on two men--Auenbrugger, of Vienna, and Laennec, of Paris. To Auenbrugger, whose work was done nearly half a century before that of Laennec, must be given the credit of having first approached the problem of differentiating diseases of the lungs from one {56} another by methods which were so objectively practical that every practitioner of medicine could, after having become expert in their employment, use them with absolute confidence in his diagnosis. Modern medical science and practice acknowledges very gratefully its deep obligations to what is known as the Vienna school of medicine. It is not a little surprising to find that it was the practical side of medicine particularly which was developed at Vienna, since the inhabitants of the Austrian capital, while supposed to have artistic tastes far above the average, are usually considered to be among the most impractical people in Europe. For over one hundred and fifty years, however, the medical department of the University of Vienna has always ranked among the first in the world. Many of the Viennese professors of medicine have been acknowledged as the greatest teachers of their time. Beginning with Van Swieten and De Haen during the second half of the eighteenth century, the medical department of the University of Vienna has scarcely ever been without at least one of the leading lights of medicine in Europe. Wunderlich, Rokitansky and Skoda were, in the middle of the nineteenth century, the greatest medical men of their time. Hebra, Billroth and Nothnagel worthily continued the tradition of medical greatness in the Austrian capital. Even at the present time, notwithstanding the great advance in medicine and medical teaching that has come over all Europe, it is generally conceded that the best place in the world to study clinical medicine--that is, to study illness at the bedside of the patient--is the famous Allgemeines Krankenhaus, the General Hospital of Vienna. The clinical teaching of medicine developed much later in the history of medical education than might naturally have been expected. There is a tradition of bedside instruction {57} in medicine in old Grecian times at the various shrines of AEsculapius, but this is not well authenticated. Early in the sixteenth century came the modern birth of clinical medical instruction at St. Francis's Hospital, in Padua, in connection with the University there, which in every line did so much for modern medicine. The first clinic that attracted widespread attention, however, did not come until Boerhaave's time, at the end of the seventeenth and the beginning of the eighteenth century. The bedside instruction in medicine by this distinguished master drew hosts of students to the hitherto comparatively unimportant University of Leyden, in Holland. Two rulers--just the two who, to modern minds, would perhaps appear least likely to do so--at once recognized the immense practical value of this innovation in medical teaching and immediately set about securing its benefits for their people. Pope Benedict XIII and the Empress of Austria put themselves in communication with Boerhaave, and the Pope was the first to avail himself of the advice in the matter which the great Dutch master gave. The Roman clinic became, in the first half of the eighteenth century, under the direction of the distinguished Lancisi, one of the best known in Europe. The Austrian Empress, Maria Theresa, interested in everything that could prove to be for the benefit of her people, invited the distinguished pupil of Boerhaave, Van Swieten, to become her family physician, and encouraged him in the foundation of a clinical medical school at Vienna. Van Swieten soon came to occupy a very prominent place at Court. When he was invited from Holland, on the recommendation of the sister of the Empress, there was no heir to the Austrian crown, though one had been anxiously looked for for several years. Heirs to the number of sixteen in all blessed the imperial family in the next twenty-five years, {58} and Van Swieten became the confidential adviser of the reigning monarchs in polity as well as in medicine. Accordingly, when he suggested the invitation of De Haen, who had also been a pupil of Boerhaave, the suggestion was promptly accepted, and the Leyden colleagues became the founders of the Old Vienna School of Medicine, as it is called. They established the tradition of bedside teaching, of actual practical experience in the treatment of patients, and of the collection of detailed information of every feature of cases that could possibly be helpful for diagnosis. They also established the custom of demonstrations on pathological material with confrontation of the diagnostic conclusions during life and the findings of the postmortem examination in fatal cases, which, down to our own day, makes Vienna an ideal place for serious post-graduate work in clinical medicine. It was not long after the establishment of the clinic on these broad lines at Vienna before the first important fruit of the new teaching method was to be gathered. Curiously enough, however, this initial advance in practical medicine did not come from one of the distinguished heads of the clinic, but from a comparatively young man of no previous reputation. The greatest discovery ever made at Vienna is due to Auenbrugger, an unassuming practitioner of medicine, who came from the Austrian province of Styria, or, as it is called in German, the Steiermark, about the middle of the eighteenth century. He was the son of a small hotel keeper of Gratz, and, after making his medical studies in Vienna, he remained at the capital for some years, doing hospital work. While thus engaged, the young Styrian, who attracted very little attention except for his affability, and who made no pretension to special knowledge or genius in observation, {59} laid the first stone in the structure of modern exact diagnosis of pulmonary disease, and cleared up many of the obscurities in which all affections of the chest had been shrouded before his time. Having accomplished this noteworthy achievement before he was forty years of age, Auenbrugger then quietly settled down to be an ordinary medical practitioner in the Austrian capital, with a special reputation for his knowledge of chest diseases, and for kindly ways that gave him as much interest in his poor patients as in those that could afford to pay handsomely for his services. Leopold Auenbrugger, afterward Edler von Auenbrug--a term about equivalent to the English "Knight of Auenbrug"--who thus stands at the head of modern medical diagnosis, was born on the 19th of November, 1722, at Gratz, in Lower Austria. His early education was received at Gratz, and it seems to have been of rather a comprehensive character, for Auenbrugger, later in life, was a member of the elegant literary circles in Vienna and a welcome friend at the tables of cultured and distinguished fellow-townsmen. It will be recalled, by those who remember German literature, that at this time Vienna was the centre of culture in Germany, attracting many literary men--as, for instance, the two Schlegels--from other parts of Germany. Auenbrugger's father was of the lower middle class, the proprietor of the Gasthaus Zum Schwarzen Mohren, in one of the suburbs of the city of Gratz, but also the owner of another hotel in the city itself, so that he was able, by making some sacrifices, to afford his son a university and medical education in Vienna. The family were not in very affluent circumstances, however, and in this Auenbrugger was in the same condition as many other of the distinguished medical men who have made important original discoveries. Volta, Laennec, Johann Mueller, Helmholtz, Pasteur and {60} Virchow were all the sons of comparatively poor parents, and had to eke out their university education by doing teaching work as soon as they were considered capable. Auenbrugger's studies in medicine were pursued under the well-known Baron Van Swieten. Van Swieten was, as has been said, one of the most distinguished of Boerhaave's pupils, and devoted most of his life to writing a set of commentaries on Boerhaave's aphorisms and editing his master's work. Van Swieten's greatest ambition was to make the Austrian capital the home of the great clinical school of medicine and a pilgrimage at least as attractive for physicians seeking to study practical medicine at the bedside as had been his own alma mater at Leyden. He was of so great administrative ability that Maria Theresa made him one of her state counsellors. With all the influence of the government behind him, then, it is not surprising that Van Swieten succeeded in his very laudable project of establishing a great medical school at Vienna. It was fortunate that Auenbrugger made his medical studies under such good auspices. We have no details of his student life nor of his success in his examinations. Even as a student his engagement of marriage to Marianna von Priesterberg was announced. The formal marriage ceremony took place in 1754, when Auenbrugger was about thirty-two years of age. His wife seems to have had a dowry, and this enabled Auenbrugger to begin his medical career in Vienna. Some years before this, as a young graduate physician, he had accepted the position of resident medical attendant at the Spanish military hospital of the Holy Trinity in Vienna. This hospital was large and important and provided manifold opportunities for clinical study. Its wards were frequently drawn on by the {61} clinical department of the University of Vienna for cases to be demonstrated before the students. This fact was sufficient to make Auenbrugger's position of great educative value for him. Mistakes in diagnosis would be apt to be discovered, since the interesting cases were reviewed by some of the best physicians of the time in Europe. His position carried with it no salary beyond his maintenance, but proved well worth the time he gave it, since it developed in him habits of careful investigation. Just ten years after he began his work at this hospital he published the little book called "Inventum Novum," or new discovery, on which his reputation depends. It was written in Latin, and its full title ran: "A New Discovery that Enables the Physician, from the Percussion of the Human Thorax, to Detect the Diseases Hidden within the Chest." Altogether his little manual probably does not contain much more than ten thousand words. It is perhaps two or three times as long as thousands of medical articles published every year in our modern medical journals. It contains, however, one of the most important discoveries in the whole history of medicine. One of the best diagnosticians of the nineteenth century, Skoda, the distinguished head of the Vienna school of sixty years ago, calls the discovery that Auenbrugger outlined so unpretentiously "the beginning of modern diagnosis," and hailed Auenbrugger himself as the founder of the new science of diagnosis that was to prove so fruitful of good in the prevention of human suffering. It is interesting to compare Auenbrugger's little book with Van Swieten's commentaries on Boerhaave's works, which were published in some eight huge volumes. Van Swieten's successor, De Haen, an equally illustrious contemporary of Auenbrugger, published about the same time some eighteen volumes on the science of medicine. Neither {62} of these works is ever consulted now, except by some enthusiastic student of the history of medicine, who wishes to clear up a point in medical historical development; but Auenbrugger's unpretending monograph is, and will ever remain, a classic. Practically nothing has been needed to complete the clinical usefulness of his discovery. Like Laennec, whose work was done just half a century later, he had the genius to realize what the possibilities and the limitations of his discovery are, and he completed it in all its details before giving it to the public. Auenbrugger's discovery consisted in recognizing that diseases of the chest can be distinguished from one another and their varying character differentiated by the sounds elicited when the chest is tapped with the finger. To this tapping he gave the technical name, since become classic in medicine, of percussion. Wherever there is air in the chest, that is all over the healthy lungs, the sound elicited by percussion resembles that given out by a drum over which a thick woolen cloth has been placed. Over the heart, where there is no air, the sound given out, when the chest is percussed, corresponds very nearly to the sound produced when the thigh is tapped. The sound elicited by percussion of the thigh Auenbrugger took as the standard of dulness and applied to it the term Schenkel-ton, or thigh sound. When the lungs become consolidated because of an inflammatory process such as pneumonia or tuberculosis, then the percussion note over the consolidated area resembles the sound over the leg or that found over the heart. As a rule the heart is somewhat covered by the lungs, and the sound produced by percussion over it is not quite as dull as that over the solid muscular structures of the legs. Whenever fluid finds its way into the thorax, as in pleurisy, then the sound produced on percussion is very dull. {63} Auenbrugger further showed that by means of the sound thus obtained he could demonstrate the size of the heart under varying conditions, and so determine whether it is larger than normal or not. This gave the first inkling as to the discernment of hypertrophy and dilatation of the heart, and was the first step in the modern differential diagnosis of heart diseases. He showed, moreover, that he could, by percussion, outline very exactly the extent to which a consolidation of the lung has taken place, or the height to which an effusion into the pleural cavity reaches. These conclusions and demonstrations require not only the greatest care but the most deliberate confirmation of every detail by comparison of the diagnosis during life with the condition found after death in fatal cases. Auenbrugger seems to have spared neither time nor labor in this work of confirmation. He made a number of experiments upon dead bodies, injecting fluid into the pleural cavity and then demonstrating by percussion the line of demarcation that indicated the level of the fluid within the chest, as well as the pulmonary conditions that developed because of its presence. In the study of pneumonia and tuberculosis particularly, Auenbrugger spent many hours of patient investigation during his ten years of hospital service. He succeeded not only in demonstrating the presence of consolidation, but also the existence of cavities in the lungs and their size and general character. Vienna was an ideal place for the development of Auenbrugger's ideas of confirmation. At this time, it must have been one of the most unhealthy places in Europe as regards pulmonary diseases. The city was surrounded by walls that occupied the ground now taken up by the magnificent Ring Strasse and the inhabitants were packed into extremely narrow quarters, The modern municipal sanitary {64} conscience is lax enough in our own day, but at that time it had not been awakened to the slightest sense of duty toward the citizens. Narrow, wandering streets lined by high buildings that made an attaché of the British Legation of Vienna speak of the houses of the city, scarcely more than fifty years ago, as "well-like," were the universal rule. It must be remembered that the present magnificent Austrian capital, containing, perhaps, the handsomest single street and some of the finest buildings in the world, is entirely a creation of the last half-century. The old city had every cause to be unsanitary. Situated in the valley of the Danube, liable in the spring-time to serious floodings from the capricious, mighty river, which has been brought under control only in recent years at great expense; in an exposed situation, which makes it a veritable temple of the winds during the autumn and winter; it is not surprising that tuberculosis should have been very frequent. Even with all its improvements in recent years, sanitary, hygienic, municipal and domiciliary, Vienna has at the present time one of the highest death rates from tuberculosis in Europe. In Auenbrugger's time there must have been practically unlimited opportunity for the study of pulmonary diseases of all kinds. How well the brilliant young medical observer took advantage of the opportunities thus afforded him can be judged very well from the passages of his book that refer to chronic pulmonary diseases. He divides the chronic diseases of the thorax in which abnormal percussion sounds are heard into two classes. In the first place, he places those in which the thoracic organs are rendered less capable of resisting disease and become actually affected, because of insidious influences, such as hereditary conditions, depressing circumstances, poverty and poor nutrition. Without really calling it tuberculosis, it is evident that in this group pulmonary {65} consumption is included. The second class consists of affections in which the thoracic organs become diseased from definite, easily recognizable causes. Such are disturbances of the general health in pulmonary affections that follow thoracic disease not completely recovered from. By these diseases Auenbrugger evidently intends cases of pneumonia or other affections of the lungs, or trauma and the like, which are followed by tuberculous processes. With regard to cavities in the lungs, Auenbrugger was able not only to demonstrate their presence and to show by autopsy records that his localization and determination of their approximate form and size were correct, but he also understood the method of their formation and explains the reasons for certain varieties of cavities that occur. He speaks of two classes of cavity formations. From one kind there is an ichorous discharge; from the other variety the evacuations are purulent. Cavities with non-purulent secretions are situated only in the lung. Abscesses of various kinds--that is, cavities with purulent secretions--may occur in any part, or in any of the organs of the thorax. The lung cavities are usually due to the breaking down of what he calls crude tubercles. Both kinds of cavities may either be closed or have an opening into the bronchi. Auenbrugger showed very well how to distinguish, by percussion, cavities of various kinds, and set it down as a principle, that before the evacuation of the contents of the cavity percussion over it gave a distinctly dull note, resembling that obtained when the thigh is percussed, while after evacuation, as by copious expectoration, a distinctly resonant note occurred. It is clear from his discussion of the symptoms noted in cavities (at least in the opinion of Dr. Merbach, who wrote a sketch of Auenbrugger's life for the Jahresbericht der Gesellschaft für Natur und Heilkunde in Dresden, {66} in 1861), that Auenbrugger was very near the discovery of auscultation in his study of pulmonary cavities. Auenbrugger says that when a cavity has been located by means of percussion, if the hand be laid over the place beneath which it lies and the patient is asked to cough, the fremitus produced by the pus in the cavity can be felt as it moves under the coughing impulse. This is what we now know as palpation. If instead of using his hand Auenbrugger had applied his ear to the chest, auscultation would have been discovered nearly half a century before Laennec began his work upon the subject. Perhaps Merbach, who was himself a native of Styria and a professor at the University of Gratz, was for patriotic motives more ready than others might be to give Auenbrugger credit for practically discovering auscultation. Auenbrugger's and Laennec's observations were made on exactly the same sort of clinical material. They were both studying advanced cases of tuberculosis in the hospitals of a great city. Laennec's work was actually not anticipated in the slightest degree however. How Auenbrugger could have made the careful examinations of the chest that he did in thoracic diseases without acquiring some knowledge of the value of the further application of the sense of hearing, which Laennec was to employ so fruitfully in the diagnosis of affections of the lungs and heart, seems to us almost impossible to understand. Discoveries once made, however, always seem so obvious that the wonder is they were not made long before. It takes genius to cross the line into the realm of the hitherto unknown, and the contemporary generation usually occupies itself mainly with making little of the new discovery. Even genius very rarely makes more than one original observation in a lifetime, and it would be too much to expect more from Auenbrugger. {67} The preface to Auenbrugger's little book is a model of concise directness typical of the man and his ways. As the modest introduction to a work that will ever be a classic in medicine it seems to deserve a place here: "I present to you, kind reader, a new sign for the detection of diseases of the chest, which I have discovered. It consists in the percussion of the human thorax and the determination of the internal condition of this cavity by the varying resonance of the sounds thus produced. My discoveries in this subject are not committed to paper because of an itch for writing, nor an inordinate desire for theorizing. Seven years of observation have put the subject in order and have clarified it for myself and now I feel that it should be published. "I foresee very well that I shall encounter no little opposition to my views and I put my invention before the public with that anticipation. I realize, however, that envy and blame and even hatred and calumny have never failed to come to men who have illuminated art or science by discoveries or have added to their perfection. I expect to have to submit to this danger myself, but I think that no one will be able to call any of my observations to account. I have written only what I have myself learned by personal observation over and over again, and what my senses have taught me during long hours of toil. I have never permitted myself to add or subtract anything from my observations because of the seductions of preconceived theory. "I would not wish, however, that any one should think that this method of diagnosis, which I suggest, has been developed to its utmost perfection. I confess with all candor that there are defects in the system which conscientious observation will, I hope, amend with time. It is possible that there are even other important truths for the recognition {68} of disease still hidden from this method of diagnosis. Some of these may prove of great usefulness for the differentiation, prognosis and cure of diseases of the chest. "This was the reason why in my personal experience, after I had succeeded in finding the signs in the chest and proceeded further to the investigation of their causes so far as my own observation could help me, I have always afterward had recourse to the commentaries of the illustrious Baron Van Swieten, since I have considered that whatever can be desired by an observant man is sure to be found in his work. I have thus been able to spare you a long disquisition. I have found in his work a sure basis of knowledge on which my slight superstructure may be raised up to view. "I do not doubt, however, that I have accomplished a work which will earn the gratitude of all true devotees of the art of medicine, since I have succeeded in making clear certain things which shed not a little light on our knowledge of the obscure diseases of the chest, a subject hitherto very imperfectly understood. "I have omitted many things that seem doubtful because they are as yet not sufficiently elaborated. I shall endeavor, however, faithfully to devote myself to [literally to sweat over] the further development of these points. Finally, it has not been my effort to write in any elegant diction. I have chosen a style in which I may be thoroughly understood. _Vale;_ "December 31, 1760." Auenbrugger's own realization of the importance of his work and of its significant value for medicine kept him faithfully investigating his chosen subject, though he seems to have met with very little encouragement from members of {69} the medical profession near him. It is extremely difficult to understand how his practical observations and thoroughly conservative claim failed to attract more attention than they did from really great physicians who were deeply interested in the progress of medicine. At least two distinguished writers on medicine, Van Swieten and De Haen, compiled treatises on medical subjects that included the consideration of diseases of the chest within a few years after Auenbrugger's _Inventum Novum_ appeared, and yet neither of them devotes any space to the question of percussion nor hints at its possible value. Van Swieten's work consisted of commentaries upon the aphorisms of Boerhaave. The Vienna professor did not, however, limit himself to the consideration of the aphorisms alone, but made his work also a compendium of his own clinical experiences with acute and chronic diseases. As a matter of fact his commentaries on the aphorisms are each a monograph on some special disease. The two last volumes of this commentary appear after the publication of Auenbrugger's book on percussion, one volume being published in 1772, the other in 1774. The first of these articles contains a long article on pulmonary consumption, and the other an almost equally long chapter on pleurisy with effusion. In neither of the volumes, however, is there any mention of percussion, or of Auenbrugger's work, though if Van Swieten had given any serious attention to the subject, he must have become convinced how valuable Auenbrugger's invention was in the diagnosis of these conditions. This omission is all the more surprising as Auenbrugger was a pupil of Van Swieten's and practically dedicated his _Inventum Novum_ to his master. He mentions Van Swieten's work several times in his little book. Auenbrugger's {70} investigations were not unknown to Van Swieten then, and the only conclusion to be drawn from his neglect to mention Auenbrugger's methods is that he deliberately omitted reference to them because of his failure to recognize the value of the discovery. This constitutes one of the most serious blots on Van Swieten's medical career. He was succeeded as the head of the clinic in Vienna by De Haen, who also came from Leyden and brought with him the methods of Boerhaave's clinical school. As the time during which Auenbrugger was making his valuable observations at the Spanish military hospital coincides with the years when De Haen was professor of clinical medicine, and when he was frequently indebted to his colleague of the Spanish hospital for his cases for demonstration, it is impossible to conceive that Auenbrugger or his work should have remained unknown to the distinguished head of the clinic. There is not a single mention, however, to be found anywhere in De Haen's voluminous writings of Auenbrugger or his work. De Haen's principal work is his _Ratio Medendi_ (_System of Medicine_), published at Vienna during the years from 1757 to 1779. It consists of eighteen volumes, in which all the important forms of disease as well as the rarer types of affections that came to the clinic are thoroughly discussed. De Haen treated of pneumonia, of consumption, of pleurisy with effusion, which he calls dropsy of the chest, but never suggests the use of percussion. On the contrary, he complains in a number of places how very obscure and difficult of diagnosis are thoracic diseases and especially dropsy of the chest, pleuritic and pericardial exudates, and insists on the ease with which errors of diagnosis may be made in these subjects. He failed completely to recognize how much light had just been thrown on this subject by Auenbrugger's work, and how much easier the differential {71} diagnoses of these conditions were to be as the result of systematic percussion. Some of the commentaries on Auenbrugger's work are not entirely depreciative, however. In Ludwig's _Commentaria de Rebus in Scientia Naturali et Medicina Gestis_ for the year 1762, published at Leipzig, there is an excellent notice of Auenbrugger's work within a year after its appearance. It is not known who the reviewer was, but he calls Auenbrugger's discovery "a torch that was designed to illumine the darkness in which diseases of the thorax had up to this time lain concealed." A brilliant future was prophesied for the new method of examination. It is evident that the writer not only thoroughly comprehended Auenbrugger's work, but had himself applied the percussion method for purposes of diagnosis. This is almost the only favorable and reasonably intelligent review of Auenbrugger's work to be found in the medical journals of the time. In the new Medical Library, issued by Rudolph Vogel, Professor of Medicine in Göttingen, published in six volumes in 1766, there is a short mention of Auenbrugger's book and his new discovery. This reference is, however, an extremely curious affair. The good professor completely failed to understand in what the new discovery really consists. It is clear that he had never read Auenbrugger's book. He seems to have heard of the subject from some medical friend, and to have obtained an entirely wrong notion. He talks of Auenbrugger's new diagnostic method as if it were an imitation of Hippocrates's succussion method of recognizing the presence of fluid in the chest by shaking the patient till the liquid gave the characteristic splash. Other medical writers of the time perhaps, as the result of reading Professor Vogel's book, made the same mistake {72} in their appreciation of Auenbrugger's work. Vogel himself insisted that Auenbrugger did wrong to claim any originality for his invention, since it had been used so long before by Hippocrates. He adds that what is original with Auenbrugger is of very little value, the older ideas being the only ones worth while considering with regard to the application of this so-called new method of diagnosis. Vogel was an authority in medicine at the time and other commentators took the key note from him in this matter, and in many parts of Germany it was generally accepted that Auenbrugger's method of percussion was only an elaborated method of the so-called succussion of Hippocrates. Under these circumstances it is perhaps not surprising that Auenbrugger's work attracted very little attention in the German-speaking countries. In Vienna itself, as we have already said, Van Swieten and De Haen failed utterly to recognize its value. Outside of Vienna their example was naturally followed, for the Vienna school was considered authoritative, and surely, if any one, the professors of the University of Vienna might be expected to know whether Auenbrugger's new discovery was really of any value or not. It is interesting to compare Auenbrugger's state of mind, with regard to the neglect of his discovery, with Laennec's remark in the preface of his book. Laennec said: "For our generation is not inquisitive as to what is being accomplished by its own sons. Claims of new discoveries made by contemporaries are apt for the most part to be met by smiles and mocking remarks. It is always easier to condemn than to test by actual experience." Auenbrugger seems to have suffered from more than the neglect of which Laennec complains. When he speaks of envy and calumny in no uncertain terms, the only conclusion possible is that his representations as to his discoveries must have been set {73} down as pretensions that his contemporaries considered unjustified by what they knew of his work. It is interesting also to note that both men found their prospects of reward, not in the good will of their contemporaries, nor even the prospect of fame, but in the hope that their work would be useful in lessening the sum of human suffering. Laennec said: "It suffices for me if I can only feel sure that this method will commend itself to a few worthy and learned men who will make it of use to many patients. I shall consider it ample, yea more than sufficient reward for my labor, if it should prove the means by which a single human being is snatched from untimely death." Laennec's words are almost an echo fifty years afterward of Auenbrugger's expressions, just quoted: "I console myself," he said, "with the thought that I have accomplished a work which will earn the gratitude of all true devotees of the art of medicine, since I have succeeded in making clear many things which shed not a little light on the chapter of the obscure diseases of the chest, in which our knowledge has hitherto been so very incomplete." As a rule it may be said that medical observers whose genius leads them to step across the narrow line that separates the known from the unknown are likely to lack the appreciation of their own generation. Long before Auenbrugger or Laennec, Harvey, the discoverer of the circulation of the blood, said to friends that he did not expect any one of his generation to accept the new doctrine, and it is well known that the great medical men of the time did not accept it. Harvey is not an isolated example, and even in our own time real medical progress sometimes waits for years for recognition, while well-advertised pretended advances are occupying the centre of the stage. Auenbrugger's discovery made its impress, however, and was never entirely lost to sight. Even {74} before his death there was the consoling prospect of its meeting with adequate attention. De Haen's successor in Vienna, Maximilian Stoll, treated Auenbrugger's work very differently from his predecessors, and was the first to introduce it practically into clinical medical training. Stoll did not hesitate in his clinic, on the strength of what was discovered by means of percussion, to attempt the evacuation of fluid from the pleural cavity on a number of occasions. It can be easily understood that with their lack of knowledge of the necessity for thorough cleanliness in the surgical sense, such an operation might readily be followed by discouragingly fatal results. This actually happened in Stoll's own experience. He does not, however, seem to have abandoned his practice of tapping the chest because of this. He insisted to his students that Auenbrugger more than anyone else had experience in removing fluid, and especially purulent collections, from the chest, and he recommended the practice to them. He added that medicine owed as much to Auenbrugger for his rational method of treating effusions into the pleural cavity, whether of pus or serum, as for his diagnostic sign by which the presence of the fluid could surely be recognized. Some of Stoll's pupils took up the work of commending Auenbrugger's method, and a little book written by one of them, Eyerel, came into the hands of the distinguished French physician, Corvisart. Eyerel did not hesitate to say, in his treatise on empyema, that the practice of percussion of the thorax, a diagnostic method introduced by the very distinguished Vienna physician, Auenbrugger, had been of great help to them in the study of this disease. Once the great French professor of medicine, Corvisart, took it up, the new method of diagnosis was destined to have an immediate and world-wide vogue. Corvisart was not {75} only a power in medicine because of his faculty of observation and his thorough appreciation of the work of others, but he was the court physician of the first Napoleon, and this gave any ideas that he favored many adventitious chances for publicity. Napoleon's well-known faculty for selecting men for special positions whose genius was calculated to be of service to him was never less at fault than when he violated most of the court medical traditions in Paris and chose Corvisart for the imperial physician. Corvisart's selection was the result of Napoleon's appreciation of his new method of diagnosis, namely, that of percussion, in chest diseases. The Emperor himself was suffering from a persistent cold and was told that Corvisart, instead of following the traditional method of feeling the pulse, looking very wisely at the tongue and then gazing learnedly into space, conducted an actual examination of the chest and sounded it carefully all over, in order to determine where abnormal conditions might exist. This struck Napoleon as a very practical and possibly valuable feature of diagnosis. Accordingly Corvisart was summoned to give his professional opinion. After the consultation he was made the Emperor's private physician. When Corvisart took up the subject of percussion of the chest, it was practically unknown in Europe outside of Vienna. Even in the city of its origin, as we have seen, it was not well appreciated. Auenbrugger's little book had fallen into oblivion. Corvisart obtained his hint as to the possible value of percussion from Stoll's and Eyerel's appreciative remarks with regard to it. The Frenchman used the method to some extent and, realizing its value, resolved to call the attention of his countrymen and the medical world to this very helpful aid in diagnosis. It was at this time that he came upon Auenbrugger's original monograph. Instead then of writing himself on the subject, he translated {76} Auenbrugger's little book into French and made a commentary on it. Corvisart was Laennec's patron in medicine, his favorite teacher, and the man to whom the great French physician owed much of his early inspiration. It is no little merit in Corvisart's career thus to have been the connecting link between the men who did most for the practical science of medicine, and especially for the important but obscure chapter of diseases of the chest. He did not attempt at all to claim for himself any of the merit that he felt should rightfully go to Auenbrugger, and while his own observations and writings established percussion upon a firm basis and extended its knowledge, he shares the immortality of his discoverer, and comes down to us in medical history as an example of the reward of having rendered faithfully what was due, where it was due. It has been the custom to praise Corvisart for his justice toward Auenbrugger. Mere justice seems scarcely a worthy reason for praise of a great man, yet the history of medicine is so full of failures on the part of subsequent observers to acknowledge priority of discovery, that perhaps the praise does not seem quite as futile as it otherwise would. It is not surprising then that Corvisart's pupil Laennec should have appreciated very thoroughly the value of Auenbrugger's discovery. In the preface of his book on Mediate Auscultation, Laennec bewails the fact that men are generally neglectful of discoveries made in their own time, and fail to give them the attention they deserve. He attributes this neglect rather to the well-known carelessness of men than to any deliberate failure to recognize the merit of contemporary work. He says: "Lack of attention is an extremely common failing of all men. What it takes years and hard labor to acquire, is not {77} infrequently passed over without notice. Auenbrugger's method, published some fifty years ago, though capable of being learned in a few days, and without difficulty, and of being put into practice without the use of any instruments, although snatched from oblivion by my illustrious preceptor, Professor Corvisart, and made clearer than it had been left even by the author himself, is not as yet in ordinary use among physicians. Even the wonderful invention of the illustrious Jenner, though received with so much praise, and with regard to whose efficaciousness numberless confirmatory observations have been made, is already somewhat less prominent in the minds of men than it should be, or at least it would be, only for the fact that the governments of many countries, provinces and cities, the foresight of the clergy, of the authorities of all kinds, and the advice of the best physicians have exerted all their influence to keep it at public expense constantly in practice." After about ten years of service at the Spanish military hospital, Auenbrugger resigned his position there and took up private practice. In this he was eminently successful, being, as might be expected, especially in demand for cases involving affections of the thorax. His practice appears to have been to a great extent among the better class of people, but he seems never to have neglected the poorer patients whom he had come to know during his hospital experience. There are traditions in Vienna of his unfailing willingness to assist the poor and even to put himself to considerable inconvenience in order to be of service to them. Tradition tells that he was very conscientious in the pursuit of his vocation as a physician, and among the family relics there is preserved a small lantern which he kept always by his bedside, to light him on his visits to the sick when called out at night. It must not be forgotten that city streets {78} were not regularly lighted at the end of the eighteenth century, and night calls even in city work must have been a source of great annoyance and discomfort. There is a family tradition, too, that the night bell at his house was connected directly with Auenbrugger's room, so that the others of the household might not be disturbed when night callers came for him. Every tradition points to him as a man among men in his unselfish readiness to save others trouble, and do all the good in his power. Auenbrugger was, according to well-grounded traditions, especially admirable in his relations toward other members of the medical profession. This may not seem a very significant sign of amiability to those outside the profession, but it is well recognized that even great physicians have not always been known to get on well with brother practitioners. Auenbrugger has, besides, the pleasant reputation of having been of great material assistance to a number of needy medical students during the time of their university careers, and to have frequently lent a helping hand to young practitioners in the city, who probably found it quite as discouraging, beginning practice in those days, as any of their young confreres of this generation find it at the present time. To physicians and medical students when ill, Auenbrugger was almost unceasing in attention. Two or three physicians of the generation immediately after his attributed to his unselfish care and devotion to them their recovery from what would otherwise have been mortal illnesses. In this way Auenbrugger seems to have been a man whom everyone who came to know him, even slightly, learned to love and respect. His relations to his family and relatives were always of the most happy, kind character, and family traditions show that his fatherly care was befittingly returned to him in his old age. The number of his friends was very great, {79} and he counted among them some of the most distinguished inhabitants of the Austrian capital. Notwithstanding his devotion to his practice, Auenbrugger did not cease to make observations that occasionally he considered worthy of being committed to paper. He was especially careful in the study of his cases, and left fully written records of over 400 important cases that he had studied very faithfully. His attention seems to have been attracted particularly to certain mental diseases. This work was done half a century before even the first beginnings of the modern classifications of mental diseases were attempted. He wrote a short article with regard to mania and its treatment, and a longer article on melancholia. How well he recognized the essential feature of this latter affection and the main symptom that must be guarded against, can be gathered very well from the title of his paper, which he called "The Still Madness, or the Impulse to Self-Murder." It is about the time that he was engaged in the study of melancholia, perhaps as a contrast to sadder things, that he wrote a comic opera, of which we shall have more to say presently. His description of the conditions that he saw during an epidemic of dysentery that occurred in Vienna show how exact and careful a clinical observer he could be, and that the demands of his practice did not absorb all his attention to the detriment of his faculty for observation. He seems himself to have suffered from a severe attack of typhus fever which raged epidemically in Vienna in 1798. Auenbrugger had a wide circle of interests beyond the subject of medicine. There is a family tradition that he had a magnificent library. He seems with true Viennese spirit to have been a great devotee of the opera, and to have had an especial liking for music. He wrote the text, {80} score, and libretto of a comic opera with the title, "The Chimney Sweep." This operetta evidently enjoyed more than a _succes d'estime_, and further writing in this line was confidently expected from him by his friends. There is even a story to the effect that the Empress Maria Theresa, of whom he was an intimate friend, and who made use, it is said, of his counsel in political matters more than once, asked him why he did not follow up his first success in operatic writing. His blunt reply shows how intimate must have been his relations with the great empress. He said he had things much better with which to occupy himself than the writing of comic operas. Seeing that he was so favored at court, it is not surprising to find the family tradition that Auenbrugger was associated with many of the most prominent persons in the Austrian capital during his lifetime. He was a special friend of and spent a great deal of time with the famous philosopher, Werner. As he grew older he delighted especially in music, and spent many hours at the house of Baron Zois, where many of the distinguished European musicians were to be found and where famous matinee concerts were given every Sunday from twelve to two. The day and the time may seem strange to foreigners, but Vienna still has concerts at this time on Sunday, and after the Viennese have gone to Mass in the morning they think that they could not occupy themselves better than with listening to good music in the middle of the day. Toward the end of his life, Auenbrugger lived during the summer time in the suburb of Rossau and cultivated a little garden, taking the greatest pleasure in spending his time at this simple occupation. It is a source of satisfaction to find that though Auenbrugger's medical work failed during his life to attract the attention it deserved, he had his reward, {81} for his patient investigations in earlier life, in a peaceful and contented ending to a career that had been so worthy of what was best in the man. He lived to celebrate his golden wedding in 1804 and was especially happy in the almost constant companionship of the good wife who had proved so faithful a helpmate during her long life. After her death, which took place the year following the celebration of their jubilee, his vitality and his contentment with life seemed to abandon him. He was a changed man and kept himself for the most part to his room. He went to bed very early and did not care to see anyone but his near relatives. His last illness was the result of a cold, and his advanced age, eighty-seven, left him little resistive vitality. He retained his consciousness until the very end, and said the day before his death that the next day would be his last. Shortly before noon of the day of his death he looked at the clock in his room and said that when the hands would point to two o'clock he would be no more. His prophecy came true. Vienna has never had the reputation of honoring its great geniuses during their lifetime, unless they happened to belong to the higher nobility. The exclusiveness of court society at the capital made itself felt in all circles, and the consequence was that genius sprung from the lower orders was almost sure not to receive its due share of attention. The comparative neglect of Auenbrugger does not seem so bad when we recall the case of Mozart. Music has always been one of the special fads of the Austrian and the Viennese pride themselves on their appreciation of it. Mozart, however, perhaps the greatest musical genius that ever lived, received some attention during his life, but passed away almost unnoticed at the early age of thirty-five, was buried in a common trench with the poor people of the city, and now Vienna cannot {82} find his resting place. There is a magnificent monument to him, but his bones lie with his own people forever. Outside the circle of his personal friends Auenbrugger did not receive much attention, so that even the year of his death was until recently more or less uncertain and the resting place of his remains continues to be unknown. The present generation of medical men has done more to afford the due meed of praise to Auenbrugger than any preceding generation. The interest in tuberculosis particularly has led medical men to appreciate all the significance of Auenbrugger's work, and the practical importance of his discovery for the early recognition and consequently for the cure of the disease. The appreciation of Auenbrugger in our time has been so flattering as quite to make up for previous neglect. His name has been linked with that of Laennec as the great discoverers of physical diagnosis in chest diseases. At the opening of his address as President of the American Climatological Association, some five years ago, Dr. Edward O. Otis, of Boston, said: "It is quite improbable, I think, that we should be here to-day, or, indeed, have an existence as a society largely devoted to the consideration of diseases of the chest, were it not for the methods of thoracic examination which Auenbrugger and Laennec have given us in their discoveries of percussion and auscultation. Without these two precious methods of investigation we could scarcely have arrived at any degree of precision or certainty in thoracic pathology and might have been not unlike the old physicians and surgeons, 'who would swear,' as Morgagni says, 'that there was fluid in the chest when in reality there was not a single drachm, or perform paracentesis of the thorax upon a duke for an empyema which did not exist.'" His tribute is only an echo of many others not less {83} appreciative of Auenbrugger's important original work than have been expressed by modern medical men of all nations. The simple old German practitioner, who had the annoyance of seeing his discovery neglected by his contemporaries for so many years, has at last come into his own. There is scarcely an important medical meeting held anywhere in the world in which diseases of the chest are discussed without a mention of Auenbrugger's name. This is not surprising in Germany, but is quite as true of France, and England, and America. As Dr. Otis said, in closing the address from which we have just quoted: "Although we possess but meagre and fragmentary records of Auenbrugger's life, there is yet enough to enable us to fill in the lines and gain a distinct idea of his personality and character. With some persons one does not need to be acquainted with much of the detail of their lives in order to know what manner of men they are; a few characteristic illustrations here and there in their career redeem the spirit and motives of their lives, and show the kind of men just as they are, quite as well and clearly as an extended and continuous biographical narrative. Always enthusiastically devoted to the study of disease, Auenbrugger escaped the not infrequent misfortune of the student, a loss of sympathy with one's kind. His love for his fellow-men, for suffering humanity, for struggling students in his own profession, kept pace with his love for medical study. He never sacrificed the man for the scientist, nor did he lose his interest for other things in life, as happens sometimes with men intensely devoted to one pursuit. A man of original powers, as some one has truly remarked, can never be confined within the limits of a single field of activity. "He was interested in music, philosophy and the drama, and well illustrates what Dr. Da Costa has so happily styled {84} 'the scholar in medicine.' With dignity, sympathy, enthusiasm in his profession, even to the last; ever seeking to improve and add to his art; modest, like most great men; never refusing to give what is best to suffering humanity, he richly lived out his long life. As we teach our students percussion, as a matter of just recognition and due honor let us tell them something of the life of the discoverer, and at least his name, which I fear but few, who avail themselves of the result of his long and arduous labors, know." Auenbrugger's German biographer, Professor Clar, of Gratz, says of his early life that from his parents he received an excellent early training, especially edifying because of the exemplary Christian family life he saw about him, the piety of his father and mother, and of the other members of the family. The baptismal register of the parish church at Gratz is one of the important documents in his life history, for there is some dispute as to the exact date of his birth, as there is also with regard to his death. In 1798 he suffered from a severe attack of typhus fever, which at the time was epidemic in Vienna, and some of his biographers report his death in this year as a consequence of it. His descendants, however, have shown, by the burial register of the parish church in Vienna, that his death did not take place until May 17, 1807; from this church, of which he had been for half a century a faithful member, he was buried. Few of the lives of the great discoverers in medicine have in them more of encouragement for the busy practitioner of medicine than that of Auenbrugger. He began his medical career by a series of practical observations that stamped him for all time as one of the great geniuses. When his discoveries failed to meet with the acceptance they deserved, he was not disturbed, and, above all, he did not insist on acrid controversy. He took up the practice of medicine and {85} demonstrated how much his discovery could help in the diagnosis of the obscure chapter of the diseases of the chest. In the mean time he went on his way placidly doing the good that he found to do, taking care of his poor patients and faithfully tending brother-physicians who happened to be ill. He found an avocation to fill the moments spent apart from his vocation, and added to the pleasure of humanity by his work in music. All the time he remained a simple, faithful believer in the relation of Providence to man, and considered that somehow the inexplicable things of this life would find an explanation in the hereafter. He was probably the best-liked member of the profession in Vienna during his lifetime, and the profession of his native town are very proud to recall the example that he sets physicians generally in all the ethical qualities that make a physician's life not only successful in the material sense, but also in inspiration for those around him to do their duty rather than seek the fulfilment of merely selfish aims. {86} {87} EDWARD JENNER, THE DISCOVERER OF VACCINATION {88} "It helps a man immensely to be a bit of a hero worshipper, and the stories of the lives of the masters of medicine do much to stimulate our ambition and rouse our sympathies. If the life and work of such men as Bichat and Laennec will not stir the blood of a young man and make him feel proud of France and of Frenchmen, he must be a dull and muddy-mettled rascal. In reading the life of Hunter, of Jenner, who thinks of the nationality which is merged and lost in our interest in the man and in his work! In the halcyon days of the Renaissance there was no nationalism in medicine, but a fine catholic spirit made great leaders like Vesalius, Eustachius, Stenson and others at home in every country in Europe." --Osler, _Aequanimitas and other Essays_. {89} EDWARD JENNER, THE DISCOVERER OF VACCINATION. A very striking life in its lessons for the serious student of medical problems is that of Edward Jenner, who first demonstrated to the world that a simple attack of mild, never fatal, cowpox, deliberately acquired, might serve as a protective agent against the deadly smallpox, which before that time raged so violently all over the civilized world. His successful solution of this problem has probably saved more lives and suffering than any other single accomplishment in the whole history of medicine. While this fact is apparently not generally appreciated, Jenner's discovery did not come by mere chance, but was the result of his genius for original investigation, which led him to make many other valuable observations covering nearly the whole range of medicine; nor indeed was his activity limited to medicine alone, but extended itself to many of the allied sciences, and even to scientific departments quite beyond the domain of medicine. In medicine we owe to Jenner the first hint of the possible connection between rheumatism and heart disease. He pointed out, at a discussion in a little English medical society, how often affections of the heart occurred in those who had suffered from previous attacks of rheumatism. He was among the first, perhaps the very first, to hint at the pathological basis of angina pectoris. While Heberden's name is usually connected with this discovery, there seems good reason to think that already Jenner had independently noted and called attention to the frequency with which {90} degenerative affections of the arteries within the heart muscle itself were to be found where during life heart-pang had been a prominent and annoying symptom. Besides these important advances in medicine made by him, and his great discovery of the identity of cowpox and smallpox, Dr. Jenner was an interesting observer of phenomena in all the biological sciences, and in geology and palaeontology. He was a great friend of Dr. John Hunter, who frequently suggested to him the making of such experiments and observations as were more likely to succeed in the country than in the city, and one cannot help but be struck with the determination evinced all his life to take nothing on authority, but to test everything by actual observation, and above all not to theorize where he did not have the actual data necessary for assured conclusions; and even where he thought he had them, his wonderful faculty for waiting until they had properly matured, and their true significance had become evident, stamped him for all time as a model for scientific investigators. Undoubtedly Jenner's greatest work was that of determining the value of vaccination. His patient investigation of this subject, the thorough conservatism with which he guarded himself from publishing his conclusions until he had tested them in every way, the absence of that haste to rush into print so characteristic of most present-day medical investigators, and which is the cause of so much disappointment in modern medicine, all distinguished this country physician as one of the greatest investigating geniuses that medicine has produced. His life is a mirror for the medical student and the investigating practitioner of medicine. His discovery was so complete when he finally announced it that but very little has been added to it since. His invention came from his mind as Minerva from the brain {91} of Jove fully armed for the conflict that was sure to come. In this Jenner resembled very much Laennec and the other investigating geniuses in medicine. As a matter of fact only one improvement has been made in the preparation of vaccine material since Jenner's time, and that is the incorporation of glycerin in very recent years, which gradually destroys any micro-organisms that may be present, leaving the vaccine virus itself unimpaired in its efficacy, though without the possibility of inflicting those secondary infections which for so long cast a shadow on vaccination. Dr. Edward Jenner was the third son of an Anglican clergyman, his mother being the daughter of a clergyman who had been at one time prebend in the cathedral of Bristol. The family held considerable property in Gloucestershire. He received his early education at Wotton-under-Edge and later at Cirencester, the old Roman town in Gloucestershire. While he acquired a good working knowledge of the classics, from his earliest years he was interested in natural history. Before he was nine he made a collection of the nests of the dormouse. The hours that other boys spent at play he devoted to searching for fossils or other interesting natural curiosities. After his preliminary education had been finished he was apprenticed to Mr. Ludlow, an eminent surgeon at Bristol, and after two years here he went to London, where he had the privilege of residing as a favorite pupil in the family of John Hunter for two years. At this time Jenner was in his twenty-first year, John Hunter in his forty-second. Hunter was not then a public lecturer, but he had been for two years surgeon to St. George's Hospital, and for nearly five years had been engaged in studying the habits and structure of animals in a menagerie and laboratory which he had established at Brompton. The inspiration of Hunter's original {92} genius meant much for young Jenner. He learned not only to respect the teacher but to love the man. In Hunter's unquenchable desire for knowledge and love of truth there was something very congenial to the spirit of Jenner, who was himself, above all things, an inquirer. After completing his two years of work with Hunter he still remained intimately associated with him by letter. Though later in life Jenner's correspondence became very voluminous, these letters from Hunter were always very carefully preserved in a special cover, and they serve to show how stimulating to the young man must have been Hunter's virile enthusiasm for truth as it could be deduced by observation and experiment. It was to Hunter that Jenner once wrote that he had heard it said in Gloucestershire that the dairy workers who suffered from a certain disease caught from the udders of cows and called cowpox were protected thereafter from attacks of smallpox. He added that this tradition interested him very much and that he intended to think about it. "Don't think," wrote Hunter to him, in return; "make observations, investigate for yourself the truth of the tradition." Jenner did so, and the result is now known to all. These letters from Hunter contained many other interesting suggestions. For instance, it was under Hunter's direction that Jenner succeeded in finding out that in hibernating animals the temperature is very much reduced and the respirations are very slow, while the rate and force of the pulse are often so much diminished as to be scarcely more than noticeable at the extremities. Between Hunter and Jenner it had already been discovered that the sap in trees will not freeze at temperatures much lower than that at which the same fluid freezes when withdrawn from the tree, and the same thing seemed to be true with regard to {93} the blood of hibernating animals. He learned that notwithstanding the low temperature to which it is reduced the animals are not affected particularly by the cold, though their store of fat is consumed and they awake very hungry in the spring-time. Besides hibernation Jenner also investigated the habits of the cuckoo, that crux of the biologist which insists on foisting its eggs upon other birds and allowing its orphan young to be brought up in alien nests, while the real young of the deceived foster-parents are often pushed out of their nests by this burly intruder which grows so fast and strong. It is needless to say, this subject interested John Hunter very much and there are a number of letters which passed between them on the subject. It must not be supposed, however, that young Jenner was entirely occupied with his scientific work to the exclusion of social life and recreation. He was one of the best-known men of the county, and was looked upon as a genial companion from whom might be expected on almost any occasion pleasant jests and epigrams, not too biting, with regard to friends and acquaintances. Some of these have been preserved and we quote several of them as indicative of his special vein of humor. ON THE DEATH OF A MISER. "Tom at last has laid by his old niggardly forms, And now gives good dinners; to whom pray?--the worms." ON LORD BERKELEY'S HUNTSMAN, WHO DIED IN THE CHASE. "Determined much higher to hoist up his name, Than Nimrod the hunter, in annals of fame, 'Hark forward!' cried Charles, and gallantly whirled His high-mettled steed o'er the gates of the world." {94} DEATH AND MR. PEACH. A Short Dialogue. N. B.--Mr. P. died in April. "P.--Awhile forbear thy horrid gripe, Do pray, dread Sir! remember Peaches are never fairly ripe 'Till August or September." "D.--To gratify my longing taste, And make thy flavour fine, I had thee in a hot-house placed, And moistened well with wine." "Mr. Peach had shortened his life by the too free use of the bottle." We have said that Dr. Jenner's supreme accomplishment in science was the working out of the vaccination problem to a great humane conclusion. His discovery was no mere accident, nor chance confirmation of a medical tradition. He devoted himself for many years to the study of cowpox, as he had the opportunity to see it, and it is what we know of this investigation, his patience and care in eliminating all the factors of error, that stamped Jenner as a medical scientist worthy of honor. When he began practice in Berkeley, he made many inquiries among his professional brethren, with regard to their opinion of the protecting power of cowpox, but most of them had either paid no attention to such reports, or shook their heads at once, and said they were at most popular traditions, due merely to coincidences and unsupported by any credible evidence. In the face of this, Jenner began to follow John Hunter's advice to investigate. The first careful investigation dates from about 1775, and it took him more than five years to clear away the difficulties surrounding the solution of the question, in which he was interested. As Pasteur found in the next century, when investigating the silkworm disease, Jenner soon learned that there was {95} more than one disease called cowpox, and that the confusion consequent upon the existence of at least two specific diseases and a number of skin affections of the hands of various kinds, which existed among dairy workers, made the recognition of the protective power of true cowpox extremely difficult. After he had differentiated genuine cowpox, however, there was no difficulty in tracing its apparent protective power. He soon found, however, that the protection was not afforded unless the cowpox had been communicated at a particular stage of the disease. In other words, after the true vaccinia has run its course, secondary affections of the skin of the cows usually take place, and if dairy workers became infected from these lesions, then no protection against smallpox is afforded them. Another important observation that Jenner made at this time was that the disease known as grease in horses is the same affection as cowpox, and that both of these diseases are smallpox as modified by the organism in which they develop. It may be said at once that this opinion so difficult to arrive at, more than a century ago, when so little was known of comparative pathology, is held at the present day, and was confirmed by the last series of investigations made under the auspices of the Jenner Society, in England. One difficulty that confronted Jenner in his researches was the fact that cowpox was scarce in his part of the country, and he had no opportunity of making inoculations with the disease in a proper stage, so as to put his suspicions to an absolute test. He collected much information, however, and stimulated others to the making of observations, so that when his discovery was announced the mind of the medical profession was more ready to receive it. In 1788 he carried a carefully made drawing of a case of cowpox as it occurred on the hands of a Gloucester milkmaid to London, and {96} showed it to a number of medical men, whose opinions he wished to obtain. Among these was Sir Edward Holme, who agreed that there was a distinct similarity between it and certain stages of smallpox and considered that the question of a connection between the two diseases was an interesting and curious subject. He did not share any of Jenner's views, however, with regard to the practical importance of his discovery in this matter, and gave little encouragement to the idea that a possible prophylactic for smallpox might be discovered. Something of Jenner's enthusiasm for experiment may be gathered from the fact that he did not hesitate even to inject various materials related to cowpox into the arm of his own children. We know Mrs. Jenner to have been a very wonderful woman, quite as deeply interested as the doctor himself in securing the great benefit to humanity that would result from the demonstration that cowpox protected against smallpox, but it is a little bit difficult for us in these days to understand how her mother-heart could have permitted some of the experiments which Dr. Jenner's biographer, Dr. Baron, describes. [Footnote 1] [Footnote 1: The life of Edward Jenner, M.D., F.R.S., Physician Extraordinary to His Majesty Geo. IV, Foreign Associate of the National Institute of France, &c. &c. &c. With illustrations of his doctrines, and selections from his Correspondence by John Baron, M.D., F.R.S., Late Senior Physician to the General Infirmary, Consulting Physician to the Lunatic Asylum at Gloucester, and Fellow of the Royal Medical and Chirurgical Society of London. In two Volumes. London: Henry Colburn, 1838.] The subject is indeed so surprising that I prefer to quote the passage with regard to these experiments directly from Dr. Baron: "In November, 1789, he inoculated his eldest son Edward, who was then about one year and a half old, with swine-pox matter. The progress of the disease seemed similar to that which arises from the insertion of true smallpox matter when {97} the disease is very slight. He sickened on the eighth day: a few pustules appeared; they were late and slow in their progress, and small. Variolous matter (this would mean material from a smallpox patient calculated to give that disease) was carefully inserted into his arms at five or six different periods, subsequently without the slightest inflammation being excited in the part. "On Thursday, April 7th, 1791, variolous matter was again inserted by two small incisions through the cutis, [beneath the skin]. Then the following notes of observed conditions day after day are made: 9th, Evidently inflamed. 10th, An efflorescence of the size of a shilling spread round the inferior wound. 11th, The incision assumed a kind of erysipelatous elevation: the efflorescence much increased. 12th, These appearances much advanced. 13th, A vesicle, containing a brownish fluid, and transparent, about the size of a large split-pea on the superior incision, the inferior about twice as big; the surrounding parts affected with erysipelas. The erysipelas extended to the shoulder, and then pretty quickly went off. The child showed no signs of indisposition the whole time." "March, 1792. E. Jenner was again inoculated: the matter was taken from a child that caught the disease in the natural way, and had it pretty full. It was inserted fresh from the pustule. The same evening an inflammation appeared round the incision, which, at the end of twenty hours, increased to the diameter of a sixpence, and some fluid had already been collected on the lips of the scratch, which the child had rubbed off." It was not for five years after this time, however, that Jenner was able to make his crucial experiments in the matter. On the 14th of May, 1796 (the date is still recalled as Vaccination Day in Germany, especially in Berlin), vaccine {98} matter was taken from the hand of a dairy maid, Sarah Nelmes, and inserted by two superficial incisions in the arms of James Phipps, a healthy boy of about eight years of age. The boy went through an attack of cowpox in a regularly satisfactory manner. After this, however, it was necessary to determine whether he was protected from smallpox. After waiting two months Jenner inoculated him with variolous material. The result of this experiment can best be learned from the following letter written to his friend Gardner: "Dear Gardner: "As I promised to let you know how I proceeded in my inquiry into the nature of that singular disease the Cow Pox, and being fully satisfied how much you feel interested in its success, you will be gratified in hearing that I have at length accomplished what I have been so long waiting for, the passing of the Vaccine Virus from one human being to another by the ordinary mode of inoculation. "A boy of the name of Phipps was inoculated in the arm from a pustule on the hand of a young woman who was infected by her master's cows. Having never seen the disease but in its casual way before; that is, when communicated from the cow to the hand of the milker, I was astonished at the close resemblance of the pustules, in some of their stages, to the variolous pustules. But now listen to the most delightful part of my story. The boy has since been inoculated for the smallpox which, as I ventured to predict, produced no effect. I shall now pursue my experiments with redoubled ardour. "Believe me yours, very sincerely, "Edward Jenner. "Berkeley, July 19, 1796." {99} Notwithstanding the complete success of this experiment, Jenner did not rush into print with it. Two years later, at the end of June, 1798, his "Inquiry into the Causes and Effects of the Variolae Vaccinae" was published. In the mean time Jenner had succeeded in demonstrating the protective quality against smallpox of vaccination, contracted either casually or by direct inoculation, in some twenty-three cases. Sixteen of these had occurred accidentally in the course of occupations connected with cows and horses; the rest were done under Jenner's directions. Among the persons inoculated was Jenner's own little second son, Robert Fitts Harding Jenner, an infant eleven months old. Jenner demonstrated conclusively that the cowpox protects the human constitution from the infection of smallpox. After Dr. Jenner had made his tests he prepared a pamphlet for publication. Before publishing, however, he thought it better to make a visit to London, so that he might have the opportunity to introduce the subject personally to friends, and demonstrate the truth of his assertion to them. He remained in London for nearly three months without being able to find any one who would submit to vaccination. The medical profession generally took very little interest in the subject and seemed to consider him sadly visionary. Under the circumstances it is not surprising that Jenner went back to Gloucestershire, and his country practice, rather disappointed. It happened, however, that soon after his return home, a distinguished London surgeon named Cline resolved to make a trial of the vaccine material which Jenner had left with his friends. The surgeon's purpose in using it, however, was not altogether to test its efficacy as a prophylactic against smallpox, but with the notion that the counterirritation thus obtained might be useful in a case which he had under treatment. Those {100} were the days when the seton and the issue were still in common use, and counterirritation was considered one of the most important remedial measures at the command of the surgeon. The patient was a child suffering from a form of chronic hip-joint disease that at this distance of time, and with rather incomplete descriptions, seems to have been the ordinary tuberculosis of the hip. The vaccine material was inoculated over the joint and, surprising though it may appear now, the vaccine vesicle ran rather a normal course and healed kindly. The little patient was afterward inoculated with smallpox and found to be incapable of acquiring that disease. This case attracted considerable attention. It is not, however, a matter for congratulation as regards the openness of mind of the medical men of the period to find that this was the only sort of a case that was considered suitable for such an experiment. It is very easy to understand that in a child in a run-down condition the vaccine material might very well have provoked a rather serious local reaction. In a way, the fate of vaccination hung in the balance and good luck was in its favor. Mr. Cline, however, after this, became a strong advocate of vaccination, and brought it very decidedly before the London physicians. There was still a feeling of opposition, as indeed there always is against any novelty in medicine, but this gradually disappeared, to give place to a suspension of judgment, until more accurate and detailed information could be obtained from further observations and tests. It was not long before the opposition to the practice of vaccination took definite form. One of the best-known London physicians of the time, Dr. Ingenhouz, became the leader of a strong faction of the medical profession of London, who not only would have nothing to do with vaccination, {101} but proclaimed openly that it was a dangerous innovation, absolutely unjustifiable, and communicated a disease without protecting against any other. On the other hand, there were overzealous advocates of vaccination, who insisted on its value but did not know how to recognize the true cowpox from other lesions sometimes confounded with it, nor the exact stage of the disease in which the vaccine material obtained would prove effectively protective. A number of these used vaccine material so contaminated by secondary infections of one kind or another that no wonder serious sores were reported as a result. Physicians who have for many years known how difficult it is to bring certain people to a recognition of the benefits that have been conferred on modern civilization by vaccination, will appreciate how many difficulties and prejudices and misunderstandings Jenner himself must have encountered during the original introduction of vaccination. Some of the supposed objections to vaccination wear a very modern air, and come from physicians whose only purpose apparently is to bring out the truth, and yet who are evidently led to the drawing of conclusions much wider than their premises by the fact that they know they will have an attentive audience among the anti-vaccinationists at least. A fair example of one of these old-time objections against vaccination may be found in the following passage from a letter by Dr. Jenner written to Mr. Moore. Corresponding objections have been made in much more modern times, and the passage will arouse the sympathetic amusement of present-day physicians: "You probably may not have seen a pamphlet lately published by Dr. Watt of Glasgow, as there is nothing in its title that develops its purport or evil tendency: 'An Inquiry into the Relative Mortality of the Principal Diseases of {102} Children,' &c. The measles, it seems, have been extremely fatal in the city of Glasgow for the last four or five years among children, and during this period vaccination was practised almost universally. Previously to this, the measles was considered as a mild disease. Hence Dr. Watt infers that the smallpox is a kind of preparative for the measles, rendering the disease more mild. In short, he says, or seems to say, that we have gained nothing by the introduction of the cow-pox; for that the measles and small-pox have now changed places with regard to their fatal tendency. Is not this very shocking? Here is a new and unexpected twig shot forth for the sinking anti-vaccinist to cling to. But mark me--should this absurdity of Mr. Watt take possession of the minds of the people, I am already prepared with the means of destroying its effects, having instituted an inquiry through this populous town and the circumjacent villages, where, on the smallest computation, 20,000 children must have been vaccinated in the course of the last twelve years by myself and others. Now it appears that, during this period, there has been no such occurrence as a fatal epidemic of measles. You would greatly oblige me in making this communication to the Board, with my respectful compliments." Fortunately only a few colleagues were so illogical, and an excellent idea of how much Jenner's discovery was appreciated by his contemporaries may be obtained from the number of honors, diplomas, addresses and communications from public bodies and distinguished individuals which he received. A chronological list of these may be found at the end of Dr. Baron's Life of Jenner. Among them may be noted the diploma of LL.D. from the Senate of Harvard University, Cambridge, Mass., under the presidency of Dr. Willard; also the Diploma of Doctor in Medicine, honoris {103} causa, which Jenner especially appreciated, as he says in one of his letters, because he understood that the University conferred this degree in this way only once or twice in a century. There is a diploma as Fellow of the American Society of Arts and Sciences in Massachusetts, as well as a Diploma as a member of the American Philosophical Society at Philadelphia. The diploma from Boston bears the signature of John Adams as president, that from Philadelphia the signature of Thomas Jefferson. Most of the prominent medical and scientific societies of Europe had elected him a member or had sent him some special token of recognition. One of these documents, expressive of the gratitude of the senders for the great benefit his work had conferred upon the human race, which Jenner valued the highest, was an address from the Five Indian Nations which, with a Wampum Belt, was delivered to him on November 8, 1807. In reply to this Dr. Jenner wrote to the American agent through whom the insignia had been forwarded: "Sir: "Your kindness in delivering to the Five Nations of Indians my Treatise on vaccination, and in transmitting to me their reply, demands my warmest thanks. "I beg you to make known to the Five Nations the sincere gratification which I feel at finding that the practice of vaccination has been so universally received among their tribes, and proved so beneficial to them; at the same time, be pleased to assure them of the great thankfulness with which I received the belt and string of Wampum, with which they condescended to honour me, and of the high estimation in which I shall for ever hold it. May the active benevolence which their chiefs have displayed in preserving the lives of {104} their people be crowned with the success it deserves; and may that destructive pestilence, the smallpox, be no more known among them. "You also, Sir, are entitled to the most grateful acknowledgments, not only from me, but from every friend of humanity, for the philanthropic manner in which you originally introduced the vaccine among these tribes of Indians. "I have the honor to remain, &c, "E. Jenner." The general trend of American appreciation for Dr. Jenner's work, at least among the intelligent classes, may be gathered from the following letter sent to Dr. Jenner by Thomas Jefferson while he was president, May 14, 1806: "Monticello, Virginia, May 14, 1806. "Sir: "I have received the copy of the evidence at large respecting the discovery of the vaccine inoculation, which you have been pleased to send me, and for which I return you my thanks. Having been among the early converts in this part of the globe to its efficacy, I took an early part in recommending it to my countrymen. I avail myself of this occasion to render you my portion of the tribute of gratitude due to you from the whole human family. Medicine has never before produced any single improvement of such utility. Harvey's discovery of the circulation of the blood was a beautiful addition to our knowledge of the human economy; but on a review of the practice of medicine before and since that epoch, I do not see any great amelioration which has been derived from that discovery. You have erased from the calender of human afflictions one of its greatest. Yours is the comfortable reflection that mankind can never forget that you have lived; future nations will know by history only that the {105} loathsome small-pox has existed, and by you has been extirpated. Accept the most fervent wishes for your health and happiness, and assurances of the greatest respect and consideration. "Th. Jefferson." Almost more interesting than the story of Jenner, the experimental scientist, the true harbinger of modern experimental medicine, the founder of experimental pathology, and the discoverer of the pregnant idea which was to mean so much for nineteenth century medicine in the hands of Pasteur and his successors, is the story of Jenner the man, the husband, the friend, and the physician of the poor. In spite of his intense preoccupation in his experimental work and the amount of time it must have required to make his observations, he found opportunities to care for the poor and to interest himself in all their concerns as well as their health. He made many firm friends among people of his own social status and generally was considered a most amiable, as well as a liberal, and humanitarian man. He was deeply religious, and, as we shall allow his earliest biographer Dr. Baron to tell, was not ashamed to exhibit his religious feelings by word and deed when the proper occasion presented itself. This part of his life deserves to be studied as carefully and remembered as faithfully as that in which he made his discoveries, since it is the complement that shows the character of the man in its entirety. Jenner's personal character may be very well understood from a paragraph of his biographer, who had been his bosom friend for many years. He says: "But Dr. Jenner was not only humble in all that concerned this, the greatest incident of his life (the successful discovery of vaccination); he continued so after success had crowned {106} his labors, and after applause greater than most men can bear had been bestowed upon him. This most estimable quality was visible at all times; but it was particularly conspicuous when he was living in familiar intercourse with the inhabitants of his native village. If the reader could in imagination accompany me with him to the dwellings of the poor, and see him kindly and heartily inquiring into their wants, and entering into all the little details of their domestic economy; or if he could have witnessed him listening with perfect patience and good humor to the history of their maladies, he would have seen an engaging instance of untiring benevolence. He never was unwilling to receive any one, however unseasonable the time may have been. Such were his habits, even to the latest period of his life. I scarcely know any part of his character that was more worthy of imitation and unqualified respect than that to which I have alluded. I have never seen any person in any station of life in whom it was equally manifest; and when it is remembered that he was well 'stricken in years;' that he had been a most indefatigable and successful laborer in the cause of humanity; and that he might have sought for a season of repose, and the uncontrolled disposal of his own time, the sacrifices which he made are the more to be valued. In the active and unostentatious exercise of kindness and charity he spent his days; and he seemed ever to feel that he was one of those 'qui se natos ad homines juvandos, tutandos, conservandos arbitrantur,' who consider themselves born to help, protect, and cherish their fellow men. "His kindness and condescension to the poor was equalled by his most considerate respect and regard to the feelings and character of the humblest of his professional brethren. I have often been struck with the total absence of everything that could bear the semblance of loftiness of demeanor. {107} Few men were more entitled to deliver their sentiments in a confident or authoritative tone; but his whole deportment was opposed to everything of that description, and he did not hesitate to seek knowledge from persons in all respects his inferiors. All his younger brethren who have ever had the happiness to meet him in practice, must have been deeply impressed with this part of his character." Many a member of the medical profession who is not a genius will find an excuse for allowing disorder about his rooms from the example which is said to have been set by Jenner. He was interested in nearly every branch of science and specimens from many departments were constantly around him. He himself, it is said, had the key to the apparent confusion. Most of the others who allow themselves to drift into careless habits in the same direction insist that they too have the key. Some of their friends, however, are inclined to doubt it. It is curiously interesting under these circumstances to have Jenner's biographer tell of the confused state of affairs that existed in his room and yet his defence of it. Perhaps in this matter it is well to remember what Augustin Birrell says at the end of his essay on Carlisle: "Don't let us quarrel with genius; we have none of it ourselves and the worst of it is we cannot get along without it." "The objects of his studies generally lay scattered around him; and, as he used often to say himself, seemingly in chaotic confusion. Fossils, and other specimens of natural history, anatomical preparations, books, papers, letters--all presented themselves in strange disorder; but every article bore the impress of the genius that presided there. The fossils were marked by small pieces of paper pasted on them, having their names and the places where they were found inscribed in his own plain and distinct handwriting. {108} His materials for thought and conversation were thus constantly before him; and a visitor, on entering his apartment, would find in abundance traces of all his private occupations. He seemed to have no secrets of any kind; and, notwithstanding a long experience with the world, he acted to the last as if all mankind were as trustworthy and free from selfishness as himself. He had a working head, being never idle, and accumulated a great store of original observations. These treasures he imparted most generously and liberally. Indeed his chief pleasure seemed to be in pouring out the ample riches of his mind to everyone who enjoyed his acquaintance. He had often reason to lament this undoubted confidence; but such ungrateful returns neither chilled his ardor nor ruffled his temper." It is interesting to note what was Jenner's opinion with regard to two subjects that are very much discussed at the present time. These are the questions of religious training in education, and the advisability of making nature study a part of the course for children. Jenner considered that no education could possibly be complete which did not include both of these subjects. Religious training he deemed absolutely indispensable. Nature study he advised for somewhat different reasons from those for which it is now urged. He thought there was a depth of interest in the study of the objects of nature that could scarcely fail to lessen the burden of education for the child, but the main reason for its study to his mind was that children intent on the wonders of nature could scarcely help but realize the power of the Creator and, learning to admire Him more and more, be thus drawn to respect His laws, to acknowledge His supremacy and to devote themselves to bringing about the fulfilment of His will in this world to the fullest extent in their power. {109} Jenner's religious opinions and beliefs must be left to the expression of the biographer already mentioned, who gives them very fully. He says: "One of the most remarkable features in Jenner's character, when treating of questions of a moral or scientific nature, was a devout expression of his consciousness of the omnipresence of the Deity. He believed that this great truth was too much overlooked in our systems of education; that it ought to be constantly impressed upon the youthful heart, and that the obligations which it implied, as well as the inward truth and purity which it required, should be rendered more familiar to all. Mrs. Jenner was constantly occupied in teaching these lessons to the poor around her, in schools which she established for the purpose of affording a scriptural education. He, building upon this foundation, wished to add instruction of a more practical description, deduced from their daily experience, and illustrated by a reference to those works of wisdom and beauty which the universe supplies. He always contended that some aid of of this kind was necessary to impress completely upon the character of the lower ranks those maxims which they derived from their teachers. He had other views, too, in recommending such a plan; he thought that the lot of the poor might be ameliorated, and many sources of amusement and information laid open to them which they are at present deprived of; that the flowers of the field and the wonders of the animal creation might supply them with subjects of useful knowledge and pious meditation." His wife, as is often, though unfortunately not always, the case, seems to have had that precious uplifting influence over him which served continually as an incentive to higher things and kept him from the sterile materialism which an exclusive absorption in scientific studies, with lack of the {110} exercise of faith and of association with human suffering, seems to bring to many men. Dr. Baron says on this point: "I remember, when discussing with him certain questions touching the conditions of man in this life, and dwelling upon his hopes, his fears, his pains, and his joys, and coming to the conclusions which merely human reason discloses to us; and when dwelling on the deformity of the heart, our blindness, our ignorance, the evils connected with our physical structures, our crimes, our calamities, and our unfathomable capacity both for suffering and for enjoyment; he observed, Mrs. Jenner can explain all these things: they cause no difficulties to her." Toward the end of his life Jenner's feelings with regard to the importance of a confident other worldliness as the only fitting explanation for the mysteries of this, became emphasized. To quote his biographer once more: "As he approached nearer to his own end, his conversations with myself were generally more or less tinged with such views as occur to the serious mind when contemplating the handiwork of the Creator. In all the confusion and disorder which appears in the physical world, and in all the anomalies and errors which deface the moral, he saw convincing demonstration that He who formed all things out of nothing still wields and guides the machinery of his mighty creation." Jenner's feelings with regard to the relative importance of medical and religious ministrations may be very well appreciated from an expression of his on the occasion when he was being presented to a distinguished nobleman by the famous missionary, Roland Hill. The Reverend Mr. Hill said: "Allow me to present your Lordship my friend, Dr. Jenner, who has been the means of saving more lives than any other man." "Ah," responded Jenner, "were I like {111} you I could save souls." In his sketch of Jenner's life in "The Disciples of AEsculapius," Sir Benjamin Ward Richardson considers that this incident shows a lack of appreciation of the dignity of the medical profession and a humility rather difficult to understand. Anyone who will place himself in Jenner's position of fervent belief that the one thing necessary is the salvation of souls will not fail to recognize, however, his sincerity or fail to appreciate its true significance. After all, Jenner was so deeply impressed with the importance of other worldly things and the comparative insignificance of this that he found it even a little difficult to understand why men should not see the direct action of the Creator and all His providence in even some of the minutest details of life. Once he said, "I do not marvel that men are grateful to me, but I am surprised that they do not feel grateful to God for making me a medium of good." Few men who have accomplished so much have felt so little vainglory over it as Jenner. There was not a jot or tittle of what is so rightly called conceit in him. He well deserves a place beside such beautiful characters as Morgagni, Auenbrugger, Laennec and Pasteur, whose work was done for others, not for themselves, and after all the most striking definition of a saint is one who thinks first of others and only second of himself. {112} {113} GALVANI, FOUNDER OF ANIMAL ELECTRICITY {114} The world that I regard is myself; it is the Microcosm of my own frame that I cast mine eye on; for the other, I use it but like my Globe, and turn it round sometimes for my recreation. Men that look upon my outside, perusing only my condition and Fortunes, do err in my Altitude; for I am above Atlas his shoulders. The earth is a point not only in respect of the Heaven above us, but of that heavenly and celestial part within us; that mass of Flesh that circumscribes me, limits not my mind; that surface that tells the Heavens it hath an end, cannot persuade me I have any: I take my circle to be above three hundred and sixty; though the number of the Arc do measure my body, it comprehendeth not my mind; whilst I study to find how I am a Microcosm, or little World, I find myself something more than the great one. There is surely a piece of Divinity in us, something that was before the Elements, and owes no homage unto the Sun. --Sir Thos. Browne, M.D. {115} GALVANI, FOUNDER OF ANIMAL ELECTRICITY. It is often thought and only too often stated that the impetus to the rise of our modern science which came during the last half of the eighteenth century was due to the spirit of the French Revolution, making itself felt long before the actual declaration of the rights of man, by the French Encyclopedists. It is the custom to conclude that the spirit of liberty which was abroad infected the minds of the rising generation to such an extent that they cast off the fetters of old traditional modes of thinking, refused to accept supposed truths on the strength of tradition or on authority as before, tested knowledge for themselves, and as a consequence made true progress in the sciences. Something doubtless there is in this, and yet a careful investigation of the lives of the men to whom especially the beginnings of the biological sciences are due, will show that not only were they men with the deepest respect for authority, the greatest reverence for old modes of thinking, but also they were typical representatives of the developing influence of methods of education which are sometimes unfortunately deemed to be narrowing in the extreme. We have already studied the life of Morgagni, the great Father of Modern Pathology, to find that he least of all, in his generation, was affected by any of the liberalizing tendencies that are supposed to have led up to the freedom of the human mind and the consequent successful broadening of human science. We shall see that there were many others who did their work at the end of the eighteenth century of whom this same thing can be said, and no more {116} striking examples of this can be found than the lives of two great Italians, Volta and Galvani, to whom the modern world has paid the tribute of acknowledging them as founders in electricity by taking their names to express important basic distinctions in the science. It was not in Italy alone, however, that this adhesion of great scientific minds to the old orthodox teachings of Christianity constituted a notable characteristic of the history of eighteenth century science. Everywhere the same thing was true. Cavendish, Sir Humphrey Davy and Faraday, the great English scientists, to whom so much of progress in electricity and in physics is due, were very similar in this respect to their Italian colleagues. Oersted the Dane belongs in the same category. In France such distinguished names as Lamarck, the great founder of modern biology and the first to broach the theory of evolution; Haüy, the father of crystallography; Laplace, and many others might be mentioned. The lives of the men who were contemporary workers in medicine as sketched in the present volume will show this same thing to be true also in their cases. A glance at the life of Aloysius Galvani will illustrate how little the spirit of the revolution had to do with the rise of electricity and the first discussions of its relations to life. He was born at Bologna, September 9, 1737. A number of his immediate relatives had been distinguished as clergymen. The early years of Galvani's life were spent in association with religious, and as a youth he wished to become a member of a religious order whose special function it was to assist the dying at their last hour. His father, however, was opposed to his entrance into religion, and so Galvani devoted himself to medicine at the University of Bologna, and at length became a professor of anatomy in his Alma Mater. Professor Galeazzi, who was at the time {117} one of the most distinguished professors in anatomy in Italy, was very much attracted to young Galvani and became his friend and patron in his student days. Galvani became a member of Galeazzi's household, and finally having fallen in love with one of his daughters, won her father's consent to their early marriage. The happiness in life that he thus prepared for himself became one of the often quoted exemplars of domestic felicity in Bologna, where Galvani's life was passed. Medici, in his panegyric of Galvani, which we shall have occasion to quote from more than once, gives a very pretty story of the doctor's wooing and marriage with Lucia Galeazzi, which we prefer to repeat in the naive simplicity with which it is related by the Italian panegyrist. Galvani had been seriously thinking of matrimony for some time and had, it seems (strange as that might be considered in a rising young scientist in our day), even prayed for counsel in the matter. One of his favorite saints was St. Francis of Sales, the Archbishop of Geneva, the gentleman saint as he has been called, for whose charming personal character Galvani had a very devout admiration. One day while praying in one of the churches of Bologna before a statue of St. Francis of Sales he looked up after some moments of abstraction to find a young woman's face between him and the altar. The face proved to be that of Lucia. Galvani looked upon it as a sign from heaven of approval of some of his wishes, and applied for the hand of the fair Lucia. Anyone who has seen the offerings at the shrine of St. Anthony of Padua, not so far from Bologna, and has realized that the good patron of things lost seems also to be a special subject of recourse in cases of lost hearts among the northern Italians even at the present day, will realize that probably the story as told is the simple truth without any tincture of romance. {118} Galvani began original work of a high order very early in his medical career. His graduation thesis with regard to bones, treating specially their formation and development, attracted no little attention and is especially noteworthy because of the breadth of view in it, for it touches on the various questions relative to bones from the standpoint of physics and chemistry as well as medicine and surgery. It was sufficient to obtain for its author the place of lecturer in anatomy in the University of Bologna, besides the post of director of the teaching of anatomy in the Institute of Sciences, a subsidiary institution. From the very beginning his course was popular. Galvani was an easy, interesting talker, and he was one of the first who introduced experimental demonstrations into his lectures. At this time the science of comparative anatomy was just beginning to attract widespread attention. John Hunter in London was doing a great work in this line which has placed him in the front rank of contributors to biology and collectors of important facts in all the sciences allied to anatomy and physiology. Galvani took up this work with enthusiasm and began the study particularly of birds. These animals, the farthest removed from man of the beings that have warm blood, present by that very fact many interesting contrasts and analogies, which furnish important suggestions for the explanation of difficult problems in human anatomy and physiology. His experimental work in comparative anatomy, strange as it might appear and apparently not to be expected, led him into the domain of electricity through the observation of certain phenomena of animal electricity and the effect of electrical current on animals. Like so many other great discoveries in science, his first and most important observations in electrical phenomena {119} were results of an accident. Of course, it is easy to talk of accidents in these cases. The fall of the apple for Newton, Laennec's observation of the little boys tapping on a log in the courtyard of the Louvre, from which he got his idea for the invention of the stethoscope, were apparently merest accidents. Without the inventive scientific genius ready to take advantage of them, however, these accidents would not have been raised to the higher planes of important incidents in history. They would have meant nothing. The phenomena had probably occurred under men's eyes hundreds of times before, but there was no great mind ready to receive the seeds of thought it suggested and go on to follow out the conclusions so obviously indicated. Galvani's observation of the twitching of the muscles of the frog under the influence of electricity may be called one of the happy accidents of scientific development, but it was Galvani's own genius that made the accident happy. There are two stories told as to the method of the first observation in this matter. Both of them make his wife an important factor in the discovery. According to the more popular form of the history, Galvani was engaged in preparing some frog's legs as a special dainty for his wife, who was ill and who liked this delicacy very much. He thought so much of her that he was doing this himself in the hope that she would be thus more readily tempted to eat them. While so engaged he exposed the large nerve of the animals' hind legs and at the same time split the skin covering the muscles. In doing this he touched the nerve-muscle preparation, as this has come to be called, with the scalpel and little forceps simultaneously, with the result that twitchings occurred. While seeking for the cause of these twitchings the idea of animal electricity came to him. The other form of the story of his original discovery is not {120} less interesting and is perhaps a little more authentic. One evening he was engaged in his laboratory in making some experiments while some friends and his wife were present. By chance some frogs, the hind legs of which had been stripped of skin, were placed upon the table not far from an apparatus for the generation of frictional electricity. They were not in contact with this apparatus at any point, however, though they were not far distant from the conductor. While the apparatus was being used to produce a series of sparks, a laboratory assistant, without thinking of any possible results, touched with the point of a scalpel the sciatic nerves of one of the animals. Just as soon as he did this all the muscles of this limb went into convulsive movement. It was Galvani's wife who noticed what had happened and who had the assistant use the scalpel once more with the same result. She was herself a woman of well-developed intellect, and her association with her father and husband made her well acquainted with the anatomy and physiology of the day. She realized that what had occurred was quite out of the ordinary. Accordingly, she called the attention of her husband to the phenomena, and is even said to have suggested their possible connection with the presence and action of the electric apparatus. Husband and wife then together, by means of a series of observations, determined that whenever the apparatus was not in use the phenomenon of the conclusive movements of the frog's legs did not take place, notwithstanding irritation by the scalpel. Whenever the electric apparatus was working, however, then the phenomenon in question always took place. According to either form of the story it is clear that Madame Galvani had an important part in the discovery, and Galvani himself, far from making little of what she had accomplished, was always {121} glad to attribute his discovery, or at least the suggestive hint that led up to it, to his wife. After these first discoveries on the influence of artificial electricity, nothing seemed more interesting than to investigate whether ordinary atmospheric electricity as manifested in lightning would produce the same effects on muscular movements. In this matter Galvani showed much courage as an inventive genius. He dared to place an atmospheric conductor on the highest point of his house and to this conductor he attached a wire, which ran down to his laboratory. During a storm he suspended on this metallic circuit by means of their sciatic nerves frogs' legs and the legs of other animals prepared for the purpose. To the feet of the animals he attached another wire sufficiently long to reach down to the bottom of a well, thus completing a current to the ground. All the phenomena took place exactly as if with artificial electricity. Whenever lightning flashed from the clouds the limbs of the animals experimented with underwent violent contractions, which were noticeable before the noise of the thunder, and were, so to say, the signal for it. These contractions took place, although there were no conductors from the muscles, and although the nerve conductors were not isolated. The muscular contractions were greater in proportion than the intensity of the lightning and the proximity of the storm. The phenomena were manifest whether the animal was in the open air or if, for greater convenience, it was enclosed in a room, or even in a vessel. The muscular contractions could even be noticed despite the fact that the nerves were separated somewhat from their conductor, especially whenever the lightning was violent. The sparks would leap over a small gap almost as in the case of artificial electricity, the muscular contraction of the animal {122} being proportioned to the energy and the nearness of the sparks. It is almost needless to say, these experiments upon the frog were not accomplished in a few days or a few weeks. Galvani had his duties as Professor of Anatomy to attend to, besides the obligations imposed upon him as a busy practitioner of medicine and surgery. At that time it was not nearly so much the custom as it is at present, to use frogs for experiments, with the idea that conclusions might be obtained of value for the biological sciences generally, and especially for medicine. There has always been an undercurrent of feeling that such experiments are more or less a beating of the air. Galvani found opposition not only to his views with regard to animal electricity as enunciated after experimental demonstration, but also met with no little ridicule because of the supposed waste of time at occupations that could not be expected to lead to any practical results. It was the custom among scientific men to laugh somewhat scornfully at his patient persistence in studying out every detail of electrical action on the frog, and one of the supposedly prominent scientists of the time even dubbed him the frog dancing master. This did not, however, deter Galvani from his work, though some of the bitter things must have proved cutting enough, and might have discouraged a smaller man, less confident of the scientific value of the work that he was doing. There were even phases of physical science quite apart from physiology or animal electricity, which he was able to illustrate by his experiments. He called special attention, for instance, to the fact that the lightning does not excite a single contraction of the muscle as is the case with a spark of artificial electricity, but that there are a series of muscular contractions succeeding one another rapidly in diminishing {123} energy and somewhat corresponding to the reiterated reports of thunder. This was Galvani's expression for the dying away of the electrical influence upon the muscle. He had thus evidently reached a hint of the pendulum-like swing with which electrical equilibrium is restored after its violent disturbance immediately following the lightning stroke. He noted, moreover, that for the production of muscular contractions the absolute appearance of lightning was not indispensable. Muscular twitchings were noted whenever the heavens were overclouded by a storm, or whenever clouds charged with electricity were passed above the conductor. These experiments were made upon living frogs, as well as upon the separated legs, and in both cases the results obtained were very similar to those observed on the employment of some form of artificial electricity. In some of these observations, Galvani was anticipating ideas that became current truth in electrical science only many years after his time. In his observations upon the effects of lightning, he was forestalling Franklin's works to a certain extent. Both of these great scientists, however, had been anticipated by a clergyman in Austria; whose work attracted very little attention, however, because he was not in touch with the scientific bodies of the day. The demonstration of the identity of ordinary terrestrial artificial electricity and the lightning was in the air, as it were, and many workers, as is usually the case with any great discovery, came very close to it, and deserve at least a portion of the credit for it. It is almost needless to say, many of these experiments with lightning thus conducted by Galvani were not without an element of serious personal danger. Not long after this time a Russian savant, Richman by name, while repeating Franklin's experiments with the kite, was struck dead by the charge received from his apparatus. Galvani, however, {124} devoted himself only in passing to the physical problems involved, and kept always in view the physiological aspects of the problem of animal electricity; and, accordingly, made a series of most interesting observations on the ray fish or torpedo, as it is sometimes called, the fish which gives electrical shocks. His idea was to demonstrate that the shocks felt when this animal is touched are really due to sparks of electricity similar to those which can be obtained by artificial means. This had never been determined, and Galvani succeeded in showing the presence of sparks exactly as if the animal were one of the apparatuses by which the sparks of frictional electricity are developed. At this time this seemed surprising enough. Galvani also endeavored to demonstrate that the electricity in the electric torpedo differed only in degree, but not in quality, from certain electric manifestations that he had noted in the bodies of other animals, especially the frog. His idea always was to show the existence of a natural animal electricity, by means of which some of the complex mechanism of life was accomplished. He seems to have had some notion of the theory that has been suggested often enough since, and is not yet entirely disproved, that there is some very close relationship between nerve impulses and the electric current. In this, of course, he was far ahead of his time, and utterly unable to make absolute demonstration, because of the lack of proper apparatus. The most interesting quality of Galvani's scientific career is the thoroughly experimental character of all his researches into natural phenomena. Few men have known so well how to vary their experiments so as to bring out new details of scientific knowledge. His experimental skill was of the highest order, and it is to this that we owe the development in his hands of the nascent science of electricity to a point {125} where it became easy to continue its natural evolution. Galvani's work furnished the necessary stimulus to Volta, and then the real foundation of modern electricity was laid. Almost more interesting than Galvani the scientist, however, is Galvani the man. As one of his biographers said of him, he joined to the most eminent intellectual genius a group of very precious qualities of the heart. Utterly unselfish in his relationship to others, he was known to be extremely sympathetic and had a large number of friends. His friends, too, he bound to him by even more than the proverbial hoops of steel, so that when they passed out of life they left him unconsolable. While it was very hard to get him to take part in social functions at which numbers of people were gathered, he was by no means a recluse, and liked to be in the company of a few friends. He seemed to care very little for the renown that his discoveries gave him, and refused, as far as possible, to be made the object of public congratulations and testimonials. His relations with his patients--for during all of his long career he continued to practise, especially surgery and obstetrics--were of the friendliest character. While his distinction as a professor at the university gave him many opportunities for practice among the rich, he was always ready and willing to help the poor, and, indeed, seemed to feel more at home among poor patients than in the society of the wealthy and noble. Even towards the end of his life, when the loss of many friends, and especially his wife, made him retire within himself much more than before, he continued to exercise his professional skill for the benefit of the poor, though he often refused to take cases that might have proved sources of considerable gain to him. Early in life, when he was very busy between his professional work and his practice, he remarked more than once, on refusing {126} to take the cases of wealthy patients, that they had the money with which to obtain other physicians, while the poor did not, and he would prefer to keep some time for his services for them. Toward the end of his life Galvani was not a little perturbed by the course of events around him and by the sweeping away of faith in old beliefs, consequent upon the French Revolution and the philosophic movement that had led up to it. Seeing around him, too, the abuses to which this supposed liberty and assertion of the rights of man led, it used to be a favorite expression of Galvani that "A little philosophy led men away from God, but a good deal of it led them back to Him again." Especially did he consider this true with regard to younger men, whose lack of wisdom in the difficult phases of life made them think their philosophy of things was complete, until sad experience had taught them the necessity for lifting men's minds above any mere religion of humanity, any mere stoic resignation to the inevitable, if what was best in them was to be brought out. A very interesting phase of the Italian university life of that time is revealed in two important incidents of Galvani's university career. One of his professors, one, by the way, for whom he seems to have had a great deal of respect, and to whose lectures he devoted much attention, was Laura Caterina Maria Bassi, the distinguished woman professor of philosophy at the University of Bologna, about the middle of the eighteenth century. It is doubtless to her teaching that Galvani owes some of his thoroughgoing conservatism in philosophic speculation, a conservatism that was of great service to him later on in life, in the midst of the ultra-radical principles which became fashionable just before and during the French Revolution. Madame Bassi seems to have had her influence on him for good not only during his student {127} career, but also later in life, for she was the wife of a prominent physician in Bologna, and Galvani was often in social contact with her during his years of connection with the university. As might, perhaps, be expected, seeing that his own happy domestic life showed him that an educated woman might be the centre of intellectual influence, Galvani seems to have had no spirit of opposition to even the highest education for women. This is very well illustrated by the first formal lecture in his course on anatomy at the university, which had for its subject the models for the teaching of anatomy that had been made by Madame Manzolini. In the early part of the eighteenth century Madame Manzolini had been the professor of anatomy at the University of Bologna, and in order to make the teaching of this difficult subject easier and more definite she modelled with great care and delicate attention to every detail, so that they imitated actual dissections of the human body very closely, a set of wax figures which replaced the human body for demonstration purposes at least at the beginning of the anatomical course. Galvani, in taking up the work of lecturer on anatomy, appreciated how much such a set of models would help in making the introduction to anatomical study easy, yet at the same time without detracting from its exactness, and, accordingly, introduced his students to Madame Manzolini's set of models in his very first lecture. At the time there were those connected with the teaching of anatomy who considered the use of these models as rather an effeminate proceeding. Galvani's lack of prejudice in the matter shows the readiness of the man to accept the best wherever he found it without regard to persons or feelings. He was one of the most popular professors that the University of Bologna has ever had. He was not in the ordinary {128} sense of the word an orator, but he was a born teacher. The source of the enthusiasm which he aroused in his hearers was undoubtedly his own love for teaching and the power it gave him to express even intricate problems in simple, straightforward language. More than any of his predecessors he understood that experiments and demonstrations must be the real groundwork of the teaching of science. Accordingly, very few of his lectures were given without the aid of these material helps to attract attention. Besides he was known to be one who delighted to answer questions and was perfectly frank about the limitations of his knowledge whenever there was no real answer to be given to a question that had been proposed. Though an original discoverer of the first rank, he was extremely modest, particularly when talking about the details of his discoveries, or subjects relating to them. The most striking proof of the thorough conscientiousness with which he faced the duties of life is to be found in his conduct after the establishment of the so-called Cis-Alpine Republic in Italy. This was a government established merely by force of arms without the consent of the people and a plain usurpation of the rights of the previous government. He considered himself bound in duty to the authority under which he had lived all his previous life and to which he had sworn fealty. When the University of Bologna was reorganized under the new government the first requirement of all those who were made professors was that they should take the oath of allegiance to the new government. This he refused to do. His motives can be readily understood, and though practically all the other professors of the university had taken the oath he did not consider that this freed him from his conscientious obligations in the matter. Accordingly, he was dropped from the roll of professors {129} and deprived of the never very large salary which he had obtained from this chair. On this sum he had practically depended for his existence and he soon began to suffer from want. While he had been a successful practitioner of medicine, especially of surgery, he had always been very liberal and had spent large sums of money in demonstrations for his lectures and personal experimentation and in materials for the museums of the university. He began to suffer from actual want and friends had to come to his assistance. He refused, however, to give up his scruples in the matter and accept the professorship which was still open for him. Finally, at the end of two years, influence was brought to bear on the new government and Galvani was allowed to accept his chair in the university without taking the oath of allegiance. This tribute came too late, however, and within a short time after his restoration to his professorship he died. That his action in this matter was very properly appreciated by his contemporaries, and that the moral influence of his example was not lost, can be realized from the expressions used by Alibert, the Secretary-general of the Medical Society of Emulation, in the historical address on Galvani which he delivered before that society in 1801: "Galvani constantly refused to take the civil oath demanded by the decrees of the Cis-Alpine Republic. Who can blame him for having followed the voice of his conscience, that sacred, interior voice, which alone prescribes the duties of man and which has preceded all human laws? Who could not praise him for having sacrificed with such exemplary resignation all the emoluments of his professorship rather than violate the solemn engagements made under religious sanction?" In the same panegyric there is a very curiously interesting passage with regard to Galvani's habit of frequently closing his {130} lectures by calling attention to the complexity yet the purposefulness of natural things and the inevitable conclusion that they must have been created with a definite purpose by a Supreme Being possessed of intelligence. At the time that Alibert wrote his memoir it was the fashion to consider, at least in France, that Christianity was a thing of the past, and that while theism might remain, that would be all that could be expected to survive the crumbling effect of the emancipation of man. He says: "We have seen already what was Galvani's zeal and his love for the religion which he professed. We may add that in his public demonstration he never finished his lectures without exhorting his pupils to a renewal of their faith by leading them always back to the idea of the eternal Providence which develops, preserves and causes life to flow among so many different kinds of things. I write now," he continues, "in the age of reason, of tolerance and of light. Must I then defend Galvani in the eyes of posterity for one of the most beautiful sentiments that can spring from the nature of man? No, and they are but little initiated in the saner mechanism of philosophy who refused to recognize the truths established on evidence so strong and so authentic. _Breves haustus in philosophiâ ad atheismum ducunt, longiores autem reducunt ad deum_, small draughts of philosophy lead to atheism, but longer draughts bring one back to God"--(which may perhaps be better translated by Pope's well-known lines, "A little learning (in philosophy) is a dangerous thing; drink deep or touch not the Pierian spring"). Galvani has been honored by his fellow-citizens of Bologna as one of their greatest townsmen and by the university as one of her worthiest sons. In 1804 a medal was struck in his honor, on the reverse of which, surrounding a figure of the {131} genius of science, were the two legends: _"Mors mihi vita"_ "Death is life or me," and _"Spiritus intus alit,"_ "The spirit works within," which were favorite expressions of the great scientist while living and are lively symbols of the spirit which animated him. In 1814 a monument was erected to him in the courtyard of the University of Bologna. It is surmounted by his bust, made by the most distinguished Bolognian sculptor of the time, De Maria. On the pedestal there are two figures in bas-relief executed by the same sculptor, which represent religion and philosophy, the inspiring geniuses of Galvani's life. Before he died, he asked, as had Dante, whose work was his favorite reading, to be buried in the humble habit of a member of the Third Order of St. Francis. He is said to have valued his fellowship with the sons of the "poor little man of Assisi" more than the many honorary fellowships of various kinds which had been conferred upon him by the scientific societies all over Europe. {132} {133} LAENNEC, MARTYR TO SCIENCE {134} The knowledge which a man can use is the only real knowledge, the only knowledge which has life and growth in it and converts itself into practical power. The rest hangs like dust about the brain, or dries like rain-drops off the stones. --Froude. {135} LAENNEC, MARTYR TO SCIENCE. On August 13, 1826, there died at Quimper in Brittany at the early age of forty-five, one of the greatest physicians of all time. His name, René Theodore Laennec, was destined to be forever associated with one of the most fruitful advances in medicine that has ever been made, and one which practically introduced the modern era of scientific diagnosis. At the present time the most interesting phase of medical development is concerned with the early recognition and the prevention of tuberculosis. To Laennec more than to any other is due all the data which enable the physician of the twentieth century to make the diagnosis of tuberculosis with assurance, and to treat it with more confidence than before, and so prevent its spread as far as that is possible. The history of pulmonary consumption in its most modern phase is centred around the names of three men, Laennec, Villemin, and Koch. To Laennec will forever belong the honor of having fixed definitely the clinical picture of the disease, and of having separated it by means of auscultation and his pathological studies from all similar affections of the lungs. Villemin showed that it was an infectious disease, absolutely specific in character, and capable of transmission by inoculation from man to the animal. To Koch the world owes the knowledge of the exact cause of the disease and consequently of the practical method for preventing its spread. The isolation of the bacillus of tuberculosis is the great triumph of the end of the nineteenth century, as the separation of the disease from all others by Laennec was the triumph of the beginning of that century. There is {136} still room for a fourth name in the list, that of the man who will discover a specific remedy for the disease. It is to be hoped that his coming will not be long delayed. The estimation in which Laennec was held by the most distinguished among his contemporaries, may be very well appreciated from the opinions expressed with regard to him and his work by the best-known Irish and English clinical observers of the period. Dr. William Stokes, who was himself, as we shall see, one of the most important contributors to our clinical knowledge of diseases of the heart and lungs in the nineteenth century, said with regard to the great French clinician whom he considered his master: "Time has shown that the introduction of auscultation and its subsidiary physical signs has been one of the greatest boons ever conferred by the genius of man on the world. "A new era in medicine has been marked by a new science, depending on the immutable laws of physical phenomena, and, like the discoveries founded on such a basis, simple in its application and easily understood--a gift of science to a favored son; one by which the ear is converted into the eye, the hidden recesses of visceral disease open to view; a new guide to the treatment, and a new help to the ready detection, prevention and cure of the most widely spread diseases which affect mankind." Dr. Addison, who is best known by the disease which since his original description has been called by his name, was no less enthusiastic in praise of Laennec's work. He said: "Were I to affirm that Laennec contributed more toward the advancement of the medical art than any other single individual, either of ancient or of modern times, I should probably be advancing a proposition which, in the estimation of many, is neither extravagant nor unjust. His work, {137} _De l'Auscultation Mediate_, will ever remain a monument of genius, industry, modesty and truth. It is a work in perusing which every succeeding page only tends to increase our admiration of the man, to captivate our attention, and to command our confidence. We are led insensibly to the bedside of his patients; we are startled by the originality of his system; we can hardly persuade ourselves that any means so simple can accomplish so much, can overcome and reduce to order the chaotic confusion of thoracic pathology; and hesitate not in the end to acknowledge our unqualified wonder at the triumphant confirmation of all he professed to accomplish." These tributes to Laennec, however, from men who were his contemporaries across the channel, have been more than equalled by distinguished physicians on both sides of the Atlantic at the end of the nineteenth and the beginning of the twentieth century. While we might hesitate to accept the opinions of those who had been so close to him at the beginning of the new era of physical diagnosis, there can be no doubt now, after the lapse of three-quarters of a century, of what Laennec's influence really was, and the tributes of the twentieth century place him among the few great geniuses to whom scientific medicine owes its most important advance. At the annual meeting of the State Medical Society of New York held in Albany at the end of January, 1903, the president of the society, Doctor Henry L. Elsner, of Syracuse, in his annual address devoted some paragraphs to a panegyric of Laennec. He wished to call attention to what had been accomplished for scientific medicine at the beginning of the last century by a simple observant practitioner. In the course of his references to Laennec and his work he said: "It is by no means to be considered an accident that, {138} among the greatest advances in medicine made during the century just closed, the introduction of pathological anatomy and auscultation into the practice of medicine at the bedside were both effected by the same clear mind, Laennec. He is one of the greatest physicians of all time." He then quoted the opinion of a distinguished English clinician, Professor T. Clifford Allbutt, who is well known, especially for his knowledge of the history of medicine. Professor Allbutt is the Regius Professor of Physic (a term about equivalent to our practice of medicine) of Cambridge University, England, and was invited to this country some years ago as the representative of English medicine to deliver the Lane lectures in San Francisco. During his stay in this country he delivered a lecture at Johns Hopkins University on "Medicine in the Nineteenth Century," in which he said, "Laennec gives me the impression of being one of the greatest physicians in history; one who deserves to stand by the side of Hippocrates and Galen, Harvey and Sydenham. Without the advances of pathology Laennec's work could not have been done; it was a revelation of the anatomy of the internal organs during the life of the patient." René Theodore Hyacinthe Laennec, who is thus conceded by twentieth century medicine a place among the world's greatest medical discoverers, was born February 17, 1781, at Quimper in Bretagne, that rocky province at the north of France which has been the sturdy nursing mother of so many pure Celtic Frenchmen who have so mightily influenced the thought not only of their own country but of all the world. The names of such Bretons as Renan and Lamennais have a universal reputation and the province was even more distinguished for its scientists. There was published [Footnote 2] a few years ago in France a detailed {139} history of Breton physicians. This work sketches the lives of the physicians of Breton birth from the sixteenth to the twentieth century. Only those of the nineteenth century concern us, but the list even for this single century includes such distinguished names as Broussais, whose ideas in physiology dominated medicine for nearly the whole of the first half of the nineteenth century; Jobert, the famous French surgeon whose reputation was world-wide; Alphonse Guerin, another distinguished surgeon, whose work in the protection of wounds in some respects anticipated that of Lister; Chassaignac, to whose inventive genius surgery owes new means of preventing hemorrhage and purulent infection, and who introduced the great principle of surgical drainage; finally Maisonneuve, almost a contemporary, whose name is a household word to the surgeons of the present generation; without mentioning for the moment the subject of this sketch, Laennec, the greatest of them all. Six greater men never came from one province in the same limited space of time. [Footnote 2: Les Médecins Bretons par Dr. Jules Roger. Paris, J. B. Baillière, 1900.] Bretagne, "the land of granite covered with oaks" as the Bretons love to call it, may well be proud of its illustrious sons in the century just past. Taken altogether they form a striking example of how much the world owes to the children of the countryside who, born far from the hurrying bustle of city life, do not have their energies sapped before the proper time for their display comes. These Bretagne physicians, illustrious discoverers and ever faithful workers, are at the same time a generous tribute to the influence of the simple, honest sincerity of well-meaning parents whose religious faith was the well-spring of humble, model lives that formed a striking example for their descendants. The foundations of many a great reputation were laid in the simple village homes, far from the turmoil and the excitement of the fuller {140} life of great cities. The Bretons are but further examples of the fact that for genuine success in life the most precious preparation is residence in the country in childhood and adolescent years. The country districts of Normandy, the province lying just next to Bretagne, have furnished even more than their share of the Paris successes of the century, and have seen the Norman country boys the leaders of thought at the capital. Laennec's father was a man of culture and intelligence, who, though a lawyer, devoted himself more to literature than his case books. His poetry is said to recall one of his better known compatriots, Deforges-Maillard. Laennec was but six years old when his mother died. His father seems to have felt himself too much preoccupied with his own work to assume the education of his son, and so the boy Laennec was placed under the guardianship of his grand-uncle, the Abbé Laennec, and lived with him for some years in the parish house at Elliant. A relative writing of Laennec after his death says that the boy had the good fortune to be thus happily started on his path in life by a hand that was at once firm and sure. The training given him at this time was calculated to initiate him in the best possible way into those habits of application that made it possible for him to make great discoveries in after life. The boy was delicate besides, and the house of the good old rector-uncle was an excellent place for him, because of its large and airy rooms and the thoroughly hygienic condition in which it was kept. Household hygiene was not as common in those days as in our own and child mortality was higher, but the delicate boy thrived under the favorable conditions. Besides the parish house was situated in the midst of a beautiful country. The perfectly regular and rather serious {141} life of the place was singularly well adapted to develop gradually and with due progression the precious faculties of a young, active mind and observant intelligence. This development was accomplished besides without any excitement or worry and without any of the violent contrasts or precocious disillusions of city life. The boy passed some four or five years with his grand-uncle the priest and then went to finish his studies with a brother of his father, Dr. Laennec, a physician who has left a deservedly honored name. At this time Dr. Laennec was a member of the Faculty of Medicine at the University of Nantes. The growing lad seems to have been wonderfully successful in his studies, and a number of prizes gained at school show how deeply he was interested in his work. During this time he learned English and German and became really ready to begin the study of the higher sciences. Besides working at his academic studies, Laennec paid some attention to his uncle in his professional work, and by careful observation laid the foundation of his medical studies. His character as an observer, rather than a student of books, showed itself very early. He devoted himself to the clinical investigation of cases in the military hospital and was especially interested in the study of anatomy. In 1800, at the age of nineteen, he went to Paris. It was typical of the man and his careful, thoroughness all through life that the first impulse when he found himself free to work for himself, was to try to make up for what he considered defects in his elementary studies. It must not be forgotten that the ten years of Laennec's life, from his tenth to his twentieth year, came in the stormy time of the French Revolution, and that school regularity was very much disturbed. His first care then was to take up the study of Latin again. He learned to read and write the language with elegance and {142} purity. Later on, occasionally, he delivered his clinical lectures, especially when foreigners were present, in Latin. We shall have the occasion to see before the end of this article, with what easy grace he learned to use it from some passages of the preface of his book written in that language. He did not allow his accessory studies, however, to interfere with his application to his professional work. He was one of those rare men who knew how to rest his mind by turning it from one occupation to another. When scarcely more than a year in Paris, Laennec secured the two first prizes for medicine and surgery in the medical department of the University of Paris. In 1804 he wrote two medical theses, one of them in Latin, the other in French. The subject of both was Hippocrates, the great Greek father of medicine, whom Laennec admired very much and whose method of clinical observation was to prove the key-note of the success of Laennec's own medical career. At this time the Paris school of medicine had two great rival teachers. One of them was Corvisart, who endeavored to keep up the traditions of Hippocrates and taught especially the necessity for careful observation of disease. The other was Pinel, famous in our time mainly for having stricken the manacles from the insane in the asylums of Paris, but who was known to his contemporaries as a great exponent of what may be called "Philosophic Medicine." Corvisart taught principally practical medicine at the bedside; Pinel mainly the theory of medicine by the analysis of diseased conditions and their probable origin. Needless to say, Laennec's sympathies were all with Corvisart. He became a favorite pupil of this great master, who did so much for scientific medicine by introducing the method of percussion, invented nearly half a century before by Auenbrugger, but forgotten and neglected, so that it {143} would surely have been lost but for the distinguished Frenchman's rehabilitation of its practice. Corvisart was a man of great influence. He had caught Napoleon's eye. The great Emperor of the French had the knack for choosing men worthy of the confidence he wished to place in them. His unerring judgment in this matter led him to select Corvisart as his personal physician at a moment when his selection was of the greatest service to practical medicine, for no one was doing better scientific work at the time, and this quasi-court position at once gave Corvisart's ideas a vogue they would not otherwise have had. Corvisart's most notable characteristic was a sympathetic encouragement of the work of others, especially in what concerned actual bedside observation. Laennec was at once put in most favorable circumstances, then, for his favorite occupation of studying the actualities of disease on the living patient and at the autopsy. For nearly ten years he devoted himself almost exclusively to the care and study of hospital patients. In 1812 he was made physician to the Beaujon Hospital, Paris. Four years later he was transferred to the Necker Hospital, where he was destined to bring his great researches to a successful issue. To the Necker Hospital, before long, students from all over the world flocked to his clinical lectures, to keep themselves in touch with the great discoveries the youthful master was making. In spite of rather delicate health Laennec fulfilled his duties of physician and professor with scrupulous exactitude and with a self-sacrificing devotion that was, unfortunately, to prove detrimental to his health before very long. One of his contemporaries says of him: "Laennec was almost an ideal teacher. He talked very easily and his lesson was always arranged with logical method, clearness and simplicity. He disdained utterly {144} all the artifices of oratory. He knew, however, how to give his lectures a charm of their own. It was as if he were holding a conversation with those who heard him and they were interested every moment of the time that he talked, so full were his lectures of practical instruction." Another of his contemporaries says, naïvely: "At the end of the lesson we did not applaud, because it was not the custom. Very few, however, who heard him once, failed to promise themselves the pleasure of assisting at others of his lectures." The work on which Laennec's fame depended and the discovery with which his name, in the words of our great American diagnostician, Austin Flint, the elder, will live to the end of time was concerned with the practice of auscultation. This is the method of listening to the sounds produced in the chest when air is inspired and expired in health and disease, and also to the sound produced by the heart and its valves in health and disease. Nearly two centuries ago, in 1705, an old medical writer quoted by Walshe, in his "Treatise on the Disease of the Lungs and Heart" said very quaintly but very shrewdly: "Who knows but that one may discover the works performed in the several offices and shops of a man's body by the sounds they make and thereby discover what instrument or engine is out of order!" It was just this that Laennec did. He solved the riddle of the sounds within the human workshop, to continue the quaint old figure, and pointed out which were the results of health and which of disease. Not only this, but he showed the difference between the sounds produced in health and disease by those different engines, the lungs and the heart. The way in which he was led to devote his attention originally to the subject of auscultation is described by Laennec himself with a simplicity and directness so charmingly characteristic {145} of the man, of his thoroughly Christian modesty, of his solicitude for even the slightest susceptibility of others and of his prompt inventive readiness, that none of his biographers has been able to resist the temptation to quote his own words with regard to the interesting incident, and so we feel that we must give them here. He says: "In 1816 I was consulted by a young person who was laboring under the general symptoms of a diseased heart. In her case percussion and the application of the hand (what modern doctors call palpation) were of little service because of a considerable degree of stoutness. The other method, that namely of listening to the sounds within the chest by the direct application of the ear to the chest wall, being rendered inadmissible by the age and sex of the patient, I happened to recollect a simple and well-known fact in acoustics and fancied it might be turned to some use on the present occasion. The fact I allude to is the great distinctness with which we hear the scratch of a pin at one end of a piece of wood on applying our ear to the other. "Immediately on the occurrence of this idea I rolled a quire of paper into a kind of cylinder and applied one end of it to the region of the heart and the other to my ear. I was not a little surprised and pleased to find that I could thereby perceive the action of the heart in a manner much more clear and distinct than I had ever been able to do by the immediate application of the ear. "From this moment I imagined that the circumstance might furnish means for enabling us to ascertain the character not only of the action of the heart, but of every species of sound produced by the motion of all the thoracic viscera, and consequently for the exploration of the respiration, the voice, the _râles_ and perhaps even the fluctuation of fluid effused in the pleura or pericardium. With this conviction I forthwith {146} commenced at the Necker Hospital a series of observations from which I have been able to deduce a set of new signs of the diseases of the chest. These are for the most part certain, simple and prominent, and calculated perhaps, to render the diagnosis of the diseases of the lungs, heart and pleura as decided and circumstantial as the indications furnished to the surgeons by the finger or sound, in the complaints wherein these are of use." This is the unassuming way in which Laennec announces his great discovery. He did not in modern fashion immediately cry "Eureka!" and announce the far-reaching importance of his method of diagnosis. For two years he devoted himself to the patient study of the application of his method and the appreciation of its possibilities and its limitations. Then he presented a simple memoir to the French Academy of Sciences on the subject. A committee of three, then distinguished members of the Academy, Doctors Portal, Pelletan and Percy were named to investigate the new discovery. It is rather interesting to notice, though almost needless to say, that the names of these men would be now absolutely unremembered in medical history but for the fortuitous circumstance that made them Laennec's investigators. Such is too often the ephemeralness of contemporary reputation. Fortunately for the committee, they reported favorably upon Laennec's discoveries. It is not always true of new and really great advances in medicine that they are received with proper appreciation upon their first announcement. Even Harvey said of his discovery of the circulation of the blood that he expected no one of any reputation in his own generation to accept it. It is not very surprising to find then in the matter of the Laennec investigators that there is a cautious reserve in their report, showing that they were not too ready {147} to commit themselves to a decided opinion on the importance of the new discovery, nor to any irretrievable commendation. The important part of the discovery was supposed to consist in the use of the wooden cylinder which Laennec came to employ instead of the roll of paper originally used. This wooden cylinder, now familiar to us under the excellent name invented for it by Laennec himself is the modern single stethoscope. This instrument is of great service. The really important part of Laennec's work, however, was not the invention of the stethoscope, but the exact observation of the changes of the breath sounds that could be noted with it in various forms of chest diseases. Laennec succeeded in pointing out how each one of the various diseases of the heart and lungs might be recognized from every other. Before his time, most of the diseases of the lungs, if accompanied with any tendency to fever particularly, were called lung fever. He showed the difference between bronchitis and pneumonia, pneumonia and pleurisy, and the various forms of tuberculosis and even the rarer pathological conditions of the lung, such as cancer, or the more familiar conditions usually not associated with fever, emphysema, and some of the forms of retraction. With regard to heart disease, it was before Laennec's discovery almost a sealed chapter in practical medicine. It was known that people died from heart disease often and, not infrequently, without much warning. The possibility that heart conditions could be separated one from another, and that some of them could be proved to be comparatively harmless, some of them liable to cause lingering illness, while others were surely associated with the probability of sudden fatal termination, was scarcely dreamed of. It is to Laennec's introduction of auscultation that modern medicine owes all its exacter knowledge of heart lesions and their {148} significance. He himself did not solve all the mysteries of sound here as he did in the lungs; indeed, he made some mistakes that render him more sympathetic because they bring him down to the level of our humanity. He did make important discoveries with regard to heart disease, and his method of diagnosis during his own life was, in the hands of the Irish school of medicine, to prove the key to the problems of disease he failed to unlock. Almost at once Laennec's method of auscultation attracted widespread attention. From Germany, from Italy, from England, even from the United States, in those days when our medical men had so few opportunities to go abroad, medical students and physicians went to Paris to study the method under the direction of the master himself and to learn from him his admirable technique of auscultation. Those who came found that the main thing to be seen was the patient observation given to every case and Laennec's admirably complete examination of each condition. The services to diagnosis rendered by the method were worthy of the enthusiasm it aroused. Only the work of Pasteur has attracted corresponding attention during the nineteenth century. Physicians practice auscultation so much as a matter of course now that it is hard to understand what an extreme novelty it was in 1820, and how much it added to the confidence of practitioners in their diagnosis of chest diseases. Bouilland said, with an enthusiasm that does not go beyond literal truth, "A sense was lacking in medicine and I would say, if I dared, that Laennec the creator, by a sort of divine delegation of a new sense, supplied the long-felt want. The sense which medicine lacked was hearing. Sight and touch had already been developed in the service of medical diagnosis. Hearing was more important than the other two senses, and in giving it to scientific medicine Laennec disclosed a new {149} world of knowledge destined to complete the rising science of diagnosis." Henri Roger said: "Laennec in placing his ear on the chest of his patient heard for the first time in the history of human disease the cry of suffering organs. First of all, he learned to know the variations in their cries and the expressive modulations of the air-carrying tubes and the orifices of the heart that indicate the points where all is not well. He was the first to understand and to make others realize the significance of this pathological language, which, until then, had been misunderstood or, rather, scarcely listened to. Henceforth, the practitioner of medicine, endowed with one sense more than before and with his power of investigation materially increased, could read for himself the alterations hidden in the depths of the organism. His ear opened to the mind a new world in medical science." The freely expressed opinions of distinguished German, English and American physicians show that these enthusiastic praises from his French compatriots are well deserved by Laennec for the beautifully simple, yet wonderfully fecund method that he placed before the medical profession in all its completeness. The first employment of the stethoscope by rolling up sheets of paper is of itself a sign of his readiness of invention. He made his own stethoscopes by hand and liked to spend his leisure time fashioning them carefully and even ornately. One of the stethoscopes certainly used by him and probably made by himself is to be seen at the Museum of the College of Physicians of Philadelphia. After three years of study and patient investigation of the use of auscultation in pulmonary and cardiac diagnosis, Laennec wrote his book on the subject. This is an immortal work--a true classic in its complete treatment of the subject. {150} We have had thousands of books written on the subject since Laennec's time, and yet no physician could do better at the present moment than study Laennec's two comparatively small volumes to learn the art of physical diagnosis. It is a characteristic of genius to give a completeness to work that endows it with an enduring independent vitality. Almost innumerable disciples follow in the footsteps of a teacher, and each thinks that he adds something to the fulness of the revelation made by the master. At the end of a century the fourth generation finds that scarcely anything has been added and that the master's work alone stands out, not merely as the great central fact of the new theory or doctrine, but as the absolute vital entity to which the other supposed discoveries are only adventitious and not entirely indispensable accessories. Dr. Austin Flint, the elder, admittedly one of the greatest diagnosticians in pulmonary and heart diseases that we have ever had in America, said on this subject: "Suffice it to say here that, although during the forty years that have elapsed since the publication of Laennec's works the application of physical exploration has been considerably extended and rendered more complete in many of its details, the fundamental truths presented by the discoverer of auscultation not only remain as a basis of the new science, but for a large portion of the existing superstructure. Let the student become familiar with all that is now known on this subject, and he will then read the writings of Laennec with amazement that there remained so little to be altered or added." Laennec's unremitting devotion to his hospital work finally impaired his health. He was never robust and strangers who came to Paris and saw him for the first time wondered that he should be able to stand the labor he required of himself. The portraits of him give a good impression of {151} his ascetic delicacy; they convey besides a certain wistfulness, the look of one close to human suffering, and unable to do all that he would wish to relieve it. Long before his discovery of the mysteries of auscultation, he had accomplished results that of themselves, and without his subsequent master discovery, would have given him an enduring name in medical literature. Laennec's genius enabled him to make a really great discovery, but Laennec's talent, the principal part of which was an inexhaustible faculty for untiring labor, an infinite capacity for taking pains with all that he did, enabled him to make a number of smaller discoveries any one of which would have given a great reputation to a lesser man. Some idea of the amount of work that he did in preparing himself for the observations that were to result in his discovery may be gathered from details of his earlier career. During the first three years of his attendance at La Charité Hospital in Paris he drew up a minute history of nearly four hundred cases of disease. As early as 1805 he read a paper on hydatid cysts. These cysts were formerly thought to be hollow tumors formed within the tissues themselves somewhat as other cystic tumors are formed. Laennec showed conclusively that their origin was entirely due to certain worms that had become parasites in human beings. The cysts instead of being tumors were really one stage of the worm's existence, and had an organization and an independent existence of their own. He gave an exact description of them and even showed that there were several types of the parasite, and described the different changes that various forms produced in the human tissues. This study of the hydatid parasites remains a remarkable contribution to medicine down even to our own day. During these early years Laennec devoted himself particularly to the study of pathology. Like all the men who {152} have made great discoveries in medicine he understood that all true medical advance must be founded on actual observation of the changes caused by disease in the tissues, and that this knowledge can only be obtained in the autopsy room. For years he devoted himself to the faithful study of the tissues of patients dead from various forms of disease. He wrote as the result of this work a treatise on peritonitis that was a distinct advance over anything known before his time and which, in the words of Benjamin Ward Richardson, "as a pathological study was shrewdly in anticipation of the later work of one who became his most formidable rival, the famous Broussais." From the peritoneum his attention was attracted to the liver. As early as 1804 he wrote a description of the membranes of the liver. Pathological changes in the liver continued to occupy his attention for some time, and it is to him we owe the name cirrhosis of the liver, as a term for the changes which are produced by alcohol in this gland. Alcoholic cirrhosis is often spoken of as Laennec's cirrhosis of the liver, and he was the first to point out the significance of the changes in the organ, their etiology and the reason for the symptoms that usually accompany this condition. This work alone would have been sufficient to have made Laennec's name a permanent fixture in medical literature. During the early years of Laennec's career at Paris, the French Anatomical Society was founded and Laennec became a prominent member of it. Corvisart, who was the moving spirit in the society, was at this time--the early years of the nineteenth century--doing his great teaching at the medical school of the University of Paris. He was Laennec's master, and was at the height of his glory. It was a constant source of surprise to his students to note how well the master's diagnosis agreed with postmortem findings. This is, after {153} all, the only true criterion of scientific diagnosis. It is not surprising that the strict application of this practical method of control of medical theory soon gave rise to a series of distinct advances in medical knowledge of the greatest importance. Discussions of cases were frequent and Laennec took a prominent part in them. His knowledge of medicine was broadening in this great field of practice, and he was chosen as one of the contributors to the _Dictionnaire des Sciences Médicales_. His articles for this work contained much original matter of great value and suggestive views of notable importance. Laennec was the first to give a description of carcinoma encephaloides and certain especially malignant forms of cancers. He showed the distinction between pigmented spots of benignant character and those that were due to malignant disease. "After all, however," says Benjamin Ward Richardson, "the grand reputation of Laennec must rest on his one immortal work. It is not too much to say that any man of good intelligence could have written the other memoirs. No one less than Laennec could have written the 'Treatise on Mediate Auscultation and the Use of the Stethoscope.' The true student of medicine, who never wears out, reads this original work of Laennec once in two years at least, so long as he is in practice and takes a living interest in the subject of which it treats. It ranks equally with the original works of Vesalius, Harvey and Bichat and as a section of medical literature is quite equal to any section of Hippocrates." [Footnote 3] [Footnote 3: The full title of this work of Laennec's is "De l'auscultation médiate ou traité du diagnostic des maladies des poumons et du coeur par R. T. H. Laennec." Its modest motto is the Greek sentence: [Greek Text], (The most important part of an art is to be able to observe properly.) The book was published in Paris by J. A. Brosson et J. S. Chandé, rue Pierre-Sarrazin, No. 9, 1819.] {154} Some quotations from the Latin preface to the book will serve to show that Laennec appreciated the value of the discovery he had made for the diagnosis of chest diseases, yet that he did not expect it to be taken up enthusiastically at once, and in his modest way he adds that he shall be satisfied if it should serve to save but one human being from suffering and death. [Footnote 4] [Footnote 4: "Imo neminem hanc methodum expertum deinceps cum Baglivio dicturum esse spero: O quantum difficile est diagnoscere morbos pulmonum." "Nostra enim _aetas incuriosa_ quoque _suorum_ (the italics are Laennec's own); et si quid novi ab homine coaevo in medio ponitur, risu ut plurimum ineptisque cavillationibus excipiunt; quippe facilius est aspernari quam experiri." "Hoc mihi satis est quod bonis doctisque viris nonnullis acceptam aegrotisque multis utilem, hanc methodum fore confidere possim; hominem unum ereptum orco dulce dignumque meae atque etiam majoris operae pretium praemium fore existimem." "I may say that no one who has made himself expert with this method will after this have occasion to say with Baglivi, Oh! how difficult it is to diagnose disease of the lungs." "For our generation is not inquisitive as to what is being accomplished by its sons. Claims of new discoveries made by contemporaries are likely for the most part to be met by smiles and mocking remarks. It is always easier to condemn than to test by actual experience." "It suffices for me if I can only feel sure that this method will commend itself to a few worthy and learned men who will make it of use to many patients. I shall consider it ample, yea, more than sufficient reward for my labor, if it should prove the means by which a single human being is snatched from untimely death."] Unfortunately, as we have said, Laennec's untiring devotion for nearly twenty years to medical investigation caused his health to give way. It is painful to think that in the full tide of the success of his great labors, when the value of his work was only just beginning to be properly appreciated and when he had attained a position which would satisfy even lofty ambitions, his nerves gave way and he had many {155} of the typical melancholic symptoms that disturb the modern neurasthenic. Fortunately, his habits of life, always extremely abstemious, and his liking for outdoor sports had been a safeguard for him. He retired to the country and for nearly two years spent most of his time in the open air. It was not long before surcease from intellectual labor and indulgence in field sport restored him to health and to activity. He foresaw, however, that to go back to the city and to his scientific work would almost surely lead to another breakdown. One of his biographers states that it was the great regard which he had for his family and the powerful influence of his religious principles which alone had sufficient weight to make him leave his retreat in the country. After an absence of two years, he returned to Paris and once more took up his hospital duties. Soon after his return he received the appointment of physician to the Duchesse de Berri. One of the main objections to this position in Laennec's mind seems to have been the necessity for occasionally wearing court dress with a sword and regalia. Ordinarily he went dressed very plainly, and it was noted that, when men of much less authority and much less practice used their own carriages, he usually took a hired cab. His position at court gave him enough influence to bring about the proper recognition of his merit as a teacher. At this time his lectures on auscultation, though he held no regular professorship, were crowded by students from all nations. The year after his return to Paris he was appointed Professor of Medicine in the College of France, and afterward of clinical medicine at the Hospital La Charité where he had made his own studies as a medical student. About this time he was offered a position of importance as a member of the Royal Council of Public Instruction. This he refused, however, because it would deprive him of {156} some of the precious time that he wished to devote to the further investigation of important subjects in clinical medicine and especially to the elaboration of his method of auscultation. One of the most striking features of Laennec's character was his absolute placidity and lack of personal ambition. His life was passed in the most complete calm. He devoted himself to his work, and had the supreme joy of duty accomplished, seeming to look for no other enjoyment in life. Those who knew him best said that they had never seen him angry or even impatient. In the midst of his discussion with Broussais, it might have been expected that there would occasionally have been some flashes of impatience, for the great protagonist of medical theory was a man of satiric character, and his supposedly scientific discussion was stained by some very bitter personalities. In spite of all Broussais' sarcasm, Laennec remained absolutely unmoved. Occasionally his friends saw a smile at some of Broussais' emphatic asseverations, but Laennec simply continued at his work, and looked straight ahead, convinced that what he was doing was for the cause of truth, and the truth would finally prevail. He was known for the kindness of his disposition, and his readiness to help his friends whenever it was possible. He was never known to injure anyone, and a certain quiet elevation of spirit preserved him from all conceit. One of his most intimate Breton friends, Kergaradec, said, "I have never heard Laennec express by a single word, or even by the slightest insinuation, anything that might seem to indicate pride in what he had accomplished or that might provoke a listener to say something in praise of him." The friends he made were bound to him with hoops of steel. They were not many, for he had not the time to waste on many friends. He was too devoted to his work, and too {157} deeply interested in the great problem whose solution he foresaw meant so much for the good of humanity, to have much time for anything but his studies and his patients. With regard to Laennec's personal character, his most recent biographer Dr. Henri Saintignon, has said: [Footnote 5] [Footnote 5: Laennec, Sa vie et son oeuvre. Par Dr. Henri Saintignon. Paris, J. B. Baillière et Fils, 1904.] "I have shown in the course of this life just what was the character of Laennec and his intellectual and moral qualities, so that it will not be necessary for me to dwell at length on this subject, in concluding. His great piety, which had never been abandoned from his earliest infancy, was his main guide during all his life. Without ostentation, yet without any weakness, absolutely ignoring human respect, he obeyed with utter simplicity the prescriptions of his faith. While he did not conceal his convictions when during the first empire they might have proved a source of lessened esteem, or positive prejudice, he made no noise about them when under the Restoration they might have proved the means of advancement and of fortune. He had not in the slightest degree what is so often objected to, in devoted persons, namely, the love of making proselytes. The words of Prof. Desgenettes might very well have been applied to him: as he did not believe himself to have any mission to lead others to his opinions, he limited himself to preaching by example. The reproach of being rabidly clerical or propagandist, which was urged against him, when he first became a member of the faculty of medicine, was absolutely unjustified. Laennec never occupied himself with politics nor with religion in public. As a physician he devoted himself exclusively to his profession, receiving at his clinic all those who desired to follow his teaching, whatever might be their opinions or their beliefs." {158} It was not long, however, before Laennec's many labors in Paris began to tell on his health once more. His practice after his return to health and his attachment to the court became large and lucrative. It is characteristic of the man and his ways that he frequently refused, owing to lack of time, to go to see wealthy patients, from whom he would have received large fees, but it is said that he never refused to go to see a poor patient. His hospital patients always received the most solicitous attention, and his time was almost entirely at their disposal. It was not long before Laennec himself, who had taught modern physicians so much about the diagnosis of pulmonary diseases, began evidently to suffer from pulmonary disease himself. There seems no doubt now that almost constant association with tuberculous patients in an overworked subject inclined naturally to be of underweight, and therefore especially susceptible, led to the contraction of the disease. After about four years in Paris, a dry, hard cough developed insidiously, gradually increased in annoyance, and finally grew so serious as to demand a return once more to his native Bretagne. He lost flesh, became subject to intermittent attacks of fever and suffered from some pleuritic and pulmonic pains. For some time after his return to his native air he improved. He was treated by the usual method employed at the time whenever fever accompanied any ailment. Venesection was the main part of what was then called the antiphlogistic treatment. It is needless to say he did not improve. He was suffering from exhausting disease and the treatment became really an accessory to further exhaustion. At last there could be no longer any doubt that the end was approaching. The old curé of the village came often to visit him, and brought him all the consolations of religion. {159} With his sincere Christian faith and firm conviction, it was not hard for Laennec to find the moral force and the calm necessary to secure an easy death. Finally one day, on August 13th, his wife saw him take off his fingers one after another the rings he wore, and place them softly upon the table. When she asked him why he did so, he replied, "It will not be long now before someone else would have to do this service for me, and I do not wish that they should have the trouble." Even in death he was thinking of others rather than of himself, and he was calmly facing the inevitable, thoroughly prepared for it. Two hours afterward, at five o'clock in the afternoon, without there having been at any time the slightest loss of consciousness, Laennec passed away. How faithfully his family had watched over him, and how simple was the feeling of Christian confidence in all of them, may very well be gathered from the letter of his cousin Ambrose to Laennec's brother Meriadec in Paris. "My dear Meriadec:--Poor Renè is no more. His life was passed in the midst of labor and of benevolence. While he had all the virtues of the true Christian, and a wisdom far beyond what was usually granted to men, they have not sufficed to obtain for him the grace of a longer life. Somehow it was ordained that this glory and ornament of our family was not to remain with us. What a sad reflection it is on our restless eagerness in this life, and on the vanity of our hopes, that a genius like this must perish just when it was about to receive the fruit of its labors! He leaves to us a name, a name difficult to sustain and the example of virtues that it will not be easy to imitate. Let us hope that he will watch over us in the future as he has done in the past, and that he will still continue to aid us after his death. Although I have been prepared for this sad event, I could not suspect how much grief I was to experience in losing my {160} second master, my friend from earliest infancy, and him whom I had become accustomed to consider as my eldest brother. I must confess that for some years now we have all had to pay dear for the short intervals of happiness that it has pleased heaven to accord to us." Laennec's burial took place in the cemetery of Ploare. The attendance at the funeral was very large. Practically the entire population of the countryside came to mourn for the benefactor that they loved so much. He had made friends even among the simplest of the country people and knew most of them by name. After his return to the country, he had improved somewhat in appearance, and the neighbors had been very glad to express their feelings of gratitude for his apparent improvement in health. Undoubtedly not a little of this state of better spirits was due to the fact that he liked Brittany and the peasants of the neighborhood so well, and always felt so much at home among them. He was mild and agreeable in his manners, and of a quiet and even temper. His conversation was lively and full of quiet humor, and his friends often said that they never came away from a conversation with him without having learned something. Toward the end of his life, when his great reputation caused him to be honored by medical men from all over the world, and when his reputation made him the lion of the hour, he lost none of his natural affability and kindness of heart. He was remarkable, especially, for his great kindness and courtesy to foreigners, and he is said to have taken special care to make himself understood by English-speaking medical visitors. It must be confessed that he was somewhat less popular with his contemporaries who did not belong to his immediate circle of friends and students. One of the reasons for this was his genius, which no generation seems ready to {161} acknowledge in any of its members. Another reason was his continued misunderstanding with Broussais. Broussais was the medical theorist of the hour, and medical theories have always been popular, while medical observation has had to wait for due recognition. There were undoubtedly good points in Broussais' theories that Laennec failed to appreciate. This is the only blot on a perfect career, taking it all in all, whether as man or as physician. It can easily be understood with what impatience Laennec, entirely devoted himself to observation, would take up the study of what he considered mere theory, and it is easy to forgive him his lack of appreciation. Benjamin Ward Richardson says: "It was a common saying regarding Laennec by his compeers that, while he was without a rival in diagnosis, he was not a good practitioner; which means that he was not a good practitioner, according to their ideas of practice, heroic and fearful. To us, Laennec would now be a practitioner very heroic; so much so, that I doubt if any medical man living would, for the life of him, take some of his prescriptions. But in his own time, when so little was known of the great system of natural cure, he would be easily out of court. It was amply sufficient against him that he had a glimmering of the truth as to the existence of a considerable run of cases of organic disease, for which the so-called practice of remedial cure by drugs, bloodlettings and other heroic plans, could do no good but was likely to do grievous harm." We are reminded of Morgagni's refusal to permit bloodletting in his own case, though he practised it himself on others. Like Laennec, Morgagni seems to have doubted the efficacy of bloodletting at a time when unfortunately all medical men were agreed that it was the sovereign remedy. If Laennec was not popular with his immediate {162} contemporaries, succeeding generations have more than made up for the seeming neglect. Less than twenty-five years after his death, Austin Flint, here in America, hailed him as one of the five or six greatest medical men of all times. Forty years after his death, Professor Chauffard, himself one of the distinguished medical men of the nineteenth century, said: "Without exaggeration we can call the glory which has come to French medicine because of the great discovery of auscultation a national honor. It must be conceded that for a long time before Laennec, the great man of medicine, those to whom medical science owed its ground-breaking work did not belong to France. Harvey, Haller and Morgagni had made the investigations on which are founded the circulation of the blood, experimental physiology, and pathological anatomy, in other lands than ours. It almost seemed that we were lacking in the fecund possibilities of daring and successful initiative. Auscultation, however, as it came to us perfect from the hands of Laennec, has given us a striking revenge for any objections foreigners might make to our apathy. This discovery has rendered the scientific medicine of the world our tributary for all time. It was an immortal creation, and its effects will never fail to be felt. More than this, it will never be merely an historical reminiscence, because of the fact that it guided men aright, but it will in its actuality remain as an aid and diagnostic auxiliary. Auscultation will not disappear but with medical science itself, and with this stage of our civilization which guides, directs and enlightens it." Laennec was known for his simple Bretagne faith, for his humble piety, and for uniformly consistent devotion to the Catholic Church, of which he was so faithful a member. His charity was well known, and while his purse was very ready to assist the needy, he did not hesitate to give to the {163} poor what was so much more precious to him, and it may be said to the world also, than money--his time. After his death, and only then, the extent of his charity became known. Dr. Austin Flint said of him: "Laennec's life affords an instance among many others disproving the vulgar error that the pursuits of science are unfavorable to religious faith. He lived and died a firm believer in the truths of Christianity. He was a truly moral and a sincerely religious man." Of his death, his contemporary, Bayle, who is one of his biographers, and who had been his friend from early youth, said: "His death was that of a true Christian, supported by the hope of a better life, prepared by the constant practice of virtue; he saw his end approach with composure and resignation. His religious principles, imbibed with his earliest knowledge, were strengthened by the conviction of his maturer reason. He took no pains to conceal his religious sentiments when they were disadvantageous to his worldly interests, and he made no display of them when their avowal might have contributed to favor and advancement." Surely in these few lines is sketched a picture of ideal Christian manhood. There are those who think it wonderful to find it in a man of genius as great as Laennec. It should not be surprising, however, for surely genius can bow in acknowledgment to its Creator. Shortly after the death of Pasteur it was well said that two of the greatest medical scientists of the nineteenth century have given to the physicians of France a magnificent, encouraging and comforting example. It is almost needless to say these two were Laennec and Pasteur, and their example is not for France alone, but for the whole medical world. They were living nineteenth century answers to the advocates of free thought, who would say that religious belief and {164} especially Catholic faith make men sterile in the realm of scientific thought. No better ending to this sketch of Laennec's life seems possible than the conclusion of Dr. Flint's address to his students in New Orleans, already so often quoted from. It has about it the ring of the true metal of sincere Christian manhood and unselfish devotion to a humanitarian profession: "The career of the distinguished man whose biography has been our theme on this occasion is preeminently worthy of admiration. In his character were beautifully blended the finest intellectual and moral qualities of our nature. With mental powers of the highest order were combined simplicity, modesty, purity and disinterestedness in such measure that we feel he was a man to be loved not less than admired. His zeal and industry in scientific pursuits were based on the love of truth for its own sake and a desire to be useful to his fellow-men. To these motives to exertion much of his success is to be attributed. Mere intellectual ability and acquirements do not qualify either to make or to appreciate important scientific discoveries. The mind must rise above the obstructions of self-love, jealousy and selfish aims. Hence it is that most of those who have attained to true eminence in the various paths of scientific research have been distinguished for excellencies of the heart as well as of the head. The example of Laennec is worthy of our imitation. His superior natural gifts we can only admire, but we can imitate the industry without which his genius would have been fruitless. Let us show our reverence to the memory of Laennec by endeavoring to follow humbly in his footsteps." _Quod faustum vertat!_ {165} THE IRISH SCHOOL OF MEDICINE {166} There are men and classes of men that stand above the common herd: the soldier, the sailor, and the shepherd not infrequently; the artist rarely; rarelier still, the clergyman; the physician almost as a rule. He is the flower (such as it is) of our civilization; and when that stage of man is done with, and only to be marvelled at in history, he will be thought to have shared as little as any in the defects of the period, and most notably exhibited the virtues of the race. --Robert Louis Stevenson, Preface to _Underwoods_. The physician who is not also a scholar may be a more or less successful practitioner, but his influence will be confined, his methods mechanical and his interests narrow. The doctor, the lawyer and the minister of religion can do but inferior work, unless to a knowledge of their several sciences they bring the insight, the wide outlook, and the confidence which nothing but intimate acquaintance with the best that has been thought and said can confer. The more accomplished the specialist, the greater the need of the control which philosophic culture gives. --Bishop Spalding. {167} THE IRISH SCHOOL OF MEDICINE. [Footnote 6] Robert Graves, M.D. [Footnote 6: For much of the material embodied in this series I am indebted to Sir Charles Cameron, the Historian of the Royal College of Surgeons in Ireland, whose courtesy to me while on a visit to Dublin in 1904 is one of the precious memories I shall always cherish. At the same time Sir Christopher Nixon and Sir John Moore, for letters of introduction to whom I was indebted to Prof. Osier, not only gave me valuable suggestions, but demonstrated how kind is the Celtic nature at its best.] It has been always generally recognized that a very important portion of what is called English literature is really due to the native genius of the English-speaking writers of Irish birth and parentage, whose Celtic qualities of mind and heart have proved the sources of some of the most significant developments in the language of their adoption. What a large lacuna would be created in English literature by the removal from it of the work of such men as Dean Swift, Goldsmith, Burke, Sheridan, and Moore! It is not so generally known, however, that if the work of the distinguished Irish physicians and surgeons of the last century were to be blotted out of English medical literature there would be left quite as striking and as wide a gap. It is, indeed, to what is known as the Dublin School of Medicine, for medical schools have very properly been named usually after the cities rather than the countries in which they were situated, that we owe not a little of our modern progress in practical medicine, and especially the advance in the clinical teaching of the medical sciences. Now that the Gaelic movement is calling attention more than ever before to things Irish, it {168} Seems only proper that this feature of the national life should be given its due prominence and that the great members of the Irish School of Medicine should not be without honor in their own and other English-speaking countries. There are three great names in the history of Irish medicine recognized by all the world as well deserving of enduring fame. These three names are Robert James Graves, William Stokes, and Dominic Corrigan. Graves' name is indelibly attached to the disease known as exophthalmic goitre, which he described and separated from other affections before anyone else had realized its individuality. William Stokes was, perhaps, the best authority on diseases of the heart and lungs in his time. His name will be preserved in the designation of the peculiar form of breathing which occurs in certain comatose conditions and has received the name Cheyne-Stokes respiration, in honor of the men who first called attention to it. Corrigan was in his time one of the greatest authorities on the heart, and especially on the pulse. His name is preserved in the term Corrigan pulse, which is applied to a peculiar condition that occurs very characteristically in disease of the aortic valves of the heart. The lives of these men deserve to be better known, for they can scarcely fail to be an inspiration to others to do work of a high order in medicine--work that will represent not alone present success and emolument but will stand for medical progress for all time. Dr. Robert Graves was the youngest son of the Rev. Richard Graves, D.D., Senior Fellow of Trinity College and Regius Professor of Divinity in the University of Dublin, and of Elizabeth, daughter of James Drought, also a fellow of Trinity College, whose family had been long settled in King's County. His father, as a tribute to his distinguished learning, was later promoted to the deanery of Armagh. There {169} were two other sons in the family, Richard and Hercules. All three of the boys passed through Trinity College with high honors and, in fact, established a record there that has since been unequalled, for at the degree examinations of three successive years the gold medal in classics and in science, then the highest distinctions attainable by students of Trinity, was conferred upon one of the brothers. Dr. Graves received his degree of Bachelor of Medicine at the University of Dublin in 1818. After this he studied for some time in London, and then spent three years on the continent, at Berlin, Göttingen, Vienna and Copenhagen, as well as in Paris and certain Italian schools, finally studying also for some months in Edinburgh before his return to Dublin. As Dr. Stokes very well says: "In this large and truly liberal education, which embraced the training of the school, the university and the world, we can discover in part the foundations of his subsequent eminence. He did not content himself, as is so commonly the case, with commending--to use his own words--'the life of a practitioner without practice,' but he made himself intimate with the recent discoveries and modes of thinking in every great school of medicine, whether abroad or at home, and formed friendships with the leading physiologists and physicians of Europe, with many of whom he kept up a correspondence during his life." An interesting incident in his travels serves to illustrate very well his facility for the acquisition of languages. Once while on a pedestrian journey in Austria he neglected to carry his passport, and was arrested as a spy. He was thrown into prison and for a time his condition seemed serious enough. He insisted that he was a British subject, but his assertions in this matter were immediately repudiated by the Austrian authorities in the little town, who insisted that no {170} Englishman could possibly speak German as well as he did. He was kept in prison for some ten days until authentic information could be obtained with regard to him, and, during this time, such was the state of the prison that he suffered many privations. Later in life this gave him a sympathy with the prisoners of Ireland and led to his making suggestions for the amelioration of their condition. Like practically all the great medical men who have proved to be original workers, Graves' interest was not confined alone to medicine. During his sojourn in Italy he became acquainted with Turner, the celebrated English landscape painter, and was his companion in many journeys. Graves himself was possessed of no mean artistic powers, as his friend Stokes tells us, and his sketches are characterized by natural vigor and truth. His thorough appreciation of his companion, however, and the breadth of his sympathy and admiration for the great painter of nature can perhaps best be understood from some candid expressions of his with regard to their work in common: "I used to work away," he said, "for an hour or more and put down as well as I could every object in the scene before me, copying form and color as faithfully as was possible in the time. When our work was done and we compared drawings the difference was strange. I assure you there was not a single stroke in Turner's drawing that I could see like nature, not a line nor an object, and yet my work was worthless in comparison with his. The whole glory of the scene was there." After wandering for some three years in Europe, Graves returned to Dublin and at once took a leading position in his profession as well as in society. He came back at a very fortunate period for him. In 1807, Dr. Cheyne, who had been educated in Edinburgh, made the first step toward the foundation of a new school of medical observation, by the {171} publication of the first volume of the Dublin Hospital Reports. Dr. Stokes says that the best proof of the value of these reports is that they appear to have given the tone to the subsequent labors of the Irish school which inherited their practical nature and truthfulness. Within a year after Graves' return he appeared as one of the founders of the new school of medicine in Park Street, and was also elected physician to the Meath Hospital, where he commenced to put into effect that system of clinical observation and instruction which has done so much to establish the lasting reputation of the Dublin School of Medicine. For the next thirty years Graves' life is full of the teaching and the practice of medicine. He was noted for his tenderness toward the poor, but the rich soon came to appreciate his skill. Nothing ever made him neglect his poor patients. Meantime he left his mark on every subject that he handled in medicine. Fevers, nervous diseases of many kinds besides that named after him, tuberculosis, and other forms of pulmonary disease, were all illuminated by his practical genius in a way that has made them clear for succeeding generations in medicine. With regard to fevers especially Graves' work will count for all time, because he set their treatment on so practical a basis. The trained nurse is quite a modern acquisition, yet seventy-five years ago Dr. Graves insisted that the services of a properly qualified nurse in severe, continued fever are inestimable. He emphasized the necessity for moral management in fever, and friends and relatives are seldom capable of discharging this office. "If they chance to discover from the physician's remarks or questions the weak points of the patient's case they generally contrive to let him know them in some way or another. If the patient is restless, for instance, the ill-judged anxiety of his friends {172} will most certainly keep him from sleeping. If he happens to take an opiate and they are aware of the nature of his medicine they will surely inform him of it in some way or another, though it may be only by a hint and his anxiety for sleep conjoined with their disturbing inquiries prevents its due operation." We are apt to think that the modern aphorism, nursing (meaning trained care) is more important than medicine in the treatment of fever, is the result of observations in our own day. Dr. Graves, however, felt very deeply that the most important element in the treatment is the conservation of the patient's strength with the preservation of his morale, and this can be best accomplished when the patient is constantly under the care of an experienced nurse, noting every symptom and averting every possible source of worry and every form of exhaustion of energy. With regard to fever treatment, however, Graves' name is immortal in medicine because of his insistence on the doctrine that fever patients must be fed. A century ago the presence of fever was supposed definitely to indicate that the patient should have no food. Any contribution to his nutrition was supposed to feed the fever rather than the patient. Graves pointed out, however, that at the end of a long-continued fever the most serious condition is the emaciation and weakness of the patient. He insisted that, appetite or no appetite, fever patients should be fed regularly. The result was at once noteworthy. Only the very hardy individuals had recovered before this; now even weaker patients had a good chance for life. The mortality from fever fell very strikingly, and in his time Dublin was overrun with typhoid and typhus fever and the saving of life produced by the new method of treatment was very considerable. Graves himself, when he saw how much he had accomplished by his {173} new doctrine, said that he wanted no better epitaph on his tombstone than the words, "He fed fevers." Some of Dr. Graves' very particular hints with regard to treatment of fever show how careful he was in clinical observation. He deprecates the allowance of very much fluid for patients, since their thirst cannot be assuaged in that way, and the amount of liquid taken may be harmful by causing depression. He suggests, therefore, the use of acidulated water made by means of a little currant jelly or raspberry vinegar, given in small portions and at regular intervals. Much better than plain water he considers water to which some light bitter has been added, such as cascarilla. Small quantities of this will appease the morbid thirst of fever more effectually and for a much longer period than large draughts of water. Even more interesting in these modern times, however, than Graves' attitude toward the treatment of fever is the position he took with regard to the habits of life that were best for the consumptive. At that time tuberculosis of the lungs was considered to be an inflammatory disease requiring the patient to be in the house most of the time, carefully protected from cold, and during any rise of temperature to be kept in warm rooms, without any special encouragement to take food. Graves and Stokes changed all that, and for the time completely revolutionized the principles of treatment for this serious ailment. Alas! their work, notwithstanding the good results shown in a certain number of cases, failed to attract widespread attention, and not until our own time did the principles that they laid down as the rational basis of successful therapeutics for tuberculosis come to be generally adopted. Graves insisted that his patients when suffering from beginning tuberculosis should not be confined to the house, {174} but on the contrary should be out of doors most of the time. He emphasized what he called the taking of exercise, but in such a way that he agrees much more than might be thought with modern ideas on this subject. Now, it is insisted that tuberculous patients must not overtire themselves by taking exercise, though they must be in the open air a large part of the time. Graves explains the exercise that he would like to have them take by saying that they should spend four or five hours every day riding in a carriage, or, as he seems to prefer, in an open jaunting-car. And that they should spend at least as much time sitting outside in quiet. Besides this the most important element in treatment he considers to be the encouragement of the appetite--as might be expected from the man who first fed fevers. His directions in this matter are very explicit, and he suggests various methods by which patients can be tempted to eat more and more food, and emphasizes the use of cereals and of milk and eggs as likely to be of most service in helping these patients to gain in weight and strength so as to be able to resist the further advance of the disease. This, it may be said in passing, is just the ideal treatment for the consumptive at the present time. Others of Graves' opinions in regard to tuberculosis are in general surprisingly modern. He insists, for instance, that the main causes of the disease are overcrowding in towns, the long hours of hard work in factories, and abuse of alcohol. He thought that the population of country places, though fed no better as a rule than in the city, do not develop the disease so frequently because of their opportunity for fresh air. He placed very little confidence in the opinion that cold has anything to do with tuberculosis, though he disputed Laennec's dictum that bronchitis was never the beginning of tuberculosis. Graves advises his students not to try to {175} protect their throats by means of mufflers, for this will only render them more liable to cold. His advice is rather to harden themselves against cold. For this he suggests the use of water plentifully on the chest and throat, to be employed not too cold during the winter time, unless one is used to it. He also suggests the use of vinegar and alcohol as hardening fluids. They should be applied freely, and in his experience were effective. Another interesting anticipation of modern methods was with regard to child feeding in summer diarrhoea. It is often thought that only in recent years, with the development of the science of bacteriology, the danger of continuing milk feeding when infants are already ill in the summer has come to be recognized. Milk is now known to be an excellent culture medium for various forms of bacteria, that is, it is a substance on which microbes grow plentifully, and it is often used in the laboratory to raise microbes. Dr. Graves, however, without any knowledge of modern bacteriology, but from clinical observation alone, pointed out that the only way to avoid summer diarrhoea is to stop all milk feeding. "Let the infant," he says, "abstain from milk in any shape for twenty-four hours, sometimes for the space of two or even three days. It is incredible how small a portion of milk, even in the most diluted state, will keep up this disease, acting like a species of poison on the intestinal mucous surface." Here, of course, was scientific intuition running far beyond medical knowledge, and pointing out a serious danger and the best means of avoiding it. There is scarcely a subject touched upon in Dr. Graves' clinical lectures, however, which is not illuminated in this way by precious sidelights, many of which unfortunately were obscured by medical {176} theories, and conclusions founded on them without due experience. We have already said that his careful clinical observations led him to separate the type of disease which has since come to be known as Graves' disease from a number of other forms of nervous disturbances of the heart rhythm. There is at least one other class of disease usually considered to be much more modern, the type of affection known as Raynaud's disease, or a tendency to spontaneous stoppage of the circulation in the extremities, and also the other type now known as Weir Mitchell's disease, or erythromelalgia, in which there is suffused redness and pain in the extremities, examples of which Graves picked out from his hospital service and described in such a way that it is easy to recognize them even at this distance of time. His two volumes of clinical lectures on the practice of medicine are much more than an index of the medical teaching of his time. They contain anticipations of many a supposed after-discovery, besides an immense amount of very practical observations made at the bedside, and valuable hints for treatment, the result of his personal experience. One of the best proofs of the greatness of the work accomplished by Graves is to be found in the tribute to his character, and what he achieved, by Professor Trousseau, who was at the time the acknowledged leader of the clinicians of Europe. He said: "For many years I have spoken of Graves in my clinical lectures; I recommend the perusal of his work; I entreat those of my pupils who understand English to consider it as their breviary; I say and repeat that, of all the practical works published in our time, I am acquainted with none more useful, more intellectual; and I have always regretted that the clinical lectures of the great Dublin practitioner have not been translated into our language." {177} A little later in the same lecture he said: "And nevertheless, when he inculcated the necessity of giving nourishment in long-continued fevers, the Dublin physician, single-handed, assailed an opinion which appeared to be justified by the practice of all ages; for low diet was then regarded as an indispensable condition in the treatment of fevers. Had he rendered no other services than that of completely reversing the medical practice upon this point, Graves would, by that act alone, have acquired an indefeasible claim to our gratitude." His tribute closes with the following very striking passage: "I freely confess that I had some difficulty in accepting, notwithstanding the imposing authority of Graves, what he states of the influence of certain remedies, such as mercurials, essence of turpentine, spirituous preparations, nitrate of silver, etc.; but the Dublin professor speaks with so much conviction that I ventured to follow his precepts, and I must say that my early trials very soon encouraged me to adopt unreservedly what I at first accepted only with misgivings. There is not a day that I do not in my practice employ some of the modes of treatment which Graves excels in describing with the minuteness of the true practitioner, and not a day that I do not, from the bottom of my heart, thank the Dublin physician for the information he has given me. "Graves is, in my acceptation of the term, a perfect clinical teacher. An attentive observer, a profound philosopher, an ingenious artist, an able therapeutist, he commends to our admiration the art whose domain he enlarges, and the practice which he renders more useful and more fertile." After this tribute from one who was himself one of the greatest medical teachers of his generation, it will be very interesting to find how much Graves anticipated nearly three-quarters of a century ago the principles of the bedside {178} teaching of medicine which have come to be acknowledged as the only sure basis of a genuine, practical medical education. For him the only possible way to learn medicine practically was to study it at the bedside, and he insisted over and over again that while the theoretical sciences allied to medicine were eminently fascinating, they were of little actual value in teaching the student how to solve the all-important problem of treating patients. In his address before the Dublin Medico-Chirurgical Society, an association of students in connection with the Dublin hospitals, he said in 1836: "Many causes contribute to prevent students from attaining what after all should be the great object of their wishes--practical knowledge. The different sciences to which you are required to turn your attention successively possess so many fascinations that you may attach to some an undue degree of importance; but be assured of this, that however accurate be your knowledge of anatomy, healthy and morbid, however skilful you may be in the chemical theories and manipulations, however extensively you may have mastered the necessary properties of botany, however well you are acquainted with the nature and properties of drugs--be assured, I say, that you have acquired all this knowledge in vain unless you have diligently studied symptoms at the bedside of the patient and have observed the consequences and causes of disease in the dead room. In fact, in whatever other pursuits you may employ your afternoon hours, the morning should always be dedicated with earnestness to the hospital; from its wards all appearance of levity and inattention must be banished, for your neglect of the opportunities there presented for observation loads you with a serious amount of responsibility, I had almost said of guilt. It is no light thing to have life entrusted into your hands; we are all liable to err, we all commit mistakes; {179} the rules of our art are not invariably precise and certain; but they only are guilty who have not used every opportunity of acquiring practical knowledge; he is doubly guilty who, conscious of his neglect, embarks in practice and commences with the decision and boldness true experience alone can confer." At a comparatively early age Graves realized more than most men that medicine is an art and not a science, and that each individual case presents problems that have to be studied out for themselves and for which no general principles of diagnosis, prognosis or therapeutics serve. He appreciated that there was no royal road to medical wisdom, in the sense of a scientific shortcut by means of which manifestations of disease and their indications for treatment might be grouped together and easily learned. Nor, may we add, has any such road been found since. Each physician must train himself by patient, repeated observation, and without this discipline and training there can be no real success. Accordingly he said to his students in Dublin: "The chief object of medical science is to relieve suffering and to save life: you must, therefore, anxiously watch the action of remedies and, by constantly noting down the effects of treatment, learn to appreciate its merits and apply it when required. Nor is this an easy task; some indeed have vainly imagined that the method of treating or curing disease could be compressed within the limits of a few short directions made easily deducible from some general principles and easily applicable in any particular case; but it is not so. Gentlemen, we have as yet discovered no such general principles to serve as guides. This discovery presupposes a knowledge of the laws and relations of the vital powers far beyond what we now possess: no, we must toil onward by a much more {180} laborious and circuitous route and must commence by making ourselves thoroughly masters of a vast number of individual cases, assisted by the observations and the writings of practical men; we may afterward proceed to arrange our knowledge, to classify it so as to render it more available; analogy and induction are here our only or at least our most valuable guides, and they will seldom fail to instruct us how to act when properly consulted." While recognizing all the difficulties of medical practice and the essential individualization of all its problems, Dr. Graves had little or no patience with the skeptic who thought that medicine could accomplish but little for the cure of many ailments. He said once before the Medico-Chirurgical Society: "Many, indeed, aiming at acquiring the character of medical skeptics, think they exhibit proofs of superior discrimination when they, with apparent candor, make the confession that the more they see the less confidence they have in the resources of medicine. This confession should be interpreted not as a reproof of our art, but as a testimony of the want of skill of the would-be philosophical asserter of so false a proposition. No, God be praised, our predecessors have not toiled in vain; the anxious experience of ages has not been recorded to no purpose; our art is in truth boundless in resources and, when applied with ability, most successful. There are, indeed, some acute and many chronic diseases which baffle our powers of diagnosis, and defy our modes of treatment; such appear to be, however, not numerous when compared with the great mass of cases capable of cure or alleviation. The medical skeptic, however acute his powers of reasoning may be, and however he may labor to render plain subjects obscure and direct facts ambiguous, can never rob the good practitioner of the {181} pure, the inward joy he feels when conscious that he has snatched a patient from the jaws of death." Knowing that such were his ideas with regard to the practice of medicine, it is all the more interesting to review the system of teaching that Graves considered most likely to produce genuine practitioners of medicine. Those who have been mainly concerned with the reform of medical education here in America in recent years can scarcely fail to be struck with the appropriateness of Graves' ideas on this subject nearly a century ago. When a very young man he did not hesitate to express his deprecation of the conventional and artificial methods of medical instruction in his own time, and he anticipated what is best in the methods that have gradually come into vogue at the end of the nineteenth and the beginning of the twentieth centuries. His views will always remain a suggestive storehouse of thought for those who have the higher medical education at heart. In his introductory lecture at the opening of the Medical course at the Meath Hospital in Dublin in 1821, he declared very definitely what he considered to be the principal aim of the medical student: "Students should aim not at seeing many diseases every day; no, their object should be constantly to study a few cases with diligence and attention; they should anxiously cultivate the habit of making accurate observations. This cannot be done at once; this habit can be only gradually acquired. It is never the result of ability alone; it never fails to reward the labors of patient industry. You should also endeavor to render your observations not only accurate but complete. You should follow when it is possible every case from its commencement to its termination; for the latter often affords the best explanation of previous symptoms and the best commentary on the treatment." {182} Graves was inculcating in principle what Corrigan and himself and Stokes were to exemplify so thoroughly in practice in the next few years. Before the end of the decade in which this address was delivered at the Meath Hospital, Corrigan at the little Jervis Street Hospital, where there were only beds for six medical patients altogether, was to make his great discoveries with regard to aortic disease, and to lay the sound basis of the diagnosis of affections of the heart for all time. There are many passages in this address of Graves that might well serve for warnings to the present day and generation as regards methods of medical education which do not include sufficient practical teaching. He said, for instance: "The chief objection to our present mode of teaching is that, however well inclined the student may be, he is never obliged to exercise his own judgment in distinguishing diseases and has no opportunity of trying his skill in their cure, and consequently at the end of his studies he is perhaps well grounded in the accessory sciences--is a perfect medical logician--able to arrange the names of diseases in their classes, orders and different subdivisions; he may be master of the most difficult theories of modern physiologists; he may have heard, seen and, if a member of the medical society, he may also have talked a great deal; but at the end of all this preparation what is he when he becomes a full doctor?--a practitioner who has never practised!" These words have quite as suggestive applications to most phases of our modern education as they had to that of Graves' time. There are other passages that bear so significant a meaning in this regard that one can scarcely refrain from quoting: "Our present method of instruction is indeed very useful and nothing better can be devised for a beginner; but for {183} the more advanced student it is by no means sufficient, nor is it calculated to give him practical experience, without which all other acquirements are of no avail. I say it does not give him experience, because he has at no time been charged with the responsibility of investigating a case for himself, and by himself; because at no time has he been called on to make a diagnosis, unassisted by others; and above all because he has never been obliged to act upon that diagnosis and prescribe the method of treatment. If those who had been thus educated, and who had been made doctors upon so slender a foundation, were to confess the truth, we should be presented with a picture calculated to excite dismay if not a stronger feeling. How many doubts and distracting anxieties attend such a man at his first patient's bedside. If the disease be acute and life in imminent danger, and if he shrink under this sudden and unusual load of responsibility, he gains little credit for professional ability. If, on the contrary, inexperienced as he is, he assumes that decision of judgment, that energy of practice which experience alone can confer, is it not probable that the result will be still more disastrous?" Graves' last days and the circumstances of his death and burial are given by Professor Stokes, his great personal friend, and himself one of the most distinguished physicians of his time. We quote the concluding paragraph of Professor Stokes' biographical notice: "It was in the autumn of 1852, he being then in his fifty-seventh year, that the symptoms of the malady which was to prove fatal first showed themselves. In the following February he began to succumb to the disease. Although at times his sufferings were great, yet he had many intervals of freedom from pain. And he then showed all his old cheerfulness and energy. To the very last he continued to {184} take pleasure in hearing of any advance of knowledge that tended to ameliorate the condition of man, or to throw light on his relations to a future state. In this latter point of view, the discoveries of Layard greatly interested him, as illustrative of the Sacred History; and thus he was permitted to fill up the intervals of his sufferings, even to the last; for his mental faculties never failed or flagged,--a mercy for which he often expressed a fervent gratitude; and so he was providentially enabled to review the past, and to form a calm and deliberate judgment on the religious convictions of his earlier years. And once the truthfulness of these were ascertained, he adhered to them with that earnestness which characterized all his decisions. "It was after the attainment of this state of patient expectation that one who was dear to him expressed a prayerful wish for his recovery. 'Do not ask for that,' he replied; 'it might prove a fatal trial.' "His mind having become thus satisfied he made few remarks on these subjects, except in reply to the inquiries of others. Thus, when referred to the prophetic illustration of purifying and redeeming love, 'A fountain shall be opened for sin and for uncleanness,' 'No,' he said, 'not a fountain, but an ocean.' "On the day before his death he desired (a second time) to partake of the Holy Communion, with his family. When some explanations were commenced, he answered, 'I know all that; I do not regard this as a charm, but I wish to die under the banner of Christ.' Feeling himself sinking, he asked for prayer, and a petition was offered suitable to his condition; but he seemed to long for something more and, when questioned, replied, 'I want some prayer that I know, some of the prayers of my youth, some of my father's prayers.' The Litany was commenced, he immediately took up the {185} well-known words, and when the speaker's voice faltered he continued them alone, and distinctly, to the end of the strain, 'Whom thou hast redeemed with thy most precious blood.' "On the twentieth day of March, 1853, and without renewed suffering, he ceased to breathe. "His tomb is in the cemetery of Mount Jerome. It bears the following inscription dictated by himself: "ROBERT JAMES GRAVES, Son of Richard Graves, Prof. of Divinity, Who, After a Protracted and Painful Disease, Died in the Love of God, and In the Faith of Jesus Christ." William Stokes. Very closely associated with the name of Robert Graves in all that made the Irish School of Medicine influential for good, about the beginning of the second quarter of the nineteenth century, is that of William Stokes. Stokes' work on Diseases of the Chest and, later in life, his treatise on Diseases of the Heart and Aorta stamp him as one of the great physicians of all time. His name is assured of immortality in medicine, because with that of the well-known Scotch physician, Cheyne, who came to Dublin late in the second decade of the nineteenth century, it is associated in the term most commonly used for a form of breathing, having special diagnostic and prognostic significance in certain serious diseases, and which is known as Cheyne-Stokes respiration. Even more interesting, however, than Stokes the physician, is, as we shall see, Stokes the man, and all that he stood for in his generation in Dublin, during a long life. {186} William Stokes was of a family that had long been distinguished in Dublin for scholarship. While his ancestors came originally from England, five generations occupied more or less prominent positions in the public life of Ireland, and they had lived in Dublin for more than one hundred and fifty years before Stokes began to be prominent in Irish medicine. His father, Whitley Stokes, had been a scholar and Senior Fellow of Trinity College, and was prominent in the scientific, political, and literary circles of the Irish capital at the end of the eighteenth and the beginning of the nineteenth century. He had been a member of the United Irishmen, but fearing that the revolutionary principles that were being propagated would only bring about an ineffectual rebellion, he separated himself from them, though years after when the United Irishmen came under the ban of the English government his previous connection with them cost him suspension from the fellowship. Later on, however, Whitley Stokes became the Regius Professor of the Practice of Medicine at Trinity College, a chair which he held until succeeded in the early forties of the nineteenth century by his son, William, the subject of this sketch. Something of the character of the man can be judged from the fact that though he was a distinguished physician and interested in every branch of science, taking an active part in the foundation of Trinity College Botanical Gardens, and being one of the founders of the Zoological Garden in Phoenix Park, he was also the author of a prize essay in reply to Tom Paine's Age of Reason, which was then attracting so much attention. Our William Stokes was the second son of Whitley Stokes, and was born in Dublin in 1804. Like many another distinguished investigator in science, he was not looked upon as a bright student as a boy, and indeed could be prevailed upon to interest himself only very slightly in what is usually {187} considered to be the absolutely necessary fundamental work in education. He had a great love for poetry and romance, which indeed he carried with him all his life. The Scottish Border Ballads were his favorite reading, and he spent days in committing them to memory. Almost needless to say his apparent indolence and disinclination to any steady, methodical system of study were, as his son, the late Sir William Stokes, records in his biography of his father, sources of real concern to his parents, and caused his mother specially much anxious thought. One day while reading his favorite author, Sir Walter Scott, he fell asleep--to be awakened shortly after by some warm drops falling on his face. He started up to find his mother bending over him. It was her tears that had awakened him. Stung with remorse at having been the cause of so much sorrow to the mother whom he loved very dearly, his nature underwent an immediate and salutary change, and the dreamy, indolent boy became thereafter the ardent and enthusiastic student. Stokes amply made up for any neglect of study there might have been in his boyhood days as soon as he entered upon the medical course to which he felt called. Here he came to be looked upon as one of the most ardent and painstaking of students. His preliminary medical studies were begun in Dublin at the Meath Hospital. Chemistry he learned in the laboratory of Trinity College and anatomy in the Royal College of Surgeons. After spending several years thus he went to Glasgow, where for two years more he was occupied mainly at chemistry in the laboratory of Professor Thompson. Like most of the young Irishmen of his time, he next proceeded to Edinburgh in order to complete his education in clinical medicine and, if possible, obtain his medical degree from that famous institution. It was at Edinburgh, under the magnetic {188} influence of that great teacher, Allison, that Stokes began to develop the rare powers of original observation which at an early age placed him in the front rank of the best medical men of the time. It is interesting to note that before he left Edinburgh he published his first medical work, a treatise on the use of the stethoscope, which was undoubtedly the means of bringing that instrument--and with it Laennec's fruitful system of physical diagnosis by means of auscultation--to the general notice of the English-speaking medical profession. Even after all that has been written on the subject, it remains a very valuable little book. It was dedicated to the famous Cullen, who had already published a series of cases which had been illustrated by the use of the stethoscope, and to whom Stokes probably owed the idea of the need for a formal little treatise on the subject. It is typical of the slow adoption of medical novelties even when they are of great importance that more than ten years afterward, old-time, though distinguished, physicians not infrequently made fun of Stokes for spending so much time in the study of cases with the stethoscope, since in their opinion it was little more than a toy. This was done in no bitter, carping spirit, but with the most friendly complacency and condescension. Stokes, however, intensely practical in his way, realized the value of the instrument, and as the result of his teaching it soon began to be more generally used; thus introducing into English-speaking medical circles that exact knowledge of diseases of the chest which can only be obtained by means of this little instrument and the methods of auscultation which are associated with it. Immediately after graduation, Stokes settled down in his native city to practise. In 1826, when Stokes was only twenty-two, Dublin was visited by one of those epidemics of typhus fever which were so common in the first half of the {189} nineteenth century, and which consisted evidently, at least to a great degree, of what we now call typhoid fever, but intermixed with many cases of the real, dread typhus. The mortality in such epidemics, as we have reason to know from statistics here in New York, was always over twenty-five per cent, and often reached far above fifty per cent. The manner of contagion was unknown, only it was very well understood that those much in contact with the patients were likely to contract the disease. Among the poorer classes in Dublin the fever raged with virulence, but young Stokes devoted himself to the care of patients to an extent that severely taxed his physical powers of endurance. He devoted himself especially to the poorer classes. He did not contract the fever during the height of the epidemic in 1826, but he did in 1827, when it recurred, but fortunately he suffered in the mild form. An epidemic of another disease, Asiatic cholera, the danger from which has been almost entirely removed by the progress of scientific medicine in modern times, followed not long after. It showed itself in Dublin, when Stokes was about twenty-five. He it was who recognized the first case of the disease, and sounded the note of warning that probably saved many lives by calling attention to the danger that was just beginning. Once more he devoted himself to the care of the patients, and, as with regard to typhus fever, wrote an account of his experiences, which is in itself a valuable medical document that shows the powers of observation of the young medical man. Stokes spent himself in labor for the poor, and his deep interest in their welfare led him to sacrifice much time in order to organize medical charities for his unfortunate countrymen during the sad years of that awful fifth decade of the nineteenth century. His interest in this matter of {190} organization led him also to realize how much might be accomplished by public hygiene and efficient government sanitation. He recognized too how much would be accomplished along these lines if men were given proper training to make them specialists in these subjects. To Stokes then, almost more than to any other man, is due the development of public sanitation as a special science, and its organization for the proper safeguarding of public hygiene. His efforts, especially with regard to the physicians of Ireland, who so nobly sacrificed, not unfrequently at the expense of other practice, their time, health, and often even their lives, in order to aid their stricken countrymen, form one of the best monuments to his tender sympathy and his goodness of heart as a man. His testimony before the Parliamentary Committee was at this time of the utmost value in securing due recognition of their services. In 1843, when the Medical Charities Bill was brought forward, Stokes and Cusack united in the effort to procure for these devoted men an amelioration of the conditions under which they labored. They repaired to London to give evidence on the subject before the House of Commons. Both these friends had had to deplore the loss of many of their dearest and most promising pupils, who, after a short experience of country practice, had fallen victims to fever contracted in the discharge of their duties. They pleaded that in all justice the remuneration for attendance on fever hospitals and dispensaries should be fixed at a liberal scale, and that some provision ought to be made for the widows and children of gentlemen who had lost their lives in the public service. They collected statistics which proved that during a period of twenty-five years the mortality of the medical practitioners of Ireland was twenty-four per cent., while in most instances the cause of death was typhus fever. They {191} showed that, on the authority of Inspector-General Marshall, the comparative mortality of combatant officers in the army was less than half that, amounting to only ten and a quarter per cent. It was little to be wondered at that William Stokes should say, in answer to the chairman's question regarding the existence of any special risk to the medical officer in Ireland: "Such a number of my pupils have been cut off by typhus fever as to make me feel very uneasy when any of them take a dispensary office in Ireland. I look upon it almost as going into battle." Again he observes: "The medical practitioners in Ireland are placed in a position very different from and far more serious than that of their brethren in Great Britain. . . . . The Irish physician is often exposed to contagion in its most concentrated force when himself under the influence of cold, wet, fatigue, and hunger, as he labors among the poor, passing from hovel to hovel in wild and thinly-populated but extensive districts. He has often to ride for many hours in the worst weather, and at night, enduring great fatigue, while himself a prey to mental as well as physical suffering; for if we add to such labor the injurious influence which the knowledge of danger must have on the system of a man feeling that he is struck down by the disease under which he has seen so many sink, and tortured by the thought of leaving a young family unprovided for, we can understand how it happens that the country is so often deprived by death of so many of its best educated and most devoted servants." Perhaps the most interesting phases of Stokes' purely medical work during the first part of his career is his treatment of the subject of consumption. When not quite thirty-three he wrote a treatise on the diagnosis and treatment of diseases of the chest. His familiarity with the work of Graves and of Auenbrugger gave him command of all the {192} modern methods of physical diagnosis, so that he was able to study tuberculosis to the best possible advantage and with the least possible chance of too favorable judgment with regard to its cure. Notwithstanding the accuracy of his knowledge, however, he insisted that the disease was curable, and that the important point with regard to it was the recognition of it as early as possible, in order that the patient might be given the best chance for life. At that time most physicians considered tuberculosis to be an hereditary disease, without any idea of its being possibly contagious. Acceptance of heredity seemed to set the stamp of inevitable fatality on the heads of victims of the disease. To announce the curability of tuberculosis then was to run counter to all the medical traditions of the time, and Stokes in doing so must have had in support of his teaching many observations of patients who had been cured notwithstanding the fact that they were assured sufferers from this supposedly fatal disease. We know that Stokes was surely correct in his judgment in this matter, and realize too that his method of treatment, which included abundant feeding and long hours each day in the outdoor air, comprised the best elements of the modern treatment of tuberculosis. Perhaps one of the most striking anticipations of what is apt to be considered quite modern in medicine is Dr. Stokes' descriptions of the methods by which he considers certain forms of heart weakness, especially that incident to incipient fatty disease, should be treated. His directions are almost exactly those which have made the names of the Schott Brothers known throughout the world during the last twenty-five years. To have anticipated our modern views with regard to tuberculosis, its curability, and the best methods of treatment shows how thoroughly Stokes had studied his cases of consumption. That the same man {193} should also have been able to work out the details of treatment for heart weakness is a triumph that indicates better than anything else perhaps the genius of the physician not only in the observation of disease, but above all in that more important part of medicine--the proper application of therapeutic principles. Stokes observes, "In the present state of our knowledge the adoption of the following principles in the management of a case of incipient fatty disease seems justifiable: "We must train the patient gradually but steadily to the giving up of all luxurious habits. He must adopt early hours, and pursue a system of graduated muscular exercises; and it will often happen that, after perseverance in this system, the patient will be enabled to take an amount of exercise with pleasure and advantage which at first was totally impossible owing to the difficulty of breathing which followed exertion. The treatment by muscular exercise is obviously more proper in younger persons than in those advanced in life. The symptoms of debility of the heart are often removable by a regulated course of gymnastics or by pedestrian exercise, even in mountainous countries, such as Switzerland, or the Highlands of Scotland or of Ireland. We may often observe in such persons the occurrence of what is commonly known as 'getting the second wind;' that is to say, during the first period of the day the patient suffers from dyspnoea and palpitation to an extreme degree, but by persevering, without overexertion, or after a short rest, he can finish his day's work and even ascend high mountains with facility. In those advanced in life, however, as has been remarked, the frequent complications with atheromatous disease of the aorta and affections of the liver and lungs must make us more cautious in recommending the course now specified." {194} If any proof of Stokes' ability as an observer and a teacher were needed it would be readily found in his original description of the form of respiratory disturbance since known as Cheyne-Stokes respiration. The passage is besides a model of succinct completeness of description that would well deserve to be in the commonplace book of physicians who write, for so many of them need to imitate his conciseness and clarity. It is to be found in his book _Diseases of the Heart and the Aorta_, p 336. "A form of respiratory distress, peculiar to this affection (fatty degeneration of the heart), consisting of a period of apparently perfect apnoea, succeeded by feeble and short inspirations, which gradually increase in strength and depth until the respiratory act is carried to the highest pitch of which it seems capable, when the respirations, pursuing a descendant scale, regularly diminished until the commencement of another apnoeal period. During the height of the paroxysm the vesicular murmur becomes intensely puerile." It is curiously interesting to find that a favorite subject of discussion in the Irish medical societies of nearly fifty years ago was a topic which is still frequently on the tapis in medical society meetings. In one of his public addresses Dr. Stokes bewailed the fact that medicine did not have its proper place in the estimation of the people and was not able to assert its dignity as a profession in its proper sphere. He discussed also the remedies for this state of affairs, and as he was a man of eminently broad views, of very large experience, and of sane, conservative judgment, they are worth while pondering at the beginning of the twentieth century, for the practical problems of professional life which he sets forth are still with us. It is for this reason that it has seemed worth while to give a rather lengthy quotation that would adequately represent his conclusions in the matter. {195} "Is it by public agitation and remonstrances addressed to deaf or unwilling ears that these medical abuses are to be corrected? Is it by the demand for class legislation? or is it, by the efforts of one and all, to place medicine in the hierarchy of the sciences--in the vanguard of human progress; eliminating every influence that can lower it, every day more and more developing the professional principle, while we foster all things that relate to its moral, literary, and scientific character? When this becomes our rule of action, then begins the real reform of all those things at which we fret and chafe. Then will medicine have its due weight in the councils of the country. There is no royal road to this consummation. On the one hand, the liberal education of the public must advance, and the introduction of the physical sciences in the arts courses of the universities must give the death-blow to empiricism; and, on the other, education of ourselves must extend its foundations, and we should trust far less to the special than to the general training of the mind. When medicine is in a position to command respect, be sure that its reward will be proportionally increased and its status elevated. In the history of the human race, three objects of man's solicitude may be indicated: first, his future state; next, his worldly interests; and lastly, his health. And so the professions which deal with these considerations have been relatively placed: first, that of divinity; next, that of law or government; and, as man loves gold more than life, the last is medicine. But, with the progress of society, a juster balance will obtain, conditionally that we work in the right direction, and make ourselves worthy to take a share in its government, not by coercive curricula of education; not by overloaded examinations in special knowledge, which are, in comparison to a large mental training, almost valueless; but by seeing to the moral and religious {196} cultivation, and the general intellectual advancement of the student." From this, it is to be feared that Dr. Stokes would have very little sympathy with the specializing trend of modern medical education. Certain it is that not thus were the medical giants of the old days developed; but the times have changed; perhaps we should change with them, only the danger of the change must be ever kept in mind so as to avert, if possible, its most serious consequences at the first warning. While Stokes felt deeply for the Irish people, and the sad conditions under which they were laboring, unfortunately, like many another educated Irishman, he had very little active sympathy in any of the movements for their relief. He was a man in early middle life when O'Connell's agitation began, but he had no part in the movement. Later on, when his personal friend, Isaac Butt, was engaged in his great political work for Ireland, Stokes tried to dissuade him from it, feeling that the arousing of the people to a realization of their rights only led to a tighter riveting of their chains. Better judgment has prevailed and now practically all classes are united in the Gaelic movement, making it harder to understand Stokes' position, yet his is a case for sympathy rather than blame. His heart was touched, but his head could not see a happy issue for his countrymen, and so he preferred to have them endure in patience rather than suffer further ills through coercive measures. Dr. Stokes realized, however, all the iniquity of the union of the Irish and English parliaments, and a favorite story of his was told with regard to one of the members of the Irish Parliament who sold themselves to England. This member, finding that he was unnoticed in the distribution of rewards after the passage of the Union, though eighteen of his {197} fellow-members were raised to the peerage, waited on the Secretary of State and in an injured tone complained of having been neglected. The Secretary answered in the blandest manner: "The government, sir, is most anxious to do all it can to assist those who supported it. What is the object of your ambition?" "Make me aqual to the rest of the blackguards," was the prompt reply of this conscientious legislator. Stokes used to add: "History does not tell if his quite reasonable request was granted." In the midst of Stokes' sympathy for his compatriots there was always a counter-current of reactionary feeling, as if he feared the Celtic enthusiasm for reform would overstep the mark and bring evils in its train, even worse than the good it might entail. The following letter to a friend, as representing one phase of this feeling on the part of a true-hearted Irishman, seems worth reproducing, because it suggests thoughts with regard to the present movement which warn of possible dangers from the commercial spirit that must be avoided at all hazards, if Irishmen are to retain the influence their idealism has ever given them in whatever part of the world they might be: "October 27, 1836.--You will be sorry to hear that I have been for two days down to Connemara, to see poor Macnamara. He is dying. Oh, what a tragedy it will be! We expect him up to town this week. I never saw the glorious Lough Corrib look so beautiful. I was entertained by Miss Blake; she is a perfect specimen of the old Irish aristocracy. Tall, distinguished, elegantly formed, with dark hair and exquisitely fair complexion; she looked, as she stood in her tapestried hall, a lady of romance; her youth, her mourning dress, her classic head, and the symbols of her loved religion all combined to form a picture not easily to be forgotten. {198} The castle, grey and worn, stands on a green platform over the clear and rapid river through which the whole waters of Lough Mask and Lough Corrib rush to the sea. It reverses Byron's simile, 'All green and wildly fresh without,' etc., etc. You will say I am raving; but in truth a little time will level these ancient castles, and their highborn and honorable inhabitants and the feelings which their communion creates, and then 'utility' will have its reign, and 'common sense,' laughing at the past and the beautiful, will build factories with the remains of history, make money, and die." Dr. Stokes' interest in Irish historical matters can be best judged from the fact that toward the close of his life, when he was extremely busy with his practice and medical work of all kinds, he took the time to write a life of his friend, George Petrie, the distinguished Irish antiquary. It will be recalled by those who are interested in Irish antiquities that Petrie's work eminently deserved this tribute, and that Stokes' life is worthy of Petrie's merit. Dr. Stokes' daughter Margaret, as the result of association with Petrie and her father's interest in Irish antiquities, became a deep student of the same subject and wrote a little volume, _Early Christian Art in Ireland_, which has come to be the standard handbook on this subject for those who want sure and definite information, yet are not specializing in antiquities. On March 17, 1874, as a recognition of his interest in Irish antiquities, Stokes was nominated to the presidency of the Royal Irish Academy. "It was a new departure for the members of that society," says Stokes' biographer, "which is mainly representative of literature and abstract science, to choose a physician as their head, but it was felt that the time had now come when medicine had obtained, owing to the labors of Stokes and others, such a position in {199} the estimation of literary and scientific men that the election of the Regius Professor of that art in Trinity College (to the presidency of the Royal Irish Academy) would be welcomed by the majority." Certainly no member of the medical profession could have been found more deserving of the tribute because of all that he had done for Irish medicine, and besides his broad, sympathetic, liberal interest in Irish antiquities eminently fitted him for this honorable position. When Stokes' death was announced at the beginning of January, 1878, the medical world thought that it had lost one of its most representative men. For some years before his death many honors had come, all unsought, to this worthy protagonist of Irish medicine. He had been made a member of the Prussian order of Merit, and an honorary Fellow of many scientific societies on the Continent. He had received the rare distinction of the degree of LL.D. from Cambridge, and had been similarly honored by many other universities. Perhaps the honor that Stokes himself would have appreciated most came after his death, when the country people who had learned to know and love him asked to be allowed to carry his remains from Carrig Breac to the church of St. Fintan--the "grassy churchyard grave," where he was to be laid beside his beloved wife and children. They laid him in the same grave and beneath the same stone with her who was the beloved companion of his life, and on whose tomb he had engraved these words: "When the ear heard her, then it blessed her; When the eye saw her it rejoiced; When the poor and suffering came unto her They were comforted." Surely a union like theirs was not destined to be but passing. {200} Stokes' beautiful domestic affection was but another index of one of the most beautifully rounded types of man that ever lived. The affective side of his being, profoundly tender, deeply sympathetic, thoughtful always of others first, and humanely devoted to the poor and the helpless above all others, was typical of the best side of the Irish character. For this even more than for all he did for practical medicine (yet the absence of his work would make a large lacuna in nineteenth century medical progress) the race may well be proud of him. His example still lives to animate his professional brethren, one of whom (Sir John Moore) said of him: "Those who have seen Dr. Stokes at the bedside of the sick know how gentle, how refined, how kindly was his bearing toward the patient. Amid all the ardor of clinical observation and research he never for one moment forgot the sufferer before him--no thoughtless word from his lips, no rough or unkind action ever ruffled the calm confidence reposed in him by those who sought his skill and care. In many eloquent lectures delivered in the Meath Hospital he inculcated those Christian lessons of charity and thoughtfulness; and so by precept and example he strove to teach the duties of a true and God-fearing physician." Dominic Corrigan. The third of the great trio of the founders of the Irish School of Medicine is Sir Dominic John Corrigan, whose name will be forever associated with the form of pulse which occurs in aortic heart disease. It was his supreme merit to have been the first to describe in all its details this type of heart disease, and the distinguished French clinician, Trousseau, declared that aortic regurgitation should be called Corrigan's Disease. At this time Trousseau was deservedly {201} looked up to as the leading spirit among the clinicians of Europe. He was never tired of commending to his students Corrigan's acute clinical observations, and insisted that it was work of this kind which assured real progress in medicine. Trousseau's suggestion as to nomenclature was not adopted in its entirety, but Corrigan's pulse is well-known all over the medical world, and there is no doubt now that it will continue for many generations to confer deserved honor on the man who first appreciated its full significance though he was not the first to recognize it--and indeed it could scarcely escape notice--but who showed just what diagnostic conclusions might be reached from it. Corrigan's career should prove a stimulating example to the young physician just taking up that real post-graduate work in medicine which comes after he has received his degree, finished, perhaps, his hospital work, and is beginning his practice. Corrigan was only twenty-seven when he began the series of observations on which was founded his paper on aortic heart disease, which was published when he was about thirty. In this matter of youthful accomplishment, Corrigan is not alone among his distinguished Irish contemporaries. Stokes, it will be remembered, wrote his little book on the stethoscope when he was only twenty-one and had made some very important observations on disease of the chest before he had reached the age of thirty. Graves had showed very clearly the sound metal of his intelligence before he was twenty-five, and had described the cases of the nervous disease which have since come to be called after his name, Graves' disease, before his fourth decade had run more than a year or two. In fact these young men accomplished so much by their careful observation and dependence on their own resources that the medical writer of the modern times is tempted to wonder if perhaps that most precious {202} quality of the human mind in the young adult, its originality, is not obscured by the amount of information that it is expected to absorb before it is tempted to do any thinking for itself. There is another remarkable feature of Corrigan's achievement, in the recognition and description of this form of heart disease. At the time he was the physician to a hospital which had only room for six medical patients. This appointment to the little Jervis Street Hospital in Dublin had been secured only after competition, and Corrigan had to pay for the privilege of being the attending physician. This he could ill afford to do at the time, and so he resolved, as he told a friend, to make all his opportunities for the study of patients count to the greatest possible extent. He did not visit his hospital merely to see patients, but to study the cases carefully. His success is only another example of the necessity for seeing much, and not many things, if there is to be any real progress. In our day, physicians scarcely consider that they have any hospital experience unless they are the attending physicians to several hospitals, seeing at least one hundred patients a week. The result is that patients do not receive the skilled care they should, and that advance in medicine suffers because of the wasted opportunities for clinical observations while a busy attending physician rushes through a ward and the resident physician has only time for the routine work that enables him to keep just sufficiently in touch with the progress of his cases to satisfy the hurrying chief. Before publishing his classic paper on the _Permanent Patency of the Aortic Valves_, on which his reputation as a wonderful clinical observer in medicine rests, Corrigan had called attention to some mistakes in the classification of heart murmurs as made by Laennec in Paris. At this time Laennec was considered to be the best authority in Europe {203} on diseases within the thorax. As regards diseases of the lungs, he well deserved the reputation. To him the medical world owes all that it knows about diseases of the chest, as far as these can be detected by means of the ear. His young contemporary in Ireland, however, was able to show that in diseases of the heart some of the ideas acquired in long years of study of the lungs were leading Laennec into false conclusions as regards the significance of murmurs of the heart. Even genius does not succeed in doing more than one thing well, and especially in the matter of taking a second step into the unknown. While the distinguished Frenchman might have been thought just the one to complete the work he began so well on the heart, and while his experience with the lungs might have been expected to help him in the recognition of the significance of heart murmur, this did not prove to be the case. The privilege of solving the mystery of heart diseases was to be left for his Irish contemporaries, one of the most successful of whom in this matter was Corrigan. Anyone who wishes to see how little subsequent study has added to our knowledge of aortic disease should read Corrigan's original paper on this subject. He describes all the varying forms of affections of the aortic valve, with their various clinical manifestations. His paper is illustrated by a set of plates that would still be valuable for demonstrative purposes, and which serve to show how painstaking were his pathological studies. He illustrated experimentally his ideas of how the murmurs and thrills occur by means of an apparatus consisting of rubber tubes through which water might be allowed to flow under pressure, and varying calibre. Some of his conclusions, derived from experimental observations, will not stand the test of our modern knowledge, but they are very suggestive. Perhaps the best idea of the clinical {204} value of Corrigan's observations can be given by a quotation from his original paper, in which he discusses the interesting and difficult question of the relationship between aneurism of the aorta and inadequacy of the aortic valve. He said: "The two diseases, aneurism of the aorta and inadequacy of the valves, may, however, be combined. Aneurism of the ascending aorta may, by extending to the mouth of this vessel, dilate it so that the valves are unable to meet, and there is then a combination of the two diseases; there is aneurism and there is permanent patency of the aortic opening. The first cases that came under my observations presenting the signs of inadequacy of the aortic valves were cases in which the valves were rendered useless in this way, namely, by the mouth of the aorta sharing in the aneurismal dilatation. These cases led me into an error; for, meeting the signs of permanent patency of the aortic orifice in conjunction with aneurism, I erroneously attributed to the aneurism the signs which arose from the permanent patency. Aneurism of the aorta of itself does not produce the signs arising from permanent patency of the mouth of the aorta. It can only produce them in the way already described, by involving in the dilatation the mouth of the aorta; and hence, when in conjunction with an aneurismal tumor of the arteria innominata or aorta, there are found visible pulsation, _bruit de soufflet_, and _frémissement_ in the ascending aorta, and the trunks arising from it, we may be certain that, in addition to the aneurism, there is a defect in the aortic valves, or that the aneurism has extended downward, involving the mouth of the aorta. On the other hand, if these signs be absent, the valves are sound and the mouth of the aorta is not included in the disease. The propriety of performing Mr. Wardrop's or indeed the common operation for aneurism about the neck might depend on the information {205} thus obtained of the state of the aortic valves. To perform either in a case where the aneurismal dilatation was so extensive as to involve the mouth of the aorta, or where the aortic valves were diseased, would only bring the surgical treatment of the disease into unmerited discredit." Another very distinct contribution of Corrigan to the medicine of his time was his insistence on the distinction that exists between typhoid and typhus fever. This is one of the most interesting features of his little book on the _Nature and Treatment of Fever_. With our present knowledge, it seems hard to understand that these two fevers should have been so long confounded, but as a matter of fact it was not until the middle of the nineteenth century that the distinction between them was recognized even by the most acute observers. In this matter the French and Americans anticipated most of the rest of the world, though Corrigan's teaching in the matter had been correct for many years before others in the British Isles came to the true position. It was his work among the poor particularly that enabled Corrigan to recognize the differences between these two diseases. He came to have one of the largest practices that any practitioner in Dublin, or for that matter in any city of the world, has ever enjoyed, if enjoyment it can be called. His office used to be crowded with patients who would occupy all his time if he allowed them to do so. In order to secure opportunities for his other work, for his lectures, for his hospital visitation, and for his pathological investigation, he had a back entrance to his house through which he could steal out--even though there were many patients waiting for him--when he felt that it was time for him to fill another engagement. Late in life, after his return from Parliament when he took up his practice again, it was only a very short time {206} before the same state of affairs developed once more. It almost seemed as though every sick Irishman and Irish woman wanted to have the opinion of Dr. Corrigan. He had also a large consultant practice, though he was known for being a very different man from the ordinary type of the medical consultant. As one of his younger colleagues said, "he never wore the supreme air of a consultant." He was always simple and easy in his manner, was always congenial and ready to listen to what had developed and had been found in the case before consultation with him, and had none of that superciliousness that was supposed to characterize the true high-grade consultant physician in the British Isles a half a century ago. Within a few years after his essay on aortic heart disease, Corrigan published a paper on chronic pneumonia or, as he called it, cirrhosis of the lungs. Corrigan's successful achievements in medicine depended mainly on the fact that he studied the pathological anatomy of fatal cases with the greatest care. He had detected that in certain cases of chronic pneumonia the process seemed to be quite different from tuberculosis. Observations made postmortem showed that his clinical observations were justified by the differences observed in the organ. As a result he formulated his opinions on the subject. He called particular attention to the fact that what he found corresponded very closely with the pathological process which had been observed by Laennec in the liver, and to which the French medical pathologist had given the name of cirrhosis. It would seem as though the pathology of the time was so crude that Corrigan must surely fall into serious errors in his account of what he saw. Twenty years later, Virchow was to revolutionize pathology by the publication of his "Cellular Pathology." Notwithstanding the progress made since his time, {207} however, Corrigan's description of the condition of the lungs that he noted and of the pathological process observed is so true that even to the present day this paper remains of distinct value in medicine and represents the beginning of correct ideas on the subject. After Corrigan's death in 1881 the London _Lancet_ said: "In the light of recent pathology Corrigan's speculations on cirrhosis of the lungs are more meritorious than ever and continue to be regarded as in the main sound. They anticipated by forty years much of the present pathology." Needless to say it is only a genius of a very high order that is thus capable of rising above the limitations of environment, and in spite of the defective knowledge of his times observing correctly and drawing proper conclusions, though all the usual accepted principles would seem to be sure to lead him from the truth. The principal lesions of chronic pneumonia, after having been the subject of much disputation, with conclusions now one way and now another in the intervening years, are at the present time recognized as being essentially due to the pathological processes Corrigan originally pointed out. The man who thus made a permanent place for himself in the history of medicine was the son of a poor shopkeeper in one of the outlying districts of Dublin. His early education was obtained at Maynooth College, which had at that time a department for the training of youth for secular vocations, though it has since become an exclusively clerical institution. It is needless to say he acquired an excellent knowledge of the classics, of which he made abundant use later in life, and of which he was always very proud. The physician in attendance at Maynooth in his time took quite a liking to him, and it was the result of his suggestion that Corrigan took up medicine as his profession. For a time {208} he was under the tutelage of this Doctor O'Kelley, who seems to have been a very intelligent man, and a rather painstaking clinical observer. Most of his medical studies were made in Dublin and he attended the practice at Sir Patrick Dun's Hospital. It was the fashion at this time, however, for Irish students of medicine to finish their medical education at Edinburgh, whenever possible, and Corrigan spent several years there, receiving his degree of Doctor in Medicine in 1825. He had attracted considerable attention in Edinburgh for his acute powers of observation, and received an appointment to the Meath Street Dispensary shortly after his return. From the service here he was appointed to the Jervis Street Hospital. He had to pay, however, for the privilege of being attending physician here, and this, as he said, made him more careful in endeavoring to secure all the advantages possible from his service. After his publication of the article on "The Permanent Patency of the Mouth of the Aorta," or "Inadequacy of the Aortic Valves," he at once became recognized as one of the best clinicians in the city. This article appeared, in April, 1832, in the _Edinburgh Medical and Surgical Journal_, at a time when, as has been said, its author was not yet thirty years of age. As soon as he began his work at the Jervis Street Hospital, he gave a course of lectures, and as he was an excellent talker and a good demonstrator, he at once attracted a large class. In 1834 he joined Hargrave's School, in Digges Street, Dublin, as lecturer on the practice of medicine, and continued to hold the position for more than ten years. His success as a lecturer attracted many students from the other medical schools. Corrigan's class was often three times as large as that of other medical lecturers in the city. It not infrequently happened that as a result of his {209} popularity the medical class was two or even three times as large as the surgical and anatomical classes at the same institution. This was very unusual, for Dublin was famous for its anatomical instruction, and there were often five times as many pupils enrolled in the anatomy classes as in the medical classes. It was not long before honors began to be showered upon Corrigan. When he was about forty the diploma of the London College of Surgeons was conferred upon him, and, as according to the by-laws of the institution the diploma can only be conferred after examination, Corrigan's examination was made to consist of the reading of the thesis, "Inadequacy of the Aortic Valves," before the faculty and the other members of the college. In 1849 the University of Dublin conferred upon him the degree of M.D., _honoris causa_. There was only one setback in Corrigan's medical career in Dublin. When first proposed for honorary fellowship in the Irish College of Physicians, he was rejected. The reason was entirely apart from medical matters. Corrigan was the most active member of the Irish Board of Health, which had charge of the famine cases in Ireland, during the awful years between 1845 and 1850. This Board proposed to allow about five shillings per day to physicians who would be sent to the country to attend famine fever cases. It is easy to understand that this remuneration was considered inadequate and the Board's decision in the matter raised a storm of protest. Graves wrote very bitterly with regard to it, and blamed Corrigan for any part he might have had in it. The result was that for some time Dr. Corrigan was the most popularly hated physician in the medical profession of Dublin. Corrigan made, up for any lack of tact he might have had {210} in this matter, however, before long, and in 1855 he obtained the license of the college. Two years later he was elected a Fellow. Before another two years had passed he was elected President of the College, and had the unprecedented honor of being re-elected four years in succession. The college further made up for its offense by having a statue of Dr. Corrigan, by the famous Irish sculptor Foley, made for its hall while he was still alive. His own self-sacrificing work during the famine fever years was well known. After he had achieved nearly every distinction that his brother physicians could confer upon him, he was created a baronet. It was understood that this distinction was mainly meant as a reward for his services during the famine, though also for the time which he had so unstintedly given to the improvement of national education in Ireland, in the capacity of a Commissioner of Education. Not long after his creation as a baronet, Sir Dominic stood, in Dublin, for a seat in Parliament in the Liberal interests. At first he was unsuccessful. In 1869, however, he was returned as one of the members of the government and sat in Parliament for five years. As he was a very eloquent speaker, it was thought that he would produce a very distinct impression in Parliament. His type of eloquence, however, did not prove to have any special influence in the cold British House of Commons, though Sir Dominic was always looked upon as one of the men to be counted on whenever there was under consideration legislation that affected Irish interests. He was defeated for re-election in 1874, but it is rather to his credit than otherwise, since he had been approached by the vintners of Dublin, who were at that time all-powerful in municipal politics, and offered the membership, provided he would agree not to actively support the Sunday Closing {211} Bill, which was to come up at the next session of Parliament. Such an agreement Sir Dominic absolutely refused to consider as consistent with his legislative honor, and the result was the close of his Parliamentary career. His years in Parliament, however, did not separate him from his interests either in medicine or in general science. He continued to be especially interested in zoology and made liberal contributions to the Dublin Zoological Garden. His residence at Dalkey, the grounds of which ran down to a rocky coast line, enabled him to obtain many specimens for his aquarium, and these were often transferred to the Dublin Zoological Gardens, for which he was one of the most active collectors. It was his custom during his Parliamentary career, though he was more than seventy, to leave London on Friday night and reach Dublin about eight o'clock on Saturday morning. From the station he went directly to the Zoological Gardens and took part in the pleasant breakfast which the Council of Officers of the Zoological Society, with some invited guests, had there every Saturday morning. He was noted for his humor, and his presence at these breakfasts was always appreciated, because in spite of his advancing years he was sure to add to the pleasure of the occasion. His friends feared that his Parliamentary career might prove a serious drawback to his health at his time of life, and their fears were not without foundation. He suffered severely from gout, which left its marks upon his feet and made it very difficult for him to walk for a time, and maimed him for all his after-life. Though a man who had worked very hard all his life and who, at the age of seventy, practically took up another career, that of politics, Sir Dominic lived to be nearly eighty years of age; thus illustrating the old aphorism that "it is not work but worry that kills," and {212} furnishing another example of the fact that great men are great also in their superabundant vitality, and are able to spend their lives in the hardest kind of work, yet, barring accident, live on to an age beyond even that which is considered the average term of human existence. Few men have had happier lives than Corrigan, if the high esteem of contemporaries can ever confer happiness. There was no honor in the gift of his Dublin professional brethren or of scientific bodies in which he was interested which was not conferred upon him. He was the president of the Royal Zoological Society, the president of the Dublin Pathological Society, of which he was one of the founders, and the first president of the Dublin Pharmaceutical Society. When not yet fifty years of age he was made physician in ordinary to the Queen in Ireland, and had the unapproached record of five elections to the presidency of the King and Queen's College of Physicians in Dublin--more than enough to make up for the one serious setback in his medical career, his black-balling by the college only a few years before. Foreign medical societies invited him to honorary membership and foreign universities conferred many degrees on him. It is easy to understand then that his death was followed by tributes of the loftiest character to his professional work, to his standing as an influential member of the community and as a man of the highest intelligence and thoroughly conservative patriotism. The London _Lancet_ said in its obituary: "By the death of Sir Dominic Corrigan, the medical profession loses one of its most conspicuous members, the University at Edinburgh one of its most illustrious graduates, and the Irish race one of its finest specimens. Though a perfect Irishman, Sir Dominic was as much at home in London, and though a sincere Catholic in religion, he had {213} too much humor and too much humanity in his constitution to be a bigot. It were well for Ireland if all her public men displayed so much moderation, sense, and good humor as Sir Dominic habitually displayed in dealing with difficult and delicate questions." About the same time the _British Medical Journal_ said, after calling attention to the distinguished contemporaries with whom Corrigan had been associated, that he was "_haud minimus inter magnos_--not the least among the great ones." "Indeed," his biographer added, "in originality of conception which, confirmed by later and independent observation, is the true test of genius, in a correct appreciation of the operation of natural laws, in producing and modifying the phenomena of disease, in a rare aptitude for testing his hypotheses by actual experience, and in a forcible exposition of them, he probably had no equal among his contemporaries." In the midst of all his honors and political influence, including association with the highest English officials in Ireland, Sir Dominic Corrigan had remained a consistent and faithful Catholic. Educated at Maynooth as a boy, he was proud to remain the physician to the college during many of the busiest years of his life when he must have often found it very difficult to spare the time to fulfil the duties attached to the position. He was the consultant physician till the end of his life. He is not even yet, after a quarter of a century, forgotten by the poor of Dublin, who recall his kindly help in affliction and his generous aid often given in ways that would be arranged with studied care so as not to hurt delicate Irish susceptibilities. The Irish School of Medicine has in Graves and Stokes and Corrigan a greater group of contemporaries than has been given to any other nation at one time. If we were to eliminate from nineteenth century medicine all the {214} inspiration derived from their work there would be much of value lacking from the history of medical progress. These men were deeply imbued with the professional side of their work as physicians, and were not, in any sense of the word, money-makers. Another very interesting phase in all their careers is that no one of them occupied himself exclusively with medical studies. All of them had hobbies followed faithfully and successfully together with medicine, and all of them were deeply interested in the uplifting of the medical profession, especially in securing the rights of its members and saving poor sick people from exploitation by quacks and charlatans. All of them gave of their time, their most precious possession, for the political and social interests of their fellow-men, and felt in so doing that they were only accomplishing their duty in helping their generation to solve the problem that lay immediately before it. {215} JOHANN MÜLLER, FATHER OF GERMAN MEDICINE {216} I say, then, that the personal influence of the teacher is able in some sort to dispense with an academical system, but that system cannot in any way dispense with personal influence. With influence there is life, without it there is none; if influence is deprived of its due position, it will not by those means be got rid of, it will only break out irregularly, dangerously. An academical system without the personal influence of teachers upon pupils is an Arctic winter; it will create an ice-bound, petrified, cast-iron university, and nothing else. --Newman, _Idea of a University_. {217} JOHANN MÜLLER, FATHER OF GERMAN MEDICINE Germany has come to occupy so large a place in progressive medicine during the last half-century that it is rather hard to conceive of a time when the Teutonic race was not the head and front of modern medical progress. The leadership that had existed in Italy for over five centuries only passed to Germany at the beginning of the nineteenth century. The first great leader in German medical thought was Johann Müller, and to the wonderful group of students that gathered around him German medicine owes the initiative which gradually forced it into the prominent place it still holds in the world of medicine. The great institutions of learning that have since come in Germany did not exist with anything like their modern systematic arrangement when Müller began his work. It was the marvellous influence of the man as a teacher, and not the scientific aids afforded by institutional methods, that brought forth the great generation of teachers which followed immediately on Müller's footsteps. Nowhere more than in the life of Müller can it be recognized with absolute certainty that the system and the institution count for little in education, as compared to the man and his methods. The keynote of Müller's career, even more than what he did for biology, and for all the biological sciences related to medicine, is the wonderful conservatism of thought which characterizes his scientific conclusions, while at the same time he began the application of the experimental methods {218} to medicine as they had never been applied before. At a time when physiologists, because of Woehler's recent discoveries of the possibility of the artificial manufacture of urea, might easily have been led to the thought that life counted for little in the scheme of the universe, Müller continued to teach consistently that vital energy may direct chemical or physical forces, but must not be confounded with them. It looked as if in the development of the chemistry of the carbon compounds, all of which are the result of life action, that materialistic views must be expected to prevail. Müller insisted, however, that life ever remains the guiding principle which rules and coordinates all the physical and chemical forces at play, within living organisms; and that the vital principle is entirely independent of these forces so closely attached to matter. All Müller's disciples, and they were the representative biological scientists in Germany during the nineteenth century, followed closely in his footsteps in this matter, and the result was a conservatism of thought in biology in Germany that is the more surprising when we realize how much German philosophers in their systems emphasized the necessity for absolute independence from all previous systems of philosophical speculation. It is so much more interesting, then, to find what was the method of education that made of Johann Müller so conservative a thinker, while not injuring his genius for experimental observations. The influences that were at work in his earlier years were evidently those that made him subsequently the bulwark against materialistic tendencies in biology, and yet did not impair his originality. His early education was obtained under influences that are usually considered to be distinctly harmful to independence of thought, and yet they seemed to have helped him to the fulfilment of his destiny, as a great thinker and investigator. {219} Müller is undoubtedly one of the very great men of modern science, and is the recognized founder of the system and methods of investigation which have given German medicine its present prominence and prestige. In recent years there have been many tributes to Müller, because as Virchow's teacher it was considered that some of the praise for the work done by Virchow must naturally reflect on the man to whom the great German pathologist acknowledged that he owed so much of his inspiration and his training in methods of investigation. Virchow's death too very naturally led to the recall of what had been accomplished in German medicine during the nineteenth century, and for much of this Johann Müller must be considered as at least indirectly responsible, since to him so many of the great German medical scientists owed their early training. These men, all of them, did not hesitate to attribute the progress of German medicine to the methods introduced by Müller. At the beginning of the twentieth century something of the estimation in which he was held in a land far distant from the German Fatherland may be gathered from the following tribute paid to him in a recent meeting of the Medical Society of the State of New York by Dr. C. A. L. Read, of Cincinnati, former President of the American Medical Association. In the midst of his panegyric of Virchow Dr. Read described in some detail the medical faculty of Berlin at the time when Virchow was beginning his work as a student at that University. He said: "In the faculty there were Dieffenbach, the foremost surgeon of his day; Schoenlein, the great physician who had come from Zurich the same year to join, not only the teaching body, but to act as a reporting counsellor for the ministry and to serve as physician-in-ordinary to the King; Froriep, who was in charge of the Pathological Institute; Caspar, who {220} was also medical counsellor, with a seat in the special deputation for medical affairs in the ministry; but towering above them all was the intellectual figure of Johann Müller, the Professor of Physiology. He was an original genius with daring, actually engaged in winnowing the wheat of demonstrated truth from the prevailing chaff of egoistic opinion which divorced physical science from speculative philosophy. Prompted by the inspiration which he had derived in turn from Bichat and the French school, the Professor of Physiology was busily retesting in the laboratory truths previously elaborated by Haller, Whytt, Spalanzani, Cullen, Prochaska, John Hunter, the Bells, Magendie, Berzelius and Bichat himself." This is the tribute to Johann Müller, nearly fifty years after his death. That of Virchow, at his obsequies in Berlin, is even more enthusiastic. Virchow, then at the age of thirty-seven, at the height of his powers, already acknowledged the greatest of living pathologists, just recalled to Berlin to become Professor of Pathology in the University which he had left more or less in disgrace because of his political opinions, could not say too much of the teacher whom he respected and honored so highly and whose inspiration he felt stood for so much in his own career. He said: "My feeble powers have been invoked to honor this great man whom we all, representatives of the great medical family, teachers and taught, practitioners and investigators, mutually lament and whose memory is still so vividly with us. Neither cares by day nor labors by night can efface from our mind the sorrow which we feel for his loss. If the will made the deed, how gladly would I attempt the hopeless task of proper appreciation. Few have been privileged, like myself, to have this great master beside them in every stage of development. It was his hand which guided {221} my first steps as a medical student. His words proclaimed my doctorate and from that spot, whence now his cold image looks down upon us, his kindly eyes beamed warmly upon me, as I delivered my first public lecture as Privat-Docent under his deanship. And, in after years, I was the one out of the large number of his pupils who, by his own choice, was selected to sit beside him within the narrow circle of the faculty. "But how can one tongue adequately praise a man who presided over the whole domain of the science of natural life; or how can one tongue depict the master mind, which extended the limits of his great kingdom until it became too large for his own undivided government? Is it possible in a few short minutes to sketch the history of a conqueror who, in restless campaigns, through more than one generation, only made use of each new victory as a standpoint whereon he might set his feet and boldly look out for fresh triumphs? "Yet such is the task to which we are called. We have to inquire what it was that raised Müller to so high a place in the estimation of his contemporaries; by what magic it was that envy became dumb before him, and by what mysterious means he contrived to enchain to himself the hearts of beginners and to keep them captive through many long years? Some have said--and not without reason--that there was something supernatural about Müller, that his whole appearance bore the stamp of the uncommon. That this commanding influence did not wholly depend on his extraordinary original endowments is certain, from what we know of the history of his mental greatness." Virchow's tribute could not well be more enthusiastic or more ample. His appreciation has been the standard for all other medical opinions of the man. How much Müller is honored at the present time in Germany can be best {222} appreciated from the number of times that his name is mentioned with respect and often with laudation in the proceedings of German medical societies. Scarcely a meeting passes in which more than once Johann Müller is not referred to as the founder of the scientific method in medicine which has given Germany her present position in the very forefront of medical scientific progress. It is a common expression, said half in jest it is true, but surely more than half in earnest, that the proceedings of no medical society would be really successful within the bounds of the German fatherland unless they were hallowed by an invocation of the great name of Johann Müller, the revered patron of modern German medicine. This is no witticism by exaggeration, after the American fashion, but a sincere Teutonic expression of feeling that occupies German medical minds with regard to the man who founded the most progressive school of modern medicine, and in doing so brought honor to his native country. Johann Müller was born at Coblentz, on July 14, 1801. About six months before, the Emperor of Austria by the treaty of Luneville, signed February 9, 1801, ceded to the French Republic all the Austrian possessions on the left bank of the Rhine. The electors of Treves, who were archbishops and reigning princes and who had resided for centuries at Coblentz, by this treaty disappeared forever from the list of German rulers. When Johann Müller was born, French prefects of the Departments of the Rhine and Moselle took up their residence in the old town which had been, since the beginning of the French Revolution, a favorite dwelling place for the French nobility driven from their homes by fear of persecution. Müller's father was a shoemaker and lived in a small house in the street of the Jesuits, so called because the fathers had had a school in it for many years. Johann was {223} not destined to receive his education from the Jesuits, however, for the order had been suppressed nearly thirty years before his birth, and did not re-establish itself in the Rhineland for many years afterward. The circumstances of the Müller family were not such as to encourage hopes of a broad education, though his father seems to have taken every possible means to secure as much school training as could be obtained for his son. The early death of his father promised to deprive Müller of whatever advantages might have accrued from family sacrifices, but his mother was one of these wonderful women who somehow succeed in raising their families well and affording their children an education in spite of untoward circumstances. Johann was the eldest of five children, with two sisters. He was very proud himself of the fact, that while he took from his father a large, strong, healthy frame and a dignified carriage, he had his mother's skill for putting things in order, her constancy of enterprise and her tireless faculty for hard work. After his father's death, his mother's energy and good sense enabled her to carry on the business established by the elder Müller by means of assistants, and as Coblentz was the centre of a district that during the Napoleonic wars was constantly overrun with soldiery, the shoemaking trade was profitable. Johann seems to have learned the trade, but his mother succeeded in enabling him to begin his education seriously at the age of eleven or twelve. About this time, Joseph Görres, who was afterward the great leader of Catholic thought in Germany, and after whom is named the famous Görres Gesellschaft which stands for so much in German Catholic life and progress, was a professor in the Sekunden Schule, or secondary school, in Coblentz, and had recently published treatises on natural philosophy with special {224} reference to physiology. Müller entered this school in 1810 and Görres did not resign his professorship until 1814, when owing to the publication of a political work he was obliged to flee from the country. It is not known how much influence Görres exercised over young Müller, but some at least of his precious love for the natural sciences, which even in his student days led to the making of natural collections of various kinds, seems to have been imbibed under the influence of the philosopher physiologist. The touching of the orbits of the two men, who were destined, more than any of their fellow-citizens of Coblentz, to influence Germany's future, must always remain an interesting consideration in the lives of both. Johann's parents were, as might have been expected, down in the old Catholic Rhineland in the capital of the spiritual principality of Treves, faithful members of the Roman Catholic Church. Very early in life, Johann conceived the wish to become a priest. His mother, rejoiced at her son's idea, was ready to make every possible sacrifice to secure his education. It was with the intention of education for the priesthood, then, that Johann entered the Sekunden Schule, an old college of the Jesuits, in which Jesuit tradition and methods of education still survived, and in which some of the old Jesuit pupils seem still to have held positions even during Müller's time as a student (1810 to 1817). It would appear probable that because of the traditions of Jesuit teachings that held over at the school in Coblentz, and perhaps, too, because of the presence of some of the old masters and teachers trained by them, Müller knew the ancient languages so well. He made his own translations of Plato and Aristotle, and consulted the latter especially always in the original and had a lifelong reverence for the great Greek philosophic naturalist's work, Latin he used {225} so well as to speak it readily, and practice in the disputations of the University at Bonn made the language still more familiar to him. It was said that he wrote Latin better than German. After the fall of Napoleon the Prussian government took up the reorganization of the schools in this part of the Rhineland, and Müller became more interested in scientific studies. At this time he became devoted to mathematics, which he studied under the old pupil of Pestalozzi, Professor Leutzinger, to whom Müller, in the sketch of his life prefixed to his thesis at the university, expressed the feeling that he owed a special debt of gratitude. During his school days Müller became a collector, as we have said, of natural objects. He was especially interested in butterflies for a time, and collected all the species in the country around. He had a curious dislike for spiders which remained with him all his life. He was able to overcome this, however, and made important studies of that insect's eyes, and of its changing expressions under the influence of fear or when about to fall upon its prey. His feeling with regard to the insect is an index of a certain feminine quality of mind that had a characteristic expression in later life in his dislike for vivisection. He could not bring himself to the conclusion that animals must be sacrificed in the midst of horrible pain unless there was some very definite scientific point to be determined, and unless every precaution was taken to avoid inflicting needless suffering. Even then he preferred that others should do this work and more than once took occasion to point out the fallacy of physiological observations founded on animal experimentation under such anomalous circumstances, and insisted that very frequently the results gave conclusions only by analogy and not by any strict logic of animal similarity or absolute physiological nexus. {226} In a sketch of Müller's life, by Professor Brücke, of Vienna, himself one of the most distinguished physiologists of the nineteenth century, to whom the University of Vienna has paid the tribute of a marble bust and tablet in its courtyard, the great Austrian physiologist sums up very well the reasons for Müller's fame. Professor Brücke's tribute may be found in the _Medical Times and Gazette_, of London, July 17, 1858. "If we inquire," he says, "what were the circumstances to which Müller, independently of his high intellectual endowment, his gigantic power for work, the energy and massiveness of his character, and his active and vigorous bodily constitution, owed the commanding position he incontestably held among men of science in our day, we must admit that before all things this was due to the breadth and depth of the foundations upon which his intellectual cultivation had been built." Professor Brücke then dilates on the variety of scientific interests which occupied Müller's earlier years and the thoroughness with which he accomplished everything that he set himself to. A very curious reflection on our modern methods of education, and especially the tendency to specialization and the formation of specialists from their very early years, is to be found in Brücke's account of the extent and variety of Müller's studies in all lines. Far from considering that these diverse intellectual interests hindered the development of his genius, he seems to consider that they rather aided in the evolution of that largeness of mind characteristic of the great genius. He says: "In his schooldays Müller's attention was directed to subjects of study far beyond the mere medical curriculum, for we find him attending the lectures of celebrated professors on poetry and rhetoric, on the German language and literature, on Shakespeare and Dante." As a matter of {227} fact, Brücke seems to have understood that no one is so little likely to make scientific discoveries as he whose mind has been directed without diversion along the narrow lines of a specialty in science. Constantly trained to see only what lies in the sphere of this short-sighted interest, the mind never raises itself to a view beyond the horizon of the already known. The old classical training, supposed to be so useless in this matter-of-fact, practical age, trained the minds of the men who have given us all the great discoveries in science. The evolution of intellectual power consequent upon the serious study of many things proved an aid rather than a hindrance to future original work. Not one of these great scientific investigators had at the beginning any hint of the work that he was to do. It seems almost an accident that their researches should have been conducted along certain lines which led to important discoveries. What was needed for them was not special training, but that mental development which puts them on a plane of high thinking above the already known, to look for progress in science. Müller continued for many years to entertain the idea of eventually becoming a priest. At about the age of sixteen, however, he became deeply interested in Goethe's work, and was especially attracted by the great poet's studies of scientific subjects. About this time he became interested in the collection of plants and animals and took up seriously the study of physiology. Lavater's work was, at that time, still sufficiently recent to have little of the novelty worn off, for young students, at least. At the age of eighteen Müller went to Bonn and, when about to begin his university career, hesitated as to whether he should study theology or not. His natural liking for nature study, however, finally caused him to decide in favor of a scientific career, and he began the study of medicine. {228} He took up his medical studies with the greatest enthusiasm. Under the special guidance of Mayer, who besides being his teacher was a personal friend, he applied himself zealously to the study of anatomy. One of his expressions in his early student days that has often been repeated, but which Müller took the greatest care in later life to correct and deny as a lasting impression, was the famous "Whatever cannot be demonstrated by the scalpel, does not exist." The professor of physiology at the time at Bonn was the famous Fredrich Nasse, especially known for the wonderful attractiveness of his lessons and his power of arousing enthusiasm in others, and it is not surprising that Müller, naturally so enthusiastic in scientific studies, should have acquired a liking for the study that he never afterward lost. During Müller's second year of medical study the University of Bonn announced its first prize, which was to be given for an investigation of the subject of respiration in the foetus. Although Müller was only in his first year as a medical student at the time, he grappled with the difficult subject and devoted all his spare time to arranging experiments for the demonstration and investigation of doubtful points. He received the prize, and Virchow, surely a good judge in the matter, says that this work of his student days is distinguished alike by the extent of its learning and by the number and boldness of the experiments detailed. At the moment of his graduation, the young doctor, in his twenty-first year, was already a marked man. From this time on everything that he did attracted attention and had a ready audience. Müller's mind was constantly occupied after this time with the arranging of experiments to demonstrate natural principles. How far he carried this habit of experimenting can be understood from some of the habits of control over {229} his muscles which he had acquired by continual practice and intense attention. He had thorough control over the muscles of his ears and used often to amuse his fellow-students by their movements. The anterior and posterior muscular portions of this occipito-frontalis muscle were able readily to move his scalp and produce curious disturbances in his hair. These habits of muscular control many people have acquired. Other acquisitions of Müller's are, however, much rarer. He could, at will, contract or dilate his pupils, having secured control over his iris by practice before a mirror, and he could use the little muscles that connect the bones within the ear, the hammer, anvil and stirrup, so as to make them produce an audible click at will. His habits of experimentation on one occasion at least placed him in a rather ridiculous position. While making his military service, it happened one day that when the command "Order arms" was given, Müller amused himself by inserting one finger after another into the muzzle of his firelock. At last his middle finger got fairly wedged into the weapon. When the order attention was given, Müller could not withdraw his finger. His predicament at once attracted notice, and he was ordered to the front to be reprimanded by the major, to the no small amusement of his comrades, who laughed heartily at his ridiculous predicament. He was sent to his quarters in disgrace and the regimental surgeon had no little trouble in liberating the thickly swollen finger. While everything thus seemed to promise a life of experimentation, Müller's imagination had a powerful hold on him, and he gave himself up for some time to certain mystical theoretical questions and problems of introspection which, for a time, threatened to take him away from his real calling of an experimental physiologist. Fortunately for Müller, as we shall see, though at the moment he doubtless {230} thought it a serious misfortune, these excursions into a too introspective psychology were followed by nervous troubles, what we could now call neurasthenia, and he was consequently led back to the study of external nature. Just after Müller's promotion to the doctorate in medicine, the Rhenish universities came once more under the authority of the Prussian government, and Berlin became a Mecca for students, who looked upon it in a way as the mother university. After his graduation at Bonn, then, Müller was attracted to Berlin, and came especially under the influence of Rudolphi, who recognized his talents and gave him special opportunities for original investigation. Rudolphi's private library and his collection were placed at the command of this young original worker, who had already proved his power of investigation and his capacity for following a subject to its ultimate conclusions, even though those were not yet extrinsically known. While at Berlin, too, Müller came under the influence of the younger Meckel, whom he learned to respect very much. After Meckel's death the _Archives of Physiology_, previously edited by Meckel, fell into Müller's hands, who successfully continued it for many years. At Müller's departure from Berlin he was presented by Rudolphi with an English microscope, as a testimonial of the old professor's appreciation of the young man's labors while under his observation. As Müller's pecuniary resources were very limited, this must have been an especially acceptable gift, since it enabled him to continue his researches in embryology, and it was not long before these began to bear fruit. At Bonn, to which Müller returned, he set up as a Privat-Docent in the University, and for several years eked out by teaching the allowance his mother could give him, and even by the practice of medicine. Bonn, at this time, had a population of perhaps 30,000, {231} and had some eighteen regular practitioners of medicine. It is easy to understand, then, that Müller's practice did not add materially to his pecuniary resources. It was not long before he gave up the practice of medicine entirely, led to the step by the sad death of a friend, who, while under his care, suffered from perforation of the intestines, followed by peritonitis. Notwithstanding the rather precarious state of his finances, at the age of twenty-six, Müller married Anna Zeiler, the daughter of a landholder in the Rhineland, not far from Bonn. He had previously dedicated to her a poem, in which he promised her, in lieu of more material advantages as a marriage settlement, an immortal name. The young man seems to have felt something of the genius that was in him, but, then, so have others, and their presages have not always been confirmed by the issue. Shortly before and after his marriage, he applied himself so hard to his investigations of many kinds that within a few months he broke down. The government allowed him a furlough, and for several months he wandered with his bride along the Rhine, in what has been described by a biographer as a "one-horse shay," and came back to his work renewed in mind and body. As a matter of fact, Müller's breakdown was what would be called at the present time a neurasthenic attack, induced by overwork and too great introspection. He had been experimenting upon himself in many apparently harmless ways, but by methods which often cause serious trouble. It was not an unusual thing for him to fast, in order to note the physiological effect on his mind and senses of the absence of proper nutrition. He would often lie awake for hours at night in the darkness, experimenting upon himself and noting the phenomena induced, especially in his sight, by the total absence of light. He devoted himself, too, to the investigation of the curiosities of second sight; those interesting {232} reminders of things seen long ago, though without producing much impression, and which recur at unexpected moments, to make us think that we are seeing again when we are really only unconsciously remembering. He used to exercise a good deal the faculty of bringing up objects into his vision with all the physical peculiarities of actual sight. In this his master was Goethe, who had written extensively on this subject in treating of the phenomena of vision, and who was able himself to recall to his imagination with great vividness the many shades of colors of objects with the sensory satisfaction of actual vision. Müller had this imaginative power only for the reds. It is not surprising that a young man, engaged too exclusively at this sort of investigation, should have impaired his nervous equilibrium to some degree, and made symptoms, otherwise unimportant, appear to him as the index of serious illness. For a time Müller despaired of ever being himself again. When he had regained his health, however, he realized what had been the essential cause of his nervous condition; and so he never went back to his introspective observations, considering their results somewhat in the nature of a series of illusions. After this, Müller devoted himself for ten years strictly to his physiological investigations. The best knowledge of what Müller accomplished for scientific medicine, during these early years, can be obtained from Virchow's summation of the discoveries of this period made shortly after his great teacher's death. Virchow says: "It was Müller who introduced to the knowledge of physiologists and physicians the doctrine of reflex actions, which had been already indicated by Prochaska, and simultaneously discovered by Marshall Hall and himself. Just before this Müller succeeded in showing an {233} easy mode of performing experiments on the anterior and posterior roots of the spinal nerve in corroboration of Bell's teaching of their diverse functions. Thus he had the privilege of establishing for all time two of the greatest practical discoveries of the physiology of the nervous system. "Next to the nerves the blood became the subject of his researches and he not only naturalized in German medicine the accurate knowledge of the fibrin and blood-corpuscles, which Hewson had cultivated with such fertility in English literature, but he also managed by simple experiment to demonstrate the peculiar composition of the vital fluid. The discernment of right methods of investigation lay ever open to his clear and cultivated intellect, and he knew well that there were cases in which the scalpel and experiments could not determine a question, and where the truth was only to be elicited by means of chemical agents and physical instruments. It was thus he discovered the peculiar gelatinous substance found in cartilage, called chondrin; thus he proved the existence of lymphatic hearts in the amphibia, and thus that he determined not only the organs but all the laws which are concerned in the production of the human voice. "The special researches of the Bonn epoch are those of the minute structure and anatomy of the glands. They put an end to the controversy which had existed so long between adherents of Malpighi and Ruysch, concerning the sacculated extremities of the glandular follicles, and obtained for us a correct knowledge of these important organs throughout the whole animal kingdom. Perhaps his most important work is that of the Ducts of Müller, the structures (named after him) which form so important a part of the genito-urinary system in the embryo." Practically all this had been accomplished before he was {234} quite thirty-two years of age. In the autumn of 1832, Rudolphi, the professor of physiology at Berlin, died. As Virchow says, candidates sprung up on every side, and some who were the least qualified considered themselves best fitted for the position. Müller took an unusual step which illustrated his decision in character, though in any other it would have seemed an evidence of conceit. He declared, in an open letter, laid before the Minister of Prussia, that his claims were superior to those of any other living physiologist, except John Frederick Meckel. So powerful was the impression produced upon the minister by this letter that he immediately appointed Müller to the vacant chair. Not long after his appointment to the chair of physiology at the University of Berlin Müller completed the well-known "Hand-book of Physiology," which established his reputation. The book is sometimes spoken of as an experimental physiology, but this is not correct. Müller was no more a mere experimentalist than Haller, and he, himself, heartily detested the tendency which experimental physiology had assumed in France, especially under the influence of Magendie. Part of Müller's aversion to experimental physiology was aesthetic. He could not bear the idea of inflicting so much pain as many of his colleagues inflicted without a thought. In his panegyric of Rudolphi, Müller says: "Rudolphi looked upon physiological experiments as having no relation to anatomical accuracy, and it is no wonder that this admirable man, who had at every opportunity expressed his abhorrence of vivisection, took up a hostile position against all hypotheses and conclusions insufficiently established upon physiological experiments." Müller adds: "We could not have failed to share his righteous indignation, had we seen how many physiologists were using every effort to reduce physiology to an experimental science by the live dissection and agonies {235} of innumerable animals, undertaken without any definite plan, and yielding often only insignificant and imperfect results." Müller shared these views of Rudolphi with regard to vivisection. The uncertainty of the conclusions, the amount of suffering inflicted, and the indefiniteness of the conditions of experiment, so that the conclusions could not have any very great weight, or any special accuracy of information, made him consider such experiments, unless very carefully conducted by trained investigators, as largely a waste of time and infliction of unnecessary pain and a leading astray of physiological advance because of the uncertainty involved. The qualities in Müller's "Hand-book of Physiology," which gave it its greatest value, are the thorough review of all of the physiological literature of the world which it contains, and the greatest number of original observations it details as the basis of the principles enunciated. Müller himself said, in the preface to his "Hand-book": "I need scarcely remark that it is the duty of a scholar to make himself acquainted with the progress of science among all nations; and this is now possible and, moreover, quite indispensable in these days of progress. A purely German, French, or English school of medical science is barbarism; and in Germany we would consider the idea of an isolated English or French system of natural history, physiology or medicine just as barbarous as the notion of Prussian, Bavarian, or Austrian medicine or physiology." How valuable the book was as the corner-stone of modern German medicine, may best be judged from Virchow's opinion of it. He says in his panegyric of Müller: "There are two qualities in his 'Hand-book of Physiology' which have particularly enhanced my estimation of its value--its strictly philosophical method and its completeness {236} in facts. Since the time of Haller no one has so thoroughly mastered the entire literature of natural history or collected in all directions so many original experiences, and no one has been at the same time familiar with medical practice, as well as with the remotest provinces of zoology. It has been well said that while Haller often, in doubtful questions, espoused a side which must eventually be forced to succumb, Müller always had the luck (if we may call that luck which was preceded by so much intelligent activity), sooner or later, to discern the opinion that was sure, eventually, of the victory. He was wonderfully fitted for the office of critic by his comprehensive knowledge. He knew how to discriminate the healthy from the unsound, the essential or real from the adventitious or accidental. And, in surveying the whole series of forms--often widely different--among which a well-determined plan of nature seemed to be realized, he knew the changes which not infrequently altered considerably the arrangement and composition of the substances within these forms. In Müller, as a physiologist, it is not the genius of the discoverer, nor the ground-breaking nature of his observations we admire, but rather the methodical exactness of investigation in calculating judgment, the confident tranquility and the perfect consummation of his knowledge." In a word, Müller owed the success of his career to the perfect poise of his intellect and the admirable critical faculty that guided him in the thorny path of knowledge at a time when there were so few landmarks of real scientific significance to show the investigator what the probable course and progress of real science must be. It was for this reason that, as Virchow has said, the reform of newer views became embodied in him, and in spite of the almost monastical retirement of the scholar, the influence of the method introduced by Müller was not limited to physiology, but continues to {237} spread beyond that science in ever-widening circles into the domain of all the biological sciences. Virchow concludes: "Müller vanquished mysticism and phantasms in the organic kingdom and he was most distinctly opposed to every dangerous tendency, whether it was pursued under the pretext of physiology or belief, or merely in accordance with conjectures. Müller did not discover, but he firmly established the exact method of investigating natural sciences: Hence, he did not found a school in the sense of dogmas--for he taught none, but only in the sense of methods. The school of natural science which Müller created knew no community of doctrine, but only of facts and still more of methods." He did not confine himself in his studies, however, to the physiology and pathology, nor even to the anatomy and embryology of man. After 1840 he devoted himself to the study of invertebrates and investigated the starfish and the pentacrinites. While engaged in his work on the invertebrates he found that the fossil remains of animals had not been carefully explored, so for a time he devoted himself to paleontology. While his salary as professor was ample for his own support, it was not what would be called generous at the present time, yet Müller became so devoted to his science that he paid certain of the workmen to be on the lookout for fossil remains for him in the quarries of the Eifel. He became deeply interested, too, in life in the sea and made his vacations times of specially hard work, investigating the conditions of low life among marine organisms. He passed from one class of life to another. From sea-urchins and starfish to infusoria and polycystina, whose varieties he was himself the first to recognize and describe. Müller was one of the first to point out that certain of the lower animals could propagate similar and dissimilar {238} generations, that is, reproduce by alternate generations. He studied and demonstrated especially the metamorphoses in the echinodermata, and his broad vision and careful observation in this new and surprising scientific field cleared up many things that had been mysteries before. In paleontology Müller worked with our own Agassiz, then a young man, or perhaps it should rather be said that Agassiz worked with Müller. A paper, for whose compilation they made a series of observations together, appeared at Neufchatel, in 1834. It was a note on the vertebrae of living and fossil dog fishes. At this time Müller was interested in fossil fishes of many kinds and wrote several articles in later years on this subject. Toward the end of Müller's life he studied especially the polycystina, certain of the radiolaria, and some of the many chambered specimens, fossil and living, that were attracting much attention at that time. As a matter of fact he went the day before his death to the zoological museum of Professor Peters in Berlin, in order to obtain some polythalamacea. How open to advance in science and how ready to encourage the work of others Müller was, may be gathered from his attitude to parasites as the cause of disease, when these began to be discovered. After Professor Schoenlien's discovery of the parasite of favus, Müller became interested in it, confirmed Schoenlein's observations and added something to our knowledge of it. About this time, also, he discovered the psorosperm as a parasite of animals and possibly of man, and devoted considerable attention to it. His work was afterward greatly extended by one of his pupils, Lieberkühn, whose researches with regard to these minute organisms attracted the attention of the medical world. It is not a little surprising how many of the investigations that afterward were to give fame to Virchow were initiated {239} by his great teacher, Müller. It was Müller whose study of tumors led Virchow to devote himself to this subject and give us the best pathological work on it that has ever been written. Virchow himself notes with regret that Müller turned aside from pathology and never finished the promised work which was to have contained his theory of the origin of tumors. Another work in which Virchow followed in Müller's footsteps was the development of craniometry and, in general, the scientific investigations of skulls. Müller had interested himself very much in microcephalic skulls and Virchow assisted him in the investigations of them. Many years afterward Virchow established the science of craniology in the department of anthropology, and succeeded in throwing not a little light on the origins of races by his discoveries in this matter. After Schoenlien's discovery of the parasite of favus, Müller became interested in the parasitology of human beings, and with Retzius, the famous Swedish anatomist, investigated certain molds which occur in the respiratory passages of birds. They succeeded in demonstrating that these vegetable parasitic growths were a form of Aspergillus. Their studies in the white owl particularly called general attention to the possibility of such molds occurring as parasites of animals. Later on, Virchow showed that these same molds occur occasionally in the respiratory passages of men. Virchow found them in three bodies at autopsy, all of them being run down individuals, two of them old subjects, and all sufferers from chronic bronchitis. Usually, when the parasites were found, there was a distinct tendency to very low resistive vitality in the tissues, sometimes proceeding even to the extent of beginning pulmonary gangrene. In reviewing the subject Virchow [Footnote 7] said that the light thrown {240} upon it by the investigations of Müller and Retzius was of the greatest possible assistance in enabling him to identify the parasite when he found it in human subjects. [Footnote 7: Virchow's Archiv, Bd. ix.] The number of positive facts which Müller brought to light in the most diverse departments of science is almost beyond calculation, and yet it is astonishing how seldom the slightest error, or even an incomplete observation, can be found in his work. On the other hand, it has happened, over and over again, that when the correctness of his observations in the beginning seemed according to other investigators to be dubious, they have come eventually to be acknowledged as representing the truth. As a rule, he went over every set of observations three times. During the second series he wrote about them. He always repeated the experiments on which his observations were founded while his material was going through the press. His manuscripts were a mass of corrections; notwithstanding this, his proof sheets were the despair of the printers. Müller accomplished all this only by the most careful husbanding of his time. He knew how to make use even of the ends of hours and brief intervals which others waste without a thought about them. He used to call these periods of short duration between the duties "the gold-dust of time," and said that he did not wish to lose a particle of it. In the quarter of an hour between two lectures it was not an unusual thing to find that he took up some dissection at which he was engaged, or continued his work sketching the observations that he had been making during the previous day. How thorough was Müller's work in everything that he devoted himself to can be gathered from certain excursions into pathology, which was, after all, only a side issue in his work, and to which he gave very little serious attention. Müller's assistant in the Museum of Berlin, and one of his {241} favorite pupils, Schwann, made a series of what Virchow calls comprehensive and magnificent investigations on the cell structures of the animal tissues, on which progress in pathology so essentially depends. Müller followed up these discoveries, and, to quote Virchow once more, he was in this matter the authority of authorities; for the medical world owes to him practically all its knowledge of tumors. Müller first demonstrated the harmony which existed between the pathological and the embryonic development of tumors. This physiological observation is of the highest importance. It came at a time when tumors were considered to have nothing of the physiological about them, but to be entirely manifestations of morbid processes foreign to all natural functions of the body. Müller's observation of the identity of the pathological and the embryonic development of tumors is really the key to the whole doctrine of morbid formations. Virchow assures us that Müller's labors gave the strongest impulse to the employment of the microscope in pathological investigations. Undoubtedly this was his most important contribution to scientific medicine. With this he laid the foundation of the explanations of tumors--a work that his great pupil was destined to carry on. Some of Müller's work in this line, his study of enchondromata for instance, Virchow confesses to have been part of the inspiration that led to his own later work. Müller was occupied, however, with too many things to devote himself to the study of pathology in the way that would have been necessary to make great discoveries in the science. He promised that he would sometime settle down to make a classification of tumors, and that the principle of such a classification would not be based either on their fineness of structure or on their chemical composition, but that their physiological nature and tendency to grow must be taken into account. When he died, however, he {242} left behind him nothing unfinished except the long-expected conclusion of his book on tumors. Müller's most important work in physiology, and his most far-reaching influence on the biological sciences, which were just then beginning their modern development, came from his assertion of vital force as a thing entirely different from and absolutely independent of the physical or chemical forces which it directs and makes use of. Vital force for Müller was the ultimate cause and supreme ruler of vital phenomena, so that all the energies of an organism follow a definite plan. It was for him the complete explanation of all the physical manifestations of life. It disappears in death without producing any corresponding effect. Without losing anything of itself it hands over in multiplication or reproduction a force equal to itself to the new being that is born from it. This vital force that is thus handed over need not necessarily manifest itself at once, but may lie dormant for a long time to be awakened to manifestations of life by the concurrence of proper conditions in its environment. In a word, Müller appreciated fully the mystery of life, faced the problem of it directly, stated it in unequivocal terms, and by so doing saved the rising science of biology from wandering off into speculations which were seductive enough at that time, but which would have proved vain and wasteful of time and investigative energy. Müller's influence on his students was sufficient in this matter to set the seal of vitalism, as it is called, on most of the biological work done in Germany about the middle of the century, and it was a recurrence to his observations and his methods which led the reaction to vitalistic theories that characterized the concluding years of the nineteenth century. With regard to the significance of Müller's work, Professor Du Bois-Reymond, himself a pupil of Müller, in his memorial {243} address delivered before the Royal Academy of Sciences of Berlin in 1859, [Footnote 8] says: "It has been objected by those who insist on the greatness of Müller's reputation that he himself made no discovery that can be said to be of the first rank. Müller's fame is great enough for us to allow that there is something true in this objection. He accomplished more in developing the ideas of others than in original research of his own. That he did not make any great discovery is, however, rather due to the fact that he came at a time when great discoveries were no longer lying around loose as they had been in the preceding century, waiting to be made, as it were; and what he accomplished was of more value than one or two single discoveries of primary importance. He made the original ideas of other men so clear that they were at once accepted by all the medical and scientific world. In this way he furthered the progress of medicine better than any devotion, however successful, to one single feature could possibly have accomplished. [Footnote 8: Gedächtnissrede auf Johannes Müller, von Emil Du Bois-Reymond, Berlin, Buckdruckerei der Königlichen Akademie der Wissenschaften (Dummler), 1860.] "Müller made mistakes, but then who ever fails to make mistakes in the face of nature? As a rule, however, he hit the nail on the head. There are many suggestive thoughts from him that the investigators of later times have proved to be true. He suggested, for instance, that there must necessarily be some connection between the ganglionic bodies and the nerve stems. He suggested, also, that there must be a special nerve system for the intestinal tract. Later discoveries in physiology have established both of these thoughts and have shown that Müller had so entered into the spirit of nature and her processes as to be able to think her thoughts. There is no doubt that there are suggestions in {244} his writings, especially those of the later years of his life, which will give a series of triumphal substantiations of the same kind." Du Bois-Reymond's final judgment is of special interest, because it tries to point out the comparative place that will be occupied by three great men in the biological sciences of a century ago: "Haller and Müller must be considered as giants of earlier days, though when future generations compare them with Cuvier they will occupy somewhat of the position that Galileo and Newton hold in comparison to La Place and Gauss, or Lavoisier in comparison to Berzelius. The first of these men had the opportunity to do great things while it was yet possible to do them, and left to their successors only the possibility of developing their thoughts." [Footnote 9] [Footnote 9: Some idea of the estimation in which Müller was held by his contemporaries, German and foreign, may be gathered from the number of scientific bodies of which he was a member. He was an associate in practically every serious scientific body in Germany. He was, besides, foreign member of the scientific academies at Stockholm, Munich, Brussels, Amsterdam; the scientific societies of Göttingen, London, Edinburgh, Copenhagen; foreign honorary member of the Academy of Sciences of Vienna; corresponding member of the Academies of St. Petersburg, Turin, Bologna, Paris and Messina; of the Society for Science at Upsala, of the Mecklenburg Naturalist Society of Rostock, of the Senkenberg Institute of Frankfort-on-Main, of the Academy of Natural Sciences of Philadelphia, of the Society of the Museum of Natural History at Strasbourg, of the Naturalists' Association of Dutch East India; member of the Holland Society of Sciences, Haarlem; of the Naturalist Society of Frieburg in Breisgau, Halle, Dantzig and Mainz; of the American Philosophical Society of Philadelphia, of the Society of Biology of Paris; honorary member of the Cambridge Philosophical Society, of the Natural Science Union of Hamburg, and the Natural Science Association of the Prussian Rheinland and Westphalia, of the American Academy of Arts and Sciences in Boston, of the Ethnological Society of London, of the Microscopic Association of Giessan, member of the Society for Science and Medicine at Heidelburg, of the Naturalists' Society at Dresden; corresponding member of the Scientific and Medical Association of Erlangen and Moscow; member of the Academy of Medicine of Paris; honorary member of the Academy of Medicine of Prague and of Dorpat, of the Medico-Chirurgical Academies of Wilna and of St. Petersburg, of the Medical Society of Guy's Hospital in London, of the Medical Society of Edinburgh and of the Hunterian Society of the same city, and of the Medico-Chirurgical Societies of London and of Zurich, of the Medical Societies of Budapest, of Lisbon, of Algiers and Constantinople; corresponding member of the Medico-Chirurgical Academy of Turin and of the Medical Society of Vienna. Even this long list does not include all his various honorary and active memberships in scientific and medical societies. He was, besides, the laureate, that is, a prize winner, of the Medical Faculty of the University of Bonn, of the Sömmering Prize of the Senkenberg Institution, of the Copley Medal of the Royal Society of London, of the Culver Prize Monthyon of the same institution, as well as laureate of the Academy of Sciences of Vienna for Experimental Physiology. He had been honored by the King of Prussia by the conferment of the knighthood of the Order of the Red Eagle, by the King of Sweden by the Royal Swedish Order of the North Star, by the King of Bavaria by the Royal Bavarian Maximilian Order, and by the King of Sardinia by a knighthood in the Order of SS. Mauritius and Lazarus.] {245} It is as a teacher that Müller did his best work. He was not by nature a good talker and never said much, but he was very direct; and, as he spoke from the largest possible and most progressive knowledge of the subject, his lectures were always interesting to serious students. There seems to be a more or less general agreement that for the mass of his students he was uninteresting because likely to be above their heads. For the talented members of his class, however, he was an ideal teacher--always suggestive, always to the point, and eminently complete. Du Bois-Reymond says that he never was confused, never repeated himself, and never contradicted himself. He was able to illustrate his lectures by sketches on the board in a way that enabled students to follow every step of {246} even a complex, embryological developmental process. He could trace, step by step, with the chalk, every stage of evolution in the organism and bring it clearly before his students. To a narrow circle of the best men within his class he became a personal friend, whose inspiration led them on to the deepest original researches. Among his students were some of the men who made German medicine and German science known all over the world in the last fifty years. Chief among them may be mentioned Virchow, Helmholtz, Du Bois-Reymond, Schwann, Lieberkuhn, the discoverer of the follicles in the intestines; Max Schultze, whose work in histology and physiology are well known; Claparede, Remak, Guido, Wagener, Lachmann and Reichert. What he demanded of his students above all was that they should learn to help themselves. He set them tasks, gave them suggestions, directed their work, corrected their errors, but he wanted them to do work for themselves. His very presence was an inspiration. Both Virchow and Du Bois-Reymond speak of the power of his eye. Du Bois-Reymond says that there was in him an almost demoniac magic, and that students looked to him as the soldiers of the first Napoleon did when the great Emperor's words were in their ears--"Soldiers, the Emperor has his eye on you." Du Bois-Reymond adds that, consciously or unconsciously, every student felt the winning influence of his great personality. With all this he knew how to unbend, especially with favorite students, and many a joke from him found its way around the laboratory even during working hours. He was not one to stand on his dignity, and Virchow tells of him that even when nearly fifty he was known to race with a student down the corridor from one class-room door to another. He took up skating at the age of forty-five, and though he had not many friends and was too entirely devoted to his work to make {247} many acquaintances, it was always a source of pleasure to young men to be allowed to associate with him, and many eagerly sought the privilege. How impressive a figure Müller made in his character of teacher can be gathered best, perhaps, from a note added to Virchow's panegyric during its progress through the press, in which the pupil tells his impressions of the master: "I must confess that Müller, in his lectures and in his manner, reminded me of a Catholic priest, which might be accounted for by the impressions of his early childhood. When as the dean of the Faculty he mounted the _cathedra superior_, dressed in his official robes, and pronounced the Latin formulary of the proclamation of the doctors of medicine, with short, broken and contracted words; when he began his ordinary lectures in almost murmured syllables; or, when with religious earnestness he was discussing any of the abstruse questions of physiology, his tone and manner, his gestures and looks, all betrayed the traditional training of the Catholic priest." Virchow adds, "Müller himself was what he styled one of his greatest predecessors--perpetually a priest of nature. The religion which he served attached his pupils to him as it were by a sacred bond; and the earnest, priest-like manner of his speech and gestures completed the feeling of veneration with which everyone regarded him." In the recently issued life of von Helmholtz, the great German physicist, his biographer makes it very clear how much Helmholtz thought of Müller, one of the earliest teachers. [Footnote 10] Helmholtz, Brücke, and Du Bois-Reymond were warm personal friends (college chums we would call them in America), and all fervent admirers of their greatest {248} master, who showed them, as Helmholtz says, "how thoughts arise in the brains of independent thinkers." A half-century later, in his recollections of the time, he said: "He who has come in contact with one or more men of the first rank has his mental intellectual standard for all time broadened, and such contact is the most interesting thing that life can hold." Curiously enough, one of the most interesting things in Helmholtz's recollections is that, despite the fact that the poverty of his parents made it advisable for him to get through his medical studies as soon as possible, Müller persuaded him to take another year's medical work before going up for his graduation. This was mainly for the purpose of having his pupil complete an essay in physiology on which he was engaged. Müller offered him the use of his own laboratory and all his instruments for this purpose. His judgment was justified by Helmholtz's wonderful work on the conservation of energy made within a few years after his graduation. [Footnote 10: Herman von Helmholtz, von Leo Koenigsberger. Bd. 2, Braunschweig, Friedrich Viewig und Sohn, 1902-3] Müller's death was sudden, though not entirely unexpected. He had been ailing for many months and had resolved to give up his lectureship. He had made most of his preparations for settling up his affairs, and had even sent for his son, who was practising medicine at Cologne, to come up to see him. He made a special engagement for a consultation with his physician for a certain morning, and having gone to bed in reasonably good spirits, in fact, feeling better than he had for a long while, was found dead in the morning. Some time before he had made his will forbidding an autopsy, and so the exact cause of death will never be known, though it is rather easy to surmise that it was due to apoplexy, as arteriosclerosis--that is, degeneration of arteries--had been noticeable in Müller for some years, and his temporal artery particularly had become hard and tortuous. Müller was buried with all the rites of the Church, and as {249} in Germany the ecclesiastical authorities are very strict in this matter, there can be no doubt that the great physiologist had been a faithful Catholic. He was known for his edifying attendance at Mass on all the Sundays of the year. Many years afterward, in the midst of the Kulturkampf in the early seventies, a monument was erected to him in his native Coblentz, and the occasion of its unveiling was taken by the Catholic Rhineland for a celebration in honor of their great scientist. For a time, in his younger years, Müller appears to have been not all unaffected by the materialistic tendencies so rife in the science of the time. His early anatomical investigations seem to have clouded somewhat his faith in things spiritual. One of the expressions attributed to him before his twenty-fifth year is that nothing exists in the human being which cannot be discovered by the scalpel. It was not long, however, before Müller repudiated this expression and came back to a realization of the importance of the immaterial. Another expression attributed to him, "Nemo psychologus, nisi physiologus," "No one can be a psychologist, unless he is a physiologist," has been often repeated as if Müller meant it in an entirely materialist sense. As a matter of fact, however, it is intended to convey only the idea that no one can really exhaust the science of psychology unless he knows the physiology of the brain, the organ which the mind uses in its functions in this life. The expression is really the foundation of the modern physiological psychology, which is by no means necessarily materialistic in its tendency, and has become a favorite subject of study even with those who appreciate thoroughly the importance of the immaterial side of psychology. Müller seems never to have gotten so far away from the Church as that other great physiologist of the succeeding generation in France, Claude Bernard, who for many years allowed himself to be swamped by the wave of materialism {250} so likely to seem irresistible to a scientist engaged in physiological researches. But, even Claude Bernard came back to the Church before the end, and, under the guidance of the great Dominican, Père Didon, reached the realization that the only peace in the midst of the mysterious problem of life and the question of a hereafter is to be found in a submissive faith of the doctrines of Christianity. Many years ago, when Virchow took it upon himself to say harsh words in public of Catholic scholarship, and to put forward the hampering influence of the Church on intellectual development as a reason for not allowing Catholics to have any weight in educational matters, the organ of the Catholics of Germany, _Germania_, reminded him that his own teacher, the great Johann Müller, the acknowledged father of modern German medicine, and the founder of the fecund scientific method to which so many discoveries in the biological and medical sciences are due, had been brought up and educated a Catholic, had lived all the years of his productive scholarship and fruitful investigation in her bosom, and had died as an acknowledged son of the great mother Church. Müller is certainly one of the great names of nineteenth century science. When many another that seems now as well, or perhaps even better known, shall have been lost, his will endure, for his original researches represent the primal step in the great movement that has made possible the advances in nineteenth century medicine. He was honored by his contemporaries, venerated by the men of science who succeeded him; he has been enshrined in a niche for himself by posterity, and his name will remain as that of one of the great geniuses to whose inventive faculty the world owes some of those steps across the borderland into the hitherto unknown which seem so obvious once made, yet require a master mind to make and mean so much for human progress. {251} THEODORE SCHWANN, FATHER OF THE CELL DOCTRINE {252} My message is chiefly to you, Students of Medicine, since with the ideals entertained now your future is indissolubly bound. The choice lies open, the paths are plain before you. Always seek your own interests, make of a high and sacred calling a sordid business, regard your fellow-creatures as so many tools of trade, and, if your heart's desire is for riches, they may be yours; but you will have bartered away the birthright of a noble heritage, traduced the physician's well-deserved title of the Friend of Man, and falsified the best traditions of an ancient and honorable Guild. On the other hand, I have tried to indicate some of the ideals which you may reasonably cherish. No matter though they are paradoxical in comparison with the ordinary conditions in which you work, they will have, if encouraged, an ennobling influence, even if it be for you only to say with Rabbi Ben Ezra, "What I aspired to be and was not, comforts me." And though this course does not necessarily bring position or renown, consistently followed it will at any rate give to your youth an exhilarating zeal and a cheerfulness which will enable you to surmount all obstacles--to your maturity a serene judgment of men and things, and that broad charity without which all else is naught--to your old age that greatest of blessings, peace of mind, a realization, maybe, of the prayer of Socrates for the beauty in the inward soul and for unity of the outer and the inner man; perhaps, of the promise of St. Bernard, "Pax sine crimine, pax sine turbine, pax sine rixa." --Osler, _Teacher and Student, Aequanimitas_. {253} THEODORE SCHWANN, FATHER OF THE CELL DOCTRINE. It is one of the curious features of history that genuine worth of human accomplishment is almost in inverse ratio to the popularity it obtains in the generation in which it is produced. Supremely great work is rarely appreciated at anything like its proper value, by contemporaries. This principle is true apparently in all fields of human endeavor. In literature and in art it is a commonplace. But also, surprising though it may be, in science and in social betterment the rule holds a prominent place. It is nearly always the sign of only passing merit when any work secures the plaudits of its own generation. Brilliant theories are often immediately hailed with universal acclaim, while ground-breaking observations that are really great discoveries are apt to be neglected. The really new discovery is so novel that men cannot appreciate it at once. It is so different from their ordinary modes of thinking that they cannot place it properly. Its complete significance fails them. This has been true for our nineteenth century biology almost more strikingly than for any other department of knowledge. Our many avenues of publicity instead of heralding abroad the great observations as soon as they have been made, in order to enable others to continue the work that the master mind has begun, have been only too constantly crowded with new opinions, novel theories, taking hypotheses, all attracting attention that they did not deserve. Men like Theodore Schwann, the father of the cell doctrine, are not apt to be so well known as the suggestor of some {254} striking bit of theory. Even the great biologists, such as Darwin himself, are known rather for their insubstantial theories than for their substantial additions to biological knowledge by patient observation and genial penetration into the secrets of nature. It is perhaps a warning to the modern physician who realizes this state of affairs, not to take the popular theories even in his own branch of biology as the current coin of truth. Theories pass, but observations endure. Auenbrugger's new method of tapping the chest in order to elicit its varying sounds looked even more childish than Galvani's acceptance of the position of dancing master to a frog, but their observations thus made continued the germs of undying truth. While the name and the life of Theodore Schwann are but little known by the general public, his work is very thoroughly appreciated by those who have made special studies in biology, and few men in the progress of that science are considered to hold as high a place as that assigned to him. A study of the life of Schwann will serve to show not only that he eminently deserves this honor which has come to him, but will also bring into evidence the fact that his career deserves to be better known popularly, because it illustrates very well the typical mode of life in which great scientists are nurtured and the methods of investigation by which great discoveries are made. Of the men who have made the biology of the nineteenth century there are three whose names stand out with special prominence. They are noted not for their controversial writing on mooted points, but for ground-breaking, original work of the highest scientific import. Their discoveries will preserve their memories for posterity long after the names of many of those to whom the glare of controversial publicity lent an ephemeral brightness for their own {255} generation shall have been forgotten. They are: Theodore Schwann, the anatomist, to whom modern biology owes its foundation by the establishment of the cell theory; Claude Bernard, the physiologist, to whom we are indebted for the great biological ideas of nervous inhibition and internal glandular secretion; finally Louis Pasteur, the chemist-bacteriologist, to whom is due the refutation of the annihilatory abiologic doctrine of spontaneous generation, and the discoveries that have revolutionized modern medicine and promise to accomplish as great a revolution in modern manufactures and industries. It has often been said that the Catholic Church is opposed to scientific advance. It has especially been insisted that in what concerns biological science the Church's attitude has been distinctly discouraging. Recently the definite assertion has been made that no original thinker in science could continue in his profession of faith. Now, it so happens that all three of these men were born in the bosom of the Catholic Church, and were educated from their earliest years to maturity under her watchful care. Schwann and Pasteur remained in the midst of their great scientific triumphs her faithful sons. For years Bernard withdrew from all his old religious associations and became indifferent to the spiritual side of life, but before the end he came back to the knees of the Mother whose fostering care meant so much to him in early life. Theodore Schwann, the first to formulate the cell doctrine, to promulgate the teaching that all living tissues, whether plant or animal, are composed of a number of minute elements which under all circumstances are biologically equivalent--is the father of modern biology. Cells had been seen and recognized as such before, but their significance was first pointed out by him. His cell theory has now become the {256} cell doctrine, the teaching of all the schools of biology. The generalization that forms the basis of the doctrine was the result of some of the most accurate and careful observation that has ever been made. The work was done when the mechanical helps to the analysis of tissues were in the most primitive condition. The microscope had just been introduced into general laboratory work. The microtome, the instrument by which tissues are cut into thin sections suitable for microscopic examination, and to which almost more than to the microscope itself we owe our detailed knowledge of the intimate constitution of tissues, was as yet unthought of. Despite these drawbacks Schwann's work was done with a completeness that leaves very little to be desired. He published, when not yet thirty, the story of his comparative investigation of the cellular constitution of plants and animals, and there is very little that can be added, even in our day, to make its scientific demonstration any clearer than it was. It was typical of the man that, heedless of disputatious controversy over details of his work, he should go calmly on to complete it, and then give it to the world in all its convincing fulness. The same trait crops out with regard to other subjects. His was one of the great scientific minds of the century, always immersed in a philosophic calm befitting the important problems he had in hand. His life is ideal in its utter devotion to science, and to the teaching of science, while no duty that could round it out and make it humanly complete for himself or others was despised or neglected. Theodore Schwann was the fourth of a family of thirteen children, born in the little German town of Reuss, not far from Cologne. He received his college education in the Jesuit Gymnasium of Cologne, and passed thence to the University of Bonn. The lower Rhineland is largely {257} Catholic, and to this day, though Bonn has become the fashionable exclusive German university to which the Kaiser and many of the scions of the great German families go for their higher education, the faculty of theology at the university remains Catholic. Schwann devoted some time here to the study of theology, but he came under the influence of Johann Müller, was allowed to assist in some of his experiments on the functions of the spinal nerves of frogs, and this seems to have determined him to a medical career. After two years spent in medicine at Würzburg, another great Catholic university of Southern Germany, we find Schwann at the University of Berlin, once more working with Johann Müller, who had been invited from Bonn to fill the distinguished Rudolphi's place in the chair of anatomy at the rising Prussian university. Müller was one of those wonderful men--they turn up, unfortunately, all too rarely--who, though not great discoverers themselves, have the invaluable faculty of inspiring students with an enthusiasm for original observation which leads to the most brilliantly successful researches. A great teacher, in the proper sense of the word, he was not. In his public lectures and his ordinary lessons he was often arid and uninteresting, insisting too much on unrelieved details, "the dry bones of science." He seems to have failed almost completely in conveying the usual scientific information of his course with the air of novelty that attracts the average student. The true teaching faculties are not given to many. Müller had a precious quality all his own that has proved much more valuable for science than the most enlightened pedagogy. To the chosen few among his students who were drawn into close intimacy with him and permitted to share his personal scientific labors, Müller proved a source of most precious incentive--a suggestive master, the inspiration of {258} whose investigating spirit was to be with them throughout life. To no one, except perhaps to Socrates of yore, has it been given to have sit at his feet as pupils so many men who were to leave their marks upon the developing thought of a great era in human progress. Beside Schwann, there studied with Müller, during these years at Berlin, Henle the anatomist, Brücke the physiologist, Virchow the pathologist, Helmholtz the physicist, Du Bois-Reymond the physiologist, Claparède, Reichert, Lachmann, Troschel, Lieberkühn and Remak. All these names are writ large in the scientific history of the century. It is a remarkable group of men, and of them Schwann, with the possible exception of Helmholtz, will be remembered the best by posterity; certainly none of them would not have cheerfully resigned his hopes of scientific renown for any work of his own to have made the discovery which, as an enthusiastic biographer said, set the crown of immortality on a young, unwrinkled forehead. Schwann's thesis for his doctorate at Berlin showed the calibre of the man, and demonstrated his thorough fitness for success as an experimental scientist. The question whether the growing embryo in the ordinary hen's egg consumes oxygen or not had been in dispute for some time. It was well known that an air-chamber existed in the egg even at the earliest stages of embryonic life. It was understood that the mature chick just before its egress from the egg must have air, and the porosity of the egg-shell was sufficient to permit its entrance. Whether at the beginning of embryonic life within the egg, however, oxygen was necessary, remained somewhat in doubt. It had been demonstrated that the gas existing in the air-chamber of an egg became changed in composition during the progress of development. From being slightly richer in oxygen than ordinary atmospheric air at the beginning of embryonic growth, {259} containing 24 to 25 parts of oxygen per 100, it became modified during comparatively early development so as to contain not more than 17 parts of oxygen per 100 and some 7 parts of carbon dioxide. This change of composition was, at least, very suggestive of the alteration that would take place during respiration. It was pointed out, however, that the argument founded on these observations was drawn only from analogy, and was by no means a scientific demonstration of the fact that the embryo not only consumed air during its growth, but actually needed oxygen for the continuance of its vital processes. It was suggested that the change of composition in the air within the egg might be due not to any essential vital functions, but to chance alterations brought on by decomposition in the unstable organic material so abundantly present in the substance of the egg. Schwann settled the question definitely by a set of ingenious experiments. He exposed eggs for various periods to the action of other gases besides air, and also placed them in the vacuum chamber of an air-pump. When not in contact with the air the eggs developed for some hours if the temperature was favorable, and then development ceased. If after twenty-four hours' exposure to an atmosphere of hydrogen eggs were allowed free contact with the air, development began once more at the point at which it had ceased. After thirty hours of exposure to hydrogen, however, or to the vacuum, all life in the egg was destroyed, and it failed to develop no matter how favorable the conditions in which it was afterward placed. The completeness with which the points in dispute in this problem were demonstrated is typical of all Schwann's work. His conclusions always went farther than the solution of the problem he set out to solve, and were always supported by simple but effective experiments, often ingeniously planned, {260} always carried out with a mechanical completeness that made them strikingly demonstrative. One of Schwann's brothers had been a worker in metal, and Schwann himself had always shown a great interest in mechanical appliances. This hobby stood him in good stead in those days when laboratories did not contain all the intricate scientific apparatus and the facilities for experimentation so common now, with their workshop and skilled mechanics for the execution of designs. Many another worker in the biological sciences of that time owes his reputation to a similar mechanical skill. Experiments were impossible unless the investigator had the mechanical ingenuity to plan and the personal handiness to work out the details of appliances that might be necessary for experiments. It is told of Schwann that when Daguerre's discoveries in photography were announced, such was his interest in the new invention that he made a trip to Paris especially to learn the details of the method. Some daguerreotypes made by him according to the original directions of the inventor himself are still preserved by his family. Schwann's investigation of the respiration of the embryo in hens' eggs led to further studies of the embryo itself, and to the discovery that it was made up of cells. Later came the resolution of other tissues into cells. When, after his graduation as doctor in medicine, the post of assistant in anatomy at Berlin fell vacant, it was offered by Johann Müller to Schwann. The position did not carry much emolument with it. The salary was ten German thalers--_i.e._, about $7.50 per month--a pittance even in those days when the purchasing power of money was ever so much greater than now. His duties took up most of his time. The work was congenial, however, and Schwann remained here for five years. As Henle has said in his biographical sketch of {261} Schwann, in the _Archiv f. mikroskopische Anatomie_, just after his death in 1882: "Those were great days. The microscope had just been brought to such a state of perfection that it was available for accurate scientific observations. The mechanics of its manufacture had besides just been simplified to such a degree that its cost was not beyond the means of the enthusiastic student even of limited means. Any day a bit of animal tissue, shaved off with a scalpel or picked to pieces with a pair of needles or the finger-nails, might lead to important ground-breaking discoveries." For at that time almost everything as to the intimate composition of tissues was unknown. Discoveries were lying around loose, so to speak, waiting to be made. Schwann was not idle. The precious years at Berlin saw the discovery that many other tissues were composed of cells. The nuclei of the striped and unstriped muscles were found, and while the cellular character of these tissues was not demonstrated, their secret was more than suspected and hints provided for other workers that led very shortly to Kölliker's and Henle's discovery of muscle cells. Besides his interest in histology, the branch of anatomy which treats of the intimate constitution of tissues, Schwann was working also at certain general biological questions, and at some knotty problems of physiology. Not long after his installation as an assistant at Berlin, from observations on fermenting and decomposing organic liquids, he came to a conclusion that was far in advance of the science of his day. He announced definitely _infusoria non oriuntur generatione aequivoca_--the infusoria do not originate by spontaneous generation. Under the term infusoria, at that time, were included all the minute organisms; so that Schwann's announcement was a definite rejection of the doctrine of spontaneous generation over thirty years before Pasteur's demonstrations finally settled the question. Schwann was never a {262} controversialist. He took no part in the sometimes bitter discussions that took place on the subject, but having stated his views and the observations that had led up to them he did not ask for the immediate acceptance of his conclusions. He continued his work on other subjects, confident that truth would prevail in the end. When the congratulations poured in on Pasteur for having utterly subverted the doctrine of spontaneous generation, the great French scientist generously referred the pioneer work on this subject to Schwann, and sent felicitations to that effect when Schwann was celebrating the jubilee anniversary of his professoriate. While studying ferments and fermentations Schwann became interested in certain functions of the human body that carry with them many reminders of the biological processes which are at work in producing the various alcohols and acids of fermentation. The changes that occur in the contents of the human stomach during the preparation of food for absorption had long been a subject of the greatest interest to physiologists. It had been studied too much, however, from the merely chemical side. The necessity for the presence of an acid in the stomach contents in order that digestion should go on led to the conclusion that the acid was the most important constituent of the gastric juice. By means of the scrapings of the stomachs of various animals Schwann succeeded in preparing an artificial gastric juice, and showed just how the action of the gastric secretions brought about the solution of the contents of the stomach. He isolated pepsin, and demonstrated that it resembled very closely in its action the substances known as ferments. He even hinted that digestion, instead of being a chemical was a biological process. Any such explanation as this was scouted by the chemists of the day, headed by Liebig. Most of the physiological functions within the human body were {263} then triumphantly claimed as examples of the working of chemical laws. Of the contradiction of his conclusions Schwann took practically no notice, but went faithfully on with his work. He could not be lured into controversy. For nearly five years he continued his work at the University of Berlin, receiving only the pittance that has been mentioned--less than ten dollars per month. Only the purest love of science for its own sake, and the satisfaction of his own enthusiastic spirit of investigation kept him at work. There was but little prospect of advancement at the University of Berlin itself. Schwann was one of the lowest in rank of the assistants; the professor was only just beyond the prime of life; and before Schwann on the list for promotion was at least one man, Henle, who had already done distinguished work. Germany had the good fortune to have all during the nineteenth century young men who, unmindful of present emolument, had been satisfied with the scantest wages for their support, provided the positions they occupied gave them opportunities for original work. Even at the present day young medical men are glad to accept what they consider the honor of the position of assistant to the professor and director of the clinic, and to remain in it for from five to ten years, sometimes even more, though the salary attached to it is only from $250 to $400 per year. They well know that if their original investigations into various medical questions are successful, advance in university rank is assured. Their promotion seldom comes from the institution where they have done their work, unless it should be one of the smaller universities; but the invitation to a chair at a university will come sooner or later for meritorious research. Schwann's invitation came from Louvain. His work on cells had attracted a great deal of attention. In the midst {264} of the rationalism and infidelity then so common among scientific men Schwann was known as a faithful, sincere Catholic. When the great Catholic University of Louvain, then, looked around for a professor of anatomy, he appeared to be the most suitable person. Henle, who had very little sympathy for Schwann's religious views, speaks most kindly of him as a man and a comrade. Schwann seems to have endeared himself to the "difficult" Prussians, as he did to those around him all his life. For the dominant note in the sketches of him by those who knew him personally is that of heartiest friendship, joined with enthusiastic admiration for his simple sincerity and unselfish devotion to his friends and to science. A little incident that has been preserved for us by Henle shows how much his young contemporaries appreciated even at that early date, long before the full significance of the cell theory could be realized, the aspect of Schwann's work which was to make him immortal. At a little farewell dinner given him by his co-workers in various laboratories of the University of Berlin the feature of the occasion was a punning poem, by the toast-master, on the words Louvain and cells. In German Louvain is Löwen, which also means lion; that is, it is the dative case of the name of the lion. Reference is made to the fact that as Samson found honeycomb (in German, bee-cells) in the lion, so now Louvain--_i.e._, in German, Löwen, the lion--finds a champion in the man of the cells. As Samson's riddle was suggested by finding the bee-cells, so will the new professor at Louvain solve the riddles of science by the demonstration of cells. The youthful jesting seer prophesied better than he knew. Schwann's first completed work at Louvain was the _Microscopical Researches into the Accordance in Structure and Growth of Plants and Animals._ [Footnote 11] {265} The theory it advanced was to prove the most potent element thus far introduced into biological science to help in the solution of the difficult problems that constantly occur in the study of the various forms of life. [Footnote 11: Mikroskopische Untersuchung über die Uebereinstimmung in der Structur und dem Wachsthum der Thiere und Pflanzen, 1839.] At Louvain, Schwann remained for about ten years. The period is marked by a continuance of his fruitful investigation of cell-life, of the physiological biology of ferments and fermentation, and of the allied subject of digestion in animals. His researches in Berlin on this interesting and important subject, which was practically a complete mystery at that time, had been mainly concerned with the gastric juice. He now began the study of various secretions which aid intestinal digestion. He proved that bile, which used to be considered an excretion, was really an important digestive secretion. He was not able to demonstrate the function of bile as completely as he had done for the gastric juice. The problem of intestinal digestion is much more complicated than that of stomach digestion, and involves a number of factors for which allowance has to be made if the value of any one of them is to be accurately determined. Even in our own day all of the physiological problems in the functions of biliary secretion are not solved. The greatest step was the demonstration that bile is a thing whose presence in the intestines is to be encouraged, not because, as Horace said, mental trouble was imminent unless one were purged of black bile in the springtime, but because its presence insures the proper preparation of food, and neutralizes in the intestinal tract certain poisonous substances that if absorbed would prove sources of irritation to all higher tissues. His work on bile practically closes Schwann's career as an investigator. The seven years between twenty and {266} twenty-seven were so full of discovery that there seemed to be great promise for his mature years. Had Schwann died at thirty his biographies would have surely contained lengthy comments on the great discoveries that would undoubtedly have rewarded his efforts in the prime of his powers. Schwann's seeming inactivity has been a fruitful cause for conjecture. The fact of the matter is, however, that original work of a high order is accomplished mainly during the time when activity of the imagination is at its height. There are very few cases in which this acme of inventive effort has lasted more than ten years. Besides this there were certain more material factors that hindered original work. Schwann was a German, yet had to give his lectures at Louvain in French. For several years most of his efforts were devoted to acquiring facility in the language of his adopted country. Then Schwann was not such a teacher as Müller, but the true pedagogue who took seriously to heart the duty of teaching all his students. To do this meant, in the rapidly advancing science of that day, unceasing toil on the part of a conscientious professor. For it was a time of great discoveries succeeding one another with almost incredible rapidity. For ten years Schwann faithfully devoted himself to his teaching duties in the anatomical course at Louvain. He then accepted the chair of comparative anatomy and physiology at Liège, where he continued to lecture for thirty years. As the result of his stay at Louvain there has always been special attention given to biological studies at that university. At the present time there is published there a very well and favorably known biological journal, _La Cellule_, through which many important contributions from the professors and students of the university find their way before the public. During his stay at Liège Schwann was formally invited, {267} on three different occasions, to return to his German Father-land to become professor at some of her great universities. Professorial chairs in anatomy or physiology at Würzburg, at Giessen, and at Breslau, were offered him between 1850 and 1860. He refused them, however, to continue his work in Belgium. He found his adopted countrymen eminently sympathetic. It seems clear that he felt more at home in the midst of the profoundly Catholic sentiment that pervaded the Belgian universities, and which was in such marked contrast to the rationalistic spirit characteristic of the German universities at that time. Schwann was penetrated with a lively sense of the deepest religious feeling, which is noticeable all through his life. His attitude in this matter greatly impressed his scientific contemporaries. His sense of duty in matters spiritual was only equalled by his affectionate regard for his relatives. His vacations were invariably spent with his parents while they were alive, and later with his brothers and sisters in the neighborhood of Cologne. It was while making a Christmas visit to them that he suffered the fatal stroke which carried him away. Toward the end of his career Schwann was invited to be a member of a commission to investigate the case of Louise Lateau. It will be remembered that the report of recurring bleedings from stigmata in this case attracted a great deal of attention, not only among Catholics, but among all classes throughout the world. After careful observation Schwann refused to concur in the report that the bleedings were manifestly miraculous. At first it was announced that he had declared them evidently beyond the domain of natural causes, but this report he took occasion to correct immediately. The circumstance led to the publication of some harsh words in the religious press, but with his usual moderation Schwann refused to enter into any discussion, and so the affair ended. {268} His thoroughly conservative attitude in the matter, and his application of the strictest scientific criteria to the case, prevented formal expression of approval on the part of those in authority. While such an opinion would have carried only personal weight with it, it might easily have been made a cause for unfortunate aspersions upon the Church. The most marked feature of Schwann's career is the unfailing friendships that linked him to those with whom he was associated. At Louvain, and later at Liège, he was the personal friend of most of his students, while at Berlin he made friendships with some of the great men in German medicine which endured to the end of his life. When the celebration of his fortieth anniversary came around, the hearty tributes from all over Europe showed in what lofty reverence the kindly old man was held, who had sacrificed some of his chances for greater scientific fame in order to be a teacher of others, and a living exponent of the fact that the frame of mind which leads to great scientific discovery and that which bows humbly to religious truth, far from being hopelessly and essentially opposed to each other, may be peacefully united in the same person in their highest expression. {269} CLAUDE BERNARD, PHYSIOLOGIST {270} The experienced eye, the power of perceiving minute differences and fine analogies which discriminate or unite the objects of science, and the readiness of comparing new phenomena with others already treasured up in the mind--these are accomplishments which no rules can teach and no precepts put us in possession of. This is a portion of knowledge which every man must acquire for himself; nobody can leave as an inheritance to his successor. It seems, indeed, as if nature had, in this instance, admitted an exception to the will by which she has ordained the perpetual accumulation of knowledge among civilized men, and had destined a considerable portion of science continually to grow up and perish with individuals. --Dr. John Brown, _Edward Forbes, Spare Hours_. {271} CLAUDE BERNARD, THE PHYSIOLOGIST. With the recent development of post-graduate education the Collège de France has become a favorite shrine of pilgrimage for educators who visit Paris. It represents the oldest educational institution deliberately founded with the idea of combining teaching with investigation. The professors were not bound to teach definite doctrines, literary or scientific, but to give rather the results of recent investigations and personal meditation on great scientific and philosophic problems. The college was not meant, in a word, so much for students as for specialists. It was intended not to convey a definite body of knowledge on any subject, but rather to round out the knowledge acquired in the regular course at the University of Paris, and to dwell particularly on recent lines of advance in special subjects in a manner that would encourage original investigation. In a word, the Collège de France was the first modern post-graduate school. We have learned in recent years how important are post-graduate departments for their influence on the regular work of a university. Unless original investigation of a high order is constantly done at a university, it is inevitable that the regular course will cease to be up to date. Modern educators are coming to realize very forcibly this quality of a successful teaching institution. Hence the interest that will surely continue to grow in the Collège de France, its foundation, its history, its teachers, and its methods. To the great majority of those who come to pay their respects at this shrine of original investigation, it will prove a {272} distinct surprise to find the centre of the court of the Collège de France occupied by a statue of Claude Bernard. Bernard is not well known, and is still less appreciated out of scientific circles. By many it is forgotten that the original free school, the _Collège de trois langues_, in which Hebrew, Greek, and Latin were the only chairs, has extended its scope, and that in our day the natural sciences represent the most fertile field of its achievements. The absolute freedom of opinion guaranteed to professors originally, and which constituted the principal reason for an educational institution apart from the University of Paris and its trammels, has proved a precious heritage to later generations. Science has flourished vigorously, and the memorial to its representative cultivator at the college in this century has deservedly been given the place of honor in its court. To the initiate, however, for whom, in medicine and physiology and general biology, his work is still an inspiration, many points of interest around the college will have all their attraction from associations with Claude Bernard's career. His neglect by the popular mind is more than compensated for by the fervent admiration of all those who are occupied with investigations along the lines he followed. For in him they recognize a master mind such as is given to a branch of science not more than once in a century; the veritable possessor of a magician's wand, who knows how to disclose the hidden veins of precious ore, the exploitation of which will prove a source of riches to so many faithful followers. For these the dark little laboratory of the college in which Bernard made so many of his ground-breaking discoveries will be in the nature of a shrine to which one comes with grateful memories of the _genius loci_ that was. The apartment across the street at No. 40 Rue des Ecoles, where Bernard lived for years, will be the term of many a pilgrimage. Scientists {273} from all over the world will wander from here out to the laboratory in the Jardin des Plantes, where Bernard's work was done in his later years, and where the fundamental problems of life--plant and animal--usurped the attention that had at first been devoted exclusively to human physiology and its allied sciences. Claude Bernard is another and a striking illustration of the historical tradition that great men usually come from the country, and not infrequently from poor parents. He was born in 1813, at St. Julien, not far from Lyons, almost in the centre of France. His father owned a small farm in the Beaujolais wine district. The little estate came later into Bernard's hands, and when he could afford the time he spent his summers there. When the air is clear the white summits of the Alps can be seen, and they make a pleasing contrast to the plains along the Saone and the hill-sides of the immediate neighborhood, all covered with vineyards. The physiologist, who enjoyed nature very much, speaks enthusiastically of his "little verdant summer nest." He was educated at the Jesuit school of Villefranche. It will be recalled that Theodore Schwann was also a student of the Jesuits. In these days, when Jesuit educational training is impugned, the facts are worth noting. It is claimed especially that the old-fashioned training by means of the classics is narrowing. The old method of a definitely prescribed course of study for every student is said to hamper development. Slavish devotion to old pedagogic methods, it is urged, cannot but shackle and destroy initiative. The subordinate place of the sciences in this scheme of education is said to hinder progress in the sciences later in life, to leave the powers of observation undeveloped until too late, and to distract the mind of the student too much from the practical side of life. Here are two men whose lives are {274} an open contradiction to all the allegations of the opponents of the old Jesuit system of training. Needless to say that they are but two of many. Bernard pursued the course with the Jesuits at the Collège de Villefranche as far as it went. After this we find him at Lyons, at first pursuing studies in philosophy in preparation for his baccalaureate degree, evidently with the idea of eventually entering the university. Family reasons, mainly financial, compelled him to give up his studies, and for nearly two years he was an assistant in a pharmacy in Lyons. Here he developed a skepticism with regard to the effect of the drugs he compounded that led later in life to his important studies on the physiological action of remedies. The science of therapeutics was at that time in a most inchoate stage. Very little was known of the exact action of drugs. Exaggerated claims were made for many, but mainly on uncertain clinical experience. The modern, patent medicine was as yet unknown, but something not unlike it had become popular among the patrons of the Lyons pharmacy. One remedy was in constant demand by city patrons and by country people, who came from long distances especially to procure it. It was known as _la thériaque_--"the cure"--I suppose from some fancied connection with the root of the word therapeutics. This remedy, according to the old women of the neighborhood and the countryside, was a panacea for every ill that flesh is heir to, and a few others besides (_pro morbis omnibus cognitis et quibusdam aliis_). The composition of this wonder-worker was even more interesting than its universal curative efficacy. Whenever a drug spoiled from too long keeping, or an error in its manufacture made it unavailable for the purpose for which it was originally intended, or whenever an involuntary mistake in compounding occurred, the {275} assistants in the pharmacy were directed not to throw the drugs away, but to reserve them for "la thériaque." "Mettez vous cela de côté pour la thériaque" (put that aside for "la thériaque") was a standing order in the shop. From a remedy of such varied ingredients the most wonderful effects could be expected and were secured. An unexpected action of the remedy, however, was that produced on Bernard's mind. This influence was later to lead to the healing of numberless ills in the system of therapeutics, and to bring about the establishment of the sciences of experimental pharmacology and physiology. Bernard developed literary ambitions while at work in the pharmacy. He spent many of his free evenings at the theatre, and wrote a musical comedy, "The Rose of the Rhone," which was acted with some success. He worked at a prose drama, and, thinking the possibilities of life too narrow in Lyons, he resolved to go to Paris. With his play in his pocket, and a letter of introduction to the distinguished critic, St. Marc Girardin, he reached the capital. Bernard's drama, "Arthur de Bretagne," was published after his death, and shows that its author possessed literary talent of a high order. This must have been evident to Girardin, to whom it was given to read; but he very wisely advised its author to eschew literature, at least for a time, until he was able to make his living by some other means. Girardin advised Bernard to take up the study of medicine, for which his work in pharmacy had already prepared him somewhat. Bernard, having once made up his mind to pursue medicine, threw himself, as was his wont, enthusiastically into the study of it. The utmost frugality was necessary in order to enable him to live on the scant income that could be allowed him from home. He lived with a fellow-student in a garret in the Quartier Latin. Their one room was study and {276} sleeping room, and even, on occasion, kitchen. When a "box" came from home, utensils were borrowed from the laboratory for whatever cooking was necessary. Bernard was especially interested in anatomy, and soon made himself known by the perfection of his dissections. Physiology attracted him not for what was known in the science, but for the many problems as yet unsolved. His was above all a mind not prone to accept scientific teaching on the _ipse dixit_ of a professor. Except in the dissecting-room, his work attracted no attention. He was not looked upon as a brilliant student, and yet all the while he was unconsciously preparing himself thoroughly for his life-work. Later on his dissecting skill was to be a most helpful acquisition. Bernard's first promising opening came unexpectedly. The nicety with which he did certain dissecting work in preparation for one of Magendie's lessons attracted the attention of the professor, at that time the greatest living experimental physiologist. Magendie, in his bluff, characteristic way, without asking further about him, called out one day: "I say, you there, I take you as my _preparateur_ at the Collège de France." This position was gladly accepted by Bernard, for it provided him with an income sufficient to support himself. The work was congenial. His duty was to prepare the specimens and make ready the demonstrations for Magendie's lectures. His career as a physiologist dates from this appointment. He had to give some private lessons, and do what is called "coaching," or "tutoring," to eke out his slender income, but in the main his time after this was entirely devoted to investigation and experiment. His first investigation concerned stomach digestion. It was important mainly because it directed his mind to digestive questions. In these he was to make his great discoveries. {277} His first independent investigation concerned the differences to be found in the digestive apparatuses and functions of the carnivora and herbivora--that is, of the meat and plant-eating animals. The differences in the natural habits of these two classes of animals had long been noted. While the meat-eaters invariably bolt their food, the plant-eaters chew theirs very carefully. Many of these latter, like the cow, are ruminants--that is, they bring up their food to chew it over again at their leisure. The instinct that makes them do this is most precious. Their food is mainly composed of starch, in the digestion of which the saliva takes a large part. The thorough mixture of the food with saliva, then, is an extremely important matter. Human beings, who are both herbivorous and carnivorous, must learn to masticate thoroughly at least the starch-containing portions of the food. Bernard's first researches concerned the nerves that supplied the salivary glands, and which consequently influence the flow of saliva. Curiously enough, the conclusions of his first experiments were erroneous. The topic led him, however, into the general subject of the influence of nerves upon glandular secretion, a problem that he was destined to illustrate in many ways. After the salivary glands the most important structure for the digestion of starches in the animal economy is the pancreas. It was early evident, however, that the pancreatic secretion effected more than the conversion merely of starch into sugar. Its most important rôle, that of influencing the digestion and absorption of fats, was only recognized as the result of a classical observation of Bernard's upon the rabbit. He noticed that fat introduced into the digestive tract of a rabbit undergoes no change until it has advanced a considerable distance beyond the stomach. When fat is introduced into the dog's digestive apparatus a marked change {278} begins in it almost as soon as it leaves the stomach. At first this seemed very mysterious. Observations were made over and over again, always with the same result. There was evidently some important distinction between the intestines of the two animals. Careful investigation showed that the difference between the behavior of the fat in the rabbit and the dog was due to the presence or absence of the pancreatic fluid from the intestinal contents. In the dog the pancreatic duct which carries the secretion of the gland to the intestine empties into the intestine just beyond the stomach. In the rabbit the duct and its secretion empty into the intestine only some eight to ten inches below the intestinal orifice of the stomach. It is just beyond where the pancreatic duct reaches the intestine in both animals that the digestion of fat begins. This observation solved the seeming mystery of fat digestion, and at the same time made clear the importance of the pancreatic secretion in the general work of digestion. Bernard's attention was directed by this first observation to the other properties of the pancreatic fluid. He soon demonstrated by experiment, not only that it split up fats into fatty acids and glycerin, and so made their absorption possible, but that it had a powerful action upon proteids--that is, upon the albuminous portions of the food, and also upon the starches and sugars. Up to this time the principal role in digestion had been assigned to the stomach and the gastric juice. After Bernard's observations it was evident that the action of the stomach was mainly preliminary to intestinal digestion, and that the chief work in the preparation of food for absorption into the system was really accomplished by the secretion of the pancreas. It took some years to make all this clear. Much of the advance in our knowledge of the effect of pancreatic juice upon proteids--that is, upon meat and other albuminous materials--is due to Kühne, a pupil {279} of Bernard; but not only did the inspiration for the pupil's work come from the master, but the important fundamental principle of pancreatic proteolysis--_i.e._, the solution of proteids by pancreatic secretion--was clearly laid down in Bernard's original publications on the subject. Only in our own day has come the greatest confirmation of the notion then first introduced into physiology, of the surpassing importance of intestinal digestion. The removal of the whole stomach for malignant disease is now undertaken without any fears as to the ultimate result on the patient's general nutrition. The operation has been done many times, and the surgeon's confidence that the intestines would compensate, as far as digestion of food was concerned, for the absent stomach has been amply justified. Patients who survived the operation have all gained in weight, and some of them have enjoyed better health than for years before the removal of their stomachs. From his studies of the pancreas, Bernard, whose mind was always of a very practical bent, was very naturally led to the study of that puzzling disease, diabetes. The question of how sugar was absorbed into the system was an interesting one even at that time. It was not realized, as it is now, that saccharine material was a most valuable food-stuff. Its use in the world's great armies of recent years has brought sugar very prominently before the medical profession of to-day. The bone and sinew for hard fighting and exhausting marches would not seem to be derivable from the favorite dainty of the child, which has besides fallen into such disrepute as a health disturber; yet tons upon tons of sweets are now shipped to fighting armies, and are distributed in their rations when especially hard work is required of them. Bernard did not quite realize that he was attacking, in the question of the digestion and consumption of sugar in the system, one of the {280} most important problems of nutrition, especially as far as regards the production of heat. Sugar is a substance that dissolves easily and in considerable quantity in water. When in solution it easily passes through an animal membrane by osmosis, and so the question of its absorption seemed simple enough. The disease diabetes showed, however, that sugar might exist very plentifully in the blood and yet the nutrition of an individual suffer very much for the lack of it. Something else beside its mere presence in the system was necessary to secure its consumption by the tissues. Bernard thought that the liver was active in the consumption of sugar, and that disease of this organ caused diabetes. He therefore secured some of the blood going to the liver of a living animal and some of the blood that was just leaving it. To his surprise the blood leaving the liver contained more sugar than that entering it. After assuring himself that his observations were correct, he tried his experiments in different ways. He found that even in the blood leaving the liver of an animal that had been fed only on substances containing no sugar, sugar could be demonstrated. Even in a fasting animal the liver itself and the blood leaving it showed the presence of a form of sugar. The only possible conclusion from this was that the liver was capable of manufacturing this form of sugar out of non-sugar-containing material, or even from the blood of a fasting animal. This was the first time in physiology that the idea of an internal secretion was advanced. Glands within the body that gave off a secretion always possessed a duct by which this secretion was conducted to where it was to produce its effect. The idea that glands exist which pour their secretion directly into the blood-stream had not occurred. This branch of physiology has developed wonderfully since {281} Bernard's discovery. The chapter of the functions of the ductless glands is one of the most interesting and most practical in modern medicine. The spleen, the thyroid, the suprarenal glands have taken on a new significance. Mysteries of disease have been solved, and, most wonderful of all, we have learned that many of the substances derived from these glands, when not present in the human body, may be effectually supplied by corresponding substances from animals, with results upon suffering human beings that are little short of marvellous. To mention but one example: the stunted, idiotic child that, because of congenital absence of the thyroid gland, formerly grew up to be a repellent, weak-minded man or woman, can now in a few short months be made the peer of most of its kind. All the modern tissue-therapy, with its hopeful outlook, is due to Bernard's far-reaching conclusions from his experiments upon sugar digestion and absorption. His studies on sugar logically led Bernard to the investigation of heat production and heat regulation in the human body. Glycogen, the sugary substance produced by the liver, occurs abundantly in all the muscles of the body, and it was evident that muscular movement leads to its consumption and the consequent production of heat. Sugar is a carbon-containing substance, and its combustion always produces energy. The question of heat regulation was a much more complicated problem. Heat is always being produced in the human body and always being given off. Very different amounts of heat are required to keep up the temperature of the human body in the winter and summer seasons. Near the pole or at the equator man's temperature in health is always the same. To secure this identity of temperature some very delicately balanced mechanism is required. Without the most nicely adjusted equilibrium of heat production and dissemination human tissues would soon freeze up at a {282} temperature of 70° below zero, or the albumin of the body fluids and muscular tissue coagulate at a temperature above 110° F. While engaged in the investigation of this interesting problem Claude Bernard found that the cutting of the sympathetic nerves in the neck of a rabbit was followed by increased heat on the side of the head supplied by the nerve, and that this increased heat coincided with heightened sensibility and greater blood-supply in the parts affected. Here was an important factor in heat regulation laid bare. It was evident that the sympathetic nerve trunk supplied filaments to the small arteries, and that when these nerves no longer acted, as after the cutting of the nerve trunk, these arteries were no longer controlled by the nervous system and became dilated. The presence of more blood than usual in the tissues and its slower flow gave occasion to more chemical changes in the part than before, and consequently to the production of more heat. These vasomotor nerves, as they have been called, because they preside over the dilatation and contraction of the walls of the bloodvessels (vasa) of the body, are now known to play an important rôle in every function. When food enters the stomach, it is dilatation of the gastric arteries, brought on by the reflex irritation of the presence of food, that causes the secretion of the gastric juices necessary for digestion. It is the disturbance of this delicate nervous mechanism that gives rise to the many forms of nervous dyspepsia so common in our day. It is its disturbance also that makes digestion so imperfect at moments of intense emotion, or that makes severe mental or bodily exertion after the taking of food extremely inadvisable. The vasomotor nerves, however, control much more than heat processes and digestion. The familiar blushing is an example of it, and blushes may occur {283} in any organ. Excitement paralyzes the efforts of some individuals, but renders others especially acute. It is probable that the regulation of the blood-supply to the brain has much to do with this. While one student always does well in an oral examination, another, as well gifted, may always do poorly. Just as there are those who cannot control the vasomotor nerves of the face, and blush furiously with almost no provocation, so there are brain-blushers in whom the rush of blood interferes with proper intellection. On the other hand, there are those, and they are not always unaware of it, in whom the slight disturbance of the facial vasomotor mechanism only gives rise to a pleasing heightened color, and in the same way the increased blood-supply to the brain only gives them more intellectual acumen. These two discoveries by Bernard--the formation of sugar by the liver and the nervous vasomotor mechanism--are, in their far-reaching application and their precious suggestiveness for other investigators, the most significant advances in physiology of the nineteenth century. They are directly due to a great imaginative faculty informing a most fertile inquiring spirit. Bernard was very different from his master, Magendie, in his applications of the experimental method. Magendie's researches were made more or less at random in the great undiscovered regions of physiology. He made his experiments as so many questions of nature. He cared not what the answer might be. He seldom had an inkling beforehand where his experiments might carry him. As he said himself, he was a rag-picker by the dust-heap of science, hoping to glean where others had missed treasures, and not knowing what his stick might turn up next. Bernard's experiments were always made with a definite idea as to what he sought. Not infrequently his pre-conceived theory proved to be a mistake. It is of the very {284} genius of the man that he was able to recognize such errors, and that he did not attempt to divert the results of experiments so as to bolster up what looked like eminently rational theories. The imaginative faculty that had come so near perverting him to literature was a precious source of inspiration and initiative in his scientific work. It was not followed as an infallible guide, however, but only as a suggestive director of the course investigation should take. Besides the important discoveries made by Bernard there are two minor investigations, successfully accomplished, that deserve a passing word. To Claude Bernard we owe the use of curare in physiological experimentation. Curare is an Indian arrow poison which absolutely prevents all muscular movement. If artificial respiration is kept up, however, the animal lives on indefinitely, and no motion will disturb the progress of the most delicate experiment. In Bernard's time it was thought that the drug did not affect the sensory nervous system at all, and that as a consequence, though absolutely immobile, the animal might be suffering the most excruciating pain. We now know that the sensory system is also affected, and that the animal in these experiments suffers little if at all. Bernard's investigation of the effect of carbonic oxide gas will probably be of more practical benefit to this generation and the next than it was to his. Like most of Bernard's discoveries, this one threw great light on important questions in physiology quite apart from the subject under investigation. Carbonic oxide is the gas produced by incomplete combustion of coal. The blue flames on the surface of a coal fire when coal is freshly added are mainly composed of this gas in combustion. From burning charcoal it is given off in considerable quantities. The gas is extremely poisonous. Unlike carbon dioxide, which does harm by shutting off the supply {285} of oxygen, carbonic oxide is actively poisonous. After death the blood of its victims, instead of being of a dark reddish-blue, is of a bright pinkish-red. Bernard's study of the change that had taken place in the blood showed that the hemoglobin of the red blood-cells had united with the carbonic oxide present in the lungs to form a stable compound. The usual interchange of oxygen and carbon dioxide in the tissues could not take place. The combinations formed between oxygen and carbon dioxide and the hemoglobin of the blood readily submit to exchanges of their gaseous elements, and so respiratory processes are kept up. Before Bernard's discovery it was thought that the respiratory oxygen was mostly carried dissolved in the blood-plasma--that is, in the watery part of the blood--or at least that its combination was a physical rather than a chemical process. This idea was overthrown by the discovery that the carbonic oxide combination with hemoglobin was very permanent. The rôle of the red blood-cell in internal respiration took on a new importance because of the discovery, and the comprehension of anaemic states of the system became much easier. About the middle of his career Bernard suffered from a succession of attacks of a mysterious malady that we now recognize to have been appendicitis. Once at least his life was despaired of, and recurring attacks made life miserable. After a year of enforced rest on the old farm of his boyhood, now become his own, he seems to have recovered more or less completely. His health, however, was never so robust as before. Toward the end of his life he lived alone. His wife and daughters were separated from him, and one of the daughters devoted her time and means to suffering animals in order to make up, as she proclaimed, for all her father's cruelty. {286} Bernard lived almost directly opposite to the Collège de France, in a small apartment in the rue des Ecoles. An old family servant took care of him, and his life was one of uttermost simplicity, devoted only to science. Once at court, in 1869, Napoleon III insisted on knowing, after an hour's conversation with him, what he could do for him. Bernard asked only for new facilities for his experimental work, and new apparatus and space for his laboratory. Honors came to him, but left him modest as before. He was elected a member of the French Academy--one of the forty immortals. Only five times in the history of the Academy has the honor of membership been conferred upon a medical man. Before Bernard, Flourens, the father of brain physiology, had occupied a _fauteuil_, while Cabanis and Vicq d'Azyr are two other names of medical immortals. Bernard was elected to the 24th _fauteuil_, which had been occupied by Flourens, and according to custom had to pronounce his predecessor's panegyric. The conclusion of his address was the expression: "There is no longer a line of demarcation between physiology and psychology." Physiology had become the all-ruler for Bernard in human function, and he drifted into what would have been simple materialism only for the saving grace of his own utter sanity, his active imagination, and the unconscious influence of early training. During his most successful years of scientific investigation, wrapped up in his experiments and their suggestions, Bernard was drawn far away from the spiritual side of things. This partial view of man and nature could not endure, however. In an article on Bernard in the _Revue des Questions scientifiques_ for April, 1880, Father G. Hahn, S. J., says of him: "A man of such uprightness of character could not be allowed to persist to the end in this restless skepticism. His mental condition was really a kind of vertigo caused by the {287} depths of nature that he saw all around him. At the threshold of eternity he came back to his true self and his good sense triumphed. The great physiologist died a true Christian." Bernard was one of the great thinkers of an age whose progress in science will stamp it as one of the most successful periods of advance in human thought. He accomplished much, but much more he seemed to have divined. He seldom gave out the slightest hint of the tendencies of his mind, or of his expectations of discovery in matters of science, until fully satisfied that his theoretic considerations were justified and confirmed by observation and experiment. In one thing, however, he allowed favored friends to share some of his anticipations, and the notes published after his death show that he was on the very point of another great discovery in biology which has since been made. He was a firm friend of Pasteur's, and had ably seconded the great chemist-biologist's efforts to disprove spontaneous generation. Bernard's demonstration that air passed through a tube heated red hot might be suffered with impunity to come in contact with any sort of organic material, yet would never cause the development of germ life, was an important link in the proof that if life were carefully destroyed, no life, however microscopic in character, would develop unless the seeds of previously existent life were somehow brought in contact with the organic matter. With regard to fermentation, too, Bernard was for many years in close accord with Pasteur, who taught that fermentation was the result of the chemical activity of living cells, the ferments. Toward the end of his life Bernard came to the view, however, that the action of ferments was really due to the presence in them of chemically active substances called diastases. These substances are of varied chemical {288} composition, but each one has a constant formula. Their presence in a fermentescible solution is sufficient of itself, even in the absence of living cells, to bring about fermentation. It has since been shown that after this substance is removed from ferment-cells by pressure, and the liquid carefully filtered so that absolutely no cells remain, fermentation will yet take place. This does not disprove the necessity for life to produce the diastases originally, though it advances science a step beyond the theory that it is the actual vital interchange of nutritious substances within the ferment-cell that causes fermentation. With each step of advance in biological science the mystery of life and its processes deepens. No one has done more to bring out the depths there are in vital function than Bernard. His early training was of the type that is, according to many prominent educators of our day, least calculated to develop originality of view, or capacity for initiating new lines of thought. Our pedagogic Solons would claim that the narrow orthodoxy that wrapped itself around his developmental years must surely stifle the precious genius for investigation that was in him. It is due, on the contrary, very probably to the thorough conservatism of his early training and the rounded fulness of the mental development acquired under the old system of classical education, that we have to chronicle of Bernard none of the errors by exaggeration of personal bias that are so common among even great scientific men. Few successful men have ever owed less to luck or to favoring circumstances in life. He was in the best sense a self-made man, and he owed his success to a large liberality of mind that enabled him to grasp things in their true proportions. With an imaginative faculty that constantly outstripped his experimental observations he was singularly free from prejudgment and was able to {289} control his theories by what he found, never allowing them to warp his powers of observation. Bernard is without doubt the greatest example of the century that a fully rounded youthful training is much more favorable to successful investigation than the early specialization which is falsely supposed to foster it. {290} {291} PASTEUR, FATHER OF PREVENTIVE MEDICINE {292} More than two hundred and fifty years ago, Descartes, the most original mind of the modern age, who, more than any other thinker, has determined the course both of speculative and of scientific inquiry, declared that if any great improvement in the condition of mankind was to be brought about, medicine would provide the means, and what he foresaw we see. --Bishop Spalding. {293} PASTEUR, FATHER OF PREVENTIVE MEDICINE. Louis Pasteur is the most striking figure in nineteenth century science. In biology, in chemistry, in physics, in medicine and surgery, and in the important practical subjects of fermentation, spontaneous generation and sanitation, he has left landmarks that represent great advances in science and starting-points for new explorations into the as yet unmapped domain of scientific knowledge. His was a typically scientific mind. His intuitions were marvellous in their prophetic accuracy, yet were surpassed by his wonderful faculty for evolving methods of experimental demonstrations of his theories. His work has changed the whole aspect of biology and medicine, and especially the precious branches of it that refer to the cure and treatment of disease. To such a man our generation owes a fitting monument. It has been given him. He was modest in life with the sincere modesty of the true man of science, who knows in the midst of great discoveries that he is only on the edge of truth, who realizes that "abyss calls to abyss" in the world of knowledge that lies beyond his grasp. Pasteur's monument, very appropriately for a man of his practical bent, is no idle ornamental memorial. It is a great institution for the perpetual prosecution of his favorite studies and for the care of patients suffering from the diseases to whose investigation the best part of his life was devoted. In this Institut Pasteur repose his ashes. They find a suitable resting-place in a beautiful chapel. Situate just below the main entrance a little lower than the ground floor, {294} of the institute proper, this chapel seems to form the main part of the foundation of the building. It is symbolic of the life of the man in whose honor it was erected. He who said, "The more I know the more nearly does my faith approach that of the Breton peasant. Could I but know it all my faith would doubtless equal even that of the Breton peasant woman." On a firm foundation of imperturbable faith this greatest scientific genius of the century raised up an edifice of acquisitions to science such as it had never before been given to man to make. Above the entrance of this chapel-tomb, and immediately beneath the words "Here lies Pasteur," is very fittingly placed his famous confession of faith: "Happy the man who bears within him a divinity, an ideal of beauty and obeys it; an ideal of art, an ideal of science, an ideal of country, an ideal of the virtues of the Gospel." [Footnote 12] [Footnote 12: Heureux celui qui porte en soi un dieu, un idéal de beauté et qui lui obéit; idéal de l'art, idéal de la science, idéal de la patrie, idéal des vertus de l'Evangile.] When we turn to the panegyric of Littré in which the words occur we find two further sentences worth noting here: "These are the living springs of great thoughts and great actions. Everything grows clear in the reflections from the infinite." [Footnote 13] [Footnote 13: Ce sont les sources vives des grandes pensées et des grandes actions. Toutes s'éclairent des reflets de l'infini.] These words are all the more striking from the circumstances in which they were uttered. When a vacant chair (_fauteuil_) in the French academy is filled by the election of a new member of the Forty Immortals, the incoming academician must give the panegyric of his predecessor in the same chair. Pasteur was elected to the fauteuil that had been occupied by Littré. Littré, who by forty years of unceasing toil made a greater dictionary of the French language than {295} the Academy has made in the nearly two hundred years devoted to the task, was the greatest living positivist of his day. He and Pasteur had been on terms of the greatest intimacy. Pasteur's appreciation of his dead friend is at once sincere and hearty, but also just and impartial. Littré had been a model of the human virtues. Suffering had touched him deeply and found him ever ready with compassionate response. His fellow-man had been the subject of his deepest thoughts, though his relationship to other men appealed to him only because of the bonds of human brotherhood. Pasteur called him a "laic" saint. For many of us it is a source of genuine consolation and seems a compensation for the human virtues exercised during a long life that the great positivist died the happy death of a Christian confident in the future life and its rewards. But Pasteur himself rises above the merely positive. The spiritual side of things appeals to him and other-worldliness steps in to strengthen the merely human motives that meant so much for Littré. Higher motives dominate the life and actions of Pasteur himself. In the midst of his panegyric of the great positivist the greatest scientist of his age makes his confession of faith in the things that are above and beyond the domain of the senses--his ideals and his God. There is said to exist a constant, unappeasable warfare between science and religion. Perhaps it does exist, but surely only in the narrow minds of the lesser lights. In no century has science developed as in the one that has just closed. Faraday the great scientific mind of the beginning of the century, said, at one of his lectures before the Royal Academy of Sciences of England, when the century was scarcely a decade old: "I do not name God here because I am lecturing on experimental science. But the notion of respect for God comes to my mind by ways as sure as those {296} which lead us to physical truth." At the end of the century the monument of a great man of science is a chapel with an altar on which the sacrifice of Him that died for men is commemorated on Pasteur anniversaries. The walls of the chapel are inscribed with the scientific triumphs of the master whose ashes repose here. It is a striking catalogue. Each heading represents a great step forward in science: 1848, Molecular Dissymmetry. 1857, Fermentations. 1862, So-called Spontaneous Generation. 1863, Studies in Wine. 1865, Diseases of Silk Worms. 1871, Studies in Beer. 1877, Virulent Microbic Diseases. 1880, Vaccinating Viruses. 1885, Prophylaxis of Rabies. Apparently these various subjects are widely separated from one another. It might seem that Pasteur was an erratic genius. As a matter of fact, each successive subject follows its predecessor by a rigid logic. Pasteur's life-work can be best studied by a consideration of these various topics and an appreciation of the advance made in each one. Pasteur was first of all and always a chemist! He was interested in chemistry from his early years. In the decade from 1840 to 1850 organic chemistry--or as we prefer to call it now, the chemistry of the carbon compounds--was just opening up. Great discoveries were possible as they were not before or since. Pasteur, with a devotion to experimental work that amounted to a passion, was a pupil at the Ecole Normale, in Paris. Bruited about he heard all the suggestive questions that were insoluble problems even to the great men around him. He was especially interested in the burning {297} question of the day, the internal constitution of molecules and the arrangement of atoms in substances which, though they are composed of exactly the same constituents, exhibit very different physical and chemical qualities. The subject is, almost needless to say, a basic problem in chemistry and remains to our own day the most attractive of scientific mysteries. Mitscherlich, one of the greatest chemists of the time, had just announced that certain salts--the tartrates and paratartrates of soda and ammonia--"had the same chemical composition, the same crystalline form, the same angles in the crystalline condition, the same specific weight, the same double refraction and, consequently, the same inclination of the optic axes. Notwithstanding all these points of similarity, if the tartrate is dissolved in water it causes the plane of polarized light to rotate while the paratartrate exerts no such action." Pasteur could not believe that all the chemical and physical qualities of two substances could be identical and their action to polarized light be so different. Mitscherlich was known, however, as an extremely careful observer. For several years Pasteur revolved all the possibilities in Mitscherlich's observations and, finally, came to the conclusion that there perhaps existed in the paratartrates, as prepared by Mitscherlich, two different groups of crystals, the members of one of which turned the plane of polarization to the right, the other to the left. These two effects neutralized each other and apparently the paratartrates have no influence on the polarized beam of light. Pasteur found that the paratartrates were composed of crystals that were dissymmetrical--that is, whose image reflected in a mirror cannot be superposed on the crystal itself. This idea Pasteur makes clear by reference to the mirrored image of a hand. The image of the right hand as {298} seen in a mirror is a left hand. It cannot be superposed on the hand of which it is the reflection any more than the left hand can be superposed on the right and have corresponding parts occupy corresponding places. Pasteur found that the paratartrates were not only dissymmetrical, but that they possessed two forms of dissymmetry. The mirrored image of some of the crystals could be superposed on certain of the other crystals just as the mirror image of the right hand can be superposed on the actual left hand. He concluded that if he separated these two groups from each other he would have two very different substances, and so the mystery propounded by Mitscherlich would be solved. With Pasteur to conceive an idea was to think out its experimental demonstration. He manufactured the paratartrates according to the directions given by Mitscherlich, and then proceeded to sort the two varieties of crystals by hand. It was slow, patient work, and for hours Pasteur strove feverishly on alone in the laboratory. At length, the crystals were ready for solution and examination as to their effect upon polarized light. If Pasteur's idea as to the dissymmetry of crystals were confirmed, a great scientific advance was assured. Tremblingly the young enthusiast adjusted his polariscope. He tells the story himself of his first hesitant glance. But hesitation was changed to triumph. His prevision was correct. There were two forms of crystals with different effects on polarized light in Mitscherlich's supposed simple substance. Pasteur could not stay to put his instrument away. The air of the laboratory had become oppressive to him. Drunk with the wine of discovery, as a French biographer remarks, he rushed into the open air and almost staggered into the arms of a friend who was passing. "Ah," he said, "I have just made a great discovery. Come to the Luxembourg garden and I will tell you all about {299} it." It was characteristic of the man all through life to have no doubt of the true significance of his work. He was sure of each step in the demonstration and his conclusions were beyond doubt. Pasteur's discovery made a profound sensation. The French Academy of Sciences at once proceeded to its investigation. Among the members who were intensely interested, some bore names that now belong to universal science--Arago, Biot, Dumas, De Senarmont. Pasteur told long years afterward of Biot's emotion when the facts were visibly demonstrated to him. Greatly moved, the distinguished old man took the young man's arm and, trembling, said: "My dear child, I have loved science so well that this makes my heart beat." How deeply these men were bound up in their work! How richly they were rewarded for their devotion to science! There were giants in those days. Pasteur's discovery was much more than a new fact in chemistry and physics. It was the foundation-stone that was to support the new science of stereochemistry--the study of the physiochemical arrangement of atoms within the molecule--that took its rise a few years later. Much more, it was a great landmark in biology. Pasteur pointed out that all mineral substances--that is, all the natural products not due to living energy--have a superposable image and are, therefore, not dissymmetrical. All the products of vegetable and animal life are dissymmetrical. All these latter substances turn the plane of polarization. This is the great fundamental distinction between organic and inorganic substances--the only one that has endured thus far in the advance of science. Dissymmetry probably represents some essential manifestation of vital force. Often there seem to be exceptions to this law; but careful analysis of the conditions of the problem shows that they are not real. {300} An apparent contradiction, for instance, to this law of demarcation between artificial products and the results of animal and vegetable life is presented by the existence in living creatures of substances like oxalic acid, formic acid, urea, uric acid, creatine, creatinin, and the like. None of these substances, however, has any effect on polarized light or shows any dissymmetry in the form of its crystals. These substances, it must be remembered, are the result of secondary action. Their formation is evidently governed by the laws which determine the composition of the artificial products of our laboratory, or of the mineral kingdom properly so called. In living beings they are the results of excretion rather than substances essential to life. The essential fundamental components of vegetables and animals are always found to possess the power of acting on polarized light. Such substances as cellulose, fecula, albumin, fibrin, and the like, never fail to have this power. This is sufficient to establish their internal dissymmetry, even when, through the absence of characteristic crystallization, they fail to manifest this dissymmetry outwardly. It would scarcely be possible to indicate a more profound distinction between the respective products of living and of mineral nature than the existence of the dissymmetry among living beings and its absence in all merely dead matter. It is strange that not one of the thousands of artificial products of the laboratory, the number of which is each day growing greater and greater, should manifest either the power of turning the plane of polarization or non-superposable dissymmetry. Natural dissymmetrical substances--gum, sugar, tartaric and malic acids, quinine, strychnine, essence of turpentine, and the like--may be and are employed in forming new compounds which remain dissymmetrical though they are artificially prepared. It is evident, however, that all these new {301} products only inherit the original dissymmetry of the substances from which they are derived. When chemical action becomes more profound--that is, becomes absolutely analytic or loosening of the original bonds imposed by nature--all dissymmetry disappears. It never afterward reappears in any of these successive ulterior products. "What can be the causes of so great a difference?" We quote from Pasteur's life by his son-in-law: "Pasteur often expressed to me the conviction," says M. Radot, "that it must be attributed to the circumstance that the molecular forces which operate in the mineral kingdom and which are brought into play every day in our laboratory are forces of the symmetrical order; while the forces which are present and active at the moment when the grain sprouts, when the egg develops, and when under the influence of the sun the green matter of the leaves decomposes the carbonic acid of the air and utilizes in diverse ways the carbon of this acid, the hydrogen of the water and the oxygen of these two products are of the dissymmetrical order, probably depending on some of the grand dissymmetrical cosmic phenomena of our universe." For the first few years after this discovery Pasteur endeavored by every possible means to secure experimental modifications of some of these phenomena of dissymmetry. He hoped thus to learn more fully their true nature. Magnetic influences especially would, he hoped, enable him to pierce, at least to some degree, this fundamental mystery of nature. While acting as professor at Strasburg, he procured powerful magnets with the view of comparing the actions of their poles and, if possible, of introducing by their aid among the forms of crystals a manifestation of dissymmetry. At Lille, where he was for several years dean of the scientific faculty, he contrived a piece of clockwork intended {302} to keep a plant in continual rotary motion, first in one direction and then in the other. "All this was crude," he says himself, "but further than this I had proposed with the view of influencing the vegetation of certain plants to invert, by means of a heliostat and a reflecting mirror, the motion of the solar rays which should strike them from the birth of their earliest shoots. In this direction there was more to be hoped for." He did not have time, however, to follow out these ingenious experiments. He became involved, as we shall see, in labors more than sufficient to take up all his time and all his energy. These labors were of great practical importance for France. Pasteur always insisted, however, that great discoveries will yet be made in following out this order of ideas, and that there is in this subject magnificent opportunity for young men possessed of the genius of discovery and the power of persistent work. When, only a few years ago, Professor Duclaux, Pasteur's successor as the head of the Pasteur Institute, and himself one of the greatest living authorities on biological chemistry, wrote the story of the mind of the master, [Footnote 14] he said, of this subject of dissymmetry: "A living cell appears to us, then, as a laboratory of dissymmetrical forces, a bit of dissymmetrical protoplasm acting under the influence of the sun--that is to say, under the influence of exterior dissymmetrical forces. It presides over actions of very different kinds. It can manufacture, in its turn, new dissymmetrical substances which add to or take away from its energy. It can, for instance, utilize one of the elements of a paratartrate without touching another. It can manufacture crystalline sugar at one moment and consume it at another, laying by stores for itself to-day using them up to-morrow. In a word, the living cell {303} presents a marvellous plasticity, which exerts itself without the slightest disturbance by minimal deviations of forces due to dissymmetrical influence. Ah, if spontaneous generation were only possible! If we could only create living matter, raise up in the midst of inactive mineral material a living cell, then it would be easy for us to understand something more of vital manifestations and to comprehend better the mystery of dissymmetry." [Footnote 14: L'Histoire d'un esprit, par M. Duclaux, Paris, 1896.] But spontaneous generation is as far off as ever. Pasteur's discoveries in dissymmetry have brought us closer than ever before to the mystery of life. Scientists still hope, but it is with ever-waning confidence, that they may pluck out the heart of the mystery. Pasteur's own thoughts with regard to dissymmetry rose above even the lofty heights of mere earthly biology. He saw in it the great force that links the universe together. On one occasion, at the Academy of Sciences, he expressed himself as follows: "The universe is a dissymmetrical whole. I am inclined to think that life, as manifested to us, must be a function of the dissymmetry of the universe or of the consequences that follow in its train. The universe is dissymmetrical; for, placing before a mirror the group of bodies which compose the solar system with their proper movement, we obtain in the mirror an image not superposable on the reality. Even the motion of solar light is dissymmetrical. A luminous ray never strikes in a straight line. Terrestrial magnetism, the opposition which exists between the north and the south poles of a magnet, the opposition presented to us by positive and negative electricity, are all the resultants of dissymmetrical actions and motions." This raising of his thoughts far above the sordid realities he is concerned with into the realms of suggestive theory is typical of Pasteur. His was a true creative mind--poetic {304} in its highest sense. The imagination properly controlled is of as great value to the scientist as to the poet. Pasteur's theories were ever pregnant with truth to be. All his life he kept this question of dissymmetry before his mind and hoped to get back to work at it. But opportunity failed. Other and more practical work was destined to occupy the busy half-century of investigation that followed. Most of Pasteur's work, after this first thrilling discovery and its possible significance, is very well known. His meditations on the distinction between material derived from living and non-living sources led him to investigate certain processes called fermentations--before his time considered merely chemical. It is well known that if a dilute solution of sugar be exposed to the air anywhere in the world it will ferment--that is, certain changes will take place in the liquid, some gas will escape from its surface and alcohol will be formed. There are changes that take place in other organic substances--milk, meat solutions, butter, etc.--that resemble quite closely alcoholic fermentations, though the end-product of the process is not alcohol. Pasteur showed that all these supposed chemical changes are really due to the presence of minute living cells, called ferments. During the growth of these cells they split up the substances contained in the material in which they occur, using parts of them for their nutrition. He proved this very clearly for the lactic acid and butyric acid fermentations. Milk was supposed to become sour and butter rancid because they are unstable organic compounds, liable to change in the presence of the oxygen of the air. These changes were now shown to be due to minute living things that grow in the milk and the butter. When Pasteur offered the same explanation of the origin of vinegar he found a strenuous opponent in Liebig, the great chemist. Liebig admitted the existence of specific substances, {305} called ferments, but said that they were nitrogenous compounds in unstable equilibrium as regards their composition, and with a marked tendency to undergo alteration when exposed to the air or free oxygen. These alterations, once begun, affect also the liquids in which the ferments are contained--milk, blood, sugar solutions and the like. Theodore Schwann had shown the existence of certain yeast-like bodies in fermenting liquids, but these were considered to be effects, not causes, of the fermentation, and even Schwann, himself, believed that they originated in the liquids in which they were found. It remained for Pasteur to demonstrate, as he did by a brilliant series of ingenious and conclusive experiments, that ferments are living cells, that they never originate except from previous cells of the same species, and that no fermentation takes place unless they are present. The changes that take place in organic liquids when exposed to the air and the frequent development in such liquids of moving bodies evidently possessed of life constituted, before Pasteur's time, the principal reason for believing that life might originate from some special combination of chemical forces, and without the necessity for preceding life of the same species as its efficient cause. The new explanation of fermentation greatly weakened the position of those who believed in spontaneous generation--that is, the origin of life from dead matter under certain specially favorable circumstances. Pasteur proceeded to show, by rigid demonstration, that if all life were destroyed in organic substances, living beings never originated in them unless living seeds from the air gained access to them. After a meat solution has been thoroughly boiled nothing living develops in it, even though the air is allowed free access, if the air admitted has been previously filtered through cotton, He showed that even the {306} bending of the neck of the tube into the shape of an "S," so as to prevent the entrance of dust particles, suffices to protect the most changeable organic material from the growth of micro-organisms in it. His teaching was not accepted at once. Details of his experiments were impugned. Apparently complete counter-demonstrations were made, but Pasteur knew how, by his marvellous intuition, to detect the fallacy of supposed demonstration, and to invent new crucial tests of the proof of biological succession. These studies in minute life and in fermentation led him almost naturally to the study of disease. Two centuries before, Robert Boyle, of whom his notorious descendant the great bullster, Sir Boyle Roche, had said that he was the father of chemistry and the brother of the Earl of Cork, made use of an expression wonderfully prophetic in its accurate penetration of the future. "He that thoroughly understands the nature of ferments and fermentations," said Boyle, "shall probably be much better able than he that ignores them to give a fair account of divers phenomena of certain diseases (as well fevers as others) which will perhaps be never properly understood without an insight into the doctrine of fermentations." The marvel is that the very first man who understood the nature of fermentation proved to be the one destined to unlock the mystery of contagious disease and its origin. Pasteur's first investigations in the field of disease concerned a mysterious malady that affected the silkworm and was ruining the silk industry of France. This disease was first noted seriously about 1850. When a colony of silkworms had been attacked it was useless to try to do anything with them. The only resource for the silk farmers was to get the eggs of an unaffected race of worms from some distant country. These became infected after several generations, {307} and untainted eggs had to be brought from a distance once more. Soon the silkworm plague invaded most of the silk-growing countries of Europe. In 1864, only the races of silkworms in China and Japan were surely not infected. Great suffering had been entailed on many departments of France by the failure of the silk industry. The most careful investigation failed to reveal any method of combating the disease. Acute observers had been at work and some very suggestive observations on the affected worms had been made, but the solution of the problem of the prevention of the disease seemed as far off as ever. In 1863 the French minister of agriculture formally agreed to pay 500,000 francs (about $100,000) to an Italian investigator who claimed to have found a remedy for the disease, if his remedy proved efficient. The offer was to no purpose. In 1865 the weight of cocoons of silk had fallen to 4,000,000 kilos. It had formerly been nearly 30,000,000 kilos. This involved a yearly loss of 100,000,000 francs (about $20,000,000). Pasteur showed that the failure of the silkworm was not due to one disease, but to two diseases--pebrine and flacherie. These diseases are communicated to the eggs of the worms, so that the young begin life handicapped by the maladies. The crawling of the worms over leaves and stems makes these liable to communicate the diseases. The prevention of the diseases is accomplished by procuring absolutely healthy eggs and then never letting them come in contact with anything that may have been touched by diseased worms. If, at the egg-laying period, worms show any signs of disease their eggs are to be rejected. These simple suggestions were the result of rigid experimental demonstration of the spread of the diseases from worm to worm, including the demonstration of the microbic causes of the two diseases. These precautions proved effective, {308} but their introduction met with opposition. The strain of the work and the worry of controversy brought Pasteur to the brink of the grave by a paralytic stroke. From this he never entirely recovered and was always afterward somewhat lame. After the severest symptoms had passed off he was given the opportunity to make a crucial test of preventing the silkworm diseases at the villa of the French Prince Imperial. The products obtained from the silkworms on the estate had, for years, not sufficed to pay for the fresh supplies of eggs obtained from a distance. Pasteur was given full charge of the silk industry on the estate. The sale of the cocoons at the end of the year gave a net profit of 26,000,000 francs (over $5,000,000). This decisive demonstration effectually ended all opposition. His attention was next naturally directed to the diseases of animals and human beings. His studies in fermentations and in silkworm diseases had taught him the use of the microscope for such investigations. Splenic fever--known also as anthrax--a disease that attacks most species of domestic animals and may also prove fatal to man, was the first to yield the secret of its origin. The cause proved to be a bacterium--that is, a small, rod-shaped plant. This was but the first of a series of similar discoveries, until now the science of bacteriology has become one of the most important branches of knowledge. Pasteur's investigations included much more, however, than the mere discovery of the germ of the disease. He showed that a series of diseases which passed under different names in different animals were all due to the same cause. Further, he discovered one of the methods of distributing the disease. When the carcasses of animals that have died from the disease are not buried deeply below the surface of the ground, animals grazing above may become infected with the disease. {309} The germs of the disease can be shown to occur in the grass above the graves. It is carried to the surface in the bodies of earth-worms. This important observation was the first hint of the methods of disease distribution by some living intermediary. Modern medicine has come to understand that these biological distributing agents are far more important than the fabled transmission through the air. Pasteur overturned the notion of spontaneous generation of life. Then his work eradicated the idea of the spontaneous generation of disease. It opened up a new era by showing that the origin of many diseases is not due to changes in the atmosphere nor to some morbid productivity of soil or water under favoring circumstances, but to minute living organisms whose multiplication is encouraged by the conditions that were supposed to produce disease. Finally, came the precious suggestion that living things always convey and distribute disease; man to man, for epidemics travel not with the velocity of the wind but only as fast as the means of communication between distant points; animal to man, as is well known, for many diseases now; and, lastly, insects, worms and the like were also shown to be real carriers of disease. In investigating chicken cholera Pasteur discovered another great basic principle in the knowledge of disease, especially of its treatment. After considerable difficulty he succeeded in finding the germ of this disease which was causing great losses in the poultry industry of France and other European countries. This germ was cultivated for a number of generations on artificial media and never failed to produce the disease when fowls had been inoculated. During the course of his studies in the malady Pasteur was called away to a distant part of France in connection with his investigation of anthrax. He was away from his laboratory for several months. When he returned he inoculated {310} some fowls with the cultures of chicken cholera which he had left behind. To his surprise and annoyance the inoculations failed to produce the typical symptoms of the disease. The fowls suffered from some slight symptoms and then recovered. When he left his laboratory inoculations had been invariably fatal. It took considerable time and trouble to procure fresh cultures of the chicken-cholera microbe. Meantime, the fowls which had been only slightly affected by the old cultures were carefully preserved. When these birds were inoculated with the fresh virulent cultures they failed to take the disease. Other fowls promptly died, exhibiting all the characteristic symptoms of chicken cholera. Those that had suffered from the mild form of the disease produced by the old cultures were protected from further attacks of the disease. One of the great mysteries of medicine, the varying virulence of disease, had been thus solved by what seemed an accident. There are no accidents in the lives of great investigators. There are surprises, but genius knows how to reconcile their occurrence with the principles they are working out. Pasteur understood at once the wonderful utility there might be in this discovery for the protection of men and animals from disease. He proceeded to practical applications of the new theory by providing old cultures for the inoculation of fowls in districts where chicken cholera produced serious ravages. Then, working on the same lines as for chicken cholera, he proceeded to elaborate vaccine material for anthrax. Vaccine was the name deliberately selected for the inoculating substance in order to honor the genius of the English physician Jenner, who had discovered the power of vaccination to protect from smallpox. The weakening of the germs of anthrax, so as to produce only a mild form of the disease, was a much more intricate problem than for chicken cholera, {311} because the anthrax bacillus does not weaken with age, but enters a resting or spore stage, resembling the seed stage in large plants. After a patient series of investigations Pasteur accomplished his object by some ingenious methods that served to show, perhaps better than any other details of his career, how thoroughly practical was his inventive genius. Unfortunately the absorption in his work proved too much for his health. He was seized by a series of apoplectic attacks which for a time threatened to put an end to his invaluable career. When he did begin to recover his health one of the most serious problems in his regard was to keep him from hindering his convalescence by a return to his old-time absorption in the important problems of the cure and the prevention of disease, at which he had been so happily engaged. The keynote of Pasteur's life was to prevent human suffering as far as possible, and any time not given to this important duty seemed to him to be utterly wasted. With regard to this unfortunate break in Pasteur's work Dr. Christian Herter, in his address on the "Influence of Pasteur in Medical Science," delivered before the Medical Society of Johns Hopkins University, [Footnote 15] has an interesting passage, in which he discusses the significance of the master's work up to this time, and the interest that his illness awakened among all the distinguished medical scientists of Europe at the time: [Footnote 15: New York: Dodd, Mead & Co., 1904.] "It is likely that excessive work and mental stress in some degree contributed to the onset of the series of paralytic seizures which in October, 1868, threatened the life of Louis Pasteur. During the critical period of his illness, many of the most distinguished scientific men of France vied with each other to share with Mme. Pasteur the privilege of nursing the man they loved so well and of rescuing the life {312} that had already placed science and a nation under enduring obligation through discoveries which were either of the greatest practical utility or appeared susceptible of almost unlimited development. Had Pasteur died in 1868, he would have left a name immortal in the annals of science. Others would in some degree have developed his ideas. Already inspired by the researches on fermentation, Lister would have continued to develop those life-saving surgical methods which will forever be associated with his name. But we may well question whether investigations in biology and medicine would not have been for a time at least conducted along less fruitful paths. Who shall say how soon the great principle of experimental immunity to pathogenic bacteria, the central jewel in the diadem of Pasteur's achievements, would have been brought to light?" When Pasteur recovered sufficiently to resume work, it was soon clear to apprehensive friends that he had no intention of leaving his ideas to be worked out by other men. The miseries of the Franco-Prussian War deeply affected him, and could not fail to inhibit his productiveness, but after a time the unquenchable love for experimental research was once more ascendant and there began a new epoch, the epoch of great discoveries relating to the origin and cure or prevention of the infectious diseases of man and the domestic animals. As in the case of Ignatius Loyola, it seems as if the lamp of the genius shone with a larger and more luminous flame after the onset of bodily infirmity in defiance of the physical mechanism which is too often permitted to master the will. After his illness Pasteur devoted himself even more than before to the study of the various biological problems connected with human diseases. There was one exception to this, in his series of studies on beer, undertaken shortly after {313} the Franco-Prussian War. Pasteur was an ardent patriot, so much so, indeed, that after the war he sent back to the German government certain decorations and diplomas that had been conferred upon him. He thought that his country had been overreached by a scheming, political statesman, bent on the aggrandizement of the kingdom of Prussia. To the end of his life this feeling of hostility never entirely vanished. It was his hope, then, that by improving the character of French beer it might not only be made more wholesome in the best sense of the word, but also that the French brewing industry might be made a serious rival of its German competitors. Pasteur's discoveries are the most important for the brewing industry that have ever been made. The Germans proved, however, even more capable of taking advantage of them than his French compatriots. After this Pasteur devoted himself without further interruption to the study of the microbic diseases of man. His greatest practical triumph was undoubtedly with regard to hydrophobia, or, as it is more properly called, rabies. The mystery of the disease was most illusive. Pasteur could not succeed in finding the germ of the disease. Even down to our own day it has not been satisfactorily demonstrated. In spite of this lack of an important element of knowledge, which might be supposed absolutely essential for the successful therapeutics of rabies from a biological standpoint, Pasteur succeeded in producing material that would protect those bitten by rabid dogs from developing the affection. Long and bitter was the opposition to the introduction of his method of treatment. The greatest living German bacteriologist said that it was idle to provide "remedies of which we know nothing for diseases of which we know less." The reference was to the failure to find the germ of the disease and the claim, nevertheless, of having discovered {314} a cure. Wherever the Pasteur treatment for rabies was introduced, however, the number of deaths following the bites of mad animals fell off. In Russia, where the mad wolves of the Steppes so often inflict fatal bites, the power of the new treatment was soon recognized. In Hungary its value was appreciated without delay. Then the British government, after a most careful investigation, introduced it into the Indian army. Then Austria took it up officially. At the International Medical Congress at Moscow, in 1897, Americans, who expressed doubts as to the efficiency of the Pasteur treatment for rabies, were laughed at by the medical representatives of nations who have the most opportunities for studying the disease. Shortly after the Moscow congress the German government officially announced its intention of treating all persons bitten by rabid animals by the Pasteur method. A Pasteur institute for the treatment was opened in connection with the University of Berlin. With this the last serious opposition disappeared. The Germans are now enthusiastic advocates of the value of the Pasteur treatment. The statistics of the Berlin Pasteur Institute are pointed to as demonstrating beyond doubt the possession of power to cope with one of the most fatal diseases man is liable to. Alas, that this should not have come during the master's lifetime! It would have been the happiest moment of Pasteur's life to have had his ideas triumphant in Germany. Unlike the generality of great men, however, Pasteur enjoyed the meed of almost unstinted appreciation during life. Geniuses are often said to be neglected by their contemporaries. The expression is exemplified much less frequently in our own time than formerly. The rapid diffusion of ideas, and the consequent control and confirmation of scientific claims by many minds, enable the present generation to recognize merit before its possessor has starved. {315} Pasteur's career was certainly an exemplification of the fact that true genius, though it may meet with opposition, will be well rewarded. The son of the poor tanner of Dole, by the mere force of his intellectual energy, lifted himself to the level of earth's great ones. His funeral obsequies were a pageant in which French officialdom felt itself honored to take part. The President of the French Republic, the members of both houses of the legislative department, the officials of the city of Paris, the members of the faculty of the university, of the French Academy, and of the various scientific societies of the French capital, gathered to honor their mighty dead. Never has it been given to anyone without family prestige or political or ecclesiastical influence to have a great world-capital and a great nation accord such glorious obsequies, while all the world extended its sympathy and added paeans of praise. Nor was it only at the moment of death that the expression of sincere respect and merited honor was paid. When there was question of erecting a Pasteur institute, in which the master's great work could be carried on more effectually, contributions poured in from every part of France and from all over the civilized world. Two of the world's greatest hereditary rulers made it a point to visit the humble laboratory of the great scientist whenever they came to Paris. Alexander II, the Czar of the Russians, was the intimate friend of the tanner's son, who became the world's benefactor. Dom Pedro II, the late Emperor of Brazil was another royal visitor to Pasteur. In the library of the _Institut Pasteur_ at Paris, the busts of these two and of two other great friends of his, scarcely less in worldly importance and greater in their beneficence, keep watch above the ashes of the dead scientist. They are Baroness Hirsch, the world benefactress, and Baron Albert Rothschild, the head of the French branch of the great banking family. {316} All united in honoring the marvellous genius whose work has proved of such practical utility for mankind, and whose discoveries are as yet only beginning their career of pregnant suggestiveness to scientific men. His genius has brought the great ones of earth to his level or raised him to theirs. His own thought on the equality of man is a confession of the faith that was in him. It was expressed in his discourse of reception into the French Academy in the midst of the panegyric on Littré, from which we quoted at the beginning of this sketch: "Where are the true sources of human dignity, of liberty and of modern democracy, if not in the infinite, before which all men are equal? The notion of the infinite finds everywhere its inevitable expression. By it the supernatural is at the bottom of every heart." Pasteur, the man, is, however, if possible, even more interesting than Pasteur, the greatest of living scientists. In the midst of all his work and his wonderful success, amid the plaudits of the world, Pasteur remained one of the simplest of men and the kindest of friends to those who knew him. Dr. Roux's expression is well known: "The work of Pasteur is admirable; it shows his genius; but one must have lived on terms of intimacy with him in order to know all the goodness of his heart." He was kindness personified, and those who think of him as a cruel vivisector and encourager of experiments upon animals that cause suffering, belie him and his humanity very much. He would never permit animals to be used in experiments without an anesthetic, and even then only when he deemed that use absolutely necessary for the furtherance of projects that promised great benefit to humanity. Nothing was harder for him to do than to walk the hospitals and see human suffering when he was studying the causes of disease in human beings. Even the slight pain inflicted during the {317} injections for hydrophobia was a source of great discomfort to him, and his anxiety with regard to these patients was one of the main causes of the breakdown in health that shortened his life. One of the most beautiful things about Pasteur's personal life is the relation to his family, and especially to his children, and their union in religious simplicity. On the occasion of the death of his father, whom Pasteur loved very deeply and for whom he had instilled the deepest affection into the hearts of his children, he wrote to his daughter, whose first communion was to occur on that day. His letter is that of a man deeply affectionate, sincerely religious, and eminently trustful of the future that faith alone points out. His letter runs: "He died, my dear Cecelia, the day of your first communion. Those are two memories which will, I hope, never leave your heart, my dear child. I had a presentiment of his death when I asked you to pray particularly on that morning for your grandfather at Arbois. Your prayers will surely be very agreeable to God at such a time, and who knows if grandpa himself did not know of them and did not rejoice with our little Jeanne [a daughter who had died the year before] over the pious sentiments of Cecelia?" It is not surprising, then, to find many other expressions of Pasteur's extreme interest in spiritual things, though they might have been little expected from a man so deeply immersed in scientific investigations as he was. After all, it must not be forgotten that his discoveries, by solving the mystery that surrounds the origin of disease, cleared some of the ways of Providence of that inscrutable character which is supposed in shallow minds to constitute the greatest part of their impressiveness. With epidemics explained, not as dispensations of Divine Providence, but as representing the sanction of nature for the violation of natural laws, one of the {318} reasons for which mankind worshipped the Deity seemed to be gone. The man who had done most to make clear these mysterious processes of nature was, however, himself far from thinking that materialism offers any adequate explanation of the mysteries of life, or of the relations of man to man, and of man to his Creator. Impatient at the pretensions of such pseudoscientists, Pasteur once said: "Posterity will one day laugh at the sublime foolishness of the modern materialistic philosophy. The more I study nature, the more I stand amazed at the work of the Creator. I pray while I am engaged at my work in the laboratory." For Pasteur, death had no mysteries. He had written to his father, once, on the death of his little daughter Jeanne: "I can only think at this moment of my poor little one so good, so full of life, so happy in living, and whom this fatal year, now drawing to a close, has snatched from us. After a very short time she would have been for her mother and for me, for all of us, a friend, a companion, a helpmate. But I ask your pardon, dear father, for recalling to you such sad memories. She is happy. Let us think of those who remain, and let us try to prevent for them, as far as lies in our power, the bitternesses of life." So, when it came to the hour of his own death, Pasteur faced it with the simple confidence of a sincere Christian, and the undoubting faith of a lifelong son of the Church. For many hours he remained motionless, one of his hands resting in that of Madame Pasteur, while the other held a crucifix. His last conscious glance was for his lifelong companion, his last conscious act a pressure of the image of his Redeemer. Thus, surrounded by his family and disciples in a room of almost monastic simplicity, on Saturday, September 28, 1895, about five in the afternoon, passed peacefully away the greatest of the nineteenth century scientists. {319} Almost needless to say, the life of a man like Pasteur contains the most wonderful lessons for the young scientists of the twentieth century. Few men have lived their lives so unselfishly, and with so much preoccupation for the good that they might accomplish, as he did. To have remained in the midst of it all simple, earnest and faithful to duty, without self-seeking, is a triumph worthy of recording, and makes a career well deserving of emulation. When Pasteur made his discoveries with regard to fermentation the Empress of the French asked to be shown just what his investigations had demonstrated. Pasteur went to Court for the purpose, and after the Emperor and Empress had been shown the ferment cells, and expressed their interest, Eugenie said: "Now, you will develop this discovery industrially, will you not?" Pasteur replied. "Ah, no, that will be left for others. It does not seem to me that it would be worthy of a French scientist to allow himself to be diverted to the industrial applications of his discoveries, even though it might prove eminently lucrative for him." As a matter of fact, had Pasteur allowed himself to be allured into the foundation of an immense manufactory constructed and directed on the great principles which he had discovered, there seems no doubt that this would have been a wonderful money-making scheme. Certain it is that the capital for such an adventure would have been readily available. Had Pasteur yielded to the solicitations made him he might have died worth many millions, instead of the very modest competency which came to him in the ordinary course of his scientific labors. The money might have seemed a temptation for the sake of his children, but the world would have lost all the great discoveries with regard to human diseases. It is not unlikely that these would have been made even without Pasteur, There is no doubt, however, that their discovery {320} would have been very much delayed and that as a consequence almost untold human suffering that has been prevented would have occurred. It must never be forgotten that such men as Lister and Koch derived their most fertile suggestions from the discoveries made by Pasteur. Pasteur's life may very well be held up, then, as a model to the present and future generations of what the highest ideals of a scientific career can be. Dr. Christian Herter, in the discourse already quoted from, has stated this so well and at the same time has joined with it so felicitously a quotation from Pasteur's advice to young men, that we can find no better way in which to close this consideration of Pasteur's career than by quoting him once more: "To have fought the long battle of life with unwavering constancy to the loftiest ideals of conduct, toiling incessantly without a thought of selfish gain; to have remained unspoiled by success and unembittered by opposition and adversity; to have won from nature some of her most precious and covert secrets, turning them to use for the mitigation of human suffering;--these are proofs of rare qualities of heart and mind. Such full success in life did Louis Pasteur attain, and from the consciousness of good achieved his noble nature found full reward for all his labors. "Of the children whom nature has endowed with splendid gifts there are few whose lives have affected so profoundly and so beneficently the fate of their fellows, few who have earned in equal degree the gratitude and reverence of all civilized men. Although not many can hope to enrich science with new principles, all of us may gain from Pasteur's life the inspiration to cultivate the best that is in us. Let us keep living in our memories the inspiring words which the master spoke on the seventieth anniversary of his birthday: "'Young men, young men, devote yourselves to those sure {321} and powerful methods, of which we as yet know only the first secrets. And I say to all of you, whatever may be your career, never permit yourselves to be overcome by degrading and unfruitful skepticism. Neither permit the hours of sadness which come upon a nation to discourage you. Live in the serene peace of your laboratories and your libraries. First, ask yourselves, What have I done for my education? Then, as you advance in life, What have I done for my country? So that some day that supreme happiness may come to you, the consciousness of having contributed in some manner to the progress and welfare of humanity. But, whether our efforts in life meet with success or failure, let us be able to say, when we near the great goal, 'I have done what I could.'" {322} {323} JOSEPH O'DWYER, THE INVENTOR OF INTUBATION {324} I have hope and wish that the nobler sort of physicians will advance their thoughts, and not employ their time wholly in the sordidness of cures; neither be honored for necessity only; but that they will become coadjutors and instruments in prolonging and renewing the life of man. --Bacon {325} JOSEPH O'DWYER, THE INVENTOR OF INTUBATION. At the beginning of the nineteenth century a young medical practitioner, working faithfully in the wards of his hospital in Paris, pitying especially the patients who suffered from pulmonary disease, and realizing how hopeless was their treatment, since medical science knew so little of the real nature of the ailment from which they suffered, invented the stethoscope and established the principles on which modern physical diagnosis is based in a method so complete that after the lapse of three-quarters of a century very little has been added to what was then discovered. This genius was the famed Laennec, of whom we have written in a preceding chapter, who was wont to spend his days walking the wards of the Necker Hospital in Paris, caring more for his poor patients than for the nobility and members of the wealthy classes, who willingly would have taken advantage of his clinical knowledge so conscientiously gained. Laennec made possible progress in medicine that places him among the five or six greatest medical men of all times. At the end of the nineteenth century a man of about Laennec's age was touched with pity for the sufferings of the poor children whom he saw dying from suffocation because of the ravages of laryngeal diphtheria. Nothing could be done for them except, perhaps, to benumb their senses by means of narcotics, while nurse and medical man stood idly by suffering excruciatingly themselves while their little patients bore all the lingering, awful pains of death by asphyxiation. {326} For years Joseph O'Dwyer labored at the problem of relieving these little patients, and finally achieved similar success to Laennec with his stethoscope. The modern doctor, moreover, was quite as patient in his work of research as Laennec, and though his discovery had not so wide an application as the latter's it was accomplished through the same tireless, persevering labor, and through the same instinct of genius that finally led to the culminating invention which no one has been able to improve, and which has made its inventor's name a familiar word to medical men over the world. American medicine has no more shining light than the name of Joseph O'Dwyer, and the record of his simple, sincere, straightforward life, faithful during his successful career to the simple religious principles imbibed in the bosom of an old-fashioned Catholic family, who, during a long career, thought little of self and mainly of the possibilities for good presented by his profession, cannot but prove one of the standard biographies in this country's medical history. Dr. Joseph O'Dwyer, the inventor of intubation, was born in 1841, in Cleveland, Ohio. Shortly after his birth his parents, who were only moderately well to do, moved to Canada, so that O'Dwyer's boyhood was passed not far from London, Ontario. There he received his early education, and there also, as was the custom in those days, he began his medical studies by becoming a student in the office of a Dr. Anderson. After two years of apprenticeship, he came to New York and attended lectures in the New York College of Physicians and Surgeons, where he was graduated in 1866, at the age of twenty-five. Immediately after graduation he obtained the first place in the competitive examination for resident physician and sanitary superintendent of the Charity or City Hospital of New York City, on Blackwell's Island. Shortly after his appointment {327} an epidemic of cholera broke out in the workhouse (under his charge), and Dr. O'Dwyer nobly devoted himself to the care of the patients. While engaged in this work he contracted the disease himself, but fortunately recovered completely without suffering from any of its usual after-effects. When, not long subsequently, another epidemic of cholera occurred in New York, and a number of cases of the disease were transferred to Hart's Island and there quarantined, volunteers for their medical attendance were asked from among the members of the medical staff of the Charity Hospital. Dr. O'Dwyer was one of the first to come forward and offer his services. Again he contracted the disease, but recovered from it as completely as from typhus. Years afterward he described to a friend his feelings as he lay in one of the hospital tents, the only accommodation that could be provided for him owing to the crowded condition of the wards. His attack was rather severe and yet left him his consciousness, while as he lay expecting death at almost any moment, the thought (as he was wont to relate) sometimes came to him that it was perhaps foolish of him to have volunteered in so dangerous a service. This thought was always put away, however, and he assured his friend that at no time had he ever regretted his exposure to the disease in the cause of suffering humanity. The risks that usually come with professional obligations (it appeared to him) are not to be avoided at the cost of the consciousness of a duty refused. During his service at the Charity Hospital, Dr. O'Dwyer endeared himself to all those with whom he came in contact. In examination for the position of resident on the Island he had passed first, and during his service there it was generally conceded that he towered above his companions in his efficiency and attention to duty. Some of {328} those who were residents with him afterward made names that are distinguished in the history of the practice of medicine in New York City, yet all of them were ever ready to acknowledge that O'Dwyer had been a leader among them in the service. With a very practical turn of mind, he united the capacity for patient work that enabled him to master difficulties, while his devotion to his profession gave him a deep interest in every department of medicine. The foundation of his future success as a practitioner of medicine was laid in these fruitful years of hard work among the poor charity patients of New York City, for whose welfare, as is evident from what we have said, he was ready to make any sacrifice. After about two years of service on Blackwell's Island, Dr. O'Dwyer, who had attracted no little attention by his faithful fulfilment of duty, was appointed examiner of patients--applicants for admission to the hospitals under the control of the City Board of Charities and Correction. He therefore resigned his position on the Island, and in partnership with Dr. Warren Schoonover opened an office on Second Avenue, between Fifty-seventh and Fifty-eighth Streets. With his colleague, he devoted himself especially to obstetrical practice, in which he had great success, delivering in one year, it is said, over three thousand patients. In 1872 Dr. O'Dwyer was appointed to the staff of the New York Foundling Asylum, in connection with which his real life-work was to be accomplished. While there Doctors Reynolds and J. Lewis Smith were his colleagues, and all three of them have added no little distinction to American medicine by the careful observations made at that asylum. At this time one of the most fearful scourges that could afflict a foundling asylum or children's hospital was an epidemic of diphtheria. Those who pretend not to believe {329} in the efficacy of the antitoxin treatment of diphtheria should listen to the account given by some of the Sisters, who for long years were in service in the New York Foundling Asylum, of the fear that came over them when it was announced that diphtheria had entered the wards in their charge. It was always certain beyond doubt that this disease would spread very extensively, and, in spite of all precautions and the enforcement of whatever quarantine was possible, the mortality rate would be very high. Usually forty or fifty per cent, of those who were attacked by diphtheria would perish from the disease, nor was it easy to foresee the end of any epidemic. In not a few cases death took place from that most excruciating of all fatal terminations--asphyxia. The false membrane, characteristic of diphtheria, would form, in a certain proportion of cases, in the larynx and upper part of the trachea of the little patient, the inflammatory swelling that accompanied it further decreasing the naturally small lumen of the child's undeveloped air passages. Gradually dyspnoea would set in, the dreaded croup begin to be heard, and difficulty of breathing developed at times to such a degree that the little one would use every effort to secure breath, the aeration of the blood growing less and less, and cyanosis--that is, an intense blueness of the face and hands--becoming evident, till finally the child died slowly in all the agonies of asphyxiation, while doctor and nurse stood sadly by, absolutely powerless to do anything to relieve the heart-rending symptoms. About the middle of the nineteenth century tracheotomy--that is, the surgical opening of the trachea, or wind-pipe, below the larynx, for the purpose of admitting air to the lungs through such artificial opening--had been introduced by Trousseau, of Paris. In many cases this afforded relief; {330} at least the little patients did not die the awful death by asphyxiation, though not many recovered from the diphtheria or the results of the operation. O'Dwyer himself, when asked what had led him to think of intubating the larynx, said that he had been aroused to experimentation in this direction by the complete failure of tracheotomy during the years from 1873 to 1880 at the New York Foundling Asylum. In 1880, Dr. O'Dwyer began to devise some method of providing a channel for the passage of air and secretions through the larynx. He knew that tracheotomy, as a serious, bloody operation, always is put off until the condition of the patient is quite alarming, if not hopeless, and that some device for holding the larynx open, if not too difficult of application, would surely prove life-saving in a great many cases. His first thought was that the introduction of a wire spring within the larynx might serve to hold the inflamed sides apart. He realized, however, that the edema and false membrane would force their way around the wires, and so gradually occlude the throat passage in spite of the presence of the spring. His next thought was a small bivalve speculum, that is to say, two portions of tubes cut longitudinally and fastened together in such a way that the ends could be forced apart. Such instruments are used very commonly for the examination of various cavities in the human body. The laryngeal spring, or speculum, was more successful than the wire, but it had one of the faults of the wire spring. Into the slit between the two portions of the speculum the inflamed mucous membrane was apt to force itself, so that before long difficulty of breathing would recur. Besides, if the spring which kept the blades of the speculum apart were weak, the instrument would fail of its purpose in {331} keeping the mucous membrane apart, while, if it were strong, the pressure of the blades would cause ulceration. Notwithstanding its faults, however, the bivalve laryngeal speculum accomplished somewhat of the purpose intended. In one case it kept a child alive until the dangerous period of the disease was passed, and thus was the means of saving the first little patient suffering from membranous croup in the thirteen years that the Foundling Asylum had been in existence. Dr. O'Dwyer continued to experiment with the speculum for some time, but finally gave it up and began to study the detailed anatomy of the human larynx. These studies included not only the normal larynx, but also its conditions under the influence of various pathological lesions. Finally (as one of Dr. O'Dwyer's assistants at that time says), he appeared one day in the autopsy-room with a tube. This tube was a little longer than the speculum that before had been in use. It was somewhat flattened laterally, and had a collar at its upper end. This tube was very soon to prove of practical value. In the first case in which it was employed it was a failure, inasmuch as the patient died from the progress of the diphtheria, though the notes of the case show that after the introduction of the tube the dyspnoea was relieved and the child breathed with comparative ease for the sixteen hours that elapsed before death took place. To any one who knows the harrowing agony of death from asphyxiation, and who appreciates the fact that this form of death was now to be definitely done away with, the triumph of this first introduction of the tube will be at once clear. Dr. O'Dwyer himself was very much encouraged. The relief afforded the patient was for him a great personal satisfaction, since one of the severest trials to his sensitive nature in the midst of his professional work had always {332} been to have to stand helplessly by while these little patients suffered. The fact that this tube had been retained for sixteen hours demonstrated definitely that the larynx would tolerate a foreign body of this kind without any of the severe spasmodic reflexes that might ordinarily be expected under such circumstances, while the fact that the tube had not been coughed up showed definitely that the inventor was working along the proper lines for the solution of his life-problem. The second case in which the tube was employed resulted in recovery, and Dr. O'Dwyer's more than a dozen years of labor and thought were rewarded by not only relief of symptoms, but the complete recovery of the patient without any serious complications and without any annoying sequelae. As the first case (alluded to above) is now a landmark in the history of medicine, the details relating to it seem worth giving. The little patient was a girl of about four years of age, who on the fifth or sixth day of a severe laryngeal diphtheria developed symptoms of laryngeal stenosis, with great dyspnoea. Hitherto the only hope would have been tracheotomy, but Dr. O'Dwyer introduced one of his tubes. The little patient was very much frightened and, as might be expected, in an intensely irritable condition because of the difficulty of breathing. She absolutely refused to permit any manipulations, and it was only with great difficulty that he finally succeeded in introducing the tube. After its introduction the little one shut her teeth tightly upon the metallic shield which the doctor wore on his finger for his protection, and he was absolutely unable to withdraw it from her mouth. It was only after chloroform had been given to her to the extent of partial anesthesia, with consequent relaxation of muscles, that he succeeded in freeing himself. This proved to Dr. O'Dwyer the need of another {333} instrument (to be employed in the introduction of tubes)--an apparatus by which the mouth could be kept widely open so as to allow of manipulation without undue interference by the patient. For this purpose he contrived the mouth-gag--a very useful little instrument that has been found of service in many other surgical procedures about the mouth besides intubation. His first tubes, however, were not without serious defects. For instance, in order to permit of the extraction of the tube afterward, there was a small slit in the side of the tube, into which the extractor hooked. Into this slit the swollen and edematous mucous membrane was apt to force its way, and (as can readily be understood) in the removal of the tube considerable laceration in the tissues usually was inflicted. Accordingly the tubes subsequently made were without this slit. Moreover, the first tubes that were employed were not quite long enough, a defect which led to their being rather frequently coughed up. This inconvenience was not wholly obviated even by the lengthening of them. O'Dwyer continued his studies, and finally hit upon the idea of putting a second shoulder on the tubes. This, it was hoped, would fit below the vocal cords, and with the cords in between the two shoulders the tubes would surely be retained. This improved tube was actually retained, but the drawback to its adoption (as shown in practice) proved to be that it was retained too tightly. When the time for its removal came it was almost impossible to get it out. It was evident then that some other model of tube would have to be constructed in order to make the process of intubation entirely practical, and thus do away with certain dangers. One of O'Dwyer's assistants at this time at the Foundling Asylum tells of the amount of time the doctor gave to the {334} study of the problem involved in these difficulties and of his ultimate success therein. Putty was moulded in various ways on tubes, which were inserted in specimen larynxes, and plaster casts were taken, with the idea of determining just the form of tube which would so exactly fit the average normal larynx as to be retained without undue pressure, yet at the same time keep the false membrane from occluding the respiratory passages and furnish as much breathing space as possible. Finally Dr. O'Dwyer decided that the best form of tube for all purposes would be one with a collar, or sort of flaring lip at the top, which was to rest on the vocal cord, with, moreover, a spindle-shaped enlargement of the middle portion of the tube, which lay below the vocal cords, fitting more or less closely to the shape of the trachea. To avoid the pressure and ulceration at the base of the epiglottis--a very sensitive and tender portion of the laryngeal tissues--a backward curve was given to the upper portion of the tube. On the other hand, the lower end, which rests within the cricoid ring and which was likely to be forced against the mucous membrane of the trachea occasionally, was somewhat thickened to avoid the friction and leverage that might be exerted if there were any free-play allowed. At the same time the lower end of the tube was thoroughly rounded off. Thus Dr. O'Dwyer, realizing all the difficulties of this new method of treatment, solved them, as experience proved that the tubes could be made of still smaller calibre than had been hitherto supposed and yet be efficient in relieving respiratory dyspnoea. Experience also proved that the metal tubes at first used had a number of serious disadvantages. They were heavier than those which could be made of hard rubber in the same size and shape, while the metal tubes besides had a tendency to encourage the deposition and {335} incrustation on their surfaces of calcium salts. These incrustations, roughening the surface of the tube, increased its tendency to produce pressure ulceration, as well as added to the difficulty of its removal, and consequently to the liability of producing laceration of tissues after convalescence had been established. Accordingly tubes were made of hard rubber, which could be allowed to remain in the larynx almost for an indefinite period without any inconvenience. While at first intubation was looked upon as a merely temporary expedient, clinical experience showed that sometimes in neurotic patients it was necessary to let the tube remain in the throat for several weeks or even months. Dr. O'Dwyer's originality in the invention of intubation has sometimes been doubted. The idea of some such instrumental procedure as he finally perfected seems to have occurred to practitioners of medicine a number of times in medical history. No one reduced the idea to practice in any successful degree. O'Dwyer's invention was not some chance hit of good fortune in lighting on a brilliant idea, but the result of years of patient investigation and shaping of means to ends. Often failure seemed inevitable, but he continued to experiment until he forced the hand of the goddess of invention to be favorable to him. The history of intubation is interesting mainly because it brings out clearly O'Dwyer's success where others had failed. The evolution of intubation forms, moreover, a very interesting chapter in the story of medicine. It is curious to learn that the Greeks of the classical period, and very probably for a long time before, knew something of the possibility of putting a tube into the larynx in cases of stenoses or contractions which threatened to prevent breathing. It is clear that they thus secured patency of the air-passages after these had become occluded. Hippocrates mentions {336} canalization of the air-passages, and suggests that in inflammatory croup with difficulty of respiration, canulas should be carried into the throat along the jaws so that air could be drawn into the lungs. This is probably diphtheria, the first mention of the disease in medical literature, though it is usually said to have been first described in Spain at the beginning of the nineteenth century. There is evidence, too, in Greek medical history that these directions were followed by many practising physicians of those early times. Considering that intubation of the larynx is usually thought to be a very modern treatment, this tradition in Greek medical history serves to show how transitory may be the effect of real progress in applied science. After a time the Asclepiades, and some centuries later Paulinus of AEginetus, rejected the teaching of Hippocrates in this matter, while the latter suggested even the employment of bronchotomy. After this episodic existence among the Greeks, there is no mention of anything like intubation of the larynx until about the beginning of the nineteenth century. In 1801, Desault, a French surgeon, while attempting to feed a patient suffering with a stricture of the oesophagus through a tube passed down the throat, inadvertently allowed the tube to pass into the larynx. This brought on a severe fit of coughing, but after a time the tube was tolerated and an attempt was made to feed the patient through it, with the production (as can be readily imagined) of a very severe spasmodic laryngeal attack. Desault realized the probable position of the tube then, and, taking a practical hint from this accident, suggested that possibly tubes could be passed down into the lungs even through a spasmodically contracted or infiltrated larynx, with the consequent assurance of free ingress of air. As these cases were otherwise extremely {337} hopeless, it was not long before he found the opportunity to put his hypothesis to the test, and in some half a dozen cases he succeeded in lengthening patient's lives and making them more comfortable for some hours at least. Desault's suggestion was followed by similarly directed experiments on the part of Chaussier, Ducasse and Patissier. All these came during the first quarter of the century in France, while, in 1813, Finaz of Seyssel, a student of the University of Paris, in writing his graduation thesis for the faculty of medicine, suggested the use of a gum-elastic tube that should be passed down into the larynx in order to allow the passage of air in spasmodic and other obstructive conditions. In 1820, Patissier suggested that some such remedy as this should be employed for edema of the glottis. This affection, which is apt to be rapidly fatal, is a closing of the chink of the glottis, or _rima glottidis_, as it is called, which occurs very rapidly as the result of inflammatory conditions, especially in patients who are suffering from some kidney affection. There was no doubt in the mind of practitioners generally of the necessity in many cases for some such expedient as the intubation of the larynx, but there was a very generally accepted notion that the mucous membrane of the larynx was entirely too sensitive to permit of a tube remaining for any considerable length of time in contact with the vocal cords and the very sensitive mucous membrane of the epiglottis. Meantime many precious lives were lost. Our own Washington was a sufferer, perhaps, from inflammatory edema of the larynx, complicated by a kidney trouble, though this was thirty years before Bright's work, and (as a matter of course) we have no definite data in the matter; or, as seems not unlikely, he suffered from a severe attack of laryngeal diphtheria, and, after hours of intense dyspnoea, {338} suffocated while his physicians stood hopelessly by, unable to do anything for him. There are many other names in the history of attempts at intubation during the first half of the century, two of the most important of which are Liston and John Watson, who, as the result of chance observations in cases in which feeding-tubes were inadvertently passed into the larynx, came to the thought that the larynx might tolerate a tube much better than had been previously imagined. About the middle of the nineteenth century there was no little discussion with regard to the possibility of applying remedies within the larynx after the insertion of a tube, and a large number of medical articles appeared thereon. Diefenbach, the great German surgeon, interested himself in this matter particularly, and protected his left index-finger by a shield that acted also as mouth-gag in inserting the tubes. This technique was afterward to be made use of by O'Dwyer. The first great step in intubation, as we know it at the present time, however, came from Bouchut, who suggested the use of a tube about the size of a thimble meant to be inserted into the larynx. At the upper part of this tube there were a pair of rings, between which the vocal cords were supposed to rest and hold it in place. Bouchut operated in seven cases with his tube, but five of his patients died, while two of them recovered only after tracheotomy had been performed. Bouchut succeeded, however, in showing that the larynx would tolerate a tube, though he made exaggerated claims for his method, while the very imperfect instruments he employed foredoomed his inventions to failure. It happened, moreover, that the time was unpropitious. Trousseau had not long before re-invented tracheotomy, and had employed it with considerable success in cases of croup. Under Trousseau's influence, a committee of the Academy of {339} Medicine of Paris declared Bouchut's method unphysiological and impracticable. Moeller, of Koenigsberg, tried to reintegrate Bouchut's method with certain ameliorations, but failed. The field of intubation--and a very discouraging one it seems, strewn as it was with failures made by many excellent workers--was left for O'Dwyer to exploit. How thoroughly he worked out his methods can best be appreciated from the fact that no improvement of importance has come since he presented to the medical profession the intubation system as he had elaborated it some fifteen years ago. How thoroughly Dr. O'Dwyer realized all the difficulties attached to the practice of intubation may be gathered from some of his articles on details of the treatment of patients necessary in order to make intubation a success. One of the great difficulties in the matter was the liability, when a tube was in place, for food and drink to find their way, during the process of swallowing, into contact with sensitive tissues of the larynx. To overcome this difficulty, Dr. O'Dwyer made many modifications of the upper part of the tube. Accordingly he made many wax models of the larynx, and studied the function of the epiglottis and its method of covering the larynx in order to facilitate the complete protection of the laryngeal tissues during the process of swallowing. Finally, he succeeded in making a tube that enables most patients to learn how to swallow without much difficulty. In the mean time O'Dwyer was full of practical suggestions with regard to the management of these cases. His clinical experience showed him that it was better to teach the patients to swallow rapidly and then cough up any material that might find its way into the larynx rather than to take small sips with a spasm of coughing after each sip. He showed that, notwithstanding the apparently great danger {340} of portions of food being carried past the larynx into the trachea, and so to the lungs, there was not nearly so much risk in this matter as had been anticipated. The almost inevitable occurrence of pneumonia was supposed to be one of the serious objections to the use of the intubation methods. Careful pathological investigations, however, soon showed that pneumonia developed much less frequently than had been expected, and, as a rule, when it did develop, it was due to an extension of the diphtheritic processes from the throat rather than to any infection by material that, because of the presence of the tube, had been inadvertently allowed to find its way into the respiratory tract. However, O'Dwyer's work was not done without considerable opposition. Bouchut's original invention of tubes for the larynx had failed to attract attention because of its condemnation by the Academy of Medicine of Paris, under the influence of Trousseau. When O'Dwyer's tubes were first suggested, then, there were not lacking critics, who said at once that his method was not new, that it had been fairly tried already and found wanting, and that it was hopeless to expect that any intubation method would succeed, since the larynx would not tolerate such a foreign body. There are always those who are sure, on _a priori_ grounds, that a new invention cannot succeed because it infringes on certain well-known physical laws that make it impossible. Similarly there were a number of experienced clinicians who were sure that O'Dwyer's reported results could not be as represented. It was not only from members of the medical profession that O'Dwyer met with discouragement. His work at the Foundling Asylum was carried on in spite of many difficulties and disappointments. His first contrivances for keeping the larynx open in spite of the inflammatory swelling were all failures, and, as owing to unfamiliarity considerable {341} difficulty was experienced in the insertion of the various mechanical appliances, he seemed to be adding to the torture of his little patients. Many of the attendants at the hospital became discouraged and almost dreaded to see any attempt made to save the children. From one of the sisters attached to that institution O'Dwyer received the greatest possible encouragement. Sister Rosalie had often been known to weep at the death of her little charges, orphans though they were, and, though death frequently seemed a welcome relief from suffering, she hoped against hope that something would be accomplished to make deaths by asphyxiation rarer; so that even in the face of repeated failure she was ever ready to encourage O'Dwyer in further attempts in the accomplishment of his humane purpose. Not a little of his ultimate success is due to her sympathy and the enthusiastic faith inspired by her motherly love for the little homeless waifs who had come to occupy places in her heart. At the beginning, some of the specialists in children's diseases gave the new method a trial, yet without obtaining satisfactory results. Professor Jacobi, our most distinguished specialist in that field in America, to whom the German government offered the chair of pediatrics at the University of Berlin, contended, in writing his article on diphtheria for Pepper's _System of Medicine_, that intubation could not be expected to accomplish all that was claimed for it. It was not long, however, before Jacobi realized his mistake in this matter and handsomely made up for it. While he was president of the Academy of Medicine, in opening a discussion on intubation before the academy, in 1886, he said that O'Dwyer's work deserved all possible praise, and that his untiring devotion to the subject, in silent patience until he had brought it to perfection, was a model {342} that might well be held up for the emulation of American physicians, commonly only too prone to announce discoveries even before they were made. Besides the application of O'Dwyer's tubes in acute diseases affecting the larynx and causing difficulty of breathing, the method of intubation has proved of special service in the treatment of stenotic diseases of the larynx. There are certain diseases in which deep ulcerations of the vocal cords, and of the laryngeal structures in their neighborhood, are followed by persistent contraction. This contraction may extend so as to cause serious narrowing of the chink of the glottis, producing difficulty of breathing, and an intense breath-hunger that usually causes excruciating agony. Such patients formerly were objects of very special pity, but unfortunately very little could be done for them. Since the introduction of O'Dwyer's tubes, the lot of these patients has been made not only more tolerable, but, in course of time, even actual cures have been obtained, the tendency to contraction in the scar-tissue in the larynx being eventually overcome, with consequent relief of all the symptoms. Dr. O'Dwyer himself tells the story of the first patient thus treated. It was a woman, about forty years of age, the innocent victim of a dissolute husband, who came suffering with labored, stridulous breathing. The morning of the previous day she had visited a prominent laryngologist of New York City, who advised her to have tracheotomy done before the sun went down. A colleague suggested that she should go to Dr. O'Dwyer to see if he could not give her relief by means of his process of intubation. The stricture in the larynx had resulted after the healing of frequently repeated ulcerations. The tissue all around the site of the old ulcers was densely cicatricial, with a very marked tendency to contract. The aperture through which the breathing {343} had to be done was just sufficient to admit air enough to allow the patient to continue on her feet, but it was becoming ever narrower, while her discomfort was very marked. The stenosis had been coming on for two years, and was slowly progressive in spite of every form of treatment then known to the medical profession. At this time there was no such thing as intubation tubes suited for adults. Dr. O'Dwyer, therefore, had a set made, using as models casts taken from a series of various-sized bodies, and furnishing directions to the instrument-maker from careful measurements of adult larynxes. The tubes were made in various sizes for different-sized people, but none of them was small enough to be of service in this case, and even the largest of the tubes that had been made for children could be inserted only after the use of considerable force. This tube was inserted and allowed to remain for several days and then the next larger size was introduced. As considerable irritation had been set up by the previous tube, however, an interval of several days' rest was allowed. At the end of about eighteen days, breathing had become quite comfortable and the patient was allowed to return to her home in a suburban town. In two months and a half, however, all her symptoms had returned. Another course of dilatation was then undertaken, and the patient was instructed to return thereafter every week for some time, until the tendency to contraction had been overcome. After a time, the intervals between dilatations were increased to a month, and then to six weeks, without any return of the dyspnoea. It is characteristic of O'Dwyer's very conservative view of things to find his prognosis of this case as given to the "Laryngological Section" of the Ninth International Medical Congress. He said: "It is now one year and nine months since I began the {344} dilatation of this patient's larynx, and there is scarcely any doubt that it will be necessary to continue it during the rest of her life." Later, however, we find the report: "The cicatricial tissue in the larynx (as reported by the doctor) lost its tendency to contract, and the patient has remained now for over five years free from any return of the stenosis." This last sentence is from Dr. O'Dwyer's note of the case, when by special invitation he discussed the subject at the annual meeting of the British Medical Association, held at Bristol, England, in July, 1894. Interesting as is the career of Dr. O'Dwyer as an investigator and discoverer in medicine, his character as a man is still more worthy of attention. For nearly thirty-five years he was a member of the staff of the New York Foundling Asylum; during which time he endeared himself to sisters and nurses, to his brother-physicians on the staff and to his little patients. He was eminently conscientious in the fulfilment of his duty, and had a tender sympathy that made him feel every slightest pain of his child-patients almost as personal. One very stormy evening, in the closing years of his life, after his more than twenty years' service as a member of the asylum staff, a little child fell ill and he was sent for. Though not well himself, the doctor came out into the night and the storm to attend the little patient. As he was leaving the hospital, long after midnight, one of the sisters, who had been longest in the hospital and who knew him very well, said to him: "But Doctor, why did you come out on such an awful night? The house physician might have gotten on very well without you until morning, even though the little one was much worse than usual." {345} "Ah, sister," he said, "it was a child suffering, and I couldn't stay home and think that perhaps there was something I might suggest that would relieve that suffering even a little during the night." It was this beautifully tender sympathy that urged him on against many discouragements to continue his investigations with regard to the possibility of intubation, and finally led him to his brilliant and perfected discovery. Yet it is even more interesting to find that after all these years of labor, just as soon as antitoxin was introduced, and it became clear that a new and great advance in therapeutics had probably been made, O'Dwyer immediately took up the new remedy in order to test fully its possibilities. If antitoxin were to prove the success that was claimed for it abroad, if cases of diphtheria were to recover under its influence as they apparently had done in France and Germany, then the role of intubation would soon be a very small one and O'Dwyer's years of patient investigation would go for very little. Such considerations, however, had no weight with him, and it may be said that during his superintendency at the New York Foundling Asylum antitoxin had for the first time a full, unrestricted opportunity given it to demonstrate its power for good. Notwithstanding discouragements of many kinds, the test of the efficacy of diphtheria serum was persevered in when others with more apparent reason for interest in it became disheartened and were ready to give it up, if not even actually deprecating its use. The medical profession understands very well now how unfavorable were the conditions under which diphtheria antitoxin was used at first. The original experiments had been made in the laboratory with small animals, and the amount of antitoxin necessary to produce good effects in human beings was not well understood. As {346} a distinguished authority in children's diseases, who is himself a great advocate of the efficacy of antitoxin, once said: "It can practically be admitted that when first antitoxin was introduced its use was scarcely more than expectant treatment." That is to say, so little of antitoxic power was contained in the serum injected at first that the children were practically only kept from other and more exhausting forms of treatment, while the physicians awaited the results with nature as the only really active therapeutic agent. After all, it must not be forgotten that the first doses of antitoxin contained at most 50 to 100 antitoxin units, as we now measure serum efficacy for the treatment of diphtheria. At the present time no one would think of using less than five hundred units as a beginning dose, and those who obtain the best results begin with 1000 to 1500, or in severe cases with 2000 to 3000 units of antitoxic strength. It is almost providential that, notwithstanding this failure to understand the serum properly, the verdict of the profession did not go so generally against antitoxin as to condemn its use hopelessly. It is owing to O'Dwyer and a few other sympathetic souls, who "hoped almost against hope," that finally experience succeeded in demonstrating the true value of diphtheria antitoxin. There was another difficulty, however, in the way of the adoption of antitoxin that had to be overcome, one that proved no little source of discouragement to many of those who were testing the remedy. The original diphtheria serum employed was not concentrated; so when a sufficient amount of antitoxic units to neutralize the toxins of the disease under treatment was employed, a large quantity of serum had to be injected. Experience shows that the injection of any foreign blood serum into an animal is followed by a certain amount of haemolysis, or blood destruction, and by {347} certain cutaneous manifestations, such as urticaria, erythemata, the familiar hives-like eruption and red itchy spots, which prove a great source of annoyance. In very susceptible cases the injection of even a small amount of foreign serum is followed by some fever, by restlessness, and red and swollen joints. In the early days of the employment of diphtheria antitoxin, all of these complications were noted in many cases. They were sufficient to make many who were interested in the demonstration of the value of antitoxin so disappointed and discouraged that they gave up the task. Not so, however, with O'Dwyer, who continued its use, and encouraged others by his example so that in spite of these objections antitoxin obtained a firm foothold. Dr. O'Dwyer's conduct, with regard to the continued use of antitoxin under the discouraging conditions we have sketched, stamps him as a great member of his humanitarian profession, whose only purpose was the relief of suffering and the cure of disease, without any thought, moreover, of self-glorification. The use of antitoxin has made the necessity for intubation occur much less frequently than before, and thus has undone some of the good contemplated by Dr. O'Dwyer, but has accomplished it in a way which he eminently approved and helped on as far as lay in his power, even at the time when others were doubtful, not without good reasons, as to the results that were being obtained from the use of antitoxin. Perhaps the best index of the sincere simplicity and frank goodness of O'Dwyer's character is to be found in his relations to the religious community of which he had been so long a medical attendant. In the words of one of their superiors, he was looked upon by the sisters at the Foundling Asylum as the father of the house, who had, as might be expected, the confidence and trust of every member of the {348} community. His relations to Sister Irene, the famed superior of the asylum, became those almost of brother to sister. Sister Irene (as is well known), though a woman who accomplished some of the best philanthropic work that, at least, our generation has known, was always in delicate health. For several years before his death, Dr. O'Dwyer scarcely ever let an evening go by without coming to see her personally. He, better than anyone else, realized how much she had done for the Foundling Asylum, and how much her wonderful influence was still accomplishing in making the extension of that work possible. There is, of course, another side to this story of Dr. O'Dwyer's solicitude for Sister Irene that deserves to be noticed. Few women have ever accomplished work of the extent and character that Sister Irene succeeded in doing with so little friction. In the parlor of the Foundling Asylum there is an engrossed scroll--a tribute to her memory from the medical board of the Asylum--which shows how well she was appreciated. As a bit of hospital history it deserves a place here, especially as there seems no doubt that O'Dwyer's mutual relations to the sisters and to the medical staff were of a kind that helped wonderfully in securing the frictionless co-operation that meant so much for the institution. The memorial scroll reads as follows: "Tribute to the memory of Sister Irene--to the Sister Superior who secured friends and funds for the building of the first and largest foundling hospital in America. "To the sweet-souled woman--the friend of the foundling and fallen; to the best friend any medical board ever had, this tribute is presented with their sympathies to the Reverend Mother and the Sisterhood of the Sisters of Charity by the Medical Board of the New York Foundling Hospital." While an extremely modest man himself, and one of very {349} few words, Dr. O'Dwyer delighted in teaching others anything he felt that he knew well himself. His conduct with regard to the teaching of intubation was especially admirable. He was ready to show any serious-minded physician just how the operation was accomplished, and many a young doctor obtained precious training in the exercise of the rather difficult manipulation involved in placing a tube in a child's larynx from the hands of O'Dwyer himself. He never lost patience with the awkward ones and never seemed to consider that too many calls were made on his time. He might easily have made money on the operation or the instruments, but deemed such considerations unworthy of his professional dignity. Personally he was a very reticent man, but, as a number of friends have said of him, "he made every word count;" and those who knew him best justly appreciated the expression of an opinion from him, since it was always sure to be the fruit of mature consideration and the result of personal clinical experience, usually extending over long periods. The opinion held of Dr. O'Dwyer by his colleagues in the profession--and, be it well understood, there is no more searching appreciation of practical methods and theoretical opinions than that obtained by brother-physicians--is the best possible tribute to his greatness as an investigator, his honorableness as a practitioner, and his distinction as a man. We quote the summing up of his character given by Dr. Northrup, who had been his colleague for a score of years at the New York Foundling Asylum, and whose paper on the subject was read before the New York Academy of Medicine shortly after O'Dwyer's death: "What the world knows of O'Dwyer," said Dr. Northrup, "is his genius as an inventor, his achievement in adding a great operation to the equipment of the profession, and thus {350} making the most conspicuous real contribution to medical progress within the last fifty years. This the world knows and has acknowledged. To us there is another and a pleasant duty to testify, that with this genius there was all that goes to make a man. His home life, his religious life, his civic life, his professional relations with both colleague and patient, his hospital relations, were such as befit a high-principled man. As highly as we esteem him as an inventor and genius and practitioner of wide knowledge, as much as we valued his superior medical judgment, we would write upon the monument of his achievements, 'O'Dwyer the Man.'" In a previous passage of his address before the Academy, Dr. Northrup had said: "If I were asked what most contributed to Dr. O'Dwyer's medical excellence I would say his habit of thinking and his good logic. He had a good medical mind, an excellent medical judgment. Above all, that quality of intellect which allows a man to grow after the age of forty. To the New York Foundling Asylum, with which Dr. O'Dwyer was connected for twenty-five years, he was everything; to the maternity service he was the expert obstetrician; in intubation he was the inventor and teacher; in the general medical service he was the constant consulting mind, whose opinion in times of difficulties and in the midst of puzzling clinical problems every one voluntarily sought. To the Sisters of Charity he was physician and friend, consulted with regard to every important concern of the house, whether medical or not. All adored him." Dr. O'Dwyer's domestic life was most happy. He had married, very suitably, a woman of bright disposition, who was a foil to his own soberer and more melancholy ways, and the relations between husband and wife growing tenderer with the progress of years, their home-life became the model {351} of an ideal Christian family. When he lost her through death, more than half of his life seemed to have gone, and he never quite recovered from the blow. The circumstances of her death added to his sense of loss, as it must have increased his appreciation of her worth. She died a martyr to what she considered her duty as a Christian mother. During the course of a pregnancy she was taken with what is known as pernicious vomiting, an affection that is likely to prove fatal unless the irritated uterus should be relieved of its burden--a means that neither she nor her husband would consent to adopt. Her death thus was the result. During the years after the death of the doctor's wife, intimate friends found out what an effort of Christian fortitude it was for him to keep up his spirits and his work. Though he was one of the busiest of professional men, in very active practice, not a week passed but he found time to go to her grave and put flowers thereon. Just after her death he was as a man stricken by some dazing mental affection. Yet his sense of duty was so great that on his return from her funeral, being informed that a little child suffering from diphtheria needed his services for the performance of intubation, he at once made haste to comply with the untimely demand on him, and had given the little patient relief within the quarter of an hour after he had alighted from the funeral carriage. Personally, Dr. O'Dwyer was of cold exterior, nor had he many close friends. Those who knew him well understood that beneath the layer of ice there was a warm, considerate, tender heart for those whom he admitted to the penetralia of his intimacy. On the other hand, few men have ever had friends more devoted than were O'Dwyer's. He was, however, of an extremely sensitive disposition. His conclusions in medicine had always been worked out with {352} the greatest care, and were the results of personal observations. To have them criticised then by those who had much less experience, or who had never thought along the same lines, was always intolerable to him, and generally kept him out of medical discussions. Those who knew him best realized that his opinions were of the greatest value, nor ever failed to contain a germ of original thought, the result of his personal experience. After his long years of work at intubation, many of his medical brethren refused at first to accept his new method of treatment, claiming that it did not reduce the mortality, even though it did for a moment relieve the sufferings of the patient. This position was a source of the keenest disappointment and depression to O'Dwyer. After the method of treatment by intubation had been for some time before the medical profession of the country, a thorough discussion of it was held at one of the meetings of the Academy of Medicine of New York. Authorities in children's diseases from several of the large Eastern cities were invited to be present to give their opinions of intubation. Most of them were agreed that O'Dwyer's invention was of very little service. It was not a novelty in the history of medicine to have a really great and helpful discovery thus at first rejected by those who were later to be its ardent advocates. To O'Dwyer, however, who was present and took part in the discussion, the criticism of his method of treatment was a source of veritable torment. He did not show at the meeting how deeply wounded was his spirit, but for three days afterward he practically shut himself up in his room and refused to see anyone. Naturally he was of a rather melancholic tendency, prone to dwell on the sadder side of things, and was constantly interested in sad stories and songs. He liked sad music, {353} and usually refused to listen to the livelier airs that others, especially of his race, were apt to find so refreshing. Something of this sterner side of his character entered into all his relations with others, and even with his own family. Though deeply affectionate, he very seldom permitted them to see and appreciate that fact. He was rather apt to be stern than otherwise, fearful lest his affection should in any way spoil them. To the very young children, in whose regard he did not consider this objection to hold, he was almost demonstratively affectionate, and those who knew his love for little children appreciated the sacrifice he made in denying himself demonstrations of affection to his own. With all his sadness there was, as might be expected from his racial descent, a vein of dry humor, not infrequently manifest, though only to very near friends. He appreciated a good story, though the slightest tendency to vulgarity was extremely displeasing to him. He is said to be the originator of the humorous expression that has since been used often enough. While one day calling at a friend's house, in the absence of the friend, the servant asked him to leave his name, but was met with the reply (from the doctor) that "he preferred not to, as he thought he might have use for it before he got home." The religious side of O'Dwyer's character is intensely interesting, because it represents a successful professional man--the maker of an important discovery in medicine; a logical, scientific thinker, whose opinion was valued by all his professional brethren--as one of the simplest of believers, tenderly pious and faithful. The sexton of the church near which he lived tells (since his death) of frequently seeing him steal in during the day to say his prayers at the foot of the altar. He was one of the most faithful attendants at the communions and retreats of the Xavier Alumni Sodality {354} of New York City, of which he was an enthusiastic member. His deep piety can, perhaps, be best appreciated from a characteristic incident, which illustrates his faith in prayer--his confidence in Providence. He had asked for something with regard to one of his children over and over again, and finally thought that his prayer had been heard. Later on he had reason to regret the fact that his wish had been granted, and to a friend, to whom he told the circumstances, he said: "All that we can do is to say with resignation, 'Thy will be done,' and then we shall be sure that whatever happens will be for the best." The story of O'Dwyer's death serves to illustrate some of the weaker points of modern medicine. During the nearly ten years after his wife's death he had never been quite the same man, but had succeeded in doing a large amount of work and had continued to care for a very large practice. In December, 1897, he began to develop some anomalous symptoms, pointing to a serious pathological condition within the skull. He seemed to have had what are known as "Ménière's symptoms," that is, a tendency to vertigo, some ringing in the ears and other unpleasant feelings. Toward the end of that month some hemiplegia, or at least some weakness of one side of his body, developed. He was rather neglectful of his personal health, as most physicians are, and until this time had paid very little attention to his symptoms. Most of the prominent New York consultants and nervous specialists were called in, but there was a marked disaccord as to the cause of the symptoms. After some days in bed, comatose symptoms began to manifest themselves, and on January the seventh following, after having been lethargic for some days, Dr. O'Dwyer died. The _antemortem_ diagnosis of his case was dubious, lying amid the possibilities of tubercular meningitis, {355} secondary infection after otitis media, and secondary infection from some external cause. During the previous December, O'Dwyer had been treating a patient with carbuncle, and developed himself a small carbuncle on his chin. By some it is thought that infectious material from this lesion had been carried by emissary veins or their accompanying lymphatics to the inside of the skull, affecting the meninges, and perhaps portions of the brain-substance itself. The _postmortem_ examination did not entirely clear up the doubts of diagnosis. The lateral sinus was found thrombosed, while there were some suspicious signs in the middle ear, but no distinct inflammatory condition. Just how the infection took place, then, is not clear, but O'Dwyer's condition of lowered resistive vitality was evidently at fault, to an important degree, in permitting infection to take place and in not throwing it off afterward. At the time of his death he was about fifty-seven years of age. He had reached the maturity of his powers, and with the consciousness of having accomplished one good work was ready for further original investigations in practical medicine. A thought that had occupied him very much toward the end of his life was the possibility of a mechanical method of treating pneumonia. He had made a series of experiments on the lungs, and many clinical observations with regard to the possibility of producing over-inflation by mechanical measures. He confided to one of his physician friends, who had been closest to him during life, that he hoped thus to secure a method of treating pneumonia successfully. This, after all, is the most serious problem in present-day medicine. Our death-rate from pneumonia is at least as high now as it was a century ago. O'Dwyer started from the observation that those suffering from emphysema seldom develop true pneumonia. And he hoped {356} to prevent the progress of the disease, or to abort it in its inception, by producing artificial emphysema for the time being. Had he lived, it seems not unlikely that we would have had further original work of a high order from him. Though of Irish descent, Dr. O'Dwyer illustrated very well the expression that was used of the English nobility who went to Ireland in Elizabeth's time, and who are said to have become "more Irish than the Irish themselves." O'Dwyer became an American of the Americans. He believed in meeting Americans on their own ground, cultivating their acquaintance, and making them realize the worth of new citizens of the republic by showing them how sincere was the patriotism of their recently admitted compatriots. Dr. O'Dwyer was in everything the model of a Christian gentleman, and an exemplary member of the great humanitarian profession whose charitable opportunities he knew how to find and take advantage of at every turn in life. The American medical profession has never had a more worthy model of all that can be expected from physicians in their philanthropic duties toward suffering humanity, nor a better exemplar of what Christian manhood means in the widest sense of that expressive term. With an inventive genius of a high order, that gave him a prominent place in a great generation and that has stamped his name on the roll of medical fame for all time, there were united the simple faith, the earnest purpose, the clear-sighted judgment and the feeling kindness--those supreme qualities of head and heart that will always secure for him a prominent place in the small group of great medical men. {357} INDEX. Allbutt, 138 Allison, 188 Alternate generation, 238 America to Jenner, 102 Ampere, 19 Aneurism, 43 Aneurism of aorta, 45, 203 Angelo Michel, 33 Angina pectoris, 89 Animal electricity, 119 Antivaccination, 100 Aortic aneurism, 45, 203 Aortic valves, 202 Appendicitis, 285 Arago, 299 Archimedes, 50 Asiatic cholera, 189 Aspergillus, 239 Atmospheric electricity, 121 Attending physician, 202 Auenbrugger and Laennec, 66-72 beneficence, 78; cases, 79; neglect, 69-73; preface, 67 Auscultation, mediate, 145 Avocation, 54 B Bacon, 324 Baron, Dr., 96 Bassi, Laura 126 Bayle, 163 Bedside instruction, 57 Bell, 233 Bernard statue, 272; honors, 286; musical comedy, 275; poverty, 273-275; succeeds Flourens, 286 Benedict XIII, 48 Benedict XIV, 48 Berzelius, 244 Bichat, 153 Biological succession 306 Biot, 299 Birrell Augustine, 107 Blushing, 283 Boerhaave, 49 Bologna, 35-37 Bologna sausage, 34 Bonn, 231 Bouillaud, 148 Bouchut, intubation, 338 Boyle, Robt., 306 Breadth of education, 226 Breton peasant's faith, 294; peasant woman, 294 Bribery and union, 197 Brittany, 138 Bronchitis, chronic, 46 Broussais, 139-152 Brown, Dr. Jno., 270 Browne, Sir Thos., 114 Bruecke, 226 Butt, Isaac, 196 Butyric acid, 304 C Cabanis, 286 Cameron, Sir Chas., 167 Cancer, removal, 46 Carbonic oxide 284 Carlyle, 107 Carriers of disease, 309 Caspar, 219 Catarina Sforza, 33 Cavendish, 19 Cavities, 65 Cell doctrine, 255, 261-264 Cellulose, 300 Charité, La, 152 Chassaignac, 131 Chauffard, 164 Chaussier's tubes, 337 {358} Chauvinism, 235 Chemistry, organic, 296 Cheyne, 170 Cheyne-Stokes, 168, 185, 194 Chicken cholera, 309 Cholera, epidemic, 327 Cirrhosis, 152 Cirrhosis of lungs, 206 Cisalpine republic, 128 Classical training, 227, 288 Claude Bernard, 42 Clement XIII, 48 Cline, Dr., 99 Clinical teaching, 57, 178 Collège de France, 271 Common sense and the beautiful, 198 Comparative pathology, 45 Confidence in medicines, 180 Conservatism, 288 Consumption and alcohol, 174; and city life, 174; curable, 192; outdoor life, 193 Contagion of tuberculosis, 46 Contemporary popularity, 253 Cook, Dr. Win, 48 Corrigan and Sunday closing, 210; as a consultant, 206; as a teacher, 208; disease, 15, 200; honors, 209; member of parliament, 214; physician in ordinary, 212; pulse, 168; practice, 201, 205 Corvisart, 74, 142 Cowpox, 94 Croup, 329 Cuckoo, 93 Cullen, 188 Curare, 284 D Da Costa, 83 Daguerre, 260 Dalkey, 211 Dante, 131 Danube capricious, 64 Darwin, 254 Dean Swift, 167 De Haen, 58; writings, 69 De Maria, 131 Desault, 336; tubes, 337 Desgenettes, 157 Diabetes, 279 Diastases, 287 Dictionnaire des sciences méd., 153 Dieffenbach, 219 Digestion, 278; and emotion, 282 Dignity of medicine, 194 Diphtheria fatality, 329; antitoxin, 345 Discoveries rejected, 14 Discovery in distans, 18; wine of, 298 Dissymmetrical forces, 301 Dissymmetry and universe, 302, 303 Distinction, living and non-living, 300 Doctor of medicine and philosophy, 37 Do not think, investigate, 92 Dom Pedro II, 315 Dublin Zoological Garden, 211 Du Bois-Reymond, 242 Duchesse de Berri, 155 Duclaux, 302 Ductless glands, 281 Ducts of Müller, 233 Dust and life, 306 Dyspepsia, nervous, 282 E Earth worms, carriers of disease, 309 Edinburgh, 208 Education, classical, 288; rounded, 289 Eggs and oxygen, 258 Electricity, animal, 119; atmospheric, 121 Elsner, Dr. Henry L., 137 Emanuel III, 48 Emphysema and pneumonia, 355 Empress Eugenie, 319 Encyclopedists, 115 Eustachius, 32 Eyerel, 74 F Fallopius, 32 Faraday, 19 Fat digestion, 277 Father Morgagni, S. J., 50 Father of German medicine, 217 Father of pathology, 29 Fatty heart, 192 {359} Fermentations, 304; and disease, 306 Ferments, 287 Fever, nature and treatment, 205 Flacherie, 307 Flint, 144, 150, 166 Flourens, 286 Foolishness of materialism, 318 Forli, 33 Foundling Asylum (N. Y.), 328 Franco-Prussian War, 312 Franklin, 19; anticipated, 123 French Revolution, 115; Academy of Physicians, 286 Frog dancing-master, 122 Froriep, 219 Froude, 134 G Gaelic movement, 167 Gairdner, 30 Galeazzi, 116 Galen, 35 Galileo, 244 Galvani, 19; Mme., 117, 120; dancing frogs, 21; the physician, 125; medal, 130 Gases and eggs, 259 German students at Padua, 40; decorations returned, 313; rabies, 313, 314 Girardin, St. Marc, 275 Glycogen, 281 Goerres, 223 Goethe, 227 Gold dust of time, 240 Graves family, 169; as a traveler, 169; fed fevers, 172; perfect teacher, 177; remedies, 177; last moments, 185 Grease in horses, 95 Guerin, 131 H Hahn, S. J., 286 Haller, 29; and Müller, 244 Harvey, 28, 35, 104 Haüy, 116 Heart percussion, 63 Heat production, 281; regulation, 282 Heberden, 89 Heliostat and growth, 302 Helmholtz, 247 Henle, 200 Herter, Dr. Christian, 311, 320 Hibernation, 92 Hippocrates, 35, 142, 336; succussion, 72 Hirsch, Baroness, 315 History, 12 Holme, Sir Edw., 95 Hunter, 90, 120 Huxley, 20 Hydatids, 151 I Ideals, 294; in life, 320 Il Morgagni, 50 Imagination, 284 Indians, American, and Jenner, 103 Infinite and supernatural, 316 Institutions and men, 217 Internal secretion, 280 Intubation experiments, 330; first, 332; for chronic ills, 342; history, 335; improvement, 333; studies, 334; tubes, 331 Inventum novum, 61 Investigating spirit, 16 Irene, Sister, 348 Irish aristocracy, 197; College of Physicians, 210 Italy's leadership in medicine, 31; medical schools, 32 J Jacobi, 341 Jardin des Plantes, 273 Jefferson, 104 Jenner, 77; and Indians, 103; epigrams, 93; honors conferred, 102; Hunter, 91; Mrs. Jenner, 109; Jenner's patience, 91; personality, 105; son inoculated, 93 Jesuit education, 224-273 K Koch, 135 Kühne, 278 Kulturkampf, 249 {360} L La Cellule, 266 Laennec's character, 156; in practice, 161; preface, 154 Laic, saint, 295 Lamarck, 116 Lamennais, 138 Lancet on Corrigan, 207, 212 Lancisi, 57 Laplace, 116 Lavater, 227 Lavoisier, 244 Layard, 184 Lieberkühn, 238 Liebig, 262, 304 Liège, 266 Limitations of genius, 203 Lister, 312 Liston, 338 Littré, 294 Liver sugar, 280 Lough Corrib, 197 Louise Lateau, 267 Louvain, 264 Ludwig, 71 M Magendie, 276, 283 Maisonneuve, 139 Malpighi, 32, 233 Manzolini, Mme., 127 Maria Theresa, 23, 80 Mayer, 22 Maynooth, 207, 212 Mead, Sir Richard, 49 Meckel, 42 Meckel's Archiv, 230 Medical charities bill, 190; education, 181; progress, 19 Medicine an art, 178; and the public, 195; faith, 24; in Italy, 31 Ménière's symptoms, 354 Merbach, 65 Microcosm, 114 Microtome, 256 Milk in diarrhea, 175 Mitscherlich, 297 Molecular forces, 301 Mondino, 32, 34 Moore, Sir Jno., 167, 200 Morgagni daughters nuns, 49; basic idea, 14; literary light, 23; long life, 31; method, 30; popularity, 48 Mouth-gag, 333 Mozart, 81 Müller, a priest of nature, 247; as a teacher, 245, 257; and Aristotle, 224; education, 218; discoveries, 232; distinctions, 244; ducts, 233; father, 222; handbook, 234; introspection, 231; methods, 237; monument, 249; mother, 223; muscular control, 229; panegyric, 220; personality, 246; students, 246; translates plate, 224; vivisection, 225, 235 Muscle sugar, 281 N Napoleon III, 286; judgment, 75, 143 Nasse, 228 Nature, study, 108 Necker hospital, 143 Nervous reflex, 42 Newman, 216 Newton, 244 Normandy, 140 Northrup, 349; O'Dwyer's personality, 350 Not many patients, 181 Nurses, trained, 171 O Observation, 181 O'Connell, 196 O'Dwyer Americanism, 356; birth, boyhood, 326; careful prognosis, 343; cholera volunteer, 327; clinical experience, 339; devotion to duty, 344; discouragements, 340; domestic life, 353; feeling for children, 345; originality, 335; patient work, 328, 339; resignation, 354; sensitiveness, 352 Oersted, 19, 116 Ohm, 19 Olfactory nerve, 42 {361} Opposition to vaccination, 101; to science, 22 Organotherapy, 281 Original research, 13 Origins in electricity, 19 Osler, 14, 252 Otis, Dr. Edw. O., 82 P Padua, 1000 German students, 40 Paine's Age of Reason, 186 Pancreas, 277 Paradise Lost, 41 Parasites, 238 Paratartrates, 297 Pasteur, advice to young men, 321; and money, 319; chemist, 296; faith, 294; ideals, 295; illness, 311; last moments, 318; letters, 317; monument, 293; obsequies, 315; prayer in laboratory, 318; tenderness, 317 Pathology, comparative, 45 Pebrine, 307 Pepsin, 262 Percussion, 62 Petrie, 198 Pharmacy, old-time, 274 Phila. College of Physicians, 144 Philosophy, a little, 126 Phipps Institute, 55 Physiology and Psychology, 286 Pilgrim's Progress, 41 Pindar, 50 Pinel, 142 Pneumonia, 355 Polarization, 299 Poor patients, 214; Corrigan, 213; Galvani, 125; Graves, 171; Laennec, 156; Stokes, 190 Positivism, 295 Practical teaching, 183 Psychologus physiologus, 249 Pulse, intermittence, 45 R Rabies, 313, 314 Radot, M., 301 Ragpicker of science, 283 Ratio medendi, 70 Ray-fish, 124 Read, Dr. C. A. L., 219 Red blood cell, 285 Religion and science, 255; and medicine, 24 Religious training, 108 Removal of stomach, 279 Respiration, 285 Retzius, 239 Rheumatism and the heart, 89 Richardson, Benj. Ward, 36, 40, 153 Richman, 123 Roger, 149 Rosalie, Sister, 341 Rothschild, 315 Roux, 316 Royal Irish Academy, 198 Rudolphi, 230, 234 Ruskin, 20 Ruysch, 49, 233 S Saintignon, Life of Laennec, 157 Salivary nerves, 277 Sap temperatures, 92 Schenkelton, 62 Schlegels, August and Friedrich, 59 Schoenlein, 219, 238 Scholar in medicine, 84 Schott treatment anticipated, 193 Schwann and professorships, 267; devotion to science, 256; friendships, 268; handiness, 260; scientific work, 265 Science and religion, 24, 255 Scott, Sir Walter, 187 Seats and causes of disease, 40 Sense, a new, 148 Silkworm diseases, 306, industry, 307 Sisters Irene and Rosalie, 341, 348 Skepticism, medical, 180 Skoda, 61 Sources of democracy, 316 Spalding, 166, 292 Spanish hospital, Vienna, 60 Specialization, 289 Spigelius, 32 Splenic fever, 308 {362} Spontaneous generation, 262, 287, 309; of disease, 263 Spores, 311 Stereochemistry, 299 Stethoscope, 147; a toy, 16 St. Francis of Assisi, 131 St. Francis of Sales, 117 Still madness, 79 Stokes, 136, 186; character, 200; distinctions, 199; Margaret, 198; Sir Wm. Jr., 198; wife, 199 Stoll, 74 Sugar absorption, 279 Sydenham, 138 Sympathetic nerves, 43, 282 T Tartrates, 297 The chimney sweep, 80 Theorists, 20 Theory and observation, 20 Theriaque, 274 Thompson, 187 Tissue-therapy, 281 Titian, 35 Torpedo fish, 124 Tracheotomy, 329; failure, 330 Trousseau, 15, 176, 200, 238 Trudeau, 55 Truth in medicine, 17 Tuberculosis, 173, 192 Tufnell treatment anticipated, 44 Turner, 170 Typhoid and typhus, 188, 205 U United Irishmen, 186 Unselfish devotion, 25 Uric acid, 300 Utility and ideals, 198 V Vaccination and measles, 102; day, 97; first successful, 98 Valsalva, 36 Van Swieten, 58, 60; writings, 69 Vasomotor nerves, 282 Venesection, 47, 158 Venetian patricians, 48 Vesalius, 32, 35 Vicq d'Azyr, 286 Vienna school, 15, 56; general hospital, 56 Villemin, 135 Virago of Forli, 33 Virchow, 29, 206, 219, 220; Virchow and Müller, 239 Vital force, 218, 242, 288, 299 Vogel, 71 Volta, 19 W Walshe, 144 Wardrop's operation, 204 Washington, 337 Watson, Jno., 338 Werner, 80 Woehler, 218 Women at Italian Universities, 126, 127 Woodhead, G. Sims, 55 Y Young Germany, 263 Young men discoverers, 14, 15, 16; in biology, 16; electricity, 19; in medicine, 201 Z Zois, Baron, 80 Zoological Society, 211 
46664	----	Masters of Medicine Title. Author. JOHN HUNTER _Stephen Paget_ WILLIAM HARVEY _D'Arcy Power_ EDWARD JENNER _Ernest Hart_ SIR JAMES SIMPSON _H. Laing Gordon_ HERMANN VON HELMHOLTZ _John G. McKendrick_ WILLIAM STOKES _Sir William Stokes_ CLAUDE BERNARD _Michael Foster_ SIR BENJAMIN BRODIE _Timothy Holmes_ THOMAS SYDENHAM _J. F. Payne_ VESALIUS _C. Louis Taylor_ MASTERS OF MEDICINE WILLIAM HARVEY [Decoration] [Illustration: MASTERS OF MEDICINE] [Illustration: _Art Repro. Co.y Ph. Sc._ _Cornelius Jonson_ _Engraved by Hall._ WILLIAM HARVEY. 1578 1657] WILLIAM HARVEY BY D'ARCY POWER, F.S.A., F.R.C.S. Eng. SURGEON TO THE VICTORIA HOSPITAL FOR CHILDREN, CHELSEA _LONDON_ T. FISHER UNWIN PATERNOSTER SQUARE MDCCCXCVII _Copyright by T. Fisher Unwin, 1897, for Great Britain and Longmans Green & Co. for the United States of America_ TO DR. PHILIP HENRY PYE-SMITH, F.R.S. IN RECOGNITION OF HIS PROFOUND KNOWLEDGE OF THE PRINCIPLES ADVOCATED BY HARVEY, AND IN GRATITUDE FOR MANY KINDNESSES CONFERRED BY HIM UPON THE AUTHOR PREFACE [Decoration] It is not possible, nor have I attempted in this account of Harvey, to add much that is new. My endeavour has been to give a picture of the man and to explain in his own words, for they are always simple, racy, and untechnical, the discovery which has placed him in the forefront of the Masters of Medicine. The kindness of Professor George Darwin, F.R.S., and of Professor Villari has introduced me to Professor Carlo Ferraris, the Rector Magnificus, and to Dr. Girardi, the Librarian of the University of Padua. These gentlemen, at my request, have examined afresh the records of the University, and have given me much information about Harvey's stay there. The Cambridge Archæological Society has laid me under an obligation by allowing me to reproduce the Stemma which still commemorates Harvey's official connection with the great Italian University. Dr. Norman Moore has read the proof sheets; his kindly criticism and accurate knowledge have added greatly to the value of the work, and he has lent me the block which illustrates the vileness of Harvey's handwriting. I have collected in an Appendix a short list of authorities to each chapter that my statements may be verified, for Harvey himself would have been the first to cry out against such a gossiping life as that which Aubrey wrote of him. D'ARCY POWER. _May 20, 1897._ CONTENTS [Decoration] PAGE I. HARVEY'S LINEAGE 1 II. EARLY LIFE 11 III. THE LUMLEIAN LECTURES 39 IV. THE ZENITH 70 V. THE CIVIL WAR 117 VI. HARVEY'S LATER YEARS 141 VII. HARVEY'S DEATH, BURIAL, AND EULOGY 166 VIII. HARVEY'S ANATOMICAL WORKS 188 IX. THE TREATISE ON DEVELOPMENT 238 APPENDIX 265 INDEX 271 WILLIAM HARVEY I HARVEY'S LINEAGE The history of the Harvey family begins with Thomas Harvey, father of William, the discoverer of the circulation of the blood. The careful search of interested and competent genealogists has ended in the barren statement that the family is apparently descended from, or is a branch of the same stock as, Sir Walter Hervey, "pepperer," or member of the ancient guild which afterwards became the important Company of Grocers. Sir Walter was Mayor of London in the year reckoned from the death of Henry III. in November, 1272. It was the noise of the citizens assembled in Westminster Hall clamouring for Hervey's election as Mayor that disturbed the King's deathbed. The lineage would be a noble one if it could be established, for Hervey was no undistinguished Mayor. He was the worthy pupil and successor of Thomas Fitzthomas, one of the great champions in that struggle for liberty which ended in the death of Simon de Montfort, between Evesham and Alcester, but left the kingdom with a Parliament. Hervey's counsels reconstituted in London the system of civic government, and established it upon its present base; for he assumed as chief of the executive the right to grant charters of incorporation to the craftsmen of the guilds. For a time his efforts were successful, and they wrought him much harm. But his idea survived, and in due season prevailed, for the companies have entirely replaced the guilds not only in London but throughout England. It would be truly interesting if the first great discoverer in physiology could be shown to be a descendant of this original thinker on municipal government. The statement depends for the present on the fact that both bore for arms "argent, two bars nebulée sable, on a chief of the last three crosses pattée fitchée; with the crest, a dexter hand appaumée proper, over it a crescent inverted argent," but arms were as often assumed in the reign of Elizabeth as they are in the Victorian era. Thomas Harvey, the father of William, was born in 1549, and was one of a family of two brothers and three sisters, all of whom left children. Thomas married about 1575 Juliana, the eldest daughter of William Jenkin. His wife died in the following year, probably in childbed, for she left him a daughter, Julian or Gillian, who married Thomas Cullen, of Dover, and died about 1639. Thomas Harvey married again on the 21st of January, 1576-1577, his second wife being Joane, the daughter of Thomas Halke, or Hawke, who was perhaps a relative of his first wife on her mother's side. She lived at Hastingleigh, a village about six miles from Ashford in Kent, and to this couple William was born on the 1st of April, 1578, his father being then twenty-nine and his mother twenty-three. William proved to be the eldest of "a week of sons," as Fuller quaintly expresses it, "whereof this William was bred to learning, his other brethren being bound apprentices in London, and all at last ended in effect in merchants." This statement is not strictly true, as only five of the sons became Turkey merchants and there were besides two daughters. Thomas Harvey was a jurat, or alderman, of Folkestone, where he served the office of mayor in 1600. He lived in a fair stone house, which afterwards became the posthouse. Its site, however, is no longer known, though it is the opinion of those best qualified to judge that it stood at the junction of Church Street with Rendezvous Street. Thomas Harvey seems to have been a man of more than ordinary intelligence and judgment, for "his sons, who revered, consulted, and implicitly trusted him, made their father the treasurer of their wealth when they got great estates, who, being as skilful to purchase land," says Fuller, "as they to gain money kept, employed and improved their gainings to their great advantage, so that he survived to see the meanest of them of far greater estate than himself." To this end he came to London after the death of his wife in 1605, and lived for some time at Hackney, where he died and was buried in June, 1623. His portrait is still to be seen in the central panel in one end wall of the dining-room at Rolls Park, Chigwell, in Essex, which was one of the first estates acquired by his son Eliab. "It is certainly," says Dr. Willis, "of the time when he lived, and it bears a certain resemblance to some of the likenesses we have of his most distinguished son." All that is known of Joan Harvey is on a brass tablet, which still exists to her memory in the parish church at Folkestone. It bears the following record of her virtues, written either by her husband or by William Harvey, her son:-- "A.D. 1605 Nov. 8th died in the 50th. yeare of her age Joan Wife of Tho. Harvey. Mother of 7 sones & 2 Daughters. A Godly harmles Woman: A chaste loveinge Wife: A Charitable qviet Neighbour: A c[~o]fortable frendly Matron: A provident diligent Hvswyfe: A carefvll t[-e]der-harted Mother. Deere to her Hvsband: Reverensed of her Children: Beloved of her Neighbovrs: Elected of God. Whose Soule rest in Heaven, her body in this Grave: To her a Happy Advantage: to Hers an Unhappy Loss." The children of Thomas and Joan Harvey were-- (1) William, born at Folkestone on the 1st of April, 1578; died at Roehampton, in Surrey, on the 3rd of June, 1657; buried in the "outer vault" of the Harvey Chapel at Hempstead, in Essex. (2) Sarah, born at Folkestone on the 5th of May, 1580, and died there on the 18th of June, 1591. (3) John, born at Folkestone on the 12th of November, 1582; servant-in-ordinary, or footman, to James I.--"a post," says Sir James Paget, "which does not certainly imply that he was in a much lower rank than his brothers. It may have been such a place at Court as is now called by a synonym of more seeming dignity; or, if not, yet he may have received a good salary for the office whilst he discharged its duties by deputy." Thus Burke in his famous speech on Economical Reform mentions that the king's _turnspit_ was a member of Parliament. He received a pension of fifty pounds a year when he resigned his place to Toby Johnson on the 6th of July, 1620. He was a member of Gray's Inn, and filled several offices of importance, for he was "Castleman" at Sandgate, in Kent, and King's Receiver for Lincolnshire jointly with his brother Daniel. He sat in Parliament as a member for Hythe, and died unmarried on the 20th of July, 1645. (4) Thomas was born at Folkestone on the 17th of January, 1584-1585. He married first Elizabeth Exton, about 1613; and, secondly, Elizabeth Parkhurst, on the 10th of May, 1621, and he had children by both marriages. His only surviving son sat as M.P. for Hythe in 1621; he also acted as King's Receiver for Lincolnshire. Thomas Harvey was a Turkey merchant in St. Laurence Pountney, at the foot of London Bridge. He was perhaps a member of the Grocers' Company. He died on the 2nd of February, 1622-1623, and was buried in St. Peter-le-Poor. (5) Daniel, also of Laurence Pountney Hill, a Turkey merchant and member of the Grocers' Company, was born at Folkestone on the 31st of May, 1587. He was King's Receiver for Lincolnshire jointly with his brother John. He married Elizabeth Kynnersley about 1619, paid a fine rather than serve the office of Sheriff of London at some time before 1640, and died on the 10th of September, 1649. He was a churchwarden of St. Laurence Pountney in 1624-1625, and was buried there; but his later days were spent on his estate at Combe, near Croydon, in Surrey. His fourth son became Sir Daniel Harvey, and was ambassador at Constantinople, where he died in 1672. His daughter Elizabeth married Heneage Finch, the first Earl of Nottingham, and from this marriage are descended the Earls of Winchelsea and Aylesford. (6) Eliab, also of Laurence Pountney Hill, a Turkey merchant and member of the Grocers' Company, was born at Folkestone on the 26th of February, 1589-1590. He was the most successful of the merchant brothers, and to his watchful care William owed much of his material wealth; for Aubrey says that "William Harvey took no manner of care about his worldly concerns, but his brother Eliab, who was a very wise and prudent manager, ordered all not only faithfully but better than he could have done for himself." Eliab had estates at Roehampton, in Surrey, and at Chigwell, in Essex. He built the "Harvey Mortuary Chapel with the outer vault below it" in Hempstead Church, near Saffron Walden. Here he buried his brother William in 1657, and here he was himself buried in 1661. He married Mary West on the 15th of February, 1624-1625, and by her had several children, of whom the eldest at the Restoration became Sir Eliab Harvey. Walpole writes to Mann about one of his descendants. "Feb. 6, 1780. Within this week there has been a cast at hazard at the Cocoa Tree, the difference of which amounted to an hundred and fourscore thousand pounds. Mr. O'Birne, an Irish gamester, had won £100,000 of a young Mr. Harvey of Chigwell, just started for a midshipman into an estate by his elder brother's death. O'Birne said, 'You can never pay me.' 'I can,' said the youth; 'my estate will sell for the debt.' 'No,' said O'B., 'I will win ten thousand--you shall throw for the odd ninety.' They did, and Harvey won." This midshipman afterwards became Sir Eliab Harvey, G.C.B., in command of the _Téméraire_ at the battle of Trafalgar, and Admiral of the Blue. He sat in the House of Commons for the town of Maldon from 1780 to 1784, and for the county of Essex from 1802 until his death in 1830. With him the male line of the family of Harvey became extinct. (7) Michael, the twin brother of Matthew, was born at Folkestone on the 25th of September, 1593. He lived in St. Laurence Pountney, and St. Helen's, Bishopsgate. Like his other brothers he was a Turkey merchant, and perhaps a member of the Grocers' Company. He married Mary Baker on the 29th of April, 1630, and after her death Mary Millish, about 1635. He had three children by his second wife, and one of his sons died at Bridport in 1685 from wounds received in the service of King James II. Michael Harvey died on the 22nd of January, 1642-1643, and is buried in the church of Great St. Helen's, Bishopsgate. (8) Matthew, the twin brother of Michael, and like him a Turkey merchant and perhaps a member of the Grocers' Company, was born at Folkestone on the 25th of September, 1593. He married Mary Hatley on the 15th of December, 1628, and dying on the 21st of December, 1642, was buried at Croydon. His only child died in her infancy. (9) Amye, the youngest daughter and last child of Thomas and Joan Harvey, was born at Folkestone on the 26th of December, 1596. She married George Fowke in 1615, and died, leaving issue, at some time after 1645. Mr. W. Fleming, the assistant librarian, tells me that nine autotype reproductions of the portraits of the Harvey family at Rolls Park (page 4) are now suspended on the left-hand side wall of the hall of the Royal College of Physicians in Pall Mall. They represent (1) Thomas Harvey and his seven sons. (2) William Harvey, probably an enlarged portrait of that in the preceding group. (3) A family group in the dress of the Queen Anne period. (4) Portrait of a lady in the dress of the reign of Queen Elizabeth; in the corner of the picture appears "obiit 25 Maii 1622." (5), (6) and (7) Portraits of ladies in the dress of the eighteenth century. (8) Portrait of a gentleman in the dress of Charles II.'s time. (9) Portrait of a gentleman in the dress of Queen Anne's reign. II EARLY LIFE Very little is known of the early life of William Harvey. His preliminary education was probably carried on in Folkestone, where he learnt the rudiments of knowledge, gaining his first acquaintance with Latin. One of his earliest distinct recollections must have been in the memorable days in July, 1588, when all was bustle and commotion in his native town. The duty of resisting the Spanish Armada in Kent and Sussex fell upon the "Broderield," or confederation of the Cinque Ports, a body which consisted of the Mayor, two elected Jurats, and two elected Commoners from Hastings, Sandwich, Dover, Romney, Hythe, Winchelsea, and Rye. And as Folkestone for all purposes of defence was intimately allied with Dover, it is not at all unlikely that Thomas Harvey, one of its Jurats, was of its number, or that he was a member of the "Guestling," which, affiliated with the Broderield, had to fix the number, species, and tonnage of the shipping to be found by each port, a somewhat difficult task, as each port's share was a movable quantity requiring constant rearrangement. But even with the machinery of the Broderield and the Guestling, it must have needed much activity to raise the £43,000 which the Cinque Ports contributed to set out the handy little squadron of thirteen sail which did its duty under the orders of Lord Henry Seymour in dispersing the remains of the great Spanish fleet. Harvey must have had some remembrance of the turmoil of the period, though it may have been partially effaced by his new experiences at the King's School, Canterbury, where he was entered for the first time in the same year. He remained at the King's School for five years, no doubt coming home for the holidays, some of which must have been spent in watching the constant transport of troops to Spain and Portugal which was so noticeable a feature in the history of the Cinque Ports during the later years of the life of Elizabeth. His schooling ended, Harvey entered at once as a pensioner, or ordinary student, at Caius College, Cambridge, his surety being George Estey. The record of his entry still exists in the books of the College. It runs: "Gul. Harvey, Filius Thomae Harvey, Yeoman Cantianus, ex oppido Folkeston, educatus in Ludo Literario Cantuar. natus annos 16, admissus pensionarius minor in commeatum scholarium, ultimo die Mai 1593." (William Harvey, the son of Thomas Harvey, a yeoman of Kent, of the town of Folkestone, educated at the Canterbury Grammar School, aged 16 years, was admitted a lesser pensioner at the scholars' table on the last day of May, 1593.) The choice of the college seems to show that Harvey was already destined by his father to follow the medical profession. His habits of minute observation, his fondness for dissection and his love of comparative anatomy had probably shown the bias of his mind from his earliest years. Thirty-six years before Harvey's entry, Gonville Hall had been refounded as Gonville and Caius College, Cambridge, by Dr. Caius, who was long its master. Caius, in addition to his knowledge of Greek, may be said to have introduced the study of practical anatomy into England. His influence obtained for the college the grant of a charter in the sixth year of the reign of Queen Elizabeth, a charter by which the Master and Fellows were allowed to take annually the bodies of two criminals condemned to death and executed in Cambridge or its Castle free of all charges, to be used for the purposes of dissection, with a view to the increase of the knowledge of medicine and to benefit the health of her Majesty's lieges, without interference on the part of any of her officials. Unfortunately no record has been kept as to the use which the college made of this privilege, nor are there any means of ascertaining whether Harvey did more than follow the ordinary course pursued by students until he graduated as a Bachelor of Arts in 1597. His education, in all probability, had been wholly general thus far, consisting of a sound knowledge of Greek, a very thorough acquaintance with Latin, and some learning in dialectics and physics. He was now to begin his more strictly professional studies, and the year after he had taken his Arts degree at Cambridge found him travelling through France and Germany towards Italy, where he was to study the sciences more nearly akin to medicine, as well as medicine itself. The great North Italian Universities of Bologna, Padua, Pisa, and Pavia, were then at the height of their renown as centres of mathematics, law, and medicine. Harvey chose to attach himself to Padua, and many reasons probably influenced him in his choice. The University was specially renowned for its anatomical school, rendered famous by the labours of Vesalius, the first and greatest of modern anatomists, and by the work of his successor, Fabricius, born at Aquapendente in 1537. Caius had lectured on Greek in Padua, and some connection between his college at Cambridge and his old University may still have been maintained, though it was now nearly a quarter of a century since his death. The fame of Fabricius and his school was no doubt the chief reason which led Harvey to Padua, but there was an additional reason which led his friends to concur cheerfully in his resolve. Padua was the University town of Venice, and the tolerance which it enjoyed under the protection of the great commercial republic rendered it a much safer place of residence for a Protestant than any of the German Universities, or even than its fellows in Italy. The matriculation registers which have recently been published show how large a number of its medical and law students were drawn from England and the other Protestant countries of Europe, and the English and Scotch "nation" existed in Padua as late as 1738, when the days of mediæval cosmopolitanism were elsewhere rapidly passing away. The Universities of Europe have always been of two types, the one Magistral, like that of Paris, with which we are best acquainted, for Oxford and Cambridge are modelled on Paris, and the Masters of Arts form the ruling body; the other, the Student Universities, under the control of the undergraduates, of which Bologna was the mother. Hitherto Harvey had been a member of a Magistral University, now he became attached to a University of Students, for Padua was an offshoot of Bologna. Hitherto he had received a general education mainly directed by the Church, now he was to follow a special course of instruction mainly directed by the students themselves, for they had the power of electing their own teachers, and in these points lies the great difference between a University of Masters and a University of Students. In 1592 there were at Padua two Universities, that of the jurists, and that of the humanists--the Universitas juristarum and the Universitas artistarum. The jurists' University was the most important, both in numbers and in the rank of its students; the artistarum Universitas consisted of the faculties of divinity, medicine, and philosophy. It was the poorer, and in some points it was actually under the control of the jurists. In each university the students were enrolled according to their nationality into a series of "nations." Each nation had the power of electing one, and in some cases two, representatives--conciliarii--who formed with the Rectors the executive of the University. The conciliarii, with the consent of one Rector, had the power of convening the congregation or supreme governing body of the University, which consisted of all the students except those poor men who lived "at other's expense." Harvey went to Padua in 1598, but it appears to be impossible to recover any documentary evidence of his matriculation, though it would be interesting to do so, as up to the end of the sixteenth century each entry in the register is accompanied by a note of some physical peculiarity as a means of identifying the student. Thus:-- "D. Henricus Screopeus, Anglus, cum naevo in manu sinistrâ, die nonâ Junii, 1593." [Mr. Henry Scrope, an Englishman, with a birthmark on his left hand (matriculated), 9 June, 1593.] "Johannes Cookaeus, anglus, cum cicatrice in articullo medii digiti die dicta." [John Cook, an Englishman, with a scar over the joint of his middle finger (matriculated) on the same day (9 June, 1593).] And at another time, "Josephus Listirus, anglus, cum parva cicatrice in palpebra dextera." [Joseph Lister, an Englishman, with a little scar on his right eyebrow (matriculated on the 21st of November, 1598).] Notwithstanding Harvey entered at Padua in 1598 no record of him has been found before the year 1600, although Professor Carlo Ferraris, the present Rector Magnificus and Dr. Girardi, the Librarian of the University, have, at my request, made a very thorough examination of the archives. Dr. Andrich published in 1892 a very interesting account of the English and Scotch "nation" at Padua with a list of the various persons belonging to it. This register contains the entry, "D. Gulielmus Ameius, Anglus," the first in the list of the English students in the Jurist University of Padua for the new century as it heads the year 1600-1601, and a similar entry occurs in 1601-1602. There are also entries about this person which show that at the usual time of election, that is to say, on the 1st of August in the years 1600, 1601, and 1602, he was elected a member of the council (conciliarius) of the English nation in the Jurist University of Padua. His predecessors, colleagues, and successors in the council usually held office for two years. He was therefore either elected earlier into the council, or he was resident in the university for a somewhat longer time than the majority of the students. Prof. Ferraris and Dr. Girardi have carefully examined this entry for me, and they assure me that there is no doubt that in the original the word is Arveius and not Ameius and that it refers to William Harvey. They are confirmed in this idea by the discovery of his "Stemma" as a councillor of the English nation for the year 1600. Stemmata are certain tablets erected in the university cloisters and in the hall or "Aula Magna" (which is on the first floor) to commemorate the residence in Padua of many doctors, professors, and students. They are sometimes armorial and sometimes symbolical. In 1892 Professor George Darwin carried an address from the University of Cambridge to that of Padua on the occasion of the tercentenary celebration of the appointment of Galileo to a Professorship in Padua. Professor Darwin then made a careful examination of these monuments so far as they related to Cambridge men, but he was unable to find any memorial of Harvey. Professor Ferraris continued the search, and on the 20th of March, 1893, he wrote to Professor Darwin: "We have succeeded in our search for the arms of Harvey. We have discovered two in the courtyard in the lower cloister. The first is a good deal decayed and the inscription has disappeared; but the second is very well preserved and we have also discovered the inscription under a thin coating of whitewash which it was easy to remove." The monuments, which are symbolical, though Harvey was a gentleman of coat armour, are situated over the capitals of the columns in the concavity of the roof, one being in the left cloister, the other in the cloister opposite to the great gate of the court of the palace. [Illustration: [_To face page 20._ ] The kindness of Professor George Darwin has enabled me to reproduce this "stemma" from a photograph made for the Cambridge Antiquarian Society's publications. The memorial consists of an oval shield with a florid indented border having a head carved at each end of the oval. The shield shows a right arm which issues from the sinister side of the oval and holds a lighted candle round which two serpents are twined. Traces of the original colouring (a red ground, a white sleeved arm, and green serpents) remained on one of the monuments, and both have now been accurately restored by the Master and Fellows of Gonville and Caius College, Cambridge. A coloured drawing of the tablet has also been made at the expense of the Royal College of Physicians of London, and is now in their possession. A replica of this drawing was presented by the University Senate of Padua to Gonville and Caius College on the occasion of the dinner given in their hall in June, 1893, to commemorate the admission of Harvey to the college on the 31st of May, 1593. It appears, therefore, that Harvey was a member of the more aristocratic Universitas Juristarum at Padua, which admitted a few medical and divinity students into its ranks, and that he early attained to the position of conciliarius of his nation. As a conciliarius Harvey must have taken part more than once in one of the most magnificent ceremonials which the university could show--the installation of a new Rector. The office of Rector was biennial, the electors being the past rectors, the councillors, and a great body of special delegates. The voting was by ballot, a Dominican priest acting as the returning officer. The ceremony took place in the Cathedral in the presence of the whole university. Here the Rector elect was solemnly invested with the rectorial hood by one of the doctors, and he was then escorted home in triumph by the whole body of students, who expected to be regaled with a banquet, or at the least with wine and spices. Originally a tilt or tournament was held, at which the new rector was required to provide two hundred spears and two hundred pairs of gloves; but this practice had been discontinued for some time before Harvey came into residence. A remarkable custom, however, remained, which allowed the students to tear the clothes from the back of the newly elected rector, who was then called upon to redeem the pieces at an exorbitant rate. So much license attended the ceremony that a statute was passed in 1552 to restrain "the too horrid and petulant mirth of these occasions," but it did not venture to abolish the time-honoured custom of the "vestium laceratio." To make up for the magnificence of these scenes the Paduan student underwent great hardships. Food was scanty and bad, forms were rough, the windows were mere sheets of linen, which the landlord was bound to renew as occasion required; but to this Harvey was accustomed, for as late as 1598 the rooms of some of the junior fellows at King's College, Cambridge, were still unprovided with glass. Artificial light was ruinously expensive, and there was an entire absence of any kind of amusement. The medical session began on St. Luke's Day in each year, when there was an oration in praise of medicine followed by High Mass and the Litany of the Holy Ghost. The session lasted until the Feast of the Assumption, on August 15th, and in this time the whole human body was twice dissected in public by the professor of Anatomy. The greater part of the work in the university was done between six and eight o'clock in the morning, and some of the lectures were given at daybreak, though Fabricius lectured at the more reasonable hour (horà tres de mane) which corresponded with nine o'clock before noon. Hieronymus Fabricius was at once a surgeon, an anatomist, and the historian of medicine; and as he was one of the most learned so he was one of the most honoured teachers of his day. Amongst the privileges which the Venetian Senate conferred upon the rector of the University of Padua was the right to wear a robe of purple and gold, whilst upon the resignation of his office he was granted the title for life of Doctor, and was presented with the golden collar of the Order of St. Mark. Fabricius, like the Rector, was honoured with these tokens of regard. He was granted precedence of all the other professors, and in his old age the State awarded him an annual pension of a thousand crowns as a reward for his services. The theatre in which he lectured still exists. It is now an ancient building with circular seats rising almost perpendicularly one above another. The seats are nearly black with age, and they give a most venerable appearance to the small apartment, which is wainscoted with curiously carved oak. The lectures must have been given by candlelight, for the building is so constructed that no daylight can be admitted. But when Harvey was at Padua the theatre was new, and the Government had placed an inscription over the entrance to commemorate the liberality as well as the genius of Fabricius, who had built the former theatre at his own expense. Here Harvey sat assiduously during his stay in Padua, learning charity, perhaps, as well as anatomy from his master; for Fabricius had at home a cabinet set apart for the presents which he had received instead of fees, and over it he had placed the inscription, "Lucri neglecti lucrum." Fabricius was more than a teacher to Harvey, for a fast friendship seems to have sprung up between master and pupil. Fabricius--then a man of sixty-one he lived to be eighty-two--was engaged during Harvey's residence in Padua in perfecting his knowledge of the valves of the veins. The valves had been known and described by Sylvius of Louvilly (1478-1555), that old miser, but prince of lecturers, who warmed himself in the depth of a Parisian winter by playing ball against the wall of his room rather than be at the expense of a fire, and who threatened to close the doors of his class-room until two defaulting students either paid their fees or were expelled by their fellows. But the work of Sylvius had fallen into oblivion and Fabricius rediscovered the valves in 1574. His observations were not published until 1603, when they appeared as a small treatise "de venarum ostiolis." There is no doubt that he demonstrated their existence to his class, and Harvey knew of the treatise, though it was published a year after he had returned to England. Indeed, when we look at Harvey's work, much of it appears to be a continuation and an amplification of that done by Fabricius. Both were intensely interested in the phenomena of development; both wrote upon the structure and functions of the skin; both studied the anatomy of the heart, lungs, and blood vessels; both wrote a treatise "de motu locali." Harvey's youth, his comparative freedom from the trammels of authority, and his more logical mind, enabled him to outstrip his master and to avoid the errors into which he had fallen. This advance is particularly well seen in connection with the valves of the veins. Fabricius taught that their purpose was to prevent over-distension of the vessels when the blood passed from the larger into the smaller veins (a double error) whilst they were not needed in the arteries because the blood was always in a state of ebb and flow. It was left for Harvey to point out their true use and to indicate their importance as an anatomical proof of the circulation of the blood. Harvey graduated as Doctor of Medicine at Padua in 1602 in the presence, it is said, of Fortescue, Willoughby, Lister, Mounsell, Fox [disguised in the Records as Vulperinus], and Darcy, some of whom remained his friends throughout life. The eulogistic terms in which his diploma is couched leave no doubt that his abilities had made a deep impression upon the mind of his teachers. By some means it came into the hands of Dr. Osmond Beauvoir, head master of the King's School, Canterbury, by whom it was presented to the College of Physicians of London on September 30, 1766. The diploma is dated April 25, 1602, and it confers on Harvey the degree of Doctor of Physic, with leave to practise and to teach arts and medicine in every land and seat of learning. It further recites that "he had conducted himself so wonderfully well in the examination, and had shown such skill, memory, and learning that he had far surpassed even the great hopes which his examiners had formed of him. They decided therefore that he was skilful, expert, and most efficiently qualified both in arts and medicine, and to this they put their hands, unanimously, willingly, with complete agreement, and unhesitatingly." Armed with so splendid a testimonial Harvey must have returned at once to England, for he obtained the degree of Doctor of Medicine from the University of Cambridge in the same year. The University records of Padua seemed to show that he maintained a somewhat close relationship with his Italian friends for some years afterwards as the following entries appear:-- "1608-9 xxi. julii d. Gulielmus Herui, anglus. ix-xxx d. Gulielmus Heruy. 30 D. Gulielmus Heruy anglus die xx aug. cons. anglicae electus." The entries are given as they stand in Dr. Andrich's book, "De natione Anglica." They need further elucidation, for they either refer to some other person of the name of Harvey, or they point to visits made by Harvey in some of his numerous continental journeys. It is somewhat remarkable that all the records are found in the annals of the jurist university when Harvey should have belonged to the humanists. Perhaps the prestige of the dominant University more than compensated for the separation from his colleagues who were studying medicine. Indeed the separation may have been only nominal, for the students of the humanist and jurist universities might have sat side by side in the lecture theatre and in the dissecting room, just as members of the different colleges still do in Oxford. But party distinctions ran high at the time, and there was probably no more social intercourse between the members of the two universities than there is now between the individuals of different corps in a German university. Soon after his return to England Harvey seems to have taken a house in London, in the parish of St. Martin's, extra Ludgate, and he lost no time in attaching himself to the College of Physicians. This body had the sole right of licensing physicians to practise in London and within seven miles of the City. Admission to the College was practically confined to graduates in medicine of the English Universities, but those who held a diploma from a foreign university were allowed to enrol themselves if they produced letters testimonial of admission _ad eundem_ at Oxford or Cambridge, and perhaps it was for this reason that Harvey proceeded to qualify himself by taking his M.D. degree at Cambridge. He was admitted a Candidate of the College of Physicians on October 5, 1604, in the stone house, once Linacre's, in Knightrider Street, the candidates being the members or commonalty of the College from whom its Fellows were chosen. Harvey married a few weeks after his admission to the College of Physicians. The Registers of St. Sepulchre's Church are wanting at this time, but the allegation for his marriage licence is still extant. It was issued by the Bishop of London and runs:-- "1604 Nov. 24. William Harvey, Dr. of Physic, Bachelor, 26, of St. Martin's, Ludgate, and Elizabeth Browne, Maiden, 24, of St. Sepulchre's, daughter of Lancelot Browne of same, Dr. of Physic who consents; consent also of Thomas Harvey, one of the Jurats of the town of Folston in Kent, father of the said William; at St. Sepulchre's Newgate." Dr. Browne was physician to Queen Elizabeth and to James I. He died the year following the marriage of his daughter. Harvey's union was childless, and we know nothing of Mrs. Harvey except that she died before her husband, though she was alive in 1645, when John Harvey died and left her a hundred pounds. She is incidentally mentioned by her husband in the following account of an accomplished parrot, who was Mrs. Harvey's pet. Through a long life the parrot maintained the masculine character until in one unguarded moment she lost both life and reputation. "A parrot, a handsome bird and a famous talker, had long been a pet of my wife's. It was so tame that it wandered freely through the house, called for its mistress when she was abroad, greeted her cheerfully when it found her, answered her call, flew to her, and aiding himself with beak and claws, climbed up her dress to her shoulder, whence it walked down her arm and often settled upon her hand. When ordered to sing or talk, it did as it was bidden even at night and in the dark. Playful and impudent, it would often seat itself in my wife's lap to have its head scratched and its back stroked, whilst a gentle movement of its wings and a soft murmur witnessed to the pleasure of its soul. I believed all this to proceed from its usual familiarity and love of being noticed, for I always looked upon the creature as a male on account of its skill in talking and singing (for amongst birds the females rarely sing or challenge one another by their notes, and the males alone solace their mates by their tuneful warblings) ... until ... not long after the caressings mentioned, the parrot, which had lived for so many years in health, fell sick, and by and by being seized with repeated attacks of convulsions, died, to our great sorrow, in its mistress's lap, where it had so often loved to lie. On making a post-mortem examination to discover the cause of death I found an almost complete egg in its oviduct, but it was addled." There are no means of knowing how Harvey spent the first few years of his married life in London, though it is certain that he was not idle. He was probably occupied in making those observations on the heart and blood vessels which have since rendered his name famous. Indeed his lectures show an intimate acquaintance with the anatomy of more than sixty kinds of animals, as well as a very thorough knowledge of the structure of the human body, and such knowledge must have cost him years of patient study. At the same time he practised his profession, and won for himself the good opinion of his seniors. He was elected a Fellow of the College of Physicians, June 5, 1607, and thereupon he sought almost immediately to attach himself to St. Bartholomew's Hospital. The offices in the hospital at that time were usually granted in reversion--that is to say, a successor was appointed whilst the occupant was still in possession. Following this custom the hospital minutes record that-- "At a Court [of Governors] held on Sunday, the 25th day of February, Anno Domini 1608-9, "In presence of Sir John Spencer, Knight, President (and others). "Mr.[1] Dr. HARVEY "This day Mr. William Harvey Doctor of Physic made suit for the reversion of the office of the Physician of this house when the same shall be next void and brought the King's Majesty his letters directed to the Governors of this house in his behalf, and showed forth a testimony of his sufficiency for the same place under the hand of Mr. Doctor Adkynson president of the College of the physicians and diverse other doctors of the auncientest of the said College. It is granted at the contemplation of his Majesty's letters that the said Mr. Harvey shall have the said office next after the decease or other departure of Mr. Doctor Wilkenson who now holdeth the same with the yearly fee and duties thereunto belonging, so that then he be not found to be otherwise employed, that may let or hinder the charge of the same office, which belongeth thereunto." This grant practically gave Harvey the position which is now occupied by an assistant physician, as one who was appointed to succeed to an office in this manner was usually called upon to discharge its duties during the absence or illness of the actual holder. Harvey seems to have carried out his duties with tact and zeal, for Dr. Wilkinson, himself a Fellow of Trinity College, Cambridge, gave him the benefit of his professional experience and remained his friend. It seems possible that John Harvey's position at Court enabled him to obtain from the King the letters recommendatory which rendered his brother's application so successful at St. Bartholomew's Hospital. However this may be, Harvey did not long occupy the subordinate position, for Dr. Wilkinson died late in the summer of 1609, and on August 28 in the same year Harvey offered himself to the House Committee "to execute the office of physician of this house until Michaelmas next, without any recompense for his pains herein, which office Mr. Doctor Wilkinson, late deceased, held. And Mr. Doctor Harvey being asked whether he is not otherwise employed in any other place which may let or hinder the execution of the office of the physician toward the poor of this hospital hath answered that he is not, wherefore it is thought fit by the said governors that he supply the same office until the next Court (of governors). And then Mr. Doctor Harvey to be a suitor for his admittance to the said place according to a grant thereof to him heretofore made." The form of his election therefore was identical with that which is still followed at the Hospital in cases of an appointment to an uncontested vacancy. The House Committee or smaller body of Governors recommend to the whole body or Court of Governors with whom the actual appointment lies. Harvey performed his duties as physician's substitute at the hospital until-- "At a Court [of Governors] held on Sunday the 14th day of October 1609. "In presence of Sir John Spencer, Knight, President (and others). "Dr. HARVEY. "This day Mr. William Harvey Doctor of Physic is admitted to the office of Physician of this Hospital, which Mr. Dr. Wilkenson, deceased, late held, according to a former grant made to him and the charge of the said office hath been read unto him." The charge runs in the following words; it is dated the day of Harvey's election:-- "_October 14, 1609._ "The Charge of the Physician of St. Bartholomew's Hospital. "PHYSICIAN. "You are here elected and admitted to be the physician for the Poor of this Hospital, to perform the charge following, That is to say, one day in the week at the least through the year or oftener as need shall require you shall come to this hospital and cause the Hospitaller, Matron, or Porter to call before you in the hall of this hospital such and so many of the poor harboured in this hospital as shall need the counsell and advice of the physician. And you are here required and desired by us, in God his most holy name, that you endeavour yourself to do the best of your knowledge in the profession of physic to the poor then present, or any other of the poor at any time of the week which shall be sent home unto you by the Hospitaller or Matron for your counsel, writing in a book appointed for that purpose such medicines with their compounds and necessaries as appertaineth to the apothecary or this house to be provided and made ready for to be ministered unto the poor, every one in particular according to his disease. You shall not, for favour, lucre, or gain, appoint or write anything for the poor but such good and wholesome things as you shall think with your best advice will do the poor good, without any affection or respect to be had to the apothecary. And you shall take no gift or reward of any of the poor of this house for your counsel. This you will promise to do as you shall answer before God, and as it becometh a faithful physician, whom you chiefly ought to serve in this vocation, is by God called unto and for your negligence herein, if you fail, you shall render account. And so we require you faithfully to promise in God his most holy name to perform this your charge in the hearing of us, with your best endeavour as God shall enable you so long as you shall be physician to the poor of this hospital." Dr. Norman Moore says that, as physician, Harvey sat once a week at a table in the hall of the hospital, and that the patients who were brought to him sat by his side on a settle--the apothecary, the steward, and the matron standing by whilst he wrote his prescriptions in a book which was always kept locked. The hall was pulled down about the year 1728, but its spacious fireplace is still remembered because, to maintain the fire in it, Henry III. granted a supply of wood from the Royal Forest at Windsor. The surgeons to the hospital discharged their duties in the wards, but the physician only went into them to visit such patients as were unable to walk. The office of physician carried with it an official residence rented from the governors of the hospital at such a yearly rent and on such conditions as was agreed upon from time to time. Harvey never availed himself of this official residence, for at the time of his election he was living in Ludgate, where he was within easy reach of the hospital. For some reason, however, it was resolved at a Court of Governors, held under the presidency of Sir Thomas Lowe on July 28, 1614, that Harvey should have this residence, consisting of two houses and a garden in West Smithfield adjoining the hospital. The premises were let on lease at the time of the grant, but the tenure of Harvey or of his successor was to begin at its expiration. The lease did not fall in until 1626, when Harvey, after some consideration, decided not to accept it. It was therefore agreed, on July 7, 1626, that his annual stipend should be increased from £25 to £33 6s. 8d. In these negotiations, as well as in some monetary transactions which he had with the steward of the hospital at the time of his election as physician to the hospital, we seem to see the hand of Eliab, for throughout his life William was notoriously open-handed, indifferent to wealth, and constitutionally incapable of driving a bargain. III THE LUMLEIAN LECTURES Until the year 1745 the teaching of Anatomy in England was vested in a few corporate bodies, and private teaching was discouraged in every possible way, even by fine and imprisonment. The College of Physicians and the Barber Surgeons' Company had a monopoly of the anatomical teaching in London. In the provinces the fragmentary records of the various guilds of Barber Surgeons show that many of them recognised the value of a knowledge of Anatomy as the foundation of medicine. In the universities there were special facilities for its teaching. But subjects were difficult to procure, and dissection came to be looked upon as part of a legal process so inseparably connected with the death penalty for crime that it was impossible to obtain even the body of a "stranger" for anatomical purposes. The Act of Parliament which, in 1540, united the Guild of Surgeons with the Company of Barber Surgeons in London especially empowered the masters of the united company to take yearly the bodies of four malefactors who had been condemned and put to death for felony for their "further and better knowledge, instruction, insight, learning, and experience in the science and faculty of surgery." Queen Elizabeth, following this precedent, granted a similar permission to the College of Physicians in 1565. The Charter allowed the President of the College of Physicians to take one, two, three, or four bodies a year for dissection. The radius from which the supply might be obtained was enlarged, so that persons executed in London, Middlesex, or any county within sixteen miles might be taken by the college servants. The proviso would appear to be unnecessary, considering the great number of executions which then took place and the small number of bodies which were required, but it probably enabled the subjects to be obtained with greater ease. The executions in London were witnessed by great crowds, who often sided with the friends of the felons, and rendered it impossible for the body to be taken away for dissection. The Charter of James I. enlarged these powers by allowing the College of Physicians to take annually the bodies of six felons executed in London, Middlesex, or Surrey. Little is known in detail of the manner in which Anatomy was taught by the College of Physicians, but the labours of Mr. Young and Mr. South have given us an accurate picture of the way in which it was carried out by the Barber Surgeons in London. We may be sure that in so conservative an age the methods did not differ greatly at the two institutions, especially as the Barber Surgeons usually enlisted the services of the better trained physicians to teach their members both Anatomy and Surgery. Anatomy was taught practically in a series of demonstrations upon the body; but as there was no means of preserving the subject, it had to be taught by a general survey rather than in minute detail. The method adopted was the one still followed by the veterinary student. A single body was dissected to show the muscles (this was the muscular lecture); another to show the bones (the osteological lecture); another to show the parts within the head, chest, and abdomen (the visceral lecture). The osteological lecturer was not always identical with the visceral lecturer, nor he with the lecturer upon the muscles, though some great teachers, like Reid and Harvey, gave a course upon each subject. The Demonstrations usually took place four times a year, and were called Public Anatomies, because the subject was generally a public body--that is to say, it was a felon executed for his misdeeds. There was also an indefinite number of Private Anatomies. The attendance of surgeons at the Public Anatomies was compulsory. The attendance at the Private Anatomies was by invitation. It was illegal for any surgeon to dissect a human body in the City of London, or within a radius of seven miles, without permission of the Barber Surgeons' Company; and in 1573 the Company's Records for May 21st contain the minute: "Here was John Deane and appointed to bring in his fine of ten pounds (for having an Anatomy in his house contrary to an order in that behalf) between this and Midsummer next"--an enormously heavy punishment when we remember the relative value of money in those days. Whenever a surgeon wished to dissect a particularly interesting subject, it was termed a Private Anatomy, and it was generally performed at the Hall of the Company after due permission had been asked for and obtained, the surgeon inviting his own friends and pupils, the Company inviting whom it chose. Every effort was made to insure the punctual attendance at the public or compulsory anatomies, for it was enacted in 1572 that every man of the Company using the mystery or faculty of surgery, be he freeman, foreigner, or alien stranger, shall come unto the Anatomy lecture, being by the beadle warned thereto. And for not keeping their hour, both in the forenoon and also in the afternoon, and being a freeman, shall forfeit and pay at every time fourpence. The foreigner (or one who was not free of the Company) in like manner, and the stranger sixpence. The said fines and forfeits to be employed by the anatomists for their expenses. Excuses were sometimes admitted, for a few years earlier Robert Mudsley "hath licence to be absent from all lecture days without payment of any fine because he hath given over exercising of the art of Surgery and doth occupy only a silk shop and shave." In later years, the higher the position of the defaulter in the Company, the heavier was his fine for non-attendance; so that the assistants of the Company, who corresponded to the Council of the present Royal College of Surgeons, were fined 3s. 4d. for each lecture they missed. Every effort was made to render the lectures successful. The best teachers were obtained; they were paid liberally, and each lecturer or reader was himself assisted by two demonstrators. Each course lasted three days--a lecture in the morning, a lecture in the afternoon, and a feast between the two lectures. As the anatomies were a public show, we may feel sure that Pepys attended one, and, as usual, he gives a perfectly straightforward account of the proceedings. He records under the date February 27, 1662-1663: "Up and to my office.... About eleven o'clock Commissioner Pett and I walked to Chyrurgeon's Hall (we being all invited thither, and promised to dine there), where we were led into the Theatre: and by and by comes the reader Dr. Tearne, with the Master and Company in a very handsome manner: and all being settled, he begun his lecture, this being the second upon the kidneys, ureters, &c., which was very fine; and his discourse being ended, we walked into the Hall, and there being great store of company, we had a fine dinner and good learned company, many Doctors of Phisique, and we used with extraordinary great respect.... After dinner Dr. Scarborough took some of his friends, and I went along with them, to see the body alone, which we did, which was a lusty fellow, a seaman that was hanged for a robbery. I did touch the dead body with my bare hand: it felt cold, but methought it was a very unpleasant sight.... Thence we went into a private room, where I perceive they prepare the bodies, and there were the kidneys, ureters, &c., upon which he read to-day, and Dr. Scarborough, upon my desire and the company's, did show very clearly the manner of the disease of the stone and the cutting, and all other questions that I could think of.... Thence with great satisfaction to me back to the Company, where I heard good discourse, and so to the afternoon lecture upon the heart and lungs, &c., and that being done we broke up, took leave and back to the office, we two, Sir W. Batten, who dined here also, being gone before." Pepys' interest in this particular lecture lay in the fact that he had himself been cut for stone, a disease which seems to have been hereditary in his mother's family. Dr. Scarborough, who had been the Company's lecturer for nineteen years, was the friend and pupil of Harvey, whose interest had obtained the post for him. He seems to have been succeeded by Dr. Christopher Terne, assistant physician to St. Bartholomew's Hospital, whose lecture Pepys heard. The cost of the lectures and demonstrations was defrayed at first by the Corporations, but in course of time, benefactors came forward and bequeathed funds for the purpose. In the year 1579 there was a motion before the Court of the Barber Surgeons' Company concerning a lecture in surgery "to be had and made in our Hall and of an annuity of ten pounds to be given for the performance thereof yearly by Master Doctor Caldwall, Doctor in phisick; but it was not concluded upon neither was any further speech at that time." No reference to the proposal occurs subsequently in the minute books, so that the idea was probably abandoned, no doubt upon the ground that it would lead to additional expense which the Company was unprepared to meet. The annuity was only ten pounds a year, and in 1646 the cost of the lectures, including the dinners, amounted to £22 14s. 6d., or without the feasts to £12 14s. 6d. It is now obvious that the Company did a very stupid thing, for in 1581, two years later, Lord Lumley in conjunction with Dr. Caldwell, and at his instance, founded the Lumleian lectureship at the College of Physicians. The surgeons thus lost a noble benefaction which should of right have belonged to them and with which Harvey might still have been associated, for whilst he was lecturing at the College of Physicians, Alexander Reid, his junior in years as well as in standing, was lecturing at the Barber Surgeons' Hall in Monkwell Street. The Lumleian lecture was a surgery lecture established at a cost of forty pounds a year, laid as a rent charge upon the lands of Lord Lumley in Essex, and of Dr. Caldwell in Derbyshire. Its founders were two notable men. Lord Lumley, says Camden, was a person of entire virtue, integrity, and innocence, and in his old age, was a complete pattern of true nobility. His father, the sixth baron, suffered death for high treason, but the son was made a Knight of the Bath two days before the coronation of Queen Mary. He was one of the lords appointed to attend Queen Elizabeth at her accession, in the journey from Hatfield to London, and at the accession of James I. he was made one of the Commissioners for settling the claims at his coronation. He died April 11, 1609, without surviving issue. Dr. Caldwell had enjoyed unique honour at the College of Physicians. He was examined, approved, and admitted a Fellow upon 22nd December, 1559, and upon the same day he was appointed a Censor. He became President in 1570, and was present at the institution of the lecture in 1582. He was then so aged, his white head adding double reverence to his years, that when he attempted to make a Latin oration to the auditors he was compelled to leave it unfinished by reason of his manifold debilities. And in a very short time afterwards the good old doctor fell sick, and as a candle goeth out of itself or a ripe apple falleth from a tree, so departed he out of this world at the Doctors' Commons, where his usual lodgings were, and was buried on the 6th of June immediately following, in the year 1584, at S. Ben'et's Church by Paul's Wharf, at the upper end of the chancel. The design of the benefaction was a noble one. It was the institution of a lecture on Surgery to be continued perpetually for the common benefit of London and consequently of all England, the like whereof had not been established in any University of Christendom (Bologna and Padua excepted). An attempt had been made to establish such a lectureship at Paris, but the project failed when Francis I. died, on the last day of March, 1547. The reader of the Lumleian lecture was to be a Doctor of Physic of good practice and knowledge who was to be paid an honest stipend, no less in amount than that received by the Regius Professors of law, divinity, and physic, in the Universities of Oxford and Cambridge. The lecturer was enjoined to lecture twice a week throughout the year, to wit on Wednesdays and Fridays, at ten of the clock till eleven. He was to read for three-quarters of an hour in Latin and the other quarter in English "wherein that shall be plainly declared for those that understand not Latin." The lecturer was appointed for life and his subjects were so arranged that they recurred in cycles. The first year he was to read the tables of Horatius Morus, an epitome or brief handling of all the whole art of surgery, that is, of swellings, wounds, ulcers, bone-setting, and the healing of broken bones commonly called fractures. He was also to lecture upon certain prescribed works of Galen and Oribasius, and at the end of the year in winter he was directed "to dissect openly in the reading place all the body of man, especially the inward parts for five days together, as well before as after dinner; if the bodies may last so long without annoy." The second year he was to read somewhat more advanced works upon surgery and in the winter "to dissect the trunk only of the body, namely, from the head to the lowest part where the members are and to handle the muscles especially. The third year to read of wounds, and in winter to make public dissections of the head only. The fourth year to read of ulcers and to anatomise [or dissect] a leg and an arm for the knowledge of muscles, sinews, arteries, veins, gristles, ligaments, and tendons. The fifth year to read the sixth book of Paulus Aegineta, and in winter to make an anatomy of a skeleton and therewithall to show the use of certain instruments for the setting of bones. The sixth year to read Holerius of the matter of surgery as well as of the medicines for surgeons to use. And the seventh year to begin again and continue still." The College of Physicians made every effort to fulfil its trust adequately. Linacre, its founder and first President in 1518, allowed the Fellows to use the front part of his house--the stone house in Knightrider Street, consisting of a parlour below and a chamber above, as a council room and library, and the college continued to use these rooms for some years after his death, the rest of the premises being the property of Merton College, Oxford. At the Institution of the Surgery lecture the Fellows determined to appropriate the sum of a hundred pounds out of their common stock--and this proved to be nearly all the money the College possessed--to enlarge the building and to make it more ornamental and better suited for their meetings and for the attendance at their lectures. The result appears to have been satisfactory, for two years later, it was ordered, on the 13th of March, 1583-1584, that a capacious theatre should be added to the College thus enlarged. Dr. Richard Forster was appointed the first Lumleian lecturer, and when he died in 1602, William Dunne took his place. Dunne, however, did not live to complete a single cycle of lectures for Thomas Davies was elected in May, 1607. The College then again began to outgrow its accommodation, and as the site did not allow of any further additions to the buildings, a suitable house and premises were bought of the Dean and Chapter of St. Paul's in Amen Corner, at the end of Paternoster Row. The last meeting of the College in Linacre's old house in Knightrider Street, took place on the 25th of June, 1614, and its first meeting in Amen Corner was held on the 23rd of August, 1614. Dr. Davies died in the following year, and on the 4th of August, 1615, William Harvey was appointed to the office of Lumleian lecturer, though his predecessor was not buried until August 20th. He continued to occupy this post until his resignation in 1656, when his place was taken by (Sir) Charles Scarborough. The duties of the lecturer, no doubt, had been modified with each fresh appointment, but even in Harvey's time, there is some evidence to show that the subjects were still considered in a definite order. Harvey, in all probability, began to lecture at once upon surgery as the more theoretical portion of his subject, but it was not until April, 1616, that he gave his first anatomical lecture. It was a visceral lecture for the terms of the bequest required that it should be upon the inward parts. At this time Harvey was thirty-seven years of age. A man of the lowest stature, round faced, with a complexion like the wainscot; his eyes small, round, very black and full of spirit; his hair as black as a raven and curling; rapid in his utterance, choleric, given to gesture, and used when in discourse with any one, to play unconsciously with the handle of the small dagger he wore by his side. The MS. notes of his first course of lectures are now in the British Museum. They formed a part of the library of Dr. (afterwards Sir Hans) Sloane, which was acquired under the terms of his will by the nation in 1754. For a time the book was well known and extracts were made from it, then it disappeared and for many years it was mourned as irretrievably lost. But in 1876 it was found again amongst some duplicate printed books which had been set aside, and in the following year it was restored to its place in the Manuscript Department. The notes were reproduced by an autotype process, at the instigation of Sir E. H. Sieveking, and under the supervision of a Committee of the Royal College of Physicians. This facsimile reproduction was published in 1886 with a transcript by Mr. Scott, and an interesting introduction from the pen of Dr. Norman Moore. The original notes are written upon both sides of about a hundred pages of foolscap, which had been reduced to a uniform size of six inches by eight, though the creases on the paper show that they have been further folded so as to occupy a space of about eight inches by two. These leaves have been carefully bound together in leather which presents some pretensions to elegance, but it is clear that the pages were left loose for some years after they were written. There seems to be no doubt that Harvey used the volume in its present form whilst he was lecturing, for three small threads of twine have been attached by sealing wax to the inner side of the cover so that additional notes could be slipped in as they were required. It must be assumed that Harvey did this himself, for he wrote so badly and the notes are so full of abbreviations, interlineations, and alterations, as to render them useless to any one but the author. The title-page, which is almost illegible, is written in red ink. It runs, "Stat Jove principium, Musae, Jovis omnia plena. Prelectiones Anatomiae Universalis per me Gulielmum Harveium Medicum Londinensem Anatomie et Chirurgie Professorem. Anno Domini 1616. Anno aetatis 37 prelectae Aprili 16, 17, 18. Aristoteles Historia Animalium, lib. i. cap. 16. Hominum partes interiores incertae et incognitae quam ob rem ad caeterorum Animalium partes quarum similes humanae referentes eas contemplare." The motto prefixed to the title-page that "everything is full of Jove" is an incorrect quotation from the third Eclogue of his favourite author Virgil, of whom he was so enamoured that after reading him for a time he would throw away the book with the exclamation, "He hath a devil." This particular line appears especially to have struck his fancy, for he quotes it twice in his treatise on development, and he works out the idea which it represents in his fifty-fourth essay. He there shows that he understands it to mean that the finger of God or nature, for with him they are synonymous terms, is manifest in every detail of our structure whether great or small. For he says: "And to none can these attributes be referred save to the Almighty, first cause of all things by whatever this name has been designated--the Divine Mind by Aristotle; the Soul of the Universe by Plato; the Natura Naturans by others; Saturn and Jove by the Gentiles; by ourselves, as is seemly in these days, the Creator and Father of all that is in heaven and earth, on whom all things depend for their being, and at whose will and pleasure all things are and were engendered." He thus opened his lectures in a broad spirit of religious charity quite foreign to his environment but befitting the position he has been called upon to occupy in the history of science. These notes of Harvey's visceral lecture are of especial value to us though they are a mere skeleton of the course--a skeleton which he was accustomed to clothe with facts drawn from his own vast stores of observation, with the theories of all his great predecessors and with the most apposite illustrations. Fortunately they deal with the thorax and its contents so that they show us the exact point which he had reached in connection with his great discovery of the circulation of the blood and the true function of the heart. The notes therefore are interesting reading quite apart from the peculiarities of their style. Harvey was so good a Latin scholar, and during his stay in Italy had acquired such a perfect colloquial knowledge of the language that it is clear he thought with equal facility in Latin or in English, so that it is immaterial into which language he put his ideas. He uses therefore many abbreviations, and whole sentences are written in a mixture of Latin and English, which always sounds oddly to our unaccustomed ears, and often seems comical. Thus, in speaking of the lungs and their functions, he says, "Soe curst children by eager crying grow black and suffocated _non deficiente animali facultate_," and in speaking of the eyes and their uses, he says, "Oculi eodem loco, viz., Nobilissimi supra et ante ad processus eminentes instar capitis in a Lobster ... snayles cornubus tactu pro visu utuntur unde occuli as a Centinell to the Army locis editis anterioribus." Sometimes he embodies an important experimental observation in this jargon as in the example, "Exempto corde, frogg scipp, eele crawle, dogg Ambulat." The more important and original ideas throughout the notes are initialled WH., and this seems to have been Harvey's constant practice, for it occurs even in the books which he has read and annotated, whilst to other parts of his notes he has appended the sign [Greek: D]. The lectures were partly read and partly oral, and we know from the minute directions laid down by the Barber Surgeons Company the exact manner in which they were given. The "Manual of Anatomy," published by Alexander Reid in 1634, has a frontispiece showing that the method of lecturing adopted in England was the same as that in use throughout Europe. The body lay upon a table, and as the dissections were done in sight of the audience, the dissecting instruments were close to it. The lecturer, wearing the cap of his doctor's degree, sate opposite the centre of the table holding in his hand a little wand[2] to indicate the part he mentions, though in many cases the demonstration was made by a second doctor of medicine known as the demonstrator, whilst the lecturer read his remarks. At either end of the table was an assistant--the Masters of the Anatomy--with scalpel in hand ready to expose the different structures, and to clear up any points of difficulty. The audience grouped themselves in the most advantageous positions for seeing and hearing, though in some cases places were assigned to them according to age and rank. The lecturer upon Anatomy, apart from the fact that he was a Doctor of Physic was a person of considerable importance in the sixteenth century. The greatest care was taken of him, as may be understood from the directions which the Barber Surgeons gave to their Stewards in Anatomy or those members of the Company who were appointed to supervise the arrangements for the lectures. They were ordered "to see and provide that there be every year a mat about the hearth in the Hall that Mr. Doctor be made not to take cold upon his feet, nor other gentlemen that do come and mark the Anatomy to learn knowledge. And further that there be two fine white rods appointed for the Doctor to touch the body where it shall please him; and a wax candle to look into the body, and that there be always for the doctor two aprons to be from the shoulder downwards and two pair of sleeves for his whole arm with tapes, for change for the said Doctor, and not to occupy one Apron and one pair of sleeves every day which is unseemly. And the Masters of the Anatomy that be about the body to have like aprons and sleeves every day both white and clean. That if the Masters of the Anatomy that be about the Doctor do not see these things ordered and that their knives, probes, and other instruments be fair and clean accordingly with Aprons and sleeves, if they do lack any of the said things afore rehearsed he shall forfeit for a fine to the Hall forty shillings." The whole business of a public anatomy was conducted with much ceremony, and every detail was regulated by precedent. The exact routine in the Barber Surgeons' Company is laid down in another series of directions. The clerk or secretary is instructed in his duties in the following words: "So soon as the body is brought in deliver out your tickets which must be first filled up as followeth four sorts:--The first form, to the Surgeons who have served the office of Master you must say: Be pleased to attend &c. with which summons you send another for the Demonstrations: to those below the Chair [_i.e._, who have not filled the office of Master of the Company] you say: Our Masters desire your Company in your Gown and flat Cap &c. with the like notice for the Demonstrations as you send to the ancient Master Surgeons. To the Barbers, if ancient masters, you say: Be pleased to attend in your Gown only, and if below the Chair, then: Our Masters desire &c. as to the others above, but without the tickets for the demonstrations. "The body being by the Masters of Anatomy prepared for the lecture (the Beadles having first given the Doctor notice who is to read) and having taken orders from the Master or Upper Warden [of the Company] of the Surgeons' side concerning the same, you meet the whole Court of Assistance [_i.e._, the Council] in the Hall Parlour where every gentlemen cloathes himself [_i.e._, puts on his livery or gown], and then you proceed in form to the Theatre. The Beadles going first, next the Clerk, then the Doctor, and after him the several gentlemen of the Court; and having come therein, the Doctor and the rest of the Company being seated, the Clerk walks up to the Doctor and presents him with a wand and retires without the body of the Court [_i.e._, the theatre in which the assemblage of the company technically constituted a "court"] until the lecture is over when he then goes up to the Doctor and takes the wand from him with directions when to give notice for the reading in the afternoon which is usually at five precisely, and at one of the clock at noon, which he pronounces with a distinct and audible voice by saying, This Lecture, Gentlemen, will be continued at five of the clock precisely. Having so said he walks out before the Doctor, the rest of the Company following down to the Hall parlour where they all dine, the Doctor pulling off his own robes and putting on the Clerk's Gown first, which it has always been usual for him to dine in. And after being plentifully regaled they proceed as before until the end of the third day, which being over (the Clerk having first given notice in the forenoon) that the lecture will be continued at five of the clock precisely (at which time the same will be ended) he attends the Doctor in the clothing room where he presents him folded up in a piece of paper the sum of ten pounds, and where afterwards he waits upon the Masters of Anatomy and presents each of them in like manner with the sum of three pounds, which concludes the duty of the Clerk on this account. "N.B.--The Demonstrator, by order of the Court of Assistants, is allowed to read to his pupils after the public lecture is over for three days and till six of the clock on each day and no longer, after which the remains of the body is decently interred at the expence of the Masters of Anatomy, which usually amounts unto the sum of three pounds seven shillings and fivepence." The study of Anatomy seems to have been regarded universally as an exhausting occupation, for throughout Europe it was the custom to present the auditors with wine and spices after each lecture, unless some more substantial refreshment was provided. Harvey's lectures at the College of Physicians were probably given with similar ceremony to those just described. His first course was delivered on Tuesday, Wednesday, and Thursday, April 16, 17, and 18, 1616. On the following Tuesday, April 23rd, Shakespeare died at Stratford-on-Avon, and on the succeeding Thursday, April 25th, he was buried in the chancel of the parish church. At the beginning of his lectures Harvey lays down the following excellent canons for his guidance, of which the sixth seems to indicate that he was acquainted with the works of John of Arderne-- 1. To show as much as may be at a glance, the whole belly for instance, and afterwards to subdivide the parts according to their position and relations. 2. To point out what is peculiar to the actual body which is being dissected. 3. To supply only by speech what cannot be shown on your own credit and by authority. 4. To cut up as much as may be in the sight of the audience. 5. To enforce the right opinion by remarks drawn from far and near, and to illustrate man by the structure of animals according to the Socratic rule [given by Aristotle and affixed as an extract to the title-page of the lectures[3]]. To bring in points beyond mere anatomy in relation to the causes of diseases, and the general study of nature with the object of correcting mistakes and of elucidating the use and actions of parts for the use of anatomy to the physician is to explain what should be done in disease. 6. Not to praise or dispraise other anatomists, for all did well, and there was some excuse even for those who are in error. 7. Not to dispute with others, or attempt to confute them, except by the most obvious retort, for three days is all too short a time [to complete the work in hand]. 8. To state things briefly and plainly, yet not letting anything pass unmentioned which can be seen. 9. Not to speak of anything which can be as well explained without the body or can be read at home. 10. Not to enter into too much detail, or into too minute a dissection, for the time does not permit. 11. To serve in their three courses according to the glass (_i.e._, to allot a definite time to each part of the body). In the first day's lectures the abdomen, nasty, yet recompensed by its infinite variety. In the second day's lecture the parlour [_i.e._, the thorax?]. In the third day's lecture the divine banquet of the brain. Harvey adheres pretty closely in his visceral lecture to the programme which he had thus laid down for his own guidance. The first set of notes deal with the outside of the body, and the abdomen and its contents. The second portion contains an account of the chest and its contents; whilst the third portion is devoted to a consideration of the head with the brain and its nerves. Only nine pages of the ninety-eight which the book contains are allotted to the heart. The scheme of the lectures is first to give a general introduction in which the subject is arranged under different headings, and then to consider each part under a variety of sub-headings. Harvey's playfulness is shown even in the introduction. Each main division is indicated by a roughly drawn hand, and each hand is made to point with a different finger. The first hand points with its little finger, and has the other fingers bent, though the thumb is outstretched as if applied to the nose of the lecturer. The next heading is indicated by an extended ring finger, the next by the middle finger, whilst the later ones are mere "bunches of fives," or single amputated digits. In his description of the abdomen Harvey shows himself fully alive to the evils of tight-lacing, for, in speaking of the causes of difficult respiration he says, "young girls by lacing: unde cut their laces." After a full discussion of the situation and functions of the various parts of the abdominal viscera, he passes on to the thorax and enunciates his memorable discovery in these remarkable words, which are initialled to show that he thought the idea was peculiarly his own:-- "It is plain from the structure of the heart that the blood is passed continuously through the lungs to the aorta as by the two clacks of a water bellows to raise water. "It is shown by the application of a ligature that the passage of the blood is from the arteries into the veins. "Whence it follows that the movement of the blood is constantly in a circle, and is brought about by the beat of the heart. It is a question therefore whether this is for the sake of nourishment or rather for the preservation of the blood and the limbs by the communication of heat, the blood cooled by warming the limbs being in turn warmed by the heart." Here the notes on the heart end abruptly, and Harvey passes on to consider the lungs. These few sentences show, however, that he had discovered the circulation, and that although he delayed for twelve years to make his results public he was unable to add any important fact in the interval. The College of Physicians still preserve some interesting memorials of this portion of Harvey's Lumleian lectures. They consist of a series of six dissections of the blood vessels and nerves of the human body, which are traditionally reported to have been made by Harvey himself. The dissections are displayed upon six boards of the size of the human body, and they exhibit the complete system of the blood vessels separated from the other parts so as to form diagrams of the circulatory apparatus. They have been made with such care that one of the series still shows the semilunar valves at the beginning of the aorta. These "tabulae Harveianae" were kept for many years at Burley-on-the-Hill, the seat of the Earls of Winchelsea, one of whose ancestors--Heneage Finch--the Lord Chancellor Nottingham, married Elizabeth, a daughter of William Harvey's younger brother Daniel. Harvey continued his Lumleian lectures year by year, but we know nothing more of them until 1627, when he delivered a series of lectures upon the anatomy and physiology of the human body, more especially of the arm and leg, with a description of the veins, arteries, and nerves of these parts. This was clearly the Muscular lecture, and if he had followed the course prescribed by the founders of the lecture it should have been given in the years 1619 and 1625, for the years 1621 and 1627 should not have embraced an anatomical course. The notes of the Muscular lecture are in the Sloane collection at the British Museum, where they have been preserved by as happy an accident as those of the much more important Visceral lecture. The volume consists of 121 leaves with writing upon both sides of each page. The notes are as rough and as concise as those of the Visceral lecture, and the language is again a mixture of Latin and homely English. They show, like the treatise on development, that Harvey had by no means emancipated himself from the trammels of authority. He felt for Aristotle what many of us still feel for John Hunter, for he said of his great Master that he had hardly ever made any discovery in connection with the structure of an animal but that Aristotle either knew of it or explained it. He seems to have given his fertile imagination full play in these lectures, and amongst a wealth of similes we find:-- An cerebrum rex [Whether the Brain is to be looked upon as King,] Nervi Magistratus [The nerves as his ministers,] Ramuli nervorum officiales [and the branches of the nerves as their subordinates,] Musculi Cives, populus [whilst the muscles are the burgesses or the commonalty]. And in another place:-- An Cerebrum, Master: Spina his mate. Nervi, Boteswayne. Musculi, Saylors. "There are similar comparisons," says Sir George Paget, who analysed these lectures, and published an account of the manuscript, "of the brain with a military commander, the leader of an orchestra, an architect, and the prius motor, and of the nerves and muscles with the respective subordinate officers." His treatise on the movement of the blood must have been passing through the press at the time he gave these lectures, and the subject of the circulation must therefore have been uppermost in his mind. He compares the heart to the other organs thus:-- An WH. potius. Cor, imperator, Rex. [Whether the heart should not rather be considered as the Emperor or King,] Cerebrum, Judex, Serjeant-Major, praepositi [whilst the brain is the judge, serjeant-major, or monitor]. IV THE ZENITH Year by year Harvey continued to deliver the Lumleian lectures at the College of Physicians and to attend his patients at St. Bartholomew's Hospital. He soon obtained an important and fairly lucrative practice. On the 3rd of February, 1618, he was appointed Physician Extraordinary to James I. or in the language of the time, "The king, as a mark of his singular favour, granted him leave to consult with his ordinary physicians as to his Majesty's health," and at the same time he promised him the post of a Physician in Ordinary as soon as one should become vacant. This promise he was unable to fulfil, but it was redeemed by his son Charles I., who appointed Harvey a Physician in Ordinary in 1631 and remained his friend through life. We can still obtain glimpses of Harvey's practice during the ten years which preceded the issue in 1628 of his "Anatomical Essay on the Movement of the Heart and Blood." Aubrey tells us that "he rode on horseback with a footcloth to visit his patients, his man still following on foot, as the fashion then was, which was very decent, now quite discontinued. The judges rode also with their footclothes to Westminster Hall, which ended at the death of Sir Robert Hyde, Lord Chief Justice. Anthony, Earl of Shaftesbury, would have revived it, but several of the judges being old and ill-horsemen would not agree to it." The footcloth was originally a mark of dignity, and it is still seen in its full splendour hanging over the backs of the horses in a state pageant and in a debased form on those drawing the hearse at a funeral. Besides being physician to the household of the king, Harvey seems to have held a similar position in the households of the most distinguished nobles and men of eminence. He treated amongst others the Lord Chancellor Bacon, always a weak and ailing man, and somewhat of a hypochondriac. Bacon, with the curious lack of individuality which has so often obscured the greatness of the highest form of speculative genius, entirely failed to impress the more practical mind of Harvey, who would not allow him to be a great philosopher, though he esteemed him much for his wit and style. Speaking of him in derision, he told Aubrey, "He writes philosophy like a Lord Chancellor." Nothing, perhaps, brings home to us more clearly the real greatness of Aristotle and the immeasurably superior position to which he attained than this want of sympathy between Harvey and Bacon. Both were master minds, both were working on the lines laid down by Aristotle himself, yet their results were so little in accord that whilst Bacon, working upon the theoretical side, succeeded in undermining his authority, Harvey taking the experimental side actually enhanced his lustre. The following notice of Harvey's practice is preserved in the Domestic Series of the State Papers. It is dated the 18th of November, 1624, and it is interesting, because it shows that the country gentry had to obtain special leave if they wanted to stay in London during the winter:-- "Mr. ATTORNEY. "His Majesty is graciously pleased in regard of the indisposition of health of Sir William Sandis and his Lady and the great danger of their remove into the Country, as appears by the enclosed certificate of Dr. Harvey, to dispense with their stay in London this winter season, notwithstanding the proclamation. And accordingly requires you to take present order for their indemnity that no charge or trouble come upon them for their stay in London this winter for which they have his Majesty's leave." But the patient did not improve under Harvey's care, though he kept him alive, for it is noted again on the 1st of January, 1627-1628:-- "I do hereby certify of a truth that Sir William Sands is in body infirm and subject to those diseases (which) in the country he cannot receive remedy for, nor undergo and perform that course of physic which is fitting for his recovery. "WILLIAM HARVEY." The Domestic Series of State Papers also contains a letter showing that Harvey was attending the Lord Treasurer for a fit of the stone on the 23rd of May, 1627. The year 1628 may fairly be looked upon as the crowning year of Harvey's scientific life. It was that in which he published at Frankfort-on-the-Main his matured account of the circulation of the blood. After its publication he was sometimes heard to say that "he fell mightily in his practice," for it was believed by the vulgar that he was crack-brained, and all the physicians were against him. Such ideas probably occurred to him in his later years when he was depressed by repeated attacks of gout. But party feeling ran high, and was even greater than professional jealousy at a time when Harvey was very closely connected with the losing side. Some of his contemporaries took advantage of the double meaning attaching to the word Circulator which Celsus applies to a merry andrew. It was also said about him that "though all of his profession would allow him to be an excellent anatomist, I never heard of many that admired his therapeutic way. I knew several practitioners in this town that would not have given threepence for one of his bills, as a man can hardly tell by his bills what he did aim at." The apothecaries at this time were accustomed to buy up the bills or prescriptions of the leading physicians in much the same manner and for the same purpose that a clinical clerk or a dresser in a hospital now treasures up the prescriptions of his physician or surgeon. We can afford to smile at these pieces of contemporary criticism by empirics, for we remember that as the apothecaries objected to the practice of Harvey, the attorneys led by Coke sneered at the legal knowledge of Bacon, but in neither case has the verdict of posterity ratified that of contemporary opinion. Harvey early attained to high office in the College of Physicians, then but a small body, though it contained as it has always done, the picked men of the medical profession. Here he was elected a Censor in 1613, an office to which he was reappointed in 1625 and again in 1629. The Censors were four fellows of the College appointed annually, with power "to supervise, watch, correct, and govern" those who practised physic in London or within the statutory limit of seven miles, whether members of the College or not. They had power to punish by fine and summary imprisonment in the Wood Street Counter, and the name of Harvey occurs more than once about this time in connection with proceedings taken by the College against quacks or "Empirics" as they were then called. The Censors attended by the representatives of the Society of Apothecaries were empowered to visit the shops of the apothecaries in London to "search, survey, and prove whether the medicines, wares, drugs, or any thing or things, whatsoever in such shop or shops contained and belonging to the art and mystery of an apothecary be wholesome, meet and fit for the cure, health, and ease of his Majesty's subjects." These inquisitorial visits were made at irregular times every summer and autumn. The procession, consisting of the Censors with the Wardens and the Beadle of the Society of Apothecaries, started at one o'clock, and before six in the afternoon from twenty to thirty shops had been visited. At each shop the visitors entered and asked for a few drugs selected at random. They then examined the stock from which the supply was taken, as well as the individual sample offered, a few rough tests were applied, and if the drugs were found to be bad or adulterated they were at once destroyed by the simple but effectual method of throwing them out into the street. The records of each visitation were kept in a book belonging to the College of Physicians. Dr. Robert Pitt, Censor in 1687 and again in 1702 has left us an interesting account of the results of such a visitation, which in all probability did not differ materially from those which it was Harvey's duty to conduct. The Transcript of the Deposition in the time of Dr. Pitt's censorship runs thus-- MR. G----'S SHOP. _London Laudanum_ without either colour or smell. _Oxycroceum_ without saffron. _Pil. Ruff._ no colour of saffron. [This was a pill largely used as a preservative against the plague. It contained myrrh, aloes, and saffron.] MR. R----'S SHOP. _Diascordium_ dark and thin, without a due proportion of the gums. [It was a compound electuary containing no less than 19 ingredients. It was considered useful in the treatment of epilepsy, megrim, want of appetite, wind, colic, and malignant fevers.] _London Laudanum_, a dry, hard substance, without smell or colour. MR. S----'S SHOP. _Diascordium_ too thin (let down with honey, I suppose). _Venice treacle_, a thin body, much candied. [This, like Diascordium and Mithridate, was one of the complex electuary medicines of the Middle Ages. Its proportions were almost word for word those recommended by Galen in his treatise, [Greek: Peri Antidotôn]. It was also known as the treacle of Andromachus.] _London Laudanum_, a dry, hard substance, without smell or colour. MR. G----'S SHOP. _Diascordium_ thin bodied, much candied. _Venice treacle_ thin, candied, without its proportions. _London Laudanum_, a dry, hard substance. MR. G.----'S SHOP. _Paracelsus_ without its powders or gums. _Oxycroceum_ of a dark colour. _Diascordium_ of a thin substance. _Gascoin's powder_ without bezoar. [This was the compound powder of crabs' claws much used in measles, smallpox, and all spotted fevers. It contained in addition to bezoar and crabs' eyes, red coral, white amber, hart's horn philosophically prepared, and jelly of English vipers' skins.] _London Laudanum_ hard, without smell or colour. _Pil. ex duobus_ without the oil of cloves. [This was reckoned one of the best and most general pills in the Dispensatory, being strong but yet safe. It was especially useful against scurvy, dropsy, and gout. It consisted of colocynth, scammony, and cloves.] MR. S----'S SHOP. _Diascordium_ of a thin body without the gums. _Mithridate_ no colour of saffron. [This was the remedy _par excellence_ until the middle of the eighteenth century. It was said to owe its name to Mithridates, King of Pontus and Bithynia, who invented it. Like Diascordium it was an electuary, though it was more complex, for it contained over fifty ingredients. Mithridate was reputed to cure the bites and stings of any poisonous animal. It expelled poison and cured nearly every disease. It was not only a cure, but a preservative against the plague and all pestilential and infectious fevers.] _London Laudanum_ neither smell nor colour. _Liquid Laudanum_ no smell, thin, no colour of saffron. _Gascoin's powder_ without bezoar. A part of Harvey's time was employed in duties of this nature, but on the 3rd of December, 1627, he was appointed to the still more important office of "Elect." The "Elects" were eight in number. They were chosen from the most cunning and expert men of the faculty in London. It was their duty once in a year to select one of their number to fill the office of President, whilst as a Board with a quorum of three they formed the examiners of those who desired to exercise or practise physic throughout England, whose fitness they certified by letters testimonial. These examinations were conducted at the house of the President, where, on the 9th of December, 1629, Harvey examined and approved that Dr. James Primrose who soon became the most malignant opponent of his teaching. Primrose was a pupil of Riolanus, Professor of Anatomy in Paris, and was well described as the quibbling advocate of exploded teaching. Harvey seems to have comported himself well even in the high position of an elect, for in 1628 he was made Treasurer of the College, an office to which he was re-elected in 1629, so that he must have shown some of the business capacity which was so marked a feature in the other members of his family. In this year Harvey received the commands of the King to accompany the Duke of Lennox (born in 1612) who was sent to travel abroad. This was the first interval in the monotony of his professional life since Harvey's return to England from Padua. But the times soon became so broken that he never afterwards settled down again into anything like his old habits. He was nearly fifty-two years of age when, in September, 1629, the Lord Secretary Dorchester procured a licence for James Stuart, Duke of Lennox, to travel for three years taking with him Dr. Topham, Dean of Lincoln, John St. Almain, and eight other servants. The Duke, who was advanced to the Dukedom of Richmond by letters patent dated the 8th of August, 1641, afterwards became Lord Great Chamberlain, and held many honourable appointments in the reign of Charles I. Clarendon often mentions him as a young nobleman of the highest principles, and his staunch loyalty to the King is shown by his being one of the four Lords who with Juxon attended their master's funeral at Windsor. He subscribed no less than £40,000 towards the expenses of the war. Harvey had to make many arrangements before he could leave England. On the 3rd of December, 1629, he collected the seven "Elects" at his house, and, after a sumptuous banquet, he asked their permission to resign his office of Treasurer at the College of Physicians, a request which was immediately granted. On the 21st of January he applied for leave of absence from his post of physician to St. Bartholomew's Hospital, for the Minutes record-- "Curia tent. Sabti xxi die Januarii 1629-30. "In presence of Sir Robt. Ducy Knight & Barronet, President (and others). "DR. HARVEY. "This day Dr. Harvey Physician to this hospital declares to this court that he is commanded by the Kings most excellent majesty to attend the illustrious Prince the now Duke of Lenox in his travels beyond the seas and therefore desireth this court would allow of [Edmund] Smith, Doctor in Physic for his deputy in performance of the office of physician for the poor of this hospital during his absence. It is thought fit that the Governors of this Hospital shall have further knowledge & satisfaction of the sufficiency of the said Mr. Smith. Then they to make their choice either of him or of some other whom they shall think meet for the execution of the same place during the absence of the said Dr. Harvey." Leave of absence having been thus granted by the College of Physicians and St. Bartholomew's Hospital, Harvey had only to get a substitute for his Court appointment. An undated letter written from abroad by Harvey to Mr. Secretary Dorchester, says: "Before I went I entreated and appointed Dr. Chambers and Dr. Bethune [physicians in ordinary to the King] and one Dr. Smith of London, one of them at all occasions to perform the duty for me; and I acquainted the household therewith [though] it is not usual [to do so] for serjeant [surgeon] Primrose was away above a year (and he is surgeon of the household) and yet none were put in his place to wait whilst he was in Germany with my Lord Marquis. Sir Theodore Mayerne [too] in Switzerland in King James his time was away very long and none put in his place." The letter was written upon an unfounded report which had reached Harvey in his absence that Dr. Adam Moesler "hath gotten to be appointed to wait in my place for the household." Dr. Aveling's care has traced the course of the travellers on this journey. Sir Henry Mervyn writes to Nicholas (clerk of the Council) under the date of the 28th of July, 1630, "of having put over my Lord Duke [Lennox] for the coast of France." The journey was therefore begun at this date, but the Duke and his retinue seem to have stayed for a time in the towns upon the French coast, for on the 2nd of August Sir Henry Mervyn writes that he is going to attend the Duke of Lennox, and purposes to be in the Downs, &c.; and again on the 10th of August he says he has landed the Duke of Lennox at Dieppe. On the 23rd of September of the same year Edward Dacres writes to Secretary Dorchester that the Duke of Lennox is now settled in Paris for the winter; and again on the 22nd of November, saying that the Duke is willing to stay in Paris, and that "in the spring he intends the tour de France, and in the end of the summer to go into Italy, unless the continuance of the wars or the plague hinder him." Dacres writes again, on the 5th of April, 1631, that the Duke is still in Paris but he thinks of going out of town for a few days. Harvey, however, was in London on the 8th of October and on the 22nd of December, 1630, so that he probably joined the Duke in Paris in the spring or early summer of 1631. Nothing is known of the movements of the party after April, until Dacres writes again to Dorchester in August, 1631, saying: "Blois proved a place not long to be endured by my Lord because of the plague which grew hot there, as Tours likewise, where we made little stay, so that we came down to Saumurs there to pass the dog days from whence we are now parting they being at an end. My Lord hath continually been in good health and intends now to follow your Lordship's directions this winter for Spain whither we are now bending our course (_viâ_ Bordeaux) where we shall be before the latter end of September." It is probably of this part of his journey that Harvey writes to Viscount Dorchester, "the miseries of the countries we have passed and the hopes of our good success and such news your Honour hath from better hands. I can only complain that by the way we could scarce see a dog, crow, kite, raven or any other bird, or any thing to anatomise, only some few miserable people, the relics of the war and the plague where famine had made anatomies before I came. It is scarce credible in so rich, populous, and plentiful countries as these were that so much misery and desolation, poverty and famine should in so short a time be, as we have seen. I interprete it well that it will be a great motive for all here to have and procure assurance of settled peace. It is time to leave fighting when there is nothing to eat, nothing to be kept, and nothing to be gotten." The forecast was correct. The Mantuan war was soon afterwards brought to a close by the mediation of Pope Urban VIII. It was one of the minor struggles in which Richelieu's attempts to consolidate the power of his master were counteracted by the combined efforts of Spain and the Empire, for in the end Charles of Nevers was left to enjoy his Duchy of Mantua. The plague, too, was especially virulent in Northern Italy about this time. It was reckoned that above a million died of it in the territories which Lennox and his retinue would have traversed to reach Venice; and 33,000 are said to have died in Verona alone. It was partly for this reason and partly, perhaps, from political motives, that the travellers turned off into Spain instead of visiting Italy, as had been intended. In February, 1632, Sir Thomas Edmonde, writing to Sir Harry Vane, says: "the Duke of Lenox has been made a Grand in Spain;" and it was about this time that the party returned homewards. Harvey was certainly in England on the 26th of March, 1632, for on that day he drew up a set of rules for the Library of the College of Physicians, towards a site for which he had subscribed £100 on the 22nd of December, 1630. The necessity for a new set of rules to govern the use of the Library seems to have been due to an important bequest of 680 volumes presented by Dr. Holsbosch, a graduate in medicine, and a German who had practised surgery and physic in England for fifty years, though he had not attached himself to the College. The new regulations laid down that the key of the room was to remain in the keeping of the President, whilst the key of the book-cases was kept by the Senior Censor. The Library was to be open on all College days to the Fellows, Candidates, and Licentiates; but no book was to be taken away from the College without leave from the President and Censor and the deposit of a "sufficient caution" for its value. Harvey was also present at a meeting of the College of Physicians on the last day of May, 1632, when he signed a petition to the King, praying him to limit the sale of certain poisons unless the purchaser was willing to give his name. There is no record of the exact date at which Harvey was made Physician in Ordinary to the King Charles I., though the time is fixed approximately by the following extract from the minutes at St. Bartholomew's Hospital:-- "Monday 25 April 1631 at a Court [of Governors] held in the Mansion house in the presence of Sir Robert Ducy Lord Mayor, President. "DR. ANDREWES "It is granted that Richard Andrewes Doctor of Physic shall have the reversion, next avoidance and place of physician to this hospital after the death, resignation or other departure of Doctor Harvey now physician to this hospital late sworn Physician in Ordinary for his Majesty's Household, with the yearly stipend thereunto now belonging." The actual date of his appointment seems to have been at some time during the quarter ending Lady Day, 1630, for the Calendar of State Papers (Domestic Series) contains the record, "3 July 1635. To William Harvey, one of his Majesty's physicians in ordinary, his annuity for a year ending at Our Lady Day 1631 £300." And again on the 17th of July, 1635, "Dr. William Harvey £25;" and a few months later, on the 5th of February, 1635-1636--"Dr. William Harvey upon his annuity of £300 per annum £150." These entries also make it appear that although his salary amounted to the considerable sum of £300 a year, it was paid very irregularly and by small instalments. Harvey's appointment as personal physician to the King seems to have brought him into close connection with his master, and it was no doubt at this time that Charles allowed him to obtain the intimate knowledge of the habits and structure of the deer which was afterwards turned to such good use in the treatise on Development. Harvey, in fact, became the personal friend of his king, he accompanied him everywhere, and consequently took a share in the hunting excursions to which his Majesty was so devoted. This constant attendance at Court naturally interfered with Harvey's professional duties, and his colleagues at St. Bartholomew's Hospital soon began to complain of his absence. "At a Court held on Sunday 19 January 1632-1623, "In presence of Sir Robert Ducie Knight & Baronet, President. "DR. HARVY "It hath been thought convenient upon complaint of some of the chirurgions of this hospital that whereas Doctor Harvy physician for the poor of the said hospital by reason of his attendance on the King's Majesty cannot so constantly be present with the poor as heretofore he hath been, but sometimes doth appoint his deputy for the same. That therefor Doctor Andrewes physician in reversion of the same place to this hospital in the absence of Doctor Harvey do supply the same place whereby the said poor may be more respected and Doctor Andrewes the better acquainted to perform the same office when it shall fall [vacant], and in the mean time to be recompensed by this court yearly as shall be thought fit. This order not to prejudice Dr. Harvy in his yearly fee or in any other respect than aforesaid." Early in 1633 Harvey received the commands of Charles I. to attend him on his journey to Scotland, and the annexed Minute shows that he again endeavoured to gain the permission of the Governors of the hospital to allow Dr. Smith to act for him in his absence. "13 May Anno Domini 1633. "This day came into this Compting house Doctor Smith physician by the appointment of Dr. Harvey, physician to this hospital who is to attend the King's Majesty into Scotland and tendered his service to Mr. Treasurer and other the Governors for the poor in the behalf and absence of Doctor Harvey. Answer was made by Mr. Treasurer that Doctor Andrewes physician in reversion to this house was by the Court ordered to attend the occasions of this house in the absence of Doctor Harvey and to have allowance from this house accordingly. Nevertheless if Doctor Smith pleased to accompany Doctor Andrewes in the business, this house would be very well content, unto which Doctor Smith replied that if Dr. Andrewes was appointed and did perform accordingly, there is no need of two." It seems to be evident from these Minutes that Dr. Smith was Harvey's nominee. He was his life-long friend, and he only survived a fortnight the opening of the Harveian Museum, of which he was the most active promoter. Dr. Andrewes, on the other hand, had powerful City influence to back him. He was a distinguished graduate of St. John's College, Oxford. He had been educated at the Merchant Taylors' School, and stood high in the favour of the Merchant Taylors' Company. He died the 25th of July, 1634. Charles' tour in Scotland was fraught with the most momentous consequences both to himself and his kingdom. He was crowned with great pomp in the Abbey Church at Holyrood, and the rochet worn by the Bishop of Moray when he preached before the assembled Court on this occasion was an innovation which gave the greatest offence to the people. Their discontent was still further increased by an order from the King enjoining the ministers to wear surplices and the Bishops vestments instead of the Geneva gown to which they had been accustomed since the Reformation. The dissatisfaction thus aroused culminated in the Liturgy tumults of 1637, when Jenny Deans launched her stool at the head of the Bishop of St. Giles whilst he was preaching in Edinburgh. The tumults in turn led to the formation of "the Tables" and to the taking of "the Covenant," which are so familiar to every student of the history of the Civil War. Harvey must have been in close attendance upon the King during the whole of his stay in Scotland, but he probably interested himself very little in the proceedings of the Court or in the hot discussions between the rival sects around him. We know, indeed, that, he was thinking about the method by which a chick is formed within the egg, and that to solve the point he paid a visit to the Bass Rock, of which he gives the following description in the eleventh essay of his treatise on Development:-- "In the barren island of the East Coast of Scotland, such flights of almost every kind of seabirds congregate, that were I to state what I have heard from those who were worthy of credit, I fear I should be held guilty of telling greater stories than they who have committed themselves about the Scottish geese produced as they say from the fruits of certain trees (which they had never seen) that had fallen into the sea.[4] What I have seen myself, however, I will relate truthfully. "There is a small island, Scotsmen call it the Bass (let it serve as a type of all the rest), lying near the shore, but in deep water. It is so rugged and precipitous that it might rather be called a huge stone or rock than an island, for it is not more than a mile in circumference. The whole surface of the island in the months of May and June is almost completely carpeted with nests, birds, and fledglings. There are so many that you can scarcely avoid stepping upon them, and when they fly the crowd is so great that it hides the sun and the sky like a cloud. The screaming and the din too are so great that you can hardly hear any one speaking close to you. If you look down upon the sea, as if from a tower or tall precipice, whichever way you turn you will see an enormous number of different kinds of birds skimming about and gaping for their prey, so that the sea looks like a pond which is swarming with frogs in springtime, or like those sunny hills looked at from below when they are covered with numerous flocks of sheep and goats. If you sail round the island and look up you see on every ledge, shelf, and recess innumerable flocks of birds of every sort and size, more numerous than the stars seen at night in the unclouded moonless sky, and if you watch the flights that come and go incessantly, you might imagine that it was a mighty swarm of bees. I should hardly be believed if I said what a large revenue was obtained annually from the feathers and from the old nests (used for firing) and from the eggs, which are boiled and then sold, though the owner told me himself. There is one feature, too, which seems to be especially worthy of note because it bears closely upon my argument and is clear proof of what I have just said about the crowd of birds. The whole island shines brilliantly white to those who approach it, and the cliffs are as bright as if they were made of the whitest chalk; yet the natural colour of the rock is dusky and black. It is due to a brittle crust of the whitest colour that is spread over all and gives the island its whiteness and brilliancy, a crust of the same consistence, colour, and nature as the shell of an egg." Harvey was in London again on the 5th of October, 1633, for on this day, at St. Bartholomew's Hospital, "upon the motion of Dr. Harvey, physician to this house, it is thought fit that Tuesday se'night in the afternoon be the time that the Governors shall hear himself and the Chirurgeons upon some particulars concerning the good of the poor of this house and reformation of some orders conceived to be in this house. And the Chirurgeons and the Apothecary to be warned to meet accordingly. And Mr. Alderman Mowlson, Sir Maurice Abbott, Mr. Alderman Perry, and others the Governors here present, are intreated to meet at the Compting house to hear and determine the same." Accordingly, on the 15th of October some radical changes were made in the management of the hospital, as is indicated in the next Minute. The articles are introduced with the following preface, which gives a clear account of the high estimation in which Harvey's services were held at this time. "This day Dr. Harvey, physician to this hospital, presented to this court [of Governors] certain articles for the good and benefit of the poor of this house, which the Governors have taken into their considerations and do allow and order them to be put in practice. And all defaults in the not performance of any of the said articles to be corrected and amended by the Governors as they in their discretions shall think fit and convenient. "Forasmuch as the poor of this house are increased to a greater number than formerly have been, to the great charge of this hospital, and to the greater labour and more necessary attendance of a physician. And being much more also than [it] is conceived one physician may conveniently perform. "And forasmuch as Dr. Harvey, the now physician to this hospital, is also chosen to be physician to his Majesty, and [is] thereby tied to daily service and attendance on his Majesty, "It hath been thought fit and so ordered, that there shall be for this present occasion two physicians for this hospital. And that Dr. Andrewes, physician in reversion, be now admitted to be also an immediate physician to this hospital. And to have the salary or yearly fee of £33 6s, 8d. for his pains henceforth during the pleasure of this court. "And this court, for the long service of the said Dr. Harvey to this hospital, and in consideration that he is physician to his Majesty, do give and allow him leave and liberty to dispose of himself and time, and to visit the poor no oftener than he in his discretion shall think fit. "And it is ordered that Mr. Treasurer shall also pay unto the said Dr. Andrewes the sum of £20 for his pains taken in visiting and prescribing for the poor of this house for this year last past by the direction and at the request of the Governors of this house. "Also at the suit of the apothecary (for the considerations abovesaid), it is thought fit and so granted, that £10 be yearly added to his salary from Michaelmas last past for and towards the maintenance of a journeyman to be daily present in the apothecary's shop in this hospital to help him in the dispatch of his business during the pleasure of this court. "Likewise at the motion of Dr. Harvey, it is granted that Mr. Treasurer shall pay unto Dr. Smith, who was the deputy of Dr. Harvey and by him appointed in his absence to visit the poor of this hospital, the sum of £10 in gratuity from this court, and he is thereupon intreated in respect the hospital hath now two physicians, that he do not henceforth trouble himself any more to visit or prescribe to the poor of this hospital." On the same day (October 15, 1633), "Dr. Harvey, physician to this hospital, presented to this court certain orders or articles by him thought fit to be observed and put in practice, viz.:-- "1. That none be taken into the Hospital but such as be curable, or but a certain number of such as are incurable. "Allowed. "2. That those that shall be taken in for a certain time be discharged at that time by the Hospitaller, unless they obtain a longer time. And to be discharged at the end of that time also. "In use. "3. That all such are certified by the doctor uncurable, and scandalous or infectious shall be put out of the said house or to be sent to an outhouse,[5] and in case of sudden inconvenience this to be done by the Doctor or Apothecary. "Allowed. "4. That none be taken into any outhouse on the charge of this Hospital but such as are sent from hence. "Allowed. "5. That no Chirurgion, to save himself labour, take in or present any for the doctor; otherwise the charge of the Apothecary's shop will be so great, and the success so little, as it will be scandalous to the house. "Allowed. "6. That none lurk here for relief only or for slight causes. "Allowed. "7. That if any refuse to take their physic, they may be discharged by the Doctor or Apothecary or punished by some order. "Allowed. "8. That the Chirurgions, in all difficult cases or where inward physic may be necessary, shall consult with the Doctor, at the times he sitteth once in the week and then the Master [_i.e._, the Surgeon] himself relate to the Doctor what he conceiveth of the cure and what he hath done therein. And in a decent and orderly manner proceed by the Doctor's directions for the good of the poor and credit of the house.[6] "Agreed unto. "9. That no Chirurgion or his man do trepan the head, pierce the body, dismember [amputate], or do any great operation on the body of any but with the approbation and by the direction of the Doctor (when conveniently it may be had) and the Chirurgions shall think it needful to require. "Agreed unto. "10. That no Chirurgion or his man practice by giving inward physic to the poor without the approbation of the Doctor. "Allowed. "11. That no Chirurgion be suffered to perform the cures in this house by his boy or servant without his own oversight or care. "Allowed. "12. That every Chirurgion shall shew and declare unto the Doctor whensoever he shall in the presence of the patient require him, what he findeth and what he useth to every external malady; that so the Doctor being informed may better with judgment order his prescriptions. "The Chirurgions protest against this.[7] "13. That every Chirurgion shall follow the direction of the Doctor in outward operations for inward causes for the recovery of every patient under their several cures, and to this end shall once in the week attend the Doctor, at the set hour he sitteth to give directions for the poor. "Agreed by the Chirurgions. "14. That the Apothecary, Matron, and Sisters do attend the Doctor when he sitteth to give directions and prescriptions, that they may fully conceive his directions and what is to be done. "Allowed. "15. That the Matron and Sisters shall signify and complain to the Doctor, or Apothecary in the Doctor's absence, if any poor lurk in the house and come not before the Doctor when he sitteth or taketh not his physic but cast it away and abuse it. "Allowed. "16. That the Apothecary keep secret and do not disclose what the Doctor prescribeth nor the prescriptions he useth but to such as in the Doctor's absence may supply his place and that with the Doctor's approbation. "Allowed." The ordinances are peremptory, and for many years they governed the action of the Hospital in the control of the patients. Some of them, indeed (as §6), are still acted upon. They show that Harvey was determined to maintain the superior status of the physicians, and there is but little room to doubt that this was one of the guiding principles of his life. In February, 1620, he was appointed by the College of Physicians to act with Dr. Mayerne and Dr. William Clement in watching the proceedings of the surgeons who were moving Parliament in their own interest. For this purpose he attended a Conference at Gray's Inn on the 17th of February, 1620, and he afterwards went to Cambridge; but he failed to induce the University to co-operate with the College of Physicians. On the 4th of July, 1634, Harvey gave a tanned human skin to the College of Physicians, and on the same day by the order of the President he made a speech to the Apothecaries persuading them to conform to the orders of the College. On the 7th of August, 1634, John Clarke was granted the reversion of Harvey's office of Physician to St. Bartholomew's Hospital "in the room and place of Dr. Andrewes late deceased. And this Hospital do order that after Doctor Harvey his death or departure, there be but one Physician forthwards." Harvey, however, outlived Dr. Clarke, who died in 1653 and was buried in St. Martin's, Ludgate, but as Harvey did not attend the Hospital after 1643 Clarke probably acted as sole Physician to the Hospital for ten years before he died. He was President of the College of Physicians 1645-1649. The year 1634 was long memorable on account of "the Lancashire witches," whose story is not yet quite forgotten. Their accusation, as in that of the great outbreak at Salem in New England in 1692, began in the lying story of a child. Edward Robinson, a boy of ten, and the son of a woodcutter living on the borders of Pendle Forest in Lancashire, played truant and to excuse himself accused Mother Dickenson of being a witch. The boy, being examined by the magistrates, told his story so openly and honestly that it was at once believed. He said that as he was roaming in one of the glades of the forest picking blackberries he saw two greyhounds which he thought belonged to one of the gentlemen living in the neighbourhood. A hare appearing at the same time he hied on the dogs, but neither of them would stir. Angry at the beasts he took up a switch and was about to punish them when one of the dogs started up as a woman, the other as a little boy. The woman was Mother Dickenson, who offered him money to sell his soul to the devil, but he refused. She then took a bridle out of her pocket, and shaking it over the head of the other little boy he instantly became a horse. Mother Dickenson seized Robinson in her arms and sprang upon the animal. They rode with inconceivable swiftness over forests, fields, bogs, and rivers until they came to a large barn. The witch alighted, and taking him by the hand led him inside. There he saw seven old women pulling at seven halters which hung from the roof. As they pulled, large pieces of meat, lumps of butter, loaves of bread, basins of milk, hot puddings and black puddings fell from the halters on to the floor. Thus a supper was provided, and when it was ready other witches came to share it. Many persons were arrested, for the boy was led about from church to church to identify those he had seen in the barn. The story made a great sensation and Sir William Pelham wrote to Lord Conway that "the greatest news from the country is of a huge pack of witches which are lately discovered in Lancashire, whereof it is said nineteen are condemned and that there are at least sixty already discovered. It is suspected that they had a hand in raising the great storm wherein his Majesty was in so great danger at sea in Scotland." Popular report exaggerated the number arrested, but seven of the accused were condemned and Bishop Bridgman, of Chester, was requested to examine them. He went to the gaol and found that three had died and another, Janet Hargreaves, lay "past hope of recovery." Of the three examined by him two declared that they had no knowledge of witchcraft, but the third, Margaret Johnson, a widow of sixty, whom the Bishop describes as a person of strong imagination and weak memory, confessed to have been a witch for six years. She told him, "There appeared to her a man in black attire, who said, if she would give him her soul she should have power to hurt whom she would. He called himself Mamilion, and appeared in the shape of a brown-coloured dog, a white cat, and a hare, and in these shapes sucked her blood." The report of the Bishop to Secretary Coke reached the ears of the King, who commanded Henry Earl of Manchester, the Lord Privy Seal, to write:-- "To Alexander Baker Esq. and Sarjeant Clowes his Majesty's Chirurgions. "These shall be to will and require you forthwith to make choice of such midwives as you shall think fit to inspect and search the bodies of those women that were lately brought by the sheriff of the County of Lancaster indicted for witchcraft and to report unto you whether they find about them any such marks as are pretended: wherein the said midwives are to receive instructions from Mr. Dr. Harvey his Majesty's Physician and yourselves. "Dated at Whitehall the 29 June 1634. "H. MANCHESTER." The prisoners, who were then at the Ship Tavern in Greenwich, were brought to London upon the receipt of the King's order. They were examined and the following certificate was issued:-- "Surgeons Hall in Monkwell Street, London. "2 July A.D. 1634. "We in humble obedience to your Lordship's command have this day called unto us the Chirurgeons and midwives whose names are hereunder written who have by the directions of Mr. Dr. Harvey (in our presence and his) made diligent search and inspection on those women which were lately brought up from Lancaster and find as followeth, viz.:-- "On the bodies of Jennett Hargreaves, Ffrances Dicconson and Mary Spencer nothing unnatural nor anything like a teat or mark or any sign that any such thing hath ever been. "On the body of Margaret Johnson we find two things (which) may be called teats. The first in shape like to the teat of a bitch but in our judgement nothing but the skin as it will be drawn out after the application of leeches. The second is like the nipple or teat of a woman's breast, but of the same colour with the rest of the skin without any hollowness or issue for any blood or juice to come from thence." The report is signed by ten midwives, by Alexander Reid, M.D., the lecturer on Anatomy at the Barber Surgeons' Hall, whom Harvey seems to have deputed to take his place, and by six surgeons evidently chosen from amongst the most eminent of those then practising in London. The result of this report was that four of the seven convicted witches were pardoned, an exercise of mercy "which may have been due," says Mr. Aveling, "to the enlightened views and prompt and energetic action of Dr. Harvey." There is no doubt that at this time and throughout his life Harvey practised every branch of his profession. That he was primarily a physician is evident; that he was a surgeon is shown by the fact that in his will he bequeathed to Dr. Scarborough his "silver instruments of surgery," whilst in his writings he says, "Looking back upon the office of the arteries, I have occasionally, and against all expectation, completely cured enormous sarcoceles by the simple means of dividing or tying the little artery that supplied them, and so preventing all access of nourishment or spirit to the part affected, by which it came to pass that the tumour on the verge of mortification was afterwards easily extirpated with the knife or searing iron." No one, reading his treatise on Development, can doubt for a moment that he was well versed in the diseases of women and in such practical midwifery as the prejudices and habits of the time allowed him to become familiar. Specialism, indeed, as it is now understood in England, did not exist at this time, though there was a debased form in which men attended only to outward injuries or to internal complaints. Harvey sometimes got into trouble with his cases, as must always happen even to the most experienced. The records of the Barber Surgeons' Company contain the following notice under the date 17th of November, 1635. It has the marginal note, "Dr. Harvey's ill practise":-- "This day Wm. Kellett being called here in Court for not making presentation of one of Mr. Kinnersley's maids that died in his charge, he said here in Court that Mr. Doctor Harvey being called to the patient did upon his view of the patient say, that by means of a boulster [poultice?] the tumour on the temporal muscle could be discussed and his opinion was that there was no fracture but the vomiting came by reason of the foulness of the stomach and to that purpose prescribed physic by Briscoe the Apothecary, so the patient died by ill practice, the fracture being neglected and the Company not called to the view." When a person was dangerously ill of a surgical disease in London it was long the custom for the practitioner to call in those surgeons who held an official position in the Barber Surgeons' Company. This was called "viewing" the patient. It divided the responsibility whilst it ensured that everything possible was done for the relief of the patient. In this year too Harvey was ordered by the King to examine the body of Thomas Parr, who is said to have died at the extraordinary age of 152 years and nine months, having survived through the reigns of nine princes. He had lived frugally in Shropshire until shortly before his death, when he was brought to London by Thomas Howard, Earl of Arundel, who showed him to the King. Harvey examined the body on the 16th of November, 1635, the birthday--as he is careful to note--of Her Serene Highness Henrietta Maria, Queen of Great Britain, France, and Ireland. The notes of the autopsy came into the possession of Harvey's nephew Michael, who presented them to Dr. Bett, and they were not printed until 1669, when they were published in Dr. Bett's work "On the Source and Quality of the Blood." The notes give a clear account of the appearances seen upon opening the body, and the very practical conclusion is drawn that as all the internal parts seemed so healthy the old man might have escaped paying the debt due to nature for some little time longer if nothing had happened to interfere with his usual habits. His death is therefore attributed to the change from the pure air of Shropshire to that of London, and to the alteration in his diet which necessarily attended his residence in the house of a great nobleman. The mutual interest taken by the Earl of Arundel and Harvey in old Parr may have led to the friendship which existed between the two men; perhaps, too, Lord Arundel--the prince of art collectors, to whom we owe the Arundel marbles--had detected in Harvey some similar love of art which rendered him a kindred spirit. It is clear that some bond of union existed, for in the following year--1636--Lord Arundel was sent to Vienna as Ambassador Extraordinary to the Emperor Ferdinand in connection with the peace which the Protestant States of Germany had concluded in 1635. The mission left England in April, 1636; and the Clarendon State Papers contain a letter dated from Cologne in May in which Lord Arundel speaks of a visit to the Jesuits' new college and church, where he says "they received me with all civility," and then adds jokingly, "I found in the College little Doctor Harvey, who means to convert them." There are no means of knowing when or why Harvey left England, but he seems to have attached himself to the Embassy and to have visited with it the principal cities on the way to Vienna. He used the opportunity to make the acquaintance of the leading scientific men in Germany, as he had already introduced himself to those in France on a former journey. On the 20th of May, 1636, he was at Nuremberg, where he wrote to Caspar Hofmann offering to demonstrate the circulation of the blood. He has heard, he says, that Hofmann complained of his theory, that "he impeached and condemned Nature of folly and error, and that he had imputed to her the character of a most clumsy and inefficient artificer in suffering the blood to become recrudescent, and making it return again and again to the heart in order to be reconcocted only to grow effete again in the arterial system: thus uselessly spoiling the perfectly made blood merely to find her something to do." Tradition says that Harvey actually gave this demonstration in public, and that it proved satisfactory to every one except to Hofmann himself. The old man--then past the grand climacteric--remained unconvinced, and as he continued to urge objections Harvey at length threw down his knife and walked out of the theatre. We are indebted to Aubrey for the following anecdote, which is probably more true than some of his other statements about Harvey, for it is in exact accordance with what we know of his habits. Aubrey says that one of the Ambassador's gentlemen, Mr. William Hollar--the celebrated painter--told him that in this voyage "Dr. Harvey would still be making observations of strange trees and plants, earths, &c., and sometimes [he was] like to be lost. So that my Lord Ambassador would be really angry with him, for there was not only a danger of thieves, but also of wild beasts." How real the danger was may be gauged by remembering that the party was passing through the country devastated by the Thirty Years' War, which had still to drag out its disastrous length until it was brought to a close by the peace of Westphalia in 1648--a time so productive of lawlessness that it was only two years since Wallenstein, the great Commander-in-chief of the Imperial forces, had been murdered by those who were afterwards publicly rewarded by his Imperial master. Harvey parted company with the Embassy at Ratisbon, for in a letter dated from there he is spoken of as "Honest little Harvey whom the Earl is sending to Italy about some pictures for his Majesty." From Ratisbon he proceeded to Rome, where the pilgrims' book at the English College shows that he dined in the refectory on the 5th of October, 1636. Dr. Ent dined there the same night. The two travellers probably met by arrangement, for Ent was born at Sandwich, closely allied as a Cinque Port to Folkestone, Harvey's native home. He was educated too in Cambridge--at Sidney Sussex College--and after five years at Padua he took his degree of Doctor of Physic on the 28th of April, 1636. Harvey and Ent had therefore much in common, and they remained firm friends until Harvey died. Ent's love for Harvey led him to defend the doctrine of the circulation against the attacks of Parisanus; Harvey's love for Ent caused him to entrust to him the essay on Development; to be printed or preserved unpublished as Ent should think most fit. Nothing is known of Harvey's return to England except that he was in London attending to his duties and seeing his patients at the end of the year 1636. The following certificate appears to be the only record left of his work during the next two years. It is dated the 2nd of December, 1637: "Having had experience of the disposition and weakness of the body of Sir Thomas Thynne, Knight (who hath been and still is our patient), we testify that we are of opinion that it will be dangerous for the health of his body to travel this winter into the country and place of his usual abode until he hath better recovered his health and strength. "WILL. HARVEY." CHAPTER V THE CIVIL WAR The life of Harvey, like that of all his contemporaries, falls naturally into two great divisions. Hitherto it had been passed in peace and learned ease, but for the future much of it was to be spent in camps amongst the alarms of war. War indeed he had seen both in the Mantuan campaign and in the Thirty Years' War in Germany, and the war clouds had been gathering rapidly at home. Few, however, could have imagined that the religious excitement in Scotland, coupled with the results of Strafford's policy in Ireland and the acts of Laud in England, would provoke in a few years an internecine struggle which was not ended even by the execution of him whom in 1640 all looked upon as the Lord's Anointed. Harvey, perhaps, saw what was coming less clearly than any of those in a responsible position round the King, and it affected him less. Dr. Bethune, the senior Physician in Ordinary to the King, died in July, 1639, and Harvey was appointed in his place. The post was more valuable than the one he had held, for the College of Physicians contains a memorandum giving an account of the sums of money due to Harvey out of the King's Exchequer. It is docketed-- "Money due out of the Exchequer for my pension 21 April 1642 and also since for my pension of £400 p. ann." The appointment carried with it a lodging at Whitehall and certain perquisites which are mentioned in the following order extracted by Mr. Peter Cunningham from the Letter Book of the Lord Steward's office: "CHARLES R. "Whereas we have been graciously pleased to admit Doctor Harvey into the place of Physician in Ordinary to our Royal Person, our will and pleasure is that you give order for the settling a diet of three dishes of meat a meal, with all incidents thereunto belonging, upon him the said Doctor Harvey, and the same to begin from the seventeenth day of July last past and to continue during the time that the said Doctor Harvey shall hold and enjoy the said place of Physician in Ordinary to our Royal Persen, for which this shall be your warrant. "Given at our Court of Whitehall the sixth of December 1639. "To our trusty and well beloved Councillors Sir Henry Vane and Sir Thomas Jermyn, Knights, Treasurer and Comptroller of our Household or to either of them." In Scotland the religious riots of 1637 had culminated in the destruction of episcopacy and the formation of the Covenant, acts of rebellion which were assisted by Richelieu in revenge for Charles's opposition to his designs upon Flanders. Preparations were at once made for war. Early in the summer of 1639 the King joined the army under the command of Harvey's friend the Earl of Arundel, and summoned the peers of England to attend him in his progress towards Scotland. His splendid Court, accompanied by nearly 25,000 troops, marched to Berwick. The Scotch forces, with Leslie as their leader, marched South and encamped on Dunse Law, a hill commanding the North Road. The two armies faced each other for a short time, but the King, finding that his troops sided with the Scotch and that defeat was inevitable, concluded a sudden treaty,--signed on the 18th of June, 1639, and known as the "Pacification of Berwick,"--and returned to London. The pacification was not of long duration, but it led to the summoning of that Parliament whose actions soon showed the more sagacious politicians that a civil war was imminent. The Estates met in Edinburgh on the 2nd of June, 1640, and ordered every one to sign the Covenant under pain of civil penalties. In so doing they acted in direct defiance of the King, and they refused to adjourn at his order. They sent Commissioners to London, but Charles refused to see them, and the Estates then appealed for help to France. A Scotch army was again mustered. It crossed the Tweed and entered England on the 20th of August, 1640. Newcastle, Durham, Tynemouth, and Shields were occupied, whilst the fortresses of Edinburgh and Dumbarton again fell into the hands of the insurgents, who defeated the King's troops at Newburn-on-Tyne. The King travelled to York, where he held a great Council of Peers on the 24th of September, 1640. By the advice of the Council negotiations were opened with the Scots. Eight Commissioners from their army came to Ripon, and a treaty--called the Treaty of Ripon--was entered upon, though it was not signed until nearly a year later. All that the Scots asked was conceded, and they were promised £300,000 to defray the expenses they had incurred. The armies were then disbanded, and for a time peace seemed to be restored. The King again visited Scotland, and a meeting of the Estates was held, whilst in London the Long Parliament met on the 3rd of November, 1640, and chose Lenthall their Speaker. Harvey must have witnessed all these events, for he was in close personal attendance upon the King during the whole time. He received a warrant by Royal Sign Manual whilst the King was at York, addressed to the Comptroller of the Household and dated the 25th of September, 1640, by which the King gives £200 to Dr. William Harvey for his diet." This was in lieu of the three dishes of meat, which in those troublous times were not easily to be obtained. A month or two later Harvey was in London, for on the 24th of November, 1640, he obtained permission from the College of Physicians to sue the heirs of Baron Lumley in the name of the College to recover the salary of the Lumleian lecturer on surgery and anatomy. Leave was given him, but the political disturbances and Harvey's attendance upon the King appear to have prevented him from carrying out his object. Dr. Munk says that no further mention of this suit occurs in the Annals of the College until the 31st of May, 1647, when "a letter was read from Dr. Harvey desiring the College to grant him a letter of attorney to one Thompson to sue for the anatomical stipend. It was presently generally granted, and shortly afterwards sent him under the general seal." From a manuscript of Dr. Goodall's, in the possession of the College, it appears that Harvey expended at least five hundred pounds in various lawsuits on this subject, which was not settled until some time after his death, and then at the expense of Sir Charles Scarborough, his successor in the chair of the Lumleian Lecturer. The only notice of Harvey during the year 1641 is the following entry on page 38 of the Album of Philip de Glarges, preserved amongst the manuscripts at the British Museum: "'Dii laboribus omnia vendunt.' "Nobilissimo juveni Medico. Phillipo de Glarges amicitiae ergo libenter scripsit GUL HARVEUS. Anglus Med. Reg. et Anatomie professor. Londin: May 8 A.D. 1641." ["'For toil the Gods sell everything.' "This was willingly written as a mark of friendship for the noble young Doctor Philip de Glarges by William Harvey, the Englishman, Physician to the King and Professor of Anatomy. "At London 8 May A.D. 1641."] Nothing appears to be known of De Glarges except that he was a wandering student of medicine, theology, and philosophy, and an ardent collector of autographs. He seems to have graduated at the Hague in 1640 when he defended a thesis upon palpitation of the heart. His collection of autographs show that he was provided with first-rate introductions, and that he was apparently a promising student. It would be difficult, says Dr. Aveling, to find a more suitable motto than the one Harvey has chosen to impress upon the mind of a young man. It is one which Harvey had always acted upon and found to be true. Matters were soon brought to a crisis in England; only four days after Harvey wrote this motto Strafford was beheaded. On January 3, 1641-1642, the King's desperate attempt to seize the five members precipitated his fate. It led Parliament to make preparations for the war which had now become inevitable, and Isaac Pennington, a vigorous and determined Puritan, was chosen Lord Mayor of London. Soldiers were enrolled to form an army. On the 16th of August, 1642, the King left London, and six days later his standard was raised at Nottingham. Harvey accompanied him. The newly raised troops belonging to the Parliament, as yet ignorant of the trammels of discipline, broke into the houses of suspected persons, rifled them of their contents and often sold their booty for the merest trifle. Harvey had been living in his official lodgings at Whitehall, and though he attended the King, not only with the consent, but at the desire of the Parliament, he was very rightly suspected of being a vehement Royalist. Perhaps, too, the mention of his name in Parliament had brought him prominently into notice, for though the proceedings of the Parliament were nominally private, every act was rigorously scrutinised and actively canvassed by the agitators and local politicians. The chief outbreak of lawlessness occurred in August, 1642, immediately after it was known that the King had unfurled his standard, and it was probably on this occasion that the mob of citizen-soldiers entered Harvey's lodgings, stole his goods, and scattered his papers. The papers consisted of the records of a large number of dissections, or as they would now be called post-mortem examinations, of diseased bodies, with his observations on the development of insects, and a series of notes on comparative anatomy. Aubrey says: "He had made dissections of frogs, toads, and a number of animals, and had curious observations upon them." Harvey bitterly regretted the loss of his papers which he thus laments: "Let gentle minds forgive me, if recalling the irreparable injuries I have suffered, I here give vent to a sigh. This is the cause of my sorrow:--Whilst in attendance on His Majesty the King during our late troubles, and more than civil wars, not only with the permission but by the command of the Parliament, certain rapacious hands not only stripped my house of all its furniture, but, what is a subject of far greater regret to me, my enemies abstracted from my museum the fruits of many years of toil. Whence it has come to pass that many observations, particularly on the generation of insects, have perished with detriment, I venture to say, to the republic of letters." Charles left Nottingham on the 13th of September, so that it was probably early in this month that Harvey took the opportunity of riding over to Derby to see Percival Willoughby, who had been admitted an extra-licentiate at the College of Physicians on the 20th of February, 1640-1641. Willoughby says: "There came to my house at Derby, my honoured good friend Dr. Harvey. We were talking of several infirmities incident to the womb. He added to my knowledge an infirmity which he had seen in women, and he gave it the name of a honey-comb [epithelioma] which he said would cause flooding in women." A few weeks later Harvey was actually under fire at Edgehill. The battle took place on the 23rd of October, 1642. All the morning was spent in collecting the King's troops from their scattered quarters, and it was not until one o'clock that the royal army descended the steep hill leading to the wide plain in which stand the village of Radway and the little town of Kineton. Harvey took charge of the two Princes, boys of 12 and 10 years old, who afterwards became Charles II. and James II., and in the course of the morning he probably walked along the brow of the hill from the inn at Sunrising to the Royalist headquarters which were placed about a mile further east. Weary with waiting he and the boys betook themselves to the wide ditch at the very edge of the hill, and to while away the time Harvey took a book out of his pocket and read. "But," says Aubrey, "he had not read very long before the bullet from a great gun grazed the ground near him, which made him remove his station." As soon as the battle had really begun, Harvey, we may be sure, was alive and interested, his book was pocketed and he devoted himself at once to assist the wounded. The very nature of the wounds would give additional zest to the work for, unless he was present at the battle of Newburn-on-Tyne, this must have been his first opportunity of treating gunshot wounds. Anthony Wood in his account of Adrian Scrope shows that Harvey was no impassive spectator of the fight, for he says: "This most valiant person, who was son of Sir Jervais Scrope, did most loyally attend his Majesty at the fight of Edgehill, where receiving several wounds he was stripped and left among the dead, as a dead person there, but brought off by his son and recovered by the immortal Dr. Will. Harvey, who was there but withdrawn under a hedge with the Prince and Duke while the battle was at its height. 'Tis reported that this Adrian Scrope received 19 wounds in one battle in defence of his Majesty's cause, but whether in that fight at Edgehill I cannot justly say. Sure I am that he was made Knight of the Bath at the Coronation of King Charles II., An. 1661." The battle was undecided, and Harvey, like the other personal attendants upon the King, must for a while have felt the keenest anxiety for the safety of his master. The King remained for a time at the top of the hill, but when the battle began in earnest he could not be restrained from mixing with the troops, sharing their danger and adjuring them to show mercy to such of the enemy as fell into their hands. Perhaps too Harvey saw one of the most picturesque acts of the battle. The Royal Standard, carried by Sir Edmund Verney at the beginning of the fight, had waved over the King's Red Regiment--the Royal Foot Guards. Verney slain, and the Guards broken, it passed to the Parliamentary army, and was committed to the charge of the secretary of the Earl of Essex, the Commander-in-chief. Captain Smith, a Catholic officer in the King's Life Guards, hearing of the loss, picked up from the field the orange scarf which marked a Parliamentarian and threw it over his shoulders. Accompanied by some of his troop, similarly attired, he slipped through the ranks of the enemy, found the secretary holding the standard, and telling him that so great a prize was not fitly bestowed in the hands of a penman, snatched it from him. Then, protected by the scarf, he made his way once more through the hostile force and laid his trophy at the feet of the King, who knighted him upon the spot. The battle over, Charles pushed on towards London. Banbury surrendered on the 27th of October, and on the 29th he entered Oxford in triumph. Harvey attended the King to Oxford where he was at once received as a _persona grata_. His position in London, his attachment to the King, and his fame as a scientific man, must have combined to render his entrance to the most exclusive Common Rooms a matter of ease. In Oxford he very soon settled down to his accustomed pursuits, unmindful of the clatter of arms and of the constant marching and countermarching around him, for the city remained the base of operations until its surrender in July, 1646. Aubrey says that he first saw Harvey at Oxford "in 1642, after the Edgehill fight, but [I] was then too young to be acquainted with so great a doctor. I remember he came several times to our College [Trinity] to George Bathurst, B.D., who had a hen to hatch eggs in his chamber, which they opened daily to see the progress and way of generation." Two years later Bathurst was killed in defending Faringdon, but he was a distinguished Fellow of his College, and it was doubtless, with the aid and by the advice of such a friend, that Harvey was incorporated Doctor of Physic at Oxford on the 7th of December, 1642. For the next year or two Harvey lived quietly at Oxford, making dissections and carrying on his professional work amongst the courtiers who thronged the town. It appears too from the following report that Dr. Edmund Smith was living with him in Oxford. The memorial consists of a letter from Richard Cave to Prince Rupert, concerning the health of his brother, Prince Maurice. It is preserved among the Rupert Correspondence in the British Museum, and it runs-- "May it please your Highness. "This last night arrived here at Milton, Dr. Harvey and Doctor Smyth and this morning they were with the other two Doctors having seen and spoken with his Highness your brother intreateth me to write as followeth. "That his sickness is the ordinary raging disease of the army, a slow fever with great dejection of strength and since last Friday he hath talked idly and slept not but very unquietly, yet the last night he began to sleep of himself and took his rest so quietly that this present morning when Doctor Harvey came to him he knew him and welcomed Doctor Smith respectively and upon Doctor Harvey's expression of his Majesty's sorrow for and great care of him he showed an humble, thankful sense thereof. Doctor Harvey asking his highness how he did, he answered that he was very weak, and he seemed to be very glad to hear of and from your Highness as was delivered by Doctor Harvey. "Now the Doctors having conferred and computed the time have good hopes of his recovery yet by reason that the disease is very dangerous and fraudulent they dare not yet give credit to this alteration. And concluding the disease to be venomous they resolved to give very little physic only a regular diet and cordial antidotes. The Doctors present their most humble service to your Highness and subscribe themselves "Sir, "Your Highness' most humble servants, "WILL. HARVEY "ROBERT VILVAIN "EDMUND SMITH "THO. KING. "MILTON, _Oct. 17th, 1643_." Dr. Aveling, from whose "Memorials of Harvey" this letter is copied, says "the treatment by 'very little phisick' and 'only a regular diet' seems to have been successful, for Cave, writing soon afterwards to Prince Rupert, says: "Maurice is not able yet to write letters, but hath this day taken physic and so intends to bid his physicians farewell." In this year, 1643, Harvey received his last payment as physician to St. Bartholomew's Hospital. The Journals contain no record of his retirement from office in the hospital, but the ledgers, which have been kept with great accuracy and minuteness ever since the granting of the Charter in 1547, show the entry standing in its usual place, but for the last time. "Item to Doctor Harvey, Physician, xxxiii li. vi s. viii d." Harvey was resident in Oxford at the time of his retirement, and the absence of any allusion to so important an event in the history of the hospital must be ascribed in part to the confusion of the times. The Journals of the House of Commons, however, contain a significant note: "Feb. 12, an. 1643-1644. A motion this day made for Dr. Micklethwayte to be recommended to the Wardens and Masters of St. Bartholomew's Hospital, to be physician in the place of Dr. Harvey, who hath withdrawn himself from his charge and is retired to the party in arms against the Parliament." (Sir) John Micklethwaite was as a matter of fact appointed Physician in reversion to St. Bartholomew's Hospital, May 26, 1648, and he succeeded to the post of full physician May 13, 1653. He was one of the physicians in ordinary to Charles II., and died in 1682. Harvey's presence in Oxford, and his method of working by experiment and by logical deduction from observation, must have been singularly agreeable to that band of experimental philosophers who in a few years were destined to found the Royal Society. Harvey's leaven worked successfully in the brains of such men as Scarborough, Highmore, Willis, and Wren, and in due season the pupils brought forth fruit worthy of their master. Harvey's connection with the University of Oxford was destined soon to become both intimate and honourable, though it was unfortunately only of short duration. In 1645 he was elected Warden of Merton College, in succession to Sir Nathaniel Brent. The present Warden of Merton, the Hon. G. C. Brodrick, says that on the 27th of Jan., 1645, letters were received from the King, then lodged at Christ Church, reciting that Sir Nathaniel Brent had absented himself for nearly three years, had adhered to the rebels, and had accepted the office of Judge Marshal in their ranks, to which might have been added that he had actually signed the Covenant, for he gradually became more and more Presbyterian in his views though he was originally a friend of Laud. We learn from the articles afterwards exhibited against [Sir] John Greaves, then a Fellow of the College, Savilian Professor of Astronomy, and the senior Linacre lecturer upon anatomy, that he was the person who drew up the petition against the Warden, and "inveigled some unwary young men to subscribe to it." The King's letters accordingly pronounce the deposition of Brent, and direct the seven senior Fellows to present three persons as eligible to be his successor, out of whom the King would choose one. The Royal mandate was obeyed, but there were some irregularities in the consequent election, against which Peter Turner protested and resigned his Fellowship on his protest being overruled by Lord Hertford, who had succeeded the Earl of Pembroke as Chancellor of the University in October, 1645. However, five out of the seven seniors, including the Sub-Warden, placed Harvey first on their lists, and the King lost no time in nominating him. He was solemnly admitted Warden according to ancient custom, on the 9th of April, and two days later, on April 11th, he addressed the Fellows in a short speech which is still preserved. The extract from the College register runs:--"Dominus Custos, Convocatis in Altâ Gaul Sociis, haec verba ad illos fecit. Forsitan decessores Custodiam Collegii ambiisse, ut exinde sese locupletarent, se vere longe alio animo nimirum ut College lucro et emolumento potius foret: simulque socios, ut concordiam amicitiamque inter se colerent sedule solliciteque hortatus est." [The Warden spoke thus to the Fellows assembled in the Great Hall. He said that it was likely enough that some of his forerunners had sought the Wardenship to enrich themselves, but that for his own part he undertook its duties with far other motives, wishing as he did to increase the wealth and prosperity of the College. At the same time he appealed earnestly and anxiously to the Fellows to cherish amongst themselves an harmonious friendship.] The speech was thought at the time to be somewhat "Pharisaical," but there seems to be no doubt that Harvey was really expressing his feelings. There had always been a close bond between Merton and the medical profession from the days when John of Gaddesden, one of the earliest Englishmen to write a complete treatise on medicine, was a Fellow, and it was peculiarly fitting that Harvey should have been elected head of the College. He was a rich man, childless, without expensive habits, and so devoted to the pursuit of science that there is but little doubt that if he had retained his position he would have become one of the greatest benefactors of the College. As it was, the College during Harvey's year of office presented more the appearance of a Court than of a seat of learning. From 1643 to 1646, when the Queen was in Oxford, she lodged in Merton College, occupying the Warden's House, and living in the room still known as "the Queen's room," with the drawing-room adjoining it. Anthony Wood says that during her occupation "there were divers marriages, christenings, and burials carefully registered in a private register by Mr. John Gurgany, one of the chaplains of Merton College; but about the time of the surrender of Oxford the said register, among other books, was stolen by the soldiers out of his window in his chamber joining to the church door." Many officers too were quartered in Merton, and the College was so full on the 1st of August, 1645, that the annual meeting had to be held in the library, as neither the Hall nor the Warden's lodgings were available for the purpose. The year 1645-1646, during which Harvey held the office of Warden of Merton, was long a memorable one in the annals of Oxford. The City was invested by Fairfax for fifteen days from May 22nd, whilst the King was at Droitwich. On June 14th the Royal cause was ruined at Naseby, and on November 27th the College was called upon to lay in a supply of provisions against another siege. On December 28th the King ordered a special form of prayer to be used in the chapel on Wednesdays and Fridays "during these bad times." On March 24th the College gave a bond for £94 on account of provisions which it had no money to buy. At three in the morning of April 27th the King, disguised as a servant, with his beard and hair closely trimmed, passed over Magdalen bridge in apparent attendance upon Ashburnham and Hudson, and we cannot but believe that Harvey was one of the little band who closed the gates of the city with heavy hearts as his Majesty rode off to begin his wearisome captivity. On May 11, 1646, Oxford was summoned by Fairfax, and on June 24th it was surrendered on very honourable terms, the garrison marching out over Shotover 3,000 strong. The Duke of York fell into the hands of the Parliament; but Rupert, Maurice, and the greater part of the noblemen and gentlemen attendant upon the Court had left Oxford the day before its surrender. Mr. Brodrick says that "Harvey must now have retired from the Wardenship and Brent must have resumed office, though no minute of either event is preserved in the College Register." We find, however, that in September, 1648, Brent rendered accounts, as Warden, for the four years from 1642 to 1646. Anthony Wood describes in language which has often been quoted, the utter confusion in which the past three years had left the University--the colleges impoverished, lectures almost abandoned, many of the students dispersed and others quite demoralised--"in a word, scarce the face of an University left, all things being out of order and disturbed." This account is confirmed by a striking entry in the College Register, under the date October 19, 1646, where it is stated that by the Divine goodness the Civil War had at last been stayed, and the Warden [Brent] with most of the Fellows had returned, but that as there were no Bachelors, hardly any scholars and few Masters, it was decided to elect but one Bursar and one Dean. It is also added that as the Hall still lay "situ et ruinis squalida" the College meeting was held in the Warden's lodgings. Of the few students whom we know that the influence of Harvey's name attracted to Oxford that of Charles Scarborough, the first English editor of Euclid, is the most noted. Ejected from his fellowship at Caius College, Cambridge, on account of his Royalist tendencies, he immediately withdrew to Oxford, entered himself at Merton College, obtained the friendship of Harvey and rendered him considerable assistance in the preparation of his work on the development of animals. He was created a Doctor of Physic on June 23, 1646, by virtue of letters from the Chancellor of the University, and in these letters he is described as a Master of Arts of Cambridge of seven years' standing and upwards, who was spoiled of his library in the beginning of the Civil War, and afterwards for his conscience deprived of his fellowship. His letters testimonial are under the hand of Dr. William Harvey, who says that he is well learned in Physic, Philosophy, and Mathematics. CHAPTER VI HARVEY'S LATER YEARS The surrender of Oxford in 1645 marks the period of Harvey's severance from the Court and of his practical retirement from public life. He was now 68; a martyr to gout, childless, and suffering under a series of heavy bereavements, he can have had but little heart to re-enter upon an active professional life in London. His twin brothers Matthew and Michael died in 1643. John, his second brother, died in 1645. His wife who was alive in this year, must have died shortly afterwards, or she would probably have accompanied him to Oxford. Such a series of shocks would act prejudicially upon his affectionate nature, and would still further unfit him to pursue the harassing cares of his profession. His mind, always philosophical and reflective rather than empirical, was now allowed to follow its bent to the uttermost, and his time was employed in putting into shape his treatise upon Development. Harvey returned to London after the surrender of Oxford, and one of his first thoughts was to send to Charles Scarborough, who had continued with the Royal army, the message--"Prithee leave off thy gunning and stay here. I will bring thee into practice." And well he kept his word, for on the 8th of October, 1649, Dr. Scarborough was elected by the Company of Barber Surgeons of London reader of the anatomical lectures. "He was the first," says Wood, "that introduced geometrical and mechanical speculations into Anatomy, and applied them in all his learned conversation, as more particularly in his famous lectures upon the muscles of the human body for sixteen or seventeen years together in the public theatre at Surgeons' Hall, which were read by him with infinite applause and admiration of all sorts of learned men in the great City. Afterwards he became a most learned and incomparable anatomist, a Fellow of the College of Physicians in 1650, principal physician to King Charles II. (from whom he received the honour of knighthood, August 15, 1669), and to His Royal Highness James, his brother, while Duke of York and when King, Physician to the Tower of London, and afterwards to King William III." His friendship with Harvey, commenced at Oxford, continued unabated to the end of his patron's life; and when on July 28, 1656, Harvey presented to the College of Physicians the title-deeds of his paternal estate in Kent and resigned his Lumleian lectureship, the office was transferred to Charles Scarborough. In his will, too, Harvey makes affectionate mention of his friend, and bequeaths to him his surgical instruments and his velvet gown, so that literally as well as metaphorically Harvey's mantle fell upon Sir Charles Scarborough, and he nobly sustained the charge, great as it was. The bond of friendship which had always marked the members of the Harvey family now comes into striking relief. The eldest brother, whose goods had been destroyed at Whitehall and scattered at Oxford, was a welcome guest for the rest of his life in the houses of his younger brothers. He appears to have lived chiefly at Cockaine House, which was probably situated in Broad Street, for it afterwards became the Excise Office. It was the town house of his brother Eliab, who also lived either at Roehampton or at Rolls Park. But sometimes Harvey spent a part of his time with Daniel in the suburban village of Lambeth, or at Combe, near Croydon in Surrey. Some curious details of his habits at this time have been handed down. Aubrey says: "He was much and often troubled with the gout, and his way of cure was thus: He would sit with his legs bare, though it were frost, on the leads of Cockaine House, put them into a pail of water till he was almost dead with cold, then betake himself to his stove, and so 'twas gone." "A method of treatment," says Heberden, "which I neither recommend nor propose to others for imitation, although Harvey lived to his eightieth year, and died not so much from disease as from old age." The first coffee-house was opened in London about the year 1652 by Bowman (a coachman to Mr. Hodges, a Turkey merchant, who put him upon it), but Harvey was wont to drink coffee, which he and his brother Eliab did before coffee-houses were in fashion in London. In his will he makes a special reservation of his "coffy-pot;" his niece, Mary West, and her daughter are to have all his plate except this precious utensil, which, with the residue of his fortune, he evidently desired should descend to his brother Eliab, as a memorial doubtless of the pleasure he had often enjoyed over its contents, for coffee was not yet a common drink. Another coffee-house in London was opened just after the Restoration. It was kept by an old sergeant of Monk's army. Among some papers at the College of Physicians relating to Harvey, which were collected by Dr. Macmichael, is one in the handwriting of Dr. Heberden, which runs as follows:-- "1761, May 29th.--Mrs. Harvey (great-niece to Dr. Harvey) told me that the Doctor lived at his brother's at Roehampton the latter part of his life. That he used to walk out in a morning, combing his hair in the fields. "That he was humoursome and would sit down exactly at the time he had appointed for dinner whether the company was come or not. That his salt-cellar was always filled with sugar which he used to eat instead of salt. "That if the gout was very painful to him in the night he would rise and put his feet into cold water." This list of harmless little eccentricities is further enlarged by Aubrey, who says: "He was always very contemplative and was wont to frequent the leads of Cockaine House, which his brother Eliab had bought, having there his several stations in regard to the sun and the wind for the indulgence of his fancy; whilst at the house at Combe in Surrey, he had caves made in the ground in which he delighted in the summer-time to meditate." He also loved darkness, telling Aubrey "that he could then best contemplate." "His thoughts working would many times keep him from sleeping, in which case his way was to rise from his bed and walk about his chamber in his shirt till he was pretty cool and then return to his bed and sleep very comfortably." He was ready at all times to communicate what he knew and to instruct any that were modest and respectful to him, and when Aubrey was starting for Italy "he dictated to me what to see, what company to keep, what books to read, and how to manage my studies--in short, he bid me go to the fountain head and read Aristotle, Cicero, and Avicenna, and did call the Neoteriques" by a foul name. Dr. Ent has left a striking picture of the old man at Christmas, 1650, nearly a year after the execution of the King. It shows at first a weariness of spirit which we would fain hope was not quite natural to him, like the sadness of age which is so marked a feature in the life-like portrait left by Janssen. Dr. Ent's account is the epistle dedicatory to Harvey's work on the development of animals, and it so clearly shows the man in the fashion as he lived, and as his beloved pupil saw him, that I have not ventured to shorten it. The Epistle is addressed:-- "To the learned and illustrious, the President and Fellows of the College of Physicians of London. "Harassed with anxious, and in the end not much availing cares, about Christmas last, I sought to rid my spirit of the cloud that oppressed it, by a visit to that great man, the chief honour and ornament of our College, Dr. William Harvey, then dwelling not far from the city. I found him, Democritus like, busy with the study of natural things, his countenance cheerful, his mind serene, embracing all within its sphere. I forthwith saluted him and asked if all were well with him? 'How can it be,' said he, 'whilst the Commonwealth is full of distractions, and I myself am still in the open sea? And truly,' he continued, 'did I not find solace in my studies, and a balm for my spirit in the memory of my observations of former years, I should feel little desire for longer life. But so it has been, that this life of obscurity, this vacation from public business, which causes tedium and disgust to so many, has proved a sovereign remedy to me.' "I, answering, said, 'I can readily account for this: whilst most men are learned through others' wits, and under cover of a different diction and a new arrangement, vaunt themselves on things that belong to the ancients, thou ever interrogatest Nature herself concerning her mysteries. And this line of study as it is less likely to lead into error, so is it also more fertile in enjoyment, inasmuch as each particular point examined often leads to others which had not before been surmised. You yourself, I well remember, informed me once that you had never dissected any animal--and many and many a one you have examined--but that you discovered something unexpected, something of which you were formerly uninformed.' "'It is true,' said he; 'the examination of the bodies of animals has always been my delight, and I have thought that we might thence not only obtain an insight into the lighter mysteries of Nature, but there perceive a kind of image or reflex of the omnipotent Creator himself. And though much has been made out by the learned men of former times, I have still thought that much more remained behind, hidden by the dusky night of nature, uninterrogated: so that I have oftentimes wondered and even laughed at those who have fancied that everything had been so consummately and absolutely investigated by an Aristotle or a Galen or some other mighty name, that nothing could by any possibility be added to their knowledge. Nature, however, is the best and most faithful interpreter of her own secrets; and what she presents, either more briefly or more obscurely in one department, that she explains more fully and clearly in another. No one indeed has ever rightly ascertained the use or function of a part who has not examined its structure, situation, connections by means of vessels and other accidents in various animals, and carefully weighed and considered all he has seen. The ancients, our authorities in science, even as their knowledge of geography was limited by the boundaries of Greece, so neither did their knowledge of animals, vegetables, and other natural objects extend beyond the confines of their country. But to us the whole earth lies open and the zeal of our travellers has made us familiar not only with other countries and the manners and customs of their inhabitants, but also with the animals, vegetables, and minerals that are met with in each. And truly there is no nation so barbarous which has not discovered something for the general good, whether led to it by accident or compelled by necessity, which had been overlooked by more civilised communities. But shall we imagine that nothing can accrue to the wide domains of science from such advantages or that all knowledge was exhausted by the first ages of the world? If we do, the blame very certainly attaches to our indolence, nowise to nature. "'To this there is another evil added. Many persons, wholly without experience, from the presumed verisimilitude of a previous opinion, are often led by and by to speak of it boldly, as a matter that is certainly known; whence it comes, that not only are they themselves deceived, but that they likewise lead other incautious persons into error.' "Discoursing in this manner and touching upon many topics besides with wonderful fluency and facility, as is his custom, I interposed by observing 'How free you yourself are from the fault you indicate all know who are acquainted with you; and this is the reason wherefore the learned world, who are aware of your unwearied industry in the study of philosophy, are eagerly looking for your farther experiments.' "'And would you be the man,' said Harvey smiling, 'who should recommend me to quit the peaceful haven where I now pass my life and launch again upon the faithless sea? You know full well what a storm my former lucubrations raised. Much better is it oftentimes to grow wise at home and in private, than by publishing what you have amassed with infinite labour, to stir up tempests that may rob you of peace and quiet for the rest of your days.' "'True,' said I; 'it is the usual reward of virtue to have received ill for having merited well. But the winds which raised those storms like the north-western blast, which drowns itself in its own rain, have only drawn mischief on themselves.' "Upon this he showed me his 'Exercises on the Generation of Animals,' a work composed with vast labour and singular care, and having it in my hands I exclaimed, 'Now have I what I so much desired, and unless you consent to make this work public, I must say that you will be wanting both to your own fame and to the public usefulness. Nor let any fear of farther trouble in the matter induce you to withhold it longer; I gladly charge myself with the whole business of correcting the press.' "Making many difficulties at first, urging among other things that his work must be held imperfect, as not containing his investigations on the generation of insects; I nevertheless prevailed at length, and he said to me, 'I intrust these papers to your care with full authority either speedily to commit them to the press, or to suppress them till some future time.' Having returned him many thanks, I bade him adieu and took my leave, feeling like another Jason laden with the golden fleece. On returning home I forthwith proceeded to examine my prize in all its parts, and could not but wonder with myself that such a treasure should have lain so long concealed; and that whilst others produce their trifles and emptiness with much ado, their messes twice, aye, an hundred times, heated up, our Harvey should set so little store by his admirable observations. And indeed so often as he has sent forth any of his discoveries to the world, he has not comported himself like those who, when they publish, would have us believe that an oak had spoken, and that they had merited the rarest honours--a draught of hen's milk at the least. Our Harvey rather seems as though discovery were natural, a matter of ordinary business; though he may nevertheless have expended infinite labour and study on his works. And we have evidence of his singular candour in this, that he never hostilely attacks any previous writer, but ever courteously sets down and comments upon the opinions of each; and indeed he is wont to say that it is argument of an indifferent cause when it is contended for with violence and distemper, and that truth scarce wants an advocate. [Illustration: [_To face page 152._ FACSIMILE OF WILLIAM HARVEY'S HANDWRITING.] "It would have been easy for our illustrious colleague to have woven the whole of this web from materials of his own; but to escape the charge of envy he has rather chosen to take Aristotle and Fabricius of Aquapendente as his guides, and to appear as contributing but his portion to the general fabric. Of him whose virtue, candour, and genius are so well known to you all I shall say no more, lest I should seem to praise to his face one whose singular worth has exalted him beyond the reach of all praise. Of myself I shall only say that I have done no more than perform the midwife's office in this business, ushering into the light this product of our colleague's genius as you see it, consummate and complete, but long delayed and fearing perchance some envious blast; in other words, I have overlooked the press; and as our author writes a hand which no one without practice can easily read[8] (a thing that is common among our men of letters), I have taken some pains to prevent the printer committing any very grave blunders through this--a point which I observe not to have been sufficiently attended to in the small work[9] of his which lately appeared. Here then, my learned friends, you have the cause of my addressing you at this time, viz., that you may know that our Harvey presents an offering to the benefit of the republic of letters, to your honour, to his own eternal fame. "Farewell, and prosper "GEORGE ENT." This account brings home to us the charm of Harvey's personality. Beloved by his family and honoured by the College of Physicians, the old man went to his grave amidst the genuine grief of all who knew him. The publication of his essay on Development in 1651 was almost his last literary effort. He wrote a few letters to different friends abroad which show that his mind was still actively engaged upon the problem of the circulation of the blood, but nothing more of importance appeared from his pen. His love for the College of Physicians remained unabated, and he gave proof of it in a most practical manner. At an extraordinary Comitia held July 4, 1651, Dr. Prujean, the President, read a written paper to the assembled Fellows which contained the following proposition: "If I can procure one that will build a library and a repository for simples and rarities, such a one as shall be suitable and honourable to the College, will you assent to have it done or no, and give me leave and such others as I shall desire to be the designers and overlookers of the work both for conveniency and ornament?" This offer from an anonymous donor was too handsome to meet with other than immediate acceptance, and as the Annals of the College express it, "super hac re prompté gratéque itum est ab omnibus in suffragia" [the proposition was instantly and thankfully agreed to by the votes of all present]. The building proceeded apace, but there is no doubt that the name of the benefactor became known, for on December 22, 1652, and before it was completed, the College voted that a statue of Harvey should be placed in their hall which then occupied a site in Amen Corner. It was accordingly erected there with an inscription upon the pedestal which ran:-- GULIELMO HARVEIO Viro monumentis suis immortali Hoc insuper Collegium Medicorum Londinense posuit, Qui enim sanguini motum ut et Animalibus ortum dedit, Meruit esse Stator perpetuus. It represented Harvey in the cap and gown of his degree, and though it perished in the Great Fire of London in 1666, it was not replaced when the College was rebuilt on or near its old site nor in the more recent building in Pall Mall. Harvey's building was a noble example of Roman architecture (of rustic work with Corinthian pilasters). It stood close to the site now occupied by Stationers' Hall, and consisted of two stories, a great parlour with a kind of convocation house for the Fellows to meet in below and a library above. This inscription was engraved upon the frieze outside the building in letters three inches long: "Suasu et cura Fran. Prujeani, Praesidis et Edmundi Smith, elect: inchoata et perfecta est haec fabrica An. Mdcliii" (This building was begun and finished in the year 1653, at the suggestion and under the eye of Francis Prujean, the President, and Edmund Smith, an Elect). Harvey therefore with characteristic modesty refrained from taking any share in the praise; perhaps he was wise. The building is destroyed and forgotten, Smith's name has perished, Prujean's is only remembered as that of a square in the Old Bailey, but Harvey's memory remains and needs neither bricks and mortar, nor pictures, nor a statue to perpetuate it. Harvey not only paid for the building but he furnished its library with books, amongst which were treatises on geometry, geography, astronomy, music, optics, natural history, and travels, in addition to those upon medical subjects. It was to be open on Fridays from two till five o'clock in summer, but only till four in winter; during all meetings of the College and whenever the librarian, being at leisure, should choose to be present; but no books were allowed to be taken out. The Museum contained numerous objects of curiosity and a variety of surgical instruments. The doors of the buildings were formally opened on February 2, 1653, when Harvey received the President and the Fellows at a sumptuous entertainment, and afterwards addressed a speech to them in which he made over to the College the title-deeds and his whole interest in the structure and its contents. The College gave a fresh proof of its gratitude by choosing Harvey unanimously as its President when Dr. Prujean's term of office came to an end on Michaelmas Day, 1654. As he was absent when the election took place, the Comitia was prorogued until the next day, and Dr. Alston and Dr. Hamey, two of the Elects, were asked to wait upon him to tell him of the honour his colleagues had done themselves and him, and to say that they awaited his answer. Every act of Harvey's public life that has come down to us is marked, as Dr. Willis very properly observes, not merely by propriety, but by grace. He attended the Comitia or assembly of the College next day, thanked his colleagues for the distinguished honour of which they had thought him worthy--the honour, as he said, of filling the foremost place amongst the physicians of England; but the concerns of the College, he proceeded, were too weighty to be entrusted to one who, like himself, was laden with years and infirm in health; and if he might be acquitted of arrogance in presuming to offer advice in such circumstances, he would say that the College could not do better than reinstate in the authority which he had just laid down their late President, Dr. Prujean, under whose prudent management and fostering care the affairs of the College had greatly prospered. This disinterested counsel had a fitting response, and Harvey's advice being adopted by general consent, Dr. Prujean was forthwith re-elected President. His first act was to nominate Harvey one of the Consilarii--an honourable office which he did not refuse to accept, and to which he was reappointed in 1655 and 1656. That Harvey's complaint of age with its attendant infirmities was no mere figure of speech may be gathered from his letters written about this time. Thus he tells Dr. Horst, the principal physician at Hesse Darmstadt, on the 1st of February, 1654-1655: "I am much pleased to find that in spite of the long time that has passed, and the distance that separates us, you have not yet lost me from your memory, and I could wish that it lay in my power to answer all your inquiries. But indeed my age does not permit me to have this pleasure, for I am not only far stricken in years, but am afflicted with more and more indifferent health." And writing again to Dr. Horst five months later he says: "Advanced age, which unfits us for the investigation of novel subtleties, and the mind which inclines to repose after the fatigues of lengthened labours, prevent me from mixing myself up with the investigation of these new and difficult questions; so far am I from courting the office of umpire in this dispute [about the digestion and absorption of the food] that I send you the substance of what I had formerly written about it." Harvey appears to have devoted much of his time in his later years to a study of general literature, which must always have had many attractions to his cultivated mind--a study which is indeed absolutely necessary as a relaxation to one whose mind is bent upon the solution of obscure scientific problems if he desires to make his results intelligible. Writing to Nardi on the 30th of November, 1653, to thank him for a commentary on Lucretius' account of the plague, he goes on to say, "Nor need you plead in excuse your advanced life. I myself, though verging on my eightieth year and sorely failed in bodily health, nevertheless feel my mind still vigorous, so that I continue to give myself up to studies of this kind, especially connected with the sacred things of Apollo, for I do indeed rejoice to see learned men everywhere illustrating the republic of letters." It would seem too as if he had gained some reputation as a judge of general literature, for Howell in his familiar letters writes to him:-- "To Dr. Harvey, at St. Lawrence Pountney. "SIR,--I remember well you pleased not only to pass a favourable censure but gave a high character of the first part of 'Dodona's Grove,' which makes this second to come and wait on you, which, I dare say, for variety and fancy, is nothing inferior to the first. It continueth an historical account of the occurrences of the times in an allegorical way, under the shadow of trees; and I believe it omits not any material passage which happened as far as it goes. If you please to spend some of the parings of your time and fetch a walk in this Grove, you may haply find therein some recreation. And if it be true what the Ancients write of some trees, that they are fatidical, these come to foretell, at least to wish you, as the season invites me, a good New Year, according to the Italian compliment, Buon principio, miglior mezzo, ed ottimo fine. With these wishes of happiness in all the three degrees of comparison, "I rest, Your devoted Servant, "J. H. "LOND. _2 Jan._" As a rule it is almost impossible to fix the dates of the "Epistolæ Ho-Elianæ," but the first part of "Dodona's Grove" was issued in 1640, and the second part in 1650, so that the letter was probably written in 1651. Even if the letters were never really sent to those to whom they are addressed, Howell selected his apparent correspondents with such care that he would not have addressed Harvey in this manner unless he had been credited with some skill as a critic of general literature. This, too, is borne out in another letter to Nardi on October 25, 1655, in which he says that he is used to solace his declining years and to refresh his understanding, jaded with the trifles of everyday life, by reading the best works. Shortly before he died he was engaged in reading Oughtred's "Clavis Mathematica," and in working out the problems. The book was no doubt brought under his notice by Charles Scarborough, who with Seth Ward was the first to read it with his pupils at Cambridge, where it long remained a favourite textbook. When Scarborough and Ward were young, they once made a journey to see Oughtred, an old Etonian, "who was then living at Albury, in Surrey, to be informed of many things in his 'Clavis Mathematica,' which seemed at that time very obscure to them. Mr. Oughtred treated them with great humanity, being very much pleased to see such ingenious young men," says Anthony Wood, who tells the story, "apply themselves to those studies, and in a short time he sent them away well satisfied in their desires." Harvey still retained his Lumleian lectureship, the duties of which he conscientiously discharged to the last. His life, says Dr. Munk, already prolonged beyond the span allotted to man, and his waning powers yet further broken by repeated and severe attacks of illness, warned him of his approaching end. He had lived to see his grand discovery of the circulation of the blood universally accepted and inculcated as a canon in most of the medical schools of Europe; and he is said by Hobbes to have been "the only one that conquered envy in his lifetime and saw his new doctrine everywhere established." Harvey now prepared for the great change awaiting him, and on July 28, 1656, resigned his lectureship, took his leave of the College, and in so doing manifested the same zeal for its prosperity as had marked the whole of his former life. On this occasion he put the crowning act to his munificence by giving to the College in perpetuity his patrimonial estate at Burmarsh in Kent, then valued at £56 a year. The particular purposes of this donation were the institution of an annual feast, at which a Latin oration should be spoken in commemoration of the benefactors of the College, a gratuity for the orator, and a provision for the keeper of his library and museum. All this attention to perpetuate a spirit of concord and social friendship among his brethren, was in full accordance with Harvey's benevolent and liberal sentiments. The last of his letters which has been preserved is addressed to John Vlackveld, physician at Haarlem, who had sent him an interesting specimen. The letter is a characteristic one. It runs:-- "LEARNED SIR,--Your much esteemed letter reached me safely, in which you not only exhibit your kind consideration of me, but display a singular zeal in the cultivation of our art. "It is even so. Nature is nowhere accustomed more openly to display her secret mysteries than in cases where she shows traces of her workings apart from the beaten path; nor is there any better way to advance the proper practice of medicine than to give our minds to the discovery of the usual law of nature, by careful investigation of cases of rarer forms of disease. For it has been found in almost all things, that what they contain of useful or of applicable, is hardly perceived unless we are deprived of them, or they become deranged in some way. The case of the plasterer to which you refer is indeed a curious one and might supply a text for a lengthened commentary by way of illustration. But it is in vain that you apply the spur to urge me, at my present age, not mature merely but declining, to gird myself for any new investigation; for I now consider myself entitled to my discharge from duty. It will, however, always be a pleasant sight to see distinguished men like yourself engaged in this honourable arena. Farewell, most learned sir, and whatever you do, still love "Yours, most respectfully, "WILLIAM HARVEY. "LONDON, _April 24, 1657_." CHAPTER VII HARVEY'S DEATH, BURIAL, AND EULOGY Harvey died at Roehampton in the house of his brother Eliab on the 3rd of June, 1657. Aubrey says that on the morning of his death, about ten o'clock, he went to speak and found that he had the dead palsy in his tongue; then he saw what was to become of him. He knew there were then no hopes of his recovery, so presently he sends for his young nephews to come up to him, to whom he gives one the minute watch with which he had made his experiments, to another his signet ring, and to another some other remembrance. He then made signs (for being seized with the dead palsy in his tongue he could not speak) to Sambroke, his apothecary in Blackfriars, to let him blood in the tongue, which did him little or no good, and so ended his days, dying in the evening of the day on which he was stricken, the palsy giving him an easy passport. It would appear from this account that Harvey died of a cerebral hemorrhage from vessels long injured by gout and situated rather at the base or internal parts of the brain than in the frontal lobes. Most probably the left Sylvian artery gave way, leading at first to a slight extravasation of blood, which rapidly increased in quantity until it overwhelmed his brain. The copy of the death mask in the church at Hempstead shows the left eye more widely open than the right, whilst the furrows on the right side of the face are much more marked than those on the left side. The body was brought to London, where it seems to have been placed in Cockaine House, which also belonged to Eliab Harvey, and in that room of the house which became afterwards the office of Elias Ashmole, the antiquary to whom Oxford owes the Ashmolean Museum. Here it rested many days because, though Harvey died on the 3rd of June, it was not until the 25th of June that the Fellows of the College of Physicians received a notice requesting them, clothed in their gowns, to attend the funeral on the following day. In the meantime, Eliab, as his brother's executor, had decided that Harvey should be buried at Hempstead in Essex, and accordingly, on the 26th of June, 1657, the funeral procession started from London. It was followed far beyond the City walls by a large number of the Fellows of the College of Physicians, many of whom must afterwards have hurried back to Westminster Hall, where, on the same day, with the greatest ceremony and with all the pomp of circumstance, Cromwell was a second time inaugurated after the humble petition and advice had given him the power of nominating his successors and of forming a second House of Parliament, whilst it assigned to him a perpetual revenue. There is no record of the time when the funeral party reached Hempstead, nor where it stopped on the way. The village is situated about fifty miles from London and seven miles east of Saffron Walden, so that one, if not two, nights must have been spent upon the journey. Here, about 1655, Eliab Harvey had built "the Harvey Chapel," a plain, rectangular building of brick with a high-pitched tile roof, on the north side of the church, adjoining and communicating with the chancel and lighted by three large windows. He had also built the outer vault beneath it as a place of sepulture for his family, and when this became full in 1766, one of his descendants, also an Eliab Harvey, but of Claybury, built the inner vault. Twice before had Eliab made a similar journey. Once in 1655, after the death of his daughter Sarah, a girl of twelve, and again in 1656, at the funeral of Elizabeth, another daughter aged nine. Harvey was laid in the outer chapel, between the bodies of his two nieces, and like them he was "lapt in lead," coffinless, and upon his breast was placed in great letters-- DOCTOR WILLIAM + HARVEY + DECEASED + THE + 3 + OF + JUNE + 1657 + AGED + 79 + YEARS. "I was at the funeral," says Aubrey, "and helped to carry him into the vault." The simple wrapping of the body in lead seems to have been a custom peculiar to the Harvey family. The leaden case used for William Harvey was roughly shaped to the form of the body, the head part having the rude outline of a face with mouth, nose, and eyes; the neck wide and the shoulders expanded. The breastplate was broad and the inscription upon it was in raised letters. The body of the case was long and tapering towards the feet, where the lead was turned up at a right angle. The measurements of the case show that it afforded no data as to Harvey's size, for though he was a man "of the lowest stature," its extreme length from the crown of the head to the toes was no less than six feet and a quarter. When the late Sir Benjamin Ward Richardson first entered the vault in 1847, the remains of Harvey had not been visited within the memory of man, though the villagers knew by tradition that "Dr. Harvey was a very great man, who had made, they were told, some great discovery, though they did not know what it was." At that time the vault was practically open to the public, for the window in it at the eastern end was uncased and badly barred. The leaden shell containing Harvey's remains lay upon the floor just beneath the window and with the feet directed towards it. It was therefore exposed to the drift of rain when it beat into the vault with an east wind, and the sarcophagus was so unprotected that boys could throw stones upon it, and did so. The lead in the upper third of its length from the feet was almost torn through on its upper surface, though the rent was only a small one. The leaden case, too, was beginning to bend in over the middle of the body like a large scoop or spoon, in which water could accumulate. Some repairs were made in the vault after it had been visited and its condition had been reported upon by Dr. Stewart and (Sir) Richard Quain in 1868, but the leaden case still remained upon the floor and the opening had become so large that a frog jumped out of it on one occasion as soon as it was touched. Ten years later Sir Benjamin Richardson made a further examination of the case and reported that the centre of the shell, extending from the middle of the trunk to the feet had so far collapsed that the upper surface all but touched the lower one, whilst the crack in the lead was now so large that it measured fully six inches in length. But owing to the greater collapse of the lead the fissure was not so wide as it was in 1868; indeed, the edges had now closed, leaving only a space of half an inch at the widest part. "The question which interests us most," says Richardson, "has yet to be considered. Are any remains of Harvey left in the sarcophagus? Expecting to find the opening in the lead in the same condition at my latest visit, as it was at the latest but one, I took with me a small mirror, a magnesium light, and every appliance for making what may be called a sarcophoscopic investigation. To my dismay, I discovered that the opening is now almost closed by the collapse of the lead, so that the reflector could not be used, while the shell is positively filled at the opening with thick, dirty fluid, like mud--a fluid thick as melted pitch and having a peculiar organic odour. This extends into the case above and below the crack or fissure. There can be little remaining of the body, not much probably even of the skeleton." Sir Benjamin concluded his report with the suggestion that "these honoured remains should be conveyed to their one fit and final resting-place--Westminster Abbey. There, laid two feet deep in the floor in some quiet corner and covered merely with a thick glass plate, the leaden sarcophagus, still visible to those who take an interest in the history of science, would be protected for ages, instead of being destined, as it now certainly is, to fall into a mere crumbling, unrecognisable mass, in the course, at furthest, of another hundred years." The failing health and subsequent death of Dr. Stanley, the Dean of Westminster, prevented the execution of this project, which would probably have been carried into effect had he lived, for it is thought that he was willing to allow the remains of Harvey to be placed near those of Hunter or Livingstone. On the 28th of January, 1882, the whole tower of Hempstead Church fell towards the south-west into the churchyard. No injury was done to the Harvey Chapel, but the accident led to a further examination of Harvey's shell. It was found that the lead was perishing rapidly, and that the shell itself was full of water. A formal report was made to the College of Physicians, who appointed a committee of its Fellows to advise upon the best method of procedure. The labours of the Committee resulted in a decision to leave the remains at Hempstead, but to remove them to the chapel above the vault. The necessary consent having been obtained, and a marble sarcophagus to receive the leaden case having been selected, an architect was invited to examine the vault and the floor of the chapel. Under his directions pillars were built in the vault to sustain the additional weight upon the floor of the chapel, and on St. Luke's Day, 1883, the leaden case containing Harvey's remains was carried reverently from the vault by eight Fellows of the College. It was immediately deposited in the sarcophagus in the presence of the President, the Office Bearers, and many Fellows of the Royal College of Physicians. A leaden case was also deposited within the sarcophagus containing the quarto edition of Harvey's works in Latin, edited in 1766 by Drs. Akenside and Lawrence, with a memorial bottle hermetically sealed and containing a scroll with the following memorial: "The body of William Harvey lapt in lead, simply soldered, was laid without shell or enclosure of any kind in the Harvey vault of this Church of Hempstead, Essex, in June, 1657. "In the course of time the lead enclosing the remains was, from exposure and natural decay, so seriously damaged as to endanger its preservation, rendering some repair of it the duty of those interested in the memory of the illustrious discoverer of the circulation of the Blood. "The Royal College of Physicians, of which corporate body Harvey was a munificent Benefactor, and which by his favour is the possessor in perpetuity of his patrimonial estate at Burmarsh, Kent, did in the years 1882-83, by permission of the Representatives of the Harvey family, undertake that duty. "In accordance with this determination the leaden mortuary chest containing the remains of Harvey was repaired, and was, as far as possible, restored to its original state, and on this 18th day of October, 1883, in the presence of four representatives of the Harvey family and of the President, all the office bearers and many other Fellows of the College of Physicians (whose names are hereunto appended), was reverently translated from the Harvey vault to this Sarcophagus, raised by the College for its reception and preservation." High in the wall of the Church at Hempstead is a marble monument containing a bust of William Harvey. The ornamentation of the tablet is bold and effective, and below the bust is a long Latin inscription testifying to Harvey's good works. The bust was carefully examined by Mr. Thomas Woolner, R.A., who came to the conclusion that it was made from a death mask. He says that "the features presented by the bust are clearly those of a dead face. The sculptor exhibits no knowledge of sculpture except when he was copying what was directly before him. With the cast of the face for his copy he has shown true artistic delineation, but all that he has been obliged to add to make up the bust as it stands is of the worst possible quality. The ears are placed entirely out of position, the large, redundant head of hair is altogether out of character, imaginary and badly executed, and the drapery of the shoulders is simply despicable." We have nevertheless to thank the rude sculptor for the care he has devoted to the face, and we are enriched by the knowledge supplied to us by a great contemporary authority in sculpture, that the true lineaments of William Harvey, as they were seen at the time of his death, are still in our possession--lineaments which indicate a face at once refined, reflective, and commanding. Harvey's will is an interesting document. It is without date, but it seems to have been made at some time between July, 1651, and February, 1653. The codicil is also undated. Perhaps it was added shortly before Sunday, the 28th of December, 1656, the day on which Harvey read over the whole document and formally declared and published it as his last will and testament in the presence of Heneage Finch, his nephew by marriage, afterwards the Lord Chancellor, and his faithful servant, John Raby. The will runs: "The Last Will and Testament of William Harvey, M.D. "In the name of the Almighty and Eternal God, Amen. "I, WILLIAM HARVEY, of London, Doctor of Physic, do by these presents make and ordain this my last Will and testament in manner and form following, revoking hereby all former and other wills and testaments whatsoever. "Imprimis, I do most humbly render my soul to Him that gave it and to my blessed Lord and Saviour Christ Jesus, and my body to the earth to be buried at the discretion of my executor herein after named. "The personal estate which at the time of my decease I shall be in any way possessed of either in law or equity, be it in goods, household stuff, ready monies, debts, duties, arrearages of rents or any other ways whatsoever and whereof I shall not by this present will or by some Codicil to be hereunto annexed make a particular gift and disposition I do after my debts, funerals, and legacies paid and discharged, give and bequeath the same unto my loving brother Mr. Eliab Harvey, merchant of London, whom I make executor of this my last will and testament." He then settles the distribution of certain lands which "I have lately purchased in Northamptonshire or thereabouts, commonly known by the name of Oxon grounds and formerly belonging unto the Earl of Manchester; and certain other grounds in Leicestershire, commonly called or known by the name of Baron Parke and sometime heretofore belonging unto Sir Henry Hastings, Knight, both which purchases were made in the name of several persons nominated and trusted by me." The will then proceeds: "And first I appoint so much money to be raised and laid out upon that building which I have already begun to erect within the College of Physicians in London as will serve to finish the same according to the design already made. "Item, I give and bequeath unto my loving sister-in-law Mrs. Eliab Harvey one hundred pounds to buy something to keep in remembrance of me. "Item, I give to my niece Mary Pratt all that linen, household stuff and furniture which I have at Combe, near Croydon, for the use of Will. Foulkes and to whom his keeping shall be assigned after her death or before (by) me at any time. "Item, I give unto my niece Mary West and her daughter Amy West half the linen I shall leave at London in my chests and chambers together with all my plate excepting my coffee-pot. "Item, I give to my loving sister Eliab all the other half of my linen which I shall leave behind me. "Item, I give to my loving sister Daniell at Lambeth and to every one of her children severally the sum of fifty pounds. "Item, I give to my loving cousin Mr. Heneage Finch for his pains, counsel and advice about the contriving of this my will one hundred pounds. "Item, I give to all my little Godchildren, Nieces and Nephews severally to every one fifty pounds. "Item, I give and bequeath to the town of Folkestone where I was born two hundred pounds to be bestowed by the advice of the Mayor thereof and my Executor for the best use of the poor. "Item, I give to the poor of Christ Hospital [? St. Bartholomew's Hospital] in Smithfield thirty pounds. "Item, I give to Will. Harvey my godson, the son of my brother Michael Harvey deceased, one hundred pounds and to his brother Michael fifty pounds. "Item, I give to my nephew Tho. Cullen and his children one hundred pounds and to his brother my godson, Will. Cullen one hundred pounds. "Item, I give to my nephew John Harvey the son of my loving brother Tho. Harvey deceased two hundred pounds. "Item, I give to my servant John Raby, for his diligence in my service and sickness twenty pounds. And to Alice Garth, my servant, ten pounds over and above what I am already owing unto her by my bill which was her mistress's legacy. "Item, I give among the poor children of Amy Rigdon daughter of my loving uncle Mr. Tho. Halke twenty pounds. "Item, among other my poorest kindred one hundred pounds to be distributed at the appointment of my executor. "Item, I give among the servants of my sister Dan at my funeralls five pounds. And likewise among the servants of my nephew Dan. Harvey at Coombe as much. "Item, I give to my cousin Mary Tomes fifty pounds. "Item, I give to my loving friend Mr. Prestwood one hundred pounds. "Item, I give to every one of my loving brother Eliab his sons and daughters severally fifty pounds apiece. "All which legacies and gifts aforesaid are chiefly to buy something to keep in remembrance of me. "Item, I give among the servants of my brother Eliab which shall be dwelling with him at the time of my decease ten pounds. "Furthermore, I give and bequeath unto my sister Eliab's sister Mrs. Coventrey, a widow, during her natural life the yearly rent or sum of twenty pounds. "Item, I give to my niece Mary West during her natural life the yearly rent or sum of forty pounds. "Item, I give for the use and behoof and better ordering of Will Foulkes for and during the term of his life unto my niece Mary Pratt the yearly rent of ten pounds, which sum if it happen my niece shall die before him I desire may be paid to them to whom his keeping shall be appointed. "Item, I will that the twenty pounds which I yearly allow him my brother Galen Browne may be continued as a legacy from his sister during his natural life. "Item, I will that the payments to Mr. Samuel Fenton's children out of the profits of Buckholt lease be orderly performed as my dear deceased loving wife gave order so long as that lease shall stand good. "Item, I give unto Alice Garth during her natural life the yearly rent or sum of twenty pounds. "Item, to John Raby during his natural life sixteen pounds yearly rent. "All which yearly rents or sums to be paid half yearly at the two most usual feasts in the year, viz.:--Michaelmas and our Lady day without any deduction for or by reason of any manner of taxes to be anyway hereafter imposed. The first payment of all the said rents or Annuities respectively to begin at such of those feasts which shall first happen next after my decease. "Thus I give the remainder of my lands unto my loving brother Eliab and his heirs. All my legacies and gifts &c. being performed and discharged. "Touching my books and household stuff, pictures and apparell of which I have not already disposed I give to the College of Physicians all my books and papers and my best Persia long carpet and my blue satin embroidered cushion, one pair of brass Andirons with fire shovel and tongs of brass for the ornament of the meeting room I have erected for that purpose. "Item, I give my velvet gown to my loving friend Mr. Doctor Scarborough desiring him and my loving friend Mr. Doctor Ent to look over those scattered remnant of my poor Library and what books, papers or rare collections they shall think fit to present to the College and the rest to be sold and with the money buy better. And for their pains I give to Mr. Doctor Ent all the presses and shelves he please to make use of and five pounds to buy him a ring to keep or wear in remembrance of me. "And to Doctor Scarborough all my little silver instruments of surgery. "Item, I give all my chamber furniture, tables, bed, bedding, hangings which I have at Lambeth, to my sister Dan and her daughter Sarah. And all that at London to my loving sister Eliab and her daughter or my godson Eliab as she shall appoint. "Lastly, I desire my executor to assign over the custody of Will Fowkes after the death of my niece Mary Pratt, if she happen to die before him, unto the sister of the said William, my niece Mary West. "Thus I have finished my last Will in three pages, two of them written with my own hand and my name subscribed to every one with my hand and seal to the last. "WIL. HARVEY. "Signed, sealed and published as the last will and testament of me William Harvey in the presence of us Edward Dering. Henneage Finch. Richard Flud. Francis Finche." A codicil is added to the will making certain rearrangements of the bequests, rendered necessary by the deaths and marriages of some of the recipients. Amongst others, "All the furniture of my chamber and all the hangings I give to my godson, Mr. Eliab Harvey at his marriage, and all my red damask furniture and plate to my cousin Mary Harvey." "Item, I give my best velvet gown to Doctor Scarborough. "WILL. HARVEY." The entry of the issue of probate upon this will runs thus in the books at Somerset House:-- "May 1659. The second day was proved the will and Codicil annext of Dr. William Harvey, late of the parish of St. Peter's Poore, in London, but at Roehampton in the County of Surrey, deceased, by the oath of Eliab Harvey, the brother and sole executor, to whom administration was committed, he being first sworn truly to administer." This entry seems to set at rest the doubt that had been expressed as to the exact place of Harvey's death, for Aubrey with his customary inaccuracy in detail stated that he died in London. William Harvey may perhaps be compared more fitly with John Hunter than with any single scientific man who either preceded or followed him. Harvey laid the foundation of modern medicine by his discovery of the circulation of the blood. Hunter laid the foundation of modern pathology, not by any single and striking discovery, but by a long course of careful observation. Harvey, like Hunter, was a careful and competent observer; both were skilled anatomists, both were ardent pathologists, both were comparative anatomists of a high order. By singular ill fortune we have lost the records of many years of careful work done by each of these great men. Harvey's work was destroyed or scattered by the violence of the times in which he lived, and we can only be grateful that so much is spared to us; Hunter's work was lost irrevocably by the crime of his trusted assistant and brother-in-law. Harvey, like Hunter, was choleric, but his nature was the more lovable, though each had the power, innate in every great teacher, of attaching to himself and enrolling in his work all sorts of unlikely people. The collecting or acquisitive spirit was equally developed both in Hunter and Harvey, but the desire for knowledge was less insatiable in Harvey. The influence of breeding and education is nowhere more marked than in these two great men, otherwise so nearly allied. Harvey's knowledge is always well within the grasp of his intellect. He can formulate it, often in exquisite language, and it is so familiar to him that he can afford to use similes and images which show him to be a man of wide general education. He thinks clearly so that his unerring conclusions are drawn in a startlingly easy manner. Yet he was often hampered by the theories of the ancient philosophical schools of medicine. Hunter's knowledge was gigantic, but it was uncontrolled. His thoughts are obscure and so ill expressed that it is often difficult to discover what he would say. His conclusions too are sometimes incorrect and are frequently laboured, yet the advance of knowledge in the hundred years and more which separated him from Harvey afforded him many additional data. Harvey's acquaintance with the literature of medicine enabled him to cite apposite examples, and must evidently have been of the greatest service to him in elucidating his problems. Hunter too often traversed paths which were already well trodden, for his defective education prevented him from knowing the works of his predecessors. The atmosphere of Courts and of the refined and learned society in which Harvey spent most of his life has given a polish to his writings and a gentleness to his character which were wholly wanting to John Hunter, upon whom the _res angustae domi_--absent in Harvey's case--had impressed a certain ruggedness of character, but in both there was a native strength and robustness of constitution which render them not dissimilar. As mere practitioners or curers of the body neither Harvey nor Hunter were highly esteemed by their contemporaries, though both made considerable sums of money by their art. The curiosity both of Harvey and of Hunter was boundless, but their minds were of the creative rather than of the imaginative type. Both collected facts and were averse to theories. Neither Hunter nor Harvey were religious men in the ordinary and narrow sense of the term. Harvey, living at an intensely religious period in the history of England, appears to have held the broad views befitting a student of nature. An eminently religious tone runs throughout his work, "a devout and reverential recognition of God," as Sir Russell Reynolds expressed it, "not only as the great primal ever-acting force, behind, outside and before all the works of Nature; but as the Being, 'the Almighty and Eternal God,' to whom he says in his last will and testament, 'I do most humbly render my soul to Him who gave it; and to my blessed Lord and Saviour Christ Jesus.'" Hunter living in a freer age had yet the remains of his Scottish upbringing adherent to the last. CHAPTER VIII HARVEY'S ANATOMICAL WORKS Harvey's _liber aureus_ is certainly his "Exercitatio anatomica de motu cordis et sanguinis in animalibus." [An Anatomical Treatise on the Movement of the Heart and Blood in Animals, by William Harvey, the Englishman, Physician to the King and Professor of Anatomy in the London College of Physicians.] The work was issued from the press of William Fitzer, of Frankfort, in the year 1621. Harvey chose Frankfort as the place of publication for his book because the annual book fair held in the town enabled a knowledge of his work to be more rapidly spread than if it had been issued in England. The book contains the matured account of the circulation of the blood, of which somewhat more than the germ had appeared in the notes of the Lumleian visceral lecture for 1616. It is a small quarto, containing seventy-two pages and a page and half of _errata_, for Harvey wrote a villainous hand, and communication between Germany and England was too slow, expensive, and uncertain to allow an author to correct his book sheet by sheet as it issued from the press. The Treatise opens with a dedication to Charles I. couched in fitting emblematical language, and signed "Your Most August Majesty's Most Devoted Servant, William Harvey." The dedication is followed by a preface addressed to "Dr. Argent [then President of the College of Physicians, and one of Harvey's intimate friends] as well as to the other learned physicians, his most esteemed colleagues." In this preface he excuses himself for the book, saying that he had already and repeatedly presented to them his new views of the movement and function of the heart in his anatomical lectures. And that he had now for nine years and more confirmed these views by multiplied demonstrations in their presence. He had illustrated them by arguments and he had freed them from objections of the most learned and skilful Anatomists. He then proceeds so modestly that it is difficult to realise how great an innovation he was really making when he says, "I profess both to learn and to teach anatomy, not from books but from dissections, not from the positions of philosophers but from the fabric of nature." Such a statement is now a mere truism, because every one who starts upon a subject of original research follows the method adopted by Harvey. He learns thoroughly what is known already; he frames a working hypothesis and puts it to the test of experiment. He then combines his _à priori_ reasoning with a logical deduction from the facts he observes. A feeble mind is sometimes overmastered by its working hypothesis, and may be led to consider it proved when a better trained observer would dismiss it for a more promising theory. Harvey's hypothesis--tested by experiment, by observation, and by reasoning--was no longer an hypothesis but a proved fact fertile beyond measure, for it rendered possible a coherent and experimental physiology and a new medicine and surgery. The anatomical treatise gives in seventeen short chapters a perfectly clear and connected account of the action of the heart and of the movement of the blood round the body in a circle. A movement which had been foreshadowed by some of the earlier anatomists and had been clearly indicated by Harvey himself as early as 1616. But it is here laid down with a precision of detail, with a logical exactness, and with a wealth of illustration which is marvellous even to us who read of the circulation as an established and fundamental principle upon which the whole body of physic rests. Harvey's proof fell short of complete demonstration, for he had no means of showing how the smallest arteries are connected with the smallest veins. He worked, indeed, with a simple lens, but its magnifying power was too feeble to show him the arterioles and the venules, whilst the idea of an injection does not seem to have occurred to him. It was not until after the invention of the compound microscope that Leeuwenhoek, in 1675, described the blood corpuscles and the circulation in the capillary blood vessels, though they had already been seen by Malpighi. The first chapter of the Treatise is introductory. It is a review of the chief theories which had been held as to the uses of the heart and lungs. It had been maintained that the heart was the great centre for the production of heat. The blood was driven alternately to and from the heart, being sucked into it during the diastole and driven from it during the systole. The use of the arteries was to fan and cool the blood, as the lungs fanned and cooled the heart, for the pulse was due to an active dilatation and contraction of the arteries. During their dilatation the arteries sucked in air, and during their contraction they discharged murky vapours through pores in the flesh and skin. In the heart, as well as in the arteries, the dilatation was of greater importance than the contraction. The whole of this tissue of falsehood seems to have been founded upon an incorrect apprehension of the nature of heat. It was looked upon as a fundamental principle or entity, and until chemistry and physics reached the stage of experimental sciences it was impossible to give a correct explanation of the phenomena it presents. Even Harvey sometimes lost himself in mysticism when he had to deal with the subject of animal heat, though he was struggling hard to find a firm foothold when he said, "We are too much in the habit of worshipping names to the neglect of things. The word Blood has nothing of grandiloquence about it, for it signifies a substance which we have before our eyes and can touch; but before such titles as Spirit and Calidum Innatum [or inherent heat] we stand agape." Harvey begins his Treatise on the movement of the Heart and Blood with the clear statement that the heart must be examined whilst it is alive; but he says, "I found the task so truly arduous and so full of difficulties that I was almost tempted to think with Fracastorius that the movement of the heart was only to be comprehended by God. For I could neither rightly perceive at first when the systole[10] and when the diastole took place, nor when and where dilatation and contraction occurred, by reason of the rapidity of the movement, which in many animals is accomplished in the twinkling of an eye, coming and going like a flash of lightning. "At length by using greater and daily diligence and investigation, making frequent inspection of many and various animals and collating numerous observations, I thought that I had attained to the truth ... and that I had discovered what I so much desired--both the movement and the use of the heart and arteries. From that time I have not hesitated to expose my views upon these subjects, not only in private to my friends, but also in public in my anatomical lectures, after the manner of the Academy of old. "These views, as usual, pleased some more, others less: some chid and calumniated me and laid it to me as a crime that I had dared to depart from the precepts and opinion of all anatomists: others desired further explanations of the novelties, which they said were both worthy of consideration, and might perchance be found of signal use." The results of his experiments soon made it plain to Harvey that the heart's movements could be studied more readily in the colder animals, such as toads, frogs, serpents, small fishes, crabs, shrimps, snails, and shell-fish, than in warm-blooded animals. The movements of the heart became more distinct even in warm-blooded animals, such as the dog and hog, if the organ was attentively noted when it began to flag. The movements then became slower, the pauses longer, so that it was then much more easy to perceive and unravel what the movements really were and how often they were performed. Careful observation and handling the heart made it clear that the organ was muscular, and that its systole was in every way comparable with the contraction which occurs in the muscles of the forearm when the fingers are moved. "The contraction of the heart is therefore of greater importance than its relaxation. During its contraction the heart becomes erect, hard, and diminished in size, so that the ventricles become smaller and are so made more apt to expel their charge of blood. Indeed, if the ventricle be pierced the blood will be projected forcibly outwards at each pulsation when the heart is tense." After thus disproving the erroneous views of the heart's action, Harvey next proceeds to discuss the movements in the arteries as they are seen in the dissection of living animals. He shows that the pulsation of the arteries depends directly upon the contraction of the left ventricle and is due to it, whilst the contraction of the right ventricle propels its charge of blood into the pulmonary artery which is distended simultaneously with the other arteries of the body. When an artery is divided or punctured the blood is forcibly expelled from the wound at the instant when the left ventricle contracts, and when the pulmonary artery is wounded the blood spurts forth with violence when the right ventricle contracts. So also in fish, if the vessel leading from the heart to the gills be divided the blood flows out forcibly when the heart becomes tense and contracted. These facts enabled Harvey to disprove the current theory that the heart's systole corresponded with the contraction of the arteries which then became filled with blood by a process of active dilatation, as bellows are filled with air. He illustrated this by a homely method which he had been accustomed to use in his lectures for years. He says that "the pulses of the arteries are due to the impulses of the blood from the left ventricle may be illustrated by blowing into a glove, when the whole of the fingers will be found to become distended at one and the same time and in their tension to bear some resemblance to the pulse." The broad points in connection with the vascular system being thus settled, Harvey turned his attention more particularly to the mechanism of the heart's action. He shows that the two auricles move synchronously and that the two ventricles also contract at the same time. Hitherto it had been supposed that each cavity of the heart moved independently, so that every cardiac cycle consisted of four distinct movements. To prove that the movement of the heart was double he examined the eel, several fish, and some of the higher animals. He noticed that the ventricles would pulsate without the auricles, and that if the heart were cut into several pieces "the several parts may still be seen contracting and relaxing." The minute accuracy of Harvey's observation is shown by his record of what is in reality a perfusion experiment. He says: "Experimenting with a pigeon upon one occasion after the heart had wholly ceased to pulsate and the auricles too had become motionless, I kept my finger wetted with saliva and warm for a short time upon the heart and noticed that under the influence of this fomentation it recovered new strength and life, so that both ventricles and auricles pulsated, contracting and relaxing alternately, recalled as it were from death to life." We now know that this was due to the warmth, to the moisture, and to the alkalinity of Harvey's saliva, so that he performed crudely, and no doubt by accident, one of the most modern experiments to show that the heart, under suitable conditions, has the power of recovering from fatigue. This portion of the treatise affords an insight into the enormous amount of labour which Harvey had expended in its production, for he says: "I have also observed that nearly all animals have truly a heart, not the larger creatures only and those that have red blood, but the smaller and pale-blooded ones also, such as slugs, snails, scallops, shrimps, crabs, crayfish, and many others; nay, even in wasps, hornets, and flies I have, with the aid of a magnifying glass and at the upper part of what is called the tail, both seen the heart pulsating and shown it to many others." That this was the result of a careful study of the animals mentioned and not a simple observation is shown by the following sentences: "In winter and the colder season, pale-blooded animals such as the snail show no pulsations: they seem rather to live after the manner of vegetables or of those other productions which are therefore designated plant animals.... We have a small shrimp in these countries, which is taken in the Thames and in the sea, the whole of whose body is transparent: this creature, placed in a little water, has frequently afforded myself and particular friends an opportunity of observing the movements of the heart with the greatest distinctness, the external parts of the body presenting no obstacle to our view, but the heart being perceived as though it had been seen through a window. "I have also observed the first rudiments of the chick in the course of the fourth or fifth day of the incubation, in the guise of a little cloud, the shell having been removed and the egg immersed in clear, tepid water. In the midst of the cloudlet in question there was a bloody point so small that it disappeared during the contraction and escaped the sight, but in the relaxation it reappeared again red and like the point of a pin." Harvey formulates in his fifth chapter the conclusions to which he had been led about the movement, action, and use of the heart. His results appear to be absolutely correct by the light of our present knowledge, and they show how much can be done by a careful observer, even though he be unassisted by any instrument of precision. "First of all the auricle contracts, and in the course of its contraction forces the blood (which it contains in ample quantity as the head of the veins, the storehouse and cistern of the blood) into the ventricle which, being filled, the heart raises itself straightway, makes all its fibres tense, contracts the ventricles and performs a beat, by which beat it immediately sends the blood supplied to it by the auricle into the arteries. The right ventricle sends its charge into the lungs by the vessel which is called the vena arteriosa [pulmonary artery], but which in structure and function and all other respects is an artery. The left ventricle sends its charge into the aorta and through this by the arteries to the body at large. "These two movements, one of the ventricles, the other of the auricles, take place consecutively, but in such a manner that there is a kind of harmony or rhythm preserved between them, the two concurring in such wise that but one movement is apparent, especially in the warmer blooded animals in which the movements in question are rapid. Nor is this for any other reason than it is in a piece of machinery in which, though one wheel gives movement to another, yet all the wheels seem to move simultaneously; or in that mechanical contrivance which is adapted to firearms, where the trigger being touched, down comes the flint, strikes against the wheel, produces a spark, which falling among the powder, ignites it, upon which the flame extends, enters the barrel, causes the explosion, propels the ball, and the mark is attained--all of which incidents by reason of the celerity with which they happen, seem to take place in the twinkling of an eye.... Even so does it come to pass with the movements and action of the heart.... Whether or not the heart besides propelling the blood, giving it movement locally and distributing it to the body, adds anything else to it--heat, spirit, perfection--must be inquired into by and by, and decided upon other grounds. So much may suffice at this time, when it is shown that by the action of the heart the blood is transfused through the ventricles from the veins to the arteries and is distributed by them to all parts of the body. "The above indeed is admitted by all, both from the structure of the heart and the arrangement and action of its valves. But still they are like persons, purblind or groping in the dark, for they give utterance to various contradictory and incoherent sentiments, delivering many things upon conjecture.... The great cause of doubt and error in this subject appears to me to have been the intimate connection between the heart and the lungs. When men saw both the pulmonary artery and the pulmonary veins losing themselves in the lungs, of course it became a puzzle to them to know how or by what means the right ventricle should distribute the blood to the body or the left draw it from the venae cavae.... "Since the intimate connection of the heart with the lungs, which is apparent in the human subject, has been the probable cause of the errors that have been committed on this point, they plainly do amiss who, pretending to speak of the parts of animals generally, as Anatomists for the most part do, confine their researches to the human body alone, and that when it is dead. They obviously do not act otherwise than he who, having studied the forms of a single commonwealth, should set about the composition of a general system of polity: or who, having taken cognisance of the nature of a single field, should imagine that he had mastered the science of agriculture; or who, upon the ground of one particular proposition, should proceed to draw general conclusions. "Had Anatomists only been as conversant with the dissection of the lower animals as they are with that of the human body, the matters that have hitherto kept them in a perplexity of doubt would, in my opinion, have met them freed from every kind of difficulty." After this plea for the employment of comparative anatomy to elucidate human anatomy, Harvey proceeds to deal in a most logical manner with the various difficulties in following the course taken by the blood in passing from the vena cava to the arteries, or from the right to the left side of the heart. He begins with fish, in which the heart consists of a single ventricle, for there are no lungs. He then discusses the relationship of the parts in the embryo, and arrives at the conclusion that "in embryos, whilst the lungs are in a state of inaction, performing no function, subject to no movement any more than if they had not been present, Nature uses the two ventricles of the heart as if they formed but one for the transmission of the blood." He therefore concludes that the condition of the embryos of those animals which have lungs, whilst these organs are yet in abeyance or not employed, is the same as that of the animals which have no lungs. From this he wishes it to be understood that the blood passes by obvious and open passages from the vena cava into the aorta through the cavities of the ventricles. A statement which was in direct opposition to the generally received tradition of the time that the blood passed from the right into the left ventricle by concealed pores in the septum which separates the two cavities in the heart. Thus far Harvey's teaching has been excellent, but now, leaving the highway of fact, he plunges into theory and is at once involved in error. He proceeds, "And now the discussion is brought to this point, that they who inquire into the ways by which the blood reaches the left ventricle of the heart and pulmonary veins from the vena cava will pursue the wisest course if they seek by dissection to discover why, in the larger and more perfect animals of mature age, Nature has rather chosen to make the blood percolate the parenchyma of the lungs, than as in other instances chosen a direct and obvious course--for I assume no other path or mode of transit can be entertained. It must be because the larger and more perfect animals are warmer, and when adult their heat greater, ignited I might say, and requiring to be damped or mitigated, that the blood is sent through the lungs, in order that it may be tempered by the air that is inspired, and prevented from boiling up and so becoming extinguished or something else of the sort. But to determine these matters and explain them satisfactorily were to enter upon a speculation in regard to the office of the lungs and the ends for which they exist. Upon such a subject, as well as upon what pertains to respiration, to the necessity and use of the air, &c., as also to the variety and diversity of organs that exist in the bodies of animals in connection with these matters, although I have made a vast number of observations, I shall not speak till I can more conveniently set them forth in a treatise apart." The next chapter is devoted to the description of the manner in which the blood passes through the substance of the lungs from the right ventricle of the heart into the pulmonary veins. It is followed by the glorious eighth chapter, in which Harvey's style, always impressive and solid, rises into real eloquence, for a great occasion justifies the use of repetitions, of antitheses and an abundance of metaphors. He now quits the method of demonstration and experiment for that of indirect but irrefragable argument. He deals with the quantity of blood passing through the heart from the veins to the arteries, and again brings together all his threads to a nodal point. "Thus far I have spoken of the passage of the blood from the veins into the arteries, and of the manner in which it is transmitted and distributed by the action of the heart; points to which some, moved either by the authority of Galen or Columbus, or the reasonings of others, will give their adhesion. But what remains to be said upon the quantity and source of the blood which thus passes is of a character so novel and unheard of that I not only fear injury to myself from the envy of a few, but I tremble lest I have mankind at large for my enemies, so much doth wont and custom become a second nature. Doctrine once sown strikes deeply its root, and respect for antiquity influences all men. Still the die is cast, and my trust is in my love of truth and the candour of cultivated minds. And sooth to say when I surveyed my mass of evidence, whether derived from vivisections and my various reflections on them, or from the study of the ventricles of the heart and the vessels that enter into and issue from them, the symmetry and the size of these conduits, for Nature doing nothing in vain, would never have given them so large a relative size without a purpose--or from observing the arrangement and intimate structure of the valves in particular and of the other parts of the heart in general, with many things besides, I frequently and seriously bethought me and long revolved in my mind, what might be the quantity of blood which was transmitted, in how short a time its passage might be effected and the like. But not finding it possible that this could be supplied by the juices of the ingested aliment without the veins on the one hand becoming drained, and the arteries on the other getting ruptured through the excessive charge of blood, unless the blood should somehow find its way from the arteries into the veins and so return to the right side of the heart; I began to think whether there might not be a movement, as it were, in a circle. Now this I afterwards found to be true, and I finally saw that the blood, forced by the action of the left ventricle into the arteries, was distributed to the body at large and in several parts in the same manner as it is sent through the lungs impelled by the right ventricle into the pulmonary artery, and that it then passed through the veins and along the vena cava and so round to the left ventricle in the manner already indicated. This movement we may be allowed to call circular." Harvey's great discovery is here formulated in his own words. The lesser or pulmonary circulation was already tolerably well known, owing to the work of Realdus Columbus, the successor of Vesalius in the anatomical chair at Padua, though he had been anticipated by Servetus, who published it at Lyons in 1543 in the "Christianismi Restitutio," a theological work, containing doctrines for which Calvin caused him to be burnt. But it is more than doubtful whether Harvey knew of this work, as not more than three or four copies of it have escaped the flames which consumed the book and its writer. Harvey continues his treatise by laying down three propositions to confirm his main point that the blood circulates. First, that the blood is incessantly transmitted by the action of the heart from the vena cava to the arteries. Secondly, that the blood under the influence of the arterial pulse enters and is impelled in a continuous, equable, and incessant stream through every part and member of the body, in much larger quantity than is sufficient for nutrition or than the whole mass of fluids could supply. Thirdly, that the veins return this blood incessantly to the heart. "These points being proved, I conceive it will be manifest that the blood circulates, revolves, is propelled, and then returning from the heart to the extremities, from the extremities to the heart, and thus that it performs a kind of circular movement." These propositions Harvey proves to demonstration and in a most masterly manner. He says of the first: "Let us assume either arbitrarily or by experiment, that the quantity of the blood which the left ventricle of the heart will contain when distended to be, say two ounces, three ounces, or one ounce and a half--in the dead body I have found it to hold upwards of two ounces. Let us assume further how much less the heart will hold in the contracted than in the dilated state, and how much blood it will project into the aorta upon each contraction, and all the world allows that with the systole something is always projected ... and let us suppose as approaching the truth that the fourth, or fifth, or sixth, or even but the eighth part of its charge is thrown into the artery at each contraction, this would give either half an ounce, or three drachms, or one drachm of blood as propelled by the heart at each pulse into the aorta, which quantity by reason of the valves at the root of the vessel can by no means return into the ventricle. Now in the course of half an hour the heart will have made more than one thousand beats, in some as many as two, three, or even four thousand. Multiplying the number of drachms by the number of pulses we shall have either one thousand half ounces, or one thousand times three drachms, or a like proportional quantity of blood, according to the amount we assume as propelled with each stroke of the heart, sent from this organ into the artery: a larger quantity in every case than is contained in the whole body. In the same way in the sheep or dog, say that but a single scruple of blood passes with each stroke of the heart, in one half hour we should have one thousand scruples, or about three pounds and a half of blood injected into the aorta, but the body of neither animal contains more than four pounds of blood, a fact which I have myself ascertained in the case of the sheep." This is one of the highest efforts of Harvey's genius. The facts are simple and they are easily ascertained. But the reasoning was absolutely new and the conclusion must remain sound until the end of time, for it is true. It shows too the minute care taken by Harvey not to overstate his case, for he deliberately takes a measurement of the capacity of the ventricles which he knew to be well under the average. This part of his argument is ended with an appeal to practical experience. "The truth, indeed, presents itself obviously before us when we consider what happens in the dissection of living animals: the great artery need not be divided, but a very small branch only (as Galen even proves in regard to man), to have the whole of the blood in the body, as well that of the veins as of the arteries, drained away in the course of no long time--some half hour or less. Butchers are well aware of the fact and can bear witness to it; for, cutting the throat of an ox and so dividing the vessels of the neck, in less than a quarter of an hour they have all the vessels bloodless--the whole mass of blood has escaped. The same thing also occasionally occurs with great rapidity in performing amputations and removing tumours in the human subject.... Moreover it appears ... that the more frequently or forcibly the arteries pulsate, the more speedily will the body be exhausted of its blood during hæmorrhage. Hence also it happens that in fainting fits and in states of alarm when the heart beats more languidly and less forcibly, hæmorrhages are diminished and arrested. "Still further, it is from this, that after death, when the heart has ceased to beat, it is impossible by dividing either the jugular or the femoral veins and arteries by any effort to force out more than one-half of the whole mass of the blood. Neither could the butcher ever bleed the carcass effectually did he neglect to cut the throat of the ox which he has knocked on the head and stunned before the heart had ceased beating." Harvey continues to push his argument to a logical conclusion in the succeeding chapters of his Treatise partly by argument and partly by adducing fresh experimental evidence. But if any one shall here object that a large quantity may pass through (the heart) and yet no necessity be found for a circulation, that all may come from the meat and drink consumed, and quote as an illustration the abundant supply of milk in the mammæ--for a cow will give three, four, and even seven gallons a day, and a woman two or three pints whilst nursing a child or twins, which must manifestly be derived from the food consumed; it may be answered, that the heart by computation does as much and more in the course of an hour or two. "And if not yet convinced he shall still insist, that when an artery is divided, a preternatural route is, as it were, opened, and that so the blood escapes in torrents, but that the same thing does not happen in the healthy and uninjured body when no outlet is made ... it may be answered, that ... in serpents and several fish by tying the veins some way below the heart, you will perceive a space between the ligature and the heart speedily to become empty, so that unless you would deny the evidence of your senses, you must needs admit the return of the blood to the heart.... If, on the contrary, the artery instead of the vein be compressed or tied, you will observe the part between the obstacle and the heart and the heart itself to become inordinately distended, to assume a deep purple or even livid colour, and at length to be so much oppressed with blood that you will believe it about to be choked; but the obstacle removed, all things immediately return to their natural state in colour, size, and impulse." Harvey next proceeds to demonstrate his second proposition. He shows that the blood enters a limb by the arteries and leaves it by the veins; that the arteries are the vessels carrying the blood from the heart, and the veins the returning channels of the blood to the heart; that in the limbs and the extreme parts of the body the blood passes either immediately by anastomosis or mediately by the pores of the flesh. Harvey is here hampered by the conditions of the age in which he lived, yet it is here that he shows himself far superior to his contemporaries as well as to the most enlightened of his predecessors. His lens was not sufficiently powerful to show him the capillary blood-vessels, and he had therefore no real knowledge of the way by which the blood passed from the arterioles into the venules. On the other hand, he did not repeat the mistake made by Aristotle, and reiterated by Cesalpino in 1571 that the blood passed from the smallest arteries into "capillamenta," the [Greek: neura] of Aristotle. Later commentators have given to Cesalpino the credit due to Harvey by translating "capillamenta" into our term capillaries. But this process of "reading into" the writings of man what he never knew is one of the commonest pitfalls of defective scholarship. Harvey attempted to solve the problem of the capillary circulation by an appeal to clinical evidence, which soon led him into inaccuracies, as when he says that the fainting often seen in cases of blood-letting is due to the "cold blood rising upwards to the heart, for fainting often supervenes in robust subjects, and mostly at the moment of undoing the fillet, as the vulgar say from the 'turning of the blood.'" This Chapter XI. is an important one. Harvey takes the operation of bleeding as one which is familiar to every class of his readers, and he uses the various phenomena which attend the application of a ligature to the arm to clinch his arguments as to the existence of the circulation of the blood. He introduces incidentally his surgical and pathological knowledge, quoting, amongst other instances, the fact that if the blood supply to a tumour or organ be stopped, "the tissues deprived of nutriment and heat dwindle, die, and finally drop off." He also introduces some pathological results from personal experience, for he says:--"Thrown from a carriage upon one occasion, I struck my forehead a blow upon the place where a twig of the artery advances from the temple, and immediately, within the time when twenty beats could have been made, I felt a tumour the size of an egg developed, without either heat or any great pain; the near vicinity of the artery had caused the blood to be effused into the bruised part with unusual force and velocity." This passage shows one of the minor difficulties that Harvey and all observers in his age had to contend with in the fact that no method existed by which small fractions of time could be measured.[11] The ordinary watch had only a single hand marking the hours, so that neither minutes nor seconds could be registered by them. The difficulty was one of old standing, and Dr. Norman Moore alluded to it, when he says in regard to Mirfeld's "Breviarium Bartholomei:" "The mixture of prayers with pharmacy seems odd to us; but let it be remembered that Mirfeld wrote in a religious house, that clocks were scarce, and that in that age and place time might not inappropriately be measured by the minutes required for the repetition of so many verses of Scripture or so many prayers. Thus Mirfeld recommends that chronic rheumatism should be treated by rubbing the part with olive oil. This was to be prepared with ceremony. It was to be put into a clean vessel while the preparer made the sign of the cross and said the Lord's Prayer and an Ave Maria. When the vessel was put to the fire the Psalm 'Why do the heathen rage' was to be said as far as the verse, 'Desire of Me, and I shall give thee the heathen for thine inheritance.' The Gloria, Pater Noster, and Ave Maria are to be said, and the whole gone through seven times. Which done let that oil be kept. The time occupied I have tried, and found to be a quarter of an hour." In the succeeding chapters Harvey continues his observations on phlebotomy, and draws a conclusion so striking in its simplicity that it appears hard to understand why it had not already occurred to others. He says: "And now, too, we understand why in phlebotomy we apply one ligature above the part that is punctured, not below it: did the flow come from above, the constriction in this case would not only be of no service but would prove a positive hindrance. It would have to be applied below the orifice in order to have the flow more free did the blood descend by the veins from the superior to inferior parts." Harvey next returns to the question whether the blood does or does not flow in a continuous stream through the heart--a subject upon which his contemporaries had the wildest notions, for even Cesalpino says: "That whilst we are awake there is a great afflux of blood and spirit to the arteries whence the passage is to the nerves and whilst we are asleep the same heat returns to the heart by the veins, not by the arteries, for the natural ingress to the heart is by the _vena cava_, not by the artery ... so that the undulating flow of blood to the superior parts, and its ebb to the inferior parts--like Euripus--is manifest in sleeping and waking." Harvey combats this theory in exactly the same manner as we should do if it were propounded at the present day. He first brings forth his mathematical proof of the circulation, and then continues his surgical observations upon the operation of bleeding. "It is still further to be observed that in practising phlebotomy the truths contended for are sometimes confirmed in another way, for having tied up the arm properly and made the puncture duly, still, if from alarm or any other causes, a state of faintness supervenes, in which the heart always pulsates more languidly, the blood does not flow freely, but distils by drops only. The reason is that with the somewhat greater than usual resistance offered to the transit of the blood by the bandage, coupled with the weaker action of the heart and its diminished impelling power, the stream cannot make its way under the ligature; and further, owing to the weak and languishing state of the heart, the blood is not transferred in such quantity from the veins to the arteries through the sinuses of that organ.... And now a contrary state of things occurring, the patient getting rid of his fear and recovering his courage, the pulse strength is increased, the arteries begin again to beat with greater force, and to drive the blood even into the part that is bound, so that the blood now springs from the puncture in the vein, and flows in a continuous stream...." Thus far, he proceeds, "we have spoken of the quantity of blood passing through the heart and the lungs in the centre of the body, and in like manner from the arteries into the veins in the peripheral parts, and in the body at large. We have yet to explain, however, in what manner the blood finds its way back to the heart from the extremities by the veins, and how and in what way these are the only vessels that convey the blood from the external to the central parts; which done, I conceive that the three fundamental propositions laid down for the circulation of the blood will be so plain, so well established, so obviously true, that they may claim general credence. Now the remaining proposition will be made sufficiently clear from the valves which are found in the cavities of the veins themselves, from the uses of these, and from experiments cognisable by the senses." Harvey returns again to his anatomical demonstrations to prove his point. He explains the true uses of the valves in the veins, whose existence, he says, were known to his old teacher "Hieronymus Fabricius, of Aquapendente, a most skilful anatomist and venerable old man.... The discoverer of these valves did not rightly understand their use, nor have succeeding anatomists added anything to our knowledge; for their office is by no means explained when we are told that it is to hinder the blood by its weight from all flowing into the inferior part; for the edges of the valves in the jugular veins hang downwards, and are so contrived that they prevent the blood from rising upwards; the valves, in a word, do not invariably look upwards, but always towards the trunks of the veins, invariably towards the seat of the heart. Let it be added that there are no valves in the arteries, and that dogs, oxen, &c., have invariably valves at the divisions of their crural veins, in the veins that meet towards the top of the os sacrum, and in those branches which come from the haunches, in which no such effect of gravity from the erect position was to be apprehended." "The valves are solely made and instituted lest the blood should pass from the greater into the lesser veins, and either rupture them or cause them to become varicose.... The delicate valves, whilst they readily open in the right direction, entirely prevent all contrary movement.... And this I have frequently experienced in my dissections of the veins: if I attempted to pass a probe from the trunk of the veins into one of the smaller branches, whatever care I took, I found it impossible to introduce it far any way, by reason of the valves; whilst, on the contrary, it was most easy to push it along in the opposite direction from without inwards, or from the branches towards the trunks and roots." He concludes his argument by again pointing out that the uses of the valves can be clearly shown in an arm which has been tied up for phlebotomy, and that the valves are best seen in labouring people. The fourteenth chapter is devoted to the "Conclusion of the Demonstration of the Circulation." It runs thus:-- "And now I may be allowed to give in brief my view of the circulation of the blood, and to propose it for general adoption. "Since all things, both argument and ocular demonstration show that the blood passes through the lungs and heart by the force of the ventricles, and is sent for distribution to all parts of the body, where it makes its way into the veins and pores of the flesh, and then flows by the veins from the circumference on every side to the centre from the lesser to the greater veins, and is by them finally discharged into the vena cava and right auricle of the heart, and this in such quantity or in such afflux and reflux, thither by the arteries, hither by the veins, as cannot possibly be supplied by the ingesta, and is much greater than can be required for mere purposes of nutrition; it is absolutely necessary to conclude that the blood in the animal body is impelled in a circle, and is in a state of ceaseless movement; that this is the act or function which the heart performs by means of its pulse, and that it is the sole and only end of the movement and contraction of the heart." Harvey concludes his treatise with a series of reasons which he rightly considers to be of a less satisfactory nature than those he has already adduced. The seventeenth chapter contains much comparative anatomy. It opens with the statement that "I do not find the heart as a distinct and separate part in all animals; some, indeed, such as the zoophytes, have no heart.... Amongst the number I may instance grubs and earth-worms, and those that are engendered of putrefaction and do not preserve their species. These have no heart, as not requiring any impeller of nourishment into the extreme parts.... Oysters, mussels, sponges, and the whole genus of zoophytes or plant-animals have no heart, for the whole body is used as a heart, or the whole animal is heart. In a great number of animals, almost the whole tribe of insects, we cannot see distinctly by reason of the smallness of the body; still, in bees, flies, hornets, and the like we can perceive something pulsating with the help of a magnifying glass; in pediculi also the same thing may be seen, and as the body is transparent, the passage of the food through the intestines, like a black spot or stain, may be perceived by the aid of the same magnifying glass. "But in some of the pale-blooded and colder animals, as in snails, whelks, shrimps, and shell-fish, there is a part which pulsates--a kind of vesicule or auricle without a heart--slowly, indeed, and not to be perceived except in the warmer season of the year.... In fishes, serpents, lizards, tortoises, frogs, and others of the same kind there is a heart present, furnished with both an auricle and a ventricle.... And then in regard to animals that are yet larger and warmer and more perfect,... these require a larger, stronger, and more fleshy heart.... Every animal that has lungs has two ventricles to its heart, one right, the other left, and whenever there is a right there is a left ventricle, but the contrary does not hold good; where there is a left there is not always a right ventricle.... It is to be observed, however, that all this is otherwise in the embryo where there is not such a difference between the two ventricles.... Both ventricles also have the same office to perform, whence their equality of constitution. It is only when the lungs come to be used ... that the difference in point of strength and other things between the two ventricles becomes apparent. In the altered circumstances the right has only to drive the blood through the lungs, whilst the left has to propel it through the whole body." This concludes Harvey's Demonstration of the Circulation of the Blood in 1628, but he continued to work at the subject throughout his life. In two letters or anatomical disquisitions, addressed to the younger Riolanus of Paris, and dated from Cambridge in 1649, Harvey gives his latest reflections upon the subject of the Circulation of the Blood. These disquisitions differ very greatly from the original treatise. They are less clear and concise, and dwell more upon points of dispute which had arisen in connection with the controversy, which raged for many years round Harvey's discovery. The first disquisition is devoted more especially to the question of the anastomosis which takes place between the arteries and the veins, whilst the second disquisition illustrates more fully a number of details connected with the nature and quantity of the blood and its mode of progression. Harvey says incorrectly of the anastomosis, "Neither in the liver, spleen, lungs, kidneys, nor any other viscus, is such a thing as an anastomosis to be seen, and by boiling I have rendered the whole parenchyma of these organs so friable that it could be shaken like dust from the fibres or picked away with a needle, until I could trace the fibres or every sub-division, and see every capillary filament distinctly. I can, therefore, boldly affirm that there is neither any anastomosis of the vena portæ with the cava, of the arteries with the veins, or of the capillary ramifications of the biliary ducts, which can be traced through the entire liver, with the veins." The second disquisition opens with Harvey's view of the contemporary criticism upon his treatise. "But scarce a day, scarce an hour has passed since the birthday of the Circulation of the blood that I have not heard something, for good or for evil, said of this, my discovery. Some abuse it as a feeble infant, and yet unworthy to have seen the light; others again think the bantling deserves to be cherished and cared for. These oppose it with much ado, those patronise it with abundant commendation. One party holds that I have completely demonstrated the circulation of the blood by experiment, observation, and ocular inspection against all force and array of argument; another thinks it scarcely sufficiently illustrated--not yet cleared of all objections. There are some, too, who say that I have shown a vainglorious love of vivisections, and who scoff at and deride the introduction of frogs and serpents, flies, and other of the lower animals upon the scene, as a piece of puerile levity, not even refraining from opprobrious epithets. "To return evil speaking with evil speaking, however, I hold to be unworthy in a philosopher and searcher after truth. I believe that I shall do better and more advisedly if I meet so many indications of ill breeding with the light of faithful and conclusive observation. It cannot be helped that dogs bark and vomit their foul stomachs, or that cynics should be numbered among philosophers; but care can be taken that they do not bite or inoculate their mad humours, or with their dogs' teeth gnaw the bones and foundations of truth. "Detractors, mummers, and writers defiled with abuse, as I resolved with myself never to read them, satisfied that nothing solid or excellent, nothing but foul terms was to be expected from them, so have I held them still less worthy of an answer. Let them consume on their own ill-nature. They will scarcely find many well-disposed readers, I imagine, nor does God give that which is most excellent, and chiefly to be desired--wisdom--to the wicked. Let them go on railing, I say, until they are weary, if not ashamed." Amidst a mass of unprofitable speculation, the second Disquisition contains one or two gems of pathological observation, illustrating physiological conclusions. Desiring to set in a clear light "that the pulsific power does not proceed from the heart by the coats of the vessels, I beg here to refer to a portion of the descending aorta, about a span long in length, with its division into two crural trunks, which I removed from the body of a nobleman, and which is converted into a bony tube: by this hollow tube nevertheless, did the arterial blood reach the lower extremities of this nobleman during his life, and cause the arteries in these to beat.... Where it was converted into bone it could neither dilate nor contract like bellows, nor transmit the pulsific power from the heart to the inferior vessels: it could not convey a force which it was incapable of receiving through the solid matter of the bone. In spite of all, however, I well remember to have frequently noticed the pulse in the legs and feet of this patient whilst he lived, for I was myself his most attentive physician, and he my very particular friend. The arteries in the inferior extremities of this nobleman must, therefore, and of necessity, have been dilated by the impulse of the bloodlike flaccid sacs, and not have expanded in the manner of bellows through the action of their tunics. "I have several times opened the breast and pericardium of a man within two hours after his execution by hanging, and before the colour had totally left his face, and in presence of many witnesses, have demonstrated the right auricle of the heart and the lungs distended with blood: the auricle in particular of the size of a large man's fist, and so full of blood that it looked as if it would burst. This great distension, however, had disappeared next day, the body having stiffened and become cold, and the blood having made its escape through various channels. "I add another observation. A noble knight, Sir Robert Darcy, an ancestor of that celebrated physician and most learned man, my very dear friend, Dr. Argent, when he had reached to about the middle period of life, made frequent complaint of a certain distressing pain in the chest, especially in the night season, so that dreading at one time syncope, at another suffocation in his attacks, he led an unquiet and anxious life. He tried many remedies in vain, having had the advice of almost every medical man. The disease going on from bad to worse, he by and by became cachectic and dropsical, and finally grievously distressed, he died in one of his paroxysms. In the body of this gentleman, at the inspection of which there were present Dr. Argent, the President of the College of Physicians, and Dr. Gorge, a distinguished theologian and preacher, who was pastor of the parish, we found the wall of the left ventricle of the heart ruptured, having a rent in it of size sufficient to admit any of my fingers, although the wall itself appeared sufficiently thick and strong. This laceration had apparently been caused by an impediment to the passage of the blood from the left ventricle into the arteries. "I was acquainted with another strong man, who, having received an injury and affront from one more powerful than himself, and upon whom he could not have his revenge, was so overcome with hatred and spite and passion, which he yet communicated to no one, that at last he fell into a strange distemper, suffering from extreme oppression and pain of the heart and breast, and the prescriptions of none of the very best physicians proving of any avail, he fell in the course of a few years into a scorbutic and cachectic state, became tabid, and died. This patient only received some little relief when the whole of his chest was pummelled or kneaded by a strong man, as a baker kneads dough. His friends thought him poisoned by some maleficent influence or possessed with an evil spirit. His jugular arteries enlarged to the size of a thumb, looked like the aorta itself, or they were as large as the descending aorta: they had pulsated violently and appeared like two long aneurysms. These symptoms had led to trying the affects of arteriotomy in the temples, but with no relief. In the dead body I found the heart and aorta so much gorged and distended with blood that the cavities of the ventricles equalled those of a bullock's heart in size. Such is the force of the blood pent up, and such are the effects of its impulse." His letters show that Harvey was employed almost to the end of his life in devising fresh experiments in proof of the circulation of the blood. Thus, in a letter addressed to Paul Marquard Slegel, and dated London, this 26th of March, 1651, Harvey writes: "It may be well here to relate an experiment which I lately tried in the presence of several of my colleagues.... Having tied the pulmonary artery, the pulmonary veins, and the aorta, in the body of a man who had been hanged, and then opened the left ventricle of the heart, we passed a tube through the vena cava into the right ventricle of the heart, and having at the same time attached an ox's bladder to the tube, in the same way as a clyster-bag is usually made, we filled it nearly full of warm water and forcibly injected the fluid into the heart, so that the greater part of a pound of water was thrown into the right auricle and ventricle. The result was that the right ventricle and auricle were enormously distended, but not a drop of water or of blood made its escape through the orifice in the left ventricle. The ligatures having been undone, the same tube was passed into the pulmonary artery and a tight ligature having been put round it to prevent any reflux into the right ventricle, the water in the bladder was now pushed towards the lungs, upon which a torrent of the fluid, mixed with a quantity of blood, immediately gushed forth from the perforation in the left ventricle: so that a quantity of water, equal to that which was pressed from the bladder into the lungs at each effort, instantly escaped by the perforation mentioned. You may try this experiment as often as you please: the result you will still find to be as I have stated it." The exact teaching of Harvey's contemporaries in London is easily accessible. One of his distinguished colleagues at the College of Physicians was Alexander Reid, son of the first minister of Banchory, near Aberdeen, brother of Thomas Reid, Secretary for Latin and Greek to King James I. Reid was born about 1586, learnt Surgery in France, was admitted a Fellow of the College of Physicians in 1624, and was appointed Lecturer on Anatomy at the Barber Surgeons' Hall December 28, 1628, in succession to Dr. Andrewes, Harvey's assistant. Reid, eight years younger than Harvey, lectured at an annual stipend of £20 on every Tuesday throughout the year from 1628 to 1634, when he published a tiny Manual of Anatomy containing the substance of his lectures. For some reason Harvey's doctrines did not recommend themselves to Reid, and the Manual therefore contains the following traditional account of the heart. "As for the heart, the substance of it is compact and firm, and full of fibres of all sorts. The upper part is called _Basis_ or _Caput_: the lower part _Conus_, _Mucro_ or _Apex Cordis_. When the heart contracteth itself it is longer, and so the point is drawn from the head of it. But when it dilateth itself it becometh rounder, the conus being drawn to the basis. About the basis the fat is. It is covered with a skin which hardly can be separat[ed]. In moist and cowardly creatures, it is biggest.... Of all parts of the body it is hottest, for it is the wellspring of life, and by arteries communicateth it to the rest of the body. The heart hath two motions, Diastole and Systole. In Diastole, or dilatation of the heart, the conus is drawn from the basis to draw blood by the cava to the right ventricle, and air by the arteria venosa [pulmonary vein] to the left ventricle. In Systole or contraction the conus is drawn to the basis. "First, that the vital spirit may be thrust from the left ventricle of the heart into the aorta. "Secondly, that the arterial blood may be thrust into the lungs by arteria venalis [the left auricle]. "Thirdly, that the blood may be pressed to the lungs, in the right ventricle by vena arterialis [right auricle]. "The septum so called because it separateth the right ventricle from the left, is that thick and fleshy substance set between the two cavities. "Riolan will have it the matter of the vital blood to pass through the holes or porosities of it from the right to the left ventricle, but that hardly any instrument can show them. First, because they go not straight, but wreathed. Secondly, because they are exceeding narrow in the end. He affirmeth that they are more easily discerned in an ox-heart boiled." It is difficult to realise how any reasonable man could teach such a farrago of nonsense when he must have heard Harvey's perfectly simple and clear demonstration of the structure and uses of the heart. Harvey was lecturing on Tuesdays, Wednesdays, and Thursdays; Reid only lectured on Tuesdays, and Harvey had especially set himself to controvert the very errors that Reid was promulgating. But Reid was perfectly impenitent, for his Manual was reprinted in 1637, in 1638; and after his death it appeared again in 1642, 1650, 1653, and 1658, yet there is no alteration in his text. He was not even sure of the broad features of the anatomy of the heart, for he writes: "The first vessel in the chest is the vena cava or magna. The second vessel in the breast is vena arterialis. It is a vein from its office, for it carrieth natural blood to the lungs by the right side of the windpipe. It is called an artery because the coat of it is double, not single. It doth spring from the upper part of the right ventricle of the heart, and is implanted into the substance of the lungs by the right side of the windpipe." It seems obvious that this is a perverted description of the right auricle, and that Reid had no idea of the pulmonary artery as a distinct structure. "The third vessel is arteria venalis. It is called an artery because it carrieth arterial blood, but a vein because it hath a single coat as a vein. It ariseth from the upper part of the left ventricle of the heart, and is implanted into the substance of the lungs by the left side of the windpipe." This in like manner appears to be the left auricle and the pulmonary veins. "The vena arterialis hath three valves called sigmoides from the figure of the great sigma, which answereth the Latin S, the figure is this, C. They look from within outwards, to let out the blood but to hinder the return of the same. "The arteria venalis hath two valves called mitrales, because they are like a bishop's mitre. They look from without inward to let in blood carried from the vena arterialis. They are bigger than those of vena cava and have longer filaments and to strengthen them many fleshy snippets are joined together. "It hath two valves only that the fuliginous vapours might the more readily be discharged." Reid, like all his contemporaries, had a glimmering of the lesser circulation, for he says: "First the blood is carried by vena arterialis and from hence to arteria venalis by sundry anastomoses, and from hence to the left ventricle of the heart. Where being made spirituous it is sent by the aorta to impart life to the whole body. "One thing is to be noted that no air in its proper substance is carried to the heart; for the blood contained in these two vessels is sufficiently cooled by the bronchia passing between them.... One thing is to be noted, that in arteria venosa a little below the valves there is found a little valve ever open. It being removed, there appeareth a hole by the which the blood passeth freely from the vena cava to it and returneth by reason of this anastomosis that the blood in the veins may be animate." This is a description of the foramen ovale and its use. Such a comparison with the work of a contemporary teacher in the same town shows how immeasurable was the advance made by Harvey. It only remains to show what has been done since his death to perfect our knowledge of the heart and of the circulation. The use of the microscope by Malpighi in 1661 gave an insight into the true nature of the porosities by which the blood passed from the terminal arteries to the commencing veins in the lungs and proved them to be vessels. The capillary circulation was still further investigated by Leeuwenhoek in 1674 who described it as it is seen in the web of a frog's foot, and in other transparent membranes; Blankaart in 1676, William Cowper in 1697, and afterwards Ruysch, studied the arrangement of the capillaries by means of injection. In 1664 Stenson demonstrated that the heart was a purely muscular organ. The various histological details being thus settled there came a long interval until chemistry was sufficiently advanced to enable definite statements to be made about the aëration of the blood. The work of Black in 1757 and of Priestley and others in 1774 and 1775 at last allowed the process of respiration and the true function of the lungs to be explained upon scientific grounds. But the interval between the discovery of the capillaries and the explanation of the act of respiration was not wholly barren; for in 1732 Archdeacon Hales, by means of experiments, obtained an important insight into the hydraulics of the circulation. During the present century our knowledge of the physics of the heart and circulation has been reduced almost to an exact science by the labours of the German, French, and Cambridge schools of physiology under the guidance respectively of Ludwig, of Chauveau, and of Foster; whilst the nervous mechanism of the heart and of the arteries has been thoroughly investigated by Gaskell and others. CHAPTER IX THE TREATISE ON DEVELOPMENT Fuller, speaking of Harvey, says very ingeniously: "The Doctor though living a Bachelor, may be said to have left three hopeful sons to posterity: his books, "1. De circulatione sanguinis, which I may call his son and heir: the Doctor living to see it at full age and generally received. "2. De generatione, as yet in its minority: but I assure you growing up apace into public credit. "3. De ovo, as yet in the nonage thereof; but infants may be men in due time." The treatises on Development are so full of detail that it is impossible to give an exact notion of their contents in a popular work. They contain however certain passages of personal and of general interest which must not be omitted. Harvey shows the instinct of a naturalist in the following account of the cassowary which was not only new to him, but was unknown to Europe at the time he wrote. He says: "A certain bird, as large again as a swan, which the Dutch call a cassowary, was imported no long time ago from the island of Java in the East Indies into Holland. Ulysses Aldrovandus gives a figure of this bird and informs us that it is called an emu by the Indians. It is not a two-toed bird like the ostrich but has three toes on each foot, one of which is furnished with a spur of such length, strength, and hardness that the creature can easily kick through a board two fingers' breadth in thickness. The cassowary defends itself by kicking forwards. In the body, legs, and thighs it resembles the ostrich: it has not a broad bill like the ostrich, however, but one that is rounded and black. On its head by way of crest it has an orbicular protuberant horn. It has no tongue and devours everything that is presented to it--stones, coals even though alight, pieces of glass--all without distinction. Its feathers sprout in pairs from each particular quill and are of a black colour, short and slender, and approaching to hair or down in their character. Its wings are very short and imperfect. The whole aspect of the creature is truculent, and it has numbers of red and blue wattles longitudinally disposed along the neck. "This bird remained for more than seven years in Holland and was then sent among other presents by the illustrious Maurice Prince of Orange to his Serene Majesty, our King James, in whose gardens it continued to live for a period of upwards of five years." It has already been shown that Harvey was on a footing of something like intimacy with his master the King, whose artistic and scientific tastes are well known. This fact is again made clear by the following passages, in which Harvey followed his usual custom of showing to the King anything unusually curious. "I have seen a very small egg covered with a shell, contained within another larger egg, perfect in all respects and completely surrounded with a shell. An egg of this kind Fabricius calls an ovum centennium, and our housewives ascribe it to the cock. This egg I showed to his Serene Majesty King Charles, my most gracious master, in the presence of many persons. And the same year, in cutting up a large lemon, I found another perfect but very small lemon included within it, having a yellow rind like the other, and I hear that the same thing has frequently been seen in Italy." Speaking in another place of these eggs, he says: "Some eggs too are larger, others smaller; a few extremely small. These in Italy are commonly called centennia, and our country folks still believe that such eggs are laid by the cock, and that were they set they would produce basilisks. 'The vulgar,' says Fabricius, 'think that this small egg is the last that will be laid and that it comes as the hundredth in number, whence the name; that it has no yolk, though all the other parts are present--the chalazae, the albumen, the membranes, and the shell.' "It was customary with his Serene Majesty, King Charles, after he had come to man's estate, to take the diversion of hunting almost every week, both for the sake of finding relaxation from graver cares and for his health. The chase was principally the buck and doe, and no prince in the world had greater herds of deer, either wandering in freedom through the wilds and forests or kept in parks and chases for this purpose. The game, during the three summer months, was the buck then fat and in season; and in the autumn and winter for the same length of time the doe. This gave me an opportunity of dissecting numbers of these animals almost every day during the whole of the season.... I had occasion, so often as I desired it, to examine and study all the parts ... because the great prince, whose physician I was, besides taking much pleasure in such inquiries and not disdaining to bear witness to my discoveries, was pleased in his kindness and munificence to order me an abundant supply of these animals, and repeated opportunities of examining their bodies." Speaking of the first rudiments of the heart, he says: "I have exhibited this point to his Serene Highness the King, still palpitating.... It was extremely minute indeed, and without the advantage of the sun's light falling upon it from the side, its tremulous motions were not to be perceived." The late Sir George Paget published, in 1850, an autograph letter from Dr. Ward the learned divine and stout-hearted Royalist, who was master of Sidney Sussex College, Cambridge, from 1609 to 1643. Both the letter and Harvey's reply show the interest taken by King Charles in such scientific curiosities; but Harvey's letter is also valuable because the peculiarities of its writing and annotation led to the discovery that the manuscript lectures in the British Museum [pp. 52-69] were in the handwriting of Harvey. It must, therefore, be looked upon as the origin of most of the recently acquired knowledge of the discoverer of the circulation of the blood, of his methods of observation, of his reading, and of his system of arrangement, and of verbal exposition. Dr. Ward's letter is as follows:-- "SIR,--I received your letter by which I understand his Majesty's pleasure that I should send up the petrified skull, which we have in our College Library, which accordingly I have done, with the case wherein we keep it. And I send in this letter both the key of the case and a note which we have recorded of the Donor and whence he had it. And so with my affectionate prayers and best devotions for the long life of his sacred Majesty and my service to yourself I rest "At Your Command, "SAMUEL WARD. "SIDNEY COLLEGE, _June 10, Sunday_." The address is-- "To his much honoured friend Doctor Harvey one of his Majesty's Physicians at his house in the Blackfriars be this delivered." The following is Harvey's reply; it is written on the back of Dr. Ward's letter:-- "Mr. Doctor Ward, I have showed to his Majesty this skull incrustated with stone which I received from you, and his Majesty wondered at it and looked content to see so rare a thing. I do now with thanks return it to you and your College, the same with the key of the case and the memorial you sent me enclosed herein, thinking it a kind of sacrilege not to have returned it to that place where it may for the instruction of men hereafter be conserved." The letter and skull have been preserved in a small ancient cabinet of carved oak, which stands in the Library of Sidney College. The skull is very curious. It is that of a young person and is encrusted with carbonate of lime, which is very hard and compact and is spread over the bone in such a manner as to resemble a petrification of the soft parts. The "note of the Donour" states that he was Captain William Stevens of Rotherhithe, one of the elder brethren of the Trinity, and that he brought the skull in 1627 from Crete where it was discovered about ten yards (circiter passus decem) below the surface of the ground in digging a well near the town of Candia. Harvey's pathological knowledge was sometimes called into use by the King as in the following case:--"A young nobleman, eldest son of the Viscount Montgomery,[12] when a child, had a severe fall attended with fracture of the ribs of the left side. The consequence of this was a suppurating abscess, which went on discharging abundantly for a long time, from an immense gap in his side: this I had from himself and other credible persons who were witnesses. Between the eighteenth and nineteenth years of his age, this young nobleman having travelled through France and Italy, came to London, having at this time a very large open cavity in his side, through which the lungs as it was believed could both be seen and touched. When this circumstance was told as something miraculous to his Serene Majesty King Charles, he straightway sent me to wait upon the young man, that I might ascertain the true state of the case. And what did I find? A young man, well grown, of good complexion and apparently possessed of an excellent constitution, so that I thought the whole story must be a fable. Having saluted him according to custom, however, and informed him of the King's expressed desire that I should wait upon him, he immediately showed me everything, and laid open his left side for my inspection, by removing a plate which he wore there by way of defence against accidental blows and other external injuries. I found a large open space in the chest, into which I could readily introduce three of my fingers and my thumb: which done, I straightway perceived a certain protuberant fleshy part, affected with an alternating extrusive and intrusive movement: this part I touched gently. Amazed with the novelty of such a state, I examined everything again and again, and when I had satisfied myself, I saw that it was a case of old and extensive ulcer, beyond the reach of art, but brought by a miracle to a kind of cure, the interior being invested with a membrane and the edges protected with a tough skin. But the fleshy part (which I at first sight took for a mass of granulations, and others had always regarded as a portion of the lung) from its pulsating motions and the rhythm they observed with the pulse--when the fingers of one of my hands were applied to it, those of the other to the artery at the wrist--as well as from their discordance with the respiratory movements, I saw was no portion of the lung that I was handling, but the apex of the heart! covered over with a layer of fungous flesh by way of external defence as commonly happens in old foul ulcers. The servant of this young man was in the habit daily of cleansing the cavity from its accumulated sordes by means of injections of tepid water: after which the plate was applied, and with this in its place, the young man felt adequate to any exercise or expedition, and in short he led a pleasant life in perfect safety. "Instead of a verbal answer, therefore, I carried the young man himself to the King, that his Majesty might with his own eyes behold this wonderful case: that, in a man alive and well, he might without detriment to the individual, observe the movement of the heart, and with his own hand even touch the ventricles as they contracted. And his most excellent Majesty, as well as myself, acknowledged that the heart was without the sense of touch: for the youth never knew when we touched his heart, except by the sight or sensation he had through the external integument. "We also particularly observed the movements of the heart, viz., that in the diastole it was retracted and withdrawn: whilst in the systole it emerged and protruded: and the systole of the heart took place at the moment the diastole or pulse in the wrist was perceived; to conclude, the heart struck the walls of the chest and became prominent at the time it bounded upwards and underwent contraction on itself." Harvey's powers of observation were particularly brought into play in connection with his experiments on the development of the chick. He fully appreciated the method of Zadig, for he says that "different hens lay eggs that differ much in respect of size and figure, some habitually lay more oblong, others rounder eggs that do not differ greatly from one another: and although I sometimes found diversities in the eggs of the same fowl, these were still so trifling in amount that they would have escaped any other than the practised eye ... so that I myself, without much experience, could readily tell which hen in a small flock had laid a given egg and that they who have given much attention to the point of course succeed much better. But that which we note every day among huntsmen is far more remarkable: for the more careful keepers who have large herds of stags or fallow deer under their charge, will very certainly tell to which herd the horns they find in the woods or thickets belonged. A stupid and uneducated shepherd, having the charge of a numerous flock of sheep, has been known to become so familiar with the physiognomy of each, that if any one had strayed from the flock though he could not count them, he could still say which one it was, give the particulars as to where it had been bought or whence it had come. The master of this man for the sake of trying him, once selected a particular lamb from among forty others in the same pen and desired him to carry it to the ewe which was its dam, which he did forthwith. We have known huntsmen who having only once seen a particular stag or his horns or even his print in the mud (as a lion is known by his claws) have afterwards been able to distinguish him by the same marks from every other. Some, too, from the footprints of deer, seen for the first time, will draw inferences as to the size and grease and power of the stag which has left them: saying whether he were full of strength or weary from having been hunted, and farther whether the prints are those of a buck or doe. I shall say this much more, there are some who in hunting, when there are some forty hounds upon the trace of the game and all are giving tongue together will nevertheless, and from a distance, tell which dog is at the head of the pack, which at the tail, which chases on the hot scent, which is running off at fault, whether the game is still running or at bay, whether the stag have run far or have but just been raised from his lair. And all this amid the din of dogs and men and horns and surrounded by an unknown and gloomy wood. We should not therefore be greatly surprised when we see those who have experience telling by what hen each particular egg in a number has been laid. I wish there was some equally ready way from the child of knowing the true father." The next extract gives a good example of Harvey's general style. Speaking of the escape of the chicken from the egg, he says: "Now we must not overlook a mistake of Fabricius and almost every one else in regard to this exclusion or birth of the chick. Let us hear Fabricius. "'The chick wants air sooner than food, for it has still some store of nourishment within it: in which case the chick by his chirping gives a sign to his mother of the necessity of breaking the shell, which he himself cannot accomplish by reason of the hardness of the shell and the softness of his beak, to say nothing of the distance of the shell from the beak and of the position of the head under the wing. The chick, nevertheless, is already so strong, and the cavity in the egg is so ample, and the air contained within it so abundant, that the breathing becomes free and the creature can emit the sounds that are proper to it. These can be readily heard by a bystander, and were recognised both by Pliny and Aristotle, and perchance have something of the nature of a petition in their tone. For the hen hearing the chirping of the chick within, and knowing thereby the necessity of now breaking the shell in order that the chick may enjoy the air which has become needful to it, or if you will, you may say, that desiring to see her dear offspring, she breaks the shell with her beak, which is not hard to do, for the part over the hollow long deprived of moisture and exposed to the heat of incubation, has become dry and brittle. The chirping of the chick is consequently the first and principal indication of the creature desiring to make its escape and of its requiring air. This the hen perceives so nicely, that if she hears the chirping to be low and internal, she straightway turns the egg over with her feet, that she may break the shell at the place whence the voice proceeds without detriment to the chick.' Hippocrates adds, 'Another indication or reason of the chick's desiring to escape from the shell, is that when it wants food it moves vigorously, in search of a larger supply, by which the membrane around it is torn, and the mother breaking the shell at the place where she hears the chick moving most lustily, permits it to escape.' "All this is stated pleasantly and well by Fabricius; but there is nothing of solid reason in the tale. For I have found by experience that it is the chick himself and not the hen that breaks open the shell, and this fact is every way in conformity with reason. For how else should the eggs which are hatched in dung-hills and ovens, as in Egypt and other countries, be broken in due season, where there is no mother present to attend to the voice of the supplicating chick and to bring assistance to the petitioner? And how again are the eggs of sea and land tortoises, of fishes, silkworms, serpents, and even ostriches to be chipped? The embryos in these have either no voice with which they can notify their desire for deliverance, or the eggs are buried in the sand or slime where no chirping or noise could be heard. The chick, therefore, is born spontaneously, and makes its escape from the eggshell through its own efforts. That this is the case appears from unquestionable arguments: when the shell is first chipped the opening is much smaller than accords with the beak of the mother, but it corresponds exactly to the size of the bill of the chick, and you may always see the shell chipped at the same distance from the extremity of the egg and the broken pieces, especially those that yield to the first blows, projecting regularly outwards in the form of a circlet. But as any one on looking at a broken pane of glass can readily determine whether the force came from without or from within by the direction of the fragments that still adhere, so in the chipped egg it is easy to perceive, by the projection of the pieces around the entire circlet, that the breaking force comes from within. And I myself, and many others with me besides, hearing the chick scraping against the shell with its feet, have actually seen it perforate this part with its beak and extend the fracture in a circle like a coronet. I have further seen the chick raise up the top of the shell upon its head and remove it. "We have gone at length into some of these matters, as thinking that they were not without all speculative interest, as we shall show by and by. The arguments of Fabricius are easily answered. For I admit that the chick produces sounds whilst it is still within the egg, and these perchance may even have something of the implorative in their nature: but it does not therefore follow that the shell is broken by the mother. Neither is the bill of the chick so soft, nor yet so far from the shell, that it cannot pierce through its prison walls, particularly when we see that the shell, for the reasons assigned, is extremely brittle. Neither does the chick always keep its head under its wing, so as to be thereby prevented from breaking the shell, but only when it sleeps or has died. For the creature wakes at intervals and scrapes, and kicks, and struggles, pressing against the shell, tearing the investing membranes and chirps (that this is done whilst petitioning for assistance I willingly concede), all of which things may readily be heard by any one who will use his ears. And the hen, listening attentively, when she hears the chirping deep within the egg, does not break the shell, but she turns the egg with her feet, and gives the chick within another and a more commodious position. But there is no occasion to suppose that the chick by his chirping informs his mother of the propriety of breaking the shell, or seeks deliverance from it; for very frequently for two days before the exclusion you may hear the chick chirping within the shell. Neither is the mother when she turns the egg looking for the proper place to break it; but as the child when uncomfortably laid in his cradle is restless and whimpers and cries, and his fond mother turns him this way and that, and rocks him till he is composed again, so does the hen when she hears the chick restless and chirping within the egg, and feels it, when hatched, moving uneasily about in the nest, immediately raise herself and observe that she is not pressing upon it with her weight, or keeping it too warm, or the like, and then with her bill and her feet she moves and turns the egg until the chick within is again at its ease and quiet." This extract shows that here, as in all Harvey's work there was a union of common sense, observation, and experiment which enabled him to overturn without any unkindly feeling the cherished teachings of his predecessors and contemporaries. When it was necessary he did not hesitate to experiment upon himself, for he says: "I have myself, for experiment's sake, occasionally pricked my hand with a clean needle, and then having rubbed the same needle on the teeth of a spider, I have pricked my hand in another place. I could not by my simple sensation perceive any difference between the two punctures: nevertheless there was a capacity in the skin to distinguish the one from the other; for the part pricked by the envenomed needle immediately contracted into a tubercle, and by and by became red, hot, and inflamed, as if it collected and girded itself up for a contest with the poison for its overthrow." The seventy-first essay of the treatise of Development is a good example of the mystic or philosophical side of Harvey's character. The essay is entitled "Of the innate Heat." It begins, "As frequent mention is made in the preceding pages of the calidum innatum or innate heat, I have determined to say a few words here, by way of dessert, both on that subject and on the humidum primigenium or radical moisture, to which I am all the more inclined because I observe that many pride themselves upon the use of these terms without, as I apprehend, rightly understanding their meaning. There is, in fact, no occasion for searching after spirits foreign to or distinct from the blood; to evoke heat from another source; to bring gods upon the scene, and to encumber philosophy with any fanciful conceits. What we are wont to derive from the stars is in truth produced at home. The blood is the only calidum innatum or first engendered animal heat." Harvey then proceeds to examine the evidence for a spirit different from the innate heat, of celestial origin and nature, a body of perfect simplicity, most subtle, attenuated, mobile, rapid, lucid, ethereal, participant in the qualities of the quintessence. Of this spirit Harvey confesses that "we, for our own parts, who use our simple senses in studying natural things, have been unable anywhere to find anything of the sort. Neither are there any cavities for the production and preservation of such spirits, either in fact or presumed by their authors." Harvey then discusses at some length the Aristotelian and scholastic views of the word "spirit" and "vital principle," and in the end arrives at the conclusion that "the blood, by reason of its admirable properties and powers, is 'spirit.' It is also celestial; for nature, the soul, that which answers to the essence of the stars is the inmate of the spirit, in other words, it is something analogous to heaven, the instrument of heaven, vicarious of heaven.... The blood, too, is the animal heat in so far namely as it is governed in its actions by the soul; for it is celestial as subservient to heaven, and divine because it is the instrument of God the great and good." Harvey next attacks the doctrine of those who maintained that nothing composed of the elements can show powers superior to the forces exercised by these unless they at the same time partake of some other and more divine body, and on this ground conceive the spirits they evoke as constituted partly of the elements, partly of a certain ethereal and celestial substance. He observes very pertinently in opposition to such a train of reasoning: "In the first place you will scarcely find any elementary body which in acting does not exceed its proper powers; air and water, the winds and the ocean, when they waft navies to either India and round this globe, and often by opposite courses, when they grind, bake, dig, pump, saw timber, sustain fire, support some things, overwhelm others, and suffice for an infinite variety of other and most admirable offices--who shall say that they do not surpass the power of the elements? In like manner what does not fire accomplish? In the kitchen, in the furnace, in the laboratory, softening, hardening, melting, subliming, changing, in an infinite variety of ways! What shall we say of it when we see iron itself produced by its agency?--iron 'that breaks the stubborn soil and shakes the earth with war'! Iron that in the magnet (to which Thales therefore ascribed a soul) attracts other iron, 'subdues all other things and seeks besides I know not what inane,' as Pliny says; for the steel needle only rubbed with the lodestone still steadily points to the great cardinal points; and when our clocks constantly indicate the hours of the day and night, shall we not admit that all of these partake of something else, and that of a more divine nature than the elements? And if in the domain and rule of nature so many excellent operations are daily effected, surpassing the powers of the things themselves, what shall we not think possible within the pale and regimen of nature, of which all art is but imitation? And if, as ministers of man, they effect such admirable ends, what I ask may we not expect of them, when they are instruments in the hand of God? "We must therefore make the distinction and say, that whilst no primary agent or prime efficient produces effects beyond its powers, every instrumental agent may exceed its own proper powers in action; for it acts not merely by its own virtue but by the virtue of a superior efficient.... "Since the blood acts, then, with forces superior to the forces of the elements, and exerts its influence through these forces or virtues and is the instrument of the Great Workman, no one can ever sufficiently extol its admirable, its divine faculties. "In the first place and especially, it is possessed by a soul which is not only vegetative, but sensitive and motive also. It penetrates everywhere and is ubiquitous; abstracted, the soul or the life too is gone, so that the blood does not seem to differ in any respect from the soul or the life itself (anima); at all events it is to be regarded as the substance whose act is the soul or the life. Such, I say, is the soul, which is neither wholly corporeal nor yet wholly incorporeal; which is derived in part from abroad and is partly produced at home; which in one way is part of the body, but in another is the beginning and cause of all that is contained in the animal body, viz., nutrition, sense, and motion, and consequently of life and death alike; for whatever is nourished, is itself vivified, and _vice versâ_. In like manner that which is abundantly nourished increases; what is not sufficiently supplied shrinks; what is perfectly nourished preserves its health; what is not perfectly nourished falls into disease. The blood therefore, even as the soul, is to be regarded as the cause and author of youth and old age, of sleep and waking, and also of respiration. All the more and especially as the first instrument in natural things contains the internal moving cause within itself. It therefore comes to the same thing, whether we say that the soul and the blood, or the blood with the soul, or the soul with the blood performs all the acts in the animal organism." A lame and impotent conclusion which does not advance our knowledge, though perhaps it was the most plausible that could be drawn from the premisses at Harvey's command. Indeed he was himself dissatisfied with his conception of the vital principle, for in another essay after a discussion to show that the egg is not the product of the body of the hen, but is a result of the vital principle, he turns away from the subject with evident relief to more profitable subjects, and with the words "Leaving points that are doubtful and disquisitions bearing upon the general question, we now approach more definite and obvious matters." The ideas then prevalent in physical science led him in like manner to spend much time and thought upon the unprofitable subject of the primigenial moisture, and with these speculations the treatise on development comes to an abrupt end. The whole essay is an interesting one. It shows us the range of Harvey's mind filled with the knowledge of ancient philosophy, but animated by the experimental spirit of modern science. All that the work contains of observation and experiment is valuable, for Harvey had made use of his uncommon opportunities to acquire a knowledge, such as is usually possessed only by huntsmen and gamekeepers, and has very rarely been attained by a man of science. Harvey's knowledge, as shown in this treatise, may be compared to that shown by Darwin in his "Variation of Animals and Plants under Domestication." Harvey tries to explain his observations in the terms of an existing philosophy, while Darwin uses his facts to establish an original hypothesis of his own. We have so completely outlived the age of the schoolmen that it is difficult for us to recognise the bondage endured by so great a mind as Harvey's until we consider it in the light of Darwin's work. Then we recognise that the theoretical disquisitions in the treatises on development are not so foreign to the true nature of Harvey as they appear to be at first sight. They are in reality an illustration of the profound influence of the prevalent thought of a period upon every contemporary mind, and show that the most thoughtful and original are not always the least affected. We thus take leave of one of the master minds of the seventeenth century. Harvey's osteological lecture has not yet been found, and many of his investigations in comparative anatomy are still wanting. But there is a possibility that his papers and books were only dispersed, and were not destroyed at the pillage of his lodgings in Whitehall. Some of the wreckage is still cast up from time to time, and we may hope that more may yet be found. So recently as 1888 Dr. Norman Moore recognised thirty-five lines of Harvey's handwriting on a blank page at the end of the British Museum copy of Goulston's edition of Galen's "Opuscula Varia." Here, as in all the other manuscripts, the peculiarities of Harvey's writing are too distinct to leave any doubt of the authorship. Every fragment of his work is interesting, and even in these few lines we seem to learn his opinion of artificial exterior elevation as opposed to the genuine exaltation of worth or learning, for against a passage in which Galen prefers learning to rank, Harvey has written "wooden leggs." A fitting testimony from one who, though he had spent the greater part of his life at court, was yet the foremost thinker of his age. FINIS. _APPENDIX_ AUTHORITIES CHAPTER I. "The Genealogy of the Family of Harvey, compiled from Original Sources," by W. J. Harvey, Esq., F.S.A., Scotland, in the "Misc. Geneal. and Herald." Second Series, 1888-9, vol. iii. pp. 329, 362, 381. Loftie's "History of London," ed. ii., vol. i. Willis' "William Harvey," London, 1878. Fuller's "Worthies of England," folio, 1662. Sir James Paget's "Records of Harvey," London, (reprinted) 1887, by the kind permission of Sir James Paget, Bart., F.R.S. Walpole's Works, Cunningham's ed. vol. vii., p. 329. CHAPTER II. Prof. Montague Burrows' "Cinque Ports" (Historic Towns), 1888. Prof. George Darwin's "Monuments to Cambridge Men at the University of Padua." Publications of the Cambridge Antiquarian Society, vol. viii., 1895, pp. 337-347. Andrich's "De natione Anglica," Padua, 1892. Rashdall's "The Universities of Europe in the Middle Ages," Oxford, 1895. The Harveian Orations of Dr. Barclay, Dr. Ogle, Dr. Johnson, Dr. Charles West, Dr. Pollock, and Dr. Pye-Smith. Dr. Munk's "Roll of the College of Physicians," ed. ii. Dr. Moore's Life of Harvey in the "Dictionary of National Biography." Register of Marriage Licenses granted by the Bishop of London--Harleian Society's publications. Sir James Paget's "Records of Harvey." Harvey's Works--Sydenham Soc. Ed., London, 1847. Information given by Prof. Carlo Ferraris, the Rector magnificus, and by Dr. Gerardi, the Librarian of the University of Padua, at the request of Prof. Villari and Prof. George Darwin, F.R.S. CHAPTER III. South's "Memorials of the Craft of Surgery," Messrs. Cassell, 1886. Young's "Annals of the Barber Surgeons' Company." Holingshed's Chronicle. Alexander Reid's "Manual of Anatomy." The Harveian Orations of Sir George Paget, Sir E. H. Sieveking, Dr. Ogle, Dr. Charles West, Dr. Chambers, Dr. Johnson, Dr. Pavy, and Dr. Church. Harvey's MS. Notes, Messrs. Churchill, London, 1886. CHAPTER IV. Calendar of State Papers--Domestic Series. Aubrey's "Lives of Eminent Persons," London, 1813. Munk's "Roll of the College of Physicians." Munk's "Notæ Harveianæ," St. Bartholomew's Hospital Reports, vol. xxiii. Wadd's "Mems., Maxims, and Memoirs." Sir James Paget's "Records of Harvey." Dr. Norman Moore's Life of Harvey in the "Dictionary of National Biography." Mackay's "Memoirs of Extraordinary Popular Delusions." Upham's "History of Witchcraft and Salem Village." Young's "Annals of the Barber Surgeons' Company." CHAPTER V. Munk's "Notæ Harveianæ." Gardiner's "History of the Great Civil War." Aveling's "Memorials of Harvey," Messrs. Churchill, 1875. Highmore's "Corporis Humani Disquisitio anatomica," folio, 1651. Aubrey's Lives of Eminent Persons. Munk's "Roll of the College of Physicians." Brodrick's "Memorials of Merton College," Oxford Historical Society. Wood's "Life and Times," Oxford Historical Society's Edition. The Harveian Orations of Dr. Rolleston and Dr. Andrew. CHAPTER VI. Willis' "William Harvey." Wood's "Athenae Oxoniensis," Edition 1721. Aubrey's Lives of Eminent Persons. MacMichael's Life of Harvey in "Lives of British Physicians." Munk's "Notæ Harveianæ" and "Roll of the College of Physicians." Harvey's Works--Sydenham Society's Edition. Howell's "Epistolæ Ho-Elianæ," Ed., J. Jacobs, 1889. Sir George Paget's "Account of an unpublished Manuscript of Harvey," London, 1850. _The Lancet_, vol. ii., 1878, p. 176, and vol. ii., 1883, p. 706. CHAPTER IX. Brooks, W. K., "William Harvey as an Embryologist," _Johns Hopkins Hospital Bulletin_, vol. viii., p. 167. Harvey's Notes on Galen, _The Athenæum_, October, 1888, No. 3180, p. 452. INDEX A Alston, Dr., 157 Ameius Gulielmus, 18 Anatomical demonstrations, 41-46; method of conducting, 57-60; lectures, cost of, 45, 46; teaching of Reid compared with that of Harvey, 232-237; works of Harvey, 188 Anatomy, early teaching of, 39; study of, at Cambridge, 13; value of comparative, 201 Andrewes, Dr., 88, 90, 91, 97, 98, 104, 232 Andrich, Dr., 18, 27 Anecdotes of Eliab Harvey, 8; William Harvey, 144-145; Sir Charles Scarborough, 142 Appearance of Harvey, 52 Apothecaries' opinions of Harvey's prescriptions, 74; visitations of, 75-79 Aristotle, capillamenta of, 213; Harvey's opinion of, 68, 72 Armorial bearings of the Harvey family, 2 Art, Harvey an authority on, 115 Arteries, course of blood in, 213 Artistarum universitas, 16, 27 Arundel, Earl of, 111 Aubrey's first recollection of Harvey, 130; Harvey's advice to, 146 Auricle, movement of, 200 Autograph of Harvey in de Glarges' album, 123 Aveling, Dr., 83 Aylesford, Earls of, their relationship to Harvey, 7 B Bacon and Harvey, 71 Barber Surgeons Company, abortive attempt to found a surgical lectureship, 46; anatomical teaching at, 39, 40-44, 57-60; Reid's lectures at, 47, 231; Dr. Scarborough's lectures at, 142 Barnacle goose, account of, 93, _note_ Bartholomew's Hospital, _see_ St. Bartholomew's Hospital Bass rock, description of, 93 Bathurst, George, 130 Bethune, Dr., 83, 118 Birthplace of William Harvey, 4 Bleeding, proof of the circulation from the operation of, 214, 216 Blood, circulation of, as described in Lumleian lectures, 65 Blood, quantity of, 208 Brent, Sir Nathaniel, 134, 138, 139 Breviarium Bartholomei, 215 Broderield, the, 11 Browne, Dr. Lancelot, 29 Burmarsh, Harvey's estate at, 163 Butchers proof of the circulation, 210 C Caius College, Cambridge, Harvey entered at, 12 Caius, Dr., 13, 15 Caldwall, Dr., 46, 47, 48 Calidum innatum, 192, 255 Cambridge, anatomy at, 13; graduation of Harvey at, 14, 27; Harvey matriculated at, 12, 21 Canons, Harvey's lecture, 62-64 Capillamenta of Aristotle, 213 Cassowary, Harvey's account of, 239 Censors of the College of Physicians, their duties, 75, 76 Centennial eggs, 240 Cesalpino, 213, 217 Chambers, Dr., 83 Charge of the Physician at St. Bartholomew's Hospital, 35 Charles I., escape of, from Oxford, 138; Harvey appointed physician to, 70; Harvey's friendship with, 240-246; interest of, in the pursuits of Harvey, 240-46 Chick heard in shell, 198, 251; reasons for the escape of from the egg, 250-254 "Christianismi Restitutio," 207 Circulation of the blood, account of, 199-202; anatomical proof of, 206, 219; butcher's proof of, 210; comparative anatomy of, 222; deduced from syncope, 210, 218; disquisition to Riolanus on, 224; formulation of theory of, 206; Harvey's account of, 190; Harvey's propositions about, 207; mathematical proof of, 208; proof of, 206; proof of from amount of milk secreted, 211; proof by demonstration, 221, 67; by continuous flow in, 217; mathematical, 208; from phlebotomy, 214, 216; from surgical operation, 214; theory of enunciated in Lumleian lectures, 65 Circulator, meaning of term, 74 Civil war, 117-140 Clarke, John, Dr., 104 Clavis Mathematica, 161 Cold blooded animals, heart's movements in, 195 College of Physicians, anatomical teaching in, 39; attend the funeral of Harvey, 167; Harvey admitted a member, 29; admitted a Fellow, 31; Harvey's bequests to, 163, 182; Harvey's gifts to, 154-156; Harvey elected censor, 75; erect a statue to Harvey, 155; Harvey's pointer at, 57, _note_; Harvey portraits at, 10; leave of absence granted to Harvey, 81; library rules, 86; Lumleian lectures at, 45-50; offices held by Harvey, 51, 75, 80, 157, 158; portraits of the Harvey family at, 10; sites of, 50, 51; tanned skin presented to, 103; translation of Harvey's remains by, 173 Columbus Realdus, 207 Combe, near Croydon, 7 Comparative anatomy of the circulation, 222; destruction of Harvey's notes on, 125, 262; value of, 202 Concilarius, duties of, 16; Harvey elected at Padua, 18 Cookæus, Joh., 17 Contemporary estimate of Harvey, 225 Court physician, 70 Criticism, contemporary of Harvey, 225 Croydon, 7 Cusa, Cardinal Nicholas de, 215, _note_ Cusanus, 215, _note_ D Darcy, Sir Robert, the case of, 228 Darwin, Prof. George, 19, 20 Davies, Dr., 51 Death mask of Harvey, 167, 175 Demonstration, anatomical method of conducting, 57-61; of Anatomy, 42-47; of the circulation, 221 Derby, Dr. Harvey at, 126 Destruction of Harvey's papers, 125, 262 Development, treatise on, 89, 238-263; introduction to, 147-154 Diastole, meaning of the term, 193, _note_ Diploma, of Harvey, 26 Dunne, William, 51 E Eccentricities of Harvey, 144, 145 Edgehill, Harvey at, 126 Eggs, centennial, 240 Elect, Harvey chosen, 80; duties of, 80 English nation at Padua, 18 Ent, Dr., 182; account of Harvey, 146-153; meets Harvey at Rome, 115 Epitaph of Joan Harvey, 5 Estey, George, 11 Euclid, Scarborough the first English editor of, 139 F Fabricius Hieronymus, 15, 23, 219; lectures of, 23; honours paid to, 23; relation of to Harvey, 25, 240, 249-254; theatre of, 23 Fainting, assigned cause of, 214; proof of circulation deduced from, 211, 218 Ferraris, Prof. Carlo, 18, 19 Finch, Sir H., 7 Floyer, Sir John, 215, _note_ Folkestone, 3, 5, 11 Footman, the King's, 5 Forster, Richard, 51 Fracastorius' opinion of the heart's movement, 193 France, Harvey in, 84 G Generation, account of treatise on, 238-263; introduction to, 147-154; treatise on, 89 Gerarde's "Herbal" quoted, 93, _note_ Germany, Harvey's travels in, 123 Girardi, Dr., 18 Glarges, Philip de, 123 Glove, Harvey's experiment with, 196 Gonville Hall, 13 Goose, solan or barnacle account of, 93, _note_ Gurgany, John, 137 Guestling, the, 12 H Halke, Joane, 3 Halke, Thomas, 3 Hamey, Dr., 157 Harvey, Amye, 9 Harvey, Aubrey's description of William, 52 Harvey, mortuary chapel, the, 8, 168 Harvey, Daniel, 6, 143 Harvey, Eliab, 7, 38, 143, 166, 168, 177, 182 Harvey, Sir Eliab, G.C.B., anecdote of, 8 Harvey, Elizabeth, 29-31 Harvey, Joan, 3-5 Harvey, John, 5, 30, 33, 141 Harvey, Matthew, 9, 141 Harvey, Michael, 9, 141 Harvey, Mrs., 29-31, 141 Harvey, Sarah, 5 Harvey, Thomas, 3-5, 6, 11, 29 Harvey, Walter, 1 Harvey, Dr. William, advice to Aubrey, 146; anatomical teaching compared with that of Reid, 231-237; anatomical works of, 188-237; an art collector, 115; and Hofmann, 113; and Sir Charles Scarborough, 109, 139, 140, 142; and the Civil War, 117-140; and the English school of Anatomy, 134; and Willoughby, 126; anecdotes of, 144-146; apothecaries' opinion of, 74; appearance of, 52; armorial bearings of, 2; as a literary man, 159; at Cambridge, 12, 27; at Padua, 14-27; at Padua, elected councillor, 19 Harvey, Dr. William, at College of Physicians, censor, 75; demonstrator's rod at, 57, _note_; Elect, 80; elected candidate, 29; elected Fellow, 31; elected Concilarius, 158; elected President, 157; leave of absence granted to, 82; Lumleian lecturer, 51; Lumleian lectures, notes of, 53-56, 62-69; rules for library drawn up by, 87; Tabulæ Harveianæ, 68; Treasurer, 80 Harvey, William, Dr., at Court, accompanies King to Scotland, 92; Physician in Ordinary to King Charles I., 70, 87-88; relation to the King, 89; Physician Extraordinary to King James I., 70; Senior Physician in Ordinary, 118; at Oxford, 126-140; Letters to Prince Rupert, 130, 131 Harvey, Dr. William, at Ratisbon, 115; at Rome, 115; at St. Bartholomew's Hospital, elected physician in reversion, 32; last payment to, 132, 133; retirement from, 132, 133; leave of absence granted to, 82; physician to, 34-38; rules for the government of, 96; stipend as physician, 38; substitute appointed for, 90; at Trinity College, Oxford, 130; attends Prince Maurice, 131; autograph in de Glarges' album, 123; autopsy on old Parr, 111; birthplace of, 4; builds library and museum at College of Physicians, 154-157; burial of, 167; candidate at the College of Physicians, 29; compared with John Hunter, 184-187; complains of old age, 159; contemporary criticism of, 225; estimate of, 184-187; death of, 166; death mask of, 167, 175; debt to Fabricius, 24, 25; demonstrator's rod at the College of Physicians, 57, _note_; destruction of his manuscripts, 124, 262; diploma of, 26; dissections by, 66; early life of, 11-13; eccentricities of, 144, 145, 146; elected consiliarius at Padua, 18; elected President of College of Physicians, 157; elected Warden of Merton, 135; Ent's account of, 146-157; entries concerning, at Padua, 18, 27; eulogy of, 184-187; experiments on himself, 255; Fellow of the College of Physicians, 31; friendship of Charles I. with, 240-247; graduates M.D., at Cambridge, 27; at Oxford, 130; at Padua, 26; Howell's letter to, 160; humour of, 30, 64, 68, 69; ill practice by, 110; in London, 28, 31; jargon used by, 56; knowledge of Latin, 14, 18; Lancashire witches, 104-109; later years of, 141; lecture canons of, 62-64; letters to Prince Rupert, 130, 131; liberality of, 24, 38, 86, 154; lineage of, 1; love for Virgil, 54; marriage of, 29; meets Dr. Ent at Rome, 115; midwifery, practical knowledge of, possessed by, 110; muscular lecture, 67; mystical side of, 255; notes of muscular lecture, 67-69; notes of visceral lecture, 53-56; opinion of Aristotle, 68; pathological knowledge of, 228; pathological observations of, 228, 246; peculiarities of, 144, 145, 146; personal appearance of, 52; physiological advances since the time of, 237, 238; pillage of his lodgings, 124, 262; powers of observation of, 247-254; practice of, 71-75; probate of will of, 184; publication of his work, "De motu sanguinis," 73; religion of, 55, 187; 256-260; remains, treatment of, 170-175; rules drawn up by, 87; treatise on development by, 238-242; estimate of treatise on Generation, 261; resigns the Lumleian Lectureship, 163; similes used by, 68, 69; speech at Merton College, 135; "stemma" of, 19, 20; stipend as Court Physician, 88, 118-121; as Physician to St. Bartholomew's Hospital, 38; sues Lumleian trustees, 122; surgery as well as medicine practised by, 109; translation of remains, 170-175; travels with the Earl of Arundel, 112; travels with the Duke of Lennox, 81-87; travels with King Charles, 90; treatise on development, 89; will of, 176-184 Hawke, Joane, 3 Hawke, Thomas, 3 Heat, innate, 255 Heart and lungs, connection of, 201 Heart, mechanism of contraction, 196 Heart's movements, experiments concerning, 195; in cold blooded animals, 194, 197; Fracastorius' opinions of, 193; simile for, 200; relation of lungs to, 223; Reid's knowledge of, 232-236 Heberden, Dr., 144 Hempstead, Harvey's burial at, 168, 169, 170, 175; mortuary chapel at, 8 Henry III., death of, 1 Hervey, Sir Walter, 1 Henrietta Maria, Queen, at Merton College, 136 Hofmann and Harvey, 113 Hollar's anecdote of Harvey, 114 Holsbosch, Dr., bequest of, 87 Horst, Dr., 159 Hospital, _see_ St. Bartholomew's Hospital Howell's letter to Harvey, 160 Humidum primigenium, 256, 261 Hunter, John, compared with Harvey, 184-187 I Identification of students in Italy, 17 Innate Heat, 255 Insects, destruction of Harvey's notes on, 125; heart in, 198 Italian Universities, 14-16 Italy, identification of students in, 17 J James I., Harvey appointed physician to, 70 Jargon used by Harvey in his notes, 56 Jenkin, Juliana, 3 Jenkin, William, 3 Juristarum, universitas, 16, 17 K King's footman, 5 King's turnspit, 6 L Lancashire Witches, story of, 104-109 Lecture, anatomical importance of, 58 Lectures, Lumleian, 39-69 Lectures, notes of Harvey's Lumleian, 53-69 Lennox, Duke of, 81 Library, rules for use of, 87 Linacre, 50 Lineage of Harvey, 1 Listerus, Josephus, 17, 26 Literature, Harvey's love for, 160 Lock Hospitals, 99, _note_ London, Harvey settles in, 28, 31 Lumley, Lord, 47 Lumley, Lord, heirs of, sued by Harvey, 122 Lumleian lecturer, Harvey appointed, 51 Lumleian lectures, 39-69 Lumleian lecturers, early, 51 Lumleian lectures, foundation of, 46, 47 Lumleian lectures, schemes of, 48-50 Lumleian lectureship resigned by Harvey, 163 Lumleian trustees sued by Harvey, 122 Lungs, circulation in, 204 Lungs and heart, connection of, 201 Lungs, relation of heart to, 223 Lungs, use of, 204 M Magistral universities, 16 Mantuan war, Harvey's description of the results of, 85 Marriage of Harvey, 29 Mathematical proof of circulation, 208 Matriculation, Harvey's, at Cambridge, 12; at Padua, 17 Maurice, Prince, 131, 138 Merton College, Harvey at, 134-140; marriages at, during royalist occupation, 137; Queen Henrietta at, 136 Micklethwaite, Sir John, 133 Midwifery, practical knowledge of, possessed by Harvey, 110, 126 Milk, proof of circulation from secretion of, 211 Mirfield, John of, 216 Moesler, Dr. Adam, 83 Moore, Dr. Norman, 36, 53, 215, 262 Moisture the primigenial, 256, 261 Muscular lecture, 67 N Nardi, Dr., 160, 161 Nottingham, the first Earl of, 7 Nuremberg, Harvey at, 113 O O'Birne, Mr., anecdote of, 8 Observation, Harvey's powers of, 247 Oxford, surrender of, 138 Oxford, Harvey at, 126-140 Oughtred's "Clavis Mathematica," 162 Old Parr, 111 P Padua, celebration at, 19; diploma granted to Harvey, 26; election of rector at, 21; entries concerning Harvey at, 18, 27; nations at, 18; the Universities at, 14-27 Padua University, life at, 21-23; why selected by Harvey, 15 Paget, Sir George, 69, 242 Paget, Sir James, 5 Parr, Old, 111 Paris, Harvey in, 84 Parrot, Mrs. Harvey's, 30 Pathological observations by Harvey, 227, 245 Pepperer, Walter Harvey a, 1 Pepys, Mr., attends an anatomical lecture, 44 Perfusion experiment, 197 Perquisites of Court Physicians, 118-119, 121 Phlebotomy, proofs of the circulation from, 214, 216 Physicians, College of, _see_ College of Physicians Physicians, their relation to Surgeons, 100, 101 Physiological advances since the time of Harvey, 236 Pigeon, experiment with heart of, 197 Pillage of Harvey's lodgings, 124, 262 Portraits of the Harvey family, 10 Prayers used to measure time, 216 Prescriptions, secrecy attaching to, 102, 103 Primrose, James, 80 Primrose, Serjeant-Surgeon, 83 Probate of Harvey's will,184 Prujean, Dr., 154, 156, 157,158 Pulmonary circulation, 204 Pulse watch, 215, _note_ R Ratisbon, Harvey at, 115 Rector of Italian University, honours paid to, 23 Rector of Italian University, election of, 21 Reid, Alexander, 47, 57, 231, 237 Religion of Harvey, 55, 187 Richardson, Sir Benj. Ward, 170 Riolanus, treatise to, 224-230 Roehampton, 5, 7, 166 Rolls Park, 4, 10 Rolls Park portraits, 10 Rome, Harvey at, 115 Rupert, Prince, 130, 131, 138 Royal College of Physicians, _see_ Physicians, College of S St. Bartholomew's Hospital charge to the physician, 35; duties of physician, 34-38; Harvey appointed physician, 34; Harvey appointed physician in reversion, 32; physician's lodgings at, 37; rules for governance of, 96, 99-103 St. Sepulchre's, Harvey married at, 29 Scarborough, Sir Charles, 44, 52, 109, 122, 139, 140, 142, 162, 182 Scotland, Harvey in, 92 Scotch nation at Padua, 18 Screopeus, Hen., 17 Scrope, Adrian, treated by Harvey, 127 Servetus, 207 Shakespeare's death, 62 Shrimps, heart in, 198 Sieveking, Sir E. H., 53 Silvius, Jacques, 24 Skin, human, presented to College of Physicians, 103 Skull, human, at Sidney Sussex College, Cambridge, 244 Slegel, Dr., letter to, 230 Smith, Capt., at Edgehill, 129 Smith, Dr. Edward, 82, 90, 91, 92, 130, 131, 156 Solan goose, account of, 93, _note_ Spider, experiment with poison of, 255 "Stemma" of Harvey at Padua, 19, 20 Stipend of Court Physician, 88, 118, 119, 121; of physician to St. Bartholomew's Hospital, 38 Student Universities, 16 Students, identification of, in Italy, 17 Surgical Lectureship founded at the Royal College of Physicians, 48 Surgeons subordinate to physicians, 100-102 Surgery practised by Harvey, 109; proof of circulation from, 214 Syllabus of Lumleian lectures, 49 Syncope, assigned cause of, 214 Systole, meaning of the term, 193, _note_ T Tabulæ Harveianæ, 66 Tearne, Dr., 44 Theatre of Fabricius at Padua, 23 Thirty Years' War, account of devastation by, 114 Tight lacing, Harvey's treatment for, 65 Time, measurement of, 215 Turnspit, the King's, 6 Trinity College, Oxford, Harvey at, 130 U Universitas artistarum, 16, 27 Universitas juristarum, 16, 21, 27 University of Cambridge, Harvey graduates at, 14, 27; Harvey matriculated at, 12 Universities of Italy, 14 University of Oxford, 129-140 University life at Padua, 14-27 Universities, types of, 16 V Valves in veins, their discovery, 24 Valves, uses of in veins, 219, 220 Veins, course of the blood in, 213; uses of valves in, 219, 220; valves of, their discovery, 24 Ventricles, movements of, 199 Verney, Sir Edward, 128 Viewing patients, the practice of, 111 Visitation of Apothecaries' shops, 75-79 Virgil, Harvey's love for, 54 Vlackveld, Dr., Harvey's letter to, 163 W Walpole's anecdote of Eliab Harvey, 8 Ward, Samuel, Master of Sidney Sussex College, 243 Ward, Seth, 162 Watch for the pulse, 215 Wilkenson, Dr., 34 Will of Harvey, 176 Willoughby, Dr. Percival, 126 Winchelsea and Aylesford, Earls of, their relationship to the Harvey family, 7 Witches, Lancashire, story of, 104 Wood, Anthony, 138, 142 Y York, Duke of, 127, 138 Z Zadig, method of, 248 The Gresham Press UNWIN BROTHERS, WOKING AND LONDON. 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It will be found exceedingly useful.... It is beautifully printed."--_Daily Chronicle._ "A most valuable compilation, and one which will be valued for the great mass of information which it contains."--_Glasgow Herald._ "Every library of reference, no matter how richly stocked, will be the richer for having it ... may be consulted freely without the inconveniences of human haulage."--_Scotsman._ 11, Paternoster Buildings, London, E.C. FOOTNOTES: [1] The usual contraction for Magister, indicating his university degree of Artium Magister or M.A. [2] The College of Physicians still possess a little whalebone rod tipped with silver which Harvey is said to have used in demonstrating his Lumleian lectures. [3] P. 54. [4] The reference is to the passage in Gerarde's "Herbal," giving an account of the miraculous origin of the Solan Goose. It runs: "But what our eyes have seen and hands have touched we shall declare. There is a small island in Lancashire called the Pile of Foulders, wherein are found the broken pieces of old and bruised ships, some whereof have been cast thither by shipwreck, and also the trunks and bodies with the branches of old and rotten trees cast up there likewise, whereon is found a certain spume or froth that in time breedeth unto certain shells, in shape like those of a mussel, but sharper pointed, and of a whitish colour wherein is contained in form like a lace of silk finely woven as it were together, of a whitish colour, one end whereof is fastened unto the inside of the shell, even as the fish of oysters and mussels are; the other end is made fast to the belly of a rude mass or lump, which in time cometh to the shape and form of a Bird; when it is perfectly formed the shell gapeth open, and the first thing that appeareth is the aforesaid lace or string; next come the legs of the bird hanging out, and as it groweth greater it openeth the shell by degrees till at length it is all come forth and hangeth only by the bill; in short space after it cometh to full maturity and falleth into the sea, where it gathereth feathers and groweth to a fowl bigger than a mallard and lesser than a goose, having black legs and bill or beak, and feathers black and white, spotted in such manner as is our Magpie... which the people of Lancashire call by no other name than a tree goose; which place aforesaid and all those parts adjoining do so much abound therewith, that one of the best is bought for threepence. For the truth hereof if any doubt, may it please them to repair unto me, and I shall satisfy them by the testimony of good witnesses" (Gerarde's "Herbal," A.D. 1636, p. 1588, chap. 171. "Of the Goose Tree, Barnacle Tree, or the Tree-bearing Goose"). A solan goose was looked upon for many years as a delicacy. Pennant states that about the middle of the seventeenth century a young one was sold for 20_d._ He also quotes the following newspaper cutting:--"SOLAN GOOSE.--There is to be sold by John Walton, Jun., at his stand at the Poultry, Edinburgh, all lawful days in the week, wind and weather serving, good and fresh solan geese. Any who have occasion for the same, may have them at reasonable rates.--Aug. 5, 1768." [5] The outhouses, Sir James Paget tells us, were the Lock Hospitals belonging to St. Bartholomew's Hospital. There were two outhouses, one in Kent Street, Southwark, the other in Kingsland. They were founded originally as Lazar-houses for the use of lepers. The "Lock" in the Borough was used for women; the "Spital" in Kingsland for men. Each contained about thirty beds and was under the charge of a guider, guide or surgeon, who was appointed by the Governors of the Hospital, and received from them in Harvey's time an annual stipend of four pounds a year and fourpence a day for the diet of each patient under their care. [6] This and the two following regulations illustrate in a very remarkable manner the complete subjection in which the physicians held the surgeons in Harvey's time and for many subsequent years. It was not until Abernethy was surgeon to the hospital, at the beginning of the century, that the surgeons were allowed to prescribe more than a black draught or blue pill for their patients until the prescription had been countersigned by one of the physicians. [7] And no wonder, for it meant that their prescriptions were to be made public, whilst those of the Physician were kept secret [sec. 16], and at this time every practitioner had some secret remedy in which he put especial trust. [8] The kindness of Dr. Norman Moore enables me to reproduce a facsimile of Harvey's handwriting taken from his "muscular lecture." The block appeared originally in the _Lancet_, vol. i., 1895, p. 136. [9] Perhaps the Essay on the Circulation of the Blood addressed to Riolanus, published at Cambridge in 1649. [10] The _systole_ of the heart means its contraction: the _diastole_ of the heart means its dilatation. [11] Cardinal Nicholas de Cusa [Cusanus] is said to have counted the pulse by a clock about the middle of the sixteenth century, but Dr. Norman Moore points out to me that in reality he counted the water-clock, then in use, by the pulse. The number of pulse-beats was not measured by means of a watch until after the publication, in 1707, of Sir John Floyer's book, "The Physician's Pulse-watch, or an Essay to explain the old art of feeling the Pulse." In the time of Harvey and long afterwards physicians contented themselves with estimating the character of the pulse, rather than its precise rate. [12] Dr. Norman Moore suggests that this young nobleman was possibly Philip Herbert (_d._ 1669), son of Philip Herbert, the second son of Henry, Earl of Pembroke (_d._ 1648), created Earl of Montgomery 1605-1606, and Lord Chamberlain. Transcriber's Notes: Words surrounded by _ are italicized. Words surrounded by = are bold. In this e-text, [~o] represents diacritical mark tilde (~) above the letter o whereas [-e] represents a straight horizontal line (-) above the letter e. Obvious printer's errors have been repaired, other inconsistent spellings have been kept, including inconsistent use of hyphen (e.g. "blood-vessels" and "blood vessels"), proper names (e.g. "Micklethwayte" and "Micklethwaite") and accent (e.g. "Tabulæ" and "tabulae"). 
34038	----	(This file was produced from images generously made available by The Internet Archive.) [Illustration: Engraved by J. C. Buttre, expressly for Fireside Lectures. Doct. W'm. A. ALCOTT.] FORTY YEARS IN THE WILDERNESS OF PILLS AND POWDERS; OR, THE COGITATIONS AND CONFESSIONS OF AN AGED PHYSICIAN. BOSTON: JOHN P. JEWETT AND COMPANY. NEW YORK: C. M. SAXTON AND COMPANY. ROCHESTER, NEW YORK: E. DARROW AND BROTHER. 1859. Entered according to Act of Congress, in the year 1859, by JOHN P. JEWETT AND COMPANY, In the Clerk's Office of the District Court for the district of Massachusetts. LITHOTYPED BY COWLES AND COMPANY, 17 WASHINGTON ST., BOSTON. Printed by Geo. C. Rand and Avery. PREFACE. The present volume was one of the last upon which its author was engaged, the facts having been gathered from the experience and observation of a long life. It was his design to publish them anonymously, but under the changed circumstances this is rendered impracticable. A short time previous to his death, the writer spoke of this work, and said, in allusion to the termination of his own somewhat peculiar case,--"This _last chapter_ must be added." In accordance with this desire, a brief sketch, having reference chiefly to his health and physical habits, with the closing chapter of his life, has been appended. Boston, June, 1859. TO THE READER. In the sub-title to the following work, I have used the word "Confessions"--not to mislead the reader, but because _to confess_ is one prominent idea of its author. It is a work in which confessions of the impotence of the healing art, as that art has been usually understood, greatly abound; and in which the public ignorance of the laws of health or hygiene, with the consequences of that ignorance, are presented with great plainness. The world will make a wiser use of its medical men than it has hitherto done, when it comes to see more clearly what is their legitimate and what their ultimate mission. These remarks indicate the main intention of the writer. It is not so much to enlighten or aid, or in any way directly affect the medical man, as to open the eyes of the public to their truest interests; to a just knowledge of themselves; and to some faint conception of their bondage to credulity and quackery. The reader will find that I go for science and truth, let them affect whom they may. Let him, then, suspend his judgment till he has gone through this volume once, and I shall have no fears. He may, indeed, find fault with my style, and complain of my literary or philosophic unfitness for the task I assigned myself; but he will, nevertheless, be glad to know my facts. Should any one feel aggrieved by the exposures I have made in the details which follow, let me assure him that no one is more exposed--nor, indeed, has more cause to be aggrieved--than myself. Let us all, then, as far as is practicable, keep our own secrets. Let us not shrink from such exposures as are likely, in a large measure, to benefit mankind, while the greatest possible inconvenience or loss to ourselves is but trifling. Some may wish that instead of confining myself too rigidly to naked fact and sober reasoning, I had given a little more scope to the imagination. But is not plain, "unvarnished" truth sometimes not only "stranger," but, in a work like this, better also, than any attempts at "fiction"? THE AUTHOR. AUBURNDALE, March, 1859. CONTENTS. CHAPTER. PAGE. I. EDUCATIONAL TENDENCIES 1 II. MY FIRST MEDICAL LESSON, 6 III. THE ELECTRICAL MACHINE, 9 IV. THE MEASLES, AND POURING DOWN RUM, 11 V. LEE'S PILLS AND DROPSY, 13 VI. THE COLD SHOWER BATH, 16 VII. MY FIRST SICKNESS ABROAD, 18 VIII. LESSON FROM AN OLD SURGEON, 20 IX. LEE'S WINDHAM BILIOUS PILLS, 23 X. DR. SOLOMON AND HIS PATIENT. 26 XI. PHYSICKING OFF FEVER, 28 XII. MANUFACTURING CHILBLAINS, 31 XIII. HOW TO MAKE ERYSIPELAS, 34 XIV. STUDYING MEDICINE, 38 XV. NATURE'S OWN EYE WATER, 41 XVI. THE VIPER STORY, 43 XVII. STRUCK WITH DEATH, 46 XVIII. EFFICACY OF COLD SPRING WATER, 51 XIX. CHEATING THE PHYSICIAN, 56 XX. MEDICINAL EFFECTS OF STORY TELLING, 58 XXI. OSSIFIED VEINS, 61 XXII. HE WILL DIE IN THIRTY-SIX HOURS, 64 XXIII. ABOUT TO DIE OF CONSUMPTION, 72 XXIV. MY JOURNEYMANSHIP IN MEDICINE, 81 XXV. MY TEMPERANCE PLEDGE, 85 XXVI. TRIALS OF A YOUNG PHYSICIAN, 87 XXVII. A DOSING AND DRUGGING FAMILY, 90 XXVIII. POISONING WITH LEAD, 96 XXIX. STANDING PATIENTS, 102 XXX. KILLING A PATIENT, 105 XXXI. A SUDDEN CURE, 109 XXXII. GIGANTIC DOSES OF MEDICINE, 112 XXXIII. THE LAMBSKIN DISEASE, 115 XXXIV. MILK PUNCH FEVER, 120 XXXV. MY FIRST CASE IN SURGERY, 124 XXXVI. EMILIA AND THE LOVE-CURE, 127 XXXVII. HEZEKIAH JUDKINS AND DELIRIUM, 133 XXXVIII. MY FIRST AMPUTATION, 136 XXXIX. MILK AS A REMEDY IN FEVERS, 138 XL. VIRTUES OF PUMPKIN SEED TEA, 141 XLI. BROKEN LIMBS AND INTEMPERANCE, 144 XLII. DYING FROM FILTHINESS, 148 XLIII. TAKING THE FEVER, 153 XLIV. BLESSINGS OF CIDER AND CIDER BRANDY, 156 XLV. THE INDIAN DOCTOR, 160 XLVI. DYING OF OLD AGE AT FIFTY-EIGHT, 163 XLVII. DAUGHTERS DESTROYING THEIR MOTHER, 169 XLVIII. POISONING WITH STRAMONIUM, 172 XLIX. CURING CANCER, 175 L. SWELLED LIMBS, 179 LI. SUDDEN CHANGES IN OLD AGE, 182 LII. AN OPIUM EATER, 185 LIII. COFFEE AND THE LAME KNEE, 188 LIV. THE OPIUM PILL BOX, 193 LV. BLEEDING AT THE LUNGS, 196 LVI. BUTTER EATERS, 201 LVII. HOT HOUSES AND CONSUMPTION, 206 LVIII. POISONING BY A PAINTED PAIL, 216 LIX. ONE DROP OF LAUDANUM, 218 LX. MRS. KIDDER'S CORDIAL, 220 LXI. ALMOST RAISING THE DEAD, 225 LXII. FEMALE HEALTH AND INSANE HOSPITALS, 231 LXIII. A GIANT DYSPEPTIC, 236 LXIV. GETTING INTO A CIRCLE, 246 LXV. POISONING WITH MAPLE SUGAR, 249 LXVI. PHYSICKING OFF MEASLES, 251 LXVII. TIC DOULOUREUX, 253 LXVIII. COLD WATER IN FEVER, 256 LXIX. COLD-TAKING AND CONSUMPTION, 258 LXX. FREEZING OUT DISEASE, 261 LXXI. THE AIR CURE, 263 LXXII. THE CLERGYMAN, 266 LXXIII. HE MUST BE PHYSICKED OR DIE, 268 LXXIV. WHO HATH WOE? OR, THE SICK WIDOW, 272 LXXV. THE PENALTY OF SELF-INDULGENCE, 275 LXXVI. DR. BOLUS AND MORPHINE, 282 LXXVII. BLEEDING AND BLISTERING OMITTED, 286 LXXVIII. MEDICAL VIRTUES OF SLEEP, 288 LXXIX. CURE BY DEEP BREATHING, 291 LXXX. SPIRIT DOCTORING, 295 LXXXI. REMARKABLE CURE OF EPILEPSY, 301 LXXXII. SCARLATINA CURED BY LETTING ALONE, 312 LXXXIII. IGNORANCE NOT ALWAYS BLISS, 314 LXXXIV. MEASLES WITHOUT SNAKEROOT AND SAFFRON, 317 LXXXV. THE CONSUMPTIVE PAIR, 320 LXXXVI. HOW TO CURE CHOLERA, 322 LXXXVII. OBSTINACY AND SUICIDE, 324 LXXXVIII. HEALTH HOSPITALS, 327 LXXXIX. DESTRUCTION BY SCROFULA, 329 XC. STARVING OUT DISEASE, 334 XCI. DIETING ON MINCE PIE, 342 XCII. GIANTS IN THE EARTH, 346 XCIII. THE GREEN MOUNTAIN PATIENT, 349 XCIV. CURE OF POISON FROM LEAD, 355 XCV. FAITH AND WORKS, 358 XCVI. WORKS WITHOUT FAITH, 360 XCVII. DISEASES OF LICENTIOUSNESS, 365 XCVIII. CURIOUS AND INSTRUCTIVE FACTS, 367 XCIX. ANTI-MEDICAL TESTIMONY, 371 C. AN ANTI-MEDICAL PREMIUM, 375 CI. CONCLUDING REMARKS, 378 CII. A LAST CHAPTER, 380 FORTY YEARS IN THE WILDERNESS OF PILLS AND POWDERS. CHAPTER I. EDUCATIONAL TENDENCIES. I was born in a retired but pleasant part of New England, as New England was half a century ago, and as, in many places, despite of its canals, steamboats, railroads, and electromagnetic telegraphs, it still is. Hence I am entitled to the honor of being, in the most emphatic sense, a native of the land of "steady habits." The people with whom I passed my early years, though comparatively rude and uncultivated, were yet, in their manners and character, quite simple. Most of them could spell and read, and write their names, and a few could "cipher" as far as simple subtraction. To obtain the last-mentioned accomplishment, however, was not easy, for arithmetic was not generally permitted in the public schools during the six hours of the day; and could only be obtained in the occasional evening school, or by self-exertion at home. The majority of my townsmen also knew something of the dream-book and of palmistry, and of the influence of the moon (especially when first seen, after the change, over the right shoulder), not only on the weather and on vegetation, but on the world of humanity. They also understood full well, what troubles were betokened by the howling of a dog, the blossoming of a flower out of due season, or the beginning of a journey or of a job of work on Tuesday or Friday. Many of them knew how to tell fortunes in connection with a cup of tea. Nay, more, not a few of them were skilled in astrology, and by its aid could tell under what planet a person was born, and perchance, could predict thereby the future events of his life; at least after those events had actually taken place. Under what particular planet I was born, my friends never told me; though it is quite possible some of my sage grandmothers or aunts could have furnished the needful information had I sought it. They used to look often at the lines in the palms of my hands, and talk much about my dreams, which were certainly a little aspiring, and in many respects remarkable. The frequent prediction of one of these aged and wise friends I remember very well. It was, that I would eat my bread in two kingdoms. This prediction was grounded on the fact, that the hair on the top of my head was so arranged by the plastic hand of Nature as to form what were called two crowns; and was so far fulfilled, that I have occasionally eaten bread within the realms of Queen Victoria! According to the family register, kept in the cranium of my mother, I was born on Monday, which doubtless served to justify the frequent repetition of the old adage, and its application to my own case--"Born on Monday, fair of face." I was also born on the sixth day of the month, on account of which it was said that the sixth verse of the thirty-first chapter of Proverbs was, prospectively, a key to my character. It is certainly true that I have dealt out not a little "strong drink to him that" was "ready to perish;" and that few of my professional brethren have furnished a larger proportion of it gratuitously; or as Solomom says, have _given_ it. Whether there was any clear or distinct prophecy ever uttered that I would one day be a knight of the lancet, clad in full armor, is not certain. If there was, I presume it was unwritten. That I was to be distinguished in some way, everybody appeared to understand and acknowledge. I was not only at the head of all my classes at school, in spelling, reading, and writing, but exalted above most of my competitors and compeers by a whole head and shoulders. In ciphering, in particular, I excelled. I understood the grand rules of arithmetic, and could even work a little in the Rule of Three. That the thought of being a "doctor" did, in a sort of indefinable way, sometimes enter my head, even at that early period, I will not deny. One of my teachers, as I well remember, had medical books, into which bars and bolts could hardly prevent me from peeping. But there were a thousand lions in the way--or at least _two or three_. One was extreme indigence on the part of my parents. They came together nearly as poor as John Bunyan and his wife, or Sydney Smith and his companion. Or if, in addition to a knife, fork, and spoon, they had a looking-glass, an old iron kettle, an axe, and a hoe, I am sure the inventory of their property at first could not have extended much farther; and now that they had a family of four children, their wants had increased about as fast as their income. Besides, there was a confused belief in the public mind--and of course in mine--that medical men were a species of conjurors; or if nothing more, that they had a sort of mysterious knowledge of human character, obtained by dealing with the stars, or by reliance on some supernatural source or other. And to such a height as this I could not at that time presume to aspire; though I certainly did aspire, even at a very early period, to become a learned man. As a means to such an end, I early felt an ardent desire to become a printer. This desire originated, in part at least, from reading the autobiography of Dr. Franklin, of which I was exceedingly fond. It was a desire, moreover, which I was very slow to relinquish till compelled. My father, as we have seen, was a poor laborer, and thought himself unable either to give me any extra opportunities of education, or to spare me from the cultivation of a few paternal acres. Still, in secret, I I clung to the hope of one day traversing the lengths and breadths and depths and heights of the world of science. But for what purpose, as a final end? for, practically, the great question was, _cui bono_? As for becoming a lawyer, that, with me, was quite out of the question; for lawyers, even thus early, were generally regarded as bad men. All over the region of my nativity the word lawyer was nearly synonymous with liar; and to liars and lawyers the Devil was supposed to have a peculiar liking, not to say affinity. I had never at that time heard of but one honest lawyer; and him I regarded as a sort of _lusus naturæ_ much more than as an ordinary human being. My friends would have been shocked at the bare thought of my becoming a lawyer, had the road to that profession been open to my youthful aspirations. The clerical profession was in some respects looked upon more favorably than the legal or the medical. I was scarcely "three feet high" when an aged and venerable grandmother said one day, _in my hearing_, and probably _for_ my hearing, "I always did hope one of my grandsons would be a minister." This, however, neither interested me much nor encouraged me; for (reader will you believe it?), as the doctor was regarded in those days as more than half a sorcerer, and the lawyer three-fourths devil, so the minister was deemed by many as almost half an idiot, except for his learning. I am not, by any means, trifling with you. It was the serious belief of many--I think I might say of most--that those boys who "took to learning" were by nature rather "weak in the attic," especially those who inclined to the ministry. It was a common joke concerning an idiot or half idiot, "send him to college."[A] In short, so strongly was this unfounded impression concerning the native imbecility of ministers, and in general of literary men, fastened on my mind as well as on the minds of most people, that I grew up nearly to manhood with a sort of confused belief that as a general rule they were below par in point of good, common sense. One prominent reason, as I supposed, why they were sent to college and wrought into that particular shape, was to bring them up to an equality with their fellows. Hence, I not only repelled with a degree of indignation the thought of becoming a minister, but felt really demeaned by my natural fondness for books and school; and like the poet Cowper, hardly dared, all my early lifetime, to look higher than the shoe buckles of my associates. Still, I could not wholly suppress the strong desire to _know_ which had penetrated and pervaded my soul, and which had been nurtured and fed not only by an intelligent mother but by a few books I had read. Perhaps the life of Franklin, already referred to, had as much influence with me as any thing of the kind. For along with the love of knowledge which was so much developed by this book, the love of doing good was introduced. The doctor says, somewhere, that he always set a high value on a doer of good; and it is possible, nay, I might even say probable, that this desire, which subsequently became a passion with me, had its origin in this very remark. FOOTNOTES: [A] To illustrate this point, and show clearly the state of the public opinion, I will relate an anecdote. A certain calf in the neighborhood, after long and patient trial, was pronounced too ignorant to be able to procure his own nourishment, or in other words, was said to be a fool. On raising the question, what should be done with him, a shrewd colored man who stood by, said, "Master, send him to college!" CHAPTER II. MY FIRST MEDICAL LESSON. Straws, it is said, show which way the wind blows; and words, and things very small in themselves, sometimes show, much better than "two crowns," or the "stars," what is to be the future of a person's life. The choice of a profession or occupation, were we but trained to the habit of tracing effects up to their causes, will doubtless often be found to have had its origin, if not in _straws_, at least in very small matters. When I was ten years of age, my little brother, of only two years, sat one day on the floor whittling an apple. The instrument in his hand was a Barlow knife, as it was then called. The blade was about two inches in length, but was worn very narrow. How his parents and other friends, several of whom were in the same room, came to let him use such a plaything, I cannot now conceive; but as the point was almost square, and the knife very dull, they do not seem hitherto to have had any fears. Suddenly the usual quiet of the family was disturbed a little by the announcement, "Somebody is going by;" an event which, as you should know, was quite an era in that retired, mountainous region. All hastened to the window to get a view of the passing traveller. The little boy scampered among the rest; but in crossing the threshold of a door which intervened, he stumbled and fell. A sudden shriek called to him one of our friends, who immediately cried out, "Oh dear, he has put out his eye!" and made a hasty but unsuccessful effort to extract the knife, which had penetrated the full length of its blade. The mother hastened to the spot, and drew it forth, though, as she afterward said, not without the exertion of considerable force. Its back was towards the child, and by pressing the ball of the eye downward, the instrument had been able to penetrate to the bottom of the cavity, and perhaps a little way into the bone beyond. The elasticity of the eyeball had retained it so as to render its extraction seemingly difficult. Most of those who were present, particularly myself and the rest of the children, were for a short time in a state of mental agony that bordered on insanity. Not knowing at first the nature of the wound, but only that there was an eye there, and brains very near it, we naturally expected nothing less than the loss of this precious organ of vision, if not of life. There was no practising physician or surgeon, just at that time, within five or six miles, and I do not remember that any was sent for. We probably concluded that he could do no good. The child's eye swelled, and for a few days looked very badly; but after the lapse of about two weeks the little fellow seemed to be quite well; and so far as his eyes and brain are concerned, I believe he has been well to this time, a period of almost half a century. Although we resided at a considerable distance from the village, and from any practising physician, there was near by a very aged and superannuated man, who had once been a medical practitioner. Our curiosity had been so much excited by the wonderful escape of the little boy from impending destruction, that we called on the venerable doctor and asked him whether it was possible for a knife to penetrate so far into the head without injuring the brain and producing some degree of inflammation. From Dr. C. we received a good deal of valuable information concerning the structure of the eye, the shape of the cavity in which it is placed, the structure and character of the brain, etc. This was a great treat to me, I assure you. It added not a little to the interest which was imparted by his instructions when he showed us, from the relics of better days, some of the bones of the skull, especially those of the frontal region, in which the eye is situated. Of course the sight of a death's head, as we were inclined to call it, was at first frightful to us; but it was a feeling which in part soon passed away. It was a feeling, most certainly, which in me was not abiding at all. Indeed, as the title to the chapter would seem to imply, I received in this dispensation of Providence and its accompaniments my first medical lesson; though without the remotest thought, at the time, of any such thing. I was only indulging in a curiosity which was instinctive and intense, without dreaming of future consequences. CHAPTER III. THE ELECTRICAL MACHINE. Two years after this, an aged man, a distant relation, came to reside in my father's family for a short time, and brought with him a small electrical machine. He was a person of some intelligence, had travelled much, and had been an officer in the army of the American Revolution. On the whole, he was just such a man as would be likely to become a favorite with children. He was, moreover, fully imbued with the expectation of being able to cure diseases by means of electricity; which in our neighborhood, at the least, was quite a novel, not to say a heterodox idea. Curiosity alone had no small share of influence in bringing my mind to the study of electricity; but a general desire to understand the subject was greatly strengthened by the hope of being able to apply this wonderful agent in the cure of disease. One of the most interesting phases of Christianity is that the love and practice of healing the bodily maladies of mankind are almost always seen in the foreground of the New Testament representations of our Saviour's doings; and it is no wonder that a youth who reverences his Bible, and has a little benevolence, should entertain feelings like those above mentioned. The owner of the machine had brought with him a book on the subject of curing by electricity. It was a volume of several hundred pages, and was written by T. Gale, of Northern New York. It had in it much that was mere theory, in a highly bombastic style; but it also professed to give with accuracy the details of many remarkable cures, in various forms and stages, of several difficult diseases; and some of these details I knew to be realities. One or two cases at or near Ballston Springs were those of persons of whom I had some knowledge; and one of them was a relative. This last circumstance, no doubt, had great influence on my mind. As I had in those days some leisure for reading, and possessed very few books, I read--and not only read but studied--Dr. Gale's work from beginning to end. It is scarcely too much to say, that I read it till I knew it almost "by heart;" and my heart assented to it. I believed a new dispensation was at hand to bless the world of mankind; and what benevolence I had, began to be directed in this particular channel. I do not mean to say, that at twelve years of age I began to be a physician, for I do not now recollect that either our aged friend or myself ever had a patient during the whole year he remained with us. Eight or ten subsequent years at the plough and hoe, and the absence of book, electrical machine, and owner, did much towards obliterating the impressions on this subject I had received. Still, I have no doubt that the affair as a whole had a tendency to lead my thoughts towards the study and practice of medicine, and even to inspire confidence in electricity as a curative agent. In other and fewer words, it was, as I believe, a part of my medical education. CHAPTER IV. THE MEASLES AND POURING DOWN RUM. When I was about fourteen years of age, an event occurred which left a stronger impression on my mind than any of the foregoing; and hence in all probability did more to give my mind a medical bias and tendency. It was in the month of August. My father, assisted by two or three of his neighbors, was mowing a swamp meadow. It was an unusually wet season, and the water in many places was several inches deep,--in some few instances so deep that we were obliged to go continually with wet feet. To meet, and as it was by most people supposed to remove the danger of contracting disease, a bottle of rum was occasionally resorted to by the mowers, and offered to me; but at first I steadfastly refused it. At length, however, I began to droop. A feverish feeling and great languor came over me, and I was hardly able to walk. I was not then aware, nor were my friends, that I had been exposed to the contagion of measles, and therefore was not expecting it. I spoke of my ill health, but was consoled with the answer that I should soon get over it. But no; I grew worse, very fast. "Turn down the rum," said one of the mowers, "if you mean to work." But I hesitated. I was not fond of rum at any time, and just now I felt a stronger disinclination to it than ever before. "Turn down the rum," was repeated by the mowers, from time to time, with increased emphasis. At length wearied with their importunity; and, not over-willing to be the butt of their mirth and ridicule, I went to the spring, where the bottle of rum was kept, and, unperceived by any one, emptied a large portion of its contents on the ground. The mental agitation of temporary excitement dispelled in part my sufferings, and I proceeded once more to my work. In a very short time my noisy alcoholic prescribers went to the spring to pour rum down their _own_ throats. "What," said they, with much surprise, "has become of the rum?" "Have you drank it?" said they, turning to me. "Not a drop of it," I said. "But it is almost all gone," they said; "and it is a great mystery what has become of it." "The mystery is easily cleared up," I said; "you told me to turn it down, and I have done so."--"Told you to turn it down!" said one of them, the most noisy one; "I told you to drink it."--"No," said I, "you told me to turn it down; and I have poured it down--my part of it--at the foot of the stump. If you have forgotten your direction to turn it down, I appeal to two competent witnesses." The joke passed off much better than I expected. For myself, however, I grew worse rapidly, and was soon sent home. My mother put me into bed, applied a bottle of hot water to my feet, and gave me hot drinks most liberally, and among the rest some "hot toddy." Her object was to sweat away a supposed attack of fever. Had she known it was measles that assailed me, or had she even suspected it, she would almost as soon have cut off her right hand as apply the sweating process. She would, on the contrary, have given me cooling drinks and pure air. She was not wholly divested of good sense on this point, neither was the prevailing public opinion. I suffered much, very much, and was for a part of the time delirious. At length an eruption began to be visible, and to assume the appearance which is usual in measles, both to my own relief and that of my parents and other friends. But the mistaken treatment, or the disease, or both, gave a shock to my already somewhat delicate constitution, from which I doubt whether I ever fully recovered. The sequel, however, will appear more fully in the next chapter. CHAPTER V. LEE'S PILLS, AND THE DROPSY. In consequence either of the disease or its mismanagement, I was left, on recovering from the measles, with a general dropsy. I might also say here, that at the recurrence of the same season, for many years afterwards, I was attacked with a complaint so nearly resembling measles that some who were strangers to me could hardly be diverted from the belief that it was the veritable disease itself. But to the dropsy. This disease, so unusual in young people, especially those of my sanguine and nervous temperament, alarmed both my parents and myself, and medical advice was forthwith invoked. Our family physician was an old man, bred in the full belief of the necessity in such cases of what are called "alteratives," which, in plain English, means substances so active as to produce, when applied to the body either externally or internally, certain sudden changes. Alteratives, in short, are either irritants or poisons. Our aged doctor was called in to see me; and after the usual compliments, and perhaps a passing joke or two,--for both of which he was quite famous,--he asked me to let him see my tongue. Next, he felt my pulse. All the while--a matter exceedingly important to success--he looked "wondrous wise." He also asked me sundry wondrous wise questions. They were at least couched in wondrous words of monstrous length. The examination fairly over, there followed a pause; not, indeed, an "awful pause," but one of a few seconds, or perhaps in all of half a minute. "Now," said he, "you must take one of Lee's pills every day, in roasted apple." There were other directions, but this was the principal, except to avoid taking cold. The pills, of course, contained a proportion of mercury or calomel, on the alterative effects of which, as I plainly perceived, he placed his chief dependence. I took the pills, daily, for about six weeks; but they produced very little apparent effect, except to spoil my appetite. What their remoter effects were on my constitution generally, is quite another question. Suffice it to say, for the present, that for his occasional calls and wondrous wise looks, and his Lee's pills, he made quite a considerable bill. We were, it is true, always glad to see him, for he was pretty sure to crack a joke or two during his stay, and he sometimes told a good story. Nor, after all, were his charges remarkably high. For coming two or three miles to see me, he only made a charge of fifty cents a visit. It was near the beginning of October, and I was "getting no better very fast." A young physician had in the mean time come into the place, and my friends were anxious to call him in as "counsel." He proposed digitalis, and the family physician consented to it. But it was all to no purpose; I was still a bloated mass, and extremely enfeebled. At length, after some two or three months of ill health and loss of time, and the expenditure of considerable money on physicians and medicine, our good family doctor proposed a tea made from certain sweet roots, such as fennel, parsley, etc. Of this I was to drink very freely. I followed his advice, and in a few days the dropsy disappeared. Whether it was ready to depart just at this precise time, or whether the tea hastened its departure, I never knew. In any event, one thing is certain; that, either with its aid or in spite of it, I got rid of the dropsy; and it nevermore returned. But it is one thing to get rid of an inveterate disease, and quite another to be restored to our wonted measure of health and strength. The disease or the medicine or both had greatly debilitated me. I tried to attend school, but was unable till January or February; nor even then was I at all vigorous. I was able in the spring to work moderately; but it was almost a whole year before I occupied the same ground, physically, as before. Indeed, I have very many doubts whether I ever attained to the measure of strength to which I might have attained had it not been for the expenditure of vital power in a long contest with Lee's pills and disease. One lesson I learned, during my long sickness, in moral philosophy. I allude to the power of associated habits. Thus I was accustomed to take my pills daily for a long time, in combination with the pulp of a certain favorite apple. By degrees this apple, before so congenial to my taste, became so exceedingly disgusting to me that I could hardly come in sight of it, or even of the tree on which it grew, without nausea; and this dislike continued for years. By the aid of a strong will, however, I at length overcame it, and the apple is now as agreeable to my taste, for any thing I know, as it ever was. CHAPTER VI. THE COLD SHOWER-BATH. My long experience of ill health, and of dosing and drugging, had led me to reflect not a little on the causes of disease, as well as on the nature of medicinal agents; and I had really made considerable progress, unawares, in what I now regard as the most important part of a medical education. In short, I had gained something, even by the loss of so precious commodity as health. So just is the oft-repeated saying, "It is an ill wind that blows nobody any good." It was about this time that I began to reflect on bathing. What gave me the first particular impulses in this direction I do not now recollect, unless it was the perusal of the writings of Dr. Benjamin Rush and Dr. John G. Coffin. My attention had been particularly turned to cold shower bathing. I had become more than half convinced of its happy adaptation to my own constitution and to my diseased tendencies, both hereditary and acquired. But what could I do? There were in those times no fleeting shower-baths to be had; nor indeed, so far as I knew, any other apparatus for the purpose; and had there been, I was not worth a dollar in the world to buy it with; and I was hardly willing to ask for money, for such purposes of my father. I will tell you, very briefly, what I did. My father had several clean and at that time unoccupied stables, one of which was as retired as the most fastidious person could have wished. In one of these stables, directly overhead, I contrived to suspend by its two handles a corn basket, in such a way that I could turn it over upon its side and retain it in this position as long as I pleased. Into this basket, when suspended sideways, and slightly fastened, I was accustomed to set a basin or pail of water; and when I was ready for its reception, I had but to pull a string and overturn the basket in order to obtain all the benefits of a cold and plentiful shower. Here, daily, for almost a whole summer, I used my cold shower-bath, and, as I then thought and still believe, with great advantage. My consumptive tendencies were held at bay during the time very effectually. I was fortunate, indeed, in being able always, with the aid of a coarse towel and a little friction, to secure a pretty full reaction. This season of cold bathing was when I was about sixteen years of age. I shall ever look back to it as one of the most important, not to say most interesting, of my _experiences_. Indeed, I do not know that in any six months of my life I ever gained so much physical capital--thus to call it; by which I mean bodily vigor--as during these six months of the year 1814. I may also add here, that it has been my lot all my life long to learn quite as much from experiment and observation as in any other way. The foregoing experience gave me much knowledge of the laws of hygiene. Sometimes, while reflecting on this subject, I have thought of the assurance of the Apostle John, that he who "doeth truth cometh to the light," and have wondered whether the good apostle, along with this highly important truth, did not mean to intimate that the natural tendency of holy living was to an increase of light and love and holiness. And then I have gone a step further, and asked myself whether it was not possible that the doing of _physical_ truth as well as _moral_, had the same tendency. I have alluded to experience, or experiment. It is sometimes said that medical men are very much inclined to make experiments on their patients. Now, although I have a few sad confessions of this sort to make hereafter, yet I can truly say, in advance, that while I have made comparatively few experiments on other people, I have probably, during the progress of a long life, made more experiments on myself, both in sickness and in health, than any other existing individual. Whether I have learned as much in this way as I ought, in such favored circumstances, is quite another question. CHAPTER VII. MY FIRST SICKNESS ABROAD. When I was about half-way through my nineteenth year, a desire to see the world became so strong that I made up my mind to a little travelling. Accordingly, having provided myself with an employment which would, without a great deal of hindrance, enable me to earn my passing expenses, I set out on my journey. It was in the month of March, and near its close. The weather was mild, and the snow was fast disappearing--but not as yet the mud. In walking all day, my boots became soaked and my feet wet. The era of India rubbers had not then arrived. In truth, I went with my feet wet in the afternoon two or three days. On the evening of the third day I came to the house of the friends with whom I was desirous of stopping not only for the Sabbath's sake, which was now at hand, but to rest and recruit. The next morning I was quite sick, and my friends were alarmed. It was proposed to send for a physician; but against this I uttered my protest, and the plan was accordingly abandoned. The next purpose of my kind friends was to bring on a perspiration. They were accustomed in these cases to aim at sweating. This is indeed a violence to nature; but they knew no better. The mistress of the house was one of those self-assured women who cannot brook any interference or submit willingly to any modification of their favorite plans. Otherwise I should even then have preferred a gentle perspiration, longer continued. Yet on the whole, for the sake of peace, I submitted to my fate, and went through the fiery furnace which was prepared for me. More than even this I might say. I was cooler, much cooler, when I got through the fire than when I was in the midst of it! In three days I was, in a good measure, restored. I was, it is true, left very weak, but was free from fever. My strength rapidly returned; and on the fifth day I was able to set out for home, where in due time I safely arrived. During this excursion I learned one good lesson, if no more. This was, the danger of going day after day with wet feet. A vigorous person may go with wet or damp feet a little while, in the early part of the day, when in full strength, with comparative safety; but towards evening, when the vital forces are at ebb tide, or at least are ebbing, it is unsafe. The feeble especially should guard themselves in this direction; nor should those who may perchance at some future time be feeble, despise the suggestion. One important resolution was also made. This was never to use violent efforts to induce perspiration. Such a course of treatment I saw clearly, as I thought, must be contrary to the intentions of nature; and time and further observation and experiment have confirmed me in this opinion. There may of course be exceptions to the truth of such a general inference; but I am sure they cannot be very numerous. What though the forcing plan seems to have succeeded quite happily in my own case? So it has in thousands of others. So might a treatment still more irrational. Mankind are tough, and will frequently live on for a considerable time in spite of treatment which is manifestly wrong, and even without any treatment at all. CHAPTER VIII. LESSON FROM AN OLD SURGEON. Five or six miles from the place of my nativity a family resided whom I shall call by the name of Port. Among the ancestry of this family, time out of mind, there had been more, or fewer of what are usually called natural bone setters. They were known far and near; and no effort short of miraculous would have been sufficient to shake the confidence which ignorance and credulity had reposed in them. One or two of these natural bone setters were now in the middle stage of life, and in the full zenith of their glory. The name of the most prominent was Joseph. He was a man of some acquired as well as inherited knowledge; but he was indolent, coarse, vulgar, and at times profane. Had it not been for his family rank and his own skill as a surgeon, of which he really had a tolerable share, he would have been no more than at best a common man, and occasionally would have passed for little more than a common blackguard. I was in a shop one day conversing with Capt. R., when Dr. Port came in. "Capt. R., how are you?" was the first compliment. "Very well," said the captain, "except a lame foot." "I see you have one foot wrapped up," said Dr. Port; "what is the matter with it?"--"I cut it with an axe, the other day," said he, "very badly."--"On the upper part of the foot?" said the doctor. "Yes, directly on the instep," said Capt. R. "Is it doing well?"--"Not very well," he replied; "and I came into town to-day partly to see and converse with you about it."--"Well, then, undo it and let me have a look at it." Wrapper after wrapper was now taken from the lame foot, till Dr. Port began to scowl. "You keep it too warm," said he. "A wound of this sort should be kept cool, if you don't wish to have it inflame. A slight wrapping is all that is needful." They came at length to the wound. "It does not look very badly," said Dr. Port; "but you must keep it cool. And then," added he with an oath, the very thought of which to this day almost makes me shudder, "You must keep your nasty, abominable ointments away from it. Remember one thing, Capt. R., whenever you have a new flesh wound, all you can possibly do with any hope of advantage is to bring the divided edges of the parts together and keep them there, and nature will take care of the rest." "Would you, then, do nothing at all but bind it up and keep it still?" said Capt. R. "Nothing at all," said he, "unless it should inflame; and then a little water applied to it is as good as any thing."--"But is there nothing of a healing nature I can use?" said the captain. "I have told you already," said he, with another strange oath, "that you don't want any thing healing on the outside, if you had a cart-load of medicaments. All wounds, when they heal at all, heal from the bottom; and of course all your external applications are useless, except so far as is necessary to protect the parts from fresh injury and keep them from the air." The crowd around looked as if they were amazed; but it was Dr. Port who said it, and therefore it must be swallowed. I was somewhat surprised with the rest. And I have not a doubt that what he said was to most of them an invaluable lecture. For myself, as a student of _man_, it was just what I needed. It set me to thinking. It was a lesson which I could never forget if I were to live a thousand years. It was a lesson, moreover, which I have repeated almost a thousand times, in circumstances not dissimilar. Indeed, I believe this very occurrence did much to turn my attention to the medical profession. I saw at once it was a rational thing; a matter of plain common sense; a thing of principle; and not on the one hand a bundle of mysteries, nor on the other a mere humbug. Dr. Port long ago paid the debt of nature; but not till he had made his mark on the age he lived in. If, indeed, he died as the fool dieth,--and thus it was said he _did_ die,--he was at least a means of teaching others to live right. He did great good by his frequent wise precepts, as well as not a little harm by his sometimes immoral example. For myself, I honor him because he was my teacher on a point of great practical importance, and because he was to thousands of over-credulous people a light and a benefactor. Although I had not at this time any very serious thoughts of becoming a physician and surgeon, yet I certainly inclined in that direction. My great poverty was the chief difficulty that lay in my way; but this difficulty at that time seemed insurmountable. Besides, I was wedded to my father's farm, and I did not see how the banns could very well be sundered. CHAPTER IX. LEE'S WINDHAM BILIOUS PILLS. I was, at length, twenty-two years of age. I had about fifty dollars in my pocket, besides a few books. But what would this do towards giving me a liberal education? And yet, to an education in the schools, of some sort, either as a means to a profession, or as affording facilities for obtaining knowledge or communicating it to others, I certainly did aspire. But I seemed compelled for the present to plod on in the old way. There had been, but recently, a gold fever--not, it is true, of California, but of Carolina. The young men of the North, shrewd, intelligent, active, and ambitious Yankees, had flocked by hundreds, if not by thousands, from New England to the Southern States, to sell tin ware and clocks, especially the former. The trade at first had been very lucrative. Though many had been made poor by it, yet many more had been made rich. I do not say how honorably the trade had been conducted. To sell tin lanterns, worth fifty cents each, for silver, at fifty dollars, and tin toddy sticks, worth a New York shilling, for twelve dollars, did not in the final result redound much to our New England credit. Though it brought us gold, it did not permanently enrich us. A much better trade had now, in 1820, sprung up with the South. The North--the great nursery of America--had still a surplus of young men who wanted to go somewhere. A part of them found their way to Carolina and Georgia, and engaged during the winter, and occasionally through the year, in teaching; while another part labored on their canals and railroads and in their shops. This was to furnish the South with a commodity of real value, for which we received in return a fair compensation. Besides, it had a better effect than clock and tin peddling, both on the seller and buyer. To improve my pecuniary condition, and to acquaint myself with the world, I prepared to embark for the South. My purpose was to teach. It was the beginning of October, and yellow fever was said to be raging in Charleston, where I purposed to disembark. Was it, then, safe for me to go? Should the prospect of doing good, improving my mind, and bettering my condition in many other respects, weigh against the danger of disease; or was it preferable that I should wait? My numerous friends counselled me according to their various temperaments and prepossessions. The strong and vigorous in body and mind said, _Go on_; the feeble and timorous and trembling interposed their caution. But the vessel was ready and would soon sail; and I saw on board many of my acquaintances. The temptation was before me, and was great; the dangers, though many, were remote--the dangers of the sea excepted. For these, it is true, I was, like everybody else, entirely unprepared, having never before in my life crossed more than a single river. I was moreover exceedingly timid. One kind friend--kind, I mean, in general intention--who had been many years at the South, amid the ravages of the gold fever, as well as other fevers more or less yellow, whispered me just at this critical moment, "Take with you a box of Lee's Windham Bilious Pills; and as soon as you arrive at Charleston, make it your rule to swallow, every other day, one of these pills. That will prevent your getting the fever. I have often tried it, and always with success." My friend's words gave me more courage than his pills. I saw that he had been in the midst of sickness and had lived through it. Why might not I? My mind was soon made up to proceed on the journey. We sailed from New Haven in Connecticut, and were seventeen days on our passage. When we reached Charleston, either the yellow fever had spent itself or it had not recently been there, except in a few rare instances. I found no use for pills of any kind, except _such as grew on fruit-trees_--the apple, peach, orange, persimmon, etc., or such as were the products of the corn, potato, and rice fields; nor did I ever take any other while I remained in the South. A queer idea, I often said to myself, that of taking poison while a person is well, in order to prevent becoming sick! In any event, I did not do it. There was sickness in the country, however, if not in the city; and I was much and often exposed to it. But what then? How would one of Lee's pills defend me from it, even for two days? I preferred to eat and drink and sleep correctly, and then trust to my good fortune and to Him who controlled it, rather than to nauseous and poisonous medicine. And I had my choice, and with it a blessed reward. I was in the low country of North and South Carolina and Virginia six months or more, and often and again much exposed to disease, and yet I never had a sick day while I remained there. And yet, as I have before intimated, I never took a particle of medicine during the whole time. Once, indeed, I was beguiled into the foolish habit of using French brandy with my dinner, under the idea that it would promote digestion. But I did not continue it long; and I verily believe that it did me more harm than good while I used it; for I have at no other period of my life suffered so much from dyspeptic tendencies as during the summer which followed this temporary indulgence of brandy with my dinner. During my wanderings in the South, I had, much of the time, a fellow traveller, who, though he took no medicine, was less cautious than myself, and less fortunate. Perhaps his very recklessness served as a warning to me. In truth, without being much of a theologian, I have sometimes thought that the errors of mankind were intended in the divine plan--at least in part--for this very end. Happy, then, if this is so, are they who make a wise use of them! CHAPTER X. DR. SOLOMON AND HIS PATIENT. I have said that my fellow traveller was less cautious than myself, and have intimated much more. He was in some respects cautious, and yet in others absolutely reckless. When hot and thirsty, for example, instead of just rinsing out his mouth and swallowing a very little water, he would half-fill his stomach with some of that semi-putrid stuff, ycleped water, which you often find in Virginia and the Carolinas; and when hungry, he would eat almost any thing he could lay hold of, and in almost any quantity, as well as at almost any hours, whether seasonable or unseasonable. This course of conduct seemed to answer very well for a few months; but a day of retribution at last came. He was then in Norfolk, in Virginia. I had been absent from the place a few weeks, and on my return found him sick with a fever, and without such assistance as was absolutely and indispensably necessary. There were Yankees in the place in great numbers, and some of them were his personal acquaintances and friends; but they had hitherto refused to come near him, lest they should take the fever. I proceeded to take care of him by night and by day. At the suggestion of an old citizen, in whom I placed great confidence, Dr. Solomon was called in as his physician. There was some bleeding and drugging, and a pretty constant attendance for many weeks; but the young man finally recovered. If you ask what this chapter has to do with my medical confessions, I will tell you. Dr. Solomon was an old school physician, and made certain blunders, which I am about to confess for him. He prescribed--as very many of us his medical brethren formerly did, for the _name_ of a disease rather than for the disease itself, just as it now appeared. Thus, suppose the disease was typhus fever; in that case he seemed to give just about so many pills and powders every day, without much regard to the circumstances; believing that somehow or other, and at some time or other, good would come out of it. If his patient had sufficient force of constitution to enable him to withstand both the disease and the medicine, and ultimately to recover, Dr. S. had the credit of a cure; not, perhaps that he claimed it,--his friends awarded the honor. If the patient died, it was on account of the severity of the disease. Neither the doctor nor his medicine was supposed to be at fault. Some, indeed, regarded it as the mysterious work of Divine Providence. Dr. S. attended my young companion in pedestrianism a long time, and sometimes brought a student into the bargain. He probably kept his patient insane with his medicine about half the time, and greatly prolonged his disease and his sufferings. But he knew no better way. He was trained to all this. The idea that half a dozen careful visits, instead of fifty formal ones, and a few shillings' worth of medicine instead of some twenty or thirty dollars' worth, would give the young man a better prospect of recovery than his own routine of fashionable book-dosing and drugging, never for once, I dare say, entered his head. And yet his head was large enough to hold such a simple idea, had it been put there very early; and the deposit would have done much to make him--what physicians will one day become--a rich blessing to the world. Reader, are here no confessions of medical importance? If not, bear with me awhile, and you will probably find them. We have yet a long road to travel, and there are many confessions to be made in which I have a personal concern and responsibility, and, as you may perhaps conclude, no small share of downright culpability. CHAPTER XI. PHYSICKING OFF FEVER. The eyes of my mind having just begun to be opened to the impotence of a mere routine of medication as a _substitute for nature_, rather than _as an aid to her enfeebled efforts_, I was prepared to make a wise use of other facts that came before me, especially those in which I had a personal concern and interest. Here is one of this description. On the morning of March 12, 1821, during the very period when I was watching over my sick friend, as mentioned in the preceding chapter, I took from the post-office a letter with a black seal. It contained the distressing intelligence of the death of a much-valued sister and her husband, both of whom, but a few months before, I had left in apparently perfect health. On a careful inquiry into the particulars, both by letter and, after my return, in other ways, I learned that the Connecticut River fever, as it was then and there called, having carried off several persons who were residing in the same house with my brother, the survivors were advised to do something to prevent the germination and development of such seeds of the disease as were supposed to be in their bodies and ready to burst forth into action. I do not know that any medical man encouraged this notion, the offspring of ignorance and superstition; but my brother and his wife had somehow or other imbibed it, and they governed themselves accordingly. Both of them took medicine--moderate cathartics--till they thought they had physicked off the disease; and all seemed, for a time, to be well, except that they complained still of great weakness and debility. It was not long, however, before they were both taken with the disease and perished; my brother in a very short time, and my sister more slowly. My sister, on being taken ill, had been removed to the house of her mother, in the hope that a change of air might do something for her; but all in vain. My mother and a few other friends who were with them as assistants sickened, but they all ultimately recovered. They, however, took no medicine by way of prevention. Now I do not presume to say, that my young friends were destroyed solely by medicine, for the assertion would be unwarranted. I only state the facts, and tell you what my convictions then were, and what they are still. My belief is, that though they might have sickened had they taken no medicine or preventive, yet their chance of recovery after they sickened was very much diminished by the unnecessary and uncalled-for dosing and drugging. The notion that we can physick off the seeds of disease, or by our dosing prevent their germination, is as erroneous as can possibly be, and is a prolific source of much suffering and frequent death. The best preventive of disease is good health. Now, physicking off generally weakens us, instead of giving strength. It takes away from our good health instead of adding to or increasing it. As a general rule, to which there are very few exceptions, all medicine, when disease is unusually common or fatal, is hazardous without sound medical advice, and not generally safe even then. It is fit only for extreme cases. You may be at a loss to understand how such facts and reflections as these could allure me to the study and practice of medicine as a profession. Yet they most certainly had influence. Not that I felt a very strong desire to deal out medicine, for to this I felt a repugnance which strengthened with increase of years and experience. What I most ardently desired was to know the causes of disease, and how far they were or were not within human control. Such a science as that of _hygiene_--nay, even the word itself, and the phrase _laws of health_--was at that time wholly unknown in the world in which I moved. There was, in truth, no way then to this species of knowledge, except through the avenues opened by a course of medical study. Hence it was that I blundered on, in partial though not entire ignorance, for some time longer, groping and searching for that light which I hardly knew how or whence to seek, except in pills and powders and blisters and tinctures. CHAPTER XII. MANUFACTURING CHILBLAINS. At the period of my life to which we have at length arrived, I was for four or five months of every year a school teacher. This was, in no trifling degree, an educational process; for is it not well known that, "Teaching we learn, and giving we retain?" It was at least an education in the great school of human nature. Every morning of one of these winter sessions of school keeping, Lydia Maynard, eight years of age, after walking about a mile, frequently in deep snow, and combating the cold northwest winds of one of the southern Green Mountain ranges, would come into the schoolroom with her feet almost frozen, and take her seat close to the stove, so as to warm them and be ready for school as quickly as possible. Here she would sit, if permitted to do so, till the bell rang for school. It was not long before I learned that she was a great sufferer from chilblains. Whether she inherited a tendency to this troublesome and painful disease, which was awakened and aggravated by sudden changes of temperature, or whether the latter were the original cause of the disease, I never knew with certainty. But I was struck with the fact that sudden warming was followed by such lasting and terrible consequences. And herein is one reason why I have opposed, from that day to this, the custom or habit, so exceedingly prevalent, of rushing to the fire when we are very cold, and warming ourselves as quickly as possible. I have reasoned; I have commanded; and in some few instances I have ridiculed. Every one knows it is hazardous to bring the ears or fingers or toes, or any other parts of the body, suddenly to the fire when really frozen,--that is, when the temperature is lowered down in the part to 32°; and yet, if it is only down to 33°, and the part not quite frozen, almost every one, young and old, will venture to the fire. Can there be such a difference in the effects when there is only a difference of one degree in temperature? No reflecting person will for one moment believe it. The trouble is we do not think about it. Sudden changes from heat to cold are little more favorable than when the change is in the other direction. Indeed, it often happens that children at school are subjected to both these causes. Thus, in the case of Lydia, suppose that after roasting herself a long time at the stove, she had gone to her seat and placed her feet directly over crevices in the floor, through which the cold wind found its way at almost freezing temperature. Would not this have greatly added to the severity of the disease? There are, it is true, other reasons against sudden changes of temperature, particularly the change from cold to heat, besides the fact that they tend to produce chilblains; but I cannot do more just now than barely advert to them. The eyes are apt to be injured; it renders us more liable than otherwise we should be to take cold. Occasionally it brings on faintness and convulsions, and still more rarely, sudden death. I will only add now, that sudden warming after suffering from extreme cold, whether we perceive it or not at the time, is very apt to produce deep and lasting injury to the brain and nervous system. But my main object in relating the story is answered if I have succeeded in clearly pointing out to the reader one of the avenues through which light found its way to my benighted intellect, and led me to reflection on the whole subject of health and disease. Here was obviously one cause of a frequent but most painful complaint. It was natural, perfectly natural, that by this time I should begin to inquire. Have all diseases, then, their exciting causes? Many certainly have; and if many, perhaps all. At least, how do we know but it may be so? And then again, if the causes of chilblains are within our control, and this troublesome disease might be prevented, or its severity mitigated if no more, why may it not be so with all other diseases? To revert for a moment to the case of Lydia Maynard. Though I was the cause, in a certain sense, of her suffering, yet it was a sin of ignorance. But it taught me much wisdom. It made me cautious ever afterward. I do not doubt but I have been a means of preventing a very considerable amount of suffering in this form, since that time, by pointing out the road that leads to it. Prevention is better than cure, was early my motto, and is so still. And from the day in which I began to open my eyes on the world around me, and to reason from effects up to their causes, I have been more and more confirmed in the belief that mankind as a race are to be the artificers of their own happiness or misery. All facts point in this direction, some of them with great certainty. And facts, everywhere and always, are stubborn things. CHAPTER XIII. HOW TO MAKE ERYSIPELAS. My periodical tendency to a species of eruptive disease closely resembling measles, was mentioned in Chapter IV. During the summer of 1823 this affection became unusually severe, and seemed almost beyond endurance. The circumstances were as follows:-- I had in charge a large and difficult school. The weather was very hot, and I was not accustomed to labor in summer within doors. Besides, my task was so difficult as to call forth all the energies of body and mind both; and the "wear and tear" of my system was unusually great. It was in the very midst of these severe labors, in hot and not well-ventilated air, that the eruption appeared. Perhaps it was aggravated by my diet, which, in "boarding around," was of course not the best. The eruption not only affected my body and reached to the extremities, but was accompanied by an itching so severe that I was occasionally compelled to lie awake all night. My general strength at last began to give way under it, and I sought the advice of our family physician. He advised me to use, as a wash to the irritated and irritable surface, a weak solution of corrosive sublimate. I hesitated; especially as I believed it to be, with him, an experiment. But on his repeated assurance, that if I would take special care of myself and avoid taking cold, there was no danger, I waived my objections, and proceeded to carry out his plan. The solution was applied, accordingly, to the letter of the doctor's directions. For many days no change appeared, either favorable or adverse. At length a most distressing headache came on and remained. My sufferings became so severe that I was obliged to postpone my school and return to my father's house. On the road, I observed that an eruption of a peculiar kind had appeared, particularly about the forehead, accompanied with small blisters. It was not here that I had applied the solution, but on the arms, chest, and lower limbs. Of course the corrosive sublimate, if at all operative, had affected me through the medium of the circulation and not by direct contact. Our physician came, pronounced the disease erysipelas, and without saying a word about the cause, prescribed; and I followed out carefully his prescription. But the disease had its course in spite of us both, and was very severe. It took away my sleep entirely for a day or two. It proved a means of removing the hair from one side of my head, and of so injuring the skin that it never grew again. Indeed, gangrene or mortification had actually commenced at several points. Suddenly, however, the pain and inflammation subsided, and I recovered. Now my physician never said that I was poisoned by the corrosive sublimate, probably for the two following reasons: 1, I never made the inquiry. 2, He would probably have ascribed the disease to taking cold rather than to the mercury, had I inquired. I do not believe I took cold, however. How it came to affect me so unfavorably I never knew with certainty; but that it was the medicine that did the mischief I never for one moment doubted. I suppose it was absorbed; but of the manner of its introduction to the system I am less certain than of the fact itself. But besides the absorption of the corrosive sublimate into the system, and its consequences--a terrible caution to those who are wont to apply salves, ointments, washes, etc., to the surface of the body unauthorized--I learned another highly important lesson from this circumstance. Active medicines, as I saw more plainly than ever before, are as a sword with two edges. If they do not cut in the right direction, they are almost sure to cut in the wrong. I must not close, however, without telling you a little more about the treatment of my disease. After I had left my school and had arrived at home, a solution of sugar of lead was ordered in the very coldest water. With this, through the intervention of layers of linen cloth, I was directed to keep my head constantly moistened. Its object, doubtless, was to check the inflammation, which had become exceedingly violent. Why the sugar of lead itself was not absorbed, thus adding poison to poison, is to me inconceivable. Perhaps it was so; and yet, such was the force of my constitution, feeble though it was, that I recovered in spite of both poisons. Or, what is more probable, perhaps the lead, if absorbed at all, did not produce its effects till the effects of the corrosive sublimate were on the wane; so that the living system was only necessitated to war with one poison at a time. Mankind are made to live, at least till they are worn out; and it is not always easy to poison a person to death, if we would. In other words, human nature is tough. Now I do not know, by the way, that any one but myself ever suspected, even for one moment, that this attack of erysipelas was caused by the corrosive sublimate. But could I avoid such a conclusion? Was it a hasty or forced one? Judge, then, whether it was not perfectly natural that I should be led by such an unfortunate adventure to turn my attention more than ever to the subject of preserving and promoting health. For if our family physician--cautious and judicious as in general he was--had been the unintentional cause of a severe attack from a violent and dangerous disease, which had come very near destroying my life, what blunders might not be expected from the less careful and cautious man, especially the beginner in medicine? And if medical men, old and young, scientific as well as unscientific, make occasional blunders, how much more frequently the mass of mankind, who, in their supposed knowledge of their own constitutions and those of their families, are frequently found dosing and drugging themselves and others? I do not mean to say that in the incipiency of my observations and inquiries my mind was mature enough--well educated enough, I mean--to pursue exactly the foregoing train of thought; but there was certainly a tendency that way, as will be seen more fully in the next chapter. The spell at least was broken, and I saw plainly that if "died by the visitation of God" _never_ means any thing, it _generally_ does not. And as it turned out that the further I pushed my inquiries the more I found that diseases were caused by transgression of physical and moral law, and hence not uncontrollable, why should it not be so, still farther on, in the great world of facts which I had not yet penetrated? CHAPTER XIV. STUDYING MEDICINE. My thoughts were now directed with considerable earnestness and seriousness, to the study of medicine. It is true that I was already in the twenty-fourth year of my age, and that the statute law of the State in which I was a resident required three years of study before receiving a license to practise medicine and surgery, and I should hence be in my twenty-seventh or twenty-eighth year before I could enter actively and responsibly upon the duties of my profession, which would be rather late in life. Besides, I had become quite enamored of another profession, much better adapted to my slender pecuniary means than the study of a new one. However, I revolved the subject in my mind, till at length, as I thought, I saw my path clearly. It was my undoubted duty to pursue the study of medicine. Still, there were difficulties which to any but men of decision of character were not easily got removed. Shall I tell you how they were gradually and successfully overcome? Our family physician had an old skeleton, and a small volume of anatomy by Cheselden, as well as a somewhat more extended British work on anatomy and physiology; all these he kindly offered to lend me. Then he would permit me to study with him, or at least occasionally recite to him, which would answer the letter of the law. Then, again, I could, during the winter of each year of study except the last, teach school, and thus add to my pecuniary means of support. And lastly, my father would board me whenever I was not teaching, and on as long a credit as I desired. Were not, then, all my difficulties practically overcome, at least prospectively? It was early in the spring of the year 1822 that I carried to my father's house an old dirty skeleton and some musty books, and commenced the study of medicine and surgery, or at least of those studies which are deemed a necessary preparation. It was rather dry business at first, but I soon became very much interested in the study of physiology, and made considerable progress. My connection with our physician proved to be merely nominal, as I seldom found him ready to hear a recitation. Besides, my course of study was rather desultory, not to say irregular. In the autumn of 1824, having occasion to teach school at such a distance as rendered it almost impracticable for me to continue my former connection as a student, I made arrangements for studying with another physician on terms not unlike those in the former case. My new teacher, however, occasionally heard me recite, especially in what is properly called the practice of medicine and in surgery. His instructions, though very infrequent, were of service to me. In 1825 I became a boarder in his family, where I remained about a year. Here I had an opportunity to consult and even study the various standard authors in the several departments which are usually regarded as belonging to a course of medical study. So that if I was not in due time properly qualified to "practise medicine and surgery in this or any other country," the fault was chiefly my own. However, in the spring of 1825, after I had attended a five months' course of lectures in one of the most famous medical colleges of the Northern States, I was regularly examined and duly licensed. _How_ well qualified I was supposed to be, did not exactly appear. It was marvellous that I succeeded at all, for I had labored much on the farm during the three years, taught school every winter and two summers, had two or three seasons of sickness, besides a severe attack of influenza (this, you know, is not regarded as a disease by many) while attending lectures, which confined me a week or more. And yet one of my fellow students, who was present at the examination, laughed at my studied accuracy! One word about my thesis, or dissertation. It was customary at the college where I heard lectures--as it probably is at all others of the kind--to require each candidate for medical license to read before the board, prior to his examination, an original dissertation on some topic connected with his professional studies. The topic I selected was pulmonary consumption; especially, the means of preventing it. It was, as may be conjectured, a slight departure from the ordinary routine, but was characteristic of the writer's mind, prevention being then, as it still is, and probably always will be, with him a favorite idea. I go so far, even, as to insist that it should be the favorite idea of every medical man, from the beginning to the end of his career. "The best part of the medical art is the art of avoiding pain," was the motto for many years of the _Boston Medical Intelligencer_; and it embraced a most important truth. When will it be fully and practically received? But I must recapitulate a little; or rather, I must go back and give the reader a few chapters of incidents which occurred while I was a student under Dr. W., my second and principal teacher. I will however study brevity as much as possible. CHAPTER XV. NATURE'S OWN EYE WATER. When I began the study of medicine, my eyes were so exceedingly weak, and had been for about ten years, or indeed always after the attack of measles, that I was in the habit of shading them, much of the time, with green or blue glasses. My friends, many of them, strongly objected to any attempt to pursue the study of medicine on this very account. And the attempt was, I confess, rather hazardous. What seemed most discouraging in the premises was the consideration that I had gone, to no manner of purpose, the whole round of eye waters, elixir vitriol itself not excepted. Was there room, then, for a single gleam of hope? Yet I was resolutely, perhaps obstinately, determined on making an effort. I could but fail. Soon after I made a beginning, the thought struck me, "Why not make the experiment of frequently bathing the eyes in cold water?" At that very moment they were hot and somewhat painful; and suiting the action to the thought, I held my face for some seconds in very cold water. The sensation was indescribably agreeable; and I believe that for once in my life, at the least, I felt a degree of gratitude to God, my Creator, for cold water. The practice was closely and habitually followed. Whenever my eyes became hot and painful, I put my face for a short time in water, even if it were _twenty_ times a day. The more I bathed them, the greater the pleasure, nor was it many days before they were evidently less inflamed and less troublesome. Why, then, should I not persevere? I carried the practice somewhat further still. I found from experiment, that I could open my eyes in the water. At first, it is true, the operation was a little painful, and I raised, slightly, its temperature. Gradually, however, I became so much accustomed to it that the sensation was not only less painful, but even somewhat agreeable. In a few weeks I could bear to open my eyes in the water, and keep them open as long as I was able to hold my breath, even at a very low temperature. Perseverance in this practice not only enabled me to proceed with my studies, contrary to the expectation of my friends, and in spite, too, of my own apprehensions, but gave me in addition the unspeakable pleasure of finding my eyes gaining every year in point of strength, as well as clearness of sight. My glasses were laid aside, and I have never used any for that specific purpose since that time. Of course I do not mean by this to say that my eyes remain as convex as they were at twenty-five or thirty years of age, for that would not be true. They have most certainly flattened a little since I came to be fifty years of age, for I am compelled to wear glasses when I would read or write. I mean, simply, that they have never suffered any more from inflammation or debility, since I formed the habit of bathing them, even up to the present hour. The more I observe on this subject, the more I am persuaded--apart from my own experience--that pure water, at the lowest temperature which can be used without giving pain, is the best known eye medicine in the world, not merely for one, two, or ten in a hundred persons, but for all. I recommend it, therefore, at every opportunity, not only to my patients but to others. It may doubtless be abused, like every other good gift; but in wise and careful hands it will often accomplish almost every thing but downright miracles. We may begin with water a little tepid, and lower the temperature as gradually as we please, till we come to use it ice cold. CHAPTER XVI. THE VIPER STORY. I was, early in life, greatly perplexed in mind by the oft-recurring question, why it was that in the hands of common sense men, every known system of medicine--even one which was diametrically opposed to the prevailing custom or belief, like that of Hahnemann, seemed to be successful. Not only the botanic practitioner with his herbs, and the homoeopathist with his billionth dilutions, but even the no-medicine man[B] could boast of his cures, and, for aught I could see, of about an equal number--good sense and perseverance and other things being equal. And then, again, he that bled everybody, or almost everybody, if abounding in good sense, like the late Dr. Hubbard, of Pomfret, in Connecticut, was about as successful as those who, like Dr. Danforth, once an eminent practitioner of Boston, would bleed nobody, nor, if in his power to prevent it, suffer the lancet to be used by anybody else. While cogitating on this subject one day, the following anecdote from a surgical work--I think a French work--came under my eye, and at once solved the problem, and relieved me of my difficulty. It may probably be relied on. When the Abbé Fontana, a distinguished medical man and naturalist, was travelling, once, in some of the more northern countries of Europe, he was greatly surprised to find such a wonderful variety of applications to the bite of the viper, and still more to find them all successful, or at least about equally so. Even those that were in character diametrically opposed to each other, _all cured_. His astonishment continued and increased when he found at length that those who applied nothing at all recovered about as readily as any of the rest. In the sequel, as the result of diligent and scientific research, it turned out that the bite of this animal, however dangerous and fatal in hot climates, is scarcely dangerous at all in cold ones. Hence it was that all sorts of treatment appeared to cure. In other words, the persons who were bitten all recovered in spite of the applications made to their wounds, and generally in about the same period of time. Thus, as I began to suspect,--and the reader must pardon the suspicion, if he can,--it may be with our diversified and diverse modes of medical treatment. A proportion of our patients,--perhaps I should say a large proportion,--if well nursed and cared for and encouraged, would recover if let alone so far as regards medicine. And it is in proof of this view, that nearly as many recover under one mode of practice, provided that practice is guided by a large share of plain, unsophisticated sense, as another. And does not this fully account for a most remarkable fact? Hence it is, too,--and perhaps hence alone,--that we can account for the strange development in Boston, not many years since, during a public medical discussion; viz., that he who had given his tens of pounds of calomel to his patients, and taken from their arms his hogsheads of blood, had been on the whole about as successful a practitioner as he who had revolted from the very thought of both, and had adopted some of the various forms of the stimulating rather than the depleting system. "Is there, then, no choice between medication and no-medication? For if so, what necessity is there of the medical profession? Why not annihilate it at once?" My reply is,--and it would have been about the same when these discoveries began to be made,--that there is no occasion to give up the whole thing because it has been so sadly abused. Every mode of medical practice, not to say every medical practitioner from the very beginning, has been, of necessity, more or less empirical. The whole subject has been involved in so much ignorance and uncertainty, that even our wisest practitioners have been liable to err. They have been led, unawares, to prescribe quite too much for names rather than for symptoms; and their patients were often glad to have it so. And were the whole matter to come to an end this day, it might well be questioned whether the profession, as a whole, has been productive of more good than evil to mankind. But then, every thing must have its infancy before it can come to manhood. And it is a consolation to believe that the duration of that manhood always bears some degree of proportion to the time required in advancing from infancy to maturity. Medicine, then, as a science, is valuable in prospect. And then, too, it is worth something to have a set of men among us on whom we may fasten our faith; for, credulous as everybody is and will be in this matter of health and disease, till they can duly be taught the laws of hygiene, they will lean upon somebody; it is certainly desirable that they should rely on those whom they know, rather than upon strangers, charlatans, and conjurors, of whom they know almost nothing. But I shall have frequent occasion to revert to this subject in other chapters, and must therefore dismiss it for the present, in order to make room for other facts, anecdotes, and reflections. FOOTNOTES: [B] Of the hydropathist at that time I had not heard. CHAPTER XVII. STRUCK WITH DEATH. Throughout the region where I was brought up, and perhaps throughout the civilized world, the notion has long prevailed that in some of the last moments of a person's life, he is or may be "struck with death;" by which, I suppose the more intelligent simply mean that such a change comes over him as renders his speedy departure to the spirit-world inevitable. Now that we are really justified in saying of many persons who are in their last moments, that they are beyond the reach of hope, is doubtless true. When decomposition, for instance, has actually commenced, and the vital organs have already begun to falter, it would be idle to conceal the fact, were we able to do so, that life is about to be extinguished beyond the possibility of doubt. In general, however, it is never quite impossible for the sick to recover even after recovery _seems_ to be impossible. So many instances of this kind have been known, that we ought at least, to be exceedingly cautious about pronouncing with certainty, and to encourage rather than repel the application of the old saying, "as long as there is life, there is hope."[C] I had a lesson on this subject while a medical student, which was exceedingly instructive, and which, if I were to live a thousand years, I could never forget. It was worth more to me in practical life afterward, than all my books and recitations would have been without it. The facts were these:-- My teacher of medicine used occasionally to take his students with him when he rode abroad on his professional visits. One day, it fell to my lot to bear him company. His patient was an aged farmer, a teamster rather, who had been for some time ill of a fever, and had not been expected to recover. Yet his case was not so desperate but that the physician was expected to continue his daily visits. On our arrival at the house of the sick man, we were met by a member of the family, who said, "Come in, doctor, but you are too late to do us any good. Mr. H. is struck with death; all the world could not save him now." We entered the room. There lay the patient almost gone, surely. So at least, at the first view, it appeared. It was a hot summer day, and hardly a breath of air was stirring. The friends were gathered around the bed, and there was less freedom of circulation in the air of the sick-room than elsewhere. It was almost enough to kill a healthy man to be shut up in such a stagnant atmosphere; what, then, must have been the effect on one so sick and feeble? The doctor beckoned them away from the bed, and requested them to open another window. They did it rather reluctantly; but then, _they did it_. The sufferer lay panting, as if the struggle was almost over. "Don't you think he is struck with death, doctor?" whispered one and another and another. Almost out of patience, the doctor at length replied: "Struck with death? What do you mean? No; he is no more struck with death than I am. He is struck much more with the heat and bad air. Raise another window." The window was raised. "Now," said he, "set that door wide open." It was quickly done. "Now bring me a bowl of water, and a teaspoon." The bowl of water was quickly brought. "Put a little water into his mouth with the teaspoon," said he. "O doctor," they replied, "it will only distress him; he is already struck with death."--"Try it then, and see." Tremblingly they now moistened his parched lips. "Put a little of it in his mouth, with the teaspoon," he said. They shuddered; the doctor persisted. "Why," said the attendant, "he has not been able to swallow any thing these two hours." "How do you know?" said he. "Why, he has been all the while struck with death."--"Nonsense! have you tried it?" "Tried it? oh, no; by no means."--"Why not?"--"Because we knew it would only distress him. He is too far gone to swallow, doctor; you may rely on it." The physician's patience was now well nigh exhausted, as well it might have been, and seizing the bowl and teaspoon with his own sacrilegious hands, "I will see," said he, "whether he is struck with death or not." He not only wetted his lips and tongue, as they had partially done before, but gradually insinuated a few drops of Nature's best and only drink, into the top of his throat. At last he swallowed! The doctor's hopes revived; while the family stood as if themselves struck, not with death, but with horror. At length, he swallowed again and again. In half an hour, he opened his eyes; before we left him, he had become quite sensible, and, had we encouraged it, might have spoken. To make my story as short as possible, the next day he could swallow a little gruel. The third day, he could be raised upon the bed. The fourth, though still weak, he was dressed and sat up an hour. In a fortnight, he was once more driving his team; and for ought I know to the contrary, unless debarred by reason of age, he may be driving it at this very moment! Going home together from our visit, already so fully described, the conversation turned on the silly notion which so extensively prevails about being struck with death. We talked of its origin, its influence, and its consequences. It had done no good in the world, while it had been the means, we could not doubt, of indirectly destroying thousands of valuable lives. OF ITS ORIGIN.--How came the notion abroad that a person can be struck with death, so affected that there is no possible return for him, to life and health? Struck! By whom? Is there a personage, spiritual but real, that strikes? Is it the Divine Being? Surely not. Is it an arch enemy? is it Satan himself? "No day, no glimpse of day, to solve the knot." The doctor and I had, however, one conjecture concerning it, which, if it should not instruct the reader, may at least, afford him a little amusement. It certainly amused us. You have seen the old-fashioned New England Primer. It has been in vogue, I believe, a full century; perhaps nearer two centuries. It has done not a little to give shape to New England character. In its preliminary pages is a sort of alphabet of couplets, with cuts prefixed or annexed. One of the couplets reads thus:-- "Youth forward slips, Death soonest nips." While at its left, is the representation of a skeleton, armed with a dagger, and pursuing a youth--a child rather--with the apparent intention of striking him through. Now I cannot say how this picture may have affected others, but to my medical teacher and myself, as we mutually agreed, it always brings up the idea of striking down a youth or child prematurely, and sending him away to the great congregation of the dead. Nor am I quite sure that this representation, innocent as may have been its intention, has not been the origin of a relentless and cruel superstition. I know certainly, that my own early notions about being struck with death, had, somehow or other, a connection with this picture; and why may it not be so with others? But the _influence_ and _consequences_ of this superstition must be adverted to for a moment. I said they affect and have affected thousands; perhaps I ought to have said millions. Under the confused and preposterously silly idea that Death, the personification of Satan or some other demon, has laid hold of the sick or distressed, and that it would be a sort of useless, not to say sacrilegious, work to oppose, or attempt to oppose, the grim messenger, we sometimes leave our sick friends in the greatest extremity, to suffer and perhaps die, when the gentle touch of a kind hand, a mere drop of water, or a breath of fresh air, might often bring them back again to life and health and happiness and usefulness. If this chapter should not be deemed a confession of medical impotence, it is at least a practical confession of medical selfishness or ignorance. If duly enlightened themselves, medical men ought long ago, to have rid society of this abominable superstition; and if not sufficiently enlightened to perceive its existence and evil tendency, they ought to have abandoned their profession. FOOTNOTES: [C] Dr. Livingstone, in his work of Travels and Researches in Africa, tells us that during his residence among the Backwains, a tribe in the African interior, two persons who had been hastily buried, perhaps "struck with death" in the first place, returned home "to their affrighted relatives." p. 143. CHAPTER XVIII. EFFICACY OF COLD SPRING WATER. An aged man not far from where I was studying, had an attack of dysentery which was long and severe. Whether the fault of its long continuance lay in his own bad habits, or the injudicious use of medicine, or in both, we can inquire to better advantage by and by. I was not, however, very much acquainted with his physician, so as to be able in the premises to form a very correct opinion concerning him. The greatest puzzle with me, at that time, was why he should live so long after the disease appeared to have spent itself, without making any advances. The physician used to call on him day after day, and order tonic medicine of various kinds, all of which was given with great care and exactness. Every thing in fact, seemed to be put in requisition, except what were most needful of all, pure air and water. The former of these was, as is usual in such cases, neglected; the latter was absolutely interdicted. For this last, as not unfrequently happens at this stage of acute diseases, the poor man sighed from day to day as though his heart would break. But, no; he must not have it. The effect on his bowels, he was told, would be unfavorable. And such at that day was the general _theory_. It was not considered that a very small quantity at first, a few drops merely, would be a great relief, and might be borne, till by degrees a larger quantity would be admissible. After repeated efforts, and much begging and crying for a little water to cool his parched tongue, the old gentleman, one night dreamed that he drank from a certain cold spring, which really flowed at a remote corner of his farm and was a great favorite both with him and his whole family, and that it almost immediately restored him. Delighted with his dream, he no sooner fairly awaked than he called up his eldest son and sent him with a bottle, to the spring. He did not now _plead_, he _commanded_. The son returned in due time, with a bottle of water. He returned, it is true, with great fear and trembling, but he could do no less than obey. The demands and commands were peremptory, and the father was almost impatient. "Now, my son," said the father, "bring me a tumbler." It was brought, and the father took it. "Now," said he, "pour some of that water into it." Samuel could do no other way than submit to the lawfully constituted authority, though it was not without the most painful apprehensions with regard to the consequences, and he kindly warned his father of the danger. Nor were his sufferings at all diminished when the father, in a decided tone of voice, ordered him to fill the tumbler about half full. Whether he had at first intended to drink so large a draught and afterwards repented, is not known; but instead of swallowing it all at a draught, the son's distress was greatly mitigated when he saw that he only just tasted it, and then set down the tumbler. In a few minutes he drank a little more, and then after a short time a little more still. He was about half an hour drinking a gill of water. When that was gone, he ordered more; and persisted in this moderate way till morning. By ten o'clock, when his physician arrived, he had drunk nearly a quart of it, and was evidently better. There was a soft, breathy perspiration, as well as more strength. The physician no sooner saw him than he pronounced him better. "What have you been doing?" he said, rather jocosely. The sick man told him the simple story of his rebellion from beginning to end. The doctor at first shook his head, but when he came to reflect on the apparent good consequences which had followed, he only said: "Well, I suppose we must remember the old adage, 'Speak well of a bridge that carries you safe over,'" and then joined in the general cheerfulness. The patient continued to drink his spring water from day to day, and with increasing good effects. It acted almost like a charm; it was not only food and drink to him, but also medicine. Doubtless his great faith in it was not without its efficacy; still it was not to be denied that the water did him great and positive good. He soon found his newly discovered medicine not only more agreeable to his taste, but cheaper also than Huxham's tincture and quassia. He also found that his son's daily visits to the spring cost him less than Dr. Physic's daily rides of three or four miles. So that though he was greatly delighted to see the smiling face, and hear the stories and jolly laugh of the latter, he was glad when he proposed to call less frequently than he had done and to lay aside all medicine. He recovered in a reasonable time, and lived to a very advanced age. A friend of his and mine, found him in his eighty-sixth year, mowing thistles barefooted. Two or three years still later, I found him--it was during the cold month of January, 1852--in the woods with his hired man far from his house, assisting in cutting and loading wood; in which employment he seemed to act with much of the energy and not a little of the activity of his earlier years. I do not of course undertake to say that he owed his recovery from his long sickness, above described solely to drinking cold water, there are so many other circumstances to be taken into the account, in settling all questions like this, that such an assertion would be hazardous, not to say foolish. His fever at the time of making his experiment, had already passed away; and having great tenacity of life, it was but reasonable to expect nature would ere long, rally, if she _could_ rally at all. It is also worthy of remark, that though his physician was one of those men who place their chief reliance on the medicine they give, rather than on the recuperative powers of the system, yet to his credit be it said, he had in this instance departed from his usual routine, and given comparatively little. Perhaps we may explain the phenomenon of his recovery, as follows: nature long oppressed, yet by rest partially restored to her wonted energy, was now ready to rally as soon as she could get the opportunity; this the moderate draughts of water by their effects on the circulation enabled her to do; then, too, one consideration which I forgot to mention in its place, deserves to be noticed. When the sick man began the use of water, he laid aside (without the knowledge of his physician) most of what pills and powders and tinctures were prescribed him. And finally he had great faith in the water, as you have already seen; whereas he had lost all faith in drugging and dosing. And the efficacy of faith is almost sufficient in such cases, to work a cure, were this our only reliance. Of this we shall have an illustration in Chapter LXXVI. But though the water, as I now fully believe--and as I more than half believed when I heard of the facts at the time,--was fairly indicated, there is great hazard, in such circumstances in its use. Had this gentleman taken a large draught at first, or had he swallowed more moderate draughts with great eagerness, and a quick succession, it might have produced an ill effect; it might, even, have provoked a relapse of his dysentery and fever. Many a sick patient in the same circumstances, would have poured the cooling liquid into an enfeebled throat and stomach without the least restraint. And why did not he? I will give you one reason. He was early taught to govern himself. He told me, when eighty-eight years of age, he had made it a rule, all his life long, never to eat enough, but always to leave off his meals with a good appetite. He did not indeed, follow out with exactness the rule of the late Amos Lawrence: "Begin hungry and leave off hungrier," but he came very near it. He managed so as always to have a good appetite, and never in the progress of more than fourscore years, whether by night or day, to lose it. Such a man, if his mind is not too much reduced by long disease, can be safely trusted with cold spring water, even during the more painful and trying circumstances of convalescence from acute disease. Another thing deserves to be mentioned in this connection. He had not kept his bowels and nervous system, all his life long, under the influence of rum, tobacco, opium, coffee, tea, or highly seasoned food. He did not it is true, wholly deny himself any one of these, except opium and tobacco; but he only used them occasionally, and even then in great moderation. Nor was it from mere indigence, or culpable stinginess that he ate and drank, for the most part in a healthful manner. It seemed to be from a conviction of the necessity of being "temperate in all things;" and that such a course as he pursued tended to hardihood. As one evidence of a conviction of this kind, I have known his children and their school teacher to carry to the schoolroom for their dinner, a quantity of cold Indian cake--ycleped Johnny cake--and nothing else; nor was there an attempt at the slightest apology. Such a man would not be very likely to have an ulcerated alimentary canal, or bad blood; or to be injured by swallowing every five minutes a table-spoonful of cold water; no, nor to sink as quickly as other people under the depressing tendency of irritating or poisonous medicine. This last-mentioned fact concerning the use of water,--for it is a fact on which we can rely, and not one of those statements which Dr. Cullen was accustomed to call "false facts,"--was to me exceedingly instructive. It taught me more concerning the human constitution and the laws of health and disease than I had ever before learned from a single case of mere disease, in my whole life; and I endeavored to make a wise use of it--of which as I trust, I shall give some evidence in the very next chapter. CHAPTER XIX. CHEATING THE PHYSICIAN. It was by no means an uncommon thing with me, while studying medicine, to take long walks. One day, in the progress of one of these rambles, I came so near the family mansion of a young man with whom I had formerly been acquainted, that I thought I would, for once, go a little out of my way and make a call on him. And judge, reader, if you can, of my surprise, when I found him exceedingly sick. For residing, as we did, only a few miles apart, why had I not heard of it? Most people, in truth, would have called on some of the young doctors--for there were three or four of us together,--to take care of the sick man, especially by night. Young doctors, I grant--and this for various reasons which might be named, were it needful--are usually the very worst of watchers and nurses of the sick; but the public often appear to think otherwise, and even to prefer them. I found him under the care of an old school physician;--one who, though he otherwise prescribed very well, gave quite too much medicine; and like the old physician mentioned in the preceding chapter, mortally detested cold water; at least he detested its use in bowel complaints. The young man's case, however, was as yet wholly unlike that of the elderly gentleman of the foregoing chapter; and cold water at first, was not particularly needed; nor perhaps quite safe. Some few days afterward, I called again. Found my young friend rather less feverish, but no better; in fact, he was much worse, and was most obviously running down. I continued after this to call on him daily, till he too, like the old man before mentioned, began to beg for cold water. But his physician said, "No, not a drop," and with a good deal of emphasis. One day, while I was at his bedside, he turned to me, and with a most imploring look begged to know whether I believed a very little cold water would really hurt him. I told him no; but that a good deal doubtless would, and might even prove the means of his destruction. "Simple a thing as water is," I said, "it is to you, in circumstances like yours, a sword with two edges. If it should not cut away the disease, it would probably cut in the other direction, to the destruction of your health, if not of your life." My remarks had both awakened his curiosity and increased his desires for the interdicted beverage. I found I had gone too far, and I frankly told him so. I told him it was not in accordance with medical etiquette, nor even with the rules of good breeding, for one medical man to prescribe for another's patient without his knowledge. But this explanation did not satisfy him. Water was what he wanted; and as I had opened the budget and removed some of his fears, water he must have. He was willing, he said, to bear the responsibility. Water, then, in exceedingly small quantity at a time, was permitted; but it was to be given by stealth. The physician was not allowed to know it, or, at all events, he was not to know under whose encouragement he acted. His friends were very careful in regard to the quantity, and I had the happiness of finding him, in a few days, very much better. But, as I said in reflecting on the recovery of my aged friend before mentioned, it is not quite certain, after all, how much was effected by the water, and how much by the recuperative efforts of Nature herself. She might have been long waiting for that opportunity to rally, which the judicious introduction of the water, and the partial or entire discontinuance of other medicine, greatly facilitated. CHAPTER XX. THE MEDICINAL EFFECTS OF STORY TELLING. My aged father sickened about this time, and remained in a low condition many months. I was at a distance so great, and in circumstances so peculiar, that I could not see him often enough to become his medical adviser. Besides, in my then unfledged condition as a disciple of Galen, I should not have regarded myself competent to the discharge of so weighty a responsibility, had I even been at home with him. The result was that he employed his family physician as usual, and went through, as might have been expected, with the whole paraphernalia of a dosing and drugging campaign. Among other troubles, or rather to cap the climax of his troubles, he was exceedingly low-spirited. Confined as he had been to the house almost all winter, and seeing nobody to converse with,--no new faces, I mean,--was it very strange that his mind turned, involuntarily, to his complaints, and preyed upon itself, and that he was evidently approaching the deep vortex of hypochondria? Medicine did him no good, and could do him none. It is true he had, after three months, almost left off its use; but the little to which he still clung was most evidently a source of irritation. My own occasional visits, as I soon found out, did him more good than any thing else. This gave me a needful hint. Near him was an old Revolutionary soldier, full of mirthfulness, and a capital story teller. Unknown to my father, and even to the family, I employed this old soldier to visit my father a certain number of evenings in each week, and tell stories to him. Sergeant K. complied faithfully with the terms of the contract, and was at my father's house three evenings of each week for a long time. This gave the old gentleman something else to think of besides himself, and it was easy to see, did him much good. During the progress of the fourth month his improvement became quite perceptible; and in another month he was nearly recovered. But, as I have repeatedly said of cold water, and indeed of all other remedial efforts or applications, whether external or internal, and whether moral, mental, or physical, too much credit should not be given, at least hastily, to a single thing. The opening spring was in my father's favor, as well as the story telling. The bow, so long retained in an unnatural position, on having an opportunity, sprung back and resumed its wonted condition. Still, I could never help awarding much credit to the Revolutionary soldier. Most persons must have observed the effects which cheerfulness in a medical man has on his patients. The good-natured, jolly doctor, who tells a story now and then, and cracks a joke and has occasionally a hearty laugh _with you_, or _at_ you, about something or nothing, will do you much more good, other things being equal, than the grave, staid, sombre practitioner, who thinks it almost a sin to smile, especially at the sick-bed or in the sick-room. I think story telling, as an art, should be cultivated, were it only for its good effects in sickness. But this is not all. Its prophylactic or preventive tendencies are much more valuable. Few people know how to tell a story of any kind; while others, in some few remarkable instances, such as I could name, will make a story of almost any thing, and bring it to bear upon the precise point or end they wish to accomplish. It is yet, in reality, a mooted point, which could make the deepest, or at least most abiding, impression, Daniel Webster by a Congressional oration, or Jacob Abbott by a simple story. If this is an indirect or incautious confession of medical imperfection or impotence, let me say as Patrick Henry once did, in Revolutionary days, "then make the most of it." While on this topic of story telling, I must not forget to allude to its moral effects. Lorenzo Dow, the eccentric preacher, is not the only pulpit occupant who has acquired the art of "clinching the nail," in his discourses by a well told story. It was quite a habit, in former times, with certain preachers of certain denominations of Christians, whose sermons were chiefly unwritten, to tell stories occasionally. And I appeal to Father Waldo, late chaplain in the United States Senate, to see whether the effects of these discourses were not as deep and as lasting, to say the least, as many of our modern sermons, which, while they smell much more of the lamp, fall almost lifeless upon the sleepy ears of thousands of those whom Whitfield by his more practical course would have converted. CHAPTER XXI OSSIFIED VEINS. While I was studying medicine with my new or second master, I had several excellent opportunities for studying health and disease through the medium of the doctor's patients. One of them was a swaggering man of wealth, about sixty-three years of age. He had long lived very highly, had eaten a good deal of roast beef, and drunk a good deal of wine, and had almost swum in cider. He was in short, one of that class of men who "go off" in very many instances, at the grand climacterical period, some of them very suddenly. "Doctor," said the general, exhibiting himself in full size and the boldest relief, "I want to be bled."--"What do you want bleeding for?" said the doctor. "Oh," said he, "bleed me, and you will see. You will find my blood in a very bad state."--"Your blood, general, was always in a very bad state," said the shrewd son of Galen, with a sardonic grin. "None of your fun, doctor," was the prompt reply; "I must be bled. I have headache and giddiness half the time, and must have some blood taken."--"Very well," said Dr. S. "It shall be as you desire. Here, my son, bring me a bowl." An older student assisted, while I, glad of the privilege, kept aloof, and at a distance. The general's brawny arm was mauled a long time; and even then not much blood was obtained. At last the attempt was given up, and the man returned home, though not, as might have been expected, very well satisfied. When he was gone, I inquired of Dr. S., as modestly as I could, what serious difficulties he had to encounter in his attack on Gen. Upham's arm. "Why was it," said I, "that you could get no more blood?" "For the plainest reason in the world," he answered; "his veins were all ossified." I was quite satisfied at the time, with this answer; for I knew so well the habits of Gen. U. that I stood ready to believe almost any thing in regard to him, especially when it came from a highly respectable source. Yet I have often suspected since that time, that there was a serious mistake made. Ossified or bony arteries, even at this great distance from the heart, in such a man, ought not to excite surprise; but these would hardly be met with in attempting to open a vein, since the arteries are much more deeply imbedded in the flesh than the veins are. And as for ossified veins themselves, especially in the arm, they are seldom if ever heard of. You may wonder why I did not satisfy my curiosity at the time, by making diligent inquiry at the proper source of information; and I almost wonder too. But, in the first place, my curiosity did not rise so high on any occasion whatever, as it has since done. For, though I was hungering and thirsting for knowledge thirty years ago, my solicitude to know has so increased with increasing years that my present curiosity will admit of no comparison with the former. Secondly, I was exceedingly diffident. Thirdly, my mind was just then fully occupied with other things. And lastly, whenever I was in the company of Dr. S., both while I remained in the office and subsequently, it was only for a very short time, perhaps a single half hour, at best; and we had always so many other things to talk about, that Gen. U. and his _ossified veins_ never entered our minds. However, it was not many years afterward that I heard of the old general's death. Of the manner of his exit except that it was sudden, I never heard a word, up to this hour. It is by no means improbable that there was ossification about his heart, for he was a very fit subject for ossification of any parts that could be ossified. I do not know, indeed, that a post mortem examination was ever made; the family would doubtless have opposed it. The uses of the dead to the living are in general very little thought of. Such cases of disease are, however, a terrible warning to those who are following in the path of Gen. Upham. They may or may not come to just such an end as he did, but of one thing we may be well assured; viz., that the wicked do not live out half their days, or, in other words, that sins against the body, even though committed in ignorance, can never wholly escape the heaven-appointed penalty of transgression. "The soul that sins must die." For no physical infraction of God's holy, physical laws, do we know of any atonement. We may indeed, be thankful if we find one in the moral world or anywhere else. CHAPTER XXII. HE'LL DIE IN THIRTY SIX HOURS. In the autumn of 1824, while a severe sickness was sweeping over one or two towns adjacent to that in which I resided, and considerable apprehension was felt lest the disease should reach us, the wife and child of my medical teacher, and myself, suddenly sickened in a manner not greatly dissimilar, and all of us suffered most severely. It was perfectly natural, in those circumstances, to suspect, as a cause of our sickness, the prevailing epidemic. And yet the symptoms were so unlike those of that disease, that all suspicions of this sort were soon abandoned. Besides, no other persons but ourselves, for many miles around, had any thing of the kind, either about that time or immediately afterward. I have said that the symptoms of disease in all three of us were not dissimilar. There was much congestion of the lungs and some hemorrhage from their organs, and occasionally slight cough, and in the end considerable tendency to inflammation of the brain. The last symptom, however, may have been induced at least, in part, by the large amount of active medicine we took. When the news of my own sickness reached my near relatives who resided only a few miles distant, they were anxious to pay such attention to me as the nature of the case appeared to require. But they soon tired; and it was found needful to employ an aged and experienced nurse to take the general charge, and under the direction of the physician, assume the entire responsibility of the case. This nurse was one of those conceited people whose aid, after all, is worth very little. He was as far from affording the kind of assistance I required as could possibly be. And yet his intentions were in the main excellent. The selection of physician was equally unfortunate. My teacher had nearly as much as he could do to take care of his wife and child. At his request, and in accordance with the wishes of my friends, their and my former physician were called in. When the danger became more imminent, a third was occasionally consulted. It was supposed, no doubt, that in the midst of counsellors there was safety. The counsels of our third man, or umpire, may have had influence; but his manners were coarse, and in many respects objectionable. He was in favor, also, of a highly stimulating treatment, which appeared to me to add fuel to the flame, for I soon began to be at a loss when called upon to recollect things and circumstances. He saw the tendency, and, partly by way of "showing off" his powers of diagnosis, as well as in part to gain applause should a case so desperate turn out favorably, said, in the hearing of my nurse, "He'll die in just thirty-six hours." Now, whatever his intentions were, and however honest his declaration, my nurse swallowed it at once, and was restless till he had an opportunity to divulge what he regarded as an important secret. It is by no means improbable that he entertained the usual impressions that a special preparation should be made for death, and that it was needful I should know my danger and attend to the subject before it was too late. In one of my most lucid intervals, therefore, he said to me, "Do you expect to recover from your disease?"--"Most certainly I do," was the reply. "Do you know what Dr. Thornton thinks about it?"--"Not certainly; but from his cheerful manner, I suppose he thinks favorably."--"Do you think you could bear to know the truth? For if it was unfavorable, would it not be too much for you in your enfeebled condition?" My heart was in my mouth, as the saying is, at this broad hint; and with a strong and earnest curiosity, I begged to know the worst, and to know it immediately. My attendant saw, in my agitation, his error, and would doubtless have receded had it been in his power; but it was too late; the die was cast; my curiosity was all on tiptoe, and I trembled, as a sailor would say, from stem to stern. "Well," said he, at length, putting on a face which of itself was enough to destroy some very feeble persons, "he says you cannot live more than thirty-six hours." My friend, in divulging what he deemed an important secret, doubtless felt relieved; but not so with me. My philosophy had disappeared with the progress of my disease, and I was now, in mind, a mere child. In short, I was so much agitated by the unexpected intelligence, that I sank at once under it, and remained in this condition for several hours. When I awoke from this delirium, the symptoms of my disease were more favorable, and from that day forth I began to recover. But the risk was too great for my enfeebled and diseased frame, and should not have been incurred. Dr. Thornton, though a physician of much reputation, was nevertheless a man of very little principle, and though respected for his medical tact and skill, was beloved by very few. He died, moreover, not many years afterward, as the fool dieth; viz., by suicidal hands. Nor do I know that as a man--a mere citizen--he had many mourners. The reader will pardon me, perhaps, for saying so many times, and with so much emphasis, that "it is an ill wind that blows nobody any good." But I must be allowed to repeat the saying here, and to observe that while I entirely disapprove of the course my attendant took in the present instance, I am by no means sure that the delirium into which I was thrown by his tattling propensity was not safer for me than a restless apprehension of danger would have been, especially when long continued; nor that it did not contribute, indirectly, to bring about my recovery. I was confined to the house by my sickness about five or six weeks, or till it was midwinter. And yet, all covered as the earth was when I first ventured forth, no Paradise could ever appear more beautiful to any son or daughter of Adam than did this terrestrial abode to me. And if ever I shed tears of devout gratitude to my Father in Heaven, it was on this very occasion. It was a long time, however, after I got out of doors, before I was strong enough, in body or mind, to attempt to perform much labor. At the time of being taken sick, I was teaching a public school; and as soon as I began to be convalescent my patrons began to be clamorous about the school. They were hardly willing to wait till my physicians and myself deemed it safe to make a beginning. Indeed, notwithstanding all my caution, I was hurried into the pedagogic chair quite too soon. But it is time for me to inform my readers what were the probable causes of my sickness; for I have already said, more than once, that to be able to do this is a matter of very great importance, both as it concerns ourselves and others; and it is a thing which can be done, at least to a considerable extent, whenever parents and teachers shall be wise enough to put their children and pupils upon the right track. I am well acquainted with a minister of the gospel, now nearly sixty years of age, who says he never had any thing ail him in his whole lifetime of which he could not trace out the cause. For some months before my sickness I had been curtailing my hours of sleep. I had resolved to retire at eleven and rise at four. But it had often happened that instead of retiring at exactly eleven and rising exactly at four, I had not gone to bed till nearly twelve, and had risen as early as half-past three. So that instead of sleeping five full hours, as had been my original intention, I had often slept but about four. How far this abridgment of my sleep had fallen in with other causes of debility, and thus prepared the way for severe, active disease, I cannot say. I was at this time tasking my energies very severely, for I was not only pursuing my professional studies with a good deal of earnestness, but at the same time, as has been already intimated, teaching a large and somewhat unmanageable district school. If ever a good supply of sleep is needful, whatever the quantum required may really be, I am sure it is in such circumstances. But then it should be remembered, in abatement of all this, that the symptoms of disease, in all the three cases which I have alluded to, as occurring in the family with which I was connected, were very much alike; whereas neither the mother nor the child had suffered, prior to the sickness, for want of sleep. Must we not, therefore, look for some other cause? Or if it is to be admitted that sleeplessness is exceedingly debilitating in its tendencies, must there not have been in addition some exciting cause still more striking? We will see. During the latter part of the autumn which preceded our sickness, the water of the well from which we were drinking daily had a very unpleasant odor, and a fellow student and myself often spoke of it. As it appeared to give offence, however, we gradually left off our remarks and complaints about the water, and only abstained, as much as we could conveniently, from its use. In the progress of the autumn, the well became nearly dry, and the offensive odor having become troublesome to others no less than to ourselves, it was very wisely concluded to draw out the water to the bottom, and thus find and remove the impurities. The task was exceedingly trying, but was at length accomplished. Besides other impurities, there were found at the bottom of the well, several toads in a state of putrefaction, and so very offensive that it was difficult to approach them, or even to approach the top of the well that contained them. They were of course removed as soon as possible, and every practicable measure was adopted which was favorable to cleanliness. This final clearing of the well was about two months before the sickness commenced. Now whether there was a connection between the use of this water and the sickness which followed, is a curious, and at the same time, a very important question. Against this belief, at least apparently so, is the fact that our disease resembled in no trifling degree, the prevailing disease in certain neighboring towns. Another fact is also worthy of consideration. The rest of the family drank freely of the water, why did not they sicken as well as we? But as a deduction from the force of these facts, it is to be observed that nobody else around us for several miles had the prevailing epidemic unless it was ourselves. And then as to the objection that only a part of the family sickened, it is to be recollected that in the case of some of them who sickened there might have been, nay, probably were, other debilitating causes in operation previously, to prepare the way; such as, for example, in my own case, the want of sufficient sleep. Thus far, then, though we arrive at nothing positive, we yet find our suspicions of a poisonous influence emanating from the putrid reptiles remaining. Indeed, it were impossible wholly to suppress them, and I will ask the candid reader's attention for a few moments to certain analogical evidence in the case, which, it is believed, will greatly aid the mind in coming to a right decision on the subject. An eruptive disease broke out in two families residing in a house in Eastern Massachusetts, a few years ago, which was observed to affect more or less, every member of the two families who had drunk water from the common family well, except two; and these last had drank but very little. On cleaning the well, the same species of reptiles which I have already mentioned, were found in it, in a state of decomposition, and highly offensive. No eruptive complaints of the same general kind prevailed at the time in the neighborhood, and those which I have mentioned disappeared soon after resuming the use of pure water. Another instance occurred in this same region, a few years afterward. In the latter case, however, the putrid animals were rats and mice, and the eruption, instead of having a diffused or miliary appearance, partook largely of the character of the common boil. Forty years ago a sickness broke out in Litchfield county in Connecticut, in a neighborhood where the wells were all very low; and the water which remained being in a cavity of rock, and continuing unchanged or nearly so, had at length become putrid. It was late in the autumn when the disease broke out, and it disappeared as soon as the wells were duly filled for the winter. It is true, I never heard in the latter case, any thing about putrid animals, but their existence and presence under such circumstances, would be natural enough. It has, I know, been sometimes said that putrid animal substances, however unpleasant their odor might be, were not poisonous. But this opinion is doubtless unfounded; and, for myself, I find it difficult to resist the belief that in all the foregoing cases, except the last, and very possibly in that too, animal putridity had influence. The practical lessons to be derived from the developments of the foregoing chapter are exceedingly numerous. I shall direct your attention for a few moments, to some of the more important. First, we learn the necessity of keeping our wells in a proper condition. Could it be even proved that dead reptiles never produce disease, it is at least highly desirable to avoid them. No reasonable person would be willing to drink water highly impregnated with their odor, even if it did not reach his own seat of sensation. Secondly, we should avoid the use of stagnant water, even though it should be free from animal impurities. Especially should we be cautious where there is a liability, or even a possibility, to impurity and stagnation both. Either of these causes may, as it is most fully believed, produce disease; but if so, what is not to be expected from a combination of the two? Our wells should be often cleaned. It is not possible, of course, to say with exactness, how often, but we shall hardly err in the line of excess. Very few wells are cleaned too often. Once a year, in ordinary cases, cannot be too much; nor am I quite sure that twice would be useless. It seems to me quite possible to exclude animals from our wells, would we but take the necessary pains; and this, too, without covering them closely at the top. I can not see how any toad, unless it be the tree-toad so called, could climb a well-curb three feet high. Other animals, however, might do so, and therefore I would keep a well as closely covered as possible. Many, I know, believe it desirable that the surface of the water in a well should be exposed to the air. I do not believe there is any necessity for this, though it is certainly desirable to avoid stagnation of the air at the bottom. Motion is essential, I might even say indispensable. I have sometimes thought the modern endless or chain pump as perfect a fixture as any other. Thirdly, we may learn from the details of the foregoing chapter, the necessity of having in our sick-chambers the right sort of nurses or attendants. There should be a class of persons educated to this service, as a profession; and most happily for the prospects of the great human family, such efforts are now being made; it is hoped and believed they will be crowned with success. One thing more may, as I think, be inferred from the story of my sickness as above:--the folly of multiplying physicians. In the present case, when the physician's own family was in a condition to demand a large share of his attention, if not to absorb all his energies, it may have been desirable to call in an additional medical man as counsellor. But the multiplication of counsel, besides adding to the danger of too much dosing and drugging, brings with it a host of ills too numerous to be mentioned in this place, and should be studiously avoided. My full belief is, that Dr. Thornton was a principal agent in creating the dangers he deprecated, and which came so near effecting my own destruction. CHAPTER XXIII. ABOUT TO DIE OF CONSUMPTION. I have already mentioned more than once,--or at least done so by implication,--that I hold my existence, on this earth by a very feeble tenure. Consumption, by right of inheritance, made very early claims; and its demands, as I approached manhood, became more and more cogent, in consequence of measles, dropsy, Lee's Pills, and the injudicious use of medicine and many other errors. My employment, too, as school teacher had been far enough from favorable to health. While thus engaged from winter to winter, and sometimes from year to year; I was accustomed to have cold upon cold, till at length especially towards the close of winter and at the opening of the spring, I was often apparently on the verge of a rapid decline. A ramble up and down the country, with a summer or part of a summer on the farm or garden, did indeed for a time partially set me up again, so that I could return to my favorite employment of teaching in the autumn and during the winter; and thus time with me went on. A course of medical lectures which I heard in 1825-6, left me, in March, 1826, in about as bad a state of health as school keeping usually had done. However I was too indigent, I might even say too destitute, to be idle. Scarcely was my license to practise medicine and surgery fairly in my pocket, than I found myself turning towards the district school again. Yet I did not continue it many weeks before my old enemy returned upon me with renewed strength; till I was at length compelled to abandon the school entirely. I had as much as I could do, in attempting to keep up a successful war with cough, night-sweats, purulent expectoration, and hectic fever. This was one of the darkest periods of my life. Destitute of money, and even somewhat in debt, yet too proud or self-relying to be willing to ask my friends to aid me; my hopes of usefulness defeated in two favorite fields of activity, teaching and medicine; and practically given up to linger out a year or two and then die, how could I avoid discouragement? Was it strange even, if I approached at times, the very borders of despair? For some time prior to this crisis--indeed at certain seasons all my life long,--I relied not a little on medicine, in various forms, especially in the shape of tonics. Strange that I should have done thus, when my general impressions were so unfavorable to its exhibition; and yet such inconsistencies have been, and may be again. Huxham's tincture, quassia, ale, and other bitter infusions and tinctures, had been successively invoked, and I still clung to ale. I also used some wine, and I attached a good deal of importance to a stimulating diet. But it was all to no purpose, the disease was marching on steadily, and appeared destined to triumph; and that, too, at no very distant period. In these circumstances, I repeat, what could be done? Nature's extremity is sometimes said to be God's opportunity. But without assuming that there was any special providence about it, I will say, that I was driven to desperation, nay almost to insanity or madness. I deemed myself on the very verge of a mighty precipice, beneath which yawned a gulf unfathomable. I must make a last mighty struggle, or perish irretrievably and forever. It was July 4th, the anniversary of American Independence; I sought and found a few moments of calm reflection, and began to interrogate myself. Why was I so dependent on the physician and the apothecary's shop, and so tremblingly alive to every external impression of atmospheric temperature, or purity? Why must I, at the early age of twenty-eight, be doomed to tread the long road of decline and death? Why can I not declare independence of all external remedial agents, and throw myself wholly on nature and nature's God? I know, full well, the laws of my being. If trust in these, and faithful and persevering obedience will not save me, nothing will. Thus I mused; but alas! it was to muse only. Though almost ready to take the critical step,--I will not say make the desperate plunge,--the fourth of July finally passed away, and found me still lingering, to use a Scripture expression, "between the porch and the altar." July the fifth at length arrived. And is it all over? I said to myself. Has the "glorious" _Fourth_ gone by and I have not acted up to the dignity of a well-formed and glorious resolution? Must I, alas! now go on to woe irretrievable? Must I go down to the consumptive's grave? Must I perish at less than thirty years of age, and thus make good the declaration that the wicked shall not live out half his days? A new thought came to me. "One of the South American provinces celebrated her Independence to day, the fifth. I will take the hint,--I will yet be free. I will escape from present circumstances. I will fly from my native home, and all that pertains to it. I will fly from myself,--It is done," I added, "and I go with the first conveyance." I could indeed walk a little distance, but it either set me to coughing, severely, or else threw me into a profuse perspiration which was equally exhausting. One favorable symptom alone remained, a good appetite and tolerable digestion. Had there been, in addition to the long train of troublesome and dangerous symptoms above mentioned, a loss of digestive power and energy, with colliquative diarrhoea, my hopes must have been forever abandoned. But I had made my resolution, and was prepared to execute it, let the consequences be what they might. With little more than a single change of clothing, I contrived to find a conveyance before night, quite beyond my immediate neighborhood. Fatigued, at length I stopped, and without much delay, committed myself to the friendship of Morpheus. On the top of a considerable eminence, in the very midst of a mountain range, one of the most delightful in all New England, only a few miles from the place of my lodging, was a tower some sixty or seventy feet high, which commanded a view of the surrounding country. I had often wished to enjoy the prospect which this tower afforded. Was there, now an opportunity? I had the leisure, had I the needful strength? Could I possibly reach it? And by what means? I rested for the remainder of the day and the night following, at the foot of the eminence, in order to prepare myself for the excursion of the following morning. It was as much as I could do, that night to take care of my irritable and irritated lungs. At length, however, I slept, and was refreshed. The only drawback upon my full renewal, was my usual night--or rather as I ought to say morning--perspiration, which was quite drenching and exhausting; though not much worse after all my fears than usual. God is good, I said to myself, when I saw from my chamber window the top of the hills I wished to climb, and perceived that the first rays of the morning sun were already falling upon them. By the middle of the forenoon I was at the foot of the mountain, and prepared to ascend it. After a little rest, I wound my way to the tower, and finally to its top, when I took a survey of what seemed to me like a new world. Here I renewed my declaration of independence with regard to those earthly props on which I had so long been wont to lean, and of dependence on God, and on his natural and moral enactments. Here, too, I formed my programme for the day and for the week. Distant from the point which I occupied not more than eight miles was a most interesting educational institution I had long wished to see; and near it was an old acquaintance, with, whom I might perhaps spend the Sabbath, which was now approaching. Could I carry out my plan? Had I the needful strength? My resolution was at length made; and no sooner made than begun to be executed. The public houses on the way were miserable things; but they were better far than none. They gave me a temporary home, such as it was. I reached the institution, had a partial view of it, and, half worn out with my week's labor, was glad to rest the seventh day, "according to the commandment," in the house of an old acquaintance. Monday morning came, and with the aid of the intervening Sabbath, brought to my attenuated and almost sinking frame a new recruit of strength. With a new object of interest some fifteen miles distant, I was once more on the road. I could now walk several miles a day without greatly increasing my cough, or ride in a stage coach many miles. Nor was the nightly perspiration, nor even that which was induced by exercise, any more distressing than it had been, if indeed it was as much so. In due time I reached my point of destination, and curiosity became fully gratified. What next? A few miles distant was a high mountain which I greatly desired to climb. I reached its base; but the heat was great, so dog-days like, that my courage failed me. I had the necessary strength, but dared not use it for such a purpose. Perhaps I acted wisely. Twelve miles in the distance still was my father's house, now grown from a few patrimonial acres to full New England size; viz., a hundred acres or more, and well cultivated. My wandering abroad had given me a little strength and very much courage. Why should it not? Was it not truly encouraging that while I was making a long excursion, chiefly on foot, in the heats of midsummer, my cough and hectic and night sweats should become no worse, while my muscular strength had very much increased? My mind's eye turned towards my father's house as a place of refuge. In a day or two I was in it; and in another day or two I was caparisoned as a laborer, and in the field. It is true that I did not at first accomplish a great deal; but I held the implements of husbandry in my hands, and spent a certain number of hours every day in attempting to work. Some of the workmen laughed about me, and spoke of the vast benefits to be derived from having a ghost in the field with them; but I held on in spite of their jokes. I had been accustomed of old to the labor of a farm, which greatly facilitated my efforts. Habit is powerful. Not many weeks passed ere I was able to perform half a day's work or more in a day. My consumptive tendencies, moreover, were far less exhausting and trying. In a word, I was better. The Rubicon was already passed. I did not, indeed, expect to get entirely well, for this would have been a hope too big for me. But I should not die, I thought, immediately. Drowning men, as you know, catch at straws; and this is a wise arrangement, for otherwise they would not often be saved by planks. One point, at least, I had gained. I was emancipated from slavery to external forms, especially medicated forms. But I had not only declared and found myself able to maintain independence of medicine, but I had acquired much confidence in nature and nature's laws. And this faith in the recuperative powers of nature was worth more to me than worlds would have been without it. Much was said, in those days, not only in books but by certain learned professors, about shaking off pulmonary consumption on horseback. Whether, indeed, this had often been done--for it is not easy, in the case of a joint application of various restorative agencies, such as air, light, full mental occupation etc., to give to each agency its just due--I am not quite prepared to say. But as soon as I was able to ride on horseback several miles a day, the question was agitated whether it was or was not advisable. In prosecuting this inquiry, another question came up. How would it do, thought I, to commence at once the practice of medicine? But difficulties almost innumerable--some of them apparently insurmountable--lay in my way. Among the rest, I had no confidence in my medical knowledge or tact; I was a better school-master. But teaching, as I had every reason to fear, would bring me down again, and I could not think of that: whereas the practice of medicine, on horseback, which at that time and in that region was not wholly out of date, might, as I thought, prove quite congenial. Besides being "fearful and unbelieving" in the matter, I was still in the depths of poverty. I had not even five dollars. In fact, during my excursion already described, I had lived on a few ounces of solid food and a little milk or ale each day, in order to eke out my almost exhausted finances; though, by the way, I do not know but I owed my partial final recovery in no small degree to this very starvation system. However, to become a practising physician, money would be indispensable, more or less. What could be done without it? My father had credit, and could raise money for me; but _would_ he? He had never wholly approved of my medical tendencies and course; and would it be right to ask him to aid me in an undertaking which he could not conscientiously approve? Just at this time our own family physician wanted to sell, and offered me his stand. His practice, he said, was worth a thousand dollars a year. He had an old dilapidated house and a couple of acres of miserable land, and a horse. These, he said, he would sell to me for so much. I might ride with him as a kind of apprentice or journeyman for six months, at the expiration of which time he would vacate the field wholly. The house, land, and horse were worth perhaps one-third the sum demanded, but probably not more. However, the price with me, made very little difference. One sum was much the same with another. For I was so anxious to live, that I was willing to pay almost any price which might be required by a reasonable man, and till that time, it had not entered my heart that a good man would take any serious advantage of a fellow being in circumstances so desperate. And then I was not only anxious to live, but very confident I should live. So strong was my determination to live on, and so confident was I in the belief that I should do so, that I was willing to incur a debt, which at any other period of my life would have discouraged me. There was another thing that tended to revive me and restore my courage. The more I thought of commencing business, and talked about living, the more I found my strength increasing. That talking about dying had a downward or down-hill tendency, I had long known; but that the tendency of talking up-hill was exactly the reverse, I had not fully and clearly understood. My father tried to dissuade me from a hasty decision, but it was to no purpose. To me, it seemed that the course I had proposed was my only alternative. "I must do it," I said to myself, "or die;" and life to me, as well as to others, was sweet. But although it was a course to which I seemed shut up, and which I must pursue or die, it was a step which I could not take unaided. I had not the pecuniary ability to purchase so much as a horse, or, had I needed one, hardly a good dog. It was at length proposed by my medical friend, the seller, to accept of a long credit for the amount due for the place and appurtenances, provided, however, I would get my father or some other good man to be my endorser. But here was a difficulty almost or quite insurmountable. My father had always said he would endorse for nobody. And as for asking any one else to endorse for me, I dared not. But I cannot dwell at this point. My father at length became my endorser, and the bargain was signed and sealed. It was indeed, a desperate effort, and I have a thousand times wondered how I could have ventured. Why! only one or two years before, I was miserable for several days because I was in debt to the extent of only two dollars for a much-needed article, and actually procured the money with considerable difficulty, and went and paid the debt to get rid of my anguish; whereas now, without much pain and without being worth fifty dollars in the world, I could be willing to contract a debt of from twelve to fifteen hundred dollars, and involve my good old father in the consequences besides. How entirely unaccountable! But mankind love life, and fear death. The scheme proposed was, as I believed, not only a dernier but a needful resort. It was a wrong step no doubt, but I did not then think so. I believed the end "sanctified" or at least sanctioned the means. How could I have done so? "What ardently we wish, we soon believe." I had most ardently wished, I now began to believe! My consumptive tendencies now receded apace, even before I was astride of my horse. The stimulus of the hope of life with a forgetfulness of myself, were better tonics than Huxham or ale or rich food. There was the expectation of living, and consequently the beginning of life. Mind has great power over even inert matter; how much more over the living animated machine! CHAPTER XXIV. MY JOURNEYMANSHIP IN MEDICINE. Journeymen in medicine, though without the full responsibilities of the profession, have yet their difficulties. I had mine; and I had not only the ordinary complement of ordinary men, but some which were a little extra. For example, I was no horseman at all, and people around me knew it. At the first attempt to mount a new horse, and ride out with the old physician, of whom I had purchased my stand, to see his patients, I made an exhibition of my horsemanship which I shall not soon forget, and which I am sure certain wags and half-buffoons and common loungers who witnessed the scene _never_ will. My horse stood at the post all caparisoned, while I made ready. In setting off, I knew well I must submit to the ordeal of being gazed at and commented on by a crowd assembled in an adjoining store. It was a rainy day, and the crowd would doubtless be much larger than usual. Now my love of approbation was excessive; so great as at times to defeat entirely its object. So in truth, it proved on the present occasion. When I was ready to go forth on my journey, I mounted my horse and attempted to place my right foot in the stirrup. At this critical instant the gaping multitude in the grocery, presented themselves in quite a formidable column at the door to see the young doctor on his new horse. Their appearance threw my mind off its balance to an extent that prevented me from well-balancing my body, and with every possible exertion I could not get my feet firmly fixed in the stirrups. To add to my trouble, my horse was in haste and trotted off high and hard before I could muster presence of mind enough to check him. I rolled this way and that, till at length, down I came headlong. My hat went one way, and my whip another. A great shout was at once raised by the spectators, but being cured by this time, of my excessive diffidence, and not at all hurt, I could soon join in the laugh with the rest. I could most heartily adopt my old maxim, "It is an ill wind that blows nobody any good;" and I had learned by my fall at least, one thing, at least for the moment; viz., my excessive regard to human approbation. Thenceforward, I rode as I pleased. But before I enter upon the details and particular confessions of my professional career, it is needful that I should say something of those changes which were made about this time in my physical habits, by means of which I gained at least a temporary victory over my great enemy, the consumption. For it must not be supposed that because I could sit on a horse and ride six, eight, ten, or twelve miles a day, or work in the field or garden half the day, I was out of danger. I had, indeed, gained important victories, but there remained very much land yet to be possessed. Of my abandonment of all medicine, I have already told you. But I had also greatly changed my dietetic habits. During my excursion of the fifth of July, and subsequently, I had lived almost wholly on what might have been denominated the starvation system. The case was this: I started with less than five dollars in my pocket, and with too much pride to borrow more. That my money might hold out, therefore, though I took care to secure a good, clean bed by nights, even at the full market price (except when I was entertained occasionally, by particular friends), I almost went without food. Many a time was I satisfied, because I was determined to have it so, with a tumbler of milk and a couple of crackers for my breakfast, or even my dinner; and as for supper, I often dispensed with it wholly; and all this too, strange though it may seem, not only without the loss of strength, but with a slow, yet steady, increase. These dietetic changes, though they were a necessity, were continued and extended from principle. I had known, for a long time, what the laws of digestion, respiration, circulation, cleanliness, exercise, etc., were, but had not fully obeyed them. But I now set myself obeying them up to the full extent of my knowledge. I do not mean to affirm that my obedience was perfect and entire--wanting in nothing; but only that I made an attempt at sinless perfection. However, I speak here, of course, of the physical code; for to moral obligation, at that time, I do not mean, now, to refer. My diet was exceedingly plain and comparatively unstimulating. It consisted chiefly of bread, fruits, potatoes; and, once a day of salted meats. These last should have been exchanged for those which were not pickled, and which are of course less stimulating; but at that time I was not fully aware of their tone and tendency. My drink was water and a little tea; for cider I had long before abandoned. I paid particular attention to purity of air, and to temperance. Fortunately I resided in a house which from age and decrepitude, pretty effectually ventilated itself. But temperature, as I well knew, must be carefully attended to, particularly by consumptive people. While they avoid permanent chilliness, and even at times, the inhalation of very cold air on the one hand, it is quite indispensable that they should breathe habitually as cool an air as possible, and yet not be permanently chilly. This, by means of a proper dress, by night and by day, and proper fixtures for heating my room, I contrived to secure. Cleanliness, too, by dint of frequent bathing, received its full share of my attention. It was a rule from which I seldom if ever departed, to wet my body daily with cold water, and follow it up by friction. At home or abroad, wherever I could get a bowl of water I would have a hand bath. Need I say here that a medical man--one who rode daily on horseback--paid a proper regard to the laws of exercise? And yet I am well persuaded that not a few medical men exercise far too little. Riding on horseback, though it may sometimes shake off consumption, is not so good an exercise for the mass of mankind--perhaps not even for consumptive people themselves--as an alternation of walking with the riding. This, also, I took good care to secure. Physicians are usually either very greatly addicted to the habit of dosing and drugging for every little ill, real or imaginary, or particularly hostile to it. I have seldom found any such thing as a golden mean in this respect, among them. My feelings, saying nothing at present of the sober convictions of my head, led me almost to the extreme of no medicine, if extreme it can be called. I did not even retain my daily tumbler of ale. Though I began my medical career as an apprentice or journeyman, merely, and went abroad chiefly as the associate of my predecessor, I was soon called upon in his absence, and in other circumstances, to take the whole charge of patients; or at least to do so till a longer experience was available. Thus I was gradually inducted into an important office, without incurring a full and proportionate share of its responsibilities. CHAPTER XXV. MY TEMPERANCE PLEDGE. The subject of Temperance, in its present associated forms, had, at this time, just began to be agitated. At least, it had just begun to receive attention in the newspapers which I was accustomed to see. It could not be otherwise than that I should be deeply interested in its discussion. I had been brought up, as I have before intimated, to a pretty free use of cider and tea; but not of ardent spirits or coffee. Neither of these was regularly used in my father's family; though both occasionally were. But I had abandoned cider long before this time, because I found it had a tendency to produce, or at least to aggravate, those eruptive diseases to which I was greatly liable. Temperance, then, in the popular sense of the term, was, to me, an easy virtue. And yet as a temperance man--in the circle of my acquaintance--I stood nearly alone. No individual around me was ready to take the ground I occupied. Of this, however, I was not fully apprised, till a patient attempt to recruit the temperance ranks convinced me of the fact. But I will give you a full account of my enterprise, since it has a bearing on my subsequent history and confessions. With the aid of a Boston paper which I habitually read, I drew up the customary preamble, declaration, and pledge of a temperance society. It involved the great idea of total abstinence from spirituous liquors; though by the term spirituous liquors, as used at that day, was meant chiefly _distilled_ spirits. Having first affixed my own name to the paper I went to the most influential of my patrons and friends and asked them to sign it likewise. But, reader,--will you believe it?--not a single subscriber could I obtain far, or near. They all, with one consent, made excuse. The elder deacon of the most evangelical church in the place where I resided, had for his apology that he suffered seriously from a complaint for which his physicians had prescribed the daily use of gin, "Now," said he, "though there is nothing in the pledge which goes to prohibit the use of spirits in a case like my own, yet as some might think otherwise and charge me with inconsistency, I must on the whole be excused from signing it." His son, who was also a deacon in the same church with the father, excused himself by saying he was young, and without influence, and it would be far better for the old people to put their names down first. "Perhaps," said he, "I may conclude to sign the paper by-and-by. I will consider well the matter, and if I conclude to sign it, I will let you know." Other leading men in the church as well as in the town affairs, refused to sign the pledge, because Deacon H. and son would not. It belonged to the deacons in the church, they said, to take the lead in all good things, and not to them. When _they_ had put _their_ names to the document, others would not long hesitate to follow. In short nobody would consent to sign the paper, and it remains to this day, just as it was when I drew it up; and it is now more than thirty years old. There it is, with my name attached to it, as large as life. I have been President, Vice President, Treasurer, Secretary, and "all hands too," of my would-be Temperance Society, from that day to this. I doubt whether many societies can be found which in thirty years have made so little change as the one under consideration. For about four years from the time of getting up the above-named temperance society, strange as the assertion may seem, I retained the right to use a little beer and a good deal of coffee. But in May, 1830, I abandoned all drinks but water, to which custom I have ever since adhered and in which I shall probably die. CHAPTER XXVI. TRIALS OF A YOUNG PHYSICIAN. The poet Cowper, in his delineations of a candidate for the pulpit, prescribes, as one needful condition or qualification, "That he is honest in the sacred cause." So, when I entered upon the medical profession, which I regarded as next of kin to sacred, I deemed honesty quite a high recommendation; and whatever in the abstract appeared to me to be right, I endeavored to pursue through the routine of every-day life. Alas, that I should ever have had occasion to doubt the policy of common honesty! I was called to see Mrs. ----. The case was an urgent one. There was no time for deliberation or consultation. I understood her case but very poorly; yet I knew that in order to success I must at least _seem_ to be wise. Besides, what was to be done must be done quickly; so I boldly prescribed. My prescription was entirely successful, and I left the house with flying colors. I left, moreover, with the full consciousness of having acted in the main like an honest man. A few days afterward I was sent for by Mrs. ----, who immediately filled my ears with the most piteous complaints, the sum total of which was that she was exceedingly _nervous_, and I told her so. Of course I did not complain of culpability or crime. But I told her, very plainly, that she needed no medicine--nothing but plenty of air and exercise, and less high-seasoned food. My great frankness gave offence, and impaired my reputation. She employed, in my stead, Dr. Robinson, who continued to attend her till his bill amounted to a sum sufficient to buy a good carriage and harness, and till his credit for skill was advanced in a degree corresponding. Mr. B.'s child was sick, and his wife besides. He came for my predecessor; but, not finding him at home,--though he still remained in the place,--he was compelled to Hobson's choice--myself or nobody; Dr. Robinson lived at too great a distance. I was accordingly employed, and was soon on the spot. The child was very sick; and for some little time after my arrival I was so much occupied in the performance of my duties that I paid no attention to any thing else. But having prescribed for both my patients, I sat down quietly to look over the newspaper. Presently I heard from Mrs. B. a deep groan. I was immediately at her bedside, anxious to know the cause. "Oh, nothing at all," she said, "except a momentary feeling of disappointment because Dr. ---- did not come." I said to her, "You can send for him now, madam, as soon as he returns. Do not think yourselves compelled to adhere to me, simply because you have been obliged to call me once. I will yield most cheerfully to the individual of your preference." Mrs. B. apologized. She knew I had done as well as I could, she said; and perhaps no one could have done better. "But little Leonora," said she, "is dreadfully sick; and I do very much want to see Dr. B. He has had more experience than you. These young doctors, just from the schools, what can they know, the best of them?" I saw her difficulties; but, as I have already intimated, I did not look so wise as Dr. B., nor had I so grave a face, nor so large an abdomen. I could neither tell so good a story, nor laugh so heartily; I could not even descend to that petty talk which is so often greatly preferred to silence or newspaper reading, not only by such individuals as Mrs. B. and her friends, but by most families. A physician must be a man of sympathy. He need not, however, descend to so low a level as that of dishonesty; but he must come down to the level of his people in regard to manners and conversation. He must converse with them in their own language. He must not only _seem_ to be devoted, unreservedly, to their interests, but must actually _be_ so. This confession is most cheerfully and sincerely and honestly made; and may he who reads it understand. On a certain occasion I was called to prescribe in a family where the disappointment was so great that the patient was actually made worse by my presence, and an unfavorable turn given to the disease. It may be said that people ought not to yield themselves up to the influence of such feelings; and it is certainly true that they ought not. But sick people are not always rational, nor even judicious. Dr. Johnson says: "Every sick man is a rascal;" but we need not go quite so far as that. Sickness changes us, morally, sometimes for the better, but much oftener for the worse; and in general it makes us much less reasonable. But it is far enough from being my intention to present a full account of the trials incident to the life of a young medical man; for, in order to do this, I should be obliged to carry you with me, at least mentally, to places which you would not greatly desire to visit. Physicians can seldom choose their patients; they are compelled to take them as they find them. They will sometimes be called to the vilest of the vile and the filthiest of the filthy. Their office is indeed a noble one; but is noblest of all when performed honestly, in the fear of God, with a view to do good, and not merely to please mankind and gratify their own ambition. Above all, they should not practise medicine for the mere love of money. A physician should have a heart overflowing with benevolence, and should feel it incumbent upon him, at every step in his professional life, not only to do good to his patients, but to all around him. He should be a guide to mankind, physically, for moral ends. He should let his light so shine, that they, seeing his good works, may be led to glorify the Father who is in heaven. His object should be to spread, by the good he performs, the everlasting gospel, just as truly as this should be the object of him who ministers in holy things at the altar. Such a physician, however, at first, I was not. Such, however, I soon aspired to be; such, as I trust, I at length became. Of this, however, the reader will judge for himself, by-and-by. "By their fruits ye shall know them." CHAPTER XXVII. A DOSING AND DRUGGING FAMILY. For several months of the first year of my medical life, I was a boarder in a family, all of whom were sickly. Some of the number were even continually or almost continually under the influence of medicine, if not of physicians. Here my trials were various, and some of them severe. But I must give you a particular description of this family; for I have many things to say concerning it, some of which may prove instructive. Mr. L. had been brought up a farmer; but being possessed of a delicate constitution, had been subsequently converted into a country shop-keeper,--a dealer, I mean, in dry goods and groceries. As is usual in such cases, he was in the habit of keeping a small assortment of drugs and medicines. The circumstance of having medicine always at hand, and often _in_ hand, had led him, as it has thousands of others, into temptation, till he had formed and confirmed the habit of frequent dosing and drugging his frail system. But as usually happens in such cases, the more medicine he took, the more he seemed to require, and consequently the more he swallowed. One thing prepared the way for another. With Mrs. L. matters were still worse. In the vain belief that without a course of medication, _she could never have any constitution_, as she was wont to express it, her mother had begun to dose and drug her as early as at the age of twelve or fourteen years. And what had been thus early begun, had been continued till she was twenty-four, when she married Mr. L. But she was feebler, if possible, at twenty-four, than at fourteen, and believed herself under the necessity of taking medicine in order to be able to sit up a part of the day and perform a little light, but needful, family labor, such as sewing, mending, etc. When I first had a seat at their family table, it was by no means uncommon for Mr. and Mrs. L. to begin their meal, as soon as "grace" was over, with Stoughton's bitters, or some other supposed cordial, or strengthener of the appetite. As I not only refused to join them, but occasionally spoke a kind word against the custom into which they had fallen, the bitters at length fell into disuse; and it was found that their meals could be digested as well without the stimulus, as with its aid. But I was much less successful in preventing the torrent of medicine from producing its wonted ---- upon this family, at other times and seasons; for which Mr. L.'s business furnished such facilities. But you must not think of Mrs. L. as a mere tyro in this business of compounding medicine, nor in that of administering it, especially to herself. From the apothecary's shop of her husband, as well as from other sources, she selected one thing after another, not merely for the time, but for permanent purposes, till it was almost difficult to say which had the best assortment, she or her husband. And she not only had it on hand, but she took it, as freely, almost so, as her food and drink. More than even this should be affirmed. Had she at any time flagged in this work of self-destruction, she would have been brought up again to the line by her mother. For though the latter resided at a considerable distance, she paid Mrs. L. an occasional visit, and sometimes remained in the family several weeks. Whenever she did so, little was heard of in the usual hours of conversation,--especially at the table,--but Sarah's stomach, Sarah's nerves, and what was good for Sarah. It was enough to make one _sick at the stomach_, to witness the conversation even for a single day; and above all to be compelled to join in it. She was there once, in the early spring, and remained until the ground was fairly settled. No sooner could she get into the woods, and come to the naked surface of the earth, than the whole country around was laid under tribute to furnish roots "good for the blood." These were put into a beer to be prepared for Sarah. It was supposed by many,--and by this wondrous wise old lady, among the rest,--that the efficacy of these medicinal beers in cleansing the blood, must ever be in due proportion to the number of their respective ingredients. Thus, if twenty articles, "good for the blood," could be procured and boiled in the wort, the result would be a compound which would be worth twenty times as much, or at least be _many_ times as useful, in accomplishing its supposed specific purpose, as if only one kind of root had been obtained. It was a long time before I could break in upon this tissue of error, to any practical purpose. For so deeply imbedded in the human brain is the idea of purifying the blood by some such unnatural means, that one might almost as well think of building a railroad to the moon, as of overcoming it. They never thought--perhaps never knew--that the blood of the human body of to-day, will be little more the blood of the body to-morrow, than the river which flows by our door to-day will be the river of to-morrow; and that the one can no more be purified independently of any and all things else, than the other. But it is said to be a long road which never turns. Some good impressions had been made on this family, as we shall see hereafter. Not, indeed, until there had been much unnecessary suffering, and many an unwilling penalty paid for transgression, as well as much money uselessly expended for physicians and medicine. For though I was somewhat a favorite in the family, I was as yet young and inexperienced, and many a wiser head than mine was from time to time invoked, and much time and money lost in other ways, that might have been saved for better and nobler purposes. Among the items of loss, as well as of penalty, was that of offspring. These were generally still-born. One, indeed, lived about two weeks and then perished. The parents seemed to be written childless. Or rather, they seemed to have written themselves so. They seemed destined moreover, to follow their premature children, at no great distance, to an untimely grave. For nothing was more obvious--I mean to the medical observer--than at an age when everybody ought to be gaining in bodily no less than in mental and moral vigor, they were both of them growing feeble as well as irresolute. As a boarder, I left the family some time afterward, though I did not lose sight of it wholly; nor did they entirely forget or disregard the numerous hints I had given them. They made some progress every year. At length, however, I lost sight of them entirely, and only kept up a faint recollection of them by means of an occasional word of intelligence from the place where they resided, showing that they were still alive. One day, after the lapse of about eight years, as I was passing through a charming New England village, the stage-coach stopped to let the passengers dine, when, to my great surprise, on stepping out of the coach, whom should I see but my old friend Mr. L.? He was equally surprised, and perhaps equally rejoiced, to see me. The interview was utterly unexpected to us both. "How do you do?" said he, grasping my hand. I returned the compliment by inquiring after his own health and that of Mrs. L. It turned out that he had failed in his business a few months before, and that, as a consequence, he had been compelled to remove to the place where he now was, and engage in an employment which brought his skin into contact with the air, and his muscles into prolonged and healthful activity. It appeared also that both he and his family had long since banished the use of medicine. "And now," said he, "thank God I know what it is, once more, to enjoy health; I can not only eat, but work." It was Monday, the great _washing-day_ of Yankee house-keepers; and while we were talking together with so much earnestness, that, like Milton's first pair in innocence, we "forgot all time," a female approached, with her sleeves rolled up, greeted me with much cordiality and seized me by the hand. "Can this be Mrs. L.?" I asked. How changed! She was, it is true, like her husband, a little sunburnt; but then she was as she assured me, and, as I had every reason for believing to be true, comparatively healthy. While I was still in amazement, hardly knowing whether I was awake or dreaming, a little girl approached us. Though somewhat slender and delicate, she was only slightly diseased; rather, she was only predisposed to disease by inheritance; and mere predispositions no more destroy us, than a train of powder explodes without igniting. The girl was about four or five years old. "Who is this?" I inquired. "Not yours, most certainly," I added, turning to Mr. and Mrs. L. "We call her ours," they said, "and yours; for we, no doubt, owe her life and health, in no small degree, to your instructions."--"This," said I, "is what I little expected to see; but you may thank God for it rather than me, since she lives by virtue of obedience to his laws, and not mine. Then you are not only pretty healthy yourselves," I added, "but you have a healthy child."--"We have two," said they. "The other is in the cradle; we will go and bring her." At this moment, the loud declaration, "The coach is ready, gentlemen," reminded us that our conversation was at an end for the present, and we were obliged to separate. Not, however, till we had enjoyed a most luxurious mental repast in "the feast of reason, and the flow of soul," with no abatement but the consciousness, on my part, of a little loss to the landlord, who had provided for the passengers a smoking dinner. This, reader, to speak somewhat paradoxically, was one of the proudest, and yet one of the humblest days of my life. To have been the Heaven-appointed instrument of such a marked change for the better in a human family, was more than could have been foreseen or even expected. It is more than has often fallen to my lot. True, I do not hesitate to regard it as an extreme case; and yet it is, in magnitude, just what I could show you in miniature, at various points in the same vicinity, and indeed, all over the country. Mr. and Mrs. L. still pursue the even tenor of their way, and have their reward in it. One of their two daughters,--buds of early promise,--though probably more or less scrofulous, hardly reached maturity, ere she descended to the tomb. The rest enjoy a tolerable degree of health. Of course, I do not speak of their health as greater than that of the average of mankind, notwithstanding their thorough reformation. It is much, all things considered, that it should be equal to that average. As for the mother of Mrs. L., who still occasionally visits the family, she looks on in silent amazement, hardly knowing whether to recommend any more beer, with all sorts of roots good for the blood in it, or whether to give up the pursuit. I believe, however, that she does not often presume to interfere with their habits. Perhaps she has learned--if not, she may possibly live long enough to acquire the lesson,--to "let well alone," as her children and grandchildren already have. I certainly hope she has. It will conduce greatly to her health and happiness, as well as make her a better citizen and better Christian. CHAPTER XXVIII. POISONING WITH LEAD. Nearly at the beginning of my practice in medicine, I was called to see a fine and hitherto healthy youth, twelve years old, but who had for several weeks before application was made to me, complained of a steady and sometimes severe pain in his bowels, attended with more or fewer febrile symptoms and a loss of appetite. In endeavoring to trace out carefully the causes of his disease, the first thing that attracted my attention was his employment. His father was a blacksmith, and being in moderate circumstances and destitute of any other help besides this son, had for a considerable time required him to perform the work of an adult, or nearly such. It had not been suspected at the time, that the work injured him, though he had sometimes complained of great fatigue, and of a slight weakness and uneasiness in the place where the pain had now become fixed. As the result of my investigations, I came to the conclusion that he had been overworked, and certain ligaments of the bowels had been weakened. My treatment in the case was at first mild and palliative, in the hope that after a few days of rest the trouble would disappear. Instead of this, however, it grew worse. At my special request, various counselling physicians were called in; but I do not know that they were of any service to me. No new light was thrown on the case, though we could all converse very learnedly on the subject. Like many other young practitioners, I was at that time apt to indulge in gloomy fears about poisons. I seldom had a case of acute disease, without suspecting their influence. I suspected poison now, and accordingly made search into every possible nook and corner whence such an influence could possibly have emanated. For a long time nothing could be found. One day, on examining a pot of pickled cucumbers which had hitherto escaped observation, I found that a part of its glazing had been destroyed by the acid. I no sooner saw this than I was ready to say, _eureka_ (I have found it), and to inform the family and my patient. It appeared that the pickles had been there for some time, and that the boy had eaten of them very freely. The parents and friends, though they had much confidence in the wisdom and skill of their physician, were very slow to believe in the injurious tendency of the pickles. They admitted the danger of such cases generally; but how could the boy be injured, and not the rest of them? they asked. They forgot, or did not know, that the poison would be more likely to affect one who was weakened in the abdomen from other causes, than those who were sound; especially when he took much more of it into his stomach than they did. In my suspicion about lead poisoning, I had very little sympathy from those around me. Even the counselling physicians had little confidence in any such existing cause of disease. They were nearly as ready as other people to leave the case in the dark, and to say, practically, "The finger of Providence is here;" or, in other words, It comes of some cause which God alone knows or _can_ know. How much of human ignorance--ay, and of human credulity and folly, too--is clustered round the well-known decision of many a court of inquest; viz., "Died by the visitation of God!" What do they mean by it? Do they suppose that since Satan or some other personage whom we call Death, is guilty of striking us down here and there, those who are not "struck with death" are struck down by the great Source of light and life? The far greater probability is, that they know not what they _do_ mean. Mankind are not addicted to thinking, especially on subjects of this sort. It is much easier, or at least much lazier, to refer all our ills and complaints, as well as their unfavorable terminations, to God or Satan, friend or foe,--to some agency exterior to themselves,--than to consider themselves as the probable cause, and proceed to make diligent search for their own errors. Thus it was, in a remarkable degree, in the region where it was my lot to meet and palliate and try to cure diseases. I say, here, _cure_; for the idea would hardly have found a lodgment, at that early period, in any human brain which could have been found in that region of rural simplicity, hardly in my own somewhat more highly enlightened cranium, that _medical men never cure_; and that when people get well, it is the result of the operations and efforts of nature, or of nature's God, who is doing the best thing possible to set matters right. It was even deemed by many as not only foolish, but almost sacrilegious, to say much about the causes of disease, and especially about lead. And then to talk about lead as connected with the use of their favorite red earthen, which had been in use time immemorial, and which had never, in all past time, killed anybody, as they supposed, was the dictate of almost any thing else rather than of good, sound, sober, common sense. You can hardly imagine, at this day, in the year 1859, what an air of incredulity the gaping countenances of the family and neighbors of my young friend and patient presented, when I told them stories of lead disease in different parts of the country, especially of such cases as were then recent and fresh in my memory. One of these stories may not be out of place in the present connection. About the year 1812, the people of Elizabethtown, Penn., put up what they called their apple butter in these same red earthen vessels, glazed, as almost everybody now knows, with an oxyde of lead. There had been a pottery established near the village that very year, and it was thought not a little patriotic to purchase and use its products, thus favoring the cause of home manufacture. Nearly every family, as it appeared in the sequel, had bought and used more or fewer of these vessels. This was, of course, some time in the autumn. In the progress of a few months a dreadful disease broke out in the village, which baffled the skill of the best physicians, and consigned some forty or fifty of the inhabitants to the grave. The cause, at first, was not at all suspected. At length, however, from a careful examination of facts, it was ascertained that the disease which had proved so fatal must have had its origin in the glazing of these vessels. The sickness abated only when it had attacked all whose bowels--already weakened by some other cause or causes--were duly prepared for the poisonous operation of the lead. It is indeed true that the physicians supposed the disease came to a stand on account of the overwhelming tendency of huge doses of calomel, which they gave to almost everybody who had used the apple butter; but of this there was no satisfactory evidence. It ceased, as I believe, and as I have already intimated, because--except in the case of those who were enfeebled by other causes, nature was too strong for it, or her recuperative powers too energetic. Now this story illustrates a case which, in magnitude or in miniature, is in our country of almost every-day occurrence; and the only reason why the results everywhere else are not like those at Elizabethtown, is simply this: that there is not so much of the poison used in any one village, at the same time, as there was at that place in the circumstances which have been mentioned. One is sick here, another there, and another elsewhere. In one, owing to peculiar predisposition or habit, it takes the shape of fever; in another, of palsy; in another, of eruptions or boils; in another, of bowel complaint. And as all these and many other diseases have been known before, and have been induced by other causes equally unobserved or obscure, we have fallen into the habit of supposing that these things must needs be, do what we will. In other words, God the Creator, is supposed to have made the world and appointed to us, for trial or otherwise, these various forms of disease; and they are for the most part dealt out to us arbitrarily; or, if not arbitrarily, by chance or hap-hazard. But to return to the young man. There was such a hostility of the public mind to the idea that his disease was induced or even aggravated by lead, that I receded in part from my suspicions. At least, I proceeded, with fresh energy and enthusiasm, to search for other and more probable or popular causes. Cause there must have been, of some sort, I was confident; while to all my efforts of this kind the friends of the boy stood opposed. They did not, it is true, say much against it; but then it was perfectly evident from all their conversation and conduct that they regarded it as not only idle, but presumptuous, perhaps wicked. How can it be, they seemed to say, by those looks and actions which so often speak louder than words, that this young doctor is always trying to ferret out the causes of disease, while Dr ---- (my predecessor) never attempted any such thing, but rather dissuaded us from it? Yet thus it was precisely. For three long months I was endeavoring to meet and obviate the symptoms of a disease which I secretly believed was induced by lead, but of which I had no such strong evidence as would have justified the positive affirmation that it was so, or prevented me from searching for other causes. This state of mind was by no means favorable to my success as a medical practitioner; for it somehow greatly impaired or weakened their general confidence in my wisdom and skill. Had I, on the other hand, "looked very wise," declared the disease to be so and so, with great pertinacity, and adhered, through good report and through evil, to my opinion, whenever it was assailed, and withal manifested no desire to receive medical counsel, I should have had a larger measure of their esteem, and a very much larger measure, as a professional man, of their confidence. They might then have thought me a very wise and good physician. A man who wishes to be greatly popular in the world must learn the ways of the world, and walk in them more or less, whether they are crooked or straight. He must not be over-modest, or over-honest; nor must he be over-solicitous to improve his own mind or heart, or encourage others, by precept or example, to walk in the way of improvement. He must not only make up his mind to take the world as it is, but to suffer it to remain so. The world does not like to be found fault with; it has a great deal of self-confidence. The young man, in the end, recovered; not, as I now believe, in consequence of the treatment, but in spite of it. Had he been nursed carefully from the first, and kept from every source of irritation, both external and internal, even from food, except a very little of the mildest sort, just enough to keep him from absolute starvation; and had his air been pure and his temper of mind easy, cheerful and hopeful, he would probably have recovered much sooner than he did, and with far better prospects for the future. But he had been frightened about himself, from the very first, by my own inquiries about poison,--which had unwarily been communicated to him,--and his fears never wholly subsided. How much wisdom from both worlds does it require in order to be a physician! The office of a medical man, I repeat, is one of the noblest under the whole heaven. The physician is, or should be, a missionary. Do you regard this assertion as extravagant or unfounded? Why, then, was it made an adjunct, and more than an adjunct, in the first promulgation of the gospel, and this, too, by the gospel's divine Author? Why is it that our success in modern times, in spreading the gospel, has been greater--other things being equal--in America or China, in proportion as its preachers have attended to the body as well as to the soul? At the time of my commencing the practice of medicine, I was no more fit for it than I was to preach the cross of Christ; that is, I was almost entirely unqualified for either profession. I was honest, sanguine, philanthropic, but I was uneducated. I knew very little, indeed, of human nature; still less did I know of the sublime art of becoming all things to all men, in the nobler and more elevated sense of the great apostle Paul. I would yield to no other compromise than such as he encourages, of course. Let us be honest and truthful, though the heavens fall. CHAPTER XXIX. STANDING PATIENTS. Medical men well know--should any such condescend to look over this volume--what is meant when I affirm that I was not long in securing to myself a good share of _standing patients_. They are the dread, not to say the curse, of the profession. And yet they abound. They are found throughout the length and breadth of the land, and in great numbers. They are a class of persons, not always of one sex, who hang continually, like an incubus, on the physician, and yet are forever a disadvantage to him. They are never well enough to let him alone, and yet seldom ill enough to require much medical advice or treatment. And yet, medicine they will have, of somebody, even if they go to the apothecary for it, without so much as the semblance of a medical prescription of any sort. But then, after all, they are seldom reduced to any such necessity. They usually have on hand prescriptions enough of some sort. A dearth of Yankee physicians--could such a thing possibly occur--would still leave us a supply of Indian doctors, mesmeric doctors, nutritive doctors, etc., etc., to say nothing of doctresses, in liberal abundance, ever ready to prescribe. When I succeeded Dr. ----, in the chair of medicine, surgery, etc., at ----, I received, as if by contract, if not by inheritance, his whole stock of standing patients. They were not slow to _call on_, sometimes to _call in_, the new doctor. Nor was I often long in the house before comparisons began to be made between my predecessor and myself. They did not, of course, directly traduce or slander Dr. ----, but they were very careful to intimate that, having got his name up, he had grown careless about his patients, especially such of them as did not belong to his clique, political or sectarian; and that, on this account, they were almost willing to part with him, and to receive and accept as his substitute one who was not only younger and more active, but also less tinctured with conservatism and aristocracy! A very large amount of valuable time was spent during the first year of my practice as a physician, in endeavors to do good to these very devoted and loving and loyal patients; for if they did not always call me when I had occasion to pass their doors, I knew full well they expected me, and so I usually called. Besides, in many an instance I was sent for in post haste, with entreaties that I would come and see them immediately; and no atonement for neglect or even delay--if such neglect or delay was ventured--would suffice. And yet, despite of their fears of "monarchy and aristocracy," they were my most truly aristocratic patients. They expected me to come and go at their request, whether anybody else was attended to or not. And, to add to the vexation of the case, though they boasted of having paid most enormous bills to my predecessor, they never, if they could avoid it, paid any thing to me. Now, I do not suppose that every medical man has as large a share of these standing patients as fell to my unhappy lot; but from the knowledge I have acquired of mankind, and from the acquaintance I have necessarily formed with medical men, I do not think I err when I affirm that they are everywhere numerous, and that they are everywhere not only a pest to society at large, but particularly so to the physician. But the worst feature of the case is, that after all our efforts, we can seldom, if ever, cure them. They are always hanging upon us like an incubus; and yet like Solomon's daughters of the horseleech, are never satisfied. They take the medicine, and follow the advice, if they _like_ it; or they take such parts of it as they choose, and reject the rest. Or they take the advice and follow us to-day, but get discouraged and abandon us, at least practically, to-morrow; especially if some smart young physician happens to come along, who has more than an average share of empiricism and pretension, and more than he has of real merit. I must here confess, among other confessions, that at first I was not a little deceived by their open countenances and concealed thoughts, and unintelligent and hence unconfiding professions. It was a long time before I relinquished the hope of doing them good; or at least a portion of them. But I was at length compelled. There was nothing on which to build. If a foundation seemed to be laid one day, it would disappear the next. One fundamental difficulty lay in the way of these persons to health, as it has to thousands of others. They were all the while talking or thinking about themselves, their ailments and woes and abuses and neglects. They were particularly inclined to turn their attention to their own diseased feelings. Now it may be pretty safe to say that no individual can fully recover from chronic disease,--nervous, stomachic, or glandular--who is always turning his thoughts inward, and watching his own feelings, and perhaps relating his woes to every one he meets with. We must learn to forget ourselves, at least a part of the time, and think of others, if we are in earnest to get rid of chronic disease. I do not say, of course, that everybody would recover of disease, even if they acted right in every particular; but this I _do_ say, that if every person who is ill would act wisely, and if their physicians, in every instance, were wise enough to take the best course, the number of these standing patients would soon dwindle to a very small remnant. Instead of thousands, or tens of thousands, it would soon be reduced to hundreds. CHAPTER XXX. KILLING A PATIENT. President Lindsley, late of one of our south western colleges,--a very shrewd and observing, as well as learned and excellent individual--has been often heard to say that no half-educated young physician ever succeeded in obtaining a good run of professional business, and a fair medical reputation, without despatching prematurely to the other world, at least as many as half a dozen of his patients. It is said that most rules have their exceptions; and it is even affirmed by some, that the exceptions strengthen the rule. If this is so, perhaps the rule of Pres. L. may stand; though to many it seems at first exceedingly sweeping. One known exception to its universality may be worth mentioning, on which the reader may make his own comments, and from which he may draw his own inferences. I was so fortunate for one, as to attain to the eminence he mentions, without killing any thing _like_ half a dozen patients; at least, so far as I know. And yet, as I verily fear and most honestly confess, I _did_ kill one or two. Not, of course, with malice aforethought, for they were among my very best friends; and one in particular was a near and highly valued neighbor. Let me give you a few details concerning the latter. It may serve as a lesson of instruction, as well as a confession. He was about six feet high, with large vital organs; and though by no means possessed of a strong constitution, yet in virtue of a most rigid temperance, generally healthy. He was, however, subjected to the habitual influences of a most miserable cookery. Indeed, I never knew worse. Seldom, if ever, did he pass a single week--I might even say a single day--without having his alimentary organs irritated to subinflammation by more or fewer of what Dr. Dunglison, the physiologist, would call "rebellious" mixtures. I do not wonder, in truth, that he occasionally sickened. The wonder with me is, that he did not sicken and die long before he did. And though the blow that finished his perilous mortal career, was doubtless inflicted by my own hand, I do not hesitate to say that his "housekeeper" had nearly half destroyed him before I was called. It was a midsummer night, when the messenger came across an intervening field, and aroused me from my slumbers with the intelligence that Mr. M. was very sick, and wanted to have me come and see him immediately. Although it was fully twelve o'clock, and I had been so fully occupied during the preceding evening, that I had but just crawled into bed and begun my slumbers, I was instantly on my feet, and in about twelve minutes at the bedside of the sick man. He had been affected with a bowel complaint, as it appeared, for several days, during which his wife, who was one of those conceited women who know so much, in their own estimation, that nobody can teach them any thing, had dosed him with various things, such as were supposed to be good for the blood, or the stomach, among which was brandy and loaf sugar. Now his bowels, though they were inflamed, might have borne the sugar; but the brandy was a little too much for them. They had endured it for a time, it is true, but had at length yielded, and were in a worse condition than when she began her treatment. And what was worse, her alcoholic doses, frequently "inflicted," had heated the circulatory apparatus, and even the whole system, into a burning fever. It needed no very active imagination, in such circumstances, to make out, at least in prospect, a very "hard case." And as he who has a giant foe to contend with, arms himself accordingly, I immediately invoked the strongholds of the Materia Medica for the strongest doses which it could furnish, and these in no measured or stinted quantity. In short, I attacked the disease with the most powerful agents of which I could avail myself. I will not trouble the non-professional reader with the names of the various and powerful drugs which were laid under contribution in this trying and dangerous case, and which were most assiduously plied. It is sufficient, perhaps, to say that on looking over my directions--fairly written out as they were, and laid on a small stand near the sick-bed--you might have discovered that hardly a half-hour, by night or day, could pass, in which he was not required to swallow some very active or in other words poisonous medicinal agent or other. For though I was even then greatly opposed, in _theory_, to the exhibition of much medicine in disease, yet in _practice_ I could not free myself wholly from the idea that my prospects of affording aid, or rather of giving nature a chance of saving a patient, was nearly in proportion to the amount I could force into him of opium, calomel, nitrate of silver, carbonate of ammonia, etc. It was, in short, enough to kill a Samson or a Hercules; and I repeat that I verily fear that it did kill in the present instance; not, however, immediately. For several days and nights we watched over him, heating his brain, in our over-kindness, to a violent delirium on the one hand, or to a stupor almost like the sleep of death on the other. Not satisfied with our own murderous efforts, we at length applied for medical counsel. My predecessor was not so far off as to be quite beyond our reach, and was in due time on the spot. He, good man, sanctioned the deeds already done, and only made through the force of their prepossessions, an addition to the dark catalogue of demons which already assailed if they did not actually possess him. For the first time in my medical career, I suffered, here, from a loss of the confidence of my employers. A very mean man, who could gain notoriety in no other way, undertook to insinuate that I did not understand well my profession; and this story for a short time made an impression. However, there was soon a reaction in my favor, so that nothing was lost in the end. More than even this might be said--that I rose higher, as the result of the report. Mr. M. at length began to decline. Nature, though strongly entrenched in her citadel, and loth to "give up the ship," began to succumb to the powers of disease and the load of medicine; and he gradually descended to the tomb. His whole sickness was of little more than a week's duration. I was present at the funeral, but I could scarcely hold up my head, or look any person in the face. To my perturbed imagination every one who was but "three feet high" was ready to point at me the finger of scorn, and say, "You have killed that man." The heavens themselves seemed covered with thick darkness, and the green earth with sackcloth and ashes. "Never again," I said to myself a thousand times, "can I bear up under such sad and severe responsibilities." And yet--will the reader believe it?--no one circumstance of my whole medical life ever did more to establish my reputation than this. True, I had contended on the battle field, and had been beaten, but then it was thought I had contended against a powerful foe. Men sometimes think it honorable even to be beaten. I well remember an instance of this sort. A very great scoundrel heaped insults upon a worthy justice of the peace, till the latter seized him and held him down to the ground for a considerable time. The man was quite respectable afterward, and told the story to his own praise a thousand times over! He had measured lances with 'Squire H.! And though the 'Squire was too much for him, he obtained a town-wide reputation by the contest. You will see, more and more, as I proceed with these confessions, that it is not in him that willeth nor in him that runneth, to be acceptable as a physician, but in certain circumstances, partly within and partly beyond our control. You will see, however, that the best way in the end is, boldly and fearlessly to do right, and then trust in Him who loves right, and whose throne is in the Heavens, for the final issue. We may not always be popular in doing right--probably we shall _not_ be--but we shall, in any event, have a clear conscience. CHAPTER XXXI. A SUDDEN CURE. I was called one morning very early, to see a little girl, five or six years of age, who, it was said, was extremely sick, and without immediate aid could not probably long survive. She was one of a very numerous family, most of whom, though suffered to run almost wild, like so many rabbits, were comparatively healthy. I do not suppose they had ever called in a physician more than once or twice in a year. In truth, they had very little confidence in physicians; though in extremities, they were accustomed to call on them almost as much as other people. In any event Caroline was very sick now; and they loudly demanded aid. I was forthwith on the spot. Caroline was groaning most piteously. "Where is your distress?" I inquired. She gave no direct answer, but continued to groan and writhe, as if she were impaled. As I could obtain no reliable information from her, and could discover no special or exciting cause of her suffering, and as the case was urgent, I proceeded to do _something_, though, as I must honestly confess, it was to labor quite in the dark. One thing I knew, it is true; that there were spasms, and that it depended on a diseased condition of the brain and nervous system; but what the cause or causes were, I could hardly divine. Nor, in truth, had I time to ask many questions. Though the days of Hydropathy had not yet arrived, the world, even then, had a good deal of water in it, and physicians were sometimes wise enough to use it. It was demanded, as I thought, on the present occasion. It would, at least, by whiling away the time, give opportunity for further observation and reflection, and deeper investigation. There was a good fire in the kitchen, and I ordered a warm bath immediately. Every effort was made to hasten the process of warming the water, as well as to keep the patient quiet and within doors; for she raved like a maniac--partly indeed from a childish fear, but partly also from real bodily suffering. The family and neighborhood--for the latter were very largely collected together--were almost as much alarmed and distressed as the little patient, and this reacted on the patient to her increased disadvantage. As there were no special preparations in those days for bathing--I mean in the region of which I am now speaking--we used a large wash-tub. The water was soon ready, and was made rather warm, quite above 100° of Fahrenheit. I had taken the precaution to have my patient already undressed, so as to lose no time. The very instant the bath was ready, she was plunged into it. It cost some trouble, for she resisted with almost superhuman strength, and uttered most terrific screams. But as the ox is dragged to the slaughter, she was dragged into the water and held in it. The effect was like magic. She had not been in the water twenty seconds before every thing was quiet; and I do not know that she has ever had another pang to the present hour. Certain it is that she seemed to be entirely cured by this single bath, and none of her spasms ever returned. The family were greatly delighted, and so were the neighbors. And was the physician, think you, an uninterested spectator? Had he been wholly destitute of the love of doing good, by relieving human distress, he must at least have been susceptible of receiving pleasure from general approbation. He certainly sought respectability as a physician. And this he was by degrees now attaining. It is hardly possible to refer the sudden quiet which followed in this instance from the application of warm water, to a mere coincidence, as if the system was ready, just at this very instant, to react or rally. The bath must have had something more than a mere imaginary or accidental effect, though its prescription may be said to have been empirical. Had the experiment in the present instance wholly failed, it is by no means improbable the physician would still have been on a par with other men. The _guess_ he made was his _only_ thought. He had nothing in reserve. But he was successful; he _guessed right_, and it built him up. His fame now began to spread far and wide, wafted, as it were, on the wings of every breeze. If he succeeded, it was supposed to be undeniable proof of his skill; if he failed, it was not supposed to be so much his fault as the result of circumstances; or, more properly, the severity of the disease. And even in the case of failure, as I have said elsewhere, he often gained credit; for he had boldly contended, at great odds, with a mighty because intangible antagonist! It is an old proverb,--but by no means the less true for its age,--that when a person is going down hill every one will give him a kick. But is it not equally true that when he is resolutely going up hill, they are equally ready to help him on? So at least I found it at this period of my progress. CHAPTER XXXII. GIGANTIC DOSES OF MEDICINE. Although I was opposed to the frequent and free use of medicine, I early fell into one habit which was as diametrically opposed to my general theory as could possibly have been. I refer to the habit of giving my patients, at least occasionally, most enormous doses of those more active preparations which should seldom, if ever, be administered in this way. As nearly as I can now recollect, I fell into this habit in the following manner: Among my standing patients, before mentioned, were several drunkards. Occasionally, however, they were more than standing or standard patients; they had attacks of mania, or as it is usually called in the case of drunkards, delirium tremens. In these circumstances, among these patients, I often had the most severe trials. Sometimes I could relieve them; but sometimes, too, I failed. One night, while endeavoring to relieve the sufferings of one of these patients in delirium tremens, almost to no purpose, the thought struck me, "What effect would a prodigious dose of calomel have on the poor creature? Can it kill him? I doubt it. I will venture on the trial." So, without communicating the slightest hint to any one around me of what I was about to do, I contrived to insinuate a hundred grains or more of this substance into the man's stomach, that like a chemical receiver took what was poured into it. Having succeeded in the administration of the dose, I waited patiently the issue. The medicine had, in due time, its full ordinary effect; but the degree of its cathartic effect was not in proportion to the largeness of the dose. Its activity hardly amounted to violence. It seemed, however, to quiet the brain and nerves as if by magic; nor am I aware that any injurious effects, either local or general, ever followed its exhibition. I had the full credit of a speedy and wonderful cure. Another fact. I was frequently called to prescribe for children who were threatened with the croup. One night, on being called to a child of some eight or ten months, I thought of large doses of calomel. Was there any great risk in trying one? I ventured. I gave the child almost a teaspoonful of this active cathartic. It was indeed a gigantic dose, and the treatment was bold if not heroic. For a couple of hours the patient breathed badly enough. There was evidently much oppression, not only of the lungs but of the nervous system. The parents and friends of the child grew uneasy. They were not, however, more uneasy than their physician. But I consoled myself by laboring to compose them. I preached to them long and loud, and to some extent with success. At the end of about two hours, the latter part of which had been marked by a degree of stupor which almost discouraged me, a gentle vomiting came on, followed by moderately cathartic effects; and the child immediately recovered its mental activity, and in a few days was well. Empirical as this practice was, I ventured on it again and again, and with similar success. At length the practice of giving giant doses in this disease became quite habitual with me, and I even extended it to other diseases. Not only calomel, but several other active medicines were used in the same bold and fearless manner. I do not know that I ever did any direct or immediate mischief in this way. On the contrary, I was regarded as eminently successful. And yet I should not now dare to repeat the treatment, however urgent might seem to be the demand, or recommend it to others. It might, perhaps, be successful; but what if it should prove otherwise? I could make no appeal to principle or precedent in justification of my conduct. It is true, I have met with one or two practitioners whose experience has been similar; but what are a few isolated cases, of even honest practice, in comparison with the deductions of wise men for centuries? There may be after consequences, in these cases, which are not foreseen. Sentence against an evil work, as Solomon says, is not always executed speedily. CHAPTER XXXIII THE LAMBSKIN DISEASE. Should any medical man look through these pages, he may perchance amuse himself by asking where the writer obtained his system of classification of disease. It will not, certainly, be very easy to find such a disease as the lambskin disease in any of our modern nosologies. But he will better understand me when he has read through the chapter. He may be reminded, by its perusal and its quaint title, of the classification which is found in Whitlow's New Medical Discoveries, founded, as the doctor says, on the idea that "every disease ought to be named from the plant or other substance which is the principal exciting cause of such disease." It is as follows: "The Mercurial Disease, The Belladonna do The Stramonium do The Tobacco do The Cicuta do The Butter Cup do The Colchicum do The Colocynth do The Pork or Hog do The Vinegar do The Fool's Parsley do The Fox Glove do The Nux Vomica do The Quassia do The Opium do The Hellebore do The Salt do The Mineral Acid do The Acrid do The Putrid do" If on examination the curious reader should find no such disease as the "Lambskin disease" in Dr. W.'s catalogue, he should remember that the list is by no means complete, and that there will be no objection to the addition of one more. And why, indeed, may I not coin terms as well as others? All names must have been given by somebody. But I will not dwell on the subject of nosology too long. I have something else to do in this chapter than merely to amuse. I have some thoughts to present on health and sickness,--thoughts, too, which seem to me of vast importance. A son of Mr. G., a farmer, had been at work in an adjoining town, all summer, with a man who was accustomed to employ a great number of hands in various occupations,--farming, road building, butchering, etc., etc. Of a sudden, young G., now about twenty years of age, was brought home sick, and I was sent for late at night--a very common time for calling the doctor--to come and see him. I found him exceedingly weak and sick, with strong tendencies to putridity. What could be the cause? There was no prevailing or epidemic disease abroad at the time, either where he had been laboring, or within my own jurisdiction; nor could I, at first, find out any cause which was adequate to the production of such effects as were before me. I prescribed for the young man, as well as I could; but it was all to no purpose. Some unknown influence, local or general, seemed to hang like an incubus about him, and to depress, in particular, his nervous system. In short, the symptoms were such as portended swift destruction, if not immediate. I could but predict the worst. And the worst soon came. He sunk, in a few days, to an untimely grave. I say _untimely_ with peculiar emphasis; for he had hitherto been regarded as particularly robust and healthy. His remains were scarcely entombed when several members of his father's family were attacked in a similar way. Another young man in the neighborhood, who had been employed at the same place with the deceased, and who had returned at the same time, also sickened, and with nearly the same symptoms. And then, in a few days more, the father and mother of the latter began to droop, and to fall into the same train of diseased tendencies with the rest. Of these, too, I had the charge. My hands were now fully occupied, and so was my head. Anxious as most young men are, in similar circumstances, not only to save their patients, but their reputation, and though the distance at which they resided was considerable, I visited both families twice a day, and usually remained with one of them during the night. I was afraid to trust them with others. Physically this constant charge was too much for me, and ought not to have been attempted. No physician should watch with his patients, by night or by day,--above all by night--any more than a general should place himself in the front of his army, during the heat of battle. His life is too precious to be jeoparded beyond the necessities involved in his profession. But while my hands were occupied, my mind was racked exceedingly with constant inquiry into the cause of this terrible disease,--for such to my apprehension it was becoming. The whole neighborhood was alarmed, and the paleness of death was upon almost every countenance. My doubts were at length removed, and the cause of trouble, as I then supposed and still believe, fully revealed. The disease so putrescent in its tendencies, had originated in animal putrefaction. The circumstances were as follows:-- The individual with whom the young men who sickened had been residing and laboring, had laid aside, in his chamber, some time before, quite a pile of lambskins, just in the condition in which they were when removed from their natural owners, and had suffered them to lie in that condition until they were actually putrescent and highly offensive. The two young men, owing to the relative position of the chambers they occupied, were particularly exposed to the poisonous effluvia. I did not forget--I did not then forget--the oft inculcated and frequently received doctrine, that animal impurity is not apt to engender disease. It most certainly had an agency--a prominent one--in the case before us. Perhaps it has such an influence much more frequently than is generally supposed. One of my patients, in the family which I first mentioned,--a little boy two or three years old,--died almost as soon, after being seized with disease, as his elder brother had done. The rest, though severely sick, and at times given over to die, finally recovered. Some of them were sick, however, many months, and none of them, so far as I now recollect,--with perhaps a single exception,--ever enjoyed as good health afterward as before. I had in these families six or eight of the most trying cases I ever had in my life; and yet, with the exceptions before named, all recovered. How much agency my own labors as a medical man had in producing this result, I am at a loss to conjecture. As an attendant or nurse, I have no doubt my services were valuable. And it was because a good nurse is worth more than a physician that I so frequently ran the risk of watching over the sick so closely as considerably to impair my own health. The neighbors and friends of the two sick families, as I have already intimated, looked on in silent agony during the whole campaign; expecting, first that _their_ families, too, would soon be called to take their turn; and secondly, that I, the commander in chief, should be a sufferer, which of course would be a great public disadvantage. They were almost as much gratified as I, when we all came forth from the fire unscathed. On the whole, except as regards health, I was a gainer rather than a loser by the affair. I mean, of course, in the way of medical reputation. I was by this time fairly established as a powder and pill distributer, of the _first water_. In other words, I was beginning to be regarded as a good family physician, and to be sought for, not only within the narrow limits of my own native township, some four or five miles square, but also quite beyond these narrow precincts. Occasionally I had patients in three or four adjoining towns, and I was even occasionally called as counsel to other physicians. My ambition was high, perhaps higher than it ought to have been; but it had its checks and even its valleys of humiliation; so that on the whole I retained my sanity and a full measure of public confidence. And yet, in conclusion, I have to confess that besides exposing my own health, I made many medical blunders. I would not again run the risk to health or reputation which, during this long trial of several months, I certainly ran, for any sum of money which king Croesus or the Rothschilds could command. Nor do I believe an intelligent physician can do it, without being guilty of a moral wrong. Every one has his province; let him carefully ascertain what that is, and confine himself to it. The acting commander in an important military expedition has no right to place himself in the ranks of those who are about to leap a ditch, scale a wall, or charge bayonet. Paul has no right to labor in Athens when he knows perfectly well that he can do more good in Jerusalem, and the voice of God, by his Providence or otherwise, calls him thither. And "to him that knoweth to do good and doeth it not, to him it is sin." CHAPTER XXXIV. MILK PUNCH FEVER. A certain young woman who had great general confidence in my skill, after I had stood by her many long hours in one of Nature's sorest trials, was left at length in a fair way to recover, except that she was exceedingly exhausted, and needed the most careful attendance on the part of those around her. She no longer needed any medicine, nothing but to be let alone. In other words, she needed nothing but good nursing and entire freedom from all care and responsibility. Being obliged at this juncture to leave her for nearly the whole night, I gave the best directions to her principal nurse of which I was capable, as well as the principal reasons on which it was founded. She seemed entirely submissive, and perhaps, in theory, was so. But in my zeal to make them understand that I was acting on common-sense principles, I committed one error, a very common one, indeed, but yet an error. It was that of reasoning with them with a view to make every thing particularly intelligible. One has authority, in these matters, as long as he takes the _attitude_ of authority, but the moment he descends to the general level of his patients, and in true republican style puts himself on a par with them, he begins to lose their confidence as a physician. You may not be sensible of a loss of this sort, nor even the physician. You may even think the reverse were more true. But you deceive yourself. Though your patients may love you better as a friend or even as a father, yet they have lost confidence in you medically, in nearly the same proportion. Strange indeed that it should be so; but so, according to my own observation, it ever has been. That a prophet is "without honor"--and most so in his own country and among his own personal friends--is as true now as it was eighteen hundred years ago. Had I told Mrs. D.'s attendants to do so or so, and left them without saying a word more, they would probably have done it. But I had condescended to reason with them about the matter; their belief that medical men dealt with the stars, and spoke with a species of supernatural authority, had been shaken; and they were emboldened to reason on the subject, and to hearken to the reasonings as well as to what had but the slightest resemblance thereto in others, during my absence. Having occasion to use all possible precaution against the supervention of milk fever in my patient, I left particular directions that nothing stimulating should be administered, and assigned several good, substantial reasons. No food was to be given, except a little bread and some plain chicken broth, with no condiment or dressing but a little salt; and this at intervals of about four hours. No drink--not a particle--was to be given, except frequent very small draughts of cold water. While I was absent Mrs. D.'s mother came into their family, not only to rejoice with them in an accession to their number, but to render them a little aid. She was one of those mothers whose kindness so often defeats their best and purest intentions. She was all eyes, ears, and attention, and _nearly all talk_. The daughter's treatment soon underwent a special scrutiny, and was found "wanting." "Has the doctor ordered my daughter no milk punch?" she said to the attendants. "Not a drop," they replied. She raised both hands in astonishment. "How, then," she asked, "can the ninny expect she can ever have any nourishment for that _boy_?" The attendants could not inform her. "The doctor," they said, "gave reasons," but they could not fully understand them. "He did not probably understand them himself," said she. "There are no reasons against it, I am confident. It is only a notion of his. These young doctors are always full of their book wisdom. Why, a little experience is worth a whole world full of theories. Now _I_ know--and so does every other person who has nursed children--that a little milk punch, in these cases, is necessary. Not a great deal, it is true; but a little, just enough to give the system strength. Nature is weak in these cases. I wish some of these young doctors themselves were obliged to endure the trials we have to endure, and we should see whether they could get along with no drink but cold water!" The rebellion soon reached the daughter's ears, who, till now, had confided in the "doctor's" prescription, and was doing well. She was soon as uneasy with things as they were, as her mother and the nurse and the neighbors. The husband was not of the clique; but then he was one of those good-natured men who leave every thing to their wives; and though they may not fully approve of every thing that is attempted, will yet do and refrain from doing many things for the sake of peace. He interposed no veto on the present occasion. The mother, in short, soon reigned "sole monarch," and proceeded to issue from her imperial throne, the sage decree that a little milk punch must be made. Judith, the nurse, was to have it prepared so and so, and she would herself administer it. Only just so many spoonfuls of rum must be added to the tumbler of milk and water, and just so much sugar. It must be weak, the decree said. Mrs. D. drank freely of the punch, because her mother told her that it would do her good. True, she asked after the first swallow, "what will the doctor say to this?" but her mother bade her be quiet, she would see to all that. "It is made very weak," said the mother, "on purpose for you; drink of it a little and often. It will be both food and drink to you. It will be good for the babe, dear child! how can these doctors wish to starve folks? I have no notion of starving to death, or having my children or grandchildren starved." It was now past midnight, and Mrs. D. had as yet slept but very little. Had she simply followed out my directions she might have slept an hour or two before midnight, and several hours in the aggregate afterward. This, though done by stealth and in short naps, would have given her more real rest and strength than a whole gallon of milk punch, and instead of kindling fever, would have carried off all tendencies of the kind. On my arrival, early the next morning, I found a good deal of headache, such as cold water and plain food and rest seldom, if ever, create. My fears were at once excited, and they were greatly strengthened when I saw her mother. But the blow had been struck, and could not be recalled. Mrs. D., in short, was already in the beginning stage of a fever which came within a hair's breadth of destroying her. It is indeed true that she finally recovered. No thanks, however, were due to the mother's over-kindness, nor to my own over-communicativeness. Had I done my duty, had I kept my own counsel, nobody, not even the mother herself, as I now verily believe, would have ventured to disobey my positive injunctions. And had this mother done, as she would have been done by in similar circumstances, all would probably have been well still. We should have saved a little reputation, and a good deal of health. I learned, I repeat, from this unexpected adventure, that it was wisdom to keep my own secrets. I do not say that I have always acted up to the dignity of this better knowledge, but I am justified in saying that I have sometimes profited from an acquaintance with human nature that cost me dear. It is no trifle to see an individual suffer from painful disease a couple of weeks, and jeopard the life of a child during the whole time, when a little knowledge how to refrain from speaking _ten words_ of a particular kind and cast, would have prevented every evil. CHAPTER XXXV. MY FIRST CASE IN SURGERY. My first surgical case of any magnitude, was that of a wounded foot. For, though I had been required to bleed patients many times,--and bleeding is properly a surgical operation,--yet it had become so common in those days, and was performed with so little science or skill, that it was seldom recognized as belonging to the department of surgery. One of my neighbors had struck his axe into the upper part of his foot, and cut it nearly through. Happening to be at home when the accident occurred, which was in my own immediate neighborhood, I was soon on the spot, and ready to afford assistance; and, as good luck would have it, the man was not at all weakened by loss of blood, at my arrival. My lesson from an old surgeon[D] was not yet forgotten. I still knew, as well as any one could have told me, that to put together the divided edges of the wound and keep them there, was half the cure. But how was this to be done? Slips of adhesion plaster would bring the divided edges of the wounded surface into their place, but would the deeper-seated and more tendinous parts unite while left without touching each other? Or should a few stitches be taken? The wound was lengthwise of the foot, and no tendons were divided. I made up my mind to dress it without any sewing, and acted accordingly. The bleeding soon ceased. When all was secured, the patient inquired what he should put on it, to cure it. Had he not raised the question, I might, perhaps, have followed out my own ultra tendencies, and left it without any application at all; but as it was, I concluded to order something on which he might fasten his faith,--something which, though it should do no good, would do no harm. "Nothing is better for a fresh wound," I said, "than the 'Balsam of Life.' Just send Thomas over to Mr. Ludlow's, and get a couple of ounces of his 'Balsam of Life.'" It was soon brought, and the surface of the wound and its bandages moistened with it. "Now," said I, "keep your foot as still as you can till I see you again. I will be in again before I go to bed." I called again at nine o'clock in the evening. All appeared well, only the patient had some doubts whether the Balsam of Life was just the right thing. Several of the neighbors had been in, as he said, and, though they admitted that the Balsam might be very good, they knew, or thought they knew, of something better. However, I succeeded in quieting most of his rising fears for the present, by assuring him that nothing in the wide world was equal, for its healing virtues, to the "Balsam." My voice here was law, for _I gave no reasons_! On making inquiry, afterward, with a view chiefly to gratify curiosity,[E] I found that the first individual who came in after I had left the house, assured them there was nothing so good for a fresh wound as a peach leaf. The next, however, insisted that the best way was to bind up the part in molasses. The third said the best way was to take just three stitches to the wound, and bind it up in the blood. The fourth said the most sovereign thing in the world, for a fresh cut, was tobacco juice! Now I could have told these various representatives of as many various public opinions, that all these things and many more which might have been named, are, in a certain sense, good, since any mere flesh wound, in the ordinary circumstances of ordinary life, will heal in a reasonable time, in spite of them. I could have told them, still further, that the Balsam of Life was probably little, if any, better than the other things proposed, any farther than as it secured more faith and confidence, and prevented the application of something which was worse. I could have assured them that all the external applications in the world are of no possible service, except to defend from cold air, and prevent external injuries, or reduce inflammation; and that the last-mentioned symptom, should it occur, would be best relieved by cold water. But what good would it have done? Just none at all, according to my own experience. Positive assurance--mere dogmatism--was much better. The wound did well as it was, though it might have done much better, could the patient's faith have been just as firmly fixed on nothing at all but Nature, as it was on _medicaments_. However, the tincture I proposed, which somebody had dignified with the name of Balsam of life, had done very little harm, if any, to the parts to which it had been applied, while it had done a great deal of good to the patient's mind, and the minds of his friends. It was nothing, I believe, but a compound tincture of benzoin. I have used it a great number of times, and with the same wonderful results. The patient always gets well, either on account of it, or in spite of it! Does it make much practical difference which? FOOTNOTES: [D] See Chap. VIII. [E] Even such inquiries as these are usually of doubtful tendency. They weaken public confidence. There must be but one opinion of any value to the physician or his patients, and that must be _his own_! CHAPTER XXXVI. EMILIA AND THE LOVE CURE. One young family on whom I was accustomed to call from time to time, was not only accustomed to send for me in the night, as did many others, but, what made it much worse for me, they resided some four or five miles distant, among the mountains. They were of that class of people who look every man on his own things, and never, as the apostle would enjoin, on the things of others. They knew very well that a physician, though he might be half a conjuror, required sleep; still, they were willing to finish their day's work, eat their supper, perform a large number of _et ceteras_, even if they did not call for the doctor till he had fairly taken off his boots to retire for the night. But there was one consolation in all this, that they paid me promptly; and medical men, as you know, like other men, work for pay. They cannot live wholly on air. In the same house with the family alluded to, was a young woman, about twenty-five years of age, who had been confined to her bed ten or twelve years. She was the only daughter of very indulgent parents, who had never, from her earliest years, thought they could do too much for her. In truth, this was the source of her feebleness. Some little ailment, indeed, there might have been at the outset, induced by pie, cake, preserves, pickles, or something which no truly kind parents should permit a child to take; though nothing more than might have been got rid of in its effects, by a little patient waiting. But instead of waiting a little, the anxious mother had dosed and drugged her. And these ill turns had been more and more frequent, just in proportion to the frequency with which she had been drugged for them; till, at twelve years of age, she was almost all the while complaining. And at fourteen, she was completely bedridden--a burden to herself and to others. "I wonder," said my principal employer, at about twelve o'clock, when I had attended to his own little family, and was about to leave, "whether you could do any thing for our Millie. She has tried almost all the doctors, to no purpose; but we have so much confidence here in your skill, that she sometimes speaks of trying you. She is hardly willing to 'give up the ship' without another trial." This, as you must be aware, was a stirring appeal to my love of approbation; but it was too late at night to make a call on her at that moment. So, promising to come and see her shortly, I took my leave, and rode home, as usual, meditating. Now I had never seen Emilia, but from the account which I had received from the neighbors, as well as from the nature of the case, I knew very nearly how she was; and that the great difficulty in the way of recovery was the constant habit of watching herself and attending to every internal sensation. In other words, she was so completely wrapped up in self, that I could see no reasonable prospect of getting her mind out of the maze in which it had been so long involved. But I found time, a few days afterward, as I was employed again in the same neighborhood, to call and see her; and I ventured accordingly. She was sitting up in the bed, well bolstered, with a huge mass of clothing both on herself and on the bed. Then, at her right hand, was a stand half covered with bowls, saucers and tumblers; and near it a little closet or recess, in which were nearly an equal number of parcels of medicine, wrapped in papers ready to be used, when they were supposed to be necessary. I had no sooner entered the room, than she began to give me an account of her medicine, rather than of herself. So rapid was her enunciation, and so eager was she to tell me what she knew--not about the symptoms of her disease, but about the treatment--that it was a full quarter of an hour before I could reach the inmost recesses of her condition. "That," said she, "is for canker in the mouth; that for sore throat; that is an eye wash I sometimes use, and that is a kind of bitters Dr. R. left for me, but which I have now nearly done taking--and they never did me any good," etc. When I found an opportunity, I endeavored to investigate, very fully and freely, what had hitherto been supposed to be a very remarkable case. I found, indeed, that the patient had a great many little troubles, dependent mainly on the state of a mind greatly harassed by constant reflex tendencies, not easily eradicable. But I did not find it easy to prescribe for her. She was one of those very inquisitive people who wish to know what every thing you give them is, and who have a very conscientious objection to every thing. However, I at last settled down on a course of treatment, and wrote it out in a fair hand, and left it at the bedside. Not, however, I repeat, till I had foolishly fallen into my former error, and told her all the whys and wherefores. This familarity into which she had drawn me, had already extracted one-half the virtue of my medicine; for that is no longer mysterious which the medical man openly and freely discusses. The freedom of thinking she had indulged in while I was present, had been extended to freedom of action; and the very medicine, whose virtues she had dared to discourse upon, she ventured to set aside, when her experience assured her it was not producing the effect she desired, and for which she supposed it was intended. So that what, from the first, I had feared, and more than I had feared, at length happened. She took my medicine, professedly,--that is, just when she pleased,--for about four weeks, to no manner of purpose whatever, except to deceive herself; for during the first and second weeks of its use, she imagined herself all the while getting better; while during the third week she began to doubt, and about the fourth week she came to the sage conclusion that she was just where she had been a month or two before. The great, abiding difficulties of her case--her want of simple, confiding trust in her physician, and her constant, anxious attention to her own internal sensations, were far enough from being overcome. She was, in short, very nearly where she was ten years before, except that she was in circumstances rather more difficult to be reached, and had become rather more sceptical about medicine. What should now be done? Must the case be abandoned? Or was there some other way, some _new_ way, by means, of which it could be reached? I was not quite willing to give her up as irrecoverable, and yet I saw nothing remaining which I could do. I revolved the thing in my mind, by night and by day. At last a plan struck me which I verily believed would succeed. A few miles distant was a young physician, just from the schools, who vainly, though naturally, supposed he knew almost every thing which was known, and who wanted business. As he had nothing to lose, even if he were to fail in a hundred trials, but every thing to gain could he effect one very remarkable cure, I proposed to the family to employ him. I knew well he would have one or two advantages over his older and more experienced brethren. He would not at once place himself on the same platform with his patient and the friends, by answering their numerous questions; and for this plain and simple reason: In the first place, that he _could_ not, and very probably knew his own weakness; secondly, he would have more of that blind faith in medicine which inspires the ignorant with confidence. But there was another thought beyond all this, a wheel within a wheel. The young physician might succeed better than I, in drawing her thoughts, and even her affections, away from herself; for he was a single man, and the patient, though sick, not destitute of charms, especially of that more tangible charm which, to _indigent_ young men, and especially young _medical_ men, so often eclipses all others. She, on her part, as I well knew, was not wholly resigned to the world of single blessedness, though her long-continued ill health had almost unfitted her for any thing else. It only required a little _management_ to bring about the desired result. Dr. Juvenis was soon employed; and, though he did not always reply to her questions, which were numerous, and often wholly irrelevant, yet according to my own secret anticipations, he gradually raised her hopes in another direction, and hence drew her attention in no small degree from herself. His reserve, too, served but to inspire her with confidence in his great wisdom. There was something deep beyond the exterior, she always thought, which did not come out to the full, vulgar gaze. The final result was a strong attachment on her part, which, though not reciprocated by him in a direct manner, was not by any means repelled. The virtues of the medicines were no longer discussed or doubted; and it was obvious to all that she was beginning to mend. It was now high time for me to abandon a field which was not only fully occupied, but _well_ occupied. The visits of the young physician were continued, at longer or shorter intervals, for years, till the young woman's health was nearly restored; and, as I subsequently learned, they were married. The more recent history of her life, I have not been able to ascertain, except that neither party gained as much by the new connection as had been expected,--a result which, alas! is by no means any thing new, and that there was, after some time, a relapse of disease. This artifice for restoring health to a bedridden patient, is not mentioned in a way of approbation, but of regret, or at least of confession. Yet, while it declares my weakness, it develops or at least confirms a well-known principle, which it concerns mankind, patients as well as physicians, most fully and clearly to understand. The medical efficiency of an agent is greatly enhanced when the mind can be made to go along with it. I have wished a thousand times, both by night and by day, that I had never commended Dr. Juvenis to the favorable notice and regard of this illiterate but confiding family. True, I had the good fortune thus to get rid of a most troublesome, standing _patient_. Had I a moral right thus to do? Did the end either sanction or sanctify the means? Grant that I saved, or seemed to save, the patient;--was she really saved? Was there any absolute gain in the end? These are questions which I cannot, as yet, fully settle. Most certainly she was not quite cured. What a mighty work for this fallen world education has yet to achieve; especially Physical Education! This, reader, let me say once for all, this physical education, under the guidance of Christianity, whose handmaid all true science should be, and to whose development and application all true religion should be directed, is our chief dependence. It is the lever by which we are to raise the world. CHAPTER XXXVII. HEZEKIAH AND DELIRIUM TREMENS. One morning, about two o'clock, in the depth of winter, I was roused from my slumbers by a stranger's voice, requesting me to get up and go immediately along the sides of the mountain and see Hezekiah. "And who is Hezekiah?" I said, only half awake; "and where is the side of the mountain? And who are you with whom I am conversing?" The mystery was easily cleared up, and I mounted my horse and was soon on the road through the sides of the mountain. It was wild and unfrequented; nay, it was, in places, almost impassable, especially in the night. Mr. Judkins, the father of the sick man, not only resided quite beyond my usual range of practice, but almost out of the range of everybody else, squirrels and rabbits and wild fowls excepted. In passing along, I made many inquiries with regard to the particular condition of the young man, in order to prepare myself for a more rapid investigation of his case whenever I should arrive. But I sought in vain. The messenger's lips were almost wholly sealed. The cause, at that time, I did not at all understand; but I had, subsequently, great reason to believe he was silent and reserved by the special command of the patient's friends. All I could obtain from my guide, was that Hezekiah had an ill turn; that he was occasionally subject to ill turns, and that the family were greatly alarmed about him. On my arrival, I found a group of friends large enough, almost, for a train band, gathered so closely round the bed of the young man that he could hardly breathe. There was, also, a monstrous fire in the chimney, sufficient to heat well the whole house, had the heat been properly distributed. The air was, at best, greatly confined; but it was particularly so to the poor patient, who lay panting as if in a dying condition. Yet I soon saw, and, as it were, instinctively, that he was not likely to die immediately. Some adventitious cause was evidently operating to throw his brain and nervous system into an abnormal condition, nor was I long in determining what it was. The father was a farmer. He possessed immense orchards, and made great quantities of cider, and one of his neighbors owned a distillery. For every barrel of cider Mr. J. carried to the distillery, he received in return a certain amount of cider-brandy; and at the time when I was called to see Hezekiah, he had more than two barrels of this "precious commodity" in his cellar. At the close of autumn he had had three barrels. Why this deposit of an article so doubtful? And what had become of the one barrel which had disappeared? Not a member of the family would touch it, but Mr. J. himself, and Hezekiah. The women and children did, indeed, sometimes taste a little molasses toddy, as it was called. Mr. J. would prepare it and pass it round in the morning just before breakfast, in the hope and expectation that all would taste it; and they usually did so. It was not, however, quite a voluntary thing on their part, but a species of moral compulsion. Left entirely to themselves, they never would have tasted it. Now think, reader, of two persons in a family, with two or three barrels of brandy at their entire disposal, with the expectation of consuming it, or the far greater part of it, during autumn and winter. Why, three barrels are more than a quart a day, for every day of the year. Mr. J. drank freely; but not more freely than his son. The latter was treading in the steps of his father, with the almost certain prospect of going, in the end, quite beyond him. It was not difficult to prescribe for the young man. The far greater difficulty was to induce him to follow out the prescription. I was honest enough to tell the father what ailed the son, and what ought to be done, and to plead with him to change his own habits immediately. I could not, it is true, quite prevail, when I urged him to pour his brandy, the whole of it, into the street; for that, as he said and doubtless thought, would be a waste of property. But he _did_ promise to _sell_ it; though even this promise he never kept. He even continued to drink it; though as he always insisted, with great moderation. But the greatest drinkers we have among us, are usually the first to speak of their own moderation. The sequel of the story may easily be guessed. Hezekiah became a miserable creature, and ere he reached the age of fifty came to a most miserable end,--the drunkard's death, by the drunkard's mania. Mr. J. having inherited a strong constitution passed on to sixty-three, when, like a mighty tree with decayed trunk, a slight wind crushed him to the dust. His family, most of them, still survive; but they are daughters, and have not inherited the vices of their father, so much as his diseases. They have, at least, inherited the disease which drinking is so apt to entail on the next generation,--I mean scrofula. Several of Mr. J.'s elder daughters are already dead; and the younger ones--for he had a very large family--are feeble, and always will be so; and their children are still more feeble. Thus "earthward," and not heavenward, "all things" in the family of the drunkard have a tendency. How painful the reflection that I did not labor with this family, not only in season, as I certainly did, but also out of season, and try to save it! I had influence with them. My honest plainness at my first visit, above described, did not prevent them from calling on me again for counsel; though at first I had feared such a result. I was often in the family, but not so often as I might have been; nor was I so bold as I ought to have been. Shall I be able to render up my account of the intercourse I had with them, in the great day, with joy, or must it be with grief and shame? CHAPTER XXXVIII. MY FIRST AMPUTATION. It is easy in imagination, to be wise, especially at a distance. How many a surgical operation have I performed _on paper_; or still oftener, and with more assurance, in my own brain. The difficulties are much fewer than in the reality. A fine young man came to me, one day, with a crushed thumb. He had been at work on a wool-carding machine, and through the most inexcusable carelessness had suffered his thumb to be drawn in. On a careful examination, I found the wound to be very severe, and, as I believed, requiring amputation. But what could I do? I had no surgical instruments. Young medical men, in plain country places, are hardly expected to purchase these conveniences, except perhaps a lancet and the needful instruments for extracting teeth. I had, however, a keen penknife in my pocket, and without the smallest formality, I proceeded to separate the mangled thumb at the joint. It was a very painful process, and as I now fully believe, quite an unnecessary one. But young men are not apt to see things in the same light with those who have had experience. They are not half as ready to rely on nature. They are inclined to think art will do every thing; nature, almost nothing. They frequently love to use the lancet, the knife, the scalpel, and the trephine. Of this fondness, however, I knew comparatively little. In the present instance, I simply saw it to be a doubtful, and as I thought, a hopeless case to attempt to save the thumb; and therefore, without much reflection, I removed it. Now I shall never cease to feel a pang, whenever memory calls up this hasty act, as long as I live. Were life to be protracted to a thousand years, I should always reproach myself for it. And yet I am not aware that either the young man himself or his friends ever respected me the less for it. And so far was I from suffering in the eyes of society at large, I verily believe I was a gainer by it. But I respected myself less on account of it. I respect myself less to-day. I am fully conscious I was too hasty,--that had I waited a little, I might have been a means of saving his hand without much deformity. Nature, in such cases, left to herself, will work all but miracles, especially in the young, and in those who have a sound constitution. CHAPTER XXXIX. MILK, AS A REMEDY IN FEVERS. Early in my practice as a physician I had a patient, a little girl, who, after having been sick for many weeks with a fever, seemed at length to become stationary. She was not weak or sick enough to die, and yet she seemed not strong enough to recover. Her vitality was almost exhausted, and yet Nature was loth to give up. On this young patient, during her long sickness, I had tried a thousand things, to see if I could not give Nature a "start;" but all to no purpose. The wheels would not move. She would either vomit up every thing I gave her, or it would pass away as into a reservoir, unchanged. There appeared to be, I repeat, no vital action in the system. To check the vomiting or prevent it, I had tried various measures, both external and internal. I had used warm applications to her stomach, both dry and moist. I had tried frictions of the skin and fomentations of the abdomen, both simple and medicated. Electricity I believe I had not used. Cheerful conversation, music to some extent, and the society of pleasant faces had all been invoked. Still there she was, on her bed. It seemed next to impossible for her "chariot" to go either backward or forward. One day she asked for some milk. In an instant I determined to try it. So I took a teaspoonful of this fluid, warm from the animal, and gave it to her, only requiring her to swallow it very slowly. She not only obeyed me, but appeared to relish it. Nor was there any nausea afterward, nor any evidence of evil effects or evil tendencies. At the end of four hours, I gave her another teaspoonful of milk, in the same way and with similar effects. At the end of four hours more, another was given; and thus onward. In twenty-four hours I was able to increase, slightly, the dose. All this while there was no stomach sickness, in the smallest degree. In three or four days, she could bear a table-spoonful of the "new medicine," every four hours, or a quantity equal to two or three ounces a day. In a week or ten days, she could take nearly half a gill at once, and had gained considerable strength. She recovered in the end, though her recovery was very slow. But I had hardly used the milk three days, before I began to be denounced as an almost insane man, especially by those who were wont to set themselves up as the arbiters of public opinion, and who lived too remotely to witness the good effects of the course I was pursuing. The family, of course, though they disapproved of what I did, could say nothing against it, especially as it afforded the only ground of hope of recovery. The whole public mind, in that region, was affected by the belief that milk, in a fever, is heating and dangerous. "What a strange thing it is," said many an old woman, and not a few young ones, "that the doctor should give milk to a person sick with a fever! He will certainly kill the girl before he is through with her. If these young doctors are determined to make experiments, they ought surely to make them on themselves, and not on their patients." The public complaint involved one serious mistake, else it would have had the semblance of reason to justify it. As a general fact, milk is heating in a fever, and is consequently inadmissible. The mistake to which I allude consisted in the belief that the fever still existed, when it had wholly passed away and left nothing behind it but debility, or the consequences of the fever. But the evidence that milk did not hurt her, lay, after all, in the indisputable fact that she improved as soon as she began to use it, and under its moderate and judicious exhibition entirely recovered her health. Observe, however, that I do not say it cured her; although I might make this affirmation with as much confidence as can justly exist with regard to any thing belonging to the _materia medica_. All I say is, that after having hung in suspense for some time, neither growing better nor appearing likely to do so, she commenced the use of the milk as aforesaid; and almost as soon as she began to use it she began to be convalescent, and her improvement went on steadily, till it terminated in sound health. And yet our good friends, up and down the country, who uttered so many jeremiades about the folly of giving milk to a little girl in a fever, lived to witness her complete recovery, notwithstanding. She is now a mother in our New England Israel, and I believe a very healthy one. Whether I would venture to pursue exactly the same course in the same circumstances, were I to live my life over again, is not quite certain. And yet I certainly think it not only safe, but desirable in such cases, to do something. Why, I have occasionally, in circumstances of convalescence from fever, given things which, in themselves considered, are much more objectionable than a little milk, and with the most perfect success. I have even given pork, cabbage, cheese, and beans. It is true, I have been compelled to exercise a good deal of care in these cases, with regard to quantity. That which in the quantity of half a pound might destroy life, might in the quantity of half an ounce, be the one thing needful to the salvation, physically, of a valuable member of society. A man in New Haven County, in Connecticut, some fifty years ago, was for a long time suspended, as it were, between this world and the next, in consequence of being left in great debility after a long and dangerous fever. For several weeks, in fact, it was scarcely guessed, except in the softest whisper, whether the slightest movement or change in his system might not precipitate him at once into the eternal world. In this perilous condition, he one day asked for sweet cider, just from the press. His attendants very properly and naturally hesitated; but the physician, when he arrived and was made acquainted with his request, immediately said, "Yes; give him a teaspoonful of good, clean, sweet cider, every two hours." The cider was given, according to the commandment, and appeared to have a restorative effect. The man recovered in a reasonable time, and is, I believe, alive to this day. CHAPTER XL. THE VIRTUES OF PUMPKIN-SEED TEA. Physicians are sometimes compelled by the force of circumstances, to visit the poor as well as the rich; albeit, they expect, so far as mere pecuniary compensation is concerned, that they are to have "their labor for their pains." They know well that honesty here, if nowhere else, is the best policy. Dr. Cullen, who became, as is well known, a giant in the profession, first attracted public attention from the act that he was often seen coming out of the hovels of the poor. My own lot for several years was to labor _chiefly_ for the poor. In a region where it had been customary for a medical man who had the whole control of the business to charge one thousand dollars a year, my charges scarcely exceeded three hundred. A few of the wealthy employed me, it is true, but not all; while I had all the poor. Indeed, it is among the poor, as a general rule, that sickness is most frequent and prevalent, not to say fatal. In one of these poor families, on a certain occasion, I had a long campaign and a hard one. First, I was obliged to travel a great distance to see them; secondly, I had a very severe disease to encounter; thirdly, there were several patients in the house; and the family, usually unprovided with sufficient space for a free circulation of the air, was still more incommoded when sick. Fourthly, the mistress of the house was exceedingly ignorant; and ignorance in a mother is, of itself, almost enough to insure the destruction of all patients over whom she has control. My chief source of trouble, in the present instance, was the injudicious conduct of the mother to the family; for all else could have been borne. She was almost incessantly trying to do something over and above what I had ordered or recommended. The neighbors, almost as weak as herself, would come in and say: "Why don't your doctor give such or such a thing? Mr. Blarney was sick exactly like Samuel, and they gave him a certain powder and he got right up in a very few days." This would usually be quite sufficient to make Mrs. ----very unhappy, at least till she had again seen me. Among the sick members of her family, was a daughter of about fifteen years of age. For this daughter, in particular, more than for the son Samuel, the good matrons of the neighborhood had their thousand remedies; and they regarded them all as infallible. With these, their favorite notions and doses, they were continually filling the ears of Mrs. ----. One day, when I had been the usual round of the family, and given all needful directions for the day, Mrs. ---- came to me and said: "Doctor, what do you think would be the effect of a little pumpkin-seed tea on my daughter Eunice? Do you think it would hurt her?" "Why, no; I suppose not," I said. "But for what purpose would you give her pumpkin-seed tea? Is she not doing as well as could be expected? And if so, is it not desirable to let well enough alone?" "To be sure she is doing very well," said Mrs. ----; "and I do not know but every thing is just as it should be. We certainly have great confidence in your treatment. But she is so feeble it seems as if something might be given which would make her gain strength faster. Why, she is very weak, doctor! Mrs. Gay and several others have thought a little pumpkin-seed tea might give her strength; but I do not like to order any thing new without first consulting you." I did not object to the pumpkin-seed tea, _administered in great moderation_. I did not say as I ought boldly to have said: "I shall be obliged, as your physician, at least till you choose to dismiss me, to pursue the course I have marked out for myself, since I shall have to bear the responsibility." In my modesty and even diffidence, I preferred to let the ignorant friends of the young woman dabble with this comparatively inoffensive article, rather than with something worse. Besides, I wished to have no clandestine movements, and had already rejected so many proposals to give this or that medicament, that I dared not do it longer. "Oh, yes," said I, "you may give her pumpkin-seed tea; but give it in moderation." The pumpkin-seed tea was given for the next twenty-four hours, I believe, with great exactness. But as there was no obvious or immediate advantage from using it during that time, it shared the fate which might have been expected. Like the wad in the child's pop-gun, which some new wad soon and effectually expels, the pumpkin-seed tea was thrown aside, and some other infallible cure proposed in its stead. Now, reader, do not suppose I deemed it at all derogatory to medical authority that pumpkin-seed tea should be proposed by a weak and silly mother for a darling daughter. Such a feeling as that would have placed me on the same level of human folly that she herself occupied. On the contrary, a medical man of any considerable experience among the sick and the friends of the sick, should think himself exceedingly fortunate when nothing worse is suggested by ignorance for his patients than _pumpkin-seed tea_! CHAPTER XLI. BROKEN LIMBS AND INTEMPERANCE. Wrestling for amusement, in the region where I practised medicine, was a very common occurrence, and certainly had its advantages. But there was one drawback upon its excellence, except to physicians. It involved a good deal of bone-breaking. One famous wrestler with whom I was well acquainted, broke, for his neighbors, an arm and a collar-bone; and in the end almost broke his own neck. He certainly injured it to an extent from which there was never an entire recovery. I shall mention him in another place. For more or fewer of these broken bones from wrestling, I was called on to prescribe. One case in particular may be worth a few moments' attention, especially as it brings with it certain medical confessions. I was sent for one evening, about nine o'clock, to visit a young man who had been injured, as it was said, by wrestling. On my arrival, I found him in great distress. He had delayed sending for aid so long that there was much inflammation, and consequent heat, swelling, tenderness, and pain. It was not easy, at first, to ascertain the exact character of the fractures; but on inquiry and examination, it appeared that while the patient was resting nearly or quite his whole weight on the fractured leg, his antagonist had struck or tripped with his foot so violently as to fracture both bones a little way above the ankle. It was rather a trying-case to me--for as yet I was, in the art of surgery, a mere tyro. But it was a case which would not admit of much delay; for the inflammation, already sufficiently great, was rapidly increasing. Nor would it do long to hesitate from mere modesty. I was among a class of people, who would, as I well knew, construe modesty, even though it should chance to be, as sometimes it is, an accompaniment of true science, into sheer ignorance; and this would deprive me, as a physician, of my principal lever. For who can lift up the down-fallen without having their full confidence. But I must explain. My patient with the fractured leg, though not in the usual acceptation of the term a drunkard, was, nevertheless, in the habit of drinking more or less of ardent spirit; and there were not wanting those who believed he was pretty well heated with liquor at the time his leg was broken. But, however this may have been, his frequent and excessive use of spirituous liquors had rendered his blood exceedingly impure; and I could not help shrinking, at first, from the task of having charge of him. Yet, it was a war from which there was no honorable discharge. There was no other surgeon within a reasonable distance, and why should I refuse to do my best for him? Somebody must assist him; and though the case was a troublesome one, why should I not take my share of troublesome cases among the rest? There was another consideration. As he was poor, any thing like reluctance would have been construed into a willingness to neglect him on account of his poverty--a suspicion from which I should, at that time, have shrunk as readily as from the charge of robbery or murder. But his associates were worse than he; and, with the exception of his own immediate relations, not an individual would be likely to call on or proffer him aid who was not half or two thirds of the time steeped in spirits. Has the surgeon or physician, in such circumstances, much reason to hope? And what is the hope of his patient? Can he reasonably expect, even with the aid of a skilful surgeon, ever to have a good leg? However, I did my duty, according to my best knowledge. I had the man laid in a proper position, then placed the divided bones as nearly in their natural position as possible, and bound them. I confess, here, to very great ignorance. Moreover, I repeat, it was a difficult case. And yet I think I succeeded very well for a beginner. Having properly placed the fractured bones and detained them there by suitable means, I gave due orders concerning the patient's management and treatment. I was particularly careful to interdict all stimulating or indigestible food, and all drink but water. My directions were written down with great care, and the strictest charge was given to his friends and family to see that they were faithfully regarded. But, alas, for the best person in the world with such attendants! Whenever his wife took care of him, things went on very well; but in other instances, almost every thing went wrong. His attendants gave him rum, opium, laudanum, or almost any thing that he called for. It is true--and I mention it to his credit--that he was often rather moderate in his use of interdicted articles; but then he took just about enough of these unnatural or extra stimulants, to prevent the healing process from going forward as fast as in a man of only thirty years might have been expected. Instead of being on his feet in a couple of months or so, he lay on his bed three months or more. And then, instead of having a good leg, it was not merely slightly crooked, but half an inch too short. And then, in addition,--and what was very hard to endure,--he charged the whole blame of its imperfection on the surgeon, and insisted that it was not "set" right! Now, while I confess to much awkwardness, and to the possibility that the limb was not managed as well as it might have been, I must maintain, notwithstanding, that such a charge was wholly misplaced and even gratuitous. Had he employed the best surgeon in the world, and had the leg received the best possible attention, it could not have been kept in its proper place with so much distilled spirits in the house, and so many slaves of the bottle! One might almost as well expect a leg to heal in the nether pit. Though I have never said, either by way of retaliating the abuse or otherwise, that his punishment was richly merited, I _might_ have said so. A man is hardly entitled to good health and a good frame who keeps such company as he did, whether in sickness or in health. God has so connected law and penalty, that he who should complain of the penalty would but insult the law given. Many cases of petty surgery as well as of severe and complicated disease, fell to my lot, which embarrassed me in a manner not unlike the foregoing; though in no one did I suffer quite so much from misrepresentation as in this. For at least twenty years, to my certain knowledge, my patient took pains to speak of me in terms of reproach, and to say that his leg was set badly; and all without the slightest evidence. I do not positively aver, I again say, that the surgery in the case was faultless; but whether it was so or not, neither he nor any living individual could know, unless it were a more skilful surgeon than myself; and no such surgeon, I am sure, ever saw him during the time I was in attendance. CHAPTER XLII. DYING FROM MERE FILTHINESS. The family of a wealthy farmer came under my hands, as physician, one autumn, in circumstances peculiarly painful and trying. Several of them had been taken suddenly and severely sick, and one or two were almost dead before they were fairly aroused to a sense of danger. They lived, however, quite remote from any village, and were strongly prejudiced against both physicians and medicine. But a fearful foe, in the shape of typhoid dysentery, now assailed them, and handled them so roughly that they laid aside their prejudices for the moment, and cried aloud for help. I was soon on the spot, but, oh, what a scene presented itself! As I have more than intimated, two of the family were already beyond hope. Others seemed likely to die. What was to be done for them, as I saw plainly, must be done quickly. On nearly every countenance I met with, both within the family and beyond its precincts, were the marks of consternation, and on some, of despair. In these circumstances--for desperate cases require a desperate remedy--I sought the counsels of an older physician. He came immediately and took a survey of the dreadful field of slaughter. On retiring with him for consultation, he immediately said; "There must be some local cause or causes for all this. Have you," he added, "been into the cellar?" When I replied in the negative, he said, "Then we must go there immediately." On speaking to the lady of the house, who was among the sick, by the way of asking permission, she objected, and with a good deal of promptitude and spirit. However, she at length yielded, and we made a thorough examination. The results of this examination were such as to confirm our suspicions. "We need not search further for the causes of a deadly disease," said Dr. B., and I thought so too. I have said already that the family was wealthy; but wealth need not include negligence, and still more filth. It was now September; and I am quite of opinion that the cellar had not been cleaned in one year, perhaps not in two. I had seen many farmers' cellars before, but I had never seen such an one as this. Nor do I believe my consulting physician ever had, though he was some twenty years older in medical practice than myself. Nor am I certain that what I may state will appear to you wholly reliable. In the first place there were, in abundance, cabbage leaves and stumps in a semi-putrid state. Next there were decayed potatoes, turnips, beets, and apples. Then there were in various parts of the cellar remnants of cider and vinegar, and cider lees--the latter in a most offensive condition. Finally, there were remnants of barrels of beef and pork, in a bad state--to say nothing of other casual filth--the whole contributing to such a stench as I had never before perceived in a cellar. The old physician who accompanied me had said, "We need not go farther;" but our determination was, on full and mature reflection, to know the worst and the whole, and we governed ourselves accordingly. Close to one corner of the kitchen was the well, the water in which was very low, and near to that the sink. And if the contents of the sink did not find their way, from day to day, into the well, thus adding impurity to putridity, it must have been in virtue of some unknown law which stood opposed to the great law of specific gravity and attraction. It is true that many speak of the earth as having a _cleansing_ power in such cases; but I know of no power which it possesses of cleaning sink water, while the latter is passing only five or six feet through it. The coarser parts may be strained out, but the essence must remain.[F] But our work was not yet finished. The vault, greatly neglected, was not far from the well; and so of the pigsty. Nor was it easy to resist the conviction that there was an underground communication between them. Then, finally, the house instead of standing on an elevation, greater or less,--a very common mode of building in New England,--stood in a sort of concavity, which contained also the barn and barnyard and woodpile;--connected with both of which was a large amount of decayed and decaying animal and vegetable matter. Now after such a review as this, he who could remain in doubt with regard to the cause of existing disease, especially on its assuming the form of bowel complaint with typhoid tendencies, must be much more ignorant of the laws of health and disease than I was. In fact the signs were unmistakable. We immediately made our report to the heads of the family, and recommended a most thorough cleansing, at once. It was easy to see that we gave great offence; indeed we had anticipated such a result. But we were not at all intimidated. We insisted on a work of immediate expurgation, which was finally effected, only we could not put pure water into the well. But we could and did require that the well water should not be used for any thing except washing clothes. The result was a decided and almost immediate improvement in the condition of the family, except the two already spoken of, and a very young child. These three died. Some of the rest lingered for weeks, and one or two for months; but they finally recovered. It is worthy of remark, moreover, that of the people of the neighborhood, though they had been excessively frightened and had not at first dared to come near the house, at least without holding their breath, not a person among them sickened. The disease began and ended over the foul cellar I have mentioned; nor has a similar disease ever since broken out there. The fair presumption is, that they have never since suffered such foul accumulations to remain through the hot season, on their premises. My honest and truly honorable course of conduct, in this instance, cost me something. Though I was a means of saving their lives, the survivors never thanked me for the exposure I made of their slovenliness. Perhaps I was wrong in reporting it abroad; but it was next to impossible to conceal the facts; and I, for once, did not attempt it. Physicians sometimes thus stand between the living and the dead, and must expect to give offence. They are, however, in duty bound to keep the secrets of their patients' faults as long as they can, unless the greater good of the public demands an exposition. But while I lost reputation in this particular family, I have not a doubt that I gained a strong hold, by this adventure, on the public mind and feelings. In truth, despite of even some trifling errors, I deserved it. I had, moreover, during the adventure, acquired a good deal of practical knowledge, of which, in the progress of my course as a medical man, I was glad to avail myself. This was doubtless an extreme case of disease from filthiness; but cases of the same general character are quite numerous. I have sometimes wished the public could have a history of these cases. There is an immense amount of neglect in the departments of cleanliness and ventilation; and the consequent suffering in the various forms of disease, is in similar degree and proportion. I will conclude this chapter with a single anecdote, which, were it necessary, could be substantiated by a very great number of living witnesses. Some fifteen or twenty years ago, a severe disease was accustomed to visit one of our New England factory villages, and to carry off more or fewer of its inhabitants. So regular and certain were its yearly visits and ravages, that not a few were disposed to regard it as a sort of necessary evil, or, perhaps, as a divine infliction. At length a very shrewd old gentleman told the people that the troublesome visitor was of human and not of divine origin; and that if they would attend properly to their cellars, sleeping-rooms, wells, etc., it would no more be heard of. At first, they were disposed to laugh at him; but the matter was talked of and agitated, till a work of general purgation was actually attempted and finally accomplished. The disease has never re-appeared. Was all this the result of mere accident? Do our diseases spring out of the ground? Are they the result of chance or hap-hazard? or, are they not the heaven-appointed penalties of transgression? FOOTNOTES: [F] Farmers, in former times, while making cider, were very slovenly. When I observed a large amount of filth adhering to their boots and shoes as they carried the pumice from the vat to the press, I thought of the worms, insects, and dust, which were ground up and incorporated with the mass, I sometimes expressed surprise. "Oh," said they, "the cider will work itself clean!" If so, I thought, and still think, it must be by the operation of some law not yet discovered. It may work itself _clear_, perhaps; but to work itself _clean_, is quite another matter. CHAPTER XLIII. TAKING THE FEVER. A large family, not much more careful of their habits or cleanly about their premises than the family alluded to in the foregoing chapter, had sickened one autumn, and one of them had died. Anxious to save the rest, I again acted as physician and nurse both, and effected my object; or, at least, appeared to do so. The rest of my patients ultimately recovered. But while thus watching these patients, by night and day, standing in the very front of the battle, I suddenly sickened. The circumstances, as nearly as I can recollect them, were the following:---- Among the sick of this afflicted family was one unmarried man of rather eccentric and very unsociable habits, and exceedingly negligent both of his person and dress. His linen, and I think also his bed-clothes, were hardly changed once a month; at least as long as he was well. And then he had, of course, extended the same neglect to his sick chamber. Added to this, moreover, was a species of _necessity_ at this juncture; for so much distressed were the family, and so difficult was it to procure aid in the neighborhood, that a part of the neglect to which our old bachelor was subjected seemed unavoidable. I took notice of the neglect, spoke of it repeatedly, and labored assiduously to correct the evil. But the case seemed an almost forlorn one. I was morally obliged, as I then felt, to do a thousand things for him that usually fall to the lot of nurses and assistants. In some instances, I passed even whole nights in the family, in attendance on him and the other sick persons. My task was the more severe from the fact that a similar fever was prevailing in other parts of the town, and my labors beyond the precincts of this family were exceedingly fatiguing and severe. In truth, I was, in the end, greatly overworked and debilitated, and my system most admirably prepared for the reception of disease. For various reasons, some of which, have already been named, I often assisted in turning my bachelor-patient in his foul bed. It is true the process was so offensive that I avoided it whenever I could; but on occasions, I yielded to the pressure of necessity. One night, when I was greatly fatigued and exhausted, and at the bottom of my condition,--utterly unfit for exertion, even in a pure atmosphere,--I was stooping over Mr. V., to turn him in his bed, when I suddenly felt a sensation like that of receiving a blow externally on the chest and stomach. The thought struck me as quickly as the imaginary blow did--have I not taken the disease? I knew the laws of contagion; the only question was whether any contagion had been generated. My opinion was to the contrary; nevertheless, I could not wholly suppress my fears. A sensation of oppression which followed the imaginary blow, soon gradually passed away, though I felt, each succeeding day, more and more debilitated. Many a resolution was made to leave my patients, so far as personal manual care was concerned, and be much more than I had been, in the open air, though it was only made for a time--to be broken. At length, however, principle prevailed over sympathy and inclination, and I did as I ought to have done long before. It was, however, rather late, for the die was already cast. I was taken sick, and the symptoms of my disease were precisely like those of Mr. V. Perceiving now, most clearly, my condition, and that I was engaged in a war from which there could be no discharge, I made preparation for a long and severe sickness. First, I calmly and deliberately adjusted all my domestic concerns of a pecuniary kind, and made such arrangements as would, in case of my demise, render every thing intelligible. Then, in the second place, I made up my mind to submit, as cheerfully as I could, to my condition. I determined to keep quiet, and not indulge for a moment in any undue anxiety. I employed a physician,--my old master--but steadfastly, and almost obstinately determined not to take much medicine;--nor was there much prescribed. My disease proved to be much milder than was expected; but it had its regular course. I never wholly lost my muscular strength or my appetite. While I was sick, several of my nearest friends and patrons sickened in a similar way, only more severely; and one or two of them died. On my recovery, however, or about the same time, the most of them began also to recover, and the disease in general abated. Now, when I came to reflect coolly and carefully on the whole affair, I could not help perceiving that I richly deserved all I suffered. It was the just penalty of transgression. I had been fully and repeatedly warned not to watch with my patients, as those who turn back to Chapter XXIII, and those too who remember its contents, will perceive. It was fit, therefore, that I should feel the rod, even if I could not kiss the hand that had appointed it. The only wonder with me now is, that my punishment was not more severe. CHAPTER XLIV. BLESSINGS OF CIDER AND CIDER BRANDY. Some of these blessings have been alluded to in Chapter XXXVI. But the subject is one of too much importance to be left in an unfinished state, and I have concluded to make it the principal topic of a separate chapter. A man came to me, one day, with sundry grievous complaints about his head and stomach. It was easy to see, at once, that they were not of mushroom growth, and that they could not be removed either in an hour or a day. However, I did the best I could with him, and charged him to follow, implicitly, my directions, which he promised faithfully to do. I told him, even, that he was in danger of a severe disease, but counselled him to do his utmost to escape it, if possible. He was, in the first place, a New England or Yankee farmer. Not quite satisfied with the products of his farm from the labors of the day, he coupled with them the night labors of managing a saw-mill and a distillery. And not satisfied with even these, he sometimes burned charcoal, which also involved more or less of nocturnal labor. In truth, these employments and avocations kept him up a great many nights during a considerable portion of the year, and were evidently wearing him out prematurely; for, though less than forty years of age, he had the appearance of being fifty or sixty. This severe tasking of his system, had led him greatly into temptation. Not only had he acquired the habit of chewing tobacco, as a solace in his seclusion and toil, but also of drinking very freely of cider and cider brandy; the last two of which, as might naturally be inferred from what has been said, he was accustomed to manufacture in large quantities. He was not a great eater, though I have no doubt he ate too much. But he did not take time to eat--he did not masticate any thing; almost every thing was swallowed in masses, and washed down with tea, coffee, or cider. Then, lastly and finally, he ate, as it were, by the job, when he _did_ eat; for his meals were very irregular and sometimes very infrequent. Another thing should be noticed. His cider and perhaps his tobacco, having leagued together, took away his appetite. Cider, as is well known, practically and in a gradual way, takes away the appetite, and so does coffee. Many a farmer will tell you that it is a matter of economy to give his laborers cider or coffee, since they will not eat so much. It is highly probable that brandy, and indeed all extra stimulants, have the same appetite-destroying effect. And as the result of his various irregularities and abuses, his digestive and nervous systems had become very much deranged and disordered, and I could hardly help foreboding evil concerning him. I prescribed for him as well as I could, and requested him to call on me in two or three days, and "report progress." On the next day but one, I was summoned to his bedside. My medicine had indeed appeared to afford him a little temporary relief, but it was only temporary. He was now much worse than ever before. I prescribed again; but it was with similar effect. Nature, somewhat relieved, as I then vainly imagined, seemed disposed to rally, but was unable. Every successive effort to rally, showed more and more clearly how much she had been crippled. At least she seemed to succumb either to the treatment or the disease, which last became in the end quite formidable. But though Nature had yielded, apparently vanquished, she still made occasional faint efforts, every two or three days, to regain the supremacy, or, in other words, to set things right; and sometimes we were led to indulge in hope. But the remissions of disease and of suffering were only temporary, and were succeeded, in every instance, by a worse condition of things than before. I called for sage medical counsel, but all to no permanent purpose. Downward he tended, step by step, and no human power or skill seemed likely to arrest his progress. In this downward course his constitution held out--for he was by nature exceedingly tenacious of life--till about the twenty-third day, when the vital forces began to retreat. He died on the twenty-fifth. One practical but general error deserves to be noticed, for want of a better place, in this very connection. Notwithstanding the great difficulty of convincing a person who habitually uses extra stimulants, narcotics, or any medicinal agents, all the way from rum, opium, and tobacco, down to tea, coffee, and saleratus, that they are injuring him at all, as long as he does not feel very ill, yet it ought to be clearly and fully known that every one who is thus addicted to unnatural habits, and _being_ thus addicted is seized with disease of any kind and from any cause whatever, is certain to have that disease with greater severity than if his habits had been, from the first, perfectly correct or normal. Nor is this all. Medical aid, whenever invoked under these circumstances, is more questionable as to its good tendencies. No medical man of any skill or observation but must feel, in such a case, most painfully, the terrible uncertainty of that treatment of the living machine which is quite enough so when the habits have been most favorable, by being most correct. One caution of quite another kind may be interposed here. My patient above had neglected to call on me for several days in the beginning of his disease, under the very general impression of ignorant people, that if he called a physician he should certainly be severely sick; for if he was not already very sick, any efforts to prevent disease would only serve to make him so. Now this is, as a general rule, a very great mistake. It would be much more safe to call a physician very early, than to wait till Nature is so much embarrassed and even crippled that we can place very little reliance on her efforts. Worse still is it for the physician, when called late, to load down the enfeebled system with medicine by way of atoning for past neglects. Thousands have made the mistake here alluded to, and have thus been a means of hastening on a fatal termination of the disease. It is not by any means improbable that such was the result in the foregoing instance. CHAPTER XLV. THE INDIAN DOCTOR. A little child about two years of age, severely afflicted with bowel complaint, came under my care during the first year of my medical practice, and proved the source of much difficulty. She was the child of a mother who had been trained to delicacies, in the usual fashionable way, and who had begun to carry out the same wretched course of education in her own family. In addition to a generally wrong treatment, the child had been indulged, for many weeks before I was called, with a large amount of green, or at least very unripe, fruit. It was at a season of the year when both children and adults were suffering from bowel complaints much more than at any other; but as the hot days and nights were expected soon to give way to the cooler and longer nights of October, I fastened my hopes of the child's final recovery, very largely, on the natural recuperative effects of the autumnal season. I did not attempt to give much medicine. My reliance was almost wholly on keeping up what I was wont to call a good centrifugal force, or in keeping the skin--the great safety valve of the system--in proper and healthful activity. Much that I ordered was in the way of bathing, local and general, especially warm bathing. The parents of the child were among my most confidential, not to say influential, friends. If there was a family within the whole of my medical circuit with whom my word was law, it was this. Yet after all they were ignorant, especially of themselves; and such people always were and always will be credulous. They would open their ears, not only to the thousand and one insinuations of malice and envy, which at times are ventured against a young physician,--especially if he is going ahead, and as they say "getting rich" too fast, and thus securing more than they believe to be his share of public popularity;--but to the still larger number, if possible, of weak criticisers in his practice. My friend's residence, moreover, was in a neighborhood contiguous to quacks and quackery, in the pretensions to which there were many believers. These dupes of ignorance and assurance were ever and anon filling the heads of my "patrons" with their stories of wonderful cures, in cases almost _exactly like that of my own little patient_, and urging the poor half-distracted parents to try something new--either medicine or physician. They would appeal to their feelings by asking them how they could be willing, as parents,--however great might be their confidence in me as a physician,--to let a darling child lie, day after day, and yet make no extra effort to save it. Their appeals were not wholly ineffective; indeed, what else could have been expected? My first suspicion of any thing radically wrong, arose from a decidedly unexpected effect from a little medicine I had previously ordered. It seemed quite clear to my mind that a neutralizing agent had been at work somehow, by design or otherwise. And yet I shrunk from making an inquiry. In the end, however, I found myself morally compelled to do so. The results were very nearly what I had feared, and what might have been expected. One of the _reliabilities_ of the wise ones of the neighborhood went by the name of the "Indian" doctor. Whether in addition to a very little Indian blood he was half or three-fourths Spanish, Portuguese, or Canadian, I never knew, for I never took pains to inquire. But he had Indian habits. He was at times intemperate and vicious. No one who knew him would have trusted him with a sixpence of his own honest earnings, at least any longer than he was within his sight or reach. Yet many people would and did trust him with their own lives and the lives of their children. There was one redeeming circumstance in connection with the history of this Indian doctor. He would never prescribe for the sick when in a state of intoxication. He knew, in this respect, his own weakness. But then it must be confessed he was not often free from intoxication. He was almost always steeped in cider or spirits. He was seldom, if ever, properly a sane or even a steady man. On pressing the parents of the sick child more closely than usual, they frankly owned that though they had not of themselves called in the Indian doctor, they had permitted Mrs. A. B. to invite him in, and had permitted the child to take a little of his medicine. The secret was now fully revealed, and it was no longer a matter of wonder with me, why poison did not work well against poison. The wonder was why, together, we had not killed the poor child. And yet it was by no means certain that the Indian's prescription was of much force, save the few drops of alcohol which it contained, for all his medicine was to be taken in alcohol. I stated to the parents the probable issues--that unless the child possessed more than ordinary tenacity of life, it must ultimately sink under the load it was compelled to sustain. But to our great surprise--certainly my own--it survived; and, though it was suspended for weeks between life and death, it finally recovered. The most mortifying circumstance of all was, that this miserable mongrel of a man had the credit of curing a child that only survived because it was tough and strong enough to resist the destructive tendency of two broadside fires--mine and his own. But medical men are compelled to put up with a great many things which, of course, they would not prefer. They must take the world as it is--as the world does the corps of physicians. They must calculate for deductions and drawbacks; and what they calculate on, they are pretty sure to experience. But, like other men with other severe trials, they have their reward. CHAPTER XLVI. DYING OF OLD AGE, AT FIFTY-EIGHT. Within the usual limits assigned me in the daily routine of my profession, but on its very verge, there resided an individual of much general reputation for worth of character, but of feeble constitution and cachetic or deranged habits, for whom as well as for his numerous family I had frequently prescribed. He was at length, one autumn, unusually reduced in health and strength, and I was again sent for. There was evidently very little of real disease about him, and yet there was very great debility. All his bodily senses were greatly deranged, and all his intellectual faculties benumbed. His internal machinery--his breathing, circulation, and digestion--was all affected; but it seemed more the result of debility than any thing else. There was no violence or excess of action anywhere, except a slight increase of the circulation. The man was about fifty-eight years of age. Had he been ninety-eight or even eighty-eight, I should have had no difficulty in understanding his case. I should have said to myself, "Nature, nearly exhausted by the wear and tear of life, is about to give way;" or in other words, "The man is about to did (?die) of mere old age." But could he have been thus worn out at the age of fifty-eight? I gave him gentle, tonic medicine, but it did not work well. Without increasing his strength, it increased his tendencies to fever. Yet, as I well knew, depletion would not answer in a case like this, whether of bleeding, blistering, or cathartics. In these circumstances, I contrived to while away the time in a routine of that negative character which, in true medical language, means laboriously doing nothing. He was visited about twice a week. I heard patiently all his complaints, and endeavored to be patient under all my disappointments, for disappointments I had to encounter at nearly every step. No active treatment whatever would have the general effect I desired and intended. If I gave him but a single dose of elixir paregoric for his nervousness, it only added, nine times in ten, to the very woes it was intended to relieve. My policy--and I fully believe it was the only true policy--was to leave him to himself and to Nature, as much as possible. Though I have spoken here of what I regarded as the true policy in the case then under my care, yet, after all, the truest course would have been to call for consultation some wiser head than my own. Another individual, even though he were no wiser than I, might have aided me most essentially, in compliance with, and in confirmation of, the good old adage--"Two eyes see more than one." Why, then, did I not call on some inquiring and highly experienced physician? It was not that I was too proud to do so, nor that I was too jealous of my reputation. It was not that I feared any evil result to myself. It was rather because I did not, at first, think it really necessary; and then, subsequently, when I supposed it to be really needful, I feared my patient would grudge the expense. This fear, by the way, was grounded in something more than mere conjecture. The proposal had been practically made, and had been rejected. In this general way things went on for some time. The friends grew uneasy, as they should have done; and one or two of them, now that it was almost too late, spoke of another physician as counsel. My own readiness and more than readiness for this seemed to have the effect to quiet the patient, though it had the contrary effect on his friends. They appeared to construe my own liberality and the admixture of modesty and conscientiousness, which were conspicuous in my general behavior, into self-distrust, and hence began themselves to distrust me. The patient's state of mind--for he was a man whose habits of thinking and feeling approximated very closely to those of the miser--more than once reminded me of some doggerel verses I have seen, perhaps in an old almanac, which are so pertinent in illustration of the point in my patient's character which these remarks are intended to expose, that I have ventured to insert them:-- "The miser Sherdi, on his sick-bed lying, Affrighted, groaning, fainting, wheezing, dying, Expecting every hour to lose his breath, Enters a Dervise: 'Holy Father, say, As life seems parting from this sinful clay, What can preserve me from the jaws of death?' "'Sacrifice, dear son, good joints of meat,-- Of lamb and mutton for the priest and poor. Nay, shouldst thou from the Koran lines repeat, Those lines might possibly thy health restore,' "'Thank you, good father, you have said enough; Your counsels have already given me ease. Now as my sheep are all a great way off, I'll quote holy our Koran, if you please.'" At length my patient began, most evidently, to decline. There were various marks on him and in him, of approaching dissolution. When pressed, as I frequently was, to say definitely what the disease was--that is, to give it a name--under which Mr. ---- labored, I only replied that he was suffering from premature old age. This always awakened surprise, and led to much and frequent inquiry how it was that a man of fifty-eight years could be dying of mere old age. My explanations, whenever attempted,--for sometimes in my pride of profession I wholly evaded them,--were usually, in substance like the following:-- "Mr. ---- was feeble by inheritance. He never had that firmness of constitution which several of his brothers now possess. Then, too, he was precocious. His body and mind, both of them, came to maturity very early; which, as you know, always betokens premature decay. Men live about four times as long, when not cut short by disease, as they are in reaching maturity. As he was apparently mature at fourteen or fifteen, he might very naturally be expected to wear out at or before sixty. "But then, in addition to this, he has all his lifetime labored too hard, not only from necessity, but from habit and choice. His ambition, it is well known, has been unlimited, except by his want of strength to accomplish. He has only ceased to labor hard when he had strength to labor no longer, or when it was so dark or so cold or so stormy as to prevent him. "Then of late years he has had the care and anxiety which are almost inseparable from the work of bringing up a numerous family. It is indeed true that he has not been called to that severest of all possible trials pertaining to the family, the pain of seeing that family or any of its members go materially wrong. Still he has had a world of care; of its effects none are aware who have not been called to the same forms of experience. "There is one thing more; Mr. ---- has, at times, taken a good deal of medicine: not alcohol, in any of its forms, I admit, but substances which for the time were, in their effects, almost equally bad for him. He has used tea immoderately, and even tobacco. His constant smoking has been very injurious to his nervous system, and along with other things has, doubtless, greatly hurried on the wheels of life." Remarks like these had their intended effect on a few individuals, especially such of them as were couched in language with which they were already familiar. On most, however, they fell lifeless and hopeless. What knew they about precocity and its effects on the after life? In short, it was quite doubtful then, and is still more doubtful with me now, whether, on the whole, any thing was gained by attempts at explanation. For example, when I spoke of my patient being worn out, prematurely, by overworking, it was asked by one man, "But how is this? Other men as well as Mr. ---- have worked too hard, and brought up large families, and perhaps taken a great deal of medicine, and smoked a vast amount of tobacco? Why are they not affected in this way as well as Mr. ----?" It was not easy to make current the idea that Mr. ---- was about to die of old age; although partly from conviction, but partly, also, to conceal my ignorance, I still endeavored to promulgate it. It was the only apology I could make for suffering a man to run down and die, without appearing to those around him to be very sick. But he died, after some time, to my infinite mortification and great regret. I was invited to his funeral, as I was usually to the funerals of my patients. In this case, however, I contrived to be absent. So great was my consciousness of ignorance and so much ashamed was I of my ill success, that I felt as if the veriest ignoramus would be disposed to point at me, and to charge me with having been, practically, the murderer of the much-beloved head of a family, and a worthy and highly respected member of society. But, whether others would deem me culpable for my ignorance or not, I could not avoid the pangs of habitual condemnation. There were, I grant, a few extenuating circumstances in the case. One or two causes existed, of premature decline, on which, in a work like this, I cannot stop to expatiate. It was also very unfortunate for him that he was accustomed to look on the dark side of things, and to forebode ills, where, oftentimes, none existed. Notwithstanding my former ignorance and doubt, and numerous misgivings, in cases like the foregoing, I have of late years, on a maturer review, been obliged very frequently to confirm my earlier decisions. In the case which has been detailed in this chapter, I have, on the whole, come to a belief that my first judgment was nearly correct; and that the patient actually perished, as much as men ever do, of premature old age. It is, indeed, very possible that had I pursued a different course in several important particulars, his life might have been prolonged for a year or two. Men have a tendency to become what they are taken to be; and many a person has died much sooner for being taken to be near his end, and treated accordingly. If we would have our patients recover, we must take for granted that recovery is at least possible. In the case above, I believe I lost reputation, in large measure. Several shrewd people insisted, at the time and long afterward, that I ought to have had medical counsel. Mr. ----, they said, was too good a man to lose without a more persevering effort to raise him. They charged me with having got my name up, and having at the same time grown careless. Had he been properly doctored, they said, from the very first, they believed he might still have been alive to ornament and bless society. CHAPTER XLVII. DAUGHTERS DESTROYING THEIR MOTHER. There are, of course, many ways of destroying or killing people. To kill, with malice aforethought, though sometimes done, is a much less frequent occurrence than killing in the heat of passion, or by carelessness; by leading into bad habits, or by the injudicious use of medicine. Then, again, there is such a thing as killing by omitting to keep alive. Thus we have sins of omission as well as of commission. If I leave a man in a mill-pond and suffer him to drown, or if I suffer him to take a dose of arsenic or Prussic acid, when I might, with the utmost ease, or even with considerable difficulty, prevent it,--is it not, in a practical sense, to destroy or kill him? It is certainly within the wide range of human possibility, that a daughter may, without bludgeon or pistol, and even without poison, kill her mother. And it is quite notorious and a plain matter of fact that many a mother kills her own children. It could be demonstrated that thousands, if not tens of thousands of children are destroyed every year by their own mothers; as truly so as if they had received at their hands a quantity of arsenic. Why, then, may not children sometimes kill their parents? I have known people, in very many instances, kill, in trying to save. I have even known the medical man do this, as may be seen by turning back to Chapter XXX. Then, too, I have known the attendants of the sick, though among their dearest friends, sometimes kill in this very way. In truth, such killing is not uncommon. One of the most painful instances of this last kind of killing came under my own immediate observation, and was in the range of my own practice. I was visiting a sick woman, whose only property lay in three or four lovely and loving children. Two of these, who were full-grown daughters, resided in her house and took care of her. She was severely afflicted with typhoid dysentery. Her daughters in turn watched over her, both by day and night, and would not suffer her to be left in the care of anybody else for a single minute. And, in general, their faithfulness was above all praise. One day, however, disliking the appearances of a part of my medicine, they mutually agreed to throw it into the fire; and the deed was done. They had supposed it to be calomel, as it had the color and general appearance of that drug, and to calomel they had a most inveterate and irreconcilable hatred. It was a hatred, however, which whether well or ill founded, very extensively prevails. At first, I could not help wondering at the results of my supposed doses of medicine; and indeed it was a long time before I began to suspect the true cause. For, while I verily believed I was employing the only thing which could help her,--one which I then thought _ought_ to help her,--I had the unspeakable mortification of finding her every day growing worse. What could be the possible cause, I often asked myself, of this downward tendency? While thus perplexed and pained, I accidentally learned that the main ingredient in my plan of treatment--the main pillar in my fabric--had been habitually withdrawn by her anxious but injudicious attendants. I no longer wondered at the threatening symptoms. My only wonder was, that things had not gone wrong with her at a much more rapid rate. The patient continued to sink from day to day, and to become more and more insensible. The daughters themselves saw her downward tendency, for it could not be concealed. I did not tell the young women of their error at first, although I did so afterwards. It was a most painful duty, but it was one from which I dared not shrink. I hoped and trusted it would be a means of saving some among the coming generations. I have never met with either of these daughters since that day--for one of them, at least, is still living--without blushing for their sake. They, on their part, appear to be equally affected and agitated. They almost adored their mother, and yet they inadvertently destroyed her. She might have perished, it is true, without their aid; but I rather think she would have slowly recovered. Let him that readeth understand: It is extremely hazardous for a second or third person to change the doses of a physician's medicine, either by the omission or addition of an ingredient. It would be safer--very much safer--to omit every thing, and leave the disease wholly to nature. The true course, however, in all cases, is to follow the prescription of the physician, to the best of our abilities, or else dismiss him. I might pause here a moment to animadvert on the unreasonableness of the vulgar prejudice which almost everywhere prevails against calomel. That this drug does great harm, in many instances, is most certain; but that it does more mischief to the human constitution when in the hands of judicious practitioners, than some half a dozen articles of the _materia medica_ I could name, about which complaint is seldom made, remains to be proved. Let us, if possible, prevent the necessity of using any of these two-edged weapons, by so living that disease cannot assail us, and then we shall not, of necessity, be exposed to the danger of medicinal agents, whether calomel or any thing else. My own principal error in relation to this interesting case, consisted in not telling the attendants of the sick woman, in the plainest language, what my medicines were and how much, in my own estimation, depended on their careful and proper exhibition; that if they should take away or suffer to be taken away, one faggot from the bundle, they would not only spoil their effect, but might, very probably, turn the edge of the sword against the very citadel of life itself. But from the extreme of explaining every thing, in sick families where I was called, I had passed over to that of explaining nothing. Truth here, as elsewhere, usually lies midway between extremes. CHAPTER XLVIII. POISONING WITH STRAMONIUM. One of my patients was subject to repeated attacks of rheumatism. He was by no means a man of good and temperate habits, and never had been so. And even his rheumatic attacks, though they were now frequently excited by taking cold, or by a sudden strain, as well as by many other causes of no considerable magnitude, often had both a foundation or predisposition in his former and later intemperance. Let me here say, most distinctly and unequivocally, even at the risk of being charged with repetition, that a large proportion of even these casual or apparently accidental attacks of rheumatism, neuralgia, sick headache, etc., etc., with which our world--the fashionable part of it, at least--is half filled, instead of springing out of the ground, or coming upon us by the special appointment of high Heaven, have their origin in the intemperance, excess, or licentiousness of somebody. The cause may lie many years back, and may be almost forgotten; nay, it may be found in a preceding generation rather than the present. But it lies somewhere in the range of human agency. "Almighty man," as the poet has well said, "decrees it." Solomon never uttered a more palpable truth than when he said: "Because sentence against an evil work is not executed speedily, therefore the heart of the sons of men is fully set in them to do evil." My rheumatic friend sent for me one day, to come and see him in great haste, for, as the messenger said, he could not long continue in such suffering. I found him in the greatest distress, and after making the usual temporary applications, I gave him what I had never given him before--a pretty full dose of tincture of stramonium. It had, in due time, its accustomed effect, and I left him, rather prematurely, to visit another patient in a somewhat distant part of the town, intending, however, to see him again in the evening. But I had not been absent more than an hour, before I was sent for in post-haste. As soon as possible I hastened to the spot. I found my patient in a state somewhat peculiar and not easily described. He was evidently affected by the stramonium; but how, I said to myself, can this be? I certainly did not give him an overdose. Besides, as I well knew, the effects, so long as I remained with him, had been decidedly favorable. The mystery was soon revealed. On finding himself much better, soon after my departure, he had resorted again to the stramonium bottle, which in my haste and contrary to my usual practice, I had left within his reach. The result was a degree of delirium that had alarmed his friends and induced them to send for me. By means of careful and persevering management, a partial recovery soon took place, though a train of incidental evils followed which it is not necessary here to enumerate. The patient was one of those ignorant and selfish individuals on whom a permanent cure can rarely be effected. This circumstance taught me one important lesson which ought to have been impressed on my mind long before. It was, not to leave medicine of any kind within reach of my patients or their friends. In many an instance, medicine thus left has been taken by others, under the belief that since it operated favorably in the case for which it had been prescribed by the physician, it would do so in another case which was vainly supposed to be just like it, when, in truth, it was not at all similar. To the custom of keeping medicine in the house, of any sort, I am equally opposed, and for similar reasons. There will generally be time enough to send for it when its presence is really needed. Such at least is the fact, ninety-nine times in a hundred. And as a set-off against the fact of its being thus useful once in a hundred times, we have to acknowledge the multiplied dangers to which we are exposed, of using it without prescription, and to which we are otherwise exposed by having it constantly before us in our houses. CHAPTER XLIX. CURING CANCER. Theodore, a laborious young man, came to me one day, saying, "I am afraid I have a cancer on one side of my nose, and I wish you would look at it." Accordingly I made a careful examination of the sore, taking care to give him a little pain, and, at the same time, as a most indispensable ingredient, to look "wondrous wise;" after which the following conversation, in its essentials, took place between us:-- "What makes you suspect this sore to be a cancer?" "There are various reasons. Many of the neighbors think it to be so. Then, too, it has a very strong resemblance to the cancer on Mrs. Miller's lip. And then, again, it burns and itches and smarts, just as people say cancers always do." "How long have you been troubled with it?" "It is three months or more since I first observed it; but it has given me very little uneasiness or trouble till within a few weeks." "What have you done for it?" "It would take a long time to tell you of all I have done for it. Every thing I could hear of, far or near, has been applied; from plasters of clay and chalk, to plasters of vitriol and other poisonous things. But I have used most a plaster made of chalk and the white of an egg. I do not know that any thing I have done has benefited it." "Perhaps you have not persevered in the use of any thing long enough. How long is it, pray, since you began to use the chalk and egg plaster?" "Oh, it is three weeks, or more." "And how long is it usual to wear it? do you know?" "Mrs. Lovejoy, who advised it, only said, 'Use it as long as it appears to do good.'" "Is it a favorite remedy with her?" "Very much so." "Has any one been really cured by it?" "Oh, yes. Mr. Browning, the gardener, was entirely cured by it; so, at least, people say." "Any one else?" "Yes, half a hundred or more have tried it." "But how many have been cured by it? That is my main inquiry." "That I cannot tell you. I have heard of no positive cure but that of Mr. Browning." "It is almost incredible, my dear sir, that any thing like fifty cases can have come within such a small range of population as the village or even the town in which Mrs. Lovejoy resides. Do you mean as you say?" "Well, then, a great many. I know of a dozen, most certainly; and I have heard of a great many more. I venture, at least, to say twenty." "And you have no positive knowledge of but one permanent cure among them all?" "Only one, I meant to say, that I can call by name. There must be many more, I am sure, but I have not their names." "Have you much confidence in a method of treatment that succeeds once in fifty times, or even once in twenty?" "Not much, I confess; but if it now and then succeed, that is something. You know that they who run in a race _all_ run, though but one receives the prize." "Are you quite sure there _is_ any gain or prize, after all?" "Do you mean to ask if I believe Mr. Browning was really cured?" "Yes." "How could I doubt what I have seen and known?" "I do not expect you will doubt the existence of what you have seen and known. But the question before us is, what you _have_ seen and known. Mr. Browning had something on his face, and it got well; but do we know it was a cancer? Only a very small proportion of twenty sores suspected to be cancers ever prove to be such, and many of them get well after a little time, if they are let entirely alone; or, if not let entirely alone, they would probably still get well, in spite of the treatment. It is quite a marvel with me, not that one person, Mr. Browning, recovered in spite of the treatment, but that more did not." "This is to me a new way of reasoning on this subject, and yet I do not know but you are correct. I confess, that on reflection, I do not find positive evidence that any good has been done to Mr. Browning. It may be so, or it may not. And yet the story of his cure is told all over the neighborhood and for many miles around, and Mrs. Lovejoy gets great credit by it." "No doubt she does; and thousands obtain both credit and cash in a similar way. Much of the reputation of our wonderful cure-alls, advertised in the newspapers, comes in a similar way." "Do you really think so?" "It can be demonstrated." "Why, then, is it not oftener done?" "It has been done, again and again." "Are the public, then, fully determined to act against their own interest? Do they choose to be humbugged?" "It seems so." "But can you do nothing with my face?" "I can try. I will do what I can. But I must first tell you what I _cannot_ do. I cannot pronounce your disease to be cancer. I cannot say positively that my method of treatment will cure it. I cannot say, moreover, that somebody else cannot cure you, even if I cannot. If, however, I prescribe for you, you must consent to follow me for the time most implicitly, and let everybody else alone." "That I shall be both willing and glad to do." "You need not begin till you are fully satisfied in regard to the efficacy of Mrs. Lovejoy's plaster." "I am pretty well satisfied already. I see that science is modest but honest, and I prefer it to humbuggery." My prescription was an application of the common blistering ointment of the apothecary's shop. The part to which it was to be applied was quite denuded and tender; but I told the patient to stick a small piece of the plaster over it and wear it, and keep it as sore as he could for a month or more. He was, however, to call on me once a week,--or, perhaps, at first, twice,--that I might watch the effects. There was some danger of an absorption of the cantharides into the system, which might do more of general harm than would justify an attempt at local good. No man ever followed the prescription of his physician with more pertinacity and faithfulness than young Theodore. He adhered, without wavering, to plain and unstimulating food, and to water for drink. At the end of twenty-one days, all the fiery redness of the ulcer had passed away, and it had begun to wear a healthy appearance. "Now," said I, "you may take away your plasters, and let the sore get well, if it will." In about ten, or at most fourteen days more, the young man's nose was as well as any other part of his system. Whether the Spanish flies contained in the plaster had any thing to do with it, or whether it recovered its healthful condition in spite of them,--having just then got ready to heal,--I cannot, of course, positively determine. In any event, the case was a strong one, though not stronger, I confess, than that of dosing largely with calomel, as detailed in Chapter XXXII. And yet, as I have already told you, I should not dare to repeat that heroic treatment. Success is not always competent proof that a given course is correct;--at least, this is true with regard to the success of a particular formulary of medicine. There are very many things on earth to be known and thought of, as well as in heaven. CHAPTER L. SWELLED LIMBS. Not far from this period I was called to visit Mr. O. B., sixty-one years of age, a farmer by occupation. He had been for twenty or thirty years addicted to cider drinking very freely, according to the custom of the country; which habit, conjoined with full feeding, a diminished amount of exercise, and a lymphatic tendency by inheritance, had rendered him exceedingly corpulent. His legs had even fallen into a habit of swelling, especially at night, sometimes to a very alarming extent. His story concerning himself was essentially as follows: In getting into a wagon, some time before, he had detached a small portion of skin from one of his legs. Although the wound was slight, and was duly attended to, according to the usual method of the family, with cabbage leaves, and with considerable care and neatness, yet, instead of healing kindly, it had put on a very unhealthy appearance, and had, at length, even become extensively ulcerated. He was also habitually a sufferer from chronic rheumatism in his back and hips, partly constitutional and partly as the result of overstraining the parts, especially in wrestling. When I was called in to see him, it was about the last of June. His wounded leg was now evidently growing worse; and as the heat of the weather was increasing, and was for some time to come likely to increase, I could hardly help apprehending the most serious consequences. He had been in the habit of making greasy applications to it for a short time, but these at my special request were set aside immediately. He was also encouraged to keep his leg cool; to exercise his whole system moderately; to avoid exciting, above all, stimulating, food and drink; and to keep his mind quiet. In regard to drinks, particularly, he was directed to use none but water. He was also required to abstain wholly from pork, and all long-salted meats. He had also been, for almost half a century, a chewer of tobacco--a circumstance rather unfavorable to a rapid return of healthy action; but I did not think it expedient to interdict its use entirely at the very first; for I feared the change, at his advanced age, would be more than his system could well endure. In fact, I found it extremely difficult to persuade him to pursue the straight and narrow path which, letting alone his tobacco, I had deemed indispensably necessary. To encourage him to do so, I availed myself of a circumstance which, though in itself trifling, was nevertheless likely to have its influence. The thirteenth day of July was at hand, and would be the fortieth anniversary of his marriage. My proposal was that he should commence the change of habits that very day, and continue it precisely eighteen months. Although the danger to which he would be exposed by neglecting my prescription was neither immediate nor imminent; yet it was so considerable in prospect that I pressed him very hard to comply with my requirements, notwithstanding their seeming rigidity. And as a further inducement,--for he was not above the influence of pecuniary considerations,--I offered him a certain sum of money. I left him without much hope, after all, that he would follow out my suggestions and advice, so difficult is it, at the age of sixty, to make substantial and radical changes. But I was most happily disappointed. He began the work of reform on the very day appointed, and began it well; and though he did not adhere to the letter of my prescription entirely, he did quite as much as I had dared, even in my most sanguine moments, to expect. And though his leg did not at first improve much, it was something to find that during the very hottest weather of the season it did not grow worse. For three months he did not use, as he said, so much as fifty cents worth of pork, nor much salted food of any kind. He abandoned entirely all drinks but water, and all condiments with his food except a little salt. He subsisted almost wholly on bread, fruits, and vegetables, with a very little flesh or fish. At the end of three months he ventured abroad more than before; and as it was now near the middle of October, he consented to put on woollen stockings. But he made one change at this time which I had not intended. He returned to the use of one of his former greasy and worse than useless ointments. In the course of the month, however, in spite of the foul external application, his leg was entirely healed; and the swelling considerably abated. In short, at the close of the year he had entirely recovered. The friends and neighbors attributed the cure to the ointment. How very unreasonable! The ointment had been used during the spring, up to the time when he came under my direction, without any apparent benefit. What evidence then was there that it had been useful now? Why should not the change for the better be attributed to his increased exercise, the change of air and food, and the stimulus and warmth of woollen stockings? Had water, moreover, as his only drink, nothing to do with the cure? But while standing in the position I did, it was useless to decry the ointment or exalt my own treatment, since it would have been regarded as merely special pleading. Still, I did not shrink wholly from the statement of my honest convictions, whenever I was inquired of, even though I did not manifest a disposition to carry the war into Africa. CHAPTER LI. SUDDEN CHANGES IN OLD AGE. Mrs. N. was about seventy years of age. In her early years she had possessed a sort of masculine constitution; and though embarrassed by poverty, had reared a large family of children, who were all well settled in the world. She resided with the youngest but one of them, where she did just as she pleased. In short, she had a good home, and, had she enjoyed health, might have been happy. But a change had come over her in point of health, which it was not so easy to account for at its outset as in its progress. For her first derelictions, at least, I know of no cause. But she had, at length, become reconciled to the use of tea, and as her spirits began to flag, she added to it strong coffee. From these she proceeded to the pipe. The more she increased her extra stimulants, the more she added to her troubles, and the greater was her necessity for additional stimulus. Laudanum was very soon on her list; at first, it is true, in very small quantities. Yet, as she grew older, she found a necessity, as she verily believed, for increasing the size of her dose from year to year, till, at the age of seventy, I found her in the full and free use of tea, coffee, tobacco, and laudanum,--the latter to the enormous extent of half an ounce a day,--and yet her complaints were more numerous than ever. She was a reasonable woman, and therefore I attempted to set forth, in their true colors, the realities of her condition. However, as I was not acting as her physician, but only as a friend, I had little hope of making any very permanent impressions. She knew the whole story as well as I or any one else could know it. The great difficulty under which she labored was a want of resolution to change her habits. Her irresolution was sustained by the belief--a very general one--that old people cannot make sudden changes in their physical habits with safety.[G] But she was unhappy in the condition she then was. She had no peace with conscience, nor, as I might almost venture to say,--for she was a religious woman by profession,--with God. I assured her that the real danger of sudden changes, at her age, had been greatly overrated; though danger there certainly was, in greater or less degree. But I pointed out to her the means of obviating what danger there was, and urged her, as a Christian, to make up her mind to meet it. Of course, I did not presume to urge her to cast every thing aside, and return to Nature's path at once; but to drop first one thing and then another. I counselled her to be thorough and determined, as far as she went; and when she abandoned a thing to make no reserve, but to be sure of not going too fast and too far at once. When I left her one day, after a somewhat protracted conversation, it was with many feelings of discouragement. I doubted very seriously whether, on the whole, she would move at all. The power of half an ounce of laudanum and a paper of tobacco daily, in paralyzing the human will, is very great. But she was one of those persons who cannot, or think they cannot, leave off a habit gradually, in the way I proposed. She must "go the whole figure," as it is said vulgarly, or do nothing at all. Judge then, if you can, of my surprise, when about two months afterward I learned, from a source which was perfectly reliable, that the very next day after I saw her, she abandoned the whole herd of extra stimulants, both solid and liquid, and betook herself to water. Nor had it, so far as I could learn, at all injured her. No sooner did I hear the news of her reformation, than I took my horse and made her a visit. There she was, nearly as well as ever she had been in her life, though perhaps a little paler and thinner. And oh, what rejoicing she had in her freedom! It would have done you good to see her. She had now no fears for the result. "True," she said, "I suffered for a few days, but the agony was soon over." One thing should be mentioned, since it doubtless added to the dangers, real and imaginary, of her condition and trial. It took place during the middle of a very cold winter--one of the coldest which we of the North ever experienced; scarcely, if at all, behind those of 1855-6 and 1856-7. But all persons have not Mrs. N.'s faith, nor her deep-abiding religious principles. These, it is presumed, greatly aided her in the terrible conflict. No one ought to attempt such changes, at least in life's decline, unless most fully convinced of their importance and necessity. Yet, _with_ this conviction, and strong faith in addition, all becomes comparatively easy. Mrs. N. died a few years after her reform; but she died a free woman, and not a slave to her appetite. Some few there were of her acquaintance who appeared to think that the sudden changes to which she had subjected herself several years before, hastened her dissolution. But I do not believe there was a particle of evidence to be found that such was the fact. Reader, remember Mrs. N., and if you are in the road of error, and not more than seventy years of age, go and do likewise. If you have not _lived_ free, resolve at least to have the pleasure of dying so. FOOTNOTES: [G] This error has been met and refuted in the happiest manner, by the late lamented Dr. John C. Warren, of Boston, in his little work, entitled, "Hints for the Preservation of Health." Also, by Dr. Alcott's new work, "The Laws of Health." CHAPTER LII. AN OPIUM EATER. Almost at the next door from me was an opium eater. He, like the female whose case was described in the preceding chapter, was not far from three score and ten, and was of industrious and, in many respects, temperate habits. And yet he was one of the most inveterate and abandoned voluntary slaves to the drug opium I have ever seen. He had used it largely thirty years. His case is the more singular from the fact that he became enslaved to it so very early. To use opium or laudanum at the present day, I grant is no uncommon occurrence. We may often find six, eight, or ten opium takers in a single township, if not a single village, or even a single neighborhood; and the number is rapidly increasing. Opium has not that offensive appearance to many that tobacco has, and a much larger amount of stimulus may be kept in a very small space, perhaps in the very corner of the smallest pocket. Another circumstance which rendered the case of my opium-taking neighbor somewhat striking, was his usual good health. I say, here, _usual_, for there were exceptions which will appear presently. Yet though he was nearly threescore and ten, this man had, while under the influence of his accustomed stimulus, as much elasticity and nearly as much strength as most men of thirty. How could this happen, you will naturally ask, if opium is such a deadly narcotic as some medical men proclaim it to be? How can a person, male or female, begin its use at forty and continue it to seventy years of age, and yet be, for the most part, strong and healthy? In the first place, we must remember the force of habit. We have seen how it is with alcoholic drinks and tobacco. I might tell you how it is with arsenic, which is beginning to be taken, it is said, by men and horses, both in the old world and the new. I might even give you the story of Mithridates, king of Pontus, who is said to have so accustomed himself to hemlock,--the most deadly poison of his time,--that in any ordinary dose, it would not affect him injuriously, or, at least, would not do so immediately. We must remember, in the second place, the active, industrious habits of this patient--of which, however, I have already spoken. He who is always or almost always in the open air, is less likely to suffer from the use of extra stimulants, and the penalty when it _does_ fall on his head, is much more likely to be deferred, than in the case of the sedentary and inactive. He was so hardy and withal so bold, that in the summer season he sometimes slept in the open air, under a tree. But, thirdly, he was descended from a very long-lived race or family. His father died at the age of ninety-seven. At the time of his decease he had been the progenitor of nineteen children, one hundred and five grandchildren, one hundred and fifty-five great grandchildren, and four of the fifth generation,--a posterity amounting in all, to two hundred and eighty-three. And what is most marvellous, nearly all of them were at that very moment living. In truth, he had several sons and daughters already between the ages of sixty-five and eighty. There was one of the brotherhood, whom I had seen, nearly eighty, and yet as active and elastic as the opium eater of seventy. One thing more: The latter, as we have seen, was a man of excellent habits in respect to nearly every thing but opium. He drank no ardent spirits, nor much coffee and tea; he used very little tobacco, and he ate in great moderation. He was an early riser and was in general cheerful. In short, but for his opium taking, he would have enjoyed a green old age. I have said he was usually healthy. When he was out of opium and could not obtain any, I have seen him sit and writhe in the most intense apparent anguish till the arrival of the accustomed stimulus, when the transformation would be as sudden as it was striking. In fifteen minutes, instead of writhing and groaning and almost dying, he might be found talking, laughing, and telling stories most merrily, to the infinite amusement of all around him. But he had troubles more abiding than this; at least, occasionally. After taking his opium for a long time, such a degree of costiveness would sometimes supervene, as seemed almost to defy the combined powers of both nature and art. In these circumstances, of course, the aid of the physician was usually invoked. It was on one of these occasions that I first became fully acquainted with his habits and tendencies. Once, when thus called to his bedside, I began to think he was not very far from the end of his career. The wheels of life seemed so completely obstructed, that I doubted whether they would ever start again. He himself declared, most positively and I doubt not in sincerity that he must die. But he lived on many years longer. He died at about seventy-five years of age--more than twenty years younger than his venerable and more temperate father. From this distinguished opium eater, and from his family, I learned two things: First, that Solomon was right when he spoke of the certainty of punishment, even though long deferred. Secondly, the certainty of the visitation, so to call it, of human transgression upon subsequent generations no less than on the individual transgressor. The fourth generation from the patriarch of ninety-seven was puny and feeble--exceedingly so; the fifth and sixth not only puny and feeble, but absolutely sickly, not to say dwarfish. Did I say I learned these important truths from this source? Not at all. I mean only, that I received from it a new confirmation of what I had fully believed long before, and concerning which, till compelled, most men--even some thinking men--appear to me not a little sceptical. They seem to think it reflects dishonor on our Maker. How this is, we shall perhaps see more fully in another place. Let it suffice, for the present, to say that the fact itself is fully established, whatever may be the deductions or its consequences. CHAPTER LIII. COFFEE, AND THE LAME KNEE. Mr. W. was a distinguished minister of the gospel, and teacher of females. He could not at this time have been much less than seventy years of age. He was originally a man of iron constitution and of great mental activity. Of late it had been observed by some of the members of his family, that his mind had seasons of great inactivity, and it was even suspected he had, either in his sleep or at some other time, suffered from a slight attack of paralysis. His face seemed a little distorted, and one of the angles of his mouth a little depressed. There appeared to be a slight change even of his speech. It was recollected, too, that he inherited a tendency of this kind. Along with other difficulties was a lame knee. This he called rheumatism; but was it so? People are very fond of having a name for every thing; and yet names very often mislead. Prof. Ives, of the Medical College in Connecticut, was wont to say to his students, "Diseases, young gentlemen, are not creatures to whom we can give particular names, or assign particular marks of distinction. They are merely _modes of action_." My friend's over solicitude for a name to his complaint was therefore no new thing. I explained the matter as well as I could, very cautiously. I told him it was of little consequence about the name of his disease, provided we could ascertain the cause and remove it. "However," I said, "we will conclude to call it rheumatism." For though possessed of a good natural constitution, and, in general, of comparatively temperate habits, he had nevertheless set at defiance some of nature's laws, and was suffering under a just penalty. One member of his family, a favorite son, was suspicious of coffee. He himself had abandoned it long before, and had thus placed himself in a position to observe its effects on others. His father used it very strong, he said; and had used it in this way for a long time. He even ventured, at length, to express his fears to his father. "Nonsense, my son," said the father; "do you think coffee is powerful enough to give a man a lame knee? Why, the whole world--I mean the whole civilized world--use it; and do they all have stiff knees?" "Perhaps not," said the son; "but almost every coffee-drinker has, sooner or later, some ailment about him, that may very possibly have its origin in this source. Our troubles, as you yourself are accustomed to say, do not spring out of the ground. Coffee, as the best authorities tell us, is a slow poison; and if it is so, its effects must, at some time, be manifested." "Ay, a very slow poison this coffee must be, my son," said the half-indignant father; "for I have used it pretty freely forty years, and am not dead yet. But to be serious for a moment, Henry, do you really believe that such a small transgression as this, even if it could be proved to be a transgression at all, would be the cause of so much suffering?" "You admit, then, that your troubles may possibly be the result of transgression, and that they did not spring out of the ground." "Oh yes, I suppose it must be so; but there is such a strange disproportion between the transgression and the penalty, in the case you mention, that I cannot for one moment believe any thing about it. Why, what rational man in the world will believe that a little coffee, once a day, will entail upon a person severe rheumatism?" "To what larger transgression, my dear father, will you be more ready to refer it? You do not use tobacco, or rum, or opium; and I am happy in being able to say that you never did. You are no tea-drinker. You are no worshipper of the apothecary's shop. You have not, so far as I know, strained your knee, by over exertion, either in labor or amusement Yet, here you are a sufferer; and you have suffered for months. Now, how do you account for it?" "There is no possibility of accounting for it, my son, and why should we talk about it? If any thing can be done to cure it, I am sure I shall be glad; but though I admit that the complaint may have had a cause--and indeed _must_ have had--I do not think we shall ever be able to trace it out." The son still adhered to the opinion that the coffee was the cause of the father's sufferings; and there was reason for believing that the father was more than half convinced of it himself; only that he was too proud to confess it. He concluded by asking his father if he would like to consult me on the subject--to which he cheerfully consented. On a careful investigation of the case, I came to a full conclusion that the son was right in his conjectures; that the coffee was the principal source of his troubles; and that troubles still more serious might befall him unless he abandoned it; and accordingly I told him so. It was a severe trial. He was, in truth, a most inveterate coffee-drinker; and the greater his slavery to it had become, the greater his reluctance to believe it produced, on him, any injurious effects. He consented, at length, to leave off its use for two months, and see if it made any difference with him. Being, however, about half a convert to hydropathy, as was also his son, it was concluded, with my permission, to apply the cold _douche_ every day to his knee, by way of an adjunct to the abstinence plan. No change was made in his diet; as, in fact, very little was needed after the coffee had been removed. "But one thing is needful," at the same meal, had long been his motto; and he was never excessive in the use of even that. The coffee was laid aside, and resolution was put to the test. He suffered in his feelings for want of his accustomed stimulus during the first month; but during the second, very little. In about five weeks after I saw and had prescribed for him, I met him one day, by accident, and inquired about his lameness. "Very much better," said he, smiling; "but no thanks to you for it. It is the _douche_ which is curing me." I replied that I was not very solicitous to know the cause, provided he was cured. On a more particular inquiry I found that his lameness had nearly disappeared already; and what is more remarkable still, it never returned. As long as he lived he could walk up and down stairs nearly as well as I. He continued to be a water-drinker about ten years, when he died, as he had lived, rejoicing in his emancipation from slavery to coffee. He believed, most fully, in its evil effects and tendencies, and did not hesitate, for many years before he died, to acknowledge that belief. Neither his son nor myself had firmer faith in the connection of law with penalty, in these matters, that he. And his only regret, in this particular, seemed to be that he had suffered himself to remain, almost all his lifetime, in what he now regarded as utter ignorance. And yet, compared with most men of his day, he was quite enlightened. The case of Mr. W. was a pretty apt illustration of the truth of what I regard as the great or cardinal doctrine of temperance, faintly announced in Chapters XVIII., XXI., XXVIII, and elsewhere, viz., that, as a general rule, much more mischief is done to society at large by the frequent or at least habitual use of small quantities of poison, than by an equal aggregate quantity in much larger doses. I mean just this: The poisonous effects of Mr. W.'s coffee, though the amount daily taken was trifling, produced a greater aggregate of mischief, in the end, than if the same amount of poison had been applied in a very short time. A pint of rum drank in a single day will do much less mischief to the human constitution, than if divided into twenty _small_ doses and two of them are taken every day for ten days. In the first case the effect will be severe, but temporary; in the second, it will seem to be trifling, but there will be an accumulation of ill effects, a heaping up, as it were, of combustible matter in the system, till by and by when an igniting spark comes to be applied to the pile, lo! we have an explosion. Some of the hydropathists who knew the facts concerning Mr. W.,--for the case did not occur in a corner,--tried to make it appear, perhaps in all honesty, that he was cured by the cold _douche_. Now I have no disposition to deny, wholly, its good effects. I have given you the facts just as they were. Yet I have not a doubt that had he returned to his coffee, the same troubles or others of equal magnitude would have fallen to his lot again, despite the influences of the _douche_. In truth, I know of no sensible hydropathist who, in such a case, would rely upon the _douche_ alone; which is to concede, practically, all that I desire to claim. CHAPTER LIV. THE OPIUM PILL BOX. The statements of the following chapter will include a confession of one of the principal faults of my life,--a fault, moreover, which, as a physician, I ought to have guarded against with the most assiduous and unwearied care. For no man more than the medical man, is bound to let his light shine--especially in the matter of general temperance, in such a manner that others may be benefited by it. When, in the beginning of my medical career, I attempted to establish a temperance society, though I was exceedingly free from the charge of using distilled liquors, according to the tenor and spirit of the pledge, yet exposed, as I was, to colds, and delicate in constitution, and above all, particularly liable, in the daily routine of business, to temptation, I was yet one of those who lay aside one stimulus and retain or resort to another. I did not, indeed, use my substitute with much freedom, at first. The example daily before me, which was alluded to in Chapter LII, was sufficient, one would think, to deter me from excess; and so it proved. All I did for some time, whenever I had been peculiarly exposed and feared I had taken cold, was to go and swallow a small pill--say about a grain--of opium. But as usually happens in such cases, though the pill seemed to remove all tendency to cold, or in other words to cure me for the time, the necessity for recurring to it became more and more frequent and imperious, till I was, at length, a confirmed opium taker. And yet--strange to say it--all the while I regarded myself as a rigid temperance man; nay, I was a violent opposer of the use even of opium as a daily stimulus, in the case of everybody but myself. My apology was--and here was the ground of self-deception--that I only used it as a medicine, or rather as a medical means of prevention. It is, however, quite obvious to my own apprehension now, that a substance is hardly entitled to the name of medicine, in any ordinary sense of the term, which is used nearly or quite every day. Yet to this stage of opium taking I soon arrived. Nay, I went even much farther than this, and was, at length, pretty well established in the wretched habit of using this poisonous drug three times a day. In the summer of 1830, while under the full habitual influence of opium, I had a slight attack of dysentery. It even went so far as to derange all my habits, and to break in, among the rest, upon my opium taking. Opium or laudanum was, indeed, included in the prescription of my physician,--for I did not wholly rely on my own judgment in the case,--but as a habitual daily stimulus, at certain fixed hours, it was, of course, omitted. As I began to recover, however, my old desire for the opium pill began to recur, at the accustomed former hours, and with all its wonted imperiousness. In a moment of reflection, reason resumed her throne, and the inquiry came up, whether I should ever again wear the chain which had been temporarily loosened. After a short debate, it was decided in the negative. But a second question soon came up, whether I could keep my resolution. This was a matter of serious inquiry, and it caused a somewhat lengthy mental discussion. During the discussion a new thought struck me. It was a child's thought, perhaps; and yet it was interesting, and not to be despised for its simplicity and childishness. It was that I would take my opium, what I had in the house, and after carefully enclosing it in my pill box, would make use of the box as a nucleus for the twine I was daily using. "When I am inclined to break my resolution," thought I, "nothing shall be done till I have unwound the ball of twine. I shall thus gain a little time for reflection; and perhaps before I come to the opium, I may permit reason to return and to mount the throne. The trial shall, at all events, be made." My resolution was carried into effect, and steadily adhered to. The opium was fairly entombed in the twine, where, for aught I know, it still remains. Most certainly I never saw it more; nor have I ever tasted any of the opium or laudanum family, from that day to the present, whether in sickness or in health. CHAPTER LV. BLEEDING AT THE LUNGS. Having occasion to go to the metropolis, one day, I took the most expeditious public conveyance which the times and the season afforded. It was January, 1832. Railroad cars were not so much in vogue that I could step into one of them, and, unless in case of accident, be there in four or five hours, as I now could. It required something like twenty-four hours to perform the journey I proposed, especially in the winter. We started at three o'clock in the morning. It had recently snowed, the snow was deep, and the path was not well broken. Of course it was not daylight when we set out, and as it was cloudy, it proved, as is not unfrequent in such cases, to be the darkest time in the whole twenty-four hours. However, we did as well as we could--driver, horses, passengers, and all. Our company consisted of seven males and two females. The coach was small, and we filled it to the brim. The weather was by no means very cold for the season; at least, it was not extreme. There was a sound of rain,--the January thaw, perhaps, as we are wont to call it,--but as yet, fortunately for us, the storm had not begun. We had proceeded about ten miles, and the day had not yet dawned, when, in passing around the point of a hill and winding our way among the deep drifts, our driver and his charge missed the path, and we were precipitated down a steep bank. The horses stopped immediately. Every effort was made to rescue us from the stage-coach, which was lying on its side, deeply embedded in the snow. I was so situated at the first moment after the overturn, that most of the affrighted passengers made use of me as a stepping-stone in their endeavors to reach the door above, which was either opened or broken. At last we were all fairly outside of the coach; no one appeared to be seriously injured. As we were at a considerable distance from any dwelling-house, and as the stage-coach was somewhat broken, and the harnesses torn, it required a full hour to put things to rights, so as to enable us to proceed. Meanwhile, though the weather was not very cold, it was quite chilly. Some of the passengers stood still or sat still; others walked about. The day had broken when we renewed our journey. The sleighing here was better than at the place where we started. At the next stage-office we exchanged our coach for a huge sleigh, which was not only more commodious than the coach, but more easily drawn over the ground, especially for a short time. About noon it began to rain. Soon the travelling became worse again, and our progress was slow and tedious. To me, the tediousness of the journey was increased by a lame shoulder--the effect either of the overturn, or of being used as a stair when the passengers made their sudden exit, or of both. No bones were broken, nor joints dislocated; though there were several considerable bruises. Our other troubles were not yet over. In the midst of a violent rain, and at a considerable distance from any public house, our sleigh broke down, and we were obliged to send for a wagon. In making the exchange, moreover, we were more or less exposed to the storm. I for one became considerably wet, and did not get perfectly dry till we reached the metropolis. We arrived at evening at a large thoroughfare, forty miles or more from our point of destination, when, after procuring a comfortable supper and a good sleigh, with a new relay of horses, we set out to perform the remainder of our journey. This was fortunate and very expeditious. We reached our place of destination just before midnight, having travelled the last forty-two miles in little more than four hours. This was almost equal to railroad speed; but it was good sleighing, and we had with us, in the sleigh, the United States mail, which imposed on the driver a necessity of being as expeditious as the nature of the case would admit. For even then, we had been twenty-one hours in making our passage. I soon discovered that I had taken a severe cold during the journey; nor do I believe my opium itself would have saved me. My only medicine was a warm bed, into which I threw myself as soon as possible. In the morning I repaired as early as I could to a boarding-house, in which a friend to whom I had previously written, had made ready a place for me. I was at first quite ill; but in the hope that a few days of rest would restore me, I was not particularly anxious about myself, though some of my friends were so. Several individuals called to inquire after my health--nearly every one of whom pressed me to take medicine. The second day after my arrival I began to expectorate a little blood. Those who were familiarly acquainted with my consumptive tendencies became greatly alarmed. They thought me not only presumptuous, because I took nothing, but absolutely and carelessly ungrateful. And as I refused to dose myself, they pressed me to send for a physician. Yielding, at length, to their importunity, they called one of the oldest and best physicians in the metropolis. He was an eccentric man, but he had the full confidence of the better sort of people, and richly deserved it; and I knew I should not be advised by him hastily. He was acquainted with my peculiar views, at least in part. Besides, I should not be obliged to follow his counsel implicitly. I should still be my own physician. My disease had not, at least thus far, impaired my intellect or taken out of my hands my free agency. The doctor remained with me half an hour or so, during which time I made him acquainted, as perfectly as I could, with my whole case. My good friends, many of them, sat around waiting almost with impatience, to hear him bid them or me to do some great thing--for great men though some of them were, they were not great in matters pertaining to health and disease. They were born, several of them, in the eighteenth century. At length the time for prescription and departure had arrived, and my good brother and father of the lancet rose very deliberately, and said with great gravity, "You will be obliged to stay in your room a few days, and keep both your body and mind as quiet as possible. For the most part, it will be well to maintain a recumbent position. For food, use a little water gruel. In following this course, I think you will very soon find yourself convalescent." Then, with a sort of stiff bow, that every one who knew him could pardon in so excellent a man, he said, "Good-morning, sir,--Good-morning, gentlemen;" and was making the best of his way to the door of the chamber. "Will it not be needful for you to call again?" I said to him. "I shall be most happy to call," said he, "should it be necessary; but I doubt very much whether my advice will be any farther required." My friends were very much astonished that he did not prescribe active medicine. "What can it mean?" they asked again and again. For myself, too, I must confess that I was not a little disappointed. Not that I had any considerable attachment to pills and pill boxes,--such a confidence had gone by long before, as you know,--but I verily thought my particular tendencies to pulmonary consumption demanded a little tincture of digitalis, or something in the shape of strong medicine. But the physician knew my theories, better than he knew the power of that habit whose chains, in this respect, he had long ago escaped. For I learned afterwards, much better than I then knew, that so feeble was his faith in medicine, at least in all ordinary cases, that whenever the intelligence of his patients would at all warrant it, he prescribed, as he had for me, just nothing at all, but left every thing to be done by Nature and good common-sense attendants. This was, in fact, just what he attempted to do here. He doubtless supposed my friends were nearly as well informed in the matter as I was; and that I was as fully emancipated in practice as I was in theory. "How much drugging and dosing might be saved," I said to myself, when I came to reflect properly on the subject, "if mankind were duly trained to place a proper reliance on Nature and Nature's laws, instead of fastening all their faith on the mere exhibition of some mystic powder or pill or tincture--or, at best, a few drops of some irritant or poison. It is their ignorance that makes their physicians' and apothecaries' bills so heavy, and the grave-digger's calling so good and so certain." It is hardly necessary for me to say that I followed the advice which had been so wisely given, and which, after all, was but the echo of my own judgment, when that judgment was freely exercised. My friends were not satisfied at first; but when they saw that I was slowly recovering, they submitted with as good a grace as they could. The fact was that they had no court of appeal. They had selected a man who was at the head of his profession, and whose voice, in the medical world, and as a medical man, wherever he was known, was law. Had some young man given such "old woman's" advice, as they would most certainly have regarded it, they would have appealed to a higher court. No man ever did better, when placed in similar circumstances, with the aid of medicine, than I did without it. In two weeks, at farthest, I was as well as I had been at any time in ten years or even twenty. What more or greater could I have asked? What more could my friends have expected? What more could have been possible? Could Hippocrates or Galen have done more? CHAPTER LVI. BUTTER EATERS. About the year 1833, I became somewhat intimately acquainted with the dietetic and general physical habits of a young woman in a family where I was a boarder, whose case will be instructive. She was about twenty-five years of age, and resided in a family that had adopted her as their own, her parents being unknown. She possessed a good natural constitution; and was, for the most part, of good habits. If there was any considerable defect of constitution, it consisted in a predominance of the biliary and lymphatic over the nervous and sanguine temperaments. Yet she was not wholly wanting in that susceptibility, not to say activity, which the sanguine temperament is wont to impart. But the same necessity which is so often the mother of invention, is also sometimes the progenitor of a good share of activity; and this was, in a remarkable degree, the lot of Miss Powell. Although her skin was not by any means fair, it was not a bad skin. It was firm in its structure, and very little susceptible of those slight but ever recurring diseased conditions in which persons of a sanguine temperament so often find themselves involved. Such I mean to say was her natural physical condition, when uninfluenced by any considerable practical errors. And yet I had not been many months one of her more intimate acquaintances, ere her face--hitherto so smooth and transparent--became as rough and congested as any drunkard's face ever was, only the eruption was more minute. It was what the common opinion of that region would have called a rash. It came on suddenly, was visible for a short time, and then gradually disappeared, leaving, in some instances, a branny substance, consisting of a desquamation of the cuticle. When the eruption had once fairly disappeared, her skin was as smooth as ever. Then again, however, in a little time, its roughness would return, to an extent which, to young ladies, is usually quite annoying. Young men, in general, are not so much disturbed by a little roughness of the skin, as the young of the other sex. My particular acquaintance with her habits and annoyances continued as many as four or five years. During this period there were several ebbings and flowings of this tide of eruptive disease. My curiosity, towards the end of this period, was so much excited that I sought and obtained of her an opportunity for conversation on the subject. The result was as curious as it was, to me, unexpected. It appeared, in the sequel, that she understood, perfectly well, the whole matter, and held the control of her cutaneous system in her own hands, nearly as much as if she had been a mere piece of mechanism. She had not sought for medical advice, because she knew the true method of cure for her complaints as well as anybody could have told her. In truth, she cured it about once a year, simply by omitting the cause which produced it. This she had found out was butter, salted butter, of course, eaten with her meals. She had somehow discovered that this article of food was the real cause of her disease, and that entire abstemiousness in this particular, would, in a reasonable time, remove it. I inquired why, after a long period of abstinence from butter, she ever returned to its use. Her reply was that she was too fond of it to omit it entirely and forever. She preferred to use it till the eruption began to be quite troublesome, which was sometimes many weeks; then abstain from it till she recovered, and then return to it. This gave her an opportunity to use it from one-third to one-half of the time; and this she thought greatly preferable to entire abstinence. At this time I did not press her to abandon wholly an article of food, which, though partially rejected, was yet slowly producing derangement of her digestive system, and might, in time, result in internal disease, which would be serious and irremediable. I did not do it; first, because I knew my advice would not be very acceptable; secondly, for want of that full measure of gospel benevolence which leads us to try to do good, even in places where we have no right to expect it will be received; and, lastly, no doubt for want of moral courage. Were I to live my life over again, particularly my medical life, I would pray and labor for a little more of what I am accustomed to call holy boldness. By this term I do not mean _meddlesomeness_,--for this is by no means to be commended,--but true Christian or apostolic boldness. Of late years the young woman above referred to has been in circumstances which, I have reason to believe, practically precluded the use of the offending article. I meet her occasionally, but always with a smooth face, which greatly confirms my prepossessions.[H] Happy would it be for a multitude of our race if their circumstances were such as to exclude this and many other articles of food and drink which are well known to injure them. One instance occurred in the very neighborhood of the foregoing, which, though I received it at second hand, is not a little striking, and is wholly reliable. A certain young mother--the wife of a merchant in easy circumstances, was so excessively fond of butter, that, though she was a dyspeptic, and knew it increased her dyspepsia, she used to eat it in a manner the most objectionable which could possibly have been devised. For example: she would take a ball of this article,--say half or three-quarters of a pound,--pierce it with the point of a firm stick, and having heated it, on all sides, over the fire, till the whole surface was softened, would then plunge it into a vessel of flour, in such a manner that the latter would adhere to it on all sides, till a great deal was absorbed by the butter. Having done this, she would again heat the surface of the ball and again dip or roll it in the flour. This alternate melting the surface of the ball and rolling it in flour, was continued till the whole became a mass of heated or scorched flour, entirely full of the melted butter, and as completely indigestible as it possibly could be, when she would leisurely sit down at a table and eat the whole of it. Did it make her sick?--you will ask. It did, indeed, and she expected it would. She would go immediately to bed, as soon as the huge bolus was swallowed, and lie there a day or two, perhaps two or three days. Occasionally such a surfeit cost her the confinement of a whole week. It is truly surprising that any Christian woman should thus make a beast of herself, for the sake of the momentary indulgence of the appetite; but so it is. I have met with a few such. Happily, however, conduct so low and bestial is not so frequent among females as males, though quite too frequent among the former so long as a single case is found, which could be prevented by reasoning or even by authority. There is one thing concerning butter which deserves notice, and which it may not be amiss to mention in this place. What we call butter, in this country,--what is used, I mean, at our tables,--is properly pickled or salted butter. Now, I suppose it is pretty well understood, that in some of the countries of Europe no such thing as salted or pickled butter is used or known. They make use of milk, cream, and a little fresh butter; but that is all. In the kingdom of Brazil, among the native population, at least, no such thing as butter, in any shape, has ever yet been known. Fresh butter is sufficiently difficult of digestion; but salted butter is much more so; and this is the main point to which I wish to call your attention. Why, what is our object in salting down butter? Is it not to prevent change? Would it not otherwise soon become acid and disagreeable? And does not salting it so harden or toughen it, or, as it were, fix it, that it will resist the natural tendency to decomposition or putrefaction? But will not this same "fixation," so to call it, prepare it to resist changes within the stomach as well as outside of it; or, in other words, prevent, in a measure, the work of digestion? Most unquestionably it will. And herein is the stronghold of objection to this article. Hence, too, the reason why it causes eruptions on the skin. The irritation begins on the lining membrane of the stomach. The latter is first coated with eruption; and, after a time, by what is called sympathy, the same tendency is manifested in the face. These things ought to be well understood. There is great ignorance on this subject, and what is known is generally the _ipse dixit_ of somebody. Reasons there are none for using salted butter. Or, if any, they are few, and frequently very flimsy and weak. Let us have hygiene taught us, were it only that we may know for ourselves the right and wrong of these matters. FOOTNOTES: [H] Since this was penned, the young woman has died of erysipelas. Can it be that she has been compelled, in this form, to pay a fearful penalty for her former abuses? One might think that twenty years of reformation would have worn out the diseased tendencies. Perhaps she recurred, in later years, unknown to the writer, to her former favorite article. CHAPTER LVII. HOT HOUSES AND CONSUMPTION. If any individual in the wide world needs to breathe the pure atmospheric mixture of the Most High,--I mean a compound of gases, consisting, essentially, of about twenty parts of oxygen and eighty of nitrogen,--it is the consumptive person. Mr. Thackrah, a foreign writer on health, says, "That though we are eating animals, we are breathing animals much more; for we subsist more on air than we do on food and drink." And yet I know of no class of people, who, as a class, breathe other mixtures, and all sorts of impurities, more than our consumptive people. First, their employments are very apt to be sedentary. Under the impression that their constitutions are not equal to the servitude of out-of-door work, agricultural or mechanical, they are employed, more generally, within doors. They are very often students; for they usually have active, not to say brilliant minds. And persons who stay in the house, whether for the sake of study or anything else, are exceedingly apt to breathe more or less of impure air. Secondly, it is thought by many that since consumptive people are feeble, they ought to be kept very warm. Now I have no disposition to defend the custom of going permanently chilly, in the case of any individual, however strong and healthy he may be; for it is most certainly, in the end, greatly debilitating. It would be worse than idle--it would be wicked--for consumptive people to go about shivering, day after day, since it would most rapidly and unequivocally accelerate their destruction. And yet, every degree of atmospheric heat, whether it is applied to the internal surface of the lungs through the medium of atmospheric air, or externally to the skin, is quite as injurious as habitual cold; and this in two ways: First, it weakens the internal power to generate heat, which, no doubt, resides very largely in the lungs. Secondly, it takes from them a part of that oxygen or vital air which they would otherwise inhale, and gives them in return a proportional quantity of carbonic acid gas, which, except in the very small proportion in which the Author of nature has commingled it with the oxygen and nitrogen of the atmosphere, is, to every individual, in effect, a rank poison. Hence it is that those who have feeble lungs, or whose ancestors had, should pay much attention to the quality of the air they breathe, especially its temperature. And this they should do, not only for the _sake_ of its temperature, but also for the sake of its purity. Such a caution is always needful; but its necessity is increased in proportion to the feebleness of the lungs and their tendency to suppuration, bleeding, etc. I was once called to see a young woman (in the absence of her regular physician) who was bleeding at the lungs. She had bled occasionally before, and was under the general care of two physicians; but a sudden and more severe hemorrhage than usual had alarmed her friends, and, _in the absence of better counsel_, they sought, temporarily, the advice of a stranger. It was a cold, spring day, and in order to keep up a proper temperature in her room, I had no doubt that a little fire was needful. But instead of a heat of 65° in the morning and something more in the afternoon, I found her sitting in a temperature, at ten o'clock in the forenoon, of not less than 75° or 80°. On inquiry, I was surprised to find that the temperature of her room was seldom much lower than this, and that sometimes it was much higher. I was still more surprised when I ascertained that she slept at night in a small room adjoining her sitting-room, and that a fire was kept all night in the latter, for her special benefit. No wonder her cough was habitually severe! No wonder she was subject to hemorrhage, from the irritated vessels of the lungs! The wonder was that she was not worse. The greatest wonder of all was, however, that two sensible physicians should, for weeks if not for months, have overlooked this circumstance. For I could not learn, on inquiry, that a single word had been said by either of them on the subject. If you should be inclined to ask whether she had no exercise in the more open and pure air, either on horseback or in a carriage, the reply would be, none at all. Horseback exercise was even regarded as hazardous, and other forms of exertion had not been urged, or, that I could learn, so much as recommended. I was anxious to meet her physicians, that I might communicate my views and feelings directly to them; but as this was not convenient I gave such directions as the nature of the case seemed to require, requesting them to follow my advice till the arrival of her physicians, and then to lay the whole case before them. My advice was, to reduce the temperature of the sitting-room as low as possible, and yet not produce a sensation of chilliness, and to have her sleeping-room absolutely cold, taking care to protect her body, however, by proper covering. I also recommended exercise in the open air, such as she could best endure; and withal, a plain, unstimulating diet. What was done, I never knew for many months. At last, however, I met with a neighbor of the family, one day, who told me that the young woman's physicians entirely approved of my suggestions, and that by following them out for some time, she partially recovered her wonted measure of health. Whether she recovered entirely, I never knew. The far greater probability is, that she remained more comfortable through the summer and autumn, but that the injudicious management of the next winter and spring reduced her to her former condition, or to a condition much worse. People are exceedingly forgetful even of their dearest rights and interests. They may, perhaps, exert themselves in the moment of great and pressing danger; but as soon as the danger appears to be somewhat over they relapse into their former stupidity. There is, however, much reason for believing that consumptive people might often live on many years beyond their present scanty limit, could they be made to feel that their recovery depends, almost wholly, on a strict obedience to the laws of health, and not on taking medicine. If Miss H., by strict obedience, could recover from a dangerous condition, and enjoy six or eight months of tolerable health, is it not highly probable, to say the least, that a rigid pursuance of the same course would have kept her from a relapse into her former low and dangerous condition? It is in this way, as I suppose, that consumption is to be cured, if cured at all. It is to be _postponed_. In some cases it can be postponed one year; in some, five years; in some, ten, fifteen, or twenty; in a few, forty or fifty. It is in this respect with consumption, however, as it is with other diseases. In a strictly pathological sense, no disease is ever entirely cured. In one way or another its effects are apt to be permanent. The only important difference, in this particular, between consumption and other diseases, is, that since the lungs are vital organs, more essential to life and health than some other organs or parts, the injury inflicted on them is apt to be deeper, and more likely to shorten, with certainty, the whole period of our existence. Connected with this subject, viz., the treatment of consumption, there is probably much more of quackery than in any other department of disease which could possibly be mentioned. One individual who makes pretensions to cure, in this formidable disease, and who has written and spoken very largely on the subject, heralds his own practice with the following proclamation: "Five thousand persons cured of consumption in one year, by following the directions of this work." Another declares he has cured some sixty or seventy out of about one hundred and twenty patients of this description, for whom he has been called to prescribe. Now, if by curing this disease is meant the production of such changes in the system, that it is no more likely to recur than to attack any other person who has not yet been afflicted with it, then such statements or insinuations as the foregoing are not merely groundless, but absolutely and unqualifiedly false, and their authors ought to know it. For I have had ample opportunity of watching their practice, and following it up to the end, and hence speak what I know, and testify what I have seen. But if they only mean by cure, the _postponement_ of disease for a period of greater or less duration, then the case is altered; though, in that case, what becomes of their skill? No book worthy of the name can be consulted by a consumptive person without his deriving from it many valuable hints, which if duly attended to may assist him in greatly prolonging his days; and the same may be said of the prescriptions of the physician. Yet, I repeat, it is a misnomer, in either case, to call the improvement a cure. Consumptive people continue to live, whenever their lives are prolonged, as the consequence of what they do to promote their general health. One is roused to a little exercise, which somewhat improves his condition, and prolongs his days. Another is induced to pay an increased regard to temperature, and he lives on. Another abandons all medicine, and throws himself into the open arms of Nature, and thus prolongs, for a few months or a few years, his existence. If this is _cure_, then we may have all or nearly all of our consumptives cured, some of them a great many times over. Some few aged practitioners may be found to have cured, during the long years of their medical practice, more than five thousand persons of this description. There is no higher or larger sense than this in which any individual has cured five thousand, or five hundred, or even fifty persons a year, of consumption. On this, a misguided, misinformed public may reply: Many, indeed, revive a little, as the lamp sometimes brightens up in its last moments; but this very revival or flickering only betokens a more speedy and certain dissolution. On the other hand, predisposition to consumption no more renders it necessary that we should die of this disease in early life, at an average longevity of less than thirty years, than the loading and priming of a musket or piece of artillery renders it necessary that there should be an immediate or early explosion. Without an igniting spark there will be no discharge in a thousand years. In like manner, a person may be "loaded and primed" for consumption fifty years, if not even a hundred, without the least necessity of "going off," provided that the igniting spark can be kept away. Our power to protect life, both in the case of consumption and many more diseases, is in proportion to our power to withhold the igniting spark. And herein it is that medical skill is needful in this dreadful disease, and ought to be frequently and largely invoked. If the estimate which has been made by Prof. Hooker, of Yale College, that one in five of the population of the northern United States die of consumption, is correct, then not less than two millions of the present inhabitants of New England, New York, Pennsylvania, and Ohio, are destined, as things now are, to die of this disease. What a thought! Can it be so? Can it be that two millions of the ten millions now on the stage of action in the northern United States, are not only _predisposed_ to droop and die, but are laid under a constitutional necessity of so doing? Must the igniting spark be applied? Must the disease be "touched off" with hot or impure air, by hard colds, by excitements of body and mind, and in a thousand and one other ways? People are not wholly ignorant on this great subject. Would they but _do_ as well as they _know_, the fatal igniting spark would be much oftener and longer withheld; and, indeed, in many instances, would never prove the immediate cause of dissolution. The lamp of life would burn on--_sometimes, it may be, rather feebly_--till its oil was wholly exhausted, as it always ought. Man has no more occasion, as a matter of necessity, to die of consumption, than the lamp or the candle. This, if true,--and is it not?--should be most welcome intelligence in a country where, at some seasons and in particular localities, one-fourth of all who die, perish of this disease. In March, 1856, twenty-one persons out of eighty who died in Boston in a single week, were reported as having died of consumption; and in June of the same year, the proportion was nearly as great. In Newton, a few miles from Boston, the proportion for the last ten years has been also about one in four. But place the proportion for the whole northern United States, at one in five only, or even one in six. Yet even at this rate, the annual mortality for New York or New England, must be about twelve or fourteen thousand. Yet it seems to excite little if any surprise. But when or where has the cholera, the yellow fever, or the plague depopulated a country of three millions of people, for each succeeding year, at the rate of twelve thousand annually, or one hundred and twenty thousand every ten years? One reason why the statements I have made, of the possible postponement of consumptive disease, should be most welcome intelligence, is found in the fact that they inspire with the hope of _living_. The ordinary expectation that those who inherit a consumptive tendency must die prematurely, has been fatal to thousands. Mankind, in more respects than one, tend to become what they are taken to be. If we take them to be early destined to the tomb, they go there almost inevitably. There is, I grant, one most fortunate drawback upon this tendency. Most people who have the truly consumptive character, are disposed to disbelieve it. They are generally "buoyant and hopeful," which, in some degree, neutralizes the effect of sombre faces, and grave and prognosticating jeremiades. It will not be out of place to present the patient reader with an anecdote, which may or may not be true, but which I received as truth from the people of the neighborhood where the facts which it discloses are said to have occurred. In the eastern part of Connecticut, not many years since, a young man lay on his bed, very feeble and greatly emaciated, almost gone, as everybody supposed but himself, with pulmonary consumption. And yet, up to that very hour, the thought that his disease was consumption, had never obtained a lodgment in his own mind for a moment. On the contrary, he was still fondly hoping that sooner or later he should recover. It was fortunately about the middle of the forenoon one day,--an hour when his body and mind were in the best condition to endure it,--that his listening ear first caught from those around him the word _consumption_. Starting up, he said, "Do you think my disease is consumption?" They frankly told him their fears. "And do you think," he added, "that I must die?" They did not conceal longer their real sentiments. He was for a few moments greatly distressed, and seemed almost overpowered. At length, however, a reaction came, when, raising his head a little, he deliberately but firmly exclaimed, "I can't die, and I won't die." After a few moments' pause and reflection, he said, "I must be got up." His attendants protested against the effort, but it was to no purpose. Nothing would satisfy him but the attempt. He was bolstered up in his bed, but the effort brought on a severe fit of coughing, and he was obliged to lie down again. The next forenoon, at about the same hour, he renewed the request to be got up. The result was nearly as before. The process, however, was repeated from day to day, till at length, to the great joy and surprise of his friends, he could sit in his bed fifteen or twenty minutes. It is true that it always slightly increased the severity of his cough; but the paroxysm was no worse at the twentieth trial than at the first, while he evidently gained, during the effort, a little muscular strength. It was not many weeks before he could sit up in bed for an hour or more, with a good degree of comfort. "Now," said he, "I must be taken out of bed and placed in a chair." At first his friends remonstrated, but they at length yielded and made the attempt. It was too much for him; but he persevered, and after a few repeated daily efforts, as before, at length succeeded. Continuing to do what he could, from day to day, he was, ere long, able to sit up a considerable time twice a day. He now made a third advance. He begged to be placed in an open carriage. As I must be brief, I will only say that, after many efforts and some failures, he at length succeeded, and was able to ride abroad several miles a day, whenever the weather was at all favorable. Nor was his cough at all aggravated by it. On the contrary, as his strength increased, it became rather less harassing and exhausting. One more advance was made. He must be helped, as he said, upon a horse. It was doubtful, even to himself, whether he had strength enough to endure exercise in this form; but he was determined to try it. The attempt was completely successful, and it was scarcely a week before he could ride a mile or two without very much fatigue. The final result was such a degree of recovery as enabled him to ride about on horseback several miles a day for six years. He was never quite well, it is true, but he was comfortable, and, to some extent, useful. He could do errands. He could perform many little services at home and abroad. He could, at least, take care of himself. At the end of this period, however, his strength gave way, and he sank peacefully to the tomb. He was completely worn out. Now the principal lesson to be learned from this story is obvious. _Determination_ to live is almost equivalent to _power_ to live. A strong will, in other words, is almost omnipotent. Of the good effects of this strong determination, in case of protracted and dangerous disease of this sort, I have had no small share of experience, as the reader has already seen in Chapter XXIII. Another fact may be stated under this head. A young man in southern Massachusetts, a teacher, was bleeding at the lungs, and was yielding at length to the conviction--for he had studied the subjects of health and disease--that he must ere long perish from consumption. I told him there was no necessity of such a result, and directed him to the appropriate means of escape. He followed my directions, and after some time regained his health. Ten or twelve years have now passed away, and few young men have done more hard work during that time than he; and, indeed, few are able, at the present moment, to do more. It is to be observed, however, that he made an entire change in his dietetic habits, to which he still adheres. He avoids all stimulating food--particularly all animal food--and uses no drink but water. I did not advise him, while bleeding, to mount a hard-trotting horse, and trot away as hard as he could, and let the blood gush forth as it pleased. It is a prescription which I have not yet hazarded. I might do so in some circumstances, when I was sure of being aided by that almost omnipotent determination of which I have elsewhere spoken. I might do it occasionally; but it would be a rare combination of circumstances that would compel me. I might do it in the case of a resolute sea captain, who insisted on it, would not take _no_ for an answer, and would assume the whole responsibility. I might and would do it for such a man as Dr. Kane. I have, myself, bled slightly at the lungs; but while I did not, on the one hand, allow myself to be half frightened to death, I did not, on the other hand, dare to meet the hemorrhagic tendency by any violent measures; not even by the motion of a trotting horse. I preferred the alternative of moderate exercise in the open air, with a recumbent position in a cool room, having my body well protected by needful additional clothing, with deep breathing to expand gently my chest, and general cheerfulness. But I have treated on this subject--my own general experience--at sufficient length elsewhere. CHAPTER LVIII. POISONING BY A PAINTED PAIL. A child about a week old, but naturally very sensitive and irritable, became, one night, unusually restless and rather feverish, with derangement of the bowels. The condition of the latter was somewhat peculiar, and I was not a little puzzled to account for it. There was nothing in the condition of the mother which seemed to me adequate to the production of such effects. She was as healthy as delicate females usually are in similar circumstances. The derangement of the child's bowels continued and increased, and I was more and more puzzled. Was it any thing, I said to myself, which was imbibed or received from the mother? Just at the time, I happened to be reading what Dr. Whitlaw, a foreign medical writer, says of the effects which sometimes follow when cows that are suckling calves feed on buttercup. The poison of the latter, as he says, instead of injuring the cow herself, affects, most seriously, the calf, and, in some few instances, destroys it. This led me to search more perseveringly than I had before done, for a cause of so much bowel-disturbance in my young patient. At length I found that a wooden pail, in which water was kept for family use, had been but recently painted inside; and that the paint used was prepared in part, from the oxyde of lead, usually called white lead. On this I immediately fastened the charge of poisoning. My suspicions were confirmed by the fact that the mother had been more thirsty and feverish than usual, during a few hours previous to the child's first manifestation of disease, and had allowed herself to drink very freely of water, which was taken from the very pail on which our suspicions now rested. Another fact of kindred aspect was, that the child recovered just in proportion as the mother left off drinking from the painted pail, and used water which was procured in vessels of whose integrity we had no doubt. Most people who had any knowledge of the facts in the case, said that the cause I assigned could not have been the true one, since it was inadequate to the production of such an effect. But the truth is, we know very little about poisons, in their action on the living body, whether immediate or remote. Till this time, although I had read on it as much as most medical men, yet I knew--practically knew--almost as little as the most illiterate. Yet the subject was one with which professional physicians should be familiarly acquainted, if nobody else is. Many an individual, as we have the most abundant reason for believing, loses his health, if not his life, from causes which appear to be equally slight. A Mr. Earle, of Massachusetts, cannot swallow a tumbler of water containing a few particles of lead, without being made quite sick by it. Nor is he alone in this particular. Such sensitiveness to the presence of a poisonous agency is by no means uncommon. It may be found to exist in some few individuals in every country, and almost every neighborhood. CHAPTER LIX. ONE DROP OF LAUDANUM. A babe, not yet a day old, came under my care for treatment. What the symptoms were, except those of nervous irritation, I have now forgotten; but there was ample evidence of much disturbance in the system, and the parents and friends were exceedingly anxious about the results. Now it was one of those cases in which a large proportion of our medical men are exceedingly ignorant, and only guess out the cause or causes as well as they can. I was thus ignorant, and would not--and as an honest man, _could_ not--attempt to divine the cause or give a name to the disease. Yet I must needs, as I verily thought, prescribe something and somehow. So I took a single drop of laudanum, and diluted it well, and made the child swallow it. He soon became easy, quite too easy, and fell into a profound sleep. So deep and profound, in fact, was its sleep, or rather its _stupor_, that I began to be afraid it never would awake. How strange, I thought within myself, that a single drop of this liquid should produce so much effect! Yet it taught me wisdom. It taught me to let medicine alone--strong medicine, at least--in the diseases of very young children. It also taught me not to give too large doses to anybody, especially to those who had never taken any before. The first dose, for unperverted nature, must be very small indeed! How much my little patient was injured, permanently, by this act of unpardonable carelessness, I never knew. It may have laid the foundation for many ills which he has since experienced, some of which have been severe and trying. Or, if otherwise, it may have aggravated such ills as had their origin in other causes. Or, if nothing more, it may have contributed to a delicacy and sensitiveness and feebleness of structure, which can never, in all probability, be fully overcome, and which have more to do, even with our moral tendencies and character, than most of us are fully aware. How much would I give to be able to blot from my history such errors and defects of character as this! For, though I confess to nothing worse than haste and carelessness, in the present instance, yet a medical man, like the commander in the battle field or elsewhere, has no right to be careless. My aged, honored father gravely insisted, all his life long, that no accidents, as they are termed, in human life, ever take place, unless there is in the first place, carelessness, somewhere. Much more is it true that many an individual who sickens and loses his life, is the victim of carelessness; or, what is the same thing, want of attention, when great care and attention were necessary, and the issues of life and death were suspended, as it were, on a thread! CHAPTER LX. MRS. KIDDER'S CORDIAL. Should you ever go to Boston, and pass along a certain street called Court Street, almost to its western extremity, you may probably see at your left hand, in large letters of various fantastical shapes, the words which I have placed at the head of this chapter; viz., "MRS. KIDDER'S CORDIAL." Sometimes, I believe, it is called her cholera cordial; but it is sufficiently well known, as I suppose, by the former name. But how is it known? Not merely by the sign I have mentioned, fastened up at the door of that aforesaid shop in Court Street, but by a host of advertisements in the public papers; and in other cities as well as Boston. You may find them in almost every public house, post-office, railroad depot, and grocery in New England; or, as I might perhaps say, in the whole Union. I once had a child severely sick, at a season of the year when not only the Asiatic cholera prevailed, but also the cholera morbus. She was teething at the time, which was doubtless one cause of her illness,--to which however, as I suppose, other causes may have been added. In any event, she was in a very bad condition, and required the wisest and most careful medical attention. There was also a young woman in the house who was ill in the same way, but not so ill as the child. At that time my residence was very near the metropolis, though, as I have already told you, Mrs. Kidder's cordial could be had almost everywhere. Having occasion to go to town, I fell in with an old friend who kindly inquired after the health of my family. When I had told him, he boldly and with true Yankee impertinence, asked what I had done for my family patients; to which I replied, with a frankness and simplicity which was fully equal to his boldness, "Nothing, as yet." "Do you mean to do nothing?" said he, with some surprise. I told him that I did not know what I might do in future, but that I saw no necessity of using any active medication at present. "Are you not aware," I added, "that physicians seldom take their own medicines or give them to their families?" "I know very well," said he, "that physicians theorize a good deal about these matters; but after all, experience is the best school-master. Should you lose that little girl of yours, simply because you are anxious to carry out a theory, will you not be likely to regret it? As yet you have lost no children, and therefore, though much older than myself, you have not had all the experience which has fallen to my lot; and experience is the best school-master." "True," I answered, "I am not too old to learn from that experience, which, in a certain sense, is the basis of all just knowledge, especially in medicine. What you call my theory, or at least all the theory I have, is grounded on this same experience; not, indeed, that of one man in one neighborhood, nor, indeed, in one nation. I have looked the world over." "And you have come to the very wise conclusion, it would seem," said he, "that medicine never does any good, and that you will never give it more, except to those who are determined to have it, or will not fasten their faith on any thing else." "Not exactly that," I replied. "I can think of a great number of cases in which I would give medicine. For example: suppose one of my children had by the merest accident taken a dose of poison, which, if retained, must inevitably destroy it, I would much sooner give that child an active emetic--which, of course, is medicine--than stand still and see it die." "Very well," said he, "your child and Miss L., are, in one point of view, poisoned. They will probably die, if you stand still and do nothing; at least I have not a doubt that the little girl will. Now take my advice, and do something before it is too late. Give up all your theories and fine-spun reasonings, and do as others do, and save your child." As I had but little time for conversation with him, even on a highly important and deeply interesting subject, above all to point out the difference between the two cases he mentioned. I was now about ready to say "Good-morning," and leave him. "Stop a moment," said he, "and go with me to the second shop beyond that corner, and get a bottle of Mrs. Kidder's cordial for your sick folks." Here I smiled. "Well," said he, "you may continue to smile; but you will mourn in the end. I have used Mrs. Kidder's cordial in my family a good deal, and I assure you it is no humbug. It is all it promises. Now just go with me, for once, and get a bottle of it. Depend upon it, you will never regret it." Although my good friend had not succeeded in changing my views by his many affirmations, nor by his strong appeal to his experience of the good effects of the cordial in his own family (for I well knew he had lost almost all his children), I consented to go with him to the shop, partly to get rid of him. When we arrived I bought a bottle of the cordial,--I believe for fifty cents,--put it in my pocket, and carried it home with me. When I reached home I put away the bottle, on a shelf in our family closet which was quite unoccupied, and inquired about the patients. The little girl was rather better, it was thought, but Miss L. was still weak and low. I told them about the adventure with the bookseller, but omitted to state that I had purchased the cordial. In a very few days, by dint of good care and attention, and the blessing of a kind Providence, the sick were both of them much better, and I could leave them for a whole day at a time. My business in town demanded my presence, and I repaired thither again. And who should I meet, on getting out of the omnibus, but my old friend, who had reasoned with me so patiently and perseveringly, in defence of Mrs. Kidder's cordial? He inquired, almost immediately, about my family; to which I joyfully replied, "Better, all better. They were better in less than two days after I last saw you;--yes, they were a little better that very evening." "I told you it would be so," said he. "I never knew the cordial to fail when taken in season. I have lost several children, it is true; but they did not take it soon enough. I am profoundly glad you were in season. Does it not operate like a charm?" "Exactly so," said I, "if it operates at all; exactly like a charm, or like magic. Shall I tell you the whole story?" "By all means," he replied; "let us have the whole of it; keep nothing back." "Well, then, I went home, and placed the bottle of cordial on a high and obscure shelf, where nobody would be likely to see it, and proceeded with our sick folks just as before. The bottle of cordial remained unknown, except to myself, and untouched, and is probably untouched to the present hour. So you see--do you not?--how like a charm it operates." "Just _like_ you, doctor. Well, as long as they recovered I do not care. But I shall always have full faith in the medicine. I know what I know; and if all the world were of your opinion I could not resist a full belief in the efficacy of Mrs. Kidder's Cholera Cordial." My friend was not offended with me, for he was, in the main, a sensible, rational man. He pitied me; but, I believe from that time forth, gave up all hopes of my conversion. I come to this conclusion because he has never uttered a syllable on the subject, in my hearing, from that day to this hour, though I have met with him probably fifty times. There can be no doubt that were we to place full faith in the recuperative efforts of nature, three-fourths of our medicine--perhaps I may just as well say nine-tenths--would be quite as useful were it disposed of in the way I disposed of Mrs. Kidder's cordial, as when swallowed. Nay, it is possible it might be much more useful. If a sick person can recover without it just as well as _with_ it, he certainly will get well more easily, even if it should not be more quickly, than if he had a load of foreign substance at his stomach to be disposed of. In other words, to get well in spite of medicine seems to me much less agreeable, after all that is said in its favor, than to get well in Nature's own way. CHAPTER LXI. ALMOST RAISING THE DEAD. So many people regarded it, and therefore I use the phrase as a title for my chapter. I have heard of families of children so large that it was not easy to find names for them all. My chapters of confession are short, but very numerous, and I already begin to find it difficult to procure titles that are _apropos_. Mary Benham was the second daughter, in an obscure and indigent family that resided only a little distance from my house, just beyond the limits of what might properly be called the village. I do not know much of her early history, except that she was precocious in mind, and scrofulous and feeble in body. The first time I ever heard any thing about her, was one night at a prayer-meeting. Mr. Brown, the minister, took occasion to observe, at the close of the meeting, in my hearing, that he must go to Mr. Benham's and see Mary, for she was very ill, and it was thought would not live through the night. She survived, however, as she had done many times before, and as she did many times afterward, in similar circumstances. More than once Mr. Brown had been sent for--though sometimes other friends were called, as Mr. Brown lived more than a mile distant--to be with her and pray with her, in what were supposed to be her last moments. But there was still a good deal of tenacity of life; and she continued to live, notwithstanding all her expectations and those of her friends. It appeared, on inquiry, that her nervous system was very much disordered, and also her digestive machinery. She was also taking, from day to day, a large amount of active medicine. Still no one appeared to doubt the propriety of such a course of treatment, in the case of a person so very sick as she was; for how, it was asked, could she live without it? In one or two instances I was sent for; not, indeed, as her physician, but as a substitute for the more distant or the absent minister. At these visits I learned something, incidentally, of her true physical condition. I found her case a very bad one, and yet, as I believed, made much worse by an injudicious use of medicine. Yet what could I do in the premises? I had not been asked to prescribe for her, nor even to give counsel as a supernumerary or consulting physician. Dr. M. paid her his weekly and semi-weekly visits, and doubtless supposed all the wisdom of the world added to his own would hardly improve her condition. I was, of course, by all the rules of medical etiquette, and even by the common law of politeness, obliged to bite my lips in silence. One thing, indeed, I ventured to do, which was to send her a small tract or two, in some of the departments of hygiene or health. Soon after this her physician died; and died, too, by his own confession, publicly made, of stomach disease,--at least, in part. He was a man of gigantic body and great natural physical force. His digestive apparatus was particularly powerful, and it had been both unwisely cultivated and developed in early life, and unwisely and wickedly managed afterward. For an example of the latter, he would, while abroad among his patients, sometimes go without his dinner, and then, on his return to his family and just as he was going to bed, atone for past neglect by eating enough for a whole day, and of the most solid and perhaps indigestible food. In this and other abusive ways he had been suicidal. But he was now gone to his final account, and on whose arm could Mary lean for medical advice? Her parents were too poor to pay a physician's bill. What had been paid to her former medical attendant--which, indeed was but a mere pittance--was by authority of the town. Mary felt all the delicacy she should have felt, in her circumstances, and perhaps more, for she refused for some time to ask for farther aid, preferring to groan her way alone. One evening, when I was present on a moral errand, she spoke of the great benefit she had derived from the perusal of the little books I had sent her, and modestly observed that, deprived as she was by the wise dispensation of Providence, of her old friend and physician, she had sometimes dared to wish she could occasionally consult me. I told her I hoped she would not hesitate a moment to send for me, whenever she desired, for if in a situation to comply with her requests, I would always do so immediately. She was about to speak of her poverty, when I begged her not to think of that. The only condition I should impose, I told her, was that she should do her very best to follow, implicitly, my directions. With this condition she did not hesitate to promise a full and joyful compliance. From that time forth I saw her frequently, since I well knew that even voluntary visits would be welcome. I found she had become convinced of the necessity of breathing pure air, and of ventilating her room every day. Nor did she neglect, as much as formerly, the great laws of cleanliness. Yet, alas! in this respect, the hard hand of necessity was upon her. She could not do all she wished. However, she could apply water to her person daily, if she could not to her clothing and bedding; so that, on the whole, she did not greatly suffer. Her mother did what she could, but she was old and decrepit. She had also made another advance. She had contrived to obtain, I hardly know from what source, but probably from the hands of kind friends, a small amount of good fruit to use daily, with one or more of her meals. This excluded a part or portion of that kind of food which was more stimulating and doubtful. But the greatest difficulty we had to encounter was to shake off the enormous load of narcotic medicine which had been so long prescribed for her that she seemed unable to live without it. Morphine, in particular, she had come to use in quantities which would have destroyed a person who was unaccustomed to its influence, and in frequently repeated doses. I told her she might as well die in one way as another; that the morphine, though it afforded a little temporary relief, was wearing out her vital energies at a most rapid rate, and that the safest, and, in the end, the easiest way for her was, to abandon it entirely. She followed my advice, and made the attempt. I have forgotten how long a time it required to effect a complete emancipation from her slavery to drugs; but the process was a gradual one, and occupied at least several months. In the end, however, though not without considerable suffering, she was perfectly free, not only from her slavery to morphine, but to all other drugs. All this time, moreover, she was as _well_, to say the least, as before; perhaps, on the whole, a little better. I now set myself, in good earnest, to the work of improving her physical habits. The laws of ventilation and cleanliness, to which her attention, as I have already intimated, had become directed, were still more carefully heeded. She was required to retire early and rise early, and to keep her mind occupied, though never to the point of fatigue, while awake. Her habits with regard to food and drink were changed very materially. The influence of the mind on the condition of the body was also explained to her, and the influence of temperature. In short, she was brought, as fast as possible, to the knowledge of physical law in its application to her circumstances, and encouraged to obey it. The recuperative powers of nature, even in unfavorable circumstances, were soon apparent. This greatly increased her docility and inspired her with faith and hope. The greatest trouble was in regard to muscular exercise. Much of this was needed; and yet how could it be obtained? She could not walk, and yet, in her indigence, she had no means of conveyance, except at the occasional invitation of some friend. But this even had its good tendencies. To take her up, as we would have taken a child, set her in a carriage and let her ride half a mile or a mile, was obviously of great service to her. She was far less fatigued by it than was expected; her subsequent sleep was far better; nor did any remote evil effects follow. This greatly increased her courage, and raised the hopes of her friends. She was at length able to be placed in the railroad cars, and with the aid of coaches, at embarking and disembarking, to travel about a good deal, to the distance of ten, twelve, or twenty miles; and all this with favorable effects. Her recovery, at no distant day, began to be regarded, by the most sceptical, as quite probable. My removal, a hundred miles or so from the village, just at this time, was, however, a misfortune to her. In one of her excursions, she received and accepted an invitation to spend a few months with a distant relative, where she came under the influence of one of the phases of modern quackery, by means of which her progress to the promised land of health was very considerably retarded. She even sickened, but afterward recovered. Sometime after this, as I subsequently learned, she partially regained her good condition of steady progress, and returned to her father's house. Finding herself, at length, able to do something for her support, she entered into the service of a neighboring family, at first with little compensation except her board, but subsequently at half pay or more. Her domestic duties were such as only taxed her system to a degree which she was able to endure without any injury. It was in this condition, that, after two or three years of absence, I found her and rejoiced with her. For, though she could no more be said to be restored to perfect health, than a vessel could be considered perfectly sound that is full of shot holes, yet her condition was far enough from being desperate, and was even comparatively excellent. I left her once more with the tear of gratitude to God on her cheek, and again, for many long years, neither saw her nor heard from her. At our next interview she brought with her a gentleman whom she introduced to me as her husband. The meeting was to me wholly unexpected, but most happy. She lived in this relation, but without progeny, a few years more, and then sank in a decline, to rise no more till the sound of the last trumpet. Of the particulars of her decline and death, I have never heard a word. Her scrofulous temperament and tendencies rendered her liable to numerous diseases of greater or less severity and danger, to some of which she probably fell a victim. It is, however, by no means impossible that her numerous cares and anxieties--for she was naturally very sensitive--may have hastened her exit. If I have any misgivings in connection with this protracted, but very interesting case, and consequently any confessions to make, it is with reference to the point faintly alluded to in a preceding paragraph. While I honor, as much as any man, the marriage relation,--for it is in accordance with God's own intention, and is the first institution of high Heaven for human benefit and happiness,--I must freely confess that in the present fallen condition of our race, it occasionally happens that an individual is found unfit for the discharge of its various duties, as well as for the endurance of some of its peculiar responsibilities. Such, as I believe, among others, was Mary Benham. CHAPTER LXII. FEMALE HEALTH, AND INSANE HOSPITALS. A female, about thirty-five years of age, and naturally of a melancholic temperament, was very frequently at my room for the purpose of conversing with me in regard to her health. Most of her complaints--for they were numerous--were grafted upon a strongly bilious habit, and were such as required in the possessor and sufferer, more than an ordinary measure of attention to the digestive organs and the skin. And yet both these departments, especially the latter, had been in her case, hitherto, utterly neglected. To speak plainly, and with some license as a physiologist, _she had no skin_. It was little more than a mere wrapper, so far as the great purposes of health were concerned. A dried and even tanned hide, could it have been fitted to her person with sufficient exactness, would have subserved nearly the same purposes. Perhaps you will excuse the tendency in the description of this case, to exaggeration, when you are informed that the treatment of themselves, in the particular here alluded to, by females especially, is one which habitually fills one with disgust, and sometimes with indignation. Persons of good sense, of both sexes, who from month to month, perhaps from year to year, never wash their skins, nor use much muscular exercise, ought to know that they must, sooner or later, experience the dreadful penalty attached to violated physical law, and from which there is, neither on earth nor in heaven, any possible escape. Can any one suppose, for a moment, that so curious and complicated an organ as the skin, and one of such considerable extent, has nothing to do? Nearly every living person has some idea, of greater or less intensity, of pores in the skin; at least, they use language which implies such an idea. They talk, often, of the necessity of keeping these pores open. But how is it to be done? Not certainly while they use little or no muscular exercise, by washing, once a day, their hands and faces merely, or, as some say, their fingers, their noses, and the tips of their chins. They may talk, on occasions, very boldly and flippantly, about _sweating_ away a cold, as they term it; but do they vainly suppose that the sweat vessels or sweating machinery has nothing to do, from day to day, which might prevent the necessity of resorting to these sweating processes? Miss L. appeared to be in utter ignorance of any laws of the skin, or of the digestive or muscular systems. And yet her thoughts had been turned, often and frequently, to her own feelings and sensations. She would talk, almost incessantly, if anybody would hear her, about her aches and pains, and could describe her whole train of feelings, from morning to evening, with a faithfulness and patience and minuteness that would have furnished a genius less than Defoe with material sufficient for quite a huge volume. Now I could have visited and counselled Miss L., at least once a week, with great profit to herself, had she been as intelligent, in general, as she was familiar with her own sensations. As things were, her confidence was rather more troublesome than agreeable; but she was, practically, a standing patient; and physicians, as you know, cannot choose. They must be, among mankind, like the Great Physician, as they who "_serve_;" not as those who are _to be served_, or accommodated. And they must serve those who come to them. Miss L. was evidently somewhat disappointed, when she found I was not disposed to give her any medicine. A little, she thought, might sometimes be useful; a great deal she did not believe in, of course. Experience had forced upon her some of the lessons of wisdom. However, she contrived to fasten a good deal of faith on the laws of health, which I continually held forth to her. In particular, I urged on her the necessity of endeavoring to keep up what I was wont to call a centrifugal tendency in her system. A good plump, healthful, ever active, and ever vigorous skin was, as I told her, our only hope in her case. As a means to this end, and also as a means of withdrawing her attention from the slavery of a constant attendance on her own sensations, I urged her to mingle with society much more, and go about doing good to others, on the great principle, "It is more blessed to give than to receive." I warned her, however, against the danger of falling into the habit of giving an account of herself--her woes and sorrows--to every one she might meet with, who should kindly inquire about her condition, since it would greatly retard her improvement, even if it did not keep up or renew her disease. Among other things, I ventured to suggest to her the importance of having something to do--something of a permanent nature. "We hear," I said, "of gentlemen at large, and you seem to be a lady at large. You have, in the usual acceptation of the phrase, nothing to do. Would it not be well for you to take charge of something or of somebody? You might, perhaps, assume the office of teacher, and take the charge of a few pupils; or even adopt a child or two as your own, where you might receive compensation. Or," as I finally added,--for I perceived she shrunk from all responsibilities of this kind,--"you might, perhaps, become the mistress of a family." On the last mentioned topic, I was also obliged, for obvious reasons, to speak with considerable caution. She was unsocial, timid, fearful of being burdened with cares--the very stuff, though she knew it not, that human life is made of, ay, and human happiness too. But I could not hesitate to make the trial. My suggestions, however, were of little avail. She went on for some time, in the old way, and made very little progress. I lost sight of her about this time, and never met her more. The sequel of her history I only know from report. It is painful in the extreme. It is, however, the history, in all its essential features, of thousands of selfish people, who, after all, by dint of numbers, force, and influence, contrive to rule the world. Being fully determined to have no cares or responsibilities connected with children or household, she not only refused to hearken to my advice, but also to one or more truly kind and promising offers of marriage. She pursued her selfish course undisturbed, unless by occasional misgivings, till her brain and nervous system suffered so severely that she began to approach the confines of insanity. It was, however, a considerable time before the silver cord was loosed, the golden bowl broken, and the wheel broken at the cistern. But the terrible result at length came. The demands of violated physical law are inexorable. She was conveyed, as a last resort, in the hope of cure, to an insane hospital. Here, after many and patient attempts to restore the crippled and broken down machinery to healthful motion, she ended her days. My female patients were not all equally unfortunate. One I had, whose case, if minutely described, would present an array of facts painful in the extreme. She, too, approached the dark regions of insanity; but she did not enter. She still lives, and is at once a useful and happy woman, and an excellent wife and housekeeper. As a means to her recovery, however, she pursued a course diametrically opposite to that pursued by Miss L. She did not shrink from care and responsibility; on the contrary, she submitted to both. First, she sought increased activity and usefulness in her father's family; and, secondly, in a family of her own. Concerning the last mentioned case, I have few misgivings, and equally few confessions to make. I call it a remarkable case; but it must not be revealed in its details, for other reasons besides its tediousness. In the case of Miss L., however, I have one deep and lasting regret. In the early part of my acquaintance with her, as a medical man, she probably had more confidence in my integrity and skill than in those of any other living individual. She had been early left an orphan; and I was among the first--perhaps the very first--to take the attitude towards her of a true father. Such kindness, and especially such paternal care, never fail to make their impression. "Love, and love only, is the loan for love." At this early sympathizing period, had I been more faithful, I might, perhaps, have saved her. But I was remiss--disposed to delay. I waited, a thousand times, for a better opportunity. I waited till the favorable moment--ay, the _only_ moment--had passed by. Physicians often err here. God gives to many individuals the most unbounded confidence in medical men; and this remarkable provision of his has a deep meaning. It is not, however, to the intent that they should abuse the influence thus secured to them, by filling their patients' stomachs with pills and powders; but for such purposes, rather, as have been indicated by the general tenor of the foregoing remarks. It is that they may give them wise paternal counsel and sound physiological and pathological instruction. Such counsel and such instruction were indeed given to Miss L., but not to that extent which the nature of the case required, and which a little more moral courage and Christian plainness would have secured. She was worth saving, and I might, perchance, have been the honored instrument of saving her, and of thus rendering to society a most valuable service. That vital energy of hers which was expended in watching over her own internal feelings, might have been rendered a much more profitable investment. But the account is closed and sealed, to be agitated or questioned no more till the inquisitions of the last day. Let such considerations and reflections as this remark suggests to the human mind have their intended effect. Let us ever increase our zeal and watchfulness, that we may avoid such a course of conduct as makes confessions meet, or needful, or even salutary. CHAPTER LXIII. A GIANT DYSPEPTIC. There have been giants in the earth, in nearly every age, if not in every clime--giants mentally, and giants physically. Of course they may have been rare exhibitions, and may thus have elicited much attention; and some of them have attained to quite a memorable place in history. There have been and still are, on the earth, giants of other descriptions. We sometimes even meet with giant dyspeptics. Dyspepsia, at best, is formidable, many-headed, but not always gigantic. If gigantic size, in this case, were the general rule, what we now call giants would, of course, cease to be regarded as such. It may be thought that what I shall here call dyspeptic giants, or giant dyspeptics, were better designated as monsters, than giants. Be it so, for we will not quarrel about names; though a difficulty might be found in making the required distinction between giants and monsters; for is not every giant a monster? Not far from the year 1830, perhaps a little earlier, you might have seen, in connection with a certain private seminary of education, in New England, one of these giant dyspeptics. I do not mean, of course, that he had already attained to giant size, but only that what proved in the result to be gigantic was already a giant in miniature, and was rapidly advancing to one of magnitude. He had early been a cabin boy; and like many other cabin boys, had been gluttonous, and in some respects intemperate. Not by any means, that he had ever been guilty of downright intoxication; for of this I have no certain knowledge. My belief is, however, that he had gone very far in this direction, though he might not have--probably _had_ not--been justly chargeable with going quite to the last extremity. But why should such a young man be found at a seminary of learning? Was he with "birds of a feather?" Do not these attract each other? Mr. Gray, for that is the name I shall give to our young dyspeptic, had been recently subjected to the influences of one of those seasons of excitement well known in the religious world by the name of _revivals_; and what is not at all uncommon with the rude and uncultivated minds of even more hardened sailors than he, a great change had come over him. In short, he had the appearance, in every respect, of being a truly converted young man. Why this change of character had led him to this school-house, may not at first appear. Yet such a result is by no means unusual. This waking up the mind, by awakening the soul, and causing it to hunger and thirst after knowledge, has been observed long since, by those who have had their eyes open to what was going on around them. Young Gray was penniless, and his parents not only poor, but overburdened with the cares of a large family, so that they could give him no aid but by their prayers. He was not, however, to be discouraged by poverty. He agreed to ring the bell, sweep the hall, build fires, etc., for his board and tuition. As for clothing, he had none, or almost none. Charity, cold as her hand oftentimes is, supplied him with something. Dyspepsia had not, as yet, marred his visage or weakened his energies. In his connection with this seminary and others of kindred character, such as he could attend and yet pay his expenses by his labor, he became, ere long, able to teach others. Here was a new means of support, of which he eagerly availed himself. In whatever he undertook, moreover, he was singularly successful. He was in earnest. An earnest mind, in connection with an indomitable will--what may it not accomplish? It is every thing but omnipotent. "Heaven but persuades, almighty man decrees," as I have before said, assuming our old English poets as standard authority; but this saying has more in it than mere poetry. Or, if Heaven more than persuades--somewhat more--does not man still decree? But I am inclined, I see, to press this thought, perhaps in undue proportion to its magnitude. Whether or not it abates one half the guilt, I make the confession. For several years Gray pushed his devious course, through "thick and thin," sustaining himself chiefly by his teaching. In 1835, he was the private instructor of a wealthy family in Rhode Island; but so puzzling, not to say erratic, were some of his movements, that he was not very popular. Subsequently to this, he was found in another part of New England, editing a paper, and teaching at the same time a small number of pupils. All this while he paid great attention to physical education; but being either a charity scholar, or obliged to pay his way by his own exertions, he had not at command the needful time to render him thorough in any thing, even in his obedience, as he called it, to Nature's laws. Nearly all his studies were pursued by snatches, or, at least, with more or less irregularity. In nothing, however, was he more irregular than in his diet. This, to a person already inclined, as he certainly was, to dyspepsia, was very unfortunate. Perhaps, as generally happens in such cases, there was _action and reaction_. Perhaps, I mean, his dyspeptic tendencies led to more or less of dietetic irregularity; while the latter, whenever yielded to, had a tendency, in its turn, to increase his load of dyspepsia. There was, indeed, one apology to be found for his irregularity with regard to diet, in his extreme poverty. There were times when he was actually compelled to subsist on the most scanty fare; while his principles, too, restricted him to very great plainness. In one instance, for example, after he had finished his preparatory, course of study and entered college, he subsisted wholly on a certain quantity of bread daily; and as if not quite satisfied with even this restriction, while he needed his money so much more for clothing and books, he purchased stale bread--sometimes that which was imperfect--at a cheaper rate. Now a diet, exclusively of fine flour bread, and withal more or less sour or mouldy, is not very suitable for a dyspeptic, nor yet, indeed, for anybody whatever. However, he learned, at length, to improve a little upon this, by purchasing coarse, or Graham bread. Subsequently to this period, not being able, either alone or with the aid of friends, most of whom were poor, to pursue a regular academic course of instruction, he accepted the proposition that he should become an assistant teacher in the English department of a school in Europe. This, he feared, might postpone the completion of his studies, but would enable him, as he believed, to improve his mind, establish his health, and add greatly to his experience and to his knowledge of the world. It would also perfect him in teaching, so far at least as the mere inculcation of English grammar was concerned. His health was by no means improved by a residence of three or four years in Europe, but rather impaired. He returned to America, in the autumn of 1839, and as soon as he had partially recovered from the effects of a tedious and dangerous voyage, went to reside in the family of a near relative who was a farmer, with a view to learn, for the first time, what the labors of the farm would do for him. Here he often resorted to the same rigid economy which he had before practised, both at academy and college, and in Europe. The very best living he would allow himself was a diet exclusively of small potatoes--those, I mean, from which the larger ones had been separated for the use of others. This, his dyspeptic stomach would not long endure. His digestive and nervous systems both became considerably deranged; and even his skin, sympathizing with the diseased lining membrane of his stomach and intestines, became the seat of very painful boils and troublesome sores. These, while they indicated still deeper if not more troublesome disease, gave one encouraging indication--that the recuperative powers of the system were not as yet irrecoverably prostrated. He now came to me and begged to become my patient, and to reside permanently under my roof, so that he might not only receive such daily attention and counsel as the circumstances required, but also such food, air, exercise, and ablutions as were needful. He was accordingly admitted to the rights, privileges, and self-denials of the family. Here he spent a considerable time. While under my care, I made every reasonable exertion for his recovery which I would have made for a favorite child. Indeed, few children were ever more obedient or docile. He would sometimes say to me: "Doctor, I have no more power over myself than a child, and you must treat me _as you would_ a child." Nor was he satisfied till I restricted his every step, both with regard to the quantity and quality of his food, and the hours and seasons of bathing, exercise, reading, etc. It was to me a painful task, and I sometimes shrunk from it, for the moment. There was, however, no escape. I had embarked in the enterprise, and must take the consequences. At first, his improvement was scarcely perceptible, and I was almost discouraged. But at length, after much patience and perseverance, the suffering digestive organs began, in some measure, to resume their healthful condition, and the whole face of things to wear a different aspect. He left us to take charge of a public school. For some time after the opening of this school, his health seemed to be steadily improving, and the world around him began to have its charms again. He was in his own chosen, and, I might say, native element, which was to him a far more healthful stimulus than any other which could have been devised, whether by the physician or the physiologist. Nothing in this world is so well calculated to preserve and promote human health, as full and constant employment, of a kind which is perfectly congenial and healthful, and which we are fully assured is useful. In other words, the first great law of health is benevolence. It keeps up in the system that centrifugal tendency of the circulation of which I have already spoken, and which is so favorable for the rejection of all effete and irritating matters. It would have been next to impossible for our Saviour, with head, heart, and hands engaged as his were, to have sickened; nor was it till the most flagrant physiological transgressions had been long repeated, that even Howard the philanthropist sickened and died. Not the whole combined force of malaria and contagion could overcome him, till continual over-fatigue, persistent cold, and strong tea,--an almost matchless trio,--lent their aid to give the finishing stroke. Mr. Gray was a boarder with a gentleman who kept a grocery store, and who was glad to employ him on certain days and hours of vacation or recess, in taking care of the shop and waiting on his customers. Here the tempter again assailed him, in the form of foreign fruits, raisins, figs, prunes, oranges, dried fish, cordials, candy, etc. For some time past he had been wholly unaccustomed to these things; they had even been forbidden him, especially between his meals. As a consequence of his indulgences, and his neglect of exercise, his health again declined, and he came a second time under my care. He was partially restored the second time, but not entirely. His labors, which were teaching still, became more exhausting than formerly. Cheerfulness, hope, sympathy, conscious usefulness, and the force of many good habits, sustained him for a time, but not always. His great labors of body and mind, with a deep sense of responsibility, and the indulgences to which I have alluded, preyed upon him, and dyspepsia began once more her reign of tyranny. Doubtless he attempted too much here, for he was an enthusiast on the subject of common schools and common school instruction. And yet, under almost any circumstances of school-keeping, dyspepsia, nurtured as it was by every physical habit, would most certainly have assailed him. With regard to his food and drink he was very unwise. It contributed largely to an extreme of irritability, which was unfavorable, and which at the end of a single term compelled him to resign his place and seek some other employment. This was a grievous disappointment to Mr. Gray, and, as some of his friends believe, was the mountain weight that crushed him. The horrors of the abyss into which he believed he had plunged himself, were the more intolerable from the fact that he now, for the first time, began to despair of being able to consummate a plan by means of which both his sorrows and joys, especially the latter, would have been shared by another. Yet, even here, he did not absolutely despair. Hope revived when he found himself, a third time, my patient. I did all in my power to encourage him till I had at length, to my own surprise as well as his, the unspeakable pleasure of finding him again returning to the path of health and happiness. It is indeed true, that a capricious appetite still retained its sway, in greater or less degree, and whenever he was not awed by my presence, he would indulge himself in the use of things which he knew were injurious to him, as well as in the excessive, not to say gluttonous, use of such good things as were tolerated. He occasionally confessed his impotence, and begged us to keep every thing out of his way, even those remnants which were designed for the domestic animals! And yet, after all, strange to say, he absented himself very frequently, as if to seek places of retirement, where he could indulge his tyrannical appetite. I saw most clearly his danger, and spoke to him concerning it. I appealed to his fears, to his hopes, to his conscience. I reminded him of the love he bore to humanity, and the regard he had for Divinity. Once more, being partly recruited, he resumed his labors as a teacher. This was doubtless a wrong measure, and yet I was not aware of the error at the time, or I should not have encouraged the movement, or assisted him as I did in procuring a situation. But I then thought he had been punished so effectually for his transgressions, that he would at length be wise. Besides he was exceedingly anxious to be at work, and to avoid dependence, a desire in which his friends participated, and in regard to which they were so unwise as to express their over anxiety in his hearing. Three months in the school-house found him worse than ever before. He had attempted to board himself, to subsist on a very few ounces of "Graham wafers" at each meal, and to be an hour in masticating it. As an occasional compensation for this, however, a sort of _treating resolution_, he allowed himself to pick up the crusts and other fragments left about the school-house by his pupils, and when he had collected quite a pile of these, to indulge his appetite with them, _ad libitum_. Nor was this all. He erred in other particulars, perhaps in many. He came to my house a fourth time, but my situation was such that I could not well receive him. He staid only a day or two, but his residence with us was long enough to enable me to mark the progress of his case, and to deplore what I feared must be the final issue. From me he went to a friend in an adjoining State; not, however, till he had alluded to certain errors of his recent life that he had not yet devulged, even to his best friend. "Doctor," said he, "there are some things that I have not yet told you about." To me, also, it belongs, at this point of Gray's lamentable history, to make confession of great and glaring error. To have received the young man to my house, and to have devoted myself to the work of endeavoring again to raise him, would, most undoubtedly, have been a sacrifice to which few people in my circumstances would have thought themselves called. Yet, difficult as it was, the sacrifice might have been made. Had he been my only brother, I should, doubtless, have received him. The Saviour of mankind, in my circumstances, would probably have taken him in. Was I not his follower? And was I not bound to do what I believed he would do, in similar circumstances? His more distant friend, but more consistent Christian brother, opened wide his doors for his reception, and did the best he could for him. It was his intention, at first, to employ him, as I now think he ought to have been employed long before; viz., on a small farm. In this point of view this friend's house was particularly favorable. Yet there were offsets to this advantage. One thing in particular, cast a shade upon our efforts in his behalf. It was about April 1st, and the house and farm had an eastern aspect, and the easterly winds, which at that season so much prevailed, were very strong and surcharged with vapor at a low temperature. For a few days after his arrival he was worse than ever. This was discouragement heaped upon discouragement, and he began soon to sink under it. For a short time he was the subject of medical treatment. What was the character of the medicine he took, I never knew. At length there were signs of convalescence; but no sooner did his bodily health and strength begin to improve, than his mental troubles began to press upon him, till he was driven to the very borders of insanity. Indeed, so strong was the tendency to mental derangement that his relatives actually carried him, _per force_, to an insane hospital. But his residence at the hospital was very short. Provision having in the mean time been made for his reception in a private family, among his acquaintance, and the superintendent of the hospital having advised to such a course, he was remanded to the country, to familiar faces, and to a farm. On reaching the place assigned him, he became extremely ill,--worse, by far, than ever before,--so that, for several weeks, his life was despaired of. But by means of careful medical treatment, and a judicious and very simple diet, which at the hospital had been exchanged for a stimulating one, nature once more rallied, and in three or four weeks he appeared to be in a fair way for recovery. His strength increased, his mind became clear; his digestive function, though still erratic, appeared about to resume its natural condition, and to perform once more its wonted office; and the other troublesome symptoms were all gradually disappearing, except one;--he had still a very frequent pulse. But even this rapid arterial action was at length abating. From a frequency of the pulse equal to 100, 110, and sometimes 120 in a minute, it fell in two weeks to from 70 to 75; and this, too, under the influence of very mild and gentle treatment. There was no reduction of activity or power, by bleeding, or by blistering, or in any other way; on the contrary, as I have intimated, there was a general increase of strength and vigor, both of body, and mind. He did not even take digitalis or morphine. The prospect, therefore, was, on the whole, truly encouraging. And yet he had a set of friends--relatives, I should say, rather--who were not satisfied. It was strongly written on their minds that he was about to die; and they sternly insisted on removing him to his native home, that if he should die, he might die in the bosom of his own kindred. I was consulted; but I entered my most solemn protest against the measure, as both uncalled for and hazardous. It was to no purpose, however. In their over-kindness they determined to remove him; and the removal was effected. I ought also to say that though Mr. Gray highly appreciated their kindness, he was himself opposed to the measure, as one attended with much hazard. On the road to his paternal home, influenced in no small degree by mental excitement, his delirium returned, and with an intensity that never afterwards abated. He was, for about three weeks, a most inveterate and raving maniac, when, worn out prematurely with disease, he sunk to rise no more till the general resurrection. There was no post-mortem examination of this young man, though there should have been. Not that there was any lurking suspicion of peculiarity of disease, but because such examinations may always be made serviceable to the cause of medical science, while they cannot possibly injure either the dead or the living. I have been the more minute in my account of this man, because the case is an instructive one, both to the professional and non-professional reader, and also because it places medicine and physicians in the true light, and holds forth to the world the wonderfully recuperative power of nature, and the vast importance of giving heed to the laws of health and to the voice of physiology. CHAPTER LXIV. GETTING INTO A CIRCLE. The oddity of some of my captions may seem to require an apology; but I beg the doubtful reader to suspend any unfavorable decisions, till he has read the chapter which follows. He will not, either in the present instance or in any other, be introduced to a magic ring, or to the mysteries of modern "spiritualism." The circle into which my patient fell, was of a different description. A young mother from the west, about the year 1840, came to consult me with regard to her health. Not being able to receive her into my own family, I made arrangements for her reception in the immediate neighborhood, where she remained for a long time. She was a dyspeptic--if not of giant magnitude, but little short of it. I spent many an hour in endeavoring to set all right, both in mind and body. It was, however, much easier to set her head right, than her hands, feet, and stomach. She had been under the care of almost all sorts of medical men--hydropathic, homoeopathic, and allopathic. Some of them, from all these schools, had been men of good sense, while a much larger proportion of them had turned out to be fools, and had done her more harm than good. In short, like the woman in the New Testament, she had spent much on many physicians, and was nothing bettered by it, but rather made worse. Under such circumstances what ground was there for hope? What she most needed, it was easy to see, was a little more of resolution to carry out and complete what she believed to be her duty. I told her so. I told her how many times I had repeated to her the same directions; while she, after the lapse of a very few days,--sometimes only a day or two,--had come round again, in her remarks and inquiries, to the very point whence she had first started. I told her how easy a thing this getting into a circle was, and how difficult it was to escape from it. Although she perfectly understood her condition, there was still a strange and almost unaccountable reaching forth for something beyond the plain path of nature, which I had faithfully and repeatedly pointed out to her. She wished for some shorter road, something mysterious or magical. She was, in short, a capital subject for humbuggery, had she not tried it already to her heart's content. Occasionally, I must confess, I felt somewhat disposed to put her on the "starvation plan," as Dr. Johnson calls it,--on a diet of two pints only of plain gruel (thin hasty pudding, rather) a day,--for she would have borne it much better than did Mr. Gray, of the preceding chapter. I am sorry I did not. However, I prescribed for her, in general, very well; and, except in the last-mentioned particular, have no reason for regret nor any call for confessions. She remained under my care several weeks--all the while in a mill-horse track or circle, beginning at the same point and coming round to the same result or issue, when I frankly told her, one day, that it was a great waste, both of time and money, for her to remain longer. I saw, more and more clearly, that all her thoughts were concentrated on her own dear self. _Her_ troubles, _her_ health, _her_ concerns, _her_ prospects in life and death, were, to her, of more importance than all the world besides. No woman, as good as she was,--for she was, professedly, a disciple of him who said to his followers, "Feed my lambs,"--whom I have ever seen, was so completely wrapped up in self, and so completely beyond the pale of the world of benevolence. My final advice to her, in addition to that general change of personal habits which, from the first, I had strongly recommended to her, was to return to her native city, and, after making her resolution and laying her plan, give herself no rest, permanently, till by personal appeal or otherwise she had brought all the females within her reach into maternal associations, moral reform societies, and the like. On her return to her husband and children, she made an attempt to carry out the spirit of my prescription, and not without a good degree of success. But the great benefit which resulted from it--that, indeed, which it was my ultimate object to secure--was that it diverted her thoughts from their inward, selfish tendency, and placed her on better ground as to health than she had occupied for some time before. I saw her no more for ten or twelve years. Occasionally, it is true, I heard from her, that she was better. Yet she was never entirely well. She was never entirely beyond the circle in which she had so long moved. She returned, at times, to medical advice and medicine; but, so far as I could learn, with little permanent good effect. She died about twelve years after she left my "guardianship," an extreme sufferer, as she had lived; and a sufferer from causes that a correct education and just views of social life, and of health and disease, would, for the most part, have prevented. CHAPTER LXV. POISONING WITH MAPLE SUGAR. A particular friend of mine purchased one day, at a stand in the city, two small cakes of maple sugar. It was early in the spring, and very little of the article had as yet been manufactured. My friend, in his eagerness, devoured them immediately. He observed, before eating them, that they had a very dark appearance; but the taste was correct, as far as he could judge, and he did not hesitate. He was one of those individuals, moreover, who are not greatly given to self-denial in the matter of appetite. The next day he had as sore a mouth as I ever saw. The inflammation extended not only to the back part of the mouth, but into the throat, and probably quite into the stomach, and was attended with a most distressing thirst, with loss of appetite, and occasional nausea. In short, it unfitted him for business the whole day; indeed it was many days before he recovered entirely. My own conclusion, after a careful investigation of the facts, was, that the sugar was cooled down in vessels of iron, which were, in some way, more or less oxydated or rusted, and that a small quantity of free acid having been, by some means unknown, developed in the sugar, it entered into a chemical combination with the metallic oxyde, to form a species of copperas--perhaps the genuine sulphate of iron itself. No medicine was given, nor was any needed. It was sufficient to let the system rest, till Nature, with the assistance of small quantities of water,--such as she was constantly demanding,--could eject the intruding foe. It required only a little patient waiting. There is scarcely a doubt that the sufferer learned, from his experiment, one important lesson; viz., to let alone every thing which, by cooking, has been changed to a dark color. Beets are sometimes blackened by cooking in iron vessels, as well as sugar; and so are apples and apple-sauce, and sundry other fruits and vegetables. The word apple-sauce reminds me of an incident that recently occurred in my own family. A kind neighbor having sent us some apple-sauce, such of the family as partook of it freely, suffered, soon afterward, in a way that led to the suspicion of poison. This apple-sauce was quite dark-colored, but tasted well enough. We have seen, in Chapter XXVIII., that in the use of apple-sauce, or apple butter, or, indeed, any thing containing an acid, which has been in contact with the inner surface of red earthen ware, glazed with the oxyde of lead, people are sometimes poisoned; but for common, plain, apple-sauce, recently cooked, to be poisonous, is rather unusual. However, we can hardly be too careful in these matters. Serious evils have sometimes arisen from various kinds of complicated cookery, even when the healthiness of the vessels used was quite above suspi. A powerful argument this in favor of simplicity. It should also be remembered, with regard to sugar, that this is a substance whose use, even when known to be perfectly innoxious, is, at best, of doubtful tendency, beyond the measure which the Divine Hand has incorporated into the various substances which are prepared for our use. That sugar, in considerable quantities, leads to fulness, if not to fatness, is no proof of its healthfulness; since fatness itself is a sign of disease in man and all other animals, as has, of late, been frequently and fully demonstrated. CHAPTER LXVI. PHYSICKING OFF MEASLES. The father of a large family came to me one day, and, with unwonted politeness, inquired after my health. Of course, I did not at first understand him, but time and patience soon brought every thing to light. His family, he said, were all sick with measles, except his wife, and he wished to ask me a question or two. The truth is, he wanted to consult me professionally, without paying a fee; and yet he felt a little delicacy about it. But I was accustomed to such things; for his was neither the first nor the hundredth application of the kind; so I was as polite as he was, in return. Another individual stood near me just at that moment, who supposed he had a prior claim to my attention; and I was about to leave Mr. M. for a moment, when he said, in a low voice, and in a fawning manner: "I suppose, doctor, it is necessary to physic off well for the measles; is it not? The old women all say it is; but I thought that, as I saw you, it might be well to ask." This species of robbery is so common, that few have any hesitancy about practising it. Mr. M., though passing for a pattern of honesty and good breeding, wherever he was known, was nevertheless trained to the same meanness with the rest of the neighborhood where I resided, and was quite willing--even though a faint consciousness of his meanness chanced to come over him now and then--to defraud me a little in the fashionable or usual manner. Perhaps I may be thought fastidious on this point. But though I have been sponged,--I may as well again say robbed,--in this or a similar way, a hundred or a thousand times, I believe I never complained so loudly before. Yet it is due to the profession of medicine, and to those who resort to it, that I should give my testimony against a custom which ought never to have obtained foothold. But to return to our conversation;--for I was never mean enough to refuse to give such information as was required, to the best of my abilities, even though I never expected, directly or indirectly, to be benefited by it;--I told him, at once, that if costiveness prevailed at the beginning of convalescence, in this disease, some gentle laxative might be desirable; but that, in other circumstances, no medicine could be required, the common belief to the contrary notwithstanding. Mr. M. seemed not a little surprised at this latter statement, and yet, on the whole, gratified. It was, to him, a new doctrine, and yet he thought it reasonable. He never could understand, he said, what need there was of taking "physic," when the body was already in a good condition. This physicking off disease is about as foolish as taking physic to prevent it--of which I have said so much in Chapter XI. and elsewhere. I do not, indeed, mean to affirm that it is quite as fatal; though I know not but it may have been fatal in some instances. Death from measles is no very uncommon occurrence in these days. Now how do we know whether it is the disease that kills or the medicine? And when we physic off, in the way above mentioned, how know we, that if, very fortunately, we do not kill, some other disease may not be excited or enkindled? You are aware, both from what has been said in these pages, and from your own observation, that measles are not unfrequently followed by dropsy, weak eyes, and other troubles. No individual, perhaps, is, by constitution, less inclined to dropsy than myself; yet he who has read carefully what I have noted in Chapter IV., will not be confident of his own safety in such circumstances. Yet if they are endangered who are least predisposed to this or any other disease, where is the safety of those who inherit such a predisposition? CHAPTER LXVII. TIC DOULOUREUX. Some fifty years ago, I saw in a Connecticut paper, a brief notice of the death of an individual in Wellingworth, in that State, from a disease which, as the paper proceeded to state,--and justly too,--not one in a million had then ever felt, and which not many at that time had ever heard of; viz., _tic douloureux_. This notice, though it may have excited much curiosity,--it certainly arrested my own attention,--did not give us much light as to the nature of the disease. "What _is_ tic douloureux?" I asked my friends; for at that time, of course, I knew nothing of the study of medicine. They could not tell me. "Why do medical men," I asked, "give us such strange names? Is it to keep up the idea of mystery, as connected with the profession, in order thus to maintain an influence which modest worth cannot secure?" It was largely believed at that time, by myself and many others, that science, like wealth,--especially medical science,--was aristocratical; that the learned world, though they saw the republican tendencies of things, were predisposed to throw dust in the people's eyes as long as they could. The fact that almost all our medicines, whether in the condition in which we see them labelled at the apothecary's shop, or as prescribed by the family physician, have Latin names,--was often quoted in proof of this aristocratic feeling and tendency. Now there was doubtless some foundation for this opinion. Medical men did then and still very generally do believe, that it is better, on the whole, for the mass of mankind to have nothing to do with these matters, except at the prescription of those who have given the best part of their lives to the study of medicine and disease. That they are weapons of so much power, that even physicians--men who only partially understand the human constitution and their influence on it--are almost as likely to do harm with them as good, and that it is quite enough for society to bear the evils which are connected with the regular study and practice of the profession, without enduring a much larger host, inflicted by those who have other professions and employments, and must consequently be still more ignorant than their physicians. And may not this be one reason why a foreign language has been so long retained in connection with the names of diseases and medicines? But though physicians entertain the belief alluded to, and though it were founded in truth, it does not thence follow that mankind are to remain in ignorance of the whole subject of life and health, nor is it the intention of enlightened medical men that they shall. The latter are much more ready, as a general rule, to encourage among mankind the study of the most appropriate means of preventing disease, than they are willing to take the needful pains. In short, though physicians by their slowness to act, in this particular, are greatly faulty, the world as a mass are still more so. I was speaking, at first, of tic douloureux. This is a painful affection of a nerve or a cluster of nerves. When it first began to be spoken of, it was confined chiefly to an expansion of nerve at the side of the face, called in anatomical works _pes anserina_. But, of late years, it has been found to attack various nerves and clusters of nerves in different parts of the body. In truth, under the general name of neuralgia, which means about the same thing, we now have tic douloureux of almost every part of the human system, and it has become so common that instead of one in a million, we have probably one or two if not more in every hundred, who have suffered from it in their own persons. About the year 1840, I had a patient who was exceedingly afflicted with this painful disease. She was, at the same time, consumptive. The neuralgia was but a recent thing; the consumption had been of many years' standing, and was probably inherited. The physicians of her native region had exhausted their skill on her to no purpose. There was no hope of aid, in her case, from medicine. The only thing to be done was to invigorate her system, and thus palliate the neuralgia and postpone the consumption. She was accordingly placed under the most rigid restrictions which the code of physical law could demand. She was required to attend to exercise and bathing with great care; to avoid over anxiety and fretfulness; to drink water, and to eat the plainest food. It was not intended to interdict _nutritious_ food; but only that which was _over-stimulating_. It required considerable time to show her and her friends the practical difference between nutrition and stimulation. They thought, as thousands have thought beside them, that without a stimulating diet she could not be properly nourished. But they learned at length that good bread of all sorts, rice, peas, beans, and fruits, especially the first two, while they were unstimulating, were even more nutritious than the more stimulating articles of flesh, fish, fowl, butter, and milk and its products. The treatment to which she was directed was at length pretty carefully followed. The Friends--of which religious connection she was a member--are generally thorough, when we gain their full confidence. Her health was so far restored, that at one period I entertained strong hopes of her ultimate recovery; or, at least of a recovery which would permit of her continuance some twenty or twenty-five years longer. But after seven or eight years of comfortable though not very firm health, she again declined. She died at forty years of age. CHAPTER LXVIII. COLD WATER IN FEVER. My daughter, then about three years of age, was feverish; and as the lung fever was somewhat prevalent, the family became considerably alarmed. On examination, I found a strong tendency to the head. The eye was heavy, the head hot and painful, and the tongue thickly coated. The digestive system was disordered, and the skin was collapsed, inactive, and cold. The extremities, especially the feet, were particularly cold and pale. The days of hydropathy had now arrived; but I was not a full convert, as I have already told you, to the exclusive use of cold water in disease. However, a case was before me which obviously demanded it. So I proceeded to make frequent applications of Nature's drug to the top of her head, and to the temples, while I ordered warm and stimulating applications to the feet and ankles. This treatment had the effect to render her condition somewhat more comfortable during the day, but at evening the fever returned, and during the night was violent. The tendency to the head was so great as to cause delirium. The anxiety of the family became very great. In the morning, however, she was rather better, so that hope again revived. During the day the fever increased again, and towards evening and during the whole night was accompanied by restlessness and delirium. But we only persevered with the more earnestness in the use of what we believed to be the most rational treatment. She had, however, a very sick night. The next morning she was again better, though, as might have been expected, somewhat more feeble than she was twenty-four hours before. Most parents, I know, and not a few wise medical men among us, would have resorted to powders and pills; but we only persevered with our cold applications to the head, and our stimulating draughts to the feet. The bowels were in a very tolerable condition, otherwise a very mild cathartic might possibly have been administered. We had very strong hopes,--at least I had,--that nature would be too strong for the disease, and that the fever would, ere long, begin to abate. In the afternoon the fever increased again, in some degree, and there was a slight delirium during the succeeding night. She slept a little, however, towards morning, after which she was evidently much better. This third day was passed away very comfortably, and she slept well during the succeeding night. The fourth morning she seemed to be quite restored. Now a case of fever treated with emetics, diaphoretics, etc., and followed up with the usual paraphernalia of customary medical practice, which should yield so promptly and so immediately, would be supposed to be cured by the medicine; and the cure would very probably be regarded as rather remarkable; and if there was any peculiarity in the treatment, if the diaphoretic powders, for example, had any new or strange name, the practice would, peradventure, be thought worth imitating in other apparently similar cases of disease. For myself, however, I simply regard it as one of Nature's own cures, unobstructed and unembarrassed by medicine. As the child was young and tenacious of life, she might very probably have recovered under the more common routine of medical treatment. But would there have been any advantage in such a recovery, over one which was equally rapid and perfect without the aid of medicine? Would there, in the latter case, have been no hazard to the constitution? CHAPTER LXIX. COLD-TAKING AND CONSUMPTION. In Chapter XXIII., I have given a full account of my partial recovery from consumption. I have even spoken of the postponement as if it were complete and final. More than twenty years had now passed away, and I had begun to indulge the hope that I should never have another relapse. As one element of this hope, I had nearly broken up the habit--once very strong--of taking cold, especially on my lungs. In truth, I believed all danger from this source to be entirely removed, and my particular susceptibility to any thing like acute pulmonary attacks forever at an end. I was confident, moreover, that the art of avoiding cold was an art which not only an individual, here and there, like myself, could acquire, but one which was within the reach of every one who would take the needful pains. On a certain occasion of this latter kind, I was under a conventional necessity of exposing myself, in an unusual degree, for several successive evenings, to circumstances which, at an earlier period of my life, would, almost inevitably, have been followed by a cold. Was it safe, in my present condition, to run the risk? I hesitated for some time, but finally decided to comply with the request which had been made, and take the responsibility. I believed my susceptibility to cold so entirely eradicated that there was little if any danger. But, as the event proved, I was quite mistaken; a severe cold came on, and left me in a condition not merely alarming, but immediately so. My lungs were greatly oppressed and my cough exceedingly severe and harassing; and it was followed with great debility and rapid emaciation. Ashamed of myself, especially as I had boasted, for so many years, of an entire freedom from all tendencies of this sort, I endeavored, for a few days, to screen myself entirely from the public eye and observation. But I soon found that inaction, especially confinement to the house, would not answer the purpose,--that I should certainly die if I persisted in my seclusion. What now should I do? I was too feeble to work much, although the season had arrived when labor in the garden was beginning to be needed. Trees were to be pruned and washed, and other things promptly attended to. The open air was also the best remedy for my enfeebled and irritated bronchial cavities. Whether there was, at this time, any ulceration of tubercles in my lungs, is, to say the least, very doubtful. However, I greatly needed the whole influence of out-of-door employment, or of travelling abroad; and, as it seemed to me, could not long survive without it. Accordingly I took my pruning knife in my hand, and walked to the garden. It was about a quarter of a mile distant, and quite unconnected with the house I occupied. At first, it was quite as much as I could do to walk to the garden and return without attempting any labor. Nor could I have done even this, had I not rested several times, both on the road and in the enclosure itself. It was a week before I was able to do more than merely walk to the garden and back, and perhaps prune a small fruit tree or shrub, and then return. But I persevered. It seemed a last if not a desperate resort; yet hope sometimes whispered that my hour had not yet come, that I had more work to perform. At length I began to perceive a slight increase of muscular strength. I could work moderately a quarter of an hour or more, and yet walk home very comfortably. In about two months, I had strength enough to continue my labors several hours, in the course of a whole day, though not in succession--perhaps two in the forenoon and two in the afternoon. In about three months, I was, so far as I could perceive, completely restored. It is to be remarked and remembered that, during the whole three months, I never took the smallest particle of medicine, either solid or fluid. My simple course was to obey, in the most rigid and implicit manner, all known laws, physical and moral. It was my full belief at that time,--it is still my belief,--that conformity to all the Creator's laws is indispensable to the best of health, in every condition of human life, but particularly so when we are already feeble and have a tendency to consumption. When it became known to my neighbors, who saw me day after day, reeling to my garden or staggering home, that I refused to take any medicine, there was a very general burst of surprise, and, in some cases, of indignation. "Why," said they, "what does the man mean? He must be crazy. As he is going on he will certainly die of a galloping consumption. Any one that will act so foolishly almost _deserves_ to die." As soon as I found myself fairly convalescent, I returned gradually to all those practices on which I had so long relied as a means of fortifying myself, but which, since my _fall_, had been partially omitted. Among these was bathing, especially cold bathing. To the last, however, I returned very cautiously. Not for fear I should not be able to secure a reaction, but rather for fear Nature would have to spend more _vitality_ during the process than she could well afford to spare. I have known cases of the latter kind. An aged minister in Cleveland, Ohio, who had long followed the practice of cold bathing every morning, came to me in Dec. 1851, when the cold weather was very intense, and told me that though he could, with considerable effort, get up a reaction in his system after the bath, he was afraid it _cost_ too much. I advised him to suspend it a few weeks, which he did with evident advantage. There are, however, many other things to be done besides giving due attention to cold bathing, if we would harden ourselves fully against taking cold, to which I should be glad to advert were it not foreign to the plan I had formed, and the limits which, in this work, I have prescribed to myself. CHAPTER LXX. FREEZING OUT DISEASE. I am well acquainted with one man of Yankee origin, who formerly made it a practice to freeze out his colds, as he called it. It is certainly better to prevent them, as I have all along and always taught. But this man's story is somewhat amusing, and by way of relief from our more sober subject, I will very briefly relate it. Whenever he fancied he had taken cold, he would go, at about nine o'clock in the evening, in such diminished clothing as would render him in a very little time, quite chilly, and remain out of doors, when the weather would possibly permit, till he was almost frozen, and then come in and go immediately to bed, and procure a reaction. This he called freezing out his colds. Whether it was the cold or the heat that restored him, may be a point not yet fully settled; but it was a well-known fact to his friends, though they insisted in protesting against the practice, that every vestige of his cold would frequently, if not always, immediately disappear. But it was a method of treatment which, as the event proved, was not without its hazards. I met with him a few years since, and on inquiring whether he continued to be as successful as formerly in freezing out his colds, he replied that for some time past he had not tried the plan, for, on a former occasion, after many successful experiments, he had failed in one, and had concluded to relinquish it. He made no farther confessions for himself, but his friends have since told me that in the case he faintly alluded to, he came very near dying under the process. He was sick with a fever, as the consequence, for a long time. A man in one of the Middle States, who is himself about half a physician, and who has in various ways done much for his fellow-men as a philanthropist, is accustomed to pursue a course of treatment which, though slightly related to the former, is, nevertheless, founded on principle. He keeps the sick in a room whose temperature is very low,--little, if at all, above the freezing point,--in order that they may inhale a full supply of oxygen. For every one doubtless knows that the colder the air, the denser it is, and consequently, the greater the absolute quantity of oxygen inhaled at each breath. By compelling his patients, however weak and feeble, to breathe a cold atmosphere, he secured to them an increased and full supply of oxygen. To prevent his patients from suffering, in consequence of the external atmospheric cold, he keeps them in warm beds, and only suffers them to be out of bed a very short time, at long intervals. And while out of bed even, they are rubbed rapidly, in order to prevent any collapse of the skin from the cold. I knew him to keep a very delicate female, who was scrofulous if not consumptive, for several weeks of the coldest part of the winter, in a room whose temperature seldom exceeded 30° to 40°, scarcely permitting her to go out of it night or day, and what is still more curious, she slowly recovered under the treatment, and is now--seven or eight years afterwards--in the enjoyment of excellent health. CHAPTER LXXI. THE AIR-CURE. The individual alluded to in the preceding chapter, once sent for me to come and aid him for a time. He was the proprietor of a somewhat dilapidated water-cure establishment, which he wished to convert into what he chose to denominate an air-cure. For though half a physician himself, he had usually employed men of education to assist him; but, not having been quite fortunate in his selection, in every instance, he was disposed to make trial of myself. In expressing to me his desires, he said he understood, perfectly well, my position. He well knew, in the first place, that I was not a hydropathist, but a regular, old-school physician, with this modification: that I had, for the most part, lost my faith in medicine, and relied chiefly on the recuperative efforts of Nature. He thought, on some points, as he said, a little differently from me; still, he supposed that wherein we could not agree we could at least agree to differ. The sum total of his wishes, in short, was, that I would aid him in such way and manner as might seem to me best. He believed air to be the most important and efficient remedial agent in the world. His ideas of the virtue of this ærial fluid were hardly exceeded by those of Mr. Thackrah, of Leeds, England, who believes that we subsist more on air than on food and drink. I was with this good man about six months, when, finding it impossible to carry out his plan, I left him. But I left him with regret. His purposes were generous in the extreme--I might even say noble. He loved to cure for the pleasure of curing--not for the emolument. In short, he seemed to have no regard to the emolument--not the slightest, and to be as nearly disinterested as usually falls to the human lot. But did he cure? you will perhaps inquire. Yes, if _anybody_ cures. Persons came under his care who had been discharged by other physicians--both allopathic and homoeopathic--as incurable; and who yet, in a reasonable time, regained their health. They followed our directions, obeyed the laws of health, and recovered. You may call it what you please--either cure or spontaneous recovery. Miracle, I am quite sure, it was not. What, then, were the agencies employed in the air-cure? My friend believed that the judicious application of pure air, in as concentrated, and, therefore, as cool a state as possible, particularly to the internal surface of the lungs, was more important than every other agency, and even more important than all others. But then he did not forget the skin. He had his air bath, as well as his deep breathings; it was as frequently used, and was, doubtless, as efficacious. He also placed great reliance on good food and drink. Animal food he rejected, and condiments. I have neither known nor read of any vegetarian, of Britain or America, who carried his dietetic peculiarities to what would, by most, be regarded as an extreme, more than he. And yet his patients, with few exceptions, submitted to it with a much better grace than I had expected. Some of them, it is true, took advantage of his absence or their own, and made a little infringement upon the rigidity of his prescriptions, but these were exceptions to the general rule; and I believe the transgressors themselves regretted it in the end--fully satisfied that every indulgence was but a postponement of the hour of their discharge. One thing was permanently regarded as ultra. He did not believe in breakfasting; and therefore kept every patient, who wished to come under his most thorough treatment, from the use of food till about the middle of the day. This permitted of but two meals a day, which, however, is one more than has sometimes been recommended by O. S. Fowler, the phrenologist, and even by a few others. The main error, however, of this air-cure practice,--if error there was in it,--consisted in the idea of its applicability to everybody, in every circumstance. For though it may be true that as large a proportion of inveterate cases of disease would disappear under such treatment as under any other, yet there are probably not a few to whom it would be utterly unadapted. CHAPTER LXXII. THE CLERGYMAN. An Ohio clergyman, just setting out in his ministerial career, consulted me, one day, about his health and future physical prospects. His nervous system and cerebral centre had been over-taxed and partially prostrated; and his digestive and muscular powers were suffering from sympathy. In short, he was a run-down student, who, in order to be resuscitated, needed rest. It was not, however, the rest of mere inertia that he required, but rest from those studies to which his attention had been long and patiently confined. His bodily powers were, indeed, flagging with the rest; but then it was impossible for him to be restored without _some_ exercise. In truth, it was not so much a _rest_ of body, mind, or heart that he needed, as a _change_. I will tell you what a course he had been, for five or six years, pursuing. Though his father was reckoned among the wealthier farmers of Ohio, yet, having a large family to sustain and educate, he did not feel at full liberty to excuse his children from such co-operation with him as would not materially interfere with their studies. Hence they were required--and this son among the rest--not only to be as economical as possible, in all things, but also to earn as much as they could, especially during their vacations. They were not, of course, expected to do any thing which was likely to impair their health, but, on the contrary, to take every possible pains to preserve the latter, and to hold labor and study and every thing else in subserviency to it. The son for whom I was requested to prescribe, not only attended to his father's wishes and expectations, and endeavored to fulfil them, but went much farther than was intended, and did more than he ought. Besides keeping up with his class, he taught school a very considerable portion of the time, so that his mental apparatus, as I have already more than intimated, was continually over-taxed; and he had been a sufferer, more or less, for several years, when I met with him. My advice was that he should leave his studies, entirely, for two years, and labor moderately, in the meantime, on his father's farm. His principal objection to doing so, was, that he was already at an age so much advanced, that it seemed to him like a wrong done to society, to delay entering upon the duties of the ministry two whole years. But I reasoned the case with him as well as I could, and, among other things, pointed out to him the course pursued by his Divine Master. I have never met with him from that day to this; nor have I ever received from him--strange as it may seem--any communication on the subject. But I have been informed from other sources, that after laboring for a time with his father, he was settled as a minister in a neighboring village with greatly improved health and highly encouraging prospects. He is at the present time one of the main pillars, theologically, of the great State of New York, and, as I have reason for believing, is in the enjoyment of good health. It is easy to see that the time he spent on his father's farm, instead of being a loss to him, was, in the end, among the most important parts of the work of his education. How much better it was for him to recruit his wasted energies before he took upon him the full responsibilities of preacher and pastor in a large country church and congregation, than to rush into the ministry prematurely, with the prospect, amounting almost to a certainty, of breaking down in a few years, and spending the remnant of his days in a crippled condition,--to have the full consciousness that had he been wise he might have had the felicity of a long life of usefulness, and of doing good to the souls and bodies of mankind. CHAPTER LXXIII. HE MUST BE PHYSICKED, OR DIE. Mr. S., a very aged neighbor of mine, fell into habits of such extreme inactivity of the alimentary canal, that instead of invoking the aid of Cloacinà, as Mr. Locke would say, every day, he was accustomed to weekly invocations only. There was, however, a single exception. In the month of June, of each year, he was accustomed to visit the seaside, some twenty miles or more distant, and remain there a few days, during which and for a short time afterward, his bowels would perform their wonted daily office. And yet, despite of all this, he got along very well during summer and autumn, for a man who was over seventy years of age. It was not till winter--sometimes almost spring--that his health appeared to suffer as the consequence of his costiveness. Nor was it certain, even then, whether his inconveniences,--for they hardly deserved the name of sufferings,--arose from his costiveness, or from the croakings of friends and his own awakened fears and anxieties. Nearly every one who knew of the facts in his case was alarmed, and many did not hesitate to cry out, even in his hearing, "He must be physicked, or die!" And their fears and croakings, by leading him to turn his attention to his internal feelings, greatly added to his difficulties. My principal aim, as his friend and physician, was to convince him that there was no necessity of anxiety on the subject, as long as none of the various functions of the system were impaired. As long as digestion, circulation, respiration, perspiration, etc., were tolerably well performed, and his general health was not on the decline, it was not very material, as I assured him, whether his alvine movements were once a day, once in two days, or once a week. The various emunctories or outlets of the body should, undoubtedly, be kept open and free, so that every portion of worn-out or effete matter may be effectually got rid of. In order to have this done in the very best manner, it is indispensably necessary that we should eat, drink, breathe, sleep, and exercise the muscles and all the mental and moral powers daily. And yet we are to such an extent the creatures of habit, that we can, in all these respects, bring ourselves to almost any thing we choose, and yet pass on, for a time, very comfortably. Thus we may eat once, twice, thrice, or five times a day, and if possessed of a good share of constitutional vigor, we may even accustom ourselves to considerable variation from the general rule with regard to drinking, sleeping, exercise, temperature, etc. Healthy men have been able to maintain their health, in tolerable measure, for a long time, without drink, without exercise, and even without sleep. Of the truth of this last remark, I could give you, did time and space permit, many well-attested, not to say striking facts. I was not wholly successful in my attempts at quieting the mind and feelings of my aged patient or his friends. And yet his erratic habit was never entirely broken up. He lived to the age of fourscore without suffering much more from what are usually called the infirmities of age, than most other old men. It must not, however, be concealed that he possessed what has been sometimes denominated an iron constitution. Mr. Locke strongly insists that children should be trained, from the very first, to diurnal habits of the kind in question; and I cannot help thinking that such habits should be secured very early--certainly at eight or ten years of age. Some of the healthiest men and women I have ever known were those who had either been trained or had trained themselves in this way. And yet I would not be so anxious to bring nature back to this rule when there have been large digressions, as to be found administering cathartics on every trifling occasion. An old man, who eats little and exercises still less, but has a good pulse, a good appetite, and a free perspiration, with a cheerful mind, need not take "physic" merely because his bowels do not move more than once a week; nor need those who are feverish, and who eat and exercise but little. The disturbance which will ensue, if medicine be taken, may be productive of more mischief, on the whole, than the absorption into the system of small portions of the retained excretions, or the small amount of irritation they produce--and probably will be so. It will be a solace to some to know that the alvine excretions of the system are not so much the remnants of our food, when that food is such as it should be, as a _secretion_ from the internal or lining membrane of the bowels. Consequently, if this secretion is interrupted by disease, there will be a proportionally diminished necessity for alvine evacuations. Prof. ----, of Ohio, had been sick of fever, for a long time, and, on the departure of the disease, his bowels were left in such a condition that cathartics, or at least laxatives, began to be thought of; but his physician interdicted their use: His costiveness continued to the twenty-first day, without any known evil as the consequence. On this day nature rallied. Then followed a period of quiescence of fourteen days, and then another of seven days, after which he fell into his former diurnal habits. There was much croaking among the neighbors, on account of the treatment of his physician; but the results put all to silence. The case of Judge ----, in the interior of the same State (Ohio), was so much like that of Prof. ----, in all its essential particulars, that I need but to state the fact, without entering at all upon the details. J. W. G., a lawyer of Massachusetts, was sick with a lingering complaint, attended with more or less of fever, for several months. During this time there was one interval, of more than thirty days, during which his bowels did not move. And yet there was no evidence of any permanent suffering as the consequence. The principal use I would make of these facts, so far as the mass of general readers is concerned, is the following: If, during feebleness and sickness, human nature will bear up, for a long time, under irregularities of this sort, is it needful that we should be alarmed and fly at once to medicine in cases _less_ alarming--above all, in these cases, when, except in regard to costiveness, the health and habits are excellent? May we not trust much more than we have heretofore believed, in the recuperative efforts of Nature? CHAPTER LXXIV. WHO HATH WOE? OR, THE SICK WIDOW. Early in the year 1852, I received a letter, of which the following, with very slight needful alterations, is an extract. It was written from the interior of Massachusetts. "About three months ago, I took a long journey by stage-coach, which brought on, as I think, an internal inflammation. Since that time I have taken very little medicine. Please tell me whether it is right for me to bathe daily in, and drink freely of, cold water; and whether it is safe to make cold applications to the parts affected. "I take as much exercise as I can without producing irritation. I do not, by any means, indulge in the food which my appetite craves. "I am twenty-six years of age; was married and left a widow, while young and very ignorant, under circumstances the most deeply painful. I have a strong desire to get well if I can; though if I must give up the thought I am willing to die. "I should be very glad to see you, if you will take the trouble to come and see me. I should have made an effort to consult you, in person, before now, if I could have safely taken the journey." At the time of receiving this letter I was travelling in a distant State, and, as an immediate visit was wellnigh impracticable, I wrote her, requesting such farther information as might enable me to give her a few general directions, promising to see her on my return in the spring. In reply to my inquiries, I received what follows:-- "I have been, from childhood, afflicted with bunches in the throat. There is no consumptive tendency on either my father's or my mother's side; but I come, by the maternal side, from a king's evil[I] family. I am an ardent, impulsive creature, possessing a nervous, sanguine temperament; naturally cheerful and agreeable, but rendered, by sickness, irritable, capricious, and melancholic. I fear consumption so much, that were I convinced it was fully fastened upon me, I might be tempted, unless restrained by a strong moral influence, to commit a crime which might not be forgiven. "I have great weakness in the throat, and soreness in the chest, with a dull pain between the shoulders. My appetite is extraordinary;--I think it has increased since I have dieted. My flesh is stationary. I gain a few pounds, and then commit some wild freak and lose it. I am unaccountable to myself. I think, sir, that my mental disturbances impair my health. "I anticipate much pleasure from seeing you; for I see, by your letter, you understand me. I have always been thought inexplicable. I feel a universal languor. I am, at times, unconscious. I feel dead to all things; there seems a loss of all vitality; and sometimes there is a sense of suffocation. All these feelings are extreme, because I am, by my nature, so sensitive. I met the other day with a slight from a friend, a young lady, which caused grief so excessive that I have ever since been suffering from influenza." These lengthy extracts may not be very interesting to the general reader, except so far as they reveal to him some of the internal cogitations of a soul borne down with a load of suffering, which almost drove her to suicide. "Who hath woe,"--as Solomon says, with respect to a very different description of human character,--if not this poor widow? And yet it required a personal visit, and the conversation of a couple of hours, to fathom the depths of her woe, to the utmost. For there are secrets of the human heart, with which, of course, no stranger--not even the family physician--should presume to intermeddle; though to these depths, in the case of the half-insane sufferer of whom I am speaking, it was not necessary that I should go, in order to find out what I had all along suspected. Disease had been communicated several years before, of a kind which was much more communicable _then_, than it was eradicable now. Whenever, by the laws of hereditary descent, in their application to health and disease, our children, grandchildren, and great-grandchildren suffer, we may recognize in it the hand of the great Creator; nor do we doubt, often, the wisdom of such laws nor their ultimate tendency to work out final good. But when we find a widow suffering many long years, from a disease to which a husband's weakness and wickedness has subjected her, what shall we say, especially when we have reason to fear that the evils in question, some of them, at least, will be terminable only, in their effects, with life itself? My patient is _patiently_ wearing out her ills; and what she cannot wear out, she is learning to endure. Her case cannot be reached with medicine, at least with safety, and is only to be affected, so far as affected at all, by yielding the most unflinching obedience to the laws of God, physical and moral. She will not die of consumption; she will live on; but how much progress she may be able to make towards the land of life and health, is by no means certain. Her case is, at best, a trying one, and must compel us, whenever we reflect on the subject, to say, "Who hath woe, if not persons situated like this widow?"[J] FOOTNOTES: [I] She was not aware that king's evil, or scrofula, is oftentimes the parent of consumption. [J] Since this chapter was written, I have had the pleasure of learning from a reliable source that the young woman above referred to is now enjoying comparatively good health. She married a second time, a year or two afterwards; and by following out the course prescribed, and with the blessing of Heaven, she came at length to her present position of usefulness and happiness. CHAPTER LXXV. THE PENALTY OF SELF-INDULGENCE. The thought that a minister of the gospel can be gluttonous is so painful that, after selecting as the caption to the present chapter, "A gluttonous minister," I concluded to modify it. Perhaps, after all, it might be as well in the end, to call things by their proper names. However, we will proceed, as we have set out, for this once. A minister about forty years of age came to me one day, deeply involved in all the midnight horrors of dyspepsia. On investigating his case, I found it one of the most trying I had ever met with. It was not only trying in itself, in the particular form and shape it assumed, but it had been rendered much more troublesome and unmanageable by injudicious medical treatment. My course was a plain one, and I proceeded cautiously to prescribe for him--not medicine, for in my judgment he needed none, but simply a return to the physical laws he had so long and so palpably violated. These laws I endeavored briefly to recall to his attention. As he was an intelligent man, I dealt with him in the most plain and direct manner. Some two or three weeks afterward he called on me again, saying that he was no better. I repeated my prescription, only more particularly. Still I was not, as I now think, sufficiently particular and definite, for want of time. Moreover, he still clung to the off-hand customs of empiricism,--that of looking at the tongue, feeling the pulse, and seeming "wondrous wise,"--and vainly hoped I would treat him in the same direct way, instead of requiring what he regarded as a more circuitous course. He called on me the third time. We had now ample leisure and opportunity for attempting to ferret out the causes which had operated to bring him into his present condition, some of which, it appeared, had been of long standing. I inquired, in the first place, concerning his exercise. This, he said, was taken very irregularly, chiefly in walking abroad on business, seldom or never in company. His mind, in all probability, was not directed, to any considerable extent, from its accustomed mill-horse track. His gait, too, when he walked, was staid and measured. It was never buoyant, lively, or playful. And as for amusement, he had none at all. His diet was still worse than his exercise. He had a large family, and resided in the midst of a dense population; and was so situated as to render his house, practically, a kind of ministerial thoroughfare. He probably entertained, at his hospitable table, more ministers, literary men, and students than any other three clergymen in the neighborhood. "Now," said he to me, "we have a good deal of table preparation to make, and Mrs. Y., who dearly loves to have things in pretty good order, sets a full table, with, a large variety. Well, this food must be eaten. It will never do for a minister who has a large family and lives on a moderate salary, to _waste_ any thing. And, besides, as I ought to tell you, we sometimes, if not always, have a very considerable amount of rich food on the table." "Do you mean to intimate that the bountiful provision you make for others renders it necessary for you to overeat? Or have your remarks a reference to a supposed necessity of eating rich food?" "We are not, of course, absolutely compelled to _any_ thing. My meaning is this: In order to meet the wants of those who are liable to call on us at almost any hour, _we prepare largely_. Then, to meet these varying and often very fastidious tastes, we must have _a large variety_ of food, and it must be _highly seasoned_. And then, if it happens that our company is not as large as is expected, we have an extra quantity remaining, and I am tempted to aid in eating it up, the highly seasoned food among the rest." "And you think, do you, that this highly seasoned food is the cause of your dyspepsia?" "Undoubtedly it is." "And do you expect to be cured of a disease which is produced by certain definable causes, like this, and yet be permitted to go on in the same way you have long gone? Do you suppose I have any power to grant you an immunity from the evil effects of high living while that high living is persisted in? Can you get rid of an effect till you first remove the cause?" "Why, no, sir, not exactly. Such an expectation would be very unreasonable. But is there no medicine I can take that will _partially_ restore me? Perhaps, at my age, entire restoration from such a hydra disease as dyspepsia is hardly to be expected; but can you not patch me up in part?" "What! and suffer you to go on sinning?" "Why, yes, to some small extent. It is very hard, nay, it seems to me almost impossible, to break away from the routine of my family, at least as long as Mrs. Y. is fully determined to prepare for company according to the prevailing customs. I could submit to a different arrangement if she were ready for it." "I wish I could encourage you to pursue this compromising course of conduct. But it is not so. You must change your habits entirely, or you must continue to suffer. For if it were possible to patch you up, for a short time, while your present habits are continued, it would not be as well for you in the end: It would only add another head and horn, perhaps several others, to the monster that annoys you. No, sir; you must change your habits or give up the contest. There is no use in attempting to do any thing, in such a case as yours, with medicine." "Well, then, if it must be so, it must. I will try once more, and see what I can do." He left me with a downcast look, and, I suspected, with a heavy heart. At all events, my own heart was heavy, and seemed almost ready to bleed. Here was a father in our ministerial Israel,--one to whom multitudes looked up for the bread of spiritual life,--who was a perfect slave to his appetites; or, at least, to the conventionalisms of modern house-keeping. He groaned daily and hourly under bodily disease the most aggravated and severe. His eyes were red and swelled; the sides of his nose enlarged and inflamed, till he had the appearance of being about half a sot. He knew all about it, and yet refused to take the first step in the way of reformation. I saw him, by accident, once more, and would have spoken with him freely; but he seemed to shun every thing beyond a merely passing compliment. I saw how it was with him; and the reflections which arose in my mind gave me the most intense pain. Two or three weeks afterward, while in an intimate and confidential conversation with two of his very familiar friends, I ventured to predict his fall, with nearly as much particularity as if the events which were predicted had already taken place. I was asked how I dared to say such things, even in secret, of so good a man and such a father in the American Church. So I gave them, by way of reply, the principal facts in the case, as detailed above. Not many years passed ere this very minister was tried for a crime much more high-handed than gluttony, though sometimes the sequel to it; and not only tried, but silenced. The results of the trial were as shocking to most people as they were unexpected. Every one said: "How can it be?" Mr. Y. became a farmer, and is still so. But he is cured of his dyspepsia. Compelled, as I have reason to believe he is, to practise the most rigid economy, having very little temptation to unlawful indulgence, and having an abundance of healthful exercise in the open air, he has every appearance, externally, of a reformed man. His old friends would, I think, hardly know him. His skin is as clear, and his eyes and nose as physiologically correct in their appearance, as yours or mine. True, he is an old man, but he is not a gluttonous old man. He is a fallen man, but a healthy, and, I hope, a penitent one. He has experienced a species of first resurrection, and has, I trust, the hope of a better one still. Now, had this man believed, in the first place, that the fault of his dyspepsia was not wholly chargeable on Mrs. Y., but also on himself,--had he clearly seen that he loved high living, and would not relinquish it,--he might have been reformed without a dreadful and scathing ordeal, and without disgracing the cause of his Divine Master, But alas! "the woman that thou gavest to be with me," as he said, was in fault; and so he did not reform himself. That his wife was in fault, most deeply, I do not deny. She knew her husband's weakness, and yet continued to place before him those temptations which she well knew were too strong for him. How she could do this, and persist in doing it, is, to me, a mystery. But she had her reward; at least, in part. For in the fall and retirement of her husband from public life, and in the consciousness--which was the most terrible of all--of his guilt, must not her sufferings have been terrible? It is indeed true that she may not have been wise enough--for this wisdom has not yet been made public property, in the fullest sense--to look at the subject in one point of view, which would be calculated to add to the poignancy of her anguish. So that we may be almost ready to say, in her case, "Ignorance is bliss." I refer, here, to the infliction of scrofula and nervousness, by high living, on the next generation. For while Mrs. Y. was bowing down to public opinion, and preparing rich viands for her guests, and practically compelling her husband and children to eat up what they had nibbled at and left, she was not only fastening dyspepsia upon the former and nervousness upon herself, but imparting more or less of a tendency to nervousness and scrofula upon the rest of her family. Of the two thousand children born in a day, in the United States, from two hundred to three hundred--perhaps nearer four hundred--come into the world with a scrofulous tendency; and of these, it is highly probable, that at least one hundred per day are manufactured at just such tables as those which were set by Mrs. Y. for the teachers of the religion of Jesus Christ. I have quoted the old adage, that "Ignorance is bliss;" but alas! is it not to trifle with the most solemn considerations? Can that be regarded as blissful which leaves a mother, who, in general, means to love and honor the Saviour, to destroy her husband and one or two of his children? There is little doubt that, besides shutting her husband out of the sacred enclosure, after she had destroyed his health, Mrs. Y. was the means of destroying at least one or two of her children. One of them, who was scrofulous, ran at last--a very common occurrence--into consumption, and perished early, in the beginning of active usefulness. I may be suspected of exaggeration, by some of my readers. Would to God, for humanity's sake and for Christ's sake, it were so! For though I cannot subscribe to the creed of those who profess to be willing to come into everlasting condemnation for the glory of God, yet, so long as opportunity for repentance shall last, I would willingly be convicted of untruth, if so that the falsehood might be made palpable to my mind, rather than believe what I am compelled to believe with regard to the murderous tendency on soul and body of our murderous modern cookery. Is it not true--the old adage, that while "God," in his mercy, "sends us meats, the Devil," in his malignity, "sends us cooks?" This unnatural cookery,--this mingling medicine with viands naturally healthful, and torturing the compounds thus formed into sources of irritation, has more to do with that sensuality which has come upon us like a flood,--much of it in new forms,--than many are aware. And I am much mistaken if modern societies for moral reform, popularly so called, might not thank the over-refined cookery of a gross and highly stimulating diet, for that necessity which impels to their own field of labor. One thing more might have been mentioned in its proper place--the tendency of high living to eruptions on the skin. These, in their various forms of pimple, carbuncle, boil, etc., are becoming quite the order of the day. Mr. Y.'s family had a full share of them, especially those of them who were scrofulous. I have already mentioned the appearance of Mr. Y.'s face, and have alluded to the change which took place after his fall. But I should have spoken of the eruptions on his face, which, at times, were such as almost made him ashamed to enter the pulpit. You will see, from the tenor of these remarks, that I have laid the guilt, in this sad affair, just where I believe it ought to rest. I have not sought to exculpate one individual or party, at the expense of another equally guilty, but rather to do justice to all. Only one thing remains, which is to confess my _own_ guilt. Have I not great reason to fear that my advice was not sufficiently pointed and thorough? I might have gone to Mr. Y. and told him the truth, the whole truth. What if it had given offence? Would not the prospect of doing good, rather than of giving offence, have been worth something? In any event, I do regret most deeply my unfaithfulness, even though it arose from delicacy and diffidence, for that very delicacy and diffidence were far enough from being grounded on the love of God. They were grounded much more on the love of human approbation. No man was ever more free from it than our Saviour. Ought I not to have used the same plainness that he would have used? Had I rebuked Mrs. Y. as kindly and as faithfully as he rebuked Martha at Bethany, how much, for ought I can ever know, might have been saved, not only to the cause of health and conjugal happiness, but also to that of piety. CHAPTER LXXVI. DR. BOLUS AND MORPHINE. A telegraphic communication was made to me one day, nearly as follows: "B. J. W. is very sick, and is not expected to live through the day. Please come on immediately." The distance was about one hundred and fifty miles, and the mode and means of conveyance neither very direct nor rapid for these latter times. It was more than probable that Mr. B. J. W. would be dead before I could reach the place. However, as he was a particular friend, and as there was some hope, I concluded to set out. Late in the evening,--or rather, in the night,--I arrived at the place, and found the young man still alive. He was, however, as it was easy to perceive, in a very critical condition. Glad to find him alive, but inclined to fall in with the general opinion that his case was a hopeless one, and withal greatly fatigued, I yielded to the demands of exhausted Nature, and slept a short time, when his physician arrived. Now I had been sent for, in part, as a special friend, and in part, as a medical counsellor. And yet there were difficulties. Dr. Bolus, the family physician, was just such a man--for reasons that might be given--as I dreaded to advise with, should my advice be needed. He was one who would be likely to think any important suggestion an impeachment of his own superior wisdom. Science, true science, is always modest, and does not fear any thing; because she loves, most of all things, _to be right_. But Dr. Bolus had not, as I think, enough of true science to make him feel or perceive the want of it. The ignorant are always self-confident in proportion to their ignorance. We examined the patient, as soon as possible, and retired for consultation. Dr. Bolus gave a full history of the progress of the case, with a particular account of the treatment. I saw at once, both from the existing symptoms and Dr. Bolus's statement, that the tendency to the brain--so great as to keep up an almost constant delirium--was quite as likely to be caused by the enormous quantities of morphine and quinine, and other active medicines which had been administered, as to belong properly to the disease. I therefore advised a gradual reduction and ultimate discontinuance of the extra stimulants. Dr. Bolus was opposed to the reduction I proposed, but finally consented to it, at least in part, and the patient evidently derived almost immediate benefit from it. When I had pushed my views with regard to the stimuli as far as I could, we separated, and as the distance at which the doctor resided was considerable, and as I was on the spot to watch the patient, he proposed not to call again till early in the morning of the following day. I was by no means satisfied with the compromise we had made. It had not accomplished its intended object. Dr. Bolus had, indeed, yielded a little, but not enough to satisfy me. I believed the amount of stimulus still given vastly too great, and was unwilling to continue it. In truth, I persuaded one of the attendants to omit the principal articles, whenever the hour came for administering them, assuring him that I would take all the responsibility. Of the other attendant I would have made the same requisition, but he being exceedingly attached to Dr. Bolus, would never have tolerated the slightest concealment, or departure from the strictest letter of the law. It was easy to see that the less stimulating treatment of each alternate two hours, during which it was entirely omitted, left behind it, on the patient's frame, a better influence than the more active treatment of the other two. And when the next medical consultation came, I pleaded for a still greater diminution of the stimulus. But, as I had unwillingly used a little duplicity,--a thing I now deeply regret,--in order to come at my conclusions against the stimulants, I was not willing to state, in full, the grounds of my opinion, and therefore could not prevail with Dr. Bolus to consent to any farther advances in the unstimulating plan. I was now, at length, compelled to leave for home; and the results, for the rest of the time, were reported to me through the kindness of the young man's friends. It is sufficient, perhaps, to say that he finally recovered; but it was not till the lapse of several months. In the mean time, a severe ulcer broke out on the lower part of his back, which caused much suffering, and appeared to retard very greatly the progress of his recovery. My errors in this case were numerous and great. Believing, as I did, in the outset, that Dr. Bolus and myself could never agree, I did wrong in consenting to a consultation with him. I ought to have been nothing but a visitor, or else to have entered fully into the spirit and duty of a counsellor. In the former case I might, indeed, have outraged every feeling of benevolence; in the latter I ought to have proposed my objections in full, and not to have compromised so as to submit to what I really believed to be radically and essentially wrong. For I did most fully believe all this; and in spite of every effort at concealment, my scepticism finally came out, and I was weak enough to speak of it, and openly to find fault with Dr. Bolus. A practical quarrel followed between Dr. Bolus and myself, in which the friends joined, or, at least, strongly sympathized. My own belief, then, was, and it still remains the same, that the violence of the young man's disease, especially the tendency to the brain, was chiefly, if not wholly, owing to the medicine administered; and that, from the very first, no active medicine--nothing but an exceedingly mild and cooling treatment--was required. It was even my belief that the ulcer was caused by the medicine. But, while I lost confidence in human nature, and especially in the human nature of some of my brethren of the medical profession, by this experiment, I became more thoroughly convinced than ever before of the great need of honest and benevolent as well as scientific men in this department, and of the general impotency and worse than impotency of much that is dignified with the name of medical treatment. I became most fully convinced, that in acute diseases as well as chronic, Nature, unembarrassed, will generally accomplish her own work, when left to herself and to good and careful nursing and attendance. CHAPTER LXXVII. BLEEDING AND BLISTERING OMITTED. One of my neighbors had fallen down-stairs, and injured himself internally, in the right side of the chest; and a degree, greater or less, of inflammation had followed. The pain was constant, though not severe; but the soreness was considerable, and did not give promise of speedy amendment. My advice was to keep quiet, both in body and mind, and to avoid all kinds of exertion that could possibly affect the chest. I also advised the use of water, not only for drink, in small draughts, but, if the pain and soreness should be troublesome, as an external application to the part affected. The food was to be mild and unstimulating. A tendency to crowd around the fire was to be guarded against and prevented, by putting on, if necessary, an increased amount of clothing. Two days passed away with no great variation of the symptoms, either for better or worse. I was now fully convinced that I had taken the true course, because, otherwise, my patient must, by this time, have become worse. Accordingly, I persevered in my general let-alone plan for about two weeks, when the patient fully recovered. He was a slender boy, in the fifteenth year of his age, strongly inclined, by inheritance, to disease of the chest and brain; and this consideration, among others, led me to be extremely cautious about his treatment. The greater the danger the greater the necessity that what is done should be done right, or we shall defeat our own purposes. But the most remarkable fact in relation to this very interesting case is,--and it is chiefly for the sake of this fact that I have related the story,--that more than forty-eight hours had passed, after the occurrence of the accident, before it came into my mind that any thing could, by possibility, be done for the chest, in the way of bleeding, blistering, etc.,--so utterly irrational had this treatment, once so fashionable, come to be regarded, both by myself and a few others. How strange that I should not think of it in two whole days! Twenty years before, I should not have dared to pass through the first twenty-four hours, in such a case, without _thinking_, at least, of balsams and mustard poultices and the whole paraphernalia of external treatment, to say nothing of bleeding and blistering. CHAPTER LXXVIII. MEDICAL VIRTUES OF SLEEP. My own child, a boy nine or ten years of age, and somewhat inclined to croup, was one evening wheezing considerably, and, as his mother thought, was threatened with an immediate attack, either from this or some other disease. Of course, there was not a little anxiety manifested in the family on his account, and we were deliberating what to do with him, when the late Dr. Shew, the hydropathist, chanced to come in. After a little general conversation, we turned our thoughts again to our little patient, and asked Dr. Shew what he would do with him if he were his patient. "If it were my case," said he, "I would give him a tepid bath--say at about the temperature of 80° or 85°." "Would you do nothing more?" "Nothing at all, except to put him early to bed." I was not committed to hydropathy, as I have before told you. I never have been, though I had a sort of general respect for Dr. Shew; and hence it was that, incidentally, I asked him the question which I did; and I was pleased with his reply. There was nothing suggested which was at all akin to violence. He did not propose a shower bath of any kind. He did not speak of hot bathing, which for that hour of the day might have induced too violent a perspiration. He did not propose vapor bathing or steaming. A tepid bath could, abstractly considered, do no harm. It would, at least, while away the time till nature could have opportunity to rally. And then, if the return to health should be attributed to the application of the tepid water, we had no special objection to it. We had no medical pride--most certainly I had none--that would lead me to fear lest I should add to the popularity of the cold-water system. But it was rather late in the evening,--between seven and eight o'clock,--almost time for such a child to be in bed. In order to get up a tepid bath and make the application, so much time would be required that it would keep him from sleep till nine o'clock, and perhaps later; whereas, I had a very high opinion of the healing and renovating power of natural and healthy sleep. It struck me that to put the child to bed immediately, and let him have a good night's rest, would be a much wiser measure than to bathe him even in _tepid_ water. So, after thanking Dr. Shew for his advice, I told him that, for the reasons above stated, we had concluded to omit the bath and put the child immediately to bed. On being put in bed and suitably covered, he went to sleep immediately, and fell into a gentle perspiration, and in about two hours his breathing was much better. It continued to improve till the next morning, when he arose, at the usual time, and was nearly well. Dr. Shew himself jocosely observed that the _sleep_ cure had proved quite as successful as the _water_ cure. Much, therefore, as I prize bathing of all sorts, in its proper place, it must never take the place of other and more important influences, whenever these influences can be brought to bear on the case. Indeed, no bathing of any kind can be desirable, any farther than as it serves to aid these natural processes. It has no magic or miraculous power. If we do not eat, drink, sleep, and wake, all the better for it; if the various offices of digestion, respiration, circulation, perspiration, and cerebral action are not thereby, as a whole thing, better performed, it might as well--nay, better--be omitted. Otherwise we waste time and trifle away vital energy. If all the functions of the body and all the faculties of the mind could be kept steadily employed, and in healthful proportion, it is obvious that a person could not be sick. Or, if one of these only should be deranged, and we should fall sick, as the consequence, what else, pray tell me, is needed, but to effect a speedy return of the faltering function or part to its proper post and duty? But sleep, more than all things else, whenever the usual hour has actually arrived, has the effect to facilitate a cure. We all know how wakeful some maniacs are, and how hurried and deranged all the movements of the muscular and nervous systems are apt to become, no less than those of the brain itself. And we all know, too, how much good it does such persons to be able to obtain good, sound, substantial, quiet sleep. It acts like a charm, and does more than charms can do, or mere medicine. Half the formality of having watchers by night in the sick room, does more harm than good. It were better, in many instances, to extinguish all the lights, except at certain set times and on particular occasions, and let the patient sleep. And yet I have as exalted an estimate of the importance of careful nursing as any other individual. For example of my meaning, in a case of seeming contradiction, I may say that I have taken all the needful care of a young man who was very sick, for more than thirty successive nights with the exception of two, and yet maintained my health, which, as you already know, was never very firm. And I have known those who could do this for three months. But they extinguish or hide their light, and acquire a habit of waking at certain times, so as never to neglect the wants of the patient. So true is it that sleep is the grand restorer as well as the great curer of disease, that its salutary influence in the case of various infantile complaints, has long been known and regarded. And one reason why infants should neither be nursed nor fed in the night, as many physiologists maintain, is, that it breaks in upon the soundness of the sleep, as experience has most abundantly proved. Sleep, in short, if not a "matchless" sanative, is at least a universal one. CHAPTER LXXIX. CURE BY DEEP BREATHING. A young man, fifteen or sixteen years of age, who was in the habit of suffering from protracted colds, nearly the whole winter, till they seemed to terminate almost in consumption in the spring, came under my care about March 1st, 1854, and was treated as the nature of his case seemed to require, though with a few of what may be, by some, regarded as peculiarities. He was directed to rise in the morning at about six o'clock, which at that season of the year is about as early as any one can see well without lamp-light. At the moment of leaving his bed, he was required to wet his body all over, as quickly as possible, either with the hand or a sponge, or if preferred, with a coarse towel, and then wipe himself hastily and partially, so as to leave on the surface a little moisture, and yet not enough to cause, by evaporation, any sensations of chilliness. The water to be used was to be cold, or at such temperature as is usual at that season, when standing all night in a room without fire. This was to be followed by a rapid rubbing with _crash mittens_, a coarse towel, or the hand, as long as he could keep up a good reaction and a proper degree of vital warmth. Or, if rubbing the body increased the cough, and an assistant was required, in this case, a healthy man well charged, so to speak, with electricity, was always to be deemed preferable. In general, however, the young man found no difficulty in keeping himself warm, in this exercise, about half an hour. Whenever his strength began to flag, or a little before,--for I did not think it desirable to go farther than the mere borders of fatigue,--he was placed in bed and well covered, so as to be immediately warm. The room itself was kept as cool as possible, even in the coldest weather, the fire having been entirely removed at bedtime the night before, and the room well aired and ventilated. This method of placing him in a warm bed was called dry packing. In this dry pack he usually remained from half an hour to an hour. At the end of this period, he was required to get out of bed, and repeat the former course of rubbing the naked surface of the body a long time, in the cold air, though, in this case, without repeating the application of the cold water. Thus the forenoon passed away, with a few slight but unimportant variations. At twelve o'clock, this alternation of air-bathing with friction and dry-packing, ceased, and the patient was expected to put on his clothes and come to dinner. You will, perhaps, ask when and where he had his breakfast. No breakfast was allowed him. Nothing was to be taken, except small draughts of water, till twelve o'clock. Another operation, which had much more the appearance of peculiarity than any other part of the treatment, but which was deemed, more than all else, indispensable to his recovery, consisted in a series of deep inspirations or breathings. It may be described thus: The patient was required to draw as much air into his lungs as possible, and then immediately expel as much of it as possible. This was to be repeated and continued till a suitable degree of fatigue was induced. At first, it was only required as a species of amusement while in the dry pack; but subsequently it was demanded in other circumstances. I have usually required a person to begin the process by ten, twenty, or thirty deep inspirations, according to his strength of lungs and their irritability; for, at first, it often makes him cough. In the present case, I began with fifty, and gradually increased the number to one hundred. Sometimes, by way of experiment, and to pass away the time while in the dry pack, he went much farther; once to six hundred. In this case, however, the face became slightly flushed, the eyes reddened, and the whole arterial action became hastened. It was evidently like "too much of a good thing," and was never repeated. The afternoon was spent in physical exercise, active amusement, reading, conversation, etc. The first consisted chiefly in sawing and splitting wood, and in walking abroad. The amusements were of various kinds. The reading was chiefly of the lighter sort, such as newspapers and magazines. The conversation--not always controllable--was the best we could furnish him. Some of the walks were long, extending to five or six miles. Music, both vocal and instrumental, was regarded as a most valuable amusement, and was not wholly overlooked. It had its difficulties, but most of them could be surmounted. As a devotional exercise, its soothing influence was almost always evoked. I have said that no breakfast was taken by this young man, and no drink used but cold water. The dinner was also without drink, and so was the supper. The first consisted of a very few kinds of coarse food,--generally not more than two or three at once,--such as coarse whole-meal bread, rice, potatoes, apples, etc., and was the principal meal. The supper was a lighter meal, both as respected quantity and quality, and was taken at about six o'clock. No condiments were allowed except salt, and very little of this; and no animal food, or the products of animals, except, occasionally, a little milk. Fruits, either raw or cooked, were frequently among the staples at dinner, but never at supper. This treatment, with slight variations, would be applicable to most persons suffering with lingering complaints, and to persons in health, as a means of invigorating their systems; but my present purpose is, chiefly, to speak of it as a remedial agency in the particular case of this young man. I had hoped to be able to effect a cure on him in about a month. But I was happily disappointed in finding him recover so fast that he was dismissed and sent home on the twenty-fifth day. Nor has his consumptive tendency ever again appeared with much severity. Since the spring of 1856--now between two and three years--it has not appeared at all. This method of cure, by deep breathing, consists simply in using the lungs freely, without overworking them. They may be overworked as well as used too little; though the danger is generally in the latter direction. They are made, most undoubtedly, for a great amount of action, in breathing, conversation, singing, reading, etc.; and yet, in all these respects, they are sadly neglected. Our ordinary conversation is such as hardly to exercise the lungs at all. We talk with the mouth and throat rather than the lungs. So is it, for the most part, with our singing. And, as for breathing, we only breathe a little way down, even when our dress is such as to form no impediment. Full breathing, except in making violent efforts, is hardly known. CHAPTER LXXX. SPIRIT-DOCTORING. One of the most amusing incidents of my "Forty Years among Pills and Powders," is found at full length of detail in the following chapter. The amusement it affords has, however, a tinge of sadness. A young man came under my care in the early part of the year 1854, who, for the sake of convenience, I will call Thomas. He was about eighteen years of age, but as delicate, sensitive, and effeminate as a female directly from Broadway would have been, or as a plant reared in a hothouse. In truth, he had been reared very much like many females of the present day, in a manner entirely sedentary--the creature of over-tenderness and over-kindness. His disease was scrofula; but, with his scrofulous tendencies were conjoined some other difficulties, more obscure and still more unmanageable. His joints were enlarged; and in particular portions of his body were various watery swellings or sacs. As it was a scrofulous tendency that lay at the bottom or basis of his complaints, I proceeded to treat him accordingly. I was to have him under my care three months, during which time, it was believed, something might be done, if ever. At least, it was believed that a beginning might be made, if indeed the disease should prove to be at all curable. He was subjected to the treatment, with few variations, which is mentioned in the preceding chapter. He was not permitted, however, to do much in the way of deep breathing till his general health and strength could be improved by other measures. Warm water, in his case, was preferred, also, to cold, and was used in the form of a tub-bath, at five o'clock in the afternoon. Thomas had been with me about three weeks, without much variation of condition or prospects, when I received a long letter from his friends, the purport of which was that they had been favored with a communication from the "spirit world," which was attended with the appearance of so much truth and reality, that they were not at liberty wholly to disregard it. The communication purported to be made by the late Dr. Benjamin Rush, of Philadelphia. As these friends of Thomas well knew I was not a believer in this new-fangled spiritualism, they had taken much pains to satisfy me that I was to have for my venerable counsellor not a mere pretender, but the veritable Dr. Rush himself. As one evidence in the case, they had inquired through the "medium," who were the present associates of the good doctor in his new abode; who, nothing loath, had deigned to gratify their supposed curiosity, by giving them the names of five distinguished physicians, among whom were the elder and younger Dr. Ingalls, of Massachusetts, and Dr. Sanborn, of New Hampshire. And then, with regard to Thomas, he only said, at first, that he was very much interested in him, and that he would examine him and report. Soon after this, at another communication, he said his case was a difficult one, but he thought not incurable. He added, that he was already in very good hands, the best, perhaps, that could be found in this mundane sphere, but rather cautiously insinuated that there were symptoms in the case which I had not yet got hold of, but which would, if rightly apprehended, modify, in some of its particulars, my treatment. What it was in the case which I had not discovered, he did not say directly, but subsequently intimated that the young man's disease was not scrofula, as I had pronounced it, but dropsy of the joints. It was not long afterward that the mother paid us a visit, and brought, well written out, the substance, as she said it was, of quite a number of communications from Dr. Rush. Much was said in them about the necessity of exercise and a plain diet. And, in general, so far as the mere treatment was concerned, the statements of the spiritual doctor accorded so well with those of the earthly one, that had I been a believer in these modern mysteries, I should have been highly gratified, not only on Thomas's account, but my own. But the spirit doctor urged a few variations in the treatment of the young man. Beside pressing a little harder than myself the use of green vegetables, and particularly of vegetable juices, he requested, with great apparent earnestness, that he might be permitted to occupy a room heated by a wood fire, rather than by coal. He also made a few other suggestions of less importance. His mother was a very good woman, save her great credulity. And even here, perhaps, I do her injustice, for there were some curious facts and coincidences. The venerable spirit doctor appeared to have possessed himself of certain secrets which it was extremely puzzling to conjecture how an impostor could have obtained. After spending a day or two with me, and giving me "much exhortation," the mother returned to her friends. Of her safe arrival, as well as of certain changes that had been resolved on, the husband informed me, by a letter, which, so far as the case of Thomas is concerned, I copy entire. "Dear Sir:--By Mrs. P., in her recent visit to your place, you have been made acquainted with some of the manifestations of spirits, made to us through a young lady, a medium of our acquaintance. "The communications purporting to come from Dr. Rush (as he says in his last communication, tell Dr. ---- that it is the veritable old Dr. Rush, the signer of the Declaration of Independence), and with such apparent earnestness and reality, we feel that, to us, they are something more than human or earthly, and of momentous account in this case of Thomas, and that we are not at liberty longer to disregard them. And though we have great confidence in yourself and your practice, we hope you will not think we are losing either when I say that we have decided to have Thomas return to ----, and commence following the prescriptions of this invisible personage. They appear to be harmless, and may be of great virtue; and much which pertains to them appears to be in harmony with your practice. "Again, in closing, I must say that these communications come to us with such force and apparent reality and truth, that I think it would not be doing justly, either to Thomas or our Creator, longer to disregard them. "With much esteem, yours, etc., ---- ----." In a somewhat extended postscript it was added: "We have witnessed other manifestations, of several of which we had ample proof of their correctness." On another small portion of a sheet which was appended to the former, I found, in pencil, the following:-- "We have, this evening, had another conversation with Dr. Rush. His medium was in ---- to-day, and was brought to us in order that she might speak to us (Mrs. P. and myself). We are directed to tell you this: that he wants Thomas to be under her (Mrs. P.) care; that there are no earthly physicians that can cure him; that we could not have placed him in better hands than with you. He (Dr. Rush) says he can and _will cure him_. He says he could cure him without our help, if he could impress him, but in that he has not yet succeeded. He says he has seen Thomas with rubbers on, and that he would have taken them off if he could. Says positively, he must not wear them. Be good enough, dear sir, to see that he does not wear them in coming home." He adds, in conclusion, "Tell Dr. ---- to remove him from the room he now occupies, and place him in one with a wood fire, and where he will have no bed-fellow." Thus ended the communication. Thomas went home, according to request, and was, forthwith, put under the treatment of the spiritual doctor. All appeared to be going on very well for a short time; but after the lapse of about three weeks, I heard of his death. No particulars were added, in the papers, but I afterwards learned that his death was rather sudden. I did not chance to fall in with Mr. P. for several months, and out of respect to his feelings and those of Mrs. P., I did not depart from my usual track to call on them or even write. At the end of the year, however, I visited them, and after the usual passing remarks, the following conversation took place. "It seems, then, that Dr. Rush with all his wisdom and skill could not save Thomas." "No; he said it was too late for any power of earth or heaven to cure him." "But he was very confident he could cure him?" "Perhaps he spoke with more confidence than he really felt, in order to encourage us and lead us to exert ourselves." "Do I understand you? Do you mean to say that perhaps the spirit doctors, like the fleshly ones, in order to encourage the friends of the sick, will depart a little from the truth?" "Not exactly that. Rather this: we do not consider it a departure from the truth." "I am of a different opinion. In earth, or elsewhere, I call such a course as you intimate a species of white lying--quite common on earth, but which, till now, I did not suppose had found its way to the confines of the world spiritual." The conversation ended here, and was not afterward resumed. I have, indeed, witnessed a good deal of spiritual doctoring since that time, but it was of a somewhat different character from the foregoing. For example: I saw a family in the interior of Massachusetts, whose faith in spiritualism and spirit doctrine was perfect. The mistress of the house was the patient. The physician a young man who had been a mechanic, but who had very recently become convinced that it was his duty to attend the sick,--not to do anything for them, on his own responsibility, but only to suffer an old Indian physician to operate through him as a medium. The chief thing which Dr. H. did, so far as I observed, was to lay his hands on her, and sit for some time in that position. I am not sure that he did not prescribe a few very simple things, from time to time, such as a little weak tea, or the infusion of some domestic herb, from the garden. He was counted, everywhere (for his circuit was a large one), very successful; for his patients generally recovered. Their recovery, it is true, was often very slow. CHAPTER LXXXI. REMARKABLE CURE OF EPILEPSY. When I was a lad, a man was employed by my father on his farm, who used occasionally to fall down in convulsions, lie for some time, not entirely still, but foaming at the mouth and agitated or rocked to and fro, as if in great distress; and yet, as I afterward learned, senseless. These attacks, they told me, were _falling sickness_ fits. The man was weak in mind, and not vigorous in body, though, by diligence and perseverence, he could accomplish something in the progress of a whole day. He died but little beyond middle age. Since that time I have been intimately acquainted with several individuals who were subject to these attacks of epilepsy, some of whom were affected in one way, some in another. The cause, too, was as various as the manner of attack, and in a few instances was peculiar and remarkable. In general, their memory and intellectual faculties, as well as their bodily strength, became, ultimately, a good deal impaired. In my practice as a physician, I had very few of these cases, and none in which I could afford relief at first. The patients were, however, for the most part, of middle age, or at least beyond thirty years. Several had taken nitrate of silver or other minerals, till their skins were of a blue-black color. In the beginning of the year 1854, a young man about seventeen years of age, of scrofulous and nervous temperament and of great delicacy, came under my care, to be treated for this disease, whose history, from beginning to end, was remarkable. I will call him Samuel. When about twelve years of age he had difficulty with another boy,--an Irish or Scotch lad,--which ended in a personal affray, in which Samuel was worsted, and his head severely injured. It was thought by some that a portion of the skull, which, by the violence of the blow it had received, had been forced in, ought to have been elevated by the trephine; but I believe no surgeon of reputation ever saw him. Being young, the depressed portion of skull gradually resumed its place, so that the depression could scarcely be seen. All, however, was not right within, for he was soon afterward attacked by epilepsy. Whether, at first, any connection between the disease and the bruised skull was suspected by the friends, I was not able to learn; but probably not. The attacks having been once commenced, were frequent and severe, and every year became more so. They were particularly frequent and severe during the winter and spring. The medical art was invoked in his behalf, especially in the region round about New Haven, Conn. He was not only treated by the regular physicians, of different kinds and schools, but by not a few empirics or quacks. By some of them he was evidently injured, and by none was he benefited. The tendency still continued to be downward, on the whole, and his friends were, at length, almost discouraged. All this while his diet appears to have been the usual diet of that part of New England in which he resided---too stimulating, and too much refined by cookery. In general, too, his active and perverted appetite led him to excess in quantity; but, as his friends never thought of its being a morbid or diseased appetite, no strong efforts were made to control it. In truth, as he was feeble and growing, it was thought necessary that he should eat stimulating and highly seasoned food, and in large quantity. He was also accustomed to tea and coffee. All his appetites, as it afterwards appeared, were, to say the least, very active, though the gratification of _the third appetite_ was wholly confined to solitude. No restriction, nor indeed any direction, so far as I could learn, had been made at this period, with regard to his mental food. Whatever he chose to read, he was indulged in, both as regards quantity and quality. And as usually happens, in the case of epileptic, and scrofulous people, he was quite too much inclined to works of imagination, with which the age and country abound. It appears, also, that being regarded as quite unequal to the task of laboring in field or garden, he was thus, in large measure, deprived of two essentials of health and happiness, especially to epileptics; viz., air and exercise. In August, 1853, he went to an institution that had once been a water-cure establishment, but which had undergone many modifications, till it better deserved the name of College of Hygiene, than water cure. Here he remained several months. The peculiar treatment he received at this institution consisted, first, in a plain and unstimulating diet. Water was his only drink, and bread and fruits, with a few well-cooked vegetables, his only food. But, in the second place, he was subjected to a course of treatment not unlike that described in Chapter LXXIX, with the exception of the deep breathing and cold-bathing. The last, however, was, I believe, used occasionally. There was, indeed, one important addition made to the treatment above alluded to. This consisted in an exercise designed to expand and strengthen the lungs, by what was called _shaking down the air_. This exercise was practised very frequently, and was curious. I will describe it as well as I can. He was first required to inflate his chest as much as possible, and then, while retaining the air with all his might, rise on his toes, and suddenly drop on his heels, with a sort of jerk, several times in succession, till he could hold his breath and retain the air no longer, which was now suffered gradually to escape. A new recruit was then drawn in, and treated in the same manner. The exercise, as a whole, seemed to consist of a series of jumpings up and down, without quite raising the toes from the floor, and of deep sighing. The object aimed at was to shake down a large amount of good, pure air, into the cells of the lungs, and retain it there as long as possible; and then, to let out or force out the air, so as to empty the lungs as perfectly as possible. The warm bath was occasionally used at four o'clock in the afternoon, but with doubtful effect. Exercise, especially mechanical exercise, was of much more service, and so was the gymnasium. He was, however, required to forbear all violence, in his exercises and amusements; nor was he allowed any severe studies. His reading was to be light, though not trifling. For several months next subsequent to his arrival at the institution, he appeared to improve. Instead of weekly, or semi-weekly, or still more frequent attacks, he suffered but rarely; and, in one instance, he was exempt from an attack for several weeks. But in December and January they became, once more, rather frequent. They had, however, usually been most frequent in winter and spring. He now began to be apprehensive of a return of his disease, in all its former violence; and the dread of February, March, and April had an influence on his system which was any thing but favorable--since fear, in these cases, is often worse than the evils which excite it. And, according to his faith, or rather according to his want of faith, so it was with him. The attacks became very frequent, sometimes daily; and, in one or two instances, twice a day. He came under my special and almost exclusive care, Feb. 1, 1854. I soon discovered that there was a close connection between excess and irregularity, in regard to his food and his paroxysms of disease. I saw, also, that a part of his food had been too stimulating. In justice, however, I ought to say that in the government of the other appetites, he had succeeded far better than I had expected, though his power to control himself was far from being perfect. While, therefore, I did not materially change the general treatment in other particulars, I determined to regulate his diet; and, with a view to this important end, to watch him, and even to deal out to him his daily rations, with just as much care and particularity as if he were a mere child. He ate but two meals a day, and these were taken at _twelve_ and _six_; and then I always sat by him. I did not leave him, except for one single meal, for a period of fifty-five days. During the whole of this long period--long, I mean, to the patient--he not only had no attacks of his disease, but none of the giddiness or other symptoms which had formerly accompanied or preceded them. He did not, it is true, gain in flesh or strength during the time. In all this and in many more particulars he remained nearly stationary. Towards the close of March, his friends became desirous of taking him home. I was not without apprehension; but, hoping for the best, I submitted to their wishes as cheerfully as I could. He was among them for a short time; and was then, by my particular request, as well as in conformity with his own choice, placed on a farm. Nearly three months after his return to his friends, I received a letter from him, which I insert here, not only as a convenient nucleus around which to cluster certain suggestions I wish to make to the general reader, but also as a continuation of my patient's history. It was dated June 18, 1854. "MY DEAR PHYSICIAN,--I am now at Mr. ----'s. Every thing seems to be in perfect accordance with the wishes of those who are concerned in the case. I can get as plain a diet as I please, and have nothing, so to say, to tempt me. I confine myself to a very small variety. I have had strawberries ever since I came here, which was June 7th. I eat sometimes nearly a pint at a meal. Sometimes I eat nothing but strawberries and dry bread. I have some sugar on the table, and sweeten the berries a little. I eat considerable potatoe--say two or three at dinner--sometimes a little more. I have had two dinners of asparagus, just boiled in a little water, and poured on to some crusts of toasted bread. It was good. I do not think I have had more than three things set on the table for me, at a time, while I have been here. I have bread, potatoes, and berries for dinner. For supper I have bread and berries, and sweetened bread, as it might be called. It is sweetened but a very little. Now don't I live plainly. "But I have left out some things that I have had. I had Graham mush a few days, but I like the bread better, as Mrs. ---- makes such good bread. Mr. ---- likes it better than superfine. I have had boiled rice--a few meals. I had one meal of bag-pudding--Indian--with a few whortleberries in it. "I have now given you an account of how I live. I eat at ten or half-past ten, A. M., and at four, P. M. So I do not have to go to bed with a meal of victuals on my stomach. "After I left you, and before I came here, I had, all the time, a great looseness of the bowels. It seemed to weaken me. Afterwards I thought it was caused, partly, by some very tart, dried apples, of which I ate freely at every meal. Aunt ----thought it was working at hoeing up turf around trees, for she said that working hard with her arms affected her in that way. My stomach did not seem quite right. Perhaps I strained it in coming home. The very next day after I came here, I commenced eating the ripe strawberries at meals, and have eaten them freely ever since. I sometimes eat nearly a pint at a meal. From the first they have seemed just the thing for me. They regulated my stomach and bowels, and they have strengthened them ever since. "I eat alone, and enjoy it capitally. I would not go back to the Institution (the Hygiene establishment) for a great deal, because there are so many things there to harass one's mind, or tempt him, at every corner of the street and almost every shop. Since I came here I have not tasted of any thing between meals, and have had no inclination to do so. I think there will be no trouble on that account. "I am busy out of doors a good deal of the time. I have hoed corn, piled cord-wood, driven team, picked strawberries, etc. At night I milk one cow. I go barefooted three or four hours in the middle of the day, use no flannels, dress very thin,--as little as I can get along with. "Do you wish me to learn to swim, if possible? There is a pond--a natural one--about a mile from this place. Will you not answer me soon, and give me your opinion on this and other subjects? "In love, yours, etc. "SAMUEL." About a month later, viz., July 18, he wrote thus: "MY DEAR DOCTOR:--Five months and a half without a symptom! I have not the slightest feeling to remind me of my old attacks. Should I not be thankful? "A short time since, I had a very sore stomach. It got out of order, I think, in consequence of eating too much. I broke off, went a day without nothing to eat; eat less now, and feel well. When Mrs. ---- was here, she told me she thought I might eat all I craved. I did so, and suffered the consequences, though I cured myself. "There is a place here in the woods where raspberries are so thick that people get six quarts at a time. Apples are nearly ripe. Pears will soon succeed them. "Yours truly, "SAMUEL." Two weeks later than the above,--a little more than six months after the discontinuance of the epileptic attacks,--I received a letter from Samuel's guardian, in which he wrote as follows: "We have continued the same course of diet as at your house; in short, have carried out your views perfectly as possible. Notwithstanding all this, he (Samuel) has lost flesh and strength; and, for the last few weeks, has fallen off greatly, in mental and physical vigor. He has run down in flesh to eighty pounds, is pale as this paper, coughs considerably, especially at night, yet does not expectorate very much. He had a spell of spitting blood, some five or six weeks ago, raised perhaps a gill. I do not think that it debilitated him very much at the time." Not far from this time Samuel was taken from the farm, and subjected to various changes in his habits, which were unauthorized, and which probably proved injurious. He took a large amount of cream,--an article which had not before been allowed him,--also a little fresh meat at his dinners. Instead of going without his breakfast, as before, he now appears to have taken breakfast; and in some instances, at least, to have used not only large quantities of cream at this early hour, but animal food likewise. There was a strong and increasing belief among his friends, that his food was not sufficiently nutritious, and that he was suffering for want of materials for blood; whereas the error lay in the other direction. His stomach and other digestive organs were overloaded and depressed by the large amount of nutriment he had for some time received. But more on this hereafter. He now appeared to be falling into what is called a galloping consumption, of which he died a few weeks afterward. There should have been a post mortem examination; but, from various causes, it was not attended to. At the time of his death he was about eighteen years of age. The treatment of this young man on the farm, was by no means what had been intended. The experiment of having him eat alone was hazardous, and I sternly protested against it. But the hours at which he chose to take his two meals, especially the first, were such as to preclude, practically, a better arrangement. There was no one that wished to eat at ten in the forenoon, but himself; and it was not customary for the family to convene for eating in the afternoon, till six. Now, although, abstractly considered, he selected the best hours for his meals, yet, taking society as it is, and human nature as _his_ was, it would have been much better, in the result, had he eaten with the family at twelve and six. He would have eaten less, and yet would probably have been better nourished and better satisfied. No housekeeper who has the usual feelings of a housekeeper, will be content to set before a young man of seventeen or eighteen years of age, no more, for example, than one-sixth as much food as she would prepare for six such persons. It would seem to her almost like prisoner's fare. And then, few young men or old ones will content themselves with one sixth as much food when sitting alone, entirely unrestrained, as when in company, where pride or self-respect would have influence. And of one thing we may, at least, be sure, viz., that Samuel, with his almost illimitable appetite, tempted by abundance and assured that he might, with safety, eat as much as that appetite craved, would never be the individual to stop short of fifty per cent more of carbon than his feeble machinery could appropriate; while every ounce of the surplus was burned up by his lungs, at an expense of that vital energy which should have been husbanded with the greatest care, and expended no faster than was indispensably necessary. His friends, no doubt, supposed--for such views greatly prevail--that he would not be likely to hurt himself on plain and simple food; and, in truth, that it was so light and unsubstantial that he needed a large amount of it to keep him alive. One or two individuals, largely interested in him, gave this as their opinion, more than once, and vainly believe, to the present day, that he ran down and died for want of proper nourishment. Whereas, we need nothing more than Samuel's own confessions, to show us, as clearly as the sunlight could possibly show us any thing, that it is much more likely that he perished from excess of nutrition than for the want of it. Let us look a little at particulars. It appears, most clearly, that Samuel always had before him a good supply of bread, of such excellent quality that he could make a full and agreeable meal of it. While under my special care, he could eat and enjoy a full meal of the driest bread; and he would even have proceeded beyond the limits of safety on it, had I permitted it, and this, too, without berries, sugar, or cream, to make it still more inviting, or without his "sweetened bread," as he called it, for a dessert. It is, moreover, by no means probable, that the morbid keenness of his appetite was at all diminished by being on a farm and in the open air much of the time. Observe, now, his living. Fruit, he says, he allowed himself always, at both dinner and supper, sometimes a pint at a meal. Dried apple-sauce, very "tart," as he called it, he appears to have had at every meal. Sugar, moreover, to sweeten his berries, etc., he always had on the table. Will one who has such an appetite as he had, eat moderately, with fruit, sugar, and apple-sauce always before him,--and these regarded as a dessert, of which he may eat _ad libitum_, after having eaten a full and more than a full meal of bread? In potatoes, too, he indulged, as you will see by referring to his letter, in rather large quantity. Now the most healthy person in the world, would ere long have an acid stomach, as well as weakened lungs, who should undertake to live in this way; how much more a person who has long been feeble, especially in his lungs, nervous system, and even his digestive system, for that was active rather than strong. Indeed, there are many circumstances which favor the belief that he burned himself out by excess of stimulus, or, in chemical language, by excess of carbon. His thoughts seem to have been very largely on eating. It will be seen by the extracts I have made from his letters, that after speaking on any other needful topic, he would soon get back to the subject of eating. Observe, too, he says he feels no temptation to eat between his meals; but why? First, doubtless, because he eat to the full at his regular meals; and secondly, because the food was mostly, if not always, set away out of his reach. Another thing deserves consideration. Not only was he, but his friends also, inclined to the opinion that he would not, and perhaps could not, hurt himself on such things as plain dry bread; but they also appeared to believe, _practically_, at least,--and the belief is very common,--that the use of bread would atone for other transgressions. Thus, suppose he were to have, for once, a rich pudding to eat, or some baked beans, or sweetened rice pudding,--which, as you know, are of themselves very pure nutriments,--set before him, and he were to eat to the full, till the question should begin to arise in his own mind, whether he had not gone too far, it was apt to be thought, or rather _felt_, that an addition of plain bread, or some fruit, or a few cold potatoes, or some other vegetable, would be a correction for the preceding excess. Such, I say, is the virtue which, by a kind of tradition, is awarded to coarse and plain food, and to fruits, and even nuts. I know, indeed, that this idea would hardly be defended in so many words; still, it is practically entertained. To make plainer a great dietetic error, I will explain my meaning. It is believed, for example, that a pound or two of greasy baked beans would not be so likely to hurt a person, if a little bread or fruit or potatoe or sauce were eaten after them, as if eaten alone,--a belief than which none can be more unfounded or dangerous. One more proof that Samuel was constantly inclined to excess in eating, is found in the fact that there was a continual tendency, in his stomach, to acidity, which was best relieved by a day of entire abstinence; and the same might be said of a tendency to relaxation of the bowels, and its correction. In short, if there be a plain truth fairly deducible from the facts in the case, it is that he was destroyed by a carbonaceous nutriment in too great proportion for his expenditure. It may have been feared by his friends, that he yielded, at this period, to _other propensities_. Indeed, one letter which I received after his death, more than intimated all this. The remark alluded to was as follows:--"I have had the fear that there was something unexplained about his case, as you say you once had." For various reasons, I am inclined to believe that the indulgence referred to had little to do with his comparatively sudden death. His whole soul was pivoted on that great central organ, the stomach. For this he lived, and for this, probably, he died. My own principal error, in relation to the case, was, in suffering him to go upon the farm with such unintelligent, though well-intentioned teachers. Lord Bacon and others have said, "A little knowledge is a dangerous thing;" and in nothing is the remark more applicable than to the first or pioneer knowledge of people on hygiene. From the very nature of the case it must be so. I ought either to have protested against the farm, _in toto_, or given such minute instructions that they could not have been easily mistaken. But I had my reasons, at the time, for the course I took, and I thought them quite sufficient. How easy it is, in this world, to find cause for misgivings! CHAPTER LXXXII. SCARLATINA CURED BY LETTING ALONE. At a certain season when scarlet fever was very prevalent among us, a member of my family was attacked with it slightly, and, as it was believed by almost everybody to be contagious, the case excited much alarm. The fact that in persons of my friend's age, it had, during the season, occasionally proved fatal, no doubt increased the apprehension and alarm, and led to many anxious fears about the treatment. Those who regarded my general method of treating disease as rather too "tame," and who supposed themselves in special danger of "taking the disease," were not only curious, but curiously inquisitive to know what I would do in my own family, to meet this supposed terrible malady. My first object was to quiet all fears, especially in the patient. It would have been easy--comparatively so--to do this, had it not been for the croakings of our neighbors. They told the sick person so many dismal stories of persons of her age--she was in middle life--who had died of scarlet fever, that it was not so easy to resist, wholly, the impressions. The most resolute and determined are apt to yield, in such circumstances. However, we did the best we could. We endeavored not only to keep her quiet in mind, but in body. All irregularities were carefully watched and guarded against; not by giving medicine to prevent evil, real or imaginary; not by prophylactics, as they are called; but by strictly and carefully obeying all the laws pertaining to the human, physical frame, so far as they were then understood. It was one object to keep the patient cool,--not, of course, chilly; for this would have been worse than a temperature a little too high. But excess of heat, in its application to the surface, was dreaded as one of the worst of evils; and no pains were spared in attempts to keep the sick-room not only cool, but well ventilated. Her food, also, both for the sake of the general circulatory system, and for that, also, of the sympathizing skin, was not only cool, but unstimulating. In addition to all this, and in pursuance of the same general plan, a warm or rather a tepid bath was administered. But in applying this the greatest care was used. The water was only warmed just enough so as not to feel uncomfortable. It had so good an effect that it was repeated. The fever did not run so high as had been expected; and our apprehensions gradually disappeared. All went on well, and, in a few days, health was entirely restored. None of the neighbors sickened as the consequence, either of infection or of contagion. I do not mean, by the relation of this fact, to intimate that every case of scarlatina, treated in the same way, would be attended with similar results; for the powers of life are often fed by sicklier streams than in the present case. There is often a large amount, so to speak, of combustible matter in every "nook and corner," ready to be ignited by the burning flood, as it courses its way through the system. Yet, even then, the flame would be greatly diminished by keeping quiet. Who has not observed the difference, amid a general conflagration, between a most perfect stillness and a blustering or windy moment? The difference between perfect quiet of body and mind and great agitation and fear, in their effects on health and disease, is scarcely less striking, if not, indeed, more so. CHAPTER LXXXIII. IGNORANCE NOT ALWAYS BLISS. Pope says of the freethinker, that he may be "all things in an hour." So may some people in their medical creed, at least, practically. They change their opinions with almost every change in the position of the weathercock. To-day they are very orthodox, medically; to-morrow they are ready to throw physicians and medicine to the four winds, if not to the dogs. Just as the freethinker is now very orthodox in religious matters, and in a day or an hour quite out at sea. My troubles with patients of this description have been numerous and great. They promise well, and probably _mean_ well. But just as the new wad in a boy's pop-gun drives out the old one, in order to occupy its place, so the very next medical adviser, especially if he have much self-confidence, secures their entire trust, and I, for the time, seem to lose it. At least, mine is eclipsed. The people I am describing are of too easy virtue to be virtuous. And whence all this? It arises from ignorance--not very blissful ignorance, either. As well might Nebuchadnezzar's image, had it possessed sensation, been blissful, as such persons as these. Brass, iron, and clay may quite as easily unite to form a reliable compound, as these persons become settled in opinion with regard to a proper medical treatment. I had one patient of this description who harassed me for many years. It is true that he finally recovered; but I hardly know how. His recovery, when I reflect on it, leads me towards the belief that people oftener get well in spite of their medicine, than as the consequence of using it. He was originally a boot and shoe maker; and being exceedingly ambitious, he had neglected exercise, and worked too hard at the bench, as well as committed certain imprudences connected with diet, till he was almost a perfect wreck, from dyspepsia. He was about twenty-five years of age. At first, despite of his ignorance, I had hope of being able to put him upon the high road to health. He seemed unusually docile. But, as I have before said, virtue is sometimes too easy. He would believe in and follow me almost implicitly, for a little while; but when about half or perhaps two-thirds of the way to the land of health, he would become impatient, and either run to me anxiously or veer to somebody else. I have known him to start in pursuit of me when I was a full day's journey distant, and not easily found even then. But I have also known him go, with the same earnestness and anxiety, to another adviser, and follow his directions with the same care with which he had followed my own, and perhaps about as long. While following a person, however, he was, for a very short period at the first, entirely devoted to him and his principles, which, as far as it went, was undoubtedly favorable. Once he followed, for a time, a clairvoyant,--a female,--and took her medicine. She gave him, it is true, rather more medicine than he was willing to take, or even pay for; but as I gave him less than he desired, he thought it advisable to give her system a fair trial. I do not know whether he thought himself at all benefited by her prescriptions. Most certain it is that he did not long follow her, and that he came to me again some time afterwards, in the same condition as formerly. In another instance, he sought relief of the hydropathists. One of the most eminent of them had him under his care for a long time. I believe he even visited, and staid a week or two, at a Water Cure Institution. Yet he never acknowledged any benefit from this treatment. He finally tried to unite allopathy and hydropathy, and to invoke their combined forces. A meeting of myself and an eminent hydropathic practitioner was appointed and held, but even this did not result in his recovery. And yet he finally recovered, though I hardly know how. Such cases force me to the acknowledgment that human physical nature is tough, that we are machines made to live. Were it not so, this dyspeptic friend of mine must, at a comparatively early age, have sank to the grave, a victim of ignorance. He has, however, acquired wisdom in the school of experience. A brother of his, who was my patient in a similar complaint, and from similar causes, recovered in a very few months. But he was not a mere weathercock. CHAPTER LXXXIV. MEASLES WITHOUT SNAKEROOT AND SAFFRON. In the early part of the year 1854, measles prevailed considerably, and was rather severe even under the most favorable circumstances. In our cities, such as New York and Boston, it destroyed a great number of valuable lives. It was by no means confined to children; it attacked adults, who had hitherto escaped it, as well as children. One of my most intimate female friends, who was over forty years of age, had often been exposed to it without taking it, and had begun to hope she should escape through life. The family to which she belonged had it, and in the end a blow fell on her. It alarmed her most fearfully. She declared, again and again, that she should not and could not survive it, and her fears greatly aggravated the severity of her symptoms. She was well acquainted with the most enlightened views on the subject of disease, and though her fears were great, she endeavored to pursue the proper course at first, which, as she knew, consisted mainly in supporting her strength as much as possible, in the most appropriate and healthful ways. She had no thought, it would seem, of taking medicine. But she had neighbors,--some of them of the gossiping kind,--who called on her frequently, to convince her of the necessity of _taking something to bring out the measles_, and to relate the pitiful story of Mr. and Mrs. Such-an-one, who perished because they would do nothing to save themselves, and to entreat her to take at least a little saffron and snakeroot tea. And they had some influence with her; not indeed at first, but after she became weakened by the disease. Drowning people, it is said, catch at straws. I was called to see her late one Saturday evening. She did not know, as she said, that any medicine was needed, but as she was considerably advanced in life, and many had sunk under the disease of late, and as she had such a continual feeling of depression and fainting, she thought it barely possible I might think it advisable to give her some little thing to make her feel more comfortable. There were indeed many things that required attention. Her feet were cold, unnecessarily so, and her room was not properly ventilated. Then she needed small draughts of water much oftener than she had been accustomed to receive them, or had dared to venture in their use. She needed no snakeroot and saffron, nor indeed any other form of herb tea. I gave particular orders with regard to the little things so needful in such cases, and in order to be on hand in case of alarm, I remained in the house till morning. More than once during the night, her courage nearly failed her, and I was summoned to her bedside. In one or two instances, she ventured to complain of me as neglectful of her case, because I gave her no medicine. But I cheered and encouraged her as well as I could. Her disease had made her a child, and she needed a child's treatment. I was not, indeed, without my fears, but I did not see how her condition could be alleviated by medicinal agents, unless they become necessary as a substitute for that faith in Nature, which she was accustomed to exercise when she had more strength. This faith, as I have already told you, did indeed sometimes fall a little below the proper standard, but the depression was in general but momentary. Early in the morning a near neighbor called, and kindly inquired how she did; and when assured that she was, as yet, no better, was unable longer to repress her feelings. "Why, in the case of _my_ children," said she, "the measles never came out without giving them something, and they never would have done so to this day." Yet she had a large family. I might have asked her how she knew what Nature _could_ have done unaided, since she gave her no opportunity to test her strength; but she was too ignorant to converse with on such subjects. To have asked her how she knew whether her children got well in spite of the medicine they took, or on account of it, would have been but throwing pearls before swine, and I would not do it. It was very soon reported, all over the neighborhood, that Mrs. O. was in a very dangerous condition, and if she did not have some other doctor, would soon die. And, what was worst of all, the stories got back to Mrs. O. herself. And now came the tug of war; and had not the eruption, just at this time made its appearance, I do not know what the results might have been. Before noon, however, of this day (Sunday), every thing went right, and Mrs. O. was as blooming as she had been before pale and disconsolate. My good friend who had given me the morning homily, did not again make her appearance, and the neighbors in general who had dealt out their jeremiades so freely, kept themselves at a very respectful distance. The recovery was as rapid as could have been expected, even in the most vigorous young person. Nor was there any after-trouble, to require physic, or eye-water, or remedies for the dropsy. And,--what added to my own surprise, if not to that of the neighbors in general,--though she was a feeble woman, constitutionally, she recovered with as much rapidity as the most healthy and robust, and as well, to say the least, as if she had taken "_snakeroot and saffron_." CHAPTER LXXXV. THE CONSUMPTIVE PAIR. A young man, recently married, called on me one day, and requested me to visit his family as soon as I could conveniently, for the purpose of having what he was pleased to call a general consultation. I called in due time, and found the case as follows: Both the husband and wife were descended from consumptive families, and though they had got along tolerably well till very recently, there were now, in them both, many evidences of approaching disease; and though consumptive people are said to be slow in admitting they have consumption, yet this young couple formed an exception to the general rule. In the bosom of the family, and possessed of their entire confidence, I had an ample opportunity for examining the case of this interesting couple. I found the tendency downward much more marked and rapid than I had expected, and I frankly told them so. Some of the circumstances were, indeed, rather peculiar. Consumptive people are generally sensual, while indulgence is peculiarly fatal to them. But here was a case more glaring than I had before seen. They had been married but about three months; nor were the indulgences of the table believed to be remarkable, as they were forbidden by a due regard to economy. They suffered much by excessive heat in their rooms, both by day and by night, and in several other ways, much more than by high living. But I endeavored to put all things right, and to convince them of the necessity of keeping them so. In a long, but very familiar series of conversations,--for the most part separately,--I endeavored to show them that conjugal life was a life of duty, as well as of enjoyment; and that consumptive people, in order to live out more than half their days, must forego a great many gratifications to which they might very naturally lay claim. The results of this conversation were probably worth a hundred-fold the expense they involved. This young couple are, to this hour, for aught I know, enjoying tolerable health; and their health is improving. Their children, though not strong, reap the full benefit of thorough parental reform; and their scrofulous tendencies seem every day more and more receding. CHAPTER LXXXVI. HOW TO CURE CHOLERA. While cholera was prevailing in our large towns and cities, and a few cases were occurring and proving fatal in my own neighborhood, a friend of mine, who had till recently been a sea captain, complained, one day, of cholera symptoms, and begged to know what he could do to ward off the threatened disease. On inquiry I found he was more than half right, that cholera, surely enough, was already marking him for its victim. The rice-water discharges, so called, had actually commenced. Had he been any thing but a resolute tar, he would have gone on, most evidently, into severe if not fatal disease. I gave him the best advice I was able, with regard to diet, exercise, etc.,--probably the same, or about the same, that any thoughtful medical man, in the same circumstances, would have given. He was to be cheerful, quiet, and abstinent. For food, he was to use nothing but a little boiled rice,--at least, till the symptoms of cholera began to abate. He was especially directed to avoid all medicine. Several weeks passed away, during which I heard nothing from him. As I did not hear of his death, however, I concluded he must have recovered. One day, rather unexpectedly, I met him again, and inquired familiarly how he got along with his cholera? He laughed outright, but immediately added,--"Sit down, sir, and I will tell you the whole story." "After I left you," said he, "the thought struck me,--Why cannot I control the muscles of my system as well as my appetites and passions? Indeed, on occasions, I have done it, at least for a short time. These little rice-water evacuations cannot, in the nature of things, do much harm by being retained. I can do what any man can. These frequent demands of nature seem to me very unreasonable. I will not yield to them. And, like a good sailor, I kept my word. For nearly a whole day I never permitted a single evacuation. Then, after yielding obedience, for once, to nature's clamorous demands, I again enforced my prohibitory law. My task, the second day, was less severe than it was the first, and on the third day I got along very comfortably. The fourth day I was well; and to-day you see me here." Whether he told me the truth, I do not know, of course; but I give the statement, as nearly as I can recollect, just as it was given to me. I have reason, however, for believing it to be true. The man is still alive, and is as likely to live for twenty or twenty-five years to come, as you or I, or any other individual. Mrs. Willard, of Troy, New York, under the full impression that the seat of human life is in the lungs, and not in the heart, and that even the blue color of the skin during the collapse of Asiatic cholera, is owing to an accumulation of unburnt carbon in the air cells of the lungs, made the experiment of trusting a few patients, in this disease, to the full influence of pure air, and nothing else. According to her account the experiments were most admirably successful. She cured every individual she experimented on (and it was a considerable number), and in a comparatively short period. It was my good fortune to escape cholera patients, with the single exception mentioned above. However, I am quite confident that, but for the alarm, which more than half paralyzes our efforts, we might much more frequently recover, under its deadly influences, especially if we begin the work of preparation in good season, and duly and faithfully persevere. There is much in enduring to the end. CHAPTER LXXXVII. OBSTINACY AND SUICIDE. Without examining the term suicide, in regard to its various shades of meaning, I have placed it at the head of this chapter; for I think it properly belongs there. Of this, however, I leave the reader to judge when he has heard a statement of the facts in the case to which I have applied it. A young woman was admitted to the family where I was, to be treated for a nervous complaint so obstinate as to remind one who was not wholly insane nor strikingly imaginative, of the demoniacal possessions of eighteen hundred years ago. She would not eat; she would not drink; she would not or _could_ not sleep. In short, she would not, if she could help it, do any thing which did not have an immediate bearing on her own well-being, for the moment. She was, in truth, one of the most selfish creatures in human shape I ever yet saw. If Dr. Johnson, who is said to have held that every sick person is a rascal, had seen her, I wonder what he would have said of the case. She was one of those young women who have never been governed, and hence cannot govern themselves. If she took it into her head to do or not to do a thing, she would be sure to carry her point, if not in one way, at least in another. How she came to consent to be placed under my care, I never knew; for all the neighbors and friends of the poor girl well understood that if she came there she would have to obey me; and yet that, if she _did_ obey me, it would be the first instance in which she ever yielded to any mind or will but her own, either earthly or heavenly. Perhaps it was a last resort--a sort of desperation. I began my directions, however, as if I expected to be obeyed, and had no fears of any disinclination on her part. Some things which pleased her, she consented to attempt; others she would tell me she _could_ not do. When I was quite confident nothing was wanting but a will, I sometimes asked for a reason; but it could, in no instance, be obtained. If I pressed her for an answer, or for a reason, she would either be silent or groan most dreadfully with pain! At length I saw that nothing could be obtained in this way, and that she must either attend to my directions, as far as was really in her power, or I could have nothing to do with her; and I told her so. She did not appear to care. Her alienation of feeling was so rapid that in a very few days she seemed almost to hate the very sight of me. Indeed, I believe she made statements to this effect to several of her friends. Her report, so unfavorable and so very strange, soon reached the ears of several very respectable people, who in wonder and surprise came to me, to learn what it meant, and among the rest came her minister. They made diligent though respectful inquiry whether the facts were as she represented them to be. I believe that, for the most part, they were satisfied with the treatment. But the girl herself was not satisfied. She could not leave the house without help; and yet it was easy to see that she was determined not to remain. She preferred, as she said, to die. Everybody seemed to pity her, despite of her unreasonableness, and the more for her unreasonableness. Her friends assured her that this treatment of mine afforded her the last chance of recovery, and begged her not to decide to leave us too hastily. It was all to no purpose, however; she said she preferred death in the street to a cure at my hands. There had been serious difficulty about her diet. I had strenuously forbidden the use of certain condiments which I thought injurious to her, but which she was resolutely determined to have. At first, a few things prepared to her taste had been smuggled in by certain psuedo friends; but this, when discovered, was absolutely prohibited. One evening, just at dark, some of her friends called to see her and me. They found me in the sitting-room. We had a short conversation concerning the patient, in which they were made most distinctly to understand that they must either leave her to be treated wholly according to my discretion or remove her. They were left at a loss what course was best; but at length, in compliance with her clamors, they placed her in their carriage and carried her away. This was both the first and last patient that ever ran away from me, or that ever appeared to be desirous of doing so. On the whole, though no one pitied her more than myself, I was glad when she was gone. She was hardly worth curing. I never heard from her more, except vaguely, some time afterward, that she was dead, which was probably correct. Most certainly I could not have lived long, in her circumstances. I was very unwise in taking the charge of her, or, at least, in retaining her a moment after she refused to obey me. However, I had my reward. The public not being possessed of all the facts in the case, probably lost confidence in me. It was proper that they should. He who takes a viper to his bosom, must not be surprised if he suffers the natural consequences of his presumption. CHAPTER LXXXVIII. HEALTH HOSPITALS. Some of my friends, fully aware of my strong reliance on the recuperative powers of nature, and of my growing scepticism in regard to medicine, entered into combination and proposed to place me at the head of a hospital, in which I should have an opportunity, as they supposed, to test the superiority of my favorite practice. The buildings needful for the purpose, were to be furnished by one of the company, gratuitously. For the rest, a subscription was to have been started. The salary was to have been $1,000 a year. Matters were, in fine, carried so far that nothing remained but my own acceptance or non-acceptance, of the proposal, as there was no doubt that the subscription would readily succeed. But I saw, at the moment, so many difficulties, that after a careful consideration of the subject I was compelled to decline. Situated as I then was, and with very little self-confidence, perhaps the decision was right. And yet I have at times, ever since, regretted it. I was not then so fully aware as I now am, of the stern necessity of such institutions. Still later than this, I made an effort to establish a Hospital, on my own responsibility, and on my own plan. This was, simply, to receive patients at my house, and teach them, both by precept and example, _how to live._ In other words, I was to teach the art of preventing disease by obeying the physical and moral laws. Even disease itself was to be cured by obedience to these laws,--those of hygiene. At this time, I was residing in the country. Had I been in the crowded city, I might, perhaps, have succeeded. As it was, I found many difficulties. Just now, too, among other difficulties, my pecuniary condition became embarrassed, and I was anxious to be freed from debt before I begun a work which, at best, required a good deal of capital. Not to be able to labor wholly gratuitously would, as I thought, defeat my whole plan. In these circumstances, and after considerable delay, the whole thing was indefinitely postponed; and soon after, I removed to a region still less promising. I shall not, at present, if ever, repeat my attempts, at least on the plan of doing my work gratuitously. What costs little is, usually, little valued. And yet, such institutions are needed; and the time must come when they will succeed. Some eminent medical man who already possesses wealth, will perhaps make the trial. For myself, I prefer a more radical work. I prefer to throw my own make-weight, while I live, into the scale of early and correct physical education. CHAPTER LXXXIX. DESTRUCTION BY SCROFULA. Much is said in these days about scrofula, and much indeed should be said about it; for it has become a most frequent, not to say fatal, disease. For, if few die of it, immediately, it leads to, or renders more severe, numerous other diseases, which are more directly fatal. In truth, a scrofulous constitution not only prepares us for many other diseases, but renders them, when they assail us, much more severe than they otherwise would have been. Colds, fevers, and consumption, in particular, are not only more frequent in scrofulous people than in others, but also more intense or severe, as well as less manageable by medical skill. This disease itself, though often inherited, may, on the one hand, be greatly aggravated by improper treatment; or, by a proper course of living, may, on the other hand, be postponed many years, if not indefinitely. Living much in the open air, cheerfulness of mind, plain food and drink, and a proper regard to the skin, will do a vast deal towards arresting its progress, and in some instances will wholly prevent its doing us any harm. For though five millions of the inhabitants of the United States were probably born with a tendency to this formidable disease, and the same proportion--if not a greater--of each generation to come will be likely to have the same tendency, I do not believe it to be indispensably necessary that one-half of this number should die, as now they do, of consumption. I have not a doubt that two-thirds of them might, by proper management, be made to last many years, and some of them to what is usually called old age. It has been my lot to have a very great number of scrofulous patients, daring the last twenty-five years, from almost every part of the United States. One of the worst cases I ever had was that of Mrs. ----, of New Hampshire. Her history, prior to the period when she came to me, is very briefly as follows. She was born of parents, who, at the time of her birth, were very near their dotage; in consequence of which, as it was believed, she held her existence by a very feeble tenure. At two and a half years of age, she was nearly destroyed by dysentery, or by the medicine given to arrest her disease, or by both. In addition to this and almost before she recovered, she had an attack of scarlet fever, which was very severe, and which was also probably treated freely by medicine. By this time there is no doubt that scrofula, at first slightly inherited, had become pretty well riveted on a constitution already but poorly prepared to endure it. In her seventeenth year, she was afflicted with a troublesome eruption, which was cured, or at least checked, by a wash of sugar of lead. (See Chapter XIII.) She was married at twenty-one; and though stinted in her growth, so as to be almost a dwarf, she seemed, at first, to be tolerably healthy. But in the course of a year she suffered from various complaints, to which scrofulous and otherwise debilitated females are subject in early conjugal life, for which she was treated--as I suppose very injudiciously--with active medicine, especially calomel. And now, as if to render what was already bad enough a great deal worse, she made use of a certain patent medicine, which had been greatly lauded in the public papers. She was also persuaded to make use of a more stimulating diet than before; which was doubtless to her great disadvantage, in such a feeble condition. Her diet, though it should have been _nourishing,_ should have been _less stimulating_ than usual, and not more so. Falling in with the famous Sylvester Graham, who was lecturing near her at the time, she was overpersuaded to change her habits very suddenly, especially her dietetic habits. From a highly seasoned diet, she was at once transferred to a very plain one, to which was added cold bathing and abundant exercise in the open air. This change, though it caused great emaciation, appeared to restore her health entirely. Her appetite and general strength were such that she thought it almost impossible she could ever be sick again. But now a heavy domestic affliction befell her, which again very much reduced her; and, as she was wont to say afterward, "killed her." What it was, however, I was never informed. Being greatly depressed, she undoubtedly confined herself to the house too much, and in one instance when she ventured out, she unluckily exposed herself to a damp east wind, which appeared to give her cold. To remove this, and for other purposes, she fasted rigidly, for several days. It was at this time that she came, in part, under my care. But she was already so much diseased in mind and body, and so ignorant of any just principles of hygiene, as to be greatly liable to be led about by the fancy or whim of this friend or that--sometimes by Mr. Graham and others, who only relied on Nature; and at others, by those who went to the opposite extreme. I could do little for her to any valuable purpose, and was glad to send her to the elder Dr. Jackson, of Boston. Not, however, till I had given her to understand, in general, that aside from her scrofulous tendencies, I did not know what ailed her; and that, so far as I could understand her case, her safest course was to avoid medicine and depend almost wholly on a careful obedience to God's laws, physical and moral, especially to his laws of hygiene. I had not then fully learned how much she had been abused, in early life, by unnecessary dosing and drugging. Dr. Jackson told her it was evident there was something in her case very much out of the way; but he would be honest with her, and confess that he did not know what it was. He proposed to have Dr. Putnam see her, and another physician at Lowell. He insisted, however, on a more nutritious diet. The last suggestion was heeded for awhile, but evidently to her disadvantage. Under the impression that in order to obtain more nutriment she must do so, she suddenly returned to the free use of flesh, butter, eggs, milk, etc., which, for a long time, till now, she had refused. This course brought upon her much acidity of the stomach. She returned once more to the plain diet, and by avoiding extremes and letting alone medicine, according to the general tenor of my directions, she partly recovered, and seemed destined to still higher advance towards the land of health and life. But here, again, domestic trials, like a flood, came upon her, and brought her into great mental anxiety and embarrassment, as well as into that weak and vacillating condition which had once before existed, and which I have already described. To-day she would use her well-balanced, plain diet; to-morrow, perhaps, resort to the starvation system, for a few days. Then, in the fear of suffering from that, she would resort again, for a few days, to luxurious living. Now, too, she would adhere to and follow this physician, now that, and next, none at all; or, perchance, follow some quack. I was not in a situation to exert much influence over her, or it is possible she might still have been saved. She would, indeed, adhere to my general plan, when all else that promised more seemed to fail, and perhaps would have been more persevering, but for her friends. They wanted to have the "prophet" do "some great thing," and cure her as by magic or miracle. In saying these things, it is far enough from being my intention to be reproachful. She was not educated to a knowledge of herself; and she was by no means, at the present time, what she had been in her best days. It is not to be wondered at, therefore, that she acted like a wayward child; though it is greatly to be regretted, since, in her circumstances, it probably cut off every chance of her recovery. In the spring, two or three years after her first change of diet, a cough with which she had occasionally been troubled before, came on with renewed violence, and never after wholly left her. She remained in this condition till the opening of the next year, when her cough made still farther advances, and was attended with hectic fever. She died in the month of May following. A post mortem examination was made, which determined the case to have been what Dr. Jackson and myself and many others supposed, a case of scrofula or struma; though it was certainly attended with many curious and rather anomalous symptoms. Though there were no ulcers in the lungs, they were found full of tubercles; and so were the mesenteric glands, and the lining membrane of the alimentary canal. It was even said by the principal individual concerned in the examination, that her whole body was but a mass of disease. For myself, I was necessarily absent at the time, and therefore have no facts of my own to present. I never had a case, either before or since, in which my hands were so completely tied as in this. The patient probably had as much confidence in me as in anybody; and yet she would not long follow me implicitly and strictly, without yielding to the whims of her friends or her enemies, and halving the practice with some physician or quack, either known or unknown. Under the care of some good, common-sense physician, and with full faith in him on the part of all concerned, I am still of opinion, as I always have been, that she might have recovered and lived many years, and, perhaps, been able to do a vast amount of good. CHAPTER XC. STARVING OUT DISEASE. Dr. Johnson, one of the best British writers on dyspepsia, advises his medical brethren to starve out the disease, as the surest way of getting rid of it. He says he has by far the best success with those patients who submit to this course. It is not starvation, exactly, though it savors of it. He says, keep them on just two pints of Indian-meal gruel--by which he appears to mean thin hasty pudding--a day, and no more. If they are really afraid of starving, after the trial of a few weeks, let them eat a few times of something else; but they must soon return to the starvation plan. I have usually preferred cakes of Indian meal, or wheat meal unbolted and baked very hard, to gruel or pudding. The reason is, that I consider mastication very essential to good digestion, especially in the case of dyspeptics. I believe the small quantity of Indian meal that goes into two pints of gruel, or even of pudding, were it firmly baked, would hold out and sustain the health and strength of an individual much longer than gruel; and it will, by most persons, be preferred. One of my dyspeptic patients, a young man of great resolution, was put upon ten ounces a day of thin Indian-meal cake, or johnny cake; and it wrought wonders. The prescription was made about twenty years ago, and no young man under forty years of age, in Massachusetts, is more efficient, at the present time, than he. To another young man, similarly afflicted, I recommended eight ounces of the same kind of food. He was from a family that had long known me, and that appeared to confide in me. I have never heard from him since. My conjecture is that he refused to follow the directions, and hence did not wish to communicate with me any farther. He may be still a dyspeptic, as the consequence, though it is certainly possible he may have obeyed the prescription, to the saving of his health. Some have supposed that a quantity of food so small, is not sufficient to keep alive an ordinary adult; but they are mistaken. Much smaller quantities than eight ounces have proved sufficient for this purpose, in a great many instances. Three or four ounces have been found adequate to every want, in these circumstances. As I regard this as a highly important point, I will endeavor to establish it by two or three facts, which have come, in part, under my own observation. The first appeared in the _Boston Medical and Surgical Journal_, for 1851, and in several other papers. The other is from a Philadelphia paper, and is as reliable as the former. It is, however, of much later date; viz., December, 1853. Jervis Robinson,[K] of Nantucket, was a ship-master, born in 1800. In 1832, he became a most miserable dyspeptic. For three or four years he relied on the popular remedy of beef-steak three times a day, and with the usual consequences. It made him worse rather than better. In the year 1836, a friend of his who had heard lectures on dyspepsia, or had read on the subject, suggested a new remedy. It was three Graham crackers daily, one at each meal, without any drink at the time of eating. This, it was said, if persevered in long enough, would certainly effect a radical cure. But I prefer to let Mr. Robinson tell his own story, which he does in the following manner:-- "The novelty as well as simplicity of this prescription, greatly interested my mind, and I laid the case before my friends. But they, as with one voice, endeavored to dissuade me from a course which they said would certainly destroy me. They were particularly afraid of the sudden change from a full flesh diet to one entirely vegetable.[L] But I told them I might as well die in one way as another, and that I was resolved on the experiment. "At first I had no Graham crackers; I therefore used the common soft Graham bread cut in thin slices and thoroughly dried. Twenty-one ounces a week was my allowance. Of these I made three meals a day, at the hours of six, twelve, and six. Small as the allowance was, I spent half an hour in consuming it. Occasionally at evening, I omitted one-half of even these scanty rations. "My drink, for twenty-four hours, was one gill of water, divided into three equal parts, and one of them to be taken just two hours after each meal. I also used a cold shower-bath at rising in the morning, and walked a mile before breakfast, having retired at ten the previous evening. "Under this course, my flesh and strength wasted fast. I was weighed every week, and for the first three or four weeks, I lost half a pound a day. The daily loss then diminished somewhat, but was not entirely discontinued till the lapse of two months. At this time I had lost, in all, twenty pounds weight. "All this time the cry of starvation was heard from every quarter, and I must frankly own that, for a week or so, I was not myself wholly without fears. However, my head felt so much better, and my spirits so much revived, that I began to take courage. My bowels, moreover, which up to this time had rarely moved, and never to much purpose, now began to move more regularly, and in about three weeks they resumed their functions entirely, both as regarded time and quantity. "At the end of two months, I ceased to lose flesh, and remained, in this respect, about stationary for four weeks; but after this I began to gain. At first, the increase of weight was very slow indeed, but soon it became much more rapid, so that in two months more I gained nearly what I had lost, or at the average rate of five or six ounces a day. For a part of this time, however, the gain was half a pound a day, or nearly three times as much as the whole weight of my food, and more than the whole weight of my food and drink together. "I have said that I ate three ounces, by weight, of Graham bread, daily,--an ounce at each meal. But I afterwards procured the Graham crackers in Boston, and used them a part of the time. Of these, too, I continued frequently to omit half a cracker at evening. The water, also,--one-third of a gill,--was generally omitted at evening. "As to my appetite, during the experiment, I can truly say that, though I never in my life came to the table with a better appetite, I was never better satisfied with my meals when they were finished. After the first three weeks, I had little or no thirst. Nor had I, so far as I now recollect, any desire to eat between meals. In truth, food, except at my meals, was seldom thought of. But, on this subject, my mind had been made up at the outset. I will only add, on this point, that my bread, during the whole time, tasted better, far better, to me than the nicest cake formerly had. "As regards perspiration, my skin, after the first three or four weeks (during which it was dry and hard), became soft and moist. When I used much exercise, I perspired very freely. My sleep was sound and satisfying. Indeed, the whole "machinery," so far as I could judge, worked admirably during the latter part of the experiment, and at its close I could perform a good day's work at my trade. "I was about thirty years of age when I made the experiment. I am now above fifty. I have not always, nor indeed generally, been as rigid in my habits since that time. In one instance, however, I worked two weeks on a ship, at "sheathing," on but five ounces of food a day, and was never better in my life, and never felt less fatigue at night. In fact, I felt much better at night than I did in those instances in which I indulged myself in eating two pounds of food a day. "During a part of the time of my principal experiment, I kept a grocery. On leaving this, I established a Graham boarding-house, in which I continued for one year. "About a year after the termination of my experiment, I had occasion, for about three weeks, to work in a bake-house, where the mercury in the thermometer was at 90°. While here, I ate twelve ounces of dry bread and two apples a day, and drank nothing. Yet I perspired as freely as ever, nor did I perceive any difference in the quality or the quantity of any other secretions or excretions." The reader will take notice that Mr. Robinson's principal or starvation experiment, lasted five months, or one hundred and fifty days. He will also observe that he left off the experiment with nearly or quite as much flesh as he had when he commenced, and with a very great increase of muscular strength. The above statement was so remarkable, that not a few medical men and others regarded it as a hoax. "To live on three ounces of bread, and yet be in daily employment," they said, "even though such employment were of a kind likely to call for very little muscular effort, is altogether incredible. And what renders the whole so much more unlikely, is, the yet more extraordinary assertion, that, part of the time, he gained more in weight than the whole amount eaten and drank." It was no wonder that medical and all scientific men were staggered at the account. I was in doubt myself, in regard to the functions of waste, and made a very rigid examination, in order to be certain of the facts, before I ventured to publish any thing. On one or two points, I afterward obtained Mr. Robinson's particular statement, as follows:-- "In regard to the question you propose, I shall have to guess a little. So far as the fluids are concerned, however, I think it was about half a pint a day. The solids--for I weighed them this morning, and they appear to me about equal to those voided during the experiment--are fully half a pound." I also recently ascertained another curious fact. Mr. Robinson's eyesight, prior to the experiment, had, for many years, been very poor, but was perfectly restored during its progress. It appeared, also, that he had again resorted to the exclusive use of bread and water for food; but not in such small quantities as before. Mr. Robinson, of course, is now above sixty years old. One medical correspondent of the _Boston Medical and Surgical Journal_, pressed Mr. Robinson, very hard, for corroborative testimony concerning the facts just stated, to which Mr. Robinson very kindly replied, by sending him the certificate of his wife, Mrs. E. D. Robinson, whose veracity is undoubted. The certificate was as follows:-- "The most of the facts which my husband has written, I well recollect, and will give my name as a voucher for the truth of them." A brother of Mr. Robinson, at Holmes' Hole, whom I called on, appeared to give full credence to the statements of the latter, although he was much opposed to the experiment, at the time it was made, and mortally detested all his bread and water tendencies. I will only add, that a medical man who was sceptical in regard to the whole matter, became finally convinced that the story bore the marks of truth, and made public his conviction, in the subjoined statements and reasonings. "It is no true philosophy to refuse credence to a statement of fact supported by competent evidence, simply on the ground that we cannot understand how it can be. That his system (Robinson's) absorbed a very considerable amount of weight from the moisture at all times existing in the atmosphere, I have no doubt--partly through the skin, but chiefly, as I apprehend, through the mucous membrane of the lungs. The fact that they are capable of transmitting such an amount of water in a very short time, as may be rendered evident by breathing on a cold, polished surface, is a pretty conclusive proof that they may, under favorable circumstances, be as active in absorption. "That the alvine evacuations are purely and entirely a secretion, to become an excretion, I have been satisfied for a number of years; and I am glad of this new and striking--I might say incontrovertible--proof that it is so. To be sure, all matters incapable of solution and digestion, pass off through the alimentary canal, but they are purely accidental. One of the most satisfactory proofs, to my mind, of the fact, has been the discharges from the bowels of a healthy infant. The whole of the milk is so digested that there is no residuary matter to pass through the canal, and yet the discharges are abundant." The case of Mary B. Adams, of Oakham, Mass., though differing considerably from that of Mr. Robinson, is, nevertheless, remarkable. I have dwelt so long on the preceding case, however, that I must study brevity. What I shall say, was published in the papers of some years since, and is from her own pen. "In June, 1840, I had an abscess in my throat, accompanied by slow fever, and in the fall, dysentery. In the autumn of the same year, I discontinued the use of animal food. "In 1842, I had an attack of spinal complaint, which lasted me three months. In the spring of 1843, I had lung fever, followed, for nearly two years, by a cough, and accompanied by a very indifferent appetite. A piece of bread three inches square and one inch thick would serve me for a meal. A hard fit of coughing, however, was sure to follow every meal. I also became very much emaciated. In the fall of 1844, I took some medicine which removed my cough. "Through the winter and spring of 1845, I had diarrhoea; and in the last of May, I was suddenly and completely prostrated. I had risen in the morning more unwell than usual, but before flight I was suffering intolerable pain through the kidneys and back; and it was not till the lapse of two weeks that I was able to walk about the house. All this while I was entirely destitute of an appetite, though my stomach continually craved acids. For six months, I lived almost wholly on fruit. Four good-sized apples a day,[M] was all that I required. My drink was, for the most part, catnip tea. Sometimes I could take sugar and milk in my tea; at others, milk could not be borne. I drank four teacupfuls of it a day. "While I was at one period expectorating largely, I had custards made from the white of eggs, sweetened with loaf sugar, of which I took three table-spoonfuls, every twenty-four hours. I slept but little--not more than two hours in twenty-four.... My bowels were very costive; I do not suppose there were more than two or three natural evacuations during the whole of the six months I am describing." A more particular account of her diet, in 1846, is elsewhere given. It is in the following words: "During this year I took but little food, and that of the simplest. I lived chiefly on fruit, such as apples, currants, strawberries, gooseberries, and blueberries, and other acid fruits." Some years later than this, Miss Adams was still living very simply. "My food," she says, "is raised bread, and butter, apple or pumpkin pie, and fruit in small quantity. I do not require more than a third as much food as most females. In fact, I can eat but little of any thing. My food, even now, distresses me very much, unless I vomit it. I eat no animal food, and roots of every kind distress me. I drink tea; I cannot drink water; it seems, in swallowing it, more like a solid than a liquid." There would be no difficulty in adding largely to the list of cases of dyspepsia which have been cured on the starvation plan; but these must suffice for the present chapter. FOOTNOTES: [K] For obvious reasons, I give real names and dates in this chapter. [L] Even Mr. Graham himself, whom he accidentally met, repeated to him the same caution! [M] Or other fruits equal to them. The reader must not forget that she had already subsisted five years without animal food, and that what she took of vegetable food was a very small quantity--little more than was taken by Mr. Robinson. CHAPTER XCI. DIETING ON MINCE PIE. A recent letter from a patient of mine, contains the following statement: "I met, yesterday, with a poor dyspeptic. He said he felt very bad indeed, and that he had been _dieting_ for a long time. I asked him what his diet had been. He said 'Bread and butter, for the morning meal; beef, etc., for dinner; and nothing at all, for supper, but a piece of mince pie and one or two glasses of cider.'" Admitting this to be dieting, it is, at least, such a kind of dieting as will not be likely, very soon, to cure dyspepsia. And yet to hundreds, if not thousands, _dieting_ is little more than an increased attention to what they eat--I mean, from meal to meal. Yet no changes of food, even for the better, will compensate for this increased watchfulness over--I might perhaps say devotion _to_--the stomach. The Philippians, to whom Paul wrote so touchingly, are not the only people in the world whose god is their abdominal region. Such an anxious attention to the demands of an abnormal appetite, only tends to increase that determination of blood to the stomach, to prevent which all judicious or effective dieting is intended. Dyspepsia only renders her devotees--her very slaves--the more enslaved. With such, every attempt to cure the disease by dieting is still stomach worship. They must have their very medicine taste agreeably and _sit_ well. At all events, they must and will have their minds continually upon it, and must and will be continually inquiring whether they may safely eat this article or that or the other. It would be almost true to affirm that the fall of man from primeval integrity, consists essentially in dyspepsia, and that every descendant of Adam and Eve is a dyspeptic. The attention of mankind generally, is directed too exclusively as well as too anxiously, to the inquiry, what they shall eat, and what they shall drink. That we must eat, and drink too, is quite obvious--nothing more so. That the Author of nature intended, also, that we should take pleasure in our eating and drinking, is scarcely less so. But does he secure to himself the most pleasure who thinks most about it? Most certainly there is pleasure--_much_ pleasure in the anticipation of good. We may, by aid of imagination, then, feast upon the same dish half a dozen times. Yet, does not this--I repeat the idea--tend to determine an increased amount of blood and of nervous energy to the stomach, and to aggravate the disease? Let the reader ponder this question. My own most deliberate conviction is, that the stomach, in general, is best managed, and the greatest amount of gustatory enjoyment secured, when it is subjected most fully to good habits; that this organ, being blind and deaf, is best served when directed by the wiser head; or, to express the same truth in a better way, instead of asking the stomach at any time what it will have, _we should ask the head what is right_, and follow its directions. If the stomach is pleased, why, very well; if not, let it go without being pleased. Give it what you think is right, all things considered, and think no more about it. If it rebels, give it a smaller quantity. If it still complains, lessen still more the quantity, and perhaps diminish the frequency of your meals. There is no danger of starving to death, as every one must be convinced who has read carefully the two preceding chapters. When the system is really in a suffering condition for want of nutriment, then the stomach will be able to receive more, and dispose of it. If you give it what is right for it, there will be no want of appetite--at least, very long. Nay, more; the mere animal or gustatory enjoyment of that food which the head tells us is right, and to which we conscientiously adhere, will, in the end, be far greater than in the case of continual inquiry and anxiety and anticipation and agitation about it. Dyspepsia, I know, has a great variety of causes--as many, almost, as it has forms. And yet I do not believe it can often be induced by other causes alone, as long as the stomach is treated correctly. Give to that organ, habitually, what is exactly right for it, both as regards quality and quantity, and I do not believe we shall hear any more, in this world, about dyspepsia. But he who would confine his stomach to food which his head tells him is right, will not surely put mince pie into it. He must know that such a strange compound, however agreeable, will in the end be destructive, not only of health, but of gustatory enjoyment. The mince pie dyspeptic is just the man for quackery to feed upon. He will keep his nerves in such a state as to render him liable to read about and swallow all the wonderful cures of the day--whether hunger cures, nutrition cures, clairvoyant cures, "spiritual" cures, or any other cures. Now it is great gain, when we have got beyond all these, when we simply put into our stomachs what is right, and think no more about it, leaving ourselves to the event; and this in sickness and health both. A man in the eastern part of Massachusetts,--an asthmatic,--told me he had spent six hundred dollars in fourteen years, on quack medicines, and that he was nothing bettered by them. That man, you may depend, is the slave of his feelings. No man who has been accustomed to dictate to his stomach what it shall have, and make it submit, would ever do this. A very poor woman, on the Green Mountains, assured me she had spent, or rather wasted, four hundred dollars in the same way. We must drop all this. I do not now say we must drop or lay aside all medicine, in all cases; that is quite another question. But I do say, we must rely on obedience to the laws of God, or on doing right, not on medicine. It will be time enough to rely on medicine when our family physician urges it upon us as indispensable. If I have a single regret with regard to the instruction I have given my patients, from time to time, it is that I have not pressed upon them more forcibly and perseveringly, such views as are comprised in the foregoing reasonings and reflections. They are all-important to the dyspeptic, and by no means less important to the healthy than to the diseased. CHAPTER XCII. GIANTS IN THE EARTH. It is said of Job, and his friends who visited him to condole with him in his sufferings, that they sat down together and said nothing, for seven days and seven nights. Nearly twenty years ago, a man of gigantic frame, but haggard appearance, came to me, and after the usual compliments,--which were indeed very dry ones,--sat down by my side, and said nothing; and this for the very same reason which is assigned as the cause of the long silence of Job and his friends--his grief and his sufferings were very great. His disease, however, was very different in its nature from that of Job. It was more like insanity than small pox, or eruptive disease of any kind. But hear him tell his own story, which I solicited at his hands for the express purpose of publication: "My business, until I was twenty years of age, was farming. Since that time, it has been mechanical, and for the most part sedentary. From my youth, I ate animal food of all kinds, prepared in the usual manner. Twice a day I partook, more or less freely, of such vegetables as are in general use. Fruits, as they came in their season, I ate whenever and wherever I could lay hands on them, more especially apples; these last at almost all hours of the day, and almost without number. I was also in the habit of eating a luncheon at nine or ten o'clock in the morning, and just before going to bed. "My drinks, till 1830, were principally tea, coffee, cider, and beer; but sometimes I used rum, brandy, molasses and water, milk and water, etc. For twelve years previous to 1837, I used tobacco. From my youth, I have had a fondness for reading and study--have spent many hours in reading after the whole village were asleep. "My health I considered good, compared with that of my acquaintances, and I was able to labor hard, although I was subject to dizziness and vomiting with such intensity that I could not walk or stand without assistance; and for a number of days, the complaint seemed to bid defiance to all medical aid. Here began the day of retribution, and bitterly have I suffered for my intemperance, both in eating and drinking. At length, my dizziness in some measure wore away, so that I returned to my work; but my system had received a shock that was not to be got rid of at once. And although my dizziness and inclination to vomit were in some measure removed, yet I grew weaker by degrees, so that by spring I was unable to perform my daily labor. "I continued to decline until summer, when I was attacked with a violent cough--from what cause I did not know. Some said it was the hooping-cough, some said it was _la grippe_. Suffice it to say, I took all the medicines prescribed by our family physician, followed all his good advice, and took all to no purpose. I was also persuaded to try the prescription of a celebrated physician in a neighboring town; but, alas! his prescription was tried in vain. "My cough and dizziness not having left me, I tried a respectable physician of Boston, who, with an honesty of heart that does credit to his profession, bid me buy a ninepence worth of liquorice, keep my mouth and throat moist by chewing a little of that, and let my cough have its course; 'For,' said he, 'though I should like to sell you medicine and give you medical advice, for the sake of the emolument, it will do you no good. Your disease will have its course, and you cannot help it.' I now thought my days were few; but, as a last resort, I repaired to you." He here enters into particulars which are not needful to my present purpose; and the detail, by one so intimately concerned, and withal so complimentary to me as his physician, would be fulsome. It is sufficient, perhaps, to add the following paragraphs. "Agreeably to your advice, I now began to reform, in good earnest. With a constitution broken down, and almost rotten with disease, it was no easy matter for me to cure myself; but to it I went, determined to overcome or die in the attempt. "I now began to think of eating what God created for man to eat. And now it was that my health began to return; and by the time I had practised the rules and prescriptions you laid down for me, about three months, my cough ceased, my dizziness left me, and my health and strength partly returned. "Since that time I have lived on bread made of wheat meal, rye and Indian bread, rice boiled or stewed, rice puddings, corn puddings, apples, potatoes, etc. I sleep soundly and sweetly, on a straw bed; rise at four in summer and five in winter, refreshed both in body and mind; do as much work as it is necessary for any man to do; am cheerful, happy, contented, and thankful to God for all his mercies; go to bed at nine and go to sleep without having the night mare or any thing else to disturb my rest. I ought to add that I eat no luncheon; and but about as much in a whole day, as I used to eat at one meal." As I have already intimated, it is about twenty years since I prescribed for this individual, at which time he had a wife and two or three children. The latter seemed to require not a little watching and dosing. Now, in 1858, he has a very large family, many of whom have either arrived at maturity or nearly so; and the whole family have, for many years, been strangers to dosing and drugging. Except the mother, they seem like a family of giants, so large are their frames, and so marked and strong are their muscles. They are pictures of health, so to speak; and if Mr. Barnum would exhibit them at his museum, or elsewhere, he might, for aught I know, retrieve his shattered fortunes. I know another great family, in New England, whose history, so far as physical inheritance is concerned, is not unlike that of the family just described. "There were giants in the earth in those days," hence appears to be applicable to the world since the flood, as well as to that which was before it. CHAPTER XCIII. THE GREEN MOUNTAIN PATIENT. Not many years since, I received a letter from a family in a retired village of the Green Mountains, begging me to visit one of their number, a young woman about twenty-seven years of age. She was a farmer's daughter, and had been, in early life, employed as is customary in such families in that region; but, for a few years past had been employed, a considerable portion of the time, in teaching in the district or public schools. It is probable she exchanged the employments of home for the labors of the pedagogue, on account of increasing ill health (though of this I am not quite certain), since nothing is more common or more hazardous. The daughters of our agriculturalists, who inherit, as she did, a scrofulous constitution, and who appear to be tolerably healthy while they remain at home, almost always break down within a few years after leaving the broom and duster. But whatever may have been the first cause or causes of her diseased condition, it is probable there had been both action and reaction. She was now, at the time I received her most piteous petition, quite ill, and had been so for a considerable time. However, in order to come at the case and the results, it may be as well to make a few extracts from the letters of her friends and herself. For, though they were not accustomed to such descriptions of a case as a medical man would be apt to give, yet, for popular perusal, they are, after all, the more useful. My first extract will be made from a long letter written by her brother. "The first attack of what we suppose to be her present disease, was a year ago last spring, and was believed to be the result of taking severe colds repeatedly, while teaching school among the mountains of New Hampshire, and which ended in what Dr. K. (their family physician) called inflammation of the lungs, and was treated accordingly. There was much cough and expectoration of mucus. Though she partially recovered, so as to be able to teach again the ensuing summer, yet her cough was somewhat troublesome till autumn, when health seemed again to smile upon her. "Late in the fall, however, she had a very severe attack of diarrhoea,--caused, perhaps, by imprudence in diet, and sundry other deviations from a straight line,--which has been her constant companion ever since. (This was a period of eight months.) During all this time her food has passed almost without being dissolved. There is much pain in the stomach and bowels, unless mitigated by opiates, morphine or something analogous. But very little cough has attended her since the last attack of diarrhoea. There has been some pain and soreness in the right side; an eruption over the region of her stomach, swelling of the feet and ankles, whenever fatigued by walking, with pain and soreness in the left ankle. "I will now give you, briefly, her physician's views. He was called soon after the disease had taken hold of her, and made an examination of her case, which he then called dyspepsia, attended with a little inflammation of the right lung, or perhaps, said he, a slight filling up of the air passages, and he thought the lower part of her right lung might be somewhat indurated. 'Still,' said he, 'the case is not a serious one.' These were his very words. He said he could cure her; and, till very lately, he has always held out to her the language of hope. But now he speaks very differently; he says the case is a hopeless one--that of tubercular consumption; and he says he has always known it to be such!--and adds that there is, even now, a small cavity in her right lung, and that her lungs are passing off in her diarrhoea, without any inconvenience in breathing, or any disagreeable sensation in filling the lungs to fulness." It is difficult to believe that a medical man who has any regard for his own reputation, would tell such a downright falsehood, as that above represented; and still more difficult to believe he would make the strange mistake of representing her lungs as passing off through the bowels! Why, they might almost as well pass though the moon! Probably my correspondent did not exactly and truly apprehend his meaning; at least, I would charitably hope so. The appeal for relief was so very urgent, and withal so humble, I visited and examined her, the family physician being present. I found the latter to be a timid invalid, for whom, before I left, I was requested to prescribe; which may account, in part, for his very inefficient practice. I also found him ignorant, in many particulars, of the first principles of his profession; and it was with extreme difficulty--like that of mingling oil with water--that we could unite on any thing reasonable or desirable. He still clung to medicine, as his sheet-anchor in the case, while I was for depending, mainly, on a strict conformity to the laws of health, and the restorative efforts of Nature. There were other difficulties. A part of the family still inclined to a reliance on him and his old system, while the rest were in favor of my general views, as far as they understood them. The patient herself sometimes inclined to one, and sometimes to the other. While in health, she had been a woman of much decision of character; but, in her present condition, she was weak and vacillating. But there was, at length, a partial blending of the inharmonious elements, and a prescription made out. It did not satisfy, however. There was so strong a leaning to nature, that, after my departure, Dr. K. gradually worked his way back to his old system of full medication, as a letter received a few weeks afterwards plainly indicated. For, as the great change in her treatment which we made, left her no mystical props to lean upon, and as Dr. K. was a little disposed to speak to her in a way which was calculated to increase her fears, it preyed upon her mind so much that, though her diseased tendencies gradually diminished, yet the continual croakings of her would-be friends, and the faithlessness of a half-sick and wholly sombre physician, more than counteracted every favorable tendency. In about two weeks after I saw her, she began to have more heat and pain in the stomach, with some other threatening symptoms,--probably induced by an attempt to use food prescribed for her, but which was too stimulating. Her physician now, to gratify both his own morbid feelings, and the clamor of her friends, ordered brandy and other stimulating drinks; also morphine and camphor powders, and a new relay of stimulating food. The sequel of the story, as related by a sister of the patient, is as follows:-- "Soon after I wrote you last (which was the letter containing an account of the strange resort to beef, brandy, morphine and camphor), she began to fail very fast, and Dr. K. informed her that she could live but a very short time. But she clung to life, and it was distressing to see her going down to the grave, while we were doing nothing to help her. We spoke to her about sending for you again; but she said you were a great way off, and if you could come at all, which was doubtful, it would be a long time before you could arrive; whereas, if she could not have help soon, she must be compelled to leave us. We asked her if she could think of any other physician that she would like to see? She replied, that she should like to see Dr. Q.,--an old physician about twenty miles distant. We sent for him immediately. He came, and with him her old physician, Dr. K. "I wish to say that she had taken but very little medicine before Dr. Q. came, except the morphine, camphor, and brandy. But the counselling physician said that would not do, and he could not help her unless she took three opium pills, eighteen drops of laudanum, and from six to nine drops of the chloride of iron, a day; and when she hesitated about being able to bear it, he told her to drink down the white part of two eggs in cold water, which would keep the medicine from hurting her. "We inquired if he would come again and see her: to which he replied in the affirmative. She proceeded to take his medicine for one day, but it quickly increased her diarrhoea. Instead of six movements a day, they were increased to thirty-five. Under these circumstances, her weakness increased so fast that she could help herself very little; and her feet, hands, and limbs were very much bloated. As Dr. Q. did not come, according to his agreement, we sent for her old physician. When he saw her, he said it was a wonder she had lived so long after taking Dr. Q.'s medicine." We are not told, in the letter from which the above is extracted, why her old physician, Dr. K., consented, in the first place, that she should take the medicine, if he regarded it as so very bad for her. But, then, he was a timid as well as a Janus-faced man, and probably said as he did because he did not know what else to say. But I will go on with the extracts, since they reveal another most astounding fact in regard to medical dishonesty. "He also (the family physician) told us that we must not expect Dr. Q. any more, for he told him expressly that he should not come again, as he could do nothing for her, and that if he had known how she was before he came, he never would have come so far in a case so hopeless. And, true to his engagement with Dr. K., but contrary to his promise, both to my sister and my father, separately, he never came again. "But the other doctor came again, and attended her as formerly. He gave her a powder of morphine, and some gum myrrh, and a little anise, which reduced the evacuations from thirty-three to three a day. But her distress was still very great, and her feet soon began to turn purple, and she began to bloat in her stomach and bowels. This continued till she was as full as she could be; and you could have heard her scream and groan as far as the road (a distance of three or four rods). The physician then applied ether, to relieve her distress, and gave twenty-five drops of laudanum, and a morphine powder, upon which her distress left her for a very short time, but soon returned, not to leave her again while she lived. Almost her last breath was a scream. She died in just eight days after Dr. Q. came to see her. "But I must close by saying that we think if our sister could have been a patient of yours, she would have been restored to health. But it is past, and we cannot recall it; and all I can now do, is to tender our thanks to you for your kindness and attention during our sister's sickness. I trust you will have life and health, long to pursue your noble vocation." I am afraid the patient reader of this long chapter, will be led to one conclusion which the writer would exceedingly regret; viz., that all medical counsel, in chronic disease, is of more than doubtful utility; and that it would be safer to leave it wholly to nature and to good nursing. There are medical men in the world who are honest as well as skilful, and who, because a case is difficult to manage, will not, chameleon-like, tell two or three different stories, and thus half ruin a profession that embraces so many noble and honorable-minded men; nor will they persist in a course of treatment which is evidently murdering their patients. It is hardly needful to say that the patient above described was murdered; but I am obliged to say, without doubt, that there was no necessity of her coming to such an untimely end. Her sister, it seems, thought that, had she fallen into my hands from the first, she might have been saved. I think so too. And yet, it might have been otherwise. In any event, she ought not, at the first, to have been treated for consumption, but for dyspepsia. Starvation, and a little mental quietude, with daily exercise, such as she could bear, in the open air, would have greatly changed her condition, when her diarrhoea first commenced. I never knew a case which was worse managed in my whole life. It is a wonder to me, when I think of it, that she so long survived under it. But it is a wonder, greater still, that medical men who are so unqualified for the duties of their profession as the physicians who were most concerned in the treatment of the above case appear to me to have been, do not feel compelled, by the remonstrances of their own consciences, to quit their profession, and do something for a living for which they are better prepared. CHAPTER XCIV. CURE OF POISON FROM LEAD. Cases of poisoning by lead are occurring in our country almost daily; and it becomes a matter of much importance to know how to treat them. Indeed, there are many who are so susceptible to the action of this deleterious agent, that the reception of a single tumbler of water brought through lead pipes, in a certain condition, into their stomachs, will cause serious disturbance. I have had one patient of this description--a Mr. E., of Worcester, Mass. Some twenty years ago, much of the water used in the village of Dedham, Mass., was conveyed to the village, for half a mile or so, in lead pipes. Many who drank the water were injured by it; some of them for life. A Mr. R., a printer, is believed to have lost his life, by disease which was either induced or aggravated by this cause. I have, myself, been called to prescribe for several, who were probably led into a state of ill health by this unhealthy water. One of the clergymen of the village suffered from it very greatly, though he is, as I believe, yet living. There is some difference of opinion as to the circumstances which most favor the action of the lead, or, rather, which cause its dissolution in the water. But, with regard to its danger, in certain circumstances, either known or unknown, there can be no doubt. Nor can we doubt that, in view of facts which exist, it is our duty to banish lead pipes, as much as possible, from common use. During the early part of the year 1855, Capt. J. H., near Boston, aged thirty-four years, of good natural constitution and comparatively healthy habits in general, had a slow typhoid fever, from which, however, he finally recovered, though not without a continued liability to a relapse. About this time, he began to use water brought to his kitchen in lead pipes. Late in the year 1856, he was taken down very suddenly, with fever and great debility, and in four or five days his upper and lower limbs became completely paralyzed. He was not able to stir so much as one of his hands. Indeed, the whole abdominal region seemed to be almost as inactive as his limbs; for very severe friction across the hips, and along the spine, down the legs, produced no sensation; and his bowels were so constipated, as to remain motionless from five or six days to a fortnight at a time, unless excited by medical agents. His case was examined by several eminent medical men in the vicinity of Boston, who gave it as their unanimous opinion, that the cause of his disease was the irritation of the water. Some of them prescribed for his case, but all to no apparent purpose. On the first day of November, he was sent to an electro-chemical bathing establishment, to be treated according to the usages of that institution. I was intimately acquainted with the establishment, and, in circumstances like his, was understood to regard it with favor. I was, therefore, from time to time, consulted in the case of Captain H. To give an impulse to the nervous and arterial systems of Capt. H., one bath was administered. The use of his limbs was restored, as if by magic. When he came out of the bath, he walked some twenty feet or more, to his bed, without assistance; and, to his great surprise, could raise his hands to his head. The second day's bath, and treatment with simple diet, not only restored sensation, but gave him a better use of his hands than he had enjoyed before for many months. His bowels, also, became immediately regular, and continued so. It is, however, to be confessed, that his recovery was not so rapid as at first seemed probable. The baths seemed to give an impulse; but it was reserved for a proper diet, suitable exercise, and good air, to work out, slowly, a perfect cure. How much was attributable to the baths, considered by themselves, is not known. No medicine was given, from first to last, except the electricity. It should also be confessed, that no belief was entertained, by myself or my associates, of any mechanical power possessed by the electricity, of forcing the lead out of the system; though some individuals had believed in such a power. The most we claimed was, that the invisible agent had an immediate influence on the nerves, and a more remote one on the absorbent system. As a farther proof, if more proof had been needed, that the paralysis was induced by lead, some of the water from which he had drank was analyzed by Dr. Hayes, City Assayer for Boston, who pronounced it to be strongly impregnated with lead, and "utterly unfit for culinary purposes." CHAPTER XCV. FAITH AND WORKS. In the autumn of 1856, a fine young man, a clerk in a large mercantile house in Boston, came to me with complaints not unlike those of thousands of his own age and sex, and begged for relief; but was surprised when he learned that I treated all such cases as his without medicine. Added to the surprise, moreover, was a degree of mortification at the idea of attempting to cure himself by a change of habits, especially of dietetic habits, which, in a boarder in a family, might be observed. He would have been much better pleased to take medicine, so concentrated that a few drops or a few small boluses or pills could be taken a few times a day unperceived--than to run the risk of awakening suspicions of diseases to which he was unwilling to make confession. And herein, by the way, comes out the secret of such a wonderful imposition on our young men, by what I have elsewhere called land-sharks in the shape of physicians. The fondness of young men for secret cures,--or, at least, their money, which is the thing most wanted after all,--leads them, almost directly, into the mouths of these monsters. My young patient, however, had faith in me; and, after the first shock of surprise and the first feelings of mortification were over, resolved to follow my directions, and did so. He came to me, it is true, several times, and said he could not endure it; that he was losing flesh very fast, and that he was already so weak that he could scarcely walk to his desk. I comforted him as well as I could, told him there would be a change soon for the better, and kept him on through the tedious months of December, January, and February, when his strength began to return, and his flesh to be restored. Between March and May, he gained twenty-one pounds; and in June, he was in as good health as he ever had been before in his life. And yet he took not a particle of any thing medicinal, from first to last. If you desire to know, in few words, what he _did_ do, I will tell you. First, he took a long walk, regularly,--sufficiently long to induce a good deal of muscular fatigue,--as the last thing before he went to bed which was at an early hour. Secondly, he used a cold hand-bath, followed by much friction, daily. Thirdly, he abandoned tea and coffee (tobacco and rum he had never used), and drank only water. Fourthly, he abandoned all animal food and all concentrated substances and condiments, and lived simply on bread (unfermented), fruits, and a few choice vegetables. It was faith that served this young man,--not faith without works, but faith which is manifested by works. "According to your faith be it unto you," might be enjoined on every patient, under all circumstances. But the most remarkable thing connected with this case, is the fact that this young man had been brought up _in the lap of ease and indulgence_--an education which is as unfavorable to faith as it is to works. CHAPTER XCVI. WORKS WITHOUT FAITH. A female, in Worcester County, Massachusetts, nearly sixty years of age, having for many years been a sufferer from domestic afflictions, till, along with certain abuses of the digestive function, it had brought upon her a full load of dyspepsia, was at length subjected to a trio of evils, which capped the climax of her sufferings, reduced her to a very low condition, and laid her on her bed. While lying in this condition, a young woman who was her constant attendant, and who was acquainted with my no-medicine practice, recommended to her to send for me. She hesitated, for a time, on account of the expense; for, though by no means poor, she felt all the pangs of poverty in consequence of the hard and unworthy treatment of the individual who was to have justly executed the last will and testament of her husband. But I was at length sent for. I found her under the general care and oversight of a homoeopathic physician; but as he was ten or twelve miles distant and had not been informed of my visit, I did not see him. His practice, however, in the case, was similar to what I had usually met with in cases which had come under the care of physicians of the same school, and was, at most, as it appeared to me, negative. She had indeed been drugged by some one most fearfully, and her whole system was suffering as the consequence; but it was a physician who had preceded Dr. A., and who was of an entirely different school. I found no great difficulty in persuading her to ask Dr. A., when he should next call, to suspend his medicine a week or two; and, after ordering a warm bath two or three times a week, and certain changes in diet, with particular care about ventilation and temperature, left her, to call again the next week. On calling, at the time appointed, I was greatly disappointed in finding her with many better symptoms. There was indeed cough, which busy rumor had converted into an indication of galloping consumption; but I found no other symptom which belonged to that disease. The homoeopathic medicine had been suspended, and the warm bath had been applied with apparent success. I left, with the promise of calling again in ten days--but not sooner, unless they sent for me. At the end of the ten days, I called and found all things ajar again. Her female attendant had left her about a week before; and the new attendants--two of them--being destitute of faith in me, had found no great difficulty in persuading her that she had a fever of the lungs, and that she would die if she did not take a _little_ medicine, and that she would do well to recall Dr. A., and take his medicine. When I arrived, at this third visit, I found her taking a small amount of homoeopathic medicine, but without appetite or strength, and evidently tending downward. It was too late to do any thing, especially when there was no faith in anything but pills and powders; and I left her to her native strength of constitution, her homoeopathic physician, her croaking nurses, and God, vainly mourning, all my way home, about the inefficiency of works without faith, especially in the case of the sick. This woman's case is recent, and it is possible that she may recover, in spite of pills, powders, croakings, and faithlessness. I have witnessed such things. Nature is tough. But while I lament the inefficiency of works, where faith is wanting, I have had one case which seems an exception to the general rule, "according to your faith," etc., which I take great pleasure in recording. In June, 18--, a young man from the interior of New England called on me while abroad on business, and desired to receive my advice concerning certain complaints, attended with great debility, and accompanied by hernia and varicocele, and, in general, by dyspepsia. On examination, I found the case a very obstinate one, of long standing. The patient was a young man of twenty-two, a clerk in a country store, a man of some principle, and yet trained to find his chief happiness in the indulgence of his appetite, especially in what is called good eating. I gave him some general directions, promising him something still more specific as soon as I got home. In July, I gave him written directions, in full, and urged him to push the treatment as fast as possible, in order to get into a beginning state of convalescence, soon enough to take advantage of the naturally recuperative effects of autumn. If he could find himself recruiting in September, the month of October, I told him, would produce on him a very decided change. He went to work accordingly, but it was because it was a last resort, and he must do so. It was not because he had much faith in me. Some of his friends, it seems, had directed his attention this way; but when I came to talk of the starvation plan of cure, to which I so much inclined, both they and he revolted. However, he made a faint beginning. I had foreseen most of the difficulties I had to contend with, and was prepared to meet them. Thus, knowing full well that if I laid down the laws of diet in great strictness, either as regards, quality or quantity, he would be discouraged and do nothing at all, I permitted him to use almost all kinds of food, and only insisted on a rigid adherence to the great law, and avoiding medicine. These two points I made much of, and explained them fully. For example: I told him that all kinds of cookery or preparations which prevented the necessity of teeth labor, such as soaking in milk, forming into toast, mashing, or in any way softening, were wrong, and must be avoided. Also, that all additions to our food, whether of foreign bodies, such as pepper, mustard, vinegar, salt, etc., or of more concentrated substances, such as molasses, sugar, honey, butter, gravy, etc., should, for the same reason as well as others, be shunned as much as possible. When, therefore, said I, the question comes before your mind, whether you may or may not eat a particular thing, consider first, whether its use would be a violation of the general laws I have laid down for you. I gave him many specific directions, at first, and yet continued to urge it upon him to reason for himself. But it seemed, for a long time, a hopeless case. He kept writing to me, to know if he might eat toast, bread and butter, soup, milk, etc., or to know why it was that he ought not to make additions of foreign or concentrated substances, as of pepper, mustard, molasses, syrup, etc. I have before me sixteen letters from him, in most of which his pleadings abound, up to the very last but one. This fifteenth letter, dated December 27, more than six months after my interview with him and first prescription, has the following inquiries:-- "Will a diet do for me that admits of any pastry?--of pies, of any kind? What _kind_ of puddings, pies, and cake will answer? What kind of meats? What food shall I be obliged to avoid to keep my passions in check? What am I to eat this winter--next spring--next summer? How much at a time? Can I eat tripe--corned beef--oysters--lean pork steak? What kinds of meat and fish will do for me to eat? Any salt fish? Is milk bad in case of liver disease? Is there any objection to baked sour apples and milk, or to sour apples after using a little milk or bread? Will you allow me to eat any simple thing between meals?" And in this same letter, after six months' instruction, as aforesaid, he undertakes to tell me what his habits of living are, which, despite of all said and done, in the way of personal counsel and nearly twenty letters, strangely reads thus:-- "I use some milk three times a day, and almost always soak my toasted bread in milk. Since I have been out in the open air, I have usually had some wild game, or a piece of beef steak, or raw eggs, twice a day. My suppers, lately, have been toasted bread, of any convenient kind (usually Graham), with milk, about a tumbler full, at a time, or three-fourths full. I usually eat two apples, with or after each breakfast and dinner. I use considerable cream soaked into my bread, when I can obtain it, and some molasses. Now, which is the best for me to use on my bread, at supper time--cream, milk, molasses, or a little butter?--or with my other meals? Is there any objection to my using all these now, in proper quantities? Will a little plain sauce do with my supper? Why do you so strongly object to cream toasts, or cream on bread? Is chewing gum from spruce trees injurious?--or birch bark? Any objections to eating two sour apples after breakfast and dinner?" Now the great difficulty with this young man was, that he had but little faith, either in me or in principles--though if I would direct him, from step to step, like a child, he would obey me, for the moment: though, like a child, too, he would forget my directions at almost the next moment, and ask for information on the very same point. Was not such a trial almost too great? However, he was destined to survive it, to live on in spite of it, notwithstanding my after fears. In March, 18--, he wrote me as follows:-- "As I have been getting better all the while, and have troubled you with so many little queries from time to time, I thought I would delay this letter a while. My health has been constantly improving all winter, and I think I have not enjoyed as good health before for many years. People now say, 'How well you are looking!' and 'How fleshy you are!' I mean to live according to the '_laws_.'" In short, this young sufferer from dyspepsia in one of its worst forms, after more than half a year of works without faith, and of whining and complaining a part of the time, without either works or faith, is at last shouting victory! And a glorious victory it is! Would that the rest of our dyspeptics, with land by millions, might stand on as good a footing, with as good prospects before them, as this young man! And yet he might have come up to the same point long ago, had he used more common sense, and exercised but a little more faith and trust in just hygienic principles. CHAPTER XCVII DISEASES OF LICENTIOUSNESS. Not far from the end of July, 1857, I received the following, in a letter through the post office, as usual, and dated at Boston, but signed by a name probably fictitious. "It was with no small degree of interest that I noticed, in a book written by yourself,--I cannot recollect its name,--some remarks upon certain diseases which you called nameless; yet, through a dread to introduce so delicate a subject, I have neglected so to do, till it has become an imperative task. And now, laying aside all feelings of modesty, allow me to be familiar with you, as with a father, and to lay my case before you, assuring you that, however unfortunate I have been, it is not my fault, but has come upon me while living with my husband, having never betrayed _his_ confidence." She then proceeded at once to describe her disease and sufferings, which were terrible. It appeared that she had not been of the number of those who, in circumstances akin to hers, so often fall into shark's mouths. She had taken but little medicine of any kind, except balsam copaiba. After the details of her symptoms and sufferings were finished, she added: "Now, if you are able to understand me, I wish to ask you whether, from the description I have given, you cannot prescribe something that will relieve me. If so, you can be assured that you will put your humble correspondent and her erring but repentant companion under great obligation to yourself, and that you will be rewarded for all your trouble and advice." As the result of this request, a correspondence followed, which continued several months. At first, the patient clung to the idea that she could not possibly be restored without minerals, or at least without active medicine of some sort or other, she scarcely knew what. But she at length understood me, and followed, quite implicitly, my directions. There was indeed a little shrinking, at first, from the rigidity, or, as she would call it, the nakedness, of a diet which it was indispensable to use in order to purify her blood effectually; but she finally came bravely up to the mark, and probably reaped her reward in it. It is true, I did not hear from her till she came to the end of a very long road; but up to the last of our correspondence, she was slowly improving. My belief is that, before this time, she has fairly recovered, and with far less injury to the vital powers than if mercurial or other strong medicines had been used. And herein we are reminded of a crime that not only has no name, but deserves none. I allude to the act of communicating a disease so distressing to an innocent and unoffending female. We had an instance of this same crime in Chapter LXXIV. If there be such a thing as punishing too severely, I am sure it is not in cases like these. The individual in human shape, who, with eyes open, will run the risk of injuring those whom he professes to love better, if possible, than himself, deserves a punishment more condign and terrible than he to whom is so often awarded a halter or a guillotine. CHAPTER XCVIII. CURIOUS AND INSTRUCTIVE FACTS. It is morally impossible for any medical man who has kept his eyes open for forty years, not to have been struck with certain obvious and incontrovertible facts, of which I present a few specimens. The _Boston Medical and Surgical Journal_, a few years since, in an obituary notice of Dr. Danforth, who had long been an eminent practitioner in Boston, makes the following remarks:-- "Though considered one of the most successful practitioners, he rarely caused a patient to be bled. Probably, for the last twenty years of his practice, he did not propose the use of this remedy in a single instance. And he maintained that the abstraction of the vital fluid diminished the power of overcoming the disease. On one occasion, he was called to visit a number of persons who had been injured by the fall of a house frame, and, on arrival, found another practitioner engaged in bleeding the men. 'Doctor,' said the latter, 'I am doing your work for you.' 'Then,' said Dr. Danforth, 'pour the blood back into the veins of those men.'" Dr. Thomas Hubbard, of Pomfret, Conn., long a President of the Medical Society in that State, was, on the contrary, accustomed to bleed almost all his patients. Yet both of these men were considered as eminently successful in their profession. How is it that treatment so exactly opposite should be almost, if not quite, equally successful? There was a discussion in Boston, many years ago, between Dr. Watson, one of the most successful old-school practitioners of medicine, and a Thomsonian practitioner, whose name I have forgotten, in the progress of which the former made the open and unqualified declaration, that, in the course of four years' practice, he had drawn one hundred gallons of human blood, and that he was then on the use of his thirty-ninth pound of calomel. Now both these men had full practice; and while one did little or nothing to break up disease or destroy the enemy, the other did a great deal; and yet both were deemed successful. Can we explain this any better than we can the facts in regard to Drs. Danforth and Hubbard? Let us look at the case of Dr. M., of Boston, a successful allopathic practitioner. In order to satisfy his curiosity, with regard to the claims of homoeopathy, he suddenly substituted the usual homoeopathic treatment for allopathy, and pursued it two whole years with entire success. Curiosity still awake, he again exchanged his infinitesimal doses of active medicine for similar doses, as regards size, of fine flour, and continued this, also, for two years. The latter experiment, as he affirms, was quite as successful as the former. Do not such facts as these point, with almost unerring certainty, to the inefficiency of all medical treatment? Do they not almost, if not quite, prove that when we take medicine, properly so called, or receive active medical treatment; we recover in spite of it? Is there any other rational way of accounting for the almost equal success of all sorts of treatment,--allopathic, botanic, homoeopathic, hydropathic, etc.,--when in the hands of good, sound, common sense, and conjoined with good nursing and attendance? Is it not that man is made to live, and is tough, so that it is not easy to poison him to death? But the most remarkable fact of this kind with which I am acquainted, is the case of Isaac Jennings, M.D., now of Ohio. He was educated at Yale College, in Connecticut. During the progress of his education, he served a sort of medical apprenticeship in the family of Prof. Eli Ives, of New Haven. He took his medical degree in 1812, and soon after this commenced the practice of his profession in Trumbull, in Fairfield County. Here, for eight years, he had ample opportunity to apply the principles with which, at the schools, he had been fully indoctrinated. In the summer of 1820, he removed, by special request, to Derby, nine miles from New Haven. Up to his second year in Derby, he pursued the usual, or orthodox, course of practice. The distance from his former field of labor was not so great but that he retained a portion of his old friends in that region. He was also occasionally called to the town of Huntington, lying partly between the two. On meeting one day with Dr. Tisdale, of Bridgeport, an older physician than himself, he said to him, very familiarly, "Jennings, are you aware that we do far less good with our medicine than we have been wont to suppose?" He replied in the affirmative, and observed that he had been inclining to that opinion for some time. "Do you know," added Dr. Tisdale, "that we do a great deal more harm than good with medicine?" Dr. Jennings replied that he had not yet gone as far as that. Dr. Tisdale then proceeded to state many facts, corroborating the opinion he had thrown out concerning the impotency of medicine. These statements and facts were, to the mind of Dr. Jennings, like a nail fastened in a sure place. From this time forth his medical scepticism increased, till he came, at length, to give his doubts the test of experiment. Accordingly, he substituted for his usual medicaments, bread pills and colored water; and for many years--I believe five or six--gave nothing else. The more rigidly he confined himself to these potions, the better he found his success, till his business was so extended, and his reputation so great, as to exclude all other medical men from his own immediate vicinity. His great conscientiousness, as well as a desire of making known to his medical brethren what he believed to be true, and thus save them from the folly of dealing out that which he was assured was only a nuisance, especially under the shelter of what they supposed to be his example, led him, at length, to call a meeting of physicians, and reveal to them his discovery. The surprise was great; but greater or less, according to their tact for observation, and the length of their experience. But the secret was now out, and Dr. Jennings soon began to lose practice. Instead of employing a man to give them bread pills and colored water, many chose to take care of themselves, and let the physician wholly alone; while a far greater number, though they dearly loved and highly respected Jennings, as an old friend and physician and an eminent Christian, began to seek medical counsel at other hands. The result was, that his business became so much diminished as to leave him without a full support, except from past earnings, and he began to make preparations for a removal to the West. But this his friends were unwilling to have him do, and they accordingly raised, by subscription, $300 a year, to induce him to remain. In a few years, however, the subscription failed to be renewed, and in 1839 or 1840 he removed to Ohio, where he still remains. He does a little business, and what he does is attended with great success; and yet, the number of those who follow him is small. Facts of similar import, in very great numbers, some more and some less striking, might be related, to almost any extent; but can it be necessary? Suffice it to say that some of the oldest physicians in Boston and its vicinity, the oldest physician in Cleveland, and some of the most intelligent ones in New York and Philadelphia, as well as elsewhere, are coming rapidly to the same conclusions with Dr. Jennings, and a few of them have already arrived there. It is from stumbling on such facts as these, together with my own long experience, all bearing in the same direction, that I have long since renounced dependence on medicine, properly so called, as a means of restoring the system, when out of order, to a state of health. In other words, I have ceased to employ poison to _cure_ poison. But, lest it should still be thought I make too much of my own experience, and of the facts which have been adduced in this chapter, I subjoin another of kindred character, containing the written testimony of others, especially medical men, on the subject. CHAPTER XCIX. ANTI-MEDICAL TESTIMONY. A very large amount of testimony, going to show the inefficiency and inutility of medicine, might be presented; but I have limited myself to a selection of some of the more striking and important. Let me begin with Dr. Rush, of Philadelphia. In a published lecture of his, more than half a century ago, he made the following remark:-- "Dissections daily convince us of our ignorance of disease, and cause us to blush at our prescriptions. What mischief have we done under the belief of false facts and theories! We have assisted in multiplying diseases; we have done more; we have increased their mortality.... The art of healing is like an unroofed temple, uncovered at the top, and cracked at the foundation." Magendie, late a distinguished French physician and physiologist, says, as follows:-- "I hesitate not to declare,--no matter how sorely I shall wound our vanity,--that so gross is our ignorance of the real nature of the physiological disorders called diseases, that it would, perhaps, be better to do nothing, and resign the complaint we are called upon to treat, to the resources of nature, than to act, as we are frequently compelled to do, without knowing the why and the wherefore of our conduct, and at the obvious risk of hastening the end of our patient." Dr. Good, a learned and voluminous British writer, also says:-- "The science of medicine is a barbarous jargon; and the effects of our medicines upon the human system, are, in the highest degree, uncertain, except, indeed, that they have already destroyed more lives than war, pestilence, and famine combined." Professor Clark, of the Harvard Medical School, in Boston, in an address of his, recently published, insists, again and again, that medicine never cures, and that it rarely, if ever, so much as _aids_ nature; while he exalts, in an unwonted degree, the remedial effects of every hygienic influence. Let him who longer doubts, read this most remarkable production; and with the more care from the fact that it is a very fair exponent of the doctrines now held at the very fountain-head of medical orthodoxy. From a work entitled, "Memoirs of James Jackson, Jr.," late of Boston, written by his father, I have extracted the following. It is part of a letter, written from Europe, to his venerable father, the present elder Dr. James Jackson, of Boston. "But our poor pathology and worse therapeutics--shall we ever get to a solid bottom? Shall we ever have fixed laws? Shall we ever _know_, or, must we always be doomed to _suspect_, to _presume_? Is _perhaps_ to be our qualifying word forever and for aye? Must we forever be obliged to hang our heads when the chemist and natural philosopher ask us for our laws and principles?... If honest, must we not acknowledge that, even in the natural history of disease, there is very much _doubtful_, which is received as _sure_? And in therapeutics, is it better yet, or worse? Have we judged--have we deduced our results, especially in the last science--from _all_, or from a selection of facts? "Do we know, for example, in how many instances such a treatment fails, for the one time it succeeds? Do we know how large a proportion of cases would get well without any treatment, compared with those that recover under it? Do not imagine, my dear father, that I am becoming a sceptic in medicine. It is, not quite as bad as that. I shall ever believe, _at least_, that the rules of _hygeia_ must be and are useful, and that he only can understand and value them, who has studied pathology. Indeed, I may add that, to a certain extent, I have seen demonstrated the actual benefit of certain modes of treatment in acute diseases. But, is this benefit immense? When life is threatened, do we very often save it? When a disease is destined by _Nature_ to be long, do we very often materially diminish it?" It is worthy of remark, that the discussions in the pages of the _Boston Medical and Surgical Journal_, for two or three years past, concerning the treatment of scarlatina, have usually resulted, practically, in favor of the no-medicine system. It clearly appears that the less our reliance on medicine, in this disease, the better. But what shall hinder or prevent our coming to similar results, in the investigation, in time to come, of other diseases? Dr. Reynolds, one of the most aged as well as most distinguished medical men of Boston, has been heard to affirm that if one hundred patients were to call on him during the day, and he could induce them to follow such directions as would keep them from injuring themselves from eating and drinking,--no matter what the disease,--he should be surprised at a mortality of more than three per cent of their number; and he should _not_ be surprised if every one who implicitly followed his direction should finally recover. I will only add, in this place, the testimony of two or three distinguished individuals on this subject, whose opinion, though they were not medical men, will with many have weight, as it certainly ought. Thomas Jefferson, in a letter to Dr. Caspar Wistar, of Philadelphia, thus writes: "I have lived to see the disciples of Hoffman, Boerhaave, Stahl, Cullen, and Brown succeed each other, like the shifting figures of a magic lantern.... The patient treated on the fashionable theory, sometimes recovers in spite of the medicine. The medicine, therefore, restores him (!!!), and the doctor receives new courage to proceed in his experiment on the lives of his fellow-creatures!" Sir Walter Scott says, of Napoleon: He never obeyed the medical injunctions of his physician, Dr. O'Meara, and obstinately refused to take medicine. "Doctor," said he, "no physicking. We are a machine made to live. We are organized for that purpose. Such is our nature. Do not counteract the living principle. Let it alone; leave it the liberty of defending itself; it will do better than your drugs. The watchmaker cannot open it, and must, on handling it, grope his way blindfold and at random. For once that he assists and relieves it, by dint of tormenting it with crooked instruments, he injures it ten times, and at last destroys it." CHAPTER C. AN ANTI-MEDICAL PREMIUM. The Massachusetts Medical Society, in the year 1856, were authorized by an unknown individual to offer a premium of one hundred dollars for the best dissertation which should be presented to them, on or before April 15, 1857, on the following subject, viz.: "_We would regard every approach towards the rational and successful prevention and management of disease without the necessity of drugs, to be an advance in favor of humanity and scientific medicine._" A number of essays were accordingly presented, having, as is usual in such cases, various degrees of merit; but the preference was given to one written by Worthington Hooker, M. D., of New Haven, Conn. This essay is to be published in due time, and it is devoutly hoped there will be as little delay as possible in the circulation of so remarkable, and, as I have no doubt, valuable, an essay. The facts in connection with this essay, taken as an item in the history of human progress, are truly remarkable. The very title of the essay is at once peculiar and striking; but the main idea which it suggests to the mind is much more so. That a learned society, in the literary metropolis of New England, if not of the United States, should, at the present time, in any way or shape, encourage a discussion of the question, whether, in the practice of medicine, drugs can be dispensed with, was not an event to be expected or so much as dreamed of. It is, therefore, I repeat, very remarkable, and must have a deeper meaning than at first appears. What, then, let us inquire, is that meaning? Does it intimate that there is a belief,--a lurking belief, if you choose to call it so,--among our scientific medical men, that drugs might be entirely dispensed with? Or, does it rather imply a belief in the possibility of approximating to such a point,--with those approximations of two mathematical lines, of which we sometimes hear,--without the possibility of ever reaching it? It is by no means improbable, at least in my own view, that the essay intended by the Boston Society had its origin in a growing tendency, everywhere, among scientific medical men, to the belief that, in the most rational and successful practice of medicine, drugs are not indicated; and that they are only necessary on account of the ignorance or credulity of the community. The family practice of many sensible physicians, perhaps I might say of most, is strongly corroborative of this main idea. I can point to more than a score of eminent individuals, in this department, who never, or at most but seldom, give medicine in their own families; above all, they never take it themselves. It is indeed true, that some of them are hardly willing to own it, when questioned on the subject; but this does not alter the plain matter of fact. Thus Dr. S----, ten miles from Boston, is subject to attacks of a species of neuralgia, which sometimes last two days; and yet, none of his family or friends or medical brethren have ever been able to persuade him to do any thing to mitigate his pain, except to keep quiet and abstain almost entirely from food; and a daughter of his assures me that she can scarcely recollect his giving a dose of medicine to any member of his family. Dr. H., seven miles from Boston, not only does the same, but frequently disappoints the expectations of his patients, by giving them no medicine. Yet both these individuals are exceedingly slow to be seen in company with those men of heterodoxy in medicine, who dare to advocate, everywhere and on all occasions, what they habitually practice on themselves and their families. What, then, I repeat it, can these things mean? Is there not reason for believing that the truly wise men of the medical profession, at the present time, are beginning to see, in certain facts which in the providence of God are forced upon them, that in the general management of disease, and as the general rule of treatment, no drugs or medicines are needful? There is a wide difference between that practice of our profession which, as a general rule, excludes medicine, and that which, as a general rule, includes it. And an entire change from the latter to the former, is, perhaps, too great to be expected immediately. Yet, in the progress of society towards a more perfect millennial state of things, must it not come? CHAPTER CI. CONCLUDING REMARKS. It is a notorious fact, that while the number of physicians and the expenditure for drugs and medicines is constantly increasing, in every civilized country where they have been much employed, diseases have been multiplied in proportion. Perhaps, too, they have, in a like proportion, become more fatal; but this does not so clearly appear. Nor is it quite so certain that acute diseases have been multiplied, as chronic ones. Another fact deserves to be placed by the side of this; viz., that in those countries, or portions of country, where no physicians have ever been in vogue, and very little medicine beyond a few herbs, and roots, and incantations, or charms, the health of the people is quite as good, and the longevity quite as great, all other things being equal, as in those countries and places where physicians and medicine have obtained a strong foothold. There is no evidence that the want of physicians before the flood,--if such a want or deficiency there was, which appears probable,--had any influence in shortening human life, since Methuselah, who lived at the end of the series, was the oldest of all. Nor does it appear at all probable that there were more diseases, or more fatal ones, at that early period, than since. One thought more. It is confidently expected that a better day than the present is yet to dawn upon our dark world. Not only is it predicted that the child shall die a hundred years old, by the highest authority, and that men, like the oak tree, shall live several hundred years, but profane writers no less than prophets and sacred ones, have expected and still expect it. The better time coming is, as it were, in everybody's mouth. But, is it probable that this better day will dawn on a world which, in respect to health and longevity, is going in the other direction? While nearly half our children die under ten years of age, and the mortality is increasing, are we tending towards the point when a child shall die a hundred years old? And are our physicians and our medicines likely to bring us there? If not, and if a radical change is desirable, when is it to be made? Shall we wait till we have run down a century or two longer, or shall we begin the work immediately? And if we are to begin it at once, on whom shall the work devolve? These are questions, I grant, more easily asked than answered. Nevertheless, they must soon be met; they cannot much longer be shuffled off. Would it not be the part of wisdom to meet them now, rather than postpone? Here, then, I leave the subject. Let it be pondered in the light of reason, common sense, conscience, and, above all, the truth of God. Let there be no immature or hasty decisions. Truth, in truthful hands, has nothing to fear. CHAPTER CII. A LAST CHAPTER. William A. Alcott was born in Wolcott, Conn., August 6th, 1798. His father, a farmer in the rough mountain town, employed his son, as soon as he was old enough to be useful, in laboring on the farm, so that, from childhood, he was trained to habits of industry. His early employments were, in many respects, beneficial, and his feeble constitution was probably invigorated by this out-of-door work. The only apparent drawback was being kept at work too closely, with very little time left for amusement; and, as he was too conscientious to neglect the tasks assigned him, he plodded on, thus losing, in a great measure, while young, the natural and healthy relish of boys for athletic games and sports. As a natural consequence, his mind developed too rapidly. He early showed a great fondness for books, and the love of reading came to be his chief and almost only amusement. Till eight years of age he attended the district school, in summer and winter, but after this period his father employed him in farm labor constantly, except during the winter term. At the age of fourteen he had measles, from which he suffered greatly at the time, and in its consequences for several years. He grew rapidly, was, when a lad, tall and thin, and his strength, when young, and, indeed, through his whole life, lay chiefly in a strong will, combined with great energy and perseverance. To these qualities, doubtless, is owing the continuance of his life for many years. When little more than eighteen years of age, he commenced teaching, which was continued, during the winter, for several years; sometimes through the entire year. But a strong desire to improve and elevate the schools, led him to overtask himself. Mr. Barnard's _Journal of Education_, speaks thus of his labors at this period: "The severity of his exertions and self-denials, joined to other causes, especially a feeble constitution, brought on him a most violent attack of erysipelas, from the effects of which, though he escaped with his life, he never entirely recovered." About this time he commenced the study of medicine, and the succeeding winter, 1825-6, attended medical lectures in New Haven, not so much with the design of making it a profession, as with the hope that it might prove an aid in fitting him to become a more thorough teacher. The following March he received a license to practice medicine and surgery. But his health was far from being good, and he was, himself, more apprehensive of a fatal result, than consumptive people usually are. However, he soon found an opportunity to engage in teaching again, and embraced it eagerly. But here he was destined to disappointment. His pulmonary tendencies, which had for ten years been increasing upon him, aggravated, no doubt, by hard study and improper diet of the preceding winter, now became very alarming. Beside a severe cough and great emaciation, he was followed by hectic fever, and the most exhausting and discouraging perspirations. He fought bravely to the last moment, but was finally compelled to quit the field, and endeavor to regain his health. For a time, he followed the soundest medical advice he could obtain; kept quiet, took a little medicine, ate nutritious food, and when his strength would permit, breathed pure air. This course was at length changed, for one of greater activity and less stimulus. He abandoned medicine, adopted for a time the "starvation system," or nearly that, and threw himself, by such aids as he could obtain, into the fields and woods, and wandered among the hills and mountains. In autumn, he was able to perform light horticultural labors, a few hours of the day, and to ride on horseback. For six months he rode almost daily in company with a physician; at the end of which period he commenced the practice of medicine, in the place where he had last labored, and where he was born. After continuing in the practice a few years, and his health seeming to be restored, he ventured to return again to the work dearer to him than any other--that of teaching. But his labors seemed again to be slowly undermining his health, and, fearful of a relapse of the pulmonary tendencies, he abandoned for a time all hope of teaching permanently. The following year, he became connected with Rev. William C. Woodbridge, and continued to labor in the cause of education for several successive years. In Jan. 1833, he removed to Boston, and during the winter had a severe attack of bleeding at the lungs, and other dangerous symptoms. These, however, passed away; and the great change which, in 1830, had been made in his physical habits, seemed to be working one equally great in his constitutional tendencies. For while his labors were constant and often severe, there was a steady gain in health. The strength and elasticity of youth returned, and, to use his own words it was with him, now, "morning all day." The effects of an unfavorable climate, which he had feared, were apparently held in check, and he sometimes said that "Obedience gave him command over climate, in a great degree." Yet, during all these years when his health was apparently most firm, it was kept in this condition only by a rigid obedience to the laws of life and health, as he understood and expounded them. His precepts and practice were in harmony. In the spring of 1848, owing to some unusual exposure, a return of the cough and other symptoms of his old disease made their appearance.[N] But, with care, and light labor in the garden, they gradually passed away, and his usual measure of health returned, and continued, with slight interruptions, till 1855. During this year he was confined to his room several months with a broken limb. The change, at his age, from exercise daily in the open air, to confinement without exercise nearly all winter, was very unfavorable, in its results, to his general health. The lungs, doubtless, suffered greatly, and were never able to resist, as before, the effects of exposure to sudden changes of temperature. Still he labored on from year to year, untiringly as ever, writing, lecturing, visiting schools, etc. During the last winter, his time was employed more exclusively in reading and writing, and he went out less than usual. His lungs were weak and very easily affected. A difficulty of breathing after much exertion was frequent. His feet and ankles were often much swollen, and there was a loss of strength and general debility quite new to him. These indications were not to be mistaken, and in the retirement of his own home he often spoke of the possibility and even probability, that his earthly labors were drawing to a close. On the 18th of March, he left home to be absent a few days, partly with the hope that being more in the open air might prove beneficial. On Friday of the following week, though scarcely able to be moved, he was brought home, having been prostrated by what appeared to be a violent attack of pleurisy, which terminated his earthly existence, on Tuesday, March 28, 1859. In many minds the question will naturally arise: What should induce such an apparently violent disease, in a person who so rigidly obeyed the laws of health? A satisfactory answer to this can be given only by supposing the acute disease to have been merely a finishing up or termination of that disease which for years had been held in check. His own views on the subject were in accordance with this conclusion, and the condition of the lungs, as shown by a post mortem examination, served to confirm it. The amount of disease found in the lungs was so great that the examination could not be as careful and satisfactory as would have been desirable. The hand that wrote this volume, and that would have drawn important lessons from this page of life, now moulders in the dust. To the reader it is left to gather from it instruction and motive and courage, for a like battle against evil, for a like victory over self, until he, too, shall accomplish his mission upon earth. FOOTNOTES: [N] See Chapter LXIX. 
58454	----	_REMINISCENCES OF A WORKHOUSE MEDICAL OFFICER._ [Illustration: Logo] JOSEPH ROGERS, M.D. _REMINISCENCES OF A WORKHOUSE MEDICAL OFFICER_ EDITED, WITH A PREFACE BY PROF. THOROLD ROGERS London T. FISHER UNWIN 26 PATERNOSTER SQUARE MDCCCLXXXIX PREFACE. The author of the brief narrative which I have edited, and have seen through the Press, passed away before the printing of his work was completed. What he wrote was composed under the presence of a mortal disease, the issue of which he clearly foresaw. But he was unwilling to quit life without leaving behind him some record of the evils with which he grappled, of the obstacles which he had to encounter, and of the changes which he strove to effect. He might indeed, and with the acquiescence of the profession which he honoured, have claimed the credit of those great reforms in the treatment of the sick poor, and in the status of his professional brethren, to which the labours of his life were directed; but he has preferred to give a narrative of his experiences, and to leave his reputation to the members of the great and beneficent calling which he followed, and to those among the public who were cognizant of his zeal and perseverance. My late brother was the descendant of three generations of medical practitioners, who, from the first quarter of the eighteenth century, plied the art of tending and healing the sick down to the last quarter of the nineteenth, for his elder brother relinquished his practice only about ten or a dozen years ago. And this was in the same locality. But soon after my brother Joseph was qualified he went to London; and very speedily after he came to London he began the labour of his life--the reform, namely, of the medical relief accorded to the indigent poor. To this he surrendered the prospects of professional success and fortune--prospects which his professional abilities might have made certainties; for this he sacrificed popularity, health, and all that a vigorous constitution might have assured to him. He literally wore himself out by his labours. It is infinitely more difficult for a medical practitioner to urge necessary but unpopular reforms than it is for any other professional person to do so. The physician believes that he can succeed only by raising no prejudice against himself. He is always tempted to be neutral, when partizanship may seem likely to imperil his interests. There are no safe prizes to be won in the one profession which every one allows to be beneficent, whatever may be thought of other professions. By a code of honour which is rigidly adhered to, the process of a physician's treatment cannot be kept to himself. By an equally rigid rule, the confidences reposed in him are as sacred as the secrets of the confessional. It is no easy matter to win position and fortune in a calling which is regulated by the strictest rules of professional honour. It seems easy to imperil the most carefully acquired reputation by running counter to obstinacy and prejudice. A medical man has every motive to avoid hostile criticism. If he determines on doing that which is unpopular, the risks which he runs are far greater than those of any other person. Now all this was encountered by my brother's action, and he never was allowed to forget that he had to encounter it. He had to reckon with sordid London vestrymen, perhaps the worst class of men with whom honest people have to deal, and with the officials of the Poor Law Board, who were determined, as far as possible, with rare exceptions, to shirk all responsibility. In the pages of this volume he shows plainly what were the obstacles to his endeavours. As might be expected from an honest man, who never counted the odds against him when he was convinced that he was in the right, his original manuscript commented, with no little indignation, on the persons who thwarted his efforts, and would have baffled his ends. But it is entirely superfluous to stigmatize such people; and I have excised these just but unnecessary judgments. It is sufficient that the reappearance of such persons has been made improbable, if not impossible. The new Poor Law of 1834 was probably a necessary measure; but it was suddenly and frightfully harsh. The Whigs carried it, in deference to a particular school of economists, now happily, I trust, extinct. It was exceedingly and reasonably unpopular. The working classes had been impoverished in the country by the enclosure of the common lands, and in both town and country by restraints on the right of combination with the object of raising wages. But they had always been assured that the maintenance of the poor was a first charge on the land, and that it must be satisfied, and should be, before the profit of the enclosure should accrue to the landlord. When the plunder was completed the other side of the bargain was repudiated, and the easy-going system of the old method of parochial relief was abandoned for the new and severe provisions of the new departure. I am old enough to remember the indignation which the change aroused. I am sure that indignation and resentment against the new Poor Law had a good deal to do with the political reverses of 1841, and the entire destruction of the popularity which the Whigs had achieved by the Reform Act of 1832. It is true that the Act established a central authority which should control the action of the new Boards of Guardians. But these persons were by no means willing to check the machinery which they had erected. If the legislation of 1834 was distasteful to the country, they were resolved to limit their responsibility to the change which they had themselves made in the law, and to avoid further odium. The case of the permanent officials, who are really the departments of state, was much simpler. They wished to earn their salaries with as little trouble as possible, just as they wish now, and always will wish. To importunately call attention to the cruelties practised under the new system was to diminish their ease, to give them trouble, and such action must be resented and discouraged. In my personal experience of the permanent staff of the Poor Law Board I have met with officials who were persistently resolved not to give themselves, if they could help it, the trouble to rectify evils which were brought before their notice by the Board of Guardians to which I belonged, if they could in any way find a dilatory plea. Of course a reformer is always odious to a large number of persons. There are people who profit by the abuse or malpractice which he tries to remove, and such persons are naturally indignant at his meddlesomeness. There are others who acquiesce in the existing state of things from sheer indolence, and are impatient only at being disturbed. There are others who hold that all reforms cost money, and are alarmed at the expense which they may incur; while the fact is that all reforms which are wise and true save money in the end and diminish cost. To build a proper hospital for the sick poor, to supply it with properly qualified nurses, and sufficiently paid medical officers, one must incur initial expense, which is in the end constantly overpaid by eventual economies. My late brother constantly predicted that the changes which he counselled would relieve the rates in the end, and his prediction was constantly verified. The reader will find these facts illustrated in the pages which follow. A genuine reform is a sensible saving. But even if this result did not follow, the system which he found and attacked was a scandal to humanity and a dishonour to civilization. The London vestrymen did not see this; but Londoners have found out at last that the average vestryman is unteachable and incurable. The courage which will attack abuses such as were found in those workhouses near forty years ago is rare indeed. The person who undertakes the unpopular task has to come to close quarters with such Guardians of the Poor as are described below, and such government officials as are resolved to wink at abuses. Not but that, even in the worst days, the Poor Law Board and the Local Government Board were of great public service. They could be squeezed in Parliament. A judicious and temperate question has often discomfited the most corrupt official, and stirred the most lethargic. I am pretty sure that nearly all the reforms which have been achieved in the administration of the law for the relief of the poor, have been derived from persistent questioning in the House of Commons. Much indeed remains to be done, but much has been done; and my brother was exceedingly fortunate during his lifelong efforts in the advocates which he obtained among Members of the House. It must not be forgotten that a medical reformer is apt at first to be unpopular with his brethren, or at least to be discouraged by them. The more fortunate members of the profession are apt to feel a serene indifference to the purposes which he avows. I do not think that the reform of those evils with which my brother concerned himself has had much assistance from the more wealthy and influential among the physicians. As Arnold said, contemptuously and justly, of Isaac Walton, that "he fished through the civil wars," so these good people held, as a rule, severely aloof from the struggle. To the poorer members of the profession, who had to make every effort for a livelihood, and were constrained to give their services for nominal sums in order to get a status in their calling, it seemed more practical to get them better pay and not to give offence. In the end this was part of the result of my brother's labours. He was able to assert, towards the close of his active career, that he had added £18,000 a year to the incomes of the Poor Law medical officers in the Metropolis, and to allege that the change, with others, had saved ten times that amount in the Metropolitan rates. I am convinced--having once been a Guardian of the Poor in the city where I live--that the adoption of the policy which he recommended has effected a still greater saving. The first reform which my brother undertook, persevered in, and speedily saw achieved, was the prohibition of intramural interment. He had good reason to make efforts in this direction, for he had abundant evidence of what came from the old practice in the experience of his profession. Most of the Metropolitan clergy were very hostile to this reform, and for obvious reasons. But it came gradually, finally, and thoroughly. The present generation in London has a very inadequate conception of the abominations, in the midst of which their fathers and mothers lived, and not a few of them were born. The abandonment of intramural interment, and the drainage of London, imperfect as the latter is, have turned one of the unhealthiest cities in the civilized world into one of the healthiest. One of the first churchyards closed was that of St. Anne's, Soho, the parish in which my brother lived for many years. His next efforts were directed towards obtaining a mortuary in the parish. Every one admits how serious are the evils of overcrowding, and how difficult a problem it is to supply the London poor with decent homes at moderate rents. A century ago, as I know very well, house-rent, even in London, took a small part of the workman's scanty earnings; now his earnings are sometimes very little better than they were a century ago, and his rent absorbs from a fourth to a half of what he earns in poorly paid labour. At best his home is crowded and unhealthy enough, but when death occurs in the family the condition of things is intolerable. It cost my brother three or four years of incessant effort and pleading to obtain this concession from the Vestry of St. Anne, and for a long time this was the only London parish which made this necessary provision. The next mischief which he attacked was the window tax. His experience as a physician proved to him that lack of light and air intensified disease and rendered recovery difficult. There was a plea for the window tax. It seemed to bring a fair charge on large houses, which an assessed tax notoriously does not. In assailing the tax his principal helper was Lord Duncan, at that time one of the Metropolitan Members. The tax went at last in 1851. The repeal of this tax took nearly twenty years' agitation, the first physician who attacked it on sanitary grounds having been Dr. Southwood Smith. My brother commenced his practice in London in 1844. In 1855 there was a serious visitation of cholera in St. Anne's, Soho, and he became a supernumerary medical officer in the district. Cholera had a very serious effect on his private practice, as he states himself, and nearly twelve years after he had taken up his abode in London, he concluded to become a candidate for the function of medical officer to the Strand Workhouse. He was to receive a stipend of £50 a year, and find all medicines for the sick. It may be doubted whether he knew what he was undertaking: certainly they who appointed him and the officials who confirmed his appointment at the Poor Law Board had no conception of what they were doing. The character of his duties, and a description of the place in which he had to perform these duties is to be found at the commencement of his narrative. For its condition it is hard to decide whether the Guardians of the time, or the central authority were most to blame. The Strand appointment was the beginning of those systematic labours on behalf of the sick poor and the medical profession which thenceforward became the principal business of his life, to which he sacrificed such leisure as he had, health, and money which he could ill spare. He gave also what was more important--undaunted courage, and accurate information. Thus in 1861 he gave evidence before a Select Committee of the House of Commons, on the subject of the supply of drugs in Workhouse infirmaries, such a supply being as essentially part of the Guardians' duty as the purchase of food and clothing are. His views were adopted by the Committee and pressed on the Department. What he advocated was the germ of the Workhouse infirmary. During the last few months of his life he lived at Hampstead, in the hope that the air might help him. At the back of his new home there was built one of those great hospitals for the sick poor which it was the principal aim of his labours to render general, and to see constructed in such a way as would give the fairest prospect of recovery for the patients who were treated in them. The practice of the Poor Law Board at this time was to assert on paper the supremacy of the medical officer in his own department, to give him no personal support when he did his duty, to visit on his head all the consequences of their own negligence or dilatoriness, and, right or wrong, to support the Guardians when they took offence at conscientiousness and zeal. Now, in 1865, a scandalous case of neglect led to an inquest, to an exposure of the facts, and to very severe comments by the Press. Shortly afterwards the proprietors of _The Lancet_ newspaper--a medical journal which has, during a very long career, been distinguished alike for its zeal in maintaining the honour of the medical profession and for its advocacy of humanity in dealing with the sick and destitute poor--resolved on investigating the condition of the London workhouses and their hospitals. Among other places, Dr. Anstie visited the Strand Workhouse, in Cleveland Street, and made his own report on what he saw in the columns of the paper which he represented. The report was candid, graphic, and by no means flattering to the Guardians, to their management, and to their officials. But it was entirely accurate, for the Strand Union and its Guardians at that time were probably the worst examples of a thoroughly bad and vicious system. Of course the Guardians were as angry as they could have been if they had been known for the best of characters and motives and had been grossly defamed. The time was plainly come for concerted action, and one of the Strand Guardians, a Mr. Storr, a gentleman of very different character from most of his colleagues, convened a meeting at his own offices, in order to discuss the situation. It was at first suggested to call a public meeting; but my brother pointed out that even if the meeting were a success its effect would be ephemeral. It was determined, therefore, to create an association under the title of the Workhouse Infirmaries' Association, Mr. Storr offering to find £100 towards its preliminary expenses. But his generous offer was not needed. As soon as it was known that the Association was in process of formation, names and money poured in upon the scheme. New evidence about the Strand Union came out, and was forwarded to Mr. Charles Villiers, then President of the Board. An inquiry was held, and, as usual, the permanent officials strove to throw the blame on the medical officers, and to exonerate the Guardians. Now, to counteract this, my brother called a meeting of all the Workhouse medical officers in London. The object of this meeting was the formation of an Association for the protection of the character and interests of these officials, and for supplying information to the public as to the manner in which their best efforts were hampered and thwarted. This was the nucleus of the Poor Law Medical Officers' Association, an organization which has extended itself to the three kingdoms. Of this my brother was, as long as his health allowed, the president and principal administrator. In 1867 Mr. Gathorne Hardy, now Lord Cranbrook, was President of the Poor Law Board, and in this capacity introduced the Metropolitan Poor Bill, some of the provisions of which were the establishment of Workhouse hospitals and dispensaries, and the supply of all medicines and medical appliances at the charge of the Guardians. The President frankly acknowledged that he owed much of the information which he had acquired from my brother. It was unfortunate that the provisions of the Act were not made general, throughout England at least. But London at last got an instalment of Poor Law Reform, and on rational lines. The administration of the Poor Law is far from perfect; but the best part of it is that of the sick poor. Even here officials for a long time obstructed the will of the legislature and the objects of the law, but, on paper at least, the ancient abominations described in the earlier part of my brother's reminiscences were swept away. In the eyes of the Strand Guardians, or rather of a majority among them, his offences on behalf of justice and humanity were unpardonable. He had to be got rid of. In this the officials of the Poor Law Board, then under Lord Devon, agreed with the Guardians. The Guardians picked a quarrel with him, the Poor Law Board instituted an inquiry, and apparently instructed their Inspector as to what he should report, and the President gave solemnity to the farce by removing him from his office. The ground on which he was dismissed was that "he could not get on with the Board of Guardians." Of course he could not. No man of sense, honour, humanity, decency, and conscientiousness, could get on with them, or, in those evil days, with the Poor Law Board either; for the President and his officials, perhaps unconsciously, leagued with the Guardians in the maltreatment and oppression of the poor. It is a common trait in mean and malignant natures to think, if they can injure in fortune or character an advocate of justice and right dealing, that they can arrest his efforts and discourage those of others. Many experiences will occur to those who have any knowledge of public affairs which will illustrate this policy and its failure. It always fails with such men as have any character at all. They disregard the loss or the insult, and redouble their efforts after the object which they have put before them. I do not remember that my brother ever dwelt with any peculiar acerbity on the circumstances of his dismissal; but he gave himself more than ever to the self-imposed task which became the business, and eventually the success, of his life. He spoke, indeed, with bitterness, and wrote with bitterness of the crew who had sought to injure him, but for the reason that they were prolonging the miseries of the poor, and for that reason only. Of course my brother had the sympathy of his profession and the support of the medical papers. But he resolved to perfect and extend the organization which he had founded. The result was the formation of the Poor Law Medical Officers' Association. In order to give strength and stability to this agency he visited most of the principal towns in England. He made several journeys to Ireland, the infirmary system of which he highly commended, and went once at least to Scotland, where indeed reform was greatly needed. And in these places he inculcated the important truth, that where medical relief was abundantly and generously accorded by the Guardians, pauperism decreased and rates were lessened. In my frequent communications with him, I urged him to insist on this as a matter of principle and a matter of fact. Generous relief to the poor, if it be discriminating and founded on a few intelligible rules, is the truest economy in the end. Owing to his efforts, many towns voluntarily adopted the principle of the Metropolitan Act, and with the best results. In the earlier years of his campaign he obtained great assistance in Parliament from the late Dr. Brady, Member for Leitrim, and from Dr. Lush, Member for Salisbury. Four years after his expulsion from office in the Strand Union, he was elected to a similar office in the Westminster Union. His career here was not one of incessant and unavailing remonstrance. The Poor Law Board, subsequently the Local Government Board, began to awake to a sense of its duties, and to see, though reluctantly and haltingly, that Boards of Guardians sometimes need supervision. But soon his troubles recommenced. The inferior officials were harsh, violent, and dishonest, and they were abetted by a majority of the Guardians. The inevitable consequences followed. My brother undertook the cause of the poor, and the Guardians and their tools or accomplices turned on him. They tried their old trick of suspending him, in hopes that the Poor Law or Local Government Board would endorse their ruling. My brother employed his enforced leisure in extending the organization which he had founded. In due course he was reinstated by the Department, and his enemies were baffled. The mismanagement of the Workhouse by these Guardians, and the outrageous misconduct of the master, at length roused the wrath of the ratepayers. An influential committee was formed, which recommended a new list of Guardians to the electors, and the whole of the old gang were ejected from office by overwhelming majorities. I have reason to know that the atrocities perpetrated by the master roused the anger, and secured the unobtrusive but effective co-operation of a very exalted personage. The resentment which affected this total change was not the act of one section of society or of one party only, and it is just to say that my brother had the assistance of eminent persons in both political parties. I mention this the rather, because my brother made no secret of his political opinions, and never omitted any opportunity of inculcating them. He belonged, as all his brothers did, to the advanced Liberal party. During the remainder of his active life he was in perfect accord with the Board of Guardians. He had the good fortune to see that what he had laboured for, and had been persecuted for, was now acknowledged to be humane, politic, and economical. He even had the opportunity of checking reckless and unwise expenditure. He had done great services to the poor, though his clients were unable to express more than their personal gratitude to him. He had recognized and secured the co-operation of some among those excellent women who have worked so energetically and unobtrusively on behalf of the poor destitute. He had done great services to his own profession, and had secured them a little of their due; for, I repeat, there is no class of persons who do so much, from whom so much is expected, and who are more scantily remunerated than medical practitioners among the poor. Some of these practitioners in 1884 determined to offer him some recognition of his lifelong services. There was nothing in his whole career which he dwelt on with more satisfaction than on the rout of the Westminster Guardians, in 1883, and on the testimonial of 1884. Two years afterwards he was attacked by heart disease, and became conscious of the organic mischief against which his naturally strong constitution struggled for nearly three years. His incessant labours had literally worn him out. His disease rapidly increased on him, and with great pain and effort he wrote out, in the intervals of his trying disorder, the reminiscences which follow. Had he been in better physical health, they would have no doubt been fuller, for his memory was exact and tenacious. That which is printed will show what manner of man he was. But it will be seen that he dwells but little on his own unwearied labours. During his sickness he was attended by many physicians who knew him and valued him: chief and most untiring among them was Dr. Bristow. I can say, without consciousness of partiality, that my brother's life was one of incessant devotion to a noble object. They for whom he laboured were the poor and helpless; who could make him no recompense, could, perhaps, hardly understand his purposes. He was met by obstacles which would have daunted a less resolute man; but he was sustained by the rectitude of his aims, and by a firm belief in their wisdom. Such men change the face of the world, as far as their own sphere goes. Their reward is generally the approval of their own consciences, and sometimes evidence accorded in their lifetime as to what has been the fruit of their labours. Thousands of our fellow-countrymen have been saved from suffering and misery by the lifework of Joseph Rogers. JAMES E. THOROLD ROGERS. OXFORD, _April 10_. CONTENTS. CHAPTER I. PAGE THE STRAND 1 CHAPTER II. THE WESTMINSTER INFIRMARY 104 RECOGNITION 224 TESTIMONIAL TO DR. JOSEPH ROGERS 231 CONCLUSION 241 REMINISCENCES OF A WORKHOUSE MEDICAL OFFICER. CHAPTER I. THE STRAND. In the latter part of the summer of 1854 I was living in Soho, where I had been engaged in general practice for some ten years, and where, by dint of laborious attention to my profession, I had secured a sufficiency on which to live, when I became aware that an outbreak of Asiatic cholera might be looked for. Some suspicious cases had appeared, when, towards the end of the month of August, there was suddenly developed an epidemic outbreak of such virulence and extent that it became necessary for immediate action to be taken, if this fell disease was to be effectually dealt with. Having taken an active part for some years previously in sundry sanitary measures, I was requested by the parochial authorities of St. Anne's, Soho, to take charge of one of the districts into which the parish was at once divided. During the busiest of those very busy days, a medical friend and neighbour called on me, and in answer to my remark that I was too busy to talk to him, replied, "You are busy now, but you will live to regret this outbreak in Soho. It will ruin the neighbourhood and your practice for many years to come, for the public will believe that it is too unhealthy to live in, and ere long you will have nothing to do." This casual prediction was amply verified in the following year by the death of many inhabitants, and by the removal of others. As was the case with others in other callings, I had to commence the world afresh. When casting about for the best course to follow, the medical officership of the Strand Workhouse, Cleveland Street, and of the parish of St. Anne's, Soho, fell vacant. The person who held the appointment proposed to resign in favour of his son, and I was strongly urged to compete for it. I elected to try my chance, and, after a severe contest, was selected. Here I began my experiences of the sick poor, which lasted, with a very brief interval, for thirty years. My first impressions were not very exhilarating, and could I have foreseen all that was in store for me, I question whether I should have applied for the appointment at all, but, having been appointed, I resolved to try it for a time at least. The Strand Workhouse in the year 1856 was a square four-storied building fronting the street, with two wings of similar elevation projecting eastwards from each corner. Across the irregularly-paved yard in the rear was a two-storied lean-to building, with windows in the front only, used as a day and night ward for infirm women. There were sheds on each side for the reception of so-called male and female able-bodied people, whilst in the yard, on each side of the entrance gate, was a two-storied building, with an underground apartment lighted by a single window, and with a door for the reception of male and female casual paupers; the wards above being for those of both sexes admitted to the house. The necessary laundry work of the establishment, which never in my time fell below five hundred inmates, was carried on in the cellar beneath the entrance hall and the general dining-room, whence it came to pass that the said hall, &c., was for four days in each week filled with steam and the odours from washing the paupers' linen. A chapel was contrived out of one of the male infirm wards on the ground floor on the Sunday, and utilized on that occasion for both sexes. On the left of the entrance hall was the Board-room; the corresponding apartment on the right, and the room above on the first floor, being the apartments of the master and matron. On the right side of the main building was a badly paved yard, which led down to the back entrance from Charlotte Street; on each side of this back entrance there was--first, a carpenter's shop and a dead-house, and secondly, opposite to it, a tinker's shop with a forge and unceiled roof. This latter communicated with a ward with two beds in it, used for fever and foul cases, only a lath and plaster partition about eight feet high separating it from the tinker's shop. There were no paid nurses. Such nursing as we had, and continued to have for the first nine years I was there, was performed by more or less infirm paupers, with the occasional aid of some strong young woman who had been admitted temporarily and was on pass. Unfortunately it frequently happened that just as she was becoming useful she left, and there was nothing for it but to fall back upon the ordinary broken-down inmates, the selection of whom did not rest with me, but with the master or the matron, or both. Just outside the male wards of the House, at the upper end of the yard, there were two upright posts and a cross-bar. On this bar were suspended the carpets taken in to beat by the so-called able-bodied inmates, from whose labour the Guardians derived a clear income of £400 a year. In despite of the continued noise and dust caused by this beating, the Guardians persisted in carrying it on for ten of the twelve years that I was there. The noise was so great that it effectually deprived the sick of all chance of sleep, whilst the dust was so thick that to open the windows was entirely out of the question until the day's work was over. I attempted repeatedly to get this nuisance done away with, but so fierce was the antagonism of the majority of the Board that I had to abandon it. The male insane ward, used also for epileptics and imbeciles, was on the right wing above the male casual and reception ward. To reach it you had to go up some four steps; it was absurdly unsuitable for such cases, and when I had lunatic and imbecile there together I was always in dread lest some horrid catastrophe might happen. One case of an epileptic was to me the cause of much anxiety, for he was wholly unaware when his fits were coming on. When a seizure occurred he always sprang up and then dashed himself to the ground on his forehead and face. He contrived by these means to smash his nose, make dreadfully disfiguring wounds on his forehead and face, and from a good-looking, became a perfectly repulsive-looking person. Poor fellow! I tried all sorts of expedients to prevent his doing himself any further injury, but though he constantly wore a stuffed helmet, he sometimes managed to injure himself. I got him away at last, but I had two or three years of him, during which time I had a very extensive surgical experience from his case alone. I was constantly stitching up his wounds. The female insane ward was a rather large room, and was situated over the Board-room. As we always had the place full the space was desirable or necessary. It was immediately beneath the lying-in ward. When we had a troublesome or noisy lunatic in the ward, it must have been anything but a comfort to the lying-in women above, but then neither their interests, nor the feelings of any of the other inmates, were at that time officially considered by the Guardians, by the Poor Law Inspectors, nor by any one else. To be allowed to remain in the House and get waited on somehow was all that was looked for by these truly wretched women. The master of the House, a certain George Catch, since deceased, had been a common policeman in Clare Market, where he had made himself useful to the Chairman of the Board, who was the proprietor of an _à-la-mode_ beef shop in that locality. Through this Chairman's influence he became the porter of the Workhouse, and the master falling sick, he had performed his duty for him. The illness ending fatally, through the same influence Catch was promoted to the vacant office, though, at the time I first knew him, he was so ignorant that he could only write his name with difficulty. He was single on his appointment, but an alliance with the late master's niece, who had acted as matron for some time, was talked about on my taking office. As this official, Mr. G. Catch, appointed with the sanction of Mr. H. Fleming, some time Permanent Secretary of the Poor Law Board, played an important part in bringing the Department into deserved contempt, I must hereafter again refer to him. On the morning of my entering on my duties I went over the sick ward with the son of my predecessor. My curiosity was excited by sundry ill-shaped bottles, all of which contained the same description of so-called medicine. The salary did not admit of an extensive variety of medical necessaries, as it was only fifty pounds a year, out of which all drugs were to be found. It is true that this stipend was supplemented by an occasional fee from attendance on parturient women, in cases where difficulty or danger arose, or in any illness which took place prior to the ninth day after the confinement. That fee was limited to twenty shillings only. The decision as to the necessity for such attendance was vested in the midwife or matron, and until that was given the medical officer was interdicted from entering the lying-in wards. This regulation was in direct contravention of the Poor Law Regulations, but then the Department were very unwilling at that time to interfere with the so-called discretion of the Guardians, however much their regulations were disregarded. I have stated that the Chairman of the Board was the proprietor of an _à-la-mode_ beef shop. During my first year of office this dignitary would often come to the House on Sunday morning dressed in the dirty, greasy jacket in which he had been serving _à-la-mode_ beef the night before, and unshaven and unshorn, he would go into the chapel with the pauper inmates, and afterwards go to the Board-room, and have breakfast with the master and matron. Of course, between the three, there was an excellent understanding, and during this Chairman's reign all alterations for the better were resisted. I have before stated that all my nurses were pauper inmates. The responsible duties they had to perform were remunerated by an amended dietary and a pint of beer. Occasionally for laying out the dead, and for other specially repulsive duties, they had a glass of gin. This was given by the master or matron, but I was expected to sanction the supply. I have referred to the ward used for foul cases, which was in immediate proximity to the tinker's shop. It was altogether unsuitable for the reception of any human being, however degraded he might be; but it had to be used. I remember a poor wretch being admitted with frost-bitten feet, which speedily mortified, rendering the atmosphere of the ward and shop frightfully offensive. At first I was at a loss to know whom to get to go through the offensive duty of waiting on him. At last a little fellow, called Wiseman, undertook the task, the bribe being two pints of beer and some gin daily, with steaks or chops for dinner. Presently the patient was seized with tetanus, and after the most fearful sufferings died. He was followed almost immediately afterwards by poor Wiseman, who had contracted from his patient one of the most malignant forms of blood poisoning that I ever saw. These two successive deaths took place whilst the tinker was plying his business on the other side of the partition which separated this ward from his smithy. This place was an utter disgrace to the Board, but they never attempted to alter it whilst I was there. I have referred also to the nursery ward. This place was situated on the third floor, opposite to the lying-in ward. It was a wretchedly damp and miserable room, nearly always overcrowded with young mothers and their infant children. That death relieved these young women of their illegitimate offspring was only what was to be expected, and that frequently the mothers followed in the same direction was only too true. I used to dread to go into this ward, it was so depressing. Scores and scores of distinctly preventible deaths of both mothers and children took place during my continuance in office through their being located in this horrible den. It frequently happened that some casual was admitted with her child, or children, to the room below the female receiving ward. On my visiting the House next day I would find that her child had got an attack of measles and could not go out; and in spite of my sending the mother and child to the children's infectious ward above, measles always broke out in the nursery some eleven days after, and I have had as many as twenty down with it at a time. I will not horrify my readers by stating the proportion of deaths to recoveries, but content myself with stating that the latter were very few. What made these continuous outbreaks so vexatious was this, that I had laid down the most stringent regulations as regards isolation and disinfection; but unfortunately my orders could only be given to pauper women. I had no other persons to act with, and with that habitual carelessness which had led to their becoming paupers, they only in exceptional instances paid any attention to what I said. Now and then a decent widow with an infant came in, and became an inmate of the nursery ward, there being no other place for her to go to. What her feelings must have been when forced into day and night companionship with some of the most abandoned of her own sex in this miserable Gehenna, I will not attempt to portray, and yet the majority of the Board looked upon this den as a perfect paradise, and looked on me as an irreconcilable fellow for troubling them with my complaints respecting it. I had not been the medical officer for many months before I found that my pauper nurses were frequently under the influence of drink, and that, too, in the forenoon. On inquiring, I heard to my surprise that the master was in the habit of giving out the stimulants at 7 a.m., and, as many of the inmates sold their allowance, the nurses had become partly or wholly intoxicated when I reached the House in the morning. My first request to the master was that some other time should be selected for the issue of stimulants. Such request was angrily refused, and it was not until I had appealed to the Board that I succeeded in effecting an alteration, but my success made the master, henceforward, my determined foe. As I have stated, the medical officer's salary was intended to cover the provision of medicine. The Guardians, however, had supplied my predecessor with linseed-meal and mustard, but finding that I had a great many consumptive and bronchitic patients, I was induced to apply to the Guardians for some linseed, to enable me to give the patients some linseed tea. Now there was one nurse in the female sick ward, by name Charlotte Massingham, who had been in supreme authority there some years. She was nearly always muddled; to work with her was impossible; Charlotte invariably treated me with supreme indifference, not unmingled with undisguised contempt. I had introduced new-fangled notions, would have my medicines correctly given, and the patients well attended to. On hearing that my application for the linseed had met with success, I went up to the Workhouse. On going into the female sick ward I told Charlotte of my having gained the assent of the Board, when, suddenly springing up at least a foot, she came down slapping both sides, with her arms on to the ground, with the startling observation, "My God! linseed tea in a workhouse!" Charlotte's reign, however, was not of long continuance after this; she died, worn out by the effects of habitual intemperance. I heard, after she was dead, and the inmates were free to speak, that she systematically stole the wine and brandy from the sick. It was obvious that one of the first points to secure was the removal of the laundry before referred to, situated in the cellar beneath the dining hall. The Guardians having assented to my suggestions, a contract was entered into with the builder to put up a laundry in the back yard. The structure was to cost some £400. On proceeding to dig out the foundation, the workmen came on a number of skeletons, the yard having been originally the poor burial ground of St. Paul's, Covent Garden, for which parish the Workhouse, &c., had been built, and had been rented by the Guardians from that parish when the Strand Union was formed. So full was this yard of human remains, that the contractor was compelled to go down twenty feet all round, before a foundation for the laundry could be obtained. In making this huge trench, they disinterred the remains of the poor Italian boy, murdered by Bishop and Williams, whose murder was discovered by the late Mr. Partridge of King's College Hospital, to whom Bishop and Williams had sold their victim for anatomical purposes. Similar murders of the same kind in Edinburgh, led to the passing of the Anatomy Act, and to the suppression of the practice of body-snatching by the abandoned wretches who formerly supplied Schools of Anatomy with subjects. My next endeavour was an enlargement of the cellar at each wing so as to secure better accommodation for the reception of casual poor, and increased space for sick children and others. This was accomplished by nearly re-building the wings. Unfortunately these suggestions rendered me extremely unpopular with many of the Guardians, and delayed for some two years any increase of my wretched stipend, which would otherwise have been granted, if I could have remained a passive observer of that which I saw around me. But worse was in store. My first serious quarrel with the Board happened thus. Many of the young women who came in to be confined, came under treatment afterwards, suffering from extreme exhaustion, and some were hopelessly consumptive. On making inquiry, I found that the practice in the lying-in ward was to keep the single women on a dietary of gruel for nine days, and then, at the end of a fortnight, to dismiss them to the nursery ward on House diet, with their children. Assuming, as I had a perfect right to do, that this dietary had emanated from an order of the Poor Law Board, I wrote to the Department telling what I had observed, and asking that Board's permission to introduce a more generous system. My communication was sent to the Guardians, and I was informed in a letter from the Board at Whitehall that it rested with me exclusively to order whatever form of dietary I chose, a power which I did not hesitate to use. The Board of Guardians condemned my conduct in writing to the Poor Law Board, in the strongest possible terms, and the use I had made of the power vested in me. The course taken by me was held to be in the highest degree reprehensible, as it traversed the deliberate action of the Guardians, who had established the starvation dietary for single parturient women, as a deterrent against the use of the Workhouse as a place in which to be confined. As the number of fresh admissions went on increasing, and I had not sufficient accommodation, I recommended that the side wings should be enlarged by carrying the building up a storey higher. This was done, and the pressure put on the accommodation was met for a time, but all these suggestions increased my unpopularity with certain of the Board, who condemned me for the expense I was putting them to. About this time the annoyance and obstruction I met with from the master and matron compelled me to apply to the Inspector for support. He came to the House to make inquiry, but so large a number of the Guardians attended to support the master, that after a few questions had been put, he closed the inquiry. Some years after he expressed to me his regret that at that time he could not see his way to aid me. At the end of the first year some business took me to Scotland. The Board sanctioned my absence, and gave their approval of the gentleman who was to act as my substitute. On my return journey by the night train, on getting out at Peterborough at 6 a.m. to get some coffee, I was surprised to see the master of the Workhouse and the clerk of the Board standing on the platform. On reaching King's Cross I remained in the carriage till all the passengers had alighted and had passed me. I was in doubt whether I had been deceived, but I had not been, for presently the pair passed the carriage, each carrying a small bag. About ten days after, a letter was sent from the Board, asking for an explanation of an alleged neglect of a sick person in the House. I forthwith called on my substitute and showed him the letter. He denied in the most positive terms the allegation of neglect. On visiting the House, no information could be gained from any one, but it occurred to me on leaving to ask the porter whether he could throw any light on the matter. After reading the clerk's letter he made the remark, "Why, Catch was not in the House at the time he alleges the neglect took place, for he and the clerk went down to Peterborough from the Thursday to the Monday morning, to be entertained by the contractor who put up the laundry boiler." In my defence, I stated this to the Board, when great was the indignation expressed by some of the Guardians; first, at his false charge of neglect, and secondly, that he and the clerk should have gone away without leave, and for their being entertained by the contractor. The exposure of course intensified this master's hostility, in which his friend the clerk cordially cooperated. The consequence to me was that I was continually sent for on most frivolous pretences. The messenger would come to my house and say, "You are wanted at Cleveland Street;" if I asked for what, he was studiously ignorant. If I went, or if I sent my assistant, Catch would keep us waiting in the hall until it suited his humour to come out to me, when in a loud voice he would say, "You are wanted in such and such a ward." Hard as this was to bear with from this ignorant and incompetent official, I put up with it for a time, but at last I again called on the Poor Law Inspector, and asked him his advice, when he informed me that the master was bound to send a written order, stating the name of the sick person, &c. On my having intimated to him that I should not again notice his calls unless this requirement was complied with, the annoyance was stopped--nearly all of these second visits having been wholly unnecessary, and arranged with the view of wearing me out. I have stated that, unless called on, either by the midwife, matron, or master, to visit a woman recently confined, I was debarred from attendance on her, and could not claim any fee. The master and clerk arranged that no order should be given until nine days had elapsed, when it was held that I was bound to take charge of the woman as in an ordinary case of illness. This calling one in on the morning of the tenth day was so frequently done that I saw that the thing was arranged, especially as I learned on inquiry that the woman had been ill for some days, and had asked that I should be sent for. I thereupon took on myself to visit the ward daily, and to judge for myself as to the necessity for my attendance. Some half-dozen of these cases occurred within three months. On sending notice to the clerk that I had visited such and such a case, I received the reply: "I have made inquiries and find that you attended without getting the necessary authority." This I afterwards learned was done without any authority from the Board. I therefore decided that I would give up going into this ward for the future. Some time after, and in pursuance of this man's policy of annoyance, a case occurred just as I expected, which enabled me to get rid of him. On going to the House one morning, the porter told me there was a woman ill in the lying-in ward. On going into my room the pauper attendant came and asked me to go to this ward. To the inquiry, "Who sent you?" "No one," she replied. I then said, "Go to the matron, or if you cannot find her, to the master, state that the woman is very ill, and bring me the authority to visit her." She went away. Some half-hour after, I went by the ward door, and heard this poor wretch's cries for assistance, but I did not visit her. Again the attendant came to me and implored me to go up. I asked, "Have you seen the master or matron?" "Yes," she said. "What did they say to you?" "Why, they only laughed." I again declined to visit the ward. Shortly after I left the House. I had hardly passed the gate when the master rushed into the hall and inquired whether I had left; on hearing I had done so, he said in a loud voice, "I have caught that damned doctor at last," and directed the porter to go for the nearest medical man. Some gentleman came and attended to her, and the bill, and a garbled statement of the facts, was sent by Catch to the Board. I was ordered to attend their next meeting and explain my conduct. I requested the attendance of the porter and of the pauper nurse at the Board's meeting. Catch gave his version of the story. When called on for my explanation, I narrated the course adopted by the master, the matron, and the clerk, and pointed out to the Guardians the evident intention of all three to prevent me being paid any fee; that in the case in question I had asked for an authority to visit the woman; that, although both of these officers knew of the poor woman's condition, they had maliciously allowed her to remain without proper attendance, and would not give any order, so that I should not be paid a fee. The defence was so complete, and so completely turned the tables on all three, that a severe censure was passed on the master and matron for their inhumanity, and a hint was given that they had better look out for some other appointment. This they did, and a vacancy for a master and matron having taken place at Newington Workhouse, Mr. and Mrs. Catch applied for the post, and, to the delight of all the inmates and officers of the Strand Workhouse, were selected. So intensely tyrannical and cruel had been the rule of this man, that the day he resigned the keys, and was leaving the House, the whole establishment--at least, all those who could leave their beds--rose in open rebellion, and with old kettles, shovels, penny trumpets, celebrated their departure from the premises. The incoming master subsequently told me that he had never witnessed anything like it in his life, and that the row was so general and spontaneous, that he was powerless to check it. Mr. Catch's subsequent career did not disappoint the expectations of those who were cognizant of his utter unfitness for so responsible a post. I shall refer to him again in a subsequent part of this narrative. Before I had been long in office, I became aware that there was a benevolent agency at work, conducted by some Christian ladies, whose mission it was to visit the wards, read to the sick and infirm, and generally to help them in the effort they might make in re-establishing themselves. At the head of this movement was Miss Louisa Twining, who has devoted years of her busy life to the amelioration of the lot of the workhouse sick; Lady Alderson, the widow of the late judge, her daughter, Miss Louisa; and, though last, by no means the least, Miss Augusta Clifford, were associated in this good work. It was to Miss Twining's initiative that the abolition of the system of entrusting the care of the sick poor to the numberless Sairey Gamps and Betsy Prigs was mainly due; but she did not succeed in her laudable efforts until after several years of incessant appeal to the Guardians of the Poor and the Poor Law Board. Ultimately her demand was conceded in deference to outraged public opinion. The efforts of Miss Clifford demand a special reference here. Very early in my official life she called on me and volunteered to help any deserving case brought to her notice. Over and over again did she put her hand in her pocket, and give money to inmates of her own sex, whose cases I called attention to. At last her good doing attracted the notice of the Board, who passed a very eulogistic resolution, in which they thanked her for her great kindness to their sick. Here let me remark that, although the majority of the Strand Board were wholly unfitted for any administrative duties, yet it would be ungrateful not to state that there were several kindly-disposed persons among them. They were generally, however, outvoted, though occasionally their suggestions for a milder and more generous _régime_ prevailed. Catch had hardly left the house when it was proposed to increase my stipend, at first to £75, ultimately to £100 a year; and I was also entrusted by the Board with the duty of certifying as to the lunacy of the inmates who were admittedly insane. This office had been filled for many years by a Dr. Beaman, of Henrietta Street, Covent Garden, in deference to a view recently revived by the present Lord Chancellor, in his hitherto abortive attempts to amend the Lunacy Laws, and was to the effect that it would be hazardous to entrust such a duty to the Workhouse medical officer, as he might be tempted to eke out his salary by certifying that healthy persons were mentally affected, so as to secure a fee. The injustice implied in this gratuitous imputation, having been brought before one of the Presidents of the Poor Law Board, he was induced to get the prohibition removed, and one of the results was that my friends at the Board carried a resolution that in future I should be the examining official, as I had all the trouble of the case, whilst a stranger pocketed the fee. Dr. Beaman was much annoyed at this; and as the relieving officer, who was a friend of Beaman's, persisted in sending all cases to Dr. Beaman, a collision was inevitable. A short while after, a lad was brought by the police, found wandering at large. I diagnosed that he was a homicidal lunatic, and that it was necessary that he should be sent away. The relieving officer having called in Dr. Beaman, he visited the House, examined the lad, and took him down to Bow Street, and deposed before the magistrate that he was of sound mind. He would have been discharged, but the police having testified to the very questionable condition in which he was on coming into their hands, the presiding magistrate directed that he should go back to the House for further observation. This was done, and I again saw and examined him, and gave a fresh certificate of his insanity. Dr. Beaman was again requested to attend; he, however, sent his partner, who also decided that the lad was not insane. He was again taken before a magistrate, with the result that he was ordered to be discharged. Thereupon Dr. Beaman wrote to the Poor Law Board complaining of the action of the Guardians in appointing an inexperienced young man as the examining medical officer, and stating that neither he nor his partner could discover any evidence of insanity in the case in question. A copy of this letter was sent to the Guardians, who directed the clerk to write to me for an explanation of my conduct. I was satisfied that I was right, but I had a great deal of trouble in tracing what had become of the boy. Ultimately I found his father, who informed me that the day he was discharged he came home and sat down to his dinner; after the meal was over, the father resumed his work, that of shoe mending, when his son, without saying a word, struck him a severe blow on the head with a hammer. The aid of the neighbours and of the police was invoked, and after a desperate struggle he was overpowered, handcuffed, taken before a magistrate, who sent him to Marylebone Workhouse, from which establishment he had been sent to Hanwell, where he had been some days. I sent a copy of my reply to the Guardians to the Poor Law Board. My judgment was never again called in question in cases of lunacy. I found this part of my duty an agreeable episode in my daily routine of all but thankless work. I also made the acquaintance of Sir Thomas Henry, Mr. Flowers, and Mr. Vaughan, and from all these magistrates received the greatest courtesy. Before I had long held office my attention was drawn to the marvellous zeal displayed by the Catholic priests, who, although unpaid, were untiring in their attendance on the sick poor of their persuasion, a large number of whom were always in the House. A somewhat ludicrous incident occurred about this time. There was a very old woman in the infirm ward, across the yard. She was stated to be ninety-five; she had been blind from childhood, and the balls of both eyes were gone, leaving nearly empty sockets. Although life under such circumstances was not very attractive, I never met with any one who so strongly objected to dying. She was constantly sending for me to prescribe for her imaginary ailments. One very cold night, when the snow was on the ground, and it was blowing strongly from the north-east, at about 11.30 my night-bell was rung violently. I had not gone to bed, and therefore answered the door, when I found a young Irishwoman, cowering in the recess of the doorway. On asking what she wanted, she replied, "Oh, if you please, sir, the Father has sent me over to ask whether Bridget Gaines is dying, as a messenger has just come from the House saying Bridget is going, and requesting the Father to go there at once. Now the Father has a bad cold, and his feet are in hot water, and he has a poultice on his chest, and he is afraid to go out as the night is so cold." I laughingly told her to go back and tell the Father that I thought Bridget was not near her end yet. On the following morning the priest called on me. He was very anxious about Bridget, and earnestly asked whether I had heard from the House. I told him there was no need for anxiety, when, in a deprecatory tone of voice, he said, "I should have gone after all, but Bridget has been very tiresome. Do you know," he said, "Bridget has had extreme unction administered nineteen times." I saw Bridget that morning, she was much in her usual condition; she lived a long time afterwards, and probably was anointed on a great many subsequent occasions. I was constantly encountering odd stories and odd people--many of them profligates who had seen better days. One person in particular attracted my attention, as he had evidently been a gentleman; indeed, he assured me that he had once a large estate in Yorkshire, and was Master of the Hounds. I had no reason to doubt him. He did not live very long after his admission to the sick ward. After his death I received from five different solicitors written requests for a copy of my death certificate. It was accompanied in each case by a fee of a guinea. This poor fellow had insured his life in five different offices, and had sold the policies. It will be seen that I shared in the pecuniary advantages that sprang from his death. The immediate successor of Mr. and Mrs. Catch did not stay very long. The matron's health broke down, and she had to resign. They were followed by Mr. and Mrs. Thorne, who remained master and matron until the death of the former some years afterwards. Mr. Thorne was a kind-hearted person, who had filled a position of responsibility in the parish of Marylebone; whilst Mrs. Thorne was a well-educated, ladylike woman. They managed the House well, and treated the inmates with kindness and consideration, but do as they would they could not alter the structural deficiencies of the building, make it larger, nor prevent the fearful over-crowding with its disastrous results, nor improve upon the wretched system of pauper nursing, which was the curse of that and all similar institutions, and which the powers that were in those days at Whitehall made no genuine effort to change. Shortly after the collapse of his friend Catch, the proprietor of the _à-la-mode_ beef shop ceased to be a Guardian, and a wholesale fruit-dealer in Covent Garden reigned in his stead. He was a far less satisfactory Chairman than his predecessor, as all thoughts, words, and deeds were actuated by the consideration of his personal and private interests, as will be shown by the following, among other instances that could be related. One of the earliest things very properly done by the new master was to find out the previous occupation of those who had come in sick, and to utilize them, when recovered, in the trade they had followed, for the improvement of the House. One day a middle-aged man came in very ill. He had evidently seen better days; in fact, he turned out to have been a highly-skilled decorator, especially in the representation of marble and in graining. As soon as he was well enough the master set him to work to decorate the entrance hall. This he did most admirably, and his work was much admired by the Guardians, and by visitors to the House. This employment coming to an end he was allowed, as a reward for his industry, to go in and out, ostensibly to look for work. I used frequently to meet this man on my daily visits. As he continued to go out in this manner, I one day stopped him and asked whether he had been successful in finding a job. His reply, in the negative, was accompanied by a look so significant, that I was induced to push my inquiries, when he told me that he was occupied in decorating the Chairman's house, and he had been engaged at it for some three weeks. To the further inquiry, "What have you got there?" pointing to a bag he was carrying, he replied, "That is my dinner, which I always take with me, from the House." "Oh, then," I said, "the Chairman does not find you your dinner even; does he give you any beer or any money?" He replied, "I have been working there all day long for the last three weeks, and he has never given me anything." As he shortly after disappeared, I made an inquiry as to what had become of him, when I learned that he had suddenly left the work he was doing for the Chairman, and gone off and drowned himself. This Chairman did not long continue to act as such, as some months after this he died suddenly of heart disease, the only evidence he had ever afforded that he possessed one. Having occasion just at that time to go to the Poor Law Board, I was waiting in an office for the gentleman I went to see, when one of the junior officials said to me, "You have lost your Chairman." "Yes," I replied, "but I do not feel his loss very acutely;" on which he said, "It is customary for the clerk of the Board to write and apprise us of the death of the Chairman, and we always send a sympathetic letter in reply. On the clerk's letter being read the question was asked, 'Should the usual reply be sent?' The official reply was grim enough: 'Write and say that we are delighted to hear it.'" The successor in the Chair was very friendly disposed towards me, and remained so until after the official inquiry in 1866, when, having attended to hear the evidence that was given, and having made himself conspicuous by some irrelevant interruptions, he brought down on himself the criticism of the Press, which he most absurdly attributed to me, and resented by becoming a most determined opponent ever afterwards. About this time a Select Committee of the House of Commons was appointed to take into consideration the administration of the Poor Laws, and to decide as to the desirability or otherwise of the maintenance of the Central Department. In conjunction with my friend, the late R. Griffin, of Weymouth, who distinguished himself so much by an advocacy of an amended system of medical relief, and the late Dr. R. Fowler, of Bishopsgate Street, I volunteered to give evidence before the Committee. Some time after, being asked by the late Metropolitan Inspector, H. B. Farnall, Esq., C.B., to call upon him at the Poor Law Board, I did so. "I hear," said he, "that you have asked to give evidence before the Select Committee; pray, what are you going to state?" "Nothing," I replied, "that bears on my personal position as a Poor Law medical officer, except so far as I may support my views by reference to my personal knowledge. I shall give evidence for the purpose of urging on the Committee the desirability of abolishing the system, whereby Boards of Guardians for a stipulated sum, often wholly inadequate, bargain with medical men to find all medicines and appliances, because the inevitable outcome of the system is this--that the poor do not get the medicines they require. I feel that the sick of the Strand Union got very little in the way of medicine before I was appointed, and the provision of such medicines was to me in every sense a pecuniary loss, until the Guardians quite recently increased my stipend so as to make the strain less felt." He at once assured me that he would do his best to put my views before the Chairman, C. P. Villiers, M.P. for Wolverhampton. I did not at that time know Mr. Villiers personally, except by repute, but I came to know him some years later. Mr. Farnall then proposed to put some questions to me and take down the answers. This he did, and as each question was put I replied briefly, giving my reasons for my suggestion. I had to be guarded in my answers, as I was not desirous of bringing the charge against my medical brethren that they systematically failed to supply medicines for the sick, though very many have with more or less questionable candour said to me, "Why do you bother about the supply of medicines? Go in and get for us an increase of our pay." After Mr. Farnall had put me to the question, he shook me very warmly by the hand, promising that as far as I was concerned the views I held should be brought prominently forward. Some time after I received a notice to attend, when I found Mr. Richard Griffin and Dr. Fowler in the room. Griffin had come there with evidence that would have taken a month to take down. Fowler was not so diffuse, a couple of days would have got through what he had to say. Appalled by the vast body of evidence offered by these two, the Committee ordered the room to be cleared; on our re-admission we learned that the Committee had decided that Mr. Griffin and Dr. Fowler should put in their evidence, which should be taken as if delivered. I was then called on. I had neither note nor paper, as I relied on Mr. Farnall's promise. The questions were mainly put by Mr. Villiers. I amplified briefly the views I had expressed to Mr. Farnall. This led to my being asked for some additional explanations, which I supplied. Ultimately I was dismissed, but not before I had convinced myself that my day's work had not been thrown away. Poor Richard Griffin had worked for many years with wonderful industry to call attention to the grievances of Poor Law medical officers, and thought he should succeed. But he was destined to fail, for although the Committee had allowed him to put in his evidence, yet the facts he had collected with so much pains were successfully traversed by Mr. R. B. Caine, Poor Law Inspector, who by certain statistics made out to the Committee's satisfaction that medical men had no great cause for complaint. Poor Fowler's evidence was similarly snuffed out; as regards mine, the Committee reported in its favour, but not as to the whole of it. They probably dreaded the cost to the various Union Boards of the provision of all medicines, but they suggested a compromise, to wit, that Boards of Guardians should be required to supply expensive medicines, such as cod liver oil, quinine, opium, &c. Small as the concession was, Mr. H. Fleming delayed the issue of the Committee's recommendation for fifteen months after it had been made, and then sent out a letter couched in such official language that a great many Boards contented themselves with ordering the letter to lie on the table. Some years after, I asked Dr. Lush, M.P. for Salisbury, to move for a copy of the Board's letter and a return of what had been done. I found from that return that about half of those bodies had not noticed the letter at all. Subsequently, twenty years after the issue of the letter, my brother, Thorold Rogers, moved for a similar return, only to show that there were still several Boards where nothing whatever was supplied. When the letter was read at the Strand Board, a suggestion was made that I should be offered an increase of my stipend and be required to purchase the medicines myself. This I declined. Ultimately it was arranged that I should be allowed to order drugs of a wholesale chemist, but only to the extent of £27 a year: anything beyond that I was expected to pay for myself. About this time (1862) the matron informed me that on the previous day a very aged woman had been admitted, and that she had sent her to the infirm ward across the yard. On looking at the order I found it was stated that she was 104. I went to see her. She was undeniably of great age, but she still retained her faculties and conversed with me for some time. She told me that she had lived in Chancery Lane between fifty and sixty years, and was forty-five years old when she went there to live. She also told me that she went down the Lane to see Nelson's funeral procession go by, that her children and her grandchildren were dead, and that she had been looked after lately by her great grandchildren, who had grown tired of waiting on her, and that was why she had come into the House. Her eyes were blue and complexion fair. She did not live long after her admission, the change from her own airy room to the close and at times fetid atmosphere of this overcrowded ward was too much for her aged frame. She passed away quietly, and I remember filling up a death certificate for 105 years. One day, I was informed that a very distressing case had been passed from Canterbury. It was a young woman about twenty-four. She had one child, and was about to be confined again. It would appear that she had married a coach-builder, who was born in St. Paul's, Covent Garden. She told me that he was a very good, quiet man, when sober, and had been very kind and good to her, but that when he took anything to drink he became as one insane, and in one of his drunken fits he had knocked a man down and killed him; that he had been tried and found guilty of murder, and was then lying under sentence of death. I also learned that the Guardians of Canterbury had passed her on to us, away from all her friends. The poor creature was simply broken-hearted. She had a very bad confinement, and remained long sick and ill. When she got better she made an application to the Strand Board for outdoor relief. She was told to come before the Board at the next meeting in Bow Street. It was unfortunately a very wet night, and being thinly clad, she got wet through, and sat in her wet clothes two hours. She also got wet on her return journey. That night she was seized with inflammation of the lungs, and remained for many weeks in the greatest jeopardy. Ultimately, she got better, when I sent her to a Convalescent Home in Hertfordshire. She was so patient and grateful that I wrote an account of her sad story, which was published in _The Morning Star_. It evoked donations amounting to £25. After buying her some additional clothing, I paid her journey for self and child to Canterbury (the baby had died), handing her as she went away some £20. The Board, at my request, allowed her outdoor relief for a twelvemonth. Some years after, I happened to be in Canterbury, when I found her out. She had been in the same situation some seven years. She had supported herself and child, and had no occasion to spend the money I had collected for her; altogether she fully bore out the opinion I had formed of her. The reason why the Guardian Board had acted so harshly to this young woman was this: If they had allowed her to remain in their workhouse until after the execution of her husband, as a widow they could not have removed her for a twelvemonth; they therefore sent her away at once to avoid this dilemma. About two years after Mr. Catch's departure, I was surprised by a visit from the medical officer of the Newington Workhouse. He told me that he had called to ask me whether I could advise him what he was to do; that Catch obstructed him in his duty, swore at him, and refused to obey his orders. I told him to go down to the Poor Law Board, but that they might or might not assist him. Unfortunately, at that time, Mr. Farnall was away in Manchester, superintending the special relief arrangements in Lancashire with regard to the Cotton Famine, and there was no one at the Board who could or would advise him. He called on me on several occasions subsequently to tell me of the misery he daily underwent. On one occasion I told him to write down in a journal all instances of obstruction, and if possible get every case verified by a witness. Sooner or later you will catch him, I said. He followed my advice. One day he came to me and told me he thought he had got together sufficient evidence, and should now ask for an official inquiry. Mr. Farnall, one of the most honourable Poor Law Inspectors the Board ever had, had just then come back to town. I got some influence to bear on the Board, and an inquiry was granted. It lasted some time, and Mr. Simmonds proved the obstruction, &c., so completely, that on the last day, and when it was evident how the case would go, Catch followed the doctor and paid nurse out of the Board-room. They stopped in one of the day wards to discuss the case and its probable results, when Catch went to his office and wrote in his journal that he had surprised the pair holding improper relations. This charge coming to the knowledge of the nurse, who was a respectable young woman, she went at once to the physician accoucheur of Guy's Hospital and requested that he would examine her. This he did, when he gave her a certificate that Catch's allegation was untrue. A special meeting of the Board having been called to investigate this charge, it was made absolutely clear that Catch had hatched this foul accusation. The Board immediately suspended him. The circumstances were reported to the Poor Law Board, who called on him to resign. It will hardly be believed that after this, Catch, mainly through the influence of his friends at the Strand Board and the aid of the clerk, got appointed to the Lambeth Workhouse, where for some time he tyrannized over the subordinate officers and inmates, until at last, his cup being full, he lost that appointment also. Hereafter I will give the particulars of this episode, and of the notable trial in the Court of Queen's Bench, where he attempted to clear his character and to get reinstated. For five or six years after the departure of Mr. Catch my life was a fairly pleasant one. There was no obstruction from the master or the matron, and as there was nothing to ask of the Board things went on quietly, and therefore the daily duty ceased to be onerous added to which I had several pupils whose instruction in the wards was to me a very agreeable pastime. Here let me remark how melancholy it is that the vast field for clinical observation and study which the sick, nursery, and lying-in wards of large urban workhouses afford, should be utterly thrown away. There are certain diseases which can hardly be seen anywhere else, such as of those of young children and of aged persons, and yet they are completely ignored. I have said that for a time everything went on peacefully, but a rude awakening was in store, for about the years 1862-1865, in consequence of widespread distress in the metropolis, persons were admitted beyond the capacity of the House to hold them. This necessitated a representation to the Board, and, as a consequence, a revival of the antagonism from the so-called economical members of the Board, who charged me with being too squeamish, and with having brought the influx on myself by being too indulgent to the sick. The hostility went so far with one Guardian who considered me so very troublesome that he put a notice on the agenda to reduce my salary. This was renewed by him from time to time, indeed, whenever I made a representation to the Board on this subject. That there was abundant cause for such representations will be understood when it is stated that, in consequence of the overcrowding and the heated and vitiated atmosphere caused thereby, cases of fever induced therefrom were constantly cropping up, and it was one of my perplexities how to deal with them. In those days there were no such facilities as now exist for sending fever cases away to separate asylums, and we had to do the best we could. Having, in 1863, had a succession of boys affected with fever sent in from St. Anne's, Soho, I inquired of the relieving officer from where they came, whereupon he informed me that a Mr. Williams, a clergyman in Porter Street, Soho, had opened a home for friendless boys. On interviewing this clergyman, I told him that I had called to protest against his sending these fever cases to the Workhouse, there being no room for them. He replied by asking me what he was to do with them, as at that time he had some four or five boys down with fever; and then he took me into an old, disused slaughter-house, where, on some straw, I saw these lads lying ill. Before leaving him I arranged that he should go over the House and see for himself that there were no vacant beds. On the morning appointed he came, bringing with him a person whom he represented to be his secretary, and who he asked to be allowed to take with him. No objection being made, he accompanied us. I was somewhat surprised at the bearing of this so-called secretary, and still more so at his conduct in the House, when we went through the wards. I thought he was a very intelligent gentleman, and wondered at him occupying the position of secretary to Mr. Williams, at say, £1 a week. I satisfied Mr. Williams that I could not continue to take in his numerous waifs and strays, and on leaving, his companion parted from me with many expressions of thanks for my courtesy in allowing him to accompany me. I had not the least idea who he was, or his name, but I felt pretty sure that he must be a gentleman. It transpired subsequently that he was no other than Mr. J. Alexander Shaw Stewart, and my chance acquaintance became in after years one of my kindest and truest friends. As a result of this interview with Mr. Williams a school was opened, called afterwards the Newport Market Refuge Industrial School, and for several years it was under my medical charge. During the years I was connected with that establishment I never had a case of fever of any kind, although the school was located in a densely crowded and repulsively degraded neighbourhood. It was a striking instance of what could be done in keeping schools free from epidemic disease, if only the persons having control of them adopt, and strictly carry out, judicious sanitary arrangements. During my period of office I made the acquaintance of the Duke of Westminster, Mr. and Mrs. Gladstone, the latter of whom was a frequent visitor there, as well as many ladies of rank, &c. About this time there came an urgent request to go to the House. On my arrival I found a young German woman near her confinement who was in a state of great mental distress. On asking for an explanation, I was informed that the day before a gentlemanly-looking person had called at the house and asked to see the matron. To her he stated that he was a medical man, and had been commissioned by the friends of one of his patients to look out for some healthy young woman near her confinement who might be engaged as a wet nurse by a lady under his care. The master brought down to him this girl, when he instructed her to send her next day to his consulting-room, where the lady's friends might see her. She accordingly went. Shortly after her arrival there she rushed out of the house, stating that she had been insulted by the doctor. Police aid coming to her assistance, the doctor's residence was visited, with the result that he was taken into custody, and brought before the magistrate, who remanded him without bail for inquiries to be made. The publicity of the case led to the bringing of other charges of a similar character, and he was ultimately committed for trial. Having been called upon to attend the German girl, I was naturally called as a witness, and was subsequently subpoenaed to attend at the Old Bailey. I found four other young women there in a similar predicament, all in charge of a police constable, and for three days I spent my whole time in their company, for whenever I got up to walk anywhere the women and the constable got up also and followed me. The situation was suggestive, but by no means pleasant. On the Thursday morning I was informed by the prosecution that I might go away, as the prisoner, who turned out to be a man of good family and an officer in the army, had pleaded guilty to a common assault, &c., &c. As the girl's history was somewhat interesting I sent an account of it to _The Times_ newspaper. It was as follows: She had been living at Chicago with her two brothers, when they received a letter stating that their mother in Germany was very ill, and begged that her daughter would come home. She started immediately, but on arriving at her native town found that her mother was dead. She thereupon sold all the effects, and with upwards of £100 started back again for Chicago. She passed through London to Liverpool to take passage for New York, but the machinery of the steamer breaking down when two days out, the captain returned for repairs. She had made the acquaintance of a young Frenchman on board, who finding she had money, made love to her, and induced her to go back to London and become his wife. After living with her until all the money was gone, he deserted her, and being without friends, she had to come into the House. My letter appearing in _The Times_, some £45 was sent me, which sufficed to enable me to send her and her child to her brother in Chicago. I provided her with an outfit, and arranged with the captain of the steamer to take charge of her, and send one of his trustworthy officers to see her to the station in New York for Chicago, and parting with her to put into her hands the balance remaining. Some months afterwards I had a letter from the captain, stating that he had carried out my request, and had finally given her the £25 or thereabouts. There was every reason to believe that one of the subscribers was Her Majesty the Queen, though it was not so distinctly stated in a letter I received from a gentleman connected with the Court. In the early part of 1865 the Guardians appointed a superintendent nurse. She was a young, and very respectable-looking woman. The Guardians had been moved to do this by the evidence of Miss Twining before the Select Committee, and by the general feeling excited by the revelations made in Gibson's case in St. Giles's, and that of Timothy Daley in the Holborn, Union. In the winter of 1863 and 1864, and again in 1864 and 1865, as also in 1865 and 1866 the admissions had been so many, and the crowding so great, as to tax the resources of the establishment to the utmost, notwithstanding that I had moved the sick ward to the top of the building, and gained additional cubic space by removing the ceiling and re-ceiling the rafters; but I could not by any contrivance increase the area. The beds therefore were placed so close together that the patients had to get out at the end of their beds, there being no possibility of getting out at the side. It was a task beyond this young woman's strength to effectually supervise the numerous patients, but she could check some of the graver abuses connected with pauper nursing. This she did to the best of her ability. In the same spring that she was appointed--that of 1865--the late Dr. Francis Anstie called on me. He said he was deputed by the late Dr. Wakley to call and state that he had decided to appoint a commission for the purpose of investigating the state of London workhouses, and he thought I could suggest the best course to follow to obtain admission to them. I told him I would introduce him to the Chairman of the Board, who alone had the power to grant permission to a stranger to enter the Workhouse, unless special application had been made to Board, and leave given. He called on the Chairman, who gave him a letter to the master, authorizing his admission. Before he left, I told Dr. Anstie that when he went over the House I would accompany him. Some short time after, he wrote, making an appointment. I showed him through the whole House, pointing out the defects and shortcomings, and told him of my continued efforts to get the place improved, and of the determined hostility of the majority of the Board to any efforts I had made. I also showed him a list of the fever cases I had attended, and how constantly fever was developed when the numbers increased and the overcrowding was greatest. Dr. Anstie took careful notes of what I showed him, as the sequel proved. Some month or so after, I had a note from him, asking me to look in that week's _Lancet_ for the report of his visit. I did so; when I found that he had exposed the rotten condition of things with marvellous clearness and fidelity, but as he had referred to me and my efforts to clear out this Augean stable, I was perfectly convinced that the least intelligent element of the Board would be incited by their clerk to charge me with having written the article in question. As I anticipated, this came to pass, for I heard that so it had been said at the Board meeting, and in consequence, a most insulting resolution was adopted, in which I was directly charged with trying to bring the Guardians--'who were my masters'--into contempt. So angry was their language and so bitter their hostility, that Dr. Anstie wrote to the Board, stating that he had been permitted by their Chairman to go over the House, and that the observations he had made were his own, and that I had not seen a line of his manuscript, or knew of his report, until it appeared in print; he further challenged the Board to show where, in his description, he had departed from the truth. The storm he had raised was, after a while, allayed. Dr. Anstie continued to visit other workhouses, the condition of which he similarly described. These reports, which appeared in _The Lancet_, were copied into, and commented upon, in sundry daily and weekly journals, and gradually produced a feeling of intense public indignation. Dr. Anstie had acted so generously towards me in screening me from the hostility of the worst elements of the Board, that I arranged a dinner-party, to meet and discuss workhouse abuses. Among the guests was Mr. John Storr, of King Street, Covent Garden, who was one of the wealthiest, as he was one of the most respectable, members of the Strand Board, and who, since his election two years before this, had proved to be my most able advocate and friend. When Dr. Anstie arrived, he brought with him Mr. Ernest Hart, whom he introduced as one of the staff of _The Lancet_, and as one interested in the question of workhouse administration. After dinner a discussion took place as regards the general condition of these establishments. Ultimately it was arranged that a conference should be held at Mr. Storr's offices, King Street, Covent Garden, at a time hereafter to be named. Our dinner-party was held in December, 1865. In the early part of January, Dr. Anstie, Mr. Hart, and I, met by appointment at Mr. Storr's, when our discussion was resumed. At first it was proposed that we should call a public meeting and denounce the system, when I pointed out that if we only did that the agitation would soon come to an end, and therefore it would be better to form an Association for the purpose of more thoroughly enlightening the public. My suggestion was adopted. Mr. John Storr generously offered to put down £100 to float the Association. He also offered to become its treasurer, and to give us the free use of one of his offices, in which the meetings of the Association could be held. This meeting took place on a Thursday evening, and as _The Lancet_ came out next day, Mr. Hart left us and went down to _The Lancet_ office, to announce in the paper the formation of the society. At our meeting it was also arranged that we should respectively write to those we knew and ask them to join our Association. I wrote, among others, to Mr. Shaw Stewart, who at once joined us, and to Miss Twining, and to many other ladies and gentlemen who had been engaged in works of benevolence. The Association prospered beyond our wildest anticipations, and we were speedily joined by Earl Carnarvon, Earl Grosvenor, the Archbishop of York, &c.; whilst money came in freely. Shortly after the formation of the Association, of which, in conjunction with Dr. Anstie and Mr. Hart, I was one of the honorary secretaries; Mr. Farnall, the Metropolitan Poor Law Inspector, wrote to me, stating that he had been deputed by Mr. Charles P. Villiers, the President of the Poor Law Board, to offer his services in giving information to the youthful Association, and that he had written to me, as I was the only honorary secretary he knew. Mr. Farnall subsequently attended the meetings of the committee, and afforded us much valuable information. No use was ever made of Mr. John Storr's office, as all subsequent meetings of the Association were held in Mr. Hart's house, in Wimpole Street. In the month of May, 1866, Miss Beaton, the superintendent nurse, informed me that she intended to resign her situation, and apply for another as a nurse at a general hospital; at the same time asking me whether I would give her a reference. Whilst expressing my regret that she was going, I readily promised to do all I could for her, and with that object gave her a letter of introduction to Dr. Anstie, assistant physician to the Westminster Hospital, and to Mr. Hart, who was then connected with St. Mary's Hospital. Dr. Anstie took her name and address, and promised to do what he could for her; Mr. Hart asked her to sit down, and proceeded to question her on the various matters connected with the Strand Workhouse I had mentioned at the committee meetings, &c. Ultimately he dismissed her, but not until he had a promise from her that she would write down all her experience of the wrong-doing she had witnessed at the Strand. She did this. On getting her manuscript statement he sent it to Earl Carnarvon, one of the committee, and asked him to apply to Mr. Villiers for an official inquiry. I had not the remotest knowledge that anything of the kind had been done, nor had my other colleague, Dr. Anstie. In the early part of June Mr. Hart told me that there was to be an official inquiry into the management and the condition of the Strand Workhouse, and that I should be called as a witness, but he did not tell me how it had been brought about. A few days after I received an official intimation that such inquiry would be held, and that my attendance would be required. I had hoped that the inquiry would be conducted by the Metropolitan Inspector, Mr. Farnall; but it was not so. Mr. Fleming sent another member of the staff. The inquiry was held, the first witness called being Miss Beaton. She astonished me by the extent and character of her revelations, of some part of which I was an eye-witness, and therefore knew to be true. Her examination lasted all day. Next morning, the evidence she had given appeared in all the papers, which commented thereon. On the second day I was called. On taking my seat Mr. Caine said, "Oh! we have met before;" I did not know where. I had not long been under examination before Dr. Anstie, who was in the room, came behind my chair, and said, "Take care how you answer questions; this inspector does not mean fairly by you; he is trying to put you in a false position." Forewarned by this, I simply answered his questions, and parried those which were irrelevant and misleading. The next day my evidence, in full appeared in every paper, and all the leading journals denounced the Board of Guardians for their management of the House. It was unfortunate that my Board should have been selected, inasmuch as nearly all the workhouses in the metropolis were in very much the same condition. After the close of the inquiry Mr. R. B. Caine returned to Whitehall, and made the remarkable statement in his official report that the condition of the House was due to my not having made proper representations to the Guardians. I subsequently heard that on his report being submitted to the President of the Board, it was altogether set aside by him, and that he wrote the report himself. It had, however, come to my knowledge that Mr. Caine had delivered himself of this view; when I wrote to the Poor Law Board complaining of his injustice, and pointed out that for some three years he had, as Metropolitan Inspector during the time Mr. Farnall was away in Manchester, visited the Strand, and that he had always entered in the visitors' book that he was completely satisfied with the state of the House. I am happy to say that Mr. R. B. Caine got very little credit out of the whole transaction, for his report was severely criticized by the press for its transparent bias. Just at this time a circular letter was sent by the Poor Law Board to all the workhouse medical officers--some forty in number--in the metropolis. It was issued evidently with the view of entrapping these gentlemen into contradictory answers to the questions which were submitted to them. It was clearly necessary to take immediate action. I therefore sent a letter to each of them, asking them to meet me at the Freemasons' Tavern, Great Queen's Street, Lincoln's Inn Fields. The majority of them came. Having been voted into the chair, I pointed out to them what was the object of the letter, and earnestly urged that we should agree as to the form of reply. This view was adopted, and the answers as agreed upon were sent by all present to the Poor Law Board. On the same occasion it was arranged that an Association should be established of metropolitan workhouse medical officers, so that we might be prepared to deal promptly with any similar departmental trickery. This was done, and I was elected as the first president, an office which through various changes I have occupied to this day. The Association was, during the two following years, enabled to play an important part in the settlement of many vexed questions in the administration of workhouse medical relief, which, without the practical knowledge of medical men, would have been wholly left in the hands of the officials at the Poor Law Board, who at this time exhibited a singular unwillingness to face the facts. My official life after this was a particularly unpleasant one, inasmuch as I was credited with having asked for the inquiry, and having resolved to state that which would bring "my masters" into contempt. I should have survived all this misrepresentation, but unfortunately just at this juncture the Liberal Government was overthrown, and the Derby-Disraeli premiership was established. Earl Derby speedily pointed out that he intended to deal effectually with the scandal that had been brought to light in connection with workhouse infirmary administration, and with that view he had selected Mr. Gathorne Hardy--now Lord Cranborne--as the President of the Poor Law Board, he being in Lord Derby's judgment one of the fittest men in Her Majesty's dominions to put things straight. Mr. Hardy up to that date had been principally known as a Chairman at Quarter Sessions, and an _ex-officio_ Guardian of a Kentish Board of Guardians. One of the first official acts of this gentleman was to punish Mr. Henry Farnall for his conduct in aiding the Workhouse Infirmary Association. He was banished from London and sent to the northern counties. As Mr. Farnall's residence was at Blackheath, where his wife and children were living, this act of Mr. Hardy's was a serious inconvenience to him. The next thing done was to appoint Dr. Markham as a Poor Law Inspector and so-called medical adviser. Dr. Markham up to this date had been the editor of what was at that time an obscure journal. He was not known to have ever been associated with any sanitary work, nor to have seen the inside of a workhouse in his life, and yet out of all the able physicians at the time in the metropolis he was selected. The popular explanation given for this appointment was that he spent the larger portion of the day in looking out of the windows of the Carlton, Pall Mall, and that Mr. Hardy, making his acquaintance, gave him something to do. He fully justified the selection thus made, as will be shown hereafter, as he became in every sense one of the most difficult officials of the Board. At this time the permanent officials, notably Dr. Edward Smith, promulgated the heresy that the area and cubic space suggested by our Association for the housing of the sick was excessive; indeed, that the area did not so much matter if the roof of the sick ward was carried up high enough. These and other statements having been promulgated by the staff, a meeting of the Workhouse Medical Officers Association was called, to take the subject into consideration. We had the aid of the late Dr. Parkes, the eminent Professor of Hygiene, at Netley Hospital, as well as of my two colleagues in the secretaryship of our Association. Conjointly, we drew up a paper stating what was in our view the minimum area and the minimum cubic space that should be sanctioned. This action forced the hand of Mr. Hardy, and caused him to issue a cubic space commission to determine this question. Shortly after the formation of the Conservative Government a numerous and influential deputation, consisting of Earl Shaftesbury, the Archbishop of York, Earl Grosvenor, and many others, waited on Mr. Hardy, when representations were made to him urging extensive alterations on the then system. I was so hurt at the intrigues going on at the Poor Law Board and the attempt of Mr. R. B. Caine to make me solely responsible for the condition of the Strand Workhouse, that I availed myself of the opportunity to tell the President that in any scheme he might lay down for an alteration, I hoped that he would be guided by his own judgment, and not by that of the permanent officials, who would most assuredly lead him astray. This plain speaking was not particularly relished by those against whom it was mainly directed; it doubtless intensified ill feeling against me. I also handed to him a series of Resolutions drawn up by the Council of our Poor Law Medical Officers' Association protesting against the misstatements that had been propagated by Dr. E. Smith, Poor Law Inspector, against the Metropolitan Workhouse medical officers. Immediately subsequent to this our Workhouse Association engaged itself in drawing up a scheme for a general dietary for all London workhouses, which differed in every establishment; in some being, as at the Strand, when I first went there, niggardly in the extreme, while in others it was absurdly liberal. This question had engaged my attention many years before, and when I introduced an amended dietary at the Strand I was often twitted by the economical element of the Board to the effect that my liberality in the way of dietary was the reason why the House had filled so much, paupers being attracted to the Union by the prospect of being better fed by the liberality I had evinced. This allegation was absurdly unjust. Years before, in 1863, I had, at the time I amended the dietary at the Strand, addressed a letter to the Department urging that they should issue a general order to the London Boards of Guardians enclosing a copy of a uniform dietary to be used in all Metropolitan workhouses (acute cases of sickness alone excepted). Although this suggestion had the approval of Mr. Farnall, who invited me down to the Board to talk the matter over with him, it was set aside. Mr. Fleming, the secretary, objected to everything of a controversial character. About this time, understanding that Mr. Hardy was engaged in drafting his Metropolitan Poor Bill, I wrote to him on several occasions; one of the subjects I urged on him was the advisability of turning the vast field for clinical observations which our Workhouse infirmaries afforded to some practical purpose by throwing the wards open to medical students, pointing out what had been done at the Marylebone Workhouse Infirmary some thirty years before; I also urged that the hospitals he was about to establish should be officered by a resident medical man or resident medical men, but that in no instance should they be left alone in their control, but that their work should be superintended by an extern physician. I understood that my view was overruled through the opposition of certain physicians who thought that the educational opportunities thereby proposed would interfere with the voluntary hospitals they were connected with and the students attached to them. I also pointed out how desirable it was that pauper schools should be consolidated, and that permanent young pauper children should be separated from those who were constantly going in and out of workhouses. Mr. Hardy always replied personally and with marked courtesy to the letters I sent him. In the session of 1867 Mr. Hardy brought in his Metropolitan Poor Bill. In his speech introducing it he referred to my evidence before the Select Committee, and said that he had resolved to adopt the views I had advocated, namely, the provision of all medicines and appliances at the cost of the rates; but although the Bill passed with great facility and amidst general approval it was a very long time, in some cases four, five, and six years, before the dispensary clauses were carried out. The Bill had hardly become law before Mr. Hardy was transferred to the War Office and Earl Devon became President. This nobleman when Lord Courtenay, Poor Law Inspector, or Lord Courtenay, Parliamentary Secretary, had entirely supported the worst parts of the old system of administration and control. He always yielded to Boards of Guardians, and, when President, entirely deferred to the permanent staff. During the short time that he held office--for the election of 1868 shortly afterwards occurred and with it a strong reaction--he instituted a new order of officials at Gwydyr House--to wit, _Assistant Inspectors_. Of course it was not to be expected that the evidence given by me at the official inquiry would fail to intensify the bitter hostility of a section of the Board towards me, especially as the clerk to the Guardians never lost an opportunity of putting my conduct before them in the worst light. Consequently, shortly after my evidence had been given an attempt was made to displace me. The Guardian who moved my resignation was a lodging-house keeper in St. Clement's Danes. Having been told that this Guardian contemplated this procedure, I forwarded a letter to the Board in which I gave an outline of all I had done and had attempted to do during the ten years I had been the medical officer, the amount of antagonism I had provoked, and the various resolutions which had been adopted as the result of my endeavours. It was not very pleasant reading for some of them to hear, as there were several still there who had taken an active part in thwarting me at all times, and this letter thoroughly answered them. In spite of all that was alleged, when the resolution was submitted to the vote it was found that I had just as many friends as enemies, and therefore the motion was not carried. I do not know whether at that time the intrigue between the clerk and certain permanent officials of the Poor Law Board had commenced, but it took place not a very long time afterwards, as I found out some twenty months after. One result of the evidence I had given as regards the over-crowding was this: I was empowered to send some of the acutely sick to the voluntary hospitals, and I did so to a limited degree, but my action here was again met by the hostility of a section of this Board. It was suggested that I had sent them away to get rid of the trouble of attending to them, and it was gravely proposed that I should have the cost of the cabs in which they were removed deducted from my salary. As an illustration of the mode adopted by some Boards to annoy their medical officers I subjoin the following: In June, 1867, a person was sent into the Strand Workhouse by the district medical officer, insane. In conjunction with a Justice of the Peace, I examined him, and we certified as to his mental condition, whereupon he was sent to Hanwell. Three weeks after, he was discharged from the asylum, not because he had recovered, but through an informality in the certificate given by the justice. As this latter gentleman was out of town, I took the lunatic before Mr. Vaughan, at Bow Street, who, after examining him for a minute or so, threw up the certificate, and said he would not sign it, the man was not mad. I again implored him to fill up the certificate, as the man had been only sent back to the House through an informality in the certificate. As he again refused, I said, "Then I have to request that Sir Thomas Henry be apprised of the case." This was done, and Sir Thomas advised that he should go back to the House for another week. That afternoon the lunatic was interviewed by three of the Board, who pronounced the opinion that he was of sound mind. Hearing of this irregularity, I wrote to the Commissioners in Lunacy, and asked them to see the man. They attended at the House and examined him, and directed his removal to Hanwell without delay. That night he escaped by scaling a high wall, and was not captured for three days, when the police caught him. In the following September he was discharged cured, when I received a letter from the clerk, informing me thereof, and stating that the Board was of opinion that I had been too hasty in sending the man away, and that too by an unusual course. I immediately wrote to the Commissioners in Lunacy, enclosing the clerk's letter, and asked their opinion, when the secretary, Mr. C. P. Phillips, wrote to me stating that at the time the Commissioners saw him he was clearly insane, and that the Commissioners approved of my action under the exceptional circumstances of the case. I sent their reply to the Board. The evening the clerk read my letter to the Board, the man's wife made an application for his re-admission to the House, as he had a relapse of his insanity. This man went into and out of the asylum on several occasions subsequently. Whenever he was at liberty he made me aware of it by coming to my house between 1 and 2 a.m., and ringing my night-bell violently. Of course I had to put up with the infliction, as the man was not in his right mind. This annoyance went on for years, and only ceased when I left Soho. The Guardians also authorized my sending some of the infirm women to Edmonton, where the school for the pauper children was situated. This school was a favourite place of resort for the worst members of the Board, and very comfortable parties were kept up there at the expense of the ratepayers. A certain portion of the Guardians went down fortnightly in carriages to inspect the schools, and every scheme was adopted by those not on the School Committee to be asked to go out of their turn by those who were entitled to go. It meant an outing in the country, and a splendid dinner with wine, &c., and tea, free of cost, to all who went there. Of course the resident officers were always in high favour with the majority of the Board, and to arraign them or their conduct was a hopeless affair, as the least competent element immediately stood forward to shield them. In the September of 1867 a young girl was admitted, suffering with rheumatic fever; she remained ill some time, but towards the end of the month she recovered sufficiently to be sent to a Convalescent Home, but as the autumn was a cold one I decided that she should be sent to Edmonton, and to secure her considerate treatment I wrote a special certificate, which was addressed to the matron, in which I stated what had been the matter with her, and begged that she should be kept warm and not employed in scrubbing or any damp occupation. About a month afterwards I found this girl again in the women's sick ward in Cleveland Street with a severe relapse of her rheumatic attack. On inquiry I was told by the girl that shortly after she had gone to Edmonton the matron came into her ward and told her to go to the laundry. On her reminding her that she was still weak, and that the London doctor had directed that she was to be kept warm, the matron abused her and again ordered her there. She went. In a very short time she broke down; the matron, however, persisted in keeping her at work, but at last she became so ill that she was compelled to put her to bed. On the school doctor seeing her it was decided to send her back, to town, some eight miles distant. She was sent in a tilted cart and very imperfectly clad--that, too, on a very cold day. It was altogether so improper a proceeding that I complained to the Board, who made inquiries of the matron, &c., who of course denied the facts _in toto_. This false answer was sent to me. I was so enraged that I drew up another complaint and sent it to the Poor Law Board and asked for an inquiry. Dr. Markham was deputed to go through the form of an investigation, which he interpreted by going, unknown to me, to the sick ward, asking one or two questions of the girl, and sending for the matron at Edmonton to come to his private house in Harley Street. I did not know this at the time. He then reported that I had made a "frivolous and vexatious complaint." I will leave my readers to determine whether this procedure was not a mockery of a Departmental inquiry. This report, thus obtained, was sent to the Guardians, whereupon a man, who had misconducted himself at the official inquiry by coarsely asking "whether mesenteric disease was not something to eat," moved that I be suspended from my office. This was adopted by the Board, only four of the members supporting me, the fact being that the Board had changed very considerably at the preceding election, some of the Board ejected from office two years before having unfortunately returned again. Of course it was necessary for the Board to report this suspension to the Poor Law Board. The clerk asked permission to absent himself from duty for a time. He took with him the minutes of the Board for the preceding twelve years, and busied himself with extracting all the hostile resolutions which the Board had adopted against me, frequently at his suggestion, in return for my continuous efforts to cleanse their augean stable. I do not know who had distinctly intimated to the clerk that it was desirable to get rid of me, but the mover of my suspension stated that he knew the Poor Law Board wanted to get me discharged. That was admitted some time after by Sir Michael Hicks Beach in a conversation he had with a medical gentleman living near him in Gloucestershire. Some month after my suspension a copy of the clerk's extracts was sent me by the Poor Law Board, and I was asked what I had to say to it. I acknowledged its receipt, and asked for an official inquiry. This request was ignored, although it was suggested by a minority of the Board, by the Vestry of St. Anne's, Soho, who unanimously supported me, and by many influential inhabitants of the parish in which I had lived and worked. That my suspension would have been followed by the Poor Law Board calling on me to resign my office, without delay, would have been certain, but the President, Earl Devon, was away, although the most terrible distress prevailed that winter in East London. He had gone off to the South of France, and there he remained some three months. On his return, he at once put me out of doubt by removing me from my office. It is very curious, but true, that when I turned on this Department and stated my own case, he made the remark to a friend, who repeated it to me, that he was surprised at my hostility to the Board, as in calling for my resignation no reflection had been made by the Department on my character. At this time a general order was issued by the Department, imposing, without payment, additional and onerous obligations upon Workhouse medical officers. It was to the effect that they should make, from time to time, a return of all that was amiss in their respective workhouses to the Board of Guardians, the doing of which, on my own account, had led to my differences with the Strand Board. It had always been understood that this was one of the duties of the Inspectors, but it was attempted to throw the obligation on the doctors. After Earl Devon resigned, our Council had an interview with Mr. Goschen at the House of Commons, who promised an important modification of this unjust order. When my compulsory resignation was called for, it was decided by the Rev. Harry Jones, the late Dr. Anstie and others, to call a meeting of the all but moribund Infirmaries Association at Mr. Hart's house, to discuss the matter, and arrange for action. The meeting was addressed by both of these gentlemen, and by several others, and the action of the Department was severely censured by all who were present, except one person. Sir John Simeon, M.P., undertook to put a question in the House, and to move for papers. In due course the question was asked, when Sir Michael Hicks Beach made reply that the Board did not desire to make any reflection on my character, but that I had been called on to resign as I could not get on with the Board of Guardians. The insufficiency of this answer will be understood when I state that it had been already decided to break up the Strand Board by taking away St. Anne's and joining it to St. James's, in order to make the Westminster Union, and by adding St. Martin to the remnant of the Strand--thereby making it a perfectly new Union. I have stated that it was arranged at the meeting of the Workhouse Infirmaries Association, called to consider the action of the Department in requesting me to send in my resignation, that the papers connected with the subject should be moved for in the House. This was done, and in due course they were presented. On their appearance, _The Lancet_ commented as follows thereon-- "At last, after months of delay, the Parliamentary Papers concerning the enforced resignation by Dr. Rogers of his post as medical officer of the Strand Union have been published. They amply justify everything we have said as to the unwarrantable character of the action of the Poor Law Board and of the Strand Board of Guardians in the whole affair. "It is impossible for us to afford space for a detailed analysis of these papers, but we beg to draw attention to the following damning facts. 1. The evidence upon the whole case consists (_a_) of a series of quotations by the Guardians, or rather by a party among the Guardians, hostile to Dr. Rogers, from minutes and other documents extending over many years, these extracts being selected without any reference to contemporary facts which would throw light upon them, and (_b_) of utterly gratuitous and unfounded insinuations that the various leading articles in the general press which were written apropos of the notorious scandals at the Strand were written by Dr. Rogers and his friends. 2. That although Dr. Rogers (backed by a most respectable minority of the Guardians and by the Vestry of St. Anne's, Soho) protested that it was impossible to deal with these charges without an open inquiry, such inquiry was refused by the Poor Law Board. 3. As regards the Edmonton scandal which was the cause of the dispute which led immediately to the suspension of Dr. Rogers, the printed evidence distinctly bears out the justice of Dr. Rogers' allegations. 4. Nevertheless Dr. Markham reported to the Poor Law Board that his inquiries had proved these charges to be false. He does not, however, venture to specify the nature of the inquiry by which he disproved charges which, with unblushing effrontery, Mr. Fleming says were made on the unsupported testimony of a pauper, but which are now seen to be absolutely corroborated by two respectable witnesses (one of them a medical man), besides the direct observation of Dr. Rogers; and either Dr. Markham did not take, or the Poor Law Board has suppressed, the evidence of at least one other impartial witness, the master of the Strand Workhouse, which we have reason to believe would have absolutely settled the matter in Dr. Rogers' favour. "It is well-nigh incredible, but we have heard it on authority which we cannot discredit, that although the so-called inquiry on which the Medical Inspector of the Poor Law Board based the unfavourable report, which gave the Strand Guardians courage to make their onslaught upon Dr. Rogers, included an examination at Dr. Markham's private house of the Edmonton officials chiefly inculpated by Dr. Rogers' charges. Dr. Markham never asked Dr. Rogers one single question. Volumes of comment could not add anything to the ugly emphasis of this fact." Sir Michael Hicks Beach has been recently afflicted. I would ask him if he does not consider that his sufferings would have been intensified if his sleep had been disturbed by the noise of carpet-beating--if he had been waited on by infirm and drunken women, and broken-down potmen--if the air he breathed had been poisoned by the dust from the beating of carpets, and utterly vitiated by over-crowding? And yet, because I had protested against this hideous wrong-doing, and had done my best to get it altered, he had to get up in the House of Commons and do his best to justify the action of the Board. The Department thought I was disposed of; it was not long before I showed them the contrary, as some of them did not subsequently hesitate to admit. I have stated that it had been decided, owing to the all but unanimous application of the ratepayers of St. Anne's, Soho, to the Poor Law Board, to take that parish out of the Strand Union and join it to St. James's, so as to constitute the Westminster Union, and within a very brief space of time after my compulsory resignation this was done. As there was no returning officer for the Union, the Poor Law Board directed that the Vestry clerks of each parish should act as such for this time, consequently all books and papers relating to St. Anne's had to be handed over by the clerk, of Peterborough notoriety, who was the friend of Catch, when a notable discovery was made, to wit, that the proxy book, as it was called, was altogether illegal, and had been so for years, as by the efflux of time the power to vote by proxy in most instances had expired, and yet this clerk had gone on year after year issuing voting papers to persons, though he must have known that they had no right to vote. We had often wondered how it happened that we could not oust the Guardians who sat for St. Anne's: they had been returned by illegal proxy votes for years. Although the Guardians who had recently represented St. Anne's in the old Strand Union had lost the kindly aid of the clerk, it was so necessary to some of them that they should still be Guardians, that they again got themselves nominated, only to meet with a unanimous rejection on the part of the ratepayers, as the following letter from an ex-Guardian for St. Anne's, Soho, who was a supporter of Dr. Rogers, but precluded from again standing through serious illness, of which he subsequently died, will show-- "TO THE EDITOR OF _The Daily News_. "THE STRAND UNION AND THEIR LATE MEDICAL OFFICER. "SIR,--It will be gratifying to the friends of Dr. Rogers, who was suspended by the Board for his continued advocacy of the rights of the sick poor, to know that at the election of Guardians of St. Anne's, Soho, which took place on Saturday last, the whole of those who voted for his suspension, &c., were rejected by an overwhelming majority of ratepayers. "I am, Sir, "Yours obediently, "JOSEPH GEORGE. "81, DEAN STREET, "_April 11, 1868_." The story of two of these men I will here relate. The first had been appointed Assessed Tax Collector for St. Anne's, Soho, but two or three years after my resignation of the Strand he was discovered to be a defaulter to some hundreds of pounds, which his sureties had to make up. He was one of the most active of my opponents. The second had commenced life as a milkman. Very shortly afterwards he began to take tenement houses in the worst part of St. Anne's, Soho, which he let out from garret to cellar to the very poor. His lodgers lived under the most insanitary conditions, and my local knowledge induced me always to protest against this man as a Guardian of the poor. He was always the most energetic of my opponents at the Strand Board. At last retribution came upon him. It was in this wise: he was a freemason, and, though very illiterate, he had managed to obtain a high position in the masonic brotherhood, so much so that he was deputed to preside as the returning officer in an important election. There were two candidates, one a Guardian of the Strand Union, who was his personal friend--in fact, that very person who had recommended the broken-down pot-man as one of my nurses--the other was to him a comparative stranger. After the ballot had been taken, this returning officer gave the election to his friend by such a majority of voting papers that the unsuccessful candidate, who had been promised support to a large extent, suspected foul play, and made an application to the Prince of Wales, as Grand Master, to order a scrutiny. His Royal Highness assented, and directed the Earl of Carnarvon to hold it, when it came out clearly that this ex-Guardian of St. Anne's, Soho, had knowingly made a false return, and he was sentenced to a deprivation of all his offices in the brotherhood, and exclusion from his Lodge for three years. He was at this time holding various offices in St. Giles, also in St. Pancras, but the different parochial Boards' requested him to send in his resignation forthwith, as they refused any longer to associate with him or allow him to remain a member of their respective Boards. Here let me remark that there is no occupation that can be followed at which so much money can be made as by the system adopted by some speculators of taking houses in poor localities and letting them out in single rooms to the humbler classes. To get therefrom all the benefit possible you must be absolutely heartless and unprincipled. If the wretched tenants do not pay their rent weekly, they must go out--and do go! Having, after their weekly collections, much spare time on their hands, these men often get on to Boards of Guardians and frequently on to the District Boards as well: at the first they are always present when outdoor relief is given, which they strongly advocate as a means whereby the rent may be more readily secured; secondly, on the District Boards, where they are always at hand when the Inspector of Nuisances and of insanitary tenement houses makes his report. They generally try to be on the best of terms with this latter official, their scheme being to minimize the character of their reports, and to minimize what is required to be done, as it saves their pockets. One of these persons, who had some three hundred of these houses, was fined by the magistrate for neglecting to keep his houses in a sanitary condition. I had the honour of his permanent hostility. He was, at the time of being fined, not only a member of the Board, but of the Health Committee also. When I was a member of the Strand Board of Works I carried a resolution that the name of the owner of these tenements should be always included in the Inspector's Report. In my deliberate judgment, all persons of this class should be disqualified from sitting on a Board of Guardians, or on any District Board. The same class of middlemen are to be found in all large towns; they are the most dangerous members of the body politic, and should be rigorously treated as such. The person I have before referred to, was not only a member of the Strand Board of Guardians but a member of the District Board also. He was also on that of St. Giles, and St. Pancras. In all these places, and districts, he had tenement houses. It having been my habit to go to the Workhouse infirmary for twelve years early each morning, I found my time at first hang somewhat heavily on my hands, but after a short while I made up my mind what to do. I resolved to watch the action of the Department, and to do my best to make the permanent officials do their duty, so far as my observation could aid me. With that object in view, I arranged for an aggregate meeting of the profession, at the Freemason's Tavern, to discuss the composition of the so-called Board at Whitehall, and the grievances of the Poor Law medical officers. Among other things, I told them that the nominal Board never met, and that documents requiring the various members' official signature, were taken round to the residences of the Ministers, and, it was alleged, frequently signed without reading the contents. This statement had been made in the House by an ex-President. This meeting was an immense success, for not only was there a very large attendance of medical men, but they came from all parts of the country, and the Department had an opportunity of learning how their permanent officials were watched and criticized throughout the country as permanent officials always should be. Mr. Griffin having retired from further vindicating the claims of his professional brethren owing to an attack of paralysis, to which, unhappily, he ultimately succumbed, the balance of the money in his possession was handed over to me in trust for carrying on the objects of the Association. It was also decided that the Provincial Poor Law Medical Officers Association, of which he was the Chairman, should be merged in the Metropolitan Association, which had been started by me two years before, and I was elected the President, a position I held for some years, and which I resigned only when I recognized that the objects of our Association would be more readily advanced by selecting some medical member of the House of Commons to act in that capacity. So I contented myself with the humbler position of Chairman of Council. At this representative meeting of the profession, I alluded, _inter alia_, to my evidence before the Select Committee, and to my advocacy of the supply of all medicines. I also mentioned the action of one of the Inspectors, a Mr. Gulson, when Mr. Fleming's letter containing the recommendation of that committee was read out by the clerk of the Weymouth Board of Guardians at their weekly meeting. The Chairman having appealed to this official, who was present, as to what should be done, he stated that the resolution was only carried in committee by one vote, and that the Chairman of the Committee, had voted against it. Thereupon the Guardians of the Weymouth Union directed that the official letter should lie on the table, and no expensive medicines were found. I took care that a report of this meeting should be sent to every Poor Law medical officer, and to the Department, as well as to every influential Member of Parliament I could reach. One of the reports having fallen into the hands of Mr. C. P. Villiers, the ex-President and Chairman of the Select Committee on Poor Relief, that gentleman wrote to me protesting against the statement which had been made, and assuring me that it was in direct opposition to what had really taken place, as he had warmly supported my suggestion, and that he should at once call on Mr. Gulson for an explanation of his statement. He also stated that he had been much annoyed at the long delay that had occurred ere the Chief Secretary, Mr. H. Fleming, had drawn up and forwarded to the various Boards of Guardians the letter containing the recommendation of the Select Committee. From other sources, I subsequently learned that for a very long period of time prior to the resignation of Mr. Villiers as President of the Board, he held hardly any communication with his Permanent Secretary. It will be well understood, that if it took some fifteen months for the Permanent Secretary to draw up and issue the letter containing the Committee's suggestion as regards expensive medicines, that no hurry would occur in the establishment of Poor Law dispensaries in the Metropolis, which was only an amplification of my original suggestion. And that actually happened; and it was only by our constantly pegging away, that at last the Board commenced to establish them. But whilst no _bonâ fide_ effort was made to carry out this portion of the Metropolitan Poor Act, an absolute epidemic took place as regards the building of asylum hospitals, district hospitals for fever and infectious diseases, asylums for epileptics, idiots and imbeciles, district schools, &c. This arose partly from indifference on the part of the permanent officials, but to a greater degree from their complete ignorance of the necessary details required for economic building. It was never my desire, in striving to amend the system--that is, to substitute for the absence of all system of medical relief to the poorer classes the reverse policy--that architects, surveyors, and builders, should be at liberty to extract all the money they could get from the pockets of the metropolitan ratepayers. As it was, finding that the absence of all efficient control was leading to an enormous outlay, and that the public was naturally getting not only alarmed, but indignant, at the profligate expenditure of their money, I put myself in communication with Mr. Torrens, then M.P. for Finsbury, and asked him to question the President of the Poor Law Board on the subject, and to move for a return of what had been already spent and what was proposed to be spent in such buildings. I also requested him to inquire to what cause the delay in establishing Poor Law dispensaries under Mr. Hardy's Act was due. This action considerably alarmed the permanent officials. More important still, it led to a very considerable curtailment in the amount of contemplated expenditure on buildings, and, with this, an approximation to some control. Soon afterwards the establishment of Poor Law dispensaries was commenced, which was an important feature of the Act. I cannot but relate the close of Mr. George Catch's career. I have already stated that after the enforced resignation of his appointment at Newington, this model master was selected by the Guardians of Lambeth, as the master of their Workhouse, notwithstanding that he had as opponents some respectable persons who had creditably filled similar appointments elsewhere. His election was due to the assistance he received from the clerk of the Strand Union, and his old friends at that Board. His appointment was challenged at the time, but in spite of the serious evidence afforded by the Newington inquiry, it was confirmed by the Department, but with this proviso--that a special report as to his conduct should be sent by the Guardians to the Poor Law Board at the end of six months. It was not very long before the opponents of this man's appointment were fully justified in the course they took, as he speedily renewed his old course of cruelty to the inmates, and of quarrelling with the other officers. One of these acts was inquired into, and reported on by Dr. Markham. Although it was clear that the master was in the wrong, yet Dr. Markham, in his official report, managed to throw a doubt on the evidence of the medical officer, evidently to screen the master; but he was not saved for long, for shortly afterwards a young woman, who had been subjected to much harshness by Catch, ran away and hid herself, as it was supposed, in the chimney of one of the women's infirm wards, when the master, with the view of forcing her to come down, induced the junior resident medical officer, to bring from the surgery some substance, on which he poured some hydrochloric acid, whereby some extremely pungent gases were evolved, thinking thereby to compel her to come down; but as the young woman was not there (fortunately for Catch, for if she had been she would have been suffocated), the only effect was that all the old women in the ward, were set sneezing and coughing. This atrocious proceeding, having been reported to the Poor Law Board, Catch was called upon to resign. It will hardly be believed that certain of the Guardians memorialized the Poor Law Board to let him retain his office, when Mr. Shaen, the eminent solicitor, on the urgent representation of his wife, who was a lady visitor at the Workhouse, and knew a great deal of Catch's doings, took the matter up. Mr. Shaen saw me, and asked me whether I could tell him anything about Catch. I narrated the incident of the false charge which he, in connection with the clerk, had made against me when I was away in Scotland, and also told him the story of his behaviour in reference to the sick woman in the lying-in ward of the Strand Union which had led to his leaving that Workhouse. Mr. Shaen took down my statement, and subsequently he sent me a pamphlet of some two hundred pages, in which I found not only my own statement, but sundry others of a highly damaging character, but unfortunately these were so recklessly drawn, that it gave Catch the opportunity of bringing an action for libel. Its publication had induced Mr. Goschen to peremptorily call upon him to resign his office. Catch sent out an appeal to all the masters of workhouses to support him in his action, and a sufficient sum having been collected, the Attorney-General of the day, now Lord Chief Justice Coleridge, acted as his counsel. Having been asked by Mr. Shaen to support my statement in the Court of Queen's Bench, I attended. When called on, I went into the witness-box, and after giving my evidence-in-chief, was cross-examined by the Attorney-General in such a manner that three times during the cross-examination Lord Chief Justice Cockburn interfered to stop it, giving as his opinion that the Attorney-General was pressing me unfairly. As I was leaving the witness-box I turned round and thanked the Lord Chief Justice for his kindness in screening me. I was followed by the late porter of the Strand Workhouse, who was there to substantiate my evidence. A similar attempt to browbeat this witness afforded fine fun. The witness was an Irishman, and at every effort made by the counsel to confuse him, Pat was too much for the Attorney, and feeling that he could make nothing of him, he told him peremptorily to stand down, which he did in such a comical way as convulsed the court with laughter. Unfortunately Mr. Shaen failed to justify several of the libels, and the jury, after twelve days' trial, gave a verdict in favour of Catch for £600--an amount which the judge said was excessive, and for which he refused to certify, thereby affording Mr. Shaen the opportunity for asking for a fresh trial. Subsequently a compromise was effected at the instance of the Lord Chief Justice. In summing up the case to the jury, the judge said that my evidence, if it stood alone, was sufficient to stamp Catch as an improper person to hold the office of a Workhouse master. Mr. Goschen would not allow Catch to resume his office, and, having no resources whatever, he drifted downwards until ultimately, being without means and having tired out all his friends, he in a fit of despair threw himself in front of a Great Western train and was cut to pieces. I was so much annoyed by the action of the Attorney-General in cross-examining me that on my return home I wrote to the Lord Chief Justice again thanking him, and enclosing for his perusal a pamphlet I had just written on the administration of the Poor Laws. To my great surprise he sent me by hand the next morning a letter, in which he acknowledged its receipt, and informed me that he should read my pamphlet with the greatest pleasure. There is no doubt that my labours up to that time were very well known to his Lordship, as, when at the Bar, he was the standing counsel of _The Lancet_ newspaper, in which my name had frequently appeared. When he became a judge he kept up his interest in that journal. This was told me by the late Dr. Wakley, to whom I related Catch's story and the account of my cross-examination and of the courtesy and support afforded to me by Lord Chief Justice Cockburn whilst under cross-examination. The Lord Chief Justice was a man of scrupulous integrity and honour. I remember a solicitor of good position in Soho, whose brother was then the Treasurer of the County of Middlesex, and whose son now holds the position, saying to me, "Although I am opposed to him politically, yet I have the highest opinion of his conscientiousness, and of his extraordinary ability--we are all proud of him." I esteem it a high honour to have received a letter from such a man written under such circumstances. I have this letter still. An illustration of profligate expenditure, and the absence of all efficient control at the Poor Law Board, was at this time supplied by my old friends, the Strand Union Board. Shortly after I resigned the Board decided to build a new Workhouse at Edmonton, and plans of the contemplated building were issued to builders, &c. Tenders from sundry large firms for its erection were sent to the Guardians, the lowest tender being from an eminent firm that had acquired a great reputation for the buildings it had put up in various parts of town, as well as in the country. Their tender was rejected, and the contract given to a small builder, resident in St. Paul's, Covent Garden, whose estimate was some £2,000 higher. It was stated at the time that after the contract had been signed the members of the Board were invited to a dinner given by the lucky contractor. The large firm that competed for it, feeling that they had been improperly treated, got the question raised, and the new President, Mr. Goschen, investigated the transaction, but it was too late, as the builder had already set to work, and had a considerable amount of his plant on the ground. Although Mr. Goschen felt that he could not interfere to stop this disreputable transaction, he did not fail to give this party of jobbers a most severe lecture, probably the most severe that ever emanated from the Poor Law Board, in connection with the doings of a Board of Guardians. The issue of it to this Board must have brought about a change of policy among the permanent officials who had not remonstrated against it. I know not whether it was this transaction, or Mr. Goschen's general knowledge of the laxity of the staff, certain it is that during his Presidentship he kept the Secretary in his place, and did not permit him or Sir John Lambert (then plain Mr. Lambert) to obtrude themselves upon him when he received deputations from public bodies and from societies. But I am anticipating. In the autumn of 1868 a general election took place, with the result of replacing the Liberal party in power. With the concurrence of the Council of the Poor Law Medical Officers Association, I had issued a circular letter to the various candidates for Parliamentary honours, in which I drew attention to the imperfect character of the Poor Law Board, and the usurpation by the permanent officials of powers they were not entitled to, and asked whether the candidate would assist us in our efforts to reconstruct the Board, and to improve the system of medical relief. The replies I obtained were not only very numerous, but they held out the prospect of an alteration for the better. Looking back at the various changes that were made subsequently, I have no hesitation in asserting that many of these improvements were brought about by the action our Council took at this general election. These will be briefly referred to. I will here relate an incident that gave me the cue as to the line to be taken in the introduction and establishment of a Public Health Act. I was desirous of visiting an aged relative who lived in a village in Hampshire. The local medical gentleman kindly volunteered to fetch me from the station, some seven miles distant, and to put me up for the night, &c. As I neared his house my sense of smell was assailed by one of the most awful odours I had ever encountered. To my inquiry from whence it originated, my host said, "That is from the farmyard over there. Young Green, the son of the corn dealer, has taken Miss Smith's farm, and has commenced to breed pigs. He has at least 300." "Well," I replied, "if I lived here I should make short work of Mr. Green and his pigs; I would at once indict him." "Ah," he said, "you can afford to be independent, you live in London. I dare not; for if I complained, or took any action in the matter, old Green would go to all the markets round about, and would denounce me for attempting to interfere with his son's business, and I should make enemies by the score." Some three or four years after Mr. Stansfeld brought in his Public Health Bill, one of the essential features of which was that every district medical officer should be the health officer in his district. I opposed the proposition with all my might. I knew the Act would be absolutely abortive if Poor Law medical officers were placed in this utterly false position which Mr. Stansfeld proposed. In taking this course I encountered much opposition, and became for a time very unpopular, though at last my views prevailed, and gentlemen wholly independent of local influences were appointed to large areas. Among the remonstrants was the medical man who was the neighbour of the pig breeder, when I silenced him by reminding him of Mr. Green and his pigs, and of the fear that he had that if he complained that his business as a country medical gentleman might be damaged. He said no more. Having come to the conclusion that the course followed by my poor friend, Richard Griffin, of Weymouth, in continually calling attention to the grievances of Poor Law medical officers, would never eventuate in an improvement of their position, for the general public have never cared for our class in any way, I cast about to ascertain whether there could be any course adopted by which the attention of the public could be drawn to the shortcomings of the system, and decided that the only chance that existed, whereby an improvement could be effected, was by proving that an amended system of medical relief would eventuate in the diminution of the duration of sickness, and consequently of its cost to the ratepayers; and having at this time a copy of the annual report of the Irish Poor Law Commissioners placed in my hands, I studied its pages, and saw that under the Irish Medical Charities Acts the poorer classes of that country had secured to them the most complete system of Poor Law medical relief. I resolved to go over to Ireland, and study its administration on the spot. I carried out my intention, and during my stay in Ireland obtained a complete insight into the way in which the Irish dispensary system was carried out. I also brought back with me all the papers and documents that enabled me to popularize the subject here. I also spent much time in examining the annual returns of the English Poor Law Board, with the result that I was enabled to prove conclusively that efficient medical relief was followed by diminished poor relief expenditure, not only by shortening the duration of sickness, but by the actual saving of human life: this latter was shown also by a return I got Mr. W. H. Smith to move for, which was as follows-- "A return of the population at the last census in England and Wales, in Scotland and in Ireland. "A return of the mortality from general causes in the three portions of the United Kingdom, and of preventable mortality." That return exhibited the following: That whilst one in every 43 died yearly in England, one in 44 in Scotland, only one in every 60 died in Ireland; and whilst in England zymotic, or preventable diseases, constituted one-fourth of the total mortality, or one in 190 of the population, Scotland one-fourth, or one in 194 of the population, in Ireland it was one-fifth of the total mortality, and one in 308 of the population; the fact being this, that in England and Scotland there existed the same miserable system of medical relief, whilst in Ireland, after the potato famine and the fever which followed it, calamities which swept away a large portion of the inhabitants, the Medical Charities Act was introduced, and led, by its efficient working, to the beneficial changes which had taken place in the health of the country. The views I advanced met with much favour, and were commented on and approved by many general, as well as by all the medical journals. Having sent a copy of the paper I read at a meeting of our Association to Mr. C. P. Villiers, that gentleman wrote to me stating that he had derived much pleasure from its perusal, and that I had thrown more light on the causes of pauperism, and devised better measures for its diminution, than any previous writer on the subject. Subsequently, through the influence of Mr. Corrance, then M.P. for East Suffolk, I was invited to address the Central Chamber of Agriculture, which I did, when a resolution, couched in very flattering terms, was adopted, and further it was moved that a copy of the Chamber's approval of my address, and the principles contained in it, should be sent to the Poor Law Board, coupled with the request that the attention of all the provincial Chambers should be called to the subject. Subsequently I was invited to address the Worcester Chamber on the same subject, as well as that of Suffolk. At a very early period of the presidency of Mr. Goschen, several of the provincial Poor Law Inspectors were directed to make inquiry into the question of medical relief to the poor, and the desirability, or otherwise, of establishing dispensaries, modelled on the principles contained in the Irish Medical Charities Act. One of the most able and exhaustive reports was sent in, as might have been expected, by Mr. Farnall, who thus proved true to the views he held in his interview with me some ten years before; whilst the very feeblest of these was that preferred by Mr. R. B. Caine, who manifested the same lack of heartiness here as he exhibited earnestness some years before in upsetting poor Richard Griffin's statistics, of which he boasted to me during his conduct of the inquiry at the Strand Union in 1866. One of the results that sprang from my visit to Ireland was the establishment of a good understanding between our Association and that of the Irish Dispensary Medical Officers, of which the late Dr. Toler Maunsall was the honorary secretary. Dr. Maunsall was the most indefatigable secretary I ever knew. His appetite for work, and his skill in getting up statistics was remarkable. He was most valuable to me, as he assisted in getting out dry figures for my use, which would have given me infinite trouble. Poor fellow! like many others of my fellow-workers, he was destined to die early, and I sustained a great loss by his premature death. Unfortunately, too, he died badly off. I started a subscription in England for the benefit of his widow and children, which helped to swell the sum that his friends got together in Ireland. During my stay in Ireland it was arranged between us that we should mutually help each other, and consequent on that, when the Irish Association strove, under the leadership of the late Dr. Brady, M.P. for Leitrim, to obtain superannuation allowance for dispensary and workhouse medical officers, I called attention to the subject in the medical journals, and induced the members of our Association not only to petition, but to interview members in their respective localities, in favour of the Bill. Dr. Brady, having succeeded in carrying this measure, essayed the next year to do the same for England and Wales. The success of the appeal we had made to members in the general election of 1868, facilitated the passing of the measure most materially, as we had promises of support from upwards of eighty gentlemen who were subsequently elected. Prior to the second reading of our Bill, I interviewed several members, and got promises to attend the second reading and vote for the measure. Some of these gentlemen, having intimated their desire to speak in its support, and having asked to be supplied with information on the subject, I coached them up. To one of the ablest of our supporters, who asked me to provide him with facts, I said that I was opposed to superannuation on principle, as I held that every one should be able during the working days of his life to provide for the exigencies of his old age--but then it was necessary if he held an office that the pay should be such as would enable him to do so. Now it was notorious that the pay of the medical officer was based on such a starvation principle as to render it impossible for him to save anything. This argument, reproduced very much as I have written it, in the House assisted a great deal in the success of the Bill. At the time this occurred I was out of office, and had not the most distant idea I should ever again be a workhouse medical officer. I did not know what was again in store for me, nor that I was destined to have another fourteen years of it; that I should be again suspended, restored to office, and eventually, through broken health, compelled peaceably to resign and to be myself a pensioner. After the Bill had become law Dr. Brady most generously bore tribute to my efforts, and stated that he never could have carried the Bill without my help. _The Lancet_ published this statement of Dr. Brady's, and I for the time gained from my Poor Law medical brethren credit for what was, at that period, absolutely disinterested labour. About this time I was invited by a leading physician in Edinburgh to visit that city and address a meeting at the College of Physicians on the subject of Poor Law medical relief in Scotland. Although I was aware that the condition of things in that country was worse even than it was in England, yet I had not studied the subject so completely as to justify me in asserting it. Consequently I declined what was a very great compliment. Some years afterwards I went and delivered an address. It took place at the time when the annual meeting of the British Medical Association was last held there, when a highly complimentary resolution was adopted at that meeting in reference to that visit and address of mine. After occupying the position of president for a brief period only, during which time the Department was administered most vigorously and successfully, Mr. Goschen was transferred to another office in the Government, and Mr. Stansfeld was appointed President, the effect of which became immediately apparent, for the leading permanent officials, whose influence had been checked during Mr. Goschen's presidency, came directly to the front again. One of the first measures introduced by Mr. Stansfeld was the conversion of the Poor Law into the Local Government Board. This was carried out by the absorption of the Public Health Department of the Privy Council in the destitution element of the Poor Law Board--a most disastrous act of policy, as it subordinated the Health Department, which had done its work so well to the discredited section of the Poor Law Board as exhibited in the permanent officials of the Board, who had always been obstructive, and had neither carried out, nor permitted any one else to carry out, any reform whatever. This was early made apparent, for at the first deputation to the President, at which I was present, after his appointment, I saw Mr. H. Fleming and Mr. Lambert sitting together with the President, whilst Mr. (only just recently made Sir), John Simon and his staff, who were the only intellectual element of the new Board, were relegated to distant seats in the corner of the room. That a Public Health Bill started under such circumstances should be framed absurdly, seeing that those who understood the subject were ignored, and those were consulted who had never done anything well, was nothing but what might have been expected. One of the provisions of the Bill was, as I have before stated, that every district Poor Law medical officer should be the health officer of his district, and that his reports of insanitary conditions should be sent to the Board of Guardians, many members of which Board would be found to be the principal offenders against sanitary requirements. This scheme speedily evoked an opposition, and a deputation, representing the British Medical Association, the Social Science Association, and the Poor Law Medical Officers Association, had an interview with Mr. Stansfeld at the Local Government Board. The speakers from the two first Associations having addressed the President, Mr. Stansfeld announced that he had just received a summons to attend a meeting of the Cabinet, but he would leave Mr. Fleming to hear any further remarks that might be made, which would in due course be communicated to him and meet with attention. Being the sole remaining speaker, I said to Mr. Fleming that when I first heard of the proposed utilization of the Poor Law medical officers in the Public Health measures of the Government, I hailed it as a tardy recognition of the valuable services that class of official might render. But when I came to look into the details I saw it would not work, as medical officers would hesitate in affronting their Board of Guardians, many members of which would be found to be the principal offenders against the contemplated Act, and that in the few cases where the parish officers would faithfully carry out the requirements, and thereby offend their respective Boards, they would be sacrificed to the resentment of their members, and if appeal was made for support to the Central Department, such honest men would be called on to resign for not exhibiting sufficient courtesy, &c., and working with their Boards. It was very evident that my observations went home to this Permanent Secretary, but whether they were ever communicated to Mr. Stansfeld is open to much doubt, for his Bill was eventually brought in on the lines he had originally indicated, only to turn out on trial a disastrous and ludicrous failure. CHAPTER II. THE WESTMINSTER INFIRMARY. About a twelvemonth after the Act was in operation I appealed, through the medical journals, to my brethren in the provinces as to the arrangements that had been made in their respective localities. A large number of letters from all parts of England and Wales were sent to me, and with the information thus furnished I prepared a paper which I called "Chaos," in which I turned into ridicule the arrangements that had been made, showing that the Department, faithful to its traditions, had made a complete mess of the administrative arrangements. This paper, read at the meeting of the British Medical Association at Sheffield, attracted a good deal of attention both in the medical and general Press. It materially acted in evolving order out of the chaos into which the subject had drifted, owing to the indifference and incompetence of those who had drafted the measure. In the spring of 1872 I was informed that the alterations and enlargement of the old Workhouse of St. James's, commenced at the time when the Westminster Union was formed, were complete, and that Mr. French, who had been the medical officer of the workhouse and parish of St. James's for upwards of forty years, was about to retire on a superannuation allowance of £200 a year. I was told that the Chairman of the Board, a Mr. Bonthron, a Scotch baker living in Regent Street, had selected a fellow Scotchman, one Dr. S., as Mr. French's successor, and as Mr. Bonthron claimed to be omnipotent at the Board, this gentleman's appointment to the vacancy was considered to be certain. In the course of a few days I heard that a formidable opponent to Dr. S. had appeared in the person of Dr. M., who was also a Scotchman. In due course the election took place, when Dr. M. was elected. This resulted from a protest on the part of certain members of the Board who resented the predominance of Mr. Bonthron. When apprised of the result of the election, I remarked that Dr. M. could not take the office as he did not possess the necessary legal qualifications. On the following Saturday morning a member of the Board told me that a letter had been read at the meeting of the Guardians, held the previous evening, announcing that the election of Dr. M. was null and void, as he held no surgical qualifications. As his election had surprised all the Guardians, because it proved that the Chairman had not the influence he claimed, my informant advised me to apply for the office. At first I hesitated, but upon being urged again I assented. The same evening I called on Dr. M., told him of my intention, and asked him for the support of his friends. To my utter astonishment he told me he had made up his mind to try again. "Nonsense," I said; "how can you get a diploma from the College of Surgeons?" "Oh," he replied, "I have arranged all that; I have a splendid memory, and I remember all my anatomy and surgery." As I had every ground for the belief that he had never attended lectures on surgery, nor attended the surgical practice of an hospital, inasmuch as I had known him ever since he had come to London, I saw that, without collusion with some one in authority, it was impossible for it to be done; but, as he appeared determined, I left him. As soon as it was known that I seriously intended to compete for the appointment, testimonials in my favour were forwarded to me by several eminent physicians and surgeons, by Members of Parliament, among them one of a very flattering character from Mr. C. P. Villiers, M.P., the ex-President of the Poor Law Board, who strongly recommended me to the Board of Guardians, those lady visitors who had known me at the Strand, and others. Two days before the election took place I was surprised by a visit from Dr. M., who called to inform me that he had passed his examination at the College of Surgeons the night before, and now asked me to retire in his favour. On my declining to do as he wished, he said it was very hard I would not, as he had incurred an expense of upwards of £60 to get the diploma. Prior to the election my friends entered into a compact with his supporters to the effect that if I was in a minority on the show of hands my name was to be withdrawn, when they would support him, but if I was in the majority his friends would support me. This occurring, I was elected, to the great surprise of the Chairman, who looked on me as a dangerous person, seeing that I had taken an active part in bringing about the formation of the Union, whereby St. Anne's had been joined to St. James's, which had the effect of somewhat increasing his poor rate assessment in St. James's--for St. Anne's, a poor parish, had considerably improved its position by being put into union with St. James's, which was comparatively a rich one. Having at this time received an invitation from the Irish Dispensary Medical Officers Association to address them at the College of Physicians in Dublin, I did so, when Sir Dominic Corrigan, Bart., M.P., was in the chair; and I afterwards spent a very pleasant week there, visiting the North and South Dublin Workhouses, the latter having 4,000 inmates, with a large staff of visiting physicians and surgeons, besides resident medical officers. It is one of the finest hospitals in Dublin, and the arrangements for the efficient treatment of the sick poor were in the highest degree creditable to the Irish Poor Law, now the Local Government Board. I also visited the Richmond Lunatic Asylum, situated on the outskirts of Dublin, at that date under the superintendence of Dr. Lalor, who, I understand, was the first physician who introduced vocal and instrumental music as a means of relieving the insane. There I witnessed one of the most extraordinary sights it was ever my lot to see. I will give a sketch of the tableau. In the foreground sat a young lady discoursing most eloquent music on a harmonium, immediately behind her there stood some young Irish women, three or four of them, singularly beautiful, with music in their hands, accompanying her; behind them were older women, and then on to the old and weird, all joining most heartily in the performance. The fringe of this female gathering of nearly 100 performers were harmless imbeciles and idiots. I stood and listened some moments whilst this singular performance continued. I was so struck with the beauty of one of the Irish girls that I asked her history, when I was informed that her condition had been induced by a disappointment in a love affair. It was the old story of love followed by desertion, and she had been admitted some six months before in a state of maniacal excitement. She was too young and altogether too pretty to be an inmate of a lunatic asylum. Dr. Lalor also showed me a typical case, exhibiting the truth of the opinion I have long held, that of all the forms of insanity, none are so uncertain of having been really cured as those which have exhibited symptoms of homicidal or suicidal violence. The patient in question had been admitted when suffering with a homicidal tendency but had steadily improved, and his name was on the list of those to go before the Visiting Committee for discharge on probation, when a startling incident occurred. He had secreted one of the knives used in the asylum about his person, and he had, when unobserved, whittled away the thick, blunt portion used in the asylum, until he had given it a sharp cutting edge, from handle to point; when, raising his right leg up, he cut through the calf down to the bone, severing the muscle completely. This patient, Dr. Lalor told me, had been employed on various offices of trust, and that he was commonly considered to be completely cured, and altogether harmless. I obtained one of the old knives used in this asylum, had it copied, and, having got the sanction of the Board for getting several, used them all the time I was at the Westminster Union, in the male and female insane wards. The cutting edge was about two inches in length, but the rest of the knife was about the twelfth of an inch thick. It was impossible for lunatics to do any harm either to themselves or others with such knives. On my return to London I was informed that my appointment to the Westminster Union had been confirmed by the Local Government Board. A day or so before the 23rd of June an appointment was made by Mr. French for me to go over the House with him, and to have the establishment formally handed over to me. I went, accompanied by a young Irish physician, recently one of the resident surgeons of an Irish hospital, with whom I was in treaty to be my assistant. I had never been in this workhouse infirmary before. Shortly after my arrival Mr. French joined us, and, in company with the head nurse on the female side, we went through the female part of the establishment. The nurse was most elaborately "got up." We went on and examined each patient, a large number of whom were in the wards--in fact, although it was midsummer, the place was full. I noticed bed-cards over each patient's bed, but as I could not make out what was given to the patients, I asked what was being done for this and that case. To my astonishment Mr. French said, "Nothing; I do not believe in physic, and therefore do not give the people anything." Presently we entered a large ward where a woman, evidently in great pain, was lying in bed, writhing in apparent agony. After ascertaining the nature of the case, which was one of colicky diarrhoea, I asked, "Well, what do you here?" to which he replied, "Nurse, give her a glass of Number Two." With that, he pulled me into the centre of the ward, and giving me a friendly nudge of the ribs, laughingly said, "What do you imagine is Number Two? Why it is peppermint-water coloured; I never give any physic." Feeling by this time somewhat disgusted by these remarkable confessions, seeing that his stipend was £350 a year, out of which it was arranged by the Board that he should supply these medicines. I dropped his company, and went on examining the people independently. Mr. French speedily buttonholed my young companion, and went on looking at the patients with him. At last our visit came to an end, and on coming out of the male sick wards he shook me warmly by the hand and wished me the same happy official life as he had had. He had hardly got out of hearing when the young Irishman commenced to reproach me with having transferred Mr. French to him; saying, "I take it, sir, as a very unkind thing that you should have done so, as I was shocked at his boasting that he never did anything at all for these poor sick people." The next day I entered on my duties. On taking my seat in the consulting-room the master brought in and laid before me a large volume, the Workhouse Medical Relief Book. I turned over the pages for the week, and noticed the names and extras ordered for the sick. I saw that ham, sausages, tripe, fish, eggs, were entered rather frequently. At last I said to the master, who was standing by, "You surely have not all these people on the sick list in the House! I did not see a third of this number when I went over the House yesterday." "Yes," he replied, "they are here;" on which I said, "Let everything remain as entered in the book until I can arrange to go over the establishment and see them all, which I will do this week." I then went through the sick and infirm wards. On going through the wards I ordered what in my judgment was necessary for the sick in the way of medicines, much to the astonishment of the head nurse, who stared at me in a half-dazed manner. There was one patient with a very foul and offensive ulcer, for whom I ordered a charcoal poultice: she came to me before I left the House to ask me "what I meant." I replied, "A charcoal poultice." She then said, "I never heard of such a thing before." I then asked her how long she had been there; she said eight years. The next day I had occasion to order a carrot poultice; I met with the same astonishment and ignorance of what was meant. At last she frankly stated that she was about to learn her duties, for nothing of the kind had ever been used by her before; and further, she said that as she never had any medicine to give the people, she had not troubled herself much about the patients; indeed, I learned on inquiry that she used to be in waiting to see the doctor each morning, and so soon as he was gone she considered her duties were over, and she returned to her own sitting-room till next day. I could never get her to give my medicines as directed. Apart from this indifference as to medicines, she was kind to the patients and respectful to me. On the male side I found a superintendent nurse who really knew her duties. She confirmed the statement voluntarily made by Mr. French, that no medicines were ever provided for the sick. She also said that the Guardians knew all about it, and that they treated it as a great joke. This was not correct as regards some of the Guardians, as I subsequently ascertained. It was known to the St. James's section of the Board, but repudiated by those of St. Anne's. Seeing that we had had a medical inspector and self-called medical adviser for five years, whose duty it was to visit this Workhouse infirmary, his failure to discover these omissions was in the highest degree remarkable; but then the system prevailed at the Local Government Board, and our Workhouse Infirmaries Association had utterly failed to alter it. The reason for all this was not far to seek. On the day after, in company with a pauper inmate, told off to carry the Medical Relief Book, I went through the wards for the purpose of seeing the infirm men and women who were on extras. I found on the women's side that, as it was leave-day, many had gone out, and therefore drew the inference that if they were well enough to go out they could dispense with sausages, ham, tripe, eggs, &c., entered against their names, and could eat the ordinary infirm diet provided by Dr. Markham's diet table, which I saw hung up in the wards, which diet table had been drawn up from the form drafted by our Association some years before. It is curious that he claimed it to be his, without any reference to any one. Whilst going through the female wards some of the inmates returned drunk, one old woman very much so. She at once proceeded to ask me who I was, and what I was doing there. On my replying that I had come into the ward to see why she was on a diet of daily sausages, she tartly replied, pulling up her petticoats and showing both her legs, which she struck with her hands, "For these bad legs." I at once ran the pen through her name. She lived in the House years after that, but she ate no more sausages. I learned on inquiry that this fat old woman, who could go out and return drunk, had had sausages, nominally, as her dinner for two years. I write nominally because I learned afterwards that in the matter of diets an extensive system of exchange obtained throughout the House without any check or hindrance on the part of the officials. It took me the greater part of four days to see all the infirm people on extras, but the result was satisfactory, as it enabled me to put the establishment so far as the diets were concerned, on an economic basis. The clerk of the Board assured me at the time that I had caused a saving of some hundreds of pounds, a statement which I honestly believe was the truth. It might be a matter of wonder how this could be, but having regard to the very large amount of extras purchased from day to day, none of which were supplied under contract, it can be well understood what an opportunity was given for large prices being charged for such extras, as practically no check existed on the cupidity of the tradesmen (selected by the master) who supplied these things. I do not state that such was the case here, but unless some good understanding existed between those who ordered and those who supplied, how is it possible that masters of workhouses, with their limited incomes, should succeed in leaving at their deaths so much money, as many of them do? I was informed that the old master who preceded Catch at the Strand Union had gone there after failing in business as a tradesman in Covent Garden, that he held office as master twelve years, and when he died that he left some £2,000. I found on inspection of the specially infirm, paralytic, and wholly infirm, that the women were located in wards 16, 17, and 18, and on inquiry discovered that there were no conveniences whatever for the instantaneous removal of excreta, and yet this condition of things had not been discovered by the Government Inspectors or by the medical advisers, or if it had been no steps had been taken to alter it. On my first visit to these wards I noticed some black patches in the corners of the compartments, which stood out very distinctly from the recently whitewashed ceiling and walls. Noticing some days after that these patches had increased in size, I asked the nurse what it was due to, when she quietly said, "Those are bugs." So soon as I could I saw the master, and told him of it, and asked him to see to it. He did not say he would or he would not, he only laughed. Finding some days after that nothing had been done, I again saw him in his office, when I told him that I must insist on those bugs being removed. The labour master was present, who remarked, "Well, doctor, as you make such a fuss about the bugs I will see to it for you" (evidently regarding the matter in the light of a personal favour); and the bugs were swept down into a dustpan by hundreds and put into the fire and burnt. This was told me by an eye-witness, who was present whilst it was being done. I do not wish it supposed that the master was harsh or cruel; quite the reverse, he was very kind to the inmates. But he had lived long enough in the service of the Poor Law not to be fully aware that no good would accrue to him or his by too much zeal in the performance of his duty. He calmly let things slide; consequently there was more drunkenness on liberty days than could be possibly imagined, and was unchecked, and although I repeatedly begged that the names of all persons who were on my sick list who had been allowed to go out should be reported to me if they came home drunk, I never could get my wishes attended to, though occasionally it happened that I discovered the circumstance, especially when an accident occurred. I was not wholly unprepared for this laxity of discipline, as some few days before entering on my duties I met the ex-chaplain of the Strand Workhouse, who, whilst congratulating me on my return to the Poor Law service, said, "You will have a great deal to meet with at St. James's. I have taken the duty there for the chaplain occasionally, and the scenes of drunkenness and quarrelling among the inmates on their return home on liberty days, which I have witnessed, exceeds anything you can imagine." One of the most terrible exhibitions of this kind I ever witnessed was on the first Christmas Day after my appointment. The subject having previously been brought under the attention of the Board, an order was issued that for the future this indiscriminate permission to the inmates to leave the house on Christmas Day should be stopped. It will hardly be believed that on the next Christmas Day the Chairman took upon himself, most presumptuously, to go to the House and give permission for them to again go out. The scene that occurred that night was the most disgraceful that ever happened in the history of a workhouse. Several of the drunken inmates on their return home fought like demons. I and my assistant were engaged for some time in dealing with the injuries that were caused. I must state that I never saw the master so justly indignant as he was at the impertinent interference of this Chairman, in setting his authority and that of the Board at defiance in the way he had done. Finding that no dietary for the sick and infirm had been adopted at the House, I at once drew up a form which continued in force until ill-health caused my resignation. It was similar to that which I had introduced at the Strand several years before. There was one diet for which I claim especial credit. It was framed with the view of dealing with capricious appetites or severe sickness. It was called Number Five, or _ad. lib._, and consisted of either eggs, fish, a chop, beef-tea, or arrowroot, or anything else of the same value. It was enjoined that the nurse should at 8 a.m. ask what these special sick would take for dinner. When she had ascertained the wishes of the patient, a statement on a diet-sheet showing how many of each description of diet would be required was sent down to the kitchen. At the end of the week the cook handed to the master's clerk the number of each diets she had supplied, who then proceeded to distribute these among all those who were on _ad. lib._ diet. It might appear on the master's side of the Medical Relief Book that A or B had had a chop daily, whilst in reality the dinner might, by this arrangement, have been changed every day. This plan of dealing with capricious appetites has since been adopted in several workhouses. Although five years had passed away since the Metropolitan Poor Law Act had become law, no attempt had been made to carry out the dispensary clauses until after my election, and one of the first things I had to do was to put the dispensary in order. I had been taught a lesson in economic prescribing whilst at the Strand, and therefore was enabled to speedily arrange for a pharmacopoeia. I also drew up a formula for the supply of large bottles of simple medicines, which were placed in charge of the nurses, for administration in trivial ailments so common among the aged poor. I also introduced bed pulleys, to enable the sick to assist themselves in rising, or in getting in or out of bed. I also ordered small shawls for the aged women and woollen jackets for the men--a great comfort to those who were suffering from consumption or bronchitis, the principal affections I had to encounter. I have stated that although it was midsummer the House was full of sick people, which arose partly on account of the sickness that prevailed in the worst part of St. Anne's and similarly in that of St. James's, and also to the fact that the Chairman had opposed the transfer of any of the sick to the Sick Asylum Hospital, at Highgate, to which the Westminster Union, in conjunction with the Strand, St. Giles's, and St. Pancras, was affiliated. He had opposed the junction of the two parishes on personal grounds, and being beaten, had, in conjunction with his party, obstructed the removal of the acutely sick. As medical officer I did not object to this, for as the sick wards were extremely good and were all that I had desired to carry out when I initiated the Workhouse infirmary movement, I simply complied with the wishes of the majority of the Guardians not to send any one away. I had held office some weeks when, in the autumn of the year, I encountered Dr. Drydges in Regent Street. This gentleman, who had acted temporarily whilst Dr. Markham was ill, had about this time been permanently appointed to be Metropolitan Inspector, Dr. Markham having resigned. He came up to me and said, "I was coming to the Westminster Union to learn why it was you did not comply with the law, and send your acute sick away." "Oh," I replied, "that is soon explained; it is because the majority of the Board will not let me." "Indeed," he said; "you must do your duty, even if the Board object to it." To which I replied, "I did that at the Strand, and your Secretary called on me to resign because I was not sufficiently respectful to the Guardians. I shall comply with the wishes of the Guardians now, and not with that of the Local Government Board, as they would throw me over." To which he rather angrily replied, "You speak to me like that, when I am an Inspector, and you only a Workhouse medical officer?" To which I answered, "And who, pray, made you a Poor Law Inspector. Why, if it had not been for me and my initiation, neither you nor Dr. Markham would ever have been Inspectors." "Oh," he replied, "I did not know you had had anything to do with it." "I think," I said, "if you will trouble yourself to inquire you will find what I state to be correct." When I broke down in 1886, and he had to call and see me, he was then most kind and sympathetic, and I take this opportunity of stating as much. This refusal on the part of the majority of the Board, led on by this Chairman, to allow me to send suitable cases of sickness to the Asylum Hospital, was in the highest degree absurd, seeing that the ratepayers of the Union had to pay their proportion of all expenses at the Asylum Hospital, and for the beds to which the Union were entitled; and although this Workhouse infirmary was a perfect paradise in comparison with the den at the Strand, still the House had not been arranged on the principle that all the sick should be retained in it. My nursing staff was insufficient to enable me effectually to deal with the great number of sick persons there at the time of my entrance on my duties. One illustration will suffice. There was a man in an infirm ward who had been under Mr. French some five or six years. He did not belong to Westminster, he was kept there because he alleged he was so ill that he could not bear the fatigue of journeying some sixty miles in the country. He was a healthy-looking man about forty years of age. He always lay in bed with his knees drawn up, and constantly asserted that he could not stand nor walk, nor put his legs down. He complained piteously of his sufferings. I exhausted every conceivable treatment, but all without the least apparent benefit, as he never owned to being any better for my attention to him. This went on for two years, until I began to get suspicious of him. One day an inmate of the ward, who had recovered and left the House, called on me at my private residence. On seeing me he said, "I have called to thank you for your kindness to me, and also to tell you that you have been deceived by that man Webster, who you have done so much for. He is an impostor. He can walk as well as I can, and, what is more, does walk about." "Nonsense," I replied; "he says he cannot get out of bed, and the nurses confirm it." "Well," he continued, "he takes very good care never to allow them to see him get out of bed, he takes his constitutional walk about the wards between 2 and 4 a.m., when the lights are down, and most of the inmates asleep." "But, surely," I said, "the night nurse must have seen him, and if so she would report it to me!" "Oh," he replied, "she hardly ever comes into the ward during the night, she is generally in her own room fast asleep--she gets herself called when she is wanted." I made some further inquiries, and finding that there was evidence of deception, I sent him to the Asylum Hospital with a letter to the superintendent medical officer, giving his history, and telling him of my suspicions, and asking that he might be carefully watched by reliable persons. He came back in a fortnight, having been found out. He was immediately transferred to his settlement, where doubtless he recommenced the game of deception, having found it answer so well. It may be here said, If you had not confidence in your nurses, why did you not get rid of them? For the simple reason that I had no power to do so. They were not selected by me, but by the Guardians, and therefore were not my officers, but the Board's. I once reported the night nurse on the male side (the woman who had allowed the malingerer to deceive me) for drunkenness, but I had so much trouble to get rid of her that I was not induced to repeat the experiment, added to which I was most grossly insulted by the master for bringing this woman's conduct before the Guardians. In my opinion the medical officer should select and discharge all the nurses--of course, reason for this latter action being shown. I should have discharged several at the Westminster Union for neglect of duty and for general incompetence if I had had the power. Simple complaint would be attended by no beneficial result, as it would be a hundred to one that the nurse would be supported in her misconduct by some member of the Board, whose protege she might be. On mentioning this to an ex-workhouse medical officer, he told me that on having occasion to represent the conduct of the resident midwife, who claimed and exercised the right to go out on every Sunday for several hours, leaving the wards wholly unattended on every such occasion except by pauper helps, the only action taken by the Board as a return for it, at the instance of the midwife's friend, was the adoption of a resolution that a return should be prepared and laid on the Board-room table, showing the occasions when the medical officer went out and the length of time he was out, &c., &c. Of course he found out that he had achieved worse than nothing by his effort to check this abuse. This circumstance occurred in one of the largest of our metropolitan workhouse infirmaries. When first I entered on my duties at the Westminster Union the chaplain there was a very energetic little man named Duval. I do not remember his Christian name, for the reason that he was known and spoken of as Claude Duval, and for a long while I supposed him to possess no other. At last I discovered that the name had been given him in joke, and that he was in no way connected with the celebrated highwayman. He most assuredly did not convey the idea that he had any brigand blood in his veins. He was extremely attentive to his duties, and deserved and had gained the respect of all the inmates and officers. Frequently he organized entertainments for the aged and infirm. These were held in the dining-hall, which on all such occasions was crowded to excess. After I had held office about a year he desired me to provide an entertainment, which I did on several occasions, and my efforts met with much success. In the carrying out of these entertainments, which were musical and recitative, I had the assistance of my nephew, Mr. Julian Rogers, and his wife, who brought with them vocalists of a high order, who contributed much to the pleasure of the inmates. These entertainments were highly appreciated by the inmates, and were frequently attended by members of the Board, and by some of the ratepayers living in the neighbourhood. Now and then I used to read extracts suitable for penny readings. On two occasions my efforts took a higher form, when I gave a lecture on the "Ear and Hearing," and on "Sight and the Eye." The preparation of these lectures and the diagrams to illustrate them was a work of considerable trouble and some anxiety, but the signal success achieved on both occasions amply repaid me for any trouble occasioned. To show the appreciation of my audience for a joke, I will relate an incident that occurred during the delivery of my lecture on "Sight and the Eye." I was describing the function of the iris, or coloured portion of the eye, as an involuntary movable veil, which regulated the amount of light which should be admitted to the eye, and said that in order to make the veil complete it was covered behind with a black pigment, so as to exclude all light except that which passed through the pupil. I then told them that in certain animals this pigment was wanting, and not only there but in the skin generally, and instanced the white mouse, ferret, &c., and showed that all these animals had red eyes and always blinked and winked when exposed to a strong light. I then passed on to state that this condition was sometimes found in man, where again the winking and blinking was noticeable as well as the whiteness of the skin and hair, from the absence of this dark pigment, hence the name of "albinos" applied to those thus afflicted. I then went on to state that recently we had a notable example of this in the Chancellor of the Exchequer, who suffered from this infirmity, and that his dread of light was so extreme that he had attempted actually to put a tax on matches. This joke was followed by a positive scream of delight from visitors and inmates--showing that Mr. Lowe's fiscal effort to increase the revenue was known to them all. At the conclusion of the night's proceedings, Miss Augusta Clifford, who was present, came up and said she should repeat my story of Mr. Lowe and the match tax wherever she went. At the next meeting of the Board, several of the Guardians having been present on the occasion referred to, it was moved and seconded and carried unanimously, that a vote of thanks should be given to Dr. Rogers for the entertainment provided by him, and for the highly interesting and instructive lecture which he had delivered. I found in the sick and infirm wards several of my old acquaintances of the Strand, who were chargeable to St. Anne's, and had been transferred to this House when the Union was formed, among them a woman by the name of Maria Hall. She had gone into the Strand several years before I left; her friends at first paid for her maintenance. She was an epileptic--and something beside. When I knew her in the Strand she professed an inability to talk, except unintelligible gibberish. She was very artful; she claimed to be a deeply religious character, and contrived to take in the benevolent lady visitors to a considerable extent. She continually showed me letters she had received, and books that had been given her by ladies, and would ask me to share with her the grapes, cakes, and sweetmeats sent her by her dupes. This went on for several years, altogether about twenty. She always posed and was spoken of as "poor Maria"--in fact, she was the pet of the nurse and of the ward. At last it came to my knowledge that she presumed on her condition to be exacting and troublesome. Finding that remonstrance was unavailing, I reluctantly ordered her removal to the insane ward. It was attended with the best result, for, finding that she was at last sternly dealt with, she threw off the mask she had worn for twenty years and talked as distinctly and clearly as any healthy person. She had traded for years on her alleged infirmity. It was true she was an epileptic, and eventually died from that form of disease; but she had been the most persistent cheat I had ever met with. On the male side I found a poor fellow who had also been transferred from the Strand, where I had known him when he was first admitted there. He was paralyzed all down on one side. He was the most patient, honest fellow I had ever seen. After I had been in office some years Sir Charles Trevelyan came to call on me respecting a public movement that we were both engaged in. Finding I was at the infirmary, he came round to the House and was shown into my room. I asked him to go over the wards with me. He did so. I introduced the poor paralytic to him as an honest, patient, and grateful poor man. Sir Charles asked him how long he had been afflicted, and he answered, "Some twenty years." Then I said, "This poor fellow cannot get downstairs; he has not seen the streets for all these years, but he is always happy and cheerful." Sir Charles kindly left with me £1 to pay his cab fare, so that he might have the chance of seeing them once again. As I had to send two people with him each time the £1 soon went. His enjoyment of this treat in his daily dull, routine life was, I was informed, most pleasing to witness. There were several other very interesting persons I found on both sides of the ward. One was an old man who was said to be eighty-eight years old. On my morning visit he was always standing on the staircase smoking. He had lived many years in Australia, and his long white hair and beard, which reached to his waist, conjoined with a florid complexion and bright blue eyes, caused me to consider him one of the handsomest old men I had ever seen. One day I took two young ladies over the infirmary. We found the old man in his usual place. I jocularly introduced him to them as the Adonis of the House. The old man was terribly offended. As we walked away I heard him muttering aloud, "That's a pretty name to call a man--'Donis indeed!" He did not forgive me for a long while. I wonder what he thought the epithet really was intended to signify. I also found in the male infirm ward an old French physician whom I had known by sight for a great many years when he was practising his profession in Soho. He was a tall, fine man when I first knew him. He always used to wear a very singular-looking broad-brimmed hat. He was in all externals a very gentlemanly-looking person. I had missed him for a long time, and was surprised and hurt to think that he should have drifted to a workhouse infirmary. On inquiring into the cause of his becoming an inmate of the House, for I always thought he was well-to-do, as he dressed exceedingly well, I learned that he had lived with a lady who was an _employé_ at a French milliner's in Regent Street, that she was much younger than he was, and that he had given to her all his money, which she, in preparation for possible consequences, had put in the Funds, but in her own name only. Unfortunately for him she was taken suddenly ill, and being ignorant of English courts made no disposition of the property, simply telling him, on her deathbed, where it was. When she was dead, he found to his dismay that the money could not be obtained, as he could not establish any legal claim of ownership. Grief at the loss of his mistress and of all his money caused the complete break-down of the poor fellow, and he had come into the House utterly crushed. He was a very interesting old man, being the only son of a French noble family. His mother and father were both executed during the Reign of Terror, and when the family property was confiscated he was but a youth. When he grew up he studied medicine, and in the year 1802 entered Napoleon's army as a regimental surgeon. After serving with his regiment in Germany, Italy, and Austria, he was attached to the Army of England, as it was called, which was stationed on the heights of Boulogne. He was there some time. Suddenly an announcement came that the encampment would be broken up, and that the army would go to Russia. He traversed the whole of Europe, taking part in the various engagements on the road to Moscow, which he saw in flames. He was in the memorable retreat, and returned to France without a scratch. On the return from Elba he rejoined his old regiment, and, as its surgeon, fought against the English at Waterloo. After the peace his regiment was disbanded, and as the old soldiers of the empire were very much at a discount he elected to come to England, where he lived since 1816. He died at the age of ninety-five, retaining his faculties to the last. After his death I raised a fund to bury him, by writing a letter to _The Times_, in which I gave his history, heading my letter, "A Relic of the Grand Armée," and asking any friends of the first Napoleon to help me in burying him in some other place than a pauper's grave. My appeal having brought me £25, the Empress Eugenie being one of the subscribers, he was buried at the Catholic Cemetery at Kensal Green. There were two seamstresses who lived in Gilbert Street, Oxford Street, who were his countrywomen and his sole visitors, with the exception of the Catholic priest of the French chapel in Leicester Square. I asked them and the priest to accompany me to the funeral, which I attended as chief mourner. On our arrival at the mortuary chapel, the coffin was placed on a raised bier with three others. Presently two lads, wearing long black cloaks which reached to the ground, came from the altar. When they arrived at the spot where the coffin was resting, one lad suddenly produced from under his cloak a censer containing fire and proceeded to incense the quartette. How he ever carried the fiery thing without setting fire to himself was to me a wonder. He was immediately followed by the other lad, who, taking just as rapidly from under his cloak a vessel like a whitewash-pot, proceeded with a brush to throw holy water on the coffins. This being completed, the coffin was put on a truck and we hurried away as fast as we could go through the miry ground for a long distance to the grave. On reaching it, down went my two lady companions on their knees in the clay. My respect for the deceased did not carry me so far as that, especially as it was raining hard and the ground was a mere bog. Presently the acolyte produced his whitewash-pot and brush, and I was courteously asked to sprinkle the poor fellow's coffin with holy water, which I did. This having been also done by my companions, I was amused by a little girl about fourteen, who, suddenly taking the brush and pot from one of the young women, went to work sprinkling in grand style, and, what was rather alarming, let me in for more than I had expected. On our return journey the priest asked me to attend service in the Catholic Chapel, in Leicester Square, on the next Sunday. This I did. He was a very gentlemanly person. He thanked me very much for the little service I was enabled to render to the poor old French doctor, whom I missed very much, as it was my habit to sit beside the old man's bed and hear him fight his battles o'er again. The opposition to the removal of the sick to the Asylum Hospital at Highgate continuing, and plausible ground for some action having been shown in the fact of that establishment being so far away, a move on the part of the Department became necessary. The old Workhouse in Cleveland Street being no longer wanted by the Strand Board (as they had built a new House at Edmonton), it was proposed to pull down and rebuild an additional Asylum Hospital upon the site. The vestry of St. James's, instigated by the Chairman of the Board, gave a determined opposition to the proposition. But for once the Department was firm and the hospital was built. At first the four Unions were associated in its use and management, but after a time its use for the reception of acute cases was limited to the St. Giles's, and St. George's, Bloomsbury, the Strand, and Westminster Unions. The Chairman having for a time retired from the Board, his place was filled by a fresh Chairman, and no obstacle being made to my utilization of Cleveland Street Asylum, suitable cases were transferred there, to the relief of the Westminster House, which, through the resistance of the Board, had become inconveniently full. The new Chairman was a very weak man, who was neither by his financial position or general intelligence justified in aspiring to hold such an office. It is possible that if he had devoted the time he spent at the Board and at the Sick Asylum to his private business he might have delayed, and possibly have staved off, his eventual bankruptcy and ultimate death in the Asylum Hospital in Cleveland Street, to the building of which he gave the most determined opposition. His successor as Chairman was a surgeon in Soho, who was a man of very fair attainments, and during the time he occupied the chair the business of the Board was carried on with remarkable success. I received from him the most generous support, and during his tenure of office my official life was hardly chequered by a single cloud. I have spoken of the clerk of the Board as having expressed a favourable opinion of the economy I had effected on my first entrance on my duties. The clerk had occupied a similar position at St. Martin's prior to its amalgamation with the Strand Union. As I never went near the clerk of that Union after the discovery of his perfidy in making, in conjunction with Catch, a false charge against me, I was often at a loss to know to whom I could go when any difficulty cropped up. Having had an introduction to this clerk, I frequently called and consulted him; consequently I was not surprised when, through the loss of his office, as the result of St. Martin's being joined to the remaining parishes of the old Strand Union, he was without employment, that he should call on me and invoke my good offices in favour of his being appointed to a similar position in the Westminster Union--the gentleman who had filled the office and that of vestry clerk for St. James's having elected to continue in the latter office only, and not to combine therewith any appointment under the Poor Law. Having some influence in St. Anne's at that time, and being also known in St. James's, I gave him my support, with the result that he was elected clerk to the Board. He never exhibited gratitude for my doing this; indeed, on the contrary, he was distinctly hostile to me during the first few years after my appointment, more especially in all matters relating to lunatics, the truth being that he had a sympathy with all those who were alleged to be of unsound mind, arising, I consider, from the fact that he had a consciousness of not being quite right himself. During the two-and-twenty years I knew him I never saw him half-a-dozen times with a shirt on. I do not state that he never wore one, it was simply never visible; what did duty for it was a sheet of more or less crumpled whitey-brown paper. His clothes were as torn and ragged as those of the most poverty-stricken casual--his shoes down at heel, and the legs of his seedy-looking black trousers hanging in rags. He always complained of being so very poor through the strain put upon him in having to support some needy relatives. His condition and poverty-stricken appearance were often the subject of conversation and commiseration: "Poor fellow," it used to be said, "he has had a great deal of trouble, and is very poor." It was therefore a matter of great astonishment to find, after his death, which took place somewhat suddenly, that he was possessed of several thousand pounds. He died without making any will, and there was a legal struggle among distant relations as to who should secure his very considerable belongings. I have frequently noticed on the part of eccentric people this disbelief in and morbid sympathy with lunatics, and believe it to arise from a species of innate consciousness of mental deficiency, and a fear lest they also should be incarcerated. One morning, some time before his death, he came to me in my room and showed me a letter he had received from the military Commandant of Devonport Barracks Hospital, which was to the effect that they had a young soldier under treatment for lunacy, who, in his attestation when enlisting, had stated that he belonged to St. James's, London, and that the authorities determined to send him up to us. The clerk said to me, "That does not show that he belongs here, as there are several St. James's in London; I shall write and refuse to take him until his settlement has been determined." But he reckoned without his host, for when did the military ever recognize the civil power? The same evening I was requested to go to the insane ward, where I found the young soldier, and the attendant informed me that he had been brought by a corporal and left in the ward, and that the corporal said that he should call the next day for the hospital clothes. The attendant also stated that when brought in the man's hands were tied together behind his back. I could make nothing of the poor fellow, as no history was brought with him, and he would not speak. As he appeared to be very exhausted I ordered him some milk, beef-tea, and wine, and desired that when the corporal called the next day he should be detained, so that I might learn something about the patient, but when asked to stay and explain, the corporal would not stop. On visiting the man on the next morning I found that he had taken nothing, and as he would not open his mouth, speak to me, nor do anything, I sent for the stomach-pump and some of the strongest of the pauper inmates, that he might be fed by artificial means. It took four to take him out of bed, secure him in a chair, and to assist me to get his mouth open, when I made the dreadful discovery that all his teeth had recently been broken away in the forcible efforts that had been made to feed him. After a most desperate struggle I administered some beef-tea, arrowroot, and wine. This had to be repeated for two or three days, until the necessary certificates were ready, which enabled me to send him away to Hanwell. I was so disgusted with the barbarous manner in which the young man had been treated, that I wrote an indignant letter to the military authorities at Devonport, complaining of his treatment, and their neglect in sending the poor fellow to the Workhouse without affording any history of his case. The reply was a cool denial of the truth of my statement, and an assertion that he took his food readily and without artificial feeding. I sent this letter to the medical superintendent of Hanwell, and asked for his opinion, when he replied that the man had been forcibly fed for some time, and that his teeth had been destroyed in doing so. I then wrote an account of the case and sent it to Dr. Lush, M.P. for Salisbury, and asked him to see the Minister for War on the subject, and in the House to ask the question I had drafted. A few days after Dr. Lush replied, telling me that he had seen the Minister, who read the statement, and said he thought that it was a very shocking story, but he hoped that I would not press for an official inquiry, as it would ruin the officers inculpated, and promised that he would send out to all military hospitals such an instructional letter as would prevent the occurrence of such things in future. Dr. Lush also added, "I have promised not to press the matter, especially as the Minister for War did not hesitate to tell me that he entirely believed your statement," and continuing, said, "I know, Rogers, you do not want to ruin anybody, and if the matter is made public there will be a dreadful row, and the whole blame will be thrown on the doctor." I reluctantly assented to this view, and the matter dropped. The poor fellow was afterwards proved not to belong to St. James's, Westminster, but to some parish in the East End. He did not remain chargeable to any parish very long, as he died soon after at Hanwell. Dr. Raynor, when I appealed to him for his opinion, stated that if I had not written at the time of his admission and explained how I had become possessed of the man, he should have felt it his duty to have made a special representation to the Commissioners in Lunacy as to the condition he was in on admission, and the barbarous usage he had received. When at the Strand I was required to give the certificate in lunacy and attend before the magistrates in its support, and was paid a fee for my trouble; when appointed to the Westminster Union it was arranged that my salary should include all extra fees, particularly because the magistrates at Great Marlborough Street, contrary to the statute, required two certificates. The Guardians being unwilling to pay the fees of two medical men, the medical man called upon to give the second certificate was paid. As this appointment was dependent on the caprice of the Board, it frequently happened that the other medical man, who was aware of the feeling of certain of the Guardians, would refuse to endorse my opinion, but I always succeeded in getting my way in the end. One medical man who held this office for some time was constantly striving to secure favour by giving the most unaccountable certificates as to the condition of the lunatic submitted to him. I had the satisfaction of getting rid of him at last, but not until he had given me and the officers of the House a great deal of unnecessary trouble and annoyance. In addition to this, the magistrates at Great Marlborough Street, forgetting altogether that when two certificates were presented their duty became simply a ministerial one, would frequently decline to certify for removal of undeniably insane persons, and direct the return to the House for further observation. No magistrate was more original in this way than Mr. Newton, of Miss Cass notoriety. Over and over again Mr. Newton has set up his expression of opinion in opposition to my certificate and that of the extern, but after giving unnecessary trouble and delaying the removal of the patient, thereby diminishing her or his chance of recovery, he would eventually be obliged to affix his signature to the certificate. To such an extent did this action prevail, and so much were the officers worried by this magistrate, that it became a custom on the part of the removal officer to send and inquire what magistrate would be on the bench, and if he found it was Mr. Newton, to take the case on the next day when he was not there. As I am on the subject of lunacy, and as I believe that much mischief has ensued from the laity assuming that persons are improperly confined in asylums, I will relate one or two instances of ill results that have followed from treating insane persons as responsible for their conduct when a very small amount of consideration of their actions would show that they were of unsound mind. Upon one occasion, on going into the male insane ward, a tall, decent-looking man, turned round and looked at me. His aspect instantly told me that he was of unsound mind. To my inquiry where he came from the attendant replied, "I do not know, sir; all I do know is that his wife brought him here yesterday and left him". I spoke to the poor fellow, and was perfectly convinced that he was insane. I directed the attendant to go for the wife. On my return from the wards to the consulting-room I found a decent-looking little woman waiting my arrival. To my inquiry what she wanted, she said, "You sent for me." "Oh," I replied, "you are the wife of that poor fellow over the way in the insane ward--how long has he been out of his mind, and where have you brought him from?" To my astonishment she burst into tears, at the same time saying, "He came out of prison yesterday, sir." "Out of prison," I replied; "why, how could he have got into a prison? That poor man has, to my certain knowledge, been a lunatic for a long while." She immediately said, "Yes, sir, I have known it for nearly a twelvemonth, but no one but you has ever said so before." I told her to compose herself and tell me his history, when she stated as follows: "We have been married about five years, and a better husband no woman could have had, but about a twelvemonth ago he complained of his head, and could not sleep or work as he had done. I did my best to cheer him up, and told him to struggle against the feeling and all would come right. His occupation was that of a coat-maker for one of the best West End master tailors. One afternoon, some months ago, he threw down a coat he was making, saying he could not go on with it, he must go out, which he did. About an hour afterwards a policeman came to tell me my husband was in Vine Street Police Station, and that he had been taken up for stealing. I hurried there, when I heard that, walking along Little Pulteney Street, he came opposite a poulterer's shop, when, suddenly springing on the show-board, he clambered up by the hooks till he reached the top, and, taking off a hare, he put it over his shoulder, and jumping down some ten feet, he stood there. The proprietor gave him into custody. The next day he was taken before Mr. Knox, who committed him for a term of six weeks' imprisonment and hard labour, it being his first offence. "Whilst he was in prison I had to part with many of my things to keep my children. On his discharge I met him at the prison gate, and saw he was worse. I did my best to cheer him up, and told him if he would not do anything of the kind again I would do all I could for him. On his reaching home I said that I had been compelled to part with some of our things, and that, therefore, he must go to work at once. The same day I went to one of our employers, a master tailor in Maddox Street, and asked for some work. A dress coat was given me to make up. My husband went to work at it, but he did it so badly that when he took it to the shop the master refused to pay him, and gave it him back again. During the conversation my poor husband took off a pair of black dress trousers from a hook, and put them under his arm. He had not long left the shop when it was discovered, and one of the shopmen, running after him, caught him with the property. He was again given into custody, and taken before Mr. Knox, who committed him for trial. At his trial at Clerkenwell Sessions shortly after, he was found guilty, and evidence of a previous conviction having been given, he was sentenced to six months' imprisonment and hard labour. That his time was up yesterday morning, that she had met him at the prison gate, and seeing that he was much worse she had brought him straight to the Workhouse, so that he might be kept out of further mischief." She followed it up by saying (with a burst of tears), "You are the only gentleman who has ever said that he was not right in his head, but I have known of it for months past." I stood utterly astonished that so gross a miscarriage of justice should have been perpetrated; that a man evidently so bereft of the knowledge of right and wrong should have been punished as a criminal. After inquiring where she lived, and also for some references, I told her if my inquiries bore out what she had stated, I would publicly expose the treatment her husband had been subjected to. I made inquiry the same afternoon, and found that both the husband and wife had borne a most excellent character up to the time of his first arrest. The next morning, so soon as my official duties were over, I went to Great Marlborough Street Police Court, and asked to see Mr. Knox. I related the story to the magistrate. When I had finished it he was very much affected, and expressed his regret that such a dreadful thing should have occurred. He also went on to state that they had so many people brought before them, and it was all done in such a hurried way, that without special attention was drawn to a case, and if the facts were not disputed, and if no one appeared for a prisoner, a decision was come to at once. He further said, "I remember the poor fellow being brought before me perfectly. I do not think that it is desirable that this story should be made public; it can do no good. Send the wife to me and I will give her a present from the poor-box." When leaving the court the jailor followed me, and said, "I am pleased you have been here. I saw that poor fellow was out of his mind on each occasion when he was brought before the magistrate." On reaching the street I met Mr. W. J. Fraser, Guardian, and now the Chairman of the Board, to whom I told the circumstances. Mr. Fraser was very much shocked at the treatment this poor lunatic had received, and that Mr. Knox had desired that no publicity should be given to the case, and replied, "Give it every publicity you can." That same evening I wrote to the editor of _The Times_ the particulars of the case, and, as the poor husband's condition was irremediable, I pleaded that monies should be sent me to enable me to put the wife into some way of earning her livelihood. The letter duly appeared, and caused a great deal of sensation, many subsequent letters from gentlemen interested in the question of lunacy being published. As a result the sum of £85 was subscribed for the wife, and was sent to me. It was a puzzle to me to know what to do with the money, which was not enough to buy a chandler's shop and stock it. I decided to set the woman up in business as a laundress at Battersea. I went there, took a suitable cottage, and guaranteed the rent for six months. Then I went to a firm in Holborn and purchased the laundry plant, which, under the special circumstances of the case, was sold to me at a reduced rate. I got a forewoman whom I borrowed from one of my patients in a large way of business as a laundress, and started her by inducing people to patronize her. I could do all this, but I could not make the poor woman a laundress, and after a few months' trial she came and asked me to let her dispose of the business and plant that she might go to her friends in the country. I assented, for I had discovered that she was a business failure. She sold off everything, went away, and I have never heard of her since. Her poor husband did not long survive, and without doubt his death was hastened by prison life and the treatment he had received there. He died at Hanwell of general paralysis of the insane. It would prove instructive if it could be ascertained how many poor creatures have been similarly taken into custody, convicted, imprisoned, and after spending more or less time in prison discharged with their mental condition hopelessly shattered from the treatment received. Some years since I went over the Naval Hospital at Yarmouth, for those who had become insane whilst in the service. There were several men of magnificent physique, who were stricken with the same kind of mental infirmity as that which had caused the death of my unfortunate patient. I inquired of the courteous medical superintendent whether he had any history of these men. He said yes. I asked whether the first evidence of their mental ailment was not the exhibition of some departure from discipline or of theft, or some other action which was totally at variance with their previous conduct. He informed me that their records showed that such was the case. Woful results have followed the action of judges and police magistrates in dealing with numbers of their fellow-creatures as criminals when they rather required a nurse and skilful attention than the rough services of a prison warder. But then this deplorable condition of things will continue so long as such scant consideration is shown to the actions of the poor, who, being without means, cannot command the services either of barristers or solicitors. It was during the reign of the Chairman of the Board who subsequently died in Cleveland Street Asylum, that one of the most extraordinary cases of lunacy I ever witnessed came under notice--extraordinary in one sense only, viz., in the manifest determination of certain officials to prevent me from sending to the asylum one of the most artful and yet hopeless lunatics I ever encountered. Originally she had been admitted as a woman of unsound mind. I examined her at the time, and at once filled in a certificate that she was a case for removal to an asylum. She was not, however, sent away, as the clerk intervened, and at the next meeting of the Board he showed that the woman was the wife of the parish broker, who was a man of means and quite able to keep his wife in a private asylum, whereupon it was ordered that the husband should take her out. After her return home her husband asked me to see her; he could not live with her, her conduct was in every way so objectionable. I saw her again, certified that she was of unsound mind, and she was sent to St. Luke's, and her husband paid £1 a week for her maintenance therein. Getting tired of this, for he was a most penurious person, he took her out. Sometime after he was taken ill and died, leaving upwards of £4,000. Dying intestate, his property was divided between two brothers and the widow, her share, the third, being upwards of £1,500. The solicitor who wound up the estate, recognizing her mental condition, tried to induce her to let him invest the money in some security, but she refused. She would have her money paid over to her absolutely. This was in November. By the middle of the following August the money was all gone. She had squandered it all away; and having by her habits, which were to the last degree objectionable, caused her ejection from one lodging after another, the relieving officer was again called in, and removed this wretched woman to the Workhouse insane ward. She brought with her a large amount of property which was not convertible into cash. Now, it may be asked, How was the large sum of £1,500 got rid of in but little over eight months? The explanation is a sad one. The first thing this poor woman did was to buy some £24 worth of plants in pots, which were taken to a furnished room she had hired in Gerrard Street, Soho. She never attempted to attend to them in any way, and, therefore, in a very short time they were all dead. She then sent to a well-known drapery business in Regent Street to buy some clothes. Before she left the shop the person in the department she went to had induced her to buy some £300 worth of personal clothing, which was all sent to this single room in Gerrard Street. She also went to a pianoforte manufacturer in Regent Street, and purchased a sixty guinea piano, at the same time being absolutely ignorant of music; and if any one had taken much trouble they must have recognized by her appearance her mental deficiency. About two months after she first purchased at this draper's shop, the shopwoman who had sold her £300 worth of clothing, called on her in Gerrard Street, and, although this room contained the dead flowers and unopened boxes of the first purchase, she induced her to buy £250 worth more, thus making a total of £550 expended by a poor insane woman. The Rector of St. Anne's, Soho, informed me that she regularly attended the sacrament, and always put £1 in the plate in new gold. What made the conduct of the shopkeeper of the firm in Regent Street the more inexcusable was that at the time she called on her the woman was in such a state, in consequence of her dirty habits, as to be plainly insane, and this compelled the landlady shortly afterwards to insist on her leaving the house, as all the other lodgers complained. When she was first admitted to the Workhouse her habits were so repulsive that she was an intolerable nuisance to the other inmates and nurses, for she was alive with parasites. I considered the treatment this poor creature had received at the hands of the proprietors of the drapery establishment so abominable that it merited exposure, and with that view I called on a gentleman connected with the Press, and asked him to take the matter up. He declined, as it was not within the province of his journal. At the same time he gave me an introduction to the editor of _Truth_, who he said would do so. On going home I drew up a history of the case, and sent it in a letter marked private to the editor, enclosing the letter of introduction, and asking that he would grant me an interview, when we might arrange for publishing my statements without my name appearing. I received no answer from the editor, but a day or two afterwards I was told that my statement had been published _in extenso_ in _Truth_. A day or two after that the Chairman, who lived nearly opposite the draper's shop, called on me and stated that he was deputed by the firm to inform me that if I did not at once write to the editor of _Truth_ and disavow the letter and story an action for libel would be commenced against me without delay. My answer was as follows: "Go back to this firm and say that I did not give any authority for the story to appear as it has done, but as it is all absolutely true I shall decline to withdraw or modify a single syllable." I certainly did write to the editor and complained of the way in which he had published the story, and told him of the threat which had been made of prosecuting me. The only result was that an annotation appeared in the next week's issue which, under the guise of an explanation, made the scandalous story a great deal worse. The firm did not prosecute me or the editor of _Truth_. It would be imagined by my readers that there would have been no difficulty in getting this poor woman sent to an asylum, but I never had greater trouble in my life, owing to the action of Mr. Newton, the police magistrate at Great Marlborough Street. Five times during the five months that she was detained in the insane ward, where her habits were most disgusting and highly objectionable to the other inmates and to the nurses, I certified for her removal. On each occasion she was sent back by this magistrate. Hearing that he was gone for a holiday, I, for the sixth time, filled in a certificate and went with her and my out-door colleague to the police office. To my surprise I found the Chairman of the Board and two of his friends, members of the Board, in attendance to give evidence in this woman's favour. The clerk had found out what I was doing, and had sent word to them. At the hearing before the magistrate they attempted to interrupt me in my evidence, but they were very properly put down by the magistrate. He at once countersigned the certificate and she was removed. But my troubles were not at an end. The trio sent to the Commissioners in Lunacy an intimation that I had unjustifiably sent a sane woman to Hanwell Asylum. Upon this coming to my knowledge I went there to see her, when the medical superintendent of the female side informed me that a special letter had been sent from the Lunacy Commissioners requiring him, at the end of three weeks, to send a detailed account of the case to them. He said, "I never met with such a case. I was sure from your certificate she must be insane, but she pulled herself together so wonderfully and was so well conducted that I had come to the conclusion that you must be mistaken, when suddenly she broke down, and her insanity became apparent, and I have reported in that sense to the Commissioners in Lunacy." This story illustrates the utter absurdity of the provision in the Lord Chancellor's Bill committing the examination of these cases to a county court judge, police magistrate, or Justice of the Peace, who cannot possibly understand anything about the varied phases which insanity presents. The district medical officer who jointly filled in the certificate with me was deprived of his office, and a more manageable person was elected by the Board in his stead--that person I have before referred to in the earlier part of this narrative as giving me so much needless trouble. Some three years ago I had occasion to go to Hanwell. Whilst there I asked whether the woman was still in the asylum. On learning that she was I expressed a desire to see her, when the superintendent medical officer gave directions that she should be brought down. Immediately on seeing me she sprung upon me, and, before I was able to defend myself, pinioned me in her arms, at the same time imploring that I would take her away with me. It took three able-bodied women to release me from her grasp. Should I ever go to Hanwell again I will keep clear of her. I have had quite enough of her. She is a hopelessly incurable lunatic. As she gets older she will become more and more demented, and will be eventually removed to some imbecile establishment. The female insane ward at the Westminster Union was always full, and when a noisy or dangerous lunatic was sent in, and whilst the necessary steps were being taken to get them away, the harmless patients had anything but a pleasant time of it. But then the comfort of these people was never at any time considered by those members of the Board who considered themselves authorities in lunacy. Fortunately they could not state that my action arose from the desire to get a fee, as I was never paid one, but they did say that I sent them away as I did not want to attend to them. We had on several occasions very amusing cases of lunacy. One of the most so was a Welshman, who, until he lost his reason, had been a very respectable journeyman tailor. I was asked to see him by a member of the Vestry in whose house he lodged, and who gave him a most excellent character for honesty and industry. He had saved money, and was exceptionally respectable in his appearance and conduct. On being shown into his room he rose and received me with much politeness. I noticed a quantity of ladies' underclothing on the table, and evidently intended for some small woman, as the various things were all on the same diminutive scale. On asking what it all meant he said, "Oh, that is for the lady I am about to marry. I have just purchased a complete set of ladies' underclothing as a present for my future bride." "Indeed," I said, "is it usual for the gentleman to buy his future wife's underclothing?" "Well," he replied, "perhaps not, but I am a very particular person, and my wife must dress as a lady." "Just so," I said, "but how have you managed to get all these things so exactly arranged as to size?" To which he replied, "You see, I am accustomed to measure people, and I have taken my dear little girl's size exactly." I then took up a pair of some two dozen of kid gloves, with the remark, "You have bought her some good gloves, at any rate." "Do you think so?" he said. "Do oblige me by taking a pair away with you; they may suit one of your daughters." As his insanity was undoubted, I suggested his removal to the insane ward. This was carried out. On seeing me next day in the House he spoke rapturously of the ward he was in, and of his companions, all of whom he had invited to his wedding. They would have been sorry-looking persons to have made part of a company at a marriage-feast! I was so amused at this poor fellow's delusions that next day I took one of my young lady relatives to see him. On my asking the attendant to bring him out into the yard, he came. At first he looked dazed, but, seeing a young lady, he ran towards her, and, peeping under her bonnet, he looked up and said, "She is devilishly like Mary Jane," this being the only name he had for his imaginary future wife. My young companion was so tickled that she burst into a hearty laugh in which the poor fellow joined. Subsequently he was sent to Hanwell. On visiting the asylum some months afterwards I asked to see him, when he was sent for. On entering the room he recognized me instantly, and expressed his gratification at my calling to see him. His delusions were as marked as ever. As I had gone there on other business I resumed my conversation with Dr. Raynor, and forgot our Welsh friend altogether. Presently we both went out into the yard, when, to our astonishment, we found that he had gone out, and would have escaped altogether if he had not luckily been observed and taken back to his ward. Poor fellow! Some time after he was removed to Wales, where he was settled, and he ultimately died of general paralysis, and so the contemplated wedding was adjourned _sine die_. The underclothing, gloves, silk stockings, &c., were all sold to help pay for his maintenance. I never saw such a genial and absolutely happy lunatic. He lived in the company of his imaginary Mary Jane. It must not, however, be imagined that all are so light-hearted as this Welshman. I have encountered homicidal lunatics, and have personally experienced what some are capable of, having sometimes sustained severe assaults from incautiously going too near them. Early in 1872 the present Chairman of the Westminster Union, W. J. Fraser, Esq., solicitor, asked me to visit the Rev. H. Watson, ex-master of Stockwell Grammar School, who was then located in Horsemonger Lane Gaol on the charge of killing his wife. I did so, and after an interview which lasted an hour, came away and wrote a report that in my judgment he was of unsound mind. I formed that opinion from the levity of his manner, his self-exaltation, his total indifference to his fate, the absence of all regret for what he had done, and the absolute want of any feeling on the subject. He was lost in the belief that his services in the education of youth precluded the possibility of any punishment for his deed. At the Old Bailey, as I was about being called upon to give evidence, the counsel who defended him, the late Sergeant Parry, called me over to tell me that they had decided not to call me as a witness, but only just to support the views of the others. He said, "We think you may be a dangerous witness." After asking me a few questions he said, "You can stand down." But I was not to stand down, for the prosecuting counsel, Mr. Poland, immediately proceeded to severely cross-examine me. But to all his questions I had my reply ready, and after some half hour's trial of questions and answers I managed to get out all the points on which I relied to prove Watson's mental unsoundness. When I got down Dr. Blandford said, "You have done well; you have convinced the judge;" which was shown in his summing up and in his after action at the Home Office. Whilst under cross-examination I spoke of his enormous self-exaltation, &c., giving instances, whereupon Mr. Poland said, in a professional tone of voice, "Oh, you consider that is a sign of insanity, do you?" "Well," I said, "seeing he was only a schoolmaster, I do." Whereupon Watson, who was listening attentively to my evidence, wrote on a piece of paper and gave it to Mr. Fraser for presentation to his counsel. He had written, "What does this d----d fellow mean by calling me 'only a schoolmaster'?" After his conviction and sentence he was removed to Horsemonger Lane Gaol. When Mr. Fraser went to see him next day the only thing he complained of was my having spoken of him as only a schoolmaster. He had nothing to say about his conviction and fate; as regards that he was absolutely indifferent. There was a terrible row in the Press about this man, and the doctors were all condemned for their efforts to prove that his mind was unhinged. It was therefore some comfort to me when, in going down the street in which I then lived some few days after, I saw Lord Elliot, the son of the Earl of St. Germains. On meeting me he crossed over the road, came up to me, and holding out his hand and taking mine he said, "I see you have been figuring at the Old Bailey." "Yes, my lord," I replied; "I hope, however, you do not think I have done wrong in giving the evidence I did?" "Oh no," he said; "I have just come from the Home Office, and have met there the Lord Chief Justice (Cockburn) and Mr. Justice Byles, who have both advised the Home Secretary that they consider that the plea of insanity was, in their judgment, fully sustained: at any rate, he will not be hanged." His sentence was commuted to penal servitude for life. Poor old Watson was sent to Parkhurst Prison. Some years after the governor and surgeon informed me that he preserved the same callous and indifferent manner which I had described at his trial. His only complaint was that he could not get the particular copy of the Greek Testament he wanted, and he never to the last referred to or expressed any regret for the act he had committed.[1] After I had been at the Workhouse some two years I was requested by the Board to go down and take temporary charge of the Union school at Wandsworth Common. It would appear that there had been a quarrel between the superintendent matron and the medical officer, and an official inquiry having been held by a Poor Law Inspector he had reported that he could not decide which was in the wrong; he would advise the Board to call on all three to resign at the end of the following Midsummer quarter. The medical officer, Dr. Noel, who, strange to say, had been a schoolfellow of mine nearly fifty years before, at once sent in his resignation. I took over the duty at the end of April, and had charge of the schools nine weeks. It was a very pleasant excuse for an outing, and as the Common at that time was not much built upon and the gorse was in full bloom, it made for me a very agreeable change. At the Midsummer quarter a new medical officer was appointed, and my temporary appointment came to an end. There was extremely little sickness during the time I had charge of the establishment, and I therefore came to the conclusion that the only possible explanation of the quarrelling was because they had so very little to do. My successor was appointed on the distinct understanding that in the event of any serious illness occurring he was to send for me. His neglect to do this led, some five years afterwards, to his being called on to resign, and to my being put again in control of the schools and retention of the office for eight months. The occasion for my being sent down the second time was a serious outbreak of ophthalmia which had taken place, one-half of the school, about sixty children, being more or less affected with it. I could not afford the time or undergo the fatigue to go there every day, so on my return home I made a report to the Board that on condition that the Board gave me full powers to act as I thought best I would root out the epidemic. This was assented to, whereupon I brought back forty-eight of the worst cases to the Workhouse, and isolated them in the large wards at the top of the main building. I also brought with me the nurse and assistant school-mistress. I told the Board that some of the cases were so very bad that I must be allowed to call in an ophthalmic surgeon to aid me in my treatment. This was also assented to. I also arranged that the children should go for a run in the park every day, weather permitting. I considered the dietary of the children, and, finding it to be wholly insufficient, I amended it. I adopted a similar course at the school. Fortunately for the children the Chairman of the Board, a medical man, supported me in all I advised and did. I had the children's hospital at the school whitewashed and painted green and varnished, the walls stopped and covered with neatly-framed engravings kindly sent me by the proprietors of _The Graphic_. At the end of eight months I gave up the appointment, leaving the children perfectly well, except in a few cases where irretrievable mischief had taken place ere I was called in. Much of my success was due to the Chairman of the Board, the late Mr. Henry Cooper, of Soho, who throughout gave me the most generous and unfaltering support. Many of these poor children would have hopelessly gone blind if it had not happened that at the period of the epidemic the Board fortunately possessed an intelligent and public spirited Chairman. Not a very long time afterwards he was taken ill, and after lingering some time died, to be succeeded by another person who, most unluckily for the welfare of the House, had again been returned as a member of the Board and elected the Chairman. About some two years after my appointment a woman, extremely ill, was brought from Vine Street Police Station. She was an unfortunate, as it is called, who had been taken ill in the cell. Repeated requests from her for attendance met with no attention. At last, her condition appearing desperate even to the constables, the divisional surgeon was sent for, who directed that she should at once be removed to the Workhouse. She was brought in on a stretcher, and I was summoned to attend her without delay. I found that she was dying, and not a long while afterwards she succumbed. A coroner's inquiry taking place I made a post mortem, when I found that she had died from the rupture on an aneurism of the abdominal aorta, which, giving way in the loins, had slowly infiltrated the tissues until, a vent being found, the whole thing gave way. There is no doubt that this rupture had been precipitated by the violence attending her arrest. The verdict, under the direction of the coroner, led to a censure of the police for their inhumanity and indifference. The ultimate result was to immensely add to my troubles, as will hereafter be shown. Just at this time the old and sagacious surgeon of the division died, and his place was sought after by several medical men living in the neighbourhood of the two police stations in St. James's, some of whom were men of acknowledged position. The gift of the appointment was vested in the Chief Surgeon of Police, Mr. Timothy Holmes, of St. George's Hospital. He gave the office to one of his old pupils who at the time was non-resident, but who at once took a house in Jermyn Street. It was not very long before I experienced the result of the change. Case after case was sent into the House from the two stations with certificates that the persons were ill when they were undeniably and plainly drunk. At first I complained of this to the inspectors, but it led to no result. I then wrote to the Commissioners of Police, complaining of the annoyance. I got only an official reply. At last the nuisance became so great, for we were always called to these police cases sent in from the station in the small hours of the morning, that I again wrote to the Commissioners and requested an interview. This was granted. I took with me my assistant who had been principally called out of bed to attend to these cases, sometimes only to dress a wound which the police surgeon was too indolent to do himself although he was paid a fee for each visit. On arrival we stated our complaint, but, although the Commissioners listened to us attentively, not much benefit accrued. It is true they stated that an inquiry should be made and instructions given and that more care should be exhibited. Some time after this I happened to be at the gate when a constable brought a perfectly drunken woman, who, he said, had fallen down in a fit. I said, "Why, she is only drunk and incapable; take her away to the station;" and turning to the master I said, "Do not admit her." An entertainment was being held that evening which I had assisted to get up, and I went on into the dining-hall. About an hour afterwards the master came to me and said, "They have brought that woman back with a certificate from the doctor that she is dangerously ill." I went to see her. She was only a shade more under the influence of liquor than she was before, but, not caring to contest the subject any further, I directed that she should be sent to the receiving ward and put to bed. The next morning on seeing her she had got over the drunkenness, and she owned to me that she had been only drunk the night before. On going to my room I directed that a special messenger should take a letter from me to the station, telling the inspector on duty that the woman that had been sent in the night before alleged to be ill, had confessed to having been only drunk, and requesting him to send a constable and take her away. The constable came. In the after-part of the day, a constable of that division called at my house and said that Mr. Newton requested that I should attend the police court the next morning. I went, when I found the woman there and the divisional surgeon. The magistrate, before hearing a word from me, proceeded to inveigh against me for my action in the matter, and peremptorily ordered me to admit the woman at once. The divisional surgeon also jumped up and protested against my refusal to admit the woman, and stated, to my astonishment, that she had heart disease, and that she was a confirmed epileptic. I mildly replied that she was suffering under nothing of the kind, but Mr. Newton told me to leave the court. The woman did not come into the Workhouse until the evening, and she was then under the influence of drink. On my return to the Workhouse I told the master what had occurred, and also asked him if he knew where she came from. "Oh," he said, "the receiving wards woman informs me that she belongs to Whitechapel Union, whose clothes she is wearing." I then asked him to write to the master of the Whitechapel Union and ask him what he knew of her. In less than twenty-four hours the reply came. It was to the effect that she was one of the most abandoned characters ever in their House; that she did not suffer from fits, though she often assumed to have one; that she never went out except to return drunk; that she had no heart disease, but was a hale, hearty woman; that on the day she went out, wearing the House clothes, it was after three months' detention, she having returned on the last occasion drunk and disorderly. Having received this report, I sent it to Mr. Newton. At the same time I protested against his having sent for me to attend his court, and for the remarks he had made to me on the faith of the opinion expressed by a person of very little experience, and further informed him that I should continue to protest against the use of the wards of the Workhouse as a receptacle for merely drunken men and women, and should advise the master accordingly. The annoyance still continuing, I made a point of sending for the police each morning after every drunken admission. Then a new antagonistic element was imported in the shape of a letter to the Local Government Board from Mr. Timothy Holmes, containing a complaint against me for the trouble I was giving the police authorities in objecting to the reception of sick people from the station to the Workhouse. The letter having been sent to me to answer, I forwarded to the Local Government Board the names of some sixty persons brought in by the police under the certificate of the divisional surgeon, and showed that two-thirds of the entire number were proved to be only drunk and incapable, and that the rest were, in the majority of instances, very trivial cases of illness. The nuisance after this was very much diminished. It may be asked, What are the police to do with persons who allege that they are ill? Are these complaints to be disregarded? Certainly not. But I contend that reasonable care should be taken by police surgeons, before they send cases of alleged illness to a workhouse infirmary; for it must be remembered that they are paid a fee for each visit and examination. To go, therefore, to the station, make a cursory examination, and then write a certificate that the person is seriously ill and must be removed without delay, or in the case of a simply cut head send it at once away to the infirmary for the workhouse surgeon to get out of bed and dress it, is, in my judgment, an entirely unsatisfactory procedure, especially as the latter is paid no special fee, be his trouble ever so great. There was nothing in all my duty as a workhouse medical officer, which irritated me more than these police cases. I remember on one occasion a superintendent of police said to me, "I hold that if after our surgeon makes these mistakes he were to forfeit his fee, which should be paid to you, you would not have many then." Sometimes the police brought cases of interest. On one occasion two Italian children were admitted. One was a boy of nine, clean and well nourished, the other was a little fellow of about five, wonderfully emaciated, and bearing about his little lean body evidence of recent ill-usage. The parents, who were Italian Jews, had been taken into custody for maltreating this child, and had been remanded. He was dreadfully dirty. I had him weighed and found that he was much lighter than he should have been, regard being had to his age. He was ravenous; but he had to be fed with care so as to prevent mischief. His parents had been remanded for a week, and a good-natured constable of the C Division who had intervened and got the parents arrested came and asked me to attend at the re-examination. Before taking the child to the court I again weighed him, and found he had gained three pounds. After some four remands at each of which I was enabled to show he had gained in weight, the parents were committed for trial. I attended as a witness at the Old Bailey when the trial came on, and the parents were convicted and sentenced to eighteen months' imprisonment with hard labour. The poor little fellow was brought back to our House, whilst the elder brother was sent to the school. Foreseeing what was probably in store for this unhappy child, if he ever passed into the hands of his unnatural parents, I wrote to _The Times_ paper, and pointed out what would be the inevitable fate of this boy when his parents came out of prison and claimed possession of him, and pointed out that, as the Italian Consul had found counsel for the defence of the parents at the trial, I trusted that they would find some means whereby the child might be secured against further ill-treatment. On the same day that the letter appeared, I received a letter from the Consul asking me to call on him, which I did, when he told me that he would bring the case under the attention of the King of Italy. Some three weeks after I received a communication stating that the King had resolved to take the child, and bring him up at the cost of the State, as a ward of the Italian Government. Some ten days afterwards a tailor came and measured him for clothing, and a messenger from the Italian Consul having given an undertaking to the Board, he was taken away and I saw him no more. If alive he must be now some eighteen years old. I write "if alive," for the poor little fellow had a singular deformity. He had no abdominal muscles; what did duty for them was a dull, parchment-like-looking structure, stretched across the abdomen. One could make out without much difficulty the various abdominal organs. I had never seen anything like it before. Strange to relate, just at this time a young lady from Natal was sent over to me with a request from her parents that I would ask some expert to see her. On her arrival I found that she had exactly the same infirmity. The late Dr. Alfred Meadows, who saw her with me, would not believe my statement at all until he had himself seen and examined her. Her mother was very anxious to know whether she might be permitted to marry the gentleman to whom she was engaged. We gave a guarded opinion on the subject, and she returned to Natal, and was married, and has two or three children. I therefore trust that the little Jew Italian boy has also survived. I have never heard anything of him since he left the Poland Street Workhouse. One morning in 1877, shortly after I had left the House, the attendant came round to my residence, and informed me of the almost sudden death of the master, who was at my official visit half an hour before apparently in good health. He had never been partial to me, as my system of management clashed considerably with the stereotyped arrangements that had prevailed in the House prior to my appointment, and I very much question whether he ever approved of my having caused almost everything consumed in the House to be supplied under contract. He did not openly quarrel with me, but contented himself with passive resistance; and if I complained of any order not being carried out, he always excused himself by saying, Did you give an order for this, that, and the other? all the time knowing full well, that I had given the order. A striking instance of this obstructiveness occurred in the first autumn and winter after I took office. I had asked the Board's permission that some jackets should be supplied for the sick men and some shawls for the women, which they might wear when sitting up in bed to keep their chests and shoulders warm. This application was made to the Board of Guardians early in October, and was at once acceded to. Week after week went by, and in spite of repeated requests made by me, either to the master or matron, no notice was taken beyond the same answer which was always given when the one or the other thought fit to reply at all, "Oh, I have given the order for the material and for the shawls, but the contractor is so negligent, he has not sent us in the goods." In the early part of January I received a letter from Dr. Mouatt, Poor Law Inspector, stating that he had been instructed by the Local Government Board to go over the House and see how many persons could be described as fit to be sent away to the Sick Asylum, and, as he wished me to accompany him, he desired to know what day would suit me best. In reply I fixed the next Sunday, and as I did not wish the master to accompany us, for I knew he would report all that took place to the Board, I wrote in that sense to Dr. Mouatt. Dr. Mouatt came on the following Sunday morning. I had told the master he was coming, and, just as I expected, he stayed away from chapel, in order to go with us. Dr. Mouatt promptly said, "As this is a purely medical visit, master, we can dispense with your company." He coloured up and looked very much put out, but he had to comply. As I went through the wards I told the Inspector that I had asked the Board three months before to let me have some shawls for the women and jackets for the men, that the Board had given an order for them, but neither the master nor matron had supplied them, and that I felt satisfied they did not intend to do so, to which he quietly said, "I will soon alter that." At the same time I urged on him the necessity of so referring to the subject, as not to make them think I had said anything about it, but that the necessity for them had occurred to him, "For," I said, "if you do, they will make it the subject of an open quarrel." It was humbling to do this, but I knew what these people would do. At the conclusion of our examination, which lasted nearly three hours, we returned to my room, where the master promptly joined us. On seeing him Dr. Mouatt asked that the matron should be sent for. On her arrival he addressed them both as follows: "I have been over the sick wards and have seen all the sick that should be sent away and taken the number; this I shall report to the Local Government Board. I see that your House is kept clean and in good order, but there is one thing I notice which must at once be altered, and that is, the large number of patients sitting up in bed without anything over their shoulders. I have called Dr. Rogers' attention to it, and he tells me that the Board gave an order three months ago for jackets and shawls to be provided, but that they have never been supplied." Both immediately began to throw the blame on the contractor, but he cut them short by stating, "That excuse, master and matron, will not do for me; you know as well as I do you could have got them if you had chosen. I shall report the omission to supply them to the Board of Guardians and also to the Local Government Board." On hearing this they were dreadfully put out, and expressed an earnest hope that, as it was not their fault, he would not be so severe. "Well," he said, "I shall request the medical officer to report to me when they are supplied, and if every person needing them is not furnished with them before the end of the week, I shall carry out what I have said." By the following Wednesday all my patients were provided with them. At his death the master left some £4,000, notwithstanding he had a large and expensive family. After his decease I learned that he had signed a quantity of blank orders for my attendance, and had given them to the porter with the instructions that if any person was admitted who either looked ill or complained of being so, he was at once to send for me. His death led to the diminution of second calls by at least two-thirds. He was nearly always out in the after-part of the day. For several weeks after his death the duties of master were performed by the labour master. At last the Board advertised for a master and matron, the appointment of matron having come to an end when the late master died. As the Guardians were fully alive to the bad discipline which had prevailed for so many years, they resolved to appoint two officers who should more strictly exercise their authority. The choice of the Board fell upon Mr. John Bliss, a corporal-major of the Life Guards, and a Miss Heatley, lately assistant matron of the Manchester Workhouse. Both of these officers were strict disciplinarians, and something besides, as the sequel will show. For the first two or three years, indeed, during the whole Chairmanship of Mr. Cooper, the surgeon, they were kept in their places and behaved fairly well, but unfortunately for them, for the inmates, and the Board, Mr. Cooper was taken ill and died, and another Chairman being elected, serious results soon followed, for this Chairman was always in the House, and when so was constantly closeted with the master and matron in their rooms. Speedily after that the master began to dispute my orders, and the matron did the same, and as the Chairman again began to obstruct my sending the acutely sick inmates away to the Sick Asylum, the House became full of sick people, who were detained in it through the restrictions put in my way. At last the obstruction to the performance of my duty, by both master and matron, became almost unbearable, especially as Mr. Bliss thought fit to accompany his refusals by telling me to go to h--l, and sundry other coarse and blasphemous expressions; and to such an extent was it carried, that I felt I could not put up with it. To complain to the Board would have been perfectly futile, the majority would most assuredly have gone against me. At last the loud-mouthed, coarse, and outrageous blasphemy of the master quite appalled me; and this, coupled with his refusal to obey my orders and his general interference with me in my treatment of the sick, by deriding my judgment and by openly stating that I did not know my profession, caused me to speak to Mr. Fraser, a Guardian, in reference to the annoyance I was being daily subjected to. He advised that I should go to the Local Government Board and confer with the Poor Law Inspector. I did so, but got very little encouragement by my action. Some time after, in a letter to the Department, I did not hesitate to refer to it, and state as much. One result, however, accrued from this visit, which I foresaw was in the near future imminent, and I accordingly took steps forthwith to get some influence in the House of Commons so as to secure a proper inquiry. On my return I again saw Mr. Fraser, and told him of the way I had been treated. Just about this time this Guardian came into collision with Mr. Bliss. It happened in this way: there was a lady living on Wandsworth Common, the wife of the chaplain of a public institution, and, being very benevolent, she had constantly visited the Union school, and had interested herself in the future welfare of the girls. A girl she was much interested in had gone to a situation some months before, and, not being kindly treated, had left and returned to the Workhouse, when she wrote to this lady, who at once came up to the House to see her and some other girl. The master refused to allow her to do so, whereupon she went round to Soho Square and saw Mr. Fraser, whom she had known as a Guardian, and told how she had been treated, whereupon he wrote to the master, stating who the lady was, and asking him to allow her to see the girls. The master read the letter and replied, with a coarse oath, "I have already told you you shall not see the girls, and you shall not." On reporting this conduct to Mr. Fraser, he was much incensed, and at the next meeting of the Board brought the master's behaviour before the Guardians. To his astonishment, the majority of the Guardians absolutely howled him down. Mr. Fraser then formulated a series of charges against Mr. Bliss, among them his constant refusal to obey my orders, his swearing and generally violent treatment of the inmates, and moved that these charges should be sent to the Local Government Board, and an inquiry into the master's conduct asked for. This proposition was rejected, but, at the suggestion of the Chairman, it was resolved that the Board would conduct an inquiry themselves. This was done evidently with the intention that the whole matter as against the master should be quashed. The inquiry was held, and I was ordered by the Board to attend. At the inquiry by the Guardians the Chairman presided, and proceeded to ask questions; but finding he was no match for the solicitor, Baron H. de Worms, an _ex-officio_ guardian, put in an appearance and conducted the inquiry for them, and as I declined to recognize his or the Board's right to put questions to me, the Baron threatened to report my behaviour to the Local Government Board. I said to him, however, that if it were a regular legal inquiry, conducted by a properly constituted authority, I would answer on oath, and prove all the charges I had ever made against the master and matron. One of my charges was that I had discovered that my Medical Relief Book had been tampered with, and that entries for wines and spirits, neither ordered by me or given to the sick, had been placed against certain names. When this was gone into by the Baron the master's clerk was sent for and insolently denied the allegation. The Guardians completely exonerated the master and matron, his clerk, and all concerned with them; but the matter did not end there. During the progress of this so-called inquiry the matron brought before the Guardians eight of the very worst characters in the House, in order to depose to her and the master's continuous kindness and consideration to all the inmates, and that Mr. Bliss never swore at all. After they had given their evidence they were entertained by the matron in the store-room, a hot supper and brandy-and-water being provided. As she knew I was keeping a sharp look-out on my books to prevent any additional frauds, the next morning she was at her wits' end to make up the deficiency in the brandy, but at last she managed it by adding some water; but in her hurry she forgot to add clean water. She put what she wanted to increase the quantity into a jug which had contained milk, and so gave a cloudy appearance to the whole of it. On my arrival at the House I was informed of the entertainment that had been given to these witnesses to character, and on going into the women's sick ward, the head nurse showed me the brandy which had been tampered with, and I was further told by her that the brandy given out on the male side had the same appearance--indeed, that the nurse on that side had just called her attention to it. I directed that she should carry it down into my room. On going through to the male side, I requested the nurse to show me her brandy. At first she objected to do so, but on my insisting she reluctantly did so, when I took it away. On reaching my room I sent for a large bottle and mixed it all together and sealed down the cork. I then wrote to the contractors, Messrs. Hedges and Butler, of Regent Street, and asked them to examine it and write me word whether the brandy sent was the same as that supplied by them under the contract. It was taken by one of the officers. In the course of an hour he came back with the brandy and a statement from the firm proving that it had been lowered by the addition of so much water, and that the water that had been used was not clean. I then wrote to the Board giving the history now related, and enclosed Messrs. Hedges and Butler's certificate. I wrapped all up together in a piece of brown paper and addressed it to the Board of Guardians. I called the clerk into my room and having in his presence sealed up the parcel, I requested him to take charge of it and not to let it go out of his hands until the Board met. I then ordered a fresh supply for my sick. I had hardly left the House when the Chairman came, and, going to the clerk, demanded to see the parcel. The clerk gave it to him, when he immediately broke it open and read my letter and the spirit-merchant's certificate. Of course his supporters passed over this abominable transaction when the subject was brought before the Board, and the matron was not even censured; at least, so I was told. There was, however, a Nemesis. Just as they were rejoicing at the success of their proceedings a letter was on its way to the clerk from the Local Government Board, stating that, in consequence of certain information having been sent to the Department, an official inquiry into the master's management of the House had been determined on, and that Mr. Robert Hedley had been directed to hold it. I immediately went down to the House of Commons, saw some Members, and begged that they would see Sir Charles Dilke, who was then the President, and ask him to send some other Inspector instead. A day or so afterwards I heard that as his name had been mentioned it could not be changed, but that another Inspector, Mr. Taylor, a barrister-at-law, would be appointed with him in the inquiry. In due course the inquiry took place, Mr. Robert Hedley presiding, Mr. Taylor sitting on his right, Mr. Fraser, the solicitor, one of the Guardians, on the left. Mr. Fraser conducted the proceedings against the master, who was defended by Mr. Ricketts. The proceedings lasted several days. During the progress of the inquiry Mr. Hedley rendered no assistance whatever, and if it had not been for the conscientious conduct of Mr. Taylor, not one-half of the evidence which was given would have been brought out. Nearly all the evidence which was tendered was voluntary--that is, inmates and officers came forward to testify to Mr. Bliss's continual refusal to comply with my orders, to his swearing at me and the inmates, and his general harshness and positive cruelty to many of them. When the master's clerk was examined, he swore that he had never made false entries in my Medical Relief Book; but when my attendant, who had assisted in making up the book, gave evidence and stated that he had seen him make them, his tone altered, and eventually he confessed to sixty-three fraudulent entries of wines and spirits, amounting in the whole to a very considerable quantity of stimulants, presumably supplied to my sick but in reality consumed by other people. When called as a witness, I deposed to the continued refusal of Mr. Bliss to comply with my orders, as to his swearing at me and at others, and to the fact that he derided my judgment, and had intimated to the sick inmates under my charge his disbelief in my knowledge of my profession, &c. When Bliss was called on for his defence he contented himself with giving a general denial to everything that had been given in evidence against him. At last Mr. Hedley said that he should close the inquiry. I do not know whether at that time he had communicated to Mr. Bliss that he intended to report in his favour, but I had a suspicion of it, as no one could possibly be in better spirits than Mr. Bliss was that day, and it was clear from Mr. Hedley's manner and Mr. Bliss's familiarity with the Inspector what his decision would be. I was therefore not surprised on going down to the House some three weeks after to make some inquiries that certain Members, whose names I am precluded even now from mentioning, informed me confidentially that it had oozed out that Mr. Hedley and the other Inspector had recommended to the President that Mr. Bliss should be allowed to remain as master. On my expressing my astonishment at such a monstrous decision, I was informed that, to a great extent, the President was powerless in such matters--that, having appointed an Inspector to conduct an inquiry, he was by the rules of the Department bound by his decision, and that if he made a report in favour of the individual into whose management he was deputed to inquire, and reported favourably or the reverse of that, the President was compelled to accept it, however much he felt that the evidence did not support the view taken by the Inspectors. I lay stress upon this assumption that Inspectors cannot by any possibility err in their judgment, or be guilty of favouritism in their conduct of such inquiries, because ere long, if we are to have County Government Boards, the obligations of these Inspectors will be largely increased, and if the official inquiries of the future are to be conducted by men such as I have had experience of, Heaven help the unfortunate officials whose actions are being inquired into, unless there are some special reasons why they should be officially befriended, such as evidently held good in Mr. John Bliss's case. Having regard to the fate that always attends crooked courses, I am very much disposed to think that a different line would have been followed could it have been foreseen that Mr. Bliss would have acted as he did three weeks after the inquiry was ended, when a woman was brought in a cab so very ill that I decided to send her away forthwith to the Asylum Hospital; but, as she was blue in the face from difficulty of breathing and from general exhaustion, I told the receiving wards woman to come into my room, and then gave her a written order for some brandy and beef-tea to be given to the woman before she went away. I addressed the order to the matron. Shortly afterwards the nurse came back and told me that this woman had refused to supply what I had ordered. I then said, "Take the order to the master." After a minute or so she returned, telling me that the master would see me d----d before the woman should have it. I then left the House, and on the next day heard that, exhausted as she was, the woman was taken to Cleveland Street without anything being given to her. That morning I wrote to the medical superintendent of the Sick Asylum, and asked him to let me have a copy of any remarks he had made on her admission (of course, stating the refusal of both master and matron to give her anything at all before she left the Westminster Workhouse). His reply bore out the view I had formed of her condition, and he further said that if I had not written to him he should have made a special report to the managers showing her exhausted condition when admitted. A copy of this letter and a formal complaint against the matron and Bliss for their refusal to give the poor woman anything, was sent to the Board of Guardians, who simply ignored it. I also sent a similar statement to the Local Government Board, but no acknowledgment of its ever having been received was sent to me. Knowing what I do, from many years' experience, what this Department is, I very much regret that I did not send this complaint under cover (privately) to Sir Charles Dilke. It is a curious fact that, although the suppression of my statement at the Local Government Board, and the refusal of the Chairman and his party to make any inquiry into my complaint caused Mr. Bliss to keep his appointment a twelvemonth longer, yet this refusal, having been subsequently conclusively proved, ultimately led to his being called on to resign his appointment, as will be shown hereafter, after the Chairman had in the interval been ejected from office by an overwhelming vote of the indignant ratepayers. No report of the inquiry having been forwarded to the Board, the Chairman, after the lapse of about three months, caused a letter to be written to the Local Government Board asking that the result of the inquiry should be forwarded. The President sent a copy of the evidence given on oath to the Guardians, thinking that after the Board had read it through they would surely concur with him in thinking that Mr. Bliss was not a fit person to remain as master. But he reckoned wrongly. Sir Charles Dilke did not know the Chairman. This man simply induced his dozen followers to utterly ignore all the evidence, and to assert that it proved nothing. Meeting one of these Guardians in the House two or three mornings after, he came up to me, and, in a loud tone of voice, he said, "I have been reading your disgraceful evidence against our master." To which I quietly replied, "It was given on oath, and every word of it is true;" when, in a towering passion, he said, "You have disgraced yourself, I tell you; you have disgraced yourself:" and then, before I could reply to this outburst of vulgar vituperation, he went on to say, "I see the Local Government Board have directed us to pay you five guineas for your attending to give evidence: I am the Chairman of the Board, and not one penny shall you ever be paid for your disgraceful evidence." Had this outburst been indulged in some few years before I cannot answer for the form which my resentment would have taken; but I kept my temper, as I knew no credit could accrue from any squabble with this man. The cheque was subsequently paid. The Chairman was far too wise to enter into a struggle with the Local Government Board over such a matter. At the next meeting of the Board of Guardians he, or one of his followers, moved that a letter be written to the Local Government Board, stating that they had considered the evidence and were of opinion that it in no way affected the character of their master, and requesting that the Board should forthwith send its opinion of the evidence and what charges they considered proved, whereupon there was forwarded to them a list of thirteen charges which the Local Government Board held had been proved against Bliss. It is probable that if the Chairman and the majority had remained quiet, these serious charges against the master would never have seen the light. As it happened, the publication of them gave the opponents of Mr. Bliss the opportunity of conclusively showing up the action of the Board. The letter of the Local Government Board, containing particulars of the charges proved, was as follows-- "LOCAL GOVERNMENT BOARD, "WHITEHALL, "_August 28, 1883_. "SIR,--I am directed by the Local Government Board to acknowledge the receipt of your letter of the 10th inst. respecting the decision communicated to the Guardians of the Westminster Union in the letter which we addressed to them by the Board on the 18th ult. upon the charges preferred against Mr. Bliss, the master of the Workhouse, and recently investigated by their Inspectors, Mr. Hedley and Mr. Taylor. "The Board direct me to state, in reply, that the charges to which they referred in that letter were the following-- "That Mr. Bliss twice threw water from a bucket over an inmate named Ellen Coleman. "That he kicked a woman named Ann Lane on the back of the thigh [she was sixty-eight years old], the bruise caused thereby was about four inches across. "That he kicked a boy named James Daley twice on the back [he was about thirteen years old, and was a very good boy]. "That he was in the habit of swearing, and of using expressions of an objectionable character when irritated. "That he had exercised no supervision as regards the entries in his portion of the Workhouse Medical Relief Book. "That he had not entered in the Provision Accounts as absent inmates who were in fact absent on leave from the Workhouse. "That he had contravened the Board's regulations by placing Caroline Barber, aged sixty-four years, upon bread and water. "That there had been undue delay in the registration of four births in the Workhouse. "That in the cases of two females, named Caroline Clegg and Elizabeth Jacob, who died in the Workhouse, he did not take sufficient care to give notice of their decease to their respective relatives. "That through want of due care, a mistake was made as to a body sent for burial. "That he allowed Elizabeth Farquharson to leave the Workhouse for four days to go to work, and that he charged in his accounts rations for her during that period. "That his behaviour towards Mrs. Casher, on her visiting the Workhouse to see two girls in whom she was interested, was discourteous; and that he used very improper language to Emily Brown on her visiting the Workhouse to see her husband, an inmate [who was on his deathbed]. "I am, Sir, "Your obedient servant, "(_Signed_) C. N. DALTON, "_Assistant Secretary_." I have been informed that the reading of the above letter was received by the Chairman and his followers with much exasperation, which exhibited itself in threats of vengeance against all those, whether inmates or officers, who had given evidence against the master. One of the first to feel the wrath of the Chairman was Thomas Bailey, a man seventy years of age, who was discharged from his employment in aiding me and the master in keeping the Medical Officer's Relief Book, which he had done for nearly twenty years, because of his wickedness in bringing under my notice the fraudulent entries made in my portion of the Medical Book by the master's clerk at the instance of the matron, an irregularity which it is reasonable to suppose could only have been condoned by the majority of the Board on the supposition that some of them had helped to get rid of what had been falsely entered against the names of my sick patients. Although this fraud had been clearly proved, no attention had been drawn to it in the report, but a mere misty reference was made to the subject in the fifth charge proved. Here let me observe that I believe this inquiry would have been absolutely nugatory of any beneficial results if it had been conducted without an assessor being present, and, considering the bearing and physique of the two Inspectors, it seems to me that the assessor modified his own judgment, which would have been entirely adverse to Mr. Bliss, in deference to the manifest wish of the Inspector to screen an old soldier from the proved charges of blasphemy and unmanly violence to an aged woman and a small boy, for which two latter offences Mr. Bliss would have been taken before a magistrate and severely punished if the miserable victims had had the necessary means. The Chairman thought, in flouting the Local Government Board by his protection of his friend the master, that he would triumph; but at that time he was wholly unaware of what was in store for him and the party he had so long led. The Inspector was not, indeed, an acceptable person to all Boards of Guardians, as the following letter from the Holborn Board indicates-- "_February 28, 1884._ "_Re_ STANTON. Official Inquiry. "MY LORDS AND GENTLEMEN,--I am directed by the Guardians of the Poor of the Holborn Union to acknowledge the receipt of your letter of the 26th inst., stating that you have instructed your Inspector, Mr. Hedley, to hold an inquiry into the charges preferred against Mr. Stanton, and that Mr. Hedley will give the Guardians due notice of the time and place in which he intends holding the inquiry, and to inform you that the following Resolution was passed upon your communication being submitted to the Guardians, viz.-- "'That the clerk write to the Local Government Board and inform them that the Guardians are of opinion that an official should be appointed to conduct the inquiry who has not already expressed an opinion on the subject, which Mr. Hedley has publicly done, and that if the Local Government Board adhere to the appointment of Mr. Hedley to hold the inquiry, the Guardians must decline to take part therein.' "I am further directed to inform you that this Resolution was carried with only one dissentient at the Board last evening. "I have the honour to be, "My Lords and Gentlemen, "Your obedient servant, "JAMES W. HILL, _Clerk_. "THE LOCAL GOVERNMENT BOARD." I do not know whether it was at the meeting of the Board when the decision of the Department was first read, or on the occasion when the Guardians heard their clerk read out the list of charges which the Department considered were proved against Mr. Bliss, but it is certain that the Chairman rose in his seat and moved that I be called on to resign my appointment forthwith. Of course it was carried, and the clerk was directed to forward me a copy of the resolution. I briefly acknowledged its receipt. I understood that at this time this person was much put out at my not at once complying with his request, and threatened all sorts of vengeance on me. He was so ignorant that, in his rage, he forgot that he could not so summarily get rid of me, and therefore I waited patiently for his next move; indeed, I applied for and took my usual autumn holiday. At this time there appeared in _The Standard_ daily newspaper an article commenting on the evidence given at the official inquiry, on the charges found to be proved, and the conduct of the Chairman and his docile followers. It was republished and sent to every ratepayer in both parishes. And here I may be allowed to call attention to the fact, that in the reforms which I have tried to secure, I have had the assistance of papers of all parties. The article was as follows-- "WESTMINSTER UNION. THE LOCAL GOVERNMENT BOARD, THE GUARDIANS OF THE POOR, AND J. D. BLISS, MASTER OF THE WORKHOUSE, POLAND STREET. "Defend the poor and fatherless; see that such as are in need and necessity have right."--PSALM lxxxii. 3. "The Local Government Board, in an official communication to the Guardians of the Westminster Union, say they have 'entertained very great doubt whether, consistently with their public duty,' they could 'properly allow' the present master of the Poland Street Workhouse to retain his post. It is likely that the public will go all the way with the Local Government Board, and even a little further. The Board, having instituted a long and searching inquiry into sundry charges brought against the master, have arrived at the conclusion that several of the accusations have been established. They told the Guardians so much as this some little time back; but these authorities wished to know more precisely what were the charges considered to be proved. It is fortunate that these gentlemen were so far disposed to challenge the conclusions arrived at by the central power, for the answer they received puts the public in possession of some notable facts which otherwise might have remained in obscurity. We now learn that the demonstrated delinquencies of this Workhouse master include such peccadilloes as twice emptying a bucket of water over an inmate named Ellen Coleman, and kicking a woman named Ann Lane, as well as a boy named James Daley, the latter twice. He also contravened the Board's regulations by placing an old woman upon bread and water. There might be some economy in this, but it was more than counterbalanced by an awkward habit in which the master indulged, of charging rations for paupers absent on leave. Another irregularity consisted in a 'mistake as to a body sent for burial,' coupled with which we hear of 'undue delay in the registration of four births.' Then there was confusion in the Medical Relief Books, and a neglect to give notice when people were dead. To all this must be added a 'habit of swearing and using expressions of an objectionable character when irritated.' This model master of a Workhouse is further proved to have been discourteous to the wife of a clergyman, and to have 'used very improper language to Emily Brown,' a poor woman who came to see her husband. For all this he is master of the Workhouse still, and, as he retains 'the confidence of the Guardians,' the Local Government Board 'refrain from adopting the extreme course of requiring his resignation.' But, at the same time, this redoubtable official is warned that if any further complaints are substantiated against him he will be most certainly asked, with all due politeness, to relinquish his responsible office. There is, for the moment, nothing more to be done, except, perhaps, for the Guardians to present him with a testimonial."--_Extracted from "The Standard,"_ September 14, 1883. (It should be clearly understood that this inquiry was instituted by a minority of the Board, who have steadily voted for Mr. Bliss's resignation.) On my return to town I found that the Board generally had also gone away, but the Chairman had given notice that when the Guardians met in September he should move that I be suspended from my office; which in due course he did, and, having a passive majority, carried it. This did not alarm me at all. It was not then as it was some years ago. There was a new Secretary at the Local Government Board, who was the worthy successor of a most estimable father, the late Hugh Owen. Added to this I had several friends in the House of Commons, and most assuredly Sir Charles Dilke was not prejudiced against me. Besides this, the Chairman could not get up a case against me. So, being aware that it would take some weeks before any decision could be come to, as the head officials at the Central Department would be certainly out of town, and that it was a task beyond the intelligence of the Chairman to draft an indictment, I again went into the country. So soon as it became known that this Chairman had moved my suspension simply for having resented the conduct of Bliss in cursing and swearing at me, and disobeying my orders for the sick, numerous friends wrote to me, and the medical journals vied with each other in denouncing the conduct of this Board, and called on my professional brethren to rally round me as I had been called on to resign, and was now suspended for interfering with Bliss in his treatment of my sick poor. The action of the Chairman and his supporters turned to my advantage, and eventually led to his and their complete and signal expulsion from office. Among other annotations and leading articles which appeared at this date, I will here insert one from _The Lancet_, bearing date October 27, 1883-- "THE SUSPENSION OF DR. ROGERS. "The suspension of Dr. Rogers from his duties by the Guardians of the Westminster Union because of his honest testimony in an inquiry into the conduct of the master, is an event of very great consequence. It is impossible that the Local Government Board can sanction the action of the Board, or disregard the memorial signed by fifty-four of the most respectable inhabitants of St. Anne's, including the rector, the Catholic priest, &c.; and another, signed by ninety-four of the ratepayers of St. James's. Dr. Rogers is a representative man. He represents not only the Poor Law medical service, but the independence of the members of that service, and no greater misfortune can befall the poor or the ratepayers than that he should be persecuted by the Guardians of Westminster for doing his duty. We cannot believe that Sir Charles Dilke will allow such a misfortune to happen. The Local Government Board have acted with a strange inconsistency in retaining the master of the Workhouse. It is inconceivable that they will play into his hands, and those of the Guardians who assist him, by sanctioning the dismissal of Dr. Rogers. But the profession and the members of the Poor Law service, should lose no time in organizing a proper movement for vindicating Dr. Rogers' claims and position." After my suspension I went to Bournemouth, and whilst there heard of the above movement in my support, and also saw that my friends in the profession were organizing a testimonial in my favour, subscriptions to which came from all parts of the kingdom. So that, instead of injuring me, the action of the Guardians secured me three months' holiday, a testimonial worth £200, and gave me that leisure which enabled me to work up a party that some six months after drove the Chairman and his followers from office. On my return from Bournemouth I set to work to get up a list of candidates for Guardians for the ensuing year. It was necessary to get thirteen, as I had only five supporters. It is true that they were the most respectable men on the Board. I was not very long in getting three respectable ratepayers to stand for St. Anne's; but the great difficulty was in St. James's, where ten were required; and if it had not have happened that the Rev. Henry Sheringham, Vicar of St. Peter's, Great Windmill Street, exerted himself most earnestly, we could not have succeeded at all. He not only came forward himself, but he induced a colleague, the Vicar of St. John's, Great Marlborough Street, and four very wealthy and well-known gentlemen in St. James's to do likewise. The obtaining of four others ceased to be a matter of difficulty. The Rev. H. Sheringham took the greatest interest in the election, and it was through his help that the Bishop of London, the Marquis of Waterford, and a large number of the nobility and gentry, bankers, and others who were ratepayers in St. James's, and up to that date had never voted in any election of Guardians, were, on this occasion, secured. Mr. Sheringham was the incumbent of the poorest district in St. James's, and consequently he was constantly brought into contact with those who had either been inmates, or had friends in the House, and for a long time he had been cognisant of Mr. Bliss's management, and of the Chairman's support of the master. When I was suspended, Mr. Sheringham showed his feeling by going round to some of the leading people in St. James's and getting them to sign the testimonial in my favour, and at the election in the following April he worked hard all day long to get rid of the Chairman and his party. It may be thought by those who have followed this narrative of Poor Law management in 1883, that I had not sufficiently referred to the action of Mr. W. J. Fraser, solicitor, of Soho Square, and of 191, Clapham Road, but it does not arise from want of gratitude to this gentleman, who has known me for many years, who asked me to see poor Watson in 1872, who induced me to become a candidate for the office the same year, and whose worthy father used to take an honest pride in bringing him to my house nearly thirty years before, to show me how he had got on during his half-year's schooling. If it had not been for the high sense of conscientiousness, and his invariable hatred of such wrong-doing as was implied in the support of such a person as J. Bliss, as a young solicitor he could not have made so great a sacrifice of time, of labour, and of money. The fact of Mr. Bliss being no longer master of the Westminster Workhouse, and his chief supporter no longer in power as the Chairman of the Westminster Union, with all its possible advantages, is owing almost entirely to Mr. W. J. Fraser, who, recognizing the wrong-doing of both, exerted himself untiringly to get rid of both, which he achieved with singularly complete success. It was not until just before Christmas that one of the Guardians who was friendly to me, told me that a letter had just been received from the Local Government Board, directing me to resume my duties, thereby removing my suspension; at the same time saying there was an oblique reference to me at the end of the letter. "Oh," I replied, "I understand all about that; but I can afford to let that pass so long as the President supports me." I returned to my duties, but had it not been for the fact that my nurses (one woman excepted, who was Bliss's confidant, and whom I would have got rid of months before for incompetence and worse qualities) welcomed me back, as did the sick inmates, whose friend I had tried to be, I really should have hesitated to continue in my office, for every form of petty obstructiveness was exhibited by the master, matron, the master's clerk, the Chairman, and his followers. The only retaliation in my power was to draft questions and get them put in the House. This process made the names and doings of the majority of the Westminster Board of Guardians come out rather awkwardly before the public and the ratepayers of the Union; the extraordinary circumstance being that both parties, or rather I may state all parties, in the House assisted me in getting these questions put to Ministers. At last the election took place. I feel pretty well convinced that when the Chairman saw our list of candidates and who were the nominators, consisting as they did of most of the nobility, gentry, bankers, clergy, and leading ratepayers in both parishes, he felt that his reign was over, but he did not think, even then, that his defeat could have been so complete and overwhelming, for not only was he left in an absurd minority, but his twelve followers were left also. Subjoined is a copy of the address sent to the ratepayers of both parishes. "ELECTION OF GUARDIANS. "_To the Ratepayers of the Parish of St. James, Piccadilly, and St. Anne, Soho._ "MY LORDS, LADIES, AND GENTLEMEN,--Having been nominated to be Guardians to represent St. James's Parish as well as that of St. Anne's, Soho, at the Westminster Union, by many of the nobility, clergy, gentry, and leading tradesmen and large ratepayers of both parishes, we confidently solicit your votes and support at the approaching election. "We wish it to be understood that, in offering ourselves as candidates, we are actuated by no personal motives or considerations whatever, but solely by a desire to secure the faithful, humane, and economical administration of the laws relating to the relief of the poor in the Westminster Union. "Public attention has, during the past year, been frequently drawn to serious complaints respecting the treatment of inmates, subordinate officials and others in, and visitors to, the Poland Street Workhouse, and it is very widely felt that a searching and careful investigation should be instituted without delay into matters vitally affecting the comfort, happiness, and welfare of a large body of poor and helpless people, such as inhabit our workhouses. "We beg to draw your attention to the accompanying copies of two letters addressed by the Local Government Board to the late Guardians; and also to the enclosed copy of an article which appeared in _The Standard_ newspaper. "Many of the ratepayers will learn with surprise that, notwithstanding the serious and grave charges substantiated against the master of the Workhouse, at the Local Government Board inquiry, held by two of their Inspectors, a large majority of the late Guardians felt themselves able formally to record their confidence in the master. "It should be clearly understood that this inquiry was demanded by a small minority of the Guardians, who found themselves powerless to bring to light or redress in any other way the flagrant abuses of which they had been informed. And at the same time it should be known that those Guardians upon whom devolved the duty of conducting the inquiry, were denied, both by the majority of the Board, who were opposed to any action being taken, and also by the master, both before and at the time of the inquiry, all access to inmates and resident officers, whose evidence was essential to establish the charges alleged. It was, therefore, only with the greatest difficulty that the necessary evidence could be collected. "We have further to state that, after the decision of the Local Government Board was communicated to the Guardians, and when all the facts of the case were fully before them, the Chairman and the majority of the Board presented to Mr. Bliss, in the Board-room of the Poland Street Workhouse, a testimonial, in the form of a sum of money, ostensibly for the purpose of defraying the expenses of his professional adviser in conducting his defence during the inquiry into his conduct. "It may be added that the Chairman, when compelled to admonish Mr. Bliss, in accordance with the directions of the Local Government Board, did so with reluctance, entertaining, it would seem, the belief that the master was not guilty of all or any of the charges proved against him; and, when so admonished, the master himself expressed no regret that the charges set forth in the Local Government Board's letter should have been held to be established against him, and gave no assurance whatever that he would comport himself differently in future. "Thus the official inquiry was rendered practically abortive, owing, as we believe, to the action of the majority of the Guardians in virtually upholding the master, in the face of such overwhelming evidence of misconduct. "Various complaints have since been made both by inmates and officers respecting their treatment, and, notwithstanding the recent inquiry, the internal condition of the Workhouse remains up to the present time unaltered and unimproved. "It is for these reasons that we feel it our duty to offer ourselves as candidates at the present election, believing that the ratepayers of St. James's and of St. Anne's, Soho, will no longer be able to place confidence in the Board as lately constituted, and that they will demand a searching inquiry into the whole system of the management of the Poland Street Workhouse. "If, therefore, it be your pleasure to elect us as your representatives on the Board, we shall address ourselves, without fear or favour, promptly and impartially to the consideration of every matter requiring attention; and with the co-operation of the Local Government Board, which we doubt not will readily be given, we shall make it our chief aim and endeavour to remove all legitimate grievances, and to secure humane and kindly treatment for the many aged sick and helpless inmates of our Workhouse. "We have the honour to remain, "Your most obedient servants, "----." As the election had mainly turned on the conduct of Mr. Bliss, one of the first things done by the new Board when it met was to suspend Mr. Bliss from his office, which being done, shortly afterwards a committee of the Board met and drew up an indictment against him; but as the Department had condoned the whole of the thirteen charges which were considered proved, they could not raise any of these again; but as Mr. Fraser was aware that the complaints I had made subsequent to the inquiry had been ignored by the late Chairman and his friends, and that the duplicate copy had never been acknowledged by the Department, I, and the nurse of the receiving wards, and the head nurse on the female side, were called to prove the order given by me, the refusal of the matron and the master to comply with it, the woman's condition when admitted, her state on her arrival at Cleveland Street Asylum, the remarks as to her exhausted condition when carried by the porter in his arms, she being too ill to walk; all these facts were shown to be absolutely true, and were completely borne out by evidence. Other matters against Mr. Bliss were also gone into and forwarded to the Local Government Board, and with it an intimation that it was the desire of the new Board that he should not be permitted to return to his duties. Whilst away in Belfast, where I went in the month of August to deliver my customary annual address on Poor Law Medical Relief, I received a telegram that Sir Charles Dilke had called on Mr. J. Bliss to resign. When the master was suspended I can hardly describe the relief I experienced, it was so great. No longer did I dread loud-mouthed expressions of dissent from me in my treatment of the sick, no longer did I fear that he would stalk, unannounced, through the female sick wards when I was examining the poor women; but instead of it there was respectful quiet and orderly behaviour. The matron, who ought to have been sent away also, kept out of my way and was obsequiously obliging when I gave a necessary order. One person only did I at once bring to book--it was the head nurse on the male side. After the formation of the new Board, I immediately drew up and sent in a list of charges against her, comprising refusal to obey my orders, complicity in and support of certain malingerers who she falsely informed me were ill. One of these I had discovered some months before to be an impostor, and ordered his discharge, but the nurse got her friend Bliss to direct his return, thus flouting my authority. She did not stop to meet my charges, but sent in her resignation, and, it being accepted, these complaints were not investigated. I speedily got rid of the malingerer also, and during the remainder of the time I held office the man remained out of the sick ward. What was the tie between the nurse and this malingerer I was never able to divine. During the latter part of April, the whole of May, and the first part of June, 1884, there had been an outbreak of fever at the Union schools on Wandsworth Common, and it appeared that the medical officer of the schools, the Visiting Committee, and the Poor Law Medical Inspector, could throw no light on the causes of it, when it was suggested at the Board that I should be sent down to examine into the matter and report to the Board thereon. I wrote to the medical officer informing him of the Board's wish, and asked him to arrange a time to meet me and we would go into the subject together. He was not sufficiently courteous even to acknowledge my letter. I then asked a member of the Board (a builder) to accompany me, which he did. On my arrival at the schools I requested the attendance of the superintendent and matron, as I wished to state the object of my visit and to obtain from them certain information as regards the commencement of the outbreak, the symptoms presented by the sick, &c. I also elicited from them that the medical officer had said that he would not meet me--an act of discourtesy to the Board, whose joint officers we were. I speedily ascertained that the outbreak commenced amongst the girls, and had been almost entirely limited to the female side of the House, and of these girls those mainly who were employed in the laundry. But as I wanted to make a complete examination of all the water supply, I asked the Guardian to pioneer the way in our general survey. With this object I got out upon the roof of the main building and peered into all the cisterns. I did not discover anything vastly amiss in these, and nothing wrong at all on the male side. I then proceeded with my examination of the cistern supply in the laundry and kitchen, and that on the roof which furnished the kitchen and part of the laundry supply, when I came upon the source of the mischief; for, on lifting the lid of a large cistern there containing many gallons of water, my sense of smell was assailed by one of the most horrible odours I had ever encountered, and I saw a large mass of thick scum floating there which was evolving offensive gases and in constant motion from the activity of innumerable forms of the lowest type of animal life. I asked my friend to hand me up a stick, and with it I took out a large piece of it and spread it out upon the roof of the building. I also requested the Guardian to come up and judge for himself. I did this because I knew that any statement I might make would most assuredly be denied by the parties who are responsible for looking into and examining the condition of the cisterns and keeping them cleansed, a circumstance which, as I expected, did subsequently occur, but which could not be controverted by them as I had the gentleman in question as my witness. Before leaving I left a written instruction that every cistern throughout the building should be emptied and disinfected, additional care to be taken with the offending one. On my return home I drew up and forwarded to the Board my opinion as to the cause of the outbreak, and the orders I had given to the superintendent. As no other cases of fever occurred after my visit, it was clear I had discovered the cause and the remedy. The Board wrote me, through their clerk, a handsome acknowledgment of my success, and voted me five guineas for my visit, and informed me that they had directed the clerk to send a copy of my report and the results that had followed it to the Local Government Board. This was somewhat of a rebuke to those permanent officials who had placed that addendum to the letter directing me to resign my duties some six months before, as I had discovered and stopped the outbreak, the cause of which they had utterly failed to ascertain; but then these aforesaid permanent officials never throw any heart or intelligence into the work they are so handsomely paid to do. In the early part of June the honorary secretary of the fund, Mr. J. W. Barnes, F.R.C.S., wrote to me, stating that it was decided to present a testimonial to me at a meeting of the subscribers, at the rooms of the Medical Society of London, in Chandos Street, Cavendish Square, in June, 1884, and that Mr. J. A. Shaw Stewart had arranged to take the chair. On the day mentioned the presentation took place, and subjoined is a condensed report of the proceedings extracted from _The British Medical Journal_, June 28, 1884. The assemblage was a very large one, and certainly was a striking manifestation of good feeling towards me from many of my old friends and fellow-workers in the cause of Sanitary and Poor Law Medical Reform. FOOTNOTE: [1] The attacks upon me were so scurrilous for the evidence I had given that I wrote as follows to the editor of _The Lancet_, the staff there being divided in opinion whether I should be supported or condemned-- "REGINA _v._ WATSON. "TO THE EDITOR OF _The Lancet_. "SIR,--As I have been made to occupy, through the exceptionally severe and not over-courteous cross-examination at the Old Bailey, a more conspicuous position than I had desired before the public, perhaps you will permit me to give the reasons why I held, and do hold, that the prisoner in the above case was, and is, of unsound mind; and, subsequently, to briefly comment on each head. "1st. There were the evidences of pre-existent melancholia. "2nd. The ferocity with which the deed was committed. "3rd. The total absence of criminal motive. "4th. The calmness and indifference of the prisoner's manner after the deed was done. "5th. His justification of suicide, and the expression of his belief that God would forgive the homicide under the circumstances. "First, as regards the proofs of mental disease prior to the act--they were deposed to by the Rev. Folliott Baugh and his wife as existing a month before the murder; by Mr. H. Rogers on the preceding day; whilst further evidence on this head, not available for the defence owing to the sickness of the deponent, has since been forwarded to the Home Secretary, the statement being that some months before he was in communication with the prisoner for the purpose of employing him in his school, but on an interview he found his mental condition to be such that he at once broke off the engagement: the evidences of aging and altered aspect deposed to by the secretary of the school a short while after his dismissal. And mark, that to him was no ordinary event: at sixty-seven he found himself suddenly without employment, without any realized money, absolute penury in the not distant prospective, whilst, during the nine months he had been thus thrown in upon himself, every attempt to add to his means or to obtain an engagement, whether literary or scholastic, had entirely failed. "Second. Passing to my next point, the ferocity of the act, it was argued by the prosecution that it was done in a fit of rage; but, for the credit of our common human nature, I would ask, Is it conceivable that mere anger would so transform a mild, quiet old gentleman, as he was shown to be, into such a brutal criminal, so that, not content with slaying his victim, he should go on battering her head and body long after passion alone would have been exhausted? It is, I contend, explicable only as the act of a homicidal melancholic, not otherwise. "Third. The senseless character of the deed. If done consciously and by premeditation, as the verdict would suppose, I would ask, Where could be the gain? Here, again, I argue that the act itself, done without reasonable motive, could only be the product of reason overthrown. "Fourth. The indifference, &c. Here I would submit--can a parallel be produced from criminal records in any place (Broadmoor excepted) for the remarkable calmness (self-possession Mr. Gibson, of Newgate, phrases it) Mr. Watson maintains whenever the act is referred to, such as to lead his old friend, the Rev. J. Wallis, to state that he seemed perfectly void of shame and remorse; nay, asserting that he was an injured person by being put in prison'? "Fifth. His justification of suicide, &c. I may here be met by the remark that he is probably an unbeliever in the Christianity he professed. To this I make reply that there is not a tittle of evidence to show that such is the case. Until the act was done, a regular attendant at church, a constant communicant, his whole moral nature must have become utterly changed and corrupt ere such a consummation could be arrived at, standing out, as it does, in direct antagonism to his previous life, as portrayed by one who knew him well and gives his opinion of his old friend in this day's _Times_. "I pass over the subsequent blundering attempts to hide the act, as similar things have been done by others whose insanity has not been questioned. And as I have occupied much of your space, I subscribe myself, "Yours obediently, "JOS. ROGERS. "DEAN STREET, SOHO, "_January 15, 1872_." RECOGNITION. DR. JOSEPH ROGERS. "TO THE EDITOR OF _The Lancet_. "SIR,--Since writing my letter to you last week I am rejoiced to see that a movement has commenced for giving shape to the esteem in which Dr. Joseph Rogers is held by his professional brethren and others who know his work. I hope a large sum will be raised, which cannot fail to be the case if all whom his labours have benefited give a little. And surely the time could not be more opportune than when in a battle with his persecutors: he wants to the full the encouragement of his friends. Only one suggestion I cannot agree with--viz., that the subscription list should be limited to Poor Law medical officers. Why? Truly, he has been a great benefactor to them; but not to them only. His public work has been much wider in aim and usefulness than simply to touch the pockets of a few Poor Law surgeons. Many years ago he was a leader in the movement that ended in stopping burials within towns. I believe I am right in saying that to his influence is largely due the establishment of mortuaries. It was he who succeeded in getting expensive medicines--which it was hopeless to expect the Poor Law officers to supply out of their slender salaries--supplied by Boards of Guardians: an improvement directly benefiting the poor, and indirectly the ratepayers. The Metropolitan Poor Act of 1867 was largely brought about by his untiring zeal. From that what good has not flowed? The supply of not expensive medicines only, but all medicines, by the Guardians. The dispensary system, leading to a very large increase, probably not less than £15,000 a year to the Metropolitan medical officers. Then that great boon, the Superannuation Act, is another monument of Dr. Rogers' energy. I do not wish to undervalue the labours of Dr. Brady, and our other friends in and out of the House of Commons; but Dr. Brady himself would be the foremost to admit that he never would have been able to carry the point had it not been for Dr. Rogers' assistance. 'Instant in season, out of season,' delivering addresses from town to town; giving advice and assistance to persecuted public servants all over the country; strengthening the hands of the weaker brethren in public and private, he has been for fourteen years a tower of strength to an important section of the community whose power for good has been enhanced by his agency, which has again reacted on the whole nation. In short, Dr. Rogers has been, and is, a great social reformer, and of his work all classes reap the fruit. But as a great American philosopher says, when the flat stone of a fine old abuse is overturned, there is a great squirming of the flat-patterned animals that have thriven in the darkness. Dr. Rogers has been turning over these stones for many years, and has been attacked by the squirming animals, as is usually the case. It is for those who have been cast in a different mould and can appreciate his valuable, arduous, and often thankless labours, to show their appreciation now. "I am, Sir, yours respectfully, "JAMES MILWARD, M.D. "CARDIFF, "_October 22, 1883_." "TO THE EDITOR OF _The Lancet_. "SIR,--For a long series of years one man in the medical profession has boldly stood forward in maintaining the rights and in endeavouring by every legitimate means to redress the wrongs of the Poor Law medical officers of this country. As one unconnected entirely with Poor Law medical practice, I have, no doubt in common with a multitude of others, admired the courage and honesty with which this man, almost single-handed, has fought the battles of its medical officers. Had any one of them a real grievance or hardship to complain of, Dr. Rogers at once came to the front and became his champion. Now that he is, in his own person, the subject of an injustice, and a very serious one (for he is threatened with dismissal from his post as medical officer of the Westminster Union for doing that which in all honesty he felt compelled to do), it behoves the whole profession to give him all the moral support in its power. It cannot be possible that the Local Government Board will ever sanction such manifest injustice. But this is not purely a question between the Westminster Guardians and Dr. Rogers; but one which aims a blow at professional honour and rectitude, and if settled in the way in which the Guardians would have it, it may be the means of preventing some members of our body, however right-minded they may be, from giving evidence of wrong-doing, or performing other necessary duties not falling strictly within the scope of their ordinary work; because forsooth they may, if they do, find themselves stranded and deprived of their appointments. "Let the profession, then, as a body, and not merely the Poor Law medical officers, rally round Dr. Rogers, and, whilst recognizing the benefits derived from his unselfish public labours in their behalf, labours which may have brought upon him much obliquy, and perhaps have had something to do with his present trial, present him with such a testimonial as shall effectually demonstrate to the Local Government Board its approval of his conduct and its disapprobation of the ungenerous treatment to which he has been subjected by the Westminster Guardians. "'He's true to God who's true to man wherever wrong is done, To the humblest or the weakest 'neath the all-beholding sun. That wrong is also done to us, and they are slaves most base, Whose love of right is for themselves and not for all the race.' "I am, Sir, your obedient servant, "WILLIAM WEBB, M.D., F.R.C.S. "WIRKSWORTH, "_October 24, 1883_." "TO THE EDITOR OF _The Lancet_. "SIR,--Will you permit me to draw the attention of your readers to a movement which has been set on foot with the view of presenting to Dr. Joseph Rogers, the President of the Poor Law Medical Officers' Association, a testimonial, as a mark of the esteem in which he is held by Poor Law medical officers, and as a recognition of his unwearied advocacy of their claims, his fearless exposure of injustice done to them, and the able assistance and advice which he has freely given to such of them as have been unfortunate enough to be at variance with their Boards. "The unjust treatment Dr. Rogers has received at the hands of the Westminster Guardians, will, I hope, shortly be brought before the Local Government Board. But I venture to suggest that no better time than the present could be chosen for his fellow-officers to express their sympathy with him, and that such an expression from a large number would show that they have appreciated his labours on their behalf; that in a good cause they are capable of acting in concert, and that they respect themselves and their office in manifesting respect for one who has fearlessly done his duty, although for doing it he has received the usual punishment accorded by Guardians to parochial medical officers. "The following gentlemen have kindly promised to receive subscriptions, viz.:--Ernest Hart, Esq., Editor of _The British Medical Journal_; C. Frost, Esq. (Treasurer of the Poor Law Medical Officers' Association), 47, Ladbroke Square, Notting Hill, London; J. Wickham Barnes, Esq. (Secretary of the Poor Law Medical Officers' Association), 3, Bolt Court, Fleet Street, London. "I am, Sir, yours faithfully, "FRANCIS WHITWELL. "SHREWSBURY, "_October 23, 1883_." TESTIMONIAL TO DR. JOSEPH ROGERS. The presentation of a handsome testimonial to Dr. Joseph Rogers, Chairman of the Poor Law Medical Officers' Association, took place on Tuesday last at the rooms of the Medical Society, Chandos Street, in the presence of a numerous gathering of ladies and gentlemen. Mr. John A. Shaw Stewart, presided. Mr. J. Wickham Barnes (honorary secretary of the fund) spoke of the cordial reception with which the proposition to do honour to Dr. Rogers had been received, and the support which had been given to it by the medical journals, the editors of which had been among the most liberal contributors to the fund. The Chairman, in his opening remarks, spoke of Dr. Rogers' work and worth, which were so well known that little further need be said on those points; but, on an occasion like the present, they should not forget that Dr. Rogers was a sanitary reformer and advocate of sanitation of about forty years' standing, and that matters which were now accepted as facts were then subjects of the fiercest controversy. Dr. Rogers, in conjunction with Mr. George Alfred Walker and others, was the first who successfully advocated the closing of the burial-grounds in cities, and had succeeded in establishing the first public mortuary in London. Those facts alone testified to his energy and ability. Those who were older than the speaker could remember the time when the light of heaven was taxed; and Dr. Rogers, with the late Lord Duncan, was one who worked hard to abolish the window-tax, a more unjust tax than which it was impossible to conceive. He was appointed medical officer of the Strand Union in 1856, at a time when there were no paid nurses and when the Poor Law officer had to pay out of his small salary for all medicines. Dr. Rogers, with Dr. Anstie, and Mr. Ernest Hart, was among the stoutest advocates for the improvement of the workhouse infirmaries; and, aided by the full force of the Medical Press, the great work was commenced. The first time he (the Chairman) had had the pleasure of working with ladies was in Mr. Ernest Hart's house; he was thankful that now, in all useful social work, ladies came to the front. Dr. Rogers' work led up to Mr. Gathorne Hardy's Act, and his force and determination prevailed so far that the more expensive medicines were henceforth to be paid for by the Guardians, but for a long time the bulk of the drugs supplied was still left as a charge upon the ill-paid medical officer. Dr. Rogers' great and difficult work had been in connection with Poor Law administration. He believed one of the greatest political economists of the day, whom he saw present, would bear him out that political economy and philanthropy went hand in hand when they were employed in energetic and persistent endeavours to arrest disease in its earliest stages. No one could go much about our general hospitals without seeing how much of the misery and distress of this world were caused by disease. We were subject to a variety of diseases--and diseases meant loss of health, and ultimate loss of life, to the bread-winner, and his widow and children to be cast on the world. Dr. Rogers was subsequently very instrumental in the carrying of the Bill for the superannuation of Poor Law medical officers. Since then he had visited almost every large town in England, Scotland, and Ireland, with the view of prevailing upon the authorities to carry out improvements lately talked of in the metropolis. Dr. Rogers was a real, true specimen of the best sort of Englishmen, a man of tenacity, a hard hitter, a staunch friend, and a pertinacious foe. Mr. G. W. Fraser, Chairman of the Westminster Board of Guardians, said he had long known Dr. Rogers, and it afforded him very great pleasure to find that he was so much respected by those who had had an opportunity of appreciating his valuable work, and the many reforms he had been instrumental in effecting in the Poor Law of this country. He was very much respected by the Board of Guardians of the Westminster Union as at present constituted, and before, until he had to draw the attention of the Guardians to matters affecting the internal welfare of the Workhouse, which action resulted in his being suspended from his duties. All he could say was, there was no logical ground for the course that had been taken. It was a great satisfaction to find that that apparent evil had resulted in some good, for Mr. Wickham Barnes had told them that the treatment which Dr. Rogers then received was instrumental in bringing about the crowning result to be achieved in the presentation of the testimonial that day. Dr. Rogers had, on several occasions, rendered very valuable services to him (Mr. Fraser) and his colleagues, and he trusted that he might long he spared to fulfil the duties he had hitherto so long and so satisfactorily discharged. Professor L. E. Thorold Rogers, M.P., said it was a matter of great gratification to him to be present on an occasion when the merits of his brother's labours were being recognized with so much unanimity, and in so practical a form, by the profession to which he belonged, and which, he ventured to say, he had always adorned. Mr. Samuel Bonsor, as an old Westminster Guardian, spoke of the pleasure it was to him that he had lived long enough to see Dr. Rogers' efforts recognized as they had been. Dr. Farquharson, M.P., said he knew that Dr. Rogers had been a great sanitary reformer, but he was astonished to find that he had been a reformer of so many years' standing. Guardians were apt to go for a hard and fast rule, while medical men, on the other hand, held more towards the sympathetic side; and it was by carrying out their duties in a sympathetic and liberal spirit that medical men often got into great disputes, and great difficulty and trouble. Until recently, these gentlemen, who were often treated cruelly, had no organization or means by which they could make their grievances known, or obtain any redress whatever. The action of Dr. Rogers, and the Association which he had been instrumental in forming, had been the means of often bringing to light cases of oppression and of obtaining redress for those who had been oppressed. He was sure they might all congratulate Dr. Rogers on being present, not only from the fact that he was going to receive a substantial token of the affection and respect in which he was held by all who knew him, but on the expressions of admiration and esteem which poured in from all directions on that occasion. He hoped Dr. Rogers would long be spared to give them the benefit of the shrewdness, his tenacity, and his tact. Canon Wade (Rector of St. Anne's, Soho), said he had known Dr. Rogers for some years as a man of war. The first thing which drew forth his kindly feeling towards Dr. Rogers was observing the tender and faithful manner in which he supported the case of the sick poor in their workhouses. The Rev. W. Benham said he thought he had known Dr. Rogers and his family longer than any one else in the room, excepting his brother, and if he was a man of war, as had been stated, it was because no man in the world had a more kindly heart. The Chairman, in making the presentation to Dr. Rogers of three handsome pieces of silver plate in a case, together with a cheque for £150, said he really ought to have the assistance of a lady now, for she would so much more gracefully, in their name, present that testimonial to Dr. Rogers. The inscription ran: "Presented to Dr. Joseph Rogers, in recognition of his continuous effort in the cause of sanitary and Poor Law medical reform, for nearly forty years. June 24, 1884." The date reminded them that Dr. Rogers' voice had not been that of one crying in the wilderness; his voice had been most usefully and beneficially exercised in the metropolis. With the pieces of plate there was a substantial lining. They hoped that Dr. and Mrs. Rogers would long be spared to enjoy very many blessings. They had met together there with one heart and one mind, to show their appreciation of his excellent qualities both as a public and as a private man. The estimate of his good deeds, he (the Chairman) fully believed, would never be known till that last day, when the record of his life would be unrolled. They had met to do honour to a good man; let each in his own capacity strive to follow so noble an example, that when that great day came they might have more to record of work done for others and less for themselves. Dr. Rogers, who spoke with some emotion, said he felt much difficulty in giving expression to the feelings that actuated him on that occasion; all he would state was that, in his progress through life, if he had recognized an evil, he had done his best to relieve it; and if in the doing of it, he had occasionally--and doubtless he had--confronted the prejudices of some and aroused the antagonism of others, it was the inevitable fate of all who attempted to deal determinedly with wrong-doing, wherever it might exist. He happened to be, as it were, a child of the new Poor Law, because he remembered well when the Bill became law, and his father expressed to him his sense of deep disappointment and dissatisfaction, as a Christian man, with the way in which the Bill was framed, in regard to its harsh and bitter spirit. They must recognize the fact that the poor would be with us always; and that it was best to deal with them in a spirit of conciliation, moderation, and kindness, and especially in that particular branch of the management of the poor with which it had been his lot for many years to be associated, namely, as medical officer of a large metropolitan workhouse. He was perfectly satisfied of one thing, and that was that a judicious administration of Poor Law relief meant economy. He had studied this question most minutely. He pointed out, twenty-three years ago, to Mr. Charles Villiers, who presided over a committee on poor relief in 1861, that a more liberal administration of poor relief meant true economy to the ratepayers, because if they cut short the sickness of the poor, and if they diminished the amount of deaths that took place among the bread-winners, they would, as the ultimate result, economize expenditure and out-relief. As regarded other subjects that had been referred to, it was to him a matter of immense gratification that he had been associated in those labours that took place about forty-four years ago, initiated by Mr. George Alfred Walker, of Drury Lane, and which eventually germinated in the abolition of the most horrible system that ever took place in a Christian kingdom. He could tell them many things, terribly showing the horrible evils that arose from keeping the bodies of the dead in the single rooms of the living. He had many times seen the widowed mother and the children dining off the coffin of the dead father, and other scenes which were indescribable in a gathering like that before him. This it was which had prompted his action in the formation of a mortuary at St. Anne's. Dr. Rogers concluded by offering his sincere thanks for the great honour they had conferred on him, and to Mr. Shaw Stewart in coming and speaking so kindly of him as he had done. Mr. Wickham Barnes proposed a vote of thanks to the Chairman, which was seconded by Mr. James Hogg, and to which the Chairman briefly replied. CONCLUSION. Though there were several persons of both sexes who were very advanced in years, when one takes into account the difference in the numbers that were to be found in the Strand and Westminster Workhouses, yet in this latter House I did not see so many interesting old people as were to be found in the former. About ten years ago, however, there was an admission from St. Anne's, Soho, of an extremely aged woman. She claimed then to be one hundred years old. She must have been extremely good-looking in her youth, as she still retained evidences of personal beauty. Like my old friend in the Strand, she had a bright blue eye and a fair complexion; she was in possession of all her faculties, and talked and laughed by the half-hour together when I was in the humour to sit and chat with her. She knew the younger Pitt intimately, Charles James Fox, the Prince Regent, Edmund Burke, and several of the politicians of the latter part of the last century. She also told me she knew Wellington and Nelson. At last I discovered what she had been. Her constant references to Sheridan in her conversations with me induced me one day to ask her if she knew him. Drawing herself up in a sprightly sort of fashion, "I rather think I did," said she. Eventually it came out that she had been under the protection of the box-keeper of Drury Lane Theatre. On putting the question which brought out the somewhat equivocal relation in which she had lived during the latter part of the last century, she blushed up to her eyes--the only thing of the kind I ever witnessed in a lady of such advanced years, so much so that I felt sorry I had elicited the confession from her. She was a very interesting old woman, and her remarks about the appearance of the celebrities of the latter end of the last century and beginning of this, unmistakably showed that she had associated on familiar terms with many of the celebrated persons who lived and moved and produced a sensation nearly a hundred years ago. She used to sing some very good songs; they were chiefly Scotch, and when singing them she would work herself up into a great state of excitement. She was very fond of talking to me, and I suppose this arose from the circumstance of my taking interest in her conversation. She was a very well-behaved old woman, and therefore a great favourite with the inmates and nurses, who were highly amused whenever they could get her to sing one of her Scotch songs. At the latter end of the last century and the beginning of the present, she had accompanied her male friend through Portugal and Spain prior to the war; at the same time she knew Lord Nelson and Wellington before their names had become famous. When she had reached 104, she rather suddenly lost her vivacity, became childish, and insensibly passed from time into eternity. We had, during the portion of the time I was at the Westminster Union, quite a little community of aged and, so far as I could ascertain, religious women, at any rate they struck me as being such, and I kept them together until the harmony of their daily life was rudely interfered with by the master and matron, Mr. John Bliss and Miss Heatley, neither of whom had any sympathy with, or kindly feeling for, decently conducted pauper women. Indeed they rendered the lives of these people so wretched by harsh interference, as to compel me to distribute them among other wards; some of them I even sent away to the sick asylum hospitals, so as to get them out of their way. It was a wonder to me that Miss Heatley, after all that was proved against her on the official inquiry, should ever have been allowed to continue matron of the Workhouse; but though spared by man's power, she was destined to perish by one of the most fearful diseases that can afflict any woman, being destined to die of cancer of a certain internal organ, and I have been told her sufferings were of the acutest possible character. It is very remarkable that, having had very large opportunities of witnessing the deaths of my fellow-creatures, I have constantly observed that some untimely fate has overtaken those who, exercising power in a workhouse, have exhibited a cruel use of that power; and of one thing I am absolutely certain from personal observation, repeated over and over again, that, "Blessed is he who considereth the poor and needy, the Lord shall deliver him in the time of trouble." It has often been asserted that the inmates of a workhouse are generally worthless people, but I demur to that conclusion entirely. Of this I am certain, that many a person who has died in the infirmary of the sick ward of a workhouse has gone as straight to Abraham's bosom as has ever passed from a bishop's palace, or the death-chamber of a king or queen, or however highly placed. During the thirty years that I was engaged in waiting on the sick poor, I never lost sight of the fact that they were my fellow-creatures who were accidentally placed in a humbler social position than myself. Though, in accordance with the custom adopted in the institution, they were stigmatized as paupers, I never allowed myself to make them feel I thought them such. After the departure of Mr. John Bliss and the disappearance (through illness) of Miss Heatley, the Guardians appointed as master and matron, Mr. and Mrs. Minter. I found them to be exceedingly respectable people, kind to the old and afflicted, and fair and kind to the general population of an urban workhouse. The sick poor were quietly attended to, whilst loud-mouthed swearing and blasphemy were banished from the place. Unfortunately, however, I began to break in health. Mounting up staircases day after day, which had gone on for nearly forty years, told upon me, aggravated as it was by repeated attacks of bronchitis. Then a heart affection, followed by its usual concomitants, proved too much for me, and I was compelled to resign the work I had done for so many years. What made the blow the greater to me was this, that in all other respects my professional life was a happy one. I had nothing to ask for from the Board of Guardians, as all my legitimate requirements were at once courteously met and complied with; a different atmosphere pervaded the establishment, and therefore it was a pleasure to me to meet my fellow-officers and to work with them. Looking back upon the change which had taken place from the day I first entered upon my duties in January, 1856, in the Old Strand Workhouse, till I finally left the Westminster Union in 1886, a period of thirty years, the change that occurred was enormous. Then there was hardly a paid nurse in any workhouse in London, the duties being performed by more or less infirm, drunken, and generally profligate inmates of the House. It was a miracle to find an honest one among them; they were a chance medley of Sairey Gamps and Betsy Prigs, who were selected at the will of master and matron, and who obeyed the orders of the medical officer just as much as, and no more than, their fancy led them. The scenes of untold misery which might have been witnessed by the Guardians of the Poor will never be fully exposed until the grave record of all things is opened to universal gaze. Fortunately, a change has come over the spirit of these things: in the present day the sick poor are housed in buildings which were never dreamed of twenty years ago; pauper nursing is now entirely a thing of the past; Lazarus now meets with careful, Christian consideration, and if it be possible to restore him to health, an opportunity is afforded him of resuming a position in society, useful, though it maybe humble. My readers will therefore fully understand with what great regret I took my pen and wrote the resignation of my office, especially when I recall to mind my having been twice suspended from my duties for the efforts I had made in bringing about the changes which I have above referred to, and that at last, when I was no longer able to do my work, I was constrained to sever my connection with the Board who had come to look upon me as one solely actuated by a sense of duty. The day after the receipt of my resignation, I received the following-- "WESTMINSTER UNION, "POLAND STREET, "_September 27, 1886_. "DEAR SIR,--I am directed to forward you the annexed copy of a Resolution adopted by the Guardians at their meeting held on Friday last, when your resignation of the offices of Workhouse Medical Officer and Public Vaccinator of the Union was accepted. "I am, dear Sir, yours faithfully, "FRED J. LAMPARD, "_Assistant Clerk of the Guardians_. "J. ROGERS, ESQ., M.D., "Montagu Place, Russell Square." (Copy Resolution.) "That this Board has received with much regret the letter just read from Dr. Joseph Rogers, resigning the office of Workhouse Medical Officer and Public Vaccinator for the Union, on account of his continued ill-health, and while now accepting such resignation, the Guardians desire to convey to him their deep sympathy that he should thus be compelled to sever his connection with the Board after many years of faithful service, and to record their high sense of the zealous and efficient manner in which he has discharged the duties of his office, and for the warm interest he has at all times taken in questions affecting the proper treatment of the sick and infirm poor." After the resolution had been submitted to the vote and adopted unanimously, Mr. Samuel Bonsor rose in his seat and gave notice that that day month superannuation allowance should be accorded to Dr. Joseph Rogers. Coming from this gentleman it was indeed an honourable recognition of lengthened public services. Mr. Bonsor had been in various offices of the parish of St. Anne's, Soho, since the introduction of the new Poor Law Bill in 1834. He had filled all the usual parochial offices, even the highest, up to the time when I first made his acquaintance, which was in the autumn of 1846, on the occasion when I brought before the Vestry of St. Anne's, Soho, the terrible condition of the burial-ground of that parish. After hearing my indictment he at once concurred in the appointment of a committee from the Vestry, of the inhabitants, to take the condition of the ground into consideration, and to devise such remedies as might appear desirable. Mr. Bonsor attended several of our meetings, and entirely agreed as to the dreadful state into which the graveyard had fallen, owing to the frequent funerals and the enormous overcrowding. It was that Vestry meeting that first made me a sanitary reformer, and caused me to advocate extra-mural interment as well as many other social reforms, in all of which I had the hearty support of Mr. Bonsor. I question whether a finer representative of a middle-class tradesman could be found in this kingdom; for more than half a century he has devoted more than ordinary ability to the interests of his fellow-parishioners. I never upon one single occasion heard, or was it ever hinted by any enemy (if he ever made one, which I doubt), that his actions were ever influenced by a single act of self-seeking; indeed, he has passed through an unusually prolonged life amidst the respect and regard of all who have come in contact with him. A very short time ago he brought me a circular letter, issued by the Poor Law Commissioners, proposing the Board of Guardians in London should issue a similar letter to their respective bodies, so as to more effectually deal with casuals. Laying it down before me, he said, "This is a return to what they did between forty and fifty years ago, for I was a member of the special Board which was appointed under this letter; but," said he, "I suppose they have forgotten all about it." And so they had, no doubt. Before bringing my remarks to a close, I should like to briefly describe the various changes that have taken place since the Poor Law Commission was appointed in 1832. One of the original Commissioners was the Right Hon. C. P. Villiers, M.P. for Wolverhampton, who has told me in the course of various conversations I have had with him, that although a variety of subjects was referred to them in connection with the administration of the Poor Laws, yet that the question of sickness, as a factor in the production of pauperism was not referred to them, and if it had not been for the pertinacity of Dr. G. Wallis and some others, that this important subject would have been passed over altogether. It need not, therefore, be a matter of surprise that there has been a continual protest going on, on the part of those who have accepted Poor Law medical appointments against the way in which they have been treated by the Board of Guardians, and a reference to the Poor Law Commissioners resulting in the various changes that have taken place in the composition of the central authority up to the Local Government Board of the present day. Until 1864 the central authority was an extremely weak body, as continuous efforts were made throughout the country by Boards of Guardians and others to wipe the Poor Law Board out of existence altogether, and had it not have happened that the investigations and deliberations of the Select Committee on Poor Relief, presided over by the Right Hon. C. P. Villiers, had reported in favour of the maintenance of the Poor Law Board--not Local Government Board--such a disastrous thing would have happened. Let it here be fully understood that although I have taken a most determined antagonism to many of the acts of the Board, whether as Commissioners or as the Poor Law Board, yet that antagonism has been due to the fact that the administration has often been seriously faulty in detail. The office of a Poor Law Inspector is one which needs much judgment and tact. I trust this will be borne in mind by those who will draft the contemplated County Government Board. There is one point on which, feeling most strongly the existing mockery of so-called Poor Law inquiries, I do trust a change will be insisted upon, and that is, that those deputed to make the inquiry shall possess at least a modicum of legal intelligence. Finally, I have to express the hope that no Inspector, whether metropolitan or otherwise, will be vested with the sole power of deciding what shall be the evidence that shall be taken when the inquiry shall close, nor that he shall be the sole judge of the value of such evidence. UNWIN BROTHERS, THE GRESHAM PRESS, CHILWORTH AND LONDON. 
58859	----	generously made available by Internet Archive (https://archive.org) Note: Project Gutenberg also has an HTML version of this file which includes the original illustrations. See 58859-h.htm or 58859-h.zip: (http://www.gutenberg.org/files/58859/58859-h/58859-h.htm) or (http://www.gutenberg.org/files/58859/58859-h.zip) Images of the original pages are available through Internet Archive. See https://archive.org/details/b21935142_0001 Project Gutenberg has the other three volumes of this work. Volume II: see http://www.gutenberg.org/ebooks/58860 Volume III: see http://www.gutenberg.org/ebooks/58861 Volume IV: see http://www.gutenberg.org/ebooks/58862 Transcriber's note: The ligature oe has been marked as [oe]. Text in italics has been enclosed by underscores (_text_). Text in bold face has been enclosed by equal signs (=text=). MEDICAL INQUIRIES AND OBSERVATIONS. BY BENJAMIN RUSH, M. D. PROFESSOR OF THE INSTITUTES AND PRACTICE OF MEDICINE, AND OF CLINICAL PRACTICE, IN THE UNIVERSITY OF PENNSYLVANIA. IN FOUR VOLUMES. VOL. I. THE SECOND EDITION, REVISED AND ENLARGED BY THE AUTHOR. PHILADELPHIA, PUBLISHED BY J. CONRAD & CO. CHESNUT-STREET, PHILADELPHIA; M. & J. CONRAD & CO. MARKET-STREET, BALTIMORE; RAPIN, CONRAD, & CO. WASHINGTON; SOMERVELL & CONRAD, PETERSBURG; AND BONSAL, CONRAD, & CO. NORFOLK. PRINTED BY T. & G. PALMER, 116, HIGH-STREET. 1805. * * * * * PREFACE. In this second edition of the following Medical Inquiries and Observations, the reader will perceive many additions, some omissions, and a few alterations. A number of facts have been added to the Inquiry into the Effects of Ardent Spirits upon the Body and Mind, and to the Observations upon the Tetanus, Cynanche Trachealis, and Old Age, in the first volume; also to the Observations upon Dropsies, Pulmonary Consumption, and Hydrophobia, contained in the second volume. The Lectures upon Animal Life, which were published, a few years ago, in a pamphlet, have received no other additions than a few notes. The phænomena of fever have not only received a new title, but several new terms have been adopted in detailing them, chiefly to remove the mistake into which the use of Dr. Brown's terms had led some of the author's readers, respecting his principles. A new order has likewise been given, and some new facts added, to the inquiry upon this subject. In the Account of the Yellow Fever of 1793, many documents, interesting to the public at the time of their first publication, are omitted; and many of the facts and observations, which related to the origin of the fevers of 1794 and 1797, now form a part of a separate inquiry upon that subject, in the fourth volume. The histories of the yellow fever as epidemics, and of its sporadic cases, have been published in the order in which they have appeared in Philadelphia, to show the influence of the weather upon it, and the impropriety and danger of applying the same remedies for the same epidemic, in different and even successive seasons. The records of the first cases of yellow fever, which have appeared in each of the twelve years that have been noticed, are intended further to show the inefficacy of all the means, at present employed, to prevent its future recurrence. In the fourth volume, the reader will find a retraction of the author's former opinion of the yellow fever's spreading by contagion. He begs forgiveness of the friends of science and humanity, if the publication of that opinion has had any influence in increasing the misery and mortality attendant upon that disease. Indeed, such is the pain he feels, in recollecting that he ever entertained or propagated it, that it will long, and perhaps always, deprive him of the pleasure he might otherwise have derived from a review of his attempts to fulfil the public duties of his profession. Considerable additions are made to the facts and arguments in favour of the domestic origin of the yellow fever, and to the Defence of Blood-letting. The Account of the Means of Preventing the Usual Forms of Summer and Autumnal Disease, appears for the first time in this edition of the author's Inquiries. Part of the facts intended to prove the yellow fever not to be contagious, were published in the sixth volume of the New-York Medical Repository. The reader will perceive, among many additions to them, answers to all the arguments usually employed to defend the contrary opinion. The Inquiry into the Comparative State of Medicine, in Philadelphia, between the years 1760 and 1766, and 1805, was delivered, in the form of an oration, before the Medical Society of Philadelphia, on the 18th of February, 1804. Some things have been omitted, and a few added, in the form in which it is now offered to the public. If this edition of Medical Inquiries and Observations should be less imperfect than the former, the reader is requested to ascribe it to the author having profited by the objections he encouraged his pupils to make to his principles, in their inaugural dissertations, and in conversation; and to the many useful facts which have been communicated to him by his medical brethren, whose names have been mentioned in the course of the work. For the departure, in the modes of practice adopted or recommended in these Inquiries, from those which time and experience have sanctioned, in European and in East and West-Indian countries, the author makes the same defence of himself, that Dr. Baglivi made, near a century ago, of his modes of practice in Rome. "_Vivo et scribo in aere Romano_," said that illustrious physician. The author has lived and written in the climate of Pennsylvania, and in the city of Philadelphia. _November 18th, 1805._ * * * * * CONTENTS OF VOLUME I. _page_ _An inquiry into the natural history of medicine among the Indians of North-America, and a comparative view of their diseases and remedies with those of civilized nations_ 1 _An account of the climate of Pennsylvania, and its influence upon the human body_ 69 _An account of the bilious remitting fever, as it appeared in Philadelphia in the summer and autumn of the year 1780_ 115 _An account of the scarlatina anginosa, as it appeared in Philadelphia in the years 1783 and 1784_ 135 _An inquiry into the cause and cure of the cholera infantum_ 153 _Observations on the cynanche trachealis_ 167 _An account of the efficacy of blisters and bleeding, in the cure of obstinate intermitting fevers_ 177 _An account of the disease occasioned by drinking cold water in warm weather, and the method of curing it_ 181 _An account of the efficacy of common salt in the cure of hæmoptysis_ 189 _Thoughts on the cause and cure of pulmonary consumption_ 197 _Observations upon worms in the alimentary canal, and upon anthelmintic medicines_ 215 _An account of the external use of arsenic in the cure of cancers_ 235 _Observations on the tetanus_ 245 _The result of observations made upon the diseases which occurred in the military hospitals of the United States, during the revolutionary war_ 267 _An account of the influence of the military and political events of the American revolution upon the human body_ 277 _An inquiry into the relation of tastes and aliments to each other, and into the influence of this relation upon health and pleasure_ 295 _The new method of inoculating for the small-pox_ 309 _An inquiry into the effects of ardent spirits upon the human body and mind, with an account of the means of preventing, and the remedies for curing them_ 335 _Observations on the duties of a physician, and the methods of improving medicine; accommodated to the present state of society and manners in the United States_ 385 _An inquiry into the causes and cure of sore legs_ 401 _An account of the state of the body and mind in old age, with observations on its diseases, and their remedies_ 425 * * * * * AN INQUIRY INTO THE _NATURAL HISTORY OF MEDICINE_ AMONG THE INDIANS OF NORTH-AMERICA; AND A COMPARATIVE VIEW OF THEIR DISEASES AND REMEDIES WITH THOSE OF CIVILIZED NATIONS. Read before the AMERICAN PHILOSOPHICAL SOCIETY, held at PHILADELPHIA, on the 4th of February, 1774. GENTLEMEN[1], I rise with peculiar diffidence to address you upon this occasion, when I reflect upon the entertainment you proposed to yourselves from the eloquence of that learned member, Mr. CHARLES THOMPSON, whom your suffrages appointed to this honour after the delivery of the last anniversary oration. Unhappily for the interests of science, his want of health has not permitted him to comply with your appointment. I beg, therefore, that you would forget, for a while, the abilities necessary to execute this task with propriety, and listen with candour to the efforts of a member, whose attachment to the society was the only qualification that entitled him to the honour of your choice. [1] This INQUIRY was the subject of an Anniversary Oration. The style of an oration is therefore preserved in many parts of it. The subject I have chosen for this evening's entertainment, is "An inquiry into the natural history of medicine among the Indians in North-America, and a comparative view of their diseases and remedies, with those of civilized nations." You will readily anticipate the difficulty of doing justice to this subject. How shall we distinguish between the original diseases of the Indians and those contracted from their intercourse with the Europeans? By what arts shall we persuade them to discover their remedies? And lastly, how shall we come at the knowledge of facts in that cloud of errors, in which the credulity of the Europeans, and the superstition of the Indians, have involved both their diseases and remedies? These difficulties serve to increase the importance of our subject. If I should not be able to solve them, perhaps I may lead the way to more successful endeavours for that purpose. I shall first limit the tribes of Indians who are to be the objects of this inquiry, to those who inhabit that part of North-America which extends from the 30th to the 60th degree of latitude. When we exclude the Esquimaux, who inhabit the shores of Hudson's bay, we shall find a general resemblance in the colour, manners, and state of society, among all the tribes of Indians who inhabit the extensive tract of country above-mentioned. Civilians have divided nations into savage, barbarous, and civilized. The savage live by fishing and hunting; the barbarous, by pasturage or cattle; and the civilized, by agriculture. Each of these is connected together in such a manner, that the whole appear to form different parts of a circle. Even the manners of the most civilized nations partake of those of the savage. It would seem as if liberty and indolence were the highest pursuits of man; and these are enjoyed in their greatest perfection by savages, or in the practice of customs which resemble those of savages. The Indians of North-America partake chiefly of the manner of savages. In the earliest accounts we have of them, we find them cultivating a spot of ground. The maize is an original grain among them. The different dishes of it which are in use among the white people still retain Indian names. It will be unnecessary to show that the Indians live in a state of society adapted to all the exigencies of their mode of life. Those who look for the simplicity and perfection of the state of nature, must seek it in systems, as absurd in philosophy, as they are delightful in poetry. Before we attempt to ascertain the number or history of the diseases of the Indians, it will be necessary to inquire into those customs among them which we know influence diseases. For this purpose I shall, First, Mention a few facts which relate to the birth and treatment of their children. Secondly, I shall speak of their diet. Thirdly, Of the customs which are peculiar to the sexes, and, Fourthly, Of those customs which are common to them both[2]. [2] Many of the facts contained in the Natural History of Medicine among the Indians in this Inquiry, are taken from La Hontan and Charlevoix's histories of Canada; but the most material of them are taken from persons who had lived or travelled among the Indians. The author acknowledges himself indebted in a particular manner to Mr. Edward Hand, surgeon in the 18th regiment, afterwards brigadier-general in the army of the United States, who, during several years' residence at Fort Pitt, directed his inquiries into their customs, diseases, and remedies, with a success that does equal honour to his ingenuity and diligence. I. Of the birth and treatment of their children. Much of the future health of the body depends upon its original stamina. A child born of healthy parents always brings into the world a system formed by nature to resist the causes of diseases. The treatment of children among the Indians, tends to secure this hereditary firmness of constitution. Their first food is their mother's milk. To harden them against the action of heat and cold (the natural enemies of health and life among the Indians) they are plunged every day into cold water. In order to facilitate their being moved from place to place, and at the same time to preserve their shape, they are tied to a board, where they lie on their backs for six, ten, or eighteen months. A child generally sucks its mother till it is two years old, and sometimes longer. It is easy to conceive how much vigour their bodies must acquire from this simple, but wholesome nourishment. The appetite we sometimes observe in children for flesh is altogether artificial. The peculiar irritability of the system in infancy forbids stimulating aliment of all kinds. Nature never calls for animal food till she has provided the child with those teeth which are necessary to divide it. I shall not undertake to determine how far the wholesome quality of the mother's milk is increased by her refusing the embraces of her husband, during the time of giving suck. II. The diet of the Indians is of a mixed nature, being partly animal and partly vegetable. Their animals are wild, and therefore easy of digestion. As the Indians are naturally more disposed to the indolent employment of fishing than hunting, in summer, so we find them living more upon fish than land animals, in that season of the year.--Their vegetables consist of roots and fruits, mild in themselves, or capable of being made so by the action of fire. Although the interior parts of our continent abound with salt springs, yet I cannot find that the Indians used salt in their diet, till they were instructed to do so by the Europeans. The small quantity of fixed alkali contained in the ashes on which they roasted their meat, could not add much to its stimulating quality. They preserve their meat from putrefaction, by cutting it into small pieces, and exposing it in summer to the sun, and in winter to the frost. In the one case its moisture is dissipated, and in the other so frozen, that it cannot undergo the putrefactive process. In dressing their meat, they are careful to preserve its juices. They generally prefer it in the form of soups. Hence we find, that among them the use of the spoon, preceded that of the knife and fork. They take the same pains to preserve the juice of their meat when they roast it, by turning it often. The efficacy of this animal juice, in dissolving meat in the stomach, has not been equalled by any of those sauces or liquors which modern luxury has mixed with it for that purpose. The Indians have no set time for eating, but obey the gentle appetites of nature as often as they are called by them. After whole days spent in the chace or in war, they often commit those excesses in eating, to which long abstinence cannot fail of prompting them. It is common to see them spend three or four hours in satisfying their hunger. This is occasioned not more by the quantity they eat, than by the pains they take in masticating it. They carefully avoid drinking water in their marches, from an opinion that it lessens their ability to bear fatigue. III. We now come to speak of those customs which are peculiar to the sexes. And, first, of those which belong to the WOMEN. They are doomed by their husbands to such domestic labour as gives a firmness to their bodies, bordering upon the masculine. Their menses seldom begin to flow before they are eighteen or twenty years of age, and generally cease before they are forty. They have them in small quantities, but at regular intervals. They seldom marry till they are about twenty. The constitution has now acquired a vigour, which enables it the better to support the convulsions of child-bearing. This custom likewise guards against a premature old age. Doctor Bancroft ascribes the haggard looks, the loose hanging breasts, and the prominent bellies of the Indian women at Guiana, entirely to their bearing children too early[3]. Where marriages are unfruitful (which is seldom the case) a separation is obtained by means of an easy divorce; so that they are unacquainted with the disquietudes which sometimes arise from barrenness. During pregnancy, the women are exempted from the more laborious parts of their duty: hence miscarriages rarely happen among them. Nature is their only midwife. Their labours are short, and accompanied with little pain. Each woman is delivered in a private cabin, without so much as one of her own sex to attend her. After washing herself in cold water, she returns in a few days to her usual employments; so that she knows nothing of those accidents which proceed from the carelessness or ill management of midwives; or those weaknesses which arise from a month's confinement in a warm room. It is remarkable that there is hardly a period in the interval between the eruption and the ceasing of the menses, in which they are not pregnant, or giving suck. This is the most natural state of the constitution during that interval; and hence we often find it connected with the best state of health, in the women of civilized nations. [3] Natural History of Guiana. The customs peculiar to the Indian MEN, consist chiefly in those employments which are necessary to preserve animal life, and to defend their nation. These employments are hunting and war, each of which is conducted in a manner that tends to call forth every fibre into exercise, and to ensure them the possession of the utmost possible health. In times of plenty and peace, we see them sometimes rising from their beloved indolence, and shaking off its influence by the salutary exercises of dancing and swimming. The Indian men seldom marry before they are thirty years of age: they no doubt derive considerable vigour from this custom; for while they are secured by it from the enervating effects of the premature dalliance of love, they may insure more certain fruitfulness to their wives, and entail more certain health upon their children. Tacitus describes the same custom among the Germans, and attributes to it the same good effects. "Sera juvenum venus, eoque inexhausta pubertas; nec virgines festinantur; eadem juventa, similis proceritas, pares validique miscentur; ac robora parentum liberi referunt[4]." [4] Cæsar, in his history of the Gallic war, gives the same account of the ancient Germans. His words are "Qui diutissimi impuberes permanserunt, maximam inter suos ferunt laudem: hoc ali staturam, ali vires, nervasque confirmari putant." Lib. vi. xxi. Among the Indian men, it is deemed a mark of heroism to bear the most exquisite pain without complaining; upon this account they early inure themselves to burning part of their bodies with fire, or cutting them with sharp instruments. No young man can be admitted to the honours of manhood or war, who has not acquitted himself well in these trials of patience and fortitude. It is easy to conceive how much this contributes to give a tone to the nervous system, which renders it less subject to the occasional causes of diseases. IV. We come now to speak of those customs which are common to both sexes: these are PAINTING, and the use of the COLD BATH. The practice of anointing the body with oil is common to the savages of all countries; in warm climates it is said to promote longevity, by checking excessive perspiration. The Indians generally use bear's grease mixed with a clay, which bears the greatest resemblance to the colour of their skins. This pigment serves to lessen the sensibility of the extremities of the nerves; it moreover fortifies them against the action of those exhalations, which we shall mention hereafter, as a considerable source of their diseases. The COLD BATH likewise fortifies the body, and renders it less subject to those diseases which arise from the extremes and vicissitudes of heat and cold. We shall speak hereafter of the Indian manner of using it. It is a practice among the Indians never to drink before dinner, when they work or travel. Experience teaches, that filling the stomach with cold water in the forenoon, weakens the appetite, and makes the system more sensible of heat and fatigue. The state of society among the Indians excludes the influence of most of those passions which disorder the body. The turbulent effects of anger are concealed in deep and lasting resentments. Envy and ambition are excluded by their equality of power and property. Nor is it necessary that the perfections of the whole sex should be ascribed to one, to induce them to marry. "The weakness of love (says Dr. Adam Smith) which is so much indulged in ages of humanity and politeness, is regarded among savages as the most unpardonable effeminacy. A young man would think himself disgraced for ever, if he showed the least preference of one woman above another, or did not express the most complete indifference, both about the time when, and the person to whom, he was to be married[5]." Thus are they exempted from those violent or lasting diseases, which accompany the several stages of such passions in both sexes among civilized nations. [5] Theory of Moral Sentiments. It is remarkable that there are no deformed Indians. Some have suspected, from this circumstance, that they put their deformed children to death; but nature here acts the part of an unnatural mother. The severity of the Indian manners destroy them[6]. [6] Since the intercourse of the white people with the Indians, we find some of them deformed in their limbs. This deformity, upon inquiry, appears to be produced by those accidents, quarrels, &c. which have been introduced among them by spiritous liquors. From a review of the customs of the Indians, we need not be surprised at the stateliness, regularity of features, and dignity of aspect by which they are characterized. Where we observe these among ourselves, there is always a presumption of their being accompanied with health, and a strong constitution. The circulation of the blood is more languid in the Indians, than in persons who are in the constant exercise of the habits of civilized life. Out of eight Indian men whose pulses I once examined at the wrists, I did not meet with one in whom the artery beat more than sixty strokes in a minute. The marks of old age appear more early among Indian, than among civilized nations. Having finished our inquiry into the physical customs of the Indians, we shall now proceed to inquire into their diseases. A celebrated professor of anatomy has asserted, that we could not tell, by reasoning _à priori_, that the body was mortal, so intimately woven with its texture are the principles of life. Lord Bacon declares, that the only cause of death which is natural to man, is that from old age; and complains of the imperfection of physic, in not being able to guard the principle of life, until the whole of the oil that feeds it is consumed. We cannot as yet admit this proposition of our noble philosopher. In the inventory of the grave in every country, we find more of the spoils of youth and manhood than of age. This must be attributed to moral as well as physical causes. We need only recollect the custom among the Indians, of sleeping in the open air in a variable climate; the alternate action of heat and cold upon their bodies, to which the warmth of their cabins exposes them; their long marches; their excessive exercise; their intemperance in eating, to which their long fasting and their public feasts naturally prompt them; and, lastly, the vicinity of their habitations to the banks of rivers, in order to discover the empire of diseases among them in every stage of their lives. They have in vain attempted to elude the general laws of mortality, while their mode of life subjects them to these remote, but certain causes of diseases. From what we know of the action of these powers upon the human body, it will hardly be necessary to appeal to facts to determine that FEVERS constitute the only diseases among the Indians. These fevers are occasioned by the insensible qualities of the air. Those which are produced by cold and heat are of the inflammatory kind, such as pleurisies, peripneumonies, and rheumatisms. Those which are produced by the insensible qualities of the air, or by putrid exhalations, are intermitting, remitting, inflammatory, and malignant, according as the exhalations are combined with more or less heat or cold. The DYSENTERY (which is an Indian disease) comes under the class of fevers. It appears to be the febris introversa of Dr. Sydenham. The Indians are subject to ANIMAL and VEGETABLE POISONS. The effects of these upon the body, are in some degree analogous to the exhalations we have mentioned. When they do not bring on sudden death, they produce, according to their force, either a common inflammatory, or a malignant fever. The SMALL POX and the VENEREAL DISEASE were communicated to the Indians of North-America by the Europeans. Nor can I find that they were ever subject to the SCURVY. Whether this was obviated by their method of preserving their flesh, or by their mixing it at all times with vegetables, I shall not undertake to determine. Their peculiar customs and manners seem to have exempted them from this, as well as from the common diseases of the skin. I have heard of two or three cases of the GOUT among the Indians, but it was only among those who had learned the use of rum from the white people. A question naturally occurs here, and that is, why does not the gout appear more frequently among that class of people, who consume the greatest quantity of rum among ourselves? To this I answer, that the effects of this liquor upon those enfeebled people, are too sudden and violent, to admit of their being thrown upon the extremities; as we know them to be among the Indians. They appear only in visceral obstructions, and a complicated train of chronic diseases. Thus putrid miasmata are sometimes too strong to bring on a fever, but produce instant debility and death. The gout is seldom heard of in Russia, Denmark, or Poland. Is this occasioned by the vigour of constitution peculiar to the inhabitants of those northern countries? or is it caused by their excessive use of spirituous liquors, which produce the same chronic complaints among them, which we said were common among the lower class of people in this country? The similarity of their diseases makes the last of these suppositions the most probable. The effects of wine, like tyranny in a well formed government, are felt first in the extremities; while spirits, like a bold invader, seize at once upon the vitals of the constitution. After much inquiry, I have not been able to find a single instance of FATUITY among the Indians, and but few instances of MELANCHOLY and MADNESS; nor can I find any accounts of diseases from WORMS among them. Worms are common to most animals; they produce diseases only in weak, or increase them in strong constitutions[7]. Hence they have no place in the nosological systems of physic. Nor is DENTITION accompanied by disease among the Indians. The facility with which the healthy children of healthy parents cut their teeth among civilized nations, gives us reason to conclude that the Indian children never suffer from this quarter. [7] Indian children are not exempted from worms. It is common with the Indians, when a fever in their children is ascribed by the white people to worms (from their being discharged occasionally in their stools), to say, "the fever makes the worms come, and not the worms the fever." The Indians appear moreover to be strangers to diseases and pains in the teeth. The employments of the Indians subject them to many accidents; hence we sometimes read of WOUNDS, FRACTURES, and LUXATIONS among them. Having thus pointed out the natural diseases of the Indians, and shown what diseases are foreign to them, we may venture to conclude, that FEVERS, OLD AGE, CASUALTIES, and WAR are the only natural outlets of human life. War is nothing but a disease; it is founded in the imperfection of political bodies, just as fevers are founded on the weakness of the animal body. Providence in these diseases seems to act like a mild legislature, which mitigates the severity of death, by inflicting it in a manner the least painful, upon the whole, to the patient and the survivors. Let us now inquire into the REMEDIES of the Indians. These, like their diseases, are simple, and few in number. Among the first of them we shall mention the POWERS OF NATURE. Fevers, we said formerly, constituted the chief of the diseases among the Indians; they are likewise, in the hands of nature, the principal instruments to remove the evils which threaten her dissolution; but the event of these efforts of nature, no doubt, soon convinced the Indians of the danger of trusting her in all cases; and hence, in the earliest accounts we have of their manners, we read of persons who were intrusted with the office of physicians. It will be difficult to find out the exact order in which the Indian remedies were suggested by nature or discovered by art; nor will it be easy to arrange them in proper order. I shall, however, attempt it, by reducing them to NATURAL and ARTIFICIAL. To the class of NATURAL REMEDIES belongs the Indian practice of abstracting from their patients all kinds of stimulating aliment. The compliance of the Indians with the dictates of nature, in the early stage of a disease, no doubt, prevents, in many cases, their being obliged to use any other remedy. They follow nature still closer, in allowing their patients to drink plentifully of cold water; this being the only liquor a patient calls for in a fever. Sweating is likewise a natural remedy. It was probably suggested by observing fevers to be terminated by it. I shall not inquire how far these sweats are essential to the crisis of a fever. The Indian mode of procuring this evacuation is as follows: the patient is confined in a close tent, or wigwam, over a hole in the earth, in which a red hot stone is placed; a quantity of water is thrown upon this stone, which instantly involves the patient in a cloud of vapour and sweat; in this situation he rushes out, and plunges himself into a river, from whence he retires to his bed. If the remedy has been used with success, he rises from his bed in four and twenty hours, perfectly recovered from his indisposition. This remedy is used not only to cure fevers, but remove that uneasiness which arises from fatigue of body. A third natural remedy among the Indians, is PURGING. The fruits of the earth, the flesh of birds, and other animals feeding upon particular vegetables, and, above all, the spontaneous efforts of nature, early led the Indians to perceive the necessity and advantages of this evacuation. VOMITS constitute their fourth natural remedy. They were probably, like the former, suggested by nature, and accident. The ipecacuanha is one of the many roots they employ for that purpose. The ARTIFICIAL REMEDIES made use of by the Indians, are BLEEDING, CAUSTICS, and ASTRINGENT medicines. They confine bleeding entirely to the part affected. To know that opening a vein in the arm, or foot, would relieve a pain in the head or side, supposes some knowledge of the animal economy, and therefore marks an advanced period in the history of medicine. Sharp stones and thorns are the instruments they use to procure a discharge of blood. We have an account of the Indians using something like a POTENTIAL CAUSTIC, in obstinate pains. It consists of a piece of rotten wood called _punk_, which they place upon the part affected, and afterwards set it on fire: the fire gradually consumes the wood, and its ashes burn a hole in the flesh. The undue efforts of nature, in those fevers which are connected with a diarrh[oe]a, or dysentery, together with those hemorrhages to which their mode of life exposed them, necessarily led them to an early discovery of some ASTRINGENT VEGETABLES. I am uncertain whether the Indians rely upon astringent, or any other vegetables, for the cure of the intermitting fever. This disease among them probably requires no other remedies than the cold bath, or cold air. Its greater obstinacy, as well as frequency, among ourselves, must be sought for in the greater feebleness of our constitutions, and in that change which our country has undergone, from meadows, mill-dams, and the cutting down of woods; whereby morbid exhalations have been multiplied, and their passage rendered more free, through every part of country. This is a short account of the remedies of the Indians. If they are simple, they are like their eloquence, full of strength; if they are few in number, they are accommodated, as their languages are to their ideas, to the whole of their diseases. We said, formerly, that the Indians were subject to ACCIDENTS, such as wounds, fractures, and the like. In these cases, nature performs the office of a surgeon. We may judge of her qualifications for this office, by observing the marks of wounds and fractures, which are sometimes discovered on wild animals. But further, what is the practice of our modern surgeons in these cases? Is it not to lay aside plasters and ointments, and trust the whole to nature? Those ulcers which require the assistance of mercury, bark, and a particular regimen are unknown to the Indians. The HEMORRHAGES which sometimes follow their wounds, are restrained by plunging themselves into cold water, and thereby producing a constriction upon the bleeding vessels. Their practice of attempting to recover DROWNED PEOPLE, is irrational and unsuccessful. It consists in suspending the patient by the heels, in order that the water may flow from his mouth. This practice is founded on a belief that the patient dies from swallowing an excessive quantity of water. But modern observations teach us that drowned people die from another cause. This discovery has suggested a method of cure, directly opposite to that in use among the Indians; and has shown us that the practice of suspending by the heels is hurtful. I do not find that the Indians ever suffer in their limbs from the action of COLD upon them. Their mokasons[8], by allowing their feet to move freely, and thereby promoting the circulation of the blood, defend their lower extremities in the day-time, and their practice of sleeping with their feet near a fire, defends them from the morbid effects of cold at night. In those cases where the motion of their feet in their mokasons is not sufficient to keep them warm, they break the ice, and restore their warmth by exposing them for a short time to the action of cold water[9]. [8] Indian shoes. [9] It was remarked in Canada, in the winter of the year 1759, during the war before last, that none of those soldiers who wore mokasons were frost-bitten, while few of those escaped that were much exposed to the cold who wore shoes. We have heard much of their specific antidotes to the VENEREAL DISEASE. In the accounts of these anti-venereal medicines, some abatement should be made for that love of the marvellous, and of novelty, which are apt to creep into the writings of travellers and physicians. How many medicines which were once thought infallible in this disease, are now rejected from the materia medica! I have found upon inquiry that the Indians always assist their medicines in this disease, by a regimen which promotes perspiration. Should we allow that mercury acts as a specific in destroying this disease, it does not follow that it is proof against the efficacy of medicines which act more mechanically upon the body[10]. [10] I cannot help suspecting the anti-venereal qualities of the lobelia, ceanothus and ranunculus, spoken of by Mr. Kalm, in the Memoirs of the Swedish Academy. Mr. Hand informed me, that the Indians rely chiefly upon a plentiful use of the decoctions of the pine-trees for the cure of the venereal disease. He added, moreover, that he had often known this disease prove fatal to them. There cannot be a stronger mark of the imperfect state of knowledge in medicine among the Indians, than their method of treating the SMALL-POX. We are told that they plunge themselves in cold water in the beginning of the disease, and that it often proves fatal to them. Travellers speak in high terms of the Indian ANTIDOTES TO POISONS. We must remember that many things have been thought poisonous, which later experience hath proved to possess no unwholesome quality. Moreover, the uncertainty and variety in the operation of poisons, renders it extremely difficult to fix the certainty of the antidotes to them. How many specifics have derived their credit for preventing the hydrophobia, from persons being wounded by animals, who were not in a situation to produce that disease! If we may judge of all the Indian antidotes to poisons, by those which have fallen into our hands, we have little reason to ascribe much to them in any cases whatever. I have heard of their performing several remarkable cures upon STIFF JOINTS, by an infusion of certain herbs in water. The mixture of several herbs together in this infusion calls in question the specific efficacy of each of them. I cannot help attributing the whole success of this remedy to the great heat of the water in which the herbs were boiled, and to its being applied for a long time to the part affected. We find the same medicine to vary frequently in its success, according to its strength, or to the continuance of its application. De Haen attributes the good effects of electricity, entirely to its being used for several months. I have met with one case upon record of their aiding nature in PARTURITION. Captain Carver gives us an account of an Indian woman in a difficult labour, being suddenly delivered in consequence of a general convulsion induced upon her system, by stopping, for a short time, her mouth and nose, so as to obstruct her breathing. We are sometimes amused with accounts of Indian remedies for the DROPSY, EPILEPSY, COLIC, GRAVEL, and GOUT. If, with all the advantages which modern physicians derive from their knowledge in anatomy, chemistry, botany, and philosophy; if, with the benefit of discoveries communicated from abroad, as well as handed down from our ancestors, by more certain methods than tradition, we are still ignorant of certain remedies for these diseases; what can we expect from the Indians; who are not only deprived of these advantages, but want our chief motive, the sense of the pain and danger of those diseases, to prompt them to seek for such remedies to relieve them? There cannot be a stronger proof of their ignorance of proper remedies for new or difficult diseases, than their having recourse to enchantment. But to be more particular; I have taken pains to inquire into the success of some of these Indian specifics, and have never heard of one well attested case of their efficacy. I believe they derive all their credit from our being ignorant of their composition. The influence of secrecy is well known in establishing the credit of a medicine. The sal seignette was supposed to be an infallible medicine for the intermitting fever, while the manufactory of it was confined to an apothecary at Rochelle; but it lost its virtues as soon as it was found to be composed of the acid of tartar and the fossil alkali. Dr. Ward's famous pill and drop ceased to do wonders in scrophulous cases, as soon as he bequeathed to the world his receipts for making them. I foresee an objection to what has been said concerning the remedies of the Indians, drawn from that knowledge which experience gives to a mind intent upon one subject. We have heard much of the perfection of their senses of seeing and hearing. An Indian, we are told, will discover not only a particular tribe of Indians by their footsteps, but the distance of time in which they were made. In those branches of knowledge which relate to hunting and war, the Indians have acquired a degree of perfection that has not been equalled by civilized nations. But we must remember, that medicine among them does not possess the like advantages with the arts of war and hunting, of being the _chief_ object of their attention. The physician and the warrior are united in one character; to render him as able in the former as he is in the latter profession, would require an entire abstraction from every other employment, and a familiarity with external objects, which are incompatible with the wandering life of savages. Thus have we finished our inquiry into the diseases and remedies of the Indians in North-America. We come now to inquire into the diseases and remedies of civilized nations. Nations differ in their degrees of civilization. We shall select one for the subject of our inquiries which is most familiar to us; I mean the British nation. Here we behold subordination and classes of mankind established by government, commerce, manufactures, and certain customs common to most of the civilized nations of Europe. We shall trace the origin of their diseases through their customs, in the same manner as we did those of the Indians. I. It will be sufficient to name the degrees of heat, the improper aliment, the tight dresses, and the premature studies children are exposed to, in order to show the ample scope for diseases, which is added to the original defect of stamina they derive from their ancestors. II. Civilization rises in its demands upon the health of women. Their fashions; their dress and diet; their eager pursuits and ardent enjoyment of pleasure; their indolence and undue evacuations in pregnancy; their cordials, hot regimen, and neglect, or use of art, in child-birth, are all so many inlets to disease. Humanity would fain be silent, while philosophy calls upon us to mention the effects of interested marriages, and of disappointments in love, increased by that concealment which the tyranny of custom has imposed upon the sex[11]. Each of these exaggerates the natural, and increases the number of artificial diseases among women. [11] "Married women are more healthy and long-lived than single women. The registers, examined by Mr. Muret, confirm this observation; and show particularly, that of equal numbers of single and married women between fifteen and twenty-five years of age, more of the former died than of the latter, in the proportion of two to one: the consequence, therefore, of following nature must be favourable to health among the female sex." Supplement to Price's Observations on Reversionary Payments. p. 357. III. The diseases introduced by civilization extend themselves through every class and profession among men. How fatal are the effects of idleness and intemperance among the rich, and of hard labour and penury among the poor! What pallid looks are contracted by the votaries of science from hanging over the "sickly taper!" How many diseases are entailed upon manufacturers, by the materials in which they work, and the posture of their bodies! What monkish diseases do we observe from monkish continence and monkish vices! We pass over the increase of accidents from building, sailing, riding, and the like. War, as if too slow in destroying the human species, calls in a train of diseases peculiar to civilized nations. What havoc have the corruption and monopoly of provisions, a damp soil, and an unwholesome sky, made, in a few days, in an army! The achievements of British valour, at the Havannah, in the last war, were obtained at the expence of 9,000 men, 7,000 of whom perished with the West-India fever[12]. Even our modern discoveries in geography, by extending the empire of commerce, have likewise extended the empire of diseases. What desolation have the East and West-Indies made of British subjects! It has been found, upon a nice calculation, than only ten of a hundred Europeans, live above seven years after they arrive in the island of Jamaica. [12] The modern writers upon the diseases of armies, wonder that the Greek and Roman physicians have left us nothing upon that subject. But may not _most_ of the diseases of armies be produced by the different manner in which wars are carried on by the modern nations? The discoveries in geography, by extending the field of war, expose soldiers to many diseases from long voyages, and a _sudden_ change of climate, which were unknown to the armies of former ages. Moreover, the form of the weapons, and the variety in the military exercises of the Grecian and Roman armies, gave a vigour to the constitution, which can never be acquired by the use of muskets and artillery. IV. It would take up too much of our time to point out all the customs, both _physical_ and _moral_, which influence diseases among both sexes. The former have engendered the seeds of diseases in the human body itself: hence the origin of catarrhs, jail and miliary fevers, with a long train of other diseases, which compose so great a part of our books of medicine. The latter likewise have a large share in producing diseases. I am not one of those modern philosophers, who derive the vices of mankind from the influence of civilization; but I am safe in asserting, that their number and malignity increase with the refinements of polished life. To prove this, we need only survey a scene too familiar to affect us: it is a bedlam; which injustice, inhumanity, avarice, pride, vanity, and ambition, have filled with inhabitants. Thus have I briefly pointed out the customs which influence the diseases of civilized nations. It remains now that we take notice of their diseases. Without naming the many new fevers, fluxes, hemorrhages, swellings from water, wind, flesh, fat, pus, and blood; foulnesses on the skin, from cancers, leprosy, yawes, poxes, and itch; and, lastly, the gout, the hysteria, and the hypochondriasis, in all their variety of known and unknown shapes; I shall sum up all that is necessary upon this subject, by adding, that the number of diseases which belong to civilized nations, according to Doctor Cullen's nosology, amounts to 1387; the single class of nervous diseases form 612 of this number. Before we proceed to speak of the remedies of civilized nations, we shall examine into the abilities of NATURE in curing their diseases. We found her active and successful in curing the diseases of the Indians. Are her strength, wisdom, or benignity, equal to the increase of those dangers which threaten her dissolution among civilized nations? In order to answer this question, it will be necessary to explain the meaning of the term nature. By nature, in the present case, I understand nothing but _physical necessity_. This at once excludes every thing like intelligence from her operations: these are all performed in obedience to the same laws which govern vegetation in plants, and the intestine motions of fossils. They are as truly mechanical as the laws of gravitation, electricity, or magnetism. A ship when laid on her broadside by a wave, or a sudden blast of wind, rises by the simple laws of her mechanism; but suppose this ship to be attacked by fire, or a water-spout, we are not to call in question the skill of the ship-builder, if she be consumed by the one, or sunk by the other. In like manner, the Author of nature hath furnished the body with powers to preserve itself from its natural enemies; but when it is attacked by those civil foes which are bred by the peculiar customs of civilization, it resembles a company of Indians, armed with bows and arrows, against the complicated and deadly machinery of fire-arms. To place this subject in a proper light, I shall deliver a history of the operations of nature in a few of the diseases of civilized nations. I. There are cases in which nature is still successful in curing diseases. In fevers she still deprives us of our appetite for animal food, and imparts to us a desire for cool air and cold water. In hemorrhages she produces a faintness, which occasions a coagulum in the open vessels; so that the further passage of blood through them is obstructed. In wounds of the flesh and bones she discharges foreign matter by exciting an inflammation, and supplies the waste of both with new flesh and bone. II. There are cases where the efforts of nature are too feeble to do service, as in malignant and chronic fevers. III. There are cases where the efforts of nature are over proportioned to the strength of the disease, as in the cholera morbus and dysentery. IV. There are cases where nature is idle, as in the atonic stages of the gout, the cancer, the epilepsy, the mania, the venereal disease, the apoplexy, and the tetanus[13]. [13] Hoffman de hypothesium medicarum damno, sect. xv. V. There are cases in which nature does mischief. She wastes herself with an unnecessary fever, in a dropsy and consumption. She throws a plethora upon the brain and lungs in the apoplexy and peripneumonia notha. She ends a pleurisy and peripneumony in a vomica, or empyema. She creates an unnatural appetite for food in the hypochondriac disease. And, lastly, she drives the melancholy patient to solitude, where, by brooding over the subject of his insanity, he increases his disease. We are accustomed to hear of the salutary kindness of nature in alarming us with pain, to prompt us to seek for a remedy. But, VI. There are cases in which she refuses to send this harbinger of the evils which threaten her, as in the aneurism, schirrhous, and stone in the bladder. VII. There are cases where the pain is not proportioned to the danger, as in the tetanus, consumption, and dropsy of the head. And, VIII. There are cases where the pain is over-proportioned to the danger, as in the paronychia and tooth-ach. This is a short account of the operations of nature, in the diseases of civilized nations. A lunatic might as well plead against the sequestration of his estate, because he once enjoyed the full exercise of his reason, or because he still had lucid intervals, as nature be exempted from the charges we have brought against her. But this subject will receive strength from considering the REMEDIES of civilized nations. All the products of the vegetable, fossil, and animal kingdoms, tortured by heat and mixture into an almost infinite variety of forms; bleeding, cupping, artificial drains by setons, issues, and blisters; exercise, active and passive; voyages and journies; baths, warm and cold; waters, saline, aërial, and mineral; food by weight and measure; the royal touch; enchantment; miracles; in a word, the combined discoveries of natural history and philosophy, united into a system of materia medica, all show, that although physicians are in speculation the servants, yet in practice they are the masters of nature. The whole of their remedies seem contrived on purpose to arouse, assist, restrain, and controul her operations. There are some truths like certain liquors, which require strong heads to bear them. I feel myself protected from the prejudices of vulgar minds, when I reflect that I am delivering these sentiments in a society of philosophers. Let us now take a COMPARATIVE VIEW of the diseases and remedies of the Indians with those of civilized nations. We shall begin with their diseases. In our account of the diseases of the Indians, we beheld death executing his commission, it is true; but then his dart was hid in a mantle, under which he concealed his shape. But among civilized nations we behold him multiplying his weapons in proportion to the number of organs and functions in the body; and pointing each of them in such a manner, as to render his messengers more terrible than himself. We said formerly that fevers constituted the chief diseases of the Indians. According to Doctor Sydenham's computation, above 66,000 out of 100,000 died of fevers in London, about 100 years ago; but fevers now constitute but a little more than one-tenth part of the diseases of that city. Out of 21,780 persons who died in London between December, 1770, and December, 1771, only 2273 died of simple fevers. I have more than once heard Doctor Huck complain, that he could find no marks of epidemic fevers in London, as described by Dr. Sydenham. London has undergone a revolution in its manners and customs since Doctor Sydenham's time. New diseases, the offspring of luxury, have supplanted fevers; and the few that are left are so complicated with other diseases, that their connection can no longer be discovered with an epidemic constitution of the year. The pleurisy and peripneumony, those inflammatory fevers of strong constitutions, are now lost in catarrhs, or colds, which, instead of challenging the powers of nature or art to a fair combat, insensibly undermine the constitution, and bring on an incurable consumption. Out of 22,434 who died in London between December, 1769, and the same month in 1770, 4594 perished with that British disease. Our countryman, Doctor Maclurg, has ventured to foretel that the gout will be lost in a few years, in a train of hypochondriac, hysteric, and bilious diseases. In like manner, may we not look for a season when fevers, the natural diseases of the human body, will be lost in an inundation of artificial diseases, brought on by the modish practices of civilization? It may not be improper to compare the PROGNOSIS of the Indians, in diseases, with that of civilized nations, before we take a comparative view of their remedies. The Indians are said to be successful in predicting the events of diseases. While diseases are simple, the marks which distinguish them, or characterize their several stages, are generally uniform and obvious to the most indifferent observer. These marks afford so much certainty, that the Indians sometimes kill their physicians for a false prognosis, charging the death of the patient to their carelessness, or ignorance. They estimate the danger of their patients by the degrees of appetite; while an Indian is able to eat, he is looked upon as free from danger. But when we consider the number and variety in the signs of diseases, among civilized nations, together with the shortness of life, the fallacy of memory, and the uncertainty of observation, where shall we find a physician willing to risk his reputation, much less his life, upon the prediction of the event of our acute diseases? We can derive no advantage from the simple sign, by which the Indians estimate the danger of their patients; for we daily see a want of appetite for food in diseases which are attended with no danger; and we sometimes observe an unusual degree of this appetite to precede the agonies of death. I honour the name of HIPPOCRATES: but forgive me, ye votaries of antiquity, if I attempt to pluck a few grey hairs from his venerable head. I was once an idolater at his altar, nor did I turn apostate from his worship, till I was taught, that not a tenth part of his prognostics corresponded with modern experience, or observation. The pulse[14], urine, and sweats, from which the principal signs of life and death have been taken, are so variable, in most of the acute diseases of civilized nations, that the wisest physicians have in some measure excluded the prognosis from being a part of their profession. [14] Doctor Cullen used to inform his pupils, that after forty years' experience, he could find no relation between his own observations on the pulse, and those made by Doctor Solano. The climate and customs of the people in Spain being so different from the climate and customs of the present inhabitants of Britain, may account for the diversity of their observations. Doctor Heberden's remarks upon the pulse, in the second volume of the Medical Transactions, are calculated to show how little the issue of diseases can be learned from it. I am here insensibly led to make an apology for the instability of the theories and practice of physic. The theory of physic is founded upon the laws of the animal economy. These (unlike the laws of the mind, or the common laws of matter) do not appear at once, but are gradually brought to light by the phænomena of diseases. The success of nature in curing the simple diseases of Saxony, laid the foundation for the ANIMA MEDICA of Doctor STAHL. The endemics of Holland[15] led Doctor BOERHAAVE to seek for the causes of all diseases in the FLUIDS. And the universal prevalence of diseases of the NERVES, in Great-Britain, led Doctor CULLEN to discover their peculiar laws, and to found a system upon them; a system, which will probably last till some new diseases are let loose upon the human species, which shall unfold other laws of the animal economy. [15] "The scurvy is very frequent in Holland; and draws its origin partly from their strong food, sea-fish, and smoked flesh, and partly from their dense and moist air, together with their bad water." Hoffman on Endemical Distempers. "We are now in North-Holland; and I have never seen, among so few people, so many infected with the leprosy as here. They say the reason is, because they eat so much fish." Howell's Familiar Letters. It is in consequence of this fluctuation in the principles and practice of physic, being so necessarily connected with the changes in the customs of civilized nations, that old and young physicians so often disagree in their opinions and practices. And it is by attending to the constant changes in these customs of civilized nations, that those physicians have generally become the most eminent, who have soonest emancipated themselves from the tyranny of the schools of physic; and have occasionally accommodated their principles and practice to the changes in diseases[16]. This variety in diseases, which is produced by the changes in the customs of civilized nations, will enable us to account for many of the contradictions which are to be found in authors of equal candour and abilities, who have written upon the materia medica. [16] We may learn from these observations, the great impropriety of those Egyptian laws which oblige physicians to adopt, in all cases, the prescriptions which had been collected, and approved of, by the physicians of former ages. Every change in the customs of civilized nations, produces a change in their diseases, which calls for a change in their remedies. What havoc would plentiful bleeding, purging, and small beer, formerly used with so much success by Dr. Sydenham in the cure of fevers, now make upon the enfeebled citizens of London! The fevers of the same, and of more southern latitudes, still admit of such antiphlogistic remedies. In the room of these, bark, wine, and other cordial medicines, are prescribed in London in almost every kind of fever. In forming a comparative view of the REMEDIES of the Indians, with those of civilized nations, we shall remark, that the want of success in a medicine is occasioned by one of the following causes: First, our ignorance of the disease. Secondly, an ignorance of a suitable remedy. Thirdly, a want of efficacy in the remedy. Considering the violence of the diseases of the Indians, it is probable their want of success is always occasioned by a want of efficacy in their medicines. But the case is very different among the civilized nations. Dissections daily convince us of our ignorance of the seats of diseases, and cause us to blush at our prescriptions. How often are we disappointed in our expectation from the most certain and powerful of our remedies, by the negligence or obstinacy of our patients! What mischief have we done under the belief of false facts (if I may be allowed the expression) and false theories! We have assisted in multiplying diseases. We have done more--we have increased their mortality. I shall not pause to beg pardon of the faculty, for acknowledging, in this public manner, the weaknesses of our profession. I am pursuing Truth, and while I can keep my eye fixed upon my guide, I am indifferent whether I am led, provided she is my leader. But further, the Indian submits to his disease, without one fearful emotion from his doubtfulness of its event; and at last meets his fate without an an anxious wish for futurity; except it is of being admitted to an "equal sky," where "His faithful dog shall bear him company." But, among civilized nations, the influence of a false religion in good, and of a true religion in bad men, has converted even the fear of death into a disease. It is this original distemper of the imagination which renders the plague most fatal, upon his first appearance in a country. Under all these disadvantages in the state of medicine, among civilized nations, do more in proportion die of the diseases peculiar to them, than of fevers, casualties, and old age, among the Indians? If we take our account from the city of London, we shall find this to be the case. Near a twentieth part of its inhabitants perish one year with another. Nor does the natural increase of inhabitants supply this yearly waste. If we judge from the bills of mortality, the city of London contains fewer inhabitants, by several thousands, than it did forty years ago. It appears from this fact, and many others of a like nature, which might be adduced, that although the difficulty of supporting children, together with some peculiar customs of the Indians, which we mentioned, limit their number, yet they multiply faster, and die in a smaller proportion than civilized nations, under the circumstances we have described. The Indians, we are told, were numerous in this country, before the Europeans settled among them. Travellers agree likewise in describing numbers of both sexes who exhibited all the marks of extreme old age. It is remarkable that age seldom impairs the faculties of their minds. The mortality peculiar to those Indian tribes who have mingled with the white people, must be ascribed to the extensive mischief of spiritous liquors. When these have not acted, they have suffered from having accommodated themselves too suddenly to the European diet, dress, and manners. It does not become us to pry too much into futurity; but if we may judge from the fate of the original natives of Hispaniola, Jamaica, and the provinces on the continent, we may venture to foretel, that, in proportion as the white people multiply, the Indians will diminish; so that in a few centuries they will probably be entirely extirpated[17]. [17] Even the influence of CHRISTIAN principles has not been able to put a stop to the mortality introduced among the Indians, by their intercourse with the Europeans. Dr. Cotton Mather, in a letter to sir William Ashurst, printed in Boston, in the year 1705, says, "that about five years before there were about thirty Indian congregations in the southern parts of the province of Massachusetts-Bay." The same author, in his history of New-England, says, "That in the islands of Nantucket and Martha's Vineyard, there were 3000 _adult_ Indians, 1600 of whom professed the christian religion." At present there is but _one_ Indian congregation in the whole Massachusetts province. It may serve to extend our knowledge of diseases, to remark, that epidemics were often observed to prevail among the Indians in Nantucket, without affecting the white people. It may be said, that health among the Indians, like insensibility to cold and hunger, is proportioned to their need of it; and that the less degrees, or entire want of health, are no interruption to the ordinary business of civilized life. To obviate this supposition, we shall first attend to the effects of a single disease in those people who are the principal wheels in the machine of civil society. Justice has stopt its current, victories have been lost, wars have been prolonged, and embassies delayed, by the principal actors in these departments of government being suddenly laid up by a fit of the gout. How many offences are daily committed against the rules of good breeding, by the tedious histories of our diseases, which compose so great a part of modern conversation! What sums of money have been lavished in foreign countries in pursuit of health[18]! Families have been ruined by the unavoidable expences of medicines and watering-places. In a word, the swarms of beggars which infest so many of the European countries, urge their petitions for charity chiefly by arguments derived from real or counterfeit diseases, which render them incapable of supporting themselves[19]. [18] It is said, there are seldom less than 20,000 British subjects in France and Italy; one half of whom reside or travel in those countries upon the account of their health. [19] Templeman computes, that Scotland contains 1,500,000 inhabitants; 100,000 of whom, according to Mr. Fletcher, are supported at the public expence. The proportion of poor people is much greater in England, Ireland, France, and Italy. But may not civilization, while it abates the violence of natural diseases, increase the lenity of those that are artificial, in the same manner that it lessens the strength of natural vices by multiplying them? To answer this question, it will only be necessary to ask another: Who should exchange the heat, thirst, and uneasiness of a fever, for one fit of the colic or stone? The history of the number, combination, and fashions of the remedies we have given, may serve to humble the pride of philosophy; and to convince us, that with all the advantages of the whole circle of sciences, we are still ignorant of antidotes to many of the diseases of civilized nations. We sometimes sooth our ignorance, by reproaching our idleness in not investigating the remedies peculiar to this country. We are taught to believe that every herb that grows in our woods is possessed of some medicinal virtue, and that Heaven would be wanting in benignity, if our country did not produce remedies for all the different diseases of its inhabitants. It would be arrogating too much to suppose that man was the only creature in our world for whom vegetables grow. The beasts, birds, and insects, derive their sustenance either directly or indirectly from them; while many of them were probably intended, from their variety in figure, foliage, and colour, only to serve as ornaments for our globe. It would seem strange that the Author of nature should furnish every spot of ground with medicines adapted to the diseases of its inhabitants, and at the same time deny it the more necessary articles of food and clothing. I know not whether Heaven has provided every country with antidotes even to the _natural_ diseases of its inhabitants. The intermitting fever is common in almost every corner of the globe; but a sovereign remedy for it has been discovered only in South-America. The combination of bitter and astringent substances, which serve as a succedaneum to the Peruvian bark, is as much a preparation of art, as calomel or tartar emetic. Societies stand in need of each other as much as individuals; and the goodness of the Deity remains unimpeached when we suppose, that he intended medicines to serve (with other articles) to promote that knowledge, humanity, and politeness among the inhabitants of the earth, which have been so justly attributed to commerce. We have no discoveries in the materia medica to hope for from the Indians in North-America. It would be a reproach to our schools of physic, if modern physicians were not more successful than the Indians, even in the treatment of their own diseases. Do the blessings of civilization compensate for the sacrifice we make of natural health, as well as of natural liberty? This question must be answered under some limitations. When natural liberty is given up for laws which enslave instead of protecting us, we are immense losers by the exchange. Thus, if we arm the whole elements against our health, and render every pore in the body an avenue for a disease, we pay too high a price for the blessings of civilization. In governments which have departed entirely from their simplicity, partial evils are to be cured by nothing but an entire renovation of their constitution. Let the world bear with the professions of law, physic, and divinity; and let the lawyer, physician, and divine yet learn to bear with each other. They are all necessary, in the present state of society. In like manner, let the woman of fashion forget the delicacy of her sex, and submit to be delivered by a man-midwife[20]. Let her snatch her offspring from her breast, and send it to repair the weakness of its stamina, with the milk of a ruddy cottager[21]. Let art supply the place of nature in the preparation and digestion of all our aliment. Let our fine ladies keep up their colour with carmine, and their spirits with ratifia; and let our fine gentlemen defend themselves from the excesses of heat and cold, with lavender and hartshorn. These customs have become necessary in the corrupt stages of society. We must imitate, in these cases, the practice of those physicians who consult the appetite only, in diseases which do not admit of a remedy. [20] In the enervated age of Athens, a law was passed which confined the practice of midwifery only to the men. It was, however, repealed, upon a woman's dying in childbirth, rather than be delivered by a man-midwife. It appears from the bills of mortality in London and Dublin, that about one in seventy of those women die in childbirth, who are in the hands of midwives; but from the accounts of the lying-in hospitals in those cities, which are under the care of man-midwives, only one in a hundred and forty perishes in childbirth. [21] There has been much common-place declamation against the custom among the great, of not suckling their children. Nurses were common in Rome, in the declension of the empire: hence we find Cornelia commended as a rare example of maternal virtue, as much for suckling her sons, as for teaching them eloquence. That nurses were common in Egypt, is probable from the contract which Pharaoh's daughter made with the unknown mother of Moses, to allow her wages for suckling her own child. The same degrees of civilization require the same customs. A woman whose times for eating and sleeping are constantly interrupted by the calls of enervating pleasures, must always afford milk of an unwholesome nature. It may truly be said of a child doomed to live on this aliment, that, as soon as it receives its ------"breath, It sucks in "the lurking principles of death." The state of a country in point of population, temperance, and industry, is so connected with its diseases, that a tolerable idea may be formed of it, by looking over its bills of mortality. HOSPITALS, with all their boasted advantages, exhibit at the same time monuments of the charity and depravity of a people[22]. The opulence of physicians, and the divisions of their offices, into those of surgery, pharmacy, and midwifery, are likewise proofs of the declining state of a country. In the infancy of the Roman empire, the priest performed the office of a physician; so simple were the principles and practice of physic. It was only in the declension of the empire that physicians vied with the emperors of Rome in magnificence and splendour[23]. [22] "Aurengezebe, emperor of Persia, being asked, Why he did not build hospitals? said, _I will make my empire so rich, that there shall be no need of hospitals_. He ought to have said, I will begin by rendering my subjects rich, and then I will build hospitals. "At Rome, the hospitals place every one at his ease, except those who labour, those who are industrious, those who have lands, and those who are engaged in trade. "I have observed, that wealthy nations have need of hospitals, because fortune subjects them to a thousand accidents; but it is plain, that transient assistances are better than perpetual foundations. The evil is momentary; it is necessary, therefore, that the succour should be of the same nature, and that it be applied to particular accidents." Spirit of Laws, b. xxiii. ch. 29. It was reserved for the present generation to substitute in the room of public hospitals private DISPENSARIES for the relief of the sick. Philosophy and christianity alike concur in deriving praise and benefit from these excellent institutions. They exhibit something like an application of the mechanical powers to the purposes of benevolence; for in what other charitable institutions do we perceive so great a _quantity_ of distress relieved by so small an expence? [23] The first regular practitioners of physic in Rome, were women and slaves. The profession was confined to them above six hundred years. The Romans, during this period, lived chiefly upon vegetables, particularly upon PULSE; and hence they were called, by their neighbours, PULTIFAGI. They were likewise early inured to the healthy employments of war and husbandry. Their diseases, of course, were too few and simple to render the cure of them an object of liberal profession. When their diseases became more numerous and complicated, their investigation and cure required the aids of philosophy. The profession from this time became liberal; and maintained a rank with the other professions which are founded upon the imperfection and depravity of human institutions. Physicians are as necessary in the advanced stages of society as surgeons, although their office is less ancient and certain. There are many artificial diseases, in which they give certain relief; and even where their art fails, their prescriptions are still necessary, in order to smooth the avenues of death. I am sorry to add, in this place, that the number of patients in the HOSPITAL, and incurables in the ALMSHOUSE of this city, show that we are treading in the enervated steps of our fellow subjects in Britain. Our bills of mortality likewise show the encroachments of British diseases upon us. The NERVOUS FEVER has become so familiar to us, that we look upon it as a natural disease. Dr. Sydenham, so faithful in his history of fevers, takes no notice of it. Dr. Cadwallader informed me, that it made its first appearance in this city about five and twenty years ago. It will be impossible to name the CONSUMPTION without recalling to our minds the memory of some friend or relation, who has perished within these few years by that disease. Its rapid progress among us has been unjustly attributed to the growing resemblance of our climate to that of Great-Britain. The HYSTERIC and HYPOCHONDRIAC DISEASES, once peculiar to the chambers of the great, are now to be found in our kitchens and workshops. All these diseases have been produced by our having deserted the simple diet and manners of our ancestors. The blessings of literature, commerce, and religion were not _originally_ purchased at the expence of health. The complete enjoyment of health is as compatible with civilization, as the enjoyment of civil liberty. We read of countries, rich in every thing that can form national happiness and national grandeur, the diseases of which are nearly as few and simple as those of the Indians. We hear of no diseases among the Jews, while they were under their democratical form of government, except such as were inflicted by a supernatural power[24]. We should be tempted to doubt the accounts given of the populousness of that people, did we not see the practice of their simple customs producing nearly the same populousness in Egypt, Rome, and other countries of antiquity. The empire of China, it is said, contains more inhabitants than the whole of Europe. The political institutions of that country have exempted its inhabitants from a large share of the diseases of other civilized nations. The inhabitants of Switzerland, Denmark, Norway[25], and Sweden, enjoy the chief advantages of civilization without having surrendered for them the blessings of natural health. But it is unnecessary to appeal to ancient or remote nations to prove, that health is not incompatible with civilization. The inhabitants of many parts of New-England, particularly of the province of Connecticut, are but little affected by artificial diseases. Some of you may remember the time, and our fathers have told those of us who do not, when the diseases of PENNSYLVANIA were as few and as simple as those of the Indians. The food of the inhabitants was then simple; their only drink was water; their appetites were restrained by labour; religion excluded the influence of sickening passions; private hospitality supplied the want of a public hospital; nature was their only nurse, and temperance their principal physician. But I must not dwell upon this retrospect of primæval manners; and I am too strongly impressed with a hope of a revival of such happy days, to pronounce them the golden age of our province. [24] The principal employments of the Jews, like those of the Romans in their simple ages, consisted in war and husbandry. Their diet was plain, consisting chiefly of vegetables. Their only remedies were plasters and ointments; which were calculated for those diseases which are produced by accidents. In proportion as they receded from their simple customs, we find artificial diseases prevail among them. The leprosy made its appearance in their journey through the wilderness. King Asa's pains in his feet, were probably brought on by a fit of the gout. Saul and Nebuchadnezzar were afflicted with a melancholy. In the time of our Saviour, we find an account of all those diseases in Judea, which mark the declension of a people; such as, the palsy, epilepsy, mania, blindness, hæmorrhagia uterina, &c. It is unnecessary to suppose, that they were let loose at this juncture, on purpose to give our Saviour an opportunity of making them the chief subject of his miracles. They had been produced from natural causes, by the gradual depravity of their manners. It is remarkable, that our Saviour chose those artificial diseases for the subject of his miracles, in preference to natural diseases. The efforts of nature, and the operation of medicines, are too slow and uncertain in these cases to detract in the least from the validity of the miracle. He cured Peter's mother-in-law, it is true, of a fever; but to show that the cure was miraculous, the sacred historian adds (contrary to what is common after a fever), "that she arose _immediately_, and ministered unto them." [25] In the city of Bergen, which consists of 30,000 inhabitants, there is but one physician; who is supported at the expense of the public. Pontoppidan's Nat. Hist. of Norway. Our esteem for the customs of our savage neighbours will be lessened, when we add, that civilization does not preclude the honours of old age. The proportion of old people is much greater among civilized, than among savage nations. It would be easy to decide this assertion in our favour, by appealing to facts in the natural histories of Britain, Norway, Sweden, North-America[26], and several of the West-India islands. [26] It has been urged against the state of longevity in America, that the Europeans, who settle among us, generally arrive to a greater age than the Americans. This is not occasioned so much by a peculiar firmness in their stamina, as by an increase of vigour which the constitution acquires by a change of climate. A Frenchman (cæteris paribus) outlives an Englishman in England. A Hollander prolongs his life by removing to the Cape of Good Hope. A Portuguese gains fifteen or twenty years by removing to Brazil. And there are good reasons to believe, that a North-American would derive the same advantages, in point of health and longevity, by removing to Europe, which a European derives from coming to this country. From a calculation made by an ingenious foreigner, it appears, that a greater proportion of old people are to be found in Connecticut, than in any colony in North-America. This colony contains 180,000 inhabitants. They have no public hospitals or poor-houses; nor is a beggar to be seen among them. There cannot be more striking proofs than these facts of the simplicity of their manners. The laws of decency and nature are not necessarily abolished by the customs of civilized nations. In many of these, we read of women among whom nature alone still performs the office of a midwife[27], and who feel the obligations of suckling their children to be equally binding with the common obligations of morality. [27] Parturition, in the simple ages of all countries, is performed by nature. The Israelitish women were delivered even without the help of the Egyptian midwives. We read of but two women who died in child-birth in the whole history of the Jews. Dr. Bancroft says, that child-bearing is attended with so little pain in Guiana, that the women seem to be exempted from the curse inflicted upon Eve. These easy births are not confined to warm climates. They are equally safe and easy in Norway and Iceland, according to Pontoppidan and Anderson's histories of those countries. Civilization does not render us less fit for the necessary hardships of war. We read of armies of civilized nations, who have endured degrees of cold, hunger, and fatigue, which have not been exceeded by the savages of any country[28]. [28] Civilized nations have, in the end, always conquered savages as much by their ability to bear hardships, as by their superior military skill. Soldiers are not to be chosen indiscriminately. The greatest generals have looked upon sound constitutions to be as essential to soldiers, as bravery or military discipline. Count Saxe refused soldiers born and bred in large cities; and sought for such only as were bred in mountainous countries. The King of Prussia calls young soldiers only to the dangers and honours of the field, in his elegant poem, Sur l'Art de la Guerre, chant 1. Old soldiers generally lose the advantages of their veteranism, by their habits of idleness and debauchery. An able general, and experienced officers, will always supply the defects of age in young soldiers. Civilization does not always multiply the avenues of death. It appears from the bills of mortality, of many countries, that fewer in proportion die among civilized, than among savage nations. Even the charms of beauty are heightened by civilization. We read of stateliness, proportion, line teeth[29] and complexions, in both sexes, forming the principal outlines of national characters. [29] Bad teeth are observed chiefly in middle latitudes, which are subject to alternate heats and colds. The inhabitants of Norway and Russia are as remarkable for their fine teeth as the inhabitants of Africa. We observe fine teeth to be universal likewise among the inhabitants of France, who live in a _variable_ climate. These have been ascribed to their protecting their heads from the action of the night air by means of woollen night-caps, and to the extraordinary attention to the teeth of their children. These precautions secure good teeth; and are absolutely necessary in all variable climates, where people do not adopt all the customs of the savage life. The danger of many diseases is not proportioned to their violence, but to their duration. America has advanced but a few paces in luxury and effeminacy. There is yet strength enough in her vitals to give life to those parts which are decayed. She may tread back her steps. For this purpose, I. Let our children be educated in a manner more agreeable to nature. II. Let the common people (who constitute the wealth and strength of our country) be preserved from the effects of ardent spirits. Had I a double portion of all that eloquence which has been employed in describing the political evils that lately threatened our country, it would be too little to set forth the numerous and complicated _physical_ and _moral_ evils which these liquors have introduced among us. To encounter this _hydra_ requires an arm accustomed, like that of Hercules, to vanquish monsters. Sir William Temple tells us, that formerly in Spain no man could be admitted as an evidence in a court, who had once been convicted of drunkenness. I do not call for so severe a law in this country. Let us first try the force of severe manners. Lycurgus governed more by these, than by his laws. "Boni mores non bonæ leges," according to Tacitus, were the bulwarks of virtue among the ancient Germans. III. I despair of being able to call the votaries of Bacchus from their bottle, and shall therefore leave them to be roused by the more eloquent twinges of the gout. IV. Let us be cautious what kind of manufactures we admit among us. The rickets made their first appearance in the manufacturing towns in England. Dr. Fothergill informed me, that he had often observed, when a pupil, that the greatest part of the chronic patients in the London Hospital were Spittal-field weavers. I would not be understood, from these facts, to discourage those manufactures which employ women and children: these suffer few inconveniences from a sedentary life: nor do I mean to offer the least restraint to those manufactories among men, which admit of free air, and the exercise of all their limbs. Perhaps a pure air, and the abstraction of spiritous liquors, might render sedentary employments less unhealthy in America, even among men, than in the populous towns of Great-Britain. The population of a country is not to be accomplished by rewards and punishments. And it is happy for America, that the universal prevalence of the protestant religion, the checks lately given to negro slavery, the general unwillingness among us to acknowledge the usurpations of primogeniture, the universal practice of inoculation for the small-pox, and the absence of the plague, render the interposition of government for that purpose unnecessary. These advantages can only be secured to our country by AGRICULTURE. This is the true basis of national health, riches, and populousness. Nations, like individuals, never rise higher than when they are ignorant whether they are tending. It is impossible to tell from history what will be the effects of agriculture, industry, temperance, and commerce, urged on by the competition of colonies, united in the same general pursuits, in a country, which for extent, variety of soil, climate, and number of navigable rivers, has never been equalled in any quarter of the globe. America is the theatre where human nature will probably receive her last and principal literary, moral, and political honours. But I recall myself from the ages of futurity. The province of Pennsylvania has already shown to her sister colonies, the influence of agriculture and commerce upon the number and happiness of a people. It is scarcely a hundred years since our illustrious legislator, with a handful of men, landed upon these shores. Although the perfection of our government, the healthiness of our climate, and the fertility of our soil, seemed to ensure a rapid settlement of the province; yet it would have required a prescience bordering upon divine, to have foretold, that in such a short space of time, the province would contain above 300,000 inhabitants; and that nearly 30,000 of this number should compose a city, which should be the third, if not the second in commerce in the British empire. The pursuits of literature require leisure and a total recess from clearing forests, planting, building, and all the common toils of settling a new country: but before these arduous works were accomplished, the SCIENCES, ever fond of the company of liberty and industry, chose this spot for the seat of their empire in this new world. Our COLLEGE, so catholic in its foundation, and extensive in its objects, already sees her sons executing offices in the highest departments of society. I have now the honour of speaking in the presence of a most respectable number of philosophers, physicians, astronomers, botanists, patriots, and legislators; many of whom have already seized the prizes of honour, which their ancestors had allotted to a much later posterity. Our first offering had scarcely found its way into the temple of fame, when the oldest societies in Europe turned their eyes upon us, expecting with impatience to see the mighty fabric of science, which, like a well-built arch, can only rest upon the whole of its materials, completely finished from the treasures of this unexplored quarter of the globe. It reflects equal honour upon our society and the honourable assembly of our province, to acknowledge, that we have always found the latter willing to encourage by their patronage, and reward by their liberality, all our schemes for promoting useful knowledge. What may we not expect from this harmony between the sciences and government! Methinks I see canals cut, rivers once impassable rendered navigable, bridges erected, and roads improved, to facilitate the exportation of grain. I see the banks of our rivers vying in fruitfulness with the banks of the river of Egypt. I behold our farmers nobles; our merchants princes. But I forbear--imagination cannot swell with the subject. I beg leave to conclude, by deriving an argument from our connection with the legislature, to remind my auditors of the duty they owe to the society. Patriotism and literature are here connected together; and a man cannot neglect the one, without being destitute of the other. Nature and our ancestors have completed their works among us; and have left us nothing to do, but to enlarge and perpetuate our own happiness. AN ACCOUNT OF THE _CLIMATE OF PENNSYLVANIA_, AND ITS INFLUENCE UPON THE HUMAN BODY. In order to render the observations upon the epidemic diseases which compose the following volumes more useful, it will be necessary to prefix to them a short account of the climate of Pennsylvania, and of its influence upon the human body. This account may perhaps serve further, to lead to future discoveries, and more extensive observations, upon this subject. The state of Pennsylvania lies between 39° 43' 25", and 42° north latitude, including, of course, 2° 16' 35", equal to 157 miles from its southern to its northern boundary. The western extremity of the state is in the longitude of 5° 23' 40", and the eastern, is that of 27' from the meridian of Philadelphia, comprehending in a due west course 311 miles, exclusive of the territory lately purchased by Pennsylvania from the United States, of which as yet no accurate surveys have been obtained. The state is bounded on the south by part of the state of Delaware, by the whole state of Maryland, and by Virginia to her western extremity. The last named state, the territory lately ceded to Connecticut, and Lake Erie, (part of which is included in Pennsylvania) form the western and north-western boundaries of the state. Part of New-York, and the territory lately ceded to Pennsylvania, with a part of Lake Erie, compose the northern, and another part of New-York, with a large extent of New-Jersey (separated from Pennsylvania by the river Delaware), compose the eastern boundaries of the state. The lands which form these boundaries (except a part of the states of Delaware, Maryland, and New-Jersey) are in a state of nature. A large tract of the western and north-eastern parts of Pennsylvania are nearly in the same uncultivated situation. The state of Pennsylvania is intersected and diversified with numerous rivers and mountains. To describe, or even to name them all, would far exceed the limits I have proposed to this account of our climate. It will be sufficient only to remark, that one of these rivers, viz. the Susquehannah, begins at the northern boundary of the state, twelve miles from the river Delaware, and winding several hundred miles, through a variegated country, enters the state of Maryland on the southern line, fifty-eight miles westward of Philadelphia; that each of these rivers is supplied by numerous streams of various sizes; that tides flow in parts of two of them, viz. in the Delaware and Schuylkill; that the rest rise and fall alternately in wet and dry weather; and that they descend with great rapidity, over prominent beds of rocks in many places, until they empty themselves into the bays of Delaware and Chesapeak on the east, and into the Ohio on the western part of the state. The mountains form a considerable part of the state of Pennsylvania. Many of them appear to be reserved as perpetual marks of the original empire of nature in this country. The Allegany, which crosses the state about two hundred miles from Philadelphia, in a north, inclining to an eastern course, is the most considerable and extensive of these mountains. It is called by the Indians the back-bone of the continent. Its height, in different places, is supposed to be about 1,300 feet from the adjacent plains. The soil of Pennsylvania is diversified by its vicinity to mountains and rivers. The vallies and bottoms consist of a black mould, which extends from a foot to four feet in depth. But in general a deep clay forms the surface of the earth. Immense beds of limestone lie beneath this clay in many parts of the state. This account of the soil of Pennsylvania is confined wholly to the lands on the east side of the Allegany mountain. The soil on the west side of this mountain, shall be described in another place. The city of Philadelphia lies in the latitude of 39° 57', in longitude 75° 8' from Greenwich, and fifty-five miles west from the Atlantic ocean. It is situated about four miles due north from the conflux of the rivers Delaware and Schuylkill. The buildings, which consist chiefly of brick, extend nearly three miles north and south along the Delaware, and above half a mile due west towards the Schuylkill, to which river the limits of the city extend, the whole of which includes a distance of two miles from the Delaware. The land near the rivers, between the city and the conflux of the rivers, is in general low, moist, and subject to be overflowed. The greatest part of it is meadow ground. The land to the northward and westward, in the vicinity of the city, is high, and in general well cultivated. Before the year 1778, the ground between the present improvements of the city, and the river Schuylkill, was covered with woods. These, together with large tracts of wood to the northward of the city, were cut down during the winter the British army had possession of Philadelphia. I shall hereafter mention the influence which the cutting down of these woods, and the subsequent cultivation of the grounds in the neighbourhood of the city, have had upon the health of its inhabitants. The mean height of the ground on which the city stands, is about forty feet above the river Delaware. One of the longest and most populous streets in the city rises only a few feet above the river. The air at the north is much purer than at the south end of the city; hence the lamps exhibit a fainter flame in its southern than its northern parts. The tide of the Delaware seldom rises more than six feet. It flows four miles in an hour. The width of the river near the city is about a mile. The city, with the adjoining districts of Southwark and the Northern Liberties, contains between 70 and 80,000 inhabitants. From the accounts which have been handed down to us by our ancestors, there is reason to believe that the climate of Pennsylvania has undergone a material change. Thunder and lightning are less frequent, and the cold of our winters and heat of our summers are less uniform, than they were forty or fifty years ago. Nor is this all. The springs are much colder, and the autumns more temperate than formerly, insomuch that cattle are not housed so soon by one month as they were in former years. Within the last eight years, there have been some exceptions to part of these observations. The winter of the year 1779-80, was uniformly and uncommonly cold. The river Delaware was frozen near three months during this winter, and public roads for waggons and sleighs connected the city of Philadelphia in many places with the Jersey shore. The thickness of the ice in the river near the city, was from sixteen to nineteen inches, and the depth of the frost in the ground was from four to five feet, according to the exposure of the ground, and the quality of the soil. This extraordinary depth of the frost in the earth, compared with its depth in more northern and colder countries, is occasioned by the long delay of snow, which leaves the earth without a covering during the last autumnal and the first winter months. Many plants were destroyed by the intenseness of the cold during this winter. The ears of horned cattle and the feet of hogs exposed to the air, were frost-bitten; squirrels perished in their holes, and partridges were often found dead in the neighbourhood of farm houses. The mercury in January stood for several hours at 5° below 0, in Fahrenheit's thermometer; and during the whole of this month (except on one day), it never rose in the city of Philadelphia so high as to the freezing point. The cold in the winter of the year 1783-4 was as intense, but not so steady, as it was in the winter that has been described. It differed from it materially in one particular, viz. there was a thaw in the month of January, which opened all our rivers for a few days. The summer which succeeded the winter of 1779-80, was uniformly warm. The mercury in the thermometer, during this summer, stood on one day (the 15th of August) at 95°, and fluctuated between 93°, and 80° for many weeks. The thermometer, in every reference that has been, or shall be made to it, stood in the shade in the open air. I know it has been said by many old people, that the winters in Pennsylvania are less cold, and the summers less warm, than they were forty or fifty years ago. The want of thermometrical observations before, and during those years, renders it difficult to decide this question. Perhaps the difference of clothing and sensation between youth and old age, in winter and summer, may have laid the foundation of this opinion. I suspect the mean temperature of the air in Pennsylvania has not altered, but that the principal change in our climate consists in the heat and cold being less confined than formerly to their natural seasons. I adopt the opinion of Doctor Williamson[30] respecting the diminution of the cold in the southern, being occasioned by the cultivation of the northern parts of Europe; but no such cultivation has taken place in the countries which lie to the north-west of Pennsylvania, nor do the partial and imperfect improvements which have been made in the north-west parts of the state, appear to be sufficient to lessen the cold, even in the city of Philadelphia. I have been able to collect no facts, which dispose me to believe that the winters were colder before the year 1740, than they have been since. In the memorable winter of 1739-40, the Delaware was crossed on the ice, in sleighs, on the 5th of March, old style, and did not open till the 13th of the same month. The ground was covered during this winter with a deep snow, and the rays of the sun were constantly obscured by a mist, which hung in the upper regions of the air. In the winter of 1779-80, the river was navigable on the 4th of March; the depth of the snow was moderate, and the gloominess of the cold was sometime suspended for a few days by a cheerful sun. From these facts, it is probable the winter of 1739-40 was colder than the winter of 1779-80. [30] American Philosophical Transactions, vol. I. The winter of 1804-5 exhibited so many peculiarities that it deserves a place in the history of the climate of Pennsylvania. The navigation of the Delaware was obstructed on the 18th of December. The weather partook of every disagreeable and distressing property of every cold climate on the globe. These were intense cold, deep snows, hail, sleet, high winds, and heavy rains. They generally occurred in succession, but sometimes most of them took place in the course of four and twenty hours. A serene and star-light evening, often preceded a tempestuous day. The mercury stood for many days, in Philadelphia, at 4° and 6° above 0 in Fahrenheit's thermometer. The medium depth of the snow was two feet, but from its fall being accompanied with high winds, its height in many places was three and four feet, particularly in roads, which it rendered so impassable, as to interrupt business and social intercourse, in many parts of the state. From the great depth of the snow, the ground was so much protected from the cold, that the frost extended but six inches below its surface. The newspapers daily furnished distressing accounts of persons perishing with the cold by land and water, and of shipwrecks on every part of the coast of the United States. Poultry were found dead, or with frozen feet, in their coops, in many places. This intense cold was not confined to Pennsylvania. In Norfolk, in Virginia, the mercury stood at 18° above 0 on the 22d of January. At Lexington, in Kentucky, it stood at 0 on the 21st of the same month. In Lower Canada the snow was seven feet in depth, which is three feet deeper than in common years. And such was the quantity of ice collected in the northern seas, that a ship was destroyed, and several vessels injured, by large masses of it, floating between the 41st and 42d degrees of north latitude. Great fears were entertained of an inundation in Pennsylvania, from a sudden thaw of the immense quantities of snow and ice that had accumulated during the winter, in every part of the state; but happily they both dissolved away so gradually, as scarcely to injure a bridge or a road. On the 28th of February the Delaware was navigable, and on the 2d of March no ice was to be seen in it. Having premised these general remarks, I proceed to observe, that there are seldom more than twenty or thirty days in summer or winter, in Pennsylvania, in which the mercury rises above 80° in the former, or falls below 30° in the latter season. Some old people have remarked, that the number of _extremely_ cold and warm days in successive summers and winters, bears an exact proportion to each other. This was strictly true in the years 1787 and 1788. The warmest part of the day in summer is at two, in ordinary, and at three o'clock in the afternoon, in extremely warm weather. From these hours, the heat gradually diminishes till the ensuing morning. The coolest part of the four and twenty hours, is at the break of day. There are seldom more than three or four nights in a summer in which the heat of the air is nearly the same as in the preceding day. After the warmest days, the evenings are generally agreeable, and often delightful. The higher the mercury rises in the day time, the lower it falls the succeeding night. The mercury at 80° generally falls to 68°, while it descends, when at 60°, but to 56°. This disproportion between the temperature of the day and night, in summer is always greatest in the month of August. The dews at this time are heavy in proportion to the coolness of the evening. They are sometimes so considerable as to wet the clothes; and there are instances in which marsh-meadows, and even creeks, which have been dry during the summer, have been supplied with their usual waters from no other source, than the dews which have fallen in this month, or in the first weeks of September. There is another circumstance connected with the one just mentioned, which contributes very much to mitigate the heat of summer, and that is, it seldom continues more than two or three days without being succeeded with showers of rain, accompanied sometimes by thunder and lightning, and afterwards by a north-west wind, which produces a coolness in the air that is highly invigorating and agreeable. The warmest weather is _generally_ in the month of July. But intensely warm days are often felt in May, June, August, and September. In the annexed table of the weather for the year 1787, there is an exception to the first of these remarks. It shows that the mean heat of August was greater by a few degrees than that of July. The transitions from heat to cold are often very sudden, and sometimes to very distant degrees. After a day in which the mercury has stood at 86° and even 90°, it sometimes falls, in the course of a single night, to the 65th, and even to the 60th degree, insomuch that fires have been found necessary the ensuing morning, especially if the change in the temperature of the air has been accompanied by rain and a south-east wind. In a summer month, in the year 1775, the mercury was observed to fall 20° in an hour and a half. There are few summers in which fires are not agreeable during some parts of them. My ingenious friend, Mr. David Rittenhouse, whose talent for accurate observation extends alike to all subjects, informed me, that he had never passed a summer, during his residence in the country, without discovering frost in every month of the year, except July. The weather is equally variable in Pennsylvania during the greatest part of the winter. The mercury fell from 37° to 4-1/2° below 0 in four and twenty hours, between the fourth and fifth of February, 1788. In this season nature seems to play at cross purposes. Heavy falls of snow are often succeeded in a few days by a general thaw, which frequently in a short time leaves no vestige of the snow. The rivers Delaware, Schuylkill, and Susquehannah have sometimes been frozen (so as to bear horses and carriages of all kinds) and thawed so as to be passable in boats, two or three times in the course of the same winter. The ice is formed for the most part in a gradual manner, and seldom till the water has been previously chilled by a fall of snow. Sometimes its production is more sudden. On the night of the 31st of December, 1764, the Delaware was completely frozen over between ten o'clock at night and eight the next morning, so as to bear the weight of a man. An unusual vapour like a fog was seen to rise from the water, in its passage from a fluid to a solid state. This account of the variableness of the weather in winter, does not apply to every part of Pennsylvania. There is a line about the 41° of the state, beyond which the winters are steady and regular, insomuch that the earth there is seldom without a covering of snow during the three winter months. In this line the climate of Pennsylvania forms a union with the climate of the eastern and northern states. The time in which frost and ice begin to show themselves in the neighbourhood of Philadelphia, is generally about the latter end of October or the beginning of November. But the intense cold seldom sets in till about the the 20th or 25th of December; hence the common saying, "as the day lengthens, the cold strengthens." The coldest weather is commonly in January. The navigation of the river Delaware, after being frozen, is seldom practicable for large vessels, before the first week in March. As in summer there are often days in which fires are agreeable, so there are sometimes days in winter in which they are disagreeable. Vegetation has been observed in all the winter months. Garlic was tasted in butter in January, 1781. The leaves of the willow, the blossoms of the peach tree, and the flowers of the dandelion and the crocus, were all seen in February, 1779; and I well recollect, when a school-boy, to have seen an apple orchard in full bloom, and small apples on many of the trees, in the month of December. A cold day in winter is often succeeded by a moderate evening. The coldest part of the four and twenty hours, is generally at the break of day. In the most intense cold which has been recorded in Philadelphia, within the last twenty years, the mercury stood at 5° below 0. But it appears from the accounts published by Messieurs Mason and Dixon, in the 58th volume of the Transactions of the Royal Society of London, that the mercury stood at 22° below 0, on the 2d of January, 1767, at Brandywine, about thirty miles to the westward of Philadelphia. They inform us, that on the 1st of the same month, the mercury stood at 20°, and on the day before at 7° below 0. I have to lament that I am not able to procure any record of the temperature of the air in the same year in Philadelphia. From the variety in the height and quality of the soil, and from the difference in the currents of winds and the quantity of rain and snow which fall in different parts of the state, it is very probable this excessive cold may not have extended thirty miles from the place where it was first perceived. The greatest degree of heat upon record in Philadelphia, is 95°. The standard temperature of the air in the city of Philadelphia is 52-1/2°, which is the temperature of our deepest wells, as also the mean heat of our common spring water. The spring in Pennsylvania is generally less pleasant than in many other countries. In March the weather is stormy, variable, and cold. In April, and sometimes in the beginning of May, it is moist, and accompanied by a degree of cold which has been called _rawness_, and which, from its disagreeable effects upon the temper, has been called the _sirocco_ of this country. From the variable nature of the weather in the spring, vegetation advances very differently in different years. The colder the spring, the more favourable it proves to the fruits of the earth. The hopes of the farmer from his fruit-trees in a warm spring are often blasted by a frost in April and May. A fall of snow is remembered with regret by many of them, on the night between the 3d and 4th of May, in the year 1774; also on the morning of the 8th of May, 1803. Such was its quantity on the latter day, that it broke down the limbs of many poplar trees. This effect was ascribed to its not being accompanied with any wind. The colder the winter, the greater delay we generally observe in the return of the ensuing spring. Sometimes the weather during the spring months is cloudy and damp, attended occasionally with a gentle fall of rain resembling the spray from a cataract of water. A day of this kind of weather is called, from its resemblance to a damp day in Great-Britain, "an English day." This damp weather seldom continues more than three or four days. The month of May, 1786, will long be remembered, for having furnished a very uncommon instance of the absence of the sun for fourteen days, and of constant damp or rainy weather. The month of June is the only month in the year which resembles a spring month in the southern countries of Europe. The weather is then generally temperate, the sky is serene, and the verdure of the country is universal and delightful. The autumn is the most agreeable season in the year in Pennsylvania. The cool evenings and mornings, which generally begin about the first week in September, are succeeded by a moderate temperature of the air during the day. This kind of weather continues with an increase of cold scarcely perceptible, till the middle of October, when the autumn is closed by rain, which sometimes falls in such quantities as to produce destructive freshes in the rivers and creeks, and sometimes descends in gentle showers, which continue, with occasional interruptions by a few fair days, for two or three weeks. These rains are the harbingers of the winter; and the Indians have long ago taught the inhabitants of Pennsylvania, that the degrees of cold during the winter, are in proportion to the quantity of rain which falls during the autumn[31]. [31] I cannot help agreeing with Mr. Kirwan, in one of his remarks upon the science of meteorology, in the preface to his estimate of the temperature of different latitudes. "This science (says he), if brought to perfection, would enable us at least to foresee those changes in the weather which we could not prevent. Great as is the distance between such knowledge and our own present attainments, we have no reason to think it above the level of the powers of the human mind. The motions of the planets must have appeared as perplexed and intricate to those who first contemplated them; yet, by persevering industry, they are now known to the utmost precision. The present is (as the great Leibnitz expresses it) in every case pregnant with the future, and the connection must be found by long and attentive observation." The influence which the perfection of this science must have upon health, agriculture, navigation, and commerce, is too obvious to be mentioned. From this account of the temperature of the air in Pennsylvania, it is evident that there are seldom more than four months in which the weather is agreeable without a fire. In winter the winds generally come from the north-west in _fair_, and from the north-east in _wet_ weather. The north-west winds are uncommonly dry as well as cold. It is in consequence of the violent action of these winds that trees have uniformly a thicker and more compact bark on their northern than on their southern exposures. Even brick houses are affected by the force and dryness of these north-west winds: hence it is much more difficult to demolish the northern than the southern walls of an old brick house. This fact was communicated to me by an eminent bricklayer in the city of Philadelphia. The winds in fair weather in the spring, and in warm weather in the summer, blow from the south-west and from west-north-west. The _raw_ air before-mentioned comes from the north-east. The south-west winds likewise usually bring with them those showers of rain in the spring and summer which refresh the earth. They moreover moderate the heat of the weather, provided they are succeeded by a north-west wind. Now and then showers of rain come from the west-north-west. There is a common fact connected with the account of the usual winds in Pennsylvania, which it may not be improper to mention in this place. While the clouds are seen flying from the south-west, the _scud_, as it is called, or a light vapour, is seen at the same time flying below the clouds from the north-east. The moisture of the air is much greater than formerly, occasioned probably by the exhalations which in former years fell in the form of snow, now descending in the form of rain. The depth of the snow is sometimes between two and three feet, but in general seldom exceeds between six and nine inches. Hail frequently descends with snow in winter. Once in four or five years large and heavy showers of hail fall in the spring and summer. They generally run in narrow veins (as they are called) of thirty or forty miles in length, and two or three miles in breadth. The heaviest shower of hail that is remembered in Philadelphia, did not extend in breadth more than half a mile north and south. Some of the stones weighed half an ounce. The windows of many houses were broken by them. This shower fell in May, 1783. From sudden changes in the air, rain and snow often fall together, forming what is commonly called _sleet_. In the uncultivated parts of the state, the snow sometimes lies on the ground till the first week in April. The backwardness of the spring has been ascribed to the passage of the air over the undissolved beds of snow and ice which usually remain, after the winter months are past, on the north-west grounds and waters of the state, and of the adjacent country. The dissolution of the ice and snow in the spring is sometimes so sudden as to swell the creeks and rivers in every part of the state to such a degree, as not only to lay waste the hopes of the husbandman from the produce of his lands, but in some instances to sweep his barns, stables, and even his dwelling house into their currents[32]. The wind, during a general thaw, comes from the south-west or south-east. [32] The following account of the thaw of the river Susquehannah, in the spring of 1784, was published by the author in the Columbian Magazine, for November, 1786. It may serve to illustrate a fact related formerly in the history of the winters in Pennsylvania, as well as to exhibit an extraordinary instance of the destructive effects of a sudden thaw. "The winter of 1783-4 was uncommonly cold, insomuch that the mercury in Fahrenheit's thermometer stood several times at 5 degrees below 0. The snows were frequent, and, in many places, from two to three feet deep, during the greatest part of the winter. All the rivers in Pennsylvania were frozen, so as to bear waggons and sleds with immense weights. In the month of January a thaw came on suddenly, which opened our rivers so as to set the ice a-driving, to use the phrase of the country. In the course of one night, during the thaw, the wind shifted suddenly to the north-west, and the weather became intensely cold. The ice, which had floated the day before, was suddenly obstructed; and in the river Susquehannah, the obstructions were formed in those places where the water was most shallow, or where it had been accustomed to fall. This river is several hundred miles in length, and from half a mile to a mile and a half in breadth, and winds through a hilly, and in many places a fertile and highly cultivated country. It has as yet a most difficult communication with our bays and the sea, occasioned by the number and height of the falls which occur near the mouth of the river. The ice in many places, especially where there were falls, formed a kind of dam, of a most stupendous height. About the middle of March our weather moderated, and a thaw became general. The effects of it were remarkable in all our rivers; but in none so much as in the river I have mentioned. I shall therefore endeavour in a few words to describe them. Unfortunately the dams of ice did not give way all at once, nor those which lay nearest to the mouth of the river, first. While the upper dams were set afloat by the warm weather, the lower ones, which were the largest, and in which, of course, the ice was most impacted, remained fixed. In consequence of this, the river rose in a few hours, in many places, above 30 feet, rolling upon its surface large lumps of ice, from 10 to 40 cubic feet in size. The effects of this sudden inundation were terrible. Whole farms were laid under water. Barns, stables, horses, cattle, fences, mills of every kind, and, in one instance, a large stone house, 40 by 30 feet, were carried down the stream. Large trees were torn up by the roots; several small islands, covered with woods, were swept away, and not a vestige of them was left behind. On the barns which preserved their shape, in some instances, for many miles were to be seen living fowls; and, in one dwelling, a candle was seen to burn for some time, after it was swept from its foundation. Where the shore was level, the lumps of ice, and the ruins of houses and farms, were thrown a quarter of a mile from the ordinary height of the river. In some instances, farms were ruined by the mould being swept from them by the cakes of ice, or by depositions of sand; while others were enriched by large depositions of mud. The damage, upon the whole, done to the state of Pennsylvania by this fresh, was very great. In most places it happened in the day time, or the consequences must have been fatal to many thousands." "I know of but one use that can be derived from recording the history of this inundation. In case of similar obstructions of rivers, from the causes such as have been described, the terrible effects of their being set in motion by means of a general thaw may in part be obviated, by removing such things out of the course of the water and ice as are within our power; particularly cattle, hay, grain, fences, and farming utensils of all kinds." The air, when dry in Pennsylvania, has a peculiar elasticity, which renders the heat and cold less insupportable than the same degrees of both are in moister countries. It is in those cases only when summer showers are not succeeded by north-west winds, that the heat of the air becomes oppressive and distressing, from being combined with moisture. From tradition, as well as living observation, it is evident, that the waters in many of the creeks in Pennsylvania have diminished considerably within the last fifty years. Hence many mills, erected upon large and deep streams of water, now stand idle in dry weather; and many creeks, once navigable in large boats, are now impassable even in canoes. This diminution of the waters has been ascribed to the application of a part of them to the purpose of making meadows. The mean elevation of the barometer in Philadelphia, is about 30 inches. The variations in the barometer are very inconsiderable in the greatest changes of the weather, which occur in the city of Philadelphia. During the violent and destructive storm which blew from the south-west on the 11th of November, 1788, it suddenly fell from 30 to 29-3/10. Mr. Rittenhouse informs me, that long and faithful observations have satisfied him, that the alterations in the height of the mercury in the barometer do not _precede_ but always _succeed_ changes in the weather. It falls with the south and south-west, and rises with the north and north-west winds. The quantity of water which falls in rain and snow, one year with another, amounts to from 24 to 36 inches. But to complete the account of variable qualities in the climate, it will be necessary to add, that our summers and autumns are sometimes marked by a _deficiency_, and sometimes by an _excessive_ quantity of rain. The summer and autumn of 1782 were uncommonly dry. Near two months elapsed without a single shower of rain. There were only two showers in the whole months of September and October. In consequence of this dry weather, there was no second crop of hay. The Indian corn failed of its increase in many places, and was cut down for food for cattle. Trees newly planted, died. The pasture fields not only lost their verdure, but threw up small clouds of dust when agitated by the feet of men, or beasts. Cattle in some instances were driven many miles to be watered, every morning and evening. It was remarked during this dry weather, that the sheep were uncommonly fat, and their flesh well tasted, while all the other domestic animals languished from the want of grass and water. The earth became so inflammable in some places, as to burn above a foot below its surface. A complete consumption of the turf by an accidental fire kindled in the adjoining state of New-Jersey, spread terror and distress through a large tract of country. Springs of water and large creeks were dried up in many parts of the state. Rocks appeared in the river Schuylkill, which had never been observed before, by the oldest persons then alive. On one of them were cut the figures 1701. The atmosphere, during part of this dry weather, was often filled, especially in the mornings, with a thin mist, which, while it deceived with the expectation of rain, served the valuable purpose of abating the heat of the sun. A similar mist was observed in France by Dr. Franklin, in the summer of 1782. The winter which succeeded it was uncommonly cold in France, as well as in Pennsylvania. I am sorry that I am not able to furnish the mean heat of each of the summer months. My notes of the weather enable me to add nothing further upon this subject, than that the summer was "uncommonly cool." The summer of the year 1788 afforded a remarkable instance of _excess_ in the quantity of rain which sometimes falls in Pennsylvania. Thirteen days are marked with rain in July, in the records of the weather kept at Spring-Mill. There fell on the 18th and 19th of August seven inches of rain in the city of Philadelphia. The wheat suffered greatly by the constant rains of July in the eastern and middle parts of the state. So unproductive a harvest in grain, from wet weather, had not been known, it is said, in the course of the last 70 years. The heat of the air, during these summer months was very moderate. Its mean temperature at Spring-Mill was 67,8 in June, 74,7 in July, and only 70,6 in August. It is some consolation to a citizen of Pennsylvania, in recording facts which seem to militate against our climate, to reflect that the difference of the weather, in different parts of the state, at the same season, is happily accommodated to promote an increase of the same objects of agriculture; and hence a deficiency of crops has never been known in any one year throughout the _whole_ state. The aurora borealis and meteors are seen occasionally in Pennsylvania. In the present imperfect state of our knowledge of their influence upon the human body, it will be foreign to the design of this history of our climate to describe them. Storms and hurricanes are not unknown in Pennsylvania. They occur once in four or five years, but they are most frequent and destructive in the autumn. They are generally accompanied by rain. Trees are torn up by the roots, and the rivers and creeks are sometimes swelled so suddenly as to do considerable damage to the adjoining farms. The wind, during these storms, generally blows from the south-east and south-west. In the storms which occurred in September, 1769, and in the same month of the year 1785, the wind veered round contrary to its usual course, and blew from the north. After what has been said, the character of the climate of Pennsylvania may be summed up in a few words. There are no two successive years alike. Even the same successive seasons and months differ from each other every year. Perhaps there is but one steady trait in the character of our climate, and that is, it is uniformly variable. To furnish the reader with a succinct view of the weather in Pennsylvania, that includes all the articles that have been mentioned, I shall here sub-join a table containing the result of meteorological observations made near the river Schuylkill, for one year, in the neighbourhood of Philadelphia, by an ingenious French gentleman, Mr. Legeaux, who divides his time between rural employments, and useful philosophical pursuits. This table is extracted from the Columbian Magazine, for February, 1788. The height of Spring-Mill above the city of Philadelphia, is supposed to be about 70 feet. |====================================================================| | METEOROLOGICAL OBSERVATIONS, made at SPRING-MILL, | | 13 miles NNW of Philadelphia. Result of the year 1787. | |====================================================================| | | THERMOMETER. | BAROMETER. | PREVAILING | | | of | de | | WIND. | | MONTH. |_Fahrenheit_,| _Reaumur_, | mean height | | | | mean degree |degrés moyens| | | | | D. 1/16 O | D. 1/10 O |in. pts. 1/16| | |----------+-------------+-------------+-------------+---------------| |January | 35 1 | 1 4 | 29 9 9 |Variable still | |February | 33 8 | 8 | 29 9 9 |NE | |March | 45 1 | 5 8 | 29 9 7 |W | |April | 54 3 | 9 9 | 29 9 6 |Still, SW | |May | 61 2 | 13 | 29 9 2 |Still, WSW | |June | 70 7 | 17 2 | 29 8 2 |WNW | |July | 72 2 | 17 9 | 29 9 10 |WWSW var. | |August | 74 5 | 18 9 | 29 10 6 |W | |September | 64 7 | 14 5 | 29 10 4 |WNW | |October | 51 1 | 8 5 | 29 11 9 |WNW vari. | |November | 45 1 | 5 8 | 29 11 1 |Still, vari. | |December | 34 | 9 | 29 7 7 |WNW | |----------+-------------+-------------+-------------+---------------| | |10 Feb. |10 Feb. D. du| 8 Mar. | | | RESULT. |greatest D. |plus. gr. | greatest | | | |of cold. |froid. | elevation. | | | | 5 | 12 0 | 30 10 | | | |-------------+-------------+-------------| | | |3 July |3 July plus |2 Febr. least| WNW | | |greatest D. |G. D. de |elevation. | | | |of heat. |chaud. | | | | | 96 1 | 28 5 | 29 | | | |-------------+-------------+-------------| | | |Variation. | Variation. |Variation. | | | | 91 1 | 40 5 | 1 10 | | |----------|-------------+-------------+-------------|---------------| | |Temperature. |Temperature. |Mean elevat. | | | | 53 5 | 9 6 | 20 9 9 | | |====================================================================| | MONTH. | DAYS of | WATER | WEATHER. Key for left | | | [Key | of RAIN | A=aur. bor. | | | at right] | and SNOW. | R=rain Th=thunder | | |A|R |Th|S |T|in. pts. 1/16| S=snow T=tempest | |----------+-+--+--+--+-+-------------+------------------------------| |January | | 7| 1| 4| | 3 10 10 |Fair, still, cold, and snow. | |February | | 3| | 3|2| 3 7 3 |Fair, overcast. | |March | | 6| | 3| | 2 4 2 |Fair, windy. | |April | | 3| 2| 1|2| 1 2 13 |Fair, and very dry. | |May |1|14| 6| |2| 4 11 4 |Foggy, cold, and wet. | |June | | 9| 1| | | 1 10 4 |Very fair & growing weather. | |July |1| 5| 2| | | 3 1 11 |Fair, and overcast. | |August | |11| 4| |1| 5 2 3 |Very fair, and cloudy. | |September | | 6| 1| |1| 2 7 8 |Fair weather. | |October |1| 4| | | | 7 10 |Foggy, fair, and dry weather. | |November |1| 5| | | | 2 6 10 |Very fair. | |December | | | | 1|1| 9 |Very fair, and very dry. | |----------+-+--+--+--+-+-------------+------------------------------| | RESULT. |4|73|17|12|9|32 8 14 |TEMPERATURE OF THE YEAR 1787. | | | | | Very fair, dry, abundant in | | | | | every thing, and healthy. | |====================================================================| It is worthy of notice, how near the mean heat of the year, and of the month of April, in two successive years, are to each other in the same place. The mean heat of April, 1787, was 54°3, that of April, 1788, was 52°2. By the table of the mean heat of each month in the year, it appears that the mean heat of 1787 was 53°5 at Spring-Mill. The following accounts of the climates of Pekin and Madrid, which lie within a few minutes of the same latitude as Philadelphia, may serve to show how much climates are altered by local and relative circumstances. The account of the temperature of the air at Pekin will serve further to show, that with all the advantages of the highest degrees of cultivation which have taken place in China, the winters are colder, and the summers warmer there than in Pennsylvania, principally from a cause which will probably operate upon the winters of Pennsylvania for many centuries to come, viz. the vicinity of an uncultivated north-west country. "PEKIN, lat. 39° 54', long. 116° 29' W. "By five years observations, its annual mean temperature was found to be 55° 5'. January 20°,75 July 84°,8 February 32 August 83 March 48 September 63 April 59 October 52 May 72 November 41 June 83°,75 December 27 "The temperature of the Atlantic under this parallel is 62, but the standard of this part of the globe is the North Pacific, which is here 4 or 5 degrees colder than the Atlantic. The Yellow Sea is the nearest to Pekin, being about 200 miles distant from it; but it is itself cooled by the mountainous country of Corea, which interposes between it and the ocean, for a considerable part of its extent. Besides, all the northern parts of China (in which Pekin lies) must be cooled by the vicinity of the mountains of Chinese Tartary, among which the cold is said to be excessive. "The greatest cold usually experienced during this period was 5°, the greatest heat, 98°: on the 25th of July, 1773, the heat arose to 108° and 110°: a N. E. or N. W. wind produces the greatest cold, a S. or S. W. or S. E. the greatest heat[33]." [33] "6. Mem. Scav. Etrang. p. 528." "MADRID, lat. 40° 25', long. 3° 20' E. The usual heat in summer is said to be from 75° to 85°; even at night it seldom falls below 70°; the mean height of the barometer is 27,96. It seems to be about 1900 feet above the level of the sea[34]." [34] "Mem. Par. 1777, p. 146." The above accounts are extracted from Mr. Kirwan's useful and elaborate estimate of the temperature of different latitudes. The history which has been given of the climate of Pennsylvania, is confined chiefly to the country on the east side of the Allegany mountain. On the west side of this mountain, the climate differs materially from that of the south-eastern parts of the state in the temperature of the air, in the effects of the winds upon the weather, and in the quantity of rain and snow which falls every year. The winter seldom breaks up on the mountains before the 25th of March. A fall of snow was once perceived upon it, which measured an inch and a half, on the 11th day of June. The trees which grow upon it are small, and Indian corn is with difficulty brought to maturity, even at the foot of the east side of it. The south-west winds on the west side of the mountain are accompanied by cold and rain. The soil is rich, consisting of near a foot, in many places, of black mould. The roads in this country are muddy in winter, but seldom dusty in summer. The arrangement of strata of the earth on the west side, differs materially from their arrangement on the east side the mountain. "The country (says Mr. Rittenhouse, in a letter to a friend in Philadelphia[35]), when viewed from the western ridge of the Allegany, appears to be one vast extended plain. All the various strata of stone seem to lie undisturbed in the situation in which they were first formed, and the layers of stone, sand, clay, and coal, are nearly _horizontal_." [35] Columbian Magazine, for October, 1786. The temperature of the air on the west is seldom so hot, or so cold, as on the east side of the mountain. By comparing the state of a thermometer examined by Dr. Bedford at Pittsburg, 284 miles from Philadelphia, it appears that the weather was not so cold by twelve degrees in that town, as it was in Philadelphia, on the 5th of February, 1788. To show the difference between the weather at Spring-Mill and in Pittsburg, I shall here sub-join an account of it, in both places, the first taken by Mr. Legeaux, and the other by Doctor Bedford. +----------------------------------------------------------+ | METEOROLOGICAL OBSERVATIONS, made at SPRING-MILL, | | 13 miles NNW. of Philadelphia. April, 1788. | +-------+------------------------+-------------+-----------+ | | | | | | | | | | | | | | | | | | | | | | THERMOMETER | | | | |-------------+----------| BAROMETER. | | | | of | de | | | | |_Fahrenheit_,|_Reaumur_,| mean | | | D. | mean | degrés | height | | | of the| degree | moyens | |PREVAILING | | month.| D. 1/10 O | D. 1/10 O|in. pts. 1/10| WIND. | +-------+-------------+--------+-+-------------+-----------+ | 1 | 58 1 | | 11 6 | | 29 10 5 |W. | | 2 | 46 9 | | 6 9 | | 30 1 |Calm. | | 3 | 40 3 | | 3 7 | | 30 3 |Changeable.| | 4 | 51 3 | | 8 6 | | 29 11 7 |SW. | | 5 | 51 1 | | 8 5 | | 30 7 |E. | | 6 | 55 7 | | 10 5 | | 29 11 7 |Calm. | | 7 | 51 3 | | 8 6 | | 30 2 |NE. | | 8 | 42 1 | | 4 5 | | 29 11 |E. | | 9 | 63 5 | | 14 | | 29 8 |W. | | 10 | 46 7 | | 6 5 | | 29 10 |W. | | 11 | 53 8 | | 9 7 | | 30 2 |W. | | 12 | 44 5 | | 5 5 | | 29 10 |Calm. | | 13 | 60 5 | | 12 7 | | 29 10 3 |SW. | | 14 | 50 2 | | 8 1 | | 29 9 |E. | | 15 | 58 1 | | 11 6 | | 29 9 7 |SW. | +-------+----- --+---+-- -----+-+-------------+-----------+ | METEOROLOGICAL OBSERVATIONS, made at PITTSBURG, | | 284 miles west of Philadelphia. April, 1788. | +-------+---------+---+--------+-+-------------+-----------+ | 1 | 46 | | | | |SW. | | 2 | 42 | | | | |NE. by N. | | 3 | 43 | | | | |SE. | | 4 | 64 | | | | |Calm. | | 5 | 80 | | | | |SE. by S. | | 6 | 52 | | | | |SW. | | 7 | 48 | | | | |NE. by N. | | 8 | 66 | | | | |SE. by S. | | 9 | 56 | | | | |NW. by N. | | 10 | 60 | | | | |SW. | | 11 | 62 | | | | |Calm. | | 12 | 67 | | | | |SW. | | 13 | 62 | | | | |Calm. | | 14 | 60 | | | | |Variable. | | 15 | 52 | | | | |W. | +-------+---------+---+--------+-+-------------+-----------+ +------------------------------------------------------+ | METEOROLOGICAL OBSERVATIONS, made at SPRING-MILL, | | 13 miles NNW. of Philadelphia. April, 1788. | +-------+-----------------------+----------------------+ | | DAYS of | | | |aur. boreal. | | | | |rain. | | | | | |thunder. | | | | | | |snow. | | | | | | | | +-------------| | | | | | | | | WATER. | | | D. | | | | | | of RAIN | | | of the| | | | | | and SNOW. | | | month.| | | | | |in. pts. 1/16| WEATHER. | +-------+-+-+-+-+-+-------------+----------------------+ | 1 | | | | | | |Overcast, fair. | | 2 | | | | | | |Overcast and windy. | | 3 | |1| | | | 1 15 |Overcast, rainy. | | 4 | | | | | | |Overcast. | | 5 | | | | | | |Overcast, fair. | | 6 | |1| | | | 1 3 |Overcast, rainy. | | 7 | |1| | | | 2 7 |Overcast, rainy. | | 8 | |1| | | | 1 4 |Rainy. | | 9 | | | | | | |Overcast, windy. | | 10 | | | | | | |Fair. | | 11 | | | | | | |Very fair. | | 12 | |1| | | | 1 11 |Overcast, rainy. | | 13 | | | | | | |Very fair. | | 14 | |1| | | | 1 14 |Fair, overcast, rainy.| | 15 | |1| | | | 2 13 |Foggy, rainy. | +-------+-+-+-+-+-+-------------+----------------------+ | METEOROLOGICAL OBSERVATIONS, made at PITTSBURG, | | 284 miles west of Philadelphia. April, 1788. | +-------+-+-+-+-+-+-------------+----------------------+ | 1 | |1| | | | |Cloudy. | | 2 | | | | | | |Clear. | | 3 | |1| | | | |Cloudy. | | 4 | | | | | | |Clear. | | 5 | |1|1| | | |Cloudy. | | 6 | |1| | | | |Cloudy. | | 7 | | | | | | |Cloudy. | | 8 | |1|1| | | |Cloudy. | | 9 | | | | | | |Cloudy. | | 10 | | | | | | |Cloudy, with wind. | | 11 | | | | | | |Clear. | | 12 | | | | | | |Cloudy, with wind. | | 13 | | | | | | |Clear. | | 14 | |1| | | | |Cloudy. | | 15 | | | | | | |Cloudy. | +-------+-+-+-+-+-+-------------+----------------------+ From a review of all the facts which have been mentioned, it appears that the climate of Pennsylvania is a compound of most of the climates in the world. Here we have the moisture of Britain in the spring, the heat of Africa in summer, the temperature of Italy in June, the sky of Egypt in the autumn, the cold and snows of Norway and the ice of Holland in the winter, the tempests (in a certain degree) of the West-Indies in every season, and the variable winds and weather of Great-Britain in every month of the year. From this history of the climate of Pennsylvania, it is easy to ascertain what degrees of health, and what diseases prevail in the state. As we have the climates, so we have the health, and the acute diseases, of all the countries that have been mentioned. Without attempting to enumerate the diseases, I shall only add a few words upon the _time_ and _manner_ in which they are produced. I. It appears from the testimonies of many aged persons, that pleurisies and inflammatory diseases of all kinds, are less frequent now than they were forty or fifty years ago. II. It is a well known fact, that intermitting and bilious fevers have increased in Pennsylvania in proportion as the country has been _cleared of its wood_, in many parts of the state. III. It is equally certain that these fevers have lessened, or disappeared, in proportion as the country has been _cultivated_. IV. Heavy rains and freshes in the spring seldom produce fevers, unless they are succeeded by unseasonably warm weather. V. Sudden changes from great heat to cold, or cool weather, if they occur before the 20th of August, seldom produce fevers. After that time, they are generally followed by them. VI. The same state of the atmosphere, whether cold or warm, moist or dry, continued for a long time, without any material changes, is always healthy. Acute and inflammatory fevers were in vain looked for in the cold winter of 1779-80. The dry summer of 1782, and the wet summer of 1788, were likewise uncommonly healthy in the city of Philadelphia. These facts extend only to those diseases which depend upon the sensible qualities of the air, for diseases from miasmata and contagion, are less influenced by the uniformity of the weather. The autumn of 1780 was very sickly in Philadelphia, from the peculiar situation of the grounds in the neighbourhood of the city, while the country was uncommonly healthy. The dry summer and autumn of 1782 were uncommonly sickly in the country, from the extensive sources of morbid exhalations which were left by the diminution of the waters in the creeks and rivers. VII. Diseases are often _generated_ in one season and _produced_ in another. Hence we frequently observe fevers of different kinds to _follow_ every species of the weather that was mentioned in the last observation. VIII. The excessive heat in Pennsylvania has sometimes proved fatal to persons who have been much exposed to it. Its morbid effects discover themselves by a difficulty of breathing, a general languor, and, in some instances, by a numbness and an immobility of the extremities. The excessive cold in Pennsylvania has more frequently proved fatal, but it has been chiefly to those persons who have sought a defence from it, by large draughts of spiritous liquors. Its operation in bringing on sleepiness previous to death, is well known. On the 5th of February, 1788, many people were affected by the cold. It produced a violent pain in the head; and, in one instance, a sickness at the stomach, and a vomiting appeared to be the consequence of it. I have frequently observed that a greater number of old people die, during the continuance of extreme cold and warm weather, than in the same number of days in moderate weather. IX. May and June are usually the healthiest months in the year. X. The influence of the winds upon health, depends very much upon the nature of the country over which they pass. Winds which pass over mill-dams and marshes in August and September, generally carry with them the seeds of fevers. XI. The country in the neighbourhood of Philadelphia was formerly more sickly than the central parts of the city, after the 20th of August. Since the year 1793, the reverse of this has been the case. XII. The night-air is always unwholesome from the 20th of August, especially during the passive state of the system in _sleep_. The frequent and sudden changes of the air from heat to cold render it unsafe to sleep with open windows, during the autumnal months. XIII. Valetudinarians always enjoy the most health in Pennsylvania in the summer and winter months. The spring, in a particular manner, is very unfavourable to them. I shall conclude the account of the influence of the climate of Pennsylvania upon the human body, with the following observations. 1. The sensations of heat and cold are influenced so much by outward circumstances, that we often mistake the degrees of them by neglecting to use such conveniences as are calculated to obviate the effects of their excess. A native of Jamaica often complains less of the heat, and a native of Canada of the cold, in their respective countries, than they do under certain circumstances in Pennsylvania. Even a Pennsylvanian frequently complains less of the heat in Jamaica, and of the cold in Canada, than in his native state. The reason of this is plain. In countries where heat and cold are intense and regular, the inhabitants guard themselves, by accommodating their houses and dresses to each of them. The instability and short duration of excessive heat and cold in Pennsylvania, have unfortunately led its inhabitants, in many instances, to neglect adopting customs, which are used in hot and cold countries to guard against them. Where houses are built with a southern or south-western front exposure, and where other accommodations to the climate are observed in their construction, the disagreeable excesses of heat and cold are rendered much less perceptible in Pennsylvania. Perhaps the application of the principles of philosophy and taste to the construction of our houses, within the last thirty or forty years, may be another reason why some old people have supposed that the degrees of heat and cold are less in Pennsylvania than they were in former years. 2. The variable nature of the climate of Pennsylvania does not render it _necessarily_ unhealthy. Doctor Huxham has taught us, that the healthiest seasons in Great-Britain have often been accompanied by the most variable weather. His words upon this subject convey a reason for the fact. "When the constitutions of the year are frequently changing, so that by the _contrast_ a sort of _equilibrium_ is kept up, and health with it; and that especially if persons are careful to guard themselves well against these sudden changes[36]." Perhaps no climate or country is unhealthy, where men acquire from experience, or tradition, the arts of accommodating themselves to it. The history of all the nations of the world, whether savage, barbarous, or civilized, previously to a mixture of their manners by an intercourse with strangers, seems to favour this opinion. The climate of China appears, in many particulars, to resemble that of Pennsylvania. The Chinese wear loose garments of different lengths, and increase or diminish the number of them, according to the frequent and sudden changes of their weather; hence they have very few acute diseases among them. Those inhabitants of Pennsylvania who have acquired the arts of conforming to the changes and extremes of our weather in dress, diet, and manners, escape most of those acute diseases which are occasioned by the sensible qualities of the air; and faithful inquiries and observations have proved, that they attain to as great ages as the same number of people in any part of the world. [36] Observations on the Air and Epidemic Diseases, vol. I. p. 5. AN ACCOUNT OF THE BILIOUS REMITTING FEVER, AS IT APPEARED _IN PHILADELPHIA_, IN THE SUMMER AND AUTUMN OF THE YEAR 1780. Before I proceed to describe this fever, it will be necessary to give a short account of the weather, and of the diseases which preceded its appearance. The spring of 1780 was dry and cool. A catarrh appeared among children between one year, and seven years of age. It was accompanied by a defluxion from the eyes and nose, and by a cough and dyspn[oe]a, resembling, in some instances, the cynanche trachealis, and in others a peripneumony. In some cases it was complicated with the symptoms of a bilious remitting, and intermitting fever. The exacerbations of this fever were always attended with dyspn[oe]a and cough. A few patients expectorated blood. Some had swellings behind their ears, and others were affected with small ulcers in the throat. I met with only one case of this fever in which the pulse indicated bleeding. The rest yielded in a few days to emetics, blisters, and the bark, assisted by the usual more simple remedies in such diseases. An intermittent prevailed among adults in the month of May. July and August were uncommonly warm. The mercury stood on the 6th of August at 94-1/2°, on the 15th of the same month at 95°, and for several days afterwards at 90°. Many labouring people perished during this month by the heat, and by drinking, not only cold water, but cold liquors of several kinds, while they were under the violent impressions of the heat. The vomiting and purging prevailed universally, during these two warm months, among the children, and with uncommon degrees of mortality. Children from one year to eight and nine years old were likewise very generally affected by blotches and little boils, especially in their faces. An eruption on the skin, called by the common people the prickly heat, was very common at this time among persons of all ages. The winds during these months blew chiefly from the south, and south-west. Of course they passed over the land which lies between the city, and the conflux of the rivers Delaware and Schuylkill, the peculiar situation of which, at that time, has been already described. The dock, and the streets of Philadelphia, supplied the winds at this season, likewise, with a portion of their unwholesome exhalations. The muschetoes were uncommonly numerous during the autumn. A certain sign (says Dr. Lind) of an unwholesome atmosphere. The remitting fever made its first appearance in July and August, but its symptoms were so mild, and its extent so confined, that it excited no apprehensions of its subsequent more general prevalence throughout the city. On the 19th of August the air became suddenly very cool. Many hundred people in the city complained, the next day, of different degrees of indisposition, from a sense of lassitude, to a fever of the remitting type. This was the signal of the epidemic. The weather continued cool during the remaining part of the month, and during the whole month of September. From the exposure of the district of Southwark (which is often distinguished by the name of the _Hill_) to the south-west winds, the fever made its first appearance in that appendage of the city. Scarcely a family, and, in many families, scarcely a member of them, escaped it. From the Hill it gradually travelled along the second street from the Delaware, improperly called Front-street. For a while it was confined to this street only, after it entered the city, and hence it was called by some people the _Front-street fever_. It gradually spread through other parts of the city, but with very different degrees of violence. It prevailed but little in the Northern Liberties. It was scarcely known beyond Fourth-street from the Delaware. Intemperance in eating or drinking, riding in the sun or rain, watching, fatigue, or even a fright, but more frequently cold, all served to excite the seeds of this fever into action, where-ever they existed. All ages and both sexes were affected by this fever. Seven of the practitioners of physic were confined by it nearly at the same time. The city, during the prevalence of the fever, was filled with an unusual number of strangers, many of whom, particularly the Friends (whose yearly meeting was held in the month of September), were affected by it. No other febrile disease was observed during this time in the city. This fever generally came on with rigour, but seldom with a regular chilly fit, and often without any sensation of cold. In some persons it was introduced by a slight sore throat, and in others by a hoarseness which was mistaken for a common cold. A giddiness in the head was the forerunner of the disease in some people. This giddiness attacked so suddenly, as to produce, in several instances, a faintness, and even symptoms of apoplexy. It was remarkable, that all those persons who were affected in this violent manner, recovered in two or three days. I met with one instance of this fever attacking with coma, and another with convulsions, and with many instances, in which it was introduced by a delirium. The pains which accompanied this fever were exquisitely severe in the head, back, and limbs. The pains in the head were sometimes in the back parts of it, and at other times they occupied only the eyeballs. In some people, the pains were so acute in their backs and hips, that they could not lie in bed. In others, the pains affected the neck and arms, so as to produce in one instance a difficulty of moving the fingers of the right hand. They all complained more or less of a soreness in the seats of these pains, particularly when they occupied the head and eyeballs. A few complained of their flesh being sore to the touch, in every part of the body. From these circumstances, the disease was sometimes believed to be a rheumatism; but its more general name among all classes of people was, the _break-bone fever_. I met with one case of pain in the back, and another of an acute ear-ach, both of which returned periodically every night, and without any fever. A nausea universally, and in some instances a vomiting, accompanied by a disagreeable taste in the mouth, attended this fever. The bowels were, in most cases, regular, except where the disease fell with its whole force upon them, producing a dysentery. The tongue was generally moist, and tinctured of a yellow colour. The urine was high coloured, and in its usual quantity in fevers. The skin was generally moist, especially where the disease terminated on the third or fourth day. The pulse was quick and full, but never hard, in a single patient that came under my care, till the 28th of September. It was remarkable, that little, and, in some instances, no thirst attended this fever. A screatus, or constant hawking and spitting, attended in many cases through the whole disease, and was a favourable symptom. There were generally remissions in this fever every morning, and sometimes in the evening. The exacerbations were more severe every other day, and two exacerbations were often observed in one day. A rash often appeared on the third and fourth days, which proved favourable. This rash was accompanied, in some cases, by a burning in the palms of the hands and soles of the feet. Many people at this time, who were not confined to their beds, and some, who had no fever, had an efflorescence on their skins. In several persons the force of the disease seemed to fall upon the face, producing swellings under the jaw and in the ears, which in some instances terminated in abscesses. When the fever did not terminate on the third or fourth day, it frequently ran on to the eleventh, fourteenth, and even twentieth days, assuming in its progress, according to its duration, the usual symptoms of the typhus gravior, or mitior, of Doctor Cullen. In some cases, the discharge of a few spoons-full of blood from the nose accompanied a solution of the fever on the third or fourth day; while in others, a profuse hæmorrhage from the nose, mouth, and bowels, on the tenth and eleventh days, preceded a fatal issue of the disease. Several cases came under my care, in which the fever was succeeded by a jaundice. The disease terminated in some cases without sweating, or a sediment in the urine; nor did I observe such patients more disposed to relapse than others, provided they took a sufficient quantity of the bark. About the beginning of October the weather became cool, accompanied by rain and an easterly wind. This cool and wet weather continued for four days. The mercury in the thermometer fell to 60°, and fires became agreeable. From this time the fever evidently declined, or was accompanied by inflammatory symptoms. On the 16th of October, I met with a case of inflammatory angina; and on the next day I visited a patient who had a complication of the bilious fever with a pleurisy, and whose blood discovered strong marks of the presence of the inflammatory diathesis. His stools were of a green and black colour. On the third day of his disease a rash appeared on his skin, and on the fourth, in consequence of a second bleeding, his fever terminated with the common symptoms of a crisis. During the latter end of October, and the first weeks in November, the mercury in the thermometer fluctuated between 50° and 60°. Pleurisies and inflammatory diseases of all kinds now made their appearance. They were more numerous and more acute, than in this stage of the autumn, in former years. I met with one case of pleurisy in November, which did not yield to less than four plentiful bleedings. I shall now add a short account of the METHOD I pursued in the treatment of this fever. I generally began by giving a gentle vomit of tartar emetic. This medicine, if given while the fever was in its forming state, frequently produced an immediate cure; and if given after its formation, on the _first_ day, seldom failed of producing a crisis on the third or fourth day. The vomit always discharged more or less bile. If a nausea, or an ineffectual attempt to vomit continued after the exhibition of the tartar emetic, I gave a second dose of it with the happiest effects. If the vomit failed of opening the bowels, I gave gentle doses of salts and cream of tartar[37], or of the butter-nut pill[38], so as to procure two or three plentiful stools. The matter discharged from the bowels was of a highly bilious nature. It was sometimes so acrid as to excoriate the rectum, and so offensive, as to occasion, in some cases, sickness and faintness both in the patients and in their attendants. In every instance, the patients found relief by these evacuations, especially from the pains in the head and limbs. [37] I have found that cream of tartar renders the purging neutral salts less disagreeable to the taste and stomach; but accident has lately taught me, that the juice of two limes or of one lemon, with about half an ounce of loaf sugar, added to six drachms of Glauber or Epsom salt, in half a pint of boiling water, form a mixture that is nearly as pleasant as strong beverage. [38] This pill is made from an extract of a strong decoction of the bark of the white walnut-tree. In those cases, where the prejudices of the patients against an emetic, or where an advanced state of pregnancy, or a habitual predisposition to a vomiting of blood occurred, I discharged the bile entirely by means of the lenient purges that have been mentioned. In this practice I had the example of Doctor Cleghorn, who prescribed purges with great success in a fever of the same kind in Minorca, with that which has been described[39]. Doctor Lining prescribed purges with equal success in an autumnal pleurisy in South Carolina, which I take to have been a form of a bilious remittent, accompanied by an inflammatory affection of the breast. [39] The tertiana interposita remissione tantum of Dr. Cullen. After evacuating the contents of the stomach and bowels, I gave small doses of tartar emetic, mixed with Glauber's salt. This medicine excited a general perspiration. It likewise kept the bowels gently open, by which means the bile was discharged as fast as it was accumulated. I constantly recommended to my patients, in this stage of the disorder, to _lie in bed_. This favoured the eruption of the rash, and the solution of the disease by perspiration. Persons who struggled against the fever by _sitting up_, or who attempted to shake it off by labour or exercise, either sunk under it, or had a slow recovery. A clergyman of a respectable character from the country, who was attacked by the disease in the city, returned home, from a desire of being attended by his own family, and died in a few days afterwards. This is only one, of many cases, in which I have observed travelling, even in the easiest carriages, to prove fatal in fevers after they were formed, or after the first symptoms had shown themselves. The quickest and most effectual way of conquering a fever, in most cases, is, by an early submission to it. The drinks I recommended to my patients were sage and balm teas, weak punch, lemonade, wine whey, tamarind and apple water. The apple water should be made by pouring boiling water upon slices of raw apples. It is more lively than that which is made by pouring the water on roasted apples. I found obvious advantages, in many cases, from the use of pediluvia, every night. In every case, I found the patients refreshed and relieved by frequent changes of their linen. On the third or fourth day, in the forenoon, the pains in the head and back generally abated, with a sweat which was diffused over the whole body. The pulse at this time remained quick and weak. This was, however, no objection to the use of the bark, a few doses of which immediately abated its quickness, and prevented a return of the fever. If the fever continued beyond the third or fourth day without an intermission, I always had recourse to blisters. Those which were applied to the neck, and behind the ears, produced the most immediate good effects. They seldom failed of producing an intermission in the fever, the day after they were applied. Where delirium or coma attended, I applied the blister to the neck on the _first_ day of the disease. A worthy family in this city will always ascribe the life of a promising boy, of ten years old, to the early application of a blister to the neck, in this fever. Where the fever did not yield to blisters, and assumed malignant, or typhus symptoms, I gave the medicines usually exhibited in both those states of fever. I took notice, in the history of this fever, that it was sometimes accompanied with symptoms of a dysentery. Where this disease appeared, I prescribed lenient purges and opiates. Where these failed of success, I gave the bark in the intermissions of the pain in the bowels, and applied blisters to the wrists. The good effects of these remedies led me to conclude, that the dysentery was the febris introversa of Dr. Sydenham. I am happy in having an opportunity, in this place, of bearing a testimony in favour of the usefulness of OPIUM in this disease, after the necessary evacuations had been made. I yielded, in prescribing it at first, to the earnest solicitations of my patients for something to give them relief from their insupportable pains, particularly when they were seated in the eyeballs and head. Its salutary effects in procuring sweat, and a remission of the fever, led me to prescribe it afterwards in almost every case, and always with the happiest effects. Those physicians enjoy but little pleasure in practising physic, who know not how much of the pain and anguish of fevers, of a certain kind, may be lessened by the judicious use of opium. In treating of the remedies used in this disease, I have taken no notice of blood-letting. Out of several hundred patients whom I visited in this fever, I did not meet with a single case, before the 27th of September, in which the state of the pulse indicated this evacuation. It is true, the pulse was _full_, but never _hard_. I acknowledge that I was called to several patients who had been bled without the advice of a physician, who recovered afterwards on the usual days of the solution of the fever. This only can be ascribed to that disposition which Doctor Cleghorn attributes to fevers, to preserve their types under every variety of treatment, as well as constitution. But I am bound to declare further, that I heard of several cases in which bleeding was followed by a fatal termination of the disease. In this fever relapses were very frequent, from exposure to the rain, sun, or night air, and from an excess in eating or drinking. The convalescence from this disease was marked by a number of extraordinary symptoms, which rendered patients the subjects of medical attention for many days after the pulse became perfectly regular, and after the crisis of the disease. A bitter taste in the mouth, accompanied by a yellow colour on the tongue, continued for near a week. Most of those who recovered complained of nausea, and a total want of appetite. A faintness, especially upon sitting up in bed, or in a chair, followed this fever. A weakness in the knees was universal. I met with two patients, who were most sensible of this weakness in the right knee. An inflammation in one eye, and in some instances in both eyes, occurred in several patients after their recovery. But the most remarkable symptom of the convalescence from this fever, was an uncommon dejection of the spirits. I attended two young ladies, who shed tears while they vented their complaints of their sickness and weakness. One of them very aptly proposed to me to change the name of the disease, and to call it, in its present stage, instead of the break-bone, the _break-heart fever_. To remove these symptoms, I gave the tincture of bark and elixir of vitriol in frequent doses. I likewise recommended the plentiful use of ripe fruits; but I saw the best effects from temperate meals of oysters, and a liberal use of porter. To these was added, gentle exercise in the open air, which gradually completed the cure. AN ACCOUNT OF THE _SCARLATINA ANGINOSA_, AS IT APPEARED IN PHILADELPHIA, IN THE YEARS 1783 AND 1784. The beginning of the month of July was unusually cool; insomuch that the mercury in Fahrenheit's thermometer stood at 61° in the day time, and fires were very comfortable, especially in the evening. In the last week but one of this month, the weather suddenly became so warm, that the mercury rose to 94-1/2°, at which it remained for three days. As this heat was accompanied by no breeze from any quarter, the sense of it was extremely distressing to many people. Upwards of twenty persons died in the course of those three days, from the excess of the heat, and from drinking cold water. Three old people died suddenly within this space of time. This extreme heat was succeeded by cool weather, the mercury having fallen to 60°, and the month closed with producing a few intermitting and remitting fevers, together with several cases of inflammatory angina. The weather in the month of August was extremely variable. The mercury, after standing for several days at 92°, suddenly fell so low, as not only to render fires necessary, but in many places to produce frost. Every form of fever made its appearance in this month. The synocha was so acute, in several cases, as to require from three to four bleedings. The remitting fever was accompanied by an uncommon degree of nausea and faintness. Several people died, after a few days' illness, of the malignant bilious fever, or typhus gravior, of Dr. Cullen. The intermittents had nothing peculiar in them, in their symptoms or method of cure. Towards the close of the month, the scarlatina anginosa made its appearance, chiefly among children. The month of September was cool and dry, and the scarlatina anginosa became epidemic among adults as well as young people. In most of the patients who were affected by it, it came on with a chilliness and a sickness at the stomach, or a vomiting; which last was so invariably present, that it was with me a pathognomonic sign of the disease. The matter discharged from the stomach was always bile. The swelling of the throat was in some instances so great, as to produce a difficulty of speaking, swallowing, and breathing. In a few instances, the speech was accompanied by a squeaking voice, resembling that which attends the cynanche trachealis. The ulcers on the tonsils were deep, and covered with white, and, in some instances, with black sloughs. In several cases, there was a discharge of a thick mucus from the nose, from the beginning, but it oftener occurred in the decline of the disease, which most frequently happened on the fifth day. Sometimes the subsiding of the swelling of the throat was followed by a swelling behind the ears. An eruption on the skin generally attended the symptoms which have been described. But this symptom appeared with considerable variety. In some people it preceded, and in others it followed the ulcers and swelling of the throat. In some, it appeared only on the outside of the throat, and on the breast; in others, it appeared chiefly on the limbs. In a few it appeared on the second or third day of the disease, and never returned afterwards. I saw two cases of eruption without a single symptom of sore throat. The face of one of those patients was swelled, as in the erisypelas. In the other, a young girl of seven years old, there was only a slight redness on the skin. She was seized with a vomiting, and died delirious in fifty-four hours. Soon after her death, a livid colour appeared on the outside of her throat. The bowels, in this degree of the disease, were in general regular. I can recollect but few cases which were attended by a diarrh[oe]a. The fever which accompanied the disease was generally the typhus mitior of Doctor Cullen. In a few cases it assumed symptoms of great malignity. The disease frequently went off with a swelling of the hands and feet. I saw one instance in a gentlewoman, in whom this swelling was absent, who complained of very acute pains in her limbs, resembling those of the rheumatism. In two cases which terminated fatally, there were large abscesses; the one on the outside, and the other on the inside of the throat. The first of these cases was accompanied by troublesome sores on the ends of the fingers. One of these patients lived twenty-eight, and the other above thirty days, and both appeared to die from the discharge which followed the opening of their abscesses. Between the degrees of the disease which I have described, there were many intermediate degrees of indisposition which belonged to this disease. I saw in several cases a discharge from behind the ears, and from the nose, with a slight eruption, and no sore throat. All these patients were able to sit up, and walk about. I saw one instance of a discharge from the inside of one of the ears in a child, who had ulcers in his throat, and the squeaking voice. In some, a pain in the jaw, with swellings behind the ears, and a slight fever, constituted the whole of the disease. In one case, the disease came on with a coma, and in several patients it went off with this symptom. A few instances occurred of adults, who walked about, and even transacted business, until a few hours before they died. The intermitting fever, which made its appearance in August, was not lost during the month of September. It continued to prevail, but with several peculiar symptoms. In many persons it was accompanied by an eruption on the skin, and a swelling of the hands and feet. In some, it was attended by a sore throat and pains behind the ears. Indeed, such was the predominance of the scarlatina anginosa, that many hundred people complained of sore throats, without any other symptom of indisposition. The slightest occasional or exciting cause, and particularly cold, seldom failed of producing the disease. The month of October was much cooler than September, and the disease continued, but with less alarming symptoms. In several adults, who were seized with it, the hardness of the pulse indicated blood-letting. The blood, in one case, was covered with a buffy coat, but beneath its surface it was dissolved. In the month of November, the disease assumed several inflammatory symptoms, and was attended with much less danger than formerly. I visited one patient whose symptoms were so inflammatory as to require two bleedings. During the decline of the disease, many people complained of troublesome sores on the ends of their fingers. A number of children likewise had sore throats and fevers, with eruptions on their skins, which resembled the chicken-pox. I am disposed to suspect that this eruption was the effect of a spice of the scarlatina anginosa, as several instances occurred of patients who had all the symptoms of this disease, in whom an eruption of white blisters succeeded their recovery. This form of the disease has been called by Sauvage, the scarlatina variolosa. I saw one case of sore throat, which was succeeded not only by swellings in the abdomen and limbs, but by a catarrh, which brought on a fatal consumption. A considerable shock of an earthquake was felt on the 29th of this month, at ten o'clock at night, in the city of Philadelphia; but no change was perceived in the disease, in consequence of it. In December, January, and February, the weather was intensely cold. There was a thaw for a few days in January, which broke the ice of the Delaware, but it was followed by cold so excessive, as to close the river till the beginning of March. The mercury, on the 28th and 29th of February, stood below 0 in Fahrenheit's thermometer. For a few weeks in the beginning of December, the disease disappeared in the circle of my patients, but it broke out with great violence the latter end of that month, and in the January following. Some of the worst cases that I met with (three of which proved fatal) were in those two months. The disease disappeared in the spring, but it spread afterwards through the neighbouring states of New-Jersey, Delaware, and Maryland. I shall now add an account of the remedies which I administered in this disease. In every case that I was called to, I began the cure by giving a vomit joined with calomel. The vomit was either tartar emetic or ipecacuanha, according to the prejudices, habits, or constitutions of my patients. A quantity of bile was generally discharged by this medicine. Besides evacuating the contents of the stomach, it cleansed the throat in its passage downwards. To ensure this effect from the calomel, I always directed it to be given mixed with syrup or sugar and water, so as to diffuse it generally over every part of the throat. The calomel seldom failed to produce two or three stools. In several cases I was obliged, by the continuance of nausea, to repeat the emetics, and always with immediate and obvious advantage. I gave the calomel in moderate doses in every stage of the disease. To restrain its purgative effects, when necessary, I added to it a small quantity of opium. During the whole course of the disease, where the calomel failed of opening the bowels, I gave lenient purges, when a disposition to costiveness required them. The throat was kept clean by detergent gargles. In several instances I saw evident advantages from adding a few grains of calomel to them. In cases of great difficulty of swallowing or breathing, the patients found relief from receiving the steams of warm water mixed with a little vinegar, through a funnel into the throat. A perspiration kept up by gentle doses of antimonials, and diluting drinks, impregnated with wine, always gave relief. In every case which did not yield to the above remedies on the third day, I applied a blister behind each ear, or one to the neck, and, I think, always with good effects. I met with no cases in which the bark appeared to be indicated, except the three in which the disease proved fatal. Where the sore throat was blended with the intermitting fever, the bark was given with advantage. But in common cases it was unnecessary. Subsequent observations have led me to believe, with Doctor Withering, that it is sometimes hurtful in this disease. It proved fatal in many parts of the country, upon its first appearance; but wherever the mode of treatment here delivered was adopted, its mortality was soon checked. The calomel was used very generally in New-Jersey and New-York. In the Delaware state, a physician of character made it a practice not only to give calomel, but to anoint the outside of the throat with mercurial ointment. ADDITIONAL OBSERVATIONS UPON THE _Scarlatina Anginosa_. This disease has prevailed in Philadelphia, at different seasons, ever since the year 1783. It has blended itself occasionally with all our epidemics. Many cases have come under my notice since its first appearance, in which dropsical swellings have succeeded the fever. In some instances there appeared to be effusions of water not only in the limbs and abdomen, but in the thorax. They yielded, in every case that I attended, to purges of calomel and jalap. Where these swellings were neglected, they sometimes proved fatal. In the winter of 1786-7, the scarlatina anginosa was blended with the cynanche parotidea, and in one instance with a typhus mitior. The last was in a young girl of nine years of age. She was seized with a vomiting of bile and an efflorescence on her breast, but discovered no other symptoms of the scarlatina anginosa till the sixteenth day of her fever, when a swelling appeared on the outside of her throat, and after her recovery, a pain and swelling in one of her knees. In the month of July, 1787, a number of people were affected by sudden swellings of their lips and eyelids. These swellings generally came on in the night, were attended with little or no pain, and went off in two or three days. I met with only one case in which there was a different issue to these symptoms. It was in a patient in the Pennsylvania hospital, in whom a swelling in the lips ended in a suppuration, which, notwithstanding the liberal use of bark and wine, proved fatal in the course of twelve days. In the months of June and July, 1788, a number of people were affected by sudden swellings, not only of the lips, but of the cheeks and throat. At the same time many persons were affected by an inflammation of the eyes. The swellings were attended with more pain than they were the year before, and some of them required one or two purges to remove them; but in general they went without medicine, in two or three days. Is it proper to refer these complaints to the same cause which produces the scarlatina anginosa? The prevalence of the scarlatina anginosa at the _same time_ in this city; its disposition to produce swellings in different parts of the body; and the analogy of the intermitting fever, which often conceals itself under symptoms that are foreign to its usual type; all seem to render this conjecture probable. In one of the cases of an inflammation of the eye, which came under my notice, the patient was affected by a vomiting a few hours before the inflammation appeared, and complained of a sickness at his stomach for two or three days afterwards. Now a vomiting and nausea appear to be very generally symptoms of the scarlatina anginosa. In the autumn of 1788, the scarlatina anginosa appeared with different degrees of violence in many parts of the city. In two instances it appeared with an obstinate diarrh[oe]a; but it was in young subjects, and not in adults, as described by Doctor Withering. In both cases, the disease proved fatal; the one on the third, the other on the fifth day. In the month of December of the same year, I saw one case in which a running from one of the ears, and a deafness came on, on the fifth day, immediately after the discharge of mucus from the nose had ceased. This case terminated favourably on the ninth day, but was succeeded, for several days afterwards, by a troublesome cough. I shall conclude this essay by the following remarks: 1. Camphor has often been suspended in a bag from the neck, as a preservative against this disease. Repeated observations have taught me, that it possesses little or no efficacy for this purpose. I have had reason to entertain a more favourable opinion of the benefit of washing the hands and face with vinegar, and of rinsing the mouth and throat with vinegar and water every morning, as means of preventing this disease. 2. Whenever I have been called to a patient where the scarlatina appeared to be in a _forming_ state, a vomit of ipecacuanha or tartar emetic, mixed with a few grains of calomel, has never failed of completely checking the disease, or of so far mitigating its violence, as to dispose it to a favourable issue in a few days; and if these observations should serve no other purpose than to awaken the early attention of patients and physicians to this speedy and effectual remedy, they will not have been recorded in vain. 3. When the matter which produces this disease has been received into the body, a purge has prevented its being excited into action, or rendered it mild, throughout a whole family. For this practice I am indebted to some observations on the scarlatina, published by Dr. Sims in the first volume of the Medical Memoirs. 4. During the prevalence of the inflammatory constitution of the atmosphere, between the years 1793 and 1800, this disease occurred occasionally in Philadelphia, and yielded, like the other epidemics of those years, to copious blood-letting, and other depleting remedies. AN INQUIRY INTO THE CAUSE AND CURE OF _THE CHOLERA INFANTUM_. By this name I mean to designate a disease, called, in Philadelphia, the "vomiting and purging of children." From the regularity of its appearance in the summer months, it is likewise known by the name of "the disease of the season." It prevails in most of the large towns of the United States. It is distinguished in Charleston, in South Carolina, by the name of "the April and May disease," from making its first appearance in those two months. It seldom appears in Philadelphia till the middle of June, or the beginning of July, and generally continues till near the middle of September. Its frequency and danger are always in proportion to the heat of the weather. It affects children from the first or second week after their birth, till they are two years old. It sometimes begins with a diarrh[oe]a, which continues for several days without any other symptom of indisposition; but it more frequently comes on with a violent vomiting and purging, and a high fever. The matter discharged from the stomach and bowels is generally yellow or green, but the stools are sometimes slimy and bloody, without any tincture of bile. In some instances they are nearly as limpid as water. Worms are frequently discharged in each kind of the stools that has been described. The children, in this stage of the disease, appear to suffer a good deal of pain. They draw up their feet, and are never easy in one posture. The pulse is quick and weak. The head is unusually warm, while the extremities retain their natural heat, or incline to be cold. The fever is of the remitting kind, and discovers evident exacerbations, especially in the evenings. The disease affects the head so much, as in some instances to produce symptoms not only of delirium, but of mania, insomuch that the children throw their heads backwards and forwards, and sometimes make attempts to scratch, and to bite their parents, nurses, and even themselves. A swelling frequently occurs in the abdomen, and in the face and limbs. An intense thirst attends every stage of the disease. The eyes appear languid and hollow, and the children generally sleep with them half closed. Such is the insensibility of the system in some instances in this disease, that flies have been seen to alight upon the eyes when open, without exciting a motion in the eyelids to remove them. Sometimes the vomiting continues without the purging, but more generally the purging continues without the vomiting, through the whole course of the disease. The stools are frequently large, and extremely f[oe]tid, but in some instances they are without smell, and resemble drinks and aliment which have been taken into the body. The disease is sometimes fatal in a few days. I once saw it carry off a child in four and twenty hours. Its duration is varied by the season of the year, and by the changes in the temperature of the weather. A cool day frequently abates its violence, and disposes it to a favourable termination. It often continues, with occasional variations in its appearance, for six weeks or two months. Where the disease has been of long continuance, the approach of death is gradual, and attended by a number of distressing symptoms. An emaciation of the body to such a degree, as that the bones come through the skin, livid spots, a singultus, convulsions, a strongly marked hippocratic countenance, and a sore mouth, generally precede the fatal termination of this disease. Few children ever recover, after the last symptoms which have been mentioned make their appearance. This disease has been ascribed to several causes; of each of which I shall take notice in order. I. It has been attributed to dentition. To refute this opinion, it will be necessary to observe, that it appears only in one season of the year. Dentition, I acknowledge, sometimes aggravates it; hence we find it is most severe in that period of life, when the greatest number of teeth make their appearance, which is generally about the 10th month. I think I have observed more children to die of this disease at that age, than at any other. II. Worms have likewise been suspected of being the cause of this disease. To this opinion, I object the uncertainty of worms ever producing an idiopathic fever, and the improbability of their combining in such a manner as to produce an annual epidemic disease of any kind. But further, we often see the disease in all its force, before that age, in which worms usually produce diseases; we likewise often see it resist the most powerful anthelmintic medicines; and, lastly, it appears from dissection, where the disease has proved fatal, that not a single worm has been discovered in the bowels. It is true, worms are in some instances discharged in this disease, but they are frequently discharged in greater numbers in the hydrocephalus internus, and in the small-pox, and yet who will assert either of those diseases to be produced by worms. III. The summer fruits have been accused of producing this disease. To this opinion I object, that the disease is but little known in country places, where children eat much more fruit than in cities. As far as I have observed, I am disposed to believe, that the moderate use of ripe fruits, rather tends to prevent, than to induce the disease. From the discharge of bile which generally introduces the disease, from the remissions and exacerbations of the fever which accompanies it, and from its occurring nearly in the same season with the cholera and remitting fever in adults, I am disposed to consider it as a modification of the same diseases. Its appearance earlier in the season than the cholera and remitting fever in adults, must be ascribed to the constitutions of children being more predisposed from weakness to be acted upon, by the remote causes which produce those diseases. I shall now mention the remedies which are proper and useful in this disease. I. The first indication of cure is to evacuate the bile from the stomach and bowels. This should be done by gentle doses of ipecacuanha, or tartar emetic. The vomits should be repeated occasionally, if indicated, in every stage of the disease. The bowels should be opened by means of calomel, manna, castor oil, or magnesia. I have generally found rhubarb improper for this purpose, while the stomach was in a very irritable state. In those cases, where there is reason to believe that the offending contents of the primæ viæ have been discharged by nature (which is often the case), the emetics and purges should by no means be given; but, instead of them, recourse must be had to II. Opiates. A few drops of liquid laudanum, combined in a testaceous julep, with peppermint or cinnamon-water, seldom fail of composing the stomach and bowels. In some instances, this medicine alone subdues the disease in two or three days; but where it does not prove so successful, it produces a remission of pain, and of other distressing symptoms, in every stage of the disease. III. Demulcent and diluting drinks have an agreeable effect in this disease. Mint and mallow teas, or a tea made of blackberry roots infused in cold water, together with a decoction of the shavings of hartshorn and gum arabic with cinnamon, should all be given in their turns for this purpose. IV. Glysters made of flaxseed tea, or of mutton broth, or of starch dissolved in water, with a few drops of liquid laudanum in them, give ease, and produce other useful effects. V. Plasters of Venice treacle applied to the region of the stomach, and flannels dipped in infusions of bitter and aromatic herbs in warm spirits, or Madeira wine, and applied to the region of the abdomen, often afford considerable relief. VI. As soon as the more violent symptoms of the disease are composed, tonic and cordial medicines should be given. The bark in decoction, or in substance (where it can be retained in that form), mixed with a little nutmeg, often produces the most salutary effects. Port wine or claret mixed with water are likewise proper in this stage of the disease. After the disease has continued for some time, we often see an appetite suddenly awakened for articles of diet of a stimulating nature. I have seen many children recover from being gratified in an inclination to eat salted fish, and the different kinds of salted meat. In some instances they discover an appetite for butter, and the richest gravies of roasted meats, and eat them with obvious relief to all their symptoms. I once saw a child of sixteen months old, perfectly restored, from the lowest stage of this disease, by eating large quantities of rancid English cheese, and drinking two or three glasses of port wine every day. She would in no instance eat bread with the cheese, nor taste the wine, if it was mixed with water. We sometimes see relief given by the use of the warm bath, in cases of obstinate pain. The bath is more effectual, if warm wine is used, instead of water. I have had but few opportunities of trying the effects of cold water applied to the body in this disease; but from the benefit which attended its use in the cases in which it was prescribed, I am disposed to believe that it would do great service, could we overcome the prejudices which subsist in the minds of parents against it. After all that has been said in favour of the remedies that have been mentioned, I am sorry to add, that I have very often seen them all administered without effect. My principal dependence, therefore, for many years, has been placed upon VII. Country air. Out of many hundred children whom I have sent into the country, in every stage of this disease, I have lost but three; two of whom were sent, contrary to my advice, into that unhealthy part of the neighbourhood of Philadelphia called the _Neck_, which lies between the city and the conflux of the rivers Delaware and Schuylkill. I have seen one cure performed by this remedy, after convulsions had taken place. To derive the utmost benefit from the country air, children should be carried out on horseback, or in a carriage, every day; and they should be exposed to the open air as much as possible in fair weather, in the day time. Where the convenience of the constant benefit of country air cannot be obtained, I have seen evident advantages from taking children out of the city once or twice a day. It is extremely agreeable to see the little sufferers revive as soon as they escape from the city air, and inspire the pure air of the country. I shall conclude this inquiry, by recommending the following methods of preventing this disease, all of which have been found by experience to be useful. 1. The daily use of the cold bath. 2. A faithful and attentive accommodation of the dresses of children, to the state and changes of the air. 3. A moderate quantity of salted meat taken occasionally in those months in which this disease usually prevails. It is perhaps in part from the daily use of salted meat in diet, that the children of country people escape this disease. 4. The use of sound old wine in the summer months. From a tea-spoon-full, to half a wine glass full, according to the age of the child, may be given every day. It is remarkable, that the children of persons in easy circumstances, who sip occasionally with their parents the remains of a glass of wine after dinner, are much less subject to this disease, than the children of poor people, who are without the benefit of that article of diet. 5. Cleanliness, both with respect to the skin and clothing of children. Perhaps the neglect of this direction may be another reason why the children of the poor, are most subject to this disease. 6. The removal of children into the country before the approach of warm weather. This advice is peculiarly necessary during the whole period of dentition. I have never known but one instance of a child being affected by this disease, who had been carried into the country in order to avoid it. I have only to add to the above observations, that since the prevalence of the yellow fever in Philadelphia after the year 1793, the cholera infantum has assumed symptoms of such malignity, as to require bleeding to cure it. In some cases, two and three bleedings were necessary for that purpose. OBSERVATIONS ON THE _CYNANCHE TRACHEALIS_. The vulgar name of this disease in Pennsylvania is HIVES. It is a corruption of the word _heaves_, which took its rise from the manner in which the lungs heave in breathing. The worst degree of the disease is called the BOWEL HIVES, from the great motion of the abdominal muscles in respiration. It has been called suffocatio stridula by Dr. Home, and cynanche trachealis by Dr. Cullen. Professor Frank calls it trachitis, and Dr. Darwin considers it as a pleurisy of the windpipe. By the two latter names, the authors mean to convey the correct idea, that the disease is the same in its nature with the common diseases of other internal parts of the body. It is brought on by the same causes which induce fever, particularly by cold. I have seen it accompany, as well as succeed, the small-pox, measles, scarlet-fever, and apthous sore throat. In the late Dr. Foulke it succeeded acute rheumatism. The late Dr. Sayre informed me, he had seen it occur in a case of yellow fever, in the year 1798. It sometimes comes on suddenly, but it more frequently creeps on in the form of a common cold. Its symptoms are sometimes constant, but they more generally remit, particularly during the day. It attacks children of all ages, from three months to five years old. But it occasionally attacks adults. It generally runs its course in three or four days, but we now and then see it protracted in a chronic and feeble form, for eight and ten days. Dissections show the following appearances in the trachea. 1. A slight degree of inflammation. 2. A thick matter resembling mucus. 3. A membrane similar to that which succeeds inflammation in the pleura and bowels, formed from the coagulating lymph of the blood. 4. In some cases the trachea exhibits no marks of disease of any kind. These cases are generally violent, and terminate suddenly. The morbid excitement here transcends inflammation. Similar instances of the absence of the common signs of disease after death, occur in other parts of the body. Where the cynanche trachealis has appeared in the high grade which has been last mentioned, it has been called spasmodic. Where the serous vessels of the trachea have been tinged with red blood, it has been considered as inflammatory. Where a liquid matter has been found in the trachea, it has been called humoral; and where a membrane has been seen adhering to the trachea, it has received from Dr. Michaelis the name of angina polyposa. But all these different issues of the cynanche trachealis are the effects of a difference only in its force, or in its duration: they all depend upon one remote, and one proximate cause. In the _forming_ state of this disease, which may be easily known by a hoarseness, and a slight degree of stertorous cough, a puke of antimonial wine, tartar emetic, ipecacuanha, or oxymel of squills, is for the most part an immediate cure. To be effectual, it should operate four or five times. Happily children are seldom injured by a little excess in the operation of this class of medicines. I have prevented the formation of this disease many hundred times, and frequently in my own family, by means of this remedy. After the disease is completely formed, and appears with the usual symptoms described by authors, the remedies should be 1. Blood-letting. The late Dr. Bailie of New-York used to bleed until fainting was induced. His practice has been followed by Dr. Dick of Alexandria, and with great success. I have generally preferred small, but frequent, to copious bleedings. I once drew twelve ounces of blood, at four bleedings, in one day, from a son of Mr. John Carrol, then in the fourth year of his age. Dr. Physick bled a child, of but three months old, three times in one day. Life was saved in both these cases. Powerful as the lancet is, in this disease, its violence and danger require that it should be aided by 2. Vomits. These should be given every day, or oftener, during the continuance of the disease. Their good effects are much more obvious and certain in a disease of the trachea, than of the lungs, and hence their greater utility, as I shall say hereafter, in a consumption from a catarrh, than from any other of its causes. 3. Purges. These should consist of calomel and jalap, or rhubarb, and should always follow the use of emetics, if they fail of opening the bowels. 4. Calomel should likewise be given in large doses. Dr. Physick gave half a drachm of this medicine, in one day, to the infant whose case has been mentioned. I have never known it excite a salivation when given to children whose ages rendered them subjects of it, probably because it has been given in such large quantities as to pass rapidly through the bowels. Its good effects seem to depend upon its exciting a counter-action in the whole intestinal canal, and thereby lessening the disposition of the tracheal blood-vessels to discharge the mucus, or form the membrane, which have been described. 5. Blisters should be applied to the throat, breast, neck, and even to the limbs. 6. Dr. Archer of Maryland commends, in high terms, the use of polygola, or Seneka snake-root, in this disease. I can say nothing in favour of its exclusive use, from my own experience, having never given it, but as an auxiliary to other remedies. 7. I have seen great relief given by the use of the warm bath, especially when it has been followed by a gentle perspiration. 8. Towards the close of the disease, after the symptoms of great morbid action begin to decline, a few drops of liquid laudanum, by quieting the cough which generally succeeds it, often produce the most salutary effects. They should be given in flaxseed, or bran, or onion tea, of which drinks the patient should drink freely in every stage of the disease. The cynanche trachealis is attended with most danger, when the patient labours under a _constant_ and audible stertorous breathing. The danger is less, when a dry stertorous cough attends, with _easy_ respiration in its intervals. The danger is nearly over, when the cough, though stertorous, is _loose_, and accompanied with a _discharge_ of mucus from the trachea. An eruption of little red blotches, which frequently appears and disappears two or three times in the course of this disease, is always a favourable symptom. I once attended a man from Virginia, of the name of Bampfield, who, after an attack of this disease, was much distressed with the stertorous breathing and cough which belong to it. I suspected both to arise from a membrane formed by inflammation in his trachea. This membrane I supposed to be in part detached from the trachea, from the rattling noise which attended his breathing. He had used many remedies for it to no purpose. I advised a salivation, which in less than three weeks perfectly cured him. Since the general adoption of the remedies which have been enumerated, for the cynanche trachealis, instances of its mortality have become very uncommon in the city of Philadelphia. AN ACCOUNT OF THE EFFICACY OF BLISTERS AND BLEEDING, IN THE CURE OF OBSTINATE _Intermitting Fevers_. The efficacy of these remedies will probably be disputed by every regular-bred physician, who has not been a witness of their utility in the above disease; but it becomes such physicians, before they decide upon this subject, to remember, that many things are true in medicine, as well as in other branches of philosophy, which are very improbable. In all those cases of _autumnal_ intermittents, whether quotidian, tertian, or quartan, in which the bark did not succeed after three or four days trial, I have seldom found it fail after the application of blisters to the wrists. But in those cases where blisters had been neglected, or applied without effect, and where the disease had been protracted into the _winter_ months, I have generally cured it by means of one or two moderate bleedings. The pulse in those cases is generally full, and sometimes a little hard, and the blood when drawn for the most part appears sizy. The bark is seldom necessary to prevent the return of the disease. It is always ineffectual, where blood-letting is indicated. I have known several instances where pounds of that medicine have been taken without effect, in which the loss of ten or twelve ounces of blood has immediately cured the disease. I once intended to have added to this account of the efficacy of blisters and bleeding in curing obstinate intermittents, testimonies from a number of medical gentlemen, of the success with which they have used them; but these vouchers have become so numerous, that they would swell this essay far beyond the limits I wish to prescribe to it. AN ACCOUNT OF THE DISEASE OCCASIONED BY _DRINKING COLD WATER_ IN WARM WEATHER, AND THE METHOD OF CURING IT. Few summers elapse in Philadelphia, in which there are not instances of many persons being diseased by drinking cold water. In some seasons, four or five persons have died suddenly from this cause, in one day. This mortality falls chiefly upon the labouring part of the community, who seek to allay their thirst by drinking the water from the pumps in the streets, and who are too impatient, or too ignorant, to use the necessary precautions for preventing its morbid or deadly effects upon them. These accidents seldom happen, except when the mercury rises above 85° in Fahrenheit's thermometer. Three circumstances generally concur to produce disease or death, from drinking cold water. 1. The patient is extremely warm. 2. The water is extremely cold. And 3. A large quantity of it is suddenly taken into the body. The danger from drinking the cold water is always in proportion to the degrees of combination which occur in the three circumstances that have been mentioned. The following symptoms generally follow, where cold water has been taken, under the above circumstances, into the body: In a few minutes after the patient has swallowed the water, he is affected by a dimness of sight; he staggers in attempting to walk, and, unless supported, falls to the ground; he breathes with difficulty; a rattling is heard in his throat; his nostrils and cheeks expand and contract in every act of respiration; his face appears suffused with blood, and of a livid colour; his extremities become cold, and his pulse imperceptible; and, unless relief be speedily obtained, the disease terminates in death, in four or five minutes. This description includes only the less common cases of the effects of drinking a _large_ quantity of _cold_ water, when the body is _preternaturally_ heated. More frequently, patients are seized with acute spasms in the breast and stomach. These spasms are so painful as to produce syncope, and even asphyxia. They are sometimes of the tonic, but more frequently of the clonic kind. In the intervals of the spasms, the patient appears to be perfectly well. The intervals between each spasm become longer or shorter, according as the disease tends to life or death. It may not be improper to take notice, that punch, beer, and even toddy, when drunken under the same circumstances as cold water, have all been known to produce the same morbid and fatal effects. I know of but one certain remedy for this disease, and that is LIQUID LAUDANUM. The doses of it, as in other cases of spasm, should be proportioned to the violence of the disease. From a tea-spoonful to near a table-spoonful have been given in some instances, before relief has been obtained. Where the powers of life appear to be suddenly suspended, the same remedies should be used, which have been so successfully employed in recovering persons supposed to be dead from drowning. Care should be taken in every case of disease, or apparent death, from drinking cold water, to prevent the patient's suffering from being surrounded, or even attended by too many people. Persons who have been recovered from the immediate danger which attends this disease, are sometimes affected after it, by inflammations and obstructions in the breast or liver. These generally yield to the usual remedies which are administered in those complaints, when they arise from other causes. If neither the voice of reason, nor the fatal examples of those who have perished from this cause, are sufficient to produce restraint in drinking a _large_ quantity of _cold_ liquors, when the body is _preternaturally_ heated, then let me advise to 1. Grasp the vessel out of which you are about to drink for a minute or longer, with both your hands. This will abstract a portion of heat from the body, and impart it at the same time to the cold liquor, provided the vessel be made of metal, glass, or earth; for heat follows the same laws, in many instances, in passing through bodies, with regard to its relative velocity, which we observe to take place in electricity. 2. If you are not furnished with a cup, and are obliged to drink by bringing your mouth in contact with the stream which issues from a pump, or a spring, always wash your hands and face, previously to your drinking, with a little of the cold water. By receiving the shock of the water first upon those parts of the body, a portion of its heat is conveyed away, and the vital parts are thereby defended from the action of the cold. By the use of these preventives, inculcated by advertisements pasted upon pumps by the Humane Society, death from drinking cold water has become a rare occurrence for many years past in Philadelphia. AN ACCOUNT OF THE _EFFICACY OF COMMON SALT_, IN THE CURE OF HÆMOPTYSIS. From the present established opinions and practice respecting the cause and cure of hæmoptysis, the last medicine that would occur to a regular-bred physician for the cure of it, is COMMON SALT; and yet I have seen and heard of a great number of cases, in which it has been administered with success. The mode of giving it is to pour down from a tea to a table-spoonful of clean fine salt, as soon as possible after the hæmorrhage begins from the lungs. This quantity generally stops it; but the dose must be repeated daily for three or four days, to prevent a return of the disease. If the bleeding continue, the salt must be continued till it is checked, but in larger doses. I have heard of several instances in which two table spoons-full were taken at one time for several days. It sometimes excites a sickness at the stomach, and never fails to produce a burning sensation in the throat, in its passage into the stomach, and considerable thirst afterwards. I have found this remedy to succeed equally well in hæmorrhages, whether they occurred in young or in old people, or with a weak or active pulse. I had prescribed it for several years before I could satisfy myself with a theory, to account for its extraordinary action upon the human body. My inquiries led me to attend more particularly to the following facts: 1. Those persons who have been early instructed in vocal music, and who use their vocal organs moderately through life, are seldom affected by a hæmorrhage from the lungs. 2. Lawyers, players, public cryers, and city watchmen, all of whom exercise their lungs either by long or loud speaking, are less affected by this disease, than persons of other occupations. I acknowledge I cannot extend this observation to the public teachers of religion. I have known several instances of their being affected by hæmoptysis; but never but one in which the disease came on in the pulpit, and that was in a person who had been recently cured of it. The cases which I have seen, have generally been brought on by catarrhs. To this disease, the practice of some of our American preachers disposes them in a peculiar manner; for it is very common with this class of them, to expose themselves to the cold or evening air, immediately after taking what a celebrated and eloquent preacher used to call a _pulpit sweat_. 3. This hæmorrhage chiefly occurs in debilitated habits, or in persons afflicted by such a predisposition to consumption, as indicates a weak and relaxed state of the lungs. 4. It generally occurs when the lungs are in a passive state; as in sitting, walking, and more frequently in lying. Many of the cases that I have known, have occurred during _sleep_, in the middle of the night. From these facts, is it not probable that the common salt, by acting primarily and with great force upon the throat, extends its stimulus to the bleeding vessel, and by giving it a tone, checks the further effusion of blood? I shall only add to this conjecture the following observations: 1. I have never known the common salt perform a cure, where the hæmorrhage from the lungs has been a symptom of a confirmed consumption. But even in this case it gives a certain temporary relief. 2. The exhibition of common salt in the hæmoptysis, should by no means supersede the use of occasional bleeding when indicated by plethora, nor of that diet which the state of the pulse, or of the stomach, may require. 3. I have given the common salt in one case with success, in a hæmorrhage from the stomach, accompanied by a vomiting; and have heard of several cases in which it has been supposed to have checked a discharge of blood from the nose and uterus, but I can say nothing further in its favour in these last hæmorrhages, from my own experience. It may perhaps serve to lessen the prejudices of physicians against adopting improvements in medicine, that are not recommended by the authority of colleges or universities, to add, that we are indebted to an old woman, for the discovery of the efficacy of common salt in the cure of hæmoptysis. THOUGHTS UPON THE CAUSE AND CURE OF THE _PULMONARY CONSUMPTION_. The ancient Jews used to say, that a man does not fulfil his duties in life, who passes through it, without building a house, planting a tree, and leaving a child behind him. A physician, in like manner, should consider his obligations to his profession and society as undischarged, who has not attempted to lessen the number of incurable diseases. This is my apology for presuming to make the consumption the object of a medical inquiry. Perhaps I may suggest an idea, or fact, that may awaken the ideas and facts which now lie useless in the memories or common-place books of other physicians; or I may direct their attention to some useful experiments upon this subject. I shall begin my observations upon the consumption, by remarking, 1. That it is unknown among the Indians in North-America. 2. It is scarcely known by those citizens of the United States, who live in the _first_ stage of civilized life, and who have lately obtained the title of the _first settlers_. The principal occupations of the Indian consist in war, fishing, and hunting. Those of the first settler, are fishing, hunting, and the laborious employments of subduing the earth, cutting down forests, building a house and barn, and distant excursions, in all kinds of weather, to mills and courts, all of which tend to excite and preserve in the system, something like the Indian vigour of constitution. 3. It is less common in country places than in cities, and increases in both, with intemperance and sedentary modes of life. 4. Ship and house carpenters, smiths, and all those artificers whose business requires great exertions of strength in the _open_ air, in _all_ seasons of the year, are less subject to this disease, than men who work under cover, and at occupations which do not require the constant action of their limbs. 5. Women, who sit more than men, and whose work is connected with less exertion, are most subject to the consumption. From these facts it would seem, that the most probable method of curing the consumption, is to revive in the constitution, by means of exercise or labour, that vigour which belongs to the Indians, or to mankind in their first stage of civilization. The efficacy of these means of curing consumption will appear, when we inquire into the relative merit of the several remedies which have been used by physicians in this disease. I shall not produce among these remedies the numerous receipts for syrups, boluses, electuaries, decoctions, infusions, pills, medicated waters, powders, draughts, mixtures, and diet-drinks, which have so long and so steadily been used in this disease; nor shall I mention as a remedy, the best accommodated diet, submitted to with the most patient self-denial; for not one of them all, without the aid of exercise, has ever, I believe, cured a single consumption. 1. SEA-VOYAGES have cured consumptions; but it has been only when they have been so long, or so frequent, as to substitute the long continuance of gentle, to violent degrees of exercise of a shorter duration, or where they have been accompanied by some degree of the labour and care of navigating the ship. 2. A CHANGE OF CLIMATE has often been prescribed for the cure of consumptions, but I do not recollect an instance of its having succeeded, except when it has been accompanied by exercise, as in travelling, or by some active laborious pursuit. Doctor Gordon of Madeira, ascribes the inefficacy of the air of Madeira in the consumption, in part to the difficulty patients find of using exercise in carriages, or even on horseback, from the badness of the roads in that island. 3. JOURNIES have often performed cures in the consumption, but it has been chiefly when they have been long, and accompanied by difficulties which have roused and invigorated the powers of the mind and body. 4. VOMITS and NAUSEATING MEDICINES have been much celebrated for the cure of consumptions. These, by procuring a temporary determination to the surface of the body, so far lessen the pain and cough, as to enable patients to use profitable exercise. Where this has not accompanied or succeeded the exhibition of vomits, I believe they have seldom afforded any _permanent_ relief. 5. BLOOD-LETTING has often relieved consumptions; but it has been only by removing the troublesome symptoms of inflammatory diathesis, and thereby enabling the patients to use exercise, or labour, with advantage. 6. VEGETABLE BITTERS and some of the STIMULATING GUMS have in some instances afforded relief in consumptions; but they have done so only in those cases where there was great debility, accompanied by a total absence of inflammatory diathesis. They have most probably acted by their tonic qualities, as substitutes for labour and exercise. 7. A PLENTIFUL and REGULAR PERSPIRATION, excited by means of a flannel shirt, worn next to the skin, or by means of a stove-room, or by a warm climate, has in many instances _prolonged_ life in consumptive habits; but all these remedies have acted as palliatives only, and thereby have enabled the consumptive patients to enjoy the more beneficial effects of exercise. 8. BLISTERS, SETONS, and ISSUES, by determining the perspirable matter from the lungs to the surface of the body, lessen pain and cough, and thereby prepare the system for the more salutary effects of exercise. 9. The effects of SWINGING upon the pulse and respiration, leave us no room to doubt of its being a tonic remedy, and therefore a safe and agreeable substitute for exercise. From all these facts it is evident, that the remedies for consumptions must be sought for in those _exercises and employments which give the greatest vigour to the constitution_. And here I am happy in being able to produce several facts which demonstrate the safety and certainty of this method of cure. During the late war, I saw three instances of persons in confirmed consumptions, who were perfectly cured by the hardships of a military life. They had been my patients previously to their entering into the army. Besides these, I have heard of four well-attested cases of similar recoveries from nearly the same remedies. One of these was the son of a farmer in New-Jersey, who was sent to sea as the last resource for a consumption. Soon after he left the American shore, he was taken by a British cruiser, and compelled to share in all the duties and hardships of a common sailor. After serving in this capacity for twenty-two months, he made his escape, and landed at Boston, from whence he travelled on foot to his father's house (nearly four hundred miles), where he arrived in perfect health. Doctor Way of Wilmington informed me, that a certain Abner Cloud, who was reduced so low by a pulmonary consumption as to be beyond all relief from medicine, was so much relieved by sleeping in the open air, and by the usual toils of building a hut, and improving a farm, in the unsettled parts of a new country in Pennsylvania, that he thought him in a fair way of a perfect recovery. Doctor Latimer of Wilmington had been long afflicted with a cough and an occasional hæmoptysis. He entered into the American army as a surgeon, and served in that capacity till near the end of the war; during which time he was perfectly free from all pulmonary disease. The spitting of blood returned soon after he settled in private practice. To remedy this complaint, he had recourse to a low diet, but finding it ineffectual, he partook liberally of the usual diet of healthy men, and he now enjoys a perfect exemption from it. It would be very easy to add many other cases, in which labour, the employments of agriculture, and a life of hardship by sea and land, have prevented, relieved, or cured, not only the consumption, but pulmonary diseases of all kinds. To the cases that have been mentioned, I shall add only one more, which was communicated to me by the venerable Doctor Franklin, whose conversation at all times conveyed instruction, and not less in medicine than upon other subjects. In travelling, many years ago, through New-England, the doctor overtook the post-rider; and after some inquiries into the history of his life, he informed him that he was bred a shoe-maker; that his confinement, and other circumstances, had brought on a consumption, for which he was ordered by a physician to ride on horseback. Finding this mode of exercise too expensive, he made interest, upon the death of an old post-rider, to succeed to his appointment, in which he perfectly recovered his health in two years. After this he returned to his old trade, upon which his consumption returned. He again mounted his horse, and rode post in all seasons and weathers, between New-York and Connecticut river (about 140 miles), in which employment he continued upwards of thirty years, in perfect health. These facts, I hope, are sufficient to establish the advantages of restoring the original vigour of the constitution, in every attempt to effect a radical cure of consumption. But how shall these remedies be applied in the time of peace, or in a country where the want of woods, and brooks without bridges, forbid the attainment of the laborious pleasures of the Indian mode of hunting; or where the universal extent of civilization does not admit of our advising the toils of a new settlement, and improvements upon bare creation? Under these circumstances, I conceive substitutes may be obtained for each of them, nearly of equal efficacy, and attainable with much less trouble. 1. Doctor Sydenham pronounced riding on horseback, to be as certain a cure for consumptions as bark is for an intermitting fever. I have no more doubt of the truth of this assertion, than I have that inflammatory fevers are now less frequent in London than they were in the time of Doctor Sydenham. If riding on horseback in consumptions has ceased to be a remedy in Britain, the fault is in the patient, and not in the remedy. "It is a sign that the stomach requires milk (says Doctor Cadogan), when it cannot bear it." In like manner, the inability of the patient to bear this manly and wholesome exercise, serves only to demonstrate the necessity and advantages of it. I suspect the same objections to this exercise which have been made in Britain, will not occur in the United States of America; for the Americans, with respect to the symptoms and degrees of epidemic and chronic diseases, appear to be nearly in the same state that the inhabitants of England were in the seventeenth century. We find, in proportion to the decline of the vigour of the body, that many occasional causes produce fever and inflammation, which would not have done it a hundred years ago. 2. The laborious employments of agriculture, if steadily pursued, and accompanied at the same time by the simple, but wholesome diet of a farmhouse, and a hard bed, would probably afford a good substitute for the toils of a savage or military life. 3. Such occupations or professions as require constant labour or exercise in the open air, in all kinds of weather, may easily be chosen for a young man who, either from hereditary predisposition, or an accidental affection of the lungs, is in danger of falling into a consumption. In this we should imitate the advice given by some wise men, always to prefer those professions for our sons, which are the least favourable to the corrupt inclinations of their hearts. For example, where an undue passion for money, or a crafty disposition, discover themselves in early life, we are directed to oppose them by the less profitable and more disinterested professions of divinity or physic, rather than cherish them by trade, or the practice of the law. Agreeably to this analogy, weakly children should be trained to the laborious, and the robust, to the sedentary occupations. From a neglect of this practice, many hundred apprentices to taylors, shoemakers, conveyancers, watchmakers, silversmiths, and mantua-makers, perish every year by consumptions. 4. There is a case recorded by Dr. Smollet, of the efficacy of the cold bath in a consumption; and I have heard of its having been used with success, in the case of a negro man, in one of the West-India islands. To render this remedy useful, or even safe, it will be necessary to join it with labour, or to use it in degrees that shall prevent the alternation of the system with vigour and debility; for I take the cure of consumption ultimately to depend upon the simple and constant action of tonic remedies. It is to be lamented that it often requires so much time, or such remedies to remove the inflammatory diathesis, which attends the first stage of consumption, as to reduce the patient too low to make use of those tonic remedies afterwards, which would effect a radical cure. If it were possible to graduate the tone of the system by means of a scale, I would add, that to cure consumption, the system should be raised to the highest degree of this scale. Nothing short of an equilibrium of tone, or a free and vigorous action of every muscle and viscus in the body, will fully come up to a radical cure of this disease. In regulating the diet of consumptive patients, I conceive it to be as necessary to feel the pulse, as it is in determining when and in what quantity to draw blood. Where inflammatory diathesis prevails, a vegetable diet is certainly proper; but where the patient has _escaped_, or _passed_ this stage of the disease, I believe a vegetable diet alone to be injurious; and am sure a moderate quantity of animal food may be taken with advantage. The presence or absence of this inflammatory diathesis, furnishes the indications for administering or refraining from the use of the bark and balsamic medicines. With all the testimonies of their having done mischief, many of which I could produce, I have known several cases in which they have been given with obvious advantage; but it was only when there was a total absence of inflammatory diathesis. Perhaps the remedies I have recommended, and the opinions I have delivered, may derive some support from attending to the analogy of ulcers on the legs, and in other parts of the body. The first of these occur chiefly in habits debilitated by spiritous liquors, and the last frequently in habits debilitated by the scrophula. In curing these diseases, it is in vain to depend upon internal or external medicines. The whole system must be strengthened, or we do nothing; and this is to be effected only by exercise and a generous diet. In relating the facts that are contained in this inquiry, I wish I could have avoided reasoning upon them; especially as I am confident of the certainty of the facts, and somewhat doubtful of the truth of my reasonings. I shall only add, that if the cure of consumptions should at last be effected by remedies in every respect the opposites of those palliatives which are now fashionable and universal, no more will happen than what we have already seen in the tetanus, the small-pox, and the management of fractured limbs. Should this be the case, we shall not be surprised to hear of physicians, instead of prescribing any one, or all of the medicines formerly enumerated for consumptions, ordering their patients to exchange the amusements, or indolence of a city, for the toils of a country life; of their advising farmers to exchange their plentiful tables, and comfortable fire-sides, for the scanty but solid subsistence, and midnight exposure of the herdsman; or of their recommending, not so much the exercise of a _passive_ sea voyage, as the _active_ labours and dangers of a common sailor. Nor should it surprise us, after what we have seen, to hear patients relate the pleasant adventures of their excursions or labours, in quest of their recovery from this disease, any more than it does now to see a strong or well-shaped limb that has been broken; or to hear a man talk of his studies, or pleasures, during the time of his being inoculated and attended for the small-pox. I will not venture to assert, that there does not exist a medicine which shall supply, at least in some degree, the place of the labour or exercises, whose usefulness in consumptions has been established by the facts that have been mentioned. Many instances of the analogous effects of medicines, and of exercise upon the human body, forbid the supposition. If there does exist in nature such a medicine, I am disposed to believe it will be found in the class of TONICS. If this should be the case, I conceive its strength, or its dose, must far exceed the present state of our knowledge or practice, with respect to the efficacy or dose of tonic medicines. I except the disease, which arises from recent abscesses in the lungs, from the general observation which has been made, respecting the inefficacy of the remedies that were formerly enumerated for the cure of consumptions without labour or exercise. These abscesses often occur without being preceded by general debility, or accompanied by a consumptive diathesis, and are frequently cured by nature, or by very simple medicines. OBSERVATIONS UPON WORMS IN THE ALIMENTARY CANAL, AND UPON ANTHELMINTIC MEDICINES. With great diffidence I venture to lay before the public my opinions upon worms: nor should I have presumed to do it, had I not entertained a hope of thereby exciting further inquiries upon this subject. When we consider how universally worms are found in all young animals, and how frequently they exist in the human body, without producing disease of any kind, it is natural to conclude, that they serve some useful and necessary purposes in the animal economy. Do they consume the superfluous aliment which all young animals are disposed to take, before they have been taught, by experience or reason, the bad consequences which arise from it? It is no objection to this opinion, that worms are unknown in the human body in some countries. The laws of nature are diversified, and often suspended under peculiar circumstances in many cases, where the departure from uniformity is still more unaccountable, than in the present instance. Do worms produce diseases from an _excess_ in their _number_, and an _error_ in their place, in the same manner that blood, bile, and air produce diseases from an _error_ in their place, or from _excess_ in their _quantities_? Before these questions are decided, I shall mention a few facts which have been the result of my own observations upon this subject. 1. In many instances, I have seen worms discharged in the small-pox and measles, from children who were in perfect health previously to their being attacked by those diseases, and who never before discovered a single symptom of worms. I shall say nothing here of the swarms of worms which are discharged in fevers of all kinds, until I attempt to prove that an idiopathic fever is never produced by worms. 2. Nine out of ten of the cases which I have seen of worms, have been in children of the grossest habits and most vigorous constitutions. This is more especially the case where the worms are dislodged by the small-pox and measles. Doctor Capelle of Wilmington, in a letter which I received from him, informed me, that in the livers of sixteen, out of eighteen rats which he dissected, he found a number of the tænia worms. The rats were fat, and appeared in other respects to have been in perfect health. The two rats in which he found no worms, he says, "were very lean, and their livers smaller in proportion than the others." 3. In weakly children, I have often known the most powerful anthelmintics given without bringing away a single worm. If these medicines have afforded any relief, it has been by their tonic quality. From this fact, is it not probable--the conjecture, I am afraid, is too bold, but I will risk it:--is it not probable, I say, that children are sometimes disordered from the want of worms? Perhaps the tonic medicines which have been mentioned, render the bowels a more quiet and comfortable asylum for them, and thereby provide the system with the means of obviating the effects of crapulas, to which all children are disposed. It is in this way that nature, in many instances, cures evil by evil. I confine the salutary office of worms only to that species of them which is known by the name of the round worm, and which occurs most frequently in children. Is there any such disease as an idiopathic WORM-FEVER? The Indians in this country say there is not, and ascribe the discharge of worms to a fever, and not a fever to the worms[40]. [40] See the Inquiry into the Diseases of the Indians, p. 19. By adopting this opinion, I am aware that I contradict the observations of many eminent and respectable physicians. Doctor Huxham describes an epidemic pleurisy, in the month of March, in the year 1740, which he supposes was produced by his patients feeding upon some corn that had been injured by the rain the August before[41]. He likewise mentions that a number of people, and those too of the elderly sort[42], were afflicted at one time with worms, in the month of April, in the year 1743. [41] Vol. II. of his Epidemics, p. 56. [42] P. 136. Lieutade gives an account of an epidemic worm-fever from Velchius, an Italian physician[43]; and Sauvages describes, from Vandermonde, an epidemic dysentery from worms, which yielded finally only to worm medicines[44]. Sir John Pringle, and Doctor Monro, likewise frequently mention worms as accompanying the dysentery and remitting fever, and recommend the use of calomel as an antidote to them. [43] Vol. I. p. 76. [44] Vol. II. p. 329. I grant that worms appear more frequently in some epidemic diseases than in others, and oftener in some years than in others. But may not the same heat, moisture, and diet which produced the diseases, have produced the worms? And may not their discharge from the bowels have been occasioned in those epidemics, as in the small-pox and measles, by the increased heat of the body, by the want of nourishment, or by an anthelmintic quality being accidentally combined with some of the medicines that are usually given in fevers? In answer to this, we are told that we often see the crisis of a fever brought on by the discharge of worms from the bowels by means of a purge, or by an anthelmintic medicine. Whenever this is the case, I believe it is occasioned by offending bile being dislodged by means of the purge, at the same time with the worms, or by the anthelmintic medicine (if not a purge) having been given on, or near one of the usual critical days of the fever. What makes the latter supposition probable is, that worms are seldom suspected in the beginning of fevers, and anthelmintic medicines seldom given, till every other remedy has failed of success; and this generally happens about the usual time in which fevers terminate in life or death. It is very remarkable, that since the discovery and description of the hydrocephalus internus, we hear and read much less than formerly of worm-fevers. I suspect that disease of the brain has laid the foundation for the principal part of the cases of worm-fevers which are upon record in books of medicine. I grant that worms sometimes increase the danger from fevers, and often confound the diagnosis and prognosis of them, by a number of new and anomalous symptoms. But here we see nothing more than that complication of symptoms which often occurs in diseases of a very different and opposite nature. Having rejected worms as the cause of fevers, I proceed to remark, that the diseases most commonly produced by them, belong to Dr. Cullen's class of NEUROSES. And here I might add, that there is scarcely a disease, or a symptom of a disease, belonging to this class, which is not produced by worms. It would be only publishing extracts from books, to describe them. The _chronic_ and _nervous_ diseases of children, which are so numerous and frequently fatal, are, I believe, frequently occasioned by worms. There is no great danger, therefore, of doing mischief, by prescribing anthelmintic medicines in all our first attempts to cure their chronic and nervous diseases. I have been much gratified by finding myself supported in the above theory of worm-fevers, by the late Dr. William Hunter, and by Dr. Butter, in his excellent treatise upon the infantile remitting fever. I have taken great pains to find out, whether the presence of the different species of worms might not be discovered by certain peculiar symptoms; but all to no purpose. I once attended a girl of twelve years of age in a fever, who discharged four yards of a tænia, and who was so far from having discovered any peculiar symptom of this species of worms, that she had never complained of any other indisposition, than now and then a slight pain in the stomach, which often occurs in young girls from a sedentary life, or from errors in their diet. I beg leave to add further, that there is not a symptom which has been said to indicate the presence of worms of any kind, as the cause of a disease, that has not deceived me; and none oftener than the one that has been so much depended upon, viz. the picking of the nose. A discharge of worms from the bowels, is, perhaps, the only symptom that is pathognomonic of their presence in the intestines. I shall now make a few remarks upon anthelmintic remedies. But I shall first give an account of some experiments which I made in the year 1771, upon the common earth-worm, in order to ascertain the anthelmintic virtues of a variety of substances. I made choice of the earth-worm for this purpose, as it is, according to naturalists, nearly the same in its structure, manner of subsistence, and mode of propagating its species, with the round worm of the human body. In the first column I shall set down, under distinct heads, the substances in which worms were placed; and in the second and third columns the _time_ of their death, from the action of these substances upon them. I. BITTER AND ASTRINGENT | HOURS. | MINUTES. SUBSTANCES. | | | | Watery infusion of aloes | 2 | 48 ---- of rhubarb | 1 | 30 ---- of Peruvian bark | 1 | 30 | | II. PURGES. | | | | Watery infusion of jalap | 1 | -- ------ bear's-foot | 1 | 17 ------ gamboge | 1 | -- | | III. SALTS. | | | | 1. _Acids._ | | | | Vinegar | -- | 1-1/2 convulsed. Lime juice | -- | 1 Diluted nitrous acid | -- | 1-1/2 | | 2. _Alkali._ | | | | A watery solution of salt of tartar | -- | 2 convulsed, throwing | | up a mucus | | on the surface of 3. _Neutral Salts._ | | the water. | | In a watery solution of common | | salt | -- | 1 convulsed. ---- of nitre | -- | ditto. ---- of sal diuretic | -- | ditto. ---- of sal ammoniac | -- | 1-1/2 ---- of common salt and sugar. | -- | 4 | | 4. _Earthy and metallic salts._ | | | | In a watery solution of Epsom salt | -- | 15-1/2 ---- of rock alum | -- | 10 ---- of corrosive sublimate | -- | 1-1/2 convulsed. ---- of calomel | -- | 49 ---- of turpeth mineral | -- | 1 convulsed. ---- of sugar of lead | -- | 3 ---- of green vitriol | -- | 1 ---- of blue vitriol | -- | 10 ---- of white vitriol | -- | 30 IV. METALS. | | | | Filings of steel | -- | 2-1/2 Filings of tin | 1 | -- | | V. CALCAREOUS EARTH. | | | | Chalk | 2 | -- | | VI. NARCOTIC SUBSTANCES. | | | | Watery infusion of opium | -- | 11-1/2 convulsed. ---- of Carolina pink-root | -- | 33 ---- of tobacco | -- | 14 | | VII. ESSENTIAL OILS. | | | | Oil of wormwood | -- | 3 convulsed. ---- of mint | -- | 3 ---- of caraway seed | -- | 3 ---- of amber | -- | 1-1/2 ---- of anniseed | -- | 4-1/2 ---- of turpentine | -- | 6 | | VIII. ARSENIC. | | | | A watery solution of white | near | arsenic | 2 | -- | | IX. FERMENTED LIQUORS. | | | | In Madeira wine | -- | 3 convulsed. Claret | -- | 10 | | X. DISTILLED SPIRIT. | | | | Common rum | -- | 1 convulsed. | | XI. THE FRESH JUICES OF RIPE FRUITS. | | | | The juice of red cherries | -- | 5-1/2 ---- of black do. | -- | 5 ---- of red currants | -- | 2-1/2 ---- of gooseberries | -- | 3-1/2 ---- of whortleberries | -- | 12 ---- of blackberries | -- | 7 ---- of raspberries | -- | 5-1/2 ---- of plums | -- | 13 ---- of peaches | -- | 25 The juice of water-melons, no | | effect. | -- | -- | | XII. SACCHARINE SUBSTANCES. | | | | Honey | -- | 7 Molasses | -- | 7 Brown sugar | -- | 30 Manna | -- | 2-1/2 | | XIII. IN AROMATIC SUBSTANCES. | | | | Camphor | -- | 5 Pimento | -- | 3-1/2 Black pepper | -- | 45 | | XIV. FOETID SUBSTANCES | | | | Juice of onions | -- | 3-1/2 Watery infusion of assaf[oe]tida | -- | 27 ---- Santonicum, or worm seed | 1 | -- | | XV. MISCELLANEOUS SUBSTANCES. | | | | Sulphur mixed with oil | 2 | -- Æthiops mineral | 2 | -- Sulphur | 2 | -- Solution of gunpowder | -- | 1-1/2 ---- of soap | -- | 19 Oxymel of squills | -- | 3-1/2 Sweet oil | 2 | 30 In the application of these experiments to the human body, an allowance must always be made for the alteration which the several anthelmintic substances that have been mentioned, may undergo from mixture and diffusion in the stomach and bowels. In order to derive any benefit from these experiments, as well as from the observations that have been made upon anthelmintic medicines, it will be necessary to divide them into such as act, 1. Mechanically, 2. Chemically upon worms; and, 3. Into those which possess a power composed of chemical and mechanical qualities. 1. The mechanical medicines act indirectly and directly upon the worms. Those which act _indirectly_ are, vomits, purges, bitter and astringent substances, particularly aloes, rhubarb, bark, bear's-foot, and worm-seed. Sweet oil acts indirectly and very feebly upon worms. It was introduced into medicine from its efficacy in destroying the botts in horses; but the worms which infest the human bowels, are of a different nature, and possess very different organs of life from those which are found in the stomach of a horse. Those mechanical medicines which act _directly_ upon the worms, are cowhage[45] and powder of tin. The last of these medicines has been supposed to act chemically upon the worms, from the arsenic which adheres to it; but from the length of time a worm lived in a solution of white arsenic, it is probable the tin acts altogether mechanically upon them. [45] Dolichos Pruriens, of Linnæus. 2. The medicines which act chemically upon worms, appear, from our experiments, to be very numerous. Nature has wisely guarded children against the morbid effects of worms, by implanting in them an early appetite for common salt, ripe fruits, and saccharine substances; all of which appear to be among the most speedy and effectual poisons for worms. Let it not be said, that nature here counteracts her own purposes. Her conduct in this business is conformable to many of her operations in the human body, as well as throughout all her works. The bile is a necessary part of the animal fluids, and yet an appetite for ripe fruits seems to be implanted chiefly to obviate the consequences of its excess, or acrimony, in the summer and autumnal months. The use of common salt as an anthelmintic medicine, is both ancient and universal. Celsus recommends it. In Ireland it is a common practice to feed children, who are afflicted by worms, for a week or two upon a salt-sea weed, and when the bowels are well charged with it, to give a purge of wort in order to carry off the worms, after they are debilitated by the salt diet. I have administered many pounds of common salt coloured with cochineal, in doses of half a drachm, upon an empty stomach in the morning, with great success in destroying worms. Ever since I observed the effects of sugar and other sweet substances upon worms, I have recommended the liberal use of all of them in the diet of children, with the happiest effects. The sweet substances probably act in preventing the diseases from worms in the stomach only, into which they often insinuate themselves, especially in the morning. When we wish to dislodge worms from the bowels by sugar or molasses, we must give these substances in large quantities, so that they may escape in part the action of the stomach upon them. I can say nothing from my own experience of the efficacy of the mineral salts, composed of copper, iron, and zinc, combined with vitriolic acid, in destroying worms in the bowels. Nor have I ever used the corrosive sublimate in small doses as an anthelmintic. I have heard of well-attested cases of the efficacy of the oil of turpentine in destroying worms. The expressed juices of onions and of garlic are very common remedies for worms. From one of the experiments, it appears that the onion juice possesses strong anthelmintic virtues. I have often prescribed a tea-spoonful of gunpowder in the morning upon an empty stomach, with obvious advantage. The active medicine here is probably the nitre. I have found a syrup made of the bark of the Jamaica cabbage-tree[46], to be a powerful as well as a most agreeable anthelmintic medicine. It sometimes purges and vomits, but its good effects may be obtained without giving it in such doses as to produce these evacuations. [46] Geoffrea, of Linnæus. There is not a more _certain_ anthelmintic than Carolina pink-root[47]. But as there have been instances of death having followed excessive doses of it, imprudently administered, and as children are often affected by giddiness, stupor, and a redness and pain in the eyes after taking it, I acknowledge that I have generally preferred to it, less certain, but more safe medicines for destroying worms. [47] Spigelia Marylandica, of Linnæus. 3. Of the medicines whose action is compounded of mechanical and chemical qualities, calomel, jalap, and the powder of steel, are the principal. Calomel, in order to be effectual, must be given in large doses. It is a safe and powerful anthelmintic. Combined with jalap, it often brings away worms when given for other purposes. Of all the medicines that I have administered, I know of none more safe and certain than the simple preparations of iron, whether they be given in the form of steel-filings or of the rust of iron. If ever they fail of success, it is because they are given in too small doses. I generally prescribe from five to thirty grains every morning, to children between one year, and ten years old; and I have been taught by an old sea-captain, who was cured of a tænia by this medicine, to give from two drachms to half an ounce of it, every morning, for three or four days, not only with safety, but with success. I shall conclude this essay with the following remarks: 1. Where the action of medicines upon worms in the bowels does not agree exactly with their action upon the earth-worms in the experiments that have been related, it must be ascribed to the medicines being more or less altered by the action of the stomach upon them. I conceive that the superior anthelmintic qualities of pink-root, steel-filings, and calomel (all of which acted but slowly upon the earth-worms compared with many other substances) are in a great degree occasioned by their escaping the digestive powers unchanged, and acting in a concentrated state upon the worms. 2. In fevers attended with anomalous symptoms, which are supposed to arise from worms, I have constantly refused to yield to the solicitations of my patients, to abandon the indications of cure in the fever, and to pursue worms as the _principal_ cause of the disease. While I have adhered steadily to the usual remedies for the different states of fever, in all their stages, I have at the same time blended those remedies occasionally with anthelmintic medicines. In this I have imitated the practice of physicians in many other diseases, in which troublesome and dangerous symptoms are pursued, without seducing the attention from the original disease. The anthelmintic medicines prescribed in these cases, should not be the rust of iron, and common salt, which are so very useful in chronic diseases from worms, but calomel and jalap, and such other medicines as aid in the cure of fevers. AN ACCOUNT OF THE _EXTERNAL USE OF ARSENIC_, IN THE CURE OF CANCERS. A few years ago, a certain Doctor Hugh Martin, a surgeon of one of the Pennsylvania regiments stationed at Pittsburg, during the latter part of the late war, came to this city, and advertised to cure cancers with a medicine which he said he had discovered in the woods, in the neighbourhood of the garrison. As Dr. Martin had once been my pupil, I took the liberty of waiting upon him, and asked him some questions respecting his discovery. His answers were calculated to make me believe, that his medicine was of a vegetable nature, and that it was originally an Indian remedy. He showed me some of the medicine, which appeared to be the powder of a well-dried root of some kind. Anxious to see the success of this medicine in cancerous sores, I prevailed upon the doctor to admit me to see him apply it in two or three cases. I observed, in some instances, he applied a powder to the parts affected, and in others only touched them with a feather dipped in a liquid which had a white sediment, and which he made me believe was the vegetable root diffused in water. It gave me great pleasure to witness the efficacy of the doctor's applications. In several cancerous ulcers, the cures he performed were complete. Where the cancers were much connected with the lymphatic system, or accompanied with a scrophulous habit of body, his medicine always failed, and, in some instances, did evident mischief. Anxious to discover a medicine that promised relief in even a few cases of cancers, and supposing that all the caustic vegetables were nearly alike, I applied the phytolacca or poke-root, the stramonium, the arum, and one or two others, to foul ulcers, in hopes of seeing the same effects from them which I had seen from Doctor Martin's powder; but in these I was disappointed. They gave some pain, but performed no cures. At length I was furnished by a gentleman from Pittsburg with a powder which I had no doubt, from a variety of circumstances, was of the same kind as that used by Dr. Martin. I applied it to a fungous ulcer, but without producing the degrees of pain, inflammation, or discharge, which I had been accustomed to see from the application of Dr. Martin's powder. After this, I should have suspected that the powder was not a _simple_ root, had not the doctor continued upon all occasions to assure me, that it was wholly a vegetable preparation. In the beginning of the year 1784, the doctor died, and it was generally believed that his medicine had died with him. A few weeks after his death I procured, from one of his administrators, a few ounces of the doctor's powder, partly with a view of applying it to a cancerous sore which then offered, and partly with a view of examining it more minutely than I had been able to do during the doctor's life. Upon throwing the powder, which was of a brown colour, upon a piece of white paper, I perceived distinctly a number of white particles scattered through it. I suspected at first that they were corrosive sublimate, but the usual tests of that metallic salt soon convinced me, that I was mistaken. Recollecting that arsenic was the basis of most of the celebrated cancer powders that have been used in the world, I had recourse to the tests for detecting it. Upon sprinkling a small quantity of the powder upon some coals of fire, it emitted the garlick smell so perceptibly as to be known by several persons whom I called into the room where I made the experiment, and who knew nothing of the object of my inquiries. After this, with some difficulty I picked out about three or four grains of the white powder, and bound them between two pieces of copper, which I threw into the fire. After the copper pieces became red hot, I took them out of the fire, and when they had cooled, discovered an evident whiteness imparted to both of them. One of the pieces afterwards looked like dull silver. These two tests have generally been thought sufficient to distinguish the presence of arsenic in any bodies; but I made use of a third, which has lately been communicated to the world by Mr. Bergman, and which is supposed to be in all cases infallible. I infused a small quantity of the powder in a solution of a vegetable alkali in water for a few hours, and then poured it upon a solution of blue vitriol in water. The colour of the vitriol was immediately changed to a beautiful green, and afterwards precipitated. I shall close this paper with a few remarks upon this powder, and upon the cure of cancers and foul ulcers of all kinds. 1. The use of caustics in cancers and foul ulcers is very ancient, and universal. But I believe _arsenic_ to be the most efficacious of any that has ever been used. It is the basis of Plunket's and probably of Guy's well-known cancer powders. The great art of applying it successfully, is to dilute and mix it in such a manner as to mitigate the violence of its action. Doctor Martin's composition was happily calculated for this purpose. It gave less pain than the common or lunar caustic. It excited a moderate inflammation, which separated the morbid from the sound parts, and promoted a plentiful afflux of humours to the sore during its application. It seldom produced an escar; hence it insinuated itself into the deepest recesses of the cancers, and frequently separated those fibres in an unbroken state, which are generally called the roots of the cancer. Upon this account, I think, in some ulcerated cancers it is to be preferred to the knife. It has no action upon the sound skin. This Doctor Hall proved, by confining a small quantity of it upon his arm for many hours. In those cases where Doctor Martin used it to extract cancerous or schirrous tumours that were not ulcerated, I have reason to believe that he always broke the skin with Spanish flies. 2. The arsenic used by the doctor was the pure white arsenic. I should suppose from the examination I made of the powder with the eye, that the proportion of arsenic to the vegetable powder, could not be more than one-fortieth part of the whole compound. I have reason to think that the doctor employed different vegetable substances at different times. The vegetable matter with which the arsenic was combined in the powder which I used in my experiments, was probably nothing more than the powder of the root and berries of the solanum lethale, or deadly nightshade. As the principal, and perhaps the only design of the vegetable addition was to blunt the activity of the arsenic, I should suppose that the same proportion of common wheat flour as the doctor used of his caustic vegetables, would answer nearly the same purpose. In those cases where the doctor applied a feather dipped in a liquid to the sore of his patient, I have no doubt but his phial contained nothing but a weak solution of arsenic in water. This is no new method of applying arsenic to foul ulcers. Doctor Way of Wilmington has spoken in the highest terms to me of a wash for foulnesses on the skin, as well as old ulcers, prepared by boiling an ounce of white arsenic in two quarts of water to three pints, and applying it once or twice a day. 3. I mentioned, formerly, that Doctor Martin was often unsuccessful in the application of his powder. This was occasioned by his using it indiscriminately in _all_ cases. In schirrous and cancerous tumours, the knife should always be preferred to the caustic. In cancerous ulcers attended with a scrophulous or a bad habit of body, such particularly as have their seat in the neck, in the breasts of females, and in the axillary glands, it can only protract the patient's misery. Most of the cancerous sores cured by Doctor Martin were seated on the nose, or cheeks, or upon the surface or extremities of the body. It remains yet to discover a cure for cancers that taint the fluids, or infect the whole lymphatic system. This cure I apprehend must be sought for in diet, or in the long use of some internal medicine. To pronounce a disease incurable, is often to render it so. The intermitting fever, if left to itself, would probably prove frequently, and perhaps more speedily fatal than cancers. And as cancerous tumours and sores are often neglected, or treated improperly by injudicious people, from an apprehension that they are incurable (to which the frequent advice of physicians "to let them alone," has no doubt contributed), perhaps the introduction of arsenic into regular practice as a remedy for cancers, may invite to a more early application to physicians, and thereby prevent the deplorable cases that have been mentioned, which are often rendered so by delay or unskilful management. 4. It is not in cancerous sores only that Doctor Martin's powder has been found to do service. In sores of all kinds, and from a variety of causes, where they have been attended with fungous flesh or callous edges, I have used the doctor's powder with advantage. I flatter myself that I shall be excused in giving this detail of a _quack_ medicine, when we reflect that it was from the inventions and temerity of quacks, that physicians have derived some of their most active and most useful medicines. OBSERVATIONS UPON _THE TETANUS_. For a history of the different names and symptoms of this disease, I beg leave to refer the reader to practical books, particularly to Doctor Cullen's First Lines. My only design in this inquiry, is to deliver such a theory of the disease, as may lead to a new and successful use of old and common remedies for it. All the remote and predisposing causes of the tetanus act by inducing preternatural debility, and irritability in the muscular parts of the body. In many cases, the remote causes act alone, but they more frequently require the co-operation of an exciting cause. I shall briefly enumerate, without discriminating them, or pointing out when they act singly, or when in conjunction with each other. I. Wounds on different parts of the body are the most frequent causes of this disease. It was formerly supposed it was the effect only of a wound, which partially divided a tendon, or a nerve; but we now know it is often the consequence of læsions which affect the body in a superficial manner. The following is a list of such wounds and læsions as have been known to induce the disease: 1. Wounds in the soles of the feet, in the palms of the hands, and under the nails, by means of nails or splinters of wood. 2. Amputations, and fractures of limbs. 3. Gun-shot wounds. 4. Venesection. 5. The extraction of a tooth, and the insertion of new teeth. 6. The extirpation of a schirrous. 7. Castration. 8. A wound on the tongue. 9. The injury which is done to the feet by frost. 10. The injury which is sometimes done to one of the toes, by stumping it (as it is called) in walking. 11. Cutting a nail too closely. Also, 12. Cutting a corn too closely. 13. Wearing a shoe so tight as to abrade the skin of one of the toes. 14. A wound, not more than an eighth part of an inch, upon the forehead. 15. The stroke of a whip upon the arm, which only broke the skin. 16. Walking too soon upon a broken limb. 17. The sting of a wasp upon the glands penis. 18. A fish bone sticking in the throat. 19. Cutting the navel string in new-born infants. Between the time in which the body is thus wounded or injured, and the time in which the disease makes its appearance, there is an interval which extends from one day to six weeks. In the person who injured his toe by stumping it in walking, the disease appeared the next day. The trifling wound on the forehead which I have mentioned, produced both tetanus and death, the day after it was received. I have known two instances of tetanus, from running nails in the feet, which did not appear until six weeks afterwards. In most of the cases of this disease from wounds which I have seen, there was a total absence of pain and inflammation, or but very moderate degrees of them, and in some of them the wounds had entirely healed, before any of the symptoms of the disease had made their appearance. Wounds and læsions are most apt to produce tetanus, after the long continued application of heat to the body; hence its greater frequency, from these causes, in warm than in cold climates, and in warm than in cold weather, in northern countries. II. Cold applied suddenly to the body, after it has been exposed to intense heat. Of this Dr. Girdlestone mentions many instances, in his Treatise upon Spasmodic Affections in India. It was most commonly induced by sleeping upon the ground, after a warm day. Such is the dampness and unwholesome nature of the ground, in some parts of that country, that "fowls (the doctor says) put into coops at night, in the sickly season of the year, and on the same soil that the men slept, were always found dead the next morning, if the coop was not placed at a certain height above the surface of the earth[48]." It was brought on by sleeping on a damp pavement in a servant girl of Mr. Alexander Todd of Philadelphia, in the evening of a day in which the mercury in Fahrenheit's thermometer stood at 90°. Dr. Chalmers relates an instance of its having been induced by a person's sleeping without a nightcap, after shaving his head. The late Dr. Bartram informed me, that he had known a draught of cold water produce it in a man who was in a preternaturally heated state. The cold air more certainly brings on this disease, if it be applied to the body in the form of a current. The stiff neck which is sometimes felt after exposure to a stream of cool air from an open window, is a tendency to a locked jaw, or a feeble and partial tetanus. [48] Page 55. III. Worms and certain acrid matters in the alimentary canal. Morgagni relates an instance of the former, and I shall hereafter mention instances of the latter in new-born infants. IV. Certain poisonous vegetables. There are several cases upon record of its being induced by the hemlock dropwort, and the datura stramonium, or Jamestown weed of our country. V. It is sometimes a symptom of the bilious remitting and intermitting fever. It is said to occur more frequently in those states of fever in the island of Malta, than in any other part of the world. VI. It is likewise a symptom of that malignant state of fever which is brought on by the bite of a rabid animal, also of hysteria and gout. VII. The grating noise produced by cutting with a knife upon a pewter plate excited it in a servant, while he was waiting upon his master's table in London. It proved fatal in three days. VIII. The sight of food, after long fasting. IX. Drunkenness. X. Certain emotions and passions of the mind. Terror brought it on a brewer in this city. He had been previously debilitated by great labour, in warm weather. I have heard of its having been induced in a man by agitation of mind, occasioned by seeing a girl tread upon a nail. Fear excited it in a soldier who kneeled down to be shot. Upon being pardoned he was unable to rise, from a sudden attack of tetanus. Grief produced it in a case mentioned by Dr. Willan. XI. Parturition. All these remote and exciting causes act with more or less certainty and force, in proportion to the greater or less degrees of fatigue which have preceded them. It has been customary with authors to call all those cases of tetanus, which are not brought on by wounds, symptomatic. They are no more so than those which are said to be idiopathic. They all depend alike upon irritating impressions, made upon one part of the body, producing morbid excitement, or disease in another. It is immaterial, whether the impression be made upon the intestines by a worm, upon the ear by an ungrateful noise, upon the mind by a strong emotion, or upon the sole of the foot by a nail; it is alike communicated to the muscles, which, from their previous debility and irritability, are thrown into commotions by it. In yielding to the impression of irritants, they follow in their contractions the order of their predisposing debility. The muscles which move the lower jaw are affected more early, and more obstinately than any of the other external muscles of the body, only because they are more constantly in a relaxed, or idle state. The negroes in the West-Indies are more subject to this disease than white people. This has been ascribed to the greater irritability of their muscular systems, which constitutes a part of its predisposing cause. It is remarkable that their sensibility lessens with the increase of their irritability; and hence, Dr. Moseley says, they bear surgical operations much better than white people. New-born infants are often affected by this disease in the West-Indies. I have seen a few cases of it in Philadelphia. It is known by the name of the jaw-fall. Its causes are: 1. The cutting of the navel string. This is often done with a pair of dull scissors, by which means the cord is bruised. 2. The acrimony of the meconium retained in the bowels. 3. Cold air acting upon the body, after it has been heated by the air of a hot room. 4. Smoke is supposed to excite it, in the negro quarters in the West-Indies. It is unknown, Dr. Winterbottom informs us, among the native Africans in the neighbourhood of Sierra Leone. I am aware that it is ascribed by many physicians to only one of the above causes; but I see no reason why it should not be induced by more than one cause in infants, when we see it brought on by so many different causes in grown people. The tetanus is not confined to the human species. It often affects horses in the West-Indies. I have seen several cases of it in Philadelphia. The want of uniform success in the treatment of this disease, has long been a subject of regret among physicians. It may be ascribed to the use of the same remedies, without any respect to the nature of the causes which produce it, and to an undue reliance upon some one remedy, under a belief of its specific efficacy. Opium has been considered as its antidote, without recollecting that it was one only, of a numerous class of medicines, that are all alike useful in it. Tetanus, from all its causes, has nearly the same premonitory symptoms. These are a stiffness in the neck, a disposition to bend forward, in order to relieve a pain in the back, costiveness, a pain about the external region of the stomach, and a disposition to start in sleep. In this feeble state of the disease, an emetic, a strong dose of laudanum, the warm bath, or a few doses of bark, have often prevented its being completely formed. When it has arisen from a wound, dilating it if small or healed, and afterwards inflaming it, by applying to it turpentine, common salt, corrosive sublimate, or Spanish flies, have, in many hundred instances, been attended with the same salutary effects. The disease I have said is seated in the muscles, and, while they are preternaturally excited, the blood-vessels are in a state of reduced excitement. This is evident from the feebleness and slowness of the pulse. It sometimes beats, according to Dr. Lining, but forty strokes in a minute. By stimulating the wound, we not only restore the natural excitement of the blood-vessels, but we produce an inflammatory diathesis in them, which abstracts morbid excitement from the muscular system, and, by equalizing it, cures the disease. This remedy I acknowledge has not been as successfully employed in the West-Indies as in the United States, and that for an obvious reason. The blood-vessels in a warm climate refuse to assume an inflammatory action. Stimuli hurry them on suddenly to torpor or gangrene. Hence the danger and even fatal effects of blood-letting, in the fevers which affect the natives of the islands, a few hours after they are formed. But widely different is the nature of wounds, and of the tension of the blood-vessels, in the inhabitants of northern countries. While Dr. Dallas deplores the loss of 49 out of 50 affected with tetanus from wounds, in the West-India islands, I am sure I could mention many hundred instances of the disease being prevented, and a very different proportion of cures being performed, by inflaming the wounds, and exciting a counter _morbid_ action in the blood-vessels. When the disease is the effect of fever, the same remedies should be given, as are employed in the cure of that fever. I have once unlocked the jaw of a woman who was seized at the same time with a remitting fever, by an emetic, and I have heard of its being cured in a company of surveyors, in whom it was the effect of an intermittent, by large doses of bark. When it accompanies malignant fever, hysteria, or gout, the remedies for those forms of disease should be employed. Bleeding was highly useful in it in a case of yellow fever which occurred in Philadelphia in the year 1794. When it is produced by the suppression of perspiration by means of cold, the warm bath and sweating medicines have been found most useful in it. Nature has in one instance pointed out the use of this remedy, by curing the disease by a miliary eruption on the skin[49]. [49] Burserus. If it be the effect of poisonous substances taken into the stomach, or of worms in the bowels, the cure should be begun by emetics, purges, and anthelmintic medicines. Where patients are unable to swallow, from the teeth of the upper and lower jaw pressing upon each other, a tooth or two should be extracted, to open a passage for our medicines into the throat. If this be impracticable or objected to, they should be injected by way of glyster. In the locked jaw which arises from the extraction of a tooth, an instrument should be introduced to depress the jaw. This has been done by a noted English dentist in London, with success. As the habit of diseased action often continues after the removal of its causes, and as some of the remote causes of this disease are beyond the reach of medicine, such remedies should be given as are calculated, by their stimulating power, to overcome the morbid or spasmodic action of the muscles. These are: 1. OPIUM. It should be given in large and frequent doses. Dr. Streltz says he has found from one to two drachms of an alkali, taken in the course of a day, greatly to aid the action of the opium in this disease. 2. WINE. This should be given in quarts, and even gallons daily. Dr. Currie relates a case of a man in the infirmary of Liverpool, who was cured of tetanus, by drinking nearly a quarter cask of Madeira wine. Dr. Hosack speaks in high terms of it, in a letter to Dr. Duncan, and advises its being given without any other stimulating medicine. 3. ARDENT SPIRITS. A quack in New-England has lately cured tetanus, by giving ardent spirits in such quantities as to produce intoxication. Upon being asked his reason for this strange practice, he said, he had always observed the jaw to fall in drunken men, and any thing that would produce that effect, he supposed to be proper in the locked jaw. 4. The BARK has of late years been used in this disease with success. I had the pleasure of first seeing its good effects in the case of Colonel Stone, in whom a severe tetanus followed a wound in the foot, received at the battle of Germantown, in October, 1777. 5. The COLD BATH. This remedy has been revived by Dr. Wright of Jamaica, and has in many instances performed cures of this disease. In one of two cases in which I have used it with success, the patient's jaw opened in a few minutes after the affusion of a single bucket of water upon her body. The disease was occasioned by a slight injury done to one of her toes, by wearing a tight shoe. The signals for continuing the use of the cold bath, are its being followed by a slight degree of fever, and a general warmth of the skin. Where these do not occur, there is reason to believe it will do no service, or perhaps do harm. We have many proofs of the difference in the same disease, and in the operation of the same medicine, in different and opposite climates. Dr. Girdlestone has mentioned the result of the use of the cold bath in tetanus in the East-Indies, which furnishes a striking addition to the numerous facts that have been collected upon that subject. He tells us the cold bath uniformly destroyed life, in every case in which it was used. The reason is obvious. In that extremely debilitating climate, the system in tetanus was prostrated too low to re-act, under the sedative operation of the cold water. 6. The WARM BATH has often been used with success in this disease. Its temperature should be regulated by our wishes to promote sweats, or to produce excitement in the blood-vessels. In the latter case it should rise above the heat of the human body. 7. The OIL OF AMBER acts powerfully upon the muscular system. I have seen the happiest effects from the exhibition of six or eight drops of it, every two hours, in this disease. 8. A SALIVATION has been often recommended for the cure of tetanus, but unfortunately it can seldom be excited in time to do service. I once saw it complete the cure of a sailor in the Pennsylvania hospital, whose life was prolonged by the alternate use of bark and wine. The disease was brought on him by a mortification of his feet, in consequence of their being frost-bitten. 9. Dr. Girdlestone commends BLISTERS in high terms in this disease. He says he never saw it prove fatal, even where they only produced a redness on the skin. 10. I have heard of ELECTRICITY having been used with advantage in tetanus, but I can say nothing in its favour from my own experience. In order to ensure the utmost benefit from the use of the above remedies, it will be necessary for a physician always to recollect, that the disease is attended with great morbid action, and of course each of the stimulating medicines that has been mentioned should be given, 1st, in large doses; 2dly, in succession; 3dly, in rotation; and 4thly, by way of glyster, as well as by the mouth. The jaw-fall in new-born infants is, I believe, always fatal. Purging off the meconium from the bowels immediately after birth has often prevented it from one of its causes; and applying a rag wetted with spirit of turpentine to the navel-string, immediately after it is cut, Dr. Chisholm says, prevents it from another of its causes which has been mentioned. This disease, I have said, sometimes affects horses. I have twice seen it cured by applying a potential caustic to the neck under the mane, by large doses of the oil of amber, and by plunging one of them into a river, and throwing buckets of cold water upon the other. I shall conclude my observations upon the tetanus with the following queries: 1. What would be the effects of _copious_ blood-letting in this disease? There is a case upon record of its efficacy, in the Medical Journal of Paris, and I have now in my possession a letter from the late Dr. Hopkins of Connecticut, containing the history of a cure performed by it. Where tetanus is the effect of primary gout, hysteria, or fever, attended with highly inflammatory symptoms, bleeding is certainly indicated, but, in general, the disease is so completely insulated in the muscles, and the arteries are so far below their par of excitement in frequency and force, that little benefit can be expected from that remedy. The disease, in these cases, seems to call for an elevation, instead of a diminution, of the excitement of the blood-vessels. 2. What would be the effect of _extreme_ cold in this disease? Mr. John Hunter used to say, in his lectures, "Were he to be attacked by it, he would, if possible, fly to Nova-Zembla, or throw himself into an ice-house." I have no doubt of the efficacy of intense cold, in subduing the inordinate morbid actions which occur in the muscular system; but it offers so much violence to the fears and prejudices of sick people, or their friends, that it can seldom be applied in such a manner as to derive much benefit from it. Perhaps the sedative effects of cold might be obtained with less difficulty, by wrapping the body in sheets, and wetting them occasionally for an hour or two with cold water. 3. What would be the effect of exciting a strong counter-action in the stomach and bowels in this disease? Dr. Brown of Kentucky cured a tetanus by inflaming the stomach, by means of the tincture of cantharides. It has likewise been cured by a severe cholera morbus, induced by a large dose of corrosive sublimate. The stomach and bowels, and the external muscles of the body, discover strong associations in many diseases. A sick stomach is always followed by general weakness, and the dry gripes often paralyze the muscles of the arms and limbs. But further, one of the remote causes of tetanus, viz. cold air, often shows the near relationship of the muscles to the bowels, and the vicarious nature of disease in each of them. It often produces in the latter, in the West-Indies, what the French physicians call a "crampe seche," or, in other words, if I may be allowed the expression, a tetanus in the bowels. 4. A sameness has been pointed out between many of the symptoms of hydrophobia and tetanus. A similar difficulty of swallowing, and similar convulsions after it, have been remarked in both diseases. Death often takes place suddenly in tetanus, as it does in hydrophobia, without producing marks of fatal disorganization in any of the internal parts of the body. Dr. Physick supposes death in these cases to be the effect of suffocation, from a sudden spasm and closure of the glottis, and proposes to prevent it in the same manner that he has proposed to prevent death from hydrophobia, that is, by laryngotomy[50]. The prospect of success from it appears alike reasonable in both cases. [50] Medical Repository. THE RESULT OF OBSERVATIONS MADE UPON _THE DISEASES_ WHICH OCCURRED IN THE MILITARY HOSPITALS OF THE UNITED STATES, DURING THE REVOLUTIONARY WAR BETWEEN GREAT BRITAIN AND THE UNITED STATES. 1. The army when in tents, was always more sickly, than in the open air. It was likewise more healthy when it was kept in motion, than when it lay in an encampment. 2. Young men under twenty years of age, were subject to the greatest number of camp diseases. 3. The southern troops were more sickly than the northern or eastern troops. 4. The native Americans were more sickly than the natives of Europe who served in the American army. 5. Men above thirty, and five and thirty years of age, were the hardiest soldiers in the army. Perhaps the reason why the natives of Europe were more healthy than the native Americans, was, they were more advanced in life. 6. The southern troops sickened from the want of salt provisions. Their strength and spirits were restored only by means of salted meat. I once saw a private in a Virginia regiment, throw away his ration of choice fresh beef, and give a dollar for a pound of salted bacon. 7. Those officers who wore flannel shirts or waistcoats next to their skins, in general escaped fevers and diseases of all kinds. 8. The principal diseases in the hospitals were the typhus gravior and mitior of Doctor Cullen. Men who came into the hospitals with pleurisies or rheumatisms, soon lost the types of their original diseases, and suffered, or died, by the above-mentioned states of fever. 9. The typhus mitior always prevailed most, and with the worst symptoms in winter. A free air, which could only be obtained in summer, always prevented, or mitigated it. 10. In all those cases, where the contagion was received, cold seldom failed to render it active. Whenever an hospital was removed in winter, one half of the patients generally sickened on the way, or soon after their arrival at the place to which they were sent. 11. Drunken soldiers and convalescents were most subject to this fever. 12. Those patients in this fever who had large ulcers on their back or limbs, generally recovered. 13. I met with several instances of buboes, also of ulcers in the throat, as described by Doctor Donald Monro. They were mistaken by some of the junior surgeons for venereal sores, but they yielded to the common remedies of the hospital fever. 14. There were many instances of patients in this fever, who suddenly fell down dead, upon being moved, without any previous symptoms of approaching dissolution. This was more especially the case, when they arose to go to stool. 15. The contagion of this fever was frequently conveyed from the hospital to the camp, by means of blankets and clothes. 16. Those black soldiers who had been previously slaves, died in a greater proportion by this fever, or had a much slower recovery from it, than the same number of white soldiers. 17. The remedies which appeared to do most service in this disease were vomits of tartar emetic, gentle dozes of laxative salts, bark, wine, volatile salt, opium, and blisters. 18. An emetic seldom failed of checking this fever if exhibited while it was in a _forming_ state, and before the patient was confined to his bed. 19. Many causes concurred to produce, and increase this fever; such as the want of cleanliness, excessive fatigue, the ignorance or negligence of officers in providing suitable diet and accommodations for their men, the general use of linen instead of woollen clothes in the summer months, and the crowding too many patients together in one hospital, with such other inconveniences and abuses, as usually follow the union of the _purveying_ and _directing_ departments of hospitals in the _same_ persons. But there is one more cause of this fever which remains to be mentioned, and that is, the sudden assembling of a great number of persons together of different habits and manners, such as the soldiers of the American army were in the years 1776 and 1777. Doctor Blane informs us, in his observations upon the diseases of seamen, "that it sometimes happens that a ship with a long established crew shall be very _healthy_, yet if strangers are introduced among them, who are also _healthy_, sickness will be mutually produced." The history of diseases furnishes many proofs of the truth of this assertion[51]. It is very remarkable, that while the American army at Cambridge, in the year 1775, consisted only of New-Englandmen (whose habits and manners were the same) there was scarcely any sickness among them. It was not till the troops of the eastern, middle, and southern states met at New-York and Ticonderoga, in the year 1776, that the typhus became universal, and spread with such peculiar mortality in the armies of the United States. [51] "Cleanliness is founded on a natural aversion to what is unseemly and offensive in the persons of others; and there seems also to be an instinctive horror at strangers implanted in human nature for the same purpose, as is visible in young children, and uncultivated people. In the early ages of Rome, the same word signified both a stranger and an enemy." Dr. Blane, p. 225. 20. The dysentery prevailed, in the summer of 1777, in the military hospitals of New-Jersey, but with very few instances of mortality. This dysentery was frequently followed by an obstinate diarrh[oe]a, in which the warm bath was found in many cases to be an effectual remedy. 21. I saw several instances of fevers occasioned by the use of the common ointment made of the flour of sulphur and hog's lard, for the cure of the itch. The fevers were probably brought on by the exposure of the body to the cold air, in the usual method in which that ointment is applied. I have since learned, that the itch may be cured as speedily by rubbing the parts affected, two or three times, with the dry flour of sulphur, and that no inconvenience, and scarcely any smell, follow this mode of using it. 22. In gun-shot wounds of the joints, Mr. Ranby's advice of amputating the limb was followed with success. I saw two cases of death where this advice was neglected. 23. There was one instance of a soldier who lost his hearing, and another of a soldier who had been deaf who recovered his hearing, by the noise of artillery in a battle. 24. Those soldiers who were billetted in private houses, generally escaped the hospital fever, and recovered soonest from all their diseases. 25. Hospitals built of coarse logs, with _ground_ floors, with fire-places in the middle of them, and a hole in the roof, for the discharge of smoke, were found to be very conducive to the recovery of the soldiers from the hospital fever. This form of a military hospital was introduced into the army by Dr. Tilton of the state of Delaware[52]. [52] "It is proved, in innumerable instances, that sick men recover health sooner and better in sheds, huts, and barns, exposed occasionally to wind, and sometimes to rain, than in the most superb hospitals in Europe." Jackson's Remarks on the Constitution of the Medical Department of the British Army, p. 340. 26. In fevers and dysenteries, those soldiers recovered most certainly, and most speedily, who lay at the greatest distance from the walls of the hospitals. This important fact was communicated to me by the late Dr. Beardsley of Connecticut. 27. Soldiers are but little more than adult children. That officer, therefore, will best perform his duty to his men, who obliges them to take the most care of their HEALTH. 28. Hospitals are the sinks of human life in an army. They robbed the United States of more citizens than the sword. Humanity, economy, and philosophy, all concur in giving a preference to the conveniences and wholesome air of private houses; and should war continue to be the absurd and unchristian mode of deciding national disputes, it is to be hoped that the progress of science will so far mitigate one of its greatest calamities, as to produce an abolition of hospitals for acute diseases. Perhaps there are no cases of sickness in which reason and religion do not forbid the seclusion of our fellow creatures from the offices of humanity in private families, except where they labour under the calamities of madness and the venereal disease, or where they are the subjects of some of the operations of surgery. AN ACCOUNT OF THE INFLUENCE OF THE MILITARY AND POLITICAL EVENTS OF THE _AMERICAN REVOLUTION_ UPON THE HUMAN BODY. There were several circumstances peculiar to the American revolution, which should be mentioned previously to an account of the influence of the events which accompanied it, upon the human body. 1. The revolution interested every inhabitant of the country of both sexes, and of every rank and age that was capable of reflection. An indifferent, or neutral spectator of the controversy, was scarcely to be found in any of the states. 2. The scenes of war and government which it introduced, were new to the greatest part of the inhabitants of the United States, and operated with all the force of _novelty_ upon the human mind. 3. The controversy was conceived to be the most important of any that had ever engaged the attention of mankind. It was generally believed, by the friends of the revolution, that the very existence of _freedom_ upon our globe, was involved in the issue of the contest in favour of the United States. 4. The American revolution included in it the cares of government, as well as the toils and dangers of war. The American mind was, therefore, frequently occupied at the _same time_, by the difficult and complicated duties of political and military life. 5. The revolution was conducted by men who had been born _free_, and whose sense of the blessings of liberty was of course more exquisite than if they had just emerged from a state of slavery. 6. The greatest part of the soldiers in the armies of the United States had family connections and property in the country. 7. The war was carried on by the Americans against a nation, to whom they had long been tied by the numerous obligations of consanguinity, laws, religion, commerce, language, interest, and a mutual sense of national glory. The resentments of the Americans of course rose, as is usual in all disputes, in proportion to the number and force of these ancient bonds of affection and union. 8. A predilection to a limited monarchy, as an essential part of a free and safe government, and an attachment to the reigning king of Great-Britain (with a very few exceptions), were universal in every part of the United States. 9. There was at one time a sudden dissolution of civil government in _all_, and of ecclesiastical establishments in several of the states. 10. The expences of the war were supported by means of a paper currency, which was continually depreciating. From the action of each of these causes, and frequently from their combination in the same persons, effects might reasonably be expected, both upon the mind and body, which have seldom occurred; or if they have, I believe were never fully recorded in any age or country. It might afford some useful instruction, to point out the influence of the military and political events of the revolution upon the understandings, passions, and morals of the citizens of the United States; but my business in the present inquiry, is only to take notice of the influence of those events upon the human body, through the medium of the mind. I shall first mention the effects of the military, and secondly, of the political events of the revolution. The last must be considered in a two-fold view, accordingly as they affected the friends, or the enemies of the revolution. I. In treating of the effects of the military events, I shall take notice, first, of the influence of _actual_ war, and, secondly, of the influence of the military life. In the beginning of a battle, I have observed _thirst_ to be a very common sensation among both officers and soldiers. It occurred where no exercise, or action of the body, could have excited it. Many officers have informed me, that after the first onset in a battle, they felt a glow of heat, so universal as to be perceptible in both their ears. This was the case, in a particular manner, in the battle of Princeton, on the third of January, in the year 1777, on which day the weather was remarkably cold. A veteran colonel of a New-England regiment, whom I visited at Princeton, and who was wounded in the hand at the battle of Monmouth, on the 28th of June, 1778 (a day in which the mercury stood at 90° of Fahrenheit's thermometer), after describing his situation at the time he received his wound, concluded his story by remarking, that "fighting was hot work on a cold day, but much more so on a warm day." The many instances which appeared after that memorable battle, of soldiers who were found among the slain without any marks of wounds or violence upon their bodies, were probably occasioned by the heat excited in the body, by the emotions of the mind, being added to that of the atmosphere. Soldiers bore operations of every kind immediately _after_ a battle, with much more fortitude than they did at _any time_ afterwards. The effects of the military life upon the human body come next to be considered under this head. In another place[53] I have mentioned three cases of pulmonary consumption being perfectly cured by the diet and hardships of a camp life. [53] Page 204. Doctor Blane, in his valuable observations on the diseases incident to seamen, ascribes the extraordinary healthiness of the British fleet in the month of April, 1782, to the effects produced on the spirit of the soldiers and seamen, by the victory obtained over the French fleet on the 12th of that month; and relates, upon the authority of Mr. Ives, an instance in the war between Great-Britain and the combined powers of France and Spain, in 1744, in which the scurvy, as well as other diseases, were checked by the prospect of a naval engagement. The American army furnished an instance of the effects of victory upon the human mind, which may serve to establish the inferences from the facts related by Doctor Blane. The Philadelphia militia who joined the remains of General Washington's army, in December, 1776, and shared with them a few days afterwards in the capture of a large body of Hessians at Trenton, consisted of 1500 men, most of whom had been accustomed to the habits of a city life. These men slept in tents and barns, and sometimes in the open air during the usual colds of December and January; and yet there were but two instances of sickness, and only one of death, in that body of men in the course of nearly six weeks, in those winter months. This extraordinary healthiness of so great a number of men under such trying circumstances, can only be ascribed to the vigour infused into the human body by the victory of Trenton having produced insensibility to all the usual remote causes of diseases. Militia officers and soldiers, who enjoyed good health during a campaign, were often affected by fevers and other diseases, as soon as they returned to their respective homes. I knew one instance of a militia captain, who was seized with convulsions the first night he lay on a feather bed, after sleeping several months on a mattrass, or upon the ground. These affections of the body appeared to be produced only by the sudden abstraction of that tone in the system which was excited by a sense of danger, and the other invigorating objects of a military life. The NOSTALGIA of Doctor Cullen, or the _home-sickness_, was a frequent disease in the American army, more especially among the soldiers of the New-England states. But this disease was suspended by the superior action of the mind under the influence of the principles which governed common soldiers in the American army. Of this General Gates furnished me with a remarkable instance in 1776, soon after his return from the command of a large body of regular troops and militia at Ticonderoga. From the effects of the nostalgia, and the feebleness of the discipline, which was exercised over the militia, desertions were very frequent and numerous in his army, in the latter part of the campaign; and yet during the _three weeks_ in which the general expected every hour an attack to be made upon him by General Burgoyne, there was not a single desertion from his army, which consisted at that time of 10,000 men. The patience, firmness, and magnanimity with which the officers and soldiers of the American army endured the complicated evils of hunger, cold, and nakedness, can only be ascribed to an insensibility of body produced by an uncommon tone of mind excited by the love of liberty and their country. Before I proceed to the second general division of this subject, I shall take notice, that more instances of apoplexies occurred in the city of Philadelphia, in the winter of 1774-5, than had been known in former years. I should have hesitated in recording this fact, had I not found the observation supported by a fact of the same kind, and produced by a nearly similar cause, in the appendix to the practical works of Doctor Baglivi, professor of physic and anatomy at Rome. After a very wet season in the winter of 1694-5, he informs us, that "apoplexies displayed their rage; and perhaps (adds our author) that some part of this epidemic illness was owing to the universal grief and domestic care, occasioned by all Europe being engaged in a war. All commerce was disturbed, and all the avenues of peace blocked up, so that the strongest heart could scarcely bear the thoughts of it." The winter of 1774-5 was a period of uncommon anxiety among the citizens of America. Every countenance wore the marks of painful solicitude, for the event of a petition to the throne of Britain, which was to determine whether reconciliation, or a civil war, with all its terrible and distressing consequences, were to take place. The apoplectic fit, which deprived the world of the talents and virtues of Peyton Randolph, while he filled the chair of congress, in 1775, appeared to be occasioned in part by the pressure of the uncertainty of those great events upon his mind. To the name of this illustrious patriot, several others might be added, who were affected by the apoplexy in the same memorable year. At this time a difference of opinion upon the subject of the contest with Great-Britain, had scarcely taken place among the citizens of America. II. The political events of the revolution produced different effects upon the human body, through the medium of the mind, according as they acted upon the friends or enemies of the revolution. I shall first describe its effects upon the former class of citizens of the United States. Many persons, of infirm and delicate habits, were restored to perfect health, by the change of place, or occupation, to which the war exposed them. This was the case in a more especial manner with hysterical women, who were much interested in the successful issue of the contest. The same effects of a civil war upon the hysteria, were observed by Doctor Cullen in Scotland, in the years 1745 and 1746. It may perhaps help to extend our ideas of the influence of the passions upon diseases, to add, that when either love, jealousy, grief, or even devotion, wholly engross the female mind, they seldom fail, in like manner, to cure or to suspend hysterical complaints. An uncommon cheerfulness prevailed every where, among the friends of the revolution. Defeats, and even the loss of relations and property, were soon forgotten in the great objects of the war. The population in the United States was more rapid from births during the war, than it had ever been in the same number of years since the settlement of the country. I am disposed to ascribe this increase of births _chiefly_ to the quantity and extensive circulation of money, and to the facility of procuring the means of subsistence during the war, which favoured marriages among the labouring part of the people[54]. But I have sufficient documents to prove, that marriages were more fruitful than in former years, and that a considerable number of unfruitful marriages became fruitful during the war. In 1783, the year of the peace, there were several children born of parents who had lived many years together without issue. [54] Wheat, which was sold before the war for seven shillings and sixpence, was sold for several years _during_ the war for four, and in some places for two and sixpence Pennsylvania currency per bushel. Beggars of every description disappeared in the year 1776, and were seldom seen till near the close of the war. Mr. Hume informs us, in his History of England, that some old people, upon hearing the news of the restoration of Charles II, died suddenly of joy. There was a time when I doubted the truth of this assertion; but I am now disposed to believe it, from having heard of a similar effect from an agreeable political event, in the course of the American revolution. The door-keeper of congress, an aged man, died suddenly, immediately after hearing of the capture of Lord Cornwallis' army. His death was universally ascribed to a violent emotion of political joy. This species of joy appears to be one of the strongest emotions that can agitate the human mind. Perhaps the influence of that ardour in trade and speculation, which seized many of the friends of the revolution, and which was excited by the fallacious nominal amount of the paper money, should rather be considered as a disease, than as a passion. It unhinged the judgment, deposed the moral faculty, and filled the imagination, in many people, with airy and impracticable schemes of wealth and grandeur. Desultory manners, and a peculiar species of extempore conduct, were among its characteristic symptoms. It produced insensibility to cold, hunger, and danger. The trading towns, and in some instances the extremities of the United States, were frequently visited in a few hours or days by persons affected by this disease; and hence "to travel with the speed of a speculator," became a common saying in many parts of the country. This species of insanity (if I may be allowed to call it by that name) did not require the confinement of a bedlam to cure it, like the South-Sea madness described by Doctor Mead. Its remedies were the depreciation of the paper money, and the events of the peace. The political events of the revolution produced upon its enemies very different effects from those which have been mentioned. The hypochondriasis of Doctor Cullen occurred, in many instances, in persons of this description. In some of them, the terror and distress of the revolution brought on a true melancholia[55]. The causes which produced these diseases may be reduced to four heads. 1. The loss of former power or influence in government. 2. The destruction of the hierarchy of the English church in America. 3. The change in the habits of diet, and company, and manners, produced by the annihilation of just debts by means of depreciated paper money. And 4. The neglect, insults, and oppression, to which the loyalists were exposed, from individuals, and, in several instances, from the laws of some of the states. [55] Insania partialis sine dyspepsia, of Doctor Cullen. It was observed in South-Carolina, that several gentlemen who had protected their estates by swearing allegiance to the British government, died soon after the evacuation of Charleston by the British army. Their deaths were ascribed to the neglect with which they were treated by their ancient friends, who had adhered to the government of the United States. The disease was called, by the common people, the _protection fever_. From the causes which produced this hypochondriasis, I have taken the liberty of distinguishing it by the name of _revolutiana_. In some cases, this disease was rendered fatal by exile and confinement; and, in others, by those persons who were afflicted with it, seeking relief from spiritous liquors. The termination of the war by the peace in 1783, did not terminate the American revolution. The minds of the citizens of the United States were wholly unprepared for their new situation. The excess of the passion for liberty, inflamed by the successful issue of the war, produced, in many people, opinions and conduct which could not be removed by reason nor restrained by government. For a while, they threatened to render abortive the goodness of heaven to the United States, in delivering them from the evils of slavery and war. The extensive influence which these opinions had upon the understandings, passions, and morals of many of the citizens of the United States, constituted a form of insanity, which I shall take the liberty of distinguishing by the name of _anarchia_. I hope no offence will be given by the freedom of any of these remarks. An inquirer after philosophical truth should consider the passions of men in the same light that he does the laws of matter or motion. The friends and enemies of the American revolution must have been more, or less than men, if they could have sustained the magnitude and rapidity of the events that characterised it, without discovering some marks of human weakness, both in body and mind. Perhaps these weaknesses were permitted, that human nature might receive fresh honours in America, by the contending parties (whether produced by the controversies about independence or the national government) mutually forgiving each other, and uniting in plans of general order, and happiness. AN INQUIRY INTO THE RELATION OF _TASTES AND ALIMENTS_ TO EACH OTHER, AND INTO THE INFLUENCE OF THIS RELATION UPON HEALTH AND PLEASURE. In entering upon this subject, I feel like the clown, who, after several unsuccessful attempts to play upon a violin, threw it hastily from him, exclaiming at the same time, that "there was music in it," but that he could not bring it out. I shall endeavour, by a few brief remarks, to lay a foundation for more successful inquiries upon this difficult subject. Attraction and repulsion seem to be the active principles of the universe. They pervade not only the greatest, but the minutest works of nature. Salts, earths, inflammable bodies, metals, and vegetables, have all their respective relations to each other. The order of these relations is so uniform, that it has been ascribed by some philosophers to a latent principle of intelligence pervading each of them. Colours, odours, and sounds, have likewise their respective relations to each other. They become agreeable and disagreeable, only in proportion to the natural or unnatural combination which takes place between each of their different species. It is remarkable, that the number of original colours and notes in music is exactly the same. All the variety in both, proceeds from the difference of combination. An arbitrary combination of them is by no means productive of pleasure. The relation which every colour and sound bear to each other, was as immutably established at the creation, as the order of the heavenly bodies, or as the relation of the objects of chemistry to each other. But this relation is not confined to colours and sounds alone. It probably extends to the objects of human aliment. For example, bread and meat, meat and salt, the alkalescent meats and acescent vegetables, all harmonize with each other upon the tongue; while fish and flesh, butter and raw onions, fish and milk, when combined, are all offensive to a pure and healthy taste. It would be agreeable to trace the analogy of sounds and tastes. They have both their flats and their sharps. They are both improved by the contrast of discords. Thus pepper, and other condiments (which are disagreeable when taken by themselves) enhance the relish of many of our aliments, and they are both delightful in proportion as they are simple in their composition. To illustrate this analogy by more examples from music, would lead us from the subject of the present inquiry. It is observable that the tongue and the stomach, like instinct and reason, are, by nature, in unison with each other. One of those organs must always be disordered, when they disagree in a single article of aliment. When they both unite in articles of diet that were originally disagreeable, it is owing to a perversion in each of them, similar to that which takes place in the human mind, when both the moral faculty and the conscience lose their natural sensibility to virtue and vice. Unfortunately for this part of science, the taste and the stomach are so much perverted in infancy and childhood by heterogeneous aliment, that it is difficult to tell what kinds, and mixtures of food are natural, and what are artificial. It is true, the system possesses a power of accommodating itself both to artificial food, and to the most discordant mixtures of that which is natural; but may we not reasonably suppose, that the system would preserve its natural strength and order much longer, if no such violence had been offered to it? If the relation of aliments to each other follows the analogy of the objects of chemistry, then their union will be influenced by many external circumstances, such as heat and cold, dilution, concentration, rest, motion, and the addition of substances which promote unnatural, or destroy natural mixtures. This idea enlarges the field of inquiry before us, and leads us still further from facts and certainty upon this subject, but at the same time it does not preclude us from the hope of obtaining both; for every difficulty that arises out of this view of the subject, may be removed by observation and experiment. I come now to apply these remarks to health and pleasure. I shall select only a few cases for this purpose; for if my principles be true, my readers cannot avoid discovering many other illustrations of them. 1. When an article of diet is grateful to the taste, and afterwards disagrees with the stomach, may it not be occasioned by some other kind of food, or by some drink being taken into the stomach, which refuses to unite with the offending article of diet? 2. May not the uneasiness which many persons feel after a moderate meal, arise from its having consisted of articles of aliment which were not related to each other? 3. May not the delicacy of stomach which sometimes occurs after the fortieth or forty-fifth year of human life, be occasioned by nature recovering her empire in the stomach, so as to require simplicity in diet, or such articles only of aliment as are related? May not this be the reason why most people, who have passed those periods of life, are unable to retain or to digest fish and flesh at the same time, and why they generally dine only upon one kind of food? 4. Is not the language of nature in favour of simplicity in diet, discovered by the avidity with which the luxurious and intemperate often seek relief from variety and satiety, by retreating to spring water for drink, and to bread and milk for aliment? 5. May not the reason why plentiful meals of fish, venison, oysters, beef, or mutton, when eaten alone, lie so easily in the stomach, and digest so speedily, be occasioned by no other food being taken with them? A pound, and even more, of the above articles, frequently oppress the system much less than half the quantity of heterogeneous aliments. 6. Does not the facility with which a due mixture of vegetable and animal food digests in the stomach, indicate the certainty of their relation to each other? 7. May not the peculiar good effects of a diet wholly vegetable, or animal, be occasioned by the more frequent and intimate relation of the articles of the same kingdoms to each other? And may not this be the reason why so few inconveniences are felt from the mixture of a variety of vegetables in the stomach? 8. May not the numerous acute and chronic diseases of the rich and luxurious, arise from heterogeneous aliments being distributed in a _diffused_, instead of a _mixed_ state, through every part of the body? 9. May not the many cures which are ascribed to certain articles of diet, be occasioned more by their being taken alone, than to any medicinal quality inherent in them? A diet of oysters in one instance, of strawberries in another, and of sugar of roses in many instances, has cured violent and dangerous diseases of the breast[56]. Grapes, according to Doctor Moore, when eaten in large quantities, have produced the same salutary effect. A milk diet, persisted in for several years, has cured the gout and epilepsy. I have seen many cases of dyspepsia cured by a simple diet of beef and mutton, and have heard of a well-attested case of a diet of veal alone having removed the same disease. Squashes, and turnips likewise, when taken by themselves, have cured that distressing complaint in the stomach. It has been removed even by milk, when taken by itself in a moderate quantity[57]. The further the body, and more especially the stomach, recede from health, the more this simplicity of diet becomes necessary. The appetite in these cases does not speak the language of uncorrupted nature. It frequently calls for various and improper aliment; but this is the effect of intemperance having produced an early breach between the taste and the stomach. [56] Vansweiten, 1209. 3. [57] Medical Observations and Inquiries, vol. VI. p. 310, 319. Perhaps the extraordinary cures of obstinate diseases which are sometimes performed by persons not regularly educated in physic, may be occasioned by a long and steady perseverance in the use of a single article of the materia medica. Those chemical medicines which decompose each other, are not the only substances which defeat the intention of the prescriber. Galenical medicines, by combination, I believe, frequently produce effects that are of a compound and contrary nature to their original and simple qualities. This remark is capable of extensive application, but I quit it as a digression from the subject of this inquiry. 10. I wish it to be observed, that I have condemned the mixture of different aliments in the stomach only in a few cases, and under certain circumstances. It remains yet to determine by experiments, what changes are produced upon aliments by heat, dilution, addition, concentration, motion, rest, and the addition of uniting substances, before we can decide upon the relation of aliments to each other, and the influence of that relation upon health. The olla podrida of Spain is said to be a pleasant and wholesome dish. It is probably rendered so, by a previous tendency of all its ingredients to putrefaction, or by means of heat producing a new arrangement, or additional new relations of all its parts. I suspect heat to be a powerful agent in disposing heterogeneous aliments to unite with each other; and hence the mixture of aliments is probably less unhealthy in France and Spain, than in England, where so much less fire is used in preparing them, than in the former countries. As too great a mixture of glaring colours, which are related to each other, becomes painful to the eye, so too great a mixture of related aliments oppresses the stomach, and debilitates the powers of the system. The original colours of the sky, and of the surface of the globe, have ever been found the most permanently agreeable to the eye. In like manner, I am disposed to believe that there are certain simple aliments which correspond, in their sensible qualities, with the intermediate colours of _blue_ and _green_, that are most permanently agreeable to the tongue and stomach, and that every deviation from them, is a departure from the simplicity of health and nature. 11. While nature seems to have limited us to simplicity in aliment, is not this restriction abundantly compensated by the variety of tastes which she allows us to impart to it, in order to diversify and increase the pleasure of eating? It is remarkable that salt, sugar, mustard, horse-radish, capers, and spices of all kinds, according to Mr. Gosse's experiments, related by Abbé Spallanzani[58], all contribute not only to render aliments savoury, but to promote their digestion. [58] Dissertations, vol. I. p. 326. 12. When we consider, that part of the art of cookery consists in rendering the taste of aliments agreeable, is it not probable that the pleasure of eating might be increased beyond our present knowledge upon that subject, by certain new arrangements or mixtures of the substances which are used to impart a pleasant taste to our aliment? 13. Should philosophers ever stoop to this subject, may they not discover and ascertain a table of the relations of sapid bodies to each other, with the same accuracy that they have ascertained the relation of the numerous objects of chemistry to each other? 14. When the tongue and stomach agree in the same kinds of aliment, may not the increase of the pleasure of eating be accompanied with an increase of health and prolongation of life? 15. Upon the pleasure of eating, I shall add the following remarks. In order to render it truly exquisite, it is necessary that all the senses, except that of taste, should be as _quiescent_ as possible. Those persons mistake the nature of the appetite for food, who attempt to whet it by accompanying a dinner by a band of music, or by connecting the dining table, with an extensive and delightful prospect. The undue excitement of one sense, always produces weakness in another. Even conversation sometimes detracts from the pleasure of eating: hence great feeders love to eat in silence, or alone; and hence the speech of a passionate Frenchman, while dining in a talkative company, was not so improper as might be at first imagined. "Hold your tongues (said he); I cannot taste my dinner." I know a physician, who, upon the same principle, always shuts his eyes, and requests silence in a sick chamber, when he wishes to determine by the pulse the propriety of blood-letting, in cases where its indication is doubtful. His perceptions become more distinct, by confining his whole attention to the sense of feeling. It is impossible to mention the circumstance of the senses acting only in succession to each other in the enjoyment of pleasure, without being struck with the impartial goodness of Heaven, in placing the rich and the poor so much upon a level in the pleasures of the table. Could the numerous objects of pleasure, which are addressed to the ears and the eyes, have been possessed at the same time with the pleasure of eating, the rich would have commanded three times as much pleasure in that enjoyment as the poor; but this is so far from being the case, that a king has no advantage over a beggar, in eating the same kind of aliment. THE NEW METHOD OF INOCULATING FOR THE SMALL-POX. DELIVERED IN A LECTURE IN THE UNIVERSITY OF PENNSYLVANIA, ON THE 20TH OF FEBRUARY, 1781. GENTLEMEN, It must afford no small pleasure to a benevolent mind, in the midst of a war which daily makes so much havoc with the human species, to reflect that the small-pox, which once proved equally fatal to thousands, has been checked in its career, and in a great degree subdued, by the practice of INOCULATION. It is foreign to my purpose to deliver to you the history of this art, and to mark the various steps that have attended its progress to its present state of improvement. We have yet to lament the want of uniformity and of equal success in the practice of it among physicians. A great number of pamphlets have been written upon the subject without exhausting it. There is still ample room left for the man of genius to exercise his talents for observation and reasoning upon it. The facts I mean to lay before you are so inconsiderable, compared with what still remain to be known upon this subject, that I have to request, when your knowledge in it is completed, that you would bury my name in silence, and forget that ever I ventured to lay a single stone in this part of the fabric of science. In treating upon this subject, I shall I. Consider the proper subjects, and seasons for inoculation. II. I shall describe the method of communicating the disease. III. I shall consider the method of preparing the body for the small-pox. IV. I shall mention the treatment proper during the eruptive fever. And, V. Point out a few cautions that are necessary after the disease is over. I. Formerly there were great difficulties in the choice of subjects for inoculation. But experience teaches us, that it may be practised in every stage of life, and in almost every condition of the human body. In infancy, the periods before and after dentition are to be preferred. But we seldom see any great inconveniences from submitting to the general necessity of inoculating children between the ages of three months, and two years. Indeed we often see children cut three or four teeth during the preparation and eruptive fever, without the least addition being made to any of the troublesome symptoms which accompany the small-pox. There is one inconvenience attending the choice of the first months of infancy for inoculating, and that is, the matter often fails of producing the disease in such young subjects. I have frequently failed in two or three attempts to communicate it to children under four months old, with the same matter that has succeeded in a dozen other patients, inoculated at the same time. When the inoculation succeeds in such tender subjects, they generally have less fever, and fewer pustules, than are common in any future period of life. Although a physician would prefer a patient in good health to any other as a subject for inoculation, yet cases often occur in which it is necessary to communicate the small-pox while the body is affected with some other disease. I can with pleasure inform you, that the small-pox is rendered so perfectly safe by inoculation, that there are few chronic diseases which should be considered as obstacles in the way of it. I have inoculated patients labouring under a tertian fever, obstructed viscera, the hooping cough, the hypochondriasis, the asthma, the itch, and other cutaneous diseases, and even pregnant women, with the same, and, in some instances, with greater success, than persons in perfect health. Doctor Cullen informs us, that he has seen inoculation succeed in scrophulous patients. A physician in Jamaica informed me, that he had inoculated negroes with success in the worst stage of the yaws. To these facts I must add one more extraordinary than any that has been yet mentioned: Doctor Brown, my late colleague in the care of the military hospitals, informed me, that he had seen inoculation succeed in patients who were seized, after the infection was communicated, with the hospital fever. The preparation of the body should be accommodated to the disease which affects it. Some physicians have thought the small-pox, received in this way, was a remedy for other diseases; but my experience has not confirmed this opinion: on the contrary, I am inclined to think that no other change is produced by inoculation, than by the regimen and medicines that are used to prepare the body for the small-pox. Nor does the small-pox, during its continuance, afford any security against the attacks of other diseases. I have seen the most alarming complication of the small-pox and measles taken in _succession_ to each other, in the same person. The seasons commonly preferred for inoculation, in this country, are the spring and fall. It may be practised with equal safety in the winter, a due regard being had to the temperature of the air in the preparation of the body. The principal objection to inoculating in the summer months in this climate, arises from the frequency of bilious diseases at that season, to which the preparation necessary for the small-pox probably disposes the body. This caution applies more directly to children, who, at a certain age, are more subject than grown people to a disease in their bowels in warm weather. II. The methods of communicating the small-pox by inoculation, have been different in different countries, and in the different æras of its progress towards its present stage of improvement. The scab, dossel of lint, and the thread impregnated with variolous matter, and bound up in a gash in the arm, have been laid aside. We are indebted to Mr. Sutton for the mode of communicating it by a slight puncture with the point of a lancet, or needle, dipt in fresh matter. As it is difficult sometimes to procure matter in a fresh state, I have been led to use it with equal success by preserving it on lint in a box, and moistening it with cold water just before I used it. Matter may be kept in this way for a month, without losing its infectious quality, provided it be not exposed to heat or moisture. The former destroys its power of infecting as certainly as the salt of tartar destroys the acidity of vinegar. Moisture, by remaining long upon the matter, probably destroys its virulence, by subjecting it to fermentation. The longer matter has been kept in a general way, the longer the distance will be between the time of communicating the disease, and the eruptive fever. It will be proper always to yield to the prejudices of our patients in favour of matter taken from persons who have but few pustules. But I am persuaded from repeated observations, that the disease is no ways influenced by this circumstance. I am satisfied likewise that there is no difference between the effects of the matter, whether it be taken in its watery and purulent state. The puncture should not be larger than is sufficient to draw one drop of blood, but it should always be made by a _sharp_ lancet, for the sudden inflammation and suppuration, excited by a dull lancet, sometimes throw off the matter, so as to prevent its infecting the body[59]. No plaster or bandage should be applied over the puncture. It should be made in the left arm of all subjects. The objections to inoculating in the leg are too obvious to be mentioned. I have heard of the disease being communicated by rubbing the dry skin with the matter. My own observations upon this subject, give me reason to suspect the facts that are contained in books relative to this mode of infecting the body. I have bound large pieces of lint dipt in fresh matter for twenty-four hours upon the arm, without producing the disease. A practitioner of physic in New-Jersey informed me, that he once gave a considerable quantity of fresh variolous matter in a dose of physic, without infecting his patient. I suspect the matter that produces the disease is of the same nature with certain poisons, which require to be brought in contact with a wound or sore in the body, before they produce their effects. I deliver this opinion with diffidence. The subject stands in need of more experiments and investigation. [59] I am disposed to believe that the external applications which are used by the Indians for the cure of the bite of poisonous snakes act only by exciting inflammation and suppuration, which discharge the poison from the wound before it is absorbed. All their external remedies are of a _stimulating_ nature. III. I come now to consider the best method of preparing the body for the small-pox. This must be done, 1st, by DIET, and 2dly, by MEDICINE. The DIET should consist chiefly of vegetables. I have never seen any inconvenience from the free use of milk, as a part of the preparative diet. In some habits, where a morbid acid prevails in the stomach, we may indulge our patients in a little weak flesh broth two or three times a week with safety. A little salted meat may likewise be taken daily in such cases. Tea, coffee, and even weak chocolate, with biscuit or dry toast, may be used as usual, by persons accustomed to that kind of aliment. Wine and spirits of all kinds should be withheld from our patients, during the preparation. The more acescent their drinks are, the better. It is unnecessary that this change in the diet should take place till a day or two before the time of communicating the disease. The system accommodates to a vegetable and low diet in the course of three weeks or a month, so as to defeat in some measure the advantages we expected from it. The good effects of it appear to depend in a great degree upon the _suddenness_ with which we oblige our patients to conform to it. For this reason, when we are called upon to inoculate persons who have lived more than three or four weeks upon a low diet, we should always direct them to live a few days upon animal food, before we communicate the disease to them. By these means we may produce all the good effects of the _sudden_ change in the diet I have already mentioned. 2. The MEDICINES most commonly used to prepare the body for the small-pox are antimony and mercury. The latter has had the preference, and has been given in large quantities, under a notion of its being a specific antidote to the variolous matter. Many objections might be made to this opinion; I shall mention only three. 1. We often see the disease in a high degree, after the system is fully impregnated with mercury. 2. We often see the same salutary effects of mercury, when given before the disease is communicated to the body, that we perceive when it is given after inoculation; in which case we are sure the mercury cannot enter into the mixture with the variolous matter so as to destroy it. 3. If mercury acted specifically in destroying the variolous matter, it would render every other part of the preparation unnecessary: but this we know is not the case, for the neglect or improper use of the vegetable diet or cool regimen is often attended with an extraordinary number, or virulence of the small-pox, even in those cases where mercury is given in the largest quantity. The way in which mercury prepares the body for the small-pox, seems to be by promoting the several excretions, particularly that by perspiration, which, by diminishing the quantity of the fluids, and weakening the tone of the solids, renders the system less liable to a plentiful eruption of the small-pox. But I object to the use of this medicine for the following reasons: 1. It effectually deprives us of all the benefits of the cool regimen; for mercury, we know, always _disposes_ the system to take cold. 2. All the good effects of mercury may be produced by PURGES, which do not subject the body to the above-mentioned inconvenience. The PURGES may be suited to the constitutions, and in some cases, even to the inclinations of our patients. I have seen jalap, rhubarb, senna, manna, aloes, soluble tartar, glauber and Epsom salts, and the butter-nut pill, all given with equal success. The quantity should be sufficient to procure three or four stools every day. A little magnesia should always be mixed with rhubarb and jalap in preparing children. It will be sufficient for the mothers and nurses of infants to conform strictly to the vegetable diet. I have never seen any advantages from giving them even a single dose of physic. It is hardly necessary to observe, that the quality, dose, and number of purges are to be determined by the age, sex, and habits of our patients. A constitution enfeebled by a previous disease forbids the use of purges, and requires medicines of a restorative kind. Patients afflicted with cutaneous diseases bear larger and more frequent doses of physic, than are indicated in more healthy subjects. In adult subjects of a plethoric habit, blood-letting is very useful on the third or fourth day after inoculation. We are not to suppose, that every fat person labours under a plethora. A moderate degree of fat is so far from rendering the disease more violent, especially in children, that I think I have generally found such subjects have the small-pox more favourably than others. Moderate exercise in the open air should be used during the preparation. But hard labour, and every thing that promotes sweat or fatigue, as also the extremes of heat and cold, should be avoided. IV. We come now to consider the treatment of the body during the eruptive fever. On the eighth day after inoculation our patients are _generally_ seized with the common symptoms of fever. Sometimes this fever appears on the sixth and seventh day after inoculation. But when it is irregular, it is often delayed till the ninth and tenth days. I have seen many instances of it on the fourteenth, a few on the fifteenth and sixteenth, and _one_ case in which it did not come on till the eighteenth day after the infection was communicated to the body[60]. The place where the puncture was made with the lancet, or needle, generally serves as a harbinger of the approaching fever. A slight inflammation appears about it, and a pock rises up in the centre. But this remark is liable to some objections. I have seen _four_ instances in which the fever came on at the expected time, and the disease went through all its stages with the greatest regularity, and yet there was no sign of an inflammation or pock near the spot where the puncture was made: even the puncture itself became invisible. On the other hand, we sometimes see an inflammation and pock on the arm appear on the eighth and ninth days, without any fever accompanying them. Some physicians suppose that this inflammation and solitary pock are sufficient to constitute the disease; but repeated experience has taught me to be very cautious in relying upon these equivocal marks. It is true, I have sometimes seen patients secured against the small-pox, both in the natural way and by inoculation, where these marks have appeared; but I have as often seen such patients seized afterwards with the small-pox in the natural way, to the great distress of families, and mortification of physicians. Upon this account, I make it a constant practice to advise a second or third inoculation, where a fever and eruption have been wanting. As the absence of these symptoms is probably occasioned by the weakness or age of the variolous matter, or the too high state of preparation of the body, we should always guard against both, by making the puncture the second time with _fresh_ matter, by subjecting our patients to a _less_ abstemious diet, and by giving fewer doses of physic. I have heard it remarked, that if a slight redness and a small pimple appeared on the arm on the third day after inoculation, it was a sign the matter had infected the whole constitution. I acknowledge I have often seen a greater degree of redness on the third than on the second day after inoculation, but I have not been able to establish a diagnostic mark from it; for I have seen the disease produced on the usual days where the redness has appeared on the second day, and in some cases where it has not appeared until the eruptive fever. [60] Since the publication of the first edition of this lecture, I have heard of two cases, in one of which the fever did not come on till the twentieth, and in the other till the twenty-first day after the infection was communicated to the body. In some of these tedious cases, I have seen an inflammation and suppuration on the punctured part of the arm on the eighth day without any fever. Perhaps in these cases the inflammation and suppuration are only cuticular, and that the small-pox is taken from the matter which is formed by them. I am led here unwillingly to discuss the old question, Is it possible to have the small-pox in the natural way after inoculation?--In many of the cases supposed to be the small-pox from inoculation, it is probable the matter has been taken from the chicken-pox, which resembles the small-pox in many of its peculiarities, but in none more than that of leaving pits or marks on the skin. But there are certainly cases where there are the most irrefragable proofs of the infection implanted by inoculation being of a variolous nature, where the disease has been afterwards taken in the natural way. In these cases I would suppose the variolous matter produced only a topical or cuticular disease. We see something analogous to this in nurses who attend patients in the small-pox. But further, this topical or cuticular infection may be produced by art in persons who have had the small-pox in the natural way. Some years ago, I made a puncture on my left hand with a lancet moistened with variolous matter. On the eighth day an inflammation appeared on the place, accompanied by an efflorescence in the neighbourhood of it, which extended about two inches in every direction from the spot where the puncture was made. On the eleventh day I was surprised to find two pocks (if I may venture to call them such), the one on the outside of the fourth finger of my left hand, and the other on my forehead. They remained there for several days, but without filling with matter, and then dropped off, rather in the form of a soft wart, than of a common scab. Doctor Way of Wilmington repeated the same experiment upon himself, but with an issue to his curiosity more extraordinary than that I have just now related. On the eighth day after he had made a puncture on his hand, a pock appeared on the spot, which in the usual time filled with matter, from which he inoculated several children, who sickened at the usual time, and went through all the common stages and symptoms of the small-pox. It would seem from these facts, that it is necessary the small-pox should produce some impression upon the _whole_ system, in order to render it ever afterwards incapable of receiving an impression of a similar nature. A fever and an eruption therefore seem necessary for this purpose. As the inflammation of the arm on the eighth day is a sign of the _topical_ and cuticular infection, so an eruption (though ever so small) seems to be the only certain sign of the infection of the _whole_ system. The eruption is the more decisive in its report, in proportion as it comes out and goes off in the usual manner of the small-pox in the natural way. In those cases where patients have been secured against a second attack of the disease, when there have been no _obvious_ fever or _visible_ eruption, I think I have observed an unusual inflammation, and a copious and long continued discharge of matter from the arm. Perhaps this may serve as an outlet of the matter, which in other cases produces the fever and eruption. I am the more disposed to embrace this opinion, from the testimony which several authors have left us of the effects of ulcers in securing the body from the infection of the plague. The effects of issues are still more to our purpose. We observe a plentiful discharge of matter from them every time the body is exposed to cold, and the febrile effects of it upon the system are thereby frequently obviated. How far a ratio exists between the degrees of inflammation and the discharge of matter from the arm, and the degrees of fever and eruption, must be determined by future and very accurate observations. If it should appear, that there are the least inflammation and smallest discharge, where there have been the highest fever and most copious eruption; and, on the contrary, if it should appear that there are the greatest inflammation and discharge, where there have been the least fever and smallest eruption, I must beg leave to add, without attempting in this place to explain the reasons of it, that the remark, if generally true, is liable to some exceptions. But the subject is involved in darkness; I shall be satisfied if I have brought you within sight of the promised land. Your own ingenuity, like another Jewish leader, must conduct you thither. The indications in the treatment of the body during the eruptive fever are, I. To regulate the degree of fever. II. To mitigate troublesome and alarming symptoms. The fever which produces the eruption is generally of the inflammatory kind. It sometimes, therefore, comes on with the symptoms of great heat, preceded with chilliness, and determination to the head and breast, and a full hard pulse. The remedies proper in this case are, 1. Blood-letting. The quantity to be drawn must be regulated by the violence of the symptoms, the constitution, habits, and even country of the patient, and by the season of the year. I have never found more than one bleeding, to the quantity of twelve or fourteen ounces, necessary in any stage or degree of the eruptive fever of the small-pox by inoculation. 2. Cool air is of the utmost consequence in the eruptive fever. The use of this remedy in fevers marks an æra, not only in the management of the small-pox, but in medicine. The degrees of cold should always be increased in proportion to the violence of the fever. Stove-rooms, so common in this country, should be carefully avoided. The more we oblige our patients to sit up and walk in the open air, the better. Even in those cases where they languish most for the bed, they should be encouraged rather to lie upon, than _under_ the bed-clothes. Children should be stript of flannel petticoats that come in contact with their skins; and even clouts should be laid aside, if possible without great inconvenience, and at any rate they should be often removed. Great and obvious as the advantages of cold air appear to be in the eruptive fever, it has sometimes been used to an excess that has done mischief. There are few cases where a degree of cold below fifty of _Fahrenheit's_ thermometer is necessary in this stage of the small-pox. When it has been used below this, or where patients have been exposed to a damp atmosphere some degrees above it, I have heard of inflammations of an alarming nature being produced in the throat and breast. 3. The bowels, more especially of children, should be kept open with gentle laxatives. And, 4. Cool subacid drinks should be plentifully used until the eruption be completed. Sometimes the small-pox comes on with a fever the reverse of that which we have described. The heat is inconsiderable, the pulse is weak, and scarcely quicker than ordinary, and the patient complains of but slight pains in the back and head. Here the treatment should be widely different from that which has been mentioned when the fever is of the inflammatory kind. Bleeding in this case is hurtful, and even cool air must be admitted with caution. The business of the physician in this case is to excite a gentle action in the sanguiferous system, in order to produce the degree of fever which is necessary to the eruption of the pock. For this purpose he may recommend the use of warm drinks, and even of a warm bed with advantage. If the eruption delay beyond the third day, with all the circumstances of debility that have been mentioned, I have frequently ordered my patients to eat a few ounces of animal food, and to drink a glass or two of wine, with the most desirable success. The effects of this indulgence are most obvious where the weakness of the fever and the delay of the eruption in children, have made it necessary to allow it to mothers and nurses. The small-pox by inoculation so seldom comes on with the symptoms of what is called a malignant fever, that little need be said of the treatment proper in such cases. I shall only observe, that the cold regimen in the highest degree, promises more success in these cases than in any others. I have repeatedly been told, that when the small-pox appears confluent among the Africans, it is a common practice for mothers to rub their children all over with pepper, and plunge them immediately afterwards into a spring of cold water. This, they say, destroys a great part of the pock, and disposes the remainder to a kindly suppuration. From the success that has attended the use of the cold bath in malignant fevers in some parts of Europe[61], I am disposed to believe in the efficacy of the African remedy. [61] In a dissertation entitled "_Epidemia verna quæ Wratislaviam, Anno. 1737 afflixit_," published in the appendix to the Acta Nat. Curios. Vol. X. it appears, that washing the body all over with cold water in putrid fevers, attended with great debility, was attended with success at _Breslaw_ in _Silesia_. The practice has since been adopted, we are told, by several of the neighbouring countries. CULLEN'S FIRST LINES OF THE PRACTICE OF PHYSIC. The fever generally lasts three days, and the eruption continues for a similar length of time, counting the last day of the fever, as the first day of the eruption. But this remark is liable to many exceptions. We sometimes observe the eruption to begin on the first, and often on the second day of the fever; and we sometimes meet with cases in which a second eruption comes on after the fever has abated for several days, and the first eruption considerably advanced in its progress towards a complete suppuration. This is often occasioned by the application of excessive cold or heat to the body, or by a sudden and premature use of stimulating drinks, or animal food. I come now to treat of the best method of mitigating troublesome and alarming symptoms. The only _alarming_ symptom is convulsions, to which children are subject during the time of dentition. These have been less frequent, since the liberal and judicious use of cool air in the eruptive fever than formerly. They are often relieved by putting the feet in warm water. But a more effectual and speedy method of curing them, is to expose our patients suddenly to the open air. The colder the air the quicker relief it affords in these cases. To prevent the return of the fits, as well as to allay any disagreeable and troublesome startings, a few drops of laudanum should be given. They generally yield in a little while to this excellent remedy. The next symptom which demands the aid of our art, is the inflammation and sore on the arm. Poultices of all kinds should be laid aside, as tending to increase the inflammation and sore. Instead of these, the part affected should be washed three or four times a day with cold water[62]. This application is not only agreeable to our patients, but soon checks the progress of the inflammation, and disposes the sore to heal about the time the eruption is completed. The eyes should likewise be washed frequently with cold water, to secure them from pustules and inflammation. With respect to those alarming or troublesome symptoms which occur in those cases where the pocks are numerous, or confluent, they happen so seldom in inoculation, that they do not come properly under our notice in this place. They are moreover fully discussed by Doctors Boerhaave, Huxham, Hillary, and other practical writers. [62] Where the inflammation on the arm has been so considerable as not to yield immediately to the application of cold water, I have used the vegeto-mineral water with advantage. V. I come now, in the last place, to deliver a few directions that are necessary after the eruption and suppuration are over. It is well known that eruptions of an obstinate nature sometimes follow the small-pox. These I believe are often occasioned by a too _sudden_ and speedy use of animal food. To guard against these disagreeable consequences of inoculation, it is of the utmost importance to enjoin a cautious and _gradual_ return to the free use of an animal diet; and at the same time it will be necessary to give our patients a dose or two of purging physic. Thus, gentlemen, have I delivered to you a short history of the new method of inoculating for the small-pox. I am aware that prejudices are entertained against some parts of it by physicians of the most ancient name and character among us. I have witnessed the effects of the old and new methods of preparing the body upon many thousand patients, and I am satisfied, not only from my own observations, but from the experience of gentlemen upon whose judgments I rely more than upon my own, that the new method is by far the safest and most successful. Added to this, I can assure my pupils, that I have never known a single instance of a patient, prepared and treated in the manner I have described, that ever had an abscess after the small-pox, or even such an inflammation or sore upon the arm as required the application of a poultice. AN INQUIRY INTO THE _EFFECTS OF ARDENT SPIRITS_ UPON THE HUMAN BODY AND MIND. WITH AN ACCOUNT OF THE MEANS OF PREVENTING, AND OF THE _REMEDIES FOR CURING THEM_. PART I. By ardent spirits, I mean those liquors only which are obtained by distillation from fermented substances of any kind. To their effects upon the bodies and minds of men, the following inquiry shall be exclusively confined. Fermented liquors contain so little spirit, and that so intimately combined with other matters, that they can seldom be drunken in sufficient quantities to produce intoxication, and its subsequent effects, without exciting a disrelish to their taste, or pain, from their distending the stomach. They are moreover, when taken in a moderate quantity, generally innocent, and often have a friendly influence upon health and life. The effects of ardent spirits divide themselves into such as are of a prompt, and such as are of a chronic nature. The former discover themselves in drunkenness, and the latter, in a numerous train of diseases and vices of the body and mind. I. I shall begin by briefly describing their prompt, or immediate effects, in a fit of drunkenness. This odious disease (for by that name it should be called) appears with more or less of the following symptoms, and most commonly in the order in which I shall enumerate them. 1. Unusual garrulity. 2. Unusual silence. 3. Captiousness, and a disposition to quarrel. 4. Uncommon good humour, and an insipid simpering, or laugh. 5. Profane swearing, and cursing. 6. A disclosure of their own, or other people's secrets. 7. A rude disposition to tell those persons in company, whom they know, their faults. 8. Certain immodest actions. I am sorry to say, this sign of the first stage of drunkenness, sometimes appears in women, who, when sober, are uniformly remarkable for chaste and decent manners. 9. A clipping of words. 10. Fighting; a black eye, or a swelled nose, often mark this grade of drunkenness. 11. Certain extravagant acts which indicate a temporary fit of madness. These are singing, hallooing, roaring, imitating the noises of brute animals, jumping, tearing off clothes, dancing naked, breaking glasses and china, and dashing other articles of household furniture upon the ground, or floor. After a while the paroxysm of drunkenness is completely formed. The face now becomes flushed; the eyes project, and are somewhat watery; winking is less frequent than is natural; the under lip is protruded; the head inclines a little to one shoulder; the jaw falls; belchings and hiccup take place; the limbs totter; the whole body staggers. The unfortunate subject of this history next falls on his seat; he looks around him with a vacant countenance, and mutters inarticulate sounds to himself. He attempts to rise and walk; in this attempt, he falls upon his side, from which he gradually turns upon his back. He now closes his eyes, and falls into a profound sleep, frequently attended with snoring, and profuse sweats, and sometimes with such a relaxation of the muscles which confine the bladder and the lower bowels, as to produce a symptom which delicacy forbids me to mention. In this condition, he often lies from ten, twelve, and twenty-four hours, to two, three, four, and five days, an object of pity and disgust to his family and friends. His recovery from this fit of intoxication is marked with several peculiar appearances. He opens his eyes, and closes them again; he gapes and stretches his limbs; he then coughs and pukes; his voice is hoarse; he rises with difficulty, and staggers to a chair; his eyes resemble balls of fire; his hands tremble; he loathes the sight of food; he calls for a glass of spirits to compose his stomach; now and then he emits a deep-fetched sigh, or groan, from a transient twinge of conscience, but he more frequently scolds, and curses every thing around him. In this state of languor and stupidity he remains for two or three days, before he is able to resume his former habits of business and conversation. Pythagoras we are told maintained that the souls of men after death, expiated the crimes committed by them in this world, by animating certain brute animals; and that the souls of those animals in their turns, entered into men, and carried with them all their peculiar qualities and vices. This doctrine of one of the wisest and best of the Greek philosophers, was probably intended only to convey a lively idea of the changes which are induced in the body and mind of man by a fit of drunkenness. In folly, it causes him to resemble a calf; in stupidity, an ass; in roaring, a mad bull; in quarrelling, and fighting, a dog; in cruelty, a tiger; in fetor, a skunk; in filthiness, a hog; and in obscenity, a he-goat. It belongs to the history of drunkenness to remark, that its paroxysms occur, like the paroxysms of many diseases, at certain periods, and after longer or shorter intervals. They often begin with annual, and gradually increase in their frequency, until they appear in quarterly, monthly, weekly, and quotidian or daily periods. Finally they afford scarcely any marks of remission, either during the day or the night. There was a citizen of Philadelphia, many years ago, in whom drunkenness appeared in this protracted form. In speaking of him to one of his neighbours, I said, "Does he not _sometimes_ get drunk?" "You mean," said his neighbour, "is he not _sometimes_ sober?" It is further remarkable, that drunkenness resembles certain hereditary, family, and contagious diseases. I have once known it to descend from a father to four out of five of his children. I have seen three, and once four brothers who were born of sober ancestors, affected by it, and I have heard of its spreading through a whole family composed of members not originally related to each other. These facts are important, and should not be overlooked by parents, in deciding upon the matrimonial connections of their children. Let us next attend to the chronic effects of ardent spirits upon the body and mind. In the body, they dispose to every form of acute disease; they moreover _excite_ fevers in persons predisposed to them, from other causes. This has been remarked in all the yellow fevers which have visited the cities of the United States. Hard drinkers seldom escape, and rarely recover from them. The following diseases are the usual consequences of the habitual use of ardent spirits, viz. 1. A decay of appetite, sickness at stomach, and a puking of bile, or a discharge of a frothy and viscid phlegm by hawking, in the morning. 2. Obstructions of the liver. The fable of Prometheus, on whose liver a vulture was said to prey constantly, as a punishment for his stealing fire from heaven, was intended to illustrate the painful effects of ardent spirits upon that organ of the body. 3. Jaundice and dropsy of the belly and limbs, and finally of every cavity in the body. A swelling in the feet and legs is so characteristic a mark of habits of intemperance, that the merchants in Charleston, I have been told, cease to trust the planters of South-Carolina, as soon as they perceive it. They very naturally conclude industry and virtue to be extinct in that man, in whom that symptom of disease has been produced by the intemperate use of distilled spirits. 4. Hoarseness, and a husky cough, which often terminate in consumption, and sometimes in an acute and fatal disease of the lungs. 5. Diabetes, that is, a frequent and weakening discharge of pale, or sweetish urine. 6. Redness and eruptions on different parts of the body. They generally begin on the nose, and after gradually extending all over the face, sometimes descend to the limbs in the form of leprosy. They have been called "rum-buds," when they appear in the face. In persons who have occasionally survived these effects of ardent spirits on the skin, the face after a while becomes bloated, and its redness is succeeded by a death-like paleness. Thus the same fire which produces a red colour in iron, when urged to a more intense degree, produces what has been called a white heat. 7. A fetid breath, composed of every thing that is offensive in putrid animal matter. 8. Frequent and disgusting belchings. Dr. Haller relates the case of a notorious drunkard having been suddenly destroyed, in consequence of the vapour discharged from his stomach by belching, accidentally taking fire by coming in contact with the flame of a candle. 9. Epilepsy. 10. Gout, in all its various forms of swelled limbs, colic, palsy, and apoplexy. Lastly, 11. Madness. The late Dr. Waters, while he acted as house pupil and apothecary of the Pennsylvania hospital, assured me, that in one-third of the patients confined by this terrible disease, it had been induced by ardent spirits. Most of the diseases which have been enumerated are of a mortal nature. They are more certainly induced, and terminate more speedily in death, when spirits are taken in such quantities, and at such times, as to produce frequent intoxication: but it may serve to remove an error with which some intemperate people console themselves, to remark, that ardent spirits often bring on fatal diseases without producing drunkenness. I have known many persons destroyed by them, who were never completely intoxicated during the whole course of their lives. The solitary instances of longevity which are now and then met with in hard drinkers, no more disprove the deadly effects of ardent spirits, than the solitary instances of recoveries from apparent death by drowning, prove that there is no danger to life from a human body lying an hour or two under water. The body after its death, from the use of distilled spirits, exhibits by dissection certain appearances which are of a peculiar nature. The fibres of the stomach and bowels are contracted; abscesses, gangrene, and schirri are found in the viscera; the bronchial vessels are contracted; the blood-vessels and tendons, in many parts of the body, are more or less ossified; and even the hair of the head possesses a crispness which renders it less valuable to wig-makers than the hair of sober people. Not less destructive are the effects of ardent spirits upon the human mind. They impair the memory, debilitate the understanding, and pervert the moral faculties. It was probably from observing these effects of intemperance in drinking, upon the mind, that a law was formerly passed in Spain, which excluded drunkards from being witnesses in a court of justice. But the demoralizing effects of distilled spirits do not stop here. They produce not only falsehood, but fraud, theft, uncleanliness, and murder. Like the demoniac mentioned in the New Testament, their name is "legion," for they convey into the soul, a host of vices and crimes. A more affecting spectacle cannot be exhibited, than a person into whom this infernal spirit, generated by habits of intemperance, has entered. It is more or less affecting, according to the station the person fills in a family, or in society, who is possessed by it. Is he a husband? How deep the anguish which rends the bosom of his wife! Is she a wife? Who can measure the shame and aversion which she excites in her husband! Is he the father, or is she the mother of a family of children? See their averted looks from their parent, and their blushing looks at each other! Is he a magistrate? or has he been chosen to fill a high and respectable station in the councils of his country? What humiliating fears of corruption in the administration of the laws, and of the subversion of public order and happiness, appear in the countenances of all who see him! Is he a minister of the gospel? Here language fails me.----If angels weep,--it is at such a sight. In pointing out the evils produced by ardent spirits, let us not pass by their effects upon the estates of the persons who are addicted to them. Are they inhabitants of cities? Behold their houses stripped gradually of their furniture, and pawned, or sold by a constable, to pay tavern debts! See their names upon record in the dockets of every court, and whole pages of newspapers filled with advertisements of their estates for public sale! Are they inhabitants of country places? Behold their houses with shattered windows! their barns with leaky roofs! their gardens over-run with weeds! their fields with broken fences! their hogs without yokes! their sheep without wool! their cattle and horses without fat! and their children filthy, and half clad, without manners, principles, and morals! This picture of agricultural wretchedness is seldom of long duration. The farms and property thus neglected, and depreciated, are seized and sold for the benefit of a group of creditors. The children that were born with the prospect of inheriting them, are bound out to service in the neighbourhood; while their parents, the unworthy authors of their misfortunes, ramble into new and distant settlements, alternately fed on their way by the hand of charity, or a little casual labour. Thus we see poverty and misery, crimes and infamy, diseases and death, are all the natural and usual consequences of the intemperate use of ardent spirits. I have classed death among the consequences of hard drinking. But it is not death from the immediate hand of the Deity, nor from any of the instruments of it which were created by him. It is death from SUICIDE. Yes! thou poor degraded creature, who art daily lifting the poisoned bowl to thy lips, cease to avoid the unhallowed ground in which the self-murderer is interred, and wonder no longer that the sun should shine, and the rain fall, and the grass look green upon his grave. Thou art perpetrating gradually, by the use of ardent spirits, what he has effected suddenly, by opium, or a halter. Considering how many circumstances, from a sudden gust of passion, or from derangement, may palliate his guilt, or that (unlike yours) it was not preceded and accompanied by any other crime, it is probable his condemnation will be less than yours at the day of judgment. I shall now take notice of the occasions and circumstances which are supposed to render the use of ardent spirits necessary, and endeavour to show that the arguments in favour of their use in such cases are founded in error, and that, in each of them, ardent spirits, instead of affording strength to the body, increase the evils they are intended to relieve. 1. They are said to be necessary in very cold weather. This is far from being true; for the temporary warmth they produce, is always succeeded by a greater disposition in the body to be affected by cold. Warm dresses, a plentiful meal just before exposure to the cold, and eating occasionally a little gingerbread, or any other cordial food, is a much more durable method of preserving the heat of the body in cold weather. 2. They are said to be necessary in very warm weather. Experience proves that they increase instead of lessening the effects of heat upon the body, and thereby dispose to diseases of all kinds. Even in the warm climate of the West-Indies, Dr. Bell asserts this to be true. "Rum (says this author) whether used habitually, moderately, or in excessive quantities, in the West-Indies, always diminishes the strength of the body, and renders men more susceptible of disease, and unfit for any service in which vigour or activity is required[63]." As well might we throw oil into a house, the roof of which was on fire, in order to prevent the flames from extending to its inside, as pour ardent spirits into the stomach, to lessen the effects of a hot sun upon the skin. [63] Inquiry into the causes which produce, and the means of preventing diseases among British officers, soldiers, and others in the West-Indies. 3. Nor do ardent spirits lessen the effects of hard labour upon the body. Look at the horse: with every muscle of his body swelled from morning till night in the plough, or a team, does he make signs for a draught of toddy or a glass of spirits, to enable him to cleave the ground, or to climb a hill? No; he requires nothing but cool water, and substantial food. There is no nourishment in ardent spirits. The strength they produce in labour is of a transient nature, and is always followed by a sense of weakness and fatigue. But are there no conditions of the human body in which ardent spirits may be given? I answer, there are. 1st. When the body has been suddenly exhausted of its strength, and a disposition to faintness has been induced. Here a few spoonsful, or a wine-glassful of spirits, with or without water, may be administered with safety and advantage. In this case we comply strictly with the advice of Solomon, who restricts the use of "strong drink" only "to him who is ready to perish." 2dly. When the body has been exposed for a long time to wet weather, more especially if it be combined with cold. Here a moderate quantity of spirits is not only safe, but highly proper to obviate debility, and to prevent a fever. They will more certainly have those salutary effects, if the feet are at the same time bathed with them, or a half pint of them poured into the shoes or boots. These I believe are the only two cases in which distilled spirits are useful or necessary to persons in health. PART II. But it may be said, if we reject spirits from being a part of our drinks, what liquors shall we substitute in their room? I answer, in the first place, 1. SIMPLE WATER. I have known many instances of persons who have followed the most laborious employments for many years in the open air, and in warm and cold weather, who never drank any thing but water, and enjoyed uninterrupted good health. Dr. Moseley, who resided many years in the West-Indies, confirms this remark. "I aver (says the doctor), from my own knowledge and custom, as well as the custom and observations of many other people, that those who drink nothing but water, or make it their principal drink, are but little affected by the climate, and can undergo the greatest fatigue without inconvenience, and are never subject to troublesome or dangerous diseases." Persons who are unable to relish this simple beverage of nature, may drink some one, or of all the following liquors, in preference to ardent spirits. 2. CYDER. This excellent liquor contains a small quantity of spirit, but so diluted, and blunted by being combined with a large quantity of saccharine matter, and water, as to be perfectly wholesome. It sometimes disagrees with persons subject to the rheumatism, but it may be made inoffensive to such people, by extinguishing a red hot iron in it, or by mixing it with water. It is to be lamented, that the late frosts in the spring so often deprive us of the fruit which affords this liquor. The effects of these frosts have been in some measure obviated by giving an orchard a north-west exposure, so as to check too early vegetation, and by kindling two or three large fires of brush or straw, to the windward of the orchard, the evening before we expect a night of frost. This last expedient has in many instances preserved the fruit of an orchard, to the great joy and emolument of the ingenious husbandman. 3. MALT LIQUORS. The grain from which these liquors are obtained, is not liable, like the apple, to be affected by frost, and therefore they can be procured at all times, and at a moderate price. They contain a good deal of nourishment; hence we find many of the poor people in Great-Britain endure hard labour with no other food than a quart or three pints of beer, with a few pounds of bread in a day. As it will be difficult to prevent small beer from becoming sour in warm weather, an excellent substitute may be made for it by mixing bottled porter, ale, or strong beer with an equal quantity of water; or a pleasant beer may be made by adding to a bottle of porter, ten quarts of water, and a pound of brown sugar, or a pint of molasses. After they have been well mixed, pour the liquor into bottles, and place them, loosely corked, in a cool cellar. In two or three days, it will be fit for use. A spoonful of ginger added to the mixture, renders it more lively, and agreeable to the taste. 3. WINES. These fermented liquors are composed of the same ingredients as cyder, and are both cordial and nourishing. The peasants of France, who drink them in large quantities, are a sober and healthy body of people. Unlike ardent spirits, which render the temper irritable, wines generally inspire cheerfulness and good humour. It is to be lamented that the grape has not as yet been sufficiently cultivated in our country, to afford wine to our citizens; but many excellent substitutes may be made for it, from the native fruits of all the states. If two barrels of cyder fresh from the press, are boiled into one, and afterwards fermented, and kept for two or three years in a dry cellar, it affords a liquor which, according to the quality of the apple from which the cyder is made, has the taste of Malaga, or Rhenish wine. It affords when mixed with water, a most agreeable drink in summer. I have taken the liberty of calling it POMONA WINE. There is another method of making a pleasant wine from the apple, by adding four and twenty gallons of new cyder to three gallons of syrup made from the expressed juice of sweet apples. When thoroughly fermented, and kept for a few years, it becomes fit for use. The blackberry of our fields, and the raspberry and currant of our gardens, afford likewise an agreeable and wholesome wine, when pressed and mixed with certain proportions of sugar and water, and a little spirit, to counteract their disposition to an excessive fermentation. It is no objection to these cheap and home-made wines, that they are unfit for use until they are two or three years old. The foreign wines in common use in our country, require not only a much longer time to bring them to perfection, but to prevent their being disagreeable, even to the taste. 4. MOLASSES and WATER, also VINEGAR and WATER, sweetened with sugar or molasses, form an agreeable drink in warm weather. It is pleasant and cooling, and tends to keep up those gentle and uniform sweats, on which health and life often depend. Vinegar and water constituted the only drink of the soldiers of the Roman republic, and it is well known they marched and fought in a warm climate, and beneath a load of arms which weighed sixty pounds. Boaz, a wealthy farmer in Palestine, we find treated his reapers with nothing but bread dipped in vinegar. To such persons as object to the taste of vinegar, sour milk, or butter-milk, or sweet milk diluted with water, may be given in its stead. I have known the labour of the longest and hottest days in summer supported, by means of these pleasant and wholesome drinks, with great firmness, and ended, with scarcely a complaint of fatigue. 5. The SUGAR MAPLE affords a thin juice, which has long been used by the farmers in Connecticut, as a cool and refreshing drink, in the time of harvest. The settlers in the western counties of the middle states will do well to let a few of the trees which yield this pleasant juice remain in all their fields. They may prove the means, not only of saving their children and grand-children many hundred pounds, but of saving their bodies from disease and death, and their souls from misery beyond the grave. 6. COFFEE possesses agreeable and exhilarating qualities, and might be used with great advantage to obviate the painful effects of heat, cold, and fatigue upon the body. I once knew a country physician, who made it a practice to drink a pint of strong coffee previously to his taking a long or cold ride. It was more cordial to him than spirits, in any of the forms in which they are commonly used. The use of the cold bath in the morning, and of the warm bath in the evening, are happily calculated to strengthen the body in the former part of the day, and to restore it in the latter, from the languor and fatigue which are induced by heat and labour. Let it not be said, ardent spirits have become necessary from habit in harvest, and in other seasons of uncommon and arduous labour. The habit is a bad one, and may be easily broken. Let but half a dozen farmers in a neighbourhood combine to allow higher wages to their labourers than are common, and a sufficient quantity of _any_ of the pleasant and wholesome liquors I have recommended, and they may soon, by their example, abolish the practice of giving them spirits. In a little while they will be delighted with the good effects of their association. Their grain and hay will be gathered into their barns in less time, and in a better condition than formerly, and of course at a less expense, and a hundred disagreeable scenes from sickness, contention, and accidents will be avoided, all of which follow in a greater or less degree the use of ardent spirits. Nearly all diseases have their predisposing causes. The same thing may be said of the intemperate use of distilled spirits. It will, therefore, be useful to point out the different employments, situations, and conditions of the body and mind, which predispose to the love of those liquors, and to accompany them with directions to prevent persons being ignorantly and undesignedly seduced into the habitual and destructive use of them. 1. Labourers bear with great difficulty, long intervals between their meals. To enable them to support the waste of their strength, their stomachs should be constantly, but moderately stimulated by aliment, and this is best done by their eating four or five times in a day during the seasons of great bodily exertion. The food at this time should be _solid_, consisting chiefly of salted meat. The vegetables used with it, should possess some activity, or they should be made savoury by a mixture of spices. Onions and garlic are of a most cordial nature. They composed a part of the diet which enabled the Israelites to endure, in a warm climate, the heavy tasks imposed upon them by their Egyptian masters; and they were eaten, Horace and Virgil tell us, by the Roman farmers, to repair the waste of their strength, by the toils of harvest. There are likewise certain sweet substances, which support the body under the pressure of labour. The negroes in the West-Indies become strong, and even fat, by drinking the juice of the sugar cane, in the season of grinding it. The Jewish soldiers were invigorated by occasionally eating raisins and figs. A bread composed of wheat flour, molasses, and ginger (commonly called gingerbread), taken in small quantities during the day, is happily calculated to obviate the debility induced upon the body by constant labour. All these substances, whether of an animal or vegetable nature, lessen the desire, as well as the necessity, for cordial drinks, and impart equable and durable strength to every part of the system. 2. Valetudinarians, especially those who are afflicted with diseases of the stomach and bowels, are very apt to seek relief from ardent spirits. Let such people be cautious how they make use of this dangerous remedy. I have known many men and women of excellent characters and principles, who have been betrayed, by occasional doses of gin and brandy, into a love of those liquors, and have afterwards fallen sacrifices to their fatal effects. The different preparations of opium are much more safe and efficacious than distilled cordials of any kind, in flatulent or spasmodic affections of the stomach and bowels. So great is the danger of contracting a love for distilled liquors, by accustoming the stomach to their stimulus, that as few medicines as possible should be given in spiritous vehicles, in chronic diseases. A physician, of great eminence and uncommon worth, who died towards the close of the last century, in London, in taking leave of a young physician of this city, who had finished his studies under his patronage, impressed this caution with peculiar force upon him, and lamented at the same time, in pathetic terms, that he had innocently made many sots, by prescribing brandy and water in stomach complaints. It is difficult to tell how many persons have been destroyed by those physicians who have adopted Dr. Brown's indiscriminate practice in the use of stimulating remedies, the most popular of which is ardent spirits, but, it is well known, several of them have died of intemperance in this city, since the year 1790. They were probably led to it, by drinking brandy and water, to relieve themselves from the frequent attacks of debility and indisposition, to which the labours of a physician expose him, and for which rest, fasting, a gentle purge, or weak diluting drinks would have been safe and more certain cures. None of these remarks are intended to preclude the use of spirits in the low state of short, or what are called acute diseases, for, in such cases, they produce their effects too soon to create a habitual desire for them. 3. Some people, from living in countries subject to intermitting fevers, endeavour to fortify themselves against them, by taking two or three wine-glasses of bitters, made with spirits, every day. There is great danger of contracting habits of intemperance from this practice. Besides, this mode of preventing intermittents is far from being a certain one. A much better security against them, is a tea-spoonful of the jesuits bark, taken every morning during a sickly season. If this safe and excellent medicine cannot be had, a gill or half a pint of a strong watery infusion of centaury, camomile, wormwood, or rue, mixed with a little of the calamus of our meadows, may be taken every morning, with nearly the same advantage as the jesuits bark. Those persons who live in a sickly country, and cannot procure any of the preventives of autumnal fevers which have been mentioned, should avoid the morning and evening air; should kindle fires in their houses, on damp days, and in cool evenings, throughout the whole summer; and put on winter clothes, about the first week in September. The last part of these directions applies only to the inhabitants of the middle states. 4. Men who follow professions, which require constant exercise of the faculties of their minds, are very apt to seek relief, by the use of ardent spirits, from the fatigue which succeeds great mental exertions. To such persons, it may be a discovery to know, that TEA is a much better remedy for that purpose. By its grateful and gentle stimulus, it removes fatigue, restores the excitement of the mind, and invigorates the whole system. I am no advocate for the excessive use of tea. When taken too strong, it is hurtful, especially to the female constitution; but when taken of a moderate degree of strength, and in moderate quantities, with sugar and cream, or milk, I believe it is, in general, innoxious, and at all times to be preferred to ardent spirits, as a cordial for studious men. The late Anthony Benezet, one of the most laborious schoolmasters I ever knew, informed me, he had been prevented from the love of spiritous liquors, by acquiring a love for tea in early life. Three or four cups, taken in an afternoon, carried off the fatigue of a whole day's labour in his school. This worthy man lived to be seventy-one years of age, and died of an acute disease, with the full exercise of all the faculties of his mind. But the use of tea counteracts a desire for distilled spirits, during great _bodily_, as well as mental exertions. Of this, Captain Forest has furnished us with a recent and remarkable proof, in his History of a Voyage from Calcutta, to the Marqui Archipelago. "I have always observed (says this ingenious mariner) when sailors drink TEA, it weans them from the thoughts of drinking strong liquors, and pernicious grog; and with this, they are soon contented. Not so with whatever will intoxicate, be it what it will. This has always been my remark. I therefore always encourage it, without their knowing why." 5. Women have sometimes been led to seek relief from what is called breeding sickness, by the use of ardent spirits. A little gingerbread, or biscuit, taken occasionally, so as to prevent the stomach being empty, is a much better remedy for that disease. 6. Persons under the pressure of debt, disappointments in worldly pursuits, and guilt, have sometimes sought to drown their sorrows in strong drink. The only radical cure for those evils, is to be found in religion; but where its support is not resorted to, wine and opium should always be preferred to ardent spirits. They are far less injurious to the body and mind, than spirits, and the habits of attachment to them are easily broken, after time and repentance have removed the evils they were taken to relieve. 7. The sociable and imitative nature of man, often disposes him to adopt the most odious and destructive practices from his companions. The French soldiers who conquered Holland, in the year 1794, brought back with them the love and use of brandy, and thereby corrupted the inhabitants of several of the departments of France, who had been previously distinguished for their temperate and sober manners. Many other facts might be mentioned, to show how important it is to avoid the company of persons addicted to the use of ardent spirits. 8. Smoking and chewing tobacco, by rendering water and simple liquors insipid to the taste, dispose very much to the stronger stimulus of ardent spirits. The practice of smoking cigars has, in every part of our country, been more followed by a general use of brandy and water, as a common drink, more especially by that class of citizens who have not been in the habit of drinking wine, or malt liquors. The less, therefore, tobacco is used in the above ways, the better. 9. No man ever became suddenly a drunkard. It is by gradually accustoming the taste and stomach to ardent spirits, in the forms of GROG and TODDY, that men have been led to love them in their more destructive mixtures, and in their simple state. Under the impression of this truth, were it possible for me to speak with a voice so loud as to be heard from the river St. Croix to the remotest shores of the Mississippi, which bound the territory of the United States, I would say, Friends and fellow-citizens, avoid the habitual use of those two seducing liquors, whether they be made with brandy, rum, gin, Jamaica spirits, whiskey, or what is called cherry bounce. It is true, some men, by limiting the strength of those drinks, by measuring the spirit and water, have drunken them for many years, and even during a long life, without acquiring habits of intemperance or intoxication, but many more have been insensibly led, by drinking weak toddy and grog first at their meals, to take them for their constant drink, in the intervals of their meals; afterwards to take them, of an increased strength, before breakfast in the morning; and finally to destroy themselves by drinking undiluted spirits, during every hour of the day and night. I am not singular in this remark. "The consequences of drinking rum and water, or _grog_, as it is called (says Dr. Moseley), is, that habit increases the desire of more spirits, and decreases its effects; and there are very few grog-drinkers who long survive the practice of debauching with it, without acquiring the odious nuisance of dram-drinkers' breath, and downright stupidity and impotence[64]." To enforce the caution against the use of those two apparently innocent and popular liquors still further, I shall select one instance, from among many, to show the ordinary manner in which they beguile and destroy their votaries. A citizen of Philadelphia, once of a fair and sober character, drank toddy for many years, as his constant drink. From this he proceeded to drink grog. After a while, nothing would satisfy him but slings made of equal parts of rum and water, with a little sugar. From slings he advanced to raw rum, and from common rum to Jamaica spirits. Here he rested for a few months, but at length, finding even Jamaica spirits were not strong enough to warm his stomach, he made it a constant practice to throw a table-spoonful of ground pepper in each glass of his spirits, in order, to use his own words, "to take off their coldness." He soon after died a martyr to his intemperance. [64] Treatise on Tropical Diseases. Ministers of the gospel, of every denomination, in the United States! aid me with all the weight you possess in society, from the dignity and usefulness of your sacred office, to save our fellow men from being destroyed, by the great destroyer of their lives and souls. In order more successfully to effect this purpose, permit me to suggest to you to employ the same wise modes of instruction, which you use in your attempts to prevent their destruction by other vices. You expose the evils of covetousness, in order to prevent theft; you point out the sinfulness of impure desires, in order to prevent adultery; and you dissuade from anger, and malice, in order to prevent murder. In like manner, denounce, by your preaching, conversation, and examples, the seducing influence of toddy and grog, when you aim to prevent all the crimes and miseries, which are the offspring of strong drink. We have hitherto considered the effects of ardent spirits upon individuals, and the means of preventing them. I shall close this head of our inquiry, by a few remarks on their effects upon the population and welfare of our country, and the means of obviating them. It is highly probable, not less than 4000 people die annually, from the use of ardent spirits, in the United States. Should they continue to exert this deadly influence upon our population, where will their evils terminate? This question may be answered, by asking, where are all the Indian tribes, whose numbers and arms formerly spread terror among their civilized neighbours? I answer, in the words of the famous Mingo chief, "the blood of many of them flows not in the veins of any human creature." They have perished, not by pestilence, nor war, but by a greater foe to human life than either of them--ardent spirits. The loss of 4000 American citizens, by the yellow fever, in a single year, awakened general sympathy and terror, and called forth all the strength and ingenuity of laws, to prevent its recurrence. Why is not the same zeal manifested in protecting our citizens from the more general and consuming ravages of distilled spirits? Should the customs of civilized life, preserve our nation from extinction, and even from an increase of mortality, by those liquors; they cannot prevent our country being governed by men, chosen by intemperate and corrupted voters. From such legislators, the republic would soon be in danger. To avert this evil, let good men of every class unite and besiege the general and state governments, with petitions to limit the number of taverns; to impose heavy duties upon ardent spirits; to inflict a mark of disgrace, or a temporary abridgment of some civil right, upon every man convicted of drunkenness; and finally to secure the property of habitual drunkards, for the benefit of their families, by placing it in the hands of trustees, appointed for that purpose, by a court of justice. To aid the operation of these laws, would it not be extremely useful for the rulers of the different denominations of christian churches to unite, and render the sale and consumption of ardent spirits, a subject of ecclesiastical jurisdiction? The methodists, and society of friends, have, for some time past, viewed them as contraband articles, to the pure laws of the gospel, and have borne many public and private testimonies, against making them the objects of commerce. Their success in this benevolent enterprise, affords ample encouragement for all other religious societies to follow their example. PART III. We come now to the third part of this inquiry, that is, to mention the remedies for the evils which are brought on by the excessive use of distilled spirits. These remedies divide themselves into two kinds. I. Such as are proper to cure a fit of drunkenness, and II. Such as are proper to prevent its recurrence, and to destroy a desire for ardent spirits. I. I am aware that the efforts of science and humanity, in applying their resources to the cure of a disease, induced by an act of vice, will meet with a cold reception from many people. But let such people remember, the subjects of our remedies, are their fellow creatures, and that the miseries brought upon human nature, by its crimes, are as much the objects of divine compassion (which we are bound to imitate), as the distresses which are brought upon men, by the crimes of other people, or which they bring upon themselves, by ignorance or accidents. Let us not then, pass by the prostrate sufferer from strong drink, but administer to him the same relief, we would afford to a fellow creature, in a similar state, from an accidental, and innocent cause. 1. The first thing to be done to cure a fit of drunkenness, is to open the collar, if in a man, and remove all tight ligatures from every other part of the body. The head and shoulders should at the same time be elevated, so as to favour a more feeble determination of the blood to the brain. 2. The contents of the stomach should be discharged, by thrusting a feather down the throat. It often restores the patient immediately to his senses and feet. Should it fail of exciting a puking, 3. A napkin should be wrapped round the head, and wetted for an hour or two with cold water, or cold water should be poured in a stream upon the head. In the latter way, I have sometimes seen it used, when a boy, in the city of Philadelphia. It was applied, by dragging the patient, when found drunk in the street, to a pump, and pumping water upon his head for ten or fifteen minutes. The patient generally rose, and walked off, sober and sullen, after the use of this remedy. Other remedies, less common, but not less effectual for a fit of drunkenness, are, 4. Plunging the whole body into cold water. A number of gentlemen who had drunken to intoxication, on board a ship in the stream, near Fell's point, at Baltimore, in consequence of their reeling in a small boat, on their way to the shore, in the evening, overset it, and fell into the water. Several boats from the shore hurried to their relief. They were all picked up, and went home, perfectly sober, to their families. 5. Terror. A number of young merchants, who had drunken together, in a compting-house, on James river, above thirty years ago, until they were intoxicated, were carried away by a sudden rise of the river, from an immense fall of rain. They floated several miles with the current, in their little cabin, half filled with water. An island in the river arrested it. When they reached the shore that saved their lives, they were all sober. It is probable terror assisted in the cure of the persons who fell into the water at Baltimore. 6. The excitement of a fit of anger. The late Dr. Witherspoon used to tell a story of a man in Scotland, who was always cured of a fit of drunkenness, by being made angry. The means chosen for that purpose, was a singular one. It was talking against religion. 7. A severe whipping. This remedy acts by exciting a revulsion of the blood from the brain, to the external parts of the body. 8. Profuse sweats. By means of this evacuation, nature sometimes cures a fit of drunkenness. Their good effects are obvious in labourers, whom quarts of spirits taken in a day, will seldom intoxicate, while they sweat freely. If the patient be unable to swallow warm drinks, in order to produce sweats, they may be excited by putting him in a warm bath, or wrapping his body in blankets, under which should be placed half a dozen hot bricks, or bottles filled with hot water. 9. Bleeding. This remedy should always be used, when the former ones have been prescribed to no purpose, or where there is reason to fear from the long duration of the disease, a material injury may be done to the brain. It is hardly necessary to add, that each of the above remedies, should be regulated by the grade of drunkenness, and the greater or less degree, in which the intellects are affected in it. II. The remedies which are proper to prevent the recurrence of fits of drunkenness, and to destroy the desire for ardent spirits, are religious, metaphysical, and medical. I shall briefly mention them. 1. Many hundred drunkards have been cured of their desire for ardent spirits, by a practical belief in the doctrines of the christian religion. Examples of the divine efficacy of christianity for this purpose, have lately occurred in many parts of the United States. 2. A sudden sense of the guilt contracted by drunkenness, and of its punishment in a future world. It once cured a gentleman in Philadelphia, who, in a fit of drunkenness, attempted to murder a wife whom he loved. Upon being told of it when he was sober, he was so struck with the enormity of the crime he had nearly committed, that he never tasted spiritous liquors afterwards. 3. A sudden sense of shame. Of the efficacy of this deep seated principle in the human bosom, in curing drunkenness, I shall relate three remarkable instances. A farmer in England, who had been many years in the practice of coming home intoxicated, from a market town, one day observed appearances of rain, while he was in market. His hay was cut, and ready to be housed. To save it, he returned in haste to his farm, before he had taken his customary dose of grog. Upon coming into his house, one of his children, a boy of six years old, ran to his mother, and cried out, "O, mother! father is come home, and he is not drunk." The father, who heard this exclamation, was so severely rebuked by it, that he suddenly became a sober man. A noted drunkard was once followed by a favourite goat, to a tavern, into which he was invited by his master, and drenched with some of his liquor. The poor animal staggered home with his master, a good deal intoxicated. The next day he followed him to his accustomed tavern. When the goat came to the door, he paused: his master made signs to him to follow him into the house. The goat stood still. An attempt was made to thrust him into the tavern. He resisted, as if struck with the recollection of what he suffered from being intoxicated the night before. His master was so much affected by a sense of shame in observing the conduct of his goat to be so much more rational than his own, that he ceased from that time to drink spiritous liquors. A gentleman, in one of the southern states, who had nearly destroyed himself by strong drink, was remarkable for exhibiting the grossest marks of folly in his fits of intoxication. One evening, sitting in his parlour, he heard an uncommon noise in his kitchen. He went to the door, and peeped through the key hole, from whence he saw one of his negroes diverting his fellow servants, by mimicking his master's gestures and conversation when he was drunk. The sight overwhelmed him with shame and distress, and instantly became the means of his reformation. 4. The association of the idea of ardent spirits, with a painful or disagreeable impression upon some part of the body, has sometimes cured the love of strong drink. I once tempted a negro man, who was habitually fond of ardent spirits, to drink some rum (which I placed in his way), and in which I had put a few grains of tartar emetic. The tartar sickened and puked him to such a degree, that he supposed himself to be poisoned. I was much gratified by observing he could not bear the sight, nor smell of spirits, for two years afterwards. I have heard of a man, who was cured of the love of spirits, by working off a puke, by large draughts of brandy and water, and I know a gentleman, who in consequence of being affected with a rheumatism, immediately after drinking some toddy, when overcome with fatigue and exposure to the rain, has ever since loathed that liquor, only because it was accidentally associated in his memory with the recollection of the pain he suffered from his disease. This appeal to that operation of the human mind, which obliges it to associate ideas, accidentally or otherwise combined, for the cure of vice, is very ancient. It was resorted to by Moses, when he compelled the children of Israel to drink the solution of the golden calf (which they had idolized) in water. This solution, if made, as it most probably was, by means of what is called hepar sulphuris, was extremely bitter, and nauseous, and could never be recollected afterwards, without bringing into equal detestation, the sin which subjected them to the necessity of drinking it. Our knowledge of this principle of association upon the minds and conduct of men, should lead us to destroy, by means of other impressions, the influence of all those circumstances, with which the recollection and desire of spirits are combined. Some men drink only in the _morning_, some at _noon_, and some only at _night_. Some men drink only on a _market day_, some at _one_ tavern only, and some only in _one kind_ of company. Now by finding a new and interesting employment, or subject of conversation for drunkards at the usual times in which they have been accustomed to drink, and by restraining them by the same means from those places and companions, which suggested to them the idea of ardent spirits, their habits of intemperance may be completely destroyed. In the same way the periodical returns of appetite, and a desire of sleep have been destroyed in a hundred instances. The desire for strong drink differs from each of them, in being of an artificial nature, and therefore not disposed to return, after being chased for a few weeks from the system. 5. The love of ardent spirits has sometimes been subdued, by exciting a counter passion in the mind. A citizen of Philadelphia had made many unsuccessful attempts to cure his wife of drunkenness. At length, despairing of her reformation, he purchased a hogshead of rum, and, after tapping it, left the key in the door of the room in which it was placed, as if he had forgotten it. His design was to give his wife an opportunity of drinking herself to death. She suspected this to be his motive, in what he had done, and suddenly left off drinking. Resentment here became the antidote to intemperance. 6. A diet consisting wholly of vegetables cured a physician in Maryland, of drunkenness, probably by lessening that thirst, which is always more or less excited by animal food. 7. Blisters to the ankles, which were followed by an unusual degree of inflammation, once suspended the love of ardent spirits, for one month, in a lady in this city. The degrees of her intemperance may be conceived of, when I add, that her grocer's account for brandy alone amounted, annually, to one hundred pounds, Pennsylvania currency, for several years. 8. A violent attack of an acute disease, has sometimes destroyed a habit of drinking distilled liquors. I attended a notorious drunkard, in the yellow fever, in the year 1798, who recovered with the loss of his relish for spirits, which has, I believe, continued ever since. 9. A salivation has lately performed a cure of drunkenness, in a person of Virginia. The new disease excited in the mouth and throat, while it rendered the action of the smallest quantity of spirits upon them painful, was happily calculated to destroy the disease in the stomach which prompts to drinking, as well as to render the recollection of them disagreeable, by the laws of association formerly mentioned. 10. I have known an oath, taken before a magistrate, to drink no more spirits, produce a perfect cure of drunkenness. It is sometimes cured in this way in Ireland. Persons who take oaths for this purpose are called affidavit men. 11. An advantage would probably arise from frequent representations being made to drunkards, not only of the certainty, but of the _suddenness_ of death, from habits of intemperance. I have heard of two persons being cured of the love of ardent spirits, by seeing death suddenly induced by fits of intoxication; in the one case, in a stranger, and in the other, in an intimate friend. 12. It has been said, that the disuse of spirits should be gradual, but my observations authorize me to say, that persons who have been addicted to them, should abstain from them _suddenly_, and _entirely_. "Taste not, handle not, touch not," should be inscribed upon every vessel that contains spirits, in the house of a man who wishes to be cured of habits of intemperance. To obviate, for a while, the debility which arises from the sudden abstraction of the stimulus of spirits, laudanum, or bitters infused in water, should be taken, and perhaps a larger quantity of beer or wine, that is consistent with the strict rules of temperate living. By the temporary use of these substitutes for spirits, I have never known the transition to sober habits to be attended with any bad effects, but often with permanent health of body, and peace of mind. OBSERVATIONS ON THE _DUTIES OF A PHYSICIAN_, AND THE METHODS OF IMPROVING MEDICINE. ACCOMMODATED TO THE PRESENT STATE OF SOCIETY AND MANNERS IN THE UNITED STATES. Delivered in the University of Pennsylvania, February 7, 1789, at the conclusion of a course of lectures upon chemistry and the practice of physic. _PUBLISHED AT THE REQUEST OF THE CLASS._ GENTLEMEN, I Shall conclude our course of lectures, by delivering to you a few directions for the regulation of your future conduct and studies, in the line of your profession. I shall, _first_, suggest the most probable means of establishing yourselves in business, and of becoming acceptable to your patients, and respectable in life. _Secondly_, I shall mention a few thoughts which have occurred to me on the mode to be pursued, in the further prosecution of your studies, and for the improvement of medicine. I. Permit me, in the first place, to recommend to such of you as intend to settle in the country, to establish yourselves as early as possible upon _farms_. My reasons for this advice are as follow: 1. It will reconcile the country people to the liberality and dignity of your profession, by showing them that you assume no superiority over them from your education, and that you intend to share with them in those toils, which were imposed upon man in consequence of the loss of his innocence. This will prevent envy, and render you acceptable to your patients as men, as well as physicians. 2. By living on a farm you may serve your country, by promoting improvements in agriculture. Chemistry (which is now an important branch of a medical education) and agriculture are closely allied to each other. Hence some of the most useful books upon agriculture have been written by physicians. Witness the essays of Dr. Home of Edinburgh, and of Dr. Hunter of Yorkshire, in England. 3. The business of a farm will furnish you with employment in the healthy seasons of the year, and thereby deliver you from the tædium vitæ, or what is worse, from retreating to low or improper company. Perhaps one cause of the prevalence of dram or grog drinking, with which country practitioners are sometimes charged, is owing to their having no regular or profitable business to employ them, in the intervals of their attendance upon their patients. 4. The resources of a farm will create such an independence as will enable you to practice with more dignity, and at the same time screen you from the trouble of performing unnecessary services to your patients. It will change the nature of the obligation between you and them. While _money_ is the only means of your subsistence, your patients will feel that they are the channels of your daily bread; but while your farm furnishes you with the necessaries of life, your patients will feel more sensibly, that the obligation is on their side, for health and life. 5. The exigencies and wants of a farm in _stock_ and _labour_ of all kinds, will enable you to obtain from your patients a compensation for your services in those articles. They all possess them, and men part with that of which money is only the sign, much more readily than they do with money itself. 6. The resources of a farm will prevent your cherishing, for a moment, an impious wish for the prevalence of sickness in your neighbourhood. A healthy season will enable you to add to the produce of your farm, while the rewards of an unhealthy season will enable you to repair the inconvenience of your necessary absence from it. By these means your pursuits will be marked by that _variety_ and _integrity_, in which true happiness is said to consist. 7. Let your farms be small, and let your _principal_ attention be directed to grass and horticulture. These afford most amusement, require only moderate labour, and will interfere least with your duties to your profession. II. Avoid singularities of every kind in your manners, dress, and general conduct. Sir Isaac Newton, it is said, could not be distinguished in company, by any peculiarity, from a common well-bred gentleman. Singularity in any thing, is a substitute for such great or useful qualities as command respect; and hence we find it chiefly in little minds. The profane and indelicate combination of extravagant ideas, improperly called wit, and the formal and pompous manner, whether accompanied by a wig, a cane, or a ring, should be all avoided, as incompatible with the simplicity of science, and the real dignity of physic. There is more than one way of playing the quack. It is not necessary, for this purpose, that a man should advertise his skill, or his cures, or that he should mount a phaeton and display his dexterity in operating, to an ignorant and gaping multitude. A physician acts the same part in a different way, who assumes the character of a madman or a brute in his manners, or who conceals his fallibility by an affected gravity and taciturnity in his intercourse with his patients. Both characters, like the quack, impose upon the public. It is true, they deceive different ranks of people; but we must remember that there are two kinds of vulgar, viz. the rich and the poor; and that the rich vulgar are often upon a footing with the poor, in ignorance and credulity. III. It has been objected to our profession, that many eminent physicians have been unfriendly to christianity. If this be true, I cannot help ascribing it in part to that neglect of public worship with which the duties of our profession are often incompatible; for it has been justly observed, that the neglect of this religious and social duty, generally produces a relaxation, either in principles or morals. Let this fact lead you, in setting out in business, to acquire such habits of punctuality in visiting your patients, as shall not interfere with acts of public homage to the Supreme Being. Dr. Gregory has observed, that a cold heart is the most frequent cause of deism. Where this occurs in a physician, it affords a presumption that he is deficient in humanity. But I cannot admit that infidelity is peculiar to our profession. On the contrary, I believe christianity places among its friends more men of extensive abilities and learning in medicine, than in any other secular employment. Stahl, Hoffman, Boerhaave, Sydenham, Haller, and Fothergill, were all christians. These enlightened physicians were considered as the ornaments of the ages in which they lived, and posterity has justly ranked them among the greatest benefactors of mankind. IV. Permit me to recommend to you a regard to all the interests of your country. The education of a physician gives him a peculiar insight in the principles of many useful arts, and the practice of physic favours his opportunities of doing good, by diffusing knowledge of all kinds. It was in Rome, when medicine was practised only by slaves, that physicians were condemned by their profession "mutam exercere artem." But in modern times, and in free governments, they should disdain an ignoble silence upon public subjects. The American revolution has rescued physic from its former slavish rank in society. For the honour of our profession it should be recorded, that some of the most intelligent and useful characters, both in the cabinet and the field, during the late war, have been physicians. The illustrious Dr. Fothergill opposed faction and tyranny, and took the lead in all public improvements in his native country, without suffering thereby the least diminution of that reputation, or business, in which, for forty years, he flourished almost without a rival in the city of London. V. Let me advise you, in your visits to the sick, _never_ to appear in a hurry, nor to talk of indifferent matters before you have made the necessary inquiries into the symptoms of your patient's disease. VI. Avoid making light of any case. "Respice finem" should be the motto of every indisposition. There is scarcely a disease so trifling, that has not, directly or indirectly, proved an outlet to human life. This consideration should make you anxious and punctual in your attendance upon every acute disease, and keep you from risking your reputation by an improper or hasty prognosis. VII. Do not condemn, or oppose, unnecessarily, the simple prescriptions of your patients. Yield to them in matters of little consequence, but maintain an inflexible authority over them in matters that are essential to life. VIII. Preserve, upon all occasions, a composed or cheerful countenance in the room of your patients, and inspire as much hope of a recovery as you can, consistent with truth, especially in acute diseases. The extent of the influence of the will over the human body, has not yet been fully ascertained. I reject the futile pretensions of Mr. Mesmer to the cure of diseases, by what he has absurdly called animal magnetism. But I am willing to derive the same advantages from his deceptions, which the chemists have derived from the delusions of the alchemists. The facts which he has established, clearly prove the influence of the imagination, and will, upon diseases. Let us avail ourselves of the handle which those faculties of the mind present to us, in the strife between life and death. I have frequently prescribed remedies of doubtful efficacy in the critical stage of acute diseases, but never till I had worked up my patients into a confidence, bordering upon certainty, of their probable good effects. The success of this measure has much oftener answered, than disappointed my expectations; and while my patients have commended the vomit, the purge, or the blister which was prescribed, I have been disposed to attribute their recovery to the vigorous concurrence of the _will_ in the action of the medicine. Does the will beget insensibility to cold, heat, hunger, and danger? Does it suspend pain, and raise the body above feeling the pangs of Indian tortures? Let us not then be surprised that it should enable the system to resolve a spasm, to open an obstruction, or to discharge an offending humour. I have only time to hint at this subject. Perhaps it would lead us, if we could trace it fully, to some very important discoveries in the cure of diseases. IX. Permit me to advise you in your intercourse with your patients, to attend to that principle in the human mind, which constitutes the association of ideas. A chamber, a chair, a curtain, or even a cup, all belong to the means of life or death, accordingly as they are associated with cheerful or distressing ideas, in the mind of a patient. But this principle is of more immediate application in those chronic diseases which affect the mind. Nothing can be accomplished here, till we produce a new association of ideas. For this purpose a change of place and company are absolutely necessary. But we must sometimes proceed much further. I have heard of a gentleman in South-Carolina who cured his fits of low spirits by changing his clothes. The remedy was a rational one. It produced at once a new train of ideas, and thus removed the paroxysm of his disease. X. Make it a rule never to be angry at any thing a sick man says or does to you. Sickness often adds to the natural irritability of the temper. We are, therefore, to bear the reproaches of our patients with meekness and silence. It is folly to resent injuries at any time, but it is cowardice to resent an injury from a sick man, since, from his weakness and dependence upon us, he is unable to contend with us upon equal terms. You will find it difficult to attach your patients to you by the obligations of friendship or gratitude. You will sometimes have the mortification of being deserted by those patients who owe most to your skill and humanity. This led Dr. Turner to advise physicians never to chuse their friends from among their patients. But this advice can never be followed by a heart that has been taught to love true excellency, wherever it finds it. I would rather advise you to give the benevolent feelings of your hearts full scope, and to forget the unkind returns they will often meet with, by giving to human nature----a tear. XI. Avoid giving a patient over in an acute disease. It is impossible to tell in such cases where life ends, and where death begins. Hundreds of patients have recovered, who have been pronounced incurable, to the great disgrace of our profession. I know that the practice of predicting danger and death upon every occasion, is sometimes made use of by physicians, in order to enhance the credit of their prescriptions if their patients recover, and to secure a retreat from blame, if they should die. But this mode of acting is mean and illiberal. It is not necessary that we should decide with confidence at any time, upon the issue of a disease. XII. A physician in sickness is always a welcome visitor in a family; hence he is often solicited to partake of the usual sign of hospitality in this country, by taking a draught of some strong liquor, every time he enters into the house of a patient. Let me charge you to lay an early restraint upon yourselves, by refusing to yield to this practice, especially in the _forenoon_. Many physicians have been innocently led by it into habits of drunkenness. You will be in the more danger of falling into this vice, from the great fatigue and inclemency of the weather to which you will be exposed in country practice. But you have been taught that strong drink affords only a temporary relief from those evils, and that it afterwards renders the body more sensible of them. XIII. I shall now give some directions with respect to the method of charging for your services to your patients. When we consider the expence of a medical education, and the sacrifices a physician is obliged to make of ease, society, and even health, to his profession; and when we add to these, the constant and painful anxiety which is connected with the important charge of the lives of our fellow-creatures, and above all, the inestimable value of that blessing which is the object of his services, I hardly know how it is possible for a patient sufficiently and justly to reward his physician. But when we consider, on the other hand, that sickness deprives men of the means of acquiring money; that it increases all the expenses of living; and that high charges often drive patients from regular-bred physicians to quacks; I say, when we attend to these considerations, we should make our charges as moderate as possible, and conform them to the following state of things. Avoid measuring your services to your patients by scruples, drachms, and ounces. It is an illiberal mode of charging. On the contrary, let the number and _time_ of your visits, the nature of your patient's disease, and his rank in his family or society, determine the figures in your accounts. It is certainly just to charge more for curing an apoplexy, than an intermitting fever. It is equally just, to demand more for risking your life by visiting a patient in a contagious fever, than for curing a pleurisy. You have likewise a right to be paid for your anxiety. Charge the same services, therefore, higher, to the master or mistress of a family, or to an only son or daughter, who call forth all your feelings and industry, than to less important members of a family and of society. If a rich man demand more frequent visits than are necessary, and if he impose the restraints of keeping to hours, by calling in other physicians to consult with you upon every trifling occasion, it will be just to make him pay accordingly for it. As this mode of charging is strictly agreeable to reason and equity, it seldom fails of according with the reason and sense of equity of our patients. Accounts made out upon these principles, are seldom complained of by them. I shall only remark further upon this subject, that the sooner you send in your accounts after your patients recover, the better. It is the duty of a physician to inform his patient of the amount of his obligation to him at least _once_ a year. But there are times when a departure from this rule may be necessary. An unexpected misfortune in business, and a variety of other accidents, may deprive a patient of the money he had allotted to pay his physician. In this case, delicacy and humanity require, that he should not know the amount of his debt to his physician, till time had bettered his circumstances. I shall only add, under this head, that the poor of every description should be the objects of your peculiar care. Dr. Boerhaave used to say, "they were his best patients, because God was their paymaster." The first physicians that I have known, have found the poor the steps by which they have ascended to business and reputation. Diseases among the lower class of people are generally simple, and exhibit to a physician the best cases of all epidemics, which cannot fail of adding to his ability of curing the complicated diseases of the rich and intemperate. There is an inseparable connection between a man's duty and his interest. Whenever you are called, therefore, to visit a poor patient, imagine you hear the voice of the good Samaritan sounding in your ears, "Take care of him, and I will repay thee." I come now to the second part of this address, which was to point out the best mode to be pursued, in the further prosecution of your studies, and the improvement of medicine. I. Give me leave to recommend to you, to open all the dead bodies you can, without doing violence to the feelings of your patients, or the prejudices of the common people. Preserve a register of the weather, and of its influence upon the vegetable productions of the year. Above all, record the epidemics of every season; their times of appearing and disappearing, and the connection of the weather with each of them. Such records, if published, will be useful to foreigners, and a treasure to posterity. Preserve, likewise, an account of chronic cases. Record the name, age, and occupation of your patient; describe his disease accurately, and the changes produced in it by your remedies; mention the doses of every medicine you administer to him. It is impossible to tell how much improvement and facility in practice you will find from following these directions. It has been remarked, that physicians seldom remember more than the two or three last years of their practice. The records which have been mentioned, will supply this deficiency of memory, especially in that advanced stage of life when the advice of physicians is supposed to be most valuable. II. Permit me to recommend to you further, the study of the anatomy (if I may be allowed the expression) of the human mind, commonly called metaphysics. The reciprocal influence of the body and mind upon each other, can only be ascertained by an accurate knowledge of the faculties of the mind, and of their various modes of combination and action. It is the duty of physicians to assert their prerogative, and to rescue the mental science from the usurpations of schoolmen and divines. It can only be perfected by the aid and discoveries of medicine. The authors I would recommend to you upon metaphysics, are, Butler, Locke, Hartley, Reid, and Beattie. These ingenious writers have cleared this sublime science of its technical rubbish, and rendered it both intelligible and useful. III. Let me remind you, that improvement in medicine is not to be derived only from colleges and universities. Systems of physic are the productions of men of genius and learning; but those facts which constitute real knowledge, are to be met with in every walk of life. Remember how many of our most useful remedies have been discovered by quacks. Do not be afraid, therefore, of conversing with them, and of profiting by their ignorance and temerity in the practice of physic. Medicine has its Pharisees, as well as religion. But the spirit of this sect is as unfriendly to the advancement of medicine, as it is to christian charity. By conversing with quacks, we may convey instruction to them, and thereby lessen the mischief they might otherwise do to society. But further. In the pursuit of medical knowledge, let me advise you to converse with nurses and old women. They will often suggest facts in the history and cure of diseases, which have escaped the most sagacious observers of nature. Even negroes and Indians have sometimes stumbled upon discoveries in medicine. Be not ashamed to inquire into them. There is yet one more means of information in medicine which should not be neglected, and that is, to converse with persons who have recovered from indispositions without the aid of physicians. Examine the strength and exertions of nature in these cases, and mark the plain and home-made remedy to which they ascribe their recovery. I have found this to be a fruitful source of instruction, and have been led to conclude, that if every man in a city, or a district, could be called upon to relate to persons appointed to receive and publish his narrative, an exact account of the effects of those remedies which accident or whim has suggested to him, it would furnish a very useful book in medicine. To preserve the facts thus obtained, let me advise you to record them in a book to be kept for that purpose. There is one more advantage that will probably attend the inquiries that have been mentioned: you may discover diseases, or symptoms of diseases, or even laws of the animal economy, which have no place in our systems of nosology, or in our theories of physic. IV. Study simplicity in the preparation of your medicines. My reasons for this advice are as follow: 1. Active medicines produce the most certain effects in a simple state. 2. Medicines when mixed frequently destroy the efficacy of each other. I do not include chemical medicines alone in this remark. It applies likewise to Galenical medicines. I do not say, that all these medicines are impaired by mixture, but we can only determine when they are not, by actual experiments and observations. 3. When medicines of the same class, or even of different classes, are given together, the _strongest_ only produces an effect. But what are we to say to a compound of two medicines which give exactly the same impression to the system? Probably, if we are to judge from analogy, the effect of them will be such as would have been produced by neither, in a simple state. 4. By observing simplicity in your prescriptions, you will always have the command of a greater number of medicines of the _same_ class, which may be used in succession to each other, in proportion as habit renders the system insensible of their action. 5. By using medicines in a simple state you will obtain an exact knowledge of their virtues and doses, and thereby be able to decide upon the numerous and contradictory accounts which exist in our books, of the character of the _same_ medicines. Under this head, I cannot help adding two more directions. 1. Avoid sacrificing too much to the _taste_ of your patients in the preparation of your medicines. The nature of a medicine may be wholly changed by being mixed with sweet substances. The Author of Nature seems to have had a design, in rendering medicines unpalatable. Had they been more agreeable to the taste, they would probably have yielded long ago to the unbounded appetite of man, and by becoming articles of diet, or condiments, have lost their efficacy in diseases. 2. Give as few medicines as possible in tinctures made with distilled spirits. Perhaps there are few cases in which it is safe to exhibit medicines prepared in spirits, in any other form than in _drops_. Many people have been innocently seduced into a love of strong drink, from taking large or frequent doses of bitters, infused in spirits. Let not our profession be reproached in a single instance, with adding to the calamities that have been entailed upon mankind by this dreadful species of intemperance. V. Let me recommend to your particular attention, the indigenous medicines of our country. Cultivate or prepare as many of them as possible, and endeavour to enlarge the materia medica, by exploring the untrodden fields and forests of the United States. The ipecacuanha, the Seneka and Virginia snake-roots, the Carolina pink-root, the spice-wood, the sassafras, the butter-nut, the thoroughwort, the poke, and the stramonium, are but a small part of the medicinal productions of America. I have no doubt but there are many hundred other plants which now exhale invaluable medicinal virtues in the desert air. Examine, likewise, the mineral waters, which are so various in their impregnation, and so common in all parts of our country. Let not the properties of the insects of America escape your investigation. We have already discovered among some of them, a fly equal in its blistering qualities to the famous fly of Spain. Who knows but it may be reserved for America to furnish the world, from her productions, with cures for some of those diseases which now elude the power of medicine? Who knows but that, at the foot of the Allegany mountain, there blooms a flower that is an infallible cure for the epilepsy? Perhaps on the Monongahela, or the Potomac, there may grow a root that shall supply, by its tonic powers, the invigorating effects of the savage or military life in the cure of consumptions. Human misery of every kind is evidently on the decline. Happiness, like truth, is a unit. While the world, from the progress of intellectual, moral, and political truth, is becoming a more safe and agreeable abode for man, the votaries of medicine should not be idle. All the doors and windows of the temple of nature have been thrown open by the convulsions of the late American revolution. This is the time, therefore, to press upon her altars. We have already drawn from them discoveries in morals, philosophy, and government; all of which have human happiness for their object. Let us preserve the unity of truth and happiness, by drawing from the same source, in the present critical moment, a knowledge of antidotes to those diseases which are supposed to be incurable. I have now, gentlemen, only to thank you for the attention with which you have honoured the course of lectures which has been delivered to you, and to assure you, that I shall be happy in rendering you all the services that lie in my power, in any way you are pleased to command me. Accept of my best wishes for your happiness, and may the blessings of hundreds and thousands that were ready to perish, be your portion in life, your comfort in death, and your reward in the world to come. AN INQUIRY INTO THE CAUSE AND CURE OF _SORE LEGS_. However trifling these complaints may appear, they compose a large class of the diseases of a numerous body of people. Hitherto, the persons afflicted by them have been too generally abandoned to the care of empirics, either because the disease was considered as beneath the notice of physicians, or because they were unable to cure it. I would rather ascribe it to the latter, than to the former cause, for pride has no natural fellowship with the profession of medicine. The difficulty of curing sore legs has been confessed by physicians in every country. As far as my observations have extended, I am disposed to ascribe this difficulty to the uniform and indiscriminate mode of treating them, occasioned by the want of a theory which shall explain their proximate cause. I shall attempt in a few pages to deliver one, which, however imperfect, will, I hope, lay a foundation for more successful inquiries upon this subject hereafter. I shall begin my observations upon this disease, by delivering and supporting the following propositions. I. SORE LEGS are induced by general debility. This I infer from the occupations and habits of the persons who are most subject to them. They are day-labourers, and sailors, who are in the habit of lifting great weights; also washer-women, and all other persons, who pass the greatest part of their time upon their feet. The blood-vessels and muscular fibres of the legs are thus overstretched, by which means either a rupture, or such a languid action in the vessels is induced, as that an accidental wound from any cause, even from the scratch of a pin, or the bite of a mosquito, will not easily heal. But labourers, sailors, and washer-women are not the only persons who are afflicted with sore legs. Hard drinkers of every rank and description are likewise subject to them. Where strong drink, labour, and standing long on the feet are united, they more certainly dispose to sore legs, than when they act separately. In China, where the labour which is performed by brutes in other countries, is performed by men, varices on the legs are very common among the labouring people. Perhaps, the reason why the debility is induced in the legs produces varices instead of ulcers in these people, may be owing to their not adding the debilitating stimulus of strong drink to that of excessive labour. It is not extraordinary that the debility produced by intemperance in drinking ardent spirits, should appear first in the lower extremities. The debility produced by intemperance in the use of wine, makes its first appearance in the form of gout, in the same part of the body. The gout, it is true, discovers itself most frequently in pain only, but there are cases in which it has terminated in ulcers, and even mortification on the legs. II. Sore legs are connected with a morbid state of the whole system. This I infer, 1. From the causes which induce them, all of which act more or less upon every part of the body. 2. From their following or preceding diseases, which obviously belong to the whole system. Fevers and dysenteries often terminate critically in this disease; and the pulmonary consumption and apoplexy have often been preceded by the suppression of a habitual discharge from a sore leg. The two latter diseases have been ascribed to the translation of a morbific matter to the lungs or brain: but it is more rational to ascribe them to a previous debility in those organs, by which means their vessels were more easily excited into action and effusion by the stimulus of the plethora, induced upon the system in consequence of the confinement of the fluids formerly discharged from the leg in the form of pus. This plethora can do harm only where there is previous debility; for I maintain that the system (when the solids are exactly toned) will always relieve itself of a sudden preternatural accumulation of fluids by means of some natural emunctory. This has been often observed in the menorrhagia, which accompanies plentiful living in women, and in the copious discharges from the bowels and kidneys, which follow a suppression of the perspiration. 3. I infer it, from their appearing almost universally in one disease, which is evidently a disease of the whole system, viz. the scurvy. 4. From their becoming in some cases the outlets of menstrual blood, which is discharged in consequence of a plethora, which affects more or less every part of the female system. 5. I infer it from the _symptoms_ of sore legs, which are in some cases febrile, and affect the pulse in every part of the body with preternatural frequency or force. These symptoms were witnessed, in an eminent degree, in two of the patients who furnished subjects for clinical remarks in the Pennsylvania hospital some years ago. 6. I infer that sore legs are a disease of the whole system, from the manner in which they are sometimes cured by nature and art. They often prove the outlets of many general diseases, and all the remedies which cure them, act more or less upon the whole system. In all cases of sore legs there is a tonic and atonic state of the whole system. The same state of excessive or weak morbid action takes place in the parts which are affected by the sores. The remedies to cure them, therefore, should be _general_ and _local_. In cases where the arterial system is affected by too much tone, the general remedies should be, I. BLOOD-LETTING. Of the efficacy of this remedy in disposing ulcers suddenly to heal, the two clinical patients before-mentioned exhibited remarkable proofs, in the presence of all the students of medicine in the university. The blood drawn was sizy in both cases. I have not the merit of having introduced this remedy into practice in the cure of ulcers. I learned it from Sir John Pringle. I have known it to be used with equal success in a sore breast, attended by pain and inflammation, after all the usual remedies in that disease had been used to no purpose. II. GENTLE PURGES. III. NITRE. From fifteen to twenty grains of this medicine should be given three times a-day. IV. A TEMPERATE DIET, and a total abstinence from fermented and distilled liquors. V. COOL and PURE AIR. VI. Rest in a recumbent posture of the body. The _local_ remedies in this state of the system should be, I. Cold water. Dr. Rigby has written largely in favour of this remedy when applied to local inflammations. From its good effects in allaying the inflammation which sometimes follows the puncture which is made in the arm in communicating the small-pox, and from the sudden relief it affords in the inflammatory state of the ophthalmia and in the piles, no one can doubt of its efficacy in sore legs, accompanied by inflammation in those vessels, which are the immediate seat of the disease. II. Soft poultices of bread and milk, or of bread moistened with lead water. Dr. Underwood's method of making a poultice of bread and milk should be preferred in this case. He directs us first to boil the milk, then to powder the bread, and throw it into the milk, and after they have been intimately mixed, by being well stirred and boiled together, they should be poured out and spread upon a rag, and a knife dipped in sweet oil or lard, should be run over them. The solidity and consistence of the poultice is hereby better preserved, than when the oil or lard is mixed with the bread and milk over the fire. III. When the inflammation subsides, adhesive plasters so applied as to draw the sound edges of the sores together. This remedy has been used with great success by Dr. Physick, in the Pennsylvania hospital, and in his private practice. IV. Above all, rest, and a horizontal posture of the leg. Too much cannot be said in favour of this remedy in this species of sore legs. Nannoni, the famous Italian surgeon, sums up the cure of sore legs in three words, viz. "Tempo, riposo, e pazienza;" that is, in time, rest, and patience. A friend of mine, who was cured by this surgeon of a sore leg, many years ago, informed me, that he confined him to his bed during the greatest part of the time that he was under his care. In sore legs, attended by too little general and local action, the following remedies are proper. I. BARK. It should be used plentifully, but with a constant reference to the state of the system; for the changes in the weather, and other accidental circumstances, often produce such changes in the system, as to render its disuse for a short time frequently necessary. II. MERCURY. This remedy has been supposed to act by altering the fluids, or by discharging a morbid matter from them, in curing sore legs. But this is by no means the case. It appears to act as a universal stimulant; and if it prove most useful when it excites a salivation, it is only because in this way it excites the most general action in the system. III. MINERAL TONICS, such as the different preparations of iron, copper, and zinc. IV. GENTLE EXERCISE. Rest, and a recumbent posture of the body, so proper in the tonic, are both hurtful in this species of sore legs. The efficacy of exercise, even of the active kind, in the cure of sore legs, accompanied by deficient action in the vessels, may easily be conceived from its good effects after gun-shot wounds which are mentioned by Dr. Jackson[65]. He tells us, that those British soldiers who had been wounded at the battle of Guilford, in North-Carolina, who were turned out of the military hospitals and followed the army, soonest recovered of their wounds. It was remarkable, that if they delayed only a few days on the road, their wounds grew worse, or ceased to heal. [65] Medical Journal, 1790. In the use of the different species of exercise, the same regard should be had to the state of the system, which has been recommended in other diseases. V. A nutritious and moderately stimulating diet, consisting of milk, saccharine vegetables, animal food, malt liquors, and wine. Wort has done great service in sore legs. The manner in which I have directed it to be prepared and taken is as follows: To three or four heaped table-spoonsful of the malt, finely powdered and sifted, add two table-spoonsful of brown sugar, and three or four of Madeira, sherry, or Lisbon wine, and a quart of boiling water. After they have stood a few hours, it may be drunken liberally by the patient, stirring it each time before he takes it, so that the whole substance of the malt may be conveyed into the stomach. A little lime-juice may be added, if the patient requires it, to make it more pleasant. The above quantity may be taken once, twice, or three times a-day at the pleasure of the patient, or according to the indication of his disease. VI. OPIUM. This remedy is not only useful in easing the pain of a sore leg, but co-operates with other cordial medicines in invigorating the whole system. The _local_ applications should consist of such substances as are gently escarotic, and which excite an action in the torpid vessels of the affected part. Arsenic, precipitate, and blue vitriol, have all been employed with success for this purpose. Dr. Griffitts informed me, that he has frequently accomplished the same thing in the Dispensary by applications of tartar emetic. They should all be used, if necessary, in succession to each other; for there is often the same idiosyncrasy in a sore leg to certain topical applications, that there is in the stomach to certain aliments. After the use of these remedies, astringents and tonics should be applied, such as an infusion of Peruvian, or white-oak bark; the water in which the smiths extinguish their irons, lime-water, bread dipped in a weak solution of green vitriol (so much commended by Dr. Underwood), compresses wetted with brandy, or ardent spirits of any kind, and, above all, the adhesive plasters formerly mentioned. Tight bandages are likewise highly proper here. The laced stocking has been much used. It is made of strong coarse linen. Dr. Underwood gives several good reasons for preferring a flannel roller to the linen stocking. It sets easier on the leg, and yields to the swelling of the muscles in walking. In scorbutic sores on the legs, navy surgeons have spoken in high terms of an application of a mixture of lime-juice and molasses. Mr. Gillespie commends the use of lime or lemon-juice alone, and ascribes many cures to it in the British navy during the late war, after every common application had been used to no purpose[66]. [66] Medical Journal, Vol. VI. It is of the utmost consequence in the treatment of sore legs, to keep them clean, by frequent dressings and washings. The success of old women is oftener derived from their great attention to cleanliness, in the management of sore legs, than to any specifics they possess which are unknown to physicians. When sore legs are kept from healing by affections of the bone, the treatment should be such as is recommended by practical writers on surgery. I shall conclude this inquiry by four observations, which are naturally suggested by what has been delivered upon this disease. 1. If it has been proved that sore legs are connected with a morbid state of the whole system, is it not proper to inquire, whether many other diseases supposed to be local, are not in like manner connected with the whole system; and if sore legs have been cured by general remedies, is it not proper to use them more frequently in local diseases? 2. If there be two states of action in the arteries in sore legs, it becomes us to inquire, whether the same opposite states of action do not take place in many diseases in which they are not suspected. It would be easy to prove, that they exist in several other local diseases. 3. If the efficacy of the remedies for sore legs which have been mentioned, depend upon their being accommodated exactly to the state of the arterial system, and if this system be liable to frequent changes, does it not become us to be more attentive to the state of the pulse in this disease than is commonly supposed to be necessary by physicians? 4. It has been a misfortune in medicine, as well as in other sciences, for men to ascribe effects to one cause, which should be ascribed to many. Hence diseases have been attributed exclusively to morbid affections of the fluids by some, and of the muscles and nerves by others. Unfortunately the morbid states of the arterial system, and the influence of those states upon the brain, the nerves, the muscles, the lymphatics, the glands, the viscera, the alimentary canal, and the skin, as well as the reciprocal influence of the morbid states of each of those parts of the body upon the arteries, and upon each other, have been too much neglected in most of our systems of physic. I consider the pathology of the arterial system as a mine. It was first discovered by Dr. Cullen. The man who attempts to explore it, will probably impoverish himself by his researches; but the men who come after him, will certainly obtain from it a treasure which cannot fail of adding greatly to the riches of medicine. AN ACCOUNT OF THE _STATE OF THE BODY AND MIND_ IN OLD AGE; WITH _OBSERVATIONS ON ITS DISEASES_, AND THEIR REMEDIES. Most of the facts which I shall deliver upon this subject, are the result of observations made during the term of five years, upon persons of both sexes, who had passed the 80th year of their lives. I intended to have given a detail of the names, manner of life, occupations, and other circumstances of each of them; but, upon a review of my notes, I found so great a sameness in the history of most of them, that I despaired, by detailing them, of answering the intention which I have purposed in the following essay. I shall, therefore, only deliver the facts and principles which are the result of the inquiries and observations I have made upon this subject. I. I shall mention the circumstances which favour the attainment of longevity. II. I shall mention the phenomena of body and mind which attend it; and, III. I shall enumerate its peculiar diseases, and the remedies which are most proper to remove, or moderate them. I. The circumstances which favour longevity, are, 1. _Descent from long-lived ancestors._ I have not found a single instance of a person, who has lived to be 80 years old, in whom this was not the case. In some instances I found the descent was only from one, but, in general, it was from both parents. The knowledge of this fact may serve, not only to assist in calculating what are called the chances of lives, but it may be made useful to a physician. He may learn from it to cherish hopes of his patients in chronic, and in some acute diseases, in proportion to the capacity of life they have derived from their ancestors[67]. [67] Dr. Franklin, who died in his 84th year, was descended from long-lived parents. His father died at 89, and his mother at 87. His father had 17 children by two wives. The doctor informed me, that he once sat down as one of 11 adult sons and daughters at his father's table. In an excursion he once made to that part of England from whence his family migrated to America, he discovered, in a grave-yard, the tomb-stones of several persons of his name, who had lived to be very old. These persons he supposed to have been his ancestors. 2. _Temperance in eating and drinking._ To this remark I found several exceptions. I met with one man of 84 years of age, who had been intemperate in eating; and four or five persons who had been intemperate in drinking ardent spirits. They had all been day-labourers, or had deferred drinking until they began to feel the languor of old age. I did not meet with a single person who had not, for the last forty or fifty years of their lives, used tea, coffee, and bread and butter twice a day as part of their diet. I am disposed to believe that those articles of diet do not materially affect the duration of human life, although they evidently impair the strength of the system. The duration of life does not appear to depend so much upon the strength of the body, or upon the quantity of its excitability, as upon an exact accommodation of stimuli to each of them. A watch spring will last as long as an anchor, provided the forces which are capable of destroying both, are always in an exact ratio to their strength. The use of tea and coffee in diet seems to be happily suited to the change which has taken place in the human body, by sedentary occupations, by which means less nourishment and stimulus are required than formerly, to support animal life. 3. The _moderate exercise of the understanding_. It has long been an established truth, that literary men (other circumstances being equal) are longer lived than other people. But it is not necessary that the understanding should be employed upon philosophical subjects to produce this influence upon human life. Business, politics, and religion, which are the objects of attention of men of all classes, impart a vigour to the understanding, which, by being conveyed to every part of the body, tends to produce health and long life. 4. _Equanimity of temper._ The violent and irregular action of the passions tends to wear away the springs of life. Persons who live upon annuities in Europe have been observed to be longer lived, in equal circumstances, than other people. This is probably occasioned by their being exempted, by the certainty of their subsistence, from those fears of want which so frequently distract the minds, and thereby weaken the bodies of old people. Life-rents have been supposed to have the same influence in prolonging life. Perhaps the _desire of life_, in order to enjoy for as long a time as possible, that property which cannot be enjoyed a second time by a child or relation, may be another cause of the longevity of persons who live upon certain incomes. It is a fact, that the desire of life is a very powerful stimulus in prolonging it, especially when that desire is supported by hope. This is obvious to physicians every day. Despair of recovery, is the beginning of death in all diseases. But obvious and reasonable as the effects of equanimity of temper are upon human life, there are some exceptions in favour of passionate men and women having attained to a great age. The morbid stimulus of anger, in these cases, was probably obviated by less degrees, or less active exercises of the understanding, or by the defect or weakness of some of the other stimuli which keep up the motions of life. 5. _Matrimony._ In the course of my inquiries I met with only one person beyond eighty years of age who had never been married. I met with several women who had borne from ten to twenty children, and suckled them all. I met with one woman, a native of Herefordshire, in England, who was in the 100th year of her age, who had borne a child at 60, menstruated till 80, and frequently suckled two of her children (though born in succession to each other) at the same time. She had passed the greatest part of her life over a washing-tub. 6. _Emigration._ I have observed many instances of Europeans who have arrived in America in the decline of life, who have acquired fresh vigour from the impression of our climate, and of new objects upon their bodies and minds; and whose lives, in consequence thereof, appeared to have been prolonged for many years. This influence of climate upon longevity is not confined to the United States. Of 100 European Spaniards, who emigrate to South-America in early life, 18 live to be above 50, whereas but 8 or 9 native Spaniards, and but 7 Indians of the same number, exceed the 50th year of human life. 7. I have not found _sedentary employments_ to prevent long life, where they are not accompanied by intemperance in eating or drinking. This observation is not confined to literary men, nor to women only, in whom longevity, without much exercise of body, has been frequently observed. I met with one instance of a weaver; a second of a silver-smith; and a third of a shoe-maker, among the number of old people, whose histories have suggested these observations. 8. I have not found that _acute_, nor that all _chronic_ diseases shorten human life. Dr. Franklin had two successive vomicas in his lungs before he was 40 years old. I met with one man beyond 80, who had survived a most violent attack of the yellow fever; a second who had had several of his bones fractured by falls, and in frays; and many who had been frequently affected by intermittents. I met with one man of 86, who had all his life been subject to syncope; another who had for 50 years been occasionally affected by a cough[68]; and two instances of men who had been afflicted for forty years with obstinate head-achs[69]. I met with only one person beyond 80, who had ever been affected by a disease in the _stomach_; and in him it arose from an occasional rupture. Mr. John Strangeways Hutton, of this city, who died in 1793, in the 109th year of his age, informed me, that he had never puked in his life. This circumstance is the more remarkable, as he passed several years at sea when a young man[70]. These facts may serve to extend our ideas of the importance of a healthy state of the stomach in the animal economy; and thereby to add to our knowledge in the prognosis of diseases, and in the chances of human life. [68] This man's only remedy for his cough was the fine powder of dry Indian turnip and honey. [69] Dr. Thiery says, that he did not find the itch, or slight degrees of the leprosy, to prevent longevity. Observations de Physique, et de Medecine faites en differens lieux de L'Espagne. Vol II. p. 17 i. [70] The venerable old man, whose history first suggested this remark, was born in New-York in the year 1684. His grandfather lived to be 101, but was unable to walk for thirty years before he died, from an excessive quantity of fat. His mother died at 91. His constant drinks were water, beer, and cyder. He had a fixed dislike to spirits of all kinds. His appetite was good, and he ate plentifully during the last years of his life. He seldom drank any thing between his meals. He was never intoxicated but twice in his life, and that was when a boy, and at sea, where he remembers perfectly well to have celebrated, by a feu de joye, the birth-day of queen Anne. He was formerly afflicted with the head-ach and giddiness, but never had a fever, except from the small-pox, in the course of his life. His pulse was slow, but regular. He had been twice married. By his first wife he had eight, and by his second seventeen children. One of them lived to be 83 years of age. He was about five feet nine inches in height, of a slender make, and carried an erect head to the last year of his life. 9. I have not found the _loss of teeth_ to affect the duration of human life, so much as might be expected. Edward Drinker, who lived to be 103 years old, lost his teeth thirty years before he died, from drawing the hot smoke of tobacco into his mouth through a short pipe. Dr. Sayre of New-Jersey, to whom I am indebted for several very valuable histories of old persons, mentions one man aged 81, whose teeth began to decay at 16, and another of 90, who lost his teeth, thirty years before he saw him. The gums, by becoming hard, perform, in part, the office of teeth. But may not the gastric juice of the stomach, like the tears and urine, become acrid by age, and thereby supply, by a more dissolving power, the defect of mastication from the loss of teeth? Analogies might easily be adduced from several operations of nature, which go forward in the animal economy, which render this supposition highly probable. 10. I have not observed _baldness_, or _grey hairs_, occurring in early or middle life, to prevent old age. In one of the histories furnished me by Dr. Sayre, I find an account of a man of 81, whose hair began to assume a silver colour when he was but one and twenty years of age. 11. More women live to be old than men, but more men live to be _very_ old, than women. I shall conclude this head by the following remark: Notwithstanding there appears in the human body a certain capacity of long life, which seems to dispose it to preserve its existence in every situation; yet this capacity does not always protect it from premature destruction; for among the old people whom I examined, I scarcely met with one who had not lost brothers or sisters, in early and middle life, and who were born under circumstances equally favourable to longevity with themselves. II. I now come to mention some of the phenomena of the body and mind which occur in old age. 1. There is a great sensibility to _cold_ in all old people. I met with an old woman of 84, who slept constantly under three blankets and a coverlet during the hottest summer months. The servant of prince de Beaufremont, who came from Mount Jura to Paris, at the age of 121, to pay his respects to the first national assembly of France, shivered with cold in the middle of the dog days, when he was not near a good fire. The national assembly directed him to sit with his hat on, in order to defend his head from the cold. 2. Impressions made upon the _ears_ of old people, excite sensation and reflection much quicker than when they are made upon their eyes. Mr. Hutton informed me, that he had frequently met his sons in the street without knowing them, until they had spoken to him. Dr. Franklin informed me, that he recognized his friends, after a long absence from them, first by their voices. This fact does not contradict the common opinion, upon the subject of memory, for the recollection, in these instances, is the effect of what is called reminiscence, which differs from memory in being excited only by the renewal of the impression which at first produced the idea which is revived. 3. The _appetite_ for food is generally increased in old age. The famous Parr, who died at 152, ate heartily in the last week of his life. The kindness of nature, in providing this last portion of earthly enjoyments for old people, deserves to be noticed. It is remarkable, that they have, like children, a frequent recurrence of appetite, and sustain with great uneasiness the intervals of regular meals. The observation, therefore, made by Hippocrates, that middle-aged people are more affected by abstinence than those who are old, is not true. This might easily be proved by many appeals to the records of medicine; but old people differ from children, in preferring _solid_ to liquid aliment. From inattention to this fact, Dr. Mead has done great mischief by advising old people, as their teeth decayed or perished, to lessen the quantity of their solid, and to increase the quantity of their liquid food. This advice is contrary to nature and experience, and I have heard of two old persons who destroyed themselves by following it. The circulation of the blood is supported in old people chiefly by the stimulus of aliment. The action of liquids of all kinds upon the system is weak, and of short continuance, compared with the durable stimulus of solid food. There is a gradation in the action of this food upon the body. Animal matters are preferred to vegetable; the fat of meat to the lean, and salted meat to fresh, by most old people. I have met with but few old people who retained an appetite for milk. It is remarkable, that a less quantity of _strong drink_ produces intoxication in old people than in persons in the middle of life. This depends upon the recurrence of the same state of the system, with respect to excitability, which takes place in childhood. Many old people, from an ignorance of this fact, have made shipwreck of characters which have commanded respect in every previous stage of their lives. From the same recurrence of the excitability of childhood in their systems, they commonly drink their tea and coffee much weaker than in early or middle life. 4. The _pulse_ is generally full, and frequently affected by pauses in its pulsations when felt in the wrists of old people. A regular pulse in such persons indicates a disease, as it shows the system to be under the impression of a preternatural stimulus of some kind. This observation was suggested to me above thirty years ago by Morgagni, and I have often profited by it in attending old people. The pulse in such patients is an uncertain mark of the nature, or degree of an acute disease. It seldom partakes of the quickness or convulsive action of the arterial system, which attends fever in young or middle-aged people. I once attended a man of 77 in a fever of the bilious kind, which confined him for eight days to his bed, in whom I could not perceive the least quickness or morbid action in his pulse until four and twenty hours before he died. 5. The marks of old age appear earlier, and are more numerous in persons who have combined with hard labour, a vegetable or scanty diet, than in persons who have lived under opposite circumstances. I think I have observed these marks of old age to occur sooner, and to be more numerous in the German, than in the English or Irish citizens of Pennsylvania. They are likewise more common among the inhabitants of country places, than of cities, and still more so among the Indians of North-America, than among the inhabitants of civilized countries. 6. Old men tread upon the _whole base_ of their feet at once in _walking_. This is perhaps one reason why they wear out fewer shoes, under the same circumstances of constant use, than young people, who, by treading on the posterior, and rising on the anterior part of their feet, expose their shoes to more unequal pressure and friction. The advantage derived to old people from this mode of walking is very obvious. It lessens that disposition to totter, which is always connected with weakness: hence we find the same mode of walking is adopted by habitual drunkards, and is sometimes from habit practised by them, when they are not under the influence of strong drink. 7. The breath and perspiration of old people have a peculiar acrimony, and their urine, in some instances, emits a f[oe]tor of an offensive nature. 8. The eyes of very old people sometimes change from a dark and blue, to a light colour. 9. The _memory_ is the first faculty of the mind which fails in the decline of life. While recent events pass through the mind without leaving an impression upon it, it is remarkable that the long forgotten events of childhood and youth are recalled and distinctly remembered. I met with a singular instance of a German woman, who had learned to speak the language of our country after she was forty years of age, who had forgotten every word of it after she had passed her 80th year, but spoke the German language as fluently as ever she had done. The memory decays soonest in hard drinkers. I have observed some studious men to suffer a decay of their memories, but never of their understandings. Among these was the late Anthony Benezet of this city. But even this infirmity did not abate the cheerfulness, nor lessen the happiness of this pious philosopher, for he once told me, when I was a young man, that he had a consolation in the decay of his memory, which gave him a great advantage over me. "You can read a good book (said he) with pleasure but _once_, but when I read a good book, I so soon forget the contents of it, that I have the pleasure of reading it over and over; and every time I read it, it is alike new and delightful to me." The celebrated Dr. Swift was one of those few studious men, who have exhibited marks of a decay of understanding in old age; but it is judiciously ascribed by Dr. Johnson to two causes which rescue books, and the exercise of the thinking faculties from having had any share in inducing that disease upon his mind. These causes were, a rash vow which he made when a young man, never to use spectacles, and a sordid seclusion of himself from company, by which means he was cut off from the use of books, and the benefits of conversation, the absence of which left his mind without its usual stimulus: hence it collapsed into a state of fatuity. It is probably owing to the constant exercise of the understanding, that literary men possess that faculty of the mind in a vigorous state in extreme old age. The same cause accounts for old people preserving their intellects longer in cities, than in country places. They enjoy society upon such easy terms in the former situation, that their minds are kept more constantly in an excited state by the acquisition of new, or the renovation of old ideas, by means of conversation. 10. I did not meet with a single instance in which the moral or religious faculties were impaired in old people. I do not believe, that these faculties of the mind are preserved by any supernatural power, but wholly by the constant and increasing exercise of them in the evening of life. In the course of my inquiries, I heard of a man of 101 years of age, who declared that he had forgotten every thing he had ever known, except his GOD. I found the moral faculty, or a disposition to do kind offices to be exquisitely sensible in several old people, in whom there was scarcely a trace left of memory or understanding. 11. Dreaming is universal among old people. It appears to be brought on by their imperfect sleep, of which I shall say more hereafter. 12. I mentioned formerly the sign of a _second childhood_ in the state of the appetite in old people. It appears further, 1. In the marks which slight contusions or impressions leave upon their skins. 2. In their being soon fatigued by walking or exercise, and in being as soon refreshed by rest. 3. In their disposition, like children, to detail immediately every thing they see and hear. And, 4. In their aptitude to shed tears; hence they are unable to tell a story that is in any degree distressing without weeping. Dr. Moore takes notice of this peculiarity in Voltaire, after he had passed his 80th year. He wept constantly at the recital of his own tragedies. This feature in old age, did not escape Homer. Old Menelaus wept ten years after he returned from the destruction of Troy, when he spoke of the death of the heroes who perished before that city. 13. It would be sufficiently humbling to human nature, if our bodies exhibited in old age the marks only of a second childhood; but human weakness descends still lower. I met with an instance of a woman between 80 and 90, who exhibited the marks of a _second infancy_, by such a total decay of her mental faculties, as to lose all consciousness in discharging her alvine and urinary excretions. In this state of the body, a disposition to sleep, succeeds the wakefulness of the first stages of old age. Dr. Haller mentions an instance of a very old man who slept twenty, out of every twenty-four hours during the few last years of his life. 14. The disposition in the system to _renew_ certain parts in extreme old age, has been mentioned by several authors. Many instances are to be met with in the records of medicine of the sight[71] and hearing having been restored, and even of the teeth having been renewed in old people a few years before death. These phenomena have led me to suspect that the antediluvian age was attained by the frequent renovation of different parts of the body, and that when they occur, they are an effort of the causes which support animal life, to produce antediluvian longevity, by acting upon the revived excitability of the system. [71] There is a remarkable instance of the sight having been restored after it had been totally destroyed in an old man near Reading, in Pennsylvania. My brother, Judge Rush, furnished me with the following account of him in a letter from Reading, dated June 23, 1792. "An old man, of 84 years of age, of the name of Adam Riffle, near this town, gradually lost his sight in the 68th year of his age, and continued entirely blind for the space of twelve years. About four years ago his sight returned, without making use of any means for the purpose, and without any visible change in the appearance of the eyes, and he now sees as well as ever he did. I have seen the man, and have no doubt of the fact. He is at this time so hearty, as to be able to walk from his house to Reading (about three miles), which he frequently does in order to attend church. I should observe, that during both the gradual loss, and recovery of his sight, he was no ways affected by sickness, but, on the contrary, enjoyed his usual health. I have this account from his daughter and son-in-law, who live within a few doors of me." 15. The _fear_ of death appears to be much less in old age, than in early, or middle life. I met with many old people who spoke of their dissolution with composure, and with some who expressed earnest desires to lie down in the grave. This indifference to life, and desire for death (whether they arise from a satiety in worldly pursuits and pleasures, or from a desire of being relieved from pain) appear to be a wise law in the animal economy, and worthy of being classed with those laws which accommodate the body and mind of man to all the natural evils, to which, in the common order of things, they are necessarily exposed. III. I come now briefly to enumerate the diseases of old age, and the remedies which are most proper to remove, or to mitigate them. The diseases are chronic and acute. The CHRONIC are, 1. _Weakness_ of the _knees_ and _ancles_, a lessened ability to walk, and tremors in the head and limbs. 2. _Pains in the bones_, known among nosological writers by the name of rheumatalgia. 3. _Involuntary flow of tears_, and of mucus from the nose. 4. _Difficulty of breathing_, and a short _cough_, with copious expectoration. A weak, or hoarse voice generally attends this cough. 5. _Costiveness._ 6. An _inability to retain the urine_ as long as in early or middle life. Few persons beyond 60 pass a whole night without being obliged to discharge their urine[72]. Perhaps the stimulus of this liquor in the bladder may be one cause of the universality of dreaming among old people. It is certainly a frequent cause of dreaming in persons in early and middle life: this I infer, from its occuring chiefly in the morning when the bladder is most distended with urine. There is likewise an inability in old people to discharge their urine as quickly as in early life. I think I have observed this to be among the first symptoms of the declension of the strength of the body by age. [72] I met with an old man, who informed me, that if from any accident he retained his urine after he felt an inclination to discharge it, he was affected by a numbness, accompanied by an uneasy sensation in the palms of his hands. 7. _Wakefulness._ This is probably produced in part by the action of the urine upon the bladder; but such is the excitability of the system in the first stages of old age, that there is no pain so light, no anxiety so trifling, and no sound so small, as not to produce wakefulness in old people. It is owing to their imperfect sleep, that they are sometimes as unconscious of the moment of their passing from a sleeping to a waking state, as young and middle-aged people are of the moment in which they pass from the waking to a sleeping state. Hence we so often hear them complain of passing sleepless nights. This is no doubt frequently the case, but I am satisfied, from the result of an inquiry made upon this subject, that they often sleep without knowing it, and that their complaints in the morning, of the want of sleep, arise from ignorance, without the least intention to deceive. 8. _Giddiness._ 9. _Deafness._ 10. _Imperfect vision._ The acute diseases most common among old people, are, 1. _Inflammation of the eyes._ 2. The _pneumonia notha_, or bastard peripneumony. 3. The _colic_. 4. _Palsy_ and _apoplexy_. 5. The _piles_. 6. A _difficulty in making water_. 7. _Quartan fever._ All the diseases of old people, both chronic and acute, originate in predisposing debility. The remedies for the former, where a feeble morbid action takes place in the system, are stimulants. The first of these is, I. HEAT. The ancient Romans prolonged life by retiring to Naples, as soon as they felt the infirmities of age coming upon them. The aged Portuguese imitate them, by approaching the warm sun of Brazil, in South-America. But heat may be applied to the torpid bodies of old people artificially. 1st. By means of the _warm bath_. Dr. Franklin owed much of the cheerfulness and general vigour of body and mind which characterised his old age, to his regular use of this remedy. It disposed him to sleep, and even produced a respite from the pain of the stone, with which he was afflicted during the last years of his life. 2. Heat may be applied to the bodies of old people by means of _stove-rooms_. The late Dr. Dewit, of Germantown, who lived to be near 100 years of age, seldom breathed an air below 72°, after he became an old man. He lived constantly in a stove-room. 3. WARM CLOTHING, more especially warm bed-clothes, are proper to preserve or increase the heat of old people. From the neglect of the latter, they are often found dead in their beds in the morning, after a cold night, in all cold countries. The late Dr. Chovet, of this city, who lived to be 85, slept in a baize night-gown, under eight blankets, and a coverlet, in a stove-room, many years before he died. The head should be defended in old people, by means of woollen, or fur caps, in the night, and by wigs and hats during the day, in cold weather. These artificial coverings will be the more necessary, where the head has been deprived of its natural covering. Great pains should be taken likewise to keep the feet dry and warm, by means of thick shoes[73]. To these modes of applying and confining heat to the bodies of old people, a young bed-fellow has been added; but I conceive the three artificial modes which have been recommended, will be sufficient without the use of one, which cannot be successfully employed without a breach of delicacy or humanity. [73] I met with one man above 80, who defended his feet from moisture by covering his shoes in wet weather with melted wax; and another who, for the same purpose, covered his shoes every morning with a mixture composed of the following ingredients melted together: lintseed oil a pound, mutton suet eight ounces, bees-wax six ounces, and rosin four ounces. The mixture should be moderately warmed, and then applied not only to the upper leather, but to the soles of the shoes. This composition, the old gentleman informed me, was extracted from a book entitled, "The Complete Fisherman," published in England, in the reign of queen Elizabeth. He had used it for twenty years in cold and wet weather, with great benefit, and several of his friends, who had tried it, spoke of its efficacy in keeping the feet dry, in high terms. II. To keep up the action of the system, GENEROUS DIET and DRINKS should be given to old people. For a reason mentioned formerly, they should be indulged in eating between the ordinary meals of families. Wine should be given to them in moderation. It has been emphatically called the milk of old age. III. YOUNG COMPANY should be preferred by old people to the company of persons of their own age. I think I have observed old people to enjoy better health and spirits, when they have passed the evening of their lives in the families of their children, where they have been surrounded by grand-children, than when they lived by themselves. Even the solicitude they feel for the welfare of their descendants, contributes to invigorate the circulation of the blood, and thereby to add fuel to the lamp of life. IV. GENTLE EXERCISE. This is of great consequence in promoting the health of old people. It should be moderate, regular, and always in fair weather. V. CLEANLINESS. This should by no means be neglected. The dress of old people should not only be clean, but more elegant than in youth or middle life. It serves to divert the eye of spectators from observing the decay and deformity of the body, to view and admire that which is always agreeable to it. VI. To abate the pains of the chronic rheumatism, and the uneasiness of the old man's cough (as it is called); also to remove wakefulness, and to restrain, during the night, a troublesome inclination to make water, OPIUM may be given with great advantage. Chardin informs us, that this medicine is frequently used in the eastern countries to abate the pains and weaknesses of old age, by those people who are debarred the use of wine by the religion of Mahomet. I have nothing to say upon the acute diseases of old people, but what is to be found in most of our books of medicine, except to recommend BLEEDING in those of them which are attended with plethora, and an inflammatory action in the pulse. The degrees of appetite which belong to old age, the quality of the food taken, and the sedentary life which is generally connected with it, all concur to produce that state of the system, which requires the above evacuation. I am sure that I have seen many of the chronic complaints of old people mitigated by it, and I have more than once seen it used with obvious advantage in their inflammatory diseases. These affections I have observed to be more fatal among old people than is generally supposed. An inflammation of the lungs, which terminated in an abscess, deprived the world of Dr. Franklin. Dr. Chovet died of an inflammation in his liver. The blood drawn from him a few days before his death was sizy, and such was the heat of his body, produced by his fever, that he could not bear more covering (notwithstanding his former habits of warm clothing) than a sheet in the month of January. Death from old age is the effect of a gradual palsy. It shows itself first in the eyes and ears, in the decay of sight and hearing; it appears next in the urinary bladder, in the limbs and trunk of the body; then in the sphincters of the bladder and rectum; and finally in the nerves and brain, destroying in the last, the exercise of all the faculties of the mind. Few persons appear to die of old age. Some one of the diseases which have been mentioned, generally cuts the last thread of life. END OF VOLUME I. * * * * * Transcriber's note: The original spelling and minor inconsistencies in the spelling and formatting have been maintained. Obvious misprints have been corrected. Partly repeated chapter headings have been deleted. The table on page 107 has been split to match the page size. 
58862	----	generously made available by Internet Archive (https://archive.org) Note: Project Gutenberg also has an HTML version of this file which includes the original illustrations. See 58862-h.htm or 58862-h.zip: (http://www.gutenberg.org/files/58862/58862-h/58862-h.htm) or (http://www.gutenberg.org/files/58862/58862-h.zip) Images of the original pages are available through Internet Archive. See https://archive.org/details/b21935142_0004 Project Gutenberg has the other three volumes of this work. Volume I: see http://www.gutenberg.org/ebooks/58859 Volume II: see http://www.gutenberg.org/ebooks/58860 Volume III: see http://www.gutenberg.org/ebooks/58861 Transcriber's note: The ligature oe has been marked as [oe]. Text in italics has been enclosed by underscores (_text_). MEDICAL INQUIRIES AND OBSERVATIONS. BY BENJAMIN RUSH, M. D. PROFESSOR OF THE INSTITUTES AND PRACTICE OF MEDICINE, AND OF CLINICAL PRACTICE, IN THE UNIVERSITY OF PENNSYLVANIA. IN FOUR VOLUMES. VOL. IV. THE SECOND EDITION, REVISED AND ENLARGED BY THE AUTHOR. PHILADELPHIA, PUBLISHED BY J. CONRAD & CO. CHESNUT-STREET, PHILADELPHIA; M. & J. CONRAD & CO. MARKET-STREET, BALTIMORE; RAPIN, CONRAD, & CO. WASHINGTON; SOMERVELL & CONRAD, PETERSBURG; AND BONSAL, CONRAD, & CO. NORFOLK. PRINTED BY T. & G. PALMER, 116, HIGH-STREET. 1805. * * * * * CONTENTS OF VOLUME IV. _page_ _An account of the bilious yellow fever, as it appeared in Philadelphia in 1797_ 1 _An account of the bilious yellow fever, as it appeared in Philadelphia in 1798_ 63 _An account of the bilious yellow fever, as it appeared in Philadelphia in 1799_ 89 _An account of sporadic cases of yellow fever, as they appeared in Philadelphia in 1800_ 101 _An account of sporadic cases of yellow fever, as they appeared in Philadelphia in 1801_ 109 _An account of the measles, as they appeared in Philadelphia in 1801_ 115 _An account of the yellow fever, as it appeared in 1802_ 121 _An account of the yellow fever, as it appeared in 1803_ 131 _An account of sporadic cases of yellow fever, as they appeared in 1804_ 145 _An account of the yellow fever, as it appeared in 1805_ 151 _An inquiry into the various sources of the usual forms of the summer and autumnal disease in the United States, and the means of preventing them_ 161 _Facts, intended to prove the yellow fever not to be contagious_ 221 _Defence of blood-letting, as a remedy in certain diseases_ 273 _An inquiry into the comparative states of medicine in Philadelphia, between the years 1760 and 1766, and 1805_ 363 * * * * * AN ACCOUNT OF THE BILIOUS REMITTING AND INTERMITTING _YELLOW FEVER_, AS IT APPEARED IN PHILADELPHIA, IN 1797. The winter of 1797 was in general healthy. During the spring, which was cold and wet, no diseases of any consequence occurred. The spring vegetables were late in coming to maturity, and there were every where in the neighbourhood of Philadelphia scanty crops of hay. In June and July there fell but little rain. Dysenteries, choleras, scarlatina, and mumps, appeared in the suburbs in the latter month. On the 8th of July I visited Mr. Frisk, and on the 25th of the same month I visited Mr. Charles Burrel in the yellow fever, in consultation with Dr. Physick. They both recovered by the use of plentiful depleting remedies. The weather from the 2d to the 9th of August was rainy. On the 1st of this month I was called to visit Mr. Nathaniel Lewis, in a malignant bilious fever. On the 3d I visited Mr. Elisha Hall, with the same disease. He had been ill several days before I saw him. Both these gentlemen died on the 6th of the month. They were both very yellow after death. Mr. Hall had a black vomiting on the day he died. The news of the death of these two citizens, with unequivocal symptoms of yellow fever, excited a general alarm in the city. Attempts were made to trace it to importation, but a little investigation soon proved that it was derived from the foul air of a ship which had just arrived from Marseilles, and which discharged her cargo at Pinestreet wharf, near the stores occupied by Mr. Lewis and Mr. Hall. Many other persons about the same time were affected with the fever from the same cause, in Water and Penn-streets. About the middle of the month, a ship from Hamburgh communicated the disease, by means of her foul air, to the village of Kensington. It prevailed, moreover, in many instances in the suburbs, and in Kensington, from putrid exhalations from gutters and marshy grounds, at a distance from the Delaware, and from the foul ships which have been mentioned. Proofs of the truth of each of these assertions were afterwards laid before the public. The disease was confined chiefly to the district of Southwark and the village of Kensington, for several weeks. In September and October, many cases occurred in the city, but most of them were easily traced to the above sources. The following account of the weather, during the months of August, September, and October was obtained from Mr. Thomas Pryor. It is different from the weather in 1793. It is of consequence to attend to this fact, inasmuch as it shows that an inflammatory constitution of the atmosphere can exist under different circumstances of the weather. It likewise accounts for the variety in the symptoms of the fever in different years and countries. Such is the influence of season and climate upon the symptoms of this fever, that it led Dr. M'Kitterick to suppose that the yellow fever of Charleston, so accurately described by Dr. Lining, in the second volume of the Physical and Literary Essays of Edinburgh, was a different disease from the yellow fever of the West-Indies[1]. [1] De Febre Indiæ-Occidentalis Maligna Flava, p. 12. METEOROLOGICAL OBSERVATIONS, _MADE IN PHILADELPHIA_. AUGUST, 1797. +--+-----+------+----------------------------------------------+ |D.|Ther.|Barom.| Winds and Weather. | +--+--+--+------+----------------------------------------------+ | 1|73|75|30 0|S. E. E. Rain in the forenoon and afternoon. | | 2|72|76|30 0|N. E. by E. Cloudy, with rain in the afternoon| | | | | | and night. Wind E. by N. | | 3|72|78|30 6|E. 1/2 N. Rain in the morning, and all day and| | | | | | night. | | 4|72|78|30 4|E. Rained hard all day and at night. | | 5|74|79|29 84|Wind light, S. W. Cloudy. Rain this morning. | | | | | | The air extremely damp; wind shifted | | | | | | to N. W. This evening heavy showers, | | | | | | with thunder. | | 6|73|76|30 86|W. N. W. Cloudy. | | 7|70|76|30 4|N. W. Close day. Rain in the evening and | | | | | | all night. Wind to E. | | 8|72|76|29 95|E. Rain this morning. | | 9|72|76|29 86|S. W. Cloudy morning. | |10|69|73|30 16|N. W. Clear. | |11|70|74|30 25|N. W. Clear. Rain all night. | |12|71|74|30 5|S. W. Cloudy. Rain in the morning. Cloudy | | | | | | all day. Rain at night. | |13|73|75|29 87|S. W. Cloudy. Rain all day. | |14|70|74|29 9|N. W. Clear fine morning. | |15|56|60|30 15|N. W. Clear fine morning. | |16|60|64|30 24|N. W. Clear fine morning. | |17|60|65|30 24|N. W. Air damp. | |18|68|75|30 4|S. W. Cloudy. Rain, with thunder at night: | | | | | | a fine shower. | |19|72|78|29 7|N. W. Clear. Cloudy in the evening, with | | | | | | thunder. | |20|70|77|29 8|W. N. W. Fine clear morning. | |21|74|76|29 9|N. W. Clear to E. | |22|68|76| |E. Small shower this morning. Hard shower | | | | | | at 11, A. M. Wind N. E. | |23|71|76|29 92|E. Cloudy. At noon calm. | |24|71|75|29 95|Calm morning and clear. | |25|70|75|30 5|N. E. Clear. Rain in the afternoon, with | | | | | | thunder. | |26|70|75|30 5|S. E. Rain in the morning. Rained hard in the | | | | | | night, with thunder, N. W. | |27|68|76|29 9|N. W. Fine clear morning. | |28|64|75|29 96|N. W. Clear. | |29|59|70|30 0|E. Clear. | |30|70|76|30 1|E. by S. Rain in the morning. | |31|68|74|30 14|S. E. Cloudy. Damp air and sultry. | +--+--+--+------+----------------------------------------------+ SEPTEMBER, 1797. +--+-----+------+----------------------------------------------+ |D.|Ther.|Barom.| Winds and Weather. | +--+-----+------+----------------------------------------------+ | 1|73|80|30 6|S. W. Cloudy. Damp air. Rain in the morning | | 2|79|80|29 9|N. W. Clear. Cloudy in the evening, with | | | | | | lightning to the southward. | | 3|68|74|30 0|N. by W. Cloudy. Clear in the afternoon and | | | | | | night. | | 4|66|74|30 7|W. N. W. Clear fine morning. | | 5|58|73|30 1|N. W. Clear. Cloudy in the evening. | | 6|58|72|30 13|Fresh at E. Clear. Rain in the evening. | | 7|56|76|30 28|E. Clear. Cloudy in the evening. | | 8|54|65|30 1|N. E. Clear and cool morning. Flying clouds at| | | | | | noon. | | 9|56|65|30 1|E. N. E. Clear. | |10|58|63|30 26|N. E. Clear fine morning. Wind fresh at N. E. | | | | | | all day. | |11|53|64|30 13|N. to E. with flying clouds. | |12|51|62|30 6|W. N. W. Clear cool morning. | |13|56|67|30 3|S. W. Cloudy. Clear in the afternoon. | |14|64|70|29 98|S. W. Clear. | |15|66|73|29 85|S. W. Rain in the morning. Cloudy in the | | | | | | afternoon. | |16|62|70|29 95|N. W. Clear. | |17|56|67|30 0|N. W. Clear. | |18|58|63|29 88|E. Cloudy. Rained all day, and thunder. | | | | |29 62| Rained very heavy at night. | |19|55|63|29 75|W. N. W. Clear fine morning. | |20|47|63|30 8|W. N. W. Clear fine morning. New moon | | | | | | at 9 50 morning. | |21|46|60|30 0|N. E. Clear fine morning; to S. E. in the | | | | | | evening. Cloudy at night. | |22|56|65|30 4|N. W. Rain in the morning. Rain at night. | |23|56|66|30 0|N. N. E. Cloudy. | |24|52|66|29 9|E. by S. Clear fine morning. Cloudy at night | | | | |29 78| | |25|56|68|29 37|W. N. W. Clear fine morning; clear all day. | |26|58|68|29 95|E. In the morning flying clouds. | |27|48|63|30 2|N. W. Clear fine morning; clear all day. | |28|48|63|30 2|W. N. W. Clear fine morning; clear all day. | |29|54|63|30 15|E. Clear fine morning. | |30|60|65|30 26|E. Fresh. Cloudy morning. Rain in the night | +--+--+--+------+----------------------------------------------+ OCTOBER, 1797. +--+-----+------+----------------------------------------------+ |D.|Ther.|Barom.| Winds and Weather. | +--+-----+------+----------------------------------------------+ | 1|55|65|30 16|N. E. Rain this morning, and great, part of | | | | | | the day. | | 2|55|66|30 0|N. W. Clear. | | 3|60|70|29 9|S. E. Clear. Air damp. | | 4|60|70|29 5|W. N. W. Rain this morning. | | 5|46|60|30 0|W. N. W. to S. by W. in the evening. Clear | | | | | | all day. White frost this morning. | | 6|55|65|30 0|S. W. Clear fine morning. White frost. | | 7|56|76|30 0|S. W. Cloudy. Rain in the night. | | 8|56|70|30 29|S. Cloudy this morning; air damp. Wind | | | | | | shifted to W. N. W. Blows fresh. | | 9|50|60|29 85|W. N. W. Clear morning. Fresh at N. W. | | | | | | in the evening. | |10|40|58|30 1|W. N. W. Clear. Frost this morning. | |11|38|56|30 2|W. N. W. Cloudy. | |12|34|52|30 38|W. N. W. Clear. Ice this morning. | |13|35|55|30 5|N. Clear fine morning. Ice this morning. | |14|40|60|30 28|N. E. Cloudy. | |15|50|65|30 16|W. N. W. Clear. | |16|36|56|30 2|W. N. W. Clear fine morning. | |17|37|56|30 18|W. N. W. Clear fine morning. | |18|47|60|29 86|W. N. W. Clear fine weather. | |19|48|60|30 6|N. W. Clear fine day. | |20|42|55|30 8|N. E. Cloudy. Rain in the afternoon and | | | | | | night. Blows fresh at N. E. | |21|42|50|29 92|N. E. Blows fresh (with a little rain). | | | | | | Thunder in the night, with rain. | |22|44|56|29 57|N. W. Rain in the morning. | |23|44|56|29 95|S. W. Clear fine morning. | |24|42|54|30 5|N. E. Cloudy. A great deal of rain in the | | | | | | night. | |25|40|52|30 15|N. E. Clear fine morning. | |26|36|48|30 29|W. N. W. Clear. | |27|34|46|30 23|Fresh at S. W. Clear. | |28|40|52|29 95|W. N. W. Cloudy. | |29|34|46|29 82|W. Cloudy. | |30|32|42|29 93|N. W. Clear. Hard frost this morning. | |31|38|48|30 18|W. S. W. Cloudy part of this day; clear the | | | | | | remainder. | +--+--+--+------+----------------------------------------------+ In addition to the register of the weather it may not be improper to add, that moschetoes were more numerous during the prevalence of the fever than in 1793. An unusual number of ants and cockroaches were likewise observed; and it was said that the martins and swallows disappeared, for a while, from the city and its neighbourhood. A disease prevailed among the cats some weeks before the yellow fever appeared in the city. It excited a belief in an unwholesome state of the atmosphere, and apprehensions of a sickly fall. It generally proved fatal to them. After the first week in September there were no diseases to be seen but yellow fever. In that part of the town which is between Walnut and Vine-streets it was uncommonly healthy. A similar retreat of inferior diseases has been observed to take place during the prevalence of the plague in London, Holland, and Germany, according to the histories of that disease by Sydenham, Diemerbroeck, Sennertus, and Hildanus. It appears, from the register of the weather, that it rained during the greatest part of the day on the 1st of October. The effects of this rain upon the disease shall be mentioned hereafter. On the 10th the weather became cool, and on the nights of the 12th and 13th of the month there was a frost accompanied with ice, which appeared to give a sudden and complete check to the disease. The reader will probably expect an account of the effects of this distressing epidemic upon the public mind. The terror of the citizens for a while was very great. Rumours of an opposite and contradictory nature of the increase and mortality of the fever were in constant circulation. A stoppage was put to business, and it was computed that about two thirds of the inhabitants left the city. The legislature of the state early passed a law, granting 10,000 dollars for the relief of the sufferers by the fever. The citizens in and out of town, as also many of the citizens of our sister states, contributed more than that sum for the same charitable purpose. This money was issued by a committee appointed by the governor of the state. An hospital for the reception of the poor was established on the east side of the river Schuylkill, and amply provided with every thing necessary for the accommodation of the sick. Tents were likewise pitched on the east side of Schuylkill, to which all those people were invited who were exposed to the danger of taking the disease, and who had not means to provide a more comfortable retreat for themselves in the country. I am sorry to add that the moral effects of the fever upon the minds of our citizens were confined chiefly to these acts of benevolence. Many of the publications in the newspapers upon its existence, mode of cure, and origin partook of a virulent spirit, which ill accorded with the distresses of the city. It was a cause of lamentation likewise to many serious people, that the citizens in general were less disposed, than in 1793, to acknowledge the agency of a divine hand in their afflictions. In some a levity of mind appeared upon this solemn occasion. A worthy bookseller gave me a melancholy proof of this assertion, by informing me, that he had never been asked for playing cards so often, in the same time, as he had been during the prevalence of the fever. Philadelphia was not the only place in the United States which suffered by the yellow fever. It prevailed, at the same time, at Providence, in Rhode-Island, at Norfolk, in Virginia, at Baltimore, and in many of the country towns of New-England, New-Jersey, and Pennsylvania. The influenza followed the yellow fever, as it did in the year 1793. It made its appearance in the latter end of October, and affected chiefly those citizens who had been out of town. The predisposing causes of the yellow fever, in the year 1797, were the same as in the year 1793. Strangers were as usual most subject to it. The heat of the body in such persons, in the West-Indies, has been found to be between three and four degrees above that of the temperature of the natives. This fact is taken notice of by Dr. M'Kitterick, and to this he ascribes, in part, the predisposition of new comers to the yellow fever. In addition to the common exciting causes of this disease formerly enumerated, I have only to add, that it was induced in one of my patients by smoking a segar. He had not been accustomed to the use of tobacco. I saw no new premonitory symptoms of this fever except a tooth-ach. It occurred in Dr. Physick, Dr. Caldwell, and in my pupil, Mr. Bellenger. In Miss Elliot there was such a soreness in her teeth, that she could hardly close her mouth on the day in which she was attacked by the fever. Neither of these persons had taken mercury to obviate the disease. I shall now deliver a short account of the symptoms of the yellow fever, as they appeared in several of the different systems of the body. I. There was but little difference in the state of the pulse in this epidemic from what has been recorded in the fevers of 1793 and 1794. I perceived a pulse, in several cases, which felt like a soft quill which had been _shattered_ by being trodden upon. It occurred in Dr. Jones and Dr. Dobell, and in several other persons who had been worn down by great fatigue, and it was, in every instance, followed by a fatal issue of the fever. In Dr. Jones this state of the pulse was accompanied with such a difficulty of breathing, that every breath he drew, on the day of his attack, he informed me, was the effort of a sigh. He died on the 17th of September, and on the sixth day of his fever. The action of the arteries was, as usual, very irregular in many cases. In some there was a distressing throbbing of the vessels in the brain, and in one of my patients a similar sensation in the bowels, but without pain. Many people had issues of blood from their blisters in this fever. I saw nothing new in the effects of the fever upon the liver, lungs, brain, nor upon the stomach and bowels. II. The excretions were distinguished by no unusual marks. I met with no recoveries where there were not black stools. They excoriated the rectum in Dr. Way. It was a happy circumstance where morbid bilious matter came away in the beginning of the disease. But it frequently resisted the most powerful cathartics until the 5th or 7th day of the fever, at which time it appeared rather to yield to the disorganization of the liver than to medicine. Where sufficient blood-letting had been previously used, the patient frequently recovered, even after the black discharges from the bowels took place in a late stage of the disease. Dr. Coxe informed me, that he attended a child of seventeen months old which had _white_ stools for several days. Towards the close of its disease it had black stools, and soon afterwards died. Several of my patients discharged worms during the fever. In one instance they were discharged from the mouth. A preternatural frequency in making pale water attended the first attack of the disease in Mr. Joseph Fisher. A discharge of an unusual quantity of urine preceded, a few hours, the death of the daughter of Mrs. Read. In two of my patients there was a total suppression of urine. In one of them it continued five days without exciting any pain. There was no disposition to sweat after the first and second days of the fever. Even in those states of the fever, in which the intermissions were most complete, there was seldom any moisture, or even softness on the skin. This was so characteristic of malignity in the bilious fever, that where I found the opposite state of the skin, towards the close of a paroxysm, I did not hesitate to encourage my patient, by assuring him that his fever was of a mild nature, and would most probably be safe in its issue. III. I saw no unusual marks of the disease in the nervous system. The mind was seldom affected by delirium after the loss of blood. There was a disposition to shed tears in two of my patients. One of them wept during the whole time of a paroxysm of the fever. In one case I observed an uncommon dulness of apprehension, with no other mark of a diseased state of the mind. It was in a man whose faculties, in ordinary health, acted with celerity and vigour. Dr. Caldwell informed me of a singular change which took place in the operations of his mind during his recovery from the fever. His imagination carried him back to an early period of his life, and engaged him, for a day or two, in playing with a bow and arrow, and in amusements of which he had been fond when a boy. A similar change occurred in the mind of my former pupil, Dr. Fisher, during his convalescence from the yellow fever in 1793. He amused himself for two days in looking over the pictures of a family Bible which lay in his room, and declared that he found the same kind of pleasure in this employment that he did when a child. However uninteresting these facts may now appear, the time will come when they may probably furnish useful hints for completing the physiology and pathology of the mind. Where blood-letting had not been used, patients frequently died of convulsions. IV. The senses of seeing and feeling were impaired in several cases. Mrs. Bradford's vision was so weak that she hardly knew her friends at her bed-side. I had great pleasure in observing this alarming symptom suddenly yield to the loss of four ounces of blood. Several persons who died of this fever did not, from the beginning to the end of the disease, feel any pain. I shall hereafter endeavour to explain the cause of this insensible state of the nerves. The appetite for food was unimpaired for three days in Mr. Andrew Brown, at a time when his pulse indicated a high grade of the fever. I heard of several persons who ate with avidity just before they died. V. Glandular swellings were very uncommon in this fever. I should have ascribed their absence to the copious use of depleting remedies in my practice, had I not been informed that morbid affections of the lymphatic glands were unknown in the city hospital, where blood-letting was seldom used, and where the patients, in many instances, died before they had time to take medicine of any kind. VI. The skin was cool, dry, smooth, and even shining in some cases. Yellowness was not universal. Those small red spots, which have been compared to moscheto bites, occurred in several of my patients. Dr. John Duffield, who acted as house surgeon and apothecary at the city hospital, informed me that he saw vibices on the skin in many cases, and that they were all more or less sore to the touch. VII. The blood was dissolved in a few cases. That appearance of the blood, which has been compared to the washings of flesh, was very common. It was more or less sizy towards the close of the disease in most cases. I have suspected, from this circumstance, that this mark of ordinary morbid action or inflammation was in part the effect of the mercury acting upon the blood-vessels. It is well known that sizy blood generally accompanies a salivation. If this conjecture be well founded, it will not militate against the use of mercury in malignant fevers, for it shows that this valuable medicine possesses a power of changing an extraordinary and dangerous degree of morbid action in the blood-vessels to that which is more common and safe. I have seldom seen a yellow fever terminate fatally after the appearance of sizy blood. Dr. Stewart informed me, that in those cases in which the serum of the blood had a yellow colour, it imparted a saline taste only to his tongue. He was the more struck with this fact, as he perceived a strong bitter state upon his skin, in a severe attack of the yellow fever in 1793. I proceed next to take notice of the type of the fever. In many cases, it appeared in the form of a remitting and intermitting fever. The quotidian and tertian forms were most common. In Mr. Robert Wharton, it appeared in the form of a quartan. But it frequently assumed the character which is given of the same fever in Charleston, by Dr. Lining. It came on without chills, and continued without any remission for three days, after which the patient believed himself to be well, and sometimes rose from his bed, and applied to business. On the fourth or fifth day, the fever returned, and unless copious evacuations had been used in the early stage of the disease, it generally proved fatal. Sometimes the powers of the system were depressed below the return of active fever, and the patient sunk away by an easy death, without pain, heat, or a quick pulse. I have been much puzzled to distinguish a crisis of the fever on the third or fourth day, from the insidious appearance which has been described. It deceived me in 1793. It may be known by a preternatural coolness in the skin, and languor in the pulse, by an inability to sit up long without fatigue or faintness, by a dull eye, and by great depression of mind, or such a flow of spirits as sometimes to produce a declaration from the patient that "he feels too well." Where these symptoms appear, the patient should be informed of his danger, and urged to the continuance of such remedies as are proper for him. The following states or forms were observable in the fever: 1. In a few cases, the miasmata produced death in four and twenty hours, with convulsions, coma, or apoplexy. 2. There were _open_ cases, in which the pulse was full and tense as in a pleurisy or rheumatism, from the beginning to the end of the fever. They were generally attended with a good deal of pain. 3. There were _depressed_ or _locked_ cases, in which there were a sense of great debility, but little or no pain, a depressed and slow pulse, a cool skin, cold hands and feet, and obstructed excretions. 4. There were _divided_ or _mixed_ cases, in which the pulse was active until the 4th day, after which it became depressed. All the other symptoms of the locked state of the fever accompanied this depressed state of the pulse. 5. There were cases in which the pulse imparted a perception like that of a soft and _shattered_ quill. I have before mentioned that this state of the pulse occurred in Dr. Jones and Dr. Dobell. I felt it but once, and on the day of his attack, in the latter gentleman, and expressed my opinion of his extreme danger to one of my pupils upon my return from visiting him. I did not meet with a case which terminated favourably, where I perceived this _shattered_ pulse. A disposition to sweat occurred in this state of the fever. 6. There were what Dr. Caldwell happily called _walking_ cases. The patients here were flushed or pale, had a full or tense pulse, but complained of no pain, had a good appetite, and walked about their rooms or houses, as if they were but little indisposed, until a day or two, and, in some instances, until a few hours before they died. We speak of a _dumb_ gout and _dumb_ rheumatism; with equal propriety, the epithet might be applied to this form of yellow fever in its early stage. The impression of the remote cause of the fever, in these cases, was beyond sensation, for, upon removing a part of it by bleeding or purging, the patients complained of pain, and the excitement of the muscles passed so completely into the blood-vessels and alimentary canal, as to convert the fever into a common and more natural form. These cases were always dangerous, and, when neglected, generally terminated in death. Mr. Brown's fever came on in this insidious shape. It was cured by the loss of upwards of 100 ounces of blood, and a plentiful salivation. 7. There was the _intermitting_ form in this fever. This, like the last, often deceived the patient, by leading him to suppose his disease was of a common or trifling nature. It prevented Mr. Richard Smith from applying for medical aid in an attack of the fever for several days, by which means it made such an impression upon his viscera, that depleting remedies were in vain used to cure him. He died in the prime of life, beloved and lamented by a numerous circle of relations and friends. 8. There was a form of this fever in which it resembled the mild remittent of common seasons. It was distinguished from it chiefly by the black colour of the intestinal evacuations. 9. There were cases of this fever so light, that patients were said to be neither _sick_ nor _well_; or, in other words, they were sick and well half a dozen times in a day. Such persons walked about, and transacted their ordinary business, but complained of dulness, and, occasionally, of shooting pains in their heads. Sometimes the stomach was affected with sickness, and the bowels with diarrh[oe]a or costiveness. All of them complained of night sweats. The pulse was quicker than natural, but seldom had that convulsive action which constitutes fever. Purges always brought away black stools from such patients, and this circumstance served to establish its relationship to the prevailing epidemic. Now and then, by neglect or improper treatment, it assumed a higher and more dangerous grade of the fever, and became fatal, but it more commonly yielded to nature, or to a single dose of purging physic. 10. There were a few cases in which the skin was affected with universal yellowness, but without more pain or indisposition than usually occurs in the jaundice. They were very frequent in the year 1793, and generally prevail in the autumn, in all places subject to bilious fever. 11. There were _chronic_ cases of this fever. It is from the want of observation that physicians limit the duration of the yellow fever to certain days. I have seen many instances in which it has been protracted into what is called by authors a slow nervous fever. The wife of captain Peter Bell died with a black vomiting after an illness of nearly one month. Dr. Pinckard, formerly one of the physicians of the British army in the West-Indies, in a late visit to this city informed me, that he had often seen the yellow fever put on a chronic form in the West-India islands. In delivering this detail of the various forms of the yellow fever, I am aware that I oppose the opinions of many of my medical brethren, who ascribe to it a certain uniform character, which is removed beyond the influence of climate, habit, predisposition, and the different strength and combinations of remote and exciting causes. This uniformity in the symptoms of this fever is said to exist in the West-Indies, and every deviation from it in the United States is called by another name. The following communication, which I received from Dr. Pinckard, will show that this disease is as different in its forms in the West-Indies as it is in this country. "The yellow fever, as it appeared among the troops in Guiana and the West-India islands, in the years 1796 and 1797, exhibited such perpetual instability, and varied so incessantly in its character, that I could not discover any one symptom to be decidedly diagnostic; and hence I have been led into an opinion that the yellow fever, so called, is not a distinct or specific disease, but merely an aggravated degree of the common remittent or bilious fever of hot climates, rendered irregular in form, and augmented in malignity, from appearing in subjects unaccustomed to the climate. _Philadelphia, January 12th, 1798._" Many other authorities equally respectable with Dr. Pinckard's, among whom are Pringle, Huck, and Hunter, might be adduced in support of the unity of bilious fever. But to multiply them further would be an act of homage to the weakness of human reason, and an acknowledgment of the infant state of our knowledge in medicine. As well might we suppose nature to be an artist, and that diseases were shaped by her like a piece of statuary, or a suit of clothes, by means of a chissel, or pair of scissars, as admit every different form and grade of morbid action in the system to be a distinct disease. Notwithstanding the fever put on the eleven forms which have been described, the moderate cases were few, compared with those of a malignant and dangerous nature. It was upon this account that the mortality was greater in the same number of patients, who were treated with the same remedies, than it was in the years 1793 and 1794. The disease, moreover, partook of a more malignant character than the two epidemics that have been mentioned. The yellow fever in Norfolk, Drs. Taylor and Hansford informed me, in a letter I received from them, was much more malignant and fatal, under equal circumstances, than it was in 1795. There were evident marks of the disease attacking more persons three days before, and three days after the _full_ and _change_ of the moon, and of more deaths occurring at those periods than at any other time. The same thing has been remarked in the plague by Diemerbroeck, in the fevers of Bengal by Dr. Balfour, and in those of Demarara by Dr. Pinckard. During the prevalence of the fever I attended the following persons who had been affected by the epidemic of 1793, viz. Dr. Physick, Thomas Leaming, Thomas Canby, Samuel Bradford, and George Loxley, also Mrs. Eggar, who had a violent attack of it in the year 1794. Samuel Bradford was likewise affected by it in 1794. During my intercourse with the sick, I felt the miasmata of the fever operate upon my system in the most sensible manner. It produced languor, a pain in my head, and sickness at my stomach. A sighing attended me occasionally, for upwards of two weeks. This symptom left me suddenly, and was succeeded by a hoarseness, and, at times, with such a feebleness in my voice as to make speaking painful to me. Having observed this affection of the trachea to be a precursor of the fever in several cases, it kept me under daily apprehensions of being confined by it. It gradually went off after the first of October. I ascribed my recovery from it, and a sudden diminution of the effects of the miasmata upon my system, to a change produced in the atmosphere by the rain which fell on that day. The peculiar matter emitted by the breath or perspiration of persons affected by this fever, induced a sneezing in Dr. Dobell, every time he went into a sick room. Ambrose Parey says the same thing occurred to him, upon entering the room of patients confined by the plague. The gutters emitted, in many places, a sulphureous smell during the prevalence of the fever. Upon rubbing my hands together I could at any time excite a similar smell in them. I have taken notice of this effect of the matters which produced the disease upon the body, in the year 1794. In order to prevent an attack of the fever, I carefully avoided all its exciting causes. I reduced my diet, and lived sparingly upon tea, coffee, milk, and the common fruits and garden vegetables of the season, with a small quantity of salted meat, and smoked herring. My drinks were milk and water, weak claret and water, and weak porter and water. I sheltered myself as much as possible from the rays of the sun, and from the action of the evening air, and accommodated my dress to the changes in the temperature of the atmosphere. By similar means, I have reason to believe, many hundred people escaped the disease, who were constantly exposed to it. The number of deaths by the fever, in the months of August, September, and October, amounted to between ten and eleven hundred. In the list of the dead were nine practitioners of physic, several of whom were gentlemen of the most respectable characters. This number will be thought considerable when it is added, that not more than three or four and twenty physicians attended patients in the disease. Of the survivors of that number, eight were affected with the fever. This extraordinary mortality and sickness among the physicians must be ascribed to their uncommon fatigue in attending upon the sick, and to their inability to command their time and labours, so as to avoid the exciting causes of the fever. Among the medical gentlemen whose deaths have been mentioned, was my excellent friend, Dr. Nicholas Way. I shall carry to my grave an affectionate remembrance of him. We passed our youth together in the study of medicine, and lived to the time of his death in the habits of the tenderest friendship. In the year 1794, he removed from Wilmington, in the Delaware state, to Philadelphia, where his talents and manners soon introduced him into extensive business. His independent fortune furnished his friends with arguments to advise him to retire from the city, upon the first appearance of the fever. But his humanity prevailed over the dictates of interest and the love of life. He was active and intelligent in suggesting and executing plans to arrest the progress of the disease, and to lessen the distresses of the poor. On the 27th of August, he was seized, after a ride from the country in the evening air, with a chilly fit and fever. I saw him the next day, and advised the usual depleting remedies. He submitted to my prescriptions with reluctance, and in a sparing manner, from an opinion that his fever was nothing but a common remittent. To enforce obedience to my advice, I called upon Dr. Griffitts to visit him with me. Our combined exertions to overcome his prejudices against our remedies were ineffectual. At two o'clock in the afternoon, on the sixth day of his disease, with an aching heart I saw the sweat of death upon his forehead, and felt his cold arm without a pulse. He spoke to me with difficulty: upon my rising from his bed-side to leave him, his eyes filled with tears, and his countenance spoke a language which I am unable to describe. I promised to return in a short time, with a view of attending the last scene of his life. Immediately after I left his room, he wept aloud. I returned hastily to him, and found him in convulsions. He died a few hours afterwards. Had I met with no other affliction in the autumn of 1797 than that which I experienced from this affecting scene, it would have been a severe one; but it was a part only of what I suffered from the death of other friends, and from the malice of enemies. I beg the reader's pardon for this digression. It shall be the last time and place in which any notice shall be taken of my sorrows and persecutions in the course of these volumes. Soon after the citizens returned from the country, the governor of the state, Mr. Mifflin, addressed a letter to the college of physicians of Philadelphia, requesting to know the origin, progress, and nature of the fever which had recently afflicted the city, and the means of preventing its return. He addressed a similar letter to me, to be communicated to such gentlemen of the faculty of medicine, as were not members of the college of physicians. The college, in a memorial to the legislature of the state, asserted that the fever had been imported in two ships, the one from Havannah, the other from Port au Prince, and recommended, as the most effectual means of preventing its recurrence, a more rigid quarantine law. The gentlemen of the faculty of medicine, thirteen in number, in two letters to the governor of the state, the one in their private capacity, and the other after they had associated themselves into an "Academy of Medicine," asserted that the fever had originated from the putrid exhalations from the gutters and streets of the city, and from ponds and marshy grounds in its neighbourhood; also from the foul air of two ships, the one from Marseilles and the other from Hamburgh. They enumerated all the common sources of malignant fevers, and recommended the removal of them from the city, as the most effectual method of preventing the return of the fever. These sources of fever, and the various means of destroying them, shall be mentioned in another place. I proceed now to say a few words upon the treatment which was used in this fever. It was, in general, the same as that which was pursued in the fevers of 1793 and 1794. I began the cure, in most cases, by _bleeding_, when I was called on the first day of the disease, and was happy in observing its usual salutary effects in its early stage. On the second day, it frequently failed of doing service, and on the subsequent days of the fever, I believe, it often did harm; more especially if no other depleting remedy had preceded it. The violent action of the blood-vessels in this disease, when left to itself for two or three days, fills and suffocates the viscera with such an immense mass of blood, as to leave a quantity in the vessels so small, as barely to keep up the actions of life. By abstracting but a few ounces of this circulating blood, we precipitate death. In those cases where a doubt is entertained of such an engorgement of stagnating blood having taken place, it will always be safest to take but three or four ounces at a time, and to repeat it four or five times a day. By this mode of bleeding, we give the viscera an opportunity of emptying their superfluous blood into the vessels, and thereby prevent their collapsing, from the sudden abstraction of the stimulus which remained in them. I confine this observation upon bleeding, after the first stage of the disease, only to the epidemic of 1797. It was frequently effectual when used for the first time after the first and second days, in the fevers of 1793 and 1794, and it is often useful in the advanced stage of the common bilious fever. The different and contradictory accounts of the effects of bleeding in the yellow fever, in the West-Indies, probably originate in its being used in different stages of the disease. Dr. Jackson, of the British army, in his late visit to Philadelphia, informed me, that he had cured nineteen out of twenty of all the soldiers whom he attended, by copious bleeding, provided it was performed within six hours after the attack of the fever. Beyond that period, it mitigated its force, but seldom cured. The quantity of blood drawn by the doctor, in this early stage of the disease, was always from twenty to thirty ounces. I have said the yellow fever of 1797 was more malignant than the fevers of 1793 and 1794. Its resemblance to the yellow fever in the West-Indies, in not yielding to bleeding after the first day, is a proof of this assertion. I was struck, during my attendance upon this fever, in observing the analogy between its _mixed_ form and the malignant state of the small-pox. The fever, in both, continues for three or four days without any remission. They both have a second stage, in which death usually takes place, if the diseases be left to themselves. By means of copious bleeding in their first, they are generally deprived of their malignity and mortality in their second stage. This remark, so trite in the small-pox, has been less attended to in the yellow fever. The bleeding in the first stage of this disease does not, it is true, destroy it altogether, any more than it destroys an eruption in the second stage of the small-pox, but it weakens it in such a manner that the patient passes through its second stage without pain or danger, and with no other aid from medicine than what is commonly derived from good nursing, proper aliment, and a little gently opening physic. It is common with those practitioners who object to bleeding in the yellow fever, to admit it occasionally in _robust_ habits. This rule leads to great error in practice. From the weak action of predisposing, or exciting causes, the disease often exists in a feeble state in such habits, while from the protracted or violent operation of the same causes, it appears in great force in persons of delicate constitutions. A physician, therefore, in prescribing for a patient in this fever, should forget the natural strength of his muscles, and accommodate the loss of blood wholly to the morbid strength of his disease. The quantity of blood drawn in this fever was always proportioned to its violence. I cured many by a single bleeding. A few required the loss of upwards of a hundred ounces of blood to cure them. The persons from whom that large quantity of blood was taken, were, Messieurs Andrew Brown, Horace Hall, George Cummins, J. Ramsay, and George Eyre. But I was not singular in the liberal and frequent use of the lancet. The following physicians drew the quantities of blood annexed to their respective names from the following persons, viz. Dr. Dewees 176 ounces from Dr. Physick, Dr. Griffitts 110 Mr. S. Thomson, Dr. Stewart 106 Mrs. M'Phail, Dr. Cooper 150 Mr. David Evans, Dr. Gillespie 103 himself. All the above named persons had a rapid and easy recovery, and now enjoy good health. I lost but one patient who had been the subject of early and copious bleeding. His death was evidently induced by a supper of beef-stakes and porter, after he had exhibited the most promising signs of convalescence. OF PURGING. From the great difficulty that was found in discharging bile from the bowels, by the common modes of administering purges, Dr. Griffitts suggested to me the propriety of giving large doses of calomel, without jalap or any other purging medicine, in order to loosen the bile from its close connection with the gall-bladder and duodenum, during the first day of the disease. This method of discharging acrid bile was found useful. I observed the same relief from large evacuations of f[oe]tid bile, in the epidemic of 1797, that I have remarked in the fever of 1793. Mr. Bryce has taken notice of the same salutary effects from similar evacuations, in the yellow fever on board the Busbridge Indiaman, in the year 1792. His words are: "It was observable, that the more dark-coloured and f[oe]tid such discharges were, the more early and certainly did the symptoms disappear. Their good effects were so instantaneous, that I have often seen a man carried up on deck, perfectly delirious with subsultus tendinum, and in a state of the greatest apparent debility, who, after one or two copious evacuations of this kind, has returned of himself, and astonished at his newly acquired strength[2]." Very different are the effects of tonic remedies, when given to remove this apparent debility. The clown who supposes the crooked appearance of a stick, when thrust into a pail of water, to be real, does not err more against the laws of light, than that physician errs against a law of the animal economy, who mistakes the debility which arises from oppression for an exhausted state of the system, and attempts to remove it by stimulating medicines. [2] Annals of Medicine, p. 123. After unlocking the bowels, by means of calomel and jalap, in the beginning of the fever, I found no difficulty afterwards in keeping them gently open by more lenient purges. In addition to those which I have mentioned in the account of the fever of 1793, I yielded to the advice of Dr. Griffitts, by adopting the soluble tartar, and gave small doses of it daily in many cases. It seldom offended the stomach, and generally operated, without griping, in the most plentiful manner. However powerful bleeding and purging were in the cure of this fever, they often required the aid of a _salivation_ to assist them in subduing it. Besides the usual methods of introducing mercury into the system, Dr. Stewart accelerated its action, by obliging his patients to wear socks filled with mercurial ointment; and Dr. Gillespie aimed at the same thing, by injecting the ointment, in a suitable vehicle, into the bowels, in the form of glysters. The following fact, communicated to me by Dr. Stewart, will show the safety of large doses of calomel in this fever. Mrs. M'Phail took 60 grains of calomel, by mistake, at a dose, after having taken three or four doses, of 20 grains each, on the same day. She took, in all, 356 grains in six days, and yet, says the doctor, "such was the state of her stomach and intestines, that that large quantity was retained without producing the least griping, or more stools than she had when she took three grains every two hours." I observed the mercury to affect the mouth and throat in the following ways. 1. It sometimes produced a swelling only in the throat, resembling a common inflammatory angina. 2. It sometimes produced ulcers upon the lips, cheeks, and tongue, without any discharge from the salivary glands. 3. It sometimes produced swellings and ulcers in the gums, and loosened the teeth without inducing a salivation. 4. There were instances in which the mercury induced a rigidity in the masseter muscles of the jaw, by which means the mouth was kept constantly open, or so much closed, as to render it difficult for the patient to take food, and impossible for him to masticate it. 5. It sometimes affected the salivary glands only, producing from them a copious secretion and excretion of saliva. But, 6. It more frequently acted upon all the above parts, and it was then it produced most speedily its salutary effects. 7. The discharge of the saliva frequently took place only during the remission or intermission of the fever, and ceased with each return of its paroxysms. 8. The salivation did not take place, in some cases, until the solution of the fever. This was more especially the case in those forms of the fever in which there were no remissions or intermissions. 9. It ceased in most cases with the fever, but it sometimes continued for six weeks or two months after the complete recovery of the patient. 10. The mercury rarely dislodged the teeth. Not a single instance occurred of a patient losing a tooth in the city hospital, where the physicians, Dr. J. Duffield informed me, relied chiefly upon a salivation for a cure of the fever. 11. Sometimes the mercury produced a discharge of blood with the saliva. Dr. Coulter, of Baltimore, gave me an account, in a letter dated the 17th of September, 1797, of a boy in whom a hæmorrhage from the salivary glands, excited by calomel, was succeeded by a plentiful flow of saliva, which saved his patient. I saw no inconvenience from the mixture of blood with saliva in any of my patients. It occurred in Dr. Caldwell, Mr. Bradford, Mr. Brown, and several others. It has been said that mercury does no service unless it purges or salivates. I am disposed to believe that it may act as a counter stimulus to that of the miasmata of the yellow fever, and thus be useful without producing any evacuation from the bowels or mouth. It more certainly acts in this way, provided blood-letting has preceded its exhibition. I have supposed the stimulus from the remote cause of the yellow fever to be equal in force to five, and that of mercury to three. To enable the mercury to produce its action upon the system, it is necessary to reduce the febrile action, by bleeding, to two and a half, or below it, so that the stimulus of the mercury shall transcend it. The safety of mercury, when introduced into the system, has three advantages as a stimulus over that of the matter which produces the fever. 1. It excites an action in the system preternatural only in _force_. It does not derange the _natural_ order of actions. 2. It determines the actions chiefly to external parts of the body. And, 3. It fixes them, when it affects the mouth and throat, upon parts which are capable of bearing great inflammation and effusion without any danger to life. The stimulus which produces the yellow fever acts in ways the reverse of those which have been mentioned. It produces violent _irregular_ or _wrong_ actions. It determines them to internal parts of the body, and it fixes them upon viscera which bear, with difficulty and danger, the usual effects of disease. A late French writer, Dr. Fabre, ascribed to diseases a centrifugal, and a centripetal direction. From what has been said it would seem, the former belongs to mercury, and the latter to the yellow fever. Considering the great prejudices against blood-letting, I have wished to combat this fever with mercury alone. But, for reasons formerly given, I have been afraid to trust to it without the assistance of the lancet. The character of the fever, moreover, like that which the poet has ascribed to Achilles, is of "so swift, irritable, inexorable, and cruel" a nature, that it would be unsafe to rely exclusively upon a medicine which is not only of less efficacy than bleeding, but often slow and uncertain in its operation, _more especially_ upon the throat and mouth. Let not the reader be offended at my attempts to reason. I am aware of the evils which the weak and perverted exercise of this power of the mind has introduced into medicine. But let us act with the same consistency upon this subject that we do in other things. We do not consign a child to its cradle for life, because it falls in its first unsuccessful efforts to use its legs. In like manner we must not abandon reason, because, in our first efforts to use it, we have been deceived. A single just principle in our science will lead to more truth, in one year, than whole volumes of uncombined facts will do in a century. I lost but two patients in this epidemic in whom the mercury excited a salivation. One of them died from the want of nursing; the other by the late application of the remedy. OF EMETICS. It was said a practitioner, who was opposed to bleeding and mercury, cured this fever by means of strong emetics. I gave one to a man who refused to be bled. It operated freely, and brought on a plentiful sweat. The next day he arose from his bed, and went to his work. On the fourth day he sent for me again. My son visited him, and found him without a pulse. He died the next day. I heard of two other persons who took emetics in the beginning of the fever, without the advice of a physician, both of whom died. Dr. Pinckard informed me, that their effects were generally hurtful in the violent grades of the yellow fever in the West-Indies. The same information has since been given to me by Dr. Jackson. In the second and third grades of the bilious fever they appear not only to be safe, but useful. OF DIET AND DRINKS. The advantages of a weak vegetable diet were very great in this fever. I found but little difficulty, in most cases, in having my prohibition of animal food complied with before the crisis of the fever, but there was often such a sudden excitement of the appetite for it, immediately afterwards, that it was difficult to restrain it. I have mentioned the case of a young man, who was upon the recovery, who died in consequence of supping upon beef-stakes. Many other instances of the mortality of this fever from a similar cause, I believe, occurred in our epidemic, which were concealed from our physicians. I am not singular in ascribing the death of convalescents to the too early use of animal food. Dr. Poissonnier has the following important remark upon this subject. "The physicians of Brest have observed, that the relapses in the malignant fever, which prevailed in their naval hospitals, were as much the effect of a fault in the diet of the sick as of the contagious air to which they were exposed, and that as many patients perished from this cause as from the original fever. For this reason light soups, with leguminous vegetables in them, panada, rice seasoned with cinnamon, fresh eggs, &c. are all that they should be permitted to eat. The use of flesh should be forbidden for many days after the entire cure of the disorder[3]." [3] Maladies de Gens de Mer, vol. i. p. 345. Dr. Huxham has furnished another evidence of the danger from the premature use of animal food, in his history of a malignant fever which prevailed at Plymouth, in the year 1740. "If any one (says the doctor) made use of a flesh or fish diet, before he had been very well purged, and his recovery confirmed, he infallibly indulged himself herein at the utmost danger of his life[4]." [4] Epidemics, vol. ii. p. 67. In addition to the mild articles of diet, mentioned by Dr. Poissonnier, I found bread and milk, with a little water, sugar, and the pulp of a roasted apple mixed with it, very acceptable to my patients during their convalescence. Oysters were equally innocent and agreeable. Ripe grapes were devoured by them with avidity, in every stage of the fever. The season had been favourable to the perfection of this pleasant fruit, and all the gardens in the city and neighbourhood in which it was cultivated were gratuitously opened by the citizens for the benefit of the sick. The drinks were, cold water, toast and water, balm tea, water in which jellies of different kinds had been dissolved, lemonade, apple water, barley and rice water, and, in cases where the stomach was affected with sickness or puking, weak porter and water, and cold camomile tea. In the convalescent stage of the fever, and in such of its remissions or intermissions as were accompanied with great languor in the pulse, wine-whey, porter and water, and brandy and water, were taken with advantage. Cold water applied to the body, cool and fresh air, and cleanliness, produced their usual good effects in this fever. In the external use of cold water, care was taken to confine it to such cases as were accompanied with preternatural heat, and to forbid it in the cold fit of the fever, and in those cases which were attended with cold hands and feet, and where the disease showed a disposition to terminate, in its first stage, by a profuse perspiration. It has lately given me great pleasure to find the same practice, in the external use of cold water in fevers, recommended by Dr. Currie of Liverpool, in his medical reports of the effects of water, cold and warm, as a remedy in febrile diseases. Of the benefit of fresh air in this fever, Dr. Dawson of Tortola has lately furnished me with a striking instance. He informed me, that by removing patients from the low grounds on that island, where the fever is generated, to a neighbouring mountain, they generally recovered in a few days. Finding a disagreeable smell to arise from vinegar sprinkled upon the floor, after it had emitted all its acid vapour, I directed the floors of sick rooms to be sprinkled only with water. I found the vapour which arose from it to be grateful to my patients. A citizen of Philadelphia, whose whole family recovered from the fever, thought he perceived evident advantages from tubs of fresh water being kept constantly in the sick rooms. OF TONIC REMEDIES. There were now and then remissions and intermissions of the fever, accompanied with such signs of danger from debility, as to render the exhibition of a few drops of laudanum, a little wine-whey, a glass of brandy and water, and, in some instances, a cup of weak chicken-broth, highly necessary and useful. In addition to these cordial drinks, I directed the feet to be placed in a tub of warm water, which was introduced under the bed-clothes, so that the patient was not weakened by being raised from a horizontal posture. All these remedies were laid aside upon the return of a paroxysm of fever. I did not prescribe bark in a single case of this disease. An infusion of the quassia root was substituted in its room, in several instances, with advantage. _Blisters_ were applied as usual, but, from the insensibility of the skin, they were less effectual than applications of mustard to the arms and legs. It is a circumstance worthy of notice, that while the stomach, bowels, and even the large blood-vessels are sometimes in a highly excited state, and overcharged, as it were, with life, the whole surface of the body is in a state of the greatest torpor. To attempt to excite it by internal remedies is like adding fuel to a chimney already on fire. The excitement of the blood-vessels, and the circulation of the blood, can only be equalized by the application of stimulants to the skin. These, to be effectual, should be of the most powerful kind. Caustics might probably be used in such cases with advantage. I am led to this opinion by a fact communicated to me by Dr. Stewart. A lighted candle, which had been left on the bed of a woman whom he was attending in the apparent last stage of the yellow fever, fell upon her breast. She was too insensible to feel, or too weak to remove it. Before her nurse came into her room, it had made a deep and extensive impression upon her flesh. From that time she revived, and in the course of a few days recovered. As a tonic remedy in this fever, Dr. Jackson has spoken to me in high terms of the good effects of riding in a carriage. Patients, he informed me, who were moved with difficulty, after riding a few miles were able to sit up, and, when they returned from their excursions, were frequently able to walk to their beds. Much has been said, of late years, in favour of the application of warm olive oil to the body in the plague, and a wish has been expressed, by some people, that its efficacy might be tried in the yellow fever. Upon examining the account of this remedy, as published by Mr. Baldwin, three things suggest themselves to our notice. 1. That the oil is effectual only in the _forming_ state of the disease; 2. That the friction which is used with it contributes to excite the torpid vessels of the skin; and 3. That it acts chiefly by depleting from the pores of the body. From the unity of the remedy of depletion, it is probable purging or bleeding might be substituted to the expensive parade of the sweat induced by the warm oil, and the smoke of odoriferous vegetables. But I must not conceal here, that there are facts which favour an idea, that oil produces a sedative action upon the blood-vessels, through the medium of the skin. Bontius says it is used in this manner in the East-Indies, for the cure of malignant fevers, after the previous use of bleeding and purging. It seems to have been a remedy well known among the Jews; hence we find the apostle James advises its being applied to the body, in addition to the prayers of the elders of the church[5]. It is thus in other cases, the blessings of Heaven are conveyed to men through the use of natural means. [5] Chapter v. verse 14. During the existence of the premonitory symptoms, and before patients were confined to their rooms, a gentle purge, or the loss of a few ounces of blood, in many hundred instances, prevented the formation of the fever. I did not meet with a single exception to this remark. Fevers are the affliction chiefly of poor people. To prevent or to cure them, remedies must be cheap, and capable of being applied with but little attendance. From the affinity established by the Creator between evil and its antidotes, in other parts of his works, I am disposed to believe no remedy will ever be effectual in any general disease, that is not cheap, and that cannot easily be made universal. It is to be lamented that the greatest part of all the deaths which occur, are from diseases that are under the power of medicine. To prevent their fatal issue, it would seem to be agreeable to the order of Heaven in other things, that they should be attacked in their forming state. Weeds, vermin, public oppression, and private vice, are easily eradicated and destroyed, if opposed by their proper remedies, as soon as they show themselves. The principal obstacle to the successful use of the antidotes of malignant fevers, in their early stage, arises from physicians refusing to declare when they appear in a city, and from their practice of calling their mild forms by other names than that of a mortal epidemic. I shall now say a few words upon the success of the depleting practice in this epidemic. From the more malignant state of the fever, and from the fears and prejudices that were excited against bleeding and mercury by means of the newspapers, the success of those remedies was much less than in the years 1793 and 1794. Hundreds refused to submit to them at the _time_, and in the _manner_, that were necessary to render them effectual. From the publications of a number of physicians, who used the lancet and mercury in their greatest extent, it appears that they lost but one in ten of all they attended. It was said of several practitioners who were opposed to copious bleeding, that they lost a much smaller proportion of their patients with the prevailing fever. Upon inquiry, it appeared they had lost many more. To conceal their want of success, they said their patients had died of other diseases. This mode of deceiving the public began in 1793. The men who used it did not recollect, that it is less in favour of a physician's skill to lose patients in pleurisies, colics, hæmorrhages, contusions, and common remittents, than in a malignant yellow fever. Dr. Sayre attended fifteen patients in the disease, all of whom recovered by the plentiful use of the depleting remedies. His place of residence being remote from those parts of the city in which the fever prevailed most, prevented his being called to a greater number of cases. A French physician, who bled and purged _moderately_, candidly acknowledged that he saved but three out of four of his patients. In the city hospital, where bleeding was sparingly used, and where the physicians depended chiefly upon a salivation, more than one half died of all the patients who were admitted. It is an act of justice to the physicians of the hospital to add, that many, perhaps most of their patients, were admitted _after_ the first day of the disease. I cannot conclude this comparative view of the success of the different modes of treating the yellow fever, without taking notice, that the stimulating mode, as recommended by Dr. Kuhn and Dr. Stevens, in the year 1793, was deserted by every physician in the city. Dr. Stevens acknowledged the disease to require a different treatment from that which it required in the West-Indies; Dr. Kuhn adopted the lancet and mercury in his practice; and several other physicians, who had written against those remedies, or who had doubted of their safety and efficacy, in 1793, used them with confidence, and in the most liberal manner, in 1797. In the histories I have given of the yellow fevers of 1793 and 1794, I have scattered here and there a few observations upon their degrees of danger, and the signs of their favourable or unfavourable issue. I shall close the present history, by collecting those observations into one view, and adding to them such other signs as have occurred to me in observing this epidemic. Signs of moderate danger, and a favourable issue of the yellow fever. 1. A chilly fit accompanying the attack of the fever. The longer this chill continues, the more favourable the disease. 2. The recurrence of chills every day, or twice a day, or every other day, with the return of the exacerbations of the fever. A coldness of the whole body, at the above periods, without chills, a coldness with a profuse sweat, cold feet and hands, with febrile heat in other parts of the body, and a profuse sweat without chills or coldness, are all less favourable symptoms than a regular chilly fit, but they indicate less danger than their total absence during the course of the fever. 3. A puking of _green_ or _yellow_ bile on the first day of the disease is favourable. A discharge of black bile, if it occur on the _first_ day of the fever, is not unfavourable. 4. A discharge of green and yellow stools. It is more favourable if the stools are of a dark or black colour, and of a f[oe]tid and acrid nature, on the first or second day of the fever. 5. A softness and moisture on the skin in the beginning of the fever. 6. A sense of pain in the head, or a sudden translation of pain from internal to external parts of the body, particularly to the back. An increase of pain after bleeding. 7. A sore mouth. 8. A moist white, or a yellow tongue. 9. An early disposition to spit freely, whether excited by nature or the use of mercury. 10. Blood becoming sizy, after having exhibited the usual marks of great morbid action in the blood-vessels. 11. Great and exquisite sensibility in the sense of feeling coming on near the close of the fever. 12. Acute pains in the back and limbs. 13. The appearance of an inflammatory spot on a finger or toe, Dr. H. M'Clen says, is favourable. It appears, the doctor says, as if the cause of the fever had escaped by explosion. Signs of great danger, and of an unfavourable issue of the yellow fever are, 1. An attack of the fever, suddenly succeeding great terror, anger, or the intemperate use of venery, or strong drink. 2. The first paroxysm coming on without any premonitory symptoms, or a chilly fit. 3. A coldness over the whole body without chills for two or three days. 4. A sleepiness on the first and second days of the fever. 5. Uncommon paleness of the face not induced by blood-letting. 6. Constant or violent vomiting, without any discharge of bile. 7. Obstinate costiveness, or a discharge of natural, or white stools; also quick, watery stools after taking drink. 8. A diarrh[oe]a towards the close of the fever. I lost two patients, in 1797, with this symptom, who had exhibited, a few days before, signs of a recovery. Dr. Pinckard informed me, that it was generally attended with a fatal issue in the yellow fever of the West-Indies. Diemerbroeck declares, that "scarcely one in a hundred recovered, with this symptom, from the plague[6]." [6] Lib. i. cap. 15. 9. A suppression of urine. It is most alarming when it is without pain. 10. A discharge of dark-coloured and bloody urine. 11. A cold, cool, dry, smooth, or shining skin. 12. The appearance of a yellow colour in the face on the first or second day of the fever. 13. The absence of pain, or a sudden cessation of it, with the common symptoms of great danger. 14. A disposition to faint upon a little motion, and fainting after losing but a few ounces of blood. 15. A watery, glassy, or brilliant eye. A red eye on the fourth or fifth day of the disease. It is more alarming if it become so after having been previously yellow. 16. Imperfect vision, and blindness in the close of the disease. 17. Deafness. 18. A preternatural appetite, more especially in the last stage of the fever. 19. A slow, intermitting, and shattered pulse. 20. Great restlessness, delirium, and long continued coma. 21. A discharge of coffee-coloured or black matter from the stomach, after the fourth day of the fever. 22. A smooth red tongue, covered with a lead-coloured crust, while its edges are of a bright red. 23. A dull vacant face, expressive of distress. 24. Great insensibility to common occurrences, and an indifference about the issue of the disease. 25. Uncommon serenity of mind, accompanied with an unusually placid countenance. I shall conclude this head by the following remarks: 1. The violence, danger, and probable issue of this fever, seem to be in proportion to the duration and force of the predisposing and exciting causes. However steady the former are in bringing on debility, and the latter in acting as irritants upon accumulated excitability, yet a knowledge of their duration and force is always useful, not only in forming an opinion of the probable issue of the fever, but in regulating the force of remedies. 2. The signs of danger vary in different years, from the influence of the weather upon the disease. 3. Notwithstanding the signs of the favourable and unfavourable issue of the fever are in general uniform, when the cure of the disease is committed to nature, or to tonic medicines, yet they are far from being so when the treatment of the fever is taken out of the hands of nature, and attempted by the use of depleting remedies. We often see patients recover with nearly all the unfavourable symptoms that have been mentioned, and we sometimes see them die, with all those that are favourable. The words of Morellus, therefore, which he has applied to the plague, are equally true when applied to the yellow fever. "In the plague, our senses deceive us. Reason deceives us. The aphorisms of Hippocrates deceive us[7]." An important lesson may be learned from these facts, and that is, never to give a patient over. On the contrary, it is our duty in this, as well as in all other acute diseases, to dispute every inch of ground with death. By means of this practice, which is warranted by science, as well as dictated by humanity, the grave has often been deprived for a while of its prey, and a prelude thereby exhibited of that approaching and delightful time foretold by ancient prophets, when the power of medicine over diseases shall be such, as to render old age the only outlet of human life. [7] De Feb. Pestilent. cap. v. "Acutorum morborum incertæ admodum, ac fallaces sunt prædictiones." HIPPOCRATES. AN ACCOUNT OF THE _BILIOUS YELLOW FEVER_, AS IT APPEARED IN PHILADELPHIA, IN THE YEAR 1798. The yellow fever of the year 1797 was succeeded by scarlatina, catarrhs, and bilious pleurisies, in the months of November and December of the same year. The weather favoured the generation of the latter diseases. It became suddenly cold about the middle of November. On the 5th of December, the navigation of the Delaware was obstructed. There was a thaw on the 13th and 14th of this month, but not sufficient to open the river. In the month of January, 1798, the fevers discovered an uncommon determination to the brain. Four cases of the hydrocephalic state of fever occurred under my care during this month, all of which yielded to depleting remedies. The subjects of this state of fever were Mr. Robert Lewis, and the daughters of Messrs. John Brooks, Andrew Ellicott, and David Maffat. The weather was variable during the months of February and March. The navigation of the Delaware was not completely opened until the latter end of February. The diseases of these two months were catarrhs and bilious pleurisies. The former were confined chiefly to children, and were cured by gentle pukes, purges of calomel, and blood-letting. The last remedy was employed twice in a child of Isaac Pisso, of six weeks old, and once in a child of Thomas Billington, of three weeks old, with success. On the 7th of April, I visited Mr. Pollock, lately from the state of Georgia, in consultation with Dr. Physick, in a yellow fever. He died the evening after I saw him, on the third day of his disease. There was a snow storm on the 16th of April, and the weather was afterwards very cold. Such leaves and blossoms as had appeared, were injured by it. On the 1st of May, the mercury in Fahrenheit's thermometer rose to 84°. The weather, during the latter part of this month, and in June, was very dry. On the 6th of June, Dr. Cooper lost a patient in the yellow fever, near the corner of Twelfth and Walnut-streets. Mark Miller died with the same state of fever on the 2d of July. About a dozen cases of a similar nature occurred, under the care of different practitioners, between the 2d and 20th of this month, and all of them in parts of the city remote from Water-street. On the 19th of July, the weather was so cool as to render winter clothes comfortable. A severe hail storm had occurred, a few days before, in the neighbourhood of Wilmington, in the Delaware state. On the 21st of the month, the ship Deborah arrived from one of the West-India islands, and discharged her cargo in the city. She was moored afterwards at Kensington, where the foul air which was emitted from her hold produced several cases of yellow fever, near the shores of that village. In August the disease appeared in nearly every part of the city, and particularly in places where there was the greatest exhalation from foul gutters and common sewers. In describing the disease, as it appeared this year, I shall take notice of its symptoms as they appeared in the blood-vessels, alimentary canal, the tongue, the nervous system, in the eyes, the lymphatic system, and the blood. The subjects which furnished the materials for this history were not only private patients, but the poor in the city hospital, who were committed to the care of Dr. Physick and myself, by the board of health. I. The pulse was, in many cases, less active in the beginning of this fever than in former years. It was seldom preternaturally slow. It resembled the pulse which occurs in the first stage of the common jail fever. Hæmorrhages were common about the fourth and fifth days, and generally from the gums, throat, or stomach. II. The whole alimentary canal was much affected in most cases. Costiveness and a vomiting were general. The alvine discharges were occasionally green, dark-coloured, black, and natural. The black vomiting was more common this year than in former years, in all the forms of the fever. It was sometimes suspended for several days before death, and hopes were entertained of a recovery of patients in whom it had appeared. In a boy, at the city hospital, it ceased ten days before he died. It was sometimes succeeded by delirium or coma, but it more commonly left the patient free of pain, and in the possession of all the faculties of his mind. III. The tongue was by no means an index of the state of the fever, as in the years 1793 and 1797. I saw several deaths, attended with a black vomiting, in which the tongue retained a natural appearance. This phenomenon at first deceived me. I ascribed it to such a concentration of the disease in the stomach and other vital parts, as to prevent its diffusing itself through the external parts of the system. We observe the effects of the same cause in a natural state of the skin, and in a natural appearance of the urine, in the most malignant forms of this fever. IV. In the nervous system, the disease appeared with several new symptoms. A relation of Peter Field attempted to bite his attendants in the delirium of his fever, just before he died. I attended a young woman at Mrs. Easby's, who started every time I touched her pulse. Loud talking, or a question suddenly proposed to her, produced the same convulsive motion. She retained her reason during the whole of her illness, and was cured by bleeding and a salivation. Hiccup was a common symptom. I saw but two patients recover who had it. In one of them, Dr. Hedges, it came on after the sixth day of the fever, and continued, without any other symptom of disease, for four or five days. I lost a patient who complained of no pain but in the calves of his legs. Dr. Physick lost a girl, in the city hospital, who complained only of pains in her toes. Her stomach discovered, after death, strong marks of inflammation. Many people passed through every stage of the disease, without uttering a complaint of pain of any kind. An uncommon stiffness in the limbs preceded death a few hours, in several cases. This stiffness ceased, in one of Dr. Physick's patients, immediately after death, but returned as soon as he became cold. An obstinate wakefulness continued through the whole of the disease in Dr. Leib. It was common during the convalescence, in many cases. The whole body was affected, in many cases, with a morbid sensibility, or what has been called supersensation, so that patients complained of pain upon being touched, when they were moved in their beds. This extreme sensibility was general in parts to which blisters had been applied. It continued through every stage of the disease. Dr. Physick informed me, that he observed it in a man two hours before he died. In this man there was an absence of pulse, and a coldness of his extremities. Upon touching his wrist, he cried out, as if he felt great pain. V. A redness in the eyes was a general symptom. I saw few recoveries where this redness was not removed. A discharge of matter from one ear relieved Mr. J. C. Warren from a distressing pulsation of the arteries in his head. VI. Glandular swellings occurred in several instances. Two cases of them came under my notice. They both terminated favourably. VII. The blood had its usual appearances in this disease. In the yellow fever which prevailed at the same time in Boston, Dr. Rand says the blood was sizy in but one out of a hundred cases. The forms of the fever were nearly similar to those which have been described in the year 1797. I saw several cases in which the disease appeared in the form of a tertian fever. In one of them it terminated in death. The system, in many cases, was prostrated below the point of inflammatory re-action. These were called, by some practitioners, typhous fevers. It was the most dangerous and fatal form of the disease. Its frequent occurrence gave occasion to a remark, that our epidemic resembled the yellow fever of the West-Indies, much more than the fevers of 1793 and 1797. I attended two patients in whom the disease was protracted nearly to the 30th day. They both recovered. Dr. Francis Sayre informed me, that he saw a child, in which the morbid affection of the wind-pipe, called cynanche trachealis, appeared with all the usual symptoms of yellow fever. I attended one case in which the force of the disease was weakened, in its first stage, by a profuse hæmorrhage from the bowels. This hæmorrhage was followed by a bloody diarrh[oe]a, which continued for four or five weeks. Persons of all ages and colours were affected by this fever. I saw a case of it in a child of six months old. In the blacks, it was attended with less violence and mortality than in white people. It affected many persons who had previously had it. The disease was excited by the same causes which excited it in former years. I observed a number of people to be affected by the fever, who lived in solitude in their houses, without doing any business. The system, in these persons, was predisposed to the disease, by the debility induced by ceasing to labour at their former occupations. It was excited in a young man by a fractured leg. He died five days afterwards, with a black vomiting. I observed, in several instances, an interval of four and five days between the debility induced upon the system by a predisposing, and the action of an exciting cause. Dr. Clark says, he has seen an interval of several weeks between the operation of those causes, in the yellow fever of Dominique. These facts are worthy of notice, as they lead to a protracted use of the means of obviating an attack of the disease. During my attendance upon the sick, I twice perceived in my system the premonitory signs of the epidemic. Its complete formation was prevented each time by rest, a moderate dose of physic, and a plentiful sweat. I shall now take notice of the different manner in which patients died of this fever. The detail may be useful, by unfolding new principles in the animal economy, as well as new facts in the history of the disease. 1. The disease terminated in death, in some instances, by means of convulsions. 2. By delirium, which prompted to exertions and actions similar to those which take place in madness. 3. By profuse hæmorrhages from the gums. This occurred in two patients of Dr. Stewart. 4. By an incessant vomiting and hiccup. 5. By extreme pain in the calves of the legs and toes, which, by destroying the excitement of the system, destroyed life. 6. By a total absence of pain. In this way it put an end to the life of Mr. Henry Hill. 7. By a disposition to easy, and apparently natural sleep. I have reason to believe that Mr. Hill encouraged this disposition to sleep, a few hours before he died, under the influence of a belief that he would be refreshed by it. Diemerbroeck says the plague often killed in the same way. 8. The mind was in many cases torpid, where no delirium attended, and death was submitted to with a degree of insensibility, which was often mistaken for fortitude and resignation. I shall now mention the morbid appearances exhibited by the bodies of persons who died of this fever, as communicated to me by my friend, Dr. Physick; being the result of numerous dissections made by him at the city hospital. In all of them the stomach was inflamed. The matter which constitutes what is called the _black vomit_, was found in the stomachs of several patients who had not discharged it at any time by vomiting. In some stomachs, he found lines which seemed to separate the living from their dead parts. Those parts, though dead, were not always in a mortified state. They were distinguished from the living parts by a peculiar paleness, and by discovering a weak texture upon being pressed between the fingers. He observed the greatest marks of inflammation in the stomachs of several persons in whom there had been no vomiting, during the whole course of the disease. The brain, in a few instances, discovered marks of inflammation. Water was now and then found in its ventricles, but always of its natural colour, even in those persons whose skins were yellow. The liver suffered but little in this disease. It may serve to increase our knowledge of the influence of local circumstances upon epidemics to remark, that this viscus, which was rarely diseased in the fever of Philadelphia in 1798, discovered marks of great inflammation in the bodies which were examined by Dr. Rand and Dr. Warren, in the town of Boston, where the yellow fever prevailed at the same time it did in Philadelphia. The weather was hot and dry in August and September, during the prevalence of this fever. Its influence upon animal and vegetable life are worthy of notice. Moschetoes abounded, as usual in sickly seasons; grasshoppers covered the ground in many places; cabbages and other garden vegetables, and even fields of clover, were devoured by them. Peaches ripened this year three weeks sooner than in ordinary summers, and apples rotted much sooner than usual after being gathered in the autumn. Many fruit-trees blossomed in October, and a second crop of small apples and cherries were seen in November, on the west side of Schuylkill, near the city. Meteors were observed in several places. On the 29th of September there was a white frost. Its effects upon the fever were obvious and general. It declined, in every part of the city, to such a degree as to induce many people to return from the country. In the beginning of October the weather again became warm, and the disease revived. It was observable, that all great changes in the weather from heat to cold that were short of frost, or of cold to heat, increased the mortality of the fever. It spread most rapidly in moist weather. The origin of this fever was from the exhalations of gutters, docks, cellars, common sewers, ponds of stagnating water, and from the foul air of the ship formerly mentioned. The fever prevailed at the same time in the town of Chester, in Pennsylvania; in Wilmington, in the state of Delaware; in New-York; in New-London, in Connecticut; in Windsor, in Vermont; and in Boston; in all which places its origin was traced to domestic sources. I shall now deliver a short account of the remedies employed in the cure of this disease. I have said that the pulse was less active in this fever than in the fevers of former years. It was seldom, however, so feeble as to forbid bleeding. In Dr. Mease it called for the loss of 162 ounces of blood, and in Mr. J. C. Warren for the loss of 200, by successive bleedings, before it was subdued. But such cases were not common. In most of them, the pulse flagged after two or three bleedings. But there were cases in which the lancet was forbidden altogether. In these, the system appeared to be prostrated, by the force of the miasmata, below the point of re-action. This state of the disease manifested itself in a weak, quick, and frequent pulse, languid eye, sighing, great inquietude, or great insensibility. However unsafe bleeding was on the first day of this fever, when it appeared with those symptoms, nature often performed that operation upon herself from the gums, on the fourth or fifth day. I saw several pounds of blood discharged on those days, and in that way, with the happiest effects. It appeared to take place after the revival of the blood-vessels from their prostrated state. From a conviction that the system was depressed only in these cases, and finding that it did not rise upon blood-letting, I resolved to try the effects of emetics, in exciting and equalizing the action of the blood-vessels. The experience I had had of the inefficacy of this remedy in 1793, and of its ill effects in one instance in 1797, led me to exhibit it with a trembling hand. I gave it for the first time to a son of Richard Renshaw. I had bled him but once, and had in vain tried to bring on a salivation. On the fifth day of his disease, his pulse became languid and slow, his skin cool, a hæmorrhage had taken place from his gums, and he discovered a restlessness and anxiety which I had often seen a few hours before death. He took four grains of tartar emetic, with twenty grains of calomel, at two doses. They operated powerfully, upwards and downwards, and brought away a large quantity of bile. The effects of this medicine were such as I wished. The next day he was out of danger. I prescribed the same medicine in many other cases with the same success. To several of my patients I gave two emetics in the course of the disease. Some of them discharged bile resembling in viscidity the white of an egg. But I saw one case in which great relief was obtained from the operation of an emetic, where no bile was discharged. In the exhibition of this remedy, I was regulated by the pulse. If I found it languid on the first day of the fever, I gave it before any other medicine. When it was full and tense, I deferred it until I had reduced the pulse to the emetic point by bleeding and purges. I observed, with great pleasure, that mercury affected the mouth more speedily and certainly where an emetic had been administered, than in other cases, probably from awakening, by its stimulus, the sensibility of the stomach; for such was its torpor, that in one case ten grains of tartar emetic, and in another thirty grains, did not operate upon it, so as to excite even the slightest degree of nausea. In many cases, an emetic, given in the forming state of the disease, seemed to effect an immediate cure. Purges produced the same salutary effects that they did in former years. I always combined calomel with them in the first stage of the disease. A salivation was found to be the most certain remedy of any that was used in this fever. I did not lose a single patient, in whom the mercury acted upon the salivary glands. It was difficult to excite it in many cases, from the mercury being rejected by the stomach, from its passing off by the bowels, or from its stimulus being exceeded by the morbid action in the blood-vessels. Bleeding rendered the action of the mercury upon the mouth more speedy and more certain, but I saw several cases in which a salivation was excited in the most malignant forms of the fever, where no blood had been drawn. It will not be difficult to explain the reason of this fact if we recur to what was said formerly of the prostration of the system in this fever. In its worst forms, there is often a total absence, or a feeble degree of action in the blood-vessels, from an excess of the stimulus of the remote cause of the fever. Here the mercury meets with no resistance in its tendency to the mouth. Bleeding in this case would probably do harm, by taking off a part of the pressure upon the system, and thereby produce a re-action in the vessels, that might predominate over the action of the mercury. The disease here does that for us by its force, which, in other cases, we effect by depleting remedies. Where the mercury showed a disposition to pass too rapidly through the bowels, I observed no inconvenience from combining it with opium, in my attempts to excite a salivation. The calomel was constantly aided by mercurial ointment, applied by friction to different parts of the body. Now and then a salivation continued for weeks and months after the crisis of this fever, to the great distress of the patient, and injury of the credit of mercury as a remedy in this disease. Dr. Physick has discovered, that in these cases the salivation is kept up by carious teeth or bone, and that it is to be cured only by removing them. From the impracticability of exciting a salivation in all cases, I attempted the cure of this fever, after bleeding, by means of copious sweats. They succeeded in several instances where no other remedy promised or afforded any relief. They were excited by wrapping the patient in a blanket, with half a dozen hot bricks wetted with vinegar, and applied to different parts of the body. The sweating was continued for six hours, and repeated daily for four or five days. In those cases where the fever put on the form of an intermittent, I gave bark after bleeding and purging with advantage. I gave it likewise in all those cases where the fever put on the type of the slow chronic fever. Laudanum was acceptable and useful in many cases of pain, wakefulness, vomiting, and diarrh[oe]a, after the use of depleting remedies. I applied _blisters_ in the usual way in this fever, but I think with less effect than in the yellow fevers of former years. To relieve a vomiting, which was very distressing in many cases about the fourth and fifth days, I gave a julep, composed of the salt of tartar and laudanum. I also gave Dr. Hosack's anti-emetic medicine, composed of equal parts of lime-water and milk. I do not know that it saved any lives, but I am sure it gave ease by removing a painful symptom, and thus, where it did not cure, lessened the sufferings of the sick. The diet and drinks were the same in this fever as they were in the fevers formerly described. Cool air, cold water, and cleanliness produced their usual salutary effects in this fever. I shall now deliver a short account of the symptoms which indicated a favourable and an unfavourable issue of the disease. It has been said[8], that the signs of danger vary in this fever, from the influence of the weather. The autumn of 1798 confirmed, in many instances, the truth of this remark. [8] History of the Fever in 1797. I saw no instance of death where a bleeding occurred from the gums on the fourth or fifth day, provided depleting remedies had been used from the beginning of the disease. Few recovered who had this symptom in 1793. I saw three recoveries after convulsions in the year 1798. All died who were convulsed in 1793 and 1797. A dry, hoarse, and sore throat was followed by death in every case in which it occurred in my practice. In the fever of 1793 a sore throat was a favourable sign. It was one of the circumstances which determined me to use a salivation in that fever. The absence of pain was always a bad sign. Small, but frequent stools, and the continuance of a redness in the eyes after the ample use of depleting remedies, were likewise bad signs. An appetite for food on the fourth or fifth day of the fever, without a remission or cessation of the fever, was always unfavourable. A want of delicacy, in exposing parts of the body which are usually covered, was a bad symptom. I saw but one recovery where it took place. Boccacio says the same symptom occurred in the plague in Italy. "It suspended (he tells us) all modesty, so that young women, of great rank and delicacy, submitted to be attended, dressed, and even cleansed by male nurses." I have remarked, in another place, that but two of my patients recovered who had the hiccup. A dry tongue was a bad sign. I saw but one recovery where it occurred, and none where the tongue was black. A moist and natural tongue, where symptoms of violence or malignity appeared in other parts of the body, was always followed by a fatal issue of the disease. A desire to ride out, or to go home, in persons who were absent from their families, was, in every instance where it took place, a fatal symptom. These desires arose from an insensibility to pain, or a false idea of the state of the disease. It existed to such a degree in some of the patients in the city hospital, that they often left their beds, and dressed themselves, in order to go home. All these patients died, and some of them in the act of putting on their clothes. From the history that has been given of the symptoms, treatment, and prognosis of this fever, we see how imperfect all treatises upon epidemics must be, which are not connected with climate and season. As well might a traveller describe a foreign climate, by the state of the weather, or by the productions of the earth, during a single autumn, as a physician adopt a uniform opinion of the history, treatment, and prognosis of a fever, from its phenomena in any one country, or during a single season. There were three modes of practice used in this epidemic. The first consisted in the exhibition of purges of castor oil, salts, and manna, and cooling glysters, and in the use of the warm bath. These remedies were prescribed chiefly by the French physicians. The second consisted in the use of mercury alone, in such doses, and in such a manner, as to excite a salivation. This mode was used chiefly by an itinerant and popular quack. The third mode consisted in using all the remedies which I have mentioned in the account of the treatment of this fever, and accommodating them to the state of the disease. This mode of practice was followed by most of the American physicians. The first mode of practice was the least successful. It succeeded only in such cases as would probably have cured themselves. The second mode succeeded in mild cases, and now and then in that malignant state of the fever, in which the action of the blood-vessels was so much prostrated by the force of the miasmata, as to permit the mercury to pass over them, and thus to act upon the salivary glands in the course of four or five days. The last mode was by far the most successful. It is worthy of notice, that the business and reputation of the physicians, during this epidemic, were in the inverse ratio of their success. The number of deaths by it amounted to between three and four thousand, among whom were three physicians, and two students of medicine. Its mortality was nearly as great as it was in 1793, and yet the number of people who were affected by it was four times as great in 1793 as it was in 1798, for, in the latter year, the city was deserted by nearly all its inhabitants. The cause of this disproportion of deaths to the number who were sick, was owing to the liberal and general use of the lancet in 1793, and to the publications in 1797 having excited general fears and prejudices against it in 1798. Such was the influence of these publications, that many persons who had recovered from this fever in the two former years, by the use of depleting remedies, deserted the physicians who had prescribed them, and put themselves under the care of physicians of opposite modes of practice. Most of them died. Two of them had been my patients, one of whom had recovered of a third attack of the fever under my care. AN ACCOUNT OF THE _BILIOUS YELLOW FEVER_, AS IT APPEARED IN PHILADELPHIA, IN THE YEAR 1799. The diseases which succeeded the fever of 1798, in November and December, were highly inflammatory. A catarrh was nearly universal. Several cases of sore throat, and one of erysipelas, came under my care in the month of November. The weather in December was extremely cold. It was equally so in the beginning of January, 1799, accompanied with several falls of snow. About the middle of the month, the weather moderated so much, so as to open the navigation of the Delaware. I met with two cases of malignant colic in the latter part of this month, and one of yellow fever. The last was Swen Warner. Dr. Physick, who attended him with me, informed me that he had, nearly at the same time, attended two other persons with the same disease. The weather was very cold, and bilious pleurisies were common, during the latter part of the month of February. March was equally cold. The newspapers contained accounts of the winter having been uncommonly severe in Canada, and in several European countries. The first two weeks in April were still cold. The Delaware, which had been frozen a second time during the winter, was crossed near its origin, on the ice, on the 15th day of this month. The diseases, though fewer than in the winter, were bilious and inflammatory. During this month, I was called to a case of yellow fever, which yielded to copious bleeding, and other depleting medicines. May was colder than is usual in that month, but very healthy. In the first week of June, several cases of highly bilious fever came under my care. In one of them, all the usual symptoms of the highest grade of that fever occurred. On the 13th of the month, Dr. Physick informed me, that he had lost a patient with that disease. On the 23d of the same month, Joseph Ashmead, a young merchant, died of it. Several other cases of the disease occurred between the 20th and 29th days of the month, in different parts of the city. About this time, I was informed that the inhabitants of Keys's-alley had predicted a return of the yellow fever, from the trees before their doors emitting a smell, exactly the same which they perceived just before the breaking out of that disease in 1793. In July, the city was alarmed, by Dr. Griffitts, with an account of several cases of the fever in Penn-street, near the water. The strictness with which the quarantine law had been executed, for a while rendered this account incredible with many people, and exposed the doctor to a good deal of obloquy. At length a vessel was discovered, that had arrived from one of the West-India islands on the 14th of May, and one day before the quarantine law was put into operation, from which the disease was said to be derived. Upon investigating the state of this vessel, it appeared that she had arrived with a healthy crew, and that no person had been sick on board of her during her voyage. In the latter part of July and in the beginning of August, the disease gradually disappeared from every part of the city. This circumstance deserves attention, as it shows the disease did not spread by contagion. About this time we were informed by the newspapers, that dogs, geese, and other poultry, also that wild pigeons were sickly in many parts of the country, and that fish on the Susquehannah, and oysters in the Delaware bay, were so unpleasant, that the inhabitants declined eating them. At the same time, flies were found dead in great numbers, in the unhealthy parts of the city. The weather was dry in August and September. There was no second crop of grass. The gardens yielded a scanty supply of vegetables, and of an inferior size and quality. Cherries were smaller than usual, and pear and apple-trees dropped their fruits prematurely, in large quantities. The peaches, which arrived at maturity, were small and ill-tasted. The grain was in general abundant, and of a good quality. A fly, of an unusual kind, covered the potatoe fields, and devoured, in some instances, the leaves of the potatoe. This fly has lately been used with success in our country, instead of the fly imported from Spain. It is equal to it in every respect. Like the Spanish fly, it sometimes induces strangury. About the middle of August the disease revived, and appeared in different parts of the city. A publication from the academy of medicine, in which they declared the seeds of the disease to spread from the atmosphere only, produced a sudden flight of the inhabitants. In no year, since the prevalence of the fever, was the desertion of the city so general. I shall now add a short account of the symptoms and treatment of this epidemic. The arterial system was in most cases active. I met with a tense pulse in a patient after the appearance of the black vomiting. Delirium was less frequent in adults than in former years. In children there was a great determination of the disease to the brain. I observed no new symptoms in the stomach and bowels. One of the worst cases of the fever which I saw was accompanied with colic. A girl of Thomas Shortall, who recovered, discharged 9 worms during her fever. It appeared in Mr. Thomas Roan, one of my pupils, in the form of a dysentery. A stiffness, such as follows death, occurred in several patients in the city hospital before death. Miss Shortall had an eruption of pimples on her breast, such as I have described in the short account I gave of the yellow fever of 1762 in this city, in my account of the disease in 1793. The blood exhibited its usual appearances in the yellow fever. It was seldom sizy till towards the close of the disease. The tongue was generally whitish. Sometimes it was of a red colour, and had a polished appearance. I saw no case of a black tongue, and but few that were yellow before the seventh day of the disease. The type of this disease was nearly the same as described in 1797. It now and then appeared in the form of a quartan, in which state it generally proved fatal. It appeared with rheumatic pains in one of my patients. It blended itself with gout and small-pox. Its union with the latter disease was evident in two patients in the city hospital, in each of whom the stools were such as were discharged in the most malignant state of the fever. The remedies for this fever were bleeding, vomits, purges, sweats, and a salivation and blisters. There were few cases that did not indicate bleeding. It was performed, when proper, in the usual way, and with its usual good effects. It was indicated as much when the disease appeared in the bowels as in the blood-vessels. Mr. Roan, in whom it was accompanied with symptoms of dysentery, lost nearly 200 ounces of blood by twenty-two bleedings. I found the same benefit from emetics, in this fever, that I did in the fever of 1798. They were never administered except on the first day, before violent action had taken place in the system, or after it was moderated by one or two bleedings. Purges of calomel and jalap, also castor oil, salts, and injections were prescribed with their usual advantages. In those cases where the system was prostrated below the point of re-action, I began the cure by sweating. Blankets, with hot bricks wetted with vinegar, and the hot bath, as mentioned formerly, when practicable, were used for this purpose. The latter produced, in a boy of 14 years of age, who came into the city hospital without a pulse, and with a cold skin, in a few hours, a general warmth and an active pulse. The determination of the disease to the pores was evinced in one of my patients, by her sweating under the use of the above-mentioned remedies, for the first time in her life. A moisture upon her skin had never before been induced, she informed me, even by the warmest day in summer. The advantages of a salivation were as great as in former years. From the efficacy of bleeding, purges, emetics, and sweating, I had the pleasure of seeing many recoveries before the mercury had time to affect the mouth. In no one case did I rest the cure exclusively upon any one of these remedies. The more numerous the outlets were to convey off superfluous fluids and excitement from the body, the more safe and certain were the recoveries. A vein, the gall-bladder, the bowels, the pores, and the salivary glands were all opened, in succession, in part, or together, according to circumstances, so as to give the disease every possible chance of passing out of the body without injuring or destroying any of its vital parts. Blisters were applied with advantage. The vomiting and sickness which attend this fever were relieved, in many instances, by a blister to the stomach. In those cases in which the fever was protracted to the chronic state, bark, wine, laudanum, and æther produced the most salutary effects. I think I saw life recalled, in several cases in which it appeared to be departing, by frequent and liberal doses of the last of those medicines. The bark was given, with safety and advantage, after the seventh day, when the fever assumed the form of an intermittent. The following symptoms were generally favourable, viz. a bleeding from the mouth and gums, and a disposition to weep, when spoken to in any stage of the fever. A hoarseness and sore throat indicated a fatal issue of the disease, as it did in 1798. Dr. Physick remarked, that all those persons who sighed after waking suddenly, before they were able to speak, died. The recurrence of a redness of the eyes, after it had disappeared, or of but one eye, was generally followed by death. I saw but one recovery with a red face. I saw several persons, a few hours before death, in whom the countenance, tongue, voice, and pulse were perfectly natural. They complained of no pain, and discovered no distress nor solicitude of mind. Their danger was only to be known by the circumstances which had preceded this apparently healthy and tranquil state of the system. They had all passed through extreme suffering, and some of them had puked black matter. The success of the mode of practice I have described was the same as in former years, in private families; but in the city hospital, which was again placed under the care of Dr. Physick and myself, there was a very different issue to it, from causes that are too obvious to be mentioned. There were two opinions given to the public upon the subject of the origin of this fever; the one by the academy of medicine, the other by the college of physicians. The former declared it to be generated in the city, from putrid domestic exhalations, because they saw it only in their vicinity, and discovered no channel by which it could have been derived from a foreign country; the latter asserted it to be "imported, because it had been imported in former years." AN ACCOUNT OF SPORADIC CASES OF _YELLOW FEVER_, AS THEY APPEARED IN PHILADELPHIA, IN 1800. The weather in the month of January was less cold than is common in that month. Catarrhs, the cynanche trachealis, and bilious pleurisies were prevalent in every part of it. A few cases of yellow fever occurred likewise during this month. Several cases of erysipelas appeared in February. The month of March was unusually healthy. The weather was warm in April, and the city as healthy as in March. It was equally so in May and June. The spring fruits appeared early in the latter month, in large quantities, and were of an excellent quality. Locusts were universal in June. They had not appeared since the year 1783. A record from the journal of the Swedish missionaries was published at this time, which described their appearance in 1715, in which year it was said to be very healthy. On the 14th of June there was a severe thunder gust, with more lightning than had been known for seven years before. There fell, during all the months that have been mentioned, frequent and plentiful showers of rain, which rendered the crops of grass luxuriant in the neighbourhood of Philadelphia. The winds at this time were chiefly from the south-east. A few intermittents appeared in June, which yielded readily to the bark. On the 16th day of June, Dr. Physick informed me he had a black boy under his care with the yellow fever. In July, the hooping cough, cholera infantum, and some cases of dysentery and bilious fever appeared in the city. On the 30th of July, Dr. Pascalis informed me that he had lost a patient on the fifth day of a yellow fever. In August, the dysentery was the principal form of disease that prevailed in the city. On the 22d of this month, a woman died of the yellow fever in Gaskill-street, under the care of Dr. Church. On the 28th and 30th, there fell an unusual quantity of rain. The winds were south-west and north-west during the greatest part of the summer months. The latter were sometimes accompanied with rain. On the 11th of September, a clerk of Mr. Levi Hollingsworth, and, on the 12th, a clerk of Mr. John Connelly, died with the yellow fever. A plentiful shower of rain fell on the night of the 21st of this month. About this time there appeared one and twenty cases of yellow fever in Spruce-street, between Front and Second-streets. They were all in the neighbourhood of putrid exhalations. Fourteen of them ended fatally. No one of the above cases of malignant fever could be traced to a ship, or to a direct or indirect intercourse with persons affected by that disease. While Philadelphia was thus visited by a few sporadic cases only of yellow fever, it was epidemic in several of the cities of the United States, particularly in New-York, Providence, in Rhode Island, Norfolk, and Baltimore. In the last named place, it was publicly declared by the committee of health to be of domestic origin. The dysentery was epidemic, at the same time, in several of the towns of Massachusetts and New-Hampshire. It was attended with uncommon mortality at Hanover, in the latter state. This difference in the states of health and sickness in the different parts of the United States must be sought for chiefly in the different states of the weather in those places. The exemption of Philadelphia from the yellow fever, as an epidemic, may perhaps be ascribed to the strength and vigour of the vegetable products of the year, which retarded their putrefaction; to frequent showers of rain, which washed away the filth of the streets and gutters; and to the perfection of the summer and autumnal fruits. The months of November and December this year were uncommonly healthy. During the former, several light shocks of earthquakes were felt in Lancaster and Harrisburg, in Pennsylvania, and in Wilmington, in the state of Delaware. AN ACCOUNT OF SPORADIC CASES OF _YELLOW FEVER_, AS THEY APPEARED IN PHILADELPHIA, IN 1801. The month of January was intensely cold. In February it became more moderate. The diseases, during these two months, were catarrhs and a few pleurisies. In March and April there fell an unusual quantity of rain. The hay harvest began in the neighbourhood of Philadelphia on the 28th of May. A few mild cases of scarlatina anginosa occurred during these months. In June the weather was dry and healthy. On the 8th of July, a case of yellow fever occurred in the practice of Dr. Stewart. About the 15th of the month, a patient died with it in the Pennsylvania hospital. Dr. Physick informed me that he had, at the same time, two patients under his care with that disease. Several cases of the measles appeared in the south end of the city during this month. In every part of it, the weather was warm and dry, in consequence of which there were no second crops of grass, and a smaller quantity than usual of summer fruits and vegetables. The winds were less steady than they had been for seven years. They blew, every two or three days, from nearly every point of the compass. On the 4th of August there fell a considerable quantity of rain, which was succeeded by cool and pleasant weather. The cholera morbus was a frequent disease among both adults and children in the city, and the dysentery in several of the adjoining counties of the state. A number of emigrant families arrived this month from Ireland and Wales, who brought with them the ship fever. They were carefully attended, at the lazaretto and the city hospital, in airy rooms, by which means they did not propagate the disease. Contrary to its usual character, it partook of the remissions of the bilious fever, probably from the influence of the season upon it. In September there were a few extremely warm days. In the beginning and middle of the month a number of mild remittents occurred, and about the 22d there were five or six cases of yellow fever in Eighth-street, between Chesnut and Walnut-streets, in two houses ill ventilated, and exposed to a good deal of exhalation. I attended most of these cases in consultation with Dr. Gallaher. One of the persons who was affected with this fever puked black matter while I sat by his bed-side, a few hours before he died. During the summer and autumn of this year, a number of cases of yellow fever appeared at New-Bedford, Portland, and Norwich, in the New-England states; in New-York; in some parts of New-Jersey; and in Northampton and Bucks counties, in Pennsylvania. It prevailed so generally in New-York, as to produce a considerable desertion of the city. In none of the above places could the least proof be adduced of the disease being imported. In Philadelphia its existence was doubted or denied by most of the citizens, because it appeared in situations remote from the water, and of course could not be derived from any foreign source. It will be difficult to tell why the fever appeared only in sporadic cases in Philadelphia. Perhaps its prevalence as an epidemic was prevented by the plentiful rains in the spring months, by the absence of moisture from the filth of the streets and gutters, in consequence of the dry weather in June and July, by the vigour and perfection of the products of the earth, and by the variable state of the winds in the month of July. If none of these causes defended the city from more numerous cases of the yellow fever, it must be resolved into the want of a concurring inflammatory constitution of the atmosphere with the common impure sources of that disease. On the 12th of November, about twelve o'clock in the night, an earthquake was felt in Philadelphia, attended with a noise as if something heavy had fallen upon a floor. Several cases of scarlet fever appeared in December, but the prevailing disease, during the two last autumnal and the first winter months, was the measles. I have taken notice that it appeared in the south end of the city in July. During the months of August and September it was stationary, but in October, November, and December it spread through every part of the city. The following circumstances occurred in this epidemic, as far as it came under my notice. AN ACCOUNT OF THE MEASLES, AS THEY APPEARED IN PHILADELPHIA, IN THE YEAR 1801. I. The disease wore the livery of the autumnal fever in the following particulars. It was strongly marked by remissions and intermissions. The exacerbations came on chiefly at night. There were in many cases a constant nausea, and discharge of bile by puking. I saw one case in which the disease appeared with a violent cholera morbus, and several in which it was accompanied with diarrh[oe]a and dysentery. II. Many severe cases of phrenzy, and two of cynanche trachealis appeared with the measles. III. A distressing sore mouth followed them, in a child of two years old, that came under my care. IV. A fatal hydrocephalus internus followed them in a boy of eight years old, whom I saw two days before he died. V. I met with a few cases in which the fever and eruption came on in the same day, but I saw one case in which the eruption did not take place until the tenth, and another, in which it did not appear until the fourteenth day after the fever. VI. Two children had pustules on their skins, resembling the small-pox, before the eruption of the measles. VII. Many children had coughs and watery eyes, but without the measles. The same children had them two or three weeks afterwards. VIII. Many people who had had the measles, had coughs during the prevalence of the measles, resembling the cough which occurs in that disease. The remedies made use of in my practice were, 1. Bleeding, from four to sixty ounces, according to the age of the patient, and the state of the pulse. This remedy relieved the cough, eased the pains in the head, and in one case produced, when used a third time, an immediate eruption of the measles. 2. Lenient purges. 3. Demulcent drinks. 4. Opiates at night. 5. Blisters. And, 6. Astringent medicines, where a diarrh[oe]a took place. I saw evident advantages from advising a vegetable diet to many children, as soon as any one of the families to which they belonged were attacked by the measles. I lost but one patient in this disease, and that was a child in convulsions. I ascribed my success to bleeding more generally and more copiously than I had been accustomed to do, in the measles of former years. AN ACCOUNT OF THE _BILIOUS YELLOW FEVER_, AS IT APPEARED IN PHILADELPHIA, IN THE YEAR 1802. The weather during the month of January was unusually moderate and pleasant. In the latter end of it, many shrubs put forth leaves and blossomed. I saw a leaf of the honeysuckle, which was more than an inch in length, and above half an inch in breadth. There was but one fall of snow, and that a light one, during the whole month. The winds blew chiefly from the south-west in February. There was a light fall of snow on the 6th. A shad was caught in the Delaware, near the city, on the 17th. On the 18th and 19th of the month, the weather became suddenly very cold. On the 22d there was a snow storm, and on the 28th, rain and a general thaw. In March, the weather was wet, cold, and stormy, with the exception of a few pleasant days. The scarlatina anginosa and the cynanche trachealis were the principal diseases that prevailed during the three months that have been mentioned. In April, there were several frosts, which destroyed the blossoms of the peach-trees. In May, the weather was so cool as to make fires agreeable to the last day of the month. The wind blew chiefly, during the whole of it, from the north-east. The scarlatina continued to be the reigning disease. I saw one fatal case of it, in which a redness only, without any ulcers or sloughs, appeared in the throat; and I attended another, in which a total immobility in the limbs was substituted by nature for the pain and swellings in those parts which generally attend the disease. There were three distinct grades of this epidemic. It was attended with such inflammatory or malignant symptoms, in some instances, as to require two or three bleedings; in others it appeared with a typhoid pulse, which yielded to emetics: turbith mineral was preferred for this purpose; while a redness, without a fever, which yielded to a single purge, was the only symptom of it in many people. The weather was cool, rainy, and hot, in succession, in the month of June. The scarlatina continued to be the prevailing disease. During the first and second weeks in July, there fell a good deal of rain. On the 4th of the month I was called to visit Mrs. Harris, in Front-street, between Arch and Market-streets, with a bilious fever. The scarlatina had imparted to it a general redness on her skin, which induced her to believe it was that disease, and to neglect sending for medical relief for several days. She died on the 13th of the month, with a red eye, a black tongue, hiccup, and a yellow skin. Three other cases of malignant bilious fever occurred this month. Two of them were attended by Dr. Dewees and Dr. Otto. On the 15th of the month, the city was alarmed by an account of this fever having appeared near the corners of Front and Vine-streets, a part of the city which had for many weeks before been complained of by many people for emitting a f[oe]tid smell, derived from a great quantity of filthy matters stagnating in that neighbourhood, and from the foul air discharged from a vessel called the Esperanza, which lay at Vine-street wharf. On the 2d of August, it appeared in other parts of the city, particularly in Front and Water-streets, near the draw-bridge, where it evidently originated from putrid sources. Reports were circulated that it was derived from contagion, conveyed to Vine-street wharf in the timbers of a vessel called the St. Domingo Packet, but faithful and accurate inquiries proved that this vessel had been detained one and twenty days, and well cleaned at the lazaretto, and that no one, of fourteen men who had worked on board of her afterwards, had been affected with sickness of any kind. On the 5th of August, the board of health publicly declared the fever to be contagious, and advised an immediate desertion of the city. The advice was followed with uncommon degrees of terror and precipitation. The disease continued, in different parts of the city, during the whole of August and September. On the 5th of October, the citizens were publicly invited from the country by the board of health. During this season, the yellow fever was epidemic in Baltimore and Wilmington. In the former place it was admitted by their board of health, and in the latter it was proved by Dr. Vaughan, to be of domestic origin. It prevailed, at the same time, in Sussex county and near Woodbury, in New-Jersey. Sporadic cases of it likewise occurred in New-York and Boston, and in Portsmouth, in New-Hampshire. The chronic fever was epidemic in several of the towns of North-Carolina; cases of fever, which terminated in a swelling and mortification of the legs, and in death on the third day, appeared on the waters of the Juniata, in Pennsylvania; and bilious fevers, of a highly inflammatory grade, were likewise common near Germantown and Frankford, in the neighbourhood of Philadelphia. But few of the cases of yellow fever which have been mentioned came under my care, but I saw a considerable number of fevers of a less violent grade. They were the inflammatory, bilious, mild remitting, chronic, and intermitting fevers, and the febricula. They appeared, in some instances, distinct from each other, but they generally blended their symptoms in their different stages. The yellow fever often came on in the mild form of an intermittent, and even a febricula, and as often, after a single paroxysm, ended in a mild remittent or chronic fever. When it appeared in the latter form, it was frequently attended with a slow or low pulse, and a vomiting and hiccup, such as attend in the yellow fever. This diversity of symptoms, with which the summer and autumnal fever came on, made it impossible to decide upon its type on the day of its attack. Having been deceived in one instance, I made it a practice afterwards to watch every case I was called to with double vigilance, lest it should contract a malignant form in my hands, without my being prepared to meet it. Of the five original and obvious cases of yellow fever to which I was called, I saved none, for I saw but one of them before the last stage of the disease. In many others, I have reason to believe I prevented that malignant form of fever, by the early and liberal use of depleting medicines. The practice of those physicians who attended most of the persons who had the yellow fever, was much less successful than in our former epidemics. I suspected at the time, and I was convinced afterwards, that it was occasioned by relying exclusively upon bleeding, purges, and mercury. The skin, in several of the cases which I saw, was covered with moisture. This clearly pointed out nature's attempt to relieve herself by sweating. Upon my mentioning this fact to the late Dr. Pfeiffer, jun. he instantly adopted my opinion, and informed me, as a reason for doing so, that he had heard of several whole families in the Northern Liberties, where the disease prevailed most, who, by attacking it in its forming state by profuse sweats, had cured themselves, without the advice of a physician. AN ACCOUNT OF THE _BILIOUS YELLOW FEVER_, AS IT APPEARED IN PHILADELPHIA, IN 1803. The weather in January was uniformly cold. On the 21st of the month, the Delaware was completely frozen. On the 4th of February there was a general thaw, attended with a storm of hail, thunder, and lightning, which lasted about three quarters of an hour. The diseases of both these winter months were catarrhs and bilious pleurisies. The latter appeared in a tertian type. The pain in the side was most sensible every other day. The weather was cold and dry in March, in consequence of which, vegetation was unusually backward in April. The hooping cough, catarrhs, and scarlatina were the diseases of this month. The beginning of May was very cool. There was ice on the 7th of the month. The winds, during the greatest parts of this and the previous month, were from the north-east. In June, the weather was cool. Intermittents were common in this month, as well as in May. Such was the predominance of this type of fever over all other diseases, that it appeared in the form of profuse sweats, every other night, in a lady under the care of Dr. Dewees and myself, in the puerperile fever. On the intermediate nights she had a fever, without the least moisture on her skin. There were a few choleras this month. During the latter end of the month, I lost a patient with many of the symptoms of yellow fever. The weather in July was alternately hot, moderate, and cool, with but little rain. The first two weeks of this month were healthy. A few tertian fevers occurred, which readily yielded to bark, without previous bleeding. Between the 25th and 31st of the month, three deaths took place from the yellow fever. In the month of August, the weather was the same as in July, except that there fell more rain in it. Mild remittents and cholera infantum were now common. There were likewise several cases of yellow fever during this month. One of them was in Fromberger's-court. It was induced by the f[oe]tor of putrid fish in a cellar. A malignant dysentery was epidemic during this month in the upper part of Germantown, and in its neighbourhood. Several persons, Dr. Bensell informed me, died of it in thirty hours sickness. It prevailed, at the same time, in many parts of the New-England states. In September, cases of yellow fever appeared in different parts of the city, but chiefly in Water, near Walnut-street. On the 12th of the month, the board of health published a declaration of its existence in the city, but said it was not contagious. This opinion gave great offence, for it was generally said to have been imported by means of a packet-boat from New-York, where the fever then prevailed, because a man had sickened and died in the neighbourhood of the wharf where this packet was moored. It was to no purpose to oppose to this belief, proofs that no sick person, and no goods supposed to be infected, had arrived in this boat, and that no one of three men, who had received the seeds of the disease in New-York, had communicated it to any one of the families in Philadelphia, in which they had sickened and died. The disease assumed a new character this year, and was cured by a different force of medicine from that which was employed in some of the years in which it had prevailed in Philadelphia. I shall briefly describe it in each of the systems, and then take notice of some peculiarities which attended it. Afterwards I shall mention the remedies which were effectual in curing it. 1. The pulse was moderately _tense_ in most cases. It intermitted in one case, and in several others the tension was of a transient nature. Hæmorrhages occurred in many cases. They were chiefly from the nose, but in some instances they occurred from the stomach, bowels, and hæmorrhoidal vessels. 2. Great flatulency attended in the stomach, but sickness and vomiting were much less frequent than in former years. I saw but one case in which diarrh[oe]a attended this fever. 3. I did not meet with a single instance of a glandular swelling in any part of the body. 4. There was a general disposition to sweat in this fever from its beginning. Two of my patients died, in whom no moisture could be excited on the skin. But I recovered one with a dry skin, by means of a purge, two bleedings, and blisters. An efflorescence on the skin occurred in several instances. I saw black matter discharged from a blister in one case, and blood in another. 5. The stools were green and black. Bile was generally discharged in puking. 6. The blood exhibited the following appearances: siziness, lotura carnium, sunken crassamentum, red sediment, and what is called dense or unseparated blood. I saw no instance of its being dissolved. 7. The tongue was whitish and dark-coloured. This diseased appearance continued, in some instances, several days after a recovery took place. I saw no smooth, red, nor black tongue, and but one dry and one _natural_ tongue. The latter was followed by death. I did not see a single case in which the disease came on without an exciting cause; such as light clothing and bed-clothes, sitting at doors after night, a long walk, gunning, and violent and unusual exercises of any kind. It was excited in a number of people by their exertions to extinguish a fire which took place in Water-street, between Market and Chesnut-streets, on the morning of the 25th of August. I saw a fatal instance of it succeed a severe tooth-ach. Whether this pain was the exciting cause, or the first morbid symptom of the fever, I know not; but I was led by it to bleed a young lady twice who complained of that pain, and who had at the same time a tense pulse. Her blood had the usual appearances which occur in the yellow fever. The disease had different appearances in different parts of the city. It was most malignant in Water-street; but in many instances it became less so, as it travelled westward, so that about Ninth-street it appeared in the form of a common intermittent. In every part of the city it often came on, as in the year 1802, in all the milder forms of autumnal fever formerly enumerated, and went off with the usual symptoms of yellow fever. Again, it came on with all the force and malignity of a yellow fever, and terminated, in a day or two, in a common remittent or intermittent. These modes of attack were so common, that it was impossible to tell what the character, or probable issue of a fever would be, for two or three days. The following remedies were found, very generally, to be effectual in this fever. 1. Moderate bleeding. I bled but three patients three, and only one, four times. In general, the loss of from ten to twenty ounces of blood, reduced the pulse from a synocha to a synoichoid or typhoid state, and thereby prepared the system for other remedies. 2. Purges were always useful. I gave calomel and jalap, castor oil, salts, and senna, according to the grade of the disease, and often according to the humour or taste of the patient. I aided these purges by glysters. In one case, where a griping and black stools attended, I directed injections of lime water and milk to be used, with the happiest effects. 3. I gave emetics in many cases with advantage, but never while the pulse was full or tense. 4. Having observed, as in the year 1802, a spontaneous moisture on the skin on the first day of the disease, in several cases, I was led to assist this disposition in nature to be relieved by the pores, by means of sweating remedies, but in no instance did I follow it, without previous evacuations from the blood-vessels or bowels; for, however useful the intimations of nature may be in acute diseases, her efforts should never be trusted to alone, inasmuch as they are in most cases too feeble to do service, or so violent as to do mischief. I saw one death, and I heard of another, from an exclusive reliance upon spontaneous sweats in the beginning of this fever. The remedies I employed to promote this evacuation by the pores were, an infusion of the eupatorium perfoliatum in boiling water, aided by copious warm drinks, and hot bricks and blankets, applied to the external surface of the body. The eupatorium sometimes sickened the stomach, and puked. The sweats were intermitted, and renewed two or three times in the course of four and twenty hours. 5. I derived great advantage from the application of blisters to the wrists, _before_ the system descended to what I have elsewhere called, the blistering point. This was on the second and third days. My design, in applying them thus early, was to attract morbid excitement to the extremities, and thereby to create a substitute for a salivation. They had this effect. The pain, increase of fever, and occasional strangury, which were produced by them, served like anchors to prevent the system being drifted and lost, by the concentration of morbid excitement in the stomach and brain, on the fourth, fifth, sixth, and seventh days of the disease. It gave me great pleasure to find, upon revising Dr. Home's account of the yellow fever, that this mode of applying blisters, in the early stage of the disease, was not a new one. He often applied them in the first stage of the fever, more especially when the yellow colour of the skin made its appearance on the first or second day. By the advice of Dr. Cheney, of Jamaica, he was led to prefer them to the thighs, instead of the trunk of the body, or the legs and arms. He forbids their ever being applied below the calf of the legs. This caution is probably more necessary in the West-Indies than in the United States. The pain and inflammation excited by the blisters were mitigated by soft poultices of bread and milk. The strangury soon yielded to demulcent drinks, particularly to flaxseed tea. I was happy in not being compelled, by the violence or obstinacy of this fever, to resort to a salivation in order to cure it, in a single instance; the discharges from the stomach and bowels, and from the veins, pores, and skin, having proved sufficient to convey the disease out of the system. Two persons recovered this year who had the black vomiting. One of them was by means of large quantities of brandy and volatile alkali, administered by Dr. John Dorsey, in the city hospital; the other was by means of lime and water and milk, given by an intelligent nurse to one of my patients, during the interval of my visits to her. From the history which has been given of the symptoms of this fever; from the less force of medicine that was necessary to subdue it; from the safety and advantage of blisters in its _early_ stage; and from the small proportion which the deaths bore to the number of those who were affected, being seldom more than five in a hundred (including all the grades and forms of the disease), in the practice of most of the physicians, it is evident this fever was of a less malignant nature than it had been in most of the years in which it had been epidemic. There was one more circumstance which proved its diminution of violence, and that was, a more feeble operation of its remote cause. In the year 1802, nearly all the persons who were affected with the fever in the neighbourhood of Vine and Water-streets, and in Water, between Walnut and Spruce-streets, died. This year, but two died of a great number who were sick in the former, and not one out of twelve who were sick in the latter place. The filth, in both parts of the city, was the same in both years. This difference in the violence and mortality of the fever was probably occasioned by a less concentrated state of the miasmata which produced it, or by the co-operation of a less inflammatory constitution of the atmosphere. The yellow fever was epidemic, during the summer and autumn of this year, in New-York, and in Alexandria, in Virginia. In the latter place, Dr. Dick has informed the public, it was derived from domestic putrefaction. AN ACCOUNT OF SPORADIC CASES OF _YELLOW FEVER_, AS THEY APPEARED IN PHILADELPHIA, IN 1804. The month of January was marked by deep snows, rain, clear and cold weather, and by the general healthiness of the city. In February there fell a deep snow, which was followed by several very cold days. There was likewise a fall of snow in March, which was succeeded by an uncommon degree of cold. Catarrhs and bilious pleurisies were very common during both these months. In the beginning of April, the weather was cold and rainy. There were but few signs of vegetation before the 15th of the month. Bilious pleurisies were still the principal diseases which prevailed in the city. The month of May was wet, cool, and healthy. In June, the winds were easterly, and the weather rainy. The crops of grass were luxuriant. It was remarked, that the milk of cows that fed upon this grass yielded less butter than usual, and that horses that fed upon it, sweated profusely with but little exercise. On the third of the month, I was called upon by Dr. Physick to visit his father, who was ill with a bilious fever. He died on the seventh, with a red eye, hiccup, and black vomiting. Four persons had the yellow fever in the month of July. One of them was in Fourth-street, between Pine and Lombard-streets, another was in Fifth-street, between Race and Vine-streets, both of whom recovered. The remaining two were in the Pennsylvania hospital, both of whom died. Remitting and intermitting fevers were likewise common in this month. In August, those fevers assumed a chronic form. During this month, there died an unusual number of children with the cholera morbus. The city was uncommonly healthy in September. A storm of wind and rain, from the south-east, proved destructive to the crops of cotton this month, on the sea coast of South-Carolina. In October, intermittents were very common between Eighth-street and Schuylkill. One case of yellow fever came under my care, in conjunction with Dr. Gallaher, on the western banks of that river. While Philadelphia and all the cities of the United States (Charleston excepted) were thus exempted from the yellow fever as an epidemic, the western parts of all the middle, and several of the southern states, were visited with the bilious fever, in all its different forms. In Delaware county, in the state of New-York, at Mill river, in Connecticut, and in several of the middle counties of Pennsylvania, it prevailed in the form of a yellow fever. In other parts of the United States, it appeared chiefly as a highly inflammatory remittent. It was so general, that not only whole families, but whole neighbourhoods were confined by it. Many suffered from the want of medical advice and nursing, and some from the want of even a single attendant. In consequence of the general prevalence of this fever in some parts of Pennsylvania, the usual labours of the season were suspended. Apples fell and perished upon the ground; no winter grain was sowed; and even cows passed whole days and nights without being milked. The mortality of this fever was considerable, where those distressing circumstances took place. In more favourable circumstances, it yielded to early depletion, and afterwards to the bark. Relapses were frequent, from premature exposure to the air. Those only escaped them who had been salivated, by accident or design, for the cure of the fever. This disease was observed very generally to prevail most in high situations, which had been for years distinguished for their healthiness, while the low grounds, and the banks of creeks and rivers, were but little affected by it. The unusual quantity of rain, which had fallen during the summer months, had produced moisture in the former places, which favoured putrefaction and exhalation, while both were prevented, in the latter places, by the grounds being completely covered with water. AN ACCOUNT OF THE _BILIOUS YELLOW FEVER_, AS IT APPEARED IN PHILADELPHIA, IN THE YEAR 1805. For a history of the uncommonly cold and tempestuous winter of 1804 and 1805, the reader is referred to the Account of the Climate of Pennsylvania, in the first volume of these Inquiries and Observations. During the months of January, February, and March, there were a number of bilious catarrhs and pleurisies. On the 7th of April, I visited a patient in the yellow fever with Dr. Stewart. He was cured, chiefly by copious bleeding. The weather was rainy in May. After the middle of June, and during the whole month of July, there fell no rain. The mercury in Fahrenheit fluctuated, for ten days, between 90° and 94°, during this month. The diseases which occurred in it were cholera infantum, dysenteries, a few common bilious, and eight cases of yellow fever. Three of the last were in Twelfth, between Locust and Walnut-streets, and were first visited, on the 14th and 15th of the month, by Dr. Hartshorn, as out-patients of the Pennsylvania hospital. Two of them were attended, about a week afterwards, by Dr. Church, in Southwark, and the remaining three by Dr. Rouisseau and Dr. Stewart, in the south end of the city. On the third of August, there fell a heavy shower of rain, but the weather, during the remaining part of the month, was warm and dry. The pastures were burnt up, and there was a great deficiency of summer vegetables in the neighbourhood of Philadelphia. The water in the Schuylkill was lower by three inches than it had been in the memory of a man of 70 years of age, who had lived constantly within sight of it. In September, a number of cases of yellow fever appeared in Southwark[9], near Catharine-street. They were readily traced to a large bed of oysters, which had putrified on Catharine-street wharf, and which had emitted a most offensive exhalation throughout the whole neighbourhood, for several weeks before the fever made its appearance. This exhalation proved fatal to a number of cats and dogs, and it now became obvious that the two cases of yellow fever, that were attended by Dr. Church, in the month of July, were derived from it. An attempt was made to impose a belief that they were taken by contagion from a ship at the lazaretto, which had lately arrived from the West-Indies, but a careful investigation of this tale proved, that neither of the two subjects of the fever had been on board that, nor any other ship, then under quarantine. [9] This extensive district is continued, from the city of Philadelphia, along the Delaware, but is not subject to its government. The fever prevailed during the whole of this month in Southwark. A few cases of it appeared in the city, most of which were in persons who had resided in, or visited that district. It was brought on by weak exciting causes in Southwark, but the cases which originated in the city, required strong exciting causes to produce them. A heavy rain, accompanied with a good deal of wind, on the 28th of September, and a frost on the night of the 7th of October, gave a considerable check to the fever. But few cases of it came under my care. Having perceived the same disposition in nature to relieve herself by the pores, that I observed in the years 1802 and 1803, my remedies were the same as in the latter year, and attended with the same success. Dr. Caldwell and Dr. Stewart, whose practice was extensive in Southwark, informed me, those remedies had been generally successful in their hands. The only new medicine that the experience of this year suggested in this disease, was for one of its most distressing and dangerous symptoms, that is, the vomiting which occurs in its second stage. Dr. Physick discovered, that ten drops of the spirit of turpentine, given every two hours, in a little molasses, or syrup, or sweet oil, effectually checked it in several instances, in patients who afterwards recovered. It was administered with equal success in a case which came under my care, after an absence of pulse, and a coldness of the extremities had taken place. Dr. Church informed me that he gave great relief to the sick in the city hospital, by this medicine, by prescribing it in glysters, as well as by the mouth, in distressing affections of the stomach and bowels. Dr. Stewart observed that all those persons who had been affected by the yellow fever in former years, had mild remittents in the same situations that others had the prevailing epidemic in a malignant form. In one of four bodies the doctor examined, he found six, and in another three intussusceptions of the intestines, without any signs of inflammation. He discovered the common marks of disease from this fever in other parts of those bodies. The deaths from this fever amounted to between three and four hundred. They would probably have been more numerous, had not those families who were in competent circumstances fled into the country, and had not the poor been removed, by the board of health, from the infected atmosphere of Southwark, to tents provided for them in the neighbourhood of the city; and they would probably have been fewer, considering the tractable nature of the disease, when met by suitable remedies in its early stage, had not the sick concealed their indisposition, in many instances, for two or three days, lest they should be dragged to the city hospital, or have centinels placed at their doors, to prevent any communication with their friends and neighbours. While these attempts were made to check the progress of the fever, it did not escape the notice of many of the citizens of Philadelphia, that not a single instance occurred of its being communicated by contagion, in any of the families in the city, in which persons had sickened or died with it, and that while the sick were deprived of the kind offices of their friends and neighbours, lest they should be infected, physicians, and the members of the board of health, passed by the guards every day, in their visits to the same sick people, and afterwards mixed with their fellow-citizens, in every part of the city, without changing their clothes. The yellow fever appeared early in the season in New-Haven, in Connecticut, and in Providence, on Rhode-Island, in both of which places it was derived from putrid exhalation, and was speedily and effectually checked by removing the healthy persons who lived in its neighbourhood to a distance from it. Several sporadic cases of it occurred during the autumn in Gloucester county, in New-Jersey, and in Mifflin and Chester counties, in Pennsylvania. It was epidemic in New-York at the same time it prevailed in Southwark and Philadelphia. The following extract of a letter from the health officer of New-York, to one of his friends, contains a satisfactory proof that it was not, in that city, an imported disease. _Quarantine-ground, Sept. 7._ I most sincerely and tenderly deplore the unfortunate situation of our city. What do people say now of the origin of the disease? You may state, for the information of those who wished to be informed, that not a single vessel, on board of which a person has been sick with fever of any kind, or on board of which any person has died with any disease, while in the West-Indies, or on the voyage home, has ever gone up to the city during this whole season. This we know, and this we vouch for; and farther state, that all the cases of fever that have come down as from the city, have been _all_ people of, and belonging to the city, and unconnected with the shipping, excepting one, a sailor, who had no connection with any foul vessel. There is not a shadow of proof or suspicion that can attach to the health-office, or to infected vessels, this season. I am, &c. JOHN R. B. RODGERS. Having concluded the history of the bilious yellow fever, as it has appeared in eleven successive years, since 1793, as an epidemic, or in sporadic cases, I shall proceed next to enumerate all the sources of that fever, as well as all the other usual forms of the summer and autumnal disease of the United States, and afterwards mention the means of preventing them. AN INQUIRY INTO THE VARIOUS SOURCES OF THE USUAL FORMS OF _SUMMER & AUTUMNAL DISEASE_ IN THE UNITED STATES, AND THE MEANS OF PREVENTING THEM. The business of the following inquiry is, I. To enumerate the various sources of the usual forms of the summer and autumnal disease in the United States. And, II. To mention the means of preventing them. To render the application of those means as extensive as possible, it will be proper to mention, under the first head, all those sources of summer and autumnal disease, which have been known to produce it in other countries, as well as in the United States. They are, 1. Exhalations from marshes. These are supposed to be partly of a vegetable, and partly of an animal nature. They are derived from the shores of creeks and mill ponds, as well as from low and wet grounds; also from the following vegetable substances in a state of putrefaction. 2. Cabbage. A malignant fever was produced at Oxford, by a putrid heap of this vegetable some years ago, which proved fatal to many of the inhabitants, and to several of the students of the university at that place. 3. Potatoes. Nearly a whole ship's crew perished at Tortola, by removing from her hold, a quantity of putrid potatoes. 4. Pepper. 5. Indian meal. 6. Onions. 7. Mint. 8. Anise and caraway seeds, confined in the hold of a ship. 9. Coffee. "About the time," says Dr. Trotter, "when notice was taken of the putrifying coffee on the wharf at Philadelphia, in the year 1793, a captain of a man of war, just returned from the Jamaica station, informed me, that several vessels laden with the same produce came to Kingston, from St. Domingo. During the distracted state of that colony, this article, with other productions, had been allowed to spoil and ferment. The evolution of a great quantity of fixed air, or carbonic acid gas, was the consequence; and in these vessels, when opening the hatchways, such was its concentrated state, that the whole of the crew, in some of them, were found dead on the deck. A pilot boarded one of them in this condition, and had nearly perished himself[10]." [10] Medicina Nautica, p. 324. 10. Chocolate shells. 11. Cotton which had been wetted on board of a vessel that arrived in New-York, a few years ago, from Savannah, in Georgia. 12. Hemp, flax, and straw. 13. The canvas of an old tent. 14. Old books, and old paper money, that had been wetted, and confined in close rooms and closets. 15. The timber of an old house. A fever produced by this cause is mentioned by Dr. Haller, in his Bibliotheca Medicinæ. 16. Green wood confined in a close cellar during the summer months. A fever from this cause was once produced in this city, in a family that was attended by the late Dr. Cadwallader. 17. The green timber of a new ship. Captain Thomas Bell informed me, that in a voyage to the East-Indies, in the year 1784, he lost six of his men with the scurvy, which he supposed to be derived wholly from the foul air emitted by the green timber of his ship. The hammocks which were near the sides of the ship rotted during the voyage, while those which were suspended in the middle of the ship, retained their sound and natural state. This scurvy has been lately proved by Dr. Claiborne, in an ingenious inaugural dissertation, published in Philadelphia, in the year 1798, to be a misplaced state of malignant fever. Dr. Lind mentions likewise the timber of new ships as one of the sources of febrile diseases. The timber of soldiers' huts, and of the cabins of men who follow the business of making charcoal in the woods, often produce fevers, as soon as the bark begins to rot and fall from them, which is generally on the second year after they are erected. Fevers have been excited even by the exhalation from trees, that have been killed by being girdled in an old field. 18. The stagnating air of the hold of a ship. 19. Bilge water. 20. Water that had long been confined in hogsheads at sea. 21. Stagnating rain water. 22. The stagnating air of close cellars. 23. The matters which usually stagnate in the gutters, common sewers, docks, and alleys of cities, and in the sinks of kitchens. A citizen of Philadelphia, who had a sink in his kitchen, lost a number of cats and dogs by convulsions. At length one of his servants was affected with the same disease. This led him to investigate the cause of it. He soon traced it to his sink. By altering its construction, so as to prevent the escape of noxious air from it, he destroyed its unwholesome quality, so that all his domestics lived in good health in his kitchen-afterwards. 24. Air emitted by agitating foul and stagnating water. Dr. Franklin was once infected with an intermitting fever from this cause. 25. A duck pond. The children of a family in this city were observed, for several successive years, to be affected with a bilious remitting fever. The physician of the family, Dr. Phineas Bond, observing no other persons to be affected with the same fever in the neighbourhood, suspected that it arose from some local cause. He examined the yard belonging to the house, where he found an offensive duck pond. The pond was filled with earth, and the family were afterwards free from an annual bilious fever. 26. A hog-stye has been known to produce violent bilious fevers throughout a whole neighbourhood in Philadelphia. 27. Weeds cut down, and exposed to heat and moisture near a house. Fevers are less frequently produced by putrid animal, than by putrid vegetable matters. There are, however, instances of their having been generated by the following animal substances in a state of putrefaction. 1. Human bodies that have been left unburied upon a field of battle. 2. Salted beef and pork. 3. Locusts. 4. Raw hides confined in stores, and in the holds of ships. 5. A whale thrown upon the sea shore in Holland. 6. A large bed of oysters. The malignant fevers which prevailed in Alexandria, in Virginia, in 1803, and in Southwark, adjoining Philadelphia, in the year 1805, were derived from this cause[11]. [11] It has been a common practice with many families, in New-York and Philadelphia, for several years past, to lay in a winter store of oysters in their cellars in the fall of the year. May not a part of these oysters, left in these cellars from forgetfulness, or from being unfit for use, become, by putrifying there, the cause of malignant fevers in the succeeding summer and autumn? 7. The entrails of fish. And, 8. Privies. The diarrh[oe]a and dysentery are produced, oftener than any other form of summer and autumnal disease, by the f[oe]tor of privies. During the revolutionary war, an American regiment, consisting of 600 men, were affected with a dysentery, from being encamped near a large mass of human fæces. The disease was suddenly checked by removing their encampment to a distance from it. Five persons in one family were affected with the yellow fever in Philadelphia, in 1805, who lived in a house in which a privy in the cellar emitted a most offensive smell. No one of them had been exposed to the foul air of Southwark, in which the fever chiefly prevailed in the autumn of that year. Three of them sickened at the same time, which obviated the suspicion of the disease being produced by contagion. There are several other sources of malignant fevers besides those which have been mentioned. They are, exhalations from volcanoes, wells, and springs of water; also flesh[12], fish, and vegetables, eaten in a putrid state; but these seldom act in any country, and two of them only, and that rarely, in the United States. [12] The following fact, communicated to me by Mr. Samuel Lyman, a member of congress from the state of Massachusetts, shows the importance of attending to the condition of butchers' meat in our attempts to prevent malignant fevers. A farmer in New-Hampshire, who had overheated a fat ox by excessive labour in the time of harvest, perceiving him to be indisposed, instantly killed him, and sent his flesh to a neighbouring market. Of twenty four persons who ate of this flesh, fifteen died in a few days. The fatal disease produced by this aliment fell, with its chief force, upon the stomach and bowels. The usual forms of the disease produced by miasmata from the sources of them which have been enumerated are, 1. Malignant or bilious yellow fever. 2. Inflammatory bilious fever. 3. Mild remittent. 4. Mild intermittent. 5. Chronic, or what is called nervous fever. 6. Febricula. 7. Dysentery. 8. Colic. 9. Cholera morbus. 10. Diarrh[oe]a. In deriving all the above forms of disease from miasmata, I do not mean to insinuate, that sporadic cases of each of them are not produced by other causes. In designating them by a single name, I commit no breach upon the ancient nomenclature of medicine. The gout affects not only the blood-vessels and bowels, but every other part of the body, and yet no writer has, upon that account, distinguished it by a plural epithet. The four last of the forms of disease, that have been mentioned, have been very properly called intestinal states of fever. They nearly accord, in their greater or less degrees of violence and danger, with the first four states of fever which occupy the blood-vessels, and in the order in which both of them have been named. I shall illustrate this remark by barely mentioning the resemblance of the yellow fever to the dysentery, in being attended with costiveness in its first stage, from a suspended or defective secretion or excretion of bile, and in terminating very generally in death, when not met by the early use of depleting remedies. The variety in the forms and grades of the summer and autumnal disease, in different seasons, and their occasional changes into each other in the same seasons, are to be sought for in the variety of the sensible and insensible qualities of the atmosphere, of the course of the winds, and of the aliments of different years. II. The means of preventing the different forms of disease that have been mentioned, come next under our consideration. Happily for mankind, Heaven has kindly sent certain premonitory signs of the most fatal of them. These signs appear, I. Externally, in certain changes in previous diseases, in the atmosphere, and in the animal and vegetable creation. II. In the human body. 1. The first external premonitory sign that I shall mention is, an unusual degree of violence in the diseases of the previous year or season. Many proofs of the truth of this remark are to be met with in the works of Dr. Sydenham. It has been confirmed in Philadelphia, in nearly all her malignant fevers since the year 1793. It would seem as if great and mortal epidemics, like the planets, had satellites revolving round them, for they are not only preceded, but accompanied and followed, by diseases which appear to reflect back upon them some of their malignity. But there is an exception to this remark, for we now and then observe uncommon and general healthiness, before the appearance of a malignant epidemic. This was the case in Philadelphia, previously to the fevers of 1798 and 1799. I have ascribed this to the stimulus of the pestilential miasmata barely overcoming the action of weak diseases, without being powerful enough to excite a malignant fever. 2. Substances, painted with white lead, and exposed to the air, suddenly assuming a dark colour; and winds from unusual quarters, and unusual and long protracted calms, indicate the approach of a pestilential disease. The south winds have blown upon the city of Philadelphia, ever since 1793, more constantly than in former years. A smokiness or mist in the air, the late Dr. Matthew Wilson has remarked, generally precedes a sickly autumn in the state of Delaware. 3. Malignant and mortal epidemics are often preceded by uncommon sickness and mortality among certain birds and beasts. They have both appeared, chiefly among wild pigeons and cats in the United States. The mortality among cats, previous to the appearance of epidemics, has been taken notice of in other countries. Dr. Willan says it occurred in the city of London, between the 20th of March and the 20th of April, in the year 1797, before a sickly season, and Dr. Buneiva says it preceded a mortal epidemic in Paris. The cats, the doctor remarks, lose, on the second day of their disease, the power of emitting electrical sparks from their backs, and, when thrown from a height, do not, as in health, fall upon their feet[13]. [13] Medical Journal, vol. iv. 4. The common house fly has nearly disappeared from our cities, moschetoes have been multiplied, and several new insects have appeared, just before the prevalence of our late malignant epidemics. 5. Certain trees have emitted an unusual smell; the leaves of others have fallen prematurely; summer fruits have been less in size, and of an inferior quality; and apples and pears have been knotty, in the summers previous to several of our malignant autumnal fevers. Dr. Ambrose Parey says, an unusually rapid growth of mushrooms once preceded the plague in Paris. II. The premonitory signs of an approaching malignant epidemic in the human body are, 1. A sudden drying up, or breaking out of an old sore; fresh eruptions in different parts of the body; a cessation of a chronic disease, or a conversion of a periodical into a continual disease. Of this there were many instances in Philadelphia, in the year 1793. 2. A peculiar sallowness of the complexion. This was observed to be general in Philadelphia, previous to the yellow fever of 1793. Dr. Dick informed me, that he had observed the same appearance in the faces of the people of Alexandria, accompanied in some cases with a yellowness of the eyes, during the summer of 1793, and previous to the appearance of a violent bilious fever on the banks of the Potomac. 3. I have observed one or more of the following symptoms, namely, head-ach; a decay, or increase of appetite; costiveness; a diminished or increased secretion of urine; a hot and offensive breath[14]; constant sweats, and sometimes of a f[oe]tid nature, or a dry skin; wakefulness, or a disposition to early or protracted sleep; a preternaturally frequent pulse; unusual vivacity, or depression of spirits; fatigue and sweats from light exertions; hands, when rubbed, emitting a smell like hepar sulphuris; and, lastly, a sense of burning in the mouth; to be present in different persons, during the prevalence of our malignant epidemics. [14] I have once known this breath, in a gentleman who had carried the seeds of the yellow fever in his body from Philadelphia into its neighbourhood, create sickness at the stomach in his wife; and I have heard of an instance in which a person, who left Philadelphia when highly impregnated with the miasmata of the same fever, creating sickness at the stomach in four or five persons who sat at the same table with him in the country. None of the above persons were afterwards affected by the fever. In an anonymous history of the plague in London, in the year 1664, in the possession of the author, it is said, the breath was a well-known signal of infection to persons who were not infected, and that whenever it was perceived, individuals and companies fled from it. The sickness in the above-mentioned persons was similar to that which is sometimes excited by the smell of a sore leg, or a gun-shot wound, upon the removal of its first dressing. It does not produce fever, because there is no predisposition to it. The means of preventing the different forms of our summer and autumnal disease come next under our consideration. I shall first mention such as have been most effectual in guarding against its malignant form, and afterwards take notice of such as are proper in its milder grades. These means naturally divide themselves again, I. Into such as are proper to protect individuals. II. Such as are proper to defend whole communities from the disease. And, III. Such as are proper to exterminate it, by removing its causes. I. Of the means of protecting individuals. Where flight is practicable, it should be resorted to in every case, to avoid an attack of a malignant fever. The heights of Germantown and Darby have, for many years, afforded a secure retreat to a large number of the citizens of Philadelphia, from their late annual epidemics. It were to be wished our governments possessed a power of compelling our citizens to desert the whole, or parts, of infected cities and villages. In this way the yellow fever was suddenly annihilated in Providence, on Rhode-Island, and in New-Haven, in Connecticut, in the year 1805. But the same power should rigorously prevent the removal of the sick, except it be that class of them which have neither homes nor friends. The less the distance they are carried beyond the infected atmosphere, the better. The injury sustained by conveying them in a jolting carriage, for two or three miles, has often been proclaimed in the reports of our city hospitals, of patients being admitted without a pulse, and dying a few hours afterwards. In leaving a place infected by miasmata, care should be taken not to expose the body to great cold, heat, or fatigue, for eighteen or twenty days, lest they should excite the dormant seeds of the disease into action. But where flight is not enforced by law, or where it is not practicable, or preferred, safety should be sought for in such means as reduce the preternatural tone and fulness induced in the blood-vessels by the stimulus of the miasmata, and the suppression of customary secretions. These are, 1. A diet, accommodated to the greater or less exposure of the body to the action of miasmata, and to the greater or less degrees of labour, or exercise, which are taken. In cases of great exposure to an infected atmosphere, with but little exercise, the diet should be simple in its quality, and small in its quantity. Fresh meats and wine should be avoided. A little salted meat, and Cayenne pepper with vegetables, prevent an undue languor of the stomach, from the want of its usual cordial aliments. The less mortality of the yellow fever in the French and Spanish West-India islands than in the British, has been justly attributed to the more temperate habits of the natives of France and Spain. The Bramins, who live wholly upon vegetables, escape the malignant fevers of India, while whole regiments of Europeans, who eat animal food, die in their neighbourhood. The people of Minorca, Dr. Cleghorn says, who reside near gardens, and live chiefly upon fruit during the summer, escape the violent autumnal fever of that island. The field negroes of South-Carolina owe their exemption from bilious fevers to their living chiefly upon vegetables. There is a fact which shows, that not only temperance, but abstinence bordering upon famine, has afforded a protection from malignant fevers. In a letter which I received a few months ago, from the Rev. Thomas Hall, chaplain to the British factory at Leghorn, containing an account of the yellow fever which prevailed in that city, in the summer and autumn of 1804, there is the following communication. "Of the _rich_, who live in large airy houses, there died but four persons with the fever. Of the _commodious_, who live comfortably, but not affluently, there died ten. Of the _poor_, who inhabited small and crowded rooms, in the dirty and confined parts of the city, there died nearly seven hundred. But of the _beggars_, who had scarcely any thing to eat, and who slept half naked every night upon hard pavements, not one died." From the reduced and exhausted state of the system in these people, they were incapable, if I may be allowed the expression, of the combustion of fever. Persons reduced by chronic diseases, in like manner, often escape such as are acute. Six French ships of the line landed 300 sick, at St. Domingo, while the yellow fever prevailed there in the year 1745, and yet no one of them was infected by it[15]. [15] Desportes, vol. i. p. 140. Where the body is exposed to miasmata, and a great deal of exercise taken at the same time, broths, a little wine, or malt liquors, may be used with the fruits and garden vegetables of the season, with safety and advantage. The change from a full to a low diet should be made gradually. When made suddenly, it predisposes to an attack of the disease. 2. Laxative medicines. Hundreds, perhaps thousands, of the citizens of Philadelphia were indebted for their preservation from the yellow fever to the occasional use of a calomel pill, a few grains of rhubarb, or a table-spoonful of sweet, or castor oil, during the prevalence of our late pestilential fevers. Even the air of Batavia has been deprived of its poisonous quality, by means of this class of medicines. A citizen of Philadelphia asked a captain of a New-England ship, whom he met at that island, how he preserved the whole crew of his ship in health, while half the sailors of all the other ships in the harbour were sick or dead. He informed him, that it was by giving each of them a gentle purge of sulphur every day. 3. A plentiful perspiration, or moderate sweats, kept up by means of warm clothing and bed-clothes. The excretion which takes place by the skin, is a discharge of the first necessity. I have never known an instance of a person's being attacked by the yellow fever in whom this discharge was constant, and equally diffused all over the body. Its effects are equally salutary in preventing the plague. So well known is this fact, that Mr. Volney informs us, in his Travels into Egypt, that the common salutation at Cairo, during the prevalence of the plague, is, "Do you sweat freely?" For the purpose of promoting this excretion, flannel shirts or waistcoats worn next to the skin have been found more useful than linen. As the perspiration and sweats, which are thus discharged in a pestilential season, are often unusual in their quantity, and of a morbid quality, clean body-linen or flannel should be put on every day, and where this is not practicable, that which has been worn should be exchanged every morning and evening for that which has been exposed during the previous day and night, in a dry air. 4. Blood-letting. In addition to the authorities of Dr. Haller and Dr. Hodges, mentioned in another place[16], in favour of this remedy, I shall subjoin a few others. Dr. Mitchell, in his Account of the Yellow Fever which prevailed in Virginia, in the year 1741, informs us, that it was often prevented in persons who were under the influence of its remote cause, by the loss of a few ounces of blood. It was formerly a practice among the physicians in St. Domingo, to bleed whole regiments of troops as soon as they arrived from France, by which means they were preserved from the malignant fever of the island. [16] Account of the Yellow Fever in 1793, vol. iii. During the short visit paid to this city, in the year 1798, by Dr. Borland, a respectable physician of the British army, he put into my hands the following communication. "In the beginning of August, 1797, 109 Dutch artillery arrived at Port au Prince, in the Bangalore transport. The florid appearance of the men, their cumbersome clothing, and the season of the year, seemed all unfavourable omens of the melancholy fate we presumed awaited them. It was, however, thought a favourable opportunity, by Dr. Jackson and myself, to try what could be done in warding off the fever. It was accordingly suggested to Monsieur Conturier, the chief surgeon of the foreign troops, and the surgeon of the regiment, that the whole detachment should be blooded freely, and that, the morning after, a dose of physic should be administered to every man. This was implicitly complied with, a day or two after, and at this moment in which I write, although a period of four months has elapsed, but two of that detachment have died, one of whom was in a dangerous state when he landed. A success unparalleled during the war in St Domingo! It is true, several have been attacked with the disease, but in those the symptoms were less violent, and readily subsided by the use of the lancet. "The _crew_ of the Bangalore, on her arrival at Port au Prince, consisted of twenty-eight men. With them no preventive plan was followed. In a very few weeks eight died, and at present, of the original number, but fourteen remain." All these depleting remedies, whether used separately or together, induce such an artificial debility in the system, as disposes it to vibrate more readily under the impression of the miasmata. Thus the willow rises, after bowing before a blast of wind, while the unyielding oak falls to the ground by its side. It is from the similarity of the natural weakness in the systems of women, in the West-Indies, with that which has been induced by the artificial means that have been mentioned, that they so generally escape the malignant endemic of the islands. A second class of preventives of malignant fever are such as obviate the internal action of miasmata, by exciting a general or partial determination to the external surface of the body. These are, 1. The warm bath. I have known this grateful remedy used with success in our city. It serves the treble purposes of keeping the skin clean, and the pores open, and of defending what are called the vital organs from disease, by inviting its remote cause to the external surface of the body. 2. The cold bath, or cold water applied to the external surface of the body. Ulloa, in his travels through Cuba, tells us the Spaniards make it a practice, when partially wetted by the rain, to plunge themselves, with their wet clothes on, into the first stream of water they meet with afterwards, by which means they avoid taking the fever of the island. Where this cannot be conveniently done, the peasants strip off their clothes, and put them under a shelter, and receive showers of rain upon their naked bodies, and thus preserve themselves from the fever. Dr. Baynard has left it upon record, in his treatise upon the cold bath, that those persons who lived in water-mills, also watermen, bargemen, and fishermen, who were employed upon the river, and in dabbling in cold water, were rarely affected by the plague in London, in 1665, and that but two persons died with it on London bridge. The water carriers at Cairo, Mr. Volney says, uniformly escape the plague; and Dr. Chisholm informs us, that those negroes in Demarara who go naked, and are thereby disposed not to avoid showers of rain, are never affected with the fever of that country. 3. Washing the body, every morning and evening, with salt water. A whole ship's crew from Philadelphia was preserved by this means from the yellow fever, some years ago, in one of the West-India islands, while a large proportion of the crews of several ships, that lay in the same harbour, perished by that disease. 4. Anointing the body with oil. The natives of Africa, and some American Indians, use this preventive with success during their sickly seasons. It has lately been used, it is said, with effect in preventing the plague. Its efficacy for that purpose was first suggested by no oilman having died of that disease during four years, in which time 100,000 people perished with it in Egypt. Oliver, in his Travels into that country, says the men who make and sell butter, are equally fortunate in escaping it. 5. Issues, setons, and blisters belong to this class of preventives of malignant and bilious fevers. Issues, according to Parisinus, Florentinus, Forestus, and several other authors quoted by Diemerbroeck, have prevented the plague in many hundred instances. Paræus says, all who had ulcers from the venereal disease, or any other cause, escaped it. Dr. Hodges owed his preservation from the plague in London, in 1665, to an issue in his leg. He says he always felt a slight pain in it when he went into a sick room. Dr. Gallaher ascribed his escape from the yellow fever of 1799 to a perpetual blister, which he applied to his arm for that purpose. Dr. Barton favoured me with the sight of a letter from Dr. James Stevens, dated January 12, 1801, in which he says he believed Dr. Beach (formerly of Connecticut) had been preserved from the bilious fever by a seton in his side. He adds further, that Dr. Beach had been called to attend the labourers at the Onandoga salt springs, in the state of New-York, ninety-eight of whom out of a hundred had the bilious fever. Of the two who escaped it, one had a sore leg, the other what is called a scald-head. The discharge from the sores in each of them, as well as from the doctor's issue, was more copious during the prevalence of the fever, than it had been at any other time. A third class of preventives of malignant fever, are such as excite a general action, more powerful than that which the miasmata are disposed to create in the system, or an action of a contrary nature. These are, 1. Onions and garlic. All those citizens who used these vegetables in their diet, escaped the yellow fever in 1793. The greater exemption of the natives of France from this disease, wherever they are exposed to it, than of the inhabitants of other European countries, has been ascribed in part to the liberal use of those condiments in their food. The Jews, it has been said, have often owed to them their preservation from the plagues which formerly prevailed in Europe. It is probable leeks and onions, which to this day form a material part of the diet of the inhabitants of Egypt, were cultivated and eaten originally as the means of obviating the plagues of that country. I have been at a loss to know why the Author of Nature, who has endowed these vegetables with so many excellent qualities for diet and medicine, should have accompanied them with such a disagreeable smell. Perhaps the reason was, kindly to force them into universal use; for it is remarkable their smell in the breath is imperceptible to those who use them. 2. Calomel, taken in such small doses as gently to affect the gums. It preserved most of the crew of a Russian ship at Plymouth, in the year 1777, from a fever generated by filth in her hold. In a letter which I received from Captain Thomas Truxton, in the year 1797, he informed me, that an old and respectable merchant at Batavia had assured him, he had been preserved in good health by calomel, taken in the way that has been mentioned, during the sickly seasons, for upwards of thirty years. The mortality of the fevers of that island may easily be conceived of, when I add, on the authority of a physician quoted in Sir George Staunton's Account of his Embassy to China, that one half of all new comers die there on the first year of their arrival. Our principal dependence should be placed upon those two preventives under this head. There are several others which have been in common use, some of which I believe are hurtful, and the rest are of feeble, or doubtful efficacy. They are, 3. Wine and ardent spirits. They both prevent a malignant fever, only when they excite an action in the system above that which is ordinarily excited by the miasmata of the fever; but this cannot be done without producing intoxication, which, to be effectual, must be perpetual; for the weakness and excitability, which take place in the intervals of drunkenness, predispose to the disease. Agreeably to this remark, I observed three persons, who were constantly drunk, survive two of our most fatal epidemics, while all those persons who were alternately drunk and sober, rarely escaped an attack of the fever. In most of them, it terminated in death. 4. Tobacco. Many hundreds of the citizens of Philadelphia can witness, that no benefit was derived from this weed, in any of the ways in which it is commonly used, in the late epidemics of our city. Mr. Howard says it has no effect in preserving from the plague. 5. Camphor suspended in a bag round the neck, and rags wetted in vinegar, and applied to the nose. These means were in general use in the fever of 1793, in Philadelphia, but they afforded no protection from it. It is possible they had a contrary effect, by entangling, in their volatile particles, more of the miasmata of the fever, and thus increasing a predisposition to it. A fourth class of the preventives of malignant fevers are certain substances which are said to destroy miasmata by entering into mixture with them. Two persons, who were very much exposed to the causes of the fever in 1798, took each of them a table spoonful of sweet oil every morning. They both escaped the fever. Did the oil, in these cases, act by destroying miasmata in the stomach chemically? or did it defend the stomach mechanically from their action? or did it prevent the disease, only by gently opening the bowels? It is certain the fat of pork meat protects the men who work in the lead-mines of Great-Britain from the deleterious effects which the fumes of that metal are apt to bring upon the stomach and bowels, and that a poisoned arrow, discharged into the side of a hog, will not injure him, if it be arrested by the fat which lines that part of his body. The vapour which issues from fresh earth has been supposed to destroy the miasmata which produce malignant fevers, by entering into mixture with them. Most of the men who were employed in digging graves and cellars, and in removing the dirt from the streets of Philadelphia, in 1793, escaped the fever of that year. In the new settlements of our country, it is said, the poison of the rattlesnake is deprived of its deadly effects upon the body, by thrusting the wounded limb into a hole, recently made in the earth. The fable of Anteus, who rose with renewed strength from the ground after repeated falls, was probably intended to signify, among other things, the salutary virtues which are contained in the effluvia which issue from fresh clods of earth. 3. There are many facts which show the efficacy of the volatile alkali in destroying, by mixture, the poison of snakes. One of them was lately communicated to the public by Dr. Ramsay, of South-Carolina. What would be the effect of the daily use of a few tea spoonfuls of this medicine in a liquid form, and of frequently washing the body with it, during the prevalence of pestilential epidemics? The miasmata which produce malignant fevers often exist in an inoffensive state in the body, for weeks, and perhaps months, without doing any harm. With but a few exceptions, they seldom induce a disease without the reinforcement of an exciting cause. In vain, therefore, shall we use all the preventives that have been recommended, without, V. Avoiding of all its exciting causes. These are, 1. Heat and cold. While the former has excited the yellow fever in thousands, the latter has excited it in tens of thousands. It is not in middle latitudes only that cold awakens this disease in the body. Dr. Mosely says it is a more frequent exciting cause of that, and of other diseases, in the island of Jamaica, than in any of the most temperate climates of the globe. It is this which renders cases of yellow fever, when epidemic in our cities, more numerous in the cool months of September and October, than in July and August. For the purpose of avoiding this pernicious and universal influence of cold, the clothing and bed-covers should be rather warmer in those months, in middle and northern latitudes, than is agreeable, and fires should be made every morning and evening in common sitting rooms, and during the whole day, when the weather is damp or cool. They serve, not only to prevent the reduction of the excitement of the blood-vessels, by the gradual and imperceptible abstraction of the heat of the body, but to convey up a chimney all the unwholesome air that accumulates in those rooms during a sickly season. By these precautions, I have known whole families preserved in health, while all their neighbours who neglected them, have been confined by a prevailing autumnal fever. 3. The early morning and evening air, even in warm weather. 4. Fatigue from amusements, such as fishing, gunning, and dancing, and from _unusual_ labour or exercise. The effects of fatigue from this cause have been already noticed[17], in the maids of large families being the only persons who die of the fever, in consequence of their having performed great and _unusual_ services to those branches of the family who survive them, while nurses, who only exercise their ordinary habits in attending sick people, are seldom carried off by it. [17] Account of the Yellow Fever in 1793, vol. iii. 5. Intemperance in eating and drinking. 6. Partaking of _new_ aliments and drinks. The stomach, during the prevalence of malignant fevers, is always in an irritable state, and constantly disposed to be affected by impressions that are not habitual to it. 7. Violent emotions or passions of the mind. 8. The entire cessation of moderate labour. This, by permitting the mind to ramble upon subjects of terror and distress, and by exposing the body to idleness and company, favours an attack of fever. A predisposition to it, is likewise created by alternating labour and idleness with each other. 9. The continuance of hard labour. The miasmata which produce malignant fevers sometimes possess so much force, that the least addition to it, even from customary acts of labour, is sufficient to excite the disease. In this case, safety should be sought in retirement, more especially by those persons whose occupations expose them to the heat of fires, and the rays of the sun, such as hatters, smiths, bricklayers, and house and ship carpenters. The wealthy inhabitants of Constantinople and Smyrna erroneously suppose they escape the contagion of the plague, by shutting themselves up in their houses during its prevalence. They owe their preservation chiefly to their being removed, by an exemption from care and business, from all its exciting causes. Most of the nobility and gentry of Moscow, by these means escaped a plague which carried off 27,000 persons in that city, in the year 1771, and many whole families in Philadelphia were indebted for their safety to the same precautions in the year 1793. Confinement is more certain in its beneficial effects, when persons occupy the upper stories only of their houses. The inhabitants of St. Lucia, Dr. Chisholm says, by this means often escape the yellow fever of that island. Such is the difference between the healthiness of the upper and lower stories of a house, that, travellers tell us, birds live in the former, and die in the latter, during the prevalence of a plague in the eastern countries. All the exciting causes that have been enumerated should be avoided with double care three days before, and three days after, as well as on the days of the full and change of the moon. The reason for this caution was given in the account of the yellow fever in Philadelphia in the year 1797. To persons who have retired from infected cities, or countries, it will be necessary to suggest a caution, not to visit them while the malignant fever from which they fled prevails in them. Dr. Dow informed me, in his visit to Philadelphia in the year 1800, that the natives and old citizens of New-Orleans who retired into the country, and returned during the prevalence of the yellow fever in that city, the year before, were often affected by it, while all such persons as did not change their residence, escaped it. The danger from visiting an infected city is greater to persons who breathe an atmosphere of a uniform temperature, than one that is subject to alternate changes in its degrees of heat and cold. The inhabitants of Mexico, Baron Humboldt informed me, who descend from their elevated situation, where the thermometer seldom varies more than ten degrees in the year, and visit Vera Cruz during the prevalence of the yellow fever in that city, are much oftener affected by it than the new comers from the variable climates of European countries. But the habits of insensibility to the impressions of the miasmata of this disease in one country, do not always protect the system from their action in another. The same illustrious traveller informed me, that the inhabitants of the Havannah who visit Vera Cruz, and the inhabitants of Vera Cruz who visit the Havannah, are affected in common with strangers with the fever of those places. I shall take leave of this part of our subject, by adding, that I am so much impressed with a belief in the general, and almost necessary connection of an exciting cause with a yellow fever, that were I to enter a city, and meet its inhabitants under the first impressions of terror and distress from its appearance, my advice to them should be, "BEWARE, not of contagion, for the yellow fever of our country is not contagious, nor of putrid exhalations, when the duties of humanity or consanguinity require your attendance, but BEWARE OF EXCITING CAUSES!" In the mild grades of the summer and autumnal fevers of the United States, the means of prevention should be different from those which have been recommended to prevent the yellow fever. They consist of such things as gently invigorate the system, and thus create an action superior to that which the miasmata have excited in it. The means commonly employed for this purpose are, 1. Cordial diet and drinks; consisting of salted meat, and fish, with a moderate quantity of wine and malt liquors. Dr. Blane says, the British soldiers who lived upon salt meat, during the American war, were much less afflicted with the intermitting fever than the neighbouring country people; and, it is well known, the American army was much less afflicted with summer and autumnal fevers, after they exchanged their fresh meat for rations of salted beef and pork. Ardent spirits should be used cautiously, for, when taken long enough to do good, they create a dangerous attachment to them. A strong infusion of any bitter herb in water, taken upon an empty stomach, is a cheap substitute for all the above liquors where they cannot be afforded. The Peruvian bark has in many instances been used with success as a preventive of the mild grades of the summer and autumnal fevers of our country. 2. An equable and constant perspiration. This should be kept up by all the means formerly mentioned for that purpose. 3. Avoiding certain exciting causes, particularly great heat and cold, fatigue, long intervals between meals, intemperance, and the morning and evening air, more especially during the lunar periods formerly mentioned. Dr. Lind says, the farmers of Holdernesse, in England, who go out early to their work, are seldom long lived, probably from their constitutions being destroyed by frequent attacks of intermitting fevers, to which that practice exposes them. Where peculiar circumstances of business render it necessary for persons to inhale the morning air, care should be taken never to do it without first eating a cordial breakfast. The _intestinal_ state of our summer and autumnal disease requires several specific means to prevent it, different from those which have been advised to defend the blood-vessels from fever. Unripe and decayed fruit should be avoided, and that which is ripe and sound should not be eaten in an excessive quantity. Spices, and particularly Cayenne pepper, and the red pepper of our country, should be taken daily with food. Mr. Dewar, a British surgeon, tells us, the French soldiers, while in Egypt, carried pepper in boxes with them, wherever they went, to eat with the fruits of the country, and thereby often escaped its diseases. The whole diet, during the prevalence of intestinal diseases, when they are not highly inflammatory, should be of a cordial nature. A dysentery prevailed, a few years ago, upon the Potomac, in a part of the country which was inhabited by a number of protestant and catholic families. The disease was observed to exist only in the former. The latter, who ate of salted fish every Friday, and occasionally on other days of the week, very generally escaped it. In the year 1759, a dysentery broke out in the village of Princeton, in New-Jersey, and affected many of the students of the college. It was remarked, that it passed by all those boys who came from the cities of New-York and Philadelphia. This was ascribed to their having lived more upon tea and coffee than the farmers' sons in the college; for those cordial articles of diet were but rarely used, six and forty years ago, in the farm houses of the middle states of America. I mentioned formerly that the cordial diet of the inhabitants of our cities was probably the reason why the dysentery so seldom prevailed as an epidemic in them. Another means of preventing the dysentery is, by avoiding costiveness, and by occasionally taking purging physic, even when the bowels are in their natural state. A militia captain, in the Pennsylvania service, preserved his whole company from a dysentery which prevailed in a part of the American army at Amboy, in the year 1776, by giving each of them a purge of sea-water. He preserved his family, and many of his neighbours, some years afterwards, from the same disease, by dividing among them a few pounds of purging salts. It was prevented, a few years ago, in the academy of Bordentown, in New-Jersey, by giving all the boys molasses, in large quantities, in their diet and drinks. The molasses probably acted only by keeping the bowels in a laxative state. As the dysentery is often excited by the dampness of the night air, great care should be taken to avoid it, and, when necessarily exposed to it, to defend the bowels by more warmth than other parts of the body. The Egyptians, Mr. Dewar says, tie a belt about their bowels for that purpose, and with the happiest effects. II. I come now, according to the order I proposed, to mention the means of preserving whole cities or communities from the influence of those morbid exhalations which produce the different forms of summer and autumnal disease, and, in particular, that which is of a malignant nature. As the flight of a whole city is rarely practicable, it will be necessary to point out the means of destroying the morbid miasmata. 1. Where the putrid matters which emit them are of a small extent, they should be covered with water or earth. Purchas tells us, 500 persons less died of the plague the day after the Nile overflowed the grounds which had emitted the putrid exhalations that produced it, than had died the day before. During the prevalence of a malignant fever, it will be unsafe to remove putrid matters. A plague was generated by an attempt to remove the filth which had accumulated on the banks of the waters which surround the city of Mantua, during the summer and autumnal months[18]. Even a shower of rain, by disturbing the green pellicle which is sometimes formed over putrid matters, I shall mention in another place, has let loose exhalations that have produced a pestilential disease. [18] Burserus. 2. Impregnating the air with certain effluvia, which act either by destroying miasmata by means of mixture, or by exciting a new action in the system, has, in some instances, checked the progress of a malignant fever. The air extricated from fermenting wines, during a plentiful vintage, Vansweiten tells us, has once checked the ravages of a plague in Germany. Ambrose Parey informs us, the plague was checked in a city in Italy by killing all the cats and dogs in the place, and leaving them to putrify in the streets. Mr. Bruce relates, that all those persons who lived in smoky houses, in one of the countries which he visited, escaped bilious fevers, and Dr. Clark mentions an instance, in which several cooks, who were constantly exposed to smoke, escaped a fever which affected the whole crew of a galley. The yellow fever has never appeared within the limits of the effluvia of the sal ammoniac manufactory, nor of the tan-pits in the suburbs of Philadelphia, nor has the city of London been visited with a plague since its inhabitants have used sea-coal for fuel. But other causes have contributed more certainly to the exemption of that city from the plague for upwards of a century, one of which shall be mentioned under our next head. 3. Desquenette tells us, the infection of the plague never crosses the Nile, and that it is arrested by means of ditches, dug and filled with water for that purpose. Dr. Whitman has remarked, that the plague never passes from Abydos, on the Turkish, to Mito, on the European side of the water of the Dardanelles, which forms the entrance to Constantinople. The yellow fever has never been known to pass from Philadelphia to the Jersey shore, and the miasmata generated on the east side of the Schuylkill rarely infect the inhabitants of the opposite side of the river. Many persons found safety from the plague of London, in 1665, by flying to ships which lay in the middle of the Thames, and, it is well known, no instance of yellow fever occurred in those Philadelphia families that confined themselves to ships in the middle of the Delaware, in the year 1793. But three or four, of four hundred men, on board a ship of war called the Jason, commanded by captain Coteneuil, perished with an epidemic yellow fever, in the year 1746, at St. Domingo, in consequence, Dr. Desportes says, of her hold being constantly half filled with water[19]. I have multiplied facts upon this subject, because they lead to important conclusions. They show the immense consequence of frequently washing the streets and houses of cities, both to prevent and check pestilential fevers. What would be the effect of placing tubs of fresh water in the rooms of patients infected with malignant fevers, and in an atmosphere charged with putrid exhalations? Their efficacy in absorbing the matter which constitutes the odour of fresh paint, favours a hope that they would be useful for that purpose. I have mentioned an instance, in the Account of the Yellow Fever in Philadelphia, in the year 1797, in which they were supposed to have been employed with evident advantage. [19] Vol. I. p. 161. 4. Intercepting the passage of miasmata to the inhabitants of cities. Varro, in his Treatise upon Agriculture, relates, that his namesake Varro, a Roman general, was in great danger of suffering, with a large fleet and army, from a malignant fever at Conyra. Having discovered the course of the miasmata which produced it to be from the south, he fastened up all the southern windows and doors of the houses in which his troops were quartered, and opened new ones to the north, by which means he preserved them from the fever which prevailed in all the other houses of the town and neighbourhood. Mr. Howard advises keeping the doors and windows, of houses which are exposed to the plague, constantly shut, except during the time of sunshine. Several other means have been recommended to preserve cities from malignant fevers during their prevalence, which are of doubtful efficacy, or evidently hurtful. They are, 5. Strewing lime over putrid matters. Dr. Dalzelle says, he once checked a bilious fever, by spreading twelve barrels of lime on a piece of marshy ground, from whence the exhalations that produced it were derived[20]. A mixture of quick lime and ashes in water, when thrown into a privy, discharges from it a large quantity of offensive air, and leaves it afterwards without a smell. As this foul air is discharged into the atmosphere, it has been doubted whether the lime and ashes should be used for that purpose, after a malignant fever has made its appearance. [20] Sur les Maladies des Climats Chauds. 6. Mr. Quiton Morveau has lately proposed the muriatic gas as a means of destroying miasmata. However effectual it may be in destroying the volatile and foul excretions which are discharged from the human body in confined situations, as in filthy jails, hospitals, and ships, it is not calculated to oppose the seeds of a disease which exist in the atmosphere, and which are diffused over a large extent of city or country. Mr. Morveau ascribes great virtues to it, in checking the malignant fever in Cadiz, in 1801, but from the time at which it was used, being late in the autumn, there is more reason to believe it had run its ordinary course, or that it was destroyed by cold weather. 7. The explosion of gunpowder has been recommended for checking pestilential diseases. Mr. Quiton Morveau says, it destroys the offensive odour of putrid exhalations, but does not act upon the fevers produced by them. 8. Washing the floors of houses with a solution of alkaline salts in water, has been recommended by Dr. Mitchell, as an antidote to malignant fevers. As yet, I believe, there are no facts which establish the efficacy of the practice, when they are produced by exhalations from decayed vegetable and animal substances in a putrid state. 9. Large fires have sometimes been made in cities, in order to destroy the miasmata of pestilential diseases. They were obviously hurtful in the plague of London, in the year 1665. Dr. Hodges, who relates this fact, says, "Heaven wept for the mistake of kindling them, and mercifully put them out, with showers of rain." I cannot conclude this head, without lamenting the want of laws in all our states, to compel physicians to make public the first cases of malignant fever that come under their notice. The cry of fire is not more useful to save a city from destruction, than the early knowledge of such cases would be to save it from the ravages of pestilential and mortal epidemics. Hundreds of instances have occurred, in all ages and countries, in which they might have been stifled in their birth, by the means that have been mentioned, had this practice been adopted. But when, and where, will science, humanity, and government first combine to accomplish this salutary purpose? Most of our histories of mortal epidemics abound with facts which show a contrary disposition and conduct in physicians, rulers, and the people. I shall mention one of these facts only, to show how far we must travel over mountains of prejudice and error, before we shall witness that desirable event. It is extracted from the second volume of the Life of the late Empress of Russia. "The Russian army (says the biographer), after defeating the Turks, on entering their territories were met by the plague, and brought it to their country, where the folly of several of their generals contributed to its propagation, as if they thought by a military word of command to alter the nature of things. Lieutenantgeneral Stoffeln, at Yassy, where the pestilence raged in the winter of 1770, issued peremptory orders that its name should not be pronounced; he even obliged the physicians and surgeons to draw up a declaration in writing, that it was only _a spotted fever_. One honest surgeon of the name of Kluge refused to sign it. In this manner the season of prevention was neglected. Several thousand Russian soldiers were by this means carried off. The men fell dead upon the road in heaps. The number of burghers that died was never known, as they had run into the country, and into the forests. At length the havoc of death reached the general's own people: he remained true to his persuasion, left the town, and went into the more perilous camp. But his intrepidity availed him nothing; he died of the plague in July, 1771[21]." [21] The above disease appears to have been the camp fever, the origin and character of which will be noticed in the next article. III. Let us now consider, in the last place, the means of exterminating malignant and other forms of summer and autumnal disease, by removing their causes. These means are, 1. The removal or destruction of all those putrid matters formerly enumerated, which are capable of producing fevers. Many of the institutions of the Jewish nation, for this purpose, are worthy of our imitation. The following verses contain a fund of useful knowledge upon this subject.--"Thou shalt have a place without the camp, whether thou shalt go forth abroad; and shalt have a paddle upon thy weapon, and it shall be when thou wilt ease thyself abroad, thou shalt dig therewith, and shalt turn back, and cover that which cometh from thee; for the Lord thy God walketh in the midst of thy camp to deliver thee, therefore shall he _see no unclean thing in thee_, and turn away from thee." Deuteronomy, chapter xxiii. verses 12, 13, and 14. "But the flesh of the bullock, and his skin, and his dung, shalt thou _burn with fire without the camp_." Exodus, chapter xxxix. verse 14. The advantages of thus burying and removing all putrid matters, and of burning such as were disposed to a speedy putrefaction, in a crowded camp, and in a warm climate, are very obvious. Their benefits have often been realized in other countries. The United Provinces of Holland hold their exemption from the plague, only by the tenure of their cleanliness. In the character given by Luther of Pope Julius, he says, "he kept the streets of Rome so clean and sweet, that there were no plagues nor sicknesses during his time." The city of Oxford was prepared to afford an asylum to the royal family of Great-Britain from the plague, when it ravaged London, and other parts of England, in the year 1665, only in consequence of its having been cleaned, some years before, by the Bishop of Winchester. In a manuscript account of the life of Doctor, afterwards Governor Colden, of New-York, there is the following fact. It was first communicated to the public in the daily gazette of the capital of that state, on the 30th of October, 1799. "A malignant fever having raged with exceeding violence for two summers successively in the city of New-York, about forty years ago, he communicated his thoughts to the public, on the most probable cure of the calamity. He published a little treatise on the occasion, in which he collected the sentiments of the best authority, on the bad effects of _stagnating waters_, _moist air_, _damp cellars_, _filthy shores_, and _dirty streets_. He showed how much these nuisances prevailed in many parts of the city, and pointed out the remedies. The corporation of the city voted him their thanks, adopted his reasoning, and established a plan for draining and cleaning the city, which was attended with the most happy effects." The advantages of burning offal matters, capable by putrefaction of producing fevers, has been demonstrated by those housekeepers, who, instead of collecting the entrails of fish and poultry, and the parings and skins of vegetables, in barrels, instantly throw them into their kitchen fires. The families of such persons are generally healthy. 2. In the construction of cities, narrow streets and alleys should be carefully avoided. Deep lots should be reserved for yards and gardens for all the houses, and subterraneous passages should be dug to convey, when practicable, to running water, the contents of privies, and the foul water of kitchens. In cities that are wholly supplied with fresh water by pipes from neighbouring springs or rivers, all the evils from privies might be prevented by digging them so deep as to connect them with water. Great advantages, it has been suggested, would arise in the construction of cities, from leaving open squares, equal in number and size to those which are covered with houses. The light and dark squares of a chequer-board might serve as models for the execution of such a plan. The city of London, which had been afflicted nearly every year for above half a century by the plague, has never been visited by it since the year 1666. In that memorable year, while the inhabitants were venting their execrations upon a harmless bale of silks imported from Holland, as the vehicle of the seeds of their late mortal epidemic, Heaven kindly pointed out, and removed its cause, by permitting a fire to destroy whole streets and lanes of small wooden buildings, which had been the reservoirs of filth for centuries, and thereby the sources of all the plagues of that city[22]. Those streets and lanes were to London, what Water-street and Farmer's-row are to Philadelphia, Fell's-point to Baltimore, the slips and docks to New-York, and Water-street to the town of Norfolk. [22] A proposal was made to replace the houses that had been burnt, by similar buildings, and upon the same space of ground. Sir Christopher Wren opposed it, and with the following argument: "By so doing, you will show you have not _deserved_ the late fire!" 3. Where the different forms of summer and autumnal disease arise from marsh exhalations, they should be destroyed by drains, by wells communicating with their subterraneous springs, or by cultivating upon them certain grasses, which form a kind of mat over the soil, and, when none of these modes of destroying them is practicable, by overflowing them with water. I have met with many excellent quotations from a work upon this part of our subject, by Tozzetti, an Italian physician, from which, I have no doubt, much useful information might be obtained. The Rev. Thomas Hall, to whom I made an unsuccessful application for this work, speaks of it, in his answer to my letter, in the following terms. "It is in such high estimation, that the late emperor Leopold, when grand duke of Tuscany, caused it to be re-printed at his own expence, and presented it to his friends. The consequence of this was, it influenced the owners of low marshy grounds, in the neighbourhood of the river Arno, to drain and cultivate them, and thereby rendered the abode of noxious air, and malignant fevers, a terrestrial paradise." 4. The summer and autumnal diseases of our country have often followed the erection of mill-dams. They may easily be obviated by surrounding those receptacles of water with trees, which prevent the sun's acting upon their shores, so as to exhale miasmata from them. Trees planted upon the sides of creeks and rivers, near a house, serve the same salutary purpose. 5. It has often been observed, that families enjoy good health, for many years, in the swamps of Delaware and North-Carolina, while they are in their natural state, but that sickness always follows the action of the rays of the sun upon the moist surface of the earth, after they are cleared. For this reason, the cultivation of a country should always follow the cutting down of its timber, in order to prevent the new ground becoming, by its exhalations, a source of disease. 6. In commercial cities, no vessel that arrives with a cargo of putrescent articles should ever be suffered to approach a wharf, before the air that has been confined in her hold has been discharged. The same thing should be done after the arrival of a vessel from a distant or hot country, though her cargo be not capable of putrefaction, for air acquires a morbid quality by stagnating contiguous to wood, under circumstances formerly mentioned. All these modes of removing the causes of malignant and yellow fevers, and of promoting strict and universal cleanliness, are of more consequence in the middle and northern states of America, than in countries uniformly warm, inasmuch as the disease may be taken as often as our inhabitants are exposed to its sources. In the West-Indies, a second attack of the yellow fever is prevented by the insensibility induced upon the system, by its being constantly exposed to the impressions of heat and exhalation. After a seasoning, as it is called, or a residence of two or three years in those islands, the miasmata affect the old settlers, as they do the natives, only with mild remittents. Nearly the same thing takes place at Madras, in the East-Indies, where, Dr. Clark says, the exhalations which bring on bilious fevers, colic, cholera, and spasmodic affections in new comers, produce a puking in the morning, only in old residents. But very different is the condition of the inhabitants of the middle and northern states of America, in whom the winters prevent the acquisition of habits of insensibility to the heat and exhalations of the previous summers, and thus place them every year in the condition of new comers in the West and East-Indies, or of persons who have spent two or three years in a cold climate. This circumstance increases the danger of depopulation from our malignant epidemics, and should produce corresponding exertions to prevent them. In enumerating the various means of preventing and exterminating the malignant forms of fever, it may appear strange that I have said nothing of the efficacy of quarantines for that purpose. Did I believe these pages would be read only by the citizens of Pennsylvania, I would do homage to their prejudices, by passing over this subject by a respectful and melancholy silence; but as it is probable they will fall into the hands of physicians and citizens of other states, I feel myself under an obligation to declare, that I believe quarantines are of no efficacy in preventing the yellow fever, in any other way than by excluding the unwholesome air that is generated in the holds of ships, which may be done as easily in a single day, as in weeks or months. They originated in error, and have been kept up by a supine and traditional faith in the opinions and conduct of our ancestors in medicine. Millions of dollars have been wasted by them. From their influence, the commerce, agriculture, and manufactures of our country have suffered for many years. But this is not all. Thousands of lives have been sacrificed, by that faith in their efficacy, which has led to the neglect of domestic cleanliness. Distressing as these evils are, still greater have originated from them; for a belief in the contagious nature of the yellow fever, which is so solemnly enforced by the execution of quarantine laws, has demoralized our citizens. It has, in many instances, extinguished friendship, annihilated religion, and violated the sacraments of nature, by resisting even the loud and vehement cries of filial and parental blood. While I thus deny the yellow fever to be the offspring of a specific contagion, and of course incapable of being imported so as to become an epidemic in any country, I shall admit presently, that the excretions of a patient in this disease may, by confinement, become so acrid as to produce, under circumstances to be mentioned hereafter, a similar disease in a person, but from this person it cannot be communicated, if he possess only the common advantages of pure air and cleanliness. To enforce a quarantine law, therefore, under such a contingent circumstance, and at the expence of such a profusion of blessings as have been mentioned, is to imitate the conduct of the man, who, in attempting to kill a fly upon his child's forehead, knocked out its brains. From the detail that has been given of the sources of malignant fevers, and of the means of preventing them, it is evident that they do not exist by an unchangeable law of nature, and that Heaven has surrendered every part of the globe to man, in a state capable of being inhabited, and enjoyed. The facts that have been mentioned show further, the connection of health and longevity, with the reason and labour of man. To every natural evil the Author of Nature has kindly prepared an antidote. Pestilential fevers furnish no exception to this remark. The means of preventing them are as much under the power of human reason and industry, as the means of preventing the evils of lightning and common fire. I am so satisfied of the truth of this opinion, that I look for a time when our courts of law shall punish cities and villages, for permitting any of the sources of bilious and malignant fevers to exist within their jurisdiction. I have repeatedly asserted the yellow fever of the United States not to be contagious. I shall now mention the proofs of that assertion, and endeavour to explain instances of its supposed contagion upon other principles. FACTS, INTENDED TO PROVE _THE YELLOW FEVER_ NOT TO BE CONTAGIOUS. When fevers are communicated from one person to another, it is always in one of the following ways. 1. By secreted matters. 2. By excreted matters. The small-pox and measles are communicated in the former way; the jail, or, as it is sometimes called, the ship, or camp, and hospital fever, is communicated only by means of the excretions of the body. The perspiration, by acquiring a morbid and irritating quality more readily than any other excretion, in consequence of its stagnation and confinement to the body in a tedious jail fever, is the principal means of its propagation. The perspiration[23] is, moreover, predisposed to acquire this morbid and acrid quality by the filthiness, scanty, or bad aliment, and depression of mind, which generally precede that fever. It is confined to sailors, passengers, soldiers, prisoners, and patients, in foul and crowded ships, tents, jails, and hospitals, and to poor people who live in small, damp, and confined houses. It prevails chiefly in cool and cold weather, but is never epidemic; for the excreted matters which produce the fever do not float in the external atmosphere, nor are they communicated, so as to produce disease, more than a few feet from the persons who exhale them. They are sometimes communicated by means of the clothes which have been worn by the sick, and there have been instances in which the fever has been produced by persons who had not been confined by it, but who had previously been exposed to all the causes which generate it. It has been but little known in the United States since the revolutionary war, at which time it prevailed with great mortality in the hospitals and camps of the American army. It has now and then appeared in ships that were crowded with passengers from different parts of Europe. It is a common disease in the manufacturing towns of Great-Britain, where it has been the subject of several valuable publications, particularly by Dr. Smith and Dr. John Hunter. Dr. Haygarth has likewise written upon it, but he has unfortunately confounded it with the West-India and American yellow fever, which differs from it in prevailing chiefly in warm climates and seasons; in being the offspring of dead and putrid vegetable and animal matters; in affecting chiefly young and robust habits; in being generally accompanied with a diseased state of the stomach, and an obstruction or preternatural secretion and excretion of bile; in terminating, most commonly, within seven days; in becoming epidemic _only_ by means of an impure atmosphere; and in not furnishing ordinarily those excretions which, when received into other bodies, reproduce the same disease. [23] The deleterious nature of this fluid, and its disposition to create disease, under the above circumstances, has been happily illustrated by Dr. Mitchill, in an ingenious letter to Dr. Duncan, of Edinburgh, published in the fourth volume of the Annals of Medicine. I have been compelled to employ this tedious description of two forms of fever, widely different from each other in their causes, symptoms, and duration, from the want of two words which shall designate them. Dr. Miller has boldly and ingeniously proposed to remedy this deficiency in our language, by calling the former _idio-miasmatic_, and the latter _koino-miasmatic_ fevers, thereby denoting their _private_ or _personal_, and their _public_ or _common_ origin[24]. My best wishes attend the adoption of those terms! [24] Medical Repository, hexade ii. vol. i. I return to remark, that the yellow fever is not contagious in its simple state, and that it spreads exclusively by means of exhalations from putrid matters, which are diffused in the air. This is evident from the following considerations: 1. It does not spread by contagion in the West-Indies. This has been proved in the most satisfactory manner by Drs. Hillary, Huck, Hunter, Hector M'Lean, Clark, Jackson, Borland, Pinckard, and Scott. Dr. Chisholm stands alone, among modern physicians, in maintaining a contrary opinion. It would be easy to prove, from many passages in the late edition of the doctor's learned and instructive volumes, that he has been mistaken; and that the disease was an endemic of every island in which he supposed it to be derived from contagion. A just idea of the great incorrectness of all his statements, in favour of his opinion, may be formed from the letter of J. F. Eckard, Esq. Danish consul, in Philadelphia, to Dr. James Mease, published in a late number of the New-York Medical Repository[25]. [25] For February, March, and April, 1804. 2. The yellow fever does not spread in the country, when carried thither from the cities of the United States. 3. It does not spread in yellow fever hospitals, when they are situated beyond the influence of the impure air in which it is generated. 4. It does not spread in cities (as will appear hereafter) from any specific matter emitted from the bodies of sick people. 5. It generally requires the co-operation of an _exciting_ cause, with miasmata, to produce it. This is never the case with diseases which are universally acknowledged to be contagious. 6. It is not propagated by the artificial means which propagate contagious diseases. Dr. Ffirth inoculated himself above twenty times, in different parts of his body, with the black matter discharged from the stomachs of patients in the yellow fever, and several times with the serum of the blood, and the saliva of patients ill with that disease, without being infected by them; nor was he indisposed after swallowing half an ounce of the black matter recently ejected from the stomach, nor by exposing himself to the vapour which was produced by throwing a quantity of that matter upon iron heated over a fire[26]. [26] Inaugural Dissertation on Malignant Fever, &c. published in June, 1804. To the first four of these assertions there are some seeming exceptions in favour of the propagation of this fever by contagion. I shall briefly mention them, and endeavour to explain them upon other principles. The circumstances which seem to favour the communication of the yellow fever from one person to another, by means of what has been supposed to be contagion, are as follow: 1. A patient being attended in a small, filthy, and _close_ room. The excretions of the body, when thus accumulated, undergo an additional putrefactive process, and acquire the same properties as those putrid animal matters which are known to produce malignant fevers. I have heard of two or three instances in which a fever was produced by these means in the country, remote from the place where it originated, as well as from every external source of putrid exhalation. The plague is sometimes propagated in this way in the low and filthy huts which compose the alleys and narrow streets of Cairo, Smyrna, and Constantinople. 2. A person sleeping in the sheets, or upon a bed impregnated with the sweats or other excretions, or being exposed to the smell of the foul linen, or other clothing of persons who had the yellow fever. The disease here, as in the former case, is communicated in the same way as from any other putrid animal matters. It was once received in Philadelphia from the effluvia of a chest of unwashed clothes, which had belonged to one of our citizens who had died with it in Barbadoes; but it extended no further in a large family than to the person who opened the chest. I have heard of but two instances more of its having been propagated by these means in the United States, in which case the disease perished with the unfortunate subjects of it. To the above insolated cases of the yellow fever being produced by the clothing of persons who had died of it, I shall oppose a fact communicated to me by Dr. Mease. While the doctor resided at the lazaretto, as inspector of sickly vessels, between May, 1794, and the same month in 1798, the clothing contained in the chests and trunks of all the seamen and others, belonging to Philadelphia, who had died of the yellow fever in the West-Indies, or on their passage home, and the linen of all the persons who had been sent from the city to the lazaretto with that disease, amounting in all to more than one hundred, were opened, exposed to the air, and washed, by the family of the steward of the hospital, and yet no one of them contracted the least indisposition from them. I am disposed to believe the linen, or any other clothing of a person in good health that had been strongly impregnated with sweats, and afterwards suffered to putrify in a confined place, would be more apt to produce a yellow fever in a summer or autumnal month, than the linen of a person who had died of that disease, with the usual absence of a moisture on the skin. The changes which the healthy excretions by the pores undergo by putrefaction, may easily be conceived, by recollecting the offensive smell which a pocket-handkerchief acquires that has been used for two or three days to wipe away the sweat of the face and hands in warm weather[27]. [27] See Van Swieten on Epidemic Diseases, Aphorism 1408. 3. The protraction of a yellow fever to such a period as to dispose it to assume the symptoms, and to generate the peculiar and highly volatilised exhalation from the pores of the skin which takes place in the jail fever. I am happy in finding I am not the author of this opinion. Sir John Pringle, Dr. Monro, and Dr. Hillary, speak of a contagious fever produced by the combined action of marsh and human miasmata. The first of those physicians supposes the Hungarian bilious fever, which prevailed over the continent of Europe in the seventeenth century, was sometimes propagated in this way, as well as by marsh and other putrid exhalations. Dr. Richard Pearson, in his observations upon the bilious fevers which prevailed in the neighbourhood of Birmingham, in England, in the years 1797, 1798, and 1799, has the following remark: "In its first stage, this fever did not appear to be contagious, but it evidently was so after the eleventh and fourteenth day, when the _typhoid_ state was induced[28]." As this protracted state of bilious fever rarely occurs in our country, it has seldom been communicated in this way. [28] Page 13. It is not peculiar, I believe, to a bilious and yellow fever, when much protracted beyond its ordinary duration, to put on the symptoms of the jail fever. The same appearances occur in the pleurisy, and in other, of what Dr. Sydenham calls _intercurrent_ fevers, all of which I have no doubt, under certain circumstances of filth, confinement, and long duration, would produce a fever in persons who were exposed to it. This fever, if the weather were cold, would probably put on inflammatory symptoms, and be added, in our nosologies, to the class of contagious diseases. From the necessary influence of time, in thus rendering fevers of all kinds now and then contagious by excretion, it follows, that the yellow fever, when of its usual short duration, is incapable of generating that excretion, and that, instead of being considered as the only form of bilious fever that possesses a power of propagating itself, it should be considered as the only one that is devoid of it. 4. Miasmata, whether from marshes, or other external sources, acting upon a system previously impregnated with the excreted matters which produce the jail or ship fever. Mr. Lempriere informs us, that he saw what were supposed to be cases of yellow fever communicated by some sailors who brought the seeds of the ship fever with them to the island of Jamaica. The fevers which affected most of the crews of the Hussar frigate, mentioned by Dr. Trotter[29], and of the Busbridge Indiaman, described by Mr. Bryce[30], appear to have been the effect of the combined operation of foul air in those ships, and human excretions, upon their systems. The disease was barely tinged with bilious symptoms, and hence the facility with which it was cured, for the jail fever more readily yields to medicine than the yellow fever. The former was probably excited by some latent exhalation from dead matters in the holds of the ships, and hence we find it ceased on shore, where it was deprived of its exciting cause. It is true, great pains were taken to clean the hold and decks of the Busbridge, but there are foul matters which adhere to the timbers of ships, and which, according to Dr. Lind, are sometimes generated by those timbers when new, that are not to be destroyed by any of the common means employed for that purpose. Of this Dr. Kollock has furnished us with a most satisfactory proof, in his history of the yellow fever, which prevailed on board of the frigate General Greene, on her voyage to the Havanna, in the year 1799. "The air in the hold of the vessel (says the doctor) was so contaminated, as to extinguish lights immediately, and candles in the cockpit were almost as useless from the same cause. The fish were thrown overboard, and the decks washed and scoured, the ventilator and wind sails put in motion, and every measure of purification adopted that their situation allowed; notwithstanding these precautions disease invaded us. The men were unceasing in their exertions to purify the ship; washing, scouring with vinegar, burning powder and vinegar, old junk, and sulphur, added to constant ventilation, proved unequal even to the amelioration of their calamities, while they were in the latitude of _great heat_. After the removal of the sick, the ship was disburthened of her stores, ballast, &c. cleansed and white-washed throughout; still new cases occurred for nearly two months. Some days, two, three, or four were sent off to the hospital, which would seem to indicate the retention of some portion of this noxious principle, which was lodged beyond the reach of the cleansing process." That this noxious principle or matter existed in the ship, and not in the bodies of the crew, is evident from its not having been communicated, in a single instance by a hundred of them who were sent to an hospital on Rhode-Island, notwithstanding an intercourse sufficient to propagate it was necessarily kept up with the inhabitants. Even their nurses did not take it[31]. [29] Medicina Nautica, p. 360. [30] Annals of Medicine, vol. i. p. 116. [31] Medical Repository, vol. iv. No. 1. 5. A fifth instance in which contagion has been supposed to take place in the yellow fever is, where the exhalation from the excretions of a patient in that disease acts as an _exciting_ cause, in persons previously impregnated with the marsh, or other external miasmata, which produce it. The activity of this exhalation, even when it is attended with no smell, is so great, as to induce sickness, head-ach, vertigo, and fainting. It is not peculiar to the exhalations from such patients to produce morbid effects upon persons who visit them. The odour emitted by persons in the confluent small-pox has been known to produce the same symptoms, together with a subsequent fever and apthous sore throat. This has been remarked long ago by Dr. Lind, and latterly by Dr. Willan, in his Reports of the Diseases of London[32]. That the yellow fever is often excited in this way, without the intervention of a supposed specific contagion, I infer from its sometimes spreading through whole families, who have breathed the same impure atmosphere with the person first infected by the fever. This is more especially the case where the impression made by the exhalation from the sick person is assisted by fear, fatigue, or anxiety of mind in other branches of the family. In favour of this mode of exciting the yellow fever, Dr. Otto communicated to me the following fact. In the autumn of the year 1798, it prevailed upon the _shores_ of the Delaware, in Gloucester county, in New-Jersey. A mild remittent prevailed at the same time on the _high_ grounds, a few miles from the river. During this time, the doctor observed, if a person who had inhaled the seeds of the yellow fever in Philadelphia afterwards came into a family _near_ the river, the same disease appeared in several instances in one or more branches of that family; but where persons brought the fever from the city, and went into a family on the _high_ grounds, where the mild remittents prevailed, there was not a single instance of a yellow fever being excited by them in any of its members. This fact is important, and of extensive application. It places the stimulus from the breath, or other exhalations of persons affected by the yellow fever, upon a footing with intemperance, fatigue, heat, and all the common exciting causes of the disease; none of which, it is well known, can produce it, except in persons who have previously inhaled the putrid miasmata, which in all countries are its only remote cause. The city of Philadelphia has furnished, in all our yellow fever years, many additional proofs of the correctness of Dr. Otto's remark. In the months of July and August, when miasmata are generally local, and float chiefly near to their hot beds, the docks and holds of ships, persons who are affected by these miasmata, and sicken in other parts of the city, never communicate the disease; but after the less prepared and heterogeneous filth of our whole city has been acted on by an autumnal, as well as summer sun, so as to emit pestilential exhalations into all our streets and alleys, the fever is now and then excited in the manner that has been mentioned, by a single person in a whole family. The common intermittents of the southern states are often excited in the same way, without being suspected of spreading by contagion. Even the jail or hospital fever is vindicated by Dr. Hunter from the highly contagious nature which has been ascribed to it, upon the same principle. His words, which are directly to my purpose, are as follow: "In considering the extent and power of the contagion [meaning of the jail or hospital fever], I am not inclined to impute to this cause the fevers of all those who are taken ill in one family after the first, as they are all along exposed to the same vitiated air which occasions the first fever. In like manner, when a poor woman visits some of her sick neighbours, and is taken ill herself, and afterwards some of her children, I would not impute the disease to infection alone; she and her family having previously lived in the same kind of vitiated air which originally produced the fever. If the cases in which the infection meets with the poison already _half formed_ be excepted, the disease in itself will be found to be much less infectious than has been commonly supposed[33]." By the modes of communicating the yellow fever which have been admitted, the dysentery, and all the milder forms of autumnal fevers, have been occasionally propagated, and perhaps oftener than the first-named disease, from their being more apt to run on to the typhus or chronic state. Of this I could adduce many proofs, not only from books, but from my own observations; but none of these diseases spread by contagion, or become epidemic from that cause in any country. A contrary opinion, I know, is held by Dr. Cleghorn, and Dr. Clarke; but they have deceived themselves, as they formerly deceived me, by not attending to the difference between secreted contagions and morbid excretions from the body, produced by the causes which have been enumerated, and which are rare and accidental concomitants of bilious or summer diseases. [32] Page 13 and 113. [33] Medical Transactions, vol. iii. p. 351. 6. The last instance of supposed contagion of the yellow fever is said to arise from the effluvia of a putrid body that has died of that disease. The effluvia in this case act either as the putrified excretions mentioned under the first head, or as an exciting cause upon miasmata, previously received into the system. A dead body, in a state of putrefaction from any other disease, would produce, under the same circumstances of season and predisposition, the same kind and degrees of fever. The similarity of the fever induced by the means that have been enumerated, with the fever from which it was derived, has been supposed to favour the opinion of its being communicated by a specific contagion. But let it be recollected that the yellow fever is, at the time of its being supposed to be thus received, the reigning epidemic, and that irritants of all kinds necessarily produce that disease. The morbid sweats which now and then produce an intermitting fever, and the alvine excretions which occasionally produce a dysentery, act only by exciting morbid actions in the system, which conform in their symptoms to an immutable and universal law of epidemics. It is only when those two diseases generally prevail, that they seem to produce each other. Thus have I explained all the supposed cases of contagion of the yellow fever. To infer from the solitary instances of it thus excited, is to reason as incorrectly as to say the small-pox is not contagious, because we now and then meet with persons who cannot be infected by it. From the explanation that has been given of the instances of supposed contagion of the yellow fever, we are compelled to resort to certain noxious qualities in the atmosphere, as the exclusive causes of the prevalence, not only of that fever, but (with a few exceptions) of all other epidemic diseases. It is true, we are as yet ignorant of the precise nature of those qualities in the air which produce epidemics; but their effects are as certainly felt by the human body as the effects of heat, and yet who knows the nature of that great and universal principle of activity in our globe? That the yellow fever is propagated by means of an impure atmosphere, at all times, and in all places, I infer from the following facts: 1. It appears only in those climates and seasons of the year in which heat, acting upon moist animal and vegetable matters, fills the air with their putrid exhalations. A vertical sun, pouring its beams for ages upon a dry soil; and swamps, defended from the influence of the sun by extensive forests, have not, in a single instance, produced this disease. 2. It is unknown in places where a connection is not perceptible between it, and marshes, mill-ponds, docks, gutters, sinks, unventilated ships, and other sources of noxious air. The truth of this remark is established by the testimonies of Dr. Lind and Dr. Chisholm, and by many facts in Lempriere's excellent History of the Diseases of Jamaica. Dr. Davidson furnished me with a striking confirmation of their remarks, in the following extract from a letter, dated November 12th, 1794. "I have mentioned (says the doctor) an instance of the remarkable good health which the 66th regiment enjoyed at St. Vincents for several years, upon a high hill above the town, removed from all exhalations, and in a situation kept at all times cool by the blowing of a constant trade wind. They did not lose, during eighteen months, above two or three men (the regiment was completed to the peace establishment), and during eight years they lost but two officers, one of whom, the quarter-master, resided constantly in town, and died from over fatigue; the other arrived very ill from Antigua, and died within a few days afterwards." In the United States, no advocate for the specific nature or importation of the yellow fever, has ever been able to discover a single case of it beyond the influence of an atmosphere rendered impure by putrid exhalations. It is no objection to the truth of this remark, that malignant bilious fevers sometimes appear upon the summits of hills, while their declivities, and the vallies below, are exempted from them. The miasmata, in all these cases, are arrested by those heights, and are always to be traced to putrefaction and exhalation in their neighbourhood. Nor is it any objection to the indissoluble connection between putrid exhalations and the yellow fever, which has been mentioned, that the disease sometimes appears in places remote from the source of miasmata in _time_ and _place_. The bilious pleurisies, which occur in the winter and spring, after a sickly autumn, prove that they are retained in the body for many months, and although they are sometimes limited in their extent to a single house, and often to a village, a city, and the banks of a creek or river, yet they are now and then carried to a much greater distance. Mr. Lempriere, in his valuable Observations upon the Diseases of the British Army in Jamaica, informs us, that Kingston is sometimes rendered sickly by exhalations from a lagoon, which lies _nine_ miles to the eastward of that town[34]. The greater or less distance, to which miasmata are carried from the place where they are generated, appears to depend upon their quantity, upon the force and duration of currents of wind which act upon them, and upon their being more or less opposed by rivers, woods, water, houses, wells, or mountains. [34] Vol. i. p. 84. 3. It is destroyed, like its fraternal diseases, the common bilious and intermitting fevers, by means of _long-continued_ and _heavy_ rains[35]. When rains are heavy, but of short duration, they suspend it only in warm weather; but when they are succeeded by cold weather, they destroy all the forms of bilious fever. The malignant tertians, described by Dr. Cleghorn, always ceased about the autumnal equinox; for at that time, says the doctor, "Rain falls in such torrents as to tear up trees by the roots, carry away cattle, break down fences, and do considerable mischief to the gardens and vineyards; but, after a long and scorching summer, they are very acceptable and beneficial, for they mitigate the excessive heat of the air, and give a check to epidemical diseases[36]." There are facts, however, which would seem to contradict the assertion that miasmata are suspended or destroyed by heavy rains. Dr. Lind, in his Treatise upon the Diseases of Hot Climates, mentions instances in which they suddenly created fevers. It is probable, in these cases the rains may have had that effect, by disturbing the pellicle which time often throws over the surface of stagnating pools of water, and putrid matters on dry land. I was led to entertain this opinion by a fact mentioned in a letter I received from Dr. Davidson, dated November 4th, 1794. "Being ordered (says the doctor) up to Barbadoes, last November, upon service, I found that the troops had suffered considerably by that formidable scourge, the yellow fever. The season had been remarkably dry. It was observed, a rainy season contributed to make the season healthier, excepting at Constitution-Hill, where the sixth regiment was stationed, and where a heavy shower of rain seldom failed to bring back the fever, after it had ceased for some time. I found the barrack, where this regiment was, surrounded by a pond of brackish water, which, being but imperfectly drained by the continuance of the drought, the surface was covered with a green scum, which prevented the exhalation of marshy putrefaction. After a heavy shower of rain, this scum was broken, and the miasmata evolved, and acted with double force, according to the time of their secretion." [35] Clarke on the Diseases of Long Voyages to Hot Climates, p. 116. [36] Diseases of Minorca, p. 8. 4. It is completely destroyed by frost. As neither rains nor frosts act in sick rooms, nor affect the bodies of sick people, they must annihilate the disease by acting exclusively upon the atmosphere. Very different in their nature are the small-pox and measles, which are propagated by specific contagion. They do not wait for the suns of July or August, nor do they require an impure atmosphere, or an exciting cause, to give them activity. They spread in the winter and spring, as well as in the summer and autumnal months: wet and dry weather do not arrest their progress, and frost (so fatal to the yellow fever), by rendering it necessary to exclude cold air from sick rooms, increases the force of their contagion, and thereby propagates them more certainly through a country. 5. It is likewise destroyed, by intense heat, and high winds. The latter, we are sure, like heavy rains and frost, do not produce that salutary effect by acting upon the bodies, or in the rooms of sick people. It is worthy of notice, that while the activity of miasmata is destroyed by cold, when it descends to frost; by heat, when it is so intense as to dry up all the sources of putrid exhalation; by heavy rains, when they are succeeded by cool weather; and by high winds, when they are not succeeded by warm weather; they are rendered more active by cool, warm, and damp weather, and by light winds. The influence of damp weather, in retaining and propagating miasmata, will be readily admitted, by recollecting how much more easily hounds track their prey, and how much more extensively odours of all kinds pervade the atmosphere, when it is charged with moisture, than in dry weather. It has been asked, if putrid matters produce malignant bilious fevers in our cities, why do they not produce them in Lisbon, and in several other of the filthiest cities in the south of Europe? To this I answer, that filth and dirt are two distinct things. The streets of a city may be very _dirty_, that is, covered with mud composed of inoffensive clay, sand, or lime, and, at the same time, be perfectly free from those _filthy_ vegetable and animal matters which, by putrefaction, contaminate the air. But, admitting the streets of those cities to abound with the filthy matters that produce pestilential diseases in other countries, it is possible the exhalations from them may be so _constant_, and so _powerful_, in their impressions upon the bodies of the inhabitants, as to produce, from habit, no morbid effects, or but feeble diseases, as was remarked formerly, is the case in the natives and old settlers in the East and West-Indies. But if this explanation be not satisfactory, it may be resolved into a partial absence of an inflammatory constitution of the air, which, I shall say presently, must concur in producing pestilential diseases. Such deviations from uniformity in the works of Nature are universal. In the present instances, they no more invalidate the general proposition of malignant fevers being every where of domestic origin, than the exemption of Ireland from venomous reptiles, proves they are not generated in other countries, or that the pleurisy and rheumatism are not the effects of the alternate action of cold and heat upon the body, because hundreds, who have been exposed to them under equal circumstances, have not been affected by those diseases. There may be other parts of the world in which putrid matters do not produce bilious malignant diseases from the causes that have been mentioned, or from some unknown cause, but I am safe in repeating, there never was a bilious epidemic yellow fever that could not be traced to putrid exhalation. It has been asked, if the yellow fever be not imported, why does it make its first appearance among sailors, and near the docks and wharves of our cities? I answer, this is far from being true. The disease has as often appeared first at a distance from the shores of our cities as near them, but, from its connection with a ship not being discovered, it has been called by another name. But where the first cases of it occur in sailors, I believe the seeds of it are always previously received by them from our filthy docks and wharves, or from the foul air which is discharged with the cargoes of the ships in which they have arrived, which seeds are readily excited in them by hard labour, or intemperance, so as to produce the disease. That this is the case, is further evident from its appearing in them, only in those months in which the bilious fever prevails in our cities. It has been asked further, why were not these bilious malignant fevers more common before the years 1791, 1792, and 1793? To this I answer, by repeating what was mentioned in another place[37], that our climate has been gradually undergoing a change. The summers are more alternated by hot and cool, and wet and dry weather, than in former years. The winters are likewise less uniformly cold. Grass is two or three weeks later in the spring in affording pasture to cattle than it was within the memory of many thousand people. Above all, the summer has encroached upon the autumn, and hence the frequent accounts we read in our newspapers of trees blossoming, of full grown strawberries and raspberries being gathered, and of cherries and apples, of a considerable size, being seen, in the months of October and November, in all the middle states. By means of this protraction of the heat of summer, more time is given for the generation of putrid exhalations, and possibly for their greater concentration and activity in producing malignant bilious diseases. [37] Account of the Climate of Pennsylvania, vol i. It has been asked again, why do not the putrid matters which produce the yellow fever in some years produce it _every_ year? This question might be answered by asking two others. 1st. Why, if the yellow fever be derived from the We st-Indies, was it not imported every year before 1791, and before the existence, or during the feeble and partial operation of quarantine laws? It is no answer to this question to say, that a war is necessary to generate the disease in the islands, for it exists in some of them at all times, and the seasons of its prevalence in our cities have, in many instances, had no connection with war, nor with the presence of European armies in those and in other sickly parts of the globe. During the seven years revolutionary war it was unknown as an epidemic in the United States, and yet sailors arrived in all our cities daily from sickly islands, in small and crowded vessels, and sometimes covered with the rags they had worn in the yellow fever, in British hospitals and jails. I ask, 2dly, why does the dysentery (which is certainly a domestic disease) rise up in our country, and spread sickness and death through whole families and villages, and disappear from the same places for fifteen or twenty years afterwards? The want of uniformity in the exhalations of our country in producing those diseases depends upon their being combined with more or less heat or moisture; upon the surface of the earth being completely dry, or completely covered with water[38]; upon different currents of winds, or the total absence of wind; upon the disproportion of the temperature of the air in the day and night; upon the quantity of dew; upon the early or late appearance of warm or cold weather; and upon the predisposition of the body to disease, derived from the quality of the aliments of the season. A similar want of uniformity in the annual operations of our climate appears in the size and quality of grain, fruits, and vegetables of all kinds. [38] In the Account of the Yellow Fever of 1793, the different and opposite effects of a dry and rainy season in producing bilious fevers are mentioned from Dr. Dazilles. In the autumn of 1804, I have elsewhere remarked, after a summer in which there had fallen an unusual quantity of rain, the bilious fevers appeared chiefly on the high grounds in Pennsylvania, which were in a state of moisture, while scarcely a case of them appeared in the neighbourhood of marshes, or low grounds, owing to their being so completely covered with water, as to be incapable of generating, by putrefaction, the miasmata which produce those forms of disease. But the greater violence and mortality of our bilious fevers, than in former years, must be sought for chiefly in an inflammatory or malignant constitution of the atmosphere, the effects of which have been no less obvious upon the small-pox, measles, and the intercurrent fevers of Dr. Sydenham, than they are upon the summer and autumnal disease that has been mentioned. This malignant state of the air has been noticed, under different names, by all the writers upon epidemics, from Hippocrates down to the present day. It was ascribed, by the venerable father of physic, to a "divine something" in the atmosphere. Dr. Sydenham, whose works abound with references to it, supposes it to be derived from a mineral exhalation from the bowels of the earth. From numerous other testimonies of a belief in the influence of the insensible qualities of the air, altering the character of epidemics, I shall select the following: "It is certain (says Dr. Mosely) that diseases undergo changes and revolutions. Some continue for a succession of years, and vanish when they have exhausted the temporary, but secret cause which produced them. Others have appeared and disappeared suddenly; and others have their periodical returns." The doctor ascribes a malignant fever among the dogs in Jamaica (improperly called, from one of its symptoms, hydrophobia), to a change in the atmosphere, in the year 1783. It was said to have been imported, but experience, he says, proved the fact to be otherwise[39]. [39] Treatise upon Tropical Diseases, p. 43, 44. "This latent malignity in the atmosphere (says Baron Vansweiten) is known only by its effects, and cannot easily be reduced to any known species of acrimony." In another place he says, "It seems certain that this unknown matter disposes all the humours to a sudden and bad putrefaction[40]." [40] Commentaries on Boerhaave's Aphorisms, vol. v. p. 226, 230. Dr. John Stedman has related many facts, in his Essay upon Insalutary Constitutions of the Air, which prove, that diseases are influenced by a quality in it, which, he says, "is productive of corruption," but which has hitherto eluded the researches of physicians[41]. [41] Page 135. Mr. Lempriere, after mentioning the unusual mortality occasioned by the yellow fever, within the last five or six years, in the island of Jamaica, ascribes it wholly "to that particular constitution of atmosphere upon which the existence of epidemics, at one period rather than another, depend[42]." [42] Vol. ii. p. 31. Not only diseases bear testimony to a change in the atmosphere, but the whole vegetable and animal creation concur in it, proofs of which were mentioned in another place. Three things are remarkable with respect to this inflammatory constitution of the air. 1. It is sometimes of a local nature, and influences the diseases of a city, or country, while adjoining cities and countries are exempted from it. 2. It much oftener pervades a great extent of country. This was evident in the years 1793 and 1794, in the United States. During the same years, the yellow fever prevailed in most of the West-India islands. Many of the epidemics mentioned by Dr. Sims, in the first volume of the Medical Memoirs, affected, in the same years, the most remote parts of the continent of Europe. Even the ocean partakes of a morbid constitution of its atmosphere, and diseases at sea sympathise in violence with those of the land, at an immense distance from each other. This appears in a letter from a surgeon, on board a British ship of war, to Mr. Gooch, published in the third volume of his Medical and Surgical Observations. 3. The predisposing state of the atmosphere to induce malignant diseases continues for several years, under all the circumstances of wet and dry, and of hot and cold weather. This will appear, from attending to the accounts which have been given of the weather, in all the years in which the yellow fever has prevailed in Philadelphia since 1792[43]. The remark is confirmed by all the records of malignant epidemics. [43] Vol. iii. and iv. It is to no purpose to say, the presence of the peculiar matter which constitutes an inflammatory or malignant state of the air has not been detected by any chemical agents. The same thing has been justly said of the exhalations which produce the bilious intermitting, remitting, and yellow fever. No experiment that has yet been made, has discovered their presence in the air. The eudiometer has been used in vain for this purpose. In one experiment made by Dr. Gattani, the air from a marsh at the mouth of the river Vateline was found to be apparently purer by two degrees than the air on a neighbouring mountain, which was 2880 feet higher than the sea. The inhabitants of the mountain were notwithstanding healthy, while those who lived in the neighbourhood of the marsh were annually afflicted with bilious and intermitting fevers[44]. The contagions of the small-pox and measles consist of matter, and yet who has ever discovered this matter in the air? We infer the existence of those remote causes of diseases in the atmosphere only from their effects. Of the existence of putrid exhalations in it, there are other evidences besides bilious and yellow fevers. They are sometimes the objects of the sense of smelling. We see them in the pale or sallow complexions of the inhabitants of the countries which generate them, and we observe them occasionally in the diseases of several domestic animals. The most frequent of these diseases are inflammation, tubercles, and ulcers in the liver. Dr. Cleghorn describes a diseased state of that viscus in cattle, in an unhealthy part of the island of Minorca. Dr. Grainger takes notice of several morbid appearances in the livers of domestic animals in Holland, in the year 1743. But the United States have furnished facts to illustrate the truth of this remark. Mr. James Wardrobe, near Richmond, in Virginia, informed me, that in August, 1794, at a time when bilious fevers were prevalent in his neighbourhood, his cattle were seized with a disease, which, I said formerly, is known by the name of the yellow water, and which appears to be a true yellow fever. They were attacked with a staggering. Their eyes were muddy, or ferocious. A costiveness attended in all cases. It killed in two days. Fifty-two of his cattle perished by it. Upon opening the bodies of several of them, he found the liver swelled and ulcerated. The blood was dissolved in the veins. In the bladder of one of them, he found thirteen pints of blood and water. Similar appearances were observed in the livers of sheep in the neighbourhood of Cadiz, in the year 1799, during the prevalence of the yellow fever in that city. They were considered as such unequivocal marks of an unwholesome atmosphere among the ancients, that they examined the livers of domestic animals, in order to determine on the healthy or unhealthy situation of the spot on which they wished to live. [44] Alibert's Dissertation sur les Fievres Pernicieuses et Attaxiques Intermittentes, p. 185. The advocates for the yellow fever being a specific disease, and propagated only by contagion, will gain nothing by denying an inflammatory constitution of the atmosphere (the cause of which is unknown to us) to be necessary to raise common remittents to that grade in which they become malignant yellow fevers; for they are obliged to have recourse to an unknown quality in the air, every time they are called upon to account for the disease prevailing chiefly in our cities, and not spreading when it is carried from them into the country. The same reference to an occult quality in the air is had by all the writers upon the plague, in accounting for its immediate and total extinction, when it is carried into a foreign port. In speaking of the influence of an inflammatory constitution of the atmosphere in raising common bilious, to malignant yellow fevers, I wish not to have it supposed, that its concurrence is necessary to produce sporadic cases of that, or any other malignant disease. Strong exciting causes, combined with highly volatilized and active miasmata, I believe, will produce a yellow fever at any time. I have seen one or more such cases almost every year since I settled in Philadelphia, and particularly when my business was confined chiefly to that class of people who live near the wharves, and in the suburbs, and who are still the first, and frequently the only victims of the yellow fever. It has been said, exultingly, that the opinion of the importation of the yellow fever is of great antiquity in our country, and that it has lately been admitted by the most respectable physicians in Britain and France, and sanctioned by the laws of several of the governments in Europe. Had antiquity, numbers, rank, and power been just arguments in favour of existing opinions, a thousand truths would have perished in their birth, which have diffused light and happiness over every part of our globe. In favour of the ancient and general belief of the importation of the yellow fever, there are several obvious reasons. The idea is produced by a single act of the mind. It requires neither comparison nor reasoning to adopt it, and therefore accords with the natural indolence of man. It, moreover, flatters his avarice and pride, by throwing the origin of a mortal disease from his property and country. The principle of thus referring the origin of the evils of life from ourselves to others is universal. It began in paradise, and has ever since been an essential feature in the character of our species. It has constantly led individuals and nations to consider loathsome and dangerous diseases as of foreign extraction. The venereal disease and the leprosy have no native country, if we believe all the authors who have written upon them. Prosper Alpinus derives the plagues of Cairo from Syria, and the physicians of Alexandria import them from Smyrna or Constantinople. The yellow fever is said to have been first brought from Siam (where there are proofs it never existed) to the West-Indies, whence it is believed to be imported into the cities of the United States. From them, Frenchmen and Spaniards say it has been re-shipped, directly or indirectly, to St. Domingo, Havanna, Malaga, Cadiz, and other parts of the world. Weak and absurd credulity! the causes of the ferocious and mortal disease which we thus thrust from our respective ports, like the sin of Cain, "lie exclusively at our own doors." Lastly, it has been asserted, if we admit the yellow fever to be an indigenous disease of our cities, we shall destroy their commerce, and the value of property in them, by disseminating a belief, that the cause of our disease is fixed in our climate, and that it is out of the power of human means to remove it. The reverse of this supposition is true. If it be an imported disease, our case is without a remedy; for if, with all the advantages of quarantine laws enforced by severe penalties, and executed in the most despotic manner, the disease has existed annually, in most of our cities, as an epidemic, or in sporadic cases, ever since the year 1791, it will be in vain to expect, from similar measures, a future exemption from it. Nothing but a belief in its domestic origin, and the adoption of means founded upon that belief, can restore the character of our climate, and save our commercial cities from destruction. Those means are cheap, practicable, and certain. They have succeeded, as I shall say presently, in other countries. From the account that has been given of the different ways in which this disease is communicated from one person to another, and from the facts which establish its propagation exclusively through the medium of the atmosphere, when it becomes epidemic, we may explain several things which belong to its history, that are inexplicable upon the principle of its specific contagion. 1. We learn the reason why, in some instances, the fever does not spread from a person who sickens or dies at sea, who had carried the seeds of it in his body from a sickly shore. It is because no febrile miasmata exist in the bodies of the rest of the crew to be excited into action by any peculiar smell from the disease, or by fear or fatigue, and because no morbid excretions are generated by the person who dies. The fever which prevailed on board the Nottingham East-Indiaman, in the year 1766, affected those forty men only, who had slept on shore on the island of Joanna twenty days before. Had the whole crew been on shore, the disease would probably have affected them all, and been ascribed to contagion generated by the first persons who were confined by it[45]. A Danish ship, in the year 1768, sent twelve of her crew on shore for water. They were all seized after their return to the ship with malignant fever, and died without infecting any person on board, and from the same causes which preserved the crew of the Nottingham Indiaman[46]. [45] Observations on the Bilious Fevers usual in voyages to the East-Indies, by James Badinach, M. D. Medical Observations and Inquiries, vol. iv. [46] Clarke on the Diseases of Long Voyages to Hot Climates, p. 123, 125. 2. We learn the reason why the disease sometimes spreads through a whole ship's crew, apparently from one or more affected persons. It is either because they have been confined to small and close berths by bad weather, or because the fever has been protracted to a typhus or chronic state, or because the bodies of the whole crew are impregnated with morbid miasmata, and thus predisposed to have the disease excited in the manner that has been mentioned. In the last way it was excited in most of the crew of the United States frigate, in the Delaware, opposite to the city of Philadelphia, in the year 1797. It appears to have spread, from a similar cause, from a few sailors, on board the Grenville Indiaman, after touching at Batavia. The whole crew had been predisposed to the disease by inhaling the noxious air of that island. The same reasons account for the fever expiring in a healthy village or country; also for its spreading when carried to those towns which are seated upon creeks or rivers, and in the neighbourhood of marsh exhalations. It has uniformly perished in the high and healthy village of Germantown, when carried from Philadelphia, and has three times appeared to be contagious near the muddy shores of the creeks which flow through Wilmington and Chester. 3. From the facts that have been mentioned, we are taught to disbelieve the possibility of the disease being imported in the masts and sails of a ship, by a contagious matter secreted by a sailor who may have sickened or died on board her, on a passage from a West-India island. The death in most of the cases supposed to be imported, in this way, occurs within a few days after the ship leaves her West-India port, or within a few days after her arrival. In the former case, the disease is derived from West-India miasmata; in the latter, it is derived, as was before remarked, either from the foul air of the hold of the ship, or of the dock or wharf to which the ship is moored. Many other facts might be adduced to show the yellow fever not to be an imported disease. It has often prevailed among the Indians remote from the sea coast, and many hundred cases of it have occurred, since the year 1793, on the inland waters of the United States, from the Hudson and Susquehannah, to the rivers of the Mississippi. In South-America, Baron Humboldt assured me, it is every where believed to be an endemic of that country. These simple and connected facts, in which all the physicians in the United States who derive the yellow fever from domestic causes have agreed, will receive fresh support by comparing them with the different and contrary opinions of the physicians who maintain its importation. Some of them have asserted it to be a specific disease, and derived it from the East and West-Indies; others derive it from Beulam, on the coast of Africa; a third sect have called it a ship fever; a fourth have ascribed it to a mixture of imported contagion with the foul air of our cities; while a fifth, who believed it to be imported in 1793, have supposed it to be the offspring of a contagion left by the disease of that year, revived by the heat of our summers, and disseminated, ever since, through the different cities of our country. The number of these opinions, clearly proves, that no one of them is tenable. A belief in the non-contagion of the yellow fever, or of its being incommunicable except in one of the five ways that have been mentioned, is calculated to produce the following good effects: 1. It will deliver the states which have sea-ports from four-fifths of the expences of their present quarantine laws and lazarettoes. A very small apparatus, in laws and officers, would be sufficient to prevent the landing of persons affected by the ship fever in our cities, and the more dangerous practice, of ships pouring streams of pestilential air, from their holds, upon the citizens who live near our docks and wharves. 2. It will deliver our merchants from the losses incurred by the delays of their ships, by long and unnecessary quarantines. It will, moreover, tend to procure the immediate admission of our ships into foreign ports, by removing that belief in the contagious nature of the yellow fever, which originated in our country, and which has been spread, by the public acts of our legislatures and boards of health, throughout the globe. 3. It will deliver our citizens from the danger to which they are exposed, by spending the time of the quarantine, on board of vessels in the neighbourhood of the marshes, which form the shores of the rivers or coasts of quarantine roads. This danger is much increased by idleness, and by the vexation which is excited, by sailors and passengers being detained, unnecessarily, fifteen or twenty days from their business and friends. 4. It will lead us to a speedy removal of all the excretions, and a constant ventilation of the rooms of patients in the yellow fever, and thereby to prevent the accumulation, and further putrefaction of those exhalations which may reproduce it. 5. It is calculated to prevent the desertion of patients in the yellow fever, by their friends and families, and to produce caution in them to prevent the excitement of the disease in their own bodies, by means of low diet and gentle physic, proportioned to the impurity of the air, and to the anxiety and fatigue to which they are exposed in attending the sick. 6. It will put an end to the cruel practice of quieting the groundless fears of a whole neighbourhood, by removing the poor who are affected by the fever, from their houses, and conveying them, half dead with disease and terror, to a solitary or crowded hospital, or of nailing a yellow flag upon the doors of others, or of fixing a guard before them, both of which have been practised in Philadelphia, not only without any good effect, but to the great injury of the sick. 7. By deriving the fever from our own climate and atmosphere, we shall be able to foresee its approach in the increased violence of common diseases, in the morbid state of vegetation, in the course of the winds, in the diseases of certain brute animals, and in the increase of common, or the appearance of uncommon insects. 8. A belief in the non-contagion of the yellow fever, and its general prevalence from putrid animal and vegetable matters _only_, is calculated to lead us to drain or cover marshy grounds, and to remove from our cities all the sources of impure air, whether they exist in the holds of ships, in docks, gutters, and common sewers, or in privies, gardens, yards, and cellars, more especially during the existence of the signs of a malignant constitution of the air. A fever, the same in its causes, and similar to it in many of its symptoms, that is, the plague, has been extirpated, by extraordinary degrees of cleanliness, from the cities of Holland, Great-Britain, and several other parts of Europe. The reader will perceive, from these facts and reasonings, that I have relinquished the opinion published in my account of the yellow fever in the years 1793, 1794, and 1797, respecting its contagious nature. I was misled by Dr. Lining, and several West-India writers, in ascribing a much greater extent to the excreted matters in producing the disease, than I have since discovered to be correct, and by Bianchi, Lind, Clark, and Cleghorn, in admitting even the common bilious fever to be contagious. The reader will perceive, likewise, that I have changed my opinion respecting one of the modes in which the plague is propagated. I once believed, upon the authorities of travellers, physicians, and schools of medicine, that it was a highly contagious disease. I am now satisfied this is not the case; but, from the greater number of people who are depressed and debilitated by poverty and famine, and who live in small and filthy huts[47] in the cities of the east, than in the cities of the United States, I still believe it to be more frequently communicated from an intercourse with sick people by the morbid excretions of the body, than the yellow fever is in our country. For the change of my opinion upon this subject, I am indebted to Dr. Caldwell's and Mr. Webster's publications upon pestilential diseases, and to the travels of Mariti and Sonnini into Syria and Egypt. I reject, of course, with the contagious quality of the plague, the idea of its ever being imported into any country so as to become epidemic, by means of a knife-case, a piece of cotton, or a bale of silks, with the same decision that I do all the improbable and contradictory reports of an epidemic yellow fever being imported in a sailor's jacket, or in the timbers and sails of a ship that had been washed by the salt water, and fanned by the pure air of the ocean, for several weeks, on her passage from the West-Indies to the United States. [47] M. Savary, in his Travels, says, two hundred persons live in Cairo within a compass that accommodates but thirty persons in Paris. It gives me pleasure to find this unpopular opinion of the non-contagion of the plague is not a new one. It was held by the Faculty of Medicine in Paris, in the beginning of the eighteenth century, and it has since been defended by Dr. Stoll, of Vienna, Dr. Samoilowitz, of Russia, and several other eminent physicians. Dr. Herberden has lately called in question the truth of all the stories that are upon record of the plague having been imported into England in the last century, and the researches of Sir Robert Wilson of the British army, and of Assellini, and several other French physicians, have produced the most satisfactory proofs of its not being a contagious disease in its native country. A discovery more pregnant with blessings to mankind has seldom been made. Pyramids of error, the works of successive ages and nations, must fall before it, and rivers of tears must be dried up by it. It is impossible fully to appreciate the immense benefits which await this mighty achievement of our science upon the affairs of the globe. Large cities shall no longer be the hot-beds of disease and death. Marshy grounds, teeming with pestilential exhalations, shall become the healthy abodes of men. A powerful source of repulsion between nations shall be removed, and commerce shall shake off the fetters which have been imposed upon it by expensive and vexatious quarantines. A red or a yellow eye shall no longer be the signal to desert a friend or a brother to perish alone in a garret or a barn, nor to expel the stranger from our houses, to seek an asylum in a public hospital, to avoid dying in the street. The number of diseases shall be lessened, and the most mortal of them shall be struck out of the list of human evils. To accelerate these events, it is incumbent upon the physicians of the United States to second the discoveries of their European brethren. It becomes them constantly to recollect, that we are the centinels of the health and lives of our fellow-citizens, and that there is a grade of benevolence in our profession much higher than that which arises from the cure of diseases. It consists in exterminating their causes. A DEFENCE OF _BLOOD-LETTING_, AS A REMEDY FOR CERTAIN DISEASES. Blood-letting, as a remedy for fevers, and certain other diseases, having lately been the subject of much discussion, and many objections having been made to it, which appear to be founded in error and fear, I have considered that a defence of it, by removing those objections, might render it more generally useful, in every part of the United States. I shall begin this subject by remarking, that blood-letting is indicated, in fevers of great morbid excitement, 1. By the sudden suppression or diminution of the natural discharges by the pores, bowels, and kidneys, whereby a plethora is induced in the system. 2. By the habits of the persons who are most subject to such fevers. 3. By the theory of fever. I have attempted to prove that the higher grades of fever depend upon morbid and excessive action in the blood-vessels. It is connected, of course, with preternatural sensibility in their muscular fibres. The blood is the most powerful irritant which acts upon them. By abstracting a part of it, we lessen the principal cause of the fever. The effect of blood-letting is as immediate and natural in removing fever, as the abstraction of a particle of sand is, to cure an inflammation of the eye, when it arises from that cause. 4. By the symptoms of the first stage of violent fevers, such as a sleepiness and an oppressed pulse, or by delirium, with a throbbing pulse, and great pains in every part of the body. 5. By the rupture of the blood-vessels, which takes place from the quantity or impetus of the blood in fevers of great morbid action. Let no one call bleeding a cruel or unnatural remedy. It is one of the specifics of nature; but in the use of it she seldom affords much relief. She frequently pours the stimulating and oppressing mass of blood into the lungs and brain; and when she finds an outlet for it through the nose, it is discharged either in such a deficient or excessive quantity, as to be useless or hurtful. By artificial blood-letting, we can choose the _time_ and _place_ of drawing blood, and we may regulate its quantity by the degrees of action in the blood-vessels. The disposition of nature to cure violent morbid action by depletion, is further manifested by her substituting, in the room of blood-letting, large, but less safe and less beneficial, evacuations from the stomach and bowels. 6. By the relief which is obtained in fevers of violent action by remedies of less efficacy (to be mentioned hereafter), which act indirectly in reducing the force of the sanguiferous system. 7. By the immense advantages which have attended the use of blood-letting in violent fevers, when used at a proper time, and in a quantity suited to the force of the disease. I shall briefly enumerate these advantages. 1. It frequently strangles a fever, when used in its forming state, and thereby saves much pain, time, and expence to a patient. 2. It imparts strength to the body, by removing the depression which is induced by the remote cause of the fever. It moreover obviates a disposition to faint, which arises from this state of the system. 3. It reduces the uncommon frequency of the pulse. The loss of ten ounces of blood reduced Miss Sally Eyre's pulse from 176 strokes to 140, in a few minutes, in the fever of the year 1794. Dr. Gordon mentions many similar instances of its reducing the frequency of the pulse, in the puerperile fever. 4. It renders the pulse more frequent when it is preternaturally slow. 5. It checks the nausea and vomiting, which attend the malignant state of fever. Of this I saw many instances in the year 1794. Dr. Poissonnier Desperrieres confirms this remark, in his Account of the Fevers of St. Domingo; and adds further, that it prevents, when sufficiently copious, the troublesome vomiting which often occurs on the fifth day of the yellow fever[48]. It has the same effect in preventing the diarrh[oe]a in the measles. [48] Traite des Fievres de l'Isle de St. Domingue, vol. ii. p. 76. 6. It renders the bowels, when costive, more easily moved by purging physic. 7. It renders the action of mercury more speedy and more certain, in exciting a salivation. 8. It disposes the body to sweat spontaneously, or renders diluting and diaphoretic medicines more effectual for that purpose. 9. It _suddenly_ removes a dryness, and _gradually_ a blackness, from the tongue. Of the former effect of bleeding, I saw two instances, and of the latter, one, during the autumn of 1794. 10. It removes or lessens pain in every part of the body, and more especially in the head. 11. It removes or lessens the burning heat of the skin, and the burning heat in the stomach, so common and so distressing in the yellow fever. 12. It removes a constant chilliness, which sometimes continues for several days, and which will neither yield to cordial drinks, nor warm bed-clothes. 13. It checks such sweats as are profuse without affording relief, and renders such as are partial and moderate, universal and salutary. 14. It sometimes checks a diarrh[oe]a and tenesmus, after astringent medicines have been given to no purpose. This has often been observed in the measles. 15. It suddenly cures the intolerance of light which accompanies many of the inflammatory states of fever. 16. It removes coma. Mr. Henry Clymer was suddenly relieved of this alarming symptom, in the fever of 1794, by the loss of twelve ounces of blood. 17. It induces sleep. This effect of bleeding is so uniform, that it obtained, in the year 1794, the name of an anodyne in several families. Sleep sometimes stole upon the patient while the blood was flowing. 18. It prevents effusions of serum and blood. Hæmorrhages seldom occur, where bleeding has been sufficiently copious. 19. It belongs to this remedy to prevent the chronic diseases of cough, consumption, jaundice, abscess in the liver, and all the different states of dropsy which so often follow autumnal fevers. My amiable friend, Mrs. Lenox, furnished an exception to this remark, in the year 1794. After having been cured of the yellow fever by seven bleedings, she was affected, in consequence of taking a ride, with a slight return of fever, accompanied by an acute pain in the head, and some of the symptoms of a dropsy of the brain. As her pulse was tense and quick, I advised repeated bleedings to remove it. This prescription, for reasons which it is unnecessary to relate, was not followed at the time, or in the manner, in which it was recommended. The pain, in the mean time, became more alarming. In this situation, two physicians were proposed by her friends to consult with me. I objected to them both, because I knew their principles and modes of practice to be contrary to mine, and that they were proposed only with a view of wresting the lancet from my hand. From this desire of avoiding a controversy with my brethren, where conviction was impossible on either side, as well as to obviate all cause of complaint by my patient's friends, I offered to take my leave of her, and to resign her wholly to the care of the two gentlemen who were proposed to attend her with me. To this she objected in a decided manner. But that I might not be suspected of an undue reliance upon my own judgment, I proposed to call upon Dr. Griffitts or Dr. Physick to assist me in my attendance upon her. Both these physicians had renounced the prejudices of the schools in which they had been educated, and had conformed their principles and practice to the present improving state of medical science. My patient preferred Dr. Griffitts, who, in his first visit to her, as soon as he felt her pulse, proposed more bleeding. The operation was performed by the doctor himself, and repeated daily for five days afterwards. From an apprehension that the disease was so fixed as to require some aid to blood-letting, we gave her calomel in such large doses as to excite a salivation. By the use of these remedies she recovered slowly, but so perfectly as to enjoy her usual health. 20. Bleeding prevents the termination of malignant, in the gangrenous state of fever. This effect of blood-letting will enable us to understand some things in the writings of Dr. Morton and Dr. Sydenham, which at first sight appear to be unintelligible. Dr. Morton describes what he calls a putrid fever, which was epidemic and fatal, in the year 1678. Dr. Sydenham, who practised in London at the same time, takes no notice of this fever. The reason of his silence is obvious. By copious bleeding, he prevented the fever of that year from running on to the gangrenous state, while Dr. Morton, by neglecting to bleed, created the supposed putrid fevers which he has described. It has been common to charge the friends of blood-letting with _temerity_ in their practice. From this view which has been given of it, it appears, that it would be more proper to ascribe _timidity_ to them, for they bleed to prevent the offensive and distressing consequences of neglecting it, which have been mentioned. 21. It cures, without permitting a fever to put on those alarming symptoms, which excite constant apprehensions of danger and death, in the minds of patients and their friends. It is because these alarming symptoms are prevented, by bleeding, that patients are sometimes unwilling to believe they have been cured by it, of a malignant fever. Thus, the Syrian leper of old, viewed the water of Jordan as too simple and too common to cure a formidable disease, without recollecting that the remedies for the greatest evils of life are all simple, and within the power of the greatest part of mankind. 22. It prepares the way for the successful use of the bark and other tonic remedies, by destroying, or so far weakening, a morbid action in the blood-vessels, that a medicine of a moderate stimulus afterwards exceeds it in force, and thereby restores equable and healthy action to the system. 23. Bleeding prevents relapses. It, moreover, prevents that predisposition to the intermitting and pleuritic states of fever, which so frequently attack persons in the spring, who have had the bilious remitting fever in the preceding autumn. But great and numerous as the advantages of blood-letting are in fevers, there have been many objections to it. I shall briefly enumerate, and endeavour to refute the errors upon this subject. Blood-letting has been forbidden by physicians, by the following circumstances, and states of the system. 1. By warm weather. Galen bled in a plague, and Aræteus in a bilious fever, in a warm climate. Dr. Sydenham and Dr. Hillary inform us, that the most inflammatory fevers occur in, and succeed hot weather. Dr. Cleghorn prescribed it copiously in the warm months, in Minorca. Dr. Mosely cured the yellow fever by this remedy, in Jamaica. Dr. Broadbelt, and Dr. Weston, in the same island, have lately adopted his successful practice. Dr. Desportes speaks in the highest terms of it in all the inflammatory diseases of St. Domingo. He complains of the neglect of it in the rheumatism, in consequence of which, he says, the disease produces abscesses in the lungs[49]. I have never, in any year of my practice, been restrained by the heat of summer in the use of the lancet, where the pulse has indicated it to be necessary, and have always found the same advantages from it, as when I have prescribed it in the winter or spring months. [49] Page 35. In thus deciding in favour of bleeding in warm weather, I do not mean to defend its use to the same extent, as to diseases, or to quantity, in the native and long settled inhabitants of hot climates, as in persons who have recently migrated to them, or who live in climates alternately hot and cold. 2. Being born, and having lived in a warm climate. This is so far from being an objection to blood-letting in an inflammatory disease, that it renders it more necessary. I think I have lost several West-India patients from the influence of this error. 3. Great apparent weakness. This, in acute and violent fevers, is always from a depressed state of the system. It resembles, in so many particulars, that weakness which is the effect of the abstraction of stimulus, that it is no wonder they have been confounded by physicians. This sameness of symptoms from opposite states of the system is taken notice of by Hippocrates. He describes convulsions, and particularly a hiccup, as occurring equally from repletion and inanition, which answer to the terms of depression, and debility from action and abstraction. The natural remedy for the former is depletion, and no mode of depleting is so effectual or safe as blood-letting. But the great objection to this remedy is, when a fever of great morbid excitement affects persons of delicate constitutions, and such as have long been subject to debility of the chronic kind. In this state of the system there is the same morbid and preternatural action in the blood-vessels, that there is in persons of robust habits, and the same remedy is necessary to subdue it in both cases. It is sometimes indicated in a larger quantity in weakly than in robust people, by the plethora which is more easily induced in their relaxed and yielding blood-vessels, and by the greater facility with which ruptures and effusions take place in their viscera. Thus it is more necessary to throw overboard a large part of the cargo of an old and leaky vessel in a storm, than of a new and strong one. I know that vomits, purges, sweats, and other evacuating remedies, are preferred to bleeding in weakly constitutions, but I hope to show hereafter, that bleeding is not only more effectual, but more safe in such habits, than any other depleting remedy. 4. Infancy and childhood. This is so far from being an objection to bleeding, that the excitable state of the blood-vessels in those periods of life, renders it peculiarly necessary in their inflammatory diseases. Dr. Sydenham bled children in the hooping cough, and in dentition. I have followed his practice, and bled as freely in the violent states of fever in infancy as in middle life. I bled my eldest daughter when she was but six weeks old, for convulsions brought on by an excessive dose of laudanum given to her by her nurse; and I bled one of my sons twice, before he was two months old, for an acute fever which fell upon his lungs and bowels. In both cases, life appeared to be saved by this remedy. 5. Old age. The increase of appetite in old people, their inability to use sufficient exercise, whereby their blood-vessels become relaxed, plethoric, and excitable, and above all, the translation of the strength of the muscles to the arteries, and of plethora to the veins, all indicate bleeding to be more necessary (in equal circumstances) in old, than in middle aged people. My practice in the diseases of old people has long been regulated by the above facts. I bled Mrs. Fullarton twice in a pleurisy in January, 1804, in the 84th year of her age, and thereby cured her disease. I am not the author of this practice. Botallus left a testimony in favour of it nearly 200 years ago[50], and it has since been confirmed by the experience of Hoffman, and many other physicians. An ignorance of, or inattention to this change in the state of the blood-vessels, in persons in the decline of life, and the neglect of the only remedy indicated by it, is probably the reason why diseases often prove fatal to them, which in early or middle life cured themselves, or yielded to a single dose of physic, or a few ounces of bark. [50] Magis esse adjuvandos senes, missione sanguinis dum morbus postulat, aut corpus eorum habitus malus est, quam ubi hæc (quod absonum videbitur) juvenibus contingunt. De Cur. per Sang. missionem, cap. 11. § 11. 6. The time of menstruation. The uterus, during this period, is in an inflamed state, and the whole system is plethoric and excitable, and of course disposed to a violent degree of fever, from all the causes which excite it. Bleeding, therefore, is more indicated, in fever of great morbid action, at this time, than at any other. Formerly the natural discharge from the uterus was trusted to, to remove a fever contracted during the time of menstruation; but what relief can the discharge of four or five ounces of blood from the uterus afford, in a fever which requires the loss of 50, or perhaps of 100 ounces to cure it? 7. Pregnancy. The inflammation and distention induced upon the uterus directly, and indirectly upon the whole system by pregnancy, render bleeding, in the acute states of fever, more necessary than at other times. I have elsewhere mentioned the advantages of bleeding pregnant women, in the yellow fever. I did not learn the advantages of the practice in that disease. I bled Mrs. Philler 11 times in seven days, in a pleurisy during her pregnancy, in the month of March, 1783. Mrs. Fiss was bled 13 times in the spring of 1783; and Mrs. Kirby 16 times in the same condition, by my orders, in the winter of 1786, in a similar disease. All these women recovered, and the children they carried during their illness, are at this time alive, and in good health. 8. Fainting after bleeding. This symptom is accidental in many people. No inference can be drawn from it against blood-letting. It often occurs after the first and second bleedings in a fever, but in no subsequent bleeding, though it be repeated a dozen times. Of this I saw several instances, in the yellow fever of 1794. The pulse, during the fainting, is often tense and full. 9. Coldness of the extremities, and of the whole body. This cold state of fever when it occurs early, yields more readily to bleeding, than to the most cordial medicines. 10. Sweats are supposed to forbid blood-letting. I have seen two instances of death, from leaving a paroxysm of malignant fever to terminate itself by sweating. Dr. Sydenham has taught a contrary practice in the following case. "While this constitution (says the doctor) prevailed, I was called to Dr. Morice, who then practised in London. He had this fever, attended with profuse sweats, and numerous petechiæ. By the consent of some other physicians, our joint friends, he was blooded, and rose from his bed, his body being first wiped dry. He found immediate relief from the use of a cooling diet and medicines, the dangerous symptoms soon going off; and by continuing this method he recovered in a few days[51]." In the same fever, the doctor adds further, "For though one might expect great advantages in pursuing an indication taken from what generally proves serviceable (viz. sweating), yet I have found, by constant experience, that the patient not only finds no relief, but, contrariwise, is more heated thereby; so that frequently a delirium, petechiæ, and other very dangerous symptoms immediately succeed such _sweats_[52]." [51] Wallis's edition, vol. i. p. 210. [52] Vol. i. p. 208. Morgagni describes a malignant fever which prevailed in Italy, in which the patients died in profuse sweats, while their physicians were looking for a crisis from them. Bleeding would probably have checked these sweats, and cured the fever. 11. Dissolved blood, and an absence of an inflammatory crust on its crassamentum. I shall hereafter place dissolved blood at the highest point of a scale, which is intended to mark the different degrees of morbid action in the system. I have mentioned, in the Outlines of a Theory of Fever, that it is the effect of a tendency to a palsy, induced by the violent force of impression upon the blood-vessels. This appearance of the blood in certain states of fever, instead of forbidding bleeding, is the most vehement call of the system for it. Nor is the absence of a crust on the crassamentum of the blood, a proof of the absence of great morbid diathesis, or a signal to lay aside the lancet. On the contrary, I shall show hereafter, that there are several appearances of the blood which indicate more morbid action in the blood-vessels than a sizy or inflammatory crust. 12. An undue proportion of serum to crassamentum in the blood. This predominance of water in the blood has often checked sufficient blood-letting. But it should be constantly disregarded while it is attended with those states of pulse (to be mentioned hereafter) which require bleeding. 14. The presence of petechiæ on the skin. These, I have elsewhere said, are the effects of the gangrenous state of fever. Dr. Sydenham and Dr. de Haen have taught the safety and advantage of bleeding, when these spots are accompanied by an active pulse. A boy of Mr. John Carrol owes his recovery from the small-pox to the loss of fifty ounces of blood, by five bleedings, at a time when nearly every pock on his arms and legs had a purple appearance. Louis XIV was bled five times in the small-pox, when he was but thirteen years of age, and thereby probably saved from the grave, to the great honour and emolument of the single physician who urged it against the advice of all the other physicians of the court. Dr. Cleghorn mentions a single case of the success of bleeding in the petechial small-pox. His want of equal success afterwards, in similar cases, was probably occasioned by his bleeding too sparingly, that is, but three or four times. Abscesses and sore breasts, which accompany or succeed fever, are no objections to blood-letting, provided the pulse indicate the continuance of inflammatory diathesis. They depend frequently upon the same state of the system as livid effusions on the skin. 14. The long duration of fever. Inflammatory diathesis is often protracted for many weeks, in the chronic state of fever. It, moreover, frequently revives after having disappeared, from an accidental irritant affecting some part of the body, particularly the lungs and brain. I bled a young man of James Cameron, in the autumn of 1794, four times between the 20th and 30th days of a chronic fever, in consequence of a pain in the side, accompanied by a tense pulse, which suddenly came on after the 20th day of his disease. His blood was sizy. His pain and tense pulse were subdued by the bleeding, and he recovered. I bled the late Dr. Prowl twelve times, in a fever which continued thirty days, in the autumn of the year 1800. I wish these cases to be attended to by young practitioners. The pulmonary consumption is often the effect of a chronic fever, terminating with fresh inflammatory symptoms, by effusions in the lungs. It may easily be prevented by forgetting the number of the days of our patient's fever, and treating the pulmonary affection as if it were a recent complaint. 15. Tremors and slight convulsions in the limbs. Bark, wine, laudanum, and musk are generally prescribed to remove these symptoms; but, to be effectual, they should, in most cases, be preceded by the loss of a few ounces of blood. 16. Bleeding is forbidden after the fifth or seventh day in a pleurisy. This prohibition was introduced into medicine at a time when a fear was entertained of arresting the progress of nature in preparing and expelling morbific matter from the system. From repeated experience I can assert, that bleeding is safe in every stage of pleurisy in which there is pain, and a tense and oppressed pulse; and that it has, when used for the first time after the fifth and seventh days, saved many lives. Bleeding has likewise been limited to a certain number of ounces in several states of fever. Were the force of the remote cause of a fever, its degrees of violence, and the habits of the subject of it, always the same, this rule would be a proper one; but, this not being the case, we must be governed wholly by the condition of the system, manifested chiefly by the state of the pulse. To admit of copious bleeding in one state of fever, and not in another, under equal circumstances of morbid excitement, is to prescribe for its name, and to forget the changes which climate, season, and previous habits create in all its different states. 17. The loss of a sufficient quantity of blood is often prevented by patients being apparently _worse_, after the first or second bleeding. This change for the worse, shows itself in some one or more of the following symptoms, viz. increase of heat, chills, delirium, hæmorrhages, convulsions, nausea, vomiting, faintness, coma, great weakness, pain, a tense, after a soft pulse, and a reduction of it in force and frequency. They are all occasioned by the system rising suddenly from a state of extreme depression, in consequence of the abstraction of the pressure of the blood to a state of vigour and activity, so great, in some instances, as to reproduce a depression below what existed in the system before a vein was opened; or it is occasioned by a translation of morbid action from one part of the body to another. The chills which follow bleeding are the effects of a change in the fever, from an uncommon to a common state of malignity. They occur chiefly in those violent cases of fever which come on without a chilly fit. The hæmorrhages produced by bleeding are chiefly from the nose, hæmorrhoidal vessels, or uterus, and of course are, for the most part, safe. Uncommon weakness, succeeding blood-letting, is the effect of sudden depression induced upon the whole system, by the cause before-mentioned, or of a sudden translation of the excitement of the muscles into the blood-vessels, or some other part of the body. These symptoms, together with all the others which have been mentioned, are so far from forbidding, that they all most forcibly indicate a repetition of blood-letting. I shall briefly illustrate, by the recital of three cases, the good effects of bleeding, in removing pain, and the preternatural slowness and weakness of the pulse, when produced by the use of that remedy. In the month of June of 1795, I visited Dr. Say in a malignant fever, attended with pleuritic symptoms, in consultation with Dr. Physick. An acute pain in his head followed six successive bleedings. After a seventh bleeding, he had no pain. His fever soon afterwards left him. In thus persevering in the use of a remedy, which, for several days, appeared to do harm, we were guided wholly by the state of his pulse, which uniformly indicated, by its force, the necessity of more bleeding. In the autumn of 1794, I was sent for to visit Samuel Bradford, a young man of about 20 years of age, son of Mr. Thomas Bradford, who was ill with the reigning malignant epidemic. His pulse was at 80. I drew about 12 ounces of blood from him. Immediately after his arm was tied up, his pulse fell to 60 strokes in a minute. I bled him a second time, but more plentifully than before, and thereby, in a few minutes, brought his pulse back again to 80 strokes in a minute. A third bleeding the next day, aided by the usual purging physic, cured him in a few days. In the month of March, 1795, Dr. Physick requested me to visit, with him, Mrs. Fries, the wife of Mr. John Fries, in a malignant fever. He had bled her four times. After the fourth bleeding, her pulse suddenly fell, so as scarcely to be perceptible. I found her hands and feet cold, and her countenance ghastly, as if she were in the last moments of life. In this alarming situation, I suggested nothing to Dr. Physick but to follow his judgment, for I knew that he was master of that law of the animal economy which resolved all her symptoms into an oppressed state of the system. The doctor decided in a moment in favour of more bleeding. During the flowing of the blood, the pulse rose. At the end of three, ten, and seventeen hours it fell, and rose again by three successive bleedings, in all of which she lost about thirty ounces of _sizy_ blood. So great was the vigour acquired by the pulse, a few days after the paroxysms of depression, which have been described, were relieved, that it required seven more bleedings to subdue it. I wish the history of these two cases to be carefully attended to by the reader. I have been thus minute in the detail of them, chiefly because I have heard of practitioners who have lost patients by attempting to raise a pulse that had been depressed by bleeding, in a malignant fever, by means of cordial medicines, instead of the repeated use of the lancet. The practice is strictly rational; for, in proportion as the blood-vessels are weakened by pressure, the quantity of blood to be moved should be proportioned to the diminution of their strength. This depressed state of the pulse, whether induced by a paroxysm of fever, or by blood-letting, is sometimes attended with a strong pulsation of the arteries in the bowels and head. I have mentioned, among the _apparent_ bad effects of bleeding, that it sometimes changes a soft into a tense pulse. Of this I saw a remarkable instance in Captain John Barry, in the autumn of 1795. After the loss of 130 ounces of blood in a malignant yellow fever, his pulse became so soft as to indicate no more bleeding. In this situation he remained for three days, but without mending as rapidly as I expected from the state of his pulse. On the fourth day he had a hæmorrhage from his bowels, from which he lost above a pint of blood. His pulse now suddenly became tense, and continued so for two or three days. I ascribed this change in his pulse to the vessels of the bowels, which had been oppressed by congestion, being so much relieved by the hæmorrhage, as to resume an inflammatory action. I have observed a similar change to take place in the pulse, after a third bleeding, in a case of hæmorrhoidal fever, which came under my notice in the month of January, 1803. It is thus we see the blood-vessels, in a common phlegmon, travel back again, from a tendency to mortification, to the red colour and pain of common inflammation. From a review of the commotions excited in the system by bleeding, a reason may be given why the physicians, who do not bleed in the depressed state of the pulse, have so few patients in what they call malignant fevers, compared with those who use a contrary practice. The disease, in such cases, being locked up, is not permitted to unfold its true character; and hence patients are said to die of apoplexy, lethargy, cholera, dysentery, or nervous fever, who, under a different treatment, would have exhibited all the marks of an ordinary malignant fever. In obviating the objections to blood-letting from its apparent evils, I have said nothing of the apparent bad effects of other remedies. A nausea is often rendered worse by an emetic, and pains in the bowels are increased by a purge. But these remedies notwithstanding maintain, and justly too, a high character among physicians. 19. Bleeding has been accused of bringing on a nervous, or the chronic state of fever. The use of this remedy, in a degree so moderate as to obviate the putrid or gangrenous state of fever only, may induce the chronic state of fever; for it is the effect, in this case, of the remains of inflammatory diathesis in the blood-vessels; but when blood is drawn proportioned to the morbid action in the system, it is impossible for a chronic fever to be produced by it. Even the excessive use of blood-letting, however injurious it may be in other respects, cannot produce a chronic fever, for it destroys morbid action altogether in the blood-vessels. 20. Bleeding has been charged with being a weakening remedy. I grant that it is so, and in this, its merit chiefly consists. The excessive morbid action of the blood-vessels must be subdued in part, in a fever, before stimulating remedies can be given with safety or advantage. Now this is usually attempted by depleting medicines, to be mentioned hereafter, or it is left to time and nature, all of which are frequently either deficient, or excessive in their operations; whereas bleeding, by suddenly reducing the morbid action of the blood-vessels to a wished-for point of debility, saves a great and unnecessary waste of excitability, and thus prepares the body for the exhibition of such cordial remedies as are proper to remove the debility which predisposed to the fever. 21. It has been said that bleeding renders the habitual use of it necessary to health and life. This objection to blood-letting is founded upon an ignorance of the difference between the healthy, and morbid action of the blood-vessels. Where blood is drawn in health, such a relaxation is induced in the blood-vessels, as to favour the formation of plethora, which may require habitual bleeding to remove it; but where blood is drawn only in the inflammatory state of fever, the blood-vessels are reduced from a morbid degree of strength to that which is natural, in which state no predisposition to plethora is created, and no foundation laid for periodical blood-letting. But there are cases which require even this evil, to prevent a greater. Thus we cure a strangulated hernia, when no fever attends, by the most profuse bleeding. The plethora and predisposition to disease which follow it are trifling, compared with preventing certain and sudden death. 22. Bleeding has been accused of bringing on an intermitting fever. This is so far from being an objection to it, that it should be considered as a new argument in its favour; for when it produces that state of fever, it converts a latent, and perhaps a dangerous disease, into one that is obvious to the senses, and under the dominion of medicine. Nor is it an objection to blood-letting, that, when used in an inflammatory intermittent, it sometimes changes it into a continual fever. An instance of the good effects of this change occurred in the Pennsylvania hospital, in an obstinate tertian, in the year 1804. The continual fever, which followed the loss of blood, was cured in a few days, and by the most simple remedies. 23. It has been said that bleeding, more especially where it is copious, predisposes to effusions of serum in the lungs, chest, bowels, limbs, and brain. In replying to this objection to bleeding, in my public lectures, I have addressed my pupils in the following language: "Ask the poor patients who come panting to the door of our hospital, with swelled legs and hard bellies, every fall, whether they have been too copiously bled, and they will all tell you, that no lancet has come near their arms. Ask the parents who still mourn the loss of children who have died, in our city, of the internal dropsy of the brain, whether they were destroyed by excessive blood-letting? If the remembrance of the acute sufferings which accompanied their sickness and death will permit these parents to speak, they will tell you, that every medicine, except bleeding, had been tried to no purpose in their children's diseases. Go to those families in which I have practised for many years, and inquire, whether there is a living or a dead instance of dropsy having followed, in any one of them, the use of my lancet? Let the undertakers and grave-diggers bear witness against me, if I have ever, in the course of my practice, conveyed the body of a single dropsical patient into their hands, by excessive blood-letting? No. Dropsies, like abscesses and gangrenous eruptions upon the skin, arise, in most cases, from the _want_ of sufficient bleeding in inflammatory diseases. Debility, whether induced by action or abstraction, seldom disposes to effusion. Who ever heard of dropsy succeeding famine? And how rarely do we see it accompany the extreme debility of old age?" "If ever bleeding kills," says Botallus, either directly or indirectly, through the instrumentality of other diseases, "it is not from its excess, but because it is not drawn in a sufficient quantity, or at a proper time[53]." And, again, says this excellent writer, "One hundred thousand men perish from the want of blood-letting, or from its being used out of time, to one who perishes from too much bleeding, prescribed by a physician[54]." [53] Cap. viii. § 4. [54] Cap. xxxvi. § 4. It is remarkable, that the dread of producing a dropsy by bleeding, is confined chiefly to its use in malignant fevers; for the men who urge this objection to it, do not hesitate to draw four or five quarts of blood in the cure of the pleurisy. The habitual association of the lancet with this disease, has often caused me to rejoice when I have heard a patient complain of a pain in his side, in a malignant fever. It insured to me his consent to the frequent use of the lancet, and it protected me, when it was used unsuccessfully, from the clamours of the public, for few people censure copious bleeding in a pleurisy. 24. Against blood-letting it has been urged, that the Indians of our country cure their inflammatory fevers without it. To relieve myself from the distressing obloquy to which my use of this remedy formerly exposed me, I have carefully sought for, and examined their remedies for those fevers, with a sincere desire to adopt them; but my inquiries have convinced me, that they are not only disproportioned to the habits and diseases of civilized life, but that they are far less successful than blood-letting, in curing the inflammatory fevers which occur among the Indians themselves. 25. Evacuating remedies of another kind have been said to be more safe than bleeding, and equally effectual, in reducing the inflammatory state of fever. I shall enumerate each of these evacuating remedies, and then draw a comparative view of their effects with blood-letting. They are, I. Vomits. II. Purges. III. Sweats. IV. Salivation. And, V. Blisters. I. Vomits have often been effectual in curing fevers of a mild character. They discharge offensive and irritating matters from the stomach; they lessen the fulness of the blood-vessels, by determining the serum of the blood through the pores; and they equalize the excitement of the system, by inviting its excessive degrees from the blood-vessels to the stomach and muscles. But they are, 1. Uncertain in their operation, from the torpor induced by the fever upon the stomach. 2. They are unsafe in many conditions of the system, as in pregnancy, and a disposition to apoplexy and ruptures. Life has sometimes been destroyed by their inducing cramp, hæmorrhage, and inflammation in the stomach. 3. They are not subject to the controul of a physician, often operating more, or less than was intended by him, or indicated by the disease. 4. They are often ineffectual in mild, and always so in fevers of great morbid action. II. Purges are useful in discharging acrid fæces and bile from the bowels in fevers. They act, moreover, by creating an artificial weak part, and thus invite morbid excitement from the blood-vessels to the bowels. They likewise lessen the quantity of blood, by preventing fresh accessions of chyle being added to it; but like vomits they are, 1. Uncertain in their operation; and from the same cause. Many ounces of salts and castor oil, and whole drachms of calomel and jalap, have often been given, without effect, to remove the costiveness which is connected with the malignant state of fever. 2. They are not subject to the direction of a physician, with respect to the time of their operation, or the quantity or quality of matter they are intended to discharge from the bowels. 3. They are unsafe in the advanced stage of fevers. Dr. Physick informed me, that three patients died in the water-closet, under the operation of purges, in St. George's hospital, during his attendance upon it. I have seen death, in several instances, succeed a plentiful spontaneous stool in debilitated habits. III. Sweating was introduced into practice at a time when morbific matter was supposed to be the proximate cause of fever. It acts, not by expelling any thing exclusively morbid from the blood, but by abstracting a portion of its fluid parts, and thus reducing the action of the blood-vessels. This mode of curing fever is still fashionable in genteel life. It excites no fear, and offends no sense. The sweating remedies have been numerous, and fashion has reigned as much among them, as in other things. Alexipharmic waters, and powders, and all the train of sudorific medicines, have lately yielded to the different preparations of antimony, particularly to James's powder. I object to them all, 1. Because they are uncertain; large and repeated doses of them being often given to no purpose. 2. Because they are slow, and disagreeable, where they succeed in curing fever. 3. Because, like vomits and purges, they are not under the direction of a physician, with respect to the quantity of fluid discharged by them. 4. Because they are sometimes, even when most profuse, ineffectual in the cure of fever. 5. The preparations of antimony, lately employed for the purpose of exciting sweats, are by no means safe. They sometimes convulse the system by a violent puking. Even the boasted James's powder has done great mischief. Dr. Goldsmith and Mr. Howard, it is said, were destroyed by it. None of these objections to sweating remedies are intended to dissuade from their use, when nature shows a disposition to throw off a fever by the pores of the skin; but, even then, they often require the aid of bleeding to render them effectual for that purpose. IV. Mercury, the Sampson of the materia medica, after having subdued the venereal disease, the tetanus, and many other formidable diseases, has lately added to its triumphs and reputation, by overcoming the inflammatory and malignant state of fever. I shall confine myself, in this place, to its depleting operation, when it acts by exciting a salivation. From half a pound to two pounds of fluid are discharged by it in a day. The depletion in this way is gradual, whereby fainting is prevented. By exciting and inflaming the glands of the mouth and throat, excitement and inflammation are abstracted from more vital parts. In morbid congestion and excitement in the brain, a salivation is of eminent service, from the proximity of the discharge to the part affected. But I object to it, as an exclusive evacuant in the cure of fever, 1. Because it is sometimes impossible, by the largest doses of mercury, to excite it, when the exigences of the system render it most necessary. 2. Because it is not so quick in its operation, as to be proportioned to the rapid progress of the malignant state of fever. 3. Because it is at all times a disagreeable, and frequently a painful remedy, more especially where the teeth are decayed. 4. Because it cannot be proportioned in its duration, or in the quantity of fluid discharged by it, to the violence or changes in the fever. Dr. Chisholm relied, for the cure of the Beullam fever at Grenada, chiefly upon this evacuation. I have mentioned the ratio of success which attended it. V. Blisters are useful in depleting from those parts which are the seats of topical inflammation. The relief obtained by them in this way more than balances their stimulus upon the whole system need hardly say, that their effects in reducing the morbid and excessive action of the blood-vessels are very feeble. To depend upon them in cases of great inflammatory action, is as unwise as it would be to attempt to bale the water from a leaky and sinking ship by the hollow of the hand, instead of discharging it by two or three pumps. VI. Abstemious diet has sometimes been prescribed as a remedy for fever. It acts directly by the abstraction of the stimulus of food from the stomach, and indirectly by lessening the quantity of blood. It can bear no proportion, in its effects, to the rapidity and violence of an inflammatory fever. In chronic fever, such as occurs in the pulmonary consumption, it has often been tried to no purpose. Long before it reduces the pulse, it often induces such a relaxation of the tone of the stomach and bowels as to accelerate death. To depend upon it therefore in the cure of inflammatory fever, whether acute or chronic, is like trusting to the rays of the sun to exhale the water of an overflowing tide, instead of draining it off immediately, by digging a hole in the ground. But there are cases in which the blood-vessels become so insolated, that they refuse to yield their morbid excitement to depletion from any outlet, except from themselves. I attended a sailor, in the Pennsylvania hospital, in 1799, who was affected with deafness, attended with a full and tense pulse. I prescribed for it, purging, blisters, and low diet, but without any effect. Perceiving no change in his pulse, nor in his disease, from those remedies, I ordered him to lose ten ounces of blood. The relief obtained by this evacuation induced me to repeat it. By means of six bleedings he was perfectly cured, without the aid of any other remedy. Bleeding has great advantages over every mode of depleting that has been mentioned. 1. It abstracts one of the exciting causes, viz. the stimulus of the blood, from the seat of fever. I have formerly illustrated this advantage of blood-letting, by comparing it to the abstraction of a grain of sand from the eye to cure an opthalmia. The other depleting remedies are as indirect and circuitous in their operation in curing fever, as vomits and purges would be to remove an inflammation in the eye, while the grain of sand continued to irritate it. 2. Blood-letting is quick in its operation, and may be accommodated to the rapidity of fever, when it manifests itself in apoplexy, palsy, and syncope. 3. It is under the command of a physician. He may bleed _when_ and _where_ he pleases, and may suit the _quantity_ of blood he draws, exactly to the condition of his patient's system. 4. It may be performed with the least attendance of nurses or friends. This is of great importance to the poor at all times, and to the rich during the prevalence of mortal epidemics. 5. It disturbs the system much less than any of the other modes of depleting, and therefore is best accommodated to that state of the system, in which patients are in danger of fainting or dying upon being moved. 6. It is a more delicate depleting remedy than most of those which have been mentioned, particularly vomits, purges, and a salivation. 7. There is no immediate danger to life from its use. Patients have sometimes died under the operation of vomits and purges, but I never saw nor heard an instance of a patient's dying in a fainty fit, brought on by bleeding. 8. It is less weakening, when used to the extent that is necessary to cure, than the same degrees of vomiting, purging, and sweating. 9. Convalescence is more rapid and more perfect after bleeding, than after the successful use of any of the other evacuating remedies. By making use of blood-letting in fevers, we are not precluded from the benefits of the other evacuating remedies. Some of them are rendered more certain and more effectual by it, and there are cases of fever, in which the combined or successive application of them all is barely sufficient to save life. To rely upon any one evacuating remedy, to the exclusion of the others, is like trusting to a pair of oars in a sea voyage, instead of spreading every sail of a ship. I suspect the disputes about the eligibility of the different remedies which have been mentioned, have arisen from an ignorance that they all belong to one class, and that they differ only in their force and manner of operation. Thus the physicians of the last century ascribed different virtues to salts of different names, which the chemists of the present day have taught us are exactly the same, and differ only in the manner of their being prepared. Having replied to the principal objections to blood-letting, and stated its comparative advantages over other modes of depletion, I proceed next to mention the circumstances which should regulate the use of it. These are, I. The state of the pulse. The following states of the pulse indicate the necessity of bleeding. 1. A full, frequent, and tense pulse, such as occurs in the pulmonary, rheumatic, gouty, phrenitic, and maniacal states of fever. 2. A full, frequent, and jerking pulse, without tension, such as frequently occurs in the vertiginous, paralytic, apoplectic, and hydropic states of fever. 3. A small, frequent, but tense pulse, such as occurs in the chronic, pulmonary, and rheumatic states of fever. 4. A tense and _quick_ pulse, without much preternatural frequency. This state of the pulse is common in the yellow fever. 5. A slow but tense pulse, such as occurs in the apoplectic, hydrocephalic, and malignant states of fever, in which its strokes are from 60 to 90, in a minute. 6. An uncommonly frequent pulse, without much tension, beating from 120 to 170 or 180 strokes in a minute. This state of the pulse occurs likewise in the malignant states of fever. 7. A soft pulse, without much frequency or fulness. I have met with this state of the pulse in affections of the brain, and in that state of pulmonary fever which is known by the name of pneumonia notha. It sometimes, I have remarked, becomes tense after bleeding. 8. An intermitting pulse. 9. A depressed pulse. 10. An imperceptible pulse. The slow, intermitting, depressed, and imperceptible states of the pulse are supposed exclusively to indicate congestion in the brain. But they are all, I believe, occasioned likewise by great excess of stimulus acting upon the heart and arteries. A pulse more tense in one arm than in the other, I have generally found to attend a morbid state of the brain. Much yet remains to be known of the signs of a disease in the brain, by the states of the pulse; hence Mr. Hunter has justly remarked, that "In inflammation of the brain, the pulse varies more than in inflammations of any other part; and perhaps we are led to judge of inflammation there, more from _other_ symptoms than the pulse[55]." [55] Treatise on Inflammation, chap. iii. 9. The slow, uncommonly frequent, intermitting, and imperceptible states of the pulse, which require bleeding, may be distinguished from the same states of the pulse, which arise from an exhausted state of the system, and that forbid bleeding, by the following marks: 1. They occur in the beginning of a fever. 2. They occur in the paroxysms of fevers which have remissions and exacerbations. 3. They sometimes occur after blood-letting, from causes formerly mentioned. 4. They sometimes occur, and continue during the whole course of an inflammation of the stomach and bowels. And, 5. They occur in relapses, after the crisis of a fever. The other states of the pulse indicate bleeding in every stage of fever, and in every condition of the system. I have taken notice, in another place, of the circumstances which render it proper in the advanced stage of chronic fever. If all the states of pulse which have been enumerated indicate bleeding, it must be an affecting consideration to reflect, how many lives have been lost, by physicians limiting the use of the lancet only to the tense or full pulse! I wish it comported with the proposed limits of this essay to illustrate and establish, by the recital of cases, the truth of these remarks upon the indications of bleeding from the pulse. It communicates much more knowledge of the state of the system than any other sign of disease. Its frequency (unconnected with its other states), being under the influence of diet, motion, and the passions of the mind, is of the least consequence. In counting the number of its strokes, we are apt to be diverted from attending to its irregularity and force; and in these, it should always be remembered, fever chiefly consists. The knowledge acquired by attending to these states of the pulse is so definite and useful, and the circumstances which seduce from a due attention to them are so erroneous in their indications, that I have sometimes wished the Chinese custom of prescribing, from feeling the pulse only, without seeing or conversing with the patient, were imposed upon all physicians. To render the knowledge of the indications of blood-letting, from the state of the pulse, as definite and correct as possible, I shall add, for the benefit of young practitioners, the following directions for feeling it. 1. Let the arm be placed in a situation in which all the muscles which move it shall be completely relaxed; and let it, at the same time, be free from the pressure of the body upon it. 2. Feel the pulse, in all obscure or difficult cases, in both arms. 3. Apply all the fingers of one hand, when practicable, to the pulse. For this purpose, it will be most convenient to feel the pulse of the right hand with your left, and of the left hand with your right. 4. Do not decide upon blood-letting, in difficult cases, until you have felt the pulse for some time. The Chinese physicians never prescribe until they have counted 49 strokes. 5. Feel the pulse at the intervals of four or five minutes, when you suspect that its force has been varied by any circumstance not connected with the disease, such as emotions of the mind, exercise, eating, drinking, and the like. 6. Feel the pulsations of the arteries in the temples and in the neck, when the pulse is depressed or imperceptible in the wrists. 7. Request silence in a sick room, and close your eyes, in feeling a pulse in difficult cases. By so doing, you will concentrate the sensations of your ears and eyes, in your fingers. In judging of the states of the pulse which have been enumerated, it will be necessary always to remember the natural difference, in its frequency and force, in old people and children; also in the morning and evening, and in the sleeping and waking states of the system. Much yet remains to be known upon this subject. I have mentioned the different states of the pulse, which call for bleeding, but it is more difficult to know when to prescribe it, when the pulse imparts no sign of disease. In general it may be remarked, where the disease is _recent_, the part affected important to life, and incapable of sustaining violent morbid action long, without danger of disorganization, where pain is great, and respiration difficult, the pulse may be disregarded in the use of the lancet. But to return. II. Regard should be had to the character of the reigning epidemic, in deciding upon blood-letting. If the prevailing fever be of a highly inflammatory nature, bleeding may be used with more safety, in cases where the indications of it from the pulse are somewhat doubtful. The character of a previous epidemic should likewise direct the use of the lancet. The pestilential fever which followed the plague in London, in 1665, Dr. Sydenham says, yielded only to blood-letting. It is equally necessary in all the febrile diseases which succeed malignant fevers. III. Regard should be had to the weather and season of the year. Dr. Hillary and Dr. Huxham both say it is much more necessary in dry, than in wet weather, and, all physicians know, it is more copiously indicated in the spring and autumn, than in summer and winter. IV. The constitution of a patient, and more especially his habits with respect to blood-letting, should be taken into consideration, in prescribing it. If he be plethoric, and accustomed to bleeding in former indispositions, it will be more necessary, than in opposite states and habits of the system. Nature will expect it. V. The corpulency of a patient should regulate the use of the lancet. A butcher of great observation informed me, that a fat ox did not yield more than from one half, to one third of the quantity of blood of a lean one, of the same size of bone, and it is well known, that the loss of a small quantity of blood, after cutting off the head of a fowl, is always a sign of its being fit for the table. The pressure of fat upon the blood-vessels produces the same effects in the human species that it does in those animals; of course, less blood should be drawn from fat, than from lean people, under equal circumstances of disease. VI. As persons have more or less blood in their vessels, according to their size, less blood should be drawn, under equal circumstances, from small than large people. VII. Regard should be had to the age of adults in prescribing bleeding. In persons between fifty and sixty years of age, for reasons formerly mentioned, more blood may be drawn than in middle life, in similar diseases. In persons beyond 70, it will be necessary to regulate the quantity to be drawn by other signs than the pulse, or the appearances of the blood, the former being generally full, and sometimes tense, and the latter often putting on the sign of the second grade of morbid action formerly described. VIII. Regard should be had to the country or place from which persons affected with fevers have arrived, in prescribing the loss of blood. Fevers, in America, are more inflammatory than fevers, in persons of equal rank, in Great-Britain. A French physician once said, it was safer to draw a hogs-head of wine from a Frenchman's veins, than a quarter of a hundred pounds of beef from an Englishman's, meaning to convey an idea of the difference in the grades of morbid or inflammatory action in the diseases of the inhabitants of France and England, and of the difference in the quantity of blood proper to be drawn in each of them. A similar difference exists between the grades of fever in Great-Britain and America. From a want of attention to this circumstance, I saw a common pleurisy end in an abscess of the lungs, in a sea captain, in the city of London, in the year 1769, who was attended by a physician of the first reputation in England. He was bled but once. His pulse and American constitution called for the loss of 50 or 60 ounces of blood. IX. Regard should be had to the structure and situation of the parts diseased with febrile action. The brain, from its importance to all the functions of life, the rectum, the bladder, and the trachea, when inflamed, and the intestines, when strangulated, from their being removed so much out of the influence of the great circulation, all require more copious bleeding than the same degrees of disease in the lungs, and some other parts of the body. X. After blood-letting has been performed, the appearances of the blood should be attended to, in order to judge of the propriety of repeating it. I shall briefly describe these appearances, and arrange them in the order in which they indicate the different degrees of inflammatory diathesis, beginning with the highest. 1. Dissolved blood. It occurs in the malignant states of fever. I have seen it several times in the pleurisy, and have once heard of it in a case of gout. I have ascribed this decomposition of the blood to such a violent degree of action in the blood-vessels, as to dispose them to a paralytic state. It is generally considered as a signal to lay aside the lancet. If it occur in the _first stage_ of a fever, it indicates a very opposite practice. By repeated bleedings, the vessels recover their natural action, and the blood becomes _reduced_ to its original texture. Of this I have had frequent experience, since the year 1793. It required three successive bleedings to restore the blood from a dissolved, to a coagulable state, in Mr. Benton. It afterwards became very sizy. If this dissolved blood appear towards the close of a malignant fever, no other benefit than the protraction of life for a day or two, or an easy death, can be expected from repeating the bleeding, even though it be indicated by a tense pulse; for the viscera are generally so much choaked by the continuance of violent action in the blood-vessels, that they are seldom able to discharge the blood which distends them, into the cavity in the vessels, which is created by the abstraction of blood from a vein. There is some variety in the appearance of this state of the blood, which indicates more or less violent pressure upon the blood-vessels. It threatens most danger to life when it resembles molasses in its consistence. The danger is less when the part which is dissolved occupies the bottom of the bowl, and when its surface is covered with a sizy pellicle or coat. Does not the restoration of the blood from its disorganized state, by means of bleeding, suggest an idea of a similar change being practicable in the solids, when they are disorganized by disease? And are we not led hereby to an animating view of the extent and power of medicine? 2. Blood of a scarlet colour, without any separation into crassamentum or serum, indicates a second degree of morbid action. It occurs likewise in the malignant state of fever. It is called improperly dense blood. It occurs in old people. 3. Blood in which part of the crassamentum is dissolved in the serum, forming a resemblance to what is called the lotura carnium, or the washings of flesh in water. 4. Crassamentum sinking to the bottom of a bowl in yellow serum. 5. Crassamentum floating in serum, which is at first turbid, but which afterwards becomes yellow and transparent, by depositing certain red and fiery particles of the blood in the bottom of the bowl. 6. Sizy blood, or blood covered with a buffy coat. The more the crassamentum appears in the form of a cup, the more inflammatory action is said to be indicated by it. This appearance of the blood occurs in all the common states of inflammatory fever. It occurs too in the mild state of malignant fevers, and in the close of such of them as have been violent. It is not always confined to the common inflammatory state of the pulse, for I have observed it occasionally in most of the different states of the pulse which have been described. The appearance of this buffy coat on the blood in the yellow fever is always favourable. It shows the disease to be tending from an uncommon to a _common_ degree of inflammatory diathesis. It has been remarked, that blood which resembles claret in its colour, while flowing, generally puts on, when it cools, a sizy appearance. It would seem, from these facts, that the power of coagulation in the blood was lessened in an exact ratio to the increase of action upon the blood-vessels, and that it was increased in proportion to the diminution of that action, to that degree of it which constitutes what I have called _common_ inflammatory action. Here, as upon a former occasion, we may say with concern, if bleeding be indicated by all the appearances of the blood which have been enumerated, how many lives have been lost by physicians limiting the use of the lancet to those cases only, where the blood discovered an inflammatory crust! These remarks upon the relative signs of inflammatory action in the blood-vessels, should be admitted with a recollection that they are all liable to be varied by a moderate, or violent exacerbation of fever, by the size of the stream of blood, and by the heat, coldness, and form of the cup into which the blood flows. Even blood drawn, under exactly equal circumstances, from both arms, exhibited, in a case of pleurisy communicated to me by Dr. Mitchell, of Kentucky, very different appearances. That which was taken from one arm was sizy, while that which was taken from the other was of a scarlet colour. That which is drawn from a vein in the arm, puts on, likewise, appearances very different from that which is discharged from the bowels, in a dysentery. These facts were alluded to in the Outlines of the Theory of Fever[56], in order to prove that unequal excitement takes place, not only in the different systems of the body, but in the same system, particularly in the blood-vessels. They likewise show us the necessity of attending to the state of the _pulse_ in both arms, as well as in other parts of the body, in prescribing blood-letting. When time, and more attention to that index of the state of the system in fevers, shall have brought to light all the knowledge that the pulse is capable of imparting, the appearances of the blood, in fevers, will be regarded as little as the appearances of the urine. [56] Vol. iii. XI. Blood-letting should always be copious where there is danger from sudden and great congestion or inflammation, in vital parts. This danger is indicated most commonly by pain; but there may be congestion in the lungs, liver, bowels, and even in the head, without pain. In these cases, the state of the pulse should always govern the use of the lancet. XII. What quantity of blood may be taken, with safety, from a patient in an inflammatory fever? To answer this question it will be necessary to remark, 1. That, in a person of an ordinary size, there are supposed to be contained between 25 and 28 pounds of blood; and 2. That much more blood may be taken when the blood-vessels are in a state of morbid excitement and excitability, than at any other time. One of the uses of the blood is to stimulate the blood-vessels, and thereby to assist in originating and preserving animal life. In a healthy state of the vessels, the whole mass of the blood is necessary for this purpose; but in their state of morbid excitability, a much less quantity of blood than what is natural (perhaps in some cases four or five pounds) are sufficient to keep up an equal and vigorous circulation. Thus very small portions of light and sound are sufficient to excite vision and hearing in an inflamed, and highly excitable state of the eyes and ears. Thus too, a single glass of wine will often produce delirium in a fever in a man, who, when in health, is in the habit of drinking a bottle every day, without having his pulse quickened by it. An ignorance of the quantity of blood which has been drawn by design, or lost by accident, has contributed very much to encourage prejudices against blood-letting. Mr. Cline drew 320 ounces of blood in 20 days from a patient in St. Thomas's hospital, who laboured under a contusion of the head. But this quantity is small compared with the quantity lost by a number of persons, whose cases are recorded by Dr. Haller[57]. I shall mention a few of them. One person lost 9 pounds of blood, a second 12, a third 18, and a fourth 22, from the nose, at one time. A fifth lost 12 pounds by vomiting in one night, and a sixth 22 from the lungs. A gentleman at Angola lost between 3 and 4 pounds daily from his nose. To cure it, he was bled 97 times in one year. A young woman was bled 1020 times in 19 years, to cure her of plethora which disposed her to hysteria. Another young woman lost 125 ounces of blood, by a natural hæmorrhage, every month. To cure it, she was bled every day, and every other day, for 14 months. In none of these instances, was death the consequence of these great evacuations of blood. On the contrary, all the persons alluded to, recovered. Many similar instances of the safety, and even benefit of profuse discharges of blood, by nature and art, might be mentioned from other authors. I shall insert only one more, which shall be taken from Dr. Sydenham's account of the cure of the plague. "Among the other calamities of the civil war which afflicted this nation, the plague also raged in several places, and was brought by accident from another place to Dunstar Castle, in Somersetshire, where some of the soldiers dying suddenly, with an eruption of spots, it likewise seized several others. It happened at that time that a surgeon, who had travelled much in foreign parts, was in the service there, and applied to the governor for leave to assist his fellow-soldiers who were afflicted with this dreadful disease, in the best manner he was able; which being granted, he took so large a quantity of blood from every one at the beginning of the disease, and before any swelling was perceived, that they were ready to faint, and drop down, for he bled them all standing, and in the open air, and had no vessel to measure the blood, which falling on the ground, the quantity each person lost could not, of course, be known. The operation being over, he ordered them to lie in their tents; and though he gave no kind of remedy after bleeding, yet of the numbers that were thus treated, not a single person died. I had this relation from Colonel Francis Windham, a gentleman of great honour and veracity, and at this time governor of the castle[58]." [57] Elementa Physiologiæ, vol. iv. p. 45. [58] Vol. i. p. 131. Again. An ignorance of the rapid manner in which blood is regenerated, when lost or drawn, has helped to keep up prejudices against blood-letting. A person (Dr. Haller says) lost five pounds of blood daily from the hæmorrhoidal vessels for 62 days, and another 75 pounds of blood in 10 days. The loss each day was supplied by fresh quantities of aliment. These facts, I hope, will be sufficient to establish the safety and advantages of plentiful blood-letting, in cases of violent fever; also to show the fallacy and danger of that practice which attempts the cure of such cases of fever, by what is called _moderate_ bleeding. There are, it has been said, no half truths in government. It is equally true, that there are no half truths in medicine. This half-way practice of moderate bleeding, has kept up the mortality of pestilential fevers, in all ages, and in all countries. I have combated this practice elsewhere[59], and have asserted, upon the authority of Dr. Sydenham, that it is much better not to bleed at all, than to draw blood disproportioned in quantity to the violence of the fever. If the state of the pulse be our guide, the continuance of its inflammatory action, after the loss of even 100 ounces of blood, indicates the necessity of more bleeding, as much as it did the first time a vein was opened. In the use of this remedy it may be truly said, as in many of the enterprizes of life, that nothing is done, while any thing remains to be done. Bleeding should be repeated while the symptoms which first indicated it continue, should it be until four-fifths of the blood contained in the body are drawn away. In this manner we act in the use of other remedies. Who ever leaves off giving purges in a colic, attended with costiveness, before the bowels are opened? or who lays aside mercury as a useless medicine, because a few doses of it do not cure the venereal disease? [59] Account of the Yellow Fever in 1793. I shall only add under this head, that I have always observed the cure of a malignant fever to be most complete, and the convalescence to be most rapid, when the bleeding has been continued until a _paleness_ is induced in the face, and until the patient is able to sit up without being fainty. After these circumstances occur, a moderate degree of force in the pulse will gradually wear itself away, without doing any harm. XIII. In drawing blood, the quantity should be large or small at a time, according to the state of the system. In cases where the pulse acts with force and freedom, from 10 to 20 ounces of blood may be taken at once; but in cases where the pulse is much depressed, it will be better to take away but a few ounces at a time, and to repeat it three or four times a day. By this means the blood-vessels more _gradually_ recover their vigour, and the apparent bad effects of bleeding are thereby prevented. Perhaps the same advantages might be derived, in many other cases, from the gradual abstraction of stimuli, that are derived from the gradual increase of their force and number, in their application to the body. For a number of facts in support of this practice, the reader is referred to the history of the yellow fever, in the year 1793. In an inflammatory fever, the character of which is not accurately known, it is safest to begin with moderate bleeding, and to increase it in quantity, according as the violence and duration of the disease shall make it necessary. In fevers, and other diseases, which run their courses in a few days or hours, and which threaten immediate dissolution, there can be no limits fixed to the quantity of blood which may be drawn at once, or in a short time. Botallus drew three, four, and five pints in a day, in such cases. Dr. Jackson drew fifty-six ounces of blood, at one time, from a Mr. Thompson, of the British hospitals, in a fever of great violence and danger. This patient was instantly relieved from what he styled "chains and horrors." In three or four hours he was out of danger, and in four days, the doctor adds, returned to his duty[60]. Dr. Physick drew ninety ounces, by weight, from Dr. Dewees, in a sudden attack of the apoplectic state of fever, at one bleeding, and thereby restored him so speedily to health, that he was able to attend to his business in three days afterwards. In chronic states of fever, of an inflammatory type, small and frequent bleedings, are to be preferred to large ones. We use mercury, antimony, and diet drinks as alteratives in many diseases with advantage. We do not expect to remove debility by two or three immersions in a cold bath. We persist with patience in prescribing all the above remedies for months and years, before we expect to reap the full benefits of them. Why should not blood-letting be used in the same way, and have the same chance of doing good? I have long ago adopted this _alterative_ mode of using it, and I can now look around me, and with pleasure behold a number of persons of both sexes who owe their lives to it. In many cases I have prescribed it once in two or three months, for several years, and in some I have advised it every two weeks, for several months. [60] Remarks on the Constitution of the Medical Department of the British Army. There is a state of fever in which an excess in the action of the blood-vessels is barely perceptible, but which often threatens immediate danger to life, by a determination of blood to a vital part. In this case I have frequently seen the scale turn in favour of life, by the loss of but four or five ounces of blood. The pressure of this, and even of a much less quantity of blood in the close of a fever, I believe, as effectually destroys life as the excess of several pounds does in its beginning. In cases where bleeding does not cure, it may be used with advantage as a _palliative_ remedy. Many diseases induce death in a full and highly excited state of the system. Here opium does harm, while bleeding affords certain relief. It belongs to this remedy, in such cases, to ease pain, to prevent convulsions, to compose the mind, to protract the use of reason, to induce sleep, and thus to smooth the passage out of life. XIV. Bleeding from an artery, commonly called arteriotomy, would probably have many advantages over venesection, could it be performed at all times with ease and safety. Blood discharged by hæmorrhages affords more relief, in fevers, than an equal quantity drawn from a vein, chiefly because it is poured forth, in the former case, from a ruptured artery. I mentioned formerly, that Dr. Mitchell had found blood drawn from an artery to be what is called dense, at a time when that which was drawn from a vein, in the same persons, was dissolved. This fact may possibly admit of some application. In the close of malignant fevers, where bleeding has been omitted in the beginning of the disease, blood drawn from a vein is generally so dissolved, as to be beyond the reach of repeated bleedings to restore it to its natural texture. In this case, arteriotomy might probably be performed with advantage. The arteries, which retain their capacity of life longer than the veins, by being relieved from the immediate pressure of blood upon them, might be enabled so to act upon the torpid veins, as to restore their natural action, and thereby to arrest departing life. Arteriotomy might further be used with advantage in children, in whom it is difficult, and sometimes impracticable to open a vein. XV. Much has been said about the proper place from whence blood should be drawn. Bleeding in the foot was much used formerly, in order to excite a revulsion from the head and breast; but our present ideas of the circulation of the blood have taught us, that it may be drawn from the arm with equal advantage in nearly all cases. To bleeding in the foot there are the following objections: 1. The difficulty of placing a patient in a situation favourable to it. 2. The greater danger of wounding a tendon in the foot than in the arm, And, 3. The impossibility of examining the blood after it is drawn; for, in this mode of bleeding, the blood generally flows into a basin or pail of water. Under this head I shall decide upon the method of drawing blood by means of cups and leeches, in the inflammatory state of fever. Where an inflammatory fever arises from local affection, or from contusion in the head or breast, or from a morbid excitement in those, above other parts of the arterial system, they may be useful; but where local affection is a symptom of general and equable fever only, it can seldom be necessary, except where bleeding from the arm has been omitted, or used too sparingly, in the beginning of a fever; by which means such fixed congestion often takes place, as will not yield to general bleeding. XVI. Much has been said likewise about the proper time for bleeding in fevers. It may be used at all times, when indicated by the pulse and other circumstances, in continual fevers; but it should be used chiefly in the paroxysms of such as intermit. I have conceived this practice to be of so much consequence, that, when I expect a return of the fever in the night, I request one of my pupils to sit up with my patients all night, in order to meet the paroxysm, if necessary, with the lancet. But I derive another advantage from fixing a centinel over a patient in a malignant fever. When a paroxysm goes off in the night, it often leaves the system in a state of such extreme debility, as to endanger life. In this case, from five to ten drops of laudanum, exhibited by a person who is a judge of the pulse, obviate this alarming debility, and often induce easy and refreshing sleep. By treating the human body like a corded instrument, in thus occasionally relaxing or bracing the system, according to the excess or deficiency of stimulus, in those hours in which death most frequently occurs, I think I have been the means of saving several valuable lives. XVII. The different positions of the body influence the greater or less degrees of relief which are obtained by blood-letting. Where there is a great disposition to syncope, and where it is attended with alarming and distressing circumstances, blood should be drawn in a recumbent posture, but where there is no apprehension or dread of fainting, it may be taken in a sitting posture. The relief will be more certain if the patient be able to stand while he is bled. A small quantity of blood, drawn in this posture, brings on fainting, and the good effects which are often derived from it. It should therefore be preferred, where patients object to copious or frequent bleedings. The history of the success of this practice in the British army, recently mentioned from Dr. Sydenham, furnishes a strong argument in its favour. I regret that the limits I have fixed to this Defence of Blood-letting will not admit of my applying the principles which have been delivered, to all the inflammatory states of fever. In a future essay, I hope to establish its efficacy in the maniacal state of fever. I have said that madness is the effect of a chronic inflammation in the brain. Its remedy, of course, should be frequent and copious blood-letting. Physical and moral evil are subject to similar laws. The mad-shirt, and all the common means of coercion, are as improper substitutes for bleeding, in madness, as the whipping-post and pillory are for solitary confinement and labour, in the cure of vice. The pulse should govern the use of the lancet in this, as well as in all the _ordinary_ states of fever. It is the dial-plate of the system. But in the _misplaced_ states of fever, the pulse, like folly in old age, often points at a different mark from nature. In all such cases, we must conform our practice to that which has been successful in the reigning epidemic. A single bleeding, when indicated by this circumstance, often converts a fever from a suffocated, or latent, to a sensible state, and thus renders it a more simple and manageable disease. It is worthy of consideration here, how far local diseases, which have been produced by fevers, might be cured by re-exciting the fever. Sir William Jones says, the physicians in Persia always begin the cure of the leprosy by blood-letting[61]. Possibly this remedy diffuses the disease through the blood-vessels, and thereby exposes it to be more easily acted upon by other remedies. [61] Asiatic Essays. Having mentioned the states of fever in which blood-letting is indicated, and the manner in which it should be performed, I shall conclude this inquiry by pointing out the states of fever in which it is forbidden, or in which it should be cautiously or sparingly performed. This subject is of consequence, and should be carefully attended to by all who wish well to the usefulness and credit of the lancet. 1. It is forbidden in that state of fever, as well as in other diseases, in which there is reason to believe the brain or viscera are engorged with blood, and the whole system prostrated below the point of re-action. I have suggested this caution in another place[62]. The pulse in these cases is feeble, and sometimes scarcely perceptible, occasioned by the quantity of blood in the blood-vessels being reduced, in consequence of the stagnation of large portions of it in the viscera. By bleeding in these cases, we deprive the blood-vessels of the feeble remains of the stimulus which keep up their action, and thus precipitate death. The remedies here should be frictions, and stimulating applications to the extremities, and gentle stimuli taken by the mouth, or injected into the bowels. As soon as the system is a little excited by these remedies, blood may be drawn, but in small quantities at a time, and perhaps only by means of cups or leaches applied to the seats of the congestions of the blood. After the vessels are excited by the equable diffusion of the blood through all their parts, it may with safety be drawn from the arm, provided it be indicated by the pulse. [62] Vol. iii. 2. It is seldom proper beyond the third day, in a malignant fever, if it has not been used on the days previous to it, and for the same reason that has been given under the former head. Even the tension of the pulse is not always a sufficient warrant to bleed, for in three days, in a fever which runs its course in five days, the disorganization of the viscera is so complete, that a recovery is scarcely to be expected from the lancet. The remedies which give the only chance of relief in this case, are purges, blisters, and a salivation. 3. Where fevers are attended with paroxysms, bleeding should be omitted, or used with great caution, in the close of those paroxysms. The debility which accompanies the intermission of the fever is often so much increased by the recent loss of blood, as sometimes to endanger life. 4. Bleeding is forbidden, or should be used cautiously in that malignant state of fever, in which a weak morbid action, or what Dr. Darwin calls a tendency to inirritability, takes place in the blood-vessels. It is known by a weak and frequent pulse, such as occurs in the typhus fever, and in the plague in warm climates. I have often met with it in the malignant sore throat, and occasionally in the pleurisy and yellow fever. The remedies here should be gentle vomits or purges, and afterwards cordials. Should the pulse be too much excited by them, bleeding may be used to reduce it. 5. It should be used sparingly in the diseases of habitual drunkards. The morbid action in such persons, though often violent, is generally transient. It may be compared to a soap-bubble. The arteries, by being often overstretched by the stimulus of strong drink, do not always contract with the diminution of blood, and such patients often sink, from this cause, from the excessive use of the lancet. 6. It has been forbidden after the suppurative process has begun in local inflammation. It constantly retards the suppuration, when begun, in the angina tonsillaris, and thus protracts that disease. To this rule there are frequent exceptions. 7. It should be omitted in pneumony, after copious expectoration has taken place. This discharge is local depletion, and, though slow in its effects compared with bleeding, it serves the same purpose in relieving the lungs. The lancet can only be required where great pain in coughing, and a tense pulse, attend this stage of the disease. 8. It may be omitted (except when the blood-vessels are insulated) in those diseases in which there is time to wait, without danger to life, or future health, for the circuitous operation of purging medicines, or abstemious diet. 9. It should be avoided, when it can be done without great danger to life, where there is a great and constitutional dread of the operation. In such cases, it has sometimes done harm to the patient, and injured the credit of the lancet. 10. There are cases in which sizy blood should not warrant a repetition of blood-letting. Mr. White informs us, in the History of the Bilious Fever which has lately prevailed at Bath, that bleeding, in many cases in which this appearance of the blood took place, was useless or hurtful. In some of the fevers of our own country, we sometimes see sizy blood followed by symptoms which forbid the repeated use of the lancet, but which yield to other depleting remedies, or to such as are of a cordial nature. I have seen the same kind of blood, a few hours before death, in a pulmonary consumption, and three days after a discharge of a gallon and a half of blood from the stomach by vomiting. 11. Even a tense pulse does not always call for the repeated use of the lancet. I have mentioned one case, viz. on the third or fourth days of a malignant fever, in which it is improper. There are instances of incurable consumptions from tubercles and ulcers in the lungs, in which the pulse cannot be made to feel the least diminution of tension by either copious or frequent bleedings. There are likewise cases of hepatic fever, in which the pulse cannot be subdued by this remedy. This tense state of the pulse is the effect of a suppurative process in the liver. If a sufficient quantity of blood has been drawn in the first stage of this disease, there is little danger from leaving the pulse to reduce or wear itself down by a sudden or gradual discharge of the hepatic congestion. The recovery in this case is slow, but it is for the most part certain. I have once known a dropsy and death induced by the contrary practice. 12. and lastly. There is sometimes a tension in the pulse in hæmorrhages, that will not yield to the lancet. The man whose blood was sizy, three days after losing a gallon and a half of it from his stomach, had a tense pulse the day before he died; and I once perceived its last strokes to be tense, in a patient whom I lost in a yellow fever by a hæmorrhage from the nose. The only circumstance that can justify bleeding in these cases is extreme pain, in which case, the loss of a few ounces of blood is a more safe and effectual remedy than opium. I shall now add a few remarks upon the efficacy of blood-letting, in diseases which are not supposed to belong to the class of fevers, and which have not been included in the preceding volumes. I. The philosophers, in describing the humble origin of man, say that he is formed "inter stercus et urinam." The divines say that he is "conceived in sin, and shapen in iniquity." I believe it to be equally true, and alike humiliating, that he is conceived and brought forth in disease. This disease appears in pregnancy and parturition. I shall first endeavour to prove this to be the case, and afterwards mention the benefits of blood-letting in relieving it, in both cases. In pregnancy, the uterus is always affected with that grade of morbid action which I formerly called inflammation. This is evident from its exhibiting all its usual phænomena in other parts of the body. These are, 1. Swelling, or enlargement. 2. Hæmorrhage. The lochia are nothing but a slow and spontaneous bleeding performed by nature, and intended to cure the inflammation of the uterus after parturition. 3. Abscesses, schirri, and cancers. It is true, those disorders sometimes occur in women that have never borne children. In these cases, they are the effects of the inflammation excited by the menstrual disease. 4. A full, quick, and tense or frequent pulse; pain; want of appetite[63]; sickness at stomach; puking; syncope; and sometimes convulsions in every part of the body. [63] Dr. Hunter used to teach, in his lectures, that the final cause of the want of appetite, during the first months of pregnancy, was to obviate plethora, which disposed to abortion. This plethora should have been called an inflammatory disease, in which abstinence is useful. 5. Sizy blood. This occurs almost uniformly in pregnancy. 6. A membrane. Dr. Scarpa has proved the membrana decidua, which is formed during pregnancy, to be in every respect the same in its properties with the membrane which is formed upon other inflamed surfaces, particularly the trachea, the pleura, and the inside of the bowels. Thus we see all the common and most characteristic symptoms and effects of inflammation, in other parts of the body, are exhibited by the uterus in pregnancy. These remarks being premised, I proceed to remark, that blood-letting is indicated, in certain states of pregnancy, by all the arguments that have been used in favour of it in any other inflammatory disease. The degree of inflammation in the womb, manifested by the pulse, pain, and other signs of disease, should determine the quantity of blood to be drawn. Low diet, gentle purges, and constant exercise, are excellent substitutes for it, but where they are not submitted to, blood-letting should be employed as a substitute for them. In that disposition to abortion, which occurs about the third month of pregnancy, small and frequent bleedings should be preferred to all other modes of depletion. I can assert, from experience, that they prevent abortion, nearly with as much certainty as they prevent a hæmorrhage from the lungs: for what is an abortion but a hæmoptysis (if I may be allowed the expression) from the uterus? During the last month of pregnancy, the loss of from twelve to twenty ounces of blood has the most beneficial effects, in lessening the pains and danger of child-birth, and in preventing its subsequent diseases. The doctrine I have aimed to establish leads, not only to the use of blood-letting in the disease of pregnancy, when required, but to a more copious use of it, when combined with other diseases, than in those diseases in a simple state. This remark applies, in a particular manner, to those spasms and convulsions which sometimes occur in the latter months of pregnancy. Without bleeding, they are always fatal. By copious bleeding, amounting in some instances to 80 and 100 ounces, they are generally cured. Let it not be supposed that blood-letting is alike proper and useful in every state of pregnancy. There are what are called slow or chronic inflammations, in which the diseased action of the blood-vessels not only forbids it, but calls for cordial and stimulating remedies. The same feeble state of inflammation sometimes takes place in the pregnant uterus. In these cases cordials and stimulants should be preferred to the lancet. _Parturition_ is a higher grade of disease than that which takes place in pregnancy. It consists of convulsive or clonic spasms in the uterus, supervening its inflammation, and is accompanied with chills, heat, thirst, a quick, full, tense, or a frequent and depressed pulse, and great pain. By some divines these symptoms, and particularly pain, have been considered as a standing and unchangeable punishment of the original disobedience of woman, and, by some physicians, as indispensably necessary to enable the uterus to relieve itself of its burden. By contemplating the numerous instances in which it has pleased God to bless the labours and ingenuity of man, in lessening or destroying the effects of the curse inflicting upon the earth, and by attending to the histories of the total exemption from pain in child-bearing that are recorded of the women in the Brasils, Calabria, and some parts of Africa, and of the small degrees of it which are felt by the Turkish women, who reduce their systems by frequent purges of sweet oil during pregnancy, I was induced to believe pain does not accompany child-bearing by an immutable decree of Heaven. By recollecting further how effectually blood-letting relieves many other spasmodic and painful diseases, and how suddenly it relaxes rigidity in the muscles, I was led, in the year 1795, to suppose it might be equally effectual in lessening the violence of the disease and pains of parturition. I was encouraged still more to expect this advantage from it, by having repeatedly observed the advantages of copious bleeding for inflammatory fevers, just before delivery, in mitigating its pains, and shortening its duration. Upon my mentioning these reflections and facts to Dr. Dewees, I was much gratified in being informed, that he had been in the practice, for several years before his removal from Abingdon to Philadelphia, of drawing _large_ quantities of blood during parturition, and with all the happy effects I had expected from it. The practice has been strongly inculcated by the doctor in his lectures upon midwifery, and has been ably defended and supported by a number of recent facts, in an ingenious inaugural dissertation, published by Dr. Peter Miller, in the year 1804. It has been generally adopted by the practitioners of midwifery, of both sexes, in Philadelphia. I do not mean to insinuate that bleeding is a new remedy in parturition. It has long ago been advised and used in France, and even by the midwives of Genoa, in Italy, but never, in any country, in the large quantities that have been recommended by Dr. Dewees, that is, from 20 to 80 ounces, or until signs of fainting are induced, nor under the influence of the theory of parturition, being a violent disease. But the advantages of this remedy are not confined to lessening the pains of delivery. It prevents after pains; favours the easy and healthy secretion of milk; prevents sore breasts, swelled legs, puerperile fever, and all the distressing train of anomalous complaints that often follow child-bearing. Dr. Hunter informed his pupils, in his lectures upon midwifery, in the year 1769, that he had often observed the most rapid recoveries to succeed the most severe labours. The severity of the pains in these cases created a disease, which prevented internal congestions in the womb. Bleeding, by depleting the uterus, obviates at once both disease and congestion. Its efficacy is much aided by means of glysters, which, by emptying the lower bowels, lessen the pressure upon the uterus. Let it not be inferred, from what has been said in favour of blood-letting in parturition, that it is proper in all cases. Where there has been great previous inanition, and where there are marks of languor, and feeble morbid action in the system, the remedies should be of an opposite nature. Opium and other cordials are indicated in these cases. Their salutary effects in exciting the action of the uterus, and expediting delivery, are too well known to be mentioned. I have expressed a hope in another place[64], that a medicine would be discovered that should suspend sensibility altogether, and leave irritability, or the powers of motion, unimpaired, and thereby destroy labour pains altogether. I was encouraged to cherish this hope, by having known delivery to take place, in one instance, during a paroxysm of epilepsy, and having heard of another, during a fit of drunkenness, in a woman attended by Dr. Church, in both of which there was neither consciousness, nor recollection of pain. [64] Medical Repository, vol. vi. 2. During the period in which the menses are said to dodge, and for a year or two after they cease to flow, there is a morbid fulness and excitement in the blood-vessels, which are often followed by head-ach, cough, dropsy, hæmorrhages, glandular obstructions, and cancers. They may all be prevented by frequent and moderate bleedings. 3. It has been proved, by many facts, that opium, when taken in an excessive dose, acts by inducing a similar state of the system with that which is induced by the miasmata which bring on malignant and inflammatory fevers. The remedy for the disease produced by it (where a vomiting cannot be excited to discharge the opium) has been found to be copious blood-letting. Of its efficacy, the reader will find an account in four cases, published in the fifth volume of the New-York Medical Repository. 4. It is probable, from the uniformly stimulating manner in which poisons of all kinds act upon the human body, that bleeding would be useful in obviating their baneful effects. Dr. John Dorsey has lately proved its efficacy, in the case of a child that was affected with convulsions, in consequence of eating the leaves of the datura stramonium. 5. It has been the misfortune of diabetes to be considered by physicians as exclusively a local disease of weak morbid action, or as the effect of simple debility in the kidneys; and hence stimulating and tonic medicines have been exclusively prescribed for it. This opinion is not a correct one. It often affects the whole arterial system, more especially in its first stage, with great morbid action. In two cases of it, where this state of the blood-vessels took place, I have used blood-letting with success, joined with the common remedies for inflammatory diseases. 6. In dislocated bones which resist both skill and force, it has been suggested, that bleeding, till fainting is induced, would probably induce such a relaxation in the muscles as to favour their reduction. This principle was happily applied, in the winter of 1795, by Dr. Physick, in the Pennsylvania hospital, in a case of dislocated humerus of two months continuance. The doctor bled his patient till he fainted, and then reduced his shoulder in less than a minute, and with very little exertion of force. The practice has since become general in Philadelphia, in luxations of large bones, where they resist the common degrees of strength employed to reduce them. In contemplating the prejudices against blood-letting, which formerly prevailed so generally in our country, I have been led to ascribe them to a cause wholly political. We are descended chiefly from Great-Britain, and have been for many years under the influence of English habits upon all subjects. Some of these habits, as far as they relate to government, have been partly changed; but in dress, arts, manufactures, manners, and science, we are still governed by our early associations. Britain and France have been, for many centuries, hereditary enemies. The hostility of the former to the latter nation, extends to every thing that belongs to their character. It discovers itself, in an eminent degree, in diet and medicine. Do the French love soups? the English prefer solid flesh. Do the French love their meats well cooked? the English prefer their meats but half roasted. Do the French sip coffee after dinner? the English spend their afternoons in drinking Port and Madeira wines. Do the French physicians prescribe purges and glysters to cleanse the bowels? the English physicians prescribe vomits for the same purpose. Above all, do the French physicians advise bleeding in fevers? the English physicians forbid it, in most fevers, and substitute sweating in the room of it. Here then we discover the source of the former prejudices and errors of our country-men, upon the subject of blood-letting. They are of British origin. They have been inculcated in British universities, and in British books; and they accord as ill with our climate and state of society, as the Dutch foot stoves did with the temperate climate of the Cape of Good Hope[65]. [65] I have frequently been surprised, in visiting English patients, to hear them say, when I have prescribed bleeding, that their physicians in England had charged them never to be bled. This advice excluded all regard to the changes which climate, diet, new employments, and age might induce upon the system. I am disposed to believe that many lives are lost, and numerous chronic diseases created in Great-Britain, by the neglect of bleeding in fevers. My former pupil, Dr. Fisher, in a letter from the university of Edinburgh, dated in the winter of 1795, assured me, that he had cured several of his fellow-students of fevers (contrary to general prejudice) by early bleeding, in as easy and summary a way as he had been accustomed to see them cured in Philadelphia, by the use of the same remedy. Dr. Gordon, of Scotland, and several other physicians in Great-Britain, have lately revived the lancet, and applied it with great judgment and success to the cure of fevers. It is probable the bad consequences which have followed the indiscriminate use of the lancet France, and some other countries, may have contributed in some degree to create the prejudices against it, which are entertained by the physicians in Great-Britain. Bleeding, like opium, has lost its character, in many cases, by being prescribed for the _name_ of a disease. It is still used, Mr. Townsend tells us, in this empirical way in Spain, where a physician, when sent for to a patient, orders him to be bled before he visits him. The late just theory of the manner in which opium acts upon the body, has restrained its mischief, and added greatly to its usefulness. In like manner, may we not hope, that just theories of diseases, and proper ideas of the manner in which bleeding acts in curing them, will prevent a relapse into the evils which formerly accompanied this remedy, and render it a great and universal blessing to mankind? AN INQUIRY INTO THE _Comparative State of Medicine_, IN PHILADELPHIA, BETWEEN THE YEARS 1760 AND 1766, AND THE YEAR 1805. In estimating the progress and utility of medicine, important advantages may be derived from taking a view of its ancient, and comparing it with its present state. To do this upon an extensive scale, would be difficult, and foreign to the design of this inquiry. I shall therefore limit it, to the history of the diseases and medical opinions which prevailed, and of the remedies which were in use, in the city of Philadelphia, between the years 1760 and 1766, and of the diseases, medical opinions, and remedies of the year 1805. The result of a comparative view of each of them, will determine whether medicine has declined or improved, in that interval of time, in this part of the world. To derive all the benefits that are possible from such an inquiry, it will be proper to detail the causes, which, by acting upon the human body, influence the subjects that have been mentioned, in those two remote periods of time. Those causes divide themselves into climate, diet, dress, and certain peculiar customs; on each of which I shall make a few remarks. After what has been said, in the history of the Climate of Pennsylvania, in the first volume of these Inquiries, it will only be necessary in this place briefly to mention, that the winters in Philadelphia, between the years 1760 and 1766, were almost uniformly cold. The ground was generally covered with snow, and the Delaware frozen, from the first or second week in December, to the last week in February, or the first week in March. Thaws were rare during the winter months, and seldom of longer duration than three or four days. The springs began in May. The summers were generally warm, and the air seldom refreshed by cool north-west winds. Rains were frequent and heavy, and for the most part accompanied with thunder and lightning. The autumns began in October, and were gradually succeeded by cool and cold weather. The diet of the inhabitants of Philadelphia, during those years, consisted chiefly of animal food. It was eaten, in some families, three times, and in all, twice a day. A hot supper was a general meal. To two and three meals of animal food in a day, many persons added what was then called "a relish," about an hour before dinner. It consisted of a slice of ham, a piece of salted fish, and now and then a beef-steak, accompanied with large draughts of punch or toddy. Tea was taken in the interval between dinner and supper. In many companies, a glass of wine and bitters was taken a few minutes before dinner, in order to increase the appetite. The drinks, with dinner and supper, were punch and table beer. Besides feeding thus plentifully in their families, many of the most respectable citizens belonged to clubs, which met in the city in winter, and in its vicinity, under sheds, or the shade of trees, in summer, once and twice a week, and, in one instance, every night. They were drawn together by suppers in winter, and dinners in summer. Their food was simple, and taken chiefly in a solid form. The liquors used with it were punch, London porter, and sound old Madeira wine. Independently of these clubs, there were occasional meetings of citizens, particularly of young men, at taverns, for convivial purposes. A house in Water-street, known by the name of the Tun tavern, was devoted chiefly to this kind of accidental meetings. They were often followed by midnight sallies into the streets, and such acts of violence and indecency, as frequently consigned the perpetrators of them afterwards into the hands of the civil officers and physicians of the city. Many citizens, particularly tradesmen, met every evening for the purpose of drinking beer, at houses kept for that purpose. Instances of drunkenness were rare at such places. The company generally parted at ten o'clock, and retired in an orderly manner to their habitations. Morning drams, consisting of cordials of different kinds, were common, both in taverns and private houses, but they were confined chiefly to the lower class of people. From this general use of distilled and fermented liquors, drunkenness was a common vice in all the different ranks of society. The dresses of the men, in the years alluded to, were composed of cloth in winter, and of thin woollen or silk stuffs in summer. Wigs composed the covering of the head, after middle life, and cocked hats were universally worn, except by the men who belonged to the society of friends. The dresses of the women, in the years before mentioned, consisted chiefly of silks and calicoes. Stays were universal, and hoops were generally worn by the ladies in genteel life. Long cloth or camblet cloaks were common, in cold weather, among all classes of women. The principal custom under this head, which influenced health and life, was that which obliged women, after lying-in, "to sit up for company;" that is, to dress themselves, every afternoon on the second week after their confinement, and to sit for four or five hours, exposed to the impure air of a crowded room, and sometimes to long and loud conversations. Porches were nearly universal appendages to houses, and it was common for all the branches of a family to expose themselves upon them, to the evening air. Stoves were not in use, at that time, in any places of public worship. Funerals were attended by a large concourse of citizens, who were thereby often exposed to great heat and cold, and sometimes to standing, while the funeral obsequies were performed, in a wet or damp church-yard. The human mind, in this period of the history of our city, was in a colonized state, and the passions acted but feebly and partially upon literary and political subjects. We come now to mention the diseases which prevailed in our city between the years 1760 and 1766. The cholera morbus was a frequent disease in the summer months. Sporadic cases of dysentery were at that time common. I have never seen that disease epidemic in Philadelphia. The intermitting fever prevailed in the month of August, and in the autumn, chiefly in the suburbs and neighbourhood of the city. In the year 1765, it was epidemic in Southwark, and was so general, at the same time, as to affect two thirds of the inhabitants of the southern states. This fact is mentioned by Dr. Bond, in a lecture preserved in the minutes of the managers of the Pennsylvania hospital. The slow chronic fever, called at that time the nervous fever, was very common, in the autumnal months, in the thickly settled parts of the city. The bilious fever prevailed, at the same time, in Southwark. The late Dr. Clarkson, who began to practise medicine in that part of the city, in the year 1761, upon hearing some of his medical brethren speak of the appearance of bilious remittents in its middle and northern parts, about the year 1778, said they had long been familiar to him, and that he had met with them every year since his settlement in Philadelphia[66]. [66] From the early knowledge this excellent physician and worthy man had thus acquired of the bilious remitting fever, he was very successful in the treatment of it. It was by instruction conveyed by him to me with peculiar delicacy, that I was first taught the advantages of copious evacuations from the bowels in that disease. I had been called, when a young practitioner, to visit a gentleman with him in a bilious pleurisy. A third or fourth bleeding, which I advised, cured him. The doctor was much pleased with its effect, and said to me afterwards, "Doctor, you and I have each a great fault in our practice; I do not bleed enough, you do not purge enough." The yellow fever prevailed in the neighbourhood of Spruce-street wharf, and near a filthy stream of water which flowed through what is now called Dock-street, in the year 1762. Some cases of it appeared likewise in Southwark. It was scarcely known in the north and west parts of the city. No desertion of the citizens took place at this time, nor did the fear of contagion drive the friends of the sick from their bed-sides, nor prevent the usual marks of respect being paid to them after death, by following their bodies to the grave. A few sporadic cases of the same grade of fever appeared in the year 1763. Pneumonies, rheumatisms, inflammatory sore throats, and catarrhs were frequent during the winter and spring months. The last disease was induced, not only by sudden changes in the weather, but often by exposure to the evening air, on porches in summer, and by the damp and cold air of places of public worship in winter. The influenza was epidemic in the city in the spring of the year 1761. The malignant sore throat proved fatal to a number of children in the winter of 1763. The scarlet fever prevailed generally in the year 1764. It resembled the same disease, as described by Dr. Sydenham, in not being accompanied by a sore throat. Death from convulsions in pregnant women, also front parturition, and the puerperile fever, were common between the years 1760 and 1766. Death was likewise common between the 50th and 60th years of life from gout, apoplexy, palsy, obstructed livers, and dropsies. A club, consisting of about a dozen of the first gentlemen in the city, all paid, for their intemperance, the forfeit of their lives between those ages, and most of them with some one, or more of the diseases that have been mentioned. I sat up with one of that club on the night of his death. Several of the members of it called at his house, the evening before he died, to inquire how he was. One of them, upon being informed of his extreme danger, spoke in high and pathetic terms of his convivial talents and virtues, and said, "he had spent 200 evenings a year with him, for the last twenty years of his life." These evenings were all spent at public houses. The colica pictonum, or dry gripes, was formerly a common disease in this city. It was sometimes followed by a palsy of the upper and lower extremities. Colics from crapulas were likewise very frequent, and now and then terminated in death. Many children died of the cholera infantum, cynanche trachealis, and hydrocephalus internus. The last disease was generally ascribed to worms. Fifteen or twenty deaths occurred, every summer, from drinking cold pump water, when the body was in a highly excitable state, from great beat and labour. The small-pox, within the period alluded to, was sometimes epidemic, and carried off many citizens. In the year 1759, Dr. Barnet was invited from Elizabeth-town, in New-Jersey, to Philadelphia, to inoculate for the small-pox. The practice, though much opposed, soon became general. About that time, Dr. Redman published a short defence of it, and recommended the practice to his fellow-citizens in the most affectionate language. The success of inoculation was far from being universal. Subsequent improvements in the mode of preparing the body, and treating the eruptive fever, have led us to ascribe this want of success to the deep wound made in the arm, to the excessive quantity of mercury given to prepare the body, and to the use of a warm regimen in the eruptive fever. The peculiar customs and the diseases which have been enumerated, by inducing general weakness, rendered the pulmonary consumption a frequent disease among both sexes. Pains and diseases from decayed teeth were very common, between the years 1760 and 1766. At that time, the profession of a dentist was unknown in the city. The practice of physic and surgery were united, during those years, in the same persons, and physicians were seldom employed as man-midwives, except in preternatural and tedious labours. The practice of surgery was regulated by Mr. Sharp's treatise upon that branch of medicine. Let us now take a view of the medical opinions which prevailed at the above period, and of the remedies which were employed to cure the diseases that have been mentioned. The system of Dr. Boerhaave then governed the practice of every physician in Philadelphia. Of course diseases were ascribed to morbid acrimonies, and other matters in the blood, and the practice of those years was influenced by a belief in them. Medicines were prescribed to thin, and to incrassate the blood, and diet drinks were administered in large quantities, in order to alter its qualities. Great reliance was placed upon the powers of nature, and critical days were expected with solicitude, in order to observe the discharge of the morbid cause of fevers from the system. This matter was looked for chiefly in the urine, and glasses to retain it were a necessary part of the furniture of every sick room. To ensure the discharge of the supposed morbid matter of fevers through the pores, patients were confined to their beds, and fresh, with cool air, often excluded by close doors and curtains. The medicines to promote sweats were generally of a feeble nature. The spiritus mindereri, and the spirit of sweet nitre were in daily use for that purpose. In dangerous cases, saffron and Virginia snake-root were added to them. Blood-letting was used plentifully in pleurisies and rheumatisms, but sparingly in all other diseases. Blood was often drawn from the feet, in order to excite a revulsion of disease from the superior parts of the body. It was considered as unsafe, at that time, to bleed during the monthly disease of the female sex. Purges or vomits began the cure of all febrile diseases, but as the principal dependence was placed upon sweating medicines, those powerful remedies were seldom repeated in the subsequent stages of fevers. To this remark there was a general exception in the yellow fever of 1762. Small doses of glauber's salts were given every day after bleeding, so as to promote a gentle, but constant discharge from the bowels. The bark was administered freely in intermittents. The prejudices against it at that time were so general among the common people, that it was often necessary to disguise it. An opinion prevailed among them, that it lay in their bones, and that it disposed them to take cold. It was seldom given in the low and gangrenous states of fever, when they were not attended with remissions. The use of opium was confined chiefly to ease pain, to compose a cough, and to restrain preternatural discharges from the body. Such were the prejudices against it, that it was often necessary to conceal it in other medicines. It was rarely taken without the advice of a physician. Mercury was in general use in the years that have been mentioned. I have said it was given to prepare the body for the small-pox. It was administered by my first preceptor in medicine, Dr. Redman, in the same disease, when it appeared in the natural way, with malignant or inflammatory symptoms, in order to keep the salivary glands open and flowing, during the turn of the pock. He gave it likewise liberally in the dry gripes. In one case of that disease, I well remember the pleasure he expressed, in consequence of its having affected his patient's mouth. But to Dr. Thomas Bond the city of Philadelphia is indebted for the introduction of mercury into general use, in the practice of medicine. He called it emphatically "a revolutionary remedy," and prescribed it in all diseases which resisted the common modes of practice. He gave it liberally in the cynanche trachealis. He sometimes cured madness, by giving it in such quantities as to excite a salivation. He attempted to cure pulmonary consumption by it, but without success; for, at that time, the influence of the relative actions of different diseases and remedies, upon the human body, was not known, or, if known, no advantage was derived from it in the practice of medicine. The dry gripes were cured, at that time, by a new and peculiar mode of practice, by Dr. Thomas Cadwallader. He kept the patient easy by gentle anodynes, and gave lenient purges, only in the beginning of the disease; nor did he ever assist the latter by injections till the fourth and fifth days, at which time the bowels discharged their contents in an easy manner. It was said this mode of cure prevented the paralytic symptoms, which sometimes follow that disease. It was afterwards adopted and highly commended by the late Dr. Warren, of London. Blisters were in general use, but seldom applied before the latter stage of fevers. They were prescribed, for the first time, in hæmorrhages, and with great success, by Dr. George Glentworth. Wine was given sparingly, even in the lowest stage of what were then called putrid and nervous fevers. The warm and cold baths were but little used in private practice. The former was now and then employed in acute diseases. They were both used in the most liberal manner, together with the vapour and warm air baths, in the Pennsylvania hospital, by Dr. Thomas Bond. An attempt was made to erect warm and cold baths, in the neighbourhood of the city, and to connect them with a house of entertainment, by Dr. Lauchlin M'Clen, in the year 1761. The project was considered as unfriendly to morals, and petitions, from several religious societies, were addressed to the governor of the province, to prevent its execution. The enterprize was abandoned, and the doctor soon afterwards left the city. Riding on horseback, the fresh air of the sea-shore, and long journies, were often prescribed to invalids, by all the physicians of that day. I come now to mention the causes which influence the diseases, also the medical opinions and remedies of the present time. In this part of our discourse, I shall follow the order of the first part of our inquiry. I have already taken notice of the changes which the climate of Philadelphia has undergone since the year 1766. A change has of late years taken place in the dress of the inhabitants of Philadelphia. Wigs have generally been laid aside, and the hair worn cut and dressed in different ways. Round hats, with high crowns, have become fashionable. Umbrellas, which were formerly a part of female dress only, are now used in warm and wet weather, by men of all ranks in society; and flannel is worn next to the skin in winter, and muslin in summer, by many persons of both sexes. Tight dresses are uncommon, and stays are unknown among our women. It is to be lamented that the benefits to health which might have been derived from the disuse of that part of female dress, have been prevented by the fashion of wearing such light coverings over the breasts and limbs. The evils from this cause, shall be mentioned hereafter. A revolution has taken place in the diet of our citizens. Relishes and suppers are generally abolished; bitters, to provoke a preternatural appetite, also meridian bowls of punch, are now scarcely known. Animal food is eaten only at dinner, and excess in the use of it is prevented, by a profusion of excellent summer and winter vegetables. Malt liquors, or hydrant water, with a moderate quantity of wine, are usually taken with those simple and wholesome meals. Clubs, for the exclusive purpose of feeding, are dissolved, and succeeded by family parties, collected for the more rational entertainments of conversation, dancing, music, and chess. Taverns and beer-houses are much less frequented than formerly, and drunkenness is rarely seen in genteel life. The tea table, in an evening, has now become the place of resort of both sexes, and the midnight serenade has taken place of the midnight revels of the young gentlemen of former years. In doing justice to the temperance of the modern citizens of Philadelphia, I am sorry to admit, there is still a good deal of secret drinking among them. Physicians, who detect it by the diseases it produces, often lament the inefficacy of their remedies to remove them. In addition to intemperance from spiritous liquors, a new species of intoxication from opium has found its way into our city. I have known death, in one instance, induced by it. The following circumstances have had a favourable influence upon the health of the present inhabitants of Philadelphia. The improvements in the construction of modern houses, so as to render them cooler in summer, and warmer in winter. The less frequent practice of sitting on porches, exposed to the dew, in summer evenings. The universal use of stoves in places of public worship. The abolition of the custom of obliging lying-in women to sit up for company. The partial use of Schuylkill or hydrant water, for culinary and other purposes. The enjoyment of pure air, in country seats, in the neighbourhood of the city. They not only preserve from sickness during the summer and autumn, but they render families less liable to diseases during the other seasons of the year. And, lastly, the frequent use of private, and public warm and cold baths. For the establishment of the latter, the citizens of Philadelphia are indebted to Mr. Joseph Simons. The following circumstances have an unfavourable influence upon the health of our citizens. Ice creams taken in excess, or upon an empty stomach. The continuance of the practice of attending funerals, under all the circumstances that were mentioned in describing the customs which prevailed in Philadelphia, between the years 1760 and 1766. The combined influence of great heat and intemperance in drinking, acting upon passions unusually excited by public objects, on the 4th of July, every year. The general and inordinate use of segars. The want of sufficient force in the water which falls into the common sewers to convey their contents into the Delaware, renders each of their apertures a source of sickly exhalations to the neighbouring streets and squares. The compact manner in which the gutters are now formed, by preventing the descent of water into the earth, has contributed very much to retain the filth of the city, in those seasons in which they are not washed by rain, nor by the waste water of the pumps and hydrants. The timbers of many of the wharves of the city have gone to decay. The docks have not been cleaned since the year 1774, and many of them expose large surfaces to the action of the sun at low water. The buildings have increased in Water-street, and with them there has been a great increase of that kind of filth which is generated in all houses; the stores in this street often contain matters which putrify; from all which there is, in warm weather, a constant emission of such a f[oe]tid odour, as to render a walk through that street, by a person who does not reside there, extremely disagreeable, and sometimes to produce sickness and vomiting. In many parts of the vicinity of the city are to be seen pools of stagnating water, from which there are exhaled large quantities of unhealthy vapours, during the summer and autumnal months. The privies have become so numerous, and are often so full, as to become offensive in most of the compact parts of the city, more especially in damp weather. The pump water is impregnated with many saline and aërial matters of an offensive nature. While these causes exert an unfriendly influence upon the bodies of the citizens of Philadelphia, the extreme elevation or depression of their passions, by the different issues of their political contests (now far surpassing, in their magnitude, the contests of former years), together with their many new and fortuitous modes of suddenly acquiring and losing property, predispose them to many diseases of the mind. The present diseases of Philadelphia come next under our consideration. Fevers have assumed several new forms since the year 1766. The mild bilious fever has gradually spread over every part of the city. It followed the filth which was left by the British army in the year 1778. In the year 1780, it prevailed, as an epidemic, in Southwark, and in Water and Front-streets, below Market-street[67]. In the years 1791 and 1792, it assumed an inflammatory appearance, and was accompanied, in many cases, with hepatic affections. The connection of our subject requires that I should barely repeat, that it appeared in 1793 as an epidemic, in the form of what is called yellow fever, in which form it has appeared, in sporadic cases, or as an epidemic, every year since. During the reign of this high grade of bilious fever, mild intermittents and remittents, and the chronic or nervous forms of the summer and autumnal fever, have nearly disappeared. [67] It appears, from the account given by Mr. White of the bilious fever of Bath, that it prevailed several years in its suburbs, before it became general in that city. It is remarkable, that Southwark was nearly the exclusive seat, not only of the bilious or break-bone fever of 1780, but of the intermitting fever in 1765, taken notice of by Dr. Bond, and of the yellow fever of 1805. Inflammations and obstructions of the liver have been more frequent than in former years, and even the pneumonies, catarrhs, intercurrent, and other fevers of the winter and spring months, have all partaken more or less of the inflammatory and malignant nature of the yellow fever. The pulmonary consumption continues to be a common disease among both sexes. The cynanche trachealis, the scarlatina anginosa, the hydrocephalus internus, and cholera infantum, are likewise common diseases in Philadelphia. Madness, and several other diseases of the mind, have increased since the year 1766, from causes which have been mentioned. Several of the different forms of gout are still common among both sexes. Apoplexy and palsy have considerably diminished in our city. It is true, the bills of mortality still record a number of deaths from the former, every year; but this statement is incorrect, if it mean a disease of the brain only, for sudden deaths from all their causes are returned exclusively under the name of apoplexy. The less frequent occurrence of this disease, also of palsy, is probably occasioned by the less consumption of animal food, and of distilled and fermented liquors, by that class of citizens who are most subject to them, than in former years. Perhaps the round hat, and the general use of umbrellas, may have contributed to lessen those diseases of the brain. The dropsy is now a rare disease, and seldom seen even in our hospital. The colica pictonum, or dry gripes, is scarcely known in Philadelphia. I have ascribed this to the use of flannel next to the skin as a part of dress, and to the general disuse of punch as a common drink. The natural small-pox is nearly extirpated, and the puerperile fever is rarely met with in Philadelphia. The scrophula is much less frequent than in former years. It is confined chiefly to persons in humble life. I proceed, in the order that was proposed, to take notice of the present medical opinions which prevail among the physicians of Philadelphia. The system of Dr. Boerhaave long ago ceased to regulate the practice of physic. It was succeeded by the system of Dr. Cullen. In the year 1790, Dr. Brown's system of medicine was introduced and taught by Dr. Gibbon. It captivated a few young men for a while, but it soon fell into disrepute. Perhaps the high-toned diseases of our city exposed the fallacy and danger of the remedies inculcated by it, and afforded it a shorter life than it has had in many other countries. In the year 1790, the author of this inquiry promulgated some new principles in medicine, suggested by the peculiar phænomena of the diseases of the United States. These principles have been so much enlarged and improved by the successive observations and reasonings of many gentlemen in all the states, as to form an American system of medicine. This system rejects the nosological arrangement of diseases, and places all their numerous forms in morbid excitement, induced by irritants acting upon previous debility. It rejects, likewise, all prescriptions for the names of diseases, and, by directing their applications wholly to the forming and fluctuating states of diseases, and the system, derives from a few active medicines all the advantages which have been in vain expected from the numerous articles which compose European treatises upon the materia medica. This system has been adopted by a part of the physicians of Philadelphia, but a respectable number of them are still attached to the system of Dr. Cullen. A great change has taken place in the remedies which are now in common use in Philadelphia. I shall briefly mention such of them as are new, and then take notice of the new and different modes of exhibiting such as were in use between the years 1760 and 1766. Vaccination has been generally adopted in our city, in preference to inoculation with variolous matter. Digitalis, lead, zinc, and arsenic are now common remedies in the hands of most of our practitioners. Cold air, cold water, and ice are among the new remedies of modern practice in Philadelphia. Blood-letting is now used in nearly all diseases of violent excitement, not only in the blood-vessels, but in other parts of the body. Its use is not, as in former times, limited to ounces in specific diseases, but regulated by their force, and the importance of the parts affected to health and life; nor is it forbidden, as formerly, in infancy, in extreme old age, in the summer months, nor in the period of menstruation, where symptoms of a violent, or of a suffocated disease, manifested by an active or a feeble pulse, indicate it to be necessary. Leeches are now in general use in diseases which are removed, by their seat or local nature, beyond the influence of the lancet. For the introduction of this excellent remedy into our city we are indebted to Mr. John Cunitz. Opium and bark, which were formerly given in disguise, or with a trembling hand, are now, not only prescribed by physicians, but often purchased, and taken without their advice, by many of the citizens of Philadelphia. They even occupy a shelf in the closets of many families. The use of mercury has been revived, and a salivation has been extended; with great improvements and success, to nearly all violent and obstinate diseases. Nor has the influence of reason over ignorance and prejudice, with respect to that noble medicine, stopped here. Cold water, once supposed to be incompatible with its use, is now applied to the body, in malignant fevers, in order to insure and accelerate its operation upon the salivary glands. Wine is given in large quantities, when indicated, without the least fear of producing intoxication. The warm and cold baths, which were formerly confined chiefly to patients in the Pennsylvania hospital, are now common prescriptions in private practice. Exercise, country air, and the sea shore, are now universally recommended in chronic diseases, and in the debility which precedes and follows them. Great pains are now taken to regulate the quantity and quality of aliments and drinks, by the peculiar state of the system. Let us now inquire into the influence of the new opinions in medicine, and the new remedies which have been mentioned, upon human life. The small-pox, once the most fatal and universal of all diseases, has nearly ceased to occupy a place in our bills of mortality, by the introduction of vaccination in our city. For the prompt adoption of this great discovery, the citizens of Philadelphia owe a large debt of gratitude to Dr. Coxe, and Mr. John Vaughan. Fevers, from all their causes, and in all their forms, with the exception of the bilious yellow fever, now yield to medicine. Even that most malignant form of febrile diseases is treated with more success in Philadelphia than in other countries. It would probably seldom prove mortal, did a belief in its being derived from an impure atmosphere, and of its exclusive influence upon the body, while it prevailed as an epidemic, obtain universally among the physicians and citizens of Philadelphia. The pulmonary consumption has been prevented, in many hundred instances, by meeting its premonitory signs, in weakness and feeble morbid excitement in the whole system, by country air, gentle exercise, and gently stimulating remedies. Even when formed, and tending rapidly to its last stage, it has been cured by small and frequent bleedings, digitalis, and a mercurial salivation. The hydrocephalus internus, the cynanche trachealis, and cholera infantum, once so fatal to the children of our city, now yield to medicine in their early stages. The two former are cured by copious bleeding, aided by remedies formerly employed in them without success. The last is cured by moderate bleeding, calomel, laudanum, and country air. The gout has been torn from its ancient sanctuary in error and prejudice, and its acute paroxysms now yield with as much certainty to the lancet, as the most simple inflammatory diseases. The dropsy is cured by renouncing the unfortunate association of specific remedies with its name, and accommodating them to the degrees of excitement in the blood-vessels. The tetanus from wounds is now prevented, in most cases, by inflaming the injured parts, and thereby compelling them to defend the whole system, by a local disease. Where this preventing remedy has been neglected, and where tetanus arises from other causes than wounds, it has often been cured by adding to the diffusible stimulus of opium, the durable stimuli of bark and wine. Death from drinking cold water, in the heated state of the body, is now obviated by previously wetting the hands or feet with the water; and when this precaution is neglected, the disease induced by it is generally cured by large doses of liquid laudanum. Madness, which formerly doomed its miserable subjects to cells or chains for life, has yielded to bleeding, low diet, mercury, the warm and cold baths, fresh air, gentle exercise, and mild treatment, since its seat has been discovered to be in the blood-vessels of the brain. The last achievement of our science in Philadelphia, that I shall mention, consists in the discovery and observation of the premonitory signs of violent and mortal diseases, and in subduing them by simple remedies, in their forming state. By this means, death has been despoiled of his prey, in many hundred instances. In this successful conflict of medicine with disease and death, midwifery and surgery have borne a distinguished part. They derive their claims to the gratitude of the citizens of Philadelphia from the practice of each of them being more confined, than formerly, to a few members of our profession. It is in consequence of the former being exercised only by physicians of regular and extensive educations, that death from pregnancy and parturition is a rare occurrence in Philadelphia. I should greatly exceed the limits prescribed to this inquiry, should I mention how much pain and misery have been relieved, and how often death has been baffled in his attempts upon human life, by several late improvements in old, and the discovery of new remedies in surgery. I shall briefly name a few of them. In cases of blindness, from a partial opacity of the cornea, or from a closure of the natural pupil, a new pupil has been made; and where the cornea has been partially opaque, the opening through the iris has been formed, opposite to any part of it, which retained its transparency. The cure of fractures has been accelerated by blood-letting, and, where the union of a broken bone has not taken place from a defect of bony matter, it has been produced by passing a seton between the fractured ends of the bone, and effecting a union thereby between them. Luxations, which have long resisted both force and art, have been reduced in a few minutes, and without pain, by bleeding at deliquium animi. Old sores have been speedily healed, by destroying their surfaces, and thereby placing them in the condition of recent accidents. The fruitless application of the trepan, in concussions of the brain, has been prevented by copious bleeding, and a salivation. A suppression of urine has been cured, by the addition of a piece of a bougie to a flexible catheter. Strictures in the urethra have been removed by means of a caustic, also, in a more expeditious way, by dividing them with a lancet. Hydrocele has been cured by a small puncture, and afterwards exciting inflammation and adhesion by an injection of wine into the tunica vaginalis testis. The popliteal aneurism and varicose veins have both been removed by operations that were unknown a few years ago. For the introduction of several of those new surgical remedies, and for the discovery and improvement of others, the citizens of Philadelphia are indebted to Dr. Physick. They are likewise indebted to him and Dr. Griffitts for many of the new and successful modes of practice, in the diseases that have been mentioned. Even the few remedies that have been suggested by the author of these inquiries, owe their adoption and usefulness chiefly to the influence of those two respectable and popular physicians. Before I dismiss this part of our subject, I have only to add, that since the cure and extraction of the teeth have become a distinct branch of the profession of medicine, several diseases which have arisen from them, when decayed, have been detected and cured[68]. [68] The late Mr. Andrew Spence was the first regular bred dentist that settled in Philadelphia. There are now several well educated gentlemen in the city of that profession. We have thus taken a comparative view of the medical theories and remedies of former and modern times, and of their different influence upon human life. To exhibit the advantages of the latter over the former, I shall mention the difference in the number of deaths in three successive years, at a time when the population of the city and suburbs was supposed to amount to 30,000 souls, and in three years, after the population exceeded double that number. Between the 25th of December, 1771, and the 25th of December, 1772, there died 1291 persons. Between the same days of the same months, in 1772 and 1773, there died 1344 persons. Within the same period of time, between 1773 and 1774, the deaths amounted to 1021, making in all 3,656. I regret that I have not been able to procure the returns of deaths in years prior to those which have been mentioned. During the three years that have been selected, no unusually mortal diseases prevailed in the city. The measles were epidemic in 1771, but were not more fatal than in common years. Between the 25th of December, 1799, and the 25th of December, 1800, there died 1525 persons. Between the same days of the same months, in the years 1801 and 1802, there died 1362 persons. Within the same period of time, between 1802 and 1803, the deaths amounted to 1796, making in all 4,883. Upon these returns it will be proper to remark, that several hundreds of the deaths, in 1802 and 1803, were from the yellow fever, and that many of them were of strangers. Of 68 persons, who were interred in the Swedes' church-yard alone, one half were of that description of people. Deducting 500 from both those causes of extra-mortality in the three years, between 1799 and 1803, the increase of deaths above what they were in the years 1771 and 1774 is but 727. Had diseases continued to be as mortal as they were thirty years ago, considering the present state of our population, the number of deaths would have been more than 7,312. To render the circumstances of the statement of deaths that has been given perfectly equal, it will be necessary to add, that the measles prevailed in the city, in the year 1802, as generally as they did in 1771. From the history that has been given, of the effects of the late improvements and discoveries in medicine upon human life, in Philadelphia, we are led to appreciate its importance and usefulness. It has been said, by its enemies, to move; but its motions have been asserted to be only in a circle. The facts that have been stated clearly prove, that it has moved, and rapidly too, within the last thirty years, in a straight line. To encourage and regulate application and enterprize in medicine hereafter, let us inquire to what causes we are indebted for the late discoveries and improvements in our science, and for their happy effects in reducing the number of deaths so far below their former proportion to the inhabitants of Philadelphia. The first cause I shall mention is the great physical changes which have taken place in the manners of our citizens in favour of health and life. A second cause, is the assistance which has been afforded to the practice of physic, by the numerous and important discoveries that have lately been made in anatomy, natural history, and chemistry, all of which have been conveyed, from time to time, to the physicians of the city, by means of the Philadelphia and hospital libraries, and by the lectures upon those branches of science which are annually delivered in the university of Pennsylvania. 3. The application of reasoning to our science has contributed greatly to extend its success in the cure of diseases. Simply to observe and to remember, are the humblest operations of the human mind. Brutes do both. But to _theorize_, that is, to _think_, or, in other language, to compare facts, to reject counterfeits, to dissolve the seeming affinity of such as are not true, to combine those that are related, though found in remote situations from each other, and, finally, to deduce practical and useful inferences from them, are the high prerogatives and interest of man, in all his intellectual pursuits, and in none more, than in the profession of medicine. 4. The accommodation of remedies to the changes which are induced in diseases by the late revolutions in our climate, seasons, and manners, has had a sensible influence in improving the practice of medicine in our city. The same diseases, like the descendants of the same families, lose their resemblance to each other by the lapse of time; and the almanacks of 1803 might as well be consulted to inform us of the monthly phases of the moon of the present year, as the experience of former years, or the books of foreign countries, be relied upon to regulate the practice of physic at the present time, in any of the cities of the United States. 5. From the diffusion of medical knowledge among all classes of our citizens, by means of medical publications, and controversies, many people have been taught so much of the principles and practice of physic, as to be able to prescribe for themselves in the forming state of acute diseases, and thereby to prevent their fatal termination. It is to this self-acquired knowledge among the citizens of Philadelphia, that physicians are in part indebted for not being called out of their beds so frequently as in former years. There are few people who do not venture to administer laudanum in bowel complaints, and there are some persons in the city, who have cured the cynanche trachealis when it has occurred in the night, by vomits and bleeding, without the advice of a physician. The disuse of suppers is another cause why physicians enjoy more rest at night than formerly, for many of their midnight calls, were to relieve diseases brought on by that superfluous meal. 6. The dispensary instituted in our city, in the year 1786, for the medical relief of the poor, has assisted very much in promoting the empire of medicine over disease and death. Some lives have likewise been saved by the exertions of the humane society, by means of their printed directions to prevent sudden death; also, by the medical services which have lately been extended to out-patients, by order of the managers of the Pennsylvania hospital. 7thly and lastly. A change, favourable to successful practice in Philadelphia, has taken place in the conduct of physicians to their patients. A sick room has ceased to be the theatre of imposture in dress and manners, and prescriptions are no longer delivered with the pomp and authority of edicts. On the contrary, sick people are now instructed in the nature of their diseases, and informed of the names and design of their medicines, by which means faith and reason are made to co-operate in adding efficacy to them. Nor are patients left, as formerly, by their physicians, under the usual appearances of dissolution, without the aid of medicine. By thus disputing every inch of ground with death, many persons have been rescued from the grave, and lived, years afterwards, monuments of the power of the healing art. From a review of what has been effected within the last nine and thirty years, in lessening the mortality of many diseases, we are led to look forward with confidence and pleasure to the future achievements of our science. Could we lift the curtain of time which separates the year 1843 from our view, we should see cancers, pulmonary consumptions, apoplexies, palsies, epilepsy, and hydrophobia struck out of the list of mortal diseases, and many others which still retain an occasional power over life, rendered perfectly harmless, _provided_ the same number of discoveries and improvements shall be made in medicine in the intermediate years, that have been made since the year 1766. But in vain will the avenues of death from those diseases be closed, while the more deadly yellow fever is permitted to supply their place, and to spread terror, distress, and poverty through the city, by destroying the lives of her citizens by hundreds or thousands every year. Dear cradle of liberty of conscience in the western world! nurse of industry and arts! and patron of pious and benevolent institutions! may this cease to be thy melancholy destiny! May Heaven dispel the errors and prejudices of thy citizens upon the cause and means of preventing their pestilential calamities! and may thy prosperity and happiness be revived, extended, and perpetuated for ages yet to come! * * * * * INDEX. A Anthelmintics, i. 228 Arsenic, a remedy for cancerous sores, i. 240 Army of the United States, diseases of, i. 269 ----, causes of, i. 272 ----, remedies for, i. ibid. Agriculture, the practice of, recommended to country physicians, i. 388 Age, old, observations on the state of the body and mind in, i. 427 ----, its diseases, i. 446 ----, ----, their remedies, i. 449 Air, cool, its good effects in the yellow fever of 1793, iii. 279 Association of ideas, its effects upon morals, ii. 45 B. Barometer, its mean elevation in Philadelphia, i. 96 Blisters, their efficacy in obstinate intermittents, i. 179 ----, ----, in the bilious fever of 1780, i. 128 ----, ----, in the yellow fever of 1803, when applied in its early stage, iv. 141 Bed, lying in, useful in the bilious fever of 1780, i. 128 Bleeding, its efficacy in the cure of obstinate intermittents, i. 179 ----, ----, in the yellow fever of 1793, iii. 253 ----, reasons for the practice, iii. 254 ----, circumstances which regulated it, iii. 261 ----, objections to it answered, iii. 269 ----, gradual manner of abstracting blood recommended, iii. 273 Blood-letting, defence of it as a remedy for certain diseases, iv. 275 ----, indicated in fevers, iv. ibid. ----, its good effects in fevers, iv. 277 ----, objections to it answered, iv. 284 ----, its comparative advantages, iv. 313 ----, circumstances which should regulate its use, iv. 316 ----, appearances of the blood, iv. 326 ----, when forbidden, or to be used cautiously, iv. 344 ----, its advantages in pregnancy, iv. 349 ----, in parturition, iv. 353 ----, during the cessation of the menses, iv. 356 ----, in curing the disease induced by a large dose of opium, iv. 357 ----, in curing the disease induced by poison, iv. ibid. ----, in diabetes, iv. ibid. ----, in dislocated bones, iv. 358 Blood, quantity drawn from several persons in 1797, iv. 37 ----, appearances of it in 1793, iii. 256 ----, ----, in 1794, iii. 404 C. Civilization, diseases derived from it, i. 32 ----, ----, not necessarily connected with it, i. 60 Climate of Pennsylvania, account of, i. 71 ----, its changes, i. 76 ----, its temperature, i. 78 ----, its effects upon health and life, i. 108 Calomel, useful joined with emetics in scarlatina anginosa, i. 144 ----, its effects as a purge, when combined with jalap, in the yellow fever, iii. 241 ----, objections to it answered, iii. 243 Contagious, the yellow fever not so, iv. 223 Cholera infantum described, i. 157 ----, a form of bilious fever, i. 158 ----, its remedies, i. 160 ----, means of preventing it, i. 164 Cynanche trachealis, its different names, i. 169 ----, appearances in the trachea after death, i. 170 ----, its different grades, i. 171 ----, its remedies in its forming state, i. ibid. ----, its remedies after it is formed, i. 172 ----, favourable and unfavourable signs of its issue, i. 174 Consumption, pulmonary, thoughts on, i. 199 ----, pulmonary, Indians, and persons who lead laborious lives, not subject to it, i. 200 ----, radical remedies for it in exercise, labour, and the hardships of a camp and naval life, i. 204 ----, its causes, ii. 62 ----, not contagious, ii. 79 ----, tracheal, described, ii. 84 ----, its remedies, ii. 87 ----, premonitory signs, ii. ibid. ----, of the remedies for its inflammatory state, ii. 89 ----, of blood-letting, ii. ibid. ----, of a vegetable diet, ii. 104 ----, of the remedies for its hectic state, ii. 107 ----, for its typhus state, ii. 108 ----, of its radical remedies, ii. 128 ----, of exercise, ii. ibid. ----, of travelling, ii. 137 ----, signs of its long or short duration, and of its issue in life and death, ii. 144 ----, its different ways of terminating in death, ii. 147 College of physicians, their letter to the citizens of Philadelphia, declaring the existence of the yellow fever in the city, &c. in 1793, iii. 82 ----, their letter to the governor of the state, on the origin of the yellow fever in 1793, iii. 197 ----, their opinion of the origin of the fever in 1799, iv. 100 D. Diseases of the Indians, i. 16 ----, from civilization, i. 30 ----, produced by ardent spirits, i. 343 ----, of the military hospitals, during the revolutionary war between Great-Britain and the United States, i. 269 ----, of old age, i. 446 Drunkenness, a fit of it described, i. 338 ----, remedies for it, i. 374 Disease, summer and autumnal, its sources, iv. 163 ----, means of preventing it in its malignant forms, iv. 173 ----, in its mild forms, iv. 198 ----, in its intestinal forms, iv. 200 ----, of preserving cities and communities from them, iv. 202 ----, of exterminating them, iv. 210 ----, from drinking cold water, i. 186 ----, ----, how prevented, i. ibid. ----, ----, its cure, i. 185 Dropsies, their causes, ii. 151 ----, divided into inflammatory, and of weak morbid action in the blood-vessels, ii. 157 ----, remedies for the inflammatory state of, ii. 160 ----, ----, with weak morbid action in the blood-vessels, ii. 176 Dropsy of the brain, internal, ii. 192 ----, its history, ii. 195 ----, its causes, ii. 203 ----, its cure, ii. 210 Distress, familiarity with it, its moral effects, ii. 46 Death, its proximate cause, ii. 447 E. Emetics, useful in the bilious fever of 1780, i. 186 ----, in the scarlatina anginosa of 1783 and 1784, i. 144 ----, in the yellow fever of 1798, iv. 79 ----, in the yellow fever of 1799, iv. 97 ----, hurtful in the yellow fever of 1797, iv. 44 Exhalations, putrid, their sources and effects in producing the summer and autumnal disease, iv. 163 F. Faculty, moral, inquiry into the influence of physical causes on, ii. 3 Fruits, summer, useful in destroying worms, i. 229 Fever, bilious, history of it in 1780, i. 117 ----, outlines of a theory of, iii. 3 ----, its unity asserted, iii. 17 ----, unity of its exciting causes, iii. 16 ----, objections to a nosological arrangement of its different forms, iii. 33 ----, effects of, iii. 39 ----, different states of, enumerated, iii. 41 ----, objections to putrefaction in, iii. 43 ----, bilious yellow, history of, in 1793, iii. 69 ----, ----, its exciting causes, iii. 88 ----, ----, its premonitory signs, iii. 93 ----, ----, its first symptoms, iii. 95 ----, ----, symptoms of it in the blood-vessels, iii. 97 ----, ----, ----, in the liver, lungs, and brain, iii. 104 ----, ----, ----, in the stomach and bowels, iii. 108 ----, ----, ----, in the secretions and excretions, iii. 110 Fever, bilious yellow, symptoms of it, in the nervous system, iii. 116 ----, ----, ----, in the senses and appetites, iii. 122 ----, ----, ----, in the lymphatic and glandular system, iii. 124 ----, ----, ----, on the skin, iii. 125 ----, ----, ----, in the blood, iii. 128 ----, ----, nature of the black vomit, iii. 111 ----, ----, types of the, iii. 135 ----, ----, the empire of, over all other diseases, iii. 139 ----, ----, who most subject to it, iii. 148 ----, ----, negroes affected by it in common with white people, iii. 151 ----, ----, state of the atmosphere during the prevalence of, iii. 158 ----, ----, signs of the presence of miasmata in the body, universal, iii. 157 ----, ----, cases of re-infection, iii. 164 ----, ----, external appearances of the body after death in, iii. 165 ----, ----, appearances of the body by dissection, iii. 167 ----, ----, account of the distress of the city, iii. 175 ----, ----, its moral effects upon the inhabitants, iii. 179 ----, ----, number of deaths from it, iii. 181 ----, ----, is checked and destroyed by rain, iii. 184 ----, ----, inquiry into its origin by the governor of the state, iii. 196 ----, ----, said to be imported by the college of physicians, iii. 197 ----, ----, objections to their opinion, and proofs of its domestic origin, iii. 198 ----, the sameness of its origin with the plague, iii. 211 ----, state of the weather in 1793, iii. 215 ----, method of cure, iii. 223 ----, dissentions of the physicians, iii. 235 ----, of purging, iii. 239 ----, its salutary effects, iii. 241 ----, objections to it answered, iii. 243 ----, blood-letting, its utility, iii. 253 ----, salivation, its utility, iii. 284 ----, convalescence, iii. 289 ----, remarks on the use of stimulating remedies in this fever, iii. 292 ----, comparative view of the success of all the modes of practice employed in the fever, iii. 298 Fever, yellow, of 1794, history of, iii. 357 ----, its exciting causes, iii. 367 ----, symptoms in the different systems of the body, iii. 369 ----, in the blood-vessels, iii. ibid. ----, in the viscera, iii. 371 ----, in the alimentary canal, iii. 373 ----, in the secretions and excretions, iii. 375 ----, in the nervous system, iii. 379 ----, in the senses and appetites, iii. 383 ----, in the lymphatic system, iii. ibid. ----, in the blood, iii. 387 ----, different forms of the fever, iii. 388 ----, its origin, iii. 397 ----, method of cure, iii. 401 ----, bleeding, iii. 402 Fever, yellow, of 1794, good effects of cool air and cold water in, iii. 409 ----, of a salivation, iii. 411 ----, of blisters, iii. 413 ----, of tonic remedies, iii. 415 ----, of the inefficacy of bark, iii. ibid. ----, of the effects of wine, iii. 418 ----, ----, of opium, iii. 419 ----, ----, of nitre, iii. 421 ----, ----, of antimonials, iii. ibid. Fever, yellow, sporadic cases of, in the years 1795 and 1796, iii. 437 Fever, yellow, of 1797, iv. 3 ----, symptoms of, iv. 13 ----, type of, iv. 20 ----, different forms of, iv. 21 ----, influence of the moon upon it, iv. 27 ----, number of deaths, particularly of physicians, iv. 30 ----, origin of it, iv. 33 ----, its remedies, iv. ibid. ----, of bleeding, iv. ibid. ----, of purging medicines, iv. 37 ----, of a salivation, iv. 39 ----, different ways in which mercury acted upon the mouth and throat, iv. 40 ----, of emetics, iv. 44 ----, of diet and drinks, iv. 45 ----, of tonic remedies, iv. 49 ----, of blisters, iv. ibid. ----, of sweet oil, iv. 51 Fever, yellow, of 1797, relative success of different modes of practice, iv. 53 ----, signs of a favourable and unfavourable issue of the fever, iv. 55 Fever, yellow, of 1798, account of, iv. 67 ----, symptoms of, iv. 68 ----, in the blood-vessels, iv. ibid. ----, alimentary canal, iv. ibid. ----, on the tongue, iv. 69 ----, in the nervous system, iv. ibid. ----, in the eyes, lymphatics, and blood, iv. 71 ----, different modes in which it terminated in death, iv. 74 ----, state of the weather in 1798, iv. 77 ----, origin of the fever, iv. 78 ----, remedies for it, iv. ibid. ----, bleeding, iv. ibid. ----, emetics, iv. 79 ----, purges, iv. 81 ----, of a salivation, iv. ibid. ----, of sweats, iv. 82 ----, of bark, iv. 83 ----, of blisters, iv. ibid. ----, symptoms which indicated a favourable and unfavourable issue of the disease, iv. 84 ----, different modes of practice in this fever, and their different success, iv. 85 Fever, bilious, of 1799, iv. 91 ----, sickliness among certain animals, iv. 94 ----, its symptoms, iv. 95 ----, its remedies, iv. 97 Fever, yellow, of 1799, signs of a favourable and unfavourable issue of it, iv. 99 ----, its origin, iv. 100 Fever, yellow, sporadic cases of, in 1800, iv. 103 ----, ----, in 1801, iv. 111 Fever, yellow, of 1802, account of, iv. 123 ----, its origin, iv. 123 ----, its types, iv. 127 Fever, yellow, as it appeared in 1803, iv. 133 ----, symptoms of, iv. 136 ----, remedies for, iv. 139 Fever, yellow, sporadic cases in 1804, iv. 147 Fever, yellow, as it appeared in 1805, iv. 153 ----, its origin, iv. 155 ----, its remedies, iv. 156 ----, not contagious, iv. 223 G. Gout, peculiarities belonging to it, ii. 227 ----, its remote causes, ii. 230 ----, women most subject to it, ii. 232 ----, its exciting causes, ii. ibid. ----, its symptoms, ii. 234 ----, method of cure, ii. 251 ----, remedies in its forming state, ii. 253 ----, in a paroxysm, when attended with great morbid or inflammatory action in the blood-vessels, ii. 252 ----, when attended with weak morbid action in the blood-vessels, ii. 269 ----, remedies for its symptoms, ii. 275 ----, means for preventing the return of inflammatory, ii. 285 ----, with weak morbid action, ii. 293 H. Hospitals, their origin, i. 55 ----, military, their evils, i. 276 ----, constructed with ground floors, to be preferred in fevers, i. 275 Heat, greatest in Philadelphia, i. 87 Habit, its effects upon morals, ii. 43 Hæmoptysis, observations on, i. 191 Hydrophobia, observations on, ii. 301 ----, its causes, ii. 302 ----, its symptoms in rabid animals, ii. 306 ----, ----, in the human species, ii. 308 ----, supposed to be a malignant fever, ii. ibid. ----, remedies to prevent it, ii. 315 ----, ----, to cure it in its malignant or inflammatory state, ii. 317 ----, ----, to cure it when attended with weak morbid action in the blood-vessels, ii. 323 ----, death from it, supposed to be from suffocation, ii. 326 ----, laryngotomy suggested to prevent it, ii. 332 I. Indians, oration on their diseases and remedies, i. 3 ----, peculiar customs of their women, i. 9 ----, ----, of their men, i. 11 ----, ----, of both sexes, i. 12 Indians, their diseases, i. 16 ----, their remedies, i. 20 ----, comparative view of their diseases and remedies with those of civilized nations, i. 39 Iron, its preparations useful in destroying worms, i. 232 Imitation, its effects upon morals, ii. 42 Influenza, account of it, as it appeared in Philadelphia in 1789, 1790, and 1791, ii. 353 ----, history of its symptoms, ii. 354 ----, mode of treatment, ii. 360 Jaw-fall, or trismus, in infants, i. 254 L. Laudanum, its efficacy in the disease brought on by drinking cold water in hot weather, i. 185 Legs, sore, observations on, i. 411 ----, classes of people most subject to them, i. 412 ----, their remedies, i. 416 Longevity, circumstances which favour it, i. 428 Life, animal, inquiry into its causes, ii. 371 ----, a forced state, or the effects of impressions, ii. 377 ----, enumeration of those impressions, ii. 378 ----, how supported in sleep, ii. 397 ----, in the f[oe]tus in utero, ii. 404 ----, in infancy, ii. 405 ----, in youth, ii. 409 ----, in middle life, ii. 410 ----, in old age, ii. ibid. ----, in persons blind, or deaf and dumb from their birth, ii. 414 ----, in idiots, ii. 416 ----, after long abstinence, ii. 417 ----, in asphyxia, ii. 419 ----, in the Indians of North-America, ii. 427 ----, in the Africans, ii. 428 ----, in the Turkish empire, ii. 429 ----, in China and the East-Indies, ii. 431 ----, in the poor inhabitants of Europe, ii. 432 ----, stimuli which act alike in promoting it upon all nations, ii. 434 ----, how supported in sundry animals, ii. 441 ----, its extinction in death, how effected, ii. 447 M. Midwifery, the practice of it more successful by men than by women, i. 53 Manufactures, sedentary, unfriendly to the health of men, i. 65 Measles, history of, in 1789, ii. 338 ----, their symptoms, ii. 339 ----, a spurious, or external form of them described, ii. 342 ----, remedies used in them, ii. 346 ----, history of them, as they appeared in 1801, iv. 117 Medicine, an inquiry into its comparative state, in Philadelphia, between 1760 and 1766, and 1805, iv. 365 Diet of the inhabitants between 1760 and 1766, iv. 366 Dresses, iv. 368 Customs which had an influence on health, iv. 369 Diseases, iv. 370 N. Nature, meaning of the term, i. 35 ----, the extent of her powers in curing diseases, i. 20 Nosology, objections to it, iii. 33 Negroes subject to the yellow fever in common with the white people, iii. 366 O. Opium, useful in the bilious fever of 1780, i. 130 ----, the disease induced by it cured by blood-letting, iv. 357 Onion juice, useful in destroying worms, i. 231 P. Philadelphia, its situation, i. 74 ----, population, i. 76 ----, diseases between 1760 and 1766, and 1805, iv. 365 Purges, useful in the bilious fever of 1780, i. 127 ----, ----, in the yellow fever of 1793, iii. 231 ----, objections to them answered, iii. 243 Pulse, state of, in old people, i. 439 ----, in the yellow fever of 1793, in persons not confined with it, iii. 157 ----, in fevers, when it indicates blood-letting, iv. 316 Putrefaction, does not take place in the blood, iii. 43 Pregnancy, a morbid state of the system, iv. 349 ----, effects of blood-letting in relieving its diseases, iv. ibid. Parturition, a disease, iv. 353 ----, effects of blood-letting in lessening its pains, iv. ibid. Q. Quarantine laws, their inefficacy to prevent a yellow fever, iv. 218 ----, their evils, iv. ibid. R. Rain, usual quantity in Pennsylvania, i. 72 Revolution, American, its influence upon the human body and mind, i. 279 S. Snow, common depth in Pennsylvania, i. 91 Sweating described among the Indians of North-America, i. 22 Scarlatina anginosa of 1783 and 1784 described, i. 138 ----, additional observations on, i. 147 ----, prevented by gentle purges, i. 151 ----, cured by emetics in its forming state, i. 150 Salt, common, useful in the hæmoptysis, i. 192 ----, in destroying worms, i. 230 Sugar, useful in destroying worms, i. ibid. Spirits, ardent, their effects upon the human body and mind, i. 337 ----, diseases produced by them, i. 343 ----, their effects on property, i. 347 ----, substitutes for them, i. 353 ----, persons predisposed to their use, i. 360 ----, their influence upon the population of the United States, i. 364 Sweats, useful in the yellow fever of 1803, iv. 140 Salivation, its usefulness in the yellow fever of 1793, iii. 284 ----, ----, of 1794, iii. 411 ----, ----, of 1797, iv. 49 ----, ----, of 1798, iv. 81 Small-pox, new mode of inoculating for, i. 311 T. Tetanus, its causes, i. 248 ----, its remedies when from wounds, i. 256 ----, ----, when from other causes, i. 259 W. Winters, cold, in Pennsylvania, i. 76, 77, 79 Winds, common, in Pennsylvania, i. 90 Water, cold, disease from drinking it when the body is preternaturally heated, i. 184 Worms, natural to young children, and to young animals, i. 218 ----, intended, probably, to prevent disease, i. 219 ----, destroyed by medicines that act mechanically and chemically upon them, i. 128 Wounds, gun-shot, in joints, followed by death, i. 274 FINIS. * * * * * LATELY PUBLISHED, And for sale by CONRAD & CO. at their stores in Philadelphia, Baltimore, Washington, Petersburg, and Norfolk, _The Philadelphia Medical and Physical Journal_, collected and arranged by _Benjamin Smith Barton_, professor of materia medica, natural history, and botany, in the University of Pennsylvania. Volume I. Price, in boards, 2 dollars. _A System of Surgery_. By _Benjamin Bell_, member of the Royal Colleges of Surgeons of Edinburgh and Ireland, &c. &c. 4 vols. 8vo. Price 14 dollars. _A Treatise on the Fevers of Jamaica_, with some Observations on the Intermitting Fever of America; and an Appendix, containing some Hints on the Means of Preserving the Health of Soldiers in Hot Climates. By _Robert Jackson_, M. D. * * * * * IN THE PRESS, _The Philadelphia Medical and Physical Journal._ Part I. Vol. II. * * * * * Transcriber's note: The original spelling and minor inconsistencies in the spelling and formatting have been maintained. Obvious misprints have been corrected. Partly repeated chapter headings have been deleted. 
46727	----	provided by the Internet Archive AN EPITOME OF THE HISTORY OF MEDICINE By Roswell Park, A.M., M.D. Professor of Surgery in the Medical Department of the University of Buffalo, etc. Based Upon A Course Of Lectures Delivered In The University Of Buffalo. Illustrated with Portraits and Other Engravings. 1897, The F. A. Davis Company. [Registered At Stationers' Hall. London, Eng.] "Destiny Reserves for us Repose Enough."--Fernel. TO MY COLLEAGUES IN THE MEDICAL FACULTY OF THE UNIVERSITY OF BUFFALO, Who Authorized and Encouraged this First Attempt in the Medical Schools of this Country to Give Systematic Instruction in the History or the Science which they Teach, THIS BOOK Is Dedicated. PREFACE. The history of medicine has been sadly neglected in our medical schools. The valuable and fruitful lessons which it tells of _what not to do_ have been completely disregarded, and in consequence the same gross errors have over and over been repeated. The following pages represent an effort to bring the most important facts and events comprised within such history into the compass of a medical curriculum, and, at the same time, to rehearse them in such manner that the book may be useful and acceptable to the interested layman.,--i.e., to popularize the subject. This effort first took form in a series of lectures given in the Medical Department of the University of Buffalo. The subject-matter of these lectures has been rearranged, enlarged, and edited, in order to make it more presentable for easy reading and reference. I have also tried, so far as I could in such brief space, to indicate the relationship which has ever existed between medicine, philosophy, natural science, theology, and even _belles-lettres_. Particularly is the history of medicine inseparable from a consideration of the various notions and beliefs that have at times shaken the very foundation of Christendom and the Church, and for reasons which appear throughout the book. The history of medicine is really a history of human error and of human discovery. During the past two thousand years it is hard to say which has prevailed. Notwithstanding, had it not been for the latter the total of the former would have been vastly greater. A large part of my effort has been devoted to considering the causes which conspired to prevent the more rapid development of our art. If among these the frowning or forbidding attitude of the Church figures most prominently, it must not be regarded as any expression of a quarrel with the Church of to-day. But let any one interested read President White's _History of the Warfare of Science with Theology_, the best presentation of the subject, and he can take no issue with my statements. Reverence for the true, the beautiful, and the good has characterized physicians in all times and climes. But little of the true, the beautiful, or the good crept into the transactions of the Church for many centuries, and we suffer, to-day, more from its interference in time past than from all other causes combined. The same may be said of theology, which is as separate from religion as darkness from light. Only when students of science emancipated themselves from the prejudices and superstitions of the theologians did medicine make more than barely perceptible progress. In this connection I would like to quote a paragraph from an article by King, in the _Nineteenth Century_ for 1893: "The difficulties under which medical science labored may be estimated from the fact that dissection was forbidden by the clergy of the Middle Ages on the ground that it was impious to mutilate a form made in the image of God. We do not find this pious objection interfering with such mutilation when effected by means of the rack and wheel and such other clerical, rather than medical, instruments." Written history is, to a certain extent at least, plagiarism; and I make no apology for having borrowed my facts from whatever source could best furnish them, but wish cheerfully and publicly to acknowledge my indebtedness to the works mentioned below, those especially of Renouard, Baas, and Sprengel, and to various biographical dictionaries. I have not even scrupled to take bodily sentences or expressions from these authorities, but have tried to so indicate them when I could. The writer takes pleasure in acknowledging here the obligations which both he and the publishers feel to Dr. Joseph H. Hunt, of Brooklyn, N. Y., from whose extensive and valuable collection have been furnished the originals for most of the portraits in the following pages, and to Dr. F. P. Henry, Honorary Librarian of the College of Physicians of Philadelphia, through whose courtesy was obtained the privilege of reproducing the illustrations of instruments and operations from some of the rare old works in the college library. The kind co-operation of these gentlemen has given a distinct and added value to the contents of this little work. LIST OF PRINCIPAL WORKS CONSULTED. Baas, Outlines of the History of Medicine. Translated by Henderson. New York, 1889. Berdoe, Origin and Growth of the Heeding Art. London, 1893. Bouchut, Histoire de la Médecine. Paris, 1873. Dezeimeris, Lettres sur VHistoire de la Médecine. Paris, 1838. Dietionnaire Historique de la Médecine. Paris, 1828. Haeser, Geschiehte der Medicin. Jena, 1853. Hirsch, Biographisehes Lexikon des Hervorragendeu der Aerzte aller Zeiten und Vülker. Wien und Leipzig, 1884. Portal, Histoire de VAnatomie et de la Chirurgie. Paris, 1770. South, Memorials of the Craft of Surgery in England. London, 1886. Sprexgel, Geschicute der Chirurgie. Halle, 1819. CONTENTS. CHAP I. Medicine Among the Hebrews, the Egyptians, the Orientals, the Chinese, and the Early Greeks.--The Asclepiadæ.--Further Arrangement into Periods (Renouard's Classification). The Age of Foundation.--The Primitive; Sacred, or Mystic; and Philosophic Periods.--Systems in Vogue: Dogmatism, Methodism, Empiricism, Eclecticism.--Hippocrates...................................... 1-29 CHAP II. AGE OF Foundation (continued).--Anatomic Period: Influence of the Alexandrian Library. Herophilus and Erasistratus. Aretæus. Cel-sus. Galen.--Empiricism: Asclepiades.--Methodism: Theinison.--Eclecticism. Age of Transition.--Greek Period: Oribasins. Ætius. Alexander of Tralles. Paulus Ægineta............ 30-56 CHAP III. Age of Transition (continued).--Arabic Period: Alkindus. Mesue. Rhazes. Haly-Abbas. Avicenna. Albucassis. Avenzoar. Averroës. Maimonides.--School of Salernum: Constantinus Africanus. Roger of Salerno. Roland of Parma. The Four Masters. John of Procida................................................. 57-85 CHAP IV Age of Transition ( concluded).--The School of Montpellier: Raimond Lulli. John of Gaddesden. Arnold of Villanova. Establishment of Various Universities. Gerard of Cremona. William of Salicet. Lanfranc. Mondino. Guy de Chauliac. Age of Renovation.--Erudite Period, including the Fifteenth and Sixteenth Centuries. Thomas Linacre. Sylvius. Vesalius. Columbus. Eustaclius. Fallopius. Fabricius ab Aquapendente. Fabricius Hildanus.. 86-113 CHAP V. Age of Renovation (continued).--Erudite Period (continued): Beni-vieni. Jean Fern el. Porta. Severino. Incorporation of Brother-hood of St. Come into the University of Paris. Ambroise Paré. Guillemeau. Influence of the Occult Sciences: Agrippa. Jerome Cardan. Paracelsus. Botal. Joubert...................... 114-147 CHAP VI. Age of Renovation (continued).--Stndent-life During the Fifteenth and Sixteenth Centuries. Ceremonials Previous to Dissection.--Reform Period: The Seventeenth, Eighteenth, and Nineteenth Centuries. Modern Realism in Medicine and Science. Introduction of the Cell-doctrine. Discovery of the Circulation. William Harvey. Malpighi. Leuwenhoek. Correct-Doctrine of Respiration. Discovery of the Lymphatic Circulation. The Nervous System. Discovery of Cinchona. Development in Obstetric Art, in Medical Jurisprudence, and in Oral Clinical Teaching. Van Helmont.--The Iatrochemical System: Le Bôe. Thomas Willis... 148-170 CHAP VII. Age of Renovation (continued).--latromechanical School: Santoro. Borelli. Sydenham. Sir Thomas Browne.--Surgery: Denis. F. Collot. Dionis. Baulot (Frère Jacques). Scultetus. Rau. Wiseman. Cowper. Sir C. Wren the Discoverer of Hypodermatic Medication. Anatomical Discoveries. General Condition of the Profession During the Seventeenth Century. The Eighteenth Century. Boerliaave. Gaub.--Animism: Stahl.--Jlechanico-dynamic System: Hoffmann. Cullen.--Old Vienna School: Van Swieten. De Haën.--Vitalism: Bordeu. Erasmus Darwin .................171-202 CHAP VIII. Age of Renovation (continued).--Animal Magnetism: Mesmer. Braid. --Brunonianism: John Brown.--Realism: Pinel. Bichat. Avenbrugger. Werlliof. Frank.--Surgery: Petit. Desault. Scarpa. Gimbernat. Heister. Von Siebold. Richter. Cheselden. Monro (1st). Pott. John Hunter. B. Bell, J. Bell, C. Bell. Smellie. Denman.--Revival of Experimental Study: Haller. Winslow. Portal. Yieq d'Azvr. Morgagni.--Inoculation against Smallpox: Lady Montagu. Edward Jenner............................. 203-221 CHAP IX. Age of Renovation (continued).--The Eighteenth Century; General Considerations. Foundation of Learned Societies, etc. The Royal College of Surgeons; the Josephinum.--The Nineteenth Century Realistie Reaction Against Previous Idealism. Influence of Comte, of Claude Bernard, and of Charles Darwin. Influence Exerted by Other Sciences.--Theory of Excitement: Roeschlaub.--Stimolo and Contrastimolo: Kasori.--Homoeopathy: Halineiaim.--Isopatly, Electrohomoeopathy of Mattei.--Cranioscopy, or Phrenology: Gall and Spurzlieim.--The Physiological Theory: Broussais.--Paris Pathological School: Cruveillier. Andral. Louis. Magendie. Trousseau. Claude Bernard.--British Medicine: Bell and Hall. Travel's.--Germany, School of Natural Philosophy: Johannes Müller.--School of Natural History: Schonlein.--New Vienna School: Rokitansky. Skoda.................................... 230-252 CHAP X. Age of Transition (concluded).--New Vienna School (concluded): von Hebra. Czermak and Türck. Juger. Arlt. Gruber. Politzer.--German School of Physiological Medicine: Roser.--School of Rational Medicine: Henle.--Pseudoparacelsism: Rademaeher.--Hydrotherapeutics: Priessnitz.--Modern Vitalism: Virchow.--Seminalism: Bouchut.--Parasitism and the Germ-theory: Davaine. Pasteur. Chauveau. Klebs. F. J. Cohn. Koch. Lister.--Advances in Physical Diagnosis: Laënnec. Piorry.--Surgery: Delpecli. Stro-meyer. Sims. Bozeman. McDowell. Boyer. Larrey. Dupuytren. Cloquet. Civiale. Vidal. Velpeau. Malgaigne. Nélaton. Sir Astley Cooper. Brodie. Guthrie. Syme. Simpson. Langenbeck. Billroth.................................................. 253-275 CHAP XI. History of Medicine in America.--The Colonial Physicians. Medical Study under Preceptors. Inoculation against Small-pox. Military Surgery During the Revolutionary War. Earliest Medical Teaching and Teachers in this Country. The First Medical Schools. Benjamin Rush. The First Medical Journals. Brief List of the Best-Known American Physicians and Surgeons.... 276-299 CHAP XII. The History of Anæsthesia.--Anæsthesia and Analgesia. Drugs Possessing Narcotic Properties in use since Prehistoric Times. Mandragora; Hemp; Hasheesh. Sulphuric Ether and the Men Concerned in its Introduction as an Anæsthetic--Long, Jackson, Wells, and Morton. Morton's First Public Demonstration of the Value of Ether. Morton Entitled to the Credit of its Introduction. Chloroform and Sir Janies Simpson. Cocaine and Karl Koller.............................................. 300-315 CHAP XIII. The History of Antisepsis.--Sepsis, Asepsis, and Antisepsis. The Germ-theory of Disease. Gay-Lussac's Researches. Schwann. Tyndall. Pasteur. Davaine. Lord Lister and his Epoch-making Revolution in Surgical Methods. Modifications of his Earlier Technique without Change in Underlying Principles, which Still Remain Unshaken. Changes Effected in Consequence. Comparison of Old and Modern Statistics........... 316-329 CHAP XIV. Ax Epitome of the History of Dentistry.--Rude Dentistry of Prehistoric Times. Early Instruments for Extraction Made of Lead. Dentistry on the Same Low Plane as Medicine During the First. Half of the Christian Era. Dentistry Taught at the School of Salernum. Progress of the Art on the Continent. Prosthesis and Substitutes for Human Teeth. Introduction of Porcelain for Artificial Teeth; of Metal and of Vulcanized Rubber for Plates; of Plaster for Impressions. From being a Trade, Dentistry is now a Profession, in which Americans lead the World. Statistics... 330-341 LIST OF ILLUSTRATIONS. 1. Æsculapius,..................................007 2. Offering to Æsculapius,......................009 3. Hippocrates,.................................019 4. Aulus Cornelius Celsus,......................035 5. The Conversion of Galen,.....................037 6. Averroës,....................................064 7. Andreas Vesalius,............................105 8. Title-page, Seven Books of the Anatomy,......106 9. IV, Forceps for Extracting Balls.............108 10. Gabriel Fallopius,..........................109 11. Forms of Forceps for Enlarging Wounds,......111 12. Body Showing Various Kinds of Wounds,.......117 13. Mode of Extracting Leaden Bullets,..........121 14. Ambroise Parc,..............................124 15. Pliers, Iron for Actual Cautery,............126 16. Swan's Beak, Used for Dilating..............129 17. Instruments for the Extraction of Balls,....131 18. Spéculums for the Mouth and Womb, etc.,.....133 19. Amputation Instruments,.....................135 20. Different Forms of Trephines and Pliers,....137 21. Philip Theophrastus Paracelsus,.............143 22. William Harvey, M.D.,.......................156 23. Thomas Sydenham,............................173 24. Straight Saws and Divers Scraping Tools,....179 25. Surgical Treatment of Dislocations,.........181 26. Operations on the Arms and Lower Limbs,.....185 27. Surgical Operations on the Breast, etc.,....187 28. Boerhaave,..................................193 29. John Brown, M.D.,...........................205 30. Ph. Pinel,..................................207 31. Marie François Xavier Bicliat, M.D.,........208 32. William Hunter, M.D., F.R.S.,...............217 33. John Hunter,................................219 34. J. F. Blumenbacli,..........................223 35. Edward Jenner, M.D.,........................227 36. Samuel Hahnemann,...........................242 37. Rudolph Virchow,............................257 38. Bernhard von Langenbeck,....................265 39. Theodor Billroth,...........................266 40. Sir Astley Cooper, Bart.,...................272 41. Sir Benjamin Collins Brodie, F.R.S.,........273 42. B. Waterhouse, M.D.,........................280 43. Surgeon's Hall,.............................281 44. Benjamin Rush, M.D.,........................284 45. George B. Wood, M.D.,.......................286 46. Robley Dunglison, M.D.,.....................287 47. Austin Flint, M.D.,.........................288 48. Isaac Ray, M.D.,............................289 49. Philip Sung Physick, M.D.,..................291 50. Ephraim McDowell, M.D.,.....................292 51. S. D. Gross, M.D., LL.D.,...................294 52. J. Marion Sims, M.D.,.......................296 53. D. Hayes Agnew, M.D., LL.D.,................297 54. William T. G. Morton, M.D.,.................307 55. Dr. Morton, October 16, 1846,...............309 56. Lord Lister, M.D., D.C.L., LL.D.,...........323 AN EPITOME OF THE HISTORY OF MEDICINE. CHAPTER I. _Medicine Among the Hebrews, the Egyptians, the Orientals, the Chinese, and the Early Greeks.--The Asclepiadæ.--Further Arrangement into Periods ( Renouard's Classification). The Age of Foundation.--The Primitive; Sacred, or Mystic; and Philosophic Periods.--Systems in Vogue: Dogmatism, Methodism, Empiricism, Eclecticism.--Hippocrates, born 460 B.C._ Of the{001} origin of medicine but little need be said by way of preface, save that it must have been nearly contemporaneous with the origin of civilization. The lower animals when sick or wounded instinctively lessen or alter their diet, seek seclusion and rest, and even in certain cases seek out some particular herb or healing substance. Thus, too, does the savage in his primitive state; and experience and superstition together have led nearly all the savage tribes into certain habits and forms in case of injury or disease. For us the history of medicine must necessarily begin with the written history of events, and its earliest endeavors need detain us but a very short time. Its earliest period is enveloped in profound obscurity, and so mingled with myth and table as to be very uncertain. It embraces an indefinite time, during which medicine was not a science, but an undigested collection of experimental notions,--vaguely described, disfigured by tradition, and often made inutile by superstition and ignorance. The earliest records of probable authenticity are perhaps to be met with in the Scriptures, from which may be gathered here and there a fair notion of Egyptian knowledge and practice. Thus we read that Joseph commanded his servants and physicians to embalm him, this being about 1700 B.C.. It shows that Egypt at that time possessed a class of men who practiced the{002} healing art, and that they also embalmed the dead, which must have both required and furnished a crude idea of general anatomy. We are also informed from other sources that so superstitious were the Egyptians that they not only scoffed at, but would stone, the embalmers, for whom they had sent, after the completion of their task. The probably mythical being whom the Egyptians called Thoth, whom the Greeks named Hermes and the Latins Mercury, passed among the Egyptians as the inventor of all sciences and arts. To him are attributed an enormous number of writings concerning all subjects. Some have considered him as identical with Bacchus, Zoroaster, Osiris, Isis, Serapis, Apollo, and even Shem, the son of Xoah. Others have thought him to be a god. It is now almost certain that the books attributed to Hermes were not the work of anyone hand or of any one age. The-last six volumes of the forty-two composing the encyclopaedia, with which Hermes is credited, refer to medicine, and embrace a body of doctrines fairly complete and well arranged. Of these six, the first treats of anatomy; the second, of diseases; the third, of instruments; the fourth, of remedies; the fifth, of diseases of the eye; and the sixth, of diseases of women. In completeness and arrangement it rivals, if not surpasses, the Hippocratic collection, which it antedated by perhaps a thousand years. The Egyptians appear at first to have exposed their sick in public (at least, so says Strabo), so that if any of those who passed by had been similarly attacked they might give their advice for the benefit of the sufferers. In fact, according to Herodotus, the same custom prevailed among the Babylonians and Lusitanians. At a later date all who were thus cured were required to go to the temples and there inscribe their symptoms and what had helped them. The temples of Canopus and Vulcan at Memphis became the principal depots for these records, which were kept as carefully as were the archives of the nation, and were open for{003} public reference. These records, being under the control of the priests, were mainly studied by them, who later collected a great mass of facts of more or less importance, and endeavored to found upon the knowledge thus collected an exclusive practice of the art of medicine. In this way they formed their medical code, which was called by Diodorus the Hiera Sacra, _Sacred Book_, from whose directions they were never allowed to swerve. It was perhaps this code which was later attributed to Hermes, and that made up the collection spoken of by Clement of Alexandria. If in following these rules they could not save their patients they were held blameless, but were punished with death if any departure from them were not followed by success. I have spoken of embalming as practiced by the Egyptians. It was of three grades: the first reserved for men of position and means, which cost one talent, and according to which the brain was removed by an opening through the nasal fossæ, and the intestines through an opening on the left side of the abdomen, after which both cavities were stuffed with spices and aromatics; then the body was washed and spread over with gum and wrapped in bandages of linen. The second grade was adopted by families of moderate means; and the third was resorted to by the poor, consisting simply in the washing of the body and maceration in lye for seventy days. Pliny assures us that the kings of Egypt permitted the opening of corpses for the purpose of discovering the causes of disease, but this was only permitted by the Ptolemies, under whose reign anatomy was carried to a very high degree of cultivation. The medicine of the Hebrews is known generally through the Sacred Scriptures, especially through the writings attributed to Moses, which embraced rules of the highest sagacity, especially in public hygiene. The book of Leviticus{004} is largely made up of rules concerning matters of public health. In the eleventh chapter, for instance, meat of the rabbit and the hog is proscribed, as apparently injurious in the climate of Egypt and India; it, however, has been suggested that there was such variation of names or interpretation thereof as to make it possible that our rabbit and hog are not the animals alluded to by Moses. The twelfth and fifteenth chapters of the same book were designed to regulate the relation of man and wife and the purification of women, their outlines being still observed in some localities by certain sects, while the hygienic measure of circumcision then insisted upon is still observed as a religious rite among the descendants of Moses. For the prevention of the spread of leprosy, the measures suggested by Moses could not now be surpassed, although ancient authors have confounded under this name divers affections, probably including syphilis, to which, however, the same hygienic rules should apply. Next to Moses in medical lore should be mentioned Solomon, to whom is attributed a very high degree of knowledge of natural history, and who, Josephus claimed, had such perfect knowledge of the properties of all the productions of nature that he availed himself of it to compound remedies extremely useful, some of which had even the virtues necessary to cast out devils. The most conspicuous feature in the life of the Indian races is their division into castes, of which the most noble is that of the priests, or Brahmins, who in ancient times alone had the privilege of practicing medicine. Their Organon of Medicine, or collection of medical knowledge, was a hook which they called _Vagadasastir_. It was not systematically arranged, and in it demonology played a large rôle. They held the human body to consist of 100,000 parts, of which 17,000 were vessels, each one of which was composed of seven tubes, giving passage to ten species of gases, which by their conflicts engendered a number of diseases.{005} They placed the origin of the pulse in a reservoir located behind the umbilicus. This was four fingers wide by two long, and divided into 72,000 canals, distributed to all parts of the body. The physician examined not only the pulse of his patient, but the dejecta, consulted the stars, the flight of birds, noted any incidental occurrence during his visits, and made up his prognosis from a multitude of varying circumstances, omitting only those which were really valuable, namely, the symptoms indicating the state of the organs. Ancient Hindoo charlatan priests let fall from the end of a straw a drop of oil into the patient's water. If the oil was precipitated and attached itself to the bottom of the vessel, they predicted an unfavorable result; if, on the contrary, it floated, they gave a favorable prognosis. This is, so far as we know, the earliest recorded way of testing the specific gravity of the urine. With all their absurdities, however, the Indians appear to have done some things that we scarcely do to-day: they arè said to have had an ointment that caused the cicatrices of variola to disappear, and they cured the bites of venomous serpents with remedies whose composition has been lost. The antiquity of the Chinese is simply lost in tradition and fable. From time immemorial their rulers have taken extraordinary care to prevent contact and interchange of ideas with foreigners. For 4000 years their manners, laws, religious beliefs, language, and territory have scarcely changed. In this respect they stand alone among the nations of the earth. They attribute the invention of medicine to one of their emperors named Hoam-ti, who was the third of the first dynasty, and whose supposititious date is 2687 B.C. He is considered to be the author of the work which still serves them as a medical guide. It is, however, more probably an apochryphal book. Its philosophy was of a sphygmic kind,--i.e., based upon the pulse, which they divided{006} into the supreme or celestial, the middle, and the inferior or terrestrial; by the examination of which the Chinese physician was supposed not only to show the seat of disease, but to judge of its duration and gravity. It is related that one of the ancient Chinese emperors directed the dead bodies of criminals to be opened, but this is questionable, since it is certain that they have the most profound ignorance of rudimentary anatomy, and glaring errors abound in their system. Being thus replete with errors, and possessing no anatomical knowledge, their surgery was of the most barbarous type. No one dared attempt a bloody operation; the reduction of hernia was unknown; a cataract was regarded as beyond their resources; and even venesection was never practiced. On the other hand, they employed cups, and acupuncture, fomentation, plasters of all kinds, lotions, and baths. The moxa, or red-hot button, was in constant use, and they had their magnetizers, who appear to have been convulsionists. For a long time there existed at Pekin an Imperial School of Medicine, but now there is no such organization nor any regulation for the privilege of practicing medicine or surgery since 1792. At least until lately the country and the cities were infested with quacks, who dealt out poison and death with impunity. They practiced most murderous methods in place of the principles of midwifery. Only since the civilized missionaries have penetrated into their country has there been any improvement in this condition of affairs. It is Greece which furnishes us with the most interesting and the most significant remains of the history of medicine during antiquity, as she furnishes every other art with the same historical advantages. During the period preceding the Trojan War there is little hut myth and tradition. Leclerc catalogued some thirty divinities, heroes or heroines, who were supposed to have invented or cultivated some of the branches of medicine. _Melampus_ is perhaps{007} the first of these who immortalized himself by extraordinary cures, especially on the daughters of Proetus, King of Argos. These young princesses, having taken vows of celibacy, became subjects of hysterical monomania, with delusions, during which they imagined themselves transformed into cows and roamed the forests instead of the palaces. This nervous delusion spread to and involved many other women, and became a serious matter. [Illustration: 0027] Melampus, the shepherd, having observed the purgative effects upon goats of white hellebore, gave to the young women milk in which this plant had been steeped, thereby speedily effecting a cure. Scarcely less distinguished than Melampus was _Chiron_. He was mainly distinguished because he was the preceptor of _Æsculapius_, the most eminent of early Greeks in this field. By some Æsculapius was considered the son of Apollo by the nymph Coronis. Several{008} cities of Greece contended for the honor of his birthplace, as they did for that of Homer. That he was famous at the time of the Argonautic expedition is seen by the fact that the twins Castor and Pollux desired him to accompany the expedition as surgeon. Be his origin what it may, Æsculapius was the leading character in medicine of all the ancients, with the possible exception of Hermes among the Egyptians; in fact, some scholars consider the two identical. Temples were erected in his honor, priests were consecrated to them, and schools of instruction were there established. It is related that Pluto, god of hell, alarmed at the diminishing number of his daily arrivals, complained to Jupiter, who destroyed the audacious healer--on which account, some wit has said, "the modern children of Æsculapius abstain from performing prodigies," But the true Æsculapians, the successors of the demigod, wrere imitated or copied by the crowd of charlatans and quacks, calling themselves theosophs, thaumaturgs, and so on, and not alone at that date, but for generations and centuries thereafter, Paracelsus and Mesmer being fair examples of this class. The poet Pindar, who lived seven or eight hundred years after Æsculapius, says that he cured ulcers, wounds, fever, and pain of all who applied to him by enchantment, potions, incisions, and by external applications. * * Third Pythian Ode, The followers of Æsculapius, and the priests in the temples dedicated to him, soon formed a separate caste, transmitting from one to another, as a family heritage, their medical knowledge. At first no one was admitted to practice the sacred science unless lie joined the priesthood, although later this secrecy was relaxed. They initiated strangers, provided they fulfilled the test which they made. Some kind of medical instruction was given in each temple. The three most celebrated temples to Æsculapius were that of Rhodes, already extinct by the time of Hippocrates; that{009} of Cnidus, which published a small repertory; and finally that of Cos, most celebrated of all, because of the illustrious men who emanated from this school. In these temples votive tablets were fastened in large numbers, after the fashion of the Egyptians, the same giving the name of the patient, his affliction, and the manner of his cure. For example, such a one as this: "Julien vomited blood, and appeared lost beyond recovery. The oracle ordered him to take the pine-seeds from the altar, which they had three days mingled with honey; he did so, and was cured." [Illustration: 0029] Having solemnly thanked the god, he went away. There is reason to think that the priests of these temples made for their own uses much more minute and accurate accounts, which should be of some real service, since the writings which have come down to us evince a habit of close observation and clear description of disease. During the Trojan War{010} two men are frequently mentioned by Homer as possessing great surgical skill. These were _Machaon_ and _Podalirius_. They were regarded as sons of Æsculapius, the former being the elder. The first account of venesection, although not authentic, refers to the bleeding practiced by the latter upon the daughter of the King of Caria, upon whose shores Podalirius was cast by tempest after the ruin of Priam's kingdom. Whether he was the first of all men to practice it or not, it is certain that the act of venesection goes back long prior to the era of Hippocrates, who speaks of it as frequently performed. Many of the deities upon Olympus seem at one time or another to have usurped medical functions. Apollo, the reputed father of Æsculapius, appropriated nearly everything under the name of Pæon, who assumed the privilege of exciting or subduing epidemics. Juno was supposed to preside at accouchements, and in both the Iliad and Odyssey it is indicated that Apollo was considered as the cause of all the natural deaths among men, and Diana of those among women. The long Trojan War appears to have been an epoch-making event in the medical and surgical history of those times, as was the Civil War recently in our country. Certain vague and indefinite practices then took more fixed form, and from that time on medicine may be said to have been furnished with a history. After the dethronement of Priam and the destruction of his capital, navigation was free and unrestricted. The Hellenists covered with their colonies both shores of the Mediterranean, and their navigators even passed the pillars of Hercules. By these means the worship of Æsculapius passed from Greece into what is now Asia, Africa, and Italy. In his temple at Epidaurus was a statue of colossal size made of gold and ivory. The dialogues of Plato, especially the Phædo, make it apparent that the cock was the animal sacrificed to him, and hence sacred to the god of medicine. The priests attached to{011} his worship were called _Asclepiacloe_, or descendants of Æsculapius. The temples were usually hygienically located near thermal springs or fountains and among groves. Pilgrimages were made from all quarters, and these localities became veritable health-resorts. A well-regulated dietary, pure air, temperate habits, and faith stimulated to a fanatical degree combined and sufficed for cures which even nowadays would be regarded as wonderful. The priests prescribed venesection, purgatives, emetics, friction, sea-baths, and mineral waters, as they appeared to be indicated. The imagination of the patient was continually stimulated, and at the same time controlled. Before interrogating the oracles they must be purified by abstinence, prayer, and sacrifice. Sometimes they were obliged to lie in the temple for one or more nights. The gods sometimes revealed themselves in mysterious ways, at times devouring the cakes upon the altars under the guise of a serpent, or again causing dreams which were to be interpreted by^the priests. There can be no doubt that sometimes, at least, the grossest frauds and the basest trickery were relied upon for the purpose of impressing the minds of those weakened by abstinence or influenced by drugs. Mercenary considerations were not lacking; moreover, cures were often not obtained until zeal had been redoubled by largely increased contributions to the treasury of the temples. In the neighborhood of many of these temples serpents abounded, non-venomous and easily tamed. These were employed by the priests in various supernatural performances by which the ignorant people were astonished and profoundly impressed. In fact, the serpent and the serpent-myth played a very large rôle in the early history of medicine as well as that of religion and religious symbolism. It will thus be seen that during the space of about 700 years medicine underwent a transformation in Greece. It was first domestic and popular, practiced by shepherds, soldiers,{012} and others; then became sacerdotal; after the Trojan War it was confined to the vicinity of the temples and practiced in the name of some divinity; and finally it was wrapped in mystery and mystic symbolism, where superstition was played upon and credulity made to pay its reward. Down to the time of Hippocrates the Asclep-iadæ rendered some genuine service to science, especially by inculcating habits of observation, in which Hippocrates excelled above all. Later, however, down to the time of the Christian era, medicine in the temples declined, and became, in fact, a system based upon the grossest jugglery. It is time now that we make a systematic attempt to classify events in the history of medicine, and to recognize certain distinct epochs as they have occurred. For this purpose I know of no better arrangement than that of Renouard, which, in the main, I shall follow, at least during the forepart of this book. In this sense he divides the past into three ages, known, respectively, as the _Age of Foundation, the Age of Transition, and the Age of Renovation_. Each of these chronological divisions is subdivided into periods, of which the first contains four:-- AGE OF FOUNDATION. 1. The _Primitive Period_, or that of _Instinct_, beginning with myth, and ending with the destruction of Troy 1184 years before Christ. 2. The _Sacred, or Mystic, Period_, ending with the dispersion of the Pythagorean Society, 500 years before Christ. 3. The _Philosophic Period_, terminating with the foundation of the Alexandrian library, 320 years before Christ. 4. The _Anatomic Period_, ending with the death of Galen, about A.D. 200. THE SECOND AGE, OR THAT OF TRANSITION, is divided into a fifth, or _Greek Period_, ending at the burning of the Alexandrian library, A.D. 640, and a sixth, _Arabic Period_, ending with the revival of letters, A.D. 1400. THE THIRD AGE, OR THAT OF RENOVATION,{013} includes the seventh, or _Erudite Period_, comprising the fifteenth and sixteenth centuries, and eighth, or _Reform Period_, comprising the seventeenth, eighteenth, and nineteenth centuries. Examining this table for a moment, it will be seen that so far we have dealt with the Primitive Period and the Sacred, or Mystic, Period. Before passing on to the Philosophic Period let us for a moment follow Renouard, who likens the three schools of medical belief in the earlier part of the Primary Age, or the Age of Foundation, to the three schools of cosmogony, which obtained among the Greeks. The first of these was headed by Pythagoras, who regarded the universe as inhabited by acknowledged sentient principles which governed all substances in a determined way for preconceived purposes. Animals, plants, and even minerals were supposed to possess vivifying spirits, and above them all was a supreme principle. To this school corresponded the so-called Dogmatic School of medicine, attributed to Hippocrates, which was the precursor of modern vitalism, and regarded diseases as indivisible units from beginning to termination; in other words, they consisted of a regular programme of characteristic systems, successive periods, and of long course, either for the better or worse; that was one of the characteristic dogmas of the Hippocratic teaching. The Second System of cosmogony was that founded by Leucippus and Democritus, who explained all natural phenomena without recourse to the intervention of intelligent principles. All things for them existed as the necessary result of the eternal laws of matter. They denied preconceived purposes and ridiculed final causes. To this system corresponded that in medicine which has been termed _Methodism_ (medically and literally speaking) and which recognized as its founders Æsculapius and Themison. The believers in this doctrine attempted to apply the atomic theory of Democritus and{014} Epicurus to the theory and practice of medicine. Atoms of various size were supposed to pass and repass without cessation through cavities or pores in the human body. So long as the atoms and pores maintained a normal relationship of size and proportion health was maintained, but it was deranged so soon as the exactness of these relations was destroyed or interfered with. The Dogmatists considered vital reaction as a primary phenomenon, while with the Methodists it was secondary. The Third System of cosmogony, founded by Parmenides and Pyrrho, believed in the natural improvement of bodies in their endless reproduction and change, and concluded that wisdom consisted in remaining in doubt; in other words, they were the agnostics of that day. "What is the use," said they, "of fatiguing the mind in endeavoring to comprehend what is beyond its capability." Later they were known as Skeptics and Zetetics, to indicate that they were always in search of truth without flattering them selves that they had found it. To them corresponded a third class of physicians, with Philinus and Serapis at their head, who deemed that proximate causes and primitive phenomena of disease were inaccessible to observation; that all that is affirmed on these subjects is purely hypothetical, and hence unworthy of consideration in choosing treatment. For them objective symptoms--or, as we would say, signs--constituted the natural history of disease, they thus believing that their remedies could only be suggested by experience, since nothing else could reveal itself to them. They therefore took the name of _Empirics_. Finally a fourth class of physicians arose who would not adopt any one of these systems exclusively, but chose from each what seemed to them most reasonable and satisfactory. They called themselves _Eclectics_, wishing thereby to imply that they made rational choice of what seemed best. The idea conveyed in the term "eclecticism" has been fairly criticised for this reason: eclecticism is in reality neither{015} a system nor a theory; it is individual pretension elevated to the dignity of dogma. The true eclectic recognizes no other rule than his particular taste, reason, or fancy, and two or more eclectics have little or nothing in common. If that were true two thousand years ago, it is not much less so to-day. The eclectic carefully avoids the discussion of principles, and has neither taste nor capacity for abstract reasoning, although he may be a good practitioner; not that he has no ideas, but that his ideas form no working system. With him medical tact--i.e., cultivated instinct--replaces principle. The eclectic of our day, however, is only an empiric in disguise,--that is, a man whose opinions are based on comparison of observed facts, but whose theoretical ideas do not go beyond phenomena. In older days philosophy embraced the whole of human knowledge, and the philosopher was not permitted to be unacquainted with any of its branches. Now physics, metaphysics, natural history, etc., are arranged into separate sciences, and the sum-total of knowledge is too great to be compassed by any one man. Pythagoras was the last of the Greek sages who made use of hieroglyphic writings and transmitted his doctrine in ancient language. Born at Samos, he was, first of all, an athlete; but one day, hearing a lecture no immortality of the soul, he was thereby so strongly attracted to philosophy that he renounced all other occupation to devote himself to it. He studied arduously in Egypt, in Phoenicia, in Chaldea, and even, it is said, in India, where he was initiated into the secrets of the Brahmins and Magi. Finally, returning to his own country, he was received by the tyrant Polycrates, but not made to feel at home. Starting on his travels again, he assisted at one of the Olympic games, and, being recognized, was warmly greeted. He sailed to the south of Italy, landed at Crotona, and lodged with Milo, the athlete. Commencing here{016} his lectures, he soon gathered around him a great number of disciples, of whom he required a very severe novitiate, lasting even five or six years, during which they had to abstain almost entirely from conversation, and live upon a very frugal diet. Those only who persevered were initiated later into the mysteries of the order. His disciples had for him most profound veneration, and were accustomed to decide all disputes witlr: "The master has said it." Pythagoras possessed immense knowledge; he invented the theorem of the square of the hypothenuse, and he first divided the year into 365 days and 6 hours. He seems to have suspected the movements of our planetary system. He traveled from place to place, and founded schools and communities wherever he went, which exercised, at least at first, only the happiest influence; but the success and influence which their learning gave them later made his disciples bold, and then dishonest, and his communities were finally dispersed by angry mobs, which forced their members to conceal or expatriate themselves; and so, even during the life-time of its founder, the Pythagorean Society was destroyed, and never reconstructed. With Pythagoras and his disciples numbers played a very important rôle, and the so-called language of numbers was first taught by him. He considered the unit as the essential principle of all things, and designated God by the figure 1 and matter by the figure 2, and then he expressed the universe by 12, as representing the juxtaposition of 1 and 2. As 12 results from multiplying 3 by 4, he conceived the universe as composed of three distinct worlds, each of which was developed in four concentric spheres, and these spheres corresponded to the primitive elements of fire, air, earth, and water. The application of the number 12 to express the universe Pythagoras had received from the Chaldeans and Egyptians--it being the origin of the institution of the zodiac. Although this is digressing, it serves to show what enormous importance the people of that{017} time attached to numbers, especially to the ternary and quarternary periods in the determination of critical days in illness. Pythagoras was the founder of a philosophic system of great grandeur, beauty, and, in one sense, completion, embracing, as it does, and uniting by common bounds God, the universe, time, and eternity; furnishing an explanation of all natural phenomena, which, if not true, was at that time acceptable, and which appears in strong and favorable contrast as against the mythological systems of pagan priests. No wonder that it captivated the imagination and understanding of the thinking young men of that day. Had they continued in the original purity of life and thought in which he indoctrinated them there is no knowing how long the Pythagorean school might have continued. But after it had been dissolved by the storm of persecution, its members were scattered all over Greece and even beyond. Now no longer held by any bonds, many of them revealed the secrets of their doctrine, to which circumstance we owe the little knowledge thereof we now possess. The Pythagoreans apparently first introduced the custom of visiting patients in their own homes, and they went from city to city and house to house in performance of this duty. On this account they were called Periodic or Ambulant physicians, in opposition to the Asclepiadæ, who prescribed only in the temples. Empedocles, of Agrigentum, well known in the history of philosophy, was perhaps the most famous of these physicians. Let the following incident witness his sagacity: Pestilential fevers periodically ravaged his native city. He observed that their appearance coincided with the return of the sirocco, which blows in Sicily on its western side. He therefore advised to close by a wall, as by a dam, the narrow gorge from which this wind blew upon Agrigentum. His advice was followed and his city was made free from the pestilence. Again, the inhabitants of Selinus were ravaged by epidemic{018} disease. A sluggish stream filled the city with stagnant water from which mephitic vapors arose. Empedocles caused two small rivulets to be conducted into it, which made its current more rapid; the noxious vapors dispersed and the scourge subsided. _The Gymnasia_.--Before we proceed to a somewhat more detailed, but brief, account of Hippocrates, it is necessary to say a word or two of the ancient gymnasia of Greece, which were used long before the Asclepiadæ had practiced or begun to teach. In these gymnasia were three orders of physicians: first, the director, called the Gym-nasiarch; second, the subdirector, or Gymnast, who directed the pharmaceutical treatment of the sick; and, lastly, the Iatroliptes, who put up prescriptions, anointed, bled, gave massage, dressed wounds and ulcers, reduced dislocations, treated abscesses, etc. Of the gymnasiarclis wonderful stories are told evincing their sagacity, which, though somewhat fabulous, indicate the possession of a very high degree of skill of a certain kind. Of one of the most celebrated of these, Herodicus, we may recall Plato's accusation, who reprimanded him severely for succeeding too well in prolonging the lives of the aged. Whatever else may be said, we must acknowledge that above all others the Greeks recognized the value of physical culture in the prevention of infirmity, and of all physical methods in the treatment of disease. By their wise enactments with reference to these matters they set an example which modern legislators have rarely, if ever, been wise enough to follow,--an example of compulsory physical training for the young,--and thereby built up a nation of athletes and a people of rugged constitution among whom disease was almost unknown. I come now to the so-called _Philosophic Period_, or the third period in the Age of Foundation, which is inseparably connected with the name of _Hippocrates_. This central figure in the history of ancient medicine was born on the Island{019} of Cos, of a family in which the practice of medicine was hereditary, who traced their ancestors on the male side to Æsculapius, and on the female side to Hercules. The individual to whom every one refers under this name was the second of seven; the date of his birth goes back to 460 B.C., but of his life and his age at death we do not know; some say he lived to be over one hundred years of age. It is certain that he traveled widely, since his writings evince the knowledge thus gained. He was a contemporary of Socrates, although somewhat younger, and lived in the age of Pericles,--the golden age for science and art in Greece. [Illustration: 0039] The Island of Cos is now called Stan-Co, and is situated not far from the coast of Ionia. Formerly it was considered as having a most salubrious climate; now that it is under the dominion of the Turks, it is considered most unhealthy. It possessed a temple dedicated to Æsculapius and{020} a celebrated medical school. But Hippocrates, not satisfied with what he could learn here, visited the principal foreign cities, and seems to have been a most accurate and painstaking observer and collector of notes. That he achieved great renown in his life is known, since Plato and even Aristotle refer to him as their authority in very many matters. His children and grandchildren followed in his footsteps, and published their writings under the same name; it has, therefore, become difficult to distinguish his works from theirs. Finally, authors more unscrupulous, who bore no relationship to him, attached his name to their own writings. But the true were, as a rule, easily distinguished from the spurious, and were carefully separated by those in charge of the Alexandrian library. The enumeration of his writings by different authors varies very much. Renouard, who seems to have studied the subject very carefully, gives the following as appearing to him to be the authentic list of writings of Hippocrates the Second,--i.e., the Great: The _Prognostic_, the _Aphorisms_, the first and third books of _Epidemics_, that on _Regimen in Acute Disease_, that on _Airs, Waters, and Places, that on Articulations and Luxations_, that on _Fractures_, and the _Mochlic_, or the treatise on instruments and reduction. This list does not comprise the fourth part of the entire Hippocratic collection, but its authenticity appears to be undoubted, and it suffices, as Renouard says, to justify the enthusiasm of his contemporaries and the admiration of posterity. Later, joined with the writings of Pythagoras, Plato, Aristotle, and others, they constituted the so-called _Hippocratic collection_, which was a definite part of the great libraries of Alexandria and Pergamos, and formed the most ancient authentic monument of medical science. Respect for the bodies of the dead was a religious observance in all Greece, and prevented the dissection of the human body. Consequently the knowledge of anatomy possessed by Hippocrates must have been meagre. Nevertheless,{021} he described lesions, like wounds of the head, of the heart, the glands, the nature of bones, etc. It being impossible to establish a physiology without an anatomical basis, it is not strange that we find but little physiology in the Hippocratic writings, and that this little is very crude and incorrect. Arteries and veins were confounded, and nerves, tendons, ligaments, and membranes were represented as analogous or interchangeable tissues. The physiologists of those days abandoned themselves to transcendental speculation concerning the nature and principles of life, which some placed in moisture, others in fire, etc. Speculation, thus run wild, prevented such accurate observation as might have greatly enhanced the progress of physiological knowledge. Hippocrates wrote at least three treatises concerning hygiene: The first, on _Airs, Waters, and Places_; the second, on _Regimen_; the third, on _Salubrious Diet_,--practically an abridgement of the preceding, in which he recommends the habit of taking one or two vomits systematically every month. The classification of diseases into internal or medical, and external or surgical, is not modern, but is due to Hippocrates; neither is it philosophic, although it is very convenient. With so little knowledge of physiology and pathology as the ancients had, it is not strange that they ascribed undue importance to external appearance; in other words, to what has been termed _semeiotics_, which occupies a very considerable place in the medical treatises of the Asclep-iadæ. Indeed, the writings on this subject constitute more than one-eighth part of the entire Hippocratic collection. To prognosis, also, Hippocrates ascribed very great importance, saying that "The best physician is the one who is able to establish a prognosis, penetrating and exposing first of all, at the bedside, the present, the past, and the future of his patients, and adding what they omit in their statements. He gains their confidence, and being convinced{022} of his superiority of knowledge they do not hesitate to commit themselves entirely into his hands. He can treat, also, so much better their present condition in proportion as he shall be able from it to foresee the future," etc. To the careful scrutiny of facial appearances, the position, and other body-marks about the patient he attributed very great importance; in fact, so positive was he about these matters that he embodied the principal rules of semeiotics into aphorisms, to which, however, there came later so many exceptions that they lost much of their value. From certain passages in his book on _Prediction_, and from the book on _Treatment_, which is a part of the Hippocratic collection, it appears that it was the custom then of physicians to announce the probable issue of the disease upon the first or second visit,--a custom which still prevails in China and in Turkey, It gave the medical man the dignity of an oracle when right, but left him in a very awkward position when wrong. To Hippocrates we are indebted for the classification of sporadic, epidemic, and endemic forms, as well as for the division of disease into acute and chronic. Hippocrates wrote extensively on internal disease, including some particular forms of it, such as epilepsy, which was called the sacred disease; also fragments on diseases of girls, relating particularly to hysteria; also a book on the nature of woman, an extensive treatise on diseases of women, and a monograph on sterility. That Hippocrates was a remarkably close observer of disease as it appeared to him his books amply prove; in fact, they almost make one think that close observation is one of the lost arts, being only open to the objection that too much weight was attached to insignificant external appearances, speculation on which detracted from consideration of the serious feature of the case. His therapeutics, considering the crude information of the time, was a vast improvement on that which had preceded,{023} and really entitled him to his title of "Great Physician." Of external diseases and their surgical therapeutics he wrote fully: on _The Laboratory of the Surgeon_, dealing with dressings, bandaging, and operating; on _Fractures_; and on _Articulations and Dislocations_; showing much more anatomical knowledge than was possessed by his contemporaries. The _Mochlic_ was an abridgment of former treatises; in _Wounds of the Head_ he formulated the dictum concerning the possible danger of trifling wounds and the possible recovery from those most serious, so often ascribed to Sir Astlev Cooper. Other monographs, also, he wrote, on _Diseases of the Eye_, on _Fistula_, and on _Hoemorrhoids_. He described only a small number of operations, however, and all the Hippocratic writings on surgery would make but a very incomplete treatise as compared with those that belong to the next historical epoch; all of which we have to ascribe--in the main--to prejudice against dissection and ignorance of anatomy. From the earliest times physicians and writers occupied themselves largely with obstetrics, as was most natural. The Hippocratic collection includes monographs on _Generation; the Nature of the Infant; the Seventh Month of Pregnancy; the Eighth Month of Pregnancy; on Accouchement; Superfoetation; on Dentition; on Diseases of Women; on Extraction of the Dead Foetus_. The treatise on superfcetation concerned itself mainly with obstetrics. On epidemics Hippocrates writes extensively, showing that he had studied them carefully. He was among the first to connect meteorological phenomena with those of disease during given seasons of the year, expressing the hope that by the study of storms it would be possible to foresee the advent of the latter, and prepare for them. Seven books of the Hippocratic collection bear the title of _Epidemics_, although only two of them are exclusively devoted to this subject. In these books were contained a long{024} list of clinical observations relating to various diseases. They constituted really a clinical study of disease. The collection of Hippocrates's _Aphorisms_ fills seven of the books; no medical work of antiquity can compare with these. Physicians and philosophers of many centuries have professed for them the same veneration as the Pythagoreans manifested for their golden verses. They were considered the crowning glory of the collection. Even within a short time past the Faculty of Paris required aspirants for the medical degree to insert a certain number of these in their theses, and only the political revolution of France served to cause a discontinuance of this custom. These aphorisms formed, says Littré, "a succession of propositions in juxtaposition, but not united." It has always been and always will be disadvantageous for a work to be written in that style, since such aphorisms lose all their general significance; and that which seems isolated in itself becomes more so when introduced into modern science, with which it has but little practical relationship. But not so if the mind conceive of the ideas which prevailed when these aphorisms were written; in this light, when they seem most disjoined they are most related to a common doctrine by which they are united, and in this view they no longer appear as detached sentences. The school of the Asclepiadæ has been responsible for certain theories which have been more or less prominent during the earlier historical days. One of these which prevailed throughout the Hippocratic works is that of _Coction and Crisis_. By the former term is meant thickening or elaboration of the humors in the body, which was supposed to be necessary for their elimination in some tangible form. Disease was regarded as an association of phenomena resulting from efforts made by the conservative principles of life to effect a coction,--i.e., a combination of the morbific matter in the economy, it being held that the latter could not be properly expelled until thus united and prepared{025} so as to form excrementitious material. This elaboration was supposed to be brought about by the vital principles, which some called nature (_Physis_), some spirit (_Psyche_), some breath (_Pneuma_), and some heat (_Thermon_). The gradual climax of morbid phenomena has, since the days of Hippocrates, been commonly known as _Crisis_; it was regarded as the announcement of the completion of the union by coction. The day on which it was accomplished was termed _critical_, as were also the signs which preceded or accompanied it, and for the crisis the physician anxiously watched. Coction having been effected and crisis occurring, it only remained to evacuate the morbific material--which nature sometimes spontaneously accomplished by the critical sweat, urination, or stools, or sometimes the physician had to come to her relief by the administration of diuretics, purgatives, etc. The term "critical period" was given to the number of days necessary for coction, which in its perfection was supposed to be four, the so-called quarternary, while the septenary was also held in high consideration. Combination of figures after the Pythagorean fashion produced many complicated periods, however, and so periods of 34, 40, and 60 days were common. This doctrine of crisis in disease left an impress upon the medical mind not yet fully eliminated. Celsus was the most illustrious of its adherents, but it can be recognized plainly in the teachings of Galen, Sydenham, Stahl, Van Swieten, and many others. In explanation, it must be said that there have always existed diseases of nearly constant periods, these being nearly all of the infectious form, and that the whole "critical" doctrine is founded upon the recognition of this natural phenomenon. The Hippocratic books are full, also, of the four elements,--earth, water, air, and fire; four elementary qualities,--namely, heat, cold, dryness, and moisture; and the four cardinal humors,--blood, bile, atrabile, and phlegm. Owing{026} to the poverty of knowledge of physics and chemistry possessed by the ancients, and notwithstanding their errors and imperfections, the doctrine of Dogmatism, founded upon the theory of coction and humors, was the most intelligible and complete among the medical doctrines of antiquity, responding better, as it did, to the demands of the science of that day. That Hippocrates was a profound observer is shown in this: that he reminds both philosophers and physicians that the nature of man cannot be well known without the aid of medical observation, and that nothing should be affirmed concerning that nature until by our senses we have become certain of it. In this maxim he took position opposed to the Pythagorean doctrine, and included therein the germ of a new philosophy of which Plato misconceived, and of which Aristotle had a very faint glimpse. Another prominent theory throughout the Hippocratic books is that of Fluxions, meaning thereby about what we would call congestions, or conditions which we would say were ordinarily caused by cold, though certain fluxions were supposed to be caused by heat, because the tissues thereby became rarefied, their pores enlarged, and their humor attenuated so that it flowed easily when compressed. The whole theorv of fluxion was founded on the densest ignorance of tissues and the laws of physics, the body of man being sometimes likened to a sponge and sometimes to a sieve. The treatment recommended was almost as crazy as the theory. Certain other theories have complicated or disfigured the Hippocratic writings, and certain have been founded on the consideration of two elements--i.e., fire and earth--or on the consideration of one single element which was supposed to be air,--the breath, or _pneuma_; and there was--lastly--the theory of any _excedent_, which is very vague; of all of these we may say that they are not of sufficient interest to demand expenditure of our time. The eclat{027} which the second (i.e., the Great) Hippocrates gave to the school of Asclepiadæ in the Island of Cos long survived, and many members of his family followed in his footsteps. Among his most prominent successors were _Polybius, Diodes, and Praxagoras_, also of Cos,--the last of the Asclepiadæ mentioned in history. Praxagoras was distinguished principally for his anatomical knowledge; like Aristotle, he supposed that the veins originated from the heart, but did not confound these vessels with the arteries, as his predecessors had done, but supposed that they contained only air, or the vital spirit. It has been claimed that he dissected the human body. He laid the foundation of sphygmology, or study of the pulse, since Hippocratic writers rarely alluded to arterial pulsations and described them as of only secondary importance. The predominating theory in the Island of Cos was that which made health dependent on the exact proportion and play of the elements of the body, and on perfect combination of the four cardinal humors. This was the prevailing doctrine,--i.e., the Ancient Medical Dogmatism, so named because it embraced the most profound dogmas in medicine, and was taught exclusively until the foundation of the school at Alexandria. Two men, however, more commonly ranked among philosophers than among physicians of antiquity, dissected the statements of Hippocrates, and embodied them more or less in their own teachings, and thus exercised a great influence on the progress of the human mind, particularly in the direction of medical study. The first of these was Plato, profound moralist, eloquent writer, and most versatile thinker of his day or any other. He undertook the study of disease, not by observation (the empirical or experimental method), but by pure intuition. He seemed to have never discovered that his meditations were taken in the wrong direction, and that the method did not conduce to the discovery of abstract truths. He gave beauty an abstract{028} existence, and affirmed that all things beautiful are beautiful because of the presence of beauty. This reminds one of that famous response in the school of the Middle Ages to a question: "Why does opium produce sleep?" the answer being: "Because it possesses the sleepy principle." Plato introduced into natural science a doctrine of final causes. He borrowed from Pythagoras the dogma of homogeneity of matter, and claimed that it had a triangular form. _Aristotle_, equally great thinker with Plato, but whose mental activity was manifest in other channels, was born in Stagyrus, in Macedonia. He was fascinated by the teachings of Plato, and attained such eminence as a student that King Philip of Macedon made him preceptor to his son Alexander, subsequently the Great, by whom he was later furnished with sufficient funds to form the first known museum in natural history.--a collection of rare objects of every sort, transmitted, many of them, by the royal hands of his former student from the remote depths of Asia. Aristotle, by long odds the greatest naturalist of antiquity, laid the first philosophic basis for empiricism. He admitted four elements--fire, air, earth, and water--and believed them susceptible of mutual transmutation. He studied the nature of the soul and that of the animal body; regarded heat and moisture as two conditions indispensable to life; described the brain with some accuracy, but without the least idea of its true function; said that the nerves proceeded from the heart; termed the aorta a nervous vein; and made various other mistakes which to us seem inexcusable. Nevertheless, he was rich in many merits, and no one of his age studied or searched more things than he, nor introduced so many new facts. Although he never dissected human bodies, he nevertheless corrected errors in anatomy held to by the Hippocratic school. He dissected a large number of animals of every species, and noted the varieties of size and shape of hearts of various animals and birds. In{029} other words, he created a comparative anatomy and physiology, and the plan that he traced was so complete that two thousand years later the great French naturalist Cuvier followed it quite closely. If he be charged with having propagated a taste for scholastic subtleties, he also furnished an example of patient and attentive observation of Nature. His history of animals is a storehouse of knowledge, and his disciples cultivated with zeal anatomy, physiology, and natural history. His successor, Theophrastus, was the most eminent botanist of antiquity. It will thus be seen that Plato and Aristotle were the eminent propagators of two antagonistic opinions. One supposed knowledge to be derived by mental intuition, and the other that all ideas are due to sensation. Both count among moderns some partisans of the greatest acumen: Descartes, Leibnitz, and Kant being followers of Plato, and Bacon, Locke, Hume, and Condillac, of Aristotle. The excuse for stating these things, which apparently do not so closely concern the history of medicine, must be that of the learned interpreter of the doctrine of Cuvier, that "The first question in science is always a question of method." Hippocrates formed a transition between a period of mythology and that of history. His doctrine was received by contemporaries and by posterity with a veneration akin to worship. No other man ever obtained homage so elevated, constant, and universal. A little later ignorance reigned in the school that he made celebrated. Methods and theories were propagated there under the shadow of his name which he would have disowned. Medical science now changes its habitation as well as its aspect, and from the record of Hippocrates and his work we turn to the fourth period of the Age of Foundation,--namely, the _Anatomic_, which extends from the foundation of the Alexandrian library, 320 B.C., up to the death of Galen, about the year A.D. 200. CHAPTER II. _Age of Foundation (continued).--Anatomic Period: Influence of the Alexandrian Library. Herophilus and Erasistratus. Aretæus, f B.C. 170. Celsus, A.D. 1-65 (?). Galen.--Empiricism: Asclepiades B.C. 100 (?).--Methodism: Theinison, B.C. 50 (?).--Eclecticism. Age of Transition, A.D. 201-1400.--Greek Period: Oribasius, 326-403. Ætius, 502-575. Alexander of Tralles, 525-605. Paul us Ægineta, 625-690._ Fourth, or Anatomic,{030} Period.--As already seen, Alexander the Great and his successors collected the intellectual and natural riches of the universe, as they knew them, and placed them at the disposal of studious men to benefit humanity; their complete value has not yet been exhausted, and never can be. This undertaking was carried out under conditions that made it one of extreme difficulty. Manuscripts were then rare and most costly; but few copies of a given work were in existence, often only one, and these were held almost priceless. Under these circumstances the establishment of a public library and of a museum was an act of philanthropy and liberality simply beyond eulogy, and did more to immortalize the founder of the collection than all his victories and other achievements. This appears to have also occurred to two of Alexander's lieutenants--one Eumenes, Governor of Pergamos, and the other, Ptolemy, Governor of Egypt. After the death of the conqueror his generals shook of all dependence upon the central government, and endeavored to centralize their own authority. But these two were the only ones among so many leaders who did not devote all their attention to armies and invasion, but interested themselves in commerce and arts. So active were they in the enterprise that Eumenes had gathered two hundred thousand volumes for the library at Pergamos, and Ptolemy six to seven hundred thousand for that of Alexandria. The latter was divided{031} into two parts, the greater and the lesser, the latter of which was kept in the temple of Serapis, hence known as the _Serapium_. These notable efforts to found enormous collections first excited praiseworthy rivalry among contemporaries and rulers, which, however, degenerated into contemptible jealousy, so that some of the rulers of Alexandria even went so far as to interdict the exportation of papyrus, in order to prevent the making of copies for the library of Pergamos. But the effect was unexpected, since it led to the invention of the paper of Pergamos, otherwise called parchment, which completely displaced the bark from which papyri were made. Be this as it was, the collection at Alexandria had a much more marked influence on the medical study of the future than that of Pergamos, and calls for our particular notice. About it sprang up first a collection of learned men, and then the inevitable result--a school of learning. It was Ptolemy Soter who called around him the most renowned men of his day. He provided them with homes adjoining the library, endowed them with salaries, and charged them with the classification and collation of manuscripts, or with the giving of instruction by lectures and discussions. Ptolemy himself sometimes took part in these feasts of reason, which became still more frequent and formal under his son Ptolemy Philadelphia. These were called the Feasts of the Muses and of Apollo,--_i.e., ludi musarum_,--and, consequently, the place where they were held came to be termed the "_museum_." Often the subjects for discussion were announced in advance, and those who gained the most applause received rewards in accordance with the merits of their work. Among those who enjoyed these advantages under the reign of these two Ptolemies are prominently named two physicians, Herophilus and Erasistratus, the latter said to be the grandson of Aristotle. It was under this Philadelphus that the Hebrew wise men translated into Greek the Holy Scriptures, which translation has since{032} been called the Septuagint--so called because it is supposed to have been translated by the members of the Sanhedrim, which was composed of about seventy men, or because, according to another legend, it was translated by seventy-two men in seventy-two hours. These _savants_ of ancient Egypt, thus supported by the dynasty of the Lagides, gave the first place to the science of medicine. As regards this study, the school of Alexandria eclipsed almost from its origin the ancient schools of Cos and Pergamos, and during its existence was the leading institution of its kind in the world. At the time of Galen it was sufficient to have studied there, and even to have resided a short time in Alexandria, to obtain the reputation of being a physician. Nearly all the scholars of these five centuries had received instruction in this school. The principal reason for its eminence in medical instruction was the practice of dissection of human bodies, which, under the Ptolemies, was allowed and recommended, and by which the science of medicine received an extraordinary impulse. Although the prejudice of Egyptians was very strong against those who touched a dead body, the Ptolemies themselves are said to have participated in this kind of anatomical study, thus destroying by their example the odium previously attached to dissection. Strange to say, however, the practice of dissection fell into disuse toward the end of this Anatomic Period, and scholars preferred to indulge in subtle metaphysical discussions rather than study human tissues. But the principal reason for giving up this practice was the Roman domination of Egypt, the Romans, inconsistently, being perfectly willing to see any amount of bloodshed in the arena, and all sorts of inhumanities practiced upon living human beings, but holding that contact with a corpse was profanation; so that not a single anatomist of reputation had his origin in ancient Rome. "If on any occasion," says Renouard, "a foreign physician attached to the king or general desired to avail himself of the occasions{033} that were afforded to examine the structures of the internal parts of the human body, he was obliged to conceal and carry off during the night some body abandoned to the birds of prey." To complete the melancholy termination of the Anatomic Period, the labors of the writers of those days were all lost by the burning of the great library by Julius Cæsar, which was the beginning of the chain of disasters with which Egypt was accursed under Roman dominion. Although Mark Antony, induced thereto by the endearments and solicitations of Cleopatra, transported the library of Pergamos to Alexandria, even this was unavailing to restore the position of the school, since the atrocious and imbecile Caracalla took from the pensioners of the museum their privileges of common residence and every other advantage, and suppressed all public exhibitions and discussions. I can mention but few of the names most eminent during this Anatomic Period, and but a short account of the life and work of each. The first deserving of mention was Herophilus, who was born in Chalcedon about the end of the fourth century before Christ, and supposed to be the first to undertake systematic dissection of the human body. The so-called Torcular Herophili, or common meeting-place of the sinuses at the occiput, named after him, gives evidence of his influence upon the study of anatomy. He wrote on all departments of medical science, concerning the eyes, the pulse, midwifery, etc., as well as numerous commentaries upon the Hippocratic writings,--describing the membranes of the brain and its vessels, the choroid plexus, the ventricles of the brain, the tunics of the eye, the intestinal canal, and certain portions of the vascular system. He alluded to the thoracic duct without knowing its purpose, and gave a more accurate description of the genitalia than any previous writer. Strange to say, but little is known of his later life, and of his death absolutely nothing. Erasistratus{034} was the son of Cleombrotus, a student of Metrodorus, and lived for some time at the court of Seleucus Nicator, whose son, Antiochus, he healed of a secret ailment, which happened to be a desperate love-affair with his mother-in-law, Stratonice. He wrote extensively on fevers, hygiene, paralyses, therapeutics, and many other subjects; regarded most diseases as due to overindulgence in food, which is not digested, and consequently putrefies. Plethora was for him the prevailing disease, against which he employed not only venesection, but fasting, and bandaging of the extremities. He was a diligent student of anatomy, and carefully described the brain in many of its grosser features, regarding it as the seat of the soul and the centre of the nerves. He also described more exactly than his predecessors the valves of the heart, which organ he regarded as the origin of veins and arteries. He discovered the lymph-vessels, and maintained, against Plato and others, that the epiglottis prevents the entrance of fluids into the lungs, but he supposed digestion to be produced by mechanical trituration in the stomach, and preferred gymnastics, exercise, diet, and baths to drugs or other therapeutic measures. He died about 280 B.C. Aretæus, who died about 170 B.C., was one of the most brilliant lights of antiquity previous to the Christian era, but, in spite of all this, of his life very little is known. He came from Cappadocia about the end of the reign of Nero, and lived in Alexandria. That he lived in Alexandria is apparent from his numerous references to its location, to the habits and therapeutics of the Egyptians, and to the geography of the country. Furthermore, references to its diseases abound in his writings, so that it is made to appear that he had had the best advantages there, although he must have traveled extensively. But a small portion of his writings remain, and these consist, for the most part, of compendiums of pathology and therapeutics. He described disease, not in anatomical order from head to foot, but under{035} the classification of acute and chronic. With the exception of Hippocrates, he has shown himself the most free from vague, arbitrary speculation, and from the dogmatism of the schools of any writer of antiquity. He, more than any other up to his time, endeavored to found pathology upon a sound anatomical basis. For every picture of disease he endeavored to provide a suitable anatomical accompaniment. This appears particularly, for instance, in his description of intestinal ulcers due to dysentery, or the paralyses following brain affections, or his description of pharyngeal diphtherias, of which he gave a good account under the name of Syriac or Egyptian ulcers. Pulmonary tuberculosis, tetanus, and anal fistula are amply mentioned in his writings. His therapeutics were simple and rational; he laid great stress upon dietetic treatment. His surgical writings appear to have all been lost, but there is every reason to think that he brought to bear upon{036} external medicine the same good sense which he applied to internal affections. [Illustration: 0055] Cornelius Celsus, the most celebrated author for a number of centuries, was born in Rome about the time of Christ. Brilliant as he was, he exerted a wide-spread influence for centuries. The exact date of his death is unknown. He was a contemporary of the greatest philosophers, poets, and _savants_ of Rome during its most brilliant period. He studied rhetoric, philosophy, the art of war, economics, and medicine--he was, in fact, a walking encyclopaedia of the knowledge of his day; but it is in medicine that he shows to best advantage, and in his capacity as a physician he was and is best known. The direction in which Celsus appears to least advantage is in failure of power of direct observation, and in yielding unquestioning obedience to the views and dicta of Hippocrates, for whom he possessed the greatest reverence, not being able to brook any serious contradiction or opposition to his opinions. In this reverence for Hippocratic authority he was followed by many less prominent successors, the consequence being a failure to train men as observers, the endeavor being to make them simply storehouses of information derived from Hippocratic writings. As a result, Celsus wrote but little, or else his writings are lost. He contented himself mostly with a mere commentary upon the writings which he so highly revered. But little of his writings remain, and these pertain mostly to the therapeutics of curable disease, dietetic, pharmaceutical, and surgical. Although he exercised great authority during his period, he was later totally supplanted by Galen, and his views are seldom mentioned in the writings of those subsequent to this great physician. His death must have taken place during the first century after Christ. Of all the students of Hippocratic dogmatism, the most earnest, skillful, and learned was Claudius Galen, a native of Pergamos, a place already celebrated for its temple dedicated{037} to Æsculapius, for its school of medicine, and for a library which had been removed to Alexandria. He was placed by his father under the most distinguished teachers in all of the sciences, and even as a young man showed extraordinary progress, and became early a disputant with the most erudite in grammar, history, mathematics, and philosophy. He has related how in two different dreams he was urged by Apollo to study medicine. He traveled widely for instruction, and remained some time in Alexandria. [Illustration: 0057] On his return to his own country he was charged by its ruler to dress the wounded in the great circus, which furnished him opportunity for displaying all his anatomical knowledge and surgical skill. Not remaining long at home, he went to Rome, where his renown had preceded him, and where, by his brilliant elocution, his accurate logic, and{038} his profound erudition, as well as his versatility and practical skill, he at once took the highest place. But here his rapid success, his vanity, his disdain for his colleagues, and his useless boasting, as well as his natural jealousy, gained him the enmity of nearly all his contemporaries, and his stay at Rome was thereby made very disagreeable. In his work on _Prenotions_ he accuses his colleagues of base jealousy and stupid ignorance, lavishes upon them such epithets as "thieves" and "poisoners," and closes by saying that after having unmasked them he would leave them to their evil designs by abandoning the great city to seek a home in a smaller place, where the surroundings would be to him more congenial. This threat he carried out, but soon returned to Rome upon the invitation of the Emperors Marcus Aurelius and Lucius Yerus, whose confidence, as well as that of their successors, he enjoyed. He is supposed to have lived to the age of seventy-one, and to have died about 200 A.D. Galen strongly denied being attached to any of the sects of his day, and regarded as slaves those who took the title of Hippocratists, Praxagoreans, Herophilists, and so on. Nevertheless, his predilection in favor of the Hippocratic writings is well marked, for lie explains, comments upon, and expands them at length, refutes the objections of their adversaries, and gives them the highest place. He says: "No one before me has given the true method of treating disease; Hippocrates, I confess, lias heretofore shown the path, but as he was the first to enter it he was not able to go as far as he wished.... He has not made all the necessary distinctions, and is often obscure, as is usually the case with ancients when they attempt to be concise. He says very little of complicated diseases; in a word, he has only sketched what another was to complete; he has opened the path, but has left it for a successor to enlarge and make it plain." This implies how he regarded himself as the successor of Hippocrates, and how littleweight{039} he attached to the labors of others. He held that there were three sorts of principles in man: spirits, humors, and solids. Throughout his metaphysical speculations Galen reproduces and amplifies the Hippocratic dogmatism. Between perfect health and disease there were, he thought, eight kinds of temperaments or imperfect mixtures compatible with the exercise of the functions of life. With Plato and Aristotle, he thought the human soul to be composed of three faculties or parts: the vegetative, residing in the liver; the irascible, having its seat in the heart; and the rational, which resides in the brain. He divided diseases of the solids of the body into what he called distempers; he distinguished between the continued and intermittent fevers, regarding the quotidian as being caused by phlegm, the tertian as due to yellow bile, and the quartan as due to atrabile. In the doctrine of coction, crises, and critical days he agreed with Hippocrates; with him he also agreed in the positive statement that diseases are cured by their contraries. From all this it will be seen that Galen must be regarded as one of the earliest of Hippocratic dogmatists. He was a most extensive writer, and it is said that the total number of his works exceeded one hundred. His contributions to anatomy were not insignificant. For myology he did a great deal. He wrote a monograph on the skeleton in which he recommended that bones be seen and handled, not merely studied from books, and that the student should go to Alexandria, where teachers would place before him the real human skeleton. It has been inferred that there was not, in his time, in Rome a single skeleton. He wrote fifteen books on anatomy, of which six are lacking; also an extensive treatise on the lesions of the human body, distributed among seventeen books which have come down to us. He is supposed to have introduced the term "symphysis," and he described nearly every bone in the human body. By him the muscles were no longer considered as inert masses and tissue-layers{040} serving to cover the bones, but he classified them according to their distinct functions, and studied separately their form and uses. The location of the vessels and nerves between them was also noted, and it was proved that muscles were indispensable to the accomplishment of voluntary motions. Galen was, perhaps, the first vivisector of all, since he exposed muscles of living animals, and showed how alternate tension and relaxation of distinct groups set the bones in motion, after the manner of levers; he named a great number of them, but, curiously, took no note of others. His classification according to their uses is followed down to the present day--i.e., flexors, extensors, etc. The Hippocratic authors confounded the arteries with the veins. Praxagoras first distinguished two kinds of vessels which he supposed to contain air, whence the name artery. Aristotle and Erasistratus maintained this view, which prevailed until the time of Galen, who devoted a book to the refutation of it, basing his argument upon the observation that always when an artery is wounded blood gushes out. How near he came to being the discoverer of the circulation may thus be seen. A little less reverence for authority and a little more capacity for observation would have placed him in possession of the knowledge, lack of which for so many centuries retarded the whole profession. He thought the veins originated from the liver--in this respect being behind Aristotle--but considered the heart as the common source of the arteries and veins. Even the portal system of veins confused him, and he erroneously described a superior and inferior aorta, but atoned for this by describing the umbilical veins and arteries. Aristotle also had supposed all the nerves originated from the heart, but Galen stated that they are derived from the brain and spinal marrow, and pointed out two kinds of nerves: those of sensation, which he thought proceeded from the brain, and those of motion, which he considered{041} to originate in the spinal marrow. Thus, he described distinct nerves of sensation and motion, but sadly confused their anatomy. He seems also to have had some notion of the great sympathetic, although it was by no means accurate. He suggested the division of the principal nerves, in order to prove the fact that nervous energy is transmitted from the encephalon to other parts of the body. He speaks of glands, and thought they discharged their secretions through veins into the various cavities, but regarded them rather as receptacles of excrementitious matter than as agents for secretion of valuable fluids. He even regarded the mammæ as glandular bodies in this sense, although he knew, of course, the value of their secretion. To Galen we owe the division of the body into cranial, thoracic, and abdominal cavities, whose proper viscera and envelopes he described. He spoke of the heart as having the appearance of a muscle, but differing from it. He regarded it as the source of natural heat, and the seat of anger and of violent passions. He appreciated that inspiration is carried on by enlargement of the thoracic cavity. He thought that atmospheric air entered the cavity of the cranium through the cribriform plate of the ethmoid and passed out by the same route, carrying with it excrementitious humors from the brain, which were discharged into the nasal fossæ. But some portion of air thus entering remained, according to his views, and combined with the vital spirits in the anterior ventricles of the brain, from which combination originated the animal spirits and immediate agents of the rational soul. These acquired their last attenuation in the fourth ventricle, whence they would pass out drop by drop through a round, narrow tube. From this brief _résumé_ of the anatomy and physiology of Galen it will be seen that by the end of the second century of the Christian era immense progress had been made since the foundation of the Alexandrian school, and that it was due to the impetus in the study of anatomy given by Herophilus{042} and Erasistratus, who not only made numerous dissections, but resorted to frequent vivisections. It is even said that Herophilus did not hesitate to employ his knife on live criminals who were subjected to him for experiment; but this has been a popular tradition about almost every anatomist of antiquity, and there is no evidence in confirmation of the unkind rumor, although that such experiments might be legally and justly performed has occurred to the minds of many. But zeal for dissection rapidly cooled off, and Galen barely mentions five or six men who devoted themselves to it in the space of nearly four hundred years down to his time. He speaks of _Rufus_ of Ephesus,--who lived under Trajan of _Marinus_,--who wrote in the beginning of the second century A.D., and of _Quintus_, who instructed his own preceptor. None of them left a reputation, however, approaching that of Herophilus and Erasistratus, with whom Galen alone could compare by the number of his experiments and his discoveries. Galen strove as hard as one of his position might, by example and precept, to awaken in his contemporaries a desire for anatomical knowledge, but could not overcome their indifference. After him the practice of dissection appears to have been lost, either from the redoubled prejudices of the superstitious, who opposed it, or as the result of the apathetic ignorance or the ignorant apathy of the physicians. It has been shown that, during the Hippocratic era and subsequently, the physicians even of primitive times followed more or less by instinct the empirical method. Acron of Agrigentum was a contemporary of Pythagoras, and affirmed that experience is the only true foundation of the healing art. Hippocrates, however, showed himself more anxious to report faithfully clinical facts than to dispute theoretical views. The surprising progress in anatomy and physiology made during the first portion of the Anatomic Period and during{043} the better days of the Alexandrian institute did not keep men from confounding several different points in the Hippocratic doctrine, by which confidence in the same was naturally shaken. Thus many new speculations were hazarded which nullified each other. In the midst of this confusion practitioners continued to seek in experience a refuge from the incessant variations of dogmatism and the sterile incertitude of the skeptics. Thus, empiricism as a school of practice became placed upon a firmer and firmer foundation, and the empirics of that day seem to have laid the true basis of our art. Their doctrine took at first a rapid growth, and Galen spoke of it with great regard. The circumstances under which it was proclaimed were most favorable for its propagation. Theories had fallen into confusion; practice, methods, and opinions were questionable. Everything was conjecture, and that which rested on the evidence of facts was by the empirics received with enthusiasm. Although founded on pure observation, it did not put an end to differences of opinion, and in the eyes of the ancients it lacked in solidity, because it did not attach itself to any philosophic theory then known. This doctrine was then best able to captivate physicians on account of its simplicity, contrasted with the general inability to satisfy speculative minds; but for this very reason it subsequently fell into disgrace, and the term "empiricism" became synonymous with ignorance. For centuries condemned and despised, it was revived from its long humiliation under the name of the Experimental Method, and achieved, after the labors of Bacon, Locke, and Condillac, almost universal dominion in the sciences. This doctrine had been proclaimed for about a century during the period of which we now speak, but later led men into a fondness for secondary generalities or for the elevation and magnifying of trifles, which confused their minds and terminated its usefulness to science. Meanwhile, a man of great intelligence, renowned as an elocutionist, well{044} versed in the doctrine of philosophers and grammarians--namely, _Asclepiades_, of Bythinia--came to Rome with the intention of teaching rhetoric. By his talent and personal address he soon became one of the most illustrious persons in the Roman Republic; so early as 150 B.C. he enjoyed a high reputation as a rhetorician, and was one of the intimate friends of Cicero; nevertheless, he abandoned letters, undertook the practice of medicine, and sought moreover to create a new system, being unwilling to follow in the track of his predecessors. Imbued with the philosophy of Epicurus, who was then in high repute, he deduced from it a theory which was in harmony with the philosophy of the day. He thought that the elements of the body existed from eternity; that they were indivisible, impalpable, and perceptible to the reason only. These elements he named _atoms_, which were supposed to be animated by perpetual motion, and from which, by their frequent encounters and fortuitous contention, all sensible phenomena were supposed to result. He explained the properties of the body by saying that compounds were aggregates of atoms, differing very much from atoms themselves. Solid silver, he said, is white, but, reduced to powder, appears black; the horn of the goat, on the contrary, is black, but if it be razed its particles are white. This, it will be seen, was the parent of our present atomic theory. He ridiculed the theories of Hippocrates concerning coction, crises, etc., and sarcastically called the Hippocratic treatise on therapeutics "a meditation on death." Asclepiades based his own therapeutics on endeavors so to enlarge the pores of the human body that disease could find egress, or so to constrict them that it could not enter; consequently he rejected all violent remedies, such as vomits, purges, etc., and his favorite remedies were hygienic,--for the most part bodily exercise. A celebrated disciple of Asclepiades was _Themison_, of Laodicea (b.c. 50), who was led by the teachings of his master to{045} lay the foundation of the so-called _Methodism_ as opposed to _Dogmatism_ in the school of Cos. By him and his followers a very arbitrary arrangement of diseases was made, according to what they considered the constrictive, or contractive; the fluxionary,--congested or relaxed; and the mixed forms. From this division of diseases it appears that, according to the methodists, there were only two kinds of therapeutic indications to follow,--namely, to relax where there was constriction, to constrict where there was relaxation. They, however, admitted a third creditable result, which they called prophylactic; but the pure methodists, such as Ccelius Aurelianus, admitted neither specific disease nor specific remedies, and erased from their materia medica purgatives, diuretics, emmenagogues, nauseants, etc. According to the methodist doctrine, the study of medicine was so abridged that one of its prominent exponents said that he felt able to teach the whole of medical science in six months. It made rapid progress, and consequently was most attractive to the numerous young neophytes who were anxious to finish their apprenticeship and hasten into practice. It is not one of the smallest of the services which Galen rendered to his time and to posterity that he demolished the sophistry of the methodists, demonstrated the insufficiency of their practice, and brought to bear upon them the wittiest satire, calling them the asses of Thessaly, alluding thereby to their lack of literature and medical instruction. In summing up, then, the basis for the various systems of medicine during this period of antiquity, it is seen that the most ancient doctrine of all--_Dogmatism_--directs our attention especially to the animal economy in health and disease; that it took account of the union of vital forces, of sympathies in the organism, and of nature's efforts to repel both internal and external deleterious influences, which{046} providential tendency manifests itself especially in certain acute diseases. This was the strong side of dogmatism. Its weak side consisted in this: that it was held that the causes of diseases inhere in the access of certain qualities and humors along with organic forces,--such as dryness or moisture in combination with bile or atrabile,--and the treatment was directed against these supposed causes. It was on account of this weakness that the enemies of dogmatism attacked it. The empirics opposed the idea that inaccessible and occult causes of disease could become the basis for rational treatment. They affirmed that there was no consistent relation of antagonism or similitude between the disease and the remedies which cured it. The _Methodists_ somewhat improved on the doctrine of empiricism, but ran wild in its improvement and erected over their fundamental theory such a superstructure of secondary and tertiary generalities as to cause the fundamental part to be entirely obscured from sight. There were not lacking, in those days of old, certain educated physicians who more or less vaguely comprehended that the entire truth of medicine did not inhere in any one of these systems, but that there was good and evil in each. These men, not being able to establish general rules, tried to decide practical questions according to their fancy or their reason. They assumed the name of _Eclectics_ or _Episynthetics_, meaning thereby that they adopted no exclusive system, but selected from each that which seemed to them best. They did not constitute a sect, because they had no precise dogmas nor theories, but they should not be confounded with the Pyrrhonians, who held to doubt as a fundament doctrine, the true eclectic doubting only that which he could not understand. True eclecticism in medicine, however, is rather the absence of fixed principles, or, as Renouard says, it is "individualism erected into a dogma, which escapes refutation because it is deficient{047} in principle." Many became eclectics to avoid discussing principles, and made of it a shelter. In one sense, then, an eclectic is one destitute of profound convictions, who sides with no particular party, is committed to no person or doctrine, and who is often so indifferent that he cannot judge with impartiality; consequently, to be truly eclectic is different from being an adherent of a school of eclecticism. During the historic period just reviewed, anatomy and physiology made most progress, next internal and external nosography, and next to these medical and surgical therapeutics, and although Coelius Aurelianus and Aretæus have left to us by far the best books issued up to their times, nevertheless not one of the writers of this period has achieved the distinction in which Hippocrates is held, since he, perhaps more than any other, combined intelligence, sincerity, disinterestedness, love of his art, and humanity. Under the classification of Renouard, already alluded to, the so-called _Age of Transition_ includes centuries commencing with the death of Galen, about A.D. 201, and ending with the revival of letters in Europe, about the year 1400. The first period of this transition age is the so-called Greek Period, which ends with the burning of the Alexandrian library, A.D. 640. At the time when this historic period commenced all the known world was under the dominance of a single man. The power of Septimus Severus had more extent than that of Alexander the Great, and bid fair to be of a much longer existence. The Roman dominion, cemented by seven hundred years of bold and persevering government, seemed almost immovable. While the savages upon its frontiers occasionally troubled its peace, none were strong enough to penetrate its centres or place it in real peril. The great civil wars had ceased, or changed their object. Both the{048} people and the senate, those two eternal competitors, had gotten over the struggle for supreme power; monarchial government was accepted as a matter of fact, and the citizens contended only for choice of a master. Similar changes had taken place in the domain of the mind; philosophical discussions, which were so essentially a part of the schools of the ancient Greeks, had nearly lost their interest and were being discontinued. Such disputes as took place related less to principle than to interpretation of the language of the teacher. In morals, Plato, Epicurus, and Zeno were followed until the principles of Christianity gradually supplanted their teaching; in physics and metaphysics the authority of Aristotle, and in medicine that of Galen, were simply undisputed. Conditions being such as these, there was naturally but one sect in medicine, and one method of study and practice. Medical science retrograded rather than progressed, sad to say, and was undisturbed by any remarkable revolution. The scepter of medicine passed from the hands of one nation to those of another, and the language of Hippocrates and Galen was later replaced, as will duly be seen, by that of Avicenna and Albucassis. But this Greek Period, which is one of transition, offers little for our consideration more than the lives and writings of four of its most eminent physicians, who by their study in the school of Alexandria, and by their writings and teachings, left reputations which were sustained until the invasion of the Arabs. Of these it may be said that, while they did little or nothing original, and simply commented upon the writings of Hippocrates and Galen, they kept burning the torch of medical learning which else had been almost extinguished by their indolent contemporaries. Of these various commentators--for they were little more than that--the first of any importance after Galen was _Oribasius_, who was horn in Pergamos (328-403); he early attached himself to the fortunes of Julian the Apostate, and followed him into Gaul when he was{049} made its governor. Julian appreciated the good qualities of Oribasius, made him an intimate friend, and after he himself became emperor appointed his friend as quæstor at Constantinople. After the emperor's untimely death, Oribasius remained faithful to his memory, but his jealous colleagues so falsely and so successfully misrepresented his fidelity that he was disgraced, spoiled of his office and property, and banished among a barbarous people. In this new field, however, he displayed such courage, effected such extraordinary cures, discoursed so eloquently, and so attached to himself the savage men around him, that he was by them regarded as a god. The fame of this homage in time reached the ears of the Emperors Valens and Valentinianus, who recalled him, reimbursed him for his losses, and permitted him to enjoy his high reputation and fortune to the end of his days. He was held to be the wisest man of his time, most skillful in medicine, and the most charming in conversation. He dedicated a collection of seventy books to Julian, his first patron, and edited, at a later period, an abridgment of this work for the benefit of his son. His principal merit consisted in reproducing the ideas of others with such clearness, order, and precision that the summaries that he gives of them are often preferable to the originals. What he has said of pregnant women, nursing, and the earliest education of the child has been copied literally by writers for twelve centuries since his time. It must be said of him, however, that his prepossession in favor of Galen was so great that he adopted servilely his ideas and even his words to such an extent that he has been surnamed "the ape of Galen." _Ætius_ was born in Mesopotamia in the year 502 and died in 575. He studied at Alexandria, and afterward went to Constantinople, where he became a chamberlain at court. Ætius was the first medical man of any note who professed Christianity, as is shown by such passages as this one: he said that{050} in the composition of certain medicaments the following words should be repeated in a low voice: "May the God of Abraham, the God of Isaac, and the God of Jacob deign to bestow upon this medicament such and such virtues." In another place he recommends that to extract a bone from the throat the following words be pronounced: "Bone--as Christ caused Lazarus to come forth from the sepulchre, as Jonah came out of the whale's belly--come out of the throat or go down." But he exhibits the same credulity in not doubting the miraculous virtues attributed by the quacks of his day to most remedies. Like Oribasius, he collected everything that he found remarkable in the writings of his predecessors, and has preserved certain fragments of antiquity which would otherwise have been lost. His work formed a complete manual of medicine and surgery, except that it lacked anatomical descriptions and references to dislocations and fractures. _Alexander_ of Tralles (525-605), a city of Lydia, where Greek was spoken, was a son of the physician Stephen, and the most celebrated of five sons, who were all distinguished for their learning. He traveled extensively, and fixed his residence in Rome, where he became celebrated. He lived to an advanced age, and, being no longer able to practice, composed a treatise of twelve books, exclusively devoted to affections that did not require the aid of surgery. He professed the greatest veneration for Galen, but did not blindly adopt his opinions. He described the first reported case of excessive hunger and pain due to intestinal worms; he advised venesection in the foot rather than in the arm; but with all his sound judgment and mental enlightenment he had faith in amulets and talismans, and widely recommended them. It may be said for him, such was the universal prejudice of his age, the whole world being plunged in superstition, that it was necessary for every one to pay some tribute to the prevailing belief; and we may add that it is necessary to make this excuse for some who practice much{051} nearer to ourselves than did those ancient physicians. _Paul, or Paulus_, surnamed _Ægineta_ (because he was born in the Island of Ægina), was among the last of the Greek physicians who have special interest for us. It is supposed that he died about A.D. 690. He traveled extensively, and his skill in surgery and obstetrics rendered him celebrated even among the Arabs, whose midwives sent for him in consultation from great distances. He composed a compendium of medicine, divided into seven books, and not only did not hesitate to borrow from his predecessors, but quoted from them most extensively; a number of his chapters were taken almost _verbatim_ from Oribasius; however, he made no secret of it, but rather boasted that he had judiciously sought to appropriate the best of the writings of those he most revered. He showed originality, however, in the treatment of hydrocephalus, in advising paracentesis of the thorax and abdomen, in the extraction of calculi from the bladder, in the treatment of aneurism, the excision of hypertrophied mammæ in men, etc. He was the first to describe varicose aneurism, and the first to perform the operation of bronchotomy after the method borrowed from _Antyllus_, of which he has transmitted a very detailed account. Of this Antyllus, by the way, it may be added, _en passant_, that he was one of the most distinguished and original surgeons of antiquity. He flourished during the third century after Christ; was the first to describe the extraction of small cataracts; and is, perhaps, best known to the surgical world to-day by his exceedingly bold plan of opening aneurisms, so successfully imitated a generation or so ago by James Syme. It has already been seen that before and during the early centuries of the Christian era the secrets and learning of the physicians tended to pass gradually into the hands of the priests. It was so in the temples of ancient Greece, it was so in Alexandria, it became so in Rome, it has been so even{052} in modern times, although only for brief periods of time. This has come about in some measure from the cupidity of the clerical orders, partly because it required a certain amount of intelligence and knowledge to become a priest, and partly because, owing to ignorance, credulity, and superstition, diseases have at all times been regarded by the ignorant as evidence of divine wrath and chastisement, or of diabolical or occult influences, rather than the effect of natural causes. Hence men have turned ever toward prayers, exorcism, and expiation, especially when exhorted thereto by the priests. This has been the sacerdotal aspect of the practice of medicine in all times, and when the priests have usurped therapeutic functions they have done harm rather than good. So long as theology and science work hand in hand, each redounds to the credit of the other, but always in the history of man when theology has appropriated that which did not belong to it it has brought ridicule upon itself and has delayed the progress of knowledge. There have been frequent rebellions against religious authority in ancient as in modern times. For instance, at the commencement of the fifth century before Christ the Pythagoreans were dispersed, and the doctrines of Cos and Cnidus--i.e. the Hippocratic teachings--were promulgated; and again, in the course of events, when the descendants of Æsculapius became servile attendants at the temple and adjuncts to the priesthood or a part of it. At first, in Alexandria, the physicians were supreme; their disciples, however, had the same blind reverence for authority that too many workers in the field of theology have evinced, and men once more practiced medicine on the traditions of the past, and in so doing allied themselves more and more to the temples in Rome. At first, the oldest and best instructed of the relatives treated the diseases of his family as he understood them; simply shared this duty with its other members. Cato, the censor, was much engrossed with this domestic medicine;{053} he wrote a book in which he recommended cabbage as a sovereign remedy in many diseases. He venerated the number 3, as did the Pythagoreans; did not disdain to transmit to posterity certain medical words which it was believed should be repeated to assist in the reduction of dislocations and fractures. This old censor seemed to have a profound hatred for medical men, and most absurd ideas of their works and claims, although doubtless many Greek physicians who came to Rome merited the invectives which he launched against them. Then came Asclepiades, of Bythinia, as already mentioned, whose talents were far superior to those of his Roman contemporaries, and who did not need to call to his aid charlatanism and deceit. This medical hero unfortunately had many worthless and dishonest imitators, who appealed to superstition and ignorance in every dishonest way, and who desired to be judged by the luxury and elegance they displayed. Hence for a long time in Rome medicine was practiced without license. The Emperor Anthony the Pious was the first to occupy himself with regulating the practice of medicine. He granted certain immunities, but did ask for proof of qualifications. A certain physician to Nero, Adromachus, was honored by the emperor with the title of Archiater.-- i.e., royal healer.--but Galen, who was physician to Marcus Aurelius, never bore it. From the time of Constantine the Great, however, the title is frequently met with in the edicts of the emperors. In fact, there were two sorts of these.--one named the Palatine, who belonged to the household of the reigning monarch and who held high rank among the nobility; and the other called the Popular Archiaters, who were public-health officers. No one could practice medicine in the jurisdiction of one of these without examination and authorization. Those who transgressed this regulation were punished with a fine of two thousand drachmas. The Popular Archiaters were pensioned by the city, enjoyed certain privileges, and had to{054} attend the poor gratuitously. Practitioners who were not members of the College of Archiaters had no pay, no rights, nor emoluments. The Popular Archiaters were elected by the citizens from many candidates who had proved their capacity before the college of this medical organization. The evils of medical anarchy were thus remedied; this happy condition existed until the empire was broken up by barbarism. It is during this period--about 400 A.D.--that we first find a class of citizens to whom was delegated the duty of preparing drugs ordered by physicians. Their duties were in some respects similar to those of our apothecaries, although in attainment and in social position they were far below the physicians. They were termed _pharmacopolists_. It is worth while to stop a moment to inquire what were the medical charitable institutions of antiquity. Even in the days of ancient Athens there was a certain gymnasium, called the Cynosarga, in which abandoned and illegitimate children were brought up at public expense until such time as they were able to serve their country. A little later several private institutions of this kind were established. Rome in her earlier day never had such institutions. To be sure, she distributed provisions, or else remitted taxes, to parents who were unable to support their children, or even permitted them to destroy their newborn children when unable to maintain them; but there were no bonds of sympathy which induced the patricians to succor the plebeians in time of disease and distress; slaves were cared for as were cattle. It is one of the debts we owe Christianity that, under its influence, the first almshouses and retreats were established in Rome. It has been said that the Emperor Marcus Aurelius first instituted anything like a dispensary service in the Sacred City. We are told, also, of an illustrious woman, St. Pauline, living in the midst of the greatest wealth and pomp,{055} who retired from society and devoted her life to charity and self-denial. She went to Jerusalem, united with other Christian women of the same mission, and formed, under the direction of St. Jerome, a sisterhood whose members divided their time between reading sacred books and doing good works. They offered an asylum for the faithful and a hospice for the benefit of the indigent sick, and even established a home for convalescents outside the city-walls. After the model thus set, heathen emperors, Christian kings, and Moslem caliphs showed their zeal in this good direction by the erection of sumptuous edifices and other rich endowments for the relief of suffering human beings. Reviewing now the Greek period, let it be remembered that in the time of Galen animals were dissected, and that he made anatomical demonstrations on monkeys; that sometimes the corpses of the enemy were rudely dissected upon the field of battle, but that finally the practice of dissection fell into disuse, and human anatomy was studied only from books, the early Christians having evinced even more horror of the dead body for the purposes of anatomical study than did their pagan predecessors, while the Fathers of primitive times launched their anathemas against the dissection of human remains. Here, again, as usual, the interference of the church worked only general harm. This abandonment of anatomy contributed doubtless to the decadence of medicine; by the rapid extension of Christianity the pagan schools were disorganized and broken up, the profane sciences (such as medicine) were discarded, and the teachers still remaining in the old schools were ruined. Passion for religious controversy was engendered and took the place of study or original research, even to such an extent as to hasten the fall of the Empire of the East. In addition to these factors, reverence for authority of the past--that terribly oppressive weight which has kept down so much which would otherwise{056} have risen early, and which has been the greatest enemy of human learning--permitted the explanation of natural phenomena to be sought only in the writings of revered ancients, and not in living beings. No one dared to advocate changes in regard to received doctrines, and there could be no such thing as progress. Only two men in the lapse of four centuries showed any originality; these were Alexander of Tralles and Paul of Ægina, whose lives have already been briefly rehearsed. It is with some relief, however, that we can think that this period, so unfruitful in scientific progress, was not so in social amelioration. By the organization of the institutions above alluded to charlatanism was checked, by the requirement of capability and good character society was benefited, and the charitable institutes of this epoch perhaps gave the world its best models in teaching and an insight into the most valuable means of medical instruction. Of the old Greek Period, then, we may say that it accrues rather to the benefit of humanity than to that of science. CHAPTER III. _Age of Transition (continued).--Arabic Period: A.D. 640-1400. Alkindus, 873. Mesue, 777-857. Rhazes, 850-932. Haly-Abas, 994. Avicenna, 980-1037. Albucassis, 1122. Avenzoar, 1113-1161. Averroës, 11661198. Maimonides, 1135-1204. School of Salernum: Constantinus Afri-canus, 1018-1085. Roger of Salerno, 1210. Roland of Parma, 1250. The Four Masters, 1270 (?). John of Procida._ The Arabic{057} Period, which began with the second destruction of the Alexandrian Library--640 A.D.--ends with the fourteenth century. At the commencement of this period the Roman Empire of the West scarcely existed: the magnificent territory which composed it had been overrun and subdued by barbarous tribes from the forests of the North, while from its ruins had risen several independent kingdoms,--that of the Franks in Gallia, of the Visigoths in Spain, and of the Lombards in Italy. The last of the Western emperors of note was Justinian, whose army and generals--especially the genius and heroic devotion of Belisarius--threw some glory upon Italy, Sicily, Africa, and Spain. Meantime the Empire of the East, surrounded by enemies, and harassed from all directions, still sustained itself with vigor. The Turks had begun to show themselves on the banks of the Danube; those eternal enemies of Rome--the Persians--made incessant war; and a new and terrible enemy had sprung up in the deserts of Arabia. Then came one who was at the same time legislator, prophet, and conqueror, and united under one faith and one leader tribes hitherto divided and warring against each other. Thus arose a powerful and enthusiastic nation, animated by thirst for conquest and ardor for proselytism. In less than a century after the first preaching of Mahomet, all of Arabia, India, Syria, and Egypt were in the hands of his followers. In the year 640 Amrou effected the conquest of Egypt, seized Alexandria, and the great library of five hundred thousand volumes was, by order of Omar (successor to{058} Mahomet), delivered over to the flames; and the historian Abulpharagius declares that these books served for six months to heat the public baths, four thousand in number. Such were the first fruits of the establishment of Islam. * Happily, zeal of proselytism somewhat abated among the Mussulman princes, and religious fervor gave place to policy; so that the later Arabian caliphs showed themselves, in general, the protectors of the arts and sciences. Some, indeed, endeavored to collect the _débris_ of the scattered treasures that had been so fortunate as to escape the ignorant fanaticism of their predecessors; and others, more tolerant even than the Christian princes of the time, received without distinction all men of merit who took refuge in their State, gave them employment, and recompensed them for their services. On this account philosophers and persecuted "heretics" sought an asylum among infidels, and found there the protection which Christianity did not afford,--in return for which they gave their protectors the benefits of Greek civilization. * See a very vigorous denial of this historical statement in The Nineteenth Century, October, 1894, page 555. Of all the Moslem rulers, the most distinguished for love of learning and general enlightenment was Haroun-al-Raschid, the Charlemagne of the East, contemporary and emulator of the glory of the emperor of the Franks, the hero of a hundred Arabic poems, whose dominion extended from the borders of the Indus to the heart of the Spanish peninsula. He embellished Bagdad, his capital, with schools and hospitals. His son Almamon founded the Academy of Bagdad, which became the most celebrated of the age; likewise spared no pains to draw to his court the most illustrious men of all countries. He enjoined each of his ambassadors to purchase all the writings of the philosophers and physicians that could be found, and these he required to be translated into Arabic; his interpreter, Honain, a Christian, was employed at translating for forty-five{059} years, and received, for each book rendered into Arabic, literally its weight in gold. The eclat which the Moorish caliphs shed upon Spain from the tenth to the thirteenth century is well known. The cities of Cordova, Toledo, Seville, and Murcia possessed public libraries and academies, and students from all parts of Europe flocked to them to be instructed in arts and sciences; the library of Cordova alone embraced more than two hundred and twenty-four thousand volumes. Thus it will be seen that the dominion of mental and temporal affairs passed from the Greeks and Romans to the Saracens. Arabian medicine constitutes one of the most interesting chapters in the history of our art. An offspring from Greek schools, it was for nearly one hundred years the fostermother of that art, and, although it gave rise to no great discovery nor wonderful step in advance during all this period, it nevertheless kept alive all the learning of the past, and clarified rather than made it turbid. In the sixth century the Nestorians (followers of Bishop Nestor), having been driven out of Syria, settled in Persia, Mesopotamia, and Arabia, and there founded schools and other institutions such as they had had at home,--schools in which, beside the ordinary philosophic studies, medicine received a share of attention. Thus it came about that by the seventh century Arabian physicians were everywhere known and in high repute. Naturally the basis for their studies embodied the writings of Hippocrates, Galen, Oribasius, and Paul of Ægina; and the first Arabian works consisted solely of translations from the Greek, first out of their Syriac rendering, and later from the originals. Indeed, so much eminence was finally achieved by Arabian physicians that more than four hundred are known by name as authors. The first author deserving of mention was _Bachtischua_, of Nestorian stock, celebrated in Jondisapur, director of the medical school, and later physician to Caliph El-Mansur, in Bagdad.{060} Of his descendants several became well known in the same field. Alkindus--this being the Latin arrangement of his Arabic name--came from a Persian family, who lived first in Basara and later at the court of the caliphs El-Monon and El-Motasin, in Bagdad. He enjoyed a very high reputation as physician, philosopher, astronomer, and mathematician, and died A.D. 873. Mesue, the first of his name, sometimes known as Janus Damascenus, was director of the hospital in Bagdad and physician to Haroun-al-Raschid. He was born in 777, wrote extensively (since at least forty of his works have been catalogued), and died in 857 in Samarra. Serapion the elder, also sometimes known as Janus Damascenus, and whose Arabic name was Serafiun, was born in Damascus--the exact data is not known--and died some time prior to A.D. 930. He was author of two volumes of aphorisms concerning the practice of medicine, which had at his time the greatest repute. The most celebrated of the early Arabian physicians was Rhazes, born in the Persian province of Khorassan A.D. 850. According to the historians of his nation he was a universal genius, equally famous in music, astronomy, mathematics, chemistry, and medicine; he was surnamed "The Experienced." At the age of fifty he was one of the most distinguished professors in the Academy of Bagdad, where students came from great distances to listen to him. Chosen from among a hundred colleagues to direct the grand hospital of that city, he displayed indefatigable zeal and most scholarly learning, even to his old age and in spite of loss of sight, which overtook him at the age of eighty, when his reputation was at its height. Two years after this misfortune--i.e., in 932--he died. His generosity, which was proverbial, and his compassion for the poor left him penniless at the time of his death. Some two hundred and thirty-seven monographs of his have been{061} catalogued, though the greater number of his works are practically lost. Two treatises on medicine remain which afford excellent counsel in many respects; among other matters he advises:-- "Study carefully the antecedents of the man to whose care you propose to confide all you have most dear in this world,--that is, your life and the lives of your wife and children. If the man is dissipated, is given to frivolous pleasures, cultivates with too much zeal the arts foreign to his profession, still more if he be addicted to wine and debauchery, refrain from committing into such hands lives so precious." His greatest publication was _Continens_--extracts compiled from all authors for his own use--divided into thirty-seven books, constituting an abridgment of the science of medicine and surgery up to his time; and, notwithstanding its imperfect state, this work was held in greatest reverence, and was a common source of knowledge among Orientals long after his day. Haly-Abbas, a Persian by birth, flourished fifty years after Rhazes, and died A.D. 994. His _Almalelci_, in twenty volumes, constituted a quite complete system of theory and practice of medicine, which, however, was in large measure taken from Rhazes's _Continens_. It is generally regarded as the best work of any of the physicians of the Arabic Period; it is divided into three parts--a book on Health, a book on Death, and a book of Signs--and it is interesting to know that the portion devoted to midwifery and obstetrics was in the hands not only of the profession, but also of the midwives. Avicenna--Latinized form of his Arabic name, Ebn Sina--was born in Bokhara in 980. From his earliest youth he manifested a remarkable disposition for scientific study, and it is claimed that he mastered the entire Koran at the age of ten years; also that he devoted his entire days and the greater part of his nights to research, mastering philosophy,{062} mathematics, astronomy, and, later, medicine, which he studied at the university at Bagdad, in which city his talents were chiefly exhibited. He was received at court, loaded with favors, and elevated to the dignity of Vizier, but suddenly fell into disgrace, was deprived of property, imprisoned, and even threatened with execution. After two years, however, he was restored to liberty, and once more possessed the consideration of the public and the court, becoming the recipient of new honors. Meantime he had given himself up to intemperance, by which his previously robust constitution was undermined, and this, with excessive labor, brought about his demise at the too early age of fifty-six, in the year 1037. He was author of several books, the chief being the _Canon Medicinae_, which remained a classic for six centuries, constituting the medical code of Asia and Saracenic Europe; no author since Galen had enjoyed so wide and extensive authority in the medical world; and in the various medical schools professors, for the most part, confined themselves to reading the _Canon_ from their desks, explaining and commenting upon its text. The work was divided into five volumes, of which the first two comprised the principles of physiology, pathology, hygiene, and therapeutics, arranged to conform to the teachings of Aristotle and Galen; the third and fourth dealt with treatment; and the fifth wras devoted to the preparation and composition of remedies. Avicenna appears to have surpassed in subtlety both Aristotle and Galen; he was fond of metaphysical speculation, and his works were too much filled out with subtleties of language rather than with true science. Authors of this period were fond of torturing in every way possible the writings which they undertook to edit or quote from, and, instead of devoting themselves to original research, wasted time in seeking for vague and hidden meanings. That man was most esteemed as learned who could see the greatest subtlety in some passage from one of{063} the ancient writers; consequently, that which was obscure or unintelligible was deemed the most sublime and philosophic. A very brief study of the _Canon_, for instance, will show this, while in graphic pictures of disease the work by no means approaches those of Aretæus or Alexander of Tralles, for Avicenna too often contented himself with mentioning merely a list of symptoms without indicating in any way their progression, characters, or duration. Undoubtedly just was the criticism of an Arabian poet: "His philosophy had no sound foundation, and his medical knowledge availed him naught for the possession of personal health and long life." Albucassis was born in Zahra, near Cordova, about the beginning of the eleventh century, and is supposed to have died A.D. 1122, at the advanced age of one hundred and one. He was author of an abridgment, or compilation, devoted to the practice of medicine, the only novelty of which is a small portion devoted to surgery, in which are described certain instruments. He says:-- "I have detailed briefly the methods of operations; I have described all necessary instruments, and I present their forms by means of drawings; in a word, I have omitted nothing of what can shed light to the profession.... But one of the principal reasons why it is so rare to meet a successful surgeon is that the apprenticeship of this branch is very long, and he who devotes himself to it must be versed in the science of anatomy, of which Galen has transmitted us the knowledge.... In fine, no one should permit himself to attempt this difficult art without having a perfept knowledge of anatomy and the action of remedies." Not a word is said about dissections, however, from which we conclude that they were not tolerated in his time. He resorted enthusiastically to the cautery, and recommended it in spontaneous luxations and the commencement of curvature of the spine. He refers particularly to instrumental{064} delivery and the extraction of the after-birth, and, when speaking of fractures and dislocations, he remarks: "This part of surgery has been abandoned to men of vulgar and uncultivated minds, for which reason it has fallen into undeserved contempt." [Illustration: 0084] Avenzoar, born in 1113, of a Spanish family which had many illustrious scions, was instructed in medicine by his father, and ultimately achieved great celebrity throughout Spain and Africa; for a time he lived at the court of the Prince of Seville, loaded with honors and presents, and finally was made Vizier. Among other works he wrote a treatise on renal diseases, in which he outlined the treatment of calculus and described an operation therefor. He died in 1161. Averroës (as he is generally known, though his Arabic name was Aben Roschd) was born A.D. 1166, in Cordova, where{065} his father held official position. After being grounded in philosophy, mathematics, and other sciences he became a pupil in medicine under Avenzoar. The greater part of his life wras passed in Seville, where he was greatly esteemed and finally knighted. In 1195 he was called to the court of the King of Spain and Morocco, in Cordova, where he received the highest honors, only, however, through some misunderstanding, to be disgraced; but he soon afterward recovered his former position and dignities. He wrote extensively not only on medicine, but on philosophy, his writings taking throughout a more or less dialectic character. He died in 1198, and from him descended a number of physicians who achieved more or less reputation. _Maimonides_ was born in Cordova, A.D. 1135. He early devoted himself to the Talmud, and in his extended travels visited Jerusalem; he even founded a school of philosophy in the East, which, however, had only a brief existence. He died in 1204. He ranked higher in philosophy than in medical art, and seems to have been imbued with the methods of his teacher, Averroës, and is generally regarded as a theorist rather than as a practical physician, although he wrote more or less on medical topics, and is particularly remembered for an essay upon poisons. He was about the last of the Arabians who deserves special mention. During the period which was nearing its close at the time of the death of Maimonides, the Arabs embraced with much ardor the study of medicine, and translated into their language nearly all the treasures that had been amassed by the Greeks; indeed, the preservation of many of the great writings which would otherwise have been lost is due solely to this fact. Strange to say, however, the Arabians neglected Latin authors, and apparently possessed no knowledge of Celsus or Coelius Aurelianus. As religious prejudices prohibited dissections, they were obliged{066} to rely solely upon the anatomical descriptions of Galen, and succeeded in increasing the errors of the original by inaccurate translations. So far as originality of observation goes, the Arabians were in most respects behind the Greeks; nevertheless, they were the first to differentiate eruptive fevers, to which the latter paid little or no attention. The Arabian school also supplied the knowledge of purgatives, such as cassia and manna, which replaced the drastics employed by the ancients; also the mode of preparation of syrups, tinctures, distilled waters, pomades, and plasters. While the Arabians were gradually rising by their power, intelligence, and renown, the Greeks were declining in inverse ratio; the genius, courage, and ancient virtues of the latter grew weaker and weaker, until they seemed on the verge of extinction. In the medical history of these centuries, in all Europe not under Moslem rule, there was but one man entitled to mention as an author in medicine,--viz., John Actuarius, the son of one Zacharia. He lived at the close of the thirteenth and the beginning of the fourteenth century; was employed at Constantinople, his surname being the honorary title of the court-physicians. He is more commonly known as Zacharia. Of his life we know little, save that he wrote several volumes, for the most part abridgments or commentaries on the doctrine of Galen. He laid great stress on the theory of critical days, and sustained his views by astronomical hypotheses most ingeniously combined. His was the first Greek work in which were mentioned the remedies introduced by the Arabians, yet he has not a word to say of variola, measles, spina ventosa, and other affections fully described by Arabic authors. He held remarkable views concerning the nature of man, whom he supposed to be formed by the union of two contrary substances,--the soul and the body; described somewhat elaborately an imaginary plexus of veins connected with the digestive{067} organs, through which the animal spirits were elaborated and purified; also, and quite methodically, for his age, he explained the functions of the animal economy and the etiology of disease. While the clouds that befogged the study of medicine in the Empire of the East thus grew heavier and heavier, we must not be blind to the melancholy spectacle concerning the provinces composing the Empire of the West. Barbarians in swarms, from the forests of Germany and Scandinavia, had swept its various portions, pillaging, destroying, and reducing to slavery its inhabitants. In southern Europe everything was changed. Each generation witnessed some new and unheard-of invader, who demanded his share of booty and renown and left a track of desolation behind him. There was a brief period of order when Charlemagne reunited under one dominion these divers races and seemed to have resuscitated the Western Empire; but no sooner was he dead than its elements, being devoid of affinity, broke apart. Former vassals, no longer restrained by the firm hand of the emperor, made common warfare against his successors and against each other, and for several ages there was nothing but a succession of wars and invasions. Feudalism gave some sort of character to this military anarchy by affording repose and, in a measure, security for those who had hitherto been trampled under foot; but learning and the sciences fell into complete neglect, and it was with great difficulty that a very small number of men found within the pale of the church a limited protection that enabled them to devote themselves to the study of medicine and ecclesiastical law. Near the end of the eleventh century, however, the enthusiasm of the crusades whetted anew the turbulent appetite of the Christian barons, and led these lords of western Europe, with their belligerent spirits, to the East, as a result of which people hitherto oppressed could breathe more freely. A few States recovered their{068} independence; some semblance of law was established; municipal institutions were organized, and establishments consecrated to public use were founded and multiplied; finally, in the course of the thirteenth and fourteenth centuries, the cloud which covered the face of Roman Catholic Europe was in some measure dispersed, and men of talent and even genius began to appear upon the scene; everything about them being so obscure, they shone like stars in the firmament. In letters, for instance, there were Dante, Petrarch, Boccaccio; in mathematics, Leonard, of Pisa, the first in Europe to understand and employ figures and algebraic characters, although Cuvier has claimed this distinction for Gerbert, a Benedictine monk of the tenth century, who subsequently became Pope Sylvester II. At this time, although in scholastic estimation medicine, theology, and philosophy alone were fit to entertain the human mind, the natural sciences were not without occasional representatives. Roger Bacon was three centuries in advance of scientific reform, and endeavored to introduce experimental philosophy, and so fully convinced some of his auditors that they subscribed £2000 sterling to provide for the expense of his experiments; this was money most happily employed, since it made possible a number of important discoveries. It is said that Bacon knew the properties of convex and concave lenses, and was the first to conceive of the microscope and telescope; his astronomical knowledge led him to demand a reform in the calendar, which Gregory XIII carried out three centuries later; he had knowledge of gunpowder and its effects, and was, in fact, the wizard of his day; but his boldness and originality drew upon him the enmity of the church, by which he was persecuted and finally condemned to imprisonment for life upon a diet of bread and water, although he was ultimately released, in 1266, by Pope Clement IV. He wrote extensively, but only fragments of his works exist, since the friars believed{069} them tainted with witchcraft and prevented their publication. Before and during the time of Roger Bacon the philosophers were divided into two parties, which engaged in very unseemly and unphilosophic strife. One was termed the _Realist_, and believed, with Plato, that ideas are self-existent and independent of the mind,--in other words, veritable entities; the other, the _Nominalist_, held, with Aristotle, that general ideas are pure abstractions formed by the mind with the aid of sensations received from without, without which they could never exist,--that is, if a being could be imagined without sensibilities and the power of sensation, such being would be destitute of ideas. These two parties kept up a very active warfare, and enlisted the aid of both civil and ecclesiastical authorities, the result being persecution of each other, and that general unsatisfactory conflict into which theology and metaphysical speculation always force those who indulge in them. Now, regarding the condition of medical affairs in the Empire of the West: Down to the seventh century, in Rome, there were court-archiaters who were attached to the retinues of the nobles, and in each large city popular archiaters formed a college charged with sanitary matters, the instruction and examination of candidates, and gratuitous services to the poor. Although there is little definite information available, it is probable that after the ruin of Alexandria much the same medical organization obtained in those provinces as continued under the Greek Empire at Constantinople. Under Arab sway we know very little of what rules or regulations governed instruction in medicine and its practice; and, so soon as one of these countries fell under the rule of the Turks, all scientific institutions seem to have decayed or been discontinued,--or, as Renouard states it: "If we may judge by what still exists to-day in this unfortunate country (Turkey), consumed by the power of ignorance{070} and despotism, the most complete anarchy followed all older organizations." In southern Europe, however, things had not gone on quite so badly, although at first barbarous invasion caused everywhere disorder and confusion, and the Christian States of the Western Empire yet presented after three or four centuries a chaotic condition of affairs. The ecclesiastical schools, which were under the care of the church, still pursued courses of literary and scientific instruction; in the time of Charlemagne, for instance, the colleges of the cathedrals, and even some of the monasteries, taught medicine in a very limited way under the name of physics. Thus all the liberal professions--that of medicine included--fell under the domination of the clergy, and priests, abbots, and bishops became court-physicians. The monks of Mount Cassin, of the order of St. Benoit, enjoyed for a long time a great reputation for medical skill; and among these in the tenth century was an abbot named Berthier Didier, who became Pope Victor III toward the close of the eleventh century, and one Constantine, surnamed the African. Of the ecclesiastics who from the ninth to the eleventh century were distinguished by the knowledge of medicine, there were Hugues, abbot of St. Denis, physician to the King of France; Didon, abbot of Sens; Sigoal, abbot of Epernay; Archbishop Milo, etc. Even several religious orders of women undertook, to a certain extent, the practice of medicine, and Hildegarde, who was abbess of the convent of Rupertsburg, near Bingen, is credited with having written a treatise on _Materia Medica_. From the ninth to the thirteenth century the Jews shared with the clergy the monopoly of the healing art. Many of these studied under Arabian physicians, and, though the canons of the church forbade them to in any way minister to the ailments of Christians, they were still called upon in time of need, and even in many instances had access to the palaces of archbishops, cardinals, and popes. The education{071} of Christian priests and infidel practitioners embraced really very little, and consisted, for the most part, of knowledge of a few symptoms and possession of a few receipts; books were excessively rare and expensive, capable teachers lacking, and a good medical education out of the question. There was no law nor public regulation which concerned the practice of medicine, and any who desired could enter upon it; while besides the priests and the Jews--which latter stood at the top of the scale--there was a multitude of charlatans of the lowest order, such as barbers, keepers of baths, and even a few women. The morality of this vulgar herd was on a level with its knowledge. I have said the practice of medicine was not regulated by law, yet Theodoric, King of the Visigoths, enacted a statute that no physician should bleed a woman of noble birth without the assistance of a relative or domestic; that if a physician in treating a patient or dressing a wound happened to harm a gentleman he should pay a forfeit of one hundred sous, and if the patient died from the operation he should be handed over to the relatives of the deceased, who could do with him whatever they pleased; while if he crippled or caused the death of a serf, he was to be held accountable only for the loss, and compelled to supply another. This remained in force from the sixth to the twelfth century, and was made to apply chiefly to the practice of surgery, which had been abandoned to individuals of the lowest condition. The practice of internal medicine was, for the principal part, the privilege of the clergy, and it is not likely the secular power ever expected that one protected with the title of priest should be handed over to the relatives of the dead. It furthermore appears that the practice of medicine as divorced from surgery led to such irregularities in the manners and conduct of the clergy that from the twelfth century popes and councils of the church repeatedly forbade the medical art to those in holy orders or under vows; but that this prohibition{072} was often violated is shown by the frequent reiteration of inhibitory laws. During the twelfth century the secular authority was also affected by abuses. Roger, founder of the kingdom of Sicily, one of the first Christian princes of the Middle Ages, gave special attention thereto, and in 1140 proclaimed that every one who wished to practice medicine must present himself before a magistrate and obtain authorization, under pain of imprisonment and confiscation of goods. Other sovereigns followed this example, and regulating ordinances were gradually established, which ultimately led to the institution of medical faculties and university degrees. During the Middle Ages, in the Empire of the West, arose the School of Salernum, which became so celebrated that, like that of Alexandria, it deserves special mention. The modern city of Salerno is situated on the Neapolitan Gulf, about thirty miles southeast of the city of Naples, with a population of but a few thousand souls. The ancient city stood upon a height in the rear of the present town, where the ruins of its mediaeval citadel are still to be seen. It first appeared in history 194 B.C., when a Roman colony was founded, was a municipal town of importance, and appears even at this early day to have been a health resort, since Horace informs us he had been advised to substitute its cool baths for the warm ones of Baiæ. During the stormy centuries following the downfall of the Western Empire, Salerno successively submitted to the sway of the Goths, Lombards, Franks, Saracens, and Greeks, as the vicissitudes of Avar compelled. Under the Lombards it became the residence of the Duke of Benevcntum, and, in 1075, when taken by Robert Guiscard of Normandy, it fell to the crown of Naples, in consequence of which in the fourteenth century, the heir apparent of this kingdom took the title of Prince of Salernum. During the Middle Ages here flourished a medical school, important not alone because of its celebrity at the time, but{073} for its effect upon the medical history of the future. Its origin is obscure, though it has been ascribed to Charlemagne in 802; again, its founding has been held to be the work of fugitives from Alexandria when that city was captured by the Saracens, 640 A.D.; some attribute it to the Benedictine order of monks, others to Saracens, etc. The foundation by Alexandrian fugitives is probably conjectural, yet it must be admitted there is some evidence of knowledge of Arabian medicine in Salernum as early as this. Be the origin what it may, it is certain that the Benedictine monks exercised a very important influence upon this school, and there is considerable reason to think that it was really originated by them. Their monastery of Monte Casino was located about fifty miles the other side of Naples, occupying the site of an ancient temple of Apollo; the rules of the order enjoined the care of the sick and treatment by prayer, and St. Benedict himself was credited with performing miraculous cures. The rules which forbade public instruction were gradually discarded, for in the ninth century Abbot Bertharius wrote two books on the art of healing, and by the tenth century Monte Casino had acquired great reputation as a medical school, and was sought by medically-inclined monks from all quarters. A little later (1022) King Henry II, of Bavaria, Emperor of Germany, is said to have been cut for stone by St. Benedict himself, who appeared in ghostly form and operated with such skill that on awaking the royal patient found the calculus in his hand, and only the cicatrix of the wound through which it had been removed. Of course, the grateful emperor could do no less than richly endow the monastery, and bestow upon it additional privileges. Desiderius, the Benedictine abbot from 1058 to 1086, and in the eleventh century promoted to the papal chair under the title of Victor III, was distinguished for his attainments in medicine and in music, and founded a new hospital in connection with the monastery; he also composed four{074} books detailing the miraculous cures wrought by his patron saint. It was really within this monastery that Constantine the African, one of the most learned men and the most famous Christian physician of his time, compiled his numerous medical treatises. About Constantine there is much of romance. He was born in Carthage in 1018 and died in 1085. He visited all the prominent schools of his day in Egypt, Bagdad, Babylon, and even India, and for thirty-nine years pursued the various branches of knowledge away from home. Returning to Carthage, misunderstood and feared, he was accused of practicing sorcery and compelled to fly to save his life. Disguised as a beggar he escaped to Salernum, which had been recently captured by Robert Guiscard, and on the recommendation of some royal visitor, who had known him at another court, he was made private secretary to Guiscard. His new duties soon became irkscme, however, and he retired to a cloister to devote himself to literary labors. These, for the most part, were translations of Greek and Arabic writings, often made _verbatim_ and without credit. Whatever may be said about this lack of honesty, and the barbaric nature of his Latin, credit must be given him for reviving the study of Hippocrates and Galen in France; and he is generally credited with being the first to introduce into Europe knowledge of Arabian medicine. From Monte Casino the Benedictines at an early day spread to Salernum, where, by the middle of the tenth century, three monasteries were established, in all of which were kept holy relics. It now appears that, although there may have been some previous institution of learning at this point, and possibly even medical teachers, the real organization of a regular school of medicine was due to the Benedictines. In the annals of Naples of the middle of the ninth century the names of Salernian physicians are mentioned; and it is known that toward the close of the tenth century{075} Archbishop Verdun visited Salernum for relief from vesical calculus, and there died. The earliest medical writings of this school which have been preserved are found in the _Compendium Salernitanum_, discovered in manuscript form in 1837; and among the more prominent authors quoted are: Petronius, who wrote about 1035; Gariopontus, who wrote about 1040; Bartholomæus, Ferrarius, and Affiacius,--the latter a disciple of Constantius Africanus. The preaching of Peter the Hermit, which marked the close of the eleventh century, was followed by an outburst of crusading enthusiasm that quickly converted Europe into a vast camp, and Salernum, being situated upon the highroad to the East, was benefited in no small degree and its reputation as a medical school materially enhanced; likewise its teachers gained in experience as regards military surgery. In this way it became a favorite resort for crusaders when disabled, wounded, or diseased. Robert of Normandy, son of the conqueror, returning from the Holy Land, remained here for some time with a poisoned wound in the arm, received in 1097 at the siege of Jerusalem, and it was decided it could be healed only by sucking out the poison, a process deemed dangerous to the operator. History declares that Robert's wife, daughter of Goeffrey, Earl of Conversana, being denied permission, took advantage of her husband's unconsciousness during sleep to withdraw the poison, when the wound speedily healed. At the time of the departure of Robert, hastened by the death of his brother William, John of Milan, the then chief of the medical school, presented him with the famous _Regimen Sanitatis Salerni_, said to have been composed largely for Robert's benefit. This was a Latin poem that enjoyed most unexampled popularity for many generations, and was the _vade mecum_ of well-educated physicians for centuries. It is said to have passed through two hundred and forty different editions, and that more than one hundred manuscript{076} copies are to-day to be found in various European libraries. The latest English version was published by Professor Ordronaux in 1871. A sample is here submitted:-- "Salerno's school in conclave high unites To counsel England's king, and thus indites: If thou to health and vigor would'st attain, Shun mighty cares; all anger deem profane; From heavy suppers and much wine abstain; Nor trivial count it after pompous fare To rise from table and to take the air. Shun idle noonday slumbers, nor delay The urgent calls of nature to obey. These rules if thou wilt follow to the end, Thy life to greater length thou may'st extend." During the twelfth and thirteenth centuries the glory of the School of Salerno reached its zenith; it was the most famous school of medicine in Europe, and was fostered by various kings. The celebrated Jew, Benjamin of Tudela, traveling from Spain to India, visited Salernum in 1164, and called it the "principal university of Christendom." Early in the twelfth century flourished Cophon, Archimatheus, and Nicholas, surnamed Præpositus, all of whom were distinguished teachers. The latter published a work known as _Antidotarium_, which was for several centuries the standard pharmacopoeia, and which contained a table of weights that corresponded very closely to those of the modern apothecary. The younger Cophon, who has been confounded with his father (as both seem to have written extensively), wrote two treatises,--one on the anatomy of the hog, the other entitled _Ars Medendi_. The first is interesting as the only anatomical treatise of this school which has been preserved, and is an index of the degradation of anatomical science of that time. The names of John and Matthew Platearius are of frequent occurrence in the records of this school, and have given rise to considerable confusion; the former is supposed to have{077} been the husband of Trotula, a female physician, of whom I shall have more to say later. Bernard the Provincial, who seems to have escaped the notice of most historians, wrote about 1155, and his commentary offers much interesting information concerning the therapeutics of the day; he formulated a large number of recipes to enable the sick to escape the omnipotence of the apothecaries, and recommended wine for the delicate stomachs of the more exalted of the clergy, and, inasmuch as these stomachs did not bear medicine well, he directed, in accordance with the practice of Archbishop Æfanus, that emetics should be prescribed _after_ meals, when their action is less injurious and more agreeable; he advised young men and women tormented with love which they could not gratify to tie their hands behind their backs and drink water from a vessel in which a red-hot iron had been cooled. Indeed, his work is full of curious information and advice, and is not without therapeutic interest. A name which figures largely in the history of this school is that of Magister Salernus, about which there is great uncertainty; it is not positively known whether this refers to a particular person or is a generic name covering various individuals. The name has been mentioned as that of one of the four reputed founders of the school; it is positive that there are certain treatises which bear this name, which give an appearance of authenticity to it as an individual title. In the latter half of the twelfth century lived John of St. Paul, one of the teachers of Gilbert the Englishman; also Musandinus, who left a curious treatise on dietetics; and Urso, who wrote on the pulse and on the urine. Here in 1190 resided and studied a certain Alcadinus, from Syracuse, whose knowledge of philosophy and medicine was such that he acquired great reputation, and was made a professor; he even composed Latin medical poems. Just at the close of this century flourished Ægidius, who studied{078} at Salernum, and also at Montpellier, where a school of medicine had been founded in 1180; he was physician to Philip Augustus, of France, and became professor in the University of Paris. Three treatises, all in Latin hexameter, are ascribed to him. A contemporary was Johanes Rogerus, of Palermo, a graduate of Salernum and author of several works. Early in the thirteenth century flourished Roger of Parma, one of the most distinguished of the alumni of this school and the earliest pioneer in modern surgery; his work on this topic, familiarly known as _Rogeriana_, enjoyed the greatest reputation in its day, and was for a long time the surgical text-book of Italy; his predilection for poultices and moist dressings in the treatment of wounds, abscesses, and ulcers became, in the hands of his successors, the distinguishing feature of the surgery of Salernum in opposition to the school at Bologna, where Hugo Di Lucca and Theo-doric (his great rival) contended for the superiority of the dry treatment. Roger was also the first to use the term _seton_, and to give practical demonstration to this means of derivation. Roland of Parma, a pupil of Roger, and a surgeon of great distinction, became professor at Bologna, and wrote a treatise on surgery, which was, for the most part, a commentary on the works of his master. The treatise of Roger and that of Roland furnished the basis for a work entitled _The Treatise of the Four Masters_, supposed to have been written about 1270, and manuscripts of which have been long known in various European libraries. It is divided into four books, displays no little surgical ability, and from its title would appear to have been the joint composition of four teachers; indeed, it was long attributed to Archimatheus, Platearius, Petro Cellus, and Affiacius, though it is now pretty generally understood to be the product of but a single pen and its author most likely a Frenchman. The ascription of authorship to four masters was probably for the purpose{079} of increasing its weight and authority, and it constituted a reliable exposition of the surgery of Salernum in its day. It is quoted quite freely by Guy de Chauliac, who was the restorer of French surgery in the fourteenth century, and occasionally by later writers. Another of the distinguished Salernian physicians of the thirteenth century, one highly esteemed by Frederick II, was John of Procida, who also was active in producing--if not the real author of--the massacre of the Sicilian Vespers, A.D. 1282. In a dispute concerning the question of the two Sicilies he embraced the cause of Prince Manfred, for which he was banished by Charles of Anjou, and took refuge at the court of Peter III, of Arragon, by whom he was created a baron; and he was influential in persuading the latter to assert his claim to the throne of Sicily. By various intrigues at different courts he succeeded in organizing an alliance, which betrayed its existence in this massacre, and finally resulted in the overthrow of the French in Sicily and the transfer of the island to the crown of Spain. He was author of at least two treatises devoted to medicine and philosophy. Other writers of the School of Salernum were: a learned Jew of Agrigentum known as "Farragus," Matthew Sylvaticus, Graphæus, and Cappola. About the middle of the fifteenth century flourished Saladino, famous as an authority on materia medica. It is of no small interest that now, for the first time in history, women began to figure somewhat prominently as writers, practitioners, and even teachers of medicine. About the middle of the eleventh century appeared a work, entitled _De Midierium Passionibus_, attributed to the before-mentioned Trotula, wife of John Platearius, which has descended even to these days. There is nothing in the work to indicate the name or sex of the author, who is invariably spoken of in the third person; consequently Trotula's connection therewith has often been disputed. It mentions{080} a certain "_aqua mirabilis_" composed largely of brandy, which spirit is said to have first been employed medicinally by Thaddeus of Florence, who died in 1295; there is also an account of a patient who _wore spectacles!_ The diseases of women and children are also largely dealt with. The work is undoubtedly an anonymous production of the eleventh century, disfigured by additions of a later day, and ascribed to Trotula, perhaps, because of the celebrity that attached to her; at all events, it is the earliest work ascribed to a female physician, and thus possesses special claims to interest. Later we read of Sichelguada, wife of Robert Guiscard and a graduate of Salernum, who endeavored to poison her step-son, Bohemond, in order to secure the succession of her own child. This infamous plot was furthered by some of the Salernian physicians, and thwarted only by the prompt action of Guiscard, who swore he would slay his wife with his own sword should the malady of Bohemond prove fatal. Certain other female physicians of this period are mentioned, notably Abella, who, in spite of the modesty that is supposed to hedge about her sex, produced in Latin hexameter a work entitled _De Natura Seminis Hominis_. Mercuriolus, in the fifteenth century, produced treatises on the cure of wounds, pestilent fevers, and on the nails. The most celebrated of all, however, appears to have been Calenda, who lived during the reign of that notorious profligate, John II, of Naples (1414-1435), and who was particularly distinguished for her personal attractions. She graduated with great honor from the school at Salernum, and soon after, in 1423, married a nobleman of the court, which perhaps accounts for the fact that she never exercised the privilege of authorship. A little later, Marguerite, of Sicily or Naples, also a Salernian graduate, acquired an extended professional reputation, and was licensed to-practice by Ladislaus, King of Poland. Daremberg{081} informs us that there were numerous female physicians at Salernum, much sought after because of their talents, and, moreover, highly esteemed by the professors of the school, who freely quoted the writings of their fair pupils and contemporaries; further, that they employed ointments in paralyses; fumigations, vapors, and antimony for coughs; and lotions of aloe and rose-water for swellings of the face; they combined scientific knowledge with facetious playfulness in a manner peculiar to the sex, in that they tendered unsuspecting beaux bouquets of roses doctored with powdered euphorbium, and hugely enjoyed the forced sternutations of their victims. It will thus be seen what a wide-spread and long-continued influence the school of Salernum exerted. At first physics and philosophy were the principal branches taught, but later the other sciences were cultivated. The Emperor Frederick II united the different schools of the city into a university,--a term, however, that, as then applied, appears to have corresponded to what in the nineteenth century is understood by _corporation_. The emperor likewise published several decrees which revised the duties and privileges of practitioners of medicine and surgery in his kingdom, and, in 1224, ordered that no person should practice within the two Sicilies until examined by the faculty of the university and licensed at the royal hands; further, practitioners were compelled to devote at least one year to the study of anatomy. The faculty at this time consisted of ten professors, whose salary probably depended upon the number of pupils. A candidate for graduation was required to present proof of majority, of legitimacy of birth, and of proper duration of preliminary study, and then was examined publicly in the _Synopsis_ of Galen, the _Aphorisms_ of Hippocrates, or the Canon of Avicenna. On passing he swore to conform to all the regulations hitherto observed in medicine, to give gratuitous treatment to the poor, and to expose all apothecaries detected{082} in adulterating drugs. A book was then placed in his hands, a ring upon his finger, and a laurel crown upon his head, when he was "dismissed with a kiss." The degree conferred was that of "_Magister_"--the modern title of Doctor being at that period employed almost exclusively to designate a public teacher or professor. But the watchfulness of King Frederick was not confined alone to the regulation of medical study within his kingdom. The number of professional visits, and the recompense therefor, were fixed by law. Every physician was compelled to visit his patients twice daily, and even once at night as well, if summoned, and for this attendance was permitted a daily fee equivalent to fourteen cents for patients within the city, while for calls without the city the largest legal charge was one dollar and thirteen cents, provided he paid his own expenses. The earlier teachings and practice of Salernum were a curious mixture of methodism, dogmatism, and superstition. The latter may be better understood when it is recalled that the practice of medicine for an extended period was confined almost exclusively to ecclesiastics, who by their very education were prone to superstition and upheld the efficacy of charms and relics, and the active intervention of saints and martyrs as well as the myrmidons of evil; hence arose many of the conflicts and absurd notions peculiar to the period. The prevalence of the doctrine of medical methodism was due to the character of the writings most accessible to students of that day,--such as those of Ccelius Aurelianus and others; and it is curious that Celsus, the most elegant of medical authors, was never popular among medical monks. The Hellenic language having almost disappeared from Italy by the sixth century, the works of the Greek authors had become a sealed book to a vast majority, even of the better educated; hence the purer sources of medical knowledge were not available. Although the school of Salernum, at a later date, prided{083} itself upon its devotion to the "Father of Medicine," the Hippocratic writings were not known at this period; and, when Constantine the African, by the translation of Arabian works, introduced a new element into the Salernian school, he ingrafted upon its medical teaching a form of doctrine which found a congenial atmosphere, in which it throve vigorously, while, a century later, the translations of Gerard of Cremona gave a stronger impulse to the growth of Hippocratic medicine than to Hippocratic doctrine. From the _Commentary of the Four Masters_ we learn that Salernian practitioners recognized the diagnostic importance of nausea, vomiting, and the flow of blood from the ears in injuries to the head; that they resorted to the trepan for depressed fractures and the relief of intracranial extravasation; that hernia cerebri was treated by pressure and caustics; that ligatures, both above and below the opening, were applied for the treatment of wounds of the carotid arteries and jugular veins. It was advised to decline patients suffering from wounds of the heart, lungs, diaphragm, stomach, or liver, in order to avoid the disgrace of losing them; and in penetrating wounds of the intestines and in those complicated with protrusion of the wounded gut instruction was given how to envelop them in the warm abdomen of a slaughtered animal until natural color and temperature were restored, and then to insert a cannula of alder-wood into the wounded intestine, which was to be neatly closed and stitched; finally, the protrusion was to be carefully washed with warm water and returned into the abdominal cavity, enlarging the opening for this purpose, if necessary. Also was advised the extraction of diseased teeth; and the operation of lithotomy was described with considerable care. Compound fractures were to be treated with splints. On the whole, this commentary of the alleged Four Masters is the most interesting and ancient Salernian work which has been{084} preserved, and is well worthy the attention of even modern surgeons. Such was the school of Salernum in its prime, during the twelfth and thirteenth centuries. My readers will not have failed to note how few names have been mentioned which are prominent in medical history, and how few improvements were made in medical art by those who have been mentioned. One naturally inquires, then, what was the source of the wide-spread fame of Salerno as a school, since it was distinguished neither by notable discovery in science nor by celebrated teachers, and the predominant element was doubtless one of obstinate conservatism and unswerving devotion to ancient doctrines. Founded during the dark period of the Middle Ages, at a time when ignorance, bigotry, and superstition prevailed, it preserved, amidst the gloom that had settled upon Europe, a few rays of that intellectual light which had shown so brightly in the golden ages of Roman history. These rays, made more conspicuous by the intellectual night which they barely illumined, were a beacon for men who were groping for more light. Thus the name of Salernum became synonymous with intellectual advancement in later ages. As the parent and model of our modern university system, Salernum yet deserves, in a measure, to enjoy the esteem of a numerous scholastic offspring. At a time when priests were particularly active in passing off rudimentary knowledge for the science of healing this school began to secure all information possible from the laity for the progressive development of medicine. It began, in other words, to hold aloof and then to break away from the fetters of a fanatical church. Its decline, too, was as rapid as its career had been brilliant. One very serious blow was struck when, in 1224, Frederick II founded the University of Naples and forbade Neapolitan subjects to seek instruction at any other university. The next year a revolt in the city provoked the closure of the schools{085} of Bologna, which were, however, opened again two years later. Within a short time the universities of Naples, Montpellier, Padua, Paris, and Bologna all entered into a contest for pre-eminence with a rivalry which was not always generous. In 1224, it is said, the latter university had no less than ten thousand students. Happily, however, the period of the Renaissance proved to be one of emancipation from the fetters of ignorance and superstition, making an appeal for liberty which the conservatism of Salernum could not brook. Roger Bacon, in England; Lanfranc and Guy de Chauliac, in France; Mondino, at Bologna, and Savonarola, at Padua, found no rivals at Salernum to successfully contest their fame. Thus this ancient school fell behind the age, and in a short time sank into a mediocrity which was scarcely brightened by the reflection of a departed glory. In 1342 Robert I renewed the decree of Frederick II, which closed all the schools in his kingdom save those of Naples, but excepted Salernum solely because of its antiquity and the traditions of his predecessors. In 1413 King Ladislaus excepted the Salernian alumni and professors from all taxes, duties, and tribute. In the middle of the fourteenth century the poet Petrarch speaks of the school as a memory of the past; but its last appearance was in 1748, when a dispute at Paris relating to the rank of physicians and surgeons was referred to Salerno's university for arbitration and final decision. In 1811 a formal decree reduced this parent of all European universities to a mere gymnasium or preparatory school; and now one may wander through the streets of the modern town and among the ruins of its ancient predecessor and seek in vain to trace some reminder of those who were illustrious during some of the most terrible ages in the world's history. No echo of tradition, no stone of ancient edifice, no library preserving precious manuscripts, not even an edition of the old Salernian regimen, in the whole city; in fact, none now so poor as to do it reverence. CHAPTER IV. _Age of Transition (concluded).--The School of Montpellier: Raimond Lulli, 1235-1315. John of Gaddesden, 1305--(?). Arnold of Villanova, 12341313. Establishment of Various Universities. Gerard of Cremona, 1187. William of Salicet, 1280. Lanfranc, 1315. Mondino, 1275-1327. Guy de Chauliac, 1300-1370. Age of Renovation, 1400 to Present Time.--Erudite Period, including Fifteenth and Sixteenth Centuries. Thomas Linacre, 1461-1524. Sylvius, 1478-1555. Vesalius, 1514-1564. Columbus, 1490-1559. Eustachius, 1500-1574. Fallopius, 1523-1562. Fabricius ab Aquapendente, 1537-1619. Fabricius Hildanus, 1560-1634._ Although{086} I have taken up so much time with an account of the school of Salernum, a few words must be devoted to the school of Montpellier, which was second in time and in importance among the great influences in the culture of western Europe. There was a time when to have studied there lent a special halo of glory, for, being near the sea, and in the vicinity of thermal baths, even so early as A.D. 1153 it was famous as a school of medicine; moreover, those who presided over it did not lapse unconditionally into mediæval philosophy, with its bewildering subtleties. It is said to have been founded A.D. 738, but first mention of it as a source of medical education occurs in 1137, when Bishop Adelbert II, of Mayence, visited the city to listen to its medical teachers. A faculty of philosophy was added in 1242, and one of law in 1298. Within the walls of the city sojourned both Christians and Jews, the latter being subject directly to the civil authorities, and particularly esteemed as translators. One of the most famous of the sons of Israel was Profatius Judicus, who became a rector of the faculty. Prior to 1370, when the university became subject to the kings of France, it was under the control of the Pope; and then, as now, the school of medicine was the chief ornament of this ancient seat of learning. One of the most illustrious and famous pupils of Montpellier{087} was that religious mystic and alchemistic visionary, Raimond Lull, or Lulli, a would-be transmuter of metals and seeker for the philosopher's stone. Born in 1234, at the age of thirty he began to see visions, and was thereby roused from an atheistic tendency to soon become wonderfully pious; ultimately he entered the order of Minorites, studied Arabic, and appeared as a missionary in Africa, seeking to convert the Saracens--who, however, declined the honor, and finally (in 1315) rewarded his zeal by stoning him to death. Beside works on alchemy and theology, he wrote on medical subjects, and, like all great minds of the period, passed among the common people as a sorcerer in league with the devil. Nevertheless, he was a notable figure in his age and country. Quite celebrated became the compendium of Gilbert of England (1290), which contained the same speculative nonsense, the same polypharmacy, and the same superstition as other works of that time; what little it contained of value was taken largely from other writers. While this Gilbert, often known as Gilbertus Anglicus, was not the first English writer on practical medicine, he was the earliest whose works have been preserved. Still more famous was John Gaddesden, physician-in-ordinary to the King of England, professor in Merton College, Oxford, who wrote the famous treatise known as _Rosa Anglica_, which appeared between 1305 and 1315. This treatise was characterized by mysticism and disgusting therapeutic measures, and tainted by medical avarice, superstition, and charlatanry. Gaddesden was, perhaps, the first to formally recommend the "laying on of hands" by the king for the cure of scrofula (first performed by Edward the Confessor--1042-1056), whence comes the ancient name for this disease,--i.e., "king's evil." * *A special "Service of Healing" was used in the English Church under Henry VIII, 1484-1509. Arnold{088} de Villeneuve (1234-1313) studied seven years at Montpellier, twenty years at Paris, visited all the universities in Italy, then went to Spain to levy on the Arabian authors. He wrote on medicine, theology and especially on chemistry--in which art he obtained great renown both as an author and teacher. To him is due the discovery of spirit of wine, oil of turpentine, aromatic waters, besides several preparations of less note, and the introduction of chemical compounds into therapeutics. His was a very stirring life, for he traveled extensively; he became a teacher at Bologna, and physician to Peter III, of Arragon. Shortly before his demise he went to Paris, having fallen under the ban because of a declaration that papal bulls, far from being sacredly inspired, were human works, and that acts of charity were dearer to God than hecatombs, etc. He finally perished by shipwreck, but the spirit of fanaticism followed him after death, for his volumes were condemned by the Inquisition, because they commended experiments rather than mere speculations. In spite of his general honesty in accordance with the spirit of the times he inculcated deceit in medicine, and one of his declarations is: "If thou canst not find anything in the examination of the renal secretion, declare that an obstruction of the liver exists. Particularly use the word 'obstruction,' since it is not understood, and it is of great importance that people should not understand what thou say est." He was one of the first to administer brandy, which he regarded as the elixir of life--whence the modern _Eau de Vie_. Connected with this school, also, or well known as having studied there, were many men whose names became more or less famous--among them John Arden, who settled in London about the middle of the fourteenth century; Vinario, a contemporary of Guy de Cliauliac, and the well-known surgeon and anatomist Henri de Mondeville, who was a teacher of Guy de Chauliac. But an idea of the doctrines prevalent in the medical literature of this part of the{089} world, at this time, may be had from the fact that most writers chose titles for their works after the style of ballad singers: for instance, those describing the plague and venereal diseases were called _Flowers and Lilies of Medicine_; the _Rosa Anglica_ of John Gaddesden was another example. Matters had arrived at such a pass, indeed, that men of science no longer hesitated to confess superstition and mingle it openly with deceit, to oppose the interests of the most needy, and to extort from their fellow-creatures fees in proportion to their supposed ability to pay. In the time of Charlemagne each cathedral possessed a school in which were taught arithmetic, theology, singing, and sometimes medicine; the Episcopal College had medical teachers who gave advice and dressed wounds at the doors of the Church of Notre Dame, Paris; but when the medical profession had been divorced from the sacerdotal by councils and popes, many of these cathedral schools closed. In order to preserve the jurisdiction which they for a long time had exercised over the learned professions, many were erected into universities, and thus the clergy gave instruction in philosophy, theology, and later in medicine. During the thirteenth century arose many of the great universities in Europe, notably those of Bologna, Padua, and Naples, in Italy; of Paris, Montpellier, and Toulouse, in France; of Valencia and Tortosa, in Spain; of Oxford, in England. Pope Innocent III by papal bull guaranteed that the professors and students at Paris should be exempt from all excommunications save those which emanated directly from the Holy See; French sovereigns conferred many privileges upon the universities, and soon the members of the University of Paris formed practically a second city, with its own laws, customs, police, citizens, and magistrates. Still, however, all science belonged to the clergy, and its teachers, though removed from the cloister, were none the less Roman Catholic; so that the popes reigned over the people through the parish clergy, and over{090} the latter by the clerical teachers and professors. Nevertheless, in all candor it must be acknowledged that these studious men, thus associated together for mutual instruction and emulation in learning, contributed, in a large measure, to elevate Christian civilization above all others, though several generations were required to secure the results calculated to make men celebrated; hence the early periods of the universities developed very few names. Many were conspicuous by their love of instruction, but not by originality of research. Men undertook expensive and wearisome voyages without encouragement or hope of reward, simply to obtain some rare manuscript or to hear some renowned professor; and they appeal to us of the nineteenth century by their devotion, if not by the results of their work. Among the somewhat scattered and more or less eminent men of this period was Gerard, of Cremona in Lombardy, a man of great purity and studiousness, who arduously pursued all that Latin authors could teach him, and, not being able to procure in Italy certain manuscripts which dated from the time of Ptolemy, determined to go to Toledo in search of an Arabian translation. At this time he was unacquainted with Arabic, but soon mastered it, and--armed with this powerful resource, which no other physician had possessed since the time of Constantine the African--he could not see so many Arabic works devoted to all branches of science as were gathered at the Spanish University without a desire to translate and transmit the same to his own country; hence he gave the remainder of his life to this work. He rendered into Latin the treatises of Hippocrates and Galen, of Serapion, and of all the famous Arabian authors from the time of Phazes, including the _Canon_ of Avicenna and the work on surgery by Albucassis. He died at the age of seventy-three, in 1187, at Cremona, and left all his books to the monastery of St. Lucy, within whose walls he was buried. William{091} of Salicet, born at Plaisance in the first years of the thirteenth century, became a professor in the University of Bologna, and later at Verona. He wrote extensively on medicine, and earned a reputation as a surgeon that preserves his fame to the present day. It is claimed that his status in medical literature depends, in large measure, upon the fact that he was, perhaps, the first to refuse slavish obedience to preceding authors, preferring, instead, to draw upon the results of personal study and experience. He died in 1280. Lanfranc, or Lanfranchi (according to whether one prefers his French or Italian name), studied under William of Salicet. Of his early life very little is known, save that he practiced surgery in Milan at the time of the great dissension between the Guelphs and Ghibellines, and, for attaching himself to the weaker party, was exiled and forced to seek an asylum in France; he resided in Lyons for several years, and here wrote a work on minor surgery; in 1295 he went to Paris on the invitation of the faculty of medicine, opened a course on surgery which met with great success, and then published a second and larger treatise on the subject. It is said of him by Malgaigne that, less from his fault perhaps than that of his age, after his death (about 1315) surgery began to decline. From the time of Brunus, who practiced in Padua in 1250, the barbers had done the scarifying and bleeding. After the time of Lanfranchi there were others who applied leeches and often cauteries, and even the women meddled with surgery and in all operations competed with the barbers; the lay surgeons held themselves rivals to the clergy. Lanfranchi inherited from his old master, William, an aversion for them all, and often had to contend with uneducated and incompetent laymen. Clerical surgeons regarded operations as beneath their dignity; and Lanfranchi, who deplored this condition of affairs, confessed he had sometimes bled with his own hands, but had never operated for ascites, hernia, cataract, or stone. John{092} Pitard has descended to fame not as a writer, but as the founder of the surgical schools of St. Come and St. Damien, which occupy so eminent a position in the surgical annals of France. In 1306 he was surgeon to the King of France, Philip le Bel, and the sworn surgeon of Chatelet. The College of St. Come, in 1311, was only a little brotherhood of lay-surgeons, who gradually grew in importance as the result of the obstinate struggles sustained,--on the one hand, against the faculty of medicine, and, on the other, against the barber-surgeons. Malgaigne has, with great patience and clearness, shown that the importance of this body of men has been greatly exaggerated by historians; he has traced their various turns of fortune from beginning to end; I shall have occasion to consider them again farther on. Mondino, sometimes known as Mundinus, born in 1275, became a professor in the University of Bologna, and died in 1327. He was the author of a celebrated treatise on anatomy, said to have reached twenty-five editions, and which was the first of its kind since Galen. This science had been greatly neglected; in Salernum, for instance, they were, for a long time, contented with the treatise of Copho on the anatomy of the hog, and most of the anatomical knowledge of the age was apparently derived from this source; Mondino resurrected the study and pursued it with interest and enthusiasm, though under the greatest difficulties. His works for more than two centuries, along with the writings of Galen and the Arabic authors, served for anatomical demonstration, although very incomplete,--as witness the statement:-- "Beneath the veins of the forearm we see many muscles and many large and strong cords, of which it is not necessary to attempt the anatomy on such a corpse (i.e., a recent one), but on one dried in the sun for three years, as I have shown otherwise, in developing the number{093} and the anatomy of those of the superior and inferior extremity." On the other hand, he took the opposite course to discover and demonstrate the nerves, and advised maceration in running water. It required almost superhuman boldness to substitute demonstrations on the human cadaver for those upon swine, yet this was done by Mondino; and at the time the prejudice against dissection was so general that for more than a century after Mondino--who died in 1327--no one dared, at least publicly, to emulate his example. It was in the year 1315 that he publicly dissected the bodies of two women in Bologna. Anatomical study was further complicated at this time by certain bulls of Pope Boniface VIII, forbidding evisceration or boiling or cooking any part of the human body; these deliverances were really aimed, not against scientific investigation, but at the absurd custom introduced by the crusaders of cutting up and boiling the bodies of their relatives who died in infidel countries, in order to send them home for burial in holy ground; nevertheless, the papal injunction certainly operated to discourage and prohibit anatomical dissection, since nearly two hundred years later the University of Tübingen was obliged to apply to Pope Sixtus IV for permission to authorize dissection. Guy de Chauliac, born in Gévaudan about 1300. was the most famous physician and surgeon in Christendom during the Arabic period. He studied at the cathedral college of Mende, which at that time was quite celebrated, and was taught medicine at Montpellier under the best masters of his day. It is probable, also, that he studied in Paris, and certain that later, in Bologna, he saw dissections made. Dissatisfaction with the writings of the ancients and the knowledge which he obtained at the schools stimulated his own powers of observation, and he became, in every respect, an original student and acquired a degree{094} of erudition far more extended than that possessed by any of his contemporaries. He practiced in various places, longest at Lyons; and finally entered the service of Pope Clement VI, at Avignon, and probably enjoyed the same honor under Innocent V and Urban V; when the latter was made pope, in 1362, de Chauliac became his chaplain, or chapel-reader. In 1363 he published a work on surgery called _The Inventory_, upon which his fame chiefly rests, though several other volumes emanated from his pen. None knew better than he how to unite respect for the ancients with justice toward contemporaries, and he cited a large number of Greek, Arabian, and Latin authors, some of whom are now utterly unknown. The sciences, he declared, are "created by successive additions; the same man cannot lay the foundation and perfect the superstructure. We are as children carried on the neck of a giant; aided by the labors of our predecessors we see all that they have seen, and something beside." In tracing the character of a surgeon he recommends that he be "learned, expert, ingenious, bold where he is sure, timid when in doubt, avoiding bad cures and practices, being gracious to the sick, generous and compassionate, wise in prediction, chaste, sober, pitiful, and merciful; not covetous nor extortionate, but receiving moderate fees according to the circumstances of his patients, the character of the case, and his own dignity." "Never since Hippocrates," says Malgaigne, "has medicine learned a language stamped with such nobility and in such few words." Although a follower of Galen, in anatomy he insisted on the necessity of dissection, and proposed to make use of the corpses of executed criminals for this purpose. The drawings made by Henri de Mondeville were known to him; he divided abscesses into hot and cold, although among the latter he included oedcma, tympanites, dropsy, scirrhus, and other conditions. In practice he was more timid, yet more active,{095} than Lan franchi, who never cut for stone, but left that operation to the traveling surgeons. De Ghauliac described it as he had seen it performed; he opened the abdomen for dropsy, did not hesitate to attempt the radical cure of hernia, and operated for cataract. The plague which raged during the fourteenth century and depopulated the known world of one-fourth of its inhabitants, twice appeared in Avignon while Guy de Chauliac was a resident there--and he acknowledges that nothing but shame prevented him from fleeing. He remained at his post, visited the sick, and was himself attacked and left for dead. "In this frightful position he had sufficient presence of mind to follow the peculiarities of his case, analyze his own sufferings, and to give a description of them worthy of Hippocrates" (Renouard). His work soon became the surgical code of Christendom, and was commented upon and translated into all tongues, remaining for a long time a classic, and even at this day it preserves much of its interest as representing the condition of medical science at the close of the Middle Ages; moreover, its literary style was much superior to that of any of his contemporaries, all of whom wrote very barbarous Latin. He died about 1370. With the death of de Chauliac terminates our interest, not merely in the Arabian physicians and those who were intimately connected with them, but in the so-called Arabic Period. It may be added, in passing, that the followers of Mahomet, like those of Christ, erected by the side of each of their mosques a school, and often a hospital, endowed with more or less generosity by caliphs or the wealthy, who hoped to purchase redemption and eternal happiness by such liberality. A certain number of religious orders or communities were established during the Middle Ages to give succor to the deserving sick, the most widely known being those of St. Mary; St. Lazarus; St. John, of Jerusalem; and the Daughters{096} of God. To be sure, some, through the endowment of the opulent, became rich beyond all reason, and departed from their primitive purposes, and thus not only excited the covetousness of monarchs, but had even the temerity to resist their authority. This compelled, every now and again, a suppression of some order or institution--partly, perhaps, for laxity of morals, and partly because of their turbulence. Of this period it may be said that charitable zeal for the sick was never more pronounced; princes, bishops, and popes gave examples of devotion by dressing with their own hands the ulcers of lepers--and leprosy was in those days a frightful disease, having been contracted by the crusaders in the Orient, and everywhere spread as they returned, being, moreover, favored by the miserable uncleanliness which was then so common. Ignorance, dread, and fear rendered this disease worse than usual, and it was confounded with other maladies less formidable. It has been estimated that in the fifteenth century Europe harbored no less than nineteen thousand lepers; and that the disease was a great terror is manifest by the excessive caution taken against its spread: its victims were forbidden to enter cities, and on the highway were compelled to stand aside lest they should taint passers-by with their breath; even a healthy person convicted of being touched by a leper was banished from society; any infraction of these rules was punishable by death. It will thus be seen what depth of genuine humanity it required to have anything to do with one of these outcasts. Another institution prevailed widely during these days,--namely, public baths, which were established in nearly every city and increased to such an extent that in the fifteenth century the bathers of Paris constituted a powerful brotherhood, so powerful, in fact, that Jacque Despars, physician to Charles VII, and one of the most renowned professors of the faculty, for speaking openly against{097} the abuse of public baths, was obliged to leave the capital to avoid persecution. A study of the general history of the Arabic Period reveals that the Arabs, previously obscure and uncivilized, emerged rapidly from the demi-savage state, and took the first rank among the polished nations of the world. During the earliest portion of this period these people were religious vandals and destructive fanatics, but later embraced with enthusiasm and persistence a study of the humanities, and endeavored to repair their early ravages by collecting the _débris_ of the literary and scientific monuments of Greece; but, though they cultivated medicine with zeal and success, they added little to the Greek treasures. Later, Arabia was overrun by hordes from the deserts of Tartary, a people yet more barbarous and unknown, who established themselves in all parts of the globe then under Saracenic dominion, and by their brutal despotism degraded the Arabians to a condition approaching that from which they had emerged. This seems to have been ever the result of Turkish conquest. Meanwhile the Greek nation, which was for so many ages at the head of civilization, gradually lost its power, virtue, courage, glory, and independence, and continued to descend, until now it exercises no influence whatever on the course of events. During the course of the Arabic Period only one Grecian physician merits mention on account of his writings, and in these there was nothing-new except what he had borrowed without credit from the Saracens. The Empire of the West,--that is the western part of the ancient Roman Empire,--after subjugation by barbarians from Germany and Scandinavia, fell under a cloud whose darkness overwhelmed it. Its people, however, gradually received new life by commingling their blood with that of the invaders. Later they were able to repulse the Saracens{098} who poured in upon them from Spain; then they turned their armies against each other, and wrought mutual havoc and ruin for several centuries. Again, roused by religious fanaticism, as had been the Mohammedans previously, they rushed by thousands upon the plains of Asia Minor, Syria, and Egypt, which had been for centuries occupied by the Arabs; and their adventures and enterprises, and the new and varied scenes through which they passed, gave rise among the "Francs" to some taste for poetry and works of imagination During the twelfth and thirteenth centuries governments became more stable, liberal institutions were created, the rust of ignorance gradually disappeared, and by the end of the Arabic Period there were really apparent brilliant streaks of mentality in the horizon of the nations of Europe. In this progressive movement the study of medicine shared. In the thirteenth century it was worthily represented in Italy, in Paris, and became established in Montpellier. Notwithstanding, up to this time physicians apparently only knew how to timidly follow in the track of the Arabians, and approached little, or not at all, in their studies, the purer lore of the Greeks. THE AGE OF RENOVATION. This Age of Renovation (extending from the commencement of the fifteenth century to the present time, according to Renouard's classification) is divided into the Erudite Period, comprising the fifteenth and sixteenth centuries, and the Reform Period, comprising the seventeenth and eighteenth centuries, and one should add, in fact, the nineteenth. In general literature this age is known as that of the Renaissance, and is one of whose beginning a great deal has been written, and so much better than I can put it in this brief work, that to general sources I should perhaps refer those who are interested in knowing how and why there came about such a tremendous{099} change in methods and habits of thought and in acquirement of knowledge. But it is the history of medicine that at this time we particularly desire, and our minds must be, in some slight degree, prepared for the great changes to be recounted by some, with the conditions which brought about this revolution. It was truly an awakening in every department of knowledge and along every line of study; it was as if the minds of men had been dormant and lost their power of receptivity, and, after a long period of torpor, awakened in a new atmosphere amid new surroundings; as if there had burst upon them a sudden appreciation of ability to do things hitherto undreamed of, and to acquire knowledge such as hitherto had been possessed by none. Once free from the shackles imposed by authority of the past, these minds severed their Gothic bonds, and started forth in every direction with the ardor of youth and the interest of novelty, all engaging in the general enterprise of erecting from the _débris_ of antique science a new temple to the mind in which to worship. While some delved among the records of the past, others sought to bind the past and present, and others, bolder yet, cut entirely loose from it, rejected all tradition, and would fain have built this temple with entirely new materials. Now, what led to this sudden awakening? Was it chance, or the effect of certain causes which had long been operating'? It has been seen that hospitals and various institutions, whose foundations were dedicated to humanity, were erected in all parts of Europe; that gradually there had come about a better social organization; that there had been a diminution of conflicts between princes and their vassals, and the relations between the two were more nearly at an equilibrium. Moreover, the invention of the compass, which rendered long voyages less dangerous and more frequent, opened up to trade regions hitherto inaccessible or unknown, and attracted interest toward commerce as a means of pecuniary gain. The telescope had been invented, and{100} astronomy was able to seize upon some of the facts by it revealed, and thereby to make more interesting calculations concerning the motions of celestial bodies, and attain a knowledge of our solar system and its laws. Gradually the microscope shed light upon the hitherto unseen; engraving on copper had added its power of illustration to the works of the great writers as they appeared; but above all, that which brought about this condition of affairs was the discovery of the art of printing. The first attempts in this direction were made between the years 1435 and 1440, and by the united efforts of three men, whose names deserve mention so long as their art persists,--namely, Guttenberg, Faust, and Shoeffer. Thanks to them, the same information could be multiplied in manifold form and transmitted to all parts of the civilized globe. In this way intelligence and reason become triumphant; thenceforward the dominion of brute force was broken, and knowledge, because capable of dissemination, became imperishable. At the commencement of the Erudite Period Arabic literature still predominated in medicine. Rhazes, Haly-Abbas, and Avicenna were universally invoked and explained. But a taste for Greek literature began to prevail in the universities of Italy, and was finally extended to every part of Europe, especially after the taking of Constantinople by Mahomet II, Emperor of the Turks, in 1453. This disaster, which at first bade fair to be a mortal blow to Greek literature and language, strange to say, served only to hasten their resurrection in the Occident. Constantinople having been given over to pillage at this time, most of its learned men escaped, carrying with them all manuscripts that could be seized; most of these found refuge in Italy, and enlightened protectors in the allpowerful prince of the house of Medici, in Florence, in the popes at Rome, and in Alphonso, of Arragon, King of Naples and Sicily. Everywhere these fugitives spread the knowledge{101} of the masterpieces of Greek literature and art, and in this way a taste for books, libraries, and sound erudition was diffused, while the Greek and Latin classics were hunted up and published with great patience and ardor; thus the works of the old writers were edited, translated, commented upon, and everywhere disseminated throughout Europe. Among those who devoted themselves to the thankless task of editing, and purifying from interpolations, the works of the classic writers was Nicholas Léonicenus, born near Vincenza in the year 1428, who studied medicine at Padua and taught it for more than sixty years at Ferrara. He possessed great vigor of mind, with purity of manners and serenity of soul, and was the first to translate directly from Greek into Latin the aphorisms of Hippocrates and portions of the writings of Galen. He combated in every way the infatuation of his contemporaries for the Arabians and their lore, and called attention to many of the errors of men who, like Pliny the naturalist, had fallen for lack of fully understanding the Greek authors they compiled. At the ripe age of ninety-six he died, regretted by all. Thomas Linacre, of Canterbury, a contemporary of Léonicenus, though younger (1461-1524), studied first at the University of Oxford, went to Italy in 1484, and in Florence attracted the attention of Lorenzo de Medici, who made him the companion of his own children, to whom he gave the best possible advantages. In due time he returned to England, where his talents speedily won him high station, and he became physician to King Henry VIII, and later to Queen Mary. Linacre was the first Englishman, it is said, who spoke purely the language of the Romans. He translated several books of Galen that are still esteemed; and caused the founding of two chairs, one at Oxford, the other at Cambridge, whose incumbents were charged with the duty of explaining the works of Hippocrates{102} and Galen. But he is most entitled to the gratitude of his countrymen for his influence in founding the College of London. To appreciate properly its importance and his merits, we must remember the obstacles that had to be surmounted; for at that time bishops alone had the right to accord, in their own dioceses, permission to practice medicine, and, consequently, the healing art was abandoned entirely to monks and illiterate empirics. It was well that Linacre had influence at court, else he could never have obtained the reform of such overwhelming abuses; but he triumphed in spite of powerful opposition, and secured the issue of letters patent which prohibited the practice of medicine by any one who had not received a degree in one of the two universities in the kingdom, and been examined by the President of the College of London assisted by three others. This was the achievement which gave this learned man the title of "Restorer of Medicine" in England. Léonicenus and Linacre, who were of the early Erudite Period, also merit mention not merely because of literary talents, but because they were the first eminent physicians to embrace the study of Greek classics, and to propagate the knowledge therein contained. Subsequently others followed the same course,--too many, in fact, to be enumerated; but it was easy to follow after such leaders. From the time when men began to realize the superiority of Greek models over prolix Arabian commentaries, they were anxious to seek the light at its source, and applied themselves with avidity to the study of the originals. At this time copies of Greek authors were few in number and in a deplorable condition, owing to neglect. To rediscover them, to purify, to eliminate what was not original, to rearrange, and finally to multiply by the aid of the printing-press was an extended labor requiring great knowledge, rare sagacity, and commendable patience. One of the greatest publications in medical literature belonging to this epoch was a complete edition of the Hippocratic writings, translated{103} into Latin by Anuce Foes,--a poor, but learned, practitioner, who lived on the products of his business as pension physician in the city of Metz,--and issued from Frankfort-on-the-Main in 1495. To this master-work Foes consecrated forty years of his life. Another treatise belonging to this same time, less important, perhaps, from a medical point of view, but nevertheless showing great erudition, was a treatise on the gymnastics of the ancients, by _Jerome Mercurial_ is, a work said to be not less precious to historians than antiquarians. It was by such intense zeal and hard labor that true erudition was restored in Europe. Following now some of the special branches of medical learning and their development, let us look first at anatomy and physiology. I have already related the salient points of the life and labors of Mondino, of whom it is said that, about the year 1315, while professor at Bologna, he dissected the bodies of two women, and shortly after published an epitome of anatomy illustrated with wood-cuts. Also has been mentioned the prohibition of anatomical study pronounced by Pope Boniface VIII, in 1300. It was only toward the close of the fifteenth and the early years of the sixteenth century that this prejudice began to abate; the popes, who then stood at the head of scientific movements, withdrew their interdictions, and the universities of Italy gave public dissections. Achillini, Benedetti, and Jacques Berenger dissected at Bologna, Padua, and Pavia, previous to the year 1500; soon afterward their example was generally followed. Jacques Dubois, whose name was Latinized into Jacobus Sylvius, was born in 1478, in a village near Amiens; he studied in Paris, where he worked most industriously at anatomy, which later he was so successful in teaching. He was the first to arrange all the muscles of the human body, to determine their functions, and to give names to those of them which had not yet been so designated. He discovered{104} the valves of the large veins, and was the first to study the blood-vessels by means of colored injections. He gave the same careful attention to pharmacy, and in Paris, before a large class of students, began lectures, on anatomy, physiology, hygiene, pathology, and therapeutics; these he continued until the faculty, on account of jealousy, interrupted them. He then, in 1529, went to Montpellier, but returned two years later to become a member of the faculty, and once more lectured with the greatest eclat. Later yet he became a successor to Vidius in the Royal College,--a position he retained up to his death in 1555. His medical writings were extensive and marked by great accuracy, while for anatomy he did a great deal, contributing much to popularize it. He dissected a great number of animals and as many human cadavers as he could procure, the number, however, being small. Unfortunately, he subordinated all his own research to the authority of Galen, being himself among those anatomists who permitted themselves to be so far misled. [Illustration: 0125] The man of genius and courage, who accepted the truth of what his eyes revealed to him, and who was the true reformer in anatomy, was Andreas Vesalius, born at Brussels, in 1514, of a family already illustrious in medicine. He studied at the University of Louvain, where he early revealed the inclinations of the anatomist, since in his leisure moments he was wont to amuse himself in dissecting small animals. Near Louvain was a place where criminals were executed; and Vesalius, having observed the body of one from which the soft parts had all been cleaned away by ravenous birds, only the bones and ligaments remaining, detached the extremities separately, and then carried off the trunk by night, thus possessing himself of his first skeleton. Attracted by the fame of Sylvius, lie afterward went to Paris to become his pupil, but, not content with the lessons of his master, continued to observe for himself. On the hill Montfauçon, where executions{105} took place, he disputed with dogs and vultures for the remains of criminals, or by stealth disinterred bodies from the cemeteries at the greatest personal risk. So great was his application that his progress became rapid, and at the age of twenty he gave instruction to fellow-students; at twenty-two he became Professor of Anatomy at Padua, being appointed by the Senate of Venice; at twenty-nine he issued his great work on anatomy, which showed a completeness that left far in the rear all that had hitherto been published on this subject. The following year he was called by the Emperor Charles V to the court of Madrid, then the most brilliant in Europe, where he became the first physictan, and from this time abandoned his anatomical labors. [Illustration: 0126] He was the first who dared to dispute the words of Galen and point out his errors,--to ascertain that the greater{107} part of Galen's descriptions, having been made from monkeys, did not correctly represent human anatomy. This audacity raised a crowd of vehement opponents, the least reasonable and most fanatic being his old master, Sylvius; but even these onslaughts could not conceal the truth. The minds of men generally were ripe for the revolution whose signal-fire was thus lighted, and no sooner did Vesalius appeal from the decision of Galen to observation of nature than a crowd of anatomists were ready to follow his method. He died in 1564. One who, at Padua, had been first his pupil, then his co-laborer,--namely, Columbus, born at Cremona in 1490,--succeeded him. Columbus criticised, in some respects, the statements of his eminent predecessor, which he could better do, since he is said to have dissected fourteen bodies every year, as well as to have practiced venesection. He came so near to discovering the mystery of the circulation that it is strange how he could have missed it. He even appreciated the systole and diastole of the heart and the connection thereof with dilatation and contraction of the arteries. He knew, also, that the pulmonary veins conducted arterial blood, and that the pericardium was a shut sac. He even appreciated the lesser circulation, since he described how the blood left the right side of the heart and passed into the lungs, and came back through the veins into the left ventricle; because of this discovery, and in spite of his utter failure to appreciate the greater circulation, he has been by some regarded as entitled to the credit which is universally given to Harvey. From his position as teacher in Padua Columbus was called to Pisa, and from Pisa to Rome, where he died in 1559. [Illustration: 0128] Another of the great anatomists of this period, second only in fame to Vesalius, was Eustachius, born about the beginning of the sixteenth century. He became physician to the Duke of Urbino, and in Rome a city physician and professor of anatomy, continuing to teach in the latter city until{109} overtaken by his final sickness. He was a defender of Galen rather than an opponent, and sought to shelter his reputation from the attacks of Vesalius. In his praise it must be said that, for his day, he was a great anatomist; his chief discoveries were in the domain of comparative anatomy. He brought to bear upon his work a knowledge of embryology which enabled him, for instance, to describe the kidneys and the teeth much more accurately than would otherwise have been possible; he noted, also the pathological changes in bodies dissected, and is brought daily to our minds as we think of the connecting channel between the pharynx and the middle ear, to which his name has been given. He died in 1574. [Illustration: 8129] Fallopius, born in Modena, in 1523, was professor successively at Ferrara, Pisa, and Padua. He cultivated anatomy with the greatest ardor, and, in consequence, his name is also linked with that of Vesalius, as are those of Herophilus and Erasistratus in the history of ancient anatomy. His anatomical researches included all parts of the human body, and his name has been given to the tube through which the ovum enters the cavity of the uterus. Death overtook him in the year 1562. Jerome Fabricius, better known as _Fabricius ab Aquapendente_, was born in the town of the latter name, near the southern end of the Apennines, in 1537, received his no early{110} education in Padua, and studied anatomy under Fallopius, whose assistant he also was. After the death of the latter he succeeded to the professorship of anatomy, and later built, at his own expense, a large anatomical theater, in which he lectured and demonstrated to students from all parts of the world. Toward the end of his life he had accumulated a large number of specimens, and published extensively on anatomy, embryology, physiology, and surgery. Though often accredited with discovering the valves of the veins, he is not entitled to that honor, since Erasistratus, Sylvius, Vesalius, and others had previously described them, Estiennes had seen them in the azygos veins, and Canano in other veins. His true claim to glory rests upon embryological researches, which he was the first to undertake in a comparative way. In _De Formato Foetu_ he elucidated the development of the embryo and its membranes by a long list of observations on lower animals of many species. He was probably the first to describe the uterine decidua. Fabricius died in 1619. This Fabricius must not be confused with the almost-as-renowned Fabricius Hildanus, who was born in Hilden, near Düsseldorf, in 1560. Under the German name of Wilhelm Fabry he became widely known as a surgeon, and, after traveling through France, settled in Hilden, but later moved to Cologne, where he founded an academy. His first treatise--on gangrene and sphacelus--quickly made him known, and went through eleven editions. From Cologne he went successively to Genf, Lausanne, and Polen; returned to Cologne; and finally, after several other visits, settled in Bern, where he died of gout and asthma (in 1634.). His frequent changes of location were, perhaps, less the result of instability than a testimony to his reputation, inasmuch as he was invited from one place to another. He has been, with propriety, named the "German Paré," since he rendered such great service to German surgery,{111} and was not only an expert therein, but likewise a cultivated physician and polished humanitarian; in fact he was ahead of his time, by many years, in these regards, as is shown by his recommending amputation in cases of gangrene, and his writings concerning gunshot wounds. He enjoyed a ripe experience also in obstetrics, and even instructed his wife in the obstetric art and praised her ability most highly. His most important contributions to literature were in the field of surgery, and these passed through numerous editions, while his opinions and practice are quoted even to-day. [Illustration: 8131] During this epoch many modifications were introduced and improvements made in the teaching of medicine. Permanent amphitheaters were established for dissection, and chairs of anatomy created, their incumbents being paid out of the public treasury. The popes, appear to have taken the initiative in this respect,{112} which accounts for the great number of subjects with which Eustachius was supplied, as compared with Vesalius, who obtained only two or three in a year. Up to this time _the razor had been the sole instrument of dissection_, but was now replaced by the scalpel, which remains in use to-day. By the labors of the few men mentioned anatomy acquired a degree of perfection which it had never attained under the Greeks. Skillful artists put their labors upon paper, and plates and descriptions made from anatomical preparations represented the various parts of the human body with more fidelity than had been supposed possible. Nerves, tendons, and ligaments were no longer confused, but traced so far as possible from origin to ramifications. Ancient errors generally were corrected. It was proven that there was no bony structure in the tissue of the heart, that the partition between its cavities was not porous; and attentive examination of its valves led to the discovery of the lesser circulation by Columbus. Michael Servetus, whom John Calvin burned at the stake, was perhaps the first to note this phenomenon. He saw that the blood could not penetrate directly from the right into the left cavity of the heart, but that it was necessary for the whole fluid to pass through the lungs, where it became impregnated with the vital spirit of the atmosphere, and reached afterward the left auricle; the position of the valves in the pulmonary arteries and veins clearly confirmed his conjecture. Moreover the size of the pulmonary arteries was enormous, and disproportionate to the quantity of blood necessary for the nutrition of the lungs, which seemed to prove that this was not, as had been believed, the sole purpose of those vessels. It was about this time that Fabricius ab Aquapendente pointed out valves in veins in various parts of the body, and that Columbus and Andreas Cesalpinus explained more fully the mechanism of the lesser circulation; in fact, the former so closely approached an appreciation of the{113} purpose of the vascular system that some have thought he really knew it, but the passages in his writings thought to sustain this opinion are not at all conclusive. He seems to have confused the action of the heart during sleep with that during the waking hours; and although he realized that the blood could not flow backward through the arteries, that the vena cava was the only vessel which permitted the entrance of blood into the heart, and though he spoke of anastomosis between arteries and veins and remarked that if a band be applied around a limb the veins swell below the ligature, he contented himself with comparing the motion of the blood with the flux and reflux of Euripus, as Aristotle had done. It is even thus that he tortured his mind in trying to reconcile two irreconcilable theories,--i.e., the opinion of the ancients on the motion of the blood and recent discoveries in the anatomy of the vascular system. CHAPTER V. _Age of Renovation (continued).--Erudite Period (continued): Benivieni, 11502. Jean Fern el, 1497-1553. Porta, 1536-1615. Severino, 1580-1656. Incorporation of Brotherhood of St. Come into the University of Paris, 1515. Ambroise Paré, 1510-1590. Guillemeau, 1550-1613. Influence of the Occult Sciences: Agrippa, 1486-1535. Jerome Cardan, f 1501. Paracelsus, 14931541. Botal, born 1530. Joubert, 1529-1583._ In the{114} domain of pathology the Arabs had added only a very small number of observations to those contained in the works of Galen. The most interesting of these pertain to eruptive fevers. Most of their writers contented themselves with making an inventory of the acquisitions of the past, as did Guy de Chauliac, and this was about all they could do under existing circumstances; although they did not make discoveries, they prepared the way for their successors. Two men about this time did a great deal in the direction of creating a desire for post-mortem study of cases, and in illustrating and succinctly describing symptoms. The first of these was Benivieni, a Florentine, who died in 1502--the date of his birth being uncertain. To him, more than to any other, we owe the commencement of the study of gross pathology and pathological anatomy. He was the first to consider the knowledge that might be obtained by opening bodies for the sole purpose of ascertaining the location and cause of the diseases from which they had died. As Malgaigne remarks: "A eulogy which he merits, and which he shared with no other person, and which has not been accorded to him up to this time by the many historians of surgery who have superficially searched among these precious sources, is that he was the first who had the habit, felt the need, and set the useful example, which he transmitted to his successors, of searching in the cadaver, according to the title of his book, for the concealed causes of disease." The work referred to by Malgaigne was{115} entitled: _Concerning Some of the Secret and Strange Causes of Disease_ and was published in Florence in 1507. It is poor in quotations, but rich in original observations, which pertain especially to the etiology of disease, and gives a very concise symptomatology and history of each affection of which it treats, as well as a pathological explanation. Benivieni's observations on gall-stone, on the anatomical lesions of heart diseases, and on the conveyance of syphilis from the mother to the foetus were original, as well as many observations concerning the presence of worms and other parasites in the body. He did not limit himself to dissection of his own cases, but sought autopsies in the cases of others. He examined the bodies of those who had been hung, always thinking to find in them something of interest. In this regard he was followed by one already mentioned,--namely, Eustachius. After these two the men who most cultivated pathology and anatomy in the sixteenth century were Rembert Dodoens and Marcellus Donatus. The former was born in 1517, in Mecheln, traveled extensively, was physician to Maximilian II and the Emperor Rudolph, and died in 1585. The latter lived and worked in the latter half of the sixteenth century, the dates of his birth and death being somewhat uncertain. The next man whom we must mention is one who did a great deal for internal medicine, pathology, and anatomy. Jean Fernel, who has been surnamed "the modern Galen," was born in Clermont in 1497. Even as a boy he showed great aptitude, and very early made himself a reputation in philosophy, law, and mathematics. In 1530 he was received as doctor, with the unanimous applause of the entire faculty of Paris. He seems to have been stimulated by this only to more extended study; in fact, so hard did he work at his studies that his friends became seriously alarmed for his health, and remonstrated with him; they received for reply: "_Destiny reserves{116} for us repose enough_." He became physician to King Henry II, of France, and in the midst of a very extensive practice undertook to collect all the medical knowledge scattered in the Greek, Arabic, and Latin works, in order to form from it a body of doctrines. His work was written with a purity and elegance of Latin that reminds one of Cicero. Throughout its pages he was philosophic, and sought to unite the apparently irreconcilable doctrines of Plato and Aristotle. [Illustration: 0137] He divided medical science into three great sections,--physiology, pathology, and therapeutics. In his explanations of disease he was too often fanciful, following the speculations mainly of Galen, and making free use of the hypotheses of humors, temperaments, vital spirits, etc.; but the following statement of his would do credit to a trained pathologist of to-day: "As for myself, I shall never believe I have profound knowledge of any affection if I do not know positively, just as if I could see it with my eyes, in what part of the human body is the disease, its primitive seat, what suspicion of organic lesions constitute it, whence it proceeded, if it exists idiopathically or by sympathy, or if it be kept up by some exterior cause. He who pretends to be a rational physician must sound each of these subjects, and discern them by certain signs." The problem which he thus set himself he certainly, for his own part, considered as solved, although it was not long before his solutions were set aside and the original uncertainty reappeared. In therapeutics he very early laid down the fundamental maxim that every disease must be combated by contrary remedies, justifying this by every species of argument, amounting to this: that every disease must be combated by its contrary because all that cures a disease is contrary to it. This was, in part, the doctrine of "_Contraria contrariis curantur_"--the antithesis of the equally absurd sophism: "_Similia similibus curantur_" which three hundred years later was erected into an excuse for the foundation of an{118} alleged new school. There can be no doubt that Fernel rendered very great service to his time and to subsequent generations, despite the fact that his recommendations and statements were too often founded upon sophistry. Just here we must digress for a moment to consider the status of bleeding. Hippocrates and Galen had advised to bleed largely from the arm on the affected side in pleurisy and pneumonia. That practice was gradually abandoned as Greek traditions were lost sight of, and finally the Arabs substituted for it something entirely different,--namely, pricking a vein in the foot in order to let blood flow drop by drop. Their method prevailed throughout Europe until the commencement of the sixteenth century, or about the time when Fernel appeared upon the scene. A Parisian physician named Brissot had revived the ancient (the Greek) practice during an epidemic of pleurisy, and had obtained thereby astonishing success, which he hastened to publish, commending the method employed. He thus created a great uproar in the medical world. The innovation found foes and defenders, and disputes grew warm, even to the fever point. Finally, the ancient method was generally revived, and Fernel accepted it. Felix Plater was born in 1536, in Basel, Switzerland, and died in 1614. He had several sons who made their mark in medicine. In his large work, which preceded that of Fernel, he took perhaps the first step in an unexplored route,--namely, in the classification of disease _according to the totality of apparent symptoms_. Defective as this classification appears in our eyes, its author lived a long life as a very distinguished practitioner and professor in his native town. Giovanni Batista Porta was born in Naples in 1536, traveled extensively in Italy, France, and Spain, and founded in 1560 an Academy of the Segreti. He was accused of magic, and was compelled to refute the charges in Rome.{119} He died in 1615, having been one of the leading scientists of his time, and the founder of modern optics. In the first edition of his _Magia Naturalis_, published in Naples, 1587, is found the first description of the camera obscura,--of course, in a very incomplete form and without lenses. Severino was a celebrated surgeon of Naples. He was born in 1580, in Calabria, studied in Naples, became a doctor in Salernum, and then became professor of anatomy in his native town. For a long time the victim of intrigue and of persecution by the Inquisition, he was finally driven out of Naples, but was called back by the populace. He then became the most celebrated teacher of his time, writing extensively on a variety of subjects. He died in 1656 of the plague, an epidemic of which was at that time raging in central Italy. Arriving now at the surgery of this Age, we find that matters were more chaotic than in other departments of medicine, and for reasons which are easily given and appreciated. While, ordinarily, external diseases are more easily discerned than internal, and while in a corresponding degree they can be more satisfactorily treated; while, in other words, external pathology has ordinarily taken precedence of internal in professional as in lay minds, this view seems to have been inverted for a time during the Middle Ages. Previous to the period now under discussion the sciences had generally declined in Europe, and surgery had fallen even lower than medicine, for the reason that medicine was in the hands of the priests, who had at that time something of a liberal education, while the practice of surgery was abandoned to a class of ignorant barbers, bathers, and bone-setters. No mechanic or artisan could take as an apprentice any youth without a certificate affirming his legitimate birth, and that he came from a family in which there were neither barbers, bath-keepers, shepherds, nor butchers. Among the men who were thus made social outcasts{120} were those into whose hands most of the surgery of the fifteenth century fell. This was particularly the case in Germany, and other European countries were little in advance. We have seen that in France and in Italy Lanfranc and Guy de Chauliac did their best to rescue surgery from the hands of these men, but their efforts did not prevent it from being completely abandoned by the clergy, who devoted themselves to the practice of medicine. [Illustration: 0141] When we come to inquire the reason for this--in other words, why an art so useful as surgery, and one which made such requirements for knowledge, sagacity, and dexterity, whose necessity was almost continually felt, particularly during these troublous times of almost constant warfare, should be so neglected by men who could best comprehend its utility and respond to its requirements--it is difficult to find a satisfactory answer. The social condition of the times sheds some light upon the question. The nations of southern Europe were socially divided at that time into the nobility, who were nearly always at war; the clergy, who monopolized learning and filled the so-called liberal professions; and, finally, the common people, who were common prey for both the other classes, and who yet had to support both without having any privileges of their own. While the practice of medicine was a clerical right, the canon of the church prohibited physicians from drawing blood, under pain of excommunication; and hence surgery, shunned by the priests, to whom it naturally belonged in connection with the practice of medicine, fell into the hands of the ignorant and vulgar, who practiced it in a purely mechanical way, without knowledge or appreciation of its possibilities. In addition to this, there was an almost total lack of detailed and precise anatomical knowledge, and but small reason to expect that the ignorant practitioners of surgery would feel the need of such knowledge. Moreover, most of the operators were itinerants, going from city to city, stopping so long as they had cases to operate upon or until{122} some reverse forced them to depart. Most of these men limited themselves to one or two sorts of operations. Some operated for cataract, others for stone, others for hernia, nearly every one having a secret method which was transmitted to his posterity as a heritage. In the history of medicine certain family names of itinerant operators have been preserved; for example, the Branca, the Norsini, in Italy, and the Colot in France. Under such conditions there could be no such thing as the profession of the surgeon. The prejudice against dissection did not begin to abate until the thirteenth century, when a very few of the clergy dared, in a very timid manner, to perform surgical operations. Their numbers increased in the course of the fourteenth and fifteenth centuries, and in the sixteenth had become considerable. Most of the great anatomists of that period--such as Benivieni, de Carpi, Vesalius, Fallopius, and Fabricius ab Aquapendente--were great surgeons. In due time it came about that while the clerical physicians were willing to descend to the rank of operators, the lay-surgeons aspired to the rank of doctors of medicine. This transformation took place especially in France, the only country where at that time there was a special college of surgeons--the small Brotherhood of St. Come, already alluded to, which was always contending against the faculty on one hand and against the barber-surgeons on the other, with varying results, and which, at last, sought peace with the university and was received by it. This took place in 1515, and was the renaissance of surgery, not only for Paris, but for the whole world. By this reunion the faculty acquired authority over the barbers, who were admitted to their lectures and took courses in anatomy and surgery, gradually attaining a knowledge which entitled them to be called barber-surgeons; their rights were not curtailed, but made more difficult of procurement, for, in addition to passing their initiation for the privilege of becoming barbersurgeons,{123} they also had to pass an examination before the physicians and the two surgeons of the king, at Chatelet, for the right to practice surgery. The surgeons, as the price of their submission to the faculty, had, beside the university privilege, a sort of supremacy over the barbers; and thus it happened that the barbers were admitted to the rank of surgeons at St. Come, and that the surgeons of St. Come were admitted as barber-surgeons by the faculty of medicine. In this double capacity they approached nearer the profession of medicine, from which they should never have been separated, while surgery became an art which received numerous improvements. We must now devote a little time to the consideration of at least two or three of the men who most contributed to extend and elevate it. Among those who most contributed to make the period of which we are now speaking a glorious one, raising himself from the lowest walks of life to the attainment of the highest professional honors, is Ambroise Paré, whose name will never die while the art of surgery is taught. Paré was born about the year 1510, at Laval, of poor parents. He was an early apprentice to the provincial barber-surgeons, after which a natural ambition for improvement led him to Paris (about the year 1532), where he studied three years at the Hôtel-Dieu, and obtained the confidence of his teachers to such an extent that he sometimes operated for them. He never learned Latin, the language at that time of the books and of the schools. Paré was most fond of recalling his hospital experience; he counted it among the highest honors of his life that he should have enjoyed what he there did enjoy, and gives us to suppose that he was a favorite upon whom peculiar favors were conferred. In one of his writings, a physician of Milan having expressed astonishment at so young a man's knowledge, he remarks with pride: "But the good man did not know that I had been house-surgeon for three years at the Hôtel-Dieu de Paris." The functions of the barber apprentices in the hospital{124} in those days were probably to make dressings and bleedings, and sometimes post-mortem examinations ordered by the chiefs, to assist the latter in their operations, and to act in case of emergency; in other words, to do about as the _internes_ at present do. They probably found there a precious and rare opportunity for anatomical dissection, but it does not appear that they had regular clinical instruction. [Illustration: 0144] Communication between master and pupil depended absolutely on the pleasure of the former. In 1537 Paré was made surgeon to the Colonel-General of Infantry, René de Montijean, with whom he made his first campaign in Italy. (This was in the army which King Francis I assembled in Provence with which to repulse the invasion of Charles V.) He had never seen war nor recent gunshot wounds, and only knew of them by what he had read in the writings of John de Vigo. This was at{125} a time when it was the custom of surgeons to pour boiling oil into every amputation or other wound in order to check haemorrhage; and Paré's experience in this, his first campaign, put him in the way of his first discovery,--a discovery which will never be forgotten. He has recounted in his _Book of Arquebus Wounds_ and in his great _Apology_ how after the affair of Pas-de-Suze he watched the other surgeons, dreaming of nothing else but to imitate them as far as he could; how the boiling oil gave out; how his anxiety about it prevented him from sleeping; and how to his great wonder he found that the wounded who had submitted to the operation suffered more than the others. This set him to thinking, and led him, a young man without name or authority, without letters or philosophical studies, to observe, to reason, and to combat a doctrine which was universally admitted and which the highest surgical authorities of the day sustained. At that time all authors who had spoken of gunshot wounds considered them as poisonous and complicated with burns; consequently they gave the precept to cauterize with boiling oil or a red-hot iron, and at the same time to administer certain alexipharmics which should serve as internal antidotes. John de Vigo, physician to Pope Julius II, assures us that the danger of these wounds results from the round formation of the balls, from heat, and from the poisonous qualities communicated to them by the powder. His theory and the method of treatment above given had been adopted without contradiction until the day when Paré dared to utter the first protest against them. After a campaign of three years, in which he lost his master, he returned to Paris and married. In 1543 he was in the army of Perpignan, in the service of de Rohan, grand lord of Brittany, where he gave continuous proof of his sagacity. It was after this campaign that his reputation, so well established among warriors and the nobility, inspired Sylvius with the desire of seeing him. Paré has recounted{126} how, in a conversation which they had together, he insisted upon the then entirely new precept, of which he had made many applications, that in order to extract bullets it was best to place the wounded in the position in which they were at the moment of injury. [Illustration: 0146] Sylvius,{127} then at the height of his fame, invited the young physician to dinner, and listened to him with great attention while he explained his views on gunshot wounds, which made such an impression upon the mind of the host that he besought him eagerly to write them out and make them public. Encouraged by this advice from so high a source, Paré prepared his text, illustrated it, and in the year 1545 brought out his little work, which marked in a manner so glorious the revival of French surgery. It was published by Gaulterot, the sworn bookseller of the University of Paris, and was entitled "_The Manner of Treating Wounds made by Arquebuses and other Fire-arms, and those made by Arrows, Darts, and the Like; and also by Burns made Especially by Gunpowder_. Composed by Ambroise Paré, Master Barber-Surgeon in Paris." A few months later appeared the second edition, in which he still recommended the actual cautery in haemorrhage; but each day he meditated upon the subject, and on one occasion discussed it with two surgeons of St. Come, submitting to them the idea that, since ligatures were applied to veins and arteries, and to recent wounds, there was nothing to prevent their being equally applied to amputations. Both agreed with him, and opportunity soon presented itself at the siege of Damvilliers, when a gentleman had his leg crushed by a shot from the fortress. Paré made an amputation, omitting for the first time the use of the cautery, and had the happiness to save his patient, who, full of joy at having escaped the red-hot iron, said he had got clear of his leg on very good terms. This was, in truth, the actual renaissance of surgery, which had been to that time a torture, but which became thereafter a blessed art. It was a barber-surgeon who produced the double marvel. This took place in 1552. In 1554, after other campaigns, Paré was made, without examination, Master of the College of St. Come, and in 1559 was included among the surgeons of King Henry II (who{128} was killed in a tourney, in Paris, in 1559)r which position he retained with Francis II and Charles IX. The latter raised him to the highest position among his surgeons, and King Henry III retained him, which caused the witty and true remark that the kings of France transferred him to their successors as a legacy of the crown. Many anecdotes are related of Paré to show the remarkable esteem in which he was held by public and private citizens. For instance, in October, 1552, one of the most eminent generals of Charles V laid seige to the city of Metz, and the emperor came in person to join the army. Within the walls of this beleaguered city were gathered nearly all the nobility and princes of France. The city was defended by the Duke of Guise, and the besieged soldiers were at that time suffering alike from the attacks of the enemy, the results of the siege, and the rigors of a frightful winter. The duke had established two hospitals for the soldiers, and had put into requisition the barber-surgeons of the city, giving them money with which to furnish their supplies. But these surgeons were sadly incompetent against the combination of unfavorable circumstances, consequently nearly all the wounded perished, and a horrible suspicion was roused among the soldiers that they had been poisoned. Under these circumstances the duke dispatched one of his captains to the king to say that the place could hold out for ten months, and asked at the same time for fresh medicine. The king sent for Paré, gave him money, directed him to take all the medicine he thought necessary, and furnished him a letter to Marshal St. Andre, who commanded in Verdun, and who bribed an Italian captain for fifteen hundred crowns to introduce into the besieged city the celebrated surgeon. The expedition was perilous, and Paré himself would have willingly remained in Paris. But he entered Metz on the 8th of December, at midnight, without an accident. Having passed already sixteen years in war, he was{130} known to the chiefs and common soldiers. The day after his arrival, the duke, who knew how to strike the imagination, presented him on the ramparts to all the princes, lords, and captains, who embraced and received him with clamor. By the soldiers he was received with shouts of triumph. "We shall not die," they exclaimed; "even though wounded; Paré is among us!" From this time the defense was conducted with renewed vigor, and it has been universally conceded that to the presence of this single man the city was indebted for its salvation. The siege itself was not raised until after a terrific conflict. On the very day of Paré's arrival he began to treat the leg of one of the prominent officers, who for four days had been in charge of a charlatan, and had suffered horrible tortures. The next day he decided to trephine another, who had been struck on the head by a fragment of stone, and who had been insensible for fourteen days. Both patients recovered. [Illustration: 0149] The little brotherhood of surgeons of St. Come were ready to seize on every circumstance which might redound to their advantage, and desired to have within their ranks the man who enjoyed such great renown. They, therefore, admitted him to an examination, in spite of the statute which required that the candidate should understand Latin, and in spite of opposition by the professors of the university.{132} They not only admitted him to all their degrees, but awarded him a reception,--a hitherto unknown honor. Description of Fig. 17.--A, the instrument named, on account of its figure, lizard's beak; in Latin, "_rostrum lacerti_." It is used to extract balls which have been flattened or imbedded in bone. A displays particularly the cannula. B, hinge, by means of which the lizard's beak is opened and closed as much or as little as the surgeon wishes. C, the rod which opens and closes the lizard's beak. When drawn upon it closes and when pushed it opens the instrument. D, dilator and mirror: in Latin, "_dilatatorium, speculum_." The instrument is somewhat roughened and dentated in order to take a firm hold of whatever it grasps. It may serve two purposes: first, to dilate and enlarge the wound so that it may be seen to the bottom, and also to make way for some instrument, as pincers or crow's beak, and to grasp more easily and withdraw the foreign body; secondly, it may itself serve to extract the foreign body,--e.g., a, double-headed ball; b, a small chain; c, c, some pieces of mail. E, E, crane's beak; in Latin, "rostrum gruinum." H2, H, duck's beak; in Latin, "rostrum arserinum." K, sound. L, ball-extraetor without cannula. M, cannula with handle. [Illustration: 0151] Paré in his time met with a success which to-day would be pronounced extraordinary. He seemed to inspire the wounded with the utmost confidence, and to possess greatness and firmness of character in the highest degree. It is perhaps, even more extraordinary that with so strong a character he should have so long retained favor at court. In the midst of the excitement of camps, and a very extended practice, he found time to read all that had been published on his art, and to compose himself a great number of works, enriching all branches of surgery. Instead of keeping secret his inventions, as was the custom of the time, he made them as public as possible, saying, in the preface of his large work on surgery: "For my part, I have dispensed liberally to everybody the gifts that God has conferred upon me, and I am none the worse for it; just as the light of a candle will not diminish no matter how many may come to light their torches by it." Besides his smaller treatises, his large, collective works passed through a number of editions, and were everywhere reprinted and studied. Not only was he great in surgery, but he attained a high degree of expertness in midwifery. Among other things, he restored the forgotten practice of podalic version in cases where this procedure is necessary. He died in 1590. The doctrine of Paré on gunshot wounds was rapidly disseminated. From 1550, Maggi, of Bologna, advocated it without giving credit to its real author, and sustained it by decisive experiments. He observed that none of the wounded felt any heat, and that the torn portions of their clothing showed no trace of fire; and he shot balls through packages of powder without setting them on fire. At the same time Lange spread this view in Germany, and Botal, of Turin,{134} took it up (withholding, however, the true author's name). [Illustration: 0153] While Ambroise Paré did not disdain to act as accoucheur, it was his friend and pupil, Jacob Guillemeau (1550-1613), who, in the sixteenth century, most occupied himself with the practice of obstetrics. We owe to Guillemeau the first improvements that the moderns made in this art; for instance, the proposition to rapidly and artificially terminate parturition in cases of considerable haemorrhage or when the woman is taken with convulsions during labor. Guillemeau supported this practice on the authority of Hippocrates, and operated on a great number of patients, proving its value and the danger of its neglect. The Cæsarean operation was known to the ancient Greeks and Romans, but had been abandoned during the Middle Ages. It' remained for the accoucheurs and surgeons of the sixteenth century to re-establish it. Among others, Rousset, physician to the Duke of Savoy, who recommended it very warmly, reported several cases where it had a happy issue for both mother and child. He even reported the most remarkable case of all,--that of a woman who was six times delivered by this operation, and who perished in the seventh confinement, because, as he states, the surgeon who had been accustomed to operate on her was absent. Unfortunately, this case is not authenticated. [Illustration: 0155] Nothing shows better how the art of observation and accurate description of phenomena had progressed at the time of the revival of letters than the number of new diseases of which the authors of that period make mention. Then, for the first time did one read of whooping-cough, miliaria, scurvy, plica polonica, syphilis, and raphania. It is scarcely credible that these diseases fell upon Europe at this particular time. It is more probable that they had a more ancient existence and were not recognized. Even to-day medical men are divided in their own opinions on the origin of syphilis, some believing that it was{136} developed spontaneously in Europe toward the close of the sixteenth century, others that it was imported from the New World, others that it had a most ancient origin, and others yet that it represented a degenerated form of leprosy. Certain it is that syphilis appeared almost simultaneously in all parts of Europe,--at Bologna, Halle, Brunswick, in Lombardy, Apulia, Auvergne, and so on. Léonicenus attributed this sudden outbreak to an extraordinary inundation that occurred in all parts of Italy toward the close of the fourteenth century, and supported his views with the authority of Hippocrates and Galen. Others attributed it to astrological influence; while still others regarded it as a scourge of God with which to punish men and turn them away from unbridled libertinism, Fallopius thought venereal disease was engendered by the poison which the perfidious Neapolitans had thrown into the wells from which the French drew their water. These wild views simply indicate the spirit of the age. Oviedo published in 1545 a history of the West Indies, in which he states that syphilis originated in America. He held that when Columbus returned from his second expedition to the New World, in 1496, his men enlisted under Gonsalvo de Cordova to go and fight the French, who had invaded the Kingdom of Naples, and that they communicated to the French and Neapolitans the disease which they had brought from San Domingo. Unhappily for his veracity, it is certain that syphilis broke out in Naples at least two years before the arrival of the Spanish fleet. It is equally certain that at none of the points at which Columbus touched on his return from his first expedition was there any manifestation of syphilis for years. At this time the venereal disease, so-called, included those conditions which we now differentiate under the names of syphilis, chancroid, and gonorrhoea,--a confusion of diseases{138} which persisted even up to the time of John Hunter. It is worth while to publish this fact, since writers of two or three hundred years ago may not have meant by the term "syphilis" just what we would mean to-day. Without going into this question here, it is enough to say that one who reads intelligently may see in the Sacred Scriptures unmistakable allusions to this disease. If the statements of David, as contained in the Psalms, are reliable, he was himself a serious sufferer from it. The ancient Greek and Arabian physicians make mention of lesions which could only be attributed to this disease; and the Latin satirists, like Horace and Juvenal, describe symptoms of a certain kind as being the fruit only of shameful practices. [Illustration: 0157] It is most likely that the sudden appearance of syphilis in nearly all parts of Europe at about the same time, which has been regarded as so extraordinary, can be explained by the clearer distinctions physicians began to make between symptoms of this disease and those of leprosy. Arrangements for the cure of lepers were very complete, and such syphilitic patients as responded kindly to the treatment thereby established themselves in a very different category of disease. The first writer to systematically consider venereal disease was Astruc, who was born in Languedoc in 1684 and died in 1766. He was the principal advocate of the view that syphilis had an American origin, in which view he was bitterly opposed by Sanchez, a Portuguese physician, who collected a large amount of evidence to the effect that its first ravages were observed in Italy. Summing up this whole matter, we may agree with Jourdan, who has examined all the opinions of these writers, and who, in his treatise published in 1826, concluded that all symptoms which had been hitherto connected with syphilis had been known and described from the remotest antiquity, but were not supposed to proceed{139} from a common source, and to be attached to the same cause, until after the close of the fifteenth century. THE INFLUENCE OF THE OCCULT SCIENCES ON THE MEDICINE OF THIS PERIOD. Most of the partisans of occult science were restless minds, such as are found in all ages, who chafed under the yoke of authority, and who practiced as well as deduced their lines of thought and conduct in accordance with their own ideas. Some of these men did not lack in sagacity, imagination, or audacity, but almost all of them lacked in consistency of idea and dignity of thought. Most of them lived isolated lives, apart from each other and from the rest of the world, and were, to a large extent, what we would now regard as "cranks." While they made a wide departure from accredited doctrine, they depended upon imagination rather than upon reason. This happened to be a period, however, when such men achieved great notoriety,--more so than the same class of individuals have done since their time. Cornelius Agrippa (born in 1486) was an early promoter of occult science. He came of a noble family of Cologne, received the best éducation of his time, was a man of varied attainments, great inconsistency in conduct, and a caustic humor which everywhere made him enemies and prevented him from having any settled abode. He wandered from place to place, sometimes honored with the favor of the nobility and sometimes plunged into extreme misery. He early became a secretary in the court of Emperor Maximilian I, and under that monarch distinguished himself in the army by such bravery as to win him spurs as a knight. Soon disgusted with the profession of arms, he devoted himself to law and medicine, but his intemperate pen soon drew him into quarrels and persecution. At Dole he fell out with the monks; at Paris{140} and Turin he compromised himself with the theologians; at Metz he incurred the animosity of the Jacobins for attacking the prevailing opinion that St. Ann had three husbands. He became a vagabond and almost a beggar in Germany, England, and Switzerland, and then went to Lyons, where the mother of Francis I, who was then Queen Regent, made him her physician. He soon lost favor here, and was disgraced and banished; then he went to the Low Countries, where he was imprisoned on account of his treatise on _The Vanity of the Sciences._ Afterward he returned to Lyons, was imprisoned anew, for an old libel against his former patron, and finally died in the hospital of Grenoble, in 1535, at the age of about fifty. His treatise on _The Vanity of the Sciences_ made him most trouble, and showed best both his bitterness of spirit and the extent of his learning. Herein he laid down the paradox, which was later renewed and sustained by Rousseau, that there is nothing more pernicious and injurious to common life, or more pestilential to the salvation of souls, than the arts and sciences. He founded this thesis on Scriptural authority, and supported it by profane testimony. The conclusions which Agrippa drew were not so strange to the eyes of his contemporaries as they are to ours. Long before him, men of character and attainments, such as Pic de la Mirandola and Bessarion, had attempted to introduce the Platonic idea, that the best means of acquiring science and truth were introspective. They were, moreover, persuaded that a great number of phenomena and events have their origin in astral influences. From this system to the extravagance of the Cabal * is but{141} a step; indeed, the Christian doctrine, that events and phenomena are influenced by the direct intervention of the deity or of the devil, is but a small transposition. The cabalistic theory, summed up, was that all the events of life and all the phenomena of nature proceed from influences which gods, devils, or the stars exercised on the "archetype"'--that is, on the essential spirit, or substance. He who could withdraw his spirit possessed supernatural faculties. The day and the hour of birth, according to this view, were under the domination of particular stars and each of the principal members of the body was supposed to correspond with some planet or constellation. This is the fundamental idea underlying the pictures--which are still to be found on almanacs used by quack-medicine firms--of the individual whose interior is so completely and uncomfortably exposed, while around him are arranged the signs of the zodiac, with indications as to which part of the body is governed by each. * Cabal, or Kabbalah: A theosophieal or mystic speculative system, of Hebrew origin, which flourished from the tenth to the sixteenth century. It included a mystic theosophy and cosmogony, attributing to deity neither will, desire, nor action, but teaching that from it emanated wisdom, grace, intellect, power, beauty, firmness, and other attributes. It also ascribed hidden meanings to the sacred Hebrew writings and words. Even in the letters and forms of the sacred words the followers of the cabal pretended to find wonderful and hidden meanings; hence the modern expression "cabalistic." The teachings of the cabal were esoteric, of course, and inculcated mysticism and occultism in everything, but appear to have been more or less influenced by neoplatonism. Occult philosophy, built upon this foundation, was divided into four branches: _theosophy,_ to which a man raised himself by prayer; _magic_, or the art of controlling demons; _astrology_, or the art of reading future events by the stars; and _alchemy_, which teaches the secret of extracting the essence or the archetype of substances,--i.e., virtually the secret of the philosopher's stone, by which metals were to be transmuted and then abolished. And so the errors of science, the prejudices of the superstitious, the excitement of the religious, and the cupidity of the rich and powerful, all concurred to propagate the faults of the cabal at the close of the Middle Ages. Never were there seen so many sorcerers, astrol-ogists, and alchemists; never were prophecies, visions, and prodigies so common. Whatever happened, it was pretended{142} that it had been announced by some previous sign, or that it was a revelation of the future. This particular kind of folly persisted in Germany longer than in any other part of the world. Even Martin Luther seemed to share many of the cabalistic views, and his alleged struggle with the devil, his adventure with the inkstand, and so on, contributed much to spread them, and were, perhaps, the most prominent illustrations of their general acceptance. Surely, these were the Dark Ages. Jerome Cardan was born at Pavia in 1501. His life, like that of Agrippa, was one of vicissitude and inconsistency. Being the idol of his mother and the detestation of his father produced a peculiar effect upon his character. When he began to study he made rapid progress, and at the age of twenty-two was able to discuss publicly all questions. About two years later he received his doctor's hat. He practiced medicine in various places until he was thirty-three, and was then made professor of mathematics at Milan. He occupied this position but two years, then traveled in Germany, France, and England, and returning to Italy was imprisoned for debt in Bologna, and finally obtained a pension from the pope, in Rome, where he died in 1556. He was a man of great attainments and sagacity; his literary style was dignified, and, if he had not developed such a taste for the marvelous, such inconceivable credulity and superstition, and such vanity and boasting, he would have been a remarkable character in his age. Leibnitz said of him: "Notwithstanding his faults, Cardan was a great man and, without his defects, would have been incomparable." He wrote extensively on philosophy, mathematics, and medicine. Sometimes he admitted to his writings the most absurd statements of visions, etc., and again affirmed that he had never devoted himself to cabalistic art, blamed those who practiced it, and jeered at those who believed in it. He wrote extensively on chiromancy. For his own follies and misfortunes he apologized,{143} attributing them all to the influences of the stars. [Illustration: 0163] The most colossal figure in this collection of mediaeval charlatans and knaves was Paracelsus. He was born in 1493, near Zurich, of a well-to-do family, his father being a physician. He had a good preliminary education, and then visited the various universities, or rather university towns; but, instead of listening to the professors, Paracelsus associated with clever women, barbers, magicians, alchemists, and the like, from whom he acquired much information. He was led at once to the vagaries of the cabal, and, according to his own statement, he did not open a book for ten years. He neglected his studies and forgot his Latin, so that he became incapable of expressing himself in{144} that language. From the age of twenty-five he became a hard drinker, and this habit ultimately worked his ruin. One of his disciples says of him that during the two years which he passed with him he was so inclined to drinking and debauchery that he could scarcely be seen for an hour or two without being full of wine, although that condition did not prevent him from being admired by every one as a second Æsculapius. At this time Paracelsus was between thirty-three and thirty-five years of age, and at, apparently, the most brilliant period of his life. He had written extensively and with emphasis of his numerous cures, after the fashion of charlatans of those days,--and, unfortunately, of to-day,--and claimed to be possessed of infallible secrets against the most intractable diseases. He had just been called to Basel to the chair of physic and surgery, and crowds of curious and idle persons attended his lectures, which he gave in the vernacular, and not, as was customary in those days, in Latin. In order to strike his auditors with astonishment, he began by burning the works of Galen and Avicenna, and then reading from his own writings, breaking off from time to time into the statement: "Know, ye doctors, that my hat knows more than you; that my beard is more experienced than your academies. Greeks, Latins, Arabians, French, Italians, Jews, Christians, and Mohammedans, you must follow me; I shall not follow you, for I am your monarch, and sovereignty belongs to me." As may be imagined, his professorship was not one of long duration, and he soon had few or no listeners. In consequence of some mishaps he left Basel quite precipitately, his departure causing no such sensation as his arrival. He then resumed his nomadic life, and we find him at Alsace in 1528, at Nuremberg in 1529, at St. Galle in 1531, at Mindelheim in 1540, and in the following year at Salzburg, where he died in the hospital at the age of forty-eight. Few men there are of whom so much good and so much{145} evil has been written as of Paracelsus. Few are there of whom it is to-day so hard to judge, since, if we refer to his contemporaries, they disagree completely concerning him, and if we refer to his own writings we fall into still greater chaos and have to abandon the attempt. His writings show ideas without connection, observations which contradict each other, and phrases which defy comprehension. At one moment he gives proof of admirable penetration, at the next simply abject nonsense. That he exerted an influence upon his time is certain, but that this influence was retrograde rather than progressive seems quite likely. His exact duplicate has probably never existed since his time, and we may say that never was there another man like Aurelius Phillip-pus Theophrastus Paracelsus Bombastus ab Hohenheim--his full name. Although this man was such a prominent character in his day, his name must be erased from the list of those who have contributed to the world's progress. He was simply a pretended reformer, who counted as nothing the most erudite writings, and who relied solely on his own experience. He had the most profound self-confidence, and played upon the credulity of his neighbors and victims with the toys which were furnished him by the prevalent cabalistic notions of the day. The school which he would have founded was nothing but a school of ignorance, dissipation, and boasting--a school of medical dishonesty. In a word, it was, as Renouard has said, "a school of which Thessalus, of Tralles, had been the Corypheus in antiquity, which John of Gaddesden revived in the Middle Ages, and to which Paracelsus gave a new development." While, as has been briefly recounted, the partisans of the occult sciences strove to completely overturn the scientific edifice of antiquity, other reformers, more sensible and{146} less daring, were content to expose its defects without attacking it in its entirety. These were, for the most part, enlightened men, and at the same time free thinkers,--friends of progress, and not of destruction. During the sixteenth century these men were few in number, but at least three or four of them deserve mention. John Argentier was born in Piedmont, and taught in Naples, Pisa, and Turin. He did not hesitate to take issue with the theories and statements of Galen, and criticised those who adopted them too servilely. Of him it may be said that, although styled a reformer, nevertheless, he kept too near to the doctrines of those against whom he inveighed to seriously weaken their position. Leonard Botal, also a Piedmontese, was born in 1530. First a surgeon in the French army, he later became physician to the kings Charles IX and Henri III. He was the first to recommend frequent and general bloodletting. Apparently before his time this practice was greatly restrained. He carried his views so far as to maintain that an infirm old man should be bled from two to six times a year, and that it was good custom to open the veins of healthy individuals every six months. He wrote a remarkable memoir on the cure of disease by blood-letting. It is not to be denied that he obtained some remarkable success with his copious venesections, and it must be said, in his defense, that, if he overdid it, his contemporaries did not resort to it often enough, and that his own practices were instructive to others. In his writings he united independence and energy of thought with elegance and purity of style. Joubert (1529-1583) was Chancellor in the University of Montpellier and physician to King Henri III. He wrote a treatise on _Popular Errors_, which had an unheard-of success. In less than six months there were sold nearly five thousand copies, which, considering the times,{147} constituted a prodigious edition. For one thing, it was written in the common tongue, and so placed within the reach of all. It was also diversified with anecdotes and jokes, some of which were not of the most delicate character; in fact, the author endeavored to atone for some of its salacity by dedicating it to Queen Marguerite. He really proposed for his main purpose a serious and useful one,--namely, that of combating prejudices which were both injurious and ridiculous. Although we may make light of Joubert's treatise, it certainly achieved a useful end by dissipating a multitude of errors, giving information to those who could scarcely get it as well from any other source. That it was full of defects is simply another form of saying that it was published in the middle of the sixteenth century. It was during this period of which we have written that the separation of the priesthood from medicine was completed. From the sixteenth century celibacy was not obligatory on physicians in the Kingdom of France, and they no longer enjoyed ecclesiastical benefices. At this time, too, surgery, which had naturally been separated from medicine, began to approach it, the combination thus gradually brought about inuring to the benefit of all concerned. From now on, the professors of St. Come were on the same level as the professors of the university, and enjoyed equal privileges. Institutions for instruction in medicine increased, and those which already existed were developed. Amphitheaters for dissection were open in every city in Europe. Hospitals and dispensaries were established alongside the schools, and by the various governments more attention was paid to the protection of the public from imposition, and to the amelioration of every evil affecting either public or private health. CHAPTER VI. _Age of Renovation (continued).--Student-life During the Fifteenth and Sixteenth Centuries. Ceremonials Previous to Dissection.--Reform Period: The Seventeenth, Eighteenth, and Nineteenth Centuries. Modern Realism in Medicine and Science. Introduction of the Cell-doctrine. Discovery of the Circulation. William Harvey, 1578-1637. Malpighi, 1628-1694. Leuwenhoek, 1632-1723. Correct Doctrine of Respiration. Discovery of the Lymphatic Circulation. The Nervous System. Discovery of Cinchona. Development in Obstetric Art, in Medical Jurisprudence, in Oral Clinical Teaching. Van Helmont, 1578-1644.--The Iatrochemical System: Le Bôe, 1614-1672. Thomas Willis, 1622-1675._ For a{148} long time the Italian universities held the first rank; next came the French; and last the German, although all were well attended. The most famous were the medical faculties of Bologna, Pisa, Padua; then Paris, Montpellier, and, finally, Basel. A little of what concerned the student-life of this period may not be amiss. The students chose the rector and officers of the universities, sometimes even the teachers, and assisted in determining the curriculum of study, the execution of which they watched. In some of the Scotch universities even now the students choose the rector. The students were divided, usually according to country, into bodies denominated "nations" (some having special seals), which were the parents of the present stu-dent-corps in German universities. Certain representatives, known as vice-rectors, were chosen from each of these corps and constituted a so-called college of rectors which negotiated with the officials of the State, and possessed a power that was preserved until the end of the sixteenth century. The poorer class of students passed from one school to another, supporting themselves by singing, begging, or stealing, and were sometimes guilty of great barbarities. The younger scholars, called "Schutzen," were compelled to perform{149} most menial duties for their older comrades, the "Bacchanten,"--much like the system of fagging still in vogue in English grammar-schools; and when the bacchantes were admitted to the university proper they were required to pass through an initiation, or hazing, which eclipsed anything known in these days; indeed, the antiquity of fagging may be traced back even to the philosophic schools of Athens. The habits of the traveling scholars led many of them into dissolute and vicious ways, though some attained respectable positions,--possibly even eminence. The students who were better situated financially; for the most part entered the Italian universities. Already mention has been made of the enormous number of students congregated during this age in Bologna and in Naples. In the small University of Wettenburg there were, in 1520, only about six hundred students; in Erfurt, three hundred, and this number dwindled two years later to fifteen; in 1500 Leipzig had four hundred students; at the same time there were about seven thousand in the University of Vienna. Students and teachers migrated from one place to another, and faculties were constantly changing. Great teachers were received with great ceremony. Bitter struggles and disputes between teachers sometimes occurred; it is related of Pistorius, who died in 1523, and Pollich, deceased in 1513, that they conceived a violent enmity toward each other because of antagonistic views relative to the epidemic or contagious character of syphilis, and both ultimately left Leipzig for other schools. Some curious customs prevailed. In teaching anatomy, while the learned teachers explained the parts as exposed, the dissections were left to barbers as being unworthy of an educated medical gentleman. While the cadavers were mainly the corpses of executed criminals, it was thought that before and after each special dissection religious ceremonies were appropriate, and such were often held; it was also believed that all who came in contact with such a corpse{150} would be made disreputable unless it were itself first made reputable; hence the professors first read aloud a decree to that effect from the magistrate, and then, by order of the senate of the faculty, stamped upon the breast of the corpse the seal of the university. The body was next carried into the anatomical hall, and the cover of the box in which it had been transported was returned to the executioner, who remained at some distance for this purpose. If the corpse was one that had been decapitated, during these solemn ceremonies the head was placed between its legs. Finally, an entertainment with music, often furnished by itinerant actors, was given. But this folly was gradually discontinued, and by the second half of the sixteenth century public dissection was performed without recourse to such mummeries. The price of skeletons in those days was high; the University of Hiedelberg, in 1669, paid seventy-two dollars for one. The practitioners of the sixteenth century were often quite as roving as the students and professors, though those who held positions as State physicians were bound by contract to a fixed residence for a certain time. In 1519 the State physician of Heilbronn received a salary of twenty-one dollars per year and his firewood, but could not leave the city over night without permission of the burgomaster. Medical attendants of the King of Spain were required to kneel down when they felt the king's pulse. There were few physicians who acquired wealth, although Fabricius ab Aquapendente left a fortune of two hundred thousand ducats. The Reform Period is the name which Renouard has given to the time beginning with the commencement of the seventeenth century,--a time when the domain of natural science was daily enlarged, and when observation had enriched human knowledge with multitudes of new facts, some of which harmonized with, and some of which were in opposition to, prevailing doctrines. Men whose knowledge{151} equaled their genius began to need a radical reform, and by such men intellectual improvement was begun by which the decrepit theories of the schools of the Middle Ages were eradicated and by which there were substituted for them others which harmonized much better with known phenomena. To the period of worship of ancient authority succeeded one characterized by a desire to shake off the yoke of the same, and men now struggled, as it were, to free themselves from the tyranny of the past. As Galileo was the torch-bearer for regeneration of the knowledge of physics, and as Kepler, and others already named, or to be named, did as much for other branches of science, so there were not lacking those who broke away from the restraint of authority in medicine, and began to beat or choose paths for themselves among the facts which experimental science furnished them. With the approach of the seventeenth century there was evident improvement in both the social and mental status of medical men. While political humiliation and exhaustion were everywhere noted, in the field of literature it was evident that the line had advanced. What may have been the effect of thirty years of religious war, with other political struggles carried on under the hypocritical cloak of religion, may be imagined, if not fully described; the devastation of whole countries by disease, and notably by the plague,--the poverty and hunger consequent upon the ravages of perpetual war (it is stated that even so late as 1792 there were still in Saxony 535 wasted and extinct villages), to say nothing of the barbarity and immorality resulting therefrom,--all combined to make the early part of the seventeenth century a most mournful epoch. It is not strange that, with poverty, superstition and great rudeness of manners prevailed, or that trials for witchcraft and persecutions by the Jesuit Inquisition were common. That any advance should{152} have been made under such circumstances speaks well for the progress of the human mind. That this advance was slight in Germany and central Europe is not strange, though other countries were able to quietly enlarge their scientific borders. Now it was that England, Italy, and the Netherlands, which took but little part in the warlike struggles of the century, acquired leadership in medicine, and were seconded by the French. In Great Britain, science had been fostered by various kings, and particularly by Charles II, who professed to be something of a chemist; in fact, an epidemic of scientific interest fell upon the English court. The seventeenth century, in contrast to the idealistic sixteenth, witnessed the advent of modern realism in almost all departments of thought. Medicine furnished the first example in what we are accustomed to-day to speak of as the exact method; hence, the century is of great importance, in that physicists and chemists began to be original, instead of mere followers of the past. The most notable feature of medicine was the promulgation of three medical systems: the pietistically colored Paracelsism of Van Hel-mont; the chemical system of Sylvius; and the iatro-cliemical system of the physicist and mechanician, Borelli. This period is, moreover, illumined by the life of one great practitioner, whose name will be imperishable in the history of our art,--namely, Sydenham. The principal tendency of the time was toward skepticism, which had begun in the preceding century with Montaigne, and was continued by Charron, under the patronage of Queen Marguerite of Navarre; it was the fundamental idea of Pierre Bayle, the author of the great dictionary. Opposed thereto was the supernatural philosophy, or the theosophic, cabalistic, or mystic. The leading exponent of the latter was Boehme, who was a business colleague of the celebrated "Meistersinger," Hans Sachs, in Germany, and of Blaise Pascal and his contemporary. Malebranche,{153} in France. The doctrine of Lord Bacon, Lord Verulam (1561-1626), a man who showed himself as exalted in mind as he was mean in personal traits, was of great importance Bacon is a landmark in history as the defender and eulogist of modern realism,--i.e., of inductive philosophy. While personally contributing but little to the advance of science, he taught a great method; as Gruen says, he was the philosopher of patents and profit; he recognized the compass, the art of printing, and gunpowder as great inventions, but placed little value on the discovery of Copernicus, having little comprehension of mathematics. Hobbes and Locke went farther into realistic philosophy, and the latter was an exponent later of pure empiricism. In the seventeenth century, also, zoology and botany were largely extended. In it lived Swammerdam (1637-1680), famous as a naturalist, physiologist, linguist, poet, and _savant_; there were others, also, whose names are better known in the history of collateral science than in medicine, and who left conclusive demonstrations in accordance with their theories, and made daily use of the microscope, simple as it then was. The term "cell" had been introduced by Hooke in 1667, and Malpighi and Grew were the founders of the cell-doctrine. The astronomical laws discovered by Copernicus changed the course of the world's thought; and now appeared the brilliant Kepler (1571-1630), and Galileo (15641642), the defender of the Copernican system, and the persecuted discoverer of the law of falling bodies, of the thermometer, the telescope, and the movements of Jupiter; also, Sir Isaac Newton (1642-1727), whose discovery of the laws of gravitation in 1665 marked an era in the history of science. This century, too, gave birth to Romer, who in 1675 calculated the velocity of light; Huyghens (1627-1693), who discovered the polarization of light and the satellites of Saturn; James Gregory, who in 1663 made{154} a reflecting telescope with a metallic concave mirror; Torricelli, who in 1643 measured the weight of the air; Gascoigne, who invented the micrometer in 1639; and Napier, who invented logarithms in 1700. Now chemistry, having ceased to be alchemy, began to don the dignity of a science _per se_, and it may be claimed that medicine derived no slight benefit therefrom. Scientific societies and journals arose at this period, and were all of good service to medicine in their way. The church scented danger to the faith in everything which related to natural science, and founded certain secret associations, especially in Italy; the Accademia Degli Lyncei, so called from its seal, which bore the image of a fox or lynx, founded in Rome in 1603, was one of these. Counter-societies, or, rather, societies with opposite purposes, were also started, and the original and private so-called Invisible Society, which was originated mainly by Milton, in 1645, and remodeled by Charles II in 1662, is now the flourishing Royal Society. In France the Academy was founded in 1665 by Colbert, but developed its first real activity thirty-five years later. Those who to-day are so familiar with the course of the circulation of the blood through the arteries and veins find it difficult to understand how the recognition of this phenomenon could have been so long delayed; it seems so simple, yet to the ancients it was perfectly incompre-hensible! Although every one had recognized that blood would flow from an incision, few stopped to reason thereupon. From time immemorial it had been supposed that the veins had their origin in the liver, and were the only vessels which contained blood, since the arteries were always found empty after death; the latter were held to contain only air or spirit. The circulation was supposed to leave and return to the liver through the venous canals by undulating movements similar to those of the waves of the ocean; and this was the doctrine of the Asclepiadæ,{155} and probably of Erasistratus. Galen modified this view by showing that the arteries contained blood; he knew it was poured into the right cavities of the heart by the great veins, but he believed that only a small quantity passed from the right ventricle into the lungs, and that the major portion reached the left ventricle by passing through pores in the inner ventricular septum. This opinion was uncontested until the middle of the sixteenth century. Then the theologian, Michael Servetus, who, in 1553, perished as the victim of Calvin's jealousy, denied the passage of the blood through this septum, contending that it was returned from the lungs to the left side of the heart by the pulmonary veins. This was a happy thought, and a great step toward the truth. Soon after Columbus demonstrated anatomically that the conjecture of Servetus was plausible, by showing the function and real use of the valves of the heart. Cesalpinus came still nearer to the truth, and explained, as did Columbus, the course of the circulation through the lungs, but he opined that blood and vital spirits passed from the arteries into the veins during sleep, because at that time there was swelling of the latter and diminution of the pulse. Valves in the veins were known, and it had been shown that ligature of an artery in the living animal stopped the flow below it, while if a vein were tied there was shrinkage above the ligature, and swelling below it. Such was the state of science at the beginning of the seventeenth century; there remained, practically, but one step to take,--to find the true course of the blood. [Illustration: 0176] William Harvey was born in Folkestone, Kent, in 1578 and died in London in 1637. He first studied at Cambridge, entering at the age of fifteen; subsequently traveled in France, Germany, and Italy, remaining in Padua from 1599 to 1602, in order to hear the lectures of Fabricius ab Aquapendente. With the title of "Doctor" he returned{156} and settled in London and soon became a member of the College of Medicine, of which he was made a regent in 1613; in time he became physician to James I, and, on the demise of this sovereign, to Charlçs I; to the latter he dedicated his chief work. During the civil war he was driven from place to place, and, finally, to Oxford, where he surrendered himself to the Parliamentary troops, after which he again resided in London with his brothers, who had become rich. Modesty led him to decline the high distinction of President of the College of Physicians, and he lived a quiet and retired life, occupied with his studies and, in his later years, investigations in mathematics. Soon after 1613 he began, through his lectures, to make known the doctrine of the circulation of the blood; but he did not publish the results of his researches until 1628, after submitting them to fifteen years of proofs and counterproofs{157} of every kind. So bitter was the opposition of his contemporaries to the new doctrine that he at one time lost a part of his practice, and was even held to be demented. It is characteristic of the fate of new truths, as well as of that age of dominant authority, that his first publication--_Concerning the Motions of the Heart and the Blood_--was unable to pass censorship in England, and therefore appeared in a foreign country (Frankfort, in 1628) when he was fifty years old; but his second treatise on the same subject, in reply to Riolan, a professor in the Faculty of Paris, was published in Cambridge in 1649. "So much care and circumspection in search for truth, so much modesty and firmness in its demonstration, so much clearness and method in the development of his ideas," says Renouard, "should have prepossessed every one in favor of the theory of Harvey; but, on the contrary, it caused a general stupefaction in the medical world, and gave rise to great opposition." This theory, which to-day appears so natural that we conceive with difficulty why it was not sooner discovered, was nothing less than a revolution in physiology; it excited a tremendous controversy that continued more than twenty-five years, and in which mingled every one possessed of any pretension to knowledge of anatomy or physiology; even naturalists and philosophers took part in the dispute. René Descartes was the first to declare in its favor and to support it by experiment; John Walæus (Jan de Wale), the celebrated Professor of Anatomy in the University of Leyden, confirmed it by new observations; finally Plempius, of Louvain, for a time one of the most fiery of opponents, succumbed to the truth, and in 1652 passed publicly to the ranks of Harvey's followers--no small triumph! During these long debates Harvey remained always dignified and firm, although the early attacks rendered him unduly sensitive regarding others which he anticipated. About{158} his only answer to the arguments adduced against him, was to add new proofs and new experiments to those already published. The only one of his adversaries who obtained a direct response was Riolan, who possessed immense influence among his contemporaries as a man of attainments; Riolan combated with equal violence and obstinacy the other great discovery of the age,--viz., the circulation of the lymph. Harvey ultimately, however, had the satisfaction of seeing his theory universally adopted. But his services were not limited to this one discovery. He made most interesting observations on generation, both in man and in animals; on midwifery; and on the structure and diseases of the uterus. The intermediary system and bond of union between the arteries and veins, so very essential, yet up to this time unknown, was discovered by the great Malpighi, who was born in 1628 near Bologna, became professor in its university, and discovered in the lungs and mesentery of frogs, in 1661, the capillary circulation. He first described the corpuscles of the blood in 1665; he also discovered the lung-cells, as well as the cutaneous glands, certain portions of the kidney, and the pigmentary layer of the skin, named after him (_rete Malpighi_), which later furnished the first explanation of the difference of color in different races. In 1690 Leuwenhoek (1632-1723), who had been making observations on the larvæ of frogs and other small animals, was able to see with his improved microscope the movements of the blood in the small vessels, and gave the important testimony of his observations. In 1687 Cowper saw the passage of the arterial into the venous current in the mesentery of a cat. The capillary connection between the two vascular systems was first demonstrated by Marchetti, but was best shown by Ruysch (1638-1731), professor at Amsterdam, the famous inventor of minute injections, who greatly advanced anatomy by the formation of collections, one of which was brought into Russia by Peter{159} the Great at an expense of about seventy-five thousand dollars. The Russian transporters of the collection, however, drank the alcohol in which many of the preparations were preserved, and a portion of the specimens was thus ruined. Further illustration and amplification of Harvey's views came from various sources; the last, perhaps, from Nich-olaus Steno (1638-1686), who was first a professor in Copenhagen, then a bishop and peripatetic converter of heretics. Steno first proved the heart to be a muscle that contracts actively and expels the blood. The duct that bears his name was discovered during his residence in Leyden or at Amsterdam. His name is written also "Stenson." While ancient anatomists were able to describe in a general way the form of the lungs, their location, consistency, the ring-like structure of the trachea, and the first division of the bronchi, they did not go farther, but blindly accepted the prevalent theory that the bronchial tubes anastomosed with the terminal pulmonary veins, and that in this way atmospheric fluid was conveyed from the respiratory organs into the heart. On such vague and erroneous data was constructed the theory that the air was drawn into the lungs by the heat of the heart, which was the reservoir of the vital spirits; that in penetrating through the smaller tubes it was rarefied, its thinnest part passing into the heart, where it served as material for the formation of the vital spirit, its grosser part being exhaled. In other words, respiration was supposed to have two purposes one to refresh the lungs, which, being porous and inflammable, would otherwise take fire from the heart, or focus of animal heat; the other to furnish the pneuma, or ether, which was employed by the heart in the formation of animal spirits. Harvey's discovery upset all this, in great measure. Next it was shown that pulmonary veins carried nothing to the heart except blood. And now, during this Reform{160} Period, the purpose of the movements of the chest was better studied, for Borelli, Helvetius, and Haller made many experiments, as the result of which it was determined that during inspiration the thorax is enlarged in all directions, and during expiration partly collapsed by relaxation of muscles, and that there never is any empty space between the lungs and the sides of the chest; further, that air is drawn into the chest by the tendency of all gases or fluids to maintain an equilibrium, or, in other words, because Nature abhors a vacuum. This being settled, various pneumatic theories were adopted and abandoned, all of which had subsequently to give way before a knowledge of what really occurs. The truth was conceived of by Mayow in 1668. It had been noticed that blood which appeared black in issuing from the veins, became red in contact with the air, and direct observation proved a similar change of color to take place during its passage from the pulmonary veins during life. Goodwin, opening the thorax of a frog, was the first to see this, and Hessenfratz filled a silk bladder with venous blood, and, plunging it into an atmosphere of oxygen, saw the blood change from black to red. In this way and by the later labors of Bichat and Lavoisier were clearly established the mechanism and the purpose of the function of respiration. The discovery of the lymphatic vessels and their purpose was scarcely less remarkable than that of the circulation, though marked by less eclat because it was not the work of one man, but a matter of slow development. Herophilus and Erasistratus had seen white vessels connected with the lymph-nodes in the mesentery of animals, and supposed them to be arteries full of air. Galen disputed this, for he believed that the intestinal chyle was carried by the veins of the mesentery into the liver. In 1563 Eustachius described the thoracic duct in the horse. In 1622 Aselli, Professor of Anatomy at Milan, discovered the lacteal vessels in a dog which had been killed immediately after partaking{161} of food; having pricked one of these by mistake, he saw a white fluid issue from it. Repeating the experiment, he became certain that the white threads were vessels which drew the chyle from the intestines. He observed the valves with which they are supplied, and supposed these vessels all met in the pancreas and continued on into the liver. In 1647 Pecquet, while still a student at Montpellier, discovered the lymph-reservoir, or _receptaculum chyli_, and the canal which leads from it (the thoracic duct), which he followed to its termination in the left subclavian vein. Having ligated the duct, he saw it swell below and become empty above the ligature. He studied the courses of the lacteals, and convinced himself that they all entered into the common reservoir. This discovery gave the last blow to the ancient theory which attributed to the liver the function of blood-making, and confirmed the doctrine of Harvey. Strangely enough, the latter united with Riolan in opposing the discovery of Pecquet and denying its significance. From this time the lymphatic vessels and glands became objects of common interest and were investigated by many anatomists,--by Bartholin, Ruysch, the Hunters, Hewson, and, above all, by Mascagni, who was the first to give a graphic description of the whole lymphatic apparatus. The ancients confounded, under the name "neuron," nerves, tendons, ligaments, and membranes; even Aristotle regarded the brain as an inert mass devoid of sensation, and supposed the nerves to originate in the heart. Rufus, of Ephesus, remarked that Herophilus distinguished three sorts of nerves,--the first serving for sensation and motion and proceeding from the brain and spinal marrow, the second and third serving to unite bones and muscles. Galen also shared in this error, but, nevertheless, described the brain-membranes and the difference between white and gray matter; he supposed the cerebrum to be the seat of the soul and origin of sensory nerves, and that the cerebellum{162} gave rise to nerves of motion; the pulsation of the cerebrum exposed was held to be a sort of brain respiration. Galen came very near recognizing the distinction between nerves and tendons, but nevertheless confused them. The anatomists of the sixteenth century described certain portions of the nervous system with, more exactness than did Galen, but not with such positiveness as to prevent Cesalpinus from renewing the Aristotelian theory that the heart was the origin of sensation and the seat of the soul. Nearly two centuries later Baglivi advanced a theory which referred vital movement to the heart and the dura mater. The progress which accrued to comparative anatomy and physiology, and the experiments which were made on animals, during this period, shed a great deal of light upon the nervous system. The researches of Vieussens, Haller, Meckel, Vicq d'Azyr, Scarpa, Soemmering, and others had already rendered it manifest that the brain was the organ of sensation and voluntary motion, and Bichat had proposed to divide the nervous system into cerebrospinal and sympathetic branches. Now, too, Kepler discovered that the crystalline lens was not the seat of vision, as had been supposed, but that its function, like that of other lenses, is the refraction of light. He observed that the image of objects is depicted upon the retina, and (with Schemer) demonstrated that the expansion of the optic nerve in the retina is the essential part in the organ of sight. Obviously, also, interest in the anatomy of the eye, which these observations everywhere stimulated, was, in a great measure, aided by the researches of Newton on light and color. About this time, too, Casserius and others studied the auditory apparatus and described the ossicles, the small muscles of the internal ear, and the semicircular canals; they even followed the acoustic nerve. By the researches of a number of French and Italian anatomists it was likewise{163} established that the true seat of hearing lies within the internal ear, the external parts being merely of assistance in conducting sound. Thomas Willis was one of the first to consider the brain as an assemblage of organs and to assign special functions to certain of its divisions; he thus became a pioneer in cerebral localization, although most of his conjectures were inaccurate or fanciful. The workings of the brain were also studied by Pinel and others, who observed that in certain conditions of mania or partial insanity some of the mental faculties--such as memory, judgment, imagination, or will--were abolished or suspended, while other faculties were preserved; hence it was inferred that each faculty must have its own seat. The views thus enunciated were carried to an absurd degree by Gall, and later by Spurzheim, who made an entirely new classification, believing the cranium to be molded in a reasonably exact manner upon the brain, and that, by inspection of the exterior, the character of a given individual could be read. They thus founded the pseudoscience denominated phrenology, which we now know has practically nothing to justify itself. About the middle of the seventeenth century Glisson (a professor in the University of Oxford) recognized a property pertaining to all living tissue, which he termed irritability, and which he regarded as sufficient cause for all the phenomena of life; he enunciated certain views that, in times past, have had an important bearing upon the pathology of disease, but which were forgotten for sixty years or more until revamped by the Dutch anatomist, Goerter. It was the latter, with the great Haller, who, by a series of very ingenious experiments, elevated the suppositions of Glisson to the dignity of demonstrated facts. In 1747 the results of Haller's researches were published under the modest title of _First Lines in Physiology_; the author was, in fact, the great exponent of the doctrine of irritability in{164} neurophysiology, and for this deserves to be remembered wherever the history of our art is spoken of. This theory of irritability was applied to pathology by Fabre, of Paris, who refuted the mechanical theory of Boerhaave on inflammation, proving that the latter proceeds not from obstruction of the capillaries, but from exaltation of their irritability. It was also applied in many ways by Bichat, who enjoyed a brief, though memorable, career. The theory of irritability, along with the truths established by John Hunter in his researches on the blood, made a very distinct advance in the physiological knowledge of the seventeenth century, and the researches of those who contributed so much to its advance are well worthy of study even at the present day. In this line of investigation should, perhaps, also be mentioned the names of Winslow, Albinus, the two Monroes, besides vicq d'Azyr, and others already named. I have so far discussed the development of theories and researches of individuals. During the earlier portion of the seventeenth century there happened something which gave to materia medica a remedy so valuable, and which attracted such wide-spread attention, that it deserves special mention, I refer to the discovery of that great febrifuge, Peruvian bark. Malarial fevers had been known as early as the time of Hippocrates, and were universally treated largely with purgatives, sometimes with venesections. There had been no notable improvement in the management of pyrexias of this class down to 1638, when the Countess of Cinchon, wife of the Viceroy of Peru, became a prey to a fever which nothing could remove. It is said a Spaniard learned from the natives the secret of the bark, and advised its employment, whereby the countess recovered her health. This is the generally received account, although it has been widely discredited, and Humboldt expresses decided doubts as to the source whence the first knowledge of the bark was derived. Be this as it may, however,{165} it is certain that, in 1639, the countess and her physician, de Vega, imported into Spain a quantity of ground Peruvian bark, and distributed it to various persons, though it was not made an article of general commerce until ten years later, when it was exploited by the Jesuits, who had received a large supply; in Spain it was known as the "countess's powder," and in Italy as "Jesuit" or "cardinal" powder. Being very high-priced, it was soon so sophisticated as to be quite unreliable. Condamine, the botanist, having been sent to America for other purposes, determined the botanical position of the tree and described several species of cinchona, one of which is known by his name. To him is due the generic title bestowed in acknowledgment of the services rendered by the countess, who introduced the bark into Europe. Many vain attempts were made to determine the chemical composition of the powder, and it remained for two French chemists to isolate and separate its most important alkaloid. The first who wrote upon the therapy of cinchona was Barba, a Spanish physician, whose work was printed in Seville in 1642. After its introduction into England Peruvian bark fell into disrepute, owing to improper administration, whereby death was caused in certain instances; and it was this latter fact that instigated Sydenham to investigate it still more accurately. There has never been introduced into medicine any one drug which has proved itself so generally valuable and so widely effective as cinchona and its products. As little progress had been made in obstetrics as in other branches of applied medicine or surgery. The custom of employing midwives was general, and these, for the most part, were ignorant and filthy old women, slaves of routine procedures that had obtained from time immemorial. Educated accoucheurs were called only in extraordinary cases; but with progress the prejudice which excluded educated physicians from the practice of midwifery gradually gave{166} way, and there was opened for obstetrics a new era. In the beginning of the seventeenth century the initiative was taken by Louise Bourgeois, the _sage femme_ of Marie de Medicis, who in 1626 published a collection of observations concerning sterility, abortion, fecundity, accouchement, and diseases of women and children generally; it embodied several distinctly new ideas. A little later (in 1668), Mauriceau, of Paris, chief accoucheur to the Hôtel-Dieu, published his treatise on diseases of pregnancy and childbirth, which was translated into all the languages of Europe and became a powerful agent for good, not alone that it represented an advance in knowledge, but it stimulated such rivals and successors as Devanter, Peu, Paul Portal, and Delamotte to further research. About this time the Chamberlains, an English family devoted to the practice of midwifery, invented an instrument to facilitate the extraction of the foetal head when arrested, and one of them went to Paris, and, failing of success there, went on to Holland, where he sold his secret to two Dutch practitioners, who kept it only too faithfully. In 1721, Palfvn, a surgeon of Ghent, while seeking to fathom the device of the Chamberlains, conceived a _tire tête_ (literally a head-drawer) composed of two steel spoons, and hastened to publish an account thereof,--a praiseworthy act, whereby he merits distinction as the inventor of the forceps. As modified by Smellie in England and Levret in France, the obstetrical forceps ranks among the most useful discoveries of modern surgery, and, although not in common use until about a century ago, it may be said that the invention has been the means of saving the lives of countless women and children. Medical jurisprudence also seems to have had its beginning during this century. It had long been the practice to summon physicians to court in order to enlighten the judiciary in questions demanding particular knowledge in physics and medicine; indeed, the practice began{167} under the first Christian emperors, and owes its origin to ecclesiastical authority. Charlemagne confirmed in this regard what Justinian was perhaps the first to ordain. The tribunal of Châtelet, according to Renouard, appears to have been the first which comprehended the great utility of consultation with expert physicians; an edict of Philip le Bel, in 1311, qualified Master John Potard with the title "Sworn Surgeon of Châtelet", and the constitution promulgated by Charles V, in 1552, gave great importance to medical jurisprudence, as it treated in detail of infanticide, wounds, poisons, abortion, and other such crimes. Early in the seventeenth century Fidelis collated all that had been written on this subject, and thus published the first special treatise on legal medicine. Some writers claim to have discovered traces of clinical teaching in the history of Arabian universities, but, as Renouard says, the presence of a few pupils during visitations and consultations no more constituted real clinical teaching than the practice adopted by some practitioners of ancient Rome of being ever surrounded by a group of spectators whom they dignified with the title of disciples. The first attempt at real clinical teaching appears to have been in the hospital of St. Francis, in Padua, in 1558, by Botoni and Oddi. About the beginning of the seventeenth century Otto de Heurne, of the University of Leyden, introduced bedside instruction, which was continued by le Boe, sometimes called Sylvius, with the result of drawing-large crowds of students to Leyden from 1658 to 1672. Notwithstanding the success attained, the practice was neglected by the successors of Sylvius until renewed by Boerhaave, who, invested with several functions at the University of Leyden, also occupied the chair of medicine. So great was the renown of Boerhaave that, despite the poverty of the resources of the Leyden hospital, people came to consult him from the most distant countries, and he was a correspondent of several crowned heads, even of the Pope, although{168} himself a Protestant. During his life and long afterward he exerted an immense influence in medicine, and while, perhaps, inferior in genius to some of his contemporaries, he had a wider reputation, and his doctrines prevailed longer. The great success of his clinics decided in favor of this method of teaching, and in 1715 the Pope established in Rome a similar institution, under the direction of the celebrated Lancisi. Soon Edinburgh, Vienna, Pavia, and other universities followed suit, the first clinical chair in Paris being held by Corvisart, and the first in Vienna by Van Swieten. After the demise of Boerhaave, the school of Leyden rapidly declined, while those of Edinburgh and Vienna became rivals for the first place. It is thus seen that after an interruption of more than two thousand years clinical teaching was revived and became more brilliant than ever before. I now propose to recount the methods and deeds of some of those concerned in the development of systems, so called, and make mention of the most prominent medical men in national and historical order. This will not prevent going back to philosophical conclusions or reflections upon the philosophy of the history of medicine, when it may seem wise so to digress. First, of the system of J. B. Van Helmont, which in its day was most highly regarded, and which seems to have been, in some measure, a rearrangement of the views of Paracelsus into a mystic and pietistic system based upon mechanical principles. Van Helmont was born in Brussels in 1578, and was so precocious that he entered the University of Louvain at an age which would have enabled him, had he so desired, to obtain the degree of Magister when only seventeen years old, he deemed the degree frivolous. He had studied mathematics, astronomy, philosophy, and astrology. Going now to the Jesuits, who at that time, even, taught music, he soon became dissatisfied, and turned to the study of stoical philosophy. Believing that the{169} Capuchins (who were mere lascivious gluttons, and considered even washing unchristian) were the true stoics, he sought to join this order, but ere long abandoned them and resumed his studies in law, botany, and medicine. For the latter Van Helmont had at first little respect, since his studies in this line did not enable him to rid himself of the itch. He soon again lapsed to the monastics, and came to the conclusion that wisdom, like the grace of God, was obtainable only by fasting, supplication, and poverty; accordingly he practiced medicine among the poor as a labor of love (having received his degree of Doctor in 1599). During his travels he became familiar with the writings of Paracelsus, which he studied zealously. Finally he settled down in Vilvorde, where he practiced medicine and chemistry until his death (in 164-4). Like most "systems," that of Van Helmont is valued only as an expression of the spirit of the age, since it embodied largely the pantheism of Paracelsus, merely cloaked with a more religious or monkish dress. He held that the general cause of disease was the fall of man; though there also figured a subsidiary cause, which he denominated Archeus,--a faculty of appetite seated in the spleen or in the stomach; thus dropsy was a hindrance of renal excretion by the enraged Archeus. Demons, witches, and ghosts were included in Van Helmont's system as causes of disease. Indeed, the man seems to have been a second Paracelsus, lacking only in the dishonesty and bombast of the latter. He had no followers of any prominence, and the "system" soon lapsed into obscurity. The Chemical, or Iatrochemical, System was originated by le Bôe, commonly known as Sylvius (but who must not be confounded with the great anatomist of the same name). Le Bôe was born in Hanau in 161-4; studied in Paris, Leyden, and Basel; received his doctorate from the latter university at the age of twenty, and practiced in Switzerland with great success until 1660, when he accepted{170} a professorship in Leyden; here he was distinguished for his eloquence, wealth, and sociability, as well as for the great number of pupils that were attracted by his clinical method of teaching. His system embraced a peculiar phantasy, being based upon the elements of chemistry, the new knowledge of the circulation, the latest physiological teachings, and the old doctrine of the spirituous or innate heat of the heart, which he claimed to have felt with his finger. He asserted his theories were founded upon experience, but the truth is, they were inaccurate deductions from experimental observations, many of which were wholly irrelevant. The majority of diseases, he taught, were produced by excess of acidity or alkalinity. For him, the three great fluids of the body were the saliva, the pancreatic fluid, and the bile, while health consisted in the undisturbed performance in the body of the process of fermentation; and the saliva was supposed to give rise to hectic fevers, because such manifest exacerbation after eating. Stereotyped theory and equally stereotyped therapeutics gained for him, for a short time, a large following, but later raised numerous opponents, who alleged that his system caused as many human lives as the whole thirty years' war. He died in 1672. To the same iatrochemical school is generally assigned Thomas Willis, born in Oxford in 1622 (died in 1675), who rendered great service to anatomy, especially to anatomy of the nervous system, although his teaching was disfigured by certain unsupported theories. Like Van Helmont, he had been destined for theology, but turned his attention to medicine. Ultimately he became Professor of Philosophy in the University of Oxford. He first described the so-called circle of Willis, whence its name; also ascribed diseases, especially those of the blood, to fermentation, in which the vital spirits played the chief part. He accounted for hysteria, for instance, by the union of the spiritus with imperfectly purified blood. CHAPTER VII. _Age of Rénovation--(continued).--Iatromechanical School: Santoro, 15611635. Borelli, 1608-1679. Sydenham, 1624-1689. Sir Thomas Browne, 1605-1682.--Surgery: Denis, f 1704. F. Collot, f 1706. Dionis, f!718. Baulot (Frère Jacques), 1671-1714. Scultetus, 1595-1645. Rau, f 1719. Wiseman, 1625-1686. Cowper, 1666-1709. Sir C. Wren the Discoverer of Hypodermatic Medication. Anatomical Discoveries. General Condition of the Profession during the Seventeenth Century. The Eighteenth Century. Boerhaave, 1668-1738. Gaub, 1705-1780.--Animism: Stahl, 1660-1734.--Mechanico-dynamic System: Hoffmann, 1660-1742. Cullen, 1712-1790.--Old Vienna School: Van Swieten, 1700-1772. De Haën, 1704-1776.--Vitalism: Borden, 1732-1796. Erasmus Darwin, 1731-1802._ The physiology{171} of the Iatromathematical, or Iatro-mechanical, or Iatrophysical School devoted chief consideration to the solid parts of the economy, whose form and function it strove to discover and demonstrate by the aid of exact methods,--that is, by calculation and physical apparatus. Thus, it explained digestion as mechanical trituration; secretions were referred to variation in resistance of parts in the vascular system; warmth was supposed to be due to friction of the blood-corpuscles; health consisted in the undisturbed performance of the physical and mechanical processes of the body. Diseases were explained inversely: the blood, under diseased conditions, was held to contain pointed and angular crystals, which irritated as they passed through the pores, or disturbed because they could not so pass. The first to enunciate these views was Santoro, or Sanctorius, who flourished from 1561 to 1635, and was for a while professor at Padua. He taught how to investigate the pulse by an instrument of his own contrivance, and how to study the temperature by means of a species of thermometer, which was probably his own invention. (This instrument, by the way, was invented about this time; Drebbel [1572-1634] is regarded as the inventor of the air-thermometer, Galileo [1574-1642] of the{172} spirit-thermometer, and Roemer [1644-1710] of the mercurial thermometer.) Santoro studied the phenomenon of transpiration, and constructed apparatus for bathing bed-ridden individuals; he found that in twenty-four hours the insensible transpiration through the skin amounted to 1 1/4 kilogrammes,--which result, compared with the results of the present day, determined by the most complete observations, is only twenty per cent, too high, and proves how accurately he investigated. The important rôle of the perspiration, which he pointed out, was made use of by the iatrochemists to vindicate their terrific sweat-cures. Borelli (1608-1679), of Naples, is usually regarded, however, as the founder of the iatromechanical school. Of a quarrelsome disposition, he could not stay long in any one place, though he ultimately settled in Rome, where he joined the circle of _savants_ who gathered round Christina, the daughter of Gustavus Adolphus, who had become a convert to Catholicism. Finally Borelli entered a monastery. His services related mainly to physiology, where, like Descartes, he followed purely mathematical principles; he explained the action of the muscles by the laws of the lever, calculated the mechanical work done by the heart, and correctly ascribed inspiration to muscular action. He was the opponent of iatrochemistry, and claimed there was no such thing as corruption of the blood. His pupils and followers--like Bellini (1643-1704). of Florence, who became professor in Pisa at the early age of nineteen, and Baglivi (1668-1707), a pupil of Malpighi, and a man of universal education--carried out and elaborated the first expressions of this author. Borelli was the author of the oft-quoted maxim: "He who diagnoses well cures well." The iatromathematical system held ground for some time in Italy, and also found followers elsewhere. For instance, Dodart (1664-1707). of Paris, explained the voice on the mechanical principles enunciated by Borelli and by{173} Quesnay (1694-1774). the tirst permanent secretary of the Academy of Surgery in Paris. In England this explanation was adopted by a number of followers, none of whom, however, was eminent enough to justify special mention here. In Germany it obtained a certain amount of favor, but seems not to have attracted any very eminent disciples. The iatromechanical school ran a course not unprofit' able to science, yet was unfruitful of real advance in the domain of practical medicine. The man of this particular age, who, more than any other, exerted an influence destined to be prolonged even to the present time, and probably much longer, who had a cool, clear, and unprejudiced spirit, and who sought the true value of medicine, and recompense for the same in the benefits which it brings to the sick, without scorning or neglecting its scientific side, was Thomas Sydenham, bora at Winford Eagle in 1624. a student at Oxford in 1642, and recipient of a bachelor's degree of medicine in 1648. [Illustration: 0193] The next{174} fifteen years of his life we know practically nothing of, save that he spent some time in Montpellier pursuing his medical studies. In 1663 he became a member of the Royal College of Physicians, but did not take his degree of Doctor until 1676,--thirteen years before his death. His chief work--_Medical Observations_--is said to have been originally written in English, and translated into Latin; it first appeared in 1666,--the year when fire and plague devastated London. He died of gout in 1689, and was buried in Westminster Abbey. During the earliest years of the plague in London he fled, as was the general custom of that day. His model was Hippocrates. In pathology he was a humoralist without being a theorist. He knew only one standard,--observation and experience. Sharing the opinions of his day, he laid but little weight upon anatomy and physiology; yet he recognized their value when employed in the production of hypotheses. He conceived of disease as active, operative,--a natural effort of the body to remove morbid material from the blood; if this effort is violent and speedy, we have to do, he says, with an acute disease, but if slow and difficult, the condition is chronic. Fever was supposed to result mostly from cold or from epidemic influences. As causes of disease, he considered unknown influences and changes of the atmosphere very important. In his special pathology "inflammation of the blood" played the chief rôle, and upon it were made to depend nearly all acute and some chronic diseases. He arrived at what he called the "healing power of Nature," for which he made great claims in his description and observation of epidemics: but he believed there always remained a good deal for the physician to do, and in treating syphilis he even gave mercury until two kilogrammes of saliva were discharged daily. As compared with the therapeutics of that day his were manifestly simple,--and yet he employed, for example,{175} eighteen different herbs in one prescription, and that merely an ointment. The unreliability of the action of drugs induced him to rely upon specifics, as did Paracelsus, but he acknowledged only one such,--the then new discovery, cinchona,--not even allowing mercury such a position in the treatment of syphilis. Such drugs as he chose were mainly from the vegetable kingdom. The great importance of Sydenham, and all his statements, so far as we are concerned, centres about his struggle for the elucidation of the healing power of Nature, and for simple observation and simpler treatment, as opposed to the overgrown luxuriance of previous systems and theories. He became the standard-bearer of his age in his return to Hippocrates's method and art of healing, which are founded on the nature of things and on the limits of human ability. Sydenham was vehemently opposed by Richard Morton (1625-1648), of London, who, like Fernel, considered all diseases to be a poisoning of the vital spirits. Sydenham was also antagonized by Gideon Harvey, who ridiculed his medical contemporaries without stint, because most of them, for febrile disease, gave cathartics from the second day, and began treatment with emetics. With delightful satire Harvey divided the physicians of the day into six classes: the Ferrea, Asinaria, Jesuitica, Aquaria, Laniaria, and Stercoraria, according as their favorite systems of treatment were the administration of iron, asses' milk, cinchona, mineral water, venesection, or purgatives. Sir Thomas Browne (1605-1682), who still enjoys a great reputation, was the author of the works entitled _Religlo Medici and Inquiries into Vulgar and Common Errors_. The latter appeared in 1646, but does not seem to have protected its author from the worst error of his age,--viz., superstition,--since, in 1664, he swore that two condemned old women were actual witches. Having{176} considered the progress of medicine during the seventeenth century, it may be well to glance likewise at surgical progress. Among the Italians Santoro, already spoken of as the inventor of various instruments, should be mentioned; also Valsalva, who obtained a sound reputation as an operator, employed the ligature, and recommended a starvation plan for treating aneurism; Magati (1579-1647). who contended against the abuses of treating wounds by filling them with plasters, balsam, poultices, tents, etc., and of changing the dressing several times a day.--once in four days was better, he said; Severino (1580-1656), first a lawyer, then a professor at Xaples, and later an eminent surgeon, a good anatomist, and a particular friend of the actual cautery; Marchetti (1589-1673), a bold, versatile operator of Padua; and Borri, of Milan (1625-1695), skilled as an operator and an oculist but better known because of his sad fate, since he died in the prison of the Inquisition, alter a prison-life of twenty-five years, on account of too liberal religious views. There were also numerous other Italian surgeons who made a name, especially in plastic surgery, and particularly in that branch of it named rhinoplasty, by whose efforts one method of manufacturing a new nose came to be known as the "Italian method." France, we must remember, was the home, during this century of Richelieu. Mazarin. Louis XIV. Corneille. Racine. Molière. Fénelou. La Fontaine. Boileau, Bossuet, and many other men eminent in literature and science. During this century the French laid the foundation for that leadership in surgery which they maintained for nearly two centuries. Let us mention, among their surgeons. Morel, who invented the tourniquet at the siege of Besançon, in the year 1674. There was also Jean Baptiste Denis (who died in 1704), physician to Louis XIV. who performed the first transfusion of blood in man. (Transfusion of the blood of the young into the veins of the old for the purposes of rejuvenation,{177} was recommended by Libavius, in 1715, and Colle, of Padua, gave it new support by describing a method for its performance. In 1729 Boyle practiced transfusion on dogs. The London faculty sought the value of the operation after excessive haemorrhage, and Edmund King, physician to Charles II, in 1665 practiced transfusion from vein to vein. But Denis was the first to carry out the operation with lamb's blood upon a patient sinking under excessive venesection,--an operation which was very much abused at this time.) It was in this century that the French family of lithotomists--the Collots--distinguished themselves in their special line. The last member of the family, Francois, died in 1706. Their specialty must have found, at that time, considerable more material than comes to the front to-day. Among the general surgeons of France were de Marque (1618), who distinguished himself as a bandager; Bienaise, who invented the bistoury caché (1601-1631); de Launay (1649), monk and lithotomist; Goursaud, who survived his century, and who was the first to describe stercoral incarceration; Duverney, who demonstrated the growth and nutrition of the bones by periosteum; Lambert, who practiced injections in hydrocele; Andry, of Lyons, who wrote of orthopaedic surgery and originated the name _orthopaedics_; Pierre Dionis (who died in 1718), surgeon to the Empress Maria Theresa, famous in his art, and who first emphasized the effects of rickets upon the pelvis; and Boulot, better known as Beaulieu (1671-1714). who advanced himself from being a soldier and a day-laborer to become a physician, a famous lithotomist and surgeon. He finally joined the Franciscan order, where he obtained the name of Frère Jacques, under which title he passed for the inventor of lateral lithotomy. Then there were Saviard (1656-1702), surgeon-in-chief in the Hôtel-Dieu, who, among other things, determined the seat of hernial strangulation to be often in the neck of the sac; and Georges{178} Mareschal (1658-1736), surgeon to Louis XIV, one of the founders of the Academy of Surgery, who has a record of eight lithotomies performed in half an hour, and who became famous for his services in improving the schools of surgery in France. In this (the seventeenth) century, also, ophthalmology was much cultivated in France, although it was assigned to the despised surgeons. Those who won most renown in this line were Maitre Jean and Brisseau, who divide the honor of first recognizing the seat of true cataract. During this period, also, Duverney, Professor of Anatomy at Paris, was the first to systematically describe diseases of the ear in accordance with their anatomical seat. In Spain scholarship sank more rapidly during this century than among any other people in history, due mainly to the loss of their political supremacy and their commerce to the Dutch and English, and to the utter failure, at home, of their efforts to introduce true unity of faith. In these efforts the industrious Moors were excluded, under Philip III. In art they maintained their standing,--attaining, in fact, in Murillo, the acme of their fame; but in other branches of industry they rapidly degenerated. Students of history will readily understand how little leisure the Spaniards had at this time to devote to the cultivation of science, including medicine and surgery. Of the two men who are mentioned during this century as Spanish surgeons, namely, Almeida and Ayala, we know practically nothing. The Germans gained no such store of knowledge from their experience during the Thirty Years' War as did the French during their campaigns. The barber-surgeons, for the most part, still reigned supreme, and their guild contained some men of ability and independence of thought. The most notable man of the times was Fabricius Hildanus (1560-1634). Of him, however, I have already spoken as belonging rather to the previous century. He was the first learned{180} German surgeon recognized and esteemed as such by his contemporaries. He was distinguished, also, as an oculist and aurist, and removed a particle of iron from the cornea by means of a magnet. A man of great operative genius, and a born surgeon, was Purmann (1648-1721), who greatly lamented the low condition of surgery in Germany, and regarded a knowledge of anatomy as the prime requisite for the surgeon; he employed the speculum in the diagnosis of syphilis, although it has been Ricord's boast that this was his own idea. Scultetus (1595-1645), of Ulm, was a famous surgical writer of this period, and a bandage of his devising is still in frequent use, and bears his name. Murait, of Zürich, was also a capable surgeon (1655-1733). [Illustration: 0199] The Dutch had but few men during this century who enjoyed any reputation as surgeons. The best among them was Rau (1658-1719), who, from being a poor boy, became a barber, traveled extensively, and was finally made Professor of Anatomy and Surgery in Leyden, where he introduced the innovation of teaching practical surgery upon the cadaver. He was especially famous as a lithotomist after the method of Frère Jacques, although he did not give instruction on this subject in his lectures. By the way, it is an interesting fact that the clinical histories of many operations for stone during the seventeenth century were related in verse, and illustrated with plates. Harvey's vivisections were also related in verse. Now, for the first time, do we begin to hear of English surgeons and English surgery. The most prominent, as well as almost the earliest, was Richard Wiseman (1595-1686), ordinary surgeon of James I, called sometimes the "Pride of England" and sometimes the "Paré of England,"--a bold, judicious operator, who took hold of every novelty and who accepted the ligature of Paré (always having the actual cautery at hand, in case the ligature should fail); he also amputated through sound parts,{182} favored operating for strangulated hernia, and employed the trephine zealously. The first recorded operation for external urethrotomy for the relief of stricture is mentioned in Wiseman's writings. [Illustration: 0201] There were also William Cowper (1666-1709), a famous anatomist and surgeon; and Woolhouse, a famous, but ignorant, itinerant oculist. Sir Christopher Wren, architect of St. Paul's, was the first who devoted attention to injecting medicine into the veins,--a subject studied again much later and recently once more taken up. His example (in 1667) was followed by others, whose experiments demonstrated, as we know to-day, that the effects which follow the intravenous administration of drugs are the same as follow administration by the mouth. Midwifery during the seventeenth century advanced even more rapidly than its mother-science surgery. The accouchement of women was intrusted in many cases to the care of educated men, who contributed not a little to the art. Anatomy and physiology contributed also their quota to a clearer knowledge of these diseases. The obstetric forceps were for so long a time kept secret that they were of small benefit at first to the obstetric art. Among the French who were especially prominent as promoters of midwifery must be mentioned Marguerite de la Marche, chief midwife of the Hôtel-Dieu; Francois Mauriceau, President of the College of St. Come; Jules Clement Delamotte, who was also a skillful surgeon; and Portal, who first proposed version by one foot Among the Germans a few midwives distinguished themselves as independent observers, most of all Justine Siegemundin, daughter of a minister, who devoted herself to midwifery with such success that she became court midwife; she recommended puncture of the membranes for the production of artificial delivery, and especially advocated bimanual version. But, perhaps, the most significant advances were made in the direction of studies in anatomy, physiology, and pathology.{183} The history of the circulation we have already taken up. After Harvey's time, and largely because of his researches, physiologists were divided into two parties with regard to the origin of life. These parties were known as _animists_ and _animalculists_. It was largely by the later researches of Highmore (1613-1685) upon the anatomy of the testis and the epididymis, supplemented by those of Aubrey in Florence concerning the ovaries (which had been previously considered as female testicles), and the researches of Stenon concerning the muscular nature of the uterus, that a better knowledge of reproduction was established. De Graaf (1641-1673), a physician of Delft, Holland, pointed out the ovarian follicles, known to-day under his name, while Swammerdam (1637-1686) studied the comparative anatomy of the ovaries,--and was, by the way, the first to prove that the queen bee is a female. Needham, the London anatomist and physician, and Hoboken, of Utrecht, described more accurately the placenta and the coverings of the ovum. Anatomical discoveries crowded along about this time. For instance, Wharton (1610-1673) discovered the sub-maxillary duct, named after him; Glisson (1647-1671) studied the liver and recognized its capsule, that still bears his name; Nuck injected the lymphatics with quicksilver, and studied the glands especially; Stenson discovered the excretory duct of the parotid, and Rivinius (his name being translated in German, Bachmann) found the sublingual duct; Peyer, Schafhausen, and Brunner, the latter a professor in Heidelberg, discovered the intestinal glands which bear their names; Wirsung, of Bavaria (who was assassinated in 1643 by another physician), discovered in the dissecting-room of Vesalius, at Padua, the excretory duct of the pancreas; Pacchioni found the bodies named after him in the dura mater; Havers, of London, discovered the synovial glands and the so-called Haversian canals; Cowper, already mentioned, discovered the small glands named after{184} him, located in front of the prostate, and Bartholin yet other glands, in the labia, which bear his name; Mei-bom, professor in Helmstàdt, discovered the small glands in the eyelids which are named after him. Besides these, many other discoveries might be recorded here, did time permit. One other, however, deserves to be mentioned, with which the name of Schneider (1614-1680) must always be honorably connected. He described the mucous membrane of the nose and demonstrated anatomically and clinically that not the brain, but this membrane, secretes the mucous discharge during fluxes from the nose. This overthrew at once and forever the ancient doctrine, which included so many and various "catarrhal" diseases. I might add also that the best and most complete description of the{186} entire central nervous system which had been given up to this time was furnished by Vieussens. Description of Fig. 26.--"Of the corruption of the bones of the arm and shin, even as far as the marrow; of the shin- bone broken with a wound and the bones sticking out and bound with swathe-bands brought circularly about; and of the cutting off of the end of the hand or foot. I represents the corruption of the bone and of the marrow of the shin-bone, II represents the shin-bone wholly corrupted and rotten. III represents the place where the corrupt bone was situated and was now pulled forth with the pincers. V is that shin-bone corrupted, which the patient laid up for a memorial. VI is the bone of the right arm corrupted. VII represents the bone of the arm totally corrupted and sharp, which was pulled away with the pullers, but by pieces, without any noise or pain. VIII shows the place where the corrupt bone of the arm lay, which was now pulled forth, which Nature filled up with a callous, so that the patient could perform country business without any impediment. The patient was a countryman of Pappatavia, whose arm a souldier broke in four places, without any wound, anno 1636. IX is a fracture of the shin-bone with a wound, and laying the bone naked. X is the bone of the shin with a wound, broken, with bones sticking forth, and bound with bands not crosswise, but circularly brought about and laid within the capsula as it ought to be. XI is a hand affected with a secret canker which is cut off in the sound part, namely at the end of the radius and cubit bone. XII is a hand that is sphacelated, which, being laid upon the block (D), is amputated in the sound ends of the radius and arm-bone with a chizel (E), contrary to Hildanus, with good success. XIII is a basin filled with oxyerat, in which swims a bladder, which, being wet, must be applied to the mutilated part. XIV are two swathe-bands wrapt together (F and O), whereof each hath two ends, to bind the arm, whereof the hand at the end is cut off. XV represents a foot that is sphacelated, which is taken off in the mortified part, near the sound part with a pair of pinccrs. The mortified part being removed, the rest of the putrefaction is consumed with red-hot irons until the patient feels the force of the fire. After this two plagets are anointed with Hildanus, his unguent Egyptiae, which are applied to the escar; lastly, long plaisters (7) being laid upon it, the foot mutilated is bound with a wet band (Q} as far as the knee, as the hand is unto the middle of the arm. XVI are divers sorts of iron instruments and made red hot, both to consume the remainder of the putrefied part and are also fit to stop the flux of blood." [Illustration: 0205] By the middle and latter portions of the seventeenth century most of the better physicians and surgeons had either assumed offices and positions in which they were supported by the State, or were settled in permanent residences, which was not the case with the mass of physicians in the sixteenth century. As a result the reputation of the entire profession began to improve, while the unlimited license and absolute freedom of practice prevailing during the Middle Ages were almost entirely done away with. By this time the clerical element had disappeared almost entirely from medical circles, or only dabbled in certain specialties. The Thirty Years' War was fatal to the supremacy of the clergy in matters of public health. Moreover, the increase of international intercourse favored the communication of medical knowledge. The physicians of this period were more occupied with chemistry and physics than had ever been the case before. Nevertheless, this was also the special age of _alchemists_ and of _impecuniosity_. According to one of the classifications of the time, the regular profession was supposed to include physicians, surgeons, barbers, regimental surgeons, lithotomists, bath-keepers, midwives, nurses, apothecaries, druggists, and even confectioners and grocers. Another list of impostors and quacks, equally official, was made to include old women, village priests, hermits, quacks,-- Description of Fig. 27.--"I represents the breast affected with an ulcerated canker, the basis whereof is thrust through with two needles drawing after them a twisted flaxen thread. II shews how the chyrurgeon takes hold with his left hand, of the ends of the threads that were thrust through, and with his right hand he takes the knife and with that he cutteth the canker out by the roots. III shews a canker cut from the breast weighing six physical pounds. IV shews how the chyrurgeon, after the cutting off of a breast ulceratcd, doth lightly cautcrize the place with a red-hot iron at least to corroborate the parts. V is the instrument of Hierom Fabritius ab Aquapendente wherewith a fistula of the thorax is perforated. VI is Sostratus, his band, which is most convenient where the breast is affected with any disease that requires binding. VII shews how Celsus cured the sticking forth of the navil by manual operation. VIII is a truss for the navil made of a double: cotton linncn cloth." [Illustration: 0207] --uroscopists,{187} Paracelsists, Jews, calf-doctors, executioners, crystallomancers (a class of people--chiefly Italian--who sought after crystals), mountebanks, vagrants, magicians, exorcists, monsters, rat-catchers, jugglers, and gypsies. Veterinary physicians were also at that time included in this class. Anatomy{188} was now studied more from human bodies, and was authorized by statute. This was especially the case in non-German institutions, to which for this reason students flocked in great numbers. In Dresden, so early as 1617, there was a dissecting-room in which stuffed birds, at that time a great rarity, and similar curiosities were preserved. The study of anatomy was at a low ebb in Germany; so that when Rolfink, in 1629, arranged at Jena, which was then the most popular German university, for two public dissections upon executed malefactors, it was considered such an event that the very highest authorities were present. But the peasantry took such fright at this occurrence that for a long time afterward they watched their cemeteries by night lest the corpses should be dug up and, as they said, "Rolfinked." Vienna did not possess a skeleton until 1658. Strassburg obtained one of a male in 1671, and several years later one of a female. In Edinburgh an anatomical theatre was first erected in 1697 in Surgeons' Hall. It is worthy of remark that anatomical plates, designed to be lifted off in layers, existed even at this period. About the middle of this century there arose a dispute at the bedside of the Margrave of Baden, between two learned professors and the regular court physician, whether a plaster to be applied over the patient's heart should be placed in the middle of the chest, according to Galen, or upon the left side. The dispute was settled by opening, before the eyes of the noble patient, a hog, by means of which it was demonstrated that, as a matter of fact, the heart of the hog lay on the left side. So convinced was his excellency that he dismissed the ordinary physician, who had held a contrary opinion as to the position of a nobleman's heart. The general barbarity and immorality of this century were conspicuous, especially among the upper classes, and by its close had spread from France, became naturalized in both Germany and Italy, and extended even to the universities,{189} their professors, and their students. The life of the latter during this period was more vulgar and rude than ever before, and almost more so than ever since. Pennalism--that is to say, barbarity toward junior students--became unbounded, so that outbreaks occurred even during lectures. At last the State authorities were compelled to interfere. Student outrages were very frequent and often fatal, and their outbursts were disgraceful in the extreme. Only in France was instruction in surgery well regulated, for this was the only country which possessed a proper surgical college. Practical instruction was imparted to mid wives--in Paris through a special institution, in Germany through the Midwives' Guild; the barbers, too, continued to receive instruction from their guilds; while instruction in pharmacy was given by the master-apothe-caries, too often dogmatically and even farcically, serving as objects for the keen satire of Molière. The expenses of graduation were very great, and the ceremonies sometimes lasted two days. In another way this same seventeenth century might be characterized as one of aggrandizement for physicians,--that is, as one during which their position was improved in the eyes of the public and better supported by the State. The physicians proper--the "_medici pitri_"--were still persons of the profoundest gravity, with fur-trained robes, perukes, canes, and swords, when matters were prosperous, who for their lives would do nothing more than write prescriptions in formal style, everything else being considered beneath their dignity,--even as they affect in England to*day. They demanded to be called in every case, however, even though they knew nothing about it, claiming that only by means of their presence could things certainly go right. Nevertheless, in dangerous cases--for example, during the plague--they left the surgeons alone, while they looked upon the sick through the windows. In spite of this, however, they were generally esteemed and often{190} sought for, as well in public as in private. Some of them were supplied with large libraries by their patrons or through their positions under the government, and most of them enjoyed moderate prosperity. Their pay was, for the most part, regulated in accordance with a definite tariff, while the State gradually cut down the doctor's honorarium to the pay of a day-laborer. During that century a certain physician to a countess in Munich received $25 as his annual stipend. For being present at a post-mortem and rendering an opinion thereon, each physician received $1.75. Surgeons who were zealous and eager were always highly esteemed; they were often better educated, in many respects, because of their extensive travels; but the social emancipation of the surgeons was not completed until the eighteenth century. About this time amputation of the arm was supposed to be worth 31 marks ($7.75); of the leg, 41 marks; or, if a patient died, half this price. Lithotomy cost 51 marks, or half of that if the patient died. For cataract operation on one eye the surgeon received 17 marks; for a like operation on both eyes, 25 marks. We find in medicine, as in other branches of knowledge, that each succeeding century presents its added quota of imperishable facts, making it still more important than its predecessor. We may say that the fifteenth century had prepared the way for a reforming idealism which was the principal characteristic of the sixteenth; and that in the seventeenth century the realistic reaction against this same idealism showed itself in the church and the State by struggles against constituted authority, and in medical science by the domination of inductive philosophy. The idealism of the eighteenth century was not reformative and humanistic, but revolutionary and humanitarian. The unsettled character of the century's events may be charged, in some degree, to the American and French revolutions, with their interpretation (and their attempted attainment) of the{191} so-called "rights of man." The masses were now supposed to be released, and philosophers created new doctrines, which had a greater influence upon the times than ever had philosophical doctrines before. Rousseau, for instance, aroused a revolution in politics and education, while skeptics and materialists alike strove for general enlightenment, which was sadly needed. Among the higher classes extravagance and immorality prevailed extensively, among the lower classes poverty and ignorance. In Germany the rulers even sold their subjects, as when Hesse-Cassel sold to the English seventeen hundred mercenary soldiers, and other States sold smaller numbers. A criminal code, published in 1769, contained seventeen copper-plate engravings, illustrating various methods of torture. A physician was always present when torture was inflicted, to see that the victim's sufferings were not greater than he could bear. This inhuman mode of eliciting testimony was last practiced in Europe in 1869, in the Swiss Canton of Zug. Popular education was a myth, and the children of bondmen were not permitted to learn. No wonder the French revolution was hailed with joy along the Rhine, where it swept away at once and forever the petty rulers, abbots, and bishops, who were the "bloodsuckers" of the people. The numerous wars of the century had no great influence upon the development of medicine, except in the direction of surgery. The eighteenth century was revolutionary also in the introduction of freedom of religious thought, so that clerical physicians disappeared entirely from the ranks, save a few who officiated as lithotomists, like Frère Come, or as oculists, like Wrabetz, the latter of whom was even a professor in Prague. This was the century, too, of Leibnitz and Kant, of Linnæus and Lavoisier, as well as of Bach, Haydn, Beethoven, and Goethe. During it the most conspicuous services in nearly all branches of learning were rendered by the Germans,{192} instead of by the Italians and English, as during' the preceding century. In fact, Germany was then at the zenith of her glory, and supplied an impulse for all other nations. The influence of philosophy and the natural sciences became also more and more marked. At the head of its philosophers must be placed Leibnitz (164:6-1716), who, by his own writings and those of his pupils, created a philosophical school, whose influence is still every where felt. His doctrine was dualistic: Matter is created once for all, and has no further need of the Creator. As concerns the spiritual world, he assumed minute, indivisible, intelligent beings, called monads,--constituents of all bodies and all beings. In close relation with him stood Kant, while in England Locke and Hume became leaders of the opposed and materialistic school, declaring the brain to be an organ for the secretion of thought. Among the universities founded during the eighteenth century were those of Breslau, 1702; Bonn, 1771; Stuttgart, 1781; Pesth, 1794; Gottingen, 1737; and Erlangen, 1743. Medicine was also cultivated in learned societies, which increased constantly in numbers. In 1744 Frederick the Great united two other societies into his Royal Academy. In Switzerland, in 1751, was founded an association of physicians and naturalists, while in France royal scientific societies were founded at Bordeaux, Montpellier, Lyons, and Dijon, and the Royal Medical Society of Paris lived from 1717 until 1788. In spite of all these opportunities for enlightenment, everything was not yet enlightened. Then de Haën defended the existence of demons, and Maerz, a well-known theological teacher, in 1760 devoted a book to witches and magic. That witches were burned publicly is a matter of history, even in America. So late as 1821 there was a statute regarding witches in Ireland, and they were burned in Mexico as recently as 1877. But these are flying pictures of the eighteenth century, which are meant{193} only for the moment to illustrate the more serious topic, to which we must now address ourselves. [Illustration: 0213] First of all, the _medical systems and theories of the century_. Many hundred years previously Galen had originated a method, which deserves, perhaps, the title of pure eclecticism. The first purely eclectic system similar to his originated with Boerhaave (1688-1738), perhaps the most famous physician of his or any other century. He was the son of a clergyman near Leyden, Holland, and was one of thirteen children. Originally intended for the clerical profession, he had studied philosophy, history, logic, metaphysics, philology, mathematics, as well as theology, with great diligence. His education was, later, directed to the study of medicine, because of the statement that the purity of certain theological doctrines was endangered by him. So he studied chemistry and botany, and then anatomy and medicine,{194} graduating in 1693. He practiced in Leyden with great success, and was offered a court position. In 1709 he was tendered the chair of Medicine and Botany, and in 1714 that of the Practice of Medicine; in 1718 he was also made Professor of Chemistry. In all of these positions he displayed the greatest capacity. He was a clinical teacher of rare talent, and soon acquired such reputation as to attract to Leyden students from all parts of the world in such numbers that no lecture-room in the university could contain them. He was the first to give separate lectures on the subject of ophthalmology, and employed the magnifying-glass in examining the eye. As a practitioner he was no less popular, and he left an estate valued at two million dollars. He was so famous that, when a Chinese official addressed a letter "To the Most Famous Physician in Europe," it reached him safely. He made no distinction in his patients, and compelled Peter the Great to wait a whole night for his turn to consult him. His most eminent pupils were: Haller, Van Swieten, de Haën. Gaub, and Cullen. Boerhaave's influence and dignity, which were astonishing, even in a physician, were based no less upon his encyclopaedic attainments than upon the benevolence and purity of his character. He was free from disputatiousness and vanity, although everywhere regarded as an oracle. His universal maxim was: "Simplicity is the seal of truth," although he never manifested this in his therapeutics. He employed the thermometer in the axilla in examining his cases, as did the iatrophysicists of the previous century. His doctrines did not form a new system, but rather a composite of earlier systems, he stands also in the anomalous position of one who had the whole world at his feet, and yet contributed little or nothing which has been of essential importance. In fact, his peculiar views have been so universally given up that they are of only meagre historic interest. He looked upon disease as a condition in which{195} bodily action or natural activities, being disturbed or unsettled, could take place only with difficulty; the reverse of this, of course, constituted good health. Fever he regarded as an effort of Nature to ward off death. Digestion was explained, like the circulation, upon mechanical principles. In his therapeutics, besides his efforts to sweeten the acid, to purify the stomach, to get rid of acridities, he made Hippocrates and Sydenham his models. His biographers say that his medicines were less effective than his personal appearance. He left many adherents, but no school of followers. It must be said, however, to his credit, that, while not the first to give clinical instruction, he permanently established a clinical method in teaching. Gaub (1705-1780), professor in Leyden from 1731, was but little inferior to his master, Boerhaave, in fame as a teacher. He wrote the first complete work on the exclusive subject of general pathology. In general therapeutics he considered the healing power of Nature amply sufficient to remove sickness, but attributed this power sometimes to the soul and sometimes to the body. There arose, naturally, strenuous opposition to the views and teachings of Boerhaave, and his principal opponent was Stahl (1660-1734), who was one of the most important systematists of any age, a profound thinker, and a pioneer chemist. He began lecturing in Jena at once upon his graduation, at the age of twenty-five, and moved through two or three different university positions until he came to Berlin at the age of fifty-six. He was a great pietist, of uncouth manners, faithful to his laboriously acquired convictions, and bitter and relentless against those who could not accept them. Indeed, he regarded his convictions as revelations from God. He looked upon the success of another as a personal injury to himself, and from being first a croaker he became finally a confirmed misanthrope, until he fell into actual melancholia. Pecuniary profit he had never sought, and its pursuit he scorned.{196} His views were dynamico-organic, pietistic, and antagonistic. He regarded the soul as the supreme principle, life-giving and life-preserving, not to be confounded with the spirit; when hindered or obstructed in its operation, disease was present. The soul governed the organism chiefly by way of the circulation; consequently, plethora played an important rôle. To get rid of this plethora the soul employed either fever or convulsive movements; for example, in children plethora produces a pressure of blood to the head, and, by way of compensation, the soul provides a haemorrhage from the nose. For reasons easily appreciated, he regarded bleeding piles as safety-valves of the utmost importance. Fever was a salutary effort of the soul to preserve the body; this was true even of intermittents, and, accordingly, he never gave cinchona. He scorned anatomy and physiology, saying, in one place, that medicine had profited as much by the knowledge of the bones in the ear as by a knowledge of snow which had fallen ten years previously. But Stahl was one of the most eminent chemists of the age, and did a great deal to liberate chemistry from the glamour of alchemy and the domination of pharmacy, and to transform it into an independent science. Stahl's doctrine has been called _animism_, and was a reaction against the chemical and mechanical theories of the seventeenth century. He gained a considerable number of followers, the most notable of them among the French being Sauvages (1706-1767), the forerunner of Pinel and an opponent of pure mechanics, who animated the mechanical system of the body with Stahl's "soul." This was, par excellence, the age of artificial systems, and so Sauvages in his classification supplied a system which had ten classes of diseases, each of which had several orders, and some as many as two hundred and ninety-five genera, and two thousand four hundred species of disease!! Even Linnæus had three hundred and twenty-five genera of disease,{197} while Cullen had only four classes with one hundred and forty-nine genera. The mechanico-dynamic system was a sort of compromise or mixed system, which was held in high honor by the most eminent physicians and better minds of the last century, and has even been prized by Sprengel as the best of all. It was originated by Friedrich Hoffmann (1660-1742). Hoffmann's father was a physician, and he was himself born in Halle, whose university he attended. He acquired lasting reputation as an oculist, and was made Professor of Anatomy, Surgery, Medicine, Physics, and Chemistry at his _alma mater_. Our commonplace "Hoffmann's anodyne" is named after him. He was one of the most erudite professors of his day, more easily understood than Stahl, widely known for his fluent diction and amiable temper, and, accordingly, won great renown for his university. His good fortune as a practitioner was so great that even Boerhaave declared him his own equal. As a writer he was voluminous, one edition of his works comprising twenty-seven large volumes. According to Hoffmann's views, life was simply mechanical movement, especially of the heart; death, the cessation of heart-action, putrefaction thereupon resulting. Health meant regularity of movements; disease, a disturbance of the same. He used the word "tonus" extensively. Ether he regarded as an important factor, producing and maintaining movements of the body, itself extremely volatile, corresponding largely to the "pneuma" of the ancients; it was, in fact, a motor principle and, at the same time, the perceptive soul. Ether was stored in the medulla, and circulated in a double way in the body; spasm was the consequence of too strong, atony of too feeble, influx of ether. Fever was a general spasm of the arteries and veins, having its cause in the spinal cord. Hoffmann's therapeutics were simple, and poor in drugs. These latter were intended to weaken, alter, or evacuate, and he{198} was especially partial to the use of vinous remedies. The strong and toxic drugs he used but little. William Cullen (1712-1790), a Scotchman, rose from the deepest poverty to the greatest celebrity. First a barber, he afterward became an apothecary, then a ship-surgeon, then a village practitioner, finally entering into partnership with William Hunter as a general practitioner. Both of these eminent men being in equally poor circumstances, they agreed to live in the same place and that, while one was studying, the other should take care of the practice. In this way Cullen was enabled to graduate in 1740. Six years later he taught chemistry in Glasgow, and in ten years more came to Edinburgh as Professor of Medicine. He continued very active and famous up to the time of his death, but died as he had been born,--in poverty. Among his numerous other charitable deeds, he supported the widow of Robert Burns and published the latter's poems. Cullen was the father of modern Solidism,--a system based upon the solid parts of the body, the nerves being the chief agents. The life-giving element was, in his view, an undefined, dynamic something (different from Hoffmann's ether or Stahl's soul), which he called _nerve-force, or nerve-principle; animal force; and brain-energy_, and in it he included the spinal cord. His nerve-principle was supposed to produce spasms and atony, either actively or passively. The causes of disease, while of a debilitating character, were supposed to awaken reaction of the healing powers of Nature; fever was a reparative effort of Nature, even in its cold stage, the blood playing no part in it. He constructed a very arbitrary classification of fevers, as, in fact, he did of all diseases, his system of nosology being the secret of his reputation. His explanation of gout was famous. That disorder, he said, depended upon an atony in the digestive organs against which was periodically set up a reparative effort in form of a{190} joint inflammation. In scrofula he had to assume, in contradiction to his nervous pathology, a peculiar acridity, and in putrid fever a putridity of the humors of the body. His therapeutics were simple and salutary, because of his renunciation of venesection, which was much abused in his day. The most celebrated pupils and successors of Hoffmann were Gregory, of Edinburgh, Gardiner, and, in Germany, the famous Thaer (1752-1828), who finally abandoned the practice of medicine because it promised more than it could perform, and who became a "father of husbandry." A composite of the doctrine of Hippocrates, Sydenham, and Boerhaave was represented in the so-called Old Vienna School, whose connection with the lives of Maria Theresa and Joseph II deserves, at least, mention. Its founder was Baron Van Swieten (1700-1772), of Leyden, a descendant of a noble Jansenist family of the Netherlands, who graduated under Boerhaave after having studied at Louvain. After the death of his patron he was called to the assistance of the Archduchess Maria Anna, of Austria, who was suffering from an abortion, and gave such satisfaction that she recommended him to her sister, Maria Theresa, who up to this time had remained sterile. To her and to her husband he gave advice which resulted in sixteen successive pregnancies, and then, as the result of his success, came to Vienna in 1745 as President of the General Medical Department of Austria. He was also made censor, in which position he incurred the enmity especially of the Jesuits and of Voltaire, whom he robbed of their influence. He was made baron, and became, next to Kaunitz, the most influential counselor of the empress. His chief care was dedicated to the elevation of medical affairs in Austria, and especially to the improvement of the medical faculty. He had just seen success crown his efforts when he died of senile gangrene, with the reputation of being a great physician and benefactor of the poor. One of the greatest of his{200} services was improving the treatment of syphilis, in which he, after the example of Paracelsus, recommended the internal use of corrosive sublimate. More eminent as a physician than for personal character was de Haën (1704-1776), of The Hague,--a pupil of Boerhaave. At the suggestion of Van Swieten, he was called, in 1754, to Vienna as president of the clinic of the city hospital, which at that time afforded accommodation for only twelve patients. He was the real founder of the so-called Old Vienna School, whose merit, in contrast to the so-called new school, is to be sought in practical and diagnostic services. As de Haën quarreled with every one, he also did with Stoerck (1749-1803), the successor of Van Swieten in the direction of the Austrian Medical Department, and with Stoll (1742-1787),--a clinical teacher who was especially famous as an epidemiologist. Stoll lectured with great popularity until 1784, upon the completion of the Allgemeines Krankenhaus, when he fell into the background and was badly treated. He was the subject of numerous intrigues by his enemies, and had a wife who embittered his life, and who even had him buried in the dress of a Jesuit in order to injure his reputation after his death. To his credit be it said that, changing his views of the constituents of disease later in life and his original therapeutics becoming no longer of use to him, he abandoned them entirely. Nevertheless his therapeutic system flourished for a long time after him. There were in vogue during this period numerous other doctrines, some of which were too puerile or insubstantial to gain any foothold at all; others exerted a certain amount of influence during the life-time of their originators or for a generation afterward. With many of these I do not care in any way to deal. A few others, I think, ought to be at least mentioned in such a history as I am endeavoring to present. There was another Hoffmann--Christopher Ludwig Hoffmann{201} (1721-1807), of Westphalia, who devised a so-called humoral theory in which the "acridities" of Boer-haave were mingled with the "putridities" of the pneu-matists and the "irritability" of Glisson. His treatment and remedies for diseases were supposed to be antiseptic, as was very proper when dealing with putridities. The theory known as the "Doctrine of Infarctus" had its origin with Kampf, who died in 1753. By infarctus Kampf understood impacted fæces, which he thought originated in the humors of the body, portal vessels, and intestines; he recognized two kinds,--the black bilious and the mucous. From this theory a wide-spread clyster fashion developed, and lords and ladies vied with each other in belaboring their infarcti and in administering enemas. As Baas says: "We cannot deny to the author of this doctrine at least an extensive knowledge of human nature. He supplied a universal remedial procedure, and gratified the apothecaries with the bulkiness of the herbs required for its practice." Quite antagonistic to the views of the Vienna School were those of the School of Montpellier, inaugurated by Bordeu (1732-1796), and generally known as _vitalism_. Bordeu died in the enjoyment of great reputation, but at variance with all his colleagues. He maintained the existence of a general life of the body,--a composite life,--resulting from the harmonious working of the individual lives and powers of all the organs, which were supposed to be associated with each other, but each for its own definite function; the most important organs--the stomach, heart, and brain--being called "the tripod of life." In pathology he laid great weight upon crises, which were supposed to proceed from the glands. The most important representative of vitalism was Barthez (1734-1806), of Montpellier,--a man of great gifts and eager for knowledge. He recognized a vital principle as the cause of the phenomena of life, but acknowledged that{202} its nature was unknown, although he endowed it with motion and sensibility different from a thinking mind.. Plants were supposed to possess it likewise. Disease, he believed, was the result of an affection of this vital principle. Every disease was divisible into certain disease-elements, viewed as parts of the whole, and these were again divisible into secondary elements. He explained putrid fevers as specific vital diseases,--in which view, of course, he embodied humoral ideas. In Germany, at about this time, a similar doctrine obtained,--a doctrine of vital forces,--which the versatile Reil (1759-1813) elaborated into a system. Meantime, in England, a doctrine was elaborated by Erasmus Darwin (1731-1802) which partook, in a certain degree, of the doctrines of Stahl, Hoffmann, Haller, Brown, and Bordeu. Erasmus Darwin distinguished himself, not only as a physician, but as a poet, philosopher, and physiologist. He was a friend of James Watt. Of his life it is said that by his practice and very fortunate marriages he became wealthy, ate much, and drank nothing but water. His chief work--entitled _Zoonomia, or the Laws of Organic Life_--was published in 1784, and is well worthy of perusal to-day. He recognized two fundamental substances--spirit and matter. But it is not so much for his doctrine as for his researches into animal and plant physiology, and, reflexly, because of his more celebrated descendant of the same name, that we owe him most gratitude. CHAPTER VIII. _Age of Renovation (continued).--Animal Magnetism: Mesmer, 1754-1815. Braid.--Brunonianism: John Brown, 1735-1788.--Realism: Pinel, 17451826. Bichat, 1771-1802. Avenbrugger, 1722-1809. Werlhof, 1699-1767. Frank, 1725-1801.--Surgery: Petit, 1674-1750. Desault, 1744-1795. Scarpa, 1772-1832. Gunbernat, 11790. Heister, 1683-1758. Von Siebold, 1736-1807. Richter, 1742-1812. Cheselden, 1688-1752. Monro (1st), 1697-1767. Pott, 1749-1787. John Hunter, 1728-1793. B. Bell, 1806; J. Bell, 1820; C. Bell, 1842. Smellie, 1680. Denman, 1753-1815.--Revival of Experimental Study: Haller, 1708-1777. Winslow, 16691760. Portal, 1742-1832. Vicq d'Azyr, 1748-1794. Morgagni, 1682-1772.--Inoculation against Small-pox: Lady Montagu, 1762. Edward Jenner, 1749-1823._ During{204} the eighteenth century also arose the illusory doctrine of Animal Magnetism, which obtained among all classes a following that can be accounted for only by the attractiveness of the marvelous and unexplained. Frank Mesmer, born near Lake Constance, in 1754, was early a victim of romantic yearnings, and his graduating thesis, delivered in Vienna, dealt with the influence of the planets upon man and the use of the magnet. After traveling extensively he erected a private institution, where he treated blind girls, fidgety old maids, and simpletons, until his deceptive methods were unmasked by a commission appointed by the Empress Maria Theresa, and he was compelled to leave Vienna in twenty-four hours. This martyrdom recommended him in Paris, where the so-called Mesmerism speedily became fashionable. He finally undertook instructions in magnetizing, at the rate of 100 louis a head, and founded the "Order of Harmony." His so-called _baquets_ were tubs with magnetic ducts, partially filled with soft water and all kinds of ingredients, and armed with iron conductors, with which his pupils, joining hands, placed themselves in contact. At these _séances_ Mesmer appeared in lilac-colored clothes and professed to reinforce the action of the tubs by looks, gestures, playing upon the harmonica, and touching the subjects with wand or fingers. "If any one,{200} particularly a lady, had a crisis at this time, she was borne to the 'crisis-chamber' by Mesmer himself, where he treated her alone, as only when alone, he claimed, could he attain success." He speedily became wealthy; managed to deceive even the Queen of France; and, when he threatened to deprive the country of his presence, 20,000 francs were offered him to instruct others in his art. This offer, however, the wily charlatan declined. In 1785 some fool penned an article extolling him as a worker of miracles; this stimulated the authorities to organize a committee of investigation, the adverse decision of which, along with some contributory evidence, made Paris too warm for him. After the revolution he returned, but his day had passed, and he figures no more in medical history. He has had many imitators, and the mesmeric craze, at times, has infested different portions of the civilized globe; even some who were eminent in science have fallen into the snares of so-called Mesmerism,--notably Olbers, the discoverer of a number of asteroids. Mystic medical doctrines, founded upon Mesmer's views, still continue in certain circles, though the majority have long since succumbed to the advances of scientific psychology. In this connection it is proper to speak of the revived interest in "animal magnetism" due to the researches of Dr. James Braid, of Manchester, England. This gentleman, in 1842, published a work which pretty thoroughly exposed the fallacies of the doctrine of Mesmer, and expounded many of the truths that were entangled therein. He was among the first, perhaps, to employ the phrase "animal magnetism," and was the author of the term "hypnotism," though in his day the popular title was _Braidism_. [Illustration: 0225] During the middle of the eighteenth century arose a doctrine that, in its novelty, ease of practical application, and apparent consistency (through the ingenious employment of certain vital phenomena), secured such a hold that its influence continued even into the present century. This was{205} the "Brunonian doctrine," promulgated and upheld by the great foe and rival of Cullen,--Doctor John Brown. In youth very precocious, though of most humble birth, Doctor Brown had mastered the Latin language at the early age of seven years, and three years later essayed to learn a trade. At the age of twenty he left his native village of Dunse for Edinburgh, seeking employment as a tutor and intending to study theology. Poverty soon compelled him, however, to take a rural school, but he returned a few years later (in 1759) to the Scottish Athens and began the study of medicine, supporting himself meantime by rendering theses into Latin and by teaching, translating, and quizzing. Finally, he attracted the attention of Cullen, to whom he became useful through his knowledge of the classics; but, ultimately, a foolish quarrel made bitter enemies of the former friends. In 1770, in private lectures, Brown{206} began to advance the theory to which he had been led by one of his own attacks of gout that disappeared under the use of stimulants, the disease having previously always been aggravated by the treatment prescribed and that was held to be orthodox,--viz., antiphlogistic. He had now become somewhat dissolute, and the students he gathered about him were of very much the same character; but they formed the nidus of a great following opposed to Cullen, and quarreled on all occasions with the adherents of the latter. Finally, Doctor Brown removed to London, where fortune seemed to smile upon him, as he gained rapidly in reputation and practice; indeed, he barely missed a call to Berlin and another to Padua as a teacher, the scale being turned against him by his dissolute habits. Though possessed of the highest mental gifts, Brown was unfortunate in lack of mental stamina. He taught that life is not a natural condition, but an artificial and necessary result of constant irritations; all living beings, therefore, tend toward death. Health is an intermediate grade of excitement; diseases, which are either sthenic or asthenic, represent either too high or too low a grade of excitement. It has been said that Brown's teachings slaughtered more human beings than the French Révolution and the wars of Napoleon combined. In England this system found no important followers, but in America Benjamin Rush, of Philadelphia (1745-1815), distinguished himself as an adherent. In Spain and France it found little place; but in Italy, and later in Germany, it secured a numerous and important following, which numbered, among others, Scarpa, Massini, and Girtanner. [Illustration: 0227] Another system which attained influential development, extending even into the present century, was the so-called _Realism_, originated by Pin el (1745-1836). Born in poverty, and designed for the Roman Catholic Church, Pin el did not turn his attention to medicine until his thirtieth year,{207} but on completing his studies he rapidly rose to positions of importance. Led to the investigation of mental diseases by the fate of one of his particular friends, who had become insane, escaped into the forest, and was there devoured by wolves, Pinel speedily developed a great interest in this class of sufferers. The lot of the insane at this time was most pitiable: they were imprisoned, chained, and treated worse than wild beasts. In his efforts to improve their lot, Pinel acquired the title of conservative and aristocrat, either of which was almost equivalent to a death-sentence. Unterrified, however, he appeared before the Paris Council and urged the adoption of reformatory measures, replying to the challenges of skeptical and selfregardful opponents by liberating a number of insane patients who were in his charge. The courage thus exhibited receives appreciation in our time, if never before. Not the least{208} of Pinel's services was the substitution of analytical for synthetical methods; he also sought to determine disease by a diagnosis carefully constructed from symptoms, but unfortunately he made pathology and anatomy subordinate factors. He was a pupil of Barthez, but he placed his preceptor's vitalism far in the background. [Illustration: 0229] Francois Bichat, born in 1771, earned high rank both as a clinician and an anatomist. His education was begun in Nantes, but he studied surgery and anatomy in Lyons and Montpellier, subsequently going to Paris, where he became a member of Desault's family. After the death of his patron he lectured on surgery, and from 1797 on anatomy. Possessed of a feverish scientific activity, he became a member of the Société d'Emulation. Death overtook him in 1802 as the sequel of consumption and an injury received through a fall. He was the most capable physician of France in his time, and, brief as w>as his span of life, he was author of nine important volumes, the chief of which were a _Treatise on Membranes_ and works on general and pathological anatomy. From the latter a new tendency in study took origin. He it was who gave utterance to the aphorism: "Take away some fevers and nervous troubles, and all else falls to the kingdom of pathological anatomy." As an evidence of his energy, it is related that he in one winter examined seven hundred bodies. He taught how to discriminate between disease processes, and notably subdivided peripneumonia into pleurisy, pneumonia, and bronchitis, these having been previously confounded. He once remarked: "You may observe disease of the heart, lungs, abdominal viscera, etc., night and morning by the sick-bed for twenty years, yet the whole furnishes merely a jumble of phenomena which unite in nothing complete; but if you open a few bodies, you will see the obscurity speedily give way,--a result never accomplished by observation if we do not know the seat of the disease." To Bichat is also due our modern recognition of cellular,{209} osseous, fibrous, and other tissues, as such, wherever they appear throughout the body. He differentiated, without the aid of the microscope, twenty-one different tissues as simple and similar elements of the body, enumerating them as one does the chemical elements; he described the stomach as composed of mucous, serous, and muscular layers; overthrew the speculative tendency of medicine, and placed facts in the front rank; and so conspicuous were his services that he has been termed the "Napoleon of Medicine." He supplemented the influence of Pinel upon the side of pathological anatomy; called sensibility and contractility vital properties, whose alterations constitute disease, claiming, however, that the vital properties of individual tissues differed among themselves. His life and works are revelations to young men and show what can be accomplished at a very early age{210} by sufficiently active and harmoniously developed brains. In reviewing the theories and lives of those mentioned as medical luminaries of the eighteenth century, one experiences a feeling of mingled respect and disappointment--respect for the devoted way in which they worked and sought for the truth, and disappointment at so much waste of intellectual power and labor. The lesson is also taught, and should be impressed, that in all so-called new systems old principles for the most part reappear, and that the labors of the past are rarely so deliberately consulted as to guard against repetition and revamping of theories that had long before been proved futile. Let me now mention a few other of the physicians of the last century who have left more or less of an impress upon their successors and upon our science. One man, in particular, historians are wont to remember with the honor that was denied him by his colleagues and contemporaries. I refer to Leopold Avenbrugger, who was born in Graz in 1722, and who, after pursuing his philosophical and professional studies in his native city, obtained, at the age of twenty-nine, charge of a Spanish military hospital; while thus employed lie invented the art of percussion as applied to diagnosis. This he gave the test of experience during seven long years before making it known to the profession, and even then it was not appreciated, but remained practically unnoticed until after his death, which occurred in 1809. He did receive a patent of nobility from the Emperor Joseph II, but this hardly compensated him for the contumely heaped upon him by his colleagues. Paulus Ægineta employed sounds and specula; Santoro used the balance, counted the pulse, and resorted to the use of the thermometer; Boerhaave employed the thermometer and the simple lens; Floyer, and after him Haller, utilized the watch in marking seconds; a Salernian practitioner utilized auscultation and percussion in tympanites and ascites; but the{211} diagnosis of diseases of the great viscera by percussion was never known before Avenbrugger. His booklet of twenty-two pages, unsalable in his time, is to-day held worth far more than its weight in gold. His famous colleague, de Haën, wrote fifteen volumes without a word on percussion; Van Swieten did it no greater justice; in his great treatise the _History of Medicine_, Sprengel barely alludes to it; yet the contents of Avenbrugger's booklet were of more practical value than all that these other men ever wrote, or all the results of the vast and bloody campaigns during which it slept. In 1808 this volume was rescued from oblivion by Corvisart, who translated it into French and proclaimed its undying value. During the earlier part of this century lived Werlhof, of Helmstâdt (1699-1767), a far-famed observer, author, and practitioner, who declined a professorship, and especially distinguished himself as a writer of German poetry. Though possessed of an exceptional knowledge of modern tongues, he wrote only in Latin,--the scientific language of the day. In 1734 he was appointed physician to King George II, in which position he attained world-wide fame, while indefatigable in his efforts to elevate science. He first described the disease known by his name,--_morbus maculosus Werlhofii_,--and struggled hard to establish in Germany the use of cinchona. From 1740 to 1802 flourished Wichman, of Hanover, highly esteemed as a writer and practitioner. He is especially known for his pleas in favor of more scientific diagnosés, and his demonstration of how to make them. The rôle of the itch-mite in the transmission of scabies he demonstrated upon himself; to be sure, Bonomo, a hundred years before, had called attention thereto, but with little avail. Another eminent Hanoverian was the fickle, stubborn, and misanthropic Zimmerman, born in 1728, in Berne, upon whom misfortune and disease played many shabby tricks.{212} He was, however, a man of ingenious endowments, and merits especial regard, because he sought to free medical science from the charge of being a secret art. Another of the prodigies of medical history was J. P. Frank, born (1725) in the Bavarian Palatinate, of pauper parents, and, while an infant, abandoned by a cruel father. His early life was passed in a religious school; at twenty-five he became a court and garrison physician, and later a professor in Gottingen; finally he went to Vienna, where he died in 1801. He was greatly beloved by his pupils, and Walther, the famous surgeon, said of him: "No one ever made so elevating and permanent an impression on me." He published an extensive work on forensic medicine and sanitation,--wherein he took up the hygiene of the individual, of the family, and of the school,--which constituted an effort far ahead of anything of the kind previously known. He is also memorable for efforts toward increasing the population, for the Thirty Years' War had depopulated extensive districts--to such a degree, indeed that in 1750 bigamy was legalized in Nuremberg and many other towns. Frank was distinguished for a keen and even caustic humor, whose subject was not infrequently himself. From 1707 to 1782 there lived in England one Sir John Pringle, chief of the Army Medical Department, known to this day as an author upon military hygiene. John Huxliam (1794-1868) advanced our knowledge of putrid dissolution of the blood. John Howard (1766-1790) rendered eminent service in prison reform. Heberden (1710-1801) was the first to describe varicella, and also angina pectoris--which was long known as Heberden's asthma. John Fothergil (1712-1780), a Quaker, acquired fame by his observations on chronic angina, neuralgia, and hydrocephalus; was likewise a benefactor of the poor, regarding them as "bridges to the pockets of the rich"; indeed, a large part of what he gained from the latter class{213} he bestowed in charity, and at his death left £200,000 for the same purpose. Radcliffe (1750-1814) was an eminent, witty, successful practitioner of London, who was wont to declare that, as a young practitioner, he possessed twenty remedies for every disease, but at the close of his career had found twenty diseases for which he had not one remedy. Richard Mead (1673-1754) was a prolific writer, and the author of the first quarantine regulations adopted in England. Contemporary with Mead was Lettsom,--the busiest, most philanthropic, and most successful physician of his day,--whose practice, although a large part of it was gratuitous, brought him sixty thousand dollars a year, and who gave away immense sums for charitable purposes; also, Thomas Dover, who invented the sedative known by his name and who died in 1741. Akenside, physician and poet (1721-1770), wrote on dysentery. Baillie, of Edinburgh, was the first to accurately describe the morbid anatomy of gastric ulcer. Among the French surgeons must be mentioned la Peyronie, of Montpellier, born in 1668, who ultimately became director of the Academy of Surgery and surgeon to the king. His wealth was employed for the elevation of the craft, and he founded no less than ten different surgical professorships at his own expense. In 1743 he effected the separation of the surgeons from the barbers. He died in 1747, dedicating his estate to the purpose for which he had lived. The most famous of the earlier surgeons of this century was J. L. Petit (16741750), inventor of the screw tourniquet, and who was called to treat Augustus the Strong, of Poland; indeed, several other crowned heads became his patients. Garen-geot (1688-1759), a professor in the College of St. Come, published a work on operative surgery. Morand (1697-1773) and le Dran were distinguished surgeons of Paris, the former especially noted for the number of times{214} he performed paracentesis. Famous lithotomists were le Cat and Frère Come,--whose real name was Baseilhac, and who operated by means of the lithotome caché, Astruc (1685-1766) was a syphilographer of extensive attainments; Quesnay (1694-1774), an eminent and undaunted surgeon of Louis XV, who wrote on the history and progress of surgery in France; Brasdor (1721-1776) was best known for his method of distal ligation in aneurism; Sabatier (1732-1811) wrote a famous treatise on operations, in which he recommended resection of the head of the humerus. One of the most celebrated surgeons was P, J. Desault (1744-1795), the son of a poor farmer, originally designed for the priesthood, but who, after obtaining a thorough mathematical education, began the study of surgery with an ignorant master of his native town. Subsequently he went to Paris, and here supported himself by teaching, gradually rising, step by step, until, without collegiate education, he became professor and chief-surgeon at the Hôtel-Dieu, where he established the first surgical clinic. He opposed violently the prevalent abuse of the trephine, and was also a champion of healing by first intention. A trusted friend of Desault was Ghopart, well known because of the amputation of the foot that bears his name. Another well-known surgeon, likewise a friend of Desault, was Doublet; and it is somewhat remarkable that Desault, Ghopart, and Doublet suffered persecution and perhaps martyrdom in connection with the supposed death of the Dauphin of France,--properly Louis XVII,--in 1795. There is evidence that the child who died in the temple was not the dauphin, but a substitute, and these three surgeons, who examined the corpse, had the hardihood to express their doubts. The same day that Desault reported upon the evidence he was invited to dinner by some members of the Convention, was taken ill at the table, and died almost immediately after his return home, A few days{215} later Chopart and Doublet died, also under mysterious circumstances. Daviel (1796-1862) is remembered among French surgeons chiefly for extraction of the lens as an independent method of treating cataract; Tenon (172-4-1816), for his writings on the anatomy and diseases of the eye; and Anel for originating the operation for aneurism, mistakenly attributed to Hunter. There were also many others, of lesser note, who distinguished themselves through special services to surgery or some of its branches. Among the Italians of this century may be mentioned Scarpa (1772-1832), of Motta, professor successively in Modena and Pavia, and who advanced our knowledge of hernia, diseases of the eyes, aneurism, and general anatomy. The most famous Spanish surgeon was Gimbernat, of Madrid (1742-1790), for a time professor in Barcelona, who also became distinguished through anatomical researches. German surgeons did not rank high during the earlier half of the last century, owing to the contempt engendered by the church for this branch of the medical art. The fashion of imitating the French, however, led to some surgical development. The first German surgeon of scientific education was Heister (1683-1758), of Frankfort-on-the-Main, who, unable to obtain honorable employment in the military service of his own country, entered that of Holland, where he remained until the experience of his own nation had brought about a healthy reaction. In 1720 he came to Helmstâdt, where he developed great activity in anatomy, surgery, and botany; also distinguished himself as a dentist and oculist, and discussed the whole range of surgical topics from the least to the greatest. Bilguer (1720-1796), of Chur, became surgeon-general in Berlin, and performed the first resection of the wrist in 1762;{216} he was an opponent of amputation, which at that time was altogether too frequently practiced. Von Siebold (1736-1807) was the founder of an institution for surgical instruction, where, for the first time in Germany, surgery was taught clinically. He became one of the most famous teachers, and was first in his native land to perform the operation of symphysiotomy, so recently revived. The greatest German surgeon of the eighteenth century, however,--one eminent both as writer and operator,--was August Gottlieb Richter (1742-1812), of Zorbig, a descendant of a ministerial family, who wrote a famous work on hernia, and greatly improved all branches of surgery; he it was that enunciated the principle of dressing wounds "quickly, easily, and rarely." Among English surgeons of the century must be mentioned, first of all, Cheselden (1688-1752). wrhose name is inseparably connected with anatomy and pathology as well as surgery At first a warm advocate of the high operation for stone, his dexterity in lithotomy excited the wonder of his contemporaries. He published a treatise on anatomy, and one on the suprapubic section. Alexander Monro, Sr. (1697-1767), of Edinburgh, was also eminent in both anatomy and surgery, and contributed more than any other one man to the success and reputation of the Scottish medical school. His sons, Alexander and Donald, and his grandson, Alexander (3d), w'ere equally celebrated in anatomy. Charles White, of Manchester, is generally credited with having performed, in 1768, the first subperiosteal resection of the head of the humerus, although, as a matter of fact, this was not done until 1774, and then by Bent, of Newcastle. He also performed resection of the hip-joint upon the cadaver--another of the same name, Anthony White, having done the operation on the living subject in 1721. He invented the method of reducing dislocation of the{217} humerus with the foot in the axilla,--a procedure that is ordinarily ascribed to Sir Astley Cooper; also operations for false joint by the removal of the involved surfaces of the bone. It will be seen that the excision of the joints was peculiarly an English method, the elbow-joint having been first excised in 1758, by Wainman, and the knee-joint by Filkin, of Northwich. The man who permanently attracted the attention of surgeons to these new operations was Henry Park, a bold surgeon, who wrote in 1782. The merits of these methods were then soon forgotten, however, and were revived in the present century by Liston and Syme. One of the best-known London surgeons was Percival Pott (1749-1787), who became especially eminent through his{218} studies upon hernia, spinal disease, and diseases of the bones and joints; his complete chirurgical works appeared in London in 1771. [Illustration: 0237] William Hunter (1718-1783), of Scotch parentage, originally a theological student, and a pupil of Cullen, went to London in 1741, began to lecture on anatomy and surgery in 1746, and soon acquired a great reputation as a surgeon, obstetrician, and anatomist. He achieved enormous success in practice, and spent £100,000 upon his house, library, and private collections. The latter now form the Hunterian Museum in the University of Glasgow. His magnificent plates illustrating the gravid uterus required the labors of twenty years and appeared in 1774. [Illustration: 0239] John Hunter (1728-1793), younger brother of William, enjoyed even greater reputation than the latter. He was a pupil not only of his brother, but also of Cheselden and Pott. Beginning the practice of surgery in 1763, he became surgeon to St. George's Hospital in 1768, and Surgeon-general of the English forces in 1790. So memorable were the labors and services of this man that at the Royal College of Surgeons, of London, there is given annually an "Hunterian Oration," intended in some way to commemorate his labors or to draw some lesson from his life and work, To do justice to John Hunter would require a volume, hence we must at present dismiss the subject with this brief reference. Almost equally famous as a surgeon, though by no means such an omnivorous student as Hunter, was Benjamin Bell, of Edinburgh, who died in 1806. He employed tubes of lead and silver for the purpose of drainage. Sir Charles and John Bell, also of Edinburgh, are eminent names pertaining to the latter part of the eighteenth and first part of the nineteenth century. The latter was Professor of Anatomy, Surgery, and Obstetrics, a busy practitioner, a fertile writer, and not only one of the most successful operators of his day, but an excellent classical scholar;{219} his _Principles of Surgery_ appeared from 1801 to 1807. Sir Charles, who died in 1842, belongs more to the present century, but was equally distinguished as an operator, surgeon, and writer, and best known, perhaps, lor his _Bridgewater Treatise on the Hand_. Among the Dutch an eminent surgeon was Peter Camper (1722-1789), who, in order to acquire manual dexterity, learned to use various mechanical tools. He was a fruitful author, and did not consider it beneath his dignity to write a treatise about the best form of shoes, published in Vienna in 1782, but recently translated and republished in England as something new. Sandifort, of Leyden, discussed ruptures, dislocations, etc., and reported the first observation of downward dislocation of the femur. As already noted, the surgeons of the eighteenth century were often obstetricians,--William Hunter conspicuously. The{220} most important obstetrician of his time was William Smellie (1680-1763), of London, who invented numerous instruments, wrote a large treatise on the theory and practice of midwifery, and greatly advanced our knowledge of deformed pelves. He was the first to distinguish one diameter from the other, and to point out the importance of cephalic version and version of the breech. Parenthetically, it may be remarked that William Hunter, great as he was, was the uncompromising foe of instrumental midwifery, and was in the habit of showing his forceps, covered with rust, as evidence that he never resorted to such aids. A rival of Smellie and Hunter was Thomas Denman (1753-1815), best known, perhaps, because of his demonstration of the portability of puerperal infection. The researches of anatomists during the eighteenth century were, for the most part, directed toward the minute, more difficult, and less striking parts, and to increased thoroughness and accuracy of description. Microscopical anatomy suffered a relative quiescence. Pathological and general anatomy, which were destined to control the medicine of the succeeding century, were newly created and not yet regarded as sciences by themselves, but merely as special branches. The most important feature was the revival and more accurate study of experimental physiology, which had been scarcely resorted to since the time of Galen, except for Harvey's discoveries. This revival, which really seemed an epoch in the history of medicine, was effected by the great Haller (1708-1777), of Berne,--a man who really deserved the title of "Great," as he was a universal and indefatigable _savant_, possessed of thorough conscientiousness, marvelous capacity for work, great ingenuity, natural endowments, and an inextinguishable love for art and science; he was certainly one of the most versatile scholars and thinkers of any time, distinguished not only in his chosen field of medicine, but as a poet,{221} botanist, and statesman. Like all Swiss poets, he never passed beyond the didactic and the homely in his versification. From his tenth year he wrote poems in Latin and German, and even when eight years old had made most extensive compilations from Bayle's dictionary. At fifteen he went to the University of Tubingen, where, in the second year of his sojourn, he disputed with one of his teachers. In 1725 he went to Leyden, where Boerhaave and Albinus found in him a most indefatigable follower. At nineteen he received the degree of doctor. In the excess of his zeal for anatomy he purchased for a considerable sum, from Albinus, half of a corpse, the other half of which his teacher had dissected; and, while in Paris, he even engaged in grave-robbing, and, being betrayed by his own carelessness, was compelled to save himself by flight. In many other States, and in more than one country, he studied with the best of teachers, lecturing at times himself. At the age of twenty-six he became professor and hospital director at Berne, and in 1752 published his famous researches on irritability. Three years later he accepted a call to Gottingen as Professor of Anatomy, Surgery, Chemistry, and Botany. He was the founder of a botanical garden; for many years was so busy that he slept and lived in his library; and, in spite of his enormous and unique correspondence with the _savants_ of the world, he never left a letter unanswered. Strange to say, his permanent influence upon the practice of medicine was only indirect; and, although he was professor of surgery, and performed many vivisections, he was never able to persuade himself to perform a single surgical operation upon the living human being. He it was that introduced into Germany the use of the watch in counting the pulse. Like Hunter, Haller demands a special historian, and it is possible here to outline only a few of the services he rendered to medicine. He enriched the anatomy of the heart, of the brain and dura, and pointed out the venous nature of the{222} sinuses; taught that the uterus should be regarded as a muscle: advanced the knowledge of the lymphatic system, and believed in and taught a developmental theory that every individual is descended or derived from a preceding one. In the mechanism of the heart his doctrine of irritability especially maintained itself. He administered the death-blow to the doctrine of vital spirits, and was, in fact, the father of modern nerve-physiology. His doctrine of irritability moved the minds of his century in a way that has no parallel, unless we compare it with the doctrine of Darwin. Glisson had established the general principles of irritability, and Haller followed, teaching it by the inductive method, and proving its existence by experiments,--proving, moreover, that it is a peculiarity of the muscular substance and not governed by ordinary sensation. His researches deserve the more credit because he lacked modern aids to physiological study. The first physiological institute was founded in Breslau by Purkinje, some fifty years ago. Haller had no such opportunity; even his successor, the great Müller, possessed no such advantages. The profound impression made by Haller's teachings may be measured by the number of his supporters and opponents; he was a great man, second only in wide-spread influence to Boerhaave, and one who left a more lasting impress upon the world than even the latter. The two best known of Haller's opponents were: Wolf (1733-179-4), of St. Petersburg, who regarded each generation as an actual new creation, and was the first to teach the doctrine of the blastodermic membranes; and Blumenbach (1752-1840), of Gotha, who did great service by investigations in general anthropology, of which he was, in fact, the founder, and whose researches in comparative anatomy and the history of development have rendered him famous. Of the famous anatomists of the century may be mentioned Sommerring (1755-1830), of Frankfort,--the first to{223} distinguish the facial and auditory nerves from eacli other, and whose published works are well known, because of the beautiful illustrations furnished him by the well-known artist, Koeck. The ablest French anatomist of the century was Winslow (1669-1760),--a man of Danish birth, but who became a professor in Paris, and is best known by the foramen named for him. There were, also, Portal (1742-1832), physician to Louis XVIII, who wrote a famous history of anatomy and surgery; and Vicq d'Azyr (1748-1794), known equally well for his labors in the department of anatomy, especially of the brain, nervous system,{224} and the vocal organs. Bichat (already mentioned) would deserve to be placed at the head of French anatomists were it not for his superior rank in clinical medicine. [Illustration: 0243] The founder of pathological anatomy as a science was Morgagni, born in 1682, in Forli, Italy,--a pupil of Valsalva, and, at the age of nineteen, the assistant of the latter. It was not until his seventy-ninth year, after he had published several works, that he allowed his famous work on pathological anatomy to appear. This is the historical classic, De Seclibus et Causis Morborum, published in Venice in 1761. Its famous author did not cease work, even when he became blind, and to him we owe the maxim that observations should be "weighed, not counted." He was very versatile, and well informed in all branches of science and literature, and possessed a remarkable memory; likewise was the first to devote attention extensively and thoroughly to the anatomical products of common diseases, since, before his time, little had been regarded but rare discoveries in the body. He also called attention to the important bearing which the history of the disease has toward its products, and found his discoveries of advantage, even when they were unable to promote the cure of disease, because of the light which they threw upon physiology and normal anatomy, and because they prevented incurable patients from being continually tormented with drugs intended to cure them; also because pathological investigations alone could settle disputes in diagnosis and matters of honor among physicians. He died in 1772. Morgagni's legitimate successors in Great Britain were Baillie ( 1761-1823), a son of John Hunter's sister, and Sir Everard Home,--Hunter's brother-in-law,--who became professor in the Royal College of Surgeons, and was intrusted by Hunter with the work of describing his collection. Home, however, in a most discreditable way, burned several volumes of Hunter's own descriptions, in order to appropriate to himself the sole credit of the work. He has{225} gone down to fame especially because of his book on the prostate. One of the most notable events in the history of medicine was the introduction of the systematic practice of _preventive inoculation against small-pox_. It is so generally taught that this is entirely due to the efforts of Jenner--or, rather, we are so often allowed to think it, without being taught otherwise--that the measure deserves an historical sketch. The communication of the natural disease to the healthy, in order to afford protection,--or, in other words, the communication of small-pox to prevent the same,--reaches back into antiquity. It is mentioned in the Sanscrit Yedas as performed by Brahmins, who employed pus procured from small-pox vesicles a year before. They rubbed the place selected for operation until the skin was red, then scratched with a sharp instrument, and laid upon it cotton soaked in the variolous pus, moistened with water from the sacred Ganges. Along with this measure they insisted upon careful hygienic regulations, to which, in large measure, their good results were due. Among the Chinese was practiced what was known as "pock-sowing," and ten centuries before Christ the Celestials introduced into the nasal cavities of young children pledgets of cotton saturated with variolous pus. The Arabians inoculated with needles, and so did the Circassians, while in North Africa incisions were made between the fingers, and among some of the negroes inoculation was performed in or upon the nose. In Constantinople, under the Greeks, the custom had long been naturalized, and was practiced by old women, instructed in the art, who regarded it as a revelation of Saint Mary. The first accounts of this practice were given to the Royal Society by Timoni, a physician of Constantinople, in 1714. The actual introduction of the practice into the West, however, was due to Lady Mary Wortley Montagu, who died in 1762, and who was wife of the English Ambassador to the Porte in 1717. She had{226} her son inoculated in Constantinople, by Maitland, and on her return to London, in 1721, her daughter also was inoculated. During the same years experiments were undertaken by Maitland upon criminals, and, as these turned out favorably, the Prince of Wales and his sisters were inoculated by Mead. The practice was then more or less speedily adopted on this side of the Atlantic, but suffered occasional severe blows, because of unfortunate cases here and there, such as never can be avoided. The clergy, especially, using the Scripture, as designing men can always do, became warm opponents of the practice, and stigmatized it as an atrocious invasion of the divine prerogative. Nevertheless, in 1746 the Bishop of Worcester recommended it from the pulpit, established houses for inoculation, and thus made it again popular. In Germany it was generally favored, and a little later came into vogue in France and Italy. In 1757 Robert Sutton, near London, professed to have made fifteen thousand inoculations without a single fatal case; he kept his patients on a strict diet for nine days, then inoculated with the smallest possible quantity of virus. The operation was not prohibited in England until the year 1840, although it involved much greater dangers than vaccination with cow-pox. The first inoculation with cow-pox seems to have been performed in 1774: by a farmer of Gloucester, named Jesty, though the pioneer in the extensive and general introduction of this method was Edward Jenner (1749-1823), of Berkeley, in Gloucestershire, who, therefore, is generally known as the "Father of Vaccination." The son of a clergyman, he began early the study of medicine and surgery, and during his apprenticeship received from a milkmaid information of the protective power of cow-pox against variola, as established by popular observation. (Sutton and others had proved that inoculation of _sheep_-pox was not efficient.) This communication so struck Jenner as a means of affording protection to the whole human race{227} that the subject never afterward left his mind. In 1770 he became a pupil of John Hunter, and when he communicated to him this idea the great surgeon said: "Do not think; investigate!" Accordingly he went to Berkeley and performed the little operation which has made him famous; and from 1778 until 1788 he communicated to Sir Everard Home such observations as he had made. But the first vaccination was performed in 1796, upon a boy, with matter from the hand of a maid who had contracted cow-pox in milking. [Illustration: 0247] In 1798 he published his memorable work, and afterward removed to London. He died full of fame and honor, in his native place, having-received rewards from the government amounting to one hundred and fifty thousand dollars, besides being made an honorary citizen of the city of London. The subsequent wide-spread practice of the method, and the formation of societies{228} for the promotion of vaccination are matters of recent history. The first vaccinations in the United States were performed by Doctor Waterhouse, Professor of Medicine in Harvard College, in 1800, upon four of his own children. The transmission of humanized virus through the system of the cow, and its subsequent employment in vaccination of human beings, was first practiced by Troja (1747-1827), of Naples, shortly after the introduction of human vaccination; but in 1810 this was prohibited in Italy. Compulsory vaccination was first extensively introduced in Germany in 1807; in England it was first legalized in 1827. The occasional temporary character of the protection thus afforded was first taught by Elsâsser in 1814. Schoenlein was the first to call attention to the distinction between variola and varioloid. Another matter in which the eighteenth century witnessed great reform was the _treatment of the insane_, which continued in very bad condition until toward the close of the century, when a movement for improvement began. From and after this lunatics were liberated from their fetters and from the hands of brutal keepers, and regarded as actually ill, while so-called schools of psychiatry were founded. While the first impulse in this direction was given by Lorry, the true reformer was Pinel, already mentioned, who did away with corporeal punishment and abuse, separated the insane from convicts, limited the employment of drugs and especially venesection, placed the unfortunates in special institutions under the charge of physicians, and classified patients according to their symptoms. Yet, in spite of his humane teachings, lunatics were found incarcerated in cages in some of the French cities as late as 1834. Pinel was followed by Esquirol (1772-1840), who in 1818 established the first clinic for mental diseases. It is well known what a conspicuous part _public baths_ played in the social life of the ancient Greeks and Romans, but{229} the first public resort for sea-bathing was established in Germany in 1794. The cold-water epoch of this century, however, began with the researches of Hahn (16961773), a Silesian, who introduced a systematic and almost exclusive hydrotherapeutic method. The modern method of using cold water as an antipyretic agent was first employed in England, in 1797, by Currie, who originally was an American merchant. In France the method found little sympathy, but it made its way even to Spain later, where it was adopted by the famous Sangrado, who is well known to readers of _Gil Blas_. CHAPTER IX. _The Age of Renovation (continued).--The Eighteenth Century; General Considerations. Foundation of Learned Societies, etc. The Royal College of Surgeons, 1800; the Josephinum, 1785.--The Nineteenth Century. Realistic Reaction Against Previous Idealism. Influence of Comte, of Claude Bernard, and of Charles Darwin, 1809-1882. Influence Exerted by Other Sciences.--Theory of Excitement: Roeschlaub.--Stimolo and Contrast imolo: Rasori, 1762-1837.--Homoeopathy: Hahnemann, 1753-1843.--Isop-athy, Electrohomoeopathy of Mattei.--Cranioscopy, or Phrenology: Gall and Spurzheim.--The Physiological Theory: Broussais, 1772-1838.--Paris Pathological School: Cruveilhier, 1791-1873. Andral, 1797-1876. Louis, 17871872. Magendie, 1783-1855. Trousseau, 1801-1866. Claude Bernard, 1813-1878.--British Medicine: Bell and Hall, Travers, 1783-1858.--Germany, School of Natural Philosophy: Johannes Müller, 1801-1858.--School of Natural History: Schônlein, 1763-1874.--New Vienna School: Rokitansky, 1804-1878. Skoda, 1805-1881._ That the{230} eighteenth century, up to its close, was the golden age of medicine, is due to the prevalence during that period of a strong idealistic undertone, as a result of which any learned occupation caused the scholar to be held in higher esteem than is the case even to-day. Medicine was then regarded as _a conscientious vocation_ and not as a mere business or trade; indeed, general scientific knowledge more widely prevailed among the better class of the profession, and there was much less of that one-sided, narrow education that obtains to-day. The profession, moreover, was not overcrowded; physicians were neither too few nor too numerous, consequently their social position was higher. Again, the relations between doctor and patient were more intimate, most practitioners being of the type described as "family physicians," and those possessed of the doctorate degree ranked among the gentry rather than as artisans. They were, for the most part, fully devoted to their calling; moreover, the State took greater care to protect the people, so that it became dangerous for strolling vagabonds and imposters to attempt to trifle with human life and excite the vulgar to the prejudice of scientific knowledge. The{231} pursuit of anatomical studies was now facilitated, despite the fact that students were frequently compelled to take long journeys in order to obtain the "material" therefor. In the early part of the century so great was the lack of dissecting material that the great Haller while in Paris was compelled to purloin his cadavers, and ultimately, on discovery of this fact, to fly for his life; Hoffmann was only able to make twenty dissections during twenty-four years; even in the middle of the century there was only one dissection annually in Halle; up to 1712 there had been only three dissections in a score of years--though now subjects can be had there in abundance at a ridiculously low figure; cadavers were extremely scarce in Vienna as late as 1765; and for a long time the only places in London where the study of anatomy could be legally pursued were the College of Physicians and the College of Surgeons, and the trouble that hampered John Hunter in this direction is historical. The crime of "Burking" became known in Hunter's day. Murder was committed, and the victim sold for purposes of dissection--for at this time, as "body-snatching" was a necessity, those that purchased cadavers asked few questions, and the fees paid were, of course, high. The first clinical institution in Austria was organized in Vienna, in 1754, by Van Swieten, though there was an "ambulatory clinic" (out-patient department) in Prague nine years before. During the century, however, hospitals were everywhere in bad condition. In the Hôtel-Dieu, at Paris, several patients--even as many as six--were sometimes put in the same bed; the convalescent and the dying found themselves thus associated; in Vienna the Allgemeines Krankenhaus was composed of seventeen hospitals that subsequently were amalgamated into one. In London numerous hospitals were founded, and as the medical staff of each became eminent they attracted numerous pupils; but later it became necessary to relieve the hospital wards, and private institutions for instruction were established by popular{232} teachers, the most celebrated being the "Windmill Street School of Anatomy," founded by William Hunter about 1770, and the private school of Sir William Blizzard, which, established in 1780, developed, five years later, into the London Hospital Medical School. While few, if any, of the lectures were compulsory, particularly in the natural sciences, even more attention than now was bestowed upon the accessory branches; botany, chemistry, and natural history were the recreation of many students and physicians. Pupils enjoyed the privilege of studying what they pleased--as they do practically to-day in the Portuguese University of Coimbra,--and professors exercised to the utmost their individuality in teaching. In Spain natural sciences found no admission, and even so late as 1770 no instruction in these branches was given, as they were regarded as dangerous to the purity of the faith; mineralogy for mining purposes was an exception, for even the most faithful Catholic needs money. At the universities medical students were not permitted to go out without their scholastic cloaks,--a regulation that still obtains in Spain. That the number of students has enormously multiplied may be seen from the fact that the little University of Giessen, with scarcely any medical school at all, has always more students than had Halle in the days of the famous Hoffmann. In the middle of the last century Würzburg had at one time but _three_ medical students, while to-day it has in the neighborhood of five hundred. Even then it was complained that, on account of the number of students, there was an educated proletariat arising, and in 1791 it was proposed, in Austria, that the rush for study should be repressed. Among the Continental students the revels and bad behavior of past centuries were not to any great extent corrected; fights and debauchery were very common, and all sorts of orgies and bacchanals prevailed. The professors were, in large measure, independent of the State, and a single{233} individual often represented a number of branches now taught by special chairs. When indisposed to lecture, they simply posted upon the blackboard: "_Hodie non legitur_," and this was the end of the matter. In 1777 Vienna had one hundred and forty-seven medical teachers, and in Germany there were two to every thirty-nine students. That in the last century one man often accomplished more than a great number of average teachers do to-day is amply demonstrated by the lives of Boerhaave, Haller, and others. Then, too, the Latin tongue was generally employed for purposes of instruction, though surgeons, for the most part, lectured in the vernacular; Cullen, in 1770, was the first in Great Britain to deliver purely medical lectures in English; and as the clergy gradually retired from the ranks of the profession, Latin more and more fell into disuse. Strange to say, as the clerical influence waned, the Jews began to enter medicine, the movement beginning about 1791, in France, under the promulgation of "civil equality" ideas; previously the Hebrews had been an almost universally suppressed people, and in Berlin were permitted to enter and leave the city by only one gate, and were forbidden to learn or write pure German, in consequence whereof their dialect was an Hebraic-Teutonic jargon, that even to-day prevails in some portions of western Europe. Educated Jews were few in number, since attendance upon universities was ordinarily denied them, although long before they had been admitted at Salamanca, Toledo, Salernum, and Montpellier. In Austria the prohibition was not removed until 1789, and even then, so bitter was the prejudice against the Semitic race, the clergy vigorously protested. It was the same clerical body that, in 1667, protested with the greatest vehemence against allowing Hebrew physicians to pass through the gates of Wurtemburg without paying toll, declaring that it was "better to die with Christ than be cured by Jews, who were aided by the devil." Professors{234} were often attached to the courts of their various sovereigns, and at one time the French court possessed a faculty of forty-eight physicians, surgeons, and apothecaries, the first two physicians being required to attend every morning when the king arose; hence originated the titles, still known in Germany, of "Hofrath" and "Geheimrath." Medical fees, as a rule, were very small, though there were exceptional instances in which enormous sums were bestowed: Joseph II, of Austria, gave Guerin, who was summoned from Paris in consultation, an honorarium of 171,000 marks and made him a baronet. Taking all things into consideration, the income of the average practitioner in the eighteenth century would be in the neighborhood of $1000, which, however, was equivalent to three times that amount to-day. Fothergill, whose highest income in a single year was $25,000, bequeathed to the poor of London $1,000,000; Sir Astley Cooper had a yearly income of from $75,000 to $100,000, but it may be remembered that his practice during the first year netted him just $26, and that it was four years later before his income reached the sum of $500. The physician of the last century was, at least, on occasions of moment, very different from other men, and to be recognized by his dress. A cap was placed upon his head when he graduated, in recognition of the fact that physicians at an earlier period belonged to the learned or clerical profession; and in later life he wore a purplish or scarlet cloak (to distinguish him from lawyers, whose professional color was yellow, and from theologians, who then, as now, sported the sombre black). The regulation full-dress costume of the English physician of the last century demanded a well-powdered wig, silk coat, knee breeches with stockings, buckled shoes, lace ruffles, cap, and goldheaded cane, to which, in cold weather, was added a muff--to preserve his delicacy of touch. Surgeons{235} were still strictly separated from physicians, even in education; nor were they esteemed as equal in rank, until the French Revolution brought about the doctrine of civil equality; perhaps this is one reason why this branch of the medical art made less conspicuous progress until recent times. The change was brought about, in France, by the abolition of eighteen universities and fifteen colleges of medicine, the Royal Society of Medicine (founded in 1776), and the Academy of Surgery (founded in 1731); but by this abolition charlatanism acquired such speedy control that the arrangement was soon abandoned. Thus it came about that surgical instruction was given in special institutions or in the universities, and the conditions of instruction finally improved. When the College of St. Come was abolished in 1753 the Société de Chirurgie, founded in 1731, became the Académie de Chirurgie; and, when the French Academy was formed in 1795, the Académie was merged into its medical department. The École Pratique, where Desault and Chopart taught, was established in 1750 for the practical education of surgeons. In England the Royal College of Surgeons was not incorporated until 1800. In Austria, in 1785, the Josephinum was opened by Joseph II, who also erected permanent military hospitals in Prague, Brünn, Milan, Mantua, Pesth, Olmütz, etc.; he also created the "Joseph's Akademie" in order to educate military surgeons and thus overcome the defects of army surgery; the Josephinum unquestionably exerted great influence in elevating the social and military position of army surgeons and attained historical importance after Brambilla compelled the recognition of surgeons as social equals of other members of the medical profession. As the result of these improvements, the various armies of Europe were soon furnished with better medical officers. Prior to this, too, the field hospitals had been as badly mismanaged as their civil prototypes, and the substitution, in 1793, of movable hospitals, as suggested at{236} the close of the sixteenth century by Henry IV, of France, was scarcely an improvement. The whole system suffered from perpetuation of the dual and distinct functions of the physician and the surgeon, to destroy which was a part of the design of the Josephinum. How unpleasant was the position of the army surgeon up to this date may be inferred from the fact that in 1758 one was subjected to corporeal punishment at the command of his colonel, and that a general upon his death-bed could leave orders that fifty blows be given each of his medical staff in case the post-mortem disproved the diagnosis. In Austria, at the beginning of the Seven Years' War, all military surgeons of the Protestant faith were compelled to become Catholics or leave the service. The condition of the wounded soldiers was as deplorable as can well be imagined; but upon this subject I cannot dwell. The tendency of the nineteenth century seems to be a continuation, and, perhaps, in some respects, an exaggeration, of the condition obtaining in France during the previous century; in other words, the world has become practically an enormous school of pathological anatomy and diagnosis,--a school inaugurated by Bichat, as representing so-called scientific or exact medicine. Philosophically this has been a century of reaction against the idealism of the preceding age; it places the individual, rather than the idea, in the foregound. The mutual influence of medicine, philosophy, and the natural sciences is less conspicuous now than formerly. Recent philosophers who have exercised the greatest influence are: Schelling, who held to the equality of the real and the ideal; Hegel, whose supreme principle was absolute reason, of which religion was regarded as a representation; Hartmann, whose philosophy of the "unconscious" depends largely upon the results of natural sciences, embraces Darwinism, and is, in many respects, an extension and completion of Schopenhauer's{237} pessimism and doctrine of the soul. But one who has exercised still more influence upon our profession is Comte, whose positivism contrasted strongly with the idealism and atheism of Schelling, and who required only this of philosophy,--namely, that it should work out the general ideas and results of other sciences; his most important follower was Claude Bernard, and upon these two the whole exact school of France is based. But the most influential philosophic doctrines of this or any other century have been those emanating from Charles Darwin, Herbert Spencer, Ernst Haeckel, Alfred Wallace, and their contemporaries and followers. Darwin (1809-1882) was the grandson of Erasmus Darwin, already mentioned, and his _Variation of Animals and Plants Under Domes-tication, Origin of Species, and Descent of Man_ have found a place in all modern languages. The system known by his name is the pure science of nature, is founded upon scientific investigation, and by its merits alone has found almost universal acceptance; it has been added to and further elucidated by the efforts of Haeckel and Spencer. When it is declared that medicine of the present is influenced by no system, it is speedily found, on critical analysis, that this is an error. It necessarily follows the realistic and materialistic as readily as it did the teachings and doctrines of natural philosophy; and, in consequence, "medical thought," so called, is just as one-sided to-day as at any time in the history of the art. The watchword of to-day, natural specific tendency, veils, but does not take away, its philosophic principles, and so our ridicule of earlier medical systems is quite unjustifiable. A modern historian aptly remarks that the medicine of the present "embraces nothing but a theorem of investigation by the senses." Discoveries in botany, the result of better knowledge of natural history and more accurate habits of study, have influenced{238} modern progress not a little; have led to better classification and broader knowledge. The natural system of de Candolle (1778-1841) of Geneva, and of Endlicher, of Vienna, called into existence the so-called natural historical school of medicine; the researches into plant-cells by Schleiden and Baumgartner, and the almost contemporaneous discovery of animal cells by Schwann became, in course of time, the origin of recent cellular pathology; then came microscopic botany, and the influence of the lower fungi in the production of fermentation and putrefaction. Similarly too, the laws of physics have been shown to have an inseparable connection with anatomy and physiology, and their study has become a most important aid in the experimental researches of to-day; through Helmholz they brought in the ophthalmoscope; thermal electricity, for the discovery of which medicine is indebted to Seebeck; a better knowledge of optics, thanks to Fraunhofer, who was equally expert in electricity; spectrum analysis, invented by Kirchhoff; and the varied efforts of Faraday, Graham Bell, Thomas Alva Edison, and Daguerre, the latter better known for his invention of photography. Finally, medicine is immeasurably indebted to Tyndall and Huxley for their teaching of the correlation and conservation of energy. Chemistry also has performed its share, and, as applied to physiology, is a discovery almost wholly within the present century. The new nomenclature serves a practical purpose in that it is now possible to portray chemical combinations and isomerism in a graphic, and at least, semi-comprehensive way. Among the chemists may be specially mentioned Bertholet, whose laws are as well known as they are succinct; Humboldt; Berzelius; Dumas; Chevreuil, who recently died at the age of almost one hundred years; Magendie; Orfila, the toxicologist; Gmelin, eminent in physiological chemistry; Rose, perfecter of organic analysis; Wohler,{239} who first made organic alkaloids; Bunsen; Sir Humphry Davy; Marsh; Faraday; Graham; Young, who first showed the industrial value of coal; and Gay-Lussac. Upon medicine, zoology also, with comparative anatomy and physiology, has had a wonderful influence; here may be noted the names of Cuvier, Oken, Bilharz, Brehm, Wagner, Leuckart, Richard Owen, William Carpenter, and last, but by no means least, Thomas Huxley. But perhaps the most significant feature of the age has been the wonderful development of scientific associations and the publication of medical and scientific literature. Whether these have yet reached their climax is perhaps an open question, but the consequent widening circle of readers, as well as of writers, seems to imply that there will be for a long time to come no lack of activity in this direction. In the United States more than in any other country medical societies and associations innumerable have sprung up, and to such a degree that (in the eastern States at least) there are few counties that cannot boast of a medical organization. During the present century foreign universities have decreased in number, partly owing to consolidations and partly by surrender of charters; for instance, the old University of Ingolstadt was united with that of Landshut, and in 1827 was removed to Munich; in 1816 the University of Wurtemburg was united with that of Halle; the University of Bonn was abolished in 1792, but revived in 1818. A few new universities, like that of Zürich, have been founded. In the quaint old town of Prague the old German university was, in 1883, divided, and there now exist in that city two universities side by side, in one of which German is spoken, in the other Bohemian. It will thus be seen that the nineteenth century is essentially an era of modern science, with whose dawn was sounded the death-knell of the "demon of disease" and his twin{240} brother "visitation." In 1801 the first experiment in steam-navigation took place upon the Thames. In 1807 the slave-trade in England was abolished by Parliament. The theological part has entirely faded out of medicine; and the era of accurate scientific experimentation which long since dawned, is now, so far as we can see, at its height, since it is difficult to conceive of much improvement upon its methods under existing conditions, or of greater enthusiasm than has been already manifested. Now, regarding some of the systems and theories of this age. The systems of the past have been more or less long-lived,--as, for instance, those of Dogmatism and of Galen,--while as we come closer to the present they become more ephemeral. Those of the early part of the present century took root in the soil of the eighteenth,--for instance, the so-called _theory of excitement_ of Roeschlaub (1768-1835), which endeavored to mold into one the Brunonian errors and the fancies of Schelling. According to it, life depends upon irritability, but is inherent in the organism as an independent feature; so it recognizes both irritability and solidism, while Brown considered the former alone, adding, as an after-thought, a chemical or qualitative potency (oxygen), in order to account for alterations of quality. Roeschlaub inclined first toward natural philosophy, then, owing to an inherent theological and polemical bias (he was originally intended for the church), to mysticism and theosophy; finally, with a courage almost unexampled, he upset all his former teachings by admitting he was mistaken. To him was opposed Hufeland, who wrote on the _Lengthening of Life_, was noted for a warm and benevolent heart, and possessed no small penetration, as is evidenced by his aphorism, "Successful treatment requires one-third science and two-thirds '_savoir faire_.'" _Stimolo_ and _contrastimolo_ were titles applied to a theory advanced by Rasori (1762-1837), of Milan, that combined Methodism with Brunonism; by Baas it is characterized{241} as a "genuine blot upon the human heart beyond any other of the various systems." Long centuries of experience and the conclusions of great and venerable minds may go for naught, as Rasori abundantly demonstrated. The theories of Brown were then taught as his own to his classes in Pavia, showing he was not above plagiarism; his _stimolo_ corresponded to the sthenic diathesis devised by Brown, while his system consisted of an endeavor to make a diagnosis by watching the effects of drugs. Bleeding was held to be the best measure; if it did the patient good, the sthenic diathesis was assumed; if it made him worse, the asthenic was certain. He gave enormous doses of powerful drugs--sixty grains of gamboge, and from two to three ounces of saltpeter in a single day. Is it strange that homoeopathy or any other heterodox system sprang up in the midst of such measures? It is an old saying that there is no folly which will not secure a following; and, strange to say, Rasori had a numerous and an eminent one. As just intimated, Homoeopathy was the natural reaction against such heroic measures; in the rebound the other extreme was reached, even to practical therapeutic nihilism. Now, instead of venesection and drastic medication, came the theories expounded by Hahnemann (1753-1843), which _denied disease, admitting only symptoms_. This apostle of homoeopathy was the son of a porcelain-painter in Meissen; he studied in Leipzig and in Vienna, and later practiced in various cities, including Dresden and Leipzig. "_Similia similibus curantur_" was not original with him, as it long before had been formulated by Hippocrates, and later by Paracelsus. Of the life and labors of Hahnemann, much might be told; but this is not the time or place to go into the subject. [Illustration: 0262] An offshoot of homoeopathy, which demands only the harshest criticism, is Isopathy,--perhaps the filthiest theory ever invented,--according to which like is to be cured by like,{242} and to such an extent that small-pox is to be treated by variolous pus, tape-worm by the ingestion of the proglottides, etc. Another of the rankest of fraudulent outgrowths is the so-called Electrohomceopathic system of Count Mattei, who prates of "red," "blue" and "green" electricity,--a theory that, in spite of its utter idiocy, has attracted a considerable following and earned a fortune for its chief promoter. Another of the vagaries of the earlier portion of the present century, and that still survives, in a weak way, is Cranioscopy, or Phrenology. Gall expounded his doctrines at Vienna as early as 1796, but, being expelled, went to Germany, where he was joined by Spurzheim, who, though much{243} more of a student and scientist, accepted the doctrine of the former with enthusiasm; and it was chiefly due to the efforts of Spurzheim that phrenology was introduced into England, and later (1832) into America. Gall assumed to locate twenty-seven different organs alongside of each other in the brain, and held that external markings on the skull were guides to the development of the various parts. Every neophyte in anatomy knows how little foundation there is for such a doctrine, but for a time it attracted great attention, and there are to-day certain men and women who make their living out of this imposition. The Physiological Theory of Medicine was originated by Broussais (1772-1838), and combined the views of Pinel and Bichat with the "sympathetic" view of Hoffmann, the "concealed inflammation" of Stoll, and the theory of inflammation held by Marcus. Broussais had been a pupil of Bichat. In 1814 he began hospital teaching, and in 1831 was made professor. Personally very vain, quick-tempered, even belligerent, as a therapeutist he was a man of routine. He was, perhaps, best known shortly before his death, when delivering lectures on phrenology. According to him, life depends upon external irritation, produced by heat, which excites new chemical processes, while these in turn stimulate regeneration, assimilation, as well as contractility, and sensibility. When the functions supported by heat cease, death ensues. Health depends upon moderate action of external irritants; disease, upon either their weakness or their extraordinary strength. He saw nothing ontological about disease. In therapeutics he admitted the healing power of Nature, but regarded the physician not as a minister, but as a lord of Nature. Febrile and inflammatory diseases were all treated by the withdrawal of nourishment, carried to the extreme. His most powerful antiphlogistic treatment consisted in the application of leeches to the abdomen,{244} and to robust individuals he applied from thirty to fifty at once It is not, then, to be wondered at that, in consequence of his so-called "hirudinomania," leeches became very scarce In the year 1833 forty-one million five hundred thousand leeches were imported into France, while in 1824 one-twentieth of this number sufficed to supply the demand. Even in cases of worms, the abdominal integument had to pay its blood-tribute, particularly if enteritis prevailed. He only allowed a spare diet of mucilaginous and acid drinks. In mercurial France and Italy he gained numerous followers, but they were few and far between in practical, hard-headed Germany and England. His best follower was Bouillaud (1797-1881), who adopted the symptomatic nature of fever and the sanguinary therapeutics of his master, but used the lancet more than the leech. As the homoeopaths regard Hahnemann, so Bouillaud looked up to Broussais as the Messiah of medicine and science, which, as Baas says were "already greatly overstocked with Messiahs." Contemporaneous with the school of Broussais, and its antagonist in all respects, was the Paris School of Pathological Anatomy and Diagnosis, which has given tone to all medical art. It made it the duty of the physician to search for changes in the human body, to investigate the local products of disease, and assigned to medicine the duty of removing these products. The tendency of its teaching was to treat the patient rather as a living cadaver than as a sentient being endowed with vital forces, and the charge which Asclepiades once falsely made against Hippocrates was revived upon new grounds. Kratzmann wrote some years ago: "In France every one experiments on the sick, less to attain the best method of cure than to enrich science with an interesting discovery and to advance the accuracy of diagnosis by some new physical sign." The seductiveness of this system promoted still more onesidedness, which finally almost attained the belief that the science{245} of medicine really originated in the Anatomical School of Paris. The forerunners of this school were Bichat and Pinel, and its proper founders were Corvisart, Dupuytren, and Laënnec. There was also Bayle, who was first to apply the ear to the thorax in disease of the heart, and thus became the predecessor of Laënnec and Chomel. He was the godfather of typhoid fever, and from being a famous clinician became later a great pathologist. The most celebrated adherent of the method, however, was Cruveilhier (1791-1873), professor first in Montpellier and then in Paris, who revived the Anatomical Society founded by Bichat, and wrote his first essays as the result of Dupuytren's advice; finally, there came from his pen the famous treatise on _Pathological Anatomy_, with its magnificent plates,--a work begun in 1830 and not fully completed until 1864. Like Morgagni, he associated general and pathological anatomy with bedside observations; also established a class of inflammations to which belong gangrene and atony, and a certain class of neuroses and fevers, and endeavored to investigate the different steps in the development of lesions, not simply their final products. His teachings concerning pyæmia and phlebitis, which had been first studied by John Hunter, excited great attention, and he even came to the one-sided conclusion that "phlebitis rules the whole of pathology." He was the first to observe that its suppurative form does not occur primarily, but is secondary to coagulation of the blood. The ablest representative of this school, and one who, perhaps, more than any other man, made Paris a Mecca to which foreigners made their pilgrimages, was Andral (1797-1876),--the son of a physician and the most noted and indefatigable investigator and thinker of his time. Between 1823 and 1840 were published the five volumes of his _Medical Clinic_, which made him famous. He taught, in opposition to Broussais, the existence of primary diseases{246} of the blood, the so-called dyscrasiæ; made physiology subservient to pathology; was the creator of the chemistry of the blood; and in therapeutics was wedded to emetics and cathartics, ascribing little importance to abstraction of blood. The first man to apply the Numerical Method to pathology, and who brought about the downfall of Broussais, was Louis (1787-1872), who had studied in Russia, but came to Paris while still a young man. He expressed his principle in the following words: "As often as I have formed an _a priori_ idea and had afterward opportunity to prove the facts, I have invariably found that my idea was false. In pathology as well as in therapeutics numerical analysis is a useful practice. By numbers only can be obtained the frequency of conditions or this or that symptom; by a definite enumeration alone is it possible to utilize the special relations of age, sex, constitution of our patients, to settle that this or that symptom occurs so often in one hundred or one thousand cases." This system he applied to etiology, symptomatology, prognosis, therapeutics, and pathological anatomy. He discarded blisters and condemned large bleedings, but fell into other errors, carrying his numerical method to an unjustifiable extreme. Next to Andral and Louis should be mentioned Magendie (1783-1855), Professor of General Pathology in the College de France, and physician to the Hôtel-Dieu, who was a representative of the new French medicine, and introduced experiments into both pathology and physiology; he was the pioneer in experimental pharmacodynamics, which occupies itself largely with alkalies, a large number of which he introduced into practice. He was a solid humoralist in pathology, a most accurate diagnostician, but (it is charged) "was too simple in therapeutics"! As a result of his intravenous injections of putrefactive material, he had the terms "pyæmia," "icliorrhæmia," and "metastasis" introduced into pathology. Trousseau{247} (1801-1866), of Tours, also became professor in the Paris Faculty, and rendered especial service in his studies of croup and the employment therefor of tracheotomy, though his chief fame rests upon his merit as a clinical teacher and the publication of clinical lectures which are still models in every way of accurate, forcible teaching. Claude Bernard (1813-1878) became the successor of Magendie, and even more famous as an experimenter in pathology, physiology, and anatomy. Originally a poet, he finally turned to medicine and science, and in 1869 became a member of the French Academy. One of the results of the French fondness for pathological anatomy was an outgrowth, unfortunate in some respects, of specialism, which made its appearance early and spread to other countries, particularly to Germany, so that to-day there is scarcely an organ in the body which has not only its special student, but its special representative in medicine. It would be of interest to go over some of the various organs and count those who have become most renowned in the study of their diseases, but that is beyond the scope of this volume. As Baas says, England, after her excessive participation in the iatrochemistrv and iatromechanics of the seventeenth century, with a devotion that extended far into the eighteenth, seemed then to lose all confidence in systems and schools of medicine, inasmuch as since that time no system or so-called school has gained in Great Britain any large or permanent band of followers; even Brunonianism did not succeed in this respect. This form of conservatism is a characteristic of the British race. But while schools have not risen, individuals have formulated hypotheses or doctrines that at least attracted attention, if not followers. For instance, John Mason Goode (1764-1827) formulated an intricate nosological arrangement in his long-popular text-book entitled _The Study of Medicine_, and{248} also arranged a classification of diseases now almost forgotten. In 1816 Sir Charles Bell (1774-1842) made the memorable discovery that the posterior roots of the spinal nerves preside over sensation, and the anterior over motion; and this attracted anew the attention of English physicians to the nervous system, and was rewarded by the later discovery of reflex action or reflex phenomena, communicated to the Royal Society in 1863 by Marshall Hall. Both discoveries were important, and both were duly rewarded by yet others. Benjamin Travers (1783-1858) seems to have been greatly influenced by the first of these discoveries, and led thereby to pay special attention to what he termed "constitutional irritation"; his studies on this subject are often quoted to-day, and are well worthy of perusal; he understood by this term a process (in strong contrast with inflammation) which subsides without hyperæmia and without plastic exudate, but which, on the other hand, may occasion liquid products and result in neoplasms. Contemporaries of Travers were: Abram Colles; John Cheyne (1777-1830), of Dublin, who wrote on _Diseases of Children_ and described "Cheyne-Stokes respiration." William Stokes (1804-1878), also of Dublin, who distinguished himself in 1857 by a great work, entitled _A Treatise on the Diagnosis and Treatment of Diseases of the Chest_; Robert Graves (1797-1853), Professor of Medicine in the King's and Queen's College, Dublin, who published clinical lectures of his own, besides many clinical reports in connection with Stokes. Graves was one of the first to oppose the "absolute diet" of the earlier physicians in the management of febrile maladies, and requested that his epitaph should have but one line--"He fed fevers!" "The School of Natural Philosophy" was the title applied to a system which, in Germany, ran parallel with that of Broussais, being the legitimate outcome of the medical{249} philosophy of the eighteenth century which had originated there, and also a revival of opposition thereto on the side of realism. It led into speculative extremes, which finally sobered down, because of the meaningless scholastic phrases often introduced, and thus broke a path for the subsequent enthusiasm in behalf of French positivism in medicine. Those who constituted this school were, for the most part, men of importance, but were followed by a number of imbecile representatives. Use was made of the abstract doctrine of the philosophy of identity and the imponderables, such as electricity, mechanical forces, and magnetism, contrasted with which were the dimensions of matter and certain qualities, like sensibility, irritability, etc. Perhaps the greatest influence of this teaching was in the department of embryology and physiology, where Johannes Müller displayed his remarkable activity. Among the most distinguished representatives of the natural-philosophy school was Oken (1779-1851), of Bavaria, who subsequently taught in Munich, Jena, and Zürich, and published a large work on natural history, which did much for the popularization of this science; he explained that the skull is made up from a series of vertebræ; also discovered the Wolffian bodies, and was such a power in his way that Agassiz characterized him not only as "a master in the art of teaching," but as "a courageous and ruling spirit." Others of this school were: von Walther (1782-1849), eminent as a surgeon; Dollinger (1770-1841), of Bamberg, the distinguished leader of the Old Catholics; Reil and Procliaska, anatomists; Troxler and Schelling, philosophers and anatomists; Treviranus, the microscopist; Malfatti, Kilian, Spindler; Schmidt, of Vienna; and others too numerous to mention. As a successor to the School of Natural Philosophy came the School of Natural History (1831-1850). which made important concessions to realism; its most prominent members were from South Germany. This school was based{250} partially upon the philosophy of Nature, and expired almost suddenly. One of its most eminent exponents was Krukenberg, whose therapeutic creed was that "Physicians should be filled with pious reverence toward Nature; the organism is a whole, and must be contemplated in this sense; medical art is, undoubtedly, capable of decisive action, but let us not mistake that in many cases its activity is quite superfluous, in very many null and inadequate, and in many injurious." This school was the expression of the turn medicine was compelled to take in order to escape the after-effects of the one-sided, ideal, systematizing tendency of the eighteenth century (whose final outcome was natural philosophy), and to square itself with the realism and positivism of the nineteenth. Schonlein (1763-1874), of Bamberg, outlined a system that taught pathological and anatomical revelations as concrete expressions of the independent entity disease, whose relation to the organism is as that of a parasite sojourning temporarily in it; he also constructed a classification of diseases, something after the manner of the botanical classification of de Candolle. One of his best-known pupils was Canstadt (1807-1850), whose _Jahresbericht_ has preserved his name. Siebert, of Jena, famous as a diagnostician, and Haeser, the medical historian, belonged to this school. An offshoot of the French school of pathological anatomy and diagnosis was the so-called New Vienna School, which aided the French system in obtaining high recognition in German medicine, and gained its first influence from the labors of Wünderlich (1815-1857); next to whom should be mentioned Baron von Rokitansky (1804-1878),--a Bohemian,--one of the most famous men in modern times, and who exercised a profound influence, even in foreign countries,--particularly in Italy and Russia. Von Rokitansky worked for a long time in miserable quarters in Vienna, but finally a magnificent building was{251} specially erected for him. He was loaded with honors, and took his seat in the Austrian House of Deputies. Two sons are well known in medicine to-day, and two more have achieved reputation as singers,--a circumstance which the father embodied in the _bon mot_ that "two of his sons howled and two of them healed." He transplanted into Vienna the tendency of the earliest pathologico-anatomical school, which captivated all by its novelty and interest, and in the post-mortem room and the clinical-lecture room he converted medicine in Germany to the realism of the nineteenth century. He was, indeed, the Van Swieten of his time in his influence upon educational affairs. His works are distinguished by simplicity, clearness, and logical order. He performed more than thirty thousand autopsies; for fourteen years he studied the defects of the septum of the heart and the comparative anatomy of the uterus and genito-urinary organs, yet paid little attention to the microscope or to applied medicine. He was a pathologist, pure and simple. A friend and co-laborer,--Skoda (1803-1881),--also a Bohemian, was little, if any, less famous. In 1839 he gave to the world his famous work on _Auscultation and Percussion_; in 1847 became professor at Prague, and was the first man to lecture in German. In spite of his bachelor peculiarities, his taciturnity, and his heedlessness, he was very popular, and left a fortune,--quite in contrast to Rokitansky, who died poor. His scientific merit was based upon the fact that he overthrew the specific and pathognomonic arrangement of sounds, as taught by the French, and substituted therefor a category, based upon the physical constitution and shape of organs and tissues. He endeavored to develop a strictly scientific system of physics out of the empirical French doctrine of physical signs, and in his work on _Physical Diagnosis_ he displayed an independent spirit, though as one who had received his impulse from France. He was the first in Germany to insist upon the merits{252} of Avenbrugger, and was the leading diagnostician of his time of the new Vienna school. Skoda was the first for whom was created, in Vienna, a specialty after the French model,--that is, a special division for patients suffering from thoracic diseases. Great as he was, we must yet lay it up against him that through his influence,--first in Vienna and afterward throughout Germany,--practical medicine degenerated into simple diagnosis, and that, by his observations on the natural course of disease, undisturbed by therapeutics, he became the founder and exponent of expectant or nihilistic therapeutics,--the harbinger of a very cheerless period in the history of medicine. CHAPTER X _Age of Transition (concluded).--New Vienna School (concluded): von Hebra, 1816-1880. Czermak and Türck, Jager, Arlt, Gruber, Politzer.--German School of Physiological Medicine: Roser, 1817-1888.--School of Rational Medicine: Henle, 1809-1855.--Pseudoparacelsism: Rademaclier, 1772-1849.--Hydrotherapcvtics: Priessnitz, 1799-1852.--Modern Vitalism: Virchow.--Seminalism: Bouchut.--Parasitism and the Germ-theory: Davaine, 18111882. Pasteur, 1822-1895. Chauveau, 1827--. Klebs, 1834--. F. J. Cohn, 1828--. Koch, 1843--. Lister, 1827--.--Advances in Physical Diagnosis: Laënnec, 1781-1826. Piorry, 1794-1879.--Surgery: Delpeeli, 1772-1832. Stromeyer, 1804-1876. Sims, 1813-1883. Bozeman, 1825--. McDowell, 1771-1830. Boyer, 1757-1853. Larrey, 1766-1842. Dupuy-tren, 1777-1835. Cloquet, 1790-1883. Civiale, 1792-1867. Vidal, 18031856. Velpeau, 1795-1868. Malgaigne, 1806-1865. Nélaton, 1807-1874. Sir Astley Cooper, 1748-1841. Brodie, 1783-1862. Guthrie, 1785-1856. Syme, 1799-1870. Simpson, 1811-1870. Langenbeck, 1810-1887. Billroth, 1819-1894._ A few{253} of Skoda's more eminent colleagues deserve brief mention: Oppolzer (1808-1871) was singularly gifted in diagnosis, popular, a teacher of wide influence, and manifested in superlative degree the characteristics that constitute a great physician; he wrote little, but was for a long time Professor of Medicine at Prague. Von Hebra, the elder (1816-1880), worked a complete revolution in dermatology, and developed a classification based upon the pathological anatomy of the skin. He instituted a new and independent line of therapeutics as applied to this branch of our art, for which the medical world will ever hold him in grateful remembrance. Sigmund and Zeissel during the same period did much to clear up the problems of syphilis. To Czermak (1828-1873) and TUrck (1807-1868) we are indebted (practically) for the making a specialty of diseases of the nose and larynx; of like service to ophthalmology were Jàger, Jaxtthal, Arlt, Stellwag von Carion, Hasner, Mauthner, Fuchs, and von Reuss, while Gruber and Politzer did as much for diseases of the ear. An indirect offshoot of the new Vienna school is the so-called "Physiological Medicine," founded by Eoser (1817-1888),{254} of Stuttgart (late Professor of Surgery in Marburg), seconded by Griesinger and Wunderlich. Their views were directed against the symptomatologists and idealists, and particularly against the School of Natural History, the claim being that physiology must include vital phenomena, while from the morbid portions of these phenomena the special science should be formed as an artificial, yet practical, division of knowledge. 'Wunderlich's book of therapeutics was for a long time the best guide in this direction, inasmuch as it left to individual thought and judgment--the Hippocratic method of investigation--the determination of value and demand. Another offshoot, that differs but little from this save in definition, is the "School of Rational Medicine," originated by Pfeufer (1806-1869) and Henle (1809-1855), and which, since 1841, has been represented by a special journal. While Wunderlich claimed pathology to be the physiology of the sick, Henle considered this questionable and made no distinction at all between the physiology of the healthy and that of the ill. The language of the followers of this school contrasted strongly with that emanating from other schools, and for a time was confident and ingeniously triumphant; nevertheless, it did not forget philosophical speculation, and Hegel may now be regarded as indirectly the godfather of rational medicine. The vagaries of Paracelsus led indirectly, though positively, to the foundation of Homoeopathy, and likewise originated the doctrine that bears the name of Rademacher (1772-1849). It is curious that this pseudoparacelsic system should spring up alongside of the Vienna school, its teachings being the classification of diseases by their therapy, Rademacher's followers possessed three universal remedies,--"cubic niter (nitrate of sodium), copper, and iron,"--and also three primary diseases that must take their titles from the three universal medicaments. In spite of the admission that these diseases were unknown, it was boldly{255} asserted they were with certainty to be cured by the three chief remedies. The three primary diseases, "sodic nitrate, copper, and iron diseases," do not necessarily remain as such, as they may throw some organ "into a condition of sympathy, and thus it results that iron disease may express itself in the form of consumption, delirium tremens, etc., while a copper disease may appear as worms, paralysis, jaundice, etc." Besides universal diseases and universal remedies there were diseases of organs, to be diagnosed by the efficacy of organ remedies; thus, abdominal diseases must be relieved by corresponding "abdominal remedies," head diseases with "head remedies," chest diseases with "chest remedies," etc. Also for each particular viscus there must be a special remedy. What is the most surprising about this absurd doctrine is that it found followers, some even quite capable in their way. Now, too, reappeared the Hydrotherapeutic System--the great apostle of which was Priessnitz (1799-1852)--based upon gross views of humoral pathology, according to which a disease entity was to be expelled in the form of sweat, eruption, etc. Poultices, cold packs, and cold baths were the principal therapeutic measures. Winternitz has made hydrotherapy popular and, in a measure, effective in the management of certain maladies. Rudolph Virchow in 1858 instituted the doctrine or theory known as "Modern Vitalism," which, in fact, was borrowed from natural scientific medicine, and distinguished from the vitalism of the previous century in that it breaks up the old vital force, which was supposed to be either distributed throughout the entire body or located in a few organs, into an indefinite number of associate vital forces working harmoniously, and assigns to them all the final elementary principles without microscopic seat. "Every animal principle has a sum of vital unities, each of which bears all the characteristics of life. The characteristics and unity of life cannot be found in any determinate{256} point of a higher organism,--e.g., in the brain,--but only in the definite, ever-recurring arrangement of each element present; hence it results that the composition of a large body amounts to a kind of social arrangement, in which each one of the movements of individual existence is dependent upon the others, but in such a way that each element has a special activity of its own, and that each, although it receives the impulse to its own activity from other parts, still itself performs its own functions." This is nothing but another way of expressing the cell-doctrine, to which many medical men are now committed, which means that all bodies are built up of cells and that each cell has a unity and a purpose of its own. In 1677 Sir Robert Hooke discovered plant-cells; later Schwann discovered animal cells and Robert Brown cell-nuclei; but it remained for Virchow to supply the gap which had risen between anatomical knowledge and medical theory; that is, to supply a "cellular pathology," since which time the cell has assumed the rôle which the fibre occupied in the theories of the seventeenth and eighteenth centuries. Time alone can decide as to the ultimate validity of this theory, which has in certain circles been most enthusiastically received. One of its weakest aspects is, perhaps, that the so-called intercellular substance plays an uncertain and unsatisfactory part. An important feature in which the cellular pathology differs from other systems, and particularly from the old humoral pathology, is in the doctrine that the blood itself is not the proper and original cause of dyscrasiæ, and probably not the cause of continuous alteration of the tissues; that these dyscrasiæ arise because the blood is not an independent structure, but dependent upon the condition of the patient in consequence of its continuous conveyance of the noxious material from all parts of the body,--the blood is, therefore, merely the medium for the production of the dyscrasia. This theory has made several peculiar, new, and symptomatic or morphological{257} forms of disease, such as leukæmia, leucocytosis, etc. Virchow also cleared up the old and obscure ideas regarding pyæmia, and proved that an absorption of pus into the blood, which the name implies, is quite impossible; likewise, that pyæmia is inseparable from thrombotic processes. [Illustration: 0277] Virchow was born in Pomerania in 1821, and in 1849, he distinguished himself by attaining the highest grade in the career of the learned,--a professorship, which he first held in Würzburg. During earlier years his residence and labors were largely the result of necessities arising from political views, for on account of these he was long denied a residence in Berlin. A personal friend, now old, once an _interne_ in the great Julius Spital, in Würzburg, at the time{258} when Virchow taught there, tells me a light was burning every night in Virchow's room until 3 a.m., and yet the professor was always out at work by 7. It was by such intense application that he arrived at his present position at the very top of the professional ladder; but very few men have the physique and constitution to stand such arduous study. In 1856 he assumed the chair of Pathological Anatomy in Berlin, and introduced microscopical anatomy, to which Rokitansky had not given sufficient attention. Virchow was a former pupil of Johannes Muller, famous as a physiologist and pathologist, and his views to-day are often tinged by the doctrines acquired from this great teacher. He is also a great admirer of Harvey, whose picture, at least for a long time, was the only one permitted to hang in his study. His first edition of _Cellular Pathology_ appeared in 1858; the colossal work on _Tumors_ in 1866, in which he carried out the division of morbid growths originally adopted by Johannes Müller in 1838, classifying them according to their microscopical elements. He is also scarcely more celebrated for his teachings and labors than for the number of famous pupils brought up under his influence, among whom may be mentioned Leyden, Recklinghausen, Cohnheim, Waldeyer, Kuhne, and Rindfieisch. As a result of his labors has arisen in Germany what has been called the "Medical School of Natural Sciences," that seeks, by means of pathological anatomy and microscopy, experimental physiology and pathology, and the other applied methods, to make of medicine an exact science; and to it belong such men as Zienissen, Gerhardt, Notlniagel, Liebermeis-ter, Senator, Erb, Vogel, and others. An offshoot from this is the so-called "Munich Clinical School," to which belong von Buhl, Pettonkofer, Seitz, and Oertel. The splitting up of medicine into specialties, and the increase of its subordinate branches into schools.--so called,--resulted in great danger to the unity of medical science. A return{259} to the methods which combine science and practice--the so-called clinical-practical method--is again sought by men who have established the well-known _Zeitschrift fur Klinische Medicin_, under the management of Frerichs and Leyden,--a journal which has already done a great deal of good. The versatile Bouchut, of Paris, has recently published a theory,--the so-called "Seminalism,"--for which the claim is made that he grants nothing to hypothesis, and everything to observation; its characteristic is that this new theory is also vitalistic,--in fact, the French have scarcely ever brought forth any other than vitalistic theories. Borden and Barthez, during the previous century, created the first French theory, which was followed out by Bichat, and later by Bouchut, who, as a matter of fact, owes much to Bichat. Bouchut teaches that beasts have an intelligence of instinct, and men one of abstraction; no beast oversteps the limits of animal thought, which is separated by an abyss from the productive thought of men; there is a proper kingdom of man, in accordance with his special nature; also, that the vital forces of men and of beasts are entirely different from each other, and that the principle of physical identity remains in the bodies of each, since the constantly renewed mass is formed in exact accordance with the original plans; in all the changes of his elements man is identical with man; all internal and external causes of disease modify, more or less, the vital force and its impressibility in the fluids or at some point in the economy, either increasing it or diminishing it. This theory, published in. 1873, claimed "in the abstraction of its promise and completeness of its conclusions to yield to none of its predecessors." Yet, even in France, the task of transforming medicine into a natural and exact science is far from being a _fait accompli_. The most recent theories of disease are the result of microscopical study of germs,--the germ-theory, in fact,--and{260} stand in the closest possible relation with the doctrine of spontaneous generation, fermentation, miasm, and contagion. In 1838 Ehrenberg regarded infusoria as animals, but Dujardin in 1841 expressed doubts, and Perty in 1852 affirmed that most forms classified as infusoria should be assigned to the vegetable kingdom, where, a little later, Naegeli relegated them. The correctness of this conclusion was proved by Cohn, who also perfected a classification. This particular form of investigation began in the twenties of the present century and assumed its present direction in the thirties and forties. Gaspard, in 1823, renewed the experiments of Haller, and injected into the veins of animals, not alone putrescent material, but the blood of other creatures suffering from the effect of such injections. Bassi, in 1835, discovered the cause of silk-worm disease, thereby giving special impulse to the theory of parasitism, and this was quickly followed by evidence of the existence of both vegetable and animal exciters of disease. Schoenlein, in 1839, demonstrated the fungus of favus; Vogel discovered the Oïdium albicans in 1840; Goodsir, the _Sarcina ventriculi_, in 1841; but the greatest influence upon the development of the parasitic, or germ-theory was the sequel to the discovery of the anthrax bacillus, by Davaine in 1850. In 1837 Latour and Schwann demonstrated that the cells, which were known even to Leeuwenhoeck, were actually vegetable forms, and Schulze had already pointed out that fermentation of fluids could only occur in the presence of extremely minute vegetable organisms; Chevreuil next showed that animal solids remained free from decomposition when protected from the access of germs; and in 1857 Pasteur demonstrated that fermentation and putrefaction were caused, not by chemical forms, as Liebig had taught, but simply by the agency of lower organisms, which he divided into aerobes and anaerobes; while in 1868 Chauveau queried as to whether morbific elements resided in the formed elements of germs or in their fluid{261} constituents. Thus the theory of _contagium vivum_, for which Henle contended as early as 1821, was not forgotten. In Germany Klebs and Hueter became the prominent champions of this theory; Hallier had designated his so-called "Microsporon septicum," and introduced a method of fractional cultures. The views of Klebs were opposed by Billroth, who contended for his "phlogistic ferment" and "_Coccobacteria septica_," upon which he wrote an elaborate and extensively illustrated treatise; he also at that time opposed the specific character of the lower organisms as disease agents. Hallier's _microsporon_ was refuted by Cohn, who studied and classified the various fungi, and distinguished between the pathogenic and the septicogenic,--that is, those which produced disease and those which produced ordinary putrefaction. Then came the experimental evidence of Davaine and Koch, who demonstrated the development of bacteria from spores. It is hardly necessary to discuss this theory further, but I may mention the labors of Panum and of Brieger, who deeply investigated the poisons produced by bacteria, to which are given the general titles of ptomaines and toxins. It would be unjust, however, did I not mention the name of Lister in connection with the inestimable benefit that has accrued to surgery from the practical application of the theory of infection to wounds,--a measure that brought about an entire revolution in surgery and surgical technique, and an entire reversal of the statistics of operations; where thousands formerly died, thousands now live, their lives being indirectly due to the labors of this one man and his following. I will add that it is necessary to realize the difference between life and death to appreciate the changes that have been brought about during the last score of years. Much that in former years was unjustifiable has become both justifiable and feasible; to-day patients, as a matter of course, live after operations which, so recently as when I was{262} a student, were considered impossible, or if performed exposed the operator to the charge of manslaughter. I have spoken of the impulse which came from Avenbrugger's invention of percussion, which was greatly extended through the translation of his work by Corvisart (1755-1821); the latter also excelled as a clinical teacher and pathological anatomist, and had much to do with the education of others of his _confrères_ whose names are lustrous in history. Among the most celebrated was Laënnec (1781-1826), who, though brought up among most trying surroundings, early manifested a zeal for medicine. He became a field-surgeon in the French army soon after the Reign of Terror, and pushed his classical and medical studies with restless zeal. In 1815 his first experiments were made with the stethoscope, the invention of which was due to accident: in order to hear the sounds of the heart more clearly, lie one day applied a cylindrical roll of paper, and then immediately constructed the whole form of the stethoscope upon the principle now everywhere resorted to. In 1819 he published his work on Mediate Auscultation,--a treatise on prognosis in disease of the lungs and heart, based principally upon this new aid to investigation. The treatise was speedily translated into all the languages of Europe. After enjoying a large practice Laënnec succumbed to ill health at the early age of forty-five. He seems to have had but slight appreciation of his own services to medicine, and to have prided himself rather on his skill in riding horseback. Honor and fame, however, followed closely upon the publication of his well-known work, and the manuals of physical diagnosis which now find frequent mention in book catalogues, and come from various and wide sources are the legitimate outcome of Avenbrugger's and of Laënncc's pioneer treatises. A versatile French writer who devoted especial attention to medical nomenclature was Piorry (1794-1879), to whom we are{263} indebted for the pleximeter. The double stethoscope, a legitimate extension of Laënnec's simple instrument, was invented by Cammann, of New York, and can justly be claimed for American medicine. Other methods of physical examination--like spirometry, chest measurement, and study of expired air--have been introduced since 1846. The ophthalmoscope, which has been of such sterling service, and is based upon the simplest of principles, was the invention of the famous Helmholtz, but just deceased. The principle of endoscopy,--the illumination and visual examination of the various cavities of the human body,--the various specula, the spectroscope, the sphygmograph, the more accurate record of physical sounds, the application of electricity, and the employment of thermometry represent a few of the strides in the medical science of the present century, thereby aiding and perfecting the art of diagnosis, which, in turn, must ever necessarily form the basis for all rational treatment. Let no one complain that we are still so far from certainty in every case; the wonder is that so much has been discovered in so short a space of time. Wonderful as have been these advances, the greatest achievements have accrued to the department of surgery, which Chamisso terms "the _seeing_ portion of the healing art." The sixteenth century opened the way for checking of haemorrhages; the seventeenth accomplished great simplifications and improvement in the way of dressing wounds; the eighteenth gave a refining and elevating tendency to the study of applied practice, and raised surgery to a level with other branches of science; and now the nineteenth century has, toward its close, made surgery as nearly, perhaps, as it ever can be, an exact science, to which every other branch of science has been made contributory. The chain-saw, invented in 1806 by Jeffery, alone gave an impetus to resection, which was cultivated especially in Germany; to resection was added osteotomy by Heine{264} and Maver; this, in turn, was succeeded by the so-called subcutaneous osteotomy of Langenbeck in 1854; Stromeyer introduced subcutaneous tenotomy in 1831, which was a very pronounced advance on all that had gone before; then came the introduction of anæsthesia, by which were made possible operations that had been beyond human endurance; by the introduction of the rubber bandage by Esmarch in 1873 bloodless methods were made possible. Pain and haemorrhage, the two greatest enemies of the conscientious surgeon, being thus almost annihilated, there was left but an apparently theoretical limit to what the surgeon might accomplish. Orthopaedic surgery, introduced by Delpech, was unknown prior to 1816; it was first practiced systematically by Stromeyer and popularized in France by Guerin. Operations on nerves were studied as special methods by Schuh, Wernher, and Nussbaum. Jobert and Simon abroad, and Sims and Emmet in the United States, by their studies of fistulæ peculiar to the genito-urinary tract in females, have conferred inestimable benefits upon suffering womanhood. So late as 1839 Vidal declared there did not exist in the history of surgery a single well-authenticated case of complete cure of vesicovaginal tear. It is not my intention to more than barely refer to the living surgeons of to-day, or those who have but very recently passed away from us; but it would be an injustice to overlook Bernhard von Langenbeck and Theodor Billroth. The former, born in 1810 and deceased in 1887, was for a time a teacher of physiology, but subsequently became successor of Dieffenbach in the University of Berlin. The influence he exerted upon surgery in Germany and (since the decline of French precedence) upon surgery all over the world, has perhaps been greater than that of any one man since Dupuytren's time. He it was that introduced into surgical technique and surgical pathology the experimental method of which Johannes Müller was the great{265} exponent; indeed, the relatively high importance which pathology is given to-day in every surgical curriculum is due more to his labors than to those of any other one man. Genial, learned, indefatigable, he was the ideal accomplished teacher. It would be impossible in any short _résumé_ of his life and labors to do justice to so distinguished a man, to whom the profession owes so much. Perhaps the highest testimonial that could be given would be the enumeration of the men who were ever and always his enthusiastic admirers. Langenbeck was the founder of the German Congress of Surgeons, and for many years its president, and the permanent home this association has built for itself in Berlin bears his name; the surgical journal he founded has now passed its fiftieth volume, and is today the first periodical of its class in any country or language. [Illustration: 0285] [Illustration: 0286] Theodor{266} Billroth, who only within a few years joined the great silent majority, was for many years the surgical sun of Austro-Hungary, around whom revolved all the other lights of the profession in the empire. He was as expert with the microscope as with the knife, and equally great with both. Although his great and elaborate work on _Coccobacteria Septica_ is now obsolete, it nevertheless marked an era in surgical pathology, as does also his textbook on the same subject, which reached fifteen editions and has been widely translated. He it was who made the first resection of the larynx and of the stomach, and to him we are indebted for many other daring operations. It was the fame of this teacher that in recent years led young Americans to Vienna, and he set the example in every way for a constantly growing number of students whose names are, or ere long will be, famous. Billroth was born, in 1819,{267} in Bergen, and succeeded Schuh in Vienna, after having taught most acceptably at Zürich. What he was to his teacher, Langenbeck, such are the younger German surgeons, like Czerny, Gussenbauer, Mikulicz, and others, to _him_. Here may be recalled the pride with which Americans greet the name of McDowell, who performed the first ovariotomy, and prepared the way for a branch of abdominal surgery the results of which have fairly astonished the world. There is much to be said also for certain measures, such as the introduction into surgery of plaster of Paris, by Larrey; of starched bandages, by Seutin; of absorbable material for ligatures and sutures, the latter from animal sources. Finally, antiseptic--or, better, aseptic--methods of operating and caring for injuries and wounds have worked a revolution in methods and results that is, perhaps, the most important known to medical history. At the beginning of the present century the French appeared to lead in matters surgical, and were distinguished by dexterity in operating, fertility of invention, accuracy of observation, and clearness of clinical teaching. The foundation of this reputation was laid by Desault, and upon it his successors continued to build. From his school descended the barber-surgeon Boyer (1757-1833), who became the first surgeon and trusted adviser of Napoleon, and was by him created a baron. He was the author of a work, in eleven volumes, which has survived many editions and translations, and therein he laid especial stress upon after-treatment. Richerand (1779-1840), like Boyer, was made a baron, and was a professor in Paris; but his character suffered from his overweening ambition and vanity; he was wont to exhibit most unpleasant personal traits; nevertheless his surgical ability entitles him to front rank among his contemporaries. The third surgeon honored with the rank of baron was Larrey (1766-1842), surgeonin-chief{268} to the Grand Army, and whom Napoleon I called the most virtuous of men. In 1792 he joined the Army of the Rhine, and was the physician of the so-called "flying ambulance" for twenty-two years. He was present in sixty great battles (including that of Waterloo) and four hundred engagements, and was three times wounded. His memoirs and monographs on subjects connected with military surgery cause him to be often quoted even at the present day. It is recorded that he performed two hundred amputations in a single dav; during the march through Russia he had at one time in Smolensk ten thousand men to care for in one hospital. A wonderful organizer, he was idolized by the soldiers, and seems to have been held in nearly the same esteem as his great prototype. Ambroise Paré. The most famous French surgeon of this century,--equally celebrated as a diagnostician, as an operator, and as a teacher,--was Baron Dupuytren (1777-1835). As a child he had been stolen, on account of his eminent beauty. His early life was one of poverty and want. He zealously devoted himself to anatomy and physiology as foundations for successful work in surgery and ultimately secured a private practice that embraced all France, and, when visiting other countries, was received like a prince. For years he devoted three hours daily to didactic lectures. He died, leaving a fortune of several millions of francs; he even offered to the exiled Charles of England a million francs as a trifling recompense for his misfortune. He was known as "The Xapoleon of Surgery,"--a title well earned, yet one which drew upon him the enmity of many of his contemporaries, particularly as he seemed inclined to persecute all who dared to tread in his path. His death resulted from empyema, for which he declined operation, preferring, as he said, "to die at the hands of God, rather than man." The first truly scientific practitioner of orthopædic surgery in France was Delpech (1777-1832). of Toulouse, who{269} was likewise the pioneer in subcutaneous tenotomy of the tendo Achillis and in autoplastic operations. At his own expense he erected a large orthopaedic institute in Montpellier, and his death occurred while on his way to pay a visit to this institution, both he and his coachman being shot by an insane patient upon whom he had operated. Dupuytren's successor in the Hôtel-Dieu was Roux (1780-1854), who earned specific reputation as a dextrous and rapid operator; his labors in constructive and plastic surgery were extraordinary. The first to apply physical investigation to surgery was Lisfranc (1790-1847),--best remembered, perhaps, in connection with amputation of the foot. Marjolin (1770-1850) was a teacher of eminence, as were also Sanson (1790-1841) and Cloquet (1790-1883), though the latter is better remembered for his works on anatomy than for his exploits in surgery. Civialc (1792-1867) is chiefly famous for revamping the operation of lithotrity, for, though a lithotrite had been invented by d'Etoilles, Civiale was the first actual operator, for which he was fiercely opposed by Larrey, Sanson, Velpeau, and others; he lived to see his rivals confounded and lithotrity accepted as a legitimate surgical procedure. Amussat (1796-1856) reinvented torsion of arteries for the repression of haemorrhage, for, although this measure had been suggested by the ancients, it was held to be suitable only for very small vessels; he never held a professorship, yet at his residence were gathered so-called "conferences" that were attended by the most eminent medical men of the time; he is specially known in connection with the operation for opening the colon in the lumbar region. Pravaz was a surgeon of Lyons, whose name has been perpetuated by the small syringe--the original hypodermatic--which he devised. Vidal (1803-1856), of Cassis, made a reputation by his work on _Surgery_, in five volumes, which was extensively translated and reprinted throughout Europe. Jobert de Lamballe{270} (1799-1867) rose from abject poverty to a professorship and a seat in the Académie; he is particularly remembered for his achievements in plastic operations. Velpeau (1795-1868) in 1834 became the successor of Boyer; popular as a teacher, and an author of great fertility, he devoted attention alike to surgery and midwifery; his _Operative Surgery_, in three volumes, and a treatise on _Diseases of the Mammary Gland_ are still classics. Gerdy (1797-1856), like Velpeau, was the son of poverty-stricken parents; in 1833 he became a professor, and wrote extensively on bandages, dressings, and on operation for the radical cure of hernia. Bonnet (1802-1858) rendered great service to surgery by his researches upon diseases of the joints. Malgaigne (1806-1865), made Professor of Operative Surgery in Paris in 1865, devoted great attention to surgical anatomy, operative and experimental surgery, and especially to fractures and dislocations,--his work on fractures is met with on many book-shelves to-day. Nélaton (1807-1874) was surgeon to Emperor Napoleon III, and, though he wrote little, became peculiarly eminent as a practitioner; his ingenious probe, tipped with porcelain, by means of which he located a bullet in the foot of Garibaldi, is well known. He devoted special attention to tuberculosis of bones and joints, being, perhaps, further instigated thereto by the case of the Prince Imperial; his treatise on this subject forms most acceptable reading to-day, and he taught the existence of osseous tuberculosis long before such was recognized in either Great Britain, Germany, or the United States. Were I to refer to living contemporaries of many of the celebrities just mentioned, I should speak with special reverence and esteem of Péan, Verneuil, and Oilier, who are to-day the greatest surgeons in France; but with their lives and labors any one may easily acquaint himself from sources which are at the command of all. I pass now to the Italians, who, since Scarpa's time, have{271} never made any very decided impression upon surgery, although there are many most excellent practitioners of the art in Italy; the best known are Porta (1800-1875), Vanzetta (born in 1809), and Rizzoli (who died in 1880); lliberi, Tizzoni, Loreta, Durante, and others are, perhaps, equally entitled to mention. Since the time of Gimbernat there have been no surgeons in Spain whose services have been sufficiently important to rouse special attention away from their native peninsula. The Spaniards are well educated, and well equipped for practice, but do not appear as great originators nor experimenters; doubtless because their medical schools and universities long since lost prestige, owing to clerical and Inquisitorial interference; nevertheless, Spanish medical literature has kept well abreast with that of other countries. In Great Britain the example of John Hunter, during the eighteenth century, produced results of the greatest importance; advances were made simultaneously in physiology and pathology which the Anglo-Saxon races have been quick to utilize. While, perhaps, more conservative and less inventive than the French, the surgeons of England have ever been in the front rank, and quite early they gave great attention to careful local dietetic and hygienic measures, of which Continental surgeons were, and are, too often neglectful. English surgeons, too, while they have been specialists, have never been quite so narrow in their respective fields as the Continental surgeons, and it has always been rare to find one who was not also a good general practitioner; the immense advantages which this added knowledge confers must be apparent. The most celebrated representative of British surgery of this century was the son of a clergyman,--Sir Astley Cooper, born in Norfolk in 1748, but subsequently a resident of London. During youth he resolutely compressed the bleeding limb of a playmate who was the victim of an accident, so that time was gained for the arrival of a surgeon, who then tied the{272} vessel; this decided his future calling, and he pursued his studies in London, Edinburgh, and on the Continent. In 1791 he settled down to private practice, which soon yielded him an income in excess of £20,000 ($100,000), for his day the equivalent of thrice that amount at present. At the age of seventy-three he succumbed to a longstanding asthma. He was a somewhat voluminous writer, and his works on fractures, dislocations, and diseases of the breast are by no means obsolete. His motto was: "First observe, and then think." Exceptionally endowed with all the graces of person, he became one of the most popular and influential men of his day; withal, he was always zealous for his profession, never unoccupied, and charitable to a high degree. Of his boldness we have evidence in the fact that in 1817 he tied the abdominal aorta, being the first to undertake this surgical feat. [Illustration: 0292] [Illustration: 0293] A colleague{273} of Cooper's at St. Thomas's Hospital was Travers, already spoken of in connection with irritation. Tyrrel, a nephew of Cooper, was a well-known surgeon, particularly in diseases of the eye. Others of the same name were: Samuel Cooper (1781-1848), who wrote a voluminous treatise on practical surgery; Bransby Cooper (1792-1853), Sir Astley's nephew and adopted son, who was well known, and who achieved an eminence that is only dimmed by that of his uncle. Sir Benjamin Brodie (1783-1862) was distinguished as a special investigator and a soft-tissue operator, of whom it is said that, basing his actions upon his statistics, the older he became, the less frequently he operated. His bestknown writings concern diseases of the joints. Guthrie (1785-1856), a man of noble characteristics, was the friend and{274} companion of Wellington, whom he accompanied in all his campaigns. Although well known as a lithotomist, his fame rests chiefly upon studies and writings in the domain of military surgery. A colleague of his in the Westminster Hospital, Sir William Lawrence (1783-1867), was surgeon to the queen, highly esteemed as a dextrous operator, and an authority on ruptures and on operative surgery. John Lizars (1783-1861) was a pupil of John Bell, and distinguished himself as a bold operator and fertile writer; early in the century he treated chronic hydrocephalus by operation. Robert Liston (1794-1847) was another remarkable surgeon and a wonderful operator. Sir Charles Bell (1774-1842) has already been mentioned for his researches on the nerves, and he also wrote on operative surgery, and is somewhat famed for his opposition to venesection. In Edinburgh James Syme (1799-1870) secured great reputation both by his dexterity as an operator--which is spoken of by his own pupils as marvelous--and by his introduction of resection into general practice. Sir James Y. Simpson (1811-1870) aided to make the Edinburgh school famous by his researches into the domain of both surgery and obstetrics. Though the inventor of acupressure, his name will forever be associated with the introduction of chloroform. Professor Dunn says that, u after seeing the terrible agony of a poor Highland woman under amputation of the breast, Simpson left the class-room and went straight to Parliament House to seek work as a solicitor's clerk. But on second thought he returned to the study of medicine, asking: 'Can anything be done to make operations less painful?' The ultimate result was the discovery of chloroform, and so the suffering of one became the occasion of the deliverance of many. Upon his advocacy of chloroform in obstetrics he had to defend himself against most vehement attacks of both Scotch and English clergymen, who affected to regard such procedure as a crime that transgressed the will of the Deity; but he successfully confounded{275} these assailants with their own weapons, proving himself their more than equal in knowledge of Scripture lore. Many other British surgeons, living and dead, deserve most honorable mention, but time and space will not permit. I cannot, however, pass by without mentioning Curling, Annandale, Chiene, Cheyne, Macewen, Ogston, Jonathan Hutchinson, Sir James Paget, Christopher Heath, Thomas Langmore, Savory, Holden, Holmes, Adams, Sir Joseph Lister, and Sir Prescott Hewitt, of the value of whose labors I have already tried to speak; Sir William Ferguson, of whom it is said that he had the eagle's eye, a lion's heart, and a lady's hand; John Bowman, best known for his work in ophthalmic surgery; Sir Henry Thompson, the eminent lithotomist and lithotritist; and Sir Spencer Wells, Keith, Lawson Tait, and Bantock, whose names are inseparable from the history of abdominal surgery. And what can be said of the young men who are being trained in the methods and practice of their predecessors--trained not only in the direction of manual dexterity, but in experimental science, to which they make the former subservient'? All honor to these scions of Great Britain's surgical art, who have astonished the world with their consummate ability! I would that time permitted recapitulation of the work accomplished in late years by the present generation of men in London, Edinburgh, and other medical centres; but the scope of these chapters does not cover this ground. CHAPTER XI. HISTORY OF MEDICINE IN AMERICA. _The Colonial Physicians. Medical Study under Preceptors. Inoculation against Small-pox. Military Surgery during the Revolutionary War. Earliest Medical Teaching and Teachers in this Country. The First Medical Schools. Benjamin Rush. 1745-1813. The First Medical Journals. Brief List of the Best-Known American Physicians and Surgeons._ The{276} history of medicine in America commences with the early struggles of the physicians in the American colonies. One Dr. Wootton came to Virginia in 1607 as Surgeon-General of the London Company. The following year Dr. Russell was with Captain Smith in his exploration of Chesapeake Bay. Neither of these men stayed long in the country, since, in 1609, Captain Smith, after being wounded, was compelled to return to England for treatment, for lack of medical aid. When, in 1626. Peter Minuit _purchased the island of Manhattan for the sum of twenty-four dollars_, there was probably no physician there at the time. Undoubtedly the first physician, in what is now New York, was Lamontagne,--a Huguenot, who arrived in 1637, and who seems to have been a man of great capability for his time. It would appear that men of no little eminence left the Old World for the New during the early days of the American colonies, and that the medical services which the early colonists received were on a par with those received by those whom they left behind in their old homes. During the seventeenth century a number of reputable physicians emigrated to this country, among them Dr. John Clark, of Boston, in 1638, whose son and grandson followed him in his profession and became prominent in their chosen calling. In 1644 came Dr. Child, a graduate of Padua, who seems to have been a man of great learning. A number of younger Americans also went abroad to{277} study,--Leyden, Paris, Padua, and the British universities being those most eagerly sought. In Virginia, so early as 1619, the Colonial Assembly discussed the erection of a university or college. In 1637 a public college was established in Cambridge, and in 1638 the Rev. John Harvard left to it his library and half his fortune, after which it was called Harvard College. William and Mary College was chartered in Virginia in 1693. Probably the first lectures in anatomy given in this countrv were those of Giles Firman, which were given previous to 1647 at Harvard College. It was in this early day that arose the custom, continued until very recently, of studying medicine with a preceptor. This was necessary at that time, and until comparatively recently, because of the scarcity of institutions of learning and the expense connected with an education. The form of apprenticeship was often gone through with for a term of years varying from three to seven, during which time the young student performed the most menial duties, had very meagre opportunity for anatomical study, and acquired his knowledge rather by contact with and absorption from his preceptor than in any other way. In this method of teaching the personal element was so pronounced that everything, in fact, depended upon the preceptor, save what natural talent and industry might accomplish, With such meagre opportunities the means for doing were equally scant. Nevertheless, emergency made many of these early American practitioners self-reliant and competent to treat, according to the knowledge of that day, the various accidents then so common. In 1636 the Assembly of Virginia passed a fee-bill for surgeons and apothecaries, fees, however, being often paid in tobacco, powder, lead, wampum, etc. Not a few combined ministry of the body and the soul, and a number of eminent physicians were also preachers of more or less renown,--among them John Rogers, John Fisk, and others. Probably{278} the only medical work published in America during the seventeenth century was _A Brief Rule to Guide the Common People of New England how to Treat Them-selves and Others in the Small-pocks or Measels_. This was printed and sold in 1677, by John Foster, of Boston. It was printed upon one side of a single sheet in double columns, and described both of these diseases as due to the blood endeavoring to recover a new form and state. The old English distinction between physician and surgeon was for many years quite generally preserved, but could not persist, because of the different conditions under which men practiced. During this century, also, a number of midwives made excellent practitioners,--among them the wife of Dr. Fuller, one of the _May Flower_ pilgrims. Those colonial days, however, seem to have been free from the ravages of itinerant specialists and charlatans, who so abundantly infested Europe at the time. It is also to the everlasting credit of the American profession that it took no part in the horrible delusions and scandalous transactions connected with the Salem witchcraft. By the beginning of the eighteenth century the population of the United States was about three hundred thousand whites; by the end of the century it had increased to a total of about four millions. During this century a larger proportion of educated medical men came from abroad and settled in various parts of the country, while the Colonial and the Revolutionary Wars offered ample opportunity for the development and study of military medicine and surgery. Commerce between the two continents increased; communication became more free, and the people of the Old World and the New were constantly brought into closer relation. The most lively medical controversy of the century was, probably, that excited over the introduction of vaccination against small-pox. In previous sketches I have had to intimate that the greatest enemy of the medical profession in time past has been the clergy. In this{279} particular instance, however, it was to the Rev. Cotton Mather, of Boston, that the profession is largely indebted for the favor with which the new method was received in this country. In 1721 he called the attention of various American physicians to the method, then in vogue in Turkey, of inoculation with virus from the active disease. Dr. Boylston, of Brookline, Mass., who settled in Boston, corresponded with members of the British Royal Society and finally determined to put the method to actual proof. In 1721 he inoculated his own son with the virus of natural small-pox, and within the next year had inoculated two hundred and forty-seven persons, of whom about two per cent, died of the disease; while, of nearly six thousand persons attacked by the disease in the natural way, more than fourteen per cent. died. In spite of this, the man and the method were violently attacked by the people and the profession, and found their warmest defenders among the ranks of the clergy. Benjamin Franklin, then only sixteen years of age, joined with the rabble in opposing the inoculation method. Boylston was threatened with hanging, and had even to hide himself for a time, he died in 1766. After the great discovery of Edward Jenner societies were formed for the promotion of vaccination all over the world. The earliest vaccination in the United States was performed by Dr. Waterhouse (born 1754, died 1846), who operated upon four of his own children in 1800. [Illustration: 0300] It was during the eighteenth century that a number of our best-known educational institutions were founded in the different colonies,--among them, Yale College, in 1701; Princeton (College of New Jersey), in 1746; University of Pennsylvania, in 1749; Columbia (King's College), in 1754; and others, only a little less known. In most of these latter were established medical departments, but the method of apprenticing students to physicians was still in general observance, no preliminary education whatever, as a rule, being demanded. In 1766, however{280}, the New Jersey Medical Society ordained that no student be taken as an apprentice by any member of the society unless he had competent knowledge of Latin and some initiation in the Greek. About the middle of the century Drs. Bard and Middleton, in New York, and Dr. Cadwallader, in Philadelphia, began giving lectures in anatomy, while at Newport, Rhode Island, Dr. William Hunter, between 1754 and 1756,--a near relative of the famous Hunters of London, and a pupil of the elder Monro,--gave a course of lectures on human and comparative anatomy. Dr. William Shippen. Jr. (1736-1808),--a student of John Hunter's,--returned in 1762 to America, and gave his first course of lectures on anatomy and midwifery during the years immediately following. His lectures led to the formation of a Medical Department of the College of Philadelphia, in 1765, in which lectures were continued regularly until the winter of 1775, when the{281} War of the Revolution interfered. In July of 1776 Shippen was made Chief-Physician of the Continental Army, and in the following year was elected by the Provincial Congress Director-in-General of army hospitals. During the latter years of the war he returned to Philadelphia each winter, and delivered a course of lectures, shortened by the necessities of the case. Thus he was the first public teacher of midwifery in this country. He was ably seconded in his work by Dr. John Morgan (1735-1789),--also a pupil of Hunter and Monro, who received a prominent army appointment in 1775, but who, two years later, was unfortunately dismissed on charges{282} subsequently proved false. Shippen and Morgan were for some time the only professors in the Medical Department of the College of Philadelphia. In 1768 Kuhn--a pupil of Linnæus--was made Professor of Materia Medica and Botany; and Benjamin Bush, a year later, was given the Chair of Chemistry. The commencement of this institution occurred in 1768, when the degree of M.B. was given to seventeen graduates. In 1779 political reasons led to the abolition of the College of Philadelphia, the University of Pennsylvania taking its place. Ten years later the former institution was restored, and in 1791 the two institutions were united. The present Medical Department of the University of Pennsylvania is, therefore, the legitimate continuation of the first medical school in America. [Illustration: 0301] The Medical Department of King's College, New York, now Columbia College, was organized in 1767, by Clossey, an Irishman; Middleton, a Scotchman; James Smith, a graduate of Leyden; Tenant, an alumnus of Princeton College; and Bard, who was by far the most eminent of the group, a Philadelphian by birth, who had studied under the best masters in England. The Medical Department of Harvard University was organized in 1783. Most prominent in connection with it was Dr. John Warren, the first teacher of anatomy and surgery, and the founder of a family of eminent medical men, whose descendant, Dr. J. Collins Warren, is to-day an occupant of the chair of surgery in the same school. The Medical Department of Dartmouth College was organized in 1798 by Dr. Nathan Smith,--a man of great energy and unusual versatility. While these medical colleges were developing their strength the medical profession were not idle, and institutions and libraries sprang up in various places. The Pennsylvania Hospital, for instance, founded in 1762, is to be credited with the oldest medical library in this country, many{283} of its volumes having been selected especially for it by Louis, of Paris, and the famous Lettsom, of London. It now contains nearly fifteen thousand volumes. The library of the New York Hospital, not quite so large, was founded in 1776; that of the College of Physicians, in Philadelphia, in 1788. The profession of New Jersey organized the State Medical Society in 1765. In 1781 was founded the Massachusetts Medical Society. In 1787 arose the College of Physicians of Philadelphia. In 1789 the profession of Maryland organized the so-called Medical and Chirurgical Faculty of Maryland, constituting thereby the same organization as the societies of other States. Before the close of the century, Delaware, New Hampshire, and South Carolina had also organized societies. In the larger cities extensive hospitals were also founded,--the Pennsylvania Hospital, in Philadelphia, in 1751, inside of which the first clinical instruction in this country was given by Dr. Thomas Bond. The New York Hospital began in 1769, simultaneously with the organization of the Medical Department of King's College. The first insane-asylum in America was built at Williamsburgh, Va., in 1773, although the charter of the Pennsylvania Hospital, dated 1751, provided for the care of lunatics, though not at that time in a separate institution. [Illustration: 0304] The most conspicuous medical character of the century in American history was undoubtedly Benjamin Rush (1745-1813). He was one of Shippen's earliest students in anatomy, studied widely abroad, was a member of the Continental Congress, and one of the signers of the Declaration of Independence. After him is named Rush Medical College of Chicago. He was an extensive writer on a variety of subjects, not only professional, but political, philosophical, etc. He recognized but two kinds of remedies,--stimulants and depressants,--and held it to be the principal duty of the physician to decide as to which were most advisable in a given case. He called calomel the "Samson"{284} of the materia medica, and his opponents contended that he was right, since it had undoubtedly slain its thousands. As an accurate observer of disease, he was correct and exact, and his descriptions are to-day both classic and reliable. The study of practical anatomy lias always been carried on in this country under great disadvantages. At first only the bodies of executed criminals were sparingly furnished. In 1788, in New York, occurred the celebrated "doctor's mob," which attested the vehemence of public objection to dissection, and which for two days defied the control of all the authorities. Secret dissections had been practiced in Harvard College so early as 1771, but the practice was against the law even for sixty years later in Massachusetts. Physiology, as such, was not taught in any medical school in this country during the century, and experimental{285} physiology was practically unknown. Surgery was eagerly studied, especially during war times, and Dr. John Jones (1729-1791), of the King's College School, was, perhaps, the most eminent of the surgeons of his day. Others who vied with him were William Shippen, Jr., the first teacher of surgery in the College of Philadelphia; John Warren, of Boston; Richard Bayley, of Connecticut; Baynham, of Virginia; and McKnight, of New York. The position of midwifery during the earlier years of the country may be, perhaps, understood by the following extract from the _New York Weekly Post-Boy_, of July, 1745:-- "Last night died, in the prime of life, to the almost universal regret and sorrow of this city, Mr. John du Puy, M.D., man-midwife," etc. The first practitioner of obstetrics in New England was Dr. Lloyd (1723-1810), a pupil of Hunter and Smelley; while Dr. Shippen, in Philadelphia, endeavored to organize a school for the instruction of midwives, in which, however, he met with insuperable difficulties. The first attempt to regulate practice in colonial times was an act passed by the General Assembly of 1760, providing for at least a form of examination in physic and surgery, registration, etc. The first medical journal to appear in the United States appeared about 1790. It was entitled _A Journal of the Practice of Medicine and Surgery and Pharmacy in the Military Hospitals of France_, consisting merely of translations from the French journals of military medicine. The first real American medical journal was the _Medical Repository_, begun in 1797 and discontinued in 1824. The present century, now drawing to its close, saw in its earlier half the rise of a large number of American physicians and surgeons who have made their names illustrious for all time by their teachings, their writings, and their invention and originality. While it is, of course, invidious to{286} select names, the following certainly deserve honorable mention in this list, without the slightest disrespect or intentional slight to many others whose names must be omitted for want of space. John R. Cox (1773-1864), an early student of Benjamin Rush, filled the chair of Materia Medica and Pharmacy in the University of Pennsylvania, and published the _American Dispensatory_ in 1806. Caspar Wistar (1761-1818) was the author of a _System of Anatomy_,--held in great favor in his day as a text-book. Nathaniel Chapman (1780-1853) was Professor of Theory and Practice in the University of Pennsylvania until 1850. John Eberle held the similar chair of the Jefferson School from 1825-1831. The former wrote on _Materia Medica and Therapeutics_, the latter on the _Practice of Medicine_, both works being exceedingly popular. John W. Francis (1789-1861) taught{287} obstetrics in the College of Physicians and Surgeons from 1826-1830. Franklin Bache (1792-1864) was one of the authors of the _Dispensatory of the United States of America_, published in conjunction with George B. Wood, who was Professor of Materia Medica in the University of Pennsylvania, and who wrote also extensively on his chosen subject in monographs and large works. [Illustration: 0306] Robley Dunglison (1789-1869) taught for a number of years in the University of Virginia, but removed later to the Jefferson School in Philadelphia. He was a man of great industry and versatility, and wrote on a variety of subjects, his best-known work being his _Medical Dictionary._ [Illustration: 0307] W. E. Horner (1793-1853) taught anatomy and histology in the University of Pennsylvania, and will long be remembered for his researches in these branches. John W. Draper (1811-1882) made himself eminent as well by his researches in photography{288} and in general science, as by the publication of his treatise on _Human Physiology_, which first appeared in 1853. Better known as physiologist was John C. Dalton (18251889), whose text-book is to-day studied in many colleges and who first introduced the method of vivisectional classroom demonstrations in our own school here in Buffalo. Alonzo Clark (1807-1887) was one of the most eminent teachers of medicine that this country has produced. Austin Flint (1812-1886) was also a famous teacher of medicine in New York, who made his first reputation in the then small school in Buffalo. [Illustration: 0308] His text-book on _Practice_ is the most popular American work on the subject that has ever appeared, and is still in general use. William P. Dewees (1768-1841){289} was the author of a treatise upon _Diseases of Children_, which reached a tenth edition and which rivaled the similar treatise of John Forsyth Meigs. The best-known teacher of dermatology and venereal diseases was Freeman J. Bumstead (1826-1879), author of the most popular work upon the latter subject that has been issued from the medical press. He wras professor of these diseases at the College of Physicians in New York. His text-book vied with that produced by William H. Van Buren (1819-1883), who, in connection with Dr. Keyes (still living), wrote a treatise upon the _Surgical Diseases of the Genito-Urinary Organs_, including syphilis, which has been, since its appearance, exceedingly popular with the medical profession. Among the best-known neurologists and alienists of the century since Benjamin Rush wrote his _Inquiries and Observations upon Diseases of the Mind_ (1812){290} was Dr. Isaac Ray, who, in 1838. published a work upon the medical jurisprudence of insanity. [Illustration: 0309] Dr. Brigham ( 1798-1849) was superintendent of the Utica Insane-asylum for some years before his death; and Dr. Kirkbride, who died in 1883, had been superintendent of the Philadelphia Asylum for over forty years. Dr. John P. Gray followed Brigham as superintendent of the Utica Asylum, where he remained for thirty-two years, and founded the _Journal of Insanity_. The first independent writer upon diseases of the eye was Dr. Frick (1793-1870), of Maryland. As illustrating how little our present specialties were then separated, it is worth while to remark that Dr. Edward Delafield (1794-1875), who, in 1826. was Professor of Obstetrics and Diseases of Women and Children in the College of Physicians and Surgeons, New York, delivered at the same time a special course of lectures upon diseases of the eye. The first man in the United States to make these diseases his exclusive specialty was Dr. Williams (1822-1888), of Cincinnati. It would be very wrong, in this connection, to omit the mention of the name of Oliver Wendell Holmes, the genial "Autocrat of the Breakfast Table," but recently dead at a ripe old age, who used to say that he was "seventy years young." who was for a long time Professor of Anatomy at Harvard Medical College, but who was much more widely known and endeared to the English-speaking public by his beautiful poems and most attractive prose writings.--who, as author of the _Chambered Nautilus_, for instance, will be remembered so long as the English language has a literature and is read, he rendered a great service to the medical profession by first calling attention to the contagiousness of puerperal fever. Of his prose writings, his medical essays--entitled _Currents and Counter-currents_--make perhaps the most delightful reading. Not{291} a few Americans deserve special mention as surgeons and surgical teachers of eminence during the past hundred years. Without being invidious, there must, nevertheless, be mentioned John Collins Warren (1778-1856), first Professor of Anatomy and Surgery in the Harvard School, under whose auspices ether was first administered for the purpose of surgical anæsthesia, and who was the founder, in 1828, of the _Boston Medical and Surgical Journal_. He wrote an extensive treatise upon tumors, and, it is stated, first successfully tapped the pericardium. [Illustration: 0311] Philip S. Physick (1768-1837), a pupil of Hunter, has been spoken of as the "father of American surgery," which he taught in the University of Pennsylvania. He was a tremendous worker, but wrote very little. He employed animal ligatures made of buckskin. John Syng Dorsey (1783-1818) was a nephew of Physick; taught anatomy in{292} the University of Pennsylvania; wrote a treatise on surgery, which was the second surgical text-book published in this country, and was the first in the United States to tie the external iliac artery. He died at the age of thirty-five, at a time when he was giving promise of exceeding eminence. Nathan Smith taught in Dartmouth, Yale, and Bowdoin Colleges, and 'was considered the best man of his day in New England. [Illustration: 0312] To him is justly due the great honor of having performed the first rational and deliberate ovariotomy, which he did in 1809, his patient living for thirty-two years. The operation was performed without an anæsthetic, and considering the circumstances under which it was carried out has shed a lustre upon his name and brain which nothing can ever dim. By this performance he became practically the father of modern abdominal surgery, and to him Americans and{293} Europeans alike are delighted to render all the honor that is his due. Perhaps the most eminent surgeon of the country was Valentine Mott (1785-1865), a pupil of Cooper and Bell, who taught in the College of Physicians and Surgeons, New York, until 1840, and in the University Medical School until 1860. He was a man of exceeding boldness and brilliancy, whose operations were performed at a time when anaesthesia was unknown, or was in its infancy, and who probably did more work in the surgery of the vascular system than any other surgeon who has ever lived. He was the first to tie the arteria innominata,--in 1818. As Gross wrote of him, he had a record of one hundred and thirty-eight ligations of various large arteries,--a record probably never equaled. He was also the first to do a successful extirpation of the clavicle for tumor,--an operation which at that time was considered very formidable. Though not a great writer himself, he is best known among students as the translator and editor of Velpeau's large work upon operative surgery. Dr. George McClellan (1796-1847) was the founder of the Jefferson Medical School, and its first Professor of Surgery. He was followed later by Dr. Thomas D. Mutter, who left his surgical museum to the College of Physicians of Philadelphia and endowed a lectureship there. J. K. Rodger, of New York; John Rhea Barton, of Philadelphia; William Gibson, of Philadelphia; Gurdon Buck, of New York; Willard Parker, of New York; Frank H. Hamilton, of New York, who made his reputation while teaching in our Buffalo school, author of a most popular and valuable treatise upon fractures and dislocations; and Henry B. Sands, of New York, were men of greatest prominence during the middle and latter portion of the present century, each of whom has contributed in his way either to the science or to the literature of surgery. The most prominent figure in American surgery of the past forty{294} years was Samuel D. Gross, of Philadelphia, professor in the Jefferson School, to which he moved from Kentucky, where he laid the foundation for his attainments and reputation. [Illustration: 0314] He was an early writer upon surgical pathology and anatomy, but is best known for his elaborate _System of Surgery_, in two large volumes, which has survived several editions and is still most highly esteemed. Among others who ought to be mentioned are Nathan R. Smith, of Baltimore, the inventor of the anterior splint; Paul F. Eve, of Nashville; John T. Hodgen, of St. Louis; Daniel{295} Brainard, of Chicago, and his successor, Moses Gunn; Alden March, of Albany; Henry J. Bigelow, of Boston, who performed the first excision of the hip in this country, in 1852, and who invented the method of crushing and removing stone from the bladder at a single operation, known as litholapaxy; and D. Hayes Agnew, of Philadelphia, who finished, before his death, a large and elaborate treatise on surgery, in three thick volumes. Of obstetricians and gynaecologists America has had no lack, and, in fact, the United States may almost be said to be the first home of gynaecology. Dr. Bard was the first Professor of Midwifery in King's College, now Columbia, New York, and the author of the first work upon the subject published in this country. In Philadelphia, Dr. Thomas C. James (1756-1835) was the first distinct teacher of obstetrics, his chair falling later to Dewees, already mentioned, who wrote extensively on midwifery and the diseases of children and of women. The same chair in the University of Pennsylvania was filled later by Hugh L. Hodge (1796-1873), a man of great originality and independence, who published a most elaborate and beautiful work upon his branch, which will always remain a classic. Charles D. Meigs, professor in the Jefferson School, Philadelphia, was the first to direct attention to thrombosis as a cause of sudden death in childbirth. He wrote both on gynaecology and midwifery. Bedford, of Baltimore, was another popular teacher and writer, with whom deserves to be mentioned William H. By ford, of Chicago, who wrote on both obstetrics and gynaecology. Gynaecology owes much to the efforts of American schools and practitioners. The first successful attempt of McDowell's, already alluded to, was imitated by Nathan Smith in 1821; and during the next forty years thirty-six ovariotomies had been performed by eighteen different surgeons,{296} with a record of twenty-one recoveries. [Illustration: 0316] Probably the most prominent passed figure in American gynaecology is J. Marion Sims (1813-1883), born in the South, where he invented his well-known speculum in 1852, whose introduction marked an epoch in the treatment of the pelvic diseases of women. It was also in South Carolina, among poor negro patients, that he perfected his method of plastic operations in the vagina for the relief of vesical fistulæ, which he later demonstrated in Paris to the astonishment of incredulous Parisian surgeons, who had almost uniformly failed in their attempts, and which he later successfully and brilliantly performed in all the capitals of Europe, where, as in this country, he enjoyed the greatest reputation. He was the founder of the great Woman's Hospital in New York, in 1855, an institution from which has proceeded more good gynæcological teaching than from any similar institution in the world Other ovariotomists{297} and gynaecologists of great merit were John L. Atlee, and his brother Washington Atlee, of Pennsylvania; Dunlap, of Springfield, Ohio; Peaslee, of New York, who wrote the first American treatise on ovarian tumors; Kimball, of Lowell, Massachusetts; and D. H. Agnew, of Philadelphia, who is, perhaps, yet better known as a general surgeon because of his _magnum opus_,--his _Treatise on Surgery_, in three large volumes, already mentioned. [Illustration: 0317] After{298} this brief _résumé_ of the names and achievements of the best-known American physicians and surgeons no longer living, it remains only to say a few words with regard to the general character of their work and attainments. It certainly was the case, during the earlier and middle portions of this century, that men had much to gain, beside addition to their vernacular, by study in foreign countries. Edinburgh and London were, at first, the centres to which men flocked; during the middle of the century they gathered in Paris, attracted by such men as Broussais, Velpeau, and others; after which the tide of travel turned toward Germany, where the government does more for the education of medical men and the furnishing of distinct opportunities than is done in any other part of the world. But, thanks to the influence of the foreign schools and the receptivity and natural quickness of the American mind, we have reached a point in this country when it is no longer necessary for American students to visit the foreign centres for this purpose, advantageous as these may be in many respects. The only feature in which we are yet lacking is the matter of government aid and the government control of medical institutions, by which better opportunities may be afforded for pathological study. Aside from this, and the centralization of cases which government control permits, it may be said that the Americans are in all respects as good practitioners as--and in most respects better than--their foreign colleagues. They evince more of humanity, more of real interest and care in their patients, and more consideration for their comfort and welfare; while, in all that pertains to fertility of invention, to originality of performance, and accuracy of work, they, as a rule, excel. Divested of glamour, American surgery, both general and special, is ahead of most of that which one can see abroad, and the therapeutics of the American profession certainly surpass those of any other nationality. No one need feel, then, that it is necessary to go abroad for any{299} purpose, unless it may be that polish and wide range of general information that necessarily come from travel and observation among other nations and peoples. In practical medicine, then, as in practical living, America leads the world. CHAPTER XII. THE HISTORY OF ANÆSTHESIA. _Anaesthesia and Analgesia. Drugs Possessing Narcotic Properties in use since Prehistoric Times. Mandragora; Hemp; Hasheesh. Sulphuric Ether and the Men Concerned in its Introduction as an Anaesthetic--Long, Jackson, Wells, and Morton. Morton's First Public Demonstration of the Value of Ether. Morton Entitled to the Credit of its Introduction. Chloroform and Sir James Simpson. Cocaine and Karl Roller._ It is{300} not, perhaps, generally understood that we owe the term _anaesthesia_ and the adjective _anaesthetic_ to the genius of Dr. Oliver Wendell Holmes, who suggested their use to Dr. Morton. The term _anaesthesia_ is applied to the artificial loss or deprivation of all sensation, which may be either local or general. It should be distinguished from _analgesia_, which means simply freedom from pain, consciousness being retained. In this respect local anaesthesia is really local analgesia, although the terms are confused in this regard. Anaesthesia, in its present sense, is truly a modern discovery, which is to be credited to the United States. In its less restricted sense, however, it is a condition brought about by numerous drugs,--intoxicants, narcotics, etc.,--some of which have been more or less in use for centuries. Anaesthesia is also a condition which may be produced in the hypnotic sleep,--a fact well recognized by the ancients, although the attention of scientific men was scarcely drawn to the fact until the days of the notorious Mesmer. The substances which may produce loss of consciousness may be taken intentionally or unintentionally, and maybe taken into the stomach, beneath the skin, or, when gaseous, through the lungs, in which absorption of the same into the blood is very speedy. It is not at all unlikely that the curious effects ascribed to some of the ancient oracles were due{301} to the inhalation of gases arising from natural springs or produced from other sources. The most common source of narcotic drugs has always been the vegetable kingdom; and the peculiar effects of the juices or other ingredients of the poppy, henbane, deadly-nightshade, Indian hemp, mandragora, etc., have been sung in poetry, rehearsed in prose, and known from almost prehistoric time. Ulysses and his companions were stupefied by _nepenthe_; a draught of vinegar and myrrh, or gall, was offered to Christ upon the cross, as it often was to malefactors; and Herodotus speaks of a peculiar habit of the Scythians, who produced some stupefying vapor,--probably from the seed of the hemp. From Biblical times, at least, the most common narcotic seems to have been alcohol in some of its numerous combinations. Furthermore, the effect of hemlock has been celebrated since the days of Socrates, who was permitted to drink it in order to soothe himself during his last hour. Mandragora seems to have had a great reputation in times past,--so much so that it is probable that more than one substance was included under this term. Apuleius, who lived about a century later than Pliny, wrote: "If any one is to have a member mutilated, burned, or sawed, let him drink half an ounce of mandragora with wine, and let him sleep till the member is cut away, without any pain or sensation." Among the Chinese and the Indians similar drugs seem to have been in frequent use, especially the _bhang_, ordinarily known as _hasheesh_. In many parts of the East something of this kind was administered to condemned criminals, as well as those compelled to undergo rude operations. It is said, also, that mild intoxication was produced among the fanatics of the East for the purpose of firing them to the point of heroic deeds, as it is also said that among the Druids the practice prevailed of partially stupefying the novitiates before initiating them into the most sacred and secret rites of their cult. Guy{302} de Chauliac was almost the only surgical writer of previous centuries who has referred to agents for the relief of pain, although during and before his time it was customary to give something to those about to undergo torture, by which to deaden their sensibility; and, though in the fables of all lands and all times something has always figured to which was ascribed the power of making people oblivious to pain or to the peculiarities of their situation, it is very difficult to learn just what, if any, particular composition was referred to or deserved such mention. There is allusion to something of the kind in _Romeo and Juliet_; again, in _Cymbeline_; and in one of Middleton's tragedies, published in 1567, entitled _Women Beware Women_, occurs this passage:-- "I'll imitate the pities of old surgeons To this lost limb, who, ere they show their art, Cast one asleep, then cut the diseased part." Larrey, in his military campaigns, noticed the effect of cold in diminishing sensitiveness, and suggested that cold might be made a useful local anæsthetic. Many surgeons used to operate upon patients under the influence of alcoholic narcotization. It was in 1776 that Mesmer arrived in Paris and became the exponent of so-called "animal magnetism,"--later termed "mesmerism," now known as hypnotism,--under the influence of which he reduced to the state of unconsciousness of pain (i.e., analgesia, as well as the more complete condition, anæsthesia) a number of patients, who were operated upon without feeling the slightest suffering. But, in spite of the earnest attempts of humane surgeons in various parts of the world, no agent had been discovered which was proven safe and generally effectual, up to the time, for instance, of Velpeau, who in 1839 wrote: "To escape pain in surgical operations is a chimera which we are not permitted to look for in our time." The substance known as sulphuric ether has been known{303} since the thirteenth century, when, as it appears, Raymond Lulli made certain--perhaps ambiguous--references to it. In 1540 it was known as the sweet oil of vitriol. It was not called an ether until 1730, when Godfrey spoke of it as such. It was frequently referred to during the last century by various writers, and the first reference to its inhalation seems to have been published in 1795 by Pearson. In a work by Beddoes, on Factitious Airs, published at Bristol, in 1796, is a statement that "Ether in pectoral catarrh gives almost immediate relief, both to the oppression and pain in the chest." Beddoes also states that after inhaling two spoonfuls he soon fell asleep. Later it was in somewhat general use internally for mitigating the pains of colic. By 1812 it was often inhaled for experiment or diversion, its peculiar exhilarating effects being generally known. So it is, perhaps, not strange that so soon as it was definitely recommended for purposes of surgical anæsthesia, a number of claimants for the honor of its discovery should quickly arise. It was the same with nitrous-oxide gas, which had been knowrn for a number of years, and which was repeatedly used for the purpose of anæsthesia before the introduction of ether for the same purpose. Chloroform was discovered in the year 1831 by Guthrie, of Sackett's Harbor, New York, and about the same time by Soubeiran, in France, and Liebig, in Germany. But, although before the profession for sixteen years, it was not recommended for the same purpose as sulphuric ether until 1847, and then by Doctor--later, Sir--James Simpson. For all practical purposes we may limit further consideration of the history of anæsthesia to these three substances, and mainly to the consideration of the introduction and adoption of ether, which displaced nitrous oxide, preceded chloroform, and has held its own to the present day as the anaesthetic in most general use, although in{304} many respects inferior to chloroform. But the glamour of history pertains mostly to ether, because of the peculiar difficulties and incidents attending its production. For the honor of its discovery there are four claimants:--Crawford W. Long, of Danielsville, Ga.; Charles T. Jackson, of Plymouth, Mass.,--both physicians; Horace Wells, of Hartford, Vt., and William T. G. Morton, of Charleston, Mass.,--both dentists. It is only fair to each of these four men to consider briefly the merits of the claims made for each, while at the same time attributing the final success of the new agent to the happy accidents which permitted Morton to make a public demonstration of its power in the Massachusetts General Hospital, before such eminent men as Warren, Bigelow, and others, by whose influence and reputation the agent was at once received upon its merits. This was on the sixteenth of October, 1846,--a year which deserves to be memorable in the history of medicine. Crawford Long graduated, in 1839, from the medical department of the University of Pennsylvania, and settled in Jefferson, Georgia, where it seems to have been a common thing to have what was known as "ether frolics," during which the exhilarating effects of the inhalation of the drug were matters of common sport and amusement at various small gatherings. Long himself frequently inhaled the drug and often felt its benumbing effects. It is stated that it finally occurred to him to give it a trial in a surgical operation, and that, in May of 1842, he removed a small tumor from the neck of a patient thus anaesthetized and without any pain. Owing to the sparseness of the population and the lack of dissemination of medical knowledge in those days, no public report was made of these operations, which produced nothing more than local town-talk. A young student of Long's, named Wilhite, kept a negro boy under the influence of ether for some time, to Long's surprise. Long lived one hundred and thirty{305} miles from any railroad, and the first published account of his operations appeared in 1849, which was suggested by an account of Morton's work, which he had read in the editorials of the _Medical Examiner_ for December, 1846. Long died in 1878, the unfortunate controversy in which the four claimants already mentioned participated being not yet concluded. Nevertheless, there is every reason to think that he is entitled to the credit of having first anaesthetized a patient with sulphuric ether for the purpose of producing insensibility to pain. Horace Wells began the study of dentistry in 1834, in Boston, and later opened an office in Hartford, Connecticut. He seems to have been a young man of great ingenuity, continually making new instruments and devising new experiments. To him is to be credited the first operation ever performed without pain by the use of nitrous-oxide gas. In 1844 a Dr. Colton delivered a lecture in Hartford upon the subject of this gas. A young man who inhaled it, and became excited, ran against some furniture, badly bruising himself, but made no complaint of pain. Wells, noticing this, said to a by-stander that he believed that one, by inhaling a sufficient quantity, could have a tooth extracted or a leg amputated without pain. The following day he inhaled the gas himself and had a tooth extracted by a Dr. Higgs. Wells remained unconscious for a little while, and, on recovering consciousness, cried out: "A new era in tooth-pulling! It did not hurt me as much as the prick of a pin! It is the greatest discovery ever made!" He at once began the manufacture and use of the gas, which became quite general in that locality. His attention was also called to the action of the vapor of ether, which Dr. Marcy, a physician of Hartford, suggested to him to try as a substitute for gas; but Wells, finding it more difficult to administer, discontinued it and confined himself to the use of nitrous oxide. A month later Dr. Marcy gave{306} ether to a sailor for a small operation, the man feeling no pain. These experiences of Wells and Marcy occurred two years after Long's work with ether, each being in total ignorance of the experiments of the other. In 1845 Wells visited Boston for the purpose of introducing nitrous oxide as an anaesthetic, and called upon his fellow-dentist and old partner, Morton, among others. He was discouraged, with his lack of success, returned to Hartford, and continued the frequent use of gas for a couple of years longer, but met with no encouragement in introducing it for general surgical purposes, on account of prejudice and fear upon the part of physicians and surgeons. Wells died in January, 1848, a few days before the Medical Society of Paris passed a resolution that to him is due all the honor of having first discovered and successfully applied the use of vapors or gases whereby surgical operations could be performed without pain. There stands to-day in Hartford the monument erected by the city and the State, with the following inscription:-- "Horace Wells, who discovered anæsthesia, November, 1844." William T. G. Morton was born in 1819, and, after failing in business in Boston, in 1840 went to Baltimore and studied dentistry. In 1841 he entered the office of Horace Wells, above alluded to, as assistant, and in 1842 became his partner, after having introduced a new kind of solder for fixation of artificial teeth to gold plates. In 1843 this partnership was dissolved, Wells moving to Hartford, while Morton, in 1844, entered the office of Dr. C. P. Jackson as a medical student, matriculating in the Harvard School, but never graduating. After Wells's visit to Boston, during which he tried to introduce "laughing gas," Morton and he had numerous interviews, especially with regard to this gas. Morton was not well versed in chemistry, and sought the advice of his medical preceptor, Jackson, with regard to its manufacture. Asking why{307} Morton wished to make it and being told the reason, Jackson suggested the use of' sulphuric ether, just as Marcy had suggested its use to Wells, saying that it was easy to procure, safe in employment, and equally productive of results. He also stated that the students at Cambridge College often inhaled ether for amusement. [Illustration: 0327] On the evening of the same day, September 30, 1846, Morton administered ether for the extraction of a tooth, the patient stating that he had felt no pain. On the following day he visited the office of a well-known patent lawyer for the purpose of securing letters patent upon his supposed discovery. This lawyer, learning of Jackson's connection with the subject, took time to consider the matter, consulted with Jackson, and came to the conclusion that the patent must be a joint affair, neither one having exclusive right to claim it. But Jackson,{308} fearing the censure of the Massachusetts Medical Society should his name be connected with the patent, and Morton--as a dentist--having no such fine scruples, it was agreed that the patent should be made out in the names of both, but that Jackson was to at once assign his interest to Morton; in return for which he was to receive a ten per cent, commission. Meantime Morton called upon Warren, one of the surgeons in the Massachusetts General Hospital, who promised his co-operation and sent him an invitation to test his invention in the hospital on October 16. 1846. The clinic-room was filled when Morton placed the patient under the influence of his _letheon_, as he had named it; after which Warren removed a tumor from the neck of a young man, and as it appeared, without pain. [Illustration: 0329] Upon the following day another operation was performed upon a young woman, with the same happy result, while on November 7th an amputation was made, entirely painlessly. At this time Morton endeavored to disguise the odor of the substance he was using by aromatic oils. It was not until the staff of the Massachusetts General Hospital declined to use an agent whose composition was kept secret that Morton revealed publicly the fact that this was nothing but sulphuric ether disguised by aromatics. From a report of the Commissioner of Patents, published a little later, the following paragraph is taken, the report being in the nature of a commentary upon the discovery:-- It has been known for many years that the vapor of sulphuric ether, when freely inhaled, would intoxicate to the same extent as alcohol when taken into the stomach. The fact has stood, further, upon the pages of science for many years that the inhalation of sulphuric ether was productive of "temporary narcotic stimulant effects." After the issuance of letters patent Morton began selling office-rights, such being the custom then, as now, among the dental profession, who are much more commercial in{310} their proclivities than their brethren of the medical profession. The result was an almost endless litigation, with the development of the greatest personal animosity and rivalry between Jackson and Morton, as well as the friends and descendants of the other claimants. Morton wrecked his fortune and ruined his health in his efforts to get substantial recognition and remuneration from the United States Government; and the history of his repeated attempts to interest Congress and the various officials of the government, from the president down, is instructive, but far from pleasing, reading. In these attempts he practically failed, and died from an illness contracted through exposure, after maddening disappointment, although he had been the recipient of numerous honors and some small pecuniary recognition from societies and individuals. Morton died in 1868. In reviewing the history of his life and labors there is much to justify the inscription upon the monument erected to his memory at Mount Auburn Cemetery, Boston:-- "_Inventor and revealer of anæsthetic inhalation, before-whom in all time surgery was agony, and by whom pain in surgery was averted and annulled; since whom science has controlled pain_." Charles T. Jackson graduated at Harvard Medical College in 1829. after having led an already eventful career as geologist and mineralogist. He spent several years abroad, meeting many of the most distinguished men upon the Continent and displaying, in many ways, a great deal of scientific talent and mechanical ingenuity. In 1835 he opened, in Boston, the first laboratory for teaching analytical chemistry in the United States. A year later he was made State Geologist of Maine, and spent three years in this capacity. He also did a great deal of work upon the State geological surveys of Rhode Island, New Hampshire, and New York, while he was the first to call attention to the mineral resources of the southern shore of Lake Superior, where, in 1845. he opened up copper{311} and iron mines. In 1846 and 1847 he became deeply interested in the subject and discovery of anaesthesia, and after the successful introduction of ether by Morton, in the Massachusetts General Hospital, set up the claim that it was he who had suggested it to Morton. In a pamphlet, published a little later, he states: "In the year 1837 I discovered that ether-vapor was superior to alcohol as a remedy for the strangling and toxic effects of chlorine-gas after inhalations for that purpose in my laboratory." He then relates how he administered the vapor to himself for the relief of the irritation produced by inhaling chlorine, and describes his sensations upon going to sleep and awakening. This claim in its entirety was a great surprise to both Morton and Wells, and led to a most unseemly discussion, which degenerated into a downright professional fight. After the death of Wells, Jackson and Morton both claimed that nitrous-oxide gas was not an anaesthetic, and that insensibility to pain could not be produced by it, in consequence of which the use of the gas was quite discontinued. It became, then, simply a question of priority as to the administration of ether for relief of pain during surgical operations. Wells being dead, this brought Long into the conflict. Jackson visited Europe again, and presented his claim before numerous societies in such a way as to be recognized abroad as the discoverer of anaesthesia. The relative merits of the whole controversy appear to have been pretty well summed up in a memorial sent to the Senate and House of Representatives by several hundred members of the Massachusetts Medical Society, which contains the following paragraph:--"The undersigned hereby testify to your honorable bodies that, in their opinion, William T. G. Morton _first proved_ to the world that ether would produce insensibility to the pain of surgical operations, and that it could be used with safety. In their opinion, his fellow-men owe a debt to him for this knowledge." In{312} the Public Garden in Boston there has been erected a monument to the memory of the discoverer of ether, the donor being, at the time, unable to mention the individual to whom it should be dedicated. Upon one face is this inscription:-- "_To commemorate the discovery that the inhaling of ether causes insensibility to pain, first proven to the world at the Massachusetts General Hospital, in Boston, October, 1846_." Upon another face are these words:-- "_In gratitude for the relief of human suffering by the inhaling of ether a citizen of Boston has erected this monument, A.D. 1867_. _The gift of Thomas Lee_." Morton's untimely death, largely due to disappointment and, as he thought, to persecution, has been already mentioned. In 1873 Jackson's mind became deranged, and he died in an asylum in 1880. Sir James Paget has summed up the relative claims of our four contestants in an article entitled "Escape from Pain," published in the _Nineteenth Century_ for December, 1879. He says: "While Long waited and Wells turned back and Jackson was thinking, and those to whom they had talked were neither acting nor thinking, Morton, the practical man, went to work and worked resolutely. He gave ether successfully in severe surgical operations, he loudly proclaimed his deeds, and he compelled mankind to hear him." As Dr. Morton's son, Dr. W. J. Morton, of New York, says, when writing of his father's claim: "Men used steam to propel boats before Fulton, electricity to convey messages before Morse, vaccine-virus to avert small-pox before Jenner, and ether to annul pain before Morton." So much for ether. I have already stated that chloroform was discovered by Guthrie in 1831. But, though discovered in this country, it was first introduced as an anæsthetic agent in Scotland, by Simpson, who, in 1847, at the age of thirty-six, began to direct his attention to the discovery{313} of some means of alleviating pain during childbirth, having a very large obstetric practice. Simpson was not satisfied with sulphuric ether, because of its strong and disagreeable odor, and inquired of his friend Waldie, Master of Apothecaries' Hall, of Liverpool, if he knew of nothing likely to be a satisfactory substitute. Waldie, acquainted with the chemical composition of chloric ether, suggested that chloroform be prepared from it and used. Simpson experimented with this in 1847, and established its anaesthetic properties, which he made known through a paper read on November 10th of the same year. It was arranged that upon the 13th of the month a public test should be made at the Royal Infirmary; but Simpson, who was to administer the chloroform, was unavoidably detained. Accordingly the operation was performed as of yore, without an anaesthetic, and during its performance the patient died upon the table. Had this death taken place during the employment of chloroform, it would have been the death-blow of that substance as an anaesthetic. The first public trial took place two days later, the test proving a great success. Simpson goes down in history, then, not as the discoverer of anaesthesia, but as the one who introduced chloroform for anaesthetic purposes. He died in 1870, and upon his bust in Westminster Abbey is this inscription:-- "To whose genius and benevolence the world owes the blessings derived from the use of chloroform for the relief of suffering." It is a bit of most interesting medical history that after Simpson's announcement of his discovery he was violently and vehemently opposed by the Scottish clergy, who reviled him for endeavoring to relieve the pains of childbirth, basing their opposition upon the primeval curse: "In sorrow shalt thou bring forth children." And the beautiful ease with which Simpson refuted this childish sophistry must ever be memorable; for with one short argument he silenced his opponents and turned upon them the{314} ridicule of the entire profession. For he reminded them that the first operation recorded in history was performed under anaesthesia, since, when God created Eve from one of Adam's ribs, he "caused a deep sleep to fall upon Adam." Cocaine is now such a universally recognized local anaesthetic that there is the best of reason for referring to it here--the more so because it affords another opportunity to do honor to a discoverer who has rendered a most important service not only to our profession, but to the world in general. The principal active constituent of coca-leaves was discovered about 1860 by Niemann, and called by him cocaine. It is an alkaloid which combines with various acids in the formation of salts. It has the quality of benumbing raw and mucous surfaces, for which purpose it was applied first in 1862 by Schroff and in 1868 by Moreno. In 1880 Van Aurap hinted that this property might some day be utilized. Karl Koller logically concluded from what was known about it that this anaesthetic property could be taken advantage of for work about the eye, and made a series of experiments upon the lower animals, by which he established its efficiency and made a brilliant discovery. He reported his experiments to the Congress of German Oculists, at Heidelberg, in 1884. News of this was transmitted with great rapidity, and within a few weeks the substance was used all over the world. Its use spread rapidly to other branches of surgery, and cocaine local anaesthesia became quickly an accomplished fact. More time was required to point out its disagreeable possibilities, its toxic properties, and the like, but it now has an assured and most important place among anæsthetic agents, and has been of the greatest use to probably ten per cent, of the civilized world. To Koller is entirely due the credit of establishing its remarkable properties. The{315} writer makes no apology here for having introduced two distinct chapters,--one upon the history of antiseptic surgery, the other upon the history of anæsthesia. First of all, they are the two grandest medical discoveries of all time; and, secondly, they are of Anglo-Saxon origin,--the one British, the other American. To the introduction of anaesthetics and antiseptics is due a complete revolution of earlier methods, complete reversal of mortuary statistics, and the complete relief of pain during surgical operations; in other words, to these two discoveries the human race owes more of the prolongation of life and relief of suffering than can ever be estimated or formulated in words. What an everlasting disgrace it is that, while to the great murderers of mankind, men like Napoleon in modern times and his counterparts in all times, the world ever does honor, erects imposing monuments and writes volumes of encomiums and flattering histories, the men to whom the world is so vastly more indebted for all that pertains to life and comfort are scarcely ever mentioned save in medical history, while the world at large is even ignorant of their names. For this reason, if for none other, these chapters find an appropriate place in a work of this character. Those interested in a somewhat more elaborate presentation of this subject may find it in an anniversary address delivered by the writer on October 16, 1896 (the semicentennial of Morton's public demonstration), in the Medical School of the University of Buffalo, and published in the _Buffalo Medical Journal_ of November, 1896. CHAPTER XIII. THE HISTORY OF ANTISEPSIS. _Sepsis, Asepsis, and Antisepsis. The Germ-theory of Disease. Gay-Lussac's Researches. Schwann. Tyndall. Pasteur. Davaine. Lord Lister and his Epoch-making Revolution in Surgical Methods. Modifications of his Earlier Technique without Change in Underlying Principles, which Still Remain Unshaken. Changes Effected in Consequence. Comparison of Old and Modern Statistics._ Modern{316} surgery, and, in no small degree, modern treatment of all disease, have been so completely modified from previous methods by the introduction of the so-called antiseptic system that it seems to be only right to devote some time in such a work as this to a _résumé_ of the history of the doctrines and experiments which have led to the perfection, as it would seem, of modern methods. The adjective "septic" comes from the Greek word "sepsis," which is often transferred to the English, and which means "putrefaction," or that which is putrid, or undergoing decomposition. From this word are formed two others,--namely, "aseptic" and "antiseptic,"--the one implying the exclusion of all causes of putrefaction and complete freedom from it, the other referring to methods employed to antidote the effect or counteract the influence of the agencies which produce sepsis or destroy them while still within the living body. By general usage the term "antiseptic" has been construed as the more comprehensive; hence, the modern method is usually spoken of as "antiseptic surgery," and hence the title above: "The History of Antisepsis." The principle underlying the resort to antiseptic methods is summed up in the expression, now so generally received,--the "germ-theory" of disease. It refers, in general, to the so-called zymotic, or infectious, diseases, whose manifestations are protean, which are all communicable by one means{317} or another, but which are not all necessarily contagious; some of which, being not at all amenable to surgical treatment, are regarded as "medical" diseases, while others, which occur mostly in connection with surgical cases, or which lead to conditions requiring surgical relief, are usually spoken of as "surgical" diseases. As excellent and only too common examples of these zymotic diseases may be mentioned tetanus, erysipelas, puerperal fever, typhoid fever, and those varied conditions which are generally grouped under the term "blood poisoning." Those which most concern the surgeon, and those in which most remarkable relief has been obtained are erysipelas and the various forms of blood poisoning. These, in their varied manifestations, have, until recently, been literally the terror of surgeons, and in military hospitals, for instance, have been the cause of more deaths than have ever resulted from wounds directly upon the battle-field. In civil hospitals, as well as in general and private practice, the mortality from these diseases was, until twenty-five years ago, simply frightful; while frequently, and over wide areas of territory, endemics and epidemics of puerperal fever would result in the death of almost every lying-in woman. In consequence of this terrible death-rate surgeons were afraid to operate, and certain classes of operations, especially those on the abdomen and joints, were never performed, except under most exacting circumstances. But few of the present generation can actually realize the completeness of the changes brought about by the adoption of the germ-theory, and the practical effect of its use as a working basis for combating disease. While no intelligent student at present denies that the infectious diseases--of which the above named are but a very few--are the result of the introduction into the body, from without, of minute living organisms, for the most part vegetable,--thus constituting them in reality, as they are often called, _parasitic_ diseases,--but few are so familiar with{318} the history of modern discovery as to appreciate the basis upon which it has been demonstrated. The proof of the germ origin of disease is the legitimate outcome of the discovery of the actual causes of fermentation and putrefaction. Aside from the crude and often wild notions which have appeared here and there in literature of previous centuries, about the first accurate investigations bearing upon this subject were with reference to the cause of alcoholic fermentation. About the beginning of this century Appert published a monograph upon the Art of Preserving Animal and Vegetable Substances, which consisted in placing them in closely corked or stoppered bottles, and exposing these to the temperature of boiling water. Gay-Lussac, the celebrated chemist, noticed that so soon as these vessels were opened, particularly if much exposed to air, their contents began to at once ferment or putrefy. This led to investigations into the production of alcohol, and the antiseptic effect of pure oxygen-gas; from which he concluded that oxvgen is necessary at the commencement of the process, but not throughout its continuance. Some thirty years later, Schwann, by the use of the microscope, then reasonably developed, discovered in fermenting substances numerous very minute globular bodies, which had the power of reproduction, and which were present in juices or fluids undergoing alcoholic fermentation, but not in others, and which he concluded to be the exciting cause. Schwann also discovered that if, in vessels sealed by Appert's method, lie allowed air which had been previously heated to come in contact with the fluids, no change resulted; from which it was evident that it was something other than the gaseous elements of the air which provoked fermentation. Schwann's investigations were corroborated, in 1843, by Helmholtz. Schwann's results were contested by Liebig, one of the most eminent chemists of his time, who proposed a very different{319} theory, ascribing putrefaction to the absence of oxygen and to the upsetting of molecular arrangements. He believed that non-nitrogenous substances did not spontaneously undergo putrefaction when pure, but they must be brought into contact with some substance already undergoing change, which latter was called a _ferment_, and which converted the oxygen of the air into carbonic acid. According to him, the ferment was some material undergoing decomposition. The next researches on this subject were those of Schroeder and Dusch, in 1854 who studied the question whether filtration of air would prevent the fermentation of boiled fluids to which such filtered air might have access. The material used for filtration was cotton-wool; and they showed that air filtered through it was deprived of the agencies which produce fermentation. Then came Pasteur, who repeated the experiments of his predecessors and elaborated and confirmed them. He also found that it was not necessary to filter the air of its contained particles, but that if it were simply left undisturbed until these had settled by gravity, it might then be brought in contact with putrescible substances without causing any putrefaction. In 1870, in a lecture upon haze and dust, Tyndall demonstrated beautifully and in public the presence of countless particles in the air, as well as that these were the agencies operating to produce undesirable changes in organic substances. Both Pasteur and Tyndall, as well as others, showed, as did also Lister, that heat as well as filtration was sufficient to render these particles innocuous. As the result of these and numerous other experiments, by various observers, which there is no time here to recount, it was gradually and irrefutably established that the gases of the air, _per se_, are powerless to cause fermentation or putrefaction in boiled fluids or tissues, or in material germ-free when exposed. It was sufficient, in order to so purify{320} the air, to either previously heat it or filter it through cotton-wool or through fluids inimical to germ-life, while the boiling of organic material or its subjection to the boiling heat of water was sufficient to destroy all germ-activity in it at the time, or, as we say now, to sterilize it. In this way, and even before any minute and systematic study of bacteria,--i.e., before the inauguration of bacteriology as a separate department of scientific study,--it was practically established that the agencies which produce putrefactive changes or fermentation were minute particles which were ever present in almost every substance, and that by heat or something corresponding to filtration it was possible to remove them or destroy their activity. So much had been established without reference to the etiology of disease. In order now to study the germ-theory of disease as applied to man we must go back a little, neglecting the vagaries or the pure conjectures of the ancients, to the era of pure philosophic speculation,--perhaps to the days of Needham and Buffon.--to the middle of the previous century, when scientists and naturalists began to discuss the so-called spontaneous generation of life; for it is well known that fluids, like milk and others, abound with life after a few days of exposure; and it was supposed that the living organisms it contained had a spontaneous origin. This question of the spontaneous beginning of minute living forms was agitated for a century, or practically until Tyndall and Pasteur gave it its death-blow by their accurate and convincing demonstrations. There was no lark of experimentation, but there was lack of exact knowledge and of accurate deduction from facts observed. The bacteria--which at that time were usually spoken of as "monads" and "vibriones," because of their spontaneous motion--were found under varying circumstances, which, not being scientifically inquired into, led thinking men into a most perplexing condition{321} of mind. The two most ardent recent advocates of spontaneous generation were Bastian, of England, who wrote an elaborate treatise upon the subject, and Jeffries Wyman, of Cambridge, Mass., who gave it the benefit of all his influence. But, under the influence of blows dealt from the side of the physical laboratory by Tyndall, and from that of the biologists by Pasteur, the theory was weakened and effectually killed, so that to-day no one thinks of such a thing. On the contrary, life seems to be inevitably the gift of a preceding organism; and while the real origin of life is as unknown to-day as ever, there is not a single fact in the possession of scientists now justifying the view that life can have a spontaneous origin. Moreover the researches of Pasteur and others into alcoholic fermentation and the rôle played by the minute yeast-plant, and the early researches of Pasteur, Davaine, and Koch into the rôle of micro-organisms in producing disease in animals, and the scientific and elaborate study of bacteria and vegetable molds, inaugurated by Cohn and continued by many others, have as their legitimate outcome the creation of bacteriology as a science, and the establishment of the fact that the real condition in the so-called infectious diseases is one of fermentative or putrefactive alterations in the fluids and tissues of the living body, corresponding in minutiæ to the changes produced in saccharine fluids by the yeast-plant, or in decomposing animal or vegetable matter by the many known bacteria which are capable of producing such changes. To put it in another way, disease is simply an expression of the fact that these minute organisms, which are visible only under high powers of the microscope and which reproduce their kind with astonishing rapidity, gaining access to the surface or interior of the body, begin there to thrive and multiply, taking up from the living animal material for their own nourishment, thus robbing their host of that upon which his tissues must live, while at the same time, as the result of their activity, they produce{322} various substances which, so far as they are concerned, are excretory in nature, and many of which are extremely poisonous to the animal organism which harbors them. Such a disease as puerperal fever, for instance, is simply an expression of the fact that within the living human body there is going on active putrefactive action by which the internal cells are being destroyed. this destruction being progressive and often far-reaching; and that, as the result of their presence in the still living body, the noxious or toxic excretory materials of which they get rid are absorbed, in consequence of which such varying symptoms as nausea, fever, purging, vomiting, delirium, and many other symptoms are produced, the objective evidence of their local activity being the actual destruction of tissues, as is seen in cases of abscess, phlegmonous erysipelas, etc. The condition known everywhere as gangrene, when moist and offensive, is nothing but the putrefaction of tissues _en masse_ which are not yet detached or separated from the living body of which they but recently formed a living part. Experiments with organic material outside the body have amply demonstrated that such putrefactive processes can be checked by certain precautions--such as filtration of air, heat, etc. It remained for the genius of Lister to show how similar processes of putrefaction and exclusion of germs could be made serviceable for the prevention of disease in the human race. To Lister, then, is due the credit of having originated the antiseptic system and brought about a condition long yearned for by surgeons throughout the world, but never previously attained. What a revolution he wrought by his masterly researches can be appreciated only when one compares the impunity with which surgeons now perform operations which, in the previous era were regarded as absolutley unjustifiable--a conclusion amply warranted by the statistics of that era. Great as the credit due to Lister, it is equally desirable to state that his work was, for the most part, based upon Lister's, the{323} researches of Tyndall, Pasteur, and Koch, which had established the germ nature of the terrible infectious diseases and the germicidal effect of filtration, of heat, and of certain other substances and methods which permitted of the development of his own system. [Illustration: 0343] The antiseptic method, as it has since been known, was naturally at first crude, although its scientific basis has never been shaken; and that it has been since, in large measure, modified, and that surgeons now resort to little, if any, of the paraphernalia which first made it such a formal proceeding, in no regard shake the scientific nature of its foundation, but rather have tended ever to corroborate it and establish it more and more firmly. Lister began with the supposition that the air contains the germs which are most active and pernicious in producing disease. It has been since learned that air-contact is, perhaps, least of all to{324} be dreaded. We, however, recognize the germs as always the efficient agents, though we have since learned that other sources of contamination are much more to be dreaded than air. It had been the custom, up to Lister's time, to observe usually the ordinary forms of cleanliness, but, not appreciating the multitude of germs which lurk in and about the skin, it had not been customary to scour and prepare it as we have learned to do since Lister's day. The ligatures and instruments which were used and the dressings which were applied, as well as the sponges used during the operation, usually went through the ordinary forms of cleansing; and yet Lister's investigations showed the utter inadequacy of such preparation. His most important object-lesson, however, was that everything that came in contact with fresh or bleeding tissues might carry infectious material (i.e., germs), unless it had itself been thoroughly freed from their presence. Accordingly, the system taught the accurate preparation of everything.--from the skin of the patient, which was to be carefully cleansed and shaven, to the hands of the operator, which were to be scrupulously scrubbed, as well as those of every assistant who might handle or touch any of the instruments or dressing materials. It included, also, the careful preparation of sponges, sutures, and ligature materials, all of which were kept protected from air-contact and in antiseptic solutions until the moment of their use. The dressing materials were impregnated with substances like carbolic acid, which had been proven to be germicidal; and impermeable material, like oiled silk, was used to cover the surgical dressing, in order that fluids which might leak through should not come in contact with the air, which might permit of their putrefaction, while, at the same time, air from without could have no access to the deeper parts thus protected. The original method of Lister was very elaborate, and included also the dissemination throughout the air of the operating-room{325} of a vapor of carbolic acid, which was disagreeable, sometimes almost fatal, to operators and bystanders alike,--its use being based upon the notion that the air was the substance most to be dreaded. The instruments were placed in strong antiseptic solutions, usually carbolic, which were pungent and irritating to the hands of all that came in contact with them. So thoroughly and ubiquitously were antiseptic materials employed that it was soon learned that they were of themselves rather injurious to the best interests of the patients upon whom they were employed. Their use, of course, was contingent upon the notion, then everywhere prevalent, that powerful substances must be used in order to counteract the activity of the much-dreaded germs. In the course of time, however, it was learned that the air was not so much to be dreaded as had been supposed, and that even if it came in contact with raw tissues infection did not certainly follow. It was found also that the antiseptic solutions which had been so freely used for irrigating or drenching the parts during an operation were by no means essential, and that tissues often healed better which had not been subjected to so much irritation. It was learned further that it was not necessary to impregnate dressings with these same solutions, providing, in the first place, they were carefully sterilized by the application of heat, which in time came to be used for the purpose of sterilizing everything not injuriously affected by it. In consequence, then, all dressing material, silk ligatures, instruments, nail-brushes, etc., were subjected to live steam or to boiling water for twenty minutes or more, which was demonstrated to be completely effective in the destruction of all organic or bacterial life. This, of itself, was a very great simplification of the antiseptic method. It was also demonstrated that the vital fluids of the animal body had of themselves great germicidal power, and that the strong antiseptic fluids previously used tended rather to impair{326} this power than to enhance it. Accordingly, fluids for irrigation came to be used only when there was some noxious material to be washed away. It was found that fresh wounds healed most kindly when least irritated by applications of any kind, providing only that nothing came in contact with them which could infect them. And, in this way, as well as by resort to simpler rather than complicated procedures, there was gradually substituted for the so-called _anti_septic method that which is now everywhere recognized, and always practiced, when possible,--i.e., the aseptic method. This simply means that it is very much better to exclude germs than to permit of their access and then try to kill them after they have lodged. The aseptic method is, therefore, now in vogue, and among the best operators always the so-called _dry_ method of operating, which means that, so far as possible, nothing not absolutely needed at the moment should come in contact with the field of operation. This has been, in many respects, a great advance over the older antiseptic method, though based upon absolutely the same recognition of causes, being only an improvement in technique. The benefits of Lister's studies, and of that which has grown out of them, are simply incalculable. The surgical infections which, thirty years ago, were the dread of all operating surgeons, have practically disappeared from civil and military hospitals. I esteem myself fortunate in this,--that I have been a living witness of the benefit of change from the old to the new, since when I began my work, in 1876 (over twenty years ago), as a hospital _interne_, in one of the largest hospitals in this country, it happened that during my first winter's experience,--with but one or two exceptions,--every patient operated upon in that hospital, and that by men who were esteemed the peers of any one in their day, died of blood poisoning, while I myself nearly perished from the same disease. This was in an absolutely new building, where expenditure had been lavish; one whose{327} walls were not reeking with germs, as is the case yet in many of the old and well-established institutions. With the introduction of the antiseptic method, during the two years following, this frightful mortality was reduced to the average of the day, and in the same institution to-day is done as good work as that seen anywhere. The same was true without exception in the great hospitals of the Old World; and in Paris, where, thirty years ago, famous surgeons would go from one end of the building to the other, handling one patient after another without ever washing their hands, and where erysipelas and contagion of various kinds were thoroughly distributed, as it were, impartially, now the successors of these very same men, employing modern methods, get results which challenge comparison. The world has seen few extensive wars since the introduction of the antiseptic system; but, in such as have occurred, its incalculable value in military hospitals has been amply demonstrated. The modern soldier is now taught how to make a prompt occlusive and antiseptic dressing of the wound which he may receive upon the battle-field, which, from the moment of its attention, continues to be treated according to the same enlightened method after he reaches the field-hospital, or when sent to the rear; so that men now receive extensive injuries to joints and to viscera, which previously were either promptly fatal, or fatal within a few days from erysipelas and hospital gangrene, from which they recover with useful--often with nearly perfect--limb or function of part restored. The military hospital of to-day is, therefore, robbed of the terrors which used to make it almost a charnel-house; hospital gangrene, the special dread of active army-surgeons in time past, has almost disappeared from the category of known diseases, and one of the greatest dangers menacing the modern soldier has been removed from modern civilized life. The method has met with universal adoption among all{328} civilized races and peoples, and all this through the energy and talent of the originator, now Sir Joseph Lister. With the recognition of the germ nature of so many acute diseases has come also systematic study of the use of antiseptics internally; and, while no such exceeding satisfaction has resulted from labors in this direction, we have, nevertheless, learned that most of the infectious diseases of the alimentary canal--for example, cholera, typhoid, etc.--are well attacked by means of antiseptics administered internally; that many of the conditions that depress and annoy are due to the presence of germs in the alimentary canal and the urinary system, and are best combated by means which shall remove these agencies, if not destroy them. It has been learned, also, that many forms of skin disease are parasitic, and that these are only successfully treated by the employment of antiseptics externally. And so the recognition of the germ nature of infectious diseases and the germicidal properties of certain substances, now spoken of as antiseptics, have kept pace, the one with the other; and in consequence the world has reached a period in its medical history never even dreamed of by our forefathers, when the infectious diseases have been shown to be practically preventable and, to a large extent, curable by the employment of drugs directed especially against their exciting cause. What the years to come may have in the way of further discovery in this direction, we may not foresee. So far as one can at present see ahead, the next advances must be in the direction either of means which shall fortify the human organism against the inroads of bacteria, or disease-germs, or else in the discovery of substances, such as we do not yet know, which shall be at the same time poisonous to the germs and innocuous to the patient, to whom they may be administered in doses sufficient for their purpose. Any material possessing these properties would be an ideal antiseptic for internal purposes. At present we only approach our ideal, but are very{329} far from its active realization. In no way would mankind be more greatly benefited than by the prosecution of studies which may lead to satisfactory results in either of these directions. CHAPTER XIV. AN EPITOME OF THE HISTORY OF DENTISTRY. _Rude Dentistry of Prehistoric Times. Early Instruments for Extraction Made of Lead. Dentistry on the Same Low Plane as Medicine during the First Half of the Christian Era. Dentistry Taught at the School of Salernum. Progress of the Art on the Continent. Prosthesis and Substitutes for Human Teeth. Introduction of Porcelain for Artificial Teeth; of Metal and of Vulcanized Rubber for Plates; of Plaster for Impressions. From being a Trade, Dentistry is now a Profession, in which Americans lead the World. Statistics._ The{330} following is a _synopsis of an address_ delivered at the opening of the session of the Dental Department of the University of Buffalo, in October, 1895. It is appended here because it is certainly apropos of the topics herein considered, the colloquial form being retained. Called upon at short notice to welcome you here, and to offer remarks of general professional interest, it occurs to me to be retrospective for awhile and to consider the steps by which that which was once an exceedingly crude art has been developed until now it is an exact science. In other words, I would invite your attention, for a time, to the history of dentistry. At a time even before our combined art and science had a definite history we find that gold was used among the Egyptians for the purpose both of filling teeth and of supporting and directing them. In the bodies of many Egyptian mummies, especially of the higher class, there have been found teeth filled with gold or with wood which was covered with gold. It is known, also, that the Hindoos and Egyptians inserted artificial teeth and that some of these were made of wood, often covered with gold, and held in place by gold or silver bands and wires. Herodotus, who traveled so extensively in Egypt and wrote most entertainingly of his travels, has noted the division of medicine among the Egyptians into special branches and the existence of physicians, each of whom{331} applied himself to one disease and not to more. "Some," said he, "are for the eyes, others for the head, _others for the teeth_, and others for internal disorders." It is known, also, that about 300 B.C. Erasistratus deposited in the temple of the Delphian Apollo an _odontogogue_, or tooth-forceps, made of _lead_, intimating thereby that only those teeth should be drawn which were loose enough to be extracted with such an instrument. Celsus, who was a contemporary of Christ and of Cæsar, was the first to recommend the use of a file within the mouth for the purpose of removing irritating edges and points of teeth. He also recommended bursting hollow teeth by putting into them pepper-corns, which should absorb moisture, swell, and thus break the teeth in pieces. He also recommended to take particular pains to try to shake or manipulate teeth loose before extracting them. Galen, about 150 A.D., taught that teeth were true bones and that the canine teeth should be called "eye" teeth, because they were supplied by a branch of the optic nerve. Aëtius, 300 A.D., apparently discovered the foramina at the roots of the teeth through which the nerves enter. In Rome false teeth and sets of teeth constructed of ivory and fastened with gold wire existed as early as the Laws of the XII Tables, and before the days of Roman civilization it is known that the Etruscans were skilled in manipulation of gold within the mouth, while your dean has described and has, I believe, in his possession beautiful examples of Etruscan work of this kind. Among the Arabs, after the Arabian domination of the then civilized world, attention was paid to the teeth, although this was considered a very inferior part of the physician's work. Among these Arabians much later, and in spite of their study of Greek writers and their translations from the Greek, there may still be met such passages as{332} this from Garriopontus, 1045 A.D.: "On the island of Delphi a painful molar tooth, which was extracted by an inexperienced physician, occasioned the death of a philosopher, for the marrow of the tooth, which originates from the brain, ran down into the lungs and killed that philosopher." For all that I know, this is the first record of a death after extraction of a tooth. Albucassis, 1100 A.D., gave directions for replacing lost teeth by natural or ivory substitutes. For centuries extraction of teeth had been and was considered a critical and dangerous operation, although itinerant quacks drew them without hesitation. The Roman poets and satirists made many allusions, in their day, to the teeth and to operations performed upon them. During the Middle Ages the most celebrated medical school that the world ever saw was founded at Saleraum, and was for several centuries the headquarters to which resorted men who desired to study medicine and patients from all parts of the world who desired to be cured of various diseases. It was a favorite stopping-place for crusaders on their way to and from the Orient, and history relates many interesting episodes pertaining to such visits. Under the influence of this school dentistry was more or less cultivated by those who practiced surgery. Bruno, of Langoburo (about 1250), mentions various operations upon the teeth and the antrum, although that was nearly four hundred years before Highmore carefully described this cavity. Johannes Arculanus (Giovanni d'Arcoli), in the fifteenth century, filled teeth with gold. I must digress for a moment to speak of another suggestion of Arculanus's. You know that quite recently the use of the magnet has once more come into vogue among oculists for the removal of foreign particles of iron or steel from the anterior chamber or the globe of the eye. It was Arculanus who, some five hundred years ago, suggested extraction of iron splinters from the eye by means of the _attraction of amber electrified by friction_. (For School of Salernum{333} see page 72.) During the sixteenth and seventeenth centuries the French surgeons, especially Dionis and Verduc, made many practical contributions to dentistry. In 1728 Fauchard wrote in Paris the first complete work on dentistry,--_Le Chirurgien Dentiste, ou Traité des Dents_. Auzebi, of Lyons, wrote another. Le Cluse first mentioned the English turnkey for extraction. Jourdain introduced a number of new and appropriate instruments and new forms of artificial teeth. Bourdet, dentist to the king, made artificial palates. Porcelain teeth were first introduced in France in 1774. Among the Germans cosmetic dentistry, though still the favorite field of charlatans, was greatly cultivated. Serré wrote a treatise on _Toothache in the Fair Sex During Pregnancy_, but the first public dental clinic in Germany was not established until 1855, by Professor Albrecht, and in Vienna. It has been in Vienna, among the Germans, that dentistry has been in time past most honored, and was taught when it was scarcely recognized in the other German universities. Private dental institutions were also first established in Vienna. Of all the tooth-extracting instruments, the dental forceps in crude form is the earliest, the first on record, perhaps, being that deposited by Erasistratus in the Delphian temple, as already mentioned. For hundreds of years these instruments scarcely changed in shape. It was Garengeot who invented the _key_, early during the last century. Before that, and for awhile, dentists who had abandoned the forceps used an instrument known as _the pelican_,--said to much resemble the skid used by lumbermen. Before artificial (porcelain) teeth came into use the following substitutes were employed, their estimated value being in accordance with the order in which I name them: Human{334} teeth, animal teeth, hippopotamus tusk and teeth, elephant-ivory, and bone. _Human Teeth_.--Transplantation of teeth was at one time very common. After being inserted, they were held in place by pivots and ligatures, springs, and upon bases. The pivot method also included the use of screws. Ligatures for fastening teeth were made of silk-worm gut,--which, now so common in surgery, was used for this purpose, perhaps, two hundred years ago,--of gold wire, etc. The method by ligatures is the earliest of all. Human teeth have always been more or less expensive if fresh, few people being willing to part with sound teeth except for a money consideration. In 1784 a Philadelphia dentist offered, in an advertisement, two guineas each for sound front teeth. _Animal Teeth_.--These were largely used, being held in place the same way as above, the principal objection being that it was difficult, often impossible, to match human with animal teeth. It was found, also, that the latter decayed very much more easily. _Hippopotamus-ivory_.--This was at one time very extensively used. It was carved into the shape of the missing teeth, and was held upon a base; or it was carved into shape as a base upon which to rest human teeth. Most often it was used as a base for pivoting. Not infrequently a block was carved out which represented gum, teeth, and all, and partial dentures of this complex type were often so deftly fashioned as to be very realistic, the part representing the gum being colored. Unfortunately no dye nor color in the mouth could be made permanent. _Elephant-ivory_.--This was used for the cheaper grades of work, being less durable. _Bone_.--Bone was still more objectionable, and was used for only the cheapest work. Artificial porcelain teeth were first introduced in France in 1774 and in America in 1817. Those which were first made{335} were so large, awkward, rough, and ill-fashioned, without attempt to represent the gum, as to bear no comparison to the artistic products of to-day. They were intended for the most part for attachment to ivory bases. The artificial dentures made for George Washington were of this general character, and, although they called forth his encomiums in a letter to his dentist expressing his gratitude, they would pass for very shabby productions today. One of the greatest advances in dentistry was the introduction of gold bases as a substitute for the baseplates previously made of ivory or bone. This is distinctly an American invention, and is to be credited to Gardette, of Philadelphia, who produced the first bases of this kind in 1787. Since then other metals have been used only because cheaper, none having the valuable properties of gold. Gutta-percha was introduced for this and various dental purposes in England, in 1851, by Trueman. In 1851, too, came Goodyear's process of vulcanizing, which the dental profession were at first slow to avail themselves of, but which led, as its value was recognized later, to expensive and almost endless litigation. Another most valuable American invention was that of taking impressions by the use of plaster. This was introduced about 1844-'45. This method permitted the making of socket-plates, which, of itself, was a long step in advance. So much for a very brief epitome of some of the most interesting facts in the history of dentistry. Did time permit, the matter would warrant treatment at much greater length. But what now is to be said of the condition of dentistry to-day? First of all, that it is no longer relegated to charlatans and itinerants, but is studied, practiced, and honored by men of the ablest minds and of the highest type. There is to-day scarcely any branch of applied science which calls for greater qualifications or for greater combination{336} of mental endowment and manual dexterity than does dentistry. We, in New York, find ourselves now in position where the State has assumed not only to regulate the practice of dentistry, but even to pass upon the qualifications of those who propose to study it. In the assumption of this task by the State there is paid, perhaps, the greatest possible compliment to its dignity and to its importance. The great field of medicine is now altogether too vast, and the various branches which pertain to it are too complex, to permit a mastery of all its details by any one mind. The man does not live who to-day can be considered _facile princeps_ in more than a few departments of medicine. Life is too short to permit of it, and the study is altogether too extensive. There is also a growing public demand for specialization of work, and there is probably more excuse for the perpetuation of dentistry as a specialty than for almost any other branch. Nevertheless, it is necessary constantly to repress a tendency toward a failure to comprehend the general principles underlying all medical specialties, and it has been hard, at least until recently, to impress upon the men of the dental profession that they were really only practicing a branch of medicine, and that, in disregarding a general and comprehensive knowledge of the fundamental branches, they were but poorly preparing themselves for the practice of a dignified specialty. Certainly dentistry makes as many demands for mechanical training, digital dexterity, familiarity with the properties of materials, etc., as does. surgery, and in some respects even more. Of course, to a certain extent in these respects it is like a mechanical trade. The great trouble with the dental profession, until very recent times, is that they have regarded their work too much as a trade and not enough as a profession. By taking the latter view of it the work is ennobled and their interest for it cultivated. By taking the trade view of it they have lost those finer features which{337} lift mechanical work out of the mere level of a trade. Moreover, men in time past have been guilty of altogether too much trades-union tactics, which are vehemently opposed to professional ethics, and this has been another feature to degrade rather than elevate dentistry. This has been indeed a great misfortune, for men have been misled by the need for cultivation of their hands, or their manual powers, and have been persuaded away from a finer study of fundamental principles upon which the whole practice of dentistry should be based. And so it has happened that men have been so ambitious to become perfect operators that they have neglected anatomy, physiology, chemistry, and pathology, have even neglected odontology, sacrificing everything else to their work as mere artificers. If one scrutinizes the subject properly, there is no reason why there should not grow up a class of men fitted to attend to any lesion of the mouth or of the parts adjoining. In other words, there is no reason why there is not more excuse for true oral surgeons than there is for any other class of specialists, save possibly those who treat the eye. Aural surgery, nasal surgery, pelvic surgery, rectal surgery, etc., are simply voluntary limitations and applications of general surgery to special parts; but he who attends to the teeth has to do so much work of a character which the surgeon is not called upon to perform in any other area, that I have always claimed the oral surgeon deserved a place, as he had a field, by himself. Nevertheless, the knowledge which shall fit a man for such work is not to be obtained in the ordinary dental course, nor in three years of study, even under the best of auspices. The man who would be an ideal oral surgeon must be not only generally familiar with anatomy and physiology, but must thoroughly know the embryology of the face and teeth, the physiology not alone of the organs of the mouth, but of all the secreting glands and the chemistry of all their secretions;{338} not only the anatomy of the cranium, but general anatomy as well, and even comparative anatomy. He must be well informed in the explanations of all the congenital defects met about the face and mouth; he must be familiar not only with the ordinary principles of pathology and bacteriology, but he will find in the fluids about the mouth such a fertile opportunity for bacteriological study that, be he ever so expert or erudite, he has still much left to investigate in this direction. There is no disease-germ with which he can afford to be unfamiliar, and, as any form of tumor may be found in or about the mouth, he should be familiar with the entire subject of tumors and their surgical treatment. Then, again, he must be familiar not only with the physical properties of metals and the various materials used in plastic dentistry, nor expert alone in the operations about the teeth, but, inasmuch as he has to cope with various wounds, injuries, and operations about the soft parts, he must be thoroughly familiar with the principles of wound-healing; with the causes of sepsis and the agents which produce it, and the means of avoiding it; in other words, he must have a general training in operative surgery, and, according to my ideal, which may be high, he should be a man able to do almost any operation in surgery before he limits himself to surgery of the mouth. Unless he have this ability, he will not do such operation as well as a general surgeon can, because the underlying principles are the same, and the latter will have the greater command over them. When, then, this perhaps ideal man has become thoroughly familiar with the principles of surgical anatomy, operative surgery, surgical pathology, and bacteriology, in addition to the things already mentioned, then, and not until then, may he and should he assume to operate for harelip, cleft palate, cancer of the tongue, and various other lesions in the parts about the mouth. I{339} wish I could say and demonstrate more to impress upon you the important bearing of modern surgical pathology to dentistry. Perhaps I can give you no better illustrations than you can see in the studies and writings of Prof. W. D. Miller, of Berlin, of whom I am proud to say that he is an American, and that he is the only American occupying a professorship in a German university. In his studies on the causes of dental caries and upon the bacteria of the mouth he has identified and named nearly a hundred species of the bacteria, many of which he has shown to be the active causes of dental decay. He has done, then, for dental pathology in this direction what other eminent observers have done for the processes of suppuration and ulceration in other textures and tissues, and has helped to show that they are all evidences of pernicious germ activity. By his researches, also, upon inflammation in elephant-tusks, and the results of injury, mainly by bullet wounds, he has shown us that the phenomena attending these changes in dental tissues are practically identical with those in bone. His researches have done very much to explain the pathology of that common disease, pyorrhoea alveolaris, which is known to be but one expression of local infection, while the possibility of migration of infectious organisms and of metastatic lesions in other parts of the body, having their origin in infectious disease in or near the teeth, has been brilliantly demonstrated by his interpretation of well-known clinical facts. That American dentists are most highly regarded abroad is more than a matter of every-day knowledge. It has got to be so now that a foreigner will purchase instruments of American make, and then advertise himself as an American dentist for the purpose of getting business,--a purpose in which, as a rule, he is quite successful. But let me stop here to do honor to another American dentist who is more highly honored abroad than one ever can be at home, and of whom it might be said, perhaps, that{340} he has had more friends among the royalty and nobility of Europe than any other man of his time. This is Dr. Evans, who has lived for years in Paris, who was the personal friend of Napoleon III and the trusted guide and companion of the Empress Eugenie when she fled from Paris. While it may be said of him that the qualities that made him so universally popular were personal qualities, rather than professional knowledge, it must be said in reply that it was his eminent professional attainment which first brought him such influential friends. But time presses, and I want, before closing, to say a little about dentistry in America. It was about 1835 that Dr. Harris, then residing in Baltimore, though born near Syracuse, conceived the modern idea of the scope and practice of dentistry. He was ambitious to put the dentists of his time upon a higher professional level, and to make of dentistry a specialty in medicine. He applied to various medical schools to found dental chairs, and to teach oral pathology along with dental mechanics, as one of the branches of medicine, the graduating degree to be M.D., as with other medical specialties. But the men of his time were so short-sighted and of such constricted mental calibre, and the dentists were so uneducated, that the Baltimore schools declined. He therefore established a separate school, being forced to take this step. This school was the Baltimore College of Dental Surgery, established in 1839,--the first in any country. The dentistry of that day was crude, and its teaching was comparatively inefficient. It was not until six years later that the next, the Cincinnati College of Dental Surgery was organized,--in 1845. Then, in time, followed Philadelphia. But all these colleges were separate institutions, teaching only those branches which it was held necessary that a _dentist_ should know and having very little of medicine in their curriculum. They conferred the degree of D.D.S. In 1868 Harvard University did what she ought to have{341} done at the outset. She opened a dental department and began the teaching of dentistry as a branch of medicine, establishing therefor a separate degree,--D.M.D.,--_Den-tarioe Meclicince_ Doctor. In 1874 the University of Michigan established a dental department, and a little later the University of Pennsylvania did the same. These university schools gave an immensely widened scope to the study, which was made broader with each succeeding year. There are now forty-five dental colleges in the United States. Forty of these are members of the National Association of Dental Faculties, organized for the purpose of securing uniformity in teaching and in graduating men. Membership in this association is a certificate of high standing and of comprehensive advantages. Last year (1894) the number of students in dental colleges was 4979, while the number of graduates was 1208. At present nearly all the States have legislation governing the practice of dentistry, and often more strict than that regulating the practice of medicine. In New York the law places dentistry on precisely the same plane as medicine,--prescribes the same qualifications for matriculation, the same length of study, exactions for graduation, examination, etc. In other words, the law is quite as strict regarding admission to dental colleges as to medical. After 1897 at least a full high-school course will be demanded for matriculation, and from now on we may look forward to having a really educated dental profession. INDEX. Advances in other sciences, 153 Ægidius, 077 Æsclepiadæ, 011 Æsculapius, 007 Ætius, 049 Age of foundation, 012 Age of renovation, 012 Age of transition, 012 Agnew, D. Hayes, 295 Akenside, 213 Albiuus, 164 Albucassis, 063 Alchemists and charlatans, the, 187 Alchemy, 141 Alexander of Tralles, 050 Alexandria, library of, 031 school of, 032 Alkindus, 060 Ambulant physicians, 017 Amendment in medical affairs, 151 American teaching of to-dav, 298 Amphitheatres, dissecting, 111 Amussat, 269 Anæsthesia, history of, 300 Anatomic period, 012, 030 Anatomy and physiology of Galen, 039 Anatomy, chairs of, 111 Andral, 245 Andry, 177 Anel, 215 Animalculists, 183 Animism, 196 Animists, 183 Antiseptics, history of, 317 Antyllus, 051 Arabic period, 012, 057 review of the, 097 Archiaters, 053 Aretæus, 034 Argentier, John, 0146 Aristotle, 028 Arlt, 253 Arnold de Villeneuve, 088 Asclepiades of Bytlunia, 044 Aselli, 160 Astrology, 141 Astruc, 138, 214 Aubrey, 183 Auscultation, 262 Avenbrugger, Leopold, 210 Avenzoar, 064 Averroës, 064 Avicenna, 061 Bache, Franklin, 287 Baclitischua, 059 Bacon, Lord, 153 Bacon, Roger, 068 Baglivi, 162, 172 Baillie, 213, 224 Barba, 165 Barthez, 201 Bartholin, 161, 184 Barton, John Rhea, 293 Baseilliac, 214 Bayle, 245 Bell, Benjamin, 219 Bell, John, 219 Bell, Sir Charles, 219, 274 Bellini, 172 Benivieni, 114 Bernard, Claude. 247 Bernard the Provincial, 077 Bhang, 301 Bichat, 160, 162, 164, 208 Bienaise, 177 Bigelow, Henry J., 295 Bilguer, 215 Billroth, Theodor, 264 Blumenbach, 222 Boerhaave, 193 influence of, 168 Boerhaave's, clinics, 167 system of medicine, 194 theory of inflammation, 164 Bonnet, 270 Bordeu, 201 Borelli, 160, 172 Borri, 176 Botal, Leonard, 146 Boucliut, 259 Boyer, 267 Boylston, Dr., 279 Bouillaud, 244 Boulot, 177 Bourgeois, Louise, 166 Braid, Dr. James, 204 Braidism, 204 Brainard, Daniel, 295 Brasdor, 214 Brigham, 290 Brisseau, 178 Brissot, practice of bleeding by, 118 British surgeons, modern, 275 Brodie, Sir Benjamin, 273 Bronssais, 243 Brown, Dr. John, 200 Browne, Sir Thomas, 175 Brunner, 183 Brunonian doctrine, 205 Buck, Gurdon, 293 Bumstead, Freeman J., 289 Burking, 231 Cabalistic theory, 141 Cæsareau operation, 134 Camper, Peter, 219 Cardan, Jerome, 142 Cardinal powder, 165 Carion, Stellwag von, 253 Casserius, 162 Cataract, 178 Cathedral medical schools, 089 Cell, the term, 153 Cellular pathology, 256 Celsus, Cornelius, 036 Cesalpinus, 155 Chamberlain's obstetric forceps, 166 Chapman, Nathaniel, 286 Charitable institutions, ancient, 055 Chemical system of medicine, 169 Cheselden, 216 Cheyne, John, 248 Chinese, medicine of the, 005 Chiron, 007 Chloroform, discovery of, 303 Simpson's introduction, 313 Chopart, 314 Circulation, capillary, discovery of, 158 discovery of the, 155, 160 lesser, 112 failure to discover the, 113 Civiale, 269 Clark, Alonzo, 288 Classification of the history of medicine, 012 Clinical teaching, earliest systematic, 167 Cloquet, 269 Cnidus, Temple of Æsculapius at, 009 Cocaine, 314 Coction, doctrine of, 024 Colics, Abram, 248 Collot family of lithotomists, 177 Colonial physicians, 276 Columbus, 107, 155 Compass, invention of the, 099 Constantine the African, 074 Contrastimolo, 210 Cooper, Bransby, 273 Samuel, 273 Sir Astley, 271 Cornelius Agrippa, 139 Corpuscles of the blood, 158 Corvisart, 168 Cos, 019 Temple of Æsculapius at, 009 Cosmogony, Greek, 013 Countess's powder, 165 Cowper, 158, 182, 183 Cox, John R., 286 Crisis, doctrine of, 025 Cruveilhier, 245 Cullen, William, 198 Currie, 229 Czermak, 253 Dalton, John C., 288 Darwin, Charles, 237 Erasmus, 202 Daviel, 215 De Graaf, 183 De Haën, 200 De la Marche, Marguerite, 182 Delafield, Edward, 290 De Launay, 177 Delamotte, 166, 182 Delpech, 268 De Marque, 177 Denis, Jean Baptiste, 176 Denman, Thomas, 220 Dental surgery, the first college of, 341 Dentistry, ancient and mediaeval, 332 as a specialty of medicine, 337 in America, 341 of prehistoric times, 331 relation of, to modern surgical pathology, 340 Desault, P. J., 214, 267 Devanter, 166 Dewees, William P., 288 Diagnosis, exact methods in, 263 Dionis, Pierre, 177 Dissection, ceremonials previous to, 149 difficulties attending, 103 of human bodies, 32 Doctor's mob in New York, 284 Dodart, 172 Eberle, John, 286 Eclectics, 014, 046 Embalming, 003 Empedocles, 017 Empirics, 014 Engraving, 100 Engravings, first anatomical, 112 Epidanrus, Temple of Æsculapius at, 010 Erasistratus, 034 Erudite period, 013 Esquirol, 228 Ether, sulphuric, as an anæsthetic, 302 Eustachius, 107 Eve, Paul F., 291 Fabre, 164 Fabricius ab Aquapeiulente, 109 Fabricius Hildanus, 110, 178 Fallopius, 109 Faust, 100 Fermentation, the causes of, 319 Fernel, Jean, 115 Fidelis, on legal medicine, 167 Filkin, 217 First hospitals in United States, 283 First medical schools in the United States, 281 Flint, Austin, 288 Fothergill, John, 212 Francis, John W., 286 Frank, J. P., 212 Frère Come, 214 Frère Jacques, 177 Frick, 290 Fuchs, 253 Functions of the spinal nerves, discovery of the, 248 Gaddesden, John, 087 Galen, anatomy and physiology of, 039 Galen, Claudius, 036 Galen's, influence, 043 theories, 039 Gardiner, 199 Garengeot, 213 Gaub, 195 Gerard of Cremona, 090 Gerdy, 270 Germicides, internal use of, 329 Germ-theory of disease, 259 what it means, 323 Gibson, William, 263 Gilbert, of England, 087 Gimbernat, 215 Glisson, 163, 183 Goerter, 163 Goode, John Mason, 247 Goodwin, 160 Goursaud, 177 Graves, Robert, 248 Gray, John P., 290 Greece, medicine of, 016 Greek period, 012, 049 Gregory, 199 Griesinger, 254 Gross, Samuel P., 294 Guillemeau, Jacob, 131 Gunn, Moses, 295 Guthrie, 273 Guttenberg, 100 Guy de Chauliac, 093 Gymnasia, the, 018 Gymnasiarch, 018 Gymnast, 018 Hahn, 229 Hahnemann, 241 Haller, 160, 162, 163, 220 Ilaly-Abbas, 061 Hamilton, Frank H., 293 Harvey, Gideon, 175 J. William, 155 Hasheesh, 301 Hasner, 253 Havers, 183 Heberden, 212 Hebra, 253 Hebrews, medicine of the, 003 Heister, 215 Helvetius, 160 Henle, 254 Henri de Mondeville, 088 Herophilus, 033 Hessenfratz, 160 Heurne, Otto de, bedside instruction by, 167 Hewson, 161 Hiera sacra, 003 Highmore, 183 Hippocrates, 019 Hirudinomania, 244 Hoboken, 183 Hodgen, John T., 294 Hoffmann, Christopher Ludwig, 200 Hoffmann, Friedrich, 197 Hoffmann's dynamic system, 197 Holmes, Oliver Wendell, 290 Home, Sir Everard, 224 Homoeopathy, 241 Horner, W. E., 287 Hospitals and clinics, 231 Howard, John, 212 Hufeland, 240 Humanization of vaccine-virus, 228 Hunter, John, 164, 218 William, 218 Hunters' study of the lymphatic system, the, 161 Huxham, John, 212 Hydrotlierapeutic system, 255 Hydrotherapy, 229 Iatrocliemical system, 169 Iatroliptes, 018 Iatromechanical school, 171 Infarctus, doctrine of, 201 Influence, of botany on medicine, 237 of chemistry on medicine, 238 of Darwin and Spencer on medicine, 237 of Harvey's discovery, 159 of physics on medicine, 238 of the art of printing, 100 of the French Revolution, 191 of the Northern invaders, 071 of the occult sciences, 139 of the Salernian school, 081 of zoology on medicine, 238 Inoculation, against small-pox, in America, 279 Inoculation, preventive, against smallpox, 225 with cow-pox, the first, 226 Irritability of tissues, discovery of, 163 Isopathy, 241 Jackson, Charles T., 310 Jacobus Sylvius, 103 Jager, 253 Jaxtthal, 253 Jenner, Edward, 226 Jesuit powder, 165 Jews, prejudice against the, 233 John Actuarius, 066 John of Procida, 079 Joubert's Popular Errors, 147 Kampf, 201 Kepler, 162 Keyes, 289 Kirkbride, 290 Laennec, 262 Lamballe, Joubert de, 270 Lancisi's clinic, 168 Lanfranc, 091 Langenbeck, Bernhard von, 264 Larrey, 267 Lavoisier, 160, 191 Lawrence, Sir William, 274 Le Boe, 167, 169 Le Cat, 214 Le Dran, 213 Léonicenus, Nicholas, 101 Lettsom, 213 Leuwenhoek, 158 Levret's modification of obstetrical forceps, 166 Ligatures, first use of, in amputations, 127 Linacre, Thomas, 101 Linnæus, 191 Lisfrauc, 269 Lister, 261 Lister's, studies and methods, 325 work, benefits of, 327 Liston, Robert, 274 Lithotomy, lateral, inventor of, 177 Lizars, John, 271 Long, Crawford, 301 Lorry, 228 Louis, 216 Lymph, diseovery of the circulation of, 158 Machaon, 010 McClellan, George. 293 Me Dowell, Ephraim, 267, 292 Magati, 176 Magendie. 216 Magie, 111 Magnetism, animal, 203 Maimonides, 065 Maitre, Jean, 178 Malgaigne, 270 Malpighi, 158 Mandragora, 301 Marcellus Donatus, 115 March, Alden. 295 Marchetti, 158, 176 Mareschal, Georges, 178 Marinus, 042 Marjoliu, 269 Mascagni, 161 Mauriceau, 166, 182 Mauthner, 253 Mayow, 160 Mead, Richard, 213 Meclianico-dynamic system of medicine, 197 Meckel, 162 Medical, journals in the United States, first, 285 jurisprudence, beginning of, 166 school of the natural sciences, 258 study under preceptors, 277 systems, promulgation of, 152 Medici puri, pretensions of, 189 Medicine, and surgery, approach of, 147 dogmatic school of, 013 Imperial school of, at Pekin, 006 physiological theory of, 243 of priesthood from, 147 Meiboni, 184 Meigs, John Forsyth, 289 Melainpus, 006 Mesmer, Frank, 203 Mesmerism, 203 Mesue, 060 Methodism, 013, 045 Microscope, 100 Midwifery during the seventeenth century, 182 Midwives, 165 Mondino, 092 Monro, Alexander, Sr., 216 Alexander, second and third, 216 Donald, 216 Monroes, the two, 164 Montpellier, the school of, 086 Morarnl, 213 Morel, 176 Morgagni, 224 Morton, Richard, 175 William T. G., 306 Mott, Valentine, 293 Muller, 222 Munich Clinical School, 258 Muralt, 180 Mutter, Thomas D., 293 Mystic period, 012 Natural history, the school of, 219 Natural philosophy, the school of, 249 Needham, 183 Nélaton, 270 Nepenthe, 301 New Vienna School, 250 Nitrous-oxide gas, 303 Nominalist, 069 Nuck, 183 Obstetrical forceps, invention of the, 166 Obstetricians and gynaecologists, American, 295 Obstetrics, development of, 166 Oken, 249 Ophthalmoscope, 263 Oppolzer, 253 Oribasins, 048 Orthopaedics, origin of name, 177 Ovariotomy, the first, 267 Pacchioni, 183 Palfyn's obstetrical forceps, 166 Paracelsus, 143 Paré, Ambroise, 123 Paré and the surgeons of St. Come, 131 Park, Henry, 217 Parker, Willard, 293 Paulas Ægineta, 051 Pecquet, 161 Percussion, invention of the art of, 210 Pergamos, library of, 030 Periodic physicians, 017 Peruvian bark, discovery of, 164 Petit, J. L., 213 Pen, 166 Peyer, 183 Peyronie, 213 Pfeufer, 254 Pharmacopolists, 054 Philosophic period, 012, 018 Phrenology, 163, 242 Physical examination, methods of, 263 Physick, Philip S., 291 Physiological medicine, 253 Pinel, 163, 196, 206, 228 Piorry, 262 Pitard, John, 092 Plater, Felix, 118 Plato, 027 Pleximeter, 263 Podalirius, 010 Porta, Giovanni Batista, 118 Portal, 223 Paul, 166, 182 Pott, Percival, 217 Pravaz, 269 Praxagoras, 027 Priessnitz, 255 Primitive period, 012 Pringle, Sir John, 212 Ptolemy Soter, 031 Purkinje, 222 Purmann, 180 Pythagoras, 015 Quesnay, 173, 214 Quintus, 042 Radcliffe, 213 Rademacher, 254 Rapid multiplication of scientific literature, 239 Rasori, 240 Rau, 180 Ray, Isaac, 290 Raymond Lulli, 087 Realism, 206 Realist, 069 Receptaculum chyli, discovery of, 161 Reflex action, discovery of, 248 Reform period, 013 Regulation of practice in colonial times, 285 Reil, 202 Religious orders and the sick, 095 Rembert Dodoens, 115 Reuss, 253 Rhazes, 060 Rhinoplasty, 176 Rhodes, Temple of Æsculapius at, 008 Richerand, 267 Richter, August Gottlieb, 216 Riolan, 128 Rivinius, 183 Rodger, J. K., 293 Roeschlaub, 240 Roger of Parma, 078 Roland of Parma, 078 Rolfink, 188 Rome during the Greek period, 053 Rokitansky, 250 Roser, 253 Rousset and the Cæsarean operation, 134 Roux, 269 Rufus of Ephesus, 042 Rush, Benjamin, 206, 283 Ruysch, 158 Sabatier, 214 Sacred period, 012 Salernum, school of, 072 Sandifort, 219 Sands, Henry B., 293 Sanson, 269 Santoro, 171 Santoro's thermometer, 171 Sauvage, 196 Saviard, 177 Scalpel, first use of, in dissecting, 112 Scarpa, 162, 215 Schaf hausen, 183 Schneider, 162, 184 School of rational medicine, 254 Scientific societies and journals, origin of, 151 Scultetus, 180 Seminalism, 259 Serapion, 060 Servetus, Michael, 112, 155 Severino, 119, 176 Shoeffer, 100 Shot wounds, the new teaching of Paré concerning, 132 Siegemundin, Justine, 182 Sigmund, 253 Simpson, Sir James Y., 274 Sims, J. Marion, 296 Skoda, 251 Smellie, William, 220 Smellie's modification of the obstetrical forceps, 166 Smith, Nathan R., 292 Societies and academies, foundation of, 235 Soemmering, 162, 222 Sol id ism, 198 Spontaneous generation of life disproven, 321 St. Come, College of, 92, 122 Stahl, 195 Stahl's pietistic system, 195 Steno, Nicholas, 159 Steno's duct, 159 Stethoscope, 262 Stimolo and contrastimolo, 240 Stoerck, 200 Stokes, William, 248 Stoll, 200 Student-life during the 15th and 16th centuries, 148 Surgery, achievements of, 263 reasons for neglect of, 120 Swammerdam, 153, 183 Sydenham, 152, 165, 173 Sylvius, 167 Syme, James, 274 Syphilis, wide-spread outbreak of, 136 Teeth, substitutes for human, 335 Telescope, invention of the, 099 Tenon, 215 Thaer, 199 Themison, 011 Theory of excitement, 210 Theosophy, 111 Thermometer, discovery of the, 171 Thoth, 002 Tourniquet, invention of, 176 Tourniquet, screw, invention of, 213 Transfusion of blood in man, the first, 176 Travers, Benjamin, 248, 273 Treatment of the insane, improvement in, 228 Troja, 228 Trotula, 079 Trousseau, 247 Türck, 253 Tyrrel, 273 Universities and royal scientific societies, 192 Vaccination, compulsory, 228 in the United States, the first, 279 the first, 227 Vagadasastir, 004 Valsalva, 176 Van Buren, William H., 289 Van Helmont, 168 Van Helmont's svstem of medicine, 168 Van Siebold, 216 Van Swieten, 168 Van Swieten and the Old Vienna School, 199 Velpeau, 270 Venesection, first account of, 010 revival of, 118 Verulam, Lord, 153 Vesalius, Andreas, 104 Vicq d'Azvr, 162, 164, 223 Vidal, 269 Vieussens, 162, 186 Virchow, Rudolph, 255 Vitalism, 201 modern, 255 Wainman, 217 Warren, John Collins, 291 Waterhouse, Dr., 279 Wells, Horace, 305 Werlhof, 211 Wharton, 183 White, Anthony, 216 Charles, 216 Wiehman, 211 William of Salicet, 091 Willis, Thomas, 163, 170 Winslow, 164, 223 Winternitz, 255 Wirsnng, 183 Wiseman, Richard, 180 Wistar. Caspar, 286 Wolf, 222 Wood, George R, 287 Wren, Sir Christopher. 182 Wunderlich, 250, 254 Zeissel, 253 
58861	----	generously made available by Internet Archive (https://archive.org) Note: Project Gutenberg also has an HTML version of this file which includes the original illustrations. See 58861-h.htm or 58861-h.zip: (http://www.gutenberg.org/files/58861/58861-h/58861-h.htm) or (http://www.gutenberg.org/files/58861/58861-h.zip) Images of the original pages are available through Internet Archive. See https://archive.org/details/b21935142_0003 Project Gutenberg has the other three volumes of this work. Volume I: see http://www.gutenberg.org/ebooks/58859 Volume II: see http://www.gutenberg.org/ebooks/58860 Volume IV: see http://www.gutenberg.org/ebooks/58862 Transcriber's note: The ligature oe has been marked as [oe]. Text in italics has been enclosed by underscores (_text_). The symbol hand pointing has been marked as [hand]. MEDICAL INQUIRIES AND OBSERVATIONS. BY BENJAMIN RUSH, M. D. PROFESSOR OF THE INSTITUTES AND PRACTICE OF MEDICINE, AND OF CLINICAL PRACTICE, IN THE UNIVERSITY OF PENNSYLVANIA. IN FOUR VOLUMES. VOL. III. THE SECOND EDITION, REVISED AND ENLARGED BY THE AUTHOR. PHILADELPHIA, PUBLISHED BY J. CONRAD & CO. CHESNUT-STREET, PHILADELPHIA; M. & J. CONRAD & CO. MARKET-STREET, BALTIMORE; RAPIN, CONRAD, & CO. WASHINGTON; SOMERVELL & CONRAD, PETERSBURG; AND BONSAL, CONRAD, & CO. NORFOLK. PRINTED BY T. & G. PALMER, 116, HIGH-STREET. 1805. * * * * * CONTENTS OF VOLUME III. _page_ _Outlines of a theory of fever_ 1 _An account of the bilious yellow fever, as it appeared in Philadelphia in 1793_ 67 _An account of the bilious yellow fever, as it appeared in Philadelphia in 1794_ 355 _An account of sporadic cases of bilious yellow fever, as they appeared in Philadelphia in 1795 and 1796_ 435 * * * * * OUTLINES OF A _THEORY OF FEVER_. As many of the diseases which are the subjects of these volumes belong to the class of fevers, the following remarks upon their theory are intended to render the principles and language I have adopted, in the history of their causes, symptoms, and cure, intelligible to the reader. I am aware that this theory will suffer by being published in a detached state from the general view of the proximate cause of disease which I have taught in my lectures upon pathology, as well as from its being deprived of that support which it would receive from being accompanied with an account of the remedies for fever, and the times and manner of exhibiting them, all of which would have served to illustrate and establish the facts and reasonings which are to follow upon this difficult and interesting inquiry. I shall not attempt to give a definition of fever. It appears in so many different forms, that a just view of it can only be given in a minute detail of all its symptoms and states. In order to render the theory, which I am about to deliver, more simple and intelligible, it will be necessary to premise a few general propositions. I. Fevers of all kinds are preceded by general debility. This debility is natural or accidental. The former is the effect of the sanguineous temperament, and exists at all times in many constitutions. The latter is induced, 1. By such preternatural or unusual stimuli, as, after first elevating the excitement of the system above its healthy grade, and thereby wasting a part of its strength, or what Dr. Brown calls excitability, and Darwin sensorial power, afterwards reduces it down to that state which I shall call debility of action. Or, 2. It is induced by such an abstraction of natural stimuli as to reduce the system _below_ its healthy grade of excitement, and thereby to induce what Dr. Brown calls _direct_ debility, but what I shall call debility from abstraction. This general debility is the same, whether brought on by the former or the latter causes. When induced by the latter, the system becomes more excitable than when induced by the former causes, and hence an attack of fever is more frequently invited by it, than by that state of debility which succeeds the application of an undue portion of stimulating powers. To this there is an exception, and that is, when the remote causes of fever act with so much force and rapidity as _suddenly_ to depress the system, without an intermediate elevation of it, and before sufficient time is given to expend any part of its strength or excitability, or to produce the debility of action. The system in this state, is exactly similar to that which arises from a sudden reduction of its healthy excitement, by the abstraction of stimuli. This debility from abstraction, moreover, is upon a footing with the debility from action, when it is of a _chronic_ nature. They both alike expend so much of the quality or substance of excitability, as to leave the system in a state in which irritants are seldom able to excite the commotions of fever, and when they do, it is of a feeble nature, and hence we observe persons who have been long exposed to debilitating causes of both kinds, often escape fevers, while those who are _recently_ debilitated, are affected by them, under the same circumstances of exposure to those causes. That fevers are preceded by general debility I infer from their causes, all of which act by reducing the excitement of the system, by the abstraction of stimuli, or by their excessive or unusual application. The causes which operate in the former way are, 1. Cold. This is universally acknowledged to be a predisposing cause of fever. That it debilitates, I infer, 1. From the languor which is observed in the inhabitants of cold countries, and from the weakness which is felt in labour or exercise in cold weather. 2. From the effects of experiments, which prove, that cold air and cold water lessen the force and frequency of the pulse. 2. The debilitating passions of fear, grief, and despair. 3. All excessive evacuations, whether by the bowels, blood-vessels, pores, or urinary passages. 4. Famine, or the abstraction of the usual quantity of nourishing food. The causes which predispose to fever by the excessive or unusual application of stimuli are, 1. Heat. Hence the greater frequency of fevers in warm climates, and in warm weather. 2. Intemperance in eating and drinking. 3. Unusual labour or exercise. 4. Violent emotions, and stimulating passions of the mind. 5. Certain causes which act by over-stretching a part, or the whole of the body, such as lifting heavy weights, external violence acting mechanically in wounding, bruising, or compressing particular parts, extraneous substances acting by their bulk or gravity, burning, and the like[1]. The influence of debility in predisposing to fevers is further evident from their attacking so often in the night, a time when the system is more weak than at any other, in the four and twenty hours. [1] Cullen's First Lines. II. Debility being thus formed in the system, by the causes which have been enumerated, a _sudden_ accumulation of excitability takes place, whereby a predisposition is created to fever. The French writers have lately called this predisposition "vibratility," by which they mean a liableness in it to be thrown into vibrations or motions, from pre-existing debility. It is not always necessary that a fever should follow this state of predisposition. Many people pass days and weeks under it, without being attacked by a fever, by carefully or accidentally avoiding the application of additional stimuli or irritants to their bodies: but the space between this state of predisposition, when it is recent, and a fever, is a very small one; for, independently of additional stimuli, the common impressions which support life sometimes become irritants, and readily add another link to the chain of causes which induce fever, and that is, III. Depression of the whole system, or what Dr. Brown calls indirect debility. It manifests itself in weakness of the limbs, inability to stand or walk without pain, or a sense of fatigue, a dry, cool, or cold skin, chilliness, a shrinking of the hands and face, and a weak or quick pulse. These symptoms characterize what I have called in my lectures the forming state of fever. It is not necessary that a paroxysm of fever should follow this depressed state of the system, any more than the debility that has been described. Many people, by rest, or by means of gentle remedies, prevent its formation; but where these are neglected, and the action of stimuli, whether morbid or natural, are continued, IV. Re-action is induced, and in this re-action, according to its greater or less force and extent, consist the different degrees of fever. It is of an irregular or a _convulsive_ nature. In common cases, it is seated primarily in the blood-vessels, and particularly in the arteries. These pervade every part of the body. They terminate upon its whole surface, in which I include the lungs and alimentary canal, as well as the skin. They are the outposts of the system, in consequence of which they are most exposed to cold, heat, intemperance, and all the other external and internal, remote and exciting causes of fever, and are first roused into resistance by them. Let it not be thought, from these allusions, that I admit Dr. Cullen's supposed vires naturæ medicatrices to have the least agency in this re-action of the blood-vessels. I believe it to be altogether the effect of their elastic and muscular texture, and that it is as simply mechanical as motion from impressions upon other kinds of matter. That the blood-vessels possess muscular fibres, and that their irritability or disposition to motion depends upon them, has been demonstrated by Dr. Vasschuer and Mr. John Hunter, by many experiments. It has since been proved by Spallanzani, in an attempt to refute it. Even Dr. Haller, who denies the muscularity and irritability of the blood-vessels, implies an assent to them in the following words: "There are nerves which descend for a long way together through the surface of the artery, and at last vanish in the cellular substance of the vessel, of which we have a specimen in the external and internal carotids, and in the arch of the aorta; and from these do not the arteries seem to derive a muscular and convulsive force very different from that of their simple elasticity? Does not it show itself plainly in _fevers_, faintings, palsies, consumptions, and passions of the mind[2]?" [2] First Lines, sect. 32 of the chapter on arteries. The re-action or morbid excitement of the arteries discovers itself in preternatural force, or frequency in their pulsations. In _ordinary_ fever, it is _equally_ diffused throughout the whole sanguiferous system, for the heart and arteries are so intimately connected, that, like the bells of the Jewish high-priest, when one of them is touched, they all vibrate in unison with each other. To this remark there are some exceptions. 1. The arteries are sometimes affected with great morbid excitement, while the natural functions of the heart are unimpaired. This occurs in those states of fever in which patients are able to sit up, and even to walk about, as in pulmonary consumption, and in hectic fever from all its causes. 2. The heart and pulmonary artery are sometimes affected with great morbid excitement, while the pulsations of the arteries on the wrists are perfectly natural. 3. The morbid excitement of the arteries is sometimes greater on one side of the body than on the other. This is obvious in the difference in the number and force of the pulsations in the different arms, and in the different and opposite appearances of the blood drawn from their veins, under equal circumstances. 4. The arteries in the head, lungs, and abdominal viscera are sometimes excited in a high degree, while the arteries in the extremities exhibit marks of a feeble morbid action. Fevers attended with these and other deviations from their common phenomena, have been called by Dr. Alibert, _altaxiques_. They occur most frequently in malignant fevers. While morbid excitement thus pervades generally or partially the sanguiferous system, depression and debility are increased in the alimentary canal, and in the nervous and muscular systems. In the stomach, bowels, and muscles, this debility is occasioned by their excitement being abstracted, and translated to the blood-vessels. I shall now endeavour to illustrate the propositions which have been delivered, by taking notice of the manner in which fevers are produced by some of its most obvious and common causes. Has the body been debilitated by exposure to the cold air? its excitability is thereby increased, and heat acts upon it with an accumulated force: hence the frequency of catarrhs, pleurisies, and other inflammatory fevers in the spring, after a cold winter; and of bilious remittents in the autumn, when warm days succeed to cold and damp nights. These diseases are seldom felt for the first time in the open air, but generally after the body has been exposed to cold, and afterwards to the heat of a warm room or a warm bed. Mild intermittents have frequently been observed to acquire an inflammatory type in the Pennsylvania hospital, in the months of November and December, from the heat of the stove rooms acting upon bodies previously debilitated and rendered excitable by cold and disease. Has there been an abstraction of heat by a sudden shifting of the wind from the south-west to the north-west or north-east points of the compass, or by a cold night succeeding to a warm day? a fever is thereby frequently excited. These sources of fever occur every autumn in Philadelphia. The miasmata which exist in the body at that time in a harmless state, are excited into action, in a manner to be mentioned presently, by the debility from cold, aided in the latter case by the inaction of sleep, suddenly induced upon the system. Again: has the body been _suddenly_ debilitated by labour or exercise? its excitement is thereby diminished, but its excitability is increased in such a manner that a full meal, or an intemperate glass of wine, if taken _immediately_ after the fatigue is induced upon the body, excites a fever: hence the frequency of fevers in persons upon their return from hunting, surveying, long rides, or from a camp life. But how shall we account for the production of fever from the measles and small-pox, which attack so uniformly, and without predisposing debility from any of its causes which have been enumerated? I answer, that the contagions of those diseases seldom act so as to produce fever, until the system is first depressed. This is obvious from their being preceded by languor, and all the other symptoms formerly mentioned, which constitute the forming state of fever. The miasmata which induce the plague and yellow fever, when they are not preceded by the usual debilitating and predisposing causes, generally induce the same depression of the system, previously to their exciting fever. Even wounds, and other local irritants seldom induce fever before they have first produced the symptoms of depression formerly mentioned. I shall presently mention the exceptions to this mode of producing fever from contagious miasmata and local injuries, and show that they do not militate against the truth of the general proposition that has been delivered. It may serve still further to throw light upon this part of our subject to take notice of the difference between the action of stimuli upon the body predisposed by debility and excitability to fever, and their action upon it when there is no such predisposition to fever. In health there is a constant and just proportion between the degrees of excitement and excitability, and the force of stimuli. But this is not the case in a predisposition to a fever. The ratio between the action of stimuli and excitement, and excitability is destroyed; and hence the former act upon the latter with a force which produces irregular action, or a convulsion in the arterial system. When the body is debilitated, and its excitability increased, either by fear, darkness, or silence, a sudden noise occasions a short convulsion. We awake, in like manner, in a light convulsion, from the sudden opening of a door, or from the sprinkling of a few drops of water in the face, after the excitability of the system has been accumulated by a night's sleep. In a word, it seems to be a law of the system, that stimulus, in an over-proportion to excitability, either produces convulsion, or goes so far beyond it, as to destroy motion altogether in death. V. There is but one exciting cause of fever, and that is stimulus. Heat, alternating with cold[3], marsh and human miasmata, contagions and poisons of all kinds, intemperance, passions of the mind, bruises, burns, and the like, all act by a stimulating power only, in producing fever. This proposition is of great application, inasmuch as it cuts the sinews of the division of diseases from their remote causes. Thus it establishes the sameness of a pleurisy, whether it be excited by heat succeeding cold, or by the contagions of the small-pox and measles, or by the miasmata of the yellow fever. [3] Perhaps there is no greater enemy to the life of man than cold. Dr. Sydenham ascribes nearly all fevers to it, particularly to leaving off winter clothes too soon, and to exposing the body to cold after it has been heated. These sources of fever, he adds, destroy more than the plague, sword, or famine.--_Wallis's edition, vol. I. p. 357._ To this proposition there is a seeming objection. Cold, sleep, immoderate evacuations, and the debilitating passions of grief and fear (all of which abstract excitement) appear to induce fever without the interposition of a stimulus. In all these cases, the _sudden_ abstraction of excitement destroys the equilibrium of the system, by which means the blood is diverted from its natural channels, and by acting with preternatural force in its new directions, becomes an irritant to the blood-vessels, and thus a stimulating and exciting cause of fever. When it is induced by cold alone, it is probable so much of the perspirable matter may be retained as to co-operate, by its irritating qualities, in exciting the fever. VI. There is but one fever. However different the predisposing, remote, or exciting causes of fever may be, whether debility from abstraction or action, whether heat or cold succeeding to each other, whether marsh or human miasmata, whether intemperance, a fright, or a fall, still I repeat, there can be but one fever. I found this proposition upon all the supposed variety of fevers having but one proximate cause. Thus fire is a unit, whether it be produced by friction, percussion, electricity, fermentation, or by a piece of wood or coal in a state of inflammation. VII. All ordinary fever being seated in the blood-vessels, it follows, of course, that all those local affections we call pleurisy, angina, phrenitis, internal dropsy of the brain, pulmonary consumption, and inflammation of the liver, stomach, bowels, and limbs, are symptoms only of an original and primary disease in the sanguiferous system. The truth of this proposition is obvious from the above local affections succeeding primary fever, and from their alternating so frequently with each other. I except from this remark those cases of primary affections of the viscera which are produced by local injuries, and which, after a while, bring the whole sanguiferous system into sympathy. These cases are uncommon, amounting, probably, to not more than one in a hundred of all the cases of local affection which occur in general fever. In my 4th proposition I have called the action of the arteries _irregular_ in fever, to distinguish it from that excess of action which takes place after violent exercise, and from that quickness which accompanies fear or any other directly debilitating cause. The action of the arteries here is _regular_, and, when felt in the pulse, affords a very different sensation from that _jerking_ which we feel in the pulse of a patient labouring under a fever. This irregular action is, in other words, a _convulsion_ in the sanguiferous, but more obviously, in the arterial system. That this is the case I infer from the strict analogy between symptoms of fever, and convulsions in the nervous system. I shall briefly mention the particulars in which this analogy takes place. 1. Are convulsions in the nervous system preceded by debility? So is the convulsion of the blood-vessels in fever. 2. Does debility induced on the whole, or on a part only, of the nervous system, predispose to general convulsions, as in tetanus? So we observe debility, whether it be induced on the whole or on a part of the arterial system, predisposes to general fever. This is obvious in the fever which ensues alike from cold applied to every part of the body, or from a stream of cold air falling upon the neck, or from the wetting of the feet. 3. Do tremors precede convulsions in the nervous system? So they do the convulsion of the blood-vessels in fever. 4. Is a coldness in the extremities a precursor of convulsions in the nervous system? So it is of fever. 5. Do convulsions in the nervous system impart a jerking sensation to the fingers? So does the convulsion of fever in the arteries, when felt at the wrists. 6. Are convulsions in the nervous system attended with alternate action and remission? So is the convulsion of fever. 7. Do convulsions in the nervous system return at regular and irregular periods? So does fever. 8. Do convulsions in the nervous system, under certain circumstances, affect the functions of the brain? So do certain states of fever. 9. Are there certain convulsions in the nervous system which affect the limbs, without affecting the functions of the brain, such as tetanus, and chorea sancti viti? So there are certain fevers, particularly the common hectic, which seldom produces delirium, or even head-ach, and frequently does not confine a patient to his bed. 10. Are there local convulsions in the nervous system, as in the hands, feet, neck, and eye-lids? So there are local fevers. Intermittents often appear in the autumn with periodical heat and pains in the eyes, ears, jaws, and back. 11. Are there certain grades in the convulsions of the nervous system, as appears in the hydrophobia, tetanus, epilepsy, hysteria, and hypochondriasis? So there are grades in fevers, as in the plague, yellow fever, small-pox, rheumatism, and common remitting and intermitting fevers. 12. Are nervous convulsions most apt to occur in infancy? So are fevers. 13. Are persons once affected with nervous convulsions frequently subject to them through life? So are persons once affected with fever. The intermitting fever often returns with successive springs or autumns, and, in spite of the bark, sometimes continues for many years in all climates and seasons. 14. Is the strength of the nervous system increased by convulsions? This is so evident that it often requires four or five persons to confine a delicate woman to her bed in a convulsive fit. In like manner the strength of the arterial system is increased in a fever. This strength is great in proportion to the weakness of every other part of the body. 15. Do we observe certain nervous convulsions to affect some parts of the nervous system more than others, or, in other words, do we observe preternatural strength or excitement to exist in one part of the nervous system, while other parts of the same system exhibit marks of preternatural weakness or defect of excitement? We observe the same thing in the blood-vessels in a fever. The pulse at the wrist is often _tense_, while the force of the heart is very much diminished. A delirium often occurs in a fever from excess of excitement in the blood-vessels of the brain, while the pulse at the wrist exhibits every mark of preternatural weakness. 16. Is there a rigidity of the muscles in certain nervous diseases, as in catalepsy? Something like this solstice in convulsion occurs in that state of fever in which the pulse beats but sixty, or fewer strokes in a minute. 17. Do convulsions go off _gradually_ from the nervous system, as in tetanus, and chorea sancti viti? So they do from the arterial blood-vessels in certain states of fever. 18. Do convulsions go off _suddenly_ in any cases from the nervous system? The convulsion in the blood-vessels goes off in the same manner by a sweat, or by a hæmorrhage, frequently in the course of a night, and sometimes in a single hour. 19. Does palsy in some instances succeed to convulsions in the nervous system? Something like a palsy occurs in fevers of great inflammatory action in the arteries. They are often inactive in the wrists, and in other parts of the body, from the immense pressure of the remote cause of the fever upon them. From the facts and analogies which have been mentioned, I have been led to conclude that the common forms of fever are occasioned simply by irregular action, or convulsion in the blood-vessels. The history of the phenomena of fever, as delivered in the foregoing pages, resolves itself into a chain, consisting of the five following links. 1. Debility from action, or the abstraction of stimuli. When this debility is induced by action, it is sometimes preceded by elevated excitement in the blood-vessels, from the first impressions of stimuli upon them. 2. An increase of their excitability. 3. Stimulating powers applied to them. 4. Depression. And, 5. Irregular action or convulsion. The whole of the links of this chain are perceptible only when the fever comes on in a _gradual_ manner. But I wish the reader to remember, that the same remote cause is often debilitating, stimulating, and depressing, and that, in certain fevers, the remote cause sometimes excites convulsions in the blood-vessels without being preceded by preternatural debility and excitability, and with but little or no depression of the system. This has often been observed in persons who have been suddenly exposed to those marsh and human miasmata which produce malignant fevers. It sometimes takes place likewise in fevers induced by local injuries. The blood-vessels in these cases are, as it were, taken by storm, instead of regular approaches. I might digress here, and show that all diseases, whether they be seated in the arteries, muscles, nerves, brain, or alimentary canal, are all preceded by debility; and that their essence consists in irregular action, or in the absence of the natural order of motion, produced or invited by predisposing debility. I might further show, that all the moral, as well as physical evil of the world consists in predisposing weakness, and in subsequent derangement of action or motion; but these collateral subjects are foreign to our present inquiry. Let us now proceed to examine how far the theory which has been delivered accords with the phenomena of fever. I shall divide these phenomena into two kinds. I. Such as are transient, and more or less common to all fevers. These I shall call _symptoms_ of fever. II. Such as, being more permanent and fixed, have given rise to certain specific names. These I shall call _states_ of fever. I shall endeavour to explain and describe each of them in the order in which they have been mentioned. I. Lassitude is the effect of the depression of the whole system, which precedes fever. The same cause, when it acts upon the extremities of the blood-vessels, produces coldness and chills. This is obvious to any person, under the first impression of the miasmata which bring on fevers, also under the influence of fatigue, and debilitating passions of the mind. The absence of chills indicates the sensibility of the external parts of the body to be suspended or destroyed, as well as their irritability; hence when death occurs in the fit of an intermittent, there is no chill. A chilly fit, for the same reason, seldom occurs in the most malignant cases of fever. It is sometimes excited by blood-letting, only because it weakens those fevers to such a degree, as to carry the blood-vessels back to the grade of depression. Coldness and chills are likewise removed by blood-letting, only because it enables the arteries to re-act in such a manner as to overcome the depression that induced it. It has been remarked, that the chilly fit, in common fevers, seldom appears in its full force until the patient approaches a fire, or lies down on a warm bed; for in these situations sensibility is restored by the stimulus of the heat acting upon the extremities of the blood-vessels. The first impressions of the rays of the sun, in like manner, often produce coldness and chills in the torpid bodies of old and weakly people. Tremors are the natural consequence of the abstraction of that support which the muscles receive from the fulness and tension of the blood-vessels. It is from this retreat of the blood towards the viscera, that the capillary arteries lose their fulness and tension; hence they contract like other soft tubes that are emptied of their contents. This contraction has been called a spasm, and has improperly been supposed to be the proximate cause of fever. From the explanation that has been given of its cause, it appears, like the coldness and chills, to be nothing but an accidental concomitant, or effect of a paroxysm of fever. The local pains in the head, breast, and bones in fever, appear to be the effects of the irregular determination of the blood to those parts, and to morbid action being thereby induced in them. The want of appetite and costiveness are the consequences of a defect of secretion of the gastric juice, and the abstraction of excitement or natural action from the stomach and bowels. The inability to rise out of bed, and to walk, is the effect of the abstraction of excitement from the muscles of the lower limbs. The dry skin or partial sweats appear to depend upon diminished or partial action in the vessels which terminate on the surface of the body. The high-coloured and pale urine are occasioned by an excess or a deficiency of excitement in the secretory vessels of the kidneys. The suppression of the urine seems to arise from what Dr. Clark calls an engorgement, or choaking of the vessels of the kidneys. It occurs most frequently in malignant fevers. Thirst is probably the effect of a preternatural excitement of the vessels of the fauces. It is by no means a uniform symptom of fever. We sometimes observe it, in the highest degree, in the last stage of diseases, induced by the retreat of the last remains of excitement from every part of the body, to the throat. The white tongue is produced by a change in the secretion which takes place in that organ. Its yellow colour is the effect of bile; its dryness is occasioned by an obstruction of secretion, or by the want of action in the absorbents; and its dark and black colour, by a tendency to mortification. It will be difficult to account for the variety in the degrees and locality of _heat_ in the body in a fever, until we know more of the cause of animal heat. From whatever cause it be derived, its excess and deficiency, as well as all its intermediate degrees, are intimately connected with more or less excitement in the arterial system. It is not necessary that this excitement should exist only in the large blood-vessels. It will be sufficient for the purpose of creating great heat, if it occur only in the cutaneous vessels; hence we find a hot skin in some cases of malignant fever in which there is an absence of pulse. Eruptions seem to depend upon effusions of serum, lymph, or red blood upon the skin, with or without inflammation, in the cutaneous vessels. I decline taking notice in this place of the symptoms which are produced by the debility from action and abstraction, and by the depression of the system. They appear not only in the temperature of the body, but in all the different symptoms of fever. It is of importance to know when they originate from the former, and when from the latter causes, as they sometimes require very different and opposite remedies to remove them. It remains only to explain the cause why excess in the force or frequency of the action of the blood-vessels should succeed debility in a part, or in the whole of the body, and be connected for days and weeks with depression and preternatural debility in the nerves, brain, muscles, and alimentary canal. I shall attempt the explanation of this phenomenon by directing the attention of the reader to the operations of nature in other parts of her works. 1. A calm may be considered as a state of debility in the atmosphere. It predisposes to a current of air. But is this current proportioned to the loss of the equilibrium of the air? By no means. It is excessive in its force, and tends thereby to destroy the works both of nature and art. 2. The passions are given to man on purpose to aid the slow and uncertain operations of reason. But is their action always proportioned to the causes which excite them? An acute pneumony, brought on by the trifling injury done to the system by the fatigue and heat of an evening spent in a dancing assembly, is but a faint representation of the immense disproportion between a trifling affront, and that excess of passion which seeks for gratification in poison, assassination, or a duel. The same disproportion appears between cause and effect in public bodies. A hasty word, of no mischievous influence, has often produced convulsions, and even revolutions, in states and empires. If we return to the human body we shall find in it many other instances of the disproportion between stimulus and action, besides that which takes place in the excitement of fever. 3. A single castor oil nut, although rejected by the stomach upon its first effort in vomiting, has, in one instance that came within my knowledge, produced a vomiting that continued nearly four and twenty hours. Here the duration of action was far beyond all kind of proportion to the cause which excited it. 4. A grain of sand, after being washed from the eye, is often followed by such an inflammation or excess in the action of the vessels of the eye, as to require bleeding, purging, and blistering to remove it. Could we comprehend every part of the sublime and ineffable system of the divine government, I am sure we should discover nothing in it but what tended ultimately to order. But the natural, moral, and political world exhibit every where marks of disorder, and the instruments of this disorder, are the operations of nature. Her influence is most obvious in the production of diseases, and in her hurtful or ineffectual efforts to remove them[4]. In again glancing at this subject I wish it to be remembered that those operations were not originally the means of injuring or seducing man, and that I believe a time will come when the exact relation, between cause and effect, or, in other words, the dominion of order shall be restored over every action of his body and mind, and health and happiness again be the result of every movement of nature. [4] See the Comparative View of the Diseases of the Indians and of Civilized Nations. Vol. I. From the view I have given of the state of the blood-vessels in fever, the reader will perceive the difference between my opinions and Dr. Brown's upon this subject. The doctor supposes a fever to consist in debility. I do not admit debility to be a disease, but place it wholly in morbid excitement, invited and fixed by previous debility. He makes a fever to consist in a change only of a _natural_ action of the blood-vessels. I maintain that it consists in a _preternatural_ and convulsive action of the blood-vessels. Lastly, Dr. Brown supposes excitement and excitability to be _equally_ diffused over the whole body, but in unhealthy proportions to each other. My theory places fever in excitement and excitability _unequally_ diffused, manifesting themselves, at the _same time_, in morbid actions, depression, and debility from abstraction, in different parts of the body. No new excitement from without is infused into the system by the irritants which excite a fever. They only destroy its equal and natural distribution; for while the arteries are in a plus, the muscles, stomach, and bowels are in a minus state of excitement, and the business of medicine is to equalize it in the cure of fever, that is, to abstract its excess from the blood-vessels, and to restore it to the other parts of the body. II. I come now to apply the theory which I have delivered to the explanation and description of the different phenomena or states of fever. I have said in my sixth proposition that there is but one fever. Of course I do not admit of its artificial division into genera and species. A disease which so frequently changes its form and place, should never have been designated, like plants and animals, by unchangeable characters. The oak tree and the lion possess exactly the same properties which they did nearly 6000 years ago. But who can say the same thing of any one disease? The pulmonary consumption is sometimes transformed into head-ach, rheumatism, diarrh[oe]a, and mania, in the course of two or three months, or the same number of weeks. The bilious fever often appears in the same person in the form of colic, dysentery, inflammation of the liver, lungs, and brain, in the course of five or six days. The hypochondriasis and the hysteria seldom fail to exchange their symptoms twice in the four and twenty hours. Again: the oak tree has not united with any of the trees of the forest, nor has the lion imparted his specific qualities to any other animal. But who can apply similar remarks to any one disease? Phrenitis, gastritis, enteritis, nephritis, and rheumatism all appear at the same time in the gout and yellow fever. Many observations of the same kind might be made, to show the disposition of nearly all other diseases to anastomose with each other. To describe them therefore by any fixed or specific characters is as impracticable as to measure the dimensions of a cloud on a windy day, or to fix the component parts of water by weighing it in a hydrostatic balance. Much mischief has been done by nosological arrangements of diseases. They erect imaginary boundaries between things which are of a homogeneous nature. They degrade the human understanding, by substituting simple perceptions to its more dignified operations in judgment and reasoning. They gratify indolence in a physician, by fixing his attention upon the name of a disease, and thereby leading him to neglect the varying state of the system. They moreover lay a foundation for disputes among physicians, by diverting their attention from the simple, predisposing, and proximate, to the numerous, remote, and exciting causes of diseases, or to their more numerous and complicated effects. The whole materia medica is infected with the baneful consequences of the nomenclature of diseases, for every article in it is pointed only against their names, and hence the origin of the numerous contradictions among authors who describe the virtues and doses of the same medicines. By the rejection of the artificial arrangement of diseases, a revolution must follow in medicine. Observation and judgment will take the place of reading and memory, and prescriptions will be conformed to existing circumstances. The road to knowledge in medicine by this means will likewise be shortened; so that a young man will be able to qualify himself to practise physic at as much less expence of time and labour than formerly, as a child would learn to read and write by the help of the Roman alphabet, instead of Chinese characters. In thus rejecting the nosologies of the schools, I do not wish to see them banished from the libraries of physicians. When consulted as histories of the effects of diseases only, they may still be useful. I use the term diseases, in conformity to custom, for, properly speaking, disease is much a unit as fever. It consists simply of morbid action or excitement in some part of the body. Its different seats and degrees should no more be multiplied into different diseases, than the numerous and different effects of heat and light upon our globe should be multiplied into a plurality of suns. The advocates for Dr. Cullen's system of medicine will not, I hope, be offended by these observations. His immense stock of reputation will enable him to sustain the loss of his nosology without being impoverished by it. In my attempts to introduce a new arrangement of fevers, I shall only give a new direction to his efforts to improve the healing art. Were it compatible with the subject of the present inquiry, it would be easy to show, that the same difficulties and evils are to be expected from Dr. Darwin's division of diseases, as they affect the organs of sensation and motion, and as they are said to be exclusively related by association and volition, that have been deprecated from their divisions and subdivisions by the nosologists. Diseases, like vices, with a few exceptions, are necessarily undisciplined and irregular. Even the genius of Dr. Darwin has not been able to compel them to move within lines. I return from this digression to remark that morbid action in the blood-vessels, whether it consist in preternatural force and frequency, or preternatural force without frequency, or frequency without force, constitutes fever. Excess in the force and frequency in the pulsations of the arteries have been considered as the characteristic marks of what is called inflammatory fever. There are, however, symptoms which indicate a much greater excess of irritating impressions upon the blood-vessels. These are preternatural slowness, intermissions, and depression in the pulse, such as occur in certain malignant fevers. But there is a grade of fever, which transcends in force that which produces inflammation. It occurs frequently in hydrophobia, dysentery, colic, and, baron Humboldt lately informed me, upon the authority of Dr. Comoto, of Vera Cruz, in the yellow fever of that city, when it proves fatal in a few hours after it attacks. In vain have physicians sought to discover, by dissections, the cause of fever in those cases, when followed by death, in the parts of the body in which it was supposed, from pain and other symptoms, to be principally seated. Those parts have frequently exhibited no marks of inflammation, nor of the least deviation from a healthy state. I have ascribed this apparent absence of disease to the serous vessels being too highly excited, and thereby too much contracted, to admit the entrance of red blood into them. I wish these remarks to be remembered by the student of medicine. They have delivered me from the influence of several errors in pathology; and they are capable, if properly extended and applied, of leading to many important deductions in the practice of physic. I shall now briefly mention the usual effects of fever, or morbid excitement in the blood-vessels, when not removed by medicine. They are, 1. Inflammation. It is produced by an effusion of red particles of blood into serous vessels, constituting what Dr. Boerhaave calls error loci. It is the second grade of fever, and, in fevers of great violence, does not take place until morbid excitement has continued for some time, or has been reduced by bleeding. 2. Secretion, or an effusion from rupture, of the serum of the blood, constituting dropsies. 3. Secretion of lymph or fibrin, forming a membrane which adheres to certain surfaces in the body. 4. Secretion of pus, also of sloughs. 5. An effusion by rupture, or a congestion of all the component parts of the blood. 6. Gangrene from the death of the blood-vessels. 7. Rupture of blood-vessels, producing hæmorrhage. 8. Redness, phlegmon, pustules, and petechiæ on the skin, and tubercles in the lungs, and on the liver and bowels. 9. Schirrus. 10. Calcareous and other earthy matters. Both these take place only in the feeble and often imperceptible grades of morbid action in the blood-vessels. 11. Death. This arises from the following causes. 1. Sudden destruction of the excitability of the blood-vessels. 2. A disorganization of parts immediately necessary to life. 3. A change in the fluids, so as to render them destructive to what are called the vital organs. 4. Debility, from the exhausted or suspended state of the excitability of the blood-vessels. All these effects of fever are different according to its grade. Dr. Blane says fevers are rarely inflammatory in the West-Indies; that is, they pass rapidly from simple morbid excitement to congestion, hæmorrhage, gangrene, and death. This remark is confirmed by Dr. Dalzelle, who says the pneumony in the negroes, in the French West-India islands, rarely appears in any other form than that of the notha, from the arteries in the lungs being too much stimulated to produce common inflammation; but such is the force of morbid excitement in hot climates, that it sometimes passes suddenly over all its intermediate effects, and discovers itself only in death. This appears to have taken place in the cases at Vera Cruz, mentioned by baron Humboldt. All the different states of fever may be divided, I. Into such as affect the whole arterial system; but with no, or very little local disease. II. Into such as affect the whole arterial system, and are accompanied at the same time with evident local disease. III. Into such as appear to pass by the arterial system, and to fix themselves upon other parts of the body. I shall call these states of fever _misplaced_. I. To the first class of the states of fever belong, 1. The malignant. It constitutes the highest grade of morbid diathesis. It is known by attacking frequently without a chilly fit, by coma, a depressed, slow, or intermitting pulse, and sometimes by the absence of pain, and with a natural temperature or coldness of the skin. It occurs in the plague, in the yellow fever, in the gout, in the small-pox and measles, in the hydrophobia, and after taking opium and other stimulating substances. Dr. Quier has described a pleurisy in Jamaica, in which some of those malignant symptoms took place. They are the effect of such a degree of impression as to prostrate the arterial system, and to produce a defect of action from an excess of force. Such is this excess of force, in some instances, in this state of fever, that it induces general convulsions, tetanus, and palsy, and sometimes extinguishes life in a few hours, by means of apoplexy or syncope. From its being accompanied with these symptoms, it has received the name of _adynamique_ by Dr. Alibert. The less violent degrees of stimulus in this state of fever produce palsy in the blood-vessels. It probably begins in the veins, and extends gradually to the arteries. It seems further to begin in the extremities of the arteries, and to extend by degrees to their origin in the heart. This is evident in the total absence of pulse which sometimes takes place in malignant fevers, four and twenty, and even eight and forty hours before death. But there are cases in which this palsy affects both the veins and arteries at the same time. It is probably from this simultaneous affection of the blood-vessels, that the arteries are found to be nearly full of blood after death from malignant fevers. The depressed, and intermitting pulse which occurs in the beginning of these fevers perhaps depends upon a tendency to palsy in the arteries, independently of an affection of the heart or brain. This _prostrate_ state of fever more frequently when left to itself terminates in petechiæ, buboes, carbuncles, abscesses, and mortifications, according as serum, lymph, or red blood is effused in the viscera or external parts of the body. These morbid appearances have been ascribed to putrefaction, and the fever has received, from its supposed presence, the name of putrid. The existence of putrefaction in the blood in a fever is rendered improbable, 1. By Dr. Seybert's experiments[5], which prove that it does not take place in the blood in a living state. It occurs in the excretions of bile, fæces, and urine, but in this case it does not act as a ferment, but a stimulus only upon the living body. [5] Inaugural dissertation, entitled, "An Attempt to disprove the Putrefaction of the Blood in Living Animals." 2. By similar appearances, with those which have been ascribed to putrefaction, having been produced by lightning, by violent emotions of the mind, by extreme pain, and by every thing else which induces sudden and universal disorganization in the fluids and solids of the body. The following facts clearly prove that the symptoms which have been supposed to designate a putrid fever, are wholly the effect of mechanical action in the blood-vessels, and are unconnected with the introduction of a putrid ferment in the blood. Hippocrates relates the case of a certain Antiphillus, in whom a putrid bilious fever (as he calls it) was brought on by the application of a caustic to a wound[6]. [6] Epidemics, book iv. An acute pain in the eye, Dr. Physick informed me, produced the symptoms of what is called a putrid fever, which terminated in death in five days, in St. George's hospital, in the year 1789. Dr. Baynard relates, upon the authority of a colonel Bampfield, that a stag, which he had chased for some time, stopped at a brook of water in order to drink. Soon afterwards it fell and expired. The colonel cut its throat, and was surprised to perceive the blood which issued from it had a putrid and offensive smell[7]. Dr. Desportes takes notice that a fish, which he calls a sucker, affected the system nearly in the same manner as the miasmata of the yellow fever. A distressing vomiting, a coldness of the extremities, and an absence of pulse, were some of the symptoms produced by it, and an inflammation and mortification of the stomach and bowels, were discovered after death to be the effects of its violent operation. Even opium, in large doses, sometimes produces by its powerful stimulus the same symptoms which are produced by the stimulus of marsh miasmata. These symptoms are a slow pulse, coma, a vomiting, cold sweats, a sallow colour of the face, and a suppression of the discharges by the urinary passages and bowels. Error is often perpetuated by words. A belief in the putrefaction of the blood has done great mischief in medicine. The evil is kept up, under the influence of new theories, by the epithet putrid, which is still applied to fever in all our medical books. For which reason I shall reject it altogether hereafter, and substitute in its room. [7] Treatise on the Cold Bath. 2. The _gangrenous_ state of fever; for what appear to some physicians to be signs of putrefaction, are nothing but the issue of a violent inflammation left in the hands of nature, or accelerated by stimulating medicines. Thus the sun, when viewed at mid-day, appears to the naked eye, from the excess of its splendour, to be a mass of darkness, instead of an orb of light. The same explanation of what are called putrid symptoms in fever, is very happily delivered by Mr. Hunter in the following words: "It is to be observed (says this acute physiologist) that when the attack upon these organs, which are principally connected with life, proves fatal, that the effects of the inflammation upon the constitution run through all the stages with more rapidity than when it happens in other parts; so that at its very beginning, it has the same effect upon the constitution which is only produced by the second stage of inflammation in other parts[8]." [8] Treatise on Inflammation. chap. I. 8. 3. The _synocha_, or the common inflammatory state of fever, attacks suddenly with chills, and is succeeded by a quick, frequent, and tense pulse, great heat, thirst, and pains in the bones, joints, breast, or sides. These symptoms sometimes occur in the plague, the jail and yellow fever, and the small-pox; but they are the more common characteristics of pleurisy, gout, and rheumatism. They now and then occur in the influenza, the measles, and the puerperile fever. 4. The _synochus_ state of fever is known by a full, quick, and round pulse without tension. The autumnal bilious fever and colic, also the gout, often appear in this form. 5. There is a state of fever in which the pulse is small, but tense and quick. The patient, in this state of fever, is seldom confined to his bed. We observe it sometimes in the chronic rheumatism, and in pulmonary consumption. The inflammatory state of this grade of fever is proved from the inefficacy of the volatile tincture of guaiacum and other stimulants to remove it, and from its yielding so suddenly to blood-letting. I have called it the _synochula_ state of fever. 6. There is a state of fever inclining more to the synocha, than what is called the typhus, or low chronic state of fever. I have called it the _synochoid_ state of fever. 7. The _typhus_ state of fever is generally preceded by all those circumstances which debilitate the system, both by the action and abstraction of stimuli. It is known by a weak and frequent pulse, a disposition to sleep, a torpor of the alimentary canal, tremors of the hands, a dry tongue, and, in some instances, by a diarrh[oe]a. These symptoms occur most frequently in what is called the jail, the ship, and the hospital fever. I heard of it in a few cases in the yellow fever of 1793, and all writers take notice of cases of the plague, which run on into a slow fever that continues 30 or 40 days. I have seen it succeed the common bilious fever, pleurisy, and influenza. It has been confounded with the malignant state of fever, or what is called the typhus gravior; but it differs widely from it in being accompanied by a feeble excitement in the blood-vessels, from a feeble stimulus, and by the usual signs of debility from abstraction in every other part of the body. From the accession of new stimuli, or an increase in the force of former ones, this typhus state of fever sometimes assumes, on the 11th, 14th, and even 20th days, the symptoms of the synocha state of fever. It will be useful to remember this remark, not only because it establishes the unity of fever, but because it will justify the use of a remedy, seldom prescribed after the disease has acquired that name which associates it with stimulating medicines. The common name of this state of fever, is the _nervous_ fever. This name is improper; for it invades the nervous system by pain, delirium, and convulsions much less than several other states of fever. To prevent the absurd and often fatal association of ideas upon the treatment of this state of fever, I have called it, from its duration, the _low chronic_ state of fever. I have adopted the term _low_, from Dr. Butter's account of the remitting fever of children, in order to distinguish it from states of fever to be mentioned hereafter, in which the patient is not confined to his bed. This new name of the typhus or nervous fever establishes its analogy with several other diseases. We have the acute and the chronic rheumatism; the acute and chronic pneumony, commonly called the pleurisy and pulmonary consumption; the acute and chronic inflammation of the brain, known unfortunately by the unrelated names of phrenitis, madness, and internal dropsy of the brain. Why should we hesitate, in like manner, in admitting acute and chronic fever, in all those cases where no local inflammation attends? 8. The _typhoid_ state of fever is composed of the synocha and low chronic states of fever. It is the _slow_ nervous fever of Dr. Butter. The excitement of the blood-vessels is somewhat greater than in the _low_ chronic state of fever. Perhaps the muscular fibres of the blood-vessels, in this state of fever, are affected by different degrees of stimulus and excitement. Supposing a pulse to consist of eight cords, I think I have frequently felt more or less of them tense or relaxed, according as the fever partook more or less of the synocha, or low chronic states of fever. This state of fever occurs most frequently in what are called the hectic and puerperal fevers, and in the scarlatina. 9. The _hectic_ state of fever differs from all the other states of fever, by the want of regularity in its paroxysms, in which chills, fevers, and sweats are included; and by the brain, nerves, muscles, and alimentary canal being but little impaired in their functions by it. It appears to be an exclusive disease of the blood-vessels. It occurs in the pulmonary consumption, in some cases of lues, of scrophula, and of the gout, and after most of the states of fever which have been described. The force of the pulse is various, being occasionally synochoid, typhoid, and typhus. 10. Intermissions, or the _intermitting_ and remitting states of fever, are common to all the states of fever which have been mentioned. But they occur most distinctly and universally in those which partake of the bilious diathesis. They have been ascribed to the reproduction of bile, to the recurrence of debility, and to the influence of the heavenly bodies upon the system. None of these hypotheses has explained the recurrence of fever, where the bile has not been in fault, where debility is uniform, and where the paroxysms of fever do not accord with the revolutions of any part of the solar system. I have endeavoured to account for the recurrence of the paroxysm of fever, in common with all other periodical diseases, by means of a natural or adventitious association of motions. Dr. Percival has glanced at this law of animal matter; and Dr. Darwin has explained by it, in the most ingenious manner, many natural and morbid actions in the human body. 11. There is a state of fever in which the morbid action of the blood-vessels is so feeble as scarcely to be perceptible. Like the hectic state of fever, it seldom affects the brain, nerves, muscles, or alimentary canal. It is known in the southern states of America by the name of _inward_ fevers. The English physicians formerly described it by the name of febricula. These eleven states of fever may be considered as _primary_ in their nature. All the states which remain to be enumerated belong to some one of them, or they are compounds of two, three, or more of them. Even these primary states of fever seldom appear in the simple form in which they have been described. They often blend their symptoms; and sometimes all the states appear at different times in the course of a fever. This departure from a uniformity in the character of fevers must be sought for in the changes of the weather, in the casual application of fresh irritants, or in the operation of the remedies which have been employed to cure them. To the first class of the states of fever belong the sweating, the fainting, the burning, and the cold and chilly states of fever. 12. The _sweating_ state of fever occurs in the plague, in the yellow fever, in the small-pox, the pleurisy, the rheumatism, and in the hectic and intermitting states of fever. Profuse sweats appeared every other day in the autumnal fever of 1795 in Philadelphia, without any other symptom of an intermittent. The English sweating sickness was nothing but a symptom of the plague. The sweats in all these cases are the effects of morbid and excessive action, concentrated in the capillary vessels. 13. The _fainting_ state of fever accompanies the plague, the yellow fever, the small-pox, and some states of pleurisy. It is the effect of great depression; hence it occurs most frequently in the beginning of those states of fever. 14. The _burning_ state of fever has given rise to what has been called a species of fever. It is the causus of authors. Dr. Mosely, who rejects the epithet of yellow, when applied to the bilious fever, because it is only one of its accidental symptoms, very improperly distinguishes the same fever by another symptom, viz. the burning heat of the skin, and which is not more universal than the yellowness which attends it. 15. The _cold_ and _chilly_ state of fever differs from a common chilly fit, by continuing four or five days, and to such a degree, that the patient frequently cannot bear his arms out of the bed. The coldness is most obstinate in the hands and feet. A _coolness_ only of the skin attends in some cases, which is frequently mistaken for an absence of fever. Having mentioned those states of fever which affect the arterial system without any, or with but little local disease, I proceed next to enumerate those states of fever which belong to the II. Class of the order that was mentioned, in which there are local affections combined with general fever. They are, 16. The _intestinal_ state of fever. I have been anticipated in giving this epithet to fever, by Dr. Balfour[9]. It includes the cholera morbus, diarrh[oe]a, dysentery, and colic. The remitting bilious fever appears, in all the above forms, in the summer months. They all belong to the febris introversa of Dr. Sydenham. The jail fever appears likewise frequently in the form of diarrh[oe]a and dysentery. The dysentery is the offspring of marsh and human miasmata, but it is often induced in a weak state of the bowels, by other exciting causes. The colic occasionally occurs with states of fever to be mentioned hereafter. [9] Account of the Intestinal Remitting Fever of Bengal. 17. The _pulmonary_ state of fever includes the true and bastard pneumony in their acute forms; also catarrh from cold and influenza, and the chronic form of pneumony in what is called pulmonary consumption. 18. The _eruptive_ state of fever includes the small-pox, measles, erysipelas, miliary fever, chicken-pox, and pemphigus. 19. The _anginose_ state of fever includes all those affections of the throat which are known by the names of cynanche inflammatoria, tonsillaris, parotidea, maligna, scarlatina, and trachealis. The cynanche trachealis is a febrile disease. The membrane which produces suffocation and death in the wind-pipe is the effect of inflammation. It is said to be formed, like other membranes which succeed inflammation, from the coagulable lymph of the blood. 20. The _rheumatic_ state of fever is confined chiefly to the labouring part of mankind. The topical affection is seated most commonly in the joints and muscles, which, from being exercised more than other parts of the body, become more debilitated, and are, in consequence thereof, excited into morbid and inflammatory action. 21. The _arthritic_ or _gouty_ state of fever differs from the rheumatic, in affecting, with the joints and muscles, all the nervous and lymphatic systems, the viscera, and the skin. Its predisposing, exciting, and proximate causes are the same as the rheumatic and other states of fever. It bears the same ratio to rheumatism, which the yellow fever bears to the common bilious fever. It is a fever of more force than rheumatism. 22. The _cephalic_, in which are included the phrenitic, lethargic, apoplectic, paralytic, hydrocephalic, and maniacal states of fever. That madness is originally a state of fever, I infer, 1. From its causes, many of which are the same as those which induce all the other states of fever. 2. From its symptoms, particularly a full, tense, quick, and sometimes a slow pulse. 3. From the inflammatory appearances of the blood which has been drawn to relieve it. And, 4. From the phenomena exhibited by dissection in the brains of maniacs, being the same as are exhibited by other inflamed viscera after death. These are, effusions of water or blood, abscesses, and schirrus. The hardness in the brains of maniacs, taken notice of by several authors, is nothing but a schirrus (sui generis), induced by the neglect of sufficient evacuations in this state of fever. The reader will perceive by these observations, that I reject madness from its supposed primary seat in the mind or nerves. It is as much an original disease of the blood-vessels, as any other state of fever. It is to phrenitis, what pulmonary consumption is to pneumony. The derangement in the operations of the mind is the effect only of a chronic inflammation of the brain, existing without an abstraction of muscular excitement. 23. The _nephritic_ state of fever is often induced by calculi, but it frequently occurs in the gout, small-pox, and malignant states of fever. There is such an engorgement, or choaking of the vessels of the kidneys, that the secretion of the urine is sometimes totally obstructed, so that the bladder yields no water to the catheter. It is generally accompanied with a full or tense pulse, great pain, sickness, or vomiting, high coloured urine, and a pain along the thigh and leg, with occasionally a retraction of one of the testicles. It exists sometimes without any pain. Of this I met with several instances in the yellow fever of 1793. I include diabetes in this state of fever. 24. The _hydropic_ state of fever, in which are included collections of water, in the lungs, cavity of the thorax, cavity of the abdomen, ovaria, scrotum, testicles, and lower extremities, and usually preceded, and generally accompanied with morbid action in the blood-vessels. That dropsy is a state of fever, I have endeavoured to prove in another place[10]. Nineteen dropsies out of twenty appear to be original arterial diseases, and the water, which has been supposed to be their cause, is as much the effect of preternatural and morbid action in the blood-vessels, as pus, gangrene, and schirrus are of previous inflammation. This has been demonstrated, by the late Dr. Cooper, in a man who died of an ascites in the Pennsylvania hospital. Pus and blood, as well as water, were found in the cavity of the abdomen. It is no objection to this theory of dropsy, that we sometimes find water in the cavities of the body after death, without any marks of inflammation in the contiguous blood-vessels. We often find pus, both in the living and dead body, under the same circumstances, where we are sure it was not preceded by any of the obvious marks of inflammation. [10] On Dropsies, vol. II. 25. The _hæmorrhagic_ state of fever, in which are included discharges of blood from the nose, lungs, stomach, liver, bowels, kidneys and bladder, hæmorrhoidal vessels, uterus, and skin. Hæmorrhages have been divided into active and passive. It would be more proper to divide them, like other states of general fever, into hæmorrhages of strong and feeble morbid action. There is seldom an issue of blood from a vessel in which there does not exist preternatural or accumulated excitement. We observe this hæmorrhagic state of fever most frequently in malignant fevers, in pulmonary consumption, in pregnancy, and in that period of life in which the menses cease to be regular. 26. The _amenorrhagic_ state of fever occurs more frequently than is suspected by physicians. A full and quick pulse, head-ach, thirst, and preternatural heat often accompany a chronic obstruction of the menses. The inefficacy, and even hurtful effects, of what are called emenagogue medicines, in this state of the system, without previous depletion, show the propriety of introducing it among the different states of fever. I have designedly omitted to take notice of other states of general fever accompanied with local disease, because they are most frequently combined with some one or more of those which have been mentioned. They may all be seen in Dr. Cullen's Synopsis, with their supposed respective generic characters, under the class of pyrexiæ, and the order of fevers. We come now in the III. And last place, to mention the _misplaced_ states of fever. The term is not a new one in medicine. The gout is said to be misplaced, when it passes from the feet to the viscera. The periodical pains in the head, eyes, ears, jaws, hips, and back, which occur in the sickly autumnal months, and which impart no fulness, force, nor frequency to the pulse, are all misplaced fevers. There are, besides these, many other local morbid affections, which are less suspected of belonging to febrile diseases. The nature of these states of fever may easily be understood, by recollecting one of the laws of sensation, that is, that certain impressions, which excite neither sensation nor motion in the part of the body to which they are applied, excite both in another part. Thus worms, which are not felt in the stomach or bowels, often produce a troublesome sensation in the throat, and a stone, which is attended with no pain in the bladder, produces a troublesome itching in the glans penis. In like manner, the irritants which produce fever in ordinary cases pass through the blood-vessels, and convey their usual morbid effects into a remote part of the body which has been prepared to receive them by previous debility. That this is the case, I infer further, from fevers being called back from their misplaced or suffocated situations, by creating an artificial debility in the arteries by the abstraction of blood. This is often done in muscular convulsions, and in several diseases of the brain. Under this class of fevers are included 27. The _chronic hepatic_ state of fever. The causes, symptoms, and remedies of the liver disease of the East-Indies, as mentioned by Dr. Girdlestone, all prove that it is nothing but a bilious fever translated from the blood-vessels, and absorbed, or suffocated, as it were, in the liver. This view of the chronic hepatitis is important, inasmuch as it leads to the liberal use of all the remedies which cure bilious fever. Gall stones and contusions now and then produce a hepatitis, but under no other circumstances do I believe it ever exists, but as a symptom of general or latent fever. 28. The hæmorrhoids are frequently a local disease, but they are sometimes accompanied with pain, giddiness, chills, and an active pulse. When these symptoms occur, it should be considered as a _hæmorrhoidal_ state of fever. 29. The opthalmia, when it occurs, as it frequently does in sickly seasons, with a quick and tense pulse, and pains diffused over the whole head, may properly be called an _opthalmic_ state of fever. 30. The tooth-ach, and 31. Ear-ach, when they arise from colds, and are attended with great heat, a quick and tense pulse, and pains in the head, are _odontalgic_ and _otalgic_ states of fever. 32. The apthæ, from the pain and fever which attend them, are justly entitled to the name of the _apthous_ state of fever. 33. The symptoms of scrophula, as described by Dr. Hardy, in his treatise on the glandular disease of Barbadoes, clearly prove it to be a _misplaced_ state of fever. 34. The scurvy has lately been proved by Dr. Claiborne, in his inaugural dissertation, published in the year 1797, to arise from so many of the causes, and to possess so many of the symptoms, of the low chronic and petechial states of fever, that I see no impropriety in considering it as a state of fever. 35. The _convulsive_ or _spasmodic_ state of fever. Convulsions, it is well known, often usher in fevers, more especially in children. But the connection between spasmodic affections and fever, in adults, has been less attended to by physicians. The same causes which produced general fever and hepatitis in the East-Indies, in some soldiers, produced locked jaw in others. Several of the symptoms of this disease, as described by Dr. Girdlestone, such as coldness on the surface of the body, cold sweats on the hands and feet, intense thirst, a white tongue, incessant vomitings, and carbuncles, all belong to the malignant state of fever[11]. By means of blood-letting, and the other remedies for the violent state of bilious fever, I have seen the convulsions in this disease translated from the muscles to the blood-vessels, where they immediately produced _all_ the common symptoms of fever. [11] Essay on the Spasmodic Affections in India, p. 53, 54, 55. 36. The _hysterical_ and _hypochondriacal_ states of fever. The former is known by a rising in the throat, which is for the most part erroneously ascribed to worms, by pale urine, and by a disposition to shed tears, or to laugh upon trifling occasions. The latter discovers itself by false opinions of the nature and danger of the disease under which the patient labours. Both these states of the nervous system occur frequently in the gout and in the malignant state of fever. It is common to say, in such cases, that patients have a complication of diseases; but this is not true, for the hysterical and hypochondriacal symptoms are nothing but the effects of one remote cause, concentrating its force chiefly upon the nerves and muscles. 37. The _cutaneous_ state of fever. Dr. Sydenham calls a dysentery a "febris introversa." Eruptions of the skin are often nothing but the reverse of this introverted fever. They are a fever translated to the skin; hence we find them most common in those countries and seasons in which fevers are epidemic. The prickly heat, the rash, and the essere of authors, are all states of misplaced fever. "Agues, fevers, and even _pleurisies_ (says Mr. Townsend, in his Journey through Spain[12]), are said often to terminate in scabies, and this frequently gives place to them, returning, however, when the fever ceases. In adults it takes possession of the hands and arms, with the legs and thighs, covering them with a filthy crust." Small boils are common among the children in Philadelphia, at the time the cholera infantum makes its appearance. These children always escape the summer epidemic. The elephantiasis described by Dr. Hillary, in his account of the diseases of Barbadoes, is evidently a translation of an intermittent to one of the limbs. It is remarkable, that the leprosy and malignant fevers of all kinds have appeared and declined together in the same ages and countries. But further, petechiæ sometimes appear on the skin without fever. Cases of this kind, with and without hæmorrhages, are taken notice of by Riverius[13], Dr. Duncan, and many other practical writers. They are cotemporary or subsequent to fevers of a malignant complexion. They occur likewise in the scurvy. From some of the predisposing, remote, and exciting causes of this disease, and from its symptoms and remedies, I have suspected it, like the petechiæ mentioned by Riverius, to be originally a fever generated by human miasmata, in a misplaced state. The hæmorrhages which sometimes accompany the scurvy, certainly arise from a morbid state of the blood-vessels. The heat and quick pulse of fever are probably absent, only because the preternatural excitement of the whole sanguiferous system is confined to those extreme or cutaneous vessels which pour forth blood. In like manner the fever of the small-pox deserts the blood-vessels, as soon as a new action begins on the skin. Or perhaps the excitability of the larger blood-vessels may be so far exhausted by the long or forcible impression of the remote and predisposing causes of the scurvy, as to be incapable of undergoing the convulsive action of general fever. [12] Vol. II. Dublin edition, p. 262. [13] Praxis Medica, lib. xviii. cap. i. With this I close my inquiry into the cause of fever. It is imperfect from its brevity, as well as from other causes. I commit it to my pupils to be corrected and improved. "We think our fathers fools, so wise we grow. Our wiser sons, _I hope_, will think us so." AN ACCOUNT OF THE _Bilious Remitting Yellow Fever_, AS IT APPEARED IN PHILADELPHIA, IN THE YEAR 1793. Before I proceed to deliver the history of this fever, it will be proper to give a short account of the diseases which preceded it. The state of the weather during the first seven months of the year, and during the time in which the fever prevailed in the city, as recorded by Mr. Rittenhouse, will be inserted immediately after the history of the disease. The _mumps_, which made their appearance in December, 1792, continued to prevail during the month of January, 1793. Besides this disease there were many cases of catarrh in the city, brought on chiefly by the inhabitants exposing themselves for several hours on the damp ground, in viewing the aërial voyage of Mr. Blanchard, on the 9th day of the month. The weather, which had been moderate in December and January, became cold in February. The mumps continued to prevail during this month with symptoms so inflammatory as to require, in some cases, two bleedings. Many people complained this month of pains and swellings in the jaws. A few had the scarlatina anginosa. The mumps, pains in the jaws, and scarlatina continued throughout the month of March. I was called to two cases of pleurisy in this month, which terminated in a temporary mania. One of them was in a woman of ninety years of age, who recovered. The blood drawn in the other case (a gentleman from Maryland) was dissolved. The continuance of a tense pulse induced me, notwithstanding, to repeat the bleeding. The blood was now sizy. A third bleeding was prescribed, and my patient recovered. Several cases of obstinate erysipelas succeeded inoculation in children during this and the next month, one of which proved fatal. Blossoms were universal on the fruit-trees, in the gardens of Philadelphia, on the first day of April. The scarlatina anginosa continued to be the reigning epidemic in this month. There were several warm days in May, but the city was in general healthy. The birds appeared two weeks sooner this spring than usual. The register of the weather shows, that there were many warm days in June. The scarlatina continued to maintain its empire during this month. The weather was uniformly warm in July. The scarlatina continued during the beginning of this month, with symptoms of great violence. A son of James Sharswood, aged seven years, had, with the common symptoms of this disease, great pains and swellings in his limbs, accompanied with a tense pulse. I attempted in vain to relieve him by vomits and purges. On the 10th day of the month, I ordered six ounces of blood to be drawn from his arm, which I observed afterwards to be very sizy. The next day he was nearly well. Between the 22d and the 24th days of the month, there died three persons, whose respective ages were 80, 92, and 96-1/2. The weather at this time was extremely warm. I have elsewhere taken notice of the fatal influence of extreme heat, as well as cold, upon human life in old people. A few bilious remitting fevers appeared towards the close of this month. One of them under my care ended in a typhus or chronic fever, from which the patient was recovered with great difficulty. It was the son of Dr. Hutchins, of the island of Barbadoes. The weather, for the first two or three weeks in August, was temperate and pleasant. The cholera morbus and remitting fevers were now common. The latter, were attended with some inflammatory action in the pulse, and a determination to the breast. Several dysenteries appeared at this time, both in the city and in its neighbourhood. During the latter part of July, and the beginning of this month, a number of the distressed inhabitants of St. Domingo, who had escaped the desolation of fire and sword, arrived in the city. Soon after their arrival, the influenza made its appearance, and spread rapidly among our citizens. The scarlatina still kept up a feeble existence among children. The above diseases were universal, but they were not attended with much mortality. They prevailed in different parts of the city, and each seemed to appear occasionally to be the ruling epidemic. The weather continued to be warm and dry. There was a heavy rain on the 25th of the month, which was remembered by the citizens of Philadelphia, as the last that fell for many weeks afterwards. There was something in the heat and drought of the summer months which was uncommon, in their influence upon the human body. Labourers every where gave out (to use the country phrase) in harvest, and frequently too when the mercury in Fahrenheit's thermometer was under 84°. It was ascribed by the country people to the calmness of the weather, which left the sweat produced by heat and labour to dry slowly upon the body. The crops of grain and grass were impaired by the drought. The summer fruits were as plentiful as usual, particularly the melons, which were of an excellent quality. The influence of the weather upon the autumnal fruits, and upon vegetation in general, shall be mentioned hereafter. I now enter upon a detail of some solitary cases of the epidemic, which soon afterwards spread distress through our city, and terror throughout the United States. On the 5th of August, I was requested by Dr. Hodge to visit his child. I found it ill with a fever of the bilious kind, which terminated (with a yellow skin) in death on the 7th of the same month. On the 6th of August, I was called to Mrs. Bradford, the wife of Mr. Thomas Bradford. She had all the symptoms of a bilious remittent, but they were so acute as to require two bleedings, and several successive doses of physic. The last purge she took was a dose of calomel, which operated plentifully. For several days after her recovery, her eyes and face were of a yellow colour. On the same day, I was called to the son of Mrs. M'Nair, who had been seized violently with all the usual symptoms of a bilious fever. I purged him plentifully with salts and cremor tartar, and took ten or twelve ounces of blood from his arm. His symptoms appeared to yield to these remedies; but on the 10th of the month a hæmorrhage from the nose came on, and on the morning of the 12th he died. On the 7th of this month I was called to visit Richard Palmer, a son of Mrs. Palmer, in Chesnut-street. He had been indisposed for several days with a sick stomach, and vomiting after eating. He now complained of a fever and head-ach. I gave him the usual remedies for the bilious fever, and he recovered in a few days. On the 15th day of the same month I was sent for to visit his brother William, who was seized with all the symptoms of the same disease. On the 5th day his head-ach became extremely acute, and his pulse fell to sixty strokes in a minute. I suspected congestion to have taken place in his brain, and ordered him to lose eight ounces of blood. His pulse became more frequent, and less tense after bleeding, and he recovered in a day or two afterwards. On the 14th day of this month I was sent for to visit Mrs. Leaming, the wife of Mr. Thomas Leaming. I suspected at first that she had the influenza, but in a day or two her fever put on bilious symptoms. She was affected with an uncommon disposition to faint. Her pulse was languid, but _tense_. I took a few ounces of blood from her, and purged her with salts and calomel. I afterwards gave her a small dose of laudanum which disagreed with her. In my note book I find I have recorded that "she was worse for it." I was led to make this remark by its being so very uncommon for a person, who had been properly bled and purged, to take laudanum in a common bilious fever without being benefited by it. She recovered, however, slowly, and was yellow for many days afterwards. On the morning of the 18th of this month I was requested to visit Peter Aston, in Vine-street, in consultation with Dr. Say. I found him on the third day of a most acute bilious fever. His eyes were inflamed, and his face flushed with a deep red colour. His pulse seemed to forbid evacuations. We prescribed the strongest cordials, but to no purpose. We found him, at 6 o'clock in the evening, sitting upon the side of his bed, perfectly sensible, but without a pulse, with cold clammy hands, and his face of a yellowish colour. He died a few hours after we left him. None of the cases which I have mentioned excited the least apprehension of the existence of a malignant or yellow fever in our city; for I had frequently seen sporadic cases in which the common bilious fever of Philadelphia had put on symptoms of great malignity, and terminated fatally in a few days, and now and then with a yellow colour on the skin, before or immediately after death. On the 19th of this month I was requested to visit the wife of Mr. Peter Le Maigre, in Water-street, between Arch and Race-streets, in consultation with Dr. Foulke and Dr. Hodge. I found her in the last stage of a highly bilious fever. She vomited constantly, and complained of great heat and burning in her stomach. The most powerful cordials and tonics were prescribed, but to no purpose. She died on the evening of the next day. Upon coming out of Mrs. Le Maigre's room I remarked to Dr. Foulke and Dr. Hodge, that I had seen an unusual number of bilious fevers, accompanied with symptoms of uncommon malignity, and that I suspected all was not right in our city. Dr. Hodge immediately replied, that a fever of a most malignant kind had carried off four or five persons within sight of Mr. Le Maigre's door, and that one of them had died in twelve hours after the attack of the disease. This information satisfied me that my apprehensions were well founded. The origin of this fever was discovered to me at the same time, from the account which Dr. Foulke gave me of a quantity of damaged coffee which had been thrown upon Mr. Ball's wharf, and in the adjoining dock, on the 24th of July, nearly in a line with Mr. Le Maigre's house, and which had putrefied there to the great annoyance of the whole neighbourhood. After this consultation I was soon able to trace all the cases of fever which I have mentioned to this source. Dr. Hodge lived a few doors above Mr. Le Maigre's, where his child had been exposed to the exhalation from the coffee for several days. Mrs. Bradford had spent an afternoon in a house directly opposite to the wharf and dock on which the putrid coffee had emitted its noxious effluvia, a few days before her sickness, and had been much incommoded by it. Her sister, Mrs. Leaming, had visited her during her illness at her house, which was about two hundred yards from the infected wharf. Young Mr. M'Nair and Mrs. Palmer's two sons had spent whole days in a compting house near where the coffee was exposed, and each of them had complained of having been made sick by its offensive smell, and Mr. Aston had frequently been in Water-street near the source of the exhalation. This discovery of the malignity, extent, and origin of a fever which I knew to be attended with great danger and mortality, gave me great pain. I did not hesitate to name it the _bilious remitting yellow fever_. I had once seen it epidemic in Philadelphia, in the year 1762. Its symptoms were among the first impressions which diseases made upon my mind. I had recorded some of these symptoms, as well as its mortality. I shall here introduce a short account of it, from a note book which I kept during my apprenticeship. "In the year 1762, in the months of August, September, October, November, and December, the bilious yellow fever prevailed in Philadelphia, after a _very hot summer_, and spread like a plague, carrying off daily, for some time, upwards of twenty persons. "The patients were generally seized with rigours, which were succeeded with a violent fever, and pains in the head and back. The pulse was full, and sometimes irregular. The eyes were inflamed, and had a yellowish cast, and a vomiting almost always attended. "The 3d, 5th, and 7th days were mostly critical, and the disease generally terminated on one of them, in life or death. "An eruption on the 3d or 7th day over the body proved salutary. "An excessive heat and burning about the region of the liver, with cold extremities, portended death to be at hand." I have taken notice, in my note book, of the principal remedy which was prescribed in this fever by my preceptor in medicine, but this shall be mentioned hereafter. Upon my leaving Mrs Le Maigre's, I expressed my distress at what I had discovered, to several of my fellow-citizens. The report of a malignant and mortal fever being in town spread in every direction, but it did not gain universal credit. Some of those physicians who had not seen patients in it denied that any such fever existed, and asserted (though its mortality was not denied) that it was nothing but the common annual remittent of the city. Many of the citizens joined the physicians in endeavoring to discredit the account I had given of this fever, and for a while it was treated with ridicule or contempt. Indignation in some instances was excited against me, and one of my friends, whom I advised in this early stage of the disease to leave the city, has since told me that for that advice "he had hated me." My lot in having thus disturbed the repose of the public mind, upon the subject of general health, was not a singular one. There are many instances upon record, of physicians who have rendered themselves unpopular, and even odious to their fellow-citizens, by giving the first notice of the existence of malignant and mortal diseases. A physician, who asserted that the plague was in Messina, in the year 1743, excited so much rage in the minds of his fellow-citizens against him, as to render it necessary for him to save his life by retreating to one of the churches of that city. In spite, however, of all opposition, the report of the existence of a malignant fever in the city gained so much ground, that the governor of the state directed Dr. Hutchinson, the inspector of sickly vessels, to inquire into the truth of it, and into the nature of the disease. In consequence of this order, the doctor wrote letters to several of the physicians in the city, requesting information relative to the fever. To his letter to me, dated the 24th of August, I replied on the same day, and mentioned not only the existence of a malignant fever, but the streets it occupied, and my belief of its being derived from a quantity of coffee which had putrified on a wharf near Arch-street. This, and other information collected by the doctor, was communicated to the health officer, in a letter dated the 27th of August, in which he mentioned the parts of the city where the disease prevailed, and the number of persons who had died of it, supposed by him to be about 40, but which subsequent inquiries proved to be more than 150. He mentioned further, in addition to the damaged coffee, some putrid hides, and other putrid animal and vegetable substances, as the supposed cause of the fever, and concluded by saying, as he had not heard of any foreigners or sailors being infected, nor of its being found in any lodging-houses, that "it was not an imported disease." In the mean while the disease continued to spread, and with a degree of mortality that had never been known from common fevers. On the 25th of the month, the college of physicians was summoned by their president to meet, in order to consult about the best methods of checking the progress of the fever in the city. After some consideration upon the nature of the disease, a committee was appointed to draw up some directions for those purposes; and the next day the following were presented to the college, and adopted unanimously by them. They were afterwards published in most of the newspapers. _Philadelphia, August 26th, 1793._ The college of physicians having taking into consideration the malignant and contagious fever that now prevails in this city, have agreed to recommend to their fellow-citizens the following means of preventing its progress. 1st. That all unnecessary intercourse should be avoided with such persons as are infected by it. 2d. To place a mark upon the door or window of such houses as have any infected persons in it. 3d. To place the persons infected in the centre of large and airy rooms, in beds without curtains, and to pay the strictest regard to cleanliness, by frequently changing their body and bed linen, also by removing, as speedily as possible, all offensive matters from their rooms. 4th. To provide a large and airy hospital, in the neighbourhood of the city, for the reception of such poor persons as cannot be accommodated with the above advantages in private houses. 5th. To put a stop to the tolling of the bells. 6th. To bury such persons as die of this fever in carriages, and in as private a manner as possible. 7th. To keep the streets and wharves of the city as clean as possible. As the contagion of the disease may be taken into the body, and pass out of it without producing the fever, unless it be rendered active by some occasional cause, the following means should be attended to, to prevent the contagion being excited into action in the body. 8th. To avoid all fatigue of body and mind. 9th. To avoid _standing_ or _sitting_ in the sun; also in a current of air, or in the evening air. 10th. To accommodate the dress to the weather, and to exceed rather in warm, than in cool clothing. 11th. To avoid intemperance, but to use fermented liquors, such as wine, beer, and cyder, in moderation. The college conceive _fires_ to be very ineffectual, if not dangerous means of checking the progress of this fever. They have reason to place more dependence upon the burning of _gunpowder_. The benefits of _vinegar_ and _camphor_ are confined chiefly to infected rooms, and they cannot be used too frequently upon handkerchiefs, or in smelling-bottles, by persons whose duty calls to visit or attend the sick. Signed by order of the college, WILLIAM SHIPPEN, jun. _Vice president_. SAMUEL P. GRIFFITTS, _Secretary_. From a conviction that the disease originated in the putrid exhalations from the damaged coffee, I published in the American Daily Advertiser, of August 29th, a short address to the citizens of Philadelphia, with a view of directing the public attention to the spot where the coffee lay, and thereby of checking the progress of the fever as far as it was continued by the original cause. This address had no other effect than to produce fresh clamours against the author; for the citizens, as well as most of the physicians of Philadelphia, had adopted a traditional opinion that the yellow fever could exist among us only by importation from the West-Indies. In consequence, however, of a letter from Dr. Foulke to the mayor of the city, in which he had decided, in a positive manner, in favour of the generation of the fever from the putrid coffee, the mayor gave orders for the removal of the coffee, and the cleaning of the wharf and dock. It was said that measures were taken for this purpose; but Dr. Foulke, who visited the place where the coffee lay, repeatedly assured me, that they were so far from being effectual, that an offensive smell was exhaled from it many days afterwards. I shall pass over, for the present, the facts and arguments on which I ground my assertion of the generation of this fever in our city. They will come in more properly in the close of the history of the disease. The seeds of the fever, when received into the body, were generally excited into action in a few days. I met with several cases in which they acted so as to produce a fever on the same day in which they were received into the system, and I heard of two cases in which they excited sickness, fainting, and fever within one hour after the persons were exposed to them. I met with no instance in which there was a longer interval than sixteen days between their being received into the body and the production of the disease. This poison acted differently in different constitutions, according to previous habits, to the degrees of predisposing debility, or to the quantity and concentration of the miasmata which had been received into the body. In some constitutions, the miasmata were at once a remote, a predisposing, and an exciting cause of the disease; hence some persons were affected by them, who had not departed in any instance from their ordinary habits of living, as to diet, dress, and exercise. But it was more frequently brought on by those causes acting in succession to each other. I shall here refer the reader to the principles laid down in the outlines of the theory of fever, for an account of the manner in which the system was predisposed to this disease, by the debility induced by the reduction of its excitement, by action and abstraction, and by subsequent depression. Where a predisposition was thus produced, the fever was excited by the following causes, acting directly or indirectly upon the system. Where this predisposition did not exist, the exciting causes produced both the predisposition and the disease. They were, 1. _Great labour_, or exercises of body or mind, in walking, riding, watching, or the like. It was labour which excited the disease so universally among the lower class of people. A long walk often induced it. Few escaped it after a day, or even a few hours spent in gunning. A hard trotting horse brought it on two of my patients. Perhaps riding on horseback, and in the sun, was the exciting cause of the disease in most of the citizens and strangers who were affected by it in their flight from the city. A fall excited it in a girl, and a stroke upon the head excited it in a young man who came under my care. Many people were seized with the disease in consequence of their exertions on the night of the 7th of September, in extinguishing the fire which consumed Mr. Dobson's printing-office, and even the less violent exercise of working the fire engines, for the purpose of laying the dust in the streets, added frequently to the number of the sick. 2. _Heat_, from every cause, but more especially the heat of the sun, was a very common exciting cause of the disease. The register of the weather during the latter end of August, the whole of September, and the first two weeks in October will show how much the heat of the sun must have contributed to excite the disease, more especially among labouring people. The heat of common fires likewise became a frequent cause of the activity of the miasmata where they had been received into the body; hence the greater mortality of the disease among bakers, blacksmiths, and hatters than among any other class of people. 3. _Intemperance_ in eating or drinking. A plentiful meal, and a few extra glasses of wine seldom failed of exciting the fever. But where the body was strongly impregnated with the seeds of the disease, even the smallest deviation from the customary stimulus of diet, in respect to quality or quantity, roused them into action. A supper of twelve oysters in one, and of but three in another, of my patients produced the disease. Half an ounce of meat excited it in a lady who had lived, by my advice, for two weeks upon milk and vegetables, and even a supper of sallad, dressed after the French fashion, excited it in one of Dr. Mease's patients. 4. _Fear._ In many people the disease was excited by a sudden paroxysm of fear; but I saw some remarkable instances where timid people escaped the disease, although they were constantly exposed to it. Perhaps a moderate degree of fear served to counteract the excessive stimulus of the miasmata, and thereby to preserve the body in a state of healthy equilibrium. I am certain that fear did no harm after the disease was formed, in those cases where great morbid excess of action had taken place. It was an early discovery of this fact which led me not to conceal from my patients the true name of this fever, when I was called to them on the _day_ of their being attacked by it. The fear co-operated with some of my remedies (to be mentioned hereafter) in reducing the morbid excitement of the arterial system. 5. _Grief._ It was remarkable that the disease was not excited in many cases in the attendants upon the sick, while there was a hope of their recovery. The grief which followed the extinction of hope, by death, frequently produced it within a day or two afterwards, and that not in one person only, but often in most of the near relations of the deceased. But the disease was also produced by a change in the state of the mind directly opposite to that which has been mentioned. Many persons that attended patients who recovered, were seized with the disease a day or two after they were relieved from the toils and anxiety of nursing. The collapse of the mind from the abstraction of the stimulus of hope and desire, by their ample gratification, probably produced that debility, and loss of the equilibrium in the system, which favoured the activity of the miasmata in the manner formerly mentioned[14]. [14] Outlines of a Theory of Fever. The effects of both the states of mind which have been described, have been happily illustrated by two facts which are recorded by Dr. Jackson[15]. He tells us, that the garrisons of Savannah and York-Town were both healthy during the siege of those towns, but that the former became sickly as soon as the French and American armies retreated, from before it, and the latter, immediately after its capitulation. [15] Treatise on the Fevers of Jamaica, p. 298. 6. _Cold._ Its action, in exciting the disease, depended upon the diminution of the necessary and natural heat of the body, and thereby so far destroying the equilibrium of the system, as to enable the miasmata to produce excessive or convulsive motions in the blood-vessels. The night air, even in the warm month of September, was often so cool as to excite the disease, where the dress and bed-clothes were not accommodated to it. It was excited in one case by a person's only wetting his feet, in the month of October, and neglecting afterwards to change his shoes and stockings. Every change in the weather, that was short of producing frost, evidently increased the number of sick people. This was obvious after the 18th and 19th of September, when the mercury fell to 44° and 45°. The hopes of the city received a severe disappointment upon this occasion, for I well recollect there was a general expectation that this change in the weather would have checked the disease. The same increase of the number of sick was observed to follow the cool weather which succeeded the 6th and 7th of October, on which days the mercury fell to 43° and 46°. It was observed that those persons who were _habitually_ exposed to the cool air, were less liable to the disease than others. I ascribe it to the _habitual_ impression of the cool night air upon the bodies of the city watchmen, that but four or five of them, out of twenty-five, were affected by the disease. After the body had been heated by violent exercise, a breeze of cool air sometimes excited the disease in those cases where there had been no change in the temperature of the weather. 7. _Sleep._ A great proportion of all who were affected by this fever, were attacked in the night. Sleep induced what I have called debility from abstraction, and thereby disposed the miasmata which floated in the blood, to act with such force upon the system as to destroy its equilibrium, and thus to excite a fever. The influence of sleep as a predisposing, and exciting cause was often assisted by the want of bed-clothes, suited to the midnight or morning coolness of the air. 8. _Immoderate evacuations._ The efficacy of moderate purging and bleeding in preventing the disease, led some people to use those remedies in an excess, which both predisposed to the disease, and excited it. The morbid effects of these evacuations, were much aided by fear, for it was this passion which perverted the judgment in such a manner, as to lead to the excessive use of remedies, which, to be effectual, should only be used in moderate quantities. The disease appeared with different symptoms, and in different degrees, in different people. They both varied likewise with the weather. In describing the disease, I shall take notice of the changes in the symptoms, which were produced by changes in the temperature of the air. The precursors, or premonitory signs of this fever were, costiveness, a dull pain in the right side, defect of appetite, flatulency, perverted taste, heat in the stomach, giddiness, or pain in the head, a dull, watery, brilliant, yellow, or red eye, dim and imperfect vision, a hoarseness, or slight sore throat, low spirits, or unusual vivacity, a moisture on the hands, a disposition to sweat at nights, or after moderate exercise, or a sudden suppression of night sweats. The dull eye, and the lowness of spirits, appeared to be the effects of such an excess in the stimulus of the miasmata as to induce depression, while the brilliant eye, and the unusual vivacity, seemed to have been produced by a less quantity of the miasmata acting as a cordial upon the system. More or less of these symptoms frequently continued for two or three days before the patients were confined to their beds, and in some people they continued during the whole time of its prevalence in the city, without producing the disease. I wish these symptoms to be remembered by the reader. They will form the corner stone of a system which I hope will either eradicate the disease altogether, or render it as safe as an intermitting fever, or as the small-pox when it is received by inoculation. Frequent as these precursors of the fever were, they were not universal. Many went to bed in good health, and awoke in the night with a chilly fit. Many rose in the morning after regular and natural sleep, and were seized at their work, or after a walk, with a sudden and unexpected attack of the fever. In most of these cases the disease came on with a chilly fit, which afforded by its violence or duration a tolerable presage of the issue of the disease. Upon entering a sick room where a patient was confined by this fever, the first thing that struck the eye of a physician was the countenance. It was as much unlike that which is exhibited in the common bilious fever, as the face of a wild, is unlike the face of a mild domestic animal. The eyes were sad, watery, and so inflamed, in some cases, as to resemble two balls of fire. Sometimes they had a most brilliant or ferocious appearance. The face was suffused with blood, or of a dusky colour, and the whole countenance was downcast and clouded. After the 10th of September, when a determination of blood to the brain became universal, there was a preternatural dilatation of the pupil. Sighing attended in almost every case. The skin was dry, and frequently of its natural temperature. These were the principal symptoms which discovered themselves to the eye and hand of a physician. The answers to the first questions proposed upon visiting a patient, were calculated to produce a belief in the mind of a physician, that the disease under which the patient laboured was not the prevailing malignant epidemic. I did not for many weeks meet with a dozen patients, who acknowledged that they had any other indisposition than a common cold, or a slight remitting or intermitting fever. I was particularly struck with this self-deception in many persons, who had nursed relations that had died with the yellow fever, and who had been exposed to it in neighbourhoods where it had prevailed for days and even weeks with great mortality. I shall hereafter trace a part of this disposition in the sick to deceive themselves to the influence of certain publications, which appeared soon after the disease became epidemic in the city. In the further history of this fever, I shall describe its symptoms as they appeared, I. In the sanguiferous system. II. In the liver, lungs, and brain. III. In the alimentary canal; in which I include the stomach as well as the bowels. IV. In the secretions and excretions. V. In the nervous system. VI. In the senses and appetites. VII. In the lymphatic and glandular system. VIII. Upon the skin. IX. In the blood. After having finished this detail, I shall mention some general characters of the disease, and afterwards subdivide it into classes, according to its degrees and duration. I. The _blood-vessels_ were affected more or less in every case of this fever. I have elsewhere said, that a fever is occasioned by a convulsion in the arterial system[16]. When the epidemic, which we are now considering, came on with a full, tense, and quick pulse, this convulsion was very perceptible; but it frequently came on with a weak pulse, often without any preternatural frequency or quickness, and sometimes so low as not to be perceived without pressing the artery at the wrists. In many cases the pulse intermitted after the fourth, in some after the fifth, and in others after the fourteenth stroke. These intermissions occurred in several persons who were infected, but who were not confined by the fever. They likewise continued in several of my patients for many days after their recovery. This was the case in particular in Mrs. Clymer, Mrs. Palmer's son William, and in a son of Mr. William Compton. In some, there was a preternatural slowness of the pulse. It beat 44 strokes in a minute in Mr. B. W. Morris, 48 in Mr. Thomas Wharton, jun. and 64 in Mr. William Sansom, at a time when they were in the most imminent danger. Dr. Physick informed me, that in one of his patients the pulse was reduced in frequency to 30 strokes in a minute. All these different states of the pulse have been taken notice of by authors who have described pestilential fevers[17]. They have been improperly ascribed to the absence of fever: I would rather suppose that they are occasioned by the stimulus of the remote cause acting upon the arteries with too much force to admit of their being excited into quick and convulsive motions. The remedy which removed it (to be mentioned hereafter) will render this explanation of its cause still more probable. Milton describes a darkness from an excess of light. In like manner we observe, in this small, intermitting, and slow pulse, a deficiency of strength from an excess of force applied to it. In nearly every case of it which came under my notice, it was likewise tense or chorded. This species of pulse occurred chiefly in the month of August, and in the first ten days in September. I had met with it formerly in a sporadic case of yellow fever. It was new to all my pupils. One of them, Mr. Washington, gave it the name of the "undescribable pulse." It aided in determining the character of this fever before the common bilious remittent disappeared in the city. For a while, I ascribed this peculiarity in the pulse, more especially its _slowness_, to an affection of the brain only, and suspected that it was produced by what I have taken the liberty elsewhere to call the _phrenicula_, or inflammatory state of the internal dropsy of the brain, and which I have remarked to be an occasional symptom and consequence of remitting fever. I was the more disposed to adopt this opinion, from perceiving this slow, chorded, and intermitting pulse more frequently in children than in adults. Impressed with this idea, I requested Mr. Coxe, one of my pupils, to assist me in examining the state of the eyes. For two days we discovered no change in them, but on the third day after we began to inspect them, we both perceived a preternatural dilatation of the pupils, in different patients; and we seldom afterwards saw an eye in which it was absent. In Dr. Say it was attended by a squinting, a symptom which marks a high degree of a morbid affection of the brain. Had this slowness or intermission in the pulse occurred only after signs of inflammation or congestion had appeared in the brain, I should have supposed that it had been derived wholly from that cause; but I well recollect having felt it several days before I could discover the least change in the pupil of the eye. I am forced therefore to call in the operation of another cause, to assist in accounting for this state of the pulse, and this I take to be a spasmodic affection, accompanied with preternatural dilatation or contraction of the heart. Lieutaud mentions this species of pulse in several places, as occurring with an undue enlargement of that muscle[18]. Dr. Ferriar describes a case, in which a low, irregular, intermitting, and hardly perceptible pulse attended a morbid dilatation of the heart[19]. In a letter I received from Mr. Hugh Ferguson, then a student of medicine in the college of Edinburgh, written from Dublin, during the time of a visit to his father, and dated September 30th, 1793, I find a fact which throws additional light upon this subject. "A case (says my young correspondent) where a remarkable intermission of pulse was observed, occurred in this city last year. A gentleman of the medical profession, middle aged, of a delicate habit of body, and who had formerly suffered phthisical attacks, was attacked with the acute rheumatism. Some days after he was taken ill, he complained of uncommon fulness, and a very peculiar kind of sensation about the præcordia, which it was judged proper to relieve by copious blood-letting. This being done, the uneasiness went off. It returned, however, three or four times, and was as often relieved by bleeding. During each of his fits (if I may call them so), the patient experienced an almost total remission of his pains in his limbs; but they returned with equal or greater violence after blood-letting. During the fit there was an intermission of the pulse (the first time) of no less than thirteen strokes. It was when beating full, strong, and slow. The third intermission was of nine strokes. The gentleman soon recovered, and has enjoyed good health for ten months past. The opinion of some of his physicians was, that the heart was affected, as a muscle, by the rheumatism, and alternated with the limbs." [16] Outlines of a Theory of Fever. [17] Vergasca, Sorbait, and Boate in Haller's Bibliotheca Medicinæ, vol. iii. also by Dr. Stubbs in the Philosophical Transactions, and Riverius in his treatise de febre pestilenti. [18] Historia Anatomica Medica, vol ii. obs. 405, 418, 423, 510. [19] Medical Histories and Reflections, p. 150. I am the more inclined to believe the peculiarity in the pulse which has been mentioned in the yellow fever, arose in part from a spasmodic affection of the heart, from the frequency of an uncommon palpitation of this muscle, which I discovered in this disease, more especially in old people. The disposition, likewise, to syncope and sighing, which so often occurred, can be explained upon no other principle than inflammation, spasm, dilatation, or congestion in the heart. After the 10th of September this undescribable or _sulky_ pulse (for by the latter epithet I sometimes called it) became less observable, and, in proportion as the weather became cool, it totally disappeared. It was gradually succeeded by a pulse full, tense, quick, and as frequent as in pleurisy or rheumatism. It differed, however, from a pleuritic or rheumatic pulse, in imparting a very different sensation to the fingers. No two strokes seemed to be exactly alike. Its action was of a hobbling nature. It was at this time so familiar to me that I think I could have distinguished the disease by it without seeing the patient. It was remarkable that this pulse attended the yellow fever even when it appeared in the mild form of an intermittent, and in those cases where the patients were able to walk about or go abroad. It was nearly as _tense_ in the remissions and intermissions of the fever as it was in the exacerbations. It was an alarming symptom, and when the only remedy which was effectual to remove it was neglected, such a change in the system was induced as frequently brought on death in a few days. This change of the pulse, from extreme lowness to fulness and activity, appeared to be owing to the diminution of the heat of the weather, which, by its stimulus, added to that of the remote cause, had induced those symptoms of depression of the pulse which have been mentioned. The pulse most frequently lessened in its fulness, and became gradually weak, frequent, and imperceptible before death, but I met with several cases in which it was full, active, and even tense in the last hours of life. _Hæmorrhages_ belong to the symptoms of this fever as they appeared in the sanguiferous system. They occurred in the beginning of the disease, chiefly from the nose and uterus. Sometimes but a few drops of blood distilled from the nose. The menses were unusual in their quantity when they appeared at their stated periods, but they often came on a week or two before the usual time of their appearance. I saw one case of a hæmorrhage from the lungs on the first day of the fever, which was supposed to be a common hæmoptysis. As the disease advanced the discharges of blood became more universal. They occurred from the gums, ears, stomach, bowels, and urinary passages. Drops of blood issued from the inner canthus of the left eye of Mr. Josiah Coates. Dr. Woodhouse attended a lady who bled from the holes in her ears which had been made by ear-rings. Many bled from the orifices which had been made by bleeding, several days after they appeared to have been healed, and some from wounds which had been made in veins in unsuccessful attempts to draw blood. These last hæmorrhages were very troublesome, and in some cases precipitated death. II. I come now to mention the symptoms of this fever as they appeared in the _liver_, the _lungs_, and the _brain_. From the histories which I had read of this disease, I was early led to examine the state of the _liver_, but I was surprised to find so few marks of hepatic affection. I met with but two cases in which the patient could lie only on the right side. Many complained of a dull pain in the region of the liver, but very few complained, in the beginning of the disease, of that soreness to the touch, about the pit of the stomach, which is taken notice of by authors, and which was universal in the yellow fever in 1762. In proportion as the cool weather advanced, a preternatural determination of the blood took place chiefly to the lungs and brain. Many were affected with pneumonic symptoms, and some appeared to die of sudden effusions of blood or serum in the lungs. It was an unexpected effusion of this kind which put an end to the life of Mrs. Keppele after she had exhibited hopeful signs of a recovery. I saw one person who recovered from an affection of the lungs, by means of a copious expectoration of yellow phlegm and mucus. But the _brain_ was principally affected with morbid congestion in this disease. It was indicated by the suffusion of blood in the face, by the redness of the eyes, by a dilatation of the pupils, by the pain in the head, by the hæmorrhages from the nose and ears, by the sickness or vomiting, and by an almost universal costive state of the bowels. I wish to impress the reader with these facts, for they formed one of the strongest indications for the use of the remedies which I adopted for the cure of this disease. It is difficult to determine the exact state of these viscera in every case of bilious and yellow fever. Inflammation certainly takes place in some cases, and internal hæmorrhages in others; but I believe the most frequent affection of these viscera consists in a certain morbid accumulation of blood in them, which has been happily called, by Dr. Clark, an _engorgement_ or choaking of the blood-vessels. I believe further, with Dr. Clark[20] and Dr. Balfour[21], that death in most cases in bilious fevers is the effect of these morbid congestions, and wholly unconnected with an exhausted state of the system, or a supposed putrefaction in the fluids. It is true, the dissections of Dr. Physick and Dr. Cathrall (to be mentioned hereafter) discovered no morbid appearances in any of the viscera which have been mentioned, but it should be remembered, that these dissections were made early in the disease. Dr. Annan attended the dissection of a brain of a patient who died at Bush-hill some days afterwards, and observed the blood-vessels to be unusually turgid. In those cases where congestion only takes place, it is as easy to conceive that all morbid appearances in the brain may cease after death, as that the suffusion of blood in the face should disappear after the retreat of the blood from the extremities of the vessels, in the last moments of life. It is no new thing for morbid excitement of the brain to leave either slender, or no marks of disease after death. This, I have said, is often the case where it exceeds that degree of action which produces an effusion of red blood into serous vessels, or what is called inflammation[22]. Dr. Quin has given a dissection of the brain of a child that died with all the symptoms of hydrocephalus internus, and yet nothing was discovered in the brain but a slight turgescence of its blood-vessels. Dr. Girdlestone says, no injury appeared in the brains of those persons who died of the symptomatic apoplexy, which occurred in a spasmodic disease which he describes in the East-Indies; and Mr. Clark informs us, that the brain was in a natural state in every case of death from puerperile fever, notwithstanding it seemed to be affected in many cases soon after the attack of that disease[23]. [20] Vol. i. p. 168. [21] Treatise on the Intestinal Remitting Fever, p. 125. [22] Outlines of a theory of fever. [23] Essay on the Epidemic Disease of Lying-in Women, of the years 1787 and 1788, p. 34. I wish it to be remembered here, that the yellow fever, like all other diseases, is influenced by climate and season. The determination of the fluids is seldom the same in different years, and I am sure it varied with the weather in the disease which I am now describing. Dr. Jackson speaks of the head being most affected in the West-India fevers in _dry_ situations. Dr. Hillary says, that there was an unusual determination of the blood towards the brain, after a _hot_ and _dry_ season, in the fevers of Barbadoes in the year 1753; and Dr. Ferriar, in his account of an epidemic jail fever in Manchester, in 1789, 1790, informs us, that as soon as frost set in, a delirium became a more frequent symptom of that disease, than it had been in more temperate weather. III. The _stomach_ and _bowels_ were affected in many ways in this fever. The disease seldom appeared without nausea or vomiting. In some cases, they both occurred for several days or a week before they were accompanied by any fever. Sometimes a pain, known by the name of gastrodynia, ushered in the disease. The stomach was so extremely irritable as to reject drinks of every kind. Sometimes green or yellow bile was rejected on the first day of the disease by vomiting; but I much oftener saw it continue for two days without discharging any thing from the stomach, but the drinks which were taken by the patient. If the fever in any case came on without vomiting, or if it had been checked by remedies that were ineffectual to remove it altogether, it generally appeared, or returned, on the 4th or 5th day of the disease. I dreaded this symptom on those days, for although it was not always the forerunner of death, yet it generally rendered the recovery more difficult and tedious. In some cases the vomiting was more or less constant from the beginning to the end of the disease, whether it terminated in life or death. The vomiting which came on about the 4th or 5th day, was accompanied with a burning pain in the region of the stomach. It produced great anxiety, and tossing of the body from one part of the bed to another. In some cases, this painful burning occurred before any vomiting had taken place. Drinks were now rejected from the stomach so suddenly, as often to be discharged over the hand that lifted them to the head of the patient. The contents of the stomach (to be mentioned hereafter) were sometimes thrown up with a convulsive motion, that propelled them in a stream to a great distance, and in some cases all over the clothes of the by-standers. Flatulency was an almost universal symptom, in every stage of this disease. It was very distressing in many cases. It occurred chiefly in the stomach. The _bowels_ were generally costive, and in some patients as obstinately so as in the dry gripes. In some cases there was all the pain and distress of a bilious colic, and in others, the tenesmus, and mucous and bloody discharges of a true dysentery. A diarrh[oe]a introduced the disease in a few persons, but it was chiefly in those who had been previously indisposed with weak bowels. A painful tension of the abdomen took place in many, accompanied in some instances by a dull, and in others by an acute pain in the lower part of the belly. IV. I come now to describe the state of the _secretions_ and _excretions_ as they appeared in different stages of this fever. In some cases there was a constipation of the liver, if I may be allowed that expression, or a total obstruction of secretion and excretion of bile, but more frequently a preternatural secretion and excretion of it took place. It was discharged, in most cases, from the stomach and bowels in large quantities, and of very different qualities and colours. 1. On the first and second days of the disease many patients puked from half a pint to nearly a quart of green or yellow bile. Four cases came under my notice in which black bile was discharged on the _first_ day. Three of these patients recovered. 2. There was frequently, on the 4th or 5th day, a discharge of matter from the stomach, resembling coffee impregnated with its grounds. This was always an alarming symptom. I believed it at first to be a modification of vitiated bile, but subsequent dissections by Dr. Physick have taught me that it was the result of the first stage of those morbid actions in the stomach, which afterwards produce the black vomit. Many recovered who discharged this coffee-coloured matter. 3. Towards the close of this disease, there was a discharge of matter of a deep or pale black colour, from the stomach. Flakey substances frequently floated in the bason or chamber-pot upon the surface of this matter. It was what is called the _black vomit_. It was formerly supposed to be vitiated bile, but it has been proved by Dr. Stewart, and afterwards by Dr. Physick, to be the effect of disease in the stomach. 4. There was frequently discharged from the stomach in the close of the disease, a large quantity of grumous blood, which exhibited a dark colour on its outside, resembling that of some of the matters which have been described, and which I believe was frequently mistaken for what is commonly known by the name of the _black vomit_. Several of my patients did me the honour to say, I had cured them after that symptom of approaching dissolution had made its appearance; but I am inclined to believe, dark-coloured blood only, or the coffee-coloured matter, was mistaken for the matters which constitute the fatal black vomiting. I except here the black discharge before-mentioned, which took place in three cases on the first day of the disease. This I have no doubt was bile, but it had not acquired its greatest acrimony, and it was discharged before mortification, or even inflammation could have taken place in the stomach. Several persons died without a black vomiting of any kind. Along with all the discharges from the stomach which have been described, there was occasionally a large worm, and frequently large quantities of mucus and tough phlegm. The colour, quality, and quantity of the _fæces_ depended very much upon the treatment of the disease. Where active purges had been given, the stools were copious, f[oe]tid, and of a black or dark colour. Where they were spontaneous, or excited by weak purges, they had a more natural appearance. In both cases they were sometimes of a green, and sometimes of an olive colour. Their smell was more or less f[oe]tid, according to the time in which they had been detained in the bowels. I visited a lady who had passed several days without a stool, and who had been treated with tonic remedies. I gave her a purge, which in a few hours procured a discharge of fæces so extremely f[oe]tid, that they produced fainting in an old woman who attended her. The acrimony of the fæces was such as to excoriate the rectum, and sometimes to produce an extensive inflammation all around its external termination. The quantity of the stools produced by a single purge was in many cases very great. They could be accounted for only by calling in the constant and rapid formation of them, by preternatural effusions of bile into the bowels. I attended one person, and heard of two others, in whom the stools were as white as in the jaundice. I suspected, in these cases, the liver to be so constipated or paralyzed by the disease, as to be unable to secrete or excrete bile to colour the fæces. Large round worms were frequently discharged with the stools. The _urine_ was in some cases plentiful, and of a high colour. It was at times clear, and at other times turbid. About the 4th or 5th day, it sometimes assumed a dark colour, and resembled strong coffee. This colour continued, in one instance, for several days after the patient recovered. In some, the discharge was accompanied by a burning pain, resembling that which takes place in a gonorrh[oe]a. I met with one case in which this burning came on only in the evening, with the exacerbation of the fever, and went off with its remission in the morning. A total deficiency of the urine took place in many people for a day or two, without pain. Dr. Sydenham takes notice of the same symptom in the highly inflammatory small-pox[24]. It generally accompanied or portended great danger. I heard of one case in which there was a _suppression_ of urine, which could not be relieved without the use a the catheter. [24] Wallis's edition, vol. i. p. 197. A young man was attended by Mr. Fisher, one of my pupils, who discharged several quarts of limpid urine just before he died. Dr. Arthaud informs us, in the history of a dissection of a person who died of the yellow fever, that the urine after death imparted a green colour to the tincture of radishes[25]. [25] Rosier's Journal for January, 1790, vol. xxxvi. p. 380. Many people were relieved by copious _sweats_ on the first day of the disease. They were in some instances spontaneous, and in others they were excited by diluting drinks, or by strong purges. These sweats were often of a yellow colour, and sometimes had an offensive smell. They were in some cases cold, and attended at the same time with a full pulse. In general, the skin was dry in the beginning, as well as in the subsequent stages of the disease. I saw but few instances of its terminating like common fevers, by sweat after the third day. I wish this fact to be remembered by the reader, for it laid part of the foundation of my method of treating this fever. There was in some cases a preternatural secretion and excretion of _mucus_ from the glands of the throat. It was discharged by an almost constant hawking and spitting. All who had this symptom recovered. The _tongue_ was in every case moist, and of a white colour, on the first and second days of the fever. As the disease advanced, it assumed a red colour, and a smooth shining appearance. It was not quite dry in this state. Towards the close of the fever, a dry black streak appeared in its middle, which gradually extended to every part of it. Few recovered after this appearance on the tongue took place. V. In the _nervous system_ the symptoms of the fever were different, according as it affected the brain, the muscles, the nerves, or the mind. The sudden and violent action of the miasmata induced apoplexy in several people. In some, it brought on syncope, and in others, convulsions in every part of the body. The apoplectic cases generally proved fatal, for they fell chiefly upon hard drinkers. Persons affected by syncope, or convulsions, sometimes fell down in the streets. Two cases of this kind happened near my house. One of them came under my notice. He was supposed by the by-standers to be drunk, but his countenance and convulsive motions soon convinced me that this was not the case. A coma was observed in some people, or an obstinate wakefulness in every stage of the disease. The latter symptom most frequently attended the convalescence. Many were affected with immobility, or numbness in their limbs. These symptoms were constant, or temporary, according to the nature of the remedies which were made use of to remove them. They extended to all the limbs, in some cases, and only to a part of them in others. In some, a violent cramp, both in the arms and legs, attended the first attack of the fever. I met with one case in which there was a difficulty of swallowing, from a spasmodic affection of the throat, such as occurs in the locked jaw. A hiccup attended the last stage of this disease, but I think less frequently than the last stage of the common bilious fever. I saw but five cases of recovery where this symptom took place. There was, in some instances, a deficiency of sensibility, but, in others, a degree of it extending to every part of the body, which rendered the application of common rum to the skin, and even the least motion of the limbs painful. I was surprised to observe the last stage of this fever to exhibit so few of the symptoms of the common typhus or chronic fever. Tremors of the limbs and twitchings of the tendons were uncommon. They occurred only in those cases in which there was a predisposition to nervous diseases, and chiefly in the convalescent state of the disease. While the muscles and nerves in many cases exhibited so many marks of preternatural weakness, in some they appeared to be affected with preternatural excitement. Hence patients in the close of the disease often rose from their beds, walked across their rooms, or came down stairs, with as much ease as if they had been in perfect health. I lost a patient in whom this state of morbid strength occurred to such a degree, that he stood up before his glass and shaved himself, on the day on which he died. The mind suffered with the morbid states of the brain and nerves. A delirium was a common symptom. It alternated in some cases with the exacerbations and remissions of the fever. In some, it continued without a remission, until a few hours before death. Many, however, passed through the whole course of the disease without the least derangement in their ideas, even where there were evident signs of a morbid congestion in the brain. Some were seized with maniacal symptoms. In these there was an _apparent_ absence of fever. Such was the degree of this mania in one man, that he stripped off his shirt, left his bed, and ran through the streets, with no other covering than a napkin on his head, at 8 o'clock at night, to the great terror of all who met him. The symptoms of mania occurred most frequently towards the close of the disease, and sometimes continued for many days and weeks, after all other febrile symptoms had disappeared. The temper was much affected in this fever. There were few in whom it did not produce great depression of spirits. This was the case in many, in whom pious habits had subdued the fear of death. In some the temper became very irritable. Two cases of this kind came under my notice, in persons who, in good health, were distinguished for uncommon sweetness of disposition and manners. I observed in several persons the operations of the understanding to be unimpaired, throughout the whole course of the fever, who retained no remembrance of any thing that passed in their sickness. My pupil, Mr. Fisher, furnished a remarkable example of this correctness of understanding, with a suspension of memory. He neither said nor did any thing, during his illness, that indicated the least derangement of mind, and yet he recollected nothing that passed in his room, except my visits to him. His memory awakened upon my taking him by the hand, on the morning of the 6th day of his disease, and congratulating him upon his escape from the grave. In some, there was a weakness, or total defect of memory, for several weeks after their recovery. Dr. Woodhouse informed me that he had met with a woman, who, after she had recovered, could not recollect her own name. Perhaps it would be proper to rank that self-deception with respect to the nature and danger of the disease, which was so universal, among the instances of derangement of mind. The pain which attended the disease was different, according to the different states of the system. In those cases in which it sunk under the violence of the disease, there was little or no pain. In proportion as the system was relieved from this oppression, it recovered its sensibility. The pain in the head was acute and distressing. It affected the eye-balls in a peculiar manner. A pain extended, in some cases, from the back of the head down the neck. The ears were affected, in several persons, with a painful sensation, which they compared to a string drawing their two ears together through the brain. The sides, and the regions of the stomach, liver, and bowels, were all, in different people, the seats of either dull or acute pains. The stomach, towards the close of the disease, was affected with a burning or spasmodic pain of the most distressing nature. It produced, in some cases, great anguish of body and mind. In others it produced cries and shrieks, which were often heard on the opposite side of the streets to where the patients lay. The back suffered very much in this disease. The stoutest men complained, and even groaned under it. An acute pain extended, in some cases, from the back to one or both thighs. The arms and legs sympathized with every other part of the body. One of my patients, upon whose limbs the disease fell with its principal force, said that his legs felt as if they had been scraped with a sharp instrument. The sympathy of friends with the distresses of the sick extended to a small part of their misery, when it did not include their sufferings from pain. One of the dearest friends I ever lost by death declared, in the height of her illness, that "no one knew the pains of a yellow fever, but those who felt them." VI. The _senses_ and _appetites_ exhibited several marks of the universal ravages of this fever upon the body. A deafness attended in many cases, but it was not often, as in the nervous fever, a favourable symptom. A dimness of sight was very common in the beginning of the disease. Many were affected with temporary blindness. In some there was a loss of sight in consequence of gutta serena, or a total destruction of the substance of the eye. There was in many persons a soreness to the touch which extended all over the body. I have often observed this symptom to be the forerunner of a favourable issue of a nervous fever, but it was less frequently the case in this disease. The _thirst_ was moderate or absent in some cases, but it occurred in the greatest number of persons whom I saw in this fever. Sometimes it was very intense. One of my patients, who suffered by an excessive draught of cold water, declared, just before he died, that "he could drink up the Delaware." It was always an alarming symptom when this thirst came on in this extravagant degree in the last stage of the disease. In the beginning of the fever it generally abated upon the appearance of a moist skin. Water was preferred to all other drinks. The _appetite_ for food was impaired in this, as in all other fevers, but it returned much sooner than is common after the patient began to recover. Coffee was relished in the remissions of the fever, in every stage of the disease. So keen was the appetite for solid, and more especially for animal food, after the solution of the fever, that many suffered from eating aliment that was improper from its quality or quantity. There was a general disrelish for wine, but malt liquors were frequently grateful to the taste. Many people retained a relish for tobacco much longer after they were attacked by this fever, and acquired a relish for it much sooner after they began to recover, than are common in any other febrile disease. I met with one case in which a man, who was so ill as to require two bleedings, continued to chew tobacco through every stage of his fever. The convalescence from this disease was marked, in some instances, by a sudden revival of the venereal appetite. Several weddings took place in the city between persons who had recovered from the fever. Twelve took place among the convalescents in the hospital at Bush-hill. I wish I could add that the passion of the sexes for each other, among those subjects of public charity, was always gratified only in a lawful way. Delicacy forbids a detail of the scenes of debauchery which were practised near the hospital, in some of the tents which had been appropriated for the reception of convalescents. It was not peculiar to this fever to produce this morbid excitability of the venereal appetite. It was produced in a much higher degree by the plague which raged in Messina in the year 1743. VII. The _lymphatic_ and _glandular system_ did not escape without some signs of this disease. I met with three cases of swellings in the inguinal, two in the parotid, and one in the cervical glands: all these patients recovered without a suppuration of their swellings. They were extremely painful in one case in which no redness or inflammation appeared. In the others there was considerable inflammation and but little pain. In one of the cases of inguinal buboes, the whole force of the disease seemed to be collected into the lymphatic system. The patient walked about, and had no fever nor pain in any part of his body, except in his groin. In another case which came under my care, a swelling and pain extended from the groin along the spermatic cord into one of the testicles. These glandular swellings were not peculiar to this epidemic. They occurred in the yellow fever of Jamaica, as described by Dr. Williams, and always with a happy issue of the disease[26]. A similar concentration of the contagion of the plague in the lymphatic glands is taken notice of by Dr. Patrick Russel. [26] Essay on the Bilious or Yellow Fever, p. 35. VIII. The _skin_ exhibited many marks of this fever. It was preternaturally warm in some cases, but it was often preternaturally cool. In some there was a distressing coldness in the limbs for two or three days. The yellow colour from which this fever has derived its name, was not universal. It seldom appeared where purges had been given in sufficient doses. The yellowness rarely appeared before the third, and generally about the fifth or seventh day of the fever. Its early appearance always denoted great danger. It sometimes appeared first on the neck and breast, instead of the eyes. In one of my patients it discovered itself first behind one of his ears, and on the crown of his head, which had been bald for several years. The remissions and exacerbations of the fever seemed to have an influence upon this colour, for it appeared and disappeared altogether, or with fainter or deeper shades of yellow, two or three times in the course of the disease. The eyes seldom escaped a yellow tinge; and yet I saw a number of cases in which the disease appeared with uncommon malignity and danger, without the presence of this symptom. There was a clay-coloured appearance in the face, in some cases, which was very different from the yellow colour which has been described. It occurred in the last stage of the fever, and in no instance did I see a recovery after it. There were eruptions of various kinds on the skin, each of which I shall briefly describe. 1. I met with two cases of an eruption on the skin, resembling that which occurs in the scarlet fever. Dr. Hume says, pimples often appear on the pit of the stomach, in the yellow fever of Jamaica. I examined the external region of the stomach in many of my patients, without discovering them. 2. I met with one case in which there was an eruption of watery blisters, which, after bursting, ended in deep, black sores. 3. There was an eruption about the mouth in many people, which ended in scabs, similar to those which take place in the common bilious fever. They always afforded a prospect of a favourable issue of the disease. 4. Many persons had eruptions which resembled moscheto bites. They were red and circumscribed. They appeared chiefly on the arms, but they sometimes extended to the breast. Like the yellow colour of the skin, they appeared and disappeared two or three times in the course of the disease. 5. Petechiæ were common in the latter stage of the fever. They sometimes came on in large, and at other times in small red blotches; but they soon acquired a dark colour. In most cases they were the harbingers of death. 6. Several cases of carbuncles, such as occur in the plague, came under my notice. They were large and hard swellings on the limbs, with a black apex, which, upon being opened, discharged a thin, dark-coloured, bloody matter. From one of these malignant sores a hæmorrhage took place, which precipitated the death of the amiable widow of Dr. John Morris. 7. A large and painful anthrax on the back succeeded a favourable issue of the fever in the Rev. Dr. Blackwell. 8. I met with a woman who showed me the marks of a number of small boils on her face and neck, which accompanied her fever. Notwithstanding this disposition to cutaneous eruptions in this disease, it was remarkable that blisters were much less disposed to mortify than in the common nervous fever. I met with only one case in which a deep-seated ulcer followed the application of blisters to the legs. Such was the insensibility of the skin in some people, that blisters made no impression upon it. IX. The _blood_ in this fever has been supposed to undergo a change from a healthy to a putrid state, and many of its symptoms which have been described, particularly the hæmorrhages and eruptions on the skin, have been ascribed to this supposed putrefaction of the blood. It would be easy to multiply arguments, in addition to those mentioned in another place[27], to prove that no such thing as putrefaction can take place in the blood, and that the symptoms which have been supposed to prove its existence are all effects of a sudden, violent, and rapid inflammatory action or pressure upon the blood-vessels, and hence the external and internal hæmorrhages. The petechiæ on the surface of the skin depend upon the same cause. They are nothing but effusions of serum or red blood, from a rupture or preternatural dilatation of the capillary vessels[28]. The smell emitted from persons affected by this disease was far from being of a putrid nature; and if this had been the case, it would not have proved the existence of putrefaction in the blood, for a putrid smell is often discharged from the lungs, and from the pores in sweat, which is wholly unconnected with a putrid, or perhaps any other morbid state of the blood. There are plants which discharge an odour which conveys to the nose a sensation like that of putrefaction; and yet these plants exist, at the same time, in a state of the most healthy vegetation: nor does the early putrid smell of a body which perishes with this fever prove a putrid change to have taken place in the blood before death. All animals which die suddenly, and without loss of blood, are disposed to a speedy putrefaction. This has long been remarked in animals that have been killed after a chase, or by lightning. The poisonous air called _samiel_, which is described by Chardin, produces, when it destroys life, instant putrefaction. The bodies of men who die of violent passions, or after strong convulsions, or even after great muscular exertion, putrify in a few hours after death. The healthy state of the body depends upon a certain state of arrangement in the fluids. A derangement of these fluids is the natural consequence of the violent and rapid motions, or of the undue pressure upon the solids, which have been mentioned. It occurs in cases of death which are induced by the excessive force of stimulus, whether it be from miasmata, or the volatile vitriolic acid which is supposed to constitute the destructive samiel wind, or from violent commotions excited in the body by external or internal causes. The practice among fishermen, in some countries, of breaking the heads of their fish as soon as they are taken out of the water, in order to retard their putrefaction, proves the truth of the explanation I have given of its cause, soon after death. The sudden extinction of life in the fish prevents those convulsive or violent motions, which induce sudden _disorganization_ in their bodies. It was observed that putrefaction took place most speedily after death from the yellow fever, where the commotions of the system were not relieved by evacuations. In those cases where purges and bleeding had been used, putrefaction did not take place sooner after death than is common in any other febrile disease, under equal circumstances of heat and air. [27] Outlines of a Theory of Fever. [28] See Wallis's edition of Sydenham, vol. i. p. 165. vol. ii. p. 52, 94, 98, 350; De Haen's Ratio Medendi, vol. ii. p. 162. vol. iv. p. 172; Gaubii Pathologia, sect. 498; and Dr. Seybert's inaugural dissertation, entitled "An Attempt to Disprove the Doctrine of Putrefaction of the Blood in Living Animals," published in Philadelphia in 1793. Thus have I described the symptoms of this fever. From the history I have given, it appears that it counterfeited nearly all the acute and chronic forms of disease to which the human body is subject. An epitome, both of its symptoms and its theory, is happily delivered by Dr. Sydenham, in the following words. After describing the epidemic cough, pleurisy, and peripneumony of 1675, he adds, "But in other epidemics, the symptoms are so slight from the disturbance raised in the blood by the morbific particles contained in the mass, that nature being in a manner _oppressed_, is rendered unable to produce _regular_ symptoms that are suitable to the disease; and almost all the phenomena that happen are _irregular_, by reason of the entire _subversion_ of the animal economy; in which case the fever is often _depressed_, which, of its own nature, would be very high. Sometimes also fewer signs of a fever appear than the nature of the disease requires, from a translation of the malignant cause, either to the nervous system, or to some other parts of the body, or to some of the juices not contained in the blood; whilst the morbific matter is yet turgid[29]." [29] Wallis's edition, vol. i. p. 344. The disease ended in death in various ways. In some it was sudden; in others it came on by gradual approaches. In some the last hours of life were marked with great pain, and strong convulsions; but in many more, death seemed to insinuate itself into the system, with all the gentleness of natural sleep. Mr. Powell expired with a smile on his countenance. Dr. Griffitts informed me that Dr. Johnson exhibited the same symptom in the last hours of his life. This placid appearance of the countenance, in the act of dying, was not new to me. It frequently occurs in diseases which affect the brain and nerves. I lost a patient, in the year 1791, with the gout, who not only smiled, but laughed, a few minutes before he expired. I proceed now to mention some peculiarities of the fever, which could not be brought in under any of the foregoing heads. In every case of this disease which came under my notice, there were evident remissions, or intermissions of the fever, or of such symptoms as were substituted for fever. I have long considered, with Mr. Senac, a _tertian_ as the only original type of all fevers. The bilious yellow fever indicated its descent from this parent disease. I met with many cases of regular tertians, in which the patients were so well on the intermediate days as to go abroad. It appeared in this form in Mr. Van Berkel, the minister of the United Netherlands. Nor was this mild form of the fever devoid of danger. Many died who neglected it, or who took the common remedies for intermittents to cure it. It generally ended in a remittent before it destroyed the patient. The tertian type discovered itself in some people after the more violent symptoms of the fever had been subdued, and continued in them for several weeks. It changed from a tertian to a quartan type in Mr. Thomas Willing, nearly a month after his recovery from the more acute and inflammatory symptoms of the disease. It is nothing new for a malignant fever to appear in the form of a tertian. It is frequently the garb of the plague. Riverius describes a tertian fever which proved fatal on the third day, which was evidently derived from the same exhalation which produced a continual malignant fever[30]. [30] De Febre Pestilenti, vol. xi. p. 93. The remissions were more evident in this, than in the common bilious fever. They generally occurred in the forenoon. It was my misfortune to be deprived, by the great number of my patients, of that command of time which was necessary to watch the exacerbations of this fever under all their various changes, as to time, force, and duration. From all the observations that were suggested by visits, at hours that were seldom left to my choice, I was led to conclude, that the fever exhibited in different people all that variety of forms which has been described by Dr. Cleghorn, in his account of the tertian fever of Minorca. A violent exacerbation on even days was evidently attended with more danger than on odd days. The same thing was observed by Dr. Mitchell in the yellow fever of Virginia, in the year 1741. "If (says he) the exacerbations were on equal days, they generally died in the third paroxysm, or the sixth day; but if on unequal days, they recovered on the seventh." The deaths which occurred on the 3d, 5th, and 7th days, appeared frequently to be the effects of the commotions or depression, produced in the system on the 2d, 4th, and 6th days. The remission on the third day was frequently such as to beget a belief that the disease had run its course, and that all danger was over. A violent attack of the fever on the 4th day removed this deception, and, if a relaxation had taken place in the use of proper remedies on the 3d day, death frequently occurred on the 5th or the 7th. The termination of this fever in life and death was much more frequent on the 3d, 5th, 7th, 9th, and 11th days, than is common in the mild remitting fever. Where death occurred on the even days, it seemed to be the effect of a violent paroxysm of the fever, or of great vigour of constitution, or of the force of medicines which protracted some of the motions of life beyond the close of the odd days which have been mentioned. I think I observed the fever to terminate on the third day more frequently in August, and during the first ten days in September, than it did after the weather became cool. In this it resembled the common bilious remittents of our city, also the simple tertians described by Dr. Cleghorn[31]. The danger seemed to be in proportion to the tendency of the disease to a speedy crisis, hence more died in August in proportion to the number who were affected than in September or October, when the disease was left to itself. But, however strange after this remark it may appear, the disease yielded to the remedies which finally subdued it more speedily and certainly upon its first appearance in the city, than it did two or three weeks afterwards. [31] Diseases of Minorca, p. 185. The disease continued for fifteen, twenty, and even thirty days in some people. Its duration was much influenced by the weather, and by the use or neglect of certain remedies (to be mentioned hereafter) in the first stage of the disease. It has been common with authors to divide the symptoms of this fever into three different stages. The order I have pursued in the history of those symptoms will render this division unnecessary. It will I hope be more useful to divide the patients affected with the disease into three classes. The _first_ includes those in whom the stimulus of the miasmata produced coma, languor, sighing, a disposition to syncope, and a weak or slow pulse. The _second_ includes those in whom the miasmata acted with less force, producing great pain in the head, and other parts of the body; delirium, vomiting, heat, thirst, and a quick, tense, or full pulse, with obvious remissions or intermissions of the fever. The _third_ class includes all those persons in whom the miasmata acted so feebly as not to confine them to their beds or houses. This class of persons affected by the yellow fever was very numerous. Many of them recovered without medical aid, or by the use of domestic prescriptions; many of them recovered in consequence of a spontaneous diarrh[oe]a, or plentiful sweats; many were saved by moderate bleeding and purging; while some died, who conceived their complaints to be occasioned by a common cold, and neglected to take proper care of themselves, or to use the necessary means for their recovery. It is not peculiar to the yellow fever to produce this feeble operation upon the system, It has been observed in the southern states of America, that in those seasons in which the common bilious fever is epidemic "no body is quite well," and that what are called in those states "inward fevers" are universal. The small-pox, even in the natural way, does not always confine the patient; and thousands pass through the plague without being confined to their beds or houses. Dr. Hodges prescribed for this class of patients in his parlour in London, in the year 1665, and Dr. Patrick Russel did the same from a chamber window fifteen feet above the level of the street at Aleppo. Notwithstanding the mild form the plague put on in these cases, it often proved fatal according to Dr. Russel. I have introduced these facts chiefly with a view of preparing the reader to reject the opinion that we had two species of fever in the city at the same time; and to show that the yellow fever appears in a more simple form than with "strongly marked" characters; or, in other words, with a yellow skin and a black vomiting. It was remarkable that this fever always found out the weak part of every constitution it attacked. The head, the lungs, the stomach, the bowels, and the limbs, suffered more or less, according as they were more or less debilitated by previous inflammatory or nervous diseases, or by a mixture of both, as in the gout. I have before remarked, that the influenza, the scarlatina, and a mild bilious remittent, prevailed in the city, before the yellow fever made its appearance. In the course of a few weeks they all disappeared, or appeared with symptoms of the yellow fever; so that, after the first week of September, it was the solitary epidemic of the city. The only case like influenza which I saw after the 5th of September, was in a girl of 14 years of age, on the 13th of the month. It came on with a sneezing and cough. I was called to her on the third day of her disease. The instant I felt her pulse, I pronounced her disease to be the yellow fever. Her father was offended with this opinion, although he lived in a highly infected neighbourhood, and objected to the remedies I prescribed for her. In a few days she died. In the course of ten days, her father and sister were infected, and both died, I was informed, with the usual symptoms of the yellow fever. It has been an axiom in medicine, time immemorial, that no two fevers of unequal force can exist long together in the same place. As this axiom seems to have been forgotten by many of the physicians of Philadelphia, and as the ignorance or neglect of it led to that contrariety of opinion and practice, which unhappily took place in the treatment of the disease, I hope I shall be excused by those physicians to whom this fact is as familiar as the most simple law of nature, if I fill a few pages with proofs of it, from practical writers. Thucydides long ago remarked, that the plague chased all other diseases from Athens, or obliged them to change their nature, by assuming some of its symptoms. Dr. Sydenham makes the same remark upon the plague in London, in 1665. Dr. Hodges, in his account of the same plague, says, that "at the rise of the plague all other distempers went into it, but that, at its declension, it degenerated into others, as inflammations, head-ach, quinsies, dysenteries, small-pox, measles, fevers, and hectics, wherein the plague yet predominated[32]." [32] Dr. Hodge's Account of the Plague in London, p. 26. During the prevalence of the plague in Grand Cairo, no sporadic disease of any kind makes its appearance. The same observation is made by Sauvage, in his account of the plague at Alais, in the province of Languedoc[33]. [33] Sed hoc observatu dignum fuit, omnes alios morbos acutos, durante peste siluisse, et omnes morbos acutos e pestis genere suisse. Nosologia Methodica, vol. i. p. 416. The small-pox, though a disease of less force than the plague, has often chased it from Constantinople, probably from its being in a declining state. But this exclusive prevalence of a single epidemic is not confined to the plague and small-pox. Dr. Sydenham's writings are full of proofs of the dominion of febrile diseases over each other. Hence, after treating upon a symptomatic pleurisy which sometimes accompanied a slow fever, in the year 1675, and which had probably been injudiciously treated by some of those physicians who prescribe for the name of a disease, he delivers the following aphorism: "Whoever, in the cure of fevers, hath not always in view the constitution of the year, inasmuch as it tends to produce some particular epidemic disease, and likewise to reduce all the cotemporary diseases to its own form and likeness, proceeds in an uncertain and fallacious way[34]." It appears further, from the writings of this excellent physician, that where the monarchy of a single disease was not immediately acknowledged, by a sudden retreat of all cotemporary diseases, they were forced to do homage to it, by wearing its livery. It would be easy to multiply proofs of this assertion, from the numerous histories of epidemics which are to be found in his works. I shall mention only one or two of them. A continual fever, accompanied by a dry skin, had prevailed for some time in the city of London. During the continuance of this fever, the regular small-pox made its appearance. It is peculiar to the small-pox, when of a distinct nature, to be attended by irregular sweats before the eruption of the pock. The continual fever now put on a new symptom. It was attended by sweats in its first stage, exactly like those which attended the eruptive fever of the small-pox[35]. This despotism of a powerful epidemic extended itself to the most trifling indispositions. It even blended itself, Dr. Sydenham tells us, with the commotions excited in the system by the suppression of the lochia, as well as with the common puerperile fever[36]. Dr. Morton has left testimonies behind him, in different parts of his works, which establish, in the most ample manner, the truth of Dr. Sydenham's observations. Dr. Huxham describes the small-pox as blending some of its symptoms with those of a slow fever, at Plymouth, in the year 1729[37]. Dr. Cleghorn mentions a constitution of the air at Minorca, so highly inflammatory, "that not only tertian fevers, but even a common hurt or bruise required more plentiful evacuations than ordinary[38]." Riverius informs us, in his history of a pestilential fever that prevailed in France, that "it united itself with phrenitis, angina, pleurisy, peripneumony, hepatitis, dysentery, and many other diseases[39]." [34] Vol. i. p. 340. [35] Vol. i. p. 352. [36] Vol. ii. p. 164. See also p. 1, 109, 122, 204, 212, 233, 274, 355, 358-9, and 436. [37] De Aere et Morb. Epidem. p. 33, 34. [38] Page 285. [39] De Febre Pestilenti, vol. ii. p. 95. The bilious remitting fever which prevailed in Philadelphia, in 1780, chased away every other febrile disease; and the scarlatina anginosa which prevailed in our city, in 1783 and 1784, furnished a striking proof of the influence of epidemics over each other. In the account which I published of this disease, in the year 1789, there are the following remarks. "The intermitting fever which made its appearance in August was not lost during the month of September. It continued to prevail, but with several peculiar symptoms. In many persons it was accompanied by an eruption on the skin, and a swelling of the hands and feet. In some it was attended with sore throat, and pains behind the ears. Indeed such was the prevalence of the contagion which produced the scarlatina anginosa, that many hundred people complained of sore throats, without any other symptom of indisposition. The slightest exciting cause, and particularly cold, seldom failed of producing the disease[40]." [40] Vol. i. I shall mention only one more authority in favour of the influence of a single epidemic upon diseases. It is taken from Mr. Clark's essay on the epidemic disease of lying-in women, of the years 1787 and 1788. "There does not appear to be any thing in a parturient state which can prevent women from being affected by the general causes of disease at that time; and should they become ill, their complaints will probably partake of the nature of the reigning epidemic[41]." I have said that the fever sometimes put on the symptoms of dysentery, pleurisy, rheumatism, colic, palsy, and even of the locked jaw. That these were not original diseases, but symptomatic affections only of the reigning epidemic, will appear from other histories of bilious fevers. Dr. Balfour tells us, in his account of the intestinal remitting fever of Bengal[42], that it often appeared with symptoms of dysentery, rheumatism, and pleurisy. Dr. Cleghorn and Dr. Lind mention many cases of the bilious fever appearing in the form of a dysentery. Dr. Clark ascribes the dysentery, the diarrh[oe]a, the colic, and even the palsy, to the same cause which produced the bilious fever in the East-Indies[43]; and Dr. Hunter, in his treatise upon the diseases of Jamaica, mentions the locked jaw as one of its occasional symptoms. Even the different grades of this fever, from the mildest intermittent to the most acute continual fever, have been distinctly traced by Lancissi to the same marsh exhalation[44]. [41] Page 28. [42] Page 132. [43] Observations on the Diseases in Long Voyages to the East-Indies, vol. i. p. 13, 14, 48, 151. vol. ii. p. 99, 318, and 320. [44] Lib. ii. cap. v. However irrefragably these numerous facts and authorities establish the assertion of the prevalence of but one powerful epidemic at a time, the proposition will receive fresh support, from attending to the effects of two impressions of unequal force made upon the system at the same time: only one of them is felt; hence the gout is said to cure all other diseases. By its superior pain it destroys sensations of a less painful nature. The small-pox and measles have sometimes existed together in the body; but this has, I believe, seldom occurred, where one of them has not been the predominating disease[45]. In this respect, this combination of epidemics only conforms to the general law which has been mentioned. [45] Hunter on the Venereal Disease, introduction, p. 3. I beg pardon for the length of this digression. I did not introduce it to expose the mistakes of those physicians, who found as many diseases in our city as the yellow fever had symptoms, but to vindicate myself from the charge of innovation, in having uniformly and unequivocally asserted, after the first week in September, that the yellow fever was the only febrile disease which prevailed in the city. Science has much to deplore from the multiplication of diseases. It is as repugnant to truth in medicine, as polytheism is to truth in religion. The physician who considers every different affection of the different systems in the body, or every affection of different parts of the same system, as distinct diseases, when they arise from one cause, resembles the Indian or African savage, who considers water, dew, ice, frost, and snow, as distinct essences; while the physician who considers the morbid affections of every part of the body (however diversified they may be in their form or degrees) as derived from one cause, resembles the philosopher who considers dew, ice, frost, and snow, as different modifications of water, and as derived simply from the absence of heat. Humanity has likewise much to deplore from this paganism in medicine. The sword will probably be sheathed for ever, as an instrument of death, before physicians will cease to add to the mortality of mankind, by prescribing for the names of diseases. The facts I have delivered upon this subject will admit of a very important application to the cure, not only of the yellow fever, but of all other acute and dangerous epidemics. I shall hereafter assign a final cause for the law of epidemics which has been mentioned, which will discover a union of the goodness of the Supreme Being with one of the greatest calamities of human life. All ages were affected by this fever, but persons between fourteen and forty years of age were most subject to it. Many old people had it, but it was not so fatal to them as to robust persons in middle life. It affected children of all ages. I met with a violent case of the disease, in a child of four months, and a moderate case of it, in a child of but ten weeks old. The latter had a deep yellow skin. Both these children recovered. The proportion of children who suffered by this fever may be conceived from a single fact. Seventy-five persons were buried in the grave-yard of the Swedish church in the months of August, September, and October, twenty-four of whom were children. They were buried chiefly in September and October; months in which children generally enjoy good health in our city. Men were more subject to the disease than women. Pregnancy seemed to expose women to it. The refugees from the French West-Indies universally escaped it. This was not the case with the natives of France, who had been settled in the city. It is nothing new for epidemics to affect persons of one nation, and to pass by persons of other nations, in the same city or country. At Nimeguen, in the year 1736, Deigner informs us, that the French people (two old men excepted), and the Jews, escaped a dysentery which was universal among persons of all other nations. Ramazini tells us, that the Jews at Modena escaped a tertian fever which affected nearly all the other inhabitants of the town. Shenkius says, that the Dutch and Italians escaped a plague, which prevailed for two years in one of the towns of Switzerland; and Dr. Bell, in an inaugural dissertation, published at Edinburgh, in 1779, remarks, that the jail fever, which attacked the soldiers of the duke of Buccleugh's regiment, spared the French prisoners who were guarded by them. It is difficult to account for these facts. However numerous their causes may be, a difference in diet, which is as much a distinguishing mark of nations as dress or manners, will probably be found to be one of them. From the accounts of the yellow fever which had been published by many writers, I was led to believe that the negroes in our city would escape it. In consequence of this belief, I published the following extract in the American Daily Advertiser, from Dr. Lining's history of the yellow fever, as it had four times appeared in Charleston, in South-Carolina. "There is something very singular (says the doctor) in the constitution of the negroes, which renders them not liable to this fever; for though many of them were as much exposed as the nurses to the infection, yet I never knew of one instance of this fever among them, though they are equally subject with the white people to the bilious fever[46]." [46] Essays and Observations, Physical and Literary, vol. xi. page 409. A day or two after this publication the following letter from the mayor of the city, to Mr. Claypoole, the printer of the Mail, appeared in his paper. "SIR, "It is with peculiar satisfaction that I communicate to the public, through your paper, that the AFRICAN SOCIETY, touched with the distresses which arise from the present dangerous disorder, have voluntarily undertaken to furnish nurses to attend the afflicted; and that, by applying to ABSALOM JONES and WILLIAM GRAY, both members of that society, they may be supplied. MATTH. CLARKSON, _September 6th, 1793._ _Mayor_." It was not long after these worthy Africans undertook the execution of their humane offer of services to the sick before I was convinced I had been mistaken. They took the disease in common with the white people, and many of them died with it. I think I observed the greatest number of them to sicken after the mornings and evenings became cool. A large number of them were my patients. The disease was lighter in them than in white people. I met with no case of hæmorrhage in a black patient. The tobacconists and persons who used tobacco did not escape the disease. I observed snuff-takers to be more devoted to their boxes than usual, during the prevalence of the fever. I have remarked, formerly, that servant maids suffered much by the disease. They were the only patients I lost in several large families. I ascribe their deaths to the following causes: _1st._ To the great and unusual debility induced upon their systems by labour in attending their masters and mistresses, or their children. Debility, according to its degrees and duration, seems to have had the same effect upon the mortality of this fever that it has upon the mortality of an inflammation of the lungs. When it is moderate and of short duration it predisposes only to a common pneumony, but when it is violent and protracted, in its degrees and duration, it predisposes to a pulmonary consumption. _2dly._ To their receiving large quantities of impure air into their bodies, and in a most concentrated state, by being obliged to perform the most menial offices for the sick, and by washing, as well as removing foul linen, and the like. _3dly._ To their being left more alone in confined or distant rooms, and thereby suffering from depression of spirits, or the want of a punctual supply of food and medicines. There did not appear to be any advantage from smelling vinegar, tar, camphor, or volatile salts, in preventing the disease. Bark and wine were equally ineffectual for that purpose. I was called to many hundred people who were infected after using one or more of them. Nor did the white washing of walls secure families from the disease. I am disposed to believe garlic was the only substance that was in any degree useful in preventing it. I met with several persons who chewed it constantly, and who were much exposed to the miasmata, without being infected. All other substances seemed to do harm by begetting a false confidence in the mind, to the exclusion of more rational preservatives. I have suspected further, that such of them as were of a volatile nature helped to spread the disease by affording a vehicle for miasmata through the air. There was great mortality in all those families who lived in wooden houses. Whether this arose from the small size of these houses, or from the want of cleanliness of the people who occupied them, or from the miasmata becoming more accumulated, by adhering to the wood, I am unable to determine. Perhaps it was the effect of the co-operation of all three of those causes. I have said, formerly, that intemperance in drinking predisposed to the disease; but there were several instances of persons having escaped it who were constantly under the influence of strong drink. The stimulus of ardent spirits probably predominated over the stimulus of the miasmata, and thus excited an artificial fever which defended the system from that which was epidemic. I heard of some sea-faring people who lived on board their vessels who escaped the disease. The smell of the tar was supposed to have preserved them; but, from its being ineffectual in other cases, I am disposed to ascribe their escape to the infected air of the city being destroyed by a mixture with the water of the Delaware. Many people who were infected in the city were attacked by the disease in the country, but they did not propagate it, even to persons who slept in the same room with them. Dr. Lind informs us that many persons escaped the yellow fever which prevailed in Pensacola in the year 1765, by retiring to the ships which lay in the harbour, and that when the disease had been taken, the pure air of the water changed it into an intermitting fever[47]. The same changes have frequently been produced in malignant fevers, by sending patients infected with them from the foul air of a city, into the pure air of the country. [47] Diseases of Warm Climates, p. 169. Persons confined in the house of employment, in the hospital, and in the jail, escaped the fever. The airy and remote situation of those buildings was probably the chief means of their preservation. Perhaps they derived additional security from their simple diet, their exemption from hard labour, and from being constantly sheltered from heat and cold. Several families, who shut up their front and back doors and windows, and avoided going out of their houses except to procure provisions, escaped the disease. I have taken some pains to ascertain, whether any class of tradesmen escaped the fever, or whether there was any species of labour which protected from it. The result of my inquiries is as follows: Three butchers only, out of nearly one hundred who remained in the city, died with the disease. Many of them attended the markets every day. Two painters, who worked at their business during the whole time of the prevalence of the fever, and in exposed situations, escaped it. Out of forty scavengers who were employed in collecting and carrying away the dirt of the streets, only one was affected by the fever and died. Very few grave-diggers, compared with the number who were employed in that business, were infected; and it is well known, that scarcely an instance was heard of persons taking the disease, who were constantly employed in digging cellars. The fact is not new that grave-diggers escape malignant fevers. It is taken notice of by Dr. Clark. It was said by some physicians in the public papers, that the neighbourhood of the grave-yards was more infected than other parts of the city. The reverse of this assertion was true in several cases, owing probably to the miasmata being diluted and weakened by its mixture with the air of the grave-yards: for this air was pure, compared with that which stagnated in the streets. It was said further, that the disease was propagated by the inhabitants assembling on Sundays for public worship; and, as a proof of this assertion, it was reported, that the deaths were more numerous on Sundays than on other days; occasioned by the infection received on one Sunday producing death on the succeeding first day of the week. The register of the deaths shows that this was not the case. I am disposed to believe that fewer people sickened on Sundays, than on any other day of the week; owing to the general rest from labour, which I have before said was one of the exciting causes of the disease. From some facts to be mentioned presently, it will appear probable, that places of public worship, in consequence of their size, as well as of their being shut up during the greatest part of the week, were the freest from miasmata of any houses in the city. It is agreeable to discover in this, as well as in all other cases of public and private duty, that the means of health and moral happiness are in no one instance opposed to each other. The disease, which was at first confined to Water-street, soon spread through the whole city. After the 15th of September, the atmosphere of every street in the city was charged with miasmata; and there were few citizens in apparent good health, who did not exhibit one or more of the following marks of their presence in their bodies. 1. A yellowness in the eyes, and a sallow colour upon their skin. 2. A preternatural quickness in the pulse. I found but two exceptions to this remark, out of a great number of persons whose pulses I examined. In one of them it discovered several preternatural intermissions in the course of a minute. This quickness of pulse occurred in the negroes, as well as in the white people. I met with it in a woman who had had the yellow fever in 1762. In two women, and in one man above 70, the pulse beat upwards of 90 strokes in a minute. This preternatural state of the pulse during the prevalence of a pestilential fever, in persons in health, is taken notice of by Riverius[48]. [48] "Pulsus sanorum pulsibus similes admodum, periculosi."--_De Febre Pestilenti, p. 114._ 3. Frequent and copious discharges by the skin of yellow sweats. In some persons these sweats sometimes had an offensive smell, resembling that of the washings of a gun. 4. A scanty discharge of high coloured or turbid urine. 5. A deficiency of appetite, or a greater degree of it than was natural. 6. Costiveness. 7. Wakefulness. 8. Head-ach. 9. A preternatural dilatation of the pupils. This was universal. I was much struck in observing the pupil in one of the eyes of a young man who called upon me for advice, to be of an oblong figure. Whether it was natural, or the effect of the miasmata acting on his brain, I could not determine. It will be thought less strange that the miasmata should produce these changes in the systems of persons who resided constantly in the city, when I add, that many country people who spent but a few hours in the streets in the day, in attending the markets, were infected by the disease, and sickened and died after they returned home; and that others, whom business compelled to spend a day or two in the city during the prevalence of the fever, but who escaped an attack of it, declared that they were indisposed, during the whole time, with languor or head-ach. I was led to observe and record the above effects of the miasmata upon persons in apparent good health, by a fact I met with in Dr. Mitchell's history of the yellow fever in Virginia, in the year 1741. In that fever, blood drawn from a vein was always dissolved. The same state of the blood was observed in many persons who had been exposed to the miasmata, who discovered no other symptom of the disease. A woman whom I had formerly cured of a mania, who lived in an infected neighbourhood, had a fresh attack of that disease, accompanied by an unusual menstrual flux. I ascribed both these complaints to the action of the miasmata upon her system. The smell emitted from a patient, in a clean room, was like that of the small-pox, but in most cases of a less disagreeable nature. Putrid smells in sick rooms were the effects of the excretions, or of some other filthy matters. In small rooms, crowded in some instances with four or five sick people, there was an effluvia that produced giddiness, sickness at stomach, a weakness of the limbs, faintness, and in some cases a diarrh[oe]a. I met with a f[oe]tid breath in one patient, which was not the effect of that medicine which sometimes produces it. The state of the atmosphere, during the whole month of September, and the first two weeks in October, favoured the accumulation of the miasmata in the city. The register of the weather shows how little the air was agitated by winds during the above time. In vain were changes in the moon expected to alter the state of the air. The light of the morning mocked the hopes that were raised by a cloudy sky in the evening. The sun ceased to be viewed with pleasure. Hundreds sickened every day beneath the influence of his rays: and even where they did not excite the disease, they produced a languor in the body unknown to the oldest inhabitant of the city, at the same season of the year. A meteor was seen at two o'clock in the morning, on or about the twelfth of September. It fell between Third-street and the hospital, nearly in a line with Pine-street. Moschetoes (the usual attendants of a sickly autumn) were uncommonly numerous. Here and there a dead cat added to the impurity of the air of the streets. It was supposed those animals perished with hunger in the city, in consequence of so many houses being deserted by the inhabitants who had fled into the country, but the observations of subsequent years made it more probable they were destroyed by the same morbid state of the atmosphere which produced the reigning epidemic. It appears further, from the register of the weather, that there was no rain between the 25th of August and the 15th of October, except a few drops, hardly enough to lay the dust of the streets, on the 9th of September, and the 12th of October. In consequence of this drought, the springs and wells failed in many parts of the country. The dust in some places extended two feet below the surface of the ground. The pastures were deficient, or burnt up. There was a scarcity of autumnal fruits in the neighbourhood of the city. But while vegetation drooped or died from the want of moisture in some places, it revived with preternatural vigour from unusual heat in others. Cherry-trees blossomed, and apple, pear, and plum-trees bore young fruit in several gardens in Trenton, thirty miles from Philadelphia, in the month of October. However inoffensive uniform heat, when agitated by gentle breezes, may be, there is, I believe, no record of a dry, warm, and stagnating air, having existed for any length of time without producing diseases. Hippocrates, in describing a pestilential fever, says the year in which it prevailed was without a breeze of wind[49]. The same state of the atmosphere, for six weeks, is mentioned in many of the histories of the plague which prevailed in London, in 1665[50]. Even the sea air itself becomes unwholesome by stagnating; hence Dr. Clark informs us, that sailors become sickly after long calms in East-India voyages[51]. Sir John Pringle delivers the following aphorism from a number of similar observations upon this subject: "When the heats come on soon, and continue throughout autumn, not moderated by winds or rains, the season proves sickly, distempers appear early, and are dangerous[52]." [49] "Sine aura, usque annus fuit."--_Epid. 3._ [50] Letter from Sir John Bernard to Dr. Floyer, p. 233. [51] Vol. i. p. 5. [52] Diseases of the Army, p. 5. of the 7th London edition. Who can review this account of the universal diffusion of the miasmata which produced this disease, its universal effects upon persons apparently in good health, and its accumulation and concentration, in consequence of the calmness of the air, and believe that it was possible for a febrile disease to exist at that time in our city that was not derived from that source? The West-India writers upon the yellow fever have said that it is seldom taken twice, except by persons who have spent some years in Europe or America in the interval between its first and second attack. I directed my inquiries to this question, and I now proceed to mention the result of them. I met with five persons, during the prevalence of the disease, who had had it formerly, two of them in the year 1741, and three in 1762, who escaped it in 1793, although they were all more or less exposed to the infection. One of them felt a constant pain in her head while the disease was in her family. Four of them were aged, and of course less liable to be acted upon by the miasmata than persons in early or middle life. Mr. Thomas Shields furnished an unequivocal proof that the disease could be taken after an interval of many years. He had it in the year 1762, and narrowly escaped from a violent attack of it this year. Cases of reinfection were very common during the prevalence of this fever. They occurred most frequently where the first attack had been light. But they succeeded attacks that were severe in Dr. Griffitts, Dr. Mease, my pupil Mr. Coxe, and several others, whose cases came under my notice. I have before remarked that the miasmata sometimes excited a fever as soon as they were taken into the body, but that they often lay there from one to sixteen days before they produced the disease. How long they existed in the body after a recovery from the fever I could not tell, for persons who recovered were, in most cases, exposed to their action from external sources. The preternatural dilatation of the pupils was a certain mark of the continuance of some portion of them in the system. In one person who was attacked with the fever on the night of the 9th of October, the pupils did not contract to their natural dimensions until the 7th of November. Having described the effects of the miasmata upon the body, I proceed now to mention the changes induced upon it by death. Let us first take a view of it as it appeared soon after death. Some new light may perhaps be thrown upon the proximate cause of the disease by this mode of examining the body. My information upon this subject was derived from the attendants upon the sick, and from the two African citizens who were employed in burying the dead, viz. Richard Allen and Absalom Jones. The coincidence of the information received from different persons satisfied me that all that I shall here relate is both accurate and just. A deep yellow colour appeared in many cases within a few minutes after death. In some the skin became purple, and in others black. I heard of one case in which the body was yellow above, and black below its middle. In some the skin was as pale as it is in persons who die of common fevers. A placid countenance was observed in many, resembling that which occurs in an easy and healthful sleep. Some were stiff within one hour after death. Others were not so for six hours afterwards. This sudden stiffness after death, Dr. Valli informs us, occurred in persons who died of the plague in Smyrna, in the year 1784[53]. [53] Experiments on Animal Electricity, p. 90. Some grew cold soon after death, while others retained a considerable degree of heat for six hours, more especially on their backs. A stream of tears appeared on the cheeks of a young woman, which seemed to have flowed after her death. Some putrified in a short time after their dissolution, but others had no smell for twelve, eighteen, and twenty hours afterwards. This absence of smell occurred in those cases in which evacuations had been used without success in the treatment of the disease. Many discharged large quantities of black matter from the bowels, and others blood from the nose, mouth, and bowels after death. The frequency of these discharges gave rise to the practice of pitching the joints of the coffins which were used to bury the dead. The morbid appearances of the internal parts of the body, as they appear by dissection after death from the yellow fever, are different in different countries, and in the same countries in different years. I consider them all as effects only of a stimulus acting upon the whole system, and determined more or less by accidental circumstances to particular viscera. Perhaps the stimulus of the miasmata determines the fluids more violently in most cases to the liver, stomach, and bowels, and thereby disposes them more than other parts to inflammation and mortification, and to similar effusions and eruptions with those which take place on the skin. There can be no doubt of the miasmata acting upon the liver, and thereby altering the qualities of the bile. I transcribe, with great pleasure, the following account of the state of the bile in a female slave of forty years of age, from Dr. Mitchell's History of the Yellow Fever, as it prevailed in Virginia, in the years 1737 and 1741, inasmuch as it was part of that clue which led me to adopt one of the remedies on which much of the success of my practice depended. "The gall bladder (says the doctor) appeared outwardly of a deep yellow, but within was full of a black ropy coagulated atrabilis, which sort of substance obstructed the pori biliarii, and ductus choledochus. This atrabilis was hardly fluid, but upon opening the gall bladder, it retained its form and shape, without being evacuated, being of the consistence of a thin extract, and, within, glutinous and ropy, like soap when boiling. This black matter seemed so much unlike bile, that I doubted if there were any bile in the gall bladder. It more resembled bruised or mortified blood, evacuated from the mortified parts of the liver, surrounding it, although it would stain a knife or probe thrust into it of a yellow colour, which, with its ropy consistence, seemed more peculiar to a bilious humour." The same appearance of the bile was discovered in several other subjects dissected by Dr. Mitchell. The liver, in the above-mentioned slave, was turgid and plump on its outside, but on its concave surface, two thirds of it were of a deep black colour, and round the gall bladder it seemed to be mortified and corrupted. The duodenum was lined on its inside, near the gall bladder, with a viscid ropy bile, like that which has been described. Its villous coat was lined with a thick fur or slime, which, when scraped or pealed off, the other vascular and muscular coats of the gut appeared red and inflamed. The omentum was so much wasted, that nothing but its blood-vessels could be perceived. The stomach was inflamed, both on its outside and inside. It contained a quantity of bile of the same consistence, but of a blacker colour than that which was found in the gall bladder. Its villous coat, like that of the duodenum, was covered with fuzzy and slimy matter. It moreover appeared to be distended or swelled. This peculiarity in the inner coat of the stomach was universal in all the bodies that were opened, of persons who died of this disease. The lungs, instead of being collapsed, were inflated as in inspiration. They were all over full of black or livid spots. On these spots were to be seen small vesicles or blisters, like those of an erysipelas or gangrene, containing a yellow humour. The blood-vessels in general seemed empty of blood, even the vena cava and its branches; but the vena portarum was full and distended as usual. The blood seemed _collected_ in the _viscera_; for upon cutting the lungs or sound liver or spleen, they bled freely. The brain was not opened in this body, but it was not affected in three others whose brains were examined. Dr. Mackittrick, in his inaugural dissertation, published at Edinburgh in the year 1766, "De Febre Indiæ Occidentalis, Maligna Flava," or upon the yellow fever of the West-Indies, says, that in some of the patients who died of it, he found the liver sphacelated, the gall bladder full of black bile, and the veins turgid with black fluid blood. In others he found the liver no ways enlarged, and its "texture only vitiated." The stomach, the duodenum, and ilium, were remarkably inflamed in all cases. The pericardium contained a viscid yellow serum, and in a larger quantity than common. The urinary bladder was a little inflamed. The lungs were sound. Dr. Hume, in describing the yellow fever of Jamaica, informs us, that in several dead bodies which he opened, he found the liver enlarged and turgid with bile, and of a pale yellow colour. In some he found the stomach and duodenum inflamed. In one case he discovered black spots in the stomach, of the size of a crown piece. To this account he adds, "that he had seen some subjects opened, on whose stomachs _no marks of inflammation_ could be discovered; and yet these had excessive vomiting." Dr. Lind has furnished us with an account of the state of the body after death, in his short history of the yellow fever, which prevailed at Cadiz, in the year 1764. "The stomach (he says), mesentery, and intestines, were covered with gangrenous spots; there were ulcers on the orifice of the stomach, and the liver and lungs were of a putrid colour and texture[54]." [54] Diseases of Warm Climates, p. 125. To these accounts of the morbid appearances of the body after death from the yellow fever I shall only add the account of several dissections, which was given to the public in Mr. Brown's Gazette, during the prevalence of this epidemic, by Dr. Physick and Dr. Cathrall. "Being well assured of the great importance of dissections of morbid bodies in the investigation of the nature of diseases, we have thought it of consequence that some of those dead of the present prevailing malignant fever should be examined; and, without enlarging on our observations, it appears at present sufficient to state the following facts. "1st. That the brain in all its parts has been found in a natural condition. "2d. That the viscera of the thorax are perfectly sound. The blood, however, in the heart and veins is fluid, similar, in its consistence, to the blood of persons who have been hanged, or destroyed by electricity. "3d. That the stomach, and beginning of the duodenum, are the parts that appear most diseased. In two persons who died of the disease on the 5th day, the villous membrane of the stomach, especially about its smaller end, was found highly inflamed; and this inflammation extended through the pylorus into the duodenum, some way. The inflammation here was exactly similar to that induced in the stomach by acrid poisons, as by arsenic, which we have once had an opportunity of seeing in a person destroyed by it. "The bile in the gall-bladder was quite of its natural colour, though very viscid. "In another person, who died on the 8th day of the disease, several spots of extravasation were discovered between the membranes, particularly about the smaller end of the stomach, the inflammation of which had considerably abated. Pus was seen in the beginning of the duodenum, and the villous membrane at this part was thickened. "In two other persons, who died at a more advanced period of the disease, the stomach appeared spotted in many places with extravasations, and the inflammation disappeared. It contained, as did also the intestines, a black liquor, which had been vomited and purged before death. This black liquor appears clearly to be an altered secretion from the liver; for a fluid in all respects of the same qualities was found in the gall bladder. This liquor was so acrid, that it induced considerable inflammation and swelling on the operator's hands, which remained some days. The villous membrane of the intestines, in these last two bodies, was found inflamed in several places. "The liver was of its natural appearance, excepting in one of the last persons, on the surface of which a very few distended veins were seen: all the other abdominal viscera were of a healthy appearance. "The external surface of the stomach, as well as of the intestines, was quite free from inflammation; the veins being distended with blood, which appeared through the transparent peritonium, gave them a dark colour. "The stomach of those who died early in the disease was always contracted; but in those who died at a more advanced period of it, where extravasations appeared, it was distended with air. "P. S. PHYSICK, "J. CATHRALL." I have before remarked, that these dissections were made early in the disease, and that Dr. Annan attended a dissection of a body at Bush-hill, some time afterwards, in which an unusual turgescence appeared in the vessels of the brain. Thus far have I delivered the history of the yellow fever, as it affected the human body with sickness and death. I shall now mention a few of those circumstances of public and private distress which attended it. I have before remarked, that the first reports of the existence of this fever were treated with neglect or contempt. A strange apathy pervaded all classes of people. While I bore my share of reproach for "terrifying our citizens with imaginary danger," I answered it by lamenting "that they were not terrified enough." The publication from the college of physicians soon dissipated this indifference and incredulity. Fear or terror now sat upon every countenance. The disease appeared in many parts of the town, remote from the spot where it originated; although, for a while, in every instance, it was easily traced to it. This set the city in motion. The streets and roads leading from the city were crowded with families flying in every direction for safety to the country. Business began to languish. Water-street, between Market and Race-streets, became a desert. The poor were the first victims of the fever. From the sudden interruption of business they suffered for a while from poverty as well as from disease. A large and airy house at Bush-hill, about a mile from the city, was opened for their reception. This house, after it became the charge of a committee appointed by the citizens on the 14th of September, was regulated and governed with the order and cleanliness of an old and established hospital. An American and French physician had the exclusive medical care of it after the 22d of September. The disease, after the second week in September, spared no rank of citizens. Whole families were confined by it. There was a deficiency of nurses for the sick, and many of those who were employed were unqualified for their business. There was likewise a great deficiency of physicians, from the desertion of some, and the sickness and death of others. At one time there were but three physicians who were able to do business out of their houses, and at this time there were probably not less than 6000 persons ill with the fever. During the first three or four weeks of the prevalence of the disease I seldom went into a house the first time, without meeting the parents or children of the sick in tears. Many wept aloud in my entry, or parlour, who came to ask for advice for their relations. Grief after a while descended below weeping, and I was much struck in observing that many persons submitted to the loss of relations and friends without shedding a tear, or manifesting any other of the common signs of grief. A cheerful countenance was scarcely to be seen in the city for six weeks. I recollect once, in entering the house of a poor man, to have met a child of two years old that smiled in my face. I was strangely affected with this sight (so discordant to my feelings and the state of the city) before I recollected the age and ignorance of the child. I was confined the next day by an attack of the fever, and was sorry to hear, upon my recovery, that the father and mother of this little creature died a few days after my last visit to them. The streets every where discovered marks of the distress that pervaded the city. More than one half the houses were shut up, although not more than one third of the inhabitants had fled into the country. In walking for many hundred yards, few persons were met, except such as were in quest of a physician, a nurse, a bleeder, or the men who buried the dead. The hearse alone kept up the remembrance of the noise of carriages or carts in the streets. Funeral processions were laid aside. A black man, leading or driving a horse, with a corpse on a pair of chair wheels, with now and then half a dozen relations or friends following at a distance from it, met the eye in most of the streets of the city, at every hour of the day, while the noise of the same wheels passing slowly over the pavements, kept alive anguish and fear in the sick and well, every hour of the night[55]. [55] In the Life of Thomas Story, a celebrated preacher among the friends, there is an account of the distress of the city, in its infant state, from the prevalence of the yellow fever, in the autumn of 1699, nearly like that which has been described. I shall insert the account in his own words. "Great was the fear that fell on all flesh. I saw no lofty or airy countenance, nor heard any vain jesting to move men to laughter. Every face gathered paleness, and many hearts were humbled, and countenances fallen and sunk, as such that waited every moment to be summoned to the bar, and numbered to the grave." The same author adds, that six, seven, and sometimes eight, died of this fever in a day, for several weeks. His fellow-traveller, and companion in the ministry, Roger Gill, discovered upon this occasion an extraordinary degree of christian philanthropy. He publicly offered himself, in one of the meetings of the society, as a sacrifice for the people, and prayed that "God would please to accept of his life for them, that a stop might be put to the contagion." He died of the fever a few days afterwards. But a more serious source of the distress of the city arose from the dissentions of the physicians, about the nature and treatment of the fever. It was considered by some as a modification of the influenza, and by others as the jail fever. Its various grades and symptoms were considered as so many different diseases, all originating from different causes. There was the same contrariety in the practice of the physicians that there was in their principles. The newspapers conveyed accounts of both to the public, every day. The minds of the citizens were distracted by them, and hundreds suffered and died from the delays which were produced by an erroneous opinion of a plurality of diseases in the city, or by indecision in the choice, or a want of confidence in the remedies of their physician. The science of medicine is related to every thing, and the philosopher as well as the christian will be gratified by knowing the effects of a great and mortal epidemic upon the morals of a people. It was some alleviation of the distress produced by it, to observe its influence upon the obligations of morality and religion. It was remarked during this time, by many people, that the name of the Supreme Being was seldom profaned, either in the streets, or in the intercourse of the citizens with each other. But two robberies, and those of a trifling nature, occurred in nearly two months, although many hundred houses were exposed to plunder, every hour of the day and night. Many of the religious societies met two or three times a week, and some of them every evening, to implore the interposition of Heaven to save the city from desolation. Humanity and charity kept pace with devotion. The public have already seen accounts of their benevolent exercises in other publications. It was my lot to witness the uncommon activity of those virtues upon a smaller scale. I saw little to blame, but much to admire and praise in persons of different professions, both sexes, and of all colours. It would be foreign to the design of this work to draw from the obscurity which they sought, the many acts of humanity and charity, of fortitude, patience, and perseverance, which came under my notice. They will be made public and applauded elsewhere. But the virtues which were excited by our calamity were not confined to the city of Philadelphia. The United States wept for the distresses of their capital. In several of the states, and in many cities and villages, days of humiliation and prayer were set apart to supplicate the Father of Mercies in behalf of our afflicted city. Nor was this all. From nearly every state in the union the most liberal contributions of money, provisions, and fuel were poured in for the relief and support of such as had been reduced to want by the suspension of business, as well as by sickness and the death of friends. The number of deaths between the 1st of August and the 9th of November amounted to four thousand and forty-four. I shall here insert a register of the number which occurred on each day, beginning on the 1st of August, and ending on the 9th of November. By comparing it with the register of the weather it will show the influence of the latter on the disease. Several of the deaths in August were from other acute diseases, and a few in the succeeding months were from such as were of a chronic nature. died. | August 1 9 | 2 8 | 3 9 | 4 10 | 5 10 | 6 3 | 7 12 | 8 5 | 9 11 | 10 6 | 11 7 | 12 5 | 13 11 | 14 4 | 15 9 | 16 7 | 17 6 | 18 5 | 19 9 | 20 7 | 21 8 | 22 13 | 23 10 | 24 17 | 25 12 | 26 17 | 27 12 | 28 22 | 29 24 | 30 20 | 31 17 | September 1 17 | 2 18 | 3 11 | 4 23 | 5 20 | 6 24 | 7 18 | 8 42 | 9 32 | 10 29 | 11 23 | 12 33 | 13 37 | 14 48 | 15 56 | 16 67 | 17 81 | 18 68 | 19 61 | 20 67 | 21 57 | 22 76 | 23 68 | 24 96 | 25 87 | 26 52 | 27 60 | 28 51 | 29 57 | 30 63 | October 1 74 | 2 66 | 3 78 | 4 58 | 5 71 | 6 76 | 7 82 | 8 90 | 9 102 | 10 93 | 11 119 | 12 111 | 13 104 | 14 81 | 15 80 | 16 70 | 17 80 | 18 59 | 19 65 | 20 55 | 21 59 | 22 82 | 23 54 | 24 38 | 25 35 | 26 23 | 27 13 | 28 24 | 29 17 | 30 16 | 31 21 | November 1 13 | 2 21 | 3 15 | 4 15 | 5 14 | 6 11 | 7 15 | 8 8 | 9 6 | ---- | Total[56] 3881 | [56] In the above accounts there is a deficiency of returns from several grave-yards of 163. From this table it appears that the principal mortality was in the second week of October. A general expectation had obtained, that cold weather was as fatal to this fever as heavy rains. The usual time for its arrival had come, but the weather was still not only moderate, but warm. In this awful situation, the stoutest hearts began to fail. Hope sickened, and despair succeeded distress in almost every countenance. On the _fifteenth_ of October, it pleased God to alter the state of the air. The clouds at last dropped health in showers of rain, which continued during the whole day, and which were succeeded for several nights afterwards by cold and frost. The effects of this change in the weather appeared first in the sudden diminution of the sick, for the deaths continued for a week afterwards to be numerous, but they were of persons who had been confined before, or on the day in which the change had taken place in the weather. The appearance of this rain was like a dove with an olive branch in its mouth to the whole city. Public notice was given of its beneficial effects, in a letter subscribed by the mayor of Philadelphia, who acted as president of the committee, to the mayor of New-York. I shall insert the whole of this letter. It contains, besides the above information, a record of the liberality of that city to the distressed inhabitants of Philadelphia. "SIR, "I am favoured with your letter of the 12th instant, which I have communicated to the committee for the relief of the poor and afflicted of this city. "It is with peculiar satisfaction that I execute their request, by making, in their name, on behalf of our suffering fellow-citizens, the most grateful acknowledgements for the seasonable benevolence of the common council of the city of New-York. Their sympathy is balm to our wounds. "We acknowledge the Divine interposition, whereby the hearts of so many around us have been touched with our distress, and have united in our relief. "May the Almighty Disposer of all events be graciously pleased to protect your citizens from the dreadful calamity with which we are now visited; whilst we humbly kiss the rod, and improve by the dispensation. "The part, sir, which you personally take in our afflictions, and which you have so pathetically expressed in your letter, excites in the breasts of the committee the warmest sensations of fraternal affection. "The refreshing rain which fell the day before yesterday, though light, and the cool weather which hath succeeded, appear to have given a check to the prevalence of the disorder: of this we have satisfactory proofs, as well in the decrease of the funerals, as in the applications for removal to the hospital. "I have, at your request, this day drawn upon you, at sight, in favour of the president and directors of the Bank of North America, for the sum of five thousand dollars, the benevolent donations of the common council of the city of New-York. "With sentiments of the greatest esteem and regard, "I am, sir, "Your most obedient humble servant, "MATTH. CLARKSON. _"Philadelphia, Oct. 17, 1793._ _"Richard Varick, mayor of the city of New-York."_ It is no new thing for bilious fevers, of every description, to be checked or subdued by _wet_ and _cold_ weather. The yellow fever which raged in Philadelphia in 1699, and which is taken notice of by Thomas Story in his journal, ceased about the latter end of October, or the beginning of November. Of this there are satisfactory proofs, in the register of the interments in the friends' burying-ground, and in a letter, dated November 9th, old style, 1699, from Isaac Norris to one of his correspondents, which his grandson, Mr. Joseph P. Norris, politely put into my hands, with several others, which mention the disease, and all written in that memorable year in Philadelphia. The letter says, "It has pleased God to put a stop to our sore visitation, and town and country are now generally healthy." The same disease was checked by wet and cold weather in the year 1741. Of this there is a proof in a letter from Dr. Franklin to one of his brothers, who stopped at Burlington, on his way from Boston to Philadelphia, on account of the fever, until he was assured by the doctor, that a thunder gust, which had cooled the air, had rendered it safe for him to come into the city[57]. Mr. Lynford Lardner, in a letter to one of his English friends, dated September 24, 1747, old style, after mentioning the prevalence of the fever in the city, says, "the weather is now much cooler, and those under the disorder revive. The symptoms are less violent, and the fever gradually abates." [57] From a short note in the register of the interments in the friends' burying-ground, it appears that the fever this year made its first appearance in the month of June. The following is a copy of that note: "12th of the 6th month (O. S.), 1741, a malignant yellow fever now spreads much." Besides that note, there is the following: "25th of the 7th month (O. S.), 1741, many who died of the above distemper were persons lively, and strong, and in the prime of their time." I have in vain attempted to procure an account of the time of the commencement of cold weather in the autumn of 1762. In the short history of the fever of that year, which I have inserted from my note book, I have said that it continued to prevail in the months of November and December. The register of the interments in the friends' burying-ground in those months confirms that account. They were nearly as numerous in November and December as in September and October, viz. in September 22, in October 27, in November 19, and in December 26. The bilious remitting fever of 1780 yielded to cool weather, accompanied by rain and an easterly wind[58]. [58] Vol. i. Sir John Pringle will furnish ample satisfaction to such of my readers as wish for more proofs of the efficacy of heavy rains, and cold weather, in checking the progress and violence of autumnal remitting fevers[59]. [59] P. 5, 56, 180, and 323. From the 15th of October the disease not only declined, but assumed more obvious inflammatory symptoms. It was, as in the beginning, more necessarily fatal where left to itself, but it yielded more certainly to art than it did a few weeks before. The duration of it was now more tedious than in the warmer weather. There were a few cases of yellow fever in November and December, after the citizens who had retired to the country returned to the city. I heard of but three persons who returned to the city being infected with the disease; so completely was its cause destroyed in the course of a few weeks. In consequence of a proclamation by the governor, and a recommendation by the clergy of Philadelphia, the 12th of December was observed as a day of thanksgiving throughout the state, for the extinction of the disease in the city. It was easy to distinguish, in walking the streets, the persons who had returned from the country to the city, from those who had remained in it during the prevalence of the fever. The former appeared ruddy and healthy, while the latter appeared of a pale or sallow colour. It afforded a subject of equal surprise and joy to behold the suddenness with which the city recovered its former habits of business. In the course of six weeks after the disease had ceased, nothing but fresh graves, and the black dresses of many of the citizens, afforded a public trace of the distress which had so lately prevailed in the city. The month of November, and all the winter months which followed the autumnal epidemic, were in general healthy. A catarrh affected a number of people in November. I suspected it to be the influenza which had revived from a dormant state, and which had not spent itself, when it yielded to the predominance of the yellow fever. This opinion derives some support from a curious fact related by the late Mr. Hunter of the revival of the small-pox in a patient, in whom it had been suspended for some time by the measles[60]. The few fevers which prevailed in the winter were highly inflammatory. The small-pox in the natural way was in several instances confluent; and in one or two fatal. I was prepared to expect this inflammatory diathesis in the fevers of the winter; for I had been taught by Dr. Sydenham, that the diseases which follow a great and mortal epidemic partake more or less of its general character. But the diseases of the winter had a peculiarity still more extraordinary; and that was, many of them had several of the symptoms of the yellow fever, particularly a puking of bile, dark-coloured stools, and a yellow eye. Mr. Samuel D. Alexander, a student of medicine from South-Carolina, who was seized with a pneumony about Christmas, had, with a yellow eye, a dilated pupil and a hard pulse, which beat only fifty strokes in a minute. His blood was such as I had frequently observed in the yellow fever. Dr. Griffitts informed me that he attended a patient on the 9th of January, in a pneumony, who had a universal yellowness on his skin. I met with a case of pneumony on the 20th of the same month, in which I observed the same degrees of redness in the eyes that were common in the yellow fever. My pupil, Mr. Coxe, lost blood in an inflammatory fever, on the 18th of February, which was dissolved. Mr. Innes, the brewer, had a deep yellow colour in his eyes, on the fourth day of a pneumony, on the 27th of the same month; and Mr. Magnus Miller had the same symptom of a similar disease on the 16th of March. None of these bilious and anomalous symptoms of the inflammatory fevers of the winter and spring surprised me. I had been early taught, by Dr. Sydenham, that the epidemics of autumn often insinuate some of their symptoms into the winter diseases which follow them. Dr. Cleghorn informs us, that "the pleurisies which succeeded the autumnal tertians in Minorca, were accompanied by a vomiting and purging of green or yellow bilious matters[61]." [60] Introduction to a Treatise on the Venereal Disease, p. 3. of the American edition. [61] Page 273. It belongs to powerful epidemics to be followed by similar diseases after they disappear, as well as to run into others at their first appearance. In the former case it is occasioned by a peculiar state of the body, created by the epidemic constitution of the air, not having been changed by the weather which succeeded it. The weather in March resembled that of May; while the weather in April resembled that of March in common years. A rash prevailed in many families, in April, accompanied in a few cases by a sore throat. It was attended with an itching, a redness of the eyes, and a slight fever in a few instances. The small-pox by inoculation in this month was more mortal than in former years. However unimportant these facts may appear at this time, future observations may perhaps connect them with a similar constitution of the air which produced the previous autumnal epidemic. The appearance of bilious symptoms in the diseases of the winter, excited apprehensions in several instances of the revival of the yellow fever. The alarms, though false, served to produce vigilance and industry in the corporation, in airing and purifying such houses and articles of furniture as belonged to the poor; and which had been neglected in the autumn, after the ceasing of the disease. The modes of purifying houses, beds, and clothes were various. Fumigations of nitre and aromatic substances were used by some people. Burying infected articles of furniture under ground, and baking them in ovens, were used by others. Some destroyed all their beds and clothing that had been infected, or threw them into the Delaware. Many white-washed their walls, and painted the wood-work of their house. I did not conceive the seeds of the disease required all, or any of those means to destroy it. I believed _cold_ and _water_ to be sufficient for that purpose. I therefore advised keeping the windows of infected rooms open night and day, for a few days; to have the floors and walls of houses well washed; and to expose beds and such articles of household furniture as might be injured by washing, upon the bare earth for a week or two, taking care to turn them every day. I used no other methods of destroying the accumulated miasmata in my house and furniture, and experience showed that they were sufficient. It is possible a portion of the excretions of the sick may be retained in clothes or beds, so as to afford an exhalation that may in the course of a succeeding summer and autumn, or from accidental warmth at any time, create a solitary case of fever, but it cannot render it epidemic. A trunk full of clothes, the property of Mr. James Bingham, who died of the yellow fever in one of the West-India islands about 50 years ago, was opened, some months after they were received by his friends, by a young man who lived in his brother's family. This young man took the disease, and died; but without infecting any of the family; nor did the disease spread afterwards in the city. The father of Mr. Joseph Paschall was infected with the yellow fever of 1741, by the smell of a foul bed in passing through Norris's Alley, in the latter end of December, after the disease had left the city. He died on the 25th of the month, but without reviving the fever in the city, or even infecting his family. The matter which produced the fever in both these cases, had nothing specific in it. It acted in the same manner that the exhalation from any other putrid matters would have done in a highly concentrated state. In a letter from Dr. Senter of Newport, dated January 7th, 1794, I find the following fact, which I shall communicate in his own words. It is introduced to support the principle, that the yellow fever does not spread by contagion. "This place (says the doctor) has traded formerly very much to the West-India islands, and more or less of our people have died there every season, when the disease prevails in those parts. Clothes of these unfortunate people have been repeatedly brought home to their friends, without any accident happening to them." I feel with my reader the fatigue of this long detail of facts, and equal impatience with him to proceed to the history of the treatment of the fever; but I must beg leave to detain him a little longer from that part of the work, while I resume the subject of the origin of the fever. It is an interesting question, as it involves in it the means of preventing the return of the disease, and thereby of saving the lives of thousands of our citizens. Soon after the fever left the city, the governor of the state addressed a letter to the college of physicians, requesting to know their opinion of its origin; if imported, from what _place_, at what _time_, and in what _manner_. The design of this inquiry was to procure such information as was proper to lay before the legislature, in order to improve the laws for preventing the importation or generation of infectious diseases, or to enact new ones, if necessary for that purpose. To the governor's letter the college of physicians sent the following answer: "SIR, "It has not been from a want of respect to yourself, nor from inattention to the subject, that your letter of the 30th ult. was not sooner answered; but the importance of the questions proposed has made it necessary for us to devote a considerable portion of time and attention to the subject, in order to arrive at a safe and just conclusion. "No instance has ever occurred of the disease called the _yellow fever_ having been generated in this city, or in any other parts of the United States, as far as we know; but there have been frequent instances of its having been imported, not only into this, but into other parts of North-America, and prevailing there for a certain period of time; and from the rise, progress, and nature of the malignant fever, which began to prevail here about the beginning of last August, and extended itself gradually over a great part of the city, we are of opinion that this disease was imported into Philadelphia, by some of the vessels which arrived in the port after the middle of July. This opinion we are further confirmed in by various accounts we have received from unquestionable authorities. "Signed, by order of the college of physicians, "JOHN REDMAN, _President_. "_November 26th, 1793._ "_To the governor of Pennsylvania._" Dr. Redman, the president of the college, Dr. Foulke, and Dr. Leib, dissented from the report contained in this letter. I have been necessarily led to continue it in the present edition of this work, not only because all the other members of that body still retain their belief of the importation of the fever, but as a reason for republishing the facts and arguments in support of its domestic origin. I have asserted, in the introduction to the history of this fever, that I believed it to have been generated in our city; I shall now deliver my reasons for that belief. 1. The yellow fever in the West-Indies, and in all other countries where it is endemic, is the offspring of vegetable putrefaction. Heat, exercise, and intemperance in drinking (says Dr. Lind) _dispose_ to this fever in hot climates, but they do not produce it without the concurrence of a remote cause. This remote cause exists at all times, in some spots of the islands, but in other parts even of the same islands, where there are no marsh exhalations, the disease is unknown. I shall not waste a moment in inquiring into the truth of Dr. Warren's account of the origin of this fever. It is fully refuted by Dr. Hillary, and it is treated as chimerical by Dr. Lind. They have very limited ideas of the history of this fever who suppose it to be peculiar to the East or West-Indies. It was admitted to have been generated in Cadiz after a hot and dry summer in 1764, and in Pensacola in 1765[62]. The tertian fever of Minorca, when it attacked Englishmen, put on the usual symptoms of the yellow fever[63]. In short, this disease appears, according to Dr. Lind, in all the southern parts of Europe, after hot and dry weather[64]. [62] Lind on the Diseases of Hot Climates, p. 36 and 124. [63] Cleghorn, p. 176. [64] Diseases of Hot Climates, p. 123. 2. The same causes (under like circumstances) must always produce the same effects. There is nothing in the air of the West-Indies, above other hot countries, which disposes it to produce a yellow fever. Similar degrees of heat, acting upon dead and moist vegetable matters, are capable of producing it, together with all its various modifications, in every part of the world. In support of this opinion, I shall transcribe part of a letter from Dr. Miller, formerly of the Delaware state, and now of New-York. "_Dover, Nov. 5, 1793._ "DEAR SIR, "Since the middle of last July we have had a bilious colic epidemic in this neighbourhood, which exhibits phænomena very singular in this climate; and, so far as I am informed, unprecedented in the medical records, or popular traditions of this country. To avoid unnecessary details it will suffice at present to observe, that the disease, on this occasion, has assumed, not only all the essential characters, but likewise all the violence, obstinacy, and malignity described by the East and West-Indian practitioners. If any difference can be observed it seems here to manifest higher degrees of stubbornness and malignity than we usually meet in the histories of tropical writers. In the course of the disease, not only extreme constipation, frequent vomiting, and the most excruciating pains of the bowels and limbs, harass the unhappy patient; but to these succeed paralysis, convulsions, &c. and almost always uncommon muscular debility, oppression of the præcordia, &c. are the consequence of a severe attack. Bile discharged in enormous quantities constantly assumes the most corrupted and acrimonious appearances, commonly æruginous in a very high degree, and sometimes quite atrabilious. "The inference I mean to draw from the phænomena of this disease, as it appears in this neighbourhood, and which I presume will also apply to your epidemic, is _this_, that from the uncommon protraction and intenseness of our summer and autumnal heats, but principally from the unusual drought, we have had, since the middle of July, a near approach to a _tropical_ season, and that of consequence we ought not to be surprised if tropical diseases, even of the most malignant nature, are _engendered_ amongst us." To the above information it may be added, that the dysentery which prevailed during the autumn of 1793, in several of the villages of Pennsylvania, was attended with a malignity and mortality unknown before in any part of the state. I need not pause to remark that this dysentery arose from putrid exhalation, and that it is, like the bilious colic, only a modification of bilious fever. But further, a malignant fever, resembling that which was epidemic in our city, prevailed during the autumn in many parts of the United States, viz. at Lynn in Massachusetts, at Weatherfield and Coventry in Connecticut, at New-Galloway in the state of New-York, on Walkill and on Pensocken creeks in New-Jersey, at Harrisburgh and Hummelstown in Pennsylvania, in Caroline county in Maryland, on the south branch of the Potowmac in Hardie county, also in Lynchburgh and in Alexandria in Virginia, and in several counties in North-Carolina. In none of these places was there a suspicion of the disease being imported from abroad, or conveyed by an intercourse with the city of Philadelphia. It is no objection to the inference which follows from these facts, that the common remitting fever was not known during the above period in the neighbourhood of this city, and in many other parts of the state, where it had usually appeared in the autumnal months. There is a certain combination of moisture with heat, which is essential to the production of the remote cause of a bilious fever. Where the heat is so intense, or of such long duration, as wholly to dissipate moisture, or when the rains are so great as totally to overflow the marshy ground, or to wash away putrid masses of matter, no fever can be produced. Dr. Dazilles, in his treatise upon the diseases of the negroes in the West-Indies, informs us, that the _rainy_ season is the most healthy at Cayenne, owing to the neighbouring morasses being _deeply_ overflowed; whereas, at St. Domingo, a _dry_ season is most productive of diseases, owing to its favouring those degrees of moisture which produce morbid exhalations. These facts will explain the reason why, in certain seasons, places which are naturally healthy in our country become sickly, while those places which are naturally sickly escape the prevailing epidemic. Previously to the dissipation of the moisture from the putrid masses of vegetable matters in our streets, and in the neighbourhood of the city, there were (as several practitioners can testify) many cases of mild remittents, but they all disappeared about the first week in September. It is worthy of notice, that the yellow fever prevailed in Virginia in the year 1741, and in Charleston, in South-Carolina, in the year 1699, in both which years it prevailed in Philadelphia. Its prevalence in Charleston is taken notice of in a letter, dated November 18th, O. S. 1699, from Isaac Norris to one of his correspondents. The letter says, that "150 persons had died in Charleston in a few days," that "the survivors fled into the country," and that "the town was thinned to a very few people." Is it not probable, from the prevalence of this fever twice in two places in the same years, that it was produced (as in 1793) by a general constitution of air, co-operating with miasmata, which favoured its generation in different parts of the continent? But again, such was the state of the air in the summer of 1793, that it predisposed other animals to diseases, besides the human species. In some parts of New-Jersey, a disease prevailed with great mortality among the horses, and in Virginia among the cows, during the autumn. The urine in both was yellow.--Large abscesses appeared in different parts of the body in the latter animals, which, when opened, discharged a yellow serous fluid. From the colour of these discharges, and of the urine, the disease got the name of the _yellow water_. 3. I have before remarked, that a quantity of damaged coffee was exposed at a time (July the 24th) and in a situation (on a wharf and in a dock) which favoured its putrefaction and exhalation. Its smell was highly putrid and offensive, insomuch that the inhabitants of the houses in Water and Front-streets, who were near it, were obliged, in the hottest weather, to exclude it by shutting their doors and windows. Even persons, who only walked along those streets, complained of an intolerable f[oe]tor, which, upon inquiring, was constantly traced to the putrid coffee. It should not surprise us, that this seed, so inoffensive in its natural state, should produce, after its putrefaction, a violent fever. The records of medicine (to be mentioned hereafter) furnish instances of similar fevers being produced, by the putrefaction of many other vegetable substances. 4. The rapid progress of the fever from Water-street, and the courses through which it travelled into other parts of the city, afford a strong evidence that it was at first propagated by exhalation from the putrid coffee. It was observed that it passed first through those alleys and streets which were in the course of the winds that blew across the dock and wharf, where the coffee had been thrown in a state of putrefaction. 5. Many persons who had worked, or even visited, in the neighbourhood of the exhalation from the coffee, early in the month of August, were indisposed afterwards with sickness, puking, and yellow sweats, long before the air of Water-street was so much impregnated with the exhalation, as to produce such effects; and several patients, whom I attended in the yellow fever, declared to me, or to their friends, that their indispositions began exactly at the time they inhaled the offensive effluvia of the coffee. 6. The first cases of the yellow fever have been clearly traced to the sailors of the vessel who were first exposed to the effluvia of the coffee. Their sickness commenced with the day on which the coffee began to emit its putrid smell. The disease spread with the increase of the poisonous exhalation. A journeyman of Mr. Peter Brown's, who worked near the corner of Race and Water-streets, caught the disease on the 27th of July. Elizabeth Hill, the wife of a fisherman, was infected by only sailing near the pestilential wharf, about the 1st of August, and died at Kensington on the 14th of the same month. Many other names might be mentioned of persons who sickened during the last week in July or the first week in August, who ascribed their illnesses to the smell of the coffee. 7. It has been remarked that this fever did not spread in the country, when carried there by persons who were infected, and who afterwards died with it. During four times in which it prevailed in Charleston, in no one instance, according to Dr. Lining, was it propagated in any other part of the state. 8. In the histories of the disease which have been preserved in this country, it has _six_ times appeared about the first or middle of August, and declined or ceased about the middle of October: viz. in 1732, 1739, 1745, and 1748 in Charleston, in 1791 in New-York, and in 1793 in Philadelphia. This frequent occurrence of the yellow fever at the usual period of our common bilious remittents, cannot be ascribed to accidental coincidence, but must be resolved, in most cases, into the combination of more active miasmata with the predisposition of a tropical season. In speaking of a tropical season, I include that kind of weather in which rains and heats are alternated with each other, as well as that which is uniformly warm. 9. Several circumstances attended this epidemic, which do not occur in the West-India yellow fever. It affected children as well as adults, in common with our annual bilious fevers. In the West-Indies, Dr. Hume tells us, it never attacked any person under puberty. It had, moreover, many peculiar symptoms (as I have already shown) which are not to be met with in any of the histories of the West India yellow fever. 10. Why should it surprise us to see a yellow fever generated amongst us? It is only a higher grade of a fever which prevails every year in our city, from vegetable putrefaction. It conforms, in the difference of its degrees of violence and danger, to season as well as climate, and in this respect it is upon a footing with the small-pox, the measles, the sore-throat, and several other diseases. There are few years pass, in which a plethoric habit, and more active but limited miasmata, do not produce sporadic cases of true yellow fever in Philadelphia. It is very common in South and North-Carolina and in Virginia, and there are facts which prove, that not only strangers, but native individuals, and, in one instance, a whole family, have been carried off by it in the state of Maryland. It proved fatal to one hundred persons in the city of New-York in the year of 1791, where it was evidently generated by putrid exhalation. The yellow colour of the skin has unfortunately too often been considered as the characteristic mark of this fever, otherwise many other instances of its prevalence might be discovered, I have no doubt, in every part of the United States. I wish, with Dr. Mosely, the term _yellow_ could be abolished from the titles of this fever, for this colour is not only frequently absent, but sometimes occurs in the mildest bilious remittents. Dr. Haller, in his pathology, describes an epidemic of this kind in Switzerland, in which this colour generally attended, and I have once seen it almost universal in a common bilious fever, which prevailed in the American army, in the year 1776. I cannot help taking notice, in this place, of an omission in the answer to the governor's letter, by the college of physicians. The governor requested to know whether it was imported; if it were, from _what place_, at _what time_, and in _what manner_. In the answer of the college of physicians to the governor's letter no notice was taken of any of those questions. In vain did Dr. Foulke call upon the college to be more definite in their answer to them. They had faithfully sought for the information required, but to no purpose. The character of their departed brother, Dr. Hutchinson, for capacity and vigilance in his office, as inspector of sickly vessels, was urged without effect as an argument against the probability of the disease being imported. Public report had derived it from several different islands; had chased it from ship to ship, and from shore to shore; and finally conveyed it at different times into the city, alternately by dead and living bodies; and from these tales, all of which, when investigated, were proved to be without foundation, the college of physicians composed their letter. It would seem, from this conduct of the college, as if medical superstition had changed its names, and that, in accounting for the origin of pestilential fevers, celestial, planetary, and demoniacal influence had only yielded to the term _importation_. Let not the reader reject the opinion I have delivered because it is opposed by so great a majority of the physicians of Philadelphia. A single physician supported an opinion of the existence of the plague at Messina, in the year 1743, in opposition to all the physicians (33 in number) of that city. They denied the disease in question to exist, because it was not accompanied by glandular swellings. Time showed that they were all mistaken, and the plague, which might probably have been checked, at its first appearance, by their united efforts, was, by means of their ignorance, introduced with great mortality into every part of the city. This disposition of physicians to limit the symptoms of several other diseases, cannot be sufficiently lamented. The frequent absence of a yellow colour, in this epidemic, led to mistakes which cost the city of Philadelphia several hundred lives. The letter of the college of physicians has served to confirm me in an opinion, that the plagues which occasionally desolated most of the countries of Europe, in former centuries, and which were always said to be of foreign extraction, were of domestic origin. Between the years 1006 and 1680, the plague was epidemic fifty-two times all over Europe. It prevailed fourteen times in the 14th century. The state of Europe, in this long period, is well known. Idleness, a deficiency of vegetable aliment, a camp life, from the frequency of wars, famine, an uncultivated and marshy soil, small cabins, and the want of cleanliness in dress, diet, and furniture, all concurred to generate pestilential diseases. The plagues which prevailed in London, every year from 1593 to 1611, and from 1636 to 1649, I believe were generated in that city. The diminution of plagues in Europe, more especially in London, appears to have been produced by the great change in the diet and manners of the people; also by the more commodious and airy forms of the houses of the poor, among whom the plague _always_ makes its first appearance. It is true, these plagues were said by authors to have been imported, either directly or indirectly, from the Levant; but the proofs of such importation were as vague and deficient as they were of the West-India origin of our epidemic. The pestilential fevers which have been mentioned, have been described by authors by the generic name of the plague, but they appear to have originated from putrid vegetable exhalations, and to have resembled, in most of their symptoms, the West-India and _North-American_ yellow fever. I shall resume this interesting subject in another place, in which I shall mention a number of additional facts, not only in support of the domestic origin of the bilious yellow fever, but of its not spreading by contagion, and of course of its being impossible to import it. I shall at the same time enumerate all its different sources, and point out the means of destroying or removing them, and thus of exterminating the disease from our country. With these observations I conclude the history of the epidemic fever of the year 1793. A few of its symptoms, which have been omitted in this history, will be included in the method of cure, for they were discovered or produced by the remedies which were given for that purpose. [Hand] The following page begins an account of the states of the thermometer and weather, from the 1st of January to the 1st of August, and of the states of the barometer, thermometer, winds, and weather, from the 1st of August to the 9th of November, 1793. The times of observation, for the first three months are at 7 in the morning, and 2 in the afternoon; for the next five months they are at 6 in the morning, and 3 in the afternoon. From the 1st of October to the 9th of November, they are as in the first three months. _January, 1793._ _February, 1793._ +----+---------+----------------------+---------+---------------------+ | | Therm. | Weather. | Therm. | Weather. | | D. | 7h | 2h | | 7h | 2h | | +----+----+----+----------------------+----+----+---------------------+ | 1 | 27 | 30 | Cloudy. | 9 | 26 | Fair, hazy. | | 2 | 30 | 41 | Fair, cloudy. | 25 | 34 | Rain, ditto. | | 3 | 30 | 33 | Cloudy, rain. | 33 | 37 | Cloudy, fair. | | 4 | 38 | 41 | Rain, cloudy. | 25 | 46 | Cloudy, fair. | | 5 | 35 | 42 | Fair, cloudy. | 36 | 44 | Cloudy, ditto. | | 6 | 33 | 47 | Cloudy, fair. | 35 | 46 | Cloudy, rain. | | 7 | 38 | 51 | Fair, fair. | 36 | 40 | Cloudy, fair. | | 8 | 32 | 49 | Fair, ditto. | 28 | 44 | Cloudy, ditto. | | 9 | 33 | 48 | Hazy, fair. | 42 | 50 | Rain, fair. | | 10 | 38 | 51 | Fair, ditto. | 38 | 40 | Cloudy, fair. | | 11 | 35 | 48 | Fair, clouds. | 19 | 27 | Fair, cloudy. | | 12 | 31 | 42 | Fair, ditto. | 20 | 28 | Snow, cloudy. | | 13 | 28 | 42 | Fair, ditto. | 22 | 31 | Cloudy, snow. | | 14 | 25 | 27 | Hail, snow, sleet. | 27 | 39 | Cloudy, fair. | | 15 | 32 | 37 | Clouds, mist. | 18 | 40 | Fair, ditto. | | 16 | 37 | 39 | Rain, ditto. | 29 | 42 | Cloudy, ditto. | | 17 | 37 | 45 | Rain, snow, fair. | 44 | 48 | Rain, ditto. | | 18 | 32 | 52 | Fair, ditto. | 39 | 49 | Cloudy, fair. | | 19 | 37 | 48 | Fair, ditto. | 31 | 41 | Cloudy, rain. | | 20 | 33 | 47 | Hazy, cloudy. | 52 | 53 | Rain, fair. | | 21 | 36 | 47 | Cloudy, fair. | 37 | 49 | Fair, ditto. | | 22 | 27 | 32 | Fair, ditto. | 29 | 34 | Fair, ditto. | | 23 | 22 | 37 | Fair, ditto. | 22 | 34 | Snow, cloudy. | | 24 | 30 | 39 | Cloudy, ditto. | 54 | 59 | Rain, cloudy. | | 25 | 30 | 41 | Fair, hazy. | 34 | 35 | Cloudy, ditto. | | 26 | 31 | -- | Fair. | 35 | 43 | Rain, mist. | | 27 | 23 | 38 | Fair, cloudy, snow. | 43 | 43 | Rain, cloudy. | | 28 | 35 | 45 | Cloudy, fair. | 14 | 26 | Fair, ditto. | | 29 | 29 | 37 | Fair, ditto. | | | | | 30 | 22 | 23 | Snow, hail. | | | | | 31 | 25 | 32 | Cloudy, fair. | | | | +----+----+----+----------------------+----+----+---------------------+ _March, 1793._ _April, 1793._ +----+---------+----------------------+---------+---------------------+ | | Therm. | Weather. | Therm. | Weather. | | D. | 7h | 2h | | 7h | 2h | | +----+----+----+----------------------+----+----+---------------------+ | 1 | 20 | 38 | Fair, ditto. | 45 | 70 | Cloudy, fair. | | 2 | 31 | 51 | Hazy, cloudy. | 47 | 71 | Fair, ditto. | | 3 | 48 | 63 | Rain, fair. | 56 | 80 | Fair, ditto. | | 4 | 43 | 61 | Hazy, ditto. | 51 | 72 | Cloudy, fair. | | 5 | 51 | 52 | Rain, fair. | 53 | 61 | Cloudy, rain. | | 6 | 32 | 50 | Fair, ditto. | 60 | 76 | Misty, fair. | | 7 | 36 | 62 | Fair, ditto, clouds. | 51 | 65 | Fair, ditto. | | 8 | 54 | 60 | Cloudy, rain. | 46 | 74 | Fair, ditto. | | 9 | 26 | 41 | Fair, ditto. | 55 | 71 | Fair, cloudy. | | 10 | 29 | 51 | Fair, ditto. | 50 | 56 | Fair, ditto. | | 11 | 43 | 55 | Rain, ditto. | 37 | 63 | Fair, ditto. | | 12 | 40 | 43 | Cloudy, ditto. | 54 | 62 | Cloudy, rain, fair. | | 13 | 38 | 39 | Cloudy, fair. | 49 | 62 | Fair, ditto. | | 14 | 26 | 44 | Fair, ditto. | 50 | 70 | Fair, ditto. | | 15 | 32 | 59 | Fair, ditto. | 45 | 55 | Rain, cloudy. | | 16 | 52 | 62 | Cloudy, fair. | 46 | 62 | Cloudy, fair. | | 17 | 51 | 72 | Cloudy, fair. | 48 | 67 | Fair, clouds, fair. | | 18 | 58 | 69 | Hazy, cloudy. | 52 | 66 | Cloudy, fair. | | 19 | 53 | 59 | Fair, ditto. | 52 | 75 | Fair, ditto. | | 20 | 42 | 61 | Fair, ditto. | 52 | 49 | Rain, cloudy. | | 21 | 41 | 43 | Rain, cloudy. | 44 | 47 | Cloudy, ditto. | | 22 | 31 | 47 | Fair, ditto. | 43 | 46 | Rain, cloudy. | | 23 | 35 | 57 | Fair, ditto. | 42 | 63 | Fair, ditto. | | 24 | 37 | 50 | Fair, ditto. | 44 | 68 | Fair, ditto. | | 25 | 35 | 59 | Fair, ditto. | 45 | 65 | Cloudy, ditto. | | 26 | 47 | 54 | Cloudy, rain. | 53 | 57 | Cloudy, rain. | | 27 | 43 | 51 | Fair, cloudy. | 47 | 46 | Rain, ditto. | | 28 | 33 | 45 | Fair, clouds, fair. | 44 | 54 | Rain, cloudy. | | 29 | 34 | 57 | Fair, ditto. | 40 | 59 | Fair, ditto. | | 30 | 41 | 58 | Cloudy, fair. | 40 | 65 | Fair, ditto. | | 31 | 42 | 61 | Cloudy, fair. | | | | +----+----+----+----------------------+----+----+---------------------| _May, 1793._ _June, 1793._ +----+---------+----------------------+---------+---------------------+ | | Therm. | Weather. | Therm. | Weather. | | D. | 7h | 2h | | 7h | 2h | | +----+----+----+----------------------+----+----+---------------------+ | 1 | 45 | 69 | Foggy, cloudy. | 53 | 61 | Rain, showery. | | 2 | 52 | 73 | Fog, clouds, fair. | 54 | 64 | Clouds, showers. | | 3 | 60 | 63 | Rain, ditto. | 55 | 62 | Cloudy, rain, fair. | | 4 | 60 | 80 | Fair, ditto. | 54 | 60 | Rain, do. cloudy. | | 5 | 55 | 56 | Cloudy, ditto. | 58 | 72 | Cloudy, fair, rain. | | 6 | 47 | 58 | Cloudy, fair. | -- | 71 | Cloudy, rain. | | 7 | 50 | 68 | Cloudy, fair. | 68 | 78 | Fair, ditto. | | 8 | 59 | 78 | Cloudy, fair. | 65 | -- | Fair, ditto. | | 9 | 61 | 79 | Foggy, fair. | 70 | 88 | Fog, fair. | | 10 | 65 | 71 | Rain, hazy. | 74 | 90 | Fair, ditto. | | 11 | 55 | 75 | Cloudy, fair. | 76 | 90 | Fair, ditto. | | 12 | 61 | 76 | Cloudy, rain. | 75 | 88 | Fair, showers. | | 13 | 57 | 78 | Fair, ditto. | 74 | 81 | Cloudy, rain. | | 14 | 59 | 83 | Fair, cloudy. | 63 | 77 | Fair, ditto. | | 15 | 60 | 71 | Fair, ditto. | 63 | 82 | Fair, hazy. | | 16 | 50 | 69 | Fair, ditto. | 67 | 85 | Fair, ditto. | | 17 | 48 | 74 | Fair, ditto. | 74 | 89 | Fair, showers. | | 18 | 61 | 81 | Cloudy, fair. | 73 | 88 | Fair, ditto. | | 19 | 65 | 85 | Fair, rain. | 77 | 91 | Fair, ditto. | | 20 | 65 | 87 | Fair, ditto. | 79 | 88 | Fair, rain, fair. | | 21 | 68 | 86 | Fair, ditto, clouds. | 75 | 85 | Cloudy, rain. | | 22 | 72 | 80 | Clouds, gusts. | 58 | 78 | Cloudy, fair. | | 23 | 94 | 79 | Cloudy, fair. | 58 | 78 | Fair, ditto. | | 24 | 58 | 75 | Fair, ditto. | 60 | 79 | Fair, ditto. | | 25 | 52 | 70 | Fair, cloudy. | 67 | 74 | Cloudy, rain. | | 26 | 61 | 66 | Rain, ditto. | 66 | 69 | Cloudy, rain. | | 27 | 68 | 84 | Cloudy, fair. | 68 | 80 | Cloudy, fair. | | 28 | 70 | 68 | Fair, clouds, rain. | 71 | 85 | Cloudy, fair. | | 29 | 57 | 62 | Cloudy, rain, clouds.| 77 | 88 | Cloudy, ditto. | | 30 | 54 | 57 | Cloudy, rain. | 74 | 90 | Fair, ditto. | | 31 | 54 | 60 | Clouds, ditto. | | | | +----+----+----+----------------------+----+----+---------------------+ JULY, 1793. +-----+------------+-----------+-------------+--------------------+ | | Barom. | Ther. | Winds. | Weather. | | | 6 3 | 6 3 | 6 3 | | |Days.|A. M. P. M.|A. M. P. M.|A. M. P. M.| | | | | | | | | 1 |30 0 29 9| 77 88 | W W |fair. | | 2 |29 8 29 7| 77 81 | W |fair, showers. | | 3 |29 9 30 0| 74 80 | E E |cloudy. | | 4 |30 1 30 0| 70 83 | E SW |cloudy, fair, rain. | | 5 |30 0 29 9| 76 90 | NW SW |fair, ditto. | | 6 |29 9 29 9| 78 91 | SW SW |cloudy, thunder. | | 7 |29 9 30 0| 73 88 | NE NW |fair, clouds. | | 8 |30 1 30 1| 72 85 | E E |cloudy, fair. | | 9 |30 0 29 8| 73 81 | S SW |cloudy, ditto. | | 10 |30 0 30 0| 70 84 | W NW |fair, ditto. | | 11 |30 0 30 0| 74 88 | NW NW |fair, clouds. | | 12 |30 1 30 2| 70 84 | N N |fair, ditto. | | 13 |30 1 30 0| 68 83 | NW NW |fair, ditto. | | 14 |30 0 30 0| 65 80 | N Calm |fair, hazy. | | 15 |30 0 29 9| 66 75 | SW SW |cloudy, ditto. | | 16 |29 8 29 7| 70 83 | W W |rain, fair. | | 17 |29 8 29 9| 68 81 | NW NW |fair, ditto. | | 18 |30 0 30 0| 66 86 | W SW |fair, ditto. | | 19 |29 9 29 9| 75 85 | SW W |fair, cloudy, rain. | | 20 |30 0 30 0| 72 87 | W NW |fair, ditto, shower.| | 21 |30 1 30 1| 70 86 | NW NW |fair, ditto. | | 22 |30 0 30 0| 72 87 | SW SW |fair, ditto. | | 23 |30 0 30 0| 73 91 | SW SW |fair, cloudy. | | 24 |29 9 29 9| 75 89 | Calm W |cloudy, fair. | | 25 |30 1 30 1| 71 83 | NW NNW |fair, ditto. | | 26 |30 2 30 2| 63 82 | N NE |fair, ditto. | | 27 |30 2 30 1| 64 81 | S calm S |fair, cloudy. | | 28 |30 1 30 0| 72 85 | Calm NNE |cloudy, fair. | | 29 |30 1 30 1| 74 85 | SSE NE |cloudy, ditto, rain.| | 30 |30 1 30 0| 73 86 | S SW |cloudy, fair. | | 31 |29 9 29 8| 76 80 | SSW SW |cloudy, rain, fair. | +-----+------------+-----------+-------------+--------------------+ AUGUST, 1793. +-----+------------+-----------+-------------+--------------------+ | | Barom. | Ther. | Winds. | Weather. | | | 6 3 | 6 3 | 6 3 | 6 3 | |Days.|A. M. P. M.|A. M. P. M.|A. M. P. M.|A. M. P. M. | | 1 |29 95 30 0| 65 77 | WNW NW |cloudy, fair, | | 2 |30 1 30 1| 63 81 | NW SW |fair, fair, | | 3 |30 6 29 95| 62 82 | N NNE |fair, fair, | | 4 |29 97 30 0| 65 87 | S SW |fair, fair, | | 5 |30 5 30 1| 73 90 | SSW SW |fair, fair, | | 6 |30 2 30 0| 77 87 | SW W |cloudy, fair, | | 7 |30 12 30 1| 68 83 | NW W |fair, fair, | | 8 |30 1 29 95| 69 86 | SSE SSE |fair, rain, | | 9 |29 8 29 75| 75 85 | SSW SW |cloudy, fair, | | 10 |29 9 29 9| 67 82 | W SW |fair, fair, | | 11 |30 0 30 0| 70 84 | SW WSW |cloudy, cloudy, | | 12 |30 0 30 0| 70 87 | W W |fair, fair, | | 13 |30 5 30 0| 71 89 | SW W |fair, fair, | | 14 |30 0 29 95| 75 82 | SW SW |fair, rain, | | 15 |30 0 30 1| 72 75 | NNE NE |fair, cloudy, | | 16 |30 1 30 1| 70 83 | NNE NE |fair, fair, | | 17 |30 1 30 0| 71 86 | SW SW |fair, fair, | | 18 |30 1 30 1| 73 89 | calm SW |fair, fair, | | 19 |30 1 30 0| 72 82 | N N |fair, cloudy, | | 20 |30 1 30 12| 69 82 | NNE NNE |fair, fair, | | 21 |30 15 30 25| 62 83 | N NNE |fair, fair, | | 22 |30 3 30 35| 63 86 | NE SE |fair, fair, | | 23 |30 25 30 15| 63 85 | calm S |fair, fair, | | 24 |30 1 30 1| 73 81 | calm calm |cloudy, rain, | | 25 |30 1 30 1| 71 66 | NE NE |rain, gr. rain, | | 26 |30 15 30 2| 59 69 | NE NE |cloudy, cloudy, | | 27 |30 2 30 2| 65 73 | NE NE |cloudy, cloudy, | | 28 |30 2 30 15| 67 80 | S calm |cloudy, clearin. | | 29 |30 16 30 15| 72 86 | calm SW |cloudy, fair, | | 30 |30 1 30 1| 74 87 | calm SW |fair, fair, | | 31 |30 0 30 0| 74 84 | SW NW |rain, fair. | +-----+------------+-----------+-------------+--------------------+ SEPTEMBER, 1793. +-----+------------+-----------+-------------+--------------------+ | | Barom. | Ther. | Winds. | Weather. | | | 6 3 | 6 3 | 6 3 | 6 3 | |Days.|A. M. P. M.|A. M. P. M.|A. M. P. M.|A. M. P. M. | | 1 |30 0 29 30| 71 86 | calm SW |fog, fair, | | 2 |29 75 29 8| 73 86 | SW SW |fair, fair, | | 3 |30 0 | 60 | NW N |fair, fair, | | 4 |30 15 30 15| 55 75 | W W |fair, fair, | | 5 |30 15 30 1| 62 80 | SE S |fair, cloudy, | | 6 |29 97 29 95| 70 89 | WSW W |fair, cloudy, | | 7 |30 0 30 0| 65 77 | WNW NW |fair, fair, | | 8 |30 1 30 1| 64 70 | calm calm |cloudy, cloudy, | | 9 |30 0 30 0| 66 80 | SE NW |rain, fair, | | 10 |30 0 30 0| 64 72 | N NNE |fair, cloudy, | | 11 |30 1 30 0| 62 72 | NNE N |cloudy, fair, | | 12 |29 96 29 9| 58 76 | NW NNW |fair, fair, | | 13 |29 95 30 0| 57 72 | NW N |fair, fair, | | 14 |30 0 30 5| 58 79 | NW NW |fair, fair, | | 15 |30 0 29 97| 65 80 | N S |fair, fair, | | 16 |29 9 29 | 70 84 | S SW |cloudy, fair, | | 17 |29 8 29 85| 66 67 | N N |cloudy, cloudy, | | 18 |30 3 | 44 | N |fair, | | 19 |30 4 30 35| 45 70 | calm SW |fair, fair, | | 20 |30 3 30 15| 54 69 | calm SE |hazy, hazy, | | 21 |30 0 29 0| 59 78 | calm |cloudy, fair, | | 22 |30 0 30 0| 63 83 | calm |cloudy, fair, | | 23 |30 1 30 1| 62 80 | calm SE |cloudy, cloudy, | | 24 |30 2 30 2| 65 70 | NE ENE |cloudy, fair, | | 25 |30 15 30 0| 61 68 | NE NE |cloudy, cloudy, | | 26 |29 8 29 7| 58 79 | N N |cloudy, fair, | | 27 |29 7 | 64 | NW NW |cloudy, fair, | | 28 |30 5 30 15| 54 73 | NW NW |fair, fair, | | 29 |30 3 30 3| 56 74 | NE ENE |cloudy, fair, | | 30 |30 35 30 3| 57 75 | calm SW |foggy, fair. | +-----+------------+-----------+-------------+--------------------+ OCTOBER, 1793. +-----+------------+-----------+-------------+--------------------+ | | | | | | | | Barom. | Ther. | Winds. | Weather. | | | | | | | | | 7 2 | 7 2 | 7 2 | 7 2 | |Days.|A. M. P. M.|A. M. P. M.|A. M. P. M.|A. M. P. M. | | 1 |30 15 30 5| 64 80 | SW SW |cloudy, fair, | | 2 |29 9 30 5| 70 72 | W NNW |cloudy, fair, | | 3 |30 2 30 15| 50 72 | W SW |fair, fair, | | 4 |29 75 29 7| 59 72 | SW W |cloudy, cloudy, | | 5 |30 0 30 1| 58 66 | N N |fair, fair, | | 6 |30 3 30 3| 43 66 | NE W |fair, fair, | | 7 |30 45 | 46 | calm |fair, | | 8 |30 6 30 6| 53 68 | N N |fair, fair, | | 9 |30 5 30 4| 53 70 | NW NW |fair, fair, | | 10 |30 2 30 2| 49 74 | E NW |fair, fair, | | 11 |30 0 29 85| 51 74 | W W |fair, fair, | | 12 |29 6 29 55| 58 64 | SW NW |rain, rain, | | 13 |29 85 29 9| 49 69 | NW NW |fair, fair, | | 14 |30 5 30 0| 52 76 | SW SW |calm, fair, | | 15 |29 75 29 8| 56 54 | SW N |fair, rain, | | 16 |30 0 30 0| 37 53 | NNW N |fair, fair, | | 17 |30 1 30 1| 37 60 | NE NE |fair, fair, | | 18 |30 1 30 1| 41 62 | NW NW |fair, fair, | | 19 |30 0 29 9| 51 66 | N N |cloudy, fair, | | 20 |30 0 30 0| 44 54 | NW N |fair, fair, | | 21 |30 0 30 2| 49 59 | N NW |fair, fair, | | 22 |29 6 29 5| 51 65 | NW NW |fair, fair, | | 23 |29 8 29 8| 47 60 | W W |fair, fair, | | 24 |30 3 30 4| 36 59 | W NW |fair, fair, | | 25 |30 4 30 3| 46 71 | S S |cloudy, do. h-w. | | 26 |30 2 30 2| 60 72 | calm SW |cloudy, cloudy, | | 27 |30 3 30 3| 44 44 | NNE NNE |cloudy, cloudy, | | 28 |30 2 30 1| 34 37 | N N |cloudy, cloudy, | | 29 |29 85 29 85| 28 44 | NNW NW |fair, fair, | | 30 |30 1 30 1| 28 49 | calm SW |hazy, hazy, | | 31 |30 15 30 2| 42 45 | calm NNE |cloudy, rain. | +-----+------------+-----------+-------------+--------------------+ NOVEMBER, 1793. +-----+------------+-----------+-------------+--------------------+ | | Barom. | Ther. | Winds. | Weather. | | | 7 2 | 7 2 | 7 2 | 7 2 | |Days.|A. M. P. M.|A. M. P. M.|A. M. P. M.| A. M. P. M. | | 1 |30 1 30 1| 40 41 | NNE NE |rain, cloudy, | | 2 |30 3 30 25| 32 49 | NNE NE |fair, fair, | | 3 |30 1 30 0| 43 56 | calm SW |cloudy, cloudy, | | 4 |29 8 29 9| 55 67 | SW SW |cloudy, fair, | | 5 |30 15 30 1| 50 64 | NE NE |rain, rain, | | 6 |29 8 29 65| 63 67 | S S |cloudy, cloudy, | | 7 |29 8 29 8| 44 64 | calm SW |fair, fair, | | 8 |29 8 29 85| 43 56 | SSW SW |fair, fair, | | 9 |29 9 29 95| 42 64 | SW SW |fair, fair, | +-----+------------+-----------+-------------+--------------------+ OF THE METHOD OF CURE. In the introduction to the history of the fever, I mentioned the remedies which I used with success, in several cases which occurred in the beginning of August. I had seen, and recorded in my note book, the efficacy of gentle purges in the yellow fever of 1762; but finding them unsuccessful after the 20th of August, and observing the disease to assume uncommon symptoms of great prostration of strength, I laid them aside, and had recourse to a gentle vomit of ipecacuanha, on the first day of the fever, and to the usual remedies for exciting the action of the sanguiferous system. I gave bark in all its usual forms of infusion, powder, and tincture. I joined wine, brandy, and aromatics with it. I applied blisters to the limbs, neck, and head. Finding them all ineffectual, I attempted to rouse the system by wrapping the whole body, agreeably to Dr. Hume's practice, in blankets dipped in warm vinegar. To these remedies I added one more: I rubbed the right side with mercurial ointment, with a view of exciting the action of the vessels in the whole system, through the medium of the liver, which I then supposed to be principally, though symptomatically, affected by the disease. None of these remedies appeared to be of any service; for although three out of thirteen recovered, of those to whom they were applied, yet I have reason to believe that they would have recovered much sooner had the cure been trusted to nature. Perplexed and distressed by my want of success in the treatment of this fever, I waited upon Dr. Stephens, an eminent and worthy physician from St. Croix, who happened then to be in our city, and asked for such advice and information upon the subject of the disease, as his extensive practice in the West-Indies would naturally suggest. He politely informed me, that he had long ago laid aside evacuations of all kinds in the yellow fever; that they had been found to be hurtful, and that the disease yielded more readily to bark, wine, and, above all, to the use of the cold bath. He advised the bark to be given in large quantities by way of glyster, as well as in the usual way; and he informed me of the manner in which the cold bath should be used, so as to derive the greatest benefit from it. This mode of treating the yellow fever appeared to be reasonable. I had used bark, in the manner he recommended it, in several cases of sporadic yellow fever, with success, in former years. I had, moreover, the authority of several other physicians of reputation in its favour. Dr. Cleghorn tells us, that "he sometimes gave the bark when the bowels were full of vicious humours. These humours (he says) are produced by the fault of the circulation. The bark, by bracing the solids, enables them to throw off the excrementitious fluids, by the proper emunctories[65]." [65] Page 223. I began the use of each of Dr. Stevens's remedies the next day after my interview with him, with great confidence of their success. I prescribed bark in large quantities: in one case I ordered it to be injected into the bowels every four hours. I directed buckets full of cold water to be thrown frequently upon my patients. The bark was offensive to the stomach, or rejected by it, in every case in which I prescribed it. The cold bath was grateful, and produced relief in several cases, by inducing a moisture on the skin. For a while I had hopes of benefit to my patients from the use of these remedies, but, in a few days, I was distressed to find they were not more effectual than those I had previously used. Three out of four of my patients died, to whom the cold bath was administered, in addition to the tonic remedies before-mentioned. Baffled in every attempt to stop the ravages of this fever, I anticipated all the numerous and complicated distresses in our city, which pestilential diseases have so often produced in other countries. The fever had a malignity and an obstinacy which I had never before observed in any disease, and it spread with a rapidity and mortality far beyond what it did in the year 1762. Heaven alone bore witness to the anguish of my soul in this awful situation. But I did not abandon a hope that the disease might yet be cured. I had long believed that good was commensurate with evil, and that there does not exist a disease for which the goodness of Providence has not provided a remedy. Under the impression of this belief I applied myself with fresh ardour to the investigation of the disease before me. I ransacked my library, and pored over every book that treated of the yellow fever. The result of my researches for a while was fruitless. The accounts of the symptoms and cure of the disease by the authors I consulted were contradictory, and none of them appeared altogether applicable to the prevailing epidemic. Before I desisted from the inquiry to which I had devoted myself, I recollected that I had, among some old papers, a manuscript account of the yellow fever as it prevailed in Virginia in the year 1741, which had been put into my hands by Dr. Franklin, a short time before his death. I had read it formerly, and made extracts from it into my lectures upon that disease. I now read it a second time. I paused upon every sentence; even words in some places arrested and fixed my attention. In reading the history of the method of cure I was much struck with the following passages. "It must be remarked, that this evacuation (meaning by purges) is more necessary in this than in most other fevers. The abdominal viscera are the parts principally affected in this disease, but by this timely evacuation their feculent corruptible contents are discharged, before they corrupt and produce any ill effects, and their various emunctories and secerning vessels are set open, so as to allow a free discharge of their contents, and consequently a security to the parts themselves, during the course of the disease. By this evacuation the very minera of the disease, proceeding from the putrid miasmata fermenting with the salivary, bilious, and other inquiline humours of the body, is sometimes eradicated by timely emptying the abdominal viscera, on which it first fixes, after which a gentle sweat does as it were nip it in its bud. Where the primæ viæ, but especially the stomach, is loaded with an offensive matter, or contracted and convulsed with the irritation of its stimulus, there is no procuring a laudable sweat till that is removed; after which a necessary quantity of sweat breaks _out of its own accord_, these parts promoting it when by an absterging medicine they are eased of the burden or stimulus which oppresses them." "All these acute putrid fevers ever require some evacuation to bring them to a perfect crisis and solution, and that even by stools, which must be promoted by art, where nature does not do the business herself. On this account an _ill-timed scrupulousness about the weakness of the body_ is of bad consequence in these urging circumstances; for it is that which seems chiefly to make evacuations necessary, which nature ever attempts, after the humours are fit to be expelled, but is not able to accomplish for the most part in this disease; and I can affirm that I have given a purge in this case, when _the pulse has been so low, that it could hardly be felt_, and the _debility extreme_, yet _both one and the other_ have been _restored by it_." "This evacuation must be procured by _lenitive chologoque_ purges." Here I paused. A new train of ideas suddenly broke in upon my mind. I believed the weak and low pulse which I had observed in this fever, to be the effect of debility from a depressed state of the system, but the unsuccessful issue of purging, and even of a spontaneous diarrh[oe]a, in a patient of Dr. Hutchinson, had led me not only to doubt of, but to dread its effects. My fears from this evacuation were confirmed, by the communications I had received from Dr. Stevens. I had been accustomed to raising a weak and low pulse in pneumony and apoplexy, by means of blood-letting, but I had attended less to the effects of purging in producing this change in the pulse. Dr. Mitchell in a moment dissipated my ignorance and fears upon this subject. I adopted his theory and practice, and resolved to follow them. It remained now only to fix upon a suitable purge to answer the purpose of discharging the contents of the bowels. I have before described the state of the bile in the gall-bladder and duodenum, in an extract from the history of a dissection made by Dr. Mitchell. I suspected that my want of success in discharging this bile, in several of the cases in which I attempted the cure by purging, was owing the feebleness of my purges. I had been in the habit of occasionally purging with calomel in bilious and inflammatory fevers, and had recommended the practice the year before in my lectures, not only from my own experience, but upon the authority of Dr. Clark. I had, moreover, other precedents for its use in the practice of sir John Pringle, Dr. Cleghorn, and Dr. Balfour, in diseases of the same class with the yellow fever. But these were not all my vouchers for the safety and efficacy of calomel. In my attendance upon the military hospitals during the late war, I had seen it given combined with jalap in the bilious fever by Dr. Thomas Young, a senior surgeon in the hospitals. His usual dose was ten grains of each of them. This was given once or twice a day until it procured large evacuations from the bowels. For a while I remonstrated with the doctor against this purge, as being disproportioned to the violence and danger of the fever; but I was soon satisfied that it was as safe as cremor tartar or glauber's salts. It was adopted by several of the surgeons of the hospital, and was universally known, and sometimes prescribed, by the simple name of _ten_ and _ten_. This mode of giving calomel occurred to me in preference to any other. The jalap appeared to be a necessary addition to it, in order to quicken its passage through the bowels; for calomel is slow in its operation, more especially when it is given in large doses. I resolved, after mature deliberation, to prescribe this purge. Finding ten grains of jalap insufficient to carry the calomel through the bowels in the rapid manner I wished, I added fifteen grains of the former to ten of the latter; but even this dose was slow and uncertain in its operation. I then issued three doses, each consisting of fifteen grains of jalap and ten of calomel; one to be given every six hours until they procured four or five large evacuations. The effects of this powder not only answered, but far exceeded my expectations. It perfectly cured four out of the first five patients to whom I gave it, notwithstanding some of them were advanced several days in the disease. Mr. Richard Spain, a block-maker, in Third-street, took eighty grains of calomel, and rather more of rhubarb and jalap mixed with it, on the two last days of August, and on the first day of September. He had passed twelve hours, before I began to give him this medicine, without a pulse, and with a cold sweat on all his limbs. His relations had given him over, and one of his neighbours complained to me of my neglecting to advise them to make immediate preparations for his funeral. But in this situation I did not despair of his recovery, Dr. Mitchell's account of the effects of purging in raising the pulse, exciting a hope that he might be saved, provided his bowels could be opened. I now committed the exhibition of the purging medicine to Mr. Stall, one of my pupils, who mixed it, and gave it with his own hand, three or four times a day. At length it operated, and produced two copious, f[oe]tid stools. His pulse rose immediately afterwards, and a universal moisture on his skin succeeded the cold sweat on his limbs. In a few days he was out of danger, and soon afterwards appeared in the streets in good health, as the first fruits of the efficacy of mercurial purges in the yellow fever. After such a pledge of the safety and success of my new medicine, I gave it afterwards with confidence. I communicated the prescription to such of the practitioners as I met in the streets. Some of them I found had been in the use of calomel for several days, but as they had given it in small and single doses only, and had followed it by large doses of bark, wine, and laudanum, they had done little or no good with it. I imparted the prescription to the college of physicians, on the third of September, and endeavoured to remove the fears of my fellow-citizens, by assuring them that the disease was no longer incurable. Mr. Lewis, the lawyer, Dr. M'Ilvaine, Mrs. Bethel, her two sons, and a servant maid, and Mr. Peter Baynton's whole family (nine in number), were some of the first trophies of this new remedy. The credit it acquired, brought me an immense accession of business. It still continued to be almost uniformly effectual in all those which I was able to attend, either in person, or by my pupils. Dr. Griffitts, Dr. Say, Dr. Pennington, and my former pupils who had settled in the city, viz. Dr. Leib, Dr. Porter, Dr. Annan, Dr. Woodhouse, and Dr. Mease, were among the first physicians who adopted it. I can never forget the transport with which Dr. Pennington ran across Third-street to inform me, a few days after he began to give strong purges, that the disease yielded to them in every case. But I did not rely upon purging alone to cure the disease. The theory of it which I had adopted led me to use other remedies to abstract excess of stimulus from the system. These were _blood-letting_, _cool air_, _cold drinks_, _low diet_, and _applications of cold water_ to the body. I had bled Mrs. Bradford, Mrs. Leaming, and one of Mrs. Palmer's sons with success, early in the month of August. But I had witnessed the bad effects of bleeding in the first week in September, in two of my patients who had been bled without my knowledge, and who appeared to have died in consequence of it. I had, moreover, heard of a man who had been bled on the first day of the disease, who died in twelve hours afterwards. These cases produced caution, but they did not deter me from bleeding as soon as I found the disease to change its type, and instead of tending to a crisis on the third, to protract itself to a later day. I began by drawing a small quantity at a time. The appearance of the blood, and its effects upon the system, satisfied me of its safety and efficacy. Never before did I experience such sublime joy as I now felt in contemplating the success of my remedies. It repaid me for all the toils and studies of my life. The conquest of this formidable disease was not the effect of accident, nor of the application of a single remedy; but it was the triumph of a principle in medicine. The reader will not wonder at this joyful state of my mind when I add a short extract from my note book, dated the 10th of September. "Thank God! out of one hundred patients, whom I have visited or prescribed for this day, I have lost none." Being unable to comply with the numerous demands which were made upon me for the purging powders, notwithstanding I had requested my sister, and two other persons to assist my pupils in putting them up; and, finding myself unable to attend all the persons who sent for me, I furnished the apothecaries with the recipe for the mercurial purges, together with printed directions for giving them, and for the treatment of the disease. Hitherto there had been great harmony among the physicians of the city, although there was a diversity of sentiment as to the nature and cure of the prevailing fever. But this diversity of sentiment and practice was daily lessening, and would probably have ceased altogether in a few days, had it not been prevented by two publications, the one by Dr. Kuhn, and the other by Dr. Stevens, in which they recommended bark, wine, and other cordials, and the cold bath, as the proper remedies for the disease. The latter dissuaded from the use of evacuations of all kinds. This method of cure was supported by a letter from Alexander Hamilton, Esq. then secretary of the treasury of the United States, to the college of physicians, in which he ascribed his recovery from the fever to the use of those remedies, administered by the hand of Dr. Stevens. The respectable characters of those two physicians procured an immediate adoption of the mode of practice recommended by them, by most of the physicians of the city, and a general confidence in it by all classes of citizens. Had I consulted my interest, or regarded the certain consequences of opposing the use of remedies rendered suddenly popular by the names that were connected with them, I should silently have pursued my own plans of cure, with my old patients who still confided in them; but I felt, at this season of universal distress, my professional obligations to _all_ the citizens of Philadelphia to be superior to private and personal considerations, and therefore determined at every hazard to do every thing in my power to save their lives. Under the influence of this disposition, I addressed a letter to the college of physicians, in which I stated my objections to Dr. Kuhn and Dr. Stevens's remedies, and defended those I had recommended. I likewise defended them in the public papers against the attacks that were made upon them by several of the physicians of the city, and occasionally addressed such advice to the citizens as experience had suggested to be useful to _prevent_ the disease, particularly low diet, gentle doses of laxative physic, avoiding its exciting causes, and prompt applications for medical aid. In none of the recommendations of my remedies did I claim the credit of their discovery. On the contrary, I constantly endeavoured to enforce their adoption, by mentioning precedents in favour of their efficacy, from the highest authorities in medicine. This controversy with my brethren, with whom I had long lived in friendly intercourse, carried on amidst the most distressing labours, was extremely painful to me, and was submitted to only to prevent the greater evil of the depopulation of our city by the use of remedies which had been prescribed by myself, as well as others, not only without effect, but with evident injury to the sick. The repeated and numerous instances of their inefficacy, in some of the most opulent families in the city, and the almost uniform success of the depleting remedies, happily restored the public mind, after a while, from its distracted state, and procured submission to the latter from nearly all the persons who were affected by the fever. Besides the two modes of practice which have been described, there were two others: the one consisted of _moderate_ purging with calomel only, and moderate bleeding, on the first or second day of the fever, and afterwards by the copious use of bark, wine, laudanum, and aromatic tonics. This practice was supported by an opinion, that the fever was inflammatory in its first, and putrid in its second stage. The other mode referred to was peculiar to the French physicians, several of whom had arrived in the city from the West-Indies, just before the disease made its appearance. Their remedies were various. Some of them prescribed nitre, cremor tartar, camphor, centaury tea, the warm bath, glysters, and moderate bleeding, while a few used lenient purges, and large quantities of tamarind water, and other diluting drinks. The dissentions of the American physicians threw a great number of patients into the hands of these French physicians. They were moreover supposed to be better acquainted with the disease than the physicians of the city, most of whom, it was well known, had never seen it before. I shall hereafter inquire into the relative success of each of the four modes of practice which have been mentioned. Having delivered a general account of the remedies which I used in this disease, I shall now proceed to make a few remarks upon each of them. I shall afterwards mention the effects of the remedies used by other physicians. OF PURGING. I have already mentioned my reasons for promoting this evacuation, and the medicine I preferred for that purpose. It had many advantages over any other purge. It was detergent to the bile and mucus which lined the bowels. It probably acted in a peculiar manner upon the biliary ducts, and it was rapid in its operation. One dose was sometimes sufficient to open the bowels; but from two to six doses were often necessary for that purpose; more especially as part of them was frequently rejected by the stomach. I did not observe any inconvenience from the vomiting which was excited by the jalap. It was always without that straining which was produced by emetics; and it served to discharge bile when it was lodged in the stomach. Nor did I rest the discharge of the contents of the bowels on the issue of one cleansing on the first day. There is, in all bilious fevers, a reproduction of morbid bile as fast as it is discharged. I therefore gave a purge every day while the fever continued. I used castor oil, salts, cremor tartar, and rhubarb (after the mercurial purges had performed their office), according to the inclinations of my patients, in all those cases where the bowels were easily moved; but where this was not the case, I gave a single dose of calomel and jalap every day. Strong as this purge may be supposed to be, it was often ineffectual; more especially after the 20th of September, when the bowels became more obstinately constipated. To supply the place of the jalap, I now added gamboge to the calomel. Two grains and a half of each, made into a pill, were given to an adult every six hours, until they procured four or five stools. I had other designs in giving a purge every day, besides discharging the re-accumulated bile. I had observed the fever to fall with its principal force upon such parts of the body as had been previously weakened by any former disease. By creating an artificial weak part in the bowels, I diverted the force of the fever to them, and thereby saved the liver and brain from fatal or dangerous congestions. The practice was further justified by the beneficial effects of a plentiful spontaneous diarrh[oe]a in the beginning of the disease[66]; by hæmorrhages from the bowels, when they occurred from no other parts of the body, and by the difficulty or impracticability of reducing the system by means of plentiful sweats. The purges seldom answered the intentions for which they were given, unless they produced four or five stools a day. As the fever showed no regard to day or night in the hours of its exacerbations, it became necessary to observe the same disregard to time in the exhibition of purges: I therefore prescribed them in the evening, at all times when the patient had passed a day without two or three plentiful stools. When purges were rejected, or slow in their operation, I always directed opening glysters to be given every two hours. The effects of purging were as follow: 1. It raised the pulse when low, and reduced it when it was preternaturally tense or full. 2. It revived and strengthened the patient. This was evident in many cases, in the facility with which patients who had staggered to a close-stool, walked back again to their beds after a copious evacuation. Dr. Sydenham takes notice of a similar increase of strength after a plentiful sweat in the plague. They both acted by abstracting excess of stimulus, and thereby removing the depression of the system. 3. It abated the paroxysm of the fever. Hence arose the advantage of giving a purge in some cases in the evening, when an attack of the fever was expected in the course of the night. 4. It frequently produced sweats when given on the first or second day of the fever, after the most powerful sudorifics had been taken to no purpose. 5. It sometimes checked that vomiting which occurs in the beginning of the disease, and it always assisted in preventing the more alarming occurrence of that symptom about the 4th or 5th day. 6. It removed obstructions in the lymphatic system. I ascribe it wholly to the action of mercury, that in no instance did any of the glandular swellings, which I formerly mentioned, terminate in a suppuration. 7. By discharging the bile through the bowels as soon and as fast as it was secreted, it prevented, in most cases, a yellowness of the skin. [66] In some short manuscript notes upon Dr. Mitchell's account of the yellow fever in Virginia, in the year 1741, made by the late Dr. Kearsley, sen. of this city, he remarks, that in the yellow fever which prevailed in the same year in Philadelphia, "some recovered by an _early_ discharge of _black_ matter by stool." This gentleman, Dr. Redman informed me, introduced purging with glauber's salts in the yellow fever in our city. He was preceptor to Dr. Redman in medicine. However salutary the mercurial purge was, objections were made to it by many of our physicians; and prejudices, equally weak and ill-founded, were excited against it. I shall enumerate, and answer those objections. 1. It was said to be of too drastic a nature. It was compared to arsenic; and it was called a dose for a horse. This objection was without foundation. Hundreds who took it declared they had never taken so mild a purge. I met with but one case in which it produced bloody stools; but I saw the same effect from a dose of salts. It sometimes, it is true, operated from twenty to thirty times in the course of twenty-four hours; but I heard of an equal number of stools in two cases from salts and cremor tartar. It is not an easy thing to affect life, or even subsequent health, by copious or frequent purging. Dr. Kirkland mentions a remarkable case of a gentleman who was cured of a rheumatism by a purge, which gave him between 40 and 50 stools. This patient had been previously affected by his disease 16 or 18 weeks[67]. Dr. Mosely not only proves the safety, but establishes the efficacy of numerous and copious stools in the yellow fever. Dr. Say probably owes his life to three and twenty stools procured by a dose of calomel and gamboge, taken by my advice. Dr. Redman was purged until he fainted, by a dose of the same medicine. This venerable gentleman, in whom 70 years had not abated the ardour of humanity, nor produced obstinacy of opinion, came forward from his retirement, and boldly adopted the remedies of purging and bleeding, with success in several families, before he was attacked by the disease. His recovery was as rapid, as the medicine he had used was active in its operation. Besides taking the above purge, he lost twenty ounces of blood by two bleedings[68]. [67] Treatise on the Inflammatory Rheumatism, vol. i. p. 407. [68] Dr. Redman was not the only instance furnished by the disease, in which _reason_ got the better of the habits of old age, and of the formalities of medicine. About the time the fever declined, I received a letter from Dr. Shippen, sen. (then above 82 years of age), dated Oxford Furnace, New-Jersey, October 13th, 1793, in which, after approving in polite terms of my mode of practice, he adds, "Desperate diseases require desperate remedies. I would only propose some small addition to your present method. Suppose you should substitute, in the room of the jalap, _six_ grains of gamboge, to be mixed with ten or fifteen grains of calomel; and after a dose or two, as occasion may require, you should bleed your patients _almost_ to death, at least to _fainting_; and then direct a plentiful supply of mallows tea, with fresh lemon juice, and sugar and barley water, together with the most simple, _mild_, and nutricious food." The doctor concludes his letter by recommending to my perusal Dr. Dover's account of nearly a whole ship's crew having been cured of a yellow fever, on the coast of South-America, by being bled until they fainted. But who can suppose that a dozen or twenty stools in a day could endanger life, that has seen a diarrh[oe]a continue for several months, attended with fifteen or twenty stools every day, without making even a material breach in the constitution? Hence Dr. Hillary has justly remarked, that "it rarely or never happens that the purging in this disease, though violent, takes the patient off, but the fever and inflammation of the bowels[69]." Dr. Clark in like manner remarks, that evacuations do not destroy life in the dysentery, but the fever, with the emaciation and mortification which attend and follow the disease[70]. [69] Diseases of Barbadoes, p. 212. [70] Diseases in Voyages to Hot Climates, vol. ii. p. 322. 2. A second objection to this mercurial purge was, that it excited a salivation, and sometimes loosened the teeth. I met with but two cases in which there was a loss of teeth from the use of this medicine, and in both the teeth were previously loose or decayed. The salivation was a trifling evil, compared with the benefit which was derived from it. I lost only one patient in whom it occurred. I was taught, by this accidental effect of mercury, to administer it with other views than merely to cleanse the bowels, and with a success which added much to my confidence in the power of medicine over this disease. I shall mention those views under another head. 3. It was said that the mercurial purge excoriated the rectum, and produced the symptoms of pain and inflammation in that part, which were formerly mentioned. To refute this charge, it will be sufficient to remark that the bile produces the same excoriation and pain in the rectum in the bilious and yellow fever, where no mercury has been given to discharge it. In the bilious remitting fever which prevailed in Philadelphia in 1780, we find the bile which was discharged by "gentle doses of salts, and cream of tartar, or the butternut pill, was so acrid as to excoriate the rectum, and so offensive as to occasion, in some cases, sickness and faintness both in the patients, and in their attendants[71]." [71] Vol. i. Dr. Hume says further upon this subject, that the rectum was so much excoriated by the natural discharge of bile in the yellow fever, as to render it impossible to introduce a glyster pipe into it. 4. It was objected to this purge, that it inflamed and lacerated the stomach and bowels. In support of this calumny, the inflamed and mortified appearances, which those viscera exhibited upon dissection in a patient who died at the hospital at Bush-hill, were spoken of with horror in some parts of the city. To refute this objection it will only be necessary to review the account formerly given of the state of the stomach and bowels after death from the yellow fever, in cases in which no mercury had been given. I have before taken notice that sir John Pringle and Dr. Cleghorn had prescribed mercurial purges with success in the dysentery, a disease in which the bowels are affected with more irritation and inflammation than in the yellow fever. Dr. Clark informs us that he had adopted this practice. I shall insert the eulogium of this excellent physician upon the use of mercury in the dysentery in his own words. "For several years past, when the dysentery has resisted the common mode of practice, I have administered mercury with the greatest success; and am thoroughly persuaded that it is possessed of powers to _remove inflammation_ and _ulceration_ of the intestines, which are the chief causes of death in this distemper[72]." [72] Vol. ii. p. 342. 5. It was urged against this powerful and efficacious medicine, that it was prescribed indiscriminately in all cases, and that it did harm in all weak habits. To this I answer, that there was no person so weak by constitution or a previous disease, as to be injured by a single dose of this medicine. Mrs. Meredith, the wife of the treasurer of the United States, a lady of uncommon delicacy of constitution, took two doses of the powder in the course of twelve hours, not only without any inconvenience, but with an evident increase of strength soon afterwards. Many similar cases might be mentioned. Even children took two or three doses of it with perfect safety. This will not surprise those physicians who have been in the practice of giving from ten to twenty grains of mercury, with an equal quantity of jalap as a worm purge, and from fifty to a hundred grains of calomel, in the course of four or five days, in the internal dropsy of the brain. But I am happy in being able to add further, that many women took it in every stage of pregnancy without suffering the least inconvenience from it. Out of a great number of pregnant women whom I attended in this fever I did not lose one to whom I gave this medicine, nor did any of them suffer an abortion. One of them had twice miscarried in the course of the two or three last years of her life. She bore a healthy child three months after her recovery from the yellow fever. No one has ever objected to the _indiscriminate_ mode of preparing the body for the small-pox by purging medicines. The _uniform_ inflammatory diathesis of that disease justifies the practice, in a certain degree, in all habits. The yellow fever admits of a sameness of cure much more than the small-pox, for it is _more_ uniformly and more highly inflammatory. An observation of Dr. Sydenham upon epidemics applies, in its utmost extent, to our late fever. "Now it must be observed (says this most acute physician) that some epidemic diseases, in some years, are uniformly and constantly the same[73]." However diversified our fever was in some of its symptoms, it was in all cases accompanied by more or less inflammatory diathesis, and by a morbid state of the alimentary canal. [73] Vol. i. p. 9. Much has been said of the bad effects of this purge from its having been put up carelessly by the apothecaries, or from its having been taken contrary to the printed directions, by many people. If it did harm in any one case (which I do not believe) from the former of the above causes the fault is not mine. Twenty men employed constantly in putting up this medicine would not have been sufficient to have complied with all the demands which were made of me for it. Hundreds who were in health called or sent for it as well as the sick, in order to have it in readiness in case they should be surprised by the disease in the night, or at a distance from a physician. In all the cases in which this purge was supposed to have been hurtful, when given on the first or second day of the disease, I believe it was because it was not followed by repeated doses of the same, or of some other purge, or because it was not aided by blood-letting. I am led to make this assertion, not only from the authority of Dr. Sydenham, who often mentions the good effects of bleeding in moderating or checking a diarrh[oe]a, but by having heard no complaints of patients being purged to death by this medicine, after blood-letting was universally adopted by all the physicians in the city. It was remarked that the demand for this purging powder continued to increase under all opposition, and that the sale of it by the apothecaries was greatest towards the close of the disease. I shall hereafter say that this was not the case with the West-India remedies. It is possible that this purge sometimes proved hurtful when it was given on the fifth day of the disease, but it was seldom given for the _first_ time after the third day, and when it was, the patient was generally in such a situation that nothing did him either good or harm. I derived great pleasure from hearing, after the fever had left the city, that calomel had been given with success as a purge in bilious fevers in other parts of the union besides Philadelphia. Dr. Lawrence informed me that he had cured many patients by it of the yellow fever which prevailed in New-York, in the year 1791, and the New-York papers have told us that several practitioners had been in the habit of giving it in the autumnal fevers, with great success, in the western parts of that state. They had probably learned the use of it from Dr. Young, who formerly practised in that part of the United States, and who lost no opportunity of making its praises public wherever he went. I have only to add to my account of that purging medicine, that, under an expectation that the yellow fever would mingle some of its bilious symptoms with the common inflammatory fevers of the winter and first spring months, I gave that purge in the form of pills, in every case of inflammatory fever to which I was called. The fatal issue of several fevers in the city, during the winter, in which this precaution had been neglected, convinced me that my practice was proper and useful. It is to be lamented that all new remedies are forced to pass through a fiery ordeal. Opium and bark were long the objects of terror and invective in the schools of medicine. They were administered only by physicians for many years, and that too with all the solemnity of a religious ceremony. This error, with respect to those medicines, has at last passed away. It will, I hope, soon be succeeded by a time when the prejudices against _ten_ and _ten_, or _ten_ and _fifteen_, will sleep with the vulgar fears which were formerly entertained of the bark producing diseases and death, years after it had been taken, by "lying in the bones." OF BLOOD-LETTING. The theory of this fever which led me to administer purges, determined me to use blood-letting, as soon as it should be indicated. I am disposed to believe that I was tardy in the use of this remedy, and I shall long regret the loss of three patients, who might probably have been saved by it. I cannot blame myself for not having used it earlier, for the immense number of patients which poured in upon me, in the first week of September, prevented my attending so much to each of them, as was necessary to determine upon the propriety of this evacuation. I was in the situation of a surgeon in a battle, who runs to every call, and only stays long enough with each soldier to stop the bleeding of his wound, while the increase of the wounded, and the unexpected length of the battle, leave his original patients to suffer from the want of more suitable dressings. The reasons which determined me to bleed were, 1. The state of the pulse, which became more tense, in proportion as the weather became cool. 2. The appearance of a moist and _white_ tongue, on the first day of the disease, a certain sign of an inflammatory fever. 3. The frequency of hæmorrhages from every part of the body, and the perfect relief given in some cases by them. 4. The symptoms of congestion in the brain, resembling those which occur in the first stage of hydrocephalus internus, a disease in which I had lately used bleeding with success. 5. The character of the diseases which had preceded the yellow fever. They were all more or less inflammatory. Even the scarlatina anginosa had partaken so much of that diathesis, as to require bleeding to subdue it. 6. The warm and dry weather which had likewise preceded the fever. Dr. Sydenham attributes a highly inflammatory state of the small-pox to a previously hot and dry summer; and I have since observed, that Dr. Hillary takes notice of inflammatory fevers having frequently succeeded hot and dry weather in Barbadoes[74]. He informs us further, that the yellow fever is always most acute and inflammatory after a very hot season[75]. [74] Diseases of Barbadoes, p. 16, 43, 46, 48, 52, 122. [75] Page 147. 7. The authority of Dr. Mosely had great weight with me in advising the loss of blood, more especially as his ideas of the highly inflammatory nature of the fever accorded so perfectly with my own. 8. I was induced to prescribe blood-letting by recollecting its good effects in Mrs. Palmer's son, whom I bled on the 20th of August, and who appeared to have been recovered by it. Having begun to bleed, I was encouraged to continue it by the appearance of the blood, and by the obvious and very great relief my patients derived from it. The following is a short account of the appearances of the blood drawn from a vein in this disease. 1. It was, in the greatest number of cases, without any separation into crassamentum and serum, and of a scarlet colour. 2. There was in many cases a separation of the blood into crassamentum and _yellow_ serum. 3. There were a few cases in which this separation took place, and the serum was of a _natural_ colour. 4. There were many cases in which the blood was as sizy as in pneumony and rheumatism. 5. The blood was in some instances covered above with blue pellicle of sizy lymph, while the part which lay in the bottom of the bowl was dissolved. The lymph was in two cases mixed with green streaks. 6. It was in a few instances of a dark colour, and as fluid as molasses. I saw this kind of blood in a man who walked about his house during the whole of his sickness, and who finally recovered. Both this, and the fifth kind of blood which has been mentioned, occurred chiefly where bleeding had been omitted altogether, or used too sparingly in the beginning of the disease. 7. In some patients the blood, in the course of the disease, exhibited nearly _all_ the appearances which have been mentioned. They were varied by the time in which the blood was drawn, and by the nature and force of the remedies which had been used in the disease. The effects of blood-letting upon the system were as follow: 1. It raised the pulse when depressed, and quickened it, when it was preternaturally slow, or subject to intermissions. 2. It reduced its force and frequency. 3. It checked in many cases the vomiting which occurred in the beginning of the disease, and thereby enabled the stomach to retain the purging medicine. It likewise assisted the purge in preventing the dangerous or fatal vomiting which came on about the fifth day. 4. It lessened the difficulty of opening the bowels. Upon this account, in one of my addresses to the citizens of Philadelphia, I advised bleeding to be used _before_, as well as after taking the mercurial purge. Dr. Woodhouse informed me that he had several times seen patients call for the close-stool while the blood was flowing from the vein. 5. It removed delirium, coma, and obstinate wakefulness. It also prevented or checked hæmorrhages; hence perhaps another reason why not a single instance of abortion occurred in such of my female patients as were pregnant. 6. It disposed, in some cases, to a gentle perspiration. 7. It lessened the sensible debility of the system; hence patients frequently rose from their beds, and walked across their rooms, in a few hours after the operation had been performed. 8. The redness of the eyes frequently disappeared in a few hours after bleeding. Mr. Coxe observed a dilated pupil to contract to its natural size within a few minutes after he had bound up the arm of his patient. I remarked, in the former part of this work, that blindness in many instances attended or followed this fever. But two such cases occurred among my patients. In one of them it was of short continuance, and in the other it was probably occasioned by the want of sufficient bleeding. In every case of blindness that came to my knowledge bleeding had been omitted, or used only in a very moderate degree. 9. It eased _pain_. Thousands can testify this effect of blood-letting. Many of my patients whom I bled with my own hand acknowledged to me, while the blood was flowing, that they were better; and some of them declared, that all their pains had left them before I had completely bound up their arms. 10. But blood-letting had, in many cases, an effect the opposite of _easing_ pain. It frequently increased it in every part of the body, more especially in the head. It appeared to be the effect of the system rising suddenly from a state of great depression, and of an increased action of the blood-vessels which took place in consequence of it. I had frequently seen complaints of the breast, and of the head, made worse by a single bleeding, and from the same cause. It was in some cases an unfortunate event in the yellow fever, for it prevented the blood-letting being repeated, by exciting or strengthening the prejudices of patients and physicians against it. In some instances the patients grew worse after a second, and, in one, after a third bleeding. This was the case in Miss Redman. Her pains increased after three bleedings, but yielded to the fourth. Her father, Dr. Redman, concurred in this seemingly absurd practice. It was at this time my old preceptor in medicine reminded me of Dr. Sydenham's remark, that moderate bleeding did harm in the plague where copious bleeding was indicated, and that in the cure of that disease, we should leave nature wholly to herself, or take the cure altogether out of her hands. The truth of this remark was very obvious. By taking away as much blood as restored the blood-vessels to a morbid degree of action, without reducing this action afterwards, pain, congestion, and inflammation were frequently increased, all of which were prevented, or occurred in a less degree, when the system rose gradually from the state of depression which had been induced by the great force of the disease. Under the influence of the facts and reasonings which have been mentioned I bore the same testimony in acute cases, against what was called _moderate_ bleeding that I did against bark, wine, and laudanum in this fever. 11. Blood-letting, when used _early_ on the first day, frequently strangled the disease in its birth, and generally rendered it more light, and the convalescence more speedy and perfect. I am not sure that it ever shortened the duration of the fever where it was not used within a few hours of the time of its attack. Under every mode of treatment it seemed disposed, after it was completely formed, to run its course. I was so satisfied of this peculiarity in the fever, that I ventured in some cases to predict the day on which it would terminate, notwithstanding I took the cure entirely out of the hands of nature. I did not lose a patient on the third, whom I bled on the first or second day of the disease. 12. In those cases which ended fatally, blood-letting restored, or preserved the use of reason, rendered death easy, and retarded the putrefaction of the body after death. I shall now mention some of the circumstances which directed and regulated the use of this remedy. 1. Where bleeding had been omitted for three days, in acute cases, it was seldom useful. Where purging had been used, it was sometimes successful. I recovered two patients who had taken the mercurial purges, whom I bled for the first time on the seventh day. One of them was the daughter of Mr. James Cresson, the other was a journeyman ship-carpenter at Kensington. In those cases where bleeding had been used on the first day, it was both safe and useful to repeat it every day afterwards, during the continuance of the fever. 2. I preferred bleeding in the exacerbation of the fever. The remedy here was applied when the disease was in its greatest force. A single paroxysm was like a sudden squall to the system, and, unless abated by bleeding or purging, often produced universal disorganization. I preferred the former to the latter remedy in cases of great danger, because it was more speedy, and more certain in its operation. 3. I bled in several instances in the remission of the fever, where the pulse was tense and corded. It lessened the violence of the succeeding paroxysm. 4. I bled in all those cases in which the pulse was preternaturally slow, provided it was tense. Mr. Benj. W. Morris, Mr. Thomas Wharton, jun. and Mr. Wm. Sansom, all owe their lives probably to their having been bled in the above state of the pulse. I was led to use bleeding in this state of the pulse, not only by the theory of the disease which I had adopted, but by the success which had often attended this remedy, in a slow and depressed state of the pulse in apoplexy and pneumony. I had moreover the authority of Dr. Mosely in its favour, in the yellow fever, and of Dr. Sydenham, in his account of a new fever, which appeared in the year 1685. The words of the latter physician are so apposite to the cases which have been mentioned, that I hope I shall be excused for inserting them in this place. "All the symptoms of weakness (says our author) proceed from nature's being in a manner oppressed and overcome by the first attack of the disease, so as not to be able to raise regular symptoms adequate to the violence of the fever. I remember to have met with a remarkable instance of this, several years ago, in a young man I then attended; for though he seemed in a manner expiring, yet the outward parts felt so cool, that I could not persuade the attendants he had a fever, which could not disengage, and show itself clearly, because the vessels were so full as to obstruct the motion of the blood. However, I said, that they would soon find the fever rise high enough upon bleeding him. Accordingly, after taking away a large quantity of blood, as violent a fever appeared as ever I met with, and did not go off till bleeding had been used three or four times[76]." [76] Vol. ii. p. 351. 5. I bled in those cases in which the fever appeared in a tertian form, provided the pulse was full and tense. I well recollect the surprise with which Mr. Van Berkel heard this prescription from me, at a time when he was able to walk and ride out on the intermediate days of a tertian fever. The event which followed this prescription showed that it was not disproportioned to the violence of his disease, for it soon put on such acute and inflammatory symptoms as to require six subsequent bleedings to subdue it. 6. I bled in those cases where patients were able to walk about, provided the pulse was the same as has been mentioned under the fourth head. I was determined as to the propriety of bleeding in these two supposed mild forms of the fever, by having observed each of them, when left to themselves, frequently to terminate in death. 7. I paid no regard to the dissolved state of the blood, when it appeared on the first or second day of the disease, but repeated the bleedings afterwards in every case, where the pulse continued to indicate it. It was common to see sizy blood succeed that which was dissolved. This occurred in Mr. Josiah Coates, and Mr. Samuel Powel. Had I believed that this dissolved state of the blood arose from its putrefaction, I should have laid aside my lancet as soon as I saw it; but I had long ago parted with all ideas of putrefaction in bilious fevers. The refutation of this doctrine was the object of one of my papers in the Medical Society of Edinburgh, in the year 1767. The dissolved appearance of the blood, I suppose to be the effect of a certain action of the blood-vessels upon it. It occurs in fevers which depend upon the sensible qualities of the air, and in which no putrid or foreign matter has been introduced into the system. 8. The presence of petechiæ did not deter me from repeating blood-letting, where the pulse retained its fulness or tension. I prescribed it with success in the cases of Dr. Mease, and of Mrs. Gebler, in Dock-street, in each of whom petechiæ had appeared. Bleeding was equally effectual in the case of the Rev. Mr. Keating, at a time when his arms were spotted with that species of eruptions which I have compared to moscheto-bites. I had precedents in Dr. De Haen[77] and Dr. Sydenham[78], in favour of this practice. So far from viewing these eruptions as signs of putrefaction, I considered them as marks of the highest possible inflammatory diathesis. They disappeared in each of the above cases after bleeding. [77] Ratio Medendi, vol. ii. p. 162. vol. iv. p. 172. [78] Vol. i. p. 210, and 264. 9. In determining the quantity of blood to be drawn, I was governed by the state of the pulse, and by the temperature of the weather. In the beginning of September, I found one or two moderate bleedings sufficient to subdue the fever; but in proportion as the system rose by the diminution of the stimulus of heat, and the fever put on more _visible_ signs of inflammatory diathesis, more frequent bleedings became necessary. I bled many patients twice, and a few three times a day. I preferred frequent and small, to large bleedings, in the beginning of September; but towards the height and close of the epidemic, I saw no inconvenience from the loss of a pint, and even twenty ounces of blood at a time. I drew from many persons seventy and eighty ounces in five days; and from a few, a much larger quantity. Mr. Gribble, cedar-cooper, in Front-street, lost by ten bleedings a hundred ounces of blood; Mr. George, a carter in Ninth-street, lost about the same quantity by five bleedings; and Mr. Peter Mierken, one hundred and fourteen ounces in five days. In the last of the above persons the quantity taken was determined by weight. Mr. Toy, blacksmith near Dock-street, was eight times bled in the course of seven days. The quantity taken from him was about a hundred ounces. The blood in all these cases was dense, and in the last, very sizy. They were all attended in the month of October, and chiefly by my pupil, Mr. Fisher; and they were all, years afterwards, living and healthy instances of the efficacy of copious blood-letting, and of the intrepidity and judgment of their young physician. Children, and even old people, bore the loss of much more blood in this fever than in common inflammatory fevers. I took above thirty ounces, in five bleedings, from a daughter of Mr. Robert Bridges, who was then in the 9th year of her age. Even great debility, whether natural or brought on by previous diseases, did not, in those few cases in which it yielded to the fever, deprive it of the uniformity of its inflammatory character. The following letter from Dr. Griffitts, written soon after his recovery from a third attack of the fever, and just before he went into the country for the re-establishment of his health, will furnish a striking illustration of the truth of the above observation. "I cannot leave town without a parting adieu to my kind friend, and sincere prayers for his preservation. "I am sorry to find that the use of the lancet is still so much dreaded by too many of our physicians; and, while lamenting the death of a valuable friend this morning, I was told that he was bled but _once_ during his disease. Now if my poor frame, reduced by previous sickness, great anxiety, and fatigue, and a very low diet, could bear_ seven_ bleedings in five days, besides purging, and no diet but toast and water, what shall we say of physicians who bleed but once? "_October 19th, 1793._" I have compared a paroxysm of this fever to a sudden squall; but the disease in its whole course was like a tedious equinoctial gale acting upon a ship at sea; its destructive force was only to be opposed by handing every sail, and leaving the system to float, as it were, under bare poles. Such was the fragility (if I may be allowed the expression) of the blood-vessels, that it was necessary to unload them of their contents, in order to prevent the system sinking from hæmorrhages, or from effusions in the viscera, particularly the brain. 9. Such was the indomitable nature of the pulse, in some patients, that it did not lose its force after numerous and copious bleedings. In all such cases I considered the diminution of its frequency, and the absence of a vomiting, as signals to lay aside the lancet. The continuance of this preternatural force in the pulse appeared to be owing to the miasmata, which were universally diffused in the air, acting upon the arterial system in the same manner that it did in persons who were in apparent good health. Thus have I mentioned the principal circumstances which were connected with blood-letting in the cure of the yellow fever. I shall now consider the objections that were made to it at the time, and since the prevalence of the fever. It was said that the bleeding was unnecessarily copious; and that many had been destroyed by it. To this I answer, that I did not lose a single patient whom I bled seven times or more in this fever. As a further proof that I did not draw an ounce of blood too much it will only be necessary to add, that hæmorrhages frequently occurred after a third, a fourth, and in one instance (in the only son of Mr. William Hall) after a sixth bleeding had been used; and further, that not a single death occurred from natural hæmorrhages in the first stage of the disease. A woman, who had been bled by my advice, awoke the night following in a bath of her blood, which had flowed from the orifice in her arm. The next day she was free from pain and fever. There were many recoveries in the city from similar accidents. There were likewise some recoveries from copious natural hæmorrhages in the more advanced stages of the disease, particularly when they occurred from the stomach and bowels. I left a servant maid of Mrs. Morris's, in Walnut-street, who had discharged at least four pounds of blood from her stomach, without a pulse, and with scarcely a symptom that encouraged a hope of her life; but the next day I had the pleasure of finding her out of danger. It was remarked that fainting was much less common after bleeding in this fever than in common inflammatory fevers. This circumstance was observed by Dr. Griffitts, as well as myself. It has since been confirmed to me by three of the principal bleeders in the city, who performed the operation upwards of four thousand times. It occurred chiefly in those cases where it was used for the first time on the third or fourth day of the disease. A swelling of the legs, moreover, so common after plentiful bleeding in pneumony and rheumatism, rarely succeeded the use of this remedy in the yellow fever. 2. Many of the indispositions, and much of the subsequent weakness of persons who had been cured by copious blood-letting, have been ascribed to it. This is so far from being true that the reverse of it has occurred in many cases. Mr. Mierken worked in his sugar-house, in good health, nine days after his last bleeding; and Mr. Gribble and Mr. George seemed, by their appearance, to have derived fresh vigour from their evacuations. I could mention the names of many people who assured me their constitutions had been improved by the use of those remedies; and I know several persons in whom they have carried off habitual complaints. Mr. Richard Wells attributed his relief from a chronic rheumatism to the copious bleeding and purging which were used to cure him of the yellow fever; and Mr. William Young, the bookseller, was relieved of a chronic pain in his side, by means of the same remedies. 3. It was said, that blood-letting was prescribed indiscriminately in all cases, without any regard to age, constitution, or the force of the disease. This is not true, as far as it relates to my practice. In my prescriptions for patients whom I was unable to visit, I advised them, when they were incapable of judging of the state of the pulse, to be guided in the use of bleeding, by the degrees of pain they felt, particularly in the head; and I seldom advised it for the _first_ time, after the second or third day of the disease. In pneumonies which affect whole neighbourhoods in the spring of the year, bleeding is the universal remedy. Why should it not be equally so, in a fever which is of a more uniform inflammatory nature, and which tends more rapidly to effusions, in parts of the body much more vital than the lungs? I have before remarked, that the debility which occurs in the beginning of the yellow fever, arises from a depressed state of the system. The debility in the plague is of the same nature. It has long been known that debility from the sudden abstraction of stimuli is to be removed by the _gradual_ application of stimuli, but it has been less observed, that the excess of stimulus in the system is best removed in a _gradual_ manner, and that too in proportion to the degrees of depression, which exist in the system. This principle in the animal economy has been acknowledged by the practice of occasionally stopping the discharge of water from a canula in tapping, and of blood from a vein, in order to prevent fainting. Child-birth induces fainting, and sometimes death, only by the _sudden_ abstraction of the stimulus of distention and pain. In all those cases where purging or bleeding have produced death in the yellow fever or plague, when they have been used on the first or second day of those diseases, I suspect that it was occasioned by the quantity of the stimulus abstracted being disproportioned to the degrees of depression in the system. The following facts will I hope throw light upon this subject. 1. Dr. Hodges informs us, that "although blood could not be drawn in the plague, even in the smallest quantity without danger, yet a _hundred_ times the quantity of fluids was discharged in pus from buboes without inconvenience[79]." [79] Page 114. 2. Pareus, after condemning bleeding in the plague, immediately adds an account of a patient, who was saved by a hæmorrhage from the nose, which continued _two_ days[80]. [80] Skenkius, lib. vi. p. 881. 3. I have before remarked that bleeding proved fatal in three cases in the yellow fever, in the month of August; but at that time I saw one, and heard of another case, in which death seemed to have been prevented by a bleeding at the nose. Perhaps the uniform good effects which were observed to follow a spontaneous hæmorrhage from an orifice in the arm, arose wholly from the _gradual_ manner in which the stimulus of the blood was in this way abstracted from the body. Dr. Williams relates a case of the recovery of a gentleman from the yellow fever, by means of small hæmorrhages, which continued three days, from wounds in his shoulders made by being cupped. He likewise mentions several other recoveries by hæmorrhages from the nose, after "a vomiting of black humours and a hiccup had taken place[81]." [81] Essay on the Bilious or Yellow Fever of Jamaica, p. 40. 4. There is a disease in North-Carolina, known among the common people by the name of the "pleurisy in the head." It occurs in the winter, after a sickly autumn, and seems to be an evanescent symptom of a bilious remitting fever. The cure of it has been attempted by bleeding, in the common way, but generally without success. It has, however, yielded to this remedy in another form, that is, to the discharge of a few ounces of blood obtained by thrusting a piece of quill up the nose. 5. Riverius describes a pestilential fever which prevailed at Montpellier, in the year 1623, which carried off one half of all who were affected by it[82]. After many unsuccessful attempts to cure it, this judicious physician prescribed the loss of _two_ or _three_ ounces of blood. The pulse rose with this small evacuation. Three or four hours afterwards he drew six ounces of blood from his patients, and with the same good effect. The next day he gave a purge, which, he says, rescued his patients from the grave. All whom he treated in this manner recovered. The whole history of this epidemic is highly interesting, from its agreeing with our late epidemic in so many of its symptoms, more especially as they appeared in the different states of the pulse. [82] De Febre Pestilenti, vol. ii. p. 145, 146, and 147. An old and intelligent citizen of Philadelphia, who remembers the yellow fever of 1741, says that when it first made its appearance bleeding was attended with fatal consequences. It was laid aside afterwards, and the disease prevailed with great mortality until it was checked by the cold weather. Had blood been drawn in the manner mentioned by Riverius, or had it been drawn in the usual way, after the abstraction of the stimulus of heat by the cool weather, the disease might probably have been subdued, and the remedy of blood-letting thereby have recovered its character. Dr. Hodges has another remark, in his account of the plague in London in the year 1665, which is still more to our purpose than the one which I have quoted from it upon this subject. He says that "bleeding, as a preventive of the plague, was only safe and useful when the blood was drawn by a _small_ orifice, and a _small_ quantity taken at _different_ times[83]." [83] Page 209. I have remarked, in the history of this fever, that it was often cured on the first or second day by a copious sweat. The Rev. Mr. Ustick was one among many whom I could mention, who were saved from a violent attack of the fever by this evacuation. It would be absurd to suppose that the miasmata which produced the disease were discharged in this manner from the body. The sweat seemed to cure the fever only by lessening the quantity of the fluids, and thus _gradually_ removing the depression of the system. The profuse sweats which sometimes cure the plague, as well as the disease which is brought on by the bite of poisonous snakes, seem to act in the same way. The system, in certain states of malignant fever, resembles a man struggling beneath a load of two hundred weight, who is able to lift but one hundred and seventy-five. In order to assist him it will be to no purpose to attempt to infuse additional vigour into his muscles by the use of a whip or of strong drink. Every exertion will serve only to waste his strength. In this situation (supposing it impossible to divide the weight which confines him to the ground) let the pockets of this man be emptied of their contents, and let him be stripped of so much of his clothing as to reduce his weight five and twenty or thirty pounds. In this situation he will rise from the ground; but if the weights be abstracted suddenly, while he is in an act of exertion, he will rise with a spring that will endanger a second fall, and probably produce a temporary convulsion in his system. By abstracting the weights from his body more gradually, he will rise by degrees from the ground, and the system will accommodate itself in such a manner to the diminution of its pressure, as to resume its erect form, without the least deviation from the natural order of its appearance and motions. It has been said that the stimulating remedies of bark, wine, and the cold bath, were proper in our late epidemic in August, and in the beginning of September, but that they were improper afterwards. If my theory be just, they were more improper in August and the beginning of September, than they were after the disease put on the outward and common signs of inflammatory diathesis. The reason why a few strong purges cured the disease at its first appearance, was, because they abstracted in a _gradual_ manner some of the immense portion of stimulus under which the arterial system laboured, and thus gradually relieved it from its low and weakening degrees of depression. Bleeding was fatal in these cases, probably because it removed this depression in too sudden a manner. The principle of the gradual abstraction, as well as of the gradual application of stimuli to the body, opens a wide field for the improvement of medicine. Perhaps all the discoveries of future ages will consist more in a new application of established principles, and in new modes of exhibiting old medicines, than in the discovery of new theories, or of new articles of the materia medica. The reasons which induced me to prescribe purging and bleeding, in so liberal a manner, naturally led me to recommend _cool_ and _fresh air_ to my patients. The good effects of it were obvious in almost every case in which it was applied. It was equally proper whether the arterial system was depressed, or whether it discovered, in the pulse, a high degree of morbid excitement. Dr. Griffitts furnished a remarkable instance of the influence of cool air upon the fever. Upon my visiting him, on the morning of the 8th of October, I found his pulse so full and tense as to indicate bleeding, but after sitting a few minutes by his bed-side, I perceived that the windows of his room had been shut in the night by his nurse, on account of the coldness of the night air. I desired that they might be opened. In ten minutes afterwards the doctor's pulse became so much slower and weaker that I advised the postponement of the bleeding, and recommended a purge instead of it. The bleeding notwithstanding became necessary, and was used with great advantage in the afternoon of the same day. The cool air was improper only in those cases where a chilliness attended the disease. For the same reason that I advised cool air, I directed my patients to use cold _drinks_. They consisted of lemonade, tamarind, jelly and raw apple water, toast and water, and of weak balm, and camomile tea. The subacid drinks were preferred in most cases, as being not only most agreeable to the taste, but because they tended to compose the stomach. All these drinks were taken in the early stage of the disease. Towards the close of it, I permitted the use of porter and water, weak punch, and when the stomach would bear it, weak wine-whey. I forbade all cordial and stimulating food in the active state of the arterial system. The less my patients ate, of even the mildest vegetable food, the sooner they recovered. Weak coffee, which (as I have formerly remarked) was almost universally agreeable, and weak tea were always inoffensive. As the action of the pulse diminished, I indulged my patients with weak chocolate; also with milk, to which roasted apples, or minced peaches, and (where they were not to be had), bread or Indian mush were added. Towards the crisis, I advised the drinking of weak chicken, veal, or mutton broth, and after the crisis had taken place, I permitted mild animal food to be eaten in a small quantity, and to be increased according to the waste of the excitability of the system. This strict abstinence which I imposed upon my patients did not escape obloquy; but the benefits they derived from it, and the ill effects which arose in many cases from a contrary regimen, satisfied me that it was proper in every case in which it was prescribed. _Cold water_ was a most agreeable and powerful remedy in this disease. I directed it to be applied by means of napkins to the head, and to be injected into the bowels by way of glyster. It gave the same ease to both, when in pain, which opium gives to pain from other causes. I likewise advised the washing of the face and hands, and sometimes the feet, with cold water, and always with advantage. It was by suffering the body to lie for some time in a bed of cold water, that the inhabitants of the island of Massuah cured the most violent bilious fevers[84]. When applied in this way, it _gradually_ abstracts the heat from the body, and thereby lessens the action of the system. It differs as much in its effects upon the body from the cold bath, as rest in a cold room, differs from exercise in the cold and open air. [84] Bruce's Travels. I was first led to the practice of the partial application of cold water to the body, in fevers of too much force in the arterial system, by observing its good effects in active hæmorrhages, and by recollecting the effects of a partial application of warm water to the feet, in fevers of an opposite character. Cold water when applied to the feet as certainly reduces the pulse in force and frequency, as warm water, applied in the same way, produces contrary effects upon it. In an experiment which was made at my request, by one of my pupils, by placing his feet in cold pump water for a few minutes, the pulse was reduced 24 strokes in a minute, and became so small as hardly to be perceptible. But this effect of cold water, in reducing the frequency of the pulse, is not uniform. In weak and irritable habits, it increases its frequency. This has been fully proved by a number of experiments, made by my former pupil, Dr. Stock, of Bristol, in England, and published in his "Medical Collections of the Effects of Cold, as a Remedy in certain Diseases[85]." [85] Page 185. In the use of the remedies which were necessary to overcome the inflammatory action of the system, I was obliged to reduce it below its natural point of excitement. In the present imperfect state of our knowledge in medicine, perhaps no disease of too much action can be cured without it. Besides the remedies which have been mentioned, I was led to employ another of great efficacy. I had observed a favourable issue of the fever, in every case in which a spontaneous discharge took place from the salivary glands. I had observed further, that all such of my patients (one excepted) as were salivated by the mercurial purges recovered in a few days. This early suggested an idea to me that the calomel might be applied to other purposes than the discharging of bile from the bowels. I ascribed its salutary effects, when it salivated in the first stage of the disease, to the excitement of inflammation and effusion in the throat, diverting them from more vital parts of the body. In the second stage of the disease, I was led to prescribe it as a stimulant, and, with a view of obtaining this operation from it, I aimed at exciting a salivation, as speedily as possible, in all cases. Two precedents encouraged me to make trial of this remedy. In the month of October, 1789, I attended a gentleman in a bilious fever, which ended in many of the symptoms of a typhus mitior. In the lowest state of his fever, he complained of a pain in his right side, for which I ordered half an ounce of mercurial ointment to be rubbed on the part affected. The next day, he complained of a sore mouth, and, in the course of four and twenty hours, he was in a moderate salivation. From this time his pulse became full and slow, and his skin moist; his sleep and appetite suddenly returned, and in a day or two he was out of danger. The second precedent for a salivation in a fever, which occurred to me, was in Dr. Haller's short account of the works of Dr. Cramer[86]. The practice was moreover justified, in point of safety, as well as the probability of success, by the accounts which Dr. Clark has lately given of the effects of a salivation in the dysentery[87]. I began by prescribing the calomel in small doses, at short intervals, and afterwards I directed large quantities of the ointment to be rubbed upon the limbs. The effects of it, in every case in which it affected the mouth, were salutary. Dr. Woodhouse improved upon my method of exciting the salivation, by rubbing the gums with calomel, in the manner directed by Mr. Clare. It was more speedy in its operation in this way than in any other, and equally effectual. Several persons appeared to be benefited by the mercury introduced into the system in the form of an ointment, where it did _not_ produce a salivation. Among these, were the Rev. Dr. Blackwell, and Mr. John Davis. [86] Bibliotheca Medicinæ Practicæ, vol. iii. p. 491. [87] Diseases of Long Voyages to Hot Climates, vol. ii. p. 334. Soon after the above account was written of the good effects of a mercurial salivation in this fever, I had great satisfaction in discovering that it had been prescribed with equal, and even greater success, by Dr. Wade in Bengal, in the year 1791, and by Dr. Chisholm in the island of Granada, in the cure of bilious yellow fevers[88]. Dr. Wade did not lose one, and Dr. Chisholm lost only one out of forty-eight patients in whom the mercury affected the salivary glands. The latter gave 150 grains of calomel, and applied the strongest mercurial ointment below the groin of each side, in some cases. He adds further, that not a single instance of a relapse occurred, where the disease was cured by salivation. [88] Medical Commentaries, vol. xviii. p. 209, 288. After the reduction of the system, _blisters_ were applied with great advantage to every part of the body. They did most service when they were applied to the crown of the head. I did not see a single case, in which a mortification followed the sore, which was created by a blister. Brandy and water, or porter and water, when agreeable to the stomach, with now and then a cup of chicken broth, were the drinks I prescribed to assist in restoring the tone of the system. In some cases I directed the limbs to be wrapped in flannels dipped in warm spirits, and cataplasms of bruised garlic to be applied to the feet. But my principal dependence, next to the use of mercurial medicines, for exciting a healthy action in the arterial system, was upon mild and gently stimulating food. This consisted of rich broths, the flesh of poultry, oysters, thick gruel, mush and milk, and chocolate. I directed my patients to eat or drink a portion of some of the above articles of diet every hour or two during the day, and in cases of great debility, from an exhausted state of the system, I advised their being waked for the same purpose two or three times in the night. The appetite frequently craved more savoury articles of food, such as beef-stakes and sausages; but they were permitted with great caution, and never till the system had been prepared for them by a less stimulating diet. There were several _symptoms_ which were very distressing in this disease, and which required a specific treatment. For the vomiting, with a burning sensation in the stomach, which came on about the fifth day, I found no remedy equal to a table spoonful of sweet milk, taken every hour, or to small draughts of milk and water. I was led to prescribe this simple medicine from having heard, from a West-India practitioner, and afterwards read, in Dr. Hume's account of the yellow fever, encomiums upon the milk of the cocoa-nut for this troublesome symptom. Where sweet milk failed of giving relief, I prescribed small doses of sweet oil, and in some cases a mixture of equal parts of milk, sweet oil, and molasses. They were all intended to dilute or blunt the acrimony of the humours, which were either effused or generated in the stomach. Where they all failed of checking the vomiting, I prescribed weak camomile tea, or porter, or cyder and water, with advantage. In some of my patients the stomach rejected all the mixtures and liquors which have been mentioned. In such cases I directed the stomach to be left to itself for a few hours, after which it sometimes received and retained the drinks that it had before rejected, provided they were administered in a small quantity at a time. The vomiting was sometimes stopped by a blister applied to the external region of the stomach. A mixture of liquid laudanum and sweet oil, applied to the same place, gave relief where the stomach was affected by pain only, without a vomiting. I have formerly mentioned that a distressing _pain_ often seized the lower part of the _bowels_. I was early taught that laudanum was not a proper remedy for it. It yielded in almost every case to two or three emollient glysters, or to the loss of a few ounces of blood. The convalescence from this fever was in general rapid, but in some cases it was very slow. I was more than usually struck by the great resemblance which the system in the convalescence from this fever bore to the state of the body and mind in old age. It appeared, 1. In the great weakness of the body, more especially of the limbs. 2. In uncommon depression of mind, and in a great aptitude to shed tears. 3. In the absence or short continuance of sleep. 4. In the frequent occurrence of appetite, and, in some cases, in its inordinate degrees. And 5. In the loss of the hair of the head, or in its being suddenly changed in some cases to a grey colour. Pure air, gentle exercise, and agreeable society removed the debility both of body and mind of this premature and temporary old age. I met with a few cases, in which the yellow colour continued for several weeks after the patient's recovery from all the other symptoms of the fever. It was removed most speedily and effectually by two or three moderate doses of calomel and rhubarb. A feeble and irregular intermittent was very troublesome in some people, after an acute attack of the fever. It yielded gradually to camomile or snake-root tea, and country air. In a publication, dated the 16th of September, I recommended a diet of milk and vegetables, and cooling purges to be taken once or twice a week, to the citizens of Philadelphia. This advice was the result of the theory of the disease I had adopted, and of the successful practice which had arisen from it. In my intercourse with my fellow-citizens, I advised this regimen to be regulated by the degrees of fatigue and foul air to which they were exposed. I likewise advised moderate blood-letting to all such persons as were of a plethoric habit. To men whose minds were influenced by the publications in favour of bark and wine, and who were unable at that time to grasp the extent and force of the remote cause of this terrible fever, the idea of dieting, purging, or bleeding the inhabitants of a whole village or city appeared to be extravagant and absurd: but I had not only the analogy of the regimen made use of to prepare the body for the small-pox, but many precedents in favour of the advice. Dr. Haller has given extracts from the histories of two plagues, in which the action of the miasmata was prevented or mitigated by bleeding[89]. Dr. Hodges confirms the utility of the same practice. The benefits of low diet, as a preventive of the plague, were established by many authors, long before they received the testimony of the benevolent Mr. Howard in their favour. Socrates in Athens, and Justinian in Constantinople, were preserved, by means of their abstemious modes of living, from the plagues which occasionally ravaged those cities. By means of the low diet, gentle physic, and occasional bleedings, which I thus publicly recommended, the disease was prevented in many instances, or rendered mild where it was taken. But my efforts to prevent the disease in my fellow-citizens did not end here. I advised them, not only in the public papers, but in my intercourse with them, to avoid heat, cold, labour, and every thing else that could excite the miasmata (which I knew to be present in all their bodies) into action. I forgot, upon this occasion, the usual laws which regulate the intercourse of man with man in the streets, and upon the public roads, in my excursions into the neighbourhood of the city. I cautioned many persons, whom I saw walking or riding in an unsafe manner, of the danger to which they exposed themselves; and thereby, I hope, prevented an attack of the disease in many people. [89] Bibliotheca Medicinæ Practicæ, vol. ii. p. 93. and 387. It was from a conviction of the utility of low diet, gentle evacuations, and of carefully shunning all the exciting causes which I have mentioned, that I concealed, in no instance, from my patients the name of their disease. This plainness, which was blamed by weak people, produced strict obedience to my directions, and thereby restrained the progress of the fever in many families, or rendered it, when taken, as mild as inoculation does the small-pox. The opposite conduct of several physicians, by preventing the above precautions, increased the mortality of the disease, and, in some instances, contributed to the extinction of whole families. I proceed now to make a few remarks upon the remedies recommended by Doctors Kuhn and Stevens, and by the French physicians. The former were bark, wine, laudanum, spices, the elixir of vitriol, and the cold bath. In every case in which I prescribed bark, it was offensive to the stomach. In several tertians which attended the convalescence from a common attack of the fever, I found it always unsuccessful, and once hurtful. Mr. Willing took it for several weeks without effect. About half a pint of a weak decoction of the bark produced, in Mr. Samuel Meredith, a paroxysm of the fever, so violent as to require the loss of ten ounces of blood to moderate it. Dr. Annan informed me that he was forced to bleed one of his patients twice, after having given him a small quantity of bark, to hasten his convalescence. It was not in this epidemic only that the bark was hurtful. Baron Humboldt informed me, that Dr. Comoto had assured him, it hastened death in every case in which it was given in the yellow fever of Vera Cruz. If, in any instance, it was inoffensive, or did service, in our fever, I suspect it must have acted upon the bowels as a purge. Dr. Sydenham says the bark cured intermittents by this evacuation[90]; and Mr. Bruce says it operated in the same way, when it cured the bilious fevers at Massuah. [90] Vol. i. p. 440. _Wine_ was nearly as disagreeable as the bark to the stomach, and equally hurtful. I tried it in every form, and of every quality, but without success. It was either rejected by the stomach, or produced in it a burning sensation. I should suspect that I had been mistaken in my complaints against wine, had I not since met with an account in Skenkius of its having destroyed all who took it in the famous Hungarian fever, which prevailed, with great mortality, over nearly every country in Europe, about the middle of the 16th century[91]. Dr. Wade declares wine to be "ill adapted to the fevers of Bengal, where the treatment has been proper in other respects." [91] Omnes qui vini potione non abstinuerunt, interiere, adeo ut summa spes salvationis in vini abstinentia collocata videreter. Lib. vi. p. 847. _Laudanum_ has been called by Dr. Mosely "a fatal medicine" in the yellow fever. In one of my patients, who took only fifteen drops of it, without my advice, to ease a pain in his bowels, it produced a delirium, and death in a few hours. I was much gratified in discovering that my practice, with respect to the use of opium in this fever, accorded with Dr. Wade's in the fever of Bengal. He tells us, "that it was mischievous in almost every instance, even in combination with antimonials." The _spices_ were hurtful in the first stage of the fever, and, when sufficient evacuations had been used, they were seldom necessary in its second. The _elixir of vitriol_ was, in general, offensive to the stomach. The _cold bath_ was useful in those cases where its sedative prevailed over its stimulating effects. But this could not often happen, from the suddenness and force, with which the water was thrown upon the body. In two cases in which I prescribed it, it produced a gentle sweat, but it did not save life. In a third it removed a delirium, and reduced the pulse for a few minutes, in frequency and force, but this patient died. The recommendation of it indiscriminately, in all cases, was extremely improper. In that chilliness and tendency to fainting upon the least motion, which attended the disease in some patients, it was an unsafe remedy. I heard of a woman who was seized with delirium immediately after using it, from which she never recovered; and of a man who died a few minutes after he came out of a bathing tub. Had this remedy been the exclusive antidote to the yellow fever, the mortality of the disease would have been but little checked by it. Thousands must have perished from the want of means to procure tubs, and of a suitable number of attendants to apply the water, and to lift the patient in and out of bed. The reason of our citizens ran before the learning of the friends of this remedy, and long before it was abandoned by the physicians, it was rejected as useless, or not attempted, because impracticable, by the good sense of the city. It is to be lamented that the remedy of cold water has suffered in its character by the manner in which it was advised. In fevers of too much action, it reduces the morbid excitement of the blood-vessels, provided it be _applied without force_, and for a considerable time, to the body. It is in the jail fever, and in the second stage of the yellow fever only, in which its stimulant and tonic powers are proper. Dr. Jackson establishes this mode of using it, by informing us, that when it did service, it "gave vigour and tone" to the system[92]. [92] Fevers of Jamaica. A mode of practice which I formerly mentioned in this fever, consisted of a union of the evacuating and tonic remedies. The physicians who adopted this mode gave calomel by itself, in small doses, on the first or second day of the fever, bled once or twice, in a sparing manner, and gave the bark, wine, and laudanum, in large quantities, upon the first appearance of a remission. After they began the use of these remedies purging was omitted, or, if the bowels were moved, it was only by means of gentle glysters. This practice, I shall say hereafter, was not much more successful than that which was recommended by Dr. Kuhn and Dr. Stevens. It resembled throwing water and oil at the same time upon a fire, in order to extinguish it. The _French_ remedies were nitre and cremor tartar, in small doses, centaury tea, camphor, and several other warm medicines; subacid drinks, taken in large quantities, the warm bath, and moderate bleeding. After what has been said it must be obvious to the reader, that the nitre and cremor tartar, in small doses, could do no good, and that camphor and all cordial medicines must have done harm. The diluting subacid drinks, which the French physicians gave in large quantities, were useful in diluting and blunting the acrimony of the bile, and to this remedy, assisted by occasional bleeding, I ascribe most of the cures which were performed by those physicians. Those few persons in whom the _warm bath_ produced copious and universal sweats recovered, but, in nearly all the cases which came under my notice, it did harm. I come now to inquire into the comparative success of all the different modes of practice which have been mentioned. I have already said that ten out of thirteen patients whom I treated with bark, wine, and laudanum, and that three out of four, in whom I added the cold bath to those remedies, died. Dr. Pennington informed me, that he had lost all the patients (six in number) to whom he had given the above medicines. Dr. Johnson assured me, with great concern, about two weeks before he died, that he had not recovered a single patient by them. Whole families were swept off where these medicines were used. But further, most of those persons who received the seeds of the fever in the city, and sickened in the country, or in the neighbouring towns, and who were treated with tonic remedies, died. There was not a single cure performed by them in New-York, where they were used in several sporadic cases with every possible advantage. But why do I multiply proofs of their deadly effects? The clamours of hundreds whose relations had perished by them, and the fears of others, compelled those physicians who had been most attached to them to lay them aside, or to prepare the way for them (as it was called) by purging and bleeding. The bathing tub soon shared a worse fate than bark, wine, and laudanum, and, long before the disease disappeared, it was discarded by all the physicians in the city. In answer to these facts we are told, that Mr. Hamilton and his family were cured by Dr. Stevens's remedies, and that Dr. Kuhn had administered them with success in several instances. Upon these cures I shall insert the following judicious remarks from Dr. Sydenham. "Success (says the doctor) is not a sufficient proof of the excellency of a method of cure in acute diseases, since some are recovered by the imprudent procedure of old women; but it is further required, that the distemper should be _easily cured_, and yield conformably to its _own_ nature[93]." And again, speaking of the cure of the new fever of 1685, this incomparable physician observes, "If it be objected that this fever frequently yields to a quite contrary method to that which I have laid down, I answer, that the cure of a disease by a method which is attended with success only _now_ and _then_, in a _few_ instances, differs extremely from that practical method, the efficacy whereof appears both from its recovering _greater numbers_, and all the practical phenomena happening in the cure[94]." [93] Vol. ii. p. 254. [94] Vol, ii. p. 354. Far be it from me to deny that the depression of the system may not be overcome by such stimuli as are more powerful than those which occasion it. This has sometimes been demonstrated by the efficacy of bark, wine, and laudanum, in the confluent and petechial small-pox; but even this state of that disease yields more easily to blood-letting, or to plentiful evacuations from the stomach and bowels, on the first or second day of the eruptive fever. This I have often proved, by giving a large dose of tartar emetic and calomel, as soon as I was satisfied from circumstances, that my patient was infected with the small-pox. But the depression produced by the yellow fever appears to be much greater than that which occurs in the small-pox, and hence it more uniformly resisted the most powerful tonic remedies. In one of my publications during the prevalence of the fever I asserted, that the remedies of which I have given a history cured a greater proportion than ninety-nine out of a hundred, of all who applied to me on the first day of the disease, before the 15th day of September. I regret that it is not in my power to furnish a list of them, for a majority of them were poor people, whose names are still unknown to me. I was not singular in this successful practice in the first appearance of the disease. Dr. Pennington assured me on his death bed, that he had not lost one, out of forty-eight patients whom he had treated agreeably to the principles and practice I had recommended. Dr. Griffitts triumphed over the disease in every part of the city, by the use of what were called the new remedies. My former pupils spread, by their success, the reputation of purging and bleeding, wherever they were called. Unhappily the pleasure we derived from this success in the treatment of the disease, was of short duration. Many circumstances contributed to lessen it, and to revive the mortality of the fever. I shall briefly enumerate them. 1. The distraction produced in the public mind, by the recommendation of remedies, the opposites in every respect of purging and bleeding. 2. The opinion which had been published by several physicians, and inculcated by others, that we had other fevers in the city besides the yellow fever. This produced a delay in many people in sending for a physician, or in taking medicines, for two or three days, from a belief that they had nothing but a cold, or a common fever. Some people were so much deceived by this opinion, that they refused to send for physicians, lest they should be infected by them with the yellow fever. In most of the cases in which these delays took place, the disease proved mortal. To obviate a suspicion that I have laid more stress upon the fatal influence of this error than is just, I shall here insert an extract of a letter I received from Mr. John Connelly, one of the city committee, who frequently left his brethren in the city hall, and spent many hours in visiting and prescribing for the sick. "The publications (says he) of some physicians, that there were but few persons infected with the yellow fever, and that many were ill with colds and common remitting and fall fevers, proved fatal to almost every family which was credulous enough to believe them. That opinion slew its hundreds, if not its thousands, many of whom did not send for a physician until they were in the last stage of the disorder, and beyond the power of medicine." 3. The interference of the friends of the stimulating system, in dissuading patients from submitting to sufficient evacuations. 4. The deceptions which were practised by some patients upon their physicians, in their reports of the quantity of blood they had lost, or of the quality and number of their evacuations by stool. 5. The impracticability of procuring bleeders as soon as bleeding was prescribed. Life in this disease, as in the apoplexy, frequently turned upon that operation being performed within an _hour_. It was often delayed, from the want of a bleeder, one or two days. 6. The inability of physicians, from the number of their patients, and from frequent indisposition, to visit the sick, at such times as was necessary to watch the changes in their disease. 7. The great accumulation and concentration of the miasmata in sick rooms, from the continuance of the disease in the city, whereby the system was exposed to a constant stimulus, and the effect of the evacuations was thus defeated. 8. The want of skill or fidelity in nurses to administer the medicines properly; to persuade patients to drink frequently; also to supply them with food or cordial drinks when required in the night. 9. The great degrees of debility induced in the systems of many of the people who were affected by the disease, from fatigue in attending their relations or friends. 10. The universal depression of mind, amounting in some instances to despair, which affected many people. What medicine could act upon a patient who awoke in the night, and saw through the broken and faint light of a candle, no human creature, but a black nurse, perhaps asleep in a distant corner of the room; and who heard no noise, but that of a hearse conveying, perhaps, a neighbour or a friend to the grave? The state of mind under which many were affected by the disease, is so well described by the Rev. Dr. Smith, in the case of his wife, in a letter I received from him in my sick room, two days after her death, that I hope I shall be excused for inserting an extract from it. It forms a part of the history of the disease. The letter was written in answer to a short note of condolence which I sent to the doctor immediately after hearing of Mrs. Smith's death. After some pathetic expressions of grief, he adds, "The scene of her funeral, and some preceding circumstances, can never depart from my mind. On our return from a visit to our daughter, whom we had been striving to console on the death of Mrs. Keppele, who was long familiar and dear to both, my dear wife, passing the burying-ground gate, led me into the ground, viewed the graves of her two children, called the old grave-digger, marked a spot for herself as close as possible to them and the grave of Dr. Phineas Bond, whose memory she adored. Then, by the side of the spot she had chosen, we found room and chose _mine_, pledging ourselves to each other, and directing the grave-digger that this should be the order of our interment. We returned to our house. Night approached. I hoped my dear wife had gone to rest, as she had chosen, since her return from nursing her daughter, to sleep in a chamber by herself, through fear of infecting her grandchild and me. But it seems she closed not her eyes; sitting with them fixed through her chamber window on Mrs. Keppele's house, till about midnight she saw her hearse, and followed it with her eyes as far as it could be seen. Two days afterwards Mrs. Rodgers, her next only surviving intimate friend, was carried past her window, and by no persuasion could I draw her from thence, nor stop her sympathetic foreboding tears, so long as her eyes could follow the funeral, which was through two squares, from Fourth to Second-street, where the hearse disappeared." The doctor proceeds in describing the distress of his wife. But pointed as his expressions are, they do not convey the gloomy state of her mind with so much force as she has done it herself in two letters to her niece, Mrs. Cadwallader, who was then in the country. The one was dated the 9th, the other the 11th of October. I shall insert a few extracts from each of them. October 9th. "It is not possible for me to pass the streets without walking in a line with the dead, passing infected houses, and looking into open graves. This has been the case for many weeks." "I don't know what to write; my head is gone, and my heart is torn to pieces." "I intreat you to have no fears on my account. I am in the hands of a just and merciful God, and his will be done." October 11th. "Don't wonder that I am so low to-day. My heart is sunk down within me." The next day this excellent woman sickened, and died on the 19th of the same month. If in a person possessed naturally of uncommon equanimity and fortitude, the distresses of our city produced such dejection of spirits, what must have been their effect upon hundreds, who were not endowed with those rare and extraordinary qualities of mind! Death in this, as well as in many other cases in which medicine had done its duty, appeared to be the inevitable consequence of the total abstraction of the energy of the mind in restoring the natural motions of life. Under all the circumstances which have been mentioned, which opposed the system of depletion in the cure of this fever, it was still far more successful than any other mode of cure that had been pursued before in the United States, or in the West-Indies. Three out of four died of the disease in Jamaica, under the care of Dr. Hume. Dr. Blane considers it as one of the "most mortal" of diseases, and Dr. Jackson places a more successful mode of treating it among the subjects which will admit of "innovation" in medicine. After the 15th of September, my success was much limited, compared with what it had been before that time. But at no period of the disease did I lose more than one in twenty of those whom I saw on the first day, and attended regularly through every stage of the fever, provided they had not been previously worn down by attending the sick. The following statement, which will admit of being corrected, if it be inaccurate, will, I hope, establish the truth of the above assertions. About one half of the families whom I have attended for many years, left the city. Of those who remained, many were affected by the disease. Out of the whole of them, after I had adopted my second mode of practice, I lost but five heads of families, and about a dozen servants and children. In no instance did I lose both heads of the same family. My success in these cases was owing to two causes: 1st, To the credit my former patients gave to my public declaration, that we had only _one_ fever in the city: hence they applied on the _first_ day, and sometimes on the _first_ hour of their indisposition; and 2dly, To the numerous pledges many of them had seen of the safety and efficacy of copious blood-letting, by my advice, in other diseases: hence my prescription of that necessary remedy was always obeyed in its utmost extent. Of the few adults whom I lost, among my former patients, two of them were old people, two took laudanum, without my knowledge, and one refused to take medicine of any kind; all the rest had been worn down by previous fatigue. I have before said that a great number of the blacks were my patients. Of these not one died under my care. This uniform success, among those people, was not owing altogether to the mildness of the disease, for I shall say presently, that a great proportion of a given number died, under other modes of practice. In speaking of the comparative effects of purging and bleeding, it may not be amiss to repeat, that not one pregnant woman, to whom I prescribed them, died, or suffered abortion. Where the tonic remedies were used, abortion or death, and, in many instances, both, were nearly universal. Many whole families, consisting of five, six, and, in three instances, of nine members, were recovered by plentiful purging and bleeding. I could swell this work by publishing a list of those families; but I take more pleasure in adding, that I was not singular in my success in the use of the above remedies. They were prescribed with great advantage by many of the physicians of the city, who had for a while given tonic medicines without effect. I shall not mention the names of any of the physicians who _totally_ renounced those medicines, lest I should give offence by not mentioning them all. Many large families were cured by some of them, after they adopted and prescribed copious purging and blood-letting. One of them cured ten in the family of Mr. Robert Haydock, by means of those remedies. In one of that family, the disease came on with a vomiting of black bile. But the use of the new remedies was not directed finally by the physicians alone. The clergy, the apothecaries, many private citizens, several intelligent women, and two black men, prescribed them with great success. Nay more, many persons prescribed them to themselves, and, as I shall say hereafter, with a success that was unequalled by any of the regular or irregular practitioners in the city. It was owing to the almost universal use of purging and bleeding, that the mortality of the disease diminished, in proportion as the number of persons who were affected by it increased, about the middle of October. It was scarcely double of what it was in the middle of September, and yet six times the number of persons were probably at that time confined by it. The success of copious purging and bleeding was not confined to the city of Philadelphia. Several persons, who were infected in town, and sickened in the country, were cured by them. Could a comparison be made of the number of patients who died of the yellow fever in 1793, after having been plentifully bled and purged, with those who died of the same disease in the years 1699, 1741, 1747, and 1762, I am persuaded that the proportion would be very small in the year 1793, compared with the former years[95]. Including all who died under every mode of treatment, I suspect the mortality to be less, in proportion to the population of the city, and the number of persons who were affected, than it was in any of the other years that have been mentioned. [95] It appears from one of Mr. Norris's letters, dated the 9th of November, O. S. that there died 220 persons, in the year 1699, with the yellow fever. Between 80 and 90 of them, he says, belonged to the society of friends. The city, at this time, probably, did not contain more than 2 or 3000 people, many of whom, it is probable, fled from the disease. Not less than 6000 of the inhabitants of Philadelphia probably owe their lives to purging and bleeding, during the autumn. I proceed with reluctance to inquire into the comparative success of the French practice. It would not be difficult to decide upon it from many facts that came under my notice in the city; but I shall rest its merit wholly upon the returns of the number of deaths at Bush-hill. This hospital, after the 22d of September, was put under the care of a French physician, who was assisted by one of the physicians of the city. The hospital was in a pleasant and airy situation; it was provided with all the necessaries and comforts for sick people that humanity could invent, or liberality supply. The attendants were devoted to their duty; and cleanliness and order pervaded every room in the house. The reputation of this hospital, and of the French physician, drew patients to it in the early stage of the disease. Of this I have been assured in a letter from Dr. Annan, who was appointed to examine and give orders of admission into the hospital, to such of the poor of the district of Southwark, as could not be taken care of in their own houses. Mr. Olden has likewise informed me, that most of the patients who were sent to the hospital by the city committee (of which he was a member) were in the first stage of the fever. With all these advantages, the deaths between the 22d of September and the 6th of November, amounted to 448 out of 807 patients who were admitted into the hospital within that time. Three fourths of all the blacks (nearly 20) who were patients in this hospital died. A list of the medicines prescribed there may be seen in the minutes of the proceedings of the city committee. Calomel and jalap are not among them. _Moderate_ bleeding and purging with glauber's salts, I have been informed, were used in some cases by the physicians of this hospital. The proportion of deaths to the recoveries, as it appears in the minutes of the committee from whence the above report is taken, is truly melancholy! I hasten from it therefore to a part of this work, to which I have looked with pleasure, ever since I sat down to compose it. I have said that the clergy, the apothecaries, and many other persons who were uninstructed in the principles of medicine, prescribed purging and bleeding with great success in this disease. Necessity gave rise to this undisciplined sect of practitioners, for they came forward to supply the places of the regular bred physicians who were sick or dead. I shall mention the names of a few of those persons who distinguished themselves as volunteers in this new work of humanity. The late Rev. Mr. Fleming, one of the ministers of the catholic church, carried the purging powders in his pocket, and gave them to his poor parishioners with great success. He even became the advocate of the new remedies. In a conversation I had with him, on the 22d of September, he informed me, that he had advised four of our physicians, whom he met a day or two before, "to renounce the pride of science, and to adopt the new mode of practice, for that he had witnessed its good effects in many cases." Mr. John Keihmle, a German apothecary, has assured me, that out of 314 patients whom he visited, and 187 for whom he prescribed from the reports of their friends, he lost but 47 (which is nearly but one in eleven), and that he treated them all agreeably to the method which I had recommended. The Rev. Mr. Schmidt, one of the ministers of the Lutheran church, was cured by him. I have before mentioned an instance of the judgment of Mr. Connelly, and of his zeal in visiting and prescribing for the sick. His remedies were bleeding and purging. He, moreover, bore a constant and useful testimony against bark, wine, laudanum, and the warm bath[96]. Mrs. Paxton, in Carter's-alley, and Mrs. Evans, the wife of Mr. John Evans, in Second-street, were indefatigable; the one in distributing mercurial purges composed by herself, and the other in urging the necessity of _copious_ bleeding and purging among her friends and neighbours, as the only safe remedies for the fever. These worthy women were the means of saving many lives[97]. Absalom Jones and Richard Allen, two black men, spent all the intervals of time, in which they were not employed in burying the dead, in visiting the poor who were sick, and in bleeding and purging them, agreeably to the directions which had been printed in all the newspapers. Their success was unparalleled by what is called regular practice. This encomium upon the practice of the blacks will not surprise the reader, when I add that they had no fear of putrefaction in the fluids, nor of the calumnies of a body of fellow-citizens in the republic of medicine to deter them from plentiful purging and bleeding. They had, besides, no more patients than they were able to visit two or three times a day. But great as their success was, it was exceeded by those persons who, in despair of procuring medical aid of any kind, purged and bled themselves. This palm of superior success will not be withheld from those people when I explain the causes of it. It was owing to their _early_ use of the proper remedies, and to their being guided in the repetition of them, by the continuance of a tense pulse, or of pain and fever. A day, an afternoon, and even an hour, were not lost by these people in waiting for the visit of a physician, who was often detained from them by sickness, or by new and unexpected engagements, by which means the precious moment for using the remedies with effect passed irrevocably away. I have stated these facts from faithful inquiries, and numerous observations. I could mention the names and families of many persons who thus cured themselves. One person only shall be mentioned, who has shown by her conduct what reason is capable of doing when it is forced to act for itself. Mrs. Long, a widow, after having been twice unsuccessful in her attempts to procure a physician, undertook at last to cure herself. She took several of the mercurial purges, agreeably to the printed directions, and had herself bled _seven_ times in the course of five or six days. The indication for repeating the bleeding was the continuance of the pain in her head. Her recovery was rapid and complete. The history of it was communicated to me by herself, with great gratitude, in my own house, during my second confinement with the fever. To these accounts of persons who cured themselves in the city, I could add many others, of citizens who sickened in the country, and who cured themselves by plentiful bleeding and purging, without the attendance of a physician. [96] In the letter before quoted, from Mr. Connelly, he expresses his opinion of those four medicines in the following words: "Laudanum, bark, and wine have put a period to the existence of some, where the fever has been apparently broken, and the patients in a fair way of recovery; a single dose of laudanum has hurried them suddenly into eternity. I have visited a few patients where the hot bath was used, and am convinced that it only tended to weaken and relax the system, without producing any good effect." [97] The yellow fever prevailed at the Caraccos, in South-America, in October, 1793, with great mortality, more especially among the Spanish troops. Nearly all died who were attended by physicians. Recourse was finally had to the old women, who were successful in almost every case to which they were called. Their remedies were a liquor called _narencado_ (a species of lemonade) and a tea made of a root called _fistula_. With these drinks they drenched their patients for the first two or three days. They induced plentiful sweats, and, probably, after blunting, discharged the bile from the bowels. I received this information from an American gentleman, who had been cured, by one of those Amazons in medicine, in the above way. From a short review of these facts, reason and humanity awake from their long repose in medicine, and unite in proclaiming, that it is time to take the cure of pestilential epidemics out of the hands of physicians, and to place it in the hands of the people. Let not the reader startle at this proposition. I shall give the following reasons for it. 1. In consequence of these diseases affecting a great number of people at one time, it has always been, and always will be impossible, for them _all_ to have the benefit of medical aid, more especially as the proportion of physicians to the number of sick, is generally diminished upon these occasions, by desertion, sickness, and death. 2. The safety of committing to the people the cure of pestilential fevers, particularly the yellow fever and the plague, is established by the simplicity and uniformity of their causes, and of their remedies. However diversified they may be in their symptoms, the system, in both diseases, is generally under a state of undue excitement or great depression, and in most cases requires the abstraction of stimulus in a greater or less degree, or in a sudden or gradual manner. There can never be any danger of the people injuring themselves by mistaking any other disease for an _epidemic_ yellow fever or plague, for no other febrile disease can prevail with them. It was probably to prevent this mistake, that the Benevolent Father of mankind, who has permitted no evil to exist which does not carry its antidote along with it, originally imposed that law upon all great and mortal epidemics. 3. The history of the yellow fever in the West-Indies proves the advantage of trusting patients to their own judgment. Dr. Lind has remarked, that a greater proportion of sailors who had no physicians recovered from that fever, than of those who had the best medical assistance. The fresh air of the deck of a ship, a purge of salt water, and the free use of cold water, probably triumphed here over the cordial juleps of physicians. 4. By committing the cure of this and other pestilential epidemics to the people, all those circumstances which prevented the universal success of purging and bleeding, in this disease, will have no operation. The fever will be mild in most cases, for all will prepare themselves to receive it, by a vegetable diet, and by moderate evacuations. The remedies will be used the _moment_ the disease is felt, or even seen, and its violence and danger will thereby be obviated. There will then be no disputes among physicians, about the nature of the disease, to distract the public mind, for they will seldom be consulted in it. None will suffer from chronic debility induced by previous fatigue in attending the sick, nor from the want of nurses, for few will be so ill as to require them, and there will be no "foreboding" fears of death, or despair of recovery, to invite an attack of the disease, or to ensure its mortality. The small-pox was once as fatal as the yellow fever and the plague. It has since yielded as universally to a vegetable diet and evacuations, in the hands of apothecaries, the clergy, and even of the good women, as it did in the hands of doctors of physic. They have narrow conceptions, not only of the Divine goodness, but of the gradual progress of human knowledge, who suppose that all pestilential diseases shall not, like the small-pox, sooner or later cease to be the scourge and terror of mankind. For a long while, air, water, and even the light of the sun, were dealt out by physicians to their patients with a sparing hand. They possessed, for several centuries, the same monopoly of many artificial remedies. But a new order of things is rising in medicine. Air, water, and light are taken without the advice of a physician, and bark and laudanum are now prescribed every where by nurses and mistresses of families, with safety and advantage. Human reason cannot be stationary upon these subjects. The time must and will come, when, in addition to the above remedies, the general use of calomel, jalap, and the lancet, shall be considered among the most essential articles of the knowledge and rights of man. It is no more necessary that a patient should be ignorant of the medicine he takes, to be cured by it, than that the business of government should be conducted with secrecy, in order to insure obedience to just laws. Much less is it necessary that the means of life should be prescribed in a dead language, or dictated with the solemn pomp of a necromancer. The effects of imposture, in every thing, are like the artificial health produced by the use of ardent spirits. Its vigour is temporary, and is always followed by misery and death. The belief that the yellow fever and the plague are necessarily mortal, is as much the effect of a superstitious torpor in the understanding, as the ancient belief that the epilepsy was a supernatural disease, and that it was an offence against Heaven to attempt to cure it. It is partly from the influence of this torpor in the minds of some people, that the numerous cures of the yellow fever, performed by a few simple remedies, were said to be of _other_ diseases. It is necessary, for the conviction of such persons, that patients should always _die_ of that, and other dangerous diseases, to prove that they have been affected by them. The repairs which our world is destined to undergo will be incomplete, until pestilential fevers cease to be numbered among the widest outlets of human life. There are many things which are now familiar to women and children, which were known a century ago only to a few men who lived in closets, and were distinguished by the name of philosophers. We teach a hundred things in our schools less useful, and many things more difficult, than the knowledge that would be necessary to cure a yellow fever or the plague. In my attempts to teach the citizens of Philadelphia, by my different publications, the method of curing themselves of yellow fever, I observed no difficulty in their apprehending every thing that was addressed to them, except what related to the different states of the pulse. All the knowledge that is necessary to discover when blood-letting is proper, might be taught to a boy or girl of twelve years old in a few hours. I taught it in less time to several persons, during the prevalence of the epidemic. I would as soon believe that ratafia was intended by the Author of Nature to be the only drink of man, instead of water, as believe that the knowledge of what relates to the health and lives of a _whole_ city, or nation, should be confined to one, and that a small or a privileged order of men. But what have physicians, what have universities or medical societies done, after the labours and studies of many centuries, towards lessening the mortality of pestilential fevers? They have either copied or contradicted each other, in all their publications. Plagues and malignant fevers are still leagued with war and famine, in their ravages upon human life. To prevent the formation and mortality of this fever, it will be necessary, when it makes its appearance in a city or country, to publish an account of those symptoms which I have called the _precursors_ of the disease, and to exhort the people, as soon as they feel those symptoms, to have immediate recourse to the remedies of purging or bleeding. The danger of delay in using one, or both these remedies, should be inculcated in the strongest terms, for the disease, like Time, has a lock on its forehead, but is bald behind. The bite of a rattle-snake is seldom fatal, because the medicines which cure it are applied or taken as soon as the poison comes in contact with the blood. There is less danger to be apprehended from the yellow fever than from the poison of the snake, provided the remedies for it are administered within a few hours after it is excited into action. Let persons who are subject to chronic pains, or diseases of any kind, be advised not to be deceived by them. Every pain, at such a time, is the beginning of the disease; for it always acts first on debilitated parts of the body. From an ignorance of this law of epidemics many persons, by delaying their applications for help, perished with our fever. Let nature be trusted into no case whatever, to cure this disease; and let no attack of it, however light, be treated with neglect. Death as certainly performs his work, when he steals on the system in the form of a mild intermittent, as he does, when he comes on with the symptoms of apoplexy, or a black vomiting. Cleanliness, in houses and dress, cannot be too often inculcated during the prevalence of a yellow fever. Let it not be supposed, that I mean that the history which I have given of the method of cure of this epidemic, should be applied, in all its parts, to the yellow fevers which may appear hereafter in the United States, or which exist at all times in the West-India islands. Season and climate vary this, as well as all other diseases. Bark and wine, so fatal in this, may be proper in a future yellow fever. But in the climate of the United States, I believe it will seldom appear with such symptoms of prostration and weakness, as not to require, in its first stage, evacuations of some kind. The only inquiry, when the disease makes its appearance, should be, from what part of the body these evacuations should be procured; the order which should be pursued in obtaining them; and the quantity of each of the matters to be discharged, which should be withdrawn at a time. Thus far did I venture, from my theory of the disease, and from the authorities of Dr. Hillary and Dr. Mosely, to decide in favour of evacuations in the yellow fever; but Dr. Wade, and Mr. Chisholm again support me by their practice in the fevers of the East and West-Indies. They both gave strong mercurial purges, and bled in some cases. Dr. Wade confirmed, by his practice, the advantage of _gradually_ abstracting stimulus from the system. He never drew blood, even in the most inflammatory cases, until he had first discharged the contents of the bowels. The doctor has further established the efficacy of a vegetable diet and of water as a drink, as the best means of preventing the disease in a hot climate. The manner in which the miasmata that produce the plague act upon the system is so much like that which has been described in the yellow fever, and the accounts of the efficacy of low diet, in preparing the body for its reception, and of copious bleeding, cold air, and cold water, in curing it, are so similar, that all the directions which relate to preventing, mitigating, or curing the yellow fever may be applied to it. The fluids in the plague show a greater tendency to the skin, than they do in the yellow fever. Perhaps, upon this account, the early use of powerful sudorifics may be more proper in the former than in the latter disease. From the influence of early purging and bleeding in promoting sweats in the yellow fever, there can be little doubt but the efforts of nature to unload the system in the plague, through the channel of the pores, might be accelerated by the early use of the same remedies. One thing, with respect to the plague, is certain, that its cure depends upon the abstraction of stimulus, either by means of plentiful sweats, or of purulent matter from external sores. Perhaps the efficacy of these remedies depends wholly upon their elevating the system from its prostrated state in a _gradual_ manner. If this be the case, those natural discharges might be easily and effectually imitated by small and repeated bleedings. To correspond in quantity with the discharge from the skin, blood-letting in the plague, when indicated, should be copious. A profuse sweat, continued for twenty-four hours, cannot fail of wasting many pounds of the fluids of the body. This was the duration of the critical sweats in the famous plague which was known by the name of the English sweating sickness, and which made its appearance in the army of Henry VII. in Milford-Haven in Wales, and spread from thence through every part of the kingdom. The principles which lead to the prevention and cure of the yellow fever and the plague, apply with equal force to the mitigation of the measles, and to the prevention or mitigation of the scarlatina anginosa, the dysentery, and the inflammatory jail fever. I have remarked elsewhere[98], that a previous vegetable diet lessened the violence and danger of the measles. Dr. Sims taught me, many years ago, to prevent or mitigate the scarlatina anginosa, by means of gentle purges, after children are infected by it[99]. Purges of salts have in many instances preserved whole families and neighbourhoods from the dysentery, where they have been exposed to its remote cause. During the late American war, an emetic seldom failed of preventing an attack of the hospital fever, when given in its forming state[100]. I have had no experience of the effects of previous evacuations in abating the violence, or preventing the mortality of the malignant sore throat, but I can have no doubt of their efficacy, from the sameness of the state of the system in that disease, as in other malignant fevers. The debility induced in it is from depression, and the supposed symptoms of putrefaction are nothing but the disguised effects of a sudden and violent pressure of an inflammatory stimulus upon the arterial system. [98] Vol. ii. [99] Medical Memoirs, vol. i. [100] Vol. i. With these observations I close the history of the rise, progress, symptoms, and treatment of the bilious remitting yellow fever, which appeared in Philadelphia in the year 1793. My principal aim has been to revive and apply to it the principles and practice of Dr. Sydenham, and, however coldly those principles and that practice may be received by some physicians of the present day, I am convinced that experience, in all ages and in all countries, will vouch for their truth and utility. A NARRATIVE OF THE _STATE OF THE BODY AND MIND_ OF THE AUTHOR, DURING THE PREVALENCE OF THE FEVER. Narratives of escapes from great dangers of shipwreck, war, captivity, and famine have always formed an interesting part of the history of the body and mind of man. But there are deliverances from equal dangers which have hitherto passed unnoticed; I mean from pestilential fevers. I shall briefly describe the state of my body and mind during my intercourse with the sick in the epidemic of 1793. The account will throw additional light upon the disease, and probably illustrate some of the laws of the animal economy. It will, moreover, serve to furnish a lesson to all who may be placed in similar circumstances to commit their lives, without fear, to the protection of that Being, who is able to save to the uttermost, not only from future, but from present evil. Some time before the fever made its appearance, my wife and children went into the state of New-Jersey, where they had long been in the habit of spending the summer months. My family, about the 25th of August, consisted of my mother, a sister, who was on a visit to me, a black servant man, and a mulatto boy. I had five pupils, viz. Warner Washington and Edward Fisher, of Virginia, John Alston, of South-Carolina, and John Redman Coxe (grandson to Dr. Redman) and John Stall, both of this city. They all crowded around me upon the sudden increase of business, and with one heart devoted themselves to my service, and to the cause of humanity. The credit which the new mode of treating the disease acquired, in all parts of the city, produced an immense influx of patients to me from all quarters. My pupils were constantly employed; at first in putting up purging powders, but, after a while, only in bleeding and visiting the sick. Between the 8th and the 15th of September I visited and prescribed for between a hundred and a hundred and twenty patients a day. Several of my pupils visited a fourth or fifth part of that number. For a while we refused no calls. In the short intervals of business, which I spent at my meals, my house was filled with patients, chiefly the poor, waiting for advice. For many weeks I seldom ate without prescribing for numbers as I sat at my table. To assist me at these hours, as well as in the night, Mr. Stall, Mr. Fisher, and Mr. Coxe accepted of rooms in my house, and became members of my family. Their labours now had no remission. Immediately after I adopted the antiphlogistic mode of treating the disease, I altered my manner of living. I left off drinking wine and malt liquors. The good effects of the disuse of these liquors helped to confirm me in the theory I had adopted of the disease. A troublesome head-ach, which I had occasionally felt, and which excited a constant apprehension that I was taking the fever, now suddenly left me. I likewise, at this time, left off eating solid animal food, and lived wholly, but sparingly, upon weak broth, potatoes, raisins, coffee, and bread and butter. From my constant exposure to the sources of the disease, my body became highly impregnated with miasmata. My eyes were yellow, and sometimes a yellowness was perceptible in my face. My pulse was preternaturally quick, and I had profuse sweats every night. These sweats were so offensive, as to oblige me to draw the bed-clothes close to my neck, to defend myself from their smell. They lost their f[oe]tor entirely, upon my leaving off the use of broth, and living entirely upon milk and vegetables. But my nights were rendered disagreeable, not only by these sweats, but by the want of my usual sleep, produced in part by the frequent knocking at my door, and in part by anxiety of mind, and the stimulus of the miasmata upon my system. I went to bed in conformity to habit only, for it ceased to afford me rest or refreshment. When it was evening I wished for morning; and when it was morning, the prospect of the labours of the day, at which I often shuddered, caused me to wish for the return of evening. The degrees of my anxiety may be easily conceived when I add, that I had at one time upwards of thirty heads of families under my care; among these were Mr. Josiah Coates, the father of eight, and Mr. Benjamin Scull and Mr. John Morell, both fathers of ten children. They were all in imminent danger; but it pleased God to make me the instrument of saving each of their lives. I rose at six o'clock, and generally found a number of persons waiting for advice in my shop or parlour. Hitherto the success of my practice gave a tone to my mind, which imparted preternatural vigour to my body. It was meat and drink to me to fulfil the duties I owed to my fellow-citizens, in this time of great and universal distress. From a hope that I might escape the disease, by avoiding every thing that could excite it into action, I carefully avoided the heat of the sun, and the coldness of the evening air. I likewise avoided yielding to every thing that should raise or depress my passions. But, at such a time, the events which influence the state of the body and mind are no more under our command than the winds or weather. On the evening of the 14th of September, after eight o'clock, I visited the son of Mrs. Berriman, near the Swedes's church, who had sent for me early in the morning. I found him very ill. He had been bled in the forenoon, by my advice, but his pulse indicated a second bleeding. It would have been difficult to procure a bleeder at that late hour. I therefore bled him myself. Heated by this act, and debilitated by the labours of the day, I rode home in the evening air. During the ensuing night I was much indisposed. I rose, notwithstanding, at my usual hour. At eight o'clock I lost ten ounces of blood, and immediately afterwards got into my chair, and visited between forty and fifty patients before dinner. At the house of one of them I was forced to lie down a few minutes. In the course of this morning's labours my mind was suddenly thrown off its pivots, by the last look, and the pathetic cries, of a friend for help, who was dying under the care of a French physician. I came home about two o'clock, and was seized, immediately afterwards, with a chilly fit and a high fever. I took a dose of the mercurial medicine, and went to bed. In the evening I took a second purging powder, and lost ten ounces more of blood. The next morning I bathed my face, hands, and feet in cold water for some time. I drank plentifully, during the day and night, of weak hyson tea, and of water, in which currant jelly had been dissolved. At eight o'clock I was so well as to admit persons who came for advice into my room, and to receive reports from my pupils of the state of as many of my patients as they were able to visit; for, unfortunately, they were not able to visit them all (with their own) in due time; by which means several died. The next day I came down stairs, and prescribed in my parlour for not less than a hundred people. On the 19th of the same month, I resumed my labours, but in great weakness. It was with difficulty that I ascended a pair of stairs, by the help of a banister. A slow fever, attended with irregular chills, and a troublesome cough, hung constantly upon me. The fever discovered itself in the heat of my hands, which my patients often told me were warmer than their own. The breath and exhalations from the sick now began to affect me, in small and infected rooms, in the most sensible manner. On the morning of the 4th of October I suddenly sunk down, in a sick room, upon a bed, with a giddiness in my head. It continued for a few minutes, and was succeeded by a fever, which confined me to my house the remaining part of the day. Every moment in the intervals of my visits to the sick was employed in prescribing, in my own house, for the poor, or in sending answers to messages from my patients; time was now too precious to be spent in counting the number of persons who called upon me for advice. From circumstances I believe it was frequently 150, and seldom less than 50 in a day, for five or six weeks. The evening did not bring with it the least relaxation from my labours. I received letters every day from the country, and from distant parts of the union, containing inquiries into the mode of treating the disease, and after the health and lives of persons who had remained in the city. The business of every evening was to answer these letters, also to write to my family. These employments, by affording a fresh current to my thoughts, kept me from dwelling on the gloomy scenes of the day. After these duties were performed, I copied into my note book all the observations I had collected during the day, and which I had marked with a pencil in my pocket-book in sick rooms, or in my carriage. To these constant labours of body and mind were added distresses from a variety of causes. Having found myself unable to comply with the numerous applications that were made to me, I was obliged to refuse many every day. My sister counted forty-seven in one forenoon before eleven o'clock. Many of them left my door with tears, but they did not feel more distress than I did from refusing to follow them. Sympathy, when it vents itself in acts of humanity, affords pleasure, and contributes to health; but the reflux of pity, like anger, gives pain, and disorders the body. In riding through the streets, I was often forced to resist the entreaties of parents imploring a visit to their children, or of children to their parents. I recollect, and even _yet_ with pain, that I tore myself at one time from five persons in Moravian-alley, who attempted to stop me, by suddenly whipping my horse, and driving my chair as speedily as possible beyond the reach of their cries. The solicitude of the friends of the sick for help may further be conceived of, when I add, that the most extravagant compensations were sometimes offered for medical services, and, in one instance, for only a single visit. I had no merit in refusing these offers, and I have introduced an account of them only to inform such physicians as may hereafter be thrown into a similar situation, that I was favoured with an exemption from the fear of death, in proportion as I subdued every selfish feeling, and laboured exclusively for the benefit of others. In every instance in which I was forced to refuse these pathetic and earnest applications, my distress was heightened by the fear that the persons, whom I was unable to visit, would fall into improper hands, and perish by the use of bark, wine, and laudanum. But I had other afflictions besides the distress which arose from the abortive sympathy which I have described. On the 11th of September, my ingenious pupil, Mr. Washington, fell a victim to his humanity. He had taken lodgings in the country, where he sickened with the disease. Having been almost uniformly successful in curing others, he made light of his fever, and concealed the knowledge of his danger from me, until the day before he died. On the 18th of September Mr. Stall sickened in my house. A delirium attended his fever from the first hour it affected him. He refused, and even resisted force when used to compel him to take medicine. He died on the 23d of September[101]. Scarcely had I recovered from the shock of the death of this amiable youth, when I was called to weep for a third pupil, Mr. Alston, who died in my neighbourhood the next day. He had worn himself down, before his sickness, by uncommon exertions in visiting, bleeding, and even sitting up with sick people. At this time Mr. Fisher was ill in my house. On the 26th of the month, at 12 o'clock, Mr. Coxe, my only assistant, was seized with the fever, and went to his grandfather's. I followed him with a look, which I feared would be the last in my house. At two o'clock my sister, who had complained for several days, yielded to the disease, and retired to her bed. My mother followed her, much indisposed, early in the evening. My black servant man had been confined with the fever for several days, and had on that day, for the first time, quitted his bed. My little mulatto boy, of eleven years old, was the only person in my family who was able to afford me the least assistance. At eight o'clock in the evening I finished the business of the day. A solemn stillness at that time pervaded the streets. In vain did I strive to forget my melancholy situation by answering letters, and by putting up medicines, to be distributed next day among my patients. My faithful black man crept to my door, and at my request sat down by the fire, but he added, by his silence and dullness, to the gloom which suddenly overpowered every faculty of my mind. [101] This accomplished youth had made great attainments in his profession. He possessed, with an uncommon genius for science, talents for music, painting, and poetry. The following copy of an unfinished letter to his father (who had left the city) was found among his papers after his death. It shows that the qualities of his heart were equal to those of his head. "_Philadelphia, September 15, 1793._ "MY DEAR FATHER, "I take every moment I have to spare to write to you, which is not many; but you must excuse me, as I am doing good to my fellow-creatures. At this time, every moment I spend in idleness might probably cost a life. The sickness increases every day, but most of those who die, die for want of good attendance. We cure all we are called to on the first day, who are well attended, but so many doctors are sick, the poor creatures are glad to get a doctor's servant." On the first day of October, at two o'clock in the afternoon, my sister died. I got into my carriage within an hour after she expired, and spent the afternoon in visiting patients. According as a sense of duty, or as grief has predominated in my mind, I have approved, and disapproved of this act, ever since. She had borne a share in my labours. She had been my nurse in sickness, and my casuist in my choice of duties. My whole heart reposed itself in her friendship. Upon being invited to a friend's house in the country, when the disease made its appearance in the city, she declined accepting the invitation, and gave as a reason for so doing, that I might probably require her services in case of my taking the disease, and that, if she were sure of dying, she would remain with me, provided that, by her death, she could save my life. From this time I declined in health and strength. All motion became painful to me. My appetite began to fail. My night sweats continued. My short and imperfect sleep was disturbed by distressing or frightful dreams. The scenes of them were derived altogether from sick rooms and grave-yards. I concealed my sorrows as much as possible from my patients; but when alone, the retrospect of what was past, and the prospect of what was before me, the termination of which was invisible, often filled my soul with the most poignant anguish. I wept frequently when retired from the public eye, but I did not weep over the lost members of my family alone. I beheld or heard every day of the deaths of citizens, useful in public, or amiable in private life. It was my misfortune to lose as patients the Rev. Mr. Fleming and Mr. Graesel, both exhausted by their labours of piety and love among the poor, before they sickened with the disease. I saw the last struggles of departing life in Mr. Powel, and deplored, in his death, an upright and faithful servant of the public, as well as a sincere and affectionate friend. Often did I mourn over persons who had, by the most unparalleled exertions, saved their friends and families from the grave, at the expence of their own lives. Many of these martyrs to humanity were in humble stations. Among the members of my profession, with whom I had been most intimately connected, I had daily cause of grief and distress. I saw the great and expanded mind of Dr. Pennington, shattered by delirium, just before he died. He was to me dear and beloved, like a younger brother. He was, moreover, a Joab in the contest with the disease. Philadelphia must long deplore the premature death of this excellent physician. Had he lived a few years longer, he would have filled an immense space in the republic of medicine[102]. It was my affliction to see my friend Dr. John Morris breathe his last, and to hear the first effusions of the most pathetic grief from his mother, as she bursted from the room in which he died. But I had distress from the sickness, as well as the deaths of my brethren in physic. My worthy friends, Dr. Griffitts, Dr. Say, and Dr. Mease, were suspended by a thread over the grave, nearly at the same time. Heaven, in mercy to me, as well as in kindness to the public and their friends, preserved their lives. Had they died, the measure of my sorrows would have been complete. [102] Before he finished his studies in medicine, he published a volume of ingenious and patriotic "Chemical and Economical Essays, designed to illustrate the connection between the theory and practice of chemistry, and the application of that science to some of the arts and manufactures of the United States of America." I have said before, that I early left off drinking wine; but I used it in another way. I carried a little of it in a vial in my pocket, and when I felt myself fainty, after coming out of a sick room, or after a long ride, I kept about a table spoonful of it in my mouth for half a minute, or longer, without swallowing it. So weak and excitable was my system, that this small quantity of wine refreshed and invigorated me as much as half a pint would have done at any other time. The only difference was, that the vigour I derived from the wine in the former, was of shorter duration than when taken in the latter way. For the first two weeks after I visited patients in the yellow fever, I carried a rag wetted with vinegar, and smelled it occasionally in sick rooms: but after I saw and felt the signs of the universal presence of miasmata in my system, I laid aside this and all other precautions. I rested myself on the bed-side of my patients, and I drank milk or ate fruit in their sick rooms. Besides being saturated with miasmata, I had another security against being infected in sick rooms, and that was, I went into scarcely a house which was more infected than my own. Many of the poor people, who called upon me for advice, were bled by my pupils in my shop, and in the yard, which was between it and the street. From the want of a sufficient number of bowls to receive their blood, it was sometimes suffered to flow and putrify upon the ground. From this source, streams of miasmata were constantly poured into my house, and conveyed into my body by the air, during every hour of the day and night. The deaths of my pupils and sister have often been urged as objections to my mode of treating the fever. Had the same degrees of labour and fatigue, which preceded the attack of the yellow fever in each of them, preceded an attack of a common pleurisy, I think it probable that some, or perhaps all of them, would have died with it. But when the influence of the concentrated miasmata which filled my house was added to that of constant fatigue upon their bodies, what remedies could be expected to save their lives? Under the above circumstances, I consider the recovery of the other branches of my family from the fever (and none of them escaped it) with emotions, such as I should feel had we all been revived from apparent death by the exertions of a humane society. For upwards of six weeks I did not taste animal food, nor fermented liquors of any kind. The quantity of aliment which I took, inclusive of drinks, during this time, was frequently not more than one or two pounds in a day. Yet upon this diet I possessed, for a while, uncommon activity of body. This influence of abstinence upon bodily exertion has been happily illustrated by Dr. Jackson, in his directions for preserving the health of soldiers in hot climates. He tells us, that he walked a hundred miles in three days, in Jamaica, during which time he breakfasted on tea, supped on bread and salad, and drank nothing but lemonade or water. He adds further, that he walked from Edinburgh to London in eleven days and a half, and that he travelled with the most ease when he only breakfasted and supped, and drank nothing but water. The fatigue of riding on horseback is prevented or lessened by abstinence from solid food. Even the horse suffers least from a quick and long journey when he is fed sparingly with hay. These facts add weight to the arguments formerly adduced, in favour of a vegetable diet, in preventing or mitigating the action of the miasmata of malignant fevers upon the system. In both cases the abstraction of stimulus removes the body further from the reach of undue excitement and morbid depression. Food supports life as much by its stimulus, as by affording nourishment to the body. Where an artificial stimulus acts upon the system the natural stimulus of food ceases to be necessary. Under the influence of this principle, I increased or diminished my food with the signs I discovered of the increase or diminution of the seeds of the disease in my body. Until the 15th of September I drank weak coffee, but after that time I drank nothing but milk, or milk and water, in the intervals of my meals. I was so satisfied of the efficacy of this mode of living, that I believed life might have been preserved, and a fever prevented, for many days, with a much greater accumulation of miasmata in my system, by means of a total abstinence from food. Poison is a relative term, and an excess in quantity, or a derangement in place, is necessary to its producing deleterious effects. The miasmata of the yellow fever produced sickness and death only from the excess of their quantity, or from their force being increased by the addition of those other stimuli which I have elsewhere called exciting causes. In addition to low diet, as a preventive of the disease, I obviated costiveness by taking occasionally a calomel pill, or by chewing rhubarb. I had read and taught, in my lectures, that fasting increases acuteness in the sense of touch. My low living had that effect, in a certain degree, upon my fingers. I had a quickness in my perception, of the state of the pulse in the yellow fever, that I had never experienced before in any other disease. My abstemious diet, assisted perhaps by the state of my feelings, had likewise an influence upon my mind. Its operations were performed with an ease and a celerity, which rendered my numerous and complicated duties much less burdensome than they would probably have been under other circumstances of diet, or a less agitated state of my passions. My perception of the lapse of time was new to me. It was uncommonly slow. The ordinary business and pursuits of men appeared to me in a light that was equally new. The hearse and the grave mingled themselves with every view I took of human affairs. Under these impressions I recollect being as much struck with observing a number of men, employed in digging the cellar of a large house, as I should have been, at any other time, in seeing preparations for building a palace upon a cake of ice. I recollect, further, being struck with surprise, about the 1st of October, in seeing a man busily employed in laying in wood for the approaching winter. I should as soon have thought of making provision for a dinner on the first day of the year 1800. In the account of my distresses, I have passed over the slanders which were propagated against me by some of my brethren. I have mentioned them only for the sake of declaring, in this public manner, that I most heartily forgive them; and that if I discovered, at any time, an undue sense of the unkindness and cruelty of those slanders, it was not because I felt myself injured by them, but because I was sure they would irreparably injure my fellow-citizens, by lessening their confidence in the only remedies that I believed to be effectual in the reigning epidemic. One thing in my conduct towards these gentlemen may require justification; and that is, my refusing to consult with them. A Mahometan and a Jew might as well attempt to worship the Supreme Being in the same temple, and through the medium of the same ceremonies, as two physicians of opposite principles and practice attempt to confer about the life of the same patient. What is done in consequence of such negotiations (for they are not consultations) is the ineffectual result of neutralized opinions; and wherever they take place, should be considered as the effect of a criminal compact between physicians, to assess the property of their patients, by a shameful prostitution of the dictates of their consciences. Besides, I early discovered that it was impossible for me, by any reasonings, to change the practice of some of my brethren. Humanity was, therefore, on the side of leaving them to themselves; for the extremity of _wrong_ in medicine, as in morals and government, is often a less mischief than that mixture of _right_ and _wrong_ which serves, by palliating, to perpetuate evil. After the loss of my health I received letters from my friends in the country, pressing me, in the strongest terms, to leave the city. Such a step had become impracticable. My aged mother was too infirm to be removed, and I could not leave her. I was, moreover, part of a little circle of physicians, who had associated themselves in support of the new remedies. This circle would have been broken by my quitting the city. The weather varied the disease, and, in the weakest state of my body, I expected to be able, from the reports of my pupils, to assist my associates in detecting its changes, and in accommodating our remedies to them. Under these circumstances it pleased God to enable me to reply to one of the letters that urged my retreat from the city, that "I had resolved to stick to my principles, my practice, and my patients, to the last extremity." On the 9th of October, I visited a considerable number of patients, and, as the day was warm, I lessened the quantity of my clothing. Towards evening I was seized with a pain in the back, which obliged me to go to bed at eight o'clock. About twelve I awoke with a chilly fit. A violent fever, with acute pains in different parts of my body, followed it. At one o'clock I called for Mr. Fisher, who slept in the next room. He came instantly, with my affectionate black man, to my relief. I saw my danger painted in Mr. Fisher's countenance. He bled me plentifully, and gave me a dose of the mercurial medicine. This was immediately rejected. He gave me a second dose, which likewise acted as an emetic, and discharged a large quantity of bile from my stomach. The remaining part of the night was passed under an apprehension that my labours were near an end. I could hardly expect to survive so violent an attack of the fever, broken down, as I was, by labour, sickness, and grief. My wife and seven children, whom the great and distressing events that were passing in our city had jostled out of my mind for six or seven weeks, now resumed their former place in my affections. My wife had stipulated, in consenting to remain in the country, to come to my assistance in case of my sickness; but I took measures which, without alarming her, proved effectual in preventing it. My house was enveloped in foul air, and the probability of my death made her life doubly necessary to my family. In the morning the medicine operated kindly, and my fever abated. In the afternoon it returned, attended with a great inclination to sleep. Mr. Fisher bled me again, which removed the sleepiness. The next day the fever left me, but in so weak a state, that I awoke two successive nights with a faintness which threatened the extinction of my life. It was removed each time by taking a little aliment. My convalescence was extremely slow. I returned, in a very gradual manner, to my former habits of diet. The smell of animal food, the first time I saw it at my table, forced me to leave the room. During the month of November, and all the winter months, I was harassed with a cough, and a fever somewhat of the hectic kind. The early warmth of the spring removed those complaints, and restored me, through Divine goodness, to my usual state of health. I should be deficient in gratitude, were I to conclude this narrative without acknowledging my obligations to my surviving pupils, Mr. Fisher and Mr. Coxe, for the great support and sympathy I derived from them in my labours and distresses. I take great pleasure likewise in acknowledging my obligations to my former pupil, Dr. Woodhouse, who assisted me in the care of my patients, after I became so weak as not to be able to attend them with the punctuality their cases required. The disinterested exploits of these young gentlemen in the cause of humanity, and their success in the treatment of the disease, have endeared their names to hundreds, and, at the same time, afforded a prelude of their future eminence and usefulness in their profession. But wherewith shall I come before the great FATHER and REDEEMER of men, and what shall I render unto him for the issue of my life from the grave? ----Here all language fails:---- Come then, expressive silence, muse his praise. AN ACCOUNT OF THE BILIOUS REMITTING AND INTERMITTING _YELLOW FEVER_, AS IT APPEARED IN PHILADELPHIA, IN THE YEAR 1794. I concluded the history of the symptoms of the bilious remitting yellow fever, as it appeared in Philadelphia in the year 1793, by taking notice, that the diseases which succeeded that fatal epidemic were all of a highly inflammatory nature. In that history I described the weather and diseases of the months of March and April, in the spring of 1794. The weather, during the first three weeks of the month of May, was dry and temperate, with now and then a cold day and night. The strawberries were ripe on the 15th, and cherries on the 22d day of the month, in several of the city gardens. A shower of hail fell on the afternoon of the 22d, which broke the glass windows of many houses. A single stone of this hail was found to weigh two drachms. Several people collected a quantity of it, and preserved it till the next day in their cellars, when they used it for the purpose of cooling their wine. The weather, after this hail storm, was rainy during the remaining part of the month. The diseases were still inflammatory. Many persons were afflicted with a sore mouth in this month. The weather in June was pleasant and temperate. Several intermittents, and two very acute pleurisies, occurred in my practice during this month. The intermittents were uncommonly obstinate, and would not yield to the largest doses of the bark. In a son of Mr. Samuel Coates, of seven years old, the bark produced a sudden translation of this state of fever to the head, where it produced all the symptoms of the first stage of internal dropsy of the brain. This once formidable disease yielded, in this case, to three bleedings, and other depleting medicines. The blood drawn in every instance was sizy. From the inflammatory complexion of the diseases of the spring, and of the beginning of June, I expected the fevers of the summer and autumn would be of a violent and malignant nature. I was the more disposed to entertain this opinion from observing the stagnating filth of the gutters of our city; for the citizens of Philadelphia, having an interest in rejecting the proofs of the generation of the epidemic of 1793 in their city, had neglected to introduce the regulations which were necessary to prevent the production of a similar fever from domestic putrefaction. They had, it is true, taken pains to remove the earth and offal matters which accumulated in the streets; but these, from their being always dry, were inoffensive as remote causes of disease. Perhaps the removal of the earth did harm, by preventing the absorption of the miasmata which were constantly exhaled from the gutters. On the 6th of June, Dr. Physick called upon me, and informed me that he had a woman in the yellow fever under his care. The information did not surprise me, but it awakened suddenly in my mind the most distressing emotions. I advised him to inform the mayor of the city of the case, but by no means to make it more public, for I hoped that it might be a sporadic instance of the disease, and that it might not become general in the city. On the 12th of the month, my fears of the return of the yellow fever were revived by visiting Mr. Isaac Morris, whom I found very ill with a violent puking, great pain in his head, a red eye, and a slow tense pulse. I ordered him to be bled, and purged him plentifully with jalap and calomel. His blood had that appearance which has been compared by authors to the washings of raw flesh in water. Upon his recovery, he told me that he "suspected he had had the yellow fever, for that his feelings were exactly such as they had been in the fall of 1793, at which time he had an attack of that disease." On the 14th of June, I was sent for, in the absence of Dr. Mease, to visit his sister in a fever. Her mother, who had become intimately acquainted with the yellow fever, by nursing her son and mother in it, the year before, at once decided upon the name of her daughter's disease. Her symptoms were violent, but they appeared in an intermitting form. Each paroxysm of her fever was like a hurricane to her whole system. It excited apprehensions of immediate dissolution in the minds of all her friends. The loss of sixty ounces of blood, by five bleedings, copious doses of calomel and jalap, and a large blister to her neck, soon vanquished this malignant intermittent, without the aid of a single dose of bark. During the remaining part of the month, I was called to several cases of fever, which had symptoms of malignity of an alarming nature. The son of Mr. Andrew Brown had a hæmorrhage from his nose in a fever, and a case of menorrhagia occurred in a woman, who was affected with but a slight degree of fever. In the course of this month, I met with several cases of swelled testicles, which had succeeded fevers so slight as to have required no medical aid. Dr. Desportes records similar instances of a swelling in the testicles, which appeared during the prevalence of the yellow fever in St. Domingo, in the year 1741[103]. [103] Histoire des Maladies de Saint Domingue, p. 112. In the month of July, I visited James Lefferty and William Adams, both of whom had, with the usual symptoms of yellow fever, a yellow colour on their skin. I likewise attended three women, in whom I discovered the disease under forms in which I had often seen it in the year 1793. In two of them it appeared with symptoms of a violent colic, which yielded only to frequent bleedings. In the third, it appeared with symptoms of pleurisy, which was attended with a constant hæmorrhage from the uterus, although blood was drawn almost daily from her arm, for six or seven days. About the middle of this month many people complained of nausea, which in some cases produced a puking, without any symptoms of fever. During the month of August, I was called to Peter Denham, Mrs. Bruce, a son of Jacob Gribble, Mr. Cole, John Madge, Mrs. Gardiner, Miss Purdon, Mrs. Gavin, and Benjamin Cochran, each of whom had all the usual symptoms of the yellow fever. I found Mr. Cochran sitting on the side of his bed, with a pot in his hand, into which he was discharging black matter from his stomach, on the 6th day of the disease. He died on the next day. Mrs. Gavin died on the 6th day of her disease, from a want of sufficient bleeding, to which she objected from the influence of her friends. Besides the above persons, I visited Mr. George Eyre at Kensington, Mr. Thomas Fitzsimons, and Thomas M'Kean, jun. son of the chief justice of Pennsylvania, all of whom had the disease, but in a moderate degree. During this time I took no steps to alarm my fellow-citizens with the unwelcome news of its being in town. But my mind was not easy in this situation, for I daily heard of persons who died of the disease, who might probably have been saved had they applied early for relief, or had a suspicion become general among all our physicians of the existence of the yellow fever in the city. The cholera infantum was common during this, and part of the preceding month. It was more obstinate and more fatal than in common years. On the 12th of this month, a letter from Baltimore announced the existence of the yellow fever in that city. One of the patients whom I visited in this month, in the fever, Mr. Cole, brought the seeds of it in his body from that place. On the 25th of the month, two members of a committee, lately appointed by the government of the state, for taking care of the health of the city, called upon me to know whether the yellow fever was in town. I told them it was, and mentioned some of the cases that had come under my notice; but informed them, at the same time, that I had seen no case in which it had been contagious, and that, in every case where I had been called early, and where my prescriptions had been followed, the disease had yielded to medicine. On the 29th of the month I received an invitation to attend a meeting of the committee of health, at their office at Walnut-street. They interrogated me respecting the intelligence I had given to two of their members on the 25th. I repeated it to them, and mentioned the names of all the persons I had attended in the yellow fever since the 9th of June. Neither this, nor several subsequent communications to the committee of health produced the effect that was intended by them. Dr. Physick and Dr. Dewees supported me in my declaration, but their testimony did not protect me from the clamours of my fellow-citizens, nor from the calumnies of some of my brethren, who, while they daily attended or lost patients in the yellow fever, called it by the less unpopular names of 1. A common intermittent. 2. A bilious fever. 3. An inflammatory remitting fever. 4. A putrid fever. 5. A nervous fever. 6. A dropsy of the brain. 7. A lethargy. 8. Pleurisy. 9. Gout. 10. Rheumatism. 11. Colic. 12. Dysentery. And 13. Sore throat. It was said further, by several of the physicians of the city, not to be the yellow fever, because some who had died of it had not a sighing in the beginning, and a black vomiting in the close of the disease. Even where the black vomiting and yellow skin occurred, they were said not to constitute a yellow fever, for that those symptoms occurred in other fevers. Let not the reader complain of the citizens and physicians of Philadelphia alone. A similar conduct has existed in all cities upon the appearance of great and mortal epidemics. Nor is it any thing new for mortal diseases to receive mild and harmless names from physicians. The plague was called a spotted fever, for several months, by some of the physicians of London, in the year 1665. Notwithstanding the pains which were taken to discredit the report of the existence of the yellow fever in the city, it was finally believed by many citizens, and a number of families in consequence of it left the city. And in spite of the harmless names of intermitting and remitting fever, and the like, which were given to the disease, the bodies of persons who had died with it were conveyed to the grave, in several instances, upon a hearse, the way in which those who died of the yellow fever were buried the year before. From the influence of occasional showers of rain, in the months of September and October, the disease was frequently checked, so as to disappear altogether for two or three days in my circle of practice. It was observed, that while showers of rain lessened, moist or damp weather, without rain, increased it. The cold weather in October checked the fever, but it did not banish it from the city. It appeared in November, and in all the succeeding winter and spring months. The weather, during these months, being uncommonly moderate, will account for its not being destroyed at the time in which the disease usually disappeared in former years. The causes which predisposed to this fever were the same as in the year 1793. Persons of full habits, strangers, and negroes, were most subject to it. It may seem strange to those persons who have read that the negroes are seldom affected with this fever in the West-Indies, that they were so much affected by it in Philadelphia. There were two reasons for it. Their manner of living was as plentiful as that of white people in the West-Indies, and they generally resided in alleys and on the skirts of the city, where they were more exposed to noxious exhalation, than in its more open and central parts. The summer fruits, from being eaten before they were ripe, or in too large a quantity, became frequently exciting causes of this fever. It was awakened in one of my patients by a supper of peaches and milk. Cucumbers, in several instances, gave vigour to the miasmata which had been previously received into the system. Terror excited it in two of my patients. In one of them, a young woman, this terror was produced by hearing, while she sat at dinner, that a hearse had passed by her door with a person on it who had died of the yellow fever. Vexation excited it in a foreign master of a vessel, in consequence of a young woman suddenly breaking an engagement to marry him. The disease terminated fatally in this instance. It was sometimes unfortunate for patients when the disease was excited by an article of diet, or by any other cause which acted suddenly upon the system; for it led both them, and in some instances their physicians, to confound those exciting causes with its remote cause, and to view the disease without the least relation to the prevailing epidemic. It was from this mistake that many persons were said to die of intemperance, of eating ice creams, and of trifling colds, who certainly died of the yellow fever. The rum, the ice creams, and the changes in the air, in all these cases, acted like sparks of fire which set in motion the quiescent particles of tinder or gunpowder. I shall now proceed to describe the symptoms which this fever assumed during the periods which have been mentioned. This detail will be interesting to physicians who wish to see how little nature regards the nosological arrangement of authors, in the formation of the symptoms of diseases, and how much the seasons influence epidemics. A physician, who had practised medicine near sixty years in the city of Philadelphia, declared that he had never seen the dysentery assume the same symptoms in any two _successive_ years. The same may be said probably of nearly all epidemic diseases. In the arrangement of the symptoms of this fever, I shall follow the order I adopted in my Account of the Yellow Fever of 1793, and describe them as they appeared in the sanguiferous system, the liver, lungs, and brain, the alimentary canal, the secretions and excretions, the nervous system, the senses and appetites, upon the skin, and in the blood. Two premonitory symptoms struck me this year, which I did not observe in 1793. One of them was a frequent discharge of pale urine for a day or two before the commencement of the fever; the other was sleep unusually sound, the night before the attack of the fever. The former symptom was a precursor of the plague of Bassora, in the year 1773. I. I observed but few symptoms in the sanguiferous system different from what I have mentioned in the fever of the preceding year. The slow and intermitting pulse occurred in many, and a pulse nearly imperceptible, in three instances. It was seldom very frequent. In John Madge, an English farmer, who had just arrived in our city, it beat only 64 strokes in a minute, for several days, while he was so ill as to require three bleedings a day, and at no time of his fever did his pulse exceed 96 strokes in a minute. In Miss Sally Eyre, the pulse at one time was at 176, and at another time it was at 140; but this frequency of pulse was very rare. In a majority of the cases which came under my notice, where the danger was great, it seldom exceeded 80 strokes in a minute. I have been thus particular in describing the frequency of the pulse, because custom has created an expectation of that part of the history of fevers; but my attention was directed chiefly to the different degrees of _force_ in the pulse, as manifested by its tension, fulness, intermissions, and inequality of action. The _hobbling_ pulse was common. In John Geraud, I perceived a quick stroke to succeed every two strokes of an ordinary healthy pulse. The intermitting, chorded, and depressed pulse occurred in many cases. I called it the year before a _sulky_ pulse. One of my pupils, Mr. Alexander, called it more properly a _locked_ pulse. I think I observed this state of the pulse to occur chiefly in persons in whom the fever came on without a chilly fit. Hæmorrhages occurred in all the grades of this fever, but less frequently in my practice this year than in the year before. It occurred, after a ninth bleeding, in Miss Sally Eyre, from the nose and bowels. It occurred from the nose, after a sixth bleeding, in Mrs. Gardiner, who was at that time in the sixth month of her pregnancy. This symptom, which was accompanied by a tense and quick pulse, induced me to repeat the bleeding a seventh time. The blood was very sizy. I mention this fact to establish the opinion that hæmorrhages depend upon too much action in the blood-vessels, and that they are not occasioned by a dissolved state of the blood. There was a disposition at this time to hæmorrhage in persons who were in apparent good health. A private, in a company of volunteers commanded by Major M'Pherson, informed me that three of his messmates were affected by a bleeding at the nose, for several days after they left the city, on their way to quell the insurrection in the western counties of Pennsylvania. II. The liver did not exhibit the usual marks of inflammation. Perhaps my mode of treating the fever prevented those symptoms of hepatic affection which belong to the yellow fever in tropical climates. The lungs were frequently affected; and hence the disease was in many instances called a pleurisy or a catarrh. This inflammation of the lungs occurred in a more especial manner in the winter season. It was distinguished from the pleurisies of common years by a red eye, by a vomiting of green or yellow bile, by black stools, and by requiring very copious blood-letting to cure it. The head was affected, in this fever, not only with coma and delirium, but with mania. This symptom was so common as to give rise to an opinion that madness was epidemic in our city. I saw no case of it which was not connected with other symptoms of the bilious remitting fever. The Rev. Mr. Keating, one of the ministers of the Roman church, informed me that he had been called to visit seven deranged persons in his congregation, in the course of one week, in the month of March. Two of them had made attempts upon their lives. This mania was probably, in each of the above cases, a symptom only of general fever. The dilatation of the pupil was universal in this fever. Sore eyes were common during the prevalence of this fever. In Mrs. Leaming, this affection of the eyes was attended with a fever of a tertian type. III. The alimentary canal suffered as usual in this fever. A vomiting was common upon the first attack of the disease. I observed this symptom to be less common after the cold and rainy weather which took place about the first of October. I have in another place mentioned the influence of the weather upon the symptoms of this disease. In addition to the facts which have been formerly recorded, I shall add one more from Dr. Desportes. He tells us, that in dry weather the disease affects the head, and that the bowels in this case are more obstinately costive than in moist weather. This influence of the atmosphere on the yellow fever will not surprise those physicians who recollect the remarkable passage in Hippocrates, in which he says, that in the violent heats of summer, fevers appeared, but without any sweat; but if a shower, though ever so slight, appeared, a sweat broke out in the beginning[104]. I observed further, that a vomiting rarely attended those cases in which there was an absence of a chilly fit in the beginning of the fever. The same observation is made by Dr. Desportes[105]. [104] Epidemics, book XI. sect. I. [105] Les Maladies de St. Domingue, vol. I. p. 193. The matter discharged by vomiting was green or yellow bile in most cases. Mrs. Jones, the wife of Captain Lloyd Jones, and one other person, discharged black bile within one hour after they were attacked by the fever. I have taken notice, in the History of the Yellow Fever of 1793, that a discharge of bile in the beginning of this fever was always a favourable symptom. Dr. Davidson of St. Vincents, in a letter to me, dated the 22d July, 1794, makes the same remark. It shows that the biliary ducts are open, and that the bile is not in that viscid and impacted state which is described in the dissections of Dr. Mitchel[106]. A distressing pain in the stomach, called by Dr. Cullen gastrodynia, attended in two instances. A burning pain in the stomach, and a soreness to the touch of its whole external region, occurred in three or four cases. Two of them were in March, 1795. In Mrs. Vogles, who had the fever in September, 1794, the sensibility of the pit of the stomach was so exquisite, that she could not bear the weight of a sheet upon it. [106] Account of the Yellow Fever of 1793. Pains in the bowels were very common. They formed the true bilious colic, so often mentioned by West-India writers. In John Madge these pains produced a hardness and contraction of the whole external region of the bowels. They were periodical in Miss Nancy Eyre, and in Mrs. Gardiner, and in both cases were attended with diarrh[oe]a. Costiveness without pain was common, and, in some cases, so extremely obstinate as to resist, for several days, the successive and alternated use of all the usual purges of the shops. Flatulency was less common in this fever than in the year 1793. The disease appeared with symptoms of dysentery in several cases. IV. The following is an account of the state of the _secretions_ and _excretions_ in this fever. A puking of bile was more common this year than in the year 1793. It was generally of a green or yellow colour. I have remarked before, that two of my patients discharged black bile within an hour after they were affected by the fever, and many discharged that kind of matter which has been compared to coffee grounds, towards the close of the disease. The fæces were black in most cases where the symptoms of the highest grade of the fever attended. In one very malignant case the most drastic purges brought away, by fifty evacuations, nothing but natural stools. The purges were continued, and finally black fæces were discharged, which produced immediate relief[107]. In one person the fæces were of a light colour. In this patient the yellowness in the face was of an orange colour, and continued so for several weeks after his recovery. [107] In the account of the effects of morbid action and inflammation, in the Outlines of the Theory of Fever, the author neglected to mention the change of certain fluids from their natural to a dark colour. It appears in the secretions of the stomach and bowels, in the bile, in the urine, in carbuncles, and occasionally in the matter which is produced by blisters. All these changes occur in the yellow fever, and, in common with the other effects of fever that have been enumerated, are the result of peculiar actions in the vessels, derived from _one_ cause, viz. morbid excitement. The urine was, in most cases, high coloured. It was scanty in quantity in Peter Brown, and totally suppressed in John Madge for two days. I ascribed this defect of natural action in the kidneys to an _engorgement_ in their blood-vessels, similar to that which takes place in the lungs and brain in this fever. I had for some time entertained this idea of a morbid affection of the kidneys, but I have lately been confirmed in it by the account which Dr. Chisholm gives of the state of one of the kidneys, in a man whom he lost with the Beullam fever, at Grenada. "The right kidney (says the doctor) was mortified, although, during his illness, no symptom of inflammation of that organ was perceived[108]." It would seem as if the want of action in the kidneys, and a defect in their functions were not necessarily attended with pain. I recollect to have met with several cases in 1793, in which there was a total absence of pain in a suppression of urine of several days continuance. The same observation is made by Dr. Chisholm, in his account of the Beullam fever of Grenada[109]. From this fact it seems probable, that pain is not the effect of any determinate state of animal fibres, but requires the concurrence of morbid or preternatural excitement to produce it. I met with but one case of strangury in this fever. It terminated favourably in a few days. I have never seen death, in a single instance, in a fever from any cause, where a strangury attended, and I have seldom seen a fatal issue to a fever, where this symptom was accidentally produced by a blister. From this fact there would seem to be a connection between a morbid excitement in the neck of the bladder, and the safety of more vital parts of the body. The idea of this connection was first suggested to me, above thirty years ago, by the late Dr. James Leiper, of Maryland, who informed me that he had sometimes cured the most dangerous cases of pleurisy, after the usual remedies had failed, by exciting a strangury, by means of the tincture of Spanish flies mixed with camphorated spirit of wine. [108] Essay on the Malignant Pestilential Fever introduced into the West-Indies from Beullam, p. 137. [109] Page 224. The tongue was always moist in the beginning of the fever, but it was generally of a darker colour than last year. When the disease was left to itself, or treated with bark and wine, the tongue became of a fiery red colour, or dry and furrowed, as in the typhus fever. _Sweats_ were more common in the remissions of this fever, than they were in the year 1793, but they seldom terminated the disease. During the course of the sweats, I observed a deadly coldness over the whole body to continue in several instances, but without any danger or inconvenience to the patient. In two of the worst cases I attended, there were remissions, but no sweats until the day on which the fever terminated. In several of my patients, the fever wore away without the least moisture on the skin. The _milk_, in one case, was of a greenish colour, such as sometimes appears in the serum of the blood. In another female patient who gave suck, there was no diminution in the quantity of her milk during the whole time of her fever, nor did her infant suffer the least injury from sucking her breasts. I observed tears to flow from the eye of a young woman in this fever, at a time when her mind seemed free from distress of every kind. V. I proceed next to mention the symptoms of this fever in the nervous system. Delirium was less common than last year. I was much struck in observing John Madge, who had retained his reason while he was so ill as to require three bleedings a day, to become delirious as soon as he began to recover, at which time his pulse rose from between 60 and 70, to 96 strokes in a minute. I saw one case of extreme danger, in which a hysterical laughing and weeping alternately attended. I have before mentioned the frequency of mania as a symptom of this disease. An obstinate wakefulness attended the convalescence from this fever in Peter Brown, John Madge, and Mr. Cole. Fainting was more common in this fever than in the fever of 1793. It ushered in the disease in one of my patients, and it occurred in several instances after bleeding, where the quantity of blood drawn was very moderate. Several people complained of giddiness in the first attack of the fever, before they were confined to their beds. Sighing was less common, but a hiccup was more so, than in the year before. John Madge had an immobility in his limbs bordering upon palsy. A weakness in the wrists in one case succeeded a violent attack of the fever. Peter Brown complained of a most acute pain in the muscles of one of his legs. It afterwards became so much inflamed as to require external applications to prevent the inflammation terminating in an abscess. Mrs. Mitchell complained of severe cramps in her legs. The sensations of pain in this fever were often expressed in extravagant language. The pain in the head, in a particular manner, was compared to repeated strokes of a hammer upon the brain, and in two cases, in which this pain was accompanied by great heat, it was compared to the boiling of a pot. The more the pains were confined to the bones and back, the less danger was to be apprehended from the disease. I saw no case of death from the yellow fever in 1793, where the patient complained much of pain in the back. It is easy to conceive how this external determination of morbid action should preserve more vital parts. The bilious fever of 1780 was a harmless disease, only because it spent its whole force chiefly upon the limbs. This was so generally the case, that it acquired, from the pains in the bones which accompanied it, the name of the "break bone fever." Hippocrates has remarked that pains which descend, in a fever, are more favourable than those which ascend[110]. This is probably true, but I did not observe any such peculiarity in the translation of pain in this fever. The following fact from Dr. Grainger will add weight to the above observations. He observed the pains in a malignant fever which were diffused through the whole head, though excruciating, were much less dangerous than when they were confined to the temples or forehead[111]. [110] Epidemics, book ii. sect. 2. [111] Historia Febris Anomalæ Batavæ Annorum 1746, 1747, 1748, cap. i. I saw two cases in which a locked jaw attended. In one of them it occurred only during one paroxysm of the fever. In both it yielded in half an hour to blood-letting. I met with one case in which there was universal tetanus. I should have suspected this to have been the primary disease, had not two persons been infected in the same house with the yellow fever. The countenance sometimes put on a ghastly appearance in the height of a paroxysm of the fever. The face of a lady, admired when in health for uncommon beauty, was so much distorted by the commotions of her whole system, in a fit of the fever, as to be viewed with horror by all her friends. VI. The senses and appetites were affected in this fever in the following manner. A total blindness occurred in two persons during the exacerbation of the fever, and ceased during its remissions. A great intolerance of light occurred in several cases. It was most observable in John Madge during his convalescence. A soreness in the sense of touch was so exquisite in Mrs. Kapper, about the crisis of her fever, that the pressure of a piece of fine muslin upon her skin gave her pain. Peter Brown, with great heat in his skin, and a quick pulse, had no thirst, but a most intense degree of thirst was very common in this fever. It produced the same extravagance of expression that I formerly said was produced by pain. One of my patients, Mr. Cole, said he "could drink up the ocean." I did not observe thirst to be connected with any peculiar state of the pulse. George Eyre and Henry Clymer had an unusual degree of appetite, just before the usual time of the return of a paroxysm of fever. A young man complained to me of being afflicted with nocturnal emissions of seed during his convalescence. This symptom is not a new one in malignant fevers. Hippocrates takes notice of it[112]. I met with one instance of it among the sporadic cases of yellow fever which occurred in 1795. It sometimes occurs, according to Lomius, in the commotions of the whole system which take place in epilepsy. [112] Epidemics, book IV. VII. The disease made an impression upon the lymphatic system. Four of my patients had glandular swellings: two of them were in the groin; a third was in the parotid; and the fourth was in the maxillary glands. Two of these swellings suppurated. VIII. The yellowness of the skin, which sometimes attends this fever, was more universal, but more faint than in the year 1793. It was, in many cases, composed of such a mixture of colours, as to resemble polished mahogany. But, in a few cases, the yellowness was of a deep orange colour. The former went off with the fever, but the latter often continued for several weeks after the patients recovered. In some instances a red colour predominated to such a degree in the face, as to produce an appearance of inflammation. In Mrs. Vogles a yellowness appeared in her eyes during the paroxysm of her fever, and went off in its remissions. In James Lefferty the yellowness affected every part of his body, except his hands, which were as pale as in a common fever. Peter Brown tinged his sheets of a yellow colour, by night sweats, many weeks after his recovery. There was an exudation from the soles of the feet of Richard Wells's maid, which tinged a towel of a yellow colour. In my Account of the Yellow Fever of 1793, I ascribed the yellow colour of the skin wholly to a mixture of bile with the blood. I believe that this is the cause of it, in those cases where the colour is deep, and endures for several weeks beyond the crisis of the fever; but where it is transitory, and, above all, where it is local, or appears only for a few hours, during the paroxysm of the fever, it appears probable that it is connected with the mode of aggregation of the blood, and that it is produced wholly by some peculiar action in the blood-vessels. A similar colour takes place from the bite of certain animals, and from contusions of the skin, in neither of which cases has a suspicion been entertained of an absorption or mixture of bile with the blood. A troublesome itching, with an eruption of red blotches on the skin, attended on the first day of the attack of the fever, in Mrs. Gardiner. A roughness of the skin, and a disposition in it to peel off, appeared about the crisis of the fever, in Miss Sally Eyre. That species of eruption, which I have elsewhere compared to moscheto bites, appeared in Mrs. Sellers. John Ray, a day labourer, to whom I was called in the last stage of the fever, had petechiæ on his breast the day before he died. That burning heat on the skin, called by the ancients "calor mordens," and from which this fever, in some countries, has derived the name of _causus_, was more common this year than last. It was sometimes local, and sometimes general. I perceived it in an exquisite degree in the cheeks only of Miss Sally Eyre, and over the whole body of John Ray. It had no connection with the rapidity or force of the circulation of the blood in the latter instance, for it was most intense at a time when he had no pulse. It is remarkable that the heat of the skin has no connection with the state of the pulse. This fact did not escape Dr. Chisholm. He says he found the skin to be warm while the pulse was at 52, and that it was sometimes disagreeably cold when the pulse was as quick as in ordinary fever[113]. [113] Page 117. IX. I have in another place rejected putrefaction from the blood as the cause or effect of this fever. I shall mention the changes which were induced in its appearances when I come to treat of the method of cure. Having described the symptoms of this fever as they appeared in different parts of the body, I shall now add a few observations upon its type or general character. I shall begin this part of the history of the fever by remarking, that we had but one reigning disease in town during the autumn and winter; that this was a bilious remitting, or intermitting, and sometimes a yellow fever; and that all the fevers from other remote causes than putrid exhalation, partook more or less of the symptoms of the prevailing epidemic. As well might we distinguish the rain which falls in gentle showers in Great-Britain, from that which is poured in torrents from the clouds in the West-Indies, by different names and qualities, as impose specific names and characters upon the different states of bilious fever. The forms in which this fever appeared were as follow. 1. A tertian fever. Several persons died of the third fit of tertians, who were so well as to go abroad on the intermediate day of the fever. It is no new thing for malignant fevers to put on the form of a tertian. Hippocrates long ago remarked, that intermittents sometimes degenerate into malignant acute diseases; and hence he advises physicians to be on their guard upon the 5th, 7th, 9th, and even on the 14th day of such fevers[114]. [114] De Morb. Popular. lib. VII. 2. It appeared most frequently in the form of a remittent. The exacerbations occurred most commonly in the evening. In some there were exacerbations in the morning as well as in the evening. But I met with several patients who appeared to be better and worse half a dozen times in a day. In each of these cases, there were evident remissions and exacerbations of the fever. It assumed, in several instances, the symptoms of a colic and cholera morbus. In one case the fever, after the colic was cured, ended in a regular intermittent. In another, the colic was accompanied by a hæmorrhage from the nose. I distinguished this bilious colic from that which is excited by lighter causes, by its always coming on with more or less of a chilliness[115]. The symptoms of colic and cholera morbus occurred most frequently in June and July. [115] See Sydenham, vol. I. p. 212. 4. It appeared in the form of a dysentery in a boy of William Corfield, and in a man whom my pupil, Mr. Alexander, visited in the neighbourhood of Harrowgate. 5. It appeared, in one case, in the form of an apoplexy. 6. It disguised itself in the form of madness. 7. During the month of November, and in all the winter months, it was accompanied with pains in the sides and breast, constituting what nosologists call the "pleuritis biliosa." 8. The puerperile fever was accompanied, during the summer and autumn, with more violent symptoms than usual. Dr. Physick informed me, that two women, to whom he was called soon after their delivery, died of uterine hæmorrhages; and that he had with difficulty recovered two other lying-in women, who were afflicted with that symptom of a malignant diathesis in the blood-vessels. 9. Even dropsies partook more or less of the inflammatory and bilious character of this fever. 10. It blended itself with the scarlatina. The blood, in this disease, and in the puerperile fever, had exactly the same appearance that it had in the yellow fever. A yellowness in the eyes accompanied the latter disease in one case that came under my notice. A slight shivering ushered in the fever in several instances. But the worst cases I saw came on without a chilly fit, or the least sense of coldness in any part of the body. Such was the predominance of the intermitting, remitting, and bilious fever, that the measles, the small-pox, and even the gout itself, partook more or less of its character. There were several instances in which the measles, and one in which the gout appeared with quotidian exacerbations; and two in which madness appeared regularly in the form of a tertian. I mentioned formerly that this fever sometimes went off with a sweat, when it appeared in a tertian form. This was always the case with the second grade of the fever, but never with the first degree of it, before the third or fourth paroxysm; nor did a sweat occur on the fifth or seventh day, except after the use of depleting remedies. This peculiarity in the fever of this year was so fixed, that it gave occasion for my comparing it, in my intercourse with my patients, to a lion on the first seven days, and to a lamb during the remaining part of its duration. The fever differed from the fever of the preceding year in an important particular. I saw or heard of no case which terminated in death on the first or third day. In every case, the fever came on fraught with paroxysms. The moderate degrees of it were of so chronic a nature as to continue for several weeks, when left to themselves. I wish this peculiarity in the epidemic which I am now describing to be remembered; for it will serve hereafter to explain the reason why a treatment apparently different should be alike successful, in different seasons and in different countries. The crisis of the fever occurred on uneven days more frequently than in the fever of the year 1793. I remarked formerly[116] that remissions were more common in the yellow fever than in the common bilious fever. The same observation applies to critical days. They were observable in almost every case in which the disease was not strangled in its birth. Dr. Chisholm describes the same peculiarity in the Beullam fever. "I have not met with any disease (says the doctor) in which the periods were more accurately ascertained[117]." [116] Account of the Yellow Fever of 1793. [117] Page 141. In addition to the instances formerly enumerated[118], of the predominance of powerful epidemics over other diseases, I shall add two more, which I have lately met with in the course of my reading. [118] Account of the Yellow Fever in 1793. Dr. Chisholm, in describing the pestilential fever introduced into the West-Indies from Beullam, has the following remarks. "Most other diseases degenerated into, or partook very much of this. Dysenteries suddenly stopped, and were immediately succeeded by the symptoms of the pestilential fever. Catarrhal complaints, simple at first, soon changed their nature; convalescents from other diseases were very subject to this, but it generally proved mild. Those labouring at the same time under chronic complaints, particularly rheumatism and hepatitis, were very subject to it. The puerperile fever became malignant, and of course fatal; and even pregnant negro women, who otherwise might have had it in the usual mild degree peculiar to that description of people, were reduced to a very dangerous situation by it. In short, every disease in which the patient was liable to infection, sooner or later assumed the appearance, and acquired the danger of the pestilential fever[119]." [119] Page 129, 130. Dr. Desportes ascribes the same universal empire to the yellow fever which prevailed in St. Domingo, in the summer of 1733. "The fever of Siam (says the doctor) conveyed an infinite number of men to the grave, in a short time; but I saw but one woman who was attacked by it." "The violence of this disease was such, that it subjected all other diseases, and reigned alone. This is the character of all contagious and pestilential diseases. Sydenham, and before him Diemerbroek, have remarked this of the plague[120]." [120] Page 40, 41. See also p. 111, 230, 231. vol. I. In Baltimore, the small-pox in the natural way was attended with unusual malignity and mortality, occasioned by its being combined with the reigning yellow fever. It has been urged as an objection to the influence of powerful epidemics chasing away, or blending with fevers of inferior force, that the measles sometimes supplant the small-pox, and mild intermittents take the place of fevers of great malignity. This fact did not escape the microscopic eye of Dr. Sydenham, nor is it difficult to explain the cause of it. It is well known that epidemics, like simple fevers, are most violent at their first appearance, and that they gradually lose their force as they disappear; now it is in their evanescent and feeble state, that they are jostled out of their order of danger or force, and yield to the youthful strength of epidemics, more feeble under equal circumstances of age than themselves. It would seem, from this fact, that an inflammatory constitution of the air, and powerful epidemics, both in their aggregate and individual forms, possessed a common character. They all invade with the fury of a savage, and retire with the gentleness of a civilized foe. It is agreeable to discover from these facts and observations, that epidemic diseases, however irregular they appear at first sight, are all subject to certain laws, and partake of the order and harmony of the universe. The action of the miasmata upon the body, when, from the absence of an exciting cause, they did not produce fever, was the same as I have elsewhere described. The sensations which I experienced, in entering a small room where a person was confined with this fever, were so exactly the same with those I felt the year before, that I think I could have distinguished the presence of the disease without the assistance of my eyes, or without asking a single question. After sitting a few minutes in a sick room, I became languid and fainty. Weakness and chilliness followed every visit I paid to a gentleman at Mr. Oellers's hotel, which continued for half an hour. A burning in my stomach, great heaviness, and a slight inflammation in my eyes, with a constant discharge of a watery humour from them for two days, succeeded the first visit I paid to Mrs. Sellers. These symptoms came on in less than ten minutes after I left her room. They were probably excited thus early, and in the degree which I have mentioned, by my having received her breath in my face by inspecting her tonsils, which were ulcerated on the first attack of the fever. I formerly supposed these changes in my body were proofs of the contagious nature of the yellow fever, but I shall hereafter explain them upon other principles. I recollect having more than once perceived a smell which had been familiar to me during the prevalence of the yellow fever in 1793. It resembled the smell of liver of sulphur. I suspected for a while that it arose from the exhalations of the gutters of the city. But an accident taught me that it was produced by the perspiration of my body. Upon rubbing my hands, this odour was increased so as to become not only more perceptible to myself, but in the most sensible degree to my pupil, Mr. Otto. From this fact, I was convinced that I was strongly impregnated with miasmata, and I was led by it to live chiefly upon vegetables, to drink no wine, and to avoid, with double care, all the usual exciting causes of fever. There was another mark by which I distinguished the presence of the seeds of this fever in my system, and that was, wine imparted a burning sensation to my tongue and throat, such as is felt after it has been taken in excess, or in the beginning of a fever. Several persons, who were exposed to the miasmata, informed me that wine, even in the smallest quantity, affected them exactly in the same manner. I attended four persons in this fever who had had it the year before. It remains now that I mention the origin of this fever. This was very evident. It was produced by the exhalations from the gutters, and the stagnating ponds of water in the neighbourhood of the city. Where there was most exhalation, there were most persons affected by the fever. Hence the poor people, who generally live in the neighbourhood of the ponds in the suburbs, were the greatest sufferers by it. Four persons had the fever in Spruce, between Fourth and Fifth-streets, in which part of the city the smell from the gutters was extremely offensive every evening. In Water-street, between Market and Walnut-streets, many persons had the fever: now the filth of that confined part of the city is well known to every citizen. I have before remarked, that one reason why most of our physicians refused to admit the presence of the yellow fever in the city, was because they could not fix upon a vestige of its being imported. On the 25th of August, the brig Commerce arrived in the river, from St. Mark, commanded by Captain Shirtliff. After lying five days at the fort, she came up to the city. A boy, who had been shut out from his lodgings, went, in a state of intoxication, and slept on her deck, exposed to the night air, in consequence of which the fever was excited in him. This event gave occasion, for a few days, to a report that the disease was imported, and several of the physicians, who had neglected to attend to all the circumstances that have been stated, admitted the yellow fever to be in town. An investigation of this supposed origin of the disease soon discovered that it had no foundation. At the time of the arrival of this ship, I had attended nearly thirty persons with the fever, and upwards of a hundred had had it, under the care of other physicians. The generation of the yellow fever in our city was rendered more certain by the prevalence of bilious diseases in every part of the United States, and, in several of them, in the grade of yellow fever. It was common in Charleston, in South-Carolina, where it carried off many people, and where no suspicion was entertained of its being of West-India origin. It prevailed with great mortality at that part of the city of Baltimore, which is known by the name of Fell's Point, where, Dr. Drysdale assures me, it was evidently generated. A few sporadic cases of it occurred in New-York, which were produced by the morbid exhalation from the docks of that city. Sporadic cases of it occurred likewise in most of the states, in which the proofs of its being generated were obvious to common observation; and where the symptoms of depressed pulse, yellowness of the skin, and black discharges from the bowels and stomach (symptoms which mark the highest grade of bilious remitting fever) did not occur, the fevers in all their form of tertian, quotidian, colic, and dysentery, were uncommonly obstinate or fatal in every state in the union. In New-Haven only, where the yellow fever was epidemic, it was said to have been imported from Martinique, but this opinion was proved to be erroneous by unanswerable documents, published afterwards in the Medical Repository, by Dr. Elisha Smith, of New-York. The year 1795 furnished several melancholy proofs of the American origin of the yellow fever. All the physicians and citizens of New-York and Norfolk agree in its having been generated in their respective cities that year. It prevailed with great mortality at the same time in the neighbourhood of the lakes, and on the waters of the Genesee river, in the state of New-York. From its situation it obtained the name of the lake and Genesee fever. It was so general, in some parts of that new country, as to affect horses. Thus have I endeavoured to fix the predisposing and remote causes of the yellow fever in our country. The remote cause is sometimes so powerful as to become an exciting cause of the disease, but in general both the predisposing and remote causes are harmless in the system, until they are roused into action by some exciting cause. I shall conclude this account of the symptoms and origin of the yellow fever by relating two facts, which serious and contemplating minds will apply to a more interesting subject. 1. Notwithstanding the numerous proofs of the prevalence of the yellow fever in Philadelphia in the year 1794, which have been mentioned, there are many thousands of our citizens, and a majority of our physicians, who do not believe that a case of it existed at that time in the city; nor is a single record of it to be met with in any of the newspapers, or other public documents of that year. Let us learn from this fact, that the denial of events, or a general silence upon the subject of them, is no refutation of their truth, where they oppose the pride or interests of the learned, or the great. 2. Notwithstanding the general denial of the existence of the yellow fever in Philadelphia, and the silence observed by our newspapers relative to it in 1794, there was scarcely a citizen or physician who, three years afterwards, did not admit of its having prevailed in that year. We learn from this fact another important truth, that departed vice and error have no friends nor advocates. OF THE METHOD OF CURE. The remedies employed for the cure of this fever were the same that I employed the year before. I shall only relate such effects of them as tend more fully to establish the practice adopted in the year 1793, and such as escaped my notice in my former remarks upon those remedies. My method of cure consisted, I. In the abstraction of the stimulus of blood and heat from the whole body, and of bile and other acrid humours from the bowels, by means of the following remedies: 1. Bleeding. 2. Purging. 3. Cool air and cold drinks. 4. Cold water applied to the external parts of the body, and to the bowels by means of glysters. II. In creating a diversion of congestion, inflammation, and serous effusion, from the brain and viscera to the mouth, by means of a salivation, and to the external parts of the body, by means of blisters. III. In restoring the strength of the system, by tonic remedies. I proceed to make a few remarks upon the remedies set down under each of the above heads. I. I have taken notice that this fever differed from the fever of 1793, in coming forward in July and August with a number of paroxysms, which refused to yield to purging alone. I therefore began the cure of every case I was called to by _bleeding_. I shall mention the effects of this remedy, and the circumstances, manner, and degrees in which I used it occasionally, in this fever, in my Defence of Blood-letting. Under the present head I shall only furnish the reader with a table of the quantity of blood drawn from a number of my patients in the course of the disease. From several of them the quantity set down was taken in three, four, and five days. I shall afterwards describe the appearances of the blood. +-----------+------------------+-----------+------------+ | Month. | Patients. | Quantity. | Number of | | | | ounces. | times bled.| +-----------+------------------+-----------+------------+ | August. | Peter Denham | 50 | 5 | | | Mrs. Bruce | 70 | 7 | | | Andrew Gribble, | | | | | aged 15 years. | 50 | 5 | | | John Madge | 150 | 12 | | | Peter Brown | 80 | 8 | | September.| Mrs. Gardiner | 80 | 7 | | | Miss Sally Eyre | 80 | 9 | | | Mrs. Gass | 50 | 3 | | | Richard Wells's | | | | | maid | 100 | 10 | | | Mr. Norval | 100 | 9 | | | Mr. Harrison | 90 | 9 | | | Henry Clymer | 80 | 8 | | October. | Mrs. Mitchell | 120 | 13 | | | Mrs. Lenox | 80 | 7 | | | Mrs. Kapper | 140 | 11 | | | Rev. Dr. Magaw's | | | | | maid | 100 | 10 | | | Miss Hood | 100 | 10 | | | Mrs. Vogles | 70 | 5 | | 1795 | Guy Stone | 100 | 9 | | January. | Benj. Hancock | 100 | 10 | | | Mr. Benton | 130 | 13 | | | Mrs. Fries | 150 | 15 | | | Mrs. Garrigues | 80 | 7 | +-----------+------------------+-----------+------------+ Three of the women, whose names I have mentioned, were in the advanced stage of pregnancy, viz. Mrs. Gardiner, Mrs. Gass, and Mrs. Garrigues. They have all since borne healthy children. I have omitted the names of above one hundred persons who had the fever, from whom I drew thirty or forty ounces of blood, by two or three bleedings. I did not cure a single person without at least one bleeding. It is only by contemplating the extent in which it is necessary to use this remedy, in order to overcome a yellow fever, that we can acquire just ideas of its force. Hitherto this force has been estimated by no other measure than the grave, and this, we know, puts the strength of all diseases upon a level. The blood drawn in this fever exhibited the following appearances; 1. It was dissolved in a few instances. 2. The crassamentum of the blood was so partially dissolved in the serum, as to produce an appearance in the serum resembling the washings of flesh in water. 3. The serum was so lightly tinged of a _red_ colour as to be perfectly transparent. 4. The serum was, in many cases, of a deep yellow colour. 5. There was, in every case in which the blood was not dissolved, or in which the second appearance that has been mentioned did not take place, a beautiful scarlet-coloured sediment in the bottom of the bowl, forming lines, or a large circle. It seemed to be a tendency of the blood to dissolution. This state of the blood occurred in almost all the diseases of the last two years, and in some in which there was not the least suspicion of the miasmata of the yellow fever. 6. The crassamentum generally floated in the serum, but it sometimes sunk to the bottom of the bowl. In the latter case the serum had a muddy appearance. 7. I saw but one case in which there was not a separation of the crassamentum and serum of the blood. Its colour in this case was of a deep scarlet. In the year 1793 this appearance was very common. 8. I saw one case in which the blood drawn, amounting to 14 ounces, separated partially, and was of a deep _black_ colour. This blood was taken from Mr. Norval, a citizen of North-Carolina. 9. There was, in several instances, a transparent jelly-like pellicle which covered the crassamentum of the blood, and which was easily separated from it without altering its texture. It appeared to have no connection with the blood. 10. The blood, towards the crisis of the fever in many people, exhibited the usual forms of inflammatory crust. It was cupped in many instances. 11. After the loss of 70 or 80 ounces of blood there was an evident disproportion of the quantity of crassamentum to the serum. It was sometimes less, by one half, than in the first bleedings. Under this head it will be proper to mention that the blood, when it happened to flow along the external part of the arm in falling into the bowl, was so warm as to excite an unpleasant sensation of heat in several patients. To the appearances exhibited by the blood to the eye, I shall add a fact communicated to me by a German bleeder, who followed his business in the city during the prevalence of the fever in 1793. He informed me that he could distinguish a yellow fever from all other states of fever, by a peculiar smell which the blood emitted while it was flowing from a vein. From the certainty of his decision in one case which came under my notice, before a suspicion had taken place of the fever being in the city, I am disposed to believe that there is a foundation for his remark. II. I have but little to add to the remarks I made upon the use of _purging_ in the year 1793. I gave jalap, calomel, and gamboge until I obtained large and dark-coloured stools; after which I kept the bowels gently open every day with castor oil, cremor tartar, or glauber's salts. I gave calomel in much larger quantities than I did the year before. John Madge took nearly 150 grains of it in six days. I should have thought this a large quantity, had I not since read that Dr. Chisholm gave 400 grains of it to one patient in the course of his fever, and 50 grains to another at a single dose, three times a day. I found strong mercurial purges to be extremely useful in the winter months, when the fever put on symptoms of pleurisy. I am not singular in ascribing much to the efficacy of purges in the bilious pleurisy. Dr. Desportes tells us that he found the pleurisy of St. Domingo, which was of the bilious kind, to end happily in proportion as the bowels were kept constantly open[121]. Nor am I singular in keeping my eye upon the original type of a disease, which only changes its symptoms with the weather or the season, and in treating it with the same remedies. Dr. Sydenham bled as freely in the diarrh[oe]a of 1668 as he had done in the inflammatory fever of the preceding year[122]. How long the pleurisies of winter, in the city of Philadelphia, may continue to retain the bilious symptoms of autumn, which they have assumed for three years past, I know not; but the late Dr. Faysseaux, of South-Carolina, informed me, that for many years he had not seen a pleurisy in Charleston with the common inflammatory symptoms which characterised that disease when he was a student of medicine. They all now put on bilious symptoms, and require strong purges to cure them. The pleurisies which the late Dr. Chalmers supposes he cured by purging were probably nothing but bilious fevers, in which the cool weather had excited some pleuritic symptoms. [121] Page 140. [122] Wallis's edition, p. 211. vol. i. I have nothing to add to the remarks I have elsewhere published upon the efficacy of _cool air_ and _cold drinks_ in this fever. They were both equally pleasant and useful, and contributed, with cleanliness, very much to the success of my practice. 4. _Cold water_, applied to the external parts of the body, and injected into the bowels by way of glyster, did great service in many cases. John Madge found great relief from cloths dipped in cold water, and applied to the lower part of his belly. They eased a pain in his bowels, and procured a discharge of urine. A throbbing and most distressing pain in the head was relieved by the same remedy, in Mrs. Vogles and Mrs. Lenox. The cloths were applied for three successive days and nights to Mrs. Lenox's head, during an inflammation of her brain, which succeeded her fever, and were changed, during the greater part of the time, every ten or fifteen minutes. In 1795, I increased the coldness of pump water, when used in this way, by dissolving ice in it, and in some cases I applied powdered ice in a bladder to the head, with great advantage. The following facts will show the good effects of cold water in this, as well as other fevers of too much action. In the afternoon of one of those days in which my system was impregnated with the miasmata of the yellow fever, I felt so much indisposed that I deliberated whether I should go to bed or visit a patient about a mile in the country. The afternoon was cool and rainy. I recollected, at this time, a case related by Dr. Daignan, a French physician, of a man who was cured of the plague, by being forced to lie all night in an open field, in a shower of rain. I got into my chair, and exposed myself to the rain. It was extremely grateful to my feelings. In two hours I returned, when, to my great satisfaction, I found all my feverish symptoms had left me, nor had I the least return of them afterwards. Dr. Caldwell, who acted as a surgeon of a regiment, in the expedition against the insurgents in the western counties of Pennsylvania, furnished me, in a letter dated from Bedford, October 20th, 1794, with an account of his having been cured of a fever, by a more copious use of the same remedy. "I was (says the doctor), to use a vulgar expression, _wet to the skin_, and had no opportunity of shifting my clothes for several hours. In consequence of this thorough bathing, and my subsequent exposure to a cool air, I was relieved from every symptom of indisposition in a few hours, and have enjoyed more than my usual stock of health ever since." The efficacy of cold water, in preventing and curing inflammation, may be conceived from its effects when used with mud or clay, for obviating the pain and inflammation which arise from the sting of venomous insects. The same remedy, applied for half an hour, has lately, it is said, been equally effectual in preventing the deleterious effects of the bite of a rattle-snake. II. The good effects I had observed from a _salivation_ in the yellow fever of 1793, induced me to excite it as early as possible, in all those cases which did not yield immediately to bleeding and purging. I was delighted with its effects in every case in which it took place. These effects were as follow: 1. It immediately attracted and concentrated in the mouth all the scattered pains of every part of the body. 2. It checked a nausea and vomiting. 3. It gradually, when it was copious, reduced the pulse, and thereby prevented the necessity of further bleeding or purging. I wish it were possible to render the use of this remedy universal in the treatment of malignant fevers. Dr. Chisholm, in his account of the Beullam fever, has done much to establish its safety and efficacy. It is a rare occurrence for a patient that has been sufficiently bled and purged, to die after a salivation takes place. The artificial disease excited by the mercury suspends or destroys disease in every part of the body. The occasional inconveniences which attend it are not to be named with its certain and universal advantages. During the whole of the season in which the yellow fever prevailed, I saw but two instances in which it probably loosened or destroyed the teeth. I am not certain that the mercury was the cause of the injury or loss of those teeth; for who has not seen malignant fevers terminate in ulcers, which have ended in the erosions of bony parts of the body? It has been justly remarked, that there can be but one action at a time in the blood-vessels. This was frequently illustrated by the manner in which mercury acted upon the system in this fever. It seldom salivated until the fever intermitted or declined. I saw several cases in which the salivation came on during the intermission, and went off during its exacerbation; and many, in which there was no salivation until the morbid action had ceased altogether in the blood-vessels, by the solution of the fever. It is because the action of the vessels, in epilepsy and pulmonary consumption, surpasses the stimulus of the mercury, that it is so difficult to excite a salivation in both those diseases. Let not the advocates for the healing powers of nature complain of a salivation as an unnatural remedy in fevers. Dr. Sydenham speaks in high terms of it, in the fever of 1670, 1671, and 1672, in which cases it occurred spontaneously, and says that it cured it when it was so malignant as to be accompanied by purple spots on the body[123]. [123] Vol. ii. p. 212. Blisters, when applied at a _proper_ time, did great service in this fever. This time was, when the fever was so much weakened by evacuations, that the artificial pain excited by the stimulus of the blisters destroyed, and, like a conductor, conveyed off all the natural pain of the body. It is from ignorance, or inattention to the proper stage of fevers in which blisters have been applied, that there have been so many disputes among physicians respecting their efficacy. When applied in a state of great arterial action, they do harm; when applied after that action has nearly ceased, they do little or no service. I have called the period in which blisters are useful the _blistering point_. In bilious fevers this point is generally circumscribed within eight and forty hours. The effects of blisters were as follow: 1. They concentrated, like a salivation, all the scattered pains of the body, and thereby, 2. Reduced the pulse in force and frequency. 3. They instantly checked a sickness at the stomach and vomiting. 4. They often induced a gentle moisture upon the skin. I found it of little consequence to what part of the body the blisters were applied; for I observed a pain in the head, and even delirium, to be as speedily and certainly cured by blisters upon the wrists, as they were by a large blister to the neck. III. After the reduction of the morbid action of the blood-vessels, by means of the remedies which have been mentioned, I seldom made use of any other tonic than a nourishing and gently stimulating diet. This consisted of summer fruits, bread and milk, chicken broth, the white meats, eggs, oysters, and malt liquors, more especially porter. I made many attempts to cure this fever when it appeared in the form of a simple intermittent, without malignant symptoms, by means of _bark_, but always, except in two instances, without success; and in them it did not take effect until after bleeding. In several cases it evidently did harm. I should have suspected my judgment in these observations respecting this medicine, had I not been assured by Dr. Griffitts, Dr. Physick, and Dr. Woodhouse, that it was equally ineffectual in their practice, in nearly all the cases in which they gave it, and even where blood-letting had been premised. Dr. Woodhouse saw a case in which near a pound of bark had been taken without effect; and another in which a fatal dropsy succeeded its use. Dr. Griffitts excepted, from his testimony against the bark, the cases of seven persons from the country, who brought the seeds of the intermitting fever with them to the city. In them the bark succeeded without previous bleeding. The facility with which these seven cases of intermitting fever were cured by the bark, clearly proves that fevers of the same season differ very much, according to the nature of the exhalation which excites them. The intermittents in these strangers were excited by miasmata of less force than that which was generated in our city, in which, from the greater heat of the atmosphere, and the more heterogeneous nature of the putrid matters which stagnate in our ponds and gutters, the exhalation probably possesses a more active and stimulating quality. Thus the mild remittents in June, and in the beginning of July, which were produced by the usual filth of the streets of Philadelphia, in the year 1793, differed very much from the malignant remitting yellow fever which was produced by the stench of the putrid coffee a few weeks afterwards. Sir John Pringle long ago taught the inefficacy of bark in certain bilious fevers. But Dr. Chisholm has done great service to medicine by recording its ill effects in the Beullam fever. "Head-ach (says the doctor), a heavy dull eye, with a considerable protrusion from its orbits, low spirits, thirst, and a total want of appetite, were the general consequences of the treatment with bark without the previous antiphlogistic." I have mentioned a case of internal dropsy of the brain having been produced by the improper use of the bark, in a son of Mr. Coates. I have no doubt but this disease, as also palsy and consumption, obstructions of the liver and bowels, and dropsies of the belly and limbs, are often induced by the use of the bark, during an inflammatory state of the blood-vessels. It is to be lamented that the association of certain diseases and remedies, in the minds of physicians, becomes so fixed, as to refuse to yield to the influence of reason. Thus pain and opium, dropsy and foxglove, low spirits and assaf[oe]tida, and, above all, an intermitting fever and bark, are all connected together, in common practice, as mechanically as the candle and the snuffers are in the mind of an old and steady house servant. To abolish the mischief of these mechanical associations in medicine, it will be necessary for physicians to prescribe only for the different states of the system. Finding the bark to be so universally ineffectual or hurtful, I substituted Columbo root, the Carribean bark, and several other bitters, in its place, but without success. They did less harm than the jesuit's bark, but they did not check the return of a single paroxysm of fever. I know that bark was given in this fever in some instances in which the patients recovered; but they were subject, during the winter, and in the following spring, to frequent relapses, and, in some instances, to affections of the brain and lungs. In the highest grade of the fever it certainly accelerated a supposed putrefaction of the blood, and precipitated death. The practice of physicians who create this gangrenous state of fever by means of the bark, resembles the conduct of a horse, who attempts by pawing to remove his shadow in a stream of water, and thereby renders it so turbid that he is unable to drink it. Should the immediate success of tonic and depleting remedies in destroying the fever be equal, the effects of the former upon the constitution cannot fail of being less safe than the latter remedies. They cure by overstraining the powers of life. There is the same difference, therefore, between the two modes of practice, that there is between gently lifting the latch of a door, and breaking it open in order to go into a house. _Wine_ was hurtful in every case of yellow fever in which it was given, while there were any remains of inflammatory action in the system. I recollect that a few spoonsful of it, which Mr. Harrison of Virginia took in the depressed state of his pulse, excited a sensation in his stomach which he compared to a fire. Even wine-whey, in the excitable state of the system induced by this fever, was sometimes hurtful. In a patient of Dr. Physick, who was on the recovery, it produced a relapse that had nearly proved fatal, in the year 1795. Dr. Desperrieres ascribes the death of a patient to a small quantity of wine given to him by a black nurse[124]. These facts are important, inasmuch as wine is a medicine which patients are most apt to use in all cases, without the advice of a physician. [124] Vol. ii. p. 108. I observed _opium_ to be less hurtful in this fever than it was in the fever of 1793. I administered a few drops of laudanum, in one case, in the form of a glyster, in a violent pain of the bowels, with evident advantage, before the inflammatory action of the blood-vessels was subdued. In this way I have often obtained the composing effects of laudanum where it has been rejected by the stomach. But I gave it sparingly, and in small doses only, in the early stage of the fever. John Madge, whose pains in his bowels were often as exquisite as they are in the most acute colic, did not take a single drop of it. I used no anodyne in his case but bleeding, and applications of cold water to the inside and outside of his bowels. After the fever had passed the seventh day, and had been so far subdued by copious evacuations as to put on the form of a common inflammatory intermittent, I gave laudanum during the intermissions of the fever with great advantage. In some cases it suddenly checked the paroxysms of the fever, while in many more it only moderated them, but in such a manner that they wore themselves away in eight or ten days. One of my female patients, who had taken bitters of every kind without effect to cure a tertian, which succeeded a yellow fever, took a large dose of laudanum, in the interval of her paroxysms, to cure a tooth-ach. To her great surprise it removed her tertian. The effects of laudanum in this fever were very different from those of bark. Where it did no service it did not, like the bark, do any harm. Perhaps this difference in the operation of those two medicines depended upon the bark acting with an astringent, as well as stimulating power, chiefly upon the blood-vessels, while the action of the opium was more simply stimulating, and diffused at the same time over all the systems of the body. I shall say in another place that I sometimes directed a few drops of laudanum to be given in that state of extreme debility which succeeds a paroxysm of fever, with evident advantage. _Nitre_, so useful in common inflammatory fevers, was in most cases so offensive to the stomach in this fever, that I was seldom able to give it. Where the stomach retained it I did not perceive it to do any service. _Antimonials_ were as ineffectual as nitre in abating the action of the sanguiferous system, and in producing a sweat. I should as soon expect to compose a storm by music, as to cure a yellow fever by such feeble remedies. Thus have I finished the history of the symptoms, origin, and cure of the yellow fever as it appeared in Philadelphia in 1794, and in the winter of 1795. The efficacy of the remedies which have been mentioned was established by almost universal success. Out of upwards of 200 patients to whom I was called on the first stage of the fever, between the 12th of June, 1794, and the 1st of April, 1795, I lost but four persons, in whom the unequivocal symptoms had occurred, which characterize the first grade of the disease. It will be useful, I hope, to relate the cases of the patients whom I lost, and to mention the causes of their deaths. The first of them was Mrs. Gavin. She objected to a fifth bleeding in the beginning of a paroxysm of her fever, and died from the want of it. Her death was ascribed to the frequency of her bleedings by the enemies of the depleting system. It was said that she had been bled ten times, owing to ten marks of a lancet having been discovered on her arms after death, five of which were occasioned by unsuccessful attempts to bleed her. She died with the usual symptoms of congestion in her brain. Mr. Marr, to whom I was called on the first day of his disease, died in a paroxysm of his fever which came on in the middle of the seventh night, after six bleedings. I had left him, the night before, nearly free of fever, and in good spirits. He might probably have been saved (humanly speaking) by one more bleeding in the exacerbation of what appeared to be the critical paroxysm of his fever. Mr. Montford, of the state of Georgia, died under the joint care of Dr. Physick and myself. He had been cured by plentiful bleeding and purging, but had relapsed. He appeared to expire in a fainty fit in the first stage of a paroxysm of the fever. Death from this cause (which occurs most frequently where blood-letting is not used) is common in the yellow fever of the West-Indies. Dr. Bisset, in describing the different ways in which the disease terminates fatally, says, "In a few cases the patient is carried off by an _unexpected syncope_[125]." [125] Medical Essays and Observations, p. 28. A servant of Mr. Henry Mitchel, to whom I was called in the early stage of his disease, died in consequence of a sudden effusion in his lungs, which had been weakened by a previous pulmonary complaint. I wish the friends of bark and wine in the yellow fever, or of _moderate_ bleeding with antimonial medicines, would publish an account of the number of their deaths by the fever, within the period I have mentioned, and with the same fidelity I have done. The contrast would for ever decide the controversy in favour of copious depletion. The mortality under the tonic mode of practice may easily be conceived from the acknowledgment of one of the gentlemen who used it, but who premised it, in many cases, by two and three bleedings. He informed Dr. Woodhouse, that out of twenty-seven patients, whom he had attended in the yellow fever, he had saved but nine. Other practitioners were, I believe, equally unsuccessful, in proportion to the number of patients whom they attended. The reader will not admit of many deaths having occurred from the diseases (formerly enumerated) to which they were ascribed, when he recollects that even a single death from most of them, in common seasons, is a rare occurrence in the practice of regular bred physicians. In answer to the account I have given of the mortality of the fever in 1794, it will be said, that 30 persons died less in that year, than in the healthy year of 1792. To account for this, it will be necessary to recollect that the inhabitants of Philadelphia were reduced in number upwards of 4000, in the year 1793, and of course that the proportion of deaths was greater in 1794 than it was in 1792, although the number was less. It is remarkable that the burials in the strangers' grave-yard amounted in the year 1792 to but 201, whereas in 1794 they were 676. From this it appears, that the deaths must have been very numerous among new comers (as they are sometimes called) in the year 1794, compared with common years. Now this will easily be accounted for, when we recollect that these people, who were chiefly labourers, were exposed to the constantly exciting causes of the disease, and that, in all countries, they are the principal sufferers by it. But in order to do justice to this comparative view of the mortality induced by the yellow fever in the year 1794, it will be necessary to examine the bill of mortality of the succeeding year. By this it appears that 2274 persons died in 1795, making 1139 more than died in 1794. The greatness of this mortality, I well recollect, surprized many of the citizens of Philadelphia, who had just passed an autumn which was not unusually sickly, and who had forgotten the uncommon mortality of the months of January, February, and March, which succeeded the autumn of 1794. It will probably be asked, how it came to pass that I attended so many more patients in this fever than any of my brethren. To this I answer, that, since the year 1793, a great proportion of my patients have consisted of strangers, and of the poor; and as they are more exposed to the disease than other people, it follows, that of the persons affected by the fever, a greater proportion must have fallen to my share as patients, than to other physicians. My ability to attend a greater number of patients than most of my brethren, was facilitated by my having, at the time of the fever, several ingenious and active pupils, who assisted me in visiting and prescribing for the sick. These pupils were, Ashton Alexander and Nathaniel Potter (now physicians at Baltimore), John Otto (now physician in Philadelphia), and Gilbert Watson (since dead of the yellow fever). The antiphlogistic remedies were not successful in Philadelphia, in the yellow fever, in my hands alone. They were equally, and perhaps more so, in the hands of my friends Dr. Griffitts, Dr. Physick, Dr. Dewees, and Dr. Woodhouse. They were moreover successful at the same time in New Haven, Baltimore, and in Charleston, in South-Carolina. Eighteen out of twenty died of all who took bark and wine in New-Haven, but only one in ten of those who used the depleting medicines. In a letter from Dr. Brown, a physician of eminence in Baltimore, dated November 27th, 1794, he says, "of the many cases which fell to my care, two only proved mortal where I was called on the first day of the disease, and had an uncontrouled opportunity to follow my judgment. Where salivation took place, I had no case of mortality; and in two of those cases, a black vomiting occurred." Dr. Ramsay, of Charleston, in a letter to one of his friends in this city, dated October 14th, 1794, subscribes to the efficacy of the same practice in a fever which prevailed at that time in Charleston, and which, he says, resembled the yellow fever of Philadelphia in the year 1793. But the success of the depleting system was not confined to the United States. In a letter before quoted, which I received from Dr. Davidson, of St. Vincents, dated July 22d, 1794, there is the following testimony in favour of evacuations from the blood-vessels, bowels, and salivary glands: "Where the fever comes on with great determination to the head, and an affection of the stomach, in consequence of that determination, violent head-ach, redness of the eyes, turgescence of the face, impatience of light, &c. attended with a full and hard pulse, _blood-letting_ should be employed _freely_ and _repeatedly_, cold applications should be applied to the head, and purging medicines should be employed. As a purge, _calomel_ has been used with the greatest advantage, sometimes by itself, but most frequently combined with some active purgative medicine, such as jalap. From some peculiarity in the disease, an uncommon quantity of the calomel is necessary to affect the bowels and salivary glands. As I found a small quantity of it did not produce the effect I wished for promptly, I have gradually increased the quantity, until I now venture to give _ten_ grains of it, combined with five of jalap, every _two_ hours until stools are procured. The calomel is then given by itself. "The patients have generally an aversion to wine. The bark is seldom found of much advantage in this state of the fever, and frequently brought on a return of the vomiting. I preferred to it, in a remission of the symptoms, a vinous infusion of the quassia, which sat better upon the stomach." In the island of Jamaica, the depleting system has been divided. It appears, from several publications in the Kingston papers, that Dr. Grant had adopted blood-letting, while most of the physicians of the island rest the cure of the yellow fever upon strong mercurial purges. The ill effects of _moderate_ bleeding probably threw the lancet into disrepute, for the balance of success, from those publications, is evidently in favour of simple purging. I have no doubt of the truth of the above statement of the controversy between the exclusive advocates for bleeding and purging; or perhaps the superior efficacy of the latter remedy may be explained in the following manner. In warm climates, the yellow fever is generally, as it was in Philadelphia in the month of August and in the beginning of September, 1793, a disease of but two or three paroxysms. It is sometimes, I believe, only a simple ephemera. In these cases, purging alone is sufficient to reduce the system, without the aid of bleeding. It was found to be so until the beginning of September, in 1793, in most cases in Philadelphia. The great prostration of the system in the yellow fever, in warm weather and in hot climates, renders the restoration of it to a healthy state of action more gradual, and of course more safe, by means of purging than bleeding. The latter remedy does harm, from the system being below the point of re-action, after the pressure of the blood is taken from it, or by restoring the blood-vessels too suddenly to preternatural action, without reducing them afterwards. Had bleeding been practised agreeably to the method described by Riverius (mentioned in the history of the fever of 1793), or had the fever in Jamaica run on to more than four or five paroxysms, it is probable the loss of blood would have been not only safe, but generally beneficial. I have, in the same history, given my reasons why _moderate_ bleeding in this, as well as many other diseases, does harm. In those cases where it has occurred in large quantities from natural hæmorrhages, it has always done service in the West-Indies. The inefficacy, and, in some cases, the evils, of _moderate_ blood-letting are not confined to the yellow fever. It is equally ineffectual, and, in some instances, equally hurtful, in apoplexy, internal dropsy of the brain, pleurisy, and pulmonary consumption. Where all the different states of the pulse which indicate the loss of blood are perfectly understood, and blood-letting conformed in _time_ and in _quantity_ to them, it never can do harm, in any disease. It is only when it is prescribed empirically, without the direction of just principles, that it has ever proved hurtful. Thus the fertilizing vapours of heaven, when they fall only in dew, or in profuse showers of rain, are either insufficient to promote vegetation, or altogether destructive to it. There may be habits in which great and long protracted debility may have so far exhausted the active powers of the system, as to render bleeding altogether improper in this disease, in a West-India climate. Such habits are sometimes produced in soldiers and sailors, by the hardships of a military and naval life. Bleeding in such cases, Dr. Davidson assures me, in a letter dated from Martinique, February 29th, 1796, did no good. The cure was effected, under these circumstances, by purges, and large doses of calomel. But where this chronic debility does not occur, bleeding, when properly used, can never be injurious, even in a tropical climate, in the yellow fever. Of this there are many proofs in the writings of the most respectable English and French physicians. In spite of the fears and clamours which have been lately excited against it in Jamaica, my late friend and contemporary at the college of Edinburgh, Dr. Broadbelt, in a letter from Spanish Town, dated January 6th, 1795, and my former pupil, Dr. Weston, in a letter from St. Ann's Bay, dated June 17th, 1795, both assure me, that they have used it in this fever with great success. Dr. Weston says that he bled "_copiously_ three times in twenty-four hours, and thereby saved his patient." The superior advantages of the North-American mode of treating the yellow fever, by means of _all_ the common antiphlogistic remedies, will appear from comparing its success with that of the West-India physicians, under all the modes of practice which have been adopted in the islands. Dr. Desportes lost one half of all the patients he attended in the yellow fever in one season in St. Domingo[126]. His remedies were _moderate_ bleeding and purging, and the copious use of diluting drinks. Dr. Bisset says, "the yellow fever is often under particular circumstances very fatal, carrying off four or five in seven whom it attacks, and sometimes, but seldom, it is so favourable as to carry off only one patient in five or six[127]." The doctor does not describe the practice under which this mortality takes place. [126] Vol. i. p. 55. [127] Medical Essays and Observations, p. 29. Dr. Home, I have elsewhere remarked[128], lost "one out of four of his patients in Jamaica." His remedies were _moderate_ bleeding and purging, and afterwards bark, wine, and external applications of blankets dipped in hot vinegar. [128] Account of the Yellow Fever of 1793. Dr. Blane pronounces the yellow fever to be "one of the most fatal diseases to which the human body is subject, and in which human art is the most unavailing." His remedies were bleeding, bark, blisters, acid drinks, saline draughts, and camomile tea. Dr. Chisholm acknowledges that he lost one in twelve of all the patients he attended in the fever of Grenada. His principal remedy was a salivation. I shall hereafter show the inferiority of this single mode of depleting, to a combination of it with bleeding and purging. In Philadelphia and Baltimore, where bleeding, purging, and salivation were used in due time, and after the manner that has been described, not more than one in fifty died of the yellow fever. It is probable that greater certainty and success in the treatment of this disease will not easily be attained, for idiosyncracy, and habits of intemperance which resist or divert the operation of the most proper remedies, a dread of the lancet, or the delay of an hour in the use of it, the partial application of that or any other remedy, the unexpected recurrence of a paroxysm of fever in the middle of the night, or the clandestine exhibition of wine or laudanum by friends or neighbours, often defeat the best concerted plans of cure by a physician. Heaven in this, as in other instances, kindly limits human power and benevolence, that in all situations man may remember his dependence upon the power and goodness of his Creator. AN ACCOUNT OF SPORADIC CASES OF _BILIOUS YELLOW FEVER_, IN PHILADELPHIA, IN THE YEARS 1795 AND 1796. In my account of the yellow fever, as it appeared in Philadelphia in the year 1794, I took notice of several cases of it which occurred in the spring of the year 1795. Before I proceed to deliver the history of this disease as it appeared in 1797, I shall mention the diseases and state of the weather which occurred during the remaining part of the year 1795, and the whole of the year 1796. This detail of facts, apparently uninteresting to the reader in the present state of our knowledge of epidemics, may possibly lead to principles at a future day. The month in of April, 1795, was wet and cold. All the diseases of this month partook of the inflammatory character of the preceding winter and autumn, except the measles, which were unusually mild. The weather in May was alternately wet, cool, and warm. A few cases of malignant fever occurred this month, but with moderate symptoms. In June the weather was cool and pleasant. The measles put on more inflammatory symptoms than in the preceding months. I had two cases of mania under my care this month, and one of rheumatism, which were attended with intermissions and exacerbations every other day. The weather on the 19th, 20th, 21st, and 22d days of July was very warm, the mercury being at 90° in Fahrenheit's thermometer. The fevers of this month were all accompanied with black discharges from the bowels. Mr. Kittera, one of the representatives of Pennsylvania in the congress of the United States, in consequence of great fatigue on a warm day, was affected with the usual symptoms of the yellow fever. During his illness he constantly complained of more pain in the left, than in the right side of his head. His pulse was more tense in his left, than in his right arm. During his convalescence, it was more quick in the left arm, than it was in the right. He was cured by a salivation and the loss of above 100 ounces of blood. His head-ach was relieved by the application of a bladder half filled with ice to his forehead. Most of the cases of bilious fever, which came under my notice, were attended with quotidian, tertian, or quartan intermissions. In a few of my patients there was a universal rash. Dr. Woodhouse informed me, that he had seen several instances in which the yellow fever appeared in the same place in which some soldiers had laboured under the dysentery. These facts show the unity of fever, and the impracticability of a nosological arrangement of diseases. The cholera infantum was severe and fatal, in many instances, during this month. It yielded to blood-letting in a child of Mr. Conyngham, which was but four months old. In a child of seven weeks old which came under my care, I observed the coldness, chills, hot fits, and remissions of the bilious fever to be as distinctly marked as ever I had seen them in adult patients. In a child of Mr. Darrach, aged 5 months, the discharges from the bowels were of a black colour. I mention these facts in support of an opinion I formerly published, that the cholera infantum is a bilious fever, and that it rises and falls in its violence with the bilious fever of grown persons. About the latter end of this month and the beginning of August, there were heavy showers of rain, which carried away fences, bridges, barns, mills, and dwelling-houses in many places. Several cases of bilious yellow fever occurred in the month of August. In one of them it was accompanied with that morbid affection in the wind-pipe which has been called cynanche trachealis. It was remarkable that sweating became a more frequent symptom of the fevers of this month than it had been in July. Hippocrates ascribes this change in the character of bilious fevers to rainy weather. Perhaps it was induced by the rain which fell in the beginning of the month, in the fevers which have been named. Among the persons affected with the yellow fever during this month, was William Bradford, Esq. the attorney-general of the United States. From a dread of the lancet he objected to being bled in the early stage of his disease, in consequence of which he died on the 23d of August, in the 39th year of his age, amidst the tears of numerous friends, and the lamentations of his whole country. On the 30th and 31st of August, there was a fall of rain, which suddenly checked the fever of the season, insomuch that the succeeding autumnal months were uncommonly healthy. Several showers of rain had nearly the same effect in New-York, where this fever carried off, in a few weeks, above 700 persons. It prevailed, at the same time, and with great mortality, in the city of Norfolk, in Virginia. In both those cities, as well as in Philadelphia, the disease was evidently derived from putrid exhalation. In the same month, the dysentery prevailed in Newhaven, in Connecticut, and in the same part of the town in which the yellow fever had prevailed the year before. The latter disease was said to have been imported, but the prevalence of the dysentery, under the above circumstances, proved that both diseases were of domestic origin. The fever, as it appeared in Philadelphia, yielded in most cases to depleting remedies. After purging and blood-letting, I gave bark, where the fever intermitted, with advantage. It was effectual only when given in large doses. In one instance, it induced a spitting of blood, which obliged me to lay it aside. The winter of 1796 was uncommonly moderate. There fell a good deal of rain, but little snow. The navigation of the Delaware was stopped but two or three days during the whole season. Catarrhs were frequent, but very few violent or acute diseases occurred in my practice. The month of March and the first week in April were uncommonly dry. Several cases of malignant bilious fever came under my care during these months. A little girl, of five years old, whom I lost in this fever, became yellow in two hours after her death. The measles prevailed in April, and were of a most inflammatory nature. The weather in May and June was uncommonly wet. The fruit was much injured, and a great deal of hay destroyed by it. On the 14th of June, General Stewart died, with all the usual symptoms of a fatal yellow fever. Several other cases of it, in this and in the succeeding month, proved mortal, but they excited no alarm in the city, as the physicians who attended them called them by other names. The rain which fell about the middle of July checked this fever. August, September, and October were unusually healthy. A few cases of malignant sore throat appeared in November. They were, in all the patients that came under my notice, attended with bilious discharges from the stomach and bowels. So little rain fell during the autumnal months, that the wheat perished in many places. The weather in December was extremely cold. The lamps of the city were, in several instances, extinguished by it, on the night of the 23d of the month, at which time the mercury stood at 2° below 0 in the thermometer. The yellow fever prevailed this year in Charleston, in South-Carolina, where it was produced by putrid exhalations from the cellars of houses which had been lately burnt. It was said by the physicians of that place not to be contagious. The same fever prevailed, at the same time, at Wilmington, in North-Carolina, and at Newburyport, in the state of Massachusetts. In the latter place, it was produced by the exhalation of putrid fish, which had been carelessly thrown upon a wharf. END OF VOLUME III. * * * * * Transcriber's note: The original spelling and minor inconsistencies in the spelling and formatting have been maintained. Obvious misprints have been corrected. Partly repeated chapter headings have been deleted. 
58860	----	generously made available by Internet Archive (https://archive.org) Note: Project Gutenberg also has an HTML version of this file which includes the original illustrations. See 58860-h.htm or 58860-h.zip: (http://www.gutenberg.org/files/58860/58860-h/58860-h.htm) or (http://www.gutenberg.org/files/58860/58860-h.zip) Images of the original pages are available through Internet Archive. See https://archive.org/details/b21935142_0002 Project Gutenberg has the other three volumes of this work. Volume I: see http://www.gutenberg.org/ebooks/58859 Volume III: see http://www.gutenberg.org/ebooks/58861 Volume IV: see http://www.gutenberg.org/ebooks/58862 Transcriber's note: The ligature oe has been marked as [oe]. Text in italics has been enclosed by underscores (_text_). MEDICAL INQUIRIES AND OBSERVATIONS. BY BENJAMIN RUSH, M. D. PROFESSOR OF THE INSTITUTES AND PRACTICE OF MEDICINE, AND OF CLINICAL PRACTICE, IN THE UNIVERSITY OF PENNSYLVANIA. IN FOUR VOLUMES. VOL. II. THE SECOND EDITION, REVISED AND ENLARGED BY THE AUTHOR. PHILADELPHIA, PUBLISHED BY J. CONRAD & CO. CHESNUT-STREET, PHILADELPHIA; M. & J. CONRAD & CO. MARKET-STREET, BALTIMORE; RAPIN, CONRAD, & CO. WASHINGTON; SOMERVELL & CONRAD, PETERSBURG; AND BONSAL, CONRAD, & CO. NORFOLK. PRINTED BY T. & G. PALMER, 116, HIGH-STREET. 1805. * * * * * CONTENTS OF VOLUME II. _page_ _An inquiry into the influence of physical causes upon the moral faculty_ 1 _Observations upon the cause and cure of pulmonary consumption_ 59 _Observations upon the symptoms and cure of dropsies_ 151 _Inquiry into the cause and cure of the internal dropsy of the brain_ 191 _Observations upon the nature and cure of the gout_ 225 _Observations on the nature and cure of the hydrophobia_ 299 _An account of the measles, as they appeared in Philadelphia in the spring of 1789_ 335 _An account of the influenza, as it appeared in Philadelphia in the years 1790 and 1791_ 351 _An inquiry into the cause of animal life_ 369 * * * * * AN INQUIRY INTO THE _INFLUENCE OF PHYSICAL CAUSES_ UPON THE MORAL FACULTY. DELIVERED BEFORE _THE AMERICAN PHILOSOPHICAL SOCIETY_, HELD AT PHILADELPHIA, ON THE 27TH OF FEBRUARY, 1786. * * * * * AN INQIUIRY, &c. GENTLEMEN, It was for the laudable purpose of exciting a spirit of emulation and inquiry, among the members of our body, that the founders of our society instituted an annual oration. The task of preparing, and delivering this exercise, hath devolved, once more, upon me. I have submitted to it, not because I thought myself capable of fulfilling your intentions, but because I wished, by a testimony of my obedience to your requests, to atone for my long absence from the temple of science. The subject upon which I am to have the honour of addressing you this evening is on the influence of physical causes upon the moral faculty. By the moral faculty I mean a capacity in the human mind of distinguishing and chasing good and evil, or, in other words, virtue and vice. It is a native principle, and though it be capable of improvement by experience and reflection, it is not derived from either of them. St. Paul and Cicero give us the most perfect account of it that is to be found in modern or ancient authors. "For when the Gentiles (says St. Paul), which have not the law, do by nature the things contained in the law, _these_, having not the law, are a _law_ unto themselves; which show the works of the law written in their hearts, their consciences also bearing witness, and their thoughts the mean while accusing, or else excusing another[1]." [1] Rom. i. 14, 15. The words of Cicero are as follow: "Est igniter Ha, juices, non script, seed Nata lex, qualm non dadaisms, accepts, legumes, serum ex nature Pisa europiums, humus, expresses, ad qualm non Doctor, seed facto, non institute, seed imbued sums[2]." This faculty is often confounded with conscience, which is a distinct and independent capacity of the mind. This is evident from the passage quoted from the writings of St. Paul, in which conscience is said to be the witness that accuses or excuses us, of a breach of the law written in our hearts. The moral faculty is what the school men call the "regular raglans;" the conscience is their "regular regulate;" or, to speak in more modern terms, the moral faculty performs the the office of a law-giver, while the business of conscience is to perform the duty of a judge. The moral faculty is to the conscience, what taste is to the judgment, and sensation to perception. It is quick in its operations, and, like the sensitive plant, acts without reflection, while conscience follows with deliberate steps, and measures all her actions, by the unerring square of right and wrong. The moral faculty exercises itself upon the actions of others. It approves, even in books, of the virtues of a Trajan, and disapproves of the vices of a Marius, while conscience confines its operations only to its own actions. These two capacities of the mind are generally in an exact ratio to each other, but they sometimes exist in different degrees in the same person. Hence we often find conscience in its full vigour, with a diminished tone, or total absence of the moral faculty. [2] Oration pro Milne. It has long been a question among meta physicians, whether the conscience be seated in the will or in the understanding. The controversy can only be settled by admitting the will to be the seat of the moral faculty, and the understanding to be the seat of the conscience. The mysterious nature of the union of those two moral principles with the will and understanding, is a subject foreign to the business of the present inquiry. As I consider virtue and vice to consist in _action_, and not in opinion, and as this action has its seat in the _will_, and not in the conscience, I shall confine my inquiries chiefly to the influence of physical causes upon that moral power of the mind, which is connected with volition, although many of these causes act likewise upon the conscience, as I shall show hereafter. The state of the moral faculty is visible in actions, which affect the well-being of society. The state of the conscience is invisible, and therefore removed beyond our investigation. The moral faculty has received different names from different authors. It is the "moral sense" of Dr. Hutchison; the "sympathy" of Dr. Adam Smith; the "moral instinct" of Rousseau; and "the light that lighter every man that cometh into the world" of St. John. I have adopted the term of moral faculty from Dr. Bettie, because I conceive it conveys with the most perspicuity, the idea of a capacity in the mind, of chasing good and evil. Our books of medicine contain many records of the effects of physical causes upon the memory, the imagination, and the judgment. In some instances we behold their operation only on one, in others on two, and, in many cases, upon the whole of these faculties. Their derangement has received different names, according to the number or nature of the faculties that are affected. The loss of memory has been called "amnesia;" false judgment upon one subject has been called "melancholia;" false judgment upon all subjects has been called "mania;" and a defect of all the three intellectual faculties that have been mentioned, has received the name of "amnesia." Persons who labour under the derangement, or want of these faculties of the mind, are considered, very properly, as subjects of medicine; and there are many cases upon record that prove, that their diseases have yielded to the healing art. In order to illustrate the effects of physical causes upon the moral faculty, it will be necessary _first_ to show their effects upon the memory, the imagination, and the judgment; and at the same time to point out the analogy between their operation upon the intellectual faculties of the mind, and the moral faculty. 1. Do we observe a connection between the intellectual faculties, and the degrees of consistency and firmness of the brain in infancy and childhood? The same connection has been observed between the strength, as well as the progress of the moral faculty in children. 2. Do we observe a certain size of the brain, and a peculiar cast of features, such as the prominent eye, and the aquiline nose, to be connected with extraordinary portions of genius? We observe a similar connection between the figure and temperament of the body, and certain moral qualities. Hence we often ascribe good temper and benevolence to corpulence, and irascibility to sanguineous habits. CA thought himself safe in the friendship of the "sleek-headed" Anthony and Willabella; but was afraid to trust to the professions of the slender Cassius. 3. Do we observe certain degrees of the intellectual faculties to be hereditary in certain families? The same observation has been frequently extended to moral qualities. Hence we often find certain virtues and vices as peculiar to families, through all their degrees of consanguinity, and duration, as a peculiarity of voice, complexion, or shape. 4. Do we observe instances of a total want of memory, imagination, and judgment, either from an original defect in the stamina of the brain, or from the influence of physical causes? The same unnatural defect is sometimes observed, and probably from the same causes, of a moral faculty. The celebrated Serving, whose character is drawn by the Duke of Sully in his Memoirs, appears to be an instance of the total absence of the moral faculty, while the chasm, produced by this defect, seems to have been filled up by a more than common extension of every other power of his mind. I beg leave to repeat the history of this prodigy of vice and knowledge. "Let the reader represent to himself a man of a genius so lively, and of an understanding so extensive, as rendered him scarce ignorant of any thing that could be known; of so vast and ready a comprehension, that he immediately made himself master of whatever he attempted; and of so prodigious a memory, that he never forgot what he once learned. He possessed all parts of philosophy, and the mathematics, particularly fortification and drawing. Even in theology he was so well skilled, that he was an excellent preacher, whenever he had a mind to exert that talent, and an able disputant, for and against the reformed religion indifferently. He not only understood Greek, Hebrew, and all the languages which we call learned, but also all the different jargons, or modern dialects. He accented and pronounced them so naturally, and so perfectly imitated the gestures and manners both of the several nations of Europe, and the particular provinces of France, that he might have been taken for a native of all, or any of these countries: and this quality he applied to counterfeit all sorts of persons, wherein he succeeded wonderfully. He was, moreover, the best comedian, and the greatest droll that perhaps ever appeared. He had a genius for poetry, and had wrote many verses. He played upon almost all instruments, was a perfect master of music, and sang most agreeably and justly. He likewise could say mass, for he was of a disposition to do, as well as to know all things. His body was perfectly well suited to his mind. He was light, nimble, and dexterous, and fit for all exercises. He could ride well, and in dancing, wrestling, and leaping, he was admired. There are not any recreative games that he did not know, and he was skilled in almost all mechanic arts. But now for the reverse of the medal. Here it appeared, that he was treacherous, cruel, cowardly, deceitful, a liar, a cheat, a drunkard and a glutton, a sharper in play, immersed in every species of vice, a blasphemer, an atheist. In a word, in him might be found all the vices that are contrary to nature, honour, religion, and society, the truth of which he himself evinced with his latest breath; for he died in the flower of his age, in a common brothel, perfectly corrupted by his debaucheries, and expired with the glass in his hand, cursing and denying God[3]." [3] Vol. III. p. 216, 217. It was probably a state of the human mind such as has been described, that our Saviour alluded to in the disciple, who was about to betray him, when he called him "a devil." Perhaps the essence of depravity, in infernal spirits, consists in their being wholly devoid of a moral faculty. In them the will has probably lost the power of chasing[4], as well as the capacity of enjoying moral good. It is true, we read of their trembling in a belief of the existence of a God, and of their anticipating future punishment, by asking, whether they were to be tormented before their time: but this is the effect of conscience, and hence arises another argument in favour of this judicial power of the mind, being distinct from the moral faculty. It would seem as if the Supreme Being had preserved the moral faculty in man from the ruins of his fall, on purpose to guide him back again to Paradise, and at the same time had constituted the conscience, both in men and fallen spirits, a kind of royalty in his moral empire, on purpose to show his property in all intelligent creatures, and their original resemblance to himself. Perhaps the essence of moral depravity in man consists in a total, but temporary suspension of the power of conscience. Persons in this situation are emphatically said in the Scriptures to be "past feeling," and to have their consciences seared with a "hot iron;" they are likewise said to be "twice dead," that is, the same torpor or moral insensibility, has seized both the moral faculty and the conscience. [4] Milton seems to have been of this opinion. Hence, after ascribing repentance to Satan, he makes him declare, "Farewell remorse: all good to me is lost, _Evil_, be thou my _good_."---- PARADISE LOST, Book IV. 5. Do we ever observe instances of the existence of only _one_ of the three intellectual powers of the mind that have been named, in the absence of the other two? We observe something of the same kind with respect to the moral faculty. I once knew a man, who discovered no one mark of reason, who possessed the moral sense or faculty in so high a degree, that he spent his whole life in acts of benevolence. He was not only inoffensive (which is not always the case with idiots), but he was kind and affectionate to every body. He had no ideas of time, but what were suggested to him by the returns of the stated periods for public worship, in which he appeared to take great delight. He spent several hours of every day in devotion, in which he was so careful to be private, that he was once found in the most improbable place in the world for that purpose, viz. in an oven. 6. Do we observe the memory, the imagination, and the judgment, to be affected by diseases, particularly by madness? Where is the physician who has not seen the moral faculty affected from the same causes! How often do we see the temper wholly changed by a fit of sickness! And how often do we hear persons of the most delicate virtue, utter speeches in the delirium of a fever, that are offensive to decency or good manners! I have heard a well-attested history of a clergyman of the most exemplary moral character, who spent the last moments of a fever which deprived him both of his reason and his life, in profane cursing and swearing. I once attended a young woman in a nervous fever, who discovered, after her recovery, a loss of her former habit of veracity. Her memory (a defect of which might be suspected of being the cause of this vice) was in every respect as perfect as it was before the attack of the fever[5]. The instances of immorality in maniacs, who were formerly distinguished for the opposite character, are so numerous, and well known, that it will not be necessary to select any cases, to establish the truth of the proposition contained under this head. [5] I have selected this case from many others, which have come under my notice, in which the moral faculty appeared to be impaired by diseases, particularly by the typhus of Dr. Cullen, and by those species of palsy which affect the brain. 7. Do we observe any of the three intellectual faculties that have been named, enlarged by diseases? Patients, in the delirium of a fever, often discover extraordinary flights of imagination, and madmen often astonish us with their wonderful acts of memory. The same enlargement, sometimes, appears in the operations of the moral faculty. I have more than once heard the most sublime discourses of morality in the cell of an hospital, and who has not seen instances of patients in acute diseases, discovering degrees of benevolence and integrity, that were not natural to them in the ordinary course of their lives[6]? [6] Xenophon makes Cyrus declare, in his last moments, "That the soul of man, at the hour of death, appears _most divine_, and then foresees something of future events." 8. Do we ever observe a partial insanity, or false perception on one subject, while the judgment is sound and correct, upon all others? We perceive, in some instances, a similar defect in the moral faculty. There are persons who are moral in the highest degree, as to certain duties, who nevertheless live under the influence of some one vice. I knew an instance of a woman, who was exemplary in her obedience to every command of the moral law, except one. She could not refrain from stealing. What made this vice the more remarkable was, that she was in easy circumstances, and not addicted to extravagance in any thing. Such was her propensity to this vice, that when she could lay her hands upon nothing more valuable, she would often, at the table of a friend, fill her pockets secretly with bread. As a proof that her judgment was not affected by this defect in her moral faculty, she would both confess and lament her crime, when detected in it. 9. Do we observe the imagination in many instances to be affected with apprehensions of dangers that have no existence? In like manner we observe the moral faculty to discover a sensibility to vice, that is by no means proportioned to its degrees of depravity. How often do we see persons labouring under this morbid sensibility of the moral faculty, refuse to give a direct answer to a plain question, that related perhaps only to the weather, or to the hour of the day, lest they should wound the peace of their minds by telling a falsehood! 10. Do dreams affect the memory, the imagination, and the judgment? Dreams are nothing but incoherent ideas, occasioned by partial or imperfect sleep. There is a variety in the suspension of the faculties and operations of the mind in this state of the system. In some cases the imagination only is deranged in dreams, in others the memory is affected, and in others the judgment. But there are cases, in which the change that is produced in the state of the brain, by means of sleep, affects the moral faculty likewise; hence we sometimes dream of doing and saying things when asleep, which we shudder at, as soon as we awake. This supposed defection from virtue, exists frequently in dreams where the memory and judgment are scarcely impaired. It cannot therefore be ascribed to an absence of the exercises of those two powers of the mind. 11. Do we read, in the accounts of travellers, of men, who, in respect of intellectual capacity and enjoyments, are but a few degrees above brutes? We read likewise of a similar degradation of our species, in respect to moral capacity and feeling. Here it will be necessary to remark, that the low degrees of moral perception, that have been discovered in certain African and Russian tribes of men, no more invalidate our proposition of the universal and essential existence of a moral faculty in the human mind, than the low state of their intellects prove, that reason is not natural to man. Their perceptions of good and evil are in an exact proportion to their intellectual faculties. But I will go further, and admit with Mr. Locke[7], that some savage nations are totally devoid of the moral faculty, yet it will by no means follow, that this was the original constitution of their minds. The appetite for certain aliments is uniform among all mankind. Where is the nation and the individual, in their primitive state of health, to whom bread is not agreeable? But if we should find savages, or individuals, whose stomachs have been so disordered by intemperance, as to refuse this simple and wholesome article of diet, shall we assert that this was the original constitution of their appetites? By no means. As well might we assert, because savages destroy their beauty by painting and cutting their faces, that the principles of taste do not exist naturally in the human mind. It is with virtue as with fire. It exists in the mind, as fire does in certain bodies, in a latent or quiescent state. As collision renders the one sensible, so education renders the other visible. It would be as absurd to maintain, because olives become agreeable to many people from habit, that we have no natural appetites for any other kind of food, as to assert that any part of the human species exist without a moral principle, because in some of them, it has wanted causes to excite it into action, or has been perverted by example. There are appetites that are wholly artificial. There are tastes so entirely vitiated, as to perceive beauty in deformity. There are torpid and unnatural passions. Why, under certain unfavourable circumstances, may there not exist also a moral faculty, in a state of sleep, or subject to mistakes? [7] Essay concerning the Human Understanding, book I. chap. 3. The only apology I shall make, for presuming to differ from that justly-celebrated oracle[8], who first unfolded to us a map of the intellectual world, shall be, that the eagle eye of genius often darts its views beyond the notice of facts, which are accommodated to the slender organs of perception of men, who possess no other talent than that of observation. [8] Mr. Locke. It is not surprising, that Mr. Locke has confounded this moral principle with _reason_, or that Lord Shafts bury has confounded it with _taste_, since all three of these faculties agree in the objects of their approbation, notwithstanding they exist in the mind independently of each other. The favourable influence which the progress of science and taste has had upon the morals, can be ascribed to nothing else, but to the perfect union that subsists in nature between the dictates of reason, of taste, and of the moral faculty. Why has the spirit of humanity made such rapid progress for some years past in the courts of Europe? It is because kings and their ministers have been taught to _reason_ upon philosophical subjects. Why have indecency and profanity been banished from the stage in London and Paris? It is because immorality is an offence against the highly cultivated _taste_ of the French and English nations. It must afford great pleasure to the lovers of virtue, to behold the depth and extent of this moral principle in the human mind. Happily for the human race, the intimations of duty and the road to happiness are not left to the slow operations or doubtful inductions of reason, nor to the precarious decisions of taste. Hence we often find the moral faculty in a state of vigour, in persons in whom reason and taste exist in a weak, or in an uncultivated state. It is worthy of notice, likewise, that while _second_ thoughts are best in matters of judgment, _first_ thoughts are always to be preferred in matters that relate to morality. _Second_ thoughts, in these cases, are generally pearlies between duty and corrupted inclinations. Hence Rousseau has justly said, that "a well regulated moral instinct is the surest guide to happiness." It must afford equal pleasure to the lovers of virtue to behold, that our moral conduct and happiness are not committed to the determination of a single legislative power. The conscience, like a wise and faithful legislative council, performs the office of a check upon the moral faculty, and thus prevents the fatal consequences of immoral actions. An objection, I foresee, will arise to the doctrine of the influence of physical causes upon the moral faculty, from its being supposed to favour the opinion of the _materiality_ of the soul. But I do not see that this doctrine obliges us to decide upon the question of the nature of the soul, any more than the facts which prove the influence of physical causes upon the memory, the imagination, or the judgment. I shall, however, remark upon this subject, that the writers in favour of the _immortality_ of the soul have done that truth great injury, by connecting it necessarily with its _immateriality_. The immortality of the soul depends upon the _will_ of the Deity, and not upon the supposed properties of spirit. Matter is in its own nature as immortal as spirit. It is resolvable by heat and mixture into a variety of forms; but it requires the same Almighty hand to annihilate it, that it did to create it. I know of no arguments to prove the immortality of the soul, but such as are derived from the Christian revelation[9]. It would be as reasonable to assert, that the bason of the ocean is immortal, from the greatness of its capacity to hold water; or that we are to live for ever in this world, because we are afraid of dying, as to maintain the immortality of the soul, from the greatness of its capacity for knowledge and happiness, or from its dread of annihilation. [9] "Life and immortality _are_ brought to light _only_ through the gospel." 2 Tim. i. 10. I remarked, in the beginning of this discourse, that persons who are deprived of the just exercise of memory, imagination, or judgment, were proper subjects of medicine; and that there are many cases upon record which prove, that the diseases from the derangement of these faculties, have yielded to the healing art. It is perhaps only because the diseases of the moral faculty have not been traced to a connection with physical causes, that medical writers have neglected to give them a place in their systems of nosology, and that so few attempts have been hitherto made, to lessen or remove them by physical as well as rational and moral remedies. I shall not attempt to derive any support to my opinions, from the analogy of the influence of physical causes upon the temper and conduct of brute animals. The facts which I shall produce in favour of the action of these causes upon morals in the human species, will, I hope, render unnecessary the arguments that might be drawn from that quarter. I am aware, that in venturing upon this subject, I step upon untrodden ground. I feel as �neas did, when he was about to enter the gates of Avernus, but without a sybil to instruct me in the mysteries that are before me. I foresee, that men who have been educated in the mechanical habits of adopting popular or established opinions will revolt at the doctrine I am about to deliver, while men of sense and genius will hear my propositions with candour, and if they do not adopt them, will commend that boldness of inquiry, that prompted me to broach them. I shall begin with an attempt to supply the defects of nosological writers, by naming the partial or weakened action of the moral faculty, MICRONOMIA. The total absence of this faculty, I shall call ANOMIA. By the law, referred to in these new genera of vesaniæ, I mean the law of nature written in the human heart, and which I formerly quoted from the writings of St. Paul. In treating of the effects of physical causes upon the moral faculty, it might help to extend our ideas upon this subject, to reduce virtues and vices to certain species, and to point out the effects of particular species of virtue and vice; but this would lead us into a field too extensive for the limits of the present inquiry. I shall only hint at a few cases, and have no doubt but the ingenuity of my auditors will supply my silence, by applying the rest. It is immaterial, whether the physical causes that are to be enumerated, act upon the moral faculty through the medium of the senses, the passions, the memory, or the imagination. Their influence is equally certain, whether they act as remote, predisposing, or occasional causes. 1. The effects of CLIMATE upon the moral faculty claim our first attention. Not only individuals, but nations, derive a considerable part of their moral, as well as intellectual character, from the different portions they enjoy of the rays of the sun. Irascibility, levity, timidity, and indolence, tempered with occasional emotions of benevolence, are the moral qualities of the inhabitants of warm climates, while selfishness, tempered with sincerity and integrity, form the moral character of the inhabitants of cold countries. The state of the weather, and the seasons of the year also, have a visible effect upon moral sensibility. The month of November, in Great Britain, rendered gloomy by constant fogs and rains, has been thought to favour the perpetration of the worst species of murder, while the vernal sun, in middle latitudes, has been as generally remarked for producing gentleness and benevolence. 2. The effects of DIET upon the moral faculty are more certain, though less attended to, than the effects of climate. "Fulness of bread," we are told, was one of the predisposing causes of the vices of the cities of the plain. The fasts so often inculcated among the Jews, were intended to lessen the incentives to vice; for pride, cruelty, and sensuality, are as much the natural consequences of luxury, as apoplexies and palsies. But the _quality_ as well as the quantity of aliment, has an influence upon morals; hence we find the moral diseases that have been mentioned, are most frequently the offspring of animal food. The prophet Isaiah seems to have been sensible of this, when he ascribes such salutary effects to a temperate and vegetable diet. "Butter and honey shall he eat," says he, "_that_ he may know to refuse the evil, and to chuse the good." But we have many facts which prove the efficacy of a vegetable diet upon the passions. Dr. Arbuthnot assures us, that he cured several patients of irascible tempers, by nothing but a prescription of this simple and temperate regimen. 3. The effects of CERTAIN DRINKS upon the moral faculty are not less observable, than upon the intellectual powers of the mind. Fermented liquors, of a good quality, and taken in a moderate quantity, are favourable to the virtues of candour, benevolence, and generosity; but when they are taken in excess, or when they are of a bad quality, and taken even in a moderate quantity, they seldom fail of rousing every latent spark of vice into action. The last of these facts is so notorious, that when a man is observed to be ill-natured or quarrelsome in Portugal, after drinking, it is common in that country to say, that "he has drunken bad wine." While occasional fits of intoxication produce ill-temper in many people, habitual drunkenness (which is generally produced by distilled spirits) never fails to eradicate veracity and integrity from the human mind. Perhaps this may be the reason why the Spaniards, in ancient times, never admitted a man's evidence in a court of justice, who had been convicted of drunkenness. Water is the universal sedative of turbulent passions; it not only promotes a general equanimity of temper, but it composes anger. I have heard several well-attested cases, of a draught of cold water having suddenly composed this violent passion, after the usual remedies of reason had been applied to no purpose. 4. EXTREME HUNGER produces the most unfriendly effects upon moral sensibility. It is immaterial, whether it act by inducing a relaxation of the solids, or an acrimony of the fluids, or by the combined operations of both those physical causes. The Indians in this country whet their appetites for that savage species of war, which is peculiar to them, by the stimulus of hunger; hence, we are told, they always return meagre and emaciated from their military excursions. In civilized life we often behold this sensation to overbalance the restraints of moral feeling; and perhaps this may be the reason why poverty, which is the most frequent parent of hunger, disposes so generally to theft; for the character of hunger is taken from that vice: it belongs to it "to break through stone walls." So much does this sensation predominate over reason and moral feeling, that Cardinal de Retz suggests to politicians, never to risk a motion in a popular assembly, however wise or just it may be, immediately before dinner. That temper must be uncommonly guarded, which is not disturbed by long abstinence from food. One of the worthiest men I ever knew, who made his breakfast his principal meal, was peevish and disagreeable to his friends and family, from the time he left his bed, till he sat down to his morning repast, after which, cheerfulness sparkled in his countenance, and he became the delight of all around him. 5. I hinted formerly, in proving the analogy between the effects of DISEASES upon the intellects, and upon the moral faculty, that the latter was frequently impaired by madness. I beg leave to add further upon this head, that not only madness, but the hysteria and hypochondriasis, as well as all those states of the body, whether idiopathic or symptomatic, which are accompanied with preternatural irritability, sensibility, torpor, stupor, or mobility of the nervous system, dispose to vice, either of the body or of the mind. It is in vain to attack these vices with lectures upon morality. They are only to be cured by medicine, particularly by exercise, the cold bath, and by a cold or warm atmosphere. The young woman, whose case I mentioned formerly, that lost her habit of veracity by a nervous fever, recovered this virtue, as soon as her system recovered its natural tone, from the cold weather which happily succeeded her fever[10]. [10] There is a morbid state of excitability in the body during the convalescence from fever, which is intimately connected with an undue propensity to venereal pleasures. I have met with several instances of it. The marriage of the celebrated Mr. Howard to a woman who was twice as old as himself, and very sickly, has been ascribed, by his biographer, Dr. Aiken, to _gratitude_ for her great attention to him in a fit of sickness. I am disposed to ascribe it to a sudden paroxysm of another passion, which, as a religious man, he could not gratify in any other, than in a lawful way. I have heard of two young clergymen who married the women who had nursed them in fits of sickness. In both cases there was great inequality in their years, and condition in life. Their motive was, probably, the same as that which I have attributed to Mr. Howard. Dr. Patrick Russel takes notice of an uncommon degree of venereal excitability which followed attacks of the plague at Messina, in 1743, in all ranks of people. Marriages, he says, were more frequent after it than usual, and virgins were, in some instances, violated, who died of that disease, by persons who had just recovered from it. 6. IDLENESS is the parent of every vice. It is mentioned in the Old Testament as another of the predisposing causes of the vices of the cities of the plain. LABOUR, of all kinds, favours and facilitates the practice of virtue. The country life is happy, chiefly because its laborious employments are favourable to virtue, and unfriendly to vice. It is a common practice, I have been told, for the planters, in the southern states, to consign a house slave, who has become vicious from idleness, to the drudgery of the field, in order to reform him. The bridewells and workhouses of all civilized countries prove, that labour is not only a very severe, but the most benevolent of all punishments, inasmuch as it is one of the most suitable means of reformation. Mr. Howard tells us, in his History of Prisons, that in Holland it is a common saying, "Make men work, and you will make them honest." And over the rasp and spinhouse at Gr[oe]ningen, this sentiment is expressed (he tells us) by a happy motto: "Vitiorum semina--otium--labore exhauriendum." The effects of steady labour in early life, in creating virtuous habits, is still more remarkable. The late Anthony Benezet, of this city, whose benevolence was the centinel of the virtue, as well as of the happiness of his country, made it a constant rule, in binding out poor children, to avoid putting them into wealthy families, but always preferred masters for them who worked themselves, and who obliged these children to work in their presence. If the habits of virtue, contracted by means of this apprenticeship to labour, are purely mechanical, their effects are, nevertheless, the same upon the happiness of society, as if they flowed from principle. The mind, moreover, when preserved by these means from weeds, becomes a more mellow soil afterwards, for moral and rational improvement. 7. The effects of EXCESSIVE SLEEP are intimately connected with the effects of idleness upon the moral faculty: hence we find that moderate, and even scanty portions of sleep, in every part of the world, have been found to be friendly, not only to health and long life, but in many instances to morality. The practice of the monks, who often sleep upon a floor, and who generally rise with the sun, for the sake of mortifying their sensual appetites, is certainly founded in wisdom, and has often produced the most salutary moral effects. 8. The effects of bodily pain upon the moral, are not less remarkable than upon the intellectual powers of the mind. The late Dr. Gregory, of the university of Edinburgh, used to tell his pupils, that he always found his perceptions quicker in a fit of the gout, than at any other time. The pangs which attend the dissolution of the body, are often accompanied with conceptions and expressions upon the most ordinary subjects, that discover an uncommon elevation of the intellectual powers. The effects of bodily pain are exactly the same in rousing and directing the moral faculty. Bodily pain, we find, was one of the remedies employed in the Old Testament, for extirpating vice, and promoting virtue: and Mr. Howard tells us, that he saw it employed successfully as a means of reformation, in one of the prisons which he visited. If pain has a physical tendency to cure vice, I submit it to the consideration of parents and legislators, whether moderate degrees of corporal punishments, inflicted for a great length of time, would not be more medicinal in their effects, than the violent degrees of them, which are of short duration. 9. Too much cannot be said in favour of CLEANLINESS, as a physical means of promoting virtue. The writings of Moses have been called by military men, the best "orderly book" in the world. In every part of them we find cleanliness inculcated with as much zeal, as if it was part of the moral, instead of the Levitical law. Now, it is well known, that the principal design of every precept and rite of the ceremonial parts of the Jewish religion, was to prevent vice, and to promote virtue. All writers upon the leprosy, take notice of its connection with a certain vice. To this disease gross animal food, particularly swine's flesh, and a dirty skin, have been thought to be predisposing causes: hence the reason, probably, why pork was forbidden, and why ablutions of the body and limbs were so frequently inculcated by the Jewish law. Sir John Pringle's remarks, in his Oration upon Captain Cook's voyage, delivered before the Royal Society, in London, are very pertinent to this part of our subject. "Cleanliness (says he) is conducive to health, but it is not so obvious, that it also tends to good order and other virtues. Such (meaning the ship's crew) as were made more cleanly, became more sober, more orderly, and more attentive to duty." The benefit to be derived by parents and schoolmasters from attending to these facts, is too obvious to be mentioned. 10. I hope I shall be excused in placing SOLITUDE among the physical causes which influence the moral faculty, when I add, that I confine its effects to persons who are irreclaimable by rational or moral remedies. Mr. Howard informs us, that the chaplain of the prison at Leige, in Germany, assured him, "that the most refractory and turbulent spirits became tractable and submissive, by being closely confined for four or five days." In bodies that are predisposed to vice, the stimulus of cheerful, but much more of profane society and conversation, upon the animal spirits, becomes an exciting cause, and, like the stroke of the flint upon the steel, renders the sparks of vice both active and visible. By removing men out of the reach of this exciting cause, they are often reformed, especially if they are confined long enough to produce a sufficient chasm in their habits of vice. Where the benefit of reflection and instruction from books can be added to solitude and confinement, their good effects are still more certain. To this philosophers and poets in every age have assented, by describing the life of a hermit as a life of passive virtue. 11. Connected with solitude, as a mechanical means of promoting virtue, SILENCE deserves to be mentioned in this place. The late Dr. Fothergill, in his plan of education for that benevolent institution at Ackworth, which was the last care of his useful life, says every thing that can be said in favour of this necessary discipline, in the following words: "To habituate children from their early infancy, to silence and attention, is of the greatest advantage to them, not only as a preparative to their advancement in religious life, but as the groundwork of a well cultivated understanding. To have the active minds of children put under a kind of restraint; to be accustomed to turn their attention from external objects, and habituated to a degree of abstracted quiet, is a matter of great consequence, and lasting benefit to them. Although it cannot be supposed, that young and active minds are always engaged in silence as they ought to be, yet to be accustomed thus to quietness, is no small point gained towards fixing a habit of patience, and recollection, which seldom forsakes those who have been properly instructed in this entrance of the school of wisdom, during the residue of their days." For the purpose of acquiring this branch of education, children cannot associate too early, nor too often with their parents, or with their superiors in age, rank, and wisdom. 12. The effects of MUSIC upon the moral faculty, have been felt and recorded in every country. Hence we are able to discover the virtues and vices of different nations, by their tunes, as certainly as by their laws. The effects of music, when simply mechanical, upon the passions, are powerful and extensive. But it remains yet to determine the degrees of moral ecstacy, that may be produced by an attack upon the ear, the reason, and the moral principle, at the same time, by the combined powers of music and eloquence. 13. The ELOQUENCE of the PULPIT is nearly allied to music in its effects upon the moral faculty. It is true, there can be no permanent change in the temper, and moral conduct of a man, that is not derived from the understanding and the will; but we must remember, that these two powers of the mind are most assailable, when they are attacked through the avenue of the passions; and these, we know, when agitated by the powers of eloquence, exert a mechanical action upon every power of the soul. Hence we find in every age and country, where christianity has been propagated, the most accomplished orators have generally been the most successful reformers of mankind. There must be a defect of eloquence in a preacher, who, with the resources for oratory, which are contained in the Old and New Testaments, does not produce in every man who hears him, at least a temporary love of virtue. I grant that the eloquence of the pulpit alone cannot change men into christians, but it certainly possesses the power of changing brutes into men. Could the eloquence of the stage be properly directed, it is impossible to conceive the extent of its mechanical effects upon morals. The language and imagery of a Shakespeare, upon moral and religious subjects, poured upon the passions and the senses, in all the beauty and variety of dramatic representation; who could resist, or describe their effects? 14. ODOURS of various kinds have been observed to act in the most sensible manner upon the moral faculty. Brydone tells us, upon the authority of a celebrated philosopher in Italy, that the peculiar wickedness of the people who live in the neighbourhood of �tna and Vesuvius, is occasioned chiefly by the smell of the sulphur and of the hot exhalations which are constantly discharged from those volcanos. Agreeable odours seldom fail to inspire serenity, and to compose the angry spirits. Hence the pleasure, and one of the advantages of a flower garden. The smoke of tobacco is likewise of a composing nature, and tends not only to produce what is called a train in perception, but to hush the agitated passions into silence and order. Hence the practice of connecting the pipe or segar, and the bottle together, in public company. 15. It will be sufficient only to mention LIGHT and DARKNESS, to suggest facts in favour of the influence of each of them upon moral sensibility. How often do the peevish complaints of the night in sickness, give way to the composing rays of the light of the morning? Othello cannot murder Desdemona by candle-light, and who has not felt the effects of a blazing fire upon the gentle passions? 16. It is to be lamented, that no experiments have as yet been made, to determine the effects of all the different species of AIRS, which chemistry has lately discovered, upon the moral faculty. I have authority from actual experiments, only to declare, that dephlogisticated air, when taken into the lungs, produces cheerfulness, gentleness, and serenity of mind. 17. What shall we say of the effects of MEDICINES upon the moral faculty? That many substances in the materia medica act upon the intellects, is well known to physicians. Why should it be thought impossible for medicines to act in like manner upon the moral faculty? May not the earth contain, in its bowels, or upon its surface, antidotes? But I will not blend facts with conjectures. Clouds and darkness still hang upon this part of my subject. Let it not be suspected, from any thing that I have delivered, that I suppose the influence of physical causes upon the moral faculty, renders the agency of divine influence unnecessary to our moral happiness. I only maintain, that the operations of the divine government are carried on in the moral, as in the natural world, by the instrumentality of second causes. I have only trodden in the footsteps of the inspired writers; for most of the physical causes I have enumerated, are connected with moral precepts, or have been used as the means of reformation from vice, in the Old and New Testaments. To the cases that have been mentioned, I shall only add, that Nebuchadnezzar was cured of his pride, by means of solitude and a vegetable diet. Saul was cured of his evil spirit, by means of David's harp, and St. Paul expressly says, "I keep my body under, and bring it into subjection, lest that by any means, when I have preached to others, I myself should be a cast-away." But I will go one step further, and add in favour of divine influence upon the moral principle, that in those extraordinary cases, where bad men are suddenly reformed, without the instrumentality of physical, moral, or rational causes, I believe that the organization of those parts of the body, in which the faculties of the mind are seated, undergoes a physical change[11]; and hence the expression of a "new creature," which is made use of in the Scriptures to denote this change, is proper in a literal, as well as a figurative sense. It is probably the beginning of that perfect renovation of the human body, which is predicted by St. Paul in the following words: "For our conversation is in heaven, from whence we look for the Saviour, who shall change our vile bodies, that they may be fashioned according to his own glorious body." I shall not pause to defend myself against the charge of enthusiasm in this place; for the age is at length arrived, so devoutly wished for by Dr. Cheyne, in which men will not be deterred in their researches after truth, by the terror of odious or unpopular names. [11] St. Paul was suddenly transformed from a persecutor into a man of a gentle and amiable spirit. The manner in which this change was effected upon his mind, he tells us in the following words: "Neither circumcision availeth any thing, nor uncircumcision, but a new creature. From henceforth let no man trouble me; for I bear in _my body_, the _marks_ of our Lord Jesus." Galatians, vi. 15, 17. I cannot help remarking under this head, that if the conditions of those parts of the human body which are connected with the human soul, influence morals, the same reason may be given for a virtuous education, that has been admitted for teaching music and the pronunciation of foreign languages, in the early and yielding state of those organs which form the voice and speech. Such is the effect of a moral education, that we often see its fruits in advanced stages of life, after the religious principles which were connected with it, have been renounced; just as we perceive the same care in a surgeon in his attendance upon patients, after the sympathy which first produced this care, has ceased to operate upon his mind. The boasted morality of the deists, is, I believe, in most cases, the offspring of habits, produced originally by the principles and precepts of christianity. Hence appears the wisdom of Solomon's advice, "Train up a child in the way he should go, and when he is old he will not," I had almost said, he cannot "depart from it." Thus have I enumerated the principal causes which act mechanically upon morals. If from the combined action of physical powers that are opposed to each other, the moral faculty should become stationary, or if the virtue or vice produced by them, should form a neutral quality, composed of both of them, I hope it will not call in question the truth of our general propositions. I have only mentioned the effects of physical causes in a simple state[12]. [12] The doctrine of the influence of physical causes on morals is happily calculated to beget charity towards the failings of our fellow-creatures. Our duty to practise this virtue is enforced by motives drawn from science, as well as from the precepts of christianity. It might help to enlarge our ideas upon this subject, to take notice of the influence of the different stages of society, of agriculture and commerce, of soil and situation, of the different degrees of cultivation of taste, and of the intellectual powers, of the different forms of government, and lastly, of the different professions and occupations of mankind, upon the moral faculty; but as these act indirectly only, and by the intervention of causes that are unconnected with matter, I conceive they are foreign to the business of the present inquiry. If they should vary the action of the simple physical causes in any degree, I hope it will not call in question the truth of our general propositions, any more than the compound action of physical powers, that are opposed to each other. There remain but a few more causes which are of a compound nature, but they are so nearly related to those which are purely mechanical, that I shall beg leave to trespass upon your patience, by giving them a place in my oration. The effects of imitation, habit, and association upon morals, would furnish ample matter for investigation. Considering how much the shape, texture, and conditions of the human body, influence morals, I submit it to the consideration of the ingenious, whether, in our endeavours to imitate moral examples, some advantage may not be derived, from our copying the features and external manners of the originals. What makes the success of this experiment probable is, that we generally find men, whose faces resemble each other, have the same manners and dispositions. I infer the possibility of success in an attempt to imitate originals in a manner that has been mentioned, from the facility with which domestics acquire a resemblance to their masters and mistresses, not only in manners, but in countenance, in those cases where they are tied to them by respect and affection. Husbands and wives also, where they possess the same species of face, under circumstances of mutual attachment, often acquire a resemblance to each other. From the general detestation in which hypocrisy is held, both by good and bad men, the mechanical effects of habit upon virtue have not been sufficiently explored. There are, I am persuaded, many instances where virtues have been assumed by accident, or necessity, which have become real from habit, and afterwards derived their nourishment from the heart. Hence the propriety of Hamlet's advice to his mother: "Assume a virtue, if you have it not. That monster, Custom, who all sense doth eat Of habits evil, is angel yet in this, That to the use of actions fair and good He likewise gives a frock or livery, That aptly is put on. Refrain to-night, And that shall lend a kind of easiness To the next abstinence; the next more easy: For use can almost change the stamp of nature, And master even the devil, or throw him out, With wondrous potency." The influence of ASSOCIATION upon morals, opens an ample field for inquiry. It is from this principle, that we explain the reformation from theft and drunkenness in servants, which we sometimes see produced by a draught of spirits, in which tartar emetic had been secretly dissolved. The recollection of the pain and sickness excited by the emetic, naturally associates itself with the spirits, so as to render them both equally the objects of aversion. It is by calling in this principle only, that we can account for the conduct of Moses, in grinding the golden calf into a powder, and afterwards dissolving it (probably by means of hepar sulphuris) in water, and compelling the children of Israel to drink of it, as a punishment for their idolatry. This mixture is bitter and nauseating in the highest degree. An inclination to idolatry, therefore, could not be felt without being associated with the remembrance of this disagreeable mixture, and of course being rejected, with equal abhorrence. The benefit of corporal punishments, when they are of a short duration, depends in part upon their being connected, by time and place, with the crimes for which they are inflicted. Quick as the thunder follows the lightning, if it were possible, should punishments follow the crimes, and the advantage of association would be more certain, if the spot where they were committed, were made the theatre of their expiation. It is from the effects of this association, probably, that the change of place and company, produced by exile and transportation, has so often reclaimed bad men, after moral, rational, and physical means of reformation had been used to no purpose. As SENSIBILITY is the avenue to the moral faculty, every thing which tends to diminish it tends also to injure morals. The Romans owed much of their corruption to the sights of the contests of their gladiators, and of criminals, with wild beasts. For these reasons, executions should never be public. Indeed, I believe there are no public punishments of any kind, that do not harden the hearts of spectators, and thereby lessen the natural horror which all crimes at first excite in the human mind. CRUELTY to brute animals is another means of destroying moral sensibility. The ferocity of savages has been ascribed in part to their peculiar mode of subsistence. Mr. Hogarth points out, in his ingenious prints, the connection between cruelty to brute animals in youth, and murder in manhood. The emperor Domitian prepared his mind, by the amusement of killing flies, for all those bloody crimes which afterwards disgraced his reign. I am so perfectly satisfied of the truth of a connection between morals and humanity to brutes, that I shall find it difficult to restrain my idolatry for that legislature, that shall first establish a system of laws, to defend them from outrage and oppression. In order to preserve the vigour of the moral faculty, it is of the utmost consequence to keep young people as ignorant as possible of those crimes that are generally thought most disgraceful to human nature. Suicide, I believe, is often propagated by means of newspapers. For this reason, I should be glad to see the proceedings of our courts kept from the public eye, when they expose or punish monstrous vices. The last mechanical method of promoting morality that I shall mention, is to keep sensibility alive, by a familiarity with scenes of distress from poverty and disease. Compassion never awakens in the human bosom, without being accompanied by a train of sister virtues. Hence the wise man justly remarks, that "By the sadness of the countenance, the heart is made better." A late French writer, in his prediction of events that are to happen in the year 4000, says, "That mankind in that æra shall be so far improved by religion and government, that the sick and the dying shall no longer be thrown, together with the dead, into splendid houses, but shall be relieved and protected in a connection with their families and society." For the honour of humanity, an institution[13], destined for that distant period, has lately been founded in this city, that shall perpetuate the year 1786 in the history of Pennsylvania. Here the feeling heart, the tearful eye, and the charitable hand, may always be connected together, and the flame of sympathy, instead of being extinguished in taxes, or expiring in a solitary blaze by a single contribution, may be kept alive, by constant exercise. There is a necessary connection between animal sympathy, and good morals. The priest and the Levite, in the New Testament, would probably have relieved the poor man who fell among thieves, had accident brought them near enough to his wounds. The unfortunate Mrs. Bellamy was rescued from the dreadful purpose of drowning herself, by nothing but the distress of a child, rending the air with its cries for bread. It is probably owing, in some measure, to the connection between good morals and sympathy that the fair sex, in every age and country, have been more distinguished for virtue, than men; for how seldom do we hear of a woman, devoid of humanity? [13] A public dispensary. Lastly, ATTRACTION, COMPOSITION, and DECOMPOSITION, belong to the passions as well as to matter. Vices of the same species attract each other with the most force: hence the bad consequences of crowding young men, whose propensities are generally the same, under one roof, in our modern plans of education. The effects of composition and decomposition upon vices, appear in the meanness of the school-boy being often cured by the prodigality of a military life, and by the precipitation of avarice, which is often produced by ambition and love. If physical causes influence morals in the manner we have described, may they not also influence religious principles and opinions? I answer in the affirmative; and I have authority, from the records of physic, as well as from my own observations, to declare, that religious melancholy and madness, in all their variety of species, yield with more facility to medicine, than simply to polemical discourses, or to casuistical advice. But this subject is foreign to the business of the present inquiry. From a review of our subject, we are led to contemplate with admiration, the curious structure of the human mind. How distinct are the number, and yet how united! How subordinate, and yet how co-equal are all its faculties! How wonderful is the action of the mind upon the body! of the body upon the mind! and of the Divine Spirit upon both! What a mystery is the mind of man to itself!---- O! Nature!---- or, to speak more properly, O! THOU GOD OF NATURE! in vain do we attempt to scan THY immensity, or to comprehend THY various modes of existence, when a single particle of light, issued from THYSELF, and kindled into intelligence in the bosom of man, thus dazzles and confounds our understandings! The extent of the moral powers and habits in man is unknown. It is not improbable, but the human mind contains principles of virtue, which have never yet been excited into action. We behold with surprise the versatility of the human body in the exploits of tumblers and rope-dancers. Even the agility of a wild beast has been demonstrated in a girl of France, and an amphibious nature has been discovered in the human species, in a young man in Spain. We listen with astonishment to the accounts of the _memories_ of Mithridates, Cyrus, and Servin. We feel a veneration bordering upon divine homage, in contemplating the stupenduous _understandings_ of lord Verulam and sir Isaac Newton; and our eyes grow dim, in attempting to pursue Shakespeare and Milton in their immeasurable flights of _imagination_. And if the history of mankind does not furnish similar instances of the versatility and perfection of our species in virtue, it is because the moral faculty has been the subject of less culture and fewer experiments than the body, and the intellectual faculties of the mind. From what has been said, the reason of this is obvious. Hitherto the cultivation of the moral faculty has been the business of parents, schoolmasters, and divines[14]. But if the principles, we have laid down, be just, the improvement and extension of this principle should be equally the business of the legislator, the natural philosopher, and the physician; and a physical regimen should as necessarily accompany a moral precept, as directions with respect to the air, exercise, and diet, generally accompany prescriptions for the consumption, and the gout. To encourage us to undertake experiments for the improvement of morals, let us recollect the success of philosophy in lessening the number, and mitigating the violence of incurable diseases. The intermitting fever, which proved fatal to two of the monarchs of Britain, is now under absolute subjection to medicine. Continual fevers are much less fatal than formerly. The small-pox is disarmed of its mortality by inoculation, and even the tetanus and the cancer have lately received a check in their ravages upon mankind. But medicine has done more. It has penetrated the deep and gloomy abyss of death, and acquired fresh honours in his cold embraces. Witness the many hundred people who have lately been brought back to life by the successful efforts of the humane societies, which are now established in many parts of Europe, and in some parts of America. Should the same industry and ingenuity, which have produced these triumphs of medicine over diseases and death, be applied to the moral science, it is highly probable, that most of those baneful vices, which deform the human breast, and convulse the nations of the earth, might be banished from the world. I am not so sanguine as to suppose, that it is possible for man to acquire so much perfection from science, religion, liberty, and good government, as to cease to be mortal; but I am fully persuaded, that from the combined action of causes, which operate at once upon the reason, the moral faculty, the passions, the senses, the brain, the nerves, the blood, and the heart, it is possible to produce such a change in his moral character, as shall raise him to a resemblance of angels; nay, more, to the likeness of GOD himself. The state of Pennsylvania still deplores the loss of a man, in whom not only reason and revelation, but many of the physical causes that have been enumerated, concurred to produce such attainments in moral excellency, as have seldom appeared in a human being. This amiable citizen considered his fellow-creature, man, as God's extract, from his own works; and whether this image of himself was cut out from ebony or copper; whether he spoke his own, or a foreign language; or whether he worshipped his Maker with ceremonies, or without them, he still considered him as a brother, and equally the object of his benevolence. Poets and historians, who are to live hereafter, to you I commit his panegyric; and when you hear of a law for abolishing slavery in each of the American states, such as was passed in Pennsylvania, in the year 1780; when you hear of the kings and queens of Europe, publishing edicts for abolishing the trade in human souls; and, lastly, when you hear of schools and churches, with all the arts of civilized life, being established among the nations of Africa, then remember and record, that this revolution in favour of human happiness, was the effect of the labours, the publications, the private letters, and the prayers of ANTHONY BENEZET[15]. [14] The people commonly called Quakers and the Methodists, make use of the greatest number of physical remedies in their religious and moral discipline, of any sects of Christians; and hence we find them every where distinguished for their good morals. There are several excellent _physical_ institutions in other churches; and if they do not produce the same moral effects that we observe from physical institutions among those two modern sects, it must be ascribed to their being more neglected by the members of those churches. [15] This worthy man was descended from an ancient and honourable family that flourished in the court of Louis XIV. With liberal prospects in life he early devoted himself to teaching an English school; in which, for industry, capacity, and attention to the morals and principles of the youth committed to his care, he was without an equal. He published many excellent tracts against the African trade, against war, and the use of spiritous liquors, and one in favour of civilizing and Christianizing the Indians. He wrote to the queen of Great Britain, and the queen of Portugal, to use their influence in their respective courts to abolish the African trade. He also wrote an affectionate letter to the king of Prussia, to dissuade him from making war. The history of his life affords a remarkable instance how much it is possible for an individual to accomplish in the world; and that the most humble stations do not preclude good men from the most extensive usefulness. He bequeathed his estate (after the death of his widow) to the support of a school for the education of negro children, which he had founded and taught for several years before he died. He departed this life in May, 1784, in the 71st year of his age, in the meridian of his usefulness, universally lamented by persons of all ranks and denominations. I return from this digression, to address myself in a particular manner to you, VENERABLE SAGES and FELLOW CITIZENS in the REPUBLIC OF LETTERS. The influence of philosophy, we have been told, has already been felt in courts. To increase, and complete this influence, there is nothing more necessary, than for the numerous literary societies in Europe and America, to add the SCIENCE OF MORALS to their experiments and inquiries. The godlike scheme of Henry IV, of France, and of the illustrious queen Elizabeth, of England, for establishing a perpetual peace in Europe, may be accomplished without a system of jurisprudence, by a confederation of learned men, and learned societies. It is in their power, by multiplying the objects of human reason, to bring the monarchs and rulers of the world under their subjection, and thereby to extirpate war, slavery, and capital punishments, from the list of human evils. Let it not be suspected that I detract, by this declaration, from the honour of the Christian religion. It is true, Christianity was propagated without the aid of human learning; but this was one of those miracles, which was necessary to establish it, and which, by repetition, would cease to be a miracle. They misrepresent the Christian religion, who suppose it to be wholly an internal revelation, and addressed only to the moral faculties of the mind. The truths of Christianity afford the greatest scope for the human understanding, and they will become intelligible to us, only in proportion as the human genius is stretched, by means of philosophy, to its utmost dimensions. Errors may be opposed to errors; but truths, upon all subjects, mutually support each other. And perhaps one reason why some parts of the Christian revelation are still involved in obscurity, may be occasioned by our imperfect knowledge of the phenomena and laws of nature. The truths of philosophy and Christianity dwell alike in the mind of the Deity, and reason and religion are equally the offspring of his goodness. They must, therefore, stand and fall together. By reason, in the present instance, I mean the power of judging of truth, as well as the power of comprehending it. Happy æra! when the divine and the philosopher shall embrace each other, and unite their labours for the reformation and happiness of mankind! ILLUSTRIOUS COUNSELLORS and SENATORS of Pennsylvania[16]! I anticipate your candid reception of this feeble effort to increase the quantity of virtue in our republic. It is not my business to remind you of the immense resources for greatness, which nature and Providence have bestowed upon our state. Every advantage which France has derived from being placed in the centre of Europe, and which Britain has derived from her mixture of nations, Pennsylvania has opened to her. But my business, at present, is to suggest the means of promoting the happiness, not the greatness, of the state. For this purpose, it is absolutely necessary that our government, which unites into one, all the minds of the state, should possess, in an eminent degree, not only the understanding, the passions, and the will, but, above all, the moral faculty and the conscience of an individual. Nothing can be politically right, that is morally wrong; and no necessity can ever sanctify a law, that is contrary to equity. VIRTUE is the soul of a republic. To promote this, laws for the suppression of vice and immorality will be as ineffectual, as the increase and enlargement of jails. There is but one method of preventing crimes, and of rendering a republican form of government durable, and that is, by disseminating the seeds of virtue and knowledge through every part of the state, by means of proper modes and places of education, and this can be done effectually only by the interference and aid of the legislature. I am so deeply impressed with the truth of this opinion, that were this evening to be the last of my life, I would not only say to the asylum of my ancestors, and my beloved native country, with the patriot of Venice, "Esto perpetua," but I would add, as the last proof of my affection for her, my parting advice to the guardians of her liberties, "To establish and support PUBLIC SCHOOLS, in every part of the state." [16] The president, and supreme executive council, and the members of the general assembly of Pennsylvania, attended the delivery of the oration, in the hall of the university, by invitation from the Philosophical Society. AN INQUIRY INTO THE CAUSES AND CURE OF THE _PULMONARY CONSUMPTION_. In an essay, entitled "Thoughts on the Pulmonary Consumption[17]," I attempted to show that this disease was the effect of causes which induced general debility, and that the only hope of discovering a cure for it should be directed to such remedies as act upon the whole system. In the following inquiry, I shall endeavour to establish the truth of each of those opinions, by a detail of facts and reasonings, at which I only hinted in my former essay. [17] Vol. I. p. 199. The method I have chosen for this purpose, is to deliver, and afterwards to support, a few general propositions. I shall begin by remarking, I. That the pulmonary consumption is induced by predisposing debility. This I infer, 1st, From the remote and exciting causes which produce it. The remote causes are pneumony, catarrh, hæmoptysis, rheumatism, gout, asthma, scrophula, chronic diseases of the stomach, liver, and kidneys, nervous and intermitting fevers, measles, repelled humours from the surface of the body, the venereal disease, obstructed menses, sudden growth about the age of puberty, grief, and all other debilitating passions of the mind; hypochondriasis, improper lactation, excessive evacuation of all kinds, more especially by stool[18], cold and damp air, a cough, external violence acting upon the body[19]; and finally, every thing that tends, directly or indirectly, to diminish the strength of the system. [18] Sir George Baker relates, in the second volume of the Medical Transactions, that Dr. Blanchard had informed him, that he had seen the consumption brought on ten persons out of ninety, by excessive purging used to prepare the body for the small-pox. I have seen a case of consumption in a youth of 17, from the spitting produced by the intemperate use of segars. [19] Dr. Lind says, that out of 360 patients whom he attended between July 1st, 1758, and July 1st, 1760, in consumptions, the disease was brought on _one fourth_ of them by falls, bruises, and strains, received a year or two before the disease made its appearance. The most frequent exciting cause of consumption is the alternate application of heat and cold to the whole external surface of the body; but all the remote causes which have been enumerated, operate as exciting causes of consumption, when they act on previous debility. Original injuries of the lungs seldom excite this disease, except they first induce a debility of the whole system, by a troublesome and obstinate cough. 2. From the debilitating occupations and habits of persons who are most liable to this disease. These are studious men, and mechanics who lead sedentary lives in confined places; also women, and all persons of irritable habits, whether of body or mind. 3. From the period in which persons are most liable to be affected by this disease. This is generally between the 18th and 36th year of life, a period in which the system is liable, in a peculiar manner, to most diseases which induce it, and in which there is a greater expenditure of strength, than in any other stage of life, by the excessive exercises of the body and mind, in the pursuits of business or pleasure. I have conformed to authors, in fixing the period of consumptions between the 18th and 36th year of life; but it is well known that it sometimes appears in children, and frequently in persons beyond the 40th, or even 60th year of life. II. The pulmonary consumption is a primary disease of the _whole_ system. This I infer, 1. From the causes which produce it, acting upon the whole system. 2. From the symptoms of general debility which always precede the affection of the lungs. These symptoms are a quick pulse, especially towards evening; a heat and burning in the palms of the hands; faintness, head-ach, sickness at stomach, and an occasional diarrh[oe]a. I have frequently observed each of these symptoms for several months before I have heard of a single complaint in the breast. 3. From the pulmonary consumption alternating with other diseases which obviously belong to the whole system. I shall briefly mention these diseases. The RHEUMATISM. I have seen many cases in which this disease and the consumption have alternately, in different seasons or years, affected the system. In the winter of 1792, three clinical patients in the Pennsylvania hospital exemplified by their complaints the truth of this observation. They were relieved several times of a cough by rheumatic pains in their limbs, which seemed for a while to promise a cure to their pulmonic complaints. The GOUT has often been observed to alternate with the pulmonary consumption, especially in persons in the decline of life. Dr. Sydenham describes a short cough continuing through the whole winter, as a symptom of gouty habits. A gentleman from Virginia died under my care in the spring of 1788, in the 45th year of his age, with all the symptoms of pulmonary consumption, which had frequently alternated with pains and a swelling in his feet. The pulmonary consumption has been observed to alternate with MADNESS. Of this I have seen two instances, in both of which the cough and expectoration were wholly suspended during the continuance of the derangement of the mind. Dr. Mead mentions a melancholy case of the same kind in a young lady, and similar cases are to be met with in other authors. In all of them the disease proved fatal. In one of the cases which came under my notice, the symptoms of consumption returned before the death of the patient. I have likewise witnessed two cases in which the return of reason after madness, was suddenly succeeded by a fatal pulmonary consumption. Perhaps the false hopes, and even the cheerfulness which so universally occur in this disease, may be resolved into a morbid state of the mind, produced by a general derangement of the whole system. So universal are the delusion and hopes of patients, with respect to the nature and issue of this disease, that I have never met with but one man, who, upon being asked what was the matter with him, answered unequivocally, "that he was in a consumption." Again: Dr. Bennet mentions a case of "A phthisical patient, who was seized with a violent PAIN IN THE TEETH for two days, and in whom, during that time, every symptom of a consumption, except the leanness of the body, altogether vanished:" and he adds further, "that a defluction on the lungs had often been relieved by SALIVARY EVACUATIONS[20]." [20] Treatise of the Nature and Cure of Consumptions. Exercitation X. I have seen several instances in which the pulmonary symptoms have alternated with HEADACH and DYSPEPSIA; also with pain and noise in one EAR. This affection of the ears sometimes continues throughout the whole disease, without any remission of the pulmonary symptoms. I have seen one case of a discharge of matter from the left ear, without being accompanied by either pain or noise. In all our books of medicine are to be found cases of consumption alternating with ERUPTIONS ON THE SKIN. And who has not seen the pulmonary symptoms alternately relieved and reproduced by the appearance or cessation of a diarrh[oe]a, or pains in the BOWELS? To these facts I shall only add, under this head, as a proof of the consumption being a disease of the whole system, that it is always more or less relieved by the change which is induced in the system by pregnancy. 4. I infer that the pulmonary consumption is a disease of the whole system from its analogy with several other diseases, which, though accompanied by local affections, are obviously produced by a morbid state of the whole system. The rheumatism, the gout, the measles, small-pox, the different species of cynanche, all furnish examples of the connection of local affections with a general disease; but the APOPLEXY, and the PNEUMONY, furnish the most striking analogies of local affection, succeeding a general disease of the system in the pulmonary consumption. The most frequent predisposing cause of apoplexy is a general debility of the system, produced by intemperance in eating and drinking. The phenomena of the disease are produced by an effusion of blood or serum, in consequence of a morbid distension, or of a rupture of the vessels of the brain. The pulmonary consumption begins and ends in the same way, allowing only for the difference of situation and structure of the brain and lungs. After the production of predisposing debility from the action of the remote causes formerly enumerated, the fluids are determined to the weakest part of the body. Hence effusions of serum or blood take place in the lungs. When serum is effused, a pituitous or purulent expectoration alone takes place; when blood is discharged, a disease is produced which has been called hæmoptysis. An effusion of blood in the brain, brought on by the operation of general debility, has been called by Dr. Hoffman, with equal propriety, a hæmorrhage of the brain. The effusion of blood in the lungs, in consequence of the rupture of a blood-vessel, is less fatal than the same accident when it occurs in the brain, only because the blood in the former case is more easily discharged from the system. Where no rupture of a blood-vessel is produced, death is nearly as speedy and certain in the one case as in the other. Dissections show many cases of suffocation and death, from the lungs being preternaturally filled with blood or serum. From this great analogy between the remote and proximate causes of the two diseases which have been described, I have taken the liberty to call them both by the name of apoplexy. The only symptom which does not accord with the derivation of the term, is, that in the apoplexy of the lungs, the patient does not fall down as if by an external stroke, which is most frequently the case in the apoplexy of the brain. The history of the remote and proximate causes of pneumony will furnish us with a still more remarkable analogy of the connection between a _local_ affection, and a _general_ disease of the system. The pneumony is produced by remote exciting causes which act on the whole system. The whole arterial system is frequently agitated by a fever in this disease before a pain is perceived in the breast or sides, and this fever generally constitutes its strength and danger. The expectoration which terminates the disease in health, is always the effect of effusions produced by a general disease, and even the vomicas, which sometimes succeed a deficiency of bleeding, always depend upon the same general cause. From this view of the analogy between pneumony and pulmonary consumption, it would seem that the two diseases differed from each other only by the shorter or longer operation of the causes which induce them, and by the greater or less violence and duration of their symptoms. The pneumony appears to be an _acute_ consumption, and the consumption a _chronic_ pneumony. From the analogy of the pulmonary consumption with the diminutive term of certain fevers, I have taken the liberty of calling it a PNEUMONICULA. 5. I infer that the pulmonary consumption is a disease of the whole system, from its existence without ulcers in the lungs. Of this there are many cases recorded in books of medicine. Dr. Leigh informs us, in his Natural History of Lancashire, that the consumption was a very common disease on the sea coast of that country; but that it was not accompanied either by previous inflammation or ulcers in the lungs. It was generally attended, he says, by an unusual peevishness of temper. 6. I infer that the pulmonary consumption is a disease of the whole system, from its being relieved, or cured, only by remedies which act upon the whole system. This will appear, I hope, hereafter, when we come to treat of the cure of this disease. Let us now enquire how far the principles I have laid down will apply to the supposed causes of consumption. These causes have been said to be, an abscess in the lungs, hæmoptysis, tubercles, without and with ulcers, catarrh, hereditary diathesis, contagion, and the matter of cutaneous eruptions, or sores repelled, and thrown upon the lungs. I shall make a few observations upon each of them. 1. An abscess in the lungs is generally the consequence of a neglected, or half-cured pneumony. It is seldom fatal, where it is not connected with a predisposition to consumption from general debility, or where general debility is not previously induced by the want of appetite, sleep, and exercise, which sometimes accompany that disease of the lungs. This explanation of the production of consumption by an abscess in the lungs, will receive further support from attending to the effects of wounds in the lungs. How seldom are they followed by pulmonary consumption; and this only because they are as seldom accompanied by predisposing general debility. I do not recollect a single instance of this disease having followed a wound in the lungs, either by the bayonet, or a bullet, during our revolutionary war. The recoveries which have succeeded such wounds, and frequently under the most unfavourable circumstances, show how very improbable it is that a much slighter affection of the lungs should become the cause of a pulmonary consumption. A British officer, whom I met in the British camp, a few days after the battle of Brandywine, in September, 1777, informed me that the surgeon-general of the royal army had assured him, that out of twenty-four soldiers who had been admitted into the hospitals, during the campaign of 1776, with wounds in their lungs, twenty-three of them had recovered. Even primary diseases of the lungs often exist with peculiar violence, or continue for many years without inducing a consumption. I have never known but one instance of the whooping-cough ending in consumption, and all our books of medicine contain records of the asthma continuing for twenty and thirty years without terminating in that disease. The reason in both cases, must be ascribed to those two original diseases of the lungs not being accompanied by general debility. One fact more will serve to throw still further light upon the subject. Millers are much afflicted with a cough from floating particles of flour constantly irritating their lungs, and yet they are not more subject to consumptions than other labouring people. Hence "a miller's cough" is proverbial in some places, to denote a cough of long continuance without danger. 2. The hæmoptysis is either a local disease, or it is the effect of general debility of the whole system. When it is local, or when it is the effect of causes which induce a _temporary_ or _acute_ debility only in the system, it is seldom followed by consumption. The accidental discharge of blood from the lungs, from injuries, and from an obstruction of the menses in women is of this kind. Many persons are affected by this species of hæmorrhage once or twice in their lives, without suffering any inconvenience from it afterwards. I have met with several cases in which it has occurred for many years every time the body was exposed to any of the causes which induce _sudden_ debility, and yet no consumption has followed it. The late king of Prussia informed Dr. Zimmerman that he had been frequently attacked by it during his seven years war, and yet he lived, notwithstanding, above twenty years afterwards without any pulmonary complaints. It is only in persons who labour under _chronic_ debility, that a hæmoptysis is necessarily followed by consumption. 3. I yield to the popular mode of expression when I speak of a consumption being produced by tubercles. But I maintain that they are the _effects_ of general debility communicated to the bronchial vessels which cause them to secrete a preternatural quantity of mucus. This mucus is sometimes poured into the trachea from whence it is discharged by hawking, more especially in the morning; for it is secreted more copiously during the languid hours of sleep than in the day time. But this mucus is frequently secreted into the substance of the lungs, where it produces those tumours we call tubercles. When this occurs, there is either no cough[21] or a very dry one. That tubercles are formed in this way, I infer from the dissections and experiments of Dr. Stark[22], who tells us, that he found them to consist of inorganic matter; that he was unable to discover any connection between them and the pulmonary vessels, by means of the microscope or injections; and that they first opened into the trachea through the bronchial vessels. It is remarkable that the colour and consistence of the matter of which they are composed, is nearly the same as the matter which is discharged through the trachea, in the moist cough which occurs from a relaxation of the bronchial vessels, and which has been called by Dr. Beddoes a bronchial gleet. [21] See Med. Com. Vol. II. [22] Clinical and Anatomical Observations, p. 26, 27. See also Morgagni, letter xxii. 21. I am aware that these tumours in the lungs have been ascribed to scrophula. But the frequent occurrence of consumptions in persons in whom no scrophulous taint existed, is sufficient to refute this opinion. I have frequently directed my inquiries after this disease in consumptive patients, and have met with very few cases which were produced by it. It is probable that it may frequently be a predisposing cause of consumption in Great Britain, but I am sure it is not in the United States. Baron Humboldt informed me, that the scrophula is unknown in Mexico, and yet consumptions, he said, are very common in that part of North-America. That tubercles are the effects, and not the cause of pulmonary consumption, is further evident from similar tumours being suddenly formed on the intestines by the dysentery, and on the omentum by a yellow fever. Cases of the former are to be met with in the dissections of Sir John Pringle, and one of the latter is mentioned by Dr. Mackittrick, in his inaugural dissertation upon the yellow fever, published in Edinburgh in the year 1766[23]. [23] Pages 7, 8. 4. The catarrh is of two kinds, acute and chronic, both of which are connected with general debility, but this debility is most obvious in the chronic catarrh: hence we find it increased by every thing which acts upon the whole system, such as cold and damp weather, fatigue, and, above all, by old age, and relieved or cured by exercise, and every thing else which invigorates the whole system. This species of catarrh often continues for twenty or thirty years without inducing pulmonary consumption, in persons who pursue active occupations. 5. In the hereditary consumption there is either a hereditary debility of the whole system, or a hereditary mal-conformation of the breast. In the latter case, the consumption is the effect of weakness communicated to the whole system, by the long continuance of difficult respiration, or of such injuries being done to the lungs as are incompatible with health and life. It is remarkable, that the consumptive diathesis is more frequently derived from paternal, than maternal ancestors. 6. Physicians, the most distinguished characters, have agreed, that the pulmonary consumption may be communicated by contagion. Under the influence of this belief, Morgagni informs us, that Valsalva, who was predisposed to the consumption, constantly avoided being present at the dissection of the lungs of persons who had died of that disease. In some parts of Spain and Portugal, its contagious nature is so generally believed, that cases of it are reported to the magistrates of those countries, and the clothes of persons who die of it are burned by their orders. The doctrine of nearly all diseases spreading by contagion, required but a short and simple act of the mind, and favoured the indolence and timidity which characterized the old school of medicine. I adopted this opinion, with respect to the consumption, in the early part of my life; but I have lately been led to call its truth in question, especially in the unqualified manner in which it has been taught. In most of the cases in which the disease has been said to be propagated by contagion, its limits are always confined to the members of a single family. Upon examination, I have found them to depend upon some one or more of the following causes: 1. Mal-conformation of the breast, in all the branches of the diseased family. It is not necessary that this organic predisposition should be hereditary. 2. Upon the debility which is incurred by nursing, and the grief which follows the loss of relations who die of it. 3. Upon some local cause undermining the constitutions of a whole family. This may be exhalations from a foul cellar, a privy, or a neighbouring mill-pond, but of so feeble a nature as to produce debility only, with an acute fever, and thus to render the consumption a kind of family epidemic. I was consulted, in the month of August, 1793, by a Mr. Gale, of Maryland, in a pulmonary complaint. He informed me, that he had lost several brothers and sisters with the consumption, and that none of his ancestors had died of it. The deceased persons, five in number, had lived in a place that had been subject to the intermitting fever. 4. Upon some peculiar and unwholesome article of diet, which exerts slowly debilitating effects upon all the branches of a family. 5. Upon a fearful and debilitating apprehension entertained by the surviving members of a family, in which one or two have died of consumption, that they shall perish by the same disease. The effects of all the passions, and especially of fear, acted upon by a lively imagination, in inducing determinations to particular parts of the body, and subsequent disease, are so numerous, as to leave no doubt of the operation of this cause, in producing a number of successive deaths in the same family, from pulmonary consumption. In favour of its depending upon one or more of the above causes, I shall add two remarks. 1. There is often an interval of from two to ten years, between the sickness and deaths which occur in families from consumptions, and this we know never takes place in any disease which is admitted to be contagious. 2. The consumption is not singular in affecting several branches of a family. I was lately consulted by a young physician from Maryland, who informed me, that two of his brothers, in common with himself, were afflicted with epilepsy. Madness, scrophula, and a disposition to hæmorrhage, often affect, in succession, several branches of the same family; and who will say that any one of the above diseases is propagated by contagion? The practice of the Spaniards and Portuguese, in burning the clothes of persons who die of consumptions, no more proves the disease to be contagious, than the same acts sanctioned by the advice or orders of public bodies in the United States, establish the contagious nature of the yellow fever. They are, in both countries, marks of the superstition of medicine. In suggesting these facts, and the inferences which have been drawn from them, I do not mean to deny the possibility of the acrid and f[oe]tid vapour, which is discharged by breathing from an ulcer or abscess in the lungs, nor of the hectic sweats, when rendered putrid by stagnating in sheets, or blankets, communicating this disease to persons who are long exposed to them, by sleeping with consumptive patients; but that such cases rarely occur I infer, from the persons affected often living at a distance from each other, or when they live under the same roof, having no intercourse with the sick. This was the case with the black slaves, who were supposed to have taken the disease from the white branches of a family in Connecticut, and which was mentioned, upon the authority of Dr. Beardsley, in a former edition of this inquiry. Admitting the above morbid matters now and then to act as a remote cause of consumption, it does not militate against the theory I have aimed to establish, for if it follow the analogy of common miasmata and contagions, it must act by first debilitating the whole system. The approach of the jail and bilious fevers is often indicated by general languor. The influenza and the measles are always accompanied by general debility, but the small-pox furnishes an analogy to the case in question more directly in point. The contagion of this disease, whether received by the medium of the air or the skin, never fails of producing weakness in the whole system, before it discovers itself in affections of those parts of the body on which the contagion produced its first operation. 7. I grant that cutaneous humours, and the matter of old sores, when repelled, or suddenly healed, have in some cases fallen upon the lungs, and produced consumption. But I believe, in every case where this has happened, the consumption was preceded by general debility, or that it was not induced, until the whole system had been previously debilitated by a tedious and distressing cough. If the reasonings founded upon the facts which have been mentioned be just, then it follows, III. That the abscess, cough, tubercles, ulcers, and purulent or bloody discharges which occur in the pulmonary consumption, are the _effects_, and not the _causes_ of the disease; and, that all attempts to cure it, by inquiring after tubercles and ulcers, or into the quality of the discharges from the lungs, are as fruitless as an attempt would be to discover the causes or cure of dropsies, by an examination of the qualities of collections of water, or to find out the causes and cure of fevers, by the quantity or quality of the discharges which take place in those diseases from the kidneys and skin. It is to be lamented, that it is not in pulmonary consumption only, that the effects of a disease have been mistaken for its cause. Water in the brain, a membrane in the trachea, and a preternatural secretion of bile, have been accused of producing hydrocephalus internus, cynanche trachealis, and bilious fever, whereas we now know they are the _effects_ of those diseases only, in the successive order in which each of them has been mentioned. It is high time to harness the steeds which drag the car of medicine before, instead of behind it. The earth, in our science, has stood still long enough. Let us at last believe, it revolves round its sun. I admit that the cough, tubercles, and ulcers, after they are formed, increase the danger of a consumption, by becoming new causes of stimulus to the system, but in this they are upon a footing with the water, the membrane, and the bile that have been alluded to, which, though they constitute no part of the diseases that produce them, frequently induce symptoms, and a termination of them, wholly unconnected with the original disease. The tendency of general debility to produce a disease of the lungs appears in many cases, as well as in the pulmonary consumption. Dr. Lind tells us, that the last stage of the jail fever was often marked by a cough. I have seldom been disappointed in looking for a cough and a copious excretion of mucus and phlegm after the 14th or 15th days of the slow nervous fever. Two cases of hypochondriasis under my care, ended in fatal diseases of the lungs. The debility of old age is generally accompanied by a troublesome cough, and the debility which precedes death, generally discovers its last symptoms in the lungs. Hence most people die with what are called the _rattles_. They are produced by a sudden and copious effusion of mucus in the bronchial vessels of the lungs. Sometimes the whole force of the consumptive fever falls upon the trachea instead of the lungs, producing in it defluxion, a hawking of blood, and occasionally a considerable discharge of blood, which are often followed by ulcers, and a spitting of pus. I have called it a _tracheal_, instead of a pulmonary consumption. Many people pass through a long life with a mucous defluxion upon the trachea, and enjoy in other respects tolerable health. In such persons the disease is of a local nature. It is only when it is accompanied with debility of the whole system, that it ends in a consumption. Mr. John Harrison, of the Northern Liberties, died of this disease under my care, in the year 1801, in consequence of the discharge of pus from an ulcer which followed a hæmorrhage from the trachea being suddenly suppressed. I have seen another case of the same kind in a lady in this city, in the year 1797. Dr. Spence, of Dumfries, in Virginia, in a letter which I received from him in June, 1805, describes a case then under his care, of this form of consumption. He calls it, very properly, "phthisis trachealis." I have met with two cases of death from this disease, in which there were tubercles in the trachea. The patients breathed with great difficulty, and spoke only in a whisper. One of them died from suffocation. In the other, the tubercle bursted a few days before his death, and discharged a large quantity of f[oe]tid matter. Should it be asked, why does general debility terminate by a disease in the lungs and trachea, rather than in any other part of the body? I answer, that it seems to be a law of the system, that general debility should always produce some local disease. This local disease sometimes manifests itself in dyspepsia, as in the general debility which follows grief; sometimes it discovers itself in a diarrh[oe]a, as in the general debility which succeeds to fear. Again it appears in the brain, as in the general debility which succeeds intemperance, and the constant or violent exercise of the understanding, or of stimulating passions; but it more frequently appears in the lungs, as the consequence of general debility. It would seem as if the debility in the cases of consumption is seated chiefly in the blood-vessels, while that debility which terminates in diseases of the stomach and bowels, is confined chiefly to the nerves, and that the local affections of the brain arise from a debility, invading alike the nervous and arterial systems. What makes it more probable that the arterial system is _materially_ affected in the consumption is, that the disease most frequently occurs in those periods of life, and in those habits in which a peculiar state of irritability or excitability is supposed to be present in the arterial system; also in those climates in which there are the most frequent vicissitudes in the temperature of the weather. It has been observed, that the debility in the inhabitants of the West-Indies, whether produced by the heat of the climate or the excessive pursuits of business or pleasure, generally terminates in dropsy, or in some disease of the alimentary canal. I have said, that it seemed to be a law of the system, that general debility should always produce some local affection. But to this law there are sometimes exceptions: the atrophy appears to be a consumption without an affection of the lungs. This disease is frequently mentioned by the writers of the 16th and 17th centuries by the name of tabes. I have seen several instances of it in adults, but more in children, and a greater number in the children of black than of white parents. The hectic fever, and even the night sweats, were as obvious in several of these cases, as in those consumptions where general debility had discovered itself in an affection of the lungs. I come now to make a few observations upon the CURE of consumption; and here I hope it will appear, that the theory which I have delivered admits of an early and very important application to practice. If the consumption be preceded by general debility, it becomes us to attempt the cure of it before it produce the active symptoms of cough, bloody or purulent discharges from the lungs, and inflammatory or hectic fever. The symptoms which mark its first stage, are too seldom observed; or if observed, they are too often treated with equal neglect by patients and physicians. I shall briefly enumerate these symptoms. They are a slight fever increased by the least exercise; a burning and dryness in the palms of the hands, more especially towards evening; rheumy eyes upon waking from sleep; an increase of urine; a dryness of the skin, more especially of the feet in the morning[24]; an occasional flushing in one, and sometimes in both cheeks; a hoarseness[25]; a slight or acute pain in the breast; a fixed pain in one side, or shooting pains in both sides; head-ache; occasional sick and fainty fits; a deficiency of appetite, and a general indisposition to exercise or motion of every kind. [24] The three last-mentioned symptoms are taken notice of by Dr. Bennet, in his Treatise upon the Nature and Cure of the Consumption, as _precursors_ of the disease. Dr. Boerhaave used to tell his pupils that they had never deceived him. [25] I have seen the _hoarseness_ in one case the first symptom of approaching consumption. In this symptom it preserves the analogy of pneumony, which often comes on with a hoarseness, and sometimes with paraphonia. It would be easy for me to mention cases in which every symptom that has been enumerated has occurred within my own observation. I wish them to be committed to memory by young practitioners; and if they derive the same advantages from attending to them, which I have done, I am sure they will not regret the trouble they have taken for that purpose. It is probable, while a morbid state of the lungs is supposed to be the proximate cause of this disease, they will not derive much reputation or emolument from curing it in its forming stage; but let them remember, that in all attempts to discover the causes and cures of diseases, which have been deemed incurable, a physician will do nothing effectual until he acquire a perfect indifference to his own interest and fame. The remedies for consumption, in this stage of the disease, are simple and certain. They consist in a desertion of all the remote and exciting causes of the disorder, particularly sedentary employments, damp or cold situations, and whatever tends to weaken the system. When the disease has not yielded to this desertion of its remote and exciting causes, I have recommended the _cold bath_, _steel_, and _bark_ with great advantage. However improper, or even dangerous, these remedies may be after the disease assumes an inflammatory or hectic type, and produces an affection of the lungs, they are perfectly safe and extremely useful in the state of the system which has been described. The use of the bark will readily be admitted by all those practitioners who believe the pulmonary consumption to depend upon a scrophulous diathesis. Should even the lungs be affected by scrophulous tumours, it is no objection to the use of the bark, for there is no reason why it should not be as useful in scrophulous tumours of the lungs, as of the glands of the throat, provided it be given before those tumours have produced inflammation; and in this case, no prudent practitioner will ever prescribe it in scrophula, when seated even in the external parts of the body. To these remedies should be added a diet moderately stimulating, and gentle exercise. I shall hereafter mention the different species of exercise, and the manner in which each of them should be used, so as to derive the utmost advantage from them. I can say nothing of the use of salt water or sea air in this stage of the consumption, from my own experience. I have heard them commended by a physician of Rhode-Island; and if they be used before the disease has discovered itself in pulmonary affections, I can easily conceive they may do service. If the simple remedies which have been mentioned have been neglected, in the first stage of the disease, it generally terminates, in different periods of time, in pulmonary affections, which show themselves under one of the three following forms: 1. A fever, accompanied by a cough, a hard pulse, and a discharge of blood, or mucous matter from the lungs. 2. A fever of the hectic kind, accompanied by chilly fits, and night sweats, and a pulse full, quick, and occasionally hard. The discharges from the lungs, in this state of the disease, are frequently purulent. 3. A fever with a weak frequent pulse, a troublesome cough, and copious purulent discharges from the lungs, a hoarse and weak voice, and chilly fits and night sweats alternating with a diarrh[oe]a. From this short history of the symptoms of pulmonary consumption there are occasional deviations. I have seen four cases, in which the pulse was natural, or slower than natural, to the last day of life. Mrs. Rebecca Smith, the lovely and accomplished wife of Mr. Robert Smith, of this city, passed through the whole course of this disease, in the year 1802, without a single chilly fit. Two other cases have come under my notice, in which there was not only an absence of chills, but of fever and night sweats. A similar case is recorded in the Memoirs of the Medical Society of London; and lastly, I have seen two cases which terminated fatally, in which there was neither cough nor fever for several months. One of them was in Miss Mary Loxley, the daughter of the late Mr. Benjamin Loxley, in the year 1785. She had complained of a pain in her right side, and had frequent chills with a fever of the hectic kind. They all gave way to frequent and gentle bleedings. In the summer of 1786, she was seized with the same complaints, and as she had great objections to bleeding, she consulted a physician who gratified her, by attempting to cure her by recommending exercise and country air. In the autumn she returned to the city, much worse than when she left it. I was again sent for, and found her confined to her bed with a pain in her right side, but without the least cough or fever. Her pulse was preternaturally slow. She could lie only on her left side. She sometimes complained of acute flying pains in her head, bowels, and limbs. About a month before her death, which was on the 3d of May, 1787, her pulse became quick, and she had a little hecking cough, but without any discharge from her lungs. Upon my first visit to her in the preceding autumn, I told her friends that I believed she had an abscess in her lungs. The want of fever and cough afterwards, however, gave me reason to suspect that I had been mistaken. The morning after her death, I received a message from her father, informing me that it had been among the last requests of his daughter, that the cause of her death should be ascertained, by my opening her body. I complied with this request, and, in company with Dr. Hall, examined her thorax. We found the left lobe of the lungs perfectly sound; the right lobe adhered to the pleura, in separating of which, Dr. Hall plunged his hand into a large sac, which contained about half a pint of purulent matter, and which had nearly destroyed the whole substance of the right lobe of the lungs. I have never seen a dry tongue in any of the forms or stages of this disease. The three different forms of the pulmonary affection that I have mentioned, have been distinguished by the names of the first, second, and third stages of the consumption; but as they do not always succeed each other in the order in which they have been mentioned, I shall consider them as different states of the system. The first I shall call the INFLAMMATORY, the second the HECTIC, and the third the TYPHUS state. I have seen the pulmonary consumption come on sometimes with all the symptoms of the second, and sometimes with most of the symptoms of the third state; and I have seen two cases in which a hard pulse, and other symptoms of inflammatory action, appeared in the last hours of life. It is agreeable to pursue the analogy of this disease with a pneumony, or an acute inflammation of the lungs. They both make their first appearance in the same seasons of the year. It is true, the pneumony most frequently attacks with inflammatory symptoms; but it sometimes occurs with symptoms which forbid blood-letting, and I have more than once seen it attended by symptoms which required the use of wine and bark. The pneumony is attended at first by a dry cough, and an expectoration of streaks of blood; the cough in the consumption, in like manner, is at first dry, and attended by a discharge of blood from the lungs, which is more copious than in the pneumony, only because the lungs are more relaxed in the former than in the latter disease. There are cases of pneumony in which no cough attends. I have just now mentioned that I had seen the absence of that symptom in pulmonary consumption. The pneumony terminates in different periods, according to the degrees of inflammation, or the nature of the effusions which take place in the lungs: the same observation applies to the pulmonary consumption. The symptoms of the different forms of pneumony frequently run into each other; so do the symptoms of the three forms of consumption which have been mentioned. In short, the pneumony and consumption are alike in so many particulars, that they appear to resemble shadows of the same substance. They differ only as the protracted shadow of the evening does from that of the noon-day sun. I know that it will be objected here that the consumption is sometimes produced by scrophula, and that this creates an essential difference between it and pneumony. I formerly admitted scrophula to be one of the _remote_ causes of the consumption; but this does not invalidate the parallel which has been given of the two diseases. The phenomena produced in the lungs are the same as to their nature, whether they be produced by the remote cause of scrophula, or by the sudden action of cold and heat upon them. No more happens in the cases of acute and chronic pneumony, than what happens in dysentery and rheumatism. These two last diseases are for the most part so acute, as to confine the patient to his bed or his room, yet we often meet with both of them in patients who go about their ordinary business, and, in some instances, carry their diseases with them for two or three years. The parallel which has been drawn between the pneumony and consumption, will enable us to understand the reason why the latter disease terminates in such different periods of time. The less it partakes of pneumony, the longer it continues, and vice versa. What is commonly called in this country a _galloping_ consumption, is a disease compounded of different degrees of consumption and pneumony. It terminates frequently in two or three months, and without many of the symptoms which usually attend the last stage of pulmonary consumption. But there are cases in which patients in a consumption are suddenly snatched away by an attack of pneumony. I have met with one case only, in which, contrary to my expectation, the patient mended after an attack of an acute inflammation of the lungs, so as to live two years afterwards. It would seem from these facts, as if nature had preferred a certain gradation in diseases, as well as in other parts of her works. There is scarcely a disease in which there is not a certain number of grades, which mark the distance between health and the lowest specific deviation from it. Each of these grades has received different names, and has been considered as a distinct disease, but more accurate surveys of the animal economy have taught us, that they frequently depend upon the same original causes, and that they are only greater or less degrees of the same disease. I shall now proceed to say a few words upon the cure of the different states of pulmonary consumption. The remedies for this purpose are of two kinds, viz. PALLIATIVE and RADICAL. I shall first mention the palliative remedies which belong to each state, and then mention those which are alike proper in them all. The palliative remedies for the I. Or INFLAMMATORY STATE, are I. BLOOD-LETTING. It may seem strange to recommend this debilitating remedy in a disease brought on by debility. Were it proper in this place, I could prove that there is no disease in which bleeding is prescribed, which is not induced by predisposing debility, in common with the pulmonary consumption. I shall only remark here, that in consequence of the exciting cause acting upon the system (rendered extremely excitable by debility) such a morbid and excessive excitement is produced in the arteries, as to render a diminution of the stimulus of the blood absolutely necessary to reduce it. I have used this remedy with great success, in every case of consumption attended by a hard pulse, or a pulse rendered weak by a laborious transmission of the blood through the lungs. In the months of February and March, in the year 1781, I bled a Methodist minister, who was affected by this state of consumption, fifteen times in the course of six weeks. The quantity of blood drawn at each bleeding was never less than eight ounces, and it was at all times covered with an inflammatory crust. By the addition of country air, and moderate exercise, to this copious evacuation, in the ensuing spring he recovered his health so perfectly, as to discharge all the duties of his profession for many years, nor was he ever afflicted afterwards with a disease in his breast. I have, in another instance, bled a citizen of Philadelphia eight times in two weeks, in this state of consumption, and with the happiest effects. The blood drawn at each bleeding was always sizy, and never less in quantity than ten ounces. Mr. Tracey of Connecticut informed me, in the spring of 1802, that he had been bled eighty-five times in six months, by order of his physician, Dr. Sheldon, in the inflammatory state of this disease. He ascribed his recovery chiefly to this frequent use of the lancet. To these cases I might add many others of consumptive persons who have been perfectly cured by frequent, and of many others whose lives have been prolonged by occasional bleedings. But I am sorry to add, that I could relate many more cases of consumptive patients, who have died martyrs to their prejudices against the use of this invaluable remedy. A common objection to it is, that it has been used without success in this disease. When this has been the case, I suspect that it has been used in one of the other two states of pulmonary consumption which have been mentioned, for it has unfortunately been too fashionable among physicians to prescribe the same remedies in every stage and form of the same disease, and this I take to be the reason why the same medicines, which, in the hands of some physicians, are either inert or instruments of mischief, are, in the hands of others, used with more or less success in every case in which they are prescribed. Another objection to bleeding in the inflammatory state of consumption, is derived from the apparent and even sensible weakness of the patient. The men who urge this objection, do not hesitate to take from sixty to a hundred ounces of blood from a patient in a pneumony, in the course of five or six days, without considering that the debility in the latter case is such as to confine a patient to his bed, while, in the former case, the patient's strength is such as to enable him to walk about his house, and even to attend to his ordinary business. The difference between the debility in the two diseases, consists in its being _acute_ in the one, and _chronic_ in the other. It is true, the preternatural or convulsive excitement of the arteries is somewhat greater in the pneumony, than in the inflammatory consumption; but the plethora, on which the necessity of bleeding is partly founded, is certainly greater in the inflammatory consumption than in pneumony. This is evident from women, and even nurses, discharging from four to six ounces of menstrual blood every month, while they are labouring with the most inflammatory symptoms of the disease; nor is it to be wondered at, since the appetite is frequently unimpaired, and the generation of blood continues to be the same as in perfect health. Dr. Cullen recommends the use of bleeding in consumptions, in order to lessen the inflammation of the ulcers in the lungs, and thereby to dispose them to heal. From the testimonies of the relief which bleeding affords in external ulcers and tumours accompanied by inflammation, I am disposed to expect the same benefit from it in inflamed ulcers and tumours in the lungs: whether, therefore, we adopt Dr. Cullen's theory of consumption, and treat it as a local disease, or assent to the one which I have delivered, repeated bleedings appear to be equally necessary and useful. I have seen two cases of inflammatory consumption, attended by a hæmorrhage of a quart of blood from the lungs. I agreed at first with the friends of these patients in expecting a rapid termination of their disease in death, but to the joy and surprise of all connected with them, they both recovered. I ascribed their recovery wholly to the inflammatory action of their systems being suddenly reduced by a spontaneous discharge of blood. These facts, I hope, will serve to establish the usefulness of blood-letting in the inflammatory state of consumption, with those physicians who are yet disposed to trust more to the fortuitous operations of nature, than to the decisions of reason and experience. I have always found this remedy to be more necessary in the winter and first spring months, than at any other season. We obtain by means of repeated bleedings, such a mitigation of all the symptoms as enables the patient to use exercise with advantage as soon as the weather becomes so dry and settled, as to admit of his going abroad every day. The relief obtained by bleeding, is so certain in this state of consumption, that I often use it as a palliative remedy, where I do not expect it will perform a cure. I was lately made happy in finding, that I am not singular in this practice. Dr. Hamilton, of Lynn Regis, used it with success in a consumption, which was the effect of a most deplorable scrophula, without entertaining the least hope of its performing a cure[26]. In those cases where inflammatory action attends the last scene of the disease, there is often more relief obtained by a little bleeding than by the use of opiates, and it is always a more humane prescription, in desperate cases, than the usual remedies of vomits and blisters. [26] Observations on Scrophulous Affections. I once bled a sea captain, whom I had declared to be within a few hours of his dissolution, in order to relieve him of uncommon pain, and difficulty in breathing. His pulse was at the same time hard. The evacuation, though it consisted of but four ounces of blood, had the wished for effect, and his death, I have reason to believe, was rendered more easy by it. The blood, in this case, was covered with a buffy coat. The quantity of blood drawn in every case of inflammatory consumption, should be determined by the force of the pulse, and the habits of the patient. I have seldom taken more than eight, but more frequently but six ounces at a time. It is much better to repeat the bleeding once or twice a week, than to use it less frequently, but in larger quantities. From many years experience of the efficacy of bleeding in this state of consumption, I feel myself authorised to assert, that where a greater proportion of persons die of consumption when it makes its first appearance in the lungs, with symptoms of inflammatory diathesis, than die of ordinary pneumonies (provided exercise be used afterwards), it must, in nine cases out of ten, be ascribed to the ignorance, or erroneous theories of physicians, or to the obstinacy or timidity of patients. In speaking thus confidently of the necessity and benefits of bleeding in the inflammatory state of consumption, I confine myself to observations made chiefly in the state of Pennsylvania. It is possible the inhabitants of European countries and cities, may so far have passed the simple ages of inflammatory diseases, as never to exhibit those symptoms on which I have founded the indication of blood-letting. I suspect moreover that in most of the southern states of America, the inflammatory action of the arterial system is of too transient a nature to admit of the repeated bleedings in the consumption which are used with so much advantage in the middle and northern states. In reviewing the prejudices against this excellent remedy in consumptions, I have frequently wished to discover such a substitute for it as would with equal safety and certainty take down the morbid excitement, and action of the arterial system. At present we know of no such remedy; and until it be discovered, it becomes us to combat the prejudices against bleeding; and to derive all the advantages from it which have been mentioned. 2. A second remedy for the inflammatory state of consumption should be sought for in a MILK and VEGETABLE DIET. In those cases where the milk does not lie easy on the stomach, it should be mixed with water, or it should be taken without its cheesy or oily parts, as in whey, or butter-milk, or it should be taken without skimming; for there are cases in which milk will agree with the stomach in this state, and in no other. The oil of the milk probably helps to promote the solution of its curds in the stomach. It is seldom in the power of physicians to prescribe ass' or goat's milk in this disease; but a good substitute may be prepared for them by adding to cow's milk a little sugar, and a third or fourth part of water, or of a weak infusion of green tea. The quantity of milk taken in a day should not exceed a pint, and even less than that quantity when we wish to lessen the force of the pulse by the abstraction of nourishment. The vegetables which are eaten in this state of the disease, should contain as little stimulus as possible. Rice, in all the ways in which it is usually prepared for aliment, should be preferred to other grains, and the less saccharine fruits to those which abound with sugar. In those cases where the stomach is disposed to dyspepsia, a little salted meat, fish, or oysters, also soft boiled eggs, may be taken with safety, mixed with vegetable aliment. Where there is no morbid affection of the stomach, I have seen the white meats eaten without increasing the inflammatory symptoms of the disease. The transition from a full diet to milk and vegetables should be gradual, and the addition of animal to vegetable aliment, should be made with the same caution. From the neglect of this direction, much error, both in theory and practice, has arisen in the treatment of consumptions. In every case it will be better for the patient to eat four or five, rather than but two or three meals in a day. A less stimulus is by this means communicated to the system, and less chyle is mixed with the blood in a given time. Of so much importance do I conceive this direction to be, that I seldom prescribe for a chronic disease of any kind without enforcing it. 3. VOMITS have been much commended by Dr. Read in this disease. From their indiscriminate use in every state of consumption, I believe they have oftener done harm than good. In cases where a patient objects to bleeding, or where a physician doubts of its propriety, vomits may always be substituted in its room with great advantage. They are said to do most service when the disease is the effect of a catarrh. 4. NITRE, in moderate doses of ten or fifteen grains, taken three or four times a day, has sometimes been useful in this disease; but it has been only when the disease has appeared with inflammatory symptoms. Care should be taken not to persevere too long in the use of this remedy, as it is apt to impair the appetite. I have known one case in which it produced an obstinate dyspepsia, and a disposition to the colic; but it removed, at the same time, the symptoms of pulmonary consumption. 5. COLD and DRY AIR, when combined with the exercise of _walking_, deserves to be mentioned as an antiphlogistic remedy. I have repeatedly prescribed it in this species of the consumption with advantage, and have often had the pleasure of finding a single walk of two or three miles in a clear cold day, produce nearly the same diminution of the force and frequency of the pulse, as the loss of six or eight ounces of blood. I come now to treat of the palliative remedies which are proper in the II. Or HECTIC STATE of consumption. Here we begin to behold the disease in a new and more distressing form than in the state which has been described. There is in this state of consumption the same complication of inflammatory and typhus diathesis which occurs in the typhoid and puerperile fevers, and of course the same difficulty in treating it successfully; for the same remedies do good and harm, according as the former or latter diathesis prevails in the system. All that I shall say upon this state is, that the treatment of it should be accommodated to the predominance of inflammatory or typhus symptoms, for the hectic state presents each of them alternately every week, and sometimes every day to the hand, or eye of a physician. When a hard pulse with acute pains in the side and breast occur, bleeding and other remedies for the inflammatory state must be used; but when the disease exhibits a predominance of typhus symptoms, the remedies for that state to be mentioned immediately, should be prescribed in moderate doses. There are several palliative medicines which have been found useful in the hectic state, but they are such as belong alike to the other two states; and therefore will be mentioned hereafter in a place assigned to them. I am sorry, however, to add, that where bleeding has not been indicated, I have seldom been able to afford much relief by medicine in this state of consumption. I have used alternately the most gentle, and the most powerful vegetable and metallic tonics to no purpose. Even arsenic has failed in my hands of affording the least alleviation of the hectic fever. I conceive the removal of this fever to be the great desideratum in the cure of consumption; and should it be found, after all our researches, to exist only in exercise, it will be no departure from a law of nature, for I believe there are no diseases produced by equal degrees of chronic debility, in which medicines are of any more efficacy, than they are in the hectic fever of the pulmonary consumption. I proceed now to speak of the palliative remedies which are proper in the III. Or TYPHUS STATE of the pulmonary consumption. The first of these are STIMULATING MEDICINES. However just the complaints of Dr. Fothergill may be against the use of balsams in the inflammatory and mixed states of consumption, they appear to be not only safe, but useful likewise, in mitigating the symptoms of weak morbid action in the arterial system. I have therefore frequently prescribed opium, the balsam of copaivæ, of Peru, the oil of amber, and different preparations of turpentine and tar, in moderate doses, with obvious advantage. Garlic, elixir of vitriol, the juice of dandelion, a strong tea made of horehound, and a decoction of the inner bark of the wild cherry tree[27], also bitters of all kinds, have all been found safe and useful tonics in this state of consumption. Even the Peruvian bark and the cold bath, so often and so generally condemned in consumptions, are always innocent, and frequently active remedies, where there is a total absence of inflammatory diathesis in this disease. The bark is said to be most useful when the consumption is the consequence of an intermitting fever, and when it occurs in old people. With these remedies should be combined 2. A CORDIAL and STIMULATING DIET. Milk and vegetables, so proper in the inflammatory, are improper, when taken alone, in this state of consumption. I believe they often accelerate that decay of appetite and diarrh[oe]a, which form the closing scene of the disease. I have lately seen three persons recovered from the lowest stage of this state of consumption, by the use of animal food and cordial drinks, aided by frequent doses of opium, taken during the day as well as in the night. I should hesitate in mentioning these cures, had they not been witnessed by more than a hundred students of medicine in the Pennsylvania hospital. The history of one of them is recorded in the 5th volume of the New-York Medical Repository, and of the two others in Dr. Coxe's Medical Museum. Oysters, it has been said, have performed cures of consumption. If they have, it must have been only when they were eaten in that state of it which is now under consideration. They are a most savoury and wholesome article of diet, in all diseases of weak morbid action. To the cordial articles of diet belong sweet vegetable matters. Grapes, sweet apples, and the juice of the sugar maple tree, when taken in large quantities, have all cured this disease. They all appear to act by filling the blood-vessels, and thereby imparting tone to the whole system. I have found the same advantage from dividing the meals in this state of consumption, that I mentioned under a former head. The exhibition of food in this case, should not be left to the calls of appetite, any more than the exhibition of a medicine. Indeed food may be made to supply the place of cordial medicines, by keeping up a constant and gentle action in the whole system. For this reason, I have frequently advised my patients never to suffer their stomachs to be empty, even for a single hour. I have sometimes aimed to keep up the influence of a gentle action in the stomach upon the whole system, by advising them to eat in the night, in order to obviate the increase of secretion into the lungs and of the cough in the morning, which are brought on in part by the increase of debility from the long abstraction of the stimulus of aliment during the night. [27] Prunus Virginiana. However safe, and even useful, the cordial medicines and diet that have been mentioned may appear, yet I am sorry to add, that we seldom see any other advantages from them than a mitigation of distressing symptoms, except when they have been followed by suitable and long continued exercise. Even under this favourable circumstance, they are often ineffectual; for there frequently occurs, in this state of consumption, such a destruction of the substance and functions of the lungs, as to preclude the possibility of a recovery by the use of any of the remedies which have been discovered. Perhaps, where this is not the case, their want of efficacy may be occasioned by their being given before the pulse is completely reduced to a typhus state. The weaker the pulse, the greater is the probability of benefit being derived from the use of cordial diet and medicines. I have said formerly, that the three states of consumption do not observe any regular course in succeeding each other. They are not only complicated in some instances, but they often appear and disappear half a dozen times in the course of the disease, according to the influence of the weather, dress, diet, and the passions upon the system. The great secret, therefore, of treating this disease consists in accommodating all the remedies that have been mentioned to the predominance of any of the three different states of the system, as manifested chiefly by the pulse. It is in consequence of having observed the evils which have resulted from the ignorance or neglect of this practice, that I have sometimes wished that it were possible to abolish the seducing nomenclature of diseases altogether, in order thereby to oblige physicians to conform exactly to the fluctuating state of the system in all their prescriptions; for it is not more certain, that, in all cultivated languages, every idea has its appropriate word, than that every state of a disease has its appropriate dose of medicine, the knowledge and application of which can alone constitute rational, or secure uniformly successful practice. I come now to say a few words upon those palliative remedies which are alike proper in every state of the pulmonary consumption. The first remedy under this head is a DRY SITUATION. A damp air, whether breathed in a room, or out of doors, is generally hurtful in every form of this disease. A kitchen, or a bed-room, below the level of the ground, has often produced, and never fails to increase, a pulmonary consumption. I have often observed a peculiar paleness (the first symptom of general debility) to show itself very early in the faces of persons who work or sleep in cellar kitchens or shops. 2. COUNTRY AIR. The higher and drier the situation which is chosen for the purpose of enjoying the benefit of this remedy, the better. Situations exposed to the sea, should be carefully avoided; for it is a singular fact, that while consumptive persons are benefited by the sea-air, when they breathe it on the ocean, they are always injured by that portion of it which they breathe on the sea-shore. To show its influence, not only in aggravating consumptions, but in disposing to them, and in adding to the mortality of another disease of the lungs, I shall subjoin the following facts. From one fourth to one half of all the adults who die in Great Britain, Dr. Willan says, perish with this disease. In Salem, in the state of Massachusetts, which is situated near the sea, and exposed, during many months in the year, to a moist east wind, there died, in the year 1799, one hundred and sixty persons; fifty-three died of the consumption, making in all nearly one third of all the inhabitants of the town. Eight more died of what is called a lung fever, probably of what is called in Pennsylvania the galloping grade of that disease. Consumptions are more frequent in Boston, Rhode-Island, and New-York, from their damp winds, and vicinity to the sea-shore, than they are in Philadelphia. In the neighbourhood of Cape May, which lies near the sea-shore of New-Jersey, there are three religious societies, among whom the influenza prevailed in the year 1790. Its mortality, under equal circumstances, was in the exact ratio to their vicinity to the sea. The deaths were most numerous in that society which was nearest to it, and least so in that which was most remote from it. These unfriendly effects of the sea air, in the above pulmonary diseases, do not appear to be produced simply by its moisture. Consumptions are scarcely known in the moist atmosphere which so generally prevails in Lincolnshire, in England, and in the inland parts of Holland and Ireland. I shall not pause to inquire, why a mixture of land and sea air is so hurtful in the consumption, and at the same time so agreeable to persons in health, and so medicinal in many other diseases, but shall dismiss this head by adding a fact which was communicated to me by Dr. Matthew Irvine, of South-Carolina, and that is, That those situations which are in the neighbourhood of bays or rivers, where the salt and fresh waters mix their streams together, are more unfavourable to consumptive patients than the sea-shore, and therefore should be more carefully avoided by them in exchanging city for country air. 3. A CHANGE OF CLIMATE. It is remarkable that climates uniformly cold or warm, which seldom produce consumptions, are generally fatal to persons who visit them in that disease. Countries between the 30th and 40th degrees of latitude are most friendly to consumptive people. 4. LOOSE DRESSES, AND A CAREFUL ACCOMMODATION OF THEM TO THE CHANGES IN THE WEATHER. Many facts might be mentioned to show the influence of compression and of tight ligatures of every kind, upon the different parts of the body; also of too much, or too little clothing, in producing, or increasing diseases of every kind, more especially those which affect the lungs. Tight stays, garters, waistbands, and collars, should all be laid aside in the consumption, and the quality of the clothing should be suited to the weather. A citizen of Maryland informed me, that he twice had a return of a cough and spitting of blood, by wearing his summer clothes a week after the weather became cool in the month of September. But it is not sufficient to vary the weight or quality of dress with the seasons. It should be varied with the changes which take place in the temperature of the air every day, even in the summer months, in middle latitudes. I know a citizen of Philadelphia, who has laboured under a consumptive diathesis near thirty years, who believes that he has lessened the frequency and violence of pulmonic complaints during that time, by a careful accommodation of his dress to the weather. He has been observed frequently to change his waistcoat and small clothes twice or three times in a day, in a summer month. A repetition of colds, and thereby an increase of the disease, will be prevented by wearing flannel next to the skin in winter, and muslin in the summer, either in the form of a shirt or a waistcoat: where these are objected to, a piece of flannel, or of soft sheepskin, should be worn next to the breast. They not only prevent colds, but frequently remove chronic pains from that part of the body. 5. ARTIFICIAL EVACUATIONS, by means of BLISTERS and ISSUES. I suspect the usefulness of these remedies to be chiefly confined to the inflammatory and hectic states of consumption. In the typhus state, the system is too weak to sustain the discharges of either of them. Fresh blisters should be preferred to such as are perpetual, and the issues, to be useful, should be large. They are supposed to afford relief by diverting a preternatural secretion and excretion of mucus or pus from the lungs, to an artificial emunctory in a less vital part of the body. Blisters do most service when the disease arises from repelled eruptions, and when they are applied between the shoulders, and the upper and internal parts of the arms. When it arises from rheumatism and gout, the blisters should be applied to the joints, and such other external parts of the body as had been previously affected by those diseases. 6. Certain FUMIGATIONS and VAPOURS. An accidental cure of a pulmonary affection by the smoke of rosin, in a man who bottled liquors, raised for a while the credit of fumigations. I have tried them, but without much permanent effect. I think I have seen the pain in the breast relieved by receiving the vapour from a mixture of equal parts of tar, bran, and boiling water into the lungs. The sulphureous and saline air of Stabiæ, between Mount Vesuvius and the Mediterranean Sea, and the effluvia of the pine forests of Lybia, were supposed, in ancient times, to be powerful remedies in consumptive complaints; but it is probable, the exercise used in travelling to those countries, contributed chiefly to the cures which were ascribed to foreign matters acting upon the lungs. 7. LOZENGES, SYRUPS, and DEMULCENT TEAS. These are too common and too numerous to be mentioned. 8. OPIATES. It is a mistake in practice, founded upon a partial knowledge of the qualities of opium, to administer it only at night, or to suppose that its effects in composing a cough depend upon its inducing sleep. It should be given in small doses during the day, as well as in larger ones at night. The dose should be proportioned to the degrees of action in the arterial system. The less this action, the more opium may be taken with safety and advantage. 9. DIFFERENT POSITIONS OF THE BODY have been found to be more or less favourable to the abatement of the cough. These positions should be carefully sought for, and the body kept in that which procures the most freedom from coughing. I have heard of an instance in which a cough, which threatened a return of the hæmorrhage from the lungs, was perfectly composed for two weeks, by keeping the patient nearly in one posture in bed; but I have known more cases in which relief from coughing was to be obtained only by an erect posture of the body. 10. Considerable relief will often be obtained from the patient's SLEEPING BETWEEN BLANKETS in winter, and on a MATTRASS in summer. The former prevent fresh cold from night sweats; the latter frequently checks them altogether. In cases where a sufficient weight of blankets to keep up an agreeable warmth cannot be borne, without restraining easy and full acts of inspiration, the patient should sleep under a light feather bed, or an eider down coverlet. They both afford more warmth than double or treble their weight of blankets. However comfortable this mode of producing warmth in bed may be, it does not protect the lungs from the morbid effects of the distant points of temperature of a warm parlour in the day time, and a cold bed-chamber at night. To produce an equable temperature of air at all hours, I have frequently advised my patients, when going to a warm climate was not practicable, to pass their nights as well as days in an open stove room, in which nearly the same degrees of heat were kept up at all hours. I have found this practice, in several cases, a tolerable substitute for a warm climate. 11. The MODERATE use of the lungs, in READING, PUBLIC SPEAKING, LAUGHING, and SINGING. The lungs, when debilitated, derive equal benefit with the limbs, or other parts of the body, from moderate exercise. I have mentioned, in another place[28], several facts which support this opinion. But too much pains cannot be taken to inculcate upon our patients to avoid all _excess_ in the use of the lungs, by _long_, or _loud_ reading, speaking, or singing, or by sudden and violent _bursts_ of laughter. I shall long lament the death of a female patient, who had discovered many hopeful signs of a recovery from a consumption, who relapsed, and died, in consequence of bursting a blood-vessel in her lungs, by a sudden fit of laughter. [28] An Account of the Effects of Common Salt in the Cure of Hæmoptysis. 12. Are there any advantages to be derived from the excitement of certain PASSIONS in the treatment of consumptions? Dr. Blane tells us, that many consumptive persons were relieved, and that some recovered, in consequence of the terror which was excited by a hurricane in Barbadoes, in the year 1780. It will be difficult to imitate, by artificial means, the accidental cures which are recorded by Dr. Blane; but we learn enough from them to inspire the invigorating passions of hope and confidence in the minds of our patients, and to recommend to them such exercises as produce exertions of body and mind analogous to those which are produced by terror. Van Sweiten and Smollet relate cures of consumptions, by patients falling into streams of cold water. Perhaps, in both instances, the cures were performed only by the fright and consequent exertion produced by the fall. This is only one instance out of many which might be mentioned, of partial and unequal action being suddenly changed into general and equal excitement in every part of the system. The cures of consumptions which have been performed by a camp life[29], have probably been much assisted by the commotions in the passions which were excited by the various and changing events of war. [29] Vol. I. p. 204. 13. A SALIVATION has lately been prescribed in this disease with success. An accident first suggested its advantages, in the Pennsylvania hospital, in the year 1800[30]. Since that time, it has performed many cures in different parts of the United States. It is to be lamented, that in a majority of the cases in which the mercury has been given, it has failed of exciting a salivation. Where it affects the mouth, it generally succeeds in recent cases, which is more than can be said of any, or of all other remedies in this disease. In its hectic state, a salivation frequently cures, and even in its typhus and last stage, I have more than once prescribed it with success. The same regard to the pulse should regulate the use of this new remedy in consumption, that has been recommended in other febrile diseases. It should never be advised until the inflammatory diathesis of the system has been in a great degree reduced, by the depleting remedies formerly mentioned. [30] Medical Repository of New-York. Vol. V. During the use of the above remedies, great care should be taken to relieve the patient from the influence of all those debilitating and irritating causes which induced the disease. I shall say elsewhere that decayed teeth are one of them. These should be extracted where there is reason to suspect they have produced, or that they increase the disease. I have hitherto said nothing of the digitalis as a palliative remedy in pulmonary consumption. I am sorry to acknowledge that, in many cases in which I have prescribed it, it has done no good, and in some it has done harm. From the opposite accounts of physicians of the most respectable characters of the effects of this medicine, I have been inclined to ascribe its different issues, to a difference in the soil in which it has been cultivated, or in the times of gathering, or in the manner of preparing it, all of which we know influence the qualities of many other vegetables. If the theory of consumption which I have endeavoured to establish be admitted, that uncertain and unsafe medicine will be rendered unnecessary by the remedies that have been enumerated, provided they are administered at the times, and in the manner that has been recommended. Before I proceed to speak of the radical cure of the consumption, it will be necessary to observe, that by means of the palliative remedies which have been mentioned, many persons have been recovered, and some have had their lives prolonged by them for many years; but in most of these cases I have found, upon inquiry, that the disease recurred as soon as the patient left off the use of his remedies, unless they were followed by necessary or voluntary exercise. It is truly surprising to observe how long some persons have lived who have been affected by a consumptive diathesis, and by frequent attacks of many of the most troublesome symptoms of this disease. Van Sweiten mentions the case of a man, who had lived thirty years in this state. Morton relates the history of a man, in whom the symptoms of consumption appeared with but little variation or abatement from his early youth till the 70th year of his age. The widow of the celebrated Senac lived to be 84 years of age, thirty of which she passed in a pulmonary consumption. Dr. Nicols was subject to occasional attacks of this disease during his whole life, and he lived to be above eighty years of age. Bennet says he knew an instance in which it continued above sixty years. I prescribed for my first pupil, Dr. Edwards, in a consumption in the year 1769. He lived until 1802, and seldom passed a year without spitting blood, nor a week without a cough, during that long interval of time. The fatal tendency of his disease was constantly opposed by occasional blood-letting, rural exercises, a cordial, but temperate diet, the Peruvian bark, two sea voyages, and travelling in foreign countries. There are besides these instances of long protracted consumptions, cases of it which appear in childhood, and continue for many years. I have seldom known them prove fatal under puberty. I am led here to mention another instance of the analogy between pneumony and the pulmonary consumption. We often see the same frequency of recurrence of both diseases in habits which are predisposed to them. I have attended a German citizen of Philadelphia, in several fits of the pneumony, who has been confined to his bed eight-and-twenty times, by the same disease, in the course of the same number of years. He has, for the most part, enjoyed good health in the intervals of those attacks, and always appeared, till lately, to possess a good constitution. In the cases of the frequent recurrence of pneumony, no one has suspected the disease to have originated exclusively in a morbid state of the lungs; on the contrary, it appears evidently to be produced by the _sudden_ influence of the same causes, which, by acting with less force, and for a _longer_ time, produce the pulmonary consumption. The name of pneumony is taken from the principal symptom of this disease, but it as certainly belongs to the whole arterial system as the consumption; and I add further, that it is as certainly produced by general predisposing debility. The hardness and fulness of the pulse do not militate against this assertion, for they are altogether the effects of a morbid and convulsive excitement of the sanguiferous system. The strength manifested by the pulse is moreover partial, for every other part of the body discovers, at the same time, signs of extreme debility. It would be easy, by pursuing this subject a little further, to mention a number of facts which, by the aid of principles in physiology and pathology, which are universally admitted, would open to us a new theory of fevers, but this would lead us too far from the subject before us. I shall only remark, that all that has been said of the influence of _general_ debilitating causes upon the lungs, both in pneumony and consumption, and of the alternation of the consumption with other general diseases, will receive great support from considering the lungs only as a part of the whole external surface of the body, upon which most of the remote and exciting causes of both diseases produce their first effects. This extent of the surface of the body, not only to the lungs, but to the alimentary canal, was first taken notice of by Dr. Boerhaave; but was unhappily neglected by him in his theories of the diseases of the lungs and bowels. Dr. Keil supposes that the lungs, from the peculiar structure of the bronchial vessels, and air vesicles, expose a surface to the action of the air, equal to the extent of the whole external and visible surface of the body. Thus have I mentioned the usual palliative remedies for the consumption. Many of these remedies, under certain circumstances, I have said have cured the disease, but I suspect that most of these cures have taken place only when the disease has partaken of an intermediate nature between a pneumony and a true pulmonary consumption. Such connecting shades, appear between the extreme points of many other diseases. In a former essay[31], I endeavoured to account for the transmutation (if I may be allowed the expression) of the pneumony into the consumption, by ascribing it to the increase of the debilitating refinements of civilized life. This opinion has derived constant support from every observation I have made connected with this subject, since its first publication, in the year 1772. [31] Inquiry into the Diseases and Remedies of the Indians of North-America; and a comparative view of their diseases and remedies with those of civilized nations. Vol. I. I come now to treat of the RADICAL REMEDIES for the pulmonary consumption. In an essay formerly alluded to[32], I mentioned the effects of labour, and the hardships of a camp or naval life, upon this disease. As there must frequently occur such objections to each of those remedies, as to forbid their being recommended or adopted, it will be necessary to seek for substitutes for them in the different species of exercise. These are, _active_, _passive_, and _mixed_. The _active_ includes walking, and the exercise of the hands and feet in working or dancing. The _passive_ includes rocking in a cradle, swinging, sailing, and riding in carriages of different kinds. The _mixed_ is confined chiefly to riding on horseback. [32] Thoughts on the Pulmonary Consumption. Vol. I. I have mentioned all the different species of exercise, not because I think they all belong to the class of radical remedies for the consumption, but because it is often necessary to use those which are passive, before we recommend those of a mixed or active nature. That physician does not err more who advises a patient to take physic, without specifying its qualities and doses, than the physician does who advises a patient, in a consumption, to use exercise, without specifying its species and degrees. From the neglect of this direction, we often find consumptive patients injured instead of being relieved by exercises, which, if used with judgment, might have been attended with the happiest effects. I have before suggested that the stimulus of every medicine, which is intended to excite action in the system, should always be in an exact ratio to its excitability. The same rule should be applied to the stimulus of exercise. I have heard a well-attested case of a young lady, upon whose consumption the first salutary impression was made by rocking her in a cradle; and I know another case in which a young lady, in the lowest state of that debility which precedes an affection of the lungs, was prepared for the use of the mixed and active exercises, by being first moved gently backwards and forwards in a chariot without horses, for an hour every day. Swinging appears to act in the same gentle manner. In the case of a gardener, who was far advanced in a consumption, in the Pennsylvania hospital, I had the pleasure of observing its good effects, in an eminent degree. It so far restored him, as to enable him to complete his recovery by working at his former occupation. In cases of extreme debility, the following order should be recommended in the use of the different species of exercise. 1. Rocking in a cradle, or riding on an elastic board, commonly called a chamber-horse. 2. Swinging. 3. Sailing. 4. Riding in a carriage. 5. Riding on horseback. 6. Walking. 7. Running and dancing. In the use of each of those species of exercise great attention should be paid to the _degree_ or _force_ of action with which they are applied to the body. For example, in riding in a carriage, the exercise will be less in a four-wheel carriage than in a single horse chair, and less when the horses move in a walking, than a trotting gait. In riding on horseback, the exercise will be less or greater according as the horse walks, paces, canters, or trots, in passing over the ground. I have good reason to believe, that an English sea-captain, who was on the verge of the grave with the consumption, in the spring of the year 1790, owed his perfect recovery to nothing but the above gradual manner, in which, by my advice, he made use of the exercises of riding in a carriage and on horseback. I have seen many other cases of the good effects of thus accommodating exercise to debility; and I am sorry to add, that I have seen many cases in which, from the neglect of this manner of using exercise, most of the species and degrees of it, have either been useless, or done harm. However carelessly this observation may be read by physicians, or attended to by patients, I conceive no direction to be more necessary in the cure of consumptions. I have been thus particular in detailing it, not only because I believe it to be important, but that I might atone to society for that portion of evil which I might have prevented by a more strict attention to it in the first years of my practice. The more the arms are used in exercise the better. One of the proprietary governors of Pennsylvania, who laboured for many years under consumptive diathesis, derived great benefit from frequently rowing himself in a small boat, a few miles up and down the river Schuylkill. Two young men, who were predisposed to a consumption, were perfectly cured by working steadily at a printing press in this city. A French physician in Martinique cured this disease, by simply rubbing the arms between the shoulders and the elbows, until they inflamed. The remedy is strongly recommended, by the recoveries from pulmonary consumption which have followed abscesses in the arm-pits. Perhaps the superior advantages of riding on horseback, in this disease, may arise in part from the constant and gentle use of the arms in the management of the bridle and the whip. Much has been said in favour of sea voyages in consumptions. In the mild degrees of the disease they certainly have done service, but I suspect the relief given, or the cures performed by them, should be confined chiefly to seafaring people, who add to the benefits of a constant change of pure air, a share of the invigorating exercises of navigating the ship. I have frequently heard of consumptive patients reviving at sea, probably from the transient effects of sea sickness upon the whole system, and growing worse as soon as they came near the end of their voyage. It would seem as if the mixture of land and sea airs was hurtful to the lungs, in every situation and condition in which it could be applied to them. Nor are the peculiar and morbid effects of the first operation of land and sea airs upon the human body, in sea voyages, confined only to consumptive people. I crossed the Atlantic ocean, in the year 1766, with a sea captain, who announced to his passengers the agreeable news that we were near the British coast, before any discovery had been made of our situation by sounding, or by a change in the colour of the water. Upon asking him upon what he founded his opinion, he said, that he had been sneezing, which, he added, was the sign of an approaching cold, and that, in the course of upwards of twenty years, he had never made the land (to use the seaman's phrase) without being affected in a similar manner. I have visited many sick people in Philadelphia, soon after their arrival from sea, who have informed me, that they had enjoyed good health during the greatest part of their voyage, and that they had contracted their indispositions after they came within sight of the land. I mention these facts only to show the necessity of advising consumptive patients, who undertake a sea voyage for the recovery of their health, not to expose themselves upon deck in the morning and at night, after they arrive within the region in which the mixture of the land and sea airs may be supposed to take place. I subscribe, from what I have observed, to the bold declaration of Dr. Sydenham, in favour of the efficacy of riding on horseback, in the cure of consumption. I do not think the existence of an abscess, when broken, or even tubercles in the lungs, when recent, or of a moderate size, the least objection to the use of this excellent remedy. An abscess in the lungs is not necessarily fatal, and tubercles have no malignity in them which should render their removal impracticable by this species of exercise. The first question, therefore, to be asked by a physician who visits a patient in this disease should be, not what is the state of his lungs, but, is he able to ride on horseback. There are two methods of riding for health in this disease. The first is by short excursions; the second is by long journies. In slight consumptive affections, and after a recovery from an acute illness, short excursions are sufficient to remove the existing debility; but in the more advanced stages of consumption, they are seldom effectual, and frequently do harm, by exciting an occasional appetite without adding to the digestive powers. They, moreover, keep the system constantly vibrating by their unavoidable inconstancy, between distant points of tone and debility[33], and they are unhappily accompanied at all times, from the want of a succession of fresh objects to divert the mind, by the melancholy reflection that they are the sad, but necessary conditions of life. [33] The bad effects of _inconstant_ exercise have been taken notice of in the gout. Dr. Sydenham says, when it is used only by fits and starts in this disease, it does harm. In a consumption of long continuance or of great danger, long journies on horseback are the most effectual modes of exercise. They afford a constant succession of fresh objects and company, which divert the mind from dwelling upon the danger of the existing malady; they are moreover attended by a constant change of air, and they are not liable to be interrupted by company, or transient changes in the weather, by which means appetite and digestion, action and power, all keep pace with each other. It is to be lamented that the use of this excellent remedy is frequently opposed by indolence and narrow circumstances in both sexes, and by the peculiarity of situation and temper in the female sex. Women are attached to their families by stronger ties than men. They cannot travel alone. Their delicacy, which is increased by sickness, is liable to be offended at every stage; and, lastly, they sooner relax in their exertions to prolong their lives than men. Of the truth of the last observation, sir William Hamilton has furnished us with a striking illustration. He tells us, that in digging into the ruins produced by the late earthquake in Calabria, the women who perished in it, were all found with their arms folded, as if they had abandoned themselves immediately to despair and death; whereas, the men were found with their arms extended, as if they had resisted their fate to the last moment of their lives. It would seem, from this fact, and many others of a similar nature which might be related, that a capacity of bearing pain and distress with fortitude and resignation, was the distinguishing characteristic of the female mind; while a disposition to resist and overcome evil, belonged in a more peculiar manner to the mind of man. I have mentioned this peculiarity of circumstances and temper in female patients, only for the sake of convincing physicians that it will be necessary for them to add all the force of eloquence to their advice, when they recommend journies to women in preference to all other remedies, for the recovery of their health. Persons, moreover, who pursue active employments, frequently object to undertaking journies, from an opinion that their daily occupations are sufficient to produce all the salutary effects we expect from artificial exercise. It will be highly necessary to correct this mistake, by assuring such persons that, however useful the habitual exercise of an active, or even a laborious employment may be to _preserve_ health, it must always be exchanged for one which excites new impressions, both upon the mind and body, in every attempt to _restore_ the system from that debility which is connected with pulmonary consumption. As travelling is often rendered useless, and even hurtful in this disease, from being pursued in an improper manner, it will be necessary to furnish our patients with such directions as will enable them to derive the greatest benefit from their journies. I shall, therefore, in this place, mention the substance of the directions which I have given in writing for many years to such consumptive patients as undertake journies by my advice. 1. To avoid fatigue. Too much cannot be said to enforce this direction. It is the hinge on which the recovery or death of a consumptive patient frequently turns. I repeat it again, therefore, that patients should be charged over and over when they set off on a journey, as well as when they use exercise of any kind, to avoid fatigue. For this purpose they should begin by travelling only a few miles in a day, and increase the distance of their stages, as they increase their strength. By neglecting this practice, many persons have returned from journies much worse than when they left home, and many have died in taverns, or at the houses of their friends on the road. Travelling in stage-coaches is seldom safe for a consumptive patient. They are often crowded; they give too much motion; and they afford by their short delays and distant stages, too little time for rest, or for taking the frequent refreshment which was formerly recommended. 2. To avoid travelling too soon in the morning, and after the going down of the sun in the evening, and, if the weather be hot, never to travel in the middle of the day. The sooner a patient breakfasts after he leaves his bed the better; and in no case should he leave his morning stage with an empty stomach. 3. If it should be necessary for a patient to lie down, or to sleep in the day time, he should be advised to undress himself, and to cover his body between sheets or blankets. The usual ligatures of garters, stocks, knee-bands, waistcoats, and shoes, are very unfriendly to sound sleep; hence persons who lie down with their clothes on, often awake from an afternoon's nap in terror from dreams, or in a profuse sweat, or with a head-ach or sick stomach; and generally out of humour. The surveyors are so sensible of the truth of this remark, that they always undress themselves when they sleep in the woods. An intelligent gentleman of this profession informed me, that he had frequently seen young woodsmen, who had refused to conform to this practice, so much indisposed in the morning, that, after the experience of a few nights, they were forced to adopt it. Great care should be taken in sleeping, whether in the day time or at night, never to lie down in damp sheets. Dr. Sydenham excepts the danger from this quarter, when he speaks of the efficacy of travelling on horseback in curing the consumption. 4. Patients who travel for health in this disease should avoid all large companies, more especially evening and night parties. The air of a contaminated room, phlogisticated by the breath of fifteen or twenty persons, and by the same number of burning candles, is poison to a consumptive patient. To avoid impure air from every other source, he should likewise avoid sleeping in a crowded room, or with curtains around his bed, and even with a bed-fellow. 5. Travelling, to be effectual in this disease, should be conducted in such a manner as that a patient may escape the extremes of heat and cold. For this purpose he should pass the winter, and part of the spring, in Georgia or South-Carolina, and the summer in New-Hampshire, Massachusetts, or Vermont, or, if he pleases, he may still more effectually shun the summer heats, by crossing the lakes, and travelling along the shores of the St. Laurence to the city of Quebec. He will thus escape the extremes of heat and cold, particularly the less avoidable one of heat; for I have constantly found the hot month of July to be as unfriendly to consumptive patients in Pennsylvania, as the variable month of March. By these means too he will enjoy nearly an equable temperature of air in every month of the year; and his system will be free from the inconvenience of the alternate action of heat and cold upon it. The autumnal months should be spent in New-Jersey or Pennsylvania. In these journies from north to south, or from south to north, he should be careful, for reasons before mentioned, to keep at as great a distance as possible from the sea coast. Should this inquiry fall into the hands of a British physician, I would beg leave to suggest to him, whether more advantages would not accrue to his consumptive patients from advising them to cross the Atlantic ocean, and afterwards to pursue the tour which I have recommended, than by sending them to Portugal, France, or Italy. Here they will arrive with such a mitigation of the violence of the disease, in consequence of the length of their sea voyage, as will enable them immediately to begin their journies on horseback. Here they will be exposed to fewer temptations to intemperance, or to unhealthy amusements, than in old European countries. And, lastly, in the whole course of this tour, they will travel among a people related to them by a sameness of language and manners, and by ancient or modern ties of citizenship. Long journies for the recovery of health, under circumstances so agreeable, should certainly be preferred to travelling among strangers of different nations, languages, and manners, on the continent of Europe. 6. To render travelling on horseback effectual in a consumption, it should be continued with moderate intervals from _six to twelve months_. But the cure should not be rested upon a single journey. It should be repeated every _two_ or _three years_, till our patient has passed the consumptive stages of life. Nay, he must do more; he must acquire a _habit_ of riding constantly, both at home and abroad; or, to use the words of Dr. Fuller, "he must, like a Tartar, learn to live on horseback, by which means he will acquire in time the constitution of a Tartar[34]." [34] Medicina Gymnastica, p. 116. Where benefit is expected from a change of climate, as well as from travelling, patients should reside at least two years in the place which is chosen for that purpose. I have seldom known a residence for a shorter time in a foreign climate do much service. To secure a perfect obedience to medical advice, it would be extremely useful if consumptive patients could always be accompanied by a physician. Celsus says, he found it more easy to cure the dropsy in slaves than in freemen, because they more readily submitted to the restraints he imposed upon their appetites. Madness has become a curable disease in England, since the physicians of that country have opened private mad-houses, and have taken the entire and constant direction of their patients into their own hands. The same successful practice would probably follow the treatment of consumptions, if patients were constantly kept under the eye and authority of their physicians. The keenness of appetite, and great stock of animal spirits, which those persons frequently possess, hurry them into many excesses which defeat the best concerted plans of a recovery; or, if they escape these irregularities, they are frequently seduced from our directions by every quack remedy which is recommended to them. Unfortunately the cough becomes a signal of their disease, at every stage of their journey, and the easy or pleasant prescriptions of even hostlers and ferrymen, are often substituted to the self-denial and exertion which have been imposed by physicians. The love of life in these cases seems to level all capacities; for I have observed persons of the most cultivated understandings to yield in common with the vulgar, to the use of these prescriptions. In a former volume I mentioned the good effects of accidental LABOUR in pulmonary consumptions. The reader will find a particular account in the first volume of Dr. Coxe's Medical Museum, of a clergyman and his wife, in Virginia, being cured by the voluntary use of that remedy. The following circumstances and symptoms, indicate the longer or shorter duration of this disease, and its issue in life and death: The consumption from gout, rheumatism, and scrophula, is generally of long duration. It is more rapid in its progress to death, when it arises from a half cured pleurisy, or neglected colds, measles, and influenza. It is of shorter duration in persons under thirty, than in those who are more advanced in life. It is always dangerous in proportion to the length of time, in which the debilitating causes, that predisposed to it, have acted upon the body. It is more dangerous when a predisposition to it has been derived from ancestors, than when it has been acquired. It is generally fatal when accompanied with a bad conformation of the breast. Chilly fits occurring in the forenoon, are more favourable than when they occur in the evening. They indicate the disease to partake a little of the nature of an intermittent, and are a call for the use of the remedies proper in that disease. Rheumatic pains, attended with an abatement of the cough, or pains in the breast, are always favourable; so are Eruptions, or an abscess on the external parts of the body, if they occur before the last stage of the disease. A spitting of blood, in the early, or forming stage of the disease, is favourable, but after the lungs become much obstructed, or ulcerated, it is most commonly fatal. A pleurisy, occurring in the low state of the disease, generally kills, but I have seen a case in which it suddenly removed the cough and hectic fever, and thus became the means of prolonging the patient's life for several years. The discharge of calculi from the lungs by coughing and spitting, and of a thin watery liquid, with a small portion of pus swimming on its surface, are commonly signs of an incurable consumption. No prediction unfavourable to life can be drawn from pus being discharged from the lungs. We see many recoveries after it has taken place, and many deaths where that symptom has been absent. Large quantities of pus are discharged in consumptions attended with abscesses, and yet few die of them, where they have not been preceded by long continued debility of the whole system. No pus is expectorated from tubercles, and how generally fatal is the disease, after they are formed in the lungs! It is only after they ulcerate that they discharge pus, and it is only after ulcers are thus formed, that the consumption probably becomes uniformly fatal. I suspect these ulcers are sometimes of a cancerous nature. A sudden cessation of the cough, without a supervening diarrh[oe]a, indicates death to be at hand. A constant vomiting in a consumption, is generally a bad sign. Feet obstinately cold, also a swelling of the feet during the day, and of the face in the night, commonly indicate a speedy and fatal issue of the disease. Lice, and the falling off of the hair, often precede death. A hoarseness, in the beginning of the disease, is always alarming, but it is more so in its last stage. A change of the eyes from a blue, or dark, to a light colour, similar to that which takes place in very old people, is a sign of speedy dissolution. I have never seen a recovery after an apthous sore throat took place. Death from the consumption comes on in some or more than one, of the following ways: 1. With a diarrh[oe]a. In its absence, 2. With wasting night sweats. 3. A rupture of an abscess. 4. A rupture of a large blood-vessel in the lungs, attended with external or internal hæmorrhage. _Sudden_ and _unexpected_ death in a consumption is generally induced by this, or the preceding cause. 5. Madness. The cough and expectoration cease with this disease. It generally carries off the patient in a week or ten days. 6. A pleurisy, brought on by exposure to cold. 7. A typhus fever, attended with tremors, twitchings of the tendons, and a dry tongue. 8. Swelled hands, feet, legs, thighs, and face. 9. An apthous sore throat. 10. Great and tormenting pains, sometimes of a spasmodic nature in the limbs. In a majority of the fatal cases of consumption, which I have seen, the passage out of life has been attended with pain; but I have seen many persons die with it, in whom all the above symptoms were so lenient, or so completely mitigated by opium, that death resembled a quiet transition from a waking, to a sleeping state. I cannot conclude this inquiry without adding, that the author of it derived from his paternal ancestors a predisposition to the pulmonary consumption, and that between the 18th and 43d years of his age, he has occasionally been afflicted with many of the symptoms of that disease which he has described. By the constant and faithful use of many of the remedies which he has recommended, he now, in the 61st year of his age, enjoys nearly an uninterrupted exemption from pulmonary complaints. In humble gratitude, therefore, to that BEING, who condescends to be called the preserver of men, he thus publicly devotes this result of his experience and inquiries to the benefit of such of his fellow-creatures as may be afflicted with the same disease, sincerely wishing that they may be as useful to them, as they have been to the author. OBSERVATIONS ON THE SYMPTOMS AND CURE OF _DROPSIES_. Whether we admit the exhaling and absorbing vessels to be affected in general dropsies by preternatural debility, palsy, or rupture, or by a retrograde motion of their fluids, it is certain that their exhaling and absorbing power is materially affected by too much, or too little action in the arterial system. That too little action in the arteries should favour dropsical effusions, has been long observed; but it has been less obvious, that the same effusions are sometimes promoted, and their absorption prevented, by too much action in these vessels. That this fact should have escaped our notice is the more remarkable, considering how long we have been accustomed to seeing serous swellings in the joints in the acute rheumatism, and copious, but partial effusions of water in the form of sweat, in every species of inflammatory fever. It is nothing new that the healthy action of one part, should depend upon the healthy action of another part of the system. We see it in many of the diseases of the nerves and brain. The tetanus is cured by exciting a tone in the arterial system; madness is cured by lessening the action of the arteries by copious blood-letting; and epilepsy and hysteria are often mitigated by the moderate use of the same remedy. By too much action in the arterial system, I mean a certain morbid excitement in the arteries, accompanied by preternatural force, which is obvious to the sense of touch. It differs from the morbid excitement of the arteries, which takes place in common inflammatory fevers, in being attended by less febrile heat, and with little or no pain in the head or limbs. The thirst is nearly the same in this state of dropsy, as in inflammatory fevers. I include here those dropsies only in which the whole system is affected by what is called a hydropic diathesis. That debility should, under certain circumstances, dispose to excessive action, and that excessive action should occur in one part of the body, at the same time that debility prevailed in every other, are abundantly evident from the history and phenomena of many diseases. Inflammatory fever, active hæmorrhages, tonic gout, asthma, apoplexy, and palsy, however much they are accompanied by excessive action in the arterial system, are always preceded by original debility, and are always accompanied by obvious debility in every other part of the system. But it has been less observed by physicians that an undue force or excess of action occurs in the arterial system in certain dropsies, and that the same theory which explains the union of predisposing and nearly general debility, with a partial excitement and preternatural action in the arterial system, in the diseases before-mentioned, will explain the symptoms and cure of certain dropsies. That debility predisposes to every state of dropsy, is evident from the history of all the remote and occasional causes which produce them. It will be unnecessary to mention these causes, as they are to be found in all our systems of physic. Nor will it be necessary to mention any proofs of the existence of debility in nearly every part of the body. It is too plain to be denied. I shall only mention the symptoms which indicate a morbid excitement and preternatural action of the arterial system. These are, 1. A _hard_, _full_, and _quick_ pulse. This symptom, I believe, is more common in dropsies than is generally supposed, for many physicians visit and examine patients in these diseases, without feeling the pulse. Dr. Home mentions the _frequency_ of the pulse, in the patients whose cures he has recorded[35], but he takes no notice of its force except in two cases. Dr. Zimmerman, in his account of the dropsy which terminated the life of Frederick II, of Prussia, tells us that he found his pulse _hard_ and _full_. I have repeatedly found it full and hard in every form of dropsy, and more especially in the first stage of the disease. Indeed I have seldom found it otherwise in the beginning of the dropsy of the breast. [35] Medical Facts. 2. _Sizy blood._ This has been taken notice of by many practical writers, and has very justly been ascribed, under certain circumstances of blood-letting, to an excessive action of the vessels upon the blood. 3. _Alternation of dropsies with certain diseases which were evidently accompanied by excess of action in the arterial system._ I have seen anasarca alternate with vertigo, and both ascites and anasarca alternate with tonic madness. A case of nearly the same kind is related by Dr. Mead. Dr. Grimes, of Georgia, informed me that he had seen a tertian fever, in which the intermissions were attended with dropsical swellings all over the body, which suddenly disappeared in every accession of a paroxysm of the fever. 4. _The occasional connection of certain dropsies with diseases evidently of an inflammatory nature_, particularly pneumony, rheumatism, and gout. 5. Spontaneous _hæmorrhages_ from the lungs, hæmorrhodial vessels, and nose, cases of which shall be mentioned hereafter, when we come to treat of the cure of dropsies. 6. _The appearance of dropsies in the winter and spring, in habits previously affected by the intermitting fever._ The debility produced by this state of fever, frequently disposes to inflammatory diathesis, as soon as the body is exposed to the alternate action of heat and cold, nor is this inflammatory diathesis always laid aside, by the transition of the intermitting fever into a dropsy, in the succeeding cold weather. 7. _The injurious effects of stimulating medicines in certain dropsies_, prove that there exists in them, at times, too much action in the blood-vessels. Dr. Tissot, in a letter to Dr. Haller, "De Variolis, apoplexia, et hydrope," condemns, in strong terms, the use of opium in the dropsy. Now the bad effects of this medicine in dropsies, must have arisen from its having been given in cases of too much action in the arterial system; for opium, we know, increases, by its stimulating qualities, the action and tone of the blood-vessels, and hence we find, it has been prescribed with success in dropsies of too little action in the system. 8. _The termination of certain fevers in dropsies in which blood-letting was not used._ This has been ascertained by many observations. Dr. Wilkes relates[36], that after "an epidemical fever, which began in Kidderminster, in 1728, and soon afterwards spread, not only over Great Britain, but all Europe, more people died dropsical in three years, than did perhaps in twenty or thirty years before," probably from the neglect of bleeding in the fever. [36] Historical Essay on the Dropsy, p. 326. But the existence of too much action in the arterial system in certain dropsies, will appear more fully from the history of the effects of the remedies which have been employed either by design or accident in the cure of these diseases. I shall first mention the remedies which have been used with success in tonic or inflammatory dropsies; and afterwards mention those which have been given with success in dropsies of a weak action in the arteries. I have constantly proposed to treat only of the theory and cure of dropsies in general, without specifying any of the numerous names it derives from the different parts of the body in which they may be seated; but in speaking of the remedies which have been used with advantage in both the tonic and atonic states, I shall occasionally mention the name or seat of the dropsy in which the remedy has done service. The first remedy that I shall mention for dropsies is _blood-letting_. Dr. Hoffman and Dr. Home both cured dropsies accompanied by pulmonic congestion by means of this remedy. Dr. Monroe quotes a case of dropsy from Sponius, in which bleeding succeeded, but not till after it had been used twenty times[37]. Mr. Cruikshank relates a case[38] of accidental bleeding, which confirms the efficacy of blood-letting in these diseases. He tells us that he attended a patient with dropsical swellings in his legs, who had had a hoarseness for two years. One morning, in stooping to buckle his shoes, he bursted a blood-vessel in his lungs, from which he lost a quart of blood; in consequence of which, both the swellings and the hoarseness went off gradually, and he continued well two years afterwards. I have known one case in which spontaneous hæmorrhages from the hæmorrhodial vessels, and from the nose, suddenly reduced universal dropsical swellings. In this patient there had been an uncommon tension and fulness in the pulse. [37] Treatise on the Dropsy. [38] Treatise on the Lymphatics. I could add the histories of many cures of anasarca and ascites, performed by means of blood-letting, not only by myself, but by a number of respectable physicians in the United States. Indeed I conceive this remedy to be as much indicated by a tense and full pulse in those forms of dropsy, as it is in a pleurisy, or in any other common inflammatory disease. In those deplorable cases of hydrothorax, which do not admit of a radical cure, I have given temporary relief, and thereby protracted life, by taking away occasionally a few ounces of blood. Had Dr. Zimmerman used this remedy in the case of the king of Prussia, I cannot help thinking from the account which the doctor gives us of the diet and pulse of his royal patient, that he would have lessened his sufferings much more than by plentiful doses of dandelion; for I take it for granted, from the candour and integrity which the doctor discovered in all his visits to the king, that he did not expect that dandelion, or any other medicine, would cure him. Although a _full_ and _tense_ pulse is always an indication of the necessity of bleeding; yet I can easily conceive there may be such congestions, and such a degree of stimulus to the arterial system, as to produce a depressed, or a _low_ or _weak_ pulse. Two cases of this kind are related by Dr. Monroe, one of which was cured by bleeding. The same symptom of a low and weak pulse is often met with in the _first_ stage of pneumony, and apoplexy, and is only to be removed by the plentiful use of the same remedy. II. _Vomits_ have often been given with advantage in dropsies. Dr. Home says, that squills were useful in these diseases only when they produced a vomiting. By abstracting excitement and action from the arterial system, it disposes the lymphatics to absorb and discharge large quantities of water. The efficacy of vomits in promoting the absorption of stagnating fluids is not confined to dropsies. Mr. Hunter was once called to visit a patient in whom he found a bubo in such a state that he purposed to open it the next day. In the mean while, the patient went on board of a vessel, where he was severely affected by sea-sickness and vomiting; in consequence of which the bubo disappeared, and the patient recovered without the use of the knife. Mr. Cruikshank further mentions a case[39] of a swelling in the knee being nearly cured by a patient vomiting eight and forty hours, in consequence of his taking a large dose of the salt of tartar instead of soluble tartar. [39] Letter to Mr. Clare, p. 166. III. _Purges._ The efficacy of this remedy, in the cure of dropsies, has been acknowledged by physicians in all ages and countries. Jalap, calomel, scammony, and gamboge, are often preferred for this purpose; but I have heard of two cases of ascites being cured by a table spoonful of sweet oil taken every day. It probably acted only as a gentle laxative. The cream of tartar, so highly commended by Dr. Home, seems to act _chiefly_ in the same way. Gherlius, from whom Dr. Home learned the use of this medicine, says, that all the persons whom he cured by it were in the vigour of life, and that their diseases had been only of a few months continuance. From these two circumstances, it is most probable they were dropsies of great morbid action in the arterial system. He adds further, that the persons who were cured by this medicine, were reduced very low by the use of it. Dr. Home says that it produced the same effect upon the patients whom he cured by it, in the infirmary of Edinburgh. Dr. Sydenham prefers gentle to drastic purges, and recommends the exhibition of them every day. Both drastic and gentle purges act by diminishing the action of the arterial system, and thereby promote the absorption and discharge of water. That purges promote absorption, we learn not only from their effects in dropsies, but from an experiment related by Mr. Cruikshank[40], of a man who acquired several ounces of weight after the operation of a purge. The absorption in this case was from the atmosphere. So great is the effect of purges in promoting absorption, that Mr. Hunter supposes the matter of a gonorrh[oe]a, or of topical venereal ulcers to be conveyed by them in some instances into every part of the body. [40] Letter to Mr. Clare, p. 117. IV. _Certain medicines_, which, by lessening the _action of the arterial system_, favour the absorption and evacuation of water. The only medicines of this class which I shall name are _nitre_, _cream of tartar_, and _foxglove_. 1. Two ounces of nitre dissolved in a pint of water, and a wine-glass full of it taken three times a-day have performed perfect cures, in two cases of ascites, which have come under my notice. I think I have cured two persons of anasarca, by giving one scruple of the same medicine three times a-day for several weeks. The two last cures were evidently dropsies of violent action in the arterial system. Where nitre has been given in atonic dropsies it has generally been useless, and sometimes done harm. I have seen one instance of an incurable diarrh[oe]a after tapping, which I suspected arose from the destruction of the tone of the stomach and bowels, by large and long continued doses of nitre, which the patient had previously taken by the advice of a person who had been cured by that remedy. To avoid this, or any other inconvenience from the use of nitre in dropsies, it should be given at first in small doses, and should always be laid aside, if it should prove ineffectual after having been given two or three weeks. 2. I can say nothing of the efficacy of _cream of tartar_ in dropsies from my own experience, where it has not acted as a purge. Perhaps my want of decision upon this subject has arisen only from my not having persisted in the use of it for the same length of time which is mentioned by Dr. Home. 3. There are different opinions concerning the efficacy of foxglove in dropsies. From the cases related by Dr. Withering, it appears to have done good; but from those related by Dr. Lettsom[41] it seems to have done harm. I suspect the different accounts of those two gentlemen have arisen from their having given it in different states of the system, or perhaps from a difference in the quality of the plant from causes mentioned in another place[42]. I am sorry to add further, that after many trials of this medicine I have failed in most of the cases in which I have given it. I have discharged the water in three instances by it, but the disease returned, and my patients finally died. I can ascribe only one complete cure to its use, which was in the year 1789, in a young man in the Pennsylvania hospital, of five and thirty years of age, of a robust habit, and plethoric pulse. [41] Medical Memoirs, vol. II. [42] Inquiry into the Causes and Cure of Pulmonary Consumption. Where medicines have once been in use, and afterwards fall into disrepute, as was the case with the foxglove, I suspect the cases in which they were useful, to have been either few or doubtful, and that the cases in which they had done harm, were so much more numerous and unequivocal, as justly to banish them from the materia medica. V. _Hard labour_, or exercise in such a degree as to produce fatigue, have, in several instances, cured the dropsy. A dispensary patient, in this city, was cured of this disease by sawing wood. And a patient in an ascites under my care in the Pennsylvania hospital, had his belly reduced seven inches in circumference in one day, by the labour of carrying wood from the yard into the hospital. A second patient belonging to the Philadelphia dispensary was cured by walking to Lancaster, 66 miles from the city, in the middle of winter. The efficacy of travelling in this disease, in cold weather, is taken notice of by Dr. Monroe, who quotes a case from Dr. Holler, of a French merchant, who was cured of a dropsy by a journey from Paris to England, in the winter season. It would seem, that in these two cases, the _cold_ co-operated as a sedative with the fatigue produced by labour or exercise, in reducing the tone of the arterial system. VI. _Low diet._ I have heard of a woman who was cured of a dropsy by eating nothing but boiled beans for three weeks, and drinking nothing but the water in which they had been boiled. Many other cases of the good effects of low diet in dropsies are to be found in the records of medicine. VII. _Thirst._ This cruel remedy acts by debilitating the system in two ways: 1st, by abstracting the stimulus of distention; and, 2dly, by preventing a supply of fresh water to replace that which is discharged by the ordinary emunctories of nature. VIII. _Fasting._ An accidental circumstance, related by sir John Hawkins, in the life of Dr. Johnson, first led me to observe the good effects of fasting in the dropsy. If the fact alluded to stood alone under the present head of this essay, it would be sufficient to establish the existence of too much action, and the efficacy of debilitating remedies in certain dropsies. I am the more disposed to lay a good deal of stress upon this fact, as it was the clue which conducted me out of the labyrinth of empirical practice, in which I had been bewildered for many years, and finally led me to adopt the principles and practice which I am now endeavouring to establish. The passage which contains this interesting fact is as follows: "A few days after (says sir John) he [meaning Dr. Johnson] sent for me, and informed me, that he had discovered in himself the symptoms of a dropsy, and, indeed, his very much increased bulk, and the swollen appearance of his legs, seemed to indicate no less. It was on Thursday that I had this conversation with him; in the course thereof he declared, that he intended to devote the whole of the next day to _fasting_, humiliation, and such other devotional exercises as became a man in his situation. On the Saturday following I made him a visit, and, upon entering his room, I observed in his countenance such a serenity as indicated, that some remarkable crisis of his disease had produced a change in his feelings. He told me that, pursuant to the resolution he had mentioned to me, he had spent the preceding day in an abstraction from all worldly concerns; that to prevent interruption he had in the morning ordered _Frank_ [his servant] not to admit any one to him, and, the better to enforce the charge, had added these awful words, _for your master is preparing himself to die_. He then mentioned to me, that in the course of this exercise he found himself relieved from the disease which had been growing upon him, and was becoming very oppressive, viz. the _dropsy_, by the gradual evacuation of water, to the amount of _twenty pints_, a like instance whereof he had never before experienced." Sir John Hawkins ascribes this immense discharge of water to the influence of Dr. Johnson's prayers; but he neglects to take notice, that these prayers were answered, in this instance, as they are in many others, in a perfect consistence with the common and established laws of nature. To satisfy myself that this discharge of water, in the case of Dr. Johnson, was produced by the fasting only, I recommended it, soon after I read the above account, to a gentlewoman whom I was then attending in an ascites. I was delighted with the effects of it. Her urine, which for some time before had not exceeded half a pint a-day, amounted to _two quarts_ on the day she fasted. I repeated the same prescription once a week for several weeks, and each time was informed of an increase of urine, though it was considerably less in the last experiments than in the first. Two patients in an ascites, to whom I prescribed the same remedy, in the Pennsylvania hospital, the one in the winter of 1790, and the other in the winter of 1792, exhibited proofs in the presence of many of the students of the university, equally satisfactory of the efficacy of fasting in suddenly increasing the quantity of urine. IX. _Fear._ This passion is evidently of a debilitating nature, and, therefore, it has frequently afforded an accidental aid in the cure of dropsies, of too much action. I suspect, that the fear of death, which was so distinguishing a part of the character of Dr. Johnson, added a good deal to the efficacy of fasting, in procuring the immense discharge of water before-mentioned. In support of the efficacy of fear simply applied, in discharging water from the body in dropsies, I shall mention the following facts. In a letter which I received from Dr. John Pennington, dated Edinburgh, August 3, 1790, I was favoured with the following communication. "Since the conversation I had with you on the subject of the dropsy, I feel more and more inclined to adopt your opinion. I can furnish you with a fact which I learned from a Danish sailor, on my passage to this country, which is much in favour of your doctrine. A sailor in an ascites, fell off the end of the yard into the sea; the weather being calm, he was taken up unhurt, but, to use the sailor's own words, who told me the story, he was _frightened half to death_, and as soon as he was taken out of the water, he discharged a gallon of urine or more. A doctor on board ascribed this large evacuation to sea bathing, and accordingly ordered the man to be dipped in the sea every morning, much against his will, for, my informant adds, that he had not forgotten his fall, and that in four weeks he was perfectly well. I think this fact can only be explained on your principles. The sedative operation of _fear_ was, no doubt, the cause of his cure." There is an account of an ascites being cured by a fall from an open chaise, recorded in the third volume of the Medical Memoirs, by M. Lowdell. I have heard of a complete recovery from dropsy, having suddenly followed a fall from a horse. In both these cases, the cures were probably the effects of fear. Dr. Hall, of York-town, in Pennsylvania, informed me, that he had been called to visit a young woman of 19 years of age, who had taken all the usual remedies for ascites without effect. He at once proposed to her the operation of tapping. To this she objected, but so great was the _fear_ of this operation, which the proposal of it suddenly excited in her mind, that it brought on a plentiful discharge of urine, which in a few days perfectly removed her disease. On the 27th of August, 1790, I visited a gentlewoman in this city with the late Dr. Jones, in an ascites. We told her for the first time, that she could not be relieved without being tapped. She appeared to be much terrified upon hearing our opinion, and said that she would consider of it. I saw her two days afterwards, when she told me, with a smile on her countenance, that she hoped she should get well without tapping, for that she had discharged two quarts of water in the course of the day after we had advised her to submit to that operation. For many days before, she had not discharged more than two or three gills in twenty-four hours. The operation, notwithstanding, was still indicated, and she submitted to be tapped a few days afterwards. I tapped the same gentlewoman a second time, in January, 1791. She was much terrified while I was preparing for the operation, and fainted immediately after the puncture was made. The second time that I visited her after the operation was performed, she told me (without being interrogated on that subject), that she had discharged a pint and a half of urine, within twenty minutes after I left the room on the day I tapped her. What made this discharge the more remarkable was, she had not made more than a table spoonful of water in a day, for several days before she was tapped. I have seen similar discharges of urine in two other cases of tapping which have come under my notice, but they resembled so nearly those which have been mentioned, that it will be unnecessary to record them. But the influence of fear upon the system, in the dropsy, extends far beyond the effects which I have ascribed to it. Dr. Currie, of this city, informed me that he called, some years ago, by appointment, to tap a woman. He no sooner entered the room than he observed her, as he thought, to faint away. He attempted to recover her, but to no purpose. She died of a sudden paroxysm of fear. It is a matter of surprise, that we should have remained so long ignorant of the influence of fear upon the urinary organs in dropsies, after having been so long familiar with the same effect of that passion in the hysteria. X. _A recumbent posture of the body._ It is most useful when the dropsy is seated in the lower limbs. I have often seen, with great pleasure, the happiest effects from this prescription in a few days. XI. _Punctures._ These, when made in the legs and feet, often discharge in eight and forty hours the water of the whole body. I have never seen a mortification produced by them. As they are not followed by inflammation, they should be preferred to blisters, which are sometimes used for the same purpose. I cannot dismiss the remedies which discharge water from the body through the urinary passages, without taking notice, that they furnish an additional argument in favour of blood-letting in dropsies, for they act, not by discharging the stagnating water, but by creating such a plentiful secretion in the kidneys from the serum of the circulating blood, as to make room for the absorption and conveyance of the stagnating water into the blood-vessels. Now the same effect may be produced in all tonic or inflammatory dropsies, with more certainty and safety, by means of blood-letting. In recommending the antiphlogistic treatment of certain dropsies, I must here confine myself to the dropsies of such climates as dispose to diseases of great morbid action in the system. I am satisfied that it will often be proper in the middle and eastern states of America; and I have lately met with two observations, which show that it has been used with success at Vienna, in Germany. Dr. Stoll tells us, that, in the month of January, 1780, "Hydropic and asthmatic patients discovered more or less marks of inflammatory diathesis, and that blood was drawn from them with a sparing hand with advantage;" and in the month of November, of the same year, he says, "The stronger diuretics injured dropsical patients in this season; but an antiphlogistic drink, composed of a quart of the decoction of grass, with two ounces of simple oxymel, and nitre and cream of tartar, of each a drachm, did service[43]." It is probable that the same difference should be observed between the treatment of dropsies in warm and cold climates that is observed in the treatment of fevers. The tonic action probably exists in the system in both countries. In the former it resembles the tides which are suddenly produced by a shower of rain, and as suddenly disappear; whereas, in the latter, it may be compared to those tides which are produced by the flow and gradual addition of water from numerous streams, and which continue for days and weeks together to exhibit marks of violence in every part of their course. [43] Ratio Medendi Nosocomio Practico Vindobonensi, vol. iv. p. 56 and 99. I come now to say a few words upon atonic dropsies, or such as are accompanied with a feeble morbid action in the blood-vessels. This morbid action is essential to the nature of dropsies, for we never see them take place without it. This is obvious from the absence of swellings after famine, marasmus, and in extreme old age, in each of which there exists the lowest degree of debility, but no morbid action in the blood-vessels. These atonic or typhus dropsies may easily be distinguished from those which have been described, by occurring in habits naturally weak; by being produced by the operation of chronic causes; by a weak and quick pulse; and by little or no preternatural heat or thirst. The remedies for atonic dropsies are all such stimulating substances as increase the action of the arterial system, or determine the fluids to the urinary organs. These are, I. _Bitter_ and _aromatic substances_ of all kinds, exhibited in substance or in infusions of wine, spirit, beer, or water. II. _Certain acrid vegetables_, such as scurvy-grass, horse-radish, mustard, water-cresses, and garlic. I knew an old man who was perfectly cured of an anasarca, by eating water-cresses, on bread and butter. III. _Opium._ The efficacy of this medicine in dropsies has been attested by Dr. Willis, and several other practical writers. It seems to possess almost an exclusive power of acting alike upon the arterial, the lymphatic, the glandular, and the nervous systems. IV. _Metallic tonics_, such as chalybeate medicines of all kinds, and the mild preparations of copper and mercury. I once cured an incipient ascites and anasarca by large doses of the rust of iron; and I have cured many dropsies by giving mercury in such quantities as to excite a plentiful salivation. I have, it is true, often given it without effect, probably from my former ignorance of the violent action of the arteries, which so frequently occurs in dropsies, and in which cases mercury must necessarily have done harm. V. _Diuretics_, consisting of alkaline salts, nitre, and the oxymels of squills and colchicum. It is difficult to determine how far these medicines produce their salutary effects by acting directly upon the kidneys. It is remarkable that these organs are seldom affected in dropsies, and that their diseases are rarely followed by dropsical effusions in any part of the body. VI. _Generous diet_, consisting of animal food, rendered cordial by spices; also sound old wine. VII. _Diluting drinks_ taken in such large quantities as to excite the action of the vessels by the stimulus of distention. This effect has been produced, sir George Baker informs us, by means of large draughts of simple water, and of cyder and water[44]. The influence of distention in promoting absorption is evident in the urinary and gall bladders, which frequently return their contents to the blood by the lymphatics, when they are unable to discharge them through their usual emunctories. Is it not probable that the distention produced by the large quantities of liquids which we are directed to administer after giving the foxglove, may have been the means of performing some of those cures of dropsies, which have been ascribed to that remedy? [44] The remark upon this fact by sir George, is worthy of notice, and implies much more than was probably intended by it. "When common means have failed, success has sometimes followed a method _directly contrary_ to the established practice." Medical Transactions, vol. II. VIII. _Pressure._ Bandages bound tightly around the belly and limbs, sometimes prevent the increase or return of dropsical swellings. The influence of pressure upon the action of the lymphatics appears in the absorption of bone which frequently follows the pressure of contiguous tumours, also in the absorption of flesh which follows the long pressure of certain parts of the body upon a sick bed. IX. _Frictions_, either by means of a dry, or oiled hand, or with linen or flannel impregnated with volatile and other stimulating substances. I have found evident advantages from following the advice of Dr. Cullen, by rubbing the lower extremities _upwards_, and that only in the _morning_. I have been at a loss to account for the manner in which sweet oil acts, when applied to dropsical swellings. If it act by what is improperly called a sedative power upon the blood-vessels, it will be more proper in tonic than atonic dropsies; but if it act by closing the pores, and thereby preventing the absorption of moisture from the air, it will be very proper in the state of dropsy which is now under consideration. It is in this manner that Dr. Cullen supposes that sweet oil, when applied to the body, cures that state of diabetes in which nothing but insipid water is discharged from the bladder. X. _Heat_, applied either separately or combined with moisture in the form of warm or vapour baths, has been often used with success in dropsies of too little action. Dampier, in his voyage round the world, was cured of a dropsy by means of a copious sweat, excited by burying himself in a bed of warm sand. Warm fomentations to the legs, rendered moderately stimulating by the addition of saline or aromatic substances, have often done service in the atonic dropsical swellings of the lower extremities. XI. The _cold bath_. I can say nothing in favour of the efficacy of this remedy in dropsies, from my own experience. Its good effects seem to depend wholly on its increasing the excitability of the system to common stimuli, by the diminution of its excitement. If this be the case, I would ask, whether _fear_ might not be employed for the same purpose, and thus become as useful in atonic, as it was formerly proved to be in tonic dropsies? XII. _Wounds_, whether excited by cutting instruments or by fire, provided they excite inflammation and action in the arteries, frequently cure atonic dropsies. The good effects of inflammation and action in these cases, appear in the cure of hydrocele by means of the needle, or the caustic. XIII. _Exercise._ This is probably as necessary in the atonic dropsy, as it is in the consumption, and should never be omitted when a patient is able to take it. The passive exercises of swinging, and riding in a carriage, are most proper in the lowest stage of the disease; but as soon as the patient's strength will admit of it, he should ride on horseback. A journey should be preferred, in this disease, to short excursions from home. XIV. A _recumbent posture of the body_ should always be advised during the intervals of exercise, when the swellings are seated in the lower extremities. XV. _Punctures in the legs and feet_ afford the same relief in general dropsy, accompanied with a weak action in the blood-vessels, that has been ascribed to them in dropsies of an opposite character. In the application of each of the remedies which have been mentioned, for the cure of both tonic and atonic dropsies, great care should be taken to use them in such a manner, as to accommodate them to the strength and excitability of the patient's system. The most powerful remedies have often been rendered _hurtful_, by being given in too large doses in the beginning, and _useless_, by being given in too small doses in the subsequent stages of the disease. I have avoided saying any thing of the usual operations for discharging water from different parts of the body, as my design was to treat only of the symptoms and cure of those dropsies which affect the whole system. I shall only remark, that if tapping and punctures have been more successful in the early, than in the late stage of these diseases, it is probably because the sudden or gradual evacuation of water takes down that excessive action in the arterial system, which is most common in their early stage, and thereby favours the speedy restoration of healthy action in the exhaling or lymphatic vessels. Thus have I endeavoured to prove, that two different states of action take place in dropsies, and have mentioned the remedies which are proper for each of them under separate heads. But I suspect that dropsies are often connected with a certain _intermediate_ or mixed action in the arterial system, analogous to the typhoid action which takes place in certain fevers. I am led to adopt this opinion, not only from having observed mixed action to be so universal in most of the diseases of the arterial and nervous system, but because I have so frequently observed dropsical swellings to follow the scarlatina, and the puerperile fever, two diseases which appear to derive their peculiar character from a mixture of excessive and moderate _force_, combined with irregularity of action in the arterial system. In dropsies of mixed action, where too much force prevails in the action of some, and too little in the action of other of the arterial fibres, the remedies must be debilitating or stimulating, according to the greater or less predominance of tonic or atonic diathesis in the arterial system. I shall conclude this history of dropsies, and of the different and opposite remedies which have cured them, by the following observations. 1. We learn, in the first place, from what has been said, the impropriety and even danger of prescribing stimulating medicines indiscriminately in every case of dropsy. 2. We are taught, by the facts which have been mentioned, the reason why physicians have differed so much in their accounts of the same remedies, and why the same remedies have operated so differently in the hands of the same physicians. It is because they have been given without a reference to the different states of the system, which have been described. Dr. Sydenham says, that he cured the first dropsical patient he was called to, by frequent purges. He began to exult in the discovery, as he thought, of a certain cure for dropsies, but his triumph was of short duration. The same remedy failed in the next case in which he prescribed it. The reason probably was, the dropsy in the first case was of a tonic, but in the second of an atonic nature; for the latter was an ascites from a quartan ague. It is agreeable, however, to discover, from the theory of dropsies which has been laid down, that all the different remedies for these diseases have been proper in their nature, and improper only in the state of the system in which they have been given. As the discovery of truth in religion reconciles the principles of the most opposite sects, so the discovery of truth in medicine reconciles the most opposite modes of practice. It would be happy if the inquirers after truth in medicine should be taught, by such discoveries, to treat each other with tenderness and respect, and to wait with patience till accident, or time, shall combine into one perfect and consistent system, all the contradictory facts and opinions, about which physicians have been so long divided. 3. If a state of great morbid action in the arteries has been demonstrated in dropsies, both from its symptoms and remedies, and if these dropsies are evidently produced by previous debility, who will deny the existence of a similar action in certain hæmorrhages, in gout, palsy, apoplexy, and madness, notwithstanding they are all the offspring of predisposing debility? And who will deny the efficacy of bleeding, purges, and other debilitating medicines in certain states of those diseases, that has seen the same medicines administered with success in certain dropsies? To reject bleeding, purging, and the other remedies for violent action in the system, in any of the above diseases, because that action was preceded by general debility, will lead us to reject them in the most acute inflammatory fevers, for these are as much the offspring of previous debility as dropsies or palsy. The previous debility of the former differs from that of the latter diseases, only in being of a more acute, or, in other words, of a shorter duration. 4. From the symptoms of tonic dropsy which have been mentioned, it follows, that the distinction of apoplexy into serous and sanguineous, affords no rational indication for a difference in the mode of treating that disease. If an effusion of serum in the thorax, bowels, or limbs, produce a hard and full pulse, it is reasonable to suppose that the same symptom will be produced by the effusion of serum in the brain. But the dissections collected by Lieutaud[45] place this opinion beyond all controversy. They prove that the symptoms of great and feeble morbid action, as they appear in the pulse, follow alike the effusion of serum and blood in the brain. This fact will admit of an important application to the disease, which is to be the subject of the next inquiry. [45] Historia Anatomica Medica, vol. II. 5. From the influence which has been described, of the different states of action of the arterial system, upon the lymphatic vessels, in dropsies, we are led to reject the indiscriminate use of bark, mercury, and salt water, in the scrophula. When the action of the arteries is weak, those remedies are proper; but when an opposite state of the arterial system occurs, and, above all, when scrophulous tumours are attended with inflammatory ulcers, stimulating medicines of all kinds are hurtful. By alternating the above remedies with a milk and vegetable diet, according to the tonic, or atonic states of the arterial system, I have succeeded in the cure of a case of scrophula, attended by large ulcers in the inguinal glands, which had for several years resisted the constant use of the three stimulating remedies which have been mentioned. 6. Notwithstanding I have supposed dropsies to be connected with a peculiar state of force in the blood-vessels, yet I have not ventured to assert, that dropsies may not exist from an exclusive affection of the exhaling and absorbing vessels. I conceive this to be as possible, as for a fever to exist from an exclusive affection of the arteries, or a hysteria from an exclusive affection of the nervous system. Nothing, however, can be said upon this subject, until physiology and pathology have taught us more of the structure and diseases of the lymphatic vessels. Nor have I ventured further to assert, that there are not medicines which may act specifically upon the lymphatics, independently of the arteries. This I conceive to be as possible as for asaf[oe]tida to act chiefly upon the nerves, or ipecacuanha and jalap upon the alimentary canal, without affecting other parts of the system. Until such medicines are discovered, it becomes us to avail ourselves of the access to the lymphatics, which is furnished us through the medium of the arteries, by means of most of the remedies which have been mentioned. 7. If it should appear hereafter, that we have lessened the mortality of certain dropsies by the theory and practice which have been proposed, yet many cases of dropsy must still occur in which they will afford us no aid. The cases I allude to are dropsies from enclosing cysts, from the ossification of certain arteries, from schirri of certain viscera from large ruptures of exhaling or lymphatic vessels, from a peculiar and corrosive acrimony of the fluids, and, lastly, from an exhausted state of the whole system. The records of medicine furnish us with instances of death from each of the above causes. But let us not despair. It becomes a physician to believe, that there is no disease necessarily incurable; and that there exist in the womb of time, certain remedies for all those morbid affections, which elude the present limits of the healing art. AN INQUIRY INTO THE _CAUSES AND CURE_ OF THE INTERNAL DROPSY OF THE BRAIN. Having, for many years, been unsuccessful in all the cases, except two, of internal dropsy of the brain, which came under my care, I began to entertain doubts of the common theory of this disease, and to suspect that the effusion of water should be considered only as the effect of a primary disease in the brain. I mentioned this opinion to my colleague, Dr. Wistar, in the month of June, 1788, and delivered it the winter following in my lectures. The year afterwards I was confirmed in it, by hearing that the same idea had occurred to Dr. Quin. I have since read Dr. Quin's treatise on the dropsy of the brain with great pleasure, and consider it as the first dawn of light which has been shed upon it. In pursuing this subject, therefore, I shall avail myself of Dr. Quin's discoveries, and endeavour to arrange the facts and observations I have collected in such a manner, as to form a connected theory from them, which I hope will lead to a new and more successful mode of treating this disease. I shall begin this inquiry by delivering a few general propositions. 1. The internal dropsy of the brain is a disease confined chiefly to children. 2. In children the brain is larger in proportion to other parts of the body, than it is in adults; and of course a greater proportion of blood is sent to it in childhood, than in the subsequent periods of life. The effects of this determination of blood to the brain appear in the mucous discharge from the nose, and in the sores on the head and behind the ears, which are so common in childhood. 3. In all febrile diseases, there is a preternatural determination of blood to the brain. This occurs in a more especial manner in children: hence the reason why they are so apt to be affected by convulsions in the eruptive fever of the small-pox, in dentition, in the diseases from worms, and in the first paroxysm of intermitting fevers. 4. In fevers of every kind, and in every stage of life, there is a disposition to effusion in that part to which there is the greatest determination. Thus, in inflammatory fever, effusions take place in the lungs and in the joints. In the bilious fever they occur in the liver, and in the gout in every part of the body. The matter effused is always influenced by the structure of the part in which it takes place. These propositions being premised, I should have proceeded to mention the remote causes of this disease; but as this inquiry may possibly fall into the hands of some gentlemen who may not have access to the description of it as given by Dr. Whytt, Dr. Fothergill, and Dr. Quin, I shall introduce a history of its symptoms taken from the last of those authors. I prefer it to the histories by Dr. Whytt and Dr. Fothergill, as it accords most with the ordinary phenomena of this disease in the United States. "In general, the patient is at first languid and inactive, often drowsy and peevish, but at intervals cheerful and apparently free from complaint. The appetite is weak, a nausea, and, in many cases, a vomiting, occurs once or twice in the day, and the skin is observed to be hot and dry towards the evenings: soon after these symptoms have appeared, the patient is affected with a sharp head-ach, chiefly in the fore-part, or, if not there, generally in the crown of the head: it is sometimes, however, confined to one side of the head, and, in that case, when the posture of the body is erect, the head often inclines to the side affected. We frequently find, also, that the head-ach alternates with the affection of the stomach; the vomiting being less troublesome when the pain is most violent, and _vice versâ_; other parts of the body are likewise subject to temporary attacks of pain, viz. the extremities, or the bowels, but more constantly the back of the neck, and between the scapulæ; in all such cases the head is more free from uneasiness. "The patient dislikes the light at this period; cries much, sleeps little, and when he does sleep, he grinds his teeth, picks his nose, appears to be uneasy, and starts often, screaming as if he were terrified; the bowels are in the majority of cases very much confined, though it sometimes happens that they are in an opposite state: the pulse in this early stage of the disorder, does not usually indicate any material derangement. "When the symptoms above-mentioned have continued for a few days, subject as they always are in this disease to great fluctuation, the axis of one eye is generally found to be turned in towards the nose; the pupil on this side is rather more dilated than the other; and when both eyes have the axes directed inwards (which sometimes happens), both pupils are larger than they are observed to be in the eyes of healthy persons: the vomiting becomes more constant, and the head-ach more excruciating; every symptom of fever then makes its appearance, the pulse is frequent, and the breathing quick; exacerbations of the fever take place towards the evening, and the face is occasionally flushed; usually one cheek is much more affected than the other; temporary perspirations likewise break forth, which are not followed by any alleviation of distress; a discharge of blood from the nose, which sometimes appears about this period, is equally inefficacious. "Delirium, and that of the most violent kind, particularly if the patient has arrived at the age of puberty, now takes place, and with all the preceding symptoms of fever, continues for a while to increase, until about fourteen days, often a much shorter space of time, shall have elapsed since the appearance of the symptoms, which were first mentioned in the above detail. "The disease then undergoes that remarkable change, which sometimes suddenly points out the commencement of what has been called its second stage: the pulse becomes slow but unequal, both as to its strength, and the intervals between the pulsations; the pain of the head, or of whatever part had previously been affected, seems to abate, or at least the patient becomes apparently less sensible of it; the interrupted slumbers, or perpetual restlessness which prevailed during the earlier periods of the disorder, are now succeeded by an almost lethargetic torpor, the strabismus, and dilatation of the pupil increase, the patient lies with one, or both eyes half closed, which, when minutely examined, are often found to be completely insensible to light; the vomiting ceases; whatever food or medicine is offered is usually swallowed with apparent voracity; the bowels at this period generally remain obstinately costive. "If every effort made by art fails to excite the sinking powers of life, the symptoms of what has been called the second stage are soon succeeded by others, which more certainly announce the approach of death. The pulse again becomes equal, but so weak and quick, that it is almost impossible to count it; a difficulty of breathing, nearly resembling the _stertor apoplecticus_, is often observed; sometimes the eyes are suffused with blood, the flushing of the face is more frequent than before, but of shorter duration, and followed by a deadly paleness; red spots, or blotches, sometimes appear on the body and limbs; deglutition becomes difficult, and convulsions generally close the scene. In one case, I may observe, the jaws of a child of four years of age were so firmly locked for more than a day before death, that it was impossible to introduce either food or medicine into his mouth; and, in another case, a hemiplegia, attended with some remarkable circumstances, occurred during the two days preceding dissolution. "Having thus given as exact a history of _apoplexia hydrocephalica_ as I could compile from the writings of others, and from my own observations, I should think myself guilty of imposition on my readers, if I did not caution them that it must be considered merely as a general outline: the human brain seems to be so extremely capricious (if the expression may be allowed) in the signals it gives to other parts of the system, of the injury it suffers throughout the course of this disease, that although every symptom above-mentioned does occasionally occur, and indeed few cases of the disease are to be met with, which do not exhibit many of them; yet it does not appear to me, that any one of them is constantly and inseparably connected with it." To this history I shall add a few facts, which are the result of observations made by myself, or communicated to me by my medical brethren. These facts will serve to show that there are many deviations from the history of the disease which has been given, and that it is indeed, as Dr. Quin has happily expressed it, of "a truly proteiform" nature. I have not found the dilated and insensible pupil, the puking, the delirium, or the strabismus, to attend universally in this disease. I saw one case in which the appetite was unimpaired from the first to the last stage of the disease. I have met with one case in which the disease was attended by blindness, and another by double vision. I have observed an uncommon acuteness in hearing to attend two cases of this disease. In one of them the noise of the sparks which were discharged from a hiccory fire, produced great pain and startings which threatened convulsions. I have seen three cases in which the disease terminated in hemiplegia. In two of them it proved fatal in a few days; in the third it continued for nearly eighteen months. I have met with one case in which no preternatural slowness or intermission was ever perceived in the pulse. I have seen the disease in children of nearly all ages. I once saw it in a child of six weeks old. It was preceded by the cholera infantum. The sudden deaths which we sometimes observe in infancy, I believe, are often produced by this disease. Dr. Stoll is of the same opinion. He calls it, when it appears in this form, "apoplexia infantalis[46]." [46] Prælectiones, vol. I. p. 254. In the month of March, 1771, I obtained a gill of water from the ventricles of the brain of a negro girl of nine years of age, who died of this disease, who complained in no stage of it of a pain in her head or limbs, nor of a sick stomach. The disease in this case was introduced suddenly by a pain in the breast, a fever, and the usual symptoms of a catarrh. Dr. Wistar informed me, that he had likewise met with a case of internal dropsy of the brain, in which there was a total absence of pain in the head. Dr. Carson informed me, that he had attended a child in this disease that discovered, for some days before it died, the symptom of hydrophobia. Dr. Currie obtained, by dissection, seven ounces of water from the brain of a child which died of this disease; in whom, he assured me, no dilatation of the pupil, strabismus, sickness, or loss of appetite had attended, and but very little head-ach. The causes which induce this disease, act either _directly_ on the brain, or _indirectly_ upon it, through the medium of the whole system. The causes which act _directly_ on the brain are falls or bruises upon the head, certain positions of the body, and childish plays which bring on congestion or inflammation, and afterwards an effusion of water in the brain. I have known it brought on in a child by falling into a cellar upon its feet. The _indirect_ causes of this disease are more numerous, and more frequent, though less suspected, than those which have been mentioned. The following diseases of the whole system appear to act indirectly in producing an internal dropsy of the brain. 1. _Intermitting_, _remitting_, and _continual_ fevers. Of the effects of these fevers in inducing this disease, many cases are recorded by Lieutaud[47]. [47] Historia Anatomica-Medica, vol. II. My former pupil, Dr. Woodhouse, has furnished me with a dissection, in which the disease was evidently the effect of the remitting fever. That state of continual fever which has been distinguished by the name of typhus, is often the remote cause of this disease. The languor and weakness in all the muscles of voluntary motion, the head-ach, the inclination to rest and sleep, and the disposition to be disturbed, or terrified by dreams, which are said to be the precursors of water in the brain, I believe are frequently symptoms of a typhus fever which terminates in an inflammation, or effusion of water in the brain. The history which is given of the typhus state of fever in children by Dr. Butter[48], seems to favour this opinion. [48] Treatise on the Infantile Remitting Fever. 2. The _rheumatism_. Of this I have known two instances. Dr. Lettsom has recorded a case from the same cause[49]. The pains in the limbs, which are supposed to be the effect, I suspect are frequently the cause of the disease. [49] Medical Memoirs, vol. I. p. 174. 3. The _pulmonary consumption_. Of the connection of this disease with an internal dropsy of the brain, Dr. Percival has furnished us with the following communication[50]: "Mr. C----'s daughter, aged nine years, after labouring under the phthisis pulmonalis four months, was affected with unusual pains in her head. These rapidly increased, so as to occasion frequent screamings. The cough, which had before been extremely violent, and was attended with stitches in the breast, now abated, and in a few days ceased almost entirely. The pupils of the eyes became dilated, a strabismus ensued, and in about a week death put an end to her agonies. Whether this affection of the head arose from the effusion of water or of blood, is uncertain, but its influence on the state of the lungs is worthy of notice." Dr. Quin likewise mentions a case from Dr. Cullen's private practice, in which an internal dropsy of the brain followed a pulmonary consumption. Lieutaud mentions three cases of the same kind[51], and two, in which it succeeded a catarrh[52]. [50] Essays, Medical, Philosophical, and Experimental, vol. II. p. 339, 340. [51] Historia Anatomica-Medica, vol. II. lib. tertius. obs. 380, 394, 1121. [52] Obs. 383, 431. 4. _Eruptive fevers._ Dr. Odier informs us[53], that he had seen four cases in which it had followed the small-pox, measles, and scarlatina. Dr. Lettsom mentions a case in which it followed the small-pox[54], and I have seen one in which it was obviously the effects of debility induced upon the system by the measles. [53] Medical Journal. [54] Medical Memoirs, vol. I. p. 171. 5. _Worms._ Notwithstanding the discharge of worms gives no relief in this disease, yet there is good reason to believe, that it has, in some instances, been produced by them. The morbid action continues in the brain, as in other cases of disease, after the cause which induced it, has ceased to act upon the body. 6. From the dissections of Lieutaud, Quin, and others, it appears further, that the internal dropsy of the brain has been observed to succeed each of the following diseases, viz. the colic, palsy, melancholy, dysentery, dentition, insolation, and scrophula, also the sudden healing of old sores. I have seen two cases of it from the last cause, and one in which it was produced by the action of the vernal sun alone upon the system. From the facts which have been enumerated, and from dissections to be mentioned hereafter, it appears, that the disease in its first stage is the effect of causes which produce a less degree of that morbid action in the brain which constitutes phrenitis, and that its second stage is the effect of a less degree of that effusion, which produces serous apoplexy in adults. The former partakes of the nature of the chronic inflammation of Dr. Cullen, and of the asthenic inflammation of Dr. Brown. I have taken the liberty to call it _phrenicula_, from its being a diminutive species or state of phrenitis. It bears the same relation to phrenitis, when it arises from indirect causes, which pneumonicula does to pneumony; and it is produced nearly in the same manner as the pulmonary consumption, by debilitating causes which act primarily on the whole system. The peculiar size and texture of the brain seem to invite the inflammation and effusions which follow debility, to that organ in childhood, just as the peculiar structure and situation of the lungs invite the same morbid phænomena to them, after the body has acquired its growth, in youth and middle life. In the latter stage which has been mentioned, the internal dropsy of the brain partakes of some of the properties of apoplexy. It differs from it in being the effect of a _slow_, instead of a _sudden_ effusion of water or blood, and in being the effect of causes which are of an acute instead of a chronic nature. In persons advanced beyond middle life, who are affected by this disease, it approaches to the nature of the common apoplexy, by a speedy termination in life or death. Dr. Cullen has called it simply by the name of "apoplexia hydrocephalica." I have preferred for its last stage the term of _chronic apoplexy_, for I believe with Dr. Quin, that it has no connection with a hydropic diathesis of the whole system. I am forced to adopt this opinion, from my having rarely seen it accompanied by dropsical effusions in other parts of the body, nor a general dropsy accompanied by an internal dropsy of the brain. No more occurs in this disease than takes place when hydrothorax follows an inflammation of the lungs, or when serous effusions follow an inflammation of the joints. I do not suppose that both inflammation and effusion always attend in this disease; on the contrary, dissections have shown some cases of inflammation, with little or no effusion, and some of effusion without inflammation. Perhaps this variety may have been produced by the different stages of the disease in which death and the inspection of the brain took place. Neither do I suppose, that the two stages which have been mentioned, always succeed each other in the common order of inflammation and effusion. In every case where the full tense, slow and intermitting pulse occurs, I believe there is inflammation; and as this state of the pulse occurs in most cases in the beginning of the disease, I suppose the inflammation, in most cases, to precede the effusion of water. I have met with only one case in which the slow and tense pulse was absent; and out of six dissections of patients whom I have lost by this disease, the brains of four of them exhibited marks of inflammation. Mr. Davis discovered signs of inflammation, after death from this disease, to be universal. In eighteen or twenty dissections, he tells us, he found the pia mater always distended with blood[55]. Where signs of inflammation have not occurred, the blood-vessels had probably relieved themselves by the effusion of serum, or the morbid action of the blood-vessels had exceeded that grade of excitement, in which only inflammation can take place. I have seen one case of death from this disease, in which there was not more than a tea-spoonful of water in the ventricles of the brain. Dr. Quin mentions a similar case. Here death was induced by simple excess of excitement. The water which is found in the ventricles of the brain refuses to coagulate by heat, and is always pale in those diseases, in which the serum of the blood, in every other part of the body, is of a yellow colour. [55] Medical Journal, vol. VIII. In addition to these facts, in support of the internal dropsy of the brain being the effect of inflammation, I shall mention one more, communicated to me in a letter, dated July 17th, 1795, by my former pupil, Dr. Coxe, while he was prosecuting his studies in London. "It so happened (says my ingenious correspondent), that at the time of my receiving your letter, Dr. Clark was at the hospital. I read to him that part which relates to your success in the treatment of hydrocephalus internus. He was much pleased with it, and mentioned to me a fact which strongly corroborates your idea of its being a primary inflammation of the brain. This fact was, that upon opening, not long since, the head of a child that had died of this disease, he found between three and four ounces of water in the ventricles of the brain; also an inflammatory crust on the optic nerves, as thick as he had ever observed it on the intestines in a state of inflammation. The child lost its sight before it died. The crust accounted in a satisfactory manner for its blindness. Perhaps something similar may always be noticed in the dissections of such as die of this disease, in whom the eyes are much affected." Having adopted the theory of this disease, which I have delivered, I resolved upon such a change in my practice as should accord with it. The first remedy indicated by it was I. _Blood-letting._ I shall briefly mention the effects of this remedy in a few of the first cases in which I prescribed it. CASE I. On the 15th of November, 1790, I was called to visit the daughter of William Webb, aged four years, who was indisposed with a cough, a pain in her bowels, a coma, great sensibility of her eyes to light, costiveness, and a suppression of urine, a slow and irregular, but tense pulse, dilated pupils, but no head-ach. I found, upon inquiry, that she had received a hurt on her head by a fall, about seven weeks before I saw her. From this information, as well as from her symptoms, I had no doubt of the disease being the internal dropsy of the brain. I advised the loss of five ounces of blood, which gave her some relief. The blood was sizy. The next day she took a dose of jalap and calomel, which operated twelve times. On the 18th she lost four ounces more of blood, which was more sizy than that drawn on the 15th. From this time she mended rapidly. Her coma left her on the 20th, and her appetite returned; on the 21st she made a large quantity of turbid dark coloured urine. On the 22d her pulse became again a little tense, for which she took a gentle puke. On the 23d she had a natural stool. On the 24th her pupils appeared to be contracted to their natural size, and on the 30th I had the pleasure of seeing her seated at a tea-table in good health. Her pulse notwithstanding, was a little more active and tense than natural. CASE II. On the 24th of the same month, I was called to visit the son of John Cypher, in South-street, aged four years, who had been hurt about a month before, by a wound on his forehead with a brick-bat, the mark of which still appeared. He had been ill for near two weeks with coma, head-ach, colic, vomiting, and frequent startings in his sleep. His evacuations by stool and urine were suppressed; he had discharged three worms, and had had two convulsion fits just before I saw him. The pupil of the right eye was larger than that of the left. His pulse was full, tense, and slow, and intermitted every _fourth_ stroke. The symptoms plainly indicated an internal dropsy of the brain. I ordered him to lose four or five ounces of blood. But three ounces of blood were drawn, which produced a small change in his pulse. It rendered the intermission of a pulsation perceptible only after every tenth stroke. On the 25th he lost five ounces of blood, and took a purge of calomel and jalap. On the 26th he was better. On the 27th the vomiting was troublesome, and his pulse was still full and tense, but regular. I ordered him to lose four ounces of blood. On the 28th his puking and head-ach continued; his pulse was a little tense, but regular; and his right pupil less dilated. On the 29th his head-ach and puking ceased, and he played about the room. On the 4th of December he grew worse; his head-ach and puking returned, with a hard pulse, for which I ordered him to lose five ounces of blood. On the 5th he was better, but on the 6th his head-ach and puking returned. On the 7th I ordered his forehead to be bathed frequently with vinegar, in which ice had been dissolved. On the 8th he was much better. On the 9th his pulse became soft, and he complained but little of head-ach. After appearing to be well for near three weeks, except that he complained of a little head-ach, on the 29th his pulse became again full and tense, for which I ordered him to lose six ounces of blood, which for the first time discovered a buffy coat. After this last bleeding, he discharged a large quantity of water. From this time he recovered slowly, but his pulse was a little fuller than natural on the 19th of January following. He afterwards enjoyed good health. CASES III. AND IV. In the month of March, 1792, I attended two children of three years of age, the one the daughter of William King, the other the daughter of William Blake: each of whom had most of the symptoms of the inflammatory stage of the internal dropsy of the brain. I prescribed the loss of four ounces of blood, and a smart purge in both cases, and in the course of a few days had the pleasure of observing all the symptoms of the disease perfectly subdued in each of them. CASE V. In the months of July and August, 1792, I attended a female slave of Mrs. Oneal, of St. Croix, who had an obstinate head-ach, coma, vomiting, and a tense, full, and _slow_ pulse. I believed it to be the phrenicula, or internal dropsy of the brain, in its inflammatory stage. I bled her five times in the course of two months, and each time with obvious relief of all the symptoms of the disease. Finding that her head-ach, and a disposition to vomit, continued after the tension of her pulse was nearly reduced, I gave her as much calomel as excited a gentle salivation, which in a few weeks completed her cure. CASE VI. The daughter of Robert Moffat, aged eight years, in consequence of the suppression of a habitual discharge from sores on her head, in the month of April, 1793, was affected by violent head-ach, puking, great pains and weakness in her limbs, and a full, tense, and _slow_ pulse. I believed these symptoms to be produced by an inflammation of the brain. I ordered her to lose six or seven ounces of blood, and gave her two purges of jalap and calomel, which operated very plentifully. I afterwards applied a blister to her neck. In one week from the time of my first visit to her she appeared to be in perfect health. CASE VII. A young woman of eighteen years of age, a hired servant in the family of Mrs. Elizabeth Smith, had been subject to a head-ach every spring for several years. The unusually warm days which occurred in the beginning of April, 1793, produced a return of this periodical pain. On the eighth of the month, it was so severe as to confine her to her bed. I was called to visit her on the ninth. I found her comatose, and, when awake, delirious. Her pupils were unusually dilated, and insensible to the light. She was constantly sick at her stomach, and vomited frequently. Her bowels were obstinately costive, and her pulse was full, tense, and so slow as seldom to exceed, for several days, from 56 to 60 strokes in a minute. I ordered her to lose ten ounces of blood every day, for three days successively, and gave her, on each of those days, strong doses of jalap and aloes. The last blood which was drawn from her was sizy. The purges procured from three to ten discharges every day from her bowels. On the 12th, she appeared to be much better. Her pulse was less tense, and beat 80 strokes in a minute. On the 14th, she had a fainting fit. On the 15th, she sat up, and called for food. The pupils of her eyes now recovered their sensibility to light, as well as their natural size. Her head-ach left her, and, on the 17th, she appeared to be in good health. Her pulse, however, continued to beat between 50 and 60 strokes in a minute, and retained a small portion of irregular action for several days after she recovered. I am the more disposed to pronounce the cases which have been described to have been internal dropsy of the brain, from my having never been deceived in a single case in which I have examined the brains of patients whom I have suspected to have died of it. I could add many other cases to those which have been related, but enough, I hope, have been mentioned to establish the safety and efficacy of the remedies that have been recommended. I believe, with Dr. Quin, that this disease is much more frequent than is commonly supposed. I can recollect many cases of anomalous fever and head-ach in children, which have excited the most distressing apprehensions of an approaching internal dropsy of the brain, but which have yielded in a few days to bleeding, or to purges and blisters. I think it probable, that some, or perhaps most of these cases, might have terminated in an effusion of water in the brain, had they been left to themselves, or not been treated with the above remedies. I believe further, that it is often prevented by all those physicians who treat the first stage of febrile diseases in children with evacuations, just as the pulmonary consumption is prevented by bleeding, and low diet, in an inflammatory catarrh. Where blood-letting has failed of curing this disease, I am disposed to ascribe it to its being used less copiously than the disease required. If its relation to pneumonicula be the same in its cure, that I have supposed it to be in its cause, then I am persuaded, that the same excess in blood-letting is indicated in it, above what is necessary in phrenitis, that has been practised in pneumonicula, above what is necessary in the cure of an acute inflammation of the lungs. The continuance, and, in some instances, the increase of the appetite in the internal dropsy of the brain, would seem to favour this opinion no less in this disease, than in the inflammatory state of pulmonary consumption. The extreme danger from the effusion of water into the ventricles of the brain, and the certainty of death from its confinement there, is a reason likewise why more blood should be drawn in this disease, than in diseases of the same force in other parts of the body, where the products of inflammation have a prompt, or certain outlet from the body. Where the internal dropsy is obviously the effect of a fall, or of any other cause which acts _directly_ on the brain, there can be no doubt of the safety of very plentiful bleeding; all practical writers upon surgery concur in advising it. The late Dr. Pennington favoured me with an extract from Mr. Cline's manuscript lectures upon anatomy, delivered in London in the winter of 1792, which places the advantage of blood-letting, in that species of inflammation which follows a local injury of the brain, in a very strong point of light. "I know (says he) that several practitioners object to the use of evacuations as remedies for concussions of the brain, because of the weakness of the pulse; but in these cases the pulse is _depressed_. Besides, experience shows, that evacuations are frequently attended with very great advantages. I remember a remarkable case of a man in this [St. Thomas's] hospital, who was under the care of Mr. Baker. He lay in a comatose state for three weeks after an injury of the head. During that time he was bled _twenty_ times, that is to say, he was bled once every day upon an average. He was bled twice a day _plentifully_, but towards the conclusion he was bled more sparingly, and only every other day; but at each bleeding, there were taken, upon an average, about sixteen ounces of blood. In consequence of this treatment, the man perfectly recovered his health and reason." Local bleeding by cups, leaches, scarifications, or arteriotomy, should be combined with venesection, or preferred to it, where the whole arterial system does not sympathize with the disease in the brain. II. A second remedy to be used in the second stage of this disease is _purges_. I have constantly observed all the patients whose cases have been related, to be relieved by plentiful and repeated evacuations from the bowels. I was led to the use of frequent purges, by having long observed their good effects in palsies, and other cases of congestion in the brain, where blood-letting was unsafe, and where it had been used without benefit. In the Leipsic Commentaries[56], there is an account of a case of internal dropsy of the brain, which followed the measles, being cured by no other medicines than purges and diuretics. I can say nothing in favour of the latter remedy, in this disease, from my own experience. The foxglove has been used in this city by several respectable practitioners, but, I believe, in no instance with any advantage. [56] Vol. xxix. p. 139. III. _Blisters_ have been uniformly recommended by all practical writers upon this disease. I have applied them to the head, neck, and temples, and generally with obvious relief to the pain in the head. They should be omitted in no stage of the disease; for even in its inflammatory stage, the discharge they occasion from the vessels of the head, greatly overbalances their stimulating effects upon the whole system. IV. _Mercury_ was long considered as the only remedy, which gave the least chance of a recovery from a dropsy of the brain. Out of all the cases in which I gave it, before the year 1790, I succeeded in but two: one of them was a child of three years old, the other was a young woman of twenty-six years of age. I am the more convinced that the latter case was internal dropsy of the brain, from my patient having relapsed, and died between two or three years afterwards, of the same disease. Since I have adopted the depleting remedies which have been mentioned, I have declined giving mercury altogether, except when combined with some purging medicine, and I have given it in this form chiefly with a view of dislodging worms. My reasons for not giving it as a sialagogue are the uncertainty of its operation, its frequent inefficacy when it excites a salivation, and, above all, its disposition to produce gangrene in the tender jaws of children. Seven instances of its inducing death from that cause, in children between three and eight years of age, and with circumstances of uncommon distress, have occurred in Philadelphia since the year 1795. V. _Linen cloths_, wetted with cold vinegar, or water, and applied to the forehead, contribute very much to relieve the pain in the head. In the case of Mr. Cypher's son[57], the solution of ice in the vinegar appeared to afford the most obvious relief of this distressing symptom. [57] Case II. A puncture in the brain has been proposed by some writers to discharge the water from its ventricles. If the theory I have delivered be true, the operation promises nothing, even though it could always be performed with perfect safety. In cases of local injuries, or of inflammation from any cause, it must necessarily increase the disease; and in cases of effusion only, the debilitated state of the whole system forbids us to hope for any relief from such a local remedy. Bark, wine, and opium promise much more success in the last stage of the disease. I can say nothing in their favour from my own experience; but from the aid they afford to mercury in other diseases, I conceive they might be made to accompany it with advantage. Considering the nature of the indirect causes which induce the disease, and the case of a relapse, which has been mentioned, after an interval of near three years, as well as the symptoms of slow convalescence, manifested by the pulse, which occurred in the first and seventh cases, I submit it to the consideration of physicians, whether the use of moderate exercise, and the cold bath, should not be recommended to prevent a return of the disease in every case, where it has yielded to the power of medicine. I have great pleasure in adding, that the theory of this disease, which I have delivered, has been adopted by many respectable physicians in Philadelphia, and in other parts of the United States, and that it has led to the practice that has been recommended, particularly to copious blood-letting; in consequence of which, death from a dropsy of the brain is not a more frequent occurrence, than from any other of the acute febrile diseases of our country. OBSERVATIONS UPON THE NATURE AND CURE OF THE _GOUT_. In treating upon the gout, I shall deliver a few preliminary propositions. 1. The gout is a disease of the whole system. It affects the ligaments, blood-vessels, stomach, bowels, brain, liver, lymphatics, nerves, muscles, cartilages, bones, and skin. 2. The gout is a primary disease, only of the solids. Chalk-stones, abscesses, dropsical effusions into cavities, and cellular membrane, and eruptions on the skin, are all the effects of a morbid action in the blood-vessels. The truth of this proposition has been ably proved by Dr. Cullen in his First Lines. 3. It affects most frequently persons of a sanguineous temperament; but sometimes it affects persons of nervous and phlegmatic temperaments. The idle and luxurious are more subject to it, than the labouring and temperate part of mankind. Women are said to be less subject to it than men. I once believed, and taught this opinion, but I now retract it. From the peculiar delicacy of the female constitution, and from the thin covering they wear on their feet and limbs, the gout is less apt to fall upon those parts than in men, but they exhibit all its other symptoms, perhaps more frequently than men, in other parts of the body. The remote causes of gout moreover to be mentioned presently, act with equal force upon both sexes, and more of them I believe upon women, than upon men. It generally attacks in those periods of life, and in those countries, and seasons of the year, in which inflammatory diseases are most common. It seldom affects persons before puberty, or in old age, and yet I have heard of its appearing with all its most characteristic symptoms in this city in a child of 6, and in a man above 80 years of age. Men of active minds are said to be most subject to it, but I think I have seen it as frequently in persons of slender and torpid intellects, as in persons of an opposite character. I have heard of a case of gout in an Indian at Pittsburg, and I have cured a fit of it in an Indian in this city. They had both been intemperate in the use of wine and fermented liquors. 4. It is in one respect a hereditary disease, depending upon the propagation of a similar temperament from father to son. When a predisposition to the gout has been derived from ancestors, less force in exciting causes will induce it than in those habits where this has not been the case. This predisposition sometimes passes by children, and appears in grand-children. There are instances likewise in which it has passed by the males, and appeared only in the females of a family. It even appears in the descendants of families who have been reduced to poverty, but not often where they have been obliged to labour for a subsistence. It generally passes by those children who are born before the gout makes its appearance in a father. It is curious to observe how extensively the predisposition pervades some families. An English gentleman, who had been afflicted with the gout, married a young woman in Philadelphia many years ago, by whom he had one daughter. His wife dying three weeks after the birth of this child, he returned to England, where he married a second wife, by whom he had six children, all of whom except one died with the gout before they attained to the usual age of matrimony in Great Britain. One of them died in her 16th year. Finally the father and grandfather died with the same disease. The daughter whom this afflicted gentleman left in this city, passed her life subject to the gout, and finally died under my care in the year 1789, in the 68th year of her age. She left a family of children, two of whom had the gout. One of them, a lady, has suffered exquisitely from it. 5. The gout is always induced by general predisposing debility. 6. The remote causes of the gout which induce this debility, are, indolence, great bodily labour, long protracted bodily exercise, intemperance in eating, and in venery, acid aliments and drinks, strong tea and coffee, public and domestic vexation, the violent, or long continued exercise of the understanding, imagination, and passions in study, business, or pleasure, and, lastly, the use of ardent, and fermented liquors. The last are absolutely necessary to produce that form of gout which appears in the ligaments and muscles. I assert this, not only from my own observations, but from those of Dr. Cadogan, and Dr. Darwin, who say they never saw a case of gout in the limbs in any person who had not used spirits or wine in a greater or less quantity. Perhaps this may be another reason why women, who drink less of those liquors than men, are so rarely affected with this disease in the extreme parts of their bodies. Wines of all kinds are more disposed to produce this form of gout than spirits. The reason of this must be resolved into the less stimulus in the former, than in the latter liquors. Wine appears to resemble, in its action upon the body, the moderate stimulus of miasmata which produce a common remitting fever, or intermitting fever, while spirits resemble that violent action induced by miasmata which passes by the blood-vessels, ligaments, and muscles, and invades at once the liver, bowels, and brain. There is one symptom of the gout in the extremities which seems to be produced exclusively by ardent spirits, and that is a burning in the palms of the hands, and soles of the feet. This is so uniform, that I have sometimes been able to convict my patients of intemperance in the use of spirits, when no other mark of their having taken them in _excess_, appeared in the system. I have enumerated among the remote causes of the gout, the use of strong tea. I infer its predisposing quality to that disease, from its frequency at Japan, where tea is used in large quantities, and from the gout being more common among that sex in our country who drink the most, and the strongest tea. 7. The exciting causes of the gout are frequently a greater degree, or a sudden application of its remote and predisposing causes. They act upon the accumulated excitability of the system, and by destroying its equilibrium of excitement, and regular order of actions, produce convulsion, or irregular morbid and local excitement. These exciting causes are either of a stimulating, or of a sedative nature. The former are violent exercise, of body or mind, night-watching, and even sitting up late at night, a hearty meal, a fit of drunkenness, a few glasses of claret or a draught of cyder, where those liquors have not been habitual to the patient, a sudden paroxysm of joy, anger, or terror, a dislocation of a bone, straining of a joint, particularly of the ankle, undue pressure upon the foot, or leg, from a tight shoe or boot, an irritated corn, and the usual remote causes of fever. The latter exciting causes are sudden inanition from bleeding, purging, vomiting, fasting, cold, a sudden stoppage of moisture on the feet, fear, grief, excess in venery, and the debility left upon the system by the crisis of a fever. All these causes act more certainly when they are aided by the additional debility induced upon the system in sleep. It is for this reason that the gout generally makes its first attack in the night, and in a part of the system most remote from the energy of the brain, and most debilitated by exercise, viz. in the great toe, or in some part of the foot. In ascribing a fit of the gout to a cause which is of a sedative nature, the reader will not suppose that I have departed from the simplicity and uniformity of a proposition I have elsewhere delivered, that disease is the effect of stimulus. The abstraction of a natural and habitual impression of any kind, by increasing the force of those which remain, renders the production of morbid and excessive actions in the system as much the effect of preternatural or disproportioned stimulus, as if they were induced by causes that are externally and evidently stimulating. It is thus in many other of the operations of nature, opposite causes produce the same effects. 8. The gout consists simply in morbid excitement, accompanied with irregular action, or the absence of all action from the force of stimulus. There is nothing specific in the morbid excitement and actions which take place in the gout different from what occur in fevers. It is to be lamented that a kind of metastasis of error has taken place in pathology. The rejection of a specific acrimony as the cause of each disease, has unfortunately been followed by a belief in as many specific actions as there are different forms and grades of disease, and thus perpetuated the evils of our ancient systems of medicine. However varied morbid actions may be by their causes, seats, and effects, they are all of the same nature, and the time will probably come when the whole nomenclature of morbid actions will be absorbed in the single name of disease. I shall now briefly enumerate the symptoms of the gout, as they appear in the ligaments, the blood-vessels, the viscera, the nervous system, the alimentary canal, the lymphatics, the skin, and the bones of the human body, and here we shall find that it is an epitome of all disease. I. The ligaments which connect the bones are the seats, of what is called a legitimate or true gout. They are affected with pain, swelling, and inflammation. The pain is sometimes so acute as to be compared to the gnawing of a dog. We perceive here the sameness of the gout with the rheumatism. Many pages, and indeed whole essays, have been composed by writers to distinguish them, but they are exactly the same disease while the morbid actions are confined to this part of the body. They are, it is true, produced by different remote causes, but this constitutes no more difference in their nature, than is produced in a coal of fire, whether it be inflamed by a candle, or by a spark of electricity. The morbid actions which are induced by the usual causes of rheumatism affect, though less frequently, the lungs, the trachea, the head, the bowels, and even the heart, as well as the gout. Those actions, moreover, are the means of a fluid being effused, which is changed into calcareous matter in the joints and other parts of the body, exactly like that which is produced by the gout. They likewise twist and dislocate the bones in common with the gout, in a manner to be described hereafter. The only difference between what are called gouty, and rheumatic actions, consists in their seats, and in the degrees of their force. The debility which predisposes to the gout, being greater, and more extensively diffused through the body than the debility which precedes rheumatism, the morbid actions, in the former case, pass more readily from external to internal parts, and produce in both more acute and more dangerous effects. A simile derived from the difference in the degrees of action produced in the system by marsh miasmata, made use of upon a former occasion, will serve me again to illustrate this part of our subject. A mild remittent, and a yellow fever, are different grades of the same disease. The former, like the rheumatism, affects the bones chiefly with pain, while the latter, like the gout, affects not only the bones, but the stomach, bowels, brain, nerves, lymphatics, and all the internal parts of the body. II. In the arterial system the gout produces fever. This fever appears not only in the increased force or frequency of the pulse, but in morbid affections of all the viscera. It puts on all the different grades of fever, from the malignity of the plague, to the mildness of a common intermittent. It has moreover its regular exacerbations and remissions once in every four and twenty hours, and its crisis usually on the fourteenth day, in violent cases. In moderate attacks, it runs on from twenty to forty days in common with the typhus or slow chronic state of fever. It is common for those persons who consider the gout as a specific disease, when it appears in the above forms, to say, that it is complicated with fever; but this is an error, for there can exist but one morbid action in the blood-vessels at once, and the same laws are imposed upon the morbid actions excited in those parts of the body by the remote causes of the gout, as by the common causes of fever. I have seen two instances of this disease appearing in the form of a genuine hectic, and one in which it appeared to yield to lunar influence, in the manner described by Dr. Balfour. In the highly inflammatory state of the gout, the sensibility of the blood-vessels far exceeds what is seen in the same state of fever from more common causes. I have known an instance in which a translation of the gouty action to the eye produced such an exquisite degree of sensibility, that the patient was unable to bear the feeble light which was emitted from a few coals of fire in his room, at a time too when the coldness of the weather would have made a large fire agreeable to him. It is from the extreme sensibility which the gout imparts to the stomach, that the bark is so generally rejected by it. I knew a British officer who had nearly died from taking a spoonful of the infusion of that medicine, while his arterial system was in this state of morbid excitability, from a fit of the gout. It is remarkable that the gout is most disposed to assume a malignant character, during the prevalence of an inflammatory constitution of the atmosphere. This has been long ago remarked by Dr. Huxham. Several instances of it have occurred in this city since the year 1793. III. The gout affects most of the viscera. In the brain it produces head-ach, vertigo, coma, apoplexy, and palsy. In the lungs it produces pneumonia vera, notha, asthma, hæmoptysis, pulmonary consumption, and a short hecking cough, first described by Dr. Sydenham. In the throat it produces inflammatory angina. In the uterus it produces hæmorrhagia uterina. It affects the kidneys with inflammation, strangury, diabetes, and calculi. The position of the body for weeks or months on the back, by favouring the compression of the kidneys by the bowels, is the principal reason why those parts suffer so much in gouty people. The strangury appears to be produced by the same kind of engorgement or choking of the vessels of the kidneys, which takes place in the small-pox and yellow fever. Four cases of it are described in the 3d volume of the Physical and Literary Essays of Edinburgh, by Dr. David Clerk. I have seen one instance of death in an old man from this cause. The catheter brought no water from his bladder. The late Mr. John Penn, formerly governor of Pennsylvania, I have been informed by one of his physicians, died from a similar affection in his kidneys from gout. The catheter was as ineffectual in giving him relief, as it was in the case of my patient. The neck of the bladder sometimes becomes the seat of the gout. It discovers itself by spasm, and a suppression of urine in some cases, and occasionally by a habitual discharge of mucus through the urethra. This disease has been called, by Lieutaud, "a catarrh of the bladder." Dr. Stoll describes it, and calls it "hæmorrhoids of the bladder." But of all the viscera, the liver suffers most from the gout. It produces in it inflammation, suppuration, melena, schirrus, gall-stones, jaundice, and a habitual increased secretion and excretion of bile. These affections of the liver appear most frequently in southern countries, and in female habits. They are substitutes for a gout in the ligaments, and in the extremities of the body. They appear likewise in drunkards from ardent spirits. It would seem that certain stimuli act specifically upon the liver, probably for the wise purpose of discharging such parts of the blood from the body, as are vitiated by the rapidity of its circulation. I shall, in another place[58], take notice of the action of marsh miasmata upon the livers of men and beasts. It has been observed that hogs that live near brewhouses, and feed upon the fermented grains of barley, always discover enlarged or diseased livers. But a determination of the blood to the liver, and an increased action of its vessels, are produced by other causes than marsh miasmata, and fermented and distilled liquors. They appear in the fever which accompanies madness and the malignant sore-throat, also in contusions of the brain, and in the excited state of the blood-vessels which is produced by anger and exercise. I have found an attention to these facts useful in prescribing for diseases of the liver, inasmuch as they have led me from considering them as idiopathic affections, but as the effects only of morbid actions excited in other parts of the body. [58] Volume IV. IV. The gout sometimes affects the arterial and nervous systems _jointly_, producing in the brain, coma, vertigo, apoplexy, palsy, loss of memory, and madness, and in the _nerves_, hysteria, hypochondriasis, and syncope. It is common to say the gout counterfeits all these diseases. But this is an inaccurate mode of speaking. All those diseases have but one cause, and they are exactly the same, however different the stimulus may be, from which they are derived. Sometimes the gout affects the brain and nerves exclusively, without producing the least morbid action in the blood-vessels. I once attended a gentleman from Barbadoes who suffered, from this affection of his brain and nerves, the most intolerable depression of spirits. It yielded to large doses of wine, but his relief was perfect, and more durable, when a pain was excited by nature or art, in his hands or feet. The muscles are sometimes affected by the gout with spasm, with general and partial convulsions, and lastly with great pain. Dr. Stoll describes a case of opisthotonos from it. The angina pectoris, or a sudden inability to breathe after climbing a hill, or a pair of stairs, and after a long walk, is sometimes a symptom of the gout. There is a pain which suddenly pervades the head, breast, and limbs, which resembles an electric shock. I have known two instances of it in gouty patients, and have taken the liberty of calling it the "aura arthritica." But the pain which affects the muscles is often of a more permanent nature. It is felt with most severity in the calves of the legs. Sometimes it affects the muscles of the head, breast, and limbs, exciting in them large and distressing swellings. But further; the gout in some cases seizes upon the tendons, and twists them in such a manner as to dislocate bones in the hands and feet. It even affects the cartilages. Of this I once saw an instance in colonel Adams, of the state of Maryland. The external parts of both his ears were so much inflamed in a fit of the gout, that he was unable to lie on either of his sides. V. The gout affects the alimentary canal, from the stomach to its termination in the rectum. Flatulency, sickness, acidity, indigestion, pain, or vomiting, usually usher in a fit of the disease. The sick head-ach, also dyspepsia, with all its train of distressing evils, are frequently the effects of gout concentrated in the stomach. I have seen a case in which the gout, by retreating to this viscus, produced the same burning sensation which is felt in the yellow fever. The patient who was the subject of this symptom died two days afterwards with a black vomiting. It was Mr. Patterson, formerly collector of the port of Philadelphia, under the British government. I was not surprised at these two uncommon symptoms in the gout, for I had long been familiar with its disposition to affect the biliary secretion, and the actions of the stomach. The colic and dysentery are often produced by the gout in the bowels. In the southern states of America, it sometimes produces a chronic diarrh[oe]a, which is known in some places by the name of the "downward consumption." The piles are a common symptom of gout, and where they pour forth blood occasionally, render it a harmless disease. I have known an instance in which a gouty pain in the rectum produced involuntary stools in a gentleman in this city, and I have heard from a southern gentleman, who had been afflicted with gouty symptoms, that a similar pain was excited in the same part to such a degree, whenever he went into a crowded room lighted by candles, as to oblige him to leave it. In considering the effects of the gout upon this part, I am led to take notice of a troublesome itching in the anus which has been described by Dr. Lettsom, and justly attributed by him to this disease[59]. I have known several cases of it. They always occurred in gouty habits. A distressing collection of air in the rectum, which renders frequent retirement from company necessary to discharge it, is likewise a symptom of gout. It is accompanied with frequent, and small, but hard stools. [59] Medical Memoirs, vol. III. Of the above morbid affections of the nerves, stomach, and bowels, the hysteria, the sick head-ach, and the colic, appear much oftener in women than in men. I have said that dyspepsia is a symptom of gout. Out of more than 500 persons who were the patients of the Liverpool infirmary and dispensary, in one year, Dr. Currie informs us, "a great majority were females[60]." [60] Medical Reports on the Effects of Hot and Cold Water, p. 215. VI. The gout affects the glands and lymphatics. It produced a salivation of a profuse nature in major Pearce Butler, which continued for two days. It produced a bubo in the groin in a citizen of Philadelphia. He had never been infected with the venereal disease, of course no suspicion was entertained by me of its being derived from that cause. I knew a lady who had periodical swellings in her breasts, at the same season of the year in which she had before been accustomed to have a regular fit of the gout. The scrophula and all the forms of dropsy are the effects in many cases of the disposition of the gout to attack the lymphatic system. There is a large hard swelling without pain, of one, or both the legs and thighs, which has been called a dropsy, but is very different from the common disease of that name. It comes on, and goes off suddenly. It has lately been called in England the _dumb_ gout. In the spring of 1798 I attended colonel Innes, of Virginia, in consultation with my Edinburgh friend and fellow-student, Dr. Walter Jones, of the same state. The colonel had large anasarcous swellings in his thighs and legs, which we had reason to believe were the effects of an indolent gout. We made several punctures in his feet and ancles, and thereby discharged a large quantity of water from his legs and thighs. A day or two afterwards his ancles exhibited in pain and inflammation, the usual form of gout in those parts. In the year 1794 I attended Mrs. Lloyd Jones, who had a swelling of the same kind in her foot and leg. Her constitution, habits, and the sober manners of her ancestors, gave me no reason to suspect it to arise from the usual remote causes of gout. She was feverish, and her pulse was tense. I drew ten ounces of blood from her, and gave her a purge. The swelling subsided, but it was succeeded by an acute rheumatic pain in the part, which was cured in a few days. I mention these facts as an additional proof of the sameness of the gout and rheumatism, and to show that the vessels in a simple disease, as well as in malignant fevers, are often oppressed beyond that point in which they emit the sensation of pain. Under this head I shall include an account of the mucous discharge from the urethra, which sometimes takes place in an attack of the gout, and which has ignorantly been ascribed to a venereal gonorrhæa. There is a description of this symptom of the gout in the 3d volume of the Physical and Literary Essays of Edinburgh, by Dr. Clark. It was first taken notice of by Sauvages by the name of "gonorrhæa podagrica," in a work entitled Pathologia Methodica. I have known three instances of it in this city. In the visits which the gout pays to the genitals, it sometimes excites great pain in the testicles. Dr. Whytt mentions three cases of this kind. One of them was attended with a troublesome itching of the scrotum. I have seen one case in which the testicles were affected with great pain, and the penis with an obstinate priapism. They succeeded a sudden translation of the gout from the bowels. From the occasional disposition of the gout to produce a mucous discharge from the urethra in men, it is easy to conceive that it is the frequent cause of the fluor albus in women, for in them, the gout which is restrained from the feet, by a cause formerly mentioned, is driven to other parts, and particularly to that part which, from its offices, is more disposed to invite disease to it, than any other. The fluor albus sometimes occurs in females, apparently of the most robust habits. In such persons, more especially if they have been descended from gouty ancestors, and have led indolent and luxurious lives, there can be no doubt but the disease is derived from the gout, and should be treated with remedies which act not only upon the affected part, but the whole system. An itching similar to that I formerly mentioned in the anus, sometimes occurs in the vagina of women. Dr. Lettsom has described it. In all the cases I have known of it, I believe it was derived from the usual causes of the gout. VII. There are many records in the annals of medicine of the gout affecting the skin. The erysipelas, gangrene, and petechiæ are its acute, and tetters, and running sores are its usual chronic forms when it appears in this part of the body. I attended a patient with the late Dr. Hutchinson, in whom the whole calf of one leg was destroyed by a mortification which succeeded the gout. Dr. Alexander, of Baltimore, informed me that petechiæ were among the last symptoms of this disease in the Rev. Mr. Oliver, who died in the town of Baltimore, about two years ago. In the disposition of the gout to attack external parts, it sometimes affects the eyes and ears with the most acute and distressing inflammation and pain. I hesitate the less in ascribing them both to the gout, because they not only occur in gouty habits, but because they now and then effuse a calcareous matter of the same nature with that which is found in the ligaments of the joints. VIII. Even the bones are not exempted from the ravages of this disease. I have before mentioned that the bones of the hands and feet are sometimes dislocated by it. I have heard of an instance in which it dislocated the thigh bone. It probably produced this effect by the effusion of that part of the blood which constitutes chalk-stones, or by an excrescence of flesh in the cavity of the joint. Two instances have occurred in this city of its dislodging the teeth, after having produced the most distressing pains in the jaws. The long protracted, and acute pain in the face, which has been so accurately described by Dr. Fothergill, probably arises wholly from the gout acting upon the bones of the part affected. I have more than once hinted at the sameness of some of the states of the gout, and the yellow fever. Who can compare the symptoms and seats of both diseases, and not admit the unity of the remote and immediate causes of fever? Thus have I enumerated proofs of the gout being a disease of the _whole_ system. I have only to add under this proposition, that it affects different parts of the body in different people, according to the nature of their congenital or acquired temperaments, and that it often passes from one part of the body to another in the twinkling of an eye. The morbid excitement, and actions of the gout, when seated in the ligaments, the blood-vessels, and viscera, and left to themselves, produce effects different in their nature, according to the parts in which they take place. In the viscera they produce congestions composed of all the component parts of the blood. From the blood-vessels which terminate in hollow cavities and in cellular membrane, they produce those effusions of serum which compose dropsies. From the same vessels proceed those effusions which produce on the skin erysipelas, tetters, and all the different kinds of eruptions. In the ligaments they produce an effusion of coagulable lymph, which by stagnation is changed into what are called chalk-stones. In the urinary organs they produce an effusion of particles of coagulable lymph or red blood, which, under certain circumstances, are changed into sand, gravel, and stone. All these observations are liable to some exceptions. There are instances in which chalk-stones have been found in the lungs, mouth, on the eye-lids, and in the passages of the ears, and a preternatural flux of water and blood has taken place from the kidneys. Pus has likewise been formed in the joints, and air has been found in the cavity of the belly, instead of water. Sometimes the gout is said to combine with the fevers which arise from cold and miasmata. We are not to suppose from this circumstance, that the system is under a twofold stimulus. By no means. The symptoms which are ascribed to the gout, are the effects of morbid excitement excited by the cold, or miasmata acting upon parts previously debilitated by the usual remote causes of that disease. A bilious diathesis in the air so often excites the peculiar symptoms of gout, in persons predisposed to it, that it has sometimes been said to be epidemic. This was the case, Dr. Stoll says, in Vienna, in the years 1782 and 1784. The same mixture of gouty and bilious symptoms was observed by Dr. Hillary, in the fevers of Barbadoes. From a review of the symptoms of the gout, the impropriety of distinguishing it from its various seats, by specific names, must be obvious to the reader. As well might we talk of a yellow fever in the brain, in the nerves, or in the groin, when its symptoms affect those parts, as talk of _misplaced_ or _retrocedent_ gout. The great toe, and the joints of the hands and feet, are no more its exclusive seats, than the "stomach is the throne of the yellow fever." In short, the gout may be compared to a monarch whose empire is unlimited. The whole body crouches before it. It has been said as a reflection upon our profession, that physicians are always changing their opinions respecting chronic diseases. For a long while they were all classed under the heads of nervous, or bilious. These names for many years afforded a sanctuary for the protection of fraud and error in medicine. They have happily yielded of late years to the name of gout. If we mean by this disease a primary affection of the joints, we have gained nothing by assuming that name; but if we mean by it a disease which consists simply of morbid excitement, invited by debility, and disposed to invade every part of the body, we conform our ideas to facts, and thus simplify theory and practice in chronic diseases. I proceed now to treat of the METHOD OF CURE. Let not the reader startle when I mention curing the gout. It is not a sacred disease. There will be no profanity in handling it freely. It has been cured often, and I hope to deliver such directions under this head, as will reduce it as much under the power of medicine, as a pleurisy or an intermitting fever. Let not superstition say here, that the gout is the just punishment of folly, and vice, and that the justice of Heaven would be defeated by curing it. The venereal disease is more egregiously the effect of vice than the gout, and yet Heaven has kindly directed human reason to the discovery of a remedy which effectually eradicates it from the constitution. This opinion of the gout being a curable disease, is as humane as it is just. It is calculated to prompt to early application for medical aid, and to prevent that despair of relief which has contributed so much to its duration, and mortality. But does not the gout prevent other diseases, and is it not improper upon this account to cure it? I answer, that it prevents other diseases, as the daily use of drams prevents the intermitting fever. In doing this, they bring on a hundred more incurable morbid affections. The yellow fever carried off many chronic diseases in the year 1793, and yet who would wish for, or admit such a remedy for a similar purpose? The practice of encouraging, and inviting what has been called a "friendly fit" of the gout as a cure for other diseases, resembles the practice of school boys who swallow the stones of cherries to assist their stomachs in digesting that delicate fruit. It is no more necessary to produce the gout in the feet, in order to cure it, than it is to wait for, or encourage abscesses or natural hæmorrhages, to cure a fever. The practice originated at a time when morbific matter was supposed to be the cause of the gout, but it has unfortunately continued under the influence of theories which have placed the seat of the disease in the solids. The remedies for the gout naturally divide themselves into the following heads. I. Such as are proper in its approaching, or forming state. II. Such as are proper in _violent_ morbid action in the blood-vessels and viscera. III. Such as are proper in a _feeble_ morbid action in the same parts of the body. IV. Such as are proper to relieve certain local symptoms which are not accompanied by general morbid action. And V. Such as are proper to prevent its recurrence, or, in other words, to eradicate it from the system. I. The symptoms of an approaching fit of the gout are great languor, and dulness of body and mind, doziness, giddiness, wakefulness, or sleep disturbed by vivid dreams, a dryness, and sometimes a coldness, numbness, and prickling in the feet and legs, a disappearance of pimples in the face, occasional chills, acidity and flatulency in the stomach, with an increased, a weak, or a defect of appetite. These symptoms are not universal, but more or less of them usher in nearly every fit of the gout. The reader will see at once their sameness with the premonitory symptoms of fever from cold and miasmata, and assent from this proof, in addition to others formerly mentioned, to the propriety of considering a fit of the gout, as a paroxysm of fever. The system, during the existence of these symptoms, is in a state of morbid depression. The disease is as yet unformed, and may easily be prevented by the loss of a few ounces of blood, or, if this remedy be objected to, by a gentle doze of physic, and afterwards by bathing the feet in warm water, by a few drops of the spirit of hartshorn in a little sage or camomile tea, by a draught of wine whey, or a common doze of liquid laudanum, and, according to a late Portuguese physician, by taking a few doses of bark. It is worthy of notice, that if these remedies are omitted, all the premonitory symptoms that have been mentioned disappear as soon as the arthritic fever is formed, just as lassitude and chilliness yield to a paroxysm of fever from other causes. II. Of the remedies that are proper in cases of great morbid action in the blood-vessels and viscera. I shall begin this head by repudiating the notion of a specific cure for the gout existing in any single article of the materia medica. Every attempt to cure it by elixirs, diet-drinks, pills, or boluses, which were intended to act singly on the system, has been as unsuccessful as the attempts to cure the whooping cough by spells, or tricks of legerdemain. The first remedy that I shall mention for reducing great morbid action in the blood-vessels and viscera, is _blood-letting_. I was first taught the safety of this remedy in the gout by reading the works of Dr. Lister, above thirty years ago, and I have used it ever since with great advantage. It has the sanction of Dr. Hoffman, Dr. Cullen, and many others of the first names in medicine in its favour. The usual objections to bleeding as a remedy, have been urged with more success in the gout, than in any other disease. It has been forbidden, because the gout is said to be a disease of debility. This is an error. Debility is not a disease. It is only its predisposing cause. Disease is preternatural strength in the state of the system now under consideration, occasioned by the abstraction of excitement from one part, and the accumulation of it in another part of the body. Every argument in favour of bleeding in a pleurisy applies in the present instance, for they both depend upon the same kind of morbid action in the blood-vessels. Bleeding acts moreover alike in both cases by abstracting the excess of excitement from the blood-vessels, and restoring its natural and healthy equality to every part of the system. It has been further said, that bleeding disposes to more frequent returns of the gout. This objection to the lancet has been urged by Dr. Sydenham, who was misled in his opinion of it, by his theory of the disease being the offspring of morbific matter. The assertion is unfounded, for bleeding in a fit of the gout has no such effect, provided the remedies to be mentioned hereafter are used to prevent it. But a fit of the gout is not singular in its disposition to recur after being once cured. The rheumatism, the pleurisy, and the intermitting fever are all equally disposed to return when persons are exposed to their remote and exciting causes, and yet we do not upon this account consider them as incurable diseases, nor do we abstain from the usual remedies which cure them. The inflammatory or violent state of the gout is said most commonly to affect the limbs. But this is far from being the case. It frequently makes its first attack upon the head, lungs, kidneys, stomach, and bowels. The remedies for expelling it from the stomach and bowels are generally of a stimulating nature. They are as improper in full habits, and in the recent state of the disease, as cordials are to drive the small-pox from the vitals to the skin. Hundreds have been destroyed by them. Bleeding in these cases affords the same speedy and certain relief that it does in removing pain from the stomach and bowels in the first stage of the yellow fever. Colonel Miles owes his life to the loss of 60 ounces of blood in an attack of the gout in his bowels, in the winter of 1795, and major Butler derived the same benefit from the loss of near 30 ounces, in an attack of the gout in his stomach in the spring of 1798. I could add many more instances of the efficacy of the lancet in the gout when it affects the viscera, from my own experience, but I prefer mentioning one only from sir John Floyer, which is more striking than any I have met with in its favour. He tells us, sir Henry Coningsby was much disposed to the palsy from the gout when he was 30 years old. By frequent bleedings, and the use of the cold bath, he recovered, and lived to be 88. During his old age, he was bled every three months. I have said, in the history of the symptoms of the gout, that it sometimes appeared in the form of a hectic fever. I have prescribed occasional bleedings in a case of this kind accompanied with a tense pulse, with the happiest effects. It confined the disease for several years wholly to the blood-vessels, and it bid fair in time to eradicate it from the system. The state of the pulse, as described in another place[61], should govern the use of the lancet in this disease. Bleeding is required as much in its depressed, as in its full and chorded state. Colonel Miles's pulse, at the time he suffered from the gout in his bowels, was scarcely perceptible. It did not rise till after a second or third bleeding. [61] Defence of Blood-letting, vol. IV. Some advantage may be derived from examining the blood. I have once known it to be dissolved; but for the most part I have observed it, with Dr. Lister, to be covered with the buffy coat of common inflammation. The arguments made use of in favour of bleeding in the diseases of old people in a former volume, apply with equal force to its use in the gout. The inflammatory state of this disease frequently occurs in the decline of life, and bleeding is as much indicated in such cases as in any other inflammatory fever. The late Dr. Chovet died with an inflammation in his liver from gout, in the 86th year of his age. He was twice bled, and his blood each time was covered with a buffy coat. Where the gout affects the head with obstinate pain, and appears to be seated in the muscles, cupping and leeches give great relief. This mode of bleeding should be trusted in those cases only in which the morbid action is confined chiefly to the head, and appears in a feeble state in the rest of the arterial system. The advantages of bleeding in the gout, when performed under all the circumstances that have been mentioned, are as follow: 1. It removes or lessens pain. 2. It prevents those congestions and effusions which produce apoplexy, palsy, pneumonia notha, calculi in the kidneys and bladder, and chalk-stones in the hands and feet. The gravel and stone are nine times in ten, I believe, the effects of an effusion of lymph or blood from previous morbid action in the kidneys. If this disease were narrowly watched, and cured as often as it occurs, by the loss of blood, we should have but little gravel or stone among gouty people. A citizen of Philadelphia died a few years ago, in the 96th year of his age, who had been subject to the strangury the greatest part of his life. His only remedy for it was bleeding. He lived free from the gravel and stone; and died, or rather appeared to fall asleep in death, from old age. Dr. Haller mentions a similar case in his Bibliotheca Medicinæ, in which bleeding had the same happy effects. 3. It prevents the system from wearing itself down by fruitless pain and sickness, and thereby inducing a predisposition to frequent returns of the disease. 4. It shortens the duration of a fit of gout, by throwing it, not into the feet, but out of the system, and thus prevents a patient's lying upon his back for two or three months with a writhing face, scolding a wife and family of children, and sometimes cursing every servant that comes near enough to endanger the touch of an inflamed limb. Besides preventing all this parade of pain and peevishness, it frequently, when assisted with other remedies to be mentioned presently, restores a man to his business and society in two or three days: a circumstance this of great importance in the public as well as private pursuits of men; for who has not read of the most interesting affairs of nations being neglected or protracted, by the principal agents in them being suddenly confined to their beds, or chairs, for weeks or months, by a fit of the gout? 2. A second remedy in the state of the gout which has been mentioned, is _purging_. Sulphur is generally preferred for this purpose, but castor oil, cream of tartar, sena, jalap, rhubarb, and calomel, may all be used with equal safety and advantage. The stomach and habits of the patient should determine the choice of a suitable purge in every case. Salts are generally offensive to the stomach. They once brought on a fit of the gout in Dr. Brown. 3. _Vomits_ may be given in all those cases where bleeding is objected to, or where the pulse is only moderately active. Mr. Small, in an excellent paper upon the gout, in the 6th volume of the Medical Observations and Inquiries, p. 205, containing the history of his own case, tells us that he always took a vomit upon the first attack of the gout, and that it never failed of relieving all its symptoms. The matter discharged by this vomit indicated a morbid state of the liver, for it was always a dark greenish bile, which was insoluble in water. A British lieutenant, whose misfortunes reduced him to the necessity of accepting a bed in the poor-house of this city, informed the late Dr. Stuben, that he had once been much afflicted with the gout, and that he had upon many occasions strangled a fit of it by the early use of an emetic. Dr. Pye adds his testimony to those which have been given in favour of vomits, and says further, that they do most service when they discharge an acid humour from the stomach. They appear to act in part by equalizing the divided excitement of the system, and in part by discharging the contents of the gall-bladder and stomach, vitiated by the previous debility of those organs. Care should be taken not to exhibit this remedy where the gout attacks the stomach with symptoms of inflammation, or where it has a tendency to fix itself upon the brain. 4. _Nitre_ may be given with advantage in cases of inflammatory action, where the stomach is not affected. 5. A fifth remedy is _cool_ or _cold air_. This is as safe and useful in the gout as in any other inflammatory state of fever. The affected limbs should be kept out of bed, _uncovered_. In this way Mr. Small says he moderated the pains of the gout in his hands and feet[62]. I have directed the same practice with great comfort, as well as advantage to my patients. Even cold water has been applied with good effects to a limb inflamed by the gout. Mr. Blair M'Clenachan taught me the safety and benefit of this remedy, by using it upon himself without the advice of a physician. It instantly removed his pain, nor was the gout translated by it to any other part of his body. It was removed in the same manner, Dr. Heberden tells us, by the celebrated Dr. Harvey from his own feet. Perhaps it would be best in most cases to prefer cool, or cold air, to cold water. The safety and advantages of both these modes of applying cold to the affected limbs, show the impropriety of the common practice of wrapping them in flannel. [62] Medical Observations and Inquiries, vol VI. p. 201. 6. _Diluting liquors_, such as are prescribed in common inflammatory fevers, should be given in such quantities as to dispose to a gentle perspiration. 7. _Abstinence from wine, spirits, and malt liquors_, also from such aliments as afford much nourishment or stimulus, should be carefully enjoined. Sago, panada, tapioca, diluted milk with bread, and the pulp of apples, summer fruits, tea, coffee, weak chocolate, and bread soaked in chicken water or beef tea, should constitute the principal diet of patients in this state of the gout. 8. _Blisters_ are an invaluable remedy in this disease, when used at a proper time, that is, after the reduction of the morbid actions in the system by evacuations. They should be applied to the joints of the feet and wrists in general gout, and to the neck and sides, when it attacks the head or breast. A strangury from the gout is no objection to their use. So far from increasing this complaint, Dr. Clark and Dr. Whytt inform us, that they remove it[63]. But the principal advantage of blisters is derived from their collecting and concentrating scattered and painful sensations, and conveying them out of the system, and thus becoming excellent substitutes for a tedious fit of the gout. [63] Physical and Literary Essays, vol. III. p. 469. 9. _Fear_ and _terror_ have in some instances cured a paroxysm of this disease. A captain of a British ship of war, who had been confined for several weeks to his cabin, by a severe fit of the gout in his feet, was suddenly cured by hearing the cry of fire on board his ship. This fact was communicated to me by a gentleman who was a witness of it. Many similar cases are upon record in books of medicine. I shall in another place insert an account of one in which the cure effected by a fright, eradicated the disease from the system so completely, as ever afterwards to prevent its return. Thus have I enumerated the remedies which are proper in the gout when it affects the blood-vessels and viscera with great morbid action. Most of those remedies are alike proper when the morbid actions are seated in the muscular fibres, whether of the bowels or limbs, and whether they produce local pain, or general convulsion, provided they are of a violent nature. There are some remedies under this head of a doubtful nature, on which I shall make a few observations. _Sweating_ has been recommended in this state of the gout. All the objections to it in preference to other modes of depletion, mentioned in another place[64], apply against its use in the inflammatory state of the gout. It is not only less safe than bleeding, purging, and abstinence, but it is often an impracticable remedy. The only sudorific medicine to be trusted in this state of the disease is the Seneka snake-root. It promotes all the secretions and excretions, and exerts but a feeble stimulus upon the arterial system. [64] Defence of Blood-letting. Many different preparations of _opium_ have been advised in this state of the gout. They are all hurtful if given before the morbid action of the system is nearly reduced. It should then be given in small doses accommodated to the excitability of the system. Applications of various kinds to the affected limbs have been used in a fit of the gout, and some of them with success. The late Dr. Chalmers of South-Carolina used to meet the pain of the gout as soon as it fixed in any of his limbs, with a blister, and generally removed it by that means in two or three days. I have imitated this practice in several cases, and always with success, nor have I ever seen the gout thrown upon any of the viscera by means of this remedy. Caustics have sometimes been applied to gouty limbs with advantage. The moxa described and used by sir William Temple, which is nothing but culinary fire, has often not only given relief to a pained limb, but carried off a fit of the gout in a few hours. These powerful applications may be used with equal advantage in those cases in which the gout by falling upon the head produces coma, or symptoms of apoplexy. A large caustic to the neck roused Mr. John M. Nesbit from a coma in which he had lain for three days, and thereby appeared to save his life. Blisters, and cataplasms of mustard, had been previously used to different parts of his body, but without the least effect. In cases of moderate pain, where a blister has been objected to, I have seen a cabbage leaf afford considerable relief. It produces a moisture upon the part affected, without exciting any pain. An old sea captain taught me to apply molasses to a limb inflamed or pained by the gout. I have frequently advised it, and generally with advantage. All volatile and stimulating liniments are improper, for they not only endanger a translation of the morbid excitement to the viscera, but where they have not this effect, they increase the pain and inflammation of the part affected. The sooner a patient exercises his lower limbs by walking, after a fit of the gout, the better. "I made it a constant rule (says Mr. Small) to walk abroad as soon as the inflammatory state of the gout was past, and though by so doing, I often suffered great pain, I am well convinced that the free use I now enjoy of my limbs is chiefly owing to my determined perseverance in the use of that exercise; nor am I less persuaded that nine in ten of gouty cripples owe their lameness more to indolence, and fear of pain, than to the genuine effects of the gout[65]." Sir William Temple confirms the propriety of Mr. Small's opinion and practice, by an account of an old man who obviated a fit of the gout as often as he felt it coming in his feet, by walking in the open air, and afterwards by going into a warm bed, and having the parts well rubbed where the pain began. "By following this course (he says) he was never laid up with the gout, and before his death recommended the same course to his son if ever he should fall into that accident." Under a conviction of the safety of this practice the same author concludes the history of his own case in the following words: "I favoured it [viz. the swelling in my feet] all this while more than I needed, upon the common opinion, that walking too much might draw down the humour, which I have since had reason to conclude is a great mistake, and that if I had walked as much as I could from the first day the pain left me, the swelling might have left me too in a much less time[66]." [65] Medical Observations and Inquiries, vol. vi. p. 220. [66] Essay upon the Cure of the Gout by Moxa, vol. i. folio edition, p. 143 and 141. III. I come now to mention the remedies which are proper in that state of the gout in which a _feeble_ morbid action takes place in the blood-vessels and viscera. I shall begin this head, by remarking, that this state of the gout is often created, like the typhus state of fever, by the neglect, or too scanty use of evacuations in its first stage. When the prejudices which now prevent the adoption of those remedies in their proper time, are removed, we shall hear but little of the low state of the arthritic fever, nor of the numerous diseases from obstruction which are produced by the blood-vessels disorganizing the viscera, by repeated and violent attacks of the disease. To determine the character of a paroxysm of gout and the remedies proper to relieve it, the climate, the season of the year, the constitution of the atmosphere, and the nature of the prevailing epidemic, should be carefully attended to by a physician. But his principal dependence should be placed upon the state of the pulse. If it do not discover the marks which indicate bleeding formerly referred to, but is weak, quick, and soft, the remedies should be such as are calculated to produce a more vigorous, and equable action in the blood-vessels and viscera. They are, 1. _Opium._ It should at first be given in small doses, and afterwards increased, as circumstances may require. 2. _Madeira_ or _Sherry wine_ alone, or diluted with water, or in the form of whey, or rendered more cordial by having any agreeable spice infused in it. It may be given cold or warm, according to the taste of the patient, or the state of his stomach. If this medicine be rejected in all the above forms, 3. _Porter_ should be given. It is often retained when no other liquor will lie upon the stomach. I think I once saved the life of Mr. Nesbit by this medicine. It checked a vomiting, from the gout, which seemed to be the last symptom of his departing life. If porter fail of giving relief, 4. _Ardent spirits_ should be given, either alone, or in the form of grog, or toddy. Cases have occurred in which a pint of brandy has been taken in the course of an hour with advantage. Great benefit has sometimes been found from Dr. Warner's tincture, in this state of the gout. As these observations may fall into the hands of persons who may not have access to Dr. Warner's book, I shall here insert the receipt for preparing it. Of raisins, sliced and stoned, half a pound. Rhubarb, one ounce. Sena, two drachms. Coriander and fennel seeds, of each one drachm. Cochineal, saffron, and liquorice root, each half a drachm. Infuse them for ten days in a quart of French brandy, then strain it, and add a pint more of brandy to the ingredients, afterwards strain it, and mix both tinctures together. Four table spoons full of this cordial are to be taken every hour, mixed with an equal quantity of water, until relief be obtained. Ten drops of laudanum may be added to each dose in those cases in which the cordial does not produce its intended effects, in two or three hours. If all the different forms of ardent spirits which have been mentioned fail of giving relief, 5. From 30 drops to a tea spoonful of _æther_ should be given in any agreeable vehicle. Also, 6. _Volatile alkali._ From five to ten grains of this medicine should be given every two hours. 7. _Aromatic substances_, such as alspice, ginger, Virginia snake-root, cloves, and mace in the form of teas, have all been useful in this state of the gout. All these remedies are indicated in a more especial manner when the gout affects the stomach. They are likewise proper when it affects the bowels. The laudanum in this case should be given by way of glyster. After the vomiting was checked in Mr. Nesbit by means of porter, he was afflicted with a dull and distressing pain in his bowels, which was finally removed by two anodyne glysters injected daily for two or three weeks. 8. Where the gout produces spasmodic or convulsive motions, the _oil of amber_ may be given with advantage. I once saw it remove for a while a convulsive cough from the gout. 9. In cases where the stomach will bear the _bark_, it should be given in large and frequent doses. It does the same service in this state of gout, that it does in the slow, or low states of fever from any other cause. Where the gout appears in the form of an intermittent, the bark affords the same relief that it does in the same disease from autumnal exhalations. Mr. Small found great benefit from it after discharging the contents of his stomach and bowels by a dose of tartar emetic. "I do not call (says this gentleman) a fit of the gout a paroxysm, for there are several paroxysms in the fit, each of which is ushered in with a rigour, sickness at stomach, and subsequent heat. In this the gout bears a resemblance to an irregular intermittent, at least to a remitting fever, and hence perhaps the efficacy of the bark in removing the gout[67]." [67] Medical Observations and Inquiries, vol. vi. p. 220. 10. The _warm bath_ is a powerful remedy in exciting a regular and healthy action in the sanguiferous system. Where the patient is too weak to be taken out of bed, and put into a bathing tub, his limbs and body should be wrapped in flannels dipped in warm water. In case of a failure of all the above remedies, 11. A _salivation_ should be excited as speedily as possible, by means of mercury. Dr. Cheyne commends it in high terms. I have once used it with success. The mercury, when used in this way, brings into action an immense mass of latent excitement, and afterwards diffuses it equally through every part of the body. 12. Besides these internal remedies, frictions with brandy, and volatile liniment, should be used to the stomach and bowels. Blisters should be applied to parts in which congestion or pain is seated, and stimulating cataplasms should be applied to the lower limbs. The flour of mustard has been justly preferred for this purpose. It should be applied to the upper part of the foot. The reader will perceive, in the account I have given of the remedies proper in the feeble state of chronic fever, that they are the same which are used in the common typhus, or what is called nervous fever. There is no reason why they should not be the same, for the supposed two morbid states of the system are but one disease. It is agreeable in medical researches to be under the direction of principles. They render unnecessary, in many instances, the slow and expensive operations of experience, and thus multiply knowledge, by lessening labour. The science of navigation has rested upon this basis, since the discovery of the loadstone. A mariner who has navigated a ship to one distant port, is capable of conducting her to every port on the globe. In like manner, the physician who can cure one disease by a knowledge of its principles, may by the same means cure all the diseases of the human body, for their causes are the same. Judgment is required, only in accommodating the force of remedies to the force of each disease. The difference in diseases which arises from their seats, from age, sex, habit, season, and climate, may be known in a short time, and is within the compass of very moderate talents. IV. Were I to enumerate all the local symptoms of gout which occur without fever, and the remedies that are proper to relieve them, I should be led into a tedious digression. The reader must consult practical books for an account of them. I shall only mention the remedies for a few of them. The theory of the gout which has been delivered, will enable us to understand the reason why a disease which properly belongs to the whole system, should at any time be accompanied only with local morbid affection. The whole body is a unit, and hence morbid impressions which are resisted by sound parts are propagated to such as are weak, where they excite those morbid actions we call disease. The _head-ach_ is a distressing symptom of the gout. It yields to depleting or tonic remedies, according to the degree of morbid action which accompanies it. I have heard an instance of an old man, who was cured of an obstinate head-ach by throwing aside his nightcap, and sleeping with his bare head exposed to the night air. The disease in this case was probably attended with great morbid action. In this state of the vessels of the brain, cupping, cold applications to the head, purges, a temperate diet, and blisters behind the ears, are all proper remedies, and should be used together, or in succession, as the nature of the disease may require. Many persons have been cured of the same complaint by sleeping in woollen nightcaps. The morbid action in these cases is always of a feeble nature. With this remedy, tonics, particularly the bark and cold bath, will be proper. I have once known a chronic gouty pain in the head cured by an issue in the arm, after pounds of bark, and many other tonic remedies, had been taken to no purpose. The _ophthalmia_ from gout should be treated with the usual remedies for that disease when it arises from other causes, with the addition of such local applications to other and distant parts of the body, as may abstract the gouty action from the eyes. _Dull but constant pains in the limbs_ yield to frictions, volatile liniments, muslin and woollen worn next to the skin, electricity, a salivation, and the warm and cold bath. A gentleman who was afflicted with a pain of this kind for three years and a half in one of his arms, informed me, that he had been cured by wearing a woollen stocking that had been boiled with sulphur in water, for two weeks upon the affected limb. He had previously worn flannel upon it, but without receiving any benefit from it. I have known wool and cotton, finely carded, and made into small mats, worn upon the hips, when affected by gout, with great advantage. In obstinate sciatic pains, without fever or inflammation, Dr. Pitcairn's remedy, published by Dr. Cheyne, has performed many cures. It consists in taking from one to four tea-spoons full of the fine spirit of turpentine every morning, for a week or ten days, in three times the quantity of honey, and afterwards in drinking a large quantity of sack whey, to settle it on the stomach, and carry it into the blood. An anodyne should be taken every night after taking this medicine. A _gouty diarrh[oe]a_ should be treated with the usual astringent medicines of the shops. Blisters to the wrists and ankles, also a salivation, have often cured it. I have heard of its being checked, after continuing for many years, by the patient eating large quantities of alspice, which he carried loose in his pocket for that purpose. The _angina pectoris_, which I have said is a symptom of the gout, generally comes on with fulness and tension in the pulse. After these are reduced by two or three bleedings, mineral tonics seldom fail of giving relief. _Spasms in the stomach_, and _pains in the bowels_, often seize gouty people in the midst of business or pleasure, or in the middle of the night. My constant prescription for these complaints is ten drops of laudanum every half hour, till relief be obtained. If this medicine be taken in the forming state of these pains, a single dose generally removes the disease. It is preferable to spiced wine and spirits, inasmuch as it acts quicker, and leaves no disposition to contract a love for it when it is not required to ease pain. The _pain in the rectum_ which has been described, yields to the common remedies for the piles. Cold water applied to the part, generally gives immediate relief. For a _preternatural secretion and excretion of bile_, gentle laxatives, and abstinence from oily food, full meals, and all violent exercises of the body and mind, are proper. The _itching in the anus_, which I have supposed to be a symptom of gout, has yielded in one instance that has come within my knowledge to mercurial ointment applied to the part affected. Dr. Lettsom recommends fomenting the part with a decoction of poppy heads and hemlock, and advises lenient purges and a vegetable diet as a radical cure for the disease[68]. [68] Medical Memoirs, vol. III. For the _itching in the vagina_ I have found a solution of the sugar of lead in water to be an excellent palliative application. Dr. Lettsom recommends as a cure for it, the use of bark in delicate habits, and occasional bleeding, with a light and moderate diet, if it occur about the time of the cessation of the menses. Obstinate _cutaneous eruptions_, which are the effects of gout, have been cured by gentle physic, a suitable diet, issues, and applications of the unguentum citrinum to the parts affected. The _arthritic gonorrh[oe]a_ should be treated with the same remedies as a gonorrh[oe]a from any other cause. In the treatment of all the local symptoms that have been enumerated, it will be of great consequence to inquire, before we attempt to cure them, whether they have not succeeded general gout, and thereby relieved the system from its effects in parts essential to life. If this have been the case, the cure of them should be undertaken with caution, and the danger of a local disease being exchanged for a general one, should be obviated by remedies that are calculated to eradicate the gouty diathesis altogether from the system. The means for this purpose, agreeably to our order, come next under our consideration. Before I enter upon this head, I shall premise, that I do not admit of the seeds of the gout remaining in the body to be eliminated by art after a complete termination of one of its paroxysms, any more than I admit of the seeds of a pleurisy or intermitting fever remaining in the body, after they have been cured by blood-letting or bark. A predisposition only remains in the system to a return of the gout, from its usual remote and exciting causes. The contrary idea took its rise in those ages of medicine in which morbific matter was supposed to be the proximate cause of the gout, but it has unfortunately continued since the rejection of that theory. Thus in many cases we see wrong habits continue long after the principles have been discarded, from which they were derived. I have known several instances in which art, and I have heard and read of others in which accidental suffering from abstinence, pain, and terror have been the happy means of overcoming a predisposition to the gout. A gentleman from one of the West-India islands, who had been for many years afflicted with the gout, was perfectly cured of it by living a year or two upon the temperate diet of the jail in this city, into which he was thrown for debt by one of his creditors. A large hæmorrhage from the foot, inflamed and swelled by the gout, accidentally produced by a penknife which fell upon it, effected in an Irish gentleman a lasting cure of the disease. Hildanus mentions the history of a gentleman, whom he knew intimately, who was radically cured of a gout with which he had been long afflicted, by the extreme bodily pain he suffered innocently from torture in the canton of Berne. He lived to be an old man, and ever afterwards enjoyed good health[69]. The following letter from my brother contains the history of a case in which terror suddenly eradicated the gout from the system. [69] Observat. Chirurg. Cent. 1. Obs. 79. "_Reading_, _July 27th, 1797_. "DEAR BROTHER, "WHEN I had the pleasure of seeing you last week, I mentioned an extraordinary cure of the gout in this town, by means of a _fright_. In compliance with your request, I now send an exact narration of the facts. "Peter Fether, the person cured, is now alive, a householder in Reading, seventy-three years of age, a native of Germany, and a very hearty man. The first fit of the gout he ever had, was about the year 1773; and from that time till 1785, he had a regular attack in the spring of every year. His feet, hands, and elbows were much swollen and inflamed; the fits lasted long, and were excruciating. In particular, the last fit in 1785 was so severe, as to induce an apprehension, that it would inevitably carry him off, when he was suddenly relieved by the following accident. "As he lay in a small back room adjoining the yard, it happened that one of his sons, in turning a waggon and horses, drove the tongue of the waggon with such force against the window, near which the old man lay stretched on a bed, as to beat in the sash of the window, and to scatter the pieces of broken glass all about him. To such a degree was he alarmed by the noise and violence, that he instantly leaped out of bed, forgot that he had ever used crutches, and eagerly inquired what was the matter. His wife, hearing the uproar, ran into the room, where, to her astonishment, she found her husband on his feet, bawling against the author of the mischief, with the most passionate vehemence. From _that_ moment, he has been entirely exempt from the gout, has never had the slightest touch of it, and _now_ enjoys perfect health, has a good appetite, and says he was never heartier in his life. This is probably the more remarkable, when I add, that he has always been used to the hard work of a farm, and _since_ the year 1785 has frequently mowed in his own meadow, which I understand is low and wet. I am well informed, in his mode of living, he has been temperate, occasionally indulging in a glass of wine, after the manner of the German farmers, but not to excess. "To you, who have been long accustomed to explore diseases, I leave the task of developing the principles, on which this mysterious restoration from the lowest decrepitude and bodily wretchedness, to a state of perfect health, has been accomplished. I well know that tooth-achs, head-achs, hiccoughs, &c. are often removed by the sudden impression of fear, and that they return again. But to see a debilitated gouty frame instantly restored to vigour; to see the whole system in a moment, as it were, undergo a perfect and entire change, and the most inveterate and incurable disease _radically_ expelled, is surely a _different_ thing, and must be acknowledged a very singular and marvellous event. If an old man, languishing under disease and infirmity, had _died_ of mere fright, nobody would have been surprised at it; but that he should be absolutely cured, and his constitution renovated by it, is a most extraordinary fact, which, while I am compelled to believe by unexceptionable evidence, I am totally at a loss to account for. I am your sincerely affectionate brother, JACOB RUSH." These facts, and many similar ones which might be mentioned, afford ample encouragement to proceed in enumerating the means which are proper to prevent the recurrence of the gout, or, in other words, to eradicate it from the system. V. I shall first mention the means of preventing the return of that state of the disease which is accompanied with _violent_ action, and afterwards take notice of the means of preventing the return of that state of it, in which a _feeble_ morbid action takes place in the blood-vessels. The means for this purpose consist in avoiding all the remote, exciting, and predisposing causes of the gout which have been mentioned. I shall say a few words upon the most important of them, in the order that has been proposed. I. The first remedy for obviating the _violent_ state of gout is, 1. _Temperance._ This should be regulated in its degrees by the age, habits, and constitution of the patient. A diet consisting wholly of milk, vegetables, and simple water, has been found necessary to prevent the recurrence of the gout in some cases. But, in general, fish, eggs, the white meats and weak broths may be taken in small quantities once a day, with milk and vegetables at other times. A little salted meat, which affords less nourishment than fresh, may be eaten occasionally. It imparts vigour to the stomach, and prevents dyspepsia from a diet consisting chiefly of vegetables. The low and acid wines should be avoided, but weak Madeira or sherry wine and water, or small beer, may be drunken at meals. The latter liquor was the favourite drink of Dr. Sydenham in his fits of the gout. Strong tea and coffee should not be tasted, where there is reason to believe the habitual use of them has contributed to bring on the disease. From the disposition of the gout to return in the spring and autumn, greater degrees of abstinence in eating and drinking will be necessary at those seasons than at any other time. With this diminution of aliment, gentle purges should be taken, to obviate an attack of the gout. In persons above fifty years of age, an abstemious mode of living should be commenced with great caution. It has sometimes, when entered upon suddenly, and carried to its utmost extent, induced fits of the gout, and precipitated death. In such persons, the abstractions from their usual diet should be small, and our dependence should be placed upon other means to prevent a return of the disease. 2. _Moderate labour_ and _gentle exercise_ have frequently removed that debility and vibratility in the blood-vessels, on which a predisposition to the gout depends. Hundreds of persons who have been reduced by misfortunes to the necessity of working for their daily bread, have thrown off a gouty diathesis derived from their patents, or acquired by personal acts of folly and intemperance. The employments of agriculture afford the most wholesome labour, and walking, the most salutary exercise. To be useful, they should be moderate. The extremes of indolence and bodily activity meet in a point. They both induce debility, which predisposes to a recurrence of a fit of the gout. Riding in a carriage, and on horseback, are less proper as a means of preventing the disease than walking. Their action upon the body is partial. The lower limbs derive no benefit from it, and on these the violent state of gout generally makes its first attack. In England, many domestic exercises have been contrived for gouty people, such as shuttle-cock, bullets, the chamber-horse, and the like, but they are all trifling in their effects, compared with labour, and exercise in the open air. The efficacy of the former of those prophylactic remedies will appear in a strong point of light, when we consider, how much the operation of the remote and exciting causes of the gout which act more or less upon persons in the humblest ranks of society, are constantly counteracted in their effects, by the daily labour which is necessary for their subsistence. 3. To prevent the recurrence of the gout, cold should be carefully avoided, more especially when it is combined with moisture. Flannel should be worn next to the skin in winter, and muslin in summer, in order to keep up a steady and uniform perspiration. Fleecy hosiery should be worn in cold weather upon the breast and knees, and the feet should be kept constantly warm and dry by means of socks and cork-soaled shoes. It was by wetting his feet, by standing two or three hours upon the damp ground, that colonel Miles produced the gout in his stomach and bowels which had nearly destroyed him in the year 1795. 4. Great moderation should be used by persons who are subject to the gout in the exercise of their understandings and passions. Intense study, fear, terror, anger, and even joy, have often excited the disease into action. It has been observed, that the political and military passions act with more force upon the system, than those which are of a social and domestic nature; hence generals and statesmen are so often afflicted with the gout, and that too, as was hinted in another place, in moments the most critical and important to the welfare of a nation. The combination of the exercises of the understanding, and the passion of avarice in gaming, have often produced an attack of this disease. These facts show the necessity of gouty people subjecting their minds, with all their operations, to the government of reason and religion. The understanding should be exercised only upon light and pleasant subjects. No study should ever be pursued till it brings on fatigue; and, above all things, midnight, and even late studies should be strictly avoided. A gouty man should always be in bed at an early hour. This advice has the sanction of Dr. Sydenham's name, and experience proves its efficacy in all chronic diseases. 5. The venereal appetite should be indulged with moderation. And, 6. Costiveness should be prevented by all persons who wish to escape a return of violent fits of the gout. Sulphur is an excellent remedy for this purpose. Dr. Cheyne commends it in high terms. His words are, "Sulphur is one of the best remedies in the intervals of the gout. In the whole extent of the materia medica, I know not a more safe and active medicine[70]." Two cases have come within my knowledge, in which it has kept off fits of the gout for several years, in persons who had been accustomed to have them once or twice a year. Rhubarb in small quantities chewed, or in the form of pills, may be taken to obviate costiveness, by persons who object to the habitual use of sulphur. Dr. Cheyne, who is lavish in his praises of that medicine as a gentle laxative, says, he "knew a noble lord of great worth and much gout, who, by taking from the hands of a quack a drachm of rhubarb, tinged with cochineal to disguise it, every morning for six weeks, lived in health, for four years after, without any symptom of it[71]." [70] Essay on the Nature and True Method of Treating the Gout, p. 36. [71] Page 30. I have said that abstinence should be enjoined with more strictness in the spring and autumn, than at any other time, to prevent a return of the gout. From the influence of the weather at those seasons in exciting febrile actions in the system, the loss of a pint of blood will be useful in some cases for the same purpose. It will be the more necessary if the gout has not paid its habitual visits to the system. The late Dr. Gregory had been accustomed to an attack of the gout every spring. Two seasons passed away without his feeling any symptoms of it. He began to flatter himself with a hope that the predisposition to the disease had left him. Soon afterwards he died suddenly of an apoplexy. The loss of a few ounces of blood at the usual time in which the gout affected him, would probably have protracted his life for many years. In the year 1796, in visiting a patient, I was accidentally introduced into a room where a gentleman from the Delaware state had been lying on his back for near six weeks with an acute fit of the gout. He gave me a history of his sufferings. His pulse was full and tense, and his whole body was covered with sweat from the intensity of his pain. He had not had his bowels opened for ten days. I advised purging and bleeding in his case. The very names of those remedies startled him, for he had adopted the opinion of the salutary nature of a fit of the gout, and therefore hugged his chains. After explaining the reason of my prescriptions, he informed me, in support of them, that he had escaped the gout but two years in twenty, and that in one of these two years he had been bled for a fall from his horse, and, in the other, his body had been reduced by a chronic fever, previously to the time of the annual visit of his gout. As a proof of the efficacy of active, or passive depletion, in preventing the gout, it has been found that persons who sweat freely, either generally or partially, or who make a great deal of water, are rarely affected by it. An epitome of all that has been said upon the means of preventing a return of the gout, may be delivered in a few words. A man who has had one fit of it, should consider himself in the same state as a man who has received the seeds of a malignant fever into his blood. He should treat his body as if it were a Florence flask. By this means he will probably prevent, during his life, the re-excitement of the disease. Are _issues_ proper to prevent the return of the violent state of gout? I have heard of an instance of an issue in the leg having been effectual for this purpose; but if the remedies before-mentioned be used in the manner that has been directed, so unpleasant a remedy can seldom be necessary. Are _bitters_ proper to prevent a return of this state of gout? It will be a sufficient answer to this question to mention, that the duke of Portland's powder, which is composed of bitter ingredients, excited a fatal gout in many people who used it for that purpose. I should as soon expect to see gold produced by the operations of fire upon copper or lead, as expect to see the gout prevented or cured by any medicine that acted upon the system, without the aid of more or less of the remedies that have been mentioned. II. We come now, in the last place, to mention the remedies which are proper to prevent a return of that state of gout which is attended with a _feeble_ morbid action in the blood-vessels and viscera. This state of gout generally occurs in the evening of life, and in persons of delicate habits, or in such as have had their constitutions worn down by repeated attacks of the disease. The remedies to prevent it are, 1. A _gently stimulating diet_, consisting of animal food well cooked, with sound old Madeira or sherry wine, or weak spirit and water. Salted, and even smoked meat may be taken, in this state of the system, with advantage. It is an agreeable tonic, and is less disposed to create plethora than fresh meat. Pickles and vinegar should seldom be tasted. They dispose to gouty spasms in the stomach and bowels. Long intervals between meals should be carefully avoided. The stomach, when overstretched or empty, is always alike predisposed to disease. There are cases in which the evils of inanition in the stomach will be prevented, by a gouty patient eating in the middle of the night. 2. The use of _chalybeate medicines_. These are more safe when used habitually, than bitters. I have long been in the practice of giving the different preparations of iron in large doses, in chronic diseases, and in that state of debility which disposes to them. A lady of a weak constitution informed Dr. Cheyne, that she once asked Dr. Sydenham how long she might safely take steel. His answer was, that "she might take it for thirty years, and then begin again if she continued ill[72]." [72] Essay on the Nature, and True Method of Treating the Gout, p. 69. Water impregnated with iron, either by nature or art, may be taken instead of the solid forms of the metal. It will be more useful if it be drunken in a place where patients will have the benefit of country air. 3. The habitual use of the _volatile tincture of gum guiacum_, and of other cordial and gently stimulating medicines. A clove of garlic taken once or twice a day, has been found useful in debilitated habits predisposed to the gout. It possesses a wonderful power in bringing latent excitement into action. It moreover acts agreeably upon the nervous system. Mr. Small found great benefit from breakfasting upon a tea made of half a drachm of ginger cut into small slices, in preventing occasional attacks of the gout in his stomach. Sir Joseph Banks was much relieved by a diet of milk, with ginger boiled in it. The root of the sassafras of our country might probably be used with advantage for the same purpose. Aurelian speaks of certain remedies for the gout which he calls "annalia[73]." The above medicines belong to this class. To be effectual, they should be persisted in, not for one year only, but for many years. [73] Morborum Chronicorum. Lib. v. Cap. 2. 4._ Warmth_, uniformly applied, by means of suitable dresses, and sitting rooms, to every part of the body. 5. The _warm bath_ in winter, and the _temperate_, or _cold bath_ in summer. 6. _Exercise._ This may be in a carriage, or on horseback. The viscera being debilitated in this state of predisposition to the gout, are strengthened in a peculiar manner by the gentle motion of a horse. Where this or other modes of passive exercise cannot be had, frictions to the limbs and body should be used every day. 7. _Costiveness_ should be avoided by taking occasionally one or two table spoons full of Dr. Warner's purging tincture prepared by infusing rhubarb, orange peel, and caraway seeds, of each an ounce, for three days in a quart of Madeira, or any other white wine. If this medicine be ineffectual for opening the bowels, rhubarb may be taken in the manner formerly mentioned. 8. The understanding and passions should be constantly employed in agreeable studies and pursuits. Fatigue of mind and body should be carefully avoided. 9. A warm climate often protracts life in persons subject to this state of gout. The citizens of Rome who had worn down their constitutions by intemperance, added many years to their lives, by migrating to Naples, and enjoying there, in a warmer sun, the pure air of the Mediterranean, and sir William Temple says the Portuguese obtain the same benefit by transporting themselves to the Brazils, after medicine and diet cease to impart vigour to their constitutions in their native country. Thus have I enumerated the principal remedies for curing and preventing the gout. Most of them are to be met with in books of medicine, but they have been administered by physicians, or taken by patients with so little regard to the different states of the system, that they have in many instances done more harm than good. Solomon places all wisdom, in the management of human affairs, in finding out the proper times for performing certain actions. Skill in medicine, consists in an eminent degree in timing remedies. There is a time to bleed, and a time to withhold the lancet. There is a time to give physic, and a time to trust to the operations of nature. There is a time to eat meat, and there is a time to abstain from it. There is a time to give tonic medicines, and a time to refrain from them. In a word, the cure of the gout depends wholly upon two things, viz. _proper_ remedies, in their proper _times_, and _places_. I shall take leave of this disease, by comparing it to a deep and dreary cave in a new country, in which ferocious beasts and venomous reptiles, with numerous ghosts and hobgoblins, are said to reside. The neighbours point at the entrance of this cave with horror, and tell of the many ravages that have been committed upon their domestic animals, by the cruel tenants which inhabit it. At length a school-boy, careless of his safety, ventures to enter this subterraneous cavern, when! to his great delight, he finds nothing in it but the same kind of stones and water he left behind him upon the surface of the earth. In like manner, I have found no other principles necessary to explain the cause of the gout, and no other remedies necessary to cure it, than such as are admitted in explaining the causes, and in prescribing for the most simple and common diseases. OBSERVATIONS UPON THE NATURE AND CURE OF THE _HYDROPHOBIA_. In entering upon the consideration of this formidable disease, I feel myself under an involuntary impression, somewhat like that which was produced by the order the king of Syria gave to his captains when he was conducting them to battle: "Fight not with small or great, save only with the king of Israel[74]." In whatever light we contemplate the hydrophobia, it may be considered as pre-eminent in power and mortality, over all other diseases. [74] II. Chron. xviii. 30. It is now many years since the distress and horror excited by it, both in patients and their friends, led me with great solicitude to investigate its nature. I have at length satisfied myself with a theory of it, which, I hope, will lead to a rational and successful mode of treating it. For a history of the symptoms of the disease, and many interesting facts connected with it, I beg leave to refer the reader to Dr. Mease's learned and ingenious inaugural dissertation, published in the year 1792. The remote and exciting causes of the hydrophobia are as follow: 1. The bite of a rabid animal. Wolves, foxes, cats, as well as dogs, impart the disease. It has been said that blood must be drawn in order to produce it, but I have heard of a case in Lancaster county, in Pennsylvania, in which a severe contusion, by the teeth of the rabid animal, without the effusion of a drop of red blood, excited the disease. Happily for mankind, it cannot be communicated by blood, or saliva falling upon sound parts of the body. In Maryland, the negroes eat with safety the flesh of hogs that have perished from the bite of mad dogs; and I have heard of the milk of a cow, at Chestertown, in the same state, having been used without any inconvenience by a whole family, on the very day in which she was affected by this disease, and which killed her in a few hours. Dr. Baumgarten confirms these facts by saying, that "the flesh and milk of rabid animals have been eaten with perfect impunity[75]." [75] Medical Commentaries, Philadelphia edition, vol. 7. p. 409. In the following observations I shall confine myself chiefly to the treatment of the hydrophobia which arises from the bite of a rabid animal, but I shall add in this place a short account of all its other causes. 2. Cold night air. Dr. Arthaud, late president of the society of Philadelphians in St. Domingo, has published several cases in which it was produced in negroes by sleeping all night in the open air. 3. A wound in a tendinous part. 4. Putrid and impure animal food. 5. Worms. 6. Eating beech nuts. 7. Great thirst. 8. Exposure to intense heat. 9. Drinking cold water when the body was very much heated. 10. A fall. 11. Fear. 12. Hysteria. 13. Epilepsy. 14. Tetanus. 15. Hydrocephalus. Of the presence of hydrophobia in the hydrocephalic state of fever, there have been several instances in Philadelphia. 16. An inflammation of the stomach. 17. The dysentery. 18. The typhus fever. Dr. Trotter mentions the hydrophobia as a symptom which frequently occurred in the typhus state of fever in the British navy[76]. [76] Medicina Nautica, p. 301. 19. It is taken notice of likewise in a putrid fever by Dr. Coste[77]; and Dr. Griffitts observed it in a high degree in a young lady who died of the yellow fever, in 1793. [77] Medical Commentaries, Dobson's edition, vol. II. p. 476. 20. The bite of an angry, but not a diseased animal. 21. An involuntary association of ideas. Cases of spontaneous hydrophobia from all the above causes are to be met with in practical writers, and of most of them in M. Audry's learned work, entitled, "Recherches sur la Rage." The dread of water, from which this disease derives its name, has five distinct grades. 1. It cannot be drunken. 2. It cannot be touched. 3. The sound of it pouring from one vessel to another, 4. the sight of it, and 5. even the naming of it, cannot be borne, without exciting convulsions. But this symptom is not a universal one. Dr. Mead mentions three cases in which there was no dread of water, in persons who received the disease from the bite of a rabid animal. It is unfortunate for this disease, as well as many others, that a single symptom should impose names upon them. In the present instance it has done great harm, by fixing the attention of physicians so exclusively upon the dread of water which occurs in it, that they have in a great measure overlooked every other circumstance which belongs to the disease. The theory of the hydrophobia, which an examination of its causes, symptoms, and accidental cures, with all the industry I was capable of, has led me to adopt, is, that it is a _malignant state of fever_. My reasons for this opinion are as follow: 1. The disease in all rabid animals is a fever. This is obvious in dogs who are most subject to it. It is induced in them by the usual causes of fever, such as scanty or putrid aliment[78], extreme cold, and the sudden action of heat upon their bodies. Proofs of its being derived from each of the above causes are to be met with in most of the authors who have written upon it. The animal matters which are rendered morbid by the action of the above causes upon them, are determined to the saliva, in which a change seems to be induced, similar to that which takes place in the perspirable matter of the human species from the operation of similar causes upon it. This matter, it is well known, is the remote cause of the jail fever. No wonder the saliva of a dog should produce a disease of the same kind, after being vitiated by the same causes, and thereby disposed to produce the same effects. [78] "Animal food, in a state of putridity, is amongst the most frequent causes of canine madness." "Canine madness chiefly arises from the excessive number of ill-kept and ill-fed dogs." YOUNG'S ANNUALS, vol. XVII. p. 561. 2. The disease called canine madness, prevails occasionally among dogs at those times in which malignant fevers are epidemic. This will not surprise those persons who have been accustomed to observe the prevalence of the influenza and bilious fevers among other domestic animals at a time when they are epidemic among the human species. 3. Dogs, when they are said to be mad, exhibit the usual symptoms of fever, such as a want of appetite, great heat, a dull, fierce, red, or watery eye, indisposition to motion, sleepiness, delirium, and madness. The symptom of madness is far from being universal, and hence many dogs are diseased and die with this malignant fever, that are inoffensive, and instead of biting, continue to fawn upon their masters. Nor is the disposition of the fever to communicate itself by infection universal among dogs any more than the same fever in the human species, and this I suppose to be one reason why many people are bitten by what are called mad dogs, who never suffer any inconvenience from it. 4. A dissection of a dog, by Dr. Cooper, that died with this fever, exhibited all the usual marks of inflammation and effusion which take place in common malignant fevers. I shall in another place mention a fifth argument in favour of the disease in dogs being a malignant fever, from the efficacy of one of the most powerful remedies in that state of fever, having cured it in two instances. II. The disease produced in the human species by the bite of a rabid animal, is a _malignant_ fever. This appears first from its symptoms. These, as recorded by Aurelian, Mead, Fothergill, Plummer, Arnold, Baumgarten, and Morgagni, are chills, great heat, thirst, nausea, a burning sensation in the stomach, vomiting, costiveness; a small, quick, tense, irregular, intermitting, natural, or slow pulse; a cool skin, great sensibility to cold air, partial cold and clammy sweats on the hands, or sweats accompanied with a warm skin diffused all over the body, difficulty of breathing, sighing, restlessness, hiccup, giddiness, head-ach, delirium, coma, false vision, dilatation of the pupils, dulness of sight, blindness, glandular swellings, heat of urine, priapism, palpitation of the heart, and convulsions. I know that there are cases of hydrophobia upon record, in which there is said to be a total absence of fever. The same thing has been said of the plague. In both cases the supposed absence of fever is the effect of stimulus acting upon the blood-vessels with so much force as to suspend morbid action in them. By abstracting a part of this stimulus, a fever is excited, which soon discovers itself in the pulse and on the skin, and frequently in pains in every part of the body. The dread of water, and the great sensibility of the system to cold air, are said to give a specific character to the hydrophobia; but the former symptom, it has been often seen, occurs in diseases from other causes, and the latter has been frequently observed in the yellow fever. It is no more extraordinary that a fever excited by the bite of a rabid animal should excite a dread of water, than that fevers from other causes should produce aversion from certain aliments, from light, and from sounds of all kinds; nor is it any more a departure from the known laws of stimulants, that the saliva of a mad dog should affect the fauces, than that mercury should affect the salivary glands. Both stimuli appear to act in a specific manner. 2. The hydrophobia partakes of the character of a malignant fever, in appearing at different intervals from the time in which the infection is received into the body. These intervals are from one day to five or six months. The small-pox shows itself in intervals from eight to twenty days, and the plague and yellow fever from the moment in which the miasmata are inhaled, to nearly the same distance of time. This latitude in the periods at which infectious and contagious matters are brought into action in the body, must be resolved into the influence which the season of the year, the habits of the patients, and the passion of fear have upon them. Where the interval between the time of being bitten, and the appearance of a dread of water, exceeds five or six months, it is probable it may be occasioned by a disease derived from another cause. Such a person is predisposed in common with other people to all the diseases of which the hydrophobia is a symptom. The recollection of the poisonous wound he has received, and its usual consequences, is seldom absent from his mind for months or years. A fever, or an affection of his nerves from their most common causes, cannot fail of exciting in him apprehensions of the disease which usually follows the accident to which he has been exposed. His fears are then let loose upon his system, and produce in a short time a dread of water which appears to be wholly unconnected with the bite of a rabid animal. Similar instances of the effects of fear upon the human body are to be met with in books of medicine. The pains produced by fear acting upon the imagination in supposed venereal infections, are as real and severe as they are in the worst state of that disease. 3. Blood drawn in the hydrophobia exhibits the same appearances which have been remarked in malignant fevers. In Mr. Bellamy, the gentleman whose case is so minutely related by Dr. Fothergill, the blood discovered with "slight traces of size, _serum_ remarkably _yellow_." It was uncommonly sizy in a boy of Mr. George Oakley whom I saw, and bled for the first time, on the fourth day of his disease, in the beginning of the year 1797. His pulse imparted to the fingers the same kind of quick and tense stroke which is common in an acute inflammatory fever. He died in convulsions the next day. He had been bitten by a mad dog on one of his temples, three weeks before he discovered any signs of indisposition. There are several other cases upon record, of the blood exhibiting, in this disease, the same appearances as in common malignant and inflammatory fevers. 4. The hydrophobia accords exactly with malignant fevers in its duration. It generally terminates in death, according to its violence, and the habit of the patient, in the first, second, third, fourth, or fifth day, from the time of its attack, and with the same symptoms which attend the last stage of malignant fevers. 5. The body, after death from the hydrophobia, putrifies with the same rapidity that it does after death from a malignant fever in which no depletion has been used. 6. Dissections of bodies which have died of the hydrophobia, exhibit the same appearances which are observed in the bodies of persons who have perished of malignant fevers. These appearances, according to Morgagni and Tauvry[79], are marks of inflammation in the throat, [oe]sophagus, trachea, brain, stomach, liver, and bowels. Effusions of water, and congestions of blood in the brain, large quantities of dark-coloured or black bile in the gall-bladder and stomach, mortifications in the bowels and bladder, livid spots on the surface of the body, and, above all, the arteries filled with fluid blood, and the veins nearly empty. I am aware, that two cases of death from hydrophobia are related by Dr. Vaughan, in which no appearance of disease was discovered by dissection in any part of the body. Similar appearances have occasionally been met with in persons who have died of malignant fevers. In another place I hope to prove, that we err in placing disease in inflammation, for it is one of its primary effects only, and hence, as was before remarked, it does not take place in many instances in malignant fevers, until the arteries are so far relaxed by two or three bleedings, as to be able to relieve themselves by effusing red blood into serous vessels, and thus to produce that error loci which I shall say hereafter is essential to inflammation[80]. The existence of this grade of action in the arteries may always be known by the presence of sizy blood, and by the more obvious and common symptoms of fever. [79] Bibliotheque Choisie de Medecine, tome XV. p. 210. [80] In the 6th volume of the Medical Observations and Inquiries, there is an account of a dissection of a person who had been destroyed by taking opium. "No morbid appearance (says Mr. Whateley, the surgeon who opened the body) was found in any part of the body, except that the villous coat of the stomach was very slightly inflamed." The stimulus of the opium in this case either produced an action which transcended inflammation, or destroyed action altogether by its immense force, by which means the more common morbid appearances which follow disease in a dead body could not take place. The remedies for hydrophobia, according to the principles I have endeavoured to establish, divide themselves naturally into two kinds. I. Such as are proper to prevent the disease, after the infection of the rabid animal is received into the body. II. Such as are proper to cure it when formed. The first remedy under the first general head is, abstracting or destroying the virus, by cutting or burning out the wounded part, or by long and frequent effusions of water upon it, agreeably to the advice of Dr. Haygarth, in order to wash the saliva from it. The small-pox has been prevented, by cutting out the part in which the puncture was made in the arm with variolous matter. There is no reason why the same practice should not succeed, if used in time, in the hydrophobia. Where it has failed of success, it has probably been used after the poison has contaminated the blood. The wound should be kept open and running for several months. In this way a servant girl, who was bitten by the same cat that bit Mr. Bellamy, is supposed by Dr. Fothergill to have escaped the disease. Dr. Weston of Jamaica believes that he prevented the disease by the same means, in two instances. Perhaps an advantage would arise from exciting a good deal of inflammation in the wound. We observe after inoculation, that the more inflamed the puncture becomes, and the greater the discharge from it, the less fever and eruption follow in the small-pox. A second preventive is a low diet, such as has been often used with success to mitigate the plague and yellow fever. The system, in this case, bends beneath the stimulus of the morbid saliva, and thus obviates or lessens its effects at a future day. During the use of these means to prevent the disease, the utmost care should be taken to keep up our patient's spirits, by inspiring confidence in the remedies prescribed for him. Mercury has been used in order to prevent the disease. There are many well-attested cases upon record, of persons who have been salivated after being bitten by mad animals, in whom the disease did not show itself, but there are an equal number of cases to be met with, in which a salivation did not prevent it. From this it would seem probable, that the saliva did not infect in the cases in which the disease was supposed to have been prevented by the mercury. At the time calomel was used to prepare the body for the small-pox, a salivation was often induced by it. The affection of the salivary glands in many instances lessened the number of pock, but I believe in no instance prevented the eruptive fever. I shall say nothing here of the many other medicines which have been used to prevent the disease. No one of them has, I believe, done any more good, than the boasted specifics which have been used to eradicate the gout, or to procure old age. They appear to have derived their credit from some of the following circumstances accompanying the bite of the animal. 1. The animal may have been angry, but not diseased with a malignant fever such as I have described. 2. He may have been diseased, but not to such a degree as to have rendered his saliva infectious. 3. The saliva, when infectious, may have been so washed off in passing through the patient's clothes, as not to have entered the wound made in the flesh. And 4. There may have been no predisposition in the patient to receive the fever. This is often observed in persons exposed to the plague, yellow fever, small-pox, and to the infection of the itch, and the venereal disease. The hydrophobia, like the small-pox, generally comes on with some pain, and inflammation in the part in which the infection was infused into the body, but to this remark, as in the small-pox, there are some exceptions. As soon as the disease discovers itself, whether by pain or inflammation in the wounded part, or by any of the symptoms formerly mentioned, the first remedy indicated is _blood-letting_. All the facts which have been mentioned, relative to its cause, symptoms, and the appearances of the body after death, concur to enforce the use of the lancet in this disease. Its affinity to the plague and yellow fever in its force, is an additional argument in favour of that remedy. To be effectual, it should be used in the most liberal manner. The loss of 100 to 200 ounces of blood will probably be necessary in most cases to effect a cure. The pulse should govern the use of the lancet as in other states of fever, taking care not to be imposed upon by the absence of _frequency_ in it, in the supposed absence of fever, and of _tension_ in affections of the stomach, bowels, and brain. This practice, in the extent I have recommended it, is justified not only by the theory of the disease, but by its having been used with success in the following cases. Dr. Nugent cured a woman by two copious bleedings, and afterwards by the use of sweating and cordial medicines. Mr. Wrightson was encouraged by Dr. Nugent's success to use the same remedies with the same happy issue in a boy of 15 years of age[81]. [81] Medical Transactions, vol. ii. p. 192. Mr. Falconer cured a young woman of the name of Hannah Moore, by "a copious bleeding," and another depleting remedy to be mentioned hereafter[82]. [82] Ditto, p. 222. Mr. Poupart cured a woman by bleeding until she fainted, and Mr. Berger gives an account of a number of persons being bitten by a rabid animal, all of whom died, except two who were saved by bleeding[83]. [83] Bibliotheque Choisie de Medecine, tome xv. p. 212. In the 40th volume of the Transactions of the Royal Society of London, there is an account of a man being cured of hydrophobia by Dr. Hartley, by the loss of 120 ounces of blood. Dr. Tilton cured this disease in a woman in the Delaware state by very copious bleeding. The remedy was suggested to the doctor by an account taken from a London magazine of a dreadful hydrophobia being cured by an accidental and profuse hæmorrhage from the temporal artery[84]. [84] Medical Essays of Edinburgh, vol. i. p. 226. A case is related by Dr. Innes[85], of the loss of 116 ounces of blood in seven days having cured this disease. In the patient who was the subject of this cure, the bleeding was used in the most depressed, and apparently weak state of the pulse. It rose constantly with the loss of blood. [85] Medical Commentaries, vol. iii. p. 496. The cases related by Dr. Tilton and Dr. Innes were said to be of a spontaneous nature, but the morbid actions were exactly the same in both patients with those which are derived from the bite of a rabid animal. There is but one remote cause of disease, and that is stimulus, and it is of no consequence in the disease now under consideration, whether the dread of water be the effect of the saliva of a rabid animal acting upon the fauces, or of a morbid excitement determined to those parts by any other stimulus. The inflammation of the stomach depends upon the same kind of morbid action, whether it be produced by the miasmata of the yellow fever, or the usual remote and exciting causes of the gout. An apoplexy is the same disease when it arises from a contusion by external violence, that it is when it arises spontaneously from the congestion of blood or water in the brain. A dropsy from obstructions in the liver induced by strong drink, does not differ in its proximate cause from the dropsy brought on by the obstructions in the same viscus which are left by a neglected, or half cured bilious fever. These remarks are of extensive application, and, if duly attended to, would deliver us from a mass of error which has been accumulating for ages in medicine: I mean the nomenclature of diseases from their remote causes. It is the most offensive and injurious part of the rubbish of our science. I grant that bleeding has been used in some instances in hydrophobia without effect, but in all such cases it was probably used out of time, or in too sparing a manner. The credit of this remedy has suffered in many other diseases from the same causes. I beg it may not be tried in this disease, by any physician who has not renounced our modern systems of nosology, and adopted, in their utmost extent, the principles and practice of Botallus and Sydenham in the treatment of malignant fevers. Before I quit the subject of blood-letting in hydrophobia, I have to add, that it has been used with success in two instances in dogs that had exhibited all the usual symptoms of what has been called madness. In one case, blood was drawn by cutting off the tail, in the other, by cutting off the ears of the diseased animal. I mention these facts with pleasure, not only because they serve to support the theory and practice which I have endeavoured to establish in this disease, but because they will render it unnecessary to destroy the life of a useful and affectionate animal in order to prevent his spreading it. By curing it in a dog by means of bleeding, we moreover beget confidence in the same remedy in persons who have been bitten by him, and thus lessen the force of the disease, by preventing the operation of fear upon the system. 2. Purges and glysters have been found useful in the hydrophobia. They discharge bile which is frequently vitiated, and reduce morbid action in the stomach and blood-vessels. Dr. Coste ascribes the cure of a young woman in a convent wholly to glysters given five or six times every day. 3. Sweating after bleeding completed the cure of the boy whose case is mentioned by Mr. Wrightson. Dr. Baumgarten speaks highly of this mode of depleting, and says further, that it has never been cured "but by evacuations of some kind." 4. All the advantages which attend a salivation in common malignant fevers, are to be expected from it in the hydrophobia. It aided blood-letting in two persons who were cured by Mr. Falconer and Dr. Le Compt. There are several cases upon record in which musk and opium have afforded evident relief in this disease. A physician in Virginia cured it by large doses of bark and wine. I have no doubt of the efficacy of these remedies when the disease is attended with a moderate or feeble morbid action in the system, for I take it for granted, it resembles malignant fevers from other causes in appearing in different grades of force. In its more violent and common form, stimulants of all kinds must do harm, unless they are of such a nature, and exhibited in such quantities, as to exceed in their force the stimulus of the disease; but this is not to be expected, more especially as the stomach is for the most part so irritable as sometimes to reject the mildest aliments as well as the most gentle medicines. After the morbid actions in the system have been weakened, tonic remedies would probably be useful in accelerating the cure. Blisters and stimulating cataplasms, applied to the feet, might probably be used with the same advantage in the declining state of the disease, that they have been used in the same stage of other malignant fevers. The cold bath, also long immersion in cold water, have been frequently used in this disease. The former aided the lancet, in the cure of the man whose case is related by Dr. Hartley. There can be no objection to the cold water in either of the above forms, provided no dread is excited by it in the mind of the patient. The reader will perceive here that I have deserted an opinion which I formerly held upon the cause and cure of the tetanus. I supposed the hydrophobia to depend upon debility. This debility I have since been led to consider as partial, depending upon abstraction of excitement from some, and a morbid accumulation of it in other parts of the body. The preternatural excitement predominates so far, in most cases of hydrophobia, over debility, that depleting remedies promise more speedily and safely to equalize, and render it natural, than medicines of an opposite character. In the treatment of those cases of hydrophobia which are not derived from the bite of a rabid animal, regard should always be had to its remote and exciting causes, so as to accommodate the remedies to them. The imperfection of the present nomenclature of medicine has become the subject of general complaint. The mortality of the disease from the bite of a rabid animal, has been increased by its name. The terms hydrophobia and canine madness, convey ideas of the symptoms of the disease only, and of such of them too as are by no means universal. If the theory I have delivered, and the practice I have recommended, be just, it ought to be called the hydrophobic state of fever. This name associates it at once with all the other states of fever, and leads us to treat it with the remedies which are proper in its kindred diseases, and to vary them constantly with the varying state of the system. In reviewing what has been said of this disease, I dare not say that I have not been misled by the principles of fever which I have adopted; but if I have, I hope the reader will not be discouraged by my errors from using his reason in medicine. By contemplating those errors, he may perhaps avoid the shoals upon which I have been wrecked. In all his researches, let him ever remember that there is the same difference between the knowledge of a physician who prescribes for diseases as limited by genera and species, and of one who prescribes under the direction of just principles, that there is between the knowledge we obtain of the nature and extent of the sky, by viewing a few feet of it from the bottom of a well, and viewing from the top of a mountain the whole canopy of heaven. Since the first edition of the foregoing observations, I have seen a communication to the editors of the Medical Repository[86], by Dr. Physick, which has thrown new light upon this obscure disease, and which, I hope, will aid the remedies that have been proposed, in rendering them more effectual for its cure. The doctor supposes death from hydrophobia to be the effect of a sudden and spasmodic constriction of the glottis, inducing suffocation, and that it might be prevented by creating an artificial passage for air into the lungs, whereby life might be continued long enough to admit of the disease being cured by other remedies. The following account of a dissection is intended to show the probability of the doctor's proposal being attended with success. [86] Volume V. On the 13th of September, 1802, I was called, with Dr. Physick, to visit, in consultation with Dr. Griffitts, the son of William Todd, Esq. aged five years, who was ill with the disease called hydrophobia, brought on by the bite of a mad dog, on the 6th of the preceding month. The wound was small, and on his cheek, near his mouth, two circumstances which are said at all times to increase the danger of wounds from rabid animals. From the time he was bitten, he used the cold bath daily, and took the infusion, powder, and seeds of the anagallis, in succession, until the 9th of September, when he was seized with a fever which at first resembled the remittent of the season. Bleeding, purging, blisters, and the warm bath were prescribed for him, but without success. The last named remedy appeared to afford him some relief, which he manifested by paddling and playing in the water. At the time I saw him he was much agitated, had frequent twitchings, laughed often; but, with this uncommon excitement in his muscles and nerves, his mind was unusually correct in all its operations. He discovered no dread of water, except in one instance, when he turned from it with horror. He swallowed occasionally about a spoon full of it at a time, holding the cup in his own hand, as if to prevent too great a quantity being poured at once into his throat. The quick manner of his swallowing, and the intervals between each time of doing so, were such as we sometimes observe in persons in the act of dying of acute diseases. Immediately after swallowing water, he looked pale, and panted for breath. He spoke rapidly, and with much difficulty. This was more remarkably the case when he attempted to pronounce the words _carriage_, _water_, and _river_. After speaking he panted for breath in the same manner that he did after drinking. He coughed and breathed as patients do in the moderate grade of the cynanche trachealis. The dog that had bitten him, Mr. Todd informed me, made a similar noise in attempting to bark, a day or two before he was killed. We proposed making an opening into his windpipe. To this his parents readily consented; but while we were preparing for the operation, such a change for the worse took place, that we concluded not to perform it. A cold sweat, with a feeble and quick pulse, came on; and he died suddenly, at 12 o'clock at night, about six hours after I first saw him. He retained his reason, and a playful humour, till the last minute of his life. An instance of the latter appeared in his throwing his handkerchief at his father just before he expired. The parents consented to our united request to examine his body. Dr. Griffitts being obliged to go into the country, and Dr. Physick being indisposed, I undertook this business the next morning; and, in the presence of Dr. John Dorsey (to whom I gave the dissecting knife), and my pupil Mr. Murduck, I discovered the following appearances. All the muscles of the neck had a livid colour, such as we sometimes observe, after death, in persons who have died of the sore throat. The muscles employed in deglutition and speech were suffused with blood. The epiglottis was inflamed, and the glottis so thickened and contracted, as barely to admit a probe of the common size. The trachea below it was likewise inflamed and thickened, and contained a quantity of mucus in it, such as we observe, now and then, after death from cynanche trachealis. The [oe]sophagus exhibited no marks of disease; but the stomach had several inflamed spots upon it, and contained a matter of a brown appearance, and which emitted an offensive odour. From the history of this dissection, and of many others, in which much fewer marks appeared of violent disease, in parts whose actions are essential to life, it is highly probable death is not induced in the ordinary manner in which malignant fevers produce it, but by a sudden or gradual suffocation. It is the temporary closure of this aperture which produces the dread of swallowing liquids: hence the reason why they are swallowed suddenly, and with intervals, in the manner that has been described; for, should the glottis be closed during the time of two swallows, in the highly diseased state of the system which takes place in this disease, suffocation would be the immediate and certain consequence. The same difficulty and danger attend the swallowing saliva, and hence the symptom of spitting, which has been so often taken notice of in hydrophobia. Solids are swallowed more easily than fluids, only because they descend by intervals, and because a less closure of the glottis is sufficient to favour their passage into the stomach. This remark is confirmed by the frequent occurrence of death in the very act of swallowing, and that too with the common symptoms of suffocation. To account for death from this cause, and in the manner that has been described, it will be necessary to recollect, that fresh air is more necessary to the action of the lungs in a fever than in health, and much more so in a fever of a malignant character, such as the hydrophobia appears to be, than in fevers of a milder nature. An aversion from swallowing liquids is not peculiar to this disease. It occurs occasionally in the yellow fever. It occurs likewise in the disease which has prevailed among the cats, both in Europe and America, and probably, in both instances, from a dread of suffocation in consequence of the closure of the glottis, and sudden abstraction of fresh air. The seat of the disease, and the cause of death, being, I hope, thus ascertained, the means of preventing death come next under our consideration. Tonic remedies, in all their forms, have been administered to no purpose. The theory of the disease would lead us to expect a remedy for it in blood-letting. But this, though now and then used with success, is not its cure, owing, as we now see, to the mortal seat of the disease being so far removed from the circulation, as not to be affected by the loss of blood in the most liberal quantity. As well might we expect the inflammation and pain of a paronychia, or what is called a felon on the finger, to be removed by the same remedy. Purging and sweating, though occasionally successful, have failed in many instances; and even a salivation, when excited (which is rarely the case), has not cured it. An artificial aperture into the windpipe alone bids fair to arrest its tendency to death, by removing the symptom which generally induces it, and thereby giving time for other remedies, which have hitherto been unsuccessful, to produce their usual salutary effects in similar diseases[87]. In removing faintness, in drawing off the water in ischuria, in composing convulsions, and in stopping hæmorrhages in malignant fever, we do not cure the disease, but we prevent death, and thereby gain time for the use of the remedies which are proper to cure it. Laryngotomy, according to Fourcroy's advice, in diseases of the throat which obstruct respiration, should be preferred to tracheotomy, and the incision should be made in the triangular space between the thyroid and cricoid cartilages. Should this operation be adopted, in order to save life, it will not offer near so much violence to humanity as many other operations. We cut through a large mass of flesh into the bladder in extracting a stone. We cut into the cavity of the thorax in the operation for the empyema. We perforate the bones of the head in trepanning; and we cut through the uterus, in performing the Cæsarian operation, in order to save life. The operation of laryngotomy is much less painful and dangerous than any of them; and besides permitting the patient to breathe and to swallow, it is calculated to serve the inferior purpose of lessening the disease of the glottis by means of local depletion. After an aperture has been thus made through the larynx, the remedies should be such as are indicated by the state of the system, particularly by the state of the pulse. In hot climates it is, I believe, generally a disease of feeble re-action, and requires tonic remedies; but in the middle and northern states of America it is more commonly attended with so much activity and excitement of the blood-vessels, as to require copious blood-letting and other depleting remedies. [87] The hoarse barking, or the total inability of mad dogs to bark, favours still further the idea that the mortal seat of the disease is in the glottis, and that the remedy which has been proposed is a rational one. Should this new mode of attacking this furious disease be adopted, and become generally successful, the discovery will place the ingenious gentleman who suggested it in the first rank of the medical benefactors of mankind. I have only to add a fact upon this subject which may tend to increase confidence in a mode of preventing the disease which has been recommended by Dr. Haygarth, and used with success in several instances. The same dog which bit Mr. Todd's son, bit, at the same time, a cow, a pig, a dog, and a black servant of Mr. Todd's. The cow and pig died; the dog became mad, and was killed by his master. The black man, who was bitten on one of his fingers, exposed the wound for some time, immediately after he received it, to a stream of pump water, and washed it likewise with soap and water. He happily escaped the disease, and is now in good health. That his wound was poisoned is highly probable, from its having been made eight hours after the last of the above animals was bitten, in which time there can be but little doubt of such a fresh secretion of saliva having taken place as would have produced the hydrophobia, had it not been prevented by the above simple remedy. I am not, however, so much encouraged by its happy issue in this case as to advise it in preference to cutting out the wounded part. It should only be resorted to where the fears of a patient, or his distance from a surgeon render it impossible to use the knife. AN ACCOUNT OF _THE MEASLES_, AS THEY APPEARED IN PHILADELPHIA, IN THE SPRING OF 1789. The weather in December, 1788, and in January, 1789, was variable, but seldom very cold. On the first of February, 1789, at six o'clock in the morning, the mercury in Fahrenheit's thermometer fell 5° below 0, in the city of Philadelphia. At twenty miles from the city, on the Schuylkill, it fell 12° below 0, at the same hour. On the 19th and 20th of this month, there fell a quantity of snow, the depth of which, upon an average, was supposed to be about eight or ten inches. On the 23d, 24th, 25th, and 27th, the weather was very cold. The mercury fluctuated during these days between 4° and 10° above 0. In the intervals between these cold days, the weather frequently moderated, so that the Delaware was frozen and thawed not less than four times. It was not navigable till the 8th of March. There were in all, during the winter and month of March, sixteen distinct falls of snow. In April and May there were a few warm days; but upon the whole, it was a very cold and backward spring. The peaches failed almost universally. There were no strawberries or cherries on the 24th of May, and every other vegetable product was equally backward. A country woman of 84 years of age informed me, that it was the coldest spring she had ever known. It was uncomfortable to sit without fire till the first of June. The measles appeared first in the Northern Liberties, in December. They spread slowly in January, and were not universal in the city till February and March. This disease, like many others, had its _precursor_. It was either a gum-boil, or a sore on the tongue. They were both very common, but not universal. They occurred, in some instances, several days before the fever, but in general they made their appearance during the eruptive fever, and were a sure mark of the approaching eruption of the measles. I was first led to observe this fact, from having read Dr. Quin's accurate account of the measles in Jamaica. I shall now proceed to mention the symptoms of the measles as they appeared in the different parts of the body. 1. In the _head_, they produced great pain, swelling of the eye-lids, so as to obstruct the eye-sight, tooth-ach, bleeding at the nose, tinnitus aurium, and deafness; also coma for two days, and convulsions. I saw the last symptom only in one instance. It was brought on by a stoppage of a running from the ear. 2. In the _throat_ and _lungs_, they produced a soreness and hoarseness, acute or dull pains in the breast and sides, and a painful or distressing cough. In one case, this cough continued for two hours without any intermission, attended by copious expectoration. In two cases, I saw a constant involuntary discharge of phlegm and mucus from the mouth, without any cough. One of them terminated fatally. Spitting of blood occurred in several instances. The symptoms of pneumonia vera notha and typhoides were very common. I saw two fatal cases from pneumonia notha, in both of which the patients died with the trunk of the body in an erect posture. I met with two cases in which there was no cough till the eruption made its appearance on the fourth day, and one which was accompanied by all the usual symptoms of the cynanche trachealis. 3. In the _stomach_ the measles produced, in many instances, sickness and vomiting. And 4. In the _bowels_, griping, diarrh[oe]a, and, in some instances, bloody stools. The diarrh[oe]a occurred in every stage of the disease, but it was bloody and most painful in its decline. I attended a black girl who discharged a great many worms, but without the least relief of any of her symptoms. There was a great variety in this disease. 1. In the _time_ of the attack of the fever, from the _time_ of the reception of the contagion. In general the interval was fourteen days, but it frequently appeared before, and sometimes later than that period. 2. In the _time of the eruption_, from the beginning of the fever. It generally appeared on the third and fourth days. In one case, Dr. Waters informed me, it did not appear till the eighth day. 3. In the _abatement_ or _continuance_ of the fever after the eruption. 4. In the _colour_ and _figure_ of the eruption. In some it put on a _pale_ red, in others a _deep_, and in a few a _livid_ colour, resembling an incipient mortification. In some there appeared red blotches, in others an equally diffused redness, and in a few, eruptions like the small-pox, called by Dr. Cullen, rubiola varioloides. 5. In the _duration_ of the eruption on the skin. It remained in most cases only three or four days; but in one, which came under my care, it remained nine days. 6. In the _manner of its retrocession_. I saw very few cases of its leaving the branny appearance so generally spoken of by authors on the skin. 7. In _not affecting_ many persons, and even families who were exposed to it. The symptoms which continued in many after the retrocession of the measles, were cough, hoarseness, or complete aphonia, which continued in two cases for two weeks; also diarrh[oe]a, opthalmy, a bad taste in the mouth, a defect or excess of appetite, and a fever, which in some instances was of the intermitting kind, but which in more assumed the more dangerous form of the typhus mitior. Two cases of internal dropsy of the brain followed them. One was evidently excited by a fall. They both ended fatally. During the prevalence of the disease I observed several persons (who had had the measles, and who were closely confined to the rooms of persons ill with them) to be affected with a slight cough, sore throat, and even sores in the mouth. I find a similar fact taken notice of by Dr. Quier. But I observed further, many children to be affected by a fever, cough, and all the other symptoms of the measles which have been mentioned, except a general eruption, for in some there was a trifling efflorescence about the neck and breast. I observed the same thing in 1773 and 1783. In my note book I find the following account of the appearance of this disease in children in the year 1773. "The measles appeared in March; a catarrh (for by that name I then called it) appeared at the same time, and was often mistaken for them, the symptoms being nearly the same in both. In the catarrh there was in some instances a trifling eruption. A lax often attended it, and some who had it had an extremely sore mouth." I was the more struck with this disease, from finding it was taken notice of by Dr. Sydenham. He calls it a morbillous fever. I likewise find an account of it in the 2d article of the 5th volume of the Edinburgh Medical Essays. The words of the author, who is anonymous, are as follow. "During this measly season, several persons, who never had the measles, had all the symptoms of measles, which went off in a few days without any eruptions. The same persons had the measles months or years afterwards." Is this disease a common fever, marked by the reigning epidemic, and produced in the same manner, and by the same causes, as the variolous fever described by Dr. Sydenham, which he says prevailed at the same time with the small-pox? I think it is not. My reasons for this opinion are as follow. 1. I never saw it affect any but children, in the degree that has been mentioned, and such only as had never had the measles. 2. It affected whole families at the same time. It proved fatal to one of three children whom it affected on the same day. 3. It terminated in a pulmonary consumption in a boy of ten years old, with all the symptoms which attend that disease when it follows the regular measles. 4. It affected a child in one family, on the same day that two other members of the same family were affected by the genuine measles. 5. It appeared on the usual days of the genuine measles, from the time the persons affected by it were exposed to its contagion. And, 6. It communicated the disease in one family, in the usual time in which the disease is taken from the genuine measles. The measles, then, appear to follow the analogy of the small-pox, which affects so superficially as to be taken a second time, and which produce on persons who have had them what are called the nurse pock. They follow likewise the analogy of another disease, viz. the scarlatina anginosa. In the account of the epidemic for 1773, published in the third volume of the Edinburgh Medical Essays, we are told, that such patients as had previously had the scarlet fever without sore throats, took the sore throat, and had no eruption, while those who had previously had the sore throat had a scarlet eruption, but the throat remained free from the distemper. All other persons who were affected had both. From these facts, I have taken the liberty of calling it the _internal measles_, to distinguish it from those which are _external_. I think the discovery of this new state of this disease of some application to practice. 1. It will lead us to be cautious in declaring any disease to be the external measles, in which there is not a general eruption. From my ignorance of this, I have been led to commit several mistakes, which were dishonourable to the profession. I was called, during the prevalence of the measles in the above-named season, to visit a girl of twelve years old, with an eruption on the skin. I called it the measles. The mother told me it was impossible, for that I had in 1783 attended her for the same disease. I suspect the anonymous author before-mentioned has fallen into the same error. He adds to the account before quoted the following words. "Others, who had undergone the measles formerly, had _at this time_ a fever of the erysipelatous kind, with eruptions like to which nettles cause, and all the _previous_ and concomitant symptoms of the measles, from the beginning to the end of the disease." 2. If inoculation, or any other mode of lessening the violence of the disease, should be adopted, it will be of consequence to know what persons are secure from the attacks of it, and who are still exposed to it. I shall now add a short account of my method of treating this disease. Many hundred families came through the disease without the help of a physician. But in many cases it was attended with peculiar danger, and in some with death. I think it was much more fatal than in the years 1773 and 1783, probably owing to the variable weather in the winter, and the coldness and dampness of the succeeding spring. Dr. Huxham says, he once saw the measles attended with peculiar mortality, during a late cold and damp spring in England. It was much more fatal (cæteris paribus) to adults than to young people. The remedies I used were, 1. _Bleeding_, in all cases where great pain and cough with a hard pulse attended. In some I found it necessary to repeat this remedy. But I met with many cases in which it was forbidden by the weakness of the pulse, and by other marks of a feeble action in the blood-vessels. 2. _Vomits._ These were very useful in removing a nausea; they likewise favoured the eruption of the measles. 3. _Demulcent_ and _diluting drinks_. These were barley water, bran, and flaxseed tea, dried cherry and raw apple water, also beverage, and cyder and water. The last drink I found to be the most agreeable to my patients of any that have been mentioned. 4. _Blisters_ to the neck, sides, and extremities, according to the symptoms. They were useful in every stage of the disease. 5. _Opiates._ These were given not only at night, but in small doses during the day, when a troublesome cough or diarrh[oe]a attended. 6. Where a catarrhal fever ensued, I used bleeding and blisters. In those cases in which this fever terminated in an intermittent, or in a mild typhus fever, I gave the bark with evident advantage. In that case of measles, formerly mentioned, which was accompanied by symptoms of cynanche trachealis, I gave calomel with the happiest effects. In the admission of _fresh air_ I observed a medium as to its temperature, and accommodated it to the degrees of action in the system. In different parts of the country, in Pennsylvania and New-Jersey, I heard with great pleasure of the _cold air_ being used as freely and as successfully in this disease, as in the inflammatory small-pox. The same people who were so much benefited by _cool air_, I was informed, drank plentifully of cold water during every stage of the fever. One thing in favour of this country practice deserves to be mentioned, and that is, evident advantage arose in all the cases which I attended, from patients leaving their beds in the febrile state of this disease. But this was practised only by those in whom inflammatory diathesis prevailed, for these alone had strength enough to bear it. The convalescent state of this disease required particular attention. 1. _A diarrh[oe]a_ often continued to be troublesome after other symptoms had abated. I relieved it by opiates and demulcent drinks. Bleeding has been recommended for it, but I did not find it necessary in a single case. 2. An _opthalmia_ which sometimes attended, yielded to astringent collyria and blisters. 3. Where a cough or fever followed so slight as not to require bleeding, I advised a milk and vegetable diet, country air, and moderate warmth; for whatever might have been the relation of the lungs in the beginning of the disease to cold air, they were now evidently too much debilitated to bear it. 4. It is a common practice to prescribe purges after the measles. After the asthenic state of this disease they certainly do harm. In all cases, the effects of them may be better obviated by diet, full or low, suitable clothing, and gentle exercise, or country air. I omitted them in several cases, and no eruption or disease of any kind followed their disuse. I shall only add to this account of the measles, that in several families, I saw evident advantages from preparing the body for the reception of the contagion, by means of a vegetable diet. AN ACCOUNT OF _THE INFLUENZA_, AS IT APPEARED IN PHILADELPHIA, IN THE AUTUMN OF 1789, IN THE SPRING OF 1790, AND IN THE WINTER OF 1791. The latter end of the month of August, in the summer of 1789, was so very cool that fires became agreeable. The month of September was cool, dry, and pleasant. During the whole of this month, and for some days before it began, and after it ended, there had been no rain. In the beginning of October, a number of the members of the first congress, that had assembled in New-York, under the present national government, arrived in Philadelphia, much indisposed with colds. They ascribed them to the fatigue and night air to which they had been exposed in travelling in the public stages; but from the number of persons who were affected, from the uniformity of their complaints, and from the rapidity with which it spread through our city, it soon became evident that it was the disease so well known of late years by the name of the influenza. The symptoms which ushered in the disease were generally a hoarseness, a sore throat, a sense of weariness, chills, and a fever. After the disease was formed, it affected more or less the following parts of the body. Many complained of acute pains in the _head_. These pains were frequently fixed between the eye-balls, and, in three cases which came under my notice, they were terminated by abscesses in the frontal sinus, which discharged themselves through the nose. The pain, in one of these cases, before the rupture of the abscess, was so exquisite, that my patient informed me, that he felt as if he should lose his reason. Many complained of a great itching in the _eye-lids_. In some, the eye-lids were swelled. In others, a copious effusion of water took place from the _eyes_; and in a few, there was a true ophthalmia. Many complained of great pains in one _ear_, and some of pains in both _ears_. In some, these pains terminated in abscesses, which discharged for some days a bloody or purulent matter. In others, there was a swelling behind each ear, without a suppuration.--_Sneezing_ was a universal symptom. In some, it occurred not less than fifty times in a day. The matter discharged from the nose was so acrid as to inflame the nostrils and the upper lip, in such a manner as to bring on swellings, sores, and scabs in many people. In some, the nose discharged drops, and in a few, streams of blood, to the amount, in one case, of twenty ounces. In many cases, it was so much obstructed, as to render breathing through it difficult. In some, there was a total defect of _taste_. In others, there was a bad taste in the mouth, which frequently continued through the whole course of the disease. In some, there was a want of _appetite_. In others, it was perfectly natural. Some complained of a soreness in their mouths, as if they had been inflamed by holding pepper in them. Some had _swelled jaws_, and many complained of the _tooth-ach_. I saw only one case in which the disease produced a _coma_. Many were affected with pains in the _breast_ and _sides_. A difficulty of breathing attended in some, and a _cough_ was universal. Sometimes this cough alternated with a pain in the _head_. Sometimes it preceded this pain, and sometimes it followed it. It was at all times distressing. In some instances, it resembled the chin-cough. One person expired in a fit of coughing, and many persons spat blood in consequence of its violence. I saw several patients in whom the disease affected the trachea chiefly, producing great difficulty of breathing, and, in one case, a suppression of the voice, and I heard of another in which the disease, by falling on the trachea, produced a cynanche trachealis. In most of the cases which terminated fatally, the patients died of pneumonia notha. The _stomach_ was sometimes affected by nausea and vomiting; but this was far from being a universal symptom. I met with four cases in which the whole force of the disease fell upon the _bowels_, and went off in a diarrh[oe]a; but in general the bowels were regular or costive. The _limbs_ were affected with such acute pains as to be mistaken for the rheumatism, or for the break-bone-fever of 1780. The pains were most acute in the back and thighs. _Profuse sweats_ appeared in many over the whole body in the beginning, but without affording any relief. It was in some instances accompanied by erysipelatous, and in four cases which came to my knowledge, it was followed by miliary eruptions. The _pulse_ was sometimes tense and quick, but seldom full. In a great majority of those whom I visited it was quick, weak, and soft. There was no appearance in the urine different from what is common in all fevers. The disease had evident remissions, and the fever seldom continued above three or four days; but the cough, and some other troublesome symptoms, sometimes continued two or three weeks. In a few persons, the fever terminated in a tedious and dangerous typhus. In several pregnant women it produced uterine hæmorrhages and abortions. It affected adults of both sexes alike. A few old people escaped it. It passed by children under eight years old with a few exceptions. Out of five and thirty maniacs in the Pennsylvania hospital, but three were affected by it. No profession or occupation escaped it. The smell of tar and tobacco did not preserve the persons who worked in them from the disease, nor did the use of tobacco, in snuff, smoking, or chewing, afford a security against it.[88] [88] Mr. Howard informs us that the use of tobacco is not a preservative against the plague, as has formerly been supposed; of course that apology for the use of an offensive weed should not be admitted. Even previous and existing diseases did not protect patients from it. It insinuated into sick chambers, and blended itself with every species of chronic complaint. It was remarkable that persons who worked in the open air, such as sailors, and 'long-shore-men, (to use a mercantile epithet) had it much worse than tradesmen who worked within doors. A body of surveyors, in the eastern woods of Pennsylvania, suffered extremely from it. Even the vigour of constitution which is imparted by the savage life did not mitigate its violence. Mr. Andrew Ellicott, the geographer of the United States, informed me that he was a witness of its affecting the Indians in the neighbourhood of Niagara with peculiar force. The cough which attended this disease was so new and so irritating a complaint among them, that they ascribed it to witchcraft. It proved most fatal on the sea-shore of the United States. Many people who had recovered, were affected a second time with all the symptoms of the disease. I met with a woman, who, after recovering from it in Philadelphia, took it a second time in New-York, and a third time upon her return to Philadelphia. Many thousand people had the disease who were not confined to their houses, but transacted business as usual out of doors. A perpetual coughing was heard in every street of the city. Buying and selling were rendered tedious by the coughing of the farmer and the citizen who met in market places. It even rendered divine service scarcely intelligible in the churches. A few persons who were exposed to the disease escaped it, and some had it so lightly as scarcely to be sensible of it. Of the persons who were confined to their houses, not a fourth part of them kept their beds. It proved fatal (with few exceptions) only to old people, and to persons who had been previously debilitated by consumptive complaints. It likewise carried of several hard drinkers. It terminated in asthma in three persons whose cases came under my notice, and in pulmonary consumption, in many more. I met with an instance in a lady, who was much relieved of a chronic complaint in her liver; and I heard of another instance of a clergyman whose general health was much improved by a severe attack of this disease. It was not wholly confined to the human species. It affected two cats, two house-dogs, and one horse, within the sphere of my observations. One of the dogs disturbed his mistress so much by coughing at night, that she gave him ten drops of laudanum for several nights, which perfectly composed him. One of the cats had a vomiting with her cough. The horse breathed as if he had been affected by the cynanche trachealis. The scarlatina anginosa, which prevailed during the summer, disappeared after the first of October; but appeared again after the influenza left the city. Nor was the remitting fever seen during the prevalence of the reigning epidemic. I inoculated about twenty children for the small-pox during this prevalence of the influenza, and never saw that disease exhibit a more favourable appearance. In the treatment of the influenza I was governed by the state of the system. Where inflammatory diathesis discovered itself by a full or tense pulse, or where great difficulty of breathing occurred, and the pulse was low and weak in the beginning of the disease, I ordered moderate bleeding. In a few cases in which the symptoms of pneumony attended, I bled a second time with advantage. In all these instances of inflammatory affection, I gave the usual antiphlogistic medicines. I found that vomits did not terminate the disease, as they often do a common catarrh, in the course of a day, or of a few hours. In cases where no inflammatory action appeared in the system, I prescribed cordial drinks and diet, and forbad every kind of evacuation. I saw several instances of persons who had languished for a week or two with the disease, who were suddenly cured by eating a hearty meal, or by drinking half a pint of wine, or a pint of warm punch. In all these cases of weak action in the blood-vessels, liquid laudanum gave great relief, not only by suspending the cough, but by easing the pains in the bones. I met with a case of an old lady who was suddenly and perfectly cured of her cough by a fright. The duration of this epidemic in our city was about six weeks. It spread from New-York and Philadelphia in all directions, and in the course of a few months pervaded every state in the union. It was carried from the United States to several of the West-India islands. It prevailed in the island of Grenada in the month of November, 1789, and it was heard of in the course of the ensuing winter in the Spanish settlements in South-America. The following winter was unusually mild, insomuch that the navigation of the Delaware was not interrupted during the whole season, only from the 7th to the 24th of February. The weather on the 3d and 4th days of March was very cold, and on the 8th and 9th days of the same month, the mercury in Fahrenheit's thermometer stood at 4° at 7 o'clock in the morning. On the 10th and 11th, there fell a deep snow. The weather during the remaining part of the month was cold, rainy, and variable. It continued to be variable during the month of April. About the middle of the month there fell an unusual quantity of rain. The showers which fell on the night of the 17th will long be connected in the memories of the citizens of Philadelphia with the time of the death of the celebrated Dr. Franklin. Several pleurisies appeared during this month; also a few cases of measles. In the last week of the month the influenza made its appearance. It was brought to the city from New-England, and affected, in its course, all the intermediate states. Its symptoms were nearly the same as they were in the preceding autumn, but in many people it put on some new appearances. Several persons who were affected by it had symptoms of madness, one of whom destroyed himself by jumping out of a window. Some had no cough, but very acute pains in the back and head. It was remarked that those who had the disease chiefly in the breast the last year, complained now chiefly of their heads, while those whose heads were affected formerly, now complained chiefly of their breasts. In many it put on the type of an intermitting fever. Several complained of constant chills, or constant sweats; and some were much alarmed by an uncommon blue and dark colour in their hands. I saw one case of ischuria, another of an acute pain in the rectum, a third of anasarca, and a fourth of a palsy in the tongue and arms; all of which appeared to be anomalous symptoms of the influenza. Sneezing, and pains in the ears and frontal sinus, were less common now than they were in the fall; but a pain in the eye-balls was a universal symptom. Some had a pain in the one eye only, and a few had sore eyes, and swellings in the face. Many women who had it, were affected by an irregular appearance of the catamenia. In two persons whom I saw, the cough was incessant for three days, nor could it be composed by any other remedy than plentiful bleeding. A patient of Dr. Samuel Duffield informed me, after his recovery, that he had had no other symptom of the disease than an efflorescence on his skin, and a large swelling in his groin, which terminated in a tedious abscess. The prisoners in the jail who had it in the autumn, escaped it this spring. During the prevalence of this disease, I saw no sign of any other epidemic. It declined sensibly about the first week in June, and after the 12th day of this month I was not called to a single patient in it. The remedies for it were the same as were used in the fall. I used bleeding in several cases on the second, third, and fourth days of the disease, where it had appeared to be improper in its first stage. The cases which required bleeding were far from being general. I saw two instances of syncope of an alarming nature, after the loss of ten ounces of blood; and I heard of one instance of a boy who died in half an hour after this evacuation. I remarked that purges of all kinds worked more violently than usual in this disease. The convalescence from it was very slow, and a general languor appeared to pervade the citizens for several weeks after it left the city. The month of December, 1790, was extremely and uniformly cold. In the beginning of the month of January, 1791, the weather moderated, and continued to be pleasant till the 17th, on which day the navigation of the Delaware, which had been completely obstructed by the ice, was opened so as to admit of the arrival of several vessels. During the month of December many people complained of _colds_; but they were ascribed wholly to the weather. In January four or five persons in a family were affected by colds at the same time; which created a suspicion of a return of the influenza. This suspicion was soon confirmed by accounts of its prevailing in the neighbouring counties of Chester and Montgomery, in Pennsylvania, and in the distant states of Virginia and Rhode-Island. It did not affect near so generally as in the two former times of appearance. There was no difference in the method of treating it. While the common inflammatory diseases of the winter bore the lancet as usual, it was remarked that patients who were attacked by the influenza, did not bear bleeding in a greater proportion, or in a larger quantity, than in the two former times of its appearance in the city. I shall conclude this account of the influenza by the following observations: 1. It exists independently of the sensible qualities of the air, and in all kinds of weather. Dr. Patrick Russel has proved the plague to be equally independent of the influence of the sensible qualities of the atmosphere, to a certain degree. 2. The influenza passes with the utmost rapidity through a country, and affects the greatest number of people, in a given time, of any disease in the world. 3. It appears from the histories of it which are upon record, that neither climate, nor the different states of society, have produced any _material_ change in the disease. This will appear from comparing the account I have given, with the histories of it which have lately been given by Dr. Grey, Dr. Hamilton, Dr. A. Fothergill, Mr. Chisholm, and other modern physicians. It appears further, that even time itself has not been able materially to change the type of this disease. This is evident, from comparing modern accounts of it with those which have been handed down to us by ancient physicians. I have hinted in a former essay at the _diminutives_ of certain diseases. There is a state of influenza, which is less violent and more local, than that which has been described. It generally prevails in the winter season. It seems to originate from a morbid matter, generated in crowded and heated churches, and other assemblies of the people. I have seen a cold, or influenza, frequently universal in Philadelphia, which I have distinctly traced to this source. It would seem as if the same species of diseases resembled pictures, and that while some of them partook of the deep and vivid nature of mosaic work, others appeared like the feeble and transient impressions of water colours. AN INQUIRY INTO THE _CAUSE OF ANIMAL LIFE_. IN THREE LECTURES, DELIVERED IN THE UNIVERSITY OF PENNSYLVANIA. LECTURE I. GENTLEMEN, My business in this chair is to teach the institutes of medicine. They have been divided into physiology, pathology, and therapeutics. The objects of the first are, the laws of the human body in its healthy state. The second includes the history of the causes and seats of diseases. The subjects of the third are the remedies for those diseases. In entering upon the first part of our course, I am met by a remark delivered by Dr. Hunter in his introductory lectures to his course of anatomy. "In our branch (says the doctor) those teachers who study to captivate young minds with ingenious speculations, will not leave a reputation behind them that will outlive them half a century. When they cease from their labours, their labours will be buried along with them. There never was a man more followed and admired in physiology, than Dr. Boerhaave. I remember the veneration in which he was held. And now, in the space of forty years, his physiology is---- it shocks me to think in what a light it appears[89]." Painful as this premonition may be to the teachers of physiology, it should not deter them from speculating upon physiological subjects. Simple anatomy is a mass of dead matter. It is physiology which infuses life into it. A knowledge of the structure of the human body occupies only the memory. Physiology introduces it to the higher and more noble faculties of the mind. The component parts of the body may be compared to the materials of a house, lying without order in a yard. It is physiology, like a skilful architect, which connects them together, so as to form from them an elegant and useful building. The writers against physiology resemble, in one particular, the writers against luxury. They forget that the functions they know and describe belong to the science of physiology; just as the declaimers against luxury forget that all the conveniences which they enjoy beyond what are possessed in the most simple stage of society, belong to the luxuries of life. The anatomist who describes the circulation of the blood, acts the part of a physiologist, as much as he does, who attempts to explain the functions of the brain. In this respect Dr. Hunter did honour to our science; for few men ever explained that subject, and many others equally physiological, with more perspicuity and eloquence, than that illustrious anatomist. Upon all new and difficult subjects there must be pioneers. It has been my lot to be called to this office of hazard and drudgery; and if in discharging its duties I should meet the fate of my predecessors, in this branch of medicine, I shall not perish in vain. My errors, like the bodies of those who fall in forcing a breach, will serve to compose a bridge for those who shall come after me, in our present difficult enterprise. This consideration, aided by just views of the nature and extent of moral obligation, will overbalance the evils anticipated by Dr. Hunter, from the loss of posthumous fame. Had a prophetic voice whispered in the ear of Dr. Boerhaave in the evening of his life, that in the short period of forty years, the memory of his physiological works would perish from the earth, I am satisfied, from the knowledge we have of his elevated genius and piety, he would have treated the prediction with the same indifference that he would have done, had he been told, that in the same time, his name should be erased from a pane of glass, in a noisy and vulgar country tavern. [89] Lect. xi. p. 198. The subjects of the lectures I am about to deliver, you will find in a syllabus which I have prepared and published, for the purpose of giving you a succinct view of the extent and connection of our course. Some of these subjects will be new in lectures upon the institutes of medicine, particularly those which relate to morals, metaphysics, and theology. However thorny these questions may appear, we must approach and handle them; for they are intimately connected with the history of the faculties and operations of the human mind; and these form an essential part of the animal economy. Perhaps it is because physicians have hitherto been restrained from investigating, and deciding upon these subjects, by an erroneous belief that they belong exclusively to another profession, that physiology has so long been an obscure and conjectural science. In beholding the human body, the first thing that strikes us, is its _life_. This, of course, should be the first object of our inquiries. It is a most important subject; for the end of all the studies of a physician is to preserve life; and this cannot be perfectly done, until we know in what it consists. I include in animal life, as applied to the human body, _motion_, _sensation_, and _thought_. These three, when united, compose perfect life. It may exist without thought, or sensation; but neither sensation, nor thought, can exist without motion. The lowest grade of life, probably exists in the absence of even motion, as I shall mention hereafter. I have preferred the term _motion_ to those of oscillation and vibration, which have been employed by Dr. Hartley in explaining the laws of animal matter; because I conceived it to be more simple, and better adapted to common apprehension. In treating upon this subject, I shall first consider animal life as it appears in the waking and sleeping states in a healthy adult, and shall afterwards inquire into the modification of its causes in the f[oe]tal, infant, youthful, and middle states of life, in certain diseases, in different states of society, in different climates, and in different animals. I shall begin by delivering three general propositions. I. Every part of the human body (the nails and hair excepted) is endowed with sensibility, or excitability, or with both of them. By sensibility is meant the power of having sensation excited by the action of impressions. Excitability denotes that property in the human body, by which motion is excited by means of impressions. This property has been called by several other names, such as irritability, contractility, mobility, and stimulability. I shall make use of the term excitability, for the most part, in preference to any of them. I mean by it, a capacity of imperceptible, as well as obvious motion. It is of no consequence to our present inquiries, whether this excitability be a quality of animal matter, or a substance. The latter opinion has been maintained by Dr. Girtanner, and has some probability in its favour. II. The whole human body is so formed and connected, that impressions made in the healthy state upon one part, excite motion, or sensation, or both, in every other part of the body. From this view, it appears to be a unit, or a simple and indivisible quality, or substance. Its capacity for receiving motion, and sensation, is variously modified by means of what are called the senses. It is external, and internal. The impressions which act upon it shall be ennumerated in order. III. Life is the _effect_ of certain stimuli acting upon the sensibility and excitability which are extended, in different degrees, over every external and internal part of the body. These stimuli are as necessary to its existence, as air is to flame. Animal life is truly (to use the words of Dr. Brown) "a forced state." I have said the _words_ of Dr. Brown; for the opinion was delivered by Dr. Cullen in the university of Edinburgh, in the year 1766, and was detailed by me in this school, many years before the name of Dr. Brown was known as teacher of medicine. It is true, Dr. Cullen afterwards deserted it; but it is equally true, I never did; and the belief of it has been the foundation of many of the principles and modes of practice in medicine which I have since adopted. In a lecture which I delivered in the year 1771, I find the following words, which are taken from a manuscript copy of lectures given by Dr. Cullen upon the institutes of medicine. "The human body is not an automaton, or self-moving machine; but is kept alive and in motion, by the constant action of stimuli upon it." In thus ascribing the discovery of the cause of life which I shall endeavour to establish, to Dr. Cullen, let it not be supposed I mean to detract from the genius and merit of Dr. Brown. To his intrepidity in reviving and propagating it, as well as for the many other truths contained in his system of medicine, posterity, I have no doubt, will do him ample justice, after the errors that are blended with them have been corrected, by their unsuccessful application to the cure of diseases. Agreeably to our last proposition, I proceed to remark, that the action of the brain, the diastole and systole of the heart, the pulsation of the arteries, the contraction of the muscles, the peristaltic motion of the bowels, the absorbing power of the lymphatics, secretion, excretion, hearing, seeing, smelling, taste, and the sense of touch, nay more, thought itself, are all the effects of stimuli acting upon the organs of sense and motion. These stimuli have been divided into external and internal. The external are light, sound, odours, air, heat, exercise, and the pleasures of the senses. The internal stimuli are food, drinks, chyle, the blood, a certain tension of the glands, which contain secreted liquors, and the exercises of the faculties of the mind; each of which I shall treat in the order in which they have been mentioned. 1. Of external stimuli. The first of these is light. It is remarkable that the progenitor of the human race was not brought into existence until all the luminaries of heaven were created. Light acts chiefly through the medium of the organs of vision. Its influence upon animal life is feeble, compared with some other stimuli to be mentioned hereafter; but it has its proportion of force. Sleep has been said to be a tendency to death; now the absence of light we know invites to sleep, and the return of it excites the waking state. The late Mr. Rittenhouse informed me, that for many years he had constantly awoke with the first dawn of the morning light, both in summer and winter. Its influence upon the animal spirits strongly demonstrates its connection with animal life, and hence we find a cheerful and a depressed state of mind in many people, and more especially in invalids, to be intimately connected with the presence or absence of the rays of the sun. The well-known pedestrian traveller, Mr. Stewart, in one of his visits to this city, informed me, that he had spent a summer in Lapland, in the latitude of 69°, during the greatest part of which time the sun was seldom out of sight. He enjoyed, he said, during this period, uncommon health and spirits, both of which he ascribed to the long duration, and invigorating influence of light. These facts will surprise us less when we attend to the effects of light upon vegetables. Some of them lose their colour by being deprived of it; many of them discover a partiality to it in the direction of their flowers; and all of them discharge their pure air only while they are exposed to it[90]. [90] "Organization, sensation, spontaneous motion, and life, exist only at the surface of the earth, and in places exposed to _light_. We might affirm the flame of Prometheus's torch was the expression of a philosophical truth that did not escape the ancients. Without light, nature was lifeless, inanimate, and dead. A benevolent God, by producing life, has spread organization, sensation, and thought over the surface of the earth."--_Lavoisier._ 2. Sound has an extensive influence upon human life. Its numerous artificial and natural sources need not be mentioned. I shall only take notice, that the currents of winds, the passage of insects through the air, and even the growth of vegetables, are all attended with an emission of sound; and although they become imperceptible from habit, yet there is reason to believe they all act upon the body, through the medium of the ears. The existence of these sounds is established by the reports of persons who have ascended two or three miles from the earth in a balloon. They tell us that the silence which prevails in those regions of the air is so new and complete, as to produce an awful solemnity in their minds. It is not necessary that these sounds should excite sensation or perception, in order to their exerting a degree of stimulus upon the body. There are a hundred impressions daily made upon it, which from habit are not followed by sensation. The stimulus of aliment upon the stomach, and of blood upon the heart and arteries, probably cease to be felt, only from the influence of habit. The exercise of walking, which was originally the result of a deliberate act of the will, is performed from habit without the least degree of consciousness. It is unfortunate for this, and many other parts of physiology, that we forget what passed in our minds the first two or three years of our lives. Could we recollect the manner in which we acquired our first ideas, and the progress of our knowledge with the evolution of our senses and faculties, it would relieve us from many difficulties and controversies upon this subject. Perhaps this forgetfulness by children, of the origin and progress of their knowledge, might be remedied by our attending more closely to the first effects of impressions, sensation, and perception upon them, as discovered by their little actions; all of which probably have a meaning, as determined as any of the actions of men or women. The influence of sounds of a certain kind in producing excitement, and thereby increasing life, cannot be denied. Fear produces debility, which is a tendency to death. Sound obviates this debility, and thus restores the system to the natural and healthy grade of life. The school-boy and the clown invigorate their feeble and trembling limbs by whistling or singing as they pass by a country church-yard, and the soldier feels his departing life recalled in the onset of a battle by the noise of the fife, and of the poet's "spirit stirring drum." Intoxication is frequently attended with a higher degree of life than is natural. Now sound we know will produce this with a very moderate portion of fermented liquor; hence we find men are more easily and highly excited by it at public entertainments where there is music, loud talking, and hallooing, than in private companies where there is no auxiliary stimulus added to that of the wine. I wish these effects of sound upon animal life to be remembered; for I shall mention it hereafter as a remedy for the weak state of life in many diseases, and shall relate an instance in which a scream suddenly extorted by grief, proved the means of resuscitating a person who was supposed to be dead, and who had exhibited the usual recent marks of the extinction of life. I shall conclude this head by remarking, that persons who are destitute of hearing and seeing possess life in a more languid state than other people; and hence arise the dulness and want of spirits which they discover in their intercourse with the world. 3. Odours have a sensible effect in promoting animal life. The greater healthiness of the country, than cities, is derived in part from the effluvia of odoriferous plants, which float in the atmosphere in the spring and summer months, acting upon the system, through the medium of the sense of smelling. The effects of odours upon animal life appear still more obvious in the sudden revival of it, which they produce in cases of fainting. Here the smell of a few drops of hartshorn, or even of a burnt feather, has frequently in a few minutes restored the system, from a state of weakness bordering upon death, to an equable and regular degree of excitement. 4. Air acts as a powerful stimulus upon the system, through the medium of the lungs. The component parts of this fluid, and its decomposition in the lungs, will be considered in another place[91]. I shall only remark here, that the circulation of the blood has been ascribed, by Dr. Goodwin, exclusively to the action of air upon the lungs and heart. Does the external air act upon any other part of the body besides those which have been mentioned? It is probable it does, and that we lose our sensation and consciousness of it by habit. It is certain children cry, for the most part, as soon as they come into the world. May not this be the effect of the sudden impression of air upon the tender surface of their bodies? And may not the red colour of their skins be occasioned by an irritation excited on them by the stimulus of the air? It is certain it acts powerfully upon denudated animal fibres; for who has not observed a sore, and even the skin when deprived of its cuticle, to be affected, when long exposed to the air, with pain and inflammation? The stimulus of air, in promoting the natural actions of the alimentary canal, cannot be doubted. A certain portion of it seems to be necessarily present in the bowels in a healthy state. [91] It is probable, the first impulse of life was imparted to the body of Adam by the decomposition of air in his lungs. I infer this from the account given by Moses of his creation, in Genesis, chap. ii. v. 7. "And the Lord God formed man of the dust of the ground, and breathed into his nostrils the breath of life," in consequence of which, the verse adds, he became "a living soul." This explanation of the origin of life in the father of the human race, appears to accord more with reason, as well as the order of the words which describe it, than the common opinion of his having been animated by the infusion of a living soul into his body. 5. Heat is a uniform and active stimulus in promoting life. It is derived, in certain seasons and countries, in part from the sun; but its principal source is from the lungs, in which it appears to be generated by the decomposition of pure air, and from whence it is conveyed, by means of the circulation, to every part of the body. The extensive influence of heat upon animal life, is evident from its decay and suspension during the winter in certain animals, and from its revival upon the approach and action of the vernal sun. It is true, life is diminished much less in man, from the distance and absence of the sun, than in other animals; but this must be ascribed to his possessing reason in so high a degree, as to enable him to supply the abstraction of heat, by the action of other stimuli upon his system. 6. Exercise acts as a stimulus upon the body in various ways. Its first impression is upon the muscles. These act upon the blood-vessels, and they upon the nerves and brain. The necessity of exercise to animal life is indicated, by its being kindly imposed upon man in paradise. The change which the human body underwent by the fall, rendered the same salutary stimulus necessary to its life, in the more active form of labour. But we are not to suppose, that motion is excited in the body by exercise or labour alone. It is constantly stimulated by the positions of standing, sitting, and lying upon the sides; all of which act more or less upon muscular fibres, and by their means, upon every part of the system. 7. The pleasures we derive from our senses have a powerful and extensive influence upon human life. The number of these pleasures, and their proximate cause, will form an agreeable subject for two or three future lectures. We proceed next to consider the internal stimuli which produce animal life. These are I. FOOD. This acts in the following ways. 1. Upon the tongue. Such are the sensibility and excitability of this organ, and so intimate is its connection with every other part of the body, that the whole system is invigorated by aliment, as soon as it comes in contact with it. 2. By mastication. This moves a number of muscles and blood-vessels situated near the brain and heart, and of course imparts impressions to them. 3. By deglutition, which acts upon similar parts, and with the same effect. 4. By its presence in the stomach, in which it acts by its quantity and quality. Food, by distending the stomach, stimulates the contiguous parts of the body. A moderate degree of distention of the stomach and bowels is essential to a healthy excitement of the system. Vegetable aliment and drinks, which contain less nourishment than animal food, serve this purpose in the human body. Hay acts in the same manner in a horse. Sixteen pounds of this light food in a day are necessary to keep up such a degree of distension in the stomach and bowels of this animal, as to impart to him his natural grade of strength and life. The _quality_ of food, when of a stimulating nature, supplies the place of its distension from its quantity. A single onion will support a lounging highlander on the hills of Scotland for four and twenty hours. A moderate quantity of salted meat, or a few ounces of sugar, have supplied the place of pounds of less stimulating food. Even indigestible substances, which remain for days, or perhaps weeks in the stomach, exert a stimulus there which has an influence upon animal life. It is in this way the tops of briars, and the twigs of trees, devoid not only of nourishing matter, but of juices, support the camel in his journies through the deserts of the eastern countries. Chips of cedar posts moistened with water have supported horses for two or three weeks, during a long voyage from Boston to Surinam; and the indigestible cover of an old Bible preserved the life of a dog, accidentally confined in a room at Newcastle upon Tyne, for twenty days. 5. Food stimulates the whole body by means of the process of digestion which goes forward in the stomach. This animal function is carried on by a process, in which there is probably an extrication of heat and air. Now both these, it has been remarked, exert a stimulus in promoting animal life. Drinks, when they consist of fermented or distilled liquors, stimulate from their quality; but when they consist of water, either in its simple state, or impregnated with any sapid substance, they act principally by distention. II. The chyle acts upon the lacteals, mesenteric glands, and thoracic duct, in its passage through them; and it is highly probable, its first mixture with the blood in the subclavian vein, and its first action on the heart, are attended with considerable stimulating effects. III. The blood is a very important internal stimulus. It has been disputed whether it acts by its quality, or only by distending the blood-vessels. It appears to act in both ways. I believe with Dr. Whytt, that the blood stimulates the heart and arteries by a specific action. But if this be not admitted, its influence in extending the blood-vessels in every part of the body, and thereby imparting extensive and uniform impressions to every animal fibre, cannot be denied. In support of this assertion it has been remarked, that in those persons who die of hunger, there is no diminution of the quantity of blood in the large blood-vessels. IV. A certain _tension_ of the glands, and of other parts of the body, contributes to support animal life. This is evident in the vigour which is imparted to the system, by the fulness of the seminal vesicles and gall bladder, and by the distension of the uterus in pregnancy. This distension is so great, in some instances, as to prevent sleep for many days and even weeks before delivery. It serves the valuable purpose of rendering the female system less liable to death during its continuance, than at any other time. By increasing the quantity of life in the body, it often suspends the fatal issue of pulmonary consumption, and ensures a temporary victory over the plague and other malignant fevers; for death, from those diseases, seldom takes place, until the stimulus, from the distension of the uterus, is removed by parturition. V. The exercises of the faculties of the mind have a wonderful influence in increasing the quantity of human life. They all act by _reflection_ only, after having been previously excited into action by impressions made upon the body. This view of the _re-action_ of the mind upon the body accords with the simplicity of other operations in the animal economy. It is thus the brain repays the heart for the blood it conveys to it, by re-acting upon its muscular fibres. The influence of the different faculties of the mind is felt in the pulse, in the stomach, and in the liver, and is seen in the face, and other external parts of the body. Those which act most unequivocally in promoting life are the understanding, the imagination, and the passions. Thinking belongs to the understanding, and is attended with an obvious influence upon the degree and duration of life. Intense study has often rendered the body insensible to the debilitating effects of cold and hunger. Men of great and active understandings, who blend with their studies temperance and exercise, are generally long lived. In support of this assertion, a hundred names might be added to those of Newton and Franklin. Its truth will be more fully established by attending to the state of human life in persons of an opposite intellectual character. The cretins, a race of idiots in Valais, in Switzerland, travellers tell us, are all short lived. Common language justifies the opinion of the stimulus of the understanding upon the brain: hence it is common to say of dull men, that they have scarcely ideas enough to keep themselves awake. The imagination acts with great force upon the body, whether its numerous associations produce pleasure or pain. But the passions pour a constant stream upon the wheels of life. They have been subdivided into emotions and passions properly so called. The former have for their objects present, the latter, future good and evil. All the objects of the passions are accompanied with desire or aversion. To the former belong chiefly, hope, love, ambition, and avarice; to the latter, fear, hatred, malice, envy, and the like. Joy, anger, and terror, belong to the class of emotions. The passions and emotions have been further divided into stimulating and sedative. Our business at present is to consider their first effect only upon the body. In the original constitution of human nature, we were made to be stimulated by such passions and emotions only as have moral good for their objects. Man was designed to be always under the influence of hope, love, and joy. By the loss of his innocence, he has subjected himself to the dominion of passions and emotions of a malignant nature; but they possess, in common with such as are good, a stimulus which renders them subservient to the purpose of promoting animal life. It is true, they are like the stimulus of a dislocated bone in their operation upon the body, compared with the action of antagonist muscles stretched over bones, which gently move in their natural sockets. The effects of the good passions and emotions, in promoting health and longevity, have been taken notice of by many writers. They produce a flame, gentle and pleasant, like oil perfumed with frankincense in the lamp of life. There are instances likewise of persons who have derived strength and long life from the influence of the evil passions and emotions that have been mentioned. Dr. Darwin relates the history of a man, who used to overcome the fatigue induced by travelling, by thinking of a person whom he hated. The debility induced by disease is often removed by a sudden change in the temper. This is so common, that even nurses predict a recovery in persons as soon as they become peevish and ill-natured, after having been patient during the worst stage of their sickness. This peevishness acts as a gentle stimulus upon the system in its languid state, and thus turns the scale in favour of life and health. The famous Benjamin Lay, of this state, who lived to be eighty years of age, was of a very irascible temper. Old Elwes was a prodigy of avarice, and every court in Europe furnishes instances of men who have attained to extreme old age, who have lived constantly under the dominion of ambition. In the course of a long inquiry which I instituted some years ago into the state of the body and mind in old people, I did not find a single person above eighty, who had not possessed an active understanding, or active passions. Those different and opposite faculties of the mind, when in excess, happily supply the place of each other. Where they unite their forces, they extinguish the flame of life, before the oil which feeds it is consumed. In another place I shall resume the influence of the faculties of the mind upon human life, as they discover themselves in the different pursuits of men. I have only to add here, that I see no occasion to admit, with the followers of Dr. Brown, that the mind is active in sleep, in preserving the motions of life. I hope to establish hereafter the opinion of Mr. Locke, that the mind is always passive in sound sleep. It is true it acts in dreams; but these depend upon a morbid state of the brain, and therefore do not belong to the present stage of our subject, for I am now considering animal life only in the healthy state of the body. I shall say presently, that dreams are intended to supply the absence of some natural stimulus, and hence we find they occur in those persons most commonly, in whom there is a want of healthy action in the system, induced by the excess or deficiency of customary stimuli. Life is in a languid state in the morning. It acquires vigour by the gradual and successive application of stimuli in the forenoon. It is in its most perfect state about mid-day, and remains stationary for some hours. From the diminution of the sensibility and contractility of the system to the action of impressions, it lessens in the evening, and becomes again languid at bed-time. These facts will admit of an extensive application hereafter in our lectures upon the practice of physic. LECTURE II. GENTLEMEN, The stimuli which have been enumerated, when they act collectively, and within certain bounds, produce a healthy waking state. But they do not always act collectively, nor in the determined and regular manner that has been described. There is, in many states of the system, a deficiency of some stimuli, and, in some of its states, an apparent absence of them all. To account for the continuance of animal life under such circumstances, two things must be premised, before we proceed to take notice of the diminution or absence of the stimuli which support it. 1. The healthy actions of the body in the waking state consist in a proper degree of what has been called excitability and excitement. The former is the medium on which stimuli act in producing the latter. In an exact proportion, and a due relation of both, diffused uniformly throughout every part of the body, consists good health. Disease is the reverse of this. It depends _in part_ upon a disproportion between excitement and excitability, and in a partial distribution of each of them. In thus distinguishing the different states of excitement and excitability in health and sickness, you see I dissent from Dr. Brown, who supposes them to be (though disproportioned to each other) equably diffused in the morbid, as well as the healthy state of the body. 2. It is a law of the system, that the absence of one natural stimulus is generally supplied by the increased action of others. This is more certainly the case where a natural stimulus is abstracted _suddenly_; for the excitability is thereby so instantly formed and accumulated, as to furnish a highly sensible and moveable surface for the remaining stimuli to act upon. Many proofs might be adduced in support of this proposition. The reduction of the excitement of the blood-vessels, by means of cold, prepares the way for a full meal, or a warm bed, to excite in them the morbid actions which take place in a pleurisy or a rheumatism. A horse in a cold stable eats more than in a warm one, and thus counteracts the debility which would otherwise be induced upon his system, by the abstraction of the stimulus of warm air. These two propositions being admitted, I proceed next to inquire into the different degrees and states of animal life. The first departure from its ordinary and perfect state which strikes us, is in I. Sleep. This is either natural or artificial. Natural sleep is induced by a diminution of the excitement and excitability of the system, by the continued application of the stimuli which act upon the body in its waking state. When these stimuli act in a determined degree, that is, when the same number of stimuli act with the same force, and for the same time, upon the system, sleep will be brought on at the same hour every night. But when they act with uncommon force, or for an unusual time, it is brought on at an earlier hour. Thus a long walk or ride, by persons accustomed to a sedentary life, unusual exercise of the understanding, the action of strong passions or emotions, and the continual application of unusual sounds seldom fail of inducing premature sleep. It is recorded of pope Ganganelli, that he slept more soundly, and longer than usual, the night after he was raised to the papal chair. The effects of unusual sounds in bringing on premature sleep, is further demonstrated by that constant inclination to retire to bed at an early hour, which country people discover the first and second days they spend in a city, exposed from morning till night to the noise of hammers, files, and looms, or of drays, carts, waggons, and coaches, rattling over pavements of stone. Sleep is further hastened by the absence of light, the cessation of sounds and labour, and the recumbent posture of the body on a soft bed. Artificial sleep may be induced at any time by certain stimulating substances, particularly by opium. They act by carrying the system beyond the healthy grade of excitement, to a degree of indirect debility, which Dr. Brown has happily called the sleeping point. The same point may be induced in the system at any time by the artificial abstraction of the usual stimuli of life. For example, let a person shut himself up at mid-day in a dark room, remote from noise of all kinds, let him lie down upon his back upon a soft bed in a temperate state of the atmosphere, and let him cease to think upon interesting subjects, or let him think only upon one subject, and he will soon fall asleep. Dr. Boerhaave relates an instance of a Dutch physician, who, having persuaded himself that waking was a violent state, and sleep the only natural one of the system, contrived, by abstracting every kind of stimulus in the manner that has been mentioned, to sleep away whole days and nights, until at length he impaired his understanding, and finally perished in a public hospital in a state of idiotism. In thus anticipating a view of the cause of sleep, I have said nothing of the effects of diseases of the brain in inducing it. These belong to another part of our course. The short explanation I have given of its cause was necessary in order to render the history of animal life, in that state of the system, more intelligible. At the usual hour of sleep there is an abstraction of the stimuli of light, sound, and muscular motion. The stimuli which remain, and act with an increased force upon the body in sleep, are 1. The heat which is discharged from the body, and confined by means of bed-clothes. It is most perceptible when exhaled from a bed-fellow. Heat obtained in this way has sometimes been employed to restore declining life to the bodies of old people. Witness the damsel who lay for this purpose in the bosom of the king of Israel. The advantage of this external heat will appear further, when we consider how impracticable or imperfect sleep is, when we lie under too light covering in cold weather. 2. The air which is applied to the lungs during sleep probably acts with more force than in the waking state. I am disposed to believe that more air is phlogisticated in sleep than at any other time, for the smell of a close room in which a person has slept one night, we know, is much more disagreeable than that of a room, under equal circumstances, in which half a dozen people have sat for the same number of hours in the day time. The action of decomposed air on the lungs and heart was spoken of in a former lecture. An increase in its quantity must necessarily have a powerful influence upon animal life during the sleeping state. 3. Respiration is performed with a greater extension and contraction of the muscles of the breast in sleep than in the waking state; and this cannot fail of increasing the impetus of the blood in its passage through the heart and blood-vessels. The increase of the fulness and force of the pulse in sleep, is probably owing in part to the action of respiration upon it. In another place I hope to elevate the rank of the blood-vessels in the animal economy, by showing that they are the fountains of power in the body. They derive this pre-eminence from the protection and support they afford to every part of the system. They are the perpetual centineals of health and life; for they never partake in the repose which is enjoyed by the muscles and nerves. During sleep, their sensibility seems to be converted into contractility, by which means their muscular fibres are more easily moved by the blood than in the waking state. The diminution of sensibility in sleep is proved by many facts to be mentioned hereafter; and the change of sensibility into contractility will appear, when we come to consider the state of animal life in infancy and old age. 4. Aliment in the stomach acts more powerfully in sleep than in the waking state. This is evident from digestion going on more rapidly when we are awake than when we sleep. The more slow the digestion, the greater is the stimulus of the aliment in the stomach. Of this we have many proofs in daily life. Labourers object to milk as a breakfast, because it digests too soon; and often call for food in a morning, which they can feel all day in their stomachs. Sausages, fat pork, and onions are generally preferred by them for this purpose. A moderate supper is favourable to easy and sound sleep; and the want of it, in persons who are accustomed to that meal, is often followed by a restless night. The absence of its stimulus is probably supplied by a full gall-bladder (which always attends an empty stomach) in persons who are not in the habit of eating suppers. 5. The stimulus of the urine, accumulated in the bladder during sleep, has a perceptible influence upon animal life. It is often so considerable as to interrupt sleep; and it is one of the causes of our waking at a regular hour in the morning. It is moreover a frequent cause of the activity of the understanding and passions in dreams; and hence we dream more in our morning slumbers, when the bladder is full, than we do in the beginning or middle of the night. 6. The fæces exert a constant stimulus upon the bowels in sleep. This is so considerable as to render it less profound when they have been accumulated for two or three days, or when they have been deposited in the extremity of the alimentary canal. 7. The partial and irregular exercises of the understanding and passions in dreams have an occasional influence in promoting life. They occur only where there is a deficiency of other stimuli. Such is the force with which the mind acts upon the body in dreams, that Dr. Brambilla, physician to the emperor of Germany, informs us, that he has seen instances of wounds in soldiers being inflamed, and putting on a gangrenous appearance in consequence of the commotions excited in their bodies by irritating dreams[92]. The stimulating passions act through the medium of the will; and the exercises of this faculty of the mind sometimes extend so far as to produce actions in the muscles of the limbs, and occasionally in the whole body, as we see in persons who walk in their sleep. The stimulus of lust often awakens us with pleasure or pain, according as we are disposed to respect or disobey the precepts of our Maker. The angry and revengeful passions often deliver us, in like manner, from the imaginary guilt of murder. Even the debilitating passions of grief and fear produce an indirect operation upon the system that is favourable to life in sleep, for they excite that distressing disease called the night mare, which prompts us to speak, or halloo, and by thus invigorating respiration, overcomes the languid circulation of the blood in the heart and brain. Do not complain then, gentlemen, when you are bestrode by this midnight hag. She is kindly sent to prevent your sudden death. Persons who go to bed in good health, and are found dead the succeeding morning, are said most commonly to die of this disease. [92] A fever was excited in Cinna the poet, in consequence of his dreaming that he saw Cæsar, the night after he was assassinated, and was invited to accompany him to a dreary place, to which he pointed, in order to sup with him. Convulsions and other diseases, I believe, are often excited in the night, by terrifying or distressing dreams. _Plutarch's Life of M. Brutus._ I proceed now to inquire into the state of animal life in its different stages. I pass over for the present its history in generation. It will be sufficient only to remark in this place, that its first motion is produced by the stimulus of the male seed upon the female ovum. This opinion is not originally mine. You will find it in Dr. Haller[93]. The pungent taste which Mr. John Hunter discovered in the male seed renders it peculiarly fit for this purpose. No sooner is the female ovum thus set in motion, and the f[oe]tus formed, than its capacity of life is supported, 1. By the stimulus of the heat which it derives from its connection with its mother in the womb. 2. By the stimulus of its own circulating blood. 3. By its constant motion in the womb after the third month of pregnancy. The absence of this motion for a few days is always a sign of the indisposition or death of a f[oe]tus. Considering how early a child is accustomed to it, it is strange that a cradle should ever have been denied to it after it comes into the world. [93] "Novum f[oe]tum a seminis masculi _stimulo_ vitam concepisse."--_Elementa Physiologiæ_, vol. viii. p. 177. II. In infants there is an absence of many of the stimuli which support life. Their excretions are in a great measure deficient in acrimony, and their mental faculties are too weak to exert much influence upon their bodies. But the absence of stimulus from those causes is amply supplied 1. By the very great excitability of their systems to those of light, sound, heat, and air. So powerfully do light and sound act upon them, that the Author of nature has kindly defended their eyes and ears from an excess of their impressions by imperfect vision and hearing, for several weeks after birth. The capacity of infants to be acted upon by moderate degrees of heat is evident from their suffering less from cold than grown people. This is so much the case, that we read, in Mr. Umfreville's account of Hudson's Bay, of a child that was found alive upon the back of its mother after she was frozen to death. I before hinted at the action of the air upon the bodies of new-born infants in producing the red colour of their skins. It is highly probable (from a fact formerly mentioned) that the first impression of the atmosphere which produces this redness is accompanied with pain, and this we know is a stimulus of a very active nature. By a kind law of sensation, impressions, that were originally painful, become pleasurable by repetition or duration. This is remarkably evident in the impression now under consideration, and hence we find infants at a certain age discover signs of an increase of life by their delightful gestures, when they are carried into the open air. Recollect further, gentlemen, what was said formerly of excitability predominating over sensibility in infants. We see it daily, not only in their patience of cold, but in the short time in which they cease to complain of the injuries they meet with from falls, cuts, and even severe surgical operations. 2. Animal life is supported in infants by their sucking, or feeding, nearly every hour in the day and night when they are awake. I explained formerly the manner in which food stimulated the system. The action of sucking supplies, by the muscles employed in it, the stimulus of mastication. 3. Laughing and crying, which are universal in infancy, have a considerable influence in promoting animal life, by their action upon respiration, and the circulation of the blood. Laughing exists under all circumstances, independently of education or imitation. The child of the negro slave, born only to inherit the toils and misery of its parents, receives its master with a smile every time he enters his kitchen or a negro-quarter. But laughing exists in infancy under circumstances still more unfavourable to it; an instance of which is related by Mr. Bruce. After a journey of several hundred miles across the sands of Nubia, he came to a spring of water shaded by a few scrubby trees. Here he intended to have rested during the night, but he had not slept long before he was awakened by a noise which he perceived was made by a solitary Arab, equally fatigued and half famished with himself, who was preparing to murder and plunder him. Mr. Bruce rushed upon him, and made him his prisoner. The next morning he was joined by a half-starved female companion, with an infant of six months old in her arms. In passing by this child, Mr. Bruce says, it laughed and crowed in his face, and attempted to leap upon him. From this fact it would seem as if laughing was not only characteristic of our species, but that it was early and intimately connected with human life. The child of these Arabs had probably never seen a smile upon the faces of its ferocious parents, and perhaps had never (before the sight of Mr. Bruce) beheld any other human creature. Crying has a considerable influence upon health and life in children. I have seen so many instances of its salutary effects, that I have satisfied myself it is as possible for a child to "cry and be fat," as it is to "laugh and be fat." 4. As children advance in life, the constancy of their appetites for food, and their disposition to laugh and cry, lessen, but the diminution of these stimuli is supplied by exercise. The limbs[94] and tongues of children are always in motion. They continue likewise to eat oftener than adults. A crust of bread is commonly the last thing they ask for at night, and the first thing they call for in the morning. It is now they begin to feel the energy of their mental faculties. This stimulus is assisted in its force by the disposition to prattle, which is so universal among children. This habit of converting their ideas into words as fast as they rise, follows them to their beds, where we often hear them talk themselves to sleep in a whisper, or to use less correct, but more striking terms, by _thinking aloud_. [94] Niebuhr, in his Travels, says the children in Arabia are taught to keep themselves constantly in motion by a kind of vibratory exercise of their bodies. This motion counteracts the diminution of life produced by the heat of the climate of Arabia. 5. Dreams act at an early period upon the bodies of children. Their smiles, startings, and occasional screams in their sleep appear to arise from them. After the third or fourth year of their lives, they sometimes confound them with things that are real. From observing the effects of this mistake upon the memory, a sensible woman whom I once knew, forbad her children to tell their dreams, lest they should contract habits of lying, by confounding imaginary with real events. 6. New objects, whether natural or artificial, are never seen by children without emotions of pleasure which act upon their capacity of life. The effects of novelty upon the tender bodies of children may easily be conceived, by its friendly influence upon the health of invalids who visit foreign countries, and who pass months or years in a constant succession of new and agreeable impressions. III. From the combination of all the stimuli that have been enumerated, human life is generally in excess from fifteen to thirty-five. It is during this period the passions blow a perpetual storm. The most predominating of them is the love of pleasure. No sooner does the system become insensible to this stimulus, than ambition succeeds it in, IV. The middle stage of life. Here we behold man in his most perfect physical state. The stimuli which now act upon him are so far regulated by prudence, that they are seldom excessive in their force. The habits of order the system acquires in this period, continue to produce good health for many years afterwards; and hence bills of mortality prove that fewer persons die between forty and fifty-seven, than in any other seventeen years of human life. V. In old age, the senses of seeing, hearing, and touch are impaired. The venereal appetite is weakened, or entirely extinguished. The pulse becomes slow, and subject to frequent intermissions, from a decay in the force of the blood-vessels. Exercise becomes impracticable, or irksome, and the operations of the understanding are performed with languor and difficulty. In this shattered and declining state of the system, the absence and diminution of all the stimuli which have been mentioned are supplied, 1. By an increase in the quantity, and by the peculiar quality of the food which is taken by old people. They generally eat twice as much as persons in middle life, and they bear with pain the usual intervals between meals. They moreover prefer that kind of food which is savoury and stimulating. The stomach of the celebrated Parr, who died in the one hundred and fiftieth year of his age, was found full of strong, nourishing aliment. 2. By the stimulus of the fæces, which are frequently retained for five or six days in the bowels of old people. 3. By the stimulus of fluids rendered preternaturally acrid by age. The urine, sweat, and even the tears of old people, possess a peculiar acrimony. Their blood likewise loses part of the mildness which is natural to that fluid; and hence the difficulty with which sores heal in old people; and hence too the reason why cancers are more common in the decline, than in any other period of human life. 4. By the uncommon activity of certain passions. These are either good or evil. To the former belong an increased vigour in the operations of those passions which have for their objects the Divine Being, or the whole family of mankind, or their own offspring, particularly their grand-children. To the latter passions belong malice, a hatred of the manners and fashions of the rising generation, and, above all, avarice. This passion knows no holidays. Its stimulus is constant, though varied daily by the numerous means which it has discovered of increasing, securing, and perpetuating property. It has been observed that weak mental impressions produce much greater effects in old people than in persons in middle life. A trifling indisposition in a grand-child, an inadvertent act of unkindness from a friend, or the fear of losing a few shillings, have, in many instances, produced in them a degree of wakefulness that has continued for two or three nights. It is to this highly excitable state of the system that Solomon probably alludes, when he describes the grasshopper as burdensome to old people. 5. By the passion for talking, which is so common, as to be one of the characteristics of old age. I mentioned formerly the influence of this stimulus upon animal life. Perhaps it is more necessary in the female constitution than in the male; for it has long ago been remarked, that women who are very taciturn, are generally unhealthy. 6. By their wearing warmer clothes, and preferring warmer rooms, than in the former periods of their lives. This practice is so uniform, that it would not be difficult, in many cases, to tell a man's age by his dress, or by finding out at what degree of heat he found himself comfortable in a close room. 7. By dreams. These are universal among old people. They arise from their short and imperfect sleep. 8. It has been often said, that "We are once men, and twice children." In speaking of the state of animal life in infancy, I remarked that the contractility of the animal fibres predominated over their sensibility in that stage of life. The same thing takes place in old people, and it is in consequence of the return of this infantile state of the system, that all the stimuli which have been mentioned act upon them with much more force than in middle life. This sameness, in the predominance of excitability over sensibility in children and old people, will account for the similarity of their habits with respect to eating, sleep, exercise, and the use of fermented and distilled liquors. It is from the increase of excitability in old people, that so small a quantity of strong drink intoxicates them; and it is from an ignorance of this change in their constitutions, that many of them become drunkards, after passing the early and middle stages of life with sober characters. Life is continued in a less imperfect state in old age in women than in men. The former sew, and knit, and spin, after they lose the use of their ears and eyes; whereas the latter, after losing the use of those senses, frequently pass the evening of their lives in a torpid state in a chimney corner. It is from the influence of moderate and gently stimulating employments, upon the female constitution, that more women live to be old than men, and that they rarely survive their usefulness in domestic life. Hitherto the principles I am endeavouring to establish have been applied to explain the cause of life in its more common forms. Let us next inquire, how far they will enable us to explain its continuance in certain morbid states of the body, in which there is a diminution of some, and an apparent abstraction of all the stimuli, which have been supposed to produce animal life. I. We observe some people to be blind, or deaf and dumb from their birth. The same defects of sight, hearing, and speech, are sometimes brought on by diseases. Here animal life is deprived of all those numerous stimuli, which arise from light, colours, sounds, and speech. But the absence of these stimuli is supplied, 1. By increased sensibility and excitability in their remaining senses. The ears, the nose, and the fingers, afford a surface for impressions in blind people, which frequently overbalances the loss of their eye-sight. There are two blind young men, brothers, in this city, of the name of Dutton, who can tell when they approach a post in walking across a street, by a peculiar sound which the ground under their feet emits in the neighbourhood of the post. Their sense of hearing is still more exquisite to sounds of another kind. They can tell the names of a number of tame pigeons, with which they amuse themselves in a little garden, by only hearing them fly over their heads. The celebrated blind philosopher, Dr. Moyse, can distinguish a black dress on his friends, by its smell; and we read of many instances of blind persons who have been able to perceive colours by rubbing their fingers upon them. One of these persons, mentioned by Mr. Boyle, has left upon record an account of the specific quality of each colour as it affected his sense of touch. He says black imparted the most, and blue the least perceptible sense of asperity to his fingers. 2. By an increase of vigour in the exercises of the mental faculties. The poems of Homer, Milton, and Blacklock, and the attainments of Sanderson in mathematical knowledge, all discover how much the energy of the mind is increased by the absence of impressions upon the organs of vision. II. We sometimes behold life in idiots, in whom there is not only an absence of the stimuli of the understanding and passions, but frequently, from the weakness of their bodies, a deficiency of the loco-motive powers. Here an inordinate appetite for food, or venereal pleasures, or a constant habit of laughing, or talking, or playing with their hands and feet, supply the place of the stimulating operations of the mind, and of general bodily exercise. Of the inordinate force of the venereal appetite in idiots we have many proofs. The cretins are much addicted to venery; and Dr. Michaelis tells us that the idiot whom he saw at the Passaic falls in New-Jersey, who had passed six and twenty years in a cradle, acknowledged that he had venereal desires, and wished to be married, for, the doctor adds, he had a sense of religion upon his fragment of mind, and of course did not wish to gratify that appetite in an unlawful manner. III. How is animal life supported in persons who pass many days, and even weeks without food, and in some instances without drinks? Long fasting is usually the effect of disease, of necessity, or of a principle of religion. When it arises from the first cause, the actions of life are kept up by the stimulus of disease[95]. The absence of food when accidental, or submitted to as a means of producing moral happiness, is supplied, 1. By the stimulus of a full gall bladder. This state of the receptacle of bile has generally been found to accompany an empty stomach. The bile is sometimes absorbed, and imparts a yellow colour to the skin of persons who suffer or die of famine. 2. By increased acrimony in all the secretions and excretions of the body. The saliva becomes so acrid by long fasting, as to excoriate the gums, and the breath acquires not only a f[oe]tor, but a pungency so active, as to draw tears from the eyes of persons who are exposed to it. 3. By increased sensibility and excitability in the sense of touch. The blind man mentioned by Mr. Boyle, who could distinguish colours by his fingers, possessed this talent only after fasting. Even a draught of any kind of liquor deprived him of it. I have taken notice, in my account of the yellow fever in Philadelphia, in the year 1793, of the effects of a diet bordering upon fasting for six weeks, in producing a quickness and correctness in my perceptions of the state of the pulse, which I had never experienced before. 4. By an increase of activity in the understanding and passions. Gamesters often improve the exercises of their minds, when they are about to play for a large sum of money, by living for a day or two upon roasted apples and cold water. Where the passions are excited into preternatural action, the absence of the stimulus of food is scarcely felt. I shall hereafter mention the influence of the desire of life upon its preservation, under all circumstances. It acts with peculiar force when fasting is accidental. But when it is submitted to as a religious duty, it is accompanied by sentiments and feelings which more than balance the abstraction of aliment. The body of Moses was sustained, probably without a miracle, during an abstinence of forty days and forty nights, by the pleasure he derived from conversing with his Maker "face to face, as a man speaking with his friend[96]." [95] The stimulus of a disease sometimes supplies the place of food in prolonging life. Mr. C. S----, a gentleman well known in Virginia, who was afflicted with a palsy, which had resisted the skill of several physicians, determined to destroy himself, by abstaining from food and drinks. He lived _sixty_ days without eating any thing, and the greatest part of that time without tasting even a drop of water. His disease probably protracted his life thus long beyond the usual time in which death is induced by fasting. See a particular account of this case, in the first number of the second volume of Dr. Coxe's Medical Museum. [96] Exodus xxxiii, 11. xxxiv, 28. I remarked formerly, that the veins discover no deficiency of blood in persons who die of famine. Death from this cause seems to be less the effect of the want of food, than of the combined and excessive operation of the stimuli, which supply its place in the system. IV. We come now to a difficult inquiry, and that is, how is life supported during the total abstraction of external and internal stimuli which takes place in asphyxia, or in apparent death, from all its numerous causes? I took notice, in a former lecture, that ordinary life consisted in the excitement and excitability of the different parts of the body, and that they were occasionally changed into each other. In apparent death from violent emotions of the mind, from the sudden impression of miasmata, or from drowning, there is a loss of excitement; but the excitability of the system remains for minutes, and, in some instances, for hours afterwards unimpaired, provided the accident which produced the loss of excitement has not been attended with such exertions as are calculated to waste it. If, for example, a person should fall suddenly into the water, without bruising his body, and sink before his fears or exertions had time to dissipate his excitability; his recovery from apparent death might be effected by the gentle action of heat or frictions upon his body, so as to convert his accumulated excitability gradually into excitement. The same condition of the system takes place when apparent death occurs from freezing, and a recovery is accomplished by the same gentle application of stimuli, provided the organization of the body be not injured, or its excitability wasted, by violent exertions previously to its freezing. This excitability is the vehicle of motion, and motion, when continued long enough, produces sensation, which is soon followed by thought; and in these, I said formerly, consists perfect life in the human body. For this explanation of the manner in which life is suspended and revived, in persons apparently dead from cold, I am indebted to Mr. John Hunter, who supposes, if it were possible for the body to be _suddenly_ frozen, by an instantaneous abstraction of its heat, life might be continued for many years in a suspended state, and revived at pleasure, provided the body were preserved constantly in a temperature barely sufficient to prevent re-animation, and never so great as to endanger the destruction of any organic part. The resuscitation of insects, that have been in a torpid state for months, and perhaps years, in substances that have preserved their organization, should at least defend this bold proposition from being treated as chimerical. The effusions even of the imagination of such men as Mr. Hunter, are entitled to respect. They often become the germs of future discoveries. In that state of suspended animation which occurs in acute diseases, and which has sometimes been denominated a _trance_, the system is nearly in the same excitable state that it is in apparent death from drowning and freezing. Resuscitation, in these cases, is not the effect, as in those which have been mentioned, of artificial applications made to the body for that purpose. It appears to be spontaneous; but it is produced by impressions made upon the ears, and by the operations of the mind in dreams. Of the actions of these stimuli upon the body in its apparently lifeless state, I have satisfied myself by many facts. I once attended a citizen of Philadelphia, who died of a pulmonary disease, in the 80th year of his age. A few days before his death, he begged that he might not be interred until one week after the usual signs of life had left his body, and gave as a reason for this request, that he had, when a young man, died to all appearance of the yellow fever, in one of the West-India islands. In this situation he distinctly heard the persons who attended him, fix upon the time and place of burying him. The horror of being put under ground alive, produced such distressing emotions in his mind, as to diffuse motion throughout his body, and finally excited in him all the usual functions of life. In Dr. Creighton's essay upon mental derangement, there is a history of a case nearly of a similar nature. A young lady (says the doctor), an attendant on the princess of----, after having been confined to her bed for a great length of time, with a violent nervous disorder, was at last, to all appearance, deprived of life. Her lips were quite pale, her face resembled the countenance of a dead person, and her body grew cold. She was removed from the room in which _she died_, was laid in a coffin, and the day for her funeral was fixed on. The day arrived, and according to the custom of the country, funeral songs and hymns were sung before the door. Just as the people were about to nail on the lid of the coffin, a kind of perspiration was observed on the surface of her body. She recovered. The following is the account she gave of her sensations: she said, "It seemed to her as if in a dream, that she was really dead; yet she was perfectly conscious of all that happened around her. She distinctly heard her friends speaking and lamenting her death at the side of her coffin. She felt them pull on the dead clothes, and lay her in it. This feeling produced a mental anxiety which she could not describe. She tried to cry out, but her mind was without power, and could not act on her body. She had the contradictory feeling as if she were in her own body, and not in it, at the same time. It was equally impossible for her to stretch out her arm or open her eyes, as to cry, although she continually endeavoured to do so. The internal anguish of her mind was at its utmost height when the funeral hymns began to be sung, and when the lid of the coffin was about to be nailed on. The thought that she was to be buried alive was the first which gave activity to her mind, and enabled it to operate on her corporeal frame." Where the ears lose their capacity of being acted upon by stimuli, the mind, by its operations in dreams, becomes a source of impressions which again sets the wheels of life in motion. There is an account published by Dr. Arnold, in his observations upon insanity[97], of a certain John Engelbreght, a German, who was believed to be dead, and who was evidently resuscitated by the exercises of his mind upon subjects which were of a delightful or stimulating nature. This history shall be taken from Mr. Engelbreght's words. "It was on Thursday noon (says he), about twelve o'clock, when I perceived that death was making his approaches upon me from the lower parts upwards, insomuch that my whole body became stiff. I had no feeling left in my hands and feet, neither in any other part of my whole body, nor was I at last able to speak or see, for my mouth now becoming very stiff, I was no longer able to open it, nor did I feel it any longer. My eyes also broke in my head in such a manner that I distinctly felt it. For all that, I understood what they said, when they were praying by me, and I distinctly heard them say, feel his legs, how stiff and cold they have become. This I heard distinctly, but I had no perception of their touch. I heard the watchman cry 11 o'clock, but at 12 o'clock my hearing left me." After relating his passage from the body to heaven with the velocity of an arrow shot from a cross bow, he proceeds, and says, that as he was twelve hours in dying, so he was twelve hours in returning to life. "As I died (says he) from beneath upwards, so I revived again the contrary way, from above to beneath, or from top to toe. Being conveyed back from the heavenly glory, I began to hear something of what they were praying for me, in the same room with me. Thus was my hearing the _first_ sense I recovered. After this I began to have a perception of my eyes, so that, by little and little, my whole body became strong and sprightly, and no sooner did I get a feeling of my legs and feet, than I arose and stood firm upon them with a firmness I had never enjoyed before. The heavenly joy I had experienced, invigorated me to such a degree, that people were astonished at my rapid, and almost instantaneous recovery." [97] Vol. ii. p. 298. The explanation I have given of the cause of resuscitation in this man will serve to refute a belief in a supposed migration of the soul from the body, in cases of apparent death. The imagination, it is true, usually conducts the whole mind to the abodes of happy or miserable spirits, but it acts here in the same way that it does when it transports it, in common dreams, to numerous and distant parts of the world. There is nothing supernatural in Mr. Engelbreght being invigorated by his supposed flight to heaven. Pleasant dreams always stimulate and strengthen the body, while dreams which are accompanied with distress or labour debilitate and fatigue it. LECTURE III. GENTLEMEN, Let us next take a view of the state of animal life in the different inhabitants of our globe, as varied by the circumstances of civilization, diet, situation, and climate. I. In the Indians of the northern latitudes of America there is often a defect of the stimulus of aliment, and of the understanding and passions. Their vacant countenances, and their long and disgusting taciturnity, are the effects of the want of action in their brains from a deficiency of ideas; and their tranquillity under all the common circumstances of irritation, pleasure, or grief, are the result of an absence of passion; for they hold it to be disgraceful to show any outward signs of anger, joy, or even of domestic affection. This account of the Indian character, I know, is contrary to that which is given of it by Rousseau, and several other writers, who have attempted to prove that man may become perfect and happy without the aids of civilization and religion. This opinion is contradicted by the experience of all ages, and is rendered ridiculous by the facts which are well ascertained in the history of the customs and habits of our American savages. In a cold climate they are the most miserable beings upon the face of the earth. The greatest part of their time is spent in sleep, or under the alternate influence of hunger and gluttony. They moreover indulge in vices which are alike contrary to moral and physical happiness. It is in consequence of these habits that they discover so early the marks of old age, and that so few of them are long-lived. The absence and diminution of many of the stimuli of life in these people is supplied in part by the violent exertions with which they hunt and carry on war, and by the extravagant manner with which they afterwards celebrate their exploits, in their savage dances and songs. II. In the inhabitants of the torrid regions of Africa there is a deficiency of labour; for the earth produces spontaneously nearly all the sustenance they require. Their understandings and passions are moreover in a torpid state. But the absence of bodily and mental stimuli in these people is amply supplied by the constant heat of the sun, by the profuse use of spices in their diet, and by the passion for musical sounds which so universally characterises the African nations. III. In Greenland the body is exposed during a long winter to such a degree of cold as to reduce the pulse to 40 or 50 strokes in a minute. But the effects of this cold in lessening the quantity of life are obviated in part by the heat of close stove rooms, by warm clothing, and by the peculiar nature of the aliment of the Greenlanders, which consists chiefly of animal food, of dried fish, and of whale oil. They prefer the last of those articles in so rancid a state, that it imparts a f[oe]tor to their perspiration, which, Mr. Crantz says, renders even their churches offensive to strangers. I need hardly add, that a diet possessed of such diffusible qualities cannot fail of being highly stimulating. It is remarkable that the food of all the northern nations of Europe is composed of stimulating animal or vegetable matters, and that the use of spiritous liquors is universal among them. IV. Let us next turn our eyes to the miserable inhabitants of those eastern countries which compose the Turkish empire. Here we behold life in its most feeble state, not only from the absence of physical, but of other stimuli which operate upon the inhabitants of other parts of the world. Among the poor people of Turkey there is a general deficiency of aliment. Mr. Volney in his Travels tells us, "That the diet of the Bedouins seldom exceeds six ounces a day, and that it consists of six or seven dates soaked in butter-milk, and afterwards mixed with a little sweet milk, or curds." There is likewise a general deficiency among them of stimulus from the operations of the mental faculties; for such is the despotism of the government in Turkey, that it weakens not only the understanding, but it annihilates all that immense source of stimuli which arises from the exercise of the domestic and public affections. A Turk lives wholly to himself. In point of time he occupies only the moment in which he exists; for his futurity, as to life and property, belongs altogether to his master. Fear is the reigning principle of his actions, and hope and joy seldom add a single pulsation to his heart. Tyranny even imposes a restraint upon the stimulus which arises from conversation, for "They speak (says Mr. Volney) with a slow feeble voice, as if the lungs wanted strength to propel air enough through the glottis to form distinct articulate sounds." The same traveller adds, that "They are slow in all their motions, that their bodies are small, that they have small evacuations, and that their blood is so destitute of serosity, that nothing but the greatest heat can preserve its fluidity." The deficiency of aliment, and the absence of mental stimuli in these people is supplied, 1. By the heat of their climate. 2. By their passion for musical sounds and fine clothes. And 3. By their general use of coffee, garlic[98], and opium. [98] Niebuhr's Travels. The more debilitated the body is, the more forcibly these stimuli act upon it. Hence, according to Mr. Volney, the Bedouins, whose slender diet has been mentioned, enjoy good health; for this consists not in strength, but in an exact proportion being kept up between the excitability of the body, and the number and force of the stimuli which act upon it. V. Many of the observations which have been made upon the inhabitants of Africa, and of the Turkish dominions, apply to the inhabitants of China and the East-Indies. They want, in many instances, the stimulus of animal food. Their minds are, moreover, in a state too languid to act with much force upon their bodies. The absence and deficiency of these stimuli are supplied by, 1. The heat of the climate in the southern parts of those countries. 2. By a vegetable diet abounding in nourishment, particularly rice and beans. 3. By the use of tea in China, and by a stimulating coffee made of the dried and toasted seeds of the datura stramonium, in the neighbourhood of the Indian coast. Some of these nations likewise chew stimulating substances, as too many of our citizens do tobacco. Among the poor and depressed subjects of the governments of the middle and southern parts of Europe, the deficiency of the stimulus of wholesome food, of clothing, of fuel, and of liberty, is supplied, in some countries, by the invigorating influence of the christian religion upon animal life, and in others by the general use of tea, coffee, garlic, onions, opium, tobacco, malt liquors, and ardent spirits. The use of each of these stimuli seems to be regulated by the circumstances of climate. In cold countries, where the earth yields its increase with reluctance, and where vegetable aliment is scarce, the want of the stimulus of distension which that species of food is principally calculated to produce is sought for in that of ardent spirits. To the southward of 40°, a substitute for the distension from mild vegetable food is sought for in onions, garlic, and tobacco. But further, a uniform climate calls for more of these artificial stimuli than a climate that is exposed to the alternate action of heat and cold, winds and calms, and of wet and dry weather. Savages and ignorant people likewise require more of them than persons of civilized manners, and cultivated understandings. It would seem from these facts that man cannot exist without _sensation_ of some kind, and that when it is not derived from natural means, it will always be sought for in such as are artificial. In no part of the human species, is animal life in a more perfect state than in the inhabitants of Great Britain[99], and the United States of America. With all the natural stimuli that have been mentioned, they are constantly under the invigorating influence of liberty. There is an indissoluble union between moral, political, and physical happiness; and if it be true, that elective and representative governments are most favourable to individual, as well as national prosperity, it follows of course, that they are most favourable to animal life. But this opinion does not rest upon an induction derived from the relation, which truths upon all subjects bear to each other. Many facts prove animal life to exist in a larger quantity and for a longer time, in the enlightened and happy state of Connecticut, in which republican liberty has existed above one hundred and fifty years, than in any other country upon the surface of the globe. [99] Haller's Elements Physiologiæ, vol. viii. p. 2. p. 107. It remains now to mention certain mental stimuli which act nearly alike in the production of animal life, upon the individuals of all the nations in the world. They are, 1. The desire of life. This principle, so deeply and universally implanted in human nature, acts very powerfully in supporting our existence. It has been observed to prolong life. Sickly travellers by sea and land, often live under circumstances of the greatest weakness, till they reach their native country, and then expire in the bosom of their friends. This desire of life often turns the scale in favour of a recovery in acute diseases. Its influence will appear, from the difference in the periods in which death was induced in two persons, who were actuated by opposite passions with respect to life. Atticus, we are told, died of voluntary abstinence from food in five days. In sir William Hamilton's account of the earthquake at Calabria, we read of a girl who lived eleven days without food before she expired. In the former case, life was shortened by an aversion from it; in the latter, it was protracted by the desire of it. The late Mr. Brissot, in his visit to this city, informed me, that the application of animal magnetism (in which he was a believer) had in no instance cured a disease in a West-India slave. Perhaps it was rendered inert by its not being accompanied by a strong desire of life; for this principle exists in a more feeble state in slaves than in freemen. It is possible likewise the wills and imaginations of these degraded people may have become so paralytic by slavery, as to be incapable of being excited by the impression of this fanciful remedy. 2. The love of money sets the whole animal machine in motion. Hearts which are insensible to the stimuli of religion, patriotism, love, and even of the domestic affections, are excited into action by this passion. The city of Philadelphia, between the 10th and 15th of August, 1791, will long be remembered by contemplative men, for having furnished the most extraordinary proofs of the stimulus of the love of money upon the human body. A new scene of speculation was produced at that time by the scrip of the bank of the United States. It excited febrile diseases in three persons who became my patients. In one of them, the acquisition of twelve thousand dollars in a few minutes by a lucky sale, brought on madness which terminated in death in a few days[100]. The whole city felt the impulse of this paroxysm of avarice. The slow and ordinary means of earning money were deserted, and men of every profession and trade were seen in all our streets hastening to the coffee-house, where the agitation of countenance, and the desultory manners, of all the persons who were interested in this species of gaming, exhibited a truer picture of a bedlam, than of a place appropriated to the transaction of mercantile business. But further, the love of money discovers its stimulus upon the body in a peculiar manner in the games of cards and dice. I have heard of a gentleman in Virginia who passed two whole days and nights in succession at a card table, and it is related in the life of a noted gamester in Ireland, that when he was so ill as to be unable to rise from his chair, he would suddenly revive when brought to the hazard table, by hearing the rattling of the dice. [100] Dr. Mead relates, upon the authority of Dr. Hales, that more of the successful speculators in the South-Sea scheme of 1720 became insane, than of those who had been ruined by it. 3. Public amusements of all kinds, such as a horse race, a cockpit, a chase, the theatre, the circus, masquerades, public dinners, and tea parties, all exert an artificial stimulus upon the system, and thus supply the defect of the rational exercises of the mind. 4. The love of dress is not confined in its stimulating operation to persons in health. It acts perceptibly in some cases upon invalids. I have heard of a gentleman in South-Carolina, who always relieved himself of a fit of low spirits by changing his dress; and I believe there are few people who do not feel themselves enlivened, by putting on a new suit of clothes. 5. Novelty is an immense source of agreeable stimuli. Companions, studies, pleasures, modes of business, prospects, and situations, with respect to town and country, or to different countries, that are _new_, all exert an invigorating influence upon health and life. 6. The love of fame acts in various ways; but its stimulus is most sensible and durable in military life. It counteracts in many instances the debilitating effects of hunger, cold, and labour. It has sometimes done more, by removing the weakness which is connected with many diseases. In several instances it has assisted the hardships of a camp life, in curing pulmonary consumption. 7. The love of country is a deep seated principle of action in the human breast. Its stimulus is sometimes so excessive, as to induce disease in persons who recently migrate, and settle in foreign countries. It appears in various forms; but exists most frequently in the solicitude, labours, attachments, and hatred of party spirit. All these act forcibly in supporting animal life. It is because newspapers are supposed to contain the measure of the happiness or misery of our country, that they are so interesting to all classes of people. Those vehicles of intelligence, and of public pleasure or pain, are frequently desired with the impatience of a meal, and they often produce the same stimulating effects upon the body[101]. [101] They have been very happily called by Mr. Green, in his poem entitled Spleen, "the manna of the day." 8. The different religions of the world, by the activity they excite in the mind, have a sensible influence upon human life. Atheism is the worst of sedatives to the understanding and passions. It is the abstraction of thought from the most sublime, and of love from the most perfect of all possible objects. Man is as naturally a religious, as he is a social and domestic animal; and the same violence is done to his mental faculties, by robbing him of a belief in a God, that is done by dooming him to live in a cell, deprived of the objects and pleasures of social and domestic life. The necessary and immutable connection between the texture of the human mind, and the worship of an object of some kind, has lately been demonstrated by the atheists of Europe, who, after rejecting the true God, have instituted the worship of nature, of fortune, and of human reason; and, in some instances, with ceremonies of the most expensive and splendid kind. Religions are friendly to animal life, in proportion as they elevate the understanding, and act upon the passions of hope and love. It will readily occur to you, that christianity, when believed and obeyed, according to its original consistency with itself, and with the divine attributes, is more calculated to produce those effects than any other religion in the world. Such is the salutary operation of its doctrines and precepts upon health and life, that if its divine authority rested upon no other argument, this alone would be sufficient to recommend it to our belief. How long mankind may continue to prefer substituted pursuits and pleasures to this invigorating stimulus, is uncertain; but the time, we are assured, will come, when the understanding shall be elevated from its present inferior objects, and the luxated passions be reduced to their original order. This change in the mind of man, I believe, will be effected only by the influence of the christian religion, after all the efforts of human reason to produce it, by means of civilization, philosophy, liberty, and government, have been exhausted to no purpose. Thus far, gentlemen, we have considered animal life as it respects the human species; but the principles I am endeavouring to establish require that we should take a view of it in animals of every species, in all of which we shall find it depends upon the same causes as in the human body. And here I shall begin by remarking, that if we should discover the stimuli which support life in certain animals to be fewer in number, or weaker in force than those which support it in our species, we must resolve it into that attribute of the Deity which seems to have delighted in variety in all his works. The following observations apply more or less to all the animals upon our globe. 1. They all possess either hearts, lungs, brains, nerves, or muscular fibres. It is as yet a controversy among naturalists whether animal life can exist without a brain; but no one has denied muscular fibres, and of course contractility, or excitability, to belong to animal life in all its shapes. 2. They all require more or less air for their existence. Even the snail inhales it for seven months under ground, through a pellicle which it weaves out of slime, as a covering for its body. If this pellicle at any time become too thick to admit the air, the snail opens a passage in it for that purpose. Now air we know acts powerfully in supporting animal life. 3. Many of them possess heat equal to that of the human body. Birds possess several degrees beyond it. Now heat, it was said formerly, acts with great force in the production of animal life. 4. They all feed upon substances more or less stimulating to their bodies. Even water itself, chemistry has taught us, affords an aliment, not only stimulating, but nourishing to many animals. 5. Many of them possess senses, more acute and excitable, than the same organs in the human species. These expose surfaces for the action of external impressions, that supply the absence or deficiency of mental faculties. 6. Such of them as are devoid of sensibility, possess an uncommon portion of contractility, or simple excitability. This is most evident in the polypus. When cut to pieces, it appears to feel little or no pain. 7. They all possess loco-motive powers in a greater or less degree, and of course are acted upon by the stimulus of muscular motion. 8. Most of them appear to feel a stimulus, from the gratification of their appetites for food, and for venereal pleasures, far more powerful than that which is felt by our species from the same causes. I shall hereafter mention some facts from Spalanzani upon the subject of generation, that will prove the stimulus, from venery, to be strongest in those animals, in which other stimuli act with the least force. Thus the male frog during its long connection with its female, suffers its limbs to be amputated, without discovering the least mark of pain, and without relaxing its hold of the object of its embraces. 9. In many animals we behold evident marks of understanding and passion. The elephant, the fox, and the ant exhibit strong proofs of thought; and where is the school boy that cannot bear testimony to the anger of the bee and the wasp? 10. But what shall we say of those animals, which pass long winters in a state in which there is an apparent absence of the stimuli of heat, exercise, and the motion of the blood. Life in these animals is probably supported, 1. By such an accumulation of excitability, as to yield to impressions, which to us are imperceptible. 2. By the stimulus of aliment in a state of digestion in the stomach, or by the stimulus of aliment restrained from digestion by means of cold; for Mr. John Hunter has proved by an experiment on a frog, that cold below a certain degree, checks that animal process. 3. By the constant action of air upon their bodies. It is possible life may exist in these animals, during their hybernation, in the total absence of impression and motion of every kind. This may be the case where the torpor from cold has been _suddenly_ brought upon their bodies. Excitability here is in an accumulated, but quiescent state. 11. It remains only under this head to inquire, in what manner is life supported in those animals which live in a cold element, and whose blood is sometimes but a little above the freezing point? It will be a sufficient answer to this question to remark, that heat and cold are relative terms, and that different animals, according to their organization, require very different degrees of heat for their existence. Thirty-two degrees of it are probably as stimulating to some of these cold blooded animals (as they are called), as 70° or 80° are to the human body. It might afford additional support to the doctrine of animal life, which I have delivered, to point out the manner in which life and growth are produced in vegetables of all kinds. But this subject belongs to the professor of botany and natural history[102], who is amply qualified to do it justice. I shall only remark, that vegetable life is as much the offspring of stimuli as animal, and that skill in agriculture consists chiefly in the proper application of them. The seed of a plant, like an animal body, has no principle of life within itself. If preserved for many years in a drawer, or in earth below the stimulating influence of heat, air, and water, it discovers no sign of vegetation. It grows, like an animal, only in consequence of stimuli acting upon its _capacity_ of life. [102] Dr. Barton. From a review of what has been said of animal life in all its numerous forms and modifications, we see that it as much an effect of impressions upon a peculiar species of matter, as sound is of the stroke of a hammer upon a bell, or music of the motion of the bow upon the strings of a violin. I exclude therefore the intelligent principle of Whytt, the medical mind of Stahl, the healing powers of Cullen, and the vital principal of John Hunter, as much from the body, as I do an intelligent principle from air, fire, and water. It is no uncommon thing for the simplicity of causes to be lost in the magnitude of their effects. By contemplating the wonderful functions of life we have strangely overlooked the numerous and obscure circumstances which produce it. Thus the humble but true origin of power in the people is often forgotten in the splendour and pride of governments. It is not necessary to be acquainted with the precise nature of that form of matter, which is capable of producing life from impressions made upon it. It is sufficient for our purpose to know the fact. It is immaterial, moreover, whether this matter derives its power of being acted upon wholly from the brain, or whether it be in part inherent in animal fibres. The inferences are the same in favour of life being the effect of stimuli, and of its being as truly mechanical as the movements of a clock from the pressure of its weights, or the passage of a ship in the water from the impulse of winds and tide. The infinity of effects from similar causes, has often been taken notice of in the works of the Creator. It would seem as if they had all been made after one pattern. The late discovery of the cause of combustion has thrown great light upon our subject. Wood and coal are no longer believed to contain a principle of fire. The heat and flame they emit are derived from an agent altogether external to them. They are produced by a matter which is absorbed from the air, by means of its decomposition. This matter acts upon the predisposition of the fuel to receive it, in the same way that stimuli act upon the human body. The two agents differ only in their effects. The former produces the destruction of the bodies upon which it acts, while the latter excite the more gentle and durable motions of life. Common language in expressing these effects is correct, as far as it relates to their cause. We speak of a coal of fire being _alive_, and of the _flame_ of life. The causes of life which I have delivered will receive considerable support by contrasting them with the causes of death. This catastrophe of the body consists in such a change induced on it by disease or old age, as to prevent its exhibiting the phenomena of life. It is brought on, 1. By the abstraction of all the stimuli which support life. Death from this cause is produced by the same mechanical means that the emission of sound from a violin is prevented by the abstraction of the bow from its strings. 2. By the excessive force of stimuli of all kinds. No more occurs here than happens from too much pressure upon the strings of a violin preventing its emitting musical tones. 3. By too much relaxation, or too weak a texture of the matter which composes the human body. No more occurs here than is observed in the extinction of sound by the total relaxation, or slender combination of the strings of a violin. 4. By an error in the place of certain fluid or solid parts of the body. No more occurs here than would happen from fixing the strings of a violin upon its body, instead of elevating them upon its bridge. 5. By the action of poisonous exhalations, or of certain fluids vitiated in the body, upon parts which emit most forcibly the motions of life. No more happens here than occurs from enveloping the strings of a violin in a piece of wax. 6. By the solution of continuity by means of wounds in solid parts of the body. No more occurs in death from this cause than takes place when the emission of sound from a violin is prevented by a rupture of its strings. 7. Death is produced by a preternatural rigidity, and in some instances by an ossification of the solid parts of the body in old age, in consequence of which they are incapable of receiving and emitting the motions of life. No more occurs here, than would happen if a stick or pipe-stem were placed in the room of catgut, upon the bridges of the violin. But death may take place in old age without a change in the texture of animal matter, from the stimuli of life losing their effect by repetition, just as opium, from the same cause, ceases to produce its usual effects upon the body. Should it be asked, what is that peculiar organization of matter, which enables it to emit life, when acted upon by stimuli, I answer, I do not know. The great Creator has kindly established a witness of his unsearchable wisdom in every part of his works, in order to prevent our forgetting him, in the successful exercises of our reason. Mohammed once said, "that he should believe himself to be a God, if he could bring down rain from the clouds, or give life to an animal." It belongs exclusively to the true God to endow matter with those singular properties, which enable it, under certain circumstances, to exhibit the appearances of life. I cannot conclude this subject, without taking notice of its extensive application to medicine, metaphysics, theology, and morals. The doctrine of animal life which has been taught, exhibits in the first place, a new view of the nervous system, by discovering its origin in the extremities of the nerves, on which impressions are made, and its termination in the brain. This idea is extended in an ingenious manner by Mr. Valli, in his treatise upon animal electricity. 2. It discovers to us the true means of promoting health and longevity, by proportioning the number and force of stimuli to the age, climate, situation, habits, and temperament of the human body. 3. It leads us to a knowledge of the causes of all diseases. These consist in excessive or preternatural excitement in the whole, or a part of the human body, accompanied _generally_ with irregular motions, and induced by natural or artificial stimuli. The latter have been called, very properly, by Mr. Hunter, _irritants_. The occasional absence of motion in acute diseases is the effect only of the excess of impetus in their remote causes. 4. It discovers to us that the cure of all diseases depends simply upon the abstraction of stimuli from the whole, or from a part of the body, when the motions excited by them are in excess; and in the increase of their number and force, when motions are of a moderate nature. For the former purpose, we employ a class of medicines known by the name of sedatives. For the latter, we make use of stimulants. Under these two extensive heads, are included all the numerous articles of the materia medica. 5. It enables us to reject the doctrine of innate ideas, and to ascribe all our knowledge of sensible objects to impressions acting upon an _innate_ capacity to receive ideas. Were it possible for a child to grow up to manhood without the use of any of its senses, it would not possess a single idea of a material object; and as all human knowledge is compounded of simple ideas, this person would be as destitute of knowledge of every kind, as the grossest portion of vegetable or fossil matter. 6. The account which has been given of animal life, furnishes a striking illustration of the origin of human actions, by the impression of motives upon the will. As well might we admit an inherent principle of life in animal matter, as a self-determining power in this faculty of the mind. Motives are necessary, not only to constitute its _freedom_, but its _essence_; for, without them, there could be no more a will, than there could be vision without light, or hearing without sound. It is true, they are often so obscure as not to be perceived, and they sometimes become insensible from habit; but the same things have been remarked in the operation of stimuli, and yet we do not upon this account deny their agency in producing animal life. In thus deciding in favour of the necessity of motives, to produce actions, I cannot help bearing a testimony against the gloomy misapplication of this doctrine by some modern writers. When properly understood, it is calculated to produce the most comfortable views of the divine government, and the most beneficial effects upon morals and human happiness. 7. There are errors of an impious nature, which sometimes obtain a currency, from being disguised by innocent names. The doctrine of animal life that has been delivered is directly opposed to an error of this kind, which has had the most baneful influence upon morals and religion. To suppose a principle to reside necessarily and constantly in the human body, which acted independently of external circumstances, is to ascribe to it an attribute, which I shall not connect, even in language, with the creature man. Self-existence belongs only to God. The best criterion of the truth of a philosophical opinion, is its tendency to produce exalted ideas of the Divine Being, and humble views of ourselves. The doctrine of animal life which has been delivered is calculated to produce these effects in an eminent degree, for 8. It does homage to the Supreme Being, as the governor of the universe, and establishes the certainty of his universal and particular providence. Admit a principle of life in the human body, and we open a door for the restoration of the old Epicurean or atheistical philosophy, which supposed the world to be governed by a principle called nature, and which was believed to be inherent in every kind of matter. The doctrine I have taught, cuts the sinews of this error; for by rendering the _continuance_ of animal life, no less than its commencement, the effect of the constant operation of divine power and goodness, it leads us to believe that the whole creation is supported in the same manner. 9. The view that has been given of the dependent state of man for the blessing of life, leads us to contemplate, with very opposite and inexpressible feelings, the sublime idea which is given of the Deity in the scriptures, as possessing life "within himself." This divine prerogative has never been imparted but to one being, and that is the Son of God. This appears from the following declaration. "For as the Father hath life in himself, so hath he given to the Son to have life _within himself_."[103] To this plenitude of independent life, we are to ascribe his being called the "life of the world," "the prince of life," and "life" itself, in the New Testament. These divine epithets which are very properly founded upon the manner of our Saviour's existence, exalt him infinitely above simple humanity, and establish his divine nature upon the basis of reason, as well as revelation. [103] John v. verse 26. 10. We have heard that some of the stimuli which produce animal life, are derived from the moral and physical evils of our world. From beholding these instruments of death thus converted by divine skill into the means of life, we are led to believe goodness to be the supreme attribute of the Deity, and that it will appear finally to predominate in all his works. 11. The doctrine which has been delivered, is calculated to humble the pride of man by teaching him his constant dependence upon his Maker for his existence, and that he has no pre-eminence in his tenure of it, over the meanest insect that flutters in the air, or the humblest plant that grows upon the earth. What an inspired writer says of the innumerable animals which inhabit the ocean, may with equal propriety be said of the whole human race. "Thou sendest forth thy spirit, and they are created. Thou takest away their breath--they die, and return to their dust." 12. Melancholy indeed would have been the issue of all our inquiries, did we take a final leave of the human body in its state of decomposition in the grave. Revelation furnishes us with an elevating, and comfortable assurance that this will not be the case. The precise manner of its re-organization, and the new means of its future existence, are unknown to us. It is sufficient to believe, the event will take place, and that after it, the soul and body of man will be exalted in one respect, to an equality with their Creator. They will be immortal. Here, gentlemen, we close the history of animal life. I feel as if I had waded across a rapid and dangerous stream. Whether I have gained the opposite shore with my head clean, or covered with mud and weeds, I leave wholly to your determination. END OF VOL. II. * * * * * Transcriber's note: The original spelling and minor inconsistencies in the spelling and formatting have been maintained. Obvious misprints have been corrected. Partly repeated chapter headings have been deleted. 
41595	----	generously made available by The Internet Archive.) [Illustration] THE FUNNY SIDE OF PHYSIC: OR, THE MYSTERIES OF MEDICINE, PRESENTING THE HUMOROUS AND SERIOUS SIDES OF MEDICAL PRACTICE. AN EXPOSÉ OF MEDICAL HUMBUGS, QUACKS, AND CHARLATANS IN ALL AGES AND ALL COUNTRIES. By A. D. CRABTRE, M. D. HARTFORD: J. B. BURR & HYDE. CHICAGO AND CINCINNATI: J. B. BURR, HYDE & COMPANY. 1872. Entered according to Act of Congress, in the year 1872, by J. B. BURR AND HYDE, In the Office of the Librarian of Congress, at Washington. PREFACE. The books which most please while instructing the reader, are those which mingle the lively and gay with the sedate spirit in the narration of important facts. The verdict of the reader of this work must be (it is modestly suggested), that the author has luckily hit the happy vein in its construction. Of all facts which bear upon human happiness or sorrow, those which serve to increase the former, and alleviate or banish the latter, are most desirable for everybody to know; and of all professions which most intimately concern the personal well-being of the public at large, that of the physician is most important. The author of this book has spared no pains of research to collect the facts of which he discourses, and has endeavored to cover the whole ground embraced by his subject with pertinent and important suggestions, statements, scientific discoveries, incidents in the career of great physicians, etc., and to fix them in the reader's mind by _apt anecdotes, which will be found in abundance throughout the work_. There is no better man in the world than the true physician, and no more base wretch than the ordinary "Quack," or medical charlatan. If the author has spared no pains of study to make his book acceptable, he may be said, also, to have as unsparingly visited his indignation upon the quacks who have all along the line of historic medicine disgraced the physician's and the surgeon's profession. The general public but little understand what a vast amount of ignorance has at times been cunningly concealed by medical practitioners, and how grossly the people of every city and village are even nowadays trifled with by some who arrogate to themselves the honorable title of Doctor of Medicine. Herein not only the base and the good physician, but the honorable and the trifling apothecary, receive their due reward, or well-merited punishment, so far as the pen can give them. The reader will be utterly surprised when he comes to learn how the quacks of the past and the present have brought themselves into note by tricks and schemes very similar and equally infamous. The wanton trifling with the health and life of their patients, the greed of gain, and the perfect destitution of all moral nature, which some of these men have exhibited in their career, are astounding. The apothecaries, as well as physicians, are descanted on, and the miserable tricks to which the large majority of them resort, exposed. The public will be astonished to find what trash in the matter of drugs it pays for; how filthy, vile, and often poisonous and hurtful materials people buy for medicines at extortionate prices; how even the syrups which they drink in soda drawn from costly and splendid fountains are often made from the most filthy materials, and are not fit for the lower animals, not to say human beings, to drink. And this fact is only illustrative of hundreds of others set forth in this work. This work not only exposes the multifold frauds of quacks, apothecaries, travelling doctors, soothsayers, fortune-tellers, certain clairvoyants, and "spiritual mediums," and the like, who "practise medicine" to a more or less extent, or profess to discover and heal diseases,--but it points out to the reader the most approved rules for protecting the health, and recovering it when lost. In short, it is a work embodying the most sound advice, founded upon the judgment of the best physicians of the past and present, as tested in the Author's experience for a period of twenty years' active practice. In other words, it is a compendium of sound medical advice, as well as a racy, lively, and incisive dissection and exposure of the villanies of quacks and other medical empirics, etc. Persons of all ages will find the work not only interesting to read, but most valuable in a practical sense. To the young who would shun the crafts and villanies to which they must be exposed as they grow up,--for all are liable to be more or less ill at times,--it will prove invaluable, enabling them to detect the spurious from the reliable in medicine, and how to judge between the pretentious charlatan (even enjoying a large ride) and the true physician. And none are so old that they may not reap great advantages from the work. CONTENTS. I. MEDICAL HUMBUGS. ORIGIN AND APPLICATION OF "HUMBUG."--A FIFTH AVENUE HUMBUG.-- JOB'S OPINION OF DOCTORS.--EARLY PHYSICIANS.--PRIESTS AS DOCTORS.--WIZARDS COME TO GRIEF.--A "CAPITAL" OPERATION.--A WOMAN CUT INTO TWELVE PIECES.--ANECDOTE.--ROBIN HOOD'S LITTLE JOKE.--TIT FOR TAT. ENGLISH HUMBUGS.--FRENCH DITTO.--A FORTUNE ON DIRTY WATER.--AMERICAN HUMBUGS.--A FIRST CLASS "DODGE."--A FREE RIDE.--A SHARP INTERROGATOR.--DOCTOR PUSBELLY.--A WICKED STAGE-DRIVER'S STORY.--"OLD PILGARLIC" TAKES A BATH.--LUDICROUS SCENE.--PROFESSOR BREWSTER. 19 II. APOTHECARIES. FIRST MENTION OF.--A POOR SPECIMEN.--ELIZABETHAN.--KING JAMES I. [VI.].--ALLSPICE AND ALOES, SUGAR AND TARTAR EMETIC.-- WAR.--PHYSICIAN VS. APOTHECARY.--IGNORANCE.--STEALING A TRADE.--A LAUGHABLE PRESCRIPTION.--"CASTER ILE."--MODERN DRUG SWALLOWING.--MISTAKES.--"STEALS THE TOOLS ALSO."-- SUBSTITUTES.--"A QUID."--A "SMELL" OF PATENT MEDICINES.--"A SAMPLE CLERK." 61 III. PATENT MEDICINES. PATENT MEDICINES.--HOW STARTED.--HOW MADE.--THE WAY IMMENSE FORTUNES ARE REALIZED.--SPALDING'S GLUE.--SOURED SWILL.-- SARSAPARILLA HUMBUGS.--S. P. TOWNSEND.--"A DOWN EAST FARMER'S STORY."--"WILD CHERRY" EXPOSITIONS.--"CAPTAIN WRAGGE'S PILL" A FAIR SAMPLE OF THE WHOLE.--HOW PILL SALES ARE STARTED.--A SLIP OF THE PEN.--"GRIPE PILLS."--SHAKSPEARE IMPROVED.--H. W. B. "FRUIT SYRUP."--HAIR TONICS.--A BALD BACHELOR'S EXPERIENCE.--A LUDICROUS STORY.--A WOLF IN SHEEP'S CLOTHING. 78 IV. MANUFACTURED DOCTORS. A BOSTON BARBER AS M. D.--A BARBER "GONE TO POT."--FOOLS MADE DOCTORS.--BAKERS.--BARBERS.--"A LUCKY DOG."--TINKERS.--ROYAL FAVORS.--"LITTLE CARVER DAVY."--A BUTCHER'S BLOCKHEAD.--A SWEEPING VISIT.--HOP-PED FROM OBSCURITY.--PEDAGOGUES TURN DOCTORS.--ARBUTHNOT.--"A QUAKER."--"WALKS OFF ON HIS EAR."-- WEAVERS AND BASKET-MAKERS.--A TOUGH PRINCE; REQUIRED THREE M. D.'S TO KILL HIM.--MARAT A HORSE DOCTOR.--A MERRY PARSON.-- BLACK MAIL.--POLICE AS A MIDWIFE, ETC., ETC. 99 V. WOMAN AS PHYSICIAN. HER "MISSION."--NO PLACE IN MEDICAL HISTORY.--ONE OF THEM.-- MRS. STEPHENS.--"CRAZY SALLY."--RIGHT TO BEAR ARMS.--RUNS IN THE FAMILY.--ANECDOTES.--"WHICH GOT THRASHED?"--A WRETCHED END.--AMERICAN FEMALE PHYSICIANS.--A PIONEER.--A LAUGHABLE ANECDOTE.--"THREE WISE MEN."--"A SHORT HORSE," ETC.--BOSTON AND NEW YORK FEMALE DOCTORS.--A STORY.--"LOVE AND THOROUGHWORT."--A GAY BEAU.--UP THE PENOBSCOT.--DYING FOR LOVE.--"IS HE MAD?"--THOROUGHWORT WINS. 123 VI. QUACKS. ANECDOTE IN ILLUSTRATION.--DERIVATION.--FATHER OF QUACKS.--A MEDICAL "BONFIRE."--THE "SAMSON" OF THE PROFESSION.--SIR ASTLEY.--U. S. SURVEYOR-GENERAL HAMMOND.--HOMEOPATHIC QUACKS, ETC.--A MUDDLED DEFINITION.--"STOP THIEF!"--CRIPPLED FOR LIFE!--TWO POUNDS CALOMEL.--VICTIMS.--WASHINGTON, JACKSON, HARRISON.--THE COUNTRY QUACK.--A TRUE AND LUDICROUS ANECDOTE.--DYEING TO DIE!--A SCARED DOCTOR.--DROPSY!--A HASTY WEDDING!--A COUNTRY CONSULTATION.--"SCENES FROM WESTERN PRACTICE."--"TWIST ROOT."--A JOLLY TRIO.--NEW "BUST" OF CUPID.--AN UNWILLING LISTENER. 157 VII. CHARLATANS AND IMPOSTORS. DEFINITION.--ADVERTISING CHARLATANS.--CITY IMPOSTORS.--FALSE NAMES.--"ADVICE FREE."--INTIMIDATIONS.--WHOLESALE ROBBERY.-- VISITING THEIR DENS IN DISGUISE.--PASSING THE CERBERUS.-- WINDINGS.--INS AND OUTS.--THE IRISH PORTER.--QUEER "TWINS," AND A "TRIPLET" DOCTOR.--A HISTORY OF A KNAVE.--BOOT-BLACK AND BOTTLE-WASHER.--PERQUISITES.--PURCHASED DIPLOMAS.-- "INSTITUTES."--WHOLESALE SLAUGHTER OF INFANTS.--FEMALE HARPIES.--A BOSTON HARPY.--WHERE OUR "LOST CHILDREN" GO.-- END OF A WRETCH. 180 VIII. ANECDOTES OF PHYSICIANS. A WANT SUPPLIED.--ORIGINAL ANECDOTES OF ABERNETHY.--A LIVE IRISHMAN.--MADAM ROTHSCHILD.--LARGE FEET.--A SHANGHAI ROOSTER.--SPREADING HERSELF.--KEROSENE.--"SALERATUS."--HIS LAST JOKE.--AN ASTONISHED DARKY.--OLD DR. K.'S MARE.--A SCARED CUSTOMER.--"WHAT'S TRUMPS?"--"LET GO THEM HALYARDS."-- MEDICAL TITBITS.--MORE MUSTARD THAN MEAT.--"I WANT TO BE AN ANGEL."--TOOTH-DRAWING.--DR. BEECHER VS. DR. HOLMES.-- STEALING TIME.--CHOLERA FENCED IN.--"A JOKE THAT'S NOT A JOKE."--A DRY SHOWER-BATH.--PARBOILING AN OLD LADY. 200 IX. FORTUNE-TELLERS. PAST AND PRESENT.--BIBLE ASTROLOGERS AND FORTUNE-TELLERS.-- ARABIAN.--EASTERN.--ENGLISH.--QUEEN'S FAVORITE.--LILLY.--A LUCKY GUESS.--THE GREAT LONDON FIRE FORETOLD.--HOW.--OUR "TIDAL WAVE" AND AGASSIZ.--A HALL OF FORTUNE-TELLERS.-- PRESENT.--VISIT EN MASSE.--"FILLIKY MILLIKY."--"CHARGE BAYONETS!"--A FOWL PROCEEDING.--FINDING LOST PROPERTY.--THE MAGIC MIRROR EXPOSÉ.--"ONE MORE UNFORTUNATE."--PROCURESSES.-- BOSTON MUSEUM.--"A NICE OLD GENTLEMAN."--MONEY DOES IT.-- GREAT SUMS OF MONEY.--"LOVE POWDER" EXPOSÉ.--HASHEESH.--"DOES HE LOVE ME?" 227 X. EMINENT PHYSICIANS AND SURGEONS. THEIR ORIGIN, BOYHOOD, EARLY STRUGGLES, ETC.--DOCTORS ARE PUBLIC PROPERTY.--DR. MOTT, OF OYSTER BAY.--DR. PARKER.--A "PLOUGH-BOY."--THE FARMER'S BOY AND THE OLD DOCTOR.--SCENE IN BELLEVUE HOSPITAL.--"LEAVES FROM THE LIFE OF AN UNFLEDGED ÆSCULAPIAN."--FIRST PATIENT.--"NONPLUSSED!"--ALL RIGHT AT LAST.--PROFESSORS EBERLE AND DEWEES.--A HARD START.--"FOOTING IT."--ABERNETHY'S BOYHOOD.--"OLD SQUEERS."--SPARE THE BOY AND SPOIL THE ROD.--A DIGRESSION.--SKIRTING A BOG.--AN AGREEABLE TURN.--PROFESSOR HOLMES.--A HOMELESS STUDENT. 253 XI. GHOSTS AND WITCHES. FOLLY OF BELIEF IN GHOSTS.--WHY GHOSTS ARE ALWAYS WHITE.--A TRUE STORY.--THE GHOST OF THE CAMP.--A GHOSTLY SENTRY-BOX.--A MYSTERY.--THE NAGLES FAMILY.--RAISING THE DEAD.--A LIVELY STAMPEDE.--HOLY WATER.--CÆSAR'S GHOST AT PHILIPPI.--LORD BYRON AND DR. JOHNSON.--GHOST OF A GUILTY CONSCIENCE.-- "JOCKEYING A GHOST."--THE WOUNDED BIRD.--A BISHOP SEES A GHOST.--MUSICAL GHOSTS.--A HAUNTED HOUSE.--ABOUT WITCHES.-- "WITCHES IN THE CREAM."--HORSE-SHOES.--WOMAN OF ENDOR NOT A WITCH.--WEIGHING FLESH AGAINST THE BIBLE.--THERE ARE NO GHOSTS, OR WITCHES. 278 XII. MEDICAL SUPERSTITIONS. OLD AND NEW.--THE SIGN OF JUPITER.--MODERN IDOLATRY.--ORIGIN OF THE DAYS OF THE WEEK.--HOW WE PERPETUATE IDOLATRY.-- SINGULAR FACT.--CHRISTMAS FESTIVITIES.--"OLD NICK."-- RIDICULOUS SUPERSTITIONS.--GOLDEN HERB.--HOUSE CRICKETS.--A STOOL WALKS.--THE BOWING IMAGES AT RHODE ISLAND.--HOUSE SPIDERS.--THE HOUSE CAT.--SUPERSTITIOUS IDOLATRIES.-- WONDERFUL KNOWLEDGE.--NAUGHTY BOYS.--ERRORS RESPECTING CATS.--SANITARY QUALITIES.--OWLS.--A SCARED BOY.--HOLY WATER.--UNLUCKY DAYS.--THUNDER AND LIGHTNING.--A KISS. 307 XIII. TRAVELLING DOCTORS. PUBLIC CONFIDENCE(?).--THE EYE OF THE PUBLIC.--A BAD SPECIMEN.--"REMARKABLE TUMOR."--"THE SINGING DOCTOR."--CAUGHT IN A STORM.--BIG PUFFING.--A SPLENDID "TURNOUT."--WHO WAS HE?--A SUDDEN DISAPPEARANCE.--THE "SPANKING DOCTOR."--A FAIR VICTIM.--LOOSE LAWS.--DR. PULSEFEEL.--IMPUDENCE.--A FIDDLING DOCTOR.--AN ENCORE.--"CHEEK."--VARIOUS WAYS OF ADVERTISING. 341 XIV. SCENES FROM EVERY-DAY PRACTICE. THE BEGGAR BOY AND THE GOLDEN-HAIRED HEIRESS.--MY MIDNIGHT CALL.--THE CONSCIENCE-STRICKEN MOTHER.--"OLD SEROSITY."--THE ILLEGITIMATE CHILD.--DEATH OF THE BEAUTIFUL.--WHO IS THE HEIR?--A TOUCHING SCENE.--FATE OF THE "BEGGAR BOY."--THE TERRIBLE CALLER.--AN IRISH SCENE, FROM DR. DIXON'S BOOK.-- BIDDY ON A RAMPAGE.--TERRY ON HIS DEATH BED.--THE STOMACH PUMP.--BIDDY WON'T, AND SHE WILL.--THE BETRAYED AND HER BETRAYER.--"IS THERE A GOD IN ISRAEL?"--THE HUSBANDLESS MOTHER.--THE CRISIS AND COURT.--ANSWER.--THERE IS A "GOD IN ISRAEL." 362 XV. DOCTORS' FEES AND INCOMES. ANCIENT FEES.--LARGE FEES.--SPANISH PRIEST-DOCTORS.--A PIG ON PENANCE.--SMALL FEES.--A "CHOP" POSTPONED.--LONG FEES.--SHORT FEES.--OLD FEES.--A NIGHT-CAP.--AN OLD SHOE FOR LUCK.--A BLACK FEE.--"HEART'S OFFERING."--A STUFFED CAT.--THE "GREAT GUNS" OF NEW YORK.--BOSTON.--ROTTEN EGGS.--"CATCH WHAT YOU CAN."--FEMALE DOCTORS' FEES.--ABOVE PRICE.--"ASK FOR A FEE."--"PITCH HIM OVERBOARD."--DELICATE FEES.--MAKING THE MOST OF THEM. 386 XVI. GENEROSITY AND MEANNESS. THE WORLD UNMASKED.--A ROUGH DIAMOND.--DECAYED GENTILITY.-- "THREE FLIGHT, BACK."--SEVERAL ANECDOTES.--THE OLD FOX-HUNTER.--"STAND ON YOUR HEAD."--KINDNESS TO CLERGYMEN.-- RARE CHARITY.--OLD AND HOMELESS.--THE "O'CLO'" JEW.--DR. HUNTER'S GENEROSITY.--"WHAT'S THE PRICE OF BEEF?"--A SAD OMISSION.--INNATE GENEROSITY.--A CURB-STONE MONEY-MANIAC.--AN EYE-OPENER.--AN AVARICIOUS DOCTOR.--ROBBING THE DEAD. 410 XVII. LOVE AND LOVERS. XANTIPPE, BEFORE JEALOUSY.--A FIRST LOVE.--BLASTED HOPES.--A DOCTOR'S STORY.--THE FLIGHT FROM "THE HOUNDS OF THE LAW."-- THE EXILE AND RETURN.--DISGUISED AS A PEDDLER.--ESCAPES WITH HIS LOVE.--ENGLISH BEAUS.--YOUNG COQUETTES.--A GAY AND DANGEROUS BEAU.--HANDSOME BEAUS.--LEAP YEAR.--AN OLD BEAU.-- BEAUTY NOT ALL-POTENT.--OFFENDED ROYALTY.--YOUTH AND AGE.--A STABLE BOY.--POET-DOCTOR. 438 XVIII. MIND AND MATTER. IN WHICH ANIMAL MAGNETISM, MESMERISM, AND CLAIRVOYANCE ARE EXPLAINED.--"THE IGNORANT MONOPOLY."--YET ROOM FOR DISCOVERIES.--A "GASSY" SUBJECT.--DRS. CHAPIN AND BEECHER.-- HE "CAN'T SEE IT."--THE ROYAL TOUCH.--GASSNER.--"THE DEVIL KNOWS LATIN."--ROYALTY IN THE SHADE.--THE IRISH PROPHET; HE VISITS LONDON.--A COMICAL CROWD.--MESMERISM.--A FUNNY BED-FELLOW.--CLAIRVOYANCE.--THE GATES OF MOSCOW.--THE DOCTOR OF ANTWERP.--THE OLD LADY IN THE POKE-BONNET.--VISIT TO A CLAIRVOYANT.--"FORETELLING" THE PAST.--THE OLD WOMAN OF THE PENOBSCOT MOUNTAINS.--A SECRET KEPT.--CUI BONO?--VISITS TO SEVENTEEN CLAIRVOYANTS.--A BON-TON CLAIRVOYANT.--A BOUNCER.-- RIDICULOSITY. 461 XIX. ECCENTRICITIES. A ONE-EYED DOCTOR AND HIS HORSE.--A NEW EDIBLE.--"HAVE THEM BOILED."--"BEAUTY AND THE BEAST."--A LOVELY STAMPEDE.--AN ECCENTRIC PHILADELPHIAN.--THE POODLES, DRS. HUNTER AND SCIPIO.--SILENT ELOQUENCE.--CONSISTENT TO THE END.--WHEN DOCTORS DISAGREE.--FOUR BLIND MEN.--DIET AND SLEEP.--SAXE AND SANCHO PANZA.--MOTHER GOOSE AS A DOCTOR'S BOOK.--THE TABLES TURNED ON THE DOCTORS. 495 XX. PRESCRIPTIONS REMARKABLE AND RIDICULOUS. FIG PASTE AND FIG LEAVES.--SOME OF THOSE OLD FELLOWS.--THEY SLIGHTLY DISAGREE.--HOW TO KEEP CLEAN.--BAXTER VS. THE DOCTOR.--A CURE FOR "RHEUMATIZ."--OLD ENGLISH DOSES.--CURE FOR BLUES.--FOR HYSTERIA.--HEROIC DOSES.--DROWNING A FEVER.-- AN EXACT SCIENCE.--SULPHUR AND MOLASSES.--A USE FOR POOR IRISH.--MINERAL SPRINGS.--COLD DRINKS VS. WARM.--THE OLD LADY AND THE AIR-PUMP.--SAVED BY HER BUSTLE.--COUNTRY PRESCRIPTIONS AND A FUNNY MISTAKE.--ARE YOU DRUNK OR SOBER? 517 XXI. SCENES FROM HOSPITAL AND CAMP. "HE FOUGHT MIT SIEGEL."--A HOSPITAL SCENE AT NIGHT.-- ADMINISTERING ANGELS.--"WATER! WATER!"--THE SOLDIER-BOY'S DYING MESSAGE.--THE WELL-WORN BIBLE.--WARM HEARTS IN FROZEN BODIES.--"PUDDING AND MILK."--THE POETICAL AND AMUSING SIDE.--"TO AMELIA."--MY LOVE AND I.--A SCRIPTURAL CONUNDRUM.--MARRYING A REGIMENT. 538 XXII. GLUTTONS AND WINE-BIBBERS. GOOD CHEER AND A CHEERFUL HEART.--A MODERN SILENUS.--A SAD WRECK.--DELIRIUM TREMENS.--FATAL ERRORS.--"EATING LIKE A GLUTTON."--STRENGTH IN WEAKNESS.--A HOT PLACE, EVEN FOR A COOK.--A HUNGRY DOCTOR.--THE MODERN GILPIN.--A CHANGE! A SOW FOR A HORSE!--A DUCK POND.--THE FORLORN WIDOW.--A SCIENTIFIC GORMAND.--ANOTHER.--"DOORN'T GO TO 'IM," ETC.--DR. BUTLER'S BEER AND BATH.--CASTS HIS LAST VOTE. 550 XXIII. THE DOCTOR AS POET, AUTHOR, AND MUSICIAN. OUR PATRON, OUR PATTERN.--SOME WRITERS.--SOME BLUNDERS.--AN OLD SMOKER.--OLD GREEKS.--A DUKE ANSWERED BY A COUNTRY MISS.--THE PILGRIMS AND THE PEAS.--"LITTLE DAISY."--"CASA WAPPA!"--FINE POETRY.--MORE SCHOOLMASTERS AND TAILORS.-- NAPOLEON'S AND WASHINGTON'S PHYSICIANS.--A FRENCH "BUTCHER."--A DIF. OF OPINION.--SOME EPITAPHS.--DR. HOLMES' "ONE-HOSS SHAY."--HEALTHFUL INFLUENCE OF MUSIC.--SAVED BY MUSIC.--A GERMAN TOUCH-UP.--MUSIC ON ANIMALS.--"MUSIC AMONG THE MICE."--MUSIC AND HEALTH. 571 XXIV. ADULTERATIONS. BREAD, BUTTER, AND THE BIBLE.--"JACK ASHORE."--BUCKWHEAT CAKES ARE GOOD.--WHAT'S IN THE BREAD, AND HOW TO DETECT IT.-- BUTTER.--HOW TO TELL GOOD AND BAD.--MILK.--ANALYSIS OF GOOD AND "SWILL MILK."--WHAT'S IN THE MILK BESIDES MICE?--THE COW WITH ONE TEAT.--"LOUD" CHEESE.--TEA AND COFFEE.--TANNIN, SAWDUST, AND HORSES' LIVERS.--ALCOHOLIC DRINKS.--CHURCH WINE AND BREAD.--BEER AND BITTER HERBS.--SPANISH FLIES AND STRYCHNINE.--"NINE MEN STANDIN' AT THE DOOR."--BURTON'S ALE; AN ASTONISHING FACT.--FISHY.--"FISH ON A SPREE."--TO REMEDY IMPURE WATER.--CHARCOAL AND THE BISHOP.--HOG-ISH.--PORK AND SCROFULA.--NOTICES OF THE PRESS. 599 XXV. ALL ABOUT TOBACCO. "HOW MUCH?"--AMOUNT IN THE WORLD.--"SIAMESE TWINS."--A MIGHTY ARMY.--ITS NAME AND NATIVITY.--A DONKEY RIDE.--LITTLE BREECHES.--WHIPPING SCHOOL GIRLS AND BOYS TO MAKE THEM SMOKE.--TOM'S LETTER.--"PURE SOCIETY."--HOW A YOUNG MAN WAS "TOOK IN."--DELICIOUS MORSELS.--THE STREET NUISANCE.--A SQUIRTER.--ANOTHER.--IT BEGETS LAZINESS.--NATIONAL RUIN.-- BLACK EYES.--DISEASE AND INSANITY.--USES OF THE WEED.--GETS RID OF SUPERFLUOUS POPULATION.--TOBACCO WORSE THAN RUM.--THE OLD FARMER'S DOG AND THE WOODCHUCK.--"WHAT KILLED HIM." 633 XXVI. DRESS AND ADDRESS OF PHYSICIANS. GOSSIP IS INTERESTING.--COMPARATIVE SIGNS OF GREATNESS.--THE GREAT SURGEONS OF THE WORLD.--ADDRESS NECESSARY.--"THIS IS A BONE."--DRESS NOT NECESSARY.--COUNTRY DOCTORS' DRESS.--HOW THE DEACON SWEARS.--A GOOD MANY SHIRTS.--ONLY WASHED WHEN FOUND DRUNK.--LITTLE TOMMY MISTAKEN FOR A GREEN CABBAGE BY THE COW.--AN INSULTED LADY.--DOCTORS' WIGS.--"AIN'T SHE LOVELY?"--HARVEY AND HIS HABITS.--THE DOCTOR AND THE VALET.--A BIG WIG.--BEN FRANKLIN.--JENNER'S DRESS.--AN ANIMATED WIG; A LAUGHABLE STORY.--A CHARACTER.--"DOSH, DOSH." 659 XXVII. MEDICAL FACTS AND STATISTICS. HOW MANY.--WHO THEY ARE.--HOW THEY DIE.--HOW MUCH RUM THEY CONSUME.--HOW THEY LIVE.--OLD AGE.--WHY WE DIE.--GET MARRIED.--OLD PEOPLE'S WEDDING.--A GOOD ONE.--THE ORIGIN OF THE HONEYMOON.--A SWEET OBLIVION.--HOLD YOUR TONGUE!--MANY MEN, MANY MINDS.--"ALLOPATHY."--LOTS OF DOCTORS.--THE ITCH MITE.--A HORSE-CAR RIDE.--KEEP COOL!--KNICKKNACKS.--HUMBLE PIE.--INCREASE OF INSANITY.--A COOL STUDENT.--HOW TO GET RID OF A MOTHER-IN-LAW. 680 XXVIII. BLEEDERS AND BUTCHERS. BLEEDING IN 1872.--EARLIEST BLOOD-LETTERS.--A ROYAL SURGEON.--A DRAWING JOKE.--THE PRETTY COQUETTE.--TINKERS AS BLEEDERS.--WHOLESALE BUTCHERY.--THE BARBERS OF SOUTH AMERICA.--OUR FOREFATHERS BLEED.--A FRENCH BUTCHER.--CUR?-- ABERNETHY OPPOSES BLOOD-LETTING.--THE MISFORTUNES OF A BARBER-SURGEON (THREE SCENES FROM DOUGLASS JERROLD); JOB PIPPINS AND THE WAGONER; JOB AND THE HIGHWAYMEN; JOB NAKED AND JOB DRESSED. 695 XXIX. THE OMNIUM GATHERUM. EX-SELL-SIR!--"THE OBJECT TO BE ATTAINED."--A NOTORIOUS FEMALE DOCTOR.--A WHITE BLACK MAN.--SQUASHY.--MOTHER'S FOOL.--WHO IT WAS.--THE PHILOSOPHER AND HIS DAUGHTER.-- EDUCATION AND GIBBERISH.--SCOTTISH HOSPITALITY.--THE OLD LADY WITH AN ANIMAL IN HER STOMACH.--STORIES ABOUT LITTLE FOLKS.-- THE BOY WITH A BULLET IN HIM.--CASE OF SMALL-POX.--NOT MUCH TO LOOK AT.--FUNERAL ANTHEMS. 709 XXX. THE OTHER SIDE. PUT YOURSELF IN HIS PLACE.--STEALING FROM THE PROFESSION.-- ANECDOTE OF RUFUS CHOATE.--INGRATES.--A NIGHT ROW.--"SAVING AT THE SPIGOT AND WASTING AT THE BUNG."--SHOPPING PATIENTS.-- AN AFFECTIONATE WIFE.--RUM AND TOBACCO PATIENTS.--THE PHYSICIAN'S WIDOW AND ORPHAN, THE SUMMONS, THE TENEMENT, THE INVALIDS, HOW THEY LIVED, HER HISTORY, THE UNNATURAL FATHER, HOW THEY DIED, THE END.--A PETER-FUNK DOCTOR.--SELLING OUT. 727 XXXI. "THIS IS FOR YOUR HEALTH." THE INESTIMABLE VALUE OF HEALTH.--NO BLESSING IN COMPARISON.--MEN AND SWINE.--BEGIN WITH THE INFANT.--"BABY ON THE PORCH."--IN A STRAIT JACKET.--"TWO LITTLE SHOES."-- YOUTH.--IMPURE LITERATURE AND PASSIONS.--"OUR GIRLS."--BARE ARMS AND BUSTS.--HOW AND WHAT WE BREATHE.--"THE FREEDOM OF THE STREET."--KEEP YOUR EYES OPEN AND MOUTH CLOSED.--THE LUNGS AND BREATHING.--A MAN FULL OF HOLES.--SEVEN MILLION MOUTHS TO FEED.--PURE WATER.--CLEANLINESS. SOAP VS. WRINKLES.--GOD'S SUNSHINE. 748 XXXII. HEALTH WITHOUT MEDICINE. CHEERFULNESS.--GOOD ADVICE.--REV. FRANCIS J. COLLIER ON CHRISTIAN CHEERFULNESS.--WHAT GOD SAYS ABOUT IT.--WHINING.-- LOVE AND HEALTH.--AFFECTION AND PERFECTION.--SEPARATING THE SHEEP AND GOATS.--THE FENCES UP AND FENCES DOWN.--SIXTEEN AND SIXTY.--ACTION AND IDLENESS.--IDLENESS AND CRIME.--BEAUTY AND DEVELOPMENT.--SLEEP.--DAY AND NIGHT.--"WHAT SHALL WE EAT?"--A STOMACH-MILL AND A STEWING-PAN.--"FIVE MINUTES FOR REFRESHMENTS."--ANCIENT DIET.--COOKS IN A "STEW."--THE GREEN-GROCERIES OF THE CLASSICS.--CABBAGES AND ARTICHOKES.-- ANIMAL AND VEGETABLE DIET. 769 XXXIII. CONSUMPTION. CONSUMPTION A MONSTER!--UNIVERSAL REIGN.--SIGNS OF HIS APPROACH.--WARNINGS.--BAD POSITIONS.--SCHOOL-HOUSES.--ENGLISH THEORY.--PREVENTIVES.--AIR AND SUNSHINE.--SCROFULA.--A JOLLY FAT GRANDMOTHER.--"WASP WAISTS."--CHANGE OF CLIMATE.--"TOO LATE!"--WHAT TO AVOID.--HUMBUGS.--COD LIVER OIL.--STRYCHNINE WHISKEY.--A MATTER-OF-FACT PATIENT.--SWALLOWING A PRESCRIPTION.--SIT AND LIE STRAIGHT.--FEATHERS OR CURLED HAIR.--A YANKEE DISEASE.--CATARRH AND COLD FEET, HOW TO REMEDY.--"GIVE US SOME SNUFF, DOCTOR."--OTHER THINGS TO AVOID.--A TENDER POINT. 790 XXXIV. ACCIDENTS. RULES FOR MACHINISTS, MECHANICS, RAILROAD MEN, ETC., IN CASES OF ACCIDENT.--HOW TO FIND AN ARTERY AND STOP THE BLEEDING.-- DROWNING; TO RESTORE.--SUN-STROKE.--AVOID ICE.--"ACCIDENTS WILL HAPPEN."--WHAT TO HAVE IN THE HOUSE.--BRUISES.--BURNS.-- DO THE BEST YOU CAN AND TRUST GOD FOR THE REST. 811 ILLUSTRATIONS. 1. A. D. CRABTRE, M. D., Frontispiece. 2. DR. ANGLICUS PONTO, 31 3. MISFORTUNES NEVER COME SINGLY, 33 4. THE MISER OUTWITS HIMSELF, 38 5. COMMENCING A PRACTICE IN NEW YORK, 47 6. GRACE BEFORE MEAT, 48 7. OLD PILGARLIC TAKES A BATH, 55 8. PROFESSOR BREWSTER, 55 9. AN INFANTRY CHARGE, 60 10. THE "FREE PASS" PRESCRIPTION, 69 11. THE WRONG PATIENT, 71 12. A CANDIDATE FOR THE PRESIDENCY, 77 13. UNDER FULL SAIL, 77 14. "IT'S ALL A HUMBUG," 82 15. "BAREFOOTED ON THE TOP OF HIS HEAD," 93 16. OLD "SANDS OF LIFE," 96 17. REFRESHMENTS, 98 18. THE EYE DOCTOR, 103 19. THE YOUNG SURGEON'S FIRST EXPERIENCE, 105 20. HEALING THE SICK WITH A GOLDEN DOSE, 111 21. THE PARSON BUYING OFF THE "CONGREGATION," 120 22. A JUVENILE BACCHUS, 122 23. "DON'T YOU OBSERVE THE ARMS OF MRS. MAPP?" 128 24. THREE WISE STUDENTS CONSULTING A DOCTRESS, 134 25. "POH! YOU'RE A GIRL," 141 26. "HERE WE GO UP-UP-UPPY," 148 27. "LOVE AMONG THE ROSES," 156 28. THE INQUISITIVE COUNTRYMEN, 161 29. CURIOUS EFFECTS OF A FEVER, 171 30. MARRYING A FAMILY, 173 31. 'OPATHISTS IN CONSULTATION, 175 32. A "HYPO" PATIENT DISCHARGING HIS PHYSICIAN, 178 33. TOO MUCH HAT, 179 34. CONVINCING EVIDENCE OF INSOLVENCY, 181 35. "AN' WHO'LL YEZE LIKE TO SEE, SURE?" 183 36. A BOSTON QUACK EXAMINING A STUDENT, 189 37. ORNAMENTAL TAIL-PIECE, 199 38. DR. ABERNETHY IN THE HOSPITAL, 202 39. AN EXTENSIVE SET, 205 40. "O, DOCTHER, DEAR, I'VE PIZENED ME BOY," 207 41. "LOST MARSER! LOST MARSER!" 209 42. NOT A STOMACH PUMP, 213 43. "LOWER TIER, LARBOARD SIDE," 217 44. THE FARMER'S ESCAPE FROM THE CHOLERA, 223 45. TOO MUCH VAPOR, 224 46. A DRY SHOWER BATH, 225 47. GRAPES AND WINE, 226 48. CHARGE, INFANTRY! 239 49. AFTER THE BATTLE, 240 50. THE FORTUNE-TELLER'S MAGIC MIRROR, 244 51. CHILDREN CONSULTING A FORTUNE-TELLER, 251 52. THE HUNTRESS, 252 53. THE ONONDAGA FARMER BOY, 256 54. THE POLITE QUADRUPED, 265 55. YOUNG ABERNETHY, 266 56. "PINNY, SIR? JUST ONE PINNY," 274 57. THE PENNILESS PHYSICIAN, 276 58. THE INDIAN WARRIOR, 277 59. BELIEVERS IN GHOSTS, 278 60. "HARK! THERE'S A FEARFUL GUST!" 280 61. A GRAVE SENTRY, 282 62. A GHOST IN CAMP, 285 63. OLD NAGLES, 286 64. THE NAGLES BOYS, 287 65. CHIEF MOURNERS, 288 66. THE CORPSE THAT WOULD NOT SMOKE, 290 67. PREPARE TO DIE, 293 68. THE BISHOP'S GHOSTLY VISITOR, 295 69. THE MUSICAL PUSS, 301 70. A DARKEY BEWITCHED, 301 71. BOYLSTON STATION, 303 72. WEIGHING A WITCH BY BIBLE STANDARD, 305 73. PASSING THE FORT, 306 74. THE GOD OF RECIPES, 308 75. SUN-SUNDAY, 310 76. MOON-MONDAY, 313 77. TUISCO-TUESDAY, 313 78. WODEN-WEDNESDAY, 314 79. THOR-THURSDAY, 315 80. FRIGA-FRIDAY, 315 81. SEATER-SATURDAY, 316 82. GATHERING THE MANDRAKE, 321 83. "WAITING TO SEE THE IMAGES BOW," 323 84. SPORT FOR THE BOYS BUT DEATH TO THE CAT, 329 85. "WHO-A'-YOO?" 333 86. THE PROPER USE OF "HOLY WATER," 334 87. THE MODEST KISS, 339 88. HOLDING THE PLOW, 340 89. THE TUMOR DOCTOR CONTEMPLATES SUICIDE, 343 90. MARIAM, THE TUMOR DOCTOR, 345 91. THE SINGING DOCTOR, 349 92. THE SANATORIAN'S TURNOUT, 351 93. A NEW SCHOOL OF PRACTICE, 354 94. A VICTIM OF THE SPANKER, 355 95. DR. PULSFEEL LEAVING TOWN, 356 96. THE MUSICAL DOCTOR, 358 97. ENTHUSIASM, 359 98. ALL WOOL, 361 99. CHARITY THROWN AWAY, 363 100. THE BEGGAR BOY, 366 101. REMORSE, 368 102. THE LOST HEIR, 373 103. A MORNING CALLER, 375 104. "WHY DID I TAZE YE?" 376 105. SUCCESS OF TERRY'S COURTSHIP, 379 106. THE BETRAYED, 382 107. SAILING INTO PORT, 385 108. A SAN BENITO PIG, 388 109. AN OLD ENGLISH CLERGYMAN AND HIS FAMILY, 390 110. THE KING'S PHYSICIAN AND THE EXECUTIONER, 393 111. A SLIPPER-Y FEE, 397 112. A LIVING FEE, 399 113. STUFFED PETS, 400 114. A PIONEER OF HOMOEOPATHY, 403 115. A SHARP MULE TRADE, 405 116. ORNAMENTAL TAIL-PIECE, 409 117. PHYSICIAN'S CHARITY, 411 118. SEARCH FOR A PATIENT, 412 119. AN ECCENTRIC PATIENT, 417 120. A WOMAN'S REBUKE, 417 121. AFRAID OF A POLYPUS, 418 122. ABERNETHY'S SURGICAL OPERATION, 420 123. RECKONING A DOCTOR'S FEES, 424 124. PATIENT NUMBER FIVE, 425 125. THE ASTONISHED BUTCHER, 427 126. MODERN IMPROVEMENTS IN DENTISTRY, 431 127. CHARITY NOT SOLICITED, 431 128. CAPTURE OF A WALL STREET BULL, 433 129. DEATH'S FEE, 436 130. THE AMERICAN SAILOR, 437 131. MY FIRST LOVE, 439 132. TEN YEARS LATER, 441 133. FLIGHT OF THE DOCTOR, 443 134. THE LOVER AS A PEDDLER, 447 135. FLIGHT OF THE LOVERS, 447 136. AN AGED PUPIL, 453 137. BIRTHPLACE OF GEORGE CRABBE, 457 138. "POPPING THE QUESTION," 460 139. LOVE'S LINKS, 460 140. THE LION MAGNETIZED, 466 141. A HARD SUBJECT, 467 142. GASSNER HEALING "BY THE GRACE OF GOD," 471 143. NO LACK OF PATIENTS, 475 144. "A BOTTLE, A HEN, OR A WOMAN," 477 145. EFFECTS OF AN EARTHQUAKE, 483 146. A BELIEVER SEES HIS GRANDMOTHER, 483 147. THE CHARMER DIVULGES HER SECRET, 488 148. "I PERCEIVE YOU ARE IN LOVE," 492 149. THE FARMER'S DAUGHTERS, 494 150. A "HORSE-SLAYER" INDULGING HIS OPINION, 499 151. NO TIME TO LOSE, 500 152. BEAUTY AND THE BEAST, 503 153. DR. HUNTER IN CONSULTATION, 504 154. THE RUSSIAN GENERAL'S DRILL, 506 155. WHAT THE ELEPHANT IS LIKE, 511 156. A DOCTOR'S SOLACE, 511 157. HOW A LADY PROCURED A VALUABLE PRESCRIPTION, 525 158. DOSE--ONE QUART EVERY HOUR, 526 159. PUMPING AN OLD LADY, 537 160. A DANGEROUS PRESCRIPTION, 537 161. THE FARMER'S EMBLEMS, 537 162. THE DYING MESSAGE, 541 163. STUCK! 547 164. COMMERCE, 549 165. A GOOD LIVER, 551 166. A DOCTOR "KILLING THE DEVILS," 555 167. PAYING FOR HIS WINE, 555 168. A BAR-ROOM DOCTOR, 555 169. "THE DOCTOR ON A SOW!" 565 170. RESCUE OF THE DOCTOR, 565 171. "ONLY IRISH BEER," 568 172. CURE FOR THE AGUE, 569 173. PLAYING THE REEDS, 570 174. AN EMBRYO APOLLO, 572 175. THE PILGRIM CHEAT, 577 176. FRANKLIN'S EXPERIMENTS WITH ETHER, 585 177. END OF THE WONDERFUL ONE-HOSS SHAY, 591 178. "MUSIC, THE SOUL OF LIFE," 597 179. THE MUSICAL MICE, 597 180. FOUNTAIN, 598 181. SIGNS OF CIVILIZATION, 603 182. SWILL MILK (MAGNIFIED), 605 183. PURE MILK (MAGNIFIED), 606 184. WATERED MILK (MAGNIFIED), 606 185. "WHAT'S IN THE MILK?" 606 186. A CHAMPAGNE BATH, 611 187. MOTHER'S MILK--PURE AND HEALTHY, 612 188. MOTHER'S MILK AFTER DRINKING WHISKY, 612 189. WAITING FOR ASSISTANCE, 617 190. A CONFECTIONERY STORE, 619 191. TARTARIC ACID FOR SUPPER, 629 192. A STREET CANDY STAND, 629 193. THE NEWSBOY'S MOTHER, 630 194. THE IDOL OF TOBACCO USERS, 634 195. PUNISHMENT OF THE TURK, 638 196. SMOKERS OF FOUR GENERATIONS, 639 197. "I WANT A CHAW OF TERBACKER," 641 198. YOUNG SMOKERS, 642 199. EXAMINATION OF THE SMOKER, 643 200. PURIFYING HIS BLOOD, 644 201. CLEANSING HIS BONES, 645 202. THE SMOKER, 647 203. THE CHEWER, 648 204. SIGN OF THE TIMES, 648 205. MY LAZY SMOKING FRIEND, 650 206. "SHALL I ASSIST YOU TO ALIGHT?" 653 207. WORK FOR TONGUES AND FINGERS, 653 208. WHAT KILLED THE DOG? 657 209. THE NEWSBOY, 658 210. THE GREAT SURGEONS OF THE WORLD, 661 211. A CALL ON THE VILLAGE DOCTOR, 663 212. PHYSICIANS' COSTUME IN 1790, 664 213. HOW POOR TOMMY WAS LOST, 666 214. BRIDGET'S METHOD OF MENDING STOCKINGS, 667 215. THE UNDERTAKERS' ARMS, 671 216. DISPUTE OF THE DOCTOR AND VALET, 671 217. A WIG MOUSE, 674 218. THE MYSTERY EXPLAINED, 675 219. MEETING OF THE DOCTOR AND THE CURATE, 679 220. DOCTOR CANDEE, 679 221. A GERMAN BEER GIRL, 681 222. AN INDIGNANT BRIDE, 686 223. THE ITCH MITE, 689 224. THE BURGLAR AND STUDENT, 693 225. HARVESTED, 694 226. ASSISTANCE FROM A ROYAL SURGEON, 696 227. PETER THE GREAT AS A SURGEON, 697 228. JOB DISCHARGED BY SIR SCIPIO, 703 229. "BLEED HIM," 704 230. A BORROWED WATCH, 706 231. JOB'S DECISION, 708 232. SQUASHY'S SURGICAL OPERATION, 715 233. "WILL YE TAK' A BLAST, NOO?" 720 234. REPTILES FROM THE STOMACH, 722 235. "IT ISN'T CATCHIN'," 724 236. FUNERAL OF THE CANARY, 725 237. MY FRONT STREET PATIENT, 731 238. A SHOPPING PATIENT, 733 239. CALL AT THE TENEMENT, 737 240. THE WIDOW'S OCCUPATION, 739 241. THE PHYSICIAN AND THE FATHER, 742 242. THE PETER FUNK PHYSICIAN, 745 243. VIRTUE, 747 244. THE FREEDOM OF THE PARK, 761 245. "IT COSTS NOTHING," 766 246. A NATURAL POSITION, 792 247. AN UNNATURAL POSITION, 792 248. CORRECT POSITION, 796 249. INCORRECT POSITION, 796 250. HOW WASP WAISTS ARE MADE, 799 251. A CONSUMPTIVE WAIST, 800 252. NON-CONSUMPTIVE WAIST, 800 253. A HEALTHY POSITION, 804 254. POSITION OF ARTERY IN ARM, 811 255. COMPRESSING AN ARTERY IN ARM, 812 256. POSITION OF ARTERY IN LEG, 812 257. THE DOCTOR'S QUEUE, 816 I. MEDICAL HUMBUGS. _Marina._ ... Should I tell my history, 'Twould seem like lies disdained in the reporting. _Pericles._ Pray thee, speak.--_Shakspeare._ ORIGIN AND APPLICATION OF "HUMBUG."--A FIFTH AVENUE HUMBUG.--JOB'S OPINION OF DOCTORS.--EARLY PHYSICIANS.--PRIESTS AS DOCTORS.--WIZARDS COME TO GRIEF.--A "CAPITAL" OPERATION.--A WOMAN CUT INTO TWELVE PIECES.--ANECDOTE.--ROBIN HOOD'S LITTLE JOKE.--TIT FOR TAT.--ENGLISH HUMBUGS.--FRENCH DITTO.--A FORTUNE ON DIRTY WATER.--AMERICAN HUMBUGS.--A FIRST CLASS "DODGE."--A FREE RIDE.--A SHARP INTERROGATOR.--DOCTOR PUSBELLY.--A WICKED STAGE-DRIVER'S STORY.--"OLD PILGARLIC" TAKES A BATH.--LUDICROUS SCENE.--PROFESSOR BREWSTER. Medical humbugs began to exist with the first pretenders to the science of healing. Quacks originated at a much later period. So materially different are the two classes, that I am compelled to treat of them separately. The word _humbug_ is a corruption of _Hamburg_, Germany, and seems to have originated in London. The following episode is in illustration of both its origin and meaning:-- "O, Bridget, Bridget!" exclaimed the fashionable mistress of a brown stone front in Fifth Avenue, New York, to her surprised servant girl, "what have you been doing at the front door?" "Och, murther! Nothin', ma'am." "Nothing!" repeated the mistress. "Yes'm--that is--" stammered Bridget, greatly embarrassed. "What were you doing at the front door but a moment since?" "Nothin', ma'am, but spakin' to me cousin; he's a p'leeceman, ma'am, if ye plaze, ma'am," replied Bridget, dropping a low courtesy to the mistress. "No, no; I did not mean that. But haven't you been cleaning the door-knob and the bell-pull?" "Yes'm," replied Bridget, changing from embarrassment to surprise. "Why, Bridget, didn't I tell you never to polish the front door-knobs during the warm season? Now my friends will think that I have returned from Saratoga--" "And is it to Saratogy ye've been, ma'am?" exclaimed Bridget. "No, you dunce; but was not the front of the house closed, and the servants forbidden to polish the plates and glass, that my friends might be led to believe we had all gone to the watering-place?" That was true humbug. Double humbuggery! for the servant girl was humbugging her mistress by pretending to polish the door-knobs, while she was really coqueting with a policeman; and the mistress was humbugging her friends into the belief that the house was closed, and the family gone to Saratoga. So, Hamburg, on the Elbe, being a fashionable resort of the upper-ten-dom of London, those who would ape aristocracy, yet being unable to bear the expense of a trip to the Continent, closed the front of their dwellings, moved into the rear, giving out word that they had gone to _Hamburg_. When a house was observed so closed, with a notice on the door, the passers by would wag their heads, and exclaim, questionably, "Ah, gone to Hamburg!" or, "All gone to Hamburg!" "It's all Hamburg!" and so on. And, like a thousand other words in the English language, this became corrupted, and "humbug" followed. Hence, taking the sense from the derivation of the word, humbug means "an imposition, under fair pretences;" cheat; hoax; a deception without malicious intent. Webster says it is "a low word." The humbugs in medicine, we assert, began to exist with the first persons of whom we have any account in the history of the healing art. Among the early Egyptian physicians, Æsculapius was esteemed as the most celebrated. He was the first humbug in his line. However, nearly all the accounts we have of him are mythological. If we are to credit the early writers, this great healer restored so many to life, that he greatly interfered with undertaker Pluto's occupation, who picked a quarrel with Æsculapius, and the two referred the matter to Jupiter for adjudication. But we may go back of this "god of medicine." If he was physician to the Argonauts, we must fix the date of his great exploits at about the year B. C. 1263. It is claimed by good authority that the Book of Job dates back to B. C. 1520, and is the oldest book extant. Herein we find Job saying, "Ye are forgers of lies; ye are all physicians of no value." Since his friends were trying their best to humbug him, Job certainly intimates that physicians--some of them, at least--were looked upon as humbugs. But, then, Job was only an Arab prince; not an Israelite, at all; nor does he condescend to mention that "peculiar people" in his book. And besides, what reliance can be based upon the opinion of a man respecting physicians, whose only surgical instrument consisted of a "piece or fragment of a broken pot"? Therefore, leaving the "Arab prince," we will turn for a moment to the early Jewish physicians. Josephus does not enlighten us much respecting them. The Old Testament makes mention of physicians in three instances,--the last figuratively. The first instance--a rather amusing one--where physicians are mentioned in the sacred writings, is in 2 Chron. xvi. 12: "And Asa, in the thirty-ninth year of his reign, was diseased in his feet, until the disease was exceeding great; yet in his disease he sought not to the Lord, but to the physicians." The compiler adds, very coolly, as though a natural consequence, "_And Asa slept with his fathers_!" This reminds us of an anecdote by the late Dr. Waterhouse. An Irishman obtained twenty grains of morphine, which, instead of quinine, he took at one dose, to cure the chills. The doctor, in relating it long afterwards, added, laconically, "He being a good Catholic, his funeral was numerously attended." For generations nearly all the pretensions to healing were made by the priests and magicians, who humbugged and "bamboozled" the ignorant and superstitious rabble to their hearts' content. Kings and subjects were alike believers in the Magi. Saul believed in the magic powers of the "witch of Endor." The wicked king Nebuchadnezzar classed Daniel and his three companions with the magicians, although Daniel (chap. xi. 10) denied the imputation. Joseph laid claim to the power of divination; for, having caused the silver cup to be placed in the sack of corn, and after having sent and brought his brother back, he said (Gen. xliv. 15), "What deed is this that ye have done? Wot ye not that such a man as I can certainly divine?" It seemed necessary to deal with the people according to their belief. It was useless to dispute with them. As late as the preaching of Paul and Barnabas, the whole nations of Jews and Greeks were so tinctured with belief in magic and enchantment in healing, taught and promulgated by the priesthood, that when the apostles healed the cripple of Lystra, the rabble, headed by the priests, cried out, "The gods are come down to us in the likeness of men." And they called Barnabas Jupiter, and Paul Mercurius. The town clerk in the theatre said to the excited crowd, "These men are neither robbers of churches, nor yet blasphemers of your goddess." Diana was appealed to for women in childbirth; Mercurius for the healing of cutaneous diseases (_herpes_), probably because he carried a _herpe_, or short sword, also, at times, the caduceus; and Jupiter for various diseases. But to return to the times of Saul and David. It seems that the business became overcrowded, and the vilest and most degraded of both sexes swelled the ranks of sorcerers, astrologers, and spiritualists, until every class and condition of people became impregnated with these beliefs, from kings to the lowest subject. Finally, the strong arm of the law laid hold of them, and the edict went forth that "a witch shall not live," that "a wizard shall be put to death," and that "the soothsayer be stoned." Nevertheless, the wretches continued to practise their deceptions, but less openly for a time, and they are made mention of throughout the sacred writings, until "the closing of the canon." But the Scriptures are almost totally silent on surgery, and the remedies resorted to by those pretending to the science--as also by physicians and priests--were such as to lead us to believe that their _materia medica_ was very limited. Under the head of Ridiculous Prescriptions, we shall mention these remedies:-- The earliest record we find of surgical operations in the Old Testament is in Judges xix. 29,--a "capital operation," we may judge, for the account informs us that the patient, a woman, "was divided into twelve pieces." Turning to the profane writers for information, we plunge into an abyss of uncertainty, with this exception; that the practice of medicine--it could not be called a science--was still in the hands of the priesthood, and partook largely of the fabulous notions of the age, being connected almost entirely with idolatries and humbuggeries. The cunning priests caused the rabble, from first to last, to believe that all disease was inflicted, not from the violation of the laws of nature, but by some angry and outraged divinity, whose wrath must be appeased by bribes (_paid to the priests_), by incantations, and absurd ceremonies, or else the afflicted victim must die a painful death, and forever after suffer a more horrible eternity. The priests' receiving the pay reminds us of the following little anecdote. A very pious man, recently congratulating a convalescing patient upon his recovery, asked his friend who had been his physician. "Dr. Blank brought me safely through," was his reply. "No, no," said the friend, "God brought you out of this affliction, and healed you,--not the doctor." "Well," replied the man, "may be he did; but I am sure that the doctor will charge me for it." The offices of priest and physician were united among the Jews, Heathens, Greeks, Egyptians, and Romans. The Druids (from _draoi_, magician) ruled and ruined the ancient Celts, Gauls, Britons, and Germans. The people of these nations looked up to the priests as though life and death and immortality hung only upon their lips. Among our aborigines we have also examples of the double office of priest and "medicine man." And it is an astonishing fact, that notwithstanding the ignorance of the pretenders to healing, or the ridiculousness of the prescriptions, or the exorbitant fees, the rabble of the age relied upon them with the most implicit confidence. If the patient recovered, the priests--embodying the gods--had restored them by their great skill and the favor of some particular divinity, and so were worshipped, and again rewarded with other fees to offer sacrifices to the individual god who was supposed to favor the priest or wizard. If he died it was the will of the gods that it should so be, and the friends lost none of their faith in the abilities of their medical and spiritual advisers. The priests could not be disposed of so easily as the witches and wizards were supposed to have been, for they kept the people under greater fear, and held the balance of power in their own hands. The only difference between the priests and wizards was, that the former _claimed_ to exercise their arts by the power of the gods, while the latter were said to be assisted by the evil spirits. The priests claimed this in the times of Christ, and tried to persuade the rabble that he was assisted by Beelzebub. While the grasping priesthood professed poverty and self-denial, they were continually enriching themselves by robberies and extortions upon the ignorant and superstitious common people. A mirth-provoking anecdote is told of Robin Hood and two friars, which we cannot forbear relating here as illustrative of the above assertion. If our readers regard stories from such a source as very uncertain, we have only to reply that we are now dealing with "uncertainties." "One day, Robin disguised himself as a friar, and went out on the highway. Very soon he met two priests, to whom he appealed for charity in the blessed Virgin's name. "'That we would do, were it in our power,' they replied. "'I fear you are so addicted to falsehood, I cannot believe that you have no money, as you say. However, let us all down on our marrow bones, and pray the Virgin to send us some money.' "'No, no,' replied the priests; 'it is of no use.' "'What! have you no faith in your patron saint? Down, I say, and pray.' "In fear, down fell the two priests, and Robin by their side, and all prayed most lustily. "'Now feel in your pockets,' said Robin, rising. "'There is nothing,' they replied, plunging their hands deep into their cloaks. "'Down again, and pray harder,' shouted Robin, drawing his sword. "Down they fell, and mumbled over their Latin, but declared the gods had sent them nothing. "'I do not believe you,' said Robin; 'you ever were a pack of liars. Let each stand a search, that we deceive not each other.' So Robin turned his own empty pockets wrong side out, then compelled the friars to follow suit, when lo! out fell five hundred pieces of gold. "When Robin saw this glorious sight, he berated the priests soundly, and taking the gold, went away to Sherwood, and made merry at the expense of the church." About 1185 B. C. we find among the Grecians some traces of what was termed the healing art. But fact and fable, history and mythology, are so mixed and blended, that it is impossible to gain any reliable information so far back. Chiron is made mention of as having acquired much celebrity as a physician. It is claimed that he was learned in the arts and sciences, that he taught astronomy to Hercules, music to Apollo, and medicine to Æsculapius, who came from Egypt. From what can be gleaned, of reliability, it seems that he employed simple medicines, and possessed some knowledge of dressing wounds and reducing fractures and dislocations; but no doubt he pretended to greater things than the times would warrant, for, when shot by an arrow from the bow of Hercules, his former pupil, he was unable to heal the wound, and begged Jupiter to "set him up" among the stars, which request was complied with, and Chiron was translated to the heavens, where he still shines in the constellation Sagittarius, represented as a centaur, with drawn bow, driving before him the other eleven signs of the zodiac. We have alluded to Æsculapius, and, passing over all others of his class, we come to the times of Hippocrates. Hippocrates is rightly called the "Father of Medicine," for he was the first to raise medicine to a science. We mention him without classing him with humbugs; but Menecrates, who flourished about the same time, arrived at great notoriety by ruse and deception. He was "famous for vanity and arrogance." He went about accompanied by some patients, whom he claimed to have cured, as proofs of his great ability. One he disguised as Apollo, another he arrayed in the habit of Æsculapius, and sent them abroad to sound his praise, while he took upon himself the garb, and assumed the character, of Jupiter. Pliny says that medicine was the last of the sciences introduced into Rome, and that the Septimont City was six hundred years without a regular physician. Archagathus, a Grecian, settled in Rome about 300 B. C., and if he was a fair sample of those who followed him, it had been better for Rome that it had remained another six hundred years "without a regular physician." He introduced cruel and painful escharotics, and made free use of the knife and the lancet. He was a humbug of the first water, and a quack besides, and as such he was banished in a few years. The Christian era introduced some light into the medical, as well as the religious world; yet we learn, by both sacred and profane writers, that truth and knowledge were the exceptions, and ignorance and humbug were the rule by which medicine was practised by those who pretended to the art. Names changed, characters remained the same. The priests still held their own, and were not, as already shown, to be gotten rid of, as the witches and wizards, their rivals and imitators, by litigation, nor was their power broken until the Decree of the Council of Tours in 1163 A. D., which prohibited priests and deacons from performing certain surgical operations. After the Reformation the vocations of spiritual and medical adviser diverged wider and wider, until now a priest or minister is seldom consulted for bodily infirmities, and only by persons of the most ignorant and superstitious denominations. Setting the priesthood aside did not suppress humbugs in medicine. In fact the profession went into disrepute, which the priests hastened, and a lower order of people took upon themselves the practice of deceiving the sick and afflicted. Now and then a greater humbug than common would spring up, and for a time draw the rabble after him, till the next arose to eclipse him. From the discovery of America to about 1600, ambitious upstarts, humbugs, and seekers of fame and fortune were drawn away from the old world, and either for this reason, or because the biographers were attracted to a more interesting field, accounts of medical celebrities are very meagre; but from the latter period to the present day there has been no lack of records from which to draw our material. During the 17th and 18th centuries medical impostors had things all their own way. Ignorance was no hinderance to advancement, socially or pecuniarily. Some men published, in their own names, voluminous works, in both English and Latin, which they themselves could not read. By soft words and cunning arts others gained high positions, and, without knowledge of the first branch of medical science, became "court physicians." From the lowest walks, they rose up on every side: from the cobbler's bench, and the tailor's board; from cutting up meat in the butcher's shop, to "cutting up" naughty boys in a pedagogue's capacity; from shaving the unwashed rabble behind the striped barber's pole, to shaving their wives behind counters, where they measured the cloth of the weaver, they became cobblers of poor healths, butchers of men, and shavers of the invalided public. But these will be discoursed of under another head. We here offer one proof of this state of affairs by a quotation from the original charter of the first College of Physicians, granted by Henry VIII., which reads, "Before this period a great multitude of ignorant persons, of which the greater part had no insight into physic, _nor into any other kind of learning_,--some could not even read the Book,--so far forth that common artificers, as smiths, weavers, and women boldly and accustomedly took upon themselves great cures, to the high displeasure of God, great infamy of the faculty, and the grievous hurt, damage, and destruction of many of the king's liege people." The meetings of this august body (College of Physicians) were held at the house of Dr. Linacre. "He was a gentleman of distinction, both as a physician and scholar." He became disgusted with physic, and took "holy orders" five years before his death. He was one of the original petitioners of the charter, which complained that the above rabble of doctors could not read the Book (Bible). Now see the ignorance--the hypocrisy of the man! Dr. Caius, who wrote his epitaph, says of Linacre, "He certainly was not a very profound theologian, for a short time before his death he read the New Testament for the first time, when, so greatly was he astonished at finding the rules of Christianity so widely at variance with their practice, that he threw down the sacred volume in a passion, saying, 'Either this is not gospel, or we are not Christians.'" This was just prior to 1600. This Dr. Caius is supposed to be the same character whom Shakspeare introduced in his "_Merry Wives of Windsor_;" and as it is a fact patent to all that the great poet had no very exalted opinion of doctors, and would "throw physic to the dogs," it has been suggested that Caius was produced by him on that ground. There are others of this and a later period, whom, though ranking amongst the greatest of humbugs, we defer mentioning here, but will notice in our chapter on quacks. Mr. Jeaffreson, in his excellent work, "Book About Doctors," to which work I am indebted for several anecdotes, says,-- "The lives of three physicians--Sydenham, Sir Hans Sloane, and Heberden--completely bridge over the uncertain period between old empiricism and modern science." The former, Dr. Thomas Sydenham, was born at Windford Eagle, Dorsetshire, England, in 1624, and was esteemed as an excellent physician and profound scholar of his day. Nothing is known of his boyhood. For a time he was a soldier. He was about forty years old when admitted a member of the College of Physicians. Dr. Richard Blackmore, his contemporary, who was but a pedagogue at the outstart himself, but afterwards knighted as Sir Richard, says of Dr. Sydenham, "He was only a disbanded officer, who entered upon the practice of medicine for a maintenance, without any preparatory learning." The fact of his possessing a diploma went for nothing, since Dr. Meyersbach obtained his about this time for a few shillings, and without the rudiments of an education, made a splendid living out of the credulity even of the most learned and fashionable classes of English society, and arrived at the height of honor and distinction. The reader must admit that diplomas were cheap honors, when one was granted to a dog! A young English gentleman, for the sport of the thing, paid the price of a medical diploma soon after Dr. Meyersbach's was granted, and had it duly recorded in the archives of the college (Erfurth) as having been awarded to Anglicus Ponto. "And who was Anglicus Ponto?" "None other than the gentleman's dog--a fine mastiff." But this question was not asked till too late to prevent the joke. It had the good effect, however, to raise at once the price of degrees. Dr. Sydenham published several medical works, copies of which are now extant, but his pretensions to skill availed him but little in time of need. His prescriptions--some of them, at least--were very absurd, and during his latter years, while enjoying a lucrative practice, and possessing the utmost confidence of the _bon ton_, he suffered excruciating pains from the gout, which, with other complications, ended his days. "Physician, heal thyself." [Illustration: DR. ANGLICUS PONTO.] Dr. Blackmore, an aspirant to medical fame, applied to Dr. Sydenham, while residing in Pall Mall, with the following inquiry:-- "What is the best course of study for a medical student?" "Read Don Quixote," was Sydenham's reply. "It is a very good book. I read it yet." I find this in a biographical dictionary of 1779. While some biographers endeavor to pass this off as a joke, it is a well-known fact that the doctor was a sceptic in medicine, and those who knew him best believe that he meant just what he said. On the arrival of Dr. Sloane in London, he waited on Dr. Sydenham, as being the great gun of the town at that time, and presented a letter of introduction, in which an enthusiastic friend had set forth Sloane's qualifications in glowing language, as being perfected in anatomy, botany, and the various branches of medicine. Sydenham finished the letter, threw it on the table, eyed the young man very sharply, and said,-- "Sir, this is all very fine, on paper--very fine; but it won't do. Anatomy! botany! Nonsense. Why, sir, I know an old woman in Covent Garden who better understands botany; and as for anatomy, no doubt my butcher can dissect a joint quite as well. No, no, young man; this is all stuff. You must go to the bedside; it is only there that you can learn disease." In spite of this mortifying reception, however, Sydenham afterwards took the greatest interest in Dr. Sloane, frequently taking the young man with him in his chariot on going his rounds. In "Lives of English Physicians," the author, in writing of Dr. Sydenham, says, "At the commencement of his practice, it is handed down to us, that it was his ordinary custom, when consulted by patients for the first time, to hear attentively their story, and then reply, "Well, I will consider your case, and in a few days will prescribe something for you;" thereby gaining time to look up such a case. He soon learned that this deliberation would not do, as some forgot to return after "a few days," and to save his fees he was obliged, _nolens volens_, to prescribe on the spot. A further proof of his contemptible opinion of deriving knowledge from books, as expressed above to Dr. Blackmore, is exemplified and corroborated in an address to Dr. Mapletoft (1675). "The medical art could not be learned so well and surely as by use and experience, and that he who would pay the nicest and most accurate attention to the symptoms of distempers, would succeed best in finding out the true means of cure." "Riding on horseback," he says, in one of his books, "will cure all diseases except confirmed consumption." How about curing gout? A very amusing, though painful picture, is drawn by Dr. Winslow, a reliable author of the seventeenth century, in his book, "Physic and Physicians:"-- "Dr. Sydenham suffered extremely from the gout. One day, during the latter part of his life, he was sitting near an open window, on the ground floor of his residence in St. James Square, inspiring the cool breeze on a summer's afternoon, and reflecting, with a serene countenance and great complacency on the alleviation of human misery that his skill enabled him to give. Whilst this divine man was enjoying this delicious reverie, and occasionally sipping his favorite beverage from a silver tankard, in which was immersed a sprig of rosemary, a sneak thief approached, and seeing the helpless condition of the old doctor, stole the cup, right before his eyes, and ran away with it. The doctor was too lame to run after him, and before he could stir to ring and give alarm the thief was well off." [Illustration: MISFORTUNES NEVER COME SINGLY.] This reminds one of a story of an old man who stood in a highway, leaning on his staff, and crying, in a feeble, croaking voice, "Stop thief! stop thief!" "What is the matter, sir?" inquired a fellow, approaching. "O, a villain has stolen my hat from my head, and run away." "Your hat!" looking at the bare head; "why didn't you run after him?" "O, my dear sir, I can't run a step. I am very lame." "Can't run! then here goes your wig." And so saying, the fellow caught the poor old man's wig, and scampered away at the top of his speed. Dr. Sydenham died December 29, 1689. He could not be termed a quack, but certainly he was a consummate humbug. An author, before quoted, after copying a description of the "poor physician" of the age, adds,-- "How it calls to mind the image of Dr. Oliver Goldsmith, when, with a smattering of medical knowledge and a German diploma, he tried to pick out of the miseries and ignorance of his fellow-creatures the means of keeping soul and body together! He, too, poet and doctor, would have sold a pot of rouge to a faded beauty, or a bottle of hair dye, or a nostrum warranted to cure the bite of a mad dog." "Set a rogue to catch a rogue." And to this principle we are indebted for the exposition of many fallacies and humbugs pursued by early physicians in order to gain practice. "Dr. Radcliffe," says Dr. Hannes, "on his arrival in London, employed half of the porters in town to call for him at the coffee-houses (a famous resort of physicians of the seventeenth and eighteenth centuries) and places of public resort, so that his name might become known." On the other hand, Radcliffe accused Dr. Hannes of the same trick a few years later. Doctors were doctors' own worst enemies. Instead of standing by each other of the same school, in lip service, or passing by each other's errors and imperfections in silence, as they do nowadays, they quarrelled continually, accusing each other of the very tricks they practised themselves. Of Dr. Meade it was confidently asserted, that without practice at first, he opened extensive correspondence with all the nurses and midwives in his vicinity, associated and conversed with apothecaries and gossips, who, hoping for his trade, would recommend him as a skilful practitioner. The ruse worked, and soon the doctor found his calls were _bona fide_. This is a trick that some American physicians we know of may have learned from Dr. Meade. Certainly they know and practise the deception. When Dr. Hannes went to London, he opened the campaign with a coach and four. The carriage was of the most imposing appearance, the horses were the best bloods, sleek and high-spirited, the harnesses and caparisons of the richest mountings of silver and gold, with the most elegant trimmings. "By Jove, Radcliffe!" exclaimed Meade, "Dr. Hannes' horses are the finest I have ever seen." "Umph," growled Radcliffe, "then he will be able to sell them for all the more." But Dr. Radcliffe's _prognosis_ was at fault for once; and notwithstanding all the prejudice that Radcliffe and his friends could bring to bear against Hannes, and the lampooning verses spread broadcast against him, he kept his "fine horses," and rode into a flourishing business. To make his name known, Dr. Hannes used to send liveried footmen running about the streets, with directions to poke their heads into every coach they met, and inquire anxiously, "Is Dr. Hannes here?" "Is this Dr. Hannes' carriage?" etc. Acting upon these orders, one of these fellows, after looking into every carriage from Whitehall to Royal Exchange, ran into a coffee-house, which was one of the great places of meeting for members of the medical profession. Several physicians were present, among whom was Radcliffe. "Gentlemen," said the liveried servant, hat in hand, "can your honors tell me if Dr. Hannes is present?" "Who wants Dr. Hannes, fellow?" demanded Radcliffe. "Lord A. and Lord B., your honor," replied the man. "No, no, friend," responded the doctor, with pleasant irony; "those lords don't want _your master_; 'tis he who wants them." The humbug exploded, but Hannes had got the start before this occurred. A worthy biographer begins thus, in writing of Dr. Radcliffe: "The Jacobite partisan, the physician without learning, the luxurious _bon vivant_, Radcliffe, who grudged the odd sixpence of his tavern score," etc., "was born in Yorkshire, in the year 1650." But notwithstanding Radcliffe's plebeian birth, he died rich, therefore respected--a fact which hides many sins and imperfections. He not only humbugged the people of his day into the belief that he was a learned and eminent physician, but by his shrewdness in disposing of his gains, in bestowing wealth where it would tell in after years, when his body had returned to the dust from whence it came,--such as giving fifty thousand dollars to the Oxford University as a fund for the establishment of the great "Radcliffe Library," etc.,--he succeeded in humbugging subsequent generations into the same belief. Certainly there is room for a few more such humbugs. Dr. Barnard de Mandeville, in "Essays on Charity and Charity Schools," says of Radcliffe, "That a man with small skill in physic, and hardly any learning, should by vile arts get into practice, and lay up wealth, is no mighty wonder; but that he should so deeply work himself into the good opinion of the world as to gain the general esteem of a nation, and establish a reputation beyond all contemporaries, with no other qualities but a perfect knowledge of mankind, and a capacity of making the most of it, is something extraordinary." Mandeville further accuses him of "an insatiable greediness after wealth, no regard for religion, or affection for kindred, no compassion for the poor, and hardly any humanity to his fellow-creatures; gave no proofs that he loved his country, had a public spirit, or love of the arts, books, or literature;" and asks, in summing up all this, "What must we judge of his motives, the principle he acted from, when after his death we find that he left but a mere trifle among his (poor) relatives who stood in need, and left an immense treasure to a university that did not want it?" "Radcliffe was not endowed with a kindly nature," says another writer. "Meade, I love you," he is represented as saying to his fascinating adulator, "and I will tell you a secret to make your fortune. Use all mankind ill." Radcliffe had practised what he preached. Though mean and penurious, he could not brook meanness in others. The rich miser, John Tyson, approximating his end, magnanimously resolved to pay two of his three million guineas to Dr. Radcliffe for medical advice. The miserable old man, accompanied by his wife, came up to London, and tottered into the doctor's office at Bloomsbury Square. "I wish to consult you, sir; here are two guineas." "You may go, sir," exclaimed Radcliffe. The old miser had trusted that he was unknown, and he might pass for a poor wretch, unable to pay the five guineas expected from the wealthy, as a single consultation fee. "You may go home and die, and be d----d; for the grave and the devil are ready for Jack Tyson of Hackney, who has amassed riches out of the public and the tears of orphans and widows." As the miserable old man turned away, Radcliffe exclaimed, "You'll be a dead man in less than ten days." It required little medical skill, in the feeble condition of the old man, in order to give this correct prognosis. Radcliffe was the Barnum of doctors. "_Omnia mutantur, et nos mutamus in illis_," exclaimed Lotharius the First. But that "all things are changed, and we change with them," did not apply to medical humbugs during the seventeenth and eighteenth centuries--no, nor in the nineteenth century, as we will show, particularly in our articles on Quacks and Patent Medicines. [Illustration: THE MISER OUTWITS HIMSELF.] The requisites essential to success are amusingly described by a writer of the former time, as follows:-- _First._ A decent black suit, and (if your credit will stretch so far), a plush jacket, not a pin the worse if threadbare as a tailor's cloak--it shows the more reverend antiquity. _Second._ You must carry a caduceus, or cane, like Mercury, capped with a civet-box (or snuff-box like Sir Richard's), and must walk with becoming gravity, as if in deep contemplation upon an arbitrament between life and death. _Third._ You must hire convenient lodgings in a respectable neighborhood, with a hatch[1] at the door; have your reception-room hung with pictures of some celebrated physicians, ancient historical scenes, and anatomical plates, and the floor belittered with gallipots and half-empty bottles. Any sexton will furnish your window with a skull, in hope of your custom. _Fourth._ Let your desk never be without some old musty Greek and Arabic authors, and on your table some work on anatomy, open at a picture page, to amuse, if not astonish spectators, and carelessly thrown on the same a few gilt shillings, to represent so many guineas received that morning as fees. _Fifth._ Fail not to patronize neighboring alehouses, which may, in turn, recommend you to inquirers; and hold correspondence with all the nurses and midwives whose address you may obtain, to applaud your skill at gossiping. _Sixth._ Be not over modest in airy pretensions, not forgetting that loquaciousness and impudence are essentials to gaining a fool's confidence. In case you are naturally backward in language, or have an impediment of speech, you are recommended to persevere in a habit of mysterious and profound silence before patients, rendered impressive by grave nods and ahems. EARLY FRENCH PHYSICIANS. From what meagre biographies we have of French doctors of the past, we are led to believe that, as at the present time, the humbugs outnumbered the honest medical practitioners. In the days of Clovis and the great Charlemagne, before the power of Rome was broken, before Russia was a nation, and when England was subject to the caprices of many masters, there were many surgeons employed in the armies of these kings, but the priests and wizards were the physicians to the great public. The surgeons possessed all the knowledge there was to be attained at that distant day; yet they made the heart, not the brain, the centre of thought, and "the palace of the soul," knew little of anatomy, and nothing of the circulation of the blood. The physicians of later periods held court positions by flattery, not by merit. This was particularly true up to and inclusive of the reign of "LOUIS LE GRAND." Those who attended as physicians upon the court of this remarkable monarch of France for seventy-two years, received no stipend whatever, except the honor of holding so exalted a position as court physician to such a mighty ruler; and, notwithstanding the outside practice that this elevated station necessarily brought them, but few physicians could long bear the enormous expense attending that position. Louis resided at a distance from his capital. His changes of residence were continual, and not without a design, and chiefly made for the purpose of creating and maintaining a number of artificial distinctions. By these he kept the court in a state of constant anxiety, expense, and expectation. When the next proposed change was announced, he had made it the fashion for courtiers to accompany him,--to Versailles, to St. Germain, or Marly,--and to occupy apartments near him, and the extravagance and magnificence in which he made it incumbent upon his followers to appear, with the frequent prescribed changes, rendered it too expensive a position for a man to sustain, unless possessed of a previous ample fortune. The surgeons of the armies were paid for their services. Both Drs. O'Meara and Antommarchi have testified to Napoleon's scepticism in medicine and distrust of physicians. But "surgeons are godlike," he is represented as saying, and upon all worthy he bestowed the "Legion of Honor." At St. Helena, Dr. Antommarchi was endeavoring to persuade the emperor to take a simple remedy which he had prepared for him. "Bah!" exclaimed Napoleon, "I cannot; it is beyond my power to take medicine." "I pray your majesty to try," entreated the doctor. "The aversion I have for the slightest preparation is inconceivable. I have exposed myself to the dangers of the battle-field with indifference; I have seen death without betraying emotion; but to take medicine, I cannot," was his reply. Madame Bertrand, who was present, tried also to persuade the emperor to take the physician's prescription. "How do you manage to take all those abominable pills and drugs, Madame Bertrand, which the doctor is continually prescribing for you?" asked the emperor. "O, I take them without stopping to think about it," was her reply; "and I beg your majesty will do the same." Still the dying man shook his head, and appealed to General Montholon, who gave a similar answer. "Do you think it will relieve me from this oppression, doctor?" he finally asked of Dr. Antommarchi. "I do, my dear sire; and I entreat your majesty to drink it." "What is it?" asked Napoleon, eying the glass suspiciously. "Merely some orange water," was the reply. "Give it me, then;" and the emperor seized the cup and drank the contents at one draught. "The emperor has no faith in medicine, and never takes any," said Las Cases, in his memoirs. About the year 1723, a man sprang into notice in Paris, styling himself Dr. Villars. He claimed relationship to the Duke Louis Hector Villars, and the Abbe Pons is represented as saying that "Dr. Villars is superior to the great marshal, Louis Hector. The duke kills men,--the doctor prolongs their existence." Villars declared that his uncle, who had been killed at the age of one hundred years, and who might, but for his accidental death, have lived another half century, had confided to him the secret of his longevity. It consisted of a medicine, which, if taken according to directions accompanying each bottle, would prolong the life of the fortunate possessor _ad infinitum_. Villars employed several assistants to stand on the corners of the streets, and who, when a funeral was seen passing, would exclaim,-- "Ah! if the unfortunate deceased had but taken Dr. Villars' nostrum, he might now be riding in his own carriage, instead of in a hearse." "Of course," says our authority, "the rabble believed the testimony of such respectable and _disinterested_ appearing witnesses, and made haste to obtain the doctor's nostrum--and instructions." And here is where the laugh comes in. The patient received positive instructions to live temperately, to eat moderately, bathe daily, to avoid all excesses, to take steady and moderate exercise, to rise early, and, in fact, to obey all the laws of nature. Of course those who persevered in these instructions were greatly benefited thereby, and the dupes, attributing their recovery to the use of the nostrum, lauded the doctor. The medicine, put up in a small bottle, carefully labelled, and sold for the modest sum of five francs, consisted of water from the River Seine, tinctured with a quantity of spirits of nitre. A few were wise enough to see the trick, but most people believed in the efficacy of the nostrum. Unfortunately for Villars, he intrusted his secret to another, the humbug leaked out, and Othello's occupation was gone; but not, however, until Villars had amassed a large fortune from the credulity of the public. This brings to mind a story, the truth of which can be vouched for, respecting a New England doctor. His labels contained the following instructions:-- "The doctor charges you to take care of the health God has given you. In eating and exercise be moderate. Avoid bad habits and excesses that sap the life from you. Use no salt pork, newly-baked fine bread, vinegar, coffee, strong tea, or spirits while taking this medicine. 'Tis not in the power of man to restore you to health unless you regard these directions." "What do you think of this?" asked the editor of a journal of Dr. P., former professor of H---- College, presenting a vial of the high dilution, as the medicine was, labelled as above. "All very well," the doctor replied, after having read the label; "for if the vial contains nothing but water, with just sufficient alcohol to keep it, a strict observance of these directions might restore you to health." "You have treated my case for a long time, doctor, and have never given me such instructions. Pray why don't _you_ get up something similar?" "Well, what was his reply?" I asked, as the editor hesitated. "O, he has not yet informed me." AMERICAN HUMBUGS. Humbug is not necessarily synonymous with ignorance. So far from it, that doubtless a very perfect and successful man in the art of humbugging must be educated to his business. The following true statement is a case in point: A physician of New York, now in excellent standing, who "rolls in riches," and whose own carriage is drawn by a span of horses that Bonner once might have envied, was but a few years ago as poor as a church mouse, and as unknown as Scripture. He had graduated with honors in Transylvania University, opened an office in a country town, where his knowledge and talents were unappreciated, and which place he abandoned after a twelve months' patient waiting for a practice which did not come. He had become poorer every month, and but for the kind assistance of early friends, must have perished of want. "Either it is distressingly healthy here, or the good people are afraid to trust their lives and healths in the hands of an inexperienced physician," he remarked to a friend to whom he applied for means for a new start elsewhere. "And where will you try your luck next?" inquired his friend. "In New York city." "In New York city?" "Yes, and I shall there succeed," he exclaimed, with great determination. "Well, I hope in my heart of hearts you will," was his friend's reply, as he kindly loaned him the required sum of money. Had his friend asked the advice of a third party before making the loan, doubtless the answer would have been something like the following, though it was respecting another case:-- "Dr. J. wants me to loan him some money for thirty days; do you suppose he will refund it?" "What! lend him money?" was the reply. "He return it? No, sir; if you lend that man an emetic he would never _return_ it." On his borrowed funds,--neither principal nor interest of which his kind friend ever expected him to be able to return,--the doctor entered the great metropolis. He hired a house in a respectable locality, and hung out his sign. During his long quiet days in the country village he had read a great deal, and was "up to the tricks" of his predecessors. He had particularly posted himself on the ways and means resorted to by some of those physicians, of whom we have already made brief mention, for getting into practice. [Illustration: COMMENCING A PRACTICE IN NEW YORK.] "What avails it that I know as much as other physicians who have entered upon a practice? What does my diploma amount to if I have no patients?" he asked himself over and again. Practice was now his want, and this is the way he obtained it. Having read of a celebrated physician, who kept his few patients a long time in waiting, under pretence that he was preoccupied by the many who fortunately had preceded, our young physician adopted that great man's tactics. For want of patients to keep in waiting, he hired some decently dressed lackeys to apply regularly at his front door, at specified times, and wait till the colored servant admitted them, one at a time. Each was passed out after a half hour's supposed consultation, and the next admitted. The neighbors and others passing, seeing patients continually in waiting, some with a hand, a foot, face, or other parts bound up, were led to read his sign, and soon a _bona fide_ patient applied, who, in turn, was kept waiting a long time, notwithstanding the young doctor's anxiety to finger a real medical fee from his first New York patient. Others followed, the lackeys were dismissed, and the physician's practice was established. His merit kept what his shrewdness had obtained. Cannot the reader avouch for the reputed extensive rides of some country doctor, who, without a known patient, harnessed his bare-ribbed old horse to his crazy gig, and drove furiously about the country, returning by a roundabout way, without having made a single professional visit, thereby humbugging the honest country people into a belief that he had innumerable patients in his route? To quite another class of humbugs belongs the subject of the following sketch. I have had the pleasure of meeting him but twice--may I never meet him again. The first interview was at the board of a country hotel. [Illustration: GRACE BEFORE MEAT.] I had arrived late at evening by rail, and ordered a light supper. When the tea-bell had summoned me, I found a large, phlegmatic individual seated opposite at the table, who possibly had arrived by the same conveyance as myself. His person was quite repulsive. He was probably fifty years of age, his eyes watery and restless, his thin stock of hair--indicating a corresponding poverty of brain--black, streaked by gray, was stuck back professionally (!) over a low bump of veneration, and high organs of firmness and self-esteem, which, with a Roman nose, large, protruding under jaw, and wide, open mouth, gave him a striking appearance, at least. But what was most observable was his thin, uneven, scraggy whiskers, uncombed, and besmeared by tobacco juice and bits of the weed, drooling down over their uncertain length, over waistcoat, and so out of sight below the table. His coat sleeves had evidently been substituted for a handkerchief when too great a surplus of tobacco juice obstructed his face. He bent his great, watery eyes over towards me, and opened the ball by suggesting that I ask a blessing over the food so bountifully and temptingly laid before us. Having too much compassion on the present exhausted state of my stomach to disregard its immediate demands, and too little confidence in the veneration of my _vis-a-vis_ to return the request, I went to eating, while he closed one eye, keeping the other on a plate of hot steak just placed before him by the table girl. I have since been strongly reminded of him by the character "Bishopriggs," in Wilkie Collins's book, "_Man and Wife_." I think, however, for hypocrisy, the present subject exceeded Bishopriggs. Having wagged his enormous jaw a few times, by way of grace, he began eating and conversing alternately. "I take it, friend, you're a railroad conductor, coming in so late," he suggested, between mouthfuls. "No," was my brief reply. "Perhaps, cap'n, you're a drummer. Sell dry or wet goods?" "No." "A newspaper man?" I merely shook my head. "Then a patent medicine vender?" "No!" emphatically. "Not a minister," he asserted. "Perhaps a doctor," he perseveringly continued. "Yes, sir; I am a physician." "O! ah! indeed! I am rejoiced to learn it. Give me your hand, sir," he exclaimed, rising and reaching his enormous palm across the table. "I am rejoiced, as I said before, to meet a brother." "A _brother_!" I repeated, with unfeigned surprise and disgust. "Yes, a brother! I, too, am a doctor. I have the honor," etc., for the next ten minutes, while I hastened to finish my supper. His last interrogation was what a college boy would call a "stunner." "_Do you think, sir, that the Fillopian ducks are the same in a male as they are in a female?_" [Dr. S., a quack living in Winsted, Conn., once said to an educated physician, that he sometimes found difficulty in introducing a female catheter on account of the "prostrate" (meaning _prostate_) gland,--which exists only in the male!] I saw him once after the above interesting interview. He entered the drug house of Rust, Bird, & Brother, Boston, just as I was about to go out. I could not refrain from turning my attention towards him, as I recognized his stentorian voice. "Have you got any _Bonyset arbs_?" was all I waited to hear. I subsequently learned that he was known in Vermont and part of New York State by the _sobriquet_ of "Dr. Pusbelly." The following story respecting "Dr. Pusbelly," related in my hearing by a stage-driver, is in perfect keeping with the character of the man, as he impressed me in my first interview at the country hotel. DR. PUSBELLY. One sunny day in autumn I had occasion to take a long journey "away down in Maine," when and where there was no railroad. I was seated on the outside of a four-horse stage-coach, with three or four other passengers, one of whom was a lady, who preferred riding in that elevated station to being cramped up inside the coach with eight persons, besides sundry babies, a poodle dog, and a parrot. "Sam," our driver, was a sociable fellow, full of pleasant stories,--and Medford rum, though he was considered a perfectly safe Jehu. The greatest drawback to his otherwise agreeable yarns was his habit of swearing. Notwithstanding the presence of the lady, he would occasionally round his periods and emphasize his sentences with an expletive which had better have been omitted. "Can't you tell a story just as well without swearing, Sam?" I inquired. "O, no; it comes second natur. Why, cap'n, everybody swears sometimes. And that reminds me--Git up, Jerry" (to the horse). "There was an old doctor, Pill--Pilgarlic, I called him, on account of his pills, and the strong effluvia from his cataract mouth. He was up round Champlain, where I drove before the d--d railroads ruined the great stage business. Well, he was as religious as a cuss,--that ain't swearin', is it, cap'n? Well, he came round there pill-peddling, you see, and in order to make the old women believe in his (expletive) medicines--" "Don't swear, Sam. You can tell the story better without. Come, try," interrupted a passenger, with a twinkle of fun in his expressive eyes. "Who's telling this story,--you or me?" exclaimed Sam, with a wink. "Yes, he talked pills by Bible doctrine, swore his essences by the blood of the Lamb, the ---- old hypocrite. I knowed he was a blamed old hypocrite, for I had to drive him round every onct in a while, and he never failed, in season and out of place, to exhort me to seek salvation, and a new heart, and pure understanding, while, all the time, the filthy tobacco juice slobbered all over his filthier mug, and down his scattering whiskers;--now and then one, like the scattering trees in yonder field,--all over his vest; and his coat sleeves were as bad, from frequent drawing across his face. Yes, he said, 'Jesus,' but he meant pills. He said, 'Get wine and milk, without money and without price,' but he meant, buy his essences, _with_ money. The old gals went crazy over him, and the pill market was lively. The louder he prayed and exhorted, the faster he sold his medicines. "One Sunday afternoon he wanted me to shy him over the lake; so, taking his Hem-book and Bible in his coat pockets, and his two tin trunks of medicine, he followed me to the shore. He seated his great carcass in the starn of the boat, while I rowed him over the lake. All the way he slobbered tobacco juice; and gabbled his religion at me, while occasionally I swore mine back at him. "When we got over, I jumped out, and told him to set steady till I hauled the boat up further; but he didn't mind, and rose up in the starn with his kit, a tin trunk in each hand, just as I gave the craft a yerk, when over backwards he went kerflounce into the water,--carcass, trunks, Bible, pills, and essences, all into the lake. O, the d----! You ought to have seen him. Up he came, puffin' and blowin' like a big whale! Then I fished him out with the boat-hook, and went for his trunks. No sooner had he reached _terror firmer_ than, blowin' the surplus water and tobacco out of his throat, _he commenced swearin' at me_. Religion went by the board! O, Jerusalem! Such a blessing as he gave me I never before heard. I knowed it was pent up in him, the ---- old sinner, and he only wanted the occasion to let it out. The bath done it! It was the cussidest baptism I ever witnessed in the hull course of my life." "Was he called Dr. Pusbelly?" I suggested, at the close of the narrative. "Yes, that was his name; but I called him Old Pilgarlic, blame him." "PROFESSOR BREWSTER." When I lived in Hartford, Conn., some years ago, there resided in that city a black man, then somewhat noted as a "seer" among various classes of whites, as well as blacks, and who resides there still, and has since become quite famous. In what category to place this man,--Professor Brewster, so called,--it is perhaps a little difficult to determine; whether among "clairvoyants," "animal magnetizers," "natural doctors," "fortune-tellers," or what, or all, it must be admitted that he is a "character," and wields great influence among certain classes. Nature made him a superior man of his race, and what thorough, early education might have done for him, we are left to conjecture. So noted is Professor Brewster, that I have thought him a proper subject for comment here, as a living illustration of what a man of subtle genius may accomplish, though wholly without "book learning," or other approved instruction, in the field of medicine. [Illustration: OLD PILGARLIC TAKES A BATH.] A reliable friend of mine has gathered the following facts and statements in regard to Professor Brewster, and taken pains to secure the accompanying engraving of the veritable professor, as he appears in the year 1872. [Illustration: PROFESSOR BREWSTER.] "The full name of this remarkable man, now residing in Hartford, Conn., is Worthington Hooker Erasmus Brewster, commonly called, by those who venture on familiarity, 'Worthy' Brewster, for short. Worthy is of full medium height, powerfully built, and well knitted together. His head is very well moulded, and also extremely large, but not disproportionally large for his massive shoulders. He was born of 'poor but honest' (though undoubtedly black) parents, in the town of Granby, Conn., on the 21st day of January, 1812. "The boy Worthy, at the age of six years, went with his mother (his father having died) and her new husband to the hills of Litchfield County to live, and was there brought up to youth's estate, enjoying the opportunities of education at the district school in what is now _West_ Winsted. The places of the birth and early rearing of Professor Brewster are fixed beyond question, which fact will, it is hoped, forbid the contention of other towns, and of 'seven cities,' or more, over the question, after he shall have passed away. Worthy was not attracted to literature and science, however. He seemed to spurn these, as unworthy of his natural gifts to waste their time upon. But he learned to read, and can write a 'fair hand.' Seeing no special need of being cramped and confined by the narrow rules of spelling, Worthy has invented a style of orthography for himself, and writes a compact, forcible, and even masterly letter. "But we must not linger on the details of his youth. Suffice it that Worthy grew up a powerful lad, and became the conquering athlete of all the region about his home. No man, of hundreds who tried, was able to successfully wrestle with him. The strongest men were no match for him. He was as agile as he was powerful, and to this day retains great elasticity of foot and limb. He was a mysterious fellow also, and, before he was sixteen years old, was regarded by his friends and acquaintances, of African descent, especially, as a sort of prophet, while many whites considered him a necromancer, and people all about declared he 'had the devil in him' to no ordinary extent. Worthy claimed, in those days, to 'see visions,' and many stories are current among his contemporaries regarding his then being able to 'charm snakes,' and do other miraculous things. Abundant witnesses, such as they are, can now be found ready to take their oaths that they have seen Worthy, 'with their own eyes,' perform his miracles. It is certain that these believe in him. "At the age of twenty Worthy went to New York city, where (in Lawrence Street) he lived for the period of a year, successfully practising the art of fortune-telling. While there Worthy first discovered his powers as a 'mesmerizer,' or magnetic physician. A school-girl, knowing that Worthy 'practised the healing art' somewhat, and suffering intensely with a toothache, jeeringly asked him, 'Why can't you think of something to cure my toothache?' Whereupon Worthy clapped his hands to her head, and vigorously drew them down her cheeks, half in fun, half seriously, when, to his astonishment, he found that all his (sound) teeth ached terribly, while she declared that the pain had left hers. Such is his story; and it is by no means an improbable one; for animal magnetism is a fixed fact (however it may be analyzed or defined), and diseases are often 'magnetically' alleviated; and Worthy, with his powerful body and superb health, as well as native force of intellect, may be as naturally gifted, as a magnetic operator, as even Mesmer himself. Indeed, the writer is inclined to believe that Worthy's great power over many people is largely due to his superior vital forces. "Worthy now turned his attention considerably to diseases, but returned to Litchfield County for a while. At the age of twenty-six, he resolved 'to see more of the world,' and in the capacity of steward embarked at New Haven on board the brig Marshal, Captain Brison, freighted with horses, and bound for a long trading voyage to the Island of Demarara, and to South America, where they coasted during the winters, and took in coffee, etc., in exchange for their cargo. Worthy was gone from home on this voyage two years and two months, during which time he learned many mysteries. He was a foreign traveller now, and his polite and professional education may be said to have at that time become 'finished.' "Since then Worthy has practised medicine to considerable extent, told fortunes, 'looked' (in a crystal) for stolen property, and, if we are to believe half of what is attested by many astute people (such as police detectives, etc.), has, by force of his great sagacity, or in some way (he would say, through clairvoyance), managed to achieve great success in ferreting out lost or stolen treasures, and bringing thieves to grief. "People of all classes in society visit him with their troubles of mind and body. But the major part of his clientage is females. The wives and accomplished daughters of wealthy men, as well as poor and ignorant women, come from distant parts of the country to consult him, and a great number of the first ladies of Hartford also consult him. Worthy carries on the business of a 'chair-seater,' partly to occupy his time during the intervals of his divinations, and partly to provide an excuse for cautious persons to call on him for consultations. Those who consult him do so mostly regarding secret matters, and they pretend to visit him to engage him to seat chairs! "He is consulted in respect to all sorts of diseases, and by unsuccessful, perplexed, or doubting lovers; by husbands whose wives have absconded, and who are anxious to call them back; by wives in regard to their wandering husbands; by hosts of superstitious people (and these are found in all classes), who believe themselves 'possessed by devils,' or demons. He is expected to cast out the devils (and he does so as surely as most doctors cure imaginary diseases). People who have lost property, and officers of the law in search of stolen goods, consult him; and bachelors and widowers in want of wives, and countless maids (both old and young), anxious to get married, visit him and receive his sweet consolations, or mourn over the ill luck which he prognosticates for them. His correspondence is large. A hasty glance through several hundred letters in 'Professor Brewster's' possession convinced the writer that the amount and character of the superstition and ignorance which exist in these days, in our very midst, are probably but little conjectured by the more cultivated classes. They are indeed astounding, but are not confined, as we have before intimated, to the wholly illiterate classes. People competent to write letters with grammatical precision, and observing what would ordinarily be called an 'excellent business style,' at least, in their composition, consult the professor; and so successful is Worthy in his diagnoses of and prescriptions for various diseases, that many of his patients write him letters overflowing with gratitude, while others voluntarily and admiringly attest his skill as a 'seer.' To what talent, 'gift,' or what secret of good luck, 'Professor Brewster' owes the many successes he wins (even though he may fail ten times more often than he succeeds), we cannot, of course, decide. But certain it is that he, with all his claims to a knowledge of the 'occult,' exists, practises his arts, and through a period of years has retained his old patients, and the postulants before his supposed demigodship, while adding constantly to their number. In this he is a remarkable man. He has accumulated quite a respectable property, and is decidedly one of the 'institutions' of the enlightened and cultivated city of Hartford. "It should be remarked here that Worthy was, during the late civil war, a true patriot. He was attached to the twenty-ninth regiment Connecticut Volunteers, under Colonel Wooster (a 'colored' regiment), and was 'gone to the war' over two years. His powers as a 'clairvoyant,' or 'fore-seer,' served him in the war, and he 'always knew what was coming,' he says. As a part of the curious history of the war, serving to show how little the people of the North understood, in the first years of the contest, that they were fighting for a great humanitary end,--the abolition of chattel slavery,--it may be noted here, that Worthy wrote to Governor Buckingham, in August, 1862, proposing to raise a black regiment, and the governor, by his secretary, replied to Worthy's proposition, that he then did 'not deem it expedient,'--which fact institutes a comparison between the judgments of the governor and Worthy, not uncomplimentary to the latter." [Illustration] II. APOTHECARIES. FIRST MENTION OF.--A POOR SPECIMEN.--ELIZABETHAN.--KING JAMES I. [VI.].--ALLSPICE AND ALOES, SUGAR AND TARTAR EMETIC.--WAR.--PHYSICIAN VS. APOTHECARY.--IGNORANCE.--STEALING A TRADE.--A LAUGHABLE PRESCRIPTION.--"CASTER ILE."--MODERN DRUG SWALLOWING.--MISTAKES.-- "STEALS THE TOOLS ALSO."--SUBSTITUTES.--"A QUID."--A "SMELL" OF PATENT MEDICINES.--"A SAMPLE CLERK." There are few occupations wherein Old Time has wrought so few changes as in that of the apothecary's. What it was four hundred years ago it is to-day! Who first invented its weights, measures, and symbols, I am unable to say; but it is a fact that they remain the same as when first made mention of by the earliest writers on the subject. Drop into the "corner drug store,"--and what corner has none!--examine the balances, the tables of weights and measures, the graduating glass, the signs for grains, scruples, ounces, and pounds, and you will find them the same as those used by the earliest known _medical_ apothecaries, by those of the Elizabethan period, or when King Lear (Lyr) said, "Give me an ounce of civet, good apothecary, to sweeten my imagination; there's money for thee." The money has changed; _names_ of drugs are somewhat altered; some new ones have taken the place of old ones; prescriptions changed in quality; but quantities, and modes of expressing them, are unchanged. "In the middle ages an apothecary was the keeper of any shop or warehouse, and an officer appointed to take charge of a magazine."--_Webster._ We have good grounds for supposing this to have been the case in the time of the rebuilding of the wall of Jerusalem, more that two thousand years ago. Nehemiah informs us that the son of an apothecary assisted in "fortifying Jerusalem unto the broad wall." Was not this the office of an overseer, or "keeper of a magazine"? Various artisans were employed to perform certain portions of the work, and who more appropriate or better qualified to oversee the rebuilding of the fortifications than "an officer appointed to take charge of the magazines"? One more reference we draw from Scripture,[2] viz., in Exodus xxxvii. 29, where "the holy anointing oil" (not for medicine, but for the tabernacle), "and the pure incense of sweet spices" (not medical), "were made according to the work [book?] of the apothecary." This, however, no more implies that the said "apothecary" was a medical man, a dispenser of physic, or versed in medical lore, than that the maker of shewbread (Lev. xxiv. 5) was necessarily a pharmacist. In fact, there seems to have been no need of an apothecary, as medicine dispenser, until about the latter part of the thirteenth century. The oldest known work on compounding medicines was written by Nicolaus Mynepsus, who died in the commencement of the fourteenth century. The first apothecaries were merely growers and dispensers of herbs, and were but a poor and beggarly set. Shakspeare's delineation of the "_poor apothecary of Mantua_," in Romeo and Juliet, so completely answers the description of the whole "kit" of druggists of the times, that we may be pardoned in quoting him. Romeo says,-- "I do remember an apothecary,-- And hereabouts he dwells,--whom late I noted In tattered weeds, with overwhelming brows, Culling of simples (herbs). Meagre were his looks; Sharp misery had worn him to the bones; And in his needy shop a tortoise hung, An alligator stuffed, and other skins Of ill-shaped fishes; and about his shelves A beggarly account of empty boxes, Green earthen pots, bladders, and musty seeds; Remnants of packthread, and old cakes of roses, Were thinly scattered to make up a show. Noting this penury, to myself I said,-- 'An' if a man did need a poison now, Whose sale is present death in Mantua, Here lives a caitiff wretch would sell it him.' * * * * * What, ho! apothecary! _Apothecary._ Who calls so loud? _Romeo._ Come hither, man! I see that thou art poor. Hold! There is forty ducats! [$80.] Let me have A dram of poison. _Apoth._ Such mortal drugs I have, but Mantua's law Is death to any he that utters them. _Rom._ Art thou so bare, and full of wretchedness, And fear'st to die? Famine is on thy cheeks; Need and oppression starveth in thy eyes; Upon thy back hangs ragged misery; The world is not thy friend, nor the world's law; The world affords no law to make thee rich; Then be not poor, but break it, and take this. _Apoth._ My poverty, but not my will, consents." When we behold the opulent druggists of the present day, we can hardly credit the fact that for nearly two hundred years the apothecary of Mantua was a fair specimen of the wretches who represented that now important branch of business. The physician was the master, the apothecary the slave! The following were among the rules prescribed by Dr. Bullyn for the "apothecary's life and conduct" during the Elizabethan era:-- "1. He must serve God, be clenly, pity the poore. 2. Must not be suborned for money to hurt mankind. 4. His garden must be at hand, with plenty of herbes, seedes, and rootes. 5. To sow, set, plant, gather, preserve, and keepe them in due time. 6. To read Dioscorides, to learn ye nature of plants and herbes. (Dioscorides published a work on vegetable remedies about 1499, in Greek. The _translation_ was referred to.) 8. To have his morters, stilles, pottes, filters, glasses, and boxes cleane and sweete. 12. That he neither increase nor diminish the physician's bill (prescription), nor keepe it for his own use. 14. That he peruse often his wares, that they corrupt not. 15. That he put not in _quid pro quo_ (i. e., substitute one drug for another.) (Would not this be excellent advice to some of the apothecaries of the present day?) 16. That he meddle only in his vocation. 18. That he delight to reade Nicolaus Mynepsus, and a few other ancient authors. 19. That he remember his office is only ye physician's _cooke_. 20. That he use true waights and measures. 21. That he be not covetous or crafty, seeking his own lucre before other men's help and comfort." We may see the wisdom evinced by the author of the above advice, especially in articles Nos. 2, 12, and 21, when we know of a druggist's clerk of modern times, who, having stolen the physician's prescriptions intrusted to his care, started out on borrowed capital, and, putting them up as his own wonderful discoveries, advertised them extensively, until his remedies, for all diseases which flesh is heir to, are now sold throughout the entire universe! As the doctors were accustomed to retain their most valuable recipes, and put up the medicines themselves, selling them as nostrums, and because of the heavy percentage demanded by them for those intrusted to the apothecaries, and the small profit accruing from the sale of medicines at the time, the poor wretched "cookes" were necessarily kept in extreme poverty. So, in order to eke out a living, the apothecaries were also grocers and small tradesmen. As at the present day, they were not required to possess any knowledge of medical science beyond the reading of a few books "relating to the nature of plants," hence very little honor or profit could accrue from the business alone. Grocers kept a small stock of drugs, sometimes in a corner by themselves, but not unusually thrown about and jumbled amongst the articles kept for culinary and other purposes. As mineral medicines became more generally used, these were also added to the little stock, and not unfrequently was some poisonous substance dealt out by a green clerk (as is often the case nowadays) to the little errand girl, sent in haste for some culinary article. Allspice and aloes, sugar and tartar emetic, lemon essence and laudanum, were thrown promiscuously together into drawers, or upon the most convenient shelves, and you need not go far into the country to witness the same lamentable spectacle in the enlightened nineteenth century. The apothecary gave the most attention, as now, to the exposition and sale of those articles which sold the most readily, and returned the greatest profit. All druggists at present sell cigars and tobacco, at the same time not unusually posting up a conspicuous sign-- NO SMOKING ALLOWED HERE. The following is a case in point:-- _Druggist._ Smoking not allowed here, sir. _Customer._ Why! I just bought this cigar from you. _Druggist._ Well, we also sell emetics and cathartics. That does not license customers to sit down and enjoy them on the premises. In the thirteenth year of the reign of James I. of England (and James VI. of Scotland) the apothecaries and grocers were disunited. The charter, however, placed the former under the control of the College of Physicians, who were endowed with the arbitrary powers of inspecting their shops and wares, and inflicting punishments for alleged neglects, deficiencies, and malpractices. The physicians knew so little, that the apothecaries soon were enabled to cope with them; "and before a generation had passed away the apothecaries had gained so much, socially and pecuniarily, that the more prosperous of them could afford to laugh in the face of the faculty, and by the commencement of the next century they were fawned upon by the younger physicians, and were in a position to quarrel with the old, which they soon improved." As it was a common occurrence for patients to apply at the apothecary's for a physician, the former either recommended the applicant to one who favored him, _or else prescribed for the patient himself_. The promulgation of this fact was the declaration of war with the old physicians, who heretofore had done their best to keep down the apothecaries. The former threatened punishment, as provided by law; the latter retaliated, by refusing to call them in to consult on difficult cases. "Starving graduates of Oxford and Cambridge, with the certificate of the college in their pockets, were imbittered by having to trudge along on foot and see the mean 'medicine mixers,' who had scarce scholarship enough to construe a prescription, dashing by in their carriages." The war progressed,--Physician _vs._ Apothecary,--and the rabble joined. Education sided with the physicians, interest sided with the apothecaries. "So modern 'pothecaries taught the art, By doctors' bills, to play the doctors' part; Bold in the practice of mistaken rules, Prescribe, apply, and call their masters fools." To circumvent the apothecaries, a dispensary was established in the College of Physicians, where prescriptions were dispensed at cost. While this proceeding served to lessen the apothecary's income for a time, it could not greatly benefit the prescribing physician. The former might parallel his case with Iago, and say of the physician, he "Robs me of that which not enriches him, And makes me poor indeed." Physicians were divided into two classes,--Dispensarians and Anti-dispensarians. Charges of ignorance, extortion, and of double-dealing were preferred on both sides. The dispensary doctors charged their opponents with playing into the hands of the apothecaries by prescribing enormous doses, often changing their prescriptions uselessly to increase the druggists' revenues and _their own percentage_! On the other hand, the dispensarians were accused of charging a double profit on prescriptions whenever the ignorance of the patient, respecting the value of drugs, would admit of the extortion. Had the physicians been united, the apothecaries would have had to succumb; but a divided house must fall, and the apothecaries won the day. A London apothecary, having been prosecuted by the college for prescribing for a patient without a regular physician's advice, carried the case up to the House of Lords, where he obtained a verdict in his favor; and another apothecary, Mr. Goodwin, whose goods had been seized by some dispensary doctors, having obtained a large sum for damages, which being considered test cases, the doctors from this time (about 1725) discontinued the exercise of their authority over the apothecaries. Thus emancipated from the supervision of the physicians, the apothecaries began to feel their own importance, and most of them prescribed boldly for patients, without consulting a doctor. The ignorance of many of them was only equalled by their impudence. It is not unusual, at the present day, for not only apothecaries, but their most ignorant clerks, to prescribe for persons, strangers perhaps, who call to inquire for a physician; and cases, too, where the utmost skill and experience are required. The following amusing anecdote is sufficiently in accordance with facts within our own knowledge to be true, notwithstanding its _seeming_ improbability:-- ANECDOTE OF MACREADY, THE ACTOR. The handwriting of Macready, the actor, was curiously illegible, and especially when writing a pass to the theatre. One day, at New Orleans, Mr. Brougham obtained one of these orders for a friend. On handing it to the latter gentleman, he asked,-- "What is this, Brougham?" "A pass to see Macready." "Why, I thought it was a physician's prescription, which it most resembles." "So it does," acquiesced Mr. Brougham, again looking over the queer hieroglyphics. "Let us go to an apothecary's and have it made up." Turning to the nearest druggist's, the paper was given to the clerk, who gave it a careless glance, and proceeded to get a vial ready. With a second look at the paper, down came a tincture bottle, and the vial was half filled. Then there was a pause. Brougham and his friend pretended not to notice the proceedings. The clerk was evidently puzzled, and finally broke down, and rang for the proprietor, an elderly and pompous looking individual, who issued from the inner sanctum. The clerk presented the paper, the old dispenser adjusted his eye-glasses, examined the document for a few seconds, and then, with a depreciating expression,--a compound of pity and contempt for the ignorance of the subordinate,--he proceeded to fill the vial with some apocryphal fluid, and, giving it a professional "shake up," duly corked and labelled it. [Illustration: THE "FREE PASS" PRESCRIPTION.] "A cough mixture, gentlemen," he said, with a bland smile, as he handed it to the gentleman in waiting, "and a very excellent one, too. Fifty cents, if you please." In a copy of the London Lancet, 1844, is reported Dr. Graham's bill. In the same number of which is a reply by an apothecary, who asks if "the old and respectable class of apothecaries are to be forever abolished;" and he quotes the assertion from one of the articles in the bill: "Is it not a notorious fact that the masses of chemists and druggists know nothing of the business in which they are engaged?" Dr. Graham certainly ought to have known. Druggists are liable to make mistakes,--as are all men; but carelesness and ignorance, one or both, are usually to be found at the bottom of the fatalities so common in the dispensing of prescriptions. I know an old and experienced druggist who sold a pot of extract belladonna for extract dandelion. In the same city, on the same street, I know another who was prosecuted for dispensing opium for taraxicum, which carelesness caused the death of two children. The following mistake was less fatal, but only think of the poor lady's feelings! A servant girl was sent to a certain drug store we know of, who, in a "rich brogue," which might have caused General Scott's eyes to water with satisfaction, and his ears to lop like Bottom's after his transformation by the mischievous fairy, she asked for some "caster ile," which she wished effectually disguised. "Do you like soda water?" asked the druggist. "O, yis, thank ye, sir," was the prompt reply; "an' limmun, sir, if ye plaze; long life to yeze." The man then proceeded to draw a glass, strongly flavored with lemon, with a dose of oil cast upon its troubled waters. "Drink it at one swallow," said he, presenting it to the smiling Bridget. This she did, again thanking the gentlemanly clerk. "What are you waiting for?" he inquired, seeing that she still lingered. "I'm waitin' for the caster ile, sir," said the girl. "O! Why you have just taken it," replied the soda-drug man. "Och! Murther! It was for a sick man I wanted it, an' not meself at all." [Illustration: THE WRONG PATIENT.] While there have been great changes in the drug trade during the last fifty years, necessary to the increasing demand for drugs, the establishment of wholesale houses and some specialties, and in cities, the substitution of cigars, soda water, patent medicines, etc., for groceries and provisions, the dispensing apothecary is nearer to what he was hundreds of years ago, as we asserted at the commencement of this chapter, than any other professional we know of. The paraphernalia of the shop is nearly the same. There is no improvement in pot, in jar, in tables, in spatula; the old, ungainly mortar is not _substituted_ by a mill; the signs of ounces and drachms remain the same, though so near alike that they are easily and often mistaken one for the other, and the prescription before the dispenser is prefixed by a relic of the astrological symbol of Jupiter,--"the god of medicine to the ancient Greeks and Egyptians,"--as a species of superstitious invocation. In our largest cities even, in the shop windows, the mammoth flashing blue bottles, "a relic of empiric charlatanry," still brighten our street corners, and frighten our horses at night, as in the days of our forefathers. We intimated that "patent medicines" had added greatly to the trade. This we shall treat of under its proper head. Many have arisen from penury to affluence, from obscurity to renown, in the drug trade of later years; but take away the tobacco trade, the soda fountain, and the outside patent nostrums, and wherein would the apothecary now differ from his predecessors? "The Yankees bate the divil for swallowing drugs," said an Irishman. "A paddy will take nothing but castor oil," replied the Yankee. Yankee or Irish, English or Scotch, French or German, they all rush to the drug store for pills, for powder, for whiskey (?), for tobacco, for patent medicines, and the druggists flourish. From the window near which I write this, I overlook a wholesale drug store on a "retail street." The front windows contain only _patent medicines_, and the flashy signs that announce their virtues. Few prescriptions are dispensed within. Before the door, piled nearly a story high, I have just counted ninety-eight boxes, and some barrels. There are hundreds of these drug houses scattered over this city; and every other city of America has its quota. Yes, the Irishman had the right of it; "the Yankees _do_ bate the divil for swallowing drugs." Further, it is my positive opinion that his infernal majesty beats a good many of them by the encouragement of their purchase; and, kind reader, if you have the ghost of a doubt of the truth of our intimation, don't, I pray, promulgate it, but, like a wise judge, withhold your decision until the evidence is in; until you hear our exposition of "patent medicines." A patient comes to the city for the purpose of consulting some experienced physician for a certain complaint. Probably he gets a prescription, with instructions to go to a certain respectable druggist or apothecary in town to have the necessary medicines put up. Of course a respectable physician knows of a reliable apothecary. The patient, in nine cases out of ten, desires to retain the prescription, and often does so. He goes to another drug store, more convenient, for a second quantity of the same; and now let me ask the patient,--no matter who or where he is,--did you ever get the same kind of medicine, in _look_, color, quantity, and taste,--all,--the second time, from the same prescription? I have often heard the patient complain that he could not get the same put up at the very store where he got the original prescription compounded. I once was called to visit a lady who was laboring under great prostration; "sickness at the stomach," with constipation. "What is the disease?" inquired the anxious husband, who had previously employed two regular physicians for the case, and discharged them both. "Nux vomica," was the reply. I gathered up three of the vials on the table, and, taking them to the designated apothecary's, I demanded the prescriptions corresponding with the numbers on the vials. These were duplicates. He had made a mistake! that's all. He had compounded an ounce of tincture of nux instead of a drachm! Not that a drachm could be taken at a dose with impunity; but whatever the dose was, the patient was continually taking eight times as much as the physician intended to prescribe. Another reason of the failure of the prescribing physician meeting the expectation anticipated, is the use of old and inert medicines. Where a man's treasure is, his heart is also. An apothecary's interest is more in nostrums, tobacco, _soda_, etc., than in medicines; how, then, can he follow the excellent advice of Dr. Bullyn, in article "14, that he peruse often his wares, that they corrupt not." But the greatest cheat is in the "substituting" business; the "_quid pro quo_." Horse aloes may be bought for ten cents a pound. Podophyllin costs seventy-five cents an ounce. They each act as cathartic, and I have detected the former put in place of the latter. How is the physician to know the cheat? How is the patient to detect it? Perhaps the former _stuff_--aloes--may have given the victim the hemorrhoids. One dose may be quite sufficient to produce that distressing disease. This only calls for another prescription! So it looks a deal like a "you tickle me, and I'll tickle you" profession, at best. Thus the patient becomes disgusted, and resorts to our next--"Patent Medicines." In closing this chapter on Apothecaries, I must relate a little scene to which I was an eye-witness. Meantime, let me say to the "respectable druggist," Don't be offended if I have slighted you by leaving you out, in my description of the various kinds of apothecaries enumerated above. There is a respectable class of druggists whom I have not mentioned, and doubtless you belong to that order. On going home one evening, not long since, I observed several boys, loud and boisterous, surrounding a lamp post. As I approached, I heard, among the cries and vociferations,-- "Howld to it, Jimmy; it'll be the makin' of ye." I drew nearer, and discovered a sickly-looking lad leaning up against the lamp post, with the stump of a cigar in his mouth, and a taller boy endeavoring to hold him up by his jacket collar, while a short-set urchin was stooping behind to assist in the task. They were evidently endeavoring to teach "Jimmy" to smoke. The poor fellow was deathly sick, and faintly begged to be let off. "O, no, no. Stick to it, Jimmy; it'll be the makin' of yese," was repeated. "Sure, ye'll niver do for a _sample clark in a potecary shop_," said another, as he blew a cloud of smoke from his own cigar stump into the pale face of the victim to modern accomplishments. [Illustration: A CANDIDATE FOR THE PRESIDENCY.] "General Grant smokes, Jimmy, and you'll never be a man if you don't learn," added a voice minus the brogue. A policeman here interfered, and rescued the wretched "Jimmy." "What is a sample clerk, my lad?" I asked of the boy who had used the above expression. "O, sir, he's the divil o' the 'potecary shop; the lean, pimply-faced urchin what tastes all the pizen drugs for the boss. If his constitution is tough enough to stand it the first year, then they makes a clark of him the nixt." [Illustration] III. PATENT MEDICINES "Expunge the whole."--POPE. "These are terrible alarms to persons grown fat and wealthy."--SOUTH. PATENT MEDICINES.--HOW STARTED.--HOW MADE.--THE WAY IMMENSE FORTUNES ARE REALIZED.--SPALDING'S GLUE.--SOURED SWILL.--SARSAPARILLA HUMBUGS.--S. P. TOWNSEND.--"A DOWN EAST FARMER'S STORY."--"WILD CHERRY" EXPOSITIONS.--"CAPTAIN WRAGGE'S PILL" A FAIR SAMPLE OF THE WHOLE.--HOW PILL SALES ARE STARTED.--A SLIP OF THE PEN.--"GRIPE PILLS."--SHAKSPEARE IMPROVED.--H. W. B. "FRUIT SYRUP."--HAIR TONICS.--A BALD BACHELOR'S EXPERIENCE.--A LUDICROUS STORY.--A WOLF IN SHEEP'S CLOTHING. In the former chapters are shown some of the causes which led to the present immense _demand_ for proprietary nostrums, or patent medicines. The conflicting "_isms_" and "_opathies_" of the medical fraternity, their quarrels and depreciations of one and another, their expositions of each other's weaknesses, frauds, and duplicities, disgusted the common people, who finally resorted to the irregulars, to astrologers, and humbugs of various pretensions, and to the few advertised nostrums of those earlier periods. "While there is life there is hope," and invalids would, and still continue to seize upon almost any promised relief from present pain and anticipated death. Speculative and unprincipled men have seldom been wanting, at any period, to profit by this misfortune of their fellow-creatures, and to play upon the credulity of the afflicted, by offering various compounds warranted to restore them to perfect health. At first such medicines were introduced by the owner going about personally and introducing them; subsequently, by employing equally unprincipled parties, of either sex, to go in advance, and tell of the wonderful cures that this particular nostrum had wrought upon them. And to listen to these lauders, one would be led to suppose that they had been afflicted with all the ills nameable, adapting themselves to the parties addressed,--yesterday, the gout; to-day, consumption, etc.,--regardless of truth or circumstance. The physician created the apothecary. The two opened the way for the less principled patent medicine vender. "Are not physicians and apothecaries sometimes owners of patent medicines?" is the inquiry raised. Yes, certainly; but the true physician, or honorable apothecary, is then sunk in the nostrum manufacturer. Next we have the mountebanks. These were attendant upon fairs and in the marketplaces, who, mounted upon a bench,--hence the name,--cried the marvellous virtues of the medicine, and, by the assistance of a _decoy_ in the crowd, often drove a lucrative business. Finally, upon the general introduction of printing, physician, apothecary, mountebank, speculator, all seized upon the "power of the press," to more extensively introduce their "wonderful discoveries." When you notice the name--and, O, ye gods, such names as are patched up to attract your attention!--to a new medicine, systematically and extensively advertised in every paper you chance to pick up, you wonder how any profit can accrue to the manufacturer of the compound after paying such enormous prices as column upon column in a thousand newspapers must necessarily cost. "If the articles cost anything at the outset," you go on to philosophize, "how can the manufacturers or proprietors make enough profit to pay for this colossal advertising?" The solution of the problem is embodied in your inquiry. They cost nothing, or as near to nothing as possible for worthless trash to cost. This is the secret of the fortunes made in advertised medicines. When we _know_ the complete worthlessness of the majority of the articles that are placed before the public,--yea, their more than worthlessness, for they are, many of them, highly injurious to the user,--the fact of their enormous consumption is truly astonishing. The drug-swallowing public has grown lean and poor in proportion as the manufacturers and venders of these villanous compounds have grown fat and wealthy. Said the proprietor of "Coe's Cough Balsam" and "Dyspepsia Cure" to the author, "If you have got a _good_ medicine, one of value, don't put it before the public. I can advertise _dish water_, and sell it, just as well as an article of merit. It is all in the advertising." As the above preparations were advertised on every board fence, and in every newspaper in New England at least, did his assertion imply that those articles were mere "_dish water_"? "SPALDING'S GLUE." I was informed by a Mr. Johnston, who engineered the advertising of the preparation, that it cost but one eighth of a cent per bottle. If you want to make a liquid glue, dissolve a quantity of common glue in water at nearly boiling point, say one pound of glue to a gallon of water; add an ounce or less of nitric acid to hold it in solution, and bottle. The more glue, the stronger the preparation. The pain-killers and liniments are the most costly, on account of the alcohol necessary to their manufacture; and, in fact, the principal item of expense in all liquid medical articles put up for public sale, is in the alcohol essential to their preservation against the extremes of heat and cold to which they may be subjected. SOURED SWILL. There is an article which "smells to heaven," the acidiferous title of which glares in mammoth letters from every road-side, wherein the audacious proprietor obviates the necessity of alcohol for its preparation or preservation. It is merely fermented slops--"dish water," minus the alcohol. Take a few handfuls of any bitter herbs, saturate them in any dirty pond water,--say a barrel full,--add some nitric acid, and bottle, without straining! Here you have _Vinegared Bitters_! The cheeky proprietor informs the "ignorant public" that, "if the _medicine_ becomes sour (ferments), as it sometimes will, being its 'nature so to do,' it does not detract from its medical virtues." True, true! for it never possessed "medical virtues." The cost of this villanous decoction is _scarcely half a cent a bottle_! Soured swill! It is recommended to cure fifty different complaints! It sells to fools for "one dollar a bottle," and will go through one like so much quicksilver. "Try a bottle," if you doubt it. The "dodge" is in advertising it as a temperance bitter. Having no alcoholic properties, it in no wise endangers the user in becoming addicted to _stimulants_. Sarsaparilla humbugs are only second to the above. But a few years since an immense fortune was realized by a New York speculator in human flesh on a "Sarsaparilla" which contained not one drop of that all but useless medicine; nor did it possess any real medical properties whatever. THE DOWN EAST FARMER'S STORY. To illustrate this point, we introduce the following conversation between the author and a "down east" farmer, in 1852:-- "It's all a humbug, is saxferilla!" exclaimed the old farmer, rapping his fist "hard down on the old oaken table." "Why, no; not _all_ sarsaparilla; you must admit--" "No difference. I tell you it's a pesky humbug, all of it." [Illustration: "IT'S ALL A HUMBUG."] Withdrawing his tobacco pipe from his mouth, he laid it on the table, and standing his thumb end on the board, as a "point of departure," he turned to me, and said,-- "Why, in the medical books it has been analyzed, and they say it's nothin' but sugar-house molasses, cheap whiskey, and a sprinkling of essence of wintergreen and saxafras. Git the book, and see 'Townsend's Saxferilla,' and that is the article! But they are all alike. Let me tell you about the great New York saxferilla speculation. One man, S. P. Townsend, started a compound like this here--nothin' but molasses and whiskey, and essence to scent it nicely. When he had got it advertised from Texas to the Gut of Canser (Canso, Provinces), from the Atlantic to the Specific, and was about to make his fortune off on it, some speculators see he was doin' a good thing, and, by zounds! they put their heads together, and their dollars, to have a finger in the pie; and they done it. This is the way they circumscribed him. They hired an old fellow,--I believe he was a porter in a store when they found him,--named Jacob Townsend, and a right rough old customer he was, all rags and dirt, hadn't but one reliable eye, and a regular old rumsucker. "Well, they fixed him up with a fine suit of clothes, and, by zounds! they palmed him off for the original, Simon Pure saxferilla man. So they advertised him as the real ginuine Townsend, and started a 'saxferilla,' with his ugly old face on the bottles, and said that the other was counterfeit, you see; and there he sat, with his one eye cocked on the crowd of customers that crowded round to see the ginuine thing, you know. So they blowed the other saxferilla as counterfeit, and finding in a store a bottle or two that had _fomented_, they made a great noise about the bogus saxferilla, 'busting the bottles,' and all that, and again asserting that the Jacob Townsend was the true blue, Simon Pure; and it took, by zounds! Yes, the public swallowed the lie, the saxferilla, old Jacob, and all. I hearn that both the parties made a fortune on it." Stopping to take a whiff at his neglected pipe, he resumed:-- "Saxferilla is all a humbug!" S. P. Townsend, as is well known, amassed a fortune, at one time, on the profits of the "sarsaparilla," put up, as the reader may remember, in huge, square, black bottles. The Boston Medical and Surgical Journal, Vol. XL. p. 237, says, "Townsend's Sarsaparilla, Albany, N. Y., in nearly black bottles," is "composed of molasses, extract of roots _or_ barks (sassafras bark is better than essence, because of body and color), and _probably_ senna and sarsaparilla. A. A. HAYES, State Assayer." The medical properties are all a _supposition_, even though Dr. Hayes was _hired_ to give the analysis of it to the public, in the interest of the proprietor, and consequently he would not detract from its _supposed_ merits. Pectorals, wild cherry preparations, etc., are cheaply made. Oil of almonds produces the _cherry_ flavor, _hydrocyanic acid_ (prussic acid, a virulent poison) and morphine, or opium, constitute the medical properties. I have not examined the exception to the above. _Pills._ The bitter and cathartic properties of nearly every pill in the market,--advertised preparation,--whether "mandrake," "liver," "vegetable," or what else, are made up from aloes, the coarsest and cheapest of all bitter cathartics. One is as good as another. You pay your money, however; you can take your choice. One holds the ascendency in proportion to the money or cheek invested by the owner in its introduction. A great Philadelphia pill, now sold in all the drug stores of America, was introduced by the following "dodge": The owner began small. He took his pills to the druggists, and, as he could not sell an unknown and unadvertised patent pill, he left a few boxes on commission. He then sent round and bought them up. Their ready sale induced the druggists to purchase again, for cash. The proprietor invested the surplus cash in advertising their "rapid sale," as well as their "rare virtues," and by puffing, and a little more buying up, he got them started. He necessarily must keep them advertised, or they would become a _drug_ in market. Wilkie Collins, Esq., in "No Name," has the best written description of the _modus operandi_ of keeping a "pill before the people," and I cannot refrain from quoting Captain Wragge to Magdalen in this connection. "My dear girl, I have been occupied, since we last saw each other, in slightly modifying my old professional habits. I have shifted from moral agriculture to medical agriculture. Formerly I preyed on the public sympathy; now I prey on the public's stomach. Stomach and sympathy, sympathy and stomach. The founders of my fortune are three in number: their names are Aloes, Scammony, and Gamboge. In plainer words, I am now living--on a pill! I made a little money, if you remember, by my friendly connection with you. I made a little more by the happy decease (_Requiescat in pace_) of that female relative of Mrs. Wragge's. Very good! What do you think I did? I invested the whole of my capital, at one fell swoop, in advertising a pill, and purchased my drugs and pill boxes on credit. The result is before you. Here I am, a grand financial fact, with my clothes positively paid for, and a balance at my banker's; with my servant in livery, and my gig at the door; solvent, popular, and all on a pill!" Magdalen smiled. "It's no laughing matter for the public, my dear; they can't get rid of me and my pill; they must take us. There is not a single form of appeal in the whole range of human advertisement which I am not making to the unfortunate public at this moment. Hire the last novel--there I am inside the covers of the book; send for the last song--the instant you open the leaves I drop out of it; take a cab--I fly in at the windows in red; buy a box of tooth-powders at the chemists--I wrap it up in blue; show yourself at the theatre--I flutter down from the galleries in yellow. The mere titles of my advertisements are quite irresistible. Let me quote a few from last week's issue. Proverbial title: 'A pill in time saves nine.' Familiar title: 'Excuse me, how is your stomach?' Patriotic title: 'What are the three characteristics of a true-born Englishman?--his hearth, his home, and his pill;' etc. "The place in which I make my pill is an advertisement in itself. I have one of the largest shops in London. Behind the counter, visible to the public through the lucid medium of plate glass, are four and twenty young men, in white aprons, making the pill. Behind another, four and twenty making the boxes. At the bottom of the shop are three elderly accountants, posting the vast financial transactions accruing from the pill, in three enormous ledgers. Over the door are my name, portrait, and autograph, expanded to colossal proportions, and surrounded, in flowing letters, the motto of the establishment: 'DOWN WITH THE DOCTORS.' Mrs. Wragge contributes her quota to this prodigious enterprise. She is the celebrated woman whom I have cured of indescribable agonies, from every complaint under the sun. Her _portrait_ is engraved on all the wrappers, with the following inscription: 'Before she took the pill,' etc." [In this country we are familiar with the ghostly looking picture of a man, the said proprietor of a medicine, "before he took the pill" (aloes), and "after;" the "after" being represented by a ridiculous extreme of muscular and adipose tissue.] "Captain Wragge's" is the style in which most medicines are placed before the public. We take up our morning journal: its columns are crowded by patent medicine advertisements. We turn in disgust from their glaring statements, and attempt to read a news item. We get half through, and find we are sold into reading a puff for the same trashy article. We take a horse-car for up or down town, and opposite, in bold and variegated letters, the persistent remedy (?) stares you continually in the face. We enter the post office: the lobbies are employed for the exposition, perhaps sale, of the patent medicines. We open our box: "O, we've a large mail to-day!" we exclaim; when, lo! half of the envelopes contain patent medicine advertisements, which have been run through the post office into every man's box in the department. And so it goes all day. We breakfast on aloes, dine on quassia, sup on logwood and myrrh, and sleep on morphine and prussic acid! "The humors of the press" sometimes inadvertently tell you the truth respecting this or that remedy advertised in their columns. A religious newspaper before me says of a proprietary medicine, "Advertised in another column of our paper: It is a _hell-deserving_ article." Probably the copy read, "Well-deserving article." Said a certain paper, "A correspondent, whose duty it was to 'read up' the religious weeklies, has concluded that the reason of those journals devoting so much space to patent medicine announcements is, 'that the object of religion and quackery are similar--both prepare us for another and better world.'" The proprietor of a pill,--not Captain Wragge,--threatened recently to prosecute a New Hampshire newspaper publisher for a puff of his "Gripe Pills." As every fool, as well as some wise people, read the "personals" in the papers, an occasional notice of a tooth-paste, bitter, or tonic is inserted therein, thus:-- "AUGUSTUS APOLPHUS: I will deceive you no longer. My conscience upbraids me. Those pearly white teeth you so much admire are false! false! They were made by Dr. Grinder, dentist. I use Dr. Scourer's tooth-paste, which keeps them clean and white. 'O, how sharper than a serpent's thanks it is to have a toothless child.' SUSAN JANE." Great and public men are sometimes induced or inveigled into recommending a patent medicine. In London, one Joshua Ward, a drysalter, of Thames Street, about the year 1780, introduced a pill, composed of the usual ingredients,--aloes and senna,--which, owing to some benefit he was supposed to have derived from their use, Lord Chief Baron Reynolds was led to praise in the highest terms. The result of this high dignitary's patronage was to give prominence to Ward and his pills, which subsequently sold for the fabulous price of 2s. 6d. a pill! General Churchill added his praise, and Ward was called as a physician to prescribe for the king. Either in consequence, or in spite of the treatment, the royal malady disappeared, and Ward was _re_warded with a solemn vote of the House of Commons protecting him from the interdiction of the College of Physicians. In addition to the liberal fee, he asked for and obtained the privilege of driving his carriage through St. James Park! Notwithstanding the pill, Reynolds died of his disease not long afterwards. Henry Fielding subscribed to the wonderful efficacy of "Tar Water," a nostrum of his day, but died of the disease for which it was recommended. Some time prior to 1780 there was published in the newspapers a list of the patent nostrums, or advertised remedies, in London, which numbered upwards of two hundred. Now there are known, in the United States alone, to be upwards of three hundred differently named hair preparations. Dr. Head, of whom we have made mention, "realized large sums from worthless quack nostrums," while at the same time another popular physician, with a Cambridge (England) diploma in his office, was proprietor of a "gout mixture," which sold at the shops for two shillings a bottle. Some of these shameless scoundrels, owners of advertised nostrums, with little or no sense of honor, have published the recommendations of great men, without the knowledge or permission of the parties whose names were so falsely affixed to their worthless stuff. A New York quack recently used the name of Henry Ward Beecher in this manner. Mr. Beecher published him as a thief and forger of his name, which only served to bring the doctor (?) into universal notice. Only to-day I read his impudent advertisement in a newspaper, with Mr. Beecher's name affixed as reference. If you prosecute one of the villains for issuing false certificates, even for forging your own name, it does him no great injury, you get no satisfaction, and in the end it only serves to call public attention to a worthless article, thereby increasing its sale. In the London _Medical Journal_ of 1806, Dr. Lettsom attacked and exposed a "nervous cordial," stating that it was a deleterious article; "that it had killed its thousands;" and further asserted that Brodum, its proprietor, was a Jewish knave, having been a bootblack in Copenhagen, and a wholesale murderer. Brodum at once brought an action against the proprietor of the _Journal_, laying the damages at twenty-five thousand dollars. Brodum held the advantage, and the _Journal_ proprietor asked for terms of settlement. Brodum's terms were not modest. He, through his attorney, agreed to withdraw the action provided the name of the author was revealed, and that he should whitewash the quack in the next number of the _Journal_, over the same signature! Dr. Lettsom consented to these terms, paid the lawyers' bills and costs, amounting to three hundred and ninety pounds, and wrote the required puff of Brodum and his nostrum. SOOTHING SYRUPS, nervous cordials, etc., owe their soothing properties to opium, or its salt--morphine. From "OPIUM AND THE OPIUM APPETITE," by Alonzo Calkins, M. D., we are informed that an article sold as "Mrs. Winslow's Soothing Syrup," for children teething, contains nearly _one grain of the alkaloid_ (morphine) _to each ounce of the syrup_! Taking one teaspoonful as the dose (that is, one drachm), and there being eight drachms to the ounce, consequently about one eighth of a grain of morphine is given to an infant at a dose! Do you wonder it gives him a _quietus_? Do you wonder that the mortality among children is greatly on the increase? that so many of the darling, helpless little innocents die from dropsy, brain fever, epileptic fits, and the like? FRUIT SYRUPS FOR SODA WATER. Perhaps you take yours "plain." No! Then you may want to know how the pure fruit syrup, which sweetens and flavors the soda, is made. The "soda" itself is a very harmless article. BUTYRIC ETHER is usually taken for a basis. Butyric ether is manufactured from rancid butter, old rotten cheese, or Limburger cheese. The latter is the "loudest," and affords the best flavor to the ether. The cheese is treated with sulphuric acid. Old leather is known to give it a particularly fine flavor. Any old boots and shoes will answer. PINEAPPLE SYRUP is made from butyric and formic ether. The latter is manufactured from soap or glycerine. Sulphuric acid and red ants will do as well. STRAWBERRY is made of twelve parts of butyric ether and one of acetic ether, alcohol, and water. Color with cochineal--a bug of the tick species, from Mexico. Sometimes a little real strawberry is added, but it is not deemed essential. RASPBERRY is made from the same articles. If convenient, the druggist adds a little raspberry jam or syrup. If not, color a little deeper, add some strawberry, and change the label to raspberry. VANILLA SYRUP is made of Tonqua beans, such as boys sell on the street. PEACH is made from bitter almonds. WILD CHERRY the same. NECTAR is formed by a compound of various syrups and Madeira wine. You can easily make the Madeira of neutral spirits, sugar, raisins, and logwood to color it. SARSAPARILLA. Take the cheapest and nastiest molasses obtainable. Strain it to remove dead bees, sticks, cockroaches, etc. Flavor with essence sassafras and wintergreen. Little extract sarsaparilla will do no harm if added to the mixture. It is very harmless. LEMON is made of citric acid and sugar. COFFEE is made mostly of chiccory, burnt livers, sometimes a little coffee bean. Horses' livers are said to be the best, giving it a _racy_ flavor, and more _body_. "They are all very good," the vender tells you; he takes his plain, however. You see how much cheaper these are than the _real_ fruit syrup itself; and as neither you nor I can tell the difference by _taste_, what inducement has the dealer in soda water to use the costlier articles? I have a friend who sells the "pure syrups," and I presume the reader has also; but I respectfully decline drinking soda water with "pure fruit syrups." POISONOUS HAIR TONICS AND COSMETICS. Extract from the report of Professor C. F. Chandler, Ph. D., chemist to the Metropolitan Board of Health. This report, which presents the results of the examination of a few of the articles in general use, was printed in full in the Chemical News (American reprint) for May, 1870. We present the following list of dangerous preparations, which gives the number of grains of lead, etc., in one fluid ounce. I. HAIR TONICS, WASHES, AND RESTORATIVES. Grains of lead in one fluid ounce. 1. Clark's Distilled Restorative for the Hair, 0.11 2. Chevalier's Life for the Hair, 1.02 3. Circassian Hair Rejuvenator, 2.71 4. Ayer's Hair Vigor, 2.89 5. Professor Wood's Hair Restorative, 3.08 6. Dr. J. J. O'Brien's Hair Restorer, America, 3.28 7. Gray's Celebrated Hair Restorative, 3.39 8. Phalon's Vitalia, 4.69 9. Ring's Vegetable Ambrosia, 5.00 10. Mrs. S. A. Allen's World's Hair Restorer, 5.57 11. L. Knittel's Indian Hair Tonique, 6.29 12. Hall's Vegetable Sicilian Hair Renewer, 7.13 13. Dr. Tebbet's Physiological Hair Regenerator, 7.44 14. Martha Washington Hair Restorative, 9.80 15. Singer's Hair Restorative, 16.39 II. LOTIONS OR WASHES FOR THE COMPLEXION. _Perry's Moth and Freckle Lotion._ Mercury in solution, 2.67 gr. }equiv.{ Corrosive Sub., 3.61 gr. Zinc in solution, 0.99 " } to { Sulphate of Zinc, 4.25 " The sediment contains mercury, lead, and bismuth. III. ENAMELS FOR THE SKIN. Grains of lead in one fluid ounce, after shaking. Eugenie's Favorite, 108.94 grains. Phalon's Snow-white Enamel, 146.28 " Phalon's Snow-white Oriental Cream, 190.99 " CONCLUSION.--It appears from the foregoing,-- 1. The HAIR TONICS, WASHES, and RESTORATIVES contain lead in considerable quantities; that they owe their action to this metal, and that they are consequently highly dangerous to the health of persons using them. 2. With a single exception, Perry's Moth and Freckle Lotion, the LOTIONS for the skin are free from lead and other injurious metals. 3. That the ENAMELS are composed of either carbonate of lime, oxide of zinc, or carbonate of lead, suspended in water. The first two classes of enamels are comparatively harmless; as harmless as any other white dirt, when plastered over the skin to close the pores and prevent its healthy action. On the other hand, the enamels composed of carbonate of lead are highly dangerous, and their use is very certain to produce disastrous results to those who patronize them. HAIR RESTORATIVES: A BALD BACHELOR'S EXPERIENCE. A gentleman of perhaps thirty-five years of age once called upon the writer for advice relative to baldness, when he related the following experience, permitting me to make a note of it at leisure. "In 1865 my friends intimated to me that my hair was getting slightly thin on the crown of my head. I have always had a mortal terror of being bald, and daily examinations convinced me that my fears were about to be realized. My first inquiry was for a remedy. "'What shall I do to prevent its falling out?' I nervously inquired. "'Get a bottle of Dr. ----'s Hair Restorative,' one advised; another, some different preparation,--all advertised remedies,--till I had a list a yard long of various washes, preventives, restorers, etc., _ad infinitum_. "I obtained one of _the very best_. I used it as directed. It _stuck_ as though its virtue consisted in sticking the loose hairs firmly to the firmer-rooted ones. But alas! after a month's trial, sufficient hair had come out of my head to make a respectable _chignon_! "I next got some of Mrs. A. S. S. Allon's--or All--something; I forget the rest of the name; I'm sure of the A. S. S., however,--and that was worse than the _gum-stick-'em_ kind, for the hair came out faster than before. "In despair, I applied to a 'respectable apothecary,' who keeps the next corner drug store. 'For God's sake, Mr. Bilious, have you got any good preventive for falling of the hair?' I exclaimed. "'O, yes, just the article,' he replied, rubbing his palms vigorously. He then showed me his stock, consisting of _thirty-nine different kinds_! "'All very good--highly recommended,' he remarked, with commendable impartiality. "I selected one--with rather an ominous name, I admit:--_Kat-hair-on_!--preferring cat's hair to none. "I used the Kathairon according to directions." "'Did the cat's hair grow?' I anxiously inquired. "'Neither cat's hair nor human hair.' No. Worse and worse. I was about to abandon all effort, when, stopping on a corner to get a young boot-black to shine my boots, preparatory to making a call on a lady acquaintance, before whom I was desirous of making a genteel appearance, a dirty, ragged little urchin peered around the block, and exclaimed, 'O, mister, you're barefooted on top o' yer head!' I had inadvertently removed my hat, to wipe my forehead. [Illustration: "BAREFOOTED ON THE TOP OF HIS HEAD."] "This was the last feather. Though coming from but a dirty boot-black, it stung me to the marrow. I kicked over the boy, box, blacking, and all, and rushed into the nearest drug shop. I bought another new hair preparation. Another ominous name--'_Bare-it_!' "This I also used, as directed on the label, for a month. 'I think,' I said, 'if I use it a second month, it will entirely _bare it_!' "I bought a wig, and had my head shaved. I didn't lock myself up in a coal-cellar, or hide under a tub, like Diogenes, but I felt that I would have gladly done either, to hide myself from the eyes of the world. The girls all cast shy glances at me as they passed; as though the majority of _them_ did not wear false hair! "In utter desperation, I visited a dermatologist. What a name to make hair grow! Well, he examined my scalp with a microscope, and said the hair could be made to grow anew. 'I discover myriads of germs, which only require the right treatment in order to spring up in an exuberant crop of wavy tresses.' I bought his preparations. Bill, thirty-eight dollars. They were worthless. "Soon after this failure, I heard of a new remedy--'a sure cure.' The proprietor possessed a world-wide reputation, from the manufacture of various other remedies for nearly all diseases to which we poor mortals are subject, and there might be something in this. It was recommended to cure baldness, and restore gray hair to its natural color. I would go and see the proprietor of this excellent hair restorer. I hastened to Lowell. I was ushered into the doctor's sanctum--into the very presence of this Napoleon of medicine-makers, the Alexander of conquered worlds--of medical prejudices! "With hat in hand, I bowed low to the great Doctor Hair--or hair doctor. He beheld my veneration for himself. With a practised eye, he noted my genteel apparel. Flattered by my obeisance, and not to be outdone in politeness, he arose, removed his tile, and bowed equally low in return to my profound salutation, when lo! _O tempora! O mores!_ he was both bald and gray! I retired without specifying the object of my visit." A WOLF IN SHEEP'S CLOTHING. When a man tells you, point blank, that he is selling an article for the profit of it, believe him; but when he asserts that he is advertising and offering a remedy solely for the public good, for the benefit of suffering humanity, he is a liar. Beware of such. Furthermore, when he publishes an advertisement in every paper in the land, announcing that himself having been miraculously or "providentially" cured of a _variety_ of diseases by a certain compound, the _prescription_ for which he will send free to any address, you should hesitate, until satisfied of the disinterestedness of the party, and meantime ask yourself the following question: "Provided this be true, why don't the unparalleled benevolent gentleman _publish the recipe_, which would cost so much less than this persistent advertising 'that he will send it to any requiring it'? And you are next led to ask,-- "Where is the 'dodge'? For money is what he is after." A reverend (?), a scoundrel, a "wolf in sheep's clothing," advertises in nearly every paper you chance to notice, especially _religious_ newspapers, a remedy he discovered while a missionary to some foreign country, that cured him of a _variety_ of diseases, the recipe for which medicine he will send to any address, _free of charge_. "Here is the '_Old Sands of Life_' dodge," I said, "which I had the satisfaction of exposing fourteen years ago." The reader may recollect the advertisement of "A Retired Physician, seventy-five years of age, whose sands of life had nearly run out," who advertised so extensively a remedy which cured his daughter, etc., which remedy he would send _free_, to the afflicted, on application. I investigated his "little fraud." I found, instead of an old man "seventy-five years of age," a young man of about twenty-eight or thirty. He was no reverend. He had no daughter. He was a tall, gaunt, profane, tobacco-chewing, foul-mouthed fellow, with a bad impediment in his speech from loss of palate, whose name _was_ Oliver Phipps Brown, a printer by trade, who formerly worked as journeyman in the _Courant_ office, Hartford, Conn. The police finally got hold of him, and broke up the swindle. [Illustration: OLD "SANDS OF LIFE."] Here is now a parallel case. The above _reverend_ says he will send the recipe free. I directed my student to write for it. The recipe came, with various articles named therein, supposed to be the Latin names of plants. I assert that there are no such medicines in the Materia Medica, or the world. The _reverend_ don't want that there should be. Why? Because you would not then send to him for his "Compound." He sends with his recipe a circular, in which he gives you the history of _his marvellous discovery_. Further along, by some oversight, he says it was made known to him through a physician! The names are bogus. The whole remedy is a humbug. There are names in it as _species_ which sound something like some medical term; and the druggist may be deceived thereby. The reverend quack, foreseeing "the difficulty in obtaining the articles in their purity at any druggist's," advises you to send to him for them. Do you begin to see the _dodge_? He "will furnish it at _cost_." Only think! How benevolent! "My means make me independent." Think again. An invalid from boyhood, his time and means exhausted in travelling "in Europe two years," and was only "sent a missionary (?) through the kindness of friends," he assures us in his circular. Here he _discovered through an old physician_--surely a new mode of discovery--this wonderful compound, which cured him in "six weeks," and forthwith, in gratitude, he proceeded to New York, and began putting up this marvellous remedy "_at cost_." Let us examine the article sold for three dollars and a half a small package. Dr. Hall, of the "Journal of Health," examined the article which "Old Sands of Life" sold as _Canabis Indica_, and found the cost "_but sixteen cents, bottle and all_." Nevertheless, "The Retired Physician" sold it to his dupes for two dollars. I do not hesitate to say that the above compound cost even _less than sixteen cents a package_. "But," said a gentleman to me, "he is connected with the Bible House. Here is his address: 'Station D, Bible House, New York.'" "There is a post-station by that name. Suppose I should give an address, '34 Museum Building.' Would that imply that I was a play-actor, or owner of the Museum?" I replied. "Then it is only another 'Reverend' dodge--is it?" he asked. "Precisely; it is to give character to his characterless address." "Don't the newspaper publishers know it is a swindle?" he suggested. "There's not the least doubt that they know it." "Then hereafter I shall have little faith in the religion or honesty of the newspaper that publishes such swindling advertisements." "Admitting that they know the dishonesty of the thing,--and how can any man endowed with common sense but see that there is _swindle_ on the face of it?--the publisher of that advertisement is a _particeps criminis_ in the transaction." "Why don't some of the thousand victims who have been swindled into buying this worthless stuff expose him?" "In exposing the _reverend wolf_, don't you see they would expose their own weakness? This is the reason of the fellow's selecting the peculiar class of diseases as curable by his great discovery. The poor sufferer does not wish the community to know that he is afflicted by such a disease." "It is truly a great dodge; and no doubt the knave has found fools enough to make him '_independent_.'" * * * * * RULES. 1. Take no patent or advertised medicines at all. They are of no earthly use! You never require them, as they are not conducive to your health, happiness, or longevity. There are physicians who can cure every disease that flesh is heir to--_excepting one_. 2. Apply in your need only to a respectable physician. 3. Give your preference to such as administer the smallest quantities of medicine--_and are successful in their practice_. * * * * * I have barely begun to exhaust the material I have been years collecting for this chapter; but I must desist, to give room for other important expositions. [Illustration] IV. MANUFACTURED DOCTORS. "One says, 'I'm not of any school; No living master gives me rule; Nor do I in the old tracks tread; I scorn to learn aught from the dead.' Which means, if I am not mistook, 'I am an ass on my own hook.'" A BOSTON BARBER AS M. D.--A BARBER "GONE TO POT."--FOOLS MADE DOCTORS.--BAKERS.--BARBERS.--"A LUCKY DOG."--TINKERS.--ROYAL FAVORS.--"LITTLE CARVER DAVY."--A BUTCHER'S BLOCKHEAD.--A SWEEPING VISIT.--HOP-PED FROM OBSCURITY.--PEDAGOGUES TURN DOCTORS.--ARBUTHNOT.--"A QUAKER."--"WALKS OFF ON HIS EAR."--WEAVERS AND BASKET-MAKERS.--A TOUGH PRINCE; REQUIRED THREE M. D.'S TO KILL HIM.--MARAT A HORSE DOCTOR.--A MERRY PARSON.--BLACK MAIL.--POLICE AS A MIDWIFE, ETC., ETC. "Every man is either a physician or a fool at forty," says the old proverb. "May not a man be both?" suggested Canning, in the presence of a circle of friends, before whom Sir Henry Halford happened to quote the old saying. "There is generally a fool in every family, whom the parents select at once for a priest or a physician," said Peter Pindar. He was good authority. I am of the opinion that there are many whose mental capacity has been overrated, who have made doctors of themselves; but we are not to treat of fools in this chapter, but of men whom _circumstances_ have created physicians, and of men who, in spite of circumstances of birth or education, have made themselves doctors. In the choice of a trade or profession, every young man should weigh carefully his natural capacity to the pursuit selected. His parents or guardians should consult the youth's adaptability rather than their own convenience. How many have dragged out a miserable existence by ill choice of a calling! Men who were destined by nature to be wood-sawyers and diggers of trenches, are found daily taking upon themselves the immense responsibility of teaching those whose mental calibre is far above their own, or assuming the greater responsibility of administering to the afflicted. If a man finds himself adapted to a higher calling than that originally selected for him by his friends, by all means let him "come up higher;" but too many by far have changed from a trade to a profession to which they had no adaptability. So we find men in the medical profession who were better as they were,--bakers, barbers, butchers, tailors, tinkers, pedagogues, cobblers, horse doctors, etc., etc. There used to be a fish-peddler going about Boston, blowing a fish-horn, and crying his "fresh cod an' haddock," who, getting tired of that loud crying and loud smelling occupation, took to blowing his horn for his "wonderful discovery" of a "pasture weed," which cured every humor but a thundering humor (one can see the humor of the joke), and every eruption since the eruption of Hecla in 1783,--which is a pity that he had not made his discovery in time to have tried it on old Hecla's back when it was up. BARBERS AS DOCTORS. A barber of Boston, accidentally overhearing a gentleman mention a certain remedy for the "barber's itch," seized upon the idea of speculating upon it, and at once sold out his shop, made up the ointment, clapped M. D. to his name, put out his circulars, and is now seeking whom he may devour, as a physician. With the looseness of morals and the laxity of our laws, one of these fellows "can make a doctor as quick as a tinker can make a tin kettle." Probably more barbers have become doctors than any other artisans, for the reason that barbers were formerly nearly the only acknowledged "blood-letters." In the earlier days of Abernethy, barber surgeons were recognized, and the great doctor said of himself, "I have often doffed my hat to those fellows, with a razor between their teeth and a lancet in their hands." Doubtless some of them arrived to usefulness in the profession. Dr. Ambrose Paré, a French barber surgeon, was called the father of French surgery, and enjoyed the confidence of Charles IX. An eminent surgeon of London was Mr. Pott. He was contemporary with Dr. Hunter, and gave lectures at St. Bartholomew Hospital in Hunter's presence. Some person asking a wag one day where Dr. Hunter was, he replied that, "with barber surgeons he _had gone to pot_." This alliance of surgery and shaving, to say nothing of other qualifications with which they were sometimes associated, conceivably enough furnished some pretext for apprenticeships, since Dickey Gossip's definition of "Shaving and tooth-drawing, Bleeding, cabbaging, and sawing," was by no means always sufficiently comprehensive to include the multifarious accomplishments of "the doctor." "I have seen," says Dr. Macillwain, of England, "within twenty-five years, chemist, druggist, surgeon, apothecary, and the significant, '&c.,' followed by hatter, hosier, and linen draper, all in one establishment." I saw in New Hampshire, in 1864, doctor, barber, and apothecary represented by one man. William Butts, another barber surgeon of London, was called to attend Henry VIII., and was rewarded for his professional services with the honor of knighthood in 1512. Another, who was knighted by Henry VIII., was John Ayliffe, a sheriff, formerly a merchant of Blackwell Hall. Royalty had a chronic habit of knighting quacks. Queen Anne became so charmed by a tailor, who had turned doctor, and who, by some hook or crook, was called to prescribe for the queen's weak eyes, that she had him sworn in, with another knave, as her own oculist. "This lucky gentleman," says a reliable author, "was William Reade, a botching tailor of Grub Street, London. To the very last he was a great ignoramus, as a work entitled 'A Short and Exact Account of all Diseases Incident to the Eyes,' attests; yet he rose to knighthood, and the most lucrative and fashionable practice of the period." Reade (_Sir William_) was unable to read the book he had published (written by an _amanuensis_); nevertheless, aristocracy, and wise and worthy people at that, who listened to his dignified voice, viewed his pompous person, encased in rich garments, and adorned with jewelry and lace ruffles, _cap-a-pie_, resting his chin upon his enormous gold-headed cane, as, reclining in his splendid coach, drawn by a span of superb blood horses, up to St. James, considered him the most learned and eminent physician of that generation. In the British Museum is deposited a copy of a poem to the great oculist. This poem Reade himself had written, at the hand of a penny-a-liner, a "poet of Grub Street," immediately after he was knighted, which has been mainly instrumental in handing his name down to posterity. TINKER AS DOCTOR. About the year 1705, one Roger Grant rose into public notice in London, by his publication of his own "marvellous cures." This fellow was no fool, though a great knave. He was formerly a travelling tinker, subsequently a cobbler, and Anabaptist preacher. From tinkering of pots, he became mender of soles of men's boots and shoes; thence saver of souls from perdition, a tinkerer of sore eyes, and lightener of the body. The following bit of poetry was written in 1708 for his benefit, the "picture" being one which Grant, who was a very vain man, had gotten up from a copperplate likeness of himself, to distribute among his friends. The picture was found posted up conspicuously with the lines:-- "A tinker first, his scene of life began; That failing, he set up for a cunning man; But, wanting luck, puts on a new disguise, And now pretends that he can cure your eyes. But this expect, that, like a tinker true, Where he repairs one eye, he puts out two." [Illustration: THE EYE DOCTOR.] He worked himself into notoriety by the publication, in pamphlet form, of his cures,--a mixture of truth strongly spiced with falsehood,--and scattering it over the community. "His plan was to get hold of some poor, ignorant person, of imperfect vision, and, after treating him with medicine and half-crowns for a few weeks, induce him to sign a testimonial, which he probably had never read, that he was born blind, and by the providential intervention of Dr. Grant, he had been entirely restored. To this certificate the clergyman and church-wardens of the parish, in which the patient had been known to wander in mendicancy, were asked to attest; and if they proved impregnable to the cunning representations of the importunate solicitors, and declined to sign the certificate, the doctor did not scruple to save them that trouble by signing their names himself." More than once was the charge of being a tinker preferred against him. The following satire was written and published for his benefit--with Dr. Reade's--after Queen Anne had Dr. Grant sworn in as her "oculist in ordinary":-- "Her majesty sure was in a surprise, Or else was very short-sighted, When a tinker was sworn to look to her eyes, And the mountebank Reade was knighted." "THE LITTLE CARVER DAVY." The distinguished chemical philosopher and physician of Penzance, Sir Humphry Davy, Bart., was the son of a poor wood-carver, at which trade Humphry worked in his earlier days, and was named by his familiar associates, the "Little Carver Davy." On the death of his father, the widow established herself as a milliner at Penzance, where she apprenticed her son to an apothecary. His mother was a woman of talent and great moral sense. When, as Sir Humphry, he had reached the summit of his fame, he looked back upon the facts of his humble origin, his father's plebeian occupation and associates, and his mother's mean pursuit, followed for his benefit, with mortification instead of regarding them as sources of pride. A BUTCHER BOY ESCAPES THE CLEAVER AND BECOMES A GREAT PHYSICIAN AND POET. In a rickety old three story house, the lower part of which was occupied as a butcher's shop and trader's room, and the upper stories as a dwelling-house, at Newcastle-upon-Tyne, in 1721, was born Mark Akenside. His father was a butcher, and one day, as the boy Mark was assisting at the menial occupation of cutting up a calf, a cleaver fell from the shop block upon another "calf,"--that of young Akenside's leg,--which lamed him for life. [Illustration: THE YOUNG SURGEON'S FIRST EXPERIENCE.] Akenside was a Nonconformist, and by the aid of the Dissenters' Society young Mark was sent to Edinburgh to study theology. From theology he went to physic, his honest parent refunding the money to the society paid for his studies under their patronage, and he subsequently obtained his degree at Cambridge, and became a fellow of the R. S. Like Davy, Akenside became ashamed of his plebeian origin. His lameness, like Lord Byron's, was a continual source of mortification to him. He became a physician to St. Thomas; and, as he went with the students the rounds of the hospital, the fastidiousness of the little bunch of dignity at having come so closely in contact with the vulgar rabble, induced him, at times, to make the strongest patients precede him with _brooms_, to clear a way for him through the crowd of diseased wretches, who, nevertheless, had wonderful faith in his wisdom, and would cry out, "_Bravo for the butcher boy with a game leg!_" as they fell back before the fearful charge of corn brooms. By the assistance of friends, and his ever extensive practice, Akenside was enabled, to the day of his death, in 1770, to keep his carriage, wear his gold-hilted sword, and his huge well-powdered wig. HOW ONE HOP-PED FROM OBSCURITY. "Dr. Messenger Monsey, in the heyday of his prosperity, used to assert to his friends that the first of his known ancestors was a baker and a retailer of hops. At a critical point of this worthy man's career, when hops were 'down,' and feathers 'up,' in order to raise the needful for present emergencies he ripped up his beds, sold the feathers, and refilled the ticks with hops. When a change occurred in the market soon afterwards the process was reversed; even the children's beds were reopened, and the hops sold for a large profit over the cost of replacing the feathers!" "That's the way, sirs, that my family hop-ped from obscurity," the doctor would conclude, with great gusto. The Duke of Leeds used, in the same manner, to delight in boasting of his lucky progenitor, Jack Osborn, the shop lad, who rescued his master's beautiful daughter from a watery grave at the bottom of the Thames, and won her hand away from a score of noble suitors, who wanted, literally, the young lady's _pin_-money as much as herself. Her father was a pin manufacturer, and had in his shop on London Bridge amassed a considerable wealth in the business. The jolly old man, instead of disdaining to bestow the lovely and wealthy maid--his only child--on an apprentice, exclaimed,-- "Jack Osborn won her, and Jack shall wear her." When Lord Bath vainly endeavored to effect a reconciliation between the doctor and Garrick, who had fallen out, Monsey said,-- "Why will your lordship trouble yourself with the squabbles of a merry-andrew and a _quack_ doctor?" Monsey continued his quarrel with Garrick up to the day of the death of the great tragedian. The latter seldom retaliated, but when he did his sarcasm cut to the bone. Garrick's style of satire may be inferred from his epigram on James Quin, the celebrated actor, and illegitimate son of an Irishman, "whose wife turned out a bigamist." When Garrick make his debut on the London stage, at Godman's Fields playhouse, October 19, 1741, as "Richard the Third," Quin objected to Garrick's original style, saying,-- "If this young fellow is right, myself and all the other actors are wrong." Being told that the theatre was crowded to the dome nightly to hear the new actor, Quin replied that "Garrick was a new religion; Whitefield was followed for a time, but they would all come to church again." Hence Garrick wrote the following epigram:-- "Pope Quin, who damns all churches but his own, Complains that heresy infects the town; That Whitefield-Garrick has misled the age, And taints the sound religion of the stage. 'Schism,' he cries, 'has turned the nation's brain, But eyes will open, and to church again!' Thou great Infallible, forbear to roar; Thy bulls and errors are revered no more. When doctrines meet with general approbation, It is not _heresy_, but reformation." When confined to his bed in his last sickness, Garrick had the advice of several of the best physicians, summoned to his villa near Hampton, and Monsey, in bad taste and worse temper, wrote a satire on the occurrence. He accused the actor of parsimony, among other mean qualities, and though, after the death of Garrick, January 22, 1779, he destroyed the verses, some portions of them got into print, of which the following is a sample:-- "Seven wise doctors lately met To save a wretched sinner. 'Come, Tom,' said Jack, 'pray let's be quick, Or we shall lose _our_ dinner.' "Some roared for rhubarb, jalap some, And others cried for Dover;[3] 'Let's give him something,' each one said, 'And then let's give him over.'" At last, after much learned wrangling, one more learned than the others proposed to arouse the energies of the dying man by jingling a purse of gold in his ear. This suggestion was acted upon, and "Soon as the favorite sound he heard, One faint effort he tried; He oped his eyes, he scratched his head, He gave one grasp--and died." Riding on horseback through Hyde Park, Monsey was accompanied by a Mr. Robinson, a Trinitarian preacher, who knew that the doctor's religion was of the Unitarian stamp. After deploring, in solemn tones, the corrupt state of morals, etc., the minister turned to Monsey, and said,-- "And, doctor, I am addressing one who believes there is no God." "And I," replied Monsey, "one who believes there are _three_." [Illustration: HEALING THE SICK WITH A GOLDEN DOSE.] The good man, greatly shocked, put spurs to his horse, and, without vouchsafing a "good day," rode away at a high gallop. PEDAGOGUES TURNED OUT AS DOCTORS. Some of the hundreds of respectable medical practitioners of this democratic country, who, between commencement and the following term, used to lengthen out their scanty means by "teaching the young idea how to shoot" in some far-off country village, will scarcely thank me for introducing the above-named subject to their present notice. However, it will depend somewhat upon the way they take it; whether, like Sir Davy, they are ashamed of their "small beginnings," or, like Dr. Monsey, they may independently snap their fingers in the face of their plebeian origin, and boast of their earlier common efforts for a better foothold among the great men of their generation. Among English physicians, with whom it was, and still is, counted a disgrace to have been previously known in a more humble calling, we may find a long list of "doctors pedagogic," beginning with Dr. John Bond, who taught school until the age of forty, when he turned doctor. He was a man of great learning, however, and became a successful physician. Even among the good people of Taunton, where he had resided and labored as a pedagogue in former years, he was esteemed as a "wise physician." John Arbuthnot was a "Scotch pedagogue." He was distinguished as a man of letters and of wit; the associate of Pope and Swift, and of Bolingbroke; a companion at the court of Queen Anne. Arbuthnot owed his social elevation to his quick wit, rare conversational powers, and fascinating address, rather than to his family influence, professional knowledge, or medical success. "Dorchester, where, as a young practitioner, he endeavored to establish himself, utterly refused to give him a living; but it doubtless," says Jeaffreson, "maintained more than one dull empiric in opulence. Failing to get a living among the rustic boors, who could appreciate no effort of the human voice but a fox-hunter's whoop, Arbuthnot packed up and went to London." Poverty for a while haunted his door in London, and to keep the wolf away he was compelled to resort to "the most hateful of all occupations--the personal instruction of the ignorant." Arbuthnot was a brilliant writer as well as fluent talker, and by his literary hit, "Examination of Dr. Woodward's Account of the Deluge," he was soon brought into notice. By the merest accident and the greatest fortune he was called to Prince George of Denmark, when his royal highness was suddenly taken sick, and, as all who fell within the circle of his magical private acquaintance were led to respect and love him, the doctor was retained in the good graces of the prince. On the death of Dr. Hannes, Arbuthnot received the appointment of physician-in-ordinary to the queen. The polished manner of the fortunate doctor, his handsome person, and flattering, cordial seeming address, especially to ladies, made him a court favorite. To retain the good graces of his royal patient, the queen, "he adopted a tone of affection for her as an individual, as well as a loyal devotion to her as a queen." His conversation, while it had the semblance of the utmost frankness, was foaming over with flattery. "If the queen won't swallow my pills she will my flattery," he is said to have whispered to his friend Swift; but this report is doubtful, as he stood in fear of the displeasure of the querulous, crotchety, weak-minded queen, who had but recently discharged Dr. Radcliffe for a slip of the tongue, when at the coffee-house he had said she had the "_vapors_." "What is the hour?" asked the queen of Arbuthnot. "Whatever hour it may please your majesty," was his characteristic reply, with his most winning smile and graceful obeisance. By this sort of flattery he retained his hold in the queen's favor till her death. By these facts one is reminded of the saying of Oxenstierna, when, on concluding the peace of Westphalia in 1648, he sent his young son John as plenipotentiary to the powers on that occasion, remarking, in presence of those who expressed their surprise thereat,-- "You do not know with how little wisdom men are governed." With the loss of the queen's patronage at her death, and his wine-loving proclivities, Dr. Arbuthnot became sick and poor, and died in straitened circumstances. ANOTHER POOR PEDAGOGUE, Who reached the acme of medical fame, and became court physician, was Sir Richard Blackmer. He surely ought not to have been called an ignoramus (by Dr. Johnson), for he resided thirteen years in the University of Oxford. After leaving Oxford, his extreme poverty compelled him to adopt the profession of a schoolmaster. In the year 1700 there were collected upwards of forty sets of ribald verses, under the title of "Commendary Verses, or the Author of Two Arthurs, and Satyr against Wit;" in which Sir Richard was taunted with his earlier poverty, and of having been a pedagogue! Every man has his advertisement and his advertisers. The poets and lampooners were Blackmer's. They assisted in bringing him into notoriety. Among them were Pope, Steele, and the obscene Dr. Garth. While the authors of those filthy, licentious productions (which no bar-maid or kitchen-scullion at this day could read without blushing behind her pots and kettles) were flattering themselves that they were injuring the honest doctor, they were bringing him daily into the notice of better men than themselves, and heaping ignominy upon the authors of such vile lampoons. One satire opened thus:-- "By nature meant, by want a pedant made, Blackmer at first professed the whipping trade. * * * * * In vain his pills as well as birch he tried; His boys grew blockheads, and his patients died." Mr. Jeaffreson says, "the same dull sarcasms about killing patients and whipping boys into blockheads are repeated over and again; and as if to show, with the greatest possible force, the pitch to which the evil of the times had risen, the coarsest and most disgusting of all these lampoon writers was a lady of rank,--the Countess of Sandwich!" Wouldn't a young Harvard or Yale medical graduate, without money, friends, or a practice, leap for joy with the knowledge that he had two-score _disinterested_ writers advertising him into universal notice, since it is considered a burning disgrace for an honorable, upright, and educated physician to advertise himself! Of course Sir Richard rose, in spite of his foes, to whom he seldom replied. He says, in one of his own works, "I am but a hard-working doctor, spending my days in coffee-houses (where physicians were wont to receive apothecaries, and, hearing the cases of their patients, prescribe for them without seeing them, at half price), receiving apothecaries, or driving over the stones in my carriage, visiting my patients." The honest, upright man who rises from nothing, and continues to ascend right in the teeth of immense opposition from his enemies, seldom relapses into obscurity in after life. Though Dr. Blackmer failed as a poet, he died esteemed as an honest man, a consistent Christian, and an excellent physician. A WEAVER AND A QUAKER BOY. Many cases might be instanced of weavers becoming physicians, but let one suffice. John Sutcliffe, a Yorkshire weaver, with no early educational advantages, and with the broadest provincial dialect, became a respectable apothecary, and subsequently a first-class medical practitioner. He rose entirely by his own integrity, frugality, industry, and intelligence. Amongst his apprentices was Dr. John Coakley Lettsom, whose name must ever rank high as a literary man, and a benevolent and successful physician. Lettsom was born in the West Indies, and was a Quaker. The place under the Yorkshire apothecary was secured for the boy by Mr. Fothergill, a Quaker minister of Warrington, England. A senior drug clerk informed the rustic inhabitants of the arrival of a Quaker from a far off county, where the people were _antipodes_,--whose feet were in a position exactly opposite to those of the English. Having well circulated this startling information, the merry clerk and fellow-apprentices laid back to enjoy the joke all by themselves. The very day the new apprentice entered upon his duties, the apothecary shop became haunted by an immense and curious crowd of gaping rustics, old and young, male and female, to see the wonderful Quaker who was accustomed to walking on his head! Day after day the curious peasants came and went, and if the astonished Sutcliffe closed his doors against the unprofitable rabble, they peered in at his windows, or hung about the entrances, hoping to see the remarkable phenomenon issue forth. But as the day of "walking off on his ear" had not then arrived, they were doomed to disappointment and lost faith in his ability to do what they had expected of him. JOHN RADCLIFFE. John Radcliffe, the humbug, "the physician without learning," was the son of a Yorkshire yeoman. When he had risen to intimacy with the leading nobility of London,--as he did by his "shrewdness, arrogant simplicity, and immeasurable insolence,"--he laid claim to aristocratic origin. The Earl of Derwenter recognized _Sir_ John as a kinsman; but the heralds interfered with the little "corner" of the doctor and earl, after Radcliffe's decease, by admonishing the University of Oxford not to erect any escutcheon over his plebeian monument. Of Radcliffe's success in getting patronage we have spoken in another chapter. Doubtless he, Dr. Hannes, and Dr. Mead all resorted to the same sharp tricks, of which they accused each other by turns, in order to gain notoriety and practice. DR. EDWARD HANNES was reputed a "_basket-maker_." At least, his father followed that humble calling. Of the son's earlier life little is known. About the year 168-, he burst upon the London aristocracy with a magnificent equipage, consisting of coach and four, and handsome liveried servants and coachmen. These were _his_ advertisements, and he soon rode into a splendid practice, notwithstanding Radcliffe's contrary prognostication. Dr. Hannes and Dr. Blackmer, being called to attend upon the young Duke of Gloucester, and the disease taking a fatal turn, Sir John Radcliffe was also called to examine into the case. Radcliffe could not forego the opportunity here offered to lash his rivals, and turning to them in the presence of the royal household, he said,-- "It would have been happy for the nation had you, sir (to Hannes), been bred a basket-maker, and you, sir (to Blackmer), remained a country schoolmaster, rather than have ventured out of your reach in the practice of an art to which you are an utter stranger, and for your blunders in which you ought to be whipped with one of your own rods." As the case was simply one of rash, none of them had much to boast of. A HORSE DOCTOR. There have been, and still are, thousands in the various walks of life, who, at some period, have attempted the practice of medicine. Among the hundreds whom our colleges "grind out" annually, not more than one in twenty succeeds in medical practice so far as to gain any eminence, or the competence of a common laborer. MARAT WAS A HORSE DOCTOR. The most remarkable thing respecting this noted man occurred at his birth. _He was born triplets!_ Yes, though "born of parents entirely unknown to history," three different places have claimed themselves, or been claimed, as his birthplace. Before his energies became perverted to political aims, he had endeavored to rise, by his own talent and energies, through the sciences. The year 1789 found him in the position of veterinary surgeon to the Count d'Artois, thoroughly disgusted with his failure to rise in society with the "quacks," as he termed them, "of the Corps Scientifique." Miss Mühlbach, in her "_Maria Antoinette and her Son_," presents Marat in conversation with the cobbler, Simon, as follows:-- "The cobbler quickly turned round to confront the questioner. He saw, standing by his side, a little, remarkably crooked and dwarfed young man, whose unnaturally large head was set upon narrow, depressed shoulders, and whose whole (ludicrous) appearance made such an impression upon the cobbler that he laughed outright. "'Not beautiful, am I?' asked the stranger, who tried to join in the laugh with the cobbler, but the result was a mere grimace; which made his unnaturally large mouth extend from ear to ear, displaying two fearful rows of long, greenish teeth. 'Not beautiful at all, am I? Dreadful ugly!' "'You are somewhat remarkable, at least,' replied the cobbler. 'If I did not hear you speak French, and see you standing upright, I should think you the monstrous toad in the fable.' "'I am the monstrous toad of the fable. I have merely disguised myself to-day as a man, in order to look at this Austrian woman and her brood.' "'Where do you live, and what is your name, sir?' asked the cobbler, with glowing curiosity. "'I live in the stables of the Count d'Artois, and my name is Jean Paul Marat.' "'In the stable!' cried the cobbler. 'My faith, I had not supposed you a hostler or a coachman. It must be a funny sight, M. Marat, to see _you_ mounted upon a horse.' "'You think that such a big toad does not belong there exactly. Well, you are right, brother Simon. My real business is not at all with the horses, but with the men of the stable. I am the horse doctor of the Count d'Artois, and I can assure you that I am a tolerably skilful doctor.'" We do not quote the above author as reliable authority in personal descriptions, beyond the "shrugging of shoulders," which habit she attributes to all of her characters (_vide_ "Napoleon and Queen Louisa," where she uses the phrase some twenty-three times). At the time of his assuming the dictatorship, he resided in most squalid apartments, situated in one of the lowest back streets of Paris, in criminal intimacy with the wife of his printer.... He sold their bed to get money to bring out the first number of his journal, and lived in extreme poverty at a time when he could have become immensely rich by selling his silence. The death of this wretch was hastened only a few days by his assassination, for he was already consumed by a disgusting disease, and it is melancholy to add that he was adored after his death, and his remains deposited in the Pantheon with national honors, and an altar erected to his memory in the club of the Cordeliers. "I killed one man to save a hundred thousand!" exclaimed the magnificent Charlotte Corday to her judges; "a villain to save innocents, a furious wild beast, to give repose to my country!" Thus the "horse doctor" ignominiously perished at the hands of a woman,--a woman who immortalized herself by killing a "villain." PETER PINDAR, THE PREACHER. We find many cases where ministers have turned doctors, and _vice versa_. "PETER PINDAR" is here worthy of a passing notice. His true name was Wolcot. Descended from a family of doctors for several generations, he nevertheless himself failed to gain a living practice. When King George III. sent Sir William Trelawney out as governor of Jamaica, about 1760, he took young Dr. Wolcot with him, who acted in the treble capacity of physician, private secretary, and chaplain to the governor's household. Dr. Wolcot's professional knowledge had been acquired somewhat "irregularly," and it is very doubtful whether he ever received ordination at the hands of the bishops. It is true, however, that he acted as rector for the colony, reading prayers and preaching whenever a congregation of ten presented itself, which occurred only semi-occasionally. The doctor was fond of shooting, and 'tis gravely reported that he and his clerk used to amuse themselves on the way to church by shooting pigeons and other wild game, with which the wood abounded. Having shot their way to the sacred edifice, the merry parson and jolly clerk would wait ten minutes for the congregation to convene, and if, at the expiration of that time, the quota had not arrived, the few were dismissed with a blessing, and the pair shot their way back home. If but a few negroes presented themselves, the rector ordered his clerk to give them a bit of silver, with which to buy them off. [Illustration: THE PARSON BUYING OFF THE "CONGREGATION."] One old negro, more cunning than the rest, and who discovered that the parson's interest was rather in the discharge of his fowling-piece than the discharge of his priestly duties, used to present himself punctually every Sunday at church. "What brings you here, blackie?" asked the parson. "To hear de prayer for sinners, and de sarmon, masser." "Wouldn't a _bit_ or two serve you as well?" asked the rector, with a wink. "Well, masser, dis chile lub de good sarmon ob yer rev'rence, but dis time de money might do," was the reply, with a significant scratch of his woolly head. The parson would then pay the price, the negro would grin his thanks, and, chuckling to himself, retire; and for a year or more this sort of _black_-mailing was continued. Tiring of _acting_ as priest, Wolcot returned to London, and vainly endeavored to establish himself in practice. Neither preaching nor practising physic was his forte, and he resorted to the pen. Here he discovered his genius. Adopting the _nom de plume_ of "Peter Pindar," he became famous as a political satirist, and the author of numerous popular works. He died in London in 1819. Wolcot possessed a kindly heart, and a benevolence deeper than his pockets. POLICEMEN AS DOCTORS AND SURGEONS. Some very laughable scenes, as well as very touching and painful ones, might be recorded, had we space, where policemen have necessarily been unceremoniously summoned to act as physician or surgeon in absence of a "regular." In Portland, the police have to turn their hand to most everything. Circumstances beyond his control compelled one Mr. J. S. to act the part of midwife to a strapping Irish woman at the station-house, one evening, he being the sole "committee of reception" to a bouncing baby that came along somewhat precipitately. The account, which is well authenticated, closes by saying,-- "Mother, baby, and officer are doing as well as can be expected!" We have seen the "officer." He did better than was "expected." The writer was on a Fulton ferry boat in the winter of 1857, when a similar scene occurred. A German woman was taken in pain. A whisper was passed to a female passenger; a policeman was summoned from outside the ladies' (?) cabin; the male occupants were ejected,--even myself and another medical student, and the husband of the patient. The latter remonstrated, and demonstrated his objection to the momentary separation by beating and shouting at the saloon door. "Katharina! Katharina!" he shouted, "keep up a steef upper lips!" This roaring attracted nearly all the men from the opposite side of the boat, who crowded around him and the door, to learn the cause of the Teutonic demonstrations of alternate fear, anger, and encouragement. "Got in himmel! Vere you leefs ven you's t' home? Vich a man can't come mit his vife, altogedder? Hopen de door, unt I preaks him mit mine feest; don't it?" So he kept on, alternately cursing the policeman and encouraging "Katharina," till we reached the Brooklyn side, and left the ferry boat. [Illustration] V. WOMAN AS PHYSICIAN. "Angel of Patience! sent to calm Our feverish brow with cooling palm; To lay the storm of hope and fears, And reconcile life's smile and tears; The throb of wounded pride to still, And make our own our Father's will."--WHITTIER. HER "MISSION."--NO PLACE IN MEDICAL HISTORY.--ONE OF THEM.--MRS. STEPHENS.--"CRAZY SALLY."--RIGHT TO BEAR ARMS.--RUNS IN THE FAMILY.--ANECDOTES.--"WHICH GOT THRASHED?"--A WRETCHED END.--AMERICAN FEMALE PHYSICIANS.--A PIONEER.--A LAUGHABLE ANECDOTE.--"THREE WISE MEN."--"A SHORT HORSE," ETC.--BOSTON AND NEW YORK FEMALE DOCTORS.--A STORY.--"LOVE AND THOROUGHWORT."--A GAY BEAU.--UP THE PENOBSCOT.--DYING FOR LOVE.--"IS HE MAD?"--THOROUGHWORT WINS. "From the earliest ages the care of the sick has devolved on woman. A group by one of our sculptors, representing Eve with the body of Abel stretched upon her lap, bending over him in bewildered grief, and striving to restore the vital spirit which she can hardly believe to have departed, is a type of the province of the sex ever since pain and death entered the world. "To be first the vehicle for human life, and then its devoted guardian; to remove or alleviate the physical evils which afflict the race, or to watch their wasting, and tenderly care for all that remains when they have wrought their result--this is her divinely appointed and universally conceded mission. "Were she to refuse it, to forsake her station beside the suffering, the office of medicine and the efforts of the physician would be more than half baffled. And yet, where her post is avowedly so important, she has generally been denied the liberty of understanding much that is involved in its intelligent occupancy. With the human body so largely in her charge from birth to death, she is not allowed to inquire into its marvellous mechanism. With the administering of remedies intrusted to her vigilance and faithfulness, she has not been allowed to investigate the qualities, or even know the names or the operations of those substances committed to her use. To be a student with scientific thoroughness, and to practise independently with what she has thus acquired, has been regarded as unseemly, or as beyond her capacity, or as an invasion of prerogatives claimed exclusively for men. "Indeed, the whole domain of medicine has been '_pre-empted_' by men, and in their '_squatter sovereignty_' they have sturdily warned off the gentler sex."--Rev. H. B. Elliot, in "_Eminent Women of the Age_." It seems to my mind, and ought to every thinking mind, to be ridiculously absurd that "man born of woman" should set up his authority against woman understanding "herself." "Man, know thyself," is stereotyped, but if it ever was put in type form for "woman to know herself," it has long since been "_pied_." "Search the Scriptures," and you would never mistrust that "eternal life," or any other life, came, or existed a day, through woman. Mythological writers, who come next to scriptural, give woman no credit in medical science. We will except Hygeia, the goddess of health, the fabled daughter of Æsculapius. In the _medical_ history of no country does she occupy any prominence. There were "Witches," "Enchantresses," "Wise Women," "Fortune-tellers," who in every age have existed to no small extent, and under various names have figured in the histories of all nations, receiving the countenance of prince and beggar--but females as physicians, _as a class_, have never been recognized by nations or governments, or scarcely by communities or individuals. In searching the memorials of English authors for two hundred years past, we can find but little to disprove the above assertions. In Mr. Jeaffreson's "Book of Doctors," the author fails to find memorials of their actions, as female physicians, sufficient to fill a single chapter; and those of whom he has made mention, he discourses of mostly in a ridiculous light, as though entirely out of their sphere, or as being of the coarser sort, and questions "if two score could be rescued from oblivion whom our ancestors intrusted with the care of their invalid wives and children." In this connection, let us briefly mention such as are better known in English literature, as doctresses especially as mentioned by Mr. Jeaffreson. Two ladies, who are immortalized in "Philosophical Transactions for 1694," were Sarah Hastings and Mrs. French. Another, who received the support of bishops, dukes, lords, countesses, etc., in 1738-9, was Mrs. Joanna Stephens, "an ignorant and vulgar creature." After enriching herself by her specifics, consisting of a "pill, a powder and a decoction," she bamboozled the English Parliament into purchasing the secret, for the (then) enormous sum of £5000. "The Powder consists of _eggshells_ and _snails_, both calcined." "The decoction is made by boiling together Alicant _soap_, swine's-cresses burnt to a blackness, honey, camomile, fennel, parsley, and burdock leaves." "The pill consists of snails, wild carrot and burdock seeds, ashen keys, hips, and haws, all burnt to a blackness; soap and honey." When we take into consideration the fact that there were no "medical schools for females," at that day, nor until within the last ten or twelve years, that every female applicant was rejected by the medical colleges of England, and that all female practitioners were held in disrepute by both physician and the public, the above repulsive remedies may not so greatly excite our surprise. "CRAZY SALLY." The most remarkable woman doctor made mention of in English literature, was Mrs. Mapp, _née_ Sally Wallin. We have collected these facts respecting her origin, character, and career, from _Chambers' Miscellany_ and the _Gentlemen's Magazine_, 1736-7. Hogarth has immortalized her in his "Undertaker's arms." She is placed at the top of that picture, between Josh Ward, the _Pill_ doctor, and Chevalier Taylor, the quack oculist. (See page 668.) She was born in Weltshire, in 169-. Her father was a "bone-setter," which occupation "run in the family," like that of the Sweets, of Connecticut, or like the marine whom Mrs. Mapp saw one day, as she, in her carriage, was driving "along the Strand, O." Said sailor having a wooden leg, the doctress asked, "How does it happen, fellow, that you've a wooden leg." "O, easy enough, madam; my father had one before me. It sort o' runs in the family, marm," was the laconic reply. From a barefooted school-girl at Weltshire, where Sally obtained barely the rudiments of a common education, she became her father's assistant in bone-setting and manipulating. The next we hear of Miss Wallin, is at Epsom, where she became known as "Crazy Sally." She has been described as a "very coarse, large, vulgar, illiterate, drunken, bawling woman," "known as a haunter of fairs, about which she loved to reel, screaming and abusive, in a state of roaring intoxication." It is astonishing as true, that this unattractive specimen of the female sex became so esteemed in Epsom, where she set up as a physician, that the town offered her £100 to remain there a year! The newspapers sounded her praise, the gentry, even, lauded her skill, and physicians witnessed her operations. "Crazy Sally" awoke one morning and found herself famous. Patients of rank and wealth flocked from every quarter. Attracted by her success and her accumulating wealth, rather than by her _beauty_ or _amiable_ disposition, an Epsom swain made her an offer of marriage, which she, like a woman, accepted. This fellow's name was Mapp, who lived with her but for a fortnight, during which time he "thrashed her" (or she him, it is not just clear which) "three times," and appropriating all of her spare change, amounting to five hundred dollars, he took to himself one half of the world, and quietly left her the other. Our informant adds, "She found consolation for her wounded affections in the homage of the world. She became a notoriety of the first water; every day the public journals gave some interesting account of her, and her remarkable operations." The _Grub Street Journal_ of that period said, "The remarkable cures of the woman bone-setter, Mrs. Mapp, are too numerous to enumerate. Her bandages are extraordinarily neat, and her dexterity in reducing dislocations and fractures most wonderful. She has cured persons who have been twenty years disabled." Her patients were both male and female. Some of her most difficult operations were performed before physicians of eminence. Her carriage was splendid, on the panels of which were emblazoned her coat of arms. Regularly every week she visited London in this magnificent chariot drawn by four superb, cream-white horses, attended by servants, arrayed in gorgeous liveries. She put up at the Grecian Coffee-House, and forthwith her rooms would be thronged by invalids. Notices of her were not always of the most complimentary sort. Being one day detained by a cart of coal that was unloading in a narrow street of the metropolis, on which occasion she was arrayed in a loosely fitting robe-de-chambre, with large flowing sleeves, which set off her massive proportion most conspicuously, she let down the windows of her carriage, and leaning her bare arms upon the door, she impatiently exclaimed,-- "Fellow, how dare you detain a lady of rank thus?" "A lady of rank!" sneered the coal-man. "Yes, you villain!" screamed the enraged doctress. "Don't you observe the arms of Mrs. Mapp on the carriage?" [Illustration: "DON'T YOU OBSERVE THE ARMS OF MRS. MAPP?"] "Yes--I _do_ see the arms," replied the impudent fellow, "and a pair of durned coarse ones they are, to be sure." On another occasion she was riding up Old Kent Road, dressed as above described. "Her obesity, immodest attire, intoxication, and dazzling equipage were, in the eyes of the mob, so sure signs of royalty, that she was taken for a court lady, of German origin, and of unpopular repute. The crowd gathered about her carriage, and with oaths and yells were about to demolish the windows with clubs and stones, when the nowise alarmed occupant, like Nellie Gwynn, on a similar occasion, rose in her seat, and, with imprecations more emphatic than polite, exclaimed,-- "---- you! Don't you know who I am? I am Mrs. Sally Mapp, the celebrated bone-setter of Epsom!" "This brief address so tickled the humor of the rabble that the lady was permitted to proceed on her way, amid deafening acclamations and laughter." This famous woman's career may be likened to a rocket. She flashed before the people as suddenly, ascended as brilliantly to the zenith of fame, and fell like the burned, blackened stick. Mrs. Mapp spent her last days in poverty, wretchedness, and obscurity, at "Seven Dials," where she died almost unattended, on the night of December 22, 1737. Her demise was thus briefly announced in the journals:-- "Died at her lodgings, near Seven Dials, last week, Mrs. Mapp, the once much-talked-of bone-setter of Epsom, so wretchedly poor that the parish was obliged to bury her." Mr. Jeaffreson makes mention of two more "female doctors;" one an honest widow, mother of "Chevalier Taylor," who, at Norwich, carried on a respectable business as an apothecary and doctress, and Mrs. Colonel Blood, who, at Romford, supported herself and son by keeping an apothecary shop. AMERICAN FEMALE PHYSICIANS. Perhaps English authors and English readers may be satisfied to allow the above meagre and unenviable array of pretenders to stand on record as the representatives of "female doctors" in their liberal and enlightened country! Americans can boast of a better representative. While England claims a "Female Medical Society," and one "Female Medical College," the United States has several of the former, and three regularly chartered "Female Medical Colleges." In a recent announcement of the English college, it claims fifty students, "but the aim of the whole movement is at present only to furnish competent midwives." The "Maternity Hospital," of Paris (which existed long before the late Franco-Prussian war, but which we can learn nothing of since the fall of that once beautiful city), "afforded some opportunity for observation, receiving females nominally as students, but they were not allowed to prescribe in the wards, nor were they instructed in regard to the use and properties of the remedies there prescribed. Indeed, they can hardly rise above the position of proficient nurses," says our informant. Some few medical colleges of the United States are admitting females on the same footing as the heretofore more favored "lords of creation." A female college has been in existence in Philadelphia for above twenty years. The "New England Female Medical College" was chartered in 1856; but the "regular" colleges, as Yale, Harvard, etc., refuse all female applicants. New York has been more liberal towards the gentler sex. At Geneva, Rochester, Syracuse, and elsewhere, as early as 1849-50, medical schools of the more liberal sort, but of undoubted respectability and legal charters, opened their doors to female students. In 1869 the New York Female Medical College was chartered, since which time more than two hundred ladies have therein received medical instruction. In all the principal cities of the Union may be found from one to a dozen respectably educated and successful female practitioners, who have attained to some eminence in spite of the opposition of the "faculty," and the ignorant prejudices of the common people. It is surprising how early and persistently some men forget that they were "born of woman!" Their contempt of the capabilities of womankind would lead one to suppose them to be ashamed of their own mothers. Mark Twain's facetious but instructive speech, once delivered before an editorial gathering in Boston, ought to be rehearsed to them daily; yes, and enforced by petticoat government upon their notice till it became stereotyped into their stupid brains. Mark says, "What, sir, would the peoples of the earth be without woman? They would be scarce, sir,--almighty scarce! (Laughter.) Then let us cherish her; let us protect her; let us give her our support, our encouragement, our sympathy,--our--selves, if we get a chance. "But, jesting aside, Mr. President, woman is gracious, lovable, kind of heart, beautiful, worthy of all respect, of all esteem, of all deference. Not any here will refuse to drink her health right cordially, for each and every one of us has personally known, and loved, and honored the very best of them all,--_his own mother_!" Sarah B. Chase, M. D., a respectable and successful female physician of Ohio, gives the following excellent advice:-- "I would not encourage any woman to study medicine, with the expectation of practising, who is not ready and willing--ay, _anxious_ and _determined_--to go through the same severe drill of preparation, the same thorough discipline, as is required of man before he is crowned with the honors of an M. D." A FEMALE PIONEER. Among the first successful female physicians of Boston, where she was born in 1805, is Harriot K. Hunt, M. D. Her father was a shipping merchant, who, by honesty and uprightness died comparatively poor, for riches are not always to the upright. Her mother is described by Rev. H. B. Elliot, "as one possessing a mind of remarkable qualities, argumentative, practical, independent, and, withal, abounding in tenderness and genial brightness." In 1830 we find Miss Hunt not only thrown upon her resources for her own livelihood (her father having left but barely the house that gave them shelter to be called their own), but the support and care of an only and invalid sister, somewhat her junior, were also entirely dependent upon her labors. As a school teacher she met the former, as a student and nurse she finally surmounted the latter. "What! more pedagogues turned doctors?" After nearly three years' employment of various physicians on the part of the elder sister, and the extreme suffering from the "distressing and complicated disease," and, what was worse, the "severest forms of prescriptions of the old school of physic" for the same time by the younger sister, the Misses Hunt were led to investigate for themselves. They purchased medical works, which they read early and late. In 1833 Harriot leased her house, and entered the office of a doctress, Mrs. Mott by name, in the double capacity of secretary and student. The younger sister became a patient of Mrs. Mott's. The husband of Mrs. Mott was an English physician, who, with his wife to attend the female portion of his patients, had established himself in Boston. Mrs. Mott was without a thorough medical education. "She made extravagant claims to medical skill in the treatment of cases regarded as hopeless." In 1835 Dr. Mott died, and Mrs. Mott returned to England. Under the treatment of the latter the invalid sister had so much improved in health as to be able to "walk the streets for the first time in three years;" yet where is the "old school doctor," or the veriest charlatan, that would give her the credit she so seemingly deserved in this case. Both were her opponents. Even the students of the neighboring medical school were "pitted against her." The old adage respecting his Satanic majesty having the credit due him, did not seem to apply to her case. But Mrs. Mott was more than a match for their cunning, if not for their scientific theorizings, as the following anecdote will show. "Three wise men of Gotham," that amiable lady, Mrs. Goose, tells us, "went to sea in a bowl; and had the bowl been stronger, my song would have been longer." This has its parallel in the three wise students of H----, who laid their wise heads together, and went to _see_--Mrs. Mott, the doctress, of Hanover Street. One was to pretend that he had some peculiar disease, for which he, with his anxious friends, wished to consult the "wise woman." They entered the doctor's office, and demanded to see the doctress. This was an open insult to the woman, as she only gave her attention to females and children. Nevertheless, Mrs. Mott, whose olfactory nerves were not so obtuse as to prevent her from distinguishing the aroma of that peculiar little animal quadruped of the genus _Mus_, obeyed the summons, and entered the presence of the three wise Æsculapians. Now the fun began. Not the fun that _was to be_ at the expense of the "ignorant old female quack," however. One of the gentlemen arose, and after a profound bow, began, with some embarrassment, to state his case. "But wait just a moment," the doctress interrupted. "You intimate that it is a _peculiar_ case. My fee for consultation in such cases is _three dollars_. Please hand over the money, and proceed." This was an unexpected demand. They had thought to have a little fun, expose the woman's ignorance, and have a "huge thing" to tell to their class-fellows, _and not pay for it_! Mrs. Mott was a woman, but she possessed powerful magnetic influence, and held fast to the point, viz., her fee for consultation; and to the chagrin of the patient (?), and the astonishment of his chums, the three dollars were paid over to the doctress. "Now, sir, you will please state your case," said the lady, pocketing the fee, adjusting her eye-glasses, and seating herself for a consultation. "Yes. Well--it is a--a peculiar case," stammered the patient. "You have informed me of that point before. Please proceed," remarked the doctress with great complacency to the embarrassed fellow. "It's a delicate case," he blushingly replied. "O, indeed; then step into this private consulting room;" and arising, she led the way to an inner office, where the young man involuntarily followed, greatly to the amusement of the two remaining students, who remarked, "It is getting blamed hot for us here." [Illustration: THREE WISE STUDENTS CONSULTING A DOCTRESS.] In a moment, the invalid--greatly improved, one might judge, from his agility,--rushed from the private sanctum with a bound, grasped his hat from the table, exclaiming, "Come on, for God's sake!" and rushed from the house, followed by his now thoroughly affrighted companions. "What's the matter? What did the old tarantula say to you?" demanded the young man's chums, when well outside of the web into which they had so impudently intruded themselves. "Don't you ever ask me," he vociferated. "A ---- pretty mess you got me into. But if either of you ever again mistake that old woman for a fool, I hope to God she'll take you into her private consulting room." But to return to Miss Hunt and her sister. In 1855 or '56 the sisters opened an office in Boston. As with all young physicians without "dead men's shoes," professional support, or wealthy and influential friends to back them, patients gathered slowly at first, but with a steady increase, the care of whom soon devolved entirely upon Harriot, as her sister married, and retired from practice. In 1847 she had an extensive practice among a wealthy and influential class of people, which many an older physician of the sterner sex might envy. With a large practical knowledge, acquired in twelve years' experience, she applied to Harvard College for permission to attend a course of medical lectures. She was refused admission. In 1850 she again applied. The officers consented this time, but the students offered such objections to the admission of females into their presence, that Miss Hunt generously declined to avail herself of the long-coveted opportunity. "The Female Medical College," at Philadelphia, in 1853, granted Miss Hunt an honorary degree.... She is now in the midst of an extensive practice. Miss Hunt has lived a glorious, self-denying life, upholding her sister co-laborers, and the "dignity of the profession," never demeaning herself by stooping to sell her knowledge, by any of those disreputable practices that mark the avaricious M. D., the charlatan, the parasites, and the leeches of the profession, both male and female. Among eighty-five "female physicians" (?) of Boston, eighteen claim to be graduates of some college. We know of several who deserve a favorable mention here, but present limits will not admit. NEW YORK FEMALE DOCTORS. In New York city there are upwards of two hundred so-called "female physicians," about eighty per cent. of whom, according to the best authority,--police reports, etc.,--subsist by _vampirism_! Here, in this chapter, I shall mention a few of the really meritorious ones, reserving the large majority to be "shown up" under the various chapters as "fortune-tellers," "clairvoyants," and "astrologers." The subject of the following imperfect, because brief, sketch,--MRS. C. S. LOZIER, M. D.,--late of New York city, was born in Plainfield, New Jersey, in 1813. Her maiden name was Clemence S. Harned. Her father was a farmer by occupation, and a member of the Methodist church. Her amiable and excellent mother was a Quakeress. "Why should Mrs. Lozier, a gentle, modest, unambitious, home-loving woman, have chosen the calling of a physician?" asks her biographer. My answer would be, "She was a creature of circumstances." Another, in view of the facts to be related, would say, "_It was her destiny_." The valuable information which Mrs. Lozier gained, as a Quakeress, amongst that herbalistic people with which she was early associated, with study and practical observation enabled her to "act efficiently as a nurse and attendant upon the sick and afflicted of the neighborhood." The elder brother of Miss Clemence, William Harned, was a physician, as also were two of her cousins. In 1830 she was married to Mr. Lozier, and removed to New York. Her husband's health failing, and having no other support, Mrs. Lozier opened a select school, which she kept successfully till after the death of Mr. Lozier, in 1837. "During this period she read medicine with her brother. When her pupils were sick, she would generally be called in before a physician. She also was connected with the 'Moral Reform Society,' with Mrs. Margaret Pryor, and visited the sick and abandoned, often prescribing for them in sickness." Mrs. Lozier graduated at the Eclectic College, of Syracuse, in 1853, having attended her first course of lectures at the Central College, Rochester. From that time until her death, in 1870, she continued to minister to the sick and afflicted in the city of New York. At the commencement of this article we stated that Mrs. Lozier was a modest woman. This she continued to be to the end. Those leading physicians who often met her in consultation, with the thousands of patients who from time to time have been under her treatment, the students before whom she lectured during several years, the numerous friends who thronged her parlors, and the Christian professors with whom she mingled,--all, _all_ testify to this fact. "She denied both the expediency and practicability of mingling the sexes" in deriving a medical education. "Woman physician for women," was her motto. It was not always possible for her to refuse to prescribe for male patients, as many can testify. The efforts of some, far down in the scale of life, to connect the name of Mrs. Lozier with those disreputable practices by which the majority of female physicians--the parasites of the profession--subsist, yea, even gain a competence, in this city, and, consequently, _respectability_,--"for gold buys friends,"--have utterly failed, and her _name_ to-day, as it ever will, stands out boldly as belonging to one who was a self-denying, God-fearing, honorable, and successful female practitioner. Mrs. Lozier is said to have been a skilful surgeon, "having performed upwards of one hundred and twenty capital operations." In 1867-8 Mrs. L. visited Europe, where she was received with great marks of esteem by eminent men, and admitted to the hospitals. Her son, Dr. A. W. Lozier, is in practice in New York city. DOCTORS ELIZABETH AND EMILY BLACKWELL. The first female who received a medical diploma from any college in the United States was Miss Elizabeth Blackwell. This lady, who now stands only second in years of experience to Miss Hunt, of Boston, and second to no female in medical knowledge and usefulness, came to this country from England in 1831, when she was ten years of age. [A lady, of whom I made some inquiries respecting the above, assured me "it was only those females who were eligible as nurses, or prospective widowhood, which would make them eligible, were desirous of concealing their true age."] Being persuaded that her "mission" was to heal the sick, Miss Elizabeth applied, by writing, to six different physicians for advice as to the best means to obtain an education, and received from all the reply that it was "impracticable," utterly impossible, for a female to obtain a medical education; "the proposition eccentric," "Utopian," etc. It required just this sort of opposition to draw out the true character, and arouse the hidden abilities of such women as the Misses Blackwell. Elizabeth, while supporting herself by giving music lessons in Charleston, S. C., received regular medical instruction from S. H. Dixon, M. D., a gentleman and scholar, well known to the entire profession of two continents; also from Drs. John Dixon, Allen, and Warrington, the two latter in Philadelphia. Being considered by these gentlemen competent, Miss Blackwell applied to the medical schools of Philadelphia and New York for admission as a medical student, by all of which she was rejected "because she was a female." Finally she gained admission to the College at Geneva, N. Y., and graduated in 1848. Are the _males_ the only "oppressors" of the gentler sex? No, no; woman is woman's own worst enemy. Miss Blackwell was two years in Geneva, and so violent was the opposition of _her own sex_, that no lady in Geneva would make her acquaintance while there. "Common civilities at the table, even, were denied me." Entirely different was the treatment which she received at the hands of the students and professors of the college. "Here she found nothing but friendliness and decorum, and, on the eve of her graduation, the cordiality of the students in making way for her to receive her diploma, and pleasantly indicating their congratulations, was marked and respectful." The following morning her parlor was thronged with ladies. Miss Elizabeth Blackwell visited London and Paris, and was entered as student at St. Bartholomew's, and also at "_La Maternité_" (The Maternity). She returned to New York, and, notwithstanding "she found a blank wall of social and professional antagonism facing the woman physician, which formed a situation of singular loneliness, leaving her without support, respect, or counsel," she gained a foothold, and a respectable and living practice soon began to flow in and crown her persistent efforts. Now her sister Emily commenced the study of medicine, first with Elizabeth, subsequently with Dr. Davis, of Cincinnati Medical College. In 1852 she and her sister were permitted to attend upon some of the wards (female, we presume) of Bellevue Hospital. In 1854 Emily graduated at Cleveland College (Eclectic, I think). Through their united efforts the "New York Infirmary for Women and Children" was established. "Up to the present time over fifty thousand patients have received prescriptions and personal care by this means." Contrary to Mrs. Lozier, "they are firm in their conviction of the expediency of mingling the sexes in _all_ scholastic training. In their mode of practice they adopt the main features of the 'regular' system." Nearly all other physicians are rather of the _Eclectic_ system. Like Miss Hunt, "she was bound by no regular school, as none had indorsed her." There are many contemporaries of Miss Hunt and the sisters Blackwell whom we might mention, but the history of one is the history of the whole, so far as early struggles, opposition of the profession, and neglect and disrespect of their own sex, is concerned. Frances S. Cooke, M. D., of the "Female Medical College," East Concord Street, Boston, Mrs. Jackson, Lucy Sewall, M. D., recently returned from Europe, and a half-score others of Boston, much deserve more than a passing notice, but our limited space will not permit. Also, Hannah E. Longshore, M. E. Zakezewska, of New York, Miss Jane E. Myers, M. D., Mrs. Mary F. Thomas, M. D. (Camden, Ind.), Miss Ann Preston, M. D., of Philadelphia, Mrs. Annie Bowen, of Chicago, and others, "too numerous to mention," who, in spite of the opposition from their own sex, from the profession, and the public in general, have gained a name and a competency through their professional efforts. "A woman's intellectual incapacity and her physical weakness will ever disqualify her for the duties of the medical profession," wrote Dr. ----, of Pennsylvania. Edward H. Dixon, M. D., of New York, in an article published in the "_Scalpel_" shows, by uncontroverted arguments and facts, that the male child, at birth, "in original organic strength," holds only an equal chance with the female; that "the chances of health for the two sexes at the outset are equal, and so continue till the period when they first attain the full use of their legs." Ask the mother of a family if the labor pains show any respect of sex. Does not the female show as strong lungs as the male in its _earliest_ disapprobation of this unceremonious world? How about the comparative strength exhibited in the demonstrations of each when the lacteal fluid is not forthcoming in proportion to the appetite? Let us consult Dr. Dixon further,--and charge it to the females! "We give the girl two years' start of the boy,--we shall see why as we proceed. Both have endured the torture of bandaging, pinning (pricking), and tight dressing; both have been rocked, jounced on the knee, papped, laudanumed, paregoricked, castor oiled, suffocated with blankets over the head, sweltered with cap and feather bed, roasted at a fire of anthracite, dosed according to the formula of some superannuated doctor or 'experienced nurse,' or both, for these people usually hunt in couples, and are very gracious to each other. We give the girl the start to make up for the benefit the boy has derived from chasing the cat, rolling on the floor, or sliding down the balustrade, and the torture _she_ had endured from her sampler, and being compelled to 'sit up straight, and not be _hoidenish_.'" [Illustration: "POH! YOU'RE A GIRL."] "Well, they are off to school. Observe how circumspectly our little miss must walk, chiding her brother for being 'too rude.' He, nothing daunted, (with a '_Poh! you're a girl_'), starts full tilt after an unlucky pig or a stray dog. If he tumbles into the mud and soils his clothes the result is soon visible in increase of lungs and ruddy cheeks." "In school the boy has the advantage. The girl 'mustn't loll,' must sit up erect, the limbs hanging down, her feet probably not reaching the floor, and the spinal column must bear the main support for three to six hours! The boy gets relief in 'shying' an occasional paper ball across the room, hitching about, and drawing his legs up on the seat, or sticking a pin in his neighbor, and a good run and jump at recess, changing the monotony of the recreation by an occasional fight after school. At dinner the girl has had no exercise to create an appetite, and her meal is made up of pastry and dessert. 'Remember that her muscles move the limbs, and are composed chiefly of azote, and it is the red meat, or muscle of beef or mutton, that she would eat if she had any appetite for it, that is to say, if her stomach and blood-vessels would endure it. The fact is, _the child has fever and loathes meat_.'" While the boy, hat in hand, rushes to the common or rear yard to roll hoop, fly his kite, or, in winter, to skate or coast down hill, the girl is reminded that she has "one whole hour to practise at the piano," either in a darkened room, from whence all God's sunshine is excluded, cold and cheerless, or the other extreme--seated near a heated register, from which the dry, poisonous fumes belch forth, destroying the pure oxygen she requires to inflate her narrowing lungs, and increase the fibrine, the muscle, and strength necessary to the exhausting exercise. She closes the day by eating a bit of cake and a plate of preserves. The hungry, "neglected" boy has returned, and, with swift coursing blood, strength of muscle and brain, catches a glance at his neglected lesson, comprehending it all the quicker by the change he has enjoyed, bawls boisterously for some cold meat, or something hearty, and tumbles into his bed, forgetting to close the door or window; whereas the girl must be attended to her room, "she is so delicate," and, being tucked well in on a sweltering feather bed, and bound down by heavy blankets, the doors and windows are carefully secured, and, committed to the "care of Providence," she is left to swelter till to-morrow. The period for a great change arrives, often catching the poor, uninformed girl completely by surprise. Furthermore, the constant deprivation of her natural requirements--pure air, wholesome, nutritious food, unrestrained limbs and lungs--now become more apparent. In spite of the constant drilling which she has received, she feels exceedingly _gauche_. Her face is alternately pale and flushed; she suffers from headache,--"a rush of blood to the head." Stays and tight-lacing have weakened the action of the heart, cut off the circulation to the extremities, and deprived those parts of blood which now require the nutriment necessary to their strength and support in the time of their greatest need. The ignorant mother sends for a physician, perhaps almost as ignorant as herself; or, what is still worse, being a miserable time-server, seeing the admirable opportunity for making a bill, straightway commences a course of deception and quackery that, if it do not result in the death of the unfortunate patient, leaves her a miserable creature for life, with spinal curvature or consumption; or worse, by confinement and medication destroy her chance of restoration; and should some unlucky and ignorant young man take her as wife, and she become a mother, she surely will drag out a wretched existence as a victim to uterine displacement and its concomitant results. Physically, morally, and intellectually woman is not born inferior to man. We have briefly shown where and how she has fallen behind in the race of life in a physical view of the matter. The intellectual sense has kept pace only with the physical. Morally woman stands alone; by her own strength or weakness she stands or falls. Man scarcely upholds or encourages her. Her own sex, we have herein-before stated, is woman's own worst enemy! "Be thou as chaste as ice, or pure as snow, thou shalt not escape calumny," and if she fall, who shall restore her? The whole world is against her; one half makes her what she is, the other's scorn and neglect keeps her thus! The "ballot" will not keep woman from falling, nor raise her when fallen. The "church" does not exempt woman from the wiles of men, nor its adherents raise the fallen to their pristine strength, beauty, and respectability! Though Christ, the lowly, the magnanimous, said, "_Neither do I condemn thee_," his followers (?) cannot lay their hands upon their hearts and repeat his gracious words. Where is the fallen woman whom the church (not Roman Catholic) ever took in with that good faith and spirit of sisterly love or brotherly affection, with which a fallen man can, and is, often received into the church and into society? Echo answers, "Where?" O, deny this who will! It is no "attack upon the church;" merely a lamentably truthful statement. The church, like society, withdraws her skirts from contact with the fallen sister. "She is a wreck, drifted upon our shore, for which God holds some one accountable. Not a wreck that can be restored--not a wreck that money or repentance can atone for." (What! not money? Then surely she is lost, and forever!) "The damage is beyond earthly knowledge to estimate, beyond human power of indemnification. If ever the erring soul shall retrace her steps, it will be _Christ_ himself who shall lead her; if ever peace shall brood again over her spirit, it will be the Comforter who shall send the white-winged dove. "But the merest lad detects the lost woman. She carries the evidences of her guilt (or misfortune?) in the very clothes she wears, whether she is the richly dressed courtesan of the Bowery, or the beggarly street-walker of the village. There is a delicacy in, and a fine bloom on the nature of woman, which impurity smites with its first breath, and she cannot conceal the loss nor cover the shame!" "If there be but one spot upon thy name, One eye thou fearest to meet, one human voice Whose tones thou shrinkest from, Woman! veil thy face, And bow thy head and die!" Then is there no help for woman's condition in this cold, uncharitable world? you ask, in view of these facts related above. Yes; _but it rests with woman_. It must begin with the first breath the female infant draws. Educate her from the cradle. Give her the freedom of the boy, the pure air that the boy breathes; not the romping, rude, boisterous plays, perhaps (?), of the boy, but plenty of outdoor exercise, runs, slides, skates, rides; let her laugh, yea _shout_, if it be in a country place, till the woods ring again with the merry echoes, and the puzzled forest nymphs issue from their invaded retreats, endeavoring to solve the riddle by ocular demonstration which their ears have failed to unravel, viz., the sex, as revealed in the strength of voice and buoyancy of spirits, or expressed in unrestrained laughter! "O, shocking! How hoidenish!" Who says to laugh is "_hoidenish_?" A female invariably! And this is just what we are explaining: women must change tactics as teachers. There is time enough to instruct the _young_ lady, after the girl or the miss has developed muscle, vitalized her blood, and capacitated her brain for the sterner realities of life. Let women learn to be true teachers of women. Begin at the beginning. This is the only way. Stand by one another in the reform. Never mind the ballot; don't try to wear the _breeches_. No--the male attire I mean. The superfluous boarding-school education must give place to something more substantial. Mrs. Dashaway is to the point:-- "No, Pauline; home eddycation is perferable. If there is a requestred spot on this toad-stool I detest more'n another it is a female cemetery, where bread-and-butter girls are sent and quartered for a finished eddycation; and it does finish most of em." "O, no, no, aunty. You mean _sequestered_ spot, and sent _quarterly_ to a _seminary_." "Well, well; you've got too many oceans in your head already of Greek and zebra, of itchiology, and other humerous works; as for me, give me pure blood, sound teeth, and a good constitution, and let them what's got them sort of diseases see the good Samaritan, and ten to eleven if he don't cure them in less than no time. Land! if Pauline ain't drummin' the piany!" Shall women remain passively resigned to the lamentable physical condition of her sex? or will she see where lies the main difficulty, viz., in a _wrong start_,--in the superfluous, debilitating, _namby-pamby_ education of the female infant, miss, young lady? Thoreau wrote that he believed resignation a _virtue_, but he "rather not practise it unless it became absolutely necessary." "Resignation" is unnecessary in this case. Only let every woman arouse her energies, and stand firmly in claiming her "rights" to rightly educate her children, girls as well as boys, showing no respect of sex in their _early_ training, thereby "commencing at the beginning." What is a house without a good foundation? You may build, and rebuild, and finally it will all topple over, overwhelming you in its ruins. There is no "right" that woman may claim for herself and sex in general but men must and will concede. Man is not your master. "Habit," "fashion," "opinion," these are your only masters. These shackle woman. Do women dress for men? to please the opposite sex? or for each other's eye? "You know just how it is yourself." Poh! What do men, generally speaking, know of woman's dress? Absolutely nothing! I boldly assert that not one man in twenty, going out to a call, party, or even a concert or opera, knows the cut and color of the dress of his wife accompanying him. Woman dresses for women's inspection. Whatever she does for fear or favor of man else, woman dresses for her own sex. "What will Mrs. Codfish say when she sees this turned dress?" "Old Codfish," her husband, is worth at least fifty thousand dollars, and here is Mrs. Copyman, whose husband is as poor as "Job's turkey," standing in dread of that woman's criticism! Not one male in a thousand can detect a well turned dress, but I defy the most cunning dressmaker to alter, retrim, frill, and "furbelow" a dress that the female eye won't detect at a glance! "I rather pay the butcher's bill than the doctor's," says the father. "O, horrors! Just see that girl swallow the meat! Why, it will make your skin as rough as a grater and as greasy as an Indian's!" exclaims the mother. Miss Primrose keeps our village school; she who wears the trailing skirts, and was seen to cut a cherry in two parts before eating it, at the party last week. She almost went into convulsions--not of laughter, as I did--to see Kitty Clover astride a plank, with her brother on the opposite end, playing at "See-saw." "Here we go up--up--uppy; and here we go down--down--downy," they were singing in unison, when "ding, ding, ding!" went the school-bell, followed by a scream from Miss Primrose. With glowing cheeks--that's from the exercise--and downcast eye, from fear of Miss Primrose's anger, Kitty came demurely into the school-room before recess was half over. After a long lecture about her "masculine behavior," "horrid red countenance," and "rumpled dress," and "dishevelled hair," poor Kitty is sent to her form to "sit up straight, and not forget that she is a young lady hereafter." [Illustration: "HERE WE GO UP--UP--UPPY; AND HERE WE GO DOWN--DOWN--DOWNY."] And what of her brother who was on the other end of the plank? O, he is a boy! "That's what's the difference!" LOVE AND THOROUGHWORT. "He'll never die for love, I know, He'll never die for love, nor wear Upon his brow the marks of care." This is a true story, written for this work, but published, by permission of the author, in the "American Union." "So you believe me totally incapable of truly loving _any_ girl, do you?" "I most assuredly do," was my positive answer. My friend, George Brown, turned and walked away a few paces, looking thoughtfully to the ground. He was a splendid looking man, about twenty years of age; my late school-fellow, my present friend and confidant. He was, what I did not flatter myself as being, a great favorite with the ladies. Handsome, tall, manly, of easy address, a fine singer and dancer, the only impediment to his physical perfection was, when the least excited, a hesitancy of speech--almost a stammer. Finally he turned and walked back to me, saying,-- "Now, Ad, if you will agree to a proposition I have to offer, I will disprove your assertion, so oft repeated, that I never loved--not even that dear girl, Jenny Kingsbury." "First let me hear your proposition." "You have long desired to visit Bangor?" "Yes," I replied. "Let us harness 'Simon' early some fine morning for that delightful city; go by the way of B. and O., stop and see Jenny, who I have learned by roundabout inquiry resides with her aunt in the latter place. And," he added, triumphantly, "see for yourself if she isn't a girl to be loved." "O, no doubt Jenny Kingsbury 'is a girl to be loved;' so was Addie, and so was 'Ria, and a dozen others, whom you have sworn you loved so devotedly. O George, out upon your affections." "Will--will--you go? That's the question." "Yes--I will go--because I wish to visit Bangor very much," was my reply; and the time was at once set for the journey, which was to occupy two days. Mrs. Brown, the mother of my friend George, was a devout Christian. She believed in her Bible. Moreover, she was an excellent _nurse_, and next to her Bible, believed in _thoroughwort_. Thoroughwort tea, or thoroughwort syrup, was her panacea for all the ills, physical or moral, that ever was, or could be, detailed upon poor humanity. "Before you start, boys--" "Boys! Where are your _men_?" interrupted George. "Hear me!" continued Mrs. Brown. "Before you start for Bangor to-morrow morning, do you take a good drink of that thoroughwort syrup in the large jar on the first shelf in the pantry. It'll keep out the cold; for there'll be frost to-night, I think, and at five o'clock in the morning the air will be sharp. O, there is nothing equal to _thoroughwort_ for keeping out the cold." "Anything to eat in that pantry?" asked George, with a wink tipped to me. You see I was to sleep with him that night, preparatory to an early start for Bangor. "Yes, some cold meat, bread, and a pie. But don't forget to first take a dose of the thoroughwort syrup. Addison, you bear it in mind, for George is awful forgetful, especially about taking his thoroughwort." And Mrs. Brown detained us fully fifteen minutes, as she rehearsed the remarkable qualities of her favorite remedy,--"particularly for keeping out cold." "Mother thinks that condemnable stuff is meat, drink, and clothing," remarked George, as we sought the pantry at an early hour on the following morning, not for the thoroughwort, but for sandwiches, pies, and the like. "Let me take a taste of the 'stuff,'" I said, as I noticed the jar so conveniently at hand. "O, no; not on an empty stomach. It will make you throw up Jonah if you do," exclaimed George, with an expression of disgust distorting his features. "Eat something first, and then, if you want to taste the condemned 'stuff,' do so, and the Lord be with you," he added, pitching into the eatables. Having made away with the pie, and much of the sandwiches, we turned our attention for a moment to the thoroughwort syrup. I took a taste, and George spilled a quantity on the shelf, "that mother may know we have been to the jar," he remarked, as we left the pantry. It was not yet five o'clock when we drove noiselessly away from the door. If I remember rightly, we were not _noiseless_ after that. The morning was delightful, slightly cool,--but that was no impediment to our warm blood, owing to the thoroughwort,--and we sped on in an exuberant flow of spirits. "Simon" was in excellent travelling order, and went without whip or spur. We should have reached the village of B., where we were to breakfast, and bait Simon, by eight o'clock, but George would insist on making the acquaintance, _nolens volens_, of half the farmers on the road, ostensibly to inquire the way to B. "Hallo!" he shouted, reining up Simon before a small farm-house. Up flew a window, and out popped a nightcapped head. "What d'ye want?" called a feminine voice. It was now hardly daylight, and the person could not distinguish us. "Excuse me, madam, for disturbing your slumbers; but can you inform a stranger if this is the right road to B.?" asked George, in his most pleasing manner. "O, yes; keep right on; take the first left hand road to the top o' the hill; then go on till yer--" We drove away, not waiting for the rest. "Do you suppose that old woman is talking there now, with her nightcapped head poked out of the window?" asked George, as we reached the hotel at B. "For shame!" said I. "Waking up all the people on the road, to inquire the way, with which you were perfectly familiar!" From B. our route lay along the western bank of the beautiful Penobscot. I need not detain you while I rehearse the delightful scenery _en route_ to Bangor; the variegated and gorgeous splendors of the autumnal leaves; the bending boughs, from the abundant ripened fruit, in colors of red, orange, and yellow on one hand, and on the other the bright, glassy waters of the broad river, dotted here and there by the white sails of boats and vessels lying becalmed in the morning sunshine. We reached the village of O., and George made inquiry for the residence of Mr. Kingsbury. "The large white house just across the bridge." "Thank you." And we drove up to the front yard. "Ne-ne-now, Ad, you go up and knock, and call for Miss Kingsbury; ye-ye-you know I st-stutter when I get ex-ex-cited," said George, hitching Simon to the horse-post. "What shall I say to her? and how shall I know Miss Kingsbury from any other lady?" "O, ask for her. I'll compose myself, and follow ri-right up. You'll know her from the description I have given you. Black eyes and hair, full form--O, there is nobody else like her. Come, go up and call for her." "Well, I'll go; and if I get stuck, come quickly to my rescue," I said, turning to the house. "Is _Miss_ Kingsbury at home?" I asked of the young lady who answered my knock. "This person is surely not Miss Jenny," I said to myself; "cross-eyed, blue at that, and light, almost red hair." She smiled, took a second look at me, and said,-- "Who?" "Miss Jenny Kingsbury," I repeated. "Well--yes--I guess she is. Will you walk in?" "No, thank you. Will you please call her out?" And so saying, I beckoned to George. The girl closed the door, and I called to George "to make haste and change places with me." He came up just as the door reopened, and a beautiful dark-eyed woman appeared, whom he greeted as Miss Kingsbury. "I'll see to the horse," I said; and having taken a hurried glance at the young lady, I withdrew. For a full half hour I walked up and down beneath the maples in front of the house, watched the steamer Penobscot, as she came up the river, and from thence turned my attention to a schooner that was endeavoring to enter the cove, not far from the house. A light breeze had sprung up from the westward, and the channel being narrow, there seemed much difficulty in gaining the harbor. Finally George came to the door and beckoned me. I went in, and received an introduction to Mrs. Kingsbury and to Jenny. "O, but she is beautiful," I whispered to George. He was flushed and excited, consequently stammered some, and I was compelled to keep up a conversation, but I did not feel easy. Something was wrong. I detected more than one sly wink between aunt and niece, and when the cross-eyed miss came into the room, I could not tell whom she was glancing at, as her eyes "looked forty ways for Sunday," but she leered perceptibly towards first one, then the other of the ladies. I hinted to George that we must not delay longer. Still he tarried. Mrs. Kingsbury seemed interested in the movements of the schooner in the mouth of the cove. Miss Jenny was interested in George. I was interested in getting away from them all. Finally the schooner was moored to the wharf, and, standing at the window, I noticed a sailor, with a bundle on a stick over his shoulder, approaching the house. A whisper passed between aunt and niece, and the latter asked George to accompany her into an adjoining room. It was now past noon. A pleasant, savory smell came up from the kitchen, but no one asked me to put up the horse, and stay to dinner. The man with the bundle came familiarly into the yard. Soon George returned alone to the room, and seizing his hat, he stammered, "C-c-come, Ad," and rushed from the house. Mrs. Kingsbury attended me to the door, and wished me a pleasant ride to Bangor. George jumped into the buggy, seized the reins, and giving a cut upon the horse, bawled, "Go on, Simon." "Hold on. First let me unhitch him," I cried, seizing the spirited beast by the bridle. I unfastened the halter, and jumped into the carriage; and away flew Simon, snorting and irritated under the unnecessary cuts he had received from the whip. At the first corner George took the back road towards B. "Not that way! Hold on, and turn about," I exclaimed, catching at the reins. "Now stop and tell me all about it. Did you propose to Jenny? Has she accepted, and are you beside yourself with ecstatic joy? Come, tell me." "Ho! Simon." And laying down the reins, George drew out his wallet, and taking therefrom a bit of silk goods, he turned upon my astonished gaze a woe-begone look, and said,-- "Ad, she's mum-mum-married--" "Married!" "Yes, married; and there's a piece of her wedding gown. The fellow you saw come in while there, with the bundle on a stick,--the land-lubberish-looking fellow,--was her husband. O my God! Did you ever?" And so relieving his mind, he caught the reins and whip, and away darted Simon at a fearful rate of speed. At Bangor I said to George,-- "Well, there probably is no love lost on either side. She sold out at the first bid, and you never had the least hold on her affections." "Ah, I have had her confidence in too many moonlight walks to believe that," was his reply. "And it was all moonshine,--that's evident," I said. "No, no; I wish it was. I never shall love again," said George, with a deep sigh, and a sorry-looking cast of countenance. "No, I suppose not," was my non-consoling reply. "Still, do you believe I never loved that darling girl?" he asked, almost in a rage. "If that man--that _fellow_--should die with the autumn leaves, I would at once marry Jenny, who loves me still," he exclaimed, pacing the room like an enraged lion. "He won't die, however. He looks healthy and robust, and will outlive you and your affection for his wife," I replied, with a derisive laugh. It rained the next afternoon, as we returned home by a shorter route than _via_ O. and B. George talked a great deal of Jenny on the way back, and said he never should get over this fearful disappointment. "Only think of the lovely Jenny Kingsbury marrying that fellow with the bundle and the stick! O, I shall be sick over it; I know I shall." "Especially if you take a bad cold riding in this storm," I added, by way of consolation. "However, you can take some of your mother's good thoroughwort--" "Confound the thoroughwort," he interrupted. * * * * * "Did you know that George is sick?" asked his little brother of me the following day. "No. Is he much sick?" I inquired, in alarm. "O, yes; he's awful sick--or was last night; and mother fooled him on a dose of fresh thererwort tea, which only made him sicker," replied the little chap, turning up his nose in disgust. "Is he better now?" I inquired. "O, yes; ever so much _now_. I don't know what ma called the disease he's got; but howsomever she said thererwort was good for it, and I guess it is, 'cause he's better." I was called away, and did not see my friend George till a week after our return from the little trip to B. He never mentioned Jenny afterwards, nor said a word about the thoroughwort tea. He took to horses after that, and eventually married a poor, unpretending girl, quite unlike the dark-eyed, beautiful, and wealthy Miss Jenny Kingsbury. Mrs. Brown still recommends her favorite panacea for all ails, physical or moral; but whenever she mentions it in George's presence, he exclaims, with a look of disgust,-- "O, confound the thoroughwort!" [Illustration] VI. QUACKS. "Verily, I swear, 'tis better to be lowly born, And range with humble livers in content, Than to be perked up in a glistening grief And wear a golden sorrow."--KING HENRY VIII. ANECDOTE IN ILLUSTRATION.--DERIVATION.--FATHER OF QUACKS.--A MEDICAL "BONFIRE."--THE "SAMSON" OF THE PROFESSION.--SIR ASTLEY.--U. S. SURVEYOR-GENERAL HAMMOND.--HOMEOPATHIC QUACKS, ETC.--A MUDDLED DEFINITION.--"STOP THIEF!"--CRIPPLED FOR LIFE!--TWO POUNDS CALOMEL.--VICTIMS.--WASHINGTON, JACKSON, HARRISON.--THE COUNTRY QUACK.--A TRUE AND LUDICROUS ANECDOTE.--DYEING TO DIE!--A SCARED DOCTOR.--DROPSY!--A HASTY WEDDING!--A COUNTRY CONSULTATION.--"SCENES FROM WESTERN PRACTICE."--"TWIST ROOT."--A JOLLY TRIO.--NEW "BUST" OF CUPID.--AN UNWILLING LISTENER. On looking over my "collection" on quacks and charlatans, I am so strongly reminded of a little anecdote which you may have already seen in print, but which so well illustrates painfully the facts to be adduced in this chapter, that I _must_ appropriate the story, which story a western engineer tells of himself. "One day our train stopped at a new watering-place, being a small station in Indiana, where I observed two green-looking countrymen in 'homespun' curiously inspecting the locomotive, occasionally giving vent to expressions of astonishment. "Finally one of them approached and said,-- "'Stranger, are this 'ere a injine?' "'Certainly. Did you ever see one before?' "'No, never seen one o' the critters afore. Me an' Bill here comed down t' the station purpose to see one. Them's the biler--ain't it?' "'Yes, that is the boiler,' I answered. "'What you call that place you're in?' "'This we call a cab.' "'An' this big wheel, what's this fur?' "'That's the driving wheel.' "'That big, black thing on top I s'pose is the chimley.' "'Precisely.' "'Be you the engineer what runs the machine?' "'I am,' I replied, with the least bit of self-complacency. "He eyed me closely for a moment; then, turning to his companion, he remarked,-- "'Bill, it don't take much of a man to be a engineer--do it?'" The reader will perceive the distinction which we make between humbugs, quacks, and charlatans, though one individual may comprehend the whole. "Quacks comprehend not only those who enact the absurd impositions of ignorant pretenders, but also of _unbecoming acts of professional men themselves_."--_Thomas' Medical Dictionary._ This is the view we propose to take of it in this chapter, in connection with the derivation of the word. The word _quack_ is derived from the German "_quack salber_," or mercury, which metal was introduced into the _Materia Medica_ by _Philippus Aureolus Theophrastus Paracelsus Bombast ab Hohenhein_! "So extensively was quicksilver used by Paracelsus and his followers that they received the stigma of 'quacks.'"--See _Parr's Medical Dictionary_. There is some controversy respecting the date of birth of Paracelsus, but probably it was in the year 1493. He was born in Switzerland. [Illustration: THE INQUISITIVE COUNTRYMEN.] Professor Waterhouse (1835) says, "He was learned in Greek, Latin, and several other languages. That he introduced quicksilver," etc., "and was a vain, arrogant profligate, and died a confirmed sot." "Paracelsus was a man of most dissolute habits and unprincipled character, and his works are filled with the highest flights of unintelligible bombastic jargon, unworthy of perusal, but such as might be expected from one who united in his person the qualities of a fanatic and a drunkard."--_R. D. T._ Mercury was known to the early Greek and Roman physicians, who regarded it as a dangerous poison. They, however, used it externally in curing the _itch_, and John de Vigo employed it to cure the plague. Paracelsus used it internally first for _lues venerea_, which appeared in Naples the year of his birth, though doubtless that disease reached far back, even into the camp of Israel. The heroic doses of Paracelsus either destroyed the disease at once, _or the patient_. Paracelsus proclaimed to the world that there was no further need of the _Materia Medica_, especially the writings of Galen, and burned them in public; his "Elixir Vitæ" would cure all diseases. But in spite of his wonderful knowledge and his life-saving elixir, he died of the diseases he professed to cure, at the early age of forty-eight, while Galen lived to the age of seventy. So much for the "father of quacks." For nearly four centuries mercury has been exhibited in the _Materia Medica_ to a greater extent than any other remedy. Doubtless it possesses great medicinal virtues, but its abuse--the "heroic doses" used by the ignorant and brainless quacks, both graduates of some medical college, and _soi-disant_ physicians--has made its name a terror to the people and a reproach to the profession. To assail it is to tread on dangerous ground; to invade the "rights" of a numerous host of worshippers; to uncover an ulcer, whose rottenness, though smelling to heaven, is protracted for the pecuniary advantage of the prescriber. Eminent physicians in every age since its introduction, and in every enlightened country, have protested against its abuse; yea, even its use! They have called its users "_quacks_," the most contemptible epithet ever introduced into medical nomenclature,--the "_Samson_" of the profession, because through the instrumentality of an ass and his adherents, "it has slain its thousands." I need not quote those distinguished practitioners who have recorded their testimony against its general and indiscriminate use. Their name is legion, and every well-informed physician is aware of the fact. Do not "well-informed physicians" prescribe calomel? Certainly; but cautiously, and often under protest. It is recorded of Sir Astley Cooper that he made serious objections to its free use in the wards of the Borough Hospitals, and forthwith the "smaller fry" made such a breeze about his ears that he seemed called upon to defend, and even palliate, his offence. Dr. Macilwain says that Sir Astley is reported to have said in reply to those who demurred,-- "Why, gentlemen, was it likely that I should say anything unkind towards those gentlemen? Is not Mr. Green (surgeon of St. Thomas) my godson, Mr. Tusell my nephew, Mr. Travers my apprentice (surgeon of St. Thomas), Mr. Key and Mr. Cooper (surgeons of Guy's Hospital) my nephews?" This was very _naïve_, and as good illustration of the value of evidence in relation to one thing (his provision for his relatives) which is stated in relation to another. Herein Sir Astley exposed a weakness with which the democratic opponents of President Grant have accused him, viz., of furnishing comfortable positions for his relatives. Sir John Forbes, when at the head of the medical profession of England in 1846, wrote an earnest appeal to his brethren to rescue their art from the ruin into which it was falling, saying in relation to modes of curing diseases, "Things have become so bad that they must mend or end." This was "dangerous ground," and some physicians of the day feared Dr. Forbes had done an immense mischief. After his death, be it remembered, some of the "medical magnates" of this country virtuously refused to subscribe to his monument fund, saying, "it was a misfortune to mankind (?) that he had ever lived." Dr. W. A. Hammond, surgeon general of the United States, also blundered when, by an order dated at _Washington, May 4, 1863_, he struck calomel from the supply table of the army. This proscription was on the ground that "it has so frequently been pushed to excess by military surgeons, as to call for prompt steps to correct its abuse.... _This is done with the more confidence, as modern pathology has proved the impropriety of the use of mercury in very many of those diseases in which it was formerly unfailingly administered._" _The American Medical Times_ (regular) said, "The order appeared not only expedient, but judicious and necessary, under the circumstances." _What_ circumstances? Read on further, and the _Times_ editor explains: "No evil can result to the sick soldier from the absence of calomel, however much he may need mercurialization, when such preparations as blue pill, bichloride and iodide of mercury, etc., remain. But, in prescribing these latter remedies, the practitioner generally has a very definite idea of the object he wishes to attain, which is not always the case in the use of calomel." By this timely order it was estimated that ten thousand soldiers were released from a morning dose of calomel! Was this a blow aimed at "quackery"? Was Dr. Hammond, "a member of the medical profession highly esteemed for scientific attainments," attempting a reform in medicine? Any way, Dr. Hammond shared the fate of all medical reformers. He was suspended. He was disgraced. The American Medical Association met at Chicago, and set up a strong opposition to the "order." Certain persons brought charges against the surgeon general. A commission was appointed. The _Times_ said, "The whole affair has the appearance of a secret and deliberate conspiracy against the surgeon general.... The commission is, in the first place, headed by a person known to be hostile to the surgeon general. This fact throws suspicion upon the _object_ of the investigation." Just so. The "object" was to appoint some one instead of Dr. Hammond, who would repeal the obnoxious order. No matter what _pretence_ was set up beside, this is the fact of the case, and the people and the profession know this to be true. But how shall we judge of the motives of Dr. Hammond but by _appearances_? Who so well knew the value, or injury, of calomel, as he who had used it for twenty odd years? Admitting Professor Chapman, of Philadelphia, was within twenty years of right when he said, "He who resigns the fate of his patient to calomel, ... if he has a tolerable practice, will, in a single season, lay the foundation of a good business for life," did not Dr. H. exhibit a little selfishness in attempting to deprive young practitioners of the opportunity of laying for themselves a foundation for a prosperous future? "Doubtless," said a medical journal of the day, "all _quacks_ and _irregulars_ are congratulating themselves upon the appearance of this 'order.'" This leads us to ask, "Who are the quacks?" The governor of Ohio, in 1861, made inquiry of the United States surgeon general, to know if the regiments of that state could be allowed to choose between allopathic and homeopathic surgeons. "_No: I'll see them damned to hell first_," was the gracious reply. The resolutions drawn up and adopted by the New York Academy of Medicine as an offset against the appeal for admission of homeopathic surgeons into the army (1862), contained the following:-- "3d. That it (homeopathy) is no more worthy of such introduction than other kindred methods of practice as closely allied to _quackery_." There were then some thirty-five hundred of that sort of "quacks" practising under diplomas--mostly obtained from regular colleges--in the United States. Shame! The Royal College, Dublin, the same year, in a resolution passed, called Mesmerism and homeopathy quackery. In an article in the "Scalpel," from the able pen of Dr. Richmond,--about the time that the "swarm of vampires that was the first fruits of the tribe of rooters that swarmed the State of New York under the teachings of T. and B." (Thompson and Beach),--he calls botanics and eclectics quacks and Paracelsuses! Clear as--mud! So! The calomel practitioners are quacks. The homeopathics are quacks. The eclectics, and botanics, and Mesmerics, are all quacks! Any more, gentlemen? This is getting things somewhat mixed, and I rush to Dunglison's Medical Dictionary for explanation. Why, a quack is a _charlatan_! I turn to "Charlatan." Lo, it is quack! Clear as mud, again. In my perplexity I consult Webster. He refers me to a _goose_! So I rush to Worcester, and he implies it is a _duck_! Perhaps the _bill_ has something to do with the name; especially as I am reminded of a suit brought by a Boston M. D. to recover the exorbitant sum of three hundred dollars for reducing a dislocation. Therefore, summing up this "uncertainty," it seems to be a convenient word, expressive of contempt, which any professional man may hurl at any other whom he dislikes, or with whom he is not in fellowship. In its general use it is the _thief_ calling, "Stop thief." It was no unusual practice for physicians of the sixteenth and seventeenth centuries to use calomel in scruple, and even drachm doses. Mazerne "habitually administered calomel in scruple doses." Yandal gave it by the table-spoonful. I knew a physician in Maine who usually administered it by the tea-spoonful, and I saw a woman at Deer Isle, Me., suffering from true anchylosis of the jaw, in consequence of thus taking his prescription. In the same town was a man who was made completely imbecile by overdoses of mercury. In the town of B----l, same county and state, once lived an old quack, for convenience sake, near a large graveyard. _He "owned" it._ That is, he is said to have more victims laid away therein than all the other doctors who ever practised in town. "I knew him well." Once he sent to Boston for _two ounces_ of calomel. There was no steam conveyance in those days, and a sea captain took the order. By some mistake, _two pounds_ were sent. It was not returned. "O, never mind," said the doctor; "I shall use it all some time." Every state, county, yes, every town, in the Union has its victims to this quackery. In Rochelle, Ill., is a remarkable case, a merchant. Almost every joint in his frame is rendered useless. He can speak, and his brain is active. He has a large store, and he is carried to it every day, and there, stretched upon a counter, he gives directions to his employés. Though comparatively young, his hair is blanched like the snow-drift, falling upon his shoulders, and he is hopelessly crippled for life. "He does not speak in very flattering terms of the calomel doctors," said my informant. Neither do the thousands of diseased and mutilated soldiers, the victims to quackery while in the army. "SPEAKING FACTS.--A little boy, ten years of age, and having a paralyzed right leg, may be seen occasionally among his more able-bodied companions, the newsboys, unsuccessfully striving to 'hoe his row' with his rougher and more vigorous fellows. The limb is wholly dead, so far as its usefulness is concerned and it was caused by giving the little fellow overdoses of calomel, when he was an infant. "Another victim to calomel lives in the city of Hartford, in the person of a young lady of sixteen, who would be handsome but for deformities of face and mouth, occasioned by calomel given to her when a little child. She cannot open her mouth, and her food is always gruel, etc., introduced through the teeth. But the doctors stick to calomel as the sheet anchor of their faith." Behold WASHINGTON, who had passed through the battles of his country unharmed, and who in his last illness had, in the brief space of twelve hours, ninety ounces of blood drawn from his veins, and in the same space of time taken sixty grains of calomel! Who wonders that he should request his physician to allow him to "_die in peace_"? Andrew Jackson was another victim to calomel, as well as to the lancet, as the following letter shows:-- "HERMITAGE, October 24, 1844. "MY DEAR MR. BLAIR: On the 12th inst., I had a return of hemorrhage, and two days after, a chill. With a lancet to correct the first, and calomel to check the second, I am _greatly debilitated_. ANDREW JACKSON." Was not this double quackery? First, it was the _Similia similibus curantur_ (like cures like), of the homeopathists, which the Academy of Medicine has termed quackery. Second, it was exhibiting calomel to the injury (debilitating) of the patient. President Harrison was another victim. Are not these historical facts? Nevertheless, it is treason to mention them. "And why should any truth be counted as treasonable?" the honest and intelligent reader is led to inquire. "For truth is mighty, and must prevail," eventually. Yes, yes, truth will prevail. When bigotry and old-fogy notions are uprooted from the profession, and all educated and benevolent physicians strike hands and join fortunes to eradicate and discountenance all forms of quackery amongst themselves, they will then possess the power to suppress outside quackery. Far too many make a _trade_ of the _profession_; and just so long as educated physicians countenance or practise any one form of quackery, so long will they be powerless to check the abominations of charlatans and impostors outside of the profession. We have not introduced the foregoing facts in the interest of any persuasion. With the bickerings of the various schools of medicine we propose to have nothing to do, except to seize upon such truths as those otherwise useless quarrels are continually revealing. Opposition will not weaken a truth, nor strengthen a falsehood. You who are in the right need, therefore, have no fear as to final results. It is hard to kick against the pricks of custom, and custom has perverted the word which is the text of this chapter, and it is now more commonly applied to the ignorant, boastful _pretender_ to the science of medicine. Now we will introduce a few facts obtained from without the profession. THE COUNTRY QUACK. In the town of P----, Conn., there resided two doctors. One, old Dr. B., a regular, and the other, Dr. S--h, an irregular. It was in the autumn, and a fever was prevailing at this time, of a very malignant character. From over-exertion and exposure Dr. B. was taken sick, and in a few days fever supervened. This news spread terror over the immediate community, and the old doctor becoming delirious, his wife and family soon partook of the terror. A neighboring physician was sent for, but being absent, he did not at once respond; and the invalid becoming, as they feared, rapidly worse, Dr. S. was reluctantly called. He was known to be an ignoramus, formerly a peddler, a farmer, horse-jockey, a fifth-rate country lawyer, and, lastly, a doctor. Had Dr. B. retained his senses, he would have sooner died than have admitted his enemy, this "rooter," into his house. He came, however, with great pomposity, examined the patient, whose delirium prevented resistance, and ordered an immediate application of the juice of poke-berries rubbed over the entire skin of the old doctor, as a febrifuge. "But," inquired the wife, timidly, "is not this an unusual prescription, Dr. S.?" The doctor replied that it was a new remedy, but very efficacious. "You see," he added, with many a hem and haw, "it will out-herod the blush of the skin, put to shame the fever, which retires in disgust, and so relieves the patient." "And won't he die, if we follow this strange prescription?" asked a friend, while the doctor was proceeding to deal out a large powder. "No, no; ahem! _You_ do the _dyeing_, to prevent the _dying_. Haw, haw!" roared the vulgar old wretch, convulsed by his own pun, and the anticipation of the ludicrous corpse that he expected to see within a few days. There was no alternative. The prescription must be followed, and the children were sent to the woods to gather the ripe berries. The quack next proceeded to deal out a dose of lobelia and blood-root, which he left on the desk where Dr. B. prepared medicines when in health, giving directions for its administration, and in high glee took his departure. The inspissated juice of the highly-colored berries was applied over the face, arms, and body of the unconscious doctor, the remarkable appearance of whom we leave the reader to imagine. By mistake, a large dose of camphorated dover's powders which lay on the table was substituted for the lobelia of Dr. S., which with the warm liquid applied to the skin, checked the fever, and, contrary to the hope and expectation of Dr. S., the following morning found his patient in a fine perspiration, and the neighboring physician arriving, he was soon placed in a condition of safety. Notwithstanding Dr. S. told some friends of the joke,--for the worst have their friends, you know,--he was known to have prescribed for Dr. B., his sworn enemy; and as the patient was pronounced convalescent, S. received all the credit, and forthwith his services were in great demand. Day and night he rode, till, by the time Dr. B. got out, he was completely exhausted! He became alarmed lest he should take the fever. Such fellows are ever cowards when anything ails their precious selves. He actually became feverish with fear and excitement, and took his bed--and his emetic. He took either an overdose, or not enough, and for hours remained in the greatest distress. Finally, as a _dernier resort_, his wife sent for Dr. B.! Now came his turn to avenge the insult of the painting by poke-berries, which stain was yet scarcely removed from the skin of the old doctor. "I'll give him a dose; I'll put my mark on him--one that milk and water, or soap, cannot remove. O, I'll be avenged!" exclaimed Dr. B., as he mounted his gig, and drove to Dr. S. "O doctor, doctor! I am in fearful distress. Can you help me? Will I die?" whined S., on beholding his opponent. "No; not such good news. Those born to hang don't die in their beds. But you are very sick, and must abide my directions." "Yes, yes. Thanks, doctor. This blamed lobelia is killing me, though." "Then take this." And Dr. B. administered a half tea-spoonful of ipecac, to bring up the lobelia. So far was good. "Now a basin of water and a sponge," said Dr. B., which being procured, he seemed to examine for a moment very curiously; then ordered the face, neck, arms, and hands of the patient bathed well with the fluid. On the following morning Dr. B. was sent for, post haste, with the cheering message that "mortification had set in, and his patient was dying." Off posted the doctor, calling several neighbors, _en route_, who thronged the apartment of the invalid doctor in speechless astonishment. [Illustration: CURIOUS EFFECT OF A FEVER.] "I'm dying, Dr. B.; O, I'm dying," groaned S., rolling to and fro on his bed. "No, you are not. I told you before, no such good news. Your fever is all gone. You are scared--that's what's the matter," replied Dr. B. "But look, just look at the color of my skin,--all mortifying," said S. "O, no; that is merely dyed with _nitrate of silver_. It's much better than poke-berries--much better," repeated Dr. B. The recovered patient leaped from his bed, and, with an oath, made straight for the doctor; but the bystanders, though convulsed with laughter, caught the enraged victim, while, amid the cheers and laughter of the crowd, Dr. B. made his escape, saying to himself,-- "The nitrate of silver I put in the basin worked like a charm." The story soon circulated, and Dr. S., being unable to remove the deep stain from his skin, and the curious rabble from his door, left for parts unknown. Dr. B., on revisiting his patients, who now rejoiced in his recovery, found that S. had not only dispensed lobelia and blood-root, but had bled and mercurialized several. REMARKABLE DROPSY. The writer was acquainted with a young physician who was unceremoniously discharged by the family of a beautiful young lady to whom he had been called to prescribe, in a country village, his offence being the discovery of the true source of the patient's (?) indisposition, which fact he _dared_ to intimate to the mother. "An older and more experienced physician" succeeded him, who reversed the diagnosis, and pronounced it "a clear case of _dropsy_," and the young M. D. went into disrepute. During the entire winter the old doctor made daily visits to his patient. Daily had the old ladies of the neighborhood adjusted their "specs," smoothed down their aprons, and, watching the doctor's return, run out to the gate to inquire after the health of the lady, the belle of the town. "O, she's _convalescent_," was his usual reply, with due professional dignity; and thus the matter stood till a crisis came. [Illustration: MARRYING A FAMILY.] There was a ball in the village one night. About eleven o'clock a messenger appeared in the room, who hastily summoned a certain young gentleman, a scion of one of the "first families" in town. At the same time the minister was called, and the young man, standing by the bed, holding the invalid lady by the right hand, while on his left arm he supported a beautiful babe but an hour old, was married to the "convalescent" patient. The old doctor had run a beautiful "bill," but it was his last in that village. A COUNTRY CONSULTATION. The difficulty of obtaining competent counsel in the country can only be fully comprehended by the intelligent physician who has had experience therein. From Dr. Richmond's "_Scenes in Western Practice_," I have selected the following lamentable incidents, which I have abbreviated as much as is consistent with the facts, related by the doctor, who in this case was called to a wealthy and influential family, two of whom, wife and child, were prostrated by epidemic dysentery. "As my credit was at stake, an old and very grave man was, at my suggestion, added to the consultation, to guard our reputation from the usual visitation of gossiping slander that always follows a fatal result in the country. He examined the child, and gave his opinion that the symptoms resembled those of ipecac!... But death was ahead of the doctors, and the little sufferer passed quickly away to a better world. "Another child had died in the vicinity, and the _neighbors_ decided on a change of doctors for the lady. By my consent the inventor of the 'Chingvang Pill' was called, as I assured my friend his wife would now recover without either of us! "He came, and readily detected the fact that he was in luck. His patient and fees were both safe, and I was floored. "'Of course, Dr. R., you will call when _convenient_,' was a polite way of 'letting me down easily,' and I did call. "Everything went on swimmingly for two days, when suddenly the scale turned; two other children were taken vomiting bile and blood. The doctor was in trouble, and on my friendly call his eye caught mine, and spoke plainly, 'My credit, too, is gone,--the children will both die.' "The children grew rapidly worse; the council of the _neighborhood_ decided to call further aid. Another regular was called, and, being one of the heroes, he advised (it is solemn truth, dear reader) _one hundred grains of calomel at a dose_! His reason was, that he had given it to a child, and the patient recovered. His medical brother thought it a little too steep, and they compromised the matter by giving fifty grains! Copious quantities of fresh blood followed the operation, and the little victim of disease and quackery slipped from his suffering into the peaceful and quiet grave! "One patient remained, and it was decided to call further counsel. "A simple but shrewd old quack was curing cancers in the neighborhood, who sent word to the afflicted family that he 'could cure the remaining child by cleansing the bowels with pills of butternut bark, aloes, camphor, and Cayenne pepper;' he would feed the little fellow on twist-root tea that would at once stop the discharges. Strange as it may seem, the wily old fool was called into the august presence of three M. D.'s, and a score of other counsellors. He gave his pills; fresh blood followed the raking over the inflamed and sensitive membrane; the child screamed with torture, and was only relieved from its horrible agony by enemas of morphine. The celebrated '_twist-root_' (an Indian remedy, whose virtues could not be appreciated by the educated physician) followed, and death closed the scene. "The old cancer-killer escaped by saying the morphine given in his absence _killed the child_." [Illustration: 'OPATHISTS IN CONSULTATION.] The following brief consultation occurred in Fulton, N. Y., recently:-- Two physicians were called, of opposite schools. After shaking hands over the sick man's bed, one said to the other,-- "I believe you are an --'opathist." "Yes, I am; and you are a --'pathist; are you not?" "Yes; and I can't break over the rules of my society by aiding or counselling with you ---- for the sake of _one_ patient. Good day!" "Sir, I mistook you for a Christian, not a barbarian! Good day!" A JOLLY TRIO OF DOCTORS. Before entering upon an exposition of the viler and more reprehensible sort of quacks,--the city charlatans and impostors,--I must relate a diverting scene, also from a country consultation that occurred in New York State some years since, from the perusal of which, if the reader cannot deduce a "moral," he may derive some amusement. Mr. H. was an invalid; he was the worst kind of an invalid--a hypochondriac. The visiting physician had made a pretty good thing of it, the neighbors affirmed, for "H. was in easy circumstances." Finally he took to his bed, and declared he was about to shuffle off this mortal coil. Two eminent physicians were summoned from a distance to consult with the attending physician. They arrived by rail, examined the patient, looked wise, and the learned trio withdrew to consult upon so "complicated and important a case." A tea-table had been set in an adjoining room, and to the abundance of eatables wherewith to refresh the distinguished professionals who were there to enter upon an "arbitrament of life or death," were added sundry bottles yet uncorked. A little son and daughter of Mr. H. were amusing themselves, meantime, by a game at "hide-and-seek," and the former, having "played out" all the legitimate hiding-places, bethought himself of the top of a high secretary in the "banqueting-room." Action followed thought, and, climbing upon a chair-back, he gained the dusty elevation, where he quietly seated himself just as the three wise Æsculapians entered the apartment. His only safety from discovery was to keep quiet. Corks were drawn, supper was discussed, and conversation flowed merrily along. The weather, the news of the day, and the political crisis were discoursed, and the little fellow perched high on the secretary wondered when and what they would decide on his father's case. Nearly an hour had passed, the doctors were merry, and the boy was tired; but still the little urchin kept his position. "Well, Dr. A., how is practice here, in general?" inquired one of the counsel. "Dull; distressingly healthy. Why, if there don't come a windfall in shape of an epidemic this fall, I shall _fall_ short for provender for my horse and bread for my family. How is it with you?" "O, quite the reverse from you. I have alive twenty daily patients now." "Very sick, any of them?" asked the local physician. "No, no,--a little more wine, doctor,--some old women, whom any smart man can make think they are sick; some stout men, whom medicine will keep as patients when once under the weather; and silly girls, whom flattery will always bring again,--ha! ha!" and so saying he gulped down the wine. "Why, there goes nine o'clock." "What, so late!" exclaimed one counsellor, looking at his gold repeater. "We must go or we'll miss the return train," remarked the other; "the doctor here will manage the patient H., who's only got the _hypo_ badly," he added. "Is that a bust of Pallas he has over his secretary yonder?" asked the first, discovering the boy for the first time. "I'm afraid Dr. ---- has got a little muddled over this excellent 'Old Port,' that he can't see clearly. Why, that's a bust of _Cupid_." "Well," exclaimed the local physician, "I have been here a hundred times, and never before observed that statue; but," eying the statue fixedly, he continued, "it looks neither like Pallas nor Cupid, but rather favors H., and I guess it is a cast he has had recently made of himself." Through all this comment and inspection the boy sat as mute as a post; but the moment the door closed on the retiring doctors, he clambered down and ran into the sick room. [Illustration: A "HYPO" PATIENT DISCHARGING HIS PHYSICIAN.] The old doctor had slipped the customary fee into the hands of his brethren as he bade them good night, and entered the room of his patient. The latter instantly inquired as to the result of the consultation. The doctor entered into an elaborate account of the "diagnosis" and "prognosis" of the case, which was suddenly brought to a close by the little boy, who, climbing into a chair on the opposite side of the bed, asked his father what a "hypo" was. "You must ask the doctor, my son," replied the father in a feeble voice. "Hypo," said the unsuspecting doctor, "is an _imaginary_ disease,--the hypochondria, vapors, spleen; ha, ha, ha!" "Well, papa, that's what the doctors said you've got, 'cause I was on top of the book-case an' heard all they said, an' that's all." The doctor looked blank. H. arose in his bed, trembling with rage. "By the heavens above us, I do believe you, my son; and this fellow, this quack, has never had the manliness to tell me so;" and leaping to the floor in his brief single garment, he caught the dumb and astonished "M. D." by the coat collar and another convenient portion of his wardrobe, and running him to the open door, through the hall, he pitched him out into the midnight darkness, saying, "There! I have demonstrated the truth of the assertion by pitching the doctor out of doors." H. recovered his health. The doctor recovered damages for assault and battery. [Illustration] VII. CHARLATANS AND IMPOSTORS. "Every absurdity has a chance to defend itself, for error is always talkative."--GOLDSMITH. DEFINITION.--ADVERTISING CHARLATANS.--CITY IMPOSTORS.--FALSE NAMES.--"ADVICE FREE."--INTIMIDATIONS.--WHOLESALE ROBBERY.--VISITING THEIR DENS IN DISGUISE.--PASSING THE CERBERUS.--WINDINGS.--INS AND OUTS.--THE IRISH PORTER.--QUEER "TWINS," AND A "TRIPLET" DOCTOR.--A HISTORY OF A KNAVE.--BOOT-BLACK AND BOTTLE-WASHER.--PERQUISITES.-- PURCHASED DIPLOMAS.--"INSTITUTES."--WHOLESALE SLAUGHTER OF INFANTS.-- FEMALE HARPIES.--A BOSTON HARPY.--WHERE OUR "LOST CHILDREN" GO.--END OF A WRETCH. THE CITY CHARLATAN. A charlatan is necessarily an impostor. He is "one who prates much in his own favor, and makes unwarrantable pretensions to skill." He is "one who imposes on others; a person who assumes a character for the sole purpose of deception." Originally the charlatan was one who circulated about the country, making false pretensions to extraordinary ability and miraculous cures; but he is now located in the larger cities, and is the most dangerous and insinuating of all medical impostors. You will find his name in the cheapest daily papers. Name, did I say? No, never. Of all the charlatans advertising in the papers of this city there is but one who has not advertised under an assumed name. This is _prima facie_ evidence of imposition. Take up the daily paper,--the cheapest print is the one that the rabble patronize, a curse to any city,--and run your eye over the "_Medical Column_." Of the scores of this class advertising therein none dare publish his real name. There is one impudent fellow, who, while he assumes respectability, and under his true name, has an up-town office, and obtains something bordering on an honorable practice, runs the vilest sort of business, under an assumed name, on a public thoroughfare down town. These fellows usually advertise, "Advice Free." This is not on the modest principle, that, having no brains, they are scrupulous in not charging for what they cannot give, however; but this is to get the unsuspecting into their dens, for they are shrewd enough to perceive that whatever is "free" the rabble will run after. [Illustration: CONVINCING EVIDENCE OF INSOLVENCY.] When once the victim is within the web, flattering, intimidations, and extravagant promises, one or all, generally will accomplish their aim. As they never expect to see a special victim again, they squeeze the last dollar from the unfortunate wretch, giving therefor nothing--worse than nothing! I sent a pretended patient to one of these charlatans not long since, and, with crocodile tears in his eyes, he related his case to the _soi-disant_ doctor, who with great sympathy heard his case, and assured him it was "heart-rending, and, though very dangerous, he could cure him;" but the knave compelled the patient (!) to turn his pockets inside out to assure him they contained but the proffered dollar. A small vial of diluted spirits nitre was the prescription, for which the doctor assured the patient he usually received twenty to forty dollars! I have visited several of these places in disguise, including those of female doctors, and those advertising as "midwives," every one of whom agreed to perform a criminal operation upon the mythical lady for whom I was pretending to intercede. Their prices ranged from five to two hundred dollars. The following painfully ludicrous scene I copy from manuscript notes which I made some years ago, respecting a visit to one of these impostors. I vouch for its truthfulness. "I next bought a penny paper of a loud-mouthed urchin on the street corner, and, reading it that evening, the words 'Medical Notice' attracted my attention. It was all news to me, and I resolved to visit this 'very celebrated' doctor on the following day, 'advice free.' "Accordingly I repaired to his office, as designated in the advertisement. There were several doors wonderfully near each other, about which were several doctors' signs conspicuously displayed; and, since I had heard that 'two of a trade seldom agree,' I thought it remarkable that three or four of a profession should here be huddled together. "'STEP IN THE ENTRY AND RING THE BELL,' I read on a sign, in big yellow letters. I did so, when a big burly Irishman answered the summons. "'An' who'll yeze like to see, sure?' he inquired, with a broad grin. "'Dr. A.,' I replied, eying this Cerberus with awakening suspicion. "'He's just in, sure. Come, follow me.' "He led the way across a small room, and through a darkened hall, around which I cast a suspicious glance, noticing, among other things unusual, that the partitions did not reach the ceiling. Thence we entered another room, which, from the roundabout way we had approached, I thought must be opposite the outer door of Dr. B.'s or Dr. C.'s office. "Here Pat left me, saying, 'The ixcillint doctor will be to see yeze ferninst he gits through wid the gintleman who was before your honor.' [Illustration: "AN' WHO'LL YEZE LIKE TO SEE, SURE?"] "I took a look about the room. The partitions on two sides were temporary. On one side of the apartment stood an old mahogany secretary. Through the dingy glass doors I took a peep. The shelves contained several volumes of 'Patent Office Reports,' odd numbers of an old London magazine, and such like useless works. On the walls were a few soiled cheap anatomical plates, such as you will see in 'galleries' or 'museums' fitted up by quack doctors, to intimidate the beholder. I could look no farther, as the door opened, and a man entered, who, looking nervously around, at once asked my business. "'Are you Dr. A.?' I asked. "'I am. Please be seated. You are sick--very sick,' he said hurriedly, and in a manner intended to frighten me. "Five minutes' conversation satisfied us both--him that I had no money, and me that he had no skill. After vainly endeavoring to extort from me my present address, he unceremoniously showed me out. "As I closed the door I looked to the name and number, and, as I had anticipated, found myself at Dr. B.'s entrance. "Turning up my coat collar, and tying a large colored silk handkerchief over the lower part of my face, I knocked at the third door, Dr C.'s. "The same Irishman thrust out his uncombed head and unwashed face; the same words in the same vernacular language followed. "'I wish to see Dr. C.,' I replied, changing my voice slightly. "'He's in, jist. It never rains but it pours. Himself it is that has a bully crowd of patients the day; but coome in.' "He did not recognize me--that was certain; so I followed, and was led through a labyrinth of rooms and halls, as before, and ushered into a small room, where the polite and loquacious Pat offered me a chair, and giving the right earlock a pull and his left foot a slip back, he said, with his broadest grin and most murderous English,-- "'I'll be shpaking the doctor to come to yeze at once intirely.' "'But he has others with whom he is engaged, you said but a moment ago.' "'Ah, yeze niver mind. Theyze ben't gintlemen like yerself, if yeze do come disguised;' and with a '_whist_' he tip-toed across the room, applied his ear to the keyhole of the door a moment, and returned in the same manner. "'It's all right; now I'll go for the doctor;' but still he lingered. "'Well, why the d----l don't you go?' I said, impatiently. "'Ah, gintlemen always come disguised to see Dr. A.--no--Dr. B., I mean.' "''Tis Dr. C. I asked for,' I interrupted. "'Yis, yis,' he replied, collecting his muddled senses. 'Yis, sure, you did, an' gintlemen always swear--two signs yeze a gintleman. Could yeze spare a quarter for a poor divil? By the howly mither, I git narry a cint, bating what sich gintlemen as yeze gives me. I have a big family to ate at home. There's Bridget' (counting his fingers by the way of a reminder), 'she's sick with the baby; then there's the twins,--two of thim, as I'm a sinner,--and little lame Mike, what's got the rackabites, the doctor says--' "'Got the what?' I interrupted. "'The rackabites, or some sich dumbed disease,' he replied, scratching his head. "'O, you mean rickets. But how old are the twins, and Mike, and the baby?' "'Will, let me see. The baby is tin days, and not christened yit, for we've not got the money for Father Prince, and there's Mike is siven, and Mary is four, and Bridget junior is five.' "'And the twins?' I asked, not a little amused. "'Yis, them's Mary and Bridget junior,--four and five.' "I interrupted him by a laugh, gave him the desired quarter, and told him to hasten the doctor, which request he proceeded to execute. "On the heels of retiring Pat the door opened, and the same doctor I had before seen entered. "'I want to consult Dr. C.,' I drawled out. "'I am Dr. C.,' he replied, measuring me from head to foot sharply. "Fearing he would penetrate my disguise, I hastened my errand. 'Having an ulcerated and painful tooth I wish removed, or--' "'This ain't a dentist's office; but if you have any peculiar disease, I am the physician of all others to relieve you.' "I being sure now of my man, that this same villain was running three offices under as many different _aliases_, my next object was to get safely out of his den. "'I have no need of any such services as you intimate. 'Tis only the tooth--' "Here he interrupted me by an impatient gesture, intimating that only a descendant of the monosyllable animal once chastised by one Balaam would have entered his office to have a tooth drawn. Admitting the truth of his assertion, and offering my humblest apology, I hurriedly withdrew from this _triplet_ doctor. "Safely away, I reflected as follows: Here, now, is this scoundrel, by the assistance of an equally ignorant Irishman, conducting at least three offices on a public thoroughfare, under as many assumed names. "'Why, the fellow is a perfect chameleon!' I exclaimed, walking away. 'He changes his name to suit the applicants to the various rooms. You want Dr. A.,--he is that individual. You desire to see Dr. B.,--when, _presto!_ he is at once the identical man. And so it goes, while his amiable assistant seems to be making a nice little thing of it on his own account. Why all these intricate passages? and why was I each time taken around through them, and out through a different door from that which I entered? Did a legitimate business require such mazy windings as I had just passed through? Did Dr. A., B., or C., or whatever his name might be, rob his patients in one place and thrust them out at another, that they might not be able to testify where and by whom they had been victimized? Was not the newspaper proprietor who advertised these several offices a _particeps criminis_ in the transaction? And with these facts and suggestions I leave the fellow, who by no means is a solitary example of this sort of fraud.'" On another street in this city is another branch from the Upas tree. I do not wish to advertise for him, hence omit his _names_, which are legion. Two of them begin with the letter D. The true name of this impostor commences with an M. He is old enough to be better. I know of patients who have been fleeced by him without receiving the least benefit, when the knowledge necessary to prescribe for their recovery, or of so simple a case, might be possessed by even the office boy. You go to his first office and inquire for the first _alias_. The usher, a boy sometimes, takes you in, and, slipping out the back door, he calls the old doctor from the next office. They are not connected. Through a glass door he takes a survey of you, to assure himself that you have not been victimized by him already under his other _aliases_. If he so recognizes you, he summons a convenient "assistant" to personate the doctor, and thus you are robbed a second time. HISTORY OF A KNAVE. The following is a brief and true history of one of the vilest charlatans and impostors now practising in Boston. He has amassed a fortune within a few years by the most barefaced villanies ever resorted to by man. He is one of the most abominable charlatans, who, for the almighty dollar, would willingly sacrifice the lives of his unfortunate victims, who, by glowing newspaper statements and seductive promises, have been drawn into his murderous den. By the side of such unprincipled villains, the highwaymen, the Dick Turpins, with their "Stand and deliver!" or "Your money or your life!" are angels of mercy, for the former rob you of your last dollar, and either endanger your life by giving you useless drugs that check not the disease, or hasten your demise by poisonous compounds given at random, the virulent properties of which the vampires know but little and care less. Their boast that their remedies are "_purely vegetable_," "hence uninjurious", is as false as their pretensions to skill, and is counted for nothing when we know that vegetable poisons are more numerous, and often more rapid and violent in their action, than minerals. Both calomel and other minerals are often _given_ by these charlatans. I say _given_, for few of them know enough to write a legible prescription, much less to write the voluminous works which they put forth on "manhood," "physiology of woman," etc., which are but so many advertisements for their vile trade and criminal practices, and are intended to alarm and corrupt the young and unwary into whose hands they may unfortunately fall. This fellow, whom I am now to describe, who sometimes prefixes "professor" to his name, was born in the State of New Hampshire, and when a young man came to this city to seek his fortune. After various ups and downs, he became boot-black, porter, and general lackey in the Pearl Street House, then in full blast. He was said to be a youth of rather prepossessing, though insinuating address, and being constantly on the alert for odd pennies and "dimes," succeeded in keeping himself in pocket-money without committing theft, or otherwise compromising his liberty. But the odd change, and his meagre salary, did not long remain in pocket, for the courtesans, who are ever on the alert for unsophisticated youth who throng to the cities, managed to obtain the lion's share from this embryo doctor, whose future greatness he himself never half suspected. Disease, the usual result of intercourse with such creatures, was the consequent inheritance of this young man. "What, in the name of Heaven, shall I now do?" he asked himself, in his distress and despair. "Money I have none. O God! what shall I do?" "Drown yourself," replied the tempter. Such fellows seldom drown. Females, their victims, drown; but who ever heard of a natural-born villain committing suicide, unless to escape the threatening halter? No, he did not drown, though it had been better for humanity if he had. He went to an old advertising charlatan, who then kept an office in a lower street of this city, a mercenary old vampire, named Stevens. Into the august presence of the charlatan young M. entered, and, trembling and weeping, told his history. [Illustration: A BOSTON QUACK EXAMINING A STUDENT.] "Have you got any money, young man?" growled the old doctor, wheeling around, and for the first time condescending to notice the poor wretch. "No," he sobbed in a pitiful voice. "Then what do you come here for, sir?" roared the doctor, whose pity was a thing of the past. His soul was impenetrable to the appeal of suffering as the hide of the rhinoceros to a leaden bullet. The young man, fortunately, did not know this fact, and persevered. "I thought I might work for you to pay for treatment. O, I'll do anything--sweep your office, wash up the floors and bottles, black your boots, do anything and everything, if you'll only cure me. O, do! Say you will, sir!" and the young man writhed in agony of suspense. "Humph!" grunted the old doctor, contemplatingly. Doubtless he was considering the advantages which might accrue from accepting the proposition of this earnest applicant, for, after eying him sharply, and beating the devil's tattoo for a few moments upon his table, the doctor condescended to "look into his case," and finally to treat the young man's disease upon the proposed terms. M. began his apprenticeship by sweeping the office, and the old doctor held him to the very letter of the agreement, keeping him at the most menial service,--boot-blacking, bottle-washing, door-tending, etc.,--protracting his disease as he found the young man useful, till the old knave dared no longer delay the cure, for thereby the victim might go elsewhere for help. When cured, M. engaged to continue work for the small compensation that the doctor offered, especially since he and the old man had begun to understand each other pretty well, and each was equally unscrupulous as to the sponging of the unfortunate victims who fell into their hands. When the doctor was observed to prescribe from any particular bottle, M. took a mental memorandum thereof till such time as he could take a look at the label, thereby learning the prescription for such disease; and the result was a decision that if this was the science of healing, "_it didn't take much of a man to be a_"--_doctor_. When the old doctor was absent, M. would prescribe on his own account, charge an extra dollar or two as perquisites, and deposit the balance in the doctor's till. In course of time, by this process of extortion, solicitations, and the increasing perquisites, M. was enabled to set up doctoring on his own account. The old doctor died, and M. had it all his own way. The young self-styled doctor saw no particular need of making effort to acquire medical knowledge, but a diploma to hang upon his office walls, with the few disgusting anatomical plates (appropriated from Dr. S.), which were admirably adapted to intimidate his simple-minded dupes,--a diploma from some medical society would give character to the "institution," and such he would obtain. Being cited to court as defendant in a certain case, this _soi-disant_ "M. D." was compelled to retract a former statement that he had attended medical lectures in Pennsylvania College, where he graduated with honors, and come down to the truthful statement, _for once in his life_, and swear that he had obtained his diploma by _purchase_. His present rooms--house and office--are located in the heart of the city, and are not exceeded for convenience and neatness by those of the respectable practitioner. Having amassed a great fortune out of the credulity, misfortunes, and passions of the unfortunate, he has settled down to the plane of the more respectable advertising doctors, and the terrifying plates no longer cover the walls of the _best_ reception-room; but a few valuable pictures and the Philadelphia diploma are conspicuously displayed above the elegant furniture and valuable articles of _virtu_. The same extortions and reprehensible practices are still resorted to in order to keep up this "institution." His earlier history is gathered from _his own statements_, by piecemeal, by a confidential "student," the latter portion by _personal investigation_ of the writer. Respecting the matter of purchasing diplomas, I will state that I have seen a "Regular Medical Diploma" advertised in the New York _Herald_ for one hundred dollars. The name originally written therein is extracted by oxalic acid, or other chemicals. I knew a physician who parted with his Latin diploma for fifty dollars. I here warn the youth, and the public in general, against those advertised "_institutes_," though the name may be selected from that of some benevolent individual,--to give it a look of a benevolent character,--even though it be a "Nightengale," or a "Peabody," or a "St. Mary," and managed, _ostensibly_, under the sanction of the church or state--beware of it. Without, it is the whited sepulchre, within, the blood, flesh, and bones of dead men, women, and children. Some years since there was found, after the flight of one Dr. Jaques (?), in a vault in the city of Boston, the bones of some half score infants. The murderous charlatan escaped the halter he so richly deserved, and was practising in a New England village not above six years since. Another impostor, who has been extensively advertised in this city under an assumed name--selected to correspond with the familiar name of a celebrated New York (also a late Boston) physician and surgeon--who not only cheekily claims to be an "M. D.," but assumes the titles of F. R. S., etc., was but a short time before a dry goods seller on Hanover Street. He never read a standard medical work in his life. Although the villain has gone to parts unknown to the writer, the concern he recently represented as "consulting physician" is in full blast, and the same name and titles are blazoned forth daily in the public prints. Men get rich in these "institutes," take in an "assistant" for a few weeks, then sell out to the _novus homo_, and the thing goes on under the old name until the new man gains strength and confidence sufficient to carry it along under his own or his assumed title. FEMALE HARPIES. Under the name of "female physician," "midwife," etc., the most illicit and nefarious atrocities are daily practised by the numerous harpies who infest all our principal cities. The mythological harpies were represented as having the faces of women, heartless, with filthy bodies, and claws sharp and strong for fingers, which, once fastened upon human flesh, never relaxed till the last drop of life's blood was wrung from their unfortunate victim. Virgil thus expressively described them in the third book of the Æneid:-- "When from the mountain-tops, with hideous cry And clattering wings, the filthy harpies fly; Monsters more fierce offending Heaven ne'er sent From hell's abyss for human punishment; With virgin faces, but with ---- obscene, With claws for hands, and looks forever lean!" I will describe but one of the modern harpies of Boston, appealing to the reader if our text above is too severe. More than forty years ago, a young, fair, and promising girl came to this city from the White Mountains of New Hampshire. From her maiden home, near Meredith Village, from under the humble roof of Christian parents, she wandered into the haunts of vice and the abodes of wretchedness and disease in the lower part of Boston. Her maiden name was Elizabeth Leach. You will find her name in the City Directory (1871) "_Madam Ester, midwife_." We have not space to write out her whole history, nor inclination to spread before the refined reader the first years of the gay life of this attractive damsel, the seductive and sinful debaucheries of the fascinating, unprincipled woman, nor the more repulsive declination of the diseased and malevolent _bawd_! The writer has seen a picture of her home in New Hampshire, a daguerreotype of her in her virginity, and a painting, taken from her sittings, in middle life. In stature, she is tall and stout; in manner, coarse and repulsive. If ever I saw a woman carrying, stamped in every lineament of her countenance, a hard, heartless, soulless, murderous expression, that woman is Madam Ester. Neither the tears, the heart-anguishes, nor the life's blood of the fatherless infant, the husbandless mother, the orphaned or friendless maiden, could draw a sympathizing look or expression from the hardened features of that wretched woman. _She is the John Allen of Boston._ For years she has carried on, under the cloak of a "midwife," the most cruel and reprehensible occupation which ever disgraced an outraged community. By extortionate prices she has gained no inconsiderable wealth, and her house, though located in a narrow, darkened alley, or court, is fitted up with an elegance equalling that of some of our best and wealthiest merchants. From parlor to attic, it is splendidly furnished. She assured me she hated mankind with inexpressible hatred; that man had been her ruin, the instrument of her disease, and would eventually be the cause of her death. She cursed both man and her Maker! Last spring there appeared an advertisement in a city paper of a young girl who was lost, or abducted from the home of her parents, in which the young lady was described as being but sixteen to seventeen years of age, of light complexion, blue eyes, of but medium height, named Mary ----; and as she took no clothes but those she had on, never before went from home without her parents' consent, and had no trouble at home, her absence could not be accounted for. Any information respecting her would be gratefully received by her distressed parents. She was all this time at the home of Madam Ester. The young man who completed her ruin, like the contemptible cur he was, deserted her in her distress, leaving her in the hands of the miserable wretch above described. The girl had one hundred and twenty dollars. A part of it was her own money; some she borrowed, having some influential friends, and the balance her father gave her, ostensibly for the purchase of clothing. The old vampire appropriated every cent of the sum, and in fourteen days turned the weak and wretched girl into the street, without sufficient money to pay her coach fare to her father's house. A young girl then in the employ of the unfeeling old wretch gave her five dollars, and she informed her kind benefactress that she should go home and say that she had been at service in a family on Beacon Street, but being sick, could earn no greater wages than the sum then in her possession. "The pale and sickly countenance of the poor girl, after the abuse and torture she had undergone," said my informant, "certainly would seem to corroborate her story." Since the above was written the wicked old wretch has died--died a natural death, sitting in her chair! On the last day of July, 1871, she sent a girl, a well-dressed and very lady-like appearing young woman, to my office, to know if I could be at liberty to give her a consultation that afternoon. She sent no address; merely a "woman with a cancer of the breast." She came. She introduced her business, not her name. I pronounced her case hopeless, advised her to "close up her worldly affairs, and make her peace with God and mankind, as she could live but a short time." This was given the more plainly, since she "demanded to know the worst," and because of her bold attempt to browbeat me into treating her hopeless case. The cancer was immense, had been cut once by Dr. ----, of this city. Her attendant told me that the old woman never ceased to berate me for my truthful prognosis, and that from that time she gave up all hope of recovery, and soon closed her nefarious practice. I have since gathered all the information respecting her that was possible. I knew at sight that I had a remarkable woman to deal with, and, agreeably to her invitation, I took another physician, a graduate of Harvard College, and went to her house, ostensibly to consult over her case.... A woman who has known madam for many years told me that the old woman was familiar with chemicals, and by the use of acids and alkalies could completely destroy the flesh and bones of infants. She had never seen her do it, but had seen the chemicals, and referred me to persons who had seen the dead body of a female brought out from the house at midnight, and taken away in a wagon. She said she practised great cruelty upon the unfortunate victims who had been placed under her hands, and that their cries had often been heard by the neighbors living in the court. She said that madam claimed to have been the wife of a policeman who was killed at Fort Hill, and that she was also since married to a Captain ----. The latter was untrue. Madam told me she once _thought_ she was married, but it was a deception on her--a mock marriage. She possessed great quantities of magnificent clothing,--rich dresses of silk, satin, velvet, etc.,--and a beautiful wedding _trousseau_, which, but a short time before her death, she caused to be brought out and displayed before her. "O, take them away; I never shall wear them," she said. And she never did. There is another female physician now residing in this city, who I know has accumulated a considerable property as midwife; but if report, and assertions of victims, are true, she has gained it by threats and extortions. She is now out of practice, or nearly. Her _modus operandi_ was to take the unfortunate female, treat her very tenderly, get hold of her secret, learn the gentleman's name, business, and wealth, and then--especially if he was a family man before--make him "come down," through fear of exposure. Men have "come down" with thousands, little by little, till they were ruined pecuniarily under this fearful blackmailing. I doubt if money could hire her to perform a criminal operation. She can make more money by keeping the unfortunate girl, and blackmailing the seducer, _or any other individual_ who can be scared into the trap, provided the guilty one has no money. "Blessed be nothing," said the Arab. These people carry on their trade very quietly. Their very next door neighbors may know nothing of the unlawful acts committed right under their noses. It is for the interest of all concerned to keep everything quiet. Their customers, and even their victims, come and go after nightfall. There is still another class, mostly males, practising in this city, who, under fair pretences and great promises, get the patients' money, and give them no equivalent therefor. Beyond the robbery,--for that is what it is; no more nor less,--and the protracting of a disease (or giving nature more time, as the case may be),--they do the applicant no injury. They receive a fee, calculating it to a nicety, according to the depth of your pocket, give some simple mixture, and bow you out. Many an honest patient, seeing their high-flown advertisements in the dailies, weeklies, even religious (!) papers, from month to month, is induced to visit these impostors. Their offices may be in a less public street, in a private residence, and have every outward appearance of respectability. There is a class of male practitioners, not unusually having a Latin diploma, who never appear in the prints. They are the "Nurse Gibbon" class, who employ one or more females to drum patients for them. The following is a truthful statement respecting a visit to one in 1850:-- "On my arrival on the steamer Penobscot at Boston, the lady met me, and, according to arrangement, took me to see 'her physician.' His office was on Chambers Street, left side, a few doors from Cambridge Street, Boston. The doctor was an elderly, pompous individual, who wore gold spectacles, an immense fob chain, and chewed Burgundy pitch. Let this suffice for his description. Poor man! for if his own theology is true, he has gone where Burgundy pitch will be very likely to melt. Excuse this passing tribute to his memory, my dear reader. "Notwithstanding my friend's lavish praise of her doctor, the first sight of him failed to inspire me with confidence. I was introduced, and the doctor swelled up with his own importance, and said, impressively,-- "Those physicians--amiable men, no doubt--who have treated your case-ah have been all wrong in their diagnosis-ah." This was his prelude, as he counted my pulse by a large gold watch, which he held conspicuously before me. "Your kind friend and benefactress has saved your life-ah, by conducting you to me before too late-ah." He stopped to watch the effect of this bid for a high fee before proceeding. "Ah, sir, had you but come to me first-ah, you would now be rejoicing in perfect health-ah; whereas you have narrowly escaped death and eternal torments-ah." He again took breath, looking very solemn. "But, sir, I never heard of you before this lady wrote to me," I said. "True-ah. I do not advertise myself. The veriest quack may advertise-ah. Your case is very dangerous. _Hepatitis, cum nephritis_-ah," he soliloquized, shaking his head very wisely, while my friend nodded, as if to say, "There! I told you so. He knows all about it." "Yes, very dangerous-ah. But take my medicines; my pills--hepatica-lobus, and my neuropathicum-ah, and they will restore you to health and happiness-ah, in a few weeks-ah;" and he rubbed his palms complacently, as if in anticipation of a good fat fee for his prescription. "Will they cure this?" I asked, turning my head, and placing a finger upon a tumor on the right hand side of my neck. "O-ah, let me see." And so saying, he took a brief survey of the protuberance, and coolly remarked that it was of no material importance. As that was, to my mind, of great consequence, I was dumbfounded by his indifference to its importance. Selecting a box of pills, and a vial of transparent liquid, the doctor presented them to me with a flourish, saying, in his blandest manner,-- "All there; directions inside-ah; ten dollars-ah." "What!" And I arose in astonishment, gazing alternately at the doctor and my friend, but could not utter another word. I was but a country greenhorn, you know, and quite unused to city prices. My friend took the doctor aside, when, after a moment's conversation between them, he returned, and said that "in consideration of the recommendation of the lady, he would take but five dollars-ah." I paid the bill, and, quite disgusted, took my departure. That evening I carried the medicines to a druggist, requesting him to inform me what they were. After examining them, he replied,-- "The liquid is simply sweet spirits of nitre, diluted," looking over his glasses at me suspiciously, I thought. "These, I should say, are blue pills, a mild preparation of mercury," returning me the pills. A second druggist, to whom I applied, told me the same, and, knowing they were not what I required for a scrofulous tumor, I threw them into the gutter. _Ah!_ [Illustration] VIII. ANECDOTES OF PHYSICIANS. "I find, Dick, that you are in the habit of taking my best jokes, and passing them off as your own. Do you call that the conduct of a gentleman?" "To be sure, Tom. Why, a true gentleman will always take a joke from a friend." A WANT SUPPLIED.--ORIGINAL ANECDOTES OF ABERNETHY.--A LIVE IRISHMAN.--MADAM ROTHSCHILD.--LARGE FEET.--A SHANGHAI ROOSTER.--SPREADING HERSELF.--KEROSENE.--"SALERATUS."--HIS LAST JOKE.--AN ASTONISHED DARKY.--OLD DR. K.'s MARE.--A SCARED CUSTOMER.--"WHAT'S TRUMPS?"--"LET GO THEM HALYARDS."--MEDICAL TITBITS.--MORE MUSTARD THAN MEAT.--"I WANT TO BE AN ANGEL."--TOOTH-DRAWING.--DR. BEECHER VS. DR. HOLMES.--STEALING TIME.--CHOLERA FENCED IN.--"A JOKE THAT'S NOT A JOKE."--A DRY SHOWER-BATH.--PARBOILING AN OLD LADY. "There would be no difficulty in multiplying anecdotes attributed to Abernethy (or other celebrated physicians) _ad libitum_, but there are three objections to such a course. First, there are many told of him which never happened; others, which may possibly have occurred, you find it impossible to authenticate; and lastly, there is a class which, if they happened to Dr. Abernethy, certainly happened to others before he was born. In fact, when a man once gets a reputation of doing or saying odd things, every story in which the chief person is unknown or unremembered, is given to the next man whose reputation for such is remarkable."--_Memoirs of Dr. Abernethy, by George Macilwain, F. R. C. S., etc., etc._ Notwithstanding the great number of authentic anecdotes of physicians which might be collected together, Mr. Campbell, the experienced antiquarian bookseller, of Boston, assures me there is no such book in print. I have been many years collecting such, and for this chapter I have selected therefrom those most chaste, amusing, instructive, and authentic. The following original anecdote of the great English surgeon I obtained verbally from Mr. Sladden, of Chicago:-- "My grandmother once visited Dr. Abernethy, with her eldest son, my uncle, living in London, to consult the great physician respecting an inveterate humor of the scalp, with which the child was afflicted. "There were a great many patients in waiting, and when it came my grandmother's turn, she walked up to the great man, and removing the boy's cap, presented the case for his inspection in silence. He took a quick glance at the humory head, turned to the old lady, and said,-- "'Madam, the best thing I can recommend for that disease is a plenty of warm water and soap. And, by the way, if that don't remove it, the next best thing is to apply freely soap and warm water. Five guineas, if you please, ma'am.' "As my grandmother was the embodiment of neatness, she never forgave the doctor for this broad intimation of the questionableness of her neatness." Dr. Stowe told the following story of Dr. Abernethy and a live Irishman:-- "It occurred at Bath. A crowd of pupils, myself one of them, were following Mr. Abernethy through the crowded wards of the hospital, when the apparition of a poor Irishman, with the scantiest shirt I ever saw, jumped from a bed, and literally throwing himself on his knees at the doctor's feet, presented itself. We were startled for a moment, but the poor fellow, with all his country's eloquence, poured out such a torrent of praise, prayers, and blessings, and illustrated it with such ludicrous pantomimic displays of his leg, all splintered and bandaged, that we were not long left in doubt. "'That's the leg, your hon-nor. Glory be to God. Yer honnor's the buy what saved it. May the heavens be yer bed. Long life to yer honnor. To the divil with the spalpeens that wanted to cut it off!' etc. "With some difficulty the patient was replaced in bed, and the doctor said,-- "'I am glad your leg is doing well, but never kneel again, except to your Maker.' "The doctor took the opportunity of giving us a clinical lecture about diseases and their constitutional treatment. Every sentence Abernethy uttered, Pat confirmed. [Illustration: DR. ABERNETHY IN THE HOSPITAL.] "'Thrue for yer honnor; divil a lie at all, at all. His honnor's the grathe doctor, entirely,' etc. "At the slightest allusion to his case, off went the bed-clothes, and up went the leg, as if taking aim at the ceiling. 'That's it, be gorra! and a betther leg than the villain's that wanted to slice it off, entirely.' "The students actually roared with laughter, but Abernethy retained his usual gravity throughout the whole of the ludicrous scene." Madam Rothschild, mother of the mighty capitalists, attained the great age of ninety-eight. Her wits, which were of no common order, were preserved to the end. During her last illness, when surrounded by her family and some friends, she turned to her physician, and said, in a suppliant tone,-- "My dear doctor, I pray you try to do something for me." "Madam, what can I do? I cannot make you young again." "No, doctor; nor do I want to be young again. But I want to continue to grow old." LARGE FEET. Dr. Wood was a man of large "understanding." One day at a presidential reception he was standing in a large crowd, when he felt two feet pressing on his patent leathers. Looking down, he discovered that the said feet belonged to a female. Wood was a bachelor, and at first the sensation was delightful. It made inexpressibly delicious thrills run all up and down his body. But as the _impression_ was all on the lady's side, the above sensations became gradually superseded by those not quite so delightful, and finally the pressure became very uncomfortable. Mustering courage, he said, very gently,-- "Madam, if you please, you are standing on my feet--" "Your feet, sir, did you say?" For the crowd was so dense that she could not possibly see to the ground. "Yes, madam, on my feet--this last half hour," very politely. "O, I beg a thousand pardons, sir; I thought I was standing on a block. _They are quite large, sir_," trying to remove. "Yes, ma'am, quite large; but _yours covered 'em, madam_." A SHANGHAI ROOSTER. Many people suffer more from the anticipation of trouble than by the actual infliction. The world is full of "trouble-borrowers." They generally keep a stock on hand to lend to those who unfortunately are compelled to listen to them. The following is a mitigated case:-- "Sir," said a physician visiting a patient in the suburbs of this city, to a neighbor, "your Shanghai greatly disturbs my patient." "Is it possible?" asked the neighbor, expressing surprise. "Yes, the bird is a terrible nuisance, giving the patient no peace, day or night, he informs me; but he did not want to complain." "But," replied the sceptical owner, "I don't see how he can annoy neighbor B. Why, he only crows twice in the night, and only two or three times at regular intervals during the day." "Yes; but you don't take into consideration all the times the patient is _expecting_ him to crow." SPREADING HERSELF. In a country town in Maine the writer knew an elderly physician, who had married a wife much younger than himself, whose aristocratic notions hardly coincided with those of this democratic people, though she had now lived here several years. Finally a young physician came into the place and commenced practice. Among the patients that he obtained from the old doctor's former practice was one named Higgins. Mrs. Higgins, whose daughter had just recovered from a fever, gave a party, to which the families of both doctors, with the two ministers, and others, were invited. "Will you go to Mrs. Higgins's party?" asked a neighbor of the old doctor's wife. "Yes, I intend to go, by all means, for I want to see old Mother Higgins and her new doctor spread themselves." This reminds me of the following story, which is too good to be lost:-- "'Once upon a time,' an old lady sent her grandson to set a turkey,--not the gobbler, as did the parson in Mrs. Stowe's 'Minister's Wooing.' On his return, the following dialogue occurred:-- "'Sammy, my dear, have you set her?' "'Yes, grandma,' replied Hopeful. [Illustration: "AN EXTENSIVE SET."] "'Fixed the nest up all nice, Sammy?' "'O, mighty fine, grandma.' "'Did you count the eggs, Sammy, and get an odd number?' "'Yes, grandma.' "'How many eggs did you set her on, Sammy, dear?' "'One hundred and twenty-one, grandma.' "'O, goodness gracious! Why did you put so many eggs under her, Sammy?' "'Why, grandma, I wanted to see the old thing spread herself.'" KEROSENE. Some editors are continually making themselves ridiculous, as well as endangering the life of some person as ignorant in the matter as themselves, by publishing at random "remedies" for certain complaints, of both of which--remedy and disease--they knew nothing. The following I cut from a paper:-- "One thing I will mention which may be useful to some one. Kerosene oil has been found effective as a vermifuge. It is given by the mouth for round stomach worms, and as an enema for pin worms. It is free from the irritation which follows the use of spirits turpentine, and is equally as effective." (No directions as to quantity at a dose.) An Irishwoman in Hartford, Conn., spelling out the above in a newspaper, concluded to give her child, a boy of ten, a dose, under the belief that "wurrums ailed the child," and as it was harmless (?), she would give him the benefit of its harmlessness, and her ignorance, and administered accordingly a _tea-cup full_! Frightful symptoms supervened,--colic, vomiting, etc.,--when a doctor was sent for, who being absent, his student--who hardly understood the danger of the case, and was a bit of a wag, by the way--sent the following prescription:-- "[R]. Run a wick down the child's throat; any lamp or candle wick will do, provided it is long enough; set fire to the end left outside, _and use him for a lamp till the doctor arrives_." SELAH. This may seem too ridiculous to believe, but it is the truth, nevertheless. SALERATUS VS. SUGAR. Early one summer morning, while practising in Plymouth, Conn., the writer was startled by a loud knock at the front door, which I hastened to answer. There stood an Irishman, well known as living in a little hut, down on the "Meadows," whose name was Fitzgibbon. He was all out of breath, and the great drops of sweat were rolling all down his rough face, which he was endeavoring to mop up with a huge bandanna handkerchief. As soon as he could possibly articulate, he exclaimed,-- "O, docther, docther! take yourself--down to that sha-anty as quick as ye conva-niantly can, plaze." [Illustration: "O, DOCTHER, DEAR, I'VE PIZENED ME BOY."] "Why, what's the matter at the shanty, Fitzgibbon?" "O, docther, dear, I've pizened my boy; what will I do intirely?" "How did it happen? Don't be alarmed, Fitzgibbon." For his manner was frightful. "Will, I'll till yeze. He's been sick wid the masles. Will, he's ate nothin' for a hole wake, and in the night he wanted some bread an' sugar, do ye see? an' I had no candle, an' I wint in the dark, an' spread him some bread, an' he ate it intirely, an' it was saleratus I put on it, instead of sugar; an' it's now atin' him intirely! O, dear, dear, that I should iver give him saleratus instead o' sugar!" "Well, Fitzgibbon, if the boy is so big a fool that he don't know the difference between saleratus and sugar, let him die." "O, docther, don't say so!" exclaimed the poor fellow, in agony. Then I suddenly recollected that the sense of taste was always vitiated in measles, and thus excused the matter, adding,-- "Now, run home, 'Gibbon, and give the little fellow a tea-spoonful of vinegar in a little sugar and water,--not saleratus and water, mind you." "No, by the great St. Patrick, I'll niver mistake the likes again," he earnestly interrupted, when I went on, saying,-- "Then in half an hour give him another tea-spoonful, and that will relieve the 'gnawing at his stomach,' and by an hour I'll drive round there and see him, on my way to Watertown." "I'll trust to yeze to git it out of him. God bless yeze;" and away he darted, saying, "O, howly mother! that I should give him saleratus for sugar!" HIS LAST JOKE. A celebrated English physician, who was also a distinguished humorist, when about to die, requested that none of his friends be invited to his funeral. A friend inquired the reason of this remarkable request. "Because," sighed the dying but polite humorist, "it is a courtesy which can never be returned." Charles Matthews, the celebrated comedian, who died in 1837, put the above entirely in the shade by _his_ last joke. The attending physician had left Mr. Matthews some medicine in a vial, which a friend was to administer during the night. By mistake, he gave the patient some ink from a vial which stood near. On discovering the error, his friend exclaimed, "O, gracious Heavens, Matthews, I have given you ink, instead of medicine." "Never--never mind, my dear boy," said the dying man faintly; "_I will swallow a piece of blotting paper_." AN ASTONISHED NEGRO. Dr. Robertson, of Charleston, S. C., who attended the writer in 1852, with the yellow fever, was as competent, benevolent, and faithful a physician as I ever had the pleasure of meeting. His services were in great demand during the raging of the "yellow Jack," and on one occasion he was absent from his house and office two whole days and a night. His family became alarmed, and a faithful old negro was sent in search of his master. It was no uncommon occurrence to see a black man traversing the streets, ringing a bell, and crying a "lost child;" but to see a slave searching for his lost master, was almost a phenomenon. [Illustration: "LOST MARSER! LOST MARSER!"] It was quite dark, and the old negro was shuffling along King Street, crying, "Masser Rob'son lost, Masser Rob'son lost," when suddenly he was brought to a halt, and silenced by some one saying,-- "What's that you are crying, Neb?" His name was Nebuchadnezzar. "O, de Lord! if Masser Dr. Rob'son hain't been an' loss hisself!" "You old fool, Neb, I am your master--Dr. Robertson. Don't you know me now?" exclaimed a familiar voice. Sure enough, it was the doctor, returning from his numerous visits, tired and dust-covered. The whole thing solemnly impressed the old darky, who, a day or two later, was met by a ranting Methodist, vulgarly termed a "_carpet-bagger_," who, in a solemn voice, said,-- "My colored friend, have you yet found the Lord Jesus?" "O, golly, masser!" exclaimed the old negro in astonishment; "hab de Lord done gone an' loss hisself?" (I have seen the last part of this anecdote floating about the newspapers; but did ever any one see the former connection, or even the latter before 1852?) The writer was but a poor medical student, and an invalid, seeking here a more salubrious climate, away from the frosts and snows of his northern home, and though twenty years have since flown, I have not forgotten, and never shall, the kindness and attention received at the hands of the benevolent Dr. Robertson. While many who went out with me that fall fell victims to the fearful endemic before Jack Frost put a stop to its ravages, I escaped the grim monster Death; and to the superior knowledge and efficient treatment of Dr. R., with the excellent care of the benevolent landlady, Mrs. Butterfield, I owe my life. Morning and evening the doctor's patter-patter was heard on the stairs,--three flights to climb. The whole case was gone over, and then, if the good old doctor had a moment to spare, he would retail some little anecdote "with which to leave me in good spirits." The following is one:-- "Mr. Bacon, of Edgefield, was once courting a lady who had frequently refused him; but he, with commendable perseverance, had as often renewed the suit, until at last she became so exceedingly annoyed at his importunities that she told him that she could never marry a man whose tastes, opinions, likes and dislikes were so completely in opposition to her own as were his. "'In fact, Mr. Bacon,' she is represented as having said, 'I do not think there is one subject on earth upon which we could agree.' "'I assure you, dear madam, that you are mistaken, which I can prove.' "'If you will mention one, I will agree to marry you,' replied the lady. "'Well, I will do it,' replied Mr. Bacon. 'Suppose now you and I were travelling together; we arrive at a hotel which is crowded; there are only two rooms not entirely occupied, in one of which there is a man, in the other a woman: with which would you prefer to sleep?' "The lady arose indignantly, and replied, 'With the woman, of course, sir.' "'So would I,' replied Mr. Bacon, triumphantly." (My room had two beds in it, which suggested the above story.) DR. K.'S MARE. The outline of the following ludicrous "situation" was given me by a gentleman of Framingham:-- Old Dr. K., of F., was represented as a rough and off-handed specimen of the genus _homo_, who liked a horse even better than a woman,--not that he was by any means unmindful of the charms and claims of the beautiful,--better than he loved money, though the latter passion bordered on avariciousness. An over-nice and sensitive spinster once was visiting the family of Mr. T., in town, which employed a younger and more refined physician than Dr. K.; and the spinster, being somewhat indisposed, requested Mr. T. to call a physician. His own family doctor was suggested; but on close inquiry, she concluded to have "the oldest and most experienced physician that the town afforded," and old Dr. K. was called. Mr. T. had just purchased a beautiful mare, which the doctor was desirous of possessing; and the animal was the subject of conversation as the two entered the house, even to the parlor, where the spinster reclined upon a sofa. The old doctor examined the lady for a moment in silence, but his mind was all absorbed in the reputed qualities of the mare, as he timed the lady's pulse. "Slightly nervous," he said to the spinster. "Tongue? Ah! coated. Throat sore?" and turning towards T., he resumed the horse discussion, still holding the lady's wrist. "Good wind, Mr. T.? No spavins? Nothing the matter? Suppose you trot her out this afternoon." The spinster, supposing the conversation alluded to her, went into the most extreme kind of hysterics. "A SCARED CUSTOMER." We give this incident for what it is worth. A man recently entered a restaurant in Utica, N. Y., and ordered a very elaborate dinner. He lingered long at the table, and finally wound up with a bottle of wine. Then lighting a cigar, he sauntered up to the bar, and remarked to the proprietor,-- "Very fine dinner, landlord. Just charge it, for I haven't a cent." "But I don't know you," replied the proprietor, indignantly. "No, of course you don't, or you never would have let me have the dinner." "Pay me for the dinner, I say," shouted the landlord. "And I say I can't," vociferated the customer. "Then I'll see about it," exclaimed the proprietor, who snatched something from a drawer, leaped over the counter, and grasping the man by the collar, pointed something at his throat. "I'll see if you get away with that dinner without paying for it, you scoundrel." "What is that you hold in your hand?" demanded the now affrighted customer, trying to get a sight at the article. "That, sir, is a revolver; loaded, sir." [Illustration: NOT A STOMACH-PUMP.] "O, d---- that; I don't care a continental for a revolver; I've got one myself. _I was afraid it was a stomach-pump!_" "WHAT'S TRUMPS?" Mrs. Bray, in her book of _Anecdotes_, relates a story illustrative of the power of the ruling passion. "A Devonshire physician, boasting the not untradesman-like name of Vial, was a desperate lover of the game of whist. One evening, during his opponent's deal, he fell to the floor in a fit. Consternation seized on the company, who knew not if the doctor was dead or alive. Finally he showed signs of returning life, and retaining the last cherished idea that had possessed him on falling into the fit, he resumed his chair, exclaiming, '_What's trumps, boys?_'" * * * * * The writer was present at a similar occurrence. There were a half score of boys seated upon some logs near the country school-house, during recess, listening to a story, something about "an old woman who had just reached a well, with a pitcher to obtain some water, when the old lady tripped her toe, and fell into the well head foremost." At this juncture one of the listeners fell forward from the log in a fit. We were greatly frightened, but mustered sufficient courage to throw some water in the boy's face, when he gradually came to his senses, exclaiming,-- "_Did she break the pitcher, Johnny?_" * * * * * To Mrs. Bray's book we are again indebted for the following:-- "A _bon-vivant_, brought to his death-bed by an immoderate use of wine, was one day informed by his physician that he could not, in all human probability, survive many hours, and that he would die before eight o'clock the following morning, summoned all his remaining strength to call the doctor back, and, when the physician had returned, made an ineffectual attempt to rise in bed, saying, with the true recklessness of an innate gambler,-- "'Doctor, I'll bet you some bottles that I live till _nine_!'" "LET GO THE HALLIARDS." A sailor was taken with the pleurisy on board a vessel that was hauling through the "seven bridges" that span the Charles River from the Navy Yard to Cambridgeport, and a well-known physician, rather of the Falstaffian make-up, whom I may as well call Dr. Jones,--because that is _not_ his name,--was summoned. He prescribed for the patient, and when the schooner touched the pier of the bridge, he stepped ashore, as was supposed by the captain and crew, whose whole attention was required to keep the vessel from driving against the drawer; but "there's many a slip 'twixt cup and lip," and the old doctor had taken the "slip," and went plump overboard, unseen by any. In his descent he grasped at a rope, which happened to be the jib halliards, and as he came up, puffing and blowing the salt water from his mouth and nose, he began to haul "hand-over-hand" at the halliards. His corpulency overbalanced the jib, and gradually the sail began to ascend, to the astonishment of the cook, who stood near by, and to the wrath of the captain on the quarter-deck. "Let go the jib halliards, there, you confounded _slush_," roared the captain. "I ain't h'isting the jib," replied the terrified cook, believing that the sail was bewitched, for sailors are quite superstitious, you know. "Let go the halliards," shouted the mate. "We shall be across the draw, and all go to Davy Jones' locker. Hear, d---- you, Slush-bucket?" Still the old doctor pulled for dear life, and still rose the ghost-like sail, while the affrighted cook and all hands ran aft, looking as pale as death. Still the sail went up, up, and the captain and mate began to be astonished, when by this time--less time than it requires to tell it--the old doctor had reached the rail of the vessel, and shouted lustily for help. All ran forward to help the corpulent old doctor on deck, and by means of a man at each arm, and a boat-hook fast into the doctor's unmentionables, he was hauled safely on board, a wetter and a wiser man. If you want to get kicked out of his office, just say in his hearing, "_Let go them 'ere halliards_," and it is done. "O, mermaids, is it cold and wet Adown beneath the sea? It seems to me that rather chill Must Davy's locker be." MEDICAL TITBITS. _More Mustard than Meat._--A poor, emaciated Irishman having called in a physician as a forlorn hope, the latter spread a large mustard plaster and applied it to the poor fellow's lean chest. "Ah, docthor," said Pat, looking down upon the huge plaster with tearful eyes, "it sames to me it's a dale of mustard for so little mate." * * * * * "_Don't want to be an Angel._"--"I want to be an angel," which has been so long shouted by _millions_ of darling little Sunday school children, who hadn't the remotest idea for what they had been wishing (?), and whose parents would not voluntarily consent to the premature transformation, if the children did, has received a check in the following:-- A little sprite, who had been so very sick that her life was despaired of, was told one morning by the doctor that she would now get well. "O, I'm so glad, doctor!" she replied; "for I don't want to die and go to heaben, and be an angel, and wear fedders, like a hen." TOOTH DRAWING. A snobbish-appearing individual accosted a countryman in homespun with the following interrogation:-- "I say, ah, my fraand, are you sufficiently conversant with the topography of _this_ neighborhood to direct me to the nearest disciple of Æsculapius, eh?" "What?" exclaimed the astonished rustic. "Can you familiarize me with the most direct course to a physician?" "Hey?" "Can you tell me where a doctor lives?" "O, a doctor's house. Why didn't you say so before?" * * * * * The next is after the same sort. A sailor chap entered a dentist's office to have a tooth extracted. [Illustration: "LOWER TIER, LARBOARD SIDE."] _Doctor (with great professional dignity, speaking very slowly)._ "Well, mariner, what tooth do you require extracted? Is it an incisor, bicuspid, or a molar?" _Jack (brusque and loud)._ "It's here in the lower tier, larboard side. Bear a hand, lively, you dumb'd swab, for it's nippin' my jaw like a lobster." * * * * * _The most astonished boy_ I ever beheld was a little country lad who came to have a tooth drawn. "He thought it must be fun," his mother said; "but he never had one drawn, and knows nothing of it." "O!" with a great, round mouth, was all he had time to say, but the expression of astonishment depicted on that striking countenance, glaring eyes, and by the expressive, spasmodic "O!" I never can forget or describe; and he caught his hat and ran home, a distance of two miles, without stopping, while his mother followed in the carriage by which they came. The boy's idea was summed up as follows:-- "The doctor hitched tight onto the tooth with his pinchers, then he pulled his first best, and just before it killed me, the tooth came out, and so I run home." * * * * * "_Taking it out in trade_" is all very well when the arrangement is mutual; but there are occasions when the advantages are imperceptible, at least to one party, as thus:-- "What's the matter, Jerry?" asked old Mr. ----, as Jeremiah was jogging by, growling most furiously. "Matter 'nough," replied old Jerry. "There I've been luggin' water all the morning for the doctor's wife to wash with, and what do you s'pose she give me for it?" "About ninepence." "Ninepence? No! She told me the doctor would pull a tooth for me some time, when he got leisure." * * * * * Apothecaries sometimes "come down" from the dignity of the professional man, and crack a joke. For instance,-- A humorous druggist on Washington Street recently exposed some cakes of soap in his window with the pertinent inscription, "Cheaper than dirt." In the country, you know, they keep almost everything in the apothecaries' shops. We mentioned the fact in our chapter on Apothecaries. A wag once entered one of these apotheco-groco-dry-goods-meat-and-fish-market-stores, and asked the keeper,-- "Do you keep matches, sir?" "O, yes, all kinds," was the reply. "Well, I'll take a trotting match," said the wag. The equally humorous druggist handed down a box of pills, saying,-- "Here, take 'em and trot." * * * * * _A sure Cure._--Henry Ward Beecher is currently reported as having once written to Dr. Oliver Wendell Holmes as to the knowledge of the latter respecting a certain difficulty. The reply was characteristic, and _encouraging_. "Gravel," wrote the doctor, "gravel is an effectual cure. It should be taken about four feet deep." The "remedy" was not, however, so remarkable as the following:-- * * * * * "_Time and Cure._"--A good-looking and gentlemanly-dressed fellow was arraigned on the charge of stealing a watch, which watch was found on his person. It was his first offence, and he pleaded, "Guilty." The magistrate was struck with the calm deportment of the prisoner, and asked him what had induced him to take the watch. "Having been out of health for some time," replied the young man, sorrowfully, "the doctor advised me to take something, which I accordingly did." The magistrate was rather amused with the humor of the explanation, and further inquired why he had been led to select so remarkable a remedy as a watch. "Why," replied the prisoner, "I thought if I only had the _time_, Nature might work the _cure_." * * * * * _Dye-stuff._--During the cholera time of 1864, in Hartford, Conn., a little girl was sent to a drug store to purchase some dye-stuff, and forgetting the name of the article, she said to the clerk, "John, what do folks dye with?" "Die with? Why, the cholera, mostly, nowadays." "Well, I guess that's the name of what I want. I'll take three cents' worth." * * * * * The Hartford Courant told this story in 1869:-- "_Cholera fenced in._--You have noticed the flaming handbills setting forth the virtues of a cholera remedy, that are posted by the hundreds on the board fence enclosing the ground on Main Street, where Roberts' opera house is being erected. Well, there was a timid countryman, the other day, who had so far recovered from the 'cholera scare' as to venture into the city with a horse and wagon load of vegetables; and thereby hangs a tale. He drove moderately along the street, when he suddenly spied the word 'Cholera,' in big letters on the new fence, and he staid to see no more. Laying the lash on to his quadruped, he went past the handbills like a streak of lightning, went--'nor stood on the order of his going'--up past the tunnel, planting the vegetables along the entire route,--for the tail-board had loosened,--hardly taking breath, or allowing his beast to breathe, till he reached home at W. "Safely there, he rushed wildly into the midst of his household, exclaiming,-- "'O, wife, wife, they _have_ got the cholera in Hartford, _and have fenced it in_.'" * * * * * _A Joke that's not a Joke._--A funny limb of the law had an office, a few years since, on ---- Street, next door to a doctor's shop. One day, an elderly gentleman, of the fogy school, blundered into the lawyer's office, and asked,-- "Is the doctor in?" [Illustration: THE FARMER'S ESCAPE FROM THE CHOLERA.] "Don't live here," replied the lawyer, scribbling over some legal documents. "O, I thought this was the doctor's office." "Next door, sir;" short, and still writing. "I beg pardon, but can you tell me if the doctor has many patients?" "_Not living_," was the brief reply. The old gentleman repeated the story in the vicinity, and the doctor threatened the lawyer with a libel. The latter apologized, saying, "it was only a joke, and that no man could sustain a libel against a lawyer," when the doctor acknowledged the joke, and satisfaction, saying he would send up a bottle of wine, in token of reconciliation. The wine came, and the lawyer invited in a few friends to laugh over the joke, and _smile_ over the doctor's wine. The seal was broken, the dust and cobwebs being removed, and the doctor's health drunk right cordially. The excellence of the doctor's wine was but half discussed, when the lawyer begged to be excused a moment, caught his hat, and rushed from the room. Soon one of the guests repeated the request, and followed; then another, and another, till they had all gone out. The wine had been nicely "doctored" with _tartar emetic_, the seal replaced and well dusted over, before being sent to the lawyer. The doctor was now threatened with prosecution; but after some consideration, the following brief correspondence passed between the belligerents:-- "Nolle prosequi." Lawyer to doctor. "Quits." Doctor to lawyer. * * * * * _Parboiling an Old Lady._--In Rockland, Me., then called East Thomaston, several years ago, there resided an old Thomsonian doctor, who had erected in one room of his dwelling a new steam bath. An old lady from the "Meadows," concluding to try the virtues of the medicated steam, went down, was duly arrayed in a loose robe by the doctor's wife, and with much trepidation and many warnings not to keep her too long, she entered the bath--a sort of closet, with a door buttoned outside. The steam was kept up by a large boiler, fixed in the fireplace which the doctor was to regulate. The old lady took a book into the bath, "to occupy her mind, and keep her from getting too nervous." "Now it's going all right," said the doctor, when ding, ding, ding! went the front door bell. The doctor stepped noiselessly out, and learned that a woman required his immediate attention at South Thomaston, three miles away. He forgot all about the old lady fastened into the bath, and leaping into the carriage in waiting, he was whisked off to South Thomaston. Meantime the steam increased, and the old lady began to get anxious. The moisture gathered on her book; the leaves began to wilt. The dampness increased, and soon the book fell to pieces in her lap. Great drops of sweat and steam rolled down over her face and body, and she arose, and tapping very gently at the door, said,-- "Hadn't I better come out now, doctor?" [Illustration: TOO MUCH VAPOR.] No reply. She waited a moment longer, and repeated the knock louder. "Let me come out, doctor. I am just melting in here." Still the doctor, to her astonishment, did not reply, or open the door. "For God's sake, doctor, let me out." Listening a few seconds, she screamed, "O, I believe he's gone, and left me here to parboil! Open, open!" And she knocked louder and louder at the door, while the now almost scalding waters literally poured from her body. "O, I shall suffocate here." And giving a desperate kick, she set her foot through the panelled door, and, getting down on all fours, she crawled through the opening. Just then the doctor's wife, hearing the thumping, hastened to the room, and with many apologies and excuses, rubbed down and dried the old lady, and begged her not to mention the affair. But never, to the day of her death, did the old lady again enter a "steam bath," or cease to tell how "_the doctor went off to attend a 'birth' leaving her in the bath to parboil_!" * * * * * _A Dry Shower Bath._--When shower baths were all the rage, a few years ago, all sorts of plans were suggested to avoid getting wet. The following is to the point:-- _Doctor._ Well, deacon, how did your wife manage her new shower bath? [Illustration: A DRY SHOWER BATH.] _Deacon._ O, she had real good luck. Madam Mooney told how she managed with hern. She had made a large oiled silk hood, with a large cape to it, like a fisherman's in a storm, that came all down over her shoulders. _Doctor_ (impatiently). She's a fool for her pains. That's not the way. _Deacon._ So my wife thought. _Doctor._ And your wife did nothing of the kind, I hope. _Deacon._ O, no, no. My wife, she used an umbrilly. [Illustration] IX. FORTUNE-TELLERS. _1st Witch._ By the pricking of my thumbs, Something wicked this way comes. _Macbeth._ How now, you secret, black and midnight hags, What is't ye do? _All._ A deed without a name.--MACBETH, Act IV. Sc. 1. PAST AND PRESENT.--BIBLE ASTROLOGERS AND FORTUNE-TELLERS.--ARABIAN.--EASTERN.--ENGLISH.--QUEEN'S FAVORITE.--LILLY.--A LUCKY GUESS.--THE GREAT LONDON FIRE FORETOLD.--HOW.--OUR "TIDAL WAVE" AND AGASSIZ.--A HAUL OF FORTUNE-TELLERS.--PRESENT.--VISIT EN MASSE.--"FILLIKY MILLIKY."--"CHARGE BAYONETS!"--A FOWL PROCEEDING.--FINDING LOST PROPERTY.--THE MAGIC MIRROR EXPOSÉ.--"ONE MORE UNFORTUNATE."--PROCURESSES.--BOSTON MUSEUM.--"A NICE OLD GENTLEMAN."--MONEY DOES IT.--GREAT SUMS OF MONEY.--"LOVE POWDER" EXPOSE.--HASHEESH.--"DOES HE LOVE ME?" Under the guise of fortune-telling and clairvoyance the most nefarious atrocities are daily enacted, not only in the larger cities, but in the villages and towns even, throughout the country. In this chapter I propose to ventilate them in a manner never before attempted, and the _exposé_ may be relied upon as correct in every particular. "Why," exclaimed a friend, "I thought fortune-telling one of the follies of the past, and that there was little or none of it practised at the present." Far from it. Very few, comparatively, who practise the black art come out under the ancient name of fortune-tellers; but there are thousands of ignorant, characterless wretches, in our enlightened day and generation, who pretend to tell fortunes, if not under the open title above, as astrologers, seers, clairvoyants, or spiritualists, etc. There are some clairvoyants of whom we shall treat under the head of "Mind and Matter." The Bible fortune-tellers practised their lesser deceptions under the various titles of "wise men," "soothsayers," the former being acknowledged as the more legitimate by the Jews, and the latter mere heathenish prognosticators, without divine authority, as thus: Is. ii. 6. "Therefore thou hast forsaken thy people, the house of Jacob, because they be replenished from the east, and are _soothsayers, like the Philistines_." 8. "Their land also is full of idols; they worship the work of their own hands, that which their own fingers have made." There were also wizards, astrologers, "star-gazers" (Is. xlvii. 13), spiritualists (1 Sam. xxviii. 3), magicians, sorcerers, and "the well-favored harlot, the mistress of witchcrafts, that _selleth nations through her whoredoms, and families through her witchcrafts_." Nahum iii. 4. All of these exist at the present day, carrying on the same sort of vile deceptions and heinous crimes, to the "selling of families and nations," and souls, in spite of law or gospel. Even as those of nearly six thousand years ago were patronized by the great, the kings, and queens, and nobles of the earth, so are the fortune-tellers, under the more refined titles, visited by governors, representatives, and ladies and gentlemen of rank, of modern times. In visiting these pretenders, in order "to worm out the secrets of their trade," the writer has not only been assured by them in confidence that the above is true, but he has met distinguished characters there, face to face,--the minister of the gospel, the lawyer, the judge, the doctor, and what _ought_ to have been the representative intelligence of the land,--consulting and fellowshiping with ignorant fortune-tellers. "Ignorant?" Yes, out of the scores whom I have seen, there has not been one, male or female, possessing an intelligence above ordinary people in the unprofessional walks of life, while the majority of them were in comparison far below the mediocrity. If ignorance alone patronized ignorance, like a family intermarrying, the stock would eventually dwindle into nothingness, and entirely die out. Before the "captivity" the Jews had their wise men, and on their exodus they reported the existence of the magicians or magi of Egypt. It seems that nearly everybody, and particularly the Egyptians, regarded Moses and Aaron as but magicians in those days; and the magi of Pharaoh's household--for all kings and rulers of ancient times and countries had their fortune-tellers about them--had a little "tilt" with Moses and Aaron, commencing with the changing of the rods into snakes. The Egyptian magicians did very well at the snake "trick," as the modern magician calls it, also at producing frogs, and such like reptiles; but they were puzzled in the vermin business, and the boils troubled them, and they then gave up, and acknowledged that there _was_ a power beyond theirs, and that power was with God. Well, that is not fortune-telling; but this was the class who professed the power of foretelling; and we find them, with women of the familiar spirits, made mention of all through the scriptural writing. Isaiah testifies (chapter xix.) that the charmers, familiar spirits, and wizards ruined Egypt as a nation. What advantage were they ever to King Saul, the grass-eating king with the long name, or any other individuals, in their perplexities? They rather stood in the light of individuals, nations, and the cause of Heaven. Then Jesus and the apostles had them to meet and overcome--for their power had become very great, even to the publication of books to promulgate their doctrines; for we read in Acts xix. 19, that there were brought forth at Ephesus, at one time, these books, to the amount of fifty thousand pieces of silver, or about twenty-six thousand five hundred dollars' worth, and burned in the public square or synagogue. There are some instances recorded in the Bible, and by Josephus, where the Jews professed to foretell events. The curious case of Barjesus, at Paphos, who, for a time, hindered Sergius, the deputy of the country, from embracing Christianity, is cited in illustration of the injury that false prophets are to all advancement. Paul testifies to that fact in the following words: "O, full of all subtlety, and all mischief, child of the devil, enemy to all righteousness," etc. ARABIAN FORTUNE-TELLER. The Arabians, from time immemorial, have been implicit believers in fortune-telling, as well as believers in the efficacy of charms and all other mystic arts. "No species of knowledge is more highly venerated by them than that of the occult sciences, which affords maintenance to a vast number of quacks and impudent pretenders." The science of "Isen Allah" enables the possessor to discern what is passing in his absence, to expel evil spirits, and cure malignant diseases. Others claim to control the winds and the weather, calm tempests, and to say their prayers in person at Mecca, without stirring from their own abodes hundreds of miles away! The "Sinia" is what is better known to us as jugglery and feats of illusion. The "Ramle" is the more proper fortune-telling, and is believed in and practised by people of all ranks, male and female, and by the physicians. THE EASTERN PRINCE. Fortune-telling is practised in all Eastern countries, to a great extent, to the present day. Some pretend to foretell events by the stars and planets, some by charms, cards, the palm of the hand, or a lock of hair; the latter is the most vulgar mode, and commonly followed by the gypsies. When the fortress of Ismail was besieged, in 1790, by the Russians, Prince Potemkin, the commanding officer, began to grow impatient, after nearly two months' resistance, though he was surrounded by all the comforts and luxuries of an Eastern prince--by courtiers and beautiful women, who employed the most exciting and voluptuous means to engage his attention. Madame De Witt, one of the females, pretended to read the decrees of fate by cards, and foretold that the prince would only take the place at the expiration of three more weeks. "Ah," exclaimed the prince, with a smile, "I have a method of divination far more infallible, as you shall see;" and he immediately despatched orders to Suwarof _to take Ismail within three days_. The brave but barbarous hero obeyed the order to the very letter. THE SEER'S WIFE. When Richmond, afterwards Henry VII., landed at Milford-Haven, on his memorable march to his successful encounter with Richard III., then at Bosworth Field, he consulted a celebrated Welsh seer, who dwelt in magnificent style at a place called Matha Farm. To the duke's question as to whether he should succeed or not, the wily seer, whose name was Davyd Lloyd, requested a little time in which to consider so important a query. As Richmond lodged that night with his friend Davyd, he gave him till the following morning to make up his decision, when the seer assured Richmond that he "would succeed gloriously." For this wonderful and timely information Lloyd received immense rewards at the hand of his grateful prince when he became King Henry VII. Now for the secret of his success: During the time granted for the answer, Davyd, in great perplexity and trepidation, consulted his wife, instead of the heavens, for an answer. See the wisdom of the reply. "There can be no difficulty about an answer. Tell him he will certainly succeed. Then, if he does, you will receive honors and rewards; and if he fails, depend on't he will never come here to punish you." DEE, THE ASTROLOGER. One of the most remarkable and successful fortune-tellers known to English history was John Dee, who was born in London, 1527, and died in 1608. A biographer says, "He was an English divine and astrologer of great learning, celebrated in the history and science of necromancy, chancellor of St. Paul's, and warden of Manchester College, in the reign of Queen Elizabeth. He was also author of several published works on the subject of astrology, revelations of spirits, etc., which books are preserved in the Cottonian library and elsewhere." Dee enjoyed for a long time the confidence and patronage of Elizabeth. He then resided in an elegant house at Mortlake, which was still standing in 1830, and was used for a female boarding school. "In two hundred years it necessarily had undergone some repairs and alterations; yet portions of it still exhibited the architecture of the sixteenth century. "From the front windows might be seen the doctor's garden, still attached to the house, down the central path of which the queen used to walk from her carriage from the Shan road to consult the wily conjurer on affairs of love and war. "He was one of the few men of science who made use of his knowledge to induce the vulgar to believe him a conjurer, and one possessing the power to converse with spirits. Lilly's memoirs recorded many of his impostures, and at one time the public mind was much agitated by his extravagances. The mob more than once destroyed his house (before residing at Mortlake) for being too familiar with their devil. He pretended to see spirits in a stone, which is still preserved with his books and papers.... In his spiritual visions Dee had a confederate in one Kelley, who, of course, confirmed all his master's oracles. Both, however, in spite of their spiritual friends, died miserably--Kelley by leaping from a window and breaking his neck, and Dee in great poverty and wretchedness. The remains of the impostor lie in Mortlake Church, without any memorial." He unfortunately had survived his royal patroness. Queen Mary had had Dee imprisoned for practising by enchantment against her life; but her successor released him, and required him to name a lucky day for her coronation. "In view of this fact," asks the author of 'A Morning's Walk from London to Kew,' "is it to be wondered at that a mere man, like tens of thousands of other fanatics, persuaded himself that he was possessed of supernatural powers?" ANOTHER IMPOSTOR.--THE GREAT FIRE. William Lilly followed in the wake of, and was even a more successful impostor than the Reverend Dee. He was first known in London as a book-keeper, whose master, dying, gave him the opportunity of marrying his widow and her snug little fortune of one thousand pounds. The wife died in a few years, and Lilly set up as an astrologer and fortune-teller. His first great attempt at a public demonstration of his art was about 1630, which was to discover certain treasures which he claimed were buried in the cloister of Westminster Abbey. Lilly had studied astronomy with a Welsh clergyman, and doubtless may have been sufficiently "weather-wise" to anticipate a storm; but however that might have been, on the night of the attempt, there came up a most terrific storm of wind, rain, thunder and lightning, which threatened to bury the actors beneath the ruins of the abbey, and his companions fled, leaving Lilly master of the situation. He unblushingly declared that he himself allayed the "storm spirit," and "attributed the failure to the lack of faith and want of better knowledge in his companions." "In 1634 Lilly ventured a second marriage, with another woman of property, which was unfortunate as a commercial speculation, for the bride proved extravagant beyond her dowry and Lilly's income. In 1644 he published his first almanac, which he continued thirty-six years. In 1648 he therein predicted the "great fire" of London, which immortalized his name. While Lilly was known as a cheat, and was ridiculed for his absurdities, he received the credit for as lucky a guess as ever blessed the fortunes of a cunning rogue. "In the year 1656," said his prediction, "the aphelium of Mars, the signification of England, will be in Virgo, which is assuredly the ascendant of the English monarchy, but Aries of the kingdom. When this absis, therefore, of Mars shall appear in Virgo, who shall expect less than a strange _catastrophe_ of human affairs in the commonwealth, monarchy, and kingdom of England?" He then further stated that it would be "_ominous to London, unto her merchants at sea, to her traffique_ at land, to her poor, to her rich, to all _sorts of people inhabiting her or her liberties, by reason of fire and plague_!" These he predicted would occur within ten years of that time. The great plague did occur in London in 1665, and the great fire in 1666! The fire originated by incendiarism in a bakery on Pudding Lane, near the Tower, in a section of the city where the buildings were all constructed of wood with pitched roofs, and also a section near the storehouses for shipping materials, and those of a highly combustible nature. It occurred also at a time when the water-pipes were empty. This fearful visitation destroyed nearly two thirds of the metropolis. Four hundred and thirty-three acres were burned over. Thirteen thousand houses, eighty-nine churches, and scores of public buildings were laid in ashes and ruins. There was no estimating the amount of property destroyed, nor the many souls who perished in the relentless, devouring flames. If this great fire originated at the instigation of Lilly, in order to demonstrate his claims as a foreteller of events, as is believed to be the case by nearly all who were not themselves believers in the occult science, what punishment could be meted out to such a villain commensurate to his heinous crime? Curran says, "There are two kinds of prophets, those who are inspired, and those who prophesy events which they themselves intend to bring about. Upon this occasion, Lilly had the ill luck to be deemed of the latter class." Elihu Rich says in his biography of Lilly, "It is certain that he was a man of no character. He was a double-dealer and a liar, by his own showing, ... and perhaps as decent a man as a _trading_ prophet could well be, under the circumstances." Lilly was cited before a committee of the House of Commons, not, as was supposed by many, "that he might discover by the same planetary signs _who_ were the authors of the great fire," but because of the suspicion that he was already acquainted with them, and privy to the supposed machinations which brought about the catastrophe. At one time, 1648-9, Parliament gave him one hundred pounds a year, and he was courted by royalty and nobility, at home and abroad, from whom he received an immense revenue. He died a natural death, in 1681, "leaving some works of interest in the history of astrology," which, in connection with the important personages with whom he was associated, and the remarkable events above recorded, have immortalized his name. Respecting the prediction of the plague, I presume that if any prominent personage should, at any time, predict a great calamity to a great metropolis, to take place "_within ten years, more or less_," there necessarily would be something during that time, of a calamitous nature, that might seem to verify their prediction. Besides, we should take into consideration how many predictions are never verified. Dr. Lamb, Dee, Bell, and others prophesied earthquakes to shake up London at various times in 1203, 1598, 1760, etc., which never occurred, to any great extent. Supposing a great tidal wave should devastate our coast, within ten years even, would not Professor Agassiz be immortalized thereby, although he never predicted it, except in the imaginative and mulish brains of certain individuals, who will have it that he did so predict? A RAID ON FORTUNE-TELLERS. In London, at the present day, it is estimated that nearly two thousand persons, male and female, gain a livelihood under the guise of fortune-telling. Some of them are "seers," or "astrologers," "seventh sons," clairvoyants, etc. From the London Telegraph of the year 1871 we gather the following description of a few of the most prominent of these, with their arrest and trial, as fortune-telling is there, as elsewhere, proscribed by law:-- "First was arraigned 'Professor Zendavesta,' otherwise John Dean Bryant, aged fifty, and described as a 'botanist.' He was charged with having told a woman's fortune, for the not very extravagant sum of thirteen cents. Two married women, it seems, instructed by the police, went to No. 3 Homer Street, Marylebone, and paid sixpence each to a woman, who gave them a bone ticket in return. One might have imagined that it was a spiritualist's _seance_, but for the fact that the fee for admittance was sixpence, and not one guinea. Professor Zendavesta shook hands with one of the women, and warmly inquired after her health. She told him she was in trouble about her husband, which was false, and he bade her be of good cheer, and made an appointment to meet her on another day. Subsequently, two constables went to Bryant's house, and on going into a room on the ground floor, found thirty or forty young women seated there. The ladies began to scream, and there was a rush for the door; while the police, who seemed to labor under the impression that to attend an astrological lecture was as illegal an act as that of being present at a cock-fight or a common gambling-house, stopped several of the women, and made them give their names and addresses. The walls of the apartment were covered with pictures of Life and Death, with the 'nativities of several royal and illustrious personages, and of Constance Kent.' It is a wonder that the horoscopes of Heliogabalus and Jack the Painter should have been lacking. Then there was a medicine chest containing bottles and memoranda of nativities; also a 'magic mirror, with a revolving cylinder,' showing the figures of men and women, old and young. Of course the collection included a 'book of fate.' This was the case against Bryant. "One Shepherd, alias 'Professor Cicero,' was next charged, and it was shown that the same 'instructed' women went to his house, paying sixpence for the usual bone ticket. They saw Shepherd separately. When one of them said that she wanted her fortune told, 'Professor Cicero' took a yard tape and measured her hand. He gabbled the usual nonsense to her about love, marriage, and good luck, hinting that the price of a complete nativity would be half a crown, and before they left the place he gave them a circular, with their phrenological organs marked. Indeed, the man's defence was, that he was a professor of phrenology, and not of the black art. A 'magic mirror' and a 'lawyer's gown' were, however, found at his house, and the last named item has certainly a very black look. The evidence against the next defendant, William Henry, alias 'Professor Thalaby,' and against the fourth and last, Frederick Shipton, alias 'Professor Baretta,' did not differ to any great extent from the testimony given against Zendavesta. The solicitor retained for this sage contended that if he had infringed the law, it was likewise violated at the Crystal Palace, where the 'magic mirror' was to be seen every day. Mr. Mansfield, however, had only to deal with the case and the culprits before him, and, convicting all the four fortune-tellers, he sent them to the house of correction, there to be kept, each and every one of them, to hard labor for three months." THE FORTUNE-TELLERS OF TO-DAY. Before entering upon the _exposé_ of the viler practices of this vile art,--the "selling of families," and of virginity, and the abominable practices of the procuresses, who carry on their damnable treacheries, particularly in our large cities, at the present day,--I wish to enliven this chapter by one or more amusing instances relative to country fortune-tellers. _Filliky Milliky._--During the summer of 185-, the writer was one of a large party of excursionists to Weymouth's Point, in Union Bay. There was a large barge full of people, old and young, male and female, besides several sailboat loads, who, on the return in the afternoon, decided to stop at the hut of a fortune-teller called "Filliky Milliky." This old man, with his equally ignorant wife, professed to tell fortunes by means of a tea-cup. He claimed that he knew of our intended visit, and had set his house in order; but if that house was "in order" that day, deliver us from seeing it when out of order. There were some one hundred or more of us, and whilst but two could occupy the attention of the "Millikies" at once, we sought other means of whiling away the time. The old man lived near the river side, and at his leisure had picked up a large pile of lath edgings which had floated down from a lath mill on the river. One Captain Joy took it upon himself to form "all the gentlemen who would enlist in so noble a cause" into a "home guard," and forthwith arming themselves with the aforesaid lath edgings, a company of volunteers was quickly raised, and drawn up in battle array. I do not recollect the glorious and patriotic speech by which our noble captain fired our "sluggish souls with due enthusiasm for the great cause in which we were about to embark," but we were put through a course of military tactics, "according to Hardee," and took up our line of march. [Illustration: CHARGE, INFANTRY!] There was no Bunker Hill on which to display our valor, but there was another hill, just in rear of the barn nearly, which had not been used in farming purposes that spring, and for this hill we charged at "double-quick." In this charge--the danger lay in the _swamping_ part of the hill--we unambushed a large flock of hens, chickens, and ducks, from the opposite side. "_Charge bayonet!_" shouted our noble captain, with great presence of mind. We charged! The ducks quacked and fled. The hens cackled and ran. The noise was deafening, the chase enthusiastic, and above the dust and din of battle arose the stentorian cry, "Charge bayonet!" The Donnybrook Fair advice of "Wherever there's a head, hit it," was followed to the letter, until the last enemy lay dead on the gory field, or had hid so far under the barn that the small boys could not bring them forth. Then orders came to withdraw, and gather up the dead and wounded. [Illustration: AFTER THE BATTLE.] There was an interesting string of hens, chickens, and ducks brought in and laid at the feet of our great commander, to represent the fowl products of that campaign. The captain's congratulatory speech was characteristic also of the _fowl proceedings_, at the close of which harangue he appointed the "orderly a committee of three to wait on the fortune-teller, and present him with the spoils of war," of which his "cups" had given him no previous intimation. What next? The captain informed us that "as the company was 'mutual,' it became necessary, in consideration of the losses, to draw on the _stock-holders_ (_gun-stock_), as he could see no other 'policy' under which to assess those 'damages.'" "Filliky Milliky" never carried fowl to a better market. The "fortunate" ones entertained us, on the barge, with the marvellous revelations that had transpired within the hut. One married lady was assured that she was yet single, but would marry in a six-month. A double-and-twisted old maid was told that her husband was in California. But the most absurd revelation was to a well-known respectable middle-aged lady, who was inclined to believe in the foreseeing powers of old Mother Milliky until now, who was told that she was "soon to receive a letter from her absent husband, also in California for the last five years; that he had become rich, and was soon to return; but that her youngest child, a year old, was inclined to worms, and might not live to see its father return!" All this wonderful information for a ninepence. * * * * * _Secret of finding lost Property._--In Hopkinton, Mass., there lived a man named Sheffield, who professed to tell fortunes. The postmaster of that town told my informant that old Sheffield received from seven to ten letters per day from the fools who believed in his foreseeing powers. Once the surveyor, with a large gang of men, was working on the highway, and while they were at dinner an ox chain was stolen. The overseer, happening along before the rest of the men, saw some one unhook the chain, and steal away to a field adjoining, pull up a fence post, and deposit the chain in the hole, replace the post, and return. He "lay low," and as the thief passed he discovered him to be old Sheffield, the fortune-teller. He kept his own counsel, and, the chain being missed, a committee of three was appointed to visit the seer, to discover by his art where the stolen property was secreted. Mr. ----, the overseer, and others, called on Sheffield, who got out his mysterious book, and figured away in an impressive manner, and finally chalked out a rough plan of the ground on the floor, and again consulting his book, he solemnly declared that he had discovered the property. "You follow this line from the spot where the chain was unhooked from the plough, so many rods to this line fence, go along the fence to the seventh post, draw it up, and the chain will be found beneath, in the post-hole." The two men were struck dumb with astonishment, for they believed in the mysterious powers of old Sheffield; but the overseer exclaimed, in words more impressive than elegant,-- "Yes, you infernal scoundrel, and you put it there, for I saw you with my own eyes." THE MAGIC MIRROR EXPOSE. Not long ago the body of a once beautiful young woman was taken from the Merrimack River, below the factories at L----. She was unknown at the time, and this was all there was given to the public. To the world she was merely-- "One more unfortunate, Weary of breath, Rashly importunate, Gone to her death." Now, these are the whole facts of the case. She was the daughter of respectable, Christian parents, in a New England village, where she was highly esteemed as an amiable and virtuous young lady. But the tempter came. Not in the form of a "serpent"--very harmless animals, comparatively!--nor that other old fellow, commonly descried as having clattering hoofs and forked tail, etc.--but in the flesh and semblance of a handsome young man! I think preachers and book-makers paint their devils too hideous and too far off! Leave off the d, and look for your evils nearer home, and rather pleasant to look at, on the sly, and not (at first) very unpleasant to the senses in general. These are the dangerous (d)evils; escape _them_, and you avoid all! In the village there were two young men, rivals for the affections of this amiable young lady, and I know not but there were a dozen besides. One held the only advantage over the other of having been a native of the town, while the other was, comparatively, but little known. Both were sober, industrious, and moral young men. One day Miss ---- was going to the great city, and, for the "sport of the thing," agreed to visit a celebrated fortune-teller--a clairvoyant!--at the instigation of the young man, who, though least known to her, had recently distanced his rival by his assiduity in pressing his suit before the young lady. He assured her there could be no impropriety in a young lady's visiting a fortune-teller. It was only for fun; nobody believed in them, and she could keep her own secret if she chose! She went in broad daylight. The lady clairvoyant greeted her cordially, begged her to feel quite at her ease, as there was great fortune in store for her. She described her two lovers very minutely, and informed the girl that the one who was to marry her would come to her in a vision, if she would but look into a mirror hanging on the wall before her. "I see nothing but my own face," replied the young lady, when she had arisen and looked into the glass. The woman then turned it half around on the hinges, swung out the frame upon which the mirror was also hung, and, disclosing a plain black glass behind, fastened to the wall, said,-- "Now, if you will step behind the glass, back to the wall, and again look into the mirror, you _may_ possibly see one of the two gentlemen--I cannot _say_ which." More amused than alarmed, the lady complied. [Illustration: THE FORTUNE-TELLER'S MAGIC MIRROR.] "Still I see nothing but myself and a dark glass behind me," she said. "Look steadfastly into the glass. _Now!_" exclaimed the woman. "O, what--what do I see?" cried the girl. "'Tis he! 'tis Mr. ----" "Don't be alarmed; 'tis your future husband. No power can prevent it. It is fate--fate! But it will be a happy consummation," said the woman, closing the mirror. "Why, I left him at home, surely; and I came by steam. That is a solid wall! Ah, my fate is decreed, I believe!" Can the reader suppose any sensible person would believe this to be magic? There are thousands who believe it. Miss ---- was one. She had seen the spiritual representation of her future husband, and, finding him at home on her return, the same afternoon, she accepted him as her betrothed, and the other was dismissed. Her ruin followed. In the flight of her lover, her hopes were forever blasted. To hide her shame, she went secretly from home; and to earn her daily bread, she labored in a cotton factory. When she could no longer cover her shame in the world, she went without--into outer darkness! Her parents went down in sorrow to their untimely graves. Now about the magic mirror. The young man went to the city by the same train with the girl he proposed to ruin. He had previously arranged with the fortune-teller--no unusual thing--to appear in person behind the darkened glass in the next room, and had returned in disguise by the same train with his victim. The fortune-teller died miserably, and was buried in the Potter's Field at the expense of the city of Hartford, Conn. "The thorns which I have reaped are of the tree I planted; they have torn me,--and I bleed: I should have known what fruit would spring from such a seed." BYRON. Such is one of the results of patronizing fortune-tellers. I have seen this kind of mirror, and the first effect, even on a strong-minded person, seeing but faintly through the darkened glass, over your shoulder, the outlines of a face, and finally, as your eyes get familiar with the darkness, the very features of a person reflected therein, is truly impressive, if not startling. Young ladies, for your own sakes, for the sake of your friends, and more for Heaven's sake, keep away from fortune-tellers! _You cannot possibly see into futurity_, neither can any one, much less the ignorant wretches who profess the dark mysteries, tell for you what joys or sorrows are in store for the future! FORTUNE-TELLERS AS PROCURESSES. An able reporter to the Boston Daily Post, who devoted a considerable time in May, 1869, to visiting and writing up the fortune-tellers of Boston, which he reported in full in the above paper, and from which I shall copy more fully hereafter, says in conclusion,-- "From what we are able to learn in this direction, we have arrived at the conclusion that there are not _less than two hundred men and women_ in Boston and vicinity who get a good livelihood by this profession, while many do a large and profitable business. "One lady, who has reduced her charges to the very lowest figure (fifty cents for an interview), candidly informed us that her receipts for the past year had not been less than twelve hundred dollars. Another reported her receipts from ten to fifty dollars a day. "Of course no reliable estimate, without better statistics, can be made of the magnitude of the business; but it seems not extravagant to estimate their receipts, on an average, at fifteen hundred dollars per annum! or an annual cost to the people of Boston (and vicinity?) for fortune-telling, of the snug little sum of three hundred thousand dollars!" The price advertised for a sitting in 1870 was from twenty-five cents to one dollar. The Post reporter says of "Mrs. Nellie Richards" (_alias_ Mrs. Nelson), "Not unfrequently her receipts are fifty dollars per day." Again of one, "She has received fifty dollars for one sitting." The writer has visited the most celebrated fortune-tellers here, and been told by them that they have received five, ten, and twenty dollars for one sitting. What for? What was the value received? Not from _females_ do they receive these liberal sums; but from middle-aged or old gentlemen and "married men," as one assured me. It is quite possible for a few sharp fortune-tellers to make fifteen hundred dollars per year at merely telling fools what they may expect from the future. "Middle-aged, old, and married men" do not consult them, as a general rule, for that purpose. Here is a true history illustrative of my meaning. I gathered the facts from the lady. On Saturday, the 9th of December, 1871, a young woman, residing with her parents on ---- Street, went to the afternoon performance at the Boston Museum. A young man made three unsuccessful attempts to "flirt" with her. The third time she slightly shook her head. Some one, seated immediately behind her, touched her on the shoulder, and said, "Right, young lady; you did right not to notice him." "I turned my head," said my informant, "and just made the least bit of acknowledgment to a fine-looking, elderly gentleman, who, perhaps, was rising fifty. He was an utter stranger to me, and I did not observe him afterwards. On the following week I received a note--a very pretty, delicate letter--from the very gentleman. He explained that he saw me at the performance of "Elfie," and was much struck by my lady-like appearance, and the rest, begging the privilege of calling on me privately. Now, how could he have obtained my address?" "Did the other party, the young 'flirt,' know it?" I asked. "No--not probable. I was not so astonished in receiving a letter from a stranger, as I was on learning that the nice-looking old gent at the theatre should have sent it, and that he possessed my address." "Why not surprised by receiving the letter from a stranger?" I asked. "Because I visited a fortune-teller, a day or two before, who told me I should receive a letter from a middle-aged man, and that it would be to my interest to cultivate his friendship, as he was a nice old covey, and was rich and liberal." "The secret is out! Did the fortune-teller know your address?" "O, yes; she was an old friend of my mother's, _and asked me nothing for a sitting_. And would _she_ possibly betray the daughter of her old friend?" I have since learned that the young woman was married at the time, which fact the fortune-teller must have known when she advised her to "cultivate the friendship" of an old _roué_, "as he was rich and liberal." Rich and liberal! No doubt! The light was astounding which broke in upon the young lady's mind from my intimating that the old viper, the fortune-teller (clairvoyant she calls herself), had betrayed her, and doubtless had received ocular demonstration of the "nice old gentleman's" liberality. Doubtless there was a five, ten, or twenty dollar sitting! and the "friend of her mother" could well afford to give her sittings free! Reader, if you doubt that such villanies are daily practised in this city, such "betrayals of confidence," and "selling of families," put up "five or ten dollars for a sitting," almost anywhere, and you can have proof. None of your fifty cents or dollar affairs--those are for the females; but "come down" with the V.'s and X.'s; those bring the "great information." Let us "parable" a case. "A nice, middle-aged gentleman" calls on Madam Blank. "Here, now, my good woman, take this fee. Tell me a good future. Let her have dark hair and eyes. If it is satisfactory, I double the fee." "Call again next week, or in three or four days," is all the conversation necessary to pass for the first "sitting." Before the expiration of the time, just such a young lady calls. The wily old fortune-teller--too old to sell herself any longer--sells out this, perhaps, unsuspecting lady with black hair and eyes, by mysteriously informing her of a certain nice gentleman whom she will meet at a designated place, at a specified hour, on a particular day! She is _very_ courteous to the girl, asks her nothing for a sitting, has taken a liking to her, worms from her the secrets of her birth, poverty, weaknesses, etc., and, with many smiles and fair promises, bows her out. She next proceeds to inform the "nice gentleman" that the job is cooked, and the victim is unsuspecting, states where he is to meet her, the signal by which he is to know her; takes the "double fee," and leaves the rest to the "nice middle-aged (and shrewd) gentleman" to manage for himself. How many young women in Boston can avouch for the truth of this statement? I doubt not there are very many. _Cui Bono?_ While I know and confess that there are a few ladies who _profess_ to tell fortunes, find lost property, etc., and who do no greater deception, still, what positive advantage has ever been derived therefrom? LOVE POWDERS AND DROPS.--FRENCH SECRET, ETC. I have, by purchase and otherwise, obtained the secret of the compounds of the celebrated "Spanish," _alias_ "Turkish, Love Powders." I had previously considered them very harmless preparations. They are quite the reverse. The powder and drops are _Spanish flies_ and _blood-root_! Sometimes the former are mixed (pulverized) with fine sugar; but the Spanish flies (cantharides), either in powder or liquid, is a very dangerous irritant, a very small dose sometimes producing painful and dangerous strangury. It is far more certain to produce this distressing complaint than to cause any sexual excitement. There may be some harmless powders sold as "love powders," but I have never seen any. I have a quantity of the former. Any physician or chemist may see it, who is interested. A few drops of it will produce burning and excoriation of the mouth and stomach, and inflammation of the stomach, liver, and kidneys. And this dangerous stuff is sold by ignorant fortune-tellers to any equally ignorant, credulous creature who may send fifty cents therefor. _The French Secret_ is only for fools. Reader, _you_ have no occasion for it. It would be of no positive earthly benefit, provided I could so construe language as to explain to you what it is, in this connection. Be assured that you cannot circumvent Nature, except at the expense of health. _Qui n'a sante n'a rien._ Druggists' clerks sometimes sell to boys _tincture cantharis_ for evil purposes. _Hasheesh_ is another dangerous article, sometimes sold at random, and purchased for no good purpose. A few years since, a great excitement was produced by the young ladies of P---- Female Seminary obtaining and using a quantity of _hasheesh_. "One girl took five grains, another _ten_ grains. The latter was rendered insensible, and with difficulty restored to consciousness, while the former was rushing around under the peculiar hallucinating effect of the drug, and in a manner bordering on indecency." I obtained this statement, with more that I cannot publish, from a physician who witnessed the scene. "DOES HE LOVE ME?" Young girls and children are seduced into visiting fortune-tellers. A Boston fortune-teller, in 1871, took a summer tour through Eastern Massachusetts and New Hampshire. At Manchester, one evening, some one knocked lightly at her reception-room door, when, on her answering the summons, there stood three little girls, of ten or twelve summers. "Well," said the lady, "what do you children want?" "We came to have our fortunes told," replied the youngest, drawing her little form up to represent every half inch of her diminutive dimensions. With a smile of incredulity, the lady said, "It costs fifty cents. Besides, you are too small to have a fortune told." "We've got the money," replied the little speaker; "and we're not too little. Why, I am ten, and Jenny, here, is twelve." [Illustration: CHILDREN CONSULTING A FORTUNE-TELLER.] "Well, come in," replied the fortune-teller. There was a lady present, who also asked what those children came there for. The girls sat up in some chairs proffered. The younger one was so small that her little feet could not reach the floor, and sitting back in her chair, her little limbs stuck out straight, as such awkward little folks' will. The woman told them something, to seem to cover the money paid. It was not satisfactory, however, and the ten-year-old one put the following questions:-- "Do you think, ma'am, that the young man who is keeping company with me loves me?" This was a poser, and the woman laughed outright. "What did she reply?" I asked, shocked, though amused, by the ridiculousness of the whole affair. "O, Gad, if I know! I was too busy then to listen." The next question was more strange than the first:-- "Will the young gentleman marry me, eventually?" "Doubtless he will when you become older," was the reply; "and I advise you to think no more about it till you are much older." I obtained this item from the third party present, the husband of the fortune-teller. [Illustration] X. EMINENT PHYSICIANS AND SURGEONS. _Lord Say._ Why, Heaven ne'er made the universe a level. Some trees are loftier than the rest, some mountains O'erpeak their fellows, and some planets shine With brighter ray above the skyey route Than others. Nay, even at our feet, the rose Outscents the lily; and the humblest flower Is noble still o'er meaner plants. And thus Some men are nobler than the mass, and should, By nature's order, shine above their brethren. _Lord Clifford._ 'Tis true the noble should; but who is noble? Heaven, and not heraldry, makes noble men. THEIR ORIGIN, BOYHOOD, EARLY STRUGGLES, ETC.--DOCTORS ARE PUBLIC PROPERTY.--DR. MOTT, OF OYSTER BAY.--DR. PARKER.--A "PLOUGH-BOY."--THE FARMER'S BOY AND THE OLD DOCTOR.--SCENE IN BELLEVUE HOSPITAL.--"LEAVES FROM THE LIFE OF AN UNFLEDGED ÆSCULAPIAN."--FIRST PATIENT.--"NONPLUSSED!"--ALL RIGHT AT LAST.--PROFESSORS EBERLE AND DEWEES.--A HARD START.--"FOOTING IT."--ABERNETHY'S BOYHOOD.--"OLD SQUEERS."--SPARE THE BOY AND SPOIL THE ROD.--A DIGRESSION.--SKIRTING A BOG.--AN AGREEABLE TURN.--PROFESSOR HOLMES.--A HOMELESS STUDENT. It is amusing, as well as instructive, to compare notes on the various circumstances which have led different young men to adopt the science of medicine as their profession. The advantages of birth and "noble blood" weigh lightly, when thrown into the balance, against circumstances of after life, and its necessities, in ourselves or fellow-creatures. In searching through biographies of famous people, of all ages and countries (to collect a chapter on "Origin of Great Men"), I am peculiarly convinced of the correctness of this conclusion. The earlier histories and traits of character--no matter which way they point--of all great men are interesting to review; and yet it is a lamentable fact that the accounts of boyhood days, aspirations, hopes, and struggles, with the many little interesting items and episodes of the youth of most great men are very meagre, and, in many cases, entirely lost to the world. In the published biographies of physicians this is particularly the case. You read the biography of one, and it will suffice for the whole. It begins something like this:-- "Dr. A. was born in Blanktown, about the year 18--; entered the office of Dr. Bolus, where he studied physic; attended college at Spoon Haven, where he graduated with honors; arrived at eminence in his profession;" and, if defunct, ends, "he died at Mortgrass, and sleeps with his fathers. _Requiescat in pace._" In presenting to the public the following little sketches of physicians, I may only say that doctors, of all men, are considered public property, and have suffered more of the public's kicks and cuffs than any other class of men, from the time when Hercules amused himself by setting up old Dr. Chiron, and shooting poisoned arrows at his vulnerable heel, to the little divertisement of the lovely St. Calvin and his consistory in cooking Michael Servetus, the Spanish physician; to the imprisonment of our army surgeons by their "brethren" of the South, that they might not be instrumental in restoring Union soldiers to the ranks; or the more recent imprisonment of a physician without cause, and the wholesale slaughter of students, in the Isle of Cuba. "THE QUAKER SURGEON." Dr. Valentine Mott gave no intimation, in his boyhood days, of the great ability that for a time seemed to lie dormant within the after-developed, massive, and well-balanced brain of the celebrated surgeon. Except from the fact of his being the son of a country doctor, his schoolmates would as soon have expected to see him turn out a second-rate oyster-man,--suggested by the ominous name of the Bay, at Glen Cove, where Valentine was born,--as to believe that a boy of no more promise would develop into the greatest physician and surgeon of the age! He was reared amongst doctors,--his father, and Dr. Valentine Searnen, and others. A "plough-boy" is as likely to become an eminent surgeon as is the son of a practising physician. Dr. Willard Parker, one of the most prominent physicians and surgeons of New York city, was born in New Hampshire, in 1802, of humble though most respectable parents. When Willard was but a few years old, his family removed to Middlesex County, Mass., evidently with a hope of bettering their circumstances. Here Mr. Parker entered more fully upon the practical duties of an agricultural life, instructing his son Willard, when not attending the village school, in the mysteries of "Haw, Buck, and gee up, Dobbin." Until he was sixteen years old, young Parker was brought up a "plough-boy" and a tiller of the soil. From a "plough-boy" he became the "master" of a village school, "teaching the young idea how to shoot," which honest pursuit he continued for several years, until he had accumulated sufficient means to enter Harvard. He was a hard-working student, and his books were not thrown aside when he had obtained a diploma, in 1830.... As a lecturer and operator, Dr. Parker has been most successful.... Since the death of Dr. Valentine Mott, in April, 1865, Professor Parker has been elected president of the New York Inebriate Asylum (Binghamton). AN ONONDAGA FARMER BOY. Imagine, dear reader, looking back over the space of nearly forty years, that you see an uncouth young man, twenty years of age, clad in the coarse clothes and cowhide boots of an Onondaga farmer, who, straightening up from his laborious task of potato hoeing, stops for a moment, leaning with one hand upon his hoe, while he wipes the sweat from his handsome, intelligent, though sun-burned brow with a cotton handkerchief in the other. Here is a picture for a painter! Now he seems studiously observing the old village doctor, who, seated in his crazy old gig, drawn by his ancient sorrel mare, is leisurely jogging by on the main turnpike. [Illustration: THE ONONDAGA FARMER BOY.] "Good evening, Stephen; p'taters doin' well?" says the doctor. Receiving an affirmative answer, the doctor drives past, and is gone from the sight, but not from the memory, of the young farmer. "And _that_ is a representative of the science of medicine!" So saying, the young man "hoed out his row,"--which was his last,--picked up his coat, and returned to the parental mansion, but a few rods distant. This was the turning-point in his life. We pass over twenty years or more. It is operating-day at Bellevue Hospital, in New York city. A very serious and important operation is about to be performed. Three hundred students and physicians are seated in a semicircle under the great dome of the hospital, in profound silence and intense interest, while the professor and attending surgeon is delivering a brief but comprehensive lecture relative to the forthcoming operation. The speaker is a man of middle age, medium height, deep, expressive eyes, well-developed brow, with that excellent quality of muscle and nerve that is only the result of earlier out-door exercise and development, with calm deportment and modest speech. "His conciseness of expression and quiet self-possession are evident to every beholder, and comprehensive and congenial to every listener." Who is this splendid man before whom students and physicians bow in such profound respect and veneration, and to whom even Professors Mott, Parker, Elliott, Clark, etc., give especial attention? It is Stephen Smith, M. D., once the Onondaga farmer boy! Says Dr. Francis, of New York, "When a youthful farmer is seen studying the works of learned authors during that portion of the day which is generally set aside for relaxation and pleasing pastime, one may easily predict for him ultimate success in the branch of life that he may choose, provided he follows out the higher instincts of his nature. The same zeal that caused Stephen Smith, farmer, to study at the risk of ease, and meet the fatigue of body with the energies of mind, has ever marked his course in after years." COMMENCING PRACTICE. From that excellent work, "Scenes in the Practice of a New York Surgeon," by Dr. E. H. Dixon, I copy, with some abbreviation, the following, which the author terms "Leaves from the Log-book of an Unfledged Æsculapian:"-- "In the year 1830 I was sent forth, like our long-suffering and much-abused prototype,--old father Noah's crow,--from the ark of safety, the old St. Duane Street College. I pitched my tent, and set up my trap, in what was then a fashionable up-town street. "I hired a modest house, and had my arm-chair, my midnight couch, and my few books in my melancholy little office, and I confess that I now and then left an amputating-knife, or some other awful-looking instrument, on the table, to impress the poor women who came to me for advice. "These little matters, although the 'Academy' would frown upon them, I considered quite pardonable. God knows I would willingly have adopted their most approved method of a splendid residence, and silver-mounted harnesses for my bays; but they were yet in dream-land, eating moonbeams, and my vicious little nag had nearly all this time to eat his oats and nurse his bad temper in his comfortable stable. "In this miserable way I read over my old books, watered my rose-bushes,--sometimes with tears,--drank my tea and ate my toast, and occasionally listened to the complaint of an unfortunate Irish damsel, with her customary account of 'a pain in me side an' a flutterin' about me heart.' At rare intervals I ministered to some of her countrywomen in their fulfilment of the great command when placed in the Garden of Eden. (What a dirty place it would have been if inhabited by Irish women!) "And thus I spent nearly a year without a single call to any person of character. I think I should have left in despair if it had not been for a lovely creature up the street. She was the wife of a distinguished fish merchant down town. "This lovely woman was Mrs. Mackerel. I will explain how it was that I was summoned to her ladyship's mansion, and had the pleasure of seeing Mr. Mackerel, of the firm of 'Mackerel, Haddock & Dun.' "One bitter cold night in January, just as I was about to retire, a furious ring at the front door made me feel particularly amiable! A servant announced the sudden and alarming illness of Mrs. Mackerel, with the assurance that as the family physician was out of town, Mrs. M. would be obliged if I would immediately visit her. Accordingly, I soon found myself in the presence of the accomplished lady, having--I confess it--given my hair an extra touch as I entered the beautiful chamber. "Mrs. Mackerel was not a bad-tempered lady; she was only a beautiful fool--nothing less, dear reader, or she would have never married old Mackerel. Her charms would have procured her a husband of at least a tolerable exterior. His physiognomy presented a remarkable resemblance to his namesake. Besides, he chewed and smoked, and the combination of the aroma of his favorite luxuries with the articles of his merchandise must have been most uncongenial to the curve of such lips and such nostrils as Mrs. Mackerel's. "I was received by Mr. Mackerel in a manner that increased observation has since taught me is sufficiently indicative of the hysterical _finale_ of a domestic dialogue. He was not so obtuse as to let me directly into the true cause of his wife's nervous attack and his own collectedness, and yet he felt it would not answer to make too light of it before me. "Mr. and Mrs. M. had just returned from a party. (The party must be the 'scape-goat'!) He assured me that as the lady was in the full enjoyment of health previously, he felt obliged to attribute the cause of her attack and speechless condition--for she spoke not one word, or gave a sign--to the dancing, heated room, and the supper. "I was fully prepared to realize the powers of ice-cream, cake, oranges, chicken-salad, oysters, sugar-plums, punch, and champagne, and at one moment almost concluded to despatch a servant for an emetic of ipecac; but--I prudently avoided it. Aside from the improbability of excess of appetite through the portal of such a mouth, the lovely color of the cheeks and lips utterly forbade a conclusion favorable to Mr. Mackerel's solution of the cause. "I placed my finger on her delicate and jewelled wrist. All seemed calm as the thought of an angel's breast! "I was nonplussed. 'Could any tumultuous passion ever have agitated that bosom so gently swelling in repose?' "Mackerel's curious questions touching my sagacity as to his wife's condition received about as satisfactory a solution as do most questions put to me on the cause and treatment of diseases; and having tolerably befogged him with opinions, and lulled his suspicions to rest, by the apparent innocent answers to his leading questions, he arrived at the conclusion most desirable to him, viz., that I was a fool--a conviction quite necessary in some nervous cases.... "So pleased was Mr. M. with the soothing influences of my brief visit that he very courteously waited on me to the outside door, instead of ordering a servant to show me out, and astonished me by desiring me to call on the patient again in the morning. "After my usual diversion of investigating 'a pain an' a flutterin' about me heart,' and an 'O, I'm kilt intirely,' I visited Mrs. Mackerel, and had the extreme pleasure of finding her quite composed, and in conversation with her fashionable friend, Mrs. Tiptape. The latter was the daughter of a 'retired milliner,' and had formed a desirable union with Tiptape, the eminent dry goods merchant. Fortunately--for she was a woman of influence--I passed the critical examination of Mrs. T. unscathed by her sharp black eyes, and, as the sequel will show, was considered by her 'quite an agreeable person.' "Poor Mrs. Mackerel, notwithstanding her efforts to conceal it, had evidently received some cruel and stunning communication from her husband on the night of my summons; her agitated circulation during the fortnight of my attendance showed to my conviction some persistent and secret cause for her nervousness. "One evening she assured me that she felt she should now rapidly recover, as Mr. Mackerel had concluded to take her to Saratoga. I, of course, acquiesced in the decision, though my previous opinion had not been asked. I took a final leave of the lovely woman, and the poor child soon departed for Saratoga. "The ensuing week there was a sheriff's sale at Mackerel's residence. The day following the Mackerels' departure, Mr. Tiptape did me the honor to inquire after the health of my family; and a week later, Master Tiptape having fallen and bumped his dear nose on the floor, I had the felicity of soothing the anguish of his mamma in her magnificent _boudoir_, and holding to her lovely nose the smelling salts, and offering such consolation as her trying position required!" Thus was commenced the practice of one of the first physicians of New York. The facts are avouched for. The names, of course, are manufactured, to cover the occupation of the parties. The doctor still lives, in the enjoyment of a lucrative and respectable practice, and the love and confidence of his numerous friends and patrons. Quite as ludicrous scenes could be revealed by most physicians, if they would but take the time to think over their earlier efforts, and the various circumstances which were mainly instrumental in getting them into a respectable practice. HOW PROFESSOR EBERLE STARTED. The young man who has just squeezed through a medical college, and come out with his "sheepskin," who thinks all he then has to do is to put up his sign, and forthwith he will have a crowd of respectable patients, is to be pitied for his verdancy. The great Professor John Eberle "blessed his stars" when, after graduating as "Doctor of Medicine" in the University of Pennsylvania, and making several unsuccessful attempts at practice in Lancaster County, he received the appointment as physician of the "out-door poor" of Philadelphia. After that, his writings, attracting public attention, were mostly contributive to his success and advancement. Energy and determination are better property than even scholastic lore and a medical diploma, for unless you possess the former, talent and education fall to the earth. Dr. William P. Dewees, formerly Professor of Obstetrics in the University of Pennsylvania, the celebrated author, physician, and surgeon, practised seventeen years before he obtained a diploma. He was of Swedish descent on his father's side, and Irish on his mother's. His father died in very limited circumstances, when William was a boy; hence he received no collegiate education until such time as he could earn means, by his own efforts, to pay for that coveted desideratum. We find him, with an ordinary school education, serving as an apothecary's clerk, a student of medicine, and at the early age of twenty-one years trying to practise medicine in a country town fourteen miles from Philadelphia. Young Dewees possessed great talent and energy, but his personal appearance was scarcely such, at that early age, as to inspire the stoical country folks with the requisite confidence to speedily intrust him with their precious lives and more cherished coppers! "He was scarcely of medium stature, florid complexion, brown hair, and was remarkably youthful in his appearance," says Professor Hodge, M. D. I have before me an excellent likeness "of the embryo professor," which admirably corresponds with the description given above; but though "youthful," yea, bordering on "greenness," I can read in that frank, intelligent countenance the lines of deep thought, and a soul burning with desire for greater knowledge. The too florid countenance and narrow nostrils are sure indications of a consumptive predisposition. Dr. Dewees died May 30, 1841. He was well read in French and Latin, and also various sciences. A HARD STARTING. _Sketch of Western Practice._--The following interesting sketch is from the able pen of Dr. Richmond, of Ohio, now a wealthy and eminent M. D. It was originally contributed, if I mistake not, to the "Scalpel." "I set myself down with my household goods in a land of strangers. How I was to procure bread, or what I was to do, were shrouded in the mysterious future. Memory came to my consolation; for, in spite of myself, the 'Diary of a London Physician,' read in other days, came, with its racy pictures, flitting before my mind's eye; and I knew not but I, too, might yet wish myself, my Mary, and my child sleeping in the cold grave, to hide me from the persecution that seemed to follow me with such sleepless vigilance.... "My store of old watches now came into play. A gentleman wishing to sell out his land, I invested all the wealth I possessed in the purchase of a ten-acre lot, shouldered my axe, and by the aid of a brother I soon prepared logs for the mill sufficient to erect me a small dwelling. I never was happier than when preparing the ground and splitting the blocks of sandstone for the foundation of my house. One customer, whose wife I had carried through a lingering fever, furnished me a frame for a dwelling, and I fell in his debt for a pair of boots. Another furnished nails and glass, and in the course of eight months I moved into my new house. "For two years I fed my cow, and raised my own provender to feed my gallant nag, which shared my toil and its profits. My first two years' labor barely returned sufficient profit to pay for my home and feed my little family. "My nag had died, and the terrible drought of 1846 forced me to relinquish the horse I had hired, and for five months I performed all my visits on foot, often travelling from six to ten miles to see one patient.... "These were trying times; but what if the elements were unpropitious? I had food and shelter for myself and family,--blessings about which I had often been in doubt,--and I was fully prepared to let 'the heathen rage, and the people imagine' what they chose!... The first winter was one of great severity; the weather was very changeable, and the most awful snow-storms were often succeeded by heavy rains, and the roads so horrid as to be impassable on horseback or in carriages. I had a patient five miles distant, sick with lung fever, and, in an attendance of forty days I made thirty journeys on foot (three hundred miles to attend one patient!) His recovery added much to my reputation, and I received for my services a new cloak and coat, which I much needed, and a hive of honey bees!... "An old horse which I again hired of a friend had a polite way of limping, and was a source of much merriment among my patrons. I persistently attributed what they deemed a fault entirely to the politeness of the quadruped; and this nag, with my plain and rustic appearance, endeared me to the laboring population, and thus my calamities became my greatest friends. My fortune changed, and the experience and name I had acquired now came in as capital in trade, and a flood of 'luck' soon followed." ABERNETHY'S BOYHOOD. Seated upon the outside of an ancient London stage-coach, to which were attached four raw-boned, old horses, just ready to start for Wolverhaven one pleasant afternoon, you may easily imagine, kind reader,--for it is a fact,--a chubby-faced, commonplace little boy, some ten years old, with another like youthful companion,--"two Londoners,"--while comfortably ensconced within, in one corner of the vehicle, is a large, stern-looking old gentleman, in "immense wig and ruffled shirt." [Illustration: THE POLITE QUADRUPED.] The stage-horn is sounded, the driver cracks his whip, the sleepy old nags wake up, the coach rocks from side to side, and in a moment more the team is off for its destination. Why! the reader is readily reminded of the scene of "_Old Squeers_," taking the wretched little boys down to his "Academy," in Yorkshire, "where youth were boarded, clothed, furnished with pocket-money," and taught everything, from "writing to trigonometry," "arithmetic to astronomy," languages of the "_living_ and _dead_" and "diet unparalleled!" Nevertheless it is another case, far before "Old Squeers" time. The elderly gentleman, in top-wig and immense ruffles, was Dr. Robertson, teacher of Wolverhampton Grammar School, and the chubby little boy was Master John Abernethy. Who the "other boy" was is not known, as he never made his mark in after life. Says Dr. Macilwain,-- "We can quite imagine a little boy, careless in his dress, not slovenly, however, with both hands in his trousers pockets, some morning about the year 1774, standing under the sunny side of the wall at Wolverhampton School; his pockets containing, perhaps, a few shillings, some ha'pence, a knife with the point broken, a pencil, together with a tolerably accurate sketch of 'Old Robertson's wig,'--which article, shown in an accredited portrait now before us, was one of those enormous by-gone bushes, which represented a sort of impenetrable fence around the cranium, as if to guard the precious material within; the said boy just finishing a story to his laughing companions, though no sign of mirth appeared in him, save the least curl of the lip, and a smile that would creep out of the corner of his eye in spite of himself." [Illustration: YOUNG ABERNETHY.] "The doctor" was represented as being a passionate man. Squeers again! One day young Abernethy had to do some Greek Testament, when his glib translation aroused the suspicion of the watchful old doctor, who discovered the 'crib' in a Greek-Latin version, partially secreted under the boy's desk. No sooner did the doctor make this discovery than with his doubled fist he felled the culprit with one blow to the earth. Squeers again! "'Why, what an old plagiarist Mr. Dickens must have been!' you exclaim. "But the case in 'Nicholas Nickleby' is worse, far worse, for 'the little boy sitting on the trunk only sneezed.' "'Hallo, sir,' growled the schoolmaster (Squeers), 'what's that?' "'Nothing, sir,' replied the little boy. "'Nothing, sir!' exclaimed Squeers. "'Please, sir, I sneezed!' rejoined the boy, trembling till the little trunk shook under him. "'O, sneezed, did you?' retorted Mr. Squeers. 'Then what did you say "Nothing" for, sir?' "In default of a better answer to this question, the little boy screwed a couple of knuckles into his eyes, and began to cry; wherefore Mr. Squeers knocked him off the trunk with a blow on one side of the head, and knocked him on again with a blow on the other." Robertson was a fact; Squeers was a fable. That's the difference. As Dr. Robertson taught neither arithmetic nor writing in his school, the pupils went to King Street, to a Miss Ready, to receive instruction in those branches. This lady, if report is true, wielded the quill and cowhide with equal grace and mercy, and when the case came to hand, did not accept the modern advice, to "spare the boy and spoil the rod." When the great surgeon was at the height of his fame, in London, many years afterwards, Miss Ready, still rejoicing in "single blessedness," called on her former pupil. In introducing his respected and venerable teacher to his wife, Abernethy laconically remarked, "I beg to introduce you to a lady who has boxed my ears many a time." An old schoolmate, when eighty-five years old, wrote to the author of "Memoirs of Abernethy," saying, among other things, "In sports he took the first place, and usually made a strong side; was quick and active, and soon learned a new game." It was contrary to his own desire that John Abernethy became a physician. "Had my father let me be a lawyer, I should have known by heart every act of Parliament," he repeatedly affirmed. This was not bragging, as the following anecdote will illustrate:-- On a birthday anniversary of Mrs. Abernethy, mother of John, a gentleman recited a long copy of verses, which he had composed for the occasion. "Ah," said young Abernethy, "that is a good joke, pretending you have written these verses in honor of my mother. Why, sir, I know those lines well, and can say them by heart." "It is quite impossible, as no one has seen the copy but myself," rejoined the gentleman, the least annoyed by the accusation of plagiarism. Upon this Abernethy arose, and repeated them throughout, correctly, to the no small discomfiture of the author. Abernethy had remembered them by hearing the gentleman recite them but once! "A boy thwarted in his choice of a profession is generally somewhat indifferent as to the course next presented to him." Residing next door neighbor to Abernethy's father was Dr. Charles Blicke, a surgeon in extensive practice. This was very convenient. Sir Charles is represented as having been quick-sighted enough to discover that "the Abernethy boy" was clever, a good scholar, and withal a "sharp fellow." Thus, between the indifference of the parent, and the selfishness of the surgeon, the would-be lawyer, John Abernethy, was apprenticed to the "barber-surgeon" for five years. He was then but fifteen years of age. "All that young Abernethy probably knew of Sir Charles was, that he rode about in a fine carriage, saw a great many people, and took a great many fees; all of which, though presenting no further attractions for Abernethy, made a _prima facie_ case not altogether repulsive." We must not forget to mention that young Abernethy was of a very inquiring mind. "When I was a boy," he said in after years, "I half ruined myself in buying oranges and sweetmeats, in order to ascertain the effects of different kinds of diet on diseases." Whether he tried said "oranges and other things" on himself or some unfortunate victim, my informant saith not; but I leave the reader to decide by his own earlier appetites and experiences. "When I was a boy," I think is significant of the probabilities that it was his own digestive organs that were "half ruined." Be it as it may, it reminds me of the case of a little country boy, who, on his first advent to the city on a holiday, was chaperoned by his somewhat older and sharper city cousin,--"one of the b'hoy's,"--who exercised a sort of vigilance over the uninitiated rustic, that the little fellow might not surfeit himself by too great a rapacity for peanuts, gingerbread, candies, and oranges, often generously sharing the danger by partaking largely of the small boy's purchases in order to spare his more delicate stomach. Finding the ignorant little rustic about to devour a nice-looking orange, his cousin pounced upon him just in time to prevent the rash act. "Here, Sammy; don't you know that is one of the nastiest and most indigestiblest things you could put into your stomach? Give it here!" Rustic, whose faith in the wisdom of his maturer cousin, though very great, was yet quite counterbalanced by the sweets in the orange, slightly held back, when the other continued,-- "Leastwise, Sammy, let's have a hold of it, and suck the abominable juice out for you." (For this digression I beg the pardon of the reader; for the idea I thank Frank Leslie.) George Macilwain, M. D., F. R. C. S., etc., in prefacing the life of the great London surgeon, gives a brief and interesting sketch of his own boyhood, also his early impressions of Abernethy, and his first attendance on his lectures. "My father practised on the border of a forest, and when he was called at night to visit a distant patient, it was the greatest treat to me, when a little boy, to be allowed to saddle my pony and accompany him. I used to wonder what he could find so 'disagreeable' in that which was to me the greatest possible pleasure; for whether we were skirting a bog on the darkest night, or cantering over the heather by moonlight, I certainly thought there could be nobody happier than I and my pony. It was on one of these occasions that I first heard the name of 'Abernethy.' The next distinct impression I have of him was derived from hearing father say that a lady patient of his had gone up to London to have an operation performed by Dr. Abernethy, though my father did not think the operation necessary to a cure, and that Abernethy entirely agreed with him; that the operation was not performed; that he sent the lady back, and she was recovering. This gave me a notion that Dr. Abernethy must be a good man, as well as a great physician. "As long as surgery meant riding across the forest with my father, holding his horse, or, if he stopped in too long, seeing if his horse rode as well as my pony, I thought it a very agreeable occupation; but when I found that it included many other things not so agreeable, I soon discovered that there was a profession I liked much better.... "Disappointed in being allowed to follow the pursuit I had chosen, I looked on the one I was about to adopt with something approximating to repulsion; and thus one afternoon, about the year 1816, and somewhat to my own surprise, I found myself walking down Holborn Hill on my way to Dr. Abernethy's lecture at St. Bartholomew's. "When Dr. Abernethy entered, I was pleased with the expression of his countenance. I almost fancied he sympathized with the melancholy with which I felt oppressed. At first I listened with some attention; as he proceeded, I began even to feel pleasure; as he progressed, I found myself entertained; and before he concluded, I was delighted. What an agreeable, happy man he seems! What a fine profession! What wouldn't I give to know as much as he does! Well, I will see what I can do. In short, I was converted." All who ever heard him lecture agree that Dr. Abernethy had a most happy way of addressing students. Notwithstanding he has often been represented as rough in his every-day intercourse with men, he was easy, mild, and agreeable in the lecture-hall, and kind and compassionate in the operating-room. After having carefully studied all that has been written respecting his style and manner as a lecturer and delineator, and also studiously listened to and watched the ways and peculiarities of our most excellent lecturer on anatomy at Harvard, I find many striking resemblances between Dr. Abernethy and Professor Oliver Wendell Holmes. "The position of Abernethy was always easy and natural, sometimes almost homely. In the anatomical lecture he always stood, and either leaned against the wall, with his arms folded before him, or rested one hand on the table; sometimes one hand in his pocket. In his surgical lecture he usually sat. He was particularly happy in a kind of cosiness, or friendliness of manner, which seemed to identify him with his audience, as if we were about to investigate something interesting together, and not as though we were going to be 'lectured at,' at all. His voice seldom rose above what we term the conversational, and was always pleasing in quality, and enlivened by a sort of archness of expression." He always kept his eye on the audience, except slightly turning to one side to explain a diagram or subject, "turning his back on no man." "He had no offensive habits. We have known lecturers who never began without making faces;" we might add, "and with many a hem and haw, or nose-blowing." "Not long ago we heard a very sensible lecturer, and a very estimable man, produce a most ludicrous effect by the above. He had been stating very clearly some important facts, and he then observed,-- "'The great importance of these I will now proceed to show--' when he immediately began to apply his pocket-handkerchief most vigorously to his nose, still facing his audience." The ludicrousness of this "illustration" may well be imagined. Of course the students lost their gravity, and laughed and cheered vigorously. Going in to hear Dr. Holmes lecture, at one o'clock one afternoon, recently, the writer was both shocked and astonished, on the occasion of the professor slipping in a pleasing innuendo, by hearing the students cheer with their hands, and stamp with their thick boots on the seats. I shall have occasion to refer to this splendid man, the pleasing lecturer, the skilful operator, the able author, the ripe scholar, the pride of Harvard and the state,--Dr. O. W. Holmes,--in another chapter. THE HOMELESS STUDENT. (Scene from the EARLY LIFE OF A BOSTON PHYSICIAN. By permission.) Standing on the steps of the Astor House, New York, one cheerless forenoon in early June, with my carpet-bag in one hand and my fresh medical diploma in the other, with a heavy weight of sorrow at my heart, and only sixteen cents in my pocket, I presented, to myself at least, a picture of such utter despair as words are inadequate to express.[4] My home--no; I had none--the home, rather, of my kind old father-in-law, where dwelt, for the time being, my wife and child, was many hundred miles away. And how was I to reach it? I could not walk that distance, and sixteen cents would not carry me there. I looked up Broadway, and I looked down towards the Battery. I was alone amid an immense sea of humans, which ebbed and flowed continually past me. O, how wistfully I looked to see if there might be one face amongst the throng which I might recognize! but there was none. Strange, passing strange, not one of that host did I ever gaze upon before! Where--how--should I raise the money necessary to take me from this land of strangers? "Pinny, sir? Just one pinny. Me father is broken up, and me mither is sick at home. For God's sake give me jist one pinny to buy me some bread." I turned my gaze upon the picture of squalor and wretchedness just by my side. I need not describe her; she was just like a thousand others in that great Babel. "Here is doubtless a case of distress, but it is not of the heart, like mine. Such poor have no heart. Skin, muscle, head, stomach! heart, none!" "Where is your father, did you say?" I asked, mechanically. "In the Slarter-house; broken up from a fall from a stagin' in Twenty-sixth Street, sir," replied the beggar-girl, still extending her hand for a penny. "What is he doing in a slaughter-house, sis?" I inquired. "The Slarter-house is Bellyvew horse-pittle, sir; that's what we Irish call it, sir. Will ye give me the pinny, sir?" [Illustration: "PINNY, SIR? JUST ONE PINNY."] "O, yes, to be sure. Here are pennies for you. Go!" I knew of a poor Irishman who was brought in there at the hospital a few days before badly "broken up" from a fall on Twenty-sixth Street. His name was John Murphy; they are all named Murphy, or something similar; so it was useless to ask the child her father's name--probably it would have been Murphy. The conversation had the good effect of arousing me from my lethargy to action. I must not stay in this metropolis and starve. I could not remain and beg, like the Irish girl. I went to Professor ----, the dean, and requested him to take back my diploma, and let me have sufficient money to carry me home. He complied--God bless him!--and I took the Sound steamer that afternoon for the land of my nativity. What cared I if I was a second-class passenger; I would in two days see my wife and my child! * * * * * I had reached home, and was in the bosom of my family once more, and amongst my friends, in a Christian land; for which I "thanked God, and took courage." "Then pledged me the wine-cup, and fondly I swore Ne'er from my home and my weeping friends to part; My children kissed me a thousand times o'er; My wife sobbed aloud in her fullness of heart." I had a "call" to practise in a country town twenty-five miles from E----, where my family was to remain a few days till I had secured a house to cover their heads amongst the good friends who were to become my future patrons, as a few of them had been previous to my going to college. The stage, a one-horse affair, called for my trunk, medicine-case, etc., and, having no money with which to pay my fare, I told the driver that "I would walk along," while he picked up another passenger in an opposite direction, "and if he overtook me on the road before I got a ride with some one going to S----, he could take me in." I walked bravely along a mile or more, and, hearing the stage coming, I stepped from the road-side, secreting myself beneath a friendly tree till he drove past. Issuing from my hiding-place, I trudged along till noon. My darling little wife had taken the precaution to place in my oversack pocket some doughnuts and cheese, and, when I had reached a clear, running brook, I sat myself down upon a log, under the shade of the woods, and partook of my very frugal meal, quenching my thirst from the waters of the brook, which, like Diogenes, I raised in the hollow of my hand. Thus refreshed, I picked up my overcoat, and again walked along. Before dark I reached S----, pretty tired and foot-sore from such a long walk. [Illustration: THE PENNILESS PHYSICIAN.] The people, who were expecting me, were much surprised at my non-arrival in the mail; but the unsophisticated driver assured them I had probably secured a ride ahead of him, and I would put in an appearance before nightfall. About midnight the door-bell rang,--I stopped at the hotel that night,--and a young gentleman asked for Dr. C. I answered the call at once, which was to the daughter of one of the most influential citizens of the place. The young man who called me was her intended. They had been to a party, and she had partaken freely of oysters, milk, and pickles. Never did fifteen grains of ipecac prove a greater friend to me than it did on that occasion; and in an hour I was back to bed again. The news of the new doctor's arrival, fresh from a New York college, and his first "remarkable cure of the post-master's daughter" that same night, spread like wildfire, and my reputation was nearly established. [Illustration] XI. GHOSTS AND WITCHES. "Save and defend us from our _ghostly_ enemies."--COMMON PRAYER. FOLLY OF BELIEF IN GHOSTS.--WHY GHOSTS ARE ALWAYS WHITE.--A TRUE STORY.--THE GHOST OF THE CAMP.--A GHOSTLY SENTRY-BOX.--A MYSTERY.--THE NAGLES FAMILY.--RAISING THE DEAD.--A LIVELY STAMPEDE.--HOLY WATER.--CÆSAR'S GHOST AT PHILIPPI.--LORD BYRON AND DR. JOHNSON.--GHOST OF A GUILTY CONSCIENCE.--"JOCKEYING A GHOST."--THE WOUNDED BIRD.--A BISHOP SEES A GHOST.--MUSICAL GHOSTS.--A HAUNTED HOUSE.--ABOUT WITCHES.--"WITCHES IN THE CREAM."--HORSE-SHOES.--WOMAN OF ENDOR NOT A WITCH.--WEIGHING FLESH AGAINST THE BIBLE.--THERE ARE NO GHOSTS, OR WITCHES. Is it not quite time--I appeal to the sensible reader--that such folly was expunged from our literature? What is a ghost? Who ever saw, heard, felt, tasted, or smelled one? Must a person possess some miraculous quality of perception beyond the five senses commonly allotted to man in order to become cognizant of a ghostly presence? [Illustration: BELIEVERS IN GHOSTS.] What stupid folly is ghost belief! Yet there are very many individuals in this enlightened day and generation, who, from perverted spirituality, or great credulousness, will accept a ghost story, or a "spiritual revelation," without wincing. It would seem that many great men of the past, as Calvin, Bacon, Milton, Dante, Lords Byron and Nelson, Sir Walter Scott, Wordsworth, and others, believed in the existence of ghosts and spirits on this mundane sphere. There are but two classes who believe in ghosts, viz., the ignorant as one class, and persons with large or perverted spirituality--phrenologically speaking--as the other. These are the believers in dreams, in ghosts, in spirits, and fortune-telling. These, too, are the religious (?) fanatics, etc. THE ORIGIN OF THE WORD GHOST is curious. "The first significance of the word, as well as 'spirit,' is breath, or wind." It is of Anglo-Saxon origin, and is from _gust_, the wind. Hence, a _gust_ of _wind_. The Irish word _goath_, wind, comes nearer to the modern English pronunciation, and shows how easily it could have been corrupted to _ghost_. It is easy to imagine the good old Saxon ladies, sitting around the evening fireside, and just as one of them has finished some marvellous story of that superstitious age, they are startled by a sudden blast of wind, sweeping around the gabled cottage, and her listeners exclaim, in suppressed breath,-- "Hark! There's a fearful gust!" The transit from _gust_ to _ghost_ is easily done. The clothes spread upon the bushes without, or pinned to the lines, flapping in the night air, are seen through the shutterless windows, and they become the object of attraction. The _effect_ supersedes the _cause_, and the clothes become the gust, goath, or ghost! The clothes, necessarily, must be white, or they _could not be seen in the night time_! Hence a ghost is always clothed in white. Therefore the wind (gust) is no longer the ghost, but any white object seen moving in the night air. [Illustration: "HARK! THERE'S A FEARFUL GUST!"] "But I am a wandering ghost-- I am an idle breath, That the sweets of the things now lost Are haunting unto death. Pity me out in the cold, Never to rest any more, Because of my share in the purple and gold, Lost from the world's great store. "I whirl through empty space, A hapless, hurried ghost; For me there is no place-- I'm weary, wandering, lost. Safe from the night and cold, All else is sheltered--all, From the sheep at rest in the fold, To the black wasp on the wall." Moffat says that a tribe of Caffres formerly employed the word _Morino_ to designate the Supreme Being; but as they sank into savagery, losing the idea of God, it came to mean only a fabulous ghost, of which they had great terror. Having briefly shown the folly of the existence of the word in our vocabulary, I will proceed to explode a few of the best authenticated--so called--"ghost stories;" and if I leave anything unexplained in ghostology, let the reader attribute it to either my want of space in which to write so much, or the neglect of my early education in the _dead languages_. THE GHOST OF THE CAMP. I obtained the following story from one of the sentries:-- At Portsmouth, R. I., there was a camp established during the late war, 186-. There was a graveyard in one corner of the enclosed grounds, where several soldier-boys had been buried from the hospital, and here a guard was nightly stationed. Of course there were many stories told around the campfires, of ghosts and spirits that flitted about the mounds at the dead hours of the night, circulated particularly to frighten those stationed at that point on picket duty. The body of a soldier had recently been exhumed and placed in a new and more respectable coffin than the pine box coffin furnished by Uncle Sam, in which he had been buried, and the old one was left on the ground. Partly to protect himself from the inclemency of the weather, and quite as much to show his utter disregard of all ghostly visitors, my informant secured the old pine coffin, "washed it out, though it was impossible to remove all the stains," and, driving a stake firmly into the ground, he stood the coffin on one end, and, removing the lid, used to stand therein on rainy nights. "When it did not rain, I turned it down, and my companion and myself used to sit on the bottom. "One day a soldier-boy had died in the hospital, and his friends came to take the body home for Christian burial. It was necessary to remove him in a sheet to the place where they had an elegant casket, bought by his wealthy friends, to receive the remains. "That very night I was on duty with my friend Charley S., when, near midnight, seated upon the empty coffin, with my gun resting against the side, and my head resting in the palms of my hands, I fell into a drowse. [Illustration: A GRAVE SENTRY.] "Waking up suddenly, I saw something white through the darkness before me; for it was a fearfully dark night, I assure you. I rubbed my sleepy eyes to make sure of my sight, and took another look. I discerned a form, higher than a man, moving about over the mounds but a few yards distant. It had wide side-wings, but they did not seem to assist in the motion of the body part, which did not reach to the ground. I thought I must be asleep, and actually pinched my legs to awake myself before I took a final look at his ghostship. There he stood, stock still. I listened for my companion, without removing my eyes from the white object before me. Still I was not scared, but meant to see it out. I knew I could not see a man far through that impenetrable darkness, for there were no stars nor moon to reveal him. I would not call for help, for if it was a farce to scare me, I should become the laughing-stock of the whole camp. [Illustration: A GHOST IN CAMP.] "Just then I heard the grass crackle, and I knew Charley was approaching in the rear. Still there hung the apparition. I arose from the coffin, my eyes fixed on the object before me, picked up my musket, took deliberate aim at the centre of the thing, and just as I cocked my rifle, I heard Charley set back the hammer of his 'death-dealer.' He, too, had discovered the very remarkable appearance, whatever it was; and now the guns of two 'unfailing shots' covered the object. In another second it had suddenly disappeared! I then spoke, and we ran forward, but found nothing! Where had it gone so very suddenly? It had vanished without sight or sound. We gave up the search; but still I did not believe we had seen anything supernatural. "There was no little discussion in camp on the following day on the subject. Charley said but little. I could not explain the remarkable phenomenon, and a splendid ghost story was about established, in spite of me, before the mystery became unravelled. "A tall fellow, who worked about the hospital, and who assisted in taking away the corpse, was returning with the sheet, when he thought he would give the sentry a scare from his coffin by throwing the sheet over his head and stretching out his arms like wings. His clothes being black, his legs did not show; hence the appearance of a white object floating in the air. Hearing the guns cocked, he instantly jerked the sheet from his head; winding it up, he turned and ran away. This accounted for it becoming so instantaneously invisible. "'Yes,' said the sentry, 'and in a second more you would have been made a ghost!'" RAISING THE DEAD. _The Nagles Family._--The following remarkable and ridiculous affair transpired in a village where the writer once resided. The Nagleses were Irish. The family consisted of old Nagles, his wife,--who did washing for my mother,--John Tom and Tom John, besides Mary. The reason of having the boys named as above was, that in case either died, the sainted names would still be in the family. This was old Mrs. Nagles' explanation of the matter. The old man worked about the wharves, wheeled wood and carried coal, and did such like jobs during summer, and chopped wood in the winter. I well remember of hearing stories of his greenness when he first came to town. He was early employed to wheel wood on board a coaster lying at the dock. The captain told him to wheel a load down the plank, cry "Under!" to the men in the hold, and tip down the barrow of wood. All went well till old Nagles got to the stopping-place, over the hold, when he dumped down the load, and cried out, "Stand ferninst, there, down cellar!" to the imminent peril of breaking the heads of the wood-stevedores below. [Illustration: OLD NAGLES.] I well remember also the first appearance of the two boys at the village school one winter. "What is your name?" inquired the master of the eldest. "Me name, is it? John Tom Nagles, sir, is me name, and who comes after is the same." He always was called by us boys "John Tom Nagles, sir," thenceforward. He certainly was the rawest specimen I ever met. One day the old man was wheeling wood on board a vessel. It was at low water, and there was a distance of sixteen feet from the plank to the bottom of the vessel's hold. The poor old fellow, by some mishap or neglect, let go the barrow, when he called, "Stand ferninst, there, below!" when wood, barrow, and old Mr. Nagles, all went down together. By the fall he broke his neck. I never shall forget the awful lamentation set up by the combined voices of the poor old woman, John Tom, Tom John, and Mary, as they followed the corpse, borne on a wagon, past our house, on the way from the vessel to the Nagles' residence. [Illustration: THE NAGLES BOYS.] On the following day great preparations were made to "wake" the old gentleman according to the most approved fashion in the old country. There were many Irish living--_staying_, at least--in that town, and large quantities of pipes, tobacco, and whiskey were bought up, and the whole town knew that a "powerful time" was anticipated by the Irish who were invited to old Nagles' wake. It was an unusual occurrence, and several boys and young men of the village went to the locality of the Nagles' house to get a look upon the scene when it got under full pressure. I certainly should have been there had not my parents forbidden me to go, and I regret the inability to give my personal testimony to the truth of the statement of what followed, as I do to what preceded, as related above. [Illustration: CHIEF MOURNERS.] "When the wake was at its height, the room full of tobacco smoke, and the jovial mourners full of Irish whiskey,--strychnine and fusel oil,--there was an alarm of fire in the neighborhood. There was a grand rush from the room, as well as from the windows where stood the listeners, and only one old and drunken woman remained to watch the corpse. The door was left open, and some of the young men outside, thinking it a good opportunity to play a joke on the drunken party, ran into the room, and, seeing only the old woman, who was too drunk to offer any objections, they removed the body from the board, depositing it behind the boxes on which the board was laid, and one of their number took the place of the corpse, barely having time to draw the sheet over his face, when the 'wakers' returned. "The candles burned dimly through the hazy atmosphere of the old room, and no one noticed the change. The pipes were relighted, the whiskey freely passed, and finally one fellow proposed to offer the corpse a lighted pipe and a glass of whiskey, 'for company's sake, through purgatory.' "Suiting the action to the word, he approached, attempted to raise the head of the 'lively corpse,' and thrust the nasty pipe between his teeth. "The young man 'playing corpse' was no smoker, and in infinite disgust he motioned the fellow away, who, too drunk to notice it, stuck the pipe in his face, saying, 'Here, ould man, take a shmoke for your ghost's sake.' "'Bah! Git away wid the div'lish nasty thing,' exclaimed the young man, rising and sitting up in the coffin. "There was an instantaneous stampede from the room of every waker who was capable of rising to his legs, followed by the fellow in the sheet, who, dropping the ghostly covering at the door, mingled with the rabble, and was not recognized. The priest and the doctor were speedily summoned. The former arrived, heard, outside the house, the wonderful story, and then proceeded to lay the spirit by sprinkling holy water on the door-stone, thence into the room. By this time the smoke had sufficiently subsided to allow a view of the room, when the stiff, frigid body of old Nagles was discovered on the floor, where 'it had fallen,' as they supposed, 'in attempting to walk.' Of course the doctor ridiculed the idea of a stark, cold body rising and speaking; but the Irish, to this day, believe old Nagles, for that once, refused a pipe and a glass of whiskey. The few young men dared not divulge the secret, and it never leaked out till the entire family of Nagles had gone to parts unknown." [Illustration: A CORPSE THAT WOULD NOT SMOKE.] * * * * * I find a great many ghost stories in books, which are not explained; but since the writer knows nothing of their authenticity, nor the persons with whom they were connected, they are unworthy of notice here. THE GHOST OF CÆSAR AT PHILIPPI. Dr. Robert Macnish, of Glasgow, in his "Philosophy of Sleep," says, "No doubt the apparition of Cæsar which appeared to Brutus, and declared it would meet him at Philippi, was either a dream or a spectral illusion--probably the latter. Brutus, in all likelihood, had some idea that the great battle which was to decide his fate would be fought at Philippi. Probably it was a good military position, which he had in his mind fixed upon as a fit place to make a final stand; and he had done enough to Cæsar to account for his mind being painfully and constantly engrossed with the image of the assassinated dictator. Hence the verification of this supposed warning; hence the easy explanation of a supposed supernatural event." * * * * * "The ghost of Byron" may help to verify the above. Sir Walter Scott was engaged in his study at Abbotsford, not long after the death of Lord Byron, at about the twilight hour, in reading a sketch of the deceased poet. The room was quiet, his thoughts were intensely centred upon the person of his departed friend, when, as he laid down the volume, as he could see to read no longer, and passed into the hall, he saw before him the _eidolon_ of the deceased poet. He remained for some time impressed by the intensity of the illusion, which had thus created a phantom out of some clothes hanging on a screen at the farther end of the hall. This is not the first time that Byron had appeared to his friends, as the following, from his own pen, will show:-- Byron wrote to his friend, Alexander Murray, less than two years before the death of the latter, as follows:-- "In 1811, my old schoolmate and form-fellow, Robert Peel, the Irish secretary, told me that he saw me in St. James Street. I was then in Turkey. A day or two afterwards, he pointed out to his brother a person across the street, and said, 'There is the man I took for Byron.' His brother answered, 'Why, it is Byron, and no one else.' I was at this time _seen_ (by them?) to write my name in the Palace Book! I was then ill of a malaria fever. If I had died," adds Byron, "here would have been a ghost story established." Dr. Johnson says, "An honest old printer named Edward Cave had seen a ghost at St. John's Gate." Of course, the old man succumbed to the apparition. THE GHOST OF CONSCIENCE. I have yet to find the record of a good man seeing what he believed to be a ghostly manifestation. It is only the guilty in conscience who conjure up "horrible shadows," as pictured in Shakspeare's ghost of Banquo, as it appeared to Macbeth. What deserving scorn, what scathing contempt, were conveyed in the language of Lady Macbeth to her cowardly, conscience-stricken lord, as she thus rebuked him!-- "O, proper stuff! This is the very painting of your fear; This is the air-drawn dagger which you said Led you to Duncan! O, these flaws and starts (Impostors to true fear) would well become A woman's story at a winter's fire,[5] Authorized by her grandam. Shame itself! ... When all's done, You look but on a stool!" There is a great truth embodied in a portion of the king's reply, that-- "If charnel-houses and our graves must send Those that we bury, back, our monuments Shall be the maws of kites." The gay and dissipated Thomas Lyttleton, son of Lord George Lyttleton, and his successor in the peerage, has been the subject of "a well-authenticated ghost story, which relates that he was warned of his death three days before it happened, in 1779, while he was in a state of perfect health, and only thirty-five years of age." This is what says a biographer. Now let us present the truth of the matter. He was a dissipated man. He was subject to fits. A gentleman present at the time of his seeing a vision, says "that he had been attacked several times by suffocative fits the month before." Here, then, was a _body diseased_. The same authority says, "It happened that he dreamed, three days before his death, that he saw a _fluttering bird_; and afterwards, that he saw (dreamed) a woman in white apparel, who said to him, 'Prepare to die; you will not exist three days.' [Illustration: PREPARE TO DIE!] "His lordship was much alarmed, and called his servant, who slept in an adjoining closet, who found his master in a state of great agitation, and in a profuse perspiration." Fear blanches the cheek; perspiration is rather a symptom of bodily weakness, and the result of a laborious dream, or even a fit. He had no fear, for, on the third day, while his lordship was at breakfast with "the two Misses Amphlett, Lord Fortescue," and the narrator, he said, lightly,-- "'If I live over to-night, _I shall have jockeyed the ghost_, for this is the third day.' That day he had another fit. He dined at five, and retired at eleven, when his servant was about to give him some prescribed rhubarb and mint-water, but his lordship, seeing him about to stir the mixture with a toothpick, exclaimed,-- "'You slovenly dog, go and fetch a teaspoon.' "On the servant's return, he found his master in another fit, and, the pillow being high, his chin bore on his windpipe, when the servant, instead of relieving his lordship from his perilous position, ran away for help; but on his return, found his master dead." He had strangled. Is it anything strange that a dissipated, weakened man should die after having a score of suffocative fits? It had been more surprising if he had survived them. Then, as respecting the dream, it was the result of a "mind diseased." There was evidence that his lordship had seduced the Misses Amphlett, and prevailed upon them to leave their mother; and he is said to have admitted, before his death, that the woman seen in his dream was the mother of the unfortunate girls, and that she died of grief, through the disgrace and desertion of her children, about the time that the guilty seducer saw her in the vision. How could his dreams but have been disturbed, with the load of guilt and remorse that he ought to have had resting upon his conscience? The "fluttering bird" was the first form that the wretched mother assumed in his vision, as a bird might flutter about the prison bars that confined her darling offspring. The more natural form of the mother finally appeared to the guilty seducer, and to dream that he heard a voice is no unusual occurrence in the life of any person. The peculiar words amount to nothing. Lyttleton gave them no serious thoughts, and it was an accident of bodily position that caused his sudden death. The whole thing seems to be too flimsy for even a respectable "ghost story." THE BISHOP SEES A GHOST! An amusing as well as instructive ghost story is related by Horace Walpole, the indolent, luxurious satirist of fashionable and political contemporaries, whose twenty thousand a year enabled him to live at his ease, "coquetting haughtily with literature and literary men, at his tasty Gothic toy-house at Strawberry Hill." [Illustration: THE BISHOP'S GHOSTLY VISITOR.] He relates that the good old Bishop of Chichester was awakened in his palace at an early hour in the morning by his chamber door opening, when a female figure, clothed in white, softly entered the apartment, and quietly took a seat near him. The prelate, who, with "his household, was a disbeliever in ghosts" and spirits, said he was not at all frightened, but, rising in his bed, said, in a tone of authority,-- "Who are you?" "The presence in the room" made no reply. The bishop repeated the question,-- "Who are you?" The ghost only heaved a deep sigh, and, while the bishop rang the bell, to call his slumbering servant, her ghostship quietly drew some old "papers from its ghost of a pocket," and commenced reading them to herself. After the bishop had kept on ringing for the stupid servant, the form arose, thrust the papers out of sight, and left as noiselessly and sedately as she had arrived. "Well, what have you seen?" asked the bishop, when the servants were aroused. "Seen, my lord?" "Ay, seen! or who--what was the woman who has been here?" "Woman, my lord?" (It is said one of the fellows smiled, that a woman should have been in the aged bishop's bed-chamber in the night.) When the bishop had related what he had seen, the domestics apprehended that his lordship had been dreaming, against which the good man protested, and only told what his eyes had beheld. The story that the bishop had been visited by a ghost soon got well circulated, which greatly "diverted the ungodly, at the good prelate's expense, till finally it reached the ears of the keeper of a mad-house in the diocese, who came and deposed that a female lunatic had escaped from his custody on that night" (in light apparel), who, finding the gates and doors of the palace open, had marched directly to his lordship's chamber. The deponent further stated that the lunatic was _always reading a bundle of papers_. "There are known," says Walpole, "stories of ghosts, solemnly authenticated, less credible; and I hope you will believe this, attested by the father of our own church." MUSICAL GHOSTS. We occasionally _hear_ of this kind, but seldom, if ever, _see_ them. An old lady of Adams, Mass., came to the writer in a state bordering on monomania. She stated that at about _three o'clock_ in the night she would awake and distinctly hear bells ringing at a distance. She would awake her husband, and often compel him to arise and listen "till the poor man was almost out of patience with the annoyance;" not of the bells, for he heard none, but of being continually "wakened because of her whim," as he stated. A brief medical treatment for the disease which caused the vibration of the tympanum dispelled the illusion of bells. THE PIANO-FORTE GHOST. A family residing, three years since, but a few miles out of Boston, used to occasionally, during summer only, hear a note or two of the piano strike at the dead hour of the night. A Catholic servant girl and an excellent cook left their situations in consequence of the ghostly music. In vain the family removed the instrument to another position in the room. The musical sounds would startle them from their midnight slumbers. One thing very remarkable occurred after changing the piano: the sound, which only transpired occasionally, with no regularity as to time, would always begin with the high notes, and end with the lower. Finally, the family--I cannot say why--removed to the city, and the house was sold. The deed of conveyance did not include the ghost, but he remained with the premises, nevertheless. The writer has seen him! "O, what a pretty cat!" exclaimed a child of the new occupant of the haunted house, on discovering the domestic animal which the late possessor had left. "Yes; and she looks so very domestic and knowing, she may stay, if no one comes for her, and you'll have her for a playfellow," replied the mother. A few nights after their settlement, the new family were startled by hearing the piano sound! No particular tune, but it was surely the piano notes that had been distinctly and repeatedly heard. A search revealed nothing. The piano was kept closed thereafter, and no further annoyance occurred, until one night when the company had lingered till nearly midnight, and the instrument had been left open, the sound again occurred. The gentleman quickly lighted a lamp, ran down stairs, and closing the door leading to the connecting room, he found the cat secreted beneath the piano. The instrument was purposely left open the following night, and a watch set, when, no sooner was all quiet, than the cat entered, and leaped upon the piano keys. After touching them a few times with her fore paws, she jumped down, and hid beneath the instrument. "The cat was out." Only one thing remained for explanation, viz., why the change of sound occurred after removing the piano by the first occupants of the house. It occurred in summer. They removed the piano so that the cat, entering a side window, usually left a little raised, had necessarily jumped upon the high keys. If anybody has got a good ghost, spirit, or witch about his premises, the writer would like to investigate it. The following silly item is just going the rounds of the press:-- "A HAUNTED HOUSE. "The first floor of Mrs. Roundy's house, at Lynn, in which the recent murder occurred, is occupied by an apparently intelligent family bearing the name of Conway, who assert that they have heard supernatural noises every night since the tragedy; and they are so sincere in their belief that they are preparing to vacate in favor of their 'uncanny' visitors." There's nothing to it to investigate. A FEW WORDS ABOUT WITCHES. My colored boy, Dennis, assures me that an old woman in Norfolk, Va., having some spite against him, "did something to him that sort o' bewitched him; got some animal into him, like." The symptoms are those of _ascarides_, but I could not persuade him to take medicine therefor. "'Tain't no use, sir," he replied, solemnly; "I knowed she done it; I feels it kinder workin' in yer (placing his hand on his stomach); what med'cine neber'll reach." Neither reason nor ridicule will "budge" him. He knows he's bewitched! [Illustration: THE MUSICAL PUSS.] [Illustration: A DARKEY BEWITCHED.] WITCHES IN THE CREAM. Through all the long, long winter's day, And half the dreary night, We churned, and yet no butter came: The cream looked thin and white. Next morning, with our hopes renewed, The task began again; We churned, and churned, till back and arms And head did ache with pain. The cream rose up, then sulking fell, Grew thick, and then grew thin; It splashed and spattered in our eyes, On clothes, and nose, and chin. We churned it fast, and churned it slow, And stirred it round and round; Yet all the livelong, weary day, Was heard the dasher's sound. The sun sank in the gloomy west, The moon rose ghastly pale; And still we churned, with courage low, And hopes about to fail,-- When in walked Granny Dean, who heard, With wonder and amaze, Our troubles, as she crossed herself, And in the fire did gaze. "Lord, help us all!" she quickly said, And covered up her face; "Lord, help us all! for, as you live, There's witches in the place! "There's witches here within this churn, That have possessed the cream. Go, bring the horse-shoe that I saw Hang on the cellar-beam." The shoe was brought, when, round and round, She twirled it o'er her head; "Go, drive the witches from that cream!" In solemn voice she said;-- Then tossed it in the fire, till red With heat it soon did turn, And dropped among the witches dread, That hid within the churn. Once more the dasher's sound was heard,-- Have patience with my rhyme,-- For, sure enough, the butter came In twenty minutes' time. Some say the temperature was changed With horse-shoe glowing red; But when we ask old Granny Dean, She only shakes her head.--_Hearth and Home._ HORSE-SHOES. One would suppose the folly of putting horse-shoes into cream, "fish-skins into coffee, to settle it," and forcing filthy molasses and water down the throats of new-born babes, were amongst the follies of the past; but they are not yet, with many other superstitious, and even cruel and dangerous notions, done away with. For some prominent instances of this course of proceedings the reader may consult next chapter. Riding through the rural districts of almost any portion of the Union, one will sometimes find the horse-shoe nailed over the stable, porch, or even house front door, to keep away the witches. As in Gay's fable of "The Old Woman and her Cats:"-- "Straws laid across my path retard, The horse-shoes nailed each threshold guard," In Aubrey's time, he tells us that "most houses of the west end of London have the horse-shoe at the threshold." The nice little old gentleman who keeps the depot at Boylston Station is a dry joker, in his way. Over each door of the station he has an old horse-shoe nailed. "What have you got these nailed up over the door for?" a stranger asks. [Illustration: BOYLSTON STATION.] "To keep away witches. I sleep here nights," solemnly replies the station-master; and one must be familiar with that ever agreeable face to detect the sly, enjoyable humor with which he is so often led to repeat this assertion. In numerous towns within more than half of the states,--I state from personal inquiry,--there are at this day old women, who children, at least, are taught to believe have the power of bewitching! My first fright, when a little boy on my way to school, was from being told that an old woman, whose house we were passing, was a witch. These modern witches may not have arrived at the dignity of floating through the air on a broomstick, or crossing the water in a cockle-shell, as they were said to in ancient times; but the belief in their existence at this enlightened period of the world is more disgraceful than in the darker ages, and the frightening of children and the naturally superstitious is far more reprehensible. There is no such thing as a ghost. There are no witches. "The Bible teaches that there were witches," has often been wrongly asserted. That "choice young man and goodly," whose abilities his doting parent over-estimated when he sent him out _in search of the three stray asses_, and whose idleness prompted him to consult the seer Samuel, and by whose indolence and procrastination the asses got home first, was a very suitable personage to consult a "_woman of a familiar spirit_" (or any other woman, save his own wife), from which arose the great modern misnomer of the "_Witch of Endor_." "To the Jewish writers, trained to seek counsel only of Jehovah (not even from Christ), the 'Woman of Endor' was a dealer with spirits of evil. With us, who have imbibed truth through a thousand channels made turbid by prejudice and error, she is become a distorted being, allied to the hags of a wild and fatal delusion. We confound her with the (fabled) witches of Macbeth, the victims of Salem, and the modern Moll Pitchers. "The Woman of Endor! That is a strange perversion of taste that would represent her in hideous aspect. To me she seemeth all that is genial and lovely in womanhood." "Hearken thou unto the voice of thine handmaid, and let me set a morsel of bread before thee, and eat, that thou mayest have strength when thou goest on thy way." Then she made and baked the bread, killed and cooked the meat,--all she had in the house,--and Saul did eat, and his servants. I see nought in this but an exhibition of rare domestic ability and commendable hospitality; in the previous act (revelation), nothing more than a manifestation of the power of mind over mind (possibly the power of God, manifested through her mind?), wherein she divined the object of Saul's visit, and, through the same channel, surmised who he was that consulted her. [Illustration: WEIGHING A WITCH BY BIBLE STANDARD.] Witches are said to be "light weight." But a little above a hundred years ago, a woman was accused in Wingrove, England, by another, of "bewitching her spinning-wheel, so it would turn _neither the one way nor the other_." To this she took oath, and the magistrate, with pomp and dignity, "followed by a great concourse of people, took the woman to the parish church, her husband also being present, and having stripped the accused to her nether garment, put her into the great scales brought for that purpose, with the Bible in the opposite balance, which was the lawful test of a witch, when, to the no small astonishment and mortification of her maligner, she actually outweighed the book, and was honorably acquitted of the charge!" Just imagine the picture. In an enlightened age, a Christian people, in possession of the Bible, that gives no intimation of such things as witches, stripping and weighing a female in public, to ascertain if she really was heavier than a common Bible! [Illustration] XII. MEDICAL SUPERSTITIONS. "When cats run home, and light is come, And dew is cold upon the ground, And the far-off stream is dumb, And the whirling sail goes round, And the whirling sail goes round; Alone and warming his five wits The white owl in the belfry sits."--TENNYSON. OLD AND NEW.--THE SIGN OF JUPITER.--MODERN IDOLATRY.--ORIGIN OF THE DAYS OF THE WEEK.--HOW WE PERPETUATE IDOLATRY.--SINGULAR FACT.--CHRISTMAS FESTIVITIES.--"OLD NICK."--RIDICULOUS SUPERSTITIONS.--GOLDEN HERB.--HOUSE CRICKETS.--A STOOL WALKS!--THE BOWING IMAGES AT RHODE ISLAND.--HOUSE SPIDERS.--THE HOUSE CAT.--SUPERSTITIOUS IDOLATRIES.--WONDERFUL KNOWLEDGE.--NAUGHTY BOYS.--ERRORS RESPECTING CATS.--SANITARY QUALITIES.--OWLS.--A SCARED BOY.--HOLY WATER.--UNLUCKY DAYS.--THUNDER AND LIGHTNING.--A KISS. Medicine, above all the other sciences, was founded upon superstition. Medicine, more than all the other arts, has been practised by superstitions. Stretching far back through the vista of time to the remotest antiquity, reaching forward into the more enlightened present, it has partaken of all that was superstitious in barbarism, in heathenism, in mythology, and in religion. In showing the Alpha I am compelled to reveal the Omega. Let us begin with Jupiter. I know that some wise Æsculapian--no Jupiterite--will turn up his nose at this page, while to-morrow, if he gets a patient, he will demonstrate what I am saying, and further, help to perpetuate the ignorant absurdities which originated with the old mythologists, by placing "[R]"--the ill-drawn sign of Jupiter--before his recipe. [Illustration: THE GOD OF RECIPES.] De Paris tells us that the physician of the present day continues to prefix to his prescriptions the letter "[R]," which is generally supposed to mean "recipe," but which is, in truth, a relic of the astrological symbol of Jupiter, formerly used as a species of superstitious invocation, or to propitiate the king of the gods that the compound might act favorably. There are still in use many other things which present _prima facie_ evidence of having been introduced when the users placed more faith in mythological or planetary influence than in any innate virtue of the article itself. For instance, at a very early period all diseases were regarded as the effects of certain planetary actions; and not only diseases, but our lives, fortunes, conduct, and the various qualities that constitute one's character, were the consequences of certain planetary control under which we existed. Are there not many who now believe this? "In ancient medicine pharmacy was at one period only the application of the dreams of astrology to the vegetable world. The herb which put an ague or madness to flight did so by reason of a mystic power imparted to it by a particular constellation, the outward signs of which quality were to be found in its color or shape." Red objects had a mysterious influence on inflammatory diseases, and yellow ones on persons discolored by jaundice. Corals were introduced as a medicine, also to wear about the neck on the same principle. These notions are not yet obsolete. Certain diseases are still attributed to the action of the moon. Certain yellow herbs are used for the jaundice and other diseases. The _hepatica triloba_ (three-lobed) is recommended for diseases of the lungs as well as liver (as its first name, _hepatica_, indicates), and some other medicines for other complaints, without the least regard to their innate qualities. Corals are still worn for nose-bleed, red articles kept about the bed and apartments of the small-pox patient, and the red flag hung out at the door of the house, though few may know why a _red_ flag is so hung, or that it originated in superstition. The announcement of an approaching comet strikes terror to the hearts of thousands; the invalid has the sash raised that he may avoid first seeing the new moon through the glass, and the traveller is rejoiced to catch his first glimpse of the young queen of the night over his right shoulder, "for there is misfortune in seeing it over the left." But we are not yet done with ancient symbols. "The stick came down from heaven," says the Egyptian proverb. "The physician's cane is a very ancient part of his insignia. It has nearly gone into disuse; but until very recently no doctor of medicine would have presumed to pay a visit, or even be seen in public, without this mystic wand. Long as a footman's stick, smooth, and varnished, with a heavy gold head, or a cross-bar, it was an instrument with which, down to the present century, every prudent aspirant to medical practice was provided. The celebrated gold-headed cane which Radcliffe, Mead, Askew, Pitcairn, and Baillie successively bore, is preserved in the College of Physicians, London. It has a cross-bar, almost like a crook, in place of a knob. The knob in olden times was hollow, and contained a vinaigrette, which the man of science held to his nose when he approached a sick person, so that its fumes might protect him from the disease." The cane, doubtless, came from the wand or caduceus of Mercurius, and was a "relic of the conjuring paraphernalia with which the healer, in ignorant and superstitious times, always worked upon the imagination of the credulous." The present barber's pole originated with surgeons. The red stripe represented the arterial blood; the blue, the venous blood; the white, the bandages. The superstitious ancients showed more wisdom in their selections of names, as well as in emblems, than we do in retaining them. Heathen worship and mythological signs are mixed and interwoven with all our arts, sciences, and literature. Our days of the week were named by the old Saxons, who worshipped idols--the sun, moon, stars, earth, etc., and to their god's, perpetual honor gave to each day a name from some principal deity. Thus we are idolaters, daily, though unconsciously. I think not one person in a thousand is aware of this fact; therefore I give a sketch of each. SUNDAY. The name of our first day of the week, Sunday, is derived from the Saxon _Sunna-dæg_, which they named for the sun. It was also called _Sun's-dæg_. [Illustration: SUN--Sunday.] As the glorious sunlight brought day and warmth, and caused vegetation to spring forth in its season, warmed the blood, and made the heart of man to rejoice, they made that dazzling orb the primary object of their worship. When its absence brought night and darkness, and the storm-clouds shrouded its face in gloom, or the occasional eclipse suddenly cut off its shining, which they superstitiously attributed to the wrath of their chief deity, it then became the object of their supplication. With them, and all superstitious people, all passions, themes, and worships must be embodied--must assume form and dimensions, and as they could not gaze upon the dazzling sun, they personified it in the figure of a man--as being superior to woman with them--arrayed in a primitive garment, holding in his hand a flaming wheel. One day was specially devoted to sun worship. The modern Sunday is the day, according to historical accounts of the early Christians, on which Christ rose from the dead. It does not appear to have been the same day as, or to have superseded, the Jewish Sabbath, although the Christians early celebrated the day, devoting it to religious services. With the Christians, labor was suspended on this "first day of the week," and Constantine, about the year 320, established an edict which suspended all labor, except agricultural, and forbade also all court proceedings. In 538 A. D. the third Council of Orleans published a decree forbidding all labor on Sunday. The Sabbath (Hebrew _Shabbath_) of the Jews, meaning a day of rest, originated as far back as Moses--probably farther. It was merely a day of rest, which was commanded by Jehovah; and if considered only on physiological grounds, it evinces the wisdom and economy of God in setting apart one day in seven to be observed by man as a season of rest and recuperation. As such it only seems to have been regarded till after the forty years of exile, when it changed to a day of religious rites and ceremonies, which is continued till the present day by "that peculiar people." That particular day, given in the "law of Moses," corresponds--it is believed by the Jews--to our Saturday. Christ seemed to teach that the Jewish Sabbath was no more sacred than any other day, and he accused the Pharisees with hypocrisy in their too formal observance thereof. He attended their service on the Sabbath, on the seeming principle that he did other meetings, and as he paid the accustomed tax, because it was best to adapt one's self to the laws and customs of the country. We do not purpose to enter into any theological discussion as to which of the two days should be observed for rest and religious observances; for who shall decide? Physiologically considered, it makes no difference. There should be one day set apart for rest in seven at the most, and all men should respect it. Without a Sabbath (day of rest) we should soon relapse into a state of barbarism, and also wear out before our allotted time. "In the hurry and bustle of every-day life and labor, we allow ourselves too little relaxation, too little scope for moral, social, and religious sentiments; therefore it is well to set apart times and seasons when all cares and labors may be laid aside, and communion held with nature and nature's God." And it were better if we all could agree upon one day for our Sabbath; and let us call it "Sabbath," and not help to perpetuate any heathen dogmas and worship by calling God's holy day after the idolatrous customs of the ancient Saxons. MONDAY. The second day of the week the Saxons called _Monandæg_, or Moon's day; hence our Monday. This day was set apart by that idolatrous people for the worship of their second god in power. In their business pursuits, as well as devotional exercises, they devoted themselves to the moon worship. The name _Monandæg_ was written at the top of all communications, and remembrance had to their god in all transactions of the day. Each _monath_ (new moon or month) religious (?) exercises were celebrated. The idol Monandæg had the semblance of a female, crowned or capped with a hood-like covering, surmounted by two horns, while a basque and long robe covered the remainder of her person. In her right hand she held the image of the moon. [Illustration: MOON--Monday.] [Illustration: TUISCO--Tuesday.] TUESDAY. The third object of their worship was Tuisco--corresponding with German _Tuisto_--the son of _Terra_ (earth), the deified founder of the Teutonic race. He seems to have been the deity who presided over combats and litigations; "hence Tuesday is now, as then, court-day, or the day for commencing litigations." In some dialects it was called _Dings-dag_, or Things-day--to plead, attempt, cheapen: hence it is often selected as market-day, as well as a time for opening assizes. Hence the god _Tuisco_ was worshipped in the semblance of a venerable sage, with uncovered head, clothed in skins of fierce animals, touching the earth, while he held in his right hand a sceptre, the appropriate ensign of his authority. Thus originated the name of our third day of the week, and some of its customs. [Illustration: WODEN--Wednesday.] WEDNESDAY. This day was named for _Woden_,--the same as _Odin_,--and was sacred to the divinity of the Northern and Eastern nations. He was the Anglo-Saxons' god of war, "who came to them from the East in a very mysterious manner, and enacted more wonderful and brilliant exploits of prowess and valor than the Greek mythologists ascribed to their powerful god Hercules." As _Odin_, this deity was said to have been a monarch (in the flesh) of ancient Germany, Denmark, Scandinavia, etc., and a mighty conqueror. All those tribes, in going into battle, invoked his aid and blessing upon their arms. He was idolized as a fierce and powerful man, with helmet, shield, a drawn sword, a _gyrdan_ about his loins, and feet and legs protected by sandals and knee-high fastenings of iron, ornamented with a death's head. [Illustration: THOR--Thursday.] [Illustration: FRIGA--Friday.] THURSDAY. From the deity _Thor_ our Thursday is derived. This Saxon god was the son of Woden, or Odin, and his wife Friga. He was the god of thunder, the bravest and most powerful, after his father, of the Danish and Saxon deities. Thor is represented as sitting in majestic grandeur upon a golden throne, his head surmounted by a golden crown, richly ornamented by a circle in front, in which were set twelve brilliant stars. In his right hand he grasped the regal sceptre. FRIDAY. The sixth day of the week was named in honor of _Friga_, or Frigga, the wife of Woden and the mother of Thor. In most ancient times she was the same as Venus, the goddess of Hertha, or Earth. She was the most revered of the female divinities of the Danes and Saxons. Friga is represented draped in a light robe suspended from the shoulder, low neck and bare arms. She held in her right hand a drawn sword, and a long bow in the left. Her hair is long and flowing, while a golden band, adorned by ostrich feathers, encircle her snowy brow. There is nothing in the name or attributes to indicate the ill luck which superstition has attached to the day. [Illustration: SEATER--Saturday.] SATURDAY. The god _Seater_, for whom the last day of the week is named, is the same as Saturn, which is from Greek--_Time_. He is pictured, unlike Saturn, with long, flowing hair and beard, thin features, clothed in person with one entire garment to his ankles and wrists, with his waist girded by a linen scarf. In his right hand he carries a wheel, to represent rolling time. In his left hand he holds a pail of fruit and flowers, to indicate young time as well as old. The fish which is his pedestal represents his power over the abundance of even the sea. CHRISTMAS FESTIVALS. Amongst the very pleasant and harmless customs which have been handed down to us from the idolatrous rites and superstitions of the ancient Saxons, Scandinavians, etc., are those connected with our Christmas festivities. The whole observance and connections form a strange mixture of Christian and heathen ceremonies, illustrative of the unwillingness with which a people abandon pagan rites to the adoption of those more consistent with the spirit of a Christianized and enlightened faith. Now, little folks and big, I am not going to ridicule or deny your right to Christmas and St. Nicholas enjoyments; I will merely hint at their origin, for your own benefit. The day brings more happiness--and folks--to the homes and firesides of the people of the _whole world_ than any other holiday we celebrate.[6] Thanksgiving, you know, is mostly a New England custom. The 25th of December is just as good as any other day on which to have a good time. Ancient people used to celebrate the first and sixth of January. The first three months of the year are named after heathen gods. The _name_ of the day we celebrate is derived from a Christian source: the rest from pagan. A good feeling was always engendered amongst the most ancient people at the commencement of the lengthening of days in winter, and the approach of a new year. The hanging up of the mistletoe, with the ceremony of gathering it, the kindling of the Yule log, and giving of presents, we trace to the Druids, who were the priests, doctors, and judges of the ancient Celts, Gauls, Britons, and Germans. Our modern stoves and furnaces have shut out the pleasant old log fires, and the candles only remain. The gifts originated in the giving away of pieces of the mistletoe by the grizzly old priests. Who St. Nicholas was, is only conjectured, _not known_, any more than who St. Patrick was. It makes no difference where he sprang from; he is a good, jolly, benevolent fellow, who brings lots of presents, and, with the little folks, we are bound to defend him. It is supposed that the original St. Nicholas lived in Lycia, in Asia Minor, during the fourth century, and was early adopted as a saint of the Catholic church, and also by the Russians and ancient Germans, Celts, and others. "He has ever been regarded as a very charitable personage, and as the particular guardian of children. Great stories are told of his charity and benevolence. One of these, and that, perhaps, which attaches him to the peculiar festivities of Christmas, is to the effect that a certain nobleman had three lovely daughters, but was so reduced to poverty that he was unable to give them a marriage portion, as was the indispensable custom, and was about to give them over to a life of shame. St. Nicholas was aware of this, and determined in a secret way to assist the nobleman. "He wended his way towards the nobleman's house, thinking how he could best do this, when he espied an open window, into which he threw a purse of gold, which dropped at the nobleman's feet, and he was enabled to give his daughter a marriage portion. This was repeated upon the second daughter and the third daughter; but the nobleman, being upon the watch, detected his generous benefactor, and thus the affair was made public. From this rose the custom upon St. Nicholas Day, December 6, for parents and friends to secretly put little presents into the stockings of the children. Doubtless this custom, so near the festivities of Christmas, gradually approximated to that day, and become identical with Christmas festivities throughout the world. St. Nicholas is often represented bearing three purses, or golden balls, and these form the pawn-broker's well-known sign, which is traced to this source as its origin--not, we should judge, from their resemblance to the charity of St. Nicholas, but emblematic of his lending in time of need." POPULAR NOTIONS AND WHIMS. There was a superstition in Scotland against spinning or ploughing on Christmas; but the Calvinistic clergy, in contempt for all such superstitions, compelled their wives and daughters to spin, and their tenants to plough, on that day. It is a popular notion to the present time in Devonshire that if the sun shines bright at noon on Christmas day, there will be a plentiful crop of apples the following year. Bees were thought to sing in their hives on Christmas eve, and it was believed that bread baked then would never mould. So prevalent was the idea that all nature unites in celebrating the great event of Christ's birth, that it was a well received opinion in some sections of the old world that the cattle fell on their knees at midnight on Christmas eve. RIDICULOUS SUPERSTITIONS. "Merlin! Merlin! turn again; Leave the oak-branch where it grew. Seek no more the cress to gain, Nor the herb of golden hue." Merlin, the reputed great enchanter, flourished in Britain about the fifth century. He is said to have resided in great pomp at the court of "Good King Arthur." You all know the beautiful rhyme about the latter, if not about "Merlin! Merlin!" etc. "When good King Arthur ruled the land,-- He was a goodly king,-- He stole three pecks of barley-meal To make a bag pudding." Sublime poetry! Easy mode of obtaining the barley-meal (or Scotch territory). Merlin attached many superstitious beliefs to some of our medicinal plants. The "cress" is supposed to be the mistletoe. "The herb of gold"--golden herb--was a rare plant, held in great esteem by the peasant women of Brittany, who affirmed that it shone like gold at a distance. It must be gathered by or before daybreak. The most ridiculous part of the affair was in the searching for the "herb of golden hue." None but devout females, blessed by the priests for the occasion, were permitted the great privilege of gathering it. In order to be successful in the search, the privileged person started before daylight, barefooted, bareheaded, and _en chemise_. (Of course the priest knew the individual, and when she was going.) The root must not be cut or broken, but pulled up entire. If any one trod upon the plant, he or she would fall into a trance, when they could understand the language of fowls and animals--a belief not half as ridiculous as that of the present day, that a person may fall into a trance, and understand the language of the dead; yes, dead and decayed, the organs of speech gone! Yet thousands believe such stuff to-day. _The Mandrake._--Great superstition was formerly attached to this root, and even now is, in some rural districts. The root often resembles the lower half of a human being, and it was credulously believed it would shriek and groan when pulled from its mother earth. This notion is expressed in Romeo and Juliet:-- "Mandrakes, torn out of the earth, That mortals, hearing them, run mad." Again, in Henry VI.:-- "Would curses kill, as doth the bitter mandrake's groans." [Illustration: GATHERING THE MANDRAKE.] A favorite mode of uprooting this coveted plant--because of its defensive properties, when once gained--was to fasten cords to a dog's neck, thence to the base of the stem of the plant, and sealing their own ears with wax to prevent hearing the groans, which was death or madness, they whipped the unfortunate dog till he drew out the roots, or was killed in the attempt; for the dog usually died then or soon after the cruel beating, and the shrieks of the mandrake were supposed to have caused his death. The Scabious, or "Devil's bit," was regarded with great superstition. "The old fantastic charmers," said the quaint Gerarde, "say that the Devil bit away the greater part of this root for envy, because of its many virtues and benefits to mankind." Dr. James Smith (1799) as quaintly observes, "The malice of the Devil has unfortunately been so successful, that no virtue can now be found in the remainder of the root or herb." _House Crickets._--The superstition respecting these cheerful and harmless little _chirpers_ is remarkable. Some consider their presence a lucky sign, others their absence more fortunate. To kill one, with some persons, is a sign of death in the house. Very strange! They, blind fools, do not see that the saying originated in the death of the poor little cricket. The following very remarkable occurrence was related to the writer, as having actually taken place at Providence, R. I., a few years since. Mrs. D., a respectable lady, residing in the city, was reported to have been followed about the house and up stairs by a "cricket,"--a wooden one, used for a foot-stool. People called at her residence to inquire into the truth of the matter; others even requested to see the remarkable phenomenon of a cricket or stool walking off on all fours, until the lady became so annoyed by the continual stream of credulous callers, that she inserted a notice in the city journals denying the truth of the strange rumor. It was supposed to have started from some neighbor's seeing or hearing a house cricket when on a visit at the lady's house. _The Bowing Images._--A still more amusing story is related respecting the two images surmounting the wall each side of the gate at the residence of Professor Gammel, of Providence. A report became current among the school-boys of the city, that when the images _heard_ the clock strike nine in the forenoon they bowed their heads. My informant said it was no unusual thing to see a dozen boys waiting, with books and slates, in front of the professor's gate, to see the images bow at nine. Being late at school, the teacher would inquire,-- "Where have you been lingering, that you are behind time at school?" [Illustration: "WAITING TO SEE THE IMAGES BOW".] "Been down to Professor Gammel's, waitin' to see the images bow." Then the teacher drew his ferule or rod, and made them "bow" in submission to a smart whipping--a sequel anticipated by the older scholars who instituted the story. _House Spiders._--Was there ever a child who was not taught, directly or indirectly, that house spiders were poisonous,--that their bite was instantaneous death? Was there ever a greater mistake? Many people have a superstitious terror of these harmless creatures. The bite of spiders is only poisonous to those insects which the divine economy seems to have created for them to destroy. It is possible, as by a fly, sometimes for a slight skin inflammation, less than a mosquito's bite, to follow the sting of a spider on a very small child. Let me hereby disabuse the public mind of the repugnance or horror with which these little creatures are regarded. The Creator has evidently placed them here for the destruction of flies and other insects, which otherwise would completely overrun us. The fly is such a domestic creature, that he soon deserts a house where the family is long absent. The spider then removes also. (I have watched this proceeding, with no little interest, in the absence of my own family.) Therefore the spider was created to suppress a superabundance of insect life. When I have before stated this fact, the listener has been led to inquire why the flies were then made. We will not answer the suggestion of this "riddle" as the Irishman did (you know that he said, "To feed the spiders, to be sure"), but reply, that if this question is to arise in this connection, we may as well keep on our inquiry till we arrive at the greater riddle, "Why are _we_ created?"--to which we have no space for reply. It is said that manufacturers of quill pens in London, being greatly annoyed by a species of moth which infests their quills and devours the feathers, and the common spider being endowed with an inordinate appetite for those same moths, the penmakers and spiders are on the best of terms, and an army of these much-maligned and persecuted insects encamp in each pen factory, and do good service to the cause of literature as well as trade, by protecting the quills. We may yet find that even mosquitos and bedbugs have their uses in the wise economy of nature. Now, when tidy housewifery requires that brush and broom should ruthlessly demolish the webs,--the wonderful work and mechanism of the one species of house spider,--let it be done as a necessity, not with a feeling of repugnance to the harmless little insect; and let children be taught the truthful lesson that nothing is made in vain. _The House Cat_, with many, is regarded with unaccountable superstition. It goes with the witch, particularly the black cat. No witch ever could exist without one. This is usually the species that haunts naughty boys in their dreams after they have eaten too heartily of cake, and other indigestible stuff, at evening. Cats are as old as time. At least their existence dates back as far as man's in history, and they were formerly regarded as a sacred animal. In ancient Egypt we find that Master Tomas, with his round face and rugged whiskers, symbolized the sun. Preserved in the British Museum are abundant proofs of the reverence and superstition with which the feline race was regarded by the Egyptians. Here several of these revered Grimalkins are mummied in spices, and perfumes, and balsams, in which they have survived the unknown centuries of the past, "to contrast the value of a dead cat in the land of the Pharaohs with the fate of such relics in modern times, ignominiously consigned to the scavenger's cart, or feloniously hanging upon a tree, the scarecrow of the orchard." Diodorus, the Greek writer, 1st century B. C., informs us that such was the superstitious veneration with which the Egyptians regarded cats, that no one could ruffle the fur of Tom or Tabby with impunity, and that any man killing a cat was put to death. (O, what a country it must have been to sleep in!) In Ptolemy's time, while the Roman army was established in Egypt, one of the Romans killed a cat, when the people flew to his house, and dragged him forth, and neither the fear of the soldiers nor the influence of the prince could deliver the unfortunate cat-slayer from the wrath of the infuriated mob. Mohammed had a superstition for cats, and was said to have been constantly attended by one. A cat hospital was founded at Damascus in respect to the prophet's predilection, which Baumgarten, the German professor (1714 to 1762) found filled with feline inmates. Turkey maintained several public establishments of this kind. Howell the Good, king of Wales, 10th century, legislated for the cat propagation, and it would seem that the race was limited, since a week old kitten sold for a penny,--a great deal of money in those days,--and fourpence for one old enough to catch a mouse. The following ludicrous penalty was attached to a cat-stealer:-- "If any person stole a cat that guarded the prince's granaries he was to forfeit a milch ewe, fleece, and lamb; or, in lieu of these, as much wheat as, when poured upon the cat, suspended by the tail, her head touching the floor, would form a heap high enough to bury her to the tail tip." This would seem rather hard on poor pussy, even to threatening her suffocation. Huc, in his "Chinese Empire," tells us that the Chinese peasantry are accustomed to tell the noon hour from the narrowing and dilation of the pupils of pussy's eyes; they are said to be drawn down to a hair's-breadth precisely at twelve o'clock. This horological utility, however, by no means gives her a fixed tenure in a Chinese home. There she enters into the category of edible animals, and, having served the purpose of a cat-clock, is seen hanging side by side with the carcasses of dogs, rats, and mice in the shambles of every city and town of the celestial empire. Descending to the middle ages, a mal-odor of magic taints the fair fame of our _protégés_, more especially attaching itself to black or brindled cats, which were commonly found to be the "familiars" of witches; or, rather, their "familiars" were supposed to take the form of these animals; and hence, in nearly all judicial records of these unhappy delusionists, demons in the shape of cats are sure to figure. The witches in "Macbeth" (for what impression of the times he lived in has Shakspeare lost?) awaited the triple mewing of the brindled cat to begin their incantations; and more scientific pretenders to a knowledge of the occult arts are usually represented as attended in their laboratories by a feline companion. Fragments of a superstitious faith in the magical, or what was till comparatively recent times so nearly allied with it, the medicinal attributes of the animal, still surviving in certain rustic and remote districts of England, where the brains of a cat of the proper color (black, of course) are esteemed a cure for epilepsy; and where, within our memory, such a faith induced a wretched being, in the shape of woman, mad with despair and rage, to tear the living heart from one of these animals, that, by sticking it full of pins and roasting it, she might bring back the regard of a man, brutal and perfidious as herself. Such formulæ are frequently to be met with in the works of ancient naturalists and physicians, and were, doubtlessly, handed down from generation to generation, and locally acted upon in desperate cases. It is on evidence that more than one old woman has been condemned by our wise ancestors to pay the penalty of her presumed league with Satan in a fiery death, upon no better testimony than the fact that Harper, Rutterkin, or Robin had been seen entering her dwelling in the shape of a black cat. But if, in ancient times, old women, and young ones, too, have been brought to grief through the cats they fostered, certain it is that these creatures have suffered horrible reprisal at the hands of certain vagrants of the sex in our own. Our _Felis domestica_ has, for a long time, labored under the serious disadvantage of a traditional character. Buffon sums her up as a "faithless friend, brought in to oppose a still more insidious enemy;" and Goldsmith--who, it is well known, became a writer of natural history "upon compulsion," and had neither time nor opportunity for personal observation of the habits and instincts of the creatures he so charmingly describes--followed in the track of the great naturalist, and echoes this ungracious definition. Boys have a natural contempt for cats, and picking them up by the tail, tossing them over the wall, or tying old tin pots to their caudal end, to see how fast they can run, are among their most trifling sports at the expense of Tom and Tabby. I have known a cruel boy to roll a cat in turpentine, and set fire to her. Few men have any feeling but repugnance towards the feline race. The exceptions are in the past. Cardinal Wolsey's cat sat on the arm of his chair of state, or took up her position at the back of his throne when he held audiences; and the cat of the poet Petrarch, after death, occupied, embalmed, a niche in his studio; indeed, poets appear to be more susceptible of pussy's virtues and graces than other persons; and she has, on many occasions, been made the subject of their verse, the sentiment of which fully expresses a sense of the maligned animal's faithfulness and affection. Tasso, reduced to such a strait of poverty as to be obliged to borrow a crown from a friend to subsist on through a week, turns for mute sympathy to his faithful cat, and disburdens his case in a charming sonnet, in which he entreats her to assist him through the night with the lustre of her moon-like eyes, having no candles by which he could see to write his verses. [Illustration: SPORT FOR THE BOYS BUT DEATH FOR THE CAT.] An editor facetiously says, "We have here among us at this time an addition to the M. D.'s in the shape of two cat doctors, who have the terrible idea that they were put upon this earth for the sole object of doctoring cats, and now the mortality list shows, at the least calculation, that no less than eighteen cats and two kittens have travelled to that bourn from which no passengers have ever yet returned, and all because they were the unlucky sons and daughters of ye night prowlers who had been sacrificed for the good of the future cat generation." PRESENT ERRORS. I think some reason for the present errors and superstitions attached to cats, may be attributed to the _cat_-adioptric qualities of their eyes and fur. At night their eyes often shine with phosphoric light, and rubbing their fur with the human hand causes it to emit electric sparks, particularly in very cold weather. They are supposed to partake of ghostly, or witch-like qualities, because they can see in the night time. Fish scales, as well as the flesh of fish, contain a phosphoric principle--there is no witchery about such--which can be seen best through the dark. The fur of other animals besides the cat contain electric qualities. Humans possess it to a greater or lesser extent. The eye of the cat--as also the owl--is made, in the divine economy, expressly for night prowling. The back, or reflecting coat (retina), is white, or light, that it may reflect dark objects. In man, and most animals, it is dark. A light-complexioned person can (_cæteris paribus_) see better at night than one who is dark. In a strong light, it is reversed. So much for cat-optrics. Our cat-alogue would be incomplete without this cat-agraph, and we should "cat-ch it," hereafter, from some cat-echist, if we here discontinued our cat-enary cat-egory, without some little cat-ch relative to the domestic and redeeming qualities of this unappreciated cat-tle (excuse the cat-achresis). Webster says the cat is a deceitful animal. Webster don't know. She certainly has large cautiousness and secretiveness. Man, with the same secretiveness, with the same neglect and abuse that Tom receives, will become doubly deceitful. Treat him kindly and affectionately, and he will return it. Subject to everybody's kicks, cuffs, and suspicion, the cat necessarily becomes shy, ugly, and appears deceitful. So does a child. The cat is fond of sweet scents, and pries into drawers and cupboards, oftener to gratify her sense of smell than taste. Cats are very fond of music, and occasionally go upon the piano keys to make the strings vibrate. Depending upon their own exertions for a livelihood, they become thieves. They may, by kind instruction, soon be taught to know and keep their own places. The healthy cat is neat and systematic. Children may be taught a useful lesson by noticing that the tabby washes her face and hands after meals, and never comes to her repast with them dirty. Cats are sometimes good fish-catchers, as well as mousers and bird-catchers, often plunging into water to secure their favorite aliment. Their love of praise is exhibited in their general tendency to bring in their prey, and place it at your feet for your approbation. Give them the notice due them, and they will redouble their efforts. It is a vulgar error to suppose their washing over the head is a sign of rain, or that you can tell the time of tide by their eye-pupils, or that they can go through a solid wall, have nine lives, or suck away a child's breath. The cat, as a sanitary means, should be domesticated, especially with scrofulous children and females. Either by their absorbent or repelling powers they assist nature in eradicating that almost universal disease--scrofula. Teach children that "God has created nothing in vain," and nothing which will harm them if rightly used. Here we bid good by to Tom and Tabby. _The Owl._--The superstition which has hung about this very harmless bird is liable to soon cease in the extermination of the creature itself. "Was you born in the woods to be scared by an owl?" my grandmother once sarcastically inquired when I was frightened from the barn by an old owl inquiring,-- "Who--a'--yoo?" [Illustration: "WHO--A'--YOO?"] I acknowledge I was a great coward; but I had heard the old women affirm more than once that it was a sign of ill luck or death to hear one of these cat-faced, cat-seeing, mousing creatures cry by day; so I fled from the barn, while the old owl turned his head sidewise, as he sat on a beam, trying to penetrate the light, repeating, "Who--a'--yoo?" It was a sign of death, for my uncle shot the owl. Magpies are made the subject of superstition. To see a single one strutting across your path is a sad mishap. There is luck in three, or more, however. _Holy Water._--Church superstitions and rites are not within our province, unless they are objectionable in a sanitary point of view. If the holy water is clean, it is just as good as any other pure water; but I have seen it poured upon my Irish patients--years ago in Hartford and elsewhere--when there were "wrigglers" in it from long exposure in an unstopped bottle or tea-cup. I approve of holy water, therefore, in large quantities, with other rites, tending to a sanitary object. Have plenty of water--with soap. [Illustration: THE PROPER USE OF "HOLY WATER."] _Bells._--Few useful articles have been held in greater reverence and superstition. Their origin is of great antiquity. The first Jewish priests adorned their blue tunics with golden bells, as also did the Persian kings. The Greeks put bells upon criminals going to execution, as a warning, as it was an ill omen to see a criminal and his executioner walking. The superstition respecting bells began more particularly with the tenth century, when the priests exorcised and blessed them, giving them the names of saints, making the rabble believe that when they were rung for those ceremonies they had the power to drive devils out of the air, making them quake and tremble; also to restrain the power of the devil over a corpse; hence bell-ringing at funerals. There are many legends wherein the evil spirits' dislike to bells is promulgated. As "the devil hates holy water," so he does bell-ringing. Dr. Warner, a clergyman of the Church of England, in his "Hampshire," enumerates the virtues of a bell, by translating some lines from the "Helpe to Discourse." "Men's deaths I tell by doleful knell; Lightning and thunder I break asunder; On Sabbath all to church I call; The sleepy head I raise from bed; The winds so fierce I doe disperse; Men's cruel rage I do asswage." I think the beautiful music discoursed by a chime of bells would be more effectual "men's cruel rage" to tranquillize, than a battery of seven cannons. Aside from all superstitious notions, there is an irresistible charm about the music of bells, and I rejoice that they are gradually being redeemed from the superstition and monopoly of one ignorant denomination, as the sacred cross may be, to the use and blessing of all mankind. _Fear of Thunder and Lightning._--These have ever been sources of superstitious terror. The ancients considered thunder and lightning as direct manifestations of divine wrath; hence whatever the lightning struck was accursed. The corpses of persons so killed were allowed to remain where they fell, to the great inconvenience, often, of the living. The electricity which plays about high poles and spires was formerly attributed to spirits. "Fiery spirits or devils," says old Burton, "are such as commonly work by blazing stars, fire-drakes," etc. "Likewise they counterfeit suns and moons ofttimes, and sit on ships' masts." The electric sparks upon the metal points of soldiers' spears were regarded as omens of no small importance. In some parts of Europe, up to the last century, it was a custom to ring bells during a thunder-storm, to drive away evil spirits; but this act often was the cause of death, by the exposure of persons to the points of attraction, and the conducting power of moist ropes and metallic wires. On the night of April 15, 1718, the lightning struck twenty-four steeples while the bells were ringing. In July of the following year, while the bells were tolling at a funeral celebration in the Chateau Vieux, lightning struck the steeple, killing nine persons and injuring twenty-two. Statistics show that numerous deaths were caused by bell-ringing in England and France, during the last century, to drive away imaginary spirits. The saint usually invoked on these occasions was St. Barnabas. The houseleek and bay tree were supposed to afford protection from lightning. "The thunder has soured the beer," or the milk, is a common saying; and I once saw a piece of iron lying across the beer-barrel to keep away thunder. A heavy atmosphere may suddenly sour beer or milk. Creeping three times under the communion table while the chimes were striking, at midnight, was believed to cure fits, as late as 1835. Glass, stone, and feathers are non-conductors to electricity. Persons very susceptible to electric currents need give themselves no fear, and no more caution need be taken than we take to protect ourselves against other objects of danger. Lightning will not strike one out of doors, unless he is near a point of high attraction,--under a tree, or pole,--or has about him, exposed, some metallic substance, or some very wet article. Houses under or near tall trees, or with suitable lightning-rods, are safe enough. A feather bed, particularly one insulated by glass-rollers, or plates, under the posts, and not touching the wall, is a perfectly safe place for invalids and nervous people who are susceptible to electricity. The pulse of such is often increased in frequency before a thunder-storm. Let such first have no fear. See God in the storm and lightning as only a saving power. I know a girl who "tears around like mad" for a man at the approach of a thunder-storm. When finding one, she feels perfectly safe. If not, she hides in the cellar till the storm abates. _Unlucky Days._--The superstition respecting unlucky Friday is well known. Some cynical bachelors say it is unlucky because named for a woman. Monday was also so named. I can find no account of this superstition until after the first century A. D. It is said that our Saviour was crucified on Friday--a day of fear and trembling, of earthquakes and divers remarkable phenomena; but that day is now as uncertain as the day of his birth, in the various changes of the calendar, heathen naming of the days to suit their notions, and the great uncertainty of chronology. No doubt Christ arose from the dead on the then first day of the week, and was crucified the third day before the resurrection; but what day of our present week who can tell? If on Friday, it should be counted far from an unlucky day. Sailors are particularly superstitious as to sailing on Friday, notwithstanding Columbus sailed on Friday, and discovered America on that day. The French believe in unlucky Friday. Lord Byron, Dr. Johnson, and other authors and poets, are said to have so believed. Shakspeare, Scott, Goldsmith, Bacon, Sir Francis Drake, Napoleon, and many other great men, were pretty thoroughly tinged with superstition; the latter, it is said, believed in "luck," or destiny. The future of children is yet believed to depend much upon the day of the week on which they are born. "Monday's child is fair in face; Tuesday's child is full of grace; Wednesday's child is full of woe; Thursday's child has far to go; Friday's child works hard for its living; Saturday's child is loving and giving; And a child that's born on Christmas day Is fair, and wise, and good, and gay."[7] This, of course, is all nonsense--or rather the belief in such signs--and one day is equally as good as another for nature's work, or in which to fulfil the requirements of God and nature. Let no mother, or her who is about to become a mother, put faith in old nurses' whims. Their brains are full of all such fantastic notions, which are too often revealed in the sick room, and the effect is often detrimental to the peace and happiness of the mother, and at times dangerous to the life of the invalid. SUPERSTITION OF A KISS. The monks of the middle ages--great theorists--divided the kiss into fifteen distinct and separate orders. 1. The decorous or modest kiss. 2. The diplomatic, or kiss of policy. 3. The spying kiss, to ascertain if a woman had drank wine. 4. The slave kiss. 5. The kiss infamous--a church penance. 6. The slipper kiss, practised towards tyrants. 7. The judicial kiss. 8. The feudal kiss. 9. The religious kiss (kissing the cross). 10. The academical kiss (on joining a solemn brotherhood). 11. The hand kiss. 12. The Judas kiss. 13. The medical kiss--for the purpose of healing some sickness. 14. The kiss of etiquette. 15. The kiss of love--the only real kiss. But this was also to be variously considered; viz., given by ardent enthusiasm, as by lovers; by matrimonial affection; or, lastly, between two men--an awful kiss, tasting like sandwiches without butter or meat. [Illustration: THE MODEST KISS.] THE END IS NOT YET. The reign of superstition is not yet ended. It is impossible for any great catastrophe, involving loss of property or life, to occur without a certain superstitious class harping upon the event as a judgment of God upon the wickedness of the victims. If a great city is swept away by the devouring elements, we hear the cry that "an offended Deity has visited the 'Babylon of the West' with his vengeance for her wickedness." Some penurious wretch takes it up, and says, "I'll give nothing, then, to the victims of the fire. It is God's judgment; I won't interfere." A rich man is murdered in cold blood, and the same howl goes up, "It is the judgment of God upon him for heaping up riches." The fact of his riches going to thousands of poor artisans, actors, musicians, widows, orphans, and "western Babylonian sufferers," goes for nothing with such people. These same superstitious wretches have not yet done asserting that the assassination of President Lincoln was in judgment for his attending a theatre. Twenty-five persons were killed in a church at Bologna, recently, while kneeling in prayer. Was this an expression of God's wrath upon church-goers? "The laws by which God governs the universe are inexorable. The frost will blight, the fire destroy, the storms will ravage, disease and death will do their appointed work, though narrow-mindedness and bigotry misconstrue their intent. All things are for good. If natural laws are violated, the known and inevitable result follows." * * * * * I have already exceeded the space to which this chapter was limited, and there are a thousand superstitious beliefs and practices which are not herein enumerated nor explained. But rest assured that nothing exists without its uses, without the knowledge of the divine Author, and nothing supernatural does or ever did exist amongst natural beings. There is nothing within this world but what God has placed for man's good. There is nothing here past man's ability to fathom. God is love. What there is beyond this world, we shall find out quite soon enough. [Illustration] XIII. TRAVELLING DOCTORS. "His fancy lay to travelling."--L'ESTRANGE. PUBLIC CONFIDENCE(?).--THE EYE OF THE PUBLIC.--A BAD SPECIMEN.--"REMARKABLE TUMOR."--"THE SINGING DOCTOR."--CAUGHT IN A STORM.--BIG PUFFING.--A SPLENDID "TURNOUT."--WHO WAS HE?--A SUDDEN DISAPPEARANCE.--THE "SPANKING DOCTOR."--A FAIR VICTIM.--LOOSE LAWS.--DR. PULSEFEEL.--IMPUDENCE.--A FIDDLING DOCTOR.--AN ENCORE.--"CHEEK."--VARIOUS WAYS OF ADVERTISING. One might say, with some propriety, that these characters--travelling doctors--should have been classed under the heading of our first chapter, as "humbugs;" but if we should put all under that head that belong there, O, where would the chapter end? As "all is not gold that glitters," so neither, on the other hand, is there anything so bad that no virtue can be found in it. No heart is so utterly depraved as to prevent any good thought or deed from emanating therefrom, though sometimes the good is quite imperceptible to us short-sighted mortals. As the majority of physicians "turned" out of our medical colleges, or of those in practice in our cities, are unfit to have intrusted to their care the health and lives of our families, friends, or ourselves, so the majority of travelling doctors are to be reckoned equally untrustworthy; no more so. If the blessed Saviour should return to earth, and travel from town to city, as he did eighteen hundred years ago, healing the sick, I really think there would be a less number believing in him now than then. Less gratitude for his marvellous cures there could not be; for then some of the miserable wretches, whom he healed free of charge, did not so much as return him thanks. This may be said of some of our patients at this day. Let a medical man of ever so great reputation travel, and he is lost. A band of angels, on a healing mission, would stand no chance with a people who only expect humbugs to visit them. The Shakspearian inquiry would at once and repeatedly be put,-- "How chance it they travel? Their _residence_, both in reputation and profit, was better both ways!" Let us view a few travelling doctors through the _public_ eye:-- "So shall I dare to give him shape and hue, And bring his mazy-running tricks to view; From humbug's minions catch the scattered rays, That in one focus they may brightly blaze. "I'd give our (nameless) knight, before he starts, A tireless mind, where never Conscience smarts; An oily tongue, which word should never speak To call a blush to Satan's brazen cheek; With, yet, a power of lungs the weak to move, Which lung-quiescent ... might approve; A changing face, which e'en might Homer feign, A ton of brass for every ounce of brain. "Then launch him forth, right cunningly to rage Through the thin shams of this enlightened age; To tell the people they are lords of earth, And pick their pockets while he lauds their worth; Drug men with folly, which no clime engrosses, And sense deal out in homeopathic doses; And making goodness to his projects bend, With all right aims an ultra spirit blend. * * * * * "He leagues with those who number in their trade A falsehood told for every sixpence made; To Mammon mortgage all they have of heart, To keep their wealth, with priceless honor part. The fear of God the smallest of their fears, Rolling in wealth, but bankrupt in ideas; To save their purse, their souls contented lose, And count all right, if worldly gain accrues; Who, when they die, no memory leave behind, But in the curses of their cheated kind! "With these Sir Humbug riches seeks to gain, And feels his way through lab'rinths of chicane; Embezzles, swindles, lies, until at last The eye of Justice on his crime is cast, When, drugged with wealth, he quits our plundered shore, And Texas boasts one fiery hero more." [Illustration: THE TUMOR DOCTOR CONTEMPLATES SUICIDE.] [Illustration: MARIAM, THE TUMOR DOCTOR.] The worst specimen of a travelling doctor I ever knew first appeared at R., one of the principal towns of Vermont, a few years ago. His name was Mariam; or that was what he called himself. He was a Canadian by birth, about twenty-five years of age, short, dark-complexioned, and claimed to be the seventh son of somebody. He was very illiterate, not being able to write a prescription, or his name, for that matter, when he came to R. I visited his rooms at the hotel, after he had been in town some weeks, and noticed, among other things, that his table was strewn with sheets of paper, upon which he had been practising writing his signature. He opened here boldly. He sent out thousands of circulars in the various trains of cars running from R., distributing them in person, on the Poor Richard's principle, that "if you want your work done, do it; if not, send." He inserted cards in the two village papers, containing the most illiterate and preposterous statements, and hundreds flocked to see him. Imagine his knowledge, for he assured me, to whom he opened his heart in confidence, that he never read a page of a medical work in his life. He first claimed to cure by the laying on of hands; but as he possessed no magnetic powers, he gradually abandoned that deception. As he could not write a prescription, and knew nothing of compounding medicines, he would go with a patient to a druggist's, and looking over the names of drugs on the bottles exposed on the shelves, order two or three articles at random, and, as one druggist assured me, of the most opposite properties; such as tincture of iron and iodide of potash, etc. (NOTE. The acid in the M. Tinct. iron sets the iodine free.) His clothes were very seedy, "and the crown of his hat went flip flap," and his toes were healthy, "being able to get out to the air," when he came to R. Soon he was "in luck," and a nice suit of clothes, a new silk hat, and boots, speedily graced his not inelegant person. I saw him both before and after the transformation. The following is a true copy of one of his certificates, taken from his circular:-- "A GREAT CURE OF AN OVARIAN TUMOR! "This is to certify that Dr. Mariam cured me of an immense _ovarian tumor of the left shoulder_, weighing five pounds and a half, from which I suffered," etc., etc. (Signed) Mrs. ---- ----. "MALONE, N. Y." On this item being ridiculed in the papers of R., Mariam changed it to a "rose cancer," and continued the certificate. Mariam had been practising in Malone, N. Y., also at Whitehall, where, I was informed by a newspaper man, he was arrested for obtaining money under false pretences. He, however, escaped and fled, to practise his deceptions elsewhere. It was reported that he shuffled off his mortal coil by finally taking two ounces of laudanum, after the civil authorities had placed him comfortably in the county jail, where he had the pleasure of passing many days in viewing the world through an iron-barred window, and reflecting on his eventful career. THE SINGING DOCTOR. In remarkable contrast with the above described ignoramus, we present the following description, from two contributors, of an extraordinary personage, known for a time as "The Singing Doctor." The "Hoosac Valley News" tells this story:-- "One day late in the autumn of 1860, while the rain poured in torrents, and the wind howled fearfully along the hills of old Plymouth, I was obliged to drive to Watertown. The 'Branch' was swollen to the river's size, and foamed madly down over the sombre rocks, while above my head, on the other side of the road, the trees rocked and swayed, as though about to fall into the seething, roaring waters below. "Above, or mingled with the clashing of the elements, I heard some voice, as if singing. It struck me with wonder. I stopped to listen. It became more distinct, as if approaching. What was it? Who could it be, singing amid the fearful tempest? "In the midst of my surmising, the object of my wonder came in sight, around a turn in the road just ahead of me. "It was the Singing Doctor, whom I instantly recognized by his little old white horse, as well as by his own voice, to which I had before listened. The little animal was drenched like a 'drowned rat.' The doctor, in his open buggy, with no umbrella,--for the sweeping wind precluded the possibility of holding one,--and the driving rain pelting mercilessly upon his face and head, was singing. "'You must be a happy man,' I exclaimed, 'to be singing amid this awful storm.' "'Why not?' he replied. 'It is always better to be singing than sighing;' and we passed on through the dangerous defile, and separated.... "Last summer, as I journeyed through the Green Mountain State on a pleasure excursion, I met, on a romantic mountain pass, a magnificent turnout,--a splendid top carriage, drawn by four beautiful, jet black Morgan mares,--which did not attract my attention so much, however, as the music within the carriage. It was the Singing Doctor again, with his two little daughters, singing. "The handsome and good-natured driver offered me the best half of the road; but still I lingered till the last notes of the song died away, when I drove past the 'Sanatorian,' wondering to myself what singing had to do with his increasing prosperity." The remainder of the sketch is from the pen of a lady in Vermont:-- "I think it was during the spring of 1867 that our little 'city on the lake' was visited by the above remarkable character. We are often visited by migratory physicians, who are usually of the 'come-and-go' order; but this one burst upon us like a comet, with dazzling splendor, briefly announced, but at once proclaimed his determination of returning with the regularity of the full moon--repeating his visits every month. Few believed his last arrangement could be carried out, as his predecessors had generally fleeced the invalid public to their utmost at one visit, and if they ever again appeared, it would be under another name and phase. It soon became evident that one visit could not repay the outlay, for no ready posting-board was large enough to hold the agent's posters, which were printed in strips some twenty-five feet in length, and his advertisements occupied one, two, or more columns of the public journals, while he flooded the houses with his pictorial circulars. [Illustration: THE SINGING DOCTOR.] "He was merely announced as 'The Sanatorian,' but was indorsed (true or false?) by some of New England's most respectable people. He came in grand style, as the papers briefly announced, thus:-- "'_The Sanatorian._ This distinguished physician proposes visiting us on the 18th inst.... The doctor comes in great style.... He has the finest carriage, and the gayest four black Morgan horses we have ever had the pleasure of riding after.' [Illustration: THE SANATORIAN'S TURNOUT.] "The driver, a handsome fellow, with full brown whiskers, curling hair, and a 'heavenly blue eye,' had taken the editor and writer of this last paragraph out to an airing. The team was photographed by the artists, and many of the best citizens had the pleasure of a ride in the easy carriage, and behind the swift ponies. "The doctor usually remained _incog._ to the public. If they wished to see him, they must go to his 'parlors' at the best hotels. They did go. And now the most remarkable part of the affair remains to be recorded. An editor who interviewed him reports thus: 'The doctor rocks in a rocking-chair,--in fact, never sits in anything else,--or arises and walks the floor, and instantly, _at a glance_, tells every patient each pain and ache better than the patient could describe them himself. 'Are you a clairvoyant?' the editor asked. "'_Faugh! No, sir._ Clairvoyancy is a humbug; merely power of mind over mind. A clairvoyant can go no farther than your _own_ knowledge leads him, unless he guesses the rest,' was his emphatic reply. "The same patients, disguised, visited him twice, but he would tell the same story to them as before. His diagnosis was truly wonderful. "'What is your mode of treatment, or what school do you represent?' "'There hangs my "school,"' he would reply, pointing to a New York college diploma. 'That, however, cures nobody. What cures one patient kills another. My opathy is to cure my patient by _any means_, regardless of "schools."' "To some he gave 'nothing but water,' the patients affirmed; to others, pills, powders, syrups, or prescriptions. Well, he came the next month, to our surprise, and to the joy of most of his patients. He did the greatest amount of advertising on the first visit, doing less and less puffing each time. The rich, as well as the poor, visited him. He charged all one dollar. Then, if they declined treatment, he was satisfied; but if they doubted, or were sceptical, he refused all prescription. He advertised quite as much by telling one man he was past all help, and would die in eight weeks, which he did, as by curing the mayor of the city of a cough that jeoparded his life. If a poor woman had no money, he treated her just as cheerfully. Men he would not. His cures are said to have been remarkable. He made some eleven visits, and his patrons increased at each visit; but the novelty wore off before he disappeared. He was said to be an excellent musician, an author and composer, a man who was well read (a physician here who often conversed with him so informed the writer), could translate Latin and French, and converse with the mutes. When the day closed, he would see no more patients, but devoted his time to friends, to writing, or to music. Often the hotel parlor would be thronged at evening with the musical portion of the community. In personal appearance he was nothing remarkable,--medium size, wore full beard, had a sharp black eye, a quick, nervous movement, and his voice was not unpleasing to the ear. "Why he--such a man--should travel, no one knew. He had an object, doubtless, to accomplish, realized it, and retired upon his true name, and from whence he came." "YOURAN, THE SPANKER." The writer has many times seen a fellow who travelled the country, nicknamed "the Spanker." He was a tall, lean, lank-looking Yankee, with red hair and whiskers, a light gray eye, and claimed to cure all diseases by "spatting" the patient, or the diseased part thereof, with cold water on his bare palm, the use of a battery, and a pill. He had served as door-keeper to a famous doctor, who created a _furore_, a few years since, by the exercise of his magnetic powers, making cripples to throw down their crutches, and walk off; the deaf to hear, the blind to see; or, at least, many of them _thought_ they did, for the time being, which answered the doctor's immediate purpose. But one fine morning the magnetic doctor found his door-keeper was among the "missing." He had learned the trade, and set up on his own account. This fellow was as ignorant of physic as Jack Reynolds was of Scripture. Reynolds, who killed Townsend in 1870, when under sentence of death, listened attentively for the first time to the story of the Saviour's crucifixion in atonement for our sins, when he rather startled the visitors, as well as the eminent divine, with the inquiry, "Did that affair happen lately?" He was not, it is evident, conversant with Scripture. "The Spanker" was not read in medicine. His treatment was the most ridiculous and repulsive of the absurdities of the nineteenth century. The patient was stripped of his clothes, and often so severely spanked as to compel him, or her, to cry out with pain. [Illustration: A NEW SCHOOL OF PRACTICE.] The beautiful young wife of the Rev. Mr. F., of Vermont, was brought to the writer for medical advice. The patient was carefully examined, and the minister taken aside, and assured that the lady was past all help; she was in the last stages of consumption; that she would, in all probability, die with the falling of the autumn leaves, or within two months. The following day the minister carried the patient to the spanker doctor, who declared her case quite curable. The minister employed him to treat the patient. A few weeks later I saw the minister, seated on the doorstep of his house, bowed in grief. He was on the lookout for me, as I was expected that way. He called to me, and asked if I would view the corpse of his once beautiful wife. I dismounted, and entered the house of mourning. There lay the poor, fair young face, within the narrow confines of the coffin. The cheeks were hollow, the eyes sunken, and the nostrils closed, and I doubt if any air had passed through the left one for weeks--pathognomonic indications of that fell disease, consumption. "She did not live as long, doctor, as you thought she would, in August," said Mr. F. "No, sir: I did not then make allowance for the harsh treatment of Dr. ----, that, I am advised, soon followed." [Illustration: A VICTIM OF THE SPANKER.] "O, sir," he exclaimed, in agony of soul, while the tears coursed freely down his cheeks, and fell upon the coffin,--"O, sir, God only knows what the poor thing suffered. Dr. Youran said the spatting and cold water treatment would save her, and I was anxious to try it, and did, till the poor, dear soul begged us, with tearful eyes, not to punish her further, but to let her die in peace." The ignorant scoundrel is still at large, preying upon the invalid public. It is a burning shame that the laxity of our laws permits such ignorant, heartless wretches to go about the country, imposing upon the credulity of invalidity. The invalids, as we said in our opening, expect to be humbugged, and will believe no honest statement of a case and its probabilities, but will too often swallow the lies and braggadocio, and finally the prescriptions, of ignorant charlatans and impostors. [Illustration: DR. PULSFEEL LEAVING TOWN.] Mr. Jeaffreson, in the "Book about Doctors," before often quoted, says of the English travelling doctor of the last century,-- "When Dr. Pulsfeel was tired of London, or felt the want of country air, he adopted the pleasant occupation of fleecing rustic simplicity. For his journeys he provided himself with a stout and fast-trotting hack--stout, that it might bear weighty parcels of medical composition; fast, that in case the ungrateful rabble should commit the indecorum of stoning their benefactor as an impostor,--a mishap that would occasionally occur,--escape might be effected. "In his circuit the doctor took in all the fairs, markets, wakes, and public festivals, not disdaining to stop an entire week, or even month, at an assize town, where he found the sick anxious to benefit by his marvellous wisdom. "His manner of making himself known in a new place was to ride boldly into the thickest crowd of a town, and inform his listeners that he had come straight from the Duke of So-and-so, or the Emperor of Wallachia, out of an innate desire to do good to his fellow-creatures. He was born in that very town. He had left it when an orphan boy, to seek his fortune in the great world. His adventures had been wonderful. He had visited the Sultan and the Great Mogul; and the King of Mesopotamia had tried to persuade him to tarry and keep the Mesopotamians out of the devil's clutches by the offer of a thousand pieces of gold a month. He had cured thousands of emperors, kings, queens, princes, grand duchesses, and generalissimos. He sold all kinds of medicaments--dyes for the hair, washes for the complexion, lotions, rings, and love charms, powders to stay the palsy, fevers, croup, and jaundice. His powder was expensive; he couldn't help that; it was made of pearl-dust and dried violet leaves from the middle of Tartary. Still, he would sell his friends a package at bare cost,--one crown,--as he did not want to make money out of them. "Nothing could surpass the impudence of the fellow's lies, save the admiration with which his credulous auditors swallowed his assertions. There they stood--stout yeomen, drunken squires, gay peasant girls, gawky hinds and gabbling crones, deeming themselves in luck to have lived to behold such a miracle of wisdom. Possibly a young student, home from Oxford, with the rashness of inexperience, would smile scornfully, and cry out, 'Quack!' (quack-salver, from the article he used to cure wens); but such interruption was usually frowned down by the orthodox friends of the student, and he was warned that he would come to no good end, if he went on as he had begun, a contemptuous unbeliever, and a mocker of wise men." A MUSICAL DOCTOR. Mr. Dayton, vocalist, told me of a fellow who cut a swell in various capacities a few years ago. He first knew him as a fiddler at fairs. The next time he turned up was under the following circumstances:-- "With Madam L. and some other renowned vocalist, he was giving concerts, when one day their pianist was taken suddenly sick. Madam was in great trepidation. [Illustration: THE MUSICAL DOCTOR.] "'What shall I do? The concert cannot be postponed, and we cannot sing unless we have an accompaniment,' exclaimed the lady. "I looked about, made some inquiry,--it was in a small town,--but no competent piano player could be found. "'We must abandon the concert,' I said, which seemed inevitable, when there came a sharp knock at the door. "'Come in,' I called. "The door opened, and instead of a servant, as I had expected, there appeared a tall, stout specimen of the _genus homo_, with large black eyes, and long, dark hair flowing down on to his shoulders, making his best bow, and what he doubtless intended as his sweetest smile. "I offered him a chair, and inquired how I could serve him. "'You want a piano player?' "'Yes.' "'Well, I will undertake to assist you in your strait. Allow me to see your programme,' he continued, very patronizingly, waiting for us to make no reply whatever. "'Are you--that is, do you play rapidly, and at sight?' asked madam. "He replied only by a gesture, a sort of pitiful contempt for the ignorance of any person who should ask _him_ such a question.... "Half past seven came, and we went on the stage. I do not know what the fellow's prelude was; I was otherwise engaged; but his accompaniments were made up, and after he had heard the note sung to which he should have accompanied,--O, it was a horrid jargon, a consecutive blast of discords, a tempest of incomprehensibleness. [Illustration: ENTHUSIASM.] "Madam caught her breath at the first pausing-place, and signalled him to stop. He took a side glance at her, misinterpreted her, and played on the louder. It became ludicrous in the extreme. He played the minor strains, or what should have been minor, in the major key. He only stopped when he saw us leave the stage. The audience cheered. He took it all as a compliment to himself as a pianist, stopped, and made his most profound obeisance to the house. They laughed and cheered the harder. He mistook it for an _encore_, bowed again, and returned to the piano. Then the house came down. They stamped, they laughed, they shouted. The boys in the gallery cat-called; the building fairly shook. I ran back to see what it was all about, and there was the pianist (?) beating furiously at the keys, the perspiration pouring in streams from his face. But his playing could only be _seen_ to be appreciated; it could not be heard for the stamping of the audience. He finally desisted, and with repeated halts and smiles, he bowed himself off the stage. "His grand _debut_ and retirement upon the stage occurred the same night. Madam would not permit him to go on again, and we sang the duets from ---- without accompaniment. I think the fellow knew nothing of music; he had 'cheeked' it right through. "Perhaps it was two years afterwards--I was staying at the B. Hotel, Maine--when I heard a deal of talk about a great doctor then in town. After dinner the first day, I noticed a man sauntering leisurely from the dining-hall in embroidered slippers, white silk stockings, black pants, gaudy dressing-gown, with long hair falling down over his shoulders. I thought I recognized that face. I approached him after a while, and called him by name. "'What? Why, I think you are mistaken. I do not know you, sir,' he stammered; and then I knew he had recognized me. "'O, yes; I am Dayton. You remember you were our pianist once in a strait, in S.' "'O, ah! Come up to my room,' he said, leading the way. "I followed, when he told me he was doing a good thing at the practice of medicine about the principal towns of the state, and begged I would say nothing about his former occupation. He stated to me that he had been to Europe, and had been studying medicine meantime, which I have since ascertained was entirely untrue." And this was the fellow over whom the town was running wild. The idea of some men trying to become good physicians is as ridiculously absurd as Horace Greeley's farming, or trying to ascertain if "cundurango is explosive." The requisite qualities are not in them. They may keep along a few years, or possibly, in communities where there is no competition, succeed in making the people believe they are as good as the common run, and thus succeed on brass instead of brains. Some of these brainless travelling impostors employ a female or two to precede them from place to place, and make diligent inquiry when the great doctor who performed such marvellous cures in some adjoining town mentioned was coming there. Thus putting it in the shape of an inquiry, it was less likely to excite suspicion. Two females--one an elderly, lady-like looking woman, the other younger, and anything but lady-like--travelled for a doctor, on a salary, during the summer and autumn of 1868. A lady whose occupation took her from town to town, seeing the two females at various hotels where the doctor was advertised, inveigled the younger one into the confession, in her bad temper, and thus I got my evidence. Another travels on his hair; another on his face; and a fourth on his free advice and treatment; while a fifth succeeds by absurdity of dress. [Illustration] XIV. SCENES FROM EVERY-DAY PRACTICE. "History, so warm on meaner themes, Is cold on this."--COWPER'S TASK. "Let no one say that his task is o'er, That bonds of earth are for him no more, Until by some kind or holy deed His name from forgetfulness is freed; Until by words from his lips or pen, Dying, he's 'missed' from the ranks of men." ALICE LEE. THE BEGGAR BOY AND THE GOLDEN-HAIRED HEIRESS.--MY MIDNIGHT CALL.--THE CONSCIENCE-STRICKEN MOTHER.--"OLD SEROSITY."--THE ILLEGITIMATE CHILD.--DEATH OF THE BEAUTIFUL.--WHO IS THE HEIR?--A TOUCHING SCENE.--FATE OF THE "BEGGAR BOY."--THE TERRIBLE CALLER.--AN IRISH SCENE, FROM DR. DIXON'S BOOK.--BIDDY ON A RAMPAGE.--TERRY ON HIS DEATH BED.--THE STOMACH PUMP.--BIDDY WON'T, AND SHE WILL.--THE BETRAYED AND HER BETRAYER.--"IS THERE A GOD IN ISRAEL?"--THE HUSBANDLESS MOTHER.--THE CRISIS AND COURT.--ANSWER.--THERE IS A "GOD IN ISRAEL." Ill-clad poverty, benumbed with cold, was abroad alone, exposed to that winter's night, as the white snow fleeced the frost-hardened ground. But never mind earth's cold bosom. The rich man's heart warms _him_, making him merry, however blows the wind or rages the storm. Shiver, shiver on, beggar poor! Starvation and sense-dulling cold alone belong to you. Through the crunching snow-drifts trudged a weary boy, with alms-basket on his shivering arm. From his figure, he seemed not over ten years old; but his face was so wan and melancholy, that it was difficult to tell how many year-blights the beggar child had experienced. Summer clothes were still clinging to him; a tattered comforter was the only winter article he wore. [Illustration: CHARITY THROWN AWAY.] A gay carriage rolled noiselessly by, with a beautiful girl within, well wrapped in fur and cloak, whilst the snow was dashed from the rapid wheels like white dust. She saw, through the dim light, the weary, thin-clad boy, as he stopped, with face bent aside to the flake-burdened blast, to gaze at the smoking horses, as they plunged through the fast-deepening sheet. She dropped the sash, and threw the boy a coin. It sank from her warm hand deep into the drifted snow. It might have brought him bread and a cheering fagot, but the smitten child never found it. The snow closed over the coveted prize, while the blast grew keener. On, on toiled the beggar boy, through drift and darkness, more weary as night gathered on. Thus is it ever with the humble poor; their load grows heavier as life lessens. No light or warming hearth is there--things that make house a home--to welcome the wandering boy. The clock had just struck two as I was summoned to the house of Mrs. T. The same carriage that, in the evening, had borne the beautiful young girl, awaited at my door, with its impatient horses snorting against the frosted air. A few minutes later I entered the house. Mrs. T. met me in the hall, with her face deadly pale, and manner much excited. Her singular nervousness had before struck me on my visits, whenever her daughter ailed. She informed me that her "darling Emily" was very ill with a high fever. We entered the chamber. The young girl lay with her head turned aside upon the pillow, her golden-brown hair scattered in wild profusion upon its white cover, while the nurse was gently moistening the fevered palm of her outstretched hand. The pulse was beating wildly at the wrist and temples, and fever heat glowed from her lustrous eyes. Whilst the nurse held the light to her face, the traces of dried tears were revealed upon her suffused cheeks. "Heartache surely is here," I said to myself. There was something in the whole appearance of my patient that excited my curiosity and surprise. Only eight or ten hours had passed since she, from her carriage, had thrown the snow-claimed alms to the beggar boy, and _now_ a high fever was running hot through every artery of her body. Silently seated by the bedside, after administering a cooling draught I awaited and watched for the changes that might ensue. Her mother sat near the fire, its blaze lighting up every feature of her once beautiful face, which still remained very pale. In all my intercourse with Mrs. T., I never before had so prolonged an opportunity of examining in detail the expression of her countenance. The longer I gazed on her, the more satisfied I became that she had not passed through life without a fearful history. It was this sensation which struck me when I first became acquainted with her. A few vague rumors had floated about relative to her history; that a strange desertion of her husband had taken place, and that he afterwards was found drowned in the river, near his residence, and that by his death Mrs. T. had become possessed of an immense estate. These stories had, however, soon subsided; and as her means were ample, and her charities liberal, the gossips of the town quietly dropped the past, and speculated upon the future, as should all respectable gossips. The voice of the patient diverted my thoughts; a few words were murmured, and then the lips pressed tremblingly together, and the tear-drops again started to her cheeks. Suddenly springing up in bed, and threading her long, curling hair through her slender fingers, she exclaimed, in a thrilling, delirious tone,-- "It cannot be true! O, mother--tell me, mother!" Mrs. T. fairly leaped to the bedside, and placing her hand over the daughter's mouth, with affrighted gestures, she exclaimed,-- "What is it? What does she mean? My God, doctor, she raves!" The girl fell back on her pillow; the mother stood, pale and trembling, by the bedside, with a nameless terror depicted on every feature. Turning to me, in a quick, restless voice, she bade me hasten to give her child a quieting draught. "O, anything that will keep her from raving!" The room was not over warm for such a bitter night, yet the perspiration stood upon the brow of the excited mother like the fallen dew. "Conscience must lie here," I thought to myself. In the course of an hour the sufferer slumbered heavily; her breathing was hurried and oppressed, the fever had increased, and her moanings were constant. Day was breaking, as I left my young patient to return home through the falling snow. As I looked out of the carriage window, I saw a little boy sitting on the cold walk. It was the poor beggar boy of yesterday, as thinly clad, with his pale cheek as white as the snowdrifts through which he had toiled. I ordered the coachman to stop. [Illustration: THE BEGGAR BOY.] "What brought you out, and where are you going, on this cold winter morning, my poor boy?" I exclaimed. He raised his beautiful dark eyes to my face, and my heart grieved at their look of utter hopelessness, as he faintly answered, "To beg for me and old grandma." "Are you not very cold, in those thin clothes?" I asked. His little teeth chattered, as he replied, "O, I am very--cold--sir." The impatient horses plunged violently in the traces, and the coachman asked to be allowed to drive on. I gave the poor boy the few silver coins that were in my pocket, and we passed on. I never saw that boy but once again; his look haunts me to this day. As I rode on, memory was busy tracing where I had ever seen features like his. The dark hair, that lay in uncombed curls upon his forehead, and clustered warmly about his neck, as though in protection against the bitter cold; his large, black eyes, with their long lashes; the finely-chiselled outlines of his mouth and nose,--these all impressed me that I had somewhere seen a face which strikingly resembled his. Poor boy! beauty was his only possession. At breakfast a letter was handed me, summoning me immediately to one of my own children, who lay sick in a distant town. Before leaving I wrote a hurried note to Mrs. T., stating the cause of my sudden departure, desiring her to call another physician, during my absence. The young girl's fate and the poor beggar boy's face were almost forgotten in my own cares. On the sixth day following, I again found myself at home. My first thought was for poor Emily. I dreaded to ask; there was something whispering to my heart that all was not well. My suspense was not long; a messenger had just left, stating that the dear girl was fast failing; that her physician had pronounced her laboring under typhus fever. My God, how my heart sank under these words! I had dreaded this mistake after I left. Alas! how many have fallen by the name of a disease, and not by the disease itself! After a hurried meal, I drove rapidly to Mr. T.'s residence. The house door was quietly opened by a servant, and in another minute I stood in the chamber of the invalid. The mantel was crowded with numerous vials. The close atmosphere of the sick-room was sickening. By the bedside, with her face bowed over one of the pale hands of the daughter, which she held in both of her own, sat the wretched mother. It seemed to me as though ten years had passed over her faded and care-worn countenance, since I last gazed upon it. I could not stir; my heart stood still. _Her hair had become entirely gray._ [Illustration: REMORSE.] I gained heart to approach; the desolate mother heard me, and turning quickly she sprang from her chair, and placing her hands on my shoulders, she bowed her head: she sobbed wildly, as though her heart would break. "Look, look, doctor! Would you have known her? O, my God, she is leaving me! Save her--O, save her!" and the wretched mother fell fainting to the floor. We gently raised and bore her to her own chamber. In a few moments I returned to Emily. She turned her head languidly towards me, while her right hand moved as if to take mine. How dry was the palm! Her color had faded away; the once rounded cheeks were sunken. O, I will not describe her! The physician who had been called, after my departure, had found her with high fever and delirium. He mistook the excitement of the brain for its inflammation. O, fatal error! A consultation was called. The second comer was notedly a man who viewed every excitement as caused by "an over-action of the vessels," and bleeding was its only relief. The nervous system he entirely ignored. From his theory, man was a mere combination of blood, blood-vessels, and biliary secretions, more or less deranged. Calomel, salts, and the lancet were his Hercules. The grand _causa mortis_ amongst the human family was "serosity." Hence some evil-minded wag amongst his brethren had named him "Old Serosity." The poor child had been bled, cupped, and purged, in order to subdue this "over-action of the blood-vessels." Verily it may cure the vessels, but it certainly kills the patient. The life current was nigh exhausted; there was no blood left for renewal of brain, nerve, or vital tissue. My heart was bitter against this murderous adherence to a false principle. Here a human life, that of a young and spotless girl, was the forfeit. But to return to the thread of the narrative. "O, I am glad you have come back to me. Do try to save me, doctor," she said, with great effort. Sending the nurse from the room, I quickly pressed the young girl's hand within my own, and said to her,-- "Do you really wish to live, Emily?" "Yes, yes," she murmured; "I am very young to die." "Then, my dear, tell me truly what has so terribly shocked your nervous system; tell me." With a strength that startled me, she searched under the mattress side, and drew forth a small note, which she silently placed in my hand. It was discolored by time. I opened it; the date was above twelve years back. It ran thus:-- "When you receive this, Mira (Mrs. T.'s given name), my career will have ended. By my death you will inherit all. Let my unborn child have its just, legal claim. Your child, Emily, take to your home as though she were an adopted orphan. Let not her youth be blighted by the knowledge of her unblest birth. I forgive you. Adieu, forever. H. T." "O my God, the doomed child is illegitimate," I said. I stooped down and kissed the sufferer's forehead, and promised that I would be a father to her. "Come, cheer up," I whispered, "for your mother's sake. If she has sinned she has suffered much for your sake; forgive her." "I do forgive her," she whispered, "but can I forget myself, unblessed as I am? But I must know the whole truth. O, where is the right heir of all this wealth? My memory returns now, indistinctly, to my earlier days. A cloud intervenes. I remember but a small cottage, in a deep wood, where mother often came to see me, and a tall woman took care of me. Then came a gay carriage, and took me to a large house; but I never again returned to the cottage in the wood. There, at the large house, mother left me a long time; and when she came back--O, doctor, I can speak no longer. Do give me something to strengthen me, and I will try yet to live." A cordial was administered by my own hands, and in a short time sleep overcame her. Night again closed in; the wind had sunk to rest with the setting sun. Another night of bitter cold was ushered in. Woe to the poor! Woe to the hungry and the fireless. * * * * * As I entered the mother's apartments I found her sitting by a private secretary, which had been brought from the library. Its lid was open, and as I seated myself she took from a package of tied letters a sealed paper, and placing it in my hands, said,-- "Read this at your leisure, doctor. My pilgrimage of life is nigh ended. You will judge how great my sin, and how severe has been my punishment. I ask no forgiveness, _for there will be none left to forgive me_." Well, I knew her heart was nigh crushed! I sought the daughter's chamber. How still was everything! The very candle, with its long flame, parted by the thickened wick-char, seemed not to flicker, as it burned dimly on. I looked at the bed; the sweet girl lay with both hands crossed upon her bosom, as though in prayer. An orange-blossom had dropped from her grasp, and lay neglected by her side; her life-hand never touched it more! Death had claimed his bride! A wild shriek sounded through the house. The erring mother now knew that she was alone in the great world. Whilst the shrouding of the dead took place I retired and opened the sealed package. It briefly told its tale of sin and sorrow. It told how from the first love Emily was the fruit, and how, unknown to all, the child had been secreted; how, about three years after Emily's birth, the mother was married to Harold T., whom _she never loved_; and how, by a singular accident, the knowledge of her transgression became known to her husband; that, after violently cursing her for her sin and deception, he left her, and shortly afterwards committed suicide; that the letter (written by him just before his death), which was so fatal to the peace and life of Emily, had accidentally dropped from the secretary, and was picked up by her (that night after her return in the carriage), unknown to the mother until the sixth day after my return, when she missed it. The narrative went on to state that a male child was born after T.'s death, and that, seized with an insane fury, she resolved that he never should inherit its father's name and wealth; and that, through the assistance of a nurse, it was placed with a sum of money at a beggar's door, and a dead child laid beside the mother instead; that before sending the infant away, the nurse tattooed its father's initials on its left arm. The beggar had died, and all traces of the child had been lost. At length her guilty conscience so reproached her that the mother had instituted search for the child, but all in vain. As I read this tale of crime and repentance, busy memory traced out the features of the _beggar boy_! Like a sudden light it burst upon me--those features that had so tormented my memory to recall were those of the unhappy mother. Quickly I went to her room. She was not there. I hastened to Emily's. The mother was wildly clasping the enshrouded form of her daughter, and weeping as though her heart would break asunder. Gently removing her to her own chamber, I intimated that another child, long lost, might yet be restored to her. She listened as one bewildered. I then informed her of my adventure with the beggar boy. It was hardly day-dawn as I entered the carriage. My breath froze against the window panes. After a short ride the horses stopped before the wretched snow-covered hovel (where he had seen the beggar child once enter). I opened the carriage door, leaped out, and placed my hand on the latch. The door opened. It was neither bolted nor locked; for no thief would enter there. In the corner of the room lay a bundle of rugs, with some straw, but it was unoccupied. Near the fireplace, where nought but a little well-charred bark remained upon the cold ashes, half reclining in a large wooden chair, lay the beggar boy. [Illustration: THE LOST HEIR.] His cap had fallen on the ground, and his dark, curling hair fell clustering over his extended arm, as his head rested upon it. He had seemingly fallen asleep the night before, for his thin summer clothes were on his person, and his basket, yet filled with the fragments of broken feasts, remained untouched at his feet. I placed my hand upon his beautiful head; it was icy cold. Quickly brushing back the fallen ringlets from his face, the unmistakable evidence of death met my gaze. He had apparently fallen asleep weeping, for a tear-drop lay frozen between the long lashes that fringed the eyelids. I raised the stiffened body of the ill-fated youth, and tearing away the thin sleeve from his left arm, I distinctly discovered the letters 'H. T.' thereon. Deserted, famished, and frozen, death had claimed the darling, lone boy before he knew a mother's love! This sad tale is taken from "_Scenes in Northern Practice by Dr. Dewees_, N. Y."--_Scalpel_, 1855. (And like all the stories herein, it has the merit of being true to the letter.) THE TERRIBLE CALLER. It was about half past nine in the morning. My office door suddenly opened, and looking up from my writing, I saw, standing in the passage-way, a very tall man, in a long white frock, reaching to his knees, sleeves rolled to his elbows, a slouched hat set back on his head, his face painted or bedaubed with some white substance, and his eyes gleaming upon me most intensely! There he stood, looking almost fiercely upon me, while he held the door-knob with his left hand, and grasped with his right a long carving-knife, which was thrust through his belt. "Are you the doctor?" he shouted with excitement. "I am the doctor," I replied, calmly awaiting my fate. He instantly stepped inside the room, when close behind him was revealed the form of a very short man, who held a Kossuth hat in one hand, while with a handkerchief in the other, he stanched the blood that had evidently been flowing pretty freely from his head. "This man has cut himself very bad on the head; big iron wheel come down on him: can you fix him up?" asked the first. This accounted for his excited manner. But how about the bedaubed face and the huge knife? [Illustration: A MORNING CALLER.] I examined the wound, only through the scalp, less than three inches in length; and washing away the surplus clotted blood, I clipped off the hair, and soon secured the edges of the gaping wound by taking a stitch or two through the scalp. While so doing, the young man rolled his eyes up to his tall companion,--who had explained that they were cooks at Young's Hotel, and that the spit wheel and shaft used for turning meat had fallen eight feet; by which the assistant had barely escaped being killed,--and with a commendable show of thought for his employer's interest, rather than his own comfort or safety, he anxiously exclaimed,-- "Jim, do you think that gentleman's 'order,' what I had in the spit, is overdone yet?" AN IRISH SCENE. A young Irish girl, with a wild shriek, an "Och, hone!" and "Ah, murther!" and "Hulla-boo--a--hulla-boo, poor Terry! Ah, why did I taze ye?" burst into my office one evening, upsetting the servant, and actually laying hold on me with her hands, as she exclaimed,-- "Ah, docther, docther, come now, for the love o' the moother that bore ye; come this blessed minute. I've killed poor Terry, an' niver shall see him again. Ah, murther, murther! Why did I taze ye?" [Illustration: "WHY DID I TAZE YE?"] Trying in vain to calm her, I hastily drew on my boots, and almost ran after her to a wretched tenement, some quarter of a mile off, and found the object of the girl's solicitude alive and kicking, with his lungs in the best of order, standing on the stairs that led to his miserable chamber, with a broken scissors in his hand, stirring busily the contents of a tea-cup. It seems that he had been courting my fair guide, and after the period she had fixed for her final answer to his declaration, she had bantered him with a refusal, which her solicitude for his life plainly showed was far enough from her real intentions. In his despair he had swallowed an ounce of laudanum, which he had procured from some injudicious druggist, which act had sent Biddy off after me in such terror. He was now mixing a powder which he had obtained from another druggist, who, knowing of his love affair, it will be seen acted with more wisdom than the first, as Terry let slip enough in his hearing to show what he wanted to do with the "ratsbane" for which he inquired; and Biddy, like a true daughter of Eve, had made no secret in the neighborhood that she valued her charms beyond the poor fellow's bid. As soon as she approached, he, by some inopportune remark, re-excited her wrath, and she again declared she wouldn't have him, "if he wint to the divil." Poor Terry, in his red shirt and blue stockings, and an attitude of the grandest kind, but covering, as we soon found, a desperate purpose, flourished his tea-cup, and stirred its contents with the scissors, constantly exclaiming,-- "Ah, Biddy, will ye have me? Ye'll have me now--will ye not?" Still Biddy refused. "Divil a bit will I let the docther come near me till ye say yis! Sure, weren't we children together in the ould counthry? and didn't we take our potaties and butthermilk out o' the same bowl? And yer mother, that's now dead, always said ye were to be me wife; and now ye're kapin' coompany with that dirty blackguard, Jim O'Connor,--divil take him for a spalpeen. Ah, Biddy, will ye have me?" And he flourished the cup, and stirred away vigorously with the scissors. Biddy's blood was up at the disrespectful mention made of Jimmy's name, for "he had a winnin' way wid him," and she shouted at the top of her voice,-- "No, be the St. Patrick, I'll niver have ye." With an awful gulp, Terry drained the cup, rolled up his eyes, and with one most impassioned yet ludicrous look at her, he fell upon his knees on the step. Biddy followed, in strong hysterics. The whole affair was so irresistibly ludicrous that I scarce could keep from laughing; but on observing the bottle, labelled "laudanum," and looking into the bottom of the tea-cup, and discovering a white powder, I changed my prognosis, and hastened to the druggist's near, to see what it was, and procure an antidote, should it really prove "ratsbane." To my great relief, the man of drugs informed me, laughingly, that he had given Terry a quantity of chalk and _eight grains of tartar emetic_, as he learned that Terry was already in possession of the ounce of laudanum, and all the neighbors knew that Biddy had driven him to desperation by flirting with his rival, Jim O'Connor. The young man had judiciously told Terry that the powder would make the laudanum sure to operate more effectually. "How long will it take?" he asked, and bagged all for use when the refusal should come. My course was now clear. I was in for sport. Sending the druggist's clerk for my stomach-pump, to be in readiness in case the emetic should not operate,--which was scarcely impossible, for eight grains of tartar emetic, taken at a dose, would almost vomit the potatoes out of a bag,--I waited the result. As for Biddy, I let her lie; for I thought she deserved her punishment. My heart was always tender towards the sex, and I generally expected a "fellow-feeling." [Illustration: SUCCESS OF TERRY'S COURTSHIP.] In a short time it became evident that Terry's stomach was not so tough as his will, and he began to intermingle long and portentous sighs with his prayers, and to perspire freely. I gave him a wide berth, in anticipation of the Jonah that was to come up shortly. I was anxious now that Biddy should revive in time to witness his grand effort. Terry was tough, and held out. Shortly she revived, and suddenly starting up, and recollecting the situation, she made one bound for Terry, crying,-- "Ah, Terry, Terry, dear Terry! I'll have ye now. Yis, I will; and I don't care who hears me. I always loved ye, but that divil's baby, Mag, always kept tellin' me ye'd love me the betther if I didn't give in to ye too soon. Ah, Terry, dear, only live, and I'll go to the ends of the world for ye. Ah, an' what would me poor mother say, if she was here? Och, hone! Och, hone! Docther, now what are ye doin'? A purty docther ye are; an' ye pumped out yer own counthryman, that didn't die, sure, an' he tuk twice as much as poor Terry." Meantime the boy had arrived with the pump. "Up wid ye now, and use the black pipe ye put down the poor fellow's throat over the way last summer. I'd take it mesilf, if it would do; but God knows whether I'd be worth the throuble." As Terry had not yet cast up his accounts, and the stomach-pump was at hand, I determined to make a little more capital out of the case, and thrusting the long, flexible India rubber tube down poor Terry's throat, having separated his teeth by means of a stick, and holding his head between my knees, I soon had the satisfaction of depositing the laudanum and tartar emetic in a swill pail, the only article of the toilet the place afforded. After years proved Terry and Biddy most loving companions. He never, even when drunk, more than threatened her "wid a batin', which she was desarvin'," and she never forgave "that divil's baby, Mag," for her cruel experiment on her heroic and devoted Terry.--_Practice of a New York Surgeon._ A LIFE SCENE. _The Situation._--I was young, but, with a wife and child dependent upon my practice for food, raiment, and shelter, I was striving manfully; with my household gods and goods I had located here, in a small village, a year before. My beginning was encouraging, my success in practice more than flattering. But an immense opposition had met and nearly overthrown me, in the form of a man, a deacon of the ---- church. He was one of those "rule or ruin" men whom you will find in every one-horse village. I did not at first know my man,--he did not know me,--or I should have avoided his ill will. I did not know his tenaciousness of titles--he was an esquire also--which was my first unpardonable offence. He swore--"as deacons do"--that I should not practise in that town. I swore, as doctors will, that "so long as I could obtain a potato and a clam a day I would remain while he was my opposer." Clams could be dug at low water, within a few rods of my house; potatoes I grew on the quarter acre of ground given me as partial inducement to settle in that town. His two drunken sons were his emissaries of evil, set on for my overthrow, in addition to the father's voice and known opposition, which few dared to meet. My practice dwindled. A few Nicodemuses came by night, but my darling wife trembled for my very life when I had a night call. My provision was often short, my poor horse was mere skin and bones, standing, day after day, gnawing his empty manger. "O, is there a God in Israel?" I cried, in my anguish, more than once. Yes, the reply came to my prayers; there is a God of recompense. * * * * * _The Betrayed._--My patient was a young girl, over whose golden head but seventeen summers had flown, on rosy wings. Her form was sylph-like, and face as beautiful as the opening flower in the golden sunshine of early day. She was an attendant at _his_ church, a member of _his_ Sabbath school class, and a singer in the choir.... [Illustration: THE BETRAYED.] I was shown to her room. Sorrow, and not disease, had left its impress upon her fair young face. Rumor had already given me a hint on which to diagnose my case. "Who has done this wicked thing?" I asked, holding her hand, and looking kindly into her eyes. "O, my God! O, I must not tell," she cried, springing up from her couch. I never shall forget the terror depicted on that fair young countenance, as she pronounced these words. "You must tell. You should not suffer this shame and burden alone. Tell me truly. Who has done it? I must know. There may be a chance to cover the shame and make your babe legitimate. Come," I said. "O, sir, dear doctor, it can never be;" and she fell back on her pillow, weeping and wringing her hands in awful anguish. "Come, it shall be done;" and I firmly held to the point. She arose. I gave her a bowl and napkin that were near; she bathed her inflamed and swollen eyes, then, with surprising calmness and fortitude, took a pencil and a bit of paper from the light-stand at her bedside, and wrote a name. She then handed it to me, saying "'Tis he." I read the name. I jumped to my feet. I forgot my tender patient. I forgot all but my own sufferings, and those of my dear little wife and darling babe, and their enemy, as I cried out,-- "O, my God in Israel! I have got him! I shall be avenged!" "O, don't, doctor! What is the matter?" exclaimed the affrighted girl, rising in bed. I had rushed, almost frantically across the room and back. "Forgive me," I said, "I--I forgot myself. Pardon me." "O, sir, I thought you were mad." "I was, dear girl. It is past. Now to your case." And I proceeded to unfold to her unsophisticated mind the true state of affairs. Here was a pure, respectable, though poor young girl, under age, who had been betrayed, locked into an office, and seduced by a son of the squire, and deserted, threatened--left to bear the burden and disgrace alone. She dared not divulge the name of her destroyer, because of the position of his family in the community. I dared. But to bring her mind up above her fears, to compel the young man to make restitution, as far as lay in his power, was a severe task. It was my duty to do this; sweeter then than duty, it was my revenge! By implicating the real villain, I released several other young men from suspicion, particularly one young man with red hair. The girl was taken away from the sight of dear sister's sinister looks, and the influence and threats of the seducer, and secret offers of bribery of the deacon, his father. The law took its course. No eye could see the hand that worked the machinery. The time was counted almost to a day, as the result proved. The young man was arrested, and gave bonds. It became the theme of general conversation. I was interviewed. I was dumb--deaf--blind! Threats and bribes proved equally ineffectual to induce me to give an opinion, or a pledge not to appear in the coming trial at the next term of the Superior Court. To marry the poor, unfortunate girl was beneath the dignity of the seducer and family. They would pay their last farthing first, or the young man would sooner go to prison for the crime. His two sisters carried their heads higher than ever. The two sons threatened my life. But I kept on the even tenor of my way. The girl became a mother. "Next Tuesday court sits," whispered everybody, and nothing in town was discussed but the probabilities of the pending lawsuit. The lawsuit was nothing, the fine was nothing, which the justice might impose; even imprisonment was nothing in comparison to acknowledgment of an illegitimate child by the deacon's family, notwithstanding the child was not red-haired, but much resembled its reputed father, the deacon's son. There was no trial. The squire paid a sum of money to the idiotic old father of the beautiful young mother, and agreed, orally, to support the child, and the suit was withdrawn. But this virtually acknowledged the child, and the girl returned to her father's roof for shelter, and a place wherein to weep alone over her so-called fatherless child, and hide her shame (?) from the uncharitable world. The town became too cramped for the squire and his beautiful family. He sold out, but not before he had lost his rule there, and was hanged in effigy as being "too Secesh." The seducer married a frail beauty, who mourns a drunken, brutish husband. The other son became steady, and married a lovely girl--my first patient. The daughters never wedded. Too proud to marry a poor man, too poor and destitute of real beauty or accomplishments for a wealthy or refined man to desire to wed them, they became servants and lackeys. If I desire a lunch at a certain saloon, one of them awaits my order. No matter about the other unfortunate, unloved girl. The father is an imbecile invalid. God is my witness, my judge, I long ago buried my hard feelings against them; they have only my commiseration. [Illustration] XV. DOCTORS' FEES AND INCOMES. "Three faces wears the doctor; when first sought, An angel's and a god's, the cure half wrought; But, when, the cure complete, he seeks his fee, The d----l looks then less terrible than he." EURICUS CORDUS, 1530. ANCIENT FEES.--LARGE FEES.--SPANISH PRIEST-DOCTORS.--A PIG ON PENANCE.--SMALL FEES.--A "CHOP" POSTPONED.--LONG FEES.--SHORT FEES.--OLD FEES.--A NIGHT-CAP.--AN OLD SHOE FOR LUCK.--A BLACK FEE.--"HEART'S OFFERING."--A STUFFED CAT.--THE "GREAT GUNS" OF NEW YORK.--BOSTON.--ROTTEN EGGS.--"CATCH WHAT YOU CAN."--FEMALE DOCTORS' FEES.--ABOVE PRICE.--"ASK FOR A FEE."--"PITCH HIM OVERBOARD."--DELICATE FEES.--MAKING THE MOST OF THEM. The great German physician who wrote the above died (as he ought, for putting so much truth into four lines) in 1538. He, of all physicians of his day, earned his fees; but it is often the case that the most deserving get the least reward, and Cordus was not an exception to the rule. A good physician, or surgeon, is seldom a sharp financier, and _vice versa_. "It is hard to serve two masters." Ancient physicians' fees were much larger, considering the difference in the value of money, than modern. ERASISTRATUS, in the year 330 B. C., received from General Seleucus, of Alexander's army, to whom the kingdom of Syria fell at the termination of the Macedonian conquest, the enormous sum of 60,000 crowns as a fee for his discovery of the disorder of the general's son, Antiochus. The Emperor Augustus employed four physicians, viz., Albutus, Arantius, Calpetanus, and Rubrius, to each of whom he paid an annual salary of 250,000 sesterces, equal to $10,000. Martialis, the Spanish epigramist, who was born in 40 A. D. says Alconius received 10,000,000 sesterces ($400,000) for a few years' practice. LARGE FEES. French physicians were never very well paid. The surgeons of Charlemagne were tolerably well recompensed. Ambrose Pare, the great surgeon, and inventor of ligatures (for peculiar arteries),--previous to whose time the arteries were seared with a hot iron; otherwise the patient bled to death,--received 5,000 francs for ligaturing one artery. Louis XIV. gave his surgeons 75,000 crowns each for successfully performing upon him a surgical operation. Upon the confinement of Maria Louise, second wife of the great Napoleon, four physicians--Bourdier, Corvisat, Dubois, and Ivan--received the sum of $20,000. Dubois was the principal, and received one half of the amount,--not a very extravagant remuneration; but then Napoleon held a mean opinion of physicians in general, and this fee was not to be wondered at. Dupuytren, the distinguished French surgeon, left a property of $1,580,000. Hahnemann, who, in 1785, at Dresden, abandoned physic in disgust, afterwards went to Paris, and at the time of his death was literally besieged with patients, reaping a reward for his labors of not less than $40,000 per annum. Boerhaave was a successful practitioner, born at Leyden, and left, at his death, $200,000 from private practice. John Stow, the eminent antiquarian writer, whose misfortunes compelled him to beg his daily bread at the age of eighty, informs us that "half a crown (English) was looked upon as a large fee in Holland, while in England, at that same time, a physician scorned to touch any fee but gold, and surgeons were still more exorbitant." In Spain, until a very remote period, the priests continued to exercise the double office of priest and physician, and some of them were proficient in surgery; and though they fixed no stipulated price for their medical services, they usually managed to get two fleeces from the one shearing, and on certain occasions dispose of the carcass also, for their own pecuniary advantages, as the following will show:-- Anthony Gavin, formerly a Catholic priest of Spain, says, "I saw Fran. Alfaro, a Jew, in Lisbon, who told me that he was known to be very rich, when in Seville, where the priests finally stripped him of all his wealth, and cast him into the Inquisition, where they kept him four years, under some pretence, and finally liberated him, that he might accumulate more property. After three years' trade, having again collected considerable wealth, he was again imprisoned and his wealth confiscated by the priest-doctors, but let off, with the order to wear the mark of San Benito (picture of a man in the midst of the fire of hell) for six months. [Illustration: A SAN BENITO PIG.] "But Alfaro fled from the city, and finding a pig near the gate, he slipped the San Benito over the pig's neck, and, sending him into the town, made his escape. 'Now I am poor,' he added, 'nobody wants to imprison me.'" ENGLISH FEES AND INCOMES. In no other country have physicians' fees varied so much as in England. The Protestant divine and the physician have kept step together to the music of civilization and enlightenment. Both of these professions were held at a low estimation up to the Elizabethan era, when a young, unfledged M. D. from Oxford would gladly accept a situation in a lord's family for five or ten pounds a year, with his board, and lodgings in the garret, while, in addition to professional services he might act as sort of wise clown, "and be a patient listener, the solver of riddles, and the butt of ridicule for the family and guests. He might save the expense of a gardener--nail up the apricots; or a groom, and sometimes curry down and harness the horses; cast up the farrier's or butler's accounts, or carry a parcel or message across the country." As was said also of the divine, "Not one living in fifty enabled the incumbent to bring up a family comfortably. As the children multiplied, the household became more beggarly. Often it was only by toiling on his glebe, by feeding swine and by loading dung-carts, that he could gain his daily bread.... His sons followed the plough, and his daughters went out to service." Queen Elizabeth's physician in ordinary received one hundred pounds per annum and perquisites--"sustenance, wine, wax, and etceteras." Morgan, her apothecary, for one quarter's bill was paid £18 7_s._ 8_d._ A one pound fee, paid by the Earl of Cumberland to a Cambridge physician, was considered as exceptionally liberal, even for a nobleman to pay. Edward III. granted to his apothecary, who acted in the capacity of physician in those days, a salary amounting to six pence a day, and to Ricardus Wye, his surgeon, twelve pence per day, besides eight marks. (A mark was 13_s._ 4_d._) In the courts of the kings of Wales, the physicians and surgeons were the twelfth in rank, and whose fees were fixed by law. Dr. Caius was fortunate in holding position as physician to Edward VI., Mary, and Elizabeth. Sir Theodore Mayerne was still more fortunate in having the honor of serving Henry IV. and Louis XIII. of France, and subsequently King James I., Charles I. and II. of England. Mayerne has been the subject of many anecdotes, of which the following is a sample:-- [Illustration: AN OLD ENGLISH CLERGYMAN AND HIS FAMILY.] A parsimonious friend, consulting Mayerne, laid two broad pieces of gold (sixty shillings) on the doctor's table, to express his generosity, as he felt safe that they would be immediately returned to him. But Mayerne quietly pocketed them, saying,-- "I made my will this morning, and if it became known that I had refused a fee, I might be deemed _non compos mentis_." [Illustration: THE KING'S PHYSICIAN AND THE EXECUTIONER.] In 1700, graduated physicians' dues were ten shillings, licensed doctors, six shillings eight pence. A surgeon's fee was twelve pence per mile, be his journey long or short, and five shillings for setting a bone or dislocated joint, one shilling for bleeding, and five pounds for an amputation. All after attendance extra. ANECDOTE OF JAMES COYTHIER. This jolly doctor was employed by Louis XI., and was said to have sponged immense sums from his royal master, beyond a regular salary. "He wrung favor upon favor from the king, and if he resisted the modest demands of his physician, the latter threatened him with speedy dissolution. On this menace, the king, succumbing to the fear of death, which weakness characterized his family, would at once surrender at discretion." Finally, to rid himself of such despotic demands, the king ordered the executioner to behead the physician. The requisite officer waited on Coythier, and in a courteous and considerate manner, as became the occasion, said to him,-- "I deeply regret, my dear sir, the circumstance, but I must kill you. The king can stand you no longer, and here are my orders." "All right," replied the doctor, with surprising unconcern; "I am ready whenever you are. What time would you find it most convenient to perform the little operation?" While the officer was trying to decide, Coythier continued,-- "But I am very sorry to leave his majesty only for a few days; for I have ascertained by occult science that he can't survive me more than four days." The officer stood struck with amazement, but finally returned and imparted the astounding information to the king. "O, liberate him instantly. Hurt not a hair of his head," exclaimed the terrified monarch. Coythier was of course speedily restored to his place in the king's confidence--and treasury. A LONG FEE. Here is what may be called a _long fee_:-- An English surgeon, named Broughton, had the good fortune to open the commerce of the East Indies to his countrymen through a medical fee. Having been sent from Surat to Agra, in the year 1636, to treat a daughter of the emperor Shah Jehan, he had the great fortune to restore the princess. Beyond the present reward to the physician for his great services, the emperor gave him the privilege of a free commerce throughout the whole extent of his domains. Scarcely had Broughton returned than the favorite nabob of the province--Bengal--sent for the doctor to treat him for a very dangerous disease. Having fortunately restored this patient also, the nabob settled a pension upon the physician, and confirmed the privilege of the emperor, extending it to all Englishmen who should come to Bengal. Broughton at once communicated this important treaty, as it was, to the English governor at Surat, and, by the advice of the latter, the company sent from England, in 1640, the first ship to trade at Bengal. Such was the origin of the great Indian commerce, which has been continued to the present day,--the longest continued doctor's fee ever given. Another long fee was that given to Dr. Th. Dinsdale, who travelled from England to St. Petersburg by order of Catharine of Russia, to inoculate her son, the baron of the empire. The empress presented him with a fee of twelve thousand pounds, and a life pension of five hundred pounds. This is the largest sum ever paid to any physician since the world began, for a single operation, and I know of no physician who ever made a longer journey to attend a patient. A SHORT FEE. This is how a physician fell short of his fee. Charles II. was taken suddenly and dangerously ill with apoplexy. The court physician being out of town, Dr. King, who only being present, with one attendant, instantly bled his majesty, to which "breach of court etiquette" John Evelyn attributes his salvation for the time; for he would certainly have died, had Dr. King staid the coming of the regular physician--for which act he must have a regular pardon! The privy council ordered a handsome fee to be paid Dr. King for his great presence of mind and prompt action, but it never was paid. Charles died soon afterwards, and poor King fell short of a fat fee. ODD FEES. Amongst the many funny things told about Sir Astley Cooper, the eminent English surgeon, none is better authenticated than that respecting the "night-cap fee." In his earlier practice, he had to pass through all the trials and tribulations, "anxious and ill-rewarded waitings," that lesser stars have before and since, and ever will, before he became "established." In his first year's practice in London, his profits were but five guineas; his second reached the encouraging sum of twenty-five pounds, and increased in this ratio till the ninth year, when it was one thousand pounds. In one year he made twenty-one thousand guineas. It is said that one merchant of London paid him annually six hundred pounds. It wouldn't require but a few such lucrative patients to keep a doctor in pocket money even at this day. A West India millionnaire, named Hyatt, had been to London, and undergone a severe and dangerous surgical operation at the hands of Sir Astley, assisted by Drs. Lettsom and Nelson. The operation proved a success, and the grateful patient only waited till he could sit up in bed a little while at a time before expressing in some measure his gratitude to the physicians. All three being present one day, Hyatt arose in bed and presented the two physicians with a fee of three hundred gold guineas, and, turning to Sir Astley, who seemed for a moment to have been slighted, the millionnaire said,-- "And as for you, Sir Astley, you shall have nothing better than that," catching off his night-cap, and flinging it almost into Sir Astley's handsome face--he was said to be the handsomest man in England; "there, take it, sir." "Sir," exclaimed the surgeon, with a smile, "I pocket the affront." On reaching home, and examining the night-cap, he found it contained one thousand guineas--nearly five thousand dollars. AN OLD SHOE. Quite as odd a fee was that presented to a celebrated New York surgeon about the year 1845. An eccentric old merchant, a descendant of one of the early Dutch families of Manhattan Island, was sick at his summer residence on the Hudson, where his family physician attended him. The doctor gave him no encouragement that he ever would recover. A most celebrated surgeon, since deceased, was called as counsel, who, after careful examination of the case, and considering the merchant's age, coincided with the opinion of the family physician, and so expressed himself to the patient. "Well, if that is all the good you can do, you may return to New York," said the doomed man. But as the astonished surgeon was going out of the house, the invalid sent a servant after him, in haste, saying,-- "Here, throw this old shoe after him, telling him that I wish him better luck on the next patient;" and drawing off his embroidered slipper, he gave it to the servant, who, well used to his master's whims, as well as confident of his generosity, ran after the doctor, flinging the shoe, and giving the message, as directed. The surgeon felt sure of his fee, well knowing the ability of the eccentric merchant; but he picked up the shoe, and placing it in his coat pocket, said to his brother physician, who accompanied him, "I'll keep it, and I may get something, to _boot_." [Illustration: A SLIPPER-Y FEE.] It contained, stuffed into the toe, a draft for five hundred dollars. A BLACK FEE. Dr. Robert Glynn, of Cambridge, England, who died nearly eighty years ago, was a most benevolent man, as well as a successful medical practitioner, with a large revenue. Mr. Jeaffreson tells the following amusing story about him:-- "On one occasion a poor peasant woman, the widowed mother of an only son, trudged from the heart of the fens (ten miles) into Cambridge, to consult the good doctor about her boy, who was very sick with the ague. Her manner so interested the doctor that, though it was during an inclement winter, and the roads almost impassable by carriages, he ordered horses harnessed, and taking in the old lady, went to see the sick lad. "After a tedious attendance, and the exhibition of much port wine and bark, bought at the physician's expense, the patient recovered. A few days after the doctor had taken his discharge, without fees, the poor woman presented herself at the consulting-room, bearing in her hands a large basket. "'I hope, my good woman, your son is not ill again,' said the doctor. "'O, no, sir; he was never better,' replied the woman, her face beaming with gratitude; 'but he can't rest quiet for thinking of all the trouble you have had, and so he resolved this morning to send you this;' and she began undoing the cover of the large wicker basket which she had set on the floor. The doctor stood overlooking the transaction in no little concern. Egress being afforded, out hopped an enormous magpie, that strutted around the room, chattering away as independent as a lord. "'There, doctor, it is his favorite magpie he has sent you,' exclaimed the woman, looking proudly upon the piece of chattering ebony. It was a fee to be proud of." A HEART'S OFFERING. The gratitude of the poor country lad for his recovery did not exceed, probably, that of a young girl, as related in the Montpelier papers, from one of which I cut the following:-- "A young girl, fourteen years of age, named Celia ----, called at the hotel to-day where Dr. C., with his family, is stopping, and presenting him with a bouquet of Mayflowers, said, 'I have no money to pay you for curing my head of scrofula, and I thought these flowers might please you.' This was truly the offering of a grateful heart; for her head _had been entirely covered by sores, from her birth_, and the doctor had cured it. Another journal said, in commenting upon it, 'This heart's offering deeply affected the doctor, to whom it was a greater reward than any money recompense could have been.' The doctor has the withered and blackened flowers and leaves pressed, and hung in a frame in his office, but the memory of the touching scene of their presentation will remain fresh within his heart forever." [Illustration: A LIVING FEE.] A STUFFED CAT-SKIN. An eccentric and parsimonious old lady, who died in a small village in the State of Maine, some twenty years ago, always kept a half dozen cats about the house. She was a dried-up-looking old crone, and some ill-minded people had gone so far as to call her a witch, doubtless because of her oddities and her cats, "black, white, and brindled." When one of these delightful night-prowlers departed this life, the old lady would have the skin of the animal stuffed, to adorn her mantel shelf. My informant said he had once seen them with his own eyes, arranged along on the shelf, some half score of them, looking as demure and comfortable as a stuffed cat could, while the old woman sat by the fireplace, croning over her knitting work. [Illustration: STUFFED PETS.] The woman paid no bills that she could avoid, always pleading poverty as her excuse for the non-fulfilment of her responsibilities. One dark and stormy night she was taken very sick, and by a preconcerted signal to a neighbor,--the placing of a light in a certain window,--help was summoned, including the village doctor, to whom she owed a fee for each visit he had ever made her. But this was fated to be the doctor's last call to that patient. "O, doctor, then I am dying at last--am I?" The physician assured her such was the case. "Then, doctor, I must tell you that you've been very patient with me, and have hastened day or night to see me, in my whims, as well as my real sickness, and you shall be rewarded. I have no money, but you see all my treasures arranged along on the mantel-piece there?" "What!" exclaimed the doctor; "you don't call those cats treasures, I hope!" "Yes, they are my only treasures, doctor. Now, I want to be just to _you_, above all others, because you've not only served me as I said, but you've often sent me wood and provisions during the cold winters--" Here she became too feeble to go on, and the doctor revived her with some cordial from his saddle-bags, when she took breath, and continued,-- "See them, doctor; eleven of them. Which will you choose?" The doctor, with as much grace as possible, declined selecting any one of the useless stuffed skins; when the old lady, by much effort, raised her head from the pillow, and said, "Well, I will select for you. Take the black one--take--the black--cat--doctor!" and died. Her dying words so impressed him, that he took the cat home, and, on opening her,--for it was very heavy,--he found that the skin contained nearly a hundred dollars, in gold. AMERICAN FEES AND INCOMES. There is a surgeon in New York city whose income from practice outside of the hospital is said to be twenty-five thousand dollars per annum. Dr. Valentine Mott, the celebrated New York surgeon, who died April 26, 1865, at the age of eighty-one years, had a very large income, but less than that enjoyed by several surgeons in the metropolis at the present time. There are some specialists in New York, Philadelphia, and Boston, who receive greater sums annually than the regular medical or surgical practitioners. There is no law particularly controlling the prices of the former. The fee for a visit, by the established usage of the medical societies in these cities, is from three to ten dollars. A specialist sometimes receives fifty to one hundred dollars for prescribing in a case, for which another physician, in ordinary practice, would charge but an office fee of two to ten dollars. A quack specialist--and an impostor--in the latter city makes his brags that he has received twelve hundred dollars for one prescription. But then this same lying braggadocio says he has read medicine with Ricard, and had various honors conferred upon him. Dr. Pulte, of Ohio, one of the western pioneers in homeopathy, who has often been greeted, in his earlier professional rounds, by a shower of dirt, rotten eggs, stones, brickbats, and had rails and sticks thrust through his carriage wheels at night, and been otherwise insulted, until, finally, he had to carry his wife about with him, as a protective measure,--for his revilers would not insult a lady,--has since made as high as twenty thousand dollars a year, and has amassed a fortune of two hundred thousand dollars. There is a Boston homeopathist whose income from practice is not less than twenty to twenty-five thousand dollars annually. Some of the surgeons (allopathic) do better, but hardly reach the figures of Dr. Nelaton, the great French surgeon, who, in 1869, earned four hundred thousand francs, equal to about eighty thousand dollars. [Illustration: A PIONEER OF HOMEOPATHY.] Dr. Bigelow, the very celebrated surgeon of Harvard College, has probably received the largest fee for a surgical operation of any New England practitioner. He is said to be worth nearly a million. Dr. Buckingham, the eminent medical practitioner, of Boston, who probably earns as much as any physician in the city, a few years ago stated to the graduating class of Harvard College--so I am informed by a physician then present--that he received for his first year's practice in Boston _but fifty-seven dollars_. He then had a little office up stairs, where he slept, dined,--often on bread and cheese, or a few crackers; sometimes he did not dine,--and received his few patients. But he was a great student, and a hard worker, and often, and usually, stuck to his post during those hours when more prosperous physicians were seeking amusement or relaxation. He was one of the "_hold-fast_" kind, who always win, in the end. "_Catch what you can._"--There is a class of wretches in every city who have no established fee for prescribing for the sick. They go on the principle of "catch what I can." If they cannot get a fee of twenty dollars, they will take two, provided the patient has no more. A young man who visited one of these medical shave-shops was charged a fee of thirty-five dollars in a very simple case; but the benevolent doctor concluded to accept two dollars and a half instead, since the man had no more money. The shamefulness of such Jewing reminds one of the story of a negro trading off a worn-out old mule:-- "I say, dar, what will you take for dat yer mule, Cuffy?" "O, I axes thirty-five dollars for him, Mr. Sambo." "O, go way, dar. I gibs you five dollars for him," said the first. "Well, you can take him, Sambo. I won't stand for thirty dollars on a mule trade, nohow." There is a female practitioner in St. Louis who earns above ten thousand dollars a year, and her individual fees are moderate at that. Another doctress, Mrs. Ormsby, of Orange, N. J., accumulates some fifteen thousand a year, and is in turn outstripped by another woman practising in New York, who gets nearly twenty thousand dollars a year. Such certainly possess great business tact, with or without professional merit, and for such let all men give them credit. Several female doctors in Boston receive from three to five thousand dollars each, yearly. It is too often the case that a physician's success is reckoned, like a tradesman's, by what he has gained in a pecuniary point of view. There are, however, thousands of worthy men, successful with their cases, who, from less acquisitiveness than benevolence, have failed in securing more than a bare competence, through a life devoted to their profession. [Illustration: A SHARP MULE TRADE.] I presume nearly every physician who has experienced a dozen years in practice has some mementos of his poor patients' gratitude, in the form, if not of an ebony bird, or a black cat-skin, of something possessing more beauty, and, to the benevolent heart, which always beats within the breast of every true physician, keepsakes prized above gold and silver. "Who has not kept some trifling thing, More prized, more prized, than jewels rare, A faded flower, a broken ring, A tress of golden hair, a tress of golden hair?" A very benevolent physician, and a sexagenarian, of New York city, wrote, twenty years ago, "I even yet enjoy a sort of melancholy satisfaction in hastening to relieve the suffering poor of my neighborhood, though I know that my reward will be very small, or, what is far more frequent, that I shall be paid with ingratitude, if not slander. "Sometimes there are bright spots in my horizon, and I think myself more than repaid by a new shirt, or a couple of handkerchiefs--the gift of some poor, though grateful sewing girl. A few of these little treasures I prize with peculiar tenderness." "A tress of hair and a faded leaf Are paltry things to a cynic's eyes: But to me they are keys that open the gates Of a paradise of memories." ASKING FOR A FEE. A Boston M. D., who had been in practice fourteen years without accumulating any property, was about to abandon the profession, and, with this view, he applied to Fowler, the phrenologist, with the question, "What pursuit am I best adapted to follow?" Mr. Fowler, with whom he was unacquainted, said, "The practice of medicine;" but, at the same time, he assured the doctor that he ought to do business on a _cash_ principle,--"_accipe dum dolet_,"--or employ a collector, as he would never collect his fees. Acting on this hint, the doctor returned to his practice, and in a few years was out of debt, and owned a fine residence. In the matter of collecting fees only he was deficient. A New York student--if report is true--began earlier to be impressed with the propriety of getting his fee in advance, as the following will show. He went before the censors for examination. One of the board was a well-known penurious, fee-loving doctor, who, looking over the list of names of the applicants, said,-- "Mr. ----, if a patient came to your office, what would you first do?" "I would ask him for a fee, sir," was the prompt reply. An old navy surgeon relates the following regarding examinations:-- "I was shown into the examining-room. Large table, and a half dozen old gentlemen at it. 'Big wigs, no doubt,' I thought, 'and, sure as my name is Symonds, they'll pluck me like a pigeon.' "'Well, sir, what do you know about the science of medicine?' asked the stout man in the head seat. "'More than he does of the practice, I'll be bound,' tittered a little wasp-like dandy--a West End ladies' doctor. "I trembled in my shoes. "'Well, sir,' continued the first, 'what would you do if during an action a man was brought to you with both arms and legs shot off? Now, sir, speak out; don't keep the board waiting. What would you do?' "'By Jove, sir,' I answered, 'I would pitch him overboard, and go on to some one else to whom I could be of more service.' "By thunder! every one present burst out laughing, and they passed me directly--passed me directly." DELICATE FEES. There are certain delicate cases, usually terminating in "good news," in which it has long been an established custom for the physician to receive a double fee. "A father just presented with an heir, or a lucky fellow just made one, is expected to bleed freely for the benefit of the faculty." Even the Irish, who, in about all other cases, calculate on "cheating the doctor to pay the priest," will usually lay by a little sum from their penury, or their bank hoardings, as the case may be, "to pay the doctor for the babbie." We insert the following poetry (!) for the fun of the thing; nevertheless, it is within the experience of more than one physician, who, after doing his duty, exhibiting his best professional ability, and saving the wife of some miserable, worthless fellow, who never deserved such a godsend for a companion, has cheated the doctor out of his fees from spite, when, if the poor woman had died, he would have liberally paid the physician. Let no man take this to himself. "A woman who scolded one day so long Quite suddenly lost all use of her tongue! The doctor arrived, who, with 'hem and haw,' Pronounced the affection a true locked jaw. "'What hopes, good doctor?' 'Very small, I see.' The husband (quite sad) slips a double fee. 'No hopes, _dear_ doctor?' 'Ahem! none, I fear.' Gives another fee for an issue clear. "The madam deceased. 'Pray, sir, do not grieve.' 'My friends, one comfort I surely receive-- A fatal locked jaw was the only case From which my dear wife could have died--in peace.'" "MAKE THE MOST OF HIM." It has been said that physicians have been known to benevolently play a fee into a brother's hand when their own palm failed to be broad enough to hold them all. Perhaps the reader may derive amusement or instruction from the following, in which case the writer is well repaid for their insertion:-- "A wealthy tradesman, after drinking the waters of the Bath Springs a long time, under advice of his physician, took a fancy to try those of Bristol. Armed with an introductory letter from his Bath doctor to a professional brother at Bristol, the old gentleman set off on his journey. On the way he said to himself,-- "'I wonder what Dr. ---- has advised the Bristol physician respecting my case;' and giving way to his curiosity, or anxiety, he opened the letter, and read,-- "'DEAR DOCTOR: The bearer is a fat Wiltshire clothier; _make the most of him_. Yours, professionally, ----.'" Clutterbuck, the historian, and a pleasant writer, tells the following of his uncle, who was a physician:-- "A nervous old lady, a patient of his, took it into her crotchety old head to try the Bath waters, and applied to her physician for permission. "'The very thing I have been thinking to recommend,' he replied; 'and I know an excellent physician at the wells, to whom I will give you a letter of introduction.'" With her letter and a companion, she started for the springs. _En route_ she took out the letter, and, after looking at the address some time, her curiosity overcame her, and she said to her friend, "So long as the doctor has treated me, he has never told me what my case is, and I have a mind to just look into this letter and see what he has told the Bath physician about it." In vain her friend remonstrated against such a breach of trust. The old lady opened the epistle, and read the following instructive words:-- "DEAR SIR: Keep the old woman three weeks, and send her back." [Illustration] XVI. GENEROSITY AND MEANNESS. "Life's better joys spring up thus by the wayside, And the world calls them trifles. 'Tis not so. Heaven is not prodigal, nor pours its joys In unregarded torrents upon man: They fall, as fall the riches of the clouds Upon the parched earth, gently, drop by drop. Nothing is trifling which love consecrates."--AYLMERE. "The art of our necessities is strange."--KING LEAR. THE WORLD UNMASKED.--A ROUGH DIAMOND.--DECAYED GENTILITY.--"THREE FLIGHT, BACK."--SEVERAL ANECDOTES.--THE OLD FOX-HUNTER.--"STAND ON YOUR HEAD."--KINDNESS TO CLERGYMEN.--RARE CHARITY.--OLD AND HOMELESS.--THE "O'CLO'" JEW.--DR. HUNTER'S GENEROSITY.--"WHAT'S THE PRICE OF BEEF?"--A SAD OMISSION.--INNATE GENEROSITY.--A CURB-STONE MONEY-MANIAC.--AN EYE-OPENER.--AN AVARICIOUS DOCTOR.--ROBBING THE DEAD. Side by side, hand in hand, through the world, go generosity and meanness. If these could but be personified, and the individuals compelled to stand before men in broad daylight, O, what a staring would there be! Those whom we thought the very embodiment of generosity and kindness would "crop out" in their true hideousness of character--unmasked meanness and selfishness; yes, men too high in the estimation of the world, in church and in state. On the other hand, we should be equally astonished to find amongst those in the humbler walks of life, as well as some in the more exalted, people, whom the world counted as mean and penurious, now standing forth adorned in robes bleached like the snow-drift, shining bright as the golden sunrise, yet blushing to find that their hidden charities, and secret, self-denying generosities, had been suddenly brought to light. And when the secret works of this world shall be revealed, no class of men will stand forth more blessed in deeds of generosity and self-sacrifice than the physicians. There is an occasional black sheep in the great flock. A ROUGH DIAMOND. There is no better authority for the truth of the many queer stories told about the rough benevolence of Dr. Abernethy, the great English surgeon, than the author of his memoirs--Sir George Macilwain. [Illustration: PHYSICIANS' CHARITY.] "His manner [Dr. Abernethy's], as we shall admit, was occasionally rough, and sometimes rather prematurely truthful. One day he was called in consultation by a physician to give an opinion in a case of a pulsating tumor, which was pretty plainly an aneurism. On proceeding to examine the tumor, he found a plaster covering it. "'What is this you have on it?' asked Abernethy. "'O, that is only a plaster.' "'Pooh!' exclaimed the doctor, pulling it off and flinging it aside. "'The "pooh" was all well enough,' said the attending physician, afterwards, 'but it took several guineas out of my pocket.'" "UP THREE PAIR, BACK." A surgeon--pupil of the above--was requested to visit a patient in a low quarter of the suburbs of the metropolis. When he arrived, and mounted several flights of crazy stairs, he began searching for the designated number, which was so defaced by time that he was only enabled to determine it by the more legible condition of the next number. [Illustration: SEARCH FOR A PATIENT.] An old woman answered the shake of the dilapidated knocker. "Does Captain Blank live here?" "Yes, sir,"--trying to penetrate the darkness. "Is he at home?" "Yes, sir. Please, may I make so bold as to ask, are you the doctor?" "Yes." "O, then please to walk in, sir." In the ill-furnished, narrow room sat an old man, in a very shabby and variegated _déshabille_, who rose from his chair, and, with a grace worthy of a count, welcomed the stranger. His manner was extremely gentlemanly, his language well chosen, and the statement of his complaint particularly clear and concise. The surgeon, who like most of us see strange things, was puzzled to make out his new patient, but concluded that he was one of the many who, having been born to better things, had become reduced by misfortune to these apparently very narrow circumstances. Accordingly, having prescribed, the surgeon was about taking his leave, when the gentleman said,-- "Sir, I thank you very much for your attention," at the same time offering his hand with a fee. The benevolent surgeon declined the fee, simply saying,-- "No, I thank you, sir. I hope you will soon be better. Good morning." "Stay, sir!" exclaimed the old gentleman. "I shall insist on this, if you please," in a tone which at once convinced the surgeon that it would be more painful to refuse than accept the fee; he accordingly took it. "I am very much obliged to you, sir," the old gentleman then said; "for had you not taken your fee I could not have again had the advantage of your advice. I sent for you because I had understood that you were a pupil of Dr. Abernethy's, for whom I could not again send, _because he would not take his fee_, and I was so hurt that I am afraid I was rude to the good man. I suppose he, judging from the appearances of things here, thought I could not afford it, hence refused the fee, on which I begged him not to be deceived by appearances, but take the fee. However, he kept retreating and declining, till, forgetting myself a little, and feeling vexed, I said, 'By G----, sir, I insist on your taking it,' when he replied as fiercely, 'By G----, sir, I will not,' and hastily left the room, closing the door after him." This gentleman lived to the age of ninety. He was really in very good circumstances, but lived in this humble manner to enable him to assist very efficiently some poor relatives. The surgeon, after a while, changed his professional visits to friendly ones, and continued them up to the old man's death. When, however, the gentleman died, about four hundred guineas were found in his boxes. Sometimes Dr. Abernethy would meet with a patient who would afford a useful lesson. A lady, wife of a distinguished musician, consulted him, and, finding him uncourteous, said,-- "Sir, I had heard of your rudeness before I came, but I did not expect this." When Dr. Abernethy gave her the prescription, she asked,-- "What am I to do with this, sir?" "Anything you like. Put it into the fire if you choose." The lady laid the fee on the table, went to the grate, threw the prescription on to the fire, and hastily left the room. The doctor followed her to the hall, earnestly pressing her to take back the fee, or permit him to write her another prescription; but the lady would not yield her vantage-ground, and so withdrew. The foregoing is well authenticated. Mr. Stowe, the informant, knows the lady well. [Illustration: AN ECCENTRIC PATIENT.] [Illustration: A WOMAN'S REBUKE.] THE OLD FOX-HUNTER. Sometimes, again, the ill usage was all on one side. We know a hard-drinking old fox-hunter who abused Dr. Abernethy roundly; but all that he could say against him was this:-- "Why, sir,--will you believe me?--almost the first words he said, as he entered my room, was, 'I perceive you drink a good deal.' "Now," continued the patient, very _naïvely_, "supposing I did, what the devil was that to him?" Another gentleman, who had a most unfortunate appearance on his nose, exactly like that which accompanies dram-drinking, used to be exceedingly irate against Dr. A. because, when he told the doctor that his stomach was out of order, Abernethy would reply,-- "Ay, I see that by your nose." THE DUKE, OR THE POOR GENTLEMAN. One day, just as Dr. Abernethy was stepping into his carriage to make a professional visit to the Duke of W., to whom he had been called in a hurry, a gentleman stopped him to say that the ----, at Somers Town (mentioning a poor gentleman whom he had visited without fee), would be glad to have him visit him again at his leisure. "Why, I cannot go now," Dr. Abernethy replied, "for I am going in haste to see the Duke of W." Then, pausing a moment before stepping into his carriage, he looked up to the coachman, and quietly said, "To Somers Town." The fidgety irritability of his first impression at interference, and the beneficence of his second thought, were very characteristic of Dr. Abernethy. A pupil, who wished to consult him one day, took the very inauspicious moment when the doctor (and professor) was looking over his papers, but a few moments before lecture, in the museum. "I am fearful, sir, that I have a polypus in my nose, and want you to look at it," said the student. The doctor made no reply; but when he had completed the sorting of his preparations, he said, looking up,-- "Eh?" To which the pupil repeated his request. [Illustration: AFRAID OF A POLYPUS.] "Then stand on your head; don't you see that all the light here comes from the skylight? How am I to look into your nose?" (This was true, for there were no side-lights in the amphitheatre.) "Where do you live?" continued the doctor. "Bartholomew Close, sir." "At what time do you get up?" "At eight." "You can't be at Bedford Row" (where Abernethy resided) "at nine, then?" "Yes, sir, I can." "To-morrow morning, then." "Yes, sir; thank you." The pupil was punctual. Dr. Abernethy made a very careful examination of his nose, found nothing of the nature of polypus, made the pupil promise never to look into his nose again, and he, in after years, said, that there never was anything the matter. Dr. Abernethy never took a fee from a student, brother doctor, nor full fee from a clergyman. His great labors seemed to be in the hospitals, and on his resignation as surgeon to St. Bartholomew, he presented for its use five hundred dollars. He never neglected his poor hospital patients for the richer ones outside. One morning, on leaving his house for a visit to the hospital patients, some one wished to detain him, when he exclaimed, in terms more earnest than elegant,-- "Private patients may go to the devil" (or elsewhere, another reports), "but the poor fellows in the hospital I am bound to care for." To poor students whose funds were "doubtful," he presented free tickets to his college lectures, afterwards showing them marked attention. Everybody has heard of his rude kindness to a young fashionable miss, whom her mother took to Abernethy for treatment. It is said that the doctor ran a knife under her belt, in presence of the mother, instantly severing it, and exclaiming,-- "Why, madam, don't you know there are upwards of thirty yards of ----" (what are more elegantly termed bowels) "squeezed under that girdle? Go home, give nature fair play, and you'll have no need of a prescription." [Illustration: ABERNETHY'S SURGICAL OPERATION.] KINDNESS TO CLERGYMEN. "Cynics have been found in plenty to rail at physicians for loving their fees; and one might justly retort that the railers love nothing but their fees. Who does not love--and who is not entitled to--the sweet money earned by labor, be it labor of hand, brain, or cloth? One thing is sure--doctors are unpaid."--_A Lawyer._ The above kind-hearted physician, having attended the child of a clergyman's widow, without knowing her situation, returned all the fees he had received from her when he learned who she was, and added, in a letter, fifty pounds besides, with instructions to expend it in daily rides in the open air, for her health. To a clergyman he sent a receipt for his long services, and also enclosing ten pounds. The generosity of Dr. Wilson, of Bath (now deceased), has before been recorded. He had been attending a clergyman, who, Wilson had learned, was in indigent circumstances, and he afterwards sent fifty pounds in gold to the minister, by a friend. "Yes, I will take it to him to-morrow," said the gentleman. "O, my dear sir," exclaimed Dr. Wilson, "take it to him to-night. Only think of the importance to an invalid of one good night's rest." RARE CHARITY. Another case of "three pair, back," occurs in the memoirs of Dr. Lettsom, who is already made mention of in this work. On one of his benevolent excursions, the doctor found his way into the squalid garret of a poor old woman who had evidently seen better days. With the refined language and the easy deportment of a well-bred lady, she begged the physician to examine her case, and give her a prescription. (Alas! how often is poverty mistaken for disease, and does want foster malady!) But the kind doctor, after a careful inquiry, formed a correct diagnosis, and wrote on a slip of paper he chanced to have about him, the following brief note to the overseers of the parish:-- "A shilling per diem for Mrs. Moreton. Money, not physic, can cure her. LETTSOM." A shilling, in those days, was considered no mean sum per day. "Alas for the rarity Of Christian charity Under the sun! O, it was pitiful! Near a whole city full, Home she had none. "Sisterly, brotherly, Fatherly, motherly Feelings had changed; Love, by harsh evidence, Thrown from its eminence, Even God's providence Seeming estranged." "Alas, doctor," said an unfortunate old gentleman, some seventy-four years old,--a merchant ruined by the American war, bowed down by the weight of his misfortunes, and by disease,--to Dr. Lettsom, "those beautiful trees you may see out of my bedroom window I planted with these now feeble hands. I have lived to see them bear fruit; they have become as part of my family. But with my children still dearer to me, I must quit this dear old home, which was the delight of my youth and the hope of my declining years, and become a homeless, joyless wanderer in my old age." The benevolent Quaker doctor was deeply affected by these words, and the utter despair and hopelessness with which the weeping old man uttered them; and, speaking a few words of consolation to his unfortunate patient, he wrote a prescription, and hastily retired. On the old gentleman's examination of the remarkable looking recipe, he found it to be a check for a large sum of money. The benevolence of the physician did not end here. He purchased the residence and grounds of the old man's creditors, and prescribed them to him for life. (He is our young Quaker antipode, mentioned in another chapter.) The old apothecary, Sutcliff, was right when he said of young Lettsom, while his apprentice, "Thou may'st make a good physician, but I think not a good apothecary." An apothecary is not expected to give away his time or medicine. (They seldom disappoint one's expectations.) A grocer is not expected to give away flour, rice, sugar, tea, to even a starving, languishing neighbor; nor the baker, nor the butcher, to give bread or meat to the perishing. Why, such demands upon them daily would be laughed to scorn. But the physician! These very same niggardly men (individually) would berate the doctor, be he ever so needy, or be his family ever so large, who would accept a fee for even cold-night services to any but the richest patients. All physicians do not have access to the "richest patients." Many a good physician has been compelled to quit practice because of his too large "bump" of benevolence, and because of the limited amount of that article in his first few patients, while thousands of practitioners in this country struggle and labor on through a life of self-denial, wearing themselves out, dying prematurely, leaving their families penniless to the cold charities of an uncharitable world. (See Chapter XXX.) THE OLD JEW. "Ah me," exclaimed a Jew, one day, as he reluctantly drew out his wallet to pay three dollars for his examination, prescription, and advice, "if I could only make money like the doctors of mede_cene_! Ah me." Then, taking two dollars from his purse, he asked, "Won't that do?" This Jew was a merchant, reputed rich, and penurious as he was wealthy, and I demanded the accustomed fee. "Let me see," said he; "how many patients have you seen to-day?" "Nine," I replied. "Let me see," counting his fingers as a tally. "At least twenty-seven dollars a day, and nothing out but a bit of paper. Ah, I wish I had been a doctor in mede_cene_," he added, with a sigh, and a woful look at the money, as he reluctantly handed it over. This was casting pearls before worse than swine, prescribing for such a wretch. Brains, education, anxiety, all went for nought, with him. _Money_ was his all. A shilling before his eyes would shut out even God's sunlight. If the shilling only _shone_, _glistened_,--sunlight enough for such a wretch. [Illustration: RECKONING A DOCTOR'S FEES.] "Let _me_ see," I said, after his miserable body had taken his penurious soul out of my office; "nine patients, one three miles away. Horse-tire and carriage-wear, time, advice, and medicine given, because the patient was a widow. No. 2 patient, the sick child of an invalid mother; no fee. No. 3, an Irishman. The Irish never wish to pay anything; did pay one dollar. No. 4, a merchant. "Charge it." That was _his_ fee. No. 5, a young sewing girl, who, in sewing on army cloth, had sewed her life's blood into the seams. In consumption. Could I take her fee? God forbid. No. 6, a "lady," who, having so much upon her back, had nothing in her purse. I may get my fee at the end of the quarter. "You know my husband. Good morning." It was near two o'clock then. She had occupied my time a whole hour. My dinner was cold; my wife was out of sorts, waiting so long. Nos. 7 and 8, two sick children. Visit them daily; pay uncertain. The ninth was the wealthy Jew. Nine patients; four dollars! Don't I sometimes wish I kept an "O' clo'" store, like the old Jew? This actually occurred when I practised medicine in Hartford. [Illustration: PATIENT NUMBER FIVE.] DR. HUNTER'S GENEROSITY. No man cared _less_ for the profits of the medical profession, or _more_ for the honor thereof, than the great Dr. John Hunter. He was honest, honorable, and simple in his every day life. His works, which contributed more to the science of medicine than any other writings during a thousand years, were simply announced as by JOHN HUNTER. A plain door plate, with the same name, announced his residence. Money was a secondary consideration to him. The following shows that he desired a professional brother to so consider it:-- "DEAR BROTHER: The bearer needs your advice. He has no money, and you have plenty; so you are well met. "Yours, JOHN HUNTER." To a poor tradesman from whom he had received twenty guineas for performing a surgical operation upon his wife, he returned nineteen guineas, having learned with what difficulty and extreme self-denial the husband had raised the money. "I sent back nineteen guineas, and kept the twentieth," said he, in apology for retaining even the one, "that they might not be hurt with an idea of too great an obligation." Where is the other man, or class of men, who would have returned the money, honestly earned, as agreed upon beforehand, unasked? GENEROUS AT ANOTHER'S EXPENSE. It is all very nice when one can exercise a benevolent spirit, and not draw upon his own pocket. A well-authenticated story is repeated in this line of Dr. M. Monsey. Passing through a market one day, he noticed a miserable old woman looking wistfully at a piece of meat hanging just within a stall. "What is the price of this meat, sir?" she timidly inquired. "A penny a pound, old woman," replied the butcher, sneeringly, disdaining a civil answer to the wretched-looking woman, who probably had not a penny to pay for the chop. "Just weigh that piece of meat, my friend," said the doctor, who had been attentively watching the proceedings. The butcher cheerfully complied with the request of so respectable-looking a customer. "Ten pounds and a half, sir," replied the butcher. "There, my good woman," said the doctor, "hold up your apron;" and he dumped the whole into it, saying, "Now make haste home and cook it for your family." After blessing the very eccentric but benevolent old man over and again for the timely provision, she drew up the corners of the apron, and ran speedily down the market. "Here, my man," said the doctor, turning to the smiling butcher, "here is ten pence ha'penny, the price of your meat." "What? What do you mean?" asked the butcher. "I mean, sir, that I take you at your word. You said the meat was a penny a pound. At that price I bought it for the poor old woman. It's all I'll pay you. Good morning, sir." [Illustration: THE ASTONISHED BUTCHER.] I can imagine the "chop-fallen" butcher, standing, in his long frock, with a _beaten_ expression of countenance, alternating his gaze between the pence in his palm and the retreating form of the wigged and laughing old doctor. A REPORT ON TEETH. Many stories are told of the eccentricities of Dr. Monsey, and "No man could better gild a pill, Or make a bill, Or mix a draught, or bleed, or blister, Or draw a tooth out of your head, Or chatter scandal by your bed, Or tell a twister." Amongst the vagaries of Dr. Monsey, says Mr. Jeaffreson, was the way in which he proceeded to extract his decaying teeth. Around the tooth sentenced to be uprooted he fastened securely a strong piece of cord, or violin string, to the other end of which he attached a bullet. He then proceeded to load a pistol with powder and the bullet. By merely pulling the trigger of the pistol, the operation was speedily and effectually performed. It was seldom, however, that the doctor could induce his patients to adopt this original mode of extracting undesirable achers. One gentleman, who had agreed to try this novel process upon a tooth, got so far as to allow the whole apparatus to be adjusted, when, at the very last instant, he exclaimed,-- "Stop, stop! I have changed my mind--" "I haven't, though; and you're a fool and a coward, and here's go," which saying, the doctor pulled the trigger. "Bang!" went the pistol, and out flew the tooth, to the delight and astonishment of the patient. Taking this anecdote alone, it is scarcely credible; but considered in connection with what we have already selected from the life of Dr. Monsey, and what we may write of his eccentricities in our chapter under that head, this may be believed as being nearly correct. [Illustration: MODERN IMPROVEMENTS IN DENTISTRY.] [Illustration: CHARITY NOT SOLICITED.] A SAD OMISSION. Believing, as I do, that every reader of these pages is personally cognizant of the fact of the true benevolence of our present American physicians, and because of the silence of the few biographers respecting the generosities and benevolent deeds of those "who have gone before," I have devoted more space to anecdotes of English surgeons and physicians than I otherwise would. I have searched throughout four volumes of biographies of American physicians without being able to find a single anecdote of generosity recorded therein worthy of notice. Also in the "Lives of Surgeons ----" I have to regret this almost unpardonable neglect. I am assured from my personal knowledge of some of these latter that there are a thousand instances, which, in justice to their benevolence, ought to be put upon record, as they are engraven upon the hearts of their suffering fellow-creatures, and not for the aggrandizement of the generous bestower so much as an example for the cynical and the uncharitable world. A physician has just left my presence who has given away more than he has ever received from his practice. The good physician is always generous. A mean-souled man cannot become a successful practitioner. His success with his patients depends as much, or more, upon the kindly influences that beam from his eye, that flow from his soul, as upon the medicine that he deals out from his "saddle-bags." Generosity and kindness are innate to the man. They require little cultivation. The following amusing anecdote from "Every Saturday," I have reason to believe, has reference to one of our best physicians, who is also a man of letters, and illustrates my assertion:-- "INNATE GENEROSITY." "One hot August afternoon a gentleman, whose name attached to a check would be more valuable to the reader than if written here, was standing in front of the Revere House, waiting for a Washington Street car. He was a slim, venerable gentleman, with long white hair, and a certain dignity about him which we suppose comes of always having a handsome balance in the bank, for we never knew a poor man to have this particular air. It was a sultry afternoon, and the millionaire, standing on the curb-stone in the shade, had removed his hat, and was cooling his forehead with his handkerchief, like any common person, when the Cambridge horse-car stopped at the crossing at his feet. From this car hastily descended a well-known man of letters, whose pre-occupied expression showed at once that he was wrestling with an insubordinate hexameter, or laying out the points of a new lecture. Suddenly he found himself face to face with a white-haired old man, dejectedly holding a hat in one hand. As quick as thought the poet--to whom neither old age nor young appeals in vain--thrust his hand into his vest pocket, and, dropping a handful of nickel and fractional currency into the extended hat, passed on. The millionaire gazed aghast into the hat for an instant, and then inverted it spasmodically, allowing the money to drop into the gutter, much to the amusement of a gentleman and a tooth-pick on the steps of the Revere House, and very much more to the amusement of another party, who chanced to know that the supposed mendicant and the man of letters had been on terms of personal intimacy these twenty years." A CURB-STONE MONEY-MANIAC. A man may possess large acquisitiveness and benevolence at the same time, like Sir Astley Cooper, and succeed both pecuniarily and professionally. Such are, however, scarce. Those with an excess of the grasping principle in their composition illustrate the truth that "where the treasure is the heart will be also." Asleep or awake, drunk or sober, such men never lose sight of the almighty dollar. The annexed story, though irreverent to the doctors, is not irrelevant to the case:-- During the late "panic," a fellow, whose prominent feature was in his Jewish nose, which presented the sign of acquisitiveness by the bridge widening on to the cheeks above the _alæ_,--all men noted for accumulating have this sign, hung out by nature as a warning to the unwary,--was making a great noise, as he clung to a friendly lamp-post, to which he was arguing the state of the money market. "Come, sir, you are making too much noise," said a policeman. [Illustration: CAPTURE OF A WALL STREET BULL.] "Me? No, 'tain't me that's--hic--making the noise; it's the bulls--the bulls, sir; them's what's making all the noise," replied the fellow, skewing first one side of the post, then the other, trying to get a view of his new intruder. "You are tight, sir--tight as a peep," continued the watchman. "Me tight? No, sir; it's the money-market what's--ti--tight," replied the gentlemanly dressed individual, though much the worse for bad whiskey. "Go down Wall Street, and Fisk and Vanderbuilt--all of 'em--will tell you so. Everybody says money is--hic--tight. I never was more loose in my--hic--life;" and he demonstrated the assertion by swinging very loosely around the lamp-post, and falling down. "There, you are down. Too drunk to stand up;" and the policeman helped him to his feet again, and walked him along towards the station. "No, sir. There you are wrong again; it's stocks that's down. It's the stockholders--hic--that's staggering along; they've fallen and skinned their noses on the curb-stone of adversity. There! don't you see them--crawling along?" "O, you've got the tremens. Come on," exclaimed the policeman. "Me? No; it's the shorts and bears what's got the dol--hic--lar--tremens. I've caught the pan--hics--panics, sir; that's all." The policeman thrust the money-maniac into a cell, and the last seen of him he leaned back against the wall, his feet braced out, while, hatless and the knot of his cravat round under his left ear, he stood arguing the money-market with an imaginary broker on the opposite side of his cell. AN "EYE-OPENER." "How much do you charge, sir?" asked a poor farmer, from Framingham, of a city doctor, who had just wiped a bit of dust from the eye of his son. "Twenty-five dollars, if you please," was the modest reply. "I cannot pay it, sir," said the poor man. "It only took you a half minute. Our doctor was not at home; but I didn't think you would charge me much, sir." So the M. D. very benevolently (?) accepted ten dollars--all the poor man had. Can you wonder, after reading this statement, the truth of which is easily avouched for, that this doctor owns a whole block--stores, hotel--and is immensely rich? From the English book "About Doctors," here are three anecdotes:-- Radcliffe, the humbug, with a great effort at generosity, had refused his fees for visiting a poor friend a whole year. On making a final visit, the gentleman said, presenting a purse,-- "Doctor, here I have put aside a fee for every day's visit. Let not your goodness get the better of your judgment. Take your money." The doctor took a look, resolved to carry out his attempt at benevolence, just touched the purse to restore it to his friend, when he heard "the chink of gold" within, and--put it into his pocket, saying,-- "Singly, I could have refused the fees for a twelvemonth, but collectively, they are irresistible. Good day, sir;" and the greedy doctor walked away with a heavier pocket and a lighter heart than he came with. On visiting a nobleman, Sir Richard Jebb was paid in hand three guineas when he, by right, expected five. The doctor purposely dropped the three gold pieces on the carpet, when the nobleman directed the servant to find and restore them; but Sir Richard still continued the search after receiving the three coins. "Are they not all found?" inquired the nobleman, looking about. "No, there must be two more on the carpet, as I have only three restored," replied the wily doctor. His lordship took the hint, and said, "Never mind; here are two others." [Illustration: DEATH'S FEE.] This sticking for a fee was all cast into the shade by the act of an "eminent physician of Bristol." The doctor, entering the bedroom immediately after the death of his patient, found the right hand clinched tightly, and, pulling open the fingers of the dead man, the doctor discovered that the hand contained a guinea. "Ah!" exclaimed the doctor to the servant and friends around him, "this was doubtless intended for me;" and so saying he pocketed the coin. "Three hungry travellers found a bag of gold. One ran into the town where bread was sold. He thought, 'I will poison the bread I buy, And seize the treasure when my comrades die.' But they, too, thought, when back his feet have hied, We will destroy him, and the gold divide. They killed him, and, partaking of the bread, In a few moments all were lying dead. O world, behold what ill thy goods have done! Thy gold thus poisoned two and murdered one." [Illustration] XVII. LOVE AND LOVERS. "No task is harder than that of writing to the ideas of another."--JOHNSON. _Duke._ "If ever thou shalt love, In the sweet pangs of it, remember me; For such as I am all true lovers are; Unstaid and skittish in all things else, Save in the constant image of the creature That is beloved.... My life upon it, young as thou art, thine eye Hath stayed upon some face that it loves; Hath it not, boy?" XANTIPPE, BEFORE JEALOUSY.--A FIRST LOVE--BLASTED HOPES.--A DOCTOR'S STORY.--THE FLIGHT FROM "THE HOUNDS OF THE LAW."--THE EXILE AND RETURN.--DISGUISED AS A PEDDLER.--ESCAPES WITH HIS LOVE.--ENGLISH BEAUS.--YOUNG COQUETTES.--A GAY AND DANGEROUS BEAU.--HANDSOME BEAUS.--LEAP YEAR.--AN OLD BEAU.--BEAUTY NOT ALL-POTENT.--OFFENDED ROYALTY.--YOUTH AND AGE.--A STABLE BOY.--POET-DOCTOR. An old lady once said, "I've hearn say that doctors either are, or are not, great experts in love affairs; I've forgotten which." Just so! "I would not be a doctor's wife for the world," I have heard many a lady affirm. True; for few doctors have had the misfortune (or folly) to select a jealous woman for a life companion. Socrates, the great philosopher, and physician of the mind, seems to have had the ugliest tempered woman in the world, whose very name, _Xantippe_, has passed into a proverb for a scolding wife; yet she was not jealous of her spouse, but was said to have sincerely loved him; and he bore her outbursts of temper only as a great philosopher could, which seemed not to have disturbed the equanimity of his living nor the humor of his dying. "Crito,"--these were his last words,--"Crito, forget not the cock that I promised to Esculapius!" Alas! an affecting satire on philosophy and physic. [Illustration: MY FIRST LOVE.] No; we find no cases to record of the jealousies of physicians, or their wives. All the jealousies of the former are spent on their professional brethren. It is a philosophical fact that physicians, of all men, seldom are involved in disgrace, quarrels, or litigations on account of love affairs. Yet they have affections, like other men, and above all men know how to appreciate affection and virtue in woman. FIRST LOVE--BLASTED HOPES. I know of a little episode in the early life of a doctor, whose name modesty forbids me to mention. Let me briefly state it in the first person. Ah, friend, if you and I should meet Beneath the boughs of the bending lime, And you in the same low voice repeat The tender words of the old love-rhyme, It could not bring back the same old time-- No, never. I was young when I first fell in love,--not above six years of age; but love is without reason, blind to age. The object of my first affection was my school-_mischief_, as I then called her, who was about twenty. The disparagement of years never entered my innocent noddle. I used to start for school a half hour before nine, and stop on the way at the squire's house, where Miss ---- boarded. O, with what joy I always met her! In summer she gave me roses from the beautiful great white rose-bushes in the squire's front yard; in autumn and winter, splendid red and green apples, from the orchard and cellar, and candy and kisses at all times. So I fell desperately in love with her. I was greatly shocked, and not a little piqued, when one day she, in cold blood, bade me good by, and went away with a tall man, with shocking red whiskers. That is all I remember about him. I, however, mourned her loss for years, although my appetite remained unimpaired--my parents said. "Like a still serpent, basking in the sun, With subtle eyes, and back of russet gold, Her gentle tones and quiet sweetness won A coil upon her victims: fold on fold She wove around them with her graceful wiles, Till, serpent-like, she stung amid her smiles." The next time I saw her was about ten years afterwards. O, with what pleasant anticipations I hastened to her house! I remembered her every look--her fair, intelligent face; her wavy black hair; her heavenly dark-blue eyes. O, I should know her anywhere! Her I never could forget. [Illustration: TEN YEARS LATER.] With these thoughts I confidently knocked at the door. "Is Miss ---- at home?" I inquired of the--servant, I supposed, who opened the door. Just then three or four dirty-looking little children ran screaming after the woman, calling out, "Marm, marm!" "Hush, children, hush!" said the female, and, turning again to me, said,-- "Whom did you inquire for?" pushing back one of the red-headed urchins. "Miss Mary ----, ma'am," I answered. "She once lived at Blue Hill." She gave a sickly-looking smile. She looked sick before; her cheeks all fallen in; her skimmed-milk colored eyes had a weary, anxious expression; and her thin, bony hands, resting on the door-latch, looked like a consumptive's, as she said,-- "When did you know her?" "O, but a few years ago, ma'am. Is she here? Does she live in _this house_?" I eagerly inquired. "Well," she replied, with another more sepulchral smile, "I was once Miss Mary ----. I married Mr. ---- ----, over ten years ago. My baby, here,"--presenting the second in size of the children to my view, a reddish-brown haired girl, quite unlike any one I had ever seen before, and wiping its nose with her calico apron,--"she is named for me, Mary ----. Won't you come in, sir?" No, I thought I would not stop. I didn't stop till I reached the hotel, where I had begged the stage-driver to wait for me but a half hour before, while I called upon the lovely Miss Mary ----. "O, sunny dreams of childhood, How soon they pass away! Like flowers within the wild wood, They perish and decay." A HANDY DOCTOR. A young physician was supposed to be "keepin' company" with a young lady. The matronly friend of the latter, having praised the young man from all points of view, returned one day from the death-bed of a friend, at which the physician had been present. She eulogized the living fully as much as the dead man, and finally turning to the girl, as if she had reached the _ne plus ultra_ of enthusiasm, she said, "Jane, he's the handsomest man I ever see fixin' round a corpse." A DOCTOR'S STORY. The writer is acquainted with a young physician, who read medicine with an old doctor, named Gitchel, or Twichel, of Portland, and commenced practice in his native village,--a great mistake for any practitioner to make,--and where he met with consequences natural to even a prophet, opposition and scandal. By some mistake, or, as his opponents charged, mal-practice, he lost a patient. Being, a few days later, in a shop in the next village, he was secretly informed that the "hounds of the law were after him--even at the next door, that very moment." Terrified beyond necessity, he caught up his medicine chest, and, climbing out of the back window, fled to the woods. In the village, at home, he had courted a lovely young girl, with whom he had exchanged vows. She knew the talk that was going on respecting the young doctor, but she believed it not, or, believing, clung the firmer to her pledges. [Illustration: FLIGHT OF THE DOCTOR.] "After night fell I left the woods, and took to the highway. To go home I was afraid. O, had I but braved the doctors, and defied the lawyers, all would have been well," he told me afterwards. "But I had received such ill treatment, been scandalized so severely, that I was cowed to the earth. I knew not if my life, my Angie, had also turned against me, when the news was spread that I had tacitly admitted my crime by fleeing. "I went to W., hundreds of miles away. I took a new name, and put out my shingle. I was at once patronized, and soon extensively; but I was morose and unhappy. I was offered a home and a wife. I had as good as a wife away in my far-off home; I was bound to her, and I _loved_ her as I _hated my own soul_! I dared not write to her, nor go to her. 'O, my God, what shall I do?' I cried, in my misery. He did not hear me, and I came to believe that _He was not_! "Thus a whole year wore away, and I had not heard from home. Finally, I determined to make an attempt to see my Angie. I had, after going to W., allowed my heavy beard to go uncropped, which I had never done at home. I wore no clothes that I brought away with me from home. I purchased a few knickknacks, put on a slouched hat, and appeared in my native village as a peddler. Unless my voice betrayed me, I had no fears of detection. To prevent this mishap I kept a silver coin in my mouth when talking. "I had called at several houses, but could learn nothing of my betrothed, without fear of exciting suspicion by too close inquiries. I therefore, unable longer to stand the suspense, entered her father's house. She and her mother only were at home. I could scarcely suppress my feelings as I beheld her, the idol of my heart. When I spoke, she started to her feet, and with staring countenance gazed fixedly upon me. Then she fell back into her chair. [Illustration: FLIGHT OF THE LOVERS.] [Illustration: THE LOVER AS A PEDDLER.] "My God, she did not know me. "The mother noticed how pale the girl looked, and proposed to get her a drink of water from the porch. "'No, no, I am not faint.' "'Yes, yes,' I articulated, with the coin in my mouth; 'get her some water.' "Away went the old lady, and, dropping my basket and spitting out the coin, I cried, 'Angie, Angie, bless you, my darling,' and fell kneeling at her feet. "'O, Charley, it is you,--the Lord be praised!--come at last.' "I sprang to my feet. There was time to say no more. The mother returned and looked wistfully about. "'I thought I heard some one saying, "Charley, Charley,"' she said, presenting the water to Angie, who was now flushed and excited. I was searching for my coin. "'O, the water is warm. Mother, dear, do go to the well in the yard, and get some fresh; and look to see if there is anybody outside calling.' And away went the old lady. "'Now, Charley, what brought you back? And why did you stay? And--' "'Wait, wait. Number nine boots brought me. I've come for you, Angie.' "'You will be arrested if you are seen here, I am afraid,' she said. "'Then meet me to-night at ---- Crossing, and fly with me.' "I then told her how I had lived, how I had suffered, and how much I loved her; and she consented to marry me, and secretly go away with me. But the difficulty now lay in getting a lawful man to marry us. The license could be bought; I was certain of that. So I went away and obtained it. I next hired a horse and carriage, and paid for it in advance, to go twelve miles. "'Aren't you Charley ----?' asked the stable man, eying me sharply, as I was about to drive away to get Angie, that night. "'Take this,'--and I gave him a gold piece,--'and ask no questions, nor answer any, till you see your horse and carriage safely back,' was my reply. "As we drove out of the village, I heard wagon wheels far behind us. Reaching the woods, I drove into a wood road, and the 'hounds of the ---- doctors' rode fiercely past. Angie trembled for my safety. I reached a cross road. The moon shone quite brightly, and, jumping from the buggy, I soon found, by the fresh track, which road they had taken. I took a different. So I reached a train that night, and rode till morning; arrived at W. the next, and was married." It was at W. that I found him first. He was smart. He had a good memory. He was a handsome man, full six feet in his stockings. In all, his address was not excelled by any physician with whom I have ever met. He is now an excellent physician and surgeon, in a large city, in good practice. When he returned on a visit to his native village, as he did last year, the affair had blown over; for after a man is honored abroad, he may become so at home,--seldom before. I wish him happiness and prosperity. "There is no greater rogue than he who marries only for money; no greater fool than he who marries only for love. I could marry any lady I like, if I would only take the trouble," Dr. Macilvain heard an old fellow say. Of course, nobody but a conceited old bachelor would have said that, who needs a woman to just take some of the self-conceit out of him. ENGLISH DOCTORS AS BEAUS. Some of the old English doctors were gay fellows amongst the ladies, according to the best authorities. Nevertheless, few men have arrived at eminence in the medical profession who were known to be afflicted with an overplus of romantic or sentimental qualities in their composition. It may be interesting, particularly to ladies, to know that the majority of those physicians who have arrived at the dignity of knighthood owe their elevation rather to the smiles of love than the rewards of professional efforts. "Considering the opportunities that medical men have for pressing a suit in love, and the many temptations to gentle emotion that they experience in the aspect of female suffering, and the confiding gratitude of their fair patients, it is to be wondered at that only one medical duke is to be found in the annals of the peerage." But the physician usually has quite sufficient self-control and honor about him, not only to keep his own tender sensibilities in subjection, but often to check those of his grateful and emotional female patient. Thackeray has said that "girls of rank make love in the nursery, and practise the arts of coquetry upon the page boy who brings up the coals and kindlings." In this connection Mr. Jeaffreson, whose narratives have the virtue of being true as well as interesting, says, "I could point to a fair matron who now enjoys rank and wealth among the highest, who not only aimed tender glances, and sighed amorously upon a young, waxen-faced, blue-eyed apothecary, but even went so far as to write him a letter proposing an elopement, and other merry arrangements, in which a 'carriage and four,' to speed them over the country, bore a conspicuous part." The "silly maiden" had, like Dinah, a "fortune in silver and gold," of about two hundred and fifty thousand dollars, and her tall, blue-eyed Adonis, to whom she made this _almost_ resistless proposal, was twice her age. But he was a gentleman of honor, and, being in the confidence of the family, he generously, without divulging the mad proposition of the fair young lady, induced the father to take her to the continent, for a twelvemonth's change of air and scenery. "What a cold-blooded wretch!" will some fair reader exclaim. "What a fool he was, to be sure!" says the bachelor fortune-seeker. Well, she didn't die for her first unrequited love, but married a "very great man," and became the mother of several children. And this is the way the fair heroine of this little story avenged herself upon this "Joseph amongst doctors." Very recently she manifested her good will to the man who had offered her what is generally regarded as the greatest insult a woman can experience, by procuring a commission in the army for his eldest son. It is interesting to note the various qualities which have attracted the attention, or love, of different sons of Æsculapius to female beauties. Sometimes it has been her hair, the "pride of a woman," that was the point of attraction, as it was with Dr. Mead, "whose highest delight was to comb the luxuriant tresses of the lady on whom he lavished his affections;" or the "eyes of heavenly blue," like the lady love's of Dr. Elliot, senior; or the tiny footprint in the sand, like that which first attracted Dr. Robert Ames to the woman of his choice. What the point of attraction was in the man is not easily ascertained. A gay and dangerous beau among the "high ladies" was Dr. Hugh Smithson, the father of James Smithson (his illegitimate son), the founder of the "Smithsonian Institution" at Washington. Sir Hugh's forte lay in his remarkably handsome person, said to be only second to Sir Astley Cooper in beauty of form and features. However, he had the address which secured to him one of the handsomest and proudest heiresses of England, and this is how he accomplished it. He was but the grandson of a Yorkshire baronet, "with no prospects," and was apprenticed to an apothecary, and for a long time paid court to mortar and pestle at Hutton Garden. The story runs, that the handsome doctor had been mittened by a "belle of private rank and modest wealth," and that the only child and heiress of Seymour, Duke of Somerset, and an acquaintance of Sir Hugh's, heard of his rejection, when she publicly observed that "the beauty who had disdained such a man was guilty of a folly that no other woman in England would have been." Sir Hugh would have been unwise not to have taken this broad hint, and he did what none of the heiress's suitors, even of high rank, had yet aspired to,--proposed, and was accepted. Sixteen years later he was created Duke of Northumberland, and could well afford to laugh in his sleeve at the proposition that "his coronet should be surrounded with _senna_ leaves, instead of strawberry," since he had reached a rank that no other M. D. had previously done, and possessed the "_loveliest woman in England_," and a great fortune, to boot. Lord Glenbervie, who from the druggist's counter reached the peerage, was taunted by Sheridan with his plebeian origin, from which a patrician wife had redeemed him, in the following amusing verse:-- "Glenbervie, Glenbervie! What's good for the scurvy? But why is the doctor forgot? In his arms he should quarter A pestle and mortar, For his crest an immense gallipot." Sir John Elliot was another handsome doctor of that period, who, notwithstanding his being disliked by King George, could, with small effort and large impudence, "capture the hearts of half the prettiest women amongst the king's subjects, and then shrug his shoulders with chagrin at his success." "One lady, the daughter of a nobleman, ignorant that he was otherwise occupied, made him an offer, and on learning, to her surprise and mortification, that he was already married, vowed she would not rest till she had assassinated his wife." Dr. Arbuthnot, whose courtly address, sparkling wit, ready flow of language, innate cordiality, and polished manners made him a great favorite about London, was one of the finest looking gentlemen of his time. The doctor was contemporary with Dean Swift, with whom he used to enjoy flirtations with the queen's maids of honor about St. James. "Arm in arm with the dean, he used to peer about St. James, jesting, laughing, causing matronly dowagers to smile at 'that dear Mr. Dean,' and young girls, out for their first season at court, green and unsophisticated, to blush with annoyance at his coarse, shameless badinage,--bowing to this great man, from whom he hoped for countenance; staring insolently at that one, from whom he expected nothing; quoting Martial to the prelate, who could not understand Latin; whispering French to a youthful diplomatist, who knew no tongue but English; and continually angling for the bishopric, which he never got." From flattering court beauties, Arbuthnot became flatterer to the gouty, hypochondriacal old queen. But wine and women made sad havoc with poor Arbuthnot, who died in very straitened circumstances. Dr. Mead, before mentioned, was twice married. He was fifty-one years old when married the second time, to a baronet's daughter. Fortunate beyond fortunate men, he had the great _mis_-fortune of outliving his usefulness. His sight failed, and his powers underwent that gradual decay which is the saddest of all possible conclusions to a vigorous and dignified existence. Even his valets domineered over him. Long before this his second childhood, he excited the ridicule of the town by his vanity and absurd pretensions as a "lady-killer." "The extravagances of his amorous senility were not only whispered about, but some contemptible fellow seized upon the unpleasant rumors, and published them in a scandalous novelette, wherein the doctor was represented as a 'Cornuter of seventy-five,' when, to please the damsel who 'warmed his aged heart,'--she was a blacksmith's daughter,--the doctor, long past threescore and ten, went to Paris, and learned to dance." [Illustration: AN AGED PUPIL.] Dr. Richard Mead died aged eighty-one. The sale of his library, pictures, and statues brought the heirs eighty thousand dollars. His other effects amounted to one hundred and seventy-five thousand dollars. Another Dr. Mead, uncle to the above, lived to the age of one hundred and forty-nine years. Both of these physicians were remarkable for their kindness and liberality. The latter left five pounds a year to the poor, to continue forever. BEAUTY NOT POTENT WITH LADIES. A handsome person is not alone requisite to win the affections of a sensible lady. Radcliffe, who was as great a humbug in affairs matrimonial as in all other matters, was represented as being "handsome and imposing in person;" but his overbearing manner, and his coarse flings at the softer sex, made him anything but a favorite with the ladies. While he professed to be a misogynist, he made several unsuccessful attempts, particularly late in life, to commit himself to matrimony. A lady, with "a singing noise in her head," asked what she should do for it. "Curl your hair at night with a ballad," was the coarse reply. Once, when sitting over a bottle of wine at a public house, Queen Anne sent her servant for Dr. Radcliffe to hasten to her Royal Highness, who was taken suddenly ill with what was vulgarly called "the blue devils," to which gormandizers are subject, but more properly termed indigestion. "When the wine is in, the wits are out," was readily demonstrated in this case; for, on a second messenger arriving from the queen for her physician to make all haste, Radcliffe banged his fist down on the board, at which other physicians also sat, and exclaimed,-- "Go tell her Royal Highness that she has nothing but the vapors." When, on the following morning, the process being reversed,--the "wine was out, and wits were in"--the doctor presented himself, with pomp and a show of dignity, at St. James', judge of his mortification, when the chamberlain stopped him in the anteroom, and informed him that he was already succeeded by Dr. Gibbons. The queen never forgave him for saying she had the "vapors." Radcliffe never forgave Dr. Gibbons for superseding him. "Nurse Gibbons," he would bitterly exclaim, "is only fit to look after nervous women, who only fancy sickness." When the doctor was forty-three years of age, he made love to a lady of half his years, and followed with an offer of marriage, which was accepted. As the fact became public, the doctor was warmly congratulated upon his good fortune, for the lady was not only young, but was a beauty, and an heiress to seventy-five thousand dollars. The wedding day was set, which was to crown Radcliffe's happiness, when a little drawback arose, which was not previously mentioned in the bills. The peculiar condition of the beauty's health rendered it expedient that, instead of the doctor, she should marry her father's book-keeper. The doctor's acetous temper towards the fair sex was not lessened by this mishap, nor were the ladies backward in giving him an occasional reminder of the fact. Nevertheless, unlike the burnt child, that avoided the fire, Radcliffe, sixteen years afterwards, made a second conspicuous throw of the dice. He was then about sixty. He came out with a new and elegant equipage, employed the most fashionable tailors, hatters, and wig-makers, "who arrayed him in the newest modes of foppery, which threw all London into fits of laughter, while he paid his addresses, with the greatest possible publicity, to a lady who possessed every requisite charm,--youth, beauty, and wealth,--except a tenderness for her aged suitor. "Behold, love has taken the place of avarice [the affair was thus aired in a public print]; "or, rather, is become avarice of another kind, which still urges him to pursue what he does not want. But behold the metamorphosis! The anxious, mean cares of a usurer are turned into the languishments and complaints of a lover. 'Behold,' says the aged Æsculapian, 'I submit; I own, great Love, thy empire. Pity, Hebe, the fop you have made. What have I to do with gilding but on pills? Yet, O Fate, for thee I sit amidst a crowd of painted deities on my chariot, buttoned in gold, clasped in gold, without having any value for that beloved metal, but as it adorns the hat, person, and laces of the dying lover. I ask not to live, O Hebe! Give me gentle death. Euthanasia, Euthanasia! That is all I implore.' "O Wealth, how impotent art thou, and how little dost thou supply us with real happiness, when the usurer himself cannot forget thee for the love of what is foreign to his felicity, as thou art!" Although Radcliffe denied his own sisters during his life, "lest they should show their affection for him by dipping their hands in his pockets," some stories of his benevolence are told, one of which is, that finding one Dr. James Drake, when "each had done the utmost to injure the other," broken down and in distressed circumstances, he sent by a lady fifty guineas to his unfortunate enemy, saying,-- "Let him by no means learn who sent it. He is a gentleman who has often done his best to hurt me, and would by no means accept a benefit from one whom he had striven to make an enemy." A STABLE-BOY, POET, AND DOCTOR. Poor George Crabbe, the poet-doctor-apothecary, had a very hard time in this cold, unappreciative world, until Love smiled upon his unhappy lot. He was born in the old sea-side town of Aldoborough, where his father was salt inspector,--not an over-lucrative office in those days. George was the eldest of a numerous family. From the common school he went to apprenticeship with a rough old country doctor, who lodged him with the stable-boy. From this indignity he was, however, soon released, and went to live with a kind gentleman, a surgeon of Woodbridge. Here he began to write poetry. Here, also, he became acquainted with a young surgeon, named Leavett, who introduced Crabbe to a lovely young lady, with whom he fell desperately in love. This inestimable young lady resided at Parham Lodge with her uncle, John Tovell, yeoman, and her name was Sarah Elmy. Mr. Tovell possessed an estate worth four thousand dollars per annum, and, without assuming any "airs," was a first-class "yeoman" of that period--"one that already began to be styled, by courtesy, an esquire." "On Crabbe's first introduction to Parham Lodge, he was received with cordiality; but when it became known that he had fallen in love with the squire's niece, it was only natural that his presumption should at first meet with the disapproval of Mrs. Tovell and the squire." [Illustration: BIRTHPLACE OF GEORGE CRABBE.] After closing his term of apprenticeship with Dr. Page, young Crabbe returned to his native village, where he furnished a little shop with "a pound's worth of drugs," and an array of empty bottles, and set himself up as an apothecary. His few patients were only amongst the poorer class of the town. Although he had plighted troth with the lovely Sarah at Parham Lodge, with starvation staring him in the face at Aldoborough, and the opposition of the lady's family at the Lodge, there was little prospect of bettering his condition in life. The temporary military appointments which he received brought him no nearer his desired object. The lady remained true to her vows; and long after his friend Leavett had quitted the shores of time, and his new and true friend Burke had extended to the promising author his patronage, she received the reward for her faithful waiting. The union of Crabbe with Miss Elmy conferred eventually upon the poet, doctor, and apothecary, the possession of the estate of "yeoman" Tovell--Parham Lodge. A maiden sister of the squire's, dying, left him a considerable sum of money. The loving, waiting Sarah proved a faithful, though some might say a somewhat domineering, wife, as the following quotation intimates:-- "I can screw Crabbe up or down, just like an old fiddle," this amiable woman was wont to say; and throughout her life she amply demonstrated the assertion. "But her last will and testament was a handsome apology for all her past little tiffs." THE RIGHT MAN. A curious story is told, and vouched for, respecting the manner in which Dr. and Rev. Thomas Dawson obtained a rich and pious wife. This gentleman combined the two professions of preacher and doctor. If, during divine services, he was called upon to prescribe for an invalid, he wound up his sermon, requested his audience to pray for the sick, and repaired forthwith to administer to the body. I presume the congregation to whom the reasonable request was made did not take it in the same light as did an "M. D." of whom we heard, who made a point to be called out of church every Sabbath. Once the minister, who had a bit of humor in his manner, stopped on a certain occasion in his "thirdly," and said, "Dr. B. is wanted to attend upon Mr. ----, and may the Lord have mercy upon him." The doctor was so enraged at this "insinuation" that he called upon the parson, and demanded an "apology to the congregation, before whom he felt he had been grossly slandered." The parson agreed to this proposal, and in the afternoon he arose and said,-- "As Dr. B. feels aggrieved at my remark of this morning, and demands an apology, I hereby offer the same; and as that was the first case, I trust it may be the last in which I am ever called upon in his behalf to supplicate divine intervention." But to return to Dr. Dawson. Amongst his patients was a Miss Mary Corbett, said to be one of the wealthiest and most pious of his flock, whom, on his calling upon her one day, he found bending in reverence over the Bible. The doctor approached, and as she raised her eyes to his she held her finger upon the passage which occupied her immediate attention. The doctor bent down and read the words at which her finger pointed--"Thou art the man." The doctor was not slow to take the hint. Thus he obtained a pious wife, she a devout husband.--_See "Book About Doctors."_ A great deal has been reported respecting the "off-hand" manner in which Abernethy "popped the question" to Miss Anne Threlfall. The fact of the case is given by Dr. Macilwain. The lady was visiting at a place where the doctor was attending a patient--of all places the best to learn the true merits of a lady. He was at once interested in her, and ere long there seemed a tacit understanding between them. "The doctor was shy and sensitive; which was the real Rubicon he felt a difficulty in passing; and this was the method he adopted: he wrote her a brief note, pleading professional occupation, etc., and requesting the lady to take a fortnight in which to consider her reply." From these facts a great falsehood has oft been repeated how he "couldn't afford time to make love," etc., and that she must decide to marry him in a week, or not at all. He was married to her January 9, 1800, and attended lectures the same day. [Illustration: "POPPING THE QUESTION."] "Many years after, I met him coming out of the hospital, and said,-- "'You are looking very gay to-day, sir.' "'Yes,' he replied, looking at his white vest and smart attire, 'one of the girls was married this morning.' "'Indeed, sir? You should have given yourself a holiday on such an occasion, and not come down to lecture.' "'Nay,' he replied, 'egad, I came down to lecture the same day I was married myself.'"--_Memoirs of Abernethy._ [Illustration] XVIII. MIND AND MATTER. "The evidence of sense is the first and highest kind of evidence of which human nature is capable."--WILKINS. "They choose darkness rather than light because their deeds are evil."--SCRIPTURE. IN WHICH ANIMAL MAGNETISM, MESMERISM, AND CLAIRVOYANCE ARE EXPLAINED.--"THE IGNORANT MONOPOLY."--YET ROOM FOR DISCOVERIES.--A "GASSY" SUBJECT.--DRS. CHAPIN AND BEECHER.--HE "CAN'T SEE IT."--THE ROYAL TOUCH.--GASSNER.--"THE DEVIL KNOWS LATIN."--ROYALTY IN THE SHADE.--THE IRISH PROPHET; HE VISITS LONDON.--A COMICAL CROWD.--MESMERISM.--A FUNNY BED-FELLOW.--CLAIRVOYANCE.--THE GATES OF MOSCOW.--THE DOCTOR OF ANTWERP.--THE OLD LADY IN THE POKE-BONNET.--VISIT TO A CLAIRVOYANT.--"FORETELLING" THE PAST.--THE OLD WOMAN OF THE PENOBSCOT MOUNTAINS.--A SECRET KEPT.--CUI BONO?--VISITS TO SEVENTEEN CLAIRVOYANTS.--A BON-TON CLAIRVOYANT.--A BOUNCER.--RIDICULOSITY. Mind and matter! What is the connection? Why does one's yawning set a whole room full to yawning? What is the unseen power, appropriated mostly by the ignorant, which at times controls another weaker mind, or, for the time being, controls disease? The majority of medical men "get around" this question by denying the whole proposition. But that does not satisfy the jury--the people. The great community know that there is some unseen power, which is partially developed in certain persons, which has great controlling influence over certain other persons; hence over their diseases, especially mental or nervous diseases. I hope to be able to explain something of this "phenomenon." Those who practise it know nothing of its _modus operandi_, any more than the bird that sings on yonder willow knows of the science of music. To the common suggestion, "It's spirits," I say, No, _no_! If it were "spirits," why does the spirit always seek a _low organization_ through which to manifest itself? There are few exceptions to this rule. It is unnatural, inconsistent with the divine attributes for the supernatural to mingle with the natural. The circulation of the blood was once attributed to the action of the sun--hence a man fell asleep at sunset--and to supernatural causes. Science has done away with these absurd notions. "It is a manifestation of divine power," say others. Well, for that matter, everything is; but _directly_ it is not, for what answers the "spirit" suggestion answers this one also. Divine power cannot be limited. For want of a better name, let us call this power "animal magnetism." The man who controls the mind of another, or another's disease, through his mind, must possess the following requisites: First, health; second, will; third, faith that he can control the subject. No _reasoning_ is necessary. The less causality he possesses, the better. The less reasoning faculties, the better he can perform. Why? Animal magnetism is an animal power--not a spiritual. All the animal qualities--organs--are located in the back and lower part of the brain. They act independent of reason. Passions have no reason. The affections have no reason. Anger and hate have none. The force, driving power of man is centred back of the ears. The cerebellum, or lower brain, acts independent of reason. Birds, and most of the animals, possess all the qualities that the cerebellum of man contains. The upper brain--the cerebrum--is the instrument of our thoughts--our reason. In sleep, it is still; its action is suspended. Hence there is no reason in our dreams. The motive power is in the lower brain; hence somnambulism. If there is anything of a "trance" nature, it means shutting off the action of the cerebrum, and concentring the power in the cerebellum. Some persons have but little upper brain. If they have the other requisites, they may become good clairvoyants, or magnetizers, according to the manner in which they exercise the animal power. I have yet to find a professional clairvoyant with large or active reasoning (intellectual) qualities. YET ROOM FOR MORE DISCOVERIES. The _living_ blood has not yet been analyzed. It contains a vitalizing element which chemistry has not yet been adequate to detect. There is yet as much to be discovered in the science of life as has already been revealed to man. It will yet be found out. How is the power, or force, conveyed from the operator to the person operated upon? Through what medium does it act? Let us begin with the brain. Let us take a ball of cotton for our illustration. We draw out a piece from it, and spin it out to our fancy. It is a thread, but _cotton_ still, twisted to a fine string. The brain is located at the top of man. By means of fine threads, called nerves, the brain is distributed over the entire body, so completely that you cannot stick a pin in the flesh without touching a nerve, wounding the brain. Suspend the entire action of the brain, as by ether, chloroform, or nitrous oxygen gas, and sticking the pin is not felt. Partially suspend the action, as by a small quantity of the nitrous oxygen gas, and the force of the brain (or active force) is centred upon the lower brain, and the man under its influence acts out his animal nature in spite of reason. A man, I hold, who magnetizes or mesmerizes another, uses only the force of the lower brain. Like begets like. He cannot affect a person of large intellectual organs; only one with the animal organs active. You cannot _see_ the gas, yet it affects the person. You cannot see the subtile power conveyed from one man to a weaker. He conveys it by touch--nerve to nerve. I believe science will yet discover just what this subtile agent is--both in the blood and nerves; for it is in both, or why does the suspension of it in one destroy the other? Destroy the nerve, and the corresponding blood-vessel is inactive. Destroy the blood-vessel, and the corresponding nerve suffers. It is the power that the mother exercises to hush her sobbing babe to slumber. As the child gathers strength of mind, she loses that control. A person may be used as a mesmeric subject until he becomes a mere idiotic machine. Educate a clairvoyant doctor, and what becomes of his clairvoyant power? It is lost with the increase of intellectual power. Now, is this a "divine" quality, that only ignorance can make use of? Is it really "hidden from the wise and prudent, and given to babes?" All sciences were practised by the uneducated first, before being reduced to a _science_. I think this will be yet reduced to a useful science. As it now stands, it is useless. If it is a spirit power, the spirits are mighty silent as to the fact. We come into this world by natural causes. We live, grow, exist, and we die by natural causes. We brought no knowledge with us; we carry none out. All the qualities yet developed in man are natural, and adapted to this life. Millions upon millions have so lived and so died, and a spirit power in _this_ world is no nearer to being established than it was when Adam was a little boy. All that heretofore has been attributed to spirit, or supernatural causes, has been proven to be but natural. I claim that magnetism and the undiscovered sciences are natural, and have no connection with the next world, to which we tend. The human eye, to some extent, is magnetic. A blind man cannot thrill an audience; hardly can an orator with glasses over his eyes. Dr. Chapin approaches the nearest to it. Dr. Beecher's great magnetic power is in his eyes, and is also let off at the ends of his fingers. But to _thoroughly_ magnetize a person, he must be _touched_. POWER OF THE HUMAN EYE. A wild animal has only small reasoning organs. The influence of the human eye is potent over him. Lichtenstein says, "The African hunters avail themselves of the circumstance that the lion does not attempt to spring upon his prey until he has measured the ground, and has reached the distance of ten or twelve paces, when he lies crouching on the ground, gathering himself up for the effort. The hunters," he says, "make it a rule never to fire on the lion until he lies down at this short distance, so that they can aim directly at his head with the most perfect certainty. If one meets a lion, his only safety is to stand still, though the animal crouches to make his spring; that spring will not be hazarded if the man remain motionless, and look him steadfastly in the eyes. The animal hesitates, rises, slowly retreats some steps, looks earnestly about him, lies down, again retreats, till, getting by degrees quite out of the magic circle of man's influence, he takes flight in the utmost haste." It is said of Valentine Greatrakes, the great magnetizer and forerunner of Mesmer, that the glance of his eye had a marvellously fascinating influence upon people of a susceptible or nervous organization. All magnetizers, etc., who have tried their powers upon the writer, first bent a sharp, scrutinizing gaze upon the eye of their unruly subject. Yet they have exercised no _reason_ in selecting the subject. [Illustration: THE LION MAGNETIZED.] I attended the exhibitions of Professor Cadwell, night after night, in Boston. I went on the stage. I examined the subjects whom he controlled "like an old fiddle," and, physiognomically and phrenologically, not one of them was above mediocrity intellectually, and the most of them were far below. The best subjects had the least intellectuality. His control over them was astonishing. In some he could suspend the power of memory, others all the reasoning faculties. Some he could control muscularly, some mentally. "This is a hot stove," he said, setting an empty chair before the row of men, boys, and girls sitting along the wall side of the stage. "_It is very hot_;" and they began drawing back--all but one. "Don't you see the stove, and feel the awful heat, Frank?" he asked of one hard subject. [Illustration: A HARD SUBJECT.] "I can feel the heat, but I can't see the stove in that chair," was his droll reply. The professor could make this gentleman forget his name, but could not make him believe that "a silk hat was a basin of water." THE ROYAL TOUCH. The old ignorant kings and queens were said to remove the scrofula (king's evil) by the touch. Gouty old Queen Anne was the last to exercise the royal prerogative to any extent. A scrofulous _development_ is the result of imperfect action, and obstruction of some one or more of the five excretory organs of the human system. These are the skin (or glands of the same), the lungs, the liver, the kidneys, and the colon. The most that the regular physician does in scrofula (or one who is not a specialist in this branch of physic) is to attend to the general health of the patient of a scrofulous diathesis, build up the strength, and endeavor to increase the vitality. This _in a measure_ tends to reduce the scrofulous development. Now, will not a child sleeping continually with an aged person or invalid tend to reduce the vitality of the child? Yes, it absorbs the disease of the one, while the vitality is thrown off for the benefit of the weaker person. Here, you see, one person may partake of the vitality of another by touch. Then may not the continued touch of a healthy person (king or subject) affect the health of a weaker, on the principle of increased vitality? But it really removes no cause, hence cannot take the place of an alterative, or anti-scrofulous medicine. The "crew of wretched souls" who waited the king's touch really believed that he "solicits Heaven." Hence the cure. The coin which he hung about the neck of these "strangely visited people, all swollen and ulcerous, pitiful to the eye," called their attention continually to "the healing benediction." Pyrrhus, who was placed upon the throne by force of arms B. C. 306, was said to cure the "evil" by the "grace of God." Valentine, who only held his throne--A. D. 375--by the help of Theodosius, not by the "grace of God"--claimed to cure scrofula by the latter power, as did Valentine II., whose wicked temper ended his life in a "fit of passion." The subject of the following sketch claimed also divine power:-- HERR GASSNER. "THE DEVIL UNDERSTANDS LATIN." It seems from the following truthful account of Herr Gassner, a clergyman at Elwangen, that the devil can understand Latin, as well as "quote Scripture." About the year 1758 this clergyman became so celebrated in curing diseases by animal magnetism, that the people came flocking from Switzerland, the Tyrol, and Swabia, in great numbers, to be cured of all sorts of ailments, a thousand persons arriving at a time, who had to lodge in tents, as the town could not lodge them all. [Illustration: GASSNER HEALING "BY THE GRACE OF GOD."] His _modus operandi_ was as follows. Dressed in a long scarlet cloak, a silken sash about his loins, a chain about his neck, and wearing, or holding in one hand, a crucifix, and touching with the other the diseased part, and in the Latin tongue commanding the disease, or the evil spirit, whichever the case was termed, to depart, in the name of Jesus Christ, the patient was usually healed. Dr. Schlisel says, that Gassner "spoke chiefly in Latin, in his operations, and the devil is said to have understood him perfectly." The Austrian government gave him its assistance. The excitement became great. Elwangen was overcrowded by people, rich and poor. Riches flowed into the coffers of its trades-people, though Gassner took nothing directly for his cures. Hundreds of patients arrived daily; the apothecary gained a great revenue from dispensing simples ordered by Gassner, principally powder of _blessed thistle_, oils, and washes. The printers labored day and night at their presses in order to furnish sufficient pamphlets, prayers, pictures, etc., for the eager horde of admirers. The goldsmiths were crowded, also, to furnish all kinds of _Agni Dei_, crosses, charms, hearts, and rings. Even the beggars had their harvest, as well as bakers, hotel-keepers, and the rest. During seven years he carried on his public cures. Hundreds of physicians went to see him. Mesmer, in answer to the inquiry of the Elector of Bavaria, declared his astonishing cures were produced merely by the exercise of magnetic spiritual excitement, of which he himself (claiming no God-like power) gave to the elector convincing proofs on the spot. On the contrary, Gassner claimed that he could heal none unless they exercised faith. His surroundings, trappings, dress, crucifixes, appeals to Jesus Christ, and Latin mummery, had the effect to impress the patient with faith in Gassner's Christ-like powers. "Some," says Dr. Schlisel, "described him as a prophetic and holy man; others accused him of being a fantastic fellow, an impostor, and leagued with the devil. Some accused him of dealing in the black art; others attributed his cures to the magnet, to electricity, to sympathy, to imagination; and some attributed the whole to the omnipotent power of the name of Christ." Having touched or rubbed the affected part of the patient, Gassner, in a "loud, proud voice," commanded the disease to come forth, or to manifest itself. Sometimes he had to repeat this command ten times. Then, when the part was presented, he seized it with both hands; he inspired the patient to himself repel the disease, by saying, "Depart from me, in the name of Jesus Christ." "He then gave the patient his blessing by spreading his cloak over the head, grasping his neck or head in both hands, repeating a silent, earnest prayer, making the sign of the cross, ordering some simple from the apothecary's, which he consecrates, compels the patient to wash his hands clean, when he is permitted to 'depart in peace.' "Most diseases he cured instantly. Some required months, and others he could not affect in the least." There is but one philosophical way to account for these cures. To say there is nothing in it, or, "It is all humbug," will not satisfy the people. To affirm it is the arts of the devil is merely nonsensical. It is _influence_. Of what? Of one powerful mind over another. And when Gassner found a mind equally as powerful as his own, the disease refused to depart. There you have the whole of it, "in a nutshell,"--the exercising of one mind over another; and mind (not unusually) controls matter in the living body. For about seven years Gassner was a public healer, and then he suddenly and forever disappeared. ROYALTY IN THE SHADE. Sir John Fortesque, the learned legal writer of the time of Edward IV., spoke of the gift of healing by touch as a "time immemorial privilege of the kings of England." He very seriously attributed the virtue to the unction imparted to the hands in the coronation. Elizabeth was not superior to this superstition, and she frequently appeared before the people in the character of a miraculous healer. There was formerly a regular office in the English Book of Common Prayer for the performance of this ceremony. The curious reader is referred to Macbeth, Scene III. of Act IV. for further particulars. With the rise of Valentine Greatrakes, the "royal prerogative" received a staggering blow. The marvellous cures of this man, living in Ireland, reached England, and the king invited him to come to London; and along his journey, whither he was preceded by the returning messenger, we are told that the magistrates of the towns and cities waited upon Valentine, and begged him to remain and heal their sick. On his arrival, the king, "though not fully persuaded of his wonderful gift, recommended him to the care of his physician, and permitted him to practise his power as much as he pleased in London." Greatrakes had no medical education, nor claimed aught beyond a gift of healing most diseases by "stroking the parts with his hand." He is described as being a man of "commanding address, frank and pleasing, having a brilliant eye, gallant bearing, fine figure, and a remarkably handsome face. With a hearty and musical voice, and a natural stock of high _animal_ spirits, he was the delight of all festive assemblies. Yet he was a devout man." Daily there assembled a great number of people, invalids from all parts of the kingdom, to be healed, and to see the wonderful miracles performed by a _man_! Here congregated the dropsical, those afflicted by unsightly sores, tumors, and swellings, the lame, the halt, and the blind. "Some he could not affect, but the most of them he cured." The only visible means he took was to stroke, or at times violently rub, the part affected. Lord Conway wrote in his praise, but added, "After all, I am far from thinking his cures miraculous. I believe it is by a _sanative virtue_ and a _natural efficiency_, which extend not to all diseases." The Viscountess Conway was afflicted by an inveterate headache, which he could not remove. This lady was a positive character. The failure was attributed to the _peculiar_ disease, when it should have been assigned to the peculiarity of the person. Sir Evremond, then at court, wrote a sarcastic novel on the subject of "The Irish Prophet." The Royal Society held a meeting on the subject, and, unable to refute the facts of his cures, accounted for them as being "produced by a sanative contagion in Mr. Greatrakes' body, which had an antipathy to some peculiar diseases, and not to others." They demanded (particularly Dr. Loyd, in a "severe pamphlet") how he cured, and why he cured some, and could not others. Greatrakes replied that he was not able to tell. And "let them," he said, "tell me what substance that is which removes and goes out with such expedition, and it will be more easy to resolve their questions." To the scandalous reports respecting his operations upon female patients, without referring directly to such report, he says, attributing the diseases to evil spirits, "which kind of pains cannot endure my hand, nay, not with gloves, but fly immediately, though six or eight coats or cloaks be between the person and my hand, as at the Lady Ranelagh's," etc. The clergy had previously taken alarm, and cited Valentine before the Bishop's Court to account for his proceedings, and when he took a scriptural view of his cures, he was forbidden to practise more; which was as preposterous as the decree of Louis XIV., which commanded that no more miracles should be performed at the tomb of the Abbé Paris. Neither the clergy nor the faculty could prevent him, and daily the crowd of representatives of heterogeneous diseases made pilgrimages to the Squire of Affam. The scene was said to be ludicrously painful. They came in crowds from everywhere; on foot and in carriages; the young and the aged; some hobbling upon crutches, others literally crawling along; the blind carrying the cripple upon his back, while the latter directed the way, and the deaf and dumb followed in their wake. [Illustration: NO LACK OF PATIENTS.] While the lord mayor and the chief justice, with great physicians, were among his vehement supporters of the sterner sex, the majority of his real admirers were the ladies. The lovely Countess of Devonshire entertained him in her palace, and other high ladies lionized him nightly in their parlors, where he "performed his pleasant operations, with wonderful results, on the prettiest and most hysterical ladies present." "But his triumph was of short duration. His professions were made the butts of ridicule, to which his presence of mind and volubility were unable to effectually respond. His tone of conversation was represented by his enemies as compounded of the blasphemy of the religious enthusiast and the obscene profligate. His boast that he never received a fee for remedial services was met by a square contradiction, and a statement that he received five hundred dollars at once." Finally, the tide of opposition and slander became too strong for him, and he returned to his native land, and to oblivion. We are indebted to several authorities for the foregoing sketch of Greatrakes, particularly Chambers' Miscellany, Lord Conway, E. Rich, and Jeaffreson. MESMERISM. Frederick Anthony Mesmer, to whose name the above _ism_ is affixed, was born in Werseburg, in 1734. He neither discovered, developed, nor understood anything of the art which has immortalized him. He was a designing, audacious man. If Gassner, Prince Hohenloe, and Greatrakes were falsely accused of dealing with the devil, Mesmer was truly leagued with a Father Hell. Father Hell was professor of astronomy at Vienna, where Mesmer obtained a medical diploma, and where he was connected at first with Maximilian Hell in magnetic instruments. Having a falling out with the latter, Mesmer resorted to the arts of his great predecessor, Greatrakes, but professed to cure, without the help of God or man, all curable diseases. He produced marvellous effects (but only temporary, however) in both Vienna and Paris, to which latter place he repaired to practise animal magnetism. Among the little episodes relative to his treatment is one of Madame Campan, a lady of the royal household, author of "Memoires de Marie Antoinette." The husband of this celebrated lady sent for Dr. Mesmer--for all Paris was running mad after him--to cure him of lung fever. He came with great pomp, and having timed the pulse, and made certain inquiries respecting the case, he gravely informed the husband and wife that it was not in the way of magnetism, and the only mode of cure lay in the following: "You must lay by his side"--for he was confined to his bed--"one of three things, an old empty bottle, a black hen, or a young woman of brown complexion." [Illustration: "A BOTTLE, A HEN, OR A WOMAN."] "'Sir,' exclaimed the wife, 'let us try the empty bottle first.' "The bottle was tried, with what result is easily imagined. Monsieur Campan grew worse. Improving the opportunity of the lady's absence, Mesmer bled and blistered the patient, who recovered. "Imagine the lady's astonishment when Mesmer asked for and actually obtained a written certificate of cure by magnetism" (Mesmerism). This is more easily believed when one learns that Mesmer obtained his degree on an address, or thesis, relating to "planetary influence on the human body," and that afterwards, in answer to the inquiry by a learned Paris physician, who asked him why he ordered his patients to bathe in the Seine, instead of spring water, as the waters of the Seine were always dirty, Mesmer replied,-- "Why, my dear doctor, the cause of the water which is exposed to the sun's rays being superior to all other water is, that it is magnetized by the sun. I myself magnetized the sun some twenty years ago." All that sort of fellows have ever a short course. Mesmer reached his zenith in Paris about the year 1784, when, for one year's practice, he received the enormous sum of four hundred thousand francs. The government, at the instigation of Count Maurepas, had previously offered him an annuity of twenty thousand francs, with ten thousand francs additional, to support a college hospital, if he would remain and practise only in France. "One unpleasant condition was attached to this offer, which prevented its acceptance; viz., three nominees of the crown were to watch the proceedings." The government appointed a commission, consisting of Dr. Guillotin, and three other physicians, and five members of the Academy,--Franklin, Bailly, Borey, Leroi, and Lavoisier,--to examine the means employed by Mesmer. The result of the investigation--the discovery of his battery, which he termed the _baquet_, around which his patients assembled, and his windy pretensions to the self-possession of some animal magnetism beyond even his disciples, Bergasse and Deslon--was unfavorable to the truth of animal magnetism and morality, and the enthusiasm in his favor rapidly subsided. Mesmer soon found it convenient to repair to London. Here he made no great impression; his day had gone by. He died in his native town, in all but penury and obscurity, in 1815. Clairvoyance now made its appearance, which was but a different phase of magnetism, and Mesmerism was soon but indifferently practised in France. In England the faculty entirely ignored it. CLAIRVOYANCE. What is it? The word is French, meaning, literally, clear-sightedness. It is a power attributed to certain persons, or claimed by certain persons, of seeing things not visible to the eye, or things at a distance. It is the action of mind over mind,--the seeing, mentally, of one mind through another. By personal experiment with clairvoyants, I am positively convinced that they follow the mind (thoughts) of the subject or patient. I have laid out my programme before visiting one, and the operator, whether pretending or not to a "trance" state, has followed that course to the end, but usually adding something which was conjectural. Practice helps them very much. But the most of those persons, male and female, who proclaim themselves clairvoyants, are humbugs and impostors. Let any clear-headed man, who has good intellectual qualities, go to a good clairvoyant, and try the above plan. Think out just the places and persons you wish the clairvoyant (or spiritualist, if he or she choose to call themselves such) to bring up. Stick firmly to your text, and the operator will follow it, if he or she is a clairvoyant. They can tell you nothing that you do not already know. If they go beyond that, it is guessed at. No person of large causality can be a clairvoyant. The moment they employ cause and effect, they are lost in doubt. How else can you account for nearly all the professional clairvoyants (and spiritualists) being persons of low intellectuality? Of course they deny this; but a fact is a fact, and _it can't be rubbed out_! There is a magnetizing feature in clairvoyance. The operator can make some persons _think_ they see a thing, when it is an impossibility to see it. This influence is sometimes passed from one person to another imperceptibly. When the earthquake shook up the minds of the Bostonians, in 1870, there was one grand illustration of this fact. A gentleman standing in front of the Old State House, on Washington Street, soon after the shock, asserted that the earthquake had started a stone in the front end of the Sears Building. "There! don't you see it?" he exclaimed to the people on the sidewalk, who are always ready to stop and look at any new or curious object, as he pointed towards an imaginary crack in the marble. "It is just above the corner of that window there"--pointing--"a crack in the stone a foot long." "O, yes, I see it," said one and another; and the gentleman moved on, leaving the gaping crowd to gaze after the imaginary rent in the wall. "Where is it?" inquired a new comer. "Right up there over the door," replied one. "No, over that third window," said another. Some "saw it," and others didn't "see it," but all day long the tide of curious humans ebbed and flowed. At eight o'clock in the morning I took a look--not at the broken stone in the marble front, but at the magnetized crowd looking upon an imaginary break. People with large causality looked, exclaimed, "Pooh!" and went on. The credulous stood gazing, and pointing out the rent to the "blind ones, who wouldn't see," hour after hour. At noon I again visited the scene. The crowd had shifted, but the same class, male and female, stood gazing at the "calico building," and the same sort of people "saw the crack over the window." [Illustration: EFFECTS OF AN EARTHQUAKE.] [Illustration: A BELIEVER SEES HIS GRANDMOTHER.] At six P. M., I again visited the Old State House, and at dusk still again, to behold the crowd straining to get a last look at the rent before darkness shut out the view. On the following day, the scene was repeated, with no mitigation. The fact of the papers denying that there was any rent went for nothing. The crowd came and went, from morning till evening. THE GATES OF MOSCOW. Some readers may remember the story of the great Wizard of the North, who performed such marvellous feats before the czar, receiving from his highness a splendid present in money, and finally wound up by announcing that he would leave the city of Moscow on the following day, at twelve M., _by all the gates of the city at the same time_! The watchmen were doubled at all the gates, to whom a description of the man was sent, and a sharp lookout was commanded, when, lo! just at noon the wizard was seen leaving the city at each separate outlet at the same moment. Of course he could not have left by but one gate, but which of the twelve no one could tell, for he was seen at all, or the watchmen were made to believe that they saw him, as he passed out. To this the watchmen of the several gates testified, and that he uncovered his head to them, as he went past. At which gate did he really make his exit? The beautiful gate Spass Voratu, or Gate of the Redeemer, has over the archway a picture of the Saviour. All who pass out here are compelled to uncover. Hence it is my belief, as he was seen uncovered, that this was the gate at which he really went out, and at all the rest the watchmen imagined they saw the wizard make his marvellous exit from Moscow. THE DOCTOR OF ANTWERP. Townsend, on Mesmerism, tells an instructing and amusing anecdote of a test, by a learned doctor of Antwerp, upon a clairvoyant girl. The doctor was allowed, at a seance, to select his own test, when he said,-- "If the somnambulist"--that was what he termed her--"tells me what is in my pocket, I will believe." Then to her he put the question,-- "What is in my pocket?" "A case of lancets," was the reply. "True," said the doctor, somewhat startled. "But the young lady may know that I am a medical man; hence her guess that I carry a case of instruments in my pocket. But if she will tell me the number of lancets in the case, I will believe." "Ten," was the correct answer. Still the doctor was sceptical, and said,-- "I cannot yet believe but if the form of the case is described I must yield to conviction." And the form of the case was given. "This certainly is very singular," said the doctor, "but still I cannot believe. Now, if the young lady will give the color of the velvet lining of the case, I really _must_ believe." "The color is dark blue," was her prompt reply. "True, true!" said the puzzled doctor, and he went away, saying, "It is very curious, very, but still I cannot believe." Now, if the doctor had not known that the case was in his pocket, or no one present had known beforehand, no clairvoyant could have described it. What does this prove? That her mind was led by his inquiry to his mind, thence to the article on his mind at the moment. "This is a book" I say. The fact of my saying it, or thinking it, leads my mind to the book. As a person may look towards an object, as out of the window towards a tree, and not see it till his mind is directed to it, so, on the other hand, he may have his mind (thoughts) directed to a thing that his eyes cannot see, and in a person whose superior brain is susceptible, it maybe reflected so vividly as to permit a description of the object. One may walk over a stream, upon stones, or ground, and not realize the fact till the mind is directed to it; and the thing may be reversed, and a susceptible person may be led to think that he or she is walking over or through water when none is present. The mind must be directed to an object in order to see it mentally. A gentleman recently told me that a "medium brought up his old grandmother." "How did she describe the old lady as appearing?" I asked. "In woollen dress and poke bonnet, with specs on, just as she used to appear when I was a boy, forty years ago." "I should have thought the fashions would have changed in the unseen world, even if the clothes had not worn out in forty years' service," I suggested. This slightly staggered him, but he replied, "Perhaps fashions do not change in the spirit-world." "Then ladies can never be happy there. Besides, what a jolly, comical set they must be down there; the newer fashions appearing hourly in beautiful contrast with the ancient styles; especially the janty, little, precious morsels called hats of to-day, all covered with magnificent ribbons, and flowers, and laces, in contrast with the great ark-like, sombre poke bonnets of forty and a hundred years ago!" "Sir," I said, when he did not reply to this last poser,--"Sir, bring your stock of common sense to bear upon the matter, and see that the mind of the medium controlled yours, and led you to believe you saw, as the medium did, through your thoughts, your ancient grandmother; for how else would you imagine her, but as you remembered her, in woollen gown, poke bonnet, and spectacles." VISITS TO A CLAIRVOYANT. Twenty-five years ago, I visited Madam Young, in Ellsworth, Me. "You are going a journey," she soon said, after I was seated, and she had examined my "bumps" to learn that I was a rolling stone. "You are going south-west from here." "Marvellous!" one might say, who had little reflective qualities of brain, for that was the very thing I was about to do. But from Ellsworth, Maine, which way else could one go, without going "south-west," unless he really went to the "jumping-off place, away down east?" Again I visited her in Charleston, S. C. "You are going a journey soon," she informed me. "Which way?" I amusingly inquired. "Towards the north," was the necessary reply. Charleston is at the extremity of a neck of land. I was not expected to jump off into the bay, by going southward, and her answer was the only rational one. She would minutely describe any person, "good, bad, or indifferent," whom I would fix my mind upon. I was suffering at the time with bronchitis, which she correctly stated. She was the best clairvoyant I have ever tested. She died at Hartford, in 1862. The following item of the press does not refer to Madam Young:-- A clairvoyant doctor of Hartford proclaims his superiority over other seers on the ground that he "foretells the past and present as well as the future." We should say he would probably "foretell" them much better. As the Irishman said, one gets on better when one goes backward or stands still. I noticed his advertisement in a Providence paper, recently, where "Dr. ---- foretold the past, present, and future." A NIGHT IN THE PENOBSCOT MOUNTAINS. At Castine I heard of an old lady residing high up in the Penobscot mountains, who could magnetize a sore or a painful limb at sight. Such marvellous stories were told of her "charming," that I decided to go over the mountain and see her. She was not a "professional," however, and objected to being made too public. Therefore I made an excuse for calling at the house "on my way afoot across the country," and was cordially received by the family, of whom there were four generations residing under one roof. The house was a story and half brown cottage, large on the ground, and surrounded by numerous out-houses and barns. The view from the western slope of the mountain where she lived was most magnificent. I reached the farm before sunset. Here I lingered to overlook the beautiful Penobscot as it flowed at my feet, and the far-off islands of the sea. Here one could "gaze and never tire," out over the grand old forests, down to the sea-side, and upon countless little white specks, the whitened sails of the fishermen and coasting vessels, with an occasional ship or steamboat flitting up and down the noble Penobscot river and bay. Still above me the eagle built her nest in the rocking pines, on the mountain top, and still far below sung the nightingale and wheeled the hungry osprey in his belated piscatorial occupations. The sun sank behind the western hills, tinging the soft, fleecy clouds with its golden glory. Slowly changing from purple and gold to faint yellow, to dark blue, the clouds gradually assumed the night hue, and sombre shadows crept adown the western mountains' sides, flinging their dark mantle over the waters, from shore to shore. The sturdy farmer has shouldered his scythe, and reluctantly he leaves the half-mown lot to seek his evening repast at the family table. Then he discovers me, leaning over the gate-bar, rapt in dreamy forgetfulness, and with a hearty salutation extends to me the hospitality, so proverbially cordial, of the old New England farmer. He shows me his pigs in the pen, and his "stock" in the barn-yard, and reaching the house, he calls "mother," who, appearing in calico and homespun, though with a cheerful and smiling face, is introduced to me as his wife. "A stranger, belated, and I guess pretty tired-like, climbing up here; and I won't take no excuses from him; so he stays with us to-night." [Illustration: THE CHARMER DIVULGES HER SECRET.] I talk with the lady, I play with the babies, I even toy with Towser and Tabby, till tea is set. Now I am introduced to the old lady. I thought I would get to it at last. She was seventy odd years of age, a deaf, but devout old lady, who was easily wheedled into divulging to me her secret of "charming." She told me she had the "rheumatiz," and by my tender sympathies and a roll of plaster for her lame back, I got into her own room before bed-time. O, but I came out soon after! She was very deaf. "You see," said she, "a woman can't learn it to another woman--only to a male. He must be a _good_ man." I nodded assent. "Yes; well, you must have faith." Again I nodded--she was very deaf. "You must touch the painful part and say--" Here she bent down her lips to my ear and whispered something in seven words which she said I must never tell, and she compelled me to promise never to divulge the secret while I lived, under pain of God's great displeasure. Perhaps I had better keep my promise, though the good old lady has long since "gone to her reward." CUI BONO? The question is repeated every time there is a great robbery or a murder committed,-- "Why do not the clairvoyants tell who has committed this crime?" Simply because those who consult them do not know. If a person knew where the stolen property was secreted, and he consulted a true clairvoyant, he or she _might_ describe the property and the place where it is secreted. Not otherwise. The same with the murderer. Therefore, of what good is it? In order to do justice to this subject, to present and explain it in all its various phases, we would require a volume, instead of the space allotted in this chapter. But whatever name one may apply to it,--animal magnetism, Mesmerism, clairvoyance, spiritual or trance mediumship,--its success depends mostly upon the credulity of the person. During the five days preceding May 15, 1869, a reporter of the Boston Post visited seventeen of these clairvoyants, mediums, etc., and some curious facts and startling contradictions were revealed therein. "Putting it together," he says, "and carefully epitomizing the amount of fortune that we have in this way been able to purchase, we present our readers with the following balance sheet:" and this, he says, is from the "most experienced and trustworthy fortune-tellers in the good city of Boston, where everything like _humbug_ is most scrupulously avoided. "Four times we have been told that we were engaged in no business at all, and as many more that our affairs and prospects were never more flourishing. Repeatedly we have been told that we should speedily change our business and abode. On the other hand, we were destined to be a fixture in Boston, and were so well satisfied with our present calling that we should never change. We are not married, but a great many pretty maidens stood ready to help us out of that difficulty." Again, "we were married, and the father of several roguish boys and bright-eyed girls. Thus far in life we had enjoyed good health, were free from all infirmities, and stood a good chance to reach fourscore and ten." "In less than twenty-four hours this sweet hope was buried, and we were advised that death would overtake us suddenly and soon." There are various grades of clairvoyants, as of everything else. Here is one class. "After ascending a rickety, dirty, greasy stairway, you find the madam quartered in a small, square bedroom, poorly and miserably furnished. The room is dirty, dark, and dingy. Portions of the walls are covered with a cheap and quaint paper, patched, here and there, with some of another figure and quality. Pictures of a cheap class are hanging on two sides of the room,--of Columbus, Webster, and three or four love and courtship scenes in France and Germany. The furniture consists of a cheap bed, a dilapidated parlor cooking-stove, a small pine table, three common chairs, and a rocking-chair, cane-bottomed, a big box, covered with a remnant of the national flag, and a few cheap mantel ornaments. "The madam is a woman under thirty, very stoutly built, weighs one hundred and sixty pounds, has quite fair complexion, with pretty blue eyes, light hair, and withal not bad-looking. She was attired in a loose and rather soiled calico dress, wore no ornaments, and looked rather uninviting." A BON TON CLAIRVOYANT. The writer visited a special seance at one of the most aristocratic and _recherché_ abodes of the marvellous in this city, not long since. I was ushered into the brilliantly lighted hall by a janty-looking little biddy in white and embroidered apron. That was all I saw of her, as she disappeared and was substituted by the lady of the house, the medium. She was a pretty, pleasant little lady, with brilliant, dancing, light eyes, hair golden brown, and was dressed in a black silk dress, with blue overskirt, a rich lace collar, and flowing sleeves of the same material. Depositing hat, coat, and cane on the hall rack, I was introduced to the assembled guests in the great parlors. These rooms were united by a wide, open archway, were high, and brilliantly lighted by rich chandeliers in each room. An elegant piano occupied the west side of the front parlor, upon which was a pile of the latest music. The furniture was of black walnut, and richly upholstered in green and gold rep. The mantel was adorned with vases of porcelain, images of marble and terra-cotta, and little knickknacks of foreign production. The walls were hung with a few of Prang's chromos, oil paintings, and two "spirit" photographs. The most beautiful, as well as the most remarkable, feature of the rooms was the magnificent bouquets of native hot-house flowers, which covered the two marble-topped centre-tables and sideboard. These were presents to the spirits! They did not take them away; the only one I saw removed was knocked over by a careless elbow. I regret to add, that there was no "manifestation," nor anything revealed, worth recording. A BOUNCER. A scene that occurred at another place where I previously visited may be considered worthy of notice. I clambered two flights of stairs, and found myself face to face with a very large woman, answering to the alias of Madam ----. She was very fleshy, weighing probably two hundred and thirty-five pounds avoirdupois. Her face was pleasant, and conversation easy. I handing over the required "picture paper," she tumbled into a great easy-chair, and, without any pretence to a trance, began,-- [Illustration: "I PERCEIVE YOU ARE IN LOVE."] "I perceive that you are in love." This was startling news to a bachelor. "There are two pretty females, one dark-complexioned, the other light." (This is the usual "dodge," for, if there is a woman in the question, one of the two is bound to answer this general description.) "Which shall we follow?" she very teasingly inquired. "Either that comes handiest," was my indifferent reply. "Well, the dark one, then. She is tall, fair, and is looking anxiously for you to propose. Do you know a lady of this description whom you like?" I regretted that I did not. My "notion" ran to small ladies, of the opposite complexion. "Well," she said, not the least flurried, "here is one of that kind." I instantly placed my mind on one of this class,--my sister,--and she ran on. "She is soon to meet you. She is very rich." (Nellie will be glad to learn this.) "And I perceive a short-like man looking after her fortune. But have no concern; she loves you fondly, and you will marry her very soon. You are going a voyage, or across some water." (How far can one travel, in this country, without crossing water?) "You will meet an enemy, who will try to injure you in business." "What business?" I inquired. "You are a--yes--mechanic, though your hand is soft. I reckon you've been sick. Yes--machinist; make coffee-mills. Yes" (looking sharply into my face). (I was _leading her_!) "Corn poppers are in your line." (I nodded, and smiled, for how could I refrain from smiling?) "You trade in tin and earthen ware--chamber ware--spoons--and old boots." (True.) "You own a splendid house in the city--a large block"-(head). "Where was I born? Can you see?" "Yes; you were reared in the country; where there were deep, dark woods--all woods; in a log house, with thatched roof, and clay and stick chimney. A pig--am I right?--yes, a pig and a dog are kept in the same house. The windows are wooden, and--" "Where was it?" I suggested. "I should say in Ireland," she replied. "Enough, I believe. Now about the other lady," I said. "The dark one? Yes. She loves you, but is poor. Since you are rich, and a--" Here I tried to impress her that I was married. "You are married, but your wife will not survive you. No, she will soon go to heaven, and you will marry the dark-complexioned lady." "Good," I exclaimed. "Yes; and will have five boys and three girls." "Who?" "Why, the lady, of course." "O!" "Yes, and they will be happy and healthy." Here she informed me I had got my money's worth. I think I had. [Illustration] XIX. ECCENTRICITIES. "They'll not show their teeth in way of smile, Though Nestor swear the jest be laughable." "Democritus, dear droll, revisit earth, And with our follies glut thy heightened mirth."--PRIOR. A ONE-EYED DOCTOR AND HIS HORSE.--A NEW EDIBLE.--"HAVE THEM BOILED."--"BEAUTY AND THE BEAST."--A LOVELY STAMPEDE.--AN ECCENTRIC PHILADELPHIAN.--THE POODLES, DRS. HUNTER AND SCIPIO.--SILENT ELOQUENCE.--CONSISTENT TO THE END.--WHEN DOCTORS DISAGREE.--FOUR BLIND MEN.--DIET AND SLEEP.--SAXE AND SANCHO PANZA.--MOTHER GOOSE AS A DOCTOR'S BOOK.--THE TABLES TURNED ON THE DOCTORS. We love to see an eccentric individual--something out of the common routine of every-day, humdrum life. But what is often taken for an eccentricity is sometimes put on for an advertisement. Nearly all great men have their oddities or peculiarities. I might give many little interesting sketches of some physicians' oddities right among us, but for too great personality. I may, however, work in a few. The eccentricities of some doctors lie in their dress. Of this, I shall speak under the head of "Dress and Address." Others lie in personal acts, in their walk, manners, and conversation. I know of one physician who delights in the worst looking old horse he can obtain. The doctor himself has but one eye. His old donkey-like beast corresponded. Report said that he cut out the left eye of the horse to gain that desired end, which, however, is discredited. The beast was also lame, which defect the doctor would never admit. "What _you_ ignorantly term 'limping' is only an expression of good breeding--which I cannot attach to all whom I meet on the road. It's bowing,--merely bowing. You never see him do it unless somebody is in sight. Gid-dap!" And so delivering himself, the old doctor would drive on, chuckling softly to himself. When his old horse died, he was presented with a fine young beast, which he declined to accept, but scoured the country till he found a high-boned, rib-bared, foundered, and half-blind old roadster. A NEW DISH. Dr. James Wood was an oddity. He was a bachelor, between thirty and forty, large and attractive. He was remarkably neat in dress and person, but delighted in "an old rip of a horse." Once he was on a tour through New Brunswick, and, in company with a friend, drove up to a tavern at evening, and called for the landlord. "He ain't t' home, but I'm the horse-slayer," replied a voice, followed by the person of a tall, lean Yankee, who issued from the smoke of the bar-room, and approached our friends, still sitting in the open buggy. "Here, put up my horse; take good care of him, and feed him well." "Hoss?" said the impudent fellow. "O, yes, I see him now; he's inside that ere frame, I s'pose. Climb down, gentlemen, and go inter the house. Landlord and the Santipede (Xantippe?) has gone to St. Johns; but I guess Dolly in the kitchin, and me in the bar-room, can eat and drink yer, though you're two putty big fellows, well's myself." So saying, the gentlemen having alighted, he drove the animal to the stable. [Illustration: A "HORSE-SLAYER" INDULGING HIS OPINION.] At supper, the doctor and his friend and two ladies were the only guests. Just what part the "horse-slayer" had had in its preparation was not obvious, since he had, after caring for the horse, only sat with a pipe in his mouth and his heels elevated on the bar-room stove, or following to the sitting-room, and continually plied the doctor with questions. However, the supper was ample, thanks to "Dolly." "Is there anything more wanted?" inquired the table girl,--a round-faced, round-headed country specimen in neat calico. "Yes," replied the doctor, "we would like some napkins, seeing there are none on the table." Away hastened the girl, who, quickly returning, asked in very primitive simplicity,-- "How will you have them cooked?" "O, boiled, if you please," replied the doctor, without changing a muscle about his sober-looking face. The girl disappeared at full trot, followed by jeers of laughter from the gentlemen present, and suppressed titters from the ladies. In a few moments "Dolly" made her appearance, and after searching in vain through the side-table drawer and a cupboard in the dining-room, she said they had none in the house, and intimated that the table girl could not be induced to return, after being laughed at for her ignorance of what a napkin was, and that "herself would wait upon the guests." When the doctor returned, the "horse-slayer" called out that the napkin doctor was coming, upon which the terrified table-girl ran away and hid. My informant says, "You're only to say, any time, 'Here comes that napkin doctor,' and the table girl nearly goes wild, dropping everything, and hiding away in her chamber till assured it is only a false alarm." The writer is well acquainted with W., who assured him this was true. BEAUTY AND THE BEAST. I heard, while in the South, of a doctor, a little, short man, who rode a Canadian horse, a scraggy little specimen, and who, in yellow fever time, used to ride right straight into a drug store, and order his prescription, catch it up, wheel his pony round on his hind legs, stick in the spurs into the flanks of the animal, and go out in a clean gallop. [Illustration: NO TIME TO LOSE.] Though the writer never saw this remarkable feat, there is one more ludicrous, to which he was an eye-witness. One fine day, while in Charleston, sitting musing in the window of the Victoria Hotel, I saw an African, with bare feet and legs, his whole attire consisting of a coarse shirt and brief trousers, drive a mule attached to a dray, on which was a box, up towards a milliner's store, opposite. The negro jumped from the dray, and, with whip in hand, ran into the store to ascertain if that was the place to leave the box. [Illustration: BEAUTY AND THE BEAST.] The faithful donkey followed his master directly into the store, nor stopped till the wheels of the cart brought up against the door-jambs. The ladies, with whom the front store was crowded, screamed with terror, and fled towards the back room, where the pretty milliner girls were sewing. They caught the panic and sight of the donkey's head and ears in the front shop, and screeched in chorus. A more lively and lovely stampede I never witnessed. It was "Beauty and the Beast," and the beast stood pulling his best to get the cart through; but since a six-foot cart never could go through a four foot doorway, he backed out with the negro's assistance, and Beauty was rescued from the perilous situation. "Golly!" exclaimed the Buckee, when himself, mule and cart were back into the street. "I fought de ladies were scared ob dis chile, first sight; but I never knowed de ladies to be scared ob a hansum darky like me; and when I looked round an' see dat ar' mules coming into der mill'ner's store--O, yah, yah, yah! I shall die--O, yah, yah, yah!--de Lor'--to only fink ob it, a mule in a mill'ner's shop--he wants muslin--O, yah, yah! I shall die, sure." Then, after a few more outbursts, he stopped short--for the milliner was looking after the box--he rolled up his eyes very solemnly, and said to the donkey,-- "Yer ought to be 'shamed ob yerself to go into dat yer store--dar, take dat!" levelling a blow at the donkey's head with the whip. Then taking the box into the store, he returned, gave the donkey another solemn lecture on his impropriety, and mounted the dray and drove away. THE CONSULTING POODLES. A gentleman well known to the writer assured me that he once had occasion to repeatedly consult a physician in Philadelphia, a most excellent practitioner, who owned two pet poodle dogs. They were pure white, and occupied a portion of his office. When I first entered the doctor's presence, I was quite astonished to see, sitting on a corner of his desk, at his left, a beautiful poodle. I thought, at first sight, it was a stuffed specimen; but after inquiring the nature of my visit, the doctor said, "You can retire, sir." "What!" said I, in surprise at this summary dismissal, when I was startled to see the manikin jump from the desk and run away to a crib beside a book-case. [Illustration: DR. HUNTER IN CONSULTATION.] "I was speaking to Dr. Scipio," the doctor quietly remarked. Then adding, "Dr. Hunter, you can come instead," when another like poodle came and leaped upon the desk, and sat looking very wisely at his master. While examining my case, he occasionally cast a glance at "Dr. Hunter," sitting as quiet as a marble dog might, but seeming to understand the look which his master gave him, acknowledging it by a pricking up of the ears. I received my prescription, and what proved to be most excellent advice, and retired. The next time I visited the eccentric doctor, both Drs. Scipio and Hunter were in full consultation, sitting side by side on the desk. "Now, sirs," said the doctor, after motioning me to a seat near him, "sirs Scipio and Hunter, keep very still, and give attention." A yawning noise and expression was their simultaneous reply. "What is the object of the two canine specimens being always present when I have consulted you?" I ventured to inquire, on my last visit to the doctor. "Some physicians consult two-legged pups, in complicated cases. I prefer quadrupeds. Have we not been very successful--myself, Drs. Hunter and Scipio--in your case, sir?" This he said with a pleasant, half-serious countenance. "Indeed, you have, sir," I replied, to which the dogs gave a gap! (a smile?) "You'll find every successful man with some seeming useless habit or appendage, which, nevertheless, is essential to his success, in absorbing or distracting the superfluities of his nature. A sing-song, every-day man, whom you can see right through, and understand all his moves, seldom amounts to anything. I ape nobody, however, but I feel almost lost, in my examinations, without my dogs." Well, there may be much to this, after all. A good singer will seldom go forward to master a difficult piece of music without something in his hand. Eccentricities in some persons take the place of a vile, injurious habit, as the eccentric man is usually free from debasing habits. I am particularly reminded of Suwaroff, the great Russian general, who was so remarkable for his energy, valor, and headlong fighting propensities. This wonderful man was very small in stature, being only five feet and a half inch in height, miserably thin in flesh, with an aquiline nose, a wide mouth, wrinkled brow, and bald head--an eagle look and character. "His contempt of dress could only be equalled by his disregard of every form of politeness, and some idea may be formed of both from the fact that he was washed mornings by several buckets of water thrown over him, and that he drilled his men in his shirt sleeves, with his stockings hanging down about his heels, and proudly dispensing with the use of a pocket handkerchief." [Illustration: THE RUSSIAN GENERAL'S DRILL.] His favorite signal of attack was a shrill "_cock-a-doodle-doo!_" "To-morrow"--this was his harangue to his men before a great battle--"to-morrow morning I mean to be up one hour before daybreak. I shall wash and dress myself, then say my prayers, give one good _cock-crow_, and capture Ismail!" Which he did to the letter. After Catharine's death, Paul, her son and successor, could not brook the eccentric habits of "Old Forward and Strike," whose personal appearance was ill suited to court, and when compelled to "change or retire," Suwaroff chose the latter. Again in 1799 he was given a command, but would not change his principles, and was dismissed; and died in 1800, neglected by the imperial Paul, who was assassinated the same year. SILENT ELOQUENCE. There is a physician doing an office practice in Boston, who, when you enter his office, by one gesture and movement of his head, with the accompanying expression of his countenance, says to you, as plainly as words, "Take a seat; how do you do? State your case." He is a man of few words, professionally. Through with his business, he becomes one of the most sociable men with whom one need wish to meet. John Abernethy was remarkable for his eccentricity, and brevity in his dealings with patients. Sometimes he met his match. The following has been told about him often enough to be true. On one occasion a lady, who doubtless had heard of his _brusque_ characteristic, entered his consulting-room, at Bedford Row, and silently presented a sore finger. As silently the doctor examined and dressed the wound. In the same manner the lady deposited the accustomed fee upon the table, and withdrew. Again she presented the finger for inspection. "Better?" grunted the great surgeon. "Better," quietly answered the lady, deposited the fee, and left, without saying another word. Several visits were thus made, when, on presenting it for the last time, Abernethy said,-- "Well?" "Well," was the lady's only answer, and deposited her last fee. "Well, madam, upon my soul, you are the most sensible lady with whom I ever met," he exclaimed, and very politely bowed her out. CONSISTENT TO THE END. The most eccentric physician who ever lived, and the only one I have read of who carried his odd notions beyond this life, was Messenger Monsey, of whom I have before written in this book. He died at the age of ninety-five. He wrote his own will,--having eighty thousand dollars to dispose of,--and his epitaph. The will was remarkable, and is still preserved. "To a beautiful young lady, named ----," he gave an old battered snuff-box, not containing a shilling, lavishing upon her, at the same time, the most extravagant encomiums on her wit, taste, and elegance; and to another, whom he says he intends to enrich with a handsome legacy, he leaves the gratifying assurance that he changed his mind on finding her "a pert, conceited minx." After railing at bishops, deans, and clergymen, he left an annuity to two of the latter, who did not preach. "My body shall not be insulted with any funeral ceremonies, but after being dissected in the theatre of Guy's Hospital, by the surgeons, for the benefit of themselves and students, the remainder of my carcass may be put into a hole, or crammed into a box with holes, and thrown into the Thames." The main part of his property went to his only daughter. [Illustration: WHAT THE ELEPHANT IS LIKE.] [Illustration: A DOCTOR'S SOLACE.] This is a true copy of his epitaph:-- "Here lie my old bones; my vexation now ends; I have lived much too long for myself and my friends. As to churches and churchyards, which men may call holy, 'Tis a rank piece of priestcraft, and founded on folly. What the next world may be never troubled my pate; And, be what it may, I beseech you, O Fate, When the bodies of millions rise up in a riot, To let the old carcase of Monsey lie quiet." The above reminds me of another epitaph in Greenwood: "Underneath this turf do lie, Back to back, my wife and I. Generous stranger, spare the tear, For could she speak, I cannot hear. Happier far than when in life, Free from noise and free from strife, When the last trump the air shall fill, If she gets up, I'll just lie still!" "WHEN DOCTORS DISAGREE." The eccentricities of some doctors lie in their abuse of their brothers; especially those of a different school, of which they necessarily know little or nothing. There is a Hindoo story illustrative of the folly of this _ex parte_ decision. Four blind men went to examine an elephant, to ascertain what it was like. One felt of its foot, the second its trunk, the third its ear, and the last felt of its tail. Then they held a consultation, and began to talk it up. "The elephant is very much like a mortar," said the one who had felt of the foot. "It is like a pestle," said the one who had felt of its trunk. "No; you are both wrong. It's like a fan," said he who had felt of the ears. "You are all mistaken; it is like a broom," vehemently exclaimed the man who had felt of the tail. The dispute grew warm. Each was sure he was right, because he had personally examined for himself. Then they waxed angry, and a lasting quarrel grew out of it; so, in the end, they were all as ignorant of the truth as when they began the investigation. The diversity of medical opinion on diet is equally as great as on prescription, and often partakes largely of the notion or eccentricity of the individual physician, rather than the requirements of the patient. One is an advocate of animal diet; another is a strict Grahamite, or vegetarian, and a third is an animo-vegetarian, which, according to the two kinds of teeth given to man,--the tearing, or canine, and the grinding teeth,--seems to be the most rational decision. Then there is the slop-doctor. I know of one in Connecticut. He weighs about two hundred and fifty pounds. He breakfasts on the richest steak, dines on roast beef, and sups on a fowl. Every patient he has is a victim to "typhoid fever: the result is inflammation of the glands of the stomach, and induced by too hearty food;" hence the patient is starved a month on slop or gruel. This doctor was formerly a Methodist preacher, and-- "Exhausting all _persuasive_ means to light Our fallen race to Virtue's glorious height, To Medicine gives his comprehensive mind, And fills his pockets while he cures mankind. He scorns M. D.'s, at all hard study sneers, And soon the science of its mystery clears. _His_ knowledge springs intuitive and plain, As Pallas issued from the Thunderer's brain. He takes a patent for some potent pill Whose cure is certain--for it cures to kill. Such mighty powers in its materials lurk, It grows, like Gibbon's Rome, a standard _work_! Pill-militant, he storms the forts of pain, Where grim Disease has long entrenchéd lain, Routs fevers, agues, colics, colds, and gouts, Nor ends the war till life itself he routs. If of his skill you wish some pregnant hints, Peruse the gravestones, not the public prints! To aid his work, and fame immortal win, Brings steam from physics into medicine; From speeding packets o'er th' Atlantic waste, O'er Styx's stream old Charon's boat to haste, Proving that steam for double use is fit-- To whirl men _through_ the world, and _out_ of it!" The difference in the item of sleep is amusing. I know a poor, worn-out doctor who finds all health in early rising. Let us refer him to the following, by John G. Saxe:-- EARLY RISING. "God bless the man who first invented sleep!" So Sancho Panza said, and so say I: And bless him also that he didn't keep His great discovery to himself, nor try To make it--as the lucky fellow might-- A close monopoly by patent right. Yes, bless the man who first invented sleep (I really can't avoid the iteration); But blast the man, with curses loud and deep, Whate'er the rascal's name, or age, or station, Who first invented, and went round advising, That artificial cut-off--early rising. "Rise with the lark, and with the lark to bed," Observes some solemn, sentimental owl: Maxims like these are very cheaply said; But ere you make yourself a fool or fowl, Pray, just inquire about his rise and fall, And whether larks have any beds at all. The time for honest folks to be abed Is in the morning, if I reason right; And he who cannot keep his precious head Upon his pillow till it's fairly light, And so enjoy his forty morning winks, Is up to knavery; or else--he drinks. Thomson, who sung about the "Seasons," said It was a glorious thing to _rise_ in season; But then he said it--lying--in his bed, At ten o'clock A. M.,--the very reason He wrote so charmingly. The simple fact is, His preaching wasn't sanctioned by his practice. 'Tis doubtless well to be sometimes awake,-- Awake to duty and awake to truth,-- But when, alas! a nice review we take Of our best deeds and days, we find, in sooth, The hours that leave the slightest cause to weep Are those we passed in childhood, or asleep! 'Tis beautiful to leave the world a while For the soft visions of the gentle night; And free at last from mortal care or guile, To live as only in the angels' sight, In sleep's sweet realm so cosily shut in, Where, at the worst, we only _dream_ of sin. So let us sleep, and give the Maker praise. I like the lad who, when his father thought To clip his morning nap by hackneyed phrase Of vagrant worm by early songster caught, Cried, "Served him right!--it's not at all surprising; The worm was punished, sir, for early rising." MOTHER GOOSE. "Gabriel Betteredge," in "Moonstone," was doubtless a true character from life, picked up by the author, Wilkie Collins, somewhere in his travels. I think the best authors seldom have made up so good a character "out of whole cloth," but have gone to the highways and byways for them. Betteredge's forte lay in Robinson Crusoe. That book was his guidance and solace in all his trials and perplexities. But what would you think of a doctor, a respectable graduate of a medical college, who sought, if not advice, recreation and solace in Mother Goose? This M. D. resided a few years ago in A., New York State. He owned a large library, enjoyed the confidence of a large list of friends and patrons, and was a man of education and refinement. His eccentricity lay in his love of Mother Goose's Melodies. He kept a copy of these nursery rhymes at his very elbow, and often turned from a perplexing case, and sought solace in the jingling rhymes of old Mother Goose! Well, that was certainly better than relieving his brain by the use of narcotic stimulants, as opium, tobacco, or ardent spirits, which use can only be followed at the expense of nerve, tissue, and membrane. I have here before me an account of another physician, whose solace and relief from business cares were in his cats, of which he had several, all of which answered to their names. His attachment to these creatures was only equalled by theirs for him. Sometimes one or two perched on his shoulders and sang to him while he rested in his easy-chair. He seemed to drink in Lethean comforts, as thus he would remain for a half hour or more at a time, or till business broke the spell. When a patient came, or a servant announced a call, he would arise and say, "Pets, vamose!" and the cats would all scamper away to their nests, and the doctor, seemingly refreshed in body and mind, would return to the reality of life and its labors. One's solace is in his children, another's in his wife, a third in his flower-garden; and others' in opium, rum, or tobacco. THE TABLES TURNED. Sometimes the doctor's oddity seemed to be in his silence, again in asking "outlandish" questions. Often they get a good return; for instance,-- Dr. G., of Sycamore, Ill., riding in the country one day, saw a sign upon a gate-post, reading thus: "This farm for sail." Stopping his horse, he hailed a little old woman, who stood on tiptoe, hanging out clothes. "I say, madam, when is this farm going to _sail_?" "Just as soon, sir," replied the old lady, placing her thumb to her nose, "as anybody comes along who can raise the wind." The doctor drove thoughtfully on. THE DIFFERENCE. "A priest who was jogging along on an ass was overtaken by a loquacious doctor, and, after some preliminary conversation as to the destination, etc., the doctor proposed that they each should ask a question, and the one who proposed the best should receive hospitality at the other's expense at the next town. The priest agreed, for he was a fat, jolly little fellow, who could enjoy a laugh and "some bottles," even at a doctor's expense. So the doctor proposed the following:-- "What is the difference between a priest and a jackass?" "That's old," replied the priest. "One wears his cross on his breast, the other on his back.--Now for my turn. What is the difference between the doctor and the ass?" "I cannot tell," replied the doctor; "what is the difference?" "I see none," quietly replied the priest. "NOT BY BREAD ALONE." A physician in P., who had the reputation of being a high liver, was quite publicly reprimanded for his gluttony by an advent preacher of some note, not a thousand miles from Boston. The doctor bore his abuse without flinching, though he believed the man a hypocrite. A long time afterwards, he met the Adventist in his town, and, after some conversation, invited him to dine at his own house. The hungry Grahamite accepted, and at an early moment found himself at the doctor's board. "Will you ask a blessing?" said the doctor; which request being complied with, he uncovered one of the only two dishes on the table, which contained nothing but bread. The preacher saw the point, and said, with a disappointed grin, "You shall not live by bread alone." "Yes; I know that much Scripture," replied the doctor; "so I have provided some butter," uncovering the other dish! XX. PRESCRIPTIONS REMARKABLE AND RIDICULOUS. "He finds out what stuff they're made of."--SHAKSPEARE. "By setting brother against brother, To claw and curry one another."--BUTLER. FIG PASTE AND FIG LEAVES.--SOME OF THOSE OLD FELLOWS.--THEY SLIGHTLY DISAGREE.--HOW TO KEEP CLEAN.--BAXTER VS. THE DOCTOR.--A CURE FOR "RHEUMATIZ."--OLD ENGLISH DOSES.--CURE FOR BLUES.--FOR HYSTERIA.--HEROIC DOSES.--DROWNING A FEVER.--AN EXACT SCIENCE.--SULPHUR AND MOLASSES.--A USE FOR POOR IRISH.--MINERAL SPRINGS.--COLD DRINKS VS. WARM.--THE OLD LADY AND THE AIR PUMP.--SAVED BY HER BUSTLE.--COUNTRY PRESCRIPTIONS AND A FUNNY MISTAKE.--ARE YOU DRUNK OR SOBER? Mythology informs us that Heraclitus, the melancholy philosopher of Ephesus, fixed his residence in a manure heap, by the advice of his physicians, in hopes of thereby being cured of the dropsy. The remedy proved worse than the disease, and the philosopher died. From that time till the present, medical prescriptions have rather partaken of the extravagant and the ridiculous, than of the rational and beneficial. In biblical times the real remedies consisted of a few simples, and were almost totally confined to external uses. Fig paste was a favorite remedy for swellings, boils, and ulcers, and an ointment made of olives and some spices was used for wounds, etc. Mrs. Eve, it is said, took to fig leaves. The myrrh and hyssop were used chiefly among the Jews for purification. The former was obtained from Egypt and Arabia East. The original name was, in Arabic, _marra_, meaning bitter. The history of medicine is referable to about 1184 before Christ, from which time to Hippocrates, 460 B. C., it could not lay claim to the name of science. It was confined almost entirely to the priestcraft, and partook largely of the fabulous notions of that superstitious age, and was connected with their gods and heroes. Then, necessarily with such a belief, the remedies lay in ceremonies and incantations, as before mentioned in chapter first, and the priests had it all their own way. Chiron, according to Grecian bibliographers, was about the first who practised medicine to any extent, and who, with Apollo, claimed to have received his knowledge direct from Jupiter. Æsculapius was a son of Apollo. Æsculapius had two sons, who became celebrated physicians, and one daughter, Hygeia, the goddess of health. For a long time the practice of medicine was confined to the descendants of Æsculapius, who was worshipped in the temples of Epidaurus, the ruins of one of which is said to still be seen. Hippocrates claimed to be a descendant of Æsculapius (460 B. C.). The remedies used by his predecessors were a few vegetable medicines, accelerated by a good many mystical rites. It would seem that medicinal springs were patronized at this early date, as temples of health were established near such wells, in Greece. Theophrastus, of Lesbos, was a fuller's son, and wrote a book on plants. He was a pupil to Plato and Aristotle. Podalirius was going to cure every disease by bleeding, Herodicus by gymnastics, and Archagathus by burning and gouging out the diseased parts. Then arose Chrysippus, who reversed the blood-letting theory, and would allay the venous excitement by simple medications (not having discovered the difference between veins and arteries, and when they did, it was supposed the latter contained only air; hence the name); Asclepiades, who "kicked Hippocrates' nature out of doors," and the thermo-therapeutists, who turned out the latter. After the followers of Archagathus, or Archegenus, were driven out of Rome, the hot baths were established, which were the earliest mentioned. There was a very celebrated cold water bath established somewhat earlier, for which Mr. Noah, who owned the right, got up a very large tub, for the exclusive use of himself, family, and household pets. The bath--like nearly all cold water baths _extensively used since_--was a complete success, killing off all who ventured into the water. During the reign of the Roman emperor Caracalla (211-217) thermal baths were extensively established at Rome, and Gibbon informs us that they were open for the reception of both senators and people; that they would accommodate three thousand persons at once. The enclosure exceeded a mile in circumference. At one end there was a magnificent temple, dedicated to the god Apollo, and at the reverse another, sacred to Æsculapius, the tutelary divinities of the Thermæ. The Grecians also established cold, warm, and hot baths; and in Turkey the bathing was a religious rite until a very recent period. More recently, it is a source of diversion. "Cleanliness is akin to godliness," and recreation is a religious duty; therefore the warm bath, whether followed as a superstitious rite or as a source of amusement, is nevertheless commendable as a sanitary measure. Dr. Dio Lewis, of Boston, has a grand warm (Turkish) bathing establishment. There are several hot, champooing, and cooling rooms for ladies or gentlemen, and a grand plunge bath, containing sixteen thousand gallons of water, warmed by a steam apparatus. If the Bostonians are dirty hereafter, they must not blame the doctor. No man knows how dirty he is till he tries one of these baths. "Crosby's History of the English Baptists preserves the opinion of Sir John Floyer, physician, that immersion was of great sanitary value, and that its discontinuance, about the year 1600, had been attended with ill effects on the physical condition of the population. 'Immersion would prevent many hereditary diseases if it were still practised,' he said. An old man, eighty years of age, whose father lived at the time while immersion was the practice, said that parents would ask the priest to dip well into the water that part of the child which was diseased, to prevent its descending to posterity. "Baxter vehemently and exaggeratedly denounced it as a breach of the sixth commandment. It produced catarrh, etc., and, in a word, was good for nothing but to despatch men out of the world." "If murder be sin, then dipping ordinarily in cold water over head is a sin." So much for Dr. Floyer vs. Baxter. Surely the latter ought to have been "dipped." A western paper of respectability is responsible for the statement, that an old lady followed up a bishop as he travelled through his diocese, in that vicinity, and was confirmed several times before detected. "Why did you do such a remarkable deed?" asked the bishop. "Did you feel that your sins were so great as to require a frequent repetition of the ordinance?" "O, no," replied the old lady, complacently; "but I heerd say it was good for the rheumatiz." The bishop didn't confirm her any more. She was really going to baptism as the voters go to the polls and vote in New York--"early and often." OLD ENGLISH PRESCRIPTIONS. The prescriptions and doses of the old English doctors were "stunning." Billy Atkins, a gout doctor of Charles II.'s time, who resided in the Old Bailey, did an immense business in his specialty. His remarkable wig and dress will find a place in our chapter on "Dress." He made a nostrum on the authority of Swift, compounded of thirty different promiscuous ingredients. The apothecary to Queen Elizabeth brought in his quarter-bill, £83, 7s. 8d. Amongst the items were the following: "A confection made like a manus Christi, with bezoar stone, and unicorn's horn, 11s. Sweet scent for christening of Sir Richard Knightly's son, 2s. 6d. A conserve of barberries, damascene plums, and others, for Mr. Ralegh, 6s. Rose water for the King of Navarre's ambassador, 12s. A royal sweetmeat, with rhubarb, 16d." A sweet preparation, and a favorite of Dr. Theodore Mayerne, was "balsam of bats." A cure for hypochondria was composed of "adders, bats, angle-worms, sucking whelps, ox-bones, marrow, and hog's grease." Nice! After perusing--without swallowing--his medical prescriptions, the reader would scarcely desire to follow the directions in his "Excellent and well-approved Receipts in Cooking." I should rather, to run my risk, breakfast on boarding-house or hotel hash, than partake of food prepared from Dr. Mayerne's "Cook Book." According to Dr. Sherley, Mayerne gave violent drugs, calomel in scruple doses, mixed sugar of lead with conserves, and fed gouty kings on pulverized human bones. "A small, young mouse roasted," is recommended by Dr. Bullyn, as a cure for restlessness and nervousness in children. For cold, cough, and tightness of the lungs, he says, "Snayles (snails) broken from the shells and sodden in whyte wyne, with olyv oyle and sugar, are very holsome." Snails were long a favorite remedy, and given in consumption for no other reason than that "it was a _slow_ disease." A young puppy's skin (warm and fresh) was applied to the chest of a child with croup, because he _barked_! Fish-worms, sow-bugs, crab's eyes, fish-oil, sheep-droppings, and such delicious stuff were, and still are, favorite remedies with some physicians and country people. The following was one of Dr. Boleyn's royal remedies:-- "_Electuarium de Gemmis._ Take two drachms of white perles; two little peeces of saphyre; jacinth, corneline, emerauldes, garnettes, of each an ounce; setwal, the sweate roote doronike, the rind of pomecitron, mace, basel seede, of each two drachms; of redde corall, amber, shaving of ivory, of each two drachms; rootes both of white and red behen, ginger, long peper, spicknard, folium indicum, saffron, cardamon, of each one drachm; of troch. diarodon, lignum aloes, of each half a small handful; cinnamon, galinga, zurubeth, which is a kind of setwal, of each one drachm and a half; thin pieces of gold and sylver, of each half a scruple; of musk, half a drachm. Make your electuary with honey emblici, which is the fourth kind of mirobalans with roses, strained in equall partes, as much as will suffice. This healeth cold, diseases of ye braine, harte, stomack. It is a medicine proved against the tremblynge of the harte, faynting, and sounin, the weakness of the stomacke, pensivenes, solitarines. Kings and noblemen have used this for their comfort. It causeth them to be bold-spirited, the body to smell wel, and ingendreth to the face good coloure." "Truly a medicine for kings and noblemen," says Jeaffreson, who gives the following:-- "During the railroad panic of England (1846), an unfortunate physician prescribed the following for a nervous lady:-- [R]. Great Western, 350 shares. Eastern Counties,} North Middlesex, } a. a. 1050. M. Haust. 1. Om. noc. cap. "This direction for a delicate lady to swallow nightly (noc.) 2450 railway shares was cited as proof of the doctor's insanity, and the management of his private affairs was placed in other hands." [Illustration: HOW A LADY PROCURED A VALUABLE PRESCRIPTION.] "A humersome doctor," as Mrs. Partington would say, gives the following CURE FOR THE BLUES. Tinc. Peruvii barki bitters, 1 oz. Sugari albi, vel sweetningus, considerabilibus. Spiritus frumenti, vel old repeus, ad lib. Waterus pumpus, non multum. Nutmegus, sprinklibus. A SURE CURE. A physician of our acquaintance was called to a lady patient after she had enjoyed a season of unusual domestic quarrels, who was not over long in "turning herself wrong-side out"--as some females will insist upon doing, for the edification of the medical man--telling, not only all about her pains and aches, but her "trials with that man," her husband--her brutal usage, her scanty wardrobe, her mortification on seeing Mrs. Outsprout appear in a new blue silk, and a "love of a bonnet," and (after entertaining the doctor with wine and good things) finally wind up in hysterical sobs--for which he prescribed, as follows:-- [R]. One new silk dress--first quality. One hat and feather. One diamond--solitaire--aq. prim. Apply to patient. And 1 coach and span, to Central Park, P. M. The husband enjoyed the joke; the wife enjoyed the clothes, the diamond pin, and the ride; and the doctor heard no more of their quarrels. HEROIC DOSES. Just prior to the year 1800, two brothers, named Taylor, emerged from obscurity in Yorkshire, and set up for doctors. They were farriers, and from shoeing they advanced to doctoring and bleeding horses, thence to drugging and butchering those of their fellow-creatures who naturally preferred brute doctors to respectable physicians. Their system of practice was a wholesale one. [Illustration: DOSE--ONE QUART EVERY HOUR.] "Soft chirurgions make foul sores," said Boleyn, the grandfather of the beautiful and unfortunate Anne Boleyn. The Taylors struck no soft blows, "but opened the warfare against disease by bombardment of shot and shell in all directions. They bled their patients by the gallon, and drugged them, as they did the cattle, by the stone. Their druggists, Ewbank & Wallis, of York, supplied them with a ton of Glauber's salts at a time. Scales and weights in their dispensary were regarded as bugbears of ignoble minds. Everything was mixed by the scoop or handful. If they ordered broth for a delicate patient, they directed the nurse to boil a large leg of mutton in a copper of water, down to a strong decoction, and administer a quart at stated intervals," _nolens volens?_ The little Abbe de Voisenon, the celebrated wit and dramatic writer (1708-1775), was once sick at the chateau near Melum, and his physician ordered him to drink a quart of ptisan (a decoction of barley and other ingredients) every hour. "What was the effect of the ptisan?" asked the doctor, on his next visit. "None," replied the Abbe. "Have you swallowed it all?" "No; I could not take but half of it at once." "No more than half! My order was the whole," exclaimed the doctor. "Ah! now, friend," said the Abbe, "how could you expect me to swallow a quart at a time, when I hold only a pint?" DROWNING A FEVER. As the next anecdote has had to do service for more than one physician, it is immaterial which doctor it was. He was an irascible old fellow, at least, and not at all careful in leaving orders. "Your husband is very sick, woman," said the doctor to the wife of an Irish laborer. "His fever is high, and skin as dry as a fish, or a parish contribution box. You must give him plenty of cold water, all he will drink, and to-night I'll see him again. There, don't come snivelling around me. My heart is steeled against that sort of thing. But, as you want something to cry for, just hear me. Your husband isn't going to die! There, now, I know you are disappointed, but you brought it on to yourself." Going away--"Mind, lots of water--" "Wather, sir! Hoo much wather, docther dear? He shall have it, but, yer honor didn't tell me hoo much wather I must give him." "Zounds, woman, haven't I told you to give him all he will take? Hoo much? Give him a couple of buckets full, if he will swallow them. Do you hear now? Two buckets full." "The Lord bless yer honor," cried the woman; and the doctor made his escape. At evening the doctor stopped, on his return, to ask after the patient. "How is he, woman?" asked the doctor. "O, he's been tuck away, save yer honor," cried the widow. "The wather did him no good, only we couldn't get down the right quantity. We did our best, doctor dear, and got down him better nor a pailful and a half, when he slipped away from us. Ah, if we could oonly ha' got him to swaller the other half pailful, he might not have died, yer honor." AN EXACT SCIENCE. It is sometimes painfully amusing to observe, not only the difference of opinion expressed by medical men from one generation to another, but by those of the same period, and same school. In the "London Lancet" of July, 1864, there appeared a curious table. A medical practitioner, who had long suffered from hay fever, had from time to time consulted various other medical men by letter, and he gives us in a tabular survey the opinions they gave him of the causes of this disease, and the remedies, as follows:-- "Herewith," writes Dr. Jones, "I forward a synopsis of the opinions of a few of the most eminent men, in various countries, that I have consulted. I have substituted a letter for the name, as I do not think it prudent to place before the general reader the names of those who have so disagreed." Consulted. Opinion of Cause. Recommended. Dr. A. A predisposition to phthisis. Quinine and sea voyage. Dr. B. Disease of pneumogastric nerve. Arsen., bell., and cinchona. Dr. C. Disease of the caruncula. Apply bell. and zinc. Dr. D. Inflammation of Schneiderian To paint with nitrate of membrane. silver. Dr. E. Strumous diathesis. Quinine, cod liver oil, and wine. Dr. F. Dyspepsia. Kreosote, henbane, quinine. Dr. G. Vapor of chlorophyll. Remain in a room from 11 A. M. to 6 P. M. Dr. H. Light debility, hay pollen. Do., port wine, snuff, salt, and opium, and wear blue glasses. Dr. L. From large doses of iodine. (Never took any iodine.) Try quinine and opium. Dr. M. Disease of iris. Avoid the sun's rays from 11 A. M. to 6 P. M. Dr. N. Want of red corpuscles. Try iron, port wine, and soups. Dr. O. Disease of optic nerve. Phosph. ac. and quinine. Dr. P. Asthma from hay pollen. Chlorodyne and quinine. Dr. Q. Phrenitis. Small doses of opium. Dr. R. Nervous debility, from heat. Turkish baths. This needs no comment. The different opinions on doses of medicine is more absurd. We have already mentioned cases wherein certain physicians administered calomel in scruple, and even drachm doses. Before us is a work wherein it is seriously asserted that a medicinal action was obtained from the two hundredth trituration,--a dose so small, in comparison with the scruple doses, as to be counted only by the _millionths_. How many of us have had to wake up mornings, and swallow a table-spoonful of sulphur and molasses, with mingled feelings of disgust at the sulphur, and exquisite delight from the molasses, as we retired, lapping our mouths, to get the last taste! Now, L. B. Wells, M. D., of New York, informs us that he has cured an eruption of the skin by the use of the four thousandth dilution of sulphur,--so comparatively small that I cannot express it by figures. Well, these extremes have their uses, and we may look for relief in the mediate ground. The smaller we can get the dose, and still be reliable, the better we shall suit the people,--though we shall seriously offend the apothecaries. Dr. Francis, in his book, "Surgeons of New York," tells the following, which illustrates how a desperate remedy may apply to a desperate disease. The cases in reference were "peritonitis." Dr. Smith (our "plough-boy") had charge of the lying-in wards, under Professor Clark. "Dr. Smith, have you ever attended a common school?" asked Professor Clark. "Yes, sir." "Did you ever hear a teacher say, 'I will whip you within an inch of your life?'" pursued Dr. Clark. "Yes, sir; I have." "Well, that is the way I wish you to give opium to these patients,--'to within an inch of their lives.'" Dr. Smith determined to follow implicitly his instructions, and gave to one as high as twelve grains of opium an hour. "At this extreme point the remedy was maintained for several days. "The patient recovered, and remained in the hospital, attached to kitchen service, for several months." Certainly, the poor Irish, even, have their uses in New York city. MINERAL SPRINGS. The writer, having spent much time at the various mineral springs throughout the United States, and partaken of the water of some for weeks in succession, is competent to give an opinion as to their merits. Collectively, they are commendable, especially those located in country places, away from scenes of dissipation and profligacy. The only reliable way to expect benefit from spring waters is to select one by the advice of your physician, and go direct to the spring. Much of the bottled waters sold are "doctored," either by the retailer, the wholesaler, or often at the springs from where they are exported. Who is to know whether Vichy, Kissengen, Saratoga, or even Vermont mineral water, as sold by the package, ever saw the respective springs from which they are named? The various mineral waters are easily made, by adding to carbonized water such peculiar minerals, or salts, as analysis has shown exists in the natural springs. I knew a man who affirmed that he ruined a suit of clothes, while employed at a certain spring, by the acids with which he "doctored" the water, before it was shipped. Sulphuret of potassium covers the properties of many springs; iron others. It has been intimated that the waters of a celebrated spring which I visited is indebted for its peculiar flavor to an old tannery, which, within the memory of that mythical being, "the oldest inhabitant," occupied the site where this favorite spring "gushes forth." Having no desire to be tanned inside,--after my boyhood's experience in that delightful external process,--I respectfully declined drinking from this spring. By the immense quantities of "spring water" gulped down hourly and daily by visitors, one is led to suppose the cure lies in a thorough washing out. There is an excellent spring near Nashville, Tenn., from which I drank for a week; also another at Sheldon, Vt. There are three different springs at this latter place, but I prefer the "Sheldon" to either of the other two. I discovered a good spring at Newport, Vt., and there are others in that vicinity. COLD DRINKS VS. WARM DRINKS. "Drink freely of cold water," says an author of no small repute, to persons of a weak stomach, viz., dyspeptics. When I was an apprentice, my master (Sir Charles Blicke) used to say, "O, sir, you are faint: pray drink this water." "And what do you think was the effect of putting cold water into a man's stomach, under these circumstances?" asks the great Dr. Abernethy. "Why, of course, that it was often rejected in his face." Never put cold water, or cold victuals, into a weak stomach. The above surgeon is responsible for the following advice. An Irishman called in great haste upon the doctor, saying,-- "O, dochter--be jabers, me b'y Tim has swallowed a mouse." "Then, Paddy, be jabers, let your boy Tim swallow a cat." THE OLD LADY AND THE PUMP. One can readily conceive the utility of a warm bath--even a cold water bath, if the bather is robust--or a steam bath, a vapor, or a sun bath; but the advantage of the absurdity which the nineteenth century has introduced from antiquity, viz., the dry cupping, or pumping treatment, is not so self-evident. An old lady, suffering from "rheumatism, and a humor of the blood," was persuaded to visit a "pump-doctor's" rooms. "What's that hollow thing for?" she nervously inquired. "That is a limb-receiver," replied the polite operator. "If the disease is in the limb, we enclose it within this; the rubber excludes the air, and to this faucet we affix the pump, and remove the air from the limb." "Yes, yes; but I thought air was necessary to health; besides, I don't see how that is going to cure the limb. Does it add anything to, or take anything from the limb?" she inquired. "Well--no--yes; that is, it draws the disease out from that part." "Yes, yes; but suppose the disease is all over the person, as mine is." "Then we place them in this," putting his hand upon an article which she had not before discovered. "That? Why, that looks like the case to a Dutchman's pipe, only a sight times larger. And do tell if you shet folks up in that box," cautiously approaching and examining it. The operator assured her such was the case. "Is the disease left in the box when you are done pumping? Does it really suck all the disease into the thing by the process?" she inquired. "Well, madam, you put your questions in a remarkable manner. But it displaces the air around the person, and the vital principle within forces out the disease. It is certain to benefit all diseases," he replied. "Well, I don't see how it can, if it can't be seen. Does it act as physic, emetic, a bath, or do the sores follow right out of the blood into the box?" "Neither, madam." The operator was very patient. "Just try the limb-receiver first; then you can tell better about the whole treatment." After much persuasion, and by the assistance of the female operator, the old lady was seated, and the limb-receiver adjusted. Now the man in the next room began to pump. The old lady was very nervous, and felt for her snuff-box, and while so doing the man was still pumping. Having taken the snuff, her mind again referred to the limb in the box, and the pressure (suction) having naturally increased, her nervousness overcame her, and with a scream and a bound she left the chair and rushed for the door, dragging the receiver, which clung tight to the one limb, rather outweighing the boot and hose of the other, drawing the gutta-percha pipe after her, which only added to her fright, and with another scream for "help," and "O, will nobody save me?--O, murder, murder!" she, like a bound lion, went the length of her chain, and tumbled over in a heap on the floor. The woman rushed from behind the screen, the man from the pump-room, and rescued the old lady, who fled to her carriage in waiting; and doubtless to her dying day she will continue to tell of how narrowly she escaped "being sucked entirely through that gutta-percha pipe--only for her having on a bustle." COUNTRY MISTAKES. A Canadian, of a nervous, consumptive diathesis, went down to Portland, Maine, to consult a physician, and fell in with old Dr. F., whom he found busily engaged in examining some papers. The old doctor heard his case, and hurriedly wrote him a prescription. The chirography of the doctor was none of the best, yet the Portland druggists, who were familiar with his scrawls, could easily decipher his prescriptions. Not so the country apothecary, to whom the patient took the recipe, to save expense, which was something as follows: "Spiritus frumenti et valerianum," etc.; then followed the directions for taking. After much delay and consultation with the green-grocer boy, it was put up as a painter's article, viz., "spirits turpentine and varnish." The first glass-full satisfied the invalid. DRUNK, OR SOBER. A gentleman, knowing the parties in his boyhood, rehearsed to me the following anecdote:-- Old Dr. Gallup, of ----, N. H., was an excellent physician, whose failing lay in his propensity to imbibe more spirits then he could carry off. "Are you drunk, or sober?" was no unusual question, put by those requiring his services, before permitting the old doctor to prescribe. [Illustration: "PUMPING" AN OLD LADY.] [Illustration: A DANGEROUS PRESCRIPTION.] "Sober as a judge. What--hic--do you want?" he would reply. Mr. B., who had been a long time confined to his house, under the care of an old fogy doctor, one of the "Gods of Medicine," with whom all knowledge remains, and with whom all knowledge dies, after taking nearly all the drugs contained in his Materia Medica, decided to change, and sent for Dr. Gallup. "Are you drunk, or sober, doctor?" was the first salutation. "Sober as a judge. What's wanted?" was the reply, omitting the "hic." "Can you cure me? I've been blistered and parboiled, puked and physicked, bled in vein and pocket for the last three months. Now, can you cure me?" Gallup looked over the case, and the medicine left by the other doctor, threw the latter all out of the window, ordered a nourishing diet, told Mr. B. to take no more drugs, took his fee, and left. Mr. B. recovered without another visit. [Illustration] XXI. SCENES FROM HOSPITAL AND CAMP. "HE FOUGHT MIT SIEGEL."--A HOSPITAL SCENE AT NIGHT.--ADMINISTERING ANGELS.--"WATER! WATER!"--THE SOLDIER-BOY'S DYING MESSAGE.--THE WELL-WORN BIBLE.--WARM HEARTS IN FROZEN BODIES.--"PUDDING AND MILK."--THE POETICAL AND AMUSING SIDE.--"TO AMELIA."--MY LOVE AND I.--A SCRIPTURAL CONUNDRUM.--MARRYING A REGIMENT. I met him again; he was trudging along, His knapsack with chickens was swelling; He'd "blenkered" these dainties, and thought it no wrong, From some secessionist's dwelling. "What regiment's yours, and under whose flag Do you fight?" said I, touching his shoulder; Turning slowly about, he smilingly said,-- For the thought made him stronger and bolder,-- "I fights mit Siegel." The next time I saw him, his knapsack was gone, His cap and his canteen were missing; Shell, shrapnell, and grape, and the swift rifle-ball, Around him and o'er him were hissing. "How are you, my friend, and where have you been? And for what, and for whom, are you fighting?" He said, as a shell from the enemy's gun Sent his arm and his musket a-kiting, "I fights mit Siegel." We scraped out his grave, and he dreamlessly sleeps On the bank of the Shenandoah River; His home and his kindred alike are unknown, His reward in the hands of the Giver. We placed a rough board at the head of his grave, "And we left him alone in his glory," But on it we cut, ere we turned from the spot, The little we knew of his story-- "I fights mit Siegel."--GRANT P. ROBINSON. If any of the little "life stories" which I here relate in this brief chapter, have perchance before met the reader's eye, I can only say that they cannot be read too often. We need no longer go back to remotest history--to Joan d'Arc, Grace Darling, Florence Nightingale, nor to revolutionary scenes--to find "cases of courage and devotion, for no annals are so rich as ours in these deliberate acts of unquestioning self-sacrifice, which at once ennoble our estimate of human nature, and increase the homage we pay to the virtues of women." A HOSPITAL SCENE AT NIGHT. Night gathered her sable mantle about earth and sky, and the cold, wintry wind swept around the temporary hospital with a mournful wail, a rude lullaby, and a sad requiem to the wounded and dying soldier boys who crowded its rankling wards. Through the dark, sickly atmosphere, by the flickering lamp-lights, are just discernible the long rows of suffering, dying humanity. As the wind lulls, the sighs and groans of the unfortunate sufferers greet your ears on every side. "Water, water!" is the general request. Every moment new ones are added to the mangled and suffering throng, as they are brought in from the battle-field and the amputating-room. The surgeons are busily at work. Every able-bodied soldier must be at the front, for the emergency is great. Ah! who shall give the "water" which raging thirst momentarily demands? Who is to soothe the fearful anguish, from lacerated nerve and muscle, by cruel shot and shell? And who shall smooth the dying pillow, hear the last prayer, for self, and for loved ones far away in the northern homes? And who will kindly receive the dying messages for those dear ones,--wife, children, father, mother,--whom he never will see again, and kiss the pallid cheek, commend the soul to God, and close the eyes forever of the poor soldier boy, who died away from home and friends, in the hospital? God himself had raised up those to fill this sacred office, in the form of frail women--woman, because no man could fill the hallowed sphere. Flitting from couch to couch, like a fairy thing, noiselessly; like an angel of mercy, administering, soothing; but like a _woman_, beautiful, frail, and slender, with a cheering smile, and sympathy, as much expressed in the light of the eye as the sound of the voice, she moistened the parched lips, lightened the pillows, and the hearts, and seemed never to tire in deeds of love and kindness to the distressed soldiers. Next to the soldiers, the physicians know how to appreciate the true women at the hospital couch. After the manifestations of skill, labor, anxiety, and devotion to the cause by the physicians, thousands of men would have perished but for the hand and heart of woman, and who now live to speak her praise and cherish her memory forever. "Ain't she an angel?" said a gray-haired veteran, as she gave the boys their breakfast. "She never seems to tire; she is always smiling, and don't seem to walk, but flies from one to another. God bless her." "Ma'am, where did you come from?" asked a fair boy of seventeen summers, as she smoothed his hair, and told him, with gleaming eyes, he would soon see his mother, and the old homestead, and be won back to life and health. "How could such a lady as you come way down here to take care of us poor, sick, dirty boys?" "I consider it an honor," she said, "to wait on you, and wash off the mud you have waded through for me." Said another, "Lady, please write down your name, that I may look at it, and take it home, and show my wife who wrote my letters, combed my hair, and fed me. I don't believe you're like other people." "God bless her, and spare her life," they would say, with devotion, as she passed on. (These things were written of Miss Breckenbridge by Mrs. Hoge, of Chicago.) THE SOLDIER BOY'S DYING MESSAGE. She sat by the couch of a fair-haired boy, who was that day mortally wounded. It was night now, and in the hospital before described. The poor boy knew he must go, but before he died he wanted to leave a message of love for his mother, away in the northern home. "Tell me all you wish to have her know; I will convey your message to her," said the lady, as she bent her slender young form over the dying boy, and tenderly smoothed back the fleecy locks from his pallid brow. [Illustration: THE DYING MESSAGE.] "O, bless you, dear lady. You speak words of such joy to me. But it is this. I left a good mother, and sister Susie, in the dear old home in A. O, so much I have longed to see them during these last few hours! to see them but for one moment! O God, but for one moment!" And while he took breath she turned away her beautiful face to hide the falling tears, which she must not let the poor boy see. "Tell her," he pursued,--"my mother,--that I never found out how much I loved her till I came away from her side to fight for my country. O, lady, tell her this, and Susie, and poor father. I see it all now. And the old home comes back to my mind as clear as though I left it but yesterday. There is the old house, with its gabled roof, and the porch, all covered with clinging jessamines, and the big house-dog lying under the porch, and the great old well-sweep; and off in the meadow are the trees I used to climb. O, I never, never shall see them again. I feel very weak. Can't I have some more of that drink?" "Yes, poor, dear boy. Here; the surgeon said you could have all you wanted." "O, thank you. I wish I could write. O, there; that is so refreshing. If I could but write and tell her how good you have been to me! But write your name to her, the whole of it. She will understand, if you don't tell her how good you are. Well, I won't say any more, for you shake your head; but tell her how I love her, and them all. Am I fainting?" She arose from her knees, and taking some water, with her hand she moistened his brow and his silky hair, and offered him some more of the strengthening cordial. But he declined taking it. The boy was dying. He made one more effort, and said,-- "Mother! Tell her, too, how I have kept her little Bible; and she can see how it has been read, and marked, and worn. O for one sight of her dear face, one look from her loving eyes, one kiss from her lips! I'd then die in peace." The beautiful lady softly smoothed his hair, wiped his face, whispered words too sacred for sterner hearts, and kissed away her own tears from his pallid cheeks. "Mother! Was it you? Then good by. I die--happy, Mother!" Thus he expired. The good lady wrote the above to the mother of the brave lad, and thus I obtained the original. WARM HEARTS IN FROZEN BODIES. "A lady in one of the hospitals of the west was much attracted by two young men, lying side by side, all splintered and bandaged, so that they could not move hand or foot, but so cheerful and happy looking, that she said,-- "'Why, boys, you are looking very bright to-day.' "'O, yes,' they replied, 'we're all right now; we've been turned this morning.' "And she found that for six long weeks they had lain in one position, and for the first time that morning had been moved to the other side of their cot. "'And were you among those poor boys who were left lying where you fell, that bitter cold morning, till you froze fast to the ground?' "'Yes, ma'am; we were lying there two days. You know they had no time to attend to us. They had to go and take the fort.' "'And didn't you think it was very cruel in them to leave you there to suffer so long?' she inquired. "'Why, no, ma'am; we wanted them to go and take the fort.' "'But when it was taken, you were in too great agony to know or care for it?' "'O, no, ma'am,' they replied, with flashing eyes. 'There was a whole lot of us wounded fellows on the hill-side, watching to see if they would get the fort; and when we saw they had it, every one of us who had a whole arm, or leg, waved it in the air, and hurrahed till the air rang again.'" This is from a letter by Miss M. E. Breckenbridge, a lady who laid down her life for the sick soldiers. PUDDING AND MILK. Under Dr. Vanderkieft's supervision, in Sedgwick's corps, there was one of the noblest self-sacrificing women of the army of the Potomac. This lady was unwearied in her efforts for the good of the soldiers. While at Smoketown Hospital, there was a poor, emaciated soldier, whose weak and pitiable condition attracted her attention. He could retain nothing on his stomach. Mrs. Lee--for that was the lady--had tried all the various dishes for which the meagre hospital supplies afforded materials, but nothing afforded the patient relief and nourishment, until one day, in overhauling the stores, she found a quantity of Indian corn meal. "O, I have found a prize," she cried, in delight. "What is it?" inquired the little fellow detailed as orderly. "Indian meal," was her reply. "Pshaw! I thought you had found a bag of dollars." "Better than dollars. Bring it along." And she hastened away to the tent where lay her poor patient. "Sanburn," said she,--for that was the invalid's name,--"could you eat some mush?" "I don't know what that is. I don't like any of your fancy dishes." "Why, it's pudding and milk," said a boy on the next cot. "O, yes," exclaimed the starving soldier. "I think I could eat a bucket full of pudding and milk." Mrs. Lee was not long in giving him an opportunity for the trial. She at first brought him a small quantity, with some sweet milk, and to her joy, as well as that of the lean, hungry patient, it suited him. He ate it three times a day, and recovered. Indeed, the sack of meal was worth more than a sack of dollars, as she had said. As strange as this may seem, there are instances on record where very remarkable, yea, absurd articles of diet have cured where medicine failed. SMALL BEER. The Earl of Bath, when he was Mr. Pulteney, was very sick of the pleuristic fever, in Staffordshire. Doctor after doctor had been called down from London, till his secretary had paid out the sum of three thousand seven hundred and fifty dollars. The last two physicians had given him up. "He must die," said Drs. Friend and Broxholm. They, however prescribed some simple remedies, and were about to leave, when the invalid, just alive, was heard to mutter, "Small beer." "He asks for small beer," said the attendants. "Shall we give him some?" "Yes, give him 'small beer,' or anything," replied the doctors. A great two-quart silver pitcher full was brought, and he drank the whole contents, and demanded more. The request was granted, and, after drinking the gallon, he fell asleep, perspired freely, and recovered. THE POETICAL AND AMUSING SIDE. There is a poetical side, as well as a prosy side, to the camp and hospital. The following effusion of confusion was sent to the writer by a brother who gave his life for his country. It was written by a rebel soldier, who never realized his dream, and doubtless his "Amelia" mourns his loss as sincerely as though he had fought in a better cause. TO AMELIA. 1. O, come, my love, and go away to the land up north; for there, they say, it's rite good picketin' for rebel boys. And we'll take the land, and sweep the band of New Yorkers into the bay. 2. I've heered of Delmonico's, and Barnum's Shows, and how many hotels the land only knows. And we'll steer our bark for Centre Park. Here's a health to ourselves, and away she goes. (Here I drank.) 3. Then come with your knight so true, and down with the boys that's dressed in blue. Farewell to hoe-cake an' hominy, Richmond and Montgomery. I'll lick the damn Yankees, an' marry you. 4. Here's a heart, I reckon, as firm's a rock; no truer ever beat neath a gray or blue frock. So come, my love, and haste away. We'll moor our bark in New York Bay, when I end this fighting work. Your true lover, J. PARSLOE. The next has been in print, and was written by Major McKnight, while a prisoner. "He was a poet, musician, and joker, and used to run from grave to gay, from lively to severe, on almost all mottoes. He was an especial favorite with his guard, the Union boys." MY LOVE AND I. My love reposes in a rosewood frame; A bunk have I; A couch of feath'ry down fills up the same; Mine's straw, but dry. She sinks to rest at night without a sigh; With waking eyes I watch the hours creep by. My love her daily dinner takes in state; And so do I; The richest viands flank her plate; Coarse grub have I. Pure wines she sips at ease her thirst to slake; I pump my drink from Erie's limpid lake. My love has all the world at will to roam; Three acres I; She goes abroad, or quiet sits at home; So cannot I. Bright angels watch around her couch at night; A Yank, with loaded gun, keeps me in sight. A thousand weary miles stretch between My love and I; To her, this wintry night, cold, calm, serene, I waft a sigh, And hope, with all my earnestness of soul, To-morrow's mail may bring me my parole. There's hope ahead: we'll one day meet again, My love and I; We'll wipe away all tears of sorrow then; Her love-lit eye Will all my many troubles then beguile, And keep this wayward reb from Johnson's Isle. [Illustration: STUCK!] A SCRIPTURAL CONUNDRUM. The Georgia contrabands were great on conundrums, says a soldier of Sherman's army. One day one of these human "charcoal sketches" was driving a pair of contrary mules hitched to a cart loaded with foraging stuff. He was sitting on the load, saying to himself, "Now dat Clem ax me dat cundrum to bodder dis nigger, and I done just make it out. 'Why ar Moses like er cotton-gin?' I done see. I mighty 'fraid I hab to gib dat up. Whoa! Git up? What de debble you doin'?" While "cudgelling his brains" for a solution of Clem's conundrum, the mules had strayed from the cart road, and were stuck hard and fast in the mud. "Git up dar yer Balum's cusses!" piling on the whip and using some "swear words" not to be repeated. "Dar, take dat, and dat, yer!" Just then Chaplain C. rode up, and hearing the contraband swearing, said,-- "Do you know what the great I Am said?" "Look'er yer, masser," interrupted the negro; "done yer ax me none of yer cundrums till I git out ob dis d---- hole; and I answer Clem's fust--'Why am Moses like er gin-cotton?'" WOULDN'T MARRY A REGIMENT. When General Kelley was after Mosby's guerrillas, he captured a girl named Sally Dusky, whose two brothers were officers in the guerrilla band. The general tried in vain to induce the girl--who was not bad looking, by the way--to reveal the rebs' hiding-places. Having failed in all other ways, the general said,-- "If you will make a clean breast of it, and tell us truly, I will give you the chances for a husband of all the men and officers of my command." With this bait he turned her over to Captain Baggs. After some deliberation she asked that officer if the general meant what he said. "O, most assuredly; the general was sincere," was his reply. The girl assumed a thoughtful mood for some moments, and then said,-- "Well, I wouldn't like to marry the whole regiment, or staff, but I'd as lief have the old general as any of them." [Illustration] XXII. GLUTTONS AND WINE-BIBBERS. "Full well he knew, where food does not refresh, The shrivelled soul sinks inward with the flesh; That he's best armed for danger's rash career, _Who's crammed so full there is no room for fear_." "Strange! that a creature rational, and cast In human mould, should brutalize by choice His nature."--COWPER. GOOD CHEER AND A CHEERFUL HEART.--A MODERN SILENUS.--A SAD WRECK.--DELIRIUM TREMENS.--FATAL ERRORS.--"EATING LIKE A GLUTTON."--STRENGTH IN WEAKNESS.--A HOT PLACE, EVEN FOR A COOK.--A HUNGRY DOCTOR.--THE MODERN GILPIN.--A CHANGE! A SOW FOR A HORSE!--A DUCK POND.--THE FORLORN WIDOW.--A SCIENTIFIC GORMAND.--ANOTHER.--"DOORN'T GO TO 'IM," ETC.--DR. BUTLER'S BEER AND BATH.--CASTS HIS LAST VOTE. If I confine this chapter to modern physicians, it will be brief. Though doctors are usually pretty good livers, they, at this day of the world, too well know the deadly properties of the villanous concoctions sold as liquors to risk much of it in their own systems. There is a whole sermon on eating in our first text above, and, while we admit that gluttony is reprehensible, we detest "the shrivelled soul" who starves wittingly his body to heap up riches, or under the idle delusion of starving out disease, or "mortifying the flesh." If not very "mortifying," it is very depressing, to be bored by one of these "lean, lank hypochondriacs,"--to have to entertain, or be entertained by, such. O, give me the wide-mouthed, the round-faced, or abdomened, the cheerful, laughing man, especially if he's a doctor. [Illustration: A GOOD LIVER.] "Ah, doctor," said a poor, emaciated invalid to me during my first year's practice at ----, "you do me good like a medicine by your presence. Why, the blue devils leave the house the moment you enter. I don't believe you was ever blue." "Hereafter my patients shall never know that I am." Nor is it necessary to gulp down ardent spirits to keep the spirits up. Stimulants produce an unnatural buoyancy of spirits, and the unnatural destroys the natural habit of the system. A good and natural habit does not grow upon a person to his injury; an unnatural one always does, ending in his destruction. A good living gives good spirits; _cæteris paribus_, a poor living low spirits. A MODERN SILENUS. Silenus, of the mythologists, was a demigod, who became the nurse, the preceptor, and finally the attendant, of Bacchus. He was represented as a fat, bloated old fellow, riding on an ass, and drunk every day in the year. I knew a "bright and shining light" in the medical profession who turned out a modern Silenus. This was Dr. G., of Plymouth, Conn. His father had given him the best medical education which this country afforded. He was a gentleman of superior address, as well as talent, tall, straight, and handsome as an Apollo, with a dark, flashing eye, a massive brow, shaded by a profusion of jet-black locks. How long he had practised medicine I do not know. Throughout the county he had an excellent professional reputation, particularly as a surgeon. His instruments were numerous, and of the best and latest improvements. Alas that such a man should be lost to the community, and to humanity! But his appetite for intoxicating drink knew no bounds. His thirst was as insatiable as Tantalus'. When I first knew him, he still was in practice, but the better portion of the community had ceased to trust him. He never was sober for a day. He occupied then a little office in the square, containing a front and a back room. In the latter were his few medicines,--there was no apothecary in town,--and a number of large glass jars, containing excellent anatomical and foetal specimens. This room was not finished inside, and the walls were full of nails, projecting through from the clapboards outside. One day a Mr. Hotchkiss went after him, hoping to find the doctor sufficiently sober to prescribe for a patient, in a case of emergency. "What do you suppose I found him doing?" said Mr. Hotchkiss to me. "Hiding from the snakes in his back room?" I suggested. "No, sir; he had the tremens, and with his coat off, his hair standing every way, his eyes glaring like a demon's, he had his case of forceps strewn over the floor, and was diving at the ends of the clapboard nails, which he called devils, that came through the boards, in the back office." "Ah, there you are! Another devil staring at me!" he shouted; and with the bright, gleaming forceps he dove at a nail, wrenched it from the wall, and flinging it on the floor, he stamped on it, crying, "Another dead devil! Come on. Ah, ha! there you are again!" and he dove at another. When he broke a forceps he flung it on the floor, and caught a new pair. I tried to stop him, but he only accused me of being leagued with his evil majesty to destroy him. [Illustration: A DOCTOR KILLING THE DEVILS.] [Illustration: PAYING FOR HIS WINE.] Another day, after having pawned nearly all his instruments for money with which to buy liquor to appease his raving appetite, he was seen to unseal one of the jars containing a foetal specimen, pour out a quantity of the diluted alcohol in which it had long been preserved, and drink it down with the avidity of a starving man. His last instrument and case pawned, he sold the coat from his back to buy liquors. He could no longer get practice, no longer pay his board, and he became an outcast from all respectable society, and a frequenter of bar-rooms. A poor and simple old woman in the remote part of the town took compassion on him, and gave him a home. But nothing could chain his uncontrollable passion for intoxicating drinks. [Illustration: A BAR-ROOM DOCTOR.] The last time I saw him was in the month of December. He was in a grocery, warming himself by the store fire. He wore a crownless hat, a woman's shawl over his shoulders, and a pair of boy's pants partially covered his legs; no stockings covered his ankles, and a pair of old, low shoes encased his feet. The light had fled from his once beautiful, lustrous eyes; great wrinkles furrowed his once manly brow; his hair, once dark and glossy as the raven's wing, was now streaked with gray, uncombed and unkempt, hanging, knotted and snarled, over his neck and bloated face. "Don't you recollect me?" he asked, with a shaking voice and a distressing effort at a smile. Ah, it was sickening to the senses. Alas! Such another wreck may I never behold. What power shall awaken him from his awful condition, and "Picture a happy past, Gone from his sight, Bring back his early youth, Cloudless and bright; Tell how a mother's eye Watched while he slept, Tell how she prayed for him, Sorrowed and wept. "Point to the better land, Home of the blest, Where she has passed away, Gone to her rest. O'er the departed one Memory will yearn; God, in his mercy, grant He may return." FATAL ERRORS. Unfortunately, it is much easier to copy a great man's imperfections than those qualities which give him his greatness. Too often, also, are their defects mistaken for their marks of distinction,--vice for virtue,--and copied by the young, who have not the ability to imitate their greatness. "General Grant smokes!" "_President_ Grant drinks!" These two sentences, with the lamentable fact of their probable truth, have made more smokers of young men in the military and civil walks of life than all other texts in the English language. General or President Grant is not responsible for the lack of brains in the community, to be sure; but if "great men" will persist in bad habits, young men should be taught the difference between them and their virtues, and cautioned to shun them, or their bark will be stranded far out of sight of their desired haven,--the port of their ambition,--and nothing but a worthless wreck remains to tell what better piloting might have done for them. The voyage ended cannot be re-commenced. A student of medicine, in New York, brought a bottle of liquor to our room. I told him where that bottle would carry him. "Pshaw! It's only a pint of wine. Dr. Abernethy, the great English surgeon, bought one hundred and twenty-six gallons at once, and he did not _die a drunkard_," was his contemptuous reply. "But you must remember that Abernethy lived in the days of _good_ port wine, when every man had something to say of the sample his hospitality produced of his popular beverage. The doctor, who never was intemperate, was very hospitable. "'Honest John Lloyd!'--what an anomaly when applied to a rum-seller--was a great wine merchant of London, a particular friend of Abernethy's, and of all great men of his day, who loved wines and brandies. "One day I went to Lloyd's just as Dr. Abernethy left. "'Well,' said Mr. Lloyd, 'what a funny man your master is.' "'Who?' said I. "Why, Mr. Abernethy. He has just been here and paid me for a pipe of wine, and threw down a handful of notes and pieces of paper, with fees. I wanted him to stop to see if they were all right, and said, 'Some of those fees may be more than you think, perhaps.' 'Never mind,' said he; 'I can't stop; you have them as I took them,' and hastily went his way. "In occasional habits we may most safely recollect that faults are no less faults (as Mirabeau said of Frederick the Great) because they have the shadow of a great name; and we believe that no good man would desire to leave a better expiation of any weakness than that it should deter others from a similar error." In fact, the doctor was opposed to drunkenness, and also gluttony, although he himself "was a good liver," as the following anecdote will show:-- A wealthy merchant who resided in the country had been very sick, and barely recovered, when, from the same cause, he was again threatened with a return of the like disease. "I went to see him at home, and dined with him. He seemed to think that if he did not drink deeply, he might _eat like a glutton_," said the doctor. "Well, I saw he was at his old tricks again, and I said to him, 'Sir, what would you think of a merchant, who, having been prosperous in business and amassed a comfortable fortune, went and risked it all in what he knew was an imprudent speculation?' "Why, sir," he exclaimed, "I should say he was a great ass." "'Nay, then, thou art the man,' said Abernethy." The leopard does not change his spots. For the truth of this read the life and fall of Uniac. O, it is a fearful thing to become a drunkard. The habit once acquired is never gotten entirely rid of. It sleeps--it never dies, but with the death of the victim. Young men, avoid the first drink. Never take that first fatal glass; thus, and only thus, are you safe from a drunkard's grave, and the curse entailed upon your progeny. STRENGTH IN WEAKNESS. "Sir, I am advised that you have a barrel of beer in your room," said the president of one of our New England colleges to a student, who, contrary to rule and usage, had actually purchased a barrel of the delightful stuff made from brewed hops, copperas, and filthy slops, and deposited it under the bed, convenient for use. "Yes, sir; such is the fact," replied the student. "What explanation can you give for such conduct, sir?" "Well," began the student with the boldest confidence, "the truth is, my physician, in consideration of my ill health, advised me to take a little ale daily; and not wishing to be seen visiting the beer-shops where the beverage is retailed, I decided to buy a barrel, and take it quietly at my room." "Indeed! and have you derived the anticipated benefit therefrom, sir?" inquired the president. "O, yes, sir; indeed I have. Why, when I first had the barrel placed in my room two weeks ago, I could not move it. Now, sir, I can carry it with the greatest of ease." The president _smiled_, and ordered the barrel removed, saying that "in consideration of his rapid convalescence the treatment could safely be discontinued." A WARM PLACE FOR A COOK. Soon after the completion of the Roberts Opera House, in Hartford, Conn., the Putnam Phalanx held a grand ball within its walls. The music was exquisite; the prompters the best in the state; the ladies were the most beautiful and dressy in the land; and all went splendidly, till the supper was discussed. There had been a misunderstanding about the number for whom supper was to be prepared, and it was found out, when too late, that there were a hundred more guests than plates. The supper was spread in the basement. When the writer went down with friends, the tables, which had already been twice occupied, presented a disgusting scene--all heaped up with dirty dishes, debris of "fowl, fish, and dessert," and great complaint was made by the hungry dancers, while some unpleasant epithets, and uncomplimentary remarks were hurled at the heads of the innocent caterers. With our party were Dr. C., a great joker, and Dr. D., his match. "If you don't like this fare you can go through into the restaurant," said one of the waiters. "It is all the same," he added. We required no second invitation. We did ample justice to the fare provided, and retired, leaving Dr. C. to bring up the rear. In a half minute he came running after us, saying,-- "The fellow told me I must pay for the supper in there, extra!" "Well, what did you tell him?" "Why, I told him to go to h----." "Well, you did right; let him go; that is just the place for him." On another occasion, the dinner not being forthcoming at a hotel where we dined, the doctor "fell to," and soon demolished the best part of a blanc-mange pudding before him. "That, sir, is dessert," politely interrupted the waiter, in dismay at seeing his dessert so rapidly disappearing. "No matter," said the doctor, finishing it; "I could eat it if it were the Great Sahara!" A MODERN GILPIN. The widow Wealthy lived in the country. She was a blooming widow, fair, plump, and--sickly. She owned a valuable farm, just turning off from the main thoroughfare,--broad acres, nice cottage house, great barn and granary, and she was considered, by certain eligible old bachelors, and a widower or two, as "a mighty good catch." Dr. Filley practised in the country. He was a bachelor, above forty. He was a short, thick-set man, with a fair practice, which might have been better, but for certain whispers about a growing propensity to--drinking! That's the word. Of course he denied the insinuation, and defied any one to prove that he was ever the worse for liquor. The doctor was attendant, professionally, upon the widow, and--well you know how the gossips manage that sort of a thing in the country. But who was to know whether "the doctor made more visits per week to the widow Wealthy than her state of health seemed to warrant"? or who knew that "the widow was 'sweet' towards the little doctor, and that she intended he should throw the bill all in at the end of the year--himself to boot?" Never mind his rivals; they do not come into our amusing story. John, the widow's hired man, was sent very unexpectedly, one day in autumn, for the doctor to call that afternoon, to see the invalid. Very unexpectedly to the widow, and greatly to her mortification, two gossiping neighbors called at her residence just as the doctor was expected to arrive. "O, she was so glad to see Mrs. ---- and Mrs. ----!" Dr. Filley rode a scraggy little Canadian horse,--a fiery, headstrong beast, but a good saddle horse. Somehow, the unexpected call, at that hour, slightly "flustered" the little doctor; but he threw his saddle-bags over his shoulder, mounted the beast, and turned his head towards the widow's residence. "I b'lieve I am a little nervous over this colt; I wonder what's the matter!" And he tried to rein up the headstrong little beast, to give himself time to--sober off! "I reary bl'eve I'm a little--taken by surprise--ho, Charley! Why, what's got inter--pony? Goes like 'r devil. Ho, ho, boy." Pretty soon the beast struck into a gallop; and now he reached the lane that led into Mrs. Wealthy's farm. The pony knew the lane as well as his master, and the barn better. The said lane led by the barn-yard and out-buildings, the house being beyond. The barn-yard bars were down, and the pony made for the opening, in a clean gallop, over the fallen bars, right in amongst the cattle, the sheep, and the swine. A big ox gave a bellow at the sudden arrival, and, with tail and head in air, ran to the opposite side of the yard, intruding upon the comfort of a big old sow, that was dozing in the mud. With a loud snort, the discomfited porker rushed from the mire just in time to meet the horse, and in attempting to pass on both sides at once, she went between the short fore legs of the pony, and brought up with a loud squeal, and a shock that sent the rider over the horse's head, down astride the hog. The pony reared, wheeled, and ran out of the yard at one pair of bars, and the sow went pell-mell out of the other, bearing the doctor and saddle-bags swiftly along towards the house. The hired man witnessed the sudden change of steeds, and gave the alarm. The widow--not so very sick--was just graciously showing her two unwelcome lady callers out, after being worried nearly an hour by their company; and taking an anxious look towards the lane, she saw the doctor coming on a clean--no, dirty--gallop, on her old sow. She lost no time in giving a loud scream. What else should she do? "O, goodness gracious! What is that?" "O Lord, save and defend us! What is it?" exclaimed the two ladies, in chorus. "A man on a hog!" "The doctor on a sow!" again in chorus. Now the pony and the swine met, the doctor still clinging to the sow's ear with one hand, and to the tail with the other; of course, having turned a clean summersault from the pony, facing towards the sow's hind quarters. The swine, beset on all sides, sheered off, and made directly through a large duck-pond in the field, scattering the geese and ducks every way, which, crying out, "Quack, quack!" made off as fast as feet and wings could carry them. Half way across the pond the doctor lost his balance, and, with his saddle-bags, fell splashing into the water. Another scream from the ladies,--only two of them. The widow, like a sensible woman, when she saw the doctor's danger, ran for the well-pole. "Here, John, here! Take this well-hook, and fish him out quick, before he drowns." John obeyed, and in an instant the doctor was safely landed. The doctor was sobered. The widow, seeing no further danger, like a true woman, fainted. [Illustration: THE DOCTOR ON A SOW.] [Illustration: RESCUE OF THE DOCTOR.] Leaving the muddy and half-drowned doctor, who looked like a well-wet-down bantam cock, John turned to his mistress, whom he picked up from the grass, and carried into the house. The two ladies, who had witnessed her discomfiture, assisted in loosening the stays, and administering some salts, which revived the widow. "O, did you ever see such a comical sight?" "Never. O, wasn't it horrid? The little doctor riding backward, on a horrid, dirty, old pig! O, if I ever!" And the ladies laughed in unison, in which the widow actually joined. "But what has become of the poor, wet fellow? And did John rescue the saddle-bags?" inquired the widow. John, meantime, had returned to the doctor's assistance. He now fished out the saddle-bags, and the unfortunate doctor started on foot for home, whither the pony had long since fled. The story, in the mouth of one servant and three ladies, was anything but a secret, and--you know how it is in the country. * * * * * The widow still holds the farm in her own name, in a town in New England. Dr. Filley practises physic in California. A SCIENTIFIC GOURMAND. Our familiar friend, "A Book about Doctors," which we have before introduced to your notice as the only amusing work in the English language, upon the subject, gives a long list of _bon vivants_ of the old school, amongst whom are some eminent names in the medical profession. In fact, the abstemious doctors during the past centuries would seem to have been far in the minority. Even Harvey was accused of being fond of brandy. "Dr. George Fordyce was fond of substantial fare, like Radcliffe, who was a _gormand_. For above twenty years Fordyce dined at Dolly's chop-house. The dinner he there consumed was his only meal during the four and twenty hours. "Four o'clock was his dinner hour. Before him was set a silver tankard of strongest ale, a bottle of port wine, and a quarter pint of brandy. "The dinner was preluded by a dish of broiled fowl, or a few whitings. Having leisurely devoured this plate, the doctor took a glass of brandy, and ordered his steak, which was always a prime one, _weighing one and a half pounds_. Of course, vegetables, etc., accompanied the steak. "When the man of science had devoured the whole of this, the bulk of which would have kept a boa constrictor happy a twelvemonth, he took the rest of his brandy, drank off the tankard of ale, and topped off by sipping down his bottle of port wine. "Having thus brought his intellects, up or down, to the standard of his pupils, he rose, and walked down to Essex Street, and delivered his six o'clock lecture on chemistry." (He lived to the age of sixty-six.) Another glutton, in contrast with whom Fordyce was an abstinent, was Dr. Beauford. In 1745 he was summoned to appear before the privy council, to answer some questions relative to Lord B., with whom the doctor was intimate. "Do you know Lord Barrymore?" asked one of the lords. "Intimately, _most_ intimately," replied the doctor. "You were often with him?" "We dine together almost daily when his lordship is in town," answered the doctor, with expressions of delight. "What do you talk about?" "Eating and drinking." "Eating and drinking! What else?" asked his lordship. "O, my lord, we never talk about anything but eating and drinking,--except--" "Except what, sir?" "_Except drinking and eating_, my lord." The council retired, greatly disappointed, for they had expected to worm some important secret from the doctor. At Finch Lane Tavern, where Dr. Beauford used to receive the apothecaries at half fee, he was represented as sitting over his bottles and glasses, from which he drank deeply, never offering one of his clients a drop, though they often sat opposite, at the same table, looking with anxious countenances and watering mouths upon the tempting cordials, as the doctor tossed them off. "DOORN'T GO TO 'IM," ETC. "Not many years since, in a fishing village on the eastern coast, there flourished a doctor in great repute amongst the poor, and his influence over the humble patients literally depended on the fact that he was sure, once in the twenty-four hours, to be handsomely intoxicated. "Dickens has told us how, when he bought the raven immortalized in 'Barnaby Rudge,' the vender of that sagacious bird, after enumerating his various accomplishments, said, in conclusion,-- "'But, sir, if you want him to come out strong, you must show him a man drunk.' "The simple villagers of Flintbeach had a firm faith in the strengthening effect of looking at a tipsy doctor. They usually postponed their visits to Dr. Mutchkins till evening, because they then had the benefit of the learned man in his highest intellectual condition. "'Doorn't go to 'im i' the morning; he can't doctor no ways to speak on till he's had a glass,' was the advice usually given to strangers not aware of the doctor's little peculiarities." DR. BUTLER'S BEER AND BATH. An amusing description is given of one Dr. Butler, of London, who, like the above, used to get drunk nightly. He was the inventor of a beer which bore his name, something like our Ottawa, "with a stick in it," by one Dr. Irish. We once saw a drunken fellow holding on to a lamp post, while he held out one hand, and was arguing with an imaginary policeman that he was not drunk,--only had been taking a "little of that--hic--beverage, Dr. Waterwa's Irish beer, by the advice of his physician." [Illustration: "ONLY IRISH BEER."] Dr. Butler had an old female servant named Nell Boler. At ten o'clock, nightly, she used to go to the tavern where the doctor was, by that hour, too drunk to go home alone, when, after some argument and a deal of scolding from Nell for his "beastly drunkenness," she would carry the inebriated doctor home, and put him to bed. "Notwithstanding that Dr. Butler was fond of beer and wine for himself, he was said to approve of water for his patients. Once he occupied rooms bordering on the Thames. A gentleman afflicted by the ague came to see him. Butler tipped the wink to his assistant, who tumbled the invalid out of the window, slap into the river. We are asked to believe that the surprise actually cured the patient of his disease." [Illustration: CURE FOR THE AGUE.] Water did not cure the doctor, however, but beer did. Dr. Burrowly was stricken down in his prime, and just as he was about to succeed to the most elevated position in the medical profession. The doctor was a politician, as well as an excellent surgeon. When Lords Gower and Vandeput were contesting the election for Westminster, in 1780, the doctor was supporting the latter. One Weatherly, who kept a tavern, and whose wife wore the ---- belt, was very sick. Mrs. Weatherly deeply regretted the fact of the sickness, as she wanted her husband to vote for Lord T. Late on election day, Dr. Burrowly called round to see his patient, quite willing that he should be sufficiently sick to keep him from going to the polls. To his surprise he found him up, and dressed. "Heyday! how's this?" exclaimed the doctor, in anger. "Why are you up, without my permission?" "O, doctor," replied Joe Weatherly, feebly, "I am going to vote." "Vote!" roared the doctor, not doubting that his wife had urged him to attempt to go to the polls to vote for Lord J. "To bed. The cold air would kill you. To bed instantly, or you're a dead man before nightfall." "I'll do as you say, doctor; but as my wife was away, I thought I could get as far as Covent Garden Church, and vote for Sir George Vandeput." "For Sir George, did you say, Joe?" "O, yes, sir; I don't agree with my wife. She's for Lord Trentham." The doctor changed his prognosis. "Wait. Let me see; nurse, don't remove his stockings;" feeling the man's pulse. "Humph! A good firm stroke. Better than I expected. You took the pills? Yes; they made you sick? Nurse, did he sleep well?" "Charmingly, sir;" with a knowing twinkle of the eye. "Well, Joe, if you are bent on going to the polls, it will set your mind better at ease to go. It's a fine sunny afternoon. The ride will do you good. So, bedad, I'll take you along in my chariot." Weatherly was delighted with the doctor's urbanity, resumed his coat, went to the election, and voted for Sir George, rode back in the chariot, _and died two hours afterwards_, amidst the reproaches of his amiable spouse. "Called away from a dinner table, where he was eating, laughing, and drinking deeply, Dr. B. was found dead in the coach from apoplexy, on the arrival at the place of destination." [Illustration] XXIII. THE DOCTOR AS POET, AUTHOR, AND MUSICIAN. "Here comes the trout that must be caught with tickling." "To patient study, and unwearied thought, And wise and watchful nurture of his powers, Must the true poet consecrate his hours: Thus, and thus only, may the crown be bought Which his great brethren all their lives have sought; For not to careless wreathers of chance-flowers Openeth the Muse her amaranthine bowers, But to the few, who worthily have fought The toilsome fight, and won their way to fame. With such as these I may not cast my lot, With such as these I must not seek a name; Content to please a while and be forgot; Winning from daily toil--which irks me not-- Rare and brief leisure my poor song to frame." OUR PATRON, OUR PATTERN.--SOME WRITERS.--SOME BLUNDERS.--AN OLD SMOKER.--OLD GREEKS.--A DUKE ANSWERED BY A COUNTRY MISS.--THE PILGRIMS AND THE PEAS.--"LITTLE DAISY."--"CASA WAPPA!"--FINE POETRY.--MORE SCHOOLMASTERS AND TAILORS.--NAPOLEON'S AND WASHINGTON'S PHYSICIANS.--A FRENCH "BUTCHER."--A DIF. OF OPINION.--SOME EPITAPHS.--DR. HOLMES' "ONE-HOSS SHAY."--HEALTHFUL INFLUENCE OF MUSIC.--SAVED BY MUSIC.--A GERMAN TOUCH-UP.--MUSIC ON ANIMALS.--MUSIC AMONG THE MICE.--MUSIC AND HEALTH. Apollo,--the father of Æsculapius, the "father of physicians"--was the god of poetry and of music, as well as the patron of physicians. He presented to Mercurius the famous caduceus, which has descended in the semblance of the shepherd's crook--he being the protector of shepherds and the Muses--and the physician's cane and surgeon's pole. Apollo is represented with flowing hair,--which the Romans loved to imitate, with an effort also at his graces of person and mind. Students at this day who court the Muses begin by allowing, or coaxing their hair to grow long, forgetting, as they nurse a sickly goatee or mustache, assisting its show by an occasional dose of nitrate of silver, that their god was further represented as a tall, _beardless_ youth, and instead of a bottle or cigar, he held a lyre in his hand and discoursed music. [Illustration: AN EMBRYO APOLLO.] I think Dr. Apollo a very safe pattern for our students to imitate, those particularly who are "fast," and who only think, with _Bobby Burns_,-- "Just now we're living sound and hale; Then top and maintop crowd the sail; Heave care owre side! And large, before enjoyment's gale, Let's tak the tide." It is quite impossible to mention all, even of the most celebrated of our physicians, who have contributed to the literary and musical world. But I shall quote a sufficient number to disprove the assertion that "literary physicians have not, as a rule, prospered as medical practitioners." Who has developed and promulgated the knowledge relative to anatomy, chemistry, physiology, botany, etc., but the physicians? The true representation of sculpture, of painting, of engraving, and most of the arts, depends upon the learned writing of the doctors. Da Vinci owed his success as a portrait painter to his knowledge of anatomy and physiology derived from study under a physician, as also did Michael Angelo. How would our Powers have succeeded as a sculptor, without this knowledge, or Miss Bonheur as a painter of animals? Dr. Hunter says "Vinci (L.) was at the time the best anatomist in the world." Crabbe, to be sure, failed as a physician, but succeeded as a literary man; but then Crabbe was no physician, and was unread in medicine and surgery. Arbuthnot also failed in the same manner, and for the same cause. All who have so failed may attribute it to the fact they _did not succeed in what they were not, but did succeed in what they were_--as Oliver Goldsmith. He squandered at the gaming table the money given him by his kind uncle to get him through Trinity College, and though spending two years afterwards in Edinburgh, and passing one year at Leyden, ostensibly reading medicine, he totally failed to pass an examination before the surgeons of the college at London, and was rejected "as being insufficiently informed." He had previously been writing for the unappreciative booksellers, and authorship now became, per force, his only means of livelihood. Goldsmith was an excellent, kind-hearted man; and if he had only got married and had a good wife to develop him, he would have been a greater man than he was. It has been intimated in these pages that Shakspeare was prejudiced against medicine,--throwing "physic to the dogs;" but it is evident from a careful perusal of his works that Shakspeare was ignorant, and also superstitious, as respects this much abused science. Of the superstitions we need not further treat, but refer the intelligent reader to any of his plays for the truth of our intimation. In Act II., Scene 1, of Coriolanus, he says by Menenius Agrippa, the friend of Coriolanus, "It gives me an estate of seven years' health, in which time I will make a lip at the physician; the most sovereign prescription of Galen is but empirical," etc. Coriolanus was banished from Rome, and died in the fifth century before Christ (about 490), and Galen was not born till six hundred years afterwards, viz.,--A. D. 130. We should smile to see the Apollo Belvedere with "glasses on his nose,"--as many of our young ape-ollos now wear for _effect_; but it would scarcely be less ridiculous than Gloster saying in Lear, "I shall not want spectacles." King Lyr reigned during the earliest period of the Anglo-Saxon history, and spectacles were not introduced into England until the beginning of the fourteenth century. It is said that the painter Cigoli in his representation of the aged Simeon at the circumcision of Christ, made this same error by placing spectacles on the patriarch's nose. More ludicrous than either of the above is the painting by Albert Durer, the German artist (about 1515), of his scene, "Peter denying Christ," wherein he represents a Roman soldier leaning against the door-post comfortably smoking a tobacco pipe. The pipe, to which Germans are particularly partial, was just being introduced during Durer's latter years. The tobacco was not introduced into Europe until 1496, and was, when first burned, twisted together.[8] The Spaniards, in their report on their return from the first voyage of Columbus said that "the savages would twist up long rolls of tobacco leaves, _and lighting one end, smoke away like devils_." (The primitive cigar.) ANCIENT GREEK AUTHORS. Nearly all the ancient Greek physicians were authors of no mean calibre, considering the age in which they lived. Pherecydes, a Greek philosopher and physician, wrote a book on diet during the sixth century before Christ. Pythagoras, his illustrious pupil, was said to be the first who dissected animals. He wrote, and taught anatomy and physiology, in the school of Crotona. Herodotus was a great teacher and writer; also Herophilus, his pupil. (B. C. 4th century.) There were four physicians named Hippocrates. The second of that name has nearly eclipsed all the others. The period in which he lived was highly favorable to the development of the qualities of the great Hippocrates. He was contemporary with Plato, Herodotus, who was his teacher, Pericles, Socrates, Thucydides, etc. The most notable works of Hippocrates are 1st and 3d "Books on Epidemics," "Prognostics," "Treatise on Air and Water," "Regime of Acute Diseases," and "Treatise on Wounds." Heraclitus, of Ephesus, is conjectured to be the first who dissected the human body. "The principle of his theory is the recognition of the fire of life and the ethereal element of wisdom as the ground of all visible existence." Fragments of his writings, only, have been preserved. He imitated Pythagoras. Theophrastus wrote a book on plants. He lived to be one hundred and seven years old. Herophilus first made diagnosis by the pulse, upon which he wrote a book. Celsus was the author of eight works, yet Pliny makes no mention of him. Galen spoke of him as an excellent physician and writer; also Bostock. Galen was a man of great talent and education. Suidas--11th century--says he wrote no less than five hundred books on medicine, and half as many on other subjects. His native tongue was Greek, but he also wrote in Latin and Persic. Besides medicine, the above famous physicians wrote on philosophy, history, religion, etc. Poetry in those days was little more than heroic, or epic, prose. THE DUKE ANSWERED BY A COUNTRY MISS. Since I am not writing a medical history, I need not go on to quote the long list of the names of those who from the old Greek days to the present time have been both authors and successful medical practitioners. Their bare names would fill a large volume, and who would care to read them? To the general reader they would be quite unwelcome. The reason why medical authors are so little known is, that their writings have been too wearisome for the general reader. Such English authors as the satirical Wolcot (Peter Pindar), the courteous essayist Drake, the poetical and nature-loving Davy, and the "single-hearted, affectionate" Dr. Moir, are remembered, while greater and deeper thinkers and writers are, with their works, buried in oblivion. When the Duke of Kent was last in America (1819), he was one day taking observations in the country, when he entered a cosy little farm-house, where he noticed a pretty young girl, reading a book. "Do you have books here, my dear?" he asked, contemptuously. "O, yes, sir," replied the girl naively, "_we have the Bible and Peter Pindar_." That was a model house. The Bible and fun-provoking "Peter Pindar!" Under such a roof you will find no guile. Here you will avoid the extremes of "_all_ work and no play," for the mind, "that makes Jack a dull boy," and "all play and no work," which "makes him a mere toy." I have visited some houses in New England where the Bible, and "Baxter's Call to the Unconverted," were the only books to be seen; others where nothing was to be found upon the shelves but a vile collection of novels, such as Mrs. Partington has termed "yaller-cupboard literature." These need no comment, in either case. THE PILGRIMS AND THE PEAS. Our only excuse for copying this from Pindar will be found in reading the poem, slightly abbreviated. The pilgrims were ordered by the priest to do penance by walking fifty miles with peas in their shoes. "The knaves set off upon the same day, Peas in their shoes, to go and pray; But very different their speed, I wot; One of the sinners galloped on, Light as a bullet from a gun, _The other limped as though he'd been shot_. "One saw the Virgin soon, '_Peccavi!_' cried, Had his soul whitewashed, all so clever, When home again he nimbly hied, Made fit with saints above to live forever! In coming back, however, let me say, He met his brother rogue about half way, Hobbling with outstretched hand and bending knees, Cursing the souls and bodies of the peas! His eyes in tears, his cheeks and brows in sweat, Deep sympathizing with his groaning feet. 'How now?' the light-toed, whitewashed pilgrim broke; 'You lazy lubber!' 'You see it,' cried the other. ''Tis no joke. My feet, once hard as any rock, Are now as soft as blubber.' "'But, brother sinner, do explain How 'tis that you are not in pain; How is't that you can like a greyhound go, Merry as if nought had happened, burn ye?' 'Why,' cried the other, grinning, 'you must know That just before I ventured on my journey, To walk a little more at ease, _I took the liberty to boil my peas_!'" [Illustration: THE PILGRIM CHEAT.] LITTLE DAVY AGAIN. Sir Humphry Davy lived from 1778 to 1829. Coleridge said of him, "Had not Davy been the first chemist, he probably would have been the first poet of the age." He made some important chemical discoveries, overworked his body and brain, and took the pen "to amuse" and recreate himself, but too late, telling us of "the pleasures and advantages of fishing," etc. The following verses are from the poem of Dr. David Macbeth Moir, on the death of his darling little boy, who died at the age of five years:-- "Gem of our hearth, our household pride, Earth's undefiled, Could love have saved, thou hadst not died, Our dear, sweet child! Humbly we bow to Fate's decree; Yet had we hoped that time should see Thee mourn for us, not us for thee, Casa Wappy![9] "The nursery shows thy pictured wall, Thy bat, thy bow, Thy cloak, thy bonnet, club, and ball; But where art thou? A corner holds thine empty chair; Thy playthings, idly scattered there, But speak to us of our despair, Casa Wappy! "Yet 'tis a sweet balm to our despair, Fond, fairest boy, That heaven is God's, and thou art there, With him in joy! There past are death and all its woes, There beauty's stream forever flows, And pleasure's day no sunset knows, Casa Wappy!" "The sole purpose of poetry," says the author of the above beautiful poem, "is to delight and instruct; and no one can be either pleased or profited by what is unintelligible. Mysticism in law is quibbling; mysticism in religion is the jugglery of priestcraft; mysticism in medicine is quackery; and these often serve their crooked purposes well. But mysticism in poetry can have no attainable triumph." Again he says,-- "The finest poetry is that which is most patent to the general understanding, and hence to the approval or disapproval of the common sense of mankind." Dr. Moir enriched the pages of Blackwood's Magazine for thirty years with his beautiful poems, and occasional prose, which, according to Professor Wilson, "breathed the simplest and purest pathos." He practised medicine and surgery in his native village, six miles from Edinburgh, till the day of his death, which occurred in consequence of a wound caused by the upsetting of his carriage. I find four physicians by the name of Abercromby, who were excellent physicians, and authors of no little note. One, Patrick, a Scotchman, and physician to James II., had a library second to few physicians of his day. Lancisi, an Italian physician who lived at the same time, possessed a splendid library consisting of thirty thousand volumes. He discovered a set of lost plates of Eustachius, from which he published tables. Lancisi was physician to several popes, and was a master of polite literature, and an author of great distinction. MORE SCHOOLMASTERS AND TAILORS. Dr. Richard Blackmore (Sir)--our "schoolmaster turned doctor"--was an author of no small note. "A poet of the time of Dryden in better repute as an honest man and a physician," says a biographer. He should have been a man of importance, since Swift was pitted against him in "brutal verse." Steele and Pope scribbled about the pedagogue Blackmore. Dryden, who was unable to answer him, called him "a pedant, an ass, a quack, and a cant preacher," and he was ridiculed by the whole set of "petty scribblers, professional libellers, coffee-house rakes, and literary amateurs of the Temple who formed the rabble of the vast army against which the doctor had pitted himself in defence of public decency and domestic morality." We have already referred to the "forty sets of ribald verses taunting him of his early poverty, which caused him to become a schoolmaster." Amongst his works were "Alfred," a poem of twenty books; another of twelve books; "Hymn to Light," "Satire against Wit," "The Nature of Man;" "Creation," in seven books; "Redemption," in six books, etc. Dr. Johnson says of Dr. Blackmore, "And let it be remembered for his honor that to have been a schoolmaster is the only reproach which all the perspicacity of malice animated by wit has ever fixed upon his private life." Heinrich Stilling, "a pseudonyme adopted by Heinrich Jung, in one of the most remarkable autobiographies ever written," was born about the year 1740, in Nassau. He was bred a tailor, and with his father followed his occupation until the son, by his own efforts and by the aid of his remarkable natural abilities, raised him to a more exalted position. By great efforts and diligent study he acquired a knowledge of Latin and Greek, and something of medicine, when he proceeded to the University of Strasburg. Here he remained prosecuting his studies with much diligence and zeal until he obtained not only his degree, but succeeded to the appointment of a professorship, and raised himself to eminence both by his ability as a lecturer and as an operator. He was also an author of considerable renown, not only on medical subjects, but as a miscellaneous writer. His novel named "Theobold" is still read. He wrote a treatise on minerals. His most remarkable production, however, was his autobiography entitled "Jugend, Junglingjahre, Wanderschaft und Alter Von Heinrich Stilling." Cabanis, physician to Napoleon I., was a writer of note, particularly on physiology and philosophy. His complete works were recently published in Paris, and a portion of them have been translated into English. Bard (Samuel), physician to Washington, was an author, but his writings were principally on medicine. His father was Dr. John Bard, who, with Dr. Middleton, made at Poughkeepsie the first dissection in America. Dr. Valentine Mott, of New York, was not only the first surgeon in America, but he was an excellent lecturer and a voluminous writer, but, as far as I can learn, having before me a complete list of his writings, almost entirely on medical subjects. Having been to Europe repeatedly, a book of travels ought to have been added to the list. One day, in Paris, the celebrated surgeon Dr. R. ---- asked Dr. Mott to visit his hospital and see him perform his peculiar operation. Dr. Mott assured the surgeon that he accepted with great pleasure. "But," said the Frenchman, "on reflection I find there is no patient there requiring such an operation. However, that makes no difference, my dear sir. You shall see. There is a poor devil in one of the wards who is of no use to us, himself, or friends; and so come along, and I will operate upon him beautifully, beautifully," said the famous butcher. Dr. Mott, being a humane man, declined seeing the operation on such barbarous terms. A DIFFERENCE OF OPINION. In "Surgeons of New York" Dr. Francis gives the following:-- "On asking Dr. Batchelder (then eighty-one years of age), if he had to live over his eventful life, if he would again be a doctor, he replied,-- "Yes, sir;" most positively. Dr. Hosack's favorite branch of practice has been general surgery. On asking him the question if he would again be a surgeon, his reply was condensed into a comprehensive "Never!" Dr. Hosack was present as examining physician to Colt, who committed suicide in the city prison. It is believed to this day, in certain circles, that Colt escaped, leaving another body smuggled into prison over night to represent him. The writer was induced once in Hartford to believe this to be true, as persons stated that they had really seen Colt in California. Dr. Hosack's testimony makes the case clear. Colt did not escape. "It seems that when the prisoner found, at the last moment, that there was neither possibility of escaping nor the least probability of a reprieve, he induced some friend to send him a coffee-pot of hot coffee in which the dagger was concealed, and which he drove into his heart even _beyond the handle_." Dr. Hosack (Alex. Eddy) was also physician to Aaron Burr. [Illustration: FRANKLIN'S EXPERIMENTS WITH ETHER.] "Do you never experience any contrition, at times, for the deed?" (viz., shooting Hamilton), asked Dr. H. of his patient. "No, sir; I could not regret it. Twice he crossed my path. He brought it upon himself," was Burr's reply. Mrs. H., the doctor's mother, not unfrequently took tea and played chess of an evening with Benjamin Franklin. Franklin was a funny old gentleman. He used to amuse himself by giving ether to the children of the neighborhood and letting them out under its influence to laugh at their fellow-playmates. SOME PURITANIC EPITAPHS. The most ingenious of the Puritan poets was the Rev. Michael Wigglesworth, whose "Day of Doom" is the most remarkable curiosity in American literature. "He was as skilled," says one of his biographers, "in physic and surgery as in diviner things;" and when he could neither preach nor prescribe for the physical sufferings of his neighbors,-- "In costly verse, and most laborious rhymes, He dished up truths right worthy our regard." He was buried in Malden, near Boston, and his epitaph was written by Mather. THE EXCELLENT MICHAEL WIGGLESWORTH. _Remembered by some good tokens._ "His pen did once _meat from the eater fetch_; And now he's gone beyond the _eater's_ reach. His body, once so _thin_, was next to _none_; From hence he's to _unbodied spirits_ flown. Once his rare skill did all _diseases_ heal; And he does nothing now uneasy feel. He to his Paradise is joyful come, And waits with joy to see his _Day of Doom_." The last epitaph for which we have now space is from the monument of Dr. Clark, a grandson of the celebrated Dr. John Clark, who came to New England in 1630. "He who among physicians shone so late, And by his wise prescriptions conquered Fate, Now lies extended in the silent grave; Nor him alive would his vast merit save. But still his fame shall last, his virtues live, And all sepulchral monuments survive: Still flourish shall his name: nor shall this stone Long as his piety and love be known." And "Such graves as his are pilgrim shrines, Shrines to no code or creed confined-- _The Delphian vales, the Palestines, The Meccas of the mind_." THE ONE-HOSS SHAY. Mr. Mundella, of the British Parliament, recently said,-- "American authors are now among the best writers in the English language. Among the poets were Longfellow, Holmes, Whittier, Bryant, and Lowell--five men whom no other country in the same generation could surpass, if, indeed, they could match. Never were purer or nobler men than they." He had the honor of knowing some of the greatest literary men in England, and could say that the American authors could compare with them in every way. O. W. Holmes was the most brilliant conversationalist it was ever his good fortune to meet. As a poet, "his style is brilliant, sparkling, and terse," says Hillard. I can only find space for the following from the pen of Dr. Holmes:-- Have you heard of the wonderful one-hoss shay, That was built in such a logical way, To run a hundred years to a day, And then, of a sudden, it--ah, but stay, I'll tell you what happened without delay: Scaring the parson into fits, Frightening people out of their wits, Have you heard of that, I say? Seventeen hundred and fifty-five, _Georgius Secundus_ was then alive,-- Snuffy old drone from the German hive! That was the year when Lisbon town Saw the earth open and gulp her down, And Braddock's army was done so brown, Left without a scalp to its crown. It was on the terrible Earthquake day, That the deacon finished the one-hoss shay. Now, in building of chaises, I tell you what, There is always _somewhere_ a weakest spot; In hub, tire, felloe, in spring or thill, In panel or cross-bar, or floor or sill, In screw, bolt, thoroughbrace, lurking still, Find it somewhere you must and will, Above or below, or within or without; And that's the reason, beyond a doubt, A chaise _breaks down_, but doesn't _wear out_. But the deacon swore (as deacons do, With an "I dew vum," or an "I tell yeou") He would build one shay to beat the taown, 'n' the keounty, 'n' all the kentry raoun'; It should be so built that it _couldn't_ break down: "Fur," said the deacon, "'tis mighty plain That the weakes' place mus' stan' the strain; 'n' the way t' fix it, uz I maintain, Is only jest T' make that place uz strong uz the rest." So the deacon inquired of the village folk Where he could find the strongest oak, That couldn't be split, nor bent, nor broke,-- That was for spokes, and floor, and sills; He sent for lancewood to make the thills; The cross-bars were ash, from the straightest trees; The panels of white-wood, that cuts like cheese, But lasts like iron for things like these; The hubs of logs from the "Settler's Ellum,"-- Last of its timber--they couldn't sell 'em; Never an axe had seen their chips, And the wedges flew from between their lips, Their blunt ends frizzled like celery-tips; Step and prop-iron, bolt and screw, Spring, tire, axle, and linchpin too, Steel of the finest, bright and blue; Thoroughbrace bison skin, thick and wide; Boot, top, dasher, from tough old hide Found in the pit when the tanner died. That was the way he "put her through." "There!" said the deacon, "naow she'll dew!" Do! I tell you, I rather guess She was a wonder, and nothing less! Colts grew horses, beards turned gray, Deacon and deaconess dropped away; Children and grandchildren--where were they? But there stood the stout old one-hoss shay As fresh as on Lisbon Earthquake day! Eighteen hundred: it came and found The deacon's masterpiece strong and sound. Eighteen hundred increased by ten: "Hansum kerridge" they called it then. Eighteen hundred and twenty came,-- Running as usual; much the same. Thirty and forty at last arrive, And then came fifty and _fifty-five_. Little of all we value here Wakes on the morn of its hundredth year Without both feeling and looking queer. In fact, there's nothing that keeps its youth, So far as I know, but a tree and truth. (This is a moral that runs at large; Take it. You're welcome. No extra charge.) _First of November_,--the Earthquake day,-- There are traces of age in the one-hoss shay, A general flavor of mild decay, But nothing local, as one may say. There couldn't be,--for the deacon's art Had made it so like in every part That there wasn't a chance for one to start. For the wheels were just as strong as the thills, And the floor was just as strong as the sills, And the panels just as strong as the floor, And the whippletree neither less nor more, And the back cross-bar as strong as the fore, And spring, and axle, and hub _encore_. And yet, _as a whole_, it is past no doubt, In another hour it will be _worn out_. First of November, fifty-five! This morning the parson takes a drive. Now, small boys, get out of the way! Here comes the wonderful one-hoss shay, Drawn by a rat-tailed, ewe-necked bay. "Huddup!" said the parson. Off went they. The parson was working his Sunday's text, Had got to _fifthly_, and stopped perplexed, And what the--Moses--was coming next? All at once the horse stood still, Close by the meet'n'-house on the hill. First a shiver, and then a thrill, Then something decidedly like a spill,-- And the parson was sitting upon a rock, At half past nine by the meet'n'-house clock,-- Just the hour of the Earthquake shock! What do you think the parson found, When he got up and stared around? The poor old chaise in a heap or mound, As if it had been to the mill and ground! You see, of course, if you're not a dunce, How it went to pieces all at once,-- All at once and nothing first,-- Just as bubbles do when they burst. End of the wonderful one-hoss shay. Logic is logic. That's all I say. [Illustration: END OF THE WONDERFUL ONE-HORSE SHAY.] HEALTHFUL INFLUENCE OF MUSIC. The curative power of music is little understood. Our medical men would do well to devote more time and attention to music and its beneficial influences upon themselves and patients. In Paris, music is being introduced at the chief asylum for the benefit of the insane, the hypochondriacs, and such like patients. Its introduction at the "Retreat," at Hartford, Conn., has been attended with happy results. The writer attributes the primary step towards recovery of several patients of his, suffering under great mental, nervous, and bodily prostration, to his ordering the piano or melodeon reopened. Not long since I visited a patient at a distance. She was young and fair, and "supposed to be in consumption," which is usually a flattering disease, while this patient was laboring under great despondency, bordering on despair. Her parents could not account for her dejection. Determined not to hurry over the case, and seeing a closed piano in the room, I asked if it was not used. "No," replied the mother; "she has not touched it for more than three months; she takes no interest in anything." I looked upon the sad, fair face, and thought I had never seen a picture of such utter hopelessness in a young maiden. I approached the piano, and raised its lid. The ivory keys were all dusty. The mother dusted them off, and with a great, deep sigh, whispered to me, "The dust will soon gather on her coffin. She will never touch these keys again." "Pooh!" I exclaimed. "You, madam, discourage her. Let me sing something that will awaken her from her lethargy." No matter how I played, or what I sang. It was the right key, the sympathetic chord. The first notes aroused her. She lifted her great, dark eyes for the first time. Great tears burst their bonds, thawing out the winter-locked senses, awakening the spring-time flowers of hope, that led to a summer season of health and happiness.... I know this was decidedly unprofessional; but what care I? The young girl was aroused from her despondency, and her precious life saved. Medicine, which before was of no avail, now took effect. O, I pity the poor fool who _only_ has learned to cram drugs by the scruple, dram, and ounce down the unwilling throats of his more pitiful patients because musty books tell him to. Dr. Mason F. Cogswell, a graduate of Yale, was a man eminent for piety and benevolence, a scholar, and a successful practitioner, which none can gainsay. "In music he was a proficient," said Professor Knight. While practising medicine in Stamford, Conn., he was said to have instructed the choir in psalm tunes and anthems, and other music, and adapted one to every Sabbath in the year. He possessed a great library, and was for ten years president of the State Medical Society. Dr. Cogswell had a deaf and dumb daughter, and he originated the design of an asylum, which was more fully developed by Mr. Gallaudet, in the Hartford asylum for the deaf and dumb. He died in 1830, at the age of seventy. I know of a great many excellent physicians who are musicians and lovers of music. Guilmette is a first-class primo basso. Who does not love to listen to the beautiful heart and home songs of Dr. J. P. Ordway, such as "Home Delights," "Come to the Spirit Land," etc.? "The twinkling Stars are laughing, Love," has been sung in every land, and arranged into band music by all the best leaders of the world. A Boston musician said to the writer recently, "After the audience had been disgusted a whole hour by classic music, the house came down enthusiastically on hearing one of Dr. Ordway's touching melodies." The Germans seldom die of consumption. They are all musicians. There are many authors and poets among the German doctors. The following gem, it is needless to add, is not by one of the best authors:-- "December's came, and now der breezes Howls vay up amidst der dreeses; Now der boy mit ragged drouses Shivering feeches home der cowses. His boots vas old, und dorn his gloze is, Und bless my shdars, how blue his nose is!" INFLUENCE OF MUSIC UPON ANIMALS. Some wild animals are easily caught and readily tamed by the assistance, of music. "Whistle the rabbit and he'll stop," is as true as trite. The most common exhibition of the influence of music on animals is, perhaps, that witnessed in circuses, and other equestrian entertainments, where the horse is affected in a lively and exhilarating manner by the performances of the band, often waltzing and prancing, and keeping perfect time with the music. Dogs are affected by music, but it is difficult to determine whether agreeably or otherwise. Many naturalists believe it to be disagreeable to them. Owls have been known to die from the effect of music. On the other hand, it is well known that many kinds of birds are affected in a very agreeable manner, often approaching as near as possible the instruments, or persons, and remaining as long as the music continues, and then flapping their wings, as we should clap our hands, in approbation of the performance. Many of the wild animals are said to be fond of, and even charmed by, music. The hunters in the Tyrol, and some parts of Germany, often entice stags by singing, and the female deer by playing the flute. Beavers and rats have been taught to dance the rope, keeping time to music. Among the insects, spiders are found to be very fond of music. As soon as the sounds reach them, they descend along their web to the point nearest to that from which the music originates, and there remain motionless as long as it continues. Prisoners sometimes tame them by singing or whistling, and make companions of them. [Illustration: "MUSIC, THE SOUL OF LIFE."] [Illustration: THE MUSICAL MICE.] But perhaps the most remarkable instance of the influence of music on animals occurred at a menagerie in Paris a few years ago, when a concert was given, and two elephants were among the auditors. The orchestra being placed out of their sight, they could not perceive whence the harmony came. The first sensation was that of surprise. At one moment they gazed eagerly, at the spectators; the next they ran at their keeper to caress him, and seemed to inquire what these strange sounds meant; but at length, perceiving that nothing was amiss, they gave themselves up to the impression which the music communicated. Each new tune seemed to produce a change of feeling, causing their gestures and cries to assume an expression in accordance with it. But it was still more remarkable that, after a piece had produced an agreeable effect upon them, if it was incorrectly played, they would remain cold and unmoved. MUSIC AMONG THE MICE. The writer used to amuse himself and friends by attracting a pair of mice into his room by means of a guitar. The following, relating to the same, is from the "American," 1856:-- "We called upon our friend, and found him alone in his room, 'touching the guitar lightly.' He arose, greeted us with his bland smile, and said,-- "'Perhaps you would like to see my pupils. If you will be seated, and remain very quiet, I will call them out.' "We did so. He resumed his seat, and, taking his splendid-toned guitar, touched some beautiful chords from an opera, and, in a moment, two or three mice ran out from the corner of the room, pointed on a 'bee line' towards the sound of the instrument. They stopped and listened for a moment or two, and, as the music glided up and down, they would move to and fro some inches on the floor, reminding one of a Schottische. In various passages of the music I saw one jump up two or three inches from the floor. Thus they manoeuvred till the music ceased, when they scampered away to their holes again." MUSIC AND HEALTH. Let patients amuse themselves by music. It is conducive to health. I cannot select music for you; choose for yourself, only don't get the "Hark! from the tombs a doleful sound" style. Get church music, if you like, but select a cheering class. O, it is a very mistaken idea that all music and mirth must cease in a house because a member of the household is an invalid. Try my suggestion. Re-open the piano or organ; or, if you haven't an instrument, re-tune your voices, and let music again "flow joyfully along," and see if happy results do not follow. Physicians, I pray you, if you have never investigated this matter personally, do so. It is not adopted by any particular school of physic. It is not secured by letters patent. You will not be accounted outside of the Asclepiadæ, nor sued for infringement, if you prescribe music for the despondent patient. You need not turn "minstrels," burnt-cork fellows, etc., nor make comic actors of yourselves by so doing. Your judgment will suggest the kind of patient who most needs this sort of "soul and spirit" stimulus. It is better than slop porter; better than sulphuric acid brandy, or strychnine whiskey, and you well know the basis of those liquors. Don't think me officious in these strong suggestions. Try my advice, and you will agree with me. "PROVE ALL THINGS; HOLD FAST TO THAT WHICH IS GOOD." [Illustration] XXIV. ADULTERATIONS. BREAD, BUTTER, AND THE BIBLE.--"JACK ASHORE."--BUCKWHEAT CAKES ARE GOOD.--WHAT'S IN THE BREAD, AND HOW TO DETECT IT.--BUTTER.--HOW TO TELL GOOD AND BAD.--MILK.--ANALYSIS OF GOOD AND "SWILL MILK."--WHAT'S IN THE MILK BESIDES MICE?--THE COW WITH ONE TEAT.--"LOUD" CHEESE.--TEA AND COFFEE.--TANNIN, SAWDUST, AND HORSES' LIVERS.--ALCOHOLIC DRINKS.--CHURCH WINE AND BREAD.--BEER AND BITTER HERBS.--SPANISH FLIES AND STRYCHNINE.--"NINE MEN STANDIN' AT THE DOOR."--BURTON'S ALE; AN ASTONISHING FACT.--FISHY.--"FISH ON A SPREE."--TO REMEDY IMPURE WATER.--CHARCOAL AND THE BISHOP.--HOG-ISH.--PORK AND SCROFULA.--NOTICES OF THE PRESS. BREAD. Bread and butter and the Bible are synonymous with civilization and Christianity. Bread and the Bible, civilization and Christianity, have kept step together since the history of each began. Two shipwrecked sailors, floating on a spar, after long privation and suffering, were thrown upon an unknown land. After looking about very shyly,--for every thing looked wild and uncivilized,--they came suddenly upon a hut. Jack was afraid to advance, but his hungry companion cautiously approached, and finally entered the hut. In a moment he came rushing out, exclaiming,-- "Come on, Jack. It's all right. Nobody at home; but it's civilized land we're grounded on. I found a loaf of bread." This was conclusive evidence, next to finding a Bible, that it was a civilized country; and Jack waited for no further proof, but followed Captain Duncan into the cabin, where the two soon appeased their hunger. Wheaten bread was never an article of diet amongst savages. "Take away wheat bread and butter from our families for a few generations, and who is prepared to say that civilization would not glide easily to a state of barbarism? There is sound philosophy in this suggestion, because there is no other kind of human food that is so admirably adapted to the development of the human frame, including a noble brain, as good wheat bread." It contains phosphates in just sufficient quantities to keep up a healthful supply for brain work. Fish contains more phosphorus; but are fish-eating Esquimaux,[10] or coast-men, the more intellectual for having made fish their principal diet? In five hundred pounds of wheat, there are,-- Muscle material, 78 pounds. Bone (and teeth) material, 85 " Fat principle, 12 " Ground to a fine flour:-- Muscle material, 65 " Bone material, 30 " Fat principle, 10 " Cereal food will keep off hunger longer than animal food. By experience I have found that buckwheat will satisfy the cravings of hunger longer than wheat, rye, or corn. Dr. R. B. Welton, of Boston, says,-- "A lady of culture, refinement, and unusual powers of observation and comparison, became a widow. Reduced from affluence to poverty, with a large family of small children dependent on her manual labor for daily food, she made a variety of experiments to ascertain what articles could be purchased for the least money, and would, at the same time, "go the farthest," by keeping her children longest from crying for something to eat. She soon discovered that when they ate buckwheat cakes and molasses, they were quiet for a longer time than after eating any other kind of food. [Illustration: SIGNS OF CIVILIZATION.] "A distinguished judge of the United States District Court observed that when he took buckwheat cakes for breakfast, he could sit on the bench the whole day without being uncomfortably hungry. If the cakes were omitted, he felt obliged to take a lunch about noon. Buckwheat cakes are a universal favorite at the winter breakfast table, and scientific investigation and analysis have shown that they abound in the heat-forming principle; hence nature takes away our appetite for them in summer." Another writer says,-- "We find the lowest order of intelligences standing on a potato. Only one step above this class, another order is found on a hoe-cake. One degree above this we meet with the class that has risen in the scale of being as high as it is possible for mortals to rise on a pancake. Head and shoulders above all of these classes we find the highest order of intelligences, with large and well-developed brains, and noble characters, standing securely on their wheaten loaf." Since bread, then, is the "staff of life," the sin of its adulteration is the greatest of all wrongs to the human family. Flour is often adulterated with plaster, white earth, alum, magnesia, etc. To detect plaster, burn some of the bread to ashes, and the white grains will be discovered. Alum is a very pernicious ingredient of adulteration, intended to make the bread white and light. It is often mixed in inferior flour. It is detected thus: Soak the loaf till soft in water, adding sufficient warm water to make it thin; stir it well, and set it a few hours; then strain it and boil it, to evaporate most of the water. After it stands a while, and cools, the crystals of alum will be precipitated. You may then tell it by taste. Magnesia, so often mixed with inferior flour, to make the bread appear light, is injurious to children and invalids. You may detect it by burning the bread, and finding the magnesia in the ashes. Soda, or potash. Much soda produces dyspepsia, sour stomach, and burning. To find potash, or soda, break up the bread, and pour upon it sufficient hot water to cover it. When it is cool, take a piece of litmus paper (obtained at the apothecary's), wet it in vinegar, and put it into the dish with the bread and water. The potash will turn the litmus blue again. The more potash, the sooner it changes. In some countries it is known that bread is adulterated by copper. BUTTER. Butter stands next to bread, as an article of diet. It is adulterated, with difficulty, with lard; but the usual way is to mix very cheap butter with a quantity of good butter. Butter is colored by carrots, yellow ochre, and yolks of eggs, and "adulterated by sand and chalk." To detect all of these, melt the butter in hot water. The coloring will separate and join the water, and the other adulterations settle to the bottom. MILK. "There's chalk in the milk," is all nonsense. Chalk will not remain in solution, but will settle. Hence milk is not adulterated with chalk. Milk is reduced by water, and if the body is again made up which the water has reduced, it is done by adding corn starch, or calves' brains! _Pure Milk contains_ Water, 862.8 Solid particles, 137.2 ----- To parts 1000 Butter, 43.8 Sugar, 52.7 Caseine, 38.0 Saline, 2.7 ----- Solid matter, 137.2 _Grass-fed Cows' Milk._ Water, 868 Solid, 132 ---- To parts 1000 Butter, 44 Sugar, 46 Caseine, 39 Salt, 3 --- Solid matter, 132 _Swill Milk of New York._ Water, 930 Solid particles, 70 ---- To parts 1000 Butter, 18 Sugar, 8 Caseine, 34 Salt, 10 -- Solid matter, 70 [Illustration: SWILL MILK (MAGNIFIED).] The reader will perceive by these quotations (from Dr. Samuel R. Percy's report to the Academy of Medicine, New York), that it requires twice as much swill milk to give the same amount of nourishment as of a pure article. Furthermore, the swill milk is diseased, and, when magnified, appears as represented in the illustration. It contains corrupt matter, and pieces of _diseased udder_, with broken-down rotten globules. The result of feeding children on this pernicious article of diet is to generate scrofula, skin diseases, rickets, diarrhoea, cholera infantum, and consumption, or marasmus--wasting away. [Illustration: PURE MILK.] [Illustration: WATERED MILK.] [Illustration: "WHAT'S IN THE MILK?"] Some children in cities literally starve to death on this sort of milk. Starch in milk may be detected by putting a drop of iodine into a glass of milk, when the starch will give off a blue color; or, by boiling such milk, it will thicken. _Animals' brains_, which are sometimes mixed in milk, may be detected with the microscope. Soda is often put in cans of milk that are to be transported, to keep the milk sweet. We once saw a milkman _picking a pair of mice out of his big milk can_; but these little accidents, with hairs and dirt from the animals, are not to be mentioned, in view of the above greater facts of "what's in the milk"? During the late run on the ---- Bank, New York, a gentleman said that a Westchester milkman named Thompson W. Decker had purchased sixteen thousand dollars worth of books at a discount, not because he wanted to speculate, as he was a millionnaire, but to show he had confidence in the institution, and wished to enhance its credit. Profitable business! THE COW WITH ONE TEAT. A cute old dairyman, who lived on a farm,-- To tell you the place is no good, nor no harm,-- Kept three or four cows--"Fan," "Molly," and "Bess," With one not yet mentioned, whose name you can't guess. Two teams he kept running by night and by day, But where all the milk came from nobody could say; His cows were no better than those of his neighbor, Who kept just as many with equal the labor. And as for paying! he built a great house, And barns, and granaries that would keep out a mouse; He drove fast horses, and was said to live high, But his neighbors looked on, and couldn't tell why. "_Old Bess kicked the bucket!_ Now let's see," said they, "If he runs his two carts in the same style to-day." But the 'cute old farmer was not to be beat, For the best to give down was the cow with one teat! But since old "Bess" died the milk had grown thinner, And the fact _leaked_ out now that the old sinner Had a cow with one teat, and fixed near the rump Was a handle which worked like any good pump! CHEESE. "Poison is sometimes generated in curds, and cheese prepared too damp, without sufficient salt." Hall, of the Recorder, has been presented with some Limburger cheese; and this is how he acknowledges it: "Our friend, Wm. F. Belknap, of Watertown, sends us some _choice_, _fragrant_, Limburger cheese. Although of Dutch _descent_, we 'pass.' _Our_ 'offence is _not_ rank!' and does not 'smell to Heaven.' That _distinct_ package of Limburger could give the ninety and nine little 'stinks of Cologne' ten points, and 'skunk' 'em--just as e-a-s-y. We generously offered the package to a man who slaughters skunks for their hide and ile; but he said he didn't admire the odor, and guessed he'd worry along without it; and we finally passed it on a German, who lives over the hill five miles to leeward of the village. We suppose there _are_ some people who eat Limburger. It's just as a man is brought up. 'None for Joseph,' thank you." TEA AND COFFEE. Tea was introduced into England in the year 1666, and sold for sixty shillings per pound. It was first boiled till tender, and sauced up with butter in large dishes, the "broth" being thrown away: An excellent way for using the article! All imported tea is black, unless colored before leaving China, and is colored by prussiate of potash--a poison so deleterious as to require labelling in drug stores as "POISON." It makes one very nervous,--good tea does not, unless used to excess,--and acts as a slow poison on the system. By its over-action on the liver, it makes one yellow, and will spoil the fairest complexion. All teas contain tannic acid, which, combining with milk, makes excellent leather of one. Black teas are sometimes colored with gypsum and Prussian blue. I obtained these facts from a retired tea merchant of Philadelphia. He spent some time in China. Coffee is adulterated with mahogany sawdust, acorns, peas, beans, roasted carrots, but more commonly with dandelion root and chiccory. I have obtained some samples of these from a large coffee-grinder in this city. But what is more repulsive still, baked horses' and bullocks' livers are often mixed with cheap coffees, to _give them more body_! Pure coffee is the less injurious. All these substances may be detected, _as they become soft by boiling, which coffee-bean does not_. Coffee browned in silver-lined cylinders retains its flavor more perfectly than in iron. ALCOHOLIC DRINKS. This is not a temperance lecture. I have only to tell you of impure liquors. Excepting alcohol I know of no pure liquors. I can find none. I have offered one hundred dollars for an ounce of pure brandy. _Wines._--The following articles are used to make or adulterate wine: water, sugar, arsenic, alum, cochineal and other coloring matter, chalk, lime, sulphur, lead, corrosive sublimate, etc. To detect arsenic, put some pure lime-water in a glass, and drop the wine,--say a teaspoonful,--into it. If white clouds arise, expect that it contains arsenic. A positive test of arsenic in liquids is the ammonio-nitrate of silver, which precipitates a rich yellow matter, the _arseniate of silver_, and this quickly changes to a greenish-brown color. No elder or deacon should use wine, unless domestic, without having a sample of it analyzed by a disinterested chemist. The thought to me is perfectly shocking, that the villanous concoctions sold by even honest and Christian druggists, and used for communion purposes, to represent the blood of Christ, should be composed of _alum, arsenic, and bugs_! (cochineal). Of bread I say the same. A deacon's wife, not a hundred miles from Lowell, buys baker's bread, _sour and yellow_, for communion purposes. A lady showed me a sample of it, very unlike what my old grandmother, a deaconess, used to make for that purpose. It requires too much space to give tests of the various poisons in wines. I have no confidence in _any_ foreign wines. Alcohol has been distilled from the brain and other parts of the dead body of drunkards. A WINE BATH. An American traveller in the streets of Paris, seeing the words, "Wine Baths given here," exclaimed,-- "Well, these French are a luxurious people;" when, with true Yankee curiosity and the feeling that he could afford whatever any one else did, he walked in and demanded a "wine bath." Feeling wonderfully refreshed after it, and having to pay but five francs, he asked, in some astonishment, how a wine bath could be afforded so cheaply. His sable attendant, who had been a slave in Virginia, and enjoyed a sly bit of humor, replied,-- "O, massa, we just pass it along into anudder room, where we gib bath at four francs." "Then you throw it away, I suppose." "No, massa; den we send it lower down, and charge three francs a bath. Dar's plenty of people who ain't so berry particular, who will bathe in it after this at two francs a head. Den, massa, we let the common people have it at a franc apiece." "Then, of course, you throw it away," exclaimed the traveller, who thought this was going even beyond Yankee profit. [Illustration: A CHAMPAGNE BATH.] "No, indeed, massa," was the indignant reply, accompanied by a profound bow; "no, indeed, massa; we are not so stravagant as dat comes to; we just bottle it up den, and send it to 'Meriky for champagne." A CHEMIST'S TESTIMONY. Dr. Hiram Cox, an eminent chemist of Ohio, states that during two years he has made five hundred and seventy-nine inspections of various kinds of liquors, and has found nine tenths of them imitations, and a quarter portion of them poisonous concoctions. Of brandy, he found one gallon in one hundred pure; of wine, not a gallon in a thousand, but generally made of whiskey as a basis, with poisonous articles for condiments. Not a drop of Madeira wine had been made in that island since 1851. Some of the whiskey he inspected contained sulphuric acid enough in a quart to eat a hole through a man's stomach. [Illustration: MOTHER'S MILK PURE AND HEALTHY.] [Illustration: MOTHER'S MILK AFTER DRINKING WHISKEY.] Brandy usually contains sulphuric acid. I obtained a "pure article" yesterday, from an honest, Christian druggist. In an hour I found sulphuric acid in it. Acids are easily detected in liquors, by placing in it for an hour a bright steel spatula. The acids have an affinity to steel, and the spatula soon turns black, separating the acid from the liquid supposed to be brandy. If the brandy is sharp to the throat on swallowing it, be sure that it is not pure, but contains capsicum, horseradish, or fusel oil. Good brandy will be smooth and oily to the throat. To detect lead in wine or brandy, suspend a piece of pure zinc in the glass, and if the lead is present, delicate fibrils of that metal will form on the zinc. All malt liquors may be adulterated. Bitter herbs are used instead of hops. Copperas is used in lager beer; tobacco, nux vomica, and cocculus indicus in London porter--brown stout. To avoid them, _drink no beer_. It is of no earthly or heavenly use. A patient who would die without beer will certainly die with its use. _Spanish flies_ are said to be used in liquors sometimes. The strychnine--of whiskey--directs its action to the superior portion of the spinal cord: hence paralysis, insanity, and sudden death of whiskey drinkers. Drinkers often suffer from gravel, from the lime, or chalk, or other minerals contained in liquors. Alcohol itself will _not digest_, yet ignorant physicians prescribe alcoholic drinks for dyspeptics. Vinegar is often made from sulphuric acid. Good vinegar will not burn on your lips. To detect acid-sulphuric, drop a little of solution of sugar of lead in your vinegar; the lead precipitates a whitish sediment. A SHORT SERMON. "There's nine men standin' at the dore, an they all sed they'd take sugar in there'n. Sich, friends and brethering, was the talk in a wurldli' cens, wonst common in this our ainshunt land, but the dais is gone by and the sans run dry, and no man can say to his nabur, Thou art the man, and will you take enny more shugar in your kaughey? But the words of our tex has a difrunt and more pertikelur meenin than this. Thar they stood at the dore on a cold winter's mornin, two Baptiss and two Methodies and five Lutharians, and the tother was a publikin, and they all with one vois sed they wouldn't dirty their feet in a dram shop, but if the publikin would go and get the drinks they'd pay for 'em. And they all cried out and sed, 'I'll take mine with shugar--for it won't feel good to drink the stuff without sweetenin'.' So the publikin he marched in, and the bar-keeper said, 'What want ye?' and he answered and sed, 'A drink.' 'How will ye have it?' 'Plain and strate,' says he, 'for it ain't no use in wastin' shugar to circumsalvate akafortis. But there's nine more standin' at the dore, and they all sed they'd take shugar in ther'n.' Friends and brethering, it ain't only the likker or the spirits that is drunk in this roundabout and underhanded way, but it's the likker of all sorts of human wickedness in like manner. There's the likker of mallis that menny of you drinks to the drugs; but you're sure to sweetin' it with the shugar of self-justification. Ther's the likker of avris that some keeps behind the curtain for constant use, but they always has it well mixt with the sweetin' uv prudens and ekonimy. Ther's the likker of self-luv that sum men drinks by the gallon, but they always puts in lots of the shugar of Take Keer of Number One. "An' lastly, ther's the likker uv oxtorshun, which the man sweetins according to circumstances.... And ther's nine men at the dore, and they all sed they'd take shugar in ther'n. But, friends and brethering, thar's a time comin' and a place fixin' whar thar'll be no 'standin' at the door,' to call for 'shugar in ther'n.' But they'll have to go rite in and take the drink square up to the front, and the bar-keeper'll be old Satun, and nobody else; and he'll give 'em 'shugar in ther'n,' you'd better believe it; and it'll be shugar of lead, and red-hot at that, as shure as my name's CONSHUNCE DODGER." * * * * * ALCOHOL contains no life-supporting principle. It has no iron or salts for the blood, no lime for bone, phosphorus for brain, no nitrogen for vital tissue. Burton's "_Old Pale Ale_" is given to invalids, but (by Dr. Hassal's analysis of one gallon), one must swallow 65,320 parts (grains) of water, 200 of vinegar, 2,510 of malt gum, etc., in order to get 100 of sugar, which is the only nourishing quality therein. FISH is a good and wholesome article of diet, and salt water fish are never poisonous, if fresh. I once knew of fresh water fish being poisonous. The following article appeared in the Daily Courant of Hartford in 1864. THE FISH IN LITTLE RIVER ON A SPREE. Something got into the fish in Little River yesterday morning, "and raised the mischief" with them. They came to the top of the water, hundreds of them, and acted as if they were in the last stages of a premature decline. "Want of breath," such as boys say dogs die with, seemed to be the trouble. Never were the finny tribe so anxious to get out of water, and they poked their noses above the surface in the most beseeching way possible. The appeal was too strong to resist, and hundreds of men, women, and children, with sudden inventions for furnishing relief, such as baskets, coal-sifters, bags, etc., fixed at the end of long poles, lined the banks of the stream, and such luck in fishing has not been witnessed in this vicinity for years. What produced all this commotion among the inhabitants of the deep, is only conjectured. Some say a beer brewery, whose flavoring extracts (one of which is said to be cockle), after being relieved of their choicest qualities, are sent through a sewer into the stream, was the fountain head from which the trouble flowed. But beer drinkers look upon the idea as preposterous; they say it casts an unwarranted reflection upon a most respectable article of beverage. Perhaps so. Another claim is that somebody had thrown acid into the water; and another that decayed vegetable matter, occasioned by the long drought, has been liberally distributed in the river, from small streams which the late rains have swollen. We express no opinion about it, for, as the sensationist would say in speaking of something on a grander scale, "The whole matter is wrapped in the most profound mystery." It is a sure thing, however, that the fish had a high old time, and were considerably puzzled themselves to know what was up. Wouldn't advise anybody to invest in dressed suckers for a day or two, at least. Since writing the above, Dr. Crabtre, coroner, informs us that he has secured several of the fish, and finds, by analyzing, that they were poisoned by sulphuric acid. The evidence of it is very strong in the fish that died before being taken from the water. Acid is used at Sharp's factory, and is thrown in considerable quantities into the river. It will not be very healthy business to eat fish which have been thus "tampered with," and, as we are informed that many were dressed yesterday and sent into market, we caution the public against buying "small fry," unless they know where they were caught. WATER. Foul wells, from an accumulation of carbonic acid gas, may be purified by a horse-shoe. But the horse-shoe, or other iron, or a brick, must be red hot. The vapor thus immediately absorbs the poison gas. "Drink no water from streams or rivers on which, above, there are manufactories, etc.," says a medical writer. But if such water is filtered through charcoal, it will be tolerably pure. Even stagnant water may be purified by pulverized charcoal. Dead rats, cats, and dogs are sometimes found in wells. The taste of the water soon reveals such offensive presence. Clean out the well, and sift in some charcoal and dry earth, and the water will be all right again. * * * * * CHARCOAL will purify, but it will also defile, as the following will show:-- "A small boy, not yet in his teens, had charge of a donkey laden with coals, on a recent day in spring; and in a Midland Lane, far away from any human habitation, the wicked ass threw off his load--a load too heavy for the youngster to replace. He sat down in despair, looking alternately at the sack and the cuddy--the latter (unfeeling brute!) calmly cropping the roadside grass. At last a horseman hove in sight, and gradually drew nearer and nearer. [Illustration: WAITING FOR ASSISTANCE.] "'Halloa, thee big fellow!' cried the lad to the six-feet Archdeacon of ----, 'I wish thee'dst get off thy 'oss, and give us a lift with this here bag of coals.' "The venerable rider had delivered many a charge in his life, but never received such a one as this himself--so brief and so brusque. He was taken aback at first, and drew himself up; but his good nature overcame his offended dignity, and dismounting, he played the part, not of the Levite, but of the Samaritan. The big priest and the small boy tugged and tumbled the sack, and hugged and lifted it, till the coals were fairly _in statu quo_--the archdeacon retiring from his task with blackened hands and soiled neck-tie. "'Well,' exclaimed the small boy as his venerable friend remounted his horse, 'for such a big chap as thee art, thee's the awkwardest at a bag o' coals I ever seed in all my born days! Come op, Neddy!'" HOGISH. Pork is one of the vilest articles ever introduced into the dietetic world. It is a food for the generation and development of scrofula. The word _scrofa_ (Latin), from which _scrofula_ is derived, means a breeding sow. Pork is the Jew's abomination. I have never seen but one Jew with the scrofula. The Irish worship a pig. They die by the wholesale of scrofula and consumption. Tubercles are often found in pork, sometimes in beef. We had the gratification of adding to the health of Hartford for two summers by abating the swine nuisance. Previous to our war on them, the hogs _rooted and wallowed in the streets_! ADULTERATIONS OF SUGAR AND CONFECTIONERY. It is pleasantly supposed that sugar is the basis of all candies; and originally this was doubtless true. It would be better for the rising generation if the original prescription was still carried out, and nothing of a more injurious nature than sugar was added to it, in the innumerable varieties of confectionery which are daily sold in our shops, or in richly decorated stores, "gotten up regardless of expense," over elegant marble counters, and from tempting cut and stained glass jars, or from little stands upon the street corners, to our children, old and young. Sugar, pure and in moderate quantities, is a very harmless confection. Professor Morchand and others affirm that a solution of pure sugar has no injurious effect upon the teeth, the popular notion to the contrary notwithstanding. Neither is pure or refined sugar, taken in moderate quantities, injurious to the blood, or the stomach, _unless the stomach be very weak_. In order to cure my children of an inordinate appetite for sugar, I have repeatedly obtained a pound of pure white lump, and set it before each, respectively, allowing it to eat as much as it chose. Failing, in one case out of three, to surfeit the child with one pound, I purchased six pounds in a box, and taking off the cover, I placed the whole temptingly before her. This cloyed her, and now she does not take sugar in her tea. [Illustration: A CONFECTIONERY STORE.] I have never known serious results accruing from children eating large quantities of purified sugar; yet I would not advise it to be given them in excess, excepting for the above purpose, viz., "to cure them of an inordinate appetite for sugar." Now try to break the child of an excessive appetite for candy by giving it large quantities at once, and nine times out of ten you will have a sick or dead child in the house for your rash experiment. Hence your candies, "nine times out of ten," will be found to contain injurious or poisonous substances. REFINED SUGAR. Sugar is an aliment and condiment. It is also, medically, an alterative and a demulcent. Finely pulverized loaf sugar and gum arabic, in equal proportions, form an excellent and soothing compound for inflamed throats, catarrh, and nasal irritations, to be taken dry, by mouth and nostrils, and often repeated. Pure loaf sugar is white, brittle, inodorous, permanent in the air, and of a specific gravity of 1.6. It is chemically expressed thus: C24, H22, O22. It is nutritious to a certain extent, but alone will not support life for an unlimited length of time. This is owing to the entire absence of nitrogen in its composition. By analysis, sugar is resolved into carbon, oxygen, and hydrogen. Pulverized sugar is often adulterated with starch, flour, magnesia, and sometimes silex and terra alba. Loaf sugar, however, is usually found to be pure. BROWN OR UNREFINED SUGAR. Brown sugar changes under atmospheric influences, and loses its sweetness. This change is attributed to the lime it contains. The best grade of brown sugar is nearly dry, of yellowish color, and emits less odor than the lower grades. It consists of cane sugar, vegetable and gummy matter, tannic acid, and lime. Put your hand into a barrel containing damp brown sugar, press a quantity, and suddenly relax your grasp, and it moves as though it was alive. It is alive! Place a few grains under a powerful microscope, and lo! you see organized animals, with bodies, heads, eyes, legs, and claws! Poor people, who purchase brown sugar in preference to white, miss a figure in their selection, by the sand, water, and other foreign substances which the former contains. Brown sugar is not so wholesome as the refined. I have attributed several cases of gravel that have come under my observation to the patients' habitual use of low grades of brown sugar. CONFECTIONERY. THE FIRST STEP IN ITS ADULTERATION. Confectionery and sweetmeats used to be manufactured from sugar, flour, fruit, nuts, etc., and flavored with sassafras, lemon, orange, vanilla, rose, and the extracts of various other plants or vegetables. When competition came in the way of profits on these articles, the avaricious and dishonest manufacturer began to substitute or add something of a cheaper or heavier nature to these compositions, which would enable him to sell at a lower price, with even a greater profit. Candy cheats were not easily detected, the sweets and flavors hiding the multitude of sins of the confectioner. It seemed all but useless for the would-be honest manufacturer to attempt to either compete with his rival or to expose his rascalities, which latter would only serve to advertise the wares of his competitor. Hence he, too, adopted the same practice of adulterating his manufactures. One dishonest man makes a thousand. I do not affirm that there are no honest confectioners,--this would be as ungenerous as untrue,--or that we must use no confectionery. But let us hereby learn to avoid that which is impure. GYPSUM, TERRA ALBA, OR PLASTER OF PARIS. This is the principal article used in the manufacture of impure candies. The first intimation that the writer had of terra alba being mixed with sugar in candy, was when one confectioner placed a sample of the _white earth_ in a dish upon his counter, with a sample of confectionery made therefrom, to expose the cheat of his rivals. "But as for me, I make only pure candies," etc., was his affirmation. Well, perhaps he did. What is the nature of gypsum, terra alba, or white earth? Gypsum, or sulphate of lime, is a white, crystalline mineral, found in the excrement of most animals. Hence gypsum is extensively used as an artificial manure. It is found in peat soil, also used for manure, and is a natural production, occurring in rocky masses, under various names, as alabaster, anhydrate, and selenite. The natural gypsum, or plaster of commerce, consists of Water, 21 per cent. Lime, 33 " Sulphuric acid, 46 " --- 100 Plaster was used as a fertilizer by the early Roman and British farmers. It was introduced into America in 1772. It may here be worthy of notice, that when Dr. Franklin desired to exhibit its utility to his unbelieving countrymen, he sowed upon a field near Washington, in large letters, with pulverized gypsum, the following words: "This has been plastered." The result is supposed to have been highly convincing. But this was as a manure. Dr. Franklin did not recommend it as a condiment. You may know children who have been sown with plaster--though that plaster was modified by the smaller admixture of sugar--by their pale, puny, weakly appearance. Sugar has a tendency to increase the fatty and warming matter of the system; gypsum, or terra alba, to destroy it. Gypsum is used in confectionery without being calcined. Calcined plaster, after being wet, readily "sets," or hardens. Heating gypsum deprives it of the percentage of water, when it is known to commerce as "plaster of Paris." It is cheap as manure; hence it is used instead of sugar. Terra alba taken into the system absorbs the moisture essential to health, and disposes the child to weakness of the joints and spinal column, to rickets, marasmus, and consumption. There are other diseases to which its habitual use exposes the user; but if parents will not heed the above warning, it is useless to multiply reasons for not feeding children upon cheap or adulterated confectionery. TO DETECT MINERAL SUBSTANCE. Take no man's _ipse dixit_ when the health or lives of your precious ones are at stake. "Prove all things." To detect mineral substances in candy, put a quantity--particularly of lozenges, peppermints, or cream candy--into a bowl, pour on sufficient hot water to cover it well. Sugar is soluble in boiling water to any extent. Terra alba is not. The sugar will all disappear; the plaster, sand, etc., will settle to the bottom; the coloring matter will mix in or rise to the top of the water. _Pure candies leave no sediment when dissolved in hot water._ I have seen some "chocolate cream drops" which were half terra alba; nor were these purchased upon the street corners, where the worst sorts are said to be exhibited. Boston dealers complain that some New York houses send drummers to Boston who offer confectionery at a less price, at wholesale, than it costs to manufacture a fair grade of the same by any process yet known, in Boston. Chocolate drops are made by a patent process at about seventeen cents per pound when sugar is fourteen, and chocolate thirty-five cents per pound. Gum arabic drops have been sold for seventeen cents when sugar cost almost twice that sum, and pure gum arabic nearly three times seventeen cents. I asked an extensive confectioner how this could be explained, and he said, "By using glucose in place of gum arabic." Now, glucose is a sugar obtained from grapes, a very nice substitute for the above, though less sweet than other sugars--as cane, beet, etc. "What do you call glucose?" I asked this confectioner. "It is mucilage made from glue," was his reply. Glue is a nasty substance, at best. It is extracted by no very neat process from the refuse of skins, parings, hoofs, entrails, etc., of animals, particularly of oxen, calves, and sheep. It usually lies till it becomes stale and corrupt before being made into glue. A confectioner showed me some "gum arabic drops" made from this patent "glucose" which cost but thirteen cents per pound. Jessop exhibited some extra pure gum drops which actually cost fifty cents to manufacture. I found all his costlier candies to be pure. Gum drops are a luxury, and are excellent for bronchial difficulties, inflammation of the throat, larynx, and stomach. How shall we, then, tell a pure gum arabic drop from those nasty glue drops? First, the cheap article is usually of a darker color. The pure gum arabic drops are light color, like the gum. Take one in your fingers and double it over. If it possesses sufficient elasticity to bend on itself thus without breaking the grain, you may feel pretty sure it is gum arabic. The glue drop is brittle, and breaks up rough as it bends. Do not purchase the colored drops. Pure sugar and gum arabic are white, or nearly so, and require no coloring. Purchase only of a reliable party. Avoid colored confectionery, also all cheap candies. Even maple sugar makers _have heard_ of sand and gypsum. POISONOUS COLORING MATTER, ETC. The following poisonous coloring materials are sometimes used in confectionery, says "The Art of Confectionery," but should be avoided: Scheele's green, a deadly poison, composed of arsenic and copper; verdigris (green), or acetate of copper--another deadly poison; red oxide of lead; brown oxide of lead; massicot, or, yellow oxide of lead; oxide of copper, etc.; vermilion, or sulphuret of mercury; gamboge, chromic acid, and Naples yellow. "Litmus, also, should be avoided, as it is frequently incorporated with arsenic and the per-oxide of mercury." Ultramarine blue is barely admissible, and blue candies are less liable to be injurious than green, yellow, or red. Marigolds and saffron are sometimes used for coloring; but the cost of these, particularly the latter, compared with the minerals, as French and chrome yellows, is so high, rendering the temptation to substitute the latter so great, that purchasers should give themselves the benefit of the fear, and use no yellow candies of a cheap quality. Green candy is the most dangerous. Buy none, use none; they are mostly very dangerous confections. LICORICE, GUM DROPS, ETC. About the nastiest of all candies are the licorice and the chocolate conglomerations. Glue, molasses, brown sugar, plaster, and lampblack, are among their beauties, with, for the latter, just sufficient real chocolate to give them a possible flavor. Licorice is cheap enough and nasty enough, but the addition of refuse molasses, glue, and lampblack, which is no unusual matter, makes it still more repulsive. Metcalf & Company, extensive wholesale and retail druggists, kindly gave me the figures of cost on the first, second, and lower grades of gum arabic, glucose, etc. The first quality of gum arabic costs, by the cask, about sixty to seventy-five cents per pound; the lowest about twenty-two. There is a new manufacture in New York, with a "side issue," wherein they necessarily turn out large quantities of glucose,--refuse from grain,--and this is sold for eight to thirteen cents a pound, to confectioners. It is much better than glue, but still the glue is used to-day, and I have on my table at this moment a sample of "gum drops" made this week in Boston from cheap glue, brown sugar, and a little Tonka bean flavor. The Tonka bean represents vanilla. These cost thirteen cents a pound, and are sometimes known, with the mucilage or glucose drops, to wholesale buyers, as "A. B." drops, to distinguish them from pure gum arabic. The unfortunate consumer, however, is not informed regarding the difference. DANGEROUS ACIDS. "Sour drops," or lemon drops, are sometimes flavored with lemon; but oil of lemon is costly, and sulphuric and nitric acids are cheap, and more extensively used in confectionery. I recently sat down with a friend, in a first-class restaurant, to a piece of "lemon pie," etc. I took St. Paul's advice, and partook of what was set before me, asking no questions for conscience' sake. The next morning, meeting the friend,--a physician, by the way,--I asked him how he liked tartaric acid. He replied, "Very well in a drink, but not in pies." These acids are not only injurious to the teeth, but to the tender mucous membranes of the throat and stomach, engendering headache, colic-like pains, diarrhoea, and painful urinary diseases. Spirits of turpentine, or oil of turpentine, is extensively used in "peppermints;" also in essence of peppermint, often sold by peddlers, and in shops, as "pure essence." I question if any druggist would retail such impure and dangerous articles, since he would know it at sight, and ought to be familiar with its evil effects when used freely, as people use essence of peppermint. What I have stated respecting the flavoring of soda syrups is applicable to confectionery. [Illustration: TARTARIC ACID FOR SUPPER.] [Illustration: A STREET CANDY STAND.] Hydrocyanic acid, or prussic acid, which is mentioned as being used to represent "wild cherry," in syrup or medicines, is employed in candies to give an "almond" flavor. Oil of bitter almonds is very costly, which is the excuse for substituting the much cheaper article, prussic acid. The temptations set in the way of children to purchase candies are so great, and the adulterations so common, that I have devoted more space to the _exposé_ of these cheats than I at first intended; but I hope that the public will hereby take warning, and mark the beneficial results which will accrue from an avoidance of cheap, painted, and adulterated confectioneries. These are sold everywhere, but most commonly upon the streets. Near a stand upon a public street of this city, sandwiched by the thick flying dust on the one hand, and the warning, "Dust thou art," on the other, my attention was attracted to a little ragged urchin, who stood holding under his left arm a few dirty copies of a daily paper, while the right hand wandered furtively about in his trousers pocket, and his eyes looked longingly upon the tempting confectionery spread upon the dusty board and boxes before him. Indecision dwelt upon his pale, thin countenance, and drawing nearer, I awaited this conflict of mind and matter with a feeling of no little curiosity. Finally, he seemed to have decided upon a purchase of some variegated candy, and making a desperate dive with the hand deeper into the pocket, he drew forth some pennies, which were quickly exchanged for the coveted painted poison,--none the more poisonous for having been sold upon a street stand, however. His sharp, bluish-pale face lighted up with an unnatural glow of delight as he seized the tempting prize; and as he turned away, I said, kindly,-- "Have you been selling papers, sonny?" "Yes, sir; buy one?" he replied, with an eye yet to business. "Yes; and have you any more pennies?" "No, sir." And he dropped his head in confusion. "How much have you made to-day?" I next inquired. "Seventeen cents, sir." "And expended it all for candy, I suppose." Receiving an affirmative reply, I next kindly questioned him respecting his family. His mother was a widow, very poor, and I asked him,-- "What will she say when you return with no money to show for your day's work?" The tears started from his blue eyes, and I knew that I had made a "point." After some further conversation, I persuaded him to show me where he lived. Up the usual "three flight, back," in a low attic room, I beheld a picture of abject misery. The mother was sick, and lay uncomfortably upon an old sofa, which, with two rickety chairs and a large box, which served the double purpose of table and cupboard, were the only furniture of the apartment. She was totally dependent upon her little son's earnings for a sustenance. She had nothing in the house to eat; no money with which to obtain anything. Her boy's earnings had fallen off unaccountably, and for two days they had not tasted food. When she learned that he had brought in no money (for it was now near nightfall), she fell to weeping and upbraiding "the lazy, idle wretch for not bringing home something to eat." The boy began to cry bitterly, and acknowledged his error in spending his earnings for confectionery. I then exacted a solemn promise from him that he never would buy another penny's worth of the poison, gave him some change to purchase a bountiful meal, and left with a determination to ventilate street candy stands. [Illustration: THE NEWSBOY'S MOTHER.] XXV. ALL ABOUT TOBACCO. "The doctors admit snuff's a hurtful thing, And troubles the brain and sight, But it helps their trade; so they do not say Quite as much as they otherwise might."--L. H. S. "HOW MUCH?"--AMOUNT IN THE WORLD.--"SIAMESE TWINS."--A MIGHTY ARMY.--ITS NAME AND NATIVITY.--A DONKEY RIDE.--LITTLE BREECHES.--WHIPPING SCHOOL GIRLS AND BOYS TO MAKE THEM SMOKE.--TOM'S LETTER.--"PURE SOCIETY."--HOW A YOUNG MAN WAS "TOOK IN."--DELICIOUS MORSELS.--THE STREET NUISANCE.--A SQUIRTER.--ANOTHER.--IT BEGETS LAZINESS.--NATIONAL RUIN.--BLACK EYES.--DISEASE AND INSANITY.--USES OF THE WEED.--GETS RID OF SUPERFLUOUS POPULATION.--TOBACCO WORSE THAN RUM.--THE OLD FARMER'S DOG AND THE WOODCHUCK.--"WHAT KILLED HIM." HOW MUCH? Do you know how much money is being squandered to-day, in the United States, in the filthy, health-destroying use of tobacco? No. Only $410,958! That's all. In Commissioner Wells's report, it is shown that in the fiscal year ending June 30, 1868, the amount received from the tax on chewing and smoking tobacco was, in round numbers, fifteen million dollars. Add to this the cost of production, and dealers' profits, which are five times more than the revenue tax, amounting to seventy-five million dollars. The number of cigars taxed was six hundred millions. It is calculated as many more are used through smuggling, making a grand total yearly expenditure in the United States of one hundred and fifty millions of dollars for tobacco alone! [Illustration: THE IDOL OF TOBACCO USERS.] Give me $410,958 a day, and I will go into the pauper houses of these United States, and bring forth every pauper child; I will go down into the dark, damp cellars, and away into the cobweb-hung attics, and bring forth every ragged child of crime and poverty. I will take all these little bread-and-gospel-starved children, feed, clothe, and send them to school and Sabbath school, the year round, with $410,958 a day. Christian ministers and professors, think of it! Young men and boys, think of it! Yes, the Americans smoke, snuff, and chew one hundred and fifty million dollars in tobacco annually. The Chinamen consume $38,294,200 worth of opium in a year. The Russians stuff and glut over an unmerciful amount of lard and candles in a year; and the Frenchmen disgust the rest of mankind by eating all the frogs they can catch. Then there are the cannibals of the South Seas--they love tender babies to eat, but not an old tobacco-soaked sailor will they masticate. Tobacco kills lice, bugs, fops, small boys, and other vermin. Tobacco fees doctors, and fills hospitals. Tobacco fills insane asylums and jails. Tobacco fills pauper houses and graveyards. Tobacco makes drunkards. Tobacco and rum go hand and hand; they are one, inseparable; they are twins, yea, Siamese twins, the Chang and Eng of all villanies. I never saw a drunkard who did not first use tobacco. Did you? John H. Hawkins, the father of Washingtonians, said he never was able to find a drunkard who had not first used tobacco. TOO LOW A FIGURE. Since writing the above I have been variously informed that my figures are too low. The national revenue derived from tobacco in the States for the year ending June, 1871, was $31,350,707. CIGARS. "According to General Pleasonton, who collected the tax on them, there were 1,332,246,000 cigars used in the United States last year. This one billion three hundred and thirty-two million two hundred and forty-six thousand cigars were undoubtedly retailed at ten cents apiece. So we smoked up in this country, last year, $133,224,600 worth of tobacco." This does not include pipe-smoking nor chewing tobacco. The total amount of the vile weed produced in the world annually is as follows:-- Asia, 309,900,000 pounds. Europe, 281,844,500 " America, 248,280,500 " Africa, 24,300,100 " Australia, 714,000 " ----------- Making a total of, 865,039,100 " THE MIGHTY ARMY OF INVASION. It is estimated that there are two hundred millions of tobacco-users in the world. What a splendid regiment of sneezers, spewers, smokers, and spitters they would make! They would form a phalanx of five deep, reaching entirely around the world. Wouldn't they look gay? Forty millions, with filthy old tobacco pipes stuck in their mouths, "smoking away 'like devils!'" Eighty millions, with best Havana cigars, made in Connecticut and New York, from cabbage leaf, waste stumps of cigars, and "old soldiers," thrown away by Irish, Dutch, Italians, French, and Chinese, out of cancerous mouths, whiskey mouths, syphilitic and ulcerous mouths, rotten-toothed mouths--splendid!--protruding from between their sweet lips! Forty millions with pigtail and fine cut, sweet "honey dew," made as above, scented, grinding away in their forty million human mills! Forty millions, including five millions in petticoats, holding cartridge boxes (of snuff) in their delicate hands, from which they distribute death-dealing ammunition to--their lovely noses! See them "marching along, marching along," to the tune that never an "old cow died on" yet, or hogs, or any animal, except he unfortunately became mixed up involuntarily with viler humans,--with jolly banners, blacked in the smoke and stench of great battles, bearing the words "Death to Purity!" "War to the Hilt with Health!" "All hail, Disease, Drunkenness, and Death!" Splendid picture! Alas! true picture! And what do they leave in their wake? Death to all animal and vegetable life! The vile spittle and debris dropped by the way have killed all vegetable life. There's nothing vile and filthy that they have not cursed the ground with. The following are a few of the articles mixed with various brands of tobacco, as though the original poisonous weed was not sufficiently deleterious: Opium, copperas, iron, licorice,--blacked with lampblack,--the dirtiest refuse molasses, the offal of urine, etc. The effluvia and smoke arising have killed the foliage and the birds by the wayside, and miles of beautiful forests have been burned away. Nothing but a broad strip of blackened, cursed, and barren waste, remains. To offset this evil there is--nothing. Now, this army is daily on its march through our land, and I have only _begun_ to mention its depredations. Who will stop it? ITS NAMES AND NATIVITY. Tobacco is a native of the West Indies. Romanus Paine, who accompanied Columbus on his second voyage, seems to have been the first to introduce tobacco into Europe as an article of luxury. Paine is said to have lived a vagabond life, and died a miserable death. The natives called it _Peterna_. The name tobacco is derived from the town of Tabaco, New Spain. The Latin name, Nicotiana Tabacum, is from Jean Nicot, who was a French ambassador from the court of Francis I. (born the year tobacco was introduced by Paine) to Portugal. On the return of Nicot, he brought and introduced to the French court the narcotic plant, and popularized it in France. Thence it was introduced all over Europe, but encountered great opposition. Sir Walter Raleigh introduced tobacco into England about 1582. History informs us that a Persian king so strongly prohibited its use, and visited such severe penalties upon its votaries, that many of his subjects fled away to the caves, forests, and mountains, where they might worship this matchless deity free from persecution. The czar prohibited its use in Russia under penalty of death to smokers, mitigating snuff takers' penalty to _merely slitting open their noses_. [Illustration: PUNISHMENT OF THE TURK.] In Constantinople a Turk found smoking was placed upon a donkey, facing the beast's rump, and with a pipe-stem run through his nose, was rode about the public streets, a sad warning to all tobacco smokers. King James thundered against it. The government of Switzerland sounded its voice against it till the Alps echoed again. But in spite of opposition and the vileness of the article, it has worked itself into a general use,--next to that of table salt,--and to-day a majority of the adult male population of our Christianized and enlightened United States are its acknowledged votaries. [Illustration: SMOKERS OF FOUR GENERATIONS.] In the year 1850 I saw in a house in Sedgwick, Me., individuals of four different generations smoking. The old grandmother was eighty-five years old. She smoked. A grandmother, sixty-three, with her husband, smoked. Their son smoked, and had very weak eyes. His two nephews smoked and chewed tobacco. The elder lady died with scrofulous sore eyes, not having, for years before her death, a single eyelash, and her swollen, inflamed eyelids were a sight disgusting to view. All her grand and great grandchildren whom I saw were scrofulous. Some suffered with rheumatism, and all were yellowish or tawny. LITTLE CHILDREN LEARN TO SMOKE. I once saw a father teaching his little three-year-old boy to smoke. I knew a boy at Ellsworth who learned to smoke before he could light his pipe. His father, who taught him the wicked habit, was not at all respectable, and had often been jailed for selling rum. * * * * * The following is a sample of the modern John Hay's style of teaching:-- LITTLE-BREECHES. "I come into town with some turnips, And my little Gabe come along-- No four-year-old in the county Could beat him for pretty and strong; Peart, and chipper, and sassy, Always ready to swear and fight, And I'd larnt him to chaw terbacker, Jest to keep his milk teeth white. "The snow come down like a blanket As I passed by Taggart's store; I went in for a jug of molasses, And left the team at the door. They scared at something and started-- I heard one little squall, And hell-to-split over the prairie Went team, Little-Breeches and all. "Hell-to-split over the prairie! I was almost froze with skeer; But we rousted up some torches, And sarched for 'em far and near. At last we struck hosses and wagon, Snowed under a soft white mound: Upsot, dead beat--but of little Gabe No hide nor hair was found. "And here all hopes soured on me Of my fellow-critters' aid-- I jest flopped down on my marrow bones, Crotch-deep in the snow, and prayed. By this the torches was played out, And me and Isrul Parr Went off for some wood to a sheep-fold, That he said was somewhar thar. "We found it at last, and a little shed Where they shut up the lambs at night; We looked in, and seen them huddled thar, So warm, and sleepy, and white. "And thar sot Little-Breeches, and chirped As peart as ever you see: 'I want a chaw of terbacker, And that's what's the matter of me.'" [Illustration: "I WANT A CHAW OF TERBACKER."] WHIPPING SCHOOL BOYS AND GIRLS TO MAKE THEM SMOKE. In London, in 1721, Thomas Hearne tells us school children were compelled to smoke. "And I remember," he says, "that I heard Tom Rogers say that when he was yeoman beadle that year, when the plague raged, being a boy at Eaton, all the boys of his school were obliged to smoke in the school-room every morning, and that he never was whipped so much in his life as he was one morning for not smoking." [Illustration: YOUNG SMOKERS.] Some boys, nowadays, would gladly undergo the "flogging" if they could be permitted to enjoy a smoke afterwards. There are but few people inhabiting the eastern coast, and following fishing for a vocation, who do not smoke or chew tobacco; and their wives and children also smoke. Sailors are proverbially addicted to smoking and chewing. Their love of tobacco far exceeds their appetite for grog. * * * * * The following letter from a sailor below port to his brother in London explains itself:-- NEAR GRAVESEND, on board Belotropen. TO DEAR BROTHER BOB. DEAR BOB: This comes hopin' to find you well, as it leaves me safe anchored here yester arternoon. Voyge short an' few squalls. Hopes to find old father stout, and am out of pigtail. Sight o' pigtail at Gravesend but unfortinately unfit for a dog to chor. I send this by Capt'n's boy, and buy me pound best pigtail and let it be good--best at 7 diles (Dials), sign of black boy, and am short of shirts--only took two, whereof one is wored out and tother most. Capt'n's boy loves pigtail, so tie it up when bort an' put in his pocket. Aint so partick'ler about the shirts as present can be washed, but be sure to go to 7 diles sign of Black boy and git the pigtail as I haint had a cud to chor since thursday. Pound'll do as I spect to be up tomorrow or day arter. an' remember the pigtail--so I am your lovin' brother Tom ----. P. S. dont forget the pigtail. PURE SOCIETY.--HOW A YOUNG MAN WAS "TOOK IN." When a young man is about to be "taken into society," the question naturally arises, Is the young man, or the society, to be benefited by the accession? As the young man seems anxious to make his _debut_ there, we presume _he_ is to be benefited by the initiation into pure society. [Illustration: EXAMINATION OF THE SMOKER.] Since nine tenths of the young men are tobacco-users, we will presume safely enough that this young man is one of them. He has used it from five to seven years,--sufficient time to admit of its becoming part and parcel of him. The young man--"John" is his name--is before the examining committee, who, not being blind or obtuse from the use of the weed themselves, and knowing no young man is fit to enter pure society who uses, or has used, tobacco, without being purified, they submit him to the test, with the following results:-- "His clothes are impregnated with tobacco," the examiner reports. "Let them be removed and purified," is the command. [Illustration: PURIFYING HIS BLOOD.] They are soaked in alkalies, and soap, and water. They are washed, and boiled, dried, aired, and pressed and pronounced clean, and fit for society. The committee next examine John's skin. "It is full of nicotine. It must be cleansed." So John is taken to the Turkish bath, the most likely place to remove the filth permeating his every pore. Dr. Dio Diogenes puts him through; he is "sweated," and the great room is scented throughout by the tobacco aroma arising from the ten thousand before clogged-up pores of his skin. He is all but parboiled, then soaped and scrubbed, rubbed, and then goes into the plunge bath. The fishes are instantly killed. The canary bird in the next room is suffocated by the effluvia penetrating to his cage. The young man is wiped again, dried, and cooled. Again the committee smell. John is not yet pure. The nicotine is "in his blood," says Dr. Chemistry. A faucet is introduced into John's aorta, and his blood drawn off into a bucket for the chemist to analyze and purify of tobacco. Still the flesh is full of nicotine, and it must be removed and purified. It is too late for John to object, and the fact cannot be denied that the poison _is_ in his muscle; so he is stripped of the integuments to his framework. [Illustration: CLEANSING HIS BONES.] The committee now examine the bony structure. In Germany they have recently dug up the bones of tobacco-users who have been dead years, and found nicotine (tobacco principle) in them. May not this man's bones be full of nicotine, which will come out through, if we replace the integuments, blood, and garments? "The bones must be subjected to purification," said the judge. They are soaked in alkalies, boiled in acids, and sufficient nicotine is extracted to kill five men not hardened in the tobacco service. Thus, and only thus, could John have been purified from his vile habit and its results, and fitted for decent male society, female society, and Christian society. There is said to be one other place where John can possibly have the nicotine of seven years' deposit taken out of him. It is a very warm place, and the principal chemical ingredient used is said to be sulphuric, and kept up to a boiling point by means of infernal great fires. DELICIOUS MORSELS. Nicotine is the active principle of tobacco, expressed chemically thus: C10 H8 N. One fourth of a drop will kill a rabbit, one drop will kill a large dog. It is a virulent poison, the intoxicating principle of _prepared_ tobacco. It is not in the natural leaf. _It results from fermentation._ Two little boys were overheard discussing tobacco merits and demerits. One was in favor of tobacco, the other "anti." "Why," said anti, "it's so poisonous that a drop of the oil, put on a dog's tail, will kill a man in a minute." It is the opium in the best Havanas which enslaves the smokers more than the tobacco. Those cigars, also American manufactured cigars, are dipped in a solution of opium. It is said that twenty thousand dollars' worth of opium is used annually in one cigar manufactory in Havana. THE STREET NUISANCE. "I knew, by the smoke that so lazily curled From his lips, 'twas a loafer I happened to meet; And I said, "If a nuisance there be in the world, 'Tis the smoke of cigars on a frequented street." "It was night, and the ladies were gliding around, And in many an eye shone the glittering tear; But the loafer puffed on, and I heard not a sound, Save the sharp, barking cough of each smoke-stricken dear." [Illustration: THE SMOKER.] Here is a "blow" from Horace Greeley. "I do not say that every chewer or smoker is a blackguard; but show me a blackguard who is not a lover of tobacco, and I will show you two white blackbirds." Good enough for Horace. Now, admitting that there are gentlemen who smoke and chew on the streets, how are ladies, or the people, to know that they are such, since the loafer, the blackguard, the thief, the pickpocket, the profaners of God's name (all), the blackleg, the murderers bear the same insignia of their profession? At one time, every man incarcerated in the Connecticut state prison was a tobacco-user; nearly all, also, at the Maine, Vermont, and Massachusetts prisons. It is quite lamentable to see how liable tobacco-using is to convert a thorough gentleman into a selfish, dirty blackguard, who will promenade the streets, chatting with some boon companion, while the pair go recklessly along, blowing their offensive smoke directly into ladies' faces, their ashes into their beautiful eyes, and spitting their filthy saliva directly or indirectly over costly dresses, thinking only of self! THE MAN WHO CHEWS. Behold the picture of the man who chews! A human squirt-gun on the world let loose. A foe to neatness, see him in the streets, His surcharged mouth endangering all he meets. The dark saliva, drizzling from his chin, Betrays the nature of the flood within. Where, then, O where, shall Neatness hope to hide From this o'erwhelming of the blackened tide? Shall she seek shelter in the house of prayer? A hundred squirting mouths await her there. The same foul scene she's witnessed oft before,-- A _solemn cud_ is laid at every door! The vile spittoon finds place in many a pew, As if one part of worship were to _chew_! [Illustration: THE CHEWER.] ANOTHER STREET NUISANCE. Speaking of President Grant and his cigar, a writer says,-- "Not only do smoky editors take advantage of this weakness of our president, but tobacconists, greedy of gain, are subjecting it to their sordid purposes. Hitherto these gentlemen have insulted the public taste by posting at their shop doors some savage, some filthy squaw, or some unearthly image, to invite attention to their cigars and 'negro head tobacco.' And all this seemed appropriate. But cupidity is audacious, and they now insult American pride by installing at their doors a full, life-like, wooden bust of General Grant offering to passing travellers a cigar. Emblems of majesty are not rare. We have Jupiter with his thunderbolt, Hercules with his club, Ahasuerus with his sceptre, Washington with his Declaration of Independence, Lincoln with his Proclamation of Liberty to four millions, and now, in this year of our Lord, we have President Grant and his cigar! [Illustration: SIGN OF THE TIMES.] IT BEGETS LAZINESS AND NATIONAL RUIN. Sir Benjamin Brodie, a distinguished physician of London, says, "A large proportion of habitual smokers are rendered lazy and listless, indisposed to bodily and incapable of much mental exertion. Others suffer from depression of the spirits, amounting to hypochondriasis, which smoking relieves for the time, though it aggravates the evil afterwards.... "What will be the result, if this habit be continued by future generations?" Tobacco is ruining our nation. Its tendency is to make the individual user idle, listless, and imbecile. Individuals make up the nation. Those nations using the most tobacco are the most rapidly deteriorating. Once the ships of Holland ploughed the waters with a broom at the mast-head, emblematic of her power to sweep the ocean. Behold her now! "Her people self-satisfied, content with their pipes, and the glories once achieved by their grandfathers." Look at the Mexicans, and the lazzaroni of Italy. "Spain took the lead of civilized nations in the use of tobacco; but since its introduction into that country, the noble Castilian has become degenerated, his moral, intellectual, and physical energies weakened, paralyzed, and debased. The Turks, descendants of the warlike Saracens, are notoriously known as inveterate smokers. And to-day they are characterized as an enervated, lazy, worthless, degenerate people." Go about the shops, and bar-rooms, and billiard-halls of our own community, and see _our_ lazzaroni. What class do they principally represent--the active and virtuous, or the idle and vicious? [Illustration: MY LAZY SMOKING FRIEND.] A young man greatly addicted to smoking, and who, to my knowledge, was exceedingly lazy, was seated by the writer's fireside, listless and idle, save barely drawing slowly in and out the tobacco smoke of an old pipe, when, after repeated requests of his sister that he should go out to the shed and bring in some wood to replenish the dying embers, she got out of patience with him, and exclaimed,-- "There, Ed, you're the laziest fellow I ever saw, sitting there and smoking till the fire has nearly gone out, on a cold day like this." "Ugh!" he grunted, and slowly added, "I once heard tell of a lazier boy than I am, sister." "How could that be possible? Do tell me," she exclaimed, impatiently. "Well, you see,"--spitting on the floor,--"when he came to die, he couldn't do it. He was too lazy to draw his last breath, and they had to get a corkscrew to draw it for him." [Illustration: "SHALL I ASSIST YOU TO ALIGHT?"] [Illustration: WORK FOR TONGUES AND FINGERS.] "You think it smart and cunning, John, To use the nauseous weed; To make your mouth so filthy then, It were a shame indeed. To smoke and chew tobacco, John, Till your teeth are coated brown, Making a chimney of your nose, And of yourself a clown,-- "Yes, that would be so cunning, John,-- The girls will love you so; Your breath will smell so sweet, They'll want you for a beau. Because you use tobacco, John, You think yourself a man; But the girls will find it out, John, Disguise it all you can." "Shall I assist you to alight?" asked one of those nice young men who loaf about country hotel doors, smoking a villanous cigar, of a buxom country lass, on arrival of the stage. "Thank you, sir," said the girl, with irony, and a jump, "but I never smoke." BLACK EYES AND FINGERS. An American traveller visiting the greatest cigar manufactory in Seville, Spain, says, amongst other things,-- "Here were five thousand young girls, all in one room,--and Sevillians, too,--in the factory. They are all old enough to be mischievous, and 'put on airs.' I doubt if as many black eyes can be seen in any one place as in this factory. Their fingers move rapidly, and their tongues a little faster. The manufactories consume ten thousand pounds of tobacco per day. "I have often heard that a woman's weapon is her tongue, and that the sex were notorious for using it; but, like many other unkind statements against Heaven's best, last gift to man, I doubted it until I peeped into the Fabrico de Tabacos of Seville. What must be the weight of mischief manufactured each day along with the cigars, I don't know, but I feel safe in stating that it is at least equal with the tobacco. This factory was erected in 1750, is six hundred and sixty feet long by five hundred and twenty-five wide, and is surrounded by a mole. It is the principal factory in the kingdom, as every one uses tobacco in some shape in Andalusia, not excepting the ladies; but it is when they are on the shady side of forty that they puff and cogitate. Snuff, cigars, and cigarettes are all manufactured here. The best workers among the girls earn about forty cents per day, the poorest about half that amount. Every night they are all searched." DISEASE AND INSANITY. Tobacco helps to fill our insane asylums. Dr. Butler, of Hartford, and others, have assured me of the fact. "I am personally acquainted with several individuals, now at lunatic asylums, whose minds first became impaired by the use of tobacco." "In France, the increase in cases of lunacy and paralysis keeps pace, almost in exact ratio, with the increase of the revenue from tobacco. From 1812 to 1832, the tobacco tax yielded 28,000,000f., and there were 8000 lunatic patients. Now the tobacco revenue is 180,000,000f., and there are 44,000 paralytic and lunatic patients in French asylums. Napoleon and Eugenie, assisted by their subjects, smoked out five million pounds of tobacco the year before they went on their travels. Take notice. As ye sow, so also reap." Sir Benjamin Brodie, before quoted, says, "Occasionally tobacco produces a general nervous excitability, which in a degree partakes of the nature of _delirium tremens_." THE MEERSCHAUM. A SONNET. "The gorgeous glories of autumnal dyes; The golden glow that haloes rare old wine; The dying hectic of the day's decline; The rainbow radiance of auroral skies; The blush of Beauty, smit with Love's surprise; The unimagined hues in gems that shine,-- All these, O Nicotina, _may_ be thine! But what of thy bewildered votaries? How fares it with the more precious human clay? Keeps the _lip_ pure, while wood and ivory stains? Stays the _sight_ clear, while smoke obscures the day? Works the _brain_ true, while poison fills the veins? Shines the _soul_ fair where Tophet-blackness reigns? Let shattered nerves declare! Let palsied manhood say!" J. IVES PEASE. USES AND ABUSES OF TOBACCO. In our opening remarks on tobacco, we stated some of the uses of tobacco, such as killing bugs and lice on plants, vermin on cattle, etc. It prevents cannibals from eating up our poor sailors; and, in the Mexican war, it was ascertained that the turkey buzzards would not eat our dead soldiers who were impregnated with tobacco! Dean Swift published a pamphlet, in his day, showing how the superfluity of poor children could be made an article of diet for landlords who had already consumed the parents' substance. All may not admit that there _is_ a superfluity of children and youth in the larger towns and cities of our country. A New York paper says that "five thousand young men might leave New York city without being missed." Now for our argument. "Like begets like." The lamb feeds upon pure hay or sweet grass. It is the emblem of purity; it represented Christ. The lion and tiger have _only_ tearing teeth, and subsist upon animal food, and they are of a wild, ferocious nature. Man stuffs himself with tobacco poison. It becomes a part of him,--muscle, blood, bone! Like begets like, and behold the tobacco-user's children, puny, yellow, pale, scrofulous, rickety, and consumptive. Many years ago it was estimated that twenty thousand persons died annually in the United States from the use of tobacco. Nine tenths begin with tobacco catarrh, go on to consumption, and death. "The diseased, enfeebled, impaired, and rotten constitution of the parent is transmitted to the child, which comes into the world an invalid, and then, being exposed more directly to the poisonous effects of this pernicious habit of the parent, its struggle for life is exceedingly short, and in less than twelve months from its birth it sickens, droops, and dies, and the milkman's adulterated milk, especially in cities, is often made the scape-goat for this uncleanly, if not sinful habit of the parent." If it is true that the wicked mostly make up the tobacco-consumers, you perceive by this, that like the prisons and gallows, tobacco catches and kills off the superfluous wicked population and their offspring. The sins of the parents are visited upon their children, and what a host of puny, wretched, and wicked little children tobacco helps to rid the world of. Selah! TOBACCO WORSE THAN RUM. Tobacco is worse than rum because, by its begetting a dryness of the throat and fauces, it creates an appetite for strong drink. It is too evident to need corroboration. 1. "Rum intoxicates." So does tobacco. "Intoxication" is from the Greek _en_ (in) and _toxicon_ (poison). Therefore, when any perceptible poison is in the person, he is intoxicated. 2. "Alcohol blunts the senses, and ruins many a fair intellect." So does tobacco. But since the ruined drunkard used tobacco, how do you know it was not tobacco which ruined him? Come, tell me! 3. "Rum makes a man miserable." So does tobacco. The user is in Tophet the day he is out of the weed. 4. "Whiskey makes paupers." So does tobacco. I knew a whole family who went to the Brooklyn, Me., pauper house one winter, when, if the father and mother had not used tobacco, they could have been in health and prosperity. 5. "Rum makes thieves." So does tobacco. Men have been known to steal tobacco when they would not have stolen bread. 6. "It makes murderers." Where is the murderer of the nineteenth century who was not a tobacco-user, and an excessive user at that, from George Dennison, who on the drop asked the sheriff for a chew of tobacco, to Stokes, in his New York cell, surrounded by a cloud of tobacco smoke, awaiting the decision of the jury to ascertain if it was really he who shot the "Prince of Erie"? * * * * * [Illustration: WHAT KILLED THE DOG?] You can't always tell just what kills a man, or a dog, as the following story proves:-- "An old farmer was out one fine day looking over his broad acres, with an axe on his shoulder, and a small dog at his heels. They espied a woodchuck. The dog gave chase, and drove him into a stone wall, where action immediately commenced. The dog would draw the woodchuck partly out from the wall, and the woodchuck would take the dog back. The old farmer's sympathy getting high on the side of the dog, he thought he must help him. So, putting himself in position, with the axe above the dog, he waited the extraction of the woodchuck, when he would cut him down. Soon an opportunity offered, and the old man struck; but the woodchuck gathered up at the same time, took the dog in far enough to receive the blow, and the dog's head was chopped off on the spot. Forty years after, the old man, in relating the story, would always add, with a chuckle of satisfaction, 'And that dog don't know, to this day, but what the woodchuck killed him!'" We regret our want of space to ventilate tobacco more thoroughly. [Illustration] XXVI. DRESS AND ADDRESS OF PHYSICIANS. The fish called the Flounder, perhaps you may know, Has one side for use, and another for show; One side for the public, a delicate brown, And one that is white, which he always keeps down. * * * * * Then said an old Sculpin--"My freedom excuse, But you're playing the cobbler with holes in your shoes; Your brown side is up,--but just wait till you're _fried_, And you'll find that all flounders are white on one side." DR. O. W. HOLMES. 1844. GOSSIP IS INTERESTING.--COMPARATIVE SIGNS OF GREATNESS.--THE GREAT SURGEONS OF THE WORLD.--ADDRESS NECESSARY.--"THIS IS A BONE."--DRESS _not_ NECESSARY.--COUNTRY DOCTORS' DRESS.--HOW THE DEACON SWEARS.--A GOOD MANY SHIRTS.--ONLY WASHED WHEN FOUND DRUNK.--LITTLE TOMMY MISTAKEN FOR A GREEN CABBAGE BY THE COW.--AN INSULTED LADY.--DOCTORS' WIGS.--"AIN'T SHE LOVELY?"--HARVEY AND HIS HABITS.--THE DOCTOR AND THE VALET.--A BIG WIG.--BEN FRANKLIN.--JENNER'S DRESS.--AN ANIMATED WIG; A LAUGHABLE STORY.--A CHARACTER.--"DASH, DASH." "All personal gossip is interesting, and all of us like to know something of the men whom we hear talked of day by day, and whose works have delighted or instructed us; how they dressed, talked, or walked, and amused themselves; what they loved to eat and drink, and how they looked when their bows were unbent." Most famous men have had some peculiarity of dress or address, or both. Our first impression of Goliah--by what we heard of his size--was that he was as high as a church steeple; and of Napoleon, that he was as short as Tom Thumb. But when we read for ourselves, we found that Goliah was much less in stature than Xerxes and some modern giants, and Napoleon was of medium size. No man can become truly great in any capacity unless he has the innate qualities of greatness within his composition. These qualities, if possessed, will appear in his face,--for face, as well as acts, indicate the character. There seem to be elements of character in all great men--almost the identical basis of character in the one as in the other, the different vocations explaining any minor differences that are to be found in them. Thus we find precisely the same features in the character of Michael Angelo and the Duke of Wellington--two men living three centuries apart, in different countries--one a great artist, and the other a great warrior. Compare Washington and Julius Cæsar; you will find them surprisingly alike in many particulars. In them, as in every instance I have yet studied, the distinguishing feature is an intense love of work--work of the kind that fell to the lot of each to do. Another feature is indomitable courage; and the last is a never-dying perseverance. Though I have carefully studied the histories of many of the greatest men, in order, if I could, to discover the source of their greatness, I have never yet come upon one great life that has lacked these three features--love of work, unfailing courage, and perseverance. "To be a good surgeon one should be a complete man. He should have a strong intellect to give him judgment and enable him to understand the case to be operated on in all its bearings. He needs strong perceptive faculties especially, through which to render him practical, to enable him not only to know and remember all parts, but to use instruments and tools successfully; also large constructiveness, to give him a mechanical cast of mind. More than this, he must have inventive power to discover and apply the necessary mechanical means for the performance of the duties of his profession. He must have large Firmness, Destructiveness, and Benevolence, to give stability, fortitude, and kindness. He must have enough of Cautiousness to make him careful where he cuts, but not so much as to make him timid, irresolute, and hesitating; Self-esteem, to give assurance; Hope, to inspire in his patients confidence, and genial good-nature, to make him liked at the bedside. [Illustration: THE GREAT SURGEONS OF THE WORLD.] "In the group of eminent men whose likenesses are herewith presented, we find strongly marked physiognomies in each. There is nothing weak or wanting about them. All seem full and complete. Take their features separately--eyes, nose, mouth, chin, cheeks, lips--analyze closely as you can, and you will discover strength in every lineament and in every line. In Harvey we have the large perceptives of the observer and discoverer. He was pre-eminently practical in all things. In Abernethy there is naturally more of the author and physician than of the surgeon, and you feel that he would be more likely to give you advice than to apply the knife. In Hunter, strong, practical common sense, with great Constructiveness, predominates. See how broad the head between the ears. His expression indicates 'business.' Sir Astley Cooper looks the scholar, the operator, and the very dignified gentleman which he was. (He was the handsomest man of his day.) Carnochan, the resolute, the prompt, the expert, is large in intellect, high in the crown, and broad at the base; he has perhaps the best natural endowment, and by education is the one best fitted for his profession, among ten thousand. He is, in all respects, 'the right man in the right place.' "Dr. Mott, the Quaker surgeon, has a large and well-formed brain, and strong body, with the vital-motive temperament, good mechanical skill, and great self-control, resolution, courage, and sound common sense. Jenner, the thoughtful, the kindly, the sympathetical, and scholarly, has less of the qualities of a surgeon than any of the others." For the above interesting facts we are indebted to the "Phrenological Journal." Professor Bigelow, of Harvard, has all the requisites in his "make up" of a great surgeon. As a lecturer, Dr. Bigelow is easy and off-handed. He comes into the room without any fuss or airs. He takes up a bone, a femur, perhaps, and after looking at it and turning it round and upside down as though he never saw it before, he finally says, "This is a bone--yes, a bone." You want to laugh outright at the quaintness of the whole prelude. Then he goes on to tell all about "the bone." We have not space for more than a mere line sketch of even great men like the above, and but few of those. THE OLD COUNTRY DOCTOR'S DRESS. The country doctor of the past is interesting in both dress and address. He is almost always, somehow, an elderly gentleman. He devotes little time and attention to dress. We have one in our "mind's eye" at this moment,--the dear old soul! His head was as white as--Horace Greeley's; not so bald. His hair he combed by running his fingers though it mornings. His eyes, ears, and mouth were ever open to the call of the needy. His clothes looked as though they belonged to another man, or as if he had lodged in a hotel and there had been a fire, and every man had put on the first clothes he found. His coat belonged to a taller and bigger man, also his pants, while the vest was a boy's overcoat. His boots were not mates. His lean old spouse looked neat and prim, but as though she had been used for trying every new sample of pill which the doctor's prolific brain invented. [Illustration: A CALL ON THE VILLAGE DOCTOR.] I knew another, kind, benevolent old doctor, who started off immediately on a call, without adding to or changing his dress. I once saw him seven miles from home in his shirt sleeves in November, driving fiercely along in his gig, as dignified as though dressed in his Sunday coat. If a friend reminded him of his omission, he would smile benevolently, swear as cordially, and drive on. He did not mean to be odd, he did not mean to swear; and the minister, who had talked with him on the subject more than once, had come to that charitable conclusion--for the doctor always made due acknowledgment, and did not forget the contributions and salaries. The doctor was like an innocent old backwoods deacon we have heard of, who, chancing at a village tavern for the first time, heard some extraordinary swearing; and being fascinated by this new accomplishment, he went home, and looking about for an opportunity to put to practical use the new vocabulary, he finally electrified his amiable wife by exclaiming,-- "Lord-all-hell, wife; shut the doors by a dam' sight!" * * * * * [Illustration: PHYSICIANS COSTUME IN 1790.] In regard to shirts, a reliable author tells us that Dr. H. Davy adopted the following plan _to save time_. "He affected not to have time for the ordinary decencies of the toilet. Cold ablutions neither his constitution nor his philosophic temperament required; so he rarely ever washed himself. But the most remarkable fact was on the plea of saving time. When one shirt became too indecently dirty to be seen longer he used to put a clean one on over it; also the same with stockings and drawers. By spring he would look like the 'metamorphosis man' in the circus--big and rotund. "On rare occasions he would divest himself of his superfluous stock of linen, which occasion was a feast to the washerwoman, but it was a source of perplexity to his less intimate friends, who could not account for his sudden transition from corpulency to tenuity." The doctor's stock of shirts must have equalled Stanford's. A California paper tells us that "twenty years ago Leland Stanford arrived in that state with only one shirt to his back. Since then, by close attention to business, he has contrived to accumulate a trifle of ten million." What possible use can a man have for _ten million shirts_? The Earl of Surrey, afterwards eleventh Duke of Norfolk, who was a notorious gormand and hard drinker, and a leading member of the Beefsteak Club, was so far from cleanly in his person that his servants used to avail themselves of his fits of drunkenness--which were pretty frequent, by the way, for the purpose of washing him. On these occasions they stripped him as they would a corpse, and performed the needful ablutions. He was equally notorious for his horror of clean linen. One day, on his complaining to his physician that he had become a perfect martyr to rheumatism, and had tried every possible remedy without success, the latter wittily replied, "Pray, my lord, did you ever try a clean shirt?" Dr. Davy's remarkable oddity of dress did not end here. He took to fishing: we have noticed his writing on angling elsewhere. He was often seen on the river's banks, in season and out of season, "in a costume that must have been a source of no common amusement to the river nymphs. His coat and breeches were of a bright green cloth. His hat was what Dr. Paris describes as 'having been intended for a coal-heaver, but as having been dyed green, in its raw state, by some sort of pigment.' In this attire Davy flattered himself that he closely resembled vegetable life"--which was not intended to scare away the fishes. [Illustration: HOW POOR TOMMY WAS LOST.] This reminds me of Mrs. Pettigrew's little boy "Tommy." Never heard of it? "Well," says Mrs. Pettigrew, "I never again will dress a child in green. You see,"--very affectedly,--"I used to put a jacket and hood on little Tommy all of beautiful green color, till one day he was playing out on the grass, looking so green and innocent, when along came a cow, and eat poor little Tommy all up, mistaking him for a cabbage." Mrs. H. Davy was as curious in dress as the doctor. "One day"--it is told for the truth--"the lady accompanied her husband to Paris, and walking in the Tuileries, wearing the fashionable London bonnet of the period,--shaped like a cockle-shell,--and the doctor dressed in his green, they were mistaken for _masqueraders_, and a great crowd of astonished Parisians began staring at the couple. "Their discomfiture had hardly commenced when the garden inspector informed the lady that nothing of the kind could be permitted on the grounds, and requested a withdrawal. "The rabble increased, and it became necessary to order a guard of infantry to remove '_la belle Anglaise_' safely, surrounded by French bayonets." [Illustration: BRIDGET'S METHOD OF MENDING STOCKINGS.] A Portland paper tells how a servant girl there mended her stockings. "When a hole appeared in the toe, Bridget tied a string around the stocking below the aperture and cut off the projecting portion. This operation was repeated as often as necessary, each time pulling the stocking down a little, until at last it was nearly all cut away, when Bridget sewed on new legs, and thus kept her stockings always in repair." DOCTORS' WIGS. For the space of about three centuries the physician's wig was his most prominent insignia of office. Who invented it, or why it was invented, I am unable to learn. The name _wig_ is Anglo-Saxon. Hogarth, in his "Undertaker's Arms," has given us some correct samples of doctors' wigs. Of the fifteen heads the only unwigged one is that of a woman--Mrs. Mapp, the bone-setter. The one at her left is Taylor, the "quack oculist;" the other at her right is Ward, who got rich on a pill. Mrs. Mapp is sketched in our chapter on Female Doctors. Isn't she lovely? And how Taylor and Ward lean towards her! YE ANCIENT DOCTOR. "Each son of Sol, to make him look more big, Wore an enormous, grave, three-tailed wig; His clothes full trimmed, with button-holes behind; Stiff were the skirts, with buckram stoutly lined; The cloth-cut velvet, or more reverend black, Full made and powdered half way down his back; Large muslin cuffs, which near the ground did reach, With half a dozen buttons fixed to each. Grave were their faces--fixed in solemn state; These men struck awe; their children carried weight. In reverend wigs old heads young shoulders bore; And twenty-five or thirty seemed threescore." HARVEY'S HABITS. I think Harvey should have been represented in a wig. They were worn by doctors in his day, though John Aubrey makes no mention of Dr. Harvey's wearing one. He (Aubrey) says, "Harvey was not tall, but of a lowly stature; round faced, olive complexion, little eyes, round, black, and very full of spirit. His hair was black as a raven, but quite white twenty years before he died. I remember he was wont to drink coffee with his brother Eliab before coffee-houses were in fashion in London. "He, with all his brothers, was very choleric, and in younger days wore a dagger, as the fashion then was; but this doctor would be apt to draw out his dagger upon very slight occasions. [Illustration: THE UNDERTAKER'S ARMS.] "He rode _on horseback, with a foot-cloth, to visit his patients, his footman following, which was then a very decent fashion, now quite discontinued_." It was not unusual to see a doctor cantering along at a high rate of speed, and his footman running hard at his side, with whom the doctor was keeping up a _lively_ conversation. [Illustration: DISPUTE OF THE DOCTOR AND VALET.] Jeaffreson tells the following story of Dr. Brocklesby, also the proprietor of an immense wig. The doctor was suddenly called by the Duchess of Richmond to visit her maid. The doctor was met by the husband of the fair patient, and valet to the duke. In the hall the doctor and valet fell into a sharp discussion. On the stairs the argument became hotter, for the valet was an intelligent fellow. They became more excited as they neared the sick chamber, which they entered, declaiming at the top of their voices. The patient was forgotten, though no doubt she lifted her fair head from the pillow to see her undutiful lord disputing with her negligent doctor. The valet poured in sarcasm and irony by the broadside. The doctor, with true Johnny Bull pluck, replied volley for volley, and the battle lasted for above an hour. The doctor went down stairs, the loquacious valet courteously showing him out, when the two separated on the most amiable terms. Judge of the doctor's consternation, when, on reaching his own door, the truth flashed across his mind that he had neglected to look at the patient's tongue, feel her pulse, or, more strange, look for his fee. The valet was so ashamed, when he returned to the chamber, that his invalid wife, instead of scolding him, as he deserved, fell into a laughing fit, and forthwith recovered from her sickness. I have seen many a patient for whom I thought a right hearty laugh would do more good than all the medicine in the shops. One William--known as "Bill"--Atkins, a gout doctor, used to strut about the streets of London, about 1650, with a huge gold-headed cane in his hand, and a "stunning" big three-tailed wig on his otherwise bare head. Gout doctoring was profitable in Charles II.'s time. "Dr. Henry Reynolds, physician to George III., was the Beau Brummell of the faculty, and was the last of the big-wigged and silk-coated doctors. His dress was superb, consisting of a well-powdered wig, silk coat, velvet breeches, white silk stockings, gold-buckled shoes, gold-headed cane, and immaculate lace ruffles." Benjamin Franklin had often met and conversed with Reynolds. FRANKLIN'S COURT DRESS. Nathaniel Hawthorne relates an anecdote of the origin of Franklin's adoption of the customary civil dress, when going to court as a diplomatist. It was simply that his tailor had disappointed him of his court suit, and he wore his plain one, with great reluctance, because he had no other. Afterwards, gaining great success and praise by his mishap, he continued to wear it from policy. The great American philosopher was as big a humbug as the rest of us. DR. JENNER'S DRESS. "When I first saw him," says a writer of his day, "he was dressed in blue coat, yellow buttons and waistcoat, buskins, well-polished boots, with handsome silver spurs. His wig, after the fashion, was done up in a club, and he wore a broad-brimmed hat." AN ANIMATED QUEUE. An old English gentleman told me an amusing story of a wig. A Dr. Wing, who wore a big wig and a long queue, visited a great lady, who was confined to her bed. The lady's maid was present, having just brought in a bowl of hot gruel. As the old doctor was about to make some remark to the maid, as she held the bowl in her hands, he felt his queue, or tail to his wig, moving, when he turned suddenly round towards the lady, and looking with astonishment at his patient, he said,-- "Madam, were you pulling my tail?" "Sir!" replied the lady, in equal astonishment and indignation. Just then the tail gave another flop. Whirling about like a top whipped by a school-boy, the doctor cried to the maid,-- "Zounds, woman, it was _you_ who pulled my wig!" "Me, sir!" exclaimed the affrighted lady's maid. "Yes, you, you hussy!" "But, I beg your pardon--" "Thunder and great guns, madam!" And the doctor whirled back on his pivoted heels towards the more astonished lady, who now had risen from her pillow by great effort, and sat in her night dress, gazing in profound terror upon the supposed drunken or insane doctor. Again the wig swung to and fro, like a clock pendulum. Again the old doctor, now all of a lather of sweat, spun round, and accused the girl of playing a "scaly trick" upon his dignified person. [Illustration: A WIG MOUSE.] "Sir, do you see that I have both hands full?" Away went the tail again. The lady saw it moving as though bewitched, and called loudly for help. The greatest consternation prevailed, the doctor alternating his astounded gaze between the two females; when the queue gave a powerful jerk, and out leaped a big mouse, which went plump into the hot porridge. The maid gave a shrill scream, and dropped the hot liquid upon the doctor's silk hose, and fled. The poor, innocent mouse was dead; the doctor was scalded; the lady was in convulsions--of laughter; when the room was suddenly filled by alarmed domestics, from scullion to valet, and all the ladies and gentlemen of the household. [Illustration: THE MYSTERY EXPLAINED.] "What's the matter?" sternly inquired the master of the house, approaching the bed. "O, dear, dear!" cried the convalescent, "a mouse was in the doctor's wig, and--" "A mouse!" exclaimed the doctor, jerking the offensive wig from his bald pate. "A d--d mouse! I beg a thousand pardons, madam," turning to the lady, holding the wig by the tail, and giving it a violent shake. He had not seen the mouse jump, and till this moment thought that the lady and maid had conspired to insult him. A "CHARACTER." Old Dr. Standish was represented by our authority as "a huge, burly, surly, churlish old fellow, who died at an extremely advanced age in the year 1825. "He was as unsociable, hoggish an old curmudgeon as ever rode a stout hack. Without a companion, save, occasionally, 'poor Tom, a Thetford breeches maker,' 'he sat every night, for fifty years, in the chief parlor of the Holmnook, in drinking brandy and water, and smoking a "church warden."' Occasionally his wife, 'a quiet, inoffensive little body,' would object to the doctor's ways, and, forgetting that she was a woman, offer an opinion of her own. "On such occasions, Dr. Standish thrashed her soundly with a dog-whip." In consequence of too oft repetition of this unpleasantness, she ran away. "Standish's mode of riding was characteristic of the man. Straight on he went, at a lumbering, six-miles-an-hour gait, _dash, dash, dash_, through the muddy roads, sitting loosely in his saddle, heavy and shapeless as a bag of potatoes, looking down at his slouchy brown corduroy breeches and clay-colored boots, the toes of which pointed in opposite directions, with a perpetual scowl on his brow, never vouchsafing a word to a living creature. "'Good morning to you, doctor; 'tis a nice day,' a friendly voice would exclaim. "'Ugh!' Standish would grunt, while on, _dash, dash, dash!_ he rode. "He never turned out for a wayfarer. "A frolicsome curate, who had met old Standish, and received nothing but a grunt in reply to his urbane greeting, arranged the following plan to make the doctor speak. [Illustration: MEETING OF THE DOCTOR AND THE CURATE.] "When riding out one day, he observed Standish coming on with his usual '_dash, dash, dash_,' and stoical look. The clerical gentleman put spurs to his beast, and charged the man of pills and pukes at full tilt. Within three feet of Standish's horse's nose, the young curate reined suddenly up. The doctor's horse, as anticipated, came to a dead halt, when the burly body of old Standish rolled into the muddy highway, going clean over the horse's head. "'Ugh!' grunted the doctor. "'Good morning,' said the curate, good-humoredly. "The doctor picked himself out of the mire, and, with a volley of expletives 'too numerous to mention,' clambered on to his beast, and trotted on, _dash, dash, dash!_ as though nothing had happened." * * * * * [Illustration: DR. CANDEE.] The dress of the modern physician is a plain black suit, throughout, with immaculate linen, and possibly a white cravat. Occasionally one will "crop out" in some oddity of dress, but usually as a medium for advertising his business. With the better portion of the community, such monstrosities do not pass as indications of intelligence in the exhibitor. This engraving represents Dr. Candee, a western magnetic doctor. He was formerly from the "nutmeg state," and is a fair specimen of the travelling doctors who secure custom from their oddities and eccentricities of dress. XXVII. MEDICAL FACTS AND STATISTICS. HOW MANY.--WHO THEY ARE.--HOW THEY DIE.--HOW MUCH RUM THEY CONSUME.--HOW THEY LIVE.--OLD AGE.--WHY WE DIE.--GET MARRIED.--OLD PEOPLE'S WEDDING.--A GOOD ONE.--THE ORIGIN OF THE HONEYMOON.--A SWEET OBLIVION.--HOLD YOUR TONGUE!--MANY MEN, MANY MINDS.--"ALLOPATHY."--LOTS OF DOCTORS.--THE ITCH MITE.--A HORSE CAR RIDE.--KEEP COOL!--KNICKKNACKS.--HUMBLE PIE.--INCREASE OF INSANITY.--A COOL STUDENT.--HOW TO GET RID OF A MOTHER-IN-LAW. THE POPULATION. There are on the earth about one billion of inhabitants. They speak four thousand and sixty-four languages. Only one person in a thousand reaches his allotted years,--threescore and ten. Between the ages of sixteen and forty-five, there are more females than males. Lawyers live the longest, doctors next, ministers least of the three professions. There are more insane among farmers than of any other laborers. Caucasians live longer than Malays, Hindoos, Chinese, or Negroes. Light-skinned, dark-haired persons with dark or blue eyes live the longest. Red or florid complexioned, gray or hazel eyes, shortest. One half of the people die before the age of seventeen; one fourth before seven. About 91,824 die each day; one every second. The married live longer than the single. Tall men live longer than short ones. (No pun.) Short women live longer than tall ones. Three quarters of the adults are married. Births and deaths are more frequent by night than day. The cost of the clergy of the United States is six million dollars yearly. Lawyers receive about thirty-five million dollars. Crime costs the United States about nineteen million dollars. Tobacco one hundred and fifty million dollars. (That's crime, also.) Liquors one billion four hundred and eighty-three million four hundred and ninety-one thousand eight hundred and sixty-five dollars. (Text-book of Temperance, p. 188.) Opium is eaten in the world by one hundred and twenty million people. Hasheesh is used by some twenty millions. The temperate live longer than the intemperate. SELF-DESTRUCTION. [Illustration: A GERMAN BEER GIRL.] The Hon. Francis Gillette, in a speech in Hartford, Conn., in 1871, said that there was "in Connecticut, on an average, one liquor shop to every forty voters, and three to every Christian church. In this city, as stated in the _Hartford Times_, recently, we have five hundred liquor shops, and one million eight hundred and twenty-five thousand dollars were, last year, paid for intoxicating drinks. A cry, an appeal, came to me from the city, a few days since, after this wise: 'Our young men are going to destruction, and we want your influence, counsel, and prayers, to help save them.'" In New London, report says, the young men are falling into drinking habits as never before. So in New Haven, Bridgeport, and the other cities and large places of the state. "The pulse of a person in health beats about seventy strokes a minute, and the ordinary term of life is about seventy years. In these seventy years, the pulse of a temperate person beats two billion five hundred and seventy-four million four hundred and forty thousand times. If no actual disorganization should happen, a drunken person might live until his pulse beat this number of times; but by the constant stimulus of ardent spirits, or by pulse-quickening food, or tobacco, the pulse becomes greatly accelerated, and the two billion five hundred and seventy-four million four hundred and forty thousand pulsations are performed in little more than half the ordinary term of human life, and life goes out in forty or forty-five years, instead of seventy. This application of numbers is given to show that the acceleration of those forces diminishes the term of human life." "In New York, Mr. Greeley states that 'a much larger proportion of adult males in the state drink now than did in 1840-44.' After speaking of the adverse demonstrations all over the country, he adds, 'I cannot recall a single decisive, cheering success, to offset these many reverses.' "Massachusetts is moving to build an asylum for her twenty-five thousand drunkards. Lager beer brewers at Boston Highlands have three millions of dollars invested in the business, manufactured four hundred and ninety-five thousand barrels last year, and paid a tax of half a million to the general government. The city of Chicago, last year, received into her treasury one hundred and ten thousand dollars for the sale of indulgences to sell intoxicating drinks. "The same rate of fearful expenditure for intoxicating drinks extends across the ocean. In a speech before the Trades' Union Congress, last October, at Birmingham, 'on the disorganization of labor,' Mr. Potter shows drunkenness to be the great disorganizer of the labor of Great Britain, at a yearly cost of two hundred and twenty-eight million pounds, equal to one billion one hundred and forty million dollars; enough," he adds, "to pay the public debt of Great Britain in less than five years, and greatly diminish taxation forever." HOW THEY LIVE. In one block near the New Bowery, New York, are huddled fifteen hundred and twenty persons. Eight hundred and twelve are Irish, two hundred and eighteen Germans, one hundred and eighty-nine Poles, one hundred and eighty-six Italians, thirty-nine Negroes, sixty-four French, two Welsh, only ten American. Of these, ten hundred and sixty-two are Catholic, two hundred and eighty-seven Jews, etc. There are twenty grog-shops and fifty degraded women. Of six hundred and thirteen children, but one hundred and sixty-six went to school. New York city consumes nine thousand six hundred dollars' worth of flour a day (twelve hundred barrels), and uses ten thousand dollars' worth of tobacco per day. OLD AGE. We have mentioned some physicians who lived to an extreme old age--the Doctors Meade; one lived to be one hundred and forty-eight years and nine months. Thomas Parr, an English yeoman, lived to the remarkable age of _one hundred and fifty-three years_; and even then Dr. Harvey, who held a _post mortem_ on the body, found no internal indication of decay. One of his descendants lived to be one hundred and twenty. The Rev. Henry Reade, Northampton, England, reached the age of one hundred and thirty-two. There was a female in Lancashire, whose death was noticed in the Times, called the "Cricket of the Hedge," who lived to be one hundred and forty-one years, less a few days. The Countess Desmond arrived at the remarkable age of one hundred and forty years. One might suppose the allotted threescore and ten years a sufficiently long time to satisfy one to live in poverty in this world; but Henry Jenkins lived and died at the age of _one hundred and sixty-nine years_, in abject penury. He was a native of Yorkshire, and died in 1670. WHY WE DIE. But few of the human race die of old age. Besides the thousand and one diseases flesh is heir to, and the disease which Mrs. O'Flannagan said her husband died of, viz., "Of a Saturday 'tis that poor Mike died," very many die of disappointment. More _fret_ out. Mr. Beecher said, "It is the fretting that wears out the machinery; friction, not the real wear." "Choked with passion" is no chimera; for passion often kills the unfortunate possessor of an irritable temper, sometimes suddenly. Care and over-anxiety sweep away thousands annually. Let us see how long a man should live. The horse lives twenty-five years; the ox fifteen or twenty; the lion about twenty; the dog ten or twelve; the rabbit eight; the guinea-pig six or seven years. These numbers all bear a similar proportion to the time the animal takes to grow to its full size. But man, of all animals, is the one that seldom comes up to his average. He ought to live a hundred years, according to this physiological law, for five times twenty are one hundred; but instead of that, he scarcely reaches, on the average, four times his growing period; the cat six times; and the rabbit even eight times the standard of measurement. The reason is obvious. Man is not only the most irregular and the most intemperate, but the most laborious and hard-worked of all animals. He is also the most irritable of all animals; and there is reason to believe, though we cannot tell what an animal secretly feels, that, more than any other animal, man cherishes wrath to keep it warm, and consumes himself with the fire of his secret reflections. "Age dims the lustre of the eye, and pales the roses on beauty's cheek; while crows' feet, and furrows, and wrinkles, and lost teeth, and gray hairs, and bald head, and tottering limbs, and limping, most sadly mar the human form divine. But dim as the eye is, pallid and sunken as may be the face of beauty, and frail and feeble that once strong, erect, and manly body, the immortal soul, just fledging its wings for its home in heaven, may look out through those faded windows as beautiful as the dewdrop of summer's morning, as melting as the tears that glisten in affection's eye, by growing kindly, by cultivating sympathy with all human kind, by cherishing forbearance towards the follies and foibles of our race, and feeding, day by day, on that love to God and man which lifts us from the brute, and makes us akin to angels." GET MARRIED. There's nothing like it. Get married early. The majority of men save nothing, amount to nothing, until they are married. Don't get married _too much_. There was a man up in court recently for being too much married. A well-matched, temperate couple grow old, to be sure, but they "grow old gracefully." When people venture the second and third time in the "marriage lottery," it is fair to presume the first experience was a happy one. Here is a case:-- AN OLD PEOPLE'S WEDDING. "Married, in Gerry, Chautauqua County, New York, November 6, 1864, by Elder Jonathan Wilson, aged eighty-eight, Silvanus Fisher, a widower, aged eighty-two, to Priscilla Cowder, a widow, aged seventy-six, all of Gerry." What were their habits? Did they drink, smoke, or chew? Did they dissipate in any way? Who will tell us how these aged people managed to keep up their youthful spirits so long?. We should like to publish the recipe for "the benefit of whom it concerns." A GOOD ONE. A Maryland paper tells the story of a marriage under difficulties, where first the bridegroom failed to appear at the appointed time through bashfulness, and was discovered, pursued, and only "brought to" with a shot gun. The bride then became indignant, and refused to marry so faint-hearted a swain. And finally, the clergyman, who is something of a wag, settled the matter by threatening to have them both arrested for breach of promise unless the ceremony was immediately performed--which it was. [Illustration: AN INDIGNANT BRIDE.] THE HONEYMOON. The origin of the honeymoon is not generally known. The Saxons long and long ago got up the delightful occasion. Amongst the ancient Saxons and Teutons a beverage was made of honey and water, and sometimes flavored with mulberries. This drink was used especially at weddings and the after festivals. These festivals were kept up among the nobility sometimes for a month--"monath." The "hunig monath" was thus established, and the next moon after the marriage was called the honeymoon. Alaric, about the fifth century king of the Saxons and Western Goths, is said to have actually died on his wedding night from drinking too freely of the honeyed beverage,--at least he died before morning,--and it certainly would seem to be a charitable inference to draw, since he partook very deeply of the "festive drink." It was certainly a sweet oblivion, "yet it should be a warning to posterity, as showing that even bridegrooms may make too merry." Dr. Blanchet recently read a paper before the Academy of Science, Paris, relative to some cases of "long sleep," or lethargic slumber. One of them related to a lady twenty years of age, who took a sleeping fit during her _honeymoon_, which lasted fifty days. "During this long period a false front tooth had to be taken out in order to introduce milk and broth into her mouth. This was her only food; she remained motionless, insensible, and all her muscles were in a state of contraction. Her pulse was low, her breathing scarcely perceptible; there was no evacuation, no leanness; her complexion was florid and healthy. The other cases were exactly similar. Dr. Blanchet is of opinion that in such cases no stimulants or forced motion ought to be employed. "The report did not say whether the husband was pleased or not with her long silence." There is too much talk in the world about woman's "_jaw_." As for me, give me the woman who can _talk_; the faster and more sense the better. "MANY MEN, MANY MINDS." There are in the United States about thirty-five thousand physicians. Of this number about five thousand are Homeopathists, and nearly thirty thousand are what is wrongly termed Allopathists. Allopathic--Allopathy.--The dictionaries say this term means "the employment of medicines in order to produce effects different from those resulting from the disease--a term invented by Hahnemann to designate the ordinary practice as opposed to Homeopathy." The term is not acknowledged by physicians, only as a nick, or false one, given by the Hahnemannites to regular practitioners. "Never allow yourself," says Professor Wood, author of the American or U. S. Dispensatory, "to be called an Allopath. It is an opprobrious name, given by the enemies of regular physicians." It is, moreover, very inappropriate, for we give other remedies besides those of counter-irritation; as, for instance, an emetic for nausea. The first regular physicians of Boston were Dr. John Walon, Dr. John Cutler, and Dr. Zabdal Boylston. Some of the earlier doctors had acted in the double capacity of minister and physician, as previously mentioned. Massachusetts has now twelve hundred "regular" doctors, three hundred, or more, homeopathists, and some hundred botanics, etc. Boston has three hundred and twenty "allopathics," about fifty homeopathists, a dozen "eclectics," one hundred and twenty of miscellaneous, and eighty-four female doctors. Surely some of them must needs "scratch for a living;" yet there is always room for a first-class practitioner anywhere. THE ITCH MITE. As we are speaking of "scratching" we will mention the itch mite, which we propose to give particular--sulphur--in this chapter. [Illustration: THE ITCH MITE.] The animal which makes one love to scratch is from one sixteenth to one seventeenth of an inch in length, and may be seen with the naked eye if the eye is sharp enough to "see it." The luxury of scratching is said to greatly compensate for the filthy disease known as the "itch." Dr. Ellitson says "a Scotch king--viz., James I.--is alleged to have said that no subject deserved to have the itch--none but Royalty--on account of the great pleasure derived from scratching." The king was said to have spoken from experience. In these days of filthy horse-cars (we are speaking of New York), this fact may be interesting to passengers. A HORSE-CAR RIDE. Never full; pack 'em in; Move up, fat men, squeeze in, thin; Trunks, valises, boxes, bundles, Fill up gaps as on she tumbles. Market baskets without number; Owners easy nod in slumber; Thirty seated, forty standing, A dozen more on either landing. Old man lifts his signal finger, Car slacks up, but not a linger; He's jerked aboard by sleeve or shoulder, Shoved inside to sweat and moulder. Toes are trod on, hats are smashed, Dresses soiled, hoop skirts crashed, Thieves are busy, bent on plunder; Still we rattle on like thunder. Packed together, unwashed bodies Bathed in fumes of whiskey toddies; Tobacco, garlic, cheese, and lager beer Perfume the heated atmosphere; Old boots, pipes, leather, and tan, And, if in luck, a "soap-fat man;" Ar'n't we jolly? What a blessing! A horse-car hash, with such a dressing! HOW TO KEEP COOL. 1. _Don't fan yourself._ Those persons who are continually using a fan are ever telling you "how awful hot it is." Look at their faces! Red hot! Human nature is a contrary jade. The more you blow with a fan that warm air on your face, the more blood it calls to that part, and the more blood the more heat. So don't fan. 2. _Don't drink ice-water._ Cold, iced water is excellent for a fever, perhaps (_similia similibus curantur_); but if you drink it down when you are merely warm from outward heat, you get up an internal fever, which is increased in proportion as you take that unnatural beverage into the stomach. I drink tea, chocolate, coffee. Some persons cannot drink the latter. _Then don't_; but take black tea; not too strong, nor scalding hot. If very thirsty after, take small quantities of cold (not iced) water. Don't take ice-cream. It increases heat and thirst. Soda-water is less objectionable. Sprinkling the carpet with water several times a day keeps the room cooler. If there are small children or invalids, this may be objectionable. 3. _With the hand_ apply cool or tepid water to the entire person every six to twenty-four hours. The electricity from the hand _equalizes_ the circulation. Rub dry with a soft towel. A coarse scrubbing-cloth (even a hemlock board) does nicely for a hog, but do not apply such to human beings. It is quite unnatural. 4. Do not sleep in any garment at night worn during the day. Have your windows open as wide as you will, and bars to keep out flies and mosquitos. Keep a sheet over the limbs, to exclude the hot air from the surface. 5. Eat fruits, and but little meats. You will find, as a general rule, all ripe fruit healthy in its season. I have lived in the South several years, and know whereof I affirm. 6. And above all--_keep cool_! KNICKKNACKS. _More Truth than Poetry._--The following conversation between a colored prisoner and a temperance lecturer who was in search of facts to fortify his positions and illustrate his subject, explains itself:-- "What brought you to prison, my colored friend?" "Two constables, sah." "Yes; but I mean, had intemperance anything to do with it?" "Yes, sah; dey wuz bofe uv 'em drunk, sah." * * * * * _Humble Pie._--The humble pie of former times was a pie made out of the "umbles" or entrails of the deer; a dish of the second table, inferior, of course, to the venison pastry which smoked upon the dais, and therefore not inexpressive of that humiliation which the term "eating humble pie" now painfully describes. The "umbles" of the deer are usually the perquisites of the gamekeeper. * * * * * _Increase of Insanity._--Insanity in England is rapidly increasing. In 1861, when the population was 19,860,701, there were 36,702 lunatics, being nineteen in every ten thousand persons. In 1871, with a population of 22,704,108, there were 56,735 lunatics, or twenty-five out of every ten thousand persons. Of these lunatics 6,110 were private patients. * * * * * _Error of Diagnosis._--"Doctor," said a hard-looking, brandy-faced customer a few days ago to a physician! "Doctor, I'm troubled with an oppression and uneasiness about the breast. What do you suppose the matter is?" "All very easily accounted for," said the physician; "you have water on the chest." "Water! Come, that'll do very well for a joke; but how could I get water on my chest when I haven't touched a drop in twenty years? If you had said brandy, you might have hit it." * * * * * _Ferocity of a Wasp._--A lady at Grantham observed a wasp tearing a common fly to pieces on the breakfast table. When first noticed the wasp grasped the fly firmly, and had cut off a leg and a wing, so that its rescue would have been no kindness. The wasp was covered with a basin until it should receive a murderer's doom; and when the basin was removed for its execution, nothing was seen of the fly but the wings and a number of little black pieces. * * * * * Madame Regina Dal Cin, a famous surgeon of Austria, having performed one hundred and fifty successful operations in the city hospital at Trieste, was rewarded by the municipal authorities with a letter of thanks and a purse of gold. * * * * * _A Cool Student._--In the Quartier Latin, Paris, a student was lying in bed, to which he had gone supperless, trying to devise some means to raise the wind; suddenly, in the dead of night, his reveries were disturbed by a "click." Stealthily raising himself in bed, he saw a burglar endeavoring to open his desk with skeleton keys. The student burst into fits of laughter; the frightened thief, astounded, inquired the cause of his glee. "Why, I am laughing to see you take so much trouble to force open my desk and pick the lock to find the money which I cannot find though I have the key." The thief picked up his implements, politely expressed his regret for having uselessly disturbed him, and transferred his talents and implements to some more Californian quarter. [Illustration: THE BURGLAR AND STUDENT.] * * * * * _How to get rid of a Mother-in-Law._--During the recent small-pox excitement in Indianapolis, an excited individual rushed into a telegraph office, hurriedly wrote a despatch, and handed the same to the able and talented clerk. The message bore the startling intelligence that the sender's wife was down with the small-pox, and closed with the request that his mother-in-law come "immediately." While making change, the telegraph man said, "My friend, are you not afraid your mother-in-law will take the small-pox?" Without vouchsafing an immediate reply to the query, the dutiful son-in-law remarked, "Sir, are you a married man?" "No, sir, I am not." "Then, sir, take my word for it, it's all right. Just bring the old woman along." * * * * * _A Dying Request._--A kind physician living near Boston, wishing to smooth the last hours of a poor woman whom he was attending, asked her if there was anything he could do for her before she died. The poor soul, looking up, replied, "Doctor, I have always thought I should like to have a glass butter-dish before I died." [Illustration] XXVIII. BLEEDERS AND BUTCHERS. "Three special months, September, April, May, There are in which 'tis good to ope a vein: In these three months the moon bears greatest sway; Then old or young that store of blood contain. September, April, May, have daies apiece That bleeding do forbid, _and eating geese_." BLEEDING IN 1872.--EARLIEST BLOOD-LETTERS.--A ROYAL SURGEON.--A DRAWING JOKE.--THE PRETTY COQUETTE.--TINKERS AS BLEEDERS.--WHOLESALE BUTCHERY.--THE BARBERS OF SOUTH AMERICA.--OUR FOREFATHERS BLEED.--A FRENCH BUTCHER.--CUR?--ABERNETHY OPPOSES BLOOD-LETTING.--THE MISFORTUNES OF A BARBER-SURGEON (THREE SCENES FROM DOUGLAS JERROLD) JOB PIPPINS AND THE WAGONER; JOB AND THE HIGHWAYMEN; JOB NAKED AND JOB DRESSED. When, in the year of our Lord 1872, a full half dozen educated physicians meet around the dying bed of a _Rich_ man in this city to quarrel over him, and in the absence of one branch of the faction, the other assume charge of the patient, whom they _bleed_ and leave _in articulo mortis_, it is not too late to take up the subject of venesection. Podalirius is supposed to have been the first man who employed blood-letting, since whose time the lancet is said to have slain more than the sword; and, notwithstanding the many lives that have been sacrificed to this bloody absurdity, it is still practised by those who claim to have all science and wisdom for its sanction. It is useless to bring one learned man's opinion against it, because another's can be found equally wise to offset him: the great public has condemned the practice. It early fell into disrepute with the more refined, notwithstanding some kings took to bleeding as naturally as butchers. A ROYAL SURGEON. A gentleman who was about retiring, after having dined with a friend at St. James's, fell down a flight of stairs, which fall completely stunned him. On his recovery he found himself sitting on the floor, while a little old gentleman was busily attending to his wants, washing the blood from his head, and sticking a piece of plaster on to some variegated cuts for which he could not account. His surprise kept him silent till the kind and very convenient surgeon was through with the operation, when the patient arose from the floor, limped forward with extended hand, to offer his profound thanks, if not fees, to his benefactor, when an attendant instantly checked him with such intimation as to further astonish the gentleman by the knowledge that for his kind assistance he was indebted to George II., King of England.--_Percy's Anecdotes._ [Illustration: ASSISTANCE FROM A ROYAL SURGEON.] A DRAWING JOKE. Several kings and great lords are made mention of as being particularly fond of using the lancet. Peter the Great of Russia was remarkably fond of witnessing dissections and surgical operations. He even used to carry a case of instruments in his pocket. He often visited the hospitals to witness capital operations, at times assisting in person, and was able to dissect properly, to bleed a patient, and extract a tooth as well as one of the faculty. [Illustration: PETER THE GREAT AS A SURGEON.] The pretty wife of one of the czar's valets had the following unpleasant experience of his skill. The husband of the "maid" accused her of flirting, and vowed revenge. The czar noticed the valet seated in the ante-room, looking forlorn, and asked the cause of his dejection. The wicked valet replied that his wife had a tooth which gave her great pain, keeping them both awake day and night, but would not have it drawn. "Send her to me," said the czar. The woman was brought, but persisted in affirming that her teeth were sound, and never ached. The valet alleged that this was always the way she did when the physician was called; therefore, in spite of her cries and remonstrances, the king ordered her husband to hold her head between his knees, when the czar drew out his instruments and instantly extracted the tooth designated by the husband, disregarding the cries of the unfortunate victim. In a few days the czar was informed that the thing was a put-up job by the jealous husband, in order to punish, if not mar the beauty of, his gallant wife, whereupon the instruments were again brought into requisition; and this time the naughty valet was the sufferer, to the extent of losing a sound and valuable tooth. EVERY TINKER HAS HIS DAY. During a long period, and in several countries, the barbers were the only acknowledged blood-letters. Some of them were educated to the trade of bleeding. Dr. Meade was once lecturer to the barber-surgeons, and, if I mistake not, Dr. Abernethy; but the majority of them were as ignorant as the tinkers, who also went about the country bleeding the people at both vein and pocket. In 1592 one Nicolas Gyer published a work entitled "The English Phlebotomy, or Method of Healing by Letting of Blood." Its motto was, "The horse-leech hath two daughters, which crye, '_Give, give_.'" The author thus complains: "Phlebotomy is greatly abused by vagabond horse-leeches and travelling tinkers, who find work in almost every village, who have, in truth, neither knowledge, wit, or honesty; hence the sober practitioner and cunning chirurgeon liveth basely, is despised, and counted a very abject amongst the vulgar sort." Many of the abbeys of Europe and Asia had a "phlebotomaria," or bleeding-room, connected, in which the sacred (?) inmates underwent bleeding at certain seasons. The monks of the order of St. Victor, and others, underwent five venesections per year; for the "Salerne Schoole," 1601, says,-- "To bleed doth cheare the pensive, and remove _The raging furies fed by burning love_." The priests seem to have overlooked Paul's advice, for such to marry, as it was "better to marry than to burn." If the writer could unfold the secrets of his "prison-house,"--as doubtless is the experience of most physicians,--he could tell of worse habits of some modern priests than this quinarial venesection. "To bleed in May is still the custom with ignorant people in a few remote districts" of England. In Marchland a woman used to bleed patients for a few pence per arm. Steele tells of a bleeder of his time who advertised to bleed, at certain hours, "all who came, for three pence a head"--he meant arm, doubtless! Mention is made of the Drs. Taylor (horse doctors), who drew blood from the rabble as they would claret from a pipe. "Every Sunday morning they bled _gratis_ all who liked a prick from their lancets. On such occasions a hundred poor wretches could be seen seated on the long benches of the surgery, waiting venesection. When ready, the two brothers would pass rapidly along the lines of bared arms, one applying the white strip of cloth above the elbow, the other following and immediately opening the vein. The crimson stream was directed into a wooden trough that ran along in front of the seats where the operation was performed." It scarcely seems possible that such wholesale butchery could have been openly performed but a hundred years ago! Yet it is still practised, but with a little more decency. In South America venesection is still performed by the barbers, who are nearly all natives. "A surgeon in Ecuador would consider it an injury to his dignity to bleed a patient; so he deputes that duty to the Indian phlebotomist, who does the work in a most barbarous manner, with a blunt and jagged instrument, after causing considerable pain, and even danger, to the patient. "These barbers and bleeders are considered to be the leaders of their _caste_, as from their ranks are drawn the native _alcaldes_, or magistrates; and so proud are they of their position, that they would not exchange their badge of office (a silver-headed cane) for the cross of a bishop. "The most prominent figures at the Easter celebration are the barbers, who are almost always Indians. They dress in a kind of plaited cape, and wear collars of a ridiculous height, and starched to an extreme degree of stiffness. In this class are also to be found the _sangradores_, or bleeders, who, as of old, unite the two professions." A curious scene is presented during each successive day of the "Holy Week," when the effigies of the titular saints are brought out, and with the priests, music, and banners, and the barbers to bear burning incense, they are paraded before the superstitious, gaping, and priest-ridden people. BLEEDING OUR FOREFATHERS. Dr. Fuller, the first physician amongst the colonists of New England, wrote to Governor Bradford, June, 1630, saying,-- "I have been to Matapan (now Dorchester), and let some twenty of those people's blood." What disease demanded, in the estimation of the good and wise doctor, this seemingly bloody visit, we are not informed. "The _Mercure de France_, April, 1728, and December, 1729, gives an account of a French woman, the wife of a hussar named Gignoult, whom, under the direction of Monsieur Theveneau, Dr. Palmery bled _three thousand nine hundred and four times_, and that within the space of nine months. Again the bleeding was renewed, and in the course of a few years, from 1726 to the end of 1729, she had been bled twenty-six thousand two hundred and thirty times." No wonder our informant asks, "Did this really occur? Or was the editor of the _Mercure_ the original Baron Munchausen?" "Once, in the Duchy of Wurtemberg, the public executioner, after having sent a certain number of his fellow-creatures out of this troublesome world, was dignified by the title of 'Doctor.' Would it not be well to reverse the thing, and make such murderous physicians as Theveneau and M. Palmery rank as hangmen-extraordinary?" A FRENCH BUTCHER-SURGEON. But, then, some of those French surgeons are worse than hangmen. Dr. Mott, when once in Paris, was invited by M. ---- to witness a private operation, which was simply the removal of a tumor from the neck of an elderly gentleman. "Dr. Mott informed me," says Dr. S. Francis, "that never in his life had he seen anybody but a _butcher_ cut and slash as did this French surgeon. He cut the jugular vein. Dr. Mott instantly compressed it. In a moment more he severed it again. By this time, the patient being feeble, and having, by these two successive accidents, lost much blood, a portion of the tumor was cut off, the hole plugged up by lint, and the patient left." A week after, Dr. M. met the surgeon, and inquired after the patient. "O, _oui_," said the butcher, shrugging his shoulders. "Poor old fellow! He grew pious, and suddenly died." And this was by one of the first surgeons of France, on the authority of Dr. Valentine Mott. Cases are cited in Paget's "Surgical Pathology," of tumors being removed by the knife from four to nine times, and returning, proving fatal, in every instance. CUR? Yes, "Why?" A man's strength is in his blood, Samson notwithstanding. Then if you take away his blood, you lessen his chances of recovery, because you have lessened his strength. "_Cum sanguinem detrahere oportet, deliberatione indiget_," said Aretæus, a Greek physician of the first century. ("When bleeding is required, there is need of deliberation.") "_Cur?_" (why) was a favorite inquiry of Dr. Abernethy's. "We recollect a surgeon being called to a gentleman who was taken suddenly ill. The medical attendant, being present, asked the surgeon,-- "'Shall I bleed him at once, sir?' "'_Why_ should you desire to bleed him?' "'O, exactly. You prefer cupping?' "'Why should he be cupped?' "'Then shall I apply some leeches?' "This, too, was declined. In short, it never seemed to have occurred to the physician that neither might be necessary; still less that either might therefore prove mischievous." THE MISFORTUNES OF A BARBER-BLEEDER. Three Scenes from a Story by Douglas Jerrold--rewritten. _Scene 1._--Job Pippins, a handsome Barber, is discharged from Sir Scipio Manikin's, for kissing that gentleman's young and pretty wife. He meets a Scotch wagoner. [Illustration: JOB DISCHARGED BY SIR SCIPIO.] "I say, I ha' got a dead mun in the wagon." "A dead man?" cried Job. "Ay; picked him up i' the muddle o' the road. The bay cob wor standin' loike a lamb beside um. I shall take um to the 'Barley Mow' yonder." (An inn.) [Illustration: "BLEED HIM."] "But stop, for God's sake," exclaimed Job, jumping upon the wagon. Instantly he recognized the features of Sir Scipio. Struck by apoplexy, he had fallen from his horse. Instantly Job tore off Sir Scipio's coat, rolled up his sleeves, bound the arm, and produced a razor. "Ha! what wilt ye do, mun?" cried the wagoner, seeing the razor. "Bleed him," replied Job, with exquisite composure; "I fear his heart is stopped." "Loikely. I do think it be Grinders, the lawyer. Cut um deep, deep;" and the fellow opened wide his eyes to see if the lawyer had red blood or Japan ink in his veins. "Cut um deep; though if it be old Grinders, by what I hear, it be a shame to disturb him, ony way," said the wagoner. "Grinders! Pshaw! It's Sir Scipio Manikin." "Wounds!" roared the scared wagoner. "No, man, no! Don't meddle wi' such gentry folks in my wagon." So saying, he sought to stay the hand of the bleeder at the moment he was applying the sharp blade of the razor to the bared arm, but only succeeded in driving the instrument deep into the limb. Job turned pale. The wagoner groaned and trembled. "We shall be hanged for this job--hanged, hanged!" "Providentially," as the knight afterwards affirmed, the landlord of the "Barley Mow," in chastising his wife, had broken his leg, and had called in Dr. Saffron, who, now returning, came upon the wagon containing the bulky body of Sir Scipio, mangled and bleeding. The apoplectic squire began to return to dim consciousness, and beholding Job, with a razor between his teeth, standing over him, timing his pulse, he gave an involuntary shudder, particularly as he now recalled the late scene, which had terminated in his kicking Job penniless into the highway. Dr. Saffron took the wounded arm, looked at Job, and said,-- "Is this your doings?" Job looked, "Yes," but spoke not. "Bleeding!" repeated the doctor, fiercely; "I call it capital carving." Then turning to the wagoner, he said, "And you found Sir Scipio lying in the road?" "Ay, sir; rolled up like a hedge pig," replied the wagoner. Job wiped his razor, and slipped silently away. * * * * * _Scene 2._--Job, half starved and half dead from the fatigues of his long walk, finds his way into an old woman's hut, which unfortunately is the rendezvous of three highwaymen. "Moll, the stool," said one of the men. The stool ordered was thrown towards Job, who sank resignedly upon it. "What's o'clock?" asked Bats, one of the robbers. [Illustration: A BORROWED WATCH.] Job leaped from the stool in amazement, clapped his hand to his waistcoat pocket, and drew forth a splendid gold watch, the late property of Sir Scipio. Job had merely borrowed it to time the pulse of the apoplectic knight, and forgot to return it. The eyes of the highwayman were fixed leeringly upon the chronometer. They gave no heed to the embarrassment of the possessor. "I say, friend, time must be worth something to you to score it by such a watch." "It isn't mine," cried Job, the perspiration starting from every pore of his body. "Ha, ha, ha!" laughed the three at this unnecessary information. "A mistake; I got it in the oddest way." "Ha, ha, ha!" again roared his hearers in chorus. "O Lord! I shall be hanged for this," cried Job. "In course you will," said Mortlake, comfortingly. Job now hastily felt in his other pockets to see if he unwittingly possessed any other property not his own, when he pulled out a large handkerchief well saturated with Sir Scipio's blood. Mortlake gave an expressive cluck. Bats uttered a low, accusing whistle. "What! he was game--was he? Well, it is all over now; tell us how it happened, and what you did with the body," said the third. In vain Job persisted in the truth. He was only laughed at.... "Moll, the gin." Such a gamy highwayman as Job presented evidence of being deserves to be treated! Let us see in the next scene _how_ he was treated. * * * * * _Scene 3._--Job was drank dead drunk. Stripped of not only Sir Manikin's watch and chain, but of everything save one brief garment, and under cover of night deposited in an adjoining meadow. "Job Pippins slept." "Job Pippins awoke." An insect ticked its little note in Job's ear. "The watch!" cried the bewildered Job, springing to his feet and gaspingly applying his hands to his flesh. Who can depict his utter amazement when he had become convinced of his own identity, and found himself standing out in the broad world, reduced to the brief wardrobe, which is summed up in the one single word--"SHIRT"? Hatless, shoeless, hoseless, he stood upon the grass, the bold zephyrs playing with his garment--a bloody, tattered flag of terrible distress. Job looked timidly about. He resolved, and he re-resolved. Should he turn back to the house from whence he had been so ruthlessly ejected? Should he hide behind the hedge and solicit the help of some male passer? Who would put faith in a man with no recommendation, and possessing such a small wardrobe? O, indecision! how many better men have gone to ruin because of thee! [Illustration: JOB'S DECISION.] Decision came to Job's help--at least help out of that field. At this very moment of need for some one to help him decide what course to pursue, a ferocious bull, feeding in the next meadow, annoyed or scandalized by the appearance of Job, scaled the low fence, and with one bellow, ran full tilt after Job, who hesitated no longer, but leaped the rail fence just as the animal made a lunge at him. Job reached the highway in safety of person, though the bull retreated with a full square yard of the false flag of truce upon his horns. Job's destitution seemed perfect without this last affliction. The sound of carriage wheels startled him, but to where should he flee? He was at the zero of his fortunes. He was naked, hungry, penniless. Where should he find one friend. "Ah! the river!" That would hide him forever from the uncharitable world!... Job crawled across the field, and was already near the stream. What! Had some pitying angel, softened by Job's utter destitution and despair, alighted amongst the bushes! Or was it a temptation of the devil? Reader, "put yourself in"--No! But imagine Job reduced to the moiety of a shirt, about to take the fatal plunge, when lo! he discovers just before him, lying,--a golden waif,--a very handsome suit of clothes,--hat, breeches, hose, shoes, gloves, cane, cravat! and no visible second person near. Job's perplexity was brief. He seated himself on the grass. He changed his equivocal shirt for the ample piece of ruffled "aired-snow" in the twinkling of an eye; donned the stockings and breeches,--"just a fit,"--waistcoat, and coat, seized the hat, gloves, cravat, and cane, and in three minutes he was back on the main road. The swimmer must have been just Job's size, so admirably did the whole wardrobe fit and become him. Again Job passed the five-barred gate, where stood the bull, with glaring eyes, waving in vain the flag of truce upon his horns. Job journeyed onward, waving his cane, and smiling in supreme contempt at the bit of rag which so recently proclaimed his crime and wretchedness. He put his hand into _his_ pocket, and pulled out a _purse_! It contained eight guineas! This was too much. Job fell upon his knees in the highway, overcome with gratitude, and holding up the purse in his left hand, placing the other over his stomach, he "blessed his lucky stars" for his propitious change of fortunes. Here we bid adieu to the barber-bleeders. Those who wish to know how the swimmer came out, must consult "Men of Character," by Jerrold. THE USE OF BRAINS. Mr. G. H. Lewes tells a story of a gentleman who, under the scissors, said something about his thinning locks being caused by the development of his brains. "Excuse me, sir," remarked the barber, "but you are laboring under a mistake. The brains permeate the skull, and encourage the growth of the hair--_that's what they're for, sir_." [Illustration] XXIX. THE OMNIUM GATHERUM. EX-SELL-SIR!--"THE OBJECT TO BE ATTAINED."--A NOTORIOUS FEMALE DOCTOR.--A WHITE BLACK MAN.--SQUASHY.--MOTHER'S FOOL.--WHO IT WAS.--THE PHILOSOPHER AND HIS DAUGHTER.--EDUCATION AND GIBBERISH.--SCOTTISH HOSPITALITY.--THE OLD LADY WITH AN ANIMAL IN HER STOMACH.--STORIES ABOUT LITTLE FOLKS.--THE BOY WITH A BULLET IN HIM.--CASE OF SMALL-POX.--NOT MUCH TO LOOK AT.--FUNERAL ANTHEMS. EX-SELL-SIR. The morning sun was shining bright, As lone upon old Georgetown's height, A Bliss-ful doctor, clad in brown, Desiring wealth and great renown, Displayed aloft to wondering eyes A shrub which bore this strange device, Cundurango! A maiden fair, with pallid cheek, With ardent haste his aid did seek To stay the progress and the pain Of carcinoma of the brain; While still aloft the shrub he bore, The answer came, with windy roar, To Cundurango! A matron old, with long unrest From carcinoma of the breast, This Bliss-ful doctor rushed to see, And begged his aid on bended knee. The magic shrub waved still on high, And rushed through air the well-known cry, Try Cundurango! The evening sun went down in red-- The maid and matron both were dead; And yet, through all the realms around, This worthless shrub, of mighty sound, Will serve to fill the purse forlorn, And the cancer succumb "in a horn" To Cundurango. THE OBJECT TO BE ATTAINED. A doctor was called in to see a patient whose native land was Ireland, and whose native drink was whiskey. Water was prescribed as the only cure. Pat said it was out of the question; he could never drink it. Then milk was proposed, and Pat agreed to get well on milk. The doctor was soon summoned again. Near the bed on which the sick man lay was a table, and on the table a large bowl, and in the bowl was milk, but strongly flavored with whiskey. "What have you here?" said the doctor. "Milk, doctor; just what you orthered." "But there's whiskey in it; I smell it." "Well, doctor," sighed the patient, "there may be whiskey in it, but milk is my object." THE LAUGH WINS. An old lady reduced in circumstances applied to a physician to know if she might conscientiously sell some quack pills. The physician rather recommended that she should sell some pills made of bread, observing that, if they did no good, they would certainly do no harm. The old lady commenced business, and performed many cures with her pills, till at last she had great confidence in them. At length the physician, whom she called her benefactor, became ill by a bone sticking in his throat, which he could not pass up or down. In this situation the old lady visited him, and recommended her pills in his own language. The physician, upon this expression, burst out laughing, and in the act of laughing brought up the bone. A NOTORIOUS FEMALE DOCTOR. WASHINGTON, January 10, 1872. From an account of the "Women's National Suffrage Association," reported to the Press, I cut the following description of a noted female doctress who dresses in a garb as near to a man's as the cramped laws of the land will admit. "Ten minutes after the opening ... a curly, crinkly feminine, in very large walking boots, came to the front, being followed, after a brief pause, by the rest of the sisters. This lady was new, even to the reporters, and one of them, handing up a pencilled inquiry to Mrs. Dr. Walker, was informed that she was 'Mrs. Ricker, a beautiful, charming, and good widow, fair, forty, and rich.' This bit of interesting news started on its travels. * * * * * "The doctor, who has the usual manly proclivity for hugging the girls, threw her arms around a pretty and modest-looking girl standing by, and enthusiastically shouted, "You are a dear, sweet little creature." The frightened young woman drew hastily back, and faltered out that she was not in the habit of being hugged by men. This turned the laugh on the doctor; but she gained her lost ground by quickly replying to the inquiry of the secretary as to what place he should put her down from as a delegate, to put her down "from all the world;" but he objected, anxious for the completeness of his roster. "You must have a local habitation, you know." "Put me down from Washington, then, for that is the home of everybody who has none other." Unmindful of the eloquent protest of her coat and pantaloons against feminine distinctions, he wrote her down as "Mrs. Mary Walker;" but seizing the pencil from his fingers, she spitefully erased the "Mrs." and wrote "Doctor." "I never was Mrs.; I never will be." A WHITE MAN TURNING BLACK. The San Francisco Examiner says a gentleman of that city, about twenty-five years of age, ruddy complexion, curly red hair, who had an intractable and painful ulcer on the left arm, resisting all previous modes of treatment, yielded to the request of trying the effect of transplanting a piece of skin to the ulcer from another person. The ulcer was prepared in the usual manner by his physician, and a bit of skin, about an inch square, was taken from the arm of a fine healthy negro man and immediately spread over the ugly ulcer, and then carefully dressed and bandaged. The skin transplantation had the desired effect. Healthy granulation sprang up, and the unsightly ulcer soon healed. A few months afterwards he went to his physician and told him that ever since the sore healed the black skin commenced to spread, and it was increasing. About one third of his arm was completely negroed. The doctor himself was alarmed. The high probability is, that the whole skin of this white man will become negro. * * * * * An officer had a wooden leg so exceedingly well made that it could scarcely be distinguished from a real one. A cannon ball carried it off. A soldier who saw him fall called out, "Quick, run for the surgeon." "No," replied the officer, coolly; "it is the joiner I want." "SQUASHY." Squashy was a contraband. He came from North Carolina. He was looking about Washington for "a new masser," when Dr. ----, of ---- regiment C. V., took him for a body servant. [Illustration: SQUASHY'S SURGICAL OPERATION ON THE DOCTOR.] The doctor was out on horseback at parade that very day, and the most that Squashy had as yet learned of his master was, that he was handsome. "Dat's him! Dar's my new masser! see um! see um! ridin' on hoss-back, dar!" exclaimed the contraband to a host of other negroes watching the parade. That night, when the doctor returned to his quarters, Squashy came to assist in removing some of the superfluous and dirt-covered garments of his new master, amongst which were his heavy and mud-splashed boots. The doctor was a joker. "Now, what's your name, boy?" "Squashy, sar; dat's what dey called me, sar," replied the contraband, showing a gorgeous row of ivories, and the whites of two great, globular eyes. "Well, Squashy,--that's a very appropriate name,--just pull off these boots. Left one first. There--pull! hard! harder!--There she comes! Now the other; now pull; it always comes the hardest; pull strong--stronger--now it's coming--O, murder! you've pulled my whole leg out!" Sure enough, the boot, leg and all, came off at the thigh, and slap! crash! bang! over backwards, over a camp-stool, on to the floor, went Squashy, with the boot and wooden leg of the doctor grasped tightly in his brawny hands. "O, de Lord!" cried Squashy, rising. "I didn't go for to do it! O, Lord, see um bleed!" he continued, as in the uncertain light he saw a bit of red flannel round the stump; and, dropping the leg, he turned, and with a look of the utmost terror depicted on his countenance, he fled from the apartment. On the following day the doctor made diligent inquiry for Squashy; but he never was found, and probably to this day thinks he pulled out the leg of his "new and hansum masser." * * * * * We do not know who wrote the following which is too good to be lost; hence we give it anonymously. MOTHER'S FOOL. "'Tis plain enough to see," said a farmer's wife, "These boys will make their marks in life; They never were made to handle a hoe, And at once to college ought to go. There's Fred, he's little better than a fool, But John and Henry must go to school." "Well, really, wife," quoth farmer Brown, As he set his mug of cider down, "Fred does more work in a day for me Than both his brothers do in three. Book larnin' will never plant one's corn, Nor hoe potatoes, sure's you're born, Nor mend a rod of broken fence: For my part, give me common sense." But his wife was bound the roost to rule, And John and Henry were sent to school, While Fred, of course, was left behind, Because his mother said he had no mind. Five years at school the students spent, Then into business each one went. John learned to play the flute and fiddle, And parted his hair, of course, in the middle, While his brother looked rather higher than he, And hung out a sign, "H. Brown, M. D." Meanwhile, at home, their brother Fred Had taken a notion into his head; But he quietly trimmed his apple trees, Milked the cows and hived the bees; While somehow, either by hook or crook, He managed to read full many a book, Until at last his father said He was getting "book larnin'" into his head; "But for all that," added farmer Brown, "He's the smartest boy there is in town." The war broke out, and Captain Fred A hundred men to battle led, And, when the rebel flag came down, Went marching home as General Brown. But he went to work on the farm again, And planted corn and sowed his grain; He shingled the barn and mended the fence, Till people declared he had common sense. Now common sense was very rare, And the State House needed a portion there; So the "family dunce" moved into town, The people called him Governor Brown; And his brothers, who went to the city school, Came home to live with "mother's fool." WHO IT WAS. There is an anecdote told of Dr. Emmons, one of the most able of New England divines, meeting a Pantheistical physician at the house of a sick parishioner. It was no place for a dispute. It was no place for any unbecoming familiarity with the minister. It was no place for a physician to inquire into the age of the minister, especially with any intent of entangling him in a debate; and, above all, where the querist was too visionary for any logical discussion. But the abrupt question of the Pantheist was, "Mr. Emmons, how old are you?" "Sixty, sir; and how old are you?" came the quick reply. "As old as creation, sir," was the triumphant response. "Then you are of the same age with Adam and Eve." "Certainly; I was in the garden when they were." "I have always heard that there was a third party in the garden with them, but I never knew before that it was you." A HEAVY DOCTOR. Dr. Stone, of Savannah, walked into the river at Savannah, and, like other stones, was about to sink, when he was romantically rescued by a brave lady. SCOTTISH HOSPITALITY. The Scotch people--even the females--are great smokers, and female tobacco-users are not considered the embodiment of neatness. [Illustration: "WILL YE TAK' A BLAST NOO?"] The Countess of A., with a laudable desire to promote tidiness in the various cottages on her estate, used to visit them periodically, and exhort the inmates to cleanliness. One cottage was always found especially untidy; and getting, perhaps, the least out of patience, the countess took up a brush-broom, and having by its dexterous use made the room much improved, she turned to the housewife, who, with pipe between her lips, had been sitting on a stool, with body bent forward, her elbows on her knees, and her chin resting in the palms of her hands, watching the proceeding. The Countess said,-- "There, my good woman, is it not much better?" "Ay, my leddy," said the woman, nodding her head, and rising, she stepped towards the countess, drew the pipe from her mouth, and wiping it with her brawny palm, presented it, saying,-- "An' will ye tak' a blast noo, my leddy?" ANIMALS IN THE STOMACH. Most physicians scout the idea of terrestrial animals or reptiles living in one's stomach. The wife of Captain Hodgden, of Mount Desert, presented the writer with a singular looking reptile some three inches in length, looking not unlike an earwig, excepting having two horns on its head, which animal she said crawled from her mouth the night previous. She declared for years that there was a live animal in her stomach, and attributed its dislodgment to the use of some bitters (Chelone glabra). A nice old lady called at our office one day, some years ago, during my absence, and informed Dr. Colley, who was attending my patients temporarily, that she had a live animal in her stomach. The doctor tells the story as follows:-- "'Now don't you laugh at me, doctor, 'cause all the doctors do, and I know it ain't no whim nor notion I've got in my _head_, but a real live animal I've got into my stomach,' she said. "I looked at the good old lady, and could not find it in my heart to tell her she was laboring under a delusion, therefore I replied, very sympathetically,-- [Illustration: REPTILES FROM THE STOMACH.] "'O, no doubt you are right, and all the doctors have been wrong. Why, just sit quiet a moment, and I will show you a whole bottle full that the doctor has from time to time taken from the stomachs of patients.' So saying, I went into the laboratory, and got down a bottle of centipedes, lizards, and a big, black, southern horn-bug, which the doctor's brother had collected in the South, and, dusting off the bottle, took it to the old lady, who sat comfortably in a rocking-chair, taking snuff, and nervously humming a little pennyroyal tune. "'There, madam--there is a host of various kinds of reptiles, which the doctor has compelled to abandon the living stomach.' "'Du tell,' she exclaimed, readjusting her glasses, 'if them all come out of folks' stomachs! Let me take the bottle.' "'I suppose they really did, marm.' "'And the big black one; who did that come out of?' she asked, turning the bottle around to get a view of the ugly monster--horns two inches long! "'O, let me see. That came out of a colored man--awful appetite, madam.' "'Du tell! Well, I'm much obleeged to you for showing them to me. Now I'll go right home, and pitch into them doctors. I knowed they're all wrong.' And so saying, the old lady arose, buzzed round and round like a bee in a bottle, got her reticule, and started for the door. "'O, I forgot,' she exclaimed, coming back. 'Give me some of the medicine to get this animal out of my system, doctor.' "I gave her a quantity of gentian, told her to use no snuff for two months, and she would have no further trouble with the animal; that she must not expect to see him, as they seldom came away whole, like those in the bottle. She promised, with a sigh, and a sorry look at the snuff-box, and went away. I have no doubt _but I did the best thing possible for her case_." STORIES ABOUT LITTLE FOLKS. As ludicrous as the above may seem, it is true; but we cannot vouch for the truth of the following story:-- * * * * * _The Boy with a Bullet in him._--A lad swallowed a small bullet. His friends were very much alarmed about it; and his father thinking no pains should be spared to save his darling boy's life, sent post haste to a surgeon of skill, directing the messenger to tell the circumstances and urge his coming without delay. The doctor was found, heard the dismal tale, and with as much unconcern as he would manifest in a case of common headache, wrote the following laconic reply:-- SIR: Don't alarm yourself. If after three weeks the bullet is not removed, give the boy a charge of powder. Yours, &c., ---- P. S. _Do not aim the boy at anybody._--M. D. * * * * * [Illustration: "IT ISN'T CATCHIN'."] _Case of Small-pox._--A lady school teacher in Omaha, having an inordinate dread of the small-pox, sent home a little girl because she said her mother was sick and had marks on her face. The next day the girl presented herself at the school-house, with her finger in her mouth, and her little bonnet swinging by the strings, and said to the teacher,-- "Miss ----, we've got a baby at our house; but mother told me to tell you that 'it isn't catchin'.'" * * * * * "_Not much to look at._"--The late eminent Dr. Wallaston was introduced, at an evening party, to a rather pert young lady. "O, doctor," she said, "I am delighted to meet you; I have so long wished to see you." "Well," said the man of science, "and pray what do you think of me now you have seen me?" "You may be very clever," was the answer, "_but you are nothing to look at_." * * * * * [Illustration: FUNERAL OF THE CANARY.] _Funeral Anthems._--Reading in a western paper that at funerals out in Terre Haute they closed the solemn ceremony by singing very impressively "_The Ham-fat Man_," reminds me of the following, which actually occurred at Portsmouth, N. H., last year:-- Three little girls, who had carefully and tenderly buried a pet canary-bird in the garden, were seen holding a consultation, which terminated by sending one of the trio into the house, with the inquiry, "Do they sing at funerals?" Being answered in the affirmative, the little messenger ran back, and in a few moments the three were observed standing, hand in hand, around the little mound gravely singing,-- "_Shoo, fly! don't bodder me._" [Illustration] XXX. THE OTHER SIDE. It's a very good rule in all things of life, When judging a friend or brother, Not to look at the question alone on one side, But always to turn to the other. We are apt to be selfish in all our views, In the jostling, headlong race, And so, to be right, ere you censure a man, Just "put yourself in his place."--ANON. PUT YOURSELF IN HIS PLACE.--STEALING FROM THE PROFESSION.--ANECDOTE OF RUFUS CHOATE.--INGRATES.--A NIGHT ROW.--"SAVING AT THE SPIGOT AND WASTING AT THE BUNG."--SHOPPING PATIENTS.--AN AFFECTIONATE WIFE.--RUM AND TOBACCO PATIENTS.--THE PHYSICIAN'S WIDOW AND ORPHANS, THE SUMMONS, THE TENEMENT, THE INVALIDS, HOW THEY LIVED, HER HISTORY, THE UNNATURAL FATHER, HOW THEY DIED, THE END.--A PETER-FUNK DOCTOR.--SELLING OUT. While I trust that respectable, educated physicians will take no offence at the _exposé_ in the foregoing chapters, as nothing therein is _intended_ to lessen them in public opinion, or detract from the merit of the TRUE PHYSICIAN of any school, I cannot leave the subject without presenting some facts to show that the people are not blameless in creating and maintaining so many humbugs and impositions, to the damage and scandal of respectable practitioners and legitimate medicine. STEALING FROM THE PROFESSION. I need not tell men of any profession, that there are those, even in the respectable walks of life, who will watch their opportunity to button-hole the lawyer or the doctor, in the public streets, to "just ask him a question," rather than call at his office, where a fee would certainly be a just compensation for the expected advice. One of these highway robbers once overtook Mr. Choate, the great Boston lawyer, on a public street, and asked him if he should sue Mr. Jones, so and so, briefly stating his case, if he, the lawyer, thought he, Smith, would win the suit. "O, yes," replied the great lawyer; and Smith went on his way rejoicing. The case went to trial, Smith _vs._ Jones. Smith employed a cheap pettifogger. Jones employed Mr. Choate to defend him, and gained the suit. "Didn't you tell me I had a good case?" demanded the irascible plaintiff of Mr. Choate, when he found that the case had gone against him. "Well, I think you did say something to me about it," replied Mr. Choate, very indifferently. "Yes, and didn't you advise me to sue him?" cried the infuriated Smith. "Let me see, Mr. Smith: how much did you pay me for that advice?" "Nothing, sir! nothing!" roared Smith. "Well, that was all it was worth," remarked Mr. Choate, quietly. Another of these free advice fellows detained the author at the post-office last week, and very patronizingly asked,-- "What would you take for a code id de ed, docdor?" "Take? take two pocket handkerchiefs," was the cheap prescription for a cheap patient. INGRATES. "What, then! doth Charity fail? Is Faith of no avail? Is Hope blown out like a light By a gust of wind in the night? The clashing of creeds, and the strife Of the many beliefs, that in vain Perplex man's heart and brain, Are nought but the rustle of leaves, When the breath of God upheaves The boughs of the Tree of Life, And they subside again! And I remember still The words, and from whom they came, Not he that repeateth the name, But he that doeth the will!" "Of all men, the physician is most likely to discover the leading traits of character in his fellow-beings; on no other condition than that of sickness do they present themselves without those guards upon the countenance and tongue that an artificial mode of life has rendered almost indispensable to their existence; in city life, more especially." "The confiding patient often hangs, as it were, with an oppressive weight upon the conscientious physician, and if he be afflicted with a generous, sympathizing soul, farewell to his happiness. His heart will bleed for distress, both bodily and pecuniary, that he cannot alleviate, and he gives up in despair a profession which will so severely tax his nervous system as to render the best medical talent comparatively useless.... "Those who speak of the gratitude of the low Catholic Irish in this (New York) city, or any other city, as they present their true characters to the young practitioner, will find but one opinion,--a more improvident, heartless, and dishonest class of people never defiled the fair face of the earth. They are indeed a bitter curse to the young and humane physician." And this from the pen of one of the most noble and humane physicians of the great metropolis, whose generosity forbids him ever to refuse a visit, day or night, to the distressed, even amongst the lowest of the class he so bitterly condemns. The above is the experience of other physicians besides Dr. Dixon, and in other cities besides New York. During my days of extreme poverty in H., an Irish woman, whose child, suffering with cholera infantum, I snatched from the very jaws of death, cheated me out of my fees, when I afterwards learned that she owned two tenements, and had money in the Savings Bank. While I was practising in H., one cold winter's night, an Irishman came for me to go to Front Street, as a man had fallen down stairs, and was "kilt intirely." "Then it is Mr. Roberts, the undertaker, whom you want," I replied. "O, no, he isn't kilt intirely, but broke his arrum, doctor." Therefore I drew on my boots, took my hat and case, and was soon at the designated number. A drunken row, as usual. It was near midnight, Saturday night. A big, burly fellow lay on the bed in a large front room, surrounded by a dozen men and women, nearly all drunk, except the patient. His arm was dislocated at the shoulder downward. I drew off my coat, jumped upon the bed, set the man up, raised the limb, clapped my knee under the limb, raised the arm, and using it for a lever, the bone snapped into the socket as quickly as I am telling the story. "Ah, that gives me aise; ah, God bless you, docther. How mooch is the damage? Get the wallet, woman, and let me pay the good docther," said the grateful patient. "How mooch? Say it asy, noo." "Two dollars." A very modest fee for such a job at midnight. "O, the divil!" cried the woman. "And is it two dollars for the snap of a job likes to that, noo, ye'll be axin' a poor man?" I made no reply. The man asked for the money. "Will yeze be axin' that much?" asked a six and a half foot Irishman who stood by the opposite side of the bed. "Do you have to pay the bill, sir?" I demanded. "Noo," he replied. "Then mind your own business," I exclaimed, with a clincher, and a flash of the eyes that somehow caused him to cower like the miserable drunken coward he was, amid the laughs and jeers of the bystanders. [Illustration: MY FRONT STREET PATIENT.] "There, take the money," said the woman (boarding mistress). "Dr. B. would come ferninst the railroad over for half of it, he would," she added. "Woman," said I, "when next any of your kind want a doctor, do you go ferninst the railroad for Dr. B." (I knew she lied), "and get him for a dollar. As for me, _I never, for love or money, will come to your call again_." I never heard of money enough to induce me to visit Front or Charles Street after that night, and I have seen some anxious faces looking about for a doctor, in case of emergency, in that locality. "SAVING AT THE SPIGOT, AND WASTING AT THE BUNG." Again, there is a class in every city who, to avoid a physician's fee, go to an apothecary, briefly and imperfectly state their case, perhaps to a green clerk, or a proprietor who is as ignorant of the pathology of the disease as the miserable applicant; and who ever knew of a druggist too ignorant to prescribe for a case over the counter? The result is often the administration of harsh remedies, which aggravate the present, or produce some other disease worse than the original, and in the end the patient is obliged to seek the advice of a physician. Now the patient is ashamed to tell the whole truth, the doctor has yet to learn what drugs are rankling in the system, and the disease is often protracted thereby ten times as long as it need have been, had the man at the outset sought the advice of a respectable physician. This is an every-day occurrence. I knew a young man who recently went into consumption from having a comparatively simple case prolonged by this apotheco-medical interference. SHOPPING PATIENTS. "A queer kind of patients!" you exclaim. Yes, very queer. One class of them go round from office to office, to "just inquire about a friend" (themselves), "if they could be cured," how long it would require, and, ten to one, even ask what medicines "you would give for such a case." Such persons, if females, usually come into the city for the double purpose of seeing a doctor, or a dozen, and shopping,--doing the shopping first; tramping from one end of the city to the other, visiting the doctor last, with bundles and boxes by the score, "in a great hurry; must catch a certain train; all tired out;" making the opportunity for diagnosis an unfavorable one, and not unusually asking the doctor--a stranger, perhaps--to trust them till they come again. [Illustration: A SHOPPING PATIENT.] Whoever "O. SHAW" may be, he knows a thing or two. Hear him. AN AFFECTIONATE WIFE. A poor mechanic, three weeks after marriage, was addressed by his wife thus:-- "Harry, don't you think a new silk dress would become my beauty?" He answered affirmatively, of course, and promised that when his present job was completed, which would be in about a fortnight, the necessary stamps would be forthcoming, and that she might then array her loveliness in the wished-for dress. The affectionate wife kissed him, and thus rewarded his generosity. Three days afterwards the man met with an accident, and was brought home on a shutter, and it was evident that for weeks he would be confined to his bed. On beholding him, his wife gave vent to repeated outbursts of agony, as an affectionate woman should, considering the cause. This touched the unfortunate man, and he said, consolingly,-- "Dry your tears, dear Nettie; I'll be all right again in a few weeks." "Perhaps you may," she answered; "but all your earnings for a long time after you resume work will be required to pay your doctor's bill, and you won't be able to get me _that new silk dress_."--O. SHAW. A SENSIBLE PRESCRIPTION. A doctor up town recently gave the following prescription for a lady: "A new bonnet, a cashmere shawl, and a new pair of gaiter boots." The lady, it is needless to say, has entirely recovered. RUM AND TOBACCO PATIENTS. Then there is a large class,--men, mostly; males, at least,--who, having spent all their substance and much of their health in excess of tobacco-using and whiskey-drinking, apply to the physician for aid, "in charity, for God's sake," as they have nothing with which to pay him, and usually a numerous family dependent upon their miserable labor for sustenance. Woe to the physician who gets a reputation for benevolence at this day and generation of "cheek." "Doctor, I hope you _will_ do something for my distress," said a gentlemanly-dressed individual, not many months ago. "I have but sixteen cents in my pocket, and I owe for four weeks' board, and am out of employment." He was a play actor. Could I say no to so honest a statement of his low state of finance? I treated him faithfully, without a penny. Not many weeks afterwards I knew of his going away and stopping two days at a hotel with a strange woman. Still there are others who are quite able, but who think it no sin to cheat a doctor by misrepresenting their inability to pay. They work upon the sympathies of the benevolent doctor; they "would willingly pay a hundred dollars, if they had it," etc.; and thus slip off without compensating him for his services. Every physician knows that I have not overstated the above. There is also a large class of patients, with whom, like the "old clo' Jew," wisdom, brain work, advice, go for nothing. You must represent their case as perfectly fearful, and do something perfectly awful for them, or you are of no account. Selden, who understood these failings in mankind vastly well, gives them a sly hit in his "Table Talk." If a man had a sore leg, and he should go to an honest, judicious surgeon, and he should only bid him keep it warm, and anoint it with such an oil (an oil well known), that would do the cure, haply he would not much regard him, because he knows the medicine to be an ordinary one. But if he should go to a surgeon that should tell him, "Your leg will gangrene within three days, and it must be cut off; and you will die unless you do something that I could tell you," what listening there would be to this man! "O, for the Lord's sake, tell me what this is; I will give you any content for your pains." THE PHYSICIAN'S WIDOW AND ORPHAN. Scenes from "Practice of a New York Surgeon." I have abridged the following truthful story from the above work, which book I recommend to the perusal of all lovers of moral and entertaining literature. _The Summons._--The experienced physician knows, from the sound of the door bell, whether it is the representative of wealth or penury who is outside at the bell-pull. The doctor opened the door to the _timid_ summons. "Will you please come and see my mother?" asked a little delicate and thinly-dressed girl. "She has been very ill for nearly a year, and I'm afraid she's going to die." The poor little heart was swelling with grief. Almost ashamed as I donned my heavy coat, for the night was bitter cold, and the shivering little girl pattered after me with her well-worn shoes and scanty dress, I hurried along to the abode of poverty. _The Tenement._--The faint rays of a candle issuing from an upper window of one of those wretched wooden buildings, guided us to the invalid's tenement, and as we approached the house the little girl ran ahead of me, and stood shivering in the doorway, while I carefully walked up the rickety steps. Poor as the tenement was, its cleanliness was noticeable, from the fact that it was isolated from the loathsome Irish neighbors, whose superior means and brutal habits allowed them to occupy the lower and more accessible apartments almost in common with the swine which are fed from their very doorsteps. _The Invalid._--A violent paroxysm of coughing had just seized the lady, and I waited some moments before I could observe her features. She had surely seen better days. There were about her and the little apartment evidences of refinement, from her own tidy person to the little sweet rosebush in full bloom, and the faultless white board, and the scanty, though snowy curtains that shaded the attic window, which produced a melancholy effect upon me, which was not lessened when good breeding required me to address my patient. [Illustration: CALL AT THE TENEMENT.] Her countenance had evidently been beautiful; an immense mass of auburn hair, such as Titian loved to paint, yet shaded her brow; the eyes were large and lustrous; the nose was slightly aquiline, the lips thin; and every feature bespoke the woman of a highly refined and intellectual nature. When her gaze met mine for an instant, I felt that pity was misplaced in the emotions which swelled my heart, for the lofty dignity, almost _hauteur_, in that look, would have become an empress in reduced circumstances. "Go, dearest, to your little bed, and close the door, my love," she said, turning to the child. The girl lingered an instant. I stood between the dying mother and her child. I turned aside whilst their lips met in that holy kiss that a dying mother only can give, ay, and a prayer that she alone can breathe. When the little creature had withdrawn, by a narrow door scarcely distinguishable from the rest of the rough, whitewashed boards that divided her little closet from the main room, the mother turned her earnest gaze upon me, and said,-- "I have troubled you, doctor, not with the view of taxing your kindness to any extent, but to ask how long I may yet linger,"--placing her hand on her wasted bosom,--"depending for every service upon that little fragile creature, for whom alone I have, I fear, a selfish desire to live." I could not answer immediately. My heart was too full. I had recognized the dreadful malady at a glance. She was far gone with consumption. "I have a duty to perform, connected with her, that depends upon your answer--one that I have selfishly, alas! too long deferred." * * * * * As I arose to take my departure, she requested me to open the door to the little chamber. I did so, and there lay the poor, pale child, with her clothes unremoved. Merciful God! an infant watching its dying mother, a refined, delicate and intellectual woman, the wife of an educated physician, in a wretched tenement, surrounded by palaces! _How they lived._--O, my God, what a discovery was made on my next visit, the following morning! Then I saw what had before excited my curiosity, viz., the manner in which my patient contrived to support herself and child, for I was quite sure that she would never condescend to beg. [Illustration: THE WIDOW AT WORK.] I had observed, during my visit the previous evening, a very large package, tied up in commercial form, and by its side a large square board. The widow was now sitting up in bed, propped up with some coarse straw pillows, her cheeks burning with hectic, and the square board resting upon a couple of cross-pieces to keep it from her wasted limbs, and she and the child were at work putting up soda and seidlitz powders. Several dozen boxes had been filled during the morning, placed in envelopes, and labelled. "'Tis the lot of humanity to labor," she said, when I had detected her at the task which taxed the last mite of her remaining strength, and I stood horrified looking on; "and why should I be exempt?" she asked, actually smiling gracefully. I removed the board, but allowed the girl to resume her work by the little table near, saying that her remark was applicable only to those able to labor. She assured me that their contracted circumstances had "compelled her to make this exhibition of her industry." _Her History._--Twelve years before, this beautiful and refined lady had left a home of wealth and affluence to share the fortunes of her husband, Dr. ----, who was worthy of all the love that a pure and affectionate woman could bestow. He struggled on manfully and hopefully against misfortune until two years ago.... I had once met her husband. It was under the following circumstances. A child had been run over, and much injured. I was called, but found, on my arrival, that this young doctor had been before me, and done all that was required; but the gentleman whose duty it was said if I would attend the case he would pay all charges, and the young physician, on learning this fact on the next visit, retired in my favor. That evening I called at his office, and insisted upon his accepting one half of the fees which I knew I should receive. He hesitatingly accepted, after much persuasion on my part; and I remember that it was my impression at the time that he was excessively proud. Now, the poor wife informed me that, at the time, their means were entirely exhausted, and when he came home that evening with a large basket of necessaries, and some little delicacies to which they had long been unaccustomed, and upon her expressing her astonishment, he _sat down and wept like a child_. "Great God," he cried, in agony of soul, "why did I take you from your father's house, where you had plenty? What a reward for devoting the flower of life to such a profession! To hear a wife, and the mother of my child, expressing astonishment and joy at the unwonted sight of the very necessaries of life!" It was only when the note-books and manuscripts of this truly meritorious and unfortunate young man fell into my hands, that I discovered what a loss his family and the profession had sustained. He was too proud to ask assistance. Even in his fatal sickness, he continued, until a late period, to decline medical treatment, rather than expose his poverty to his brethren. Finally he became known to Dr. ----, who devoted his time and purse to him until he died. That season Dr. ---- died also. After his death, the lady with her child had removed to these miserable quarters. The needle, and coloring of prints, had sustained them both for a year, when, finding it impossible, with her failing health, to earn a living at that employment, she resumed the one by which her noble husband had been compelled to eke out his miserable income,--putting up seidlitz powders,--in order to sustain them. Often, she told me, had she sat by his side till late in the night reading to him, whilst he plied his fingers industriously at this employment, so utterly repulsive to an intellectual man; and when she would beg him to retire, he would often cheerfully obey the summons to an all-night visit to some wretched and dishonest Irishman--who could not get the service of a more knowing (pecuniarily) physician without an advanced fee--in the remote hope of obtaining a few dollars, which his refinement taught these wretchedly dishonest people they had only to refuse, as they almost invariably do, in order to escape entirely the obligation! This is the gratitude (!) of which we have spoken before. It was whilst attending one of these miserable people that he imbibed the fatal disease which swept him from the earth, and left his poor wife and child to struggle on alone in their cheerless journey. It is needless to say that from the time of the visits of the benevolent physician, the widow wanted for nothing that earth could bestow, to the day of her death, which soon occurred; else she would have died at her task! _The Unnatural Father._--On the fifth day, evening, a man entered my office and inquired for me. He was plainly dressed in black, and possessed one of those hard, immovable countenances which admit of no particular definition. "I received a letter from you relative to my daughter." This was said in such a perfectly business-like manner, without the least emotion, that I was shocked, and my countenance must have expressed my astonishment, for he immediately added,-- "A sad business, my dear sir. Well, well, I will not detain you. The corpse is here?" "No, sir. I will accompany you to the late abode of your daughter." I was glad that she had not been removed; I thought it might do his moral nature some good to see the condition to which his unnatural conduct had brought her. [Illustration: THE PHYSICIAN AND THE FATHER.] Not a muscle of his countenance changed, as we ascended the wretched steps. The watcher admitted us to the poor, low room, and handing him a letter from my pocket, I said, "These are your daughter's last words to you, which she intrusted to my keeping for you. I will not intrude upon your privacy, but will await you at my office;" and bowing, I retired, leaving him beside the corpse of his neglected child. In less than fifteen minutes he returned, and, without any allusion to the event, thanked me for my attentions, declining a chair, saying,-- "You will please make out your bill. I wish to be ready to start early in the morning, and take the corpse with me." He inquired for the address of an undertaker, and the present abode of _her_ child! I stood speechless! He was an anomaly. I measured him with my eyes; he cast his own for an instant to the floor, and then said,-- "My business habits, I fear, shock you, sir. I have been in a hurry all my life. I have never had time to think. I owe you an apology, sir--pardon me." I thought of the future fate of the poor child, and I must acknowledge I hypocritically, for once in my adult life, took the _hand of the man I totally despised_, as I asked him mildly if his daughter had not requested to be buried by the side of her husband, whom she loved so well. "No, sir," he sharply replied; "his name was not mentioned in the letter; very properly too. I had no respect for him, sir, none whatever; nor should I have acceded to such, had she made the request." I gave him the address of the grandchild, and also an undertaker's. "I am much obliged to you," he said, hurriedly. "I will trouble you no further. I will send for the bill in the morning. Good evening, sir." I wanted the man (_brute!_) to love the poor little orphan, his grandchild, and that night I prepared a letter--instead of a bill--which I hoped would benefit him, without aggravating his feelings towards her. I said that I deemed such a privilege a sacred one, not to be soiled by a pecuniary return. I said other things to him, in the note, which I need not repeat. Near spring, in a kind, almost affectionate letter, he announced to me the death of his grandchild. She had fulfilled her mission. She had greatly subdued his nature by her lovely character.... I learned that the remains of Dr. ---- were afterwards interred by the side of his wife and child, and I received but lately the assurance that the wretched father, before his death, admitted that money was not the chief good. Thus perished a noble physician, a devoted wife, and their lovely offspring, because of the selfish ingratitude of one to whom they were and still might have been an inestimable blessing. THE PHYSICIAN. "Honor a physician with the honor due unto him, for the uses which ye may have of him: for the Lord hath created him; for of the Most High cometh healing, and he shall receive honor of the king. The skill of the physician shall lift up his head: and in the sight of great men he shall be in admiration."--_Ecclesiasticus_ xxxviii. If there is one class of men in the world who deserves the gratitude of their fellow-creatures above another, it is the physicians. By physician I mean not him who alone can theorize garrulously upon anatomy and physiology, chemistry and therapeutics, but who can render assistance, in time of need, to the sick and distressed. In ancient days physicians were reckoned "as the gods." I much wonder, as I turn the leaves of the Testament, at the abuse heaped upon the Saviour; for he went about healing the sick, and casting out devils (evil diseases). Surely society was at a very low ebb in those times. Who has greater, firmer friends than the physician! The good physician is sure to prosper. Certainly "envy increases in exact proportion with fame; the man who is successful in his undertakings, and builds up a character, makes enemies, and calls forth swarms of stinging, peevish, biting insects, just as the sunshine awakens the world of flies;" but the true physician, having the desire at heart to benefit his fellow-creatures, is strong, is beloved, is blessed! He calls forth hosts of friends on every side, just as the pure morning air calls fragrance from every lovely flower. Would you have the prayers and blessing of the good? then "Go to the pillow of disease, Where night gives no repose, And on the cheek where sickness preys Bid health to plant the rose. Go where the sufferer ready lies To perish in his doom, Snatch from the grave his closing eyes, And bring a blessing home." A PETER-FUNK DOCTOR. One day, passing up Washington Street, Boston, I detected a familiar voice issuing from a store, on the window-panes of which lately vacated premises was pasted "Removal," and, looking in, I saw a man mounted on a box selling a pinchbeck watch. The place _looked_ a deal like a New York Peter-Funk shop. However that may have been, I recognized the hired auctioneer as once having been a medical practitioner. He was a graduate of C---- Medical College. Owing to his honesty and lack of acquisitiveness among dishonest and niggardly creatures in ----, whom he faithfully served in his earlier efforts at his profession, he was compelled to resort to other means of gaining a support for himself and family, and finally was reduced to clerking and selling goods for those whose business tact exceeded his own. [Illustration: THE PETER-FUNK PHYSICIAN.] SELLING OUT. Everybody has heard of Leavitt, the dry little joker, the humorous and popular auctioneer of Hartford, who sells everybody, and everything, from a riddled sauce-pan to a nine-acre lot in the suburbs. One fine day he was selling, in front of the State House, a various collection of articles, with a lot of ancient and modern household furniture and traps that would have made Mrs. Toodles happy for a six months, and was "looking sharp" for some one to help him over a tough place on an odd lot, when he discovered in the crowd a pleasant, open, upturned countenance,--a sort of oasis in the desert,--to whom he at once appealed for assistance. A knowing wink from young rusticus was the response, a return from the auctioneer, and the bids went on with astonishing rapidity, till down went a big lot of goods, which everybody seemed to have wanted--a truckle-bed and fixings, with earthen ware, etc. "Yours, sir--what's your name?" said L. to the young man from the agricultural district. "Mine? O, no; I didn't bid on 'em," said rustic. "Yes, you did," replied the auctioneer. "Well, I guess not, much." "But you did--the whole lot. You winked every time I looked towards you." "Winked?" "Yes, and kept winking; and a wink is a bid always," said L., the least taken aback at the prospect of losing a good sale. "Wal--as for that--so did you keep winkin' at me. I thought you was winkin' as much as to say, 'Keep dark; I'll stick somebody onto this lot of stuff;' and I kept winkin' back, as if to reply, 'Well, I'll be hanged if you don't, mister.'" [Illustration] XXXI. "THIS IS FOR YOUR HEALTH." "Like leaves on trees the race of man is found, Now green in youth, now withering on the ground; Another race the following spring supplies; They fall successive, and successive rise; So generations in their course decay, So flourish these when those have passed away." THE INESTIMABLE VALUE OF HEALTH.--NO BLESSING IN COMPARISON.--MEN AND SWINE.--BEGIN WITH THE INFANT.--"BABY ON THE PORCH."--IN A STRAIT JACKET.--"TWO LITTLE SHOES."--YOUTH.--IMPURE LITERATURE AND PASSIONS.--"OUR GIRLS."--BARE ARMS AND BUSTS.--HOW AND WHAT WE BREATHE.--"THE FREEDOM OF THE STREET."--KEEP YOUR EYES OPEN AND MOUTH CLOSED.--THE LUNGS AND BREATHING.--A MAN FULL OF HOLES.--SEVEN MILLION MOUTHS TO FEED.--PURE WATER.--CLEANLINESS.--SOAP VS. WRINKLES.--GOD'S SUNSHINE. HEALTH IS ABOVE ALL THINGS. Health is that which makes our meat and drink both savory and pleasant, else Nature's injunction of eating and drinking were a hard task and a slavish custom. It makes our beds lie easy and our sleep sweet and refreshing. It renews our strength with the morning's sun, and makes us cheerful at the light of another day. It makes the soul take delight in her mansion and pleasures, a pleasure indeed, without which we solace ourselves in nothing of terrene felicity or enjoyment.--_Mainwaring._ Without health there is no earthly blessing. In comparison with health all other blessings dwindle into insignificance. Life is a burden to the perpetual invalid, for whom the only solace is in the silent grave. Nor can such always look forward with perfect confidence to rest even beyond the dark portals of the tomb; for the infirm body is not unusually attended by an enfeebled mind which often jeopardizes Hope:-- "And Hope, like the rainbow of summer, Gives a promise of Lethe at last." If, then, health is so essential to our earthly happiness, and to our hope of peace in immortality, O, let us who possess the boon strive to retain it, and we who have it not seek diligently to regain that which is lost. The farmer does not consider it a compromise of his dignity to search out the best modes and means for increasing the quality as well as the quantity of his stock--his horses, his oxen, his sheep, and his swine,--and is man, the most noble work of his Maker,--man, created but a little below the angels,--is man an exception to this rule, that he should cease to be the study of mankind? Is humanity below the animals? Mankind deteriorates while domesticated live stock improves. God has given us bodies formed in his own likeness, and has pronounced them "good," hence, not diseased; and it is evidently our most imperative duty to regard it as a great gift, and preserve these bodies as the inestimable boon of the Almighty. It is very evident that man has fallen far short of the requirements of his Maker. From Adam to the flood--a space of time estimated at upwards of fifteen hundred years, according to Hebrew chronographers--the average of man's years was nine hundred. From Noah to Jacob, by the same chronology, it had dwindled to one hundred and forty-seven years. In the ninetieth psalm we read, "The days of our years are threescore years and ten." From actual statistics it is shown to average now less than one fourth of threescore and ten years. And this fact in the face of civilization, enlightenment, and Christianity! Why so? How shall we account for the evil? The Psalmist above quoted says further, "and if by reason of _strength_ they be fourscore years," etc., which implies that strength prolongs, and weakness--reversing the matter--shortens our days. Let us begin at the beginning. ABOUT THE BABIES.--HOW THEY ARE REARED AND HOW THEY SHOULD BE. BABY ON THE PORCH. Out on the porch, by the open door, Sweet with roses and cool with shade, Baby is creeping over the floor-- Dear little winsome blue-eyed maid! All about her the shadows dance, All above her the roses swing, Sunbeams in the lattice glance, Robins up in the branches sing. Up at the blossoms her fingers reach, Lisping her pleading in broken words, Cooing away, in her tender speech, Songs like the twitter of nestling birds. Creeping, creeping over the floor, Soon my birdie will find her wings, Fluttering out at the open door Into the wonderful world of things. Bloom of roses and balm of dew, Brooks that bubble and winds that call, All things lovely, and glad, and new, And the Father watching us over it all! "Select the best sprouts for transplanting," says the "Old Farmer's Almanac." And here you have the whole root of the matter in a nut shell; for sickly-looking sprouts produce only sickly-looking plants. Like begets like. Now, how about the babies? Women's rights are advocated. Men take their rights. But who shall defend the babies' rights? Poor, helpless little non-combatants! Let me say a few words in their behalf. Children, from the cradle, are wrongfully treated. Their first rights are here curtailed. Look at the baby that is permitted to creep out "on the porch," or over nature's green carpet, and there bask in the sunshine and frolic in the open air; then look in pity upon the pale weekly house-plant child. The contrast is as striking as lamentable. "O, he'll get his death's cold if the air blows upon him," hysterically screams the ignorant mother. Yes, "ignorant"--that is the adjective I want to describe her. The young mother has doubtless been sent to a fashionable boarding-school, where she was taught algebra, French, (?) the art of adornment, how to walk fashionably, eat delicately, and dress _à la mode_, and even how to make a good "catch," but never how to preserve her health or rear an offspring. O, this would be shockingly immodest, or "counting chickens before they are hatched," I once heard a lady affirm. Nine tenths of our American wives are totally ignorant of everything that pertains to their own health, or that of the healthful rearing of an infant. BABY IN A STRAIT JACKET. At first the infant is usually bound tightly in swaddling clothes, lest it move a limb, or for fear (like the down east orator) that it will "bust," and thus kept from air and exercise the first year or two, till it not unusually becomes a stunted, rickety thing, hardly worth "transplanting" or raising. Haven't you and I, kind reader, been subjected to something of this sort of strait jacket insanity?--insanity of parents! And having been tolerably strongly constituted from a "tough stock," we survived that first wrong, whereas thousands of "nicer" babies have succumbed to the swaddling and stifling process. This is wrong, all wrong. The infant should be left free, at least as to its chest and limbs, in order to breathe, kick, and expand. How happy the little fellows are at evening to get rid of the murderous clothes which have been bundled about them all day, and how they will fight and squirm to get down on the carpet all stripped, and creep, or, if old enough, run about in freedom! How they crow and prattle! Now, don't swaddle them--a simple, easy bandage is early admissible,--or cover their heads and faces with caps, sheets, or blankets. Inure them to the air early and continually, and they will have less colds and "snuffles" than if you confined them within doors. Give them air and sunlight, and away with your "goose-grease." Yes, I have even known some country people to apply skunk's oil, and others who larded the infant's nose and chest for the "snuffles." Croup delights in such babies! Then from the strait jacket, baby is taken to the other extreme--bare arms, neck, and chest. Old Dr. Warren once said, "Boston sacrifices hundreds of children annually by not clothing their arms and chests." Once, when in remonstrating with a mother against this barbarous practice of thus exposing her little one-year-old to a chilling atmosphere when my arms and chest were not over warm as wrapped in an overcoat, she replied to me,-- "O, the little dear looks so pretty with its little white arms and neck all bare!" "Yes," I replied, sorrowfully, "it will look pretty, also, laid out in its coffin." She was greatly shocked by the remark, which, however, too soon proved true. "Doctor's stuff" cannot counteract the fatal results of such ignorance and exposures. TWO LITTLE SHOES. Two little shoes laid away in the drawer, Treasured so fondly--never to be worn; Two little feet laid away in the tomb, Cold and all lifeless--sadly we mourn. What trifling things does not a mother keep, Tokens of love the swelling heart to ease; Useless little toys--a lock of golden hair; Something to fondle--to cherish like these Two little shoes laid away in the drawer, Treasured so fondly, never to be worn! These little shoes are only left us now; Gone is our "darling," ever to remain; Dear little feet, so plump and all dimpled, Never will press them--never again! But heavenly thoughts shall cheer me on my way: Death is but life, in fairer, sunnier view; Busy little feet but just run on before; This is my solace as my tears bedew Two little shoes laid away in the drawer, Treasured so fondly, never to be worn. IMPURE LITERATURE AND PASSIONS. It is as marvellous as true that some children survive this treatment; besides the stuffing with meat victuals, candies, and cookies, inducing colic and dysentery; then dosing with rhubarb, paregoric, peppermint, and worse. Soothing syrups! Eternal quietuses! Yes, in spite of extremes of heat and cold, stuffing and dosing with crude and poisonous articles, some babies actually reach the next stage--youth! From chilled blood, indigestion, poisonous air and drugs, repeated attacks of croup, bronchitis, dysentery, etc., the majority who have reached puberty are afflicted by some scrofulous taint, or development, or broken constitutions. Now, they have appetites and passions to grapple. We have already, in chapter fifth, shown how the school-girl is cheated out of health by the deprivation of her "rights," among which are air, freedom, and exercise. Here is another evil, which must not be passed over unnoticed. A New York physician, who wields an abler pen than myself, thus expresses my ideas. What he applies to females is not limited by copyright. Males, help yourselves; it belongs to you quite as much as to the beautiful. "It sickens the heart to contemplate the education of female children in this city." (And let me add, in this country.) "Should nature even triumph over all the evils above enumerated, no sooner has the poor girl attained the age of puberty, than her mind and nervous system are placed upon the rack of novel-reading and sentimental love stories. There is just enough of truth in some of these mawkish productions to excite the passions and distract the attention of the young girl from the love of nature and its teachings, and all rational ideas of real life, and to cause her to despise the commonplace parents whose every hour may be occupied for her consideration and welfare." This writer goes on to condemn those selfish, money-grasping wretches "professors of religion, too," in our city, who publish this impure and overstrained literature, to the great injury of the morals of the young; adding, "What language can be too strong for such disgusting hypocrisy? We punish a poor wretch for the publication of an obscene book or print, and give honor and preferment to those who instil poison into the minds of our children by a book prepared with devilish ingenuity, and in every possible style of attraction and excitement. "It is the premature excitement of the nervous and sexual system that should be avoided. The licentious characters presented in all the glowing tints of a depraved imagination cannot fail to injuriously affect the youthful organism." The dissolute and immoral characters whom we debar from the personal friendship of our sons and daughters, whom we exclude from our parlors, and even street recognition, are sugared over, and, between gilded covers, passed freely into the _boudoirs_, school-rooms, and seminaries of our children, for their companionship at their leisure. The vile characters in person would be far less injurious, for in that case their hideousness would the surer be revealed. "Nothing can be more certain than the production of these works of a precocious evidence of puberty. The forces of the young heart and vascular system are thus prematurely goaded into ephemeral action by the stimulus of an imagination alternately moved to laughter, and tears, and sexual passion." Mr. Baxter, in Part 2, ch. xxi., direction 1, of his _Christian Directory_, which is a direction for reading other books than the Bible, says, "I pre-suppose that you keep the devil's books out of your hands and house. I mean cards, and idle tales, and play-books, and romances or love-books, and false, bewitching stories, and the seducting books of false teachers.... For where these are suffered to corrupt the mind, all grave and useful writings are forestalled; and it is a wonder to see how powerfully these poison the minds of children, and many other empty heads." It would astonish and shame some parents if they would take pains to look over the books which are daily and nightly perused by their children. It is not enough for you to know that such books were obtained from a "dear friend," or from a respectable publisher, or pious bookseller, or that they are lawful publications. Parents and guardians, I pray you take warning. "OUR GIRLS." I want everybody, male and female, old and young, to read that most excellent book, "Our Girls," by Dr. Dio Lewis. It will do you good. For humanity's sake, and particularly for the benefit of females, I recommend it. Lest some of my readers should not follow this advice, I want to tell you what it says about LOW NECK AND SHORT SLEEVES. "Many a modest woman appears at a party with her arms nude, and so much of her chest exposed that you can see nearly half of the mammal glands. Many a modest mother permits her daughters to make this model-artist exhibition of themselves. "One beautiful woman said, in answer to my complaints, 'You should not look.' "'But,' I said, 'do you not adjust your dress in this way on purpose to give us a chance to look?' "She was greatly shocked at my way of putting it. "'Well,' I said, 'this assurance is perfectly stunning. You strip yourselves, go to a public party, parade yourselves for hours in a glare of gas-light, saying to the crowd, "Look here, gentlemen," and then you are shocked because we put your unmistakable actions into words.' "In discussing this subject before an audience of ladies in this city (Boston), the other evening, I said, 'Ladies, suppose I had entered this hall with my arms and bust bare; what would you have done? You would have made a rush for the door, and, as you jostled against each other in hurrying out, you would have exclaimed to each other, "O, the unconscionable scallawag!" May I ask if it is not right that we should demand of you as much modesty as you demand of us?' But you exclaim, 'Custom! it is the custom, and fashion is everything.'" Again the author says,-- "This exposure of the naked bosom before men belongs not to the highest type of Christian civilization, but to those dark ages when women sought nothing higher than the gratification of the passions of man, and were content to be mere slaves and toys. "Boston contains its proportion of the refined women of the country. We have here a few score of the old families, inheriting culture and wealth, and who can take rank with the best. A matron who knows their habits assures me that she never saw a member of one of those families in 'low neck and short sleeves.' "In the future free and Christian America, the very dress of women will proclaim a high, pure womanhood.... We shall then discard the costumes devised by the dissolute capitals of Europe. "What a strange spectacle we witness in America to-day! Free, brave American women hold out to the world the Bible of social, political, and religious freedom, and anon we see them down on their knees, waiting the arrival of the latest steamer from France, to learn how they may dress their bodies for the next month." Well, he does not censure ladies in the above manner all through; but yet, in a most earnest and interesting way he divulges the most startling truths, and even very young misses are delighted with the whole argument. "Why, it's just like a story," exclaimed my twelve-year-old Katie on reading it. What Dr. Lewis objects to on the score of immodesty, I also oppose on the ground of unhealthfulness. The idea of preventing or curing the laryngitis, or consumption, in a lady, when there is nothing but gauze, or a bit of ribbon and a galvanized bosom pin, between her neck and the cold and changeable atmosphere of the north or east, is ridiculously absurd. No doctors or doctors' pectorals can save such. "High necks," warm flannels, or make your wills. HOW AND WHAT WE SHOULD BREATHE. It would disgust the reader if I should enter into the details of telling him what people--respectable people, even, in nice houses--breathe over. Air is life. The purer the air, the purer the life-stream that courses through our hearts. You cannot get too much of it. Take it in freely. Have only pure air in your houses, in your sleeping-rooms and cellars. Particularly see that the children have the freedom of the air, day and night, at home, at school, everywhere. It is free--costs nothing! THE FREEDOM OF THE STREET. "I dwell amid the city, And hear the flow of souls; I do not hear the several contraries, I do not hear the separate tone that rolls In art or speech. "For pomp or trade, for merry-make or folly, I hear the confidence and sum of each, And what is melancholy. Thy voice is a complaint, O crowded city, The blue sky covering thee, like God's great pity." "Heaven bless the freedom of the park," has exclaimed a child of song; and he might also have invoked the same blessing upon "the freedom of the street." The street is free to all; to high and low, young and old, rich and poor. It recognizes no distinctions or castes; it is the very expressiveness of democracy. The child of fashion, arrayed in silks, ribbons, and furbelows; the child of penury and want, in rags, filth, and semi-nakedness; the shaver of notes and the shaver of faces; the college professor and the chiffonier, all mingle in common on the street. Now walking side by side, now brushing past each other, now stopping to look at the same cause of excitement, now each jostled into the gutter. No distinction in wealth, birth, or intellect is recognized; no one dare attempt to restrict the freedom of the thoroughfare, and none dare say to another, "Stand aside, for I am better than thou." The little boy trundles his hoop against the shins of the thoughtful student; the little girl knocks the spectacles from the nose of the man of science with her rope, while the preacher runs against an awning-post to make way for a red-faced nurse with a willow carriage; the antiquated apple woman, and the child with its huge chunk of bread and butter, sit on the curb; the painter digs the end of his ladder rather uncomfortably into some pursy old gentleman's stomach; while the sweep, with the soot trembling upon his eyelashes, strolls along as independently and leisurely as the dandy in tights, and with the sweeter consciousness that he is doing something for the public good. [Illustration: THE FREEDOM OF THE PARK.] The street is a world in miniature, a Vanity Fair in motion, a shifting panorama of society, painted with the pencil of folly and fancy. It is the only plane upon which society, "the field which men sow thick with friendships," meets on a common level. It does not flaunt in aristocracy, and never dares to be pretentious. "KEEP YOUR EYES OPEN AND MOUTHS CLOSED." There's true philosophy in the above saying of a wise _savant_. But there is more wisdom in the latter clause than he even dreamed of in his philosophy. The Book informs us that God breathed the breath of life (air) into man's _nostrils_. Nothing is more injurious, save continually breathing foul air, than the habit of breathing through the mouth. Keep the mouth closed. A great many diseases of the teeth, mouth, throat, head, and lungs may be traced directly to the pernicious and general habit of breathing with the mouth open--inhaling and exhaling cold air directly into the mouth and throat, inflaming and chilling the mucous membrane and the blood. The nostrils are the only proper passages for the air to the lungs. Here are filterers to exclude particles of dust and foreign matter, and various ramifications, whereby the air is properly warmed before reaching the lining of the throat and lungs. In infected air you are less injured, and less liable to contract contagious diseases, when inhaling only through the natural channel, the nostrils. I think it was Dr. Good, of London, who wrote a book on the subject, which Carlyle pronounced "a sane voice in a world of chaos." George Catlin says he learned the secret of keeping the mouth closed while among the North American Indians. They would not allow themselves or their children to sleep with the mouth open (though their reasoning is questionable), because the evil spirit would creep in them at night. Hence the parent went around after the pappooses were asleep, and closed their mouths. Pulmonary diseases are seldom found in the "close-mouthed." Kant, the philosopher, claims to have cured himself of consumption by this discovery. Persons never snore except by breathing through the open mouth. O, give us quiet, you snorers, by keeping your mouths shut, even at the expense of "keeping your eyes open" to watch yourself, and thus deliver the world from the disturbance of snoring. THE LUNGS.--BREATHING. All that live, down even to vegetables and trees, breathe, _must_ breathe, in order to live; live in proportion as they breathe; begin life's first function with breathing, and end its last in their last breath. And breathing is the _most important_ function of life, from first to last, because the grand stimulator and sustainer of all. Would you get and keep warm when cold, breathe copiously, for this renews that carbonic consumption all through the system which creates all animal warmth. Would you cool off, and keep cool, in hot weather, deep, copious breathing will burst open all those myriads of pores, each of which, by converting the water in the system into insensible perspiration, casts out heat, and refreshes mind and body. Would you labor long and hard, with intellect or muscle, without exhaustion or injury, breathe abundantly; for breath is the great re-invigorator of life and all its functions. Would you keep well, breath is your great preventive of fevers, of consumption, of "all the ills that flesh is heir to." Would you break up fevers, or colds, or unload the system of morbid matter, or save both your constitution and doctor's fee, cover up warm, drink soft water--cold, if you have a robust constitution sufficient to produce a reaction; if not, hot water should be used. Then let in the fresh air, and breathe, breathe, breathe, just as deep and much as possible, and in a few hours you can "forestall and prevent" the worst attack of disease you ever will have; for this will both unload disease at every pore of skin and lungs, and infuse into the system that _vis animæ_ which will both grapple in with and expel disease in all its forms, and restore health, strength, and life. Nature has no panacea like it. _Try the experiment_, and it will revolutionize your condition. And the longer you try, the more will it regenerate your body and your mind. Even if you have the blues, deep breathing will soon dispel them, especially if you add vigorous exercise. Would you even put forth your greatest mental exertions in speaking or writing, keep your lungs clear up to their fullest, liveliest action. Would you even breathe forth your highest, holiest orisons of thanksgiving and worship, deepening your inspiration of fresh air will likewise deepen and quicken your _divine_ inspiration. Nor can even bodily pleasures be fully enjoyed except in and by copious breathing. In short, proper breathing is the alpha and omega of all physical, and thereby of all mental and moral function and enjoyment. A MAN FULL OF HOLES. Yes, made of holes! A gentleman once told me a story, as follows. We were travelling on the Ohio River, on board of a steamer. "You see that bank over opposite?" "Yes," I replied. "Well, thereby hangs a little story. I always laugh when I think of it, or pass the spot, which is often. A fellow sat looking at that spot, watching the thousands of swallows that were continually flitting to and fro, in and out of their nests, and laughing immoderately to himself. I approached, and ventured to inquire the cause of his mirth, that I might partake of it. "Well, you see that bank and all them nests? Well, one day I went down on the boat and noticed them. When I came back, there had meantime been a heavy rain storm which washed the bank away, and left the holes all sticking out;" and the fellow continued to laugh as though he would split himself, probably from the _idea_ of the holes "sticking out." I wondered how he could see them if the bank around was washed away. Still the man full of holes is a fact. According to Krause, quoted in Gray's and Wilson's works on anatomy, there are twenty-eight hundred (2800) pores in the skin of the human body to the square inch; and the number of square inches to an average-sized man is twenty-five hundred (2500). This would give some _seven million pores in the whole body_. These pores, or tubes, are one fourth of an inch in length; hence, the entire length of them all is _twenty-eight miles_. That part of the skin is the healthiest which is the most exposed to the air, as the face and hands. That part the most diseased from which the air is most excluded, as the _feet_. Three fourths of all persons over fourteen years of age have diseased feet; either corns, chilblains, or diseased joints or nails. SEVEN MILLION MOUTHS TO FEED. These seven million mouths must be fed daily and hourly. Their food is light and air. Man is not only fed and nourished through the portal of his mouth, but through all the pores of his body, by drawing in nutriment from the surrounding elements, even from the viewless air. These little mouths also need moisture. This fact is revealed to the senses through the medium of the nerves; for, how grateful to the dry, parched skin, is a bath of cold water! or, if the blood is in a "low state,"--impoverished by disease,--let it be a tepid bath. Let it feel comfortable and grateful to the user. This is a good rule to direct you. The little children love it--love to paddle and splash in it. If they cry and fight against washing, it is usually because of the rudeness of the operator, who, with brawny palm or rough sponge takes the child unawares, nearly suffocating it, and briskly and rudely rubbing over the surface of the tender face, regardless of such small obstructions as nose, chin, and lips, and not unusually dashing a quantity of yellow soap suds into the infantile eyes. The next time the little fellow is requested to be washed, he, remembering the last _scouring_, naturally objects to a repetition of the unpleasant process. As the nostrils inhale pure air beneficially, they also exhale impurities. The pores also excrete, or throw off impurities. A healthy skin will throw out, by the pores, from two to three pounds of impure matter every twenty-four hours. To be sure a greater quantity of this impurity is a vapory substance, yet that holds in solution solid particles of corrupt matter, which greatly tend to clog the pores if left to obstruct free perspiration. WATER. Then, aside from cooling and nourishing the skin and the system through the pores, cleanliness and health demand oft and repeated ablutions of the whole body. In order that the perspiration may be unobstructed, it is absolutely necessary to wash the whole surface of the body in water, and on account of the _acid_ and oily substance collecting on the skin, using a small quantity of alkali, as soap or soda in the water, and thus, by good brisk rubbing, using the hand in preference to a cloth or sponge, thoroughly cleansing the little mouths referred to, else their action is retarded and suspended. This should be done daily during the summer season. This is a simple process, indispensable to health, and the unwashed can hardly believe what beneficial results follow such a plain course, or know the healthful influence or the comfort derived from a frequent use of pure water. Those who bathe thus daily seldom take colds. During the winter, in cold climates, weekly or semi-weekly bathing may suffice. [Illustration: "IT COSTS NOTHING."] A statesman, in seeking an illustration of the difference between price and value, very happily hit upon water, which costs nothing, and yet is of inestimable worth. Water, next to air, is the most indispensable of all the productions of nature. "Unlike most good things providentially supplied for our use, it is hardly capable of abuse. The more common danger to be feared is from too little, not too much, water. "Simple a thing, however, as it may be to quench the thirst from the running stream, or the mountain spring, there are but few people who know how to drink. Most people, in the eagerness of thirst, swallow with such avidity the welcome draught, that they deluge their stomachs without proportionately refreshing themselves. The slowly sipping of a single goblet of water will do more to alleviate thirst than the sudden gulping down of a gallon. It is more frequently the dryness of the mouth, during hot weather, than the want of the system, which calls for the supply of fluid. When larger quantities, moreover, are poured into the stomach than are required, that organ becomes oppressed mechanically by the distention, and the digestion is consequently weakened." The prescribed ablutions of the Jews and Mohammedans have not only a spiritual but a hygienic value. "The washing of the body not only whitens the outside of the sepulchre, but purifies the internal organs, and renews the spiritual man as well.... Hence, when the body becomes foul by the retention of worn-out and corrupt material accumulated on the surface and the interior of the structure, it becomes a cage suitable only for the dwelling of unclean birds, and no others will descend and make their nests therein. It is a vessel fitted to receive only the lower passions and feelings of human nature. "Public bathing-houses are as important a means of grace as our poorly ventilated churches, and many an unhappy soul would be brought nearer to heaven by a judicious application of soap and water than he could be by listening to a sermon about that of which he comprehends little and cares less."--_Rev. W. F. Evans's "Mental Cure."_ SOAP VS. WRINKLES. How much younger and fresher the wayworn traveller or the outdoor laborer looks after a thorough washing of the face and hands only. Many who complain of "bird's claws" and wrinkles might murmur less if they made a thorough use of warm water and "old brown windsor soap," or better, the true castile soap. Nearly all the soap sold at groceries for castile is spurious. A good druggist will have the desired article, and for rough, chapped skin nothing is better, not even glycerine. Then wash out the furrows of fine dirt that gather in the _little_ wrinkles, and it will surprise some folks to see how, thereby, they have reduced the size of their wrinkles. It is like cleansing an old coat! GOD'S SUNSHINE. Next to air and water in importance to health and happiness is sunlight. O, "let there be light" in your houses, that there may be light in your hearts also! Our houses should be so constructed and located that the sun may shine into every room some time during the day. Too many build houses and live in the rear. The hall and large parlors are usually situated in front, to the south or west, throwing the sitting, dining, and working-room--kitchen--in the shade. Let the cheering, life-giving influences of God's dear blessed sunshine flood the working, sitting, and, particularly, the sleeping rooms. He or she who sleeps in a room from which the sunshine is totally excluded will be pale, weak, tired, and die prematurely of consumption. Try a plant in such a room. It soon turns pale and sickly. Just so your children and yourself. I have such patients daily. Medicine cannot substitute sunshine. Throw open the blinds, dash aside the curtains, and let in the light and sunshine to your homes and hearts. Never mind the carpets; they may be replaced, but you and your children, never! Save your health, if _you ruin an old carpet in so doing_! Cholera, dysentery, scrofula, nervous diseases, and consumption prevail more extensively in narrow and darkened, as also in the shady side of streets; also in darkened prisons and hospitals. A heavy heart walks in dark and cheerless apartments. The cheerful, happy man, the joyous, contented wife, the beautiful, healthy children, dwell and rejoice in homes where flows full and free the pure air and the life-keeping, health-giving sunshine. Christianity is more likely to take up its abode with the latter. There only green leaves and beautiful flowers can gladden the sight and exhilarate the senses. Air, water, sunlight! "These three." Don't neglect them. So shall you live long, live healthy, and at last die happily! XXXII. HEALTH WITHOUT MEDICINE. How shall I stay life's sunny hours? For though the summer skies are clear, Foreboding thoughts steal o'er my heart, And autumn sounds oppress my ear. While heart with hope beats warm and high, And pleasures drink in summer bowers, I know that autumn frosts will come-- How shall I stay life's sunny hours? CHEERFULNESS.--GOOD ADVICE.--REV. FRANCIS J. COLLIER ON CHRISTIAN CHEERFULNESS.--WHAT GOD SAYS ABOUT IT.--WHINING.--LOVE AND HEALTH.--AFFECTION AND PERFECTION.--SEPARATING THE SHEEP AND GOATS.--THE FENCES UP AND FENCES DOWN.--SIXTEEN AND SIXTY.--ACTION AND IDLENESS.--IDLENESS AND CRIME.--BEAUTY AND DEVELOPMENT.--SLEEP.--DAY AND NIGHT.--"WHAT SHALL WE EAT?"--A STOMACH-MILL AND A STEWING-PAN.--"FIVE MINUTES FOR REFRESHMENTS."--ANCIENT DIET.--COOKS IN A "STEW."--THE GREEN-GROCERIES OF THE CLASSICS.--CABBAGES AND ARTICHOKES.--ANIMAL AND VEGETABLE DIET. CHEERFULNESS. I place cheerfulness next, in the catalogue of essentials to long life and happiness; before "diet," for, unless a man eats cheerfully, nothing will agree with him; and if he be constantly cheerful, nothing that he eats will injure him. "How shall I be cheerful when all the world goes wrong with me?" asks the diseased and despondent man or woman. Put on cheerfulness as a garment. Assume it. Try my suggestion. Use a little hypocrisy with yourself. Go before your glass, if necessary, and assume a cheerful countenance. Keep it up, and before long you will be astonished to find that Mr. Melancholy don't like it, and begins to withdraw his sombre person. Keep on "keeping it up," and the most happy results will soon follow your exertions. Try the reverse, and melancholy will return. This is cheap medicine. "[R]--A cheerful face, taken daily, feasting." CHRISTIAN CHEERFULNESS. The following prize essay was written by Rev. Francis J. Collier:-- "_Cheerfulness as a Medicine._--Perhaps nothing has a greater tendency to cast gloom over the spirit than _disease_. The mind sympathizes with the body as much as the body with the mind. Their union is so intimate, so delicate, so sensitive, that what affects the one necessarily affects the other. Each to a certain degree determines the other's condition. If the mind is joyful, its emotion is betrayed by the expression of the body. 'A merry heart maketh a cheerful countenance.' But if the body is injured, or the physical system deranged, the mind at once suffers, and forthwith droops into sadness. It becomes, therefore, your Christian duty, if you have health, to study the laws of your physical being; to compel yourself both to labor and to rest; to avoid unnecessary risks or exposure; to abstain from injurious indulgences; to be prudent, temperate, chaste, and, by every proper means, to try to preserve what is so essential to your spiritual comfort. If you have lost this boon, strive to regain it. Think not, speak not, all the while about your malady. Suppress moans and complaints. They are always disagreeable to others; they can never be beneficial to you. Count your mercies, and not your miseries. Try upon your body the stimulus of a cheerful spirit. It may not insure your recovery, but it will certainly produce a pleasant alleviation. 'A merry heart doeth good like a medicine; but a broken spirit dryeth the bones.' "_Borrowing Trouble._--Forebodings of evil rob the mind of cheerfulness. 'Ills that never happened have mostly made men wretched,' says Tupper. Casting our glance ahead, we see 'lions' in the way; difficulties which we are sure we can never overcome; griefs under whose heavy weight we shall be utterly crushed. Not satisfied with our present troubles, we borrow misery from the future. The Holy Scripture instructs us to do otherwise. 'Thou knowest not what a day may bring forth.'--Prov. xxvii. 1. 'Take therefore no thought for the morrow, for the morrow shall take thought for the things of itself. Sufficient unto the day is the evil thereof.'--Matt. vi. 34. And then it gives us a golden promise, 'As thy days, so shall thy strength be.' "The life of many Christians is a life of constant sadness and gloom. They seem to be entire strangers to all the happiness of earth and all the hopes of heaven. Their faces commonly appear as sombre as the stones which mark the dwelling-places of the dead. Their feelings are better expressed in sighs than in songs. Unhappy themselves, they make others unhappy. They come and go like clouds, shutting out the sunshine from cheerful hearts, and for a while casting upon them shadows cold and dark. "Arise, O, desponding one! Quit your tearful abode in the valley of gloom, and come and make your dwelling on the bright hill-top of cheerfulness. Look up! look up! and behold the sun shining through the clouds, and the stars through the darkness." WHINING. This is a habit opposed to cheerfulness, and producing contrary results. It is half-sister to scolding, and equally as obnoxious. Don't fret and whine. It makes you look old and cross. The disease soon becomes chronic if indulged in. It is a disease that not only the doctors know at sight, but every one can read it in the face of those thus afflicted. "O, what a cross face that lady has got!" I heard another female exclaim but yesterday, as they passed on the street. You cannot hide it; then don't induce such a look. Somebody has written the following, which so completely expresses my ideas of the matter, that I quote the item verbatim:-- "There is a class of persons in this world, by no means small, whose prominent peculiarity is whining. They whine because they are poor; or, if rich, because they have no health to enjoy their riches; they whine because it is too shiny; they whine because it is too rainy; they whine because they have 'no luck,' and others' prosperity exceeds theirs; they whine because some friends have died, and they are still living; they whine because they have aches and pains, and they have aches and pains because they whine, no one can tell why. "Now, we would like to say a word to these whining persons. Stop whining. It's of no use, this everlasting complaining, fretting, fault-finding, scolding, and whining. Why, you are the most deluded set of creatures that ever lived. "Do you not know that it is a well-settled principle of physiology and common sense that these habits are more exhausting to nervous vitality than almost any other violation of physiological law? And do you not know that life is pretty much what you make it and take it? You can make it bright and sunshiny, or you can make it dark and shadowy. This life is only meant to discipline us, to fit us for a higher and nobler state of being. Then stop whining and fretting, and go on your way rejoicing." LOVE. "Well, what has that to do with health and long life?" ask the cynic, the bachelor, the old maid possibly, and the plodders. Everything, I reply. The man, woman, or child who loves well and wisely, who loves the most, is the happiest, healthiest, and will live the longest. "That is a bold assertion," says my quizzer. Yes, and true as bold. Now listen in silence to my statement. Who loves, what loves, and what is the result? "God is love." Here is the first, the fundamental principle. He is the oldest of all beings. To be like him is to love,--to love all things which he has created. This is Godlike. If you are not thus, you are like the ungodly, who "shall not live out half their days." "Love God, and keep his commandments." "Love thy neighbor as thyself." Is there not more happiness and health in the obeying of this command, than in disobedience to it? Whatever is conducive to happiness is healthful. Whatever produces unhappiness is injurious to health. Love is undefinable. "There is a fragrant blossom that maketh glad the garden of the heart. Its root lieth deep; it is delicate, yet lasting as the lilac-crocus of autumn. * * * * * I saw, and asked not its name; I knew no language was so wealthy. Though every heart of every clime findeth its echo within. And yet, what shall I say? Is a sordid man capable of love? Hath a seducer known it? Can an adulterer perceive it? * * * * * Chaste, and looking up to God, as the fountain of tenderness and joy. Quiet, yet flowing deep, as the Rhine among rivers. Lasting, and knowing not change, it walketh in truth and sincerity. Love never grows old, love never perisheth." AFFECTION AND PERFECTION. Love is so closely connected with our lives, and all that makes or mars our peace and pleasure, health and beauty, that I should feel guilty of a sin of omission by excluding this item from my chapter on health and happiness. To be unloved is to be unhappy. Do not forget the connection between health and happiness. They are all but synonymous terms. You may know the unloved and unlovely by the lines of care, dissipation, or crime that are furrowed upon their brows. Go into the highways, and you may readily pick out the unloved child by its unsatisfied expression of countenance. It lifts its great, hungry eyes to yours instinctively, and asks for love and sympathy as plainly by that searching look, as the child of penury, the bread-starveling asks for alms when it presents its scrawny hand, and in pitiful tones says, "Please give me a penny, for God's sake." O, give the child "love," for God's sake; for he so loved the world that he gave us his only begotten Son, who only in turn taught us to love. Physical perfection is never found in the unloved. The unloved wife is not long beautiful, nor the child of such. There is a marked difference between them and the wife and child that the husband and father cherishes and caresses with unrestrained affection. In sickness love divides the burden, as in the common toils of life. Disguise or deny the truth of the assertion if you will, woman must love somebody or some thing. She were not otherwise a true woman, nor made in the image of her Maker. If the husband denies her that affection which truly belongs to her nature, he must not blame her, but himself, if she loves another. She will cling to something. If she has no children upon whom to lavish her affections, she will love some other's, or a pet canary, or even a cat, or lapdog; but love she will. SEPARATING THE SHEEP AND GOATS. I place cheerfulness before love, because angry and melancholy people are unlovable. If you wish to be loved and happy, be lovable. Strive to please, to make those about you happy, and then you will be lovable. Cheerfulness is the first step. A very sensible writer in the _Phrenological Journal_ says,-- "There is not enough thought, and time, and consideration devoted to this inevitable requisite, love. It is kept too much in the background. How many years are given to preparing young people for professions, trades, and occupations; how much counsel and advice are heaped around these topics; and yet how little importance is attached to the very influence which will probably be the turning-point of their lives. No wonder there are so many unhappy marriages. If we could only remember that boys and girls are not to be educated for lawyers, merchants, school-teachers, or housekeepers alone, but for husbands and wives, as well." Those girls are the most chaste and ladylike who have been brought up with a family, or neighborhood, or school of boys; and on the other hand, those boys who have from their earliest days been accustomed to female restraint and girlhood's influences, make the best men, and most faithful, loving husbands and fathers. What shall I say of those demoralizing institutions where the "young ladies" are taught algebra, languages, and ill manners? Where they are forbidden to recognize a gentleman in the school-room, prayer-room, or street? Can you, honest reader, believe there are such institutions in our enlightened land? Yet there are; where the sexes are denied not only the association with, but are forbidden the common courtesies of life; where, if a friend or brother lifts his hat to the young lady, while belonging to that institution, she is forbidden to acknowledge the courtesy. I remember Mrs. Brandyball, in one of Theodore Hook's novels of society, boasting of her seminary for young ladies as one of the _safest_ in the world, being entirely surrounded by a dense wall, eight feet high, surmounted by sharp spikes and broken glass bottles. I reckon all the virtue preserved in this way was not worth the cost of its defences. FENCES BROKEN DOWN. The writer passed some time in a town where these discourtesies were promulgated. I boarded with a pious family, where a large number of male students boarded also. There was one class of influences and _passions_ pervading that place. All female influence and restraint were withdrawn. And what was the result? The boys were forbidden to smoke, or chew tobacco, or play at cards. They reckoned me as a "right jolly good fellow," because I could be induced to play a game of euchre with them; but they occasionally smoked me out of their rooms, and I was repeatedly compelled to check their wonted flow of licentious conversation. Cards, as an innocent amusement, I could stand, but the "accomplishments" referred to I could not endure. Shall I, as a physician, mention the positive evidence, the pathognomonic indications which were revealed to me in the faces of many of those young men; of vulgar habits, which are less often or seldom revealed in those who customarily associate in pure female society? They had little or no respect for the opposite sex. Their ideas of them, thoughts and conversations, were most gross. If some now and then, as they occasionally would, took a stolen interview, a walk at night, when "Old Prof." was asleep, it was with no more exalted views of purity than any other midnight criminal prowlers are supposed to cherish. And the girls? Alas! they were ready to flirt with every strange man, drummer, or else, who came into the village. The aforesaid pious landlord assured me further, what my eyes did not see, that he knew of girls climbing out of the windows at night, and partaking of stolen rides and interviews as late as midnight; and he pointed out to me one coy, plump little miss, who he knew "had been out as late as one or two A. M., taking a ride with a gentleman scholar." The scholars all met in the "chapel" for prayers. Are sly glances, winks, or billets-doux prayers? If so, they prayed fervently. Any well read, observing physician will tell you of the ruined healths of the majority of females educated at such exclusive seminaries. And what is the reverse of this exclusiveness? Bring the sexes up together. Teach them together, as much as is consistent. They will each have better manners, be more graceful, and possess clearer ideas of propriety, more beauty and better health, than by the plan of a separate education. We all dread to grow old. Don't talk of second childhood. Keep the first youthfulness fresh till the last. Love will do much towards continuing this desirable state. Says the _Phrenological Journal_, beauty comes and goes with health. The bad habits and false conditions which destroy the latter, render the former impossible. Youthfulness of form and features depends on youthfulness of feeling. "Spring still makes spring in the mind, When sixty years are told; Love wakes anew the throbbing heart, And we are never old." If, then, we would retain youthful looks, we must do nothing that will make us _feel old_. O, the folly of parents in some things! The nonsense of sixty is the sweetest kind of sense to sixteen; and the father and mother who renew their own youths in that of their children may be said to experience a second blossoming of their lives. Teach them to talk to you of their friends and companions. Let the girls chat freely about gentlemen if they wish. It is far better to control the subject than to forbid it. Don't make fun of your boy's shamefaced first love, but help him to judge the article properly. You would hardly send him by himself to select a coat or a hat--has he not equal need of your counsel and assistance in selecting that much more uncertain piece of goods, a sweetheart? There is a great deal of popular nonsense talked and written about the folly of our girls contracting early marriages. It is not the early marriage that is in fault, it is the premature choice of a husband. Only take time enough about selecting the proper person, and it is not of much consequence how soon the minister is called in. Keep him on trial a little while, girls; look at him from every possible point of view, domestic or foreign. Don't be deluded by the hollow glitter of handsome features and prepossessing manners. A Greek nose or a graceful brow will not insure conjugal happiness by any means. A husband ought to be like a watertight roof, equally serviceable in sunny or rainy weather. ACTION AND IDLENESS. While action is surely essential to our physical and moral being, all extremes should be avoided. Excessive labor, even out of door, in the air and sunshine, may be injurious. On this point I quote the _Scientific American_:-- "It has oftentimes been asserted that those exposed to severe labor in the open atmosphere were the least subject to sickness. This has been proven a fallacy. Of persons engaged at heavy labor in outdoor exposure, the percentage of sickness in the year is 28.05. Of those engaged at heavy labor in-doors, such as blacksmiths, etc., the percentage of sickness is 26.54--not much to be sure; but of those engaged at light occupations in-doors and out, the percentage of sickness is only 20.80-21.58. For every three cases of sickness in those engaged in light labor, there are four cases among those whose lot is heavy labor. The mortality, however, is greater among those engaged in light toil, and in-door labor is less favorable to longevity than laboring in the open atmosphere. It is established clearly that the quantum of sickness annually falling to the lot of man is in direct proportion to demands on his muscular power. "How true this makes the assertion,--'Every inventor who abridges labor, and relieves man from the drudgery of severe toil, is a benefactor of his race.' There were many who looked upon labor-saving machines as great evils, because they supplanted the hand toil of many operatives. We have helped to cure the laboring and toiling classes of such absurd notions. A more enlightened spirit is now abroad, for all experience proves that labor-saving machines do not destroy the occupations of men, but merely change them." IDLENESS INDUCES CRIME. This fact cannot be too strongly or repeatedly impressed upon parents and children. Warden Haynes, of the Massachusetts State Prison, lately uttered these emphatic and significant words, which are worthy to be written in letters of gold: "Eight out of every ten come here by liquor; and a great curse is, not learning a trade. Young men get the notion that it is not genteel to learn a trade; they idle away their time, get into saloons, acquire the habits of drinking, and then gambling, and then they are ready for any crime." How many young men we see every day who are in the pathway to this end. Fathers and mothers who hold the dangerous view that it is not genteel for their children to learn a trade, can see where such ideas lead. The words of wisdom quoted above are full of weighty import for both parents and children. BEAUTY AND DEVELOPMENT. Activity of body and mind are conducive to health. Everybody ought to know that moderate exercise develops the muscular and nervous power, hence the vitality of all creatures. Is the active, prancing steed, or the inactive, sluggish swine, the better representative of beauty, strength, and long life? "The horse," answers everybody. Then avoid the habits of the other, and you will be very unlike that indolent, unclean, and gluttonous animal. When you see a man who reminds you of a hog, be assured he has swinish habits. Mental activity, unless it is excessive, is conducive to beauty, to strength, and health. A writer in the American Odd Fellow has some good ideas illustrative of my argument, that I may be pardoned for quoting him:-- "We were speaking of handsome men the other evening, and I was wondering why K. had so lost the beauty for which five years ago he was so famous. 'O, it's because he never did anything,' said B.; 'he never worked, thought, or suffered. You must have the mind chiselling away at the features, if you want handsome middle-aged men.' Since hearing that remark, I have been on the watch to see whether it is generally true--and it is. A handsome man who does nothing but eat and drink grows flabby, and the fine lines of his features are lost; but the hard thinker has an admirable sculptor at work, keeping his fine lines in repair, and constantly going over his face to improve, if possible, the original design." Therefore, we infer that this moderate (outdoor) exercise is conducive to beauty, health, and longevity. Moderate activity of the mind the same. Idleness begets licentious thoughts and deeds. Activity of body and mind in honorable pursuits calls away the nervous power from the lower to the higher organs. A lively, cheerful, clean man or woman, is seldom wicked or licentious. SLEEP. By the assistance of John G. Saxe, we have already given those "Early to bed, and early to rise, Makes a man healthy, wealthy, and wise," fellows a touch of our opinion on too early rising. I base my judgment upon careful and continued observation during many years. The Scriptures teach that the day is for work, and night for sleep. This turning day into night, sitting up till near midnight, is all wrong. It is ruinous to health and beauty. This other extreme, of rising at four or five o'clock and pitching into hard labor, is wearing and tearing to the constitution; and though nature for a while adapts herself to the necessity, by browning and unnaturally developing the exposed parts of such deluded or unfortunate persons, _it does it at the expense of his length of days_. He will not live so long for his over-doing. Begin by retiring earlier, at the first indication after nightfall of fatigue and sleepiness. If sweaty, wash the skin quickly, as previously directed, with warm water, _rubbing dry and warm_, and cover up. Lie on one side. Do not sleep on your back. You are more liable to dream laborious or frightful dreams, snore, or have nightmare. Do not sleep in clothes worn during the day. Unfortunate is the man or woman, who, from necessity, arises before six or seven in winter, or five to seven in summer. Literary persons require more sleep than laborers. Children require more than adults. Do not lie in bed long after awaking at morning. Open your window wide as soon as you arise--it is supposed to be partially open at the top all night. In inhaling air at night or morning, do it only through the nostrils. Night air is _not_ injurious any more than day air if so inhaled. Sleep when sleepy--this is a good rule, unless disease induces unnatural sleep. WHAT SHALL WE EAT? _Eat what relishes well, and agrees with you afterwards._ This is the best general rule I have been able to adopt for eating. There has been so much ridiculous stuff written upon "diet" that most sensible people have given up trying to follow the prescribed rules of writers, if not their physician's directions on that score. Take the following, by one celebrated Dr. Brown, of England, for an example, although we may find others quite as ridiculous nearer home:-- "For breakfast, toast and rich soup made on a slow fire, a walk before breakfast, and a good deal after it; a glass of wine in the forenoon, _from time to time_; good broth or soup to dinner, with meat of any kind he likes, but always the most nourishing; several glasses of port or punch to be taken after dinner, till some enlivening effect is perceived from them, and a dram after everything heavy; one hour and a half after dinner another walk; between tea-time and supper a game with cheerful company at cards or any other play, never too prolonged; a little light reading; jocose, humorous company, avoiding that of popular Presbyterian ministers and their admirers, and all hypocrites and thieves of every description.... Lastly, the company of amiable, handsome, and delightful young women and an enlivening glass." Dr. Russell, to whom we are indebted for the quotation, might well say that "John Brown's prescriptions seem a caricature of his system." A "STOMACH-MILL" AND A "STEWING-POT." There have been many speculations about the nature of the digestive process, and in relation to them the celebrated Hunter remarked, playfully, "To account for digestion, some have made the stomach a mill; some would have it to be a stewing-pot, and some a brewing-trough; yet all the while one would have thought that it must have been very evident that the stomach was neither a mill, nor a stewing-pot, nor a brewing-trough, nor anything but a _stomach_." All that can be said is, that digestion is a chemical process, the mechanical agency spoken of being of service only in thoroughly mixing the gastric juice with the food. "FIVE MINUTES FOR REFRESHMENTS." "Murder! murder!" the conductor might as well cry to passengers, as "Five minutes for refreshments." Now it makes less difference what we eat than how we eat. Cold hash, eaten slowly, therefore, well masticated, and mixed with the saliva, is more likely to "set well" than a light cake or a cracker, though it be "Bond's best," if hurried down the throat. What the English call the "blarsted Yankee style" of gulping down the food half masticated, washing it down with drinks, will ruin anything but a sheet-iron stomach in a cast-iron constitution. Talk about "mills." Why, that most excellently contrived mill in the mouth is not suffered to perform its duty. The hopper is too crammed; it clogs the whole machinery. Eating between meals destroys the regular periods naturally established by the stomach for digestion. Three meals should be sufficient for twenty-four hours. "Much has been said about exercising after eating, and the truth has been often over-stated. The famous experiment with the two dogs is cited to show that exercise after eating interferes with the process of digestion. Observe just how much was proved by the experiment. Two dogs were fed to the full, and while one was left to lie still, the other was made to run about very briskly. In an hour or two both dogs were killed, and it was found that the food was well digested in the dog that remained quiet, but not in the other. (I have seen it stated the reverse.) This proves simply that _violent_ exercise, taken _immediately_ after eating, interferes with digestion. Other facts show that light exercise rather promotes than impedes the process, and that even very strong exercise does not interfere with it if a short interval of rest be allowed, so that the process may be fairly commenced. "The same is to some extent true of exercise of mind. It seems to be necessary that there should be some measure of concentration of energy in the stomach for the due performance of digestion, and any very decided exercise, bodily or mental, tends to prevent this. In the dyspeptic, even a slight amount of effort, either of body or mind, often suffices to do it. "It is very commonly said that it is wrong to eat just before going to bed. Is this true? Cattle are apt to go to sleep after eating fully. Do sleep and digestion agree well in their case, and not so in the case of man? In some seasons of the year the farmer takes his heartiest meal at the close of the labors of the day, and soon retires. Is this a bad custom? Our opinion is that food may be taken properly at a late hour, provided, first, that the individual has not already eaten enough for the twenty-four hours,--that he has done so being true, probably, in most cases; and provided, secondly, that he is in such a state of health that digestion will not so act upon his nerves as to disturb his sleep. If it will thus act, it is clear that he had better be disturbed when awake, for he can bear the disturbance then with less of injury to his system." ANCIENT DIET. "How did them old _anti-delusion_ fellows live?" once asked an honest old farmer of the writer. "They must have lived differently than we live, or they would not have told so many years as they did." True, true. The difference between ancient and modern diet is remarkable. The ancient Greeks and Romans used no tea, coffee, tobacco, chocolate, sugar, lard, or butter. They had but few spices, no "nutmeg, cinnamon, ginger, or cloves," no Cayenne pepper, no sage, sweet marjoram, spinach, tapioca, Irish moss, arrow-root, potato, corn starch, common beans; no oranges, tamarinds, or candies, or the Yankee invention, "buckwheat cakes and molasses." What would our modern cooks do without the above enumerated articles in the culinary department? And the butter! Down to the Saviour's time butter was unknown. Dr. Galen (130-218, A. D.) saw the first butter only a short time before his death. Tea is comparatively a modern introduction. THE GREEN GROCERY OF THE CLASSICS. The cabbage has had a singular destiny--in one country an object of worship, in another of contempt. The Egyptians made of it a god, and it was the first dish they touched at their repasts. The Greeks and Romans took it as a remedy for the languor following inebriation. Cato said that in the cabbage was a panacea for the ills of man. Erasistratus recommended it as a specific in paralysis. Hippocrates accounted it a sovereign remedy, boiled with salt, for the colic. And Athenian medical men prescribed it to young nursing mothers, who wished to see lusty babies lying in their arms. Diphilus preferred the beet to the cabbage, both as food and as medicine,--in the latter case, as a vermifuge. (Horace Greeley prefers the latter, for he says that "a cabbage will beat a beet if the cabbage gets a-head.") The same physician extols mallows, not for fomentation, but as a good edible vegetable, appeasing hunger and curing the sore throat at the same time. The asparagus, as we are accustomed to see it, has derogated from its ancient magnificence. The original "grass" was from twelve to twenty feet high; and a dish of them could only have been served to the Brobdignagians. Under the Romans, stems of asparagus were raised of three pounds' weight, heavy enough to knock down a slave in waiting with. The Greeks ate them of more moderate dimensions, or would have eaten them, but that the publishing doctors of their day denounced asparagus as injurious to the sight. But then it was also said that a slice or two of boiled pumpkin would reinvigorate the sight which had been deteriorated by asparagus! "Do that as quickly as you should asparagus!" is a proverb descended to us from Augustus, and illustrative of the mode in which the vegetable was prepared for the table. A still more favorite dish, at Athens, was turnips from Thebes. Carrots, too, formed a distinguished dish at Greek and Roman tables. Purslain was rather honored as a cure against poisons, whether in the blood by wounds, or in the stomach from beverage. I have heard it asserted in France, that if you briskly rub a glass with fingers which have been previously rubbed with purslain or parsley, the glass will certainly break. I have tried the experiment, but only to find that the glass resisted the pretended charm. Broccoli was the favorite vegetable food of Drusus. He ate greedily thereof; and as his father, Tiberius, was as fond of it as he, the master of the Roman world and his illustrious heir were constantly quarrelling, like two clowns, when a dish of broccoli stood between them. Artichokes grew less rapidly into aristocratic favor; the _dictum_ of Galen was against them, and for a long time they were only used by drinkers against headache, and by singers to strengthen their voice. Pliny pronounced artichokes excellent food for poor people and donkeys. For nobler stomachs he preferred the cucumber--the Nemesis of vegetables. But people were at issue touching the merits of the cucumber. Not so regarding the lettuce, which has been universally honored. It was the most highly esteemed dish of the beautiful Adonis. It was prescribed as provocative to sleep; and it cured Augustus of the malady which sits so heavily on the soul of Leopold of Belgium--hypochondriasis. Science and rank eulogized the lettuce, and philosophy sanctioned the eulogy in the person of Aristoxenus, who not only grew lettuces as the pride of his garden, but irrigated them with wine, in order to increase their flavor. But we must not place too much trust in the stories, either of sages or apothecaries. These pagans recommended the seductive but indigestible endive as good against the headache, and young onions and honey as admirable preservers of health, when taken fasting; but this was a prescription for rustic swains and nymphs. The higher classes, in town or country, would hardly venture on it. And yet the mother of Apollo ate raw leeks, and loved them of gigantic dimensions. For this reason, perhaps, was the leek accounted not only as salubrious, but as a beautifier. The love for melons was derived, in similar fashion probably, from Tiberius, who cared for them even more than he did for broccoli. The German Cæsars inherited the taste of their Roman predecessor, carrying it, indeed, to excess; for more than one of them submitted to die after eating melons, rather than live by renouncing them. I have spoken of gigantic asparagus: the Jews had radishes that could vie with them, if it be true that a fox and cubs could burrow in the hollow of one, and that it was not uncommon to grow them of a hundred pounds in weight. It must have been such radishes as those that were employed by seditious mobs of old, as weapons in insurrections. In such case, a rebellious people were always well victualled, and had peculiar facilities, not only to beat their adversaries, but _to eat their own arms_! The horseradish is probably a descendant of this gigantic ancestor. It had at one period a gigantic reputation. Dipped in poison, it rendered the draught innocuous, and rubbed on the hands, it made an encounter with venomed serpents mere play. In short, it was celebrated as being a cure for every evil in life, the only exception being that it destroyed the teeth. There was far more difference of opinion touching garlic than there was touching the radish. The Egyptians deified it, as they did the leek and the cabbage; the Greeks devoted it to Gehenna, and to soldiers, sailors, and cocks that were not "game." Medicinally, it was held to be useful in many diseases, if the root used were originally sown when the moon was below the horizon. No one who had eaten of it, however, could presume to enter the temple of Cybele. Alphonso of Castile was as particular as this goddess; and a knight of Castile, "detected as being guilty of garlic," suffered banishment from the royal presence during the entire month. It is long since the above instructive article on the "Green Groceries of the Classics," by Dr. Doran, was in print, and I think it will be new to most of my readers. I hope it will prove interesting as well as instructive. ANIMAL OR VEGETABLE DIET? Both, if considered in regard to health. With an eye to economy only, I should recommend vegetable diet. I think that poor people lay out more, in proportion, than the rich, for the purchase of animal food. They often buy extravagantly, on the credit system, purchasing on Saturday nights, when there is a rush at the stalls, and less opportunities for good bargains than when there is more time. Again, the lower classes fry their meats, losing much of their flavor and substance, by its going up chimney; or by boiling, and throwing away much of the nutriment with the water, which stewing in a covered dish would obviate. I have been into various markets, and observed the poor as they made their purchases. I have seen them count into the butcher's hand their last penny for a rib roast, a piece of pork to fry, a hind quarter of lamb to bake, or beef to boil, when a piece to stew, with nourishing vegetables, would cost far less, and return double the nutritive principle. Beefsteak, which contains seventy-five per cent. of water, is poor economy of both money and health. The flank and neck pieces are better. The more fatty and nutritive fore quarters are better than the hind quarters. Ask the Jews. Coarse vegetables, as carrots, cabbages, turnips, and potatoes, contain more nourishment than beef, though far less than the cereals, as wheat, barley, corn, and buckwheat. Beans, peas, rice, cracked wheat or hominy, cooked with meat, make a most wholesome and nourishing diet for laborers, for the sedentary, and for invalids. Meat should never be given to toothless infants. Milk, or bread and milk, is all they require until they have teeth. A cheap, innutritious regimen is scarcely conducive to longevity, any more than a stimulating and high living is contributive to that end. A great quantity of hot roast meats is objectionable. Also hot fine flour bread. Let those particularly interested in the matter see our article on bread, etc., in chapter on Adulterations. Also, as respects coarse sugar against the refined. See, also, Nutriment for Consumptives, in next chapter. XXXIII. CONSUMPTION (PHTHISIS PULMONALIS). CONSUMPTION A MONSTER!--UNIVERSAL REIGN.--SIGNS OF HIS APPROACH.--WARNINGS.--BAD POSITIONS.--SCHOOL-HOUSES.--ENGLISH THEORY.--PREVENTIVES.--AIR AND SUNSHINE.--SCROFULA.--A JOLLY FAT GRANDMOTHER.--"WASP WAISTS."--CHANGE OF CLIMATE.--"TOO LATE!"--WHAT TO AVOID.--HUMBUGS.--COD-LIVER OIL.--STRYCHNINE WHISKEY.--A MATTER-OF-FACT PATIENT.--SWALLOWING A PRESCRIPTION.--SIT AND LIE STRAIGHT.--FEATHERS OR CURLED HAIR.--A YANKEE DISEASE.--CATARRH AND COLD FEET, HOW TO REMEDY.--"GIVE US SOME SNUFF, DOCTOR."--OTHER THINGS TO AVOID.--A TENDER POINT. Phthisis Pulmonalis is consumption of the lungs, which is the common acceptation of the term consumption. _Phthisis_ is from the Greek, meaning _to consume_. This fearful disease, from the earliest period in the history of medicine to the present day, has proved more destructive of human life than any other in the entire catalogue of ills to which frail humanity is heir. In Great Britain, one in every four dies of consumption; in France, one in five. In the United States, especially in New England, the number who die annually by this fearful disease is truly startling! One in every three! One reason for this fatality is because of the prevailing and erroneous idea that it is inevitably a fatal disease. Consumption is a relentless monster, and insidious in his approaches. He spares not the high or the low. Oftener known in the hovel, he fails not to visit dwellers in palaces. He paints the cheek of the infant, youth, maiden, the middle-aged, and the aged with the false glow of health. The delicate and beautiful are his common subjects. Tupper wrote with an understanding when he penned the following:-- "Behold that fragile form of delicate, transparent beauty, Whose light blue eye and hectic cheek are lit by the bale-fires of decline; All droopingly she lieth, as a dew-laden lily, Her flaxen tresses rashly luxuriant, dank with unhealthy moisture; Hath not thy heart said of her, 'Alas! poor child of weakness'?" Yes, the monster "Decline" seeks particularly the fair-skinned, of "transparent beauty," and those of the "light blue eye and flaxen hair," for his victims. Nor are the illiterate alone his subjects, but men of the most talented minds, men versed in arts, sciences, and _belles-lettres_, professors of hygiene and physiology, and the very practitioners of the art of medicine themselves, are often the shining marks of the insidious monster whom they by erudition diligently seek to repel. Because of the too prevalent belief of the invincibleness of consumption, it has been neglected more than any other disease. The victims to its wiles have hoped against hope, while the enemy has woven his web quietly and flatteringly around them. You must first be warned of his earliest aggression. SIGNS OF HIS APPROACH. He is a deceiver. Let us be wary of him. We have been too negligent in this matter. Let us remember that prevention is far better than cure. The slight fatigue on the least exertion we have counted as "nothing." The hectic flush of the cheeks is too often mistaken for a sign of health. The cursory pains of the chest, or left side, or under the shoulder-blades, are disregarded, or, if noticed at all, are mentioned as though "of no account." The slight hacking cough is scarcely heeded; for do not people often cough without having consumption, and without raising blood? True, true; and this is the stronghold of the deceiver. Consumption is a disease which is not entirely confined to the lungs. It is often a depraved condition of the system, particularly the blood. There is a "consumption of the blood," and a variety of morbid phenomena, which cannot be expressed in the single word consumption. It not unusually results in a scrofulous predisposition. An hereditary predisposition may or may not be the cause. If the former, its development must depend upon some exciting cause, which will be mentioned hereafter. The intermarrying of persons of like temperaments and constitutional dispositions inevitably results in children of scrofulous and consumptive diathesis. [Illustration: A NATURAL POSITION.] [Illustration: AN UNNATURAL POSITION.] A neglected cold, cough, or catarrh may soon develop this fatality. The peculiar changes in females at certain periods of life often awaken the slumbering enemy. Teething in infancy not unfrequently develops the scrofulous element, and a wasting of the system--either _marasmus_ or _tabes mesenterica_--follows, which, under the best treatment, may prove fatal. The slip-shod, doubled-up way that many people have of lying, sitting, and standing, are conducive to consumption. Badly-ventilated school-houses have heretofore been a source of great injury to children, developing scrofula and consumption in constitutions where it might have remained latent during their lifetime. Every reflecting parent should rejoice in the improvements which have been made during the last few years in the matter of ventilation in buildings, particularly in churches and school-rooms, although janitors, porters, and teachers have as yet too limited ideas on the subject of wholesome air. The dry furnaces are a very objectionable feature, and not conducive to health. _Early Symptoms._--Fatigue on the least exertion; a languid, tired feeling in the morning; rosy tint of one or both cheeks during the latter part of the day, caused by unoxygenized blood rushing to the surface; swelling of the glands of the neck, or elsewhere; enlarged joints; paleness of the lips; areola under the eyes; sensitiveness to the air; chills running over the body; taking cold easily; catarrhal symptoms; premature development of the intellect; and early physical maturity, are among its initiatory indications. Also, when the disease is located in the lungs, spitting of white, frothy mucus, or blood, with catarrhal symptoms; cough, which is noticed by others before by the patient; hacking on retiring, or early in the morning; varied appetite; tickling in the throat; short breath on exertion, with rapid pulse. _Second Stage._--Cough, and difficult breathing; increased difficulty of lying on one side; sharp, short pains; diminution of monthly period; swelling of the lower extremities, leaving corrugation on removing the hose and garters at night; raising greenish yellow matter, with (at times) hard, curd-like substance; sweating easily (sometimes the reverse); night sweats; restless, feverish, either dull or sharp bright cast to the eyes. Sputa increases to the _Third Stage._--Diarrhoea not unusually supervenes; spitting of blood; the person emaciates rapidly; the face changes from a bloated to a cadaverous appearance, with hectic fever; the patient faints easily; debility increases with the cough, or hæmoptosis occurs often, until death finally closes the scene. These are merely some of the external symptoms. Let the patient mark them, not so much to fear, as to provide against them. To be forewarned is to be forearmed. I caution you against the causes, and give you the benefit of my extensive experience with this disease, both in New England and three years in the South, that you may avoid its development by attention to rules for health and longevity. If this fearful disease was better understood by the people, it would prove far less destructive of human life. Undomesticated animals do not die of it; domesticated ones do. What does that imply? That the people have engendered the disease! Let the "people," then, take the first step in preventing its ravages. THEORY OF CONSUMPTION. At a sitting of the Academy of Medicine at London, Dr. Priory read a paper on the treatment of phthisis, in which he developed the following propositions:-- 1. Pulmonary phthisis is a combination of multifarious variable phenomena, and not a morbid unity. 2. Hence there does not and cannot exist a specific medicine against it. 3. Therefore neither iodine nor its tincture, neither chlorine, nor sea salt, nor tar, can be considered in the light of anti-phthisical remedies. 4. _There are no specifics against phthisis, but there are systems of treatment to be followed in order to conquer the pathological states which constitute the disorder._ 5. In order to cure consumptive patients, the peculiar affections under which they labor must be studied, and appreciated, and counteracted by appropriate means. 6. The tubercle cannot be cured by the use of remedies, but good hygienic precautions may prevent its development. 7. The real way to relieve, cure, or prolong the life of consumptive patients, is to treat their various pathological states, which ought to receive different names, according to their nature. 8. Consumption, thus treated, has often been cured, and oftener still life has been considerably prolonged. 9. Phthisis should never be left to itself, but always treated as stated above. 10. The old methods, founded on the general idea of a single illness called phthisis, are neither scientific nor rational. 11. The exact diagnosis of the various pathological states which constitute the malady will dictate the most useful treatment for it. PREVENTIVES OF CONSUMPTION. If a man desires a house erected, he consults a carpenter, or if a first class residence, he employs an architect. If our watch gets out of repair, we take it to a skilful jeweller. If our boots become worn, want tapping, they are sent to the cobbler. But how many people there are, who, when the complicated mechanism of the system gets out of order,--which they cannot look into as they can their watch or old boots,--first try to patch themselves up, instead of employing a professional "cobbler of poor health and broken constitutions." Before me are Wistar's, Wilson's, and Gray's Works on Anatomy. I have read them, or Krause's, more than twenty years. They contain all that has been discovered relative to the human system. But I do not know it all. I never can. I doubt if the man lives who knows it all. Then here is "Physiology," which treats of the offices or various functions of the system. I do not comprehend it all. "Great ignoramus!" Nobody is perfected in it. Next is Pathology, which treats of diseases, their causes, nature, and symptoms. Then there are Materia Medica, Chemistry, and much more to be learned before one can become competent to prescribe for diseases safely. [Illustration: CORRECT POSITION.] [Illustration: INCORRECT POSITION.] Can a carpenter, or any mechanic, a lawyer, minister, or other than he who devotes his whole powers to the theory and practice of medicine, be intrusted with the precious healths and lives of individuals, about which he knows little or nothing? Or can I, in a few chapters, instruct such in the art of curing complicated diseases? O, no, no. But I can do something better for such. I can tell you how to avoid diseases. I am quite positive of it. I should wrong you, and endanger your lives by the deception thus put forth. There are some books written on the subject which are useful to the masses in the same manner in which I trust this will prove, by instructing in the ways of health, and warnings against that which is injurious; but there are far too many issued which are but a damage to the public by their false claims of posting everybody in the knowledge of curing all diseases, particularly that complicated one termed consumption. Among the preventives of this fell destroyer I enumerate,-- _First_, Plenty of God's pure, free air; and _second_, sunshine. These are indispensable. He who prescribes for a patient without looking into this matter has yet to learn the first principle of the healing art. A lady recently came to my office with her son for medical advice. She was a robust, matronly looking individual, who might turn the scale at one hundred and eighty pounds, while the twelve-year-old boy was almost a dwarf, pale and delicate. The contrast was astounding. "Madam," I said, "I perceive that your son sleeps in a room where no sunshine permeates by day;" for I could liken the pale, sickly-looking fellow to nothing but a vegetable which had sprouted in a dark, damp cellar. A gardener can tell such a vegetable, or plant, which has been prematurely developed away from air and sunshine. And though she looked astonished at my Oedipean proclivity in solving riddles, it was nothing marvellous that a physician should detect a result in a patient which a clodhopper might discover in a cabbage. "Yes, sir," she finally answered, "he always sleeps in a room where the sunlight don't enter; but I did not think it was that which made him so pale-like; besides, I have taken him to several doctors, and they said nothing about it; but their prescriptions did him no good, and I am discouraged." Such stoicism was unpardonable, but I said in reply,-- "Take your son into a light airy room, to sleep. Try a healthy plant in the cell where you have so wrongfully intombed him, and observe how speedily the color and strength will depart from it. When you can come back and assure me of his change of apartment, I will prescribe for him." She went away, repeating to herself, as if to impress it firmly upon her mind,-- "Put a plant into his room--plant into Johnny's room." The lady afterwards returned, saying that she was sorry that the plant had died, but was glad to say that Johnny was better. It is a daily occurrence for physicians to see patients who are dying by inches from the above cause; nor are they the low foreigners alone, but, like my stoical one hundred and eighty pounder, of American birth, and without excuse for their ignorance. Do not sleep or live in apartments unventilated, or where the life-giving sunshine does not penetrate during some portion of the day. It is living a lingering death. If the patient is scrofulous, let him or her employ such remedies as are known to remove the predisposition, or seek aid from some physician who has cured scrofula. The regular practitioner seldom desires such cases. One who has devoted much time to scrofula and chronic diseases should be preferred. I think chronic practice should become a separate branch in medicine as much as surgery is fast becoming. Take the disease in season. Do not neglect colds, coughs, and catarrh. Persons of a low state of blood, who are weak and debilitated, should wear flannels the year round--thinner in summer than in winter; keep the feet dry--avoid "wafer soles,"--and the body clean, but beware of what Artemus Ward termed "too much baths." Employ soap and a small quantity of water, with a plenty of dry rubbing, till you get a healthy circulation to the surface. Mothers, see to the solitary and other habits of your daughters. Fathers, instruct your sons in the laws of nature, and of their bodies. Do you understand? See our youth swept off by the thousands annually, for want of proper care and instruction!... A JOLLY FAT GRANDMOTHER. "_Wasp Waists._"--This is what I heard a fine-looking though tobacco-sucking gentleman utter, as with his companion he passed two young and fashionably dressed ladies on the street recently. [Illustration: HOW WASP WAISTS ARE MADE.] So I fell into a reverie, in which I called up the image of a fat, jolly old lady whom I knew as my "grandmarm." She had a waist half as large around as a flour barrel. "O, horrid creature!" exclaims a modern belle. But, then, my grandmother could breathe! You cannot--_only half breathe_! And my "grandmarm" had a fresh color to her cheeks and lips, and a good bust, till she was over sixty years of age, and she lived to be almost a hundred years old. You won't live to see a third of that time. Did our grandfathers or mothers die of consumption? O, no. Still they lived well--mine did. When I see a modern mince pie, it quickly carries my mind back to childhood days, when I think of a little boy who thought grandmothers were gotten up expressly to furnish nice cakes and mince pies for the rising generation. O, but she was jolly--and so were her pies! An Irish blunderer once said, "Ah, ye don't see any of the young gals of the present day fourscore and tin years ould;" and probably we should not see many of our present "crop" if _we_ should survive that age. Drs. A., B., and C., tell me how many ladies who visit your offices can take a full, deep breath. "Not one in a score or two!" So I thought. [Illustration: A CONSUMPTIVE WAIST. CAUSE, TIGHT CORSETS.] [Illustration: NON-CONSUMPTIVE WAIST. NEVER WORE CORSETS.] Lungs which are not used in full become weak and tender. Do you have sore places about your chest? Practise inflating your lungs with pure air through the nostrils,--where God first breathed the breath of life,--and give room for the lungs to expand, and the "sore places" will all disappear after a time. See my article on breathing. Put it into steady, moderate practice, and the result will be beneficial beyond all conception. CONSUMPTION IS CURABLE. "Is it true that consumption of the lungs is ever cured?" is a question which is often seriously asked. "O, yes," I reply. "What are the proofs?" Where on dissection we find cicatrices,--places in the lungs where tubercles have existed, sloughing out great cavities, which have healed all sound, the scar only remaining--what then? Here is positive proof that consumption had been at work, was repelled by some means, and the patient had recovered, subsequently dying of some other disease, or from accident. Such is the fact in many cases. It is an error--fatal to thousands--to suppose that the lungs, of all substance in the body, cannot be healed. Yet it is a fact patent to most educated physicians, that many cases of consumption are cured in this country, while others are prolonged, and the patient made comfortable during many years. Change of climate may be much towards saving a patient. Before deciding upon such change, consult your physician. Ought not he to know best? A climate adapted to one constitution may be quite unsuited to another. What a wise provision in Providence in giving this little world a variety of climates! There are certain portions of the States and world where consumption seldom prevails. The climate of California and the western prairies, as also some portions of the South away from the coast, is less conducive of lung and throat diseases than the more bleak and changeable climate of New England and the Northern States. A change is only beneficial in those cases where there is a mere deficiency of vitality in the system. If the disease depends upon a scrofulous or other taint in the system, one gains little by going from home. Change of climate does not alter the condition of the system materially, so much as it relieves one from atmospheric pressure, reducing thereby the demands upon his small stock of vitality,--just as some places are less expensive in which to live, and your funds hold out longer. The writer resided in the Southern States during three cold seasons, and carefully studied the effects of changes. He has two brothers in California, who, during the past ten years, have often written respecting the climate west of the Rocky Mountains. If ever called upon to decide on a climate for a friend or patient who had determined to change from this, I would advise him, or her, to select California. Do not change too late! going away from home and friends to die among strangers.... AVOID HUMBUGS. Do not run to clairvoyants and spiritual humbugs for advice. A clairvoyant physician once said to me,-- "Mr. So-and-so has just called upon me to learn where he shall spend the winter. He thinks he has the consumption, and that I can tell him where he will pass the winter safely. What confounded fools some of these men are, to be sure!" she exclaimed. "Why, I have got that disease myself (not the foolish disease, but consumption), and don't know what to do to save my own life." That lady is living in Boston to-day. The gentleman went to St. Thomas, dying in the hospital in January, amongst strangers, where every dollar he possessed was stolen from him. Nearly all patent medicines are humbugs. Avoid them. Dr. Dio Lewis says that "the bath-tub is a humbug." I believe him. While you avoid drowning inside by pouring down drugs, do not exhaust your vitality externally in a bath-tub. The hand-bath is all-sufficient for consumptives. COD-LIVER OIL AND WHISKEY. "Take cod-liver oil and die!" has become proverbial. The oil is utterly worthless as a medicine, and the whiskey usually recommended to be taken in connection is decidedly injurious. It is poisonous. I defy one to obtain a pure article of whiskey in this country. If it could by any means be obtained in its purity, it would not cure this disease any more than the nasty oil from fishes' livers. The oil is often given, not as a medicine, but as an article of nourishment. If the patient so understands it, all right; it will do no harm; but if he thinks that he is taking a remedial agent, he is deceived thereby, and losing the precious time in which he ought to be employing some remedy for his recovery. The statements that cod-liver oil contains iodine, lime, phosphorus, etc., is all bosh. A most reliable druggist of this city, who has sold a _ton or two_ of the oil, told me that "all the iodine or phosphorus that it contains you might put into your eye, and not injure that organ." If good, wholesome bread, butter, milk, eggs, and beef, will not give nutriment to the wasting system, cod-liver oil will not, and the patient must die--provided he has trusted to nutriment alone. I have never known a consumptive patient to recover upon cod-liver oil. I have known them to recover by other treatment, particularly by the use of the phosphates, as "phosphate of lime," and iron, soda, and other combinations. I have intimated that a patient should be advised by "his physician;" but if that physician is one of the old-fogy style who insists upon cod-liver oil and whiskey as a cure, why, you had better "change horses in crossing a river," than to perish on an old, worn-out hobby! There are two classes of patients which the doctor has to deal with; one will follow no instructions accurately, the other swallows everything literally. I remember a story illustrative of the latter. A dyspeptic applied to Dr. C. for treatment. The doctor looked into the case, gave a prescription, telling the patient to take it, and return in a fortnight. At the designated time he returned, radiant and happy. "Did you follow my directions?" inquired the physician. "O, yes, to the letter, doctor; and see--I am well!" "I have forgotten just what I gave you; let me see the prescription," said the doctor, delighted at his success. "I haven't it. Why, I took it, sir." "Took it--the medicine, you mean," explained the man of pills and powders. "Medicine? No. You gave me no medicine--nothing but a paper, and I took that according to directions. That's what cured me." The clown had swallowed the recipe! The consumptive requires nourishment. He must derive it from wholesome food,--even fat meats are beneficial,--not from medicines. Let food be one thing, medicine another. I believe that a man would starve upon cod-liver oil. He would not upon bread or beef. SIT AND LIE STRAIGHT. Go into one of our school-houses, and you may there see subjects preparing for consumption. Our illustrations will give the reader a correct idea of our meaning, without any explanation. The sewing-machines, or rather the position which many girls assume while sitting at their work by them from three to twelve hours a day, tend to depression of the lungs, obstruction of circulation, reduction of the vitality, dyspepsia, and sooner or later lead to consumption. [Illustration: A HEALTHY POSITION.] Let everybody when walking stand erect, with shoulders slightly thrown back rather than inclined towards the chest, then outward, and keep the mouth closed. When sitting, keep the body erect, or lean back slightly, resting the shoulders, rather than the spinal column, against any substance excepting feathers, changing the limbs from time to time to any easy position. If tired, and one can consistently "loll," recline to one side, resting the cheek upon the hand. If one is very tired, and desires to "rest fast," sit with the feet and hands crossed or arms folded. [Illustration: A CONSUMPTIVE POSITION.] If you lie crooked in bed, do it on the side. "To bend up double, man never was made," says the song. Do not bolster up the head so as to get a square look at your toes, or, being in a feather bed, till you resemble a letter C. Rather use but one light curled-hair pillow. It is cool and healthy. Avoid feather beds and pillows. "Didn't your 'grandma sleep during nearly a hundred years' on a feather bed?" My quizzer has returned, peeped over my shoulder, and asked this question. Now see me quench him at a swoop. "Yes, she did; and I think it probable that if she had not she would have been living now. My grandmother's good habits, free use of muscle, sunshine, and air, more than offset the use of mince pies, and the evil of sleeping on a feather bed in winter." I sleep on a hair mattress and pillow the year round. They are the best. CATARRH AND COLD FEET.--HOW TO CURE BOTH. Catarrh is peculiarly a Yankee disease. Now, how does a Yankee differ in his habits from the rest of the world's people? Let me tell you wherein he differs. The "five minutes for refreshments" is an illustration. He hurries, he rushes, he's a talker; and having hurried unnecessarily, and got himself all in a perspiration, he stops to talk with a friend on the street, in a current of air, possibly in a puddle of water, the consequence of which is checked perspiration, a cold, the catarrh. If the circulation to the skin is checked, that excretory organ ceases to throw off the waste and worn-out matter of the system, and the work is thrown upon the mucous membrane, which if failing to perform the unnatural office, the patient goes into a decline. Set this down as reason No. 1 for the catarrh being peculiarly a "Yankee disease." Chronic catarrh necessarily must be connected with a bad circulation of the blood, a want of action in the skin, and usually with cold feet. I must take time to explain these causes of a disease which usually leads to the more fatal one--consumption. Now we have cold feet and loss of action in the skin. Result, catarrh, terminating fatal in consumption. To keep the feet warm is to restore the circulation. Has your doctor failed to do this? I fear he did not understand the connection, or the patient did not follow his instructions. Dip the cold feet into a little cold water! Is that "too homeopathic?"--cold to cure cold! Never mind, do it. It feels cold at first. Well, catch them out, rub them vigorously with a towel, then with the hands, and when quite red, cover them up in bed, or in stockings and boots. Repeat it daily till cured. Wear thick-soled boots and shoes always. Meantime, take a dose of the third dilution of sulphur mornings, or at ten A. M., and the third trituration of calcarea-carbonica at early bedtime. To restore the loss of circulation to the skin, meantime--for they must both be cured together--take a daily hand-bath; that is, with the hand and in a comfortable room, apply a dose of castile or Windsor soap to the skin, half of the person at a time, if the weather is cool,--avoiding a current of air,--then, with cool or cold water, _and the hand only_, wash rapidly over the surface, following quickly with a dry towel and the dry hand, till warm. Cover the upper extremity, and proceed to wash the other portion of the body in the same manner. I really believe that there are individuals with such peculiar temperaments, or low state of the blood, that they cannot bear cold water. See to it that it is not fear, or habit, which prevents its use, before abandoning a remedy of such curative powers. Now, there is no other way under heaven whereby man can be saved from catarrh than this which I have here given. If the patient requires further medical treatment, he or she surely requires this, else there is no catarrh in the case. "But can't you give me some snuff, doctor?" Snuffs and nasal injections are humbugs. They will not cure a chronic catarrh. The sugar and gum arabic powder is excellent for the local irritation. That is all any local remedy can reach. Thousands of dollars are expended annually for "Catarrh Remedies," which never cured a case yet, but have been the death of thousands, by aggravating and prolonging the disease. Indigestion and "a goneness at the stomach" not unusually accompany the above disease. In addition to the instructions here given, rubbing and slapping the region of the stomach with water and the hand, and taking small quantities of extract gentian, orange-peel, dock, and ginger, equal parts, twice daily, following the directions regarding slow eating and cheerfulness, will eventually remove the distressing disease. OTHER THINGS TO BE AVOIDED. For consumption, the old-fogy treatment by squills, ipecac, laudanum, and the host of expectorants, is worthless. One of the fatalities in this disease has been the sticking to these useless medicines by a certain class of physicians and patients. Use no tobacco. If tight-lacing and confined habits, as want of air and exercise, have been conducive to the development of consumption in females, more repulsive habits have led to catarrhal affections, destruction of the vitality, and finally to consumption in many of the opposite sex. Does the mother, by habits which injure her health, jeopardize the life and health of her offspring? The husband and father, by the debasing and health-destroying habit of tobacco-using, injures both mother and child. The description which I have given in the article on tobacco, respecting cleansing the young man, and purifying him fit for society, is no joke! The clothes, skin, blood, muscle, and bones,--even the seminal fluid,--of the confirmed tobacco-user, all are impregnated with tobacco poison. Does any one question but something of this virus is transmitted to the offspring? Further, I have known many a wife to become tobacco-diseased,--nervous, yellow, sick at the stomach, dyspeptic, neuralgic, etc.,--suffering untold horrors, from lying, night after night, during year in and year out, beside a great, filthy, tobacco-plant of a husband! Perhaps some sensitive gentleman--user of the weed of course--may object to my way of putting it. Sound truths, like sound meat, require no mincing. We know that children, sleeping constantly with elderly people, become prematurely old and infirm. We know also that nurses and others, sleeping with perpetual invalids, imbibe their diseases. The skin of the tobacco-user is continually giving off the tobacco poison--_nicotine_--and the more susceptible skin of the female, or child, by its absorbent powers, is as continually taking in this poison. There are many tobacco-users, who, if they knew this fact, would for this reason, if no other, abandon the injurious and sinful habit; would not want to continue a habit--be it never so slavish--which, aside from its injury to themselves, was destroying the health and lives of his wife and his children. Tobacco exhausts the saliva, the fluids, the blood, often the muscle, _and destroys the recuperative powers of the human system_. It weakens the power of the heart. Nine tenths of the reported deaths from "heart disease" really originate, or result directly from the effects of tobacco-using. And, finally, it destroys the good effects of nearly all medicines. I positively affirm that no patient afflicted with a chronic disease can recover by the use of medicines if he continues the excessive use of tobacco. I think these are good and conclusive reasons why one should not use that pernicious weed--tobacco. Avoid all excesses, particularly of coition. Consumptives should husband all their resources. One other way of doing this is to keep from wasting the breath and caloric of the system through the mouth. Again, I say, breathe only through the nostrils. Keep out of crowded and unventilated halls, school-rooms, churches, and houses. Air! air and sunshine! don't forget them. Avoid patent medicines. They are worthless. Even if one in a thousand were adapted to the _disease_ in question, it might not be to the peculiar constitution of the invalid. People are so differently constituted that one kind of food, clothing, or medicine cannot be adapted to all. I wish that I could tell every reader of these pages what remedies are adapted to persons suffering from not only consumption, but from a hundred other diseases. But it is impossible, as intimated in the fore part of this chapter. Not only the quality of a medicine suited to one constitution may not be at all suited to another, but the quantity is even as uncertain. It requires much knowledge and long experience in the disease, and its various peculiarities, as also of the varied constitution and idiosyncrasies of different patients, in order to prescribe successfully. As the majority of the readers of this work are predisposed to consumption, let them seek to prevent its development in their systems. The writer has done this; he has told you in plain terms how it was done, how it still can be; but it is you who must believe in and abide by these instructions. Do this, and you will scarcely require to obtain and retain the knowledge of a thousand remedies and a complete knowledge of yourself, which it requires a lifetime of practice and study to possess. Dr. Worcester Beach, of New York, in one of his botanical works, tells of a country-woman who, having been given up as incurable with consumption, gathered and boiled together all the different kinds of herbs and barks which she could find upon the farm, and making this decoction into a syrup, drank of it freely, and was cured thereby! I would not recommend this empirical sort of practice, but quote it to show the uncertainty of what medicine was adapted to the case. [Illustration] XXXIV. ACCIDENTS. RULES FOR MACHINISTS, MECHANICS, RAILROAD MEN, ETC., IN CASES OF ACCIDENT.--HOW TO FIND AN ARTERY AND STOP THE BLEEDING.--DROWNING; TO RESTORE.--SUN-STROKE.--AVOID ICE.--"ACCIDENTS WILL HAPPEN."--WHAT TO HAVE IN THE HOUSE.--BRUISES.--BURNS.--DO THE BEST YOU CAN, AND TRUST GOD FOR THE REST. Mechanics, machinists, railroad men, etc., may find the following rules of the most vital importance in case of accidents, whereby valuable lives may be saved:-- 1. When a person is seriously injured, do not crowd around him; give him air. 2. Send for a surgeon or physician at once. [Illustration: FIG. 1.] 3. Lay the patient on his back, and ascertain whether he is bleeding. If it is from the artery of the fore-arm, it must be compressed immediately. If from the _artery_, the blood will _spurt out in jets_. Do not try to stanch the blood at the wound, but find the main artery. Strip the arm, feel for the artery, a little below the arm-pit, _just inside_ of the _large muscle_. (Fig. 1.) _You can feel it throb._ Press it with your thumbs or fingers, while an assistant folds a large handkerchief, or piece of shirt, if necessary, and ties a knot in the middle, or places a _flat_, _round_ stone in it, puts this over the artery, ties the handkerchief below the thumbs, puts a stick through, and twists it just tight enough to stop the bleeding. (Fig. 2.) The first man may relax his grasp, to ascertain if the compress is sufficiently tight. If you get the knot (or stone) on the artery, a few twists will check the blood. If the limb becomes cold and purple, you have got it too tight. One end of the stick may be tucked under the bandage to hold it from untwisting. The surgeon will arrive and take up the bleeding vessel and tie it. [Illustration: FIG. 2.] 4. If it be the leg which is cut or mangled and bleeding, find the artery, inside the thigh, quite high up, back of the large muscle. (Fig. 3.) Bear on quite hard, for it is deeper than in the arm, till you feel it throb. Compress it hard, and proceed with the bandage as above directed for the arm. The large artery (femoral) bleeds fast. Work quickly, and do not get excited. [Illustration: FIG. 3.] A schoolmate of mine died in a few moments, in a blacksmith shop, from a piece of steel flying into his leg. If the smith had known this simple process, stripped the boy, and compressed the artery till help arrived, he would have saved a life, an only son, the support and solace of a widowed mother. 5. If the wound is much below the knee, find the artery (Fig. 4.) in the hollow back of the knee (_popliteal space_), and proceed as above directed. [Illustration: FIG. 4.] 6. If a wound is not of an artery, that is, if the blood does not spurt out, bandaging the wound may do till the doctor arrives. 7. If the shock has prostrated the patient, give him a teaspoonful of brandy or other liquor--always provided he has not been drinking. Many accidents occur in consequence of liquor-drinking. If the patient is cold, faint, and prostrate, wrap him or her up warm, placing hot bricks, or jugs of hot water, at the feet. When he can swallow, some hot tea, or soup, may be given, if necessary. 8. If the patient has delirium tremens, give him strong coffee. 9. To remove an injured person, do not call a carriage, but take a shutter, or board, or door, throw your coats upon it, and tenderly place him thereon. Carry him carefully. Don't keep step in walking; he will ride easier without. 10. If a patient faints, give him air. Let him lie on the back. Wipe the face with a little water. A little camphor in water may be applied to the face and temples, provided he has not been using it already to excess. Camphor, used excessively, may keep one faint a long time. Let the clothes be loosened. Keep cool, and wait. 11. Avoid all rude and alarming conversation around the patient. When he recovers a little, do not press around and confuse him with questions of "What can I do for you?" etc. _Let him rest._ 12. If a person has been under water, _don't roll him to get the water out of him. There is no water there beyond the mouth._ The life has been rolled out of many a poor wretch, over a barrel, under this foolish delusion of "getting the water out of him." Lay him on his side, in a warm room, or in the sun. Try to inflate the lungs. Don't get a "bellows," and blow him full of wind. He is not like a bladder, or a balloon, that he needs inflating thus. To breathe is what he needs. Let the water, if any, in the mouth, run out. Wrap him warm--hot water at feet. Rub the limbs, if cold, for a long time. Persevere. Do not give him up until a good physician has arrived, and pronounced him beyond all hope of recovery. SUN-STROKE (COUP DE SOLEIL). The "ounce of prevention" must first be considered in this case. 1. All who can should keep in the shade during the extreme heat of the summer days. You who must "bear the heat and burden of the day" may not be able always to avoid the direct rays of the scorching sun. Wide-rimmed palm or straw hats should be worn, and when the noonday sun pours down its sultry beams, wet the hair, or keep a green leaf, or wet handkerchief, in your hat. This will surely prevent sun-stroke, by the evaporation of moisture. If away in the field, swinging the scythe, or with spade levelling the "everlasting hills," and no water is near, place some green grass or damp earth in the hat,--any way to avoid sun-stroke and sudden death! 2. You will see, every summer, a paragraph in the newspapers recommending the application of ice to the head in case of threatened sun-stroke, or after sun-stroke. Do not believe all you see in the papers. Just sit down and reason a moment. Think of the great, extreme transition from the powerful heat of the sun's rays on the brain to that of the application of _ice_! It requires but little thought to convince one that the extreme contrast must give such a shock to the brain (or blood therein) as nature cannot resist. Did you ever know a patient to recover from sun-stroke when ice had been applied to his head? _I think not._ I have known one to recover from warm, moist applications. Let the head be kept wet (moist) with tepid water, and covered over by a dry cloth. He cannot swallow. Do not choke him by villanous whiskey poured into the mouth. Having placed him in a warm bed, removed his clothes, and made him comfortable, send for a physician. "ACCIDENTS WILL HAPPEN." Yes, and every family should be prepared for them. 1. As a remedy against fatal results, in severe cases, and for deliverance from pain, even in smaller accidents, every family should keep in the house an ounce bottle of tincture of arnica, the cost of which is trifling. Keep it well labelled, and out of the reach of children. To drink it is injurious. 2. For a bruise, or any injury, put half a teaspoonful of the arnica into a teacupful of tepid water, and bathe tenderly the wound. Then wet a cloth in the liquid, bind it on with a dry cloth outside to exclude the air. When dry, if pain or tenderness remains, renew the application. This will soon reduce any "bump" on your little ones' heads, except a real phrenological "bump." A woman once brought a boy to my office, to have me give her some "liniment for a bad bump on the child's head," showing me the place. "Madam," I said, "I think a considerable persuasion, with plenty of patient kindness, will do more than medicine to reduce that bump. It is called, by phrenologists, 'firmness.' By the development, I should judge that the boy was very stubborn." 3. For burns and scalds, keep in the house a vial of tincture of urtica urens. Apply it to burns as above directed for wounds. When the smarting ceases, and the wound is whitish, omit it, and dress the wound with a little mutton tallow on a linen cloth. Keep no patent medicines about; then you will be less likely to be dosing with them. It is hard to tell what are good, and do not make a medical depot of your stomach to ascertain. The individual who is continually dabbling in medicines is a perpetual invalid, from the result of such everlasting dosing. If you regard the concise, yet sufficient, instructions for preserving health laid down herein, particularly after noting the hints thrown out all through the body of the book, you will annually have less and less occasion for the use of medicines. When you actually think you require a physician, get the best,--the best article is the cheapest in the end,--and abide by his counsel. I have told you of some remarkable characters in the history of medicine; but the harp and flowing locks of Apollo, the caduceus of Mercury, the staff of Æsculapius, the hoary beard of Hippocrates, the baton of De Sault, the three-tailed wig of Atkins, the silken coat and charming address of Dr. Reynolds, the gay equipage of Hannes, the library of Radcliffe, or the knowing nods and significant silence of some of the more modern doctors, will avail nothing in the time of great danger and distress. It is the truly kind-hearted, humane, and educated physician upon whom you must depend in your time of need. Seek such. There are yet many; humanity is not a thing entirely of the past. Who loses faith in humanity has lost it in God. Do the best your circumstances allow in all things,-- "Angels can no more,"-- receiving all afflictions cheerfully, looking hopefully to God for his blessing, which faileth not, in all the walks of "this life and in that which is to come." [Illustration] FOOTNOTES: [1] Small door or window, through which to receive night calls, etc. [2] The art of embalming was known, and even practised by "servants," translated or called physicians, or sometimes apothecaries (or "by his arts"), four thousand years ago. Jacob, Joseph, Asa, and others were embalmed. The Egyptians were early versed in this art, which now is almost, or entirely, lost. [3] Dover's Powder. [4] See Frontispiece. [5] This illustrates our "Origin of Ghosts." [6] An Irishman, who was once asked why the parents of Christ were obliged to lodge in a stable on the night of the Saviour's birth, replied, "And weren't the inns full of the crowd, who had gone up before to celebrate Christmas?" [7] The writer was fortunately born on Christmas (Sabbath) day. He hopes the publishers will present his picture in this book to prove his "fairness," and let the wisdom of these pages prove the remainder. [8] The medical man in quest of a curiosity will be gratified by looking on page 228 of Hastings' Surgery, where he will find the head and face of a female engraved on the nude body of a male. I discovered it accidentally, but how such an _error_ (?) could have occurred I cannot say. [9] Casa Wappy, a self-conferred, pet name of the little boy. [10] ESQUIMAUX HOSPITALITY.--Dr. Kane relates that one day, worn out by fatigue, he turned into an Esquimaux hut to get a little sleep. His good-natured hostess covered him up with some of her own habiliments, and gave him her baby for a pillow; which, Dr. Spooner says, was a living illustration of the kindness of woman. Transcriber's Notes: Passages in italics are indicated by _italics_. The original text includes the prescription symbol that is represented as [R] in this text version. 
39074	----	Internet Archive (http://www.archive.org) Note: Images of the original pages are available through Internet Archive. See http://www.archive.org/details/curiositiesofmed00milliala Transcriber's note: Text enclosed by underscores is in italics (_italics_). The original text includes Greek characters. For this text version these letters have been replaced with transliterations. Hebrew passages are indicated by [Hebrew]. Unmatched quotation marks have been left as they were in the original text. CURIOSITIES OF MEDICAL EXPERIENCE. by J. G. MILLINGEN, M.D., M.A. SURGEON TO THE FORCES; RESIDENT PHYSICIAN OF THE COUNTY OF MIDDLESEX PAUPER LUNATIC ASYLUM AT HANWELL; MEMBER OF THE MEDICAL SOCIETY OF THE ANCIENT FACULTY OF PARIS; OF THE MEDICAL SOCIETY OF BORDEAUX; AND AUTHOR OF "THE ARMY MEDICAL OFFICER'S MANUAL," &c. SECOND EDITION. REVISED AND CONSIDERABLY AUGMENTED. IN ONE VOLUME. London: Richard Bentley, New Burlington Street, Publisher in Ordinary to Her Majesty. 1839. Whiting, Beaufort House, Strand. TO SIR JAMES M'GRIGOR, BART. M.D., F.R.S., K.T.S., &c. &c. DIRECTOR GENERAL OF THE ARMY MEDICAL DEPARTMENT, TO WHOSE ZEAL AND EXAMPLE THE MEDICAL OFFICERS OF HER MAJESTY'S FORCES ARE SO MUCH INDEBTED FOR THAT DISTINGUISHED CHARACTER AND CONSIDERATION THEY COLLECTIVELY AND INDIVIDUALLY HOLD IN THE ESTIMATION OF THE EUROPEAN ARMIES, THIS WORK IS INSCRIBED, AS A TESTIMONIAL OF PUBLIC RESPECT AND SINCERE PRIVATE ESTEEM, BY THE AUTHOR. PREFACE TO THE SECOND EDITION. The rapid sale of the first edition of this work has induced the publisher to reprint it with considerable additions in a less expensive, and more concise form--and the author embraces this opportunity, gratefully to acknowledge the liberality with which it has been received, and the indulgence shown to its many imperfections. At the same time he cannot but regret, that in some quarters it has been surmised that he yielded credence to the many strange relations which he has recorded from various medical works, but which he merely narrated, to show the fallacy even of experience, and the many dangers that may arise from the most ingenious theories and doctrines, in the very ratio of their apparent plausibility. Although these sketches were not intended for the profession, yet they may prove of some utility to the pupil who commences the arduous study of medicine. They may convince him, that great names, however justly respected and renowned, do not constitute a sufficient basis, on which to rest a satisfactory and conclusive judgment; and, as Locke has justly observed, that "_reverence or prejudice must not be suffered to give beauty or deformity to any of their opinions_." He will find that of which further experience will subsequently convince him, that medical investigation is too often founded upon analogy and hypothesis--but let not this painful and disheartening impression arrest his progress, or deter him from seeking to assist his judgment by collecting "the scattered parts of truth," for in speaking of hypothesis, Dr. Crichton has thus expressed himself: "There is a period in knowledge, when it must be indulged in if we mean to make any progress; it is that period when the facts are too numerous to be recollected without general principles, and yet, where the facts are too few to constitute a valid theory. If the exterior form of an edifice is often the principal motive with men for examining its internal structure; so it is in science, that the splendour of an hypothesis, and the desire of proving its solidity, are more frequent motives for research than a mere love of knowledge." Notwithstanding our boasted progress in scientific pursuits, and our supposed approach to perfection, there never perhaps was a period, since the fanciful days of Paracelsus, Agrippa, and Van Helmont, when more deceitful and fascinating reveries were indulged in than at the present _enlightened_ moment, nor more ingenuity and disingenuousness displayed in seeking to give substance to a vision or overthrowing its baseless fabric. It is painful to be obliged to admonish the would be legislators of our belief, in the words of the sceptical Bolingbroke: "Folly and knavery have prevailed most where they should be tolerated the least, and presumption has been excused most where diffidence and candour are on many accounts the most necessary. "Quale per incertam lunam sub luce maligna Est iter in Silvis." _Hanwell Lunatic Asylum, Dec. 1838._ INTRODUCTION. The great success and correspondent utility of D'Israeli's "Curiosities of Literature," have induced me to add to the ample harvest of that ingenious writer a few gleanings from another field. They may not afford the same amusing variety to the general reader, but they may tend to draw some attention to many important points that affect the chequered lot of mankind. The progress that every science has rapidly made during the last half-century has been astounding, and seems to have kept pace with those struggles of the intellectual faculties to burst from the shackles of prejudice and error that had ignobly bound them for so many ages. Groping in darkness, man sought the light, but unfortunately the sudden refulgence at times dazzled instead of guiding his steps in the pursuit of truth, and led him into errors as perilous as those that had surrounded him in his former mental obscurity. His gigantic powers were aroused, but, too frequently misapplied, they shook the social edifice to its very foundation. The daring hand of innovation destroyed without contemplating what better fabric could be raised on the ruin: and while the nobler faculties with which Providence had gifted us were exerted for the public weal, the baser parts of our passions sought liberty in licentiousness. Ambition degenerated into ferocity, scepticism led to impiety, and even apparent virtue sought to propagate the doctrines of good, by assuming the "goodly outside" of vice. Religion was overthrown because priestcraft had deceived, and high rank was held up to detestation because princes and nobles had been corrupt; and to use Shakespeare's words, Thus we debase The nature of our seats, and make the rabble Call our cares, fears; which will in time break ope The lock o' the senate, and bring in the crows To peck the eagles. In ten short years this mighty revolution in the intellect of man took place,--in a country too that may be considered the cradle of the future weal and woe, perhaps of the universe;--in ten short years we beheld Montesquieu, Raynal, Rousseau, Voltaire, Condillac, Helvetius, beaming like rising meteors in the dark firmament, and shedding a fearful gleam on the past, the present, and the future; boldly tracking a path once trodden with groping steps by Bacon, Descartes, Hobbes, and Gassendi![1] No longer trusting in blind confidence to the scholastic rules of those dignitaries of science whose conclusions were considered sufficient to command our faith, man became sceptical and positive; doubt and disbelief were carried into every investigation; the reign of _prestiges_ was over; the former monopolists of power and of science, the two great levers of society (the more effective since their fulcra rested on timidity and ignorance), were thrown from their antiquated stand, and found themselves brought face to face in explanatory contact with their once all-believing and obedient pupils, but now become a neoteric generation;--the crown and the sceptre, the cap and the gown, were baubles in their eyes. When the faculty of reasoning was not able to prevail, the shafts of ridicule were drawn from the quiver of philosophic wit, and inflicted rankling wounds where they could not destroy. Ancient systems were exploded with ancient prejudices, theories were overthrown with dynasties, and doctrines with governments;--one might have imagined that the formidable power of steam had been communicated to the mind, illustrating the words of Milton, The mind is its own place, and in itself Can make a heaven of hell, and hell of heaven. Science, now aimed at generalization-the physiologist, the chemist, became legislators, stepping from the academic chair to the senatorial seat, and from teaching how to benefit mankind they hurried to destroy, forgetful, in their ambitious dream, of the noble encomium of Cicero, "_Homines ad deos nullâ se proprius accedunt, quam salutem hominibus dando_." Philosophy and the study of medicine were now inseparable; this generous science was not to be attained in books only, but in the study of mankind. Rousseau thus spoke of physicians when writing to Bernardin de Saint Pierre:--"_Il n'y a pas d'état qui exige plus d'étude que le leur; par tous les pays, ce sont des hommes les plus véritablement savans et utiles_." Voltaire was of a similar opinion when he thus expressed himself:--"_Il n'est rien de plus estimable au monde, qu'un médecin qui, ayant dans sa jeunesse étudié la nature, connu les ressorts du corps humain, les maux qui le tourmentent, les remèdes qui peuvent le soulager, exerce son état en s'en défiant, et soigne également les pauvres et les riches_." How came it then that these great observers did not partake of the prejudices of Montaigne, Molière, and other writers, who invariably stigmatized the practice of physic? simply because it was no longer a dogmatic profession exercised with scholastic pedantry, but a science founded on the study of nature, and the immutable laws of sound philosophy. Although a classic education forms an indispensable part of a physician's education, yet it is in more important pursuits that his experience should be obtained: the knowledge of ancient languages is principally useful in discovering the errors of the olden writers, and in detecting the barefaced plagiarisms of the moderns. Much valuable time, however, may be lost in the pursuit of ancient lore; and Montaigne has justly observed, "There are books which should only be read, but others that must be learnt." This discrimination is of the utmost importance; for it may be said of the bookworm's library, "_Multitudo librorum sæpe est nubes testium ignorantiæ possessoris_." Aristippus very properly replied to a man who boasted of his reading, "It is not those who eat the most that are hale and healthy, but those who can best digest." Hence the distinction that arose between the philosophical physician and the dogmatizer. The one was guided by the observation of facts, the other by glossarial records. Men of erudition are seldom men of genius. The exploring mind is ever anxious to take flight from the prison-house of scholastic restraints. Scepticism, moreover, is frequently the result of deep study, which leads the neophyte into such a labyrinth of conflicting opinions, that decision and conviction are not easily attained. Laugier, a most learned German physician, had no faith in his profession: being reproached with his incredulity, he replied, "_Credo, Domine, adjuva incredulitatem meam_." The preceding observations lead to an important, and at the same time a painful reflection. Will this rapid intellectual progress tend ultimately to meliorate the condition of mankind? Nations have been compared to Man: having once reached the acme of prosperity and strength, their vigour like his gradually declines. History offers nothing more than a chronicle of such facts. Whatever may be the causes of this degeneracy, is a matter foreign to my present subject; although I may be permitted to observe by the way, that it may have arisen from the great disparity and inequality in the condition of society that tends to lull the wealthy into apathetic indifference and blind security in their power, while it urges the poor and the bold to rapine and destructive deeds. This perilous state can only cease to exist when general education is improved: if this most important source of real prosperity is attended to, we perhaps need not seek in particular events, gloomy anticipations of the future. Whatever may be the destinies of nations in the wreck of empires and the destruction of men, the philosopher calmly seated on ruins that often "speak that sometime they were a worthy building," reflects with pride that science has withstood the withering hand of time. It is true, that in every study errors have been heaped upon errors; but truth will often result from falsehood, and doubt that brings on investigation, leads to comparative certainty. Locke has justly observed, that the faculty of reasoning seldom or never deceives those who trust to it: its consequences, from what it builds on, are evident and certain; but that which it oftenest, if not only, misleads us in, is, that the principles from which we conclude, the grounds upon which we bottom our reasoning, are but a part--_something_ is left out which should go into the reckoning to make it just and exact. This _something_ is the constant pursuit of the philosopher. The name of a country may be obliterated from a map, the deeds of heroes be effaced from the annals of the world; the pursuit of truth can only cease when man is no more;--its light may be veiled by ignorance, craft, or cupidity,--but it cannot be extinguished. The cities that gave birth to the illustrious philosophers of old have long ceased to exist, yet the immortal works of those sages that have escaped the ravages of time, are still as fresh and luxuriant as when their glorious oratory enchanted and captivated their disciples' ears. No science has been cultivated with more difficulty than that of Medicine. The following papers will show how fearfully it has had to contend in turn with the power of priestcraft, that sought to monopolize its practice, as a privilege from the gods, and with the furious opposition of contemporary members of the profession, whose cupidity and vanity were alarmed by the introduction of novel doctrines, which they were too old, too busy, or too obstinate to learn. The extracts from Medical Literature that I have given will show that most of our modern notions were known to the earliest writers, and were only improved in succeeding ages, as in like manner our present doctrines will in all probability be advanced by future generations. The destruction of kingdoms and of chronicles, the inroads of barbarism,--the more destructive inroads of ignorance and bigotry, have not been able to produce a void in the world of science; the catenation of philosophic inquiry has never been broken in its connexions. Oppression only riveted the chain more firmly, as if to resist the united power of man and time. Adversity, which Like the toad, ugly and venomous, Wears yet a precious jewel in its head, has always been considered the best school of practical wisdom: and it is thus that, amidst the portentous events which have shaken every institution, and which perhaps still menace further dissolution, the fane of science has oftentimes been more vividly illumined by the surrounding conflagration. The evils that desolate society too frequently arise from the hasty acts of intemperate men, who deem it necessary to meet the tumultuous demands of the multitude with decided and energetic, but, at the same time, perilous measures: the progress of science, on the contrary, is gradual, and of course more likely to be eventually permanent. While political speculations are daily becoming more uncertain in their operations, the triumph of intellectual superiority over prejudice is every where apparent;--unjust disabilities are being abolished, and the gates of learning thrown open to every candidate, whatever may be his religious or his political tenets. In our country, more than in any other, industry and perseverance have ever had a fairer chance of attaining social pre-eminence, despite the shackles imposed upon the candidate for fame by institutions framed in the darker ages. What then may we not expect, when we behold the bright era that opens before us,--when exclusive institutions will be considered the obsolete remnants of expiring bigotry and intolerance! May we not indulge in the most sanguine hope, that our former glories are only the historic earnest of still more glorious days? If the spirit of the immortal Locke could hover over our earth, he would feel, with some degree of pride, that his admonitions have not been unheeded; and that "those who live mewed up within their own contracted territories, and will not look abroad beyond the boundaries that _chance_, _conceit_, or _laziness_ have set to their inquiries, but live separate from the notions, discourses, and attainments of the rest of mankind," have at last felt the necessity of yielding to the voice of reason, or rather of their own welfare. In the following work I merely rank myself as a compiler. I have only sketched--sometimes perhaps with too fanciful a pencil, subjects of great importance, which, by being thus rendered popular, may induce abler pens to imbody them in a more permanent form. The variety of matter introduced has obliged me to be discursive, and to have recourse to some repetitions that were necessary to illustrate subjects not easily abridged. Whenever I have held up errors and evil passions to exposure, I have not, in one single instance, I trust, been influenced by any hostility towards men or parties--ranks or creeds. If I have unwillingly and unwittingly given offence, I shall most sincerely lament it. My materials have been gleaned from the works of many contemporaries, whose well-known and justly-appreciated names will in general appear: but I should be wanting in candour, did I not avow that I have derived much valuable information from _Le Dictionnaire des Sciences Médicales_, an elaborate compilation, containing more "CURIOSITIES OF MEDICAL EXPERIENCE" than any existing work. _48, Eaton Square, January, 1837._ CONTENTS. Page Obesity 1 Dwarfs 9 Gigantic Races 12 Unlawful Cures 19 Voice and Speech 32 Ecstatic Exaltation 37 Varieties of Mankind 44 On the Inhumation of the Dead in Cities 54 Buried Alive 63 Spontaneous Combustion 66 Brassica Eruca 70 Cagliostro 71 Lunar Influence on Human Life and Diseases 73 Spectacles 76 Leeches 77 Somnambulism 79 Medical Powers of Music 88 The Food of Mankind 96 Influence of Imagination 125 Ancient Ideas of Phrenology 135 Perfumes 136 Love Philters and Potions 141 Ventriloquism 148 Chaucer's Description of a Physician 151 Dæmonomania 152 The Plague 164 Abstinence 185 Poison of the Upas, or Ipo 190 Homophagous and polyphagous 196 Causes of Insanity 202 Leprosy 221 The Aspic 227 Selden's Comparison between a Divine, a Statesman, and a Physician 229 The Lettuce 230 Medical Fees 231 Enthusiasm 237 Medical effects of Water 252 Proverbs and Sayings regarding Health and Disease 259 The Night-mare 262 Incubation of Diseases 266 Quackery and Charlatanism 269 On the use of Tea 277 Mandragore 281 Barber-Surgeons, and the Progress of Chirurgical Art 285 On Dreams 295 On Flagellation 312 On Life and the Blood 317 Of the Homoeopathic Doctrines 337 Doctrine of Signatures 365 Coffee 370 Aqua Tophania 374 Plica Polonica & Human Hair 377 Animal Magnetism 384 Poisonous Fishes 397 Memory & the Mental Faculties 404 Affections of the Sight 420 Hellebore 426 Sympathies and Antipathies 428 The Archeus of Van Helmont 439 Monsters 443 Longevity 453 Cretinism 472 Temperaments 476 Solar Influence 482 Sweating Fever 485 Smallpox 491 Drunkenness 507 Decapitation 516 Mummies 518 Hydrophobia 527 Rise and Progress of Medicine 534 Medicine of the Chinese 552 Experiments on Living Animals 559 CURIOSITIES OF MEDICAL EXPERIENCE. OBESITY. Various are the opinions concerning the cause of excessive corpulence. By some it is attributed to too great an activity in the digestive functions, producing a rapid assimilation of our food; by others, to the predominance of the liver: while indolence and apathy, such as is commonly observed in the wealthy monastic orders, are considered as occasioning a laxity of fibre favourable to this _embonpoint_. Boileau has thus described one of these fat lazy prelates, who Muni d'un déjeûner, Dormant d'un léger somme, attendait le dîner. La jeunesse en sa fleur brille sur son visage; Son menton sur son sein descend à triple étage; Et son corps ramassé, dans sa courte grosseur, Fait gémir les coussins sous sa molle épaisseur. It is certain that exercise, anxiety of mind, want of sleep, and spare food, are circumstances opposed to fatness. This fact is illustrated by Shakspeare, when Cæsar says to Antony, Let me have men about me that are fat,-- Sleek-headed men, and such as sleep o' nights; Yon Cassius has a lean and hungry look, He thinks too much: such men are dangerous. Antony and Dolabella were both men of some corpulence. The Roman ladies dreaded above all things too voluminous a development of the bosom: to prevent it they were in the habit of applying to their breasts the raw flesh of a fish called Angel. Hippocrates has maintained that obesity was an obstacle to conception. This assertion which was partaken by other medical writers, may, in some measure account for the dread of corpulence. Strange indeed have been the fancies on this subject amongst various nations. Fat is a fluid similar to vegetable oils, inodorous, and lighter than water; besides the elements common to water, to oils, and wax, it contains carbon, hydrogen, and sebacic acid, which is pretty similar to the acetic. Human fat, like that of other animals, has been frequently employed for various purposes. A story is told of an Irish tallowchandler, who, during the invasion of Cromwell's army, made candles with the fat of Englishmen, which were remarkable for their good quality; but when the times became more tranquil, his goods were of an inferior kind, and when one of his customers complained of his candles falling off, he apologised by saying, "I am sorry to inform you that the times are so bad that I have been short of Englishmen for a long time." Obesity may be considered a serious evil, and has exposed corpulent persons to many _désagrémens_. The ancients held fat people in sovereign contempt. Some of the Gentoos enter their dwellings by a hole in the roof; and any fat person who cannot get through it, they consider as an excommunicated offender who has not been able to rid himself of his sins. An Eastern prince had an officer to regulate the size of his subjects, and who dieted the unwieldy ones to reduce them to a proper volume. In China this calamity is considered a blessing, a man's intellectual qualities are esteemed in the ratio of corporeal bulk. There are cases on record among ourselves where unwieldiness led to estimation. The corpulent antiquarian Grose was requested by his butcher to tell all his friends that he bought his meat from him; and the paviers of Cambridge used to say, "God bless you, sir!" to a huge professor when he walked over their work. Fatness has often been the butt of jocularity. Dr. Stafford, who was enormously fat, was honoured with this epitaph: Take heed, O good traveller, and do not tread hard, For here lies Dr. Stafford, _in all this church-yard_. And the following lines were inscribed on the tomb of a corpulent chandler: Here lies in earth an honest fellow, Who died by fat and lived by tallow. Dr. Beddoes was so uncomfortably stout that a lady of Clifton used to call him "the walking feather-bed." At the court of Louis XV. there were two lusty noblemen, related to each other: the king, having rallied one of them on his corpulency, added, "I suppose you take little or no exercise?" "Your majesty will pardon me," replied the bulky duke, "for I generally walk two or three times round my cousin every morning." Various ludicrous anecdotes are related of fat people. A scene between Mrs. Clive and Mrs. Pritchard, two corpulent actresses, must have been very amusing. They were playing in the parts of Lady Easy and Edging, in the Careless Husband, when the former desires Edging to pick up a letter she had dropped; and Mrs. Clive, who might as well have attempted to raise a hundred pound weight, exclaimed, "Not I indeed, take it up yourself if you like it." This answer threw the audience into roars of laughter, when Mrs. Pritchard replied, "Well, if you won't take up the letter, I must find some one who will;" and so saying, she beckoned to a servant in the wing, who came forward and terminated the dispute. In some countries, especially in the East, moderate obesity is considered a beauty, and Tunisene young ladies are regularly fattened for marriage; a different practice from that of the Roman matrons, who starved their daughters, to make them as lean as possible on such occasions. Thus Terence, Nostræ virgines--si bono habitu sunt, matres pugiles esse aiunt, et cibum deducunt. Erasmus states that the Gordii carried their admiration for corpulence to such an extent, that they raised the fattest amongst them to the throne. It is well known that the preposterous size of some of the Hottentots is deemed a perfection, and one of their Venuses was not long since exhibited in London. There is no doubt that food materially influences this condition of mankind, although we frequently see enormous eaters who are miserably lean, and fat persons whose diet is most scanty. During the late war, a ravenous French prisoner was known to eat four pounds of raw cow-udder, ten pounds of raw beef, and two pounds of candles, per diem, diluting his meals with five quarts of porter; yet this carnivorous brute was a perfect skeleton. Amongst the many predisposing causes of obesity we may rank emasculation. An epicurean fishmonger of the name of Samuel Tull performed this operation on fishes, to render them more delicate. His curious experiments were submitted to the Royal Society. The same practice has been subsequently illustrated by Professor Dumeril. Father Charleroix informs us that Caraib cannibals had recourse to this process to fatten their prisoners before they were devoured. Anatomical pursuits are also known to occasion _embonpoint_. This has been frequently observed amongst medical pupils. Professor Mascagni attributed his corpulence to his constant attendance on dissections; he also excused his amorous propensities on similar grounds. For the cure of corpulency, diminution of food of a nutritious nature has been generally recommended; added to this, little sleep and much exercise are advised. Acids to reduce fatness are frequently administered, but have done considerable mischief. Amongst other wonderful accounts of their efficacy in such cases, it is related of a Spanish general who was of an enormous size, that he drank vinegar until his bulk was so reduced that he could fold his skin round his body. For a similar purpose soap has been frequently recommended, particularly by Dr. Flemyng. He began this experiment with one of his patients who weighed twenty stone and eleven pounds (jockey weight): in July 1754, he took every night a quarter of an ounce of common Castile soap. In August 1756 his bulk was reduced two stone, and in 1760 he was brought down to a proper condition. Darwin is of opinion that salt and salted meat are still more efficacious than soap. All these experiments, however, are in general not only useless but pernicious, and frequently prove fatal. Mr. Wadd, from whose curious work on corpulence much is extracted in this article, properly observes that, "certain and permanent relief is only to be sought in rigid abstemiousness, and a strict and constant attention to diet and exercise." Dr. Cheyne, who weighed thirty-two stone, reduced himself one-third, and enjoyed good health till the age of seventy-two. Numerous instances of the kind are mentioned, where journals of gradual reduction were kept: the following is an abstract of one of them, in the case of a person who, on the 17th June 1820, weighed twenty-three stone two pounds:-- June 17 23 stone 2 pounds. July 27 21 " 10 " September 10 20 " 7 " October 10 19 " 3 " November 10 18 " 11 " December 10 18 " 4 " December 25 18 " 1 " In another case, attended by Dr. Gregory of Edinburgh, the patient weighed twenty-three stone, and by a regular system of diet was brought down to fifteen stone. In this instance brown bread, with a certain quantity of bran in it, was employed; and it is well known that the alimentary secretions are materially altered by the quality of bread. The article of drink also requires much attention. Corpulent persons generally indulge to excess, and in this case, every endeavour to reduce them will be vain. We frequently see our jockeys reducing themselves to the extent of a stone and a half in the week. A lower scale of diet is by no means as injurious as it is generally supposed; the English prisoners made by Tippoo Saib, though kept upon a scanty pittance of bread and water, found themselves in better health than before, and some of them were cured during their captivity of liver complaints of long and severe duration. One of the most corpulent persons known was Mr. Lambert, of Leicestershire, who weighed fifty-two stone eleven pounds (14 lbs. to the stone). At Hainton, there died in 1816, Samuel Sugars, aged fifty-two; and his body, with a single coffin weighed fifty stone. In 1754 died Mr. Jacob Powell, of Stebbing in Essex: his body was above five yards in circumference, and weighed five hundred and sixty pounds; requiring sixteen men to bear him to his grave. In 1775 Mr. Spooner, of Skillington near Tamworth, weighed, a short time before his death, forty stone and nine pounds, and measured four feet three inches across the shoulders. Keysler mentions a young man in Lincoln who ate eighteen pounds of beef daily, and died in 1724, in the twenty-eighth of his age, weighing five hundred and thirty pounds. A baker, in Pye Corner, weighed thirty-four stone, and would frequently eat a small shoulder of mutton, baked in his oven, and weighing five pounds; he, however, persisted for one year to live upon water-gruel and brown bread, by which he lost two hundred pounds of his bulk. Mr. Collet, master of the Evesham Academy, weighed upwards of twenty-six stone; when twelve years old, he was nearly as large as at the time of his death. At two years of age he required two nurses to lift him in and out of bed, one of whom in a fit of anger he felled to the floor with a blow of his hand. At Trenaw in Cornwall, there was a man, known by the name of Grant Chillcot, who weighed four hundred and sixty pounds; one of his stockings could contain six gallons of wheat. Our poet Butler must have met with some such enormous creatures in the type of his Saxon Duke, who, in Hudibras, ------did grow so fat, That mice (as histories relate) Ate grots and labyrinths to dwell in His postique parts, without his feeling. If obesity has been the subject of ungenerous jokes, leanness has not passed unnoticed. An anecdote is related of a reverend doctor of a very ghostly appearance, who was one day accosted by a fellow with the following salutation: "Well, doctor, I hope you have taken care of your _soul_?" "Why, my friend?" said the divine. "Because," replied the impertinent interlocutor, "your _body_ is not worth caring for." A poor diminutive Frenchman being ordered by his Sangrado to drink a quart of ptisan a day, replied, with a heavy sigh, "Alas! doctor, that I cannot do, since I only hold a pint." When the Duke de Choiseuil, a remarkably meager man, came to London to negotiate a peace, Charles Townshend being asked whether the French government had sent the preliminaries of a treaty, answered, "He did not know, but they had sent the _outline of an ambassador_." That change of spare diet to a more nutritious food may bring on some corpulence, is evidenced in an anecdote of Colly Cibber, who relates that a poor half-starved actor, who used to play the Apothecary in Romeo and Juliet, to the life, and with great applause, received an augmentation of salary in consequence of his popularity. Unfortunately, increase of wealth led him to increase his fare, until he gradually assumed a plumpness which unfitted him for the worn-out pharmacopolist; and not being able to perform in any other line, the poor man was discharged. However, poverty once more brought him down to his original condition, when he reappeared upon the boards as triumphantly as ever. If _embonpoint_ is generally a sign of good-humour and a cheerful disposition, leanness frequently betokens a sour, crabbed, and ill-natured character. Solomon has said, "A merry heart doeth good like medicine; but a broken spirit drieth the bones." This observation, however, cannot be considered a rule in forming a judgment of various tempers. This is by no means an easy attempt in our intercourse with the world, when physiognomy is not always a sure guide in the selection of our companions. Dr. Franklin tells a singular story on this subject: "An old philosophical gentleman had grown, from experience, very cautious in avoiding ill-natured people. To endeavour to ascertain their disposition he made use of his legs, one of which was remarkably handsome, the other, by some accident, crooked and deformed. If a stranger at the first interview regarded his ugly leg more than his handsome one, he doubted him; but if he spoke of it, and took no notice of his handsome leg, that was sufficient to determine the philosopher to have no further acquaintance with him. Every body has not this two-legged instrument; but every one, with a little attention, may observe signs of this carping, fault-finding disposition, and take the same resolution of avoiding the acquaintance of those infected by it. I therefore advise those querulous, discontented, unhappy people, if they wish to be respected and beloved by others, and happy in themselves, _to leave off looking at the ugly leg_." Various expedients, in addition to a better diet, have been resorted to, to restore lean persons to a better case; but amongst the most singular that we have on record is that of flagellation. Galen says, that horse-dealers having been observed to fatten horses for sale by flogging them, an analogous method might be useful with spare persons who wish to become stouter. He also mentions slave-dealers who employed similar means. Suetonius informs us that Musa, the favourite physician of Augustus, used to fustigate him, not only to cure him of a sciatica, but to keep him plump. Meibomius pretends that nurses whip little children to fatten them, that they may appear healthy and chubby to their mothers. No doubt but flagellation determines a greater influx of blood to the surface, and may thus tend to increase the circulation, and give tone to parts which would otherwise be languid. With this intention, _urticatio_, or whipping with nettles, has been frequently used in medical practice with great advantage. Xenophon thawed his frozen soldiers by flagellation. In amorous despondency and grief, Coelius Aurelianus recommended this process, and Elidoeus Paduanus advises it to bring out tardy eruptions. The most singular effect of this castigation is recorded by Meibomius, in his work _De flagrorum usu_, &c., dedicated to a councillor of the Bishop of Lubeck, with the following epigraph: Delicias pariunt Veneri crudelia flagra. Dum nocet, illa juvat; dum juvat, ecce nocet. Menghus Faventinus had long before extolled this practice, mentioned also by Coelius Rhodiginus, and various ancient writers, and more recently recognised as effectual by Rousseau, in his Confessions. A remarkable case of leanness is mentioned by Lorry in a priest, who became so thin and dry in all his articulations, that at last he was unable to go through the celebration of mass, as his joints and spine would crack in so loud and strange a manner at every genuflexion, that the faithful were terrified, and the faithless laughed. One of these miserable laths once undertook a long journey to consult a learned physician on his sad condition, and having begged to know, in a most piteous tone, the cause of his desiccation, was favoured with the following luminous answer: "Sir, there is a predisposition in your constitution to make you lean, and a disposition in your constitution to keep you so." Another meager patient being told that the celebrated Hunter had fattened a dog by removing his spleen, exclaimed, with a deep sigh, "O, sir! I wish Mr. Hunter had mine." DWARFS. We can scarcely believe that the ancients gave any credence to the fabulous accounts of dwarfish nations, or could be persuaded of the existence of those pigmies spoken of by Aristotle and other writers, who, in all probability, described as such a species of diminutive monkeys. Athenæus mentions a race of dwarfs who were in perpetual war with cranes, who harnessed partridges to their chariots, and were obliged to cut down corn with felling-axes, like forest trees. Pliny asserts that their constant enemy, the crane, drove them out of Thracia, but that they still were to be met with in Ethiopia, near the source of the Nile, and above the rise of the Ganges, where they were named _Spithania_, their stature not exceeding three palms. Nicephorus Calixtus, in his Ecclesiastical History, mentions an Egyptian who was not longer than a partridge, and who, at the age of twenty-five, displayed considerable mental endowment. Strabo, however, judiciously observed that these stories arose from the circumstance of the small size of every animal in intemperate regions. Various modern travellers have recorded the most absurd stories of diminutive men, as well as of gigantic nations; but to most of them we may apply the words of Congreve-- Fernandez Mendez Pinto was but a type of thee, Thou liar of the first magnitude. It is nevertheless true, that man exhibits differences of stature in various climes. The Laplanders and Samoïdes in Europe, the Ostiacks and Tungooses in Asia, the Greenlanders and Esquimaux in America--all the natives indeed of high northern latitudes are remarkably short, measuring little more than four feet; and Niels Sara, the Laplander mentioned by Von Buch in his Travels, and who measured five feet eight inches, may be considered as a gigantic exception. It had been reported by travellers, that a nation of white dwarfs, called _Quimos_ or _Kimos_, existed in the interior of Madagascar; but Flacourt has positively denied the fact, although Commerson, the naturalist of Bougainville, and De Modave, confirm the former statement. It has also been remarked by various travellers, that dwarfs are not uncommon amongst robust and manly races, instanced in Poland and Lithuania. Sigismund de Herbestein made the same observation in Samogitia, the population of which was of a high stature. It is by no means evident that climate or any external agency invariably produces this effect; for, in the very regions inhabited by the stunted Hottentot, the shortest race in Africa, since the Bosjernan tribe scarcely ever exceed four feet, we find the strong and tall Kaffer. Amongst these it is also to be remarked, that there exists a singular difference between the sexes. Langsdorf thus expresses himself on the subject: "The Kaffer women were mostly of low stature, very strong-limbed, and particularly muscular in the leg: the men, on the contrary, were the finest figures I ever beheld; they were tall, robust, and muscular. A young man of about twenty, of six feet ten inches high, was one of the finest figures that perhaps was ever created. He was a perfect Hercules; and a cast from his body would not have disgraced the pedestal of the deity in the Farnese Palace." He further adds, "There is, perhaps, no nation on earth, taken collectively, that can produce so fine a race of men as the Kaffers: they are tall, stout, muscular, well-made, elegant figures. They are exempt, indeed, from many of those causes that in more civilized societies contribute to impede the growth of the body. Their diet is simple, their exercise of a salutary nature; their body is neither cramped nor encumbered by clothing; the air they breathe is pure; their rest is not disturbed by violent love, nor their minds ruffled by jealousy; they are free from those licentious appetites which proceed frequently more from a depraved imagination than a real natural want. Their frame is neither shaken nor enervated by the use of intoxicating liquor; they eat when hungry, and sleep when nature demands it. With such a kind of life, languor and melancholy have nothing to do. The countenance of a Kaffer is always cheerful, and the whole of his demeanour bespeaks content and peace of mind." Are diminutive races more productive than those of stronger formation? The brute creation has been taken as an example in support of this opinion; large animals producing one or two young ones, while the smaller species are singularly prolific. The lioness seldom brings forth more than two or four whelps, the cat will have a litter of eight or ten kittens; the pullulation of insects is incredible. But is not this circumstance an illustration of the wisdom of Providence? If the larger species were as abundant as the lesser races, where could they find sustenance in regions where the produce is, under the influence of the seasons, occasionally abundant or scarce? In the ocean, this is not the case; the myriads of its creatures suffice to support each other, and we therefore meet in the deep, the largest of animals in numerous shoals, while the small fry are generated in marvellous abundance. That the facility of obtaining food and the nature of the nutritious substances that animals may find, influence their stature, is evident. In sandy and arid plains poor in pasture, we find horses and cattle of a stunted breed: the herds of Flanders widely differ from those of Wales and of the Ukraine, and the Scotch and Welsh cattle cannot be compared to those of Holstein. At the same time, it must be observed, that in regard to dwarfs, although it frequently does occur that they are labouring under a hereditary lowness of stature, this is not invariably the case. In these instances dwarfs may be considered as morbid phenomena. Thus Bebe, the dwarf of Stanislaus of Poland, who was thirty-three French inches high, was weak, of delicate health, became deformed as he grew up, and died at the age of twenty-three; his parents were of the usual stature: whereas the Polish nobleman Borwlaski was well-made, active, intelligent: he measured twenty-eight inches; he had a brother of thirty-four inches, and a sister of twenty-one. Stöberin, of Nürenberg, was nearly three feet high at twenty, well-proportioned, and possessing a cultivated mind: his parents, brothers, and sisters, were all dwarfs. Such natural dwarfs have been known to evince brilliant qualities. Uladislas, king of Poland, surnamed _Cubitalis_ from his only measuring a cubit in height, was renowned for his warlike exploits; and we find a dwarf of the name of Kasan, a khan of Tartary, boldly leading their enterprising bands. These individuals sprung from dwarfish parents; whereas the dwarfs we generally meet with are deformities of nature; their head is voluminous, their intellectual faculties obtuse, they are mostly childish in their ideas and pursuits, and are rarely able to propagate their race. Held in contempt by the people, dwarfs naturally become peevish and irritable; and the diminutive names given to them to match their apparent natural imperfection tend constantly to increase their irritability. Thus the Latins called them _Homunciones_, the Italians _Piccoluomini_, the Flemings _Mennekin_,--whence, no doubt, our term _Mannikin_ given to little men, and _Minikin_ applied to small pins. A very curious case of a dwarf born from parents of the usual stature was exhibited in Paris in 1819: her name was Anne Souvray; she was born in the Vosges, and was only thirty-three inches in height. She was at that period seventy-three years of age; was gay, animated, good-humoured, and danced with tolerable grace with her sister Barbe, seventy-five years of age, and taller than her by two inches. In 1762, King Stanislaus wanted to marry her to his Bebe; the bridegroom, however, did not live to contract so desirable a match; but, faithful to her lover, she ever afterwards called herself _Madame Bébé_. Jeffrey Hudson, the dwarf of King Charles, must also have been of a very diminutive stature, since we find that he was served up in a pie to the royal table, and jumped out when the crust was raised. It appears that introducing live pies in those days were not an uncommon frolic; hence there may be some truth in the old song of Four-and-twenty black-birds bak'd in a pye, When the pye was open'd the birds began to sing, Was not that a dainty dish to lay before a king? GIGANTIC RACES. While we dismiss as fabulous all ancient and modern accounts of dwarfish races, we must also treat with the same scepticism the relations of gigantic nations. Although individuals of incredible stature have been occasionally seen, the word giant must be considered not only comparative as regarding primary races, but in many instances allegorical. Thus the Hebrew word, _Nophel_ and _Giboor_ (_Nephilim_ and _Gibborim_ in the plural), did not signify giants, as commonly translated, but cruel and violent men. Athletic power and uncommon energies were naturally associated with the idea of supernatural stature, though intellectual accomplishments were not always included in the association: on the contrary, we find the ancient axiom _Homo longus rarè sapiens_ frequently adduced. In temperate climates the height of the human race averages from four feet and a half to six feet, but occasional instances have been met with of men reaching eight and nine feet--nay, some authors go so far as ten and eighteen; but the latter assertions seem to refer to fossil bones attributed to man, but which evidently belonged to other animals. Buffon mentions gigantic human bones discovered at Lucerne, but which upon examination Blumenbach pronounced to be the remains of an elephant. Halicot, in his work called _Gigantosteologia_, describes bones found in a sepulchre in Dauphiny over which was a stone inscribed TEUTOBOCCHUS REX: this skeleton was twenty-five feet and a half high, and ten feet broad at the shoulder. Riolan, the celebrated anatomist, disputes the fact; and in his book entitled _Gigantomachia_ positively affirms that they also belonged to an elephant. It is worthy of remark, that in this controversy each party considered his opinion and decision of sufficient weight to need no illustration, and therefore neither of them thought it necessary to confirm his _dixit_ by drawings and engravings of the questionable remains. Such is the vanity of the learned! An infallible philosopher informs us that Adam's stature was one hundred and twenty-three feet nine inches; Eve's, one hundred and eighteen feet nine inches and three quarters; Noah's, twenty feet short of Adam's; Abraham's, twenty-eight feet; Moses', thirteen; and Hercules', ten. That the first races of man were of larger dimensions than those of our contemporaries, has ever been a general opinion. Thus Virgil in his Georgics: Grandiaque effossis mirabitur ossa sepulchris. Lucretius ascribes the same superiority to animals. Jamque adeò fracta est ætas, effoetaque tellus Vix animalia parva creat, quæ cuncta creavit Sæcla, deditque ferarum ingentia corpora partu. And again the Mantuan poet, Sic Omnia fatis In pejus ruere, ac retrò sublapsa referri. Not only have our forefathers been considered more gigantic in stature, but of more vigorous power. Hence Juvenal says, Nam genus hoc, vivo jam decrescebat Homero. Terra malos homines nunc educat, atque pusillos. It is however obvious, that former races, although they might have excelled the present generation in vigour from the nature of their education and pursuits, could not claim any pre-eminence in stature. The remains of human bones, found in tombs and Egyptian mummies, demonstrate this fact most clearly; and the armour, helmets, and breastplates of the ancients confirm it. Their swords were as light, nay, much lighter in many instances, than those of the present day; and those enormous ones of the times of chivalry were only wielded to inflict one overwhelming blow with both hands, and could scarcely be recovered for protection. Ancient writers corroborate this opinion. Homer, when speaking of a fine man, gives him four cubits in height and one in breadth. Vitruvius fixes the usual standard of man at six Roman feet: the giant Gabbarus mentioned by Pliny did not exceed nine feet. Aristotle's admeasurement of beds was six feet; and certainly the doorways of ancient edifices by no means indicated taller inmates than our present generation. It is therefore pretty clear that the supposed fossil remains of gigantic human bones belonged to the _Megatherium_, the _Palæotherium_, and other individuals, which certainly prove that in remote ages there existed animals of much larger dimensions than any now in being, though we have no reason to suppose that this variety extended to our species.[2] The origin of the fabled giants has led to marvellous disquisitions. Many fathers of the church, amongst whom we may quote St. Cyprian, St. Ambrosius, St. Chrosostom, St. Cyrillius, Tactantius, Tertullian, and several others, gravely maintain that giants were the favoured offsprings of holy maidens and angels. This may seem an impious conclusion, since the gigantic monsters of sacred history were any thing but angelic; for the Canaaneans, the Moabites, and the sons of Anak, descended from giants, (compared with whom the Israelites seemed as grasshoppers,) were most ferocious, and their land devoured its inhabitants; (though Neuman gives a different signification to the scriptural passage, which according to his paraphrase merely meant "that the number of inhabitants was so great, that they eat up all the land;") Og, king of Bashan, whose country was delivered into the hands of Israel, had an iron bedstead nine cubits in length and four cubits in breadth; and Goliath, the reproach of Israel, was six cubits and a span (which according to Cumberland makes eleven feet English) in stature. It is therefore difficult to imagine why so many saints considered giants as an angelic progeny. To the present day, however, we find various races distinguished by their elevated stature. Humboldt says, that the Guayaquilists measure six feet and a half, and the Payaguas are equally tall, while the Caribbees of Cumana are distinguished by their almost gigantic size from all the other nations he had met with in the New World. Hearne saw in the cold regions north of Canada individuals of six feet four inches. The Patagonians, or Tehuels, were stated by Pigafitta and the Spanish early navigators as measuring seven feet four inches; and although it appears that this account is exaggerated, more recent travellers, amongst whom we may name Bougainville, Commodore Byron, Captain Wallis, Carteret, and Falkner, affirm that their height ranges from six to seven feet. From the best authenticated observations, it appears that the tallest persons on respectable record, did not, according to Haller, exceed nine feet. A young man from Huntingdonshire was exhibited in London, and measured about eight feet at the age of seventeen; he was, as usual, born of the ordinary size, but began to grow most rapidly; his sister was of great height, and all his family were remarkably tall. Dwarfs generally die from premature old age, and giants from exhaustion. A curious instance of marvellous growth is recorded in a tract called "_Prodigium Willinghamense_," or an account of a surprising boy who was born at Willingham, near Cambridge, and upon whom the following epitaph was written:--"Stop, traveller, and wondering, know, here buried lie the remains of Thomas, son of Thomas and Margaret Hall; who, not one year old, had the signs of manhood; at three, was almost four feet high, endued with uncommon strength, a just proportion of parts, and a stupendous voice; before six, he died as it were at an advanced age." Mr. Dawker, a surgeon of St. Ives, Huntingdon, who published this account, viewed him after death, and the corpse exhibited all the appearances of decrepit old age. This is a confirmation of the case of the boy of Salamis, mentioned by Pliny as being four feet high, and having reached puberty at the age of three; and may also confirm the account of the man seen by Craterus, the brother of Antigonus, who in seven years was an infant, a youth, an adult, a father, an old man, and a corpse. The experiment of Dr. Berkeley, bishop of Cloyne, to ascertain the influence of food in promoting extraordinary growth, is curious. He selected for this purpose an orphan child of the name of Macgrath; and, by dint of feeding, at the age of sixteen he had grown to the height of seven feet; but his organization had been so exhausted by this forced process, that he died in a state of moral and physical decay at the age of twenty. In the development of organized bodies, the effects of light contribute materially. Dr. Edwards, an English physician in Paris, and one of our most distinguished physiologists, has shown that by excluding tadpoles from the light, they will grow to double and triple their ordinary size, but are not metamorphosed into frogs. He thinks that the _Proteus Anguinis_ is the first stage of an animal prevented from growing to perfection by inhabiting the subterraneous waters of Carniola. The influence of food on the changes of animals is further shown in the aphidivorous flies, that are larvæ for eight or ten days, pupæ for about a fortnight, and perfect insects in about the same time, in the whole living about six weeks; whereas a pupa deprived of food underwent no change, and lived for twelve months. Rapid development of the organism invariably brings on premature dissolution. A case is recorded of a girl who cut four teeth at the end of the first fortnight; walked about, and had hair reaching to the middle of her back after the seventh month; exhibited signs of puberty at the ninth month, but perished in a state of exhaustion in her twelfth year. Dr. Comarmond, of Lyons, relates the case of a female infant, who was perfectly developed at the age of twenty-seven months, but she sank under rachitis when she had attained her twelfth year. Precocious mental attainments are frequently as destructive of life as a rapid growth. The wonderful Baratier, at the age of four, spoke and read Latin, French, and German; was an excellent Greek scholar at six; and when ten years of age, translated the Scriptures from the Hebrew; at nineteen he died of exhaustion. The vulgar saying, "The child is too clever to live," is founded upon observation. These early specimens of superior intellect are sometimes followed by a state of imbecility. Antiochus tells us that Hermogenes, who was a celebrated rhetorician at fourteen years, was ignorant in the extreme at twenty-four; and of him it was said, In pueritia senex, in senectute puer. Tall men generally produce children of high stature. The celebrated grenadier guards of Frederick William, in the words of Dr. Johnson, "_propagated procerity_;" and the inhabitants of Potsdam are remarkable for their height. Haller states that his own family were distinguished by their tallness, without excepting one single grandchild, although they were very numerous. In the hereditary transmission of physical and moral qualities, many curious observations have been made. Women of high mental attainments have been known to produce children of genius, more frequently than men of a superior intellect; although Haller relates the singular case of two noble females who married wealthy idiots on account of their fortunes, and from whom this melancholy defect had extended for a century into several families, so that some of all their descendants still continued idiots in the fourth and fifth generation. Horace had observed this tendency to produce offsprings resembling their parents, Fortes creantur fortibus et bonis: Est in juvencis, est in equis patrum Virtus: nec imbellem feroces Progenerant aquilæ columbam. This remark, however, is more applicable to physical transmissions, and certain peculiarities characterize whole families. Pliny mentioned examples of six-fingered families, who bore the name _Sedigita_. C. Horatius had two daughters with a similar deformity. Mr. Carlisle knew a family in which supernumerary toes and fingers were observed for four generations: they were introduced by a female who had six fingers on each hand, and as many toes on each foot. From her marriage with a man naturally formed, were produced ten children, with a supernumerary member on each limb; and an eleventh, in which the peculiarity existed in both feet and one hand, the other hand being naturally formed. The latter marrying a man of ordinary formation, they had four children, of which three had one or two limbs natural, and the rest with the supernumerary parts; while the fourth had six fingers on each hand, and as many toes on each foot. The latter married a woman naturally formed, and had issue by her eight children; four with the usual structure, and the same number with the additional fingers and toes: two of them were twins, of which one was naturally formed, and the other six-fingered and six-toed.--The well-known porcupine family, that were exhibited in London and elsewhere, is a remarkable example of hereditary transmission of organic peculiarities. They were all covered with dark-coloured horny excrescences, which they shed annually in the autumn or winter. Their names were Lambert. Two brothers, John and Richard, grandsons of the original porcupine men, were shown in Germany.--One of these unsightly individuals, who was exhibited some time ago in Bond-street, stated that he was descended from the fourth generation of a savage found in the woods of America; and he further asserted that the females of the family were exempted from this lucrative but uncomfortable peculiarity: all the males had them, and shed them regularly until the thirty-sixth year, when these species of quills grew to a considerable length. We have examples of bristly hair being shed in a whole family every autumn. Amongst animals, gigantic races no longer inhabit the regions which bore them in ancient times. An extensive whale-fishery was once carried on at Biariz, in the Gulf of Gascony; and the hippopotamus is no longer to be seen on the banks of the Nile. Gigantic bones having been occasionally discovered with the remains of men and horses and fragments of armour, it has been imagined that in ancient times armies were attended by terrific giants; but it is more than probable that these large fragments of departed warriors belonged to their war-elephants, which with their horses were not unfrequently immolated on their master's tomb. Skeletons of giants were considered by the ancients as curious as in the present day; and those of Secondilla and Pusio were carefully preserved in the gardens of Sallust. Some naturalists have maintained that giants had more numerous vertebræ than ordinary men; but this has not been confirmed by observation, nor has it been found that the spinal bones of dwarfs are in smaller number. Schreber, who has collected the description of the principal modern giants, found few above seven feet and a half; although he mentions a Swedish peasant of eight feet Swedish measure, and one of the guards of the Duke of Brunswick eight feet six inches Dutch. Not so Hakewell, who informs us, from the testimony of Nannez, that the Emperor of China had archers and porters fifteen feet high. Howbeit, Ol. Magnus's account surpasses his; for he tells us of a "_puella--in capite vulnerata, mortua induta chlamyde purpurea, longitudinis cubitorum 50, latitudinis inter humeros quatuor_!" UNLAWFUL CURES. One can scarcely credit that at any period there could have existed men of science and genius who believed that there were supernatural means of curing disease, did we not even to the present day find imbeciles who verily dread the malpractices of the devil and his vicarious agents. Ancient writers divided their cures into _lawful_ and _unlawful_. The former were obtained from divine aid; the latter from sorcerers, witches, magicians, wizards, and cunning men, who treated all maladies by spells, cabalistic words, charms, characters, images, amulets, ligatures, philters, incantations, &c.; by which means, according to Cardan, Artesius, Picatrix, and sundry wise men, the aforesaid sorcerers and witches could prevent fire from burning, find out thieves and stolen goods, show absent faces in a glass, make serpents lie still, stanch blood, _salve_ gout, biting of mad dogs, toothache, _et omnia mundi mala_. "Many doubt," says Nicholas Taurellus, "whether the devil can cure such diseases he hath not made, and some flatly deny it; however, common experience confirms, to our astonishment, that magicians can work such feats, and that the devil, without impediment, can penetrate through all the parts of our body, and cure such maladies by means to us unknown." Some of these means were rather singular; for St. Austin mentions as one of these processes, "_Agentes cum patientibus conjungunt, colligere semina rerum eaque materiæ applicare_;" and learned divines, moreover inform us, that to resist exorcisms these witches and magicians had St. Catherine's wheel imprinted on the roof of their mouths, or on some other part. Taurellus asserts, that to doubt it is to run into a sceptical extreme of incredulity. Godelman affirms that Satan is an excellent physician; Langius maintains that Jupiter Menecrates was a magician; and Marcellus Donatus pays the same compliment to Solomon, who, he says, "cured all the diseases of the mind by spells, charms, and drove away devils, and that Eleazar did the same before Vespasian." Galen, in his book "_de Medicamentis facilè purandis_," observes after a preparation, "_hæc enim suffita, dæmonus abigunt_." This fact being clearly ascertained, the next question was whether it was lawful in a desperate case to crave the help of the evil one on the principle Flectere si nequeunt Superos, Acheronta movebunt. Paracelsus rather impiously argues that we might, as it matters not, he says, "whether it be God or the devil, angels or unclean spirits, (_immundi spiritus_,) that cure him, so that he be eased. If a man fall in a ditch, what matter is it whether a friend or an enemy help him out? If I be troubled with such a malady, what care I whether the devil himself, or any of his ministers, by God's permission, redeem me?"--and he therefore concludes, that diseases brought on by _malefices_ can only be cured by _incantations_. However, this doctrine was denounced as abominable by Remigius, Bodinus, Godelmannus, Erastus, and various divines and schoolmen; and Delrio plainly declares, "_mori præstat quàm superstitiosè canari_." Therefore pontificial writers and sages recommend adjuration and exorcism by "fire, suffumigations, lights, cutting the air with swords (_gladiorum ictus_), sacred herbs, odours," &c., though some hungry devils can only be cast out by fasting. Witches and impostors, says Lord Bacon, have always held a competition with physicians. Galen complains of this superstition, and observes that patients placed more confidence in the oracles of Esculapius and their own idle dreams than in the prescriptions of doctors. The introduction of precious stones into medical practice owed its origin to a superstitious belief that, from their beauty, splendour, and high value, they were the natural receptacles for _good_ spirits. Mystery, in the dark ages, and, alas! even now, increases the confidence in remedial means; reveal their true nature, the charm is dissolved: "_Minus credunt quæ ad suam salutem pertinent si intelligunt_," said Pliny. One cannot but wonder when we behold men pre-eminent in deep learning and acute observation becoming converts to such superstitious practices. Lord Bacon believed in spells and amulets; and Sir Theodore Mayence, who was physician to three English sovereigns, and supposed to have been Shakspeare's Dr. Caius, believed in supernatural agency, and frequently prescribed the most disgusting and absurd medicines, such as the heart of a mule ripped up alive, a portion of the lungs of a man who had died a violent death, or the hand of a thief who had been gibbeted on some particular day. Nauseous medicines have ever been deemed the most efficacious, on the reasoning that as every thing medicinal is nauseous, every thing that is nauseous must be medicinal. The ancients firmly believed that blood can be stanched by charms; the bleeding of Ulysses was stopped by this means; and Cato the Censor has given us an incantation for setting dislocated bones. To this day charms are supposed to arrest the flow of blood: Tom Pots was but a serving-man, But yet he was a doctor good, He bound his kerchief on the wound, And with some kind words he stanch'd the blood. Sir Walter Scott says, in the "Lay of the Last Minstrel,"-- She drew the splinter from the wound, And with a charm she stanch'd the blood. The strength of imagination in effecting wonderful cures has been observed in all ages; and Avicenna declares, "that he prefers confidence before art, precepts, and all remedies whatsoever." Our learned Burton says, "that this strong imagination or conceit is _Astrum Hominis_, and the rudder of this our ship, which reason should steer, but overborne by phantasie, cannot manage, and so suffers itself and the whole vessel of ours to be overruled and often overturned." Nothing could be more absurd than the notions regarding some of these supposed cures: a ring made of the hinge of a coffin had the power of relieving cramps; which were also mitigated by having a rusty old sword hung up by the bedside. Nails driven in an oak-tree prevented the toothache. A halter that had served in hanging a criminal was an infallible remedy for a headache, when tied round the head; this affection was equally cured by the moss growing on a human skull, dried and pulverized, and taken as a cephalic snuff. A dead man's hand could dispel tumours of the glands by stroking the parts nine times, but the hand of a man who had been cut down from the gallows was the most efficacious. To cure warts, one had nothing to do but to steal a piece of beef from the butcher, with which the warts were to be rubbed; then inter it in any filth, and as it rotted, the warts would wither and fall. The chips of a gallows on which several persons had been hanged, when worn in a bag round the neck, would cure the ague. A stone with a hole in it, suspended at the head of the bed, would effectually stop the nightmare; hence it was called a _hag-stone_, as it prevents the troublesome witches from sitting upon the sleeper's stomach. The same amulet tied to the key of a stable-door, deterred witches from riding horses over the country. Rickety children were cured by being drawn through a cleft tree, which was afterwards bound up, and as the split wood united, the child acquired strength. Creeping through a perforated stone to cure various disorders was a Druidical rite, still practised in the East. In the parish of Marden there is a stone with a hole in it, fourteen inches in diameter, through which children are drawn for the rickets; and, in the North, infants are made to pass through a hole cut in a _groaning_ cheese the day of their christening. Second sight, which, as an hereditary faculty, was deemed a malady, was cured in the Isle of Man, according to Mr. Aubrey's account, by baptizing a child upon the first sight of its head. This ceremony exempts the succeeding generation from the troublesome gift. It is a melancholy reflection that, at various periods, impostors have impiously called in Scriptural aid to promote their sordid or ambitious views. Chiromancers have quoted the Bible in support of their doctrines and adduced the following lines of Job,--"He sealeth up the hand of every man, that all men may know his works:" while, in the like manner, the Holy Inquisition of Spain and Portugal justified their atrocities on the score of the parable of the marriage of the king's son, in the 22nd of St. Matthew. Unlawful cures, as they were called, being thus anathematized, lawful remedies were resorted to, and the patient was first ordered to pray with due devotion before he took his physic; or, as Burton observes, not one without the other, but both together; for, as he adds, to pray alone, and reject ordinary means, is to do like him in Æsop, that, when his cart was stalled, lay flat on his back, and cried out "Help, Hercules!" However, Hyperius maintains that no physicians can hope for success unless "with a true faith they call upon God and teach their patients to do the like." Comineus, when he addressed the Christian princes after the overthrow of Charles of Burgundy, bade them "first pray with all submission and penitency, confess their sins, and then take physic." Another question of importance that led to much controversy was, whether it were lawful to seek the aid of the saints; the learned Burton's remarks on this controverted point are so curious that they are worth relating. "They (the papists) have a proper saint for almost every peculiar infirmity: for poisons, gout, agues, Petronella; St. Romanus, for such as are possessed; St. Vitus for madmen, &c.; and as, of old, Pliny reckons up gods for all diseases. All affections of the mind were heretofore accounted gods: Love and Sorrow, Virtue, Honour, Liberty, Contumely, Impudency, had their temples; Tempests, Seasons, _Crepitus Ventris_, _Dea Vacuna_, _Dea Cloacina_. Varro reckons up thirty thousand gods; Lucian makes Podagra, the gout, a goddess, and assigns her priests and ministers. 'Tis the same devil still, called heretofore, Apollo, Mars, Venus, &c.; the same Jupiter, and those bad angels, are now worshipped and adored by the name of St. Sebastian, St. Barbara, &c.; and our Lady succeeds Venus in many offices; and God often winks at these impostures, because they forsake his word, and betake themselves to the devil, as they do, that seek after holy water, crosses," &c. Amidst this violent denunciation against popery and devilment, evil spirits and saints, it is somewhat singular to find a spirit of anomalous perversity which justifies suicide to rid ourselves of disease and suffering; and these very sanctimonious censors quote ancient and modern authorities to sanction a practice which every Christian must condemn. Let us pursue the disquisition of our learned bookworm Burton:--"Another doubt is made by philosophers, whether it be lawful for a man in such extremity of pain and grief to make away himself, and how those men that do so are to be censured. The Platonists approve of it, that it is lawful in such cases upon a necessity. Plotinus (_L. de Beatitud._) and Socrates himself defend it (_in Plato's Phædon_): _If any man labour of an incurable disease, he may despatch himself, if it be to his good_. Epictetus and Seneca say, _Quamcunque veram esse viam ad libertatem_;--any way is allowable that leads to liberty. _Let us give God thanks no man is compelled to live against his will. Quid ad hominem claustra, carcer, custodia? liberum ostium habet._ Death is always ready at hand: _Vides illum precipitem locum, illud flumen?_ There is liberty at hand. _Effugia cervitutis et doloris sunt_, as that Laconian lad cast himself headlong, _Non serviam, aiebat puer_; to be freed of misery. Wherefore hath our mother earth brought out poisons (saith Pliny) in so great a quantity, but that men in distress might make away themselves? which kings of old had ever in readiness, _ad incerta fortunæ venenum sub custode promptum_. Many worthy men and women, _quorum memoria celebratur in ecclesiâ_, sayeth Leminctius, killed themselves to save their chastity and honour, when Rome was taken. Jerome vindicates the same, and Ambrose commendeth Pelagia for so doing. Eusebius admired a Roman matron for the same fact, to save herself from the lust of Maxentius the tyrant. Adelhelmus, the Abbot of Malmesbury, calls them, _beatas virgines quæ sic, &c._ Sir Thomas More, in his Utopia, commends voluntary death if one be _sibi aut aliis molestus; especially if to live be a torment to him_, let him free himself with his own hand from this tedious life, or from a prison, or suffer himself to be freed by others." However, be it said in justice to our worthy Burton, he condemns this practice as "a false and pagan position, founded in prophane stoical paradoxes and wicked examples;" and although he denounces most fulminating anathemas on papists, he concludes by saying, "we ought not to be rash and rigorous in our censures, as some are; Charity will judge and hope best; God be merciful unto us all!" But why should we marvel at the credulity and superstition of our forefathers, when we daily observe equal absurdities? Fanaticism and bigotry will ever strive to speculate on human weakness, and endeavour to surround with impenetrable mists every rebel to their power who gropes for the shrine of reason and of truth. Johanna Southcote had her votaries, and Prince Hohenlohe is still considered by many a pious person, as a vicarious instrument of divine mercy. No miraculous recovery recorded in the dark ages can surpass the tenebral absurdity of the following relation of one of his cures: Miss O'Connor was a nun in a convent near Chelmsford, and in December 1820, being about thirty years old, was suddenly attacked by a violent pain in the right hand, which extended with much swelling and inflammation up the arm. The whole limb became red, swollen, extremely painful, and entirely useless. Every remedy, both topical and directed to the system, was tried in vain for a year and a half. There was no suppuration, nor any formation of pus; but the malady continued obdurate, and yielded to no application. The resources of the flesh having manifestly failed, Mrs. Gerard, the worthy superior, very properly betook herself to those of the spirit. She made a request through a friend to Prince Hohenlohe to assist the patient in this her extreme case; when the following precious document, which it would be impious to translate into heretical English, was received: "_Pour la Religeuse Novice d'Angleterre._ "Le trois du mois de Mai, à huit heures, je dirai, conformément à votre demande, pour votre guérison, mes prières. Joignez-y à la même heure, après avoir confessé et communié, les votres, avec cette ferveur angélique et cette confiance plénière que nous devons à notre Rédempteur J. C.: excitez au fond de votre coeur les vertus divines d'un vrai repentir, d'un amour Chrétien, d'une croyance sans bornes d'être exaucé, et d'une résolution inébranlable de mener une vie exemplaire, afin de vous maintenir en état de grace. Agréez l'assurance de ma considération. "PRINCE ALEXANDRE HOHENLOHE. "Bamberg, Mars 16, 1822." It is to be regretted that this letter, which was no doubt a circular to his proselytes, with necessary blanks to be filled up _pro re natâ_, as the doctors have it, was not drawn out in better French. Howbeit, on the appointed day, asserts Dr. Baddely (the lady's unsuccessful medical attendant), Miss O'Connor went through the religious process prescribed by her princely physician. Mass being said, Miss O. not finding the immediate relief she expected from her faith, or faithfully expected, exclaimed somewhat impatiently, not having the fear of Job before her eyes, "Thy will be done, O Lord, since thou hast not thought me worthy of this cure;" when behold! _immediately_ after she felt an extraordinary sensation throughout the whole arm to the end of the fingers. The pain _instantly_ left her, the swelling gradually subsided, and Dr. B., who no doubt was the pet physician of the nuns, declares that the hand shortly resumed its natural size and shape. Now, Miss O'Connor was most likely a young lady from Ireland, where this miraculous cure was re-echoed in every chapel. The protestants were naturally offended by a report which seemed to impugn the sanctity of the reformed religion, and they thought it incumbent on them, for the welfare of church and state, to get up a miracle of their own which would cast Prince H., Nun O., and Dr. B. in the shade. The following statement was therefore published and certified upon oath by sundry most respectable and most worthy Orangemen: "I pledge you the word and honour of an Orangeman that the following facts, sworn to by all present, occurred yesterday evening. A party of gentlemen dined with me, and after dinner a vase, containing some orange lilies, was placed upon the table by my directions. We drank several toasts; but on the glorious and immortal memory being given, an _unblown lily_, which the party had remarked, _expanded its leaves and bloomed before us_ in all its splendour!" How appropriate are the lines of Otway when applied to the propagators of such absurdities, who dare to call upon our faith to give credence to their impostures. You want to lead My reason blindfold like a hamper'd lion Check'd of its noble vigour; then, when baited Down to obedient tameness, make it crouch And show strange tricks, which you call signs of faith: So silly souls are gull'd, and you get money. A curious anecdote is related of Lord Chief Justice Holt. When a young man, he happened, with some of his merry companions, to run up a score at a country inn, which they were not able to pay. In this dilemma they appealed to Holt, to get them out of the scrape. Our young lawyer had observed that the inn-keeper's daughter looked very ill, and, passing himself for a medical student, asked her father what ailed her, when he was informed that she suffered from an ague. Holt immediately gathered various plants, mixed them up with great ceremony, and after rolling them up in parchment, scrawled upon the ball some cabalistic characters. The amulet, thus prepared, he suspended round the neck of the young woman, and, strange to say, the ague did not return. After this cure the doctor offered to pay the bill, to which the grateful landlord would not consent, allowing Holt and his party to leave the house. Many years after, when on the bench, a woman was brought before him, accused of witchcraft--the very last person tried upon such a charge. Her only defence was, that she possessed a ball invariably efficacious in the cure of agues. The charm was produced, handed to the judge, who recognised the identical ball which he had prepared in his youthful frolics. Not only did these victims of superstition firmly believe that evil spirits had the power of inflicting disease, and afterwards salve the mischief, but they were also invested with the privilege of killing and subsequently restoring to life. The story related of the truly learned Agrippa, who was falsely represented as a necromancer, is curious. Agrippa had occasion one time to be absent for a few days from his residence in Louvain. During his absence he intrusted his wife with the key of his museum, but with an earnest injunction that no one on any account should be allowed to enter it; Agrippa happened at that time to have a boarder in his house, a young fellow of insatiable curiosity, who constantly importuned his hostess, till at length he obtained from her the forbidden key. The first thing that attracted his attention was a book of spells and incantations. He spread the volume before him, and, thinking no harm, began to read aloud. He had not long continued this occupation, when a knock was heard at the door of the chamber. The youth took no notice, but continued reading. Presently there followed a second and a louder knock, which somewhat alarmed the reader. The space of a minute having elapsed, and no answer been made, the door opened and a demon entered. "For what purpose am I called?" said the unwelcome visitor in a stern voice: "What is it you demand to have done?" The youth was seized with the greatest alarm and struck speechless. The demon then rushed upon him, seized him by the throat, and strangled him, indignant no doubt in having been interrupted in some more interesting pursuit to no purpose. At the expected time Agrippa came home, and to his great surprise found a number of devils capering about, and playing strange antics on the roof of his house. By his art he caused them to desist from their gambols, of which he demanded the cause. The chief of them then related to him what he had done, how he had been disturbed and insulted, and how he had thought proper to revenge himself. Agrippa became much alarmed at the probable consequences of this unfortunate adventure, and he ordered the demon, without loss of time, to reanimate his victim, and walk about the streets with him, that the public might behold him alive. The infernal spirit reluctantly obeyed, and went forth with the student in the marketplace and promenades. This excursion over, however, he maliciously allowed his companion to fall down, when life once more flitted from his body. For a time it was thought that the student had been killed by a sudden attack of illness; but, presently, the marks of strangulation became evident, and the truth came out. Agrippa was thus suddenly obliged to quit the town, and seek refuge in a distant state. It was further related of this supposed wizard, that he was always accompanied by a familiar spirit in the shape of a black dog; and that when he lay on his deathbed he was earnestly exhorted to repent of his sins. Struck with remorse, he took hold of the dog, and removed from his neck a collar studded with cabalistic nails, exclaiming, "Begone, wretched animal, that has been the cause of my perdition!" and lo! the dog immediately ran away, and, plunging into the river Soane, disappeared. It is to be regretted that historians do not relate whether the water hissed or not when the canine devil took his last leap. It merits notice, that the mystic and medicinal celebrity of various substances have to this hour survived the traditions of their superstitious origin; coral, for instance, which was considered as possessed of the power of keeping off evil spirits, and rendering effete the malefices of the evil eye, was constantly worn as an amulet; and Paracelsus informs us that it should be worn round the necks of infants, as an admirable preservative against fits, sorcery, charms, and poisons. We still find necklaces of this substance suspended by fond mothers and nurses round the necks of infants. In the West Indies these chaplets are worn by the negroes as a magic protection against Obiism, and they even affirm that the colour of the coral is affected by the state of health of the wearer, and becomes paler when he is ill. The irrational belief in the mysterious powers of certain remedies went so far in former days, that when they were applied to the weapon that had inflicted an injury, their indirect sympathetic action was considered as effectual as if they had been used to heal the wound. The sympathetic powder of Sir Kenelm Digby, which was nothing else but pulverized green vitriol, was eulogized in a discourse pronounced by its inventor, at Montpellier, in 1658. Our James I. purchased this wonderful discovery from Sir Kenelm, who pretended that he had obtained it from a Carmelite friar, who had learned it in America and Persia. This superstitious practice is alluded to by Walter Scott, in the "Lay of the Last Minstrel:" But she has ta'en the broken lance, And wash'd it from the clotted gore, And salved the splinter o'er and o'er. Dryden has also illustrated this absurdity in his "Enchanted Island," where Ariel says, Anoint the sword which pierced him, with this Weapon-salve, and wrap it close from air Till I have time to visit it again. Sir Kenelm's sympathetic powder was applied in the same manner; the weapon being covered with ointment and dressed three times a day. But it was not mentioned that at the same time the wound was to be brought together, and bound up with clean linen bandages for seven days. This wonderful cure was then simply the process of what surgeons call healing by first intention, which means uniting the lips of the wound without suppuration. Dr. Paris apprehends that this secret was suggested to the worthy knight by the cures operated by the rust of the spear of Telephus, which, according to Homer, healed the injuries it had occasioned; and this rust was most probably verdigris. To this day the Irish peasantry, and even many of the superior classes, firmly believe in the malevolent and destructive effect of the evil eye, when cast upon man or beast. Hence the absurd custom that prevails, especially in the western provinces, of adding "God bless it," to any expression of admiration; and if perchance a Sassenagh traveller exclaimed "What a sweet child!" or, "What a fine cow!" without the adjunctive benediction, he would be suspected of malefice, and the priest forthwith summoned to save the devoted victim of sorcery. In Scotland dairy-maids drive cattle with a switch of the mountain ash, or roan-tree, considered as held sacred since the days of Druidism; and in some districts the sheep and lambs are made to pass through a hoop of its wood on the first day of May. The toad was also considered to be possessed of marvellous qualities for the cure of various maladies, more especially the stone that was supposed to be occasionally found in the reptile's head, and which was called _Crapaudina_. Lupton, in his seventh book of "Notable Things," thus instructs us how to obtain it. "You shall knowe whether the tode stone be the ryght and perfect stone or not. Holde the stone before a tode, so that he may see it; and if it be a ryght and true stone, the tode will leape towarde it and make as though he would snatch it, he envies so much that man should have this stone." This famous toadstone is simply one of the fossil teeth of various fishes, and is chiefly formed of phosphate of lime. Its high polish and convexity has often induced lapidaries to have it set in rings and other jewels, to which marvellous powers were attached. Pulverized toads were not only employed in medicine with supposed advantage, but were also considered a slow but certain poison. Solander relates, that a Roman woman, desirous of poisoning her husband gave him this substance; but instead of attaining her criminal desire, it cured him of a dropsy that had long perplexed him. Boccaccio relates the story of Pasquino and Simona, two young lovers, who, wandering in a garden, plucked some sage-leaves, with which Pasquino rubbed his teeth and gums. In a few minutes he fell ill and expired. Simona accused of being his assassin, was brought before a magistrate, who ordered an immediate investigation of the matter, when, on proceeding to the garden, Simona, after relating the particulars of the case, took some leaves from the same plant and used them in a similar manner. In a few minutes the lovers were reunited in death; when it was discovered that a large toad was under the root of the plant to which it had communicated its deadly venom. Regarding unlawful cures, have we not seen vaccination, when first introduced, condemned from the very pulpit as an impious interference in a disease which seemed to have been assigned to mankind by the Creator as an inevitable doom? Did not these desperate bigots even pronounce that we were not warranted to seek in the brute creation a human remedy or preservative? What is still more worthy of remark, is the coincidence of a similar idea in India, where the greatest obstacle vaccination encountered arose from a belief that the natural smallpox was a dispensation of a malicious deity, called _Mah-ry-Umma_, or rather that the disease was an incarnation of the goddess herself into the person who was affected by it: the fear of irritating her, and of exposing themselves to her resentment, necessarily rendered the natives averse to vaccination, until it was impressed upon their easy belief, that _Mah-ry-Umma_ had altered her mind, and chosen this new and milder mode of manifesting her visits to her votaries. Could there ever have existed a more superstitious belief than that which vested in the regal touch a healing power? Yet from Edward the Confessor to the accession of the House of Hanover, it was generally thought in these realms that our kings could cure scrofula with their anointed fingers! Dr. Paris's truly philosophic remarks on this subject, in his valuable work, entitled Pharmacologia, are worthy of quotation:--"Credulity, although it is nearly allied to superstition, yet differs from it widely. Credulity is an unbounded belief in what is possible, although destitute of proof, and perhaps of probability; but superstition is a belief in what is wholly repugnant to the laws of the physical and moral world. Credulity is a far greater source of error than superstition; for the latter must be always more limited in its influence, and can exist only, to any considerable extent, in the most ignorant portions of society; whereas the former diffuses itself through the minds of all classes, by which the rank and dignity of science are degraded, its valuable labours confounded with the vain pretensions of empiricism, and ignorance is enabled to claim for itself the prescriptive right of delivering oracles, amidst all the triumph of truth and the progress of philosophy. Credulity has been justly defined _belief without reason_, while scepticism, its opposite, is _reason without belief_, and the natural and invariable consequence of credulity; for it may be observed that men who believe without reason are succeeded by others whom no reasoning can convince." VOICE AND SPEECH. Blumenbach has given us a most ingenious definition of this wonderful function. The voice, properly speaking, is a sound formed by means of expiration in the _larynx_, which is a most beautifully constructed organ, fixed upon the top of the windpipe, like a capital upon a column. It is composed of various cartilages, united in the form of a little box, and supplied with numerous muscles, that, moving altogether or separately, produce the variations of sound. The part of the _larynx_ most concerned in producing the voice is the _glottis_, or narrow opening of the windpipe, having the _epiglottis_ suspended over it like a valve. The air expired from the lungs strikes upon the glottis, and thus becomes sonorous. The change that the glottis undergoes in the modulation of the voice has been matter of much controversy. Aristotle and Galen compared the glottis to a wind instrument; Ferrein assimilated it to a chorded one. This latter hypothesis was objected to, on the principle that a chord, to vibrate, should not only be in a state of tension, but dryness; characters which this organ does not possess, being constantly lubrified with mucus, and in a state of greater or lesser relaxation. Fulgentius considers the human voice to be composed of ten parts: the four first are the front teeth, so useful for the appulse of the tongue in forming sounds, without which a whistle would be produced instead of a voice; the fifth and sixth are the lips, which he compares to cymbals striking against each other; the seventh the tongue, which serves as a plectrum to articulate sounds; the eighth is the palate, the concavity of which forms the belly of the instrument; the ninth the throat, which performs the part of a flute; and the tenth the lungs, which supply the place of bellows. That every degree of action in the _glottis_ is due to the muscles of the _larynx_ is proved by the experiment of tying or dividing the recurrent nerves, when the voice is destroyed or weakened. Speech is a peculiar modification of the voice adjusted to the formation of the sounds of letters, by the expiration of the air through the nostrils and mouth, and in a great measure by the assistance of the tongue applied and struck against the neighbouring parts, the palate and front teeth in particular, and by the diversified action of the lips. This is Payne Knight's doctrine, in his analytical essay on the Greek alphabet, and an illustration of the notions of Fulgentius. Singing is compounded of speech and a musical modulation of the voice, a prerogative peculiar to man even in his most savage state; for, despite the assertions of the visionary Rousseau, who maintained that it is not natural to our species, we find that even in the uncivilized regions of Ethiopia, Greenland, and Kamtschatka, singing is a solace and a comfort. The mechanism of speech and articulation is so intricate, that even the division of letters and their distribution are attended with difficulties. The following is the division of Amman in his work _Surdus Loquens_, published at Amsterdam in 1629, and enlarged under the title of _Dissert. de Loquela_, 1700, and is, perhaps, the most natural and intelligible. He divides into, I. Vowels; II. Semi-vowels; III. Consonants. I. The vowels are _simple_, _a_, _e_, _i_, _o_, _u_; and _mixed_ _ä_, _ö_, _ü_: these are formed by the _voice_ only. The semi-vowels and consonants are articulated by the mechanism of _speech_. II. The semi-vowels are _nasal_, _m_, _n_, _ng_ (_n_ before _g_, which is nearly related to it), that is, the labio-nasal _m_, the dente-nasal _n_, and the gutture-nasal _ng_; or _oral_ (lingual), _r_, _l_, that is, _r_ with a vibration of the tongue, or _l_ with the tongue less moved. III. The consonants he distinguishes into _sibilant_ (pronounced in succession), _h_, _g_, _ch_, _s_, _sh_, _f_, _v_, _ph_, that is _h_, formed in the throat, as it were a mere aspiration; _g_ and _ch_, true consonants; _s_, _sh_, produced between the teeth; and _f_, _v_, _ph_--formed by the application of the lower lip to the upper front teeth--and _explosive_ (which are as it were suddenly exploded by an expiration for a time suppressed, or interrupted), namely _k_, _q_, formed in the throat; _d_, _t_, about the teeth; _p_, _b_, near the lips; and _double_ (compound), _x_, _z_.[3] It has been thought that the tongue was indispensable for the purposes of speech, yet there are instances on record in which this has not been found an invariable rule. Dr. Conyers Middleton mentions two cases of distinct articulation with at least little or no tongue. In his exposure of the _pious_ deceptions of weak and wicked Christians during the first centuries of the Christian era, he notices a pretty tale of an Arian prince cutting out the tongues of some of the orthodox party, and these being as able to talk as before; nay, one of them, who had been dumb from his birth, gained the faculty of speech by losing his tongue! We find various accounts of persons who spoke more or less fluently without this organ. Jussieu has inserted in the _Mémoires de l'Académie des Sciences_, 1718, the case of a Portuguese girl, who instead of a tongue had merely a little protuberance of about four lines in diameter in the middle of her mouth, and endowed with the power of contraction and dilatation; she spoke distinctly, but experienced difficulty in pronouncing _c_, _f_, _g_, _l_, _n_, _r_, _s_, _t_, _x_, and _z_, when she was obliged to bend her neck forward to upraise as it were the larynx. In this case, deglutition could not be well performed, and she was obliged to use her finger to propel the masticated food downwards. Dr. Eliotson observes, that it is by no means improbable that the progress of modern art may present us at some future period with mechanical substitutes for orators and preachers; for, putting aside the magic heads of Albertus Magnus and Roger Bacon, Kratzenstein actually constructed an instrument to produce the vowels. De Kempelin has published a full account of his celebrated speaking machine, which perfectly imitated the human voice. The French celebrated mechanician, the Abbé Mical, also made two heads of brass, which pronounced very distinctly entire phrases; these heads were colossal, and their voices powerful and sonorous. The French government refusing, it is said, in 1782, to purchase these automata, the unfortunate and too sensitive inventor, in a paroxysm of despair, destroyed these masterpieces of scientific ingenuity. It has been observed, that in various races the pronunciation seemed to depend upon some peculiar and characteristic conformation; and Adelung informs us that in the Hottentots, the bony palate is smaller, shorter, and less arched than in the other races, and that the tongue, especially in the Bosjesman tribe, is rounder, thicker, and shorter. Hence their pronunciation is singular, and has been compared to the clucking of the Turkey, or the harsh and broken noises produced by some other birds. They combine their aspirated gutturals with hard consonants, without any intervening vowels, in a manner that Europeans cannot imitate. No doubt the differences of language are as numerous as the other distinctions which characterize the several races of men. The various degrees of natural capacity and of intellectual progress; the prevalence of particular faculties; the nature of surrounding circumstances; the ease or difficulty with which our different wants and desires are gratified, will produce not only peculiar characters in the nature and construction of language, but in its copiousness and development. One of the most curious points in the subject of language, is the continued existence in a large portion of Asia, very anciently civilized, and considerably advanced, at least in the useful arts, of simple monosyllabic languages, which are not in the slightest degree connected with the peculiar organization of the Mongolian variety, to which these people belong, and whose language is distinctly polysyllabic. The attempts that have been made to trace the origin of languages to the varieties of our species, or to the influence of climate, have hitherto been fruitless, and the doctrines broached on the obscure subject refuted by observation. Mr. Jefferson states that there are twenty radical languages in America for one in Asia; more than twenty languages, he adds, are still spoken in the kingdom of Mexico, most of which are at least as different from one another as the Greek and the German, the French and the Polish. The variety of idioms spoken by the people of the new continent, and which without the least exaggeration may be stated at some hundreds, offers a very striking phenomenon, particularly when we compare it to the few languages spoken in Asia and in Europe. Vater also informs us, that in Mexico, where the causes producing insulation of the several tribes have been for a long time in a course of diminution, Clavigero recognised thirty-five different languages. Some of these words are rather of difficult pronunciation, and Humboldt tells us that _Notlazomahuiztespixcatatzin_ is the term of respect with which they addressed their priests. During the French revolution, a learned Jacobin discovered that the early Peruvians adored a divinity who patronized the _Sans-culottes_, of their day, and who was named _Cawaltze-quos_, i. e. without breeches. Such barbarous words do not constitute that engaging tongue that Shakspeare calls "_speaking holiday_," but rather confirms Byron's ideas of the Russians' difficult expressions, which no man has leisure to pronounce except on high-days and holidays. Although brutes pronounce no articulate sounds, there is, no doubt but they have a language perfectly intelligible to one another. Their manner of expressing their different emotions is in some instances perfectly distinct; and birds have most decidedly a peculiar language. The following may be said to be the words of a nightingale's strain observed by Bechstein, an ingenious ornithologist, and committed to paper several times while he listened with deep attention to that sweet bird's "complaining notes," that "tune our distresses and record our woes." Tiouou, tiouou, tiouou tiouou Shpe, tiou, tokoua Tio, tio, tio, tio. Kououtio, kououtio kououtio, Tskouo, tskouo, tskouo, Tsii, tsii, tsii, tsii, tsii, tsii, tsii, tsii tsii tsii, Kouoror tiou. Tskoua pipitskousisi Tso, tso, tso, tso, tso, tso, tso tso, tso, tso, tso, tso, tsirrhading! Tsisi si tosi si, si, si, si, si, si, si. Tsorre tsorre tsorre tsorrehi Tsatn, tsatn, tsatn tsatn tsatn tsatn tsatn tsi, Dlo, dlo, dlo dla, dlo dlo dlo dlo dlo Kouioo trrrrrrrrtzt Lu, lu, lu, ly ly ly li li li li Kouio didl li loulyli Ha guour, guour, koui kouio! Kouio, kououi kououi kououi koui, koui, koui, koui, Ghi ghi ghi Gholl, gholl, gholl gooll ghia hududoi Koui koui koui ha hia dia dillhi! Hets, hets, hets, hets, hets, hets, hets hets, hets, hets Hets, hets, hets, hets, hets Tourrho hostehoi Kouia, kooia, kouia, kouia, kouia kouia kouia kouiati! A story is related of an irascible Irish piper of the name of _Molroy_, who declared a war implacable against the feline race, as he swore that they invariably pronounced his name in their nocturnal concerts. Gall and various observers of animals have fully ascertained that the attention of dogs is awakened by our conversation. He brought one of these intelligent creatures with him from Vienna to Paris, which perfectly understood French and German, of which he satisfied himself by repeating before it whole sentences in both languages. A recent anecdote has been related of an old ship-dog, that leaped overboard and swam to the shore on hearing the captain exclaim, "Poor old Neptune! I fear we shall have to drown him!" and such was the horror which that threat inspired, that he never afterwards would approach the captain or any of the ship's company, to whom he had previously been fondly attached. It must, however, be observed that in the brute creation, as in ours (sometimes more brutal species), peculiar attributes, that do not belong to the race, distinguish individuals gifted with what in man we might call a superior intellect, but which in these animals shows a superiority of what we term instinct. Spurzheim relates an instance of a cow belonging to Mr. Dupont de Nemours, which, amongst the whole kindred herd, was the only one that could open the gate leading to their pastures; and her anxious comrades, when arriving at the wished-for spot, invariably lowed for their conductor. It is also related of a hound, who, unable to obtain a seat near the fire without the risk of quarrelling with the dozing occupants that crowded the hearth, was wont to run out into the court-yard barking an alarum that brought away his rivals in comfort, when he quietly reentered the parlour, and selected an eligible stretching-place. This animal displayed as much ingenuity as the traveller who, according to the well-known story, ordered oysters for his horse for the purpose of clearing the fireside. ECSTATIC EXALTATION. This rapturous excitement is not unfrequently the province of the physician. Fortunately perhaps for the patient, it is an incurable malady, illustrating the lines of Dryden, There is a pleasure, sure, in being mad, Which none but madmen know. If we admit this state of ecstasy to be a mental aberration, it is surely of an enviable nature, since it elevates the soul to a beatitude which is rarely the lot of man. No definition of this state can equal that given by St. Theresa of her own feelings. By prayer she had attained what she calls a "celestial quietude,--a state of union, rapture, and ecstasy." "I experienced," she continues, "a sort of sleep of all the faculties of the soul--intellect, memory, and volition; during which, though they were but slumbering, they had no conception of their mode of operation. It was a voluptuous sensation, such as one might experience when expiring in raptures in the bosom of our God. The soul is unconscious of its actions; she (the soul) knows not if she speaks or if she remains silent, if she laughs or if she cries. It is, in short, a blessed extravagance, a celestial madness, in which she attains in the knowledge of true wisdom, an inconceivable consolation. She is on the point of merging into a state of languor; breathless, exhausted, the slightest motion, even of the hands, is unutterably difficult. The eyes are closed by a spontaneous movement; or, if they remain open, the power of vision has fled. In vain they endeavour to read: they can distinguish letters, but are unable to class them into words. Speak to a person in this absorbed condition, no answer will be obtained; although endeavouring to speak, utterance is impossible. Deprived of all external faculties, those of the soul are increased, to enjoy glorious raptures when conversing with the Deity and surrounding angels." These conversations the blessed St. Theresa relates; and she further states, that after having remained about an hour in this joyous trance, she recovered her usual senses, and found her eyes streaming in tears, as though they were weeping for the loss she had experienced in being restored to earthly relations. Now, with all due deference to St. Theresa, this state was most probably a hysteric condition. Zimmerman relates two cases somewhat of a similar kind. Madame M. experienced effusions of divine love of a peculiar nature. She first fell into a state of ecstasy, motionless and insensible, during which, she affirms, she felt this love penetrating her whole being, while a new life seemed to thrill through every fibre. Suddenly she started up, and seizing one of her companions, exclaimed, "Come, haste with me to follow and call Love, for I cannot sufficiently call upon his name!"--A French young lady was the second instance of this affection. She also frequently lost the power of speech and all external senses, animated with a love divine, spending whole nights in ecstatic bliss, and rapturously embraced by her mystic lover. It is difficult, perhaps, to separate this amorous feeling from physical temperament; and the following remarks of Virey on the subject of St. Theresa are most judicious:--"She possessed an ardent and sensitive disposition, transported, no doubt, by terrestrial affection, which she strove to exchange for a more exalted ardour for the Deity; for devotion and love are more or less of a similar character. Theresa was not fired by that adoration which is exclusively due to the infinite and invisible Intelligence which rules the universe; but she fancied a sensible, an anthropomorphous divinity; so much so, that she not unfrequently reproached herself with bitterness that these raptures were not sufficiently unconnected with corporeal pleasures and voluptuous feelings." St. Theresa was not the only beatified enthusiast who suspected that the evil spirit occasionally interfered in those ecstatic visions. St. Thomas Aquinas divides ecstasies into three classes;--the first arising from divine power, and enjoyed by the prophets, St. Paul, and various other saints. The second was the work of the devil, who bound down all external senses, suspended their action, and reduced the body to the condition of a corpse: such were the raptures in which magicians and sorcerers were frequently entranced, during which, according to Tertullian and other writers, the soul quitted the body to wander about the world, inquire into all its occurrences, and then returned with the intelligence it had obtained to its former abode. The third rapturous category of St. Thomas he simply attributes to physical causes, constituting mental alienation. May not all these ecstatic raptures be considered as belonging to this third class? It has been observed that women, hysteric ones in particular, were the most subject to this supposed inspired affection; and amongst men it has also been remarked, that the enraptured individual was in general nervous, debilitated, and bald; and it is well known that the fall of the hair is frequently the result of moral and physical weakness, brought on by long studies, contemplation, grief, and illness, all of which may occasion mental aberration; for what other denomination can be given to the ecstatic state of the Monks of Mount Athos, who pretended or fancied that they experienced celestial joys when gazing on their umbilical region, in converse with the Deity? Hence were they called _Omphalopsychians_, whose notions in the matter are thus described by Allatius: "Elevate thy spirit above earthly concerns, press thy beard upon thy breast, turn thine eyes and all thy thoughts upon the middle of thine abdomen, hold thy breath, seek in thy bowels the abode of thy heart--then wilt thou find it unalloyed with dense and tenebral mists; persevere in this contemplation for days and nights, and thou shalt know uninterrupted joys, when thy spirit shall have found out thy heart and has illumined itself."[4] Bernier relates an act of supposed devotion amongst the Fakirs nearly as absurd, when, to seek the blessings of a new light, they rivet their eyes in silent contemplation upon the ceiling; then gradually looking down, they fix both eyes gazing, or rather squinting, at the tip of their nose, until the aforesaid light beameth on them. St. Augustin mentions a priest who could at will fall into one of these ecstasies, during which his external senses were so totally suppressed that he did not experience the pangs of the torture. Cardanus affirms that he was possessed of the same faculty. "_Quoties volo_," he says, "_extra sensum quasi in exstasim transeo--sentio dùm eam ineo, ac (ut veriùs dicam) facio, juxta cor quandam separationem, quasi anima abscederet, totique corpori res hæc communicatur, quasi ostiolum quoddam aperiretur. Et initium hujus est à capite, maximè cerebello, diffunditurque per totam dorsi spinam, vi magnâ continetur; hocque solùm sentio, quad sum extra meipsum magnâque quâdam vi paululum me contineo._" This state of mind is usually succeeded by contemplation, which has justly been considered one of the attributes of Genius. This contemplation, however, may be applied to positive relation, or to the workings of fiction. In the latter case it becomes to a certain degree mental, and beyond the control or the influence of our reason, although we cannot regulate the rationality of our mental pursuits by any given or acknowledged standard. The pseudo-philosopher, who searches for the _elixir vitæ_ or the power of transmuting metals, and the judicial astrologer, are in the eyes of society madmen: yet, do they reason on certain rational principles, and in many respects may be considered wise; one might figuratively say, that here the mind must have taken flight beyond its natural limits, if we can limit thought. In the wild wanderings of Theosophy man has fancied that by abstracting himself from the world, he might place himself in relation with the Divinity, and has so forcibly indulged the flattering illusion, that he actually believes that he is in converse with his Creator or his angels. Unquestionably this is a state of mania, yet is it founded upon a systematic train of ideas, that, strictly speaking, does not partake of mental aberration, but rather of enthusiasm. Although an indulgence in this may terminate in mania, still there is something delightful in these fond aberrations. A new world--a new condition is evoked--we are freed from the trammels of society and its prejudices--and perhaps encompassed by misery we burst from its shackles into another orb of our own creation, when the eyes closed in a vision of bliss--a meridian sunbeam, through the darkness of night. If the slumber of the visionary ushered in death, his destiny might be enviable--he had already quitted the world, seeking the presence of his God--his soul had already soared from its earthly tenement. There is no doubt that such contemplation may lead us to a better knowledge of the Supreme Being, whose image and attributes have been distorted by ignorance and superstition. It has been truly said, that until the light of Christianity shone upon mankind, God was unknown. He had been represented as wrathful and revengeful--implacable in his anger--insatiable in his thirst for blood--when he was revealed to us upon the earth, gentle, forgiving, loving, humble, and charitable. The type of all excellence--and delivering doctrines so pure, so convincing, as to entitle him to the name of _Saviour_, even were his godhead doubted--for who could question the salvation of those who followed his laws. Until ambition swayed the church and polluted the altar with blood and rapine--how happy, how blessed were these followers--even in the midst of persecution and in agonies--pardoning their barbarous murderers and praying for their conversion. Unfortunately according to the temperament of individuals their ecstasy has frequently led to an enthusiasm which knew no bounds, and induced the illuminated visionary to consider all men who did not coincide in his opinions the enemies of Divinity--hence arose fanaticism and persecution--yet did these murderous madmen conceive that they were wielding their hateful sword in the cause of an offended God; and, although we read of their excesses and cruelty with horror, they were not bad men, and many of them imagined that they were fulfilling a heavenly mission. I have known many worthy and amiable ecclesiastics in Spain and in Portugal who advocated the inquisition as a useful institution, although they readily admitted that it had too frequently been rendered instrumental to ambition and political intrigues. This state of mental exaltation is not unfrequently within the province of a physician's care. The treatment like that of all moral affections is a task of great difficulty. Perhaps the best curative means to be adopted is occupation of the body in active pursuits. St. Augustine was so convinced of this necessity of occupation to prevent ecstatic habits, that the monks of the Thebaid cultivated their ground with such industry, that they freighted several vessels with their produce. Priest has observed in his extensive practice in insanity that he never met with an insane naturalist. Travelling is also to be enjoined. Marriage has also been advised, although it is to be feared that the little charms men of this description may have to suit a woman's fancy, might lead to contemplation of a nature widely different from beatitude. The Jewish Rabbi tell us, that as soon as Moses became contemplative and prophetic, his wife Marjarin left him. It is certain that enthusiasm produces a concentration of mind prejudicial to all other functions.[5] There is no doubt that melancholy or intense cogitation may bring on this morbid condition. Zimmerman relates that the mathematician Viote was sometimes so wrapped up in calculation, that he was known to remain three days and three nights without sleep or food: and Mendelsohn the philosopher, who was called the Plato of Germany, fell into a swoon the moment philosophy was talked of; and he was therefore ordered by his doctor not to think. Being asked one day what he contrived to do when not allowed thought, he replied, "Why, I go to the window and count the tiles on the roof of the opposite house." This morbid condition of our intellectual faculties has been admirably described by Johnson, in his Rasselas. "To indulge the power of fiction, and send imagination out upon the wing, is often the sport of those who delight too much in silent speculation. He who has nothing external that can divert him, must find pleasure in his own thoughts, and must conceive himself what he is not; for who is pleased with what he is? He then expatiates in boundless futurity, and culls from all imaginary conditions that which for the present moment he would most desire; amuses his desires with impossible enjoyments, and confers upon his pride unattainable dominion. The mind dances from scene to scene, unites all pleasures, in all combinations, and riots in delights which nature and fortune, with all their bounty cannot bestow. In time, some particular train of ideas fixes the attention: all other intellectual gratifications are rejected; the mind, in weariness or leisure, returns constantly to the favourite conception, and feasts on the luscious falsehood whenever she is offended with the bitterness of truth. By degrees the reign of fancy is confirmed; she grows first imperious, and in time despotic. Then fictions begin to operate as realities, false opinions fasten upon the mind, and life passes in dreams of raptures or of anguish." The celebrated physician Boerhaave was once engaged in so profound a meditation that he did not close his eyes for six weeks. Any fixity of idea may be considered as a monomania. Pascal, being thrown down on a bridge, fancied ever after that he was standing on the brink of a terrific precipice, which appeared to him an abyss ever ready to ingulf him. So immutable was this dread, that when his friends conversed with him they were obliged to conceal this ideal peril with a chair, on which they seated themselves, to tranquillize his perturbed mind. This is an instance of a painful fixity of thought, the result of which is melancholic mania; whereas ecstatic exultation is the enjoyment of a delicious sensation unknown in our habitual earthly enjoyments, and beautifully expressed by Shakspeare, when Pericles thus addresses Helicamus-- O Helicanus! strike me, honoured sir; Give me a gash,--put me to present pain, Lest this great sea of joy, rushing upon me, O'erbear the shores of my mortality, And drown me with their sweetness. Archimides was heedless of the slaughter around him. Father Castel, the inventor of the ocular harpsichord, spent an entire night in one position, ruminating on a thought that struck him as he was retiring to rest. And it is related of an arduous student, that he was reflecting so deeply on some interesting and puzzling subject, that he did not perceive that his feet were burnt by the fire near which he was seated. VARIETIES OF MANKIND. The most approved classification of mankind is that of Blumenbach. He divides them into five varieties: 1. The Caucasian; 2. Mongolian; 3. Ethiopian; 4. American; and 5. Malay: and the following are the characteristics of each. I. THE CAUCASIAN. The skin white; the cheeks rosy--almost a peculiarity of this variety; the hair of a nut-brown, running on the one hand to yellow, on the other into black, soft, long, and undulating; the head symmetrical, rather globular; the forehead moderately expanded; the cheek-bones narrow, not prominent; the alveolar edge round, the front teeth of each jaw placed perpendicularly. The face oval and pretty straight; its features moderately distinct; the nose narrow and slightly aquiline, the bridge of it rather prominent; the mouth small; the lips, especially the lower, gently turned out; the chin full and round. This variety comprehends all Europeans, except the Laplander and the rest of the Finnish race; the Western Asiatics as far as the Obi, the Caspian, and the Ganges; and the people of the North of Africa. II. THE MONGOLIAN. Skin of an olive colour; the hair black, stiff, straight, and sparing. The head almost square, the cheek-bones prominent outwards; the superciliary arches scarcely perceptible; the osseous nostrils narrow; the alveolar edge arched obtusely forward; the chin somewhat projecting. The face broad and flattened, and its parts consequently less distinct; the space between the eyebrows very broad as well as flat, the cheeks not only projecting outward, but nearly globular; the aperture of the eyelids narrow and linear; the nose small and flat. This comprehends the remaining Asiatics, except the Malays of the extremity of the Transgangetic Peninsula, the Finnish races of the North of Europe, Laplanders, &c., and the Esquimaux, diffused over the most northern parts of America, from Behring's Strait to the farthest habitable point of Greenland. III. THE ETHIOPIAN. Skin black; the hair black and crisp. Head narrow, compressed laterally; forehead arched; the cheek-bones projecting; the osseous nostrils large, the jaws lengthened forward; the alveolar edge narrow, elongated, more elliptical; the upper front teeth obliquely prominent, the lower jaw large and strong; the skull thick and heavy; the face narrow, and projecting at its lower part; the eyes prominent; the nose thick and confused with the projecting cheeks; the lips, especially the upper, thick; the chin somewhat receding; the legs in many instances bowed. This comprehends the inhabitants of Africa, with the exception of the Caucasian variety which inhabits the northern parts. IV. THE AMERICAN. Skin of a copper colour; hair black, stiff, straight, and sparing. Forehead short; cheek-bones broad, but more arched and rounded than in the Mongolian variety; the orbits generally deep; the forehead and vertex frequently deformed by art; cranium usually light. The face broad, with prominent cheeks, not flattened, but with every part distinctly marked if viewed in profile; the eyes deep; the nose rather flat, but still prominent. This comprehends all the American, excepting the Esquimaux. V. THE MALAY. Skin tawny; hair black, soft, curled, thick, and abundant; head rather narrow; forehead slightly arched; cheek-bones not prominent, upper jaw rather projecting. Face prominent at its lower part; the features viewed in profile more distinct; the nose full, broad, bottled at its point; mouth large. This comprehends the inhabitants of the Pacific Ocean, of the Marian, Philippine, Molucca, and Sunda isles, and of the Peninsula of Malacca. * * * * * The Caucasian variety derives its name from _Mount Caucasus_, where we meet with a beautiful race--the Georgians; and because, so far as the imperfect light of history and tradition can guide us, the original abode of the species appears to have been in that quarter. In this class are included all the ancient and modern Europeans; the Assyrians, Medes, Chaldeans, Sarmatians, Scythians, and Parthians; the Philistines, Phoenicians, Jews; the Turks, Persians, Arabians, and Hindoos of high caste. Blumenbach is inclined to believe that the primitive human race belonged to this variety. In support of this opinion it may be stated, that the part of Asia which seems to have been the cradle of the race has always been, and still is, inhabited by tribes of this formation; and the inhabitants of Europe in great part may be traced back for their origin to the West of Asia. Are all these various tribes, brethren descended from one stock? or must we trace them to more than one? The physiologists who have ventured to express the latter opinion have been stigmatized by intolerance and blind bigotry as atheists and unbelievers; yet this question belongs to the domain of the naturalist, and the philosopher has an unqualified right to moot it without incurring the heinous charge of infidelity. To form an opinion on this difficult subject, it will be necessary, as Lawrence justly observes, to ascertain carefully all the differences that exist between the various races of men; to compare them with the diversities observed among animals; to apply to them all the light which human and comparative physiology can supply, and to draw our inferences concerning their nature and causes from all the direct information and all the analogies which these considerations may unfold. "It is quite clear," continues the same ingenious writer, "that the Mosaic account makes all the inhabitants of the world descended from _Adam_ and _Eve_. The entire, or even the partial inspiration of the various writings comprehended in the Old Testament, has been and is doubted by many persons, including learned divines and distinguished Oriental and Biblical scholars. The account of the creation, and subsequent events, has the allegorical figurative character common to Eastern compositions, and it is distinguished amongst the cosmogonies by a simple grandeur and natural sublimity, as the rest of these writings are by appropriate beauties in their respective parts. The representation of all the animals being brought before Adam in the first instance, and subsequently of their all being collected in the ark, if we are to understand them as applied to the living inhabitants of the whole world, is zoologically impossible. How could the polar bear have traversed the torrid zone? If we are to believe that the original creation comprehended only a male and female of each species, or that one pair only was saved from an universal deluge, the difficulties are increased; the carnivorous animals must have perished with hunger, or destroyed most of the other species." On this obscure subject Adelung has expressed himself with much ingenuity: "Asia has been at all times regarded as the country where the human race had its beginning, and from which its increase was spread over the rest of the globe. Tracing the people up to tribes, and the tribes to families, we are conducted at last, if not by history, at least by the tradition of all old people, to a single pair, from which tribes and nations have been successively produced. What was the first family, and the first people descended from it?--where was it settled?--and how was it extended so as to fill the four large divisions of the globe? It is a question of fact, and must be answered by History. But History is silent: her first books have been destroyed by time; and the few lines preserved by _Moses_ are rather calculated to excite than to satisfy our curiosity. "We must fancy to ourselves this first tribe endowed with all human faculties, but not possessing all knowledge and experience, the subsequent acquisition of which is left to the natural operation of time and circumstances. As Nature would not unnecessarily expose her first-born and inexperienced son to conflicts and dangers, the place of his early abode would be so selected that all his wants could be easily satisfied, and every thing essential to his existence be readily procured. He would be placed, in short, in a garden of paradise. Such a country is found in central Asia, between the 30th and 50th degrees of north latitude, and the 90th and 110th of east longitude (from Ferro); a spot which in respect to its height, can only be compared to the lofty plains of Quito in South America. Here, too, all the animals are found wild, which man has tamed for his use, and carried with him over the whole earth." This ingenious historical investigation points out the east as the earliest and original seat of our species, the source of our domesticated animals and our principal vegetable food; but it by no means decides whether the globe was peopled by one or several original stocks. The startling nature of this question on the first view of the subject must induce us to consider the circumstance of these five distinct varieties arising from one stock as miraculous; but when we compare them with the corresponding difference in animals, we can easily come to the conclusion that the various races of human beings are only to be regarded as varieties of a single species, without supposing the intervention of any supernatural agency. The sceptic Voltaire, who evinced more wit than learning in his endeavours to invalidate Scriptural tradition by ridicule, thus expresses himself: "Il n'est permis qu'à un aveugle de douter que les blancs, les négres, les albinos, les Hottentots, les Lapons, les Chinois, les Américains, soient des races entièrement différentes;" but had this philosopher been better versed in zoology and physiology, he would not have made so groundless an assertion. "Analogical and direct facts," says Dr. Elliotson, "lead to the conclusion that none of the differences among mankind are so great as to require the belief of their originality." A contrary opinion, however, should not be stigmatized by bigotry, for Locke has justly observed that only matters above human reason are the proper subjects of revelation; and Bacon has also maintained that religious and philosophical inquiries should be kept separate, and not pompously united. Dr. Bostock, than whom no man could be less sceptical, plainly admits that we do not find that the writer of the book of Genesis lays claim to any supernatural source of information with respect to natural phenomena, while the whole tenour of his work seems to show that on such topics he adopted the opinions which were current among his contemporaries. The causes of the difference of our species have been the subject of as great a discrepance in opinion. Most of the Greek and Roman Historians have attributed it to the influence of climate; and amongst the moderns, Montaigne, Montesquieu, Buffon, and Zimmerman, have considered the modification of the individual and the degeneration of the offspring as the result of this external agency. Lord Kaimes, Hume, and many other philosophers, have entertained a contrary opinion. No doubt, the influence of climate may materially affect colour, stature, hair, features, and even the moral and intellectual character; but it must be considered as inadequate to act upon conformation. The prevalence of light colours in the animals of polar regions is well known: the arctic fox, the white bear, the snow-bunting, are striking instances of this peculiarity; but these circumstances are purely superficial. The skulls of these individuals are similar to those of the Europeans; nay, it is well known that light races are found among dark nations, and many protected parts of the body are blacker than those which are exposed. Buchanan tells us, that the Jews in Cochin are divided into white and black classes, though born under the same parallel; the white Jews having been known there for upwards of one thousand seven hundred years. Dr. Shaw and Bruce describe a race of fair people, near Mount Aurasius in Africa, with red hair and blue eyes, and who are, according to tradition, descended from the Vandals. We find the red Peruvian, the brown Malay, and the white Abyssinian in the very zones peopled by jet black races. This influence of temperature upon colour frequently varies according to the seasons. Pallas observed that even in domestic animals, such as the horse and cow, the coat is of a lighter colour in winter. The Siberian roe, red in summer, is white in the winter; the fur of the sable and the martin is much deeper in the warm months; and the squirrel and mustela nivalis, which become white in Siberia and Russia, do not change their hue in Germany. The winter coat, it has been observed by naturalists, is found far advanced in the preparatory autumn. This bounteous provision of nature seems to have been extended to the vegetable kingdom and it has been observed that the pellicle of onions is much thicker on the approach of a severe winter than on that of a more temperate season. But if further proof were necessary to impugn this doctrine respecting climate, we may adduce the fact of a woman having borne twins of different complexions, a white and a black. With all due respect to the much-lamented Bishop Heber, we must receive with some degree of hesitation his assertion that the Persian, Greek, Tartar, and Arabian inhabitants of India, assume, in a few generations, without any intercourse with the Hindoos, a deep blue tint, little lighter than that of a negro; and that the Portuguese, during three hundred years' residence in that climate, have assumed the blackness of a Kaffer. The same learned prelate is of opinion that our European complexion was not primitive, but rather that of an Indian; an intermediate tint is perhaps the most agreeable to the eye and instinct of the majority of the human race. Dr. Heber, perhaps, had not seen, in various Roman catholic treasures, portraits of the Virgin Mary, painted, according to tradition, by St. Luke, and in which she is represented as a negress. That solar heat produces blackness of the integuments is an ancient opinion, and is illustrated by Pliny, who tells us, "Æthiopes vicini sideris vapore torreri, adustisque similes gigni, barba et capillo vibrato, non est dubium." Buffon asserts that "climate may be regarded as the chief cause of the different colours of man;" and Smith is of opinion "that from the pole to the equator we observe a gradation in the complexion nearly in proportion to the latitude of the country." Blumenbach, under the same impression, endeavours to account for this black tinge by a chemical illustration somewhat curious. He states that the proximate cause of the dark colour is an abundance of carbon secreted by the skin with hydrogen, precipitated and fixed by the contact of the atmospheric oxygen. Our creoles, and the British inhabitants of India, may esteem themselves particularly fortunate in not being subject to this chemical operation! On the other hand, it is well known that a black state of the skin has been produced in white races under peculiar circumstances; and Le Cat and Camper mention cases of women who turned dark during their pregnancy. It would be idle to dwell further on the hypothetic illustrations regarding this supposed operation of climate, which the observation of every unprejudiced traveller can impugn. Yet the following remarks on the subject by an American divine, the Rev. J. S. Smith are worthy of notice: "In tracing the globe from the pole to the equator we observe a gradation in the complexion nearly in proportion to the latitude of the country, immediately below the arctic circle a high and sanguine colour prevails. From this you descend to the mixture of red and white. Afterwards comes the brown, the blue, the tawny, and at length the black as you proceed to the line. The same distance from the sun, however, does not in any degree indicate the same temperature of climate. Some secondary causes must be taken into consideration, in connecting and limiting its influence. The elevation of the land, its vicinity to the sea, the nature of the soil, the state of cultivation, the course of the winds, and many other circumstances enter into this view. Elevated and mountainous countries are cool in proportion to their altitude above the level of the sea, increasing to the ocean, just in opposite effects, in northern and southern latitudes; for the ocean being of a more equal temperature than the land, in one case corrects the cold, and in the other moderates the heat. Ranges of mountains, such as the Apennines in Italy, and Taurus, Caucasen, and Iman, in Asia, by interrupting the course of cold winds, render the quite dry country below them warmer, and the countries above them colder, than is equivalent to the proportionate difference of latitude. The frigid zone, in Asia, is much wider than it is in Europe; and that continent hardly knows a temperate zone." Climate also receives some difference from the nature of the soil, and some from the degree of cultivation; sand is susceptible of greater heat than clay, and an uncultivated region shaded with forests and covered with undrained marshes, is more frigid in northern and more temperate in southern latitudes, than a country laid open to the direct and constant action of the sun. History informs us that when Germany and Scythia were bound in forests, the Romans often transported their armies across the frozen Danube; but since the civilization of those barbarous regions, the Danube rarely freezes. Migration to other countries has also been adduced as one of the causes of variety in mankind; but the permanency of the characteristic distinctions of any race militates against this supposition. The physical character of the Celts, who peopled the west of Europe at an early period, is still observable in the Spaniard, most of the French, the native Welsh, the Manks, and the Scotch Highlander; whereas the German race, who occupied the more northern and eastern settlements, are still distinguished by their transparent skin, rosy complexion, flaxen hair, and blue eyes; and in Ireland, the race of the Danes and the Milesians can to this day be recognised in their respective characters. Shaw and Bruce traced the descendants of the Vandals who passed from Spain into Africa in the fifth century; and, after a lapse of thirteen centuries, Bruce says that they are "fair like the English, their hair red, and their eyes blue." Negroes have been introduced into the New World for upwards of three centuries, where, despite of a new clime and different habits, they still retain the character of their race; and the Jews who have not intermarried out of their nation, have preserved their features for nineteen centuries. Not only do we observe the peculiarities of physical conformation resisting the destructive or degenerating hand of time, but certain imperfections in their faculties have been equally permanent in certain tribes. It is a curious fact that the Mamelukes, who have resided in Egypt for upwards of five hundred and fifty years, have never perpetuated their subsisting issue. Volney observed, that there does not exist one single family of them in the second generation; all their children perishing in the first or second descent. The same observation applies to the Turks, who can only secure the continuance of their families by marrying native women, an union which the Mamelukes disdained. This singularity, remarked by Volney, has been since confirmed by late travellers. It will be found that the progress of domestication, the natural result of civilized improvement, tends more materially to operate a wonderful change in the animal conformation, than any other supposed agency. The head of the domestic pig differs as much from that of the wild one as the Negro's from the Caucasian's. At Padua, it has been observed that fowls have a cranium perforated by numerous holes, and hollowed out like a shell. In some countries, nay districts, cattle and sheep have or have not horns; and in other instances sheep have so many of them as to have acquired the epithet of _polycerateous_. Wild animals continuing to inhabit the place that bore them, undergo little or no change, and their fossil remains and skeletons are similar to the present species; but nothing can form a stronger contrast to this specific uniformity than the numerous varieties to be found in those races that have been crossed in breed and domesticated by man. We could scarcely imagine that our sheep owe their origin to the mouflon or argali, (_ovis ammon_,) an animal large in size, fleet, and fierce. The sheep of Senegal and India are those that have undergone the least degradation; while those of Barbary, Egypt, Arabia, and Persia, have experienced greater degeneration. We daily see dogs degenerate before our eyes, and it has not yet been satisfactorily ascertained whether they arise from one or several species. Cuvier, in his diligent researches, has concluded that our oxen do not originate in the urus or bison of the ancients formerly found in various parts of Europe, and still met with in the forests of Lithuania, and on the Carpathian and Caucasian chains; but he is of opinion, from the examination of fossil remains, that, like the camel and the dromedary, the species has been destroyed by civilization: the causes of these changes do not appear to operate by altering the parents but disposing them to produce offsprings more or less dissimilar in colour, form, and disposition. Dr. Prichard observes, that the negro slaves of the third and fourth generation differ materially from the natives of Africa. In opposition to this doctrine, which admits this wonderful degeneration under the plastic influence of domestication, it has been shown that, as far as we know, the lapse of ages has not produced any change in the generality of animals. The zoological descriptions given by Aristotle twenty-two centuries ago apply distinctly to the same species of the present day, and every work of art in which these animals are represented corroborates the fact. Geoffroy de St. Hilaire brought numerous mummies of animals from the sepulchres of Egypt, and found no more difference between their skeletons and the osseous conformation of the present races, than in the relics of the human mummy and the bones of our contemporaries. The following luminous conclusion of Lawrence illustrates the observation of the foregoing fact: "If new characters are produced in the domestic animals because they have been taken from their primitive condition, and exposed to the operation of many, to them, unnatural causes,--if the pig is remarkable among these for the number and degrees of his varieties, because it has been the most exposed to causes of degeneration,--we shall be at no loss to account for the diversities in man, who is, in the true, though not in the ordinary sense of the word, more of a domesticated animal than any other. We know the wild state of most of them, but we are ignorant of the natural wild condition to which man was destined. Probably there is no such state; because Nature having limited him in no respect,--having fitted him for every kind of life, every climate, and every variety of food,--has given him the whole earth for his abode, and both the organized kingdoms for his nourishment. Yet, in the wide range through which the scale of human cultivation extends, we may observe a contrast between the two extremities, analogous to that which is seen in the wild and tamed races of animals. The savage may be compared to the former, which range the earth uncontrolled by man; civilized people to the domesticated breeds of the same species, whose diversities of form and colour are endless." It is therefore obvious that the various causes which operate upon animals in producing these alterations from the primitive race, although the manner in which they act is unknown, are sufficiently evident to convince us, by analogy, that they may account for similar phenomena in the human race, without the gratuitous assumption of different original species, tending to invalidate the Mosaic account of the creation. Despite the witticisms of Voltaire and other philosophers on this subject, sound philosophy teaches us to assign the same causes to the same effects without calling in the adventitious aid of other possible influences; and no difficulties prevent us from recognising the unity of the human species, which are not applicable to all other animals. ON THE INHUMATION OF THE DEAD IN CITIES. From time immemorial, medical men have strongly pointed out to municipal authorities the dangers that arise from burying the dead within the precincts of cities or populous towns. Impressed with the same conviction, ancient legislators only allowed to the most illustrious citizens a sepulchre in the temple of the gods. Euclides was interred in the temple of Diana Euclis, as a reward for his pious journey to Delphi in search of the sacred fire; the Magnesians erected a monument to Themistocles in their forum; Euphron received the same honour in Corinth; and Medea buried her two sons, Mermerus and Pheres, under the protection of Juno Acræa's altars, to guard their ashes from their persecutors. Lycurgus was perhaps the only Grecian legislator who recommended inhumation in temples and in cities, to accustom youth to the daily spectacle of death. The primitive Grecians, it appears, buried their dead in or about their dwellings; and we find a law amongst the Thebans, ordaining that every person who built a house should provide a repository for the dead upon his premises. In latter days, both Grecians and Romans erected their tombs outside of their cities, and chiefly by the road-side. It appears also, that, among the Romans, the bodies of the lower orders were promiscuously cast into wells, called _fruticuli_. Horace seems to allude to this practice. _Hoc miseræ plebi stabat commune sepulchrum._ The funerals of the wealthy patricians appear to have been most sumptuous and costly, the pall formed of valuable materials and decorated with splendid ornaments. Thus Statius: _Ditantur flammæ: non unquam opulentioan ille ante cinis: crepitant gemmæ: atque immane litescit argentum, et pietis exsudat vestibus aurum._ The laws of the twelve tables prohibited the practice of this waste of gold. Both religious and civil motives might have dictated the propriety of this regulation. The traveller, setting out upon a journey, and passing by the sepulchres of his sires, could in the presence of their manes invoke their protection; and on his return to his penates, safe from danger, he could put up thanks to the gods for his preservation. As a prudential measure, the interment of the dead beyond the walls of their towns prevented the fatal consequences that might have arisen from extensive putrefaction and infection, and moreover the burning of bodies would have exposed the adjoining buildings to the danger of frequent fires. It is also possible that policy dictated these sanatory enactments. The ancients held the remains of the departed as a sacred trust, in the defence of which they were ever prepared to fall; and it is not improbable that their warriors would have rushed forth to meet the invader, before he would have defiled, by his approach to their cities, the ashes of their ancestors. So scrupulously religious were the Athenians in performing the funeral rites of the dead, that they put to death ten of their commanders, after the battle of Arginusæ, for not having committed to the earth the dead bodies that floated on the waters. Such was the dread of being deprived of sepulchral rites, that it is related of several citizens of Cappadocia, that during the pestilence that devastated their town in the reign of Gallus and Valerian, they actually shut themselves up to perish in their tombs. There is no doubt but that their dead were buried in such a manner as not to prove injurious to the survivors; and Seneca plainly says, "Non defunctorum causâ, sed vivorum, inventa est sepultura." The ancients both burned and buried their dead, but inhumation appears to have been the most early and the most approved rite. "Let the dead be buried," says a law of Cecrops. Solon justifies the claims of the Athenians to the island of Salamis, from the circumstance of the dead bodies interred on its shores having been inhumed according to the Athenian custom, with their feet turned to the west, whereas the Megarensians turned theirs to the east. In various instances the burial or the burning appear to have been adopted upon philosophical doctrines. Democritus, with a view to facilitate resurrection, recommended interment, and Pliny thus ridicules the intention: "Similis et de asservandis corporibus hominum, et reviviscendis promissa à Democrito vanitas, qui non revivixit ipse." Heraclitus, who considered fire as the first principle, advocated the funeral pile; while Thales, who deemed water the chief element, urged the propriety of committing the departed to the damp bosom of the earth. Although burning the dead was customary, there were curious exceptions to the rule. Infants who died before cutting their teeth, persons struck dead with lightning, were buried. The place of interment of infants was called the _suggrundarium_. The early Christians inhumed the bodies of their martyrs in their temples. This honour was afterwards conferred on the remains of distinguished citizens, illustrious prelates, and princes. The infectious diseases which at various periods arose from this custom, induced Theodosius, in his celebrated code, strictly to prohibit it; and he even ordered that the remains of the dead thus inhumed should be removed out of Rome. The vanity of man, and the cupidity of the priesthood, soon overruled these wise regulations. Every family possessing sufficient means, claimed a vault within the churches, and thereby the revenues of the clergy were materially increased. At all times, even the dead appeared to have shared with the living the obligation of supporting the ministers of the altar. By a law of Hippias, the priestesses of Minerva received a choenix[6] of wheat, and one of barley, with an obolus, for every individual who departed this life. The _libitinarii_ of the Romans fulfilled the duties of our undertakers, or rather of the directors of funeral pomp of the French; yet they were attached to the temple of the goddess Libitina, whose priests received a fee in silver for every one who died, under the name of _Libitinæ ratio_. Suetonius informs us, that in Nero's time the mortality was so great during one autumn, that thirty thousand of these silver pieces were deposited in the fatal treasury. To increase the emoluments of this sacerdotal body, these _libitinarii_ sold at high prices every thing that was requisite for the funeral ceremonies, received a toll at the city gate through which the bodies were carried out, as well as at the entrance of the amphitheatre through which the dead gladiators were borne away. Phædrus alludes to this speculation in one of his fables, when speaking of a miser, Qui circumcidis omnem impensam funeris, Libitina ne quid de tuo faciat lucrum. It is supposed that this avaricious divinity owed her name to the displeasure which it must have occasioned to all who heard it,--_quòd nemini libeat_; but it is also possible that it was derived from her bearing poor mortals away, whenever she fancied it, and _ad libitum_. In more modern times, Theodolphus, Bishop of Orleans, complained to Charlemagne that lucre and vanity had converted churches into charnel-houses, disgraceful to the clergy and perilous to the community. It was upon this representation that this prince, in his capitularies, prohibited burials in churches under heavy penalties. But the laws of the wisest could not prevent priesthood from considering this source of emolument, although endangering public salubrity, an indisputable property that could not be meddled with without endangering the church. In England the custom of burying the dead in churches was first sanctioned by Cuthbert, Archbishop of Canterbury, in 758, it having been previously forbidden by Augustine, who had decreed that no corpse either of prince or prelate should be buried within the walls of a city. In France, Maret in 1773, and Vicq d'Azyr in 1778, pointed out the danger of this practice in such glaring colours, that government by an edict, only allowed church interment to certain dignitaries; but in 1804, by a wise law that should be enforced in every civilized country, inhumation in cities was entirely abolished. Amongst the numerous well authenticated evil results of burying in churches that led to this wise prohibition, the following were the most striking and circumstantial: In 1773, in Saulieu, Burgundy, an epidemic disease arising from the inhumation of a corpse in the church of St. Saturnin created considerable alarm. The body of a corpulent person had been interred on the 3d of March, and a woman was buried near it on the 20th of April following: both had died of a reigning fever. During the last burial a fetid effluvia arose from the vault, which pervaded the whole church; and, out of one hundred and seventy persons who were present, one hundred and forty-nine were attacked with the prevailing malady, although its progress had been arrested amongst the other inhabitants of the town. In 1774, a similar accident occurred in a village near Nantes, where several coffins were removed in a vault, to make room for the lord of the manor: fifteen of the bystanders died from the emanation. In 1744, one-third of the inhabitants of Lectouse perished from a fever of a malignant character that manifested itself after some works that required the removal of a burial-ground. Two destructive epidemics swept away large proportions of the population of Riom and Ambert, two towns in Auvergne. Taking this matter under consideration in a moral, or even a religious light, it may be questioned whether any advantage can accrue from the continuance of this pernicious custom, which during the prevalence of epidemic diseases endangers the life of every person who resides near a church. Does it add to the respect which the remains of the dead are entitled to? Certainly not: the constant tolling of "the sullen bell"--the daily cortège of death that passes before us--the graves that we hourly contemplate, perusing monumental records which more frequently excite unseasonable laughter than serious reflection--every thing, in short, tends to make death of little or no moment, except to those who have heard the mutes gossiping at their door. So accustomed, indeed, are we from our childhood to sepulchral scenes, that, were it not for the parish-officers, our churchyards would become the playground of every truant urchin; and how often do we behold human bones become sportive baubles in the wanton pranks of the idlers, who group around the gravedigger's preparations! So callous are we to all feelings of religious awe when surrounded with the dead, that our cemeteries are not unfrequently made the rendezvous of licentiousness and the assembly-ground of crime, where thieves cast lots upon a tomb for the division of their spoil. With what different feelings does the traveller wander over the cemetery of _Père la Chaise_? I am well aware that many of the gewgaw attributes that there decorate the grave, have been called the "_frippery_," "_the foppery_" of grief; but does there exist a generous, a noble sentiment, that may not be perverted by interested motives and hypocrisy into contemptible professions? How often is the sublime rendered ridiculous by bad taste and hyperbolic affectation! When we behold the fond lover pressing to his lips a lock of hair, or the portrait of all that he holds dear, the cold calculating egotist may call this the _frippery of love_; but the stoic who thinks thus, has never known the "sweet pangs" of requited affection, when, in bitter absence, the recollection of bliss gone by, imbodies in our imagination the form we once pressed to our respondent heart. The creation of our busy fancy stands before us, gazing on us with that tender look that in happier days greeted the hour of meeting; or trembles in our tears as when we last parted--to meet, perhaps, no more! With what fervour of religious love do we not behold the simple girl kneeling with uplift eye and hand on the green sod that covers all that endeared her to existence, till, overwhelmed with burning, choking regrets--as idle as they are uncontrollable--she sinks prostrate on the cold earth that now shrouds that bosom which once nestled her young hopes and fears! There have I seen the pale, the haggard youth,--to all appearances a student,--seated mournfully by the side of a tomb, absorbed in deep thought, heedless of the idlers who passed by him, looking at him perhaps with contempt!--heedless of the swift flight of time, which shrouded him imperceptibly in darkness, until he was warned by the guardian of the dead that it was time to depart--and to depart _alone_! No inscription recorded the "one loved name;" he would not expose it to the unfeeling gaze of the heartless tourist: all he would willingly have traced upon her tomb, would have been "Here lies _my own_!" The mouldering earth, the fleshless skeleton over which he mourns, cannot obliterate the remembrance of what she was: though her eyes, perhaps, no longer exist, still their former languid, liquid look of bliss, beams freshly in his recollection. The lips which once pronounced the long wished-for avowal of mutual love are still moist and open to memory's embrace--still seem to lisp the delicious _tu_! Our language is rich, without comparison richer far than the French; but we have nothing so endearing, so bewitching, as their _tu-toiement_: our _thee's_ and _thou's_ are frigid, chilly, when compared to the _first toi_ that escapes inadvertently from beloved lips! A French writer has beautifully expressed this exquisite moment: "Le _premier tu_ est tout-puissant; c'est le _fiat lux_ de l'âme; il est sublime, il débrouille le chaos!" Sublime are the words, "Blessed are the dead who die in the Lord!" Would it be irreligious to say, "Happy are the dead who die beloved?" Their fond and ardent heart had never been chilled by the withering hand of infidelity and ingratitude. They died in an ecstatic dream of perfect bliss on earth, and never were awakened to the world's mocking realities!--they died when they felt and believed in their heart of hearts that they were dearly beloved--could not be loved more dearly: with that conviction, death, in a worldly acceptation, can never be untimely. Probably, they died still sufficiently animated by a latent, lingering spark of life, to press the hand that was so often linked in mutual pressure in happy days--to feel the burning tear of anguish drop on the pale cheek--to hear the sad, the awful, last word, _à Dieu!_--an expression that habit has rendered trivial, but which bears with it, in the tenderest solicitude, the most hallowed meaning; since, in pronouncing it, we leave all that we cherish under the protection and the safeguard of OUR GOD. Affection deprives death of all horrors. We shrink not from the remains of what we cherished. Despite its impiety, there was something refined in that conviction of the ancients, who imagined that in bestowing their farewell kiss they inhaled the souls of those they loved. How sweet are those lines of Macrobius, originally attributed to Plato! Dum semihulco suavio Meum pullum suavior, Dulcemque florem spiritus Duco ex aperto tramite, Animo tunc ægra et saucia Cucurrit ad labia mihi! Our Shakspeare has quaintly, yet beautifully, described this parting embrace: And lips, O you The doors of breath, seal with a righteous kiss A dateless bargain to engrossing death. Nor was it only on the dying that the ancients bestowed this mark of fondness: Tibullus and Propertius tell us, that, as their bodies were laid on the funeral pile, they clasped them in a fond and last embrace. In regard to the painted crosses, the chaplets, the garlands of flowers, which mark the hallowed resting-place of the departed, it may be said that they are but romantic and poetical expressions of grief. If it were only real grief that expressed itself by outward testimonials, how soon would mourning be banished as an idle expense!--the "inky cloak," and customary "suits of solemn black--the trappings and the suit of woes," be laid aside! What a different feeling does the splendid catafalcum, covered with black velvet, studded with silver tears, and illumined by thousands of glaring tapers, excite, when compared with the simple and verdant graves which point out the spot "where souls do couch in flowers," blessed by affection's tears instead of lustral waters. At all periods, amongst every nation, flowers and certain trees seem to have been consecrated to the dead. The Romans planted the wild vine and the box around their tombs. Thus Martial to Alcimenes: Accipe, non Phario nutantia pondera saxo, Quæ cineri vanus dat ruitura labor, Sed fragiles buxos, et opacas palmitis umbras, Quæque virent lacrymis humida prata meis. The wealthy assigned a beauteous garden to their departed favourites, as in the instance of Augustus and Mæcenas. Not only did they suspend garlands over their tombs, but scattered flowers around them. Again in Virgil, Purpureosque jacit flores, ac talia fatur. The same custom prevailed amongst the Grecians, who considered all purple and white flowers acceptable to the dead. The Thessalian's strewed Achilles' grave with the immortal amaranth and lilies. Electra complains that the tomb of Agamemnon received no myrtle boughs; in short, instances of this practice are every where to be found. In addition to flowers and perfumes, ribands and hair were also deposited on their sepulchres. Electra adorns Agamemnon's tomb with her locks, and Canace laments that she had not been able to perform the same rite on her beloved Macareus. Poets tell us that precious ointments and wines were poured upon their monuments; and we find, in Euripides, Helen bidding Hermione to take locks of her hair, honey mixed with milk, and wine, to the sepulchre of her aunt. Amongst the Chinese, to the present day, the cypress and the fir, shade their cemeteries: the former tree, an attribute of Pluto was ever considered funereal, hence called _feralis_; and the _feralia_ were festivals in honour of the dead, observed by the Romans. Varro pretends that the cypress was called funereal from _funus_, as it emitted an antiseptic aroma. Pliny and others pretend that it typified the dead, from its never shooting out fresh sprouts when the trunk was hewn down. At any rate, to this hour, it is planted in burying-grounds in every civilized country. The yew-tree has also been considered an emblem of mourning from the earliest times. The custom of planting it singly appears also to be very ancient. Statius, in his Thebaid, calls it the _solitary yew_. In England, the trees planted in churchyards were protected by legal enactments, as appears by a statute of 35 Edward I. From the scarcity of bow staves, they had been frequently despoiled by our numerous archers; and, to meet this service, by an enactment of Edward IV. every foreign trader was obliged to bring in four bow staves for every ton of imported merchandise; Elizabeth, from the scarcity of this important article, put the statute in full force. Let us then hope, both for the living and the dead, that this custom, which obtains in France and other countries, will be adopted by us, instead of becoming the subject of ridicule. It is far more desirable to see families repairing to the tomb of the departed on the anniversary of their death, than to behold them daily passing by their remains with cold indifference. It would scarcely be believed upon the continent of Europe, that to this very hour bodies are buried in confined churchyards in the most crowded and dirty parts of the British metropolis, such as Russel-court, Drury-lane, and various other similar holes and corners; the rudest nations were never guilty of such a glaring impropriety. In the kingdom of Siam, the remains of the opulent are burnt with great ceremony, while the bodies of the poor are carried out and exposed on mountains: in Ceylon, the remains of the indigent are interred in the neighbouring woods; the rich consumed on gorgeous funeral piles. The Chinese inhume their dead at some distance from their cities and towns; it is only the bodies of the rich and noble that are allowed to remain on the premises of the family. Navarette mentions a curious custom prevalent in one of their provinces, Chan Si, where, in the event of two betrothed persons dying at the same period, they are married while their coffins are still in their former dwelling, and afterwards burnt together. By the accounts of various travellers, the wealthy Chinese are burnt with great pomp, and their monuments are most curious and expensive. Their mausoleums are actually halls or grottos, decorated with splendour: and they inter with the deceased many articles to which he might have been attached during life, and that may add to his comforts after death. A custom that was more prevalent before the invasion of the Tartars--a comb, a pair of scissars to pare his nails; four little purses, containing the nail-parings of the defunct, were placed in the coffin, and, amongst the wealthy, gold coin and jewels were inserted in the mouth. The Hottentots bury their dead in the wild clefts of rocks and caverns; the Peruvians bear theirs to the neighbouring hills and mountains. The Greenlanders wrap their dead in furs and skins, and carry them to a considerable distance from their huts. In Kamtschatka and Siberia bodies are covered with snow in caverns and caves; and the African savages perform the same funeral rites as the Irish: their dead are carried to the burying-ground, followed by crowds of relatives and other people, who join the procession, bellowing and howling most piteously, "Oh! why did you die? did you want any thing that was ever denied you?" and after the funeral the survivors invariably get drunk on palm-wine, or any strong liquor they can procure; a custom similar to the _circumpotatio_ of the Romans. BURIED ALIVE. Every nation, however uncivilized, holds the idea of being buried alive in constant dread; the horrors of such a situation cannot be described. Bodies have been found where the miserable victims of precipitation had actually devoured the flesh of their arms in the agonies of hunger and despair. Such was the fate of John Scott and the Emperor Zeno. It is to be feared that this melancholy occurrence is more frequent than is supposed, more especially in countries where inhumation is speedily resorted to. The ancients were remarkably cautious in this respect, especially when we take into consideration the climate of Greece and Rome during the summer months. A law of Greece on this subject directs that "the corpse should be laid out at the relations' pleasure, but that the following morning before daylight the funeral procession should take place." From various authorities, however, it appears that the bodies were kept three, and sometimes six days. Servius was of opinion that the time for burning bodies was the eighth day, and the time for burying the tenth; it appears, however, that this was a privilege granted to the wealthy, as the poor were consumed the day after their death, a custom alluded to in an epigram of Callimachus. Among the Romans several days were also allowed to elapse before interment--sometimes seven days; during which, loud cries, in which the deceased was called by his name, and the noise of various instruments resounded near the body; this was called the _conclamatio_, alluded to by Terence: Desine, jam conclamatum est. Lucan also alludes to this custom: ----------Sic funere primo Attonitæ tacuere domus, quam corpora nondum Conclamata jacent, noc mater crine soluto Exigit ad sævos famularum brachia planctus. The ancients held hasty inhumation in great dread, and grounded their apprehension on various current traditions. Thus Plato remarks the case of a warrior who was left for ten days on the field of battle amongst the dead, and who came to life when he was being borne to the sepulchre. Asclepiades restored life to a man who was also consigned to the funeral pile, and Pliny relates the case of Lucius Aviola and Lucius Lamia, who showed signs of life upon the pile, but were too much injured to be saved. Amongst the many absurd fancies regarding the dead, was the superstitious belief of their being able to masticate in their coffin any substance buried with them. Women more especially were believed to be gifted with this _post mortem_ faculty of moving their jaw-bones very loudly. _Claro sonitu_, says the learned Michael Ranfft, in his curious and elaborate work, _de masticatione mortuorum_. In this apprehension, that the deceased in their hunger might devour their own limbs, articles of food were interred with them. According to the law of the Jews, who appear to have been in constant dread of pestilential disease, the inhumation of the dead were most hasty. Yet in this instance many Rabbi maintain that the Talmud has been erroneously interpreted, for although it decreed that a night should not be allowed to pass before inhumation, it clearly meant that actual death must have been ascertained. While such fears are entertained of suspended animation being taken for dissolution, it is strange that in some savage tribes the aged are allowed to perish without any care being taken to prolong their lives. Such is the custom of some of the Esquimaux, where old and decrepit creatures are abandoned in their huts and left to their fate. An ancient tradition stated that the inhabitants of the Isle of Syria never died of any distemper, but dropped into their graves at a certain old age. It would be desirable that in cases where interment is speedily resorted to, a physician should attend, in order to ascertain that death had actually taken place. This is seldom practised, from the common saying "that it is uncivil on the part of a doctor to visit a dead patient." Various means are employed to ascertain death: the looking-glass applied to the mouth of the corpse, to find out whether breath had departed; the coldness of the extremities, the falling of the lower jaw, the rigidity of the limbs, and various other appearances, are universally known; but in the villages of Italy and Portugal, pins and needles are frequently driven under the nails, in what is vulgarly called _the quick_, to excite an excruciating pain if life should not have fled. The most certain evidence, when bodies are long kept, is most decidedly the commencement of decomposition; but, in other cases, the action of the voltaic pile on a bared muscle is an infallible test. It is much to be feared that on the field of battle and naval actions many individuals apparently dead are buried or thrown overboard. The history of François de Civille, a French captain, who was missing at the siege of Rouen, is rather curious: at the storming of the town he was supposed to have been killed, and was thrown, with other bodies, in the ditch, where he remained from eleven in the morning to half-past six in the evening; when his servant, observing some latent heat, carried the body into the house. For five days and five nights his master did not exhibit the slightest sign of life, although the body gradually recovered its warmth. At the expiration of this time, the town was carried by assault, and the servants of an officer belonging to the besiegers, having found the supposed corpse of Civille, threw it out of window, with no other covering than his shirt. Fortunately for the captain, he had fallen upon a dunghill, where he remained senseless for three days longer, when his body was taken up by his relations for sepulture, and ultimately brought to life. What was still more strange, Civille, like Macduff, had been "from his mother's womb untimely ripp'd," having been brought into the world by a Cæsarean operation, which his mother did not survive; and after his last wonderful escape he used to sign his name with the addition of "three times born, three times buried, and three times risen from the dead by the grace of God." The fate of the unfortunate Abbé Prevost, author of "Manon Lescaut," and other esteemed novels, was lamentable beyond expression. In passing through the forest of Chantilly, he was seized with an apoplectic fit: the body, cold and motionless, was found the following morning, and carried by some woodcutters to the village surgeon, who proceeded to open it; it was during this terrific operation that the wretched man was roused to a sense of his miserable condition by the agonies he endured, to expire soon after in all the complicated horrors of his situation. Various cases are recorded where persons remained in a state of apparent death for a considerable time. Cullen mentions an hysterical woman who was deprived of movement and sensibility for six days. Licelus knew a nun of Bresia, who, after an hysteric attack, continued in an inanimate state for ten days and nights. SPONTANEOUS COMBUSTION. The singular fact of persons, more especially individuals who were in the habit of indulging in the use of spirituous liquors, having taken fire and been consumed, is authenticated beyond the slightest doubt. Little confidence, it is true, can be placed in the reports on this subject which occasionally appear in the newspapers of different countries; but many celebrated practitioners have witnessed and recorded the event, and physiologists have endeavoured to account for its causes. The celebrated Le Cat mentions a woman of Rheims, of the name of Millet, who was found consumed at the distance of two feet from her chimney; the room exhibited no appearance of fire, but of the unfortunate sufferer nothing was found except her skull, the bones of the lower extremities, and some vertebræ. A servant-girl was accused of the murder, and condemned to death; but on her appeal, and a subsequent investigation, her innocence was fully ascertained. Joseph Battaglia, a surgeon of Ponte Bosio, relates the following case:--Don G. Maria Bertholi, a priest of Mount Valerius, went to the fair of Filetto, and afterwards visited a relation in Fenilo, where he intended to pass the night. Before retiring to rest, he was left reading his breviary; when, shortly afterwards, the family were alarmed by his loud cries and a strange noise in his chamber. On opening the door, he was lying prostrate on the floor, and surrounded by flickering flames. Battaglia was immediately sent for, and on his arrival the unfortunate man was found in a most deplorable state. The integuments of the arms and the back were either consumed or detached in hanging flaps. The sufferer was sufficiently sensible to give an account of himself. He said that he felt all of a sudden as if his arm had received a violent blow from a club, and at the same time he saw scintillations of fire rising from his shirt-sleeves, which were consumed without having burned the wrists; a handkerchief, which he had tied round his shoulders, between the shirt and the skin, was intact. His drawers were also sound; but, strange to say, his silk skull-cap was burnt, while his hair bore no marks of combustion. The unfortunate man only survived the event four days, when mortification of the burnt parts was most extensive, and the body emitted intolerable putrid effluvia. The circumstances which attended this case would seem to warrant the conclusion that the electric fluid was the chief agent in the combustion. Bianchini relates the death of the Countess of Cornelia Bandi, of Cesena, who was in the habit of using frictions of camphorated spirits. She was found consumed close to her bedside. No traces of fire could be observed in the room--the very lights had been burnt down to their sockets; but the furniture, closets, and linen were covered with a grayish soot, damp and clammy. The Annual Register mentions two facts of a similar nature which occurred in England, one at Southampton, the other at Coventry. In the transactions of the Royal Society of London, an extraordinary instance of combustion is also recorded. The fact is thus related. Grace Pitt, the wife of a fishmonger of Ipswich, aged about sixty, had contracted a habit, which she continued for several years, of coming down every night from her bedroom, half dressed, to smoke a pipe. On the night of the 9th of April, 1744, she got up from her bed as usual; her daughter who slept with her, did not perceive she was absent till next morning when she awoke; soon after which she put on her clothes, and going down into the kitchen, found her mother stretched out on her right side, with her head near the grate; the body extended on the hearth, with the legs on the floor, which were of deal, having the appearance of a log of wood consumed by a fire without any apparent flames. On beholding this spectacle, the girl run in great haste and poured over her mother's body some water contained in two large vessels, in order to extinguish the fire, while the fetid odour and smoke that exhaled from the body almost suffocated some of the neighbours who had hastened to the girl's assistance. The trunk was in some measure incinerated, and resembled a heap of wood covered with white ashes. The head, the arms, the legs, and the thighs, had also participated in the burning. This woman, it is said, had drank a large quantity of spirituous liquor, in consequence of being overjoyed at hearing of the return of one of her daughters from Gibraltar. There was no fire in the grate, and the candle had burnt down to the socket of the candlestick, which was close to her. Besides, there were found close to the consumed body, the clothes of a child and a paper screen, which had sustained no injury from the fire. The dress of the woman consisted of a cotton gown. It is possible that this accident may be attributed to the escape of hydrogen gas; the presence of this inflammable body in animals is evident, and it is also proved that it is liable to ignite. Morton saw flames coming from the body of a pig. Bonami and Ruysh, with a lighted candle, set fire to the vapour arising from the stomach of a woman whom they were opening. In the Memoirs of the Academy of Science of Paris, of 1751, we find the case of a butcher, who, on opening the body of an ox that had died after a malady which had swollen him considerably, was severely burnt by an explosion and a flame which rose to the height of about five feet. Sturm, Bartholini, and Gaubius record fiery eructations in which, no doubt, phosphurated hydrogen had been generated in the stomach, from some combination of alcohol and animal substances, and inflamed upon coming into contact with atmospheric air; the fetid odour which invariably accompanies these combustions appears to warrant the conclusion. Fodéré remarks that hydrogen gas is developed in certain cases of disease even in the living body, and he agrees with Mere in attributing spontaneous combustion to the united action of hydrogen and electricity. The case of a Bohemian peasant is narrated, who lost his life in consequence of ignited inflammable air issuing from his mouth which could not be extinguished. It seems evident that this accident only occurs under certain conditions of the body; generally in aged persons upwards of sixty years old; more frequently in women than in men, and chiefly when of indolent habits, a debilitated frame, and intemperate in their mode of living. That the body has been usually consumed long before the head and the extremities is evident, since these parts have been more commonly found than the trunk. It also has been ascertained by observation that this strange accident seldom occurs in summer, but principally during severe cold and frosty weather. It appears that some experiments have been recently made in the United States, when the blood flowing from the arm of a man addicted to spirituous liquors actually took fire, being placed in contact with a lighted taper! Medical observers differ in opinion on this singular yet well-authenticated phenomenon. Lair, Vicy d'Argou, and Dupuytren maintain that to produce it, the contact of fire is necessary. Le Cat and Kopp, on the contrary, affirm that this combustion may be spontaneous without the intervention of any external agent, and resulting from some peculiar predisposition. According to Le Cat animals contain inflammable substances which ignite of themselves. De Castro relates the cases of several individuals from whom friction could draw sparks. Daniel Horstius mentions a gouty patient, from whose limbs, on being rubbed, vivid sparks arose. These physicians consider that these electric sparks are sufficient to ignite the spirituous liquor which may have saturated any organic tissue of the body, the combustion being afterwards fed by animal oil. This theory is, however, subject to many objections. It is difficult to imagine that any substance introduced into the organ of digestion should retain its former principles of inflammability. Although Cuvier and Dumeril relate, that in opening the body of a man who died from excess of drinking, the effluvia of the liquor arose from every cavity. On this subject, fraught with much interest, nothing positive has been ascertained, despite the late progress of chemical investigation. This combustion indeed differs widely from all other burning; sometimes a flickering and bluish flame arises; at other times a smothered heat or fire, without visible flames, is the consuming agent. Water increases the combustion instead of allaying it. It is moreover a well-known fact, that a considerable quantity of fuel is required to consume a dead body, whereas in this combustion, incineration is most rapid. The human body, indeed, is not easily consumed; a case is related of a baker-boy, named Renaud, who was sentenced to be burnt at Caen; two large cart-loads of fagots were required to consume the body, and at the end of more than ten hours, some remains were still visible. The extreme incombustibility of the body was singularly exemplified in the case of Mrs. King, whose murderer was engaged for several weeks in endeavouring to burn her remains without effecting his purpose. It has also been affirmed by various medical observers, that the human body will occasionally secrete an inflammable matter emitted by perspiration. Thus, it is stated, that the perspiration of the wife of a physician of the Archbishop of Toledo was of such a combustible nature, that a ribbon which she had worn, being exposed to the air, took fire. Borelli relates the case of a peasant, whose linen would ignite in a similar manner, whether it was laid up in a chest or hung up to dry. Amongst the many curious stories of the kind, we quote De Castro, who affirms that he knew a physician, from whose back-bone fire issued so vividly as to dazzle the eyes of the beholders. Krautius informs us, that certain people of the territory of Nivers (?) were burning with an invisible fire, and that some of them lopped off a foot or a hand to cut off the conflagration! BRASSICA ERUCA, OR THE ROCKET PLANT. This plant, now in total disuse, was considered by the ancients as a most powerful aphrodisiac, and consecrated to Venus. Hence Martial and Ovid-- Et Venerem revocans eruca morantem. * * * * * Nec minus erucas jubeo vitare salaces. But the most curious document regarding this obnoxious weed is found in Lobel, who states that it was carefully cultivated in the gardens of monasteries and nunneries, to preserve their chastity. "Hæc eruca, major Hispanica, vel quia in condimentis lautior, vel ad venerem vegetior erat, gentilis vulgò vocata fuit; quo vocabulo Hispanica et Itala gens designat quamlibet rem aptam reddere hominem lætum et experrectum ad munia vulgò pausibilia, ut joca ludicra et venerem; quæ commoda ut ex eâ perciperet monachorum saginata caterva, in perquàm amoena Magalonæ, insula maris Narbonensis, hujus gentilis erucæ semine à fratre quodam Hispano ambulone donato, quotannis hocce serebat, et in mensis cuilibet, vel maximo gulæ irritamento, vel blandimento, præferebat; nimirum usu gnara quantum frequens esus conferret ad calorem venereum in illis otio et frequenti crapula obrutum, ad vigorem animi excitandum, et præsertim corpus obesum extenuandum, somnumque excutiendum, quo illi veluti ursi gliresve tota hyeme saginati, fermè adipe suffocabantur. Verùm isto Hispanico remedio adeò hilarescebant et gentiles fiebant, ut plerumque recinctis lumbis castitate, coacti essent vota et coenobii moenia transilire, et aliquid solatii venerei ab vicinis plebanis efflagitare. Nobis hæc visa et risa. Eruca verò inibi superstes est copiosissima, monumentum futura monasticæ castitatis et rei veritatis."--_Adv. p. 68._ CAGLIOSTRO. The first appellation the Grecians gave to those who exercised the art of healing was _iatros_. Originally it merely signified a man possessed of the power of relieving accidents, either by manual exertions, or the hidden virtues of some amulet or charm. Sextus tells us that in ancient times it applied to an extractor of arrows, _sagittarum extractor_. No doubt, this operation constituted the chief business of the surgeon in the infancy of the art; and warriors and heroes themselves performed it on the field of battle, as fully exemplified in Homer. The primitive title of _iatros_ gradually descended to surgical practitioners. We find that Nebrus and Heraclides were the chief _iaters_ of Cos, the birthplace of Hippocrates. To this day the same name is given to medical men in Greece, where, until lately, they were in the habit of perambulating the streets, and seeking occupation by crying out at certain distances, _Callos iatros!_ (The good doctor!) Balsamo, a celebrated mountebank, being at Cairo, where he died, one of his disciples repaired to Europe, and, anxious to bear a singular name, assumed this cry, and called himself _Calloiatro_, or, according to the corrupt pronunciation, _Cagliostro_: his history is well known, and he certainly excelled in impudence and industry all his predecessors. These Greek _iaters_, when going over to Italy to practise, called themselves _medici_, which Cato wanted to change into _mendici_, for, said he, "These creatures, (_Illi Græculi_,) quit their native country, where they were starving, to seek their fortune in Rome (_ut fortunam sibi mendicent_)." Under this austere censor few of these emigrants dared to settle in the Roman territories, but after his demise they inundated the country to such an extent, that it was said that Rome had more physicians than patients who needed their attendance. This influx of practitioners occasioned constant competition, and each _iater_ endeavoured to obtain fame and emolument by underrating his opponents, and endeavouring to introduce novel doctrines, seeking a livelihood, as Pliny observed, _inter mortes et mendacia_. It was on these adventurers that the following epigram was written: Fingunt se cuncti medicos,--idiota, sacerdos, Judæus, monachus, histrio, rasor, anus. The quackery of these candidates for popularity became the subject of bitter satire; and Martial thus speaks of the _Iatre_ Symmachus: Languebam, sed tu comitatus protinus ad me Venisti centum, Symmache, discipulis; Centum me tetigere manus, aquilone gelatæ, Non habui febrem, Symmache; nunc habeo.[7] This Symmachus, it appears, invariably moved abroad surrounded by hundreds of his disciples, whose cold investigating hands produced upon their patients the effects to which Martial alludes. LUNAR INFLUENCE ON HUMAN LIFE AND DISEASES. The ancients, who were chiefly guided in their medical notions by the simple operations of nature, attached great importance to the influence of the moon. As the stars directed their navigators, so did the planets in some degree regulate their other calculations. Finding that the state of the weather materially acted on our organism whether in health or in sickness, they attributed this influence to the appearance of the moon, which generally foretold the vicissitudes in the atmospheric constitution. Thus Hippocrates advises his son Thessalus to study numbers and geometry, as the knowledge of astronomy was indispensable to a physician, the phenomena of diseases being dependent on the rising or the setting of the stars. Aristotle informs his disciples that the bodies of animals are cold in the decrease of the moon, that blood and humours are then put into motion, and to these revolutions he ascribes various derangements of women. To enter into these medical opinions would be foreign to the present purpose, but the notions of the ancients regarding lunar influence in other matters are curious. Lucilius, the Roman satirist, says that oysters and echini fatten during lunar augmentation; which also, according to Gellius, enlarges the eyes of cats: but that onions throw out their buds in the decrease of the moon, and wither in her increase, an unnatural vegetation, which induced the people of Pelusium to avoid their use. Horace also notices the superiority of shell-fish in the increase. Pliny not only recognises this influence on shell-fish, but observes, that the streaks on the livers of rats answer to the days of the moon's age; and that ants never work at the time of any change: he also informs us that the fourth day of the moon determines the prevalent wind of the month, and confirms the opinion of Aristotle that earthquakes generally happen about the new moon. The same philosopher maintains that the moon corrupts all slain carcasses she shines upon; occasions drowsiness and stupor when one sleeps under her beams, which thaw ice and enlarge all things; he further contends, that the moon is nourished by rivers, as the sun is fed by the sea. Galen asserts that all animals that are born when the moon is falciform, or at the half-quarter, are weak, feeble, and shortlived; whereas those that are dropped in the full moon are healthy and vigorous. In more modern times the same wonderful phenomena have been attributed to this planet. The celebrated Ambroise Paré observed, that people were more subject to the plague at the full. Lord Bacon partook of the notions of the ancients, and he tells us that the moon draws forth heat, induces putrefaction, increases moisture, and excites the motion of the spirits; and, what was singular, this great man invariably fell into a syncope during a lunar eclipse. Van Helmont affirms, that a wound inflicted by moonlight is most difficult to heal; and he further says, that if a frog be washed clean, and tied to a stake under the rays of the moon in a cold winter night, on the following morning the body will be found dissolved into a gelatinous substance bearing the shape of the reptile, and that coldness alone without the lunar action will never produce the same effect. Ballonius, Diemerbroeck, Ramazzini, and numerous celebrated physicians, bear ample testimony to its baneful influence in pestilential diseases. The change observed in the disease of the horse called moon-blindness is universally known and admitted. Many modern physicians have stated the opinions of the ancients as regards lunar influence in diseases, but none have pushed their inquiries with such indefatigable zeal as the late Dr. Mosely; he affirms that almost all people in extreme age die at the new or at the full moon, and this he endeavours to prove by the following records: Thomas Parr died at the age of 152, two days after the full moon. Henry Jenkins died at the age of 169, the day of the new moon. Elizabeth Steward, 124, the day of the new moon. William Leland, 140, the day after the new moon. John Effingham, 144, two days after full moon. Elizabeth Hilton, 121, two days after the full moon. John Constant, 113, two days after the new moon. The doctor then proceeds to show, by the deaths of various illustrious persons, that a similar rule holds good with the generality of mankind: Chaucer, 25th October 1400, the day of the first quarter. Copernicus, 24th May 1543, day of the last quarter. Luther, 18th February 1546, three days after the full. Henry VIII, 28th January 1547, the day of the first quarter. Calvin, 27th May 1564, two days after the full. Cornaro, 26th April 1566, day of the first quarter. Queen Elizabeth, 24th March 1603, day of the last quarter. Shakspeare, 23rd April 1616, day after the full. Camden, 9th November 1623, day before the new moon. Bacon, 9th April 1626, one day after last quarter. Vandyke, 9th April 1641, two days after full moon. Cardinal Richelieu, 4th December 1642, three days before full moon. Doctor Harvey, 30th June 1657, a few hours before the new moon. Oliver Cromwell, 3rd September 1658, two days after full moon. Milton, 15th November 1674, two days before the new moon. Sydenham, 29th December 1689, two days before the full moon. Locke, 28th November 1704, two days before the full moon. Queen Anne, 1st August 1714, two days after the full moon. Louis XIV, 1st September 1715, a few hours before the full moon. Marlborough, 16th June 1722, two days before the full moon. Newton, 20th March 1726, two days before the new moon. George I, 11th June 1727, three days after new moon. George II, 25th October 1760, one day after full moon. Sterne, 13th September 1768, two days after new moon. Whitfield, 18th September 1770, a few hours before the new moon. Swedenburg, 19th March 1772, the day of the full moon. Linnæus, 10th January 1778, two days before the full moon. The Earl of Chatham, 11th May 1778, the day of the full moon. Rousseau, 2nd July 1778, the day after the first quarter. Garrick, 20th January 1779, three days after the new moon. Dr. Johnson, 14th December 1784, two days after the new moon. Dr. Franklin, 17th April 1790, three days after the new moon. Sir Joshua Reynolds, 23rd February 1792, the day after the new moon. Lord Guildford, 5th August 1722, three days after the full moon. Dr. Warren, 23rd June 1797, a day before the new moon. Burke, 9th July 1797, at the instant of the full moon. Macklin, 11th July 1797, two days after full moon. Wilkes, 26th December 1797, the day of the first quarter. Washington, 15th December 1799, three days after full moon. Sir W. Hamilton, 6th April 1803, a few hours before the full moon. The doctor winds up this extract from the bills of mortality by the following appropriate remark: "Here we see the moon, as she shines on all alike, so she makes no distinction of persons in her influence: "------æquo pulsat pede pauperum tabernas, Regumque turres." HOR. Lib. i. Od. 4. Not only did the ancients consider the animal creation as constantly under planetary influence, but all vegetable productions and medicinal substances were subject to its laws. The Druids of Gaul and Britain gathered the famed misletoe with a golden knife when the moon was six days old. The vervain, held in such high repute by the Romans, was gathered, after libations of honey and wine, at the rising of the dog-star, and with the left hand, and thus collected served, for various sacerdotal and medical purposes: its branches were employed to sweep the temples of Jupiter; it was used in exorcisms for sprinkling lustral water; and moreover it cured fevers, the bite of venomous reptiles, and appeased discord; hence it was borne by those heralds who were sent to sue for peace, and called _verbenarii_; and when its benign powers were shed over the festive board, mirth and good temper were sure to prevail. So generally and so highly appreciated was this all-powerful plant, that Pliny tells us, Nulla herba Romanæ nobilitatis plus habet quam hierabotane. However, it is somewhat doubtful whether the vervain of the ancients was similar to the plant which now bears that name. It would appear that formerly the appellation of _verbenæ_ or _sagmina_ was given to various plants employed in religious ceremonies: and branches of pine-tree, of laurel, and of myrtle were sometimes thus denominated. Virgil says in his Eclogues, Verbenasque adole pingues, et mascula thura. Now the epithets of _pingues_ and _thura_ cannot apply to our vervain, but to some resinous production. Medicine at that period might have been called an astronomic science; every medicinal substance was under a specific influence, and to this day the R which precedes prescriptions, and is admitted to represent the first letter of _recipe_, was in fact the symbol of Jupiter, under whose special protection medicines were exhibited. Every part of the body was then considered under the influence of the zodiacal constellations, and Manilius gives us the following description of their powers: Namque Aries capiti, Taurus cervicibus hæret; Brachia sub Geminis censentur, pectora Cancro; Te, scapulæ, Nemæe, vocant, teque ilia, Virgo; Libra colit clunes, et Scorpius inguine regnat; Et femur Arcitenens, genua et Capricornus amavit; Cruraque defendit Juvenis, vestigia, Pisces. _Astronomicon_, lib. 1. SPECTACLES. The origin of these valuable instruments is uncertain: that the ancients were acquainted with the laws of refraction is beyond all doubt, since they made use of glass globes filled with water to produce combustion; and in Seneca we find the following very curious passage--"Litteræ, quamvis minutiæ et obscuræ, per vitream pilam aquâ plenam majores clarioresque cernuntur;" yet thirteen centuries elapsed ere spectacles were known. It is supposed that they were first invented by _Salvino_ or _Salvinio Armati_; but he kept his discovery secret, until Alessandro de Spina, a monk in Pisa, brought them into use in 1313. Salvino was considered their inventor, from the epitaph on his tomb in the cathedral church in Florence: "Qui giace Salvino d'Armato, degl' Armati di Firenze, inventor delli occhiali, &c., 1317." Another circumstance seems to add weight to this presumption: _Luigi Sigoli_, a contemporary artist, in a painting of the Circumcision, represents the high-priest Simeon with a pair of spectacles, which, from his advanced age, it was supposed he might have needed on the occasion. LEECHES. The origin of their introduction in the practice of medicine is uncertain. They were well known to the ancients under the name of _hirudo_. Thus Horace: Non missura cutem nisi plena cruoris hirudo. The Greeks called them [Greek: Boella], and Pliny states that elephants were often cruelly tormented by them when they swallowed any of these worms in their water: "Cruciatum in potu maximum sentiunt haustâ hirudine, quam sanguisugam vulgo coepisse appellari adverto." Leeches are oviparous, and their ova are discharged in one involucre near the surface and margin of pools, and are hatched by the heat of the sun. They do not cast their skin, as is generally supposed, but merely throw off a tough slimy membrane, which appears to be produced by disease, and from which they get disencumbered by straining themselves through grass and rushes. During winter they remain in a torpid state. They are most tenacious of life; some say they can live for several days in the exhausted receiver of the air-pump, and in other media destructive of other animals. This phenomenon is attributed to the slow oxygenation of the blood in the respiratory vesicles. In regard to their food we are ignorant, although Dr. Johnson says that they live by sucking the blood of fish and reptiles. The collection of leeches constitutes a lucrative trade on the Continent, but more particularly in France, where it is called a leech-fishery, and where, in Paris alone, three millions are annually consumed. The following is an interesting description of the miserable people engaged in this occupation from the _Gazette des Hôpitaux_. "If ever you pass through La Brenne, you will see a man, pale and straight-haired, with a woollen cap on his head, and his legs and arms naked; he walks along the borders of a marsh, among the spots left dry by the surrounding waters. This man is a leech-fisher. To see him from a distance,--his wobegone aspect, his hollow eyes, his livid lips, his singular gestures, you would take him for a maniac. If you observe him every now and then raising his legs and examining them one after another, you might suppose him a fool; but he is an intelligent leech-fisher. The leeches attach themselves to his legs and feet as he moves among their haunts; he feels their bite, and gathers them as they cluster about the roots of the bulrushes and aquatic weeds, or beneath the stones covered with a green and slimy moss. He may thus collect ten or twelve dozen in three or four hours. In summer, when the leeches retire into deep water, the fishers move about upon rafts made of twigs and rushes. One of these traders was known to collect, with the aid of his children, seventeen thousand five hundred leeches in the course of a few months; these he had deposited in a reservoir, where, in night, they were all frozen _en masse_." But congelation does not kill them, and they can easily be thawed into life, by melting the ice that surrounds them. Leeches, it appears, can bear much rougher usage than one might imagine: they are packed up closely in wet bags, carried on pack-saddles, and it is well known that they will attach themselves with more avidity when rubbed in a dry napkin previous to their application. Leech-gatherers are in general short-lived, and become early victims to agues, and other diseases brought on by the damp and noxious air that constantly surrounds them; the effects of which they seek to counteract by the use of strong liquors. Leeches kept in a glass bottle may serve as a barometer, as they invariably ascend or descend in the water as the weather changes from dry to wet, and they generally rise to the surface prior to a thunder-storm. They are most voracious, and are frequently observed to destroy one another by suction; the strong ones attaching themselves to the weaker. The quantity of blood drawn by leeches has been a subject of much controversy; but it is pretty nearly ascertained that a healthy leech, when fully gorged, has extracted about half an ounce. When they will not readily fix, Dr. Johnson recommends that they be put into a cup of porter. The cause of a leech falling off when full is not clearly ascertained, but it is supposed to arise from a state of asphyxia brought on by the compression of the breathing vesicles, and the distension of the alimentary tube. Many serious accidents have arisen from leeches being swallowed in the water of swamps and marshes, too frequently drunk with avidity by the thirsty and exhausted soldier. Larrey mentions several cases of the kind during the French campaign in Egypt, and two fatal instances fell under my observation during the Peninsular war; draughts of salt water, vinegar, and various stimulating injections could not loosen their hold, and they were too deeply attached in the throat to be seized with a forceps. Zacutus Lusitanus had witnessed the same unfortunate results. The leech thus swallowed is generally the _hirudo Alpina_. Norfolk supplies the greater part of the leeches brought to London, but they are also found in Kent, Suffolk, Essex, and Wales. The leeches imported from France differ from ours, in having the belly of one uniform colour. The best are the green, with yellow stripes along the body. The horse-leech, which is used in the north of Europe, but also common in England, is entirely brown, or only marked with a marginal yellow line. A popular belief prevails, that the application of this variety is most dangerous, as they are said to suck out all the blood in the body. SOMNAMBULISM. This singular aberration from our natural habits may be considered an intermediate state between sleeping and being awake. This infraction of physiologic laws may therefore be looked upon as a morbid condition. Physicians have given it various denominations, founded on its phenomena, _nocti-vagatio_, _nocti-surgium_, _noct-ambulatio_, _somnus vigilans_, _vigilia somnans_. Somnambulism was well known by the ancients; and Aristotle tells us, "there are individuals who rise in their sleep, and walk about seeing as clearly as those that are awake." Diogenes Laertius states that Theon the philosopher, was a sleep-walker. Galen slept whilst on a road, and pursued his journey until he was awakened by tripping on a stone. Felix Plater fell asleep while playing on the lute, and was only startled from his slumbers by the fall of the instrument. There is no doubt but that in somnambulists the intellectual functions are not only active, but frequently more developed than when the individual is awake. Persons in this state have been known to write and correct verses, and solve difficult problems, which they could not have done at other times. In their actions and locomotion they are more cautious, and frequently more dexterous, than when awake. They have been known to saddle and bridle horses, after having dressed themselves; put on boots and spurs, and afterwards ride considerable distances from home and back again. A sleep-walker wandering abroad in winter complained of being frozen, and asked for a glass of brandy, but expressed violent anger on being offered a glass of water. The celebrated sect of _Tremblers_, in the Cevennes mountains, used to rove about in their sleep, and, although badly acquainted with the French language, expressed themselves clearly and put up prayers in that tongue, instead of the Latin _Pater_ and _Credo_ which they had been taught. A singular phenomenon in some cases of this affection is that of walking about without groping, whether the eyelids are closed or open. Somnambulism has been known to be hereditary: Horstius mentions three brothers who were affected with it at the same period; Willis knew a whole family subject to it. It is not generally known that the subject of the French dramatic piece called "La Somnambule" was founded on fact. Singular faculties have been developed in the mental condition. Thus a case is related of a woman in the Edinburgh infirmary, who during her paroxysm not only mimicked the manner of the attendant physicians, but repeated correctly some of their prescriptions in Latin. Dr. Dyce, of Aberdeen, describes the case of a girl, in which this affection began with fits of somnolency, which came upon her suddenly during the day, and from which she could at first be roused by shaking or by being taken into the open air. During these attacks she was in the habit of talking of things that seemed to pass before her like a dream, and was not at the time sensible of any thing that was said to her. On one occasion she repeated the entire of the baptismal service of the Church of England, and concluded with an extemporary prayer. In her subsequent paroxysms she began to understand what was said to her, and to answer with a considerable degree of consistency, though these replies were in a certain measure influenced by her hallucination. She also became capable of following her usual employment during the paroxysm. At one time she would lay out the table for breakfast, and repeatedly dress herself and the children, her eyes remaining shut the whole time. The remarkable circumstance was now discovered, that, during the paroxysm, she had a distinct recollection of what had taken place in former attacks, though she had not the slightest recollection of it during the intervals. She was taken to church during the paroxysm, and attended the service with apparent devotion, and at one time was so affected by the sermon that she actually shed tears; yet in the interval she had no recollection whatever of the circumstance, but in the following paroxysm she gave a most distinct account of it, and actually repeated the passage of the sermon that had so much affected her. This sort of somnambulism, relating distinctly to two periods, has been called, perhaps erroneously, a _state of double consciousness_. This girl described the paroxysm as coming on with a dimness of sight and a noise in the head. During the attack, her eyelids were generally half shut, and frequently resembled those of a person labouring under amaurosis, the pupil dilated and insensible. Her looks were dull and vacant, and she often mistook the person who was speaking to her. The paroxysms usually lasted an hour, but she often could be roused from them. She then yawned and stretched herself like a person awakening from sleep, and instantly recognised those about her. At one time Dr. Dyce affirms, she read distinctly a portion of a book presented to her, and she would frequently sing pieces of music more correctly and with better taste than when awake. In illustration of the phenomena of the preceding case, Dr. Abercrombie gives the following very curious history: "A girl, aged seven years, an orphan of the lowest rank, residing in the house of a farmer, by whom she was employed in tending cattle, was accustomed to sleep in an apartment separated by a very thin partition from one which was frequently occupied by an itinerant fiddler. This person was a musician of very considerable skill, and often spent a part of the night in performing pieces of a refined description; but his performance was not taken notice of by the child, except as a disagreeable noise. After a residence of six months in this family she fell into bad health, and was removed to the house of a benevolent lady, where, on her recovery after a protracted illness, she was employed as a servant. Some years after she came to reside with this lady, the most beautiful music was often heard in the house during the night, which excited no small interest and wonder in the family; and many a waking hour was spent in endeavours to discover the invisible minstrel. At length the sound was traced to the sleeping-room of the girl, who was found fast asleep, but uttering from her lips a sound exactly resembling the sweetest tones of a small violin. On further observation it was found, that after being about two hours in bed, she became restless and began to mutter to herself; she then uttered sounds precisely resembling the tuning of a violin, and at length, after some prelude, dashed off into an elaborate piece of music, which she performed in a clear and accurate manner, and with a sound exactly resembling the most delicate modulation of the instrument, and then began exactly where she had stopped in the most correct manner. These paroxysms occurred at irregular intervals, varying from one to fourteen and even twenty nights; and they were generally followed by a degree of fever and pain over various parts of the body. "After a year or two, her music was not confined to the imitation of the violin, but was often exchanged for that of a piano, of a very old description, which she was accustomed to hear in the house in which she now lived, and then she would begin to sing, imitating exactly the voices of several ladies of the family. "In another year from this time she began to talk a great deal in her sleep, in which she fancied herself instructing a young companion. She often descanted with the utmost fluency and correctness on a variety of subjects, both political and religious, the men of the day, the historical parts of Scripture, public characters, and particularly the character of the members of the family and their visiters. In these discussions she showed the most wonderful discrimination, often combined with sarcasm, and astonishing powers of mimickry. Her language through the whole was fluent and correct, and her illustrations often forcible and even eloquent. She was fond of illustrating her subjects by what she called _a fable_, and in these, her imagery was both appropriate and correct. The justice and truth of her remarks on all subjects, excited the utmost astonishment in those who were acquainted with her limited means of acquiring information. "She had been known to conjugate correctly Latin verbs, which she had probably heard in the school room of the family, and she was once heard to speak several sentences very correctly in French, at the same time stating that she had heard them from a foreign gentleman whom she had met accidentally in a shop. Being questioned on this subject when awake, she remembered having seen the gentleman, but could not repeat a word of what he had said. "During her paroxysms it was almost impossible to awake her, and when her eyelids were raised and a candle brought near the eye, the pupil seemed insensible to the light. For several years she was, during the paroxysm, entirely unconscious of the presence of other persons, but about the age of sixteen, she began to observe those who were in the apartment, and she could tell correctly their number though the utmost care was taken to have the room darkened. She now also became capable of answering questions that were put to her, and of noticing remarks made in her presence, and, with regard to both, she showed astonishing acuteness. Her observations indeed were often of such a nature, and corresponded so accurately with character and events, that, by the country people, she was believed to be endowed with supernatural power. "During the whole period of this remarkable affection, which seems to have gone on for at least ten or eleven years, she was, when awake, a dull awkward girl, very slow in receiving any kind of instruction, though much care was bestowed upon her; and in point of intellect, she was much inferior to the other servants of the family. In particular, she showed no kind of turn for music. She did not appear to have any recollection of what passed in her sleep; but during her nocturnal ramblings, she was more than once heard to lament her infirmity of speaking in her sleep, adding how fortunate it was she did not sleep among the other servants, as they teased her enough about it as it was. "About the age of twenty-one she became immoral in her conduct, and was dismissed the family. Her propensity to talk in her sleep continued to the time of her dismissal, but a great change had taken place in her nocturnal conversation. It had gradually lost its acuteness and brilliancy, and latterly became the mere babbling of a vulgar mind, often mingled with insolent remarks against her superiors, and the most profane scoffing at morality and religion. It is believed that she afterwards became insane." To what serious reflections does not this curious history give rise. Here there did unquestionably exist a double existence. The one a relative being surrounded with the realities of life; the other a natural condition, unshackled by constraint, and left entirely to the wild enjoyment of a luxuriant fancy and an apprehension quick and brilliant. In the former, the young creature found herself derided and degraded by her vulgar companions; her generous infirmities, if such they may be called, made the subject of low ribaldy. In her second existence, she became the free child of nature. Might not proper care have saved this interesting creature from misery! It is admitted that "much care had been bestowed upon her instruction," but was she withdrawn from the low circle that surrounded her and placed in a society where, in her waking hours, she could have derived those advantages of a superior intercourse, which might have worked upon her vivid imagination as powerfully as the melodious sounds she had heard at other times? "She became immoral--scoffed at religion"--_in her sleep_. She was then in a state of nature; unconscious, to a certain extent, of immorality and religion, although conscious, no doubt, of relative good and evil. Is it not more than probable that when awake, not only were her ears assailed by profane and improper language, but is it not most likely that her ruin was perpetrated during her visionary slumbers, and ever after visited her mind during her paroxysms? Nor is it improbable that her affections had been bestowed upon her despoiler. Instead of being dismissed and cast upon the wide world, helpless, stigmatized, perhaps, with the odious epithet of witch--for we have seen that the lower order considered her such--might not a friendly hand have secured her in an abode where she might have been invited _to_ COME _and sin no more_! Alas! no wonder that the poor creature should have become insane! It is said that she was obtuse in intellect when awake. May not this be accounted for in some measure, by the exhaustion of her mental faculties during her paroxysms? It is to be lamented that the learned and philosophic Dr. Abercrombie, who has given this history, did not comment upon it. True Christianity and its benevolence breath in every line of the eloquent writer, and the poor Scotch _lassie_ might have afforded him a valuable theme. How proud would any humane person have felt in making this interesting object of pity what she might have been! Dr. Dewar also relates the case of an ignorant servant-girl, who, during the paroxysm of somnambulism, showed an astonishing knowledge of geography and astronomy, and expressed herself, in her own language, in a manner which, though often ludicrous, showed an understanding of the subject. The alteration of the seasons, for example, she explained by saying the world was set _a gee_. In many cases of somnambulism the sleeper is able to continue the occupation that he had previously carried on. Martinet mentions a watchmaker's apprentice, whose paroxysm came on once in the fortnight, and commenced in a sensation of heat ascending to the heart. This was followed by a confusion of thought and insensibility. His eyes were open, but fixed and vacant, and he was totally insensible to every thing around him. Yet he continued his usual employment, and was always much surprised when he awoke to find the progress that had taken place in his work. This case ended in epilepsy. Horstius, whom we have already quoted, tells us of a noble youth of Breslau, living in the citadel, who used to steal out of a window during his sleep, muffled up in his cloak, and ascend the roof of the building, where one night he tore in pieces a magpie's nest, wrapped up the little ones in his cloak, and returned to bed. The following morning he mentioned the circumstance as having occurred in a dream, but could not be persuaded of the reality of the circumstance till the magpies in the cloak were shown to him. Dr. Abercrombie has given a very remarkable case of a young woman of low rank, who, at the age of 19, became insane, but was gentle, and applied herself eagerly to various occupations. Before her insanity she had been only learning to read and to form a few letters; but during her lunacy she taught herself to write perfectly, though all attempts of others had failed; she had intervals of reason, which frequently continued three weeks and sometimes longer. During these she could neither read nor write, but immediately on the return of her insanity, she recovered the power of writing and reading. The faculty of conversing in a state of somnambulism is too well authenticated to be doubted, although in many instances it may have been a fraudulent trick of animal magnetism. This singular power has been recorded by several of the ancient writers, many of whom pretended that divine inspiration illumined the sleepers. Cicero tells us that when the Lacedæmonian magistrates were embarrassed in their administration, they went to sleep in the temple of Pasiphae, thus named from _Pasi phainein_, or "communicative to all." Strabo mentions a cavern, sacred to Pluto and Juno, where the sick came to consult sleeping priests. Aristides is said to have delivered his opinion while fast asleep in the temple of Æsculapius. It would be endless to quote all the authorities on this subject. Modern magnetisers, however, outstrip the ancients in the wonders they relate in regard to somnambulent faculties developed by magnetism. In 1829, Cloquet, a very distinguished Parisian surgeon, assisted by Dr. Chapelain, removed the cancerous breast of a lady in her magnetic sleep, during which she continued her conversation, unconscious of the operation, which lasted twelve minutes. The faculty of seeing through the closed eyelids was fully substantiated in the presence of a commission of investigation appointed by the Academy of Medicine of Paris, and in the presence of fifteen persons. They found a somnambulist, of the name of Paul, to all appearance fast asleep. On being requested to rise and approach the window, he complied immediately. His eyes were then covered in such a manner as not to awaken him, and a pack of cards having been shuffled by several persons, he recognised them without the slightest hesitation. Watches were then shown him, and he named the hour and minute, though the hands were repeatedly altered. A book was then presented to him,--it happened to be a collection of operas,--and he read _Cantor et Pollux_ instead of _Castor et Pollux, Tragédie Lyrique_: a volume of Horace was then submitted to him, but not knowing Latin, he returned it, saying, "This is some church-book." The celebrated Dr. Broussais laid before the same somnambulist a letter he had drawn from his pocket; to his utter surprise he read the first lines: the doctor then wrote a few words on a piece of paper in very small characters, which the somnambulist also read with the utmost facility; but, what was still more singular, when letters or books were applied to his breast, or between the shoulders, he also perused them with equal accuracy and ease. In one instance the queen of clubs was presented to his back; after a moment's hesitation he said, "This a club--the nine;" he was informed that he was in error, when he recovered himself and said, "No, 'tis the queen:" a ten of spades was then applied, when he hastily exclaimed, "At any rate this is not a court-card; it is--the ten of spades." The many astute tricks played by animal magnetisers, and frequently detected, naturally induced most persons to doubt the veracity of these experiments; but when we find that they were witnessed by seventy-eight medical men, most of them decidedly hostile to magnetism, and sixty-three intelligent individuals not belonging to the profession, and in every respect disinterested, what are we to say?--perhaps, exclaim with Hamlet, There are more things in heaven and earth, Horatio, Than are dreamt of in your philosophy! I cannot better conclude this article than by the following quotation from Dr. Pritchard's valuable work:[8] "There is an obvious relation between the state of the faculties in somnambulism and that which exists during dreams. It is indeed probable that somnambulism is dreaming in a manner so modified, that the will recovers its usual power over muscular motion, and likewise becomes endued with a peculiar control over the organs of sense and perception. This power, which gives rise to the most curious phenomena of somnambulism, is of such a kind, that, while the senses are in general obscured, as in sleep, and all other objects are unperceived, the somnambulator manifests a faculty of seeing, feeling, or otherwise discovering those particular objects of which he is in pursuit, towards which his attention is by inward movement directed, or with which the internal operations of his mind bring him into relation. As in dreams, so likewise in somnambulism the individual is intent on the pursuit of objects towards which his mind had been previously directed in a powerful manner, and his attention strongly roused; he is in both states impelled by habit, under the influence of which he repeats the routine of his daily observances. A somnambulator is a dreamer who is able to act his dreams." MEDICAL POWERS OF MUSIC. The powerful influence of music on our intellectual faculties, and consequently on our health, has long been ascertained, either in raising the energies of the mind, or producing despondency and melancholy associations of ideas. Impressed with its sublime nature, the ancients gave it a divine origin. Diodorus tells us that it was a boon bestowed on mankind after the deluge, and owed its discovery to the sound produced by the wind when whistling through the reeds that grew on the banks of the Nile. This science became the early study of philosophers and physicians. Herophilus explained the alterations of the pulse by the various modes and rhythms of music. In the sacred writings we have many instances of its influence in producing an aptitude for divine consolation. The derangement of Saul yielded to the harp of David, and the hand of the Lord came upon Elisha as the minstrel played. In Egypt certain songs were legally ordained in the education of youth, to promote virtue and morality. Polybius assures us that music was required to soften the manners of the Arcadians, whose climate was heavy and impure; while the inhabitants of Cynæthe, who neglected this science, were the most barbarous in Greece. The medical power of harmonious sounds was also fully admitted. We find Pythagoras directing certain mental disorders to be treated by music. Thales, called from Crete to Sparta, cured a disastrous pestilence by its means. Martinus Capella affirms that fevers were thus removed. Xenocrates cured maniacs by melodious sounds, and Asclepiades conquered deafness with a trumpet. In modern times it has been related of a deaf lady that she could only hear while a drum was beating, and a drummer was kept in the house for the purpose of enabling her to converse. Aulus Gellius tells us that a case of sciatica was cured by gentle modulations, and Theophrastus maintains that the bites of serpents and other venomous reptiles can be relieved by similar means. Ancient physicians, who attributed many diseases to the influence of evil spirits, fancied that harmonious sounds drove them away, more especially when accompanied by incantations; and we find in Luther, "that music is one of the most beautiful and glorious gifts of God, to which Satan is a bitter enemy." In more modern times we have several instances of the medical powers of music, and the effect produced by Farinelli on Philip of Spain is well known. This monarch was in such a deplorable state of despondency from ill health, that he refused to be shaved or to appear in public. On the arrival of Farinelli, the Queen was resolved to try the power of music, and a concert was ordered in a room adjoining the King's chamber: Farinelli sang two of his best airs,[9] which so overcame Philip that he desired he might be brought into his presence, when he promised to grant him any reasonable request he might make. The performer, in the most respectful manner, then begged of the King to allow himself to be shaved and attended by his domestics, to which Philip consented. Farinelli continued to sing to him daily until a perfect cure was effected.--The story of Tartini is rather curious: in a moment of musical enthusiasm he fell asleep, when the devil appeared to him playing on the violin, bidding him with a horrible grin to play as well as he did; struck with the vision, the musician awoke, ran to his harpsichord, and produced the splendid sonata which he entitled "_the Devil's_." Brückmann, and Hufeland relate cases of St. Vitus's dance, cured by music, which, according to Desessarts, also relieved Catalepsy. Schneider and Becker have ascertained its influence in hysteric and hypochondriac affections. The following curious case is recorded by Paret:--"Une jeune fille d'environ 11 ans, fort prématurée relativement aux facultés, ayant le genre nerveux très sensible et très irritable, fut attaquée, il y a environ deux ans, de douleurs violentes dans tout le corps, avec insomnie, tension excessive et fort douleureuse des muscles de l'abdomen, accompagnée de fièvre. Deux ans après, des convulsions se déclarèrent, avec une violence qui surpassa tout ce que je craignais; les bonds, les élans, furent, pendant quatre or cinq jours et autant de nuits, si forts, qu'il fallait deux hommes pour retenir dans le lit la jeune personne, d'ailleurs faible et délicate. Enfin, je proposai d'employer la musique. On fit, en conséquence, entrer deux ménestriers, disposés à donner leur premier coup d'archet; à l'instant de leur apparition les convulsions cessèrent d'abord et-reparurent peu de tems après: on changea d'air, et les convulsions cessèrent encore pour reparaître, aussi au troisième air, qui sans doute se trouva plus au goût de la malade, elle demanda un violon, qu'on lui donna, et quoiqu'elle n'eût jamais fait d'autre essai, son oeil fixé sur les joueurs, son attention fut si grande, et ses mouvemens si rapides, qu'elle suivait ceux des ménétriers sans causer aucune discordance. Des connaisseurs ne pouvaient s'empêcher de convenir de la justesse et de la précision qu'elle observait. Son oreille était même si délicate, qu'elle faisait des reproches aux ménétriers, qui, obligés de jouer une grande partie de la nuit, se trouvaient eux-mêmes dans le cas de manquer de mésure. La petite malade continua de jouer pendant plus de 30 heures de suite, sans autre interruption que celle qu'il fallait pour prendre ses bouillons, et dans ce court intervalle on voyait les contractions des tendons se renouveller, quoique moins fortes. Les musiciens fatigués, elle se contenta de la voix, qu'elle accompagna de son instrument. Au bout de ce terme, un sommeil de six ou sept heures, qui vint très naturellement, produisit une augmentation de calme. Au réveil, on varia les exercices, et ainsi se termina la scène qui avait duré 48 heures, après laquelle les convulsions cessèrent totalement. Trois jours après, la malade se trouva parfaitement bien; et ne restait que des convulsions très faibles, et la maladie se termina après trois mois de durée." A still more singular effect of music is related by Roger in the case of a poor wretch broken upon the wheel. In his agonies he blasphemed in the most fearful manner, and cordially damned the spiritual comforter who sought to reconcile him to his sufferings. Some itinerant musicians chanced to pass by, they were stopped by the priest and requested to play to the patient, when to the surprise of all around, he seemed relieved, and became so tranquil, that he attended with calm resignation to their exhortations, confessed his manifold offences, and died like a good Christian. Rousseau, who entertained a sovereign contempt for French music, observes, that the _Cantates_ of Bernier cured the fever of a French musician, while they most probably would have given a fever to a musician of any other country. This remark of Rousseau reminds me of the French philosophical traveller (I believe it was Diderot), who on his journey to London from Dover, while horses were changing, had the curiosity to see a sick ostler with a raging fever attended by a country practitioner, who, despairing most probably of his patient, said, that he might be allowed to eat any thing he wished for. The man asked for a red-herring, which was forthwith given to him. Our tourist, generalizing like most of his brethren, immediately noted in his diary--_English Physicians allow red-herrings to fever patients_. Some months after he changed horses at the same inn, and asked how long the unfortunate creature had survived his herring, when, to his utter surprise, he was informed that the hale, hearty fellow who was bringing out the relays, was the very man. He of course pulled out his journal and entered--_red-herrings cure the fever of Englishmen_. Our traveller crossed over, and having accidentally seen in a French inn a poor devil whose case appeared to him similar to the sturdy ostler, he ventured to prescribe a similar remedy, which the patient only survived an hour or two; when his death was announced, he philosophically shrugged up his shoulders, and wrote in his book--_Though red-herrings cure fevers in England, they most decidedly kill in France_. Mad musicians seem to be more mad than others; for Fodéré gives us the following strange account of some of them. "Les plus grands musiciens ne reconnaissent souvent plus leurs instruments: l'un prenant son violon, que je lui avais mis dans les mains, pour un vase de nuit, et un autre prenant sa flûte pour un sabre, et voulait m'en frapper." We, however, frequently meet with lunatics who, although they have no remembrance of the past circumstances of their life, recollect and perform airs which they had formerly played. Various well-authenticated cases lead us to suppose, that a sensibility to music long latent may be called into action by accidental circumstances. A case is on record of a countrywoman, twenty-eight years of age, who had never left her village, but was, by mere chance, present at a _fête_ where a concert was performed, and dancing to a full band afterwards followed. She was delighted with the novelty of the scene; but, the _fête_ concluded, she could not dismiss from her mind the impression the music had produced. Whether she was at her meals, her devotions, her daily occupation, or in her bed,--still, or moving about,--the airs she had heard, and in the succession in which they had been performed, were ever present to her recollection. To sleep she became a stranger,--every function became gradually deranged, and six short months terminated her existence, not having for one moment lost this strange sensation; and during this sad period, when any false note on the violin was purposely drawn, she would hold her head with both hands, and exclaim, "Oh! what a horrible note! it tears my brain!" Sir Henry Halford relates the case of a man in Yorkshire, who after severe misfortunes lost his senses, and was placed in a lunatic asylum. There, in a short time, the use of the violin gradually restored him to his intellects; so promptly, indeed, that six weeks after the experiment, on hearing the inmates of the establishment passing by, he said, "Good morning, gentlemen; I am quite well, and shall be most happy to accompany you." Curious anecdotes are related of the effect of music upon animals. Marville has given the following amusing account of his experiments. "While a man was playing on a trump-marine, I made my observations on a cat, a dog, a horse, an ass, a hind, some cows, small birds, and a cock and hens, who were in a yard under the window: the cat was not the least affected; the horse stopped short from time to time, raising his head up now and then as he was feeding on the grass; the dog continued for above an hour seated on his hind-legs, looking steadfastly at the player; the ass did not discover the least indication of his being touched, eating his thistles peaceably; the hind lifted up her large wide ears, and seemed very attentive; the cows slept a little, and, after gazing at us, went forward; some little birds that were in an aviary, and others on trees and bushes, almost tore their little throats with singing; but the cock, who minded only his hens, and the hens, who were solely employed in scraping a neighbouring dunghill, did not show in any manner that the trump-marine afforded them pleasure." That dogs have an ear for music cannot be doubted: Steibelt had one which evidently knew one piece of music from the other: and a modern composer, my friend, Mr. Nathan, had a pug-dog that frisked merrily about the room when a lively piece was played, but when a slow melody was performed, particularly Dussek's Opera 15, he would seat himself down by the piano, and prick up his ears with intense attention until the player came to the forty-eighth bar; as the discord was struck, he would yell most piteously, and with drooping tail seek refuge from the unpleasant sound under the chairs or tables.[10] Eastcot relates that a hare left her retreat to listen to some choristers who were singing on the banks of the Mersey, retiring whenever they ceased singing, and reappearing as they recommenced their strains. Bossuet asserts, that an officer confined in the Bastille drew forth mice and spiders to beguile his solitude with his flute; and a mountebank in Paris had taught rats to dance on the rope in perfect time. Chateaubriand states as a positive fact, that he has seen the rattlesnakes in Upper Canada appeased by a musician; and the concert given in Paris to two elephants in the Jardin des Plantes leaves no doubt in regard to the effect of harmony on the brute creation. Every instrument seemed to operate distinctly as the several modes of pieces were slow or lively, until the excitement of these intelligent creatures had been carried to such an extent that further experiments were deemed dangerous. The associations produced by national airs, and illustrated by the effect of the _Rans des Vaches_ upon the Swiss, are too well known to be related; and the _mal de pays_, or _nostalgia_, is an affection aggravated by the fond airs of infancy and youth during the sad hours of emigration, when the aching heart lingers after home and early ties of friendship and of love. It is somewhat singular, but this disease is frequent among soldiers in countries where they are forcibly made to march: but is seldom, if ever, observed in the fair sex, who most probably seek for admiration in every clime, and are reconciled by flattery to any region. The whims of musical composers have often been most singular; Gluck composed in a garden, quaffing champaign; Sarti, in a dark room; Paesiello, in his bed; Sacchini, with a favourite cat perched upon each shoulder. The extraordinary fancies of Kutswara, composer of the "Battle of Prague," are too well known, and led to his melancholy, but unpitied end. Great as the repute of the most popular musical performers, whether vocal or instrumental, in the present day may be, and enormous as their remuneration may seem, the ancients were more profuse in their generosity to musicians and the factors of musical instruments. Plutarch, in his life of Isocrates, tells us that he was the son of Theodorus, a flute-maker, who had realized so large a fortune by his business, that he was able to vie with the richest Athenian citizens in keeping up the chorus for his tribe at festivals and religious ceremonies. Ismenias, the celebrated musician of Thebes, gave three talents, or 581_l._ 5_s._ for a flute. The extravagance of this performer was so great, that Pliny informs us he was indignant at one of his agents for having purchased a valuable emerald for him at Cyprus at too low a price, adding, that by his penurious conduct he had disgraced the gem. The vanity of artists in those days appears to have been similar to the present impudent pretensions of many public favourites. Plutarch relates of this same Ismenias, that being sent for to play at a sacrifice, and having performed for some time without the appearance of any favourable omen in the victim, his employer snatched the instrument out of his hand, and began to play himself most execrably. However, the happy omen appeared, when the delighted bungler exclaimed that the gods preferred his execution and taste. Ismenias cast upon him a smile of contempt, and replied, "While _I_ played, the gods were so enchanted that they deferred the omen to hear me the longer; but they were glad to get rid of _you_ upon any terms." This was nearly as absurd as the boast of Vestris, the Parisian dancer, who, on being complimented on his powers of remaining long in the air, replied, "that he could figure in the air for half an hour, did he not fear to create jealousy among his comrades." Amoebæus the harper, according to Athenæus, used to receive an Attic talent of 193_l._ 15_s._ for each performance. The beautiful Lamia, the most celebrated female flute-player, had a temple dedicated to her under the name of Venus Lamia. The _Tibicinæ_, or female flute-players, who formed collegiate bodies, were as celebrated for their talent and their charms, as for their licentiousness and extravagance. Their performances were forbidden by the Theodosian code, but with little success; since Procopius informs us that, in the time of Justinian the sister of the Empress Theodora, who was a renowned amateur _tibicina_, appeared on the stage without any other dress than a slight and transparent scarf. In the early ages of Christianity, the power of music in adding to religious solemnity was fully appreciated, and many of the fathers and most distinguished prelates cultivated the auxiliary science. St. Gregory expressly sent over Augustine the monk, with some singers, who entered the city of Canterbury singing a litany in the Gregorian chant, which extended the number of the four tones of St. Ambrose to eight. A school for church music was established at Canterbury; and it was also taught in the diocese of Durham and Weremouth. St. Dunstan was a celebrated musician, and was accused of having invented a most wonderful magic harp; it was, perhaps, to prove that the accusation was false, that he took the devil by the nose with a pair of tongs. This ingenious saint is said to be the inventor of organs, one of which he bestowed on the abbey of Malmesbury. It appears, however, that instruments resembling the organ were known as early as 364, and were described in a Greek epigram attributed to Julian the Apostate, in which he says, "I beheld reeds of a new species, the growth of each other, and a brazen soil; such as are not agitated by winds, but by a blast that rushes from a leathern cavern beneath their roots; while a robust mortal, running with swift fingers over the concordant keys, makes them, as they smoothly dance, emit melodious sounds." The influence of music on the fair sex has long been acknowledged, and this advantage has proved fatal to some artists who had recourse to its fascinating powers; Mark Smeaton was involved in the misfortunes of Anne Boleyn; Thomas Abel, who taught harmony to Catherine, met with a similar fate, and David Rizzio was not more fortunate. They were, perhaps, too much impressed with the ideas of Cloten: "I am advis'd to give her music o' mornings; they say it will penetrate." It is worthy of remark, that no woman was ever known to excel in musical composition, however brilliant her instrumental execution might have been. The same observation has been made in regard to logical disquisitions. To what are we to attribute this exception?--are we to consider these delightful tormentors as essentially unharmonious and illogical? We leave this important question to phrenologists. THE FOOD OF MANKIND. ITS USE AND ABUSE. Destined by Providence to wander over the globe, and to live in various climes, man is essentially an omnivorous animal. According to the country he inhabits, its productions and the nature of his pursuits, his mode of living differs. The inhabitant of cold and sterile regions on the borders of the ocean becomes ichthyophagous; and fish, fresh, dried, smoked, or salted, is his principal nourishment. The bold huntsman lives upon the game he pursues; while the nomadian shepherd, who tends his herd over boundless steeps, supports himself on the milk of his flock. In warm countries fruits and vegetables constitute the chief support of life; and there the disciples of Pythagoras can luxuriate on the rich produce of a bountiful soil, solely debarring themselves from beans, which, like all flesh, they consider to have been created by putrefaction. What would these good people have done among the Scythians and the Getæ, who, according to Sidonius Apollinaris, mingled blood and milk for food-- ------------------Solitosque cruentum Lac potare Getas, ac pocula tingere venis; or the stunted natives of the arctic regions, who feed upon whales and seals, drink deep potations of train-oil, and consider the warm blood of the seal an exquisite beverage, dried herrings moistened with blubber a dainty, and the flesh of the seal half frozen in snow during winter, or half corrupted in the earth in summer, the most delicious morsel. The semi-barbarous Russians, who during the late wars enjoyed the abundant bills of fare of France and Italy, accustom themselves easily to this disgusting diet on their return; and their troops, who live amongst the Samoiedes, thrive uncommonly well on raw flesh and rein-deer blood. It is in temperate regions that man displays his omnivorous propensities: there, animal food can be abundantly procured; and every description of grain, roots, and fruit, is easily cultivated. It is as we pass from these middle climes towards the poles, that animal substances are more exclusively consumed; and towards the equator that we enjoy refreshing fruits, and nourishing roots and vegetables. So scarce is food in some desolate tracts of the globe, that we find the wandering Indian satisfying his cravings with earth and clay: and Humboldt informs us that the Ottomaques, on the banks of the Mata and Oronoco, feed on a fat unctuous earth, in the choice of which they display great epicurean skill, and which they knead into balls of four or six inches in diameter, and bake slowly over the fire. When about to be used, these clods are soaked in water, and each individual consumes about a pound of them in the day; the only addition which they occasionally make to this strange fare consists in small fish, lizards, and fern-roots. The art of cookery has improved, no doubt, with the progressive advance and development of our other institutions; and it seems to prove that the employment of all kinds of food is as natural to man, as a stationary uniformity and restriction of one species of aliment is to animals. A most erroneous idea has prevailed regarding the use of animal food, which has been considered as the best calculated to render mankind robust and courageous. This is disproved by observation. The miserable and timid inhabitants of Northern Europe and Asia are remarkable for their moral and physical debility, although they chiefly live on fish or raw flesh; whereas the athletic Scotch and Irish are certainly not weaker than their English neighbours, though consuming but little meat. The strength and agility of the negroes is well known, and the South Sea islanders can vie in bodily exercises with our stoutest seamen. We have reason to believe, that, at the most glorious periods of Grecian and Roman power, their armies were principally subsisted upon bread, vegetables, and fruits. Man by his natural structure was created omnivorous, and there is no doubt but that a judicious mixed alimentation is the best calculated to ensure health and vigour, and enable the ambitious or the industrious wanderer to spend his winters near the poles, colonize beneath the equator, or inhabit regions where the hardiest of animals must starve and die. The teeth, the jaws, all the digestive organs fit him for this mode of existence. There is a curious passage in one of Dr. Franklin's letters in regard to wine: he pleasantly observes, that the only animals created to drink water are those who from their conformation are able to lap it on the surface of the earth, whereas all those who can carry their hands to their mouth were destined to enjoy the juice of the grape. The diversity of substances which we find in the catalogue of articles of food is as great as the variety with which the art or the science of cookery prepares them: the notions of the ancients on this most important subject are worthy of remark. Their taste regarding meat was various. Beef they considered the most substantial food; hence it constituted the chief nourishment of their athletæ. Camels' and dromedaries' flesh was much esteemed, their heels most especially. Donkey-flesh was in high repute; Mæcenas, according to Pliny, delighted in it; and the wild ass, brought from Africa, was compared to venison. In more modern times we find Chancellor Dupret having asses fattened for his table. The hog and the wild boar appear to have been held in great estimation; and a hog was called "animal propter convivia natum;" but the classical portion of the sow was somewhat singular--"vulvâ nil dulcius amplâ." Their mode of killing swine was as refined in barbarity as in epicurism. Plutarch tells us that the gravid sow was actually trampled to death, to form a delicious mass fit for the gods. At other times, pigs were slaughtered with red-hot spits, that the blood might not be lost; stuffing a pig with asafoetida and various small animals, was a luxury called "porcus Trojanus;" alluding, no doubt, to the warriors who were concealed in the Trojan horse. Young bears, dogs, and foxes, (the latter more esteemed when fed upon grapes,) were also much admired by the Romans; who were also so fond of various birds, that some consular families assumed the names of those they most esteemed. Catius tells us how to drown fowls in Falernian wine, to render them more luscious and tender. Pheasants were brought over from Colchis, and deemed at one time such a rarity, that one of the Ptolemies bitterly lamented his having never tasted any. Peacocks were carefully reared in the island of Samos, and sold at such a high price, that Varro informs us they fetched yearly upwards of 2000_l._ of our money. The guinea-fowl was considered delicious; but, wretched people! the Romans knew not the turkey, a gift which we moderns owe to the Jesuits. Who could vilify the disciples of Loyola after this information! The ostrich was much relished; Heliogabalus delighted in their brains, and Apicius especially commends them. But, of all birds, the flamingo was not only esteemed as a _bonne-bouche_, but was most valuable after dinner; for, when the gluttonous sensualists had eaten too much, they introduced one of its long scarlet feathers down their throats, to disgorge their dinner. The modern gastronome is perhaps not aware that it is to the ancients he owes his delicious fattened duck and goose livers,--the inestimable _foies gras_ of France. Thus Horace: Pinguibus et ficis pastum jecur anseris albi. The swan was also fattened by the Romans, who first deprived it of sight; and cranes were by no means despised by people of taste. In later days the swan seems to have been in great estimation in our own country. We find in the Northumberland household book that in one year twenty of these birds were consumed at the earl's table. While the feathered creation was doomed to form part of ancient delights, the waters yielded their share of enjoyments, and several fishes were immortalized. The _muræna Helena_ was educated in their ponds, and rendered so tame that he came to be killed at the tinkling of his master's bell or the sound of his voice. Natat ad magistrum delicta muræna, says Martial. Hirtius ceded six thousand of these fish to Cæsar as a great favour, and Vitellius delighted in their roe. The fame of the lamprey, _mustela_ of Ausonius and Pliny, is generally known; and the sturgeon, the _acipenser sturio_, was brought to table with triumphant pomp: but the turbot, one of which was brought to Domitian from Ancona, was considered such a present from the gods, that this emperor assembled the senate to admire it. Soles were also so delectable that punning on the word _solea_, they were called the _soles_ of the gods: the dorad, _sparus auratus_, was consecrated to Venus; the _labrus scarus_ was called the brain of Jupiter, and Apuleius and Epicharmus maintain that its very entrails would be relished in Olympus. To these dainties may be added the _Alphestæ_, a fish always caught in pairs from their eagerness to be eaten. The _Amia_ so very delicious that the Athenians defied the worst cook to spoil them. The _Gnaphius_ that imparted to the water that had had the honour to boil them, the facility of taking out all stains. The _Pompilus_ which sprang with Venus from the blood of the sky. The fish called _fox_ by the Rhodians, and _dog_ by the Boeotians, was considered such a dainty that Archestratus recommended epicures to steal them if they could not procure them by honest means; adding, that all calamities should be considered immaterial after a man had once feasted on such a luscious morsel, too divine to be gazed upon by vulgar eyes, and which ought to be procured by the wealthy, if they did not wish to incur the wrath of the gods, for not appreciating at its true value the flower of their nectar. Eels were also highly esteemed by the ancients. The preference being given to the _Copaic_, which the Boeotians offered to the gods crowned with flowers, giving them the same rank among fish that Helen held amongst women. The _garum_, or celebrated fish-sauce of the Romans, was principally made out of the _sciæna umbra_, and the mackerel; the entrails and blood being macerated in brine until they became putrid. Expirantis adhuc scombri, de sanguine primo Accipe fastosum munera cara garum:-- thus says Martial: and Galen affirms that this disgusting preparation was so precious, that a measure of about three or four pints fetched two thousand silver pieces. So delightful was the effluvium of the garum considered, that Martial informs us it was carried about in onyx smelling-bottles. But our luxurious civic chiefs are not aware that the red mullet--for such I believe was the _mullus_--was held in such a distinguished category among genteel fishes, that three of them, although of small size, were known to fetch upwards of 200_l._ They were more appreciated when brought alive, and gradually allowed to die, immersed in the delicious garum; when the Romans feasted their eyes in the anticipated delight of eating them, by gazing on the dying creature as he changed colour like an expiring dolphin. Seneca reproaches them with this refinement of cruelty--"Oculis quoque gulosi sunt;" and the most renowned of Apicius's culinary discoveries was the _alec_, a compound of their livers. Snails were also a great dainty. Fulvius Herpinus was immortalized for the discovery of the art of fattening them on bran and other articles; and Horace informs us they were served up, broiled upon silver gridirons, to give a relish to wine. Oysters were brought from our coasts to Rome, and frozen oysters were much extolled. Grasshoppers, locusts, and various insects, were equally acceptable to our first gastronomic legislators. Acorns, similar to those now eaten in Spain, formed part of a Roman dessert; the best were brought from Naples and Tarentum. It does not appear that the ancients had a great variety in their vegetable diet; condiments to stimulate the sluggish appetite seemed to be their principal research: amongst these the asafoetida, which is to this day highly relished in the East, was an indispensable ingredient; this has been doubted by various naturalists, but it appears certain, since Pliny informs us that it was frequently adulterated by _sagapenum_, which bears the strongest resemblance to it. This substance was called _laser_, and by many tasteless persons, such as Aristophanes and Apuleius, considered offensive and disgusting; hence the latter, "lasere infectas carnes," and "laseratum porcellum." According to Theophrastus, asafoetida was collected and preserved, as it is at present, in skins; and, despite its estimation as a culinary ingredient, it was not unfrequently named _stercus diaboli_. In addition to this gum, they seasoned their food with various other strong articles, such as coriander and cummin seeds, sumac, saffron, cinnamon, thyme; with divers peppers, salt, and sal-ammoniac. Instead of bread, which was only introduced in Rome 580, A. D. they used a heavy kind of unleavened paste, similar to the present _polenta_. This nourishment occasioned frequent indigestion, hence the use of warm water after meals, and the necessity of emetics. Warm water was sold about the streets in their thermopolia, and Seneca observed the paleness and debility that arose from its use and abuse; a practice recorded by Martial: Et potet calidam, qui mihi livet, aquam. While water was thus freely drunk, wine was not disregarded; but the various articles with which it was adulterated, must have rendered it any thing but a delectable potation according to our received ideas. Thus we see the Greeks putting salt and sea-water in theirs; at other times dissolving mastic and myrrha, or infusing wormwood, in their choicest Falernian. Like modern tasters, however, they knew the method of developing the _bouquet_ by warmth; and, to appreciate the flavour, they frequently added hot water. That wines of a resinous taste were esteemed, appears from Martial: Resinata bibis vina, Falerna fugis. But we may conclude that, according to our modern taste, their boasted wines did not equal ours either in flavour or in delicacy. The ancients however were very careful in the preparation of their bread, justly called the "staff of life," as constituting one of the most wholesome and nutritious parts of our food. The Athenian bakers bore the palm in the confection of this article. Archestratus recommended the wheaten bread of Athens and the barley meal of Lesbos, which their poets asserted was supplied to the gods. The Grecian millet bread was also in great repute, while delicious bread was also made with the _Zea_, the _Triticum Spella_ of Linnæus and the _Far_ of the Romans. A species of wheat called _Tiphe_ was also much esteemed. Brown bread was made of a grain called _Olyra_, and it was with loaves of this description that Homer's heroes fed their horses. It appears that great attention was paid to the kneeding and the boulting: unboulted meal was called _Syncomista_, and when finely boulted in a woollen cloth, _Semidalis_. The most approved method of baking was in the _Cribanus_ or _Clibanus_, an earthen or iron vessel, which they surrounded with charcoal. Bread according to its superior or inferior quality was consecrated to various divinities. Thus the goddesses used the _Homoros_, and Hecate was served with the _Hemiantium_, but we are unacquainted with the preparation of these varieties. The flour of barley was used by the _Canephoræ_, or virgins that bore the sacred baskets in the festivals of Ceres, to sprinkle themselves. Bread according to its particular kind was served up in various ways; wheaten bread was brought to table upon fresh leaves; barley bread upon a layer of reeds. At the feasts of Ceres and Proserpine, a large loaf was kneeded and baked by the ladies of Delos, called _Achaïnas_ which gave the name to the festival, instituted most probably in Achaia, to commemorate the invention of bread, which Ceres taught to Eumelus, a citizen of Patræ. Barley for the preparation of bread was used long before wheat or any other sort of corn, and hence Artemidorus calls it _Antiquissimum in cibis_. It was also given to the athletæ who were thence called _Hordearii_. In latter times it was chiefly given to cattle, although used by the poorer classes. Barley bread was also issued to soldiers as a punishment, the loss of wheaten bread being considered a great privation. Vegetius tells us that soldiers who had been guilty of any offence were thus punished--"_hordeum pro frumentuo cogebantur accipere_." In the second Punic war we find Marcellus sentencing the cohorts that had lost their standards to this infliction. Suetonius also informs us that Augustus only allowed barley to the troops that had misbehaved in action. _Cohortes, si quæ cepissent, loco, decimatas hordeo pavit._ But there is reason to believe that under the head of bread were included various kinds of cakes, many of which were prepared with honey, some of them were called _Placentæ omnigenæ_, and were prepared by bakers who bore the name of _pistores dulciarii_. This honied bread or cake it appears, was frequently resorted to, as in the present day, to quiet troublesome children as well as to please the taste of fastidious patients. Thus Martial: Leniat ut fauces medicus, quas aspera vexat Assiduè tussis, Parthenopæ tibi Mella dari, nucleosque jubet dulcesque placentas. Est quidquid pueros non sinit esse truces, At tu non cessas totis tussire diebus Non est hæc tussis, Parthenopæ gula est. The bread made of spring wheat was called _Collabus_, and the Athenians considered a toasted _Collabus_ eaten with a slice of a pig's belly, the very best cure for a surfeit occasioned by an excess in anchovies, especially the Phalerian ones, which were deemed fit for the gods. Fragments of bread it appears were used instead of napkins to wipe the fingers on. These were called _Apomygdaliæ_, with which Aristophanes fed his sausage-makers. These dainty bits were usually thrown to dogs. The cooks of the ancients appear to have been much more consummate in their art than our modern practitioners. Athenæus records various descriptions of their incomparable science. A new dish immortalized its inventor, and transmitted his name to posterity. Apicius's cakes were called Apicians; and Aristoxenes had attained such perfection in curing hams, that the glorious appellation of Aristoxenians was bestowed upon them. Philosophers and poets gloried in their culinary science; the pleasures of the table were the subject of their writings and their conversation. Archestratus tells us with delight, that, although various delicacies can only be enjoyed in their proper season, yet we can talk about them with watering mouths all the year round. One of these illustrious ministers of luxury attained such a degree of enviable perfection, that he could serve up a pig boiled on one side and roasted on the other, and moreover stuffed with all possible delicacies, without the incision through which these dainties were introduced being perceived. Supplicated to explain this wonderful secret, he swore solemnly by the manes of all the heroes who fell at Marathon, or conquered at Salamis, that he would not reveal this sacred mystery for one year. When the happy day arrived and he was no longer bound by his vows, he condescended to inform his anxious hearers, that the animal had been bled to death by a wound under the shoulder, through which the entrails were extracted; and afterwards hanging up the victim by the legs, the stuffing was crammed down his throat. One half of the pig was then covered with a thick paste, seasoned with wine and oil, put into a brass oven, and gently and tenderly roasted: when the skin was brown and crisp, our hero proceeded to boil the other moiety; the paste was then removed, and the boiled and roasted grunter triumphantly served up. So refined was the taste of the ancient _bons vivans_, that Montanus, according to Juvenal, would proclaim, at the first bite, whether an oyster was of English produce or not. Sandwich is believed to have been the favoured spot whence Rome imported her oysters and other shell-fish. Shrimps and prawns must have been in great estimation, since we find Apicius quitting his residence at Minturnæ, upon hearing that the shrimps of Africa were finer than those he could procure in Campania. He instantly set sail for the happy coast, despite a gale of wind: after encountering a desperate storm, he reached the wished-for land of promise; but alas!--the fishermen displayed the largest prawns they could collect, and to his cruel disappointment, they could not vie, either in delicacy or beauty, with those of Minturnæ. He immediately ordered his pilot to steer a homeward course, and left Africa's shore with ineffable contempt. These ingenious gluttons had recourse to every experiment that could add to their enjoyment. Philoxenus, and many others, used to accustom themselves to swallow hot water, that they might be able to attack scalding dishes before less fireproof guests would dare to taste them. Sinon maintained that cookery was the basis of all arts and sciences: natural philosophy taught us the seasoning of dishes; architecture directed the construction of stoves and chimneys; the fine arts, the beautiful symmetry of each dish; and the principles of war were applied to the drilling and marshalling of cooks, confectioners, and scullions, posting proper sentries to watch the fires, and videttes to keep off idle intruders. That man is a "cooking animal" is considered one of his proudest attributes, and a proper bill of fare may be considered as the _ne plus ultra_ of human genius! It may be easily imagined that when good living became a science, _sponging_ upon the wealthy _Amphitryons_ became an art amongst the needy _bons vivants_, and parasites, as in the present day, were ever seen fawning and cringing for their dinner. These sycophants stuck so close to their patrons, that they were called shadows. Thus Horace: ----Quos Moecenas adduxerat umbras. They were also called flies, [Greek: gyias], by the Greeks, and _Muscæ_ by the Romans; no doubt from their constant buzzing about the object of their devotion. Plautus calls an entertainment free from these despicable guests, _Hospitium sine muscis_. Horus Apollo tells us that in Egypt a fly was the symbol of an impudent fellow; because, although driven away, it will constantly return. We have, however, reason to believe that the term _parasite_ was originally applied to the followers of princes, Patroclus was the parasite of Achilles, and Memnon of Idomeneus; it was only in later times that the appellation was given to despicable characters and "_trencher friends_." Our Shakspeare had adopted the term of the ancients, as appears in the following passages: In such as you, That creep like _shadows_ by him, and do sigh At each his needless heavings. And again-- Feast-won, fast-lost, one cloud of winter showers. These _flies_ are couched. While climate points out the most suitable articles of food, it exercises a singular influence over their qualities and properties, more especially in vegetable substances. We find plants which are poisonous in some countries, edible and wholesome in others. Next to climate, culture and soil modify plants to a singular degree: flowers which yield a powerful perfume in some latitudes, are inodorous in others; and, according to climate, their aroma is pleasant or distressing. A striking proof of this fact can be adduced from the well-known effects of perfumes in Rome; where the inhabitants, especially females, cannot support the scent even of the rose, which has been known to produce syncope, illustrating the poet's line to Die of a rose in aromatic pain. This variety in the action of vegetable substances is more particularly observable in such as are considered medicinal. Opium, narcotics, and various drugs, are more powerful in warm climates than in northern regions. The Italian physicians express astonishment at the comparatively large doses prescribed by our practitioners. Cultivation brings forth singular intermediate productions; and by its magic power we have seen the coriaceous and bitter almond transformed into the luscious peach, the sloe converted into the delicious plum, and the common crab transformed into the golden pippin. The same facts are observed in vegetables; the celery sprung from the nauseous and bitter _apium graveolens_, and the colewort, is metamorphosed into the cabbage and the cauliflower. All cruciform plants degenerate within the tropics, but acquire increased energies in cold countries. Recent experiments in Germany have demonstrated that in times of scarcity, the wood of several trees may be converted into a nutritious substance. The fibres of the beech, birch, lime, poplar, fir, and various other trees, when dried, ground, and sifted into an impalpable powder, constitute a very palatable article of food. If cold water be poured on this ligneous flour, enclosed in a linen bag, it becomes milky, and considerable pressure and kneading is required to express the amylaceous or starchy part of it. Professor Von Buch, in his travels through Norway and Lapland, has fully described the Norwegian _barke bröd_. We find the savages scattered along the coast of the great austral continent mixing up a paste of the bark of the gum-tree with the ants and the other insects, with their larvæ, which they find in it. Ground dried fish and fish-bones have from time immemorial been converted into bread; Arrianus tells us that Nearchus found several nations on the shores of the Red Sea living upon a bread of this description. It is thus evident that all substances from the animal and vegetable kingdom appear to afford more or less nutriment, provided that they contain no elements unlike the animal matter of the being they are intended to nourish. All others are either medicinal or poisonous. Food may be considered nourishing in the ratio of its easy digestion or solution. Magendie attributes the nutritious principle to the greater or lesser proportion of nitrogen or azote. According to his view of the subject, the substances that contain little or no nitrogen are the saccharine and acid fruits, oils, fats, butter, mucilaginous vegetables, refined sugar, starch, gum, vegetable mucus, and vegetable gelatin. The different kinds of corn, rice and potatoes, are elements of the same kind. The azotical aliments, on the contrary, are vegetable albumen, gluten, and those principles which are met with in the seeds, stems and leaves of grasses and herbs, the seeds of leguminous plants, such as peas and beans, and most animal substances, with the exception of fat. To this doctrine, it was objected, that animals who feed upon substances containing little nitrogen, and the field negroes, who consume large quantities of sugar, might be adduced as an exception. Magendie replies, that almost all the vegetables consumed by man and animals contain more or less nitrogen--that this element enters in large quantity in the composition of impure sugar--and lastly, that the nations whose principal food consists in rice, maize, or potatoes, consume at the same time milk and cheese. To support his theory, this physiologist had recourse to various curious experiments on dogs, whom he fed with substances which contained no nitrogen. During the first seven or eight days, the animals were brisk and active, and took their food and drink as usual. In the course of the second week they began to get thin, although their appetite continued good, and they took daily between six and eight ounces of sugar. The emaciation increased during the third week; they became feeble, lost their appetite and activity, and at the same time ulcers appeared in the cornea of their eyes. The animals still continued to eat three or four ounces of sugar daily, but, nevertheless, became at length so feeble as to be incapable of motion, and died on a day varying from the 31st to the 34th: and it must be recollected that dogs will live the same length of time without any food. The same were the results where dogs were fed upon gum, and butter; when they were fed with olive oil and water the phenomena were the same, with the exception of ulceration of the cornea. In Denmark, a diet of bread and water for a month is considered equivalent to the punishment of death. Dr. Stark died in consequence of experiments which he instituted on himself to ascertain the effects of a sugar diet. Muller has justly observed that these experiments of Magendie have thrown considerable light on the causes and the mode of treatment of the gout and calculous disorders. The subjects of these diseases are generally persons who live well and eat largely of animal food; most urinary calculi, gravelly deposits, the gouty concretions, and the perspiration of gouty persons, contain an abundance of uric acid, a substance in which nitrogen is contained in a large proportion. Thus, by diminishing the proportion of azotical substance in the food, the gout and gravelly deposits may be prevented. The experiments of Tiedemann and Gmelin have confirmed those of Magendie, whose curious observations on the necessity of varying diet I shall transcribe. 1. A dog fed on white bread, wheat, and water, did not live more than fifty days. 2. Another dog, who was kept on brown soldiers' bread did not suffer. 3. Rabbits and guineapigs who were fed solely on any one of the following substances--oats, barley, cabbage, and carrots,--died of inanition in fifteen days; but they did not suffer when these substances were given simultaneously or in succession. 4. An ass fed on dry rice, and afterwards on boiled rice, lived only fifteen days; a cock, on the contrary, was fed with boiled rice for several months with no ill consequence. 5. Dogs fed with cheese alone, or hard eggs, lived for a long time; but they became feeble and lost their hair. 6. Rodent animals will live a very long time on muscular substances. 7. After an animal has been fed for a long period on one kind of aliment, which, if continued, will not support life, allowing it the former customary food will not save it: he will eat eagerly, but will die as soon as if he had continued to be restricted to the article of food which was first given him. Dr. Paris is of opinion that all that these experiments tend to prove is, that animals cannot exist upon highly-concentrated aliment. Horses fed on concentrated aliment are liable to various disorders, originating from diseased action of the stomach and liver, broken wind, staggers, blindness, &c. Professor Muller has given an excellent definition of indigestion. "It is a state of the digestive organs in which either they do not secrete the fluid destined for the solution of the aliment, or they are in such a condition of irritability or atony, that by the mechanical irritation of the food, painful sensations and irregular motions are exerted." But the most curious experiments made on the changes which the food undergoes in the stomach, according to the greater or lesser facility with which it is digested, were those of Dr. Beaumont. This physiologist had the rare opportunity of investigating this subject in a patient of the name of St. Martin, who came under his care in consequence of a gun-shot wound, which left a considerable opening in the stomach, which, when empty, could be explored to the depth of five or six inches by artificial distention. The food and the drink could in this manner be seen to enter it. This enabled him to keep an interesting journal and table, showing the time required for the digestion of different kinds of food, which were taken with bread or vegetables, or both. The following are some of his interesting observations: _Experiment 33._ At 1 o'clock St. Martin dined on roast beef, bread, and potatoes--in half an hour examined the contents of the stomach, found what he had eaten reduced to a mass resembling thick porridge. At 2 o'clock, nearly all chymified--a few distinct particles of food still to be seen. At half-past four, chymification complete. At 6 o'clock nothing in the stomach but a little gastric juice tinged with bile. _Ex. 42._ At 8 a.m., breakfast of three hard-boiled eggs, pancakes, and coffee. At half-past eight, found a heterogenous mixture of the articles slightly digested. At a quarter-past ten, no part of breakfast could be seen. _Ex. 43._ At 2 o'clock same day, dined on roast pig and vegetables. At 3 they were chymified; and at half-past four nothing remained but a little gastric juice. _Ex. 18_, in a third series. At half-past eight a.m., two drams of fresh fried sausage, in a fine muslin bag, were suspended in the stomach of St. Martin, who immediately afterwards breakfasted on the same kind of sausage, and a piece of broiled mutton, wheaten bread, and a pint of coffee. At half-past eleven, stomach half empty, contents of bag about half diminished. At 2 o'clock p.m., stomach empty and clean, contents of bag all gone with the exception of fifteen grains, consisting of small pieces of cartilaginous and membranous fibres, and the spices of the sausage, which last weighed six grains. As I have elsewhere observed, various are the theories that have been entertained in regard to digestion, but the experiments of Dr. Beaumont seem to have proved beyond a doubt, that this operation is due to the action of the gastric juice, with which he was enabled to produce artificial digestion. Having obtained one ounce of this solvent from the stomach of his patient, he put into it a solid piece of recently-boiled beef, weighing three drams, and placed the vessel that contained it in a water bath heated to 100°. In forty minutes digestion had commenced on the surface of the meat; in fifty minutes, the fluid was quite opake and cloudy, the external texture began to separate and become loose; in sixty minutes, chyme began to form. At 1 p.m. (two hours after the commencement of the experiment), the cellular substance was destroyed, the muscular fibres loose and floating about in fine small threads very tender and soft. In six hours they were nearly all digested--a few fibres only remaining. After the lapse of ten hours, every part of the meat was completely digested. The artificial digestion by these experiments appears to be but little slower than the natural process--they also demonstrate the influence of the temperature, and the quantity of the solvent secretion. Having obtained from St. Martin two ounces of gastric juice, he divided this quantity into two equal portions, and laid in each an equal quantity of masticated roast beef. One he placed in a water bath at the temperature of 99° Farh.--and left the other exposed to the open air at the temperature of 34°; a third similar portion of meat he kept in a phial, with an ounce of cold water. An hour after the commencement of the experiment, St. Martin had finished his breakfast, which consisted of the same meat with biscuit, butter, and coffee. Two hours after the meat had been put into the phial, the portion in the warm gastric juice was as far advanced in chymification as the food in the stomach; the meat in the cold gastric juice was less acted on, and that in the cold water only slightly macerated. In two hours and forty-five minutes from the time that the experiment was begun, the food in the stomach was completely digested, the stomach empty, while even at the end of six hours the meat in the gastric juice was only half digested. Dr. Beaumont, therefore, having procured 12 drams of fresh gastric juice, added now a portion to each of the phials containing meat and gastric juice, and to a portion of the half-digested food which he had withdrawn from the stomach two hours after the commencement of the experiment, and which had not advanced towards solution. After eight hours' maceration, the portions of meat in the cold gastric juice, and in the cold water, were little changed, but, from the time of the addition of the fresh gastric juice, digestion went on rapidly in the other phials, which were kept at the proper heat, and at the end of 24 hours, the meat which had been withdrawn from the stomach after digestion had commenced, were, with the exception of a piece of meat that had not been masticated, converted into a thickish pulpy mass of a reddish-brown colour: the meat in the warm gastric juice was also digested, though less perfectly, while that in the cold gastric juice was scarcely more acted on than the meat in the water, which was merely macerated. Dr. Beaumont now exposed these two phials containing the meat in cold gastric juice, and meat in water, to the heat of the water bath for 24 hours, and the gastric juice, which when cold had no power on the meat, now digested it; while the meat in the water underwent no change, except that towards the end of the experiment, putrefaction had commenced. The antiseptic properties of the gastric juice were fully demonstrated in several other experiments. Various philosophers, in idle disquisitions, have endeavoured by the most absurd hypotheses to determine what is the natural food of man, and to show that he is not created omnivorous. The comparison between our species and animals confutes these vain theories. The masticatory and digestive organization of man assigns to him an intermediate rank between carnivorous and herbivorous creatures. The teeth may be said by their figure and construction to bear a relation with our natural food. The teeth of flesh-eating animals rise in sharp prominences to seize and lacerate their prey, and those of the lower jaw shut within those of the superior one. The herbivorous animals are not armed with these formidable weapons, but have broad flat surfaces with intermixed plates of enamel, that they should wear less rapidly in the constant labour of grinding and triturating. In the carnivorous, the jaws can only move backward and forward; in the herbivorous their motion is lateral, as observed in the cow when chewing her cud. Beasts of prey tear and swallow their food in masses, while in others it undergoes a careful communition before it is transmitted to the stomach. The teeth of man only resemble those of carnivorous animals by their enamel being confined to their external surface, while in the freedom of the motion of the jaws from side to side they partake of the conformation of the herbivorous. The teeth and jaws of man are in all respects more similar to those of monkeys than any other animals; only in some of the simiæ the canine teeth are much longer and stronger, and denote a carnivorous propensity. It is to the abuse of this omnivorous faculty that Providence has bestowed upon mankind, that we owe many of the diseases under which our species labours. "Multos morbos, multa fercula fecerunt," sayeth Seneca; yet we are far more temperate in the present age than the ancients during the period of their boasted high civilization and prosperity. Their excesses must have been of the most disgusting nature, since, to indulge more easily in their gluttonous propensities, they had recourse to emetics both before and after their meals. "Vomunt ut edant, edunt ut vomunt, et epulas quas toto orbe conquirunt nec concoquere dignantur," was the reproach of the above-quoted philosopher. Suetonius and Dion Cassius give Vitellius the credit of having introduced this revolting custom into fashion; and splendid vessels for the purpose were introduced in their feasts. Martial alludes to it in the following lines: Nec coenat priùs, aut recumbit, antè Quam septem vomuit meri deunces. And Juvenal tells us that the bath was polluted by this incredible act of bestiality,-- Et crudum pavonem in balneâ portas. The sums expended by the ancients on their table exceed all belief. Vitellius expended for that purpose upwards of 3200_l._ daily, and some of his repasts cost 40,000_l._ At one of them, according to Suetonius, 7000 birds and 2000 fishes were served up. Ælius Verus laid out 600,000 sestertii on one meal; and some of the dishes of Heliogabalus cost about 4000_l._ of our money. The excesses of this monster were such, that Herodianus affirms that he wanted to ascertain, not only the flavour of human flesh, but of the most disgusting and nameless substances. The freaks related of this emperor are scarcely credible; but his gastronomic profusion may be easily conceived when we find that his very mats were made with the down of hares or soft feathers found under the wings of partridges! When such ideas of _enjoyment_ prevailed, can we wonder that Philoxenus should have wished that he had the throat of a crane, that he might prolong the delights of eating! Our early ancestors were remarkable for their frugality, and it is supposed that luxurious, or, at least, full living was introduced by the Danes: it has been even asserted that the verb _gormandize_ was derived from _Gormond_, a Danish king, who was persuaded by Alfred to be baptized. Erasmus observed that the English were particularly fond of good fare. William the Conqueror, and Rufus, were in the habit of giving most splendid entertainments; and the former monarch was such an irascible epicure, that, upon one occasion, an underdone crane having been served up by the _master of the cury_, he would have knocked him down but for the timely interference of his _dapifer_, or purveyor of the mouth. This office of _dapifer_, with that of _lardrenius_, _magnus coquus_, _coquorum prepositus_, and _coquus regius_, were high dignitaries in those days. Cardinal Otto, the pope's legate, being at Oxford in 1238, his brother was his _magister coquorum_; and the reasons assigned for his holding that office were his brother's suspicious fears "_ne procuraretur aliquid venenosum, quod valdè timebat legatus_." These officers were not unfrequently clergymen, who were elevated to the bench for their valuable services. Whatever barbarity the ancients may have shown in preparing their dainty dishes, none could have surpassed in refinement of cruelty. Their method of roasting and eating a goose alive, is thus directed: "Take a goose or a duck, or some such _lively creature_, (but the goose is best of all for the purpose,) pull off all her feathers, only the head and neck must be spared; then make a fire round about her, not too close to her, that the smoke do not choke her, and that the fire may not burn her too soon, nor too far off, that she may not escape the fire; within the circle of the fire, let there be small cups and pots full of water, wherein salt and honey are mingled, and let there be set also chargers full of sodden apples, cut into small pieces in the dish. The goose must be all larded and basted over with butter, to make her the more fit to be eaten, and may roast the better. Put the fire about her but do not make too much haste, when as you see her begin to roast; for by walking about, and flying here and there, being cooped in by the fire that stops her way out, the unscared goose is kept in; she will fall to drink the water to quench her thirst and cool her heart, and all her body, and the apple sauce will cleanse and empty her, and when she wasteth, and consumes inwardly, always wet her head and heart with a wet sponge, and when you see her giddy with running and begin to stumble, her heart wants moisture, and she is roasted enough. Take her up and set her before your guest, and she will cry as you cut off any part from her, and will be almost eaten up before she is dead. _It is mighty pleasant_ to behold." Our forefathers were most ingenious in these diabolical fancies, we find in Portar's Magick the way how to persuade a goose to roast _herself_ if you have a lack of cooks. The heroic conduct of French cooks has been recorded in history, and compared with the noble devotion of the ancients. Vatel, maître d'hôtel of Louis XIV., put an end to his wretched existence in consequence of fish not having arrived in time for dinner. On this sad event being reported to his sovereign, he both praised and blamed his courage; and, to use the words of Madame de Sevigné, he perished "à force d'avoir de l'honneur à sa manière; on loua fort et l'on blama son courage." It is strange that Napoleon should have used the very same expressions when speaking of one of his most distinguished generals. In more modern times we have heard of persons who expected that clerical functions should be combined with various lay duties, as appears by the following curious advertisement in a late paper: "Wanted, for a family who have bad health, a sober, steady person, in the capacity of doctor, surgeon, apothecary, and man-midwife. He must occasionally act as butler, and dress hair and wigs. He will be required sometimes to read prayers, and to preach a sermon every Sunday. A good salary will be given." This was certainly an economical speculation for the use of soul and body. Cooks have sometimes been obliged to resort to pious frauds; and it is related of our Richard Coeur de Lion, that, being very ill during the holy wars, he took a strange fancy for a bit of pork, but, as no pig could be procured, a plump Saracen child was roasted as a substitute; and it was remarked that Richard was ever after partial to pork. There is little doubt but that our forefathers were harder livers than the present generation: even within the memory of man, drinking to excess is a vice seldom observed, excepting in some individuals belonging to the old school. The hours of refection have been singularly altered; and while our fashionable circles seldom sit down to table before eight o'clock in the evening, we find in olden chronicles that even royalty was used to dine at nine in the morning, more especially upon the Continent. In the Heptæmeron of the Queen of Navarre we find an account of the manner of spending the day: "As soon as the morning rose, they went to the chamber of Madame Oysille, whom they found already at her prayers; and when they had heard during a good hour her lecture, and then the mass, they went to dine at ten o'clock, and afterwards each privately retired to his room, but did not fail at noon to meet in the meadow. Vespers heard, they went to supper; and after having played a thousand sports in the meadow they retired to bed." During the reign of Charles V. of France, the court dined at ten, supped at seven, and retired to rest at nine. Holinshed gives the following curious description of our early diet: "Our tables are oftentimes more plentifully garnished than those of other nations, and this trade has continued with us since the very beginning; for, before the Romans found out and knew the way into our country, our predecessors fed largely upon flesh and milk, whereof there was great abundance in this isle, because they applied their chief studies unto pasturage and feeding. "In Scotland, likewise, they have given themselves unto very ample and large diet, wherein as for some respect nature doth make them equal with us, so otherwise they far exceed us in over much and distemperate gormandize, and so engross their bodies, that divers of them do oft become unapt to any other purpose than to spend their time in large tabling and belly cheer. In old times these North Britons did give themselves universally to great abstinence; and in time of war their soldiers would often feed but once, or twice at the most, in two or three days, especially if they held themselves in secret, or could have no issue out of their bogs and morasses, through the presence of an enemy; and in this distress they used to eat a certain kind of confection, whereof so much as a bean would qualify their hunger above common expectation. In those days, also, it was taken for a great offence over all to eat either goose, hare, or hen, because of a certain superstitious opinion which they had conceived of these three creatures. Amongst other things, baked meats, dishes never before this man's (James I.) days seen in Scotland, were generally so provided for by virtue of this act, that it was not lawful for any to eat of the same under the degree of a gentleman, and those only but on high and festival days. In number of dishes and changes of meat, the nobility of England (whose cooks are for the most part musical-headed Frenchmen and strangers) do most exceed; sith there is no day in manner that passeth over their heads, wherein they have not only beef, mutton, veal, lamb, kid, pork, cony, capon, pig, or so many of these as the season yieldeth, but also some portion of the red and fallow deer, beside great variety of fish and wild fowl, and thereto sundry other delicates, wherein the sweet hand of the seafaring Portingale is not wanting; so that for a man to dine with one of them, and to taste of every dish that standeth before him, is rather to yield unto a conspiracy, with a great deal of meat for the speedy suppression of natural health, than the use of a necessary mean to satisfy himself with a competent repast, to sustain his body withal. The chief part, likewise, of their daily provision is brought in before them commonly in silver vessels, if they be of the degree of barons, bishops, and upwards, and placed upon their tables; whereof when they have taken what it pleaseth them, the rest is reserved, and afterwards sent down to their serving-men and waiters. "The gentlemen and merchants keep much about one rate, and each of them contenteth himself with four, five, or six dishes, when they have but small resort; or, peradventure, with one or two, or three at the most, when they have no strangers. And yet their servants have their ordinary diet assigned, besides such as is left at their masters' boards, and not appointed to be brought thither the second time, which, nevertheless, is often seen, generally in venison, lamb, or some especial dish whereon the merchantman himself liketh to feed when it is cold. "At such times as the merchants do make their ordinary or voluntary feasts, it is a world to see what great provision is made of all manner of delicate meats from every quarter of the country, wherein, beside that they are often comparable herein to the nobility of the land, they will seldom regard any thing that the butcher usually killeth, but reject the same as not worthy to come in place. In such cases, also, _geliffes_ of all colours, mixed with a variety in the representation of sundry flowers, herbs, trees, forms of beasts, fish, fowls, and fruits; and thereunto _marchpane_ wrought with no small curiosity, tarts of divers hues and sundry denominations; conserves of old fruits, foreign and home-bred; suckets, codiniacs, marmalades, sugar-bread, ginger-bread, florentines, wild-fowl, venison of all sorts, and sundry outlandish confections, altogether seasoned with sugar, (which Pliny calls _mel ex arundinibus_, a device not common nor greatly used in old times at the table, but only in medicine, although it grew in Arabia, India, and Sicilia,) do generally bear the sway, besides infinite devices of our own not possible for me to remember. Of the potato, and such _venerous_ roots as are brought out of Spain, Portingale, and the Indies, to furnish our banquets, I speak not, wherein our _Mures_, of no less force, and to be had about Crosby Ravenswath, do now begin to have place. "And as all estates do exceed in strangeness and number of costly dishes, so these forget not to use the like excess in wine, insomuch as there is no kind to be had (neither any where more store of all sorts than in England, although we have none growing with us; but yearly the proportion of twenty or thirty thousand tun and upwards, notwithstanding the daily restraints on the same brought over to us) whereof at great meetings there is not some store to be had. Neither do I mean this of small wines only, such as claret, white, red, French, &c. which amount to about fifty-six sorts, according to the number of regions from whence they come; but also of the thirty kinds of Italian, Grecian, Spanish, Canarian, &c., whereof _Vernage_, _Cate-pument_, _Raspis_, _Muscadell_, _Romnie_, _Bastard Fire_, _Osey_, _Caprike_, claret, and malmsey, are not least of all accounted of, because of their strength and value. For as I have said of meat, so, the stronger the wine is, the more it is desired, by means thereof in old times, the best was called _Theologicum_ because it was had from the clergy and religious men, unto whose houses many of the laity would often send for bottles filled with the same, being sure that they would neither drink nor be served of the worst, or such as was any ways mingled or brewed by the vintner; nay, the merchant would have thought that his soul should have gone straightways to the devil, if he should have served him with any other than the best. Furthermore, when they have had their course which nature yieldeth, sundry sorts of artificial stuff, as _ypocras_ and wormwood wine, must in like manner succeed in turns, besides stale ale and strong beer, which nevertheless bears the greatest brunt in drinking, and are of so many sorts and ages as it pleaseth the brewer to make. "In feasting, the artisans do exceed after their manner, especially at bridals, purifications of women, and such like odd meetings, where it is incredible to tell what meat is consumed and spent; each one bringing such a dish, or so many as his wife and he do consult upon, but always with this consideration, that the _leefer_ (the more liberal) friend shall have the best entertainment. This is also commonly seen at these banquets, that the good man of the house is not charged with any thing, saving bread, drink, house-room, and fire. "Heretofore there hath been much more time spent in eating and drinking than commonly is in these days; for whereas of old we had breakfasts in the forenoon, _beverages_ or _nuntions_ after dinner, and thereto _rere suppers_, generally when it was time to go to rest (a toy brought in by Hard Canutus), now these odd repasts, thanked be God! are very well left, and each one in manner (except here and there some young hungry stomach that cannot fast till dinner-time contenteth himself with dinner and supper only). The Normans, disliking the gormandize of Canutus, ordained, after their arrival, that no table should be covered above once in the day; which Huntingdon imputeth to their avarice: but, in the end, either waxing weary of their own frugality, or suffering the cockle of old custom to overgrow the good corn of their new constitution, they fell to such liberty, that in often feeding they surmounted Canutus surnamed the Hardy; for whereas he covered his table but three or four times in the day, they spread their cloths five or six times, and in such wise as I before rehearsed. They brought in also the custom of long and stately sitting at meat, which is not yet left, although it be a great expense of time, and worthy reprehension; for the nobility and gentlemen, and merchantmen, especially at great meetings, do sit commonly till two or three of the clock at afternoon, so that with many it is an hard matter to rise from the table to go to evening prayer, and return from thence to come time enough to supper." The early prevalence of drinking in England seems to have been derived from our foreign intercourse. In the reign of Elizabeth and James I. we find various statutes against ebriety. Tom Nash, in his "Pierce Pennilesse" says, "Superfluity in drink is a sin that ever since we have mixed ourselves with the Low Countries is counted honourable; but, before we knew their lingering wars, was held in that highest degree of hatred that might be. Then, if we had seen a man go wallowing in the streets, or lain sleeping under the board, we should have spit at him, and warned all our friends out of his company." According to our laws intoxication is looked upon as an aggravation of any offence. Sir Edward Coke calls a drunkard _voluntarius dæmon_. The Romans thought differently: with them intoxication was often deemed an extenuation of guilt, "Per vinum delapsis capitalis poena remittitur." The Greeks, more severe, had a law of Pittacus that enacted the infliction of a double punishment on those who committed a crime when drunk. That hard drinking was introduced from Flanders and Holland, and other northern countries, seems probable from the derivation of many of the expressions used in carousing. The phrase of being "half-seas over," as applied to a state of drunkenness, originated from _op zee_, which in Dutch meant _over sea_; and Gifford informs us that it was a name given to a stupifying beer introduced in England from the Low Countries, and called _op zea_; thus Jonson in the Alchemist: I do not like the dulness of your eye; It hath a heavy cast, 'tis _up see Dutch_. An inebriating draught was also called an _up see freeze_, from the strong _Friesland_ beer. The word "carouse," according to Gifford and Blount, is derived from the name of a large glass, called by the Danes _ruuse_, or from the German words _gar_, _all_, and _ausz out_: hence drink _all out_. Nash, in the work above quoted, says, "Now he is nobody that cannot drink _super nagulum_, carouse the hunters' _hoope_, quaff _upsee freze crosse_, with healths, gloves, mumpes, frolickes, and a thousand such domineering inventions." The origin of these slang terms is not quite evident. Drinking _super nagulum_, or on the nail, was a northern custom which consisted in only leaving one drop in the cup, which was poured upon the thumb-nail, to prove that justice had been done to the potation or toast; and that, to use the language of modern drinkers, the glass was _cleared_. This custom is alluded to by Bishop Hall in his "Mundus alter et idem," in which the Duke of Tenderbelly exclaims, "'Let never this goodly-formed goblet of wine go jovially through me:' and then he set it to his mouth, stole it off every drop, save a little remainder, which he was by custom to set upon his thumb's nail and lick it off." In Fletcher we find the phrase I am thine _ad unguem_; which meant he was ready to drink with him to this extent. The term _hoop_ alludes to the marks of hoops being traced upon drinking-pots to point out certain measures. Jack Cade says, "The three-hooped pot shall have ten hoops, and I will make it felony to drink small beer!" Hence probably the common saying of "drinking deep," or to the last hoop. The _peg tankard_ was another measured vessel used in the jollifications of our forefathers, and is still to be found in some parts of England, more especially in Derbyshire. Pegge in his "Anonymiana," thus describes them: "They have in the inside a row of eight pins, one above the other, from top to bottom; the tankard holds two quarts, so that there is a gill of ale between each peg or pin. The first person who drank was to empty to the first peg, the second was to drink to the next, and so on; by which means the pegs were so many measures to the compotators, making them all drink alike or the same quantity." In Archbishop Anselm's Canons made in the council at London in 1102, priests are enjoined not to go to drinking-bouts, nor to _drink pegs_: "Ut presbyteri non eant ad potationes, nec ad _pinnas_ bibant." _Gloves_, also called _shoeing-horns_, were relishes to encourage drinking, like our modern _devils_, introduced for a similar purpose. Bishop Hall says in his description of a carousal, "Then comes me up a service of _shoeing-horns_ of all sorts,--salt cakes, red-herrings, anchovies, and gammon of bacon, and abundance of such _pullers on_." Massinger thus describes these incentives: I usher Such an unexpected dainty bit for breakfast As never yet I cooked; 'tis not _botargo_, Fried frogs, potatoes marrow'd, cavear, Carps' tongues, the pith of an English chine of beef, Nor our Italian delicate oil'd mushrooms, And yet a _drawer on too_; and if you show not An appetite, and a strong one, I'll not say To eat it, but devour it, without grace too, (For it will not stay a preface,) I am shamed, And all my past provocatives will be jeer'd at. The _botargo_ was a relish made of mullet's roes, and highly seasoned, much in use among the Italians. Amongst many other curious frolics of hard drinkers, we find the use of what they called _flap-dragons_, or _snap-dragon_, which consisted in igniting combustible substances, which were swallowed while floating on the glass of liquor. Johnson describes them "a play in which they catch raisins out of burning brandy, and, extinguishing them by closing the mouth, eat them." This prank is not uncommon to the present day in boarding-schools in certain festive entertainments of the _young ladies_. Drunkenness being considered a beastly propensity, its gradations were fixed by animal comparisons. In a curious treatise on drunkards by George Gascoigne, we find the following illustration of these degrees: "The first is _ape-drunk_, and he leaps and sings and hallos and danceth for the hearers; the second is _lion-drunk_, and he flings the pots about the house, calls the hostess w----, breaks the glass windows with his dagger, and is apt to quarrel with any man that speaks to him; the third is _swine-drunk_, heavy, lumpish, and sleepy, and cries for a little more drink and a few more clothes; the fourth is _sheep-drunk_, wise in his own conceit, when he cannot bring forth a right word; the fifth is _maudlin-drunk_, when a fellow will weep for kindness in the midst of his drink, and kiss you, saying, 'By G--! Captain, I love thee! Go thy ways; thou dost not think so often of me as I do of you; I would I could not love thee so well as I do!' and then he puts his finger in his eye and cries; the sixth is _martin-drunk_, when a man is drunk, and drinks himself sober ere he stir; the seventh is _goat-drunk_, when in drunkenness he hath no mind but in lechery; the eighth is _fox-drunk_, when he is crafty drunk, as many of the Dutchmen be, which will never bargain but when they are drunk. All these species, and more, I have seen practised _in one company at one sitting_." Drunkenness has at various periods been resorted to in religious and political fervour. Daring the usurpation of Cromwell, the Cavaliers were wont to drink their king's health in bumpers of wine in which some crumbs of bread had been thrown, exclaiming, "God send this _crum-well_ down!" and Whitelocke, in his Memorials, records the following barbarous Catilinian orgies: "Five drunkards agree to drink the king's health in their blood, and that each of them should cut out a piece of his buttock, and fry it upon the gridiron, which was done by four of them, of whom one did bleed so exceedingly that they were fain to send for a chirurgeon, and so were discovered. The wife of one of them, hearing that her husband was amongst them, came to the room, and, taking up a pair of tongs, laid about her, and so saved the cutting of her husband's flesh." The laws enacted to prevent drunkenness at various periods and by different governments, are curious. Domitian ordered all the vine-plants in the Roman territory to be rooted out. Charles IX. of France issued a similar edict. In 1536, under Francis I, a law was passed sentencing drunkards to imprisonment on bread and water for the first offence; a public whipping punished a second infringement; and, on reiteration, banishment and the loss of ears. The ancients, equally aware of the danger that arose from intoxication, were also anxious to prevent it. Draco inflicted capital punishments. Lycurgus destroyed the vineyards. The Athenians had officers, named _ophthalmos_, to prevent excesses in liquor drinking. In Rome, patricians were not allowed the use of wine until they had attained their thirty-fifth year. Wine was only drunk pure in the beginning of sober repasts in honour of _Deus Sospes_, and afterwards mixed with water in honour of _Jupiter Servator_. Notwithstanding these wise examples in support of prudent precepts, it appears that drunkenness was a common vice amongst the Romans. Tiberius was surnamed _Biberius_; and it was said of the parasite Bibulus, "dum vixit, aut bibit aut minxit." Aurelianus had officers of his household whose duty was to intoxicate foreign ambassadors; and Cato's partiality for the juice of the grape has been recorded by Horace, Narratur et prisci Catonis Sæpe mero caluisse virtus. In the middle ages, drinking was resorted to by the monks as a religious libation; and they also drank to the dead, a custom which was condemned as idolatrous. These excesses were restrained by various regulations, and in 817 the quantity of wine allowed each monk was fixed at five pints. Charlemagne, in his Capitularies, forbids the provocation of drinking healths and hob-nobbing (_pléger et trinquer_). Temperance societies are not modern institutions. In 1517, Sigismund de Dietrichstein established one under the auspices of St. Christopher; a similar association was formed in 1600 by Maurice Duke of Hesse, which, however, allowed a knight to drink seven _bocaux_, or glasses, at each meal, but only twice in the day. The size of these _bocaux_ is not recorded, but no doubt it was an endeavour to obtain a comparative condition of sobriety. Another temperate society, under the name of the Golden Ring, was instituted by Frederic V. Count Palatine. Whether the influence of temperate societies or their advocates will tend to diminish the consumption of wine and spirituous liquors in the British empire, it is difficult to say. Hitherto every act of interference, either from individuals or on the part of the legislature, has proved not only abortive, but has increased the evil it was intended to remedy. The imposition of heavy duties only threw the distillation of spirits into the hands of illicit speculators instead of respectable capitalists; and, as M'Culloch justly remarks, "superadded the atrocities of the smuggler to the idleness and dissipation of the drunkard." During the latter part of the reign of George I. and the earlier period of George II. gin-drinking was so prevalent, that it was denounced from the pulpit and the press. At length ministers determined to make a vigorous effort to put a stop to the further use of spirituous liquors except as a cordial or medicine. To accomplish this end, a duty of twenty shillings was laid on spirits, exclusive of a heavy licence duty to retailers, while a fine of 100_l._ was levied on all defaulters. But instead of the anticipated effects, this act produced results directly opposite: the respectable dealers withdrew from a trade proscribed by the legislature; and the sale of spirits fell into the hands of the lowest and most profligate characters. The officers of the revenue were hunted down by the populace, and did not dare to enforce the law; and Tindal, in his Continuation of Rapin, says, "within two years of the passing of this act, it had become so odious and contemptible, that policy as well as humanity forced the commissioners of excise to mitigate its penalties." During these two years twelve thousand persons were convicted of offences connected with the sale of spirits, while no exertion could check the torrent of smuggling, and seven millions of gallons illicitly distilled were annually consumed in London and its environs. Our present consumption of British, Colonial and Foreign spirits is immense, but not equal to what it was at the period alluded to. The following is the account of this consumption in 1832: In England, 1,530,988 imperial gallons, Foreign. 3,377,507 " Colonial. 7,259,287 " British. In Scotland, 69,236 gallons, Foreign. 112,026 " Colonial. 5,407,097 " British. In Ireland, 33,413 " Foreign. 24,432 " Colonial. 8,657,756 " British. In that year, 1832, the total amount of spirits that paid duty in the United Kingdom was 2,646,258 gallons, yielding a revenue of 8,483,247_l._ In the same year the appearance and dread of the cholera produced a singular increase in the consumption of brandy. In the preceding year, 1831, the entries for home use in England had amounted to 1,194,717 gallons; but during this state of alarm, it increased to 1,508,924; in 1833, the danger having subsided, the consumption declined to its former level, and did not exceed 1,356,620 gallons. From the above observations it may be inferred, that no penal enactments, no denunciations of canting senators or fanatic preachers, will ever succeed in checking the evils which must arise from excesses in the use of spirituous liquors. Gluttony and drunkenness can only be combated by the salutary effects of good example held out by the superior classes of society; by a gradual improvement in the moral education of the lower grades, for whom salutary amusements should be procured when a cheerful repose from their weekly labour will no longer be considered a breach of the sabbath. Diffusion of knowledge and habits of industry will do more than sanctimonious admonitions, and the Penny Magazines may be considered more hostile to gin-drinking than the ranting of pseudo-saints. In regard to the quantity that we should eat, no rules can be established, as individuals differ widely from each other, both as to their capacity and their inclination. Mr. Abernethy maintained, that it would be well if the public would follow the advice of Mr. Addison, given in the Spectator, of reading the writings of L. Cornaro, who, having a weak constitution, which he seemed to have ruined by intemperance, so that he was expected to die at the age of 32, did at that period adopt a strict regimen, allowing himself only 12 ounces daily. To this remark Dr. Paris very properly observes, "When I see the habits of Cornaro so incessantly introduced as an example for imitation, and as the standard of dietetic perfection, I am really inclined to ask with Feggio, 'Did God create Lewis Cornaro to be a rule for all mankind in what they were to eat and drink?'" In regard to the dyspeptic, Dr. Philips has given the very best advice in the following paragraph: "The dyspeptic should carefully attend to the first feeling of satiety. There is a moment when the relish given by the appetite ceases; a single mouthful taken after this oppresses a weak stomach. If he eats slowly and carefully attends to this feeling, he will never overload the stomach." To this Dr. Paris adds, "Let him remember to _eat slowly_." "This is an important condition--for when we eat too fast we introduce a greater quantity of food into the stomach than the gastric juice can at once combat with; the consequence of which is, that hunger may continue for some time after the stomach has received more than would be sufficient, under the circumstances, to induce satiety." The introduction of French cookery in every part of England amongst the wealthy will render attention to dietetic rules still more important than in former days; although Dean Swift, in his time, observed, "That modern epicurism had become so prevalent, that the world must be encompassed, before a washerwoman can sit down to breakfast." INFLUENCE OF IMAGINATION. Innumerable are the diseases that arise from our busy fancy. We are all subject to the tyrannic sway of imagination's empire. Under this mighty influence man displays energies which lead him boldly to dare danger and complicated sufferings, or he is reduced to the most degraded state of miserable despondency. These diseases are the more fearful, since they rarely yield to physical aid, and it is seldom that moral influence is sufficiently persuasive to combat their inveteracy. It is idle to tell the timid hypochondriac that he is not ill; the mere circumstance of his believing himself sick, constitutes a serious disorder. His constant apprehensions derange his functions until an organic affection arises. The patient who fancies that he labours under an affection of the heart disturbs the circulation, which is ever influenced by our moral emotions, till at last this disturbance occasions the very malady which he dreaded. These aberrations of the mind arise from various causes,--mental emotions, constitution, climate, diet, hereditary disposition, education. Tertullian called philosophy and medicine twin sisters; both may become powerful agents in controlling our imagination. The ancients have variously endeavoured to determine the seat of this faculty. Aristotle placed it in the heart, which, from the sense of its oppression observed in acute moral sufferings he considered the origin of our nerves, or sensorium. Avicenus and other philosophers located imagination in the anterior portion of the brain, which he called the _prow_; memory in the posterior part, which he denominated the _poop_, and judgment in the centre of the organ, or what mariners would term _mid-ship_. The notions of Gall and Spurzheim had long since been anticipated by philosophers and physicians, both in regard to the division of the cerebral organ, and the external appearance of the cranium, which denoted their preponderancy. That temperature exercises a powerful influence over our mental faculties is evident. In warm climates we find a greater exaltation of the mind, more enthusiasm and vivid emotion, than in northern latitudes. The East is the land of fancy, illustrated by their wondrous tales of fiction, and their vivid and fantastic imagery, displayed in the chimeras and the arabesques of their palaces and temples. In these regions all the passions are uncontrollable and wild. Love is characterized by furious or dark jealousy, according to the rank and power of the lover; and ambition is signalized by bloodthirsty and promiscuous barbarity. No opposition can be brooked: man is either a ferocious tyrant, or an abject slave; subjection alone preventing the oppressed from being as sanguinary as the oppressor. Government is despotism, and religion fatality and fanaticism. In northern climes, on the contrary, every thing is cold and calculating. The almighty passion of love may prevail; but its demonstrations are morose, concentrated, although not less ferocious than under a southern sky. In the one country, man seeks the dark shelter of the forest, and the solitude of the mountain, to ponder over his grievances, or soliloquise on his sufferings; in the other he courts the roseate bower and the orange grove, to lull him into a soft repose which may calm his feelings by temporary oblivion, to be roused again to action by the stimulus of opium, tobacco, and a burning sun. The ancients were so fully convinced of this influence of the amorphous constitution, that Lucianus tells us that the Abderites (a people so remarkable for their stupidity and sluggishness that _Abderitica mens_ was proverbial), having witnessed the performance of one of Euripides's plays under the fierce solar rays, became fired with such enthusiasm, that they ran about the streets in a wild phrensy, repeating aloud his sublime verses, until the coolness of the evening restored them to reason and to their native torpor. So predominant are these feelings, which owe their character to climate, that they regulate our ideas of a future state, as well as our conduct on earth. The paradise of the Mohammedan is a blessed region of everlasting pleasure and sensual enjoyments; beauteous houris await the soul, which is to luxuriate in corporeal voluptuousness; and the purple wine, forbidden to the living, is to flow in delectable streams, to delight the dead, who may, in the seventh paradise inhabit a land where rivers of wine, and milk, and honey, are ever flowing; where evergreen trees bend under luxurious fruits, whose very pips are transformed into lovely maidens, so sweet--to use their own metaphorical language--that the ocean would lose its bitterness if they did but condescend to spit in its briny waters; and all these enjoyments are secured to the true believer by hosts of guardian angels, who have seventy thousand mouths, and seventy thousand tongues, to praise God seventy thousand times each day in seventy thousand languages: and such is their horror of earthly heat, that in the other world one of the greatest rewards is the delight of being able to sleep under the cool shade of a tree each leaf of which is of such an expanse that a man might travel fifty thousand years under its benign protection. How different is the paradise of Odin! There, it is true, the soul of the departed dwells in magnificent palaces; but what are his enjoyments compared to those of the sensual Asiatic! Instead of soft music, the din of war is constantly to resound in his ear, while he luxuriates in drinking strong beer and hydromel, poured by the fair Valknas, the houris of the Vahalla paradise, into the skulls of his enemies. Their God is called the god of crows; and two of these sable familiars, _Hugin_, who represents the mind, and _Nunnin_, or memory, are constantly perched upon his shoulders, until they take flight to seek information for their master. To this day it is said that the Tartars fancy, that, in their future abode of bliss, their reward will be a sort of Platonic affection, and a perpetual and undisturbed state of meditation; in short, a celestial _far niente_. So convinced were the ancients of this effect of peculiar temperature, that the morose Heraclitus maintained that the power of the mind arose from a _dry splendour_; that all things were created by solar heat; and when ill himself, he sought health by endeavouring to dispel watery accumulations by the heat of a dunghill. Ptolemy and Posidonius assert, that southern climes engender genius and wit, and are better calculated for the study of things divine; and Plato, Hippocrates, and Galen, on the same principle, affirm that stupidity and forgetfulness are produced by cold and humidity. The celebrated Descartes, in his younger days, states that he felt his enthusiasm moderated by the damps and cold of Holland; and that he ever experienced more facility in pursuing his philosophic studies in winter than in summer. Poets, on the contrary, court the glowing rays of an inspiring sun, and their Phoebus and their Apollo is the conductor and the inspirer of the Muses: Cynthius aurem vellit et admonuit. That the energies of our intellectual faculties are under the influence of our food, is a fact long since observed. The stupidity of the athletæ, who lived upon coarse bread (coliphium) and underdone meat, was proverbial; even Hercules laboured under the imputation of a mind somewhat obtuse. Our genius, our energies are all affected by our mode of living. The rule of _Sanis omnia sana_, of Celsus, is applicable to very few individuals; and all our faculties may be rendered more keen or less vivid by temperance or excesses. As the nature of our _ingesta_ influences the functions of our digestive organs, so do these organs in their turn influence our moral powers when our physical energies are elevated or depressed. Our courage, our strength of mind, our religious and our moral train of thinking, are under the control of diet. Fasting has ever been considered as predisposing to meditation and ascetic contemplation. Tertullian tells us, that we should approach the altars fasting, or having eaten nothing but dry substances. All the religious ceremonies of the Egyptians were preceded by abstinence, and their sacrificators were allowed neither animal food nor wine. Indeed, the Egyptian priesthood were remarkable for their abstinence and self-denial, fearful, according to Plutarch, that "the body should not sit light upon the soul." Similar precautions were observed with animals, and the ox apis was not allowed to drink the waters of the Nile, as they were considered of a gross and fattening nature; even upon festive days they observed a similar moderation. It was customary, on the 9th day of the month Thoth, for every one to eat fried fish at their doors--the priests only conformed to the custom by burning theirs at the appointed time. In general they abstained from most sorts of pulse, especially beans and lentils, onions, garlic, leeks, mutton, pork; and on certain days of purification, even salt was forbidden. Many of their fasts lasted from seven to forty-two days, during which time they abstained entirely from animal food, from herbs and vegetables, and the indulgence of any passion. Similar privations were observed by all those who attended the mysteries of Juno and Ceres. In Holy Writ we find that it was after abstinence that Divine inspiration illumined the elect. The angel appeared unto Daniel after he had been three weeks without tasting flesh, or wine, or "pleasant bread." In the Acts, x., we find that the vision appeared to Peter, "when he had become hungry and would have eaten." Moses fasted forty days on Mount Sinai. We find in Jonah, that even cattle were frequently subject to this mortification, when he proclaimed in Nineveh that neither man nor beast, herd nor flock, should taste any thing; "let them not feed nor drink water." Congius Ripensis tells us, that the same restriction was imposed by the Lacedæmonians on their Helots and all domestic animals. Fasting was considered by the early Christians as an essential rite. St. Anthony prescribed to his disciples one meal of dry bread, salt and water, in the day without any food on Wednesdays and Fridays. In the monastery of Mocham, in Egypt, a monk of the name of Jonas was beatified for having lived until the age of eighty-five, working hard in the garden, and without any other food than raw herbs and grass steeped in vinegar; this abstemious cenobite added to his claims to canonization by always sleeping in his chair. St. Hilarius only ate fifteen figs and six ounces of barley bread _per diem_. St. Julian Sabus retired to a cavern, where he only luxuriated once in the week on millet-bread, with salt and water; and St. Macarius resolved to outdo him by restraining his sustenance to a few cabbage-leaves every Sunday. Not only did these gastric martyrs attribute their holy visions to abstinence, but they considered it as the source of their longevity. Thus, St. Anthony lived to the age of one hundred and five; St. Paphinus to ninety on dry bread; and St. Paul the Hermit thrived for one hundred and fifty-nine years upon dates. It is not derogatory to their supposed divine mission to say that all these men were as enthusiastic as the fakirs of the east. So acceptable to the Deity was starvation considered, that at various periods it was enforced by penal laws. Charlemagne denounces the punishment of death on all those who transgressed in this respect; and, by an old Polish edict, any sinner who ate on a fast-day was sentenced to have all his teeth drawn. However, monkish ingenuity endeavoured to elude these severe enactments, by interpreting the letter instead of the spirit; and we find, in the regulations of a German monastery, the following accommodation, "_Liquidum non frangit jejunium_," by which, on days of penance, the monks only took rich soups and succulent broth. In latter days, being permitted to eat fish in Lent, they saw no reason why fowl should not be included, on the authority of Genesis, that the waters brought forth every winged fowl after his kind. This relaxation in culinary discipline called forth loud indignation from many prelates. St. Ambrosius attributes the profligacy of the monks to these excesses; and Tertullian considers the fall of the Israelites as the punishment of their neglect in this respect. Our Shakspeare illustrates this belief in the influence of fasting as preparatory to inspiration. Last night the very gods shew'd me a vision-- I _fast_ and pray'd for their intelligence. Not satisfied with this mystification in food, we find some austere monks endeavouring to reduce carnal appetites by other means, such as by blood-letting, _monialem minuere_; and claustral flesh was brought down by phlebotomy and purging at regular periods. To this day we find that well-behaved Turks, during the Ramasan, make it a godly point never to swallow their saliva. This digression on fasting was somewhat necessary, to show how much our diet tends to modify our being. It is well known that troops will display more activity and courage when fasting than after a meal; and an ingenious physician of our day is perfectly correct when he attributes a daring spirit or a pusillanimous feeling to the influence of our stomach. Intellectual weakness, frequently brought on by excesses, has proved a rich source to empiricism; hence the belief in mystic and supernatural agencies, and the power of certain nostrums. Coloured fountain water and bread pills have made the fortune of various quacks, when imaginary cures have relieved imaginary diseases. In our days, numerous have been the recoveries attributed to Hohenloe's prayers. Trusting to mystic numbers, three, five, seven, or nine pills have produced effects, when other numbers less fortunate would have failed. To this hour mankind, even in enlightened nations, are fettered by these absurd trammels. Credulity, and superstition her twin sister, have in all ages been the source whence priestcraft, and quackery have derived their wealth. Next to these rich mines we may rank fashion. The adoption of any particular medicine by princes and nobles will endow it with as great a power as that which was supposed to be vested in regal hands in the cure of scrofula, hence called _king's evil_; and we have too many instances of such cures having been effected by a monarch's touch to doubt the fact. The history of the potato is a strong illustration of the influence of authority: for more than two centuries the use of this invaluable plant was vehemently opposed; at last, Louis XV. wore a bunch of its flowers in the midst of his courtiers, and the consumption of the root became universal in France. The warm bath, so highly valued by the Romans, once fell into disrepute, because the Emperor Augustus had been cured by a cold one, which for a time was invariably resorted to. Thus Horace exclaims, ----Caput ac stomachum supponere fontibus audent Clusinis, Gabiosque petunt et frigida rura. Unfortunately, the means which had relieved Augustus killed his nephew Marcellus; and the _Laconicum_ and the _Tepidarium_ were again crowded with the "fashion." Persecution and its prohibitions have also been most powerful in working upon our imagination. Rare and forbidden fruits will always be considered more desirable than those we can easily obtain. The history of tobacco is a striking instance of this influence of difficulty upon the mind of man. Pope Urban VIII. prohibited its use in any shape, under the penalty of excommunication. It was afterwards forbidden in Russia, under the pain of having the offender's nose cut off. In some cantons of Switzerland the prohibition was introduced in the decalogue, next to the commandment against adultery. Amurath IV. ordered all persons taken in _flagranti delicto_ smoking tobacco, to be impaled, on the principle that its use checked the progress of population. The denunciation of our James I. may be considered as a masterpiece of the imaginary horrors attributed to this obnoxious weed. "It is," he says, "a custome loathsome to the eye, hatefull to the nose, harmefull to the braine, dangerous to the lungs, and in the black stinking fume thereof neerest resembling the horrible Stygian smoake of the pit that is bottomlesse." During the reign of this monarch such a restriction might have been necessary, unless the consumption of tobacco enriched the exchequer: for it appears that some _amateurs_ consumed no less than £500 per annum in smoke. Surely we should reap some flourishing revenue from fashion and credulity, when we find our government awarding £5000 to a _certain_ Johanna Stephens for her discovery of _certain_ medicines for the cure of _calculi_! The same imaginary hope induced many a credulous creature to minister to the necessities of another Johanna, for _certain_ expectations. Alas! how this indefinite _sense_ exhibits the infinite folly of poor humanity! A morbid imagination, although frequently the source of much misery, will prove in many cases the fountain-head of many noble qualities; its exaltation constitutes genius, which is, in fact, a natural disposition of individual organization sometimes bordering upon insanity. "_Non est magnum ingenium sine mixturâ dementiæ_," says Seneca; and Montaigne observes, "De quoi se fait la plus subtile folie que de la plus subtile sagesse? il n'y a qu'un demi-tour à passer de l'une à l'autre." Aristotle asserts that all the great men of his time were melancholy and hypochondriac. The ancient and eastern nations entertained a singular idea regarding men of innate genius, and possessed of more than common attributes; they fancied that they were the first-born, and the offsprings of illicit love: Zoroaster, Confucius, Mahomet, Vishnou, were born of virgins; and Theseus, Hercules, Castor and Pollux, and Romulus, were all illegitimate. So prone is a lively imagination to a derangement of the intellectual harmony, that the greatest care should be taken during the youthful development to resort to a sound and proper exercise. The constant tendency to wild and supernatural visions, the disregard of every daily and vulgar matter of fact consideration, soaring in regions of fiction, should engage our incessant vigilance, such a state of mind, as Abercrombie justly observes, "tends in a most material manner to prevent the due exercise of those nobler powers which are directed towards the cultivation both of science and of virtue," and Foster has thus beautifully illustrated this subject in his essays. "The influence of this habit of dwelling on the beautiful fallacious forms of imagination, will accompany the mind into the most serious speculations or rather musings, on the real world, and what is to be done in it and expected; as the image which the eye acquires from looking at any dazzling object, still appears before it wherever it turns. The vulgar materials, that constitute the actual economy of the world, will rise up to its sight in fictitious forms, which it cannot disenchant into plain reality, nor will ever suspect to be deceptive. It cannot go about with sober, rational inspection and ascertain the nature and value of all things around it--in that paradise it walks delighted, till some imperious circumstance of real life call it thence, and gladly escapes thither again when the avocation is past. If a tenth part of the felicities that have been enjoyed, the great actions that have been performed, the beneficial institutions that have been established, and the beautiful objects that have been seen in that happy region, could have been imported into this terrestial place!--what a delightful thing the world would have been to awake each morning to see such a world once more!" Of the miseries the hypochondriacs experience the following extract of a letter to a physician will afford a specimen: "My poor body is a burning furnace, my nerves red-hot coals, my blood is boiling oil; all sleep has fled, and I am suffering martyrdom. I am in agony when I lie on my back; I cannot lie on either side; and I endure excruciating torture when I seek relief by lying on my stomach; and, to add to my misery, I can neither sit, stand, nor walk." The fancies of hypochondriacs are frequently of the most extraordinary nature: one patient imagines that he is in such a state of obesity as to prevent his passing through the door of his chamber or his house; another impressed with the idea that he is made of glass, will not sit down for fear of cracking; a third seems convinced that his head is empty; and an intelligent American, holding a high judicial seat in our West Indian colonies, could not divest himself of the occasional conviction of his being transformed into a turtle. The most melancholy record of the miseries of hypochondriacism is to be found in the diary of Dr. Walderstein of Gottingen. He was a man much deformed in person, and his mind seemed as distorted as his body. Although of deep learning and research, and convinced of the absurdity of his impressions, yet he was unable to resist their baneful influence. "My misfortune," says the doctor, "is, that I never exist in this world, but rather in possible combinations created by my imagination to my conscience. They occupy a large portion of my time, and my reason has not the power to banish them. My malady, in fact, is the faculty of extracting poison from every circumstance in life; so much so that I often felt the most wretched being because I had not been able to sneeze three times together. One night when I was in bed I felt a sudden fear of fire, and gradually became as much oppressed by imaginary heat as though my room were in flames. While in this situation, a fire-bell in the neighbourhood sounded, and added to my intense sufferings. I do not blush at what might be called my superstition any more than I should blush in acknowledging that my senses inform me that the earth does not move. My error forms the _body_ of my judgment, and I thank God that he has given it a _soul_ capable of correcting it. When I have been perfectly free from pain, as is not unfrequently the case when I am in bed, my sense of this happiness has brought tears of gratitude in my eyes. I once dreamt," adds Walderstein, "that I was condemned to be burnt alive. I was very calm, and reasoned coolly during the execution of my sentence. 'Now,' I said to myself, 'I am burning, but not yet burnt; and by-and-by I shall be reduced to a cinder.' This was all I thought, and I did nothing but think. When, upon awaking, I reflected upon my dream, I was by no means pleased with it, for I was afraid I should become _all thought and no feeling_." It is strange that this fear of thought, assuming a corporeal form in deep affliction, had occurred to our poet Rowe, when he exclaims in the Fair Penitent, "_Turn not to thought my brain_." "What is very distressing," continues the unfortunate narrator, "is, that when I am ill I can think nothing, feel nothing, without bringing it home to myself. It seems to me that the whole world is a mere machine, expressly formed to make me feel my sufferings in every possible manner." What a fearful avowal from a reflecting and intelligent man! Does it not illustrate Rousseau's definition of reason--_the knowledge of our folly_. Dr. Rush mentions a man who imagined that he had a Caffre in his stomach who had got into it at the Cape of Good Hope, and tormented him ever since. Pinel relates the case of an unfortunate man who believed that he had been guillotined, but his innocence having been made complete after his execution, his judges decided that his head should be restored to him, but the person intrusted with this operation had made a mistake, and put on a wrong head. Dr. Conolly knew a man who really believed that he had been hanged, but had been brought to life by galvanism, but he maintained that this operation had not restored the whole of his vitality. Jacobi relates the case of a man confined in the lunatic asylum at Wurtzburg, in other respects rational, of quiet, discreet habits, so that he was employed in the domestic business of the house, but who laboured under the impression that there was a person concealed in his stomach, with whom he held frequent conversations. He often perceived the absurdity of this idea, and grieved in acknowledging and reflecting that he was under the influence of so groundless a persuasion, but he never could get rid of it. "It was very curious to observe," adds our intelligent author, "how, when he had but an instant before cried what nonsense!--is it not intolerable to be thus deluded? and while the tears which accompanied these exclamations were yet in his eyes, he again began to talk, apparently with entire conviction about the person in his belly who told him that he was to marry a great princess. An attempt was made to cure him, by putting a large blister on his abdomen, and the instant that it was dressed, moving from behind him a dressed-up figure, as if just extracted from his body. The experiment so far succeeded that the patient believed in the performance, and his joy was at first boundless in the full persuasion that he was cured; but some morbid feeling about the bowels, which he had associated with the insane impression, still continuing, or being again experienced, he took up the idea that another person similar to the first was still left within him, and under that persuasion he still continues to labour." A nobleman of the court of Louis XIV., fancied himself a dog, and would invariably put his head out of window to bark aloud. Don Calmet relates the case of some nuns in a convent in Germany, who imagined that they were transformed into cats, and wandered about the building loudly mewing and spitting at and scratching each other. One of the strangest aberrations of a disordered state of mind was exhibited by some impudent fellows who fancied themselves virtuous and modest females. Esquirol relates the case of a young man of 26 years of age, handsome and of a good figure, who had been in the habit of occasionally putting on woman's attire to perform female parts in private theatricals, and who had actually fancied himself a woman. In his paryoxysms he would put off his male clothes, and equip himself like a nymph,--the greater part of his day was spent before his looking-glass, decorating his person and dressing his hair--he was incurable! ANCIENT IDEAS OF PHRENOLOGY. Although Gall and Spurzheim may fairly claim the merit of having developed in this science the particular parts of the brain that are the seat of different faculties, yet we find in various ancient writers similar notions. Burton, in his Anatomy of Melancholy, thus expresses himself on this subject: "_Inner senses_ are three in number, so called because they are in the brain-pan; as _common sense_, _phantasie_, _memory_. This common sense is the judge or moderator of the rest, by whom we discern all differences of objects; _the fore part of the brain_ is his organ or seat. _Phantasie_, or imagination, which some call æstimative, or cogitative, (confirmed saith, Fernelius, by frequent meditation,) is an inner sense, which doth more fully examine the species perceived by _common sense_, of things present or absent, and keeps them longer, recalling them to mind again, or making new of his own: his organ is the _middle cell of the brain_. _Memory_ layes up all the species which the senses have brought in, and records them as a good register, that they may be forthcoming when they are called for by _phantasie_ and _reason_; his organ is the _back part of the brain_." This corresponds with the account of the faculties given by Aristotle, and repeated by the writers of the middle ages. Albertus Magnus, Bishop of Ratisbon, designed a head divided into regions according to these opinions in the thirteenth century; and a similar plan was published by Petrus Montaguana in 1491. Ludovico Dolce published another engraving on the subject at Venice in 1562. In the British Museum is a chart of the universe and the elements of all sciences, and in which a large head of this description is delineated. It was published at Rome in 1632. In the _Tesoretto_ of Brunetto Latini, the preceptor of Dante, we find this doctrine taught in the following lines: Nel capo son tre celle, Ed io dirò di quelle, _Davanti_ è lo intelletto E la forza d'apprendere Quello que puote intendere; _In mezzo_ è la ragione E la discrezione, Che scherne buono e male; E lo terno e l'iguale _Dirietro_ sta con gloria La valente memoria, Che ricorda e retiene Quello ch'in essa viene. PERFUMES. At all periods perfumes seem to have been more or less adopted as a luxury among the wealthy and fashionable. Tradition states that they were frequently rendered instrumental to sinister purposes, as the vehicle of poisonous substances. Historians relate that the Emperor Henri VI. and a prince of Savoy, were destroyed with perfumed gloves. Jeanne d'Albret, Queen of Navarre, and mother of Henri IV., died from the poisonous effect of gloves purchased from the noted René, perfumer and confidential agent of Catherine de Medicis. Lancelot, King of Naples, was destroyed by a scented handkerchief prepared by a Florentine lady. Pope Clement VII. sunk under the baneful effluvia of a torch that was carried before him; and Mathioli relates, that nosegays thus impregnated have been frequently known to prove fatal. It is certain that, without the aid of venenous substances, various flowers have caused serious accidents. Barton tells us that the _magnolia glauca_ occasioned a paroxysm of fever, and increased the severity of an attack of gout. Jacquin had seen the _lobelia longiflora_ producing a sense of suffocation; and the _nerium oleander_ in a close chamber, has caused death. The injurious effects of bulbous flowers in giving rise to violent headachs, giddiness, and even fainting, are generally known. The horror roses inspire to the Roman ladies is scarcely credible; and Cromer affirms that it was to the odour of that ornament of our gardens that the death of one of the daughters of Nicolas I., Count of Salm, and of a Polish bishop, was attributed. The sympathetic effect that this flower can create is illustrated by Capellini, who saw a lady fall into a syncope on perceiving a rose in a girl's bosom, although it turned out to be an artificial one. The partiality or antipathy to certain odours is equally unaccountable, for the Italian ladies, who dread the rose, delight in the disgusting aroma of rue, which they carry about as a salubrious plant, that, according to their notions, dispels the _cattiva aria_, although it is not impossible that they might fancy it possessed of those salutary qualities to which Ovid had alluded: Utilius summas acuentes lumina rutas, Et quidquid veneri corpora nostra negat. Rue, according to Serenus Samonicus, was one of the ingredients of the fabled antidote of Mithridates, which he thus describes: Antidotus verò multis Mithridatica fertur Consociata modis, sed magnus Scrinia regis Cùm raperit victor, vilem deprendit in illis Synthesim, et vulgata satis medicamina risit. Bis denum _Rutæ_ folium, salis et breve granum, Juglandesque duas, totidem cum corpore ficus; Hæc oriente die, parco conspersa Lycæo, Sumebat, metuens dederat quæ pocula mater. The ancients were so fond of perfumes, that they scented their persons and garments, their vases, their domestic vessels, and their military insignia. They not only considered aromatic emanations as acceptable to the gods, and therefore used them in their temples, as they are at present by the Roman Catholics, but as announcing the presence of their divinities; and Virgil thus speaks of Venus: --------Avertens roseâ cervice refulsit, Ambrosiæque comæ divinum vertice odorem Spiravêre. Chaplets of roses were invariably worn in festivals and ceremonies; and wines were also aromatised with various odoriferous substances. The Franks and the Gauls continued the same custom; and Gregory of Tours called these artificial-flavoured liquors, _Vina odoramentis immixta_. To this day, the manipulation of French wines gives them a fictitious _bouquet_, with raspberries, orris-root, and divers drugs to suit the British market. No external sense is so intimately connected with the internal senses as that of smell; none so powerful in exciting and removing syncope, or more capable of receiving delicate and delicious impressions: hence Rousseau has denominated this faculty "_the sense of imagination_." No sensations can be remembered in so lively a manner as those which are recalled by peculiar odours, which are frequently known to act in a most energetic measure upon our physical and moral propensities. How many perfumes excite a lively feeling of fond regret when reminding us of the beloved one who was wont to select them, and whom we long to meet again! It is not improbable that our partiality to the hair of those who are dear to us, arises from this circumstance. Every individual emits a peculiar odour; and, according to Plutarch, Alexander was distinguished by the sweet aroma that he shed. Perhaps the expression, so frequently found in the lives of the saints, "who die in odour of sanctity," may be referred to a belief that this peculiar gift was granted to beatitude. It has been observed, that animals who possess the most acute smell, have the nasal organs the most extensively developed. The Ethiopians and the American Indians are remarkable for the acuteness of this sense, accounting for the wonderful power of tracking their enemies. But although we may take the peculiar organization of their olfactory organs as being partly the cause of this keen perceptibility, we must in a great measure attribute this perfection to their mode of living. Hunting and war are their chief pursuits, to which they are trained from their earliest infancy: therefore this perfection may, to a certain extent, be the result of habit; and the sight and hearing of these wanderers are as singularly perfect as their smelling. Mr. Savage relates, that a New Zealander heard the report of a distant gun at sea, or perceived a strange sail, when no other man on board could discern it. Pallas, in speaking of the Calmucks, says that many of them can distinguish by smelling at the hole of a fox whether the animal be there or not; and on their journeys and military expeditions they often smell out a fire or a camp, and thus seek quarters for the night or booty. Olaüs Borrich informs us, that the guides between Smyrna, Aleppo, and Babylon, when traversing the desert, ascertain distances by the smell of the sand. That odours float in the atmospheric air is obvious; the distance at which they are perceived is incredible. The spicy breezes of Ceylon are distinguished long before the island is seen; and it is a well-known fact that vessels have been saved by the olfactory acuteness of dogs, who, to use the common expression, were observed to "sniff" the land that had not been descried. As a proof of the intimate connexion between smell and respiration, when the breath is held odorous substances are not perceived, and it is only after expiration that they are again recognised. A proof of this may be easily obtained by placing the open neck of a small phial containing an essential oil in the mouth during the acts of inspiration and subsequent expiration. Willis was the first who observed that, on placing a sapid substance in the mouth, and at the same time closing the nostrils, the sensation of taste is suspended; and this observation has given rise to the prevailing opinion that smelling and tasting are intimately related. Odour which thus accompanies taste is termed flavour; and the ingenious Dr. Prout has admirably defined the distinction between taste and flavour, and he considers the latter an intermediate sensation between taste and smell. The acuteness of the sensation of smelling in animals is such, that in many instances our observations have been deemed fabulous. The distance at which a dog tracks his master is scarcely credible; and it is strange that the ancients attributed a similar perfection to the goose. Ælian affirms that the philosopher Lycadeus had one of these birds that found him out like a dog: Humanum longè præsentit odorem Romulidarum acris servator, candidus anser. Birds of prey will scent the battle-field at prodigious distances, and they are often seen hovering instinctively over the ground where the conflict is to supply their festival. Humboldt relates, that in Peru, at Quito, and in the province of Popayan, when sportsmen wish to obtain that species of vulture called _vultur gryphus_, they kill a cow or a horse, and in a short time these sagacious birds crowd to glut their ravenous appetites. Ancient historians assert that vultures have cleft the air one hundred and sixty-six leagues to arrive in time to feast upon a battle; and Pliny boldly affirms that even crows have so acute a sense of approaching corruption, that they can scent death three days before dissolution, and generally pay the _moribond_ a visit a day before his time, not to be disappointed. This notion has become a vulgar prejudice, as much so, indeed, as the howling of a dog, which is considered in most countries as foreboding death. In various animals an offensive odour is a protective gift. The _staphylinus olens_, for instance, sheds an effluvium which effectually keeps away the birds who would otherwise pounce upon him. But of all singular perfections in the sense of smelling that were ever recorded, may be cited the monk of Prague and the blind man in the Quinze-vingt Hospital of Paris, who possessed the faculty of ascertaining the presence of virginity whenever a female had the luck of being introduced to them. Many curious instances are recorded, where the loss of one sense has added to the acuteness of others. Dr. Moyse the well-known blind philosopher, could distinguish a black dress on his friends by the smell. Professor Upham of the United States, mentions a blind girl who could select her own articles out of a basket of linen brought in by the laundress. These anomalous senses, for such they may be called, are as wonderful as they are inexplicable, and appear to arise from a peculiar sensibility of the organs of smell, which renders them capable of being stimulated in a peculiar manner, that no language can express or define. It is scent, no doubt, that gives the migratory power to various animals; "which enables them," to use the words of Dr. Mason Good, "to steer from climate to climate, and from coast to coast; and which, if possessed by man, might perhaps render superfluous the use of the magnet, and considerably infringe upon the science of logarithms? Whence comes it that the fieldfare and red-wing, that pass the summer in Norway, or the wild-duck and merganser, that in like manner summer in the woods and lakes of Lapland, are able to track the pathless void of the atmosphere with the utmost nicety, and arrive on our own coasts uniformly in the beginning of October."[11] This sense is not limited to migratory animals, as instanced by carrier-pigeons, who have been known not only to carry bags in a straight line from city to city, but traverse the city with an undeviating flight. Surely this faculty must be attributed to the sense of smell; it can scarcely be referred to sight or hearing; although the wonders of the creation are such, that we can no more account for these peculiar attributes refused to the lords of the creation, than for the power of the lobster, who not only can reproduce his claws when deprived of them by accident, but cast them off to extricate himself, from the captor's grasp. The _Tipula pectiniformis_, or the daddy long-legs of our infant amusement and amazement, possesses the same renovating faculties. The gluttonous gad-fly may be cut to pieces without any apparent interruption in his meal, when fastened to one's hand: the polype does not seem to be at all discomposed when we turn him inside out; and, when divided into various sections, each portion is endowed with an instinctive and reformative power of multiplying his species in countless numbers! The diversity of our olfactory fancies is unaccountable and only illustrates the words of Petronius, Non omnibus unum est quod placet; hic spinas, colligit ille rosas. LOVE PHILTERS AND POTIONS. It will scarcely be credited, but to this very day the superstitious belief in the power that certain medicinal substances possess of causing a sympathetic fondness, still obtains, even amongst classes of the community whose education one would imagine ought to have rendered such an absurdity revolting. In Italy, Spain, and Portugal, the influence of love powders and aphrodisiac drugs is universally confided in. The ancients thought that there existed, not only various charms to kindle amorous feelings, but also to check all fond desires. The latter influence they considered as _malefices_, vulgarly called in more modern times, "point tying." Plato, in his Republic, warns husbands to be on their guard lest their domestic peace might be disturbed by these diabolical practices. Lovers, separated from each other's embrace by these nefarious enchantments, were said to be tied down. Thus Virgil, Dic, Veneris vincula necto: Terna tibi hæc primum triplici diversa colore Licia circumdo. No power could release one from these bonds: Quis neget et magicas nervos torpere per artes? By the laws of the twelve tables such enchantments were punished with death; and Numantina, wife of Plautius Sylvanus, was accused, Injecisse carminibus et veneficiis vecordiam marito. When Faustina, the gay bride of Marc Antonius was rapturously enamoured with an histrionic favourite, she was only cured of her folly by a potion in which some of the comedian's blood had been introduced. Petrarch relates of Charlemagne, that this monarch was so fondly attached to a fair lady, that after her death he carried about her embalmed body in a superb coffin, until a venerable and learned bishop, who very wisely thought that a living beauty was preferable to the remains of a departed one, rebuked his sovereign for his irreligious and unnatural propensities, and revealed to him the important secret of his love arising from a charm that lay under the dead woman's tongue. Whereupon the bishop went to the corpse, and drew from it a ring, which the emperor had scarcely looked upon when he abhorred the former object of his attachment, and felt such an extraordinary fancy for the bishop that he could not dispense with his presence for a single moment, until the good prelate was so obseded with royal favour that he cast the ring into a lake. From that moment Charlemagne (his historian continues) "neglected all public business, and went to live in the middle of a fen in the vicinity of Aix, where he built a temple, near which he was finally buried." St. Jerome, in the Life of Hilarius, mentions a young man who so bephiltered a maiden that she fell desperately in love with him; and Sigismundus Schereczius, in his chapter _De Hirco Nocturno_, affirms that "unchaste women, by the help of these witches, the devil's kitchen-maids, have their lovers brought to them during the night, and carried back again, by a phantom flying in the air in the likeness of a goat." "I have heard," he adds, "divers confess that they have been so carried on a goat's back to their sweethearts many miles in a night." These wonderful potions were made of strange ingredients, for amongst them we find a man's blood chemically prepared, mandrake roots, dead men's clothes, candles, a certain hair in a wolf's tail, a swallow's heart, dust of a dove's heart, tongues of vipers, brains of a jackass, pebbles found in an eagle's nest, together with "_palliola quibus infantes obvoluti nascuntur_, _funis strangulati hominis_," &c. &c. &c. Cleghorn, in his History of Minorca, tells us that water in which a hedgehog has been allowed to run into corruption, was supposed to be possessed of similar exciting powers; and a pulverized bit of a caul, scrapings of nails, and chopped hair, are to this hour deemed equally effectual to obtain these desirable ends. Notwithstanding all these absurdities, it is undoubtedly true that certain articles of food have been considered as endowed with aphrodisiac properties; fish of various kinds, the mollusca and testaceous animals more especially. Juvenal attributes this quality to oysters, which, in this respect, with cockles and muscles have become vulgarly proverbial: Grandia quæ mediis jam noctibus ostrea mordet. Wallich informs us that the ladies of his time had recourse on such occasions to the brains of the _mustela piscis_. The _sepia octopus_ was also in great repute; and Plautus, in his _Casina_, brings on an old man who had just been purchasing some in the market. There is reason to believe that these ideas were not altogether as absurd as they may appear. Fourcroy and Vauquelin have attributed this influence to the presence of phosphorus, which is well known to be highly exciting. In the East, various vegetable productions are considered in the same light. Their _hakims_ have numerous receipts for the purpose; amongst which we find several electuaries,--such as the _diacyminum_, the _diaxylaloes_, the confections of _Luffa Abunafa_, and the _chaschab abusidan_ of the Arabians, of which wonderful effects are related. The laws of every country have provided against the offence of witchcraft, sorcery, conjuration, and enchantment. We find a statute of our first James, making it "felony, without benefit of the clergy, under the penalty of death, the act of all persons invoking any evil spirit, or consulting, covenanting with, entertaining, employing, feeding, or rewarding any evil spirits; or taking up dead bodies from their graves, to be used in any witchcraft, sorcery, charm, or enchantment; or killing or otherwise hurting, any person by such infernal arts. And if any person should attempt by sorcery to discover hidden treasures, or to restore stolen goods, or to _provoke unlawful love_, (lawful love did not come within these salutary provisions,) he or she should suffer imprisonment and pillory for the first offence, and death for the second." Strange to say, that act continued in force till very lately; and Blackstone observes, "that many poor wretches were sacrificed thereby to the prejudice of their neighbours, and their own illusions; not a few having, by some means or other, confessed the fact at the gallows." Nothing could be more absurd, nay atrocious, than the means judicially resorted to at that period to detect witchcraft. Sir Robert Filmer mentions two tests by fire: the first by burning the house of the pretended witch: the other, by burning any animal supposed to have been bewitched by her. In both these cases the witch would confess her _malefices_! Moreover, it was asserted that a witch, even while enduring the pangs of torture, could only shed _three tears_, and those from the _left eye_; this was considered a sufficient proof of guilt by the judges of the day! Swimming a witch was another expedient; in this ordeal the hag was stripped naked, and cross-bound, the right thumb to the left toe, and _vice versâ_. Thus prepared, she was thrown into a pond or a river; in which, if guilty, she could not sink, for having by her compact with the Devil renounced the waters of baptism, the waters in return refused to receive her in their bosom. Our wise legislators maintained that old women were generally selected by the evil ones for their malicious purposes, and they usually appeared to them in the form of a man wearing a black coat or gown; and sometimes, especially in the north, with a bluish band and turned-up linen cuffs: hard bargains were sometimes driven between the parties for the value of the harridan's soul. This was also the case according to Echard, in the negotiation between Oliver Cromwell and the Devil before the battle of Worcester. There were black, white, and gray witches: some of them fond of junketing and merry-making, and often would Satan play on a pipe or a cittern to make them dance; and not unfrequently would he become enamoured with their withered charms, when toads and horrible serpents were the hated progeny of this unhallowed union. Sinclair tells us, in his "Invisible World," of one Mr. Barton, who was burnt with his wife for witchcraft, and who confessed, before he was tied to the stake, that he had intrigued with the Devil in the shape of a comely lady, who had given him 15_l._ for his trouble. His wife confessed at the same time, that the Devil in the shape of a poodle dog used to dance before her, playing upon the pipes with a candle under his tail. The Devil, particularly in Scotland would ever and anon get up into a pulpit, and preach a sermon in a voice "_hough_ and _gustie_." Burton gives us some curious traditions of these devilish amours, and quotes Philostratus's account of one Menippus Lycius, a young man twenty-five years of age, who going between Cenchreas and Corinth, met a phantom in the shape of a fair gentlewoman, which, taking him by the hand, carried him to her house in the suburbs of Corinth; and told him she was a Phoenician by birth, and, if he would tarry with her he should hear her sing and play, and drink such wine as never was drunk, and no man should molest him, but she, being fair and lovely, would live and die with him. The young man tarried with her awhile to his great content, and at last married her; to whose wedding, amongst other guests, came Apollonius; who by some probable conjecture, found her out to be a serpent--a lamia. When she saw herself discovered, she wept, and desired Apollonius to be silent; but he would not be moved, and thereupon she, plate, house, and all that was in it vanished in an instant. Florigerus also mentions the case of a young gentleman of Rome, "who on his wedding day went out walking with his bride and some friends after dinner; and towards the evening went to a tennis-court, and while he played he took off his ring, and placed it upon the finger of a brass _Venus statua_. The game finished, he went to fetch his ring; but Venus had bent her finger upon it, and he could not get it off. Whereupon, loth to make his companions tarry, he there left it, intending to fetch it the next day, went thence to supper, and so to bed; but in the night Venus had slipped between him and his wife, and thus troubled him for several successive nights. Not knowing how to help himself, he made his moan to one Palumbus, a learned magician; who gave him a letter, and bade him at such a time of the night, in such a cross way, where old Saturn would pass by with his associates, to deliver to him the script: the young man, of a bold spirit, accordingly did it; and when the old fiend had read it, he called Venus to him, who was riding before him, and commanded her to deliver the ring, which forthwith she did." Burton further quotes St. Augustine, Bodin, Paracelsus, and various other learned men, who firmly maintain that the Devil is particularly fond of a little flirtation with the ladies; and a Bavarian widower, who was sadly grieving for his beloved wife, was visited by Old Nick, who had assumed the form of the departed lady, and promised to live with him and comfort him on the condition that he would leave off swearing and blaspheming; he vowed it, married her, and she brought him several children; till one day, in an uxorious quarrel, he began to swear like a Pandour, whereupon she vanished, and never more was seen. The preservatives against witchcraft were as absurd as the fear it inspired: some hair, parings of nails, or any part of a person bewitched, were put into a stone bottle, with crooked nails, then corked close, and hung up the chimney; this expedient occasioned most horrible tortures to the witch, until the bottle was uncorked. Witches, moreover, cannot pursue their victims beyond the middle of a running stream, provided the fugitives had been baptized. I have now a patient under my care who fancies himself bewitched, and asserts that the only way to guard against the evil is by driving a nail in the impress left by a witch's foot on the threshold, when she will discontinue her visits. By an act of George II. these offences were considered as misdemeanors, and punished with a year's imprisonment, and standing four times in the pillory. There is no doubt that, notwithstanding the absurdity of such delusions and impostures, legislators must endeavour to secure the ignorant against these impositions, which are frequently of a perilous nature, and have been often known to occasion serious accidents, and even death. Many of the substances thus administered are of a most dangerous description, and these enchantments are not unfrequently resorted to with sinister intentions. It is related of the Asiatic women, that, under the pretext of giving these philters, they sometimes times prepare a beverage from the seeds of the _Datura Metel_, which produces a lethargic stupefaction of a convenient nature. The mischief that has frequently arisen from the exhibition of the _Lytta vesicatoria_ has been observed and recorded by every medical practitioner. The _Diablotini_, a kind of incentive sugar-plums of the Italians, have been known to occasion the most serious accidents; and the celebrated French actor Molé lost his life in one of these experiments. Yet penal enactments, in such cases, must be resorted to with much circumspection; for prohibition too frequently promotes the evils which it is designed to check. Montesquieu observes, that the ridiculous stories that are generally told, and the many impositions that have been discovered in all ages, are enough to demolish all faith in such a dubious crime, if the contrary evidence were not also extremely strong. Unquestionably, we have too many instances of criminal acts of superstition in which supernatural agency is believed; but did this philosophic writer mean to say that we have evidence of actual witchcraft and sorcery? It is with some degree of regret that we find our learned Blackstone avow his belief in these matters, and we borrow his own words on the subject: "To deny the possibility, nay, the actual existence of witchcraft and sorcery, is at once flatly to contradict the revealed Word of God, in various passages both of the New and Old Testament; and the thing itself is a truth to which every nation in the world hath in its turn borne testimony, either by examples seemingly well attested, or by prohibitory laws which at least suppose the possibility of a commerce with evil spirits. The civil law punishes with death not only the sorcerers themselves, but also those who consult them; imitating in the former the express law of God, 'Thou shalt not suffer a witch to live!'" Without calling into doubt the records of supernatural agency in Holy Writ, evident manifestations of the power and the will of the Divinity at that period, it may fairly be asked--Can we promulgate such opinions in the present times, when miraculous events do not seem to be permitted by our Creator in His inscrutable wisdom, without incurring the risk of plunging the ignorant in all the dark horrors of the early ages? Montesquieu himself has justly remarked, "that the most unexceptionable conduct, the purest morals, and the constant practice of every duty in life, are not a sufficient security against the suspicion of crimes like these." And yet, because, forsooth, there may be made to appear _examples seemingly attested_, and that on the faith of such an attestation the most absurd and cruel _prohibitory laws_ have been enacted by every _nation in the world, on the supposition of the possibility of such a crime_, however ignorant and brutalized by superstition these nations are or may have been, man is not only authorized by the Scriptures to persecute some poor miserable fool or vagrant impostor unto death, but he is sanctioned in founding this barbarous persecution on the laws of God! The mind sickens at such doctrines. It is grievous to find a man like our Addison sharing in such preposterous notions; notions which would induce a doubtful by-stander not to interfere with a mob of miscreants who were drowning some unfortunate old woman "for a witch." "There are," says Addison, "some opinions in which a man should stand _neuter_, without engaging his assent to one side or the other. It is with this temper of mind that I consider the subject of witchcraft. When I consider whether there are such persons in the world as those we call witches, my mind is divided between the two opposite opinions; or rather, to speak my thoughts freely, I believe in general that _there is_, and has been, such a thing as witchcraft, but, at the same time, can give no credit to any particular instance of it." Are we then still to believe that there may exist some supernatural hag, that can --------Untie the winds, and let them fight Against the churches-------- Control the moon, make ebbs and flows, And deal in her command without her power? or who, with the influence given to them by our poet Rowe, By force of potent spells, of bloody characters, And conjurations horrible to hear, Call fiends and spectres from the yawning deep, And set the ministers of hell to work, with the liver of a blaspheming Jew, the nose of a Turk, the lips of a Tartar, the finger of a birth-strangled babe, and ditch-delivered by a drab, &c. &c.? If we are to believe in witches with Blackstone and Addison, we must give credence to all these mystic means by which they _work_ their _way_. All these _means_ have been _seemingly attested_, and led, from the just horror they inspired, to those _prohibitory laws_ enacted by _every nation_; as if the laws of man could be of any avail in resisting the _admitted_ supernatural powers with which these witches, sorcerers, magicians, &c. must have been invested by the Deity to perform their terrific operations! If we deny this authority we are Manicheans. VENTRILOQUISM. This peculiar faculty was well known to the ancients. Hippocrates verily believed that there did exist individuals who could draw a voice from their belly. He speaks of the wife of Polimarchus, who, being affected with a quinsy, spoke in this manner; hence this power was called _Engastrimysm_. Plato gives the history of Euricles, who mentions three persons whom St. Chrysostom and Oecumenius considered to be endowed with a heavenly gift. Cælius Rhodiginus describes an old woman of Rovigo who used to deliver her oracles in the like manner, and who was never so eloquent as when stripped to the skin, when she would answer most accurately all the questions put to her by a familiar who attended upon her, and was called Cincinnatulus. Anthony Vandael, a physician of Harlem, considered ventriloquism as a supernatural power, enabling the voice to proceed "ex ventre inferiore et partibus genitalibus;" and he describes a woman of seventy-three years of age, called Barbara Jacobi, who used to ventriloquise with an imp of the name of Joachim, who would weep most piteously, or fall into roars of laughter, and sometimes danced and sung with remarkable grace and elegance, according to the depressing or the exhilarating nature of Mrs. Jacobi's communications. In the Septuagint the Hebrew word _Ob_ is rendered by _Engastrimythos_; and it was supposed that the Pythoness who evoked Samuel had recourse to this power. Oleaster, Grand Inquisitor of Portugal, in a work published at Lisbon in 1656, mentions a woman of the name of Cecilia who was brought before the court, and expressed herself in a ventriloquial voice, which she said was that of one Peter John, who had been dead for many years; but Peter John pleaded in vain for his hostess, for, despite his abdominal eloquence, she was sentenced to be transported. Whether Peter John accompanied her in exile is not stated. In 1643, Dickinson mentions a man at Oxford, who was called the King's Whisperer, and who expressed himself most clearly without opening the mouth or moving the lips. This faculty has frequently been employed in various speculations. In the sixteenth century, Borden relates the story of a valet of Francis I., named Brabant, who thus persuaded the mother of a young girl he courted to grant her consent to their marriage as speedily as possible, if she wished her husband's soul to get out of the torments of purgatory: after marriage, however, he was disappointed in his pecuniary expectations, and he applied his powers of ventriloquism to terrify a rich banker of Lyons, of the name of Corner, to bestow a fortune upon his wife; for which purpose he assumed the voice of Corner's father, who supplicated him to give the money as the only means of sending his poor consuming soul to paradise. One of the most celebrated ventriloquists was a grocer of St. Germains, one St. Gilles; but he applied the faculty he possessed to benevolent purposes. Being called to reclaim a newly-married young man from a disgraceful connexion, which rendered his wife most unhappy, his supernatural voice, supposed to come from heaven, succeeded; and he was equally fortunate in bringing to a sense of propriety one of the most sordid misers of his time. St. Gilles was not so felicitous in a trick he played to some monks, vainly attempting to prove the absurdity of their superstitious notions. One of the community had lately died, and, according to custom, the deceased was laid out in the church, and his brethren, grouped around him, were pouring forth prayers for the repose of his soul, when St. Gilles, throwing his voice into the coffin, returned them all the thanks of the departed friar for their supplications in his behalf. The astonished monks were most edified at this miraculous event; and their prior, who knew St. Gilles to be a freethinker, endeavoured to impress upon his mind the wonder that he himself had performed, and to inveigh most earnestly against the impiety and incredulity of modern philosophers, who entertained sceptic ideas concerning miracles. After a long exhortation, our ventriloquist burst into a fit of laughter, and avowed the deception he had practised: to convince the brotherhood of the veracity of his assertion, he gave them various specimens of his skill,--but to no purpose; he was called an infidel, a scoffer, an atheist, and, had it been in Spain, the stake would in all probability have rewarded his perilous frolic, or his stiff-necked impiety in refusing to believe in his own miracles. It is now pretty generally admitted that ventriloquism simply consists in a slow and gradual expiration, preceded by a strong and deep inspiration, by which a considerable quantity of air is introduced into the lungs, which is afterwards acted upon by the flexible powers of the larynx and the trachea: any person therefore, by practice, can obtain more or less expertness in this exercise; in which, although not apparently, the voice is still modified by the mouth and the tongue. Mr. Lespagnol, in a very able dissertation on this subject, has demonstrated that ventriloquists have acquired by practice the power of exercising the veil of the palate in such a manner, that, by raising or depressing it, they dilate or contract the inner nostrils. If they are closely contracted, the sound produced is weak, dull, and seems to be more or less distant; if, on the contrary, these cavities are widely dilated, the sound is strengthened by these tortuous infractuosities, and the voice becomes loud, sonorous, and apparently close to us. Thus any able mimic who can with facility disguise his voice, with the aid of this power of modifying sounds, may in time become a ventriloquist. CHAUCER'S DESCRIPTION OF A PHYSICIAN. THE DOCTOR OF PHYSIC. With us there was a doctour of phisike; In all this world, ne was there none him like To speake of phisike and of surgerie, For he was grounded in astronomie. He kept his patient a full great dell In houses: by his magike naturell Well couth he fortune the assendent Of his image for his pacient. He knew the cause of every malady, Whether it were of cold, heate, moist, or dry. And whereof engendered was each humour. He was a very parfit practisour; The cause I knew, and of his haime the roote, Anon he gave to the rich man his boot. Full ready had he his apoticaries To send him drugs and his lectuaries; For each of them made other for to winne, Their friendship was not new to beginne. Well he knew the old Esculapius, And Diascorides, and eke Ruffus, And Hippocrates, and Galen, Serapion, Rasis, and Avicen, Aberrois, Damascene, and Constantin, Bernard, Galisden, and Gilbertin Of his diet measurable was he, For it was of no superfluitie; But of great nourishing and digestible. His study was but little on the Bible. In sanguine and in percepolad withall Lined with taffata and with sendall; And yet he was but easy of dispence. He kept that he won in time of pestilence; For gold in phisike is a cordial, Therefore he loved gold speciall. It appears from this quaint and satirical picture, that, in our Chaucer's days, astrology formed part of a physician's study. It also plainly proves that a disgraceful collusion prevailed between medical practitioners and their apothecaries, mutually to enrich each other at the expense of the patient's purse and constitution. The poet, moreover, seems to tax the faculty with irreligion: that unjust accusation was not uncommon; hence the old adage, "Ubi tres medici, duo athei." To the disgrace of many illiberal persons of the present age, we have known some of our most able and praiseworthy physiologists charged with materialism. DÆMONOMANIA. This disease is perhaps the most distressing species of insanity; since, with the exception of the miserable belief of being possessed by the evil spirit, the patient is often in full possession of his other faculties, and will even endeavour to reason with his attendants, with some apparent plausibility, on the very aberration that constitutes the malady. The word 'dæmon' among the ancients was not considered as specific of an evil spirit; on the contrary, it signified genius, intellect, mind. [Greek: Daimonion], from [Greek: daimôn], meant wisdom, science. The first notions of dæmons were probably brought from Chaldea, whence they spread amongst the Persians, Egyptians, and Greeks. Gales maintains that the original institution of dæmons was an imitation of the Messiah. The Phoenicians called them _Baalim_. So far do these early opinions prevail, that among the Anabaptists we find a sect called Dæmoniac, who believe that devils shall be saved at the end of the world. Plato gave the name of dæmons to the benevolent spirits who regulated the universe. The Chaldeans and Jews considered them as the causes of all human maladies. Saul was agitated by an evil spirit, and Job and Joram suffered under a similar visitation. Dæmonomania differs widely from the mental disease called Theomania. In the latter state of insanity the patient fancies that he is placed in communication with the Deity or his angels; in the former, he feels convinced that he has become the prey of the destroyer of mankind. Under the head of "Unlawful Cures," instances are related of the firm belief in the power of evil spirits to cause various diseases. Perhaps the origin of dæmonomania may be traced to fanatical persecution; never was the malady so common as during the denunciations of Calvin, when torture was frequently resorted to, to make the victims of bigotry renounce a supposed pact with the devil. D'Agessau was right when, in advising the parliament of Paris to repeal all statutes against sorcery, he recommended that dæmoniacs should be handed over to the physician, instead of the priest or the executioner. The sufferings which dæmoniacs say they endure must be excruciating; so powerful is moral influence over our physical sensations. They will tell you that the devil is drawing them tight, and suffocating them with a cord; that he is pinching and lacerating their entrails, burning and tearing their heart, pouring hot oil or molten lead in their veins, while internal flames are consuming them. Their strength is exhausted, their digestive functions impaired, their appearance soon becomes miserable in the extreme, their countenances pale and haggard: the wretched creatures endeavour to conceal themselves during their scanty meals, or their attempts to enjoy a broken slumber; they are persuaded that they no longer possess a corporeal existence that requires refection or repose,--the evil spirit has borne away their bodies, the devil requires no earthly support; they even deny their sex: they are doomed to live for ever in constant agony. These unfortunate creatures are mostly women. One of them asserts, with horrid imprecations, that she has been the devil's wife for a million of years, and had borne him a numerous family; her body is nothing but a sack made of a devil's skin, and filled with their offsprings in the shape of devouring snakes, toads, and venomous reptiles. She exclaims that her husband constantly urges her to commit murder, theft, and every imaginable crime; and sometimes with bitter tears supplicates her keeper to put on a strait waistcoat, to prevent her from doing evil. Another woman, forty-eight years of age, assures us that she has two devils who have taken up their residence in both her hips, and have grown up to her ears: one of them is black and yellow, the other black, both in the shape of cats. She fills her ears with snuff and grease to satisfy their diabolical cravings. She eats with voracity, but is a perfect skeleton in appearance; the devils consume all, and leave her nothing. They constantly bid her to go and drown herself; but she cannot obey them, since eternity is her doom. They are scarcely sensible of painful agents, and are unconscious of heat, cold, or the inclemency of the weather. Their perspiration, frequently profuse, exhales a most unpleasant odour; hence the vulgar fancy that they smell of the lower regions. This circumstance is the usual consequence of many nervous affections, and arises, most probably, from the foulness of the breath, a natural result of impaired digestion, and from a peculiar acrimony of the cutaneous secretions. Pinel relates the case of a missionary whose enthusiastic aberrations led him into the horrible belief, that he could only be saved from eternal torments, by what he called a _baptism of blood_. This fatal mania induced him to attempt the life of his wife, who was fortunate to escape from the danger, after he had immolated two of his children, to secure their salvation! Tried for this crime he was sentenced to perpetual confinement in Bicêtre. In his dungeon he fancied himself the _fourth person in the trinity_, maintained that he was sent upon earth to baptize with blood, and all the power of the universe could not affect his life. During ten years' confinement this miserable wretch, betrayed the same insanity whenever religious subjects were touched upon, in all other matters, he reasoned most soundly. His lucid intervals at last became so long in their duration and calm, that it was questioned whether he might not be liberated--until on a Christmas eve, his sanguinary monomania resumed all its intensity, and having by some means or other obtained possession of a leather-cutter's knife, he inflicted a desperate wound on one of his keepers, and cut the throat of two patients who were near them; many other inmates of the establishment would, no doubt, have been sacrificed by the desperate maniac had he not been secured. This case might decidedly be considered one of true dæmonomania. It has been generally remarked that cases of dæmonomania are more common amongst women than in men. Their greater susceptibility to nervous affections, their warmth of imagination and strong passions, which habit and education compel them to restrain, produce a state of concentration that must cause increased excitement, and render them more liable to those terrific impressions that constitute the disease. These terrors, from false notions of the Deity, make them anticipate in this world the sufferings denounced in the next. One woman has been known to become dæmonomaniac after an intense perusal of the Apocalypse, and another by the constant reading of the works of Thomas à Kempis. Women, moreover, at certain critical periods are subject to great mental depression, which they have not the power to relieve by exciting pursuits, like men. Melancholy succeeds a dull sameness. Religion, viewed in a false light, becomes her refuge; more especially at an advanced period of life, when loss of youth and beauty is bitterly felt, as galled vanity compares the present with the past. Hysteric symptoms are now developed: the passions, which are too frequently increased even to intensity, rather than cooled, by years, prompt her to rebellious thoughts that religion and virtuous feelings strive to restrain; and these powerful agents, acting upon a predisposition morbidly impressionable from ignorance or the errors of education, accelerate the invasion of this cruel malady. Jacobi informs us, that this is still the character which, in some catholic countries, insanity connected with superstition frequently assumes. Pliny tells us that women are the best subjects for magical experiments; Quintilian is of the same opinion: Saul consults a witch; Bodin, in his calculations, estimates the proportion between wizards and witches as one to fifty. It is, perhaps, owing to these remarks that many ungenerous writers have denied _women_ a soul, as not belonging to _mankind_. There exists a curious anonymous work, published at the close of the sixteenth century, to prove that women are not men, or, in other words, reasonable creatures, and entitled "_Dissertatio perjucunda quâ Anonymus probare nititur Mulieres homines non esse_." Our author upon this principle endeavours to show that women cannot be saved. One Simon Geddicus, a Lutheran divine, wrote a serious confutation of this libel upon the fair sex, in 1595, and promises the ladies an expectation of salvation on their good behaviour. According to a popular tradition among the Mahometans, women are excluded from paradise: St. Augustin, however, calls them the _devout sex_; and in the prayer to the Virgin of the Romish Church we find "_Intercede pro devoto foemineo sexu_." An hypothesis still more absurd was broached by a Doctor Almaricus, a theological Parisian writer of the twelfth century, who advanced that, had it not been for the original sin, every individual of our species would have come into existence a complete man; and that God would have created them by himself, as he created Adam. Our worthy doctor was a disciple of Aristotle, who maintained that woman was a defective animal, and her generation purely fortuitous and foreign to nature. Howbeit, my fair readers will learn with satisfaction that the doctrines of this aforesaid Almaricus were condemned by the church as heretical, and his bones were therefore dug up, and cast into a common sewer, as an _amende honorable_ to the offended ladies. "A woman," says one of the primitive fathers of the church, "went to the play, and came back with the devil in her; whereupon, when the unclean spirit was urged and threatened, in the office of exorcising, for having dared to attack one of the faithful, 'I have done nothing,' replied he, 'but what is very fair; I found her on my own grounds, and I took possession of her.'" St. Cyprian informs us, that when he was studying magic, he was particularly intimate with the devil. "I saw the devil himself," he says; "embraced him; I conversed with him, and was esteemed one of those who held a principal rank about him." Who can doubt the assertion of a saint! It appears, that in those wonderful days the devil usually wore a black gown, with a black hat; and it was observed that, whenever he was preaching, his _glutei muscles_ were as cold as ice. At all times satire has endeavoured to make invidious distinctions between the sexes: this is not fair. Women are generally what men have made them. In a physical, and, consequently, to a certain degree in a moral point of view, their organization is essentially different from ours; therefore, a masculine woman is as intolerable as an effeminate man. The education of females tends in a great measure to increase that susceptibility to trifling excitements, which in after-life urges them to the extremes of good or evil. While the toys and amusements of boys are of a manly nature, a girl is taught to practise upon her darling doll all the arts which a few years after she will practise upon herself. Many intelligent writers have doubted the expediency of giving woman any education beyond the sphere of her domestic pursuits and occupations; Erasmus wrote largely on this subject to Budæus. Vives treats of it in his _Institutio foeminæ Christianæ_; and a German authoress, Madame Schurman, has published a treatise on the problem, "_Num foeminæ Christianæ conveniat studium literarum?_" It is this nervous flexibility in women that exposes them to that constant succession of emotions which are expressed by a rapid transition from tears to smiles; and, anomalous as it may appear, they are more exposed to fond impressions in their grief than at any other moment; they then feel more helpless, and stand in greater need of consolation. The story of the Matron of Ephesus is not so great a libel on the sex as one might imagine. Their mind is prone to romantic enthusiasm; they delight in the extraordinary, the terrible, and as Madame de Sevigné, who well knew her sex, expresses it, they enjoy in chivalric tales _les grands coups d'épée_. Prudence preventing them too frequently from expressing their thoughts, thinking becomes more intense; and Publius Syrus has said, "_Mulier quæ sola cogitat, malè cogitat_:" but when the suppressed volcano bursts forth, its eruptions are boundless; it is then that one may exclaim, "_Notumque fuerit quid foemina possit_." No passion is more overwhelming than when it has been kept down by dissimulation; opportunity is their curse: Montaigne has too truly said, "_Oh le furieux avantage que l'opportunité_!" and our Denham has beautifully illustrated its fearful circumstances: Opportunity, like a sudden gust, Hath swell'd my calmer thoughts into a tempest. Accursed opportunity! That works our thoughts into desires; desires To resolutions; those being ripe and quickened, Thou giv'st them birth, and bring'st them forth to action. It is a perilous ordeal for such to whom the lines of Ovid might apply, Quæ, quia non liceat, non facit; illa facit. To what prejudice against women are we to trace their sex having been chosen to represent the Furies, stern and inexorable ministers of Divine wrath; the Harpies, who defiled all they touched; the perilous Sirens; unless it be to woman's fascinations in youth, and envious bitterness in old age--the conventional type of witchcraft? This unhappy selection of woman for working _malefices_ has been attributed to the facility which the devil found in tempting Eve. A witch is supposed by the most learned in the black art to be in compact with Satan, whom she is obliged to obey; whereas a sorcerer commands the devil himself by his knowledge of charms and invocations, but more especially of perfumes that the evil spirits delight in when properly suffumigated, or abhor when maliciously given them to smell. Thus the burning of a fish's liver by Tobit drove the devil into the remote parts of Egypt; and Lilly informs us, that one Evans having raised a spirit at the request of Lord Bothwell and Sir Kenelm Digby, and forgotten his favourite fumigation or incense, the angry elf whipped him up, and carried him from his house in the Minories to Battersea Causeway. Although fairies are mostly considered juvenile, and many of their kind acts are recorded, yet are they in general mischievous imps; Mr. Lewis describes those he saw in the silver and lead mines of Wales, as only being about half a yard high. As a punishment for their vagaries, all their children are stunted and idiotic; and this accounts for their abominable custom of substituting their own "base elfin breed" for healthy infants. Hence are idiots commonly called changelings. Dæmoniacs are prone to commit suicide, less from their loathing an irksome life than through fear, not of future torments, but of the renewal or the continuance of their worldly sufferings. Perhaps they may entertain some doubts as to the punishment of another existence, while their actual condition is intolerable; we not unfrequently see desperate men rushing to meet the very fate they dread. Dæmonomania may be referred to a false view of divine justice,--ignorance, and consequent weakness of intellect,--and a pusillanimous apprehension of perhaps a merited chastisement. It is a disease which seldom admits of a cure. If the consolations of true religion are proffered, they are either spurned with anger, or merely produce an evanescent melioration. Zacutus relates the case of a dæmoniac who was cured by a person who appeared to her in the form of an angel, to inform her that her sins had been forgiven: it is possible that stratagems of a similar nature might prevail. I attended a monomaniac lady in Paris, who fancied herself in Jerusalem on the eve of its destruction. She furiously opposed all endeavours to move her from her residence; and it was only by personating a Jewish rabbi, and offering to take her to New Jerusalem as a place of refuge, that she consented to accompany me in a carriage to a _maison de santé_ near the capital. Here imagination subdued imagination. I have had the pleasure to hear that ever since I thus succeeded in breaking a link in the morbid association of her fancies, her state of mind rapidly improved, and that she is now restored to perfect sanity. Dæmonomania has been known to be epidemic. From 1552 to 1554 no less than eighty-four persons became possessed in Rome. The endeavours of a French monk to exorcise them proved of no avail; and as most of the unfortunate victims of credulity were Jewesses who had consented to be baptized, the Jews were of course accused of sorcery. About the same period a similar disease broke out in a convent near Kerndrop, in Germany, when all the nuns were possessed, and denounced their cook, who, having confessed that she was a witch, was duly burnt alive with her mother. Dæmonomania has been considered an hereditary visitation, and whole families have therefore been deemed in pact with the evil one. Insanity is unfortunately known to attach itself to certain generations; but perhaps it has not been sufficiently observed, when endeavouring to account for this melancholy fact, that the mind becomes gradually influenced by the nature of the constant conversation we daily and hourly are exposed to hear; and it is not impossible but that this transmission of mental disease may be attributed to morbid moral and physical sympathies, which might be avoided by withdrawing the persons exposed to it from the sphere of their action. Constant anxious thoughts and painful reflections tend to produce an increased sensorial power in the brain, with a diminished sensibility to external impressions. So great has been this effect upon the senses, that maniacs have been seen to gaze upon the meridian sun without any sensible effect on the organs of vision. It is therefore possible that an individual who beholds with incessant horror insanity in his family, or who constantly hears of their aberrations, may ultimately experience a similar peculiarity of the mind: hence wit as well as madness have been known to be the heir-looms of a race. Although the examples of vice, one might imagine, would inspire a love for virtuous actions, yet we daily see profligacy the characteristic of an entire family; and there are names which have been rendered by misconduct synonymous with depravity. This sad fact can only be attributed to natural temperament, whether it be sanguine or melancholic. It has been observed that our constitutions exercise a control over diseases, that modifies them in a peculiar manner. The more acute the sensibility, the greater is the predisposition to insanity. Warm and ungovernable passions will drive one female into all the horrid excesses of nymphomania, while the timid hypochondriac and hysteric woman will gradually sink into a morose or a malevolent despondency. Burton attributes dæmonomania to other causes, and tells us that the devil is so cunning that he is able to deceive the very elect; and, to compel them the more to stand in awe of him, he sends and cures diseases, disquiets their minds, torments and terrifies their souls, to make them adore him; and all his study, all his endeavour, is to divert them from true religion to superstition; and because he is damned himself, and is in error, he would have all the world participate of his errors, and be damned with him. Amongst the various motives that induced the evil one to pay his sinister visits to frail mortality, that of inflicting upon them a salutary, or a vexatious fustigation, is frequently recorded by the fathers and other writers. It was more especially upon the backs of saints that this castigation took place. St. Athanasius informs us that St. Anthony was frequently flagellated by the devil. St. Jerome states that St. Hilarius was often whipped in a similar manner; and he calls the devil "a wanton gladiator," and thus describes his mode of punishment: "Insidet dorso ejus festivus gladiator; et latera calcibus, cervicem flagello verberans." Grimalaïcus, a learned divine, confirms the fact in the following passage: "Nonnumquam autem et apertâ impugnatione grassantes, dæmones humana corpora verberant, sicut B. Antonio fecerant." St. Francis of Assisa received a dreadful flogging from the devil the very first night he came to Rome, which caused him to quit that city forthwith. Abbé Boileau's remarks on this circumstance savour not a little of impiety and freethinking, for he says, "It is not unlikely that, having met with a colder reception than he judged his sanctity entitled him to, he thought proper to decamp immediately, and when he returned to his convent told the above story to his brother monks." Howbeit, Abbé Boileau is no authority, and it is to be feared that, partaking of the satirical disposition of his brother, he sacrificed piety to wit; for it is well known, beyond the power of sceptic doubts, that the aforesaid saint's assertion cannot possibly be impugned by proper believers. His power over the fiery elements was established; whereby he possessed the faculty of curing erysipelas, honoured by the appellation of St. Anthony's fire. In the like manner St. Hubert cured hydrophobia, and St. John the epilepsy. It is, however, pleasing to know that it was not always that the beatified succumbed to these Satanic pranks, and many instances are recorded of the devil's being worsted in these sacrilegious amusements, as fully appears in the history of the blessed Cornelia Juliana, in whose room, one day, says her history, "the other nuns heard a prodigious noise, which turned out to be a strife she had had with the devil, whom, after having laid hold of him, she fustigated most unmercifully; then, having him upon the ground, she trampled upon him with her foot, and ridiculed him in the most bitter manner (_lacerabat sarcasmis_)." This occurrence is incontrovertible, being affirmed by that learned and pious Jesuit, Bartholomew Fisen. This partiality of devils for flagellation can most probably be attributed to their horribly jealous disposition; for it is well known that the saints took great delight in fustigating, not only those who offended them, but their most faithful votaries. Flagellation was therefore the most grateful punishment that could be inflicted to propitiate the beatified; and we have several well-authenticated facts which prove that the Virgin was frequently appeased by this practice. Under the pontificate of Sextus IV., a heterodox professor of divinity, who had written against the tabernacle, was flogged publicly by a pious monk, to the great edification of the by-standers, more particularly the ladies. The description of this operation would lose materially by translation, I therefore give it in the original. "Apprehendens ipsum revolvit super ejus genua; erat enim valdè fortis. Elevatis itaque pannis, quia ille minister contra sanctum Dei tabernaculum locutus fuerat, coepit cum palmis percutere _super quadrata tabernacula_ quæ erant nuda, non enim habebat _femoralia vel antiphonam_; et quia ipse infamare voluerat beatam Virginem, allegando forsitan Aristotelem in libro priorum, iste prædicator _illum confutavit legendo in libro ejus posteriorum_: de hoc autem omnes qui aderant gaudebant. Tunc exclamavit _quædam devota mulier_, dicens, '_Domine Prædicator, detis ei alios quatuor palmatus pro me_; et alia postmodum dixit, 'Detis ei etiam quatuor; sicque _multæ aliæ_ rogabant, ita quòd si illarum petitionibus satisfacere voluisset, per totum diem aliud facere non potuisset." We need not seek for similar instances of the mighty power of proper fustigation in foreign parts. The Annals of Wales record a singular instance of the kind, which happened in the year 1188, as related by Silvester Gerald, in such a circumstantial manner that the most obdurate incredulity alone could doubt the fact:--"On the other side of the river Humber," he says, "in the parish of Hoëden, lived the rector of that church, with his concubine. This concubine, one day, sat rather imprudently on the tomb of St. Osanna, sister to King Osred, which was made of wood, and raised above the ground in the shape of a seat: when she attempted to rise from that place, she stuck to the wood in such a manner that she could not be parted from it, till, in the presence of the people who flocked to see her, she had suffered her clothes to be torn from her, and had received a severe discipline on her naked body, and that too to a great effusion of blood, and with many tears and devout supplications on her part; which done, and after she had engaged to submit to further penitence, she was divinely released." In this instance, as in many others, freedom from vulgar habiliments appears to have been considered as acceptable to Heaven; so much so, indeed, that the state of greater or lesser nudity has been commensurate with the degree of the offence. The Cynic philosophers of Greece, among whom Diogenes made himself most conspicuous, used to appear in public without a rag upon them. The Indian wise men, called Gymnosophists, or naked sages, indulged in the same vagaries. In more modern times, the Adamites appeared in the simple condition of our first father. In the 13th century, a sect called _Les Turlupins_ (a denomination which appears to have been an opprobrious nickname), perambulated France, disencumbered of vain accoutrements; and, in 1535, some Anabaptists made an excursion in Amsterdam in the condition in which they had quitted their baths, for which breach of decorum the impious burgomasters had them bastinadoed. We further read of one Friar Juniperus, a worthy Franciscan, who, according to history, "entered the town of Viterboo, and, while he stood within the gate, he put his hose on his head, and his gown being tied round his neck in the shape of a load, he walked through the streets of the town, where he suffered much abuse and maltreatment from the wicked inhabitants; and, still in the same situation, he went to the convent of the brothers, who all exclaimed against him, but he cared little for them, _so holy was the good little brother_ (_tam sanctus fuit iste fraticellus_)." The pranks of brother Juniper have been performed at sundry periods by various holy men. Are we not warranted in conceiving that these individuals were dæmonomaniacs? for surely the devil alone could have inspired them with such fancies, although Cardinal Damian defends the practice in the following terms, when speaking of the day of judgment: "Then shall the sun lose its lustre, the moon shall be involved in darkness; the stars shall fall from their places, and all the elements be confounded together: of what service then will be to you those clothes and garments with which you are now covered, and which you refuse to lay aside, to submit to the exercise of penitence?" It must be remarked, in extenuation of these exhibitions, that they were accompanied by flagellation; which sometimes bore a close analogy to those of the Saturnalia and Lupercalia, and the discipline of the flagellants was not always dissimilar to that of the Luperci. To resume: Dæmonomania may be considered the result of a morbid condition of the mind, and the dread of supernatural agency. The belief of an incarnation of the devil leads to the natural apprehension of his having taken possession of our bodies, when a credulous creature fancies that he has fallen into his snares, and forsaken the ways of the Omnipotent. This sad delusion has been admirably illustrated by Sir Walter Scott in his curious and learned Demonology. "It is, I think," says he, "conclusive that mankind, from a very early period, have their minds prepared for such events (supernatural occurrences) by the consciousness of the existence of a spiritual world. But imagination is apt to intrude its explanations and inferences founded on inadequate evidence. Sometimes our violent and inordinate passions, originating in sorrow for our friends, remorse for our crimes, our eagerness of patriotism, or our deep sense of devotion,--these, or other violent excitements of a moral character, in the visions of the night, or the rapt ecstasy of the day, persuade us that we witness with our eyes and ears an actual instance of that supernatural communication, the possibility of which cannot be denied. At other times the corporeal organs impose upon the mind, while the eye and the ear, diseased, deranged, or misled, convey false impressions to the patient. Very often both the mental delusion and the physical deception exist at the same time; and men's belief of the phenomena presented to them, however erroneously, by the senses, is the firmer and more readily granted, that the physical impressions corresponded with the mental excitement." From the foregoing observations we may venture to conclude, that an individual who gives credence to apparitions will also believe in the incarnation of the devil. In both cases we infer that spiritual beings can assume corporeal forms; and, although we may not presume to question the possibility of such appearances when it may please the Omnipotent so to will it, to believe in possession is actually to admit that the devil is a spiritual being endowed with specific attributes and powers, and acting either independently or with the consent of the Almighty. This admission would to a certain extent border on the heresy of the Manicheans, who believed, with the heresiarch Cubricus, that there existed a good and an evil principle coeternal and independent of each other. We find in Holy Writ that indulgence was granted to Satan to visit the earth. But the period when miraculous power ceased, or rather was withdrawn from the church, is not determined. The Protestants bring it down beneath the accession of Constantine, while the Roman Catholic clergy still claim the power of producing or procuring supernatural manifestations when it suits their purpose; but, as Scott justly observes, it is alike inconsistent with the common sense of either Protestant or Roman Catholic, that fiends should be permitted to work marvels, which are no longer exhibited on the part of religion. Cullen's opinion on this disease is worthy of remark. He says, "I do not allow that there is any true dæmonomania, because few people nowadays believe that demons have any power over our bodies or our minds; and, in my opinion, the species recorded are either a species of melancholy or mania,--diseases falsely referred by the spectators to the power of demons,--feigned diseases,--or diseases partly real or partly feigned." Esquirol, moreover, justly observes, that "in modern times the punishments that the priest denounces have ceased to influence the minds and the conduct of men, and governments have recourse to restraints of a different kind. Many lunatics express now as much dread of the tribunals of justice, as they formerly entertained of the influence of stars and demons." We frequently meet with despondent monomaniacs labouring under the fatal delusion of having forfeited all hopes of salvation, and being in fact inevitably doomed to perdition, but who are apparently of sound mind when touching upon other subjects. The case of one Samuel Brown was peculiarly striking. This unfortunate man, at a period when all his intellectual faculties were in full vigour, fancied that his rational soul had gradually succumbed under divine displeasure, and that he solely enjoyed an animal life in common with brutes. Esquirol affirms that this form of lunacy is of rare occurrence, and that out of upwards of 20,000 insane persons whom he has observed, scarcely one case of dæmonomania could be found in a thousand, and these were amongst the lowest and most uneducated classes of society. The most powerful charm to withstand the efforts of the evil spirit, is the following one generally made use of in Livonia. _Two eyes have seen thee--may three eyes deign to cast a favourable look upon thee, in the name of the Father, the Son, and the Holy Ghost._ THE PLAGUE. Pestilential diseases have ever been considered a punishment inflicted on mankind for their manifold offences. The ancients deified the calamity, and viewed it in the light of an avenging god. In the Oedipus of Sophocles, the chorus implore Minerva to preserve them from that divinity, which, without sword or buckler, strews the Theban streets with corpses, and is more invincible than Mars himself. Lucretius describes the plague of Athens as a holy fire,-- Et simul, ulceribus quasi inustis, omne rubore Corpus, ut est, per membra _sacer_ quum diditur _ignis_. The plague was known in an early era both to the Israelites and to the Greeks, and its ancient and modern histories have descended to us depicted in the most terrific colours, in a regular stream of Hebrew, Greek, Arabic, and Roman writers, in most instances offering little variety from the descriptions of neoteric observers. The pestilences that visited the Israelites were, however, of a different character. They were also considered as a Divine chastisement of the sins of that stiff-necked nation. This visitation, accurately described in Holy Writ, has led to the most curious disquisitions. Bryant has endeavoured by the most recondite researches to give us the reasons why the Creator thought proper thus to visit his disobedient people. It has been truly observed that the sublime is not far removed from the ridiculous; and it may be said with equal correctness, that enthusiasm in religion too frequently borders upon impiety. Bryant, in his erudite labour, has unhappily fallen into this extreme, in assigning human motives to the decrees of the Deity. This matter is treated in so curious a manner that it will not be irrelevant to notice his bold assertions. In the first instance, taking the language of the Exodus in the most literal sense, he tells us that the river was turned into blood, _because_ it was a punishment particularly well adapted to that blinded and infatuated people, as a warning to the Israelites of the insufficiency of the false gods that the Egyptians worshipped. They had rendered divine homage to the Nile; and Herodotus informs us that the Persians held their rivers in the highest veneration; while the same worship obtained among the Medes, the Parthians, and the Sarmatians. The Greeks adored the Spercheius, to whose god Peleus vowed the hair of his son; the laureated Peneus, the earth-born Achelous, and the loving Alpheus. For, although it may be said that these streams were merely venerated as the symbols of their respective gods, it is possible that the Greeks might have fallen into the same errors as the worshippers of saintly images in more modern and enlightened times. Therefore, says our learned author, there was a great propriety in the judgment brought upon this people by Moses. They must have felt the utmost astonishment and horror when they beheld the sacred stream changed and polluted, and the divinity which they worshipped so shamefully soiled and debased. Moreover, he tells us that the Egyptian priests were particularly nice and delicate in their outward habits, making constant ablutions; and abhorred blood, or any stain of gore. In this plague the fish that were in the river died, and the river stunk. Now the priests and holy men not only never tasted fish, but looked upon them as deities. A city was built in honour of the god-fish, Oxyrunchus; the Phagrus[12] was worshipped at Syene, the Mæotis at Elephantis, and Antiphanes tells us that the Egyptians equally reverenced the eel. The second plague were frogs, _because_, further saith our sapient authority, they added to the stink of the land, as they "died out of the houses, out of the villages, and out of the fields, and were gathered together in heaps, and the land stunk," Exodus viii. 13, 14. Bryant candidly confesses that he is rather uncertain if this reptile was an object of reverence, or of abhorrence to the Egyptians; nevertheless, he draws the conclusion that, as the ancients worshipped many deities of dread, and others that they despised, (such as Priapus, Fatua, Vacuna, Cloacina,) Mephitis, or foul effluvia, was held in religious awe,--and, to use his own expressions, since Mephitis "signified stink in the abstract," and had a temple at Cremona, the pestilential emanation from the dead frogs might have been considered as entitled to some reverence.[13] Plutarch tells us that the frog was an emblem of the sun in Egypt, and that the brazen palm-tree at Delphi had many of these animals engraved on its basis. On the Bembine table we find it sitting upon the lotus, a circumstance observed in various ancient gems; the water-lily being, perhaps, congenial to this aquatic tribe, which were denominated the attendants of the deities of streams and fountains. It is also alleged that the frog was deemed an emblem of Apollo and Osiris, from its habit of inflation, which was looked upon as being typical of inspiration. That frogs were considered as evil symbols further appears in the Apocalypse, where we find that "three unclean spirits like frogs come out of the mouth of the dragon, and out of the mouth of the beast, and out of the mouth of the false prophet; they are the spirits of devils working miracles." The third plague was lice, _because_ the Egyptian priests affected great external purity, wore linen under their woollen garments, and shaved their heads, according to Herodotus, every third day, to prevent any louse, or any other detestable object, from finding a comfortable shelter. Some scholastics have ventured to insinuate that this insect was a species of gnat; but St. Jerome and Origen very properly observe that this would have been a presumptious anticipation of the plague of flies, which constituted the _fourth_ visitation, _because_ flies were also held sacred by the Egyptians, and were worshipped under the name of _Achon_, _Acoron_, and _Zebub_, more particularly in the city of _Acaron_ or _Accoron_. Baal was the god of flies, and the fly was worshipped at _Ekron_, where it was called _Baal-ze-bub_,--hence _Belzebub_. The next plague was the murrain of beasts; _because_ it was necessary that the Israelites should not only see that the cattle of the Egyptians were all infected, while theirs were exempted from the evil; but that their very living symbol of the bull Apis, in whom the soul of Osiris had taken up its dwelling, was affected with epizooty in common with other herds of horned deities, who were called _Dii Stercorei_; though it appears that the ass and the camel were involved in the same calamity. Our commentator attempts to account for the sixth plague of boils and blains with equal ingenuity. He affirms that this cruel disorder was sent among the Egyptians to show the Israelites that the medical men to whom they attributed divine powers, could neither cure nor alleviate the disease. The science of medicine bequeathed by Isis to her son Orus was of no avail, and the learned records of Tosorthrus yielded no information. In vain did their leeches search their cryptæ and sacred caverns, or consult their mystic obelisks, which, according to Manetho, were inscribed with the aphorisms of medical experience; their physicians only increased the number of the _botches_ of the land. The Scriptures state that this pestilential malady was produced by the ashes that Aaron and Moses scattered up towards heaven to be wafted over the country. Bryant also accounts for this circumstance, and attributes this method of extending the calamity to the barbarous practice of the Egyptians of burning human victims and scattering the ashes in the air, in a like manner to propitiate their gods. The fall of rain, hail, fire, and thunder, that constituted the seventh plague, was a chastisement inflicted on the worshippers of these supposed elements. Their Isis presided over the waters, and Osiris and Hephaistus governed fire. Moreover the flax was smitten, whereby the Egyptians were deprived of the means of making linen, the finest of which was their boast and their pride. The barley was also destroyed, and they had no materials for brewing their favourite potation, barley-wine; a species of beer which constituted their chief beverage when the waters of the Nile were turbid and not potable.[14] But, according to Jacob Bryant, this destruction was not deemed sufficient, since the fecundity of Egypt would soon have replenished their granaries, manufactures, and breweries; therefore locusts were sent to devour every thing that the former devastation had spared; and this plague was a punishment of their belief that Hercules and Apollo had the power of controlling these ravenous insects, which were called _Parnopes_ and _Cornopes_, whence Apollo was named _Parnopius_, and Hercules _Cornopion_. It also appears that the grasshoppers, or _cicadæ_, were venerated, both as sacred and musical; and the Athenians wore golden ones in their hair, to denote the antiquity of their race of earth-born breed. Now it is somewhat singular, that while our ingenious author makes such learned inquiries to account for the motives that induced God thus to visit the Egyptians, he does not venture to assign motives for similar calamities which befel other nations and countries; although his researches on the subject are so curious and interesting, that they deserve insertion. The following is the account given by Beauplam of the destructive inroad of these devourers in the Ukraine:--"Next to the flies, let us talk of the grasshoppers or locusts, which here are so numerous, that they put one in mind of the scourge of God sent upon Egypt when he punished Pharaoh. These creatures do not only come in legions, but in whole clouds, five or six leagues in length, and two or three in breadth, eating up all sorts of grain or grass, so that wheresoever they come, in less than two hours they crop all they can find, which causes great scarcity of provisions. It is not easy to express their numbers, for all the air is full and darkened; and I cannot better represent their flight to you, than by comparing it to the flakes of snow driven by the wind in cloudy weather; and when they alight to feed, the plains are all covered. They make a murmuring noise as they eat, and in less than two hours they devour all close to the ground; then rising, they suffer themselves to be carried away by the wind. When they fly, though the sun shines never so bright, the air is no lighter than when most clouded. In June 1646, having stayed in a new town called Novogorod, I was astonished to see so vast a multitude. They were hatched here last spring; and being as yet scarcely able to fly, the ground was all covered, and the air so full of them, that I could not eat in my chamber without a candle, all the houses being full of them, even the stables, barns, chambers, garrets, cellars, &c. I have seen at night, when they sit to rest themselves, that the roads have been four inches thick of them, one upon another. By the wheels of the carts and the feet of our horses bruising these creatures, there came from them such a stink, as not only offended the nose but the brain. I was not able to endure the stench, but was forced to wash my nose with vinegar, and to hold a handkerchief dipped in it to my nostrils perpetually. These vermin increase and multiply thus: they generate in October, and with their tails make a hole in the ground, and having laid three hundred eggs in it, and covered them with their feet, die; for they never live above six months and a half. And though the rains should come, they would not destroy the eggs; nor does the frost, never so sharp, hurt them. But they continue to the spring, which is about mid-April; when the sun warming the earth, they are hatched, and leap about, being six weeks old before they can fly; when stronger, and able to fly, they go wherever the wind carries them. If it should happen that a north-east wind prevails, it carries them all into the black sea; but if the wind blows from any other quarter, they go into some other country to do mischief. I have been told by persons who understand the languages well, that the words _Boze Guion_, which mean the scourge of God, are written in Chaldee characters upon their wings." Norden mentions that there were supposed to be hieroglyphic marks upon the heads of these insects. Such was the pestilential scourge of the Ukraine; although I do not apprehend that its inhabitants ever worshipped _Parnopius_ or _Cornopion_, or decorated their filthy heads with golden grasshoppers. Other regions were occasionally visited by these insects. Ludolphus, in speaking of Ethiopia, says, "But much more pernicious than these (the numerous serpents) are the locusts, which do not frequent the desert and sandy places, like the serpents, but the places best manured, and orchards laden with fruit. They appear in prodigious multitudes, like a cloud which obscures the sun; nor plants, nor trees, nor shrubs appear untouched, and wherever they feed, what is left appears as it were parched with fire. A general mortality ensues; and regions lie waste for years." Francis Alvarez thus speaks of the same calamity in the country of Prester John. "In this country, and in all the dominions of Prete Janni, there is a very great and horrible plague: this arises from an innumerable number of locusts, which eat and consume all the corn and the trees. And the number of these creatures is so great as to be incredible, and with their numbers they cover the earth, and fill the air in such wise, that it is a hard matter to see the sun. And if the damage they do were general through all the provinces, the people would perish with famine. But one year they destroy one province, sometimes two or three of the provinces; and wherever they go the country remaineth more ruined and destroyed than if it had been set on fire." The author adds, that he exorcised them upon their invading a district in which he resided, when they all made off; but in the mean time, he adds, "there arose a great storm and thunder towards the sea, which came right against them. It lasted three hours, with an exceeding great shower and tempest. It was a dreadful thing to behold the dead locusts, (whom, by the way he had exorcised,) which we measured to be above two fathoms high upon the banks of the rivers." Barbot, in describing Upper Guinea, tells us that "famines are some years occasioned by the dreadful swarms of grasshoppers or locusts, which come from the eastward, and spread all over the country in such prodigious multitudes, that they darken the air, passing over our heads like a mighty cloud." Orosius states that in the consulship of Marcus Plautius Hypsæus and Marcus Fulvius Flaccus, A.R. 628, Africa was desolated by a swarm of these insects, which for a while were supported in the air, but were ultimately cast into the sea. "After this," he adds, "the surf threw up upon that long extended coast such numerous heaps of their dead and corrupted bodies, that there ensued from putrefaction a most unsupportable and poisonous stench. This soon brought on a pestilence, which affected every species of animals, so that all birds, and sheep, and cattle, also the wild beasts of the field died, and their carcases being soon rendered putrid by the foulness of the air, added greatly to the general corruption. In respect to men, it is impossible, without horror, to describe the shocking devastation. In Numidia, where at the time Micipsa was king, eighty thousand persons perished. Upon that part of the sea-coast which bordered upon the regions of Carthage and Utica, the number of those carried off by this pestilence is said to have been two hundred thousand." Now when man in all his proud ignorance dares to assume the power of canvassing the acts of the Almighty, and to attribute to his inscrutable will human motives, which generally arise from mortal frailty, he might as well endeavour to account for similar casualties which visited other nations than the Egyptians, and seek for the causes of the scourges of Carthage, Ethiopia, and Tartary. It is grievous to see the intellectual faculties of man perverted in such idle, one might venture to say, in such impious researches. It is strange that the learned Bryant did not associate the death of the first-born with ideas of primogeniture! The ninth plague of darkness he attributes to the prevalence of the worship of the sun, under the title of Osiris, Ammon, Orus, Isis, and the like. _Because_ the Egyptians, the Ethiopians, Persians, Phoenicians, Syrians, Rhodians, and various other nations, considered themselves Heliadæ, or descendants of the sun. "What, then, can be more reasonable," continues our antiquary, "than for a people who thus abused their faculties, who raised to themselves a god of Day, their Osiris, and instead of that intellectual light, the wisdom of the Almighty, substituted a created and inanimate element as a just object of worship,--what could be more apposite than for people of this cast to be doomed to a judicial and temporary darkness?" Unfortunately, in the very next paragraph we are told that the Egyptians showed an equal reverence to night and darkness: obscurity, therefore, was only replacing one false god by another. They paid a religious regard to the _mugall_, a kind of mole, on account of its supposed blindness; and night was conceived more sacred than day, from its greater antiquity, since, according to the Phoenician theology, the wind _Copias_ and his wife _Baan_ were esteemed the same as night, and were the authors of the first beings. In the poems of Orpheus, Night is considered as the creative principle; and in the Orphic hymns we find Night invoked as "the parent of gods and men, and the origin of all things." This attempt to show an analogy between the crimes and sins of the Egyptians and the punishment they received, is too curious to be overlooked. The mania of seeking for the cause of every thing, reminds one of a singular character in Trinity College, Dublin, formerly well known, who invariably gave a reason for every direction he thought proper to issue; and he was once heard to address a servant in the following words: "Pat, put a cover upon that mutton. It is not for the purpose of keeping it hot, _because_ it is cold, but it is _because_ I do not wish the flies to get at it, _because_ fly-blown meat is both unpleasant to the taste and injurious to the health." It appears probable that the plague originated in Egypt. From time immemorial to the present day the lower provinces have been subject to this cruel scourge. Wars, intestine commotions, and misrule have too frequently prevented the local authorities from paying proper attention to measures of public salubrity. Herodotus tells us, that when he was at Memphis, Egypt was just liberated from a long-protracted war, during which political economy had been neglected, canals had been abandoned and choked up, and the frontiers of the land were infested with banditti, while the interior was desolated by pestilential disorders. My much esteemed friend Baron Larrey, in his valuable work upon Egypt, has given a topographical description of the country; and the influence that the seasons exercise upon it, must be evident. He informs us that after the spring equinox, and especially towards the beginning of June, the southerly winds are prevalent for about fifty days. Their scorching influence is experienced for upwards of four hours, while they waft with fatal rapidity putrid emanations exhaled by animal and vegetable bodies decomposed in the lakes formed by the receding waters of the Nile. From various observations it has been concluded that the plague is both an endemic and contagious disease in Lower Egypt, but simply contagious in Upper Egypt, Syria, the other Turkish provinces, and Europe. No account of the plague in Abyssinia, Sennaar, or the interior of Africa, is given by any traveller. The most fatal European plagues were probably those that desolated London in 1664, and Marseilles in 1720. The accounts of these fearful visitations are as curious as they are appalling. In London it broke out in the beginning of December, when two foreigners (Frenchmen it was reported) died of this disorder in Long-Acre, near Drury Lane. The cold weather and frost that followed, seemed to check its progress, until the month of April, when it appeared with intensity in the parishes of St. Andrew, Holborn, and St. Clement Danes. In May, the parish of St. Giles buried a great number. Wood Street, Fenchurch Street, and Crooked Lane, were soon visited, until terror was so general, that crowds of inhabitants panic-struck, on foot, on horse, in coaches, waggons, and carts, were thronging Broad Street and Whitechapel, fleeing from the calamity. To such an extent was migration carried, that not a horse could be bought or hired. Many fugitives, fearful of stopping at inns, carried tents to lie in the fields, and people moved in the centre of the streets, in dread of coming into contact with others sallying forth from their houses. During this state of universal panic, it may be easily imagined that hypocrisy and roguery were busily employed in increasing the evil, at the expense of the credulous. Pretended wizards and cunning people affirmed that a comet had appeared several months previous to the increase of the malady, as a similar meteor had visited London before the great fire; only the fire comet was bright and sparkling, and the plague comet was dull, and of a languid colour. Lilly's Almanac and Gadbury's Astrological Predictions were in general demand; while pamphlets, entitled "Come out of her, my people, lest you be partakers of her plagues," "Fair Warning," and "Britain's Remembrancer," were eagerly circulated, as they denounced the utter ruin of the city. One of these prophets ran about the streets, without the encumbrance of any garment, roaring out, "Yet forty days, and London shall be destroyed;" while another, equally divested of raiment, bellowed out, "Oh! the great and the dreadful God!" Some asserted that they had seen a hand with a flaming sword coming out of the clouds, while others beheld hearses and coffins floating in the air. The following is a quaint narrative of these absurdities: "One time before the plague was begun, I think it was in March, seeing a crowd of people in the street, I joined with them to satisfy my curiosity, and I found them all staring up in the air to see what a woman told them appeared plain to her, which was an angel clothed in white, with a fiery sword in his hand, waving it and brandishing it over his head. She described every part of the figure to the life, showed them the motions and the form; and the poor people came into it readily. 'Yes, I see it all plainly,' says one; 'there's the sword as plain as can be.' Another saw his very face, and cried out, 'What a glorious creature he was!' One saw one thing, and one another. I looked as earnestly as the rest, and said I could see nothing but a cloud. However, the woman turned from me; called me a profane fellow and a scoffer; told me that it was a time of God's anger, and dreadful judgments were approaching, and that despisers such as I should _wonder and perish_. Another encounter I had in the open day also, in going through a narrow passage from Petty-France into Bishopsgate churchyard. In this narrow passage stands a man looking through between the palisadoes into the burying-place, and he was pointing now to one place, then to another, and affirming that he saw a ghost walking upon such a grave-stone; he described the shape, the posture, and the movement of it so exactly, crying on a sudden, 'There it is--now it comes this way--now 'tis turned back!' till at length he persuaded the people into so firm a belief of it, that they fancied they saw it; and thus he came every day, making a strange hubbub, till Bishopsgate clock struck eleven, and then the ghost would start and disappear on a sudden." Such sanctimonious tricks are historical. Don Bernal Dias del Castello tells us, in his account of the Mexican conquest, that St. Jago appeared in the van of the army, mounted on a white horse, and leading the troops on to victory. He frankly owns that he did not see this blessed vision; nay, that a cavalier, by name Francisco de Morla, mounted on a chestnut steed, was fighting in the very place where the patron of Spain was said to have appeared; but, instead of drawing the natural conclusion, that the whole business was got up as an illusion, he devoutly exclaims, "Sinner that I was, what am I that I should have been permitted to behold the blessed apostle!" These impostures remind us of the story of the wag who, fixing his eyes upon the lion over Northumberland House, exclaimed, "By heaven! it wags--it wags!" and contrived by these means to collect an immense mob in the street, many of whom swore that they did absolutely see the lion wagging his tail. Crowds of pretended fortune-tellers, and astrologers and cunning men, were soon in good business, and their trade became so generally practised, that they had signs denoting their profession over their doors, with inscriptions announcing, "Here lives a fortune-teller,"--"Here you may have your nativity cast;" and the head of Friar Bacon, Mother Shipton, or Merlin, were their usual signs: and if any unfortunate man of grave appearance, and wearing a black cloak, went abroad, he was immediately assailed by the mob as a necromancer, and supplicated to reveal futurity. At such a period, it may be easily imagined that quacks were not satisfied with mere gleanings; and _infallible pills_, _never-failing preservatives_, _sovereign cordials_, and _incomparable drinks_, against the plague, were announced in every possible manner; and _universal remedies_, _the only true plague-water_, and _the royal antidote_, became themes of universal discourse. An eminent _High_ Dutch physician, newly come over from Holland, where he resided during all the time of the plague,--an Italian gentlewoman, having a choice secret to prevent infection, and that did wonders in a plague that destroyed twenty thousand people a-day, were announced by bills at every corner. One ingenious mountebank realized a fortune by announcing _that he gave advice to the poor for nothing_: crowds flocked to consult him; but he took half-a-crown for his remedy, on the plea that, although his advice was given gratis, he was obliged to sell his physic. While these speculations were going on, all "plays, bear-baiting, games, singing of ballads, and buckler-play," were prohibited; all feasting, "particularly by the companies of this city," was punished; watchmen guarded the doors of the pestiferated, to prevent their egress, and a red cross was painted on their houses. The inhabitants, thus shut up to suffer the pangs of starvation in addition to those of pestilence, made the best of their way out of their prison by every possible stratagem and bribery. While fervent prayers and loud ejaculations for mercy were heard amongst distracted families, the most offensive blasphemy and ribaldry prevailed amongst the gravediggers, dead-cart drivers, and their wanton companions. If any one ventured to rebuke them, he was asked, with a volley of oaths, "what business he had to be alive, when so many better fellows were shovelled in their graves?" to which was added a salutary recommendation to go home and pray, until the dead-cart called for him. The watchmen got their share of ill-usage and abuse. All the guards had been marched out of town, with the exception of small detachments at Whitehall and the Tower. Robbery of every description was of course in full vigour, and every vice indulged in with impunity, while despair drove many to madness and suicide,--several individuals rushing naked out of their houses, and running to the river to drown themselves if not stopped by the watch. People fell dead while making purchases of provisions in the market; where, instead of receiving the meat from the butcher's hands, each buyer unhooked his purchase, and paid for it by throwing the value in a vessel filled with vinegar. Mothers destroyed their children, and nurses smothered their patients, while the bedclothes were stolen from the couch of the dead. Among the curious anecdotes of the time, the following is worth insertion: "A neighbour of mine, having some money owing to him from a shopkeeper in Whitecross-street, sent his apprentice, a youth of eighteen years of age, to get the money; he came to the door, and finding it shut, knocked pretty hard until he heard somebody coming down stairs. At length the man of the house came to the door; he had on his breeches or drawers, a yellow flannel waistcoat, no stockings, and a pair of slipt shoes, a white cap on his head, and death in his face. When he opened the door, he said, 'What do you disturb me thus for?'--'I come from such a one, my master,' replied the boy, 'to ask for the money you owe him.'--'Very well, my child,' returns the living ghost; 'call as you go by at Cripple-gate church, and bid them toll the bell.' So saying, he went up stairs again, and died the same hour." The story of the piper is founded on fact. This poor fellow having made merry in a public-house in Coleman-street, fell fast asleep under a stall near London Wall, Cripplegate; the under-sexton of St. Stephen's, one John Hayward, was going his rounds with his dead-cart, when he espied the piper, and, conceiving him to be a dead man, tumbled him on his heap of corpses, till, arrived at the burying-pit at Mount Hill, as they were about shooting the cart, the musician awoke, and, to the utter terror of the sexton and his comrades, began to set up his pipes. The following relation of a case of grief is rather remarkable. "A man was so much affected by the death of all his relations, and overcome with the pressure upon his spirits, that by degrees his head sunk into his body so between his shoulders, that the crown of his head was very little seen above the bones of his shoulders, and, by degrees losing both voice and sense, his face looking forward, lay against his collar-bone, and could not be kept up any otherwise unless held up by the hands of other people; and the poor man never came to himself again, but languished near a year in this condition, and died." This was _depression_ with a vengeance! Some of these unfortunate victims of the pestilential disease seem to have had poetical inspirations, for one of two men who had fled to the country was found dead with the following inscription cut out with his knife on a wooden gate near him: OmIsErY WE. BoTH ShaLL. DyE WoE. WoE: and our historian, who fortunately escaped the calamity, terminates his work with the following lines: A dreadful plague in London was In the year sixty-five, Which swept an hundred thousand souls Away; yet I alive. Astrologers were of opinion that the plague of London arose from a conjunction of Saturn and Jupiter in Sagittarius on the tenth of October, or from a conjunction of Saturn and Mars in the same sign on the twelfth of November.[15] Great as the mortality was during this affliction, the history of various other pestilences in foreign countries presents as melancholy a result. In Moscow, the plague introduced by the Turkish army carried off 22,000 inhabitants in a single month, and sometimes 12,000 in twenty-four hours. In Morocco, the mortality amounted to 1000 daily; in Old and New Fez, to 1500; in Terodant to 800. The total loss sustained in these cities and in the Mogadore was estimated at 124,500 souls. The black pestilence of the fourteenth century also caused the most terrific ravages in England. It has been supposed to have borne some resemblance to the cholera, but that is not the case; it derived its name from the dark livid colour of the spots and boils that broke out upon the patient's body. Like the cholera, the fatal disease appeared to have followed a regular route in its destructive progress; but it did not, like the cholera, advance westward, although like that fearful visitation it appears to have originated in Asia. The black pestilence descended along the Caucasus to the shores of the Mediterranean, and instead of entering Europe through Russia, first spread over the south, and after devastating the rest of Europe penetrated into that country. It followed the caravan, which came from China across Central Asia, until it reached the shores of the Black Sea; thence it was conveyed by ships to Constantinople, the centre of commercial intercourse between Asia, Europe, and Africa. In 1347 it reached Sicily and some of the maritime cities of Italy and Marseilles. During the following year it spread over the northern part of Italy, France, Germany, and England. The northern kingdom of Europe was invaded by it in 1349, and finally Russia in 1351,--four years after it had appeared in Constantinople. The following estimate of deaths was considered far below the actual number of victims: Florence lost 60,000 inhabitants Venice " 10,000 " Marseilles " in one month 56,000 " Paris " " 50,000 " Avignon " " 60,000 " Strasburg " " 16,000 " Basle " " 14,000 " Erfurth " " 16,000 " London " " 100,000 " Norwich " " 50,000 " Hecker states that this pestilence was preceded by great commotion in the interior of the globe. About 1333, several earthquakes and volcanic eruptions did considerable injury in upper Asia, while in the same year, Greece, Italy, France, and Germany suffered under similar disasters. The harvests were swept away by inundations, and clouds of locusts destroyed all that the floods had spared, while dense masses of offensive insects strewed the land. As in the recent invasion of cholera, the populace attributed this scourge to poison and to the Jews, and these hapless beings were persecuted and destroyed wherever they could be found. In Mayence, after vainly attempting to defend themselves, they shut themselves up in their quarters, where 1200 of them were burnt to death. The only asylum found by them was Lithuania where Casimir afforded them protection; and it is perhaps owing to this circumstance that so many Jewish families are still to be found in Poland. A curious monumental record of the plague is to be seen at Eyam, an insignificant village in Derbyshire, to the eastward of Tideswell. It is an ancient stone cross of curious form and workmanship, erroneously stated to have been erected to commemorate the extinction of the pestilence which was supposed to have been brought there in a bag of woollen clothes, sent from London to a tailor of the place. The hamlet was soon infected, and its panic-struck inhabitants fled in every direction, scattering death in their flight, until driven back within their boundaries. During the prevalence of this scourge, tradition makes honourable mention of the rector of the parish, William Mompesson. Determined not to abandon his flock in the hour of need, he never quitted the devoted spot. In vain he entreated his wife to remove from the pestilential sphere of action--she would not leave him. Eyam was now cut off from all communication with the neighbourhood. The worthy clergyman addressed the Earl of Devonshire, then residing at Chatsworth, acquainting him with his resolution, and requesting that regular supplies of provisions might be duly placed in certain points of the adjacent hills. If this request was attended to, he pledged himself that none of his parishioners should transgress a given boundary. Troughs and wells, which are still there, were dug to secure water supplied by a stream, which to this day bears the hallowed name of _Mompesson brook_. The following account of this benevolent pastor's conduct in this emergency is not without interest: "Aware that any assemblage of people breathing the same air under a confined roof, and coming into immediate contact with each other, must be highly dangerous, he closed the door of the church, availing himself of a nobler substitute "not made with hands,"--a rock that projected from the side of a steep hill, near the village, in a deep and narrow dingle. This rock is excavated through in different directions, the arches being from 12 to 19 feet high. In the middle of this romantic dell, from one of these natural porticoes, three times a week did he read prayers, and twice on Sundays did he address to his death-stricken congregation, the words of eternal life. By his own immediate directions, they arranged themselves on the declivity near the bottom, at the distance of a yard asunder. This spot is deservedly still held sacred, and known by the name of _Cucklet church_." The following letter from this worthy clergyman, dated 20th November, 1666, energetically describes the calamity: "The condition of this place has been so sad, that I persuaded myself it did exceed all history and example. I may truly say that our place has become a Golgotha--the place of a skull; and had there not been a small remnant of us left, we had been as Sodom, and been made like unto Gomorrha; my ears never heard, my eyes never beheld such ghastly spectacles. Now, blessed be God, all our fears are over, for none have died of the infection since the 11th of October, and all the pesthouses have been long empty. I meant, God willing, to spend most of this week in seeing all woollen clothes fumed and purified, as well for the satisfaction as the safety of the country. "Here has been such burning of goods, that the like I think was never known. I have scarcely left myself apparel to shelter my body from the cold, and have wasted more than needed, merely for example. As for my part, I cannot say that I had ever been in better health than during the time of this dreadful visitation, neither can I say that I have had any symptoms of the disease." During a considerable time the benevolent man and his wife had escaped the malady, but at last his excellent wife was smitten, and died in his arms at the age of 27--far from her children, who had been sent away at the commencement of the invasion. In 1813, Malta was visited with this fatal malady; when the scenes of the plague that desolated the island in the sixteenth century were renewed, notwithstanding all the sanitary precautions adopted by various governments since that period. Count Ciantar in his "_Malta illustrata_," gives an interesting account of the introduction of the plague at four different periods in that island. The first was in 1592; when, in the month of May, four galleys belonging to the Grand Duke of Tuscany, entered the port to procure pilots for the service. By permission of the Grand Master, Cardinal Verclula, a pilot was obtained, and the vessels steered towards the Egyptian coast. In the vicinity of Alexandria, they captured a galley bound to Constantinople, having on board 150 Turks. On hearing that the plague was raging at Alexandria, they returned to Malta with their prize, which was discovered to be infected, and for the first time the plague was brought into the country. The second plague broke out in 1623, and originated in the house of Paulus Emilius Ramadus, guardian of the port. But the whole of the infected persons having been immediately sent to the Lazaretto, the progress of the disease was checked, and it only carried off forty-five persons. The third plague took place in 1633, and broke out at the Marina gate, where vessels from the Levant usually anchored. The proprietor of a house in that quarter, having had some communication with one of these ships, contracted the disease, and infected his sister, who resided in the country at Casal Zeitun, and shortly after the whole family was attacked, their speedy removal to the Lazaretto, however arrested the disease. The fourth appearance of this malady in Malta, was far more destructive than it had been in the preceding years, even in 1675, and it continued its ravages for seven months. This circumstance has been attributed to a difference of opinion that prevailed among the members of the commissioners appointed to take the necessary steps for checking the progress of the disease. It appears that doubts were entertained as to the nature of the malady, hence the requisite precautions were not enforced; and instead of separating the diseased from the healthy part of the community, with the utmost rigour, prayers were put up, vows and offerings were made, and processions paraded the streets, nor it was not until the Grand Master had sent to France for medical aid, that the scourge was mitigated. On their arrival the first steps adopted by these physicians was to confine the inhabitants to their homes, and to remove the sick to the Lazaret. The ravages of the disease must have been very great, since out of a population of about 60,000, there died in Valetta 4000, in Burgo 1800, Senglen 2000, Burmola 1200, and in the villages upwards of 200. The last plague was supposed to have been brought in by a vessel from Alexandria, that entered the port on the 28th of March, 1813. It appeared that two of the crew had been seized during the voyage with symptoms of plague, then prevailing in Alexandria, which place the vessel had left with a foul bill of health. On the same day another vessel, the Nancy arrived from the same port, having also on board two men labouring under the disease, and she was followed by a Spanish polacca, the Bella Maria, from the same quarter. It was on the 16th of April that the disease first appeared in the island, in the case of a shoemaker in the Strada St. Paolo. The increase of the disorder was gradual, and from Valetta it spread to Citta Vecchia Bircharcara. My late friend, staff-surgeon Tully, thus describes the situation of the Island at this period: "The warm season was now rapidly advancing, the thermometer having risen several degrees at the latter end of May, and unfortunately, through the superstitious prejudices of the natives, considerable dependence was placed upon the anxiously-looked-for alteration in the state of the atmosphere, and every day was consequently expected to diminish the danger. This belief was too generally inculcated not to be productive of much mischief, as most persons felt assured that, if they could avoid danger until the summer heat set in, the evil would cease, and that the greatly-dreaded disease would then die a natural death. The consequence of this unfortunate belief was fatal--the freedom of intercourse produced by this blind confidence, led to a very general contamination, and men every where exposed to the baneful influence of the plague, became the active agents of the dissemination throughout the whole island." While the plague was thus raging at Malta, it made its appearance amongst the inhabitants of the Morea, having, it is supposed, been introduced from Romelia, by a man of the name of Kalangi, who was taken ill on his arrival, and died in two days. The following day his wife and daughter were attacked by the malady, which rapidly extended to Tornovo, and all the neighbouring towns. During the years 1813 and 1814, the banks of the Lepanto and the shores of Albania were nearly depopulated. In 1815 the fatal scourge broke out in the island of Corfu, in the village of Marathia. None of the medical men who attended the sick during this period, attributed the invasion of the disease to contagion. The doubt that had arisen in the minds of several experienced practitioners in regard to the non-contagious nature of the plague, is a matter of vital interest, since it not only concerns the health of nations, but in a commercial point of view it becomes a question of political economy of the utmost importance, as the severity of the quarantine laws, which must materially effect the prosperity of trade, would become useless if it could be proved that no contagion is to be apprehended from a free intercourse. It is somewhat curious that Dr. Mead long ago expressed his decided opinion that whenever the doctrine of non-contagion should be revived in England, (and it will be so, he adds, even a hundred years hence,) it will always excite alarm amongst those nations who are more prudent than ourselves, and less eager to entertain every kind of wild and visionary speculation. The contagionists affirm that the destructive ravages of the plague of Marseilles in 1720, when 60,000 inhabitants were carried off, arose from neglect in enforcing a rigid separation of the diseased from the healthy part of the community. The mortality in the plague of Messina, in 1743, during which 43,000 people fell victims to the disorder, is also referred to similar causes. They also maintain that the London plague of 1593, which destroyed 11,503 persons, was ascertained to have been introduced from Alkmaer; that the pestilence of London in 1603, which carried off 36,269 inhabitants, was brought from Ostend, and further that in 1636, the scourge which destroyed 13,480 victims in our metropolis, had been imported from Leyden. In 1665, when its still more fatal ravages swept away 68,596 citizens, it had also been traced to our foreign intercourse. Dr. Merlens who has accurately described the plague that raged at Moscow in 1771, asserts that it was introduced by a communication with the Turkish army. Notwithstanding which, by keeping the patients strictly guarded, the city was maintained free from infection, while the disease raged around in every quarter. Mr. Jackson gives a similar account of the plague at Morocco; and he adds, that daily observations convinced him that the epidemic was not caught by approach, unless that approach was accompanied by an inhaling of the breath, or by tending upon the infected person. With such a discrepance of opinion, we cannot be surprised at this anxiety to impugn the doctrine of those practitioners who maintain, that contagion is not to be dreaded, and that severe sanitary precautions are therefore vexatious and oppressive. If the progress of the disease, say the non-contagionists, depends upon personal contact with infected persons or goods, its ravages would never cease in those countries where no precautionary measures are taken to prevent communication between the infected and the healthy; that in Turkey for instance, where these precautions are not resorted to, there would be no cessation of the malady until it had swept away the whole of the population. To these arguments, plausible as they may appear in theory, it has been replied, that the plague to a certain extent has never ceased to exist in the Ottoman empire, but breaks out occasionally after temporary intermissions. As to the permanence of the diseases it is well known that like all other epidemic or endemic diseases, the plague may also be subject to atmospheric influence and be arrested in its progress without human aid. Sir James M'Grigor illustrates this fact in his "Sketches of the Expedition of the Indian Troops to Egypt." When the disease first broke out in the army, the cases sent from the regiments were from the commencement attended with typhoid symptoms; while those from the Bengal volunteer battalion, and the other corps encamped near the marshes of El Hamed, were of an intermittent and remittent type. The cases that occurred in the cold and rainy months of December and January, were of an inflammatory character, after which, as the weather became warmer, the disease at Cairo, Ghiza, Boula, and the isthmus of Suez assumed the form of a mild continual fever. The plague of London in 1665, was in like manner distinguished by a peculiar constitution of the atmosphere. It has also been doubted whether the plague be contagious in every instance of its appearance. Various persons have inoculated themselves with its virus with impunity, though several were ultimately victims of the bold experiment. In Egypt Dr. White inoculated himself ten times, but died of the disease after the eleventh trial.[16] The atmosphere of contagion it appears is limited, and strict attention to keep up a line of separation generally proves effectual in arresting or checking its progress. Contact appears necessary to extend the malady, and a direct absorption through the skin forms the ordinary means of transmission. When the cutaneous pores are closed by oil, or any other substance of the kind, an exemption from the fatal scourge has been frequently observed. Mr. Baldwin states, that among upwards of a million of inhabitants carried off by the plague in Upper and Lower Egypt during the space of four years, not a single oil-man, or dealer in oil, had suffered. Mr. Jackson made the same observation in the plague of Tunis. Dr. Assalini, an intelligent medical officer of the French army in Egypt, does not attribute this exemption to the stoppage of the pores, but as the result of profuse perspiration which the inunction of oil produces. The _zeit jagghy_ or olive oil, is considered a specific by most of the Asiatics; and my late friend Mr. Tully observed that all the attendants upon patients suffering from the plague, who carefully smeared their persons and their clothes with this substance, were exempt from the infection. The same observation was corroborated by Sir Brooke Faulkener, during the plague of Malta. Various have been the remedial means proposed in this terrific malady, and preservatives against it have been recorded in the following distich: Hæc tria labificum tollunt adverbia pestem; Mox, longè, tardè,--cede, recede, redi. The celebrated plague-water was composed of master-wort, angelica, peony, and butter-bur, viper-grass, Virginia snake-root, rue, rosemary, balm, carduus, water-germander, marygold, dragon-blood, goats'-rue, and mint, infused in spirits of wine. It appears manifest from all the evidence adduced by the contending theorists, that we may come to the following corollaries: 1. Plague may generally be considered as arising from contagion. 2. The spread and decline of the disease is influenced by local peculiarities and revolutions in atmospheric constitution. 3. It appears probable, that under peculiar local circumstances, it may have arisen spontaneously, without having been introduced by contagion; but this invasion must be considered of very rare occurrence. 4. Although transmitted by contagion, a certain distance preserves the healthy from the contamination of the diseased. 5. The enforcement of a limit of separation must be considered indispensable in all our sanitary regulations, in the framing of which great attention must be paid to discriminate between contagion and infection--two sources of distemper essentially different from each other. Although these precautions are pointed out by the result of long and unbiassed experience, they will in all probability be solely applicable to the plague: for we have every reason to believe that these sanitary measures will not prove efficient against the invasion of cholera, the yellow fever, and other diseases, which are by no means proved to be infectious or contagious. Without entering into the discussion, I feel no hesitation in giving it, as my decided opinion, that the cholera and yellow fever are not contagious. ABSTINENCE. Hippocrates asserted that most individuals who abstain from food for seven days, die within that period; or, if they survive this time, and are even then prevailed upon to eat or drink they still perish. Various instances of persons who have lived much longer without sustenance have been observed. In the records of the Tower we find the history of Cicely de Ridgeway, who was condemned to death for the murder of her husband in the reign of Edward III., and who remained for forty days without food or drink. This being ascribed to a miracle, she was of course pardoned. From the result of this starvation, the story may be considered fabulous for two reasons: first, from the improbability of the alleged abstinence; and, secondly, from the selection of forty days, a period clearly fixed upon for miracle-making, being the exact number of days our Saviour fasted. We have a better authenticated case in the one mentioned by Dr. Eccles in the Edinburgh Medical Essays for 1720. The starved person was a beautiful young lady, about sixteen years of age, who, in consequence of the sudden death of her father, was thrown into a state of tetanus (lock-jaw) so violent as to render her incapable of swallowing for two long and distinct periods,--the first of thirty-four, and the second of fifty-four days,--during which she neither experienced a sense of hunger nor of thirst, and when she recovered, she was scarcely reduced in size. Sir William Hamilton saw a girl, sixteen years of age, who was extricated from the ruins of a house at Oppido, in which she had remained eleven days: an infant in her arms, but a few months old, had died on the fourth day, as the young are not so able to endure abstinence. Dr. Willan attended a young man who had abstained from any sustenance except a little water flavoured with orange-juice for sixty days: death ensued a fortnight after. Foderé mentions some workmen who were extricated alive from a cold damp cavern, in which they had been immured under a ruin for fourteen days. Cetois, a physician of Poitiers, relates a still more singular case of total abstinence in a girl, who, from the age of eleven to that of fourteen, took no nourishment. Ann Moore, called the fasting woman of Tutbury, was to a certain extent an impostor, for although there was no truth in her assertion that she lived an incredible time without food, yet it appeared evident that her chief, if not her only support, was tea. That fluid is sufficient to maintain life appears evident from two papers inserted in the Philosophical Transactions; one of them giving an account of four men who were compelled to subsist upon water for twenty-four days, and the other of a young man who tasted nothing but the same fluid for eighteen years. An imposition having been suspected, he was shut up in close confinement for twenty days as a trial, when he uniformly enjoyed good health. Another wonderful instance of the same kind is that of Janet M'Leod, published by Dr. M'Kenzie. She was at the time thirty-three years of age, unmarried, and from the age of fifteen had had various attacks of epilepsy, which had produced so rigid a lock-jaw that her mouth could rarely be forced open by any contrivance; she had lost very nearly the power of speech and deglutition, and with this all desire to eat or drink. Her lower limbs were retracted towards her body; she was entirely confined to her bed, slept much, and had periodical discharges of blood from the lungs, which were chiefly thrown out by the nostrils. During a few intervals of relaxation, she was prevailed upon with great difficulty to put a few crumbs of bread comminuted in the hand into her mouth, together with a little water sucked from her own hand, and, in one or two instances, a little gruel; but, even in these attempts, almost the whole was rejected. On two occasions, also, after a total abstinence of many months, she made signs of wishing to drink some water, which was immediately procured for her. On the first experiment the whole seemed to be returned from her mouth, but she was greatly refreshed in having it rubbed upon her throat. On the second occasion she drank off a pint at once, but could not be prevailed upon to drink any more, although her father had now fixed a wedge between her teeth. With these exceptions, however, she seemed to have passed upwards of four years without either liquids or solids of any kind, or even an appearance of swallowing; she lay for the most part like a log of wood, with a pulse scarcely perceptible from feebleness, but distinct and regular. Her countenance was clear and pretty fresh; her features neither disfigured nor sunk; her bosom round and prominent, and her limbs not emaciated. Dr. M'Kenzie watched her with occasional visits for eight or nine years, at the close of which period she seemed to be a little improved. A Dutch girl of the name of Eve Hergen is reported to have lived from the year 1597 to 1611 with no other support than the scent of flowers. The magistrates of Meurs suspecting imposition, had her closely watched for thirteen successive days, without being able to detect any fraud. Over her picture were affixed some Latin verses, of which the following translation was given in a book called "An Apologie or Declaration of the Power and Providence of God, by George Hakewell, 1635:" This maid of Meurs thirty-six yeares spent, Fourteen of which she tooke no nourishment; Thus pale and wan, she sits sad and alone, A garden's all she loves to looke upon. According to Pliny, the _Astoni_ had no other food than this Batavian maiden, being unfortunately born without mouths. Sauvages mentions an academician of Toulouse who never thirsted, and passed his summers, notwithstanding the intense heat, without drinking. In most of the recorded cases of total or nearly total abstinence, water has been found more or less necessary, but not invariably. That some animals can thrive upon water, and even upon air, is demonstrated by naturalists. Snails and chameleons have been known to exist upon air for years. Garman has found that this nutriment is sufficient for the support of spiders; and Latreille has confirmed the experiment by fixing a spider to a piece of cork, and precluding it from any communication. Every entomologist repeatedly sees insects living in their cases, although pinned down for an incredible length of time. Mr. Baker relates that he kept a beetle shut up for three years without any food. Mr. Bruce kept two cerastes, or horned snakes, in a glass jar for two years, without any apparent food; he did not observe that they slept in the winter season, and they cast their skin as usual on the last day of April. Rudolphi kept a _Proteus Anguinus_ five years, and Zoys had one for ten years living on spring water renewed from time to time. Redi found that birds could sustain the want of food from five to twenty-eight days. A seal lived out of the water and without nourishment for four weeks. Four individuals of a large species of larval shell, (_Bulimus_,) from Valparaiso, were brought to England by Lieut. Graves. They had been packed up in a box, and enclosed in cotton; two for a space of thirteen, one for seventeen, and a fourth for upwards of twenty months; but on being exposed to the warmth of a fire in London, and provided with tepid water and leaves, they revived and lived for several months in Mr. Loddige's palm house, till accidentally drowned. Dogs can live without food from twenty-five to thirty-six days, but man does not easily support starvation more than a week, except in disease or insanity. The general effects of long fasting, however, are highly injurious when not destructive. They are chiefly feelings of great debility, fever, delirium, violent passion alternating with deep despondency. In general the temperature of the body falls several degrees, although Currie observed the contrary in a patient who died of inanition in consequence of a stricture of the oesophagus; the respiration becomes fetid, the secretion of the kidneys acrid and burning, and according to Magendie and Collard bloody, and the stomach is found contracted after death. Experiments on the duration of life in man and animals deprived of food, show that the warm-blooded animals are best able to support the want of food. But a phenomenon still more wonderful is the faculty that animals have been known to possess of living when deprived of atmospheric support. A hog, weighing about one hundred and sixty pounds, was buried in his sty under thirty feet of the chalk of Dover cliff for one hundred and sixty days. When dug out, it weighed but forty pounds, and was extremely emaciated, but clean, and white. The animal had nibbled the wood of the sty, and eaten some loose chalk. Lizards, especially the Newt, have been found embedded in chalk-rock, apparently dead, but have reassumed living action on exposure to the atmosphere. On their detection in this state, the mouth is usually closed with a glutinous substance so tenaciously, that they are often suffocated in their efforts to extricate themselves from confinement. Toads have been repeatedly discovered in a similar situation, embedded in blocks of stone, or in the very heart of trees. Dr. Edwards, a learned physiologist in Paris, has ascertained that blocks of mortar and heaps of sand possess sufficient porosity to admit enough air to support the life of reptiles; but they all perish if immersed in water or mercury, when surrounded by an exhausting receiver. The duration of existence of the amphibials of the Batrachian family, when plunged in water, depends in a great measure on its temperature. They die speedily if the water be lower than 32° Fahrenheit, or higher than 108°; and the longest duration of life is under 32°. How can we account for these anomalies? Various solid substances are known to proceed from invisible elementary principles. Do water and air contain them? Metallic stones of large volume fall from the air: how are they produced? whence come they? How vain and feeble are our pursuits, when the vanity of science seeks to penetrate into the arcana of nature; searching and endeavouring to account for the causes of causation! What absurd and impertinent hypotheses have not been broached on scholastic benches! They remind us of an anecdote related of the old Parisian Academy, when one of its sapient members read a voluminous memoir to prove that tides were provided by the Creator for the purpose of bringing vessels in and out of harbour; when one of the Encyclopedian wits gravely observed, that he had no doubt of the fact, since he had discovered, after unceasing and laborious research, that noses were made for the purpose of wearing spectacles! Although total abstinence from food for any length of time, excepting with hibernating animals, is a wondrous phenomenon, yet it is singular how little aliment is necessary for the purpose of sustaining life, and even health. Many instances of a frugality bordering upon starvation are known. The most economical housekeeper on record was Roger Crabb, the Buckinghamshire hermit, who allowed himself three farthings a week. Dr. Gower of Chelmsford had a patient who lived for ten years on a pint of tea daily, now and then chewing half a dozen raisins and almonds, but without swallowing them; once a month, by way of a treat, she ate a morsel of bread the size of a nutmeg. The late Duke of Portland, after a long illness, during which he was attended by Dr. Warren, lived on bread and water for six weeks, at the expiration of which he was allowed _one boiled smelt_. Numerous persons have been known to live to old age, in perfect health, who never used animal food or wine; such was Dr. Hecquet, the Sangrado of Lesage, who published a curious treatise on fasting in Lent: Paris, 1709. The following lines were written on a man named Offley: Offley three dishes had of daily roast; An egg, an apple, and the third a toast. Most unquestionably, if this Offley was not a man of hard labour, or who took much exercise, this diet, scanty as it may appear, would have been quite sufficient to support life, for his fare was sumptuous, compared to the diet prescribed by St. Theresa to her Carmelite nuns, and which consisted of one egg, herb-soup, with wormwood ashes and aloes. However, in regard to the wondrous fasting of various hermits and holy men, we must take their histories _cum grano salis_. They clearly belonged to two classes,--enthusiasts or impostors: enthusiasm, which is little short of lunacy, enables the monomaniac to endure starvation with ease; and as to impostors, it is probable that, like Friar Tuck they had a _bonne bouche_ in a corner of their cells. POISON OF THE UPAS, OR IPO. Such are the names given by the natives of the Molucca Islands and in the Indian Archipelago to a deadly poison which is used to impregnate the heads of their arrows. The tree from which it is extracted is named _Bohou Upas_, _Boa Upas_, and _Pohou Antiar_. Various accounts of its deleterious nature have been given by ancient travellers. Cleyer and Spielman described it upwards of a century back, and state that no antidote to its dreadful action is known, though vomiting, produced by the most disgusting means, was considered the only method of arresting its dire effects. Spielman asserts that the land for several miles round these trees is desolate and barren, for no plant can grow under their influence. The poison, he states, flows in a milky form from the tree, and no one can approach it at this period, as one drop of the fatal juice falling upon the face or hands produces instant stiffness of every limb, followed by rapid death; it is therefore obtained at the end of long bamboo canes, armed with a pointed tube to receive it when plunged into the bark. Rumphius confirms in a great measure the above statements, and describes the tree, which he divides into male and female: he adds, that they only grow in the island of Celebes, and that all around the dreaded spot is desert and consumed. A more recent Dutch traveller, Foersech or Fooerch, did not let so fertile a subject escape, and has cultivated most industriously this dreary desert in the following account. Sterility prevails for upwards of ten miles round this dreadful tree on the part of the island of Java where it grows. When criminals are sentenced to death, they are offered a free pardon if they consent to seek a small boxful of this valuable yet terrific poison. They are first sent to the dwelling of a priest who resides at a safe distance from the spot; there they arrive, accompanied by their disconsolate and wailing families. They remain with this holy man for a few days, during which he affords them both spiritual comfort and good advice; the latter urging the precaution not to set out until the wind blows in such a direction as to waft from them the floating emanations. On their departure on this dreaded expedition he gives them a small box of silver or tortoise-shell, covers their head and face with a leathern hood with glass eyes, and protects their hands with a thick pair of gloves of the same material. He then accompanies them about two miles on their sad journey, and then he describes the hellish spot where this treasure is to be found as minutely as any one can describe what he has not seen; then, giving the poor pilgrim his blessing, he departs on his return. This worthy man informed our traveller that, during thirty years which he had held that enviable situation, he had sent off no less than seven hundred criminals, of whom only twenty-two returned: and he confirmed the statement by exhibiting a list bearing their names and the offences for which they had been tried. Mynheer Foersech further assures his gentle readers that he witnessed several of these expeditions, and entreated the culprits to bring him some branches of the tree; but two withered leaves were the only specimens he could obtain from the solitary wretch who had the good fortune to escape, and who described the tree as growing on the borders of a rivulet, being of moderate height, and surrounded by a cluster of young ones. The ground around them was of a brown sandy nature, and strewed with the remains of human victims. He also clearly ascertained that no living creature can exist within fifteen miles of the spot. The streams that flow near it yield no fish, and the birds that fly over it fall to the ground; several of the latter were occasionally brought to the priest,--whether he ate them, or not, the Dutchman does not inform us. Amongst various offenders doomed to death by this poison he relates the case of thirteen ladies, who, for the crime of infidelity, were inoculated in the bosom with the point of a kritz or Malayan dagger dipped in the upas; and in sixteen minutes they had ceased to live. By recent experiments upon animals this part of his narration may be credited; but, in regard to the other account, we must apply to it the French saying, "_Il vaut mieux y croire que d'y aller voir_." Indeed the whole of Foersech's account is justly considered a fiction. However, some French travellers thought otherwise; and Mr. Deschamps, physician and naturalist attached to the expedition of Mr. D'Entrecasteaux, when in Java, ascertained that this wonderful tree was not uncommon in the forests of the country, nor was the approach to it in the slightest degree apprehended. The juice procured by incisions in the bark was called by the natives _upas_ or _oupas_, and was of so active a nature that it caused immediate death when thrown into the circulation. The Malays mixed it with various other ingredients more especially galanga and garlic, when they employed it. The Javanese only impregnated their arrows with it for the chase: a proof that they did not consider it as affecting the system of the slain animal. Most probably Foersech's priest was aware of this circumstance when he accepted from the privileged malefactors the game killed by the tree they had sought. This tree, according to Deschamps, is named in the country, _pohou antiar_; it frequently rises to the height of thirty or forty feet. When one of its branches is broken, or its bark incised, a milky juice exudes, which becomes inspissated when in contact with the atmosphere. In appearance this tree bears some resemblance to our elm. Mr. Deschamps confirms the relation of Rumphius, who stated that the Dutch, in their wars with the natives, were obliged to wear thick buff cuirasses to protect them against their poisoned missiles, the wounds of which were inevitably fatal. Further information relative to the upas has been afforded by the ingenious Mr. Leschenault, who, during his residence in Java, procured two specimens of the poisonous substance obtained in Java, and of that brought from the islands of Borneo and Macassar. In Borneo, the mountaineers of the interior, who are called _Orang-Daias_, collect it, and keep its preparation a profound secret. They carry it carefully wrapped up in palm-leaves. Their hunting arrows have heads spear-pointed, and impregnated with this substance; those that are prepared for war bear a shark's tooth fixed in a brass socket, and merely attached to the shaft by the gum resin of the ipo; the barbed point remaining rankling in the wound it has inflicted, the gum dissolves, and speedily brings on death. Mr. Leschenault tried these arrows on dogs and other animals, and they expired shortly after in horrible convulsions. But the latest account of this celebrated tree is given by Dr. Horsfield who was in Java during its occupation by our troops. He informs us that although the Dutch surgeon Foersech's account must have been a fabrication, yet there did exist a tree called the _Anchar_ from the sap of which the natives prepared a fatal poison. The tree belongs to the 21st class of Linnæus, the _Monæcia_. The male and female flowers are produced on the same branch at no great distance from each other, the females being in general above the males. The seed-vessel is an oblong drupe, covered with the calyx; the seed an ovate nut with cells. The top of the stem sends off a few stout branches, which spreading nearly horizontally with several irregular curves, divide into smaller branches, and form a hemispherical, not very regular crown. The stem is cylindrical, perpendicular, and rises completely naked to the height of sixty or seventy, and even eighty feet. Near the surface of the ground it spreads obliquely like many of our large forest trees. The bark is whitish, slightly bursting into longitudinal furrows. Near the ground this bark is, in old trees, more than half an inch thick, and when wounded yields copiously the milky juice from which the poison is prepared. This juice is yellowish, frothy, and becomes brown when exposed to the air. In making these researches Dr. Horsfield had some difficulty with the native labourers, who feared a contagious eruption, but nothing more. The Doctor further informs us that it is fatal to animals,--destroying dogs in an hour, mice in ten minutes, monkeys in seven, and cats in fifteen, while a buffalo subjected to the experiment was two hours and ten minutes dying. The natives of Macassar also call this venomous production _ipo_. They have two varieties of the tree, as in Java; the one called _upas antiar_, and the other, much more violent and prompt in its action, _upas tieute_ In the preparation of the poison for use much mystery is observed by the natives, and various ingredients are mixed up with it; but as they are known to be harmless, such as onion and garlic juice, pepper, ginger, galanga, they are most probably employed to deceive the curious who might wish to ascertain the nature of this deadly composition. Mr. Leschenault having brought home a small quantity of this poison, it was tried by Messrs. Delile and Magendie in several experiments, when it was found to act more or less violently, according to the age and size of the individual, or the quantity of the upas. One grain and a half inoculated in a young dog killed it in four minutes, only producing one convulsive fit. In a dog weighing fourteen pounds, half a grain of upas occasioned death at the expiration of one hour and fifty-seven minutes, during which the animal experienced several violent convulsions. A few drops of diluted upas, injected in the chest of a dog, weighing twenty pounds, occasioned a lock-jaw, which destroyed him in a minute and a half. Eight drops injected in the jugular vein of a horse produced immediate tetanus and speedy death. For further information regarding these cruel experiments we must refer to the experimenter's publication. It appears, however, that the power of this venomous substance is so intense that time does not weaken it; for the upas employed in these experiments had been collected and kept for upwards of seven years, when its effects were as prompt as when tried in a recent state. The natives of Java consider sea-salt as the best antidote, but Mr. Delile found it quite inert: various experiments induced him to think that in these cases death is produced by asphyxia; and he considers the means employed to restore suspended animation in persons supposed to have been drowned, as the most likely to save the life of individuals who might be wounded with this substance. The rapidity with which poisonous substances are absorbed in the system is truly terrific, more especially in such as are of a narcotic nature. The latter act by abolishing all nervous energies, but when applied locally their effects are also local, as is shown by the following experiments of Müller: "I held the nerve of a frog's leg which was separated from the body, in a watery solution of opium for a short time, and that portion of the nerve lost its irritability, i.e. its property of exciting twitchings of the leg when it was irritated; but below the part that the poison had touched the nerve still retained this function." It is therefore evident that before narcotic poisons can exert a general influence they must be carried into the circulation. Duprey and Brachet, two French physiologists, have sought to prove that animals cannot be destroyed by narcotic poisons, introduced in the stomach, if the _nervus vagus_ has been divided on both sides; at least, that they do not die so soon. However, Wernscheidt, in thirty experiments on mammalia, could not perceive this difference, provided the animals were of the same size and species. Prussic acid exerts its influence so rapidly that it cannot be supposed to have been thrown into the circulation. The spirituous solution of the extract of nux vomica introduced in the mouth of a rabbit, produces immediate death, whereas when applied to any nerve distant from the brain it produces no general symptoms. This rapid effect of prussic acid is supposed to arise from its great volatility and powers of expansion, by which it is diffused more quickly through the circulation than the blood. According to Schrader one drop of this substance introduced in the bill of a bird killed it in four or five minutes. Hydrocyanic acid gas mixed with atmospheric air has when inhaled destroyed dogs, cats, rabbits, and various birds, in from two to ten seconds. Magendie found that the introduction of one drop of the acid in the jugular vein caused instantaneous death; a glass tube dipped in this perilous substance applied to the tongue of a dog, produced a similar effect, which was also the result when applied to the eye. It is not generally known that tobacco and its preparations are deadly poisons, one drop of oil of tobacco introduced in the mouth of a dog produced violent convulsions with hurried breathing; a quarter of an hour after, the unfortunate animal seemed to be recovered, when the introduction of another drop killed it in two minutes. M'Cartney and Orfila obtained similar results, though no such effects were produced when it was applied to a nerve or the surface of the brain. The French poet Santeuil died from having drank wine in a glass containing some snuff. In all cases of death produced by this substance the lungs are found dense and livid. It is not only in the upas that the Indians seek the means of poisoning their missiles. In America they employ the _Ticronas_ a juice extracted from various plants, and the preparation of which, transmitted from one generation to another is considered a valuable secret. La Condamine asserts that its mere odour is sufficient to destroy the criminals doomed to smell it, but Fontana has found by many experiments that this assertion was made upon report, which travellers too frequently rely upon to save themselves the trouble of investigation. Arrows saturated with this poison, become more active after having been dipped in hot water. The Indians of Guiana dip their arrows in the juice of the _Woorara_, and the _Curara_, which also occasions rapid death and decomposition of the lungs. Humboldt informs us that the _Curara_ is obtained from the bark of a tree called _Vejuco_ de _Mavacure_; it is inspissated over a slow fire and then mixed with a gum drawn from the _Kiracagnero_. The Abbé Salvador Gilii tells us in his history of America, that he has seen the strongest animals succumb instantly when thus wounded, but the poison does not produce any effect on their meat. HOMOPHAGOUS AND POLYPHAGOUS. These are appellations given to certain individuals of a depraved appetite, that enables them to devour raw meat, and various other substances which most unquestionably would destroy any person not gifted or cursed with such an omnivorous digestion. Various are the ancient stories related of such voracious wretches. Ovid describes one Erisichthon, who, as a punishment for cutting down the groves of Ceres, (very possibly to obtain fuel to cook his food,) was sentenced to perpetual hunger, and terminated his gluttonous career by eating up his own limbs. Theagenes thought nothing of an ox for his dinner; and the famed Crotonian athlete, Milo, knocked down bullocks with his fist for his daily meals, which usually consisted of twenty _minæ_ of meat and the same ration of bread. Vopiscus relates that a man was brought before the Emperor Maximilian, who devoured a whole calf, and was proceeding to eat up a sheep, had he not been prevented. To this day, in India, some voracious mountebanks devour a live sheep as an exhibition. Dr. Boehmen of Wittenberg witnessed the performance of one of these polyphagous individuals, who commenced his repast by eating a raw sheep, a sucking-pig, and, by way of dessert, swallowed sixty pounds of prunes, stones and all. On another festive occasion, he ate two bushels of cherries, with several earthen vases, and chips of a furnace. This meal was followed up by sundry pieces of glass and pebbles, a shepherd's bagpipe, rats, various birds with their feathers, and an incredible number of caterpillars. To conclude his dinner, he swallowed a pewter inkstand, with its pens, a pen-knife, and a sandbox. During this deglutition he seemed to relish his food, but was generally under the influence of potations of brandy. His form was athletic, and he could carry four heavy men on his shoulders for a league. He lived to the age of seventy-nine, but died in a most emaciated state, and, as might be imagined, toothless. Helwig knew an old man who was in the habit of eating eighty pounds of different articles of food daily. Real Colomb mentions an omnivorous glutton, who, in the absence of any salutary aliment, satisfied his cravings with any other substance, and was once known, when hungry, to eat the contents of a sack of charcoal, and then to swallow the bag to facilitate its digestion. One of the attendants on the menagerie of the Botanical Gardens in Paris, who bore the euphonious name of _Bijou_, used to devour all the offals of the theatre of Comparative Anatomy, and ate a dead lion in one day. He was active, and lived to the age of sixty. A cannibal once desolated the Vivarais, by dragging human victims to his den, where he devoured them. On the opening of the corpse of a convict in the galleys of Brest, there were found in his stomach about six hundred pieces of wood, pewter, and iron. All these accounts might appear most exaggerated, perhaps fabulous, had not many physicians in Paris known the celebrated Tarrare. The history of this monster is as curious as his habits were disgusting. He commenced his career in life in the capacity of clown to an itinerant quack, and used to attract the notice of the populace by his singular powers of deglutition, swallowing with the utmost ease corks, pebbles, and basketsful of apples. However, these experiments were frequently followed by severe pain and accidents, which once obliged him to seek assistance in the Hôtel Dieu of Paris. His sufferings did not deter him from similar experiments; and he once tried to exhibit his wonderful faculties by swallowing the watch, chain and seals, of Mr. Giraud, then house-surgeon of the establishment. In this repast he was foiled, having been told that he would be ripped up to recover the property. In the revolutionary war, Tarrare joined the army, but was soon exhausted on the spare diet to which the troops were obliged to submit. In the hospital of Sultzen, although put upon four full rations, he was obliged to wander about the establishment to feed upon any substance he could find however revolting, to subdue his voracious hunger. These singular powers induced several physicians to ascertain how far these omnivorous inclinations could carry him in his unnatural cravings. In presence of Dr. Lorentz he devoured a live cat, commencing by tearing open its stomach, and sucking the animal's blood with delight. What was more singular, after this horrible feast, like other carnivorous brutes, he rejected the fur and skin. Snakes were to him a delicious meal, and he swallowed them alive and whole, after grinding their heads between his teeth. One of the surgeons, Mr. Courville, gave him a wooden lancet-case to swallow in which a written paper had been folded. This case was rejected undigested, and the paper being found intact, it became a question whether he might not be employed to convey secret correspondence; but having been taken up at the Prussian outposts as a spy, being disguised as a peasant without a knowledge of the language, he received a severe bastinado, which effectually cured him of an appetite for secret service, and on his return he had recourse to the safer means of obtaining food in kitchens, slaughter-houses, and dunghills. At last, a child of fourteen months old having disappeared under suspicious circumstances, he was driven out of the hospital, and lost sight of for four years, when he applied for admission into the hospital of Versailles, in a state of complete exhaustion, labouring under a violent diarrhoea, which terminated his hateful existence in his twenty-sixth year. He was of the middle size, pale, thin, and weak; his countenance was by no means ferocious, but, on the contrary, displayed much timidity; his fair hair was remarkably fine and soft; his mouth was very large, and one could scarcely say that he had any lips; all his teeth were sound, but their enamel was speckled; his skin was always hot, in a state of perspiration, and exhaling a constant offensive vapour. When fasting, the integuments of his abdomen were so flaccid that he could nearly wrap them round him. After his meals the exhalation from his surface was increased, his eyes and cheeks became turgid with blood, and, dropping into a state of drowsiness, he used to seek some obscure corner where he might quietly lie down and digest. After his death, all the abdominal viscera were found in a state of ulceration. Instances are recorded where a similar facility to swallow fluids had been observed. At Strasburg the stomach of a hussar was exhibited who could drink sixty quarts of wine in an hour. Pliny mentions a Milanese, named _Novellus Torquatus_, who, in presence of Tiberius, drank three _congii_ of wine. Seneca and Tacitus knew a man of the name of Piso who could drink incessantly for two days and two nights; and Rhodiginus mentions a capacious monster called _the Funnel_, down whose throat an amphora of liquor could be poured without interruption. To what are we to attribute these uncommon, nay, these unnatural faculties? Neither physiological experiments during life, nor anatomical investigation after death, have hitherto enabled us to form an opinion. Great as the progress of science has been, we are still doubtful as to the nature of the digestive process. All the hypotheses on the subject are liable to insuperable objections. Hippocrates and Empedocles attributed digestion to the _putrefaction_ of food. Experiments have clearly demonstrated the fallacy of this doctrine: rejected food is never in a state of putridity; on the contrary, meat in a perfect state of putrescence has been restored to sweetness and freshness on being received into the stomach. Dead snakes have been found with animal substances, part of which had been swallowed and the remainder hanging out of their mouths; when the swallowed portion was fresh, and the portion exposed to the atmosphere in a state of corruption. Galen, and after his school, Grew and Santarelli, ascribed digestion to a _concoction_, during which, food was maturated by the stomach's heat, like fruit by the solar rays. Pringle and Macbride advocated the doctrine of _fermentation_; while Borelli, Keil, and Pitcairn resolved the question by the mechanism of _trituration_, making a mill of the stomach, which ground down food, according to Pitcairn's calculations, with a pressure equal to a weight of one hundred and seventeen thousand and eighty pounds. Boerhaave endeavoured to reconcile the opinions of the _concocters_ and _grinders_, by combining the supposed theory of _concoction_ and _trituration_. Lastly, Cheselden fancied that digestion was operated by a peculiar secretion in the stomach, called _gastric juice_; and Haller, Réaumur, Spallanzani, Blumenbach and most other modern physiologists, concur with him in the same opinion, although admitting that this function is most probably assisted by various accessory circumstances. This juice was found, upon experiment, to be endowed, not only with the antiseptic power of preserving the contents of the stomach from putrefaction, but with the property of being a most powerful solvent. Pieces of the toughest meats and bone have been enclosed in perforated metallic tubes, and thrust down the stomach of carnivorous birds, and in the space of about twenty-four hours the meats were found to be diminished, or, in other words, digested to three-fourths of their bulk, while the bones had totally disappeared. Dr. Stevens had recourse to a similar experiment on the human stomach, by means of a perforated ivory ball, and with the same result. The gastric juice of the dog dissolves ivory; and that of a hen has dissolved an onyx, and diminished a golden coin. Not long since, upon examining the stomach and intestines of a man who died in a public-house, he was found to have been a _polyphagous_ animal, since several clasp-knives that he had swallowed were discovered with their blades blunted and their handles consumed. Since these experiments, however, Dr. Montegre of Paris, who was gifted with the faculty of discharging the contents of his stomach at will, has fully proved that this gastric juice, when not in an acid state, is subject to putrefaction when submitted to external animal heat; that this corruption did not occur when an acid prevailed, and saliva intermixed with vinegar was equally free from a similar decomposition. He moreover asserts, that he had recourse to numerous experiments to digest food artificially in this supposed solvent, but without obtaining results similar to those advanced by Spallanzani; and, finally, he found little or no difference between the gastric juice and saliva. This acid, which generally exists in the gastric juice, has been ascertained by Dr. Prout to be the muriatic, both free and in combination with alkalis: while Tiedemann and Gmelin maintain that, in its natural state, no acid is to be met with; but that, when food is commingled, an acid which they consider the acetic acid is produced in considerable quantity.[17] The ostrich, that may be considered a connecting link between birds and quadrupeds, is gifted with powerful digestive organs, and is known to swallow stone, glass, and iron; but this faculty appears to be a gift of all-bounteous Providence, to enable the creature to digest the various substances it meets with when traversing burning deserts for hundreds of miles, when these hard bodies actually perform the function of teeth in the animal's stomach, by aiding the comminution of its indigestible food. The structure of the ostrich has a near resemblance to that of the camel, destined to perform the same dreary journeys. The wings are not designed for flight, and in speed he equals the horse. Adanson affirms that he had seen two ostriches at the factory of Podore, that were broken in to carry single or double riders, and the strongest and youngest would run more swiftly with two negroes on his back than the fleetest racer. Spallanzani endeavoured to prove that the pebbles and gravel swallowed by various birds were of no use in the process of digestion; but Hunter, who had found two hundred pebbles in the gizzard of a turkey, and one thousand in that of a goose, demonstrated their utility in the trituration of their food, since these birds were found to be unable to digest, and consequently to thrive upon their nourishment when deprived of this mechanical aid. It is curious that the owl, which easily digests meat and bones, cannot be made to digest bread or grain, and yet dies if confined to animal food. The eagle, and other birds of prey, can dissolve both. A singular process of digestion is observed in the stormy petrel, which lives entirely on oil and fat substances whenever it can obtain them; but when fed with other articles of food, Nature, true to her laws, converts them into oil; the bird still discharges pure oil at objects that offend him, and feeds his young with the same substance. The petrel must, no doubt, be a bilious subject, for he delights in misery, and his presence is a sure presage of foul weather to the experienced seamen; and when The wrathful skies Gallow the very wanderers of the dark, And make them keep their caves, he is seen riding triumphantly on the whirlwind, and skimming the deepest chasms of the angry waves. This bird is said to be named 'petrel' from Peter, since, like that saint, he is supposed to have the power of walking on the waters. The singular appetites which have been noticed seem to have been individual peculiarities, uninfluenced by a morbid condition; but there are cases in which a depraved appetite is symptomatic of disease, where we see persons otherwise possessed of sound judgment longing, not only for the most improper and indigestible food, but for substances of the most extraordinary and even disgusting nature. Thus we have seen patients, more especially young females and pregnant women, devouring dirt, cinders, spiders, leeches, hair, tallow, and paper. An ingenious writer affirms that "more literature in the form of paper and printed books has been thus devoured, than by the first scholars in Christendom." Dr. Darwin tells us that he saw a young lady about ten years of age that used to fill her stomach with earth out of a flowerpot, and then vomited it up, with small stones, bits of wood, and wings of various insects. John Hunter has described an endemic disease among the Africans in Jamaica, in which they devoured dirt. Mason Good, when speaking of this affection, says, "that the longing for such materials is, in this disease, a mere symptom, and rarely shows itself till the frame is completely exhausted by atrophy, dropsy, and hectic fever, brought on by a longing of a much more serious kind,--a longing to return home, a pining for the relations, the scenes, the kindnesses the domestic joys, of which the miserable sufferers have been robbed by barbarians less humanized than themselves, and which they have been forced or trepanned to resign for the less desirable banquet of whips, and threats, and harness, and hunger." Roderic à Castro relates the case of a lady who could eat twenty pounds of pepper, and another who lived upon ice. Tulpius mentions a woman who, during her pregnancy, longed for salt herrings, and ate fourteen hundred at the rate of five herrings per diem. Longius affirms that a lady in Cologne, who was in that state that ladies wish to be who love their lords, took such a fancy to taste the flesh of her husband that she actually assassinated him, and, after indulging in as much fresh meat as the weather permitted, salted the remainder for further use. This cannibal inclination seems not to be uncommon. The said Roderic à Castro knew a woman in the same thriving condition, who felt an inexpressible desire for a bit of the shoulder of a neighbouring baker, and her husband was persecuted by her constant prayers and lamentations to prevail on the worthy man to allow her one bite for charity's sake: but the first bite was so heartily inflicted, that the crusty baker would not submit to a second. In the Philosophical Transactions there is a case related of a woman whose fancies were not quite so solid, and who used to gratify her aerial appetites by putting the nozle of a bellows down her throat, and blowing away until she was tired. These longings of parturient women are most common; but it is rather curious, that, among our negroes in the West Indies, the husbands pretend to long for their wives, and endeavour to gratify them by proxy. Possibly such might have been the fancy of Cambes, the Lydian prince, who, according to Ælian, took it into his head one night to eat up his beloved wife. CAUSES OF INSANITY. Madness is attributed to moral and physical causes. Physicians do not agree as to the prevalence of either of these sources of human misery. Some of them, most unjustly accused of materialism, seem to lean to the opinion that, generally speaking, physical causes can be traced in _post mortem_ examination; while others, equally skilled in accurate anatomical investigations, maintain that these organic derangements are very seldom met with. Lawrence affirms that he had "examined after death the heads of many insane persons, and had hardly seen a single brain which did not exhibit obvious marks of disease;" and he further states, "that he feels convinced from his own experience, that very few heads of persons dying deranged will be examined after death without showing diseased structure, or evident signs of increased vascular activity." The celebrated Morgagni gives similar results of his extensive dissections. Meckel and Jones are of the same opinion. However, Pinel, whose anatomical pursuits on the subject were most extensive, clearly declares that he never met with any other appearance within the cavity of the skull than are observable in opening the bodies of persons who have died of apoplexy, epilepsy, nervous fevers and convulsions. Haslam, whose experience in this matter was also very great, asserts that nothing decisive can be obtained in reference to insanity from any variations of appearance that have hitherto been detected in the brain. Greding observed in two hundred and sixteen maniacal cases which he examined, the whole of whom died of disorders unconnected with their mental ailments, that three of the heads were exceedingly large, two exceedingly small; some of the skull bones were extremely thick, others peculiarly thin; in some the frontal bones were small and contracted, in others the temporal bones compressed and narrow. In this confusion and clashing of opinions, when unfortunately each theorist views, or fancies that he views, functional or organic derangements sufficiently evident (in his eyes at least) to support his doctrine, it is no easy matter to come to a fair conclusion. It can only be observed, that, as the wonderful sympathies of the brain with other organs especially the viscera of the abdomen, are universally acknowledged, the morbid condition in which the brain is occasionally found may have arisen from a primary morbid condition of some other organ. Hence it is difficult to say whether insanity is most generally a primary or a secondary affection. Physical causes act both upon the brain and the abdominal system. Concussion and compression of the brain will occasion nausea, vomiting, and hepatic affections, and the presence of worms in the intestines will excite convulsions and epilepsy. In regard to moral causes, they may also act directly or indirectly upon the brain, or the parts that sympathize with it. Sudden or violent emotions are known to produce an immediate effect upon our digestive functions, which may in turn by their sympathetic connexion act upon the brain and the mind, although the connexion between brain and mind is not yet proved in any conclusive manner. However, in a practical point of view, whatever discrepancy of opinion may prevail on this subject, I think it will be found advisable to consider most, if not all recent cases of insanity, as arising from physical causes, and therefore to submit the patient to such a medical treatment in addition to moral aid, as the prevalence of morbid symptoms of local derangement are more or less evident. My own experience has fully convinced me that a morbid condition of the cerebral organ, and the viscera of the thorax and abdomen, are invariably met with, and must have proved of sufficient importance to develop symptoms which the slightest observations might have detected. How far the organic derangement may have been either the cause or the result of insanity I am not prepared to say, but they have generally borne the appearance of having originated in undue excitement. On this most important subject I feel much gratification in quoting the following opinion of the experienced Pinel: "It appears in general that the primitive seat of insanity is in the region of the stomach and intestinal canal, and it is from this central part that mental aberration is propagated as by irradiation." Esquirol is of opinion that insanity arises from a lesion of the vital functions of the brain, and not unfrequently from a disturbance in the various points of sensibility in different parts of the system. That mental emotions, whether producing any alteration in the physical condition of the individual, or not, occasion various degrees of insanity, is proved by experience. The French revolution, during its execrable phases, offered a wide and fertile field of observation on this subject; and the various events that marked those fearful times were certainly well calculated to affect any brain capable of becoming deranged. The following results of these observations are curious: "Among the lunatics confined at Bicêtre," says Pinel, "during the third year of the Republic, I observed that the exciting causes of their maladies, in a great majority of cases, were extremely vivid affections of the mind; such as ungovernable or disappointed ambition, religious fanaticism, profound chagrin, and unfortunate love. Out of one hundred and thirteen madmen with whose history I took pains to make myself acquainted, thirty-four were reduced to this state by domestic misfortunes, twenty-four by obstacles to matrimonial union, thirty by political events, and twenty-five by religious fanaticism. Those were chiefly affected who belonged to professions in which the imagination is unceasingly or ardently engaged, and not controlled in its excitement by the exercise of the tamer functions of the understanding, which are more susceptible of satiety and fatigue. Hence the Bicêtre registers were chiefly filled from the professions of priests, artists, painters, sculptors, poets, and musicians, while they contained no instances of persons whose line of life demands a predominant exercise of the judging faculty,--not one naturalist, physician, chemist, or geometrician." The following is a return of the supposed moral causes of insanity observed in the Salpétrière. In the years 1811 and 1812 Domestic affliction 105 Disappointed love 46 Political events 14 Fanaticism 8 Fright 38 Jealousy 18 Anger 16 Misfortunes in circumstances 77 Offended vanity 1 --- Total 323 In Mr. Esquirol's private establishment during the same period: Domestic affliction 31 Disappointed love 25 Political events 32 Fanaticism 1 Fright 8 Jealousy 14 Misfortunes 14 Offended vanity 16 Baffled ambition 12 Intense study 13 Misanthropy 2 --- Total 168 It must be observed that the latter return, in which we find twenty-eight persons maddened by disappointed ambition and offended pride, is of a private establishment, whose inmates of course belonged to the better classes of the community. By the return from Pennsylvania, out of fifty lunatics, thirty-four cases arose from moral causes. Of physical causes hereditary madness is the most prevalent, as appears clearly from the following table extracted from the registers of the Salpétrière. Hereditary insanity 105 Convulsion during gestation 11 Epilepsy 11 Female derangements 55 Diseases of child-birth 52 Critical periods 27 Old age 60 Insolation 12 Injuries of the head 14 Fever 13 Syphilis 8 Effects of mercury 14 Worms 24 Apoplexy 60 When speaking of hereditary madness, Dr. Abercrombie is of opinion that where a tendency to insanity exists, there may be in many cases, circumstances in mental habits or mental discipline calculated to favour or to counteract the tendency, when the mind wanders away from the proper duties of life or luxuriates amid scenes of imagination, thus permitting mental emotions, of whatever kind, to be excited in a manner disproportional to the true relation of the object which gave rise to them; allowing the mind to ramble among imaginary events, or to be led away by slight and casual relations, instead of steadily exercising the judgment in the investigation of truth. These observations are no doubt most luminous, yet as I have elsewhere remarked, hereditary predisposition to insanity may be brought into action, by the constant scenes that pass in the presence of those individuals who may daily have to witness the aberrations of an unhappy relative. The mind dwells on the sad subject, and it becomes a source of constant apprehension, when the mere dread of an hereditary evil is perhaps sufficient to drive to madness. So powerful is the sway even of imaginary terror, that we need not wonder that natural fear should be productive of results still more injurious to our intellects. There seems to exist a certain fascination in what we should dread and avoid; instead of resisting evil, by a strange fatality we seem to be self-impelled to court it. We indulge in thoughts, in hopes and fears, too often chimerical, instead of endeavouring to dismiss them from our mind, by other pursuits and busy occupation; and we brood upon future and ideal miseries until we actually, from supineness and timidity, sink under their overwhelming influence. Esquirol relates some curious coincidences of hereditary insanity. A Swiss merchant lost both his sons in a state of mania at the age of 19. A lady lost her senses after childbirth at the age of 25. Her daughter became insane in her 25th year. In one family, the grandfather, the father, and the son, destroyed themselves at the age of 50. Near Newton, seven insane sisters had been observed in one family. An unfortunate female in the Salpétrière, under the influence of liquor, threw herself three times in the river and her sister in a state of intoxication drowned herself. A gentleman whose intellects became deranged in consequence of the misfortunes of the revolution remained for ten years secluded in his chamber. His daughter became insane about the same period, and with equal obstinacy could not be prevailed upon to leave her room. There is no doubt, but that were these early predispositions attended to and watched, an active course of education adopted, and change of locality resorted to, much future misery might be avoided, and possibly the invasion of the malady arrested. If the observations of the phrenologist are entitled to consideration, the mind may become mainly instrumental in attaining this _desideratum_, as the detection of certain propensities may place us upon our guard in the education of youth. This would be a point of still greater importance, were these organs innate, dooming us to the blind law of fatality; but the phrenologists maintain, that the development of these organic inequalities on the surface of the cranium are produced and developed by a corresponding enlargement of the brain, which is greater or lesser in the ratio of the preponderance of the organ as the indulgence in the propensities which they indicate. Pinel relates a curious case of hereditary mania in a man who, up to the age of fifty, fulfilled with intelligence and activity the duties of an important office which he held. At this period he indulged in various excesses, and sunk in the debasement of the lowest society. These excesses he represented to his wondering friends and acquaintances as the source of divine pleasure and celestial enjoyment. He declared that he would erect a temple to the god of love, and officiate himself as high priest at his altars; he compared the very lowest of women to angelic creatures; and finally was confined, a furious and desperate maniac. Education carried on upon mistaken principles has also been known to prepare the way to insanity, and La Bruyere has justly observed, that there are parents, the study of whose life appears to have been, their giving their children just reason not to regret their loss. Pinel has given us the interesting history of two orphan brothers, who had been brought up in a most anomalous manner--with extreme kindness and effeminacy by a nurse, and with much harshness and injustice by a tutor. The result of this erroneous management was a deficient development in their intellectual faculties, and a debilitated frame, which gradually led to a state of imbecility. When examined by Pinel at the age of twenty and twenty-two, their conversation was puerile in the extreme, and they both displayed a taste for infantile sports and pastimes, befitting children of three or four years old. They sought to express themselves with great volubility, but their language, consisting chiefly of broken syllables, was scarcely intelligible. Notwithstanding their apathic appearance, by a sort of automatic habit, every evening brought on an absurd scene of sentimentality. They would join each other in earnest conversation in a corner of the room; and, with bitter tears and deep sighs, bewail the loss of their parents, who had thus left them in a helpless orphan condition, in their tender years, expressing the sincerest affection for their nurse, but speaking of their tutor with bitter imprecations. A great partiality shown to one sister has driven another one to a state of dementia, that arose from her continually dwelling on the wrongs she experienced, which, of course, were exaggerated by jealousy. External agents producing sudden terror have been frequently known to bring on insanity. It is related of a child of three years of age, who was so terrified on being brought into a madhouse, that he was subject to horrible dreams and visions until his seventeenth year, when he became a perfect lunatic. Women frightened during pregnancy have often become alienated; and there are two cases reported of young ladies who were found insane the day after their nuptials. While disappointments and misfortunes are often the origin of insanity, a sudden melioration in circumstances, and unexpected pleasing intelligence have been also known to derange the intellects. A man who came into the possession of a large fortune, after having lived for many years in penury, was so alarmed at the thought of losing this property, that the apprehension of the evil deprived him of his senses. An instance is recorded of a young girl, long separated from her lover by parents averse to their union, who became insane immediately after her marriage. Children are generally exempted from this calamitous visitation; yet Frank relates the case of a child at St. Luke's who had been deranged since he was two years old. Age, to a certain extent, seems to influence insanity, and most individuals are alienated between their twentieth and fiftieth years. Haslam states, that out of one thousand six hundred and sixty-four patients admitted into Bedlam, nine hundred and ten came within this period of life. In France it appears that most cases of insanity are noticed between the ages of twenty-five and thirty-five. One-fifteenth of these cases among men, and one-sixth among women, are observed before their twentieth year; and in the wealthy classes of society one-fourth occur before the same period. The following table from Bicêtre regarding age is not without interest. Years. Aged 15 20 30 40 50 60 Total. ------------------------------------------- 1784 ... 5 33 31 24 11 6 110 1785 ... 4 29 49 25 14 3 124 1786 ... 4 31 40 32 15 5 127 1787 ... 12 39 41 26 17 7 142 1788 ... 9 43 53 21 18 7 151 1789 ... 6 38 39 33 14 2 132 1790 ... 6 28 34 19 9 7 103 1791 ... 9 26 32 16 7 3 93 1792 ... 6 26 33 18 12 3 98 1793 ... 4 36 28 22 13 10 113 ---------------------------- Total 65 329 380 236 130 53 1193 Thus it would appear that the astounding events which took place in France, but more especially in Paris, from the year 1789, the breaking out of the revolution, to 1793, the reign of terror, had no effect upon the intellects of the population; unless it is supposed that the entire nation being in a state of insanity, either madmen were not noticed as any peculiarity, or rushed into mischief and were murdered. This observation as to the influence of public events is confirmed by the following statement of admissions in the Salpétrière during the comparatively tranquil years of 1811, 1812, 1813, and 1814, although many cases of insanity were said to have arisen from the harsh laws of the conscription. Years. Aged 20 25 30 35 40 50 60 70 80 Total. ------------------------------------------------------ 1811 ... 34 37 38 27 48 38 24 12 4 262 1812 ... 52 34 33 18 38 57 26 19 3 280 1813 ... 43 29 33 41 32 57 31 13 6 285 1814 ... 42 35 38 31 26 53 34 22 10 291 ---------------------------------------- Total 171 135 142 117 144 205 115 66 23 1118 Therefore one might fairly conclude that the taking of the Bastille, the execution of Louis XVI., the bloody sway of the Jacobins, the ambitious wars of Napoleon, and the restoration of Louis XVIII., did not in the slightest degree affect the brains of our happy and philosophical neighbours. It has been generally imagined that women are more subject to mental alienation than men; this, however, is by no means proved by observation in other countries, as will appear by the following calculation: Men. Women. 1756 Marseilles 50 49 1786 Paris 500 509 1786-1794 Bedlam 4992 882 1807 St. Luke's 110 153 1802 Paris 1 to 2 ---- Berlin 1 to 2 ---- Vienna 117 94 ---- Pennsylvania 2 to 1 1807-1812 Various Madhouses in France 488 700 1802-1814 Mr. Esquirol's establishment 191 144 ---- ---- Total 6452 6536 In the Lunatic Asylum of Hanwell I have now under my care 265 males, and 351 females. It has long been a current opinion that madness is a more common disease in our country than any where else. This may possibly arise from the greater number of our eccentric countrymen that are widely scattered over the globe; and whenever an individual is observed whose manners and conduct are totally at variance with the habits of any other member of the community, he is generally considered an Englishman. Voltaire came to the sweeping conclusion that one half of the nation was scrofulous, and the other moiety insane. However, it would appear that insanity is on the increase; for in the report of the commissioners for licensing lunatic establishments we find the following statement: "Insanity appears to have been _considerably_ on the increase; for if we compare the sums of two distant lustra, the one beginning with 1775, and the other ending with 1809, the proportion of patients returned as having been received into lunatic asylums during the latter period, is to that of the former nearly as one hundred and twenty-nine to one hundred." Dr. Burrows has endeavoured to impugn the correctness of this statement by proving that suicide is more frequent in other countries; now, unless Dr. Burrows can prove that suicide is always an act of insanity, which will by no means be admitted, his observation can bear no weight. It is but too true that in melancholy madness we often observe a prevailing propensity to self-destruction. Dr. Abercrombie's views on this subject are so luminous that I shall transcribe them. "When the melancholic hallucination has fully taken possession of the mind, it becomes the sole object of attention, without the power of varying the impression, or of directing the thoughts to any facts or considerations calculated to remove or palliate it. The evil seems overwhelming and irremediable, admitting neither of palliation, consolation, nor hope. For the process of mind calculated to diminish such an impression, or even to produce a hope of the palliation of the evil, is precisely that exercise of mind which in this singular condition, is lost or suspended; namely, a power of changing the subject of thought, of transferring the attention to other facts and considerations, and of comparing the mental impression with these, and with the actual state of external things. Under such a conviction of overwhelming and hopeless misery, the feeling naturally arises of life being a burden, and this is succeeded by a determination to quit it. When such an association has once been formed, it also fixes itself upon the mind, and fails to be corrected by those considerations which ought to remove it. That it is in this manner the impression arises, and not from any process analogous to the determination of a sound mind, appears, among other circumstances, from the singular manner in which it is often dissipated, namely by the accidental productions of some new impression not calculated in any degree to influence the subject of thought, but simply to give a momentary direction of the mind to some other feeling. Thus a man mentioned by Pinel had left his house in the night, with the determined resolution of drowning himself, when he was attacked by robbers. He did his best to escape from them, and having done so, returned home, the resolution of suicide being entirely dissipated. A woman mentioned, I believe by Dr. Burrows, had her resolution changed in the same manner, by something falling on her head, after she had gone out for a similar purpose. "A very irregular modification occurs in some of these cases. With the earnest desire of death, there is combined an impression of the criminality of suicide; but this instead of correcting the hallucination, only leads to another and most extraordinary mode of effecting the purpose; namely by committing murder, and so dying by the hand of justice. Several instances are on record in which this remarkable mental process was distinctly traced and acknowledged; and in which there was no mixture of malice against the individuals who were murdered. On the contrary, these were generally children; and in one of the cases, the maniac distinctly avowed his resolution to commit murder, with the view of dying by a sentence of law; and at the same time his determination that his victim should be a child, as he should thus avoid the additional guilt of sending a person out of the world in a state of unrepented sin. The mental process in such a case presents a most interesting subject of reflection. It appears to be purely a process of association, without the power of reasoning. I should suppose that there had been at a former period, during a comparatively healthy state of the mental faculties, a repeated contemplation of suicide which had been always checked by an immediate contemplation of its dreadful criminality. In this manner a strong connexion had been formed, which when the idea of suicide afterwards came into the mind, during the state of insanity, led to the impression of its heinousness, not by a process of reasoning, but by simple association. The subsequent steps are the distorted reasonings of insanity, mixed with some previous impression of the safe condition of children dying in infancy. This explanation I think is strongly countenanced by the consideration that, had the idea of the criminality of suicide been in any degree a process of reasoning, a corresponding conviction of the guilt of murder must have followed it. I find, however, one case which is at variance with this hypothesis. The reasoning of that unfortunate individual was, that if he committed murder, and died by the hand of justice, there would be time for his making his peace with the almighty between the crime and his execution, which would not be the case if he should die by suicide. This was a species of reasoning but it was purely the reasoning of insanity." Still these remarks do not go to prove that suicide is always the result of insanity, since it can in most instances be attributed to a moment of despair and impatience under a heavy visitation of calamity, or the dread of contempt of society. The frequency of this rash act, cannot therefore be adduced as a proof of the greater prevalence of madness in any country. With greater reason, self-destruction is to be referred to the want of a proper religious education and feeling, which will enable man to bear up against the world's vicissitudes, and deem life a more or less painful journey to a peaceful abode. Montesquieu was one of the many writers who attributed this propensity as being nearly exclusive to the English. "Les Anglais," he says, "se tuent sans qu'on puisse imaginer aucune raison qui les y détermine; ils se tuent dans le sens même du bonheur. Cette action, chez les Romains était l'effet de l'éducation, elle tenait à leur manière de penser et à leurs coutumes; dans les Anglais c'est l'effet d'une maladie, elle tient à l'état physique de la machine." Two very curious works on suicide have been lately published in Germany by Dr. Arntzenius and Dr. Schlegel. The former writer divides this fatal propensity into acute and chronic; the first marked by great physical excitement, the latter accompanied or preceded by sadness, moroseness, and love of solitude. Curious cases are related in illustration of this doctrine, amongst others we remark that of an English nobleman who cast himself into the crater of Vesuvius. A German in the same year, not being able perhaps to travel so far, threw himself into a smelting furnace. Several cases are recorded of individuals who formed the desperate resolution of starving themselves. It appears that in many instances the most trifling circumstance has driven these reckless beings to the commission of this desperate action. The case of a young Parisian author of the name of Escoupe, who suffocated himself because one of his dramatic productions had been severely criticised, is well known. A German student destroyed himself because he had a club-foot, and another youth put an end to his existence in consequence of his not having been allowed to put on his Sunday clothes. Dr. Schlegel has given a curious table of the means of destruction resorted to according to the several ages of individuals, and we give the following abstract: By pistol. By hanging. Between 10 and 20 years of age. 61 68 " 20-30 " 283 51 " 30-40 " 182 94 " 40-50 " 150 188 " 50-60 " 161 256 " 60-70 " 126 235 " 70-80 " 35 108 " 80-90 " 2 ---- ---- 1000 1000 In classing 9000 cases of suicide which happened in Paris between the years 1796 and 1830, Dr. Schlegel concludes that what he terms the "philosophic suicide," is that which is perpetrated after deliberation, during the night or shortly before sunrise; whilst when it is not the result of premeditation, it occurs during the day. The choice between shooting and hanging may be accounted for on the same grounds. A young man, in a fit of frantic passion, from disappointed love, or losses at play, will probably, on his return home, seize a pistol and blow out his brains; whereas hanging needs reflection and some preparation and precaution, which would alone suffice to bring a reflective creature to a proper sense of his folly, unless predetermined to destroy himself by "philosophic suicide." It appears in these accounts that suicide in France has greatly increased since the revolution. The average number during the last forty-two years being 409-5/6, the number in Paris being 1639 annually. Dr. Schlegel informs us that there exists a society in Paris called, "Society of the Friends of Suicide." It consists of twelve members, and a lot is cast annually to decide which of them is to destroy himself in the presence of the others. Certain qualifications and testimonials were required before a candidate could be admitted into this amiable club: 1. He must prove himself a man of honour. 2. He must have experienced the injustice of mankind, been injured by a dear friend, or betrayed by a mistress or a wife. 3. He must have experienced, for some considerable time, a miserable vacuity of soul, and a discontent with every thing in the world. This association reminds me of a ball that was established in Paris after the reign of terror, called _Le Bal des Victimes_, to which no person could be admitted unless they had had a near relation guillotined. Dr. Schlegel has also given the following statistical table of the proportion of suicides to various populations--both as regarding counties and principal cities: _Countries._ _Proportion of suicides to population._ Sweden 1 in 92,375 The Milanais 1 ... 72,570 Russia, 1819-1820 1 ... 36,860 ---- 1824-1827 1 ... 34,246 Prussia 1 ... 14,224 Saxony 1 ... 8,446 St. Petersburg 1 ... 416 London, 18th century 1 ... 10,572 ---- 19th century 1 ... 21,491 Paris 1 ... 2,215 Geneva 1 ... 3,714 Berlin, 1788-1797 1 ... 23,066 ---- 1798-1807 1 ... 12,917 ---- 1813-1822 1 ... 3,312 Hamburg 1 ... 4,800 Leipzig 1 ... 3,143 Milan 1 ... 1,821 Naples 1 ... 27,230 New York 1 ... 9,474 Baltimore 1 ... 15,696 Philadelphia 1 ... 20,000 According to our ingenious author, drunkenness is the chief cause of suicide in England, Prussia, and Germany; love and gambling in France; whilst bigotry, or the fear of dying without having received the sacrament, he supposes, prevents it in Spain, where, comparatively speaking, suicide is seldom heard of. The same remark may apply to Italy, where a Roman lady, having heard of such an action, exclaimed, "_Dev' essere un forestiere; gli Italiani non sono tanto matti_." She was right, the suicide was a melancholy German tailor. In India, where the doctrine of predestination is generally prevalent, it is calculated that in one year there were forty suicides in a population of 250,000, twenty-three of which were females. Arntzenius quotes Gall's opinion, that suicide arises from too great a predominance of the organ of cautiousness. Combe and other phrenologists are of opinion, that with this predominance a deficient development of hope and a large destructiveness must be conjoined. It has been remarked that in Spain and Portugal, where insanity is comparatively rare, malconformation of the brain and consequent idiotism are very frequent. Since the peace it may be more difficult to arrive at any conclusion on the subject of increase of lunacy, founded on the admission of lunatics into public and private establishments, since emigration has carried so many families and operatives of every description abroad, many of whom, from various disappointments and vexations, might have been predisposed to insanity. It appears that in 1836 there existed in England and Wales 6402 lunatics, 7265 idiots--13,667 lunatics and idiots. Of paupers alone, or lunatics and idiots, there were 1.00098 of the total population, or 1 in 1024. However, according to the most probable calculation, the number of lunatics in England amounts to about 14,000, out of which about 11,000 are paupers. Idiots are nearly as numerous as lunatics. Sir A. Halliday states the former to amount to 5741, and the latter to 6806. To this it must be observed that many harmless idiots are allowed to remain in their usual residence. In Wales it appears that idiots are to lunatics in the proportion of seven to one. The difficulty of obtaining any certain information on this subject, however, is such, that it is scarcely possible to decide the question with any chance of a probable certainty. In regard to the prevalence of lunacy in other countries, the following are curious statistical statements: In Spain, in 1817, according to the report of Dr. Luzuriaga, there only existed in the asylums of Toledo, Granada, Cordova, Valencia, Cadiz, Saragossa, and Barcelona, 509 lunatics--only fifty were in the hospitals of Cadiz, sixty in that of Madrid, and thirty-six in the kingdom of Granada. In Italy, in twenty-five asylums in Turin, Genoa, Milan, Brescia, Verona, Venice, Parma, Modena, Bologna, Ferrara, Florence, Sienna, Lucca, and Rome, Mr. Brierre only found 3441 patients. The population of these parts of Italy amounting to about 16,789,000 inhabitants, which gives one lunatic to 4879 persons. Scott, who accompanied Lord Macartney's embassy to China, observed that very few insane persons were to be found there. Humboldt states that madness is rare amongst the natives of South America. Carr made the same remark in Russia. In Spain and Italy, religious melancholy, and that most vexatious species of insanity called _erotomania_, are the more common. In the savage tribes of Africa and America insanity is very rare. Dr. Winterbotham affirms, that among the Africans near Sierra Leone, mania is a disease which seldom if ever occurs. Idiotism was likewise a rare phenomenon among them. Among the negro slaves in the West Indies it is scarcely known, and during three years' residence in the Bahamas, only one case of monomania fell under my observation. Amongst the native races of America it scarcely exists. From these observations we may conclude, with Esquirol, that insanity belongs almost exclusively to civilized races of men, that it scarcely exists among savages, and is rare in barbarous countries. To what circumstance are we to attribute this exemption? Possibly it may be attributed to simplicity in living, which predisposes to less disease and morbid varieties of organization, and to the absence of that refined education which exposes man to the artificial wants and miseries of high civilization. It is moreover probable that the constant occupation which the existence of the savage requires to satisfy his absolute necessities, does not leave him leisure time to ponder over gloomy ideas and fictitious sufferings. In addition to these circumstances, Dr. Pritchard has justly remarked, that we might also conjecture that congenital predisposition is wanting in the offspring of uncivilized races. The same author admits the probability of the brain receiving a different development in the progeny of cultivated races, or of those whose mental faculties have been awakened. Various professions have been supposed to exercise much influence on the intellectual faculties. The following observations at the Salpétrière during one year may tend to illustrate this subject: Field labourers 43 Servants 51 Needlework women 85 Cooks 16 Shopkeepers 21 Pedlars 16 Shoemakers 8 House-painters and varnishers 5 Housekeepers 192 Women of the town 33 In Mr. Esquirol's establishment: Farmers 3 Military men 33 Seamen 3 Merchants 50 Students 25 Clerks in public offices 21 Engineers 2 Lawyers 11 Chemists 4 Physicians 4 Artists 8 According to the prevalence of the ideas connected with their former pursuits do we observe the hallucination of these unfortunate persons to be of a different character. Dr. Abercrombie relates the case of a Scotch clergyman, who was brought before a jury to be what is called in Scotland _cognosced_, or declared incapable of managing his affairs. Amongst the acts of extravagance alleged against him was, that he had burnt his library. When he was asked by the jury what account he would give of this part of his conduct, he replied in the following terms: "In the early part of my life I had imbibed a liking for a most unprofitable study, namely, controversial divinity. On reviewing my library, I found a great part of it to consist of books of this description, and I was so anxious that my family should not be led to follow the same pursuits, that I determined to burn the whole." He gave answers equally plausible to questions which were put to him respecting other parts of his conduct; and the result was, that the jury found no sufficient ground for cognoscing him; but in the course of a fortnight from that time, he was in a state of decided mania. What a school of humility is a lunatic asylum! What a field of observation does it not present to the philosopher who ranges among its inmates! We find the same aberrations that obtain in society; similar errors, similar passions, similar miserable self-tormenting chimeras, empty pride, worthless vanity, and overweening ambition. There we See that noble and most sovereign reason, Like sweet bells jangled, out of tune and harsh. Each madhouse has its gods and priests, its sovereigns and its subjects, terrific mimicry of worldly superstitions, pomp, pride, and degradation! There, tyranny rules with iron sway, until the keeper's appearance makes tyrants know there does exist a power still greater than their own. In madhouses egotism prevails as generally as in the world, and nothing around the lunatic sheds any influence unless relating to his wretched self. In this struggle between the mind and body, this constant action and reaction of the moral and the corporeal energies, when reason has yielded to the brute force of animal passions, and the body with all its baseness has triumphed over the soul, one cannot but think of Plutarch's fanciful idea, that, should the body sue the mind for damages before a court of justice, it would be found that the defendant had been a ruinous tenant to the plaintiff. In many cases of insanity we observe a singular fertility of glowing imagination and a vivacity of memory which is often surprising. Dr. Willis mentions a patient who was subject to occasional attacks of insanity, and who assured him that he expected the paroxysms with impatience, as they proved to him a source of considerable delight. "Every thing," he said, "appeared easy to me. No obstacles presented themselves either in theory or in practice. My memory acquired of a sudden a singular degree of perfection. Long passages of Latin authors occurred to my mind. In general I have great difficulty in finding rhythmical terminations, but then I could write verse with as much facility as prose." Old associations thus recalled into the mind are often mixed up with recent occurrences, in the same manner as in dreaming. Dr. Gooch mentions a lady who became insane in consequence of an alarm of fire in her neighbourhood. She imagined that she was transformed into the Virgin Mary, and that a luminous halo beamed round her head. It is said that the Egyptians placed a mummy at their festive board, to remind man of mortality. Would not a frequent visit to a lunatic asylum afford a wholesome lesson to the reckless despot, the proud statesman, and the arbitrary chieftain? There they might converse with tyrants, politicians, and self-created heroes, in all the naked turpitude of the evil passions, who in their frantic gestures would show them that which they wish to be--that which the world considers they are! Often would they hear the maniac express the very thoughts that ruffle their own pillows, until the dreaded bell that announces the doctor's visit, and which with one loud peal destroys his fond illusions, herald of that knell which sooner or later must call them from the busy world they think their own. How beautifully has Filmer expressed the madman's fears! See yon old miser laden with swelling bags Of ill-got gold, with how much awkward haste He limps away to shelter! See how he ducks, And dives, and dodges with the gods; and all Only in hope to avoid, for some few days Perhaps, the just reward of his own sad extortions. The hot adulterer, now all chill and impotent With fear, leaps from the polluted bed, And crams himself into a cranny! There mighty men of blood, who make a trade Of murder, forget their wonted fierceness; Out-nois'd, they shrink aside, and shake for fear O' th' louder threat'nings of the angry gods. Whatever may be the nature of insanity or our fallacious views regarding it, it is a matter of great consolation to find that our mode of treating it is at last founded on rational and humane principles. The unfortunate lunatic is no longer an object of horror and disgust, chained down like a wild beast, and sunk by ignorance or avarice, even below the level of that degradation in the scale of human beings, to which it had pleased Providence to reduce him,--we no longer behold him rising from his foul and loathsome bed of straw, scantily covered with filthy tatters, his hair and beard wild and grisly--his eyes under the influence of constant excitement, darting menacing looks--the foam bubbling through his gnashing teeth--clanking his fetters with angry words and gestures, threatening heaven and earth--gazed at with dismay, through massive bars--the very female seeming of doubtful sex: Her unregarded locks Matted like fury-tresses, her poor limbs Chain'd to the ground; and stead of those delights Which happy lovers taste, her keeper's stripes, A bed of straw, and a coarse wooden dish Of wretched sustenance.[18] Now, the unfortunate persons are restored to social life as much as their sad condition allows; they enjoy every comfort that can solace them in their lucid intervals, when their hallucinations cease; in illness they are treated with kindness and liberality, and in health, their former associations with the busy world, are recalled by labour, voluntarily performed or stimulated by the incentive of some additional comfort. No coercion is resorted to, except to prevent the furious maniac from injuring himself and others, and then, such means are adopted that restrain his violence without a painful process. Even the straight waistcoat, which impedes respiration, is generally banished in all well-regulated establishments, and belts, sleeves, and muffs, which merely secure the hands, without preventing a free motion of the articulations, are usually resorted to. To such an extent is healthy occupation carried on in lunatic asylums, that at this moment at Hanwell, out of upwards of 600 inmates under my care, 421 are at work and distributed as follows: _Males._ 57 Working in the garden and grounds. 53 Handicrafts at various trades. 38 Assistants in the wards. 28 Picking coir, or the external fibre of the cocoa-nut, for stuffing mattresses, &c. 2 Clerks in the office. ---- 178 ---- _Females._ 120 At needlework. 2 Making brushes. 21 In the kitchen and dairy. 21 Assisting in the wards. 26 Picking coir. 30 Working in the garden. 23 In the laundry. ---- 243 ---- Hanwell may be said to be an asylum for incurables, since it is doomed to receive old cases that scarcely ever afford a chance of recovery; to which are added a large proportion of the idiots and epileptics of Middlesex, whose families cannot support them. Let us hope from this gradual amelioration in the condition of this illfated class of our fellow-creatures, that every institution, both public and private, will shortly be conducted upon a similar plan, having sufficient grounds attached to it, to give occupation to such of their inmates as may still be able to enjoy some share, however trifling it may be, of the blessings of this life. LEPROSY. Bontius informs us that this disease was observed on the banks of the Ganges, where it was known by the name of _Cowrap_. Kaempfer noticed it in Ceylon and Japan. In Sumatra, whole generations are infected with both leprosy and elephantiasis; and those who are labouring under the latter disease, although it is not contagious, are driven into the woods. Christopher Columbus found lepers in the island of Buona Vista in 1498, and frictions of turtle blood were used to relieve them. In our days it is a disease of rare occurrence, at least in Europe; yet it was observed at Vetrolles and Martignes, in France, in 1808, and at Pigua and Castel Franco, in Italy, in 1807. The elephantiasis still prevails in our West India colonies, more especially that species which is called "elephant leg," and which is not uncommon at Barbadoes, St. Christopher, and Nevis. Parsons, in his Travels in Asia and Africa, informs us that a similar complaint exists on the coast of Malabar, where it is called the "Cochin leg." The Hindoo physicians treat it with pills of arsenic and black pepper. A curious species of leprosy appeared in Rome under the reign of Tiberius, which was brought thither from Asia. The eruption first broke out upon the chin, whence it was called _Mentagra_, and is thus alluded to by Martial: Non ulcus acre, pustulæve lucentes; Nec triste mentum, sordidive lichenes. From the chin it extended over the entire body, and on its disappearance left scars more unsightly, if possible, than the former disease. Its virulence and difficulty of cure induced the Romans to send to Egypt for attendance. The same disease prevailed in the second century, and Soranus, a physician of Aquitania, was sent for to heal it. Crispus, a friend of Galen, is said to have discovered the best method of cure. Pliny has given an accurate account of the mentagra in his Natural History, lib. xxvii. cap. 1. According to the same writer, elephantiasis was brought to Rome by Pompey's troops. Plutarch fixes its apparition to the time when Asclepiades of Bithynia flourished as one of his disciples. Themison wrote a treatise on the disease, which is mentioned by Cælius Aurelianus, but has not been preserved from the ravages of time. Lucilius called the affection _odiosa Vitiligo_. The _Gemursa_ of Pliny appears to have been a similar complaint; and Triller thinks that it was the _Gumretha_ of the Talmud. Formerly, in England, the causes of lepers were committed to the ecclesiastical courts, as it was prohibited to prosecute a leper before a lay judge, as they were under the protection of the church, which separated them from the rest of the people by a ritual. At this period a law existed, called _Leproso amovendo_, for the removal of lepers who ventured to mix in society. Thus leprosy may be considered one of the most terrific maladies inflicted on mankind. Holy Writ affords us abundant proofs of its fatal character. It is probable that this disease was first observed under the scorching sun of Egypt, whence it spread its ravages to Greece and Asia; and when the East was obliged to submit to the Roman legions, the conquerors carried the scourge of the vanquished to their own country. From Italy the disorder extended to France; and in the reign of Philip I. we find some members of the church militant, called _hospitaliers_, who spent their arduous life in attending upon lepers, and waging war against the infidels. The Hebrew tribes, on quitting Egypt, were subject to three kinds of leprosy; all of them were distinguished by the name of _Berat_ ([Hebrew]), or "bright spot." One called _Boak_ ([Hebrew]), of a dull white; and two named _Tsorat_ ([Hebrew]), or "venom or malignity:" the first variety of the latter being the _Berat Lebena_, or bright white berat; and the next the _Berat Cecha_, or the dark and dusky berat; both of which were highly contagious, and rendered those who laboured under their attack unclean, and dangerous to society. Manetho, Justin, and several historians, pretend that the Hebrews were expelled from Egypt in consequence of their being infected with this formidable disease; a reproach from which Josephus attempted to exculpate his countrymen. It appears, however, that, during their captivity of one hundred and thirty-four years, the Israelites laboured under this awful visitation; and, three thousand years after their migration we find Prosper Alpinus describing the banks of the Nile as the principal seat of the disease. Lucretius gives the same account of it: Est Elephas morbus, qui, propter flumina Nili Gignitur, Ægypto in mediâ, neque præterea usquam. Pliny and Marcellus Empiricus refer the calamity to the same source. They state, however, that it was more general in the lower classes, although it sometimes attacked their sovereigns; an event which added to the horrors of the infliction, since it appears that royalty had the privilege of bathing in human blood as one of the most effectual curative means. Gaul and Avicenna attribute its fatal prevalence in Alexandria to the influence of the climate, and the quality of their food. The Persian writer thus expresses himself: "Et quando aggregatur caliditas aëris cum malitiâ cibi, et ejus essentia ex genere piscium, et carne salitâ, et carne grossâ, et carnibus asinorum, et lentibus, procul dubio est ut eveniat lepra, sicut multiplicatur in Alexandriâ." The _Boak_, or slighter berat, which is not considered to be contagious, still bears the same denomination amongst the Arabs, and is the [Greek: lepra alphos] or dull white leprosy of the Greeks. The bright white and dusky berats of the Hebrews were distinguished on account of their malignity, and with the _Tsorat_ ([Hebrew]) are still called among the Arabians by the Hebrew generic term with a very slight alteration, for the _Berat Lebena_ is their _Beras Bejas_, and the _Berat Cecha_, the _Beras Asved_. While the Arabians borrowed the Hebrew terms, the Greeks took their denominations from the same source; and from _Tsorat_ they adopted the word _Psora_. The _Tsorat_ is restrained by the Hebrews to the contagious form of leprosy. Amongst the Greeks Lepra was a generic synonyme of _Berat_ or _Beras_. This confusion in the adaptation of the names given to the varieties of leprosy has occasioned much perplexity in the study of the disease. Actuarius, in endeavouring to rectify these errors, has produced a greater confusion. According to him, they are different forms of a common genus. However, the most important distinction was that which defined the contagious and the non-contagious forms. The leprosy described by Moses under the name of _Boak_ or _Bohak_ was the [Greek: alphos] of Hippocrates; _Seeth_ the [Greek: phakos]; _Saphachath_ and _Misphachath_ the [Greek: leichên]; and _Bahereth_ the [Greek: leukê]; and according to Carthenser and other writers, this leprosy was the _Leucé_ of the Greeks. The elephantiasis was long confounded with leprosy; but the former is a tubercular affection of the skin, widely different from the scaly leprosy, and certainly not contagious. Its singular name was derived from the condition of the surface of the huge misshapen limbs of those who were affected with the malady, and which bore some resemblance to the leg of an elephant. This morbid state is not uncommon in the island of Barbadoes, and in England it has been called "the Barbadoes leg." The original Arabic name for this affection was _Dal Fil_, or "the elephant's disease," which is now the common denomination; although it is frequently abridged into _Fil_ alone, literally _Elephas_. The elephantiasis is not even alluded to by Moses in his descriptions of leprosy. However, the elephant leg of the Arabians is a disease totally different from the specific elephantiasis, which is a disorder of the skin, the roughness of which led to the name, and which the Arabians called _Juzam_ or _Judam_. These errors of description amongst medical writers have of course occasioned much obscurity and perplexity in the productions of travellers and historians, who have generally confounded all these diseases with the Hebrew leprosy, or the leprosy which for so long a period desolated the fairest portions of Europe, where every country was crowded with hospitals established for the exclusive relief of the malady. The number of leper-houses, as they were denominated, has been singularly exaggerated. Paris has been made to assert that there were nineteen thousand of these hospitals, whereas he merely stated that the Knights Hospitalers, under various patron saints, but more particularly St. Lazarus, were endowed with nineteen thousand manors to support their extensive establishments; and he thus clearly expressed himself: "_Habent Hospitalarii novemdecim millia maneriorum in Christianitate_." It appears that in the reign of Louis VIII., France had no less than two thousand of these hospitals. Leprosy was well known in the eighth century, and St. Ottomar and St. Nicholas, were considered the first founders of establishments for its treatment in France and in Germany. The Crusaders, however, by their connexions with the East, materially increased its inroads in Europe, and the disgusting malady appears to have been considered as a proof of holiness. Moehser, in his work "_De medicis equestri dignitate ornatis_," informs us that the Knights of the order of St. Lazarus were not only intrusted with the care of lepers, but admitted them into their noble order: their Grand Master was himself a leper. The Crusaders, returning from their useless wars, eaten up with the disease, received the honourable distinction of being _pauperes Christi, morbi beati Lazari languentes_. The most distinguished individuals in the land attended upon them with the utmost humility; and Robert, King of France, used to wash and kiss their filthy feet to keep himself in odour of sanctity. All these attentions, however, did not always prevent the lepers from complaining of their complicated sufferings, but they were exhorted by holy men (who of course had never experienced the miseries of the malady) to be of good comfort, as their illness was a blessed favour conferred upon them as the elect of the land. St. Louis thought the Sire de Joinville an unbeliever; for having once asked him which he would prefer, being a _mezieu_ or _laide_ (a leper), or having to reproach his conscience with any mortal sin, his favourite replied to the singular question, that he would rather be guilty of thirty deadly sins; whereupon the sanctified monarch severely rebuked him by telling him in the quaint language of the times, "Nulle si laide mezeuerie n'est, comme de estre en péché mortel." Notwithstanding the sanctity of their disease, lepers were by various laws separated from the healthy portion of the community. The ceremonies used on these occasions were curious; and we find the following description of them in the History of Bretagne: A priest in his sacerdotal robes went to the leper's dwelling, bearing a crucifix. He was then exhorted to submit with resignation to the affliction: he afterwards threw holy water upon him, and conducted him to church. There he was stripped of his ordinary vestments, and clothed in a black garment; he then knelt down to hear mass, and was again sprinkled with holy water. During these ceremonies, the office for the dead was duly sung, and the leper was finally led to his destined future residence. Here he again knelt, received salutary exhortations to be patient, while a shovelful of earth was thrown on his feet. His dwelling was most diminutive: his furniture consisted of a bed, a water-jug, a chest, a table, a chair, a lamp, and a towel. He further received a cowl, a gown, a leathern girdle, a small cag with a funnel, a knife, a spoon, a wand, and a pair of _cliquettes_, (a sort of castanets,) to announce his approach. Before leaving him, the priest added another blessing to these gifts, and departed, after commanding him under the severest penalties never to appear without his distinctive apparel, and barefooted; never to enter a church, a mill, or a baker's shop; to perform all his ablutions in streams and running waters; never to touch any article he wanted to purchase, except with his wand; never to enter drinking-houses, but to buy his liquor at their doors, having it poured into his barrel by means of the funnel graciously given him for that purpose; never to answer any question unless he was to windward of his interlocutor; never to presume to take a walk in a narrow lane; never to touch or go near children, or look at a good-looking wench; and only to eat, drink, and junket with his brother lepers; and invariably to announce his unwelcome approach by rattling his castanets. The offsprings of these sequestrated creatures were seldom baptized; and when this rite was performed, the water was thrown away. After this oration his ghostly adviser took his final leave, and the patient's former dwelling was burnt to the ground. The sepulchre of St. Mein, in Britanny, was frequently visited by these poor creatures; and on such occasions they were obliged to have both their hands covered with woollen bags, as a distinguishing mark amongst the other pilgrims. Lepers were only allowed to intermarry with fellow-sufferers; yet we find in one of the Decretals of St. Gregory, that any woman who chose to run the chances of contagion could please her fancy. St. Gregory perhaps thought this the most effectual method of preventing the dreaded intercourse, as most probably, had it been prohibited, lepers would have been in great request, they having always been notorious for their amorous propensities. Muratori informs us that these unfortunate persons did not always submit quietly to these severe regulations, but several times joined the Jews in a revolt against the authorities. This affliction has been observed in various countries. In Iceland it is called _Likraa_; in Norway, _Radesyge_ or _Spedalskhed_. It is to be apprehended that many of these cases of leprosy belong more particularly to the elephantiasis: such is the red disease of Cayenne, and the _Boasi_ of Surinam. It is especially in the East, its probable original seat, that leprosy is observed. In Damascus there are two hospitals for its treatment. The waters of the Jordan are still considered efficacious in its cure, and the waters of Abraham's well are looked upon as a specific. In Candia the disease was common, and lepers were noted for their obscene profligacy. From Crimea it has also been carried to Astracan, whence it infected the Cossacks of Jaïck. Pallas and Gmelin have given an accurate account of its invasion. THE ASPIC. Various opinions are entertained respecting the reptile that inflicted the fatal sting on Cleopatra. According to Pliny, it had hollow fangs, which distilled the venom in the same manner as the tail of the scorpion. Ælian states it to have been a snake that moves slowly, covered with scales of a reddish colour, his head crowned by callous protuberances, his neck becoming swollen and inflated when he sheds his poisonous secretion. Other naturalists affirm that the scales are shining, and the eyes of a dazzling brightness; while some authorities maintain that the reptile's hue is of a dark brown colour, and that, like the chameleon, it can assume the colour of the ground on which it drags its writhing form. However, later observers have now clearly ascertained that the aspic of the ancients is the _coluber haje_, called by the Arabs _nascher_, and classed by Lacepède as the Egyptian viper. Lucan seems to have described this serpent in the following lines: Hic, quæ prima caput movit de pulvere tabes Aspida somniferum tumida cervice levârit. According to Hasselquist, the aspic's head is raised in a protuberance on both sides behind the eyes; the scales which cover the back are small, of a dirty white colour, and speckled with reddish spots. The lower surface of the reptile is striated with one hundred and eighteen small parallel zones, and forty-four smaller ones are under the tail. The teeth resemble in their structure those of other vipers; and, when the animal is irritated, its neck and throat are swelled up to the size of the body. Authors vary in regard to its length. Hasselquist, from whom we have derived the above description, says that it is a short reptile; while Savary assures us that it sometimes measures six feet. The ancients stated that the poison of the aspic did not occasion any pain, but that the person it had stung gradually sunk into a calm and languid state, which was followed by a sound sleep, the forerunner of dissolution. Modern travellers assure us, on the contrary, that this venom is most active; and Hasselquist has observed an aspic in Cyprus, the bite of which brought on a rapid mortification, which generally proved fatal in a very few hours. In Egypt the viper is still made use of in medicinal preparations; and a great number of them are sent to Venice for the confection of the celebrated _Theriaca_. Under Nero, we are told, that these reptiles were imported into Rome for pharmaceutical purposes. In the above description, and endeavour to ascertain the nature of the aspic of the ancients, there must be some error. The _coluber aspis_ of Linnæus is not venomous, and we may therefore conclude that the aspic was of the same species as our viper. The venom of this animal is of a yellow tinge, and small in quantity, seldom exceeding two grains in weight. In hot weather it becomes more active in its effects. Time does not seem to deprive it of its fatal properties; for instances have been known of persons having pricked their fingers with the pointed fangs of a viper preserved in spirits, when the most serious accidents have followed. The dried teeth lose this noxious power. The venom of the viper may be swallowed without any risk, provided there is not an ulcer in the mouth. Fontana has made upwards of six thousand experiments to prove the activity of this substance. A sparrow died under its influence in five minutes, a pigeon in eight or ten; a cat sometimes did not experience any inconvenience, a sheep seldom or never; and the horse appears to be proof against its action. Some naturalists have affirmed that the female viper, in cases of sudden alarm, possesses the faculty of securing the safety of her young by swallowing them and keeping them concealed in her stomach, as the kangaroo secures her offspring in her pouch. This assertion, although fabulous, was credited by Sir Thomas Brown, and since by Dr. Shaw. Stories equally absurd have been circulated of this reptile. The Egyptians considered the viper as a typification of a bad wife, since they believed that during their union the female was in the habit of biting off her partner's head. They also looked upon it as the emblem of undutiful children, from the idle belief that the viper came into the world by piercing an opening in its mother's side. SELDEN'S COMPARISON BETWEEN A DIVINE, A STATESMAN, AND A PHYSICIAN. If a physician sees you eat any thing that is not good for the body, to keep you from it he cries out "It is _poison_!" If the divine sees you do any thing that is hurtful to your soul, to keep you from it he cries out "You are _damned_!" To preach long, loud, and damnation, is the way to be cried up. We love a man who damns us, and we run after him again to save us. If a man has a sore leg, and he should go to an honest and judicious surgeon, and he should only bid him keep it warm, or anoint it with some well-known oil that would do the cure, haply he would not much regard him, because he knows the medicine beforehand to be an ordinary medicine. But if he should go to a surgeon that should tell him, "Your leg will be gangrene within three days, and it must be cut off; and you will die, unless you do something that I could tell you," what listening there would be to this man! "Oh! for the Lord's sake, tell me what this is:--I will give you any contents for your pains." This ingenious antiquary has also made some quaint comparisons between doctors of the body and doctors of the public interests. "All might go on well," he says, "in the commonwealth, if every one in the parliament would lay down his own interest and aim at the general good. If a man was rich, and the whole college of physicians were sent to him to administer to him severally; haply, so long as they observed the rules of art, he might recover. But if one of them had a great deal of scammony by him, he must put off that; therefore will he prescribe scammony; another had a great deal of rhubarb, and he must put off that; therefore he prescribes rhubarb: and they would certainly kill the man. We destroy the commonwealth, while we preserve our own private interests and neglect the public." Grotius called John Selden "the honour of the English nation;" and Bacon had such an implicit faith in his judgment, that he desired in his will that his advice should be taken respecting the publication or suppression of his posthumous works. THE LETTUCE. Various species of this plant were known to the ancients. Its type is supposed to be the _Lactuca quercina_, or the _Lactuca scariola_; both of Asiatic origin. Many powerful effects were formerly attributed to its use. It was considered as producing sleep, and recovery from intoxication; it was in consequence of this belief that this salad was served up after meals. Thus Martial tells us, Claudere quæ coenas Lactuca solebat avorum, Die mihi cur nostras inchoat illa dapes. Columella thus describes its properties: Jamque salutari properet Lactuca sapore Tristia quæ relevet longi fastidia mori. This belief in its narcotic qualities induced the ancients to esteem it as an aphrodisiac: the Pythagoreans had therefore named it [Greek: eunouchion]; and Eubulus calls it the food of the dead, _mortuorum cibum_. Venus covered the body of her beloved Adonis with lettuce-leaves to calm her amorous grief; and vases, in which they were planted, were introduced in the Adonian festivals. Galen, who had faith in its powers, called it the herb of sages, and in his sleepless nights sought its influence by eating it at supper. It was also frequently put under the pillow of the rich to lull them to repose. Its cooling qualities were so much dreaded by the Roman gallants, that its use was abandoned; but Augustus's physician, Antonius Musa, having calmed by its prescription his master's uneasiness in a hypochondriac attack, lettuce recovered its popularity: a statue was erected to the doctor, and salad once more became the fashion, although the prejudices against it could not be removed. Lobel informs us that an English nobleman, who had long wished for an heir, but in vain, was blessed with a numerous family by leaving off this Malthusian vegetable. MEDICAL FEES. Such is the perversity of our nature, that the remuneration given with the greatest reluctance is the reward of those who restore us, or who conscientiously endeavour to restore us to health. The daily fees, it is true, are not handed with regret, for the patient is still suffering; but if they were to be allowed to accumulate to a considerable amount, they would be parted with, with a lingering look. The lawyer's charges for a ruinous litigation, the architect's demands for an uncomfortable house, are freely disbursed, though if exorbitant they may be taxed; but the doctor's--a guinea a visit!--is sheer extortion. 'Send for the apothecary: the physician merely gives me advice; the apothecary will send me plenty of physic: at any rate I shall have something for my money.' To what can this unjust, this illiberal feeling be attributed? Simply to vanity and pride. Illness and death level all mankind. The haughty nobleman, who conceives himself contaminated by vulgar touch, can scarcely bring himself to believe that he is placed upon the same footing as a shoe-black. All _prestiges_ of grandeur and worldly pomp vanish round the bed of sickness; and the suffering peer would kneel before the humblest peasant for relief. Then it is that money would be cheerfully lavished to mitigate his sufferings. But how soon the scene is changed! The patient is well, thrown once more in the busy vortex of business or of pleasure. He had been slightly indisposed; his natural constitution is excellent: the doctors mistook his case; thought him very ill, forsooth; but nature cured him. Could the ambitious mother admit for one moment that her daughter had been seriously ill?--a sick wife is an expensive article! If her medical attendant unfortunately hinted that the young lady had been in danger, he is considered a busy old woman, exaggerating the most trifling ailment to obtain increase of business; in fact, a dangerous man in a family where there are young persons--to be provided for. Nor can we marvel at this. No one likes to be considered morally or physically weak, excepting hypochondriacs, who live upon groans, and feel offended if you tell them that they do not look miserable. The soldier will describe the slightest wound he received in battle as most severe and dangerous; a feeling of pride is associated with the relation. The bold hunter will boast of a fractured limb; the accident showed that he was a daring horseman. Nay, the agonizing gout is a fashionable disease, which seems to proclaim good living, good fellowship, and luxury: it is, in short, a gentlemanly disease. But the slow ravages of hereditary ailments, transmitted from generation to generation with armorial bearings, the development of which may be averted by proper care, or hurried on by fashionable imprudence! how difficult even to hint to a family the presence of the scourge, when, through the transparent bloom of youth and beauty, our experienced eye reads the fierce characters of death in the prime of years. The aerial coronet floats in fond visions before the doting mother's ambitious eyes. A man would be a barbarian, nay, a very brute, to deprive the darling girl of the chances of Almacks, the delights of the pestiferous ball-room, or the galaxy of court or opera! To attend the great is deemed the first stepping-stone to fortune, and patronage is considered as more than an equivalent of remuneration. Too frequently does the physician placed in that desirable situation forget what Hippocrates said of the profession. "The physician stands before his patient in the light of a demi-god, since life and death are in his hands." Curious anecdotes are related of this unbecoming subserviency. A courtly doctor, when attending one of the princesses, was asked by George III. if he did not think a little ice might benefit her. "Your majesty is right," was the reply; "I shall order some forthwith." "But perhaps it might be too cold," added the kind monarch. "Perhaps your majesty is right again; therefore her royal highness had better get it warmed." This absurd deference to rank and etiquette by a physician who at the moment is superior to all around him, reminds one of an account given by Champfort of a fashionable doctor. "D'Alembert was spending the evening at Madame Du Deffand's, where were also President Hénault and M. Pont de Vesle. On this flexible physician's entering the room, he bowed to the lady with the formal salutation, '_Madame, je vous présente mes très humbles respects_.' Then, addressing M. Hénault, '_J'ai bien l'honneur de vous saluer_.' Turning round to M. de Vesle he obsequiously said, '_Monsieur, je suis votre très humble serviteur_;' and at last, condescending to speak to D'Alembert, he nodded to him with a '_Bonjour, Monsieur_!'" On such occasions a condescending smile from power is considered a fee. Reluctance in remunerating medical attendants was also manifested by the ancients; and Seneca has treated the subject at some length. The difficulty in obtaining remuneration has unfortunately rendered many physicians somewhat sordid, and loth to give an opinion unless paid for. In this they are unquestionably right, as gratuitous advice is seldom heeded; and one of the most distinguished practitioners used to say, that he considered a fee so necessary to give weight to an opinion, that, when he looked at his own tongue in the glass, he slipped a guinea from one pocket into another. To consider themselves in proper hands, patients must incur expenses, and as much physic as possible be poured down. Malouin, physician to the Queen of France, was so fond of drugging, that it is told of him, that once having a most patient patient, who diligently and punctually swallowed all the stuff he ordered, he was so delighted in seeing all the phials and pill-boxes cleaned out, that he shook him cordially by the hand, exclaiming, "My dear sir, it really affords me pleasure to attend you, and you _deserve_ to be ill." Our apothecaries must surely meet with incessant delight! The most extraordinary remuneration was that received by Levett, Dr. Johnson's friend and frequent companion. It was observed of him that he was the only man who ever became intoxicated from motives of prudence. His patients, knowing his irregular habits, used frequently to substitute a glass of spirits for a fee; and Levett reflected that if he did not accept the gin or brandy offered to him, he could have been no gainer by their cure, as they most probably had nothing else to give him. Dr. Johnson says "that this habit of taking a fee in whatever shape it was exhibited, could not be put off by advice or admonition of any kind. He would swallow what he did not like, nay, what he knew would injure him, rather than go home with an idea that his skill had been exerted without recompence; and had his patients," continues Johnson, "maliciously combined to reward him with meat and strong liquors, instead of money, he would either have burst, like the dragon in the Apocrypha, through repletion, or been scorched up, like Portia, by swallowing fire." But though this worthy was thus rapacious, he never demanded any thing from the poor, and was remarked for his charitable conduct towards them. Various professional persons have sometimes endeavoured to remunerate their medical attendants by reciprocal services: thus an opera-dancer offered to give lessons to a physician's daughters for their father's attendance upon him; and a dentist has been known to propose to take care of the jaws of a whole family to liquidate his wine bill. One of the wealthiest merchants of Bordeaux wanted to reduce the price of a drawing-master's lessons, on the score of his taking his children's daubs with him to sell them _on account_. This arrangement, however, did not suit the indignant artist, who left the Croesus in disgust. A singular charge for medical attendance was lately brought before the court of requests of Calcutta, by a native practitioner. He demanded 314 rupees for medicine alone, and in the items of drugs appeared pearls, gold leaf, and monkeys' navels! In one of the old French farces there is an absurd scene between Harlequin and his physician. The motley hero had been cured, but refused to remunerate his Esculapius, who brought an action for his fees, when Harlequin declares to the judge that he would rather be sick again; and he therefore offers to return his health to the doctor, provided he would give him back his ailments, that each party might thus recover their own property. This incident was perhaps founded on an ancient opinion of Hippocrates, who frequently mentioned salutary diseases. In 1729, a Dr. Villars supported a thesis on this subject, entitled "_Dantur-ne morbi salutares?_" and Theodore Van Ween has also written a learned dissertation on the same subject. A celebrated Dublin surgeon was once known to give a lesson of economy to a wealthy and fashionable young man remarkably fond of his handsome face and person. He was sent for, and found the patient seated by a table, resting his cheek upon his hand, whilst before him was displayed a five-pound note. After some little hesitation he removed his hand, and displayed a small mole on the cheek. "Do you observe this mark, doctor?"--"Yes, sir, I do."--"I wish to have it removed."--"Does it inconvenience you?"--"Not in the least."--"Then why wish for its extirpation?"--"I do not like the look of it."--"Sir," replied the surgeon, "I am not in the habit of being disturbed for such trifles; moreover, I think that that little excrescence had better remain untouched, since it gives you no uneasiness; and I make it a rule only to take from my patients what is troublesome to them." So saying, he took the five-pound note, slipped it into his pocket, and walked out of the room, leaving the patient in a state of perfect astonishment. It is related of a physician who received his daily fee from a rich old miser, who had it clenched in his fist when he arrived, and turned his head away when he opened his hand for the doctor to take it, that, on being informed his patient had died in the morning, not in the least disconcerted he walked up to the dead man's chamber, and found his clenched fist stretched out as usual; presuming that it still grasped the accustomed remuneration, with some difficulty he opened the fingers, took out the guinea, and departed. The Egyptian physicians of old were paid by the state, but they were not prevented from accepting remuneration from individuals, and they were allowed to make demands for their attendance except on a foreign journey, and during military services. When we compare the value of money it appears probable that the fees of olden practitioners were more considerable than the remuneration of the present day. Attendance upon royalty and the court seems also to have been more profitable. Dr. Radcliffe says, that he received from King William 200_l._ a year more than any other physician in ordinary--this monarch upon his appointment, gave him moreover, 500 guineas out of the privy purse for his attendance on the Earl of Portland, and the Earl of Rochford. When the same physician went to Hanau to attend Lord Albemarle, he received 1200_l._ from the king, with 400 guineas from his patient, besides a valuable diamond ring. Dr. Radcliffe's fortune must have been considerable, as appears from his legacies, bequeathing 5000_l._ for the improvements of University College--4000_l._ for the building of a library at Oxford--and 500_l._ yearly for the amelioration of the diet of St. Bartholomew's hospital. Radcliffe had not been a year in London when he received 20 guineas daily, and he mentions that his fee for a visit from Bloomsbury Square to Bow, was five guineas. We do not exactly know what was the exact honorarium of Doctors in former days, yet Baldwin Hammey informs us that in 1644, Dr. Robert Wright who had only been settled three years in London, was in the habit of receiving a thousand broad pieces (22 shillings) in the course of the year. The following is a curious account of a puritan's consultation with Dr. Hammey. "It was in the time of the civil wars when it pleased God to visit him with a severe fit of sickness, or peripneumonia, which confined him a great while to his chamber, and to the more than ordinary care of his tender spouse. During this time he was disabled from practice; but the very first time he dined in his parlour afterwards, a certain great man in high station came to consult him on an indisposition--(_ratione vagi sui amoris_,) and he was one of the godly ones too of those times. After the doctor had received him in his study, and modestly attended to his long religious preface, with which he introduced his ignominious circumstances, and Dr. Hammey had assured him of his fidelity, and gave him hopes of success in his affair, the generous soldier (for such he was) drew out of his pocket a bag of gold and offered it all at a lump to his physician. Dr. Hammey, surprised at so extraordinary a fee, modestly declined the acceptance of it; upon which the great man, dipping his hand into the bag himself, grasped up as much of his coin as his fist could hold, and generously put it into the doctor's coat-pocket, and so took his leave. Dr. Hammey, returned into his parlour to dinner, which had waited for him all that time, and smiling (whilst his lady was discomposed at his being absent so long), emptied his pocket into her lap. This soon altered the features of her countenance, who telling the money over, found it to be thirty-six broad pieces of gold: at which she being greatly surprised, confessed to the doctor that surely this was the most providential fee he ever received; and declared to him that during the height of his severe illness, she had paid away (unknown to him) on a state levy towards a public supply, the like sum in number and value of pieces of gold; lest under the lowness of his spirits, it should have proved a matter of vexation, unequal to his strength at that time to bear; which being thus so remarkably reimbursed to him by Providence, it was the properest juncture she could lay hold on to let him into the truth of it." It has been supposed, that the sanctimonious sufferer was no other than Ireton, Cromwell's son-in-law. During the imprisonment of Dr. Friend in the tower, Dr. Head attended his patients, and on his liberation he presented him with 5000_l._ the amount of the fees received on his account. Dr. Meade's practice averaged from 5000_l._ to 6000_l._ per annum. It is somewhat strange, that this celebrated physician whose evenings were generally spent in convivial meetings at Batson's Coffee-house, used in the forenoon to receive consulting apothecaries at a tavern near Covent-garden, prescribing for the patients without seeing them at half-a-crown fee. ENTHUSIASM. Enthusiasm, from its derivation, might in strictness be called a _fixity of idea in divinity_; but Locke has given a better definition of this morbid state of our intellectual faculties in considering it as a heated state of the imagination, "_founded neither on reason nor divine revelation, but arising from the conceits of a warmed or overweening brain_." I shall not venture to take the field of controversy to support this doctrine against that of some metaphysicians, who most probably would consider this mental aberration as an original and natural judgment inspired by the Almighty, founded not on reason or reflection, but an instinctive impulse of the powers of the mind. The Hebrews named this impulse _Nabi_ [Hebrew], (plural _Nebiim_,) "to approach or enter," on the surmise that the spirit pervaded the prophets, who were called _Roeh_ [Hebrew], or _Seeing_, hence _Seers_. Plato divided enthusiasm into four classes. I. _The Poetical_, inspired by the Muses. II. _The Mystic_, under the influence of Bacchus. III. _The Prophetic_, a gift of Apollo; and IV. _The Enthusiasm of love_, a blessing from Venus Urania. This immortal philosopher was not the visionary speculatist which some writers have represented him; his logic did not consist of frivolous investigations, but embraced the more useful subject of correct definition and division, as he sought to reconcile practical doctrines of morality with the mysticism of theology by the study of Divine attributes. Whatever some of the Eclectic philosophers might have asserted, Plato considered that our ideas were derived from external objects, and never contemplated the extravagant doctrine of imbodying metaphysical abstractions, or personifying intellectual ideas. To this day, the attentive observer will find Plato's classification of enthusiasm to be correct. The ecstatic exaltation of religion and of love are not dissimilar; only the latter can be cured, the former seldom or never admits of mitigation: the fantastic visions of the lover may be dispelled by infidelity in the object of his misplaced affection; the phantasies of fanaticism can only yield to an improbable state of infidelity. Shaftesbury has justly observed, "There is a melancholy which accompanies all enthusiasm, be it of love or religion; nothing can put a stop to the growing mischief of either, till the melancholy be removed, and the mind be at liberty to hear what can be said against the ridiculousness of an extreme in either way." Our poet Rowe has beautifully pointed out the facility with which a noble and martial soul can free itself from love's ignoble trammels. Rouse to the combat, And thou art sure to conquer; war shall restore thee: The sound of arms shall wake thy martial ardour, And cure this amorous sickness of thy soul, Begot by sloth, and nurs'd by too much ease. The idle God of Love supinely dreams Amidst inglorious shades and purling streams; In rosy fetters and fantastic chains He binds deluded maids and simple swains; With soft enjoyment woos them to forget The hardy toils and labours of the great: But if the warlike trumpet's loud alarms To virtuous acts excite, and manly arms, The coward Boy avows his abject fear, On silken wings sublime he cuts the air, Scar'd at the noble horse and thunder of the war. The only trumpet that can arouse the religious enthusiast from his ascetic meditations is the war-whoop that calls him to destroy all those who impugn his doctrines in a battle-field, where each champion seeks pre-eminence in cruelty, and rancorous persecution. When we contemplate the miseries that have arisen from fanaticism, or fervid enthusiasm, although it is but a sad consolation, yet it affords some gratification in our charitable view of mankind, to think, nay to know, that this fearful state of mind is a disease, a variety of madness, which may in many instances be referred to a primary physical predisposition, and a natural idiosyncrasy. It is as much a malady as melancholy and hypochondriacism. In peculiar constitutions it grows imperceptibly. Lord Shaftesbury has made the following true observation: "Men are wonderfully happy in a faculty of deceiving themselves whenever they set heartily about it. A very small foundation of any passion will serve us not only to act it well, but even to work ourselves in it beyond our own reach; a man of tolerable goodnature, who happens to be a little piqued, may, by improving his resentment, become a very fury for revenge." Thus it is with enthusiasm, a malady which in its dreadful progress has been known to become contagious, one might even say epidemic. Vain terrors have seized whole populations in cities and in provinces; when every accident that happened to a neighbour was deemed a just punishment of his sins, and every calamity that befel the fanatic was considered the hostile act of others. Jealousy and dark revenge were the natural results of such a state of mind, when the furious fire of bigotry was fanned by ambition until monomania became dæmonomania of the most hideous nature, and every maniac bore in his pale and emaciated visage the characteristic of that temperament which predisposes to the disease. Seldom do we observe it in the _sanguineous temperament_, remarkable for mental tranquillity, yet determined courage when roused to action. The _choleric_ and _bilious_, impetuous, violent, ambitious, ever ready to carry their point by great virtues or great crimes, may no doubt rush into a destructive career; but then they lead to the onset the atrabilious, men saturated with black bile, and constituting the _melancholy temperament_. Here we behold the countenance sallow and sad; the visage pale and emaciated, of an unearthly hue; gloom, suspicion, hate, depicted in every lineament; the mirror of a soul unfitted for any kind sentiment of affection, pity, or forgiveness. Detesting mankind, and detested, they seek solitude, to brood upon their wretchedness, or to derive from it the means to make others as miserable as themselves. Such do we usually find the enthusiastic monomaniac. His ideas are concentrated into a burning focus, which consumes him like an ardent mirror. His life of relation is nearly extinguished. His external senses are rendered so obtuse and callous that he becomes insensible to hunger and thirst, to heat and cold however intense; and bodily injuries, which would occasion excruciating agonies in others, he bears without any apparent feeling. On this subject of religious enthusiasm the remarks of Evagrius are worthy of notice. "Contrarieties," he says, "are in themselves so tempered, and the grace of God maketh in them such an union of discordant things, that life and death, which are in essence so opposite to each other, seem to join hands and dwell together in them. Happy are they while they live, and happier still when they depart." It has been known amongst these rigid ascetics that when a stranger visited them, they mortified themselves by entertaining him and partaking of the good cheer. Thus inventing a novel kind of fasting--eating and drinking against their will. It is related of St. Macarius, that one day having killed a gnat that had stung him, he was struck with such compunction at the sight of blood, that by way of atonement, he threw off his clothes, and remained in a state of nudity for six months in a marsh exposed to the bites of every noxious insect. Sozomen in praising this mortification, assures us that this exposure to the inclemency of the weather, did so harden and tan him that his beard could not make its way through the skin. It has been erroneously supposed that such individuals, being hostile to mankind, are prone to do evil,--this is not generally the case; they seem satisfied with their own sufferings, and only seek to inflict them upon others when roused from their concentration by fanaticism. A late ingenious writer, in his work entitled "The Natural History of Enthusiasm," has somewhat overdrawn the portrait of these unfortunate but dangerous beings when labouring under the disease, which he thus defines: "It will be found that the elementary idea attached to the term in its manifold applications, is that of fictitious fervour in religion, rendered turbulent, morose, or rancorous by junction with some one or more of the unsocial emotions; or, if a definition as brief as possible were demanded, we should say that fanaticism is enthusiasm inflamed by hatred. Fanaticism supposes three elements of belief: the supposition of malignity on the part of the object of our worship; a consequent detestation of mankind at large, as the subjects of malignant power; and then, a credulous conceit of the favour of Heaven shown to the few, in contempt of the rules of virtue." Shaftesbury had already said, that "nothing besides ill-humour, either natural or forced, can bring a man to think seriously that the world is governed by any devilish or malicious power." Such a fearful conviction constitutes a clear case of dæmonomania. Patients labouring under that malady are ever prone to injure themselves and others, prompted, as they constantly avow, by an evil spirit; but enthusiasts, who live in solitary mortification until a paroxysm of fanaticism draws them from their retreat, seldom or never meditate mischief to others, or indeed that hatred to mankind which our author considers a feature of their condition. Society may become irksome, and may be shunned for ever, without a sentiment of hate. The gayest of the gay may be impelled by feelings more or less morbid to seek a voluntary endurance, to expiate real or imaginary offences, without experiencing a desire of a uselessly vindictive sentiment towards the former companions of their vices or follies. Extremes of depravity and contrition do not infrequently meet; and it has been remarked in Eastern countries, where asceticism arose, that the gates of the most splendid and luxurious cities open upon desert wilds or mountainous solitudes, to which the penitent may flee from his former scenes of ambition and enjoyment. Such enthusiasts, excepting when enjoying the beatitude of ecstatic exaltation, are more to be pitied than feared. Persecution would most probably drive them to a dangerous state of fanatic rage; and the noble philosopher whom I have already quoted, very justly observes, "They are certainly ill physicians in the body politic who would needs be tampering with these mental eruptions, and, under the specious pretence of healing the itch of superstition, and saving souls from the contagion of enthusiasm, should set all nature in an uproar, and turn a few innocent carbuncles into an inflammation and a mortal gangrene." Enthusiasts are supposed by their followers to be gifted with the faculty of prophecy; and it is somewhat strange that the ancients considered certain temperaments as best fitted for this inspiration. The atrabilious temperament took the lead; and this melancholy state was to be increased by abstinence, mortification, and more especially rigid continence. The latter privation, indeed, was deemed indispensable for prophets; and the Jewish Rabbins inform us that Moses abandoned his wife Zipporah the very moment that he was prophetically inspired. A physical reason has been adduced to prove the necessity of a chaste life, which I here must be allowed to pass over; but upon the same principle, emasculation was considered as rendering man totally unfit for prophetic revelation, or indeed any holy inspiration; and we find in the first of Deuteronomy that such subjects were not admissible to the service of the Temple. Jesaias, and some other Jewish writers, have affirmed that Daniel belonged to that class of beings; but it has been shown that the name of _Spado_, which he bore, merely gave him the high rank that eunuchs held at the Assyrian court. Potiphar bore the same title among the Pharaohs. Baruch Spinosa maintained that temperaments should vary according to the nature of the prophecy; thus, a gay prophet would predict victory and happiness, a gloomy one misery and wars; peace and concord, if he is human; destruction and merciless events, if he were sanguinary: and, in support of his doctrine, he quotes the passage in Kings, where Elisha, when brought before Jehosophat, called for a minstrel ere he predicted that victory should crown the arms of Judah. Various artificial means have been resorted to at all periods to prepare the intellects for inspirations, by creating a heated imagination. Pliny informs us that, in his days, the root of the _Halicacabum_, supposed to be a species of hyoscyamus, was chewed by soothsayers. Christopher D'Acosta relates that the Indians employ a kind of hemp called _Bangue_ for the same purpose: and in St. Domingo their supposed prophets masticate a plant called _Cohaba_. The priestesses of Delphi were also in the habit of chewing laurel-leaves before they ascended the tripod, which it is stated was originally formed of a laurel-tree root with three branches. Sophocles calls the Sibyls [Greek: daphnêphagos], laurel-eaters; and thus Tibullus, Vera cano, sic usque sacras innoxia lauros Vescar, et æternùm sit mihi virginitas. Auguries were drawn from the burning of the laurel-leaf. If it crackled and sparkled during combustion, the inference was favourable; the reverse, if it was consumed in silence. Propertius alludes to this belief: Et tacet extincto laurus adusta foco. Yet so far from possessing exhilarating qualities, laurel-leaves were supposed to diminish the excitement produced by wine; and Martial affirms that the Roman ladies made use of them to drink large potations with impunity: Foetere multo Myrtale solet vino; Sed fallat ut nos, folia devorat lauri, Merumque, cautâ fronde, non aquâ miscet. May it not be inferred that the leaves given to the Pythia might have been those of the _Lauro-cerasus_, the effects of which are similar to those of prussic acid, producing vertigo, dizziness, and various convulsive symptoms? This tree was first observed by Bélon, who discovered it in his eastern voyages in 1546; but it might have been well known to the ancients. We may thus account for the violent convulsions in which the priestesses of Apollo were thrown on these mystic occasions, and which were said to arise from the gas over which they were seated. Although the tree from which the leaves were gathered grew near the temple, and was the common _Lauros nobilis_, yet the leaves of the _Lauro-cerasus_ might have easily been substituted on the occasion; since, always green and shining, they are not very unlike each other, and the flowers of both trees are pedunculate; and, no doubt, the priests well knew to what extent they could carry the dose to serve their purposes; possibly the modern preparation of _noyau_ might have been a Pythian dram. The effects of enthusiasm in rendering its victims insensible to all external agents is truly surprising, and cannot be better illustrated than by a relation of the horrors which the famous Convulsionists of Paris and other parts of France underwent, not only voluntarily, but at their most earnest prayer and solicitation. This work of miracles, as it was called, was first performed by a priest of the name of Paris, in 1724, and strange to say, the aberration continued for upwards of twelve years. Paris having departed this life in the odour of sanctity, (at least according to the conviction of the Jansenists, who had opposed with no little violence the famous bull _Unigenitus_), the Appellants, for such they thought proper to denominate their sect, appealed to the remains of their beatified companion to operate miracles in support of their common cause. The Appellants were absurdly persecuted, therefore miracles became manifestations easy to obtain. Having succeeded in finding credulous dupes, the next step was to work their credulity into a useful state of enthusiasm. They therefore summoned all the sick, lame, and halt of their sectarians to repair to the tomb of St. Paris for radical relief. Crowds were soon collected round his blessed sepulchre. It is now generally supposed that animal magnetism was resorted to in these curative operations, or rather religious ceremonies. Had not the means thus employed for the purpose been recorded and authenticated by the most irrefragable authorities, the sceptic might long pause before he would yield them credence. The patient (a female) was stretched on the ground, and the stoutest men that could be found were directed to trample with all their might and main upon her body; kicking the chest and stomach, and attempting to tread down the ribs with their heels. So violent were these exertions, that it is related a hunchbacked girl was thus kicked and trampled into a goodly shape. The next exercise was what they called the plank, and consisted in laying a deal board upon the patient while extended on the back, and then getting as many athletic men as could stand upon it, to press the body down; and in this endeavour they seldom showed sufficient energy to satisfy the supposed sufferer, who was constantly calling for more pressure. Next came the experiment of the pebble, a diminutive name they were pleased to give to a paving-stone weighing two-and-twenty pounds, which was discharged by the operator upon the patient's stomach and bosom, from as great a height as he could well raise the weighty body. This terrific blow was frequently inflicted upwards of a hundred times, and with such violence, that the house, and the furniture of the room, vibrated under the concussion, while the astonished bystanders were terrified by the hollow sound re-echoed by the enthusiast at every blow. Carré de Montgeron affirms that the _pebble_ was not found sufficiently powerful, and the operator was obliged in one case to procure an iron fire-dog (_chenet_), weighing about thirty pounds, which was discharged as violently as possible on the pit of the patient's stomach at least a hundred times. This instrument having for the sake of curiosity been hurled against a wall, brought part of it down at the twenty-fifth blow. The operator further states, that he had commenced according to the usual practice, by inflicting moderate blows, until he was induced by her lamentable entreaties to redouble his vigour, but all to no purpose; his strength was unavailing and he was obliged to employ a more athletic surgeon, who fell to work with such energy that he shook the whole house. The convulsionist, who was of the gentle sex, would not allow sixty blows she had received from her first doctor to be included in the calculation of the dose, but insisted upon having her whole hundred as prescribed. It further appears, that at each stroke the delighted enthusiast would exclaim in ecstacy, "Oh, how nice!" "Oh, what good it does me!" "Oh, dear brother, hit away--again--again!" For be it known, these operators were called by the affectionate name of brothers, whose claims to fraternal affection were in the ratio of the weight of their kindness towards the sisterhood. One of these young ladies, who was not easily satisfied, wanted to try her own skill, and jumped with impunity into the fire, an exploit which obtained her the glorious epithet of Sister Salamander. The names that these amiable devotees gave to each other were somewhat curious. They all strove to imitate the whining and wheedling of spoiled children, or petted infants; one was called _L'Imbécile_, another _L'Aboyeuse_, a third _La Nisette_, and they used to beg and cry for barley-sugar and cakes; barley-sugar signified a stick big enough to fell an ox, and cakes meant paving-stones. The excesses of these maniacs were at last carried to so fearful an extent, and their religious ceremonies were so debased by obscenities that the police was obliged to interfere, and forbid these detestable practices; hence it was affirmed that the following somewhat impious notice was suspended over the church-door: De par le Roi, défense à Dieu, De faire miracle en ce lieu. These lunatics, for such they must be considered, were not impostors. They had been worked to this degraded state by the plastic power of superstition, and implicit reliance was placed in their assertions; for, as Pascal said, "we must believe people who are ready to have their throats cut." Whether the Jansenist priests belonged to the same class, I leave to the reader to decide. Cabanis, in his interesting work, "Rapports du Physique et du Moral de l'Homme," offers the following remarks on this most curious subject: "Sensibility may be considered in the light of a fluid the quality of which is determined, and which, when carried to certain channels in greater proportion than to others, must of course be diminished in the latter ones. This is evident in all violent affections, but more especially in those ecstasies where the brain and other sympathetic organs are possessed of the highest degree of energetic action, while the faculty of feeling and of motion--in short, the vital powers--seem to have fled from the other parts of the system. In this violent state, fanatics have received with impunity severe wounds, which, if inflicted in a healthy condition, would have proved fatal or most dangerous; for the danger that results from the violent action of external agents on our organs depends on their sensibility, and we daily see poisons, which would be deleterious to a healthy man, innocuous in a state of illness. It was by availing themselves of this physical disposition that impostors of every description, and of every country operated most of their miracles; and it was by these means that the Convulsionists of St. Medard amazed weak imaginations with the blows they received from swords and hatchets, and which in their ascetic language they called _consolations_. This was the magic wand with which Mesmer overcame habitual sufferings, by giving a fresh direction to the attention, and establishing in constitutions possessed of great mobility a sense of action to which they had been unaccustomed. It was thus also that the _Illuminati_ of France and Germany succeeded in destroying external sensations amongst their adepts, depriving them in fact of their relative existence." In these phenomena we do not witness miracles or supernatural agency. Enthusiasts are simply maniacs. Like maniacs, their vital endowments are deranged; they lose the faculty of feeling, of reasoning, of comparing, of associating their ideas; their volition, their memory have fled, and all the functions of organic life are more or less disturbed. Rousseau never proved more clearly that his own intellectual faculties were occasionally impaired, than when he stated "that the state of reflection is unnatural, and that the man who meditates is a depraved animal." Insanity may be divided into four species: 1st, _Monomania_, and _melancholy_, in which the delirium is confined to one or few objects. 2nd, _Mania_, where the delirium embraces a variety of impressions, and is accompanied with violence. 3rd, _Dementia_, or insanity in the full acceptation of the word, where the senses are totally bewildered, and the faculty of thinking destroyed. 4th, _Imbecility_ or _idiotcy_, where, from imperfect organisation, ratiocination cannot be correct. To the first of these categories enthusiasts generally belong. Delirium, or wandering, is to a certain extent applicable to all, being a want of correspondence between judgment and perception. Locke and Condillac characterize madness as a _false judgment_, or a disposition to associate ideas incorrectly, and to mistake them for truths. Hence it is observed by Locke that "Madmen err, as men do that argue right from wrong principles." Dr. Beattie refers madness to _false perception_; and Dr. Mason Good, justly remarks, that "the perceptions in madness seem, for anything we know to the contrary, to be frequently as correct as in health, the judgment or reasoning being alone diseased or defective." I hope that I may not be accused of _materialism_ when I venture to affirm that all these enthusiasts labour under a physical disease; but whether this state was originally brought on by a morbid condition of the intellectual or the empassioned faculties of the mind, or, in other words, whether a diseased state of the mind brought on a diseased state of the body, I shall not at present venture to decide, as the disquisition would be foreign to the nature of this work, and lead us into investigations of little interest to the generality of readers. In the German Psychological Magazine we meet with a curious case of a patient who believed that he was supernaturally endowed with the power of working miracles. The man was a gend'arme of the name of Gragert, of a harmless and quiet disposition, but rather of a superstitious turn of mind. From poverty, family misfortunes, and severe military discipline, a series of sleepless nights and a mental disquietude were brought on that, according to his own report, nothing could dissipate but a perusal of pious works. In reading the Bible he was struck with the book of Daniel, and was so much pleased with it, that it became his favourite study; from that moment the idea of miracles so strongly possessed his imagination, that he began to believe that he could perform some himself. He was persuaded more especially that if he were to plant an apple-tree with the view of its becoming a cherry-tree, such was his power that it would bear cherries. He was wont to answer every question correctly, except when the subject concerned miracles, in regard to which he ever entertained his old notions; adding, however, that he would relinquish this thought if he could be convinced that the event of his trials did not correspond with his expectations. That many enthusiasts, although incurable in their peculiar aberration, have possessed some amiable qualities, is undeniable. Such rare occurrences remind one of the curious case of madness recorded by Tidemann of a lunatic of the name of Moses, who was insane on one side, and who observed his insanity with the other; his better half constantly rebuking his worse half for its absurdities. This case was certainly typical of the married state. In vain have physicians endeavoured to break through this morbid catenation of incongruous ideas by diversions, or what the French call _distractions_, which in general answered to our literal translation of the word, and _distracted_ their patients. Dramatic performances were once allowed in a mad-house near Paris; but the violence of the maniacs, the moroseness of the melancholy, and the stupidity of the idiots, rendered the exertions of the actors perilous to some, and idle to all. Mr. D'Esquirol once took one of his patients to a play, and the man swore that every performer who came on was making love to his wife; and a young lady, placed in a similar situation, exclaimed that all the people were going to fight about her. Jealousy and vanity were, no doubt, the ruling passions in both these cases. Travel has been recommended both by the ancients and the moderns. Seneca on this subject quotes Socrates, who replied to a melancholy wight who complained that his journeys had afforded him no amusement, "_I am not surprised at it, since you were travelling in your own company_." The contagion of enthusiasm is a marvellous fact. Pausanias relates that the malady of the daughters of Proetus, who ran about the country fancying that they were transformed into cows, was common amongst the women of Argos. Plutarch states that a disease reigned in Miletium, in which most of the young girls hung themselves; recent observations have confirmed this singular circumstance. Dr. Deslages, of St. Maurice, relates that a woman having hanged herself in a neighbouring village, most of her companions felt an invincible desire to follow her example. Primrose and Bonet tell us that at one period it was found difficult to prevent the young girls in Lyons from casting themselves into the river. Simon Goulard has recorded the prevalent madness amongst the nuns of the States of Saxony and Brandenburg, and which soon extended its influence to Holland, during which these religious ladies "predicted, capered, climbed up walls, spoke various languages, bleated like sheep, and amused themselves by biting each other." History has recorded the horrible judicial murder of Urbain Grandier, at Laudun, who was sacrificed for bedevilling a nunnery. The recent gift of tongues amongst the _Irvingites_ is still in full vigour, and the _Southcotians_ are still on the look-out in London, as the _Sebastianists_ are in Lisbon. Addison has remarked that an enthusiast in religion is like an obstinate clown, and a superstitious man like an insipid courtier. On this subject he quotes the following old heathen saying recorded by Aulus Gellius--_Religentem esse oportet, religiosum nefas_; for, as the author tells us, Nigidius observed upon this passage, that the Latin words which terminate in _osus_ generally imply vicious characters, or the having any quality to excess. That we should enthusiastically admire all that is holy, sublime, or endowed with uncommon superiority in religion, in poetry, in the fine arts, is not only justifiable but praiseworthy. Genius cannot exist without a certain degree of fervour; its inspiration is a gift divine, naturally associated with a religious feeling. The man thus inspired must bend in humble admiration before the wondrous harmony that surrounds him. The poet, the painter, the musician, can only seek excellence by studying primitive perfection. Nothing that is not natural can be truly sublime or beautiful. A rigid observation of nature can alone lead to superiority, and we can only be taught to create by, endeavouring to imitate the beauties of the creation. How distant are these generous feelings from the low grovelling prejudices of bigotry! We admire perfection even in our enemies; and Erasmus was not a truant to his faith when, transported with Socrates's dying speech, he exclaimed, "O Socrates! I can scarce forbear kneeling down to thee, and praying, _Sancte Socrates, ora pro nobis_." While considering this interesting subject, a curious question arises: is enthusiasm more frequently excited by truth than by error? I sadly fear that the latter influence will in general be found to predominate, although falsehood then assumes the deceptive garb of veracity. The noble writer whom I have already cited,[19] has justly said, "that truth is the most powerful thing in the world, since even fiction itself must be governed by it, and can only please by its resemblance." To what then are we to attribute this power that fallacy possesses of inspiring the mind with visionary hopes and fears? Simply because we cease to reason upon matter of fact, and soar in fanciful regions in search of a flittering phantom, a creature of our own imaginative faculties. What falls every day under our personal observation ceases to amaze, and one might even become familiarized to miracles were they of frequent occurrence. Man is naturally disposed to admire what he cannot understand, and to venerate what is incomprehensible. The nature of the divinity being essentially incomprehensible, a religious character is attached to all other subjects that are equally beyond the limits of our understanding. Sir Thomas Brown has said, "Methinks there be not impossibilities enough in religion for an active faith. I love to lose myself in a mystery, to pursue my reason to an _O altitudo_! I can answer all the objections of Satan and my rebellious reason, with that odd resolution I learned from Tertullian, _Certum est quia impossibile est_." From our earliest infancy we are delighted with fictions, which we verily fancy to be relations of true facts, and whether we believe with the ancients in the metamorphoses of heathen mythology, the absurd papal stories of the miracles of their saints, or the wondrous incidents of a fairy tale, we listen to these rhapsodies with avidity; whether Jupiter is turned into a shower of gold, St. Denis and St. Livarius travel with their heads under their arm, or Tom Thumb pulls on his seven-league boots. These absurdities are our day thoughts, our night dreams--nay, busy fancy does so dwell on these enchanting phantasies, that, in some cases, the intellectual faculties become deranged, and I have at present under my care, a female who lost her reason by constantly reading the Arabian Nights, and who in her hallucinations, describes as many marvellous voyages as could have done the sailor Sinbad. The foundation of incredulity no doubt is ignorance, but too often we find men of refined education and feeling the most easily imposed upon by incredible assertions; we seldom experience as much enthusiasm in the possession of any object as in the pursuit, more especially if that pursuit be vain. The merchant who has realized a splendid fortune in his commercial ventures, is satiated with his business, and becomes careless in the pursuit of greater riches, but let him for one moment contemplate the possibility of discovering the philosopher's stone, he will lose, and cheerfully too, all his past earnings in the chimerical pursuit, and the man who would doze over his ledger, will spend his sleepless nights contemplating his crucibles, and studying the black art. What is there of an exciting nature in the common events of life and the usual course and uniformity of nature? Very little. However wondrous the works of the creation may be, habit has so accustomed us to behold them, that they are familiar to our eyes; they become matter of fact, and science has taught us to comprehend the nature of many phenomena, which might otherwise have appeared incredible: but when we seek for an unattainable object, however fallacious its attraction may be, the mind is roused to energetic action: if we strive to excel all others in the fine arts, in poetical productions, we become fired with an exalted zeal, which age and experience alone can temper. In our vain pursuit of ideal perfection, the mind may be compared to a focus in which our burning thoughts are concentrated, until we are consumed by disappointment: the love of Pygmalion was probably the most ardent passion that could fire the breast of man. Enthusiasm laughs to scorn the suggestion of the senses and common understanding, therefore all its priests and votaries are surrounded with a deceptive halo; and Plotinus maintained that a proper worship of the gods consisted in a mysterious self annihilation and a total extinction of every faculty. The same may be said of love, which, like all other enthusiastic passions, may be considered a temporary hallucination. Moreover the language of fiction is not required to maintain the self-evident testimonies of facts. As true as truth's simplicity, And simpler than the infancy of truth. Whereas false doctrines and fallacious opinions need all the aid of imagination's vivid colours to disguise their real form with a goodly outside. We may in general conclude that enthusiasts are at first deceived themselves to become in turn deceivers. Seldom does man display sufficient humility to admit that he has erred in his favourite doctrines, and how much less will he be disposed to confess his deviation from rectitude, when imposture becomes the source of wealth and power, and hypocrisy a trade: to the ghostly speculator we may well apply the lines of Massinger: Oh, now your hearts make ladders of your eyes, In show to climb to heaven, where your devotion Walks upon crutches. It is, however, fortunate that errors generally assist the development of truth. The progress of the Christian faith was materially forwarded by the absurdities and fallacies of all other religions; and Helvetius has truly observed that if we could for a moment doubt the truth of Christianity, its divine origin would be proved by its having survived the horrors of popery. False theories led Columbus to correct geographic conclusions, and Galileo's discoveries overthrew his own former theories. MEDICINAL EFFECTS OF WATER. Amongst the various means resorted to by quackery to speculate upon the credulity of mankind, simple river or spring water, coloured and flavoured with inert substances, has not been the least productive; and many a time the Thames and Seine have been fertile sources of supposed invaluable medicines. Sangrado's doctrines on aqueous potations have long prevailed in the profession; and it has been stoutly maintained that a water diet can cure the gout and various other diseases. That relief, if not cures, have been obtained by this practice, there cannot be the least doubt. Are we to attribute these favourable results to the effects of the imagination, the beneficial efforts of nature, or the salutary abstinence which this prescription imposed? Possibly they all combined to assist the physician's efforts, or rather aid his effete treatment. Cold water and warm water have in turn been praised to the very skies by their eulogists, and become the subject of ridicule and persecution on the part of more spirited practitioners. In surgery, water has ever been considered of great utility; it, no doubt, was instinctively used by man to cleanse and heal his wounds. Patroclus, having extracted the dart from his friend Eurypylus, washes the wound; and the prophet Elisha prescribes to Naaman the waters of Jordan. Rivers had various qualities, and were supposed to prove as different in their action on the economy as the mineral springs which from time immemorial, have been resorted to. These effects may in fact not be altogether doubtful; for, although these salutary streams may not possess sufficient active ingredients to be recognised by chemical tests, yet we know that substances which appear perfectly inert may prove highly active and effectual when combined and diluted naturally or artificially. Moreover, in the effects of watering-places on the invalid or valetudinarian, we must not forget the powerful influence of change of air and habit, the invigorating stimulus of hope, and the diversion from former occupations. To these auxiliaries many a remedy has owed its high reputation; and probably when Wesley attributed his recovery to brimstone and supplication, he in a great measure might have considered rest from incessant labour the chief agent in his relief. The exhilarating effects of the picturesque site of many of these salutary places of resort is universally acknowledged. Montaigne, Voltaire, Alfieri, acknowledged their influence on the imagination. Petrarch's inspirations flowed with the waters of Vaucluse, some of Sevigné's most delightful letters were written at Vichy, and Genlis and Staël were particularly happy in their epistolary elegance at Spa and Baden. We owe to accident many valuable discoveries in medicine. It is said that several Indians, having used the waters of a lake in which a cinchona tree was growing, experienced the benefit which led to the use of the Peruvian bark; and the thermal properties of the baths of Carlsbad were first made known by the howling of one of Charles the Fourth's hounds, that had fallen in them in a hunt. It has been also observed, in various countries, that particular waters produced various morbid affections; and to this cause have been attributed goitres, cretinism, calculi, and other distressing diseases. The ancients dreaded the impurity of their rivers. The Romans boiled their water in extensive _thermopolia_, where not only potations were drunk hot, but occasionally refrigerated with ice and snow, and, when thus prepared, called _decocta_. Juvenal and Martial refer this custom to the Greeks. Herodotus informs us that the Persian monarchs were accompanied on their expeditions by chariots laden with silver vases filled with the water of the _Choaspes_ that had been boiled, and which was solely destined for the king's use: Athenæus tells us that it was light and sweet. Many ancient coins and inscriptions have recorded these salutary properties of certain waters. This real or supposed efficacy was scarcely discovered before it became the domain of priests: and common rain or river water became valuable and sanctified when blessed by them: hence the introduction of lustral water. The fluid extracted from the gown of Mahomet is the sacred property of the sultan. The moment the fast of the Ramazan is proclaimed, this holy vestment is drawn from a gold chest, and, after having been kissed with due devotion, plunged in a vase of happy water, which, when wrung from the garment, is carefully preserved in precious bottles, that are sent by the monarch as valuable presents, or sold at exorbitant prices as cures for any and every disease. Thus were the good effects of ablution, especially in wounds, attributed to some secret charm or quality conferred upon it by clerical benediction or the legitimacy of princes. When a quack of the name of Doublet cured the wounded at the siege of Metz in 1553, the water he used was considered to have been of a mystic nature; and Brantome describes his treatment in the following words: "Durant le susdit et tant mémorable siège, était en la place un chirurgien nommé Doublet, lequel faisait d'estranges cures avec du simple linge blanc, et belle eau claire venant de la fontaine ou du puit; mais il s'aidait de sortilèges et paroles charmées, et chacun allait à luy." This Doublet, no doubt, was acquainted with an ingenious treatise on gun-shot wounds, written by Blondi in 1542, in which he strongly recommended the use of cold water; but, as his recommendation was not founded on any miraculous quality, he was forgotten, while Doublet was considered a supernatural being. Previous to this simple and sagacious method of healing wounds, various curious applications were in high repute; more especially the oil of kittens, which the celebrated Paré discovered to his great delight, was prepared by boiling live cats, coat and all, in olive oil, and was until then a valuable secret preparation, called _oleum catellorum_, and its use, with that of other nostrums, was known under the name of _secret dressing_.[20] This simple mode of dressing wounds, especially those that were inflicted by fire-arms, was a great desideratum; for, up to this era in surgery, these injuries were healed by the application of scalding oil or red-hot instruments, under the impression that they were of a poisonous nature. Paré was one of the first army-surgeons who exploded this barbarous practice. Having, according to his own account, expended all his boiling oil, he employed a mixture of yolk of egg, oil, and turpentine, not without the apprehension of finding his patients labouring under all the effects of poison the following day; when, to his great surprise, he found them much more relieved than those to whom the actual cautery had been applied. In more recent times, armies have been unjustly accused of making use of poisonous balls; and this absurd charge was brought against the French after the battle of Fontenoy, when the hospital fever broke out among the wounded crowded in the neighbouring villages. Chewing bullets was also considered a means of imparting to them a venomous quality. Lead and iron, the metals of which these projectiles were usually cast, were also deemed of a poisonous nature. A sort of aristocratic feeling seemed to obtain in those days; and it is related that two Spanish gentlemen had procured gold balls to fire at Francis I. at the battle of Pavia, that so noble and generous a prince should not fall by the vile metal reserved for vulgar people; and, in the adverse ranks, La Chatarguene, a noble of the French court, had prepared bullets of the same costly material for the reception of Charles V. It was under the impression of this poisonous nature of wounds, that individuals of both sexes, called suckers, followed armies, and endeavoured to extract the venom by suction; the records of chivalry give us instances of lovely damsels who condescended to perform this operation with their lovely mouths upon their _damoiseaux_; and Sibille submitted the wounds of her husband, Duke Robert, to a similar treatment: indeed, these suckers were chiefly females. May not this practice be the origin of the term _leech_, applied in ancient times to medical men? Leechcraft was the art of healing. Thus Spenser: And then the learned leech His cunning hand 'gan to his wounds to lay, And all things else the which his art did teach. To this day, the custom of sucking wounds prevails among soldiers; and there is every reason to hope, from the experiments of the late Sir David Barry, that the exhaustion produced by cupping-glasses will be found of essential service in all venomous wounds. This practice of suction, no doubt, was known in Greece; Machaon performed it at the siege of Troy. The mothers and wives of the ancient Germans had recourse to the same process. In India the suction of wounds constitutes a profession. It was by this means that the Psylli cured the bite of serpents; and it is related of Cato, that his abhorrence of the Greek surgeons was such, that he directed Psylli to follow the Roman armies. Water affords a beautiful illustration of that indestructibility with which the Creator invested matter for the preservation of the world he formed from elementary masses, and appears to have existed unchangeable from the commencement of the universe. Its constituent parts are not broken into by any atmospheric revolution; they continue the same, whether in the solid ice, the fluid state of a liquid, or the gaseous form of a vapour. Its powers are undiminished, whether in the wave or the steam; the most effective agent in the hands of man to promote that welfare and happiness which his own errors deprive him of, frequently bringing on those calamities that his perversity attributes to the will of the Omnipotent. Water is the same in the atmosphere as on the earth, and falls in the very same nature as it ascends; electricity has no other influence upon it than that of hastening its precipitation. Chemical agents, however powerful, can only decompose its elementary principles upon the most limited scale. The heterogeneous substances with which water may occasionally be alloyed must be considered as purely accidental. The homogeneous characters of this fluid admit of no alteration, and, like atmospheric air, are still obtained as pure most probably as when they first emerged from chaotic matter. The same principles are found in the clouds, the fogs, the dews, the rain, the hail, and the snow. For the preservation of the world it was indispensable that water should be endowed with the property of ever retaining its fluid form, and in this respect become subject to a law different from that of other bodies, which change from fluid to solid. This is a deviation from a general decree of Nature. Were it not for this wise provision of the Creator, the world would shortly have been converted into a frozen chaos. All bodies contract their dimensions, and acquire a greater specific gravity by cooling; but water is excepted from this law, and becomes of less specific gravity, whether it be heated, or cooled below 42° 5'. Were it not for this exemption, it would have become specifically heavier by the loss of its caloric, and the waters that float on the surface of rivers would have sunk as it froze, until the beds of rivers would have been filled up with immense masses of ice. From the observations of Perron, there is reason to believe that the mountainous accumulations of ice that have hitherto arrested the progress of polar navigators have been detached from the depths of the ocean to float upon its surface. This circumstance would account for the difference of temperature of the sea according to its depth. The experiments of Perron, made with an instrument of his own invention, which he called the thermobarometer, gave the following results: 1st, The temperature of the sea upon its surface, and at a distance from shore, is at the meridian, lower than that of the atmosphere in the shade; much more elevated at midnight, but in a state of equilibrium morning and evening. 2nd, The temperature rises as we approach continents or extensive islands. 3rd, At a distance from land, the temperature of the deep parts of the sea is lower than that of the surface, and the cold increases with the depth. It is this circumstance which led this ingenious philosopher to conclude that even under the equator the bottom of the sea is eternally frozen. Humboldt is of a contrary opinion, and maintains that the temperature is from two to three degrees lower in shallow water; and he therefore is of opinion that the thermometer might prove of material use to navigators. He attributes this diminution of temperature to the admixture of the lower bodies of water with that of the surface. Who is to decide between these two ingenious experimentalists? "Experientia fallax, judicium difficile." The curious reader may consult in this investigation the tables of Forster in Cook's second voyage, those of Lord Mulgrave when Captain Phipps, and various other navigators. The salutary medicinal effects of sea-bathing are generally acknowledged, although too frequently recommended in cases which do not warrant the practice; in such circumstances they often prove highly prejudicial. The ancients held sea-water baths in such estimation, that Lampridius and Suetonius inform us that Nero had it conveyed to his palace. As sea-bathing is not always within the reach of those who may require it, artificial sea-water has been considered a desirable substitute; and the following mode of preparing it, not being generally known, may prove of some utility. To fifty pounds of water add ten ounces of muriate of soda, ten drachms of muriate of magnesia, two ounces of muriate of lime, six drachms of sulphate of soda, and the same quantity of sulphate of magnesia. This is Swediaur's receipt. Bouillon Lagrange, and Vogel, recommend the suppression of the muriate of lime and sulphate of soda, to be replaced with carbonate of lime and magnesia; but this alteration does not appear necessary, or founded on sufficient chemical grounds for adoption. Sea-water taken internally has been considered beneficial in several maladies; and, although not potable in civilized countries, it is freely drunk by various savage tribes. Cook informs us that it is used with impunity in Easter Island; and Schouten observed several fishermen in the South Sea drinking it, and giving it to their children, when their stock of fresh water was expended. Amongst the various and capricious experiments of Peter the Great, an edict is recorded ordering his sailors to give salt water to their male children, with a view of accustoming them to a beverage which might preclude the necessity of laying in large stocks of fresh water on board his ships! The result was obvious: this nursery of seamen perished in the experiment. Russel, Lind, Buchan, and various other medical writers, have recommended the internal use of sea-water in scrofulous and cutaneous affections; but its use in the present day is pretty nearly exploded. PROVERBS AND SAYINGS REGARDING HEALTH AND DISEASE. An ague in the spring is physic for a king. Agues come on horseback, but go away on foot. A bit in the morning is better than nothing all day. You eat and eat, but you do not drink to fill you. An apple, an egg, and a nut, you may eat after a slut. _Poma, ova, atque nuces, si det tibi sordida, gustes._ Old young and old long. They who would be young when they are old, must be old when they are young. When the fern is as high as a spoon, You may sleep an hour at noon. When the fern is as high as a ladle, You may sleep as long as you are able. When fern begins to look red, Then milk is good with brown bread. At forty a man is either a fool or a physician. After dinner sit a while, after supper walk a mile. After dinner sleep a while, after supper go to bed. A good surgeon must have an eagle's eye, a lion's heart, and a lady's hand. Good kale is half a meal. If you would live for ever you must wash milk from your liver. _Vin sur lait, c'est souhait; lait sur vin, c'est venin._ Butter is gold in the morning, silver at noon, and lead at night. He that would live for aye, must eat sage in May. _Cur moriatur homo, cui salvia crescit in horto?_ After cheese comes nothing. An egg and to bed. You must drink as much after an egg as after an ox. He that goes to bed thirsty rises healthy. _Qui couche avec la soif, se leve avec la santé._ One hour's sleep before midnight is worth two hours after. Who goes to bed supperless, all night tumbles and tosses. Often and little eating makes a man fat. Fish must swim thrice. _Poisson, goret, et cochon vit en l'eau, mort en vin._ Drink wine and have the gout, drink no wine and have it too. Young men's knocks, old men feel. _Quæ peccamus Juvenes, ea luimus Senes._ Go to bed with the lamb, and rise with the lark. Early to bed, and early to rise, Makes a man healthy, wealthy, and wise. Wash your hands often, your feet seldom, and your head never. Eat at pleasure, drink by measure. _Pain tant qu'il dure, vin à mésure._ Cheese is a peevish elf, It digests all but itself. _Caseus est nequam, Quia digerit omnia se quàm._ The best physicians are Dr. Diet, Dr. Quiet, and Dr. Merryman. _Si tibi deficiant medici, medici tibi fiant Hæc tria; mens læta, requies, moderata diæta._ Drink in the morning staring, Then all the day be sparing. Eat a bit before you drink. Feed sparingly and dupe the physician. Better be meals many than one too many. You should never touch your eye but with your elbow. _Non patitur ludum fama, fides, oculus._ The head and feet keep warm, the rest will take no harm. _Tenez chaud le pied et la tête, au demurant vives en bête._ _Qui ne boit vin après salade, est en danger d'être malade._ Cover your head by day as much as you will, by night as much as you can. Fish spoils water, but flesh mends it. Apples, pears, and nuts spoil the voice. Quartan agues kill old men and cure young. Old fish, old oil, and an old friend. _Pesce, oglio, ed amico vecchio._ Raw pullet, veal, and fish, make the churchyard fat. Of wine the middle, of oil the top, of honey the bottom. _Vino di mezzo, oglio di sopra, e miele di sotto._ The air of a window is the stroke of a cross-bow. _Aria di finestra, colpo di balestra._ _Piscia chiaro, ed incaca al medico._ When the wind is in the east, it's neither good for man nor beast. A hot May makes a fat churchyard. That city is in a bad case, whose physicians have the gout.--_Hebrew Proverb._ When the sun rises, the disease will abate.[21] If you take away the salt, throw the meat to the dogs. _Splen ridere facit, cogit amare jecur._[22] Lever à cinq, dîner à neuf. Souper à cinq, coucher à neuf. Font vivre dans nonante neuf. _Surge quintâ, prande nonâ, coena quintâ, dormi nonâ, nec est morti vita prona._ Hunger's the best sauce. _Optimum condimentum fames._ _Plures occidit gula quàm gladius._ _Qui a bu, boira._ Ever drunk ever dry. _Vinum potens, vinum nocens._ The child is too clever to live long. _Præcocibus mors ingeniis est invida semper._ Le chant du cocq, le coucher du corbeau, Préservent l'homme du tombeau. Bitter to the mouth, sweet to the heart. _Paulò deterior, sed suavior potus est cibus; meliori quidem, sed ingrato, præferendus est._ Après la soupe, un coup d'excellent vin Tire un écu de la poche du médecin. THE NIGHT-MARE. The Night-mare or Ephialtes, _incubus_, from [Greek: ephallomai], "to leap upon," and _incubo_, "to lie upon," may be considered a sympathetic affection of the brain during our sleep, generally arising from a derangement in the digestive functions. We therefore observe it after a heavy supper, or the use of any article of food of difficult digestion. It is to these circumstances more than to the "unusual loss of volition," which some physiologists consider as its cause, that we are to attribute this unpleasant perturbation of our repose, which impresses the sleeper with the idea of some living being pressing upon the chest, inspiring terror, impeding respiration, and subduing all voluntary action that might endeavour to remove the unwelcome visiter. It has been observed that persons of a melancholy and contemplative disposition are more subject to it than the gay and the vivacious. Sedentary employment and anxiety of mind often bring it on; and it has been noticed in _nostalgia_, or regret of home, in soldiers and sailors. The sense of apprehension remains after the sufferer is awakened, and the fluttering of the heart and quick pulse are observed for some time after, while drops of cold perspiration frequently trickle down his brow. When the night-mare is the result of too much repletion, it is possible that its symptoms denote a pressure of the loaded stomach on the solar plexus. It is said that the _night-mare_ derives its name from _Mara_, an evil spirit of the Scandinavians, which, according to the Runic theology, seized men in their sleep, and deprived them of the powers of volition. Our old Anglo-Saxon name for the disease was _Elf-Sidenne_, or elf-squatting; hence the popular term "hag-ridden." There is a variety of the malady which makes its attack by day, and when waking: it has been called the day-mare, or _ephialtes vigilantium_. This affection, although uncommon, has been noticed by Forestus, Rhodius, Sauvages, and Good. Forestus has known it to return periodically like an intermittent fever. It is not always that the patient experiences unpleasant sensations in these nocturnal attacks, which were not unfrequently of a curious nature. The ancients thought that these intruders were sometimes sportive Fauns; hence Pliny calls the affection _ludibria Fauni_. At a subsequent period, superstition replaced the Fauns by _Incubi_, or evil spirits, who visited the earth to destroy virtuous women; and it was once gravely discussed by the Sorbonne, whether the offspring of such an union should be considered human, or the fair lady's reputation injured by the involuntary act of giving a young incubus to the world. The absurd stories of the pranks of the _Succubi_ and _Incubi_ are well known. Ephialtes has been known to be epidemic, and has attacked numbers at a time. Cælius Aurelianus informs us that Silimachus, a disciple of Hippocrates, observed the phenomenon in Rome, when the disease generally proved fatal. It is more than probable that in these cases the night-mare was merely symptomatic of other complaints. A French physician, Dr. Laurent, however, has related a very curious instance of a species of night-mare attacking an entire regiment; he thus relates the singular occurrence: "The first battalion of the regiment Latour d'Auvergne, of which I was the surgeon, was garrisoned at Palmi, in Calabria, when we received a sudden order at midnight to march with all possible speed to Tropea; a flotilla of the enemy having appeared off the coast. It was in the month of June; we had a march of forty miles of the country, and only arrived at our destination at seven o'clock the following evening, having scarcely halted during those thirty-one hours, and suffered considerably from the heat of the sun. On our arrival the men found their rations cooked and their quarters prepared; but, having arrived the last, our regiment had the worst accommodation, and eight hundred men were pent up in a building scarcely capacious enough for half the number. The soldiers were in consequence much crowded, and slept upon the straw without any bedding, and most uncomfortably. The building was an abandoned monastery; and the inhabitants warned us that we should not be able to occupy it quietly, as it was haunted every night. We laughed at their superstitious fears, but were much amazed when, towards midnight, we heard loud cries, and the soldiers rushed tumultuously, and in evident terror, out of their rooms. Being interrogated as to the causes of this alarm, they all affirmed that the devil was in the abbey; that they had seen him enter in the shape of a large black dog, that had jumped upon their breasts and disappeared. To convince them of the absurdity of their fears was of no avail; not a single man could be persuaded to return to his quarters, and they wandered about the town until daybreak. On the following morning I questioned the most steady non-commissioned officers and the oldest soldiers; and though under ordinary circumstances they were strangers to fear, and never gave credit to any tales of supernatural agency, they assured me that the dog had weighed them down and nearly suffocated them. We remained that day in Tropea, and had no other quarters to occupy but the same monastery, and the soldiers would only take up their residence on the condition that we should remain with them: the men retired to sleep--we watched; all was quiet until about one in the morning; when they awoke in the same terror, and fled from the building in dismay. We had looked out most attentively, but could not perceive the cause of this commotion. The following day we returned to Palmi; and, although we marched over a great part of Italy, and were frequently equally crowded and uncomfortable, a similar scene never recurred." Dr. Laurent very judiciously attributes this singular attack to the pernicious local influence of some deleterious gas, and the very crowded state the men slept in. It is also probable that they did not take off their accoutrements, and lay down with their belts on: might they not also have eaten some unwholesome fruit upon the line of march, for it was in the month of June, when various berries grow in abundance along the road-side? Hippocrates's theory of the night-mare was, that, during our sleep, our volition being suspended, the soul, still awake, watches over all the functions of the body. It is rather odd that the animal that most persons pretend to have thus annoyed them, is a long-haired black dog. Forestus assures us that it was a similar visiter that tormented him in his youth. This circumstance can only be attributed to vulgar superstition and tradition. Dubosquet has preceded his Treatise on Ephialtes with the engraving of a large monkey who had perplexed a young lady whom he attended; the monkey most probably came on horseback, as his steed is also delineated looking over the sleeping victim. Various medicines have been recommended to prevent these attacks; amongst others, saffron and peony: and several learned commentators have endeavoured to prove and disprove that they were only specific in the form of an amulet. Zacutus Lusitanus recommends aloes, and his advice is perhaps as good a one as could be given. The ancients attributed many powerful effects to saffron, and, amongst other properties, it was considered as an effective narcotic, and was said to occasion violent headaches. Curious anecdotes are related of its effects. Amatus Lusitanus having exhibited this medicine to accelerate a tardy accouchement, the woman was delivered of two yellow daughters; and Hertodt, in his work called Crocology, relates that, having tried it on a bitch, all her pups were of a similar colour. The ancients called saffron the king of plants, the vegetable panacea, and the soul of the lungs. In modern times we do not recognise any peculiar property in this production; and in Spain and Italy it is used as a condiment with perfect impunity. Peony was also deemed a valuable remedy, when gathered as the decreasing moon was passing under Aries: the slit root being then tied round the neck of an epileptic person, he was forthwith cured. "Unlimited scepticism," Dugald Stewart observes, "is as much the child of imbecility as implicit credulity." How difficult it is to steer the vessel of our understanding between those shoals! Medical writers have divided the night-mare, according to its phenomena, into complete, incomplete, mental, and bodily. The complete night-mare, in which the suspension of the functions had been so powerful, has been known to prove fatal. In the incomplete, we fancy ourselves placed in a peculiar situation, opposed by some unexpected obstacle, and all our efforts seem of no avail to extricate ourselves from our difficulties. There is an incubus, called indirect, in which the dreamer is not the individual arrested in his movements; but he is impeded in his progress by the stoppage of his horse, his carriage, his ship, which no power can propel. In the mental or intellectual night-mare, the flow of our ideas is embarrassed, all the associations of our very thoughts appear to be singularly unconnected; we think in an unintelligible language; we write, and cannot decipher our manuscript: all is a mental chaos, and no thread can lead us out of the perplexing labyrinth. In the corporeal ephialtes, we imagine that some of our organs are displaced, or deranged in their functions. One man fancies that a malevolent spectre is drawing out his intestines or his teeth: a patient of Galen felt the cold sensation of a marble statue having been put into bed with him. These, however, are nothing else than the actual sensations we experience at the time. Thus Conrad Gesner fancied that a serpent had stung him in the left side of the breast; an anthrax soon appeared upon the very spot, and terminated his existence. Arnauld de Villeneuve imagined that his foot had been bitten, and a pimple which broke out on the spot soon degenerated into a fatal cancerous affection. Corporeal night-mare may therefore be simply considered as a symptom of disease, and not as a mysterious forewarning. The cold stage of fever that often invades us in our sleep is the natural forerunner of the malady. This was the case with Dr. Corona, the physician of Pius VI. who upon two occasions was attacked with typhus fever, ushered in by a distressing dream or incubus. These physical phenomena only strengthen the opinion, that in our sleep we are equally alive to mental impressions and bodily sufferings; and that, correctly speaking, there is no suspension of our intellectual faculties of perception, nor is there any interruption in the susceptibilities of our relative existence. The various doctrines regarding dreams illustrate this position. INCUBATION OF DISEASES. The term "incubation" in its rigid sense applies to the act of hatching eggs, either naturally or artificially. It has however been adopted by physicians to denote that state of predisposition to disease, in which the germ of the malady lurks, latent and unperceived by the inexperienced observer. Too frequently the individual who is thus menaced is totally unaware of his condition. So far from being depressed in spirits, his hopes are more sanguine, and his future projects more industriously formed than usual. At other times, on the contrary, he labours under a load of despondency which he cannot explain, and his gloom seems to anticipate his end. This presentiment has oftentimes been singularly prophetic. Moreau de St. Remy relates the case of one of his most intimate friends, who visited him, saying, "I come to die near you." He was apparently in perfect health, but the prediction too soon proved true. It is no doubt probable, that in these cases the influence of the mind labouring under these fatal impressions brings about, by its all-powerful sympathetic power on our functions, the expected yet dreaded event. Incubation is observed in many contagious affections; and in hydrophobia its duration is amazing, this dreadful malady developing itself years after the original accident. In mental diseases, aberrations of the intellectual faculties are noticed long before the patient can be pronounced insane; oddities, as they are called, are frequently the precursors of mania. The ancient Greeks and Egyptians use the term "incubation" in another sense. With them it expressed the religious ceremony of sleeping in the temples of the gods, to be inspired with the means of relieving their sufferings. Nothing can express this superstitious rite more forcibly than the following letter from Aspasia to Pericles, recorded by one of the scholiasts of Ælian. "Aspasia to Pericles, greeting. Podalirius! Podalirius, to whom Love taught the art of healing, and who in return didst consecrate thine art to Love, I return thee my thanks. Athens will once more see me beauteous! I shall have lost none of my attractions, and Pericles shall find in his Aspasia all that he once held dear! Podalirius, I return thee my thanks; and thou, Pericles, be grateful to my benefactor. I did not wish to write to thee until I was certain that I had been cured. I shall relate to thee my voyage. I punctually followed the instructions of Nocrates, that wise and enlightened physician. I first repaired to Memphis, where I visited, but without success, the temple of Isis. I there beheld the goddess, and her son Orus, seated on a throne, supported by two lions. The _Sebestus_[23] grew round her shrine! Incense was burnt in the morning, myrrha during the day, and cyplis at eve. I was assured that young Alexander had come to this temple not long before to indulge in a holy contemplation, and learn by inspiration the means of curing his friend Ptolemy: his supplications were heeded. I also slept in the temple, but found no relief. This misfortune, alas! was attributed to my incredulity. I took my departure, and repaired to Patras. There I saw in her temple the divine Hygeia; not as she was represented by Aristophanes, when she relieved Plutus, sweet and graceful, clothed in an aerial robe and a short tunic, and holding in her hand a cup of _Musa_, whence a serpent was seen to spring, but she appeared to me in the form of a mysterious pentagon. I first paid a devout visit to the fountain; and while I deposited my offerings at the feet of the goddess, a mirror was floating on the surface of the waters upon which I gazed by order of the priests, but I was not cured! Thence I went to sleep at Pergania and at Hercyna. But the gods seemed to slumber when Aspasia slept! On a sudden the name of Podalirius struck mine ear! I was informed that his temple was at Lacera. I instantly sought it; and, on my arrival, bathed in the Althonus. After the bath, I was anointed with the perfumed balsams that our friend Sosinius had given me in the temple of Mercury the day I left Athens. I then put up my prayers to deserve the favour I implored from the god. At nightfall I sought repose on the skin of a ram close to the statuary pillar. I soon found myself in that state when we are no longer wide awake, but when sleep has not yet lulled our senses to repose. Methought that a celestial light was shed around me. Æsculapius appeared to me with his two daughters; and, from the clouds that surrounded him, he promised me my pristine health. I soon after fell into a profound sleep; but towards the break of day I beheld Cypris--Cypris who was always the friend of Podalirius: she came herself! I recognised her, although she had assumed the form of a gentle dove. Yes, Cypris came to cure me. Podalirius! Æsculapius! Cypris! each day shall you be thanked by Aspasia and by Pericles. "I must now relate to thee the vision of a Daunian, who slept near me. She suffered from an affection of her breast, and this she dreamed:--She beheld the young god Harpocrates lying on leaves of lotos, and covered with bandages from the head to the feet. He appeared weak and emaciated; he cried like an infant, supplicating the poor woman to nurse him. Soon after, she dreamt that a lamb came to seek his sustenance from her bosom. The dream was fulfilled,--it clearly indicated the use of a certain plant; but, until it could be obtained, the Daunian was advised to eat nothing but stewed raisins. Learn that here various names are given to various inspirations. The last dream I have related is called _allegorical_. When a dream prescribes a certain remedy, it is named _theôrematic_. Here are many dreams: wise Pericles, thou art perhaps smiling at them; but what is _not_ visionary is my perfect recovery, and my love for thee. Farewell!" Although this letter of Aspasia is an evident fiction, yet it gives an excellent, though a romantic description of the incubation of the ancients. Aspasia was supposed to be labouring under one of the most vexatious disorders that can affect a pretty woman,--an eruption in the face; hence the gods sent her a mirror, that her devotion might be increased by her unsightly appearance. It is not improbable that in those days, as in the present era, women of a certain, or rather an uncertain age, were more fervid in their endeavours to render themselves acceptable to Heaven when they ceased to be admired and sought for upon earth. QUACKERY AND CHARLATANISM. The origin of the word "quack" is not ascertained. Johnson derives it from the verb "_to quack_, or gabble like a goose." Butler uses this verb as descriptive of the encomiums empirics heap upon their nostrums. Thus in Hudibras: Believe mechanic Virtuosi Can raise them mountains in Potosi, Seek out for plants with signatures To _quack_ of universal cures. The word _charlatan_ is equally enveloped in obscurity. Furetiere and Calepin say that it is derived from the Italian word _Ceretano_, from _Cæretum_, a town near Spoleto, whence a band of impostors first sallied forth, marching under the banners of Hippocrates, and roving from town to town, selling drugs and giving medical advice.[24] Ménage has it that _charlatan_ springs from _Circulatanus_, from _Circulator_. Other etymologists trace it to the Italian _Ciarlare_, to chatter; hence _Ciarlatan_. The Romans called their quacks _Agyrtæ_, or _Seplasiarii_, from _Seplasium_, the generic name of aromatic substances. _Seplasium_ was the place where they vended their drugs. Thus Martial: Quodque ab Adumæis vectum _seplasia_ vendunt, Et quidquid confert medicis lagæa cataplus. An empiric was also called _Planus_ and _Circulator_ "_unde Plani unde levatores_." Some of the stratagems resorted to by needy empirics to get into practice are very ingenious, and many a regular physician has been obliged to have recourse to similar artifices to procure employment. It is related of a Parisian physician, that, on his first arrival in the capital, he was in the habit of sending his servant in a carriage about daybreak to rap at the doors of the principal mansions to inquire for his master, as he was sent for to repair instantly to such and such a prince, who was dying. The drowsy porter naturally replied, with much ill-humour, "that he knew nothing of his master."--"What! did he not pass the night in this house?" replied the footman, apparently astonished. "No," gruffly answered the Swiss; "there's nobody ill here."--"Then I must have mistaken the house. Is not this the hotel of the Duke of ----?"--"No. Go to the devil!" exclaimed the porter, closing the ponderous gates. From this house his valet then proceeded from street to street, alarming the whole neighbourhood with his loud rap. Of course nothing else was spoken of in the porter's lodge, the grocer's shop, and the servants' hall for nine days. Another quack, upon his arrival in a town, announced himself by sending the bellman round, offering fifty guineas reward for a poodle belonging to Doctor ----, Physician to his Majesty and the Royal Family, Professor of Medicine, and Surgeon General, who had put up at such and such an inn. Of course the physician of a king, who could give fifty guineas for a lost dog, must be a man of pre-eminence in his profession. Another indigent physician having complained of his ill-fortune to an ingenious friend, received the following advice: The _Café de la Régence_ is now in fashion: I play at chess every day at two o'clock, when a considerable crowd is assembled. Come there at the same hour; do not pretend to know me; call for a cup of coffee, and always pay the waiter his money in a rose-coloured paper: leave the rest to me. The doctor followed his advice; and his eccentric manners were soon observed,--when his friend informed the persons around him, that he was one of the ablest practitioners in the land; that he had known him for upwards of fifteen years, and that his cures were most marvellous,--his extreme modesty alone having prevented him from giving publicity to his abilities. He further added, I have long wished to become intimate with so great a man; but he is so absorbed in the study of his profession, that he scarcely ever enters into conversation with any one. In a short time, the Rose-colour Doctor was in extensive business. Many years ago, the jaw-breaking words _Tetrachymagogon_ and _Fellino Guffino Cardimo Cardimac Frames_, were chalked all over London, as two miracle-working doctors. Men with such names must have some superior qualification, and numbers flocked to consult them. Another quack put up as an advertisement, that he had just arrived in town, after having made the wonderful discovery of the green and red dragon and the female fern-seed. This was sure to attract notice. An advertisement was handed about of a learned physician, "who had studied thirty years by candle-light for the good of his countrymen." He was, moreover, the seventh son of a seventh son, and was possessed of a wonderful cure for hernia, as both his father and his grandfather had been ruptured. This reminds one of the oculist in Mouse Alley, mentioned in the Spectator, who undertook to cure cataracts, in consequence of his having lost an eye in the Imperial service. Dr. Case made a fortune by having the lines, _Within this place, lives Doctor Case_, written in large characters upon his door. The accidental circumstances which frequently bring medical men into extensive practice, or that notoriety which may lead to it, are truly curious. It is well known that a most eminent English physician owed all his success to his having been on a particular occasion in a state of intoxication. Disappointed on his first arrival in London, he sought comfort in a neighbouring tavern, where the servant of the house at which he lodged went to fetch him one evening, after a heavy potation, to see a certain countess. The high-sounding title of this unexpected patient tended not a little to increase the excitement under which he laboured. He followed a livery footman as steadily as he could, and was ushered in silence into a noble mansion, where her ladyship's woman anxiously waited to conduct him most discreetly to her mistress's room; her agitation most probably preventing her from perceiving the doctor's state. He was introduced into a splendid bedchamber, and staggered towards the bed in which the lady lay. He went through the routine practice of pulse-feeling, &c., and proceeded to the table to write a prescription, which, in all probability, would have been mechanically correct. But here his powers failed him. In vain he strove to trace the salutary characters, until, wearied in his attempts, he cast down the pen, and, exclaiming "Drunk, by G--!" he made his best way out of the house. Two days afterwards he was not a little surprised by receiving a letter from the lady, enclosing a check for 100_l._, and promising him the patronage of her family and friends, if he would observe the strictest secrecy on the state he found her in. The fact simply was, that the countess had been indulging in brandy and laudanum, which her abigail had procured for her, and was herself in the very condition which the doctor had frankly applied to himself. Chance, more than science or ability, has frequently brought professional men to the summit of their business. There is an Eastern story of a certain prince who had received from a fairy the faculty of not only assuming whatever appearance he thought proper, but of discerning the wandering spirits of the departed. He had long laboured under a painful chronic disease, that none of the court physicians, ordinary or extraordinary, could relieve; and he resolved to wander about the streets of his capital until he could find some one, regular or irregular, who could alleviate his sufferings. For this purpose he donned the garb and appearance of a dervish. As he was passing through one of the principal streets, he was surprised to see it so thronged with ghosts, that, had they been still inhabitants of their former earthly tenements, they must have obstructed the thoroughfare. But what was his amazement and dismay when he saw that they were all grouped with anxious looks round the door of his royal father's physician, haunting, no doubt, the man to whom they attributed their untimely doom. Shocked with the sight, he hurried to another part of the city, where resided another physician of the court, holding the second rank in fashionable estimation. Alas! his gateway was also surrounded with reproachful departed patients. Thunderstruck at such a discovery, and returning thanks to the prophet that he was still in being, despite the practice of these great men, he resolved to submit all the other renowned practitioners to a similar visit, and he was grieved to find that the scale of ghosts kept pace with the scale of their medical rank. Heartbroken, and despairing of a cure, he was slowly sauntering back to the palace, when, in an obscure street, and on the door of an humble dwelling, he read a doctor's name. One single poor solitary ghost, leaning his despondent cheek upon his fleshless hand, was seated on the doctor's steps. "Alas!" exclaimed the prince, "it is, then, too true that humble merit withers in the shade, while ostentatious ignorance inhabits golden mansions. This poor neglected doctor, who has but one unlucky case to lament, is then the only man in whom I can place confidence." He rapped; the door was opened by the doctor himself, a venerable old man, not rich enough, perhaps, to keep a domestic to answer his infrequent calls. His white locks and flowing beard added to the confidence which his situation had inspired. The elated youth then related at full length all his complicated ailments, and the still more complicated treatment to which he had in vain been submitted. The sapient physician was not illiberal enough to say that the prince's attendants had all been in error, since all mankind may err; but his sarcastic smile, the curl of his lips, and the dubious shake of his hoary head, most eloquently told the anxious patient that he considered his former physicians as an ignorant, murderous set of upstarts, only fit to depopulate a community. With a triumphant look he promised a cure, and gave his overjoyed client a much-valued prescription, which he carefully confided to his bosom; after which he expressed his gratitude by pouring upon the doctor's table a purse of golden sequins, which made the old man's blinking eyes shine as brightly as the coin he beheld in wondrous delight. His joy gave suppleness to his rigid spine, and, after bowing the prince out in the most obsequious manner, he ventured to ask him one humble question: "By what good luck, by what kind planet, had he been recommended to seek his advice?" The prince naturally asked for the reason of so strange a question: to which the worthy doctor replied, with eyes brimful with tears of gratitude, "Oh, sir, because I considered myself the most unfortunate man in Bagdad until this happy moment; for I have been settled in this noble and wealthy city for these last fifteen years, and have only been able to obtain one single patient."--"Ah!" cried the prince in despair, "then it must be that poor, solitary, unhappy-looking ghost that is now sitting on your steps!" It has been observed that religious sects have materially contributed to the elevation of physicians in society, and political associations have been equally beneficial. The celebrated Mead was the son of a non-conforming minister, who, knowing the influence he possessed over his numerous congregation, brought him up as a physician, in the full confidence of obtaining the splendid result that rewarded the speculation. His example was followed by several dissenting preachers; among whom we may name Oldfield, Clarke, Nesbitt, Lobb, Munckly, whose sons all rose to extensive and most lucrative practice. At that period, St. Thomas's and Guy's Hospitals were under the government of Dissenters and Whigs; and so soon as any one became a physician to the establishment, his fortune was made. The same advantages attended St. Bartholomew's and Bethlem, both of royal foundation. Dr. Meyer Schomberg, who was a poor Jew of Cologne, came to London without any profession, when, not knowing what to do to obtain a living, to use his own words, he said, "I am a physician;" and, having thus conferred a degree upon himself, he sedulously cultivated the acquaintance of all his fellow Jews about Duke's-place, got introduced to some of their leading and wealthy mercantile brethren, and a few years after Dr. Schomberg was in the annual receipt of four thousand pounds. It is rather strange, but the Jew was succeeded in his lucrative practice by a Quaker. This was the celebrated Dr. Fothergill. Brought up an apothecary, he took out a Scotch degree, and, attaching himself to Schomberg, calculated on following his example; and, on his patron's decease, he slipped into the practice of both Jew and Gentile. Amongst many singular instances of good fortune may be mentioned a surgeon of the name of Broughton, to whom our East India Company may consider themselves as most indebted, since he was the person who first pointed out the advantages that might result from trading in Bengal. Broughton happened to travel from Surat to Agra in the year 1636, when he had the luck to cure one of the daughters of the Emperor _Shah-Jehan_. To reward him, this prince allowed him a free trade throughout his dominions. Broughton immediately repaired to Bengal to purchase goods, which he sent round by sea to Surat. Scarcely had he returned, when he was requested to attend the favourite of a powerful nabob, and he fortunately restored her to health, when, in addition to a pension, his commercial privileges were still more widely extended; the prince promising him at the same time a favourable reception for British traders. Broughton lost no time in communicating this intelligence to the Governor of Surat; and it was by his advice that the company sent out two large ships to Bengal in 1640. There are some amusing anecdotes related regarding a vocation for the medical profession. Andrew Rudiger, a physician of Leipsic, when at college, made an anagram of his name, and, in the words _Andreas Rudiger_ he found "_Arare Rus Dei Dignus_," or "worthy to cultivate the field of God." He immediately fancied that his vocation was the church, and commenced his theological studies. Showing but little disposition for the clerical calling, the learned Thomasius recommended him to return to his original pursuits. Rudiger confessed that he had more inclination for the profession of medicine than the church; but that he had considered the anagram of his name as a divine injunction. "There you are in error," replied Thomasius; "that very anagram calls you to the art of healing; for _Rus Dei_ clearly meaneth the churchyard." The subject of quackery, in every sphere of life, whether it be resorted to by diplomatists or physicians, sanctimonious adventurers or fashionable _roués_, leads to serious consideration. How comes it that man seems more anxious to be deceived than enlightened? Simply from the errors of his education, which foster a love for the marvellous, and induce him to admire that which really is not or cannot be comprehended. The superiority of the intellectual faculties of the ancients, at an earlier age than the generality of men in the present times, is solely to be attributed to their having been brought up with philosophical views. Mallebranche has justly said, "that to become a philosopher, we must _see clearly_; but to be endued with faith, we must _believe blindly_." Although we cannot admit this axiom in matters of revealed religion, yet in many worldly concerns it does hold. If a youth was not educated with the scholastic jargon, commonly called learning, he would be considered ignorant. Helvetius has said, that man is born ignorant, but not a fool; and that it is even no easy matter to make him one; and the same writer has very justly divided stupidity into that which is natural, arising from ignorance, and that which is acquired and the result of instruction. It is thus that, by speaking to the passions, naturally weak, and to our desires and apprehensions, ever ready to grasp at a favourite phantom,--the artful manage to exercise a more powerful control, and incline persons to believe what their senses actually discredit. The traffic of hope and fear has ever been a lucrative trade; and while fear became the staple commodity of priestcraft, hope was the fortune of medical quacks. The multiplication of sins increased the profits of the one; the various diseases, real and imaginary, to which flesh is heir, became the source of emolument to the other. It is under these cherished impressions of ameliorating our condition, that many men of common sense, and even of judgment, are induced to rely on the most absurd and fallacious promises; so prone are we to believe all that we wish;--the fidelity of a woman, the truth of a sycophant, and the candour of a flatterer. If there could be established a regular college of quackery, where the errors of mankind might be studied, and pupils taught to avail themselves of their follies, as a future vocation, a more perfect knowledge of the world would be acquired than in all the universities in Europe. Our sovereigns would be wise in selecting their ministers amongst the graduates of this academy. Cardinal Du Perron, who, in a long homily, convinced his sovereign, Henry III., of the existence of a God, and afterwards informed him that he would prove the contrary, if it could afford his Majesty any consolation, might have been selected as a proper rector for such an institution. It is also to be observed that the founders of all doctrines, however hypothetical and absurd, have generally assumed a dogmatic language, which gives to their fallacious assertions an appearance of truth, and Bacon has long ago said, "Method, carrying a show of total and perfect knowledge, has a tendency to general acquiescence." Quackery is considered by many practitioners as necessary to forward the views of medical men. It is related of Charles Patin, that being on a visit to a physician at Basle, where his son was studying medicine, he questioned the youth on the principal studies required to form a physician; to which the future candidate for medical popularity replied, "Anatomy, physiology, pathology, and therapeutics." "You have omitted the chief pursuit," replied his catechiser, "_quackery_." When we cast our eyes on the absurd names which many Italian academies adopted to characterize the nature of their studies, we find an ample illustration of this science in the _Seraphici_, the _Oscuri_, the _Immaturi_, the _Infecundi_, the _Offuscati_, the _Somnolenti_, and _Phantastici_! The most ridiculous and disgusting epithets have been considered honourable distinctions. Thus, when the science of _Uroscopia_ and _Uromancy_ prevailed, we find a Dr. Theodorus Charles, a Wirtemberg physician, calling another learned practitioner, "_Urinosa Claritas_." ON THE USE OF TEA. Such is the growing consumption of this now indispensable article in England, that in 1789 there were imported 14,534,601 lbs., and in 1833 the quantity was increased to 31,829,620 lbs.; the latter importation yielding a revenue of 3,444,101_l._ In other countries we find the consumption much less. Russia in 1832 imported 6,461,064 lbs.; Holland consumes about 2,800,000 lbs., and France only 230,000 lbs. It is supposed that tea was first introduced into Europe by the Dutch, about the middle of the seventeenth century; and Lords Arlington and Ossory are said to be the first persons who made it known in England. In 1641, Tulpius, a Dutch physician, mentioned it in his works. In 1667, Fouquet, a French physician, recommended it to the French faculty; and in 1678, an elaborate treatise was written on it by Cornelius Boutkoë, physician to the Elector of Brandenburg. About the same time, several travellers and missionaries, amongst whom we find Koempfer, Kalm, Osbeck, Duhalde, and Lecomte, give various accounts of the plant and its divers qualities. The Chinese name of this plant is _theh_, a _Fokien_ word. In the Mandarin it is _tcha_, and the Japanese call it _tsjaa_. _Loureiro_, in his _Flora Cochin-China_, describes three species of tea. It is a polyandrous plant of the natural order _Columniferæ_, growing to a height varying from three to six feet, and bearing a great resemblance to our myrtle. The blossom is white, with yellow style and anthers, not unlike that of the dog-rose; the leaves are the only valuable part of the plant. The _camellias_, particularly the _camellia sesanqua_, of the same natural family, are the only plants liable to be confounded with it. The leaves of the latter camellia are indeed frequently used as a substitute for those of the tea-plant in several districts of China. This shrub is a hardy evergreen, growing in the open air from the equator to the forty-fifth degree of northern latitude; but the climate that appears the most congenial to it seems to be between the twenty-fifth and thirty-third degree. Almost every province and district in China produces tea for local consumption: but what is cultivated for trade is chiefly in Fokien, Canton, Kiang-nan, Kiang-si, and Che-Kiang; Fokien being celebrated for its black tea, and Kiang-nan for the green. The plant is also cultivated in Japan, Tonquin, and Cochin-China, and in some parts of the mountainous tracts of Ava, where, in addition to its use in infusion, it is converted into a pickle preserved in oil. When tea was first introduced as a luxury on particular occasions in the wild districts of Ireland, the people used to throw away the water in which it had been boiled, and eat the leaves with salt-butter or bacon like greens. The Dutch are now endeavouring to propagate this valuable plant in Java, and for that purpose employ cultivators, who have emigrated from Fokien. The Brazilians are making similar attempts, and some tolerable tea has been reared near Rio Janeiro. The black teas usually imported from Canton are the _bohea_, _congou_, _souchong_, and _pekoe_, according to our orthography: the French missionaries spelt them as follows: _boui_, _camphou_ or _campoui_, _saotchaon_, and _pekao_ or _peko_. Our green teas are the _twankay_, _hyson-skin_, and _hyson_, _imperial_, and _gunpowder_; the first of which French travellers write _tonkay_, _hayswin-skine_, and _hayswin_. The French import a tea called _têhulan_, but it is artificially flavoured with a leaf called _lan hoa_, or the _olea fragrans_ of Linnæus. The tea-plant grows to perfection in two or three years: the leaves are carefully picked by the family of the growers, and immediately carried to market, where they are purchased for drying in sheds. The tea-merchants from Canton repair to the several districts where it is produced, and, after purchasing the leaves thus simply desiccated, submit them to various manipulations; after which they are packed in branded cases and parcels called _chops_, from a Chinese word meaning a seal. Some of the leaf-buds of the finest black tea plants are picked early in the spring, before they expand: these constitute _pekoe_, sometimes called "white-blossomed tea," from their being intermixed with the blossoms of the _olea fragrans_. The younger the leaf, the more high-flavoured and valuable is the tea. Green teas are grown and gathered in the same manner; but amongst these the gunpowder stands in the grade of the _pekoe_ among the black, being prepared with the unopened buds of the spring crops. The alleged preparation of green teas upon copper plates, to give them a verdant colour, is an idle story. They are dried in iron vases over a gentle fire; and the operator conducts this delicate work with his naked hand, and the utmost care not to break the fragile leaves. This part of the manipulation is considered the most difficult, as the leaves are rolled into their usual shape between the palms of the hands until they are cold, to prevent them from unrolling. Teas are adulterated by various odoriferous plants, more especially the _vitex pinnata_, the _chloranthus inconspicuus_, and the _illicium anisatum_. In our markets the chief adulteration is operated by the mixture of sloe and ash leaves, and colouring with terra Japonica and other drugs. That tea is a substance injurious to health is beyond a doubt. Nothing but long habit from early life renders it less baneful than it otherwise would be: persons who take its infusion for the first time invariably experience uncomfortable sensations. It is well known that individuals who are not in the practice of taking tea in the evening, never transgress this habit with impunity; and it is quite clear that a preparation which deprives them of sleep, and renders them restless during a whole night, cannot be salubrious by day; and although the following opinion of Dr. Trotter regarding the use of this leaf is somewhat exaggerated, it is founded on experience; and I have known several persons afflicted with a variety of serious affections who never could obtain relief until they had ceased to consume it. "Tea is a beverage well suited to the taste of an indolent and voluptuous age. To the glutton it affords a grateful diluent after a voracious dinner; and, from being drunk warm, it gives a soothing stimulus to the stomach of the drunkard: but, however agreeable may be its immediate flavour, the ultimate effects are debility and nervous diseases. There may be conditions of health, indeed, where tea can do no harm, such as in the strong and athletic; but it is particularly hurtful to the female constitution, to all persons who possess the hereditary predisposition to dyspepsia, and all diseases with which it is associated, to gout, and to those who are naturally weak-nerved. Fine tea, where the narcotic quality seems to be concentrated, when taken in a strong infusion, by persons not accustomed to it, excites nausea and vomiting, tremors, cold sweats, vertigo, dimness of sight, and confusion of thought. I have known a number of men and women subject to nervous complaints, who could not use tea in any form without feeling a sudden increase of all their unpleasant symptoms; particularly acidity of the stomach, vertigo, and dimness of the eyes. As the use of this article of diet extends among the lower orders of the community and the labouring poor, it must do the more harm. A man or a woman who has to go through much toil and hardship has need of substantial nourishment; but that is not to be obtained from an infusion of tea. And if the humble returns of their industry are expended in this leaf, what remains for the purchase of food better adapted to labour? In this case tea becomes hurtful, not only from its narcotic quality, but because that quality acts with double force in a body weakened from other causes. This certainly is one great reason for the increased and increasing proportion of nervous, bilious, spasmodic, and stomach complaints, &c. appearing among the lower ranks of life." It is well known that tea is frequently resorted to by literary men to keep them awake during their lucubrations. Dr. Cullen said he never could take it without feeling gouty symptoms; and we frequently see aged females, who are in the habit of taking strong green tea, subject to paralytic affections. Many experienced physicians, such as Grimm, Crugerus, Wytt, Murray, Letsom, condemn the abuse of the plant as highly dangerous.[25] That it is a most powerful astringent we well know; and the hands of the Chinese who are employed in its preparation are shrivelled, and, to all appearance, burned with caustic. Chemists have extracted from it an astringent liquor containing tannin and gallic acid. This liquor, injected in the veins or under the integuments of frogs, produces palsy of the posterior extremities, and, applied to the sciatic nerve for half an hour, has occasioned death. There is no doubt that tea acts differently on various individuals. In some it is highly stimulant and exhilarating; in others its effects are oppression and lowness of spirits; and I have known a person who could never indulge in this beverage without experiencing a disposition to commit suicide, and nothing could arouse him from this state of morbid excitement but the pleasure of destroying something, books, papers, or any thing within his reach. Under no other circumstances than this influence of tea were these fearful aberrations observed. It has been remarked that all tea-drinking nations are essentially of a leucophlegmatic temperament, predisposed to scrofulous and nervous diseases. The Chinese, even the degraded Tartar races amongst them, are weak and infirm, their women subject to various diseases arising from debility. Although their confined mode of living, and want of the means of enjoying pure air and exercise, materially tends to render them liable to these affections; still their immoderate use of strong green tea, taken, it is true, in very small quantities at the time, but repeatedly, greatly adds to this predisposition. From long experience I am convinced that, although tea may in general be considered a refreshing and harmless beverage, yet in some peculiar cases it is decidedly injurious; and many diseases that have baffled all medical exertions, have yielded to the same curative means so soon as the action of tea had been suspended. MANDRAGORE. Self-styled wandering Turks and Armenians are frequently met with in crowded cities vending rhubarb, tooth-powder, and various drugs and nostrums, exciting the curiosity of the idlers that group around them, by exhibiting a root bearing a strong resemblance to the human form. This is the far-famed mandragore, of which such wonderful accounts have been related by both ancients and moderns. This plant is the _Atropa Mandragora_ of Linnæus, and grows wild in the mountainous and shaded parts of Italy, Spain, and the Levant, where it is also cultivated in gardens. The root bears such a likeness, at least in fancy's eyes, to our species, that it was called _Semi-homo_. Hence says Columella, Quamvis semihominis vesano gramine foeta Mandragora pariat flores moestamque cicutam. The word _vesano_ clearly refers to the supposed power it possessed of exciting delirium. It was also named _Circæa_, from its having been one of the mystic ingredients employed in Circe's spells; although the wonderful mandragore was ineffectual against the more powerful herb the _Moly_, which Ulysses received from Mercury. This human resemblance of the root, which is, moreover, of a blackish hue and hairy, inspired the vulgar with the idea that it was nothing less than a familiar dæmon. It was gathered with curious rites: three times a magic circle was drawn round it with a naked sword; and the person who was daring enough to pluck it from the earth, was subject to manifold dangers and diseases, unless under some special protection; therefore it was not unusual to get it eradicated by a dog, fastened to it by a cord, and who was whipped off until the precious root was pulled out. According to Josephus, the plant called _Buaras_, which was gifted with the faculty of keeping off evil spirits, was obtained by a similar canine operation. Often, it was asserted, did the mandragore utter piteous cries and groans, when thus severed from mother earth. Albertus the Great affirms that the root has a more powerful action when growing under a gibbet, and is brought to greater perfection by the nourishing secretions that drop from the criminal's dangling corpse. Amongst its many wonderful properties, it was said to double the amount of money that was locked up with it in a box. It was also all-powerful in detecting hidden treasures. Most probably the mandragore had bad qualities to underrate its good ones. Amongst these, we must certainly class the blackest ingratitude, since it never seemed to benefit the eloquent advocates of its virtues, who, in general, were as poor as their boasted plant was rich in attraction. It was also supposed to possess the delightful faculty of increasing population and exciting love; and the Emperor Julian writes to Calixines that he is drinking the juice of mandragore to render him amorous. Hence was it called _Loveapple_; and Venus bore the name of _Mandragontis_. It has been asserted by various scholiasts, that the _mandrake_ which Reuben found in the fields and carried to his mother, Leah, was the mandragore; the _Dudaïm_, however, which he gathered was not, according to all accounts, an unpleasant fruit, but is supposed to have been a species of orchis, still used in the East in love-philters and prolific potions. The word _Dudaïm_ seems to express a tuberculated plant; and in Solomon's Songs, he thus describes it: "The mandrakes give a smell, and at our gates are all manner of pleasant fruits, new and old, which I have laid up for thee, O my beloved." Now it is utterly impossible, whatever may have been the revolution in taste since the days of Solomon, that the nauseous and offensive mandragore could have been considered as a propitiating present to a lady. The etymology of the word _Dudaïm_ would seem to describe it. It is derived from the word [Hebrew], (_Dadim_) breasts, or [Hebrew], (_Dodim_) friends, neighbours, twins; which indicates that this plant is formed of two similar parts. It is thought that the _Dudaïm_ might be the highly-scented melon which is cultivated in the East, especially in Persia, and known by the name of _Destenbuje_, or the _Cucumis Dudaïm_ of Linnæus, and which is also found in Italy, where its powerful aroma is imparted to garments and chambers. It must have been an odoriferous production, since in the _Talmud_ we find it denominated _Siglin_, which has been considered the jessamine or the lily. The orchis is remarkable for its double bulbous roots and its agreeable perfume; we may therefore justify the idea that the _Dudaïm_ of the Jews was a species of this plant. Frontinus informs us that Hannibal employed mandragore in one of his warlike stratagems, when he feigned a retreat, and left in the possession of the barbarians a quantity of wine in which this plant had been infused. Intoxicated by the potent beverage, they were unable to withstand his second attack, and were easily put to the sword. Was it the mandragore that saved the Scotch in a similar _ruse de guerre_ with the Danish invaders of Sweno? It is supposed to have been the _Belladonna_, or deadly nightshade, the effects of which are not dissimilar to those of the plant in question. In the north of Europe, this substance is still used for medicinal purposes; and Boerhaave, Hoffberg, and Swediaur have strongly recommended it in glandular swellings, arthritic pains, and various diseases where a profuse perspiration may be desirable. Machiavel has made the fabulous powers of the mandragore the subject of a comedy, and Lafontaine has employed it as an agent in one of his tales. Another root that excited superstitious phantasies and reverential awe, from its supposed resemblance to the human form, was the Gin-seng, a Chinese production, which, according to the author of the _Kao-li-tchi-tsan_, or Eulogium of the Kingdom of Corea, "imitates the configuration of man and the efficacy of spiritual comfort, possessing hands and feet like a human being, and the mental virtues that no one can easily comprehend." According to Jartoux, _Gin-seng_ signifies "the representation of man." It appears, however, that the learned father was in error. _Jin_, it is true, signifies _man_; but _Chen_ does not mean representation, but a _ternary body_. Hence _Gin-seng_ signifies the _ternary of man, making three with man and heaven_!--no doubt some superstitious tradition, since this root bears various names in other countries, that plainly denote the veneration in which it was held. In Japan it is called _Nindsin_, and _Orkhoda_ in the Tatar-Mandchou language, both of which mean "the queen of plants." Father Lafitau informs us that the name of _Garent-oguen_ of the Iroquois, which it also bears, means the _thighs of man_. The _Gin-seng_ is a native of Tartary, Corea, and also thrives in Canada, Virginia, and Pennsylvania, in shaded and damp situations, as it soon perishes under the solar rays. The Chinese attach considerable value to it. Thunberg informs us that it sometimes is sold for forty pounds a pound; and Osbeck states that in his time it was worth twenty-four times its weight in silver. This enormous price frequently induced foreign smugglers to bring it into the Chinese territory; but the severest laws were enacted to punish this fraudulent traffic. The Tartars alone possess the privilege of cultivating and collecting it; and the districts that produce this precious plant are surrounded with palisades, and strictly guarded. In 1707, the Emperor of China, to increase his revenue, sent a body of ten thousand troops to collect the gin-seng. According to the Chinese physicians, this root possesses the faculty of renovating exhausted constitutions, giving fresh vigour, raising the drooping moral and physical faculties, and restoring to health and _embonpoint_ the victim of debauchery. It is also said that a bit of the root chewed by a man running a race will prevent his competitor from getting the start of him. It is somewhat singular that the same property is attributed to garlic; and the Hungarian jockeys frequently tie a clove of it to their racers' bits, when the horses that run against them fall back the moment they breathe the offensive odour. It has been proved that no horse will eat in a manger if the mouth of any other steed in the stable has been rubbed with the juice of this plant. I had occasion to ascertain this fact. A horse of mine was in the same stall with one belonging to a brother officer; mine fell away and refused his food, while his companion throve uncommonly well. I at last discovered that a German groom, who had charge of the prosperous animal, had recourse to this vile stratagem. It is also supposed that men who eat garlic knock up upon a march the soldiers who have not made use of it. Hence, in the old regulations of the French armies, there existed an order to prohibit the use of garlic when troops were on a march. BARBER-SURGEONS, AND THE PROGRESS OF CHIRURGICAL ART. No consideration should render man more thankful to his Creator, and justly proud of the progress of human intellect, than the perfection to which the art of surgery has been carried. In its present improved condition, we are struck with horror at the perusal of the ancient practice, and marvel that its barbarity did not sooner induce its professors to diminish the sum of misery it inflicted on their victims. Ignorance, and its offspring Superstition, seemed to sanctify this darkness. Improvement was considered as impious and unnecessary; and to deny the powers of the chirurgical art, heresy against the holy men, who alone were permitted to exercise it. This supposed divine attribute of the priesthood can be traced to remote ages: Æsculapius was son of Apollo, and princes and heroes did not consider the art of surgery beneath their dignity. Homer has illustrated the skill of Podalirius and Chiron; and Idomeneus bids Nestor to mount his chariot with Machaon, who alone was more precious than a thousand warriors; while we find Podalirius, wrecked and forlorn on the Carian coast, leading to the altar the daughter of the monarch whom he cured, and whose subjects raised a temple to his memory, and paid him divine honours. Tradition informs us, that in the infancy of the art all its branches were exercised indiscriminately by the medical practitioners. It was not then supposed that the human body was subject to distinct affections, external and internal; yet, as its study advanced, the ancients were led into an opposite extreme, and we find that in Egypt each disease became the province of a special attendant, regulated in his treatment by the sacred records handed down by their hierarchy. Herodotus informs us, that "so wisely was medicine managed by the Egyptians, that no physician was allowed to practise any but his own peculiar branch." Accouchments were exclusively the province of females. These practitioners were remunerated by the state; and they were severely punished, when, by any experimental trials, they deviated from the prescribed rules imposed upon them, and, in the event of any patient dying under a treatment differing from the established practice, the medical attendant was considered guilty of a capital offence. These wise provisions were made, says Diodorus, in the full conviction that few persons were capable of introducing any new treatment superior to that which had been sanctioned and approved by old practitioners. Pliny complains that no such laws existed in Rome, where a physician was the only man who could commit murder with impunity; "Nulla præterea lex," he says, "quæ puniat inscitium capitalem, nullum exemplum vindictæ. Discunt periculis nostris, et experimenta per mortes agunt: medicoque tantum hominem occidisse impunitas summa est." By one of these singular anomalies in public opinion, this supposed divine science was soon considered an ignoble profession. In Rome it was chiefly practised by slaves, freedmen, or foreigners. From the overthrow of the Roman empire till the revival of literature and the arts in Europe, medicine and surgery sought a refuge amongst the Arabians, who studied both branches in common; for, though exiled to the coast of Africa in point of scientific cultivation, it was necessarily cultivated in other countries, and in the greater part of Europe became the exclusive right of ecclesiastics. In time, however, it was gradually wrested from their hands by daily necessities; and every one, even amongst the lowest classes, professed himself a surgeon, and the cure of the hurt and the lame was intrusted to menials and women. As the church could no longer monopolize the art of healing, it became expedient to stigmatize it, although that very faculty had but lately been their boast; but it had fallen within the powers of vulgar and profane comprehension, and therefore was useless to maintain sacerdotal pre-eminence. In 1163, the Council of Tours, held by Pope Alexander III., maintained that the devil, to seduce the priesthood from the duties of the altar, involved them in mundane occupations, which, under the plea of humanity, exposed them to constant and perilous temptations. The edict not only prohibited the study both of medicine and law amongst all that had taken religious vows, but actually excommunicated every ecclesiastic who might infringe the decree. It appears, however, that the temptations of the evil one were still attractive, as Pope Honorius III., in 1215, was obliged to fulminate a fresh anathema on transgressors, with an additional canon, ordaining that, as the church abhorred all cruel or sanguinary practices, not only no priest should be allowed the practice of surgery, but should refuse their benediction to all who professed it.[26] The practice then fell into the hands of laymen, although priests, still regretting the advantages that it formerly had yielded them, were consulted in their convents or houses; and when patients could not visit them without exposing them to clerical censure, they asserted their ability to cure diseases by the mere inspection of the patient's dejections; and so much faith was reposed in this filthy practice, that Henry II. decreed that upon the complaints of the heirs of persons who died through the fault of their physicians, the latter should suffer capital punishment, as having been the cause of their patient's death, unless they had scientifically examined what was submitted to their investigation by the deceased's relatives or domestics: and then proceeded to prescribe for the malady. Unable to quit their cloisters, in surgical cases, which could not be so easily cured at a distance, sooner than lose the emoluments of the profession, they sent their servants, or rather the barbers of the community, who shaved, and bled, and drew teeth in their neighbourhood ever since the clergy could no longer perform these operations, on the plea of the maxim "_Ecclesia abhorret à sanguine_;" bleeding and tooth-drawing being, I believe, the only cases where this maxim was noticed. From this circumstance arose the barber craft or barber-surgeons. These practitioners, from their various avocations, were necessarily dexterous; for, in addition to the skill required for good shaving, tonsurating the crowns of clerical heads was a delicate operation; and it was about this period that Pope Alexander III. revised the canon issued by the synod of Carthage respecting the tonsure of the clergy. Surgery being thus degraded, the separation between its practice and that of medicine became unavoidable, and the two branches were formally made distinct by bulls of Boniface VI. and Clement V. St. Louis, who had witnessed the services of surgeons in the field of battle during the crusades, had formed a college or _confrérie_ of surgeons, in honour of St. Cosme and St. Damian, in 1268; and wounds and sores were dressed _gratis_ in the churches dedicated to those saints on the first Monday of every month. To this body, of course, the barber-surgeons, or _fraters_ of the priests, who had not received any regular education, did not belong. Hence arose the distinction, which even to the present day obtains in various parts of the Continent, where surgeons are divided into two classes,--those who had gone through a regular course of studies, and those who, without any academical education, were originally employed as the servants of the priests and barbers. So late as the year 1809, one of my assistants in the Portuguese army felt much hurt at my declining his offer to shave me; and in 1801, some British assistant-surgeons, who had entered the Swedish navy, were ordered to shave the ship's company, and were dismissed the service in consequence of their refusal to comply with this command. But to return to our barbers.--These ambitious shavers gradually attempted to glean in the footsteps of the regular chirurgeons, and even to encroach upon their domain, by performing more important operations than phlebotomy and tooth-drawing; the audacious intruders were therefore very properly brought up _ex officio_ by the attorney-general of France, and forbidden to transgress the boundaries of their art, until they had been duly examined by master chirurgeons; although these said masters were not better qualified than many of the barbers. Such was their ignorance indeed, that Pitard, an able practitioner, who had successively been the surgeon of St. Louis, Philip the Brave, and Philip the Fair, obtained a privilege to examine and grant licences to such of these masters who were fit to practise, without which licence all practitioners were liable to be punished by the provost of Paris; and in 1372 barbers were only allowed to dress boils, bruises, and open wounds. Although this account chiefly refers to France and its capital, yet the same distinction and division between surgeons and barbers prevailed in almost every other country; and privileges were maintained with as much virulence and absurdity as the present controversial bickerings between physicians and surgeons. In 1355 these master-surgeons constituted a faculty, which pocketed one-half of the penalties imposed upon the unlucky wights who had not the honour of belonging to their body. They also enjoyed various immunities and exemptions; amongst others, that of not keeping guard and watch in the city of Paris. To increase their emoluments, they granted as many honorary distinctions as they could in decency devise, and introduced the categories of bachelors, licentiates, masters, graduates, and non-graduates of surgery. The medical faculty now began to complain of the encroachments of the master-surgeons on their internal domain of poor mortality with as much bitterness as the masters complained of the impertinent invasion on the part of the barbers, of their external dominion. To court the powerful protection of the university against these interlopers, the surgeons consented to be considered as the scholars of the medical faculty, chiefly governed by clerical physicians. In 1452 a fresh source of dissension arose amongst clerical physicians, lay physicians, master surgeons, and barbers. Cardinal Etoutville abolished the law which bound the physicians of the university to celibacy, when, to use the historian's words, "many of the clerical physicians, thinking there was more comfort to be found in a wife without a benefice than could be expected in a benefice without a wife, abandoned the priesthood, and were then permitted to visit their patients at their own houses." Thus thrown into the uncontrolled practice of medicine, these physicians became jealous of the influence of the surgeons, to whom they had been so much indebted; and they had recourse to every art and manoeuvre that priestcraft could devise to oppress and degrade them. To aid this purpose, they resorted to the barbers, whom they instructed in private, to enable them to oppose the master-surgeons more effectually. The surgeons, indignant at this protection, had recourse to the medical faculty, supplicating them to have the barbers shorn of their rising dignity. Thus for mere motives of pecuniary interest, and the evident detriment of society, did these intriguing practitioners struggle for power and consequent fees; and, according to the vacillation of their interests, the barbers became alternately the allies of the physicians or the mercenary skirmishers of the surgeons. From this oppression of the art, for nearly three centuries surgery was considered a degrading profession. Excluded from the university, not only were surgeons deprived of all academic honours and privileges, but subjected to those taxes and public burdens from which the members of the university, being of the clerical order, were exempted. This persecution not only strove to injure them in a worldly point of view, but the priests carried their vindictive feelings to such a point of malignity that when Charles IX. was about to confer the rites of apostolical benediction upon the surgeons of the long robe, the medical faculty interposed on the plea of their not being qualified to receive this benediction, as they did not belong to any of the four faculties of the university; and as the chancellor, or any other man, had not the power of conferring a blessing without the pope's permission and special mandate, both surgeons and barbers ought to be irrevocably damned. The apostolical benediction in those days was considered of great value, since it exempted all candidates from examination in anatomy, medicine, surgery, or any other qualification, when they applied for a degree. Ever since the healing art ceased to be a clerical privilege, and a state of rivalry prevailed between spiritual and corporeal doctors, the former have sought to represent their opponents as infidels and atheists--the unbelief of physicians became prevalent, and to this day medical men are generally considered freethinkers;--an appellation which in a strictly correct acceptation might be considered more complimentary than opprobrious, since it designates a man, who extricating his intellectual faculties from the meshes of ignorance or prejudices, takes the liberty of thinking for himself. Sir Thomas Brown in his "Religio Medici," alludes to this injurious opinion entertained of medical men, when he says, "For my religion, though there be several circumstances that might persuade the world I have none at all, _as the general scandal of my profession_, the natural course of my studies, the indifferency of my behaviour and discourse in matters of religion--yet in despite thereof, I dare, without usurpation, assume the honourable style of Christian." Sir Kenelm Digby in his observations on the work from which the above is extracted, entertains a similar opinion, and quotes Friar Bacon in support of it. The following are his words: "Those students who busy themselves much with such notions as reside wholly in the fantasy, do hardly ever become idoneous for abstracted metaphysical speculations; the one having bulky foundations of matter, or of the accidents of it, to settle upon--at the least with one foot; the other flying continually, even to a lessening pitch in the subtile air. And accordingly it hath been generally noted, that the excellent mathematicians, who converse altogether with lines, figures, and other differences of quantity, have seldom proved eminent in metaphysics or speculative divinity. Nor again, the profession of their sciences in other arts, much less can it be expected that an excellent physician, whose fancy is always fraught with the material drugs that he prescribeth his apothecary to compound his medicines of, and whose hands are inured to the cutting up, and eyes to the inspection of anatomized bodies, should easily and with success ply his thoughts at so towering a game, as a pure intellect, or separated and unbodied soul." That such ideas should be maintained in former days, when bigotry and prejudice reigned paramount, we cannot be surprised; but one must marvel to see a modern and intelligent annotator of Brown's work,[27] coincide in this illiberal opinion, in the following terms: "Imaginative men, that is, persons in whom the higher attributes of genius are found, seldom delight in the sciences conversant with mere matter or form; least of all in medicine, the object of which is the derangement, or imperfection of nature, and the endeavour to substitute order and harmony in the place of their opposites. Brought thus chiefly into contact with diseased organization, surrounded by the worst elements of civil society, (for their experience must in general be among the intemperate and the vicious,) they may be said to exist in an infected moral atmosphere, and it is therefore not greatly to be wondered at that among such persons a highly religious frame of mind should be the exception and not the rule." The absurdity of this observation can only be equalled by its extreme illiberality. Can it be for one moment entertained, that the physician who gives his care to every class of society and at all ages "exists in an infected moral atmosphere?" Supposing that he is not fortunate enough to attend upon the opulent and the great, and is limited to a pauper or an hospital practice, does Mr. St. John mean to say that instances of intemperance and vice are confined to the indigent, although want of education, and poverty may degrade them in crapulous pursuits? If there does exist a profession pre-eminent for its philanthropic character, and the power of discrimination between good and evil, and right and wrong, it is undoubtedly that of medicine. The finest feelings of humanity are constantly brought to bear, both in seeking to relieve bodily sufferings and solacing an afflicted mind--whether it be with the scalpel in hand in an anatomical theatre, or by the bedside of an agonized sufferer, whom he hopes, under Providence, to restore to health and to his family, the physician has daily opportunities of beholding the wonders of the creation and the benevolence of the Creator--he is a constant witness of the fervent supplication of the unfortunate and the heartfelt gratitude of those suppliants at the throne of mercy, whose prayers have been heard. A man of exalted benevolence (and such a physician ought to be), he must be alive to all the generous feelings of humanity, and he is doomed more frequently to move in an _infected moral atmosphere_, when gratuitously attending some of the troublesome and pedantic legislators of the republic of letters, than when exerting his skill to relieve the grateful poor who may fall under his care. It has been maintained that the physician seeking in the arcana of nature the causes of every vital phenomenon becomes a materialist: nothing can be more unjust, nay, more absurd, than such a supposition. The study of physiology teaches us, more perhaps then any other pursuit, to admire the wonderful works of our Creator, and Voltaire has beautifully illustrated the fact in the following lines: Demandez à Sylva par quel secret mystère Ce pain, cet aliment dans mon corps digéré, Se transforme en un lait doucement préparé; Comment, toujours filtré dans des routes certaines, En longs ruisseaux de pourpre il court enfler mes veines; A mon corps languissant donne un pouvoir nouveau, Fait palpiter mon coeur et penser mon cerveau; Il lève au ciel les yeux, il s'incline, il s'écrie Demandez le à CE DIEU qui m'a donnez la vie. Broëseche has justly said, _Tanta est inter deum, religionem, et medicum connexio, ut sine Deo et religione nullus exactus medicus esse queat_; and it has truly been said by a later writer, "that a philosophic physician must seek in religion, strength of mind to support the painful exertions of his profession, and some consolation for the ingratitude of mankind." Amongst the many glaring absurdities which retarded the progress of medical studies, one cannot but notice the presumptuous claims of the physicians to the exclusive privilege of teaching surgery to their pupils, while anatomy was solely professed by surgeons, and not considered necessary in the instruction of a physician. All these anomalies can be easily traced to that spirit of dominion, exclusion, and monopoly, which invariably characterized clerical bodies. To such a pitch was this destructive practice carried, that surgeons were only allowed to perform operations in the presence of one or more physicians: nor were they permitted to publish any work on their profession until it had been licensed by a faculty who were utterly ignorant of the matter of which it treated. The celebrated Ambrose Paré could only obtain as a special favour from his sovereign, the permission to give to the world one of its most valuable sources of information. So late as 1726 we find the medical faculty of Paris making a formal representation to Cardinal de Noailles and the curates of that capital to prevent surgeons from granting certificates of health or of disease, and this application was grounded on the pious motive of enforcing a more rigid observance of Lent! They further insisted that this indispensable mortification was eluded in consequence of the facility of obtaining certificates that permitted persons stated to be indisposed to eat animal food, eggs, and butter, whence infidelity was making a most alarming progress, threatening the very existence of church and state, and the overthrow of every ancient and glorious institution. The faculty were formally thanked for their pious zeal in the true interests of religion, and the spiritual welfare of their patients; and orders were affixed upon the door of every church, anathematizing all certificates that emanated from the unholy hands of surgeons and barbers. These unfortunate barbers, although they humbly submitted to the sway of both physicians and surgeons when it suited their purpose, were in turn persecuted by both their allies and alternate protectors; so much so, that the clerical practitioners at one time prohibited them from bleeding, and conferred this privilege upon the bagnio-keepers. From the well-known nature of these establishments, various may be the reasons that led to this patronage, which was clearly an attempt to qualify bagnio-keepers to extend their convenient trade. At last, in the year 1505, barbers were dignified with the name of surgeons. Their instructions were delivered in their vernacular tongue, until the university again interfered, and ordered that lectures should be delivered in Latin; once more closing alma-mater against illiterate shavers, who were, however, obliged to give a smattering of classical education to their sons destined to wield alternately the razor and the lancet. In 1655, surgeons and barber-surgeons were incorporated in one college; a union which was further confirmed, in 1660, by royal ordonnance, under some limitations, whereby the barbers should not assume the title of licentiates, bachelors, or professors, nor be allowed to wear the honourable gown and cap that distinguished the higher grades of learning. Red caps were in former times given by each barber to his teacher on his being qualified, and gloves to all his fellow-students. Thus we find that the high state of perfection which the surgical art has attained is solely due to the efforts of industry to free itself from the ignoble trammels of bigotry and prejudice. Intellectual progress has invariably been opposed in every country by those powerful and interested individuals who derived their wealth and influence from the ignorance of society. Corporate bodies monopolizing the exercise of any profession will invariably retard instruction and shackle the energies of the student. It is, no doubt, indispensable that the practice of medicine in all its branches should only be allowed to such persons as are duly qualified; but whenever pecuniary advantages are derived from the grant of the permission, abuses as dishonourable as they are injurious to society will infallibly prevail. In Great Britain the period of study required in medical candidates is by no means sufficient. Five or six years is the very lowest period that should be insisted on; and, when duly instructed, degrees and licences should be conferred without fee, on all applicants, by a board of examiners unprejudiced and disinterested. This mode of granting licences would add to the respectability of the profession, while it would ensure proper attendance to the public. Physicians and surgeons would then become (what to a certain extent the latter are at present, though illegally as far as the laws of the college go), general practitioners, and society would no longer be infested by the swarms of practising apothecaries, who, from the very nature of their education, can only be skilled in making up medicines, or who must have obtained experience in the lessons taught by repeated failures in their early practice, unless perchance they have stepped beyond the usual confined instruction of their class. The consequences that arise from this fatal system are but too obvious. These men live by selling drugs, which they unmercifully supply, to the material injury of the patient's constitution. If, after ringing all the changes of their materia medica without causing the church-bell to toll, they find themselves puzzled and bewildered, a physician or a surgeon is called in, and too frequently these practitioners are bound by tacit agreement not to diminish the revenue that the shop produces. If it were necessary to prove the evils that result from the monopolizing powers vested in corporate institutions, the proof might be sought and found in the virulence and jealousy which they evince in resisting reform, from whatever quarter it may be dreaded; and it may be said that too many of the practising apothecaries of the present day stand in the same relative situation in the medical profession as the barbers of olden times. This faculty of exercising every branch of the profession, however qualified, is of olden date, and we find on the subject the following lines in the writings of Alcuin in the time of Charlemagne: Accurrunt medici mox Hippocratica tecta: Hic venas findit, herbas hic miscet in olla; Ille coquit pultes, alter sed pocula perfert. ON DREAMS. Philosophical ingenuity has long been displayed in the most learned disquisitions in an endeavour to account for the nature of these phenomena. The strangeness of these visionary perturbations of our rest--their supposed influence on our destinies--their frequent verification by subsequent events--have always shed a mystic _prestige_ around them; and superstition, ignorance, and craft, have in turns characterized them as the warnings of the Divine will, or the machinations of an evil spirit. Macrobius divided them into various categories. The first, the mere _dream_, _somnium_, he considers a figurative and mysterious representation that requires to be interpreted. Dion Cassius gives an example of this in the case of Nero, who dreamt that he saw the chair of Jupiter pass into the palace of Vespasian, which was considered as emblematical of his translation to the empire. The second distinction he terms a _vision_, _visio_, or a foreboding of future events. The third he deemed _oracular_, _oraculum_, and this was the case when a priest, or a relative, a deity, a hero, or some venerable person, denounced what was to happen, or warned us against it. As an example of this inspiration, for such it was considered, an anecdote of Vespasian is related. Having heard that a man in Achaia had dreamt that a person unknown to him had assured him that he should date his prosperity from the moment that Nero should lose a tooth,--a tooth just drawn from that emperor being shown to him the following day, he foresaw his destinies: soon after Nero died, Galba did not long survive him, and the discord that reigned between Otho and Vitellius ultimately placed the diadem on his brow. These inspirations were considered by Cicero, and various philosophers, as particularly appertaining to the shrine of the gods; those who sought that heavenly admonition were therefore recommended to lie down in temples. The Lacedæmonians sought slumber in the temple of Pasithea; Brizo, the goddess of sleep and dreams, was worshipped at Delos, and her votaries slept before her altars with their heads bound with laurel, and other fatidical symbols; hence divination by dreams was called _Brizomantia_. Supplications were offered up to Mercury for propitious visions, and a caduceus was placed for that purpose at the feet of beds; hence was it called [Greek: ermies]. Diodorus informs us that dreams were regarded in Egypt with religious reverence, and the prayers of the devout were often rewarded by the gods with an indication of appropriate remedies. But the confidence in supernatural agency and the power of magic, was only deemed a last resource, when human skill had been baffled. Some persons promised a certain sum of money for the maintenance of sacred animals, consecrated to the divinity whose aid they implored. In the case of infants, a certain portion of their hair was cut off and weighed, and when the cure was effected an equal quantity of gold was given to the successful intermediator. The fourth division was _insomny_, _insomnium_, which was characterized by a disturbed repose, caused either by mental or bodily oppression, or solicitude. The fifth class of dreams was the _phantasm_ or _visus_, which takes place between sleeping and waking, in a dozing and broken slumber, when the person thinks himself awake, and yet beholds fantastic and chimerical figures floating around his couch. Under this class is placed the _ephialtes_, or night-mare. Macrobius represents the phantasm and the insomnium as little deserving of attention, being of no use in divination and prediction. When these notions prevailed, the interpretation of dreams became a profitable trade; and it is a lamentable truth, that, to the present day, it is considered a speculation upon credulity. We find in Plutarch's Life of Aristides that there were tables drawn out for this purpose; and he speaks of one Lysimachus, a grandson of Aristides, who gained a handsome livelihood by this profession, taking up his station near the temple of Bacchus. Rules of interpretation were formed by Artemidorus, who lived in the reign of Antoninus Pius, and he drew his conclusions from circumstances considered either propitious or sinister. Thus, to dream of a large nose, signified subtlety; of rosemary or sage, trouble and weakness; of a midwife, disclosure of secrets; of a leopard, a deceitful person. These interpretations became so multiplied, that at last it was decreed that no dreams which related to the public weal should be regarded, unless they had visited the brains of some magistrates, or more than one individual. But what limits can any enactment assign to the influence of credulity and superstition? Cicero informs us that the Consul Lucius Julius repaired to the temple of Juno Sospita, in obedience to a decree of the senate regarding the dream of Cæcilia, daughter of Balearicus. In more modern times we have often seen dreams resorted to, in order to assist the speculations of policy and priestcraft; some of them as absurd in their nature as revolting in their interpretation. Monkish records relate that St. Bernard's mother dreamed that she had a little white dog barking about her, which was interpreted to her by a religious person as meaning "that she should be the mother of an excellent dog indeed, who should be the hope of God's house, and would incessantly bark against its adversaries, for he should be a famous preacher, and cure many by his medicinal tongue." Our Archbishop Laurence, to whom we owe the church of Our Lady at Canterbury, was about to emigrate to France under the discouragement of persecution, until warned in a dream, and severely scourged by St. Peter for his weakness. It was on the relation not only of this dream, but on actually exhibiting the marks of the stripes he had received, that Eadbald was baptized, and became a protector of the church. It was in a dream of this description that St. Andrew instructed Peter Pontanus how to find out the spear that had pierced our Saviour's side, and which was hidden somewhere near Antioch. Antioch was at that time besieged by the Persians, and half famished; but this weapon being carried by a bishop, enabled the besieged to beleaguer Caiban, the Persian general. The Peripatetics represented dreams as arising from a presaging faculty of the mind; other sects imagined that they were suggestions of dæmons. Democritus and Lucretius looked upon them as spectres and _simulacra_ of corporeal things, emitted from them, floating in the air, and assailing the soul. A modern writer, Andrew Baxter, entertained a notion somewhat similar, and imagined that dreams were prompted by separate immaterial beings, or spirits, who had access to the sleeper's brain with the faculty of inspiring him with various ideas. Burton divides dreams into natural, divine, and dæmoniacal; and he defines sleep, after Scaliger, as "the rest or binding of the outward senses, and of the common sense, for the preservation of body and soul." Gradually released from the trammels of superstition, modern philosophers have sought for more plausible explanations of the nature and causes of dreams, but perhaps without having attained a greater degree of certainty in this difficult question than our bewildered ancestors. Wolfius is of opinion that every dream originates in some sensation, yet the independent energies of the mind are sufficiently displayed in the preservation of the continued phantasms of the imagination. He maintains that none of these phantasms can prevail unless they arise from this previous sensation. De Formey is of the same opinion, and conceives that dreams are supernatural when not produced by these sensations. But of what nature are these sensations? Are they corporeal impressions received prior to sleep, and the continuances of reflection, or are they the children of an idle brain? Although it is not easy to trace an affinity between the subjects of our dreams and our previous train of thought, yet it is more than probable that dreams are excited by impressions experienced in our waking moments, and retransmitted to the sensorium, however difficult it may be to link the connexion of our ideas, and trace their imperceptible catenation. Moreover, there does not exist a necessary and regular association in the state of mind that succeeds any particular impressions. These impressions only predispose the mind to certain ideas, which act upon it with more or less subsequent energy, and with more or less irregularity, according to the condition in which the predisposing causes have left it. It has been observed that we seldom dream of the objects of our love or our antipathies. Such dreams may not be the natural results of such sentiments. We may fondly love a woman, and in our dreams transfer this soft sensation of fondness to another individual,--to a dog that fondles us, or any other pleasing object. We may have experienced fear--in a storm at sea; yet we may not dream of being tossed about in a boat, but of being mounted upon a runaway horse who hurries us to destruction, or of flying from a falling avalanche. Our mind had been predisposed by fear to receive any terrific impression, and most probably these alarming phantasms will be of a chimerical and an extravagant nature. A man who has been bitten by a dog may fancy himself in the coils of a boa-constrictor. When dreaming, the mind is in an abstracted state; but still is its reciprocal influence over the body manifest, although it is powerless on volition. Vigilance in sleep is still awake; but her assistance is of no avail until the connexion between mind and body is aroused by any alarm from external agents. It is well known that a hungry man will dream of an ample repast. A patient with a blister on his head has fancied himself scalped by Indians in all their fantastic ornaments. Somnambulism clearly proves that the mind retains its energies in sleep. Locke has justly observed that dreams are made up of the waking man's ideas, although oddly put together. Hartley is of opinion that dreams are nothing but the reveries of sleeping men, and are deducible from the impressions and ideas lately received, the state of the body, and association. I have endeavoured to explain, on the ground of the general effects of predisposition, the anomalies which so often are displayed in these associations. Of the surprising powers of the mind in somnambulism we have many instances too well authenticated to be doubted. Henricus ab Heeres was in the habit of composing in his sleep, reading aloud his productions, expressing his satisfaction, and calling to his chamber-fellow to join in the commendation. Cælius Rhodiginus when busied in his interpretation of Pliny, could only find the proper signification of the word _ectrapali_ in his slumbers. There is not the least doubt but that the mind is capable of receiving impressions of knowledge, but more particularly inspirations of genius, when the body is lulled in a state of apparent repose. Dreams have been ingeniously compared to a drama defective in the laws of unity, and unconnected by constant anachronisms. Yet certain incoherences are not frequent: Darwin has justly remarked that a woman will seldom dream that she is a soldier, and a soldier's visions will seldom expose him to the apprehensions of child-birth. Buffon has observed, "We represent to ourselves persons whom we have never seen, and such as have been dead for many years; we behold them alive and such as they were, but we associate them with actual things, or with persons of other times. It is the same with our ideas of locality; we see things not where they were, but elsewhere, where they never could have been." Dugald Stewart has endeavoured to account for these phenomena by the doctrine that in sleep the operations of the mind are suspended, and that therefore the cause of dreams is the loss of power of the will over the mind, which in the waking condition is subject to its control. Now, if this be the case, dreams must consist of mental operations independent of the will. However, it is not the suspension of the will and of the powers of volition that alone constitutes sleep; it is the suspension of the powers of the understanding,--attention, comparison, memory, and judgment. It is in consequence of this suspension of all our active intellectual faculties that we never can _will_ during our dreams; in that state there appears to be a resistance of the powers of volition with which the mind struggles in vain, and which is expressed both by moans, and the character of the sleeper's every feature, which portrays a state of anguish and impatience. In all dreams that are not of a morbid nature, every action is passive, involuntary. This state is widely different from delirium, in which the brain is in a morbid state of excitement; and the body is more susceptible than usual of external agency, while the mind is perplexed by hallucinations of an erroneous nature. Dr. Abercrombie considers insanity and dreaming as having a remarkable affinity when considered as mental phenomena; the impressions in the one case being more or less permanent, and transient in the other. Somnambulism he considers an intermediate state. Dreams, according to his theory, are divided into four classes: the first, when recent events and recent mental emotions are mixed up with each other, and with old events, by some feeling common to both; the second class relates to trains of images brought up by association with bodily sensations; the third, the result of forgotten associations; and the fourth class of dreams contains those in which a strong propensity of character, or a strong mental emotion, is imbodied in a dream, and by some natural coincidence is fulfilled. The following interesting cases that fell under Dr. Abercrombie's immediate notice, illustrate his views and the above classification. Regarding the first class, Dr. A. relates the following: "A woman, who was a patient in the clinical ward of the infirmary of Edinburgh, under the care of Dr. Duncan, talked a great deal in her sleep, and made numerous and very distinct allusions to the cases of other sick persons. These allusions did not apply to any patients who were in the ward at the time; but, after some observation, they were found to refer correctly to the cases of individuals who were there when this woman was a patient in the ward two years before." The following is an instance of phantasms being produced by our associations with bodily sensations, and tends to show how alive our faculties continue during sleep to the slightest impressions: The subject of this observation was an officer in the expedition to Louisburg in 1758, who had this peculiarity in so remarkable a degree, that his companions in the transport were in the constant habit of amusing themselves at his expense. They could produce in him any kind of dream by whispering in his ear, especially if this was done by a friend with whose voice he had become familiar. One time they conducted him through the whole progress of a quarrel, which ended in a duel; and when the parties were supposed to have met, a pistol was put into his hand, which he fired, and was awakened by the report. On another occasion they found him asleep on the top of a locker in the cabin, when they made him believe he had fallen overboard, and exhorted him to save himself by swimming. They then told him that a shark was pursuing him, and entreated him to dive for his life. He instantly did so, and with so much force as to throw himself from the locker upon the cabin floor, by which he was much bruised, and awakened of course. After the landing of the army at Louisburg, his friends found him one day asleep in his tent, and evidently much annoyed by the cannonading. They then made him believe that he was engaged, when he expressed great fear, and showed an evident disposition to run away. Against this they remonstrated, but at the same time increased his fears by imitating the groans of the wounded and the dying; and when he asked, as he often did, who was hit, they named his particular friends. At last they told him that the man next himself in his company had fallen, when he instantly sprung from his bed, rushed out of the tent, and was only roused from his danger and his dream by falling over the tent-ropes. A remarkable thing in this case was, that after these experiments he had no distinct recollection of his dreams, but only a confused feeling of oppression or fatigue, and used to tell his friends that he was sure they had been playing some trick upon him. It has been observed that we seldom feel courageous or daring in our dreams, and generally avoid danger when menaced by a foe, or exposed to any probable peril. The third class of dreams relates to the revival of forgotten associations. The person in question was at the time connected with one of the principal banks in Glasgow, and was at his place at the teller's table, where money is paid, when a person entered demanding payment of a sum of six pounds. There were several people waiting, who were in turn entitled to be attended to before him; but he was remarkably impatient and rather noisy, and being besides a remarkable stammerer, he became so annoying, that another gentleman requested him to pay the money and get rid of him. He did so accordingly, but with an expression of impatience at being obliged to attend to him before his turn, and thought no more of the transaction. At the end of the year, which was eight or nine months after, the books of the bank could not be made to balance, the deficiency being exactly six pounds. Several days and nights had been spent in endeavouring to discover the error, but without success, when he returned home much fatigued, and went to bed. He dreamt of being at his place in the bank, and the whole transaction of the stammerer, as now detailed, passed before him in all its particulars. He awoke under the full impression that the dream would lead him to the discovery of what he was so anxiously in search of, and on examination he soon discovered that he had neglected to enter the sum which he had thus paid. The following singular dreams are examples of the fourth class. A clergyman had come to Edinburgh from a short distance in the country, and was sleeping at an inn, when he dreamt of seeing a fire, and one of his children in the midst of it. He awoke with the impression, and instantly left town on his return home. When he arrived in sight of his house, he found it on fire, and got there in time to assist in saving one of his children, who in the alarm and confusion had been left in a situation of danger. A gentleman in Edinburgh was affected with aneurism of the popliteal artery, for which he was under the care of two eminent surgeons, and the day was fixed for the operation. About two days before the appointed time, the wife of the patient dreamt that a favourable change had taken place in the disease, in consequence of which the operation would not be required. On examining the tumour in the morning, the gentleman was astonished to find that the pulsation had entirely ceased, and, in short, this turned out to be a spontaneous cure,--a very rare occurrence in surgical practice. The following dream is still more remarkable. A lady dreamt that an aged female relative had been murdered by a black servant, and the dream occurred more than once. She was then so impressed by it, that she went to the house of the lady, and prevailed upon a gentleman to watch in an adjoining room during the following night. About three o'clock in the morning, the gentleman, hearing footsteps on the stairs, left his place of concealment, and met the servant carrying up a quantity of coals. Being questioned as to where he was going, he replied, in a hurried and confused manner, that he was going to mend his mistress's fire, which at three o'clock in the morning in the middle of summer was evidently impossible; and, on further investigation, a strong knife was found concealed beneath the coals. Dreams, to whatever causes they may be attributed, vary according to the nature of our sleep: if it is sound and natural, they will seldom prevail; if, on the contrary, it be broken and uneasy, by a spontaneous association dreams will become fanciful, and might indeed be called visions, so fantastic and chimerical are all the objects that present themselves in motley groups to the disturbed mind. This derangement in the sensorium may be referred to various physical causes,--the sensations of heat or of cold, obstruction in the course of the circulation of the blood, as when lying upon the back, a difficult digestion. In a sound sleep our dreams are seldom remembered except in a vague manner; whereas, in a broken sleep, as Formey has observed, the impression of the dream remains upon the mind, and constitutes what this philosopher called "_the lucidity of dreams_." It not unfrequently happens to us that we have had a similar dream several times, or at least we labour under this impression; nay, many persons fancy that particular events of their life at the moment of their occurrence had clearly taken place at a former period either in reality or in a dream. Morning "winged dreams" are more easily remembered in their circumstantial vagaries than those of the preceding night, for at that period (the morning) our sleep is not sound, and dreams become more lucid. These _rêvasseries_, as the French call them, are admirably described by Dryden: A dream o'ertook me at my waking hour This morn, and dreams they say are then divine, When all the balmy vapours are exhal'd, And some o'erpow'ring god continues sleep. That we are more or less impressionable in our sleep is rendered evident by the facility with which even a sound sleeper is disturbed by the slightest noise: the sparkling of a fire, or the crackling produced by the wick of our night-lamp when coming into contact with the water in the glass, the sting of an insect, the slightest admission of a higher or lower temperature, will occasion a broken sleep and its dreams. It has been remarked that the sense of seeing is more frequently acted upon in dreams than that of hearing, and very seldom do we find our smell and taste under their influence. It is possible that this peculiarity may arise from the greater variety of impressions with which the sight is daily struck, and which memory communicates by association or retransmission. Next to feeling, vision is the first sense brought into relation with external objects. When we hear noises, explosions, tumultuous cries, it is more than probable that our dreams partake of a delirious and morbid nature, or of sensorial or intellectual hallucinations, in which the mind is actually diseased, and our perceptions become erroneous: then we speak loudly to others, and to ourselves. When these hallucinations prevail after sleep, the invasion of mania may be apprehended. Cabanis, in his curious investigations on the mind, has endeavoured to fix the order in which the different parts of our organization go to sleep. First the legs and arms, then the muscles that support the head and back: the first sense that slumbers, according to his notions, is that of sight; then follow in regular succession the senses of taste, smell, hearing, and feeling. The viscera fall asleep one after the other, but with different decrees of soundness. If this doctrine be correct, we may easily conceive the wild and strange inconsistencies of our dreams, during which the waking and the sleeping organs are acting and reacting upon each other. Corporeal sensations and different organic actions frequently attend our dreams; but these may be attributed to our mode of living, or the indulgence in certain unruly desires and conversations. That man and animals dream of the pursuits of the preceding day there can be no doubt: hence the line, Et canis in somnis leporis vestigia latrat. The effects of a heavy meal, more especially a supper, in disturbing our rest, was well known and recorded by ancient physicians: and Crato tells us "that the fittest time to repair to rest is two or three hours after supper, when the meat is then settled in the bottom of the stomach: and 'tis good to lie on the right side first, because at that side the liver doth rest under the stomach, not molesting any way, but heating him as a fire doth a kettle that is put to it. After the first sleep 'tis not amiss to lie upon the left side, that the meat may the better descend; and sometimes again on the belly, but never on the back." Our ancestors had recourse to various devices to procure sound sleep. Borde recommends a good draught of strong drink before going to bed; Burton, a nutmeg and ale, with a good potation of muscadine with a toast; while Ætius recommends a sup of vinegar, which, according to Piso, "_attenuat melancholiam et ad conciliandum somnum juvat_." Oppression from repletion will occasion fearful dreams and the night-mare; and bodily sufferings, when exhaustion has brought on sleep, will also be attended with alarming and painful visions. Levinus Lemnius recommended to sleep with the mouth shut, to promote a regular digestion by the exclusion of too much external air. The night-mare is admirably described in Dryden's translation of Virgil: And as, when heavy sleep has closed the sight, The sickly fancy labours in the night, We seem to run, and, destitute of force, Our sinking limbs forsake us in the course: In vain we heave for breath; in vain we cry; The nerves, unbraced, their usual strength deny, And on the tongue the falt'ring accents die. In the Runic theology it was regarded as a spectre of the night, which seized men in their sleep, and suddenly deprived them of speech and of motion. It was vulgarly called witch-riding, and considered as arising from the weight of fuliginous spirits incumbent on the breast. _Somnus ut sit levis, sit tibi coena brevis_, is the ancient axiom of our distich, That your sleep may be light, Let your supper be slight. Notwithstanding this rule of health, it is nevertheless true that many persons sleep more soundly after a hearty supper; and, most unquestionably, dreams are more frequent towards morning than in the beginning of the night. In my opinion, I should apprehend that the sound sleep of supper-eaters is to be attributed to the narcotic nature of their potations, more than the meal, although the _siesta_ of southern countries might be advanced in favour of a contrary opinion. When philosophers speak of dreams being mental operations independent of the will, they speak vaguely, for the operations of the mind when we are awake are too frequently uncontrolled by volition. Did we possess this power over our rebellious thoughts, who would constantly ponder on a painful subject? Our thoughts cannot be suspended at will, and their influence has been beautifully described by Shakspeare: My brain I'll prove the female to my soul, My soul the father; and these two beget A generation of still breeding thoughts. Volition has no more power over thought when we are awake than sleeping; and, despite all metaphysical and psychological speculations, it cannot be demonstrated that the mind does not retain its full energies during sleep, only they cease to be regulated by judgment, and are not, to use Locke's words, under the rule and conduct of the understanding; and even on this opinion it has been fairly observed, that much of incongruity which is supposed to prove suspension of reason, and much of the wild discordancy of representation which appears to prevail during our sleep, may arise from the defect of memory when we are awake, that does not retain the impression of images which have passed across the mind in light and rapid succession, and which, therefore, exhibit but a partial and imperfect sketch of the picture that engaged the attention in sleep. The well-known fact that the impressions of our dreams are oftentimes more vivid and correct, when some time has elapsed, than on our awakening, tends to confirm this hypothesis; and these recollections are the more vivid when they bear any analogy to circumstances that come to pass. Sir Thomas Brown was of opinion that sleep was the waking of the soul; the ligation of sense, but the liberty of reason; and that our waking conceptions do not match the fancies of our sleep. He thus expresses himself in his Religio Medici: "At my nativity my ascendant was the watery sign of Scorpius; I was born in the planetary hour of Saturn, and I think I have a piece of that leaden planet in me. I am no way facetious, nor disposed for the mirth and galliardise of company; yet in one dream I can compose a whole comedy, behold the action, apprehend the jests, and laugh myself awake at the conceits thereof. Were my memory as faithful as my reason is then fruitful, I would never study but in my dreams, and this time also would I choose for my devotions; but our grosser memories have then so little hold of our abstracted understandings, that they forget the story, and can only relate to our awaked souls a confused and broken tale of that that hath passed." Dreams have been considered as prescriptive in various diseases. Diodorus Siculus relates that a certain Scythian dreamed that Æsculapius had drawn the humours of his body to one place, or head, to have it lanced. When Galen had an inflammation of the diaphragm, we are told that he was directed in a dream to open a vein between the thumb and the fourth finger--an operation which restored him to health. Marcus Antoninus asserted that he learned in his dreams various remedies for spitting of blood. It is related of Sir Christopher Wren, that, when at Paris, in 1671, being disordered with "a pain in his reins," he sent for a physician, who prescribed blood-letting, but he deferred submitting to it, and dreamed that very night that he was in a place where palm-trees grew, and that a woman in a romantic habit offered dates to him. The next day he sent for dates, which cured him. Now, although this cure, brought about by a dream, was considered wonderful, its circumstances offer nothing supernatural. It is more than probable that Sir Christopher had frequently read in foreign works on medicine, that dates were recommended as an efficacious remedy in nephritic complaints; and, moreover, had met in his daily perambulations female quacks, who exhibit themselves to this day in the French metropolis, fantastically attired, and vending their far-famed nostrums. That he should have remembered dates, and that the phantasm of the she-mountebank might at the same time have struck his fancy, were two associations by no means improbable. It is very likely that all the strange stories of prophetic dreams might be traced to a similar connexion of ideas. I have before observed that dreams do not always assume their complexion from recent occurrences, and our bodily sufferings during sleep bring to our recollection every circumstance that regards the malady. A patient who had a bottle of hot water placed at his feet dreamed that he was walking in great agony in the burning lava of Vesuvius. Similar associations exist when awake: the man whose arm has been amputated constantly refers the pain he experiences to the lost hand, or to that part of the limb which received the injury; and the very same nervous illusion prevails during his slumbers. A case is recorded of an officer who had lost his leg, and, when cold, felt comfort and warmth by wrapping the stump of his wooden leg in flannel. In various diseases the nature and the period of the invasion of dreams afford a valuable ground of observation to the physician both in his diagnosis and prognosis of the case. In incipient hydro-thorax, for instance, dreams occur at the very moment the patient falls asleep, and he fancies himself suffocated by some impending and destructive weight. Diseases of the heart are accompanied by alarming dreams, from which the patient starts up in great terror. In children the perturbation of their sleep frequently indicates the seat of their sufferings; and the valuable researches on the nervous system by Charles Bell have enabled the medical attendant to read in the features of a sleeping infant whether the malady be in the head, the cavity of the chest, or the abdomen. If proof were wanting that dreams arise from our waking thoughts, it might be found in the circumstance of those sleepers who divulge their secrets, and verify the lines of Shakspeare: There are a kind of men so loose of soul, That in their sleep will mutter their affairs. Reason, therefore, prompts us to reject the idea of dreams being preternatural suggestions. In general, we may consider them as a morbid excitement of the brain, arising either from moral or physical causes, and depending essentially on the condition of our mind and body. Our most lively hopes are ever linked with fears that prey upon us even when most secure; and these apprehensions, recurring in our dreams, prove too often prophetic of the very events we dreaded. The prejudices of early education shed around these forewarnings circumstantial incidents; and fear is the greatest ally of superstition. If our visions by night are fraught with such singular circumstances, our "day dreams," or _reveries_, are frequently attended with strange associations. The impressions received during these ecstatic visions or trances will occasionally act so powerfully upon the mind, that during our waking hours and the usual pursuits of life we cannot divest ourselves of the existence of their reality. Dr. Arnould has given the following curious account of a case of this kind, as narrated by the individual himself:--"One afternoon in the month of May, feeling himself a little unsettled and not inclined to business, he thought he would take a walk into the city to amuse his mind, and having strolled into St. Paul's Churchyard, he stopped at the shop window of Carrington and Bowles, and looked at the pictures, among which was one of the cathedral. He had not been long there before a short grave-looking elderly gentleman, dressed in dark brown clothes, came up and began to examine the prints, and occasionally casting a glance at him, very soon entered into conversation with him, and praising the view of St. Paul's which was exhibited at the window, told him many anecdotes of Sir Christopher Wren the architect, and asked him at the same time if he had ever ascended to the top of the dome. He replied in the negative. The stranger then inquired if he had dined, and proposed that they should go to an eating-house in the neighbourhood, adding that after dinner he would accompany him up St. Paul's. It was a glorious afternoon for a view, and he was so familiar with the place that he could point out every object worthy of attention. The kindness of the old gentleman's manner induced him to comply with the invitation, and they went to a tavern in some dark alley, the name of which he did not know. They dined and very soon left the table, and ascended to the ball just below the cross, which they entered alone. "They had not been there many minutes, when, while he was gazing on the extensive prospect and delighted with the splendid scene below him, the grave gentleman pulled out from an inside coat-pocket something like a compass, having round the edge some curious figures; then having muttered some unintelligible words, he placed it in the centre of the ball. He felt a great trembling, and a sort of horror came over him, which was increased by his companion asking him if he should like to see any friend at a distance and to know what he was at that time doing, for if so, the latter could show him any such person. It happened that his father had been for a long time in bad health and for some weeks past he had not visited him. A sudden thought came into his mind, so powerful, that it overcame his terror, that he should like to see his father. He had no sooner expressed the wish than the exact person of his father was immediately presented to his sight in the mirror, reclining in his armchair and taking his afternoon sleep. Not having fully believed in the power of the stranger to make good his offer, he became overwhelmed with terror at the clearness and truth of the vision presented to him, and he entreated his mysterious companion that they might immediately descend, as he felt himself very ill. The request was complied with, and on parting under the portico of the northern entrance, the stranger said to him, 'Remember you are the slave of the man of the mirror.'" He returned in the evening to his home, he does not know exactly at what hour; felt himself unquiet, depressed, gloomy, apprehensive, and haunted with thoughts of the stranger. For the last three months he has been conscious of the power of the latter over him. Dr. Arnould adds, "I inquired in what way his power was exercised? He cast on me a look of suspicion mingled with confidence, took my arm, and after leading me through two or three rooms and then into the garden, exclaimed, 'It is of no use--there is no concealment from him, for all places are alike open to him--he sees us--and he hears _us now_.' I asked him where the being was who saw us and heard us? He replied in a voice of deep agitation, 'Have I not told you that he lives in the ball below the cross on the top of St. Paul's, and that he only comes down to take a walk in the churchyard and get his dinner at the house in the dark alley. Since that fatal interview with the necromancer,' he continued, 'for such I believe him to be, he is continually dragging me before him in his mirror--he not only sees me every moment of the day, but he reads all my thoughts, and I have a dreadful consciousness that no action of my life is free from his inspection, and no place can afford me security from his power.' On my reply that the darkness of the night would afford him protection from these machinations, he said, 'I know what you mean, but you are quite mistaken--I have only told you of the mirror, but in some part of the building which he passed on coming away, he showed me what he called a great bell, and I heard sounds which came from it, and which went to it, sounds of laughter, and of anger, and of pain; there was a dreadful confusion of sounds, and I listened with wonder and affright'--he said, 'this is my organ of hearing; this great bell is in communication with all the other bells within the circle of hieroglyphics, by which every word spoken by those under my control is made audible to me.' Seeing me look surprised at him, he said, 'I have not yet told you all, for he practises his spells by hieroglyphics on walls and houses, and wields his power, like a detestable tyrant as he is, over the minds of those whom he has enchanted, and who are the objects of his constant spite within the circle of his hieroglyphics.' I asked him what these hieroglyphics were, and how he perceived them? He replied, 'Signs and symbols which you in your ignorance of their true meaning have taken for letters and words, and read, as you have thought, _Day and Martin_ and _Warren's blacking_. Oh! that is all nonsense! they are only the mysterious characters which he places to mark the boundaries of his dominions, and by which he prevents all escape from his tremendous power. How I have toiled and laboured to get beyond the limits of his influence! Once I walked for three days and three nights, till I fell down under a wall exhausted by fatigue, and dropped asleep; but on awaking I saw the dreadful sign before my eyes, and I felt myself as completely under his infernal spell at the end as at the beginning of the journey.'" Dr. Pritchard remarks on this singular case of insanity, that this gentleman had actually ascended to the top of St. Paul's, and that impressions there received being afterwards renewed in his mind when in a state of vivid excitement, in a dream or ecstatic revery, became so blended with the creation of fancy, as to form one mysterious vision, in which the true and the imaginary were afterwards inseparable. It is also possible that this person, being of a nervous and susceptible disposition, had been struck, when on the dizzy height of the cupola, with a vertigo, or fit, during which these phantasms had struck him in so vivid a manner as to derange his intellects--the loud and terrific sound of the bell adding to the horror of his situation. It is well known that persons have recollected circumstances that occurred around them during an epileptic and an apoplectic attack. Our worthy visionary was for two years an inmate of a private asylum. In regard to the verification of dreams, they may be easily accounted for by that proneness that most men, especially if of a weak and impressionable state of mind, experience in courting the object of their hopes or fears. Thus have the absurd prognostications of fortune-tellers been too frequently fatal, as we may work up our thoughts to such an intensity as to bring on the very death that we apprehend. Dr. Pritchard relates the case of a clergyman, in an indifferent state of health, who, when standing one day at the corner of a street, saw a funeral procession approaching him. He waited till it came near him, saw all the train pass him, with black nodding plumes, and read his own name on the coffin, which was carried by, and entered, with the whole procession, into the house where he resided. This was the commencement of an illness which put an end to his life in a few days. During a severe fever, in the peninsula, my nightly rest was constantly disturbed by the threatening appearance of animals with fearful horns and antlers, incessantly hovering about me. For a long time after my recovery the spectral illusion continued, and every horse or mule that passed by me appeared to be armed with immense horns. It is to be feared that, notwithstanding the ingenuity of the many physiologists who have sought to investigate the nature of dreams, we shall never come to any satisfactory conclusion, since we follow too frequently the example of the German philosopher, Lesage, who, in his endeavour to throw some light on this obscure subject, sought to ascertain the intermediate condition of the mind when passing from the waking state into sleep, a transition which never has been, and, most probably, never can be ascertained, since sleep, to a certain degree, is a suspension of all power of attention, perception, volition, and every spontaneous faculty. ON FLAGELLATION. Amongst the various moral and physical remedies introduced by the priesthood and physicians for the benefit of society, flagellation once held a most distinguished rank. As a remedy, it was supposed to reanimate the torpid circulation of the capillary or cutaneous vessels, to increase muscular energy, promote absorption, and favour the necessary secretions of our nature. No doubt, in many instances, its action as a revulsive may be beneficial; and urtication, or the stinging with nettles, has not unfrequently been prescribed with advantage. As a religious discipline, for such has this system of mortification been called, it has been considered as most acceptable to Heaven; so much so, indeed, that the fustigation was commensurate with the sinner's offence. Under the head of Dæmonomania I have endeavoured to show that whipping was equally agreeable to the evil spirit, who delighted in flogging the elect. It appears that at this period a belief prevailed that heavenly mercy restored the grace that had been forfeited, commuting for temporal punishment that which else would have been eternal. The monks of Fonte Avellana, for instance, had decreed that thirty psalms, said or sung, with an accompaniment of one hundred stripes to each psalm, would be considered as a set-off for one year of purgatory; and, by this calculation, the whole psalter, which would have demanded fifteen thousand stripes, would have procured a relief of five years from the fiery ordeal. It was no doubt under this impression that St. Dominic the Cuirassier, so named from his wearing, day and night, an iron cuirass next his skin, and which he never took off, adopted this same covering when, upon entering into priest's orders, his parents presented the bishop who ordained him with a rich fur garment, an offence for which the holy man wished to atone by donning an iron vestment. This said madman belonged to the congregation of Fonte Avellana, the monks of which never touched either wine or oil, and, during five days of the week, lived upon bread and water; moreover, every day after service they flogged each other. Dominic, in extenuation of his family's offence in having presented his diocesan with a luxurious gown, lashed himself at the rate of ten psalters, and thirty thousand lashes _per diem_; by which he calculated that he was redeeming three thousand six hundred and fifty years of purgatorial torments _per annum_: but, in addition to this wholesome allowance, he humbly petitioned his superior to allow him, during Lent, a supplementary punishment of one hundred years, when his day's work was two psalters and a half, and thirty-four thousand five hundred lashes. This punishment did not seem sufficient in his eyes to propitiate the Creator; and St. Pietro Damiano informs us that, during the Lenten days, he actually recited the psalter two hundred times, with a _crescendo_ accompaniment of sixty millions of stripes. It was on this occasion that Yepes shrewdly observed, that he marvelled less at a man's head being able to retain so many verses than that his arm was able to carry on such a flagellation; or, to use his own words, how his flesh, unless made of iron, could resist such a castigation. This blessed man must have been endowed with powers that were increased by exertion, since we find that his ambition gave him such energy, that once beginning his operations in the evening, and singing and flogging, and flogging and singing, _con amore_, through the day and night, at the expiration of twenty-four hours he had gone through the psalms twelve times, begun them a thirteenth time, and proceeded as far as _Beati quorum_, the thirty-second psalm; having inflicted upon himself one hundred and eighty-three thousand one hundred stripes, thereby reducing purgatorial stock to the amount of sixty-one years, twelve days, and thirty-three minutes, to a fraction. It would be perfectly idle and absurd for any freethinker to doubt this fact, recorded by an eyewitness--Pietro Damiano, a saint, and moreover a cardinal; and Calmet himself maintains that no man should dare to doubt a saint's assertion, more especially when speaking of another beatified person. Notwithstanding this assertion, a stiff-necked arithmetician calculated that, if during these twenty-four hours the saint had given himself two blows every second, the number of lashes would only have amounted to one hundred and seventy-two thousand eight hundred, being ten thousand three hundred short of the amount stated! However, this difficulty was overcome by Father Castaniza, who makes up the amount by maintaining that he made use of cats with ten tails, and therefore had actually a balance in his favour in his _winding_-sheet.[28] _Ubi stimulus ibi affluxus_, has been a physiological axiom since the days of Hippocrates; and flagellation thus employed is only a modification of blistering, or exciting the skin by any other irritating method. The moral influence of flagellation in the treatment of different diseases has been appreciated by the ancients: it was strongly recommended by the disciples of Asclepiades, by Cælius Aurelianus, and since by Rhasis and Valescus, in the treatment of mania. No doubt, the terror which this castigation inspires may tend materially to facilitate the management of the insane. To the present day this opinion has prevailed to a revolting degree, and it is no easy matter for the humane physician to convince a keeper of the cruelty or inutility of this practice. Seldom or never does this harsh management become necessary: I had charge of a military lunatic asylum for a considerable time, and, with one exception, never found myself warranted in causing corporal punishment to be inflicted, notwithstanding the association of ideas of discipline which such a chastisement must have produced amongst men then exposed to the capricious infliction of the lash. The case to which I allude was one of a Sergeant N--, who had twice attempted my life, and who fully remembered every circumstance in the remissions of his malady; so much so, indeed, that doubts were entertained in the minds of the casual visiter as to the real condition of his mental faculties; and in the establishment now under my superintendence a keeper is discharged when convicted of having struck a patient _under any circumstances_. To return from this digression: the authoritative power of man over the brute creation is daily witnessed, even with unruly and ferocious animals; and there are, no doubt, cases where bodily punishment becomes indispensable, when the body will feel what the judgment cannot comprehend. Boerhaave relates the case of a hypochondriac who swore that his legs were made of straw; but an officious servant-maid, who was sweeping the room, struck him across the shins with her broomstick, and soon brought him to a sense of his erroneous impression. Flagellation draws the circulation from the centre of our system to its periphery. It has been known in a fit of ague to dispel the cold stage. Galen had observed that horse-dealers were in the habit of bringing their horses into high condition by a moderate fustigation; and therefore recommended this practice to give _embonpoint_ to the lean. Antonius Musa treated a sciatica of Octavius Augustus by this process. Elidæus Paduanus recommends flagellation or urtication when the eruption of exanthematic diseases is slow in its development. Thomas Campanella records the case of a gentleman whose bowels could not be relieved without his having been previously whipped. Irritation of the skin has been often observed to be productive of similar effects. The erotic irregularities of lepers is well authenticated; and various other cutaneous diseases, which procure the agreeable relief that scratching affords, have brought on the most pleasurable sensations. There exists a curious letter of Abelard to his Eloisa, in which he says, "Verbera quandoque dabat amor, non furor; gratia, non ira; quæ omnium unguentorum suavitatem transcenderent." This effect of flagellation may be easily referred to the powerful sympathy that exists between the nerves of the lower part of the spinal marrow and other organs. Artificial excitement appears in some degree natural: it is observed in various animals, especially in the feline tribe. Even snails plunge into each other a bony and prickly spur that arises from their throats, and which, like the sting of the wasp, frequently breaks off and is left in the wound. In the monastic orders of both sexes, flagellation became a refined art. Flagellation was of two species, the upper and the lower; the upper inflicted upon the shoulders, the lower chiefly resorted to when females were to be fustigated. This mode was adopted, according to their assertions, from the accidents that might have happened in the upper flagellation, where the twisting lash might have injured the sensitive bosom. In addition to this device, nudity was also insisted upon. In the article Dæmonomania I have recorded various abominations of the kind. Nor was it only amongst religious orders and their followers that this custom obtained. It was practised by ladies of high rank amongst their commensals and attendants. Brantome gives us a curious and quaint account of this amusing castigation. Mademoiselle de Limeuil, one of the queen's maids of honour, was flagellated for having written a pasquinade, in company with all the young ladies who had been privy to the composition. And on another occasion he tells us: "J'ai ouï parler d'une grande dame de par le monde, voire grandissime, mariée et veuve, qui faisait dépouiller ses dames et filles, je dis les plus belles, et se délectait fort à les voir, et puis elle les battait du plat de la main, avec de grandes clacquades et blamuses assez rudes; et les filles qui avaient délinqué en quelque chose, avec de bonnes verges, et elle les clacquait ainsi selon le sujet qu'elles lui en donnaient, pour les faire ou rire ou pleurer." The minions of Henry III. of France, and other princes, were decked in white robes, then stripped, and whipped in procession for the gratification of their royal masters. Not unfrequently the ladies themselves were the executioners in cases where any man had offended them; and the adventure of Clopinel the poet is worth relating. This unfortunate wight had written the following lines on the fair sex: Toutes êtes, serez, ou fûtes, De fait ou de volonté putes; Et qui bien vous chercherait Toutes putes vous trouverait. This libellous effusion naturally excited the indignation of the ladies at court, who decided that Clopinel should be flagellated by the plaintiffs without mercy; and it is difficult to say to what extent they might have carried their vengeance but for a timely witticism of the culprit, who piteously addressing the angry yet beauteous group around him with uplifted arm and rod, humbly entreated that the first blow might be struck by the honourable damsel who felt herself the most aggrieved. It is needless to add that not a lash was inflicted. Medical men were frequently consulted as to the adoption of the upper or lower discipline, as flagellation on the shoulders was said to injure the eyesight. It was from the fear of this accident that the lower discipline was generally adopted amongst nuns and female penitents, as appears by the following rule: "Quippe cum eâ de causâ capucini, multæque moniales, virorum medicorum ac piorum hominum consilio, ascesim flagellandi sursum humeros reliquerint, ut sibi nates lumbosque strient asperatis virgis, ac nodosis funiculis conscribillent." In a medical point of view, urtication, or stinging with nettles, is a practice not sufficiently appreciated. In many instances, especially in cases of paralysis, it is more efficacious than blistering or stimulating frictions. Its effects, although perhaps less permanent, are more general and diffused over the limb. This process has been found effectual in restoring heat to the lower extremities; and a case of obstinate lethargy was cured by Corvisart by repeated urtication of the whole body. During the action of the stimulus, the patient, who was a young man, would open his eyes and laugh, but sink again into profound sleep. His perfect cure, however, was obtained in three weeks. ON LIFE AND THE BLOOD. THE LIFE OF ALL FLESH IS THE BLOOD THEREOF. On this doctrine, expressed in the Mosaic books, many of the olden writers founded their hypothesis that blood was the principle of life. It is, however, more than probable that this opinion was derived from a more ancient ritual than the Levitical code, since we find a similar belief among the Parsees, Hindoos, and other Oriental nations of very remote antiquity, who no doubt owed the practice of abstaining from blood to the early patriarchs. The Greeks and the Romans, if we take the expressions of their poets as being conclusive, entertained similar notions regarding the vital fluid; and the "purple death" of Homer and "the purple life" of Virgil, are phrases evidently applicable to this theory, which Critias, Empedocles, and their sects maintained. This opinion, however, does not appear to have dictated the expressions made use of by Moses. When he says "the life of all flesh is the blood thereof," it merely signifies that when the blood is abstracted death ensues; a circumstance that must have been daily and hourly observed. It is probable that this injunction was promulgated to check the barbarous custom of devouring raw meat, which seems to have prevailed long before the Jewish legislator. We read in Genesis ix. 4, "Flesh with the life thereof, which is the blood thereof, shall you not eat." From this circumstance we may infer that, like the Abyssinians of Bruce's time, the Jews were in the habit of tearing and cutting flesh from live animals. Saul's army was guilty of a similar practice. It therefore behoved their legislators to oppose a custom that increased the natural ferocity and cruelty of the nation they ruled. This theory of the ancients has been frequently revived in modern times, and has not a little contributed to increase the mystery that veils the nature of our existence. Harvey, who discovered the circulation of the blood, was a convert to this doctrine; Hoffman also adopted it; and Huxham not only fully believed in it, but sought the immediate part of the blood that constituted life, and fancied that he had discovered it in its red particles. It was John Hunter, however, who first established the system on any thing like a rational basis, although his arguments on the subject have led to much doubt and illiberal controversy. "The difficulty," says he, "of conceiving that blood is endowed with life while circulating, arises merely from its being a fluid, and the mind not being accustomed to the idea of a living fluid. I shall endeavour," he continues, "to show that organization and life do not in the least depend upon each other; that organization may arise out of living parts and produce action; but that life can never arise out of or produce organization." The errors of this doctrine are obvious, and have led many ingenious physiologists into a maze of idle wandering. The fact is, that life is the instrument of organization, or, in other words, organization is the result of life. The embryo could not be developed, did not the fluid that animates it possess a principle of vitality which it communicates to a body previously organized. In this confusion the word "life" has sometimes been applied to the power, and at others to the result. Without organization, life cannot be transmitted; and the moment the principle of life ceases, a disorganization, more or less rapid, ensues. The doctrine of the vitality of the blood has very lately been maintained by several physiologists. Professor Schultz speaks of an active vital process which can be seen constantly going on between the individual molecules of the blood and the substance of the vessels; but Muller asserts that, during ten years, he examined the circulation of the blood in various parts, at every opportunity and with different instruments, but had never seen what Schultz describes--the constant assimilation, disappearance, and new formation of the globules; nor had Rudolphi, Purkinje, Koch, and Meyer, been more successful in their investigation; and Muller further maintains that the motion of these red particles in the circulation is purely passive, which may be proved by compressing the vessels of the limb, or the limb itself. Eber and Meyer pretended that these red particles were infusory animals. On this important and curious subject I shall quote Muller's opinion: "The question whether the blood be living fluid or not, calls to mind a critical state of our science. Every thing which evidences an action which cannot be explained by the laws of inorganic matter, is said to have an organic, or, what is the same thing, a vital property. To regard merely the solids of the body as living, is incorrect, for there are strictly no organic solids; in nearly all, water constitutes four-fifths of their weight. Although, then, organic matter generally be considered as merely 'susceptible of life,' and the organized parts as 'living,' yet the blood also must be regarded as endowed with life, for its action cannot be comprehended from chemical and physical laws. The semen is not merely a stimulus for the fructification of the egg, for it impregnates the eggs of the Batrachia and fishes out of the body; and the form, endowments, and even tendencies to disease, of the father, are transferred to the new individual. The semen, therefore, although a fluid, is evidently endowed with life, and is capable of imparting life to matter. The impregnable part of the egg, the germinal membrane, is a completely unorganized aggregation of animal matter; but, nevertheless, is animated with the whole organizing power of the future being, and is capable of imparting life to a new matter, although soft, and nearly allied to a fluid. The blood also evidences organic properties; it is attracted by living organs, which are acted upon by vital stimuli. There subsists between the blood and the organized parts a reciprocal vital action, in which the blood has as large a share as the organs in which it circulates." This doctrine is, no doubt, ingenious, but I do not consider it as conclusive. It is not because that in inflammation, the blood becoming solid, forming pseudo membranes, which are shortly after supplied with a proportion of blood-vessels, blood possesses life. If this adventitious coagulation were not supplied with blood, it would prove a foreign body; but it is not, therefore, shown that the circumstance of its possessing vitality after its formation is a proof of the life of the blood; it only shows that the secretions of the blood are endowed with a susceptibility of life, when having assumed a solid form, needing vessels for its support. I shall not dwell longer on a professional question of great interest, but which would need a development foreign to the nature of these sketches. The Greeks had distinct appellations for the cause and result of life; the former they termed [Greek: psychê] the latter [Greek: zôê]. The essential nature of life is, and most probably will ever remain, an impenetrable mystery. Living matter is endowed with a property which we call life; but to find out to what we may venture to attribute this property, is a vain and hypothetical attempt. Equally vain and absurd have been the endeavours to ascertain whether life began at the creation to be subsequently transmitted from parent to offspring, or owed its origin to a spontaneous generation from matter. Many ancient philosophers considered matter as eternal: such was the doctrine of the Pythagoreans; amongst whom we must particularly notice Lucanus Ocellus, whose system, developed in a work written in the Attic dialect, was adopted by Aristotle, Plato, and Philo-Judæus. This work was first translated into Latin by Nogarola. These doctrines led to the unanswerable question, What was this matter--this _invisa materia_--from which every thing visible has proceeded? Has it existed from all eternity, or has it been called into being by the Creator? Has it uniformly exhibited its present harmonious arrangement, or was it once a waste and shapeless chaos? Was this matter endowed with intelligence as a whole, or in its separate fractions? The eternity of matter was maintained by these philosophers from the belief that _no thing could be created out of nothing, and that no thing could ever return to nonentity_. Such was the doctrine of the Epicureans, of Democritus, and of Aristotle. The poets were of the same belief; and Lucretius expresses himself as follows: Ubi viderimus nihil posse creari De nihilo, tune, quod sequimur, jam rectiùs inde Perspiciemus. Persius maintains the same idea: Gigni De nihilo nil, in nihilum nil posse reverti. This dogma was no doubt transmitted to the Greeks from the East; and, to the present day, it is a doctrine of the Brahminical creed, clearly expressed in the following terms in their Yajur Veid: "The ignorant assert that the universe in the beginning did not exist in its author, and that it was created out of nothing. O ye, whose hearts are pure! how could something arise out of nothing?" The fathers of the church embraced a similar belief; and Justin Martin says that "the word of God formed the world out of _unfashioned matter_. This Moses distinctly asserts, Plato and his adherents maintain, and ourselves have been taught to believe." Such was the doctrine of the schools that professed the eternal nature of matter. Other philosophers supported as warmly a different opinion. Thales of Miletus, Zeno of Citium, Xenocrates, and Dicearchus the Messenian, insisted that the human race had a first origin at a period when mankind did not exist. According to this hypothesis, the universe is an emanation or extension of the essence of the Creator. Zeno and the Stoics attribute this creation to the universal elements of fire and water. Anaximander the Milesian asserted that the primitive animals were formed of earth and water mixed together, heated and animated by the solar rays; these aquatic creatures became amphibious, and were gradually transformed into the human races. Strange to say, this extraordinary idea has found proselytes even in our days, and was advocated by Professor De Lamark in his Zoological Philosophy. This fancy pervades the poetry of the ancients. Homer makes Tethys, the wife of Ocean, the daughter of Uranus and Terra, the first parents; and Hesiod, in his Cosmogony, raises Venus and Proteus from the foam of the sea. The vital and intellectual fire of the ancients that animated all living beings was admitted by most of their physicians, especially by Hippocrates, Galen, and Aretæus. Aristotle describes an universal creative agent in all the elements, the source of life upon earth, and of the celestial movements in the firmament. Descartes, in modern times, maintained that a vital flame existed in the heart of every animal. This fire, and the genial warmth that it diffused, was considered the soul of the universe; and on this subject Gassendi expresses himself as follows: "Si quis velit talem calorem etiam animam dicere, nihil est similiter quod vetet." It was natural for man, even in an uncivilized state, to attribute to solar heat the same influence on animals as was manifest in its actions upon plants. When life had fled, the inanimate corpse was cold, and caloric was therefore considered the principle of vitality. It was from this conviction that we find the sun and fire objects of adoration both in ancient times and amongst savages to the present day. Fire is idolized by the Tartars, and various African tribes. The Yakouts, a Siberian horde, believe that the deity of good and evil has taken his abode in this supposed element. The Columbian Indians were fire-worshippers; and Pallas informs us that the Chinese on the confines of Siberia held it in such religious respect, that they never attempted to extinguish it even when their dwellings were burning. The doctrine of man and the universe having been created an emanation of the Creator, renders the Creator material, or matter itself; matter being considered intelligent, and susceptible of this organization. This was the belief of the Brahmins, and was no doubt transmitted to the Academic and Eleatic schools of Greece by Pythagoras. We find in the Yajur Veid, already alluded to, the following passages, that clearly demonstrate this belief: "The whole universe is the Creator, proceeds from the Creator, and returns to him. The ignorant assert that the universe in the beginning did not exist in its author, and that it was created out of nothing. O ye, whose hearts are pure! how could something arise out of nothing? This first being alone, and without likeness, was the ALL in the beginning. He could multiply himself under different forms. He created fire from his essence, which is light." And further: "Thou art Brahma! thou art Vishnu! thou art Kodra! thou art the moon! thou art substance! thou art Djam! thou art the earth! thou art the world!" These Brahminical doctrines were, beyond doubt, also held by the Greeks. In a poem ascribed to the fabled Orpheus we find the following lines, translated by Mason Good with as much correctness as elegance: Jove first exists, whose thunders roll above, Jove last, Jove midmost; all proceeds from Jove. Female is Jove--immortal Jove is male; Jove the broad earth--the heavens' irradiate pale. Jove is the boundless spirit, Jove the fire, That warms the world with feeling and desire; The sea is Jove, the sun, the lunar ball; Jove king supreme, the sovereign source of all. All power is his; to him all glory give, For his vast form embraces all that live. It may be easily imagined that a subject so recondite and obscure must have led philosophers into the wildest speculations. By some, life was considered as the result of a general consent or harmony between the different organs of which the vital frame is formed; while, as we have seen, many have attributed its phenomena to the blood. That blood, to a certain extent, is endowed with vitality is beyond a doubt; Hunter has endeavoured to prove the fact by various experiments. It is capable of being acted upon and contracting like the solid fibres; this we daily witness when blood is coagulated and comes into contact with the atmosphere. It preserves an equality of temperature in whatever medium an animal may move. He also has shown that this fluid can form solid vessels of every description; and its life is also proved by the death inflicted when any excessive stimulus destroys the muscular fibre. Thus, in a body struck with lightning, the muscles remain flaccid and uncontracted, while the blood preserves its fluidity, and is left uncoagulated. All this specious reasoning shows that blood is a living fluid, but does not in the slightest degree demonstrate to what principle this vitality is to be attributed. It merely proves that every part of a living animal, whether solid or fluid, is endowed with a certain degree of life; but leaves us in impenetrable darkness as to the nature of life. The one cannot be killed without the other; and, as Mason Good justly observes, "that which is at one time alive, and at another dead, cannot be life itself." It is clear that life cannot exist without blood, but at the same time it is equally evident that the blood is merely a secretion of the living system, and dependent upon the action of the solids, which influence its quantities and properties.[29] It is from this notion of the vitality of the blood that the absurd idea of transfusing it was first conceived. Transfusion consisted in the injection of the arterial blood of young and healthy animals into the veins of the aged and the debilitated. It was about forty years after the discovery of the circulation of the blood by Harvey that this singular project was tried upon animals, and afterwards upon man. Medicated liquids had already been introduced in Germany into the system by this method, principally by Wahrendorf. Dr. Christopher Wren, an English physician, was the first who proposed the injection of blood, and Dr. Lower put it into practice. The result of his experiments seemed to warrant their adoption. An animal was drained of a considerable proportion of blood, and lay faint and expiring; but the blood of another animal being thrown into the languid system, active circulation was restored, and the patient ran about with as much facility as before the experiment. When too great a quantity of blood was injected, the creature became drowsy, and shortly after died of plethora. These experiments were reported by the transfusers with many absurd details. In one case a simpleton had become witty by a supply of lamb's blood; in another, an old mangy cur was cured by the vital fluid of a young spaniel; a blind old dog, transfused by a Mr. Gayant, bounded and frisked about like a young pup. Dr. Blundel seriously conceived that this operation might be practised with great advantage in cases of hæmorrhage, more especially in women. Of late years these curious experiments have again been tried with singular results. Prevost and Dumas have shown that the vivifying power of the blood does not reside so much in the serum as in the red particles. An animal bled to syncope, is not revived by the injection of water or pure serum of a temperature of 68° Fahrenheit into its vessels. But if blood of one of the same species is used, the animal seems to acquire fresh life at every stroke of the piston, and is at last restored. Diemenbach has confirmed these experiments. It is also stated by these physiologists, that revival takes place likewise when the blood injected had been previously deprived of its fibrin. Another very singular fact has been elicited by these experiments; blood of animals of a different genus, of which the corpuscules, though of the same form, have a different size, effects an imperfect restoration, and the animal generally dies in six days. The injection of blood with circular corpuscules into the vessels of a bird (in which the corpuscules are elliptic and of a larger size) produces violent symptoms similar to those of the strongest poisons, and generally death, which ensues indeed instantaneously, even when a small quantity only of the blood has been injected. Such, for example, was the effect of the transfusion of some blood of the sheep into the veins of a duck; while in many cases in which the blood of sheep and oxen were injected into the vessels of cats and rabbits, these animals were revived for a few days. The fact of the blood of mammalia being poisonous to birds is very remarkable; it cannot be explained mechanically. The injection of fluids containing globules of greater diameter than the capillary vessels of the injected animal most probably produces death, by obstructing the pulmonary vessels and producing suffocation; but the globules of the blood in mammalia are even smaller than those of birds. In Dieffenbach's experiments, pigeons were killed by a few drops only of the blood of mammalia, and the blood of fishes, it is asserted, is as fatal to mammalia as to birds. These interesting facts have been confirmed by Dr. Bischoff. In all his experiments made with the fresh blood of mammalia, birds died within a few seconds after the transfusion, with violent symptoms resembling those of poisoning; but when, instead of the fresh unchanged blood, he injected blood from which the fibrin had been removed by stirring, and which was heated to a proper temperature, he was surprised to find that no such symptoms were produced, the animal not appearing to suffer any inconvenience. It seems indeed from these experiments, that the blood of an animal of a different class, is not adapted for the operation. When transfusion was first proposed in France, it met with furious opponents; and Lamartinière declared that it was a barbarous operation proceeding from Satan's workshop. The controversy between the transfusers and their adversaries was at length carried on with such virulence, that in 1668 the practice was forbidden by a decree of the Châtelet, unless the operation had been sanctioned by the faculty of Paris. In Italy it continued to be in vogue. Riva and Manfredi frequently performed it; and a physician of the name of Simboldus submitted himself to the experiment. According to the accounts given by the patients who had been thus injected, they first experienced an increased heat with violent pulsation, profuse perspiration with pains in the loins and stomach, and a sense of suffocation. Violent vomiting frequently arose, and the patient gradually sank into a torpid and heavy sleep. Whatever may be the theoretical ingenuity in favour of this practice, it is not probable that it will ever be adopted. While young blood was thus supposed to give fresh vigour to the aged, the heat communicated by young persons to debilitated bedfellows was also resorted to. This practice seems to have been founded on observation. It is an acknowledged fact that an uncommon depression of vital power takes place in the young when such experiments are tried. This abstraction of vital power is frequently observed in young females married to very old men. In illustration of this fact, Dr. Copeland relates the following case: "I was a few years since consulted about a pale, sickly, and thin boy of about five or six years of age. He appeared to have no specific ailment; but there was a slow and remarkable decline of flesh and strength, and of the energy of all the functions,--what his mother very aptly termed 'a gradual blight.' After inquiring into the history of the case, it came out that he had been a very robust and plethoric child up to his third year, when his grandmother, a very aged person, took him to sleep with her; that he soon afterwards lost his good looks, and that he had continued to decline progressively ever since, notwithstanding medical treatment. I directed him to sleep apart from his aged parent, and prescribed gentle tonics, change of air, &c., and the recovery was very rapid." This selfish indulgence of the aged in endeavouring to deprive their young bedfellows of heat and strength has been often remarked; and young women thus circumstanced have shrewdly suspected the cause of their debilitated condition. It is extremely probable that in these cases electricity is conducted from one body to another. This hypothesis is in some degree confirmed by the experiments made upon Casper Hauser by Von Feuerbach. This Casper Hauser had been kept from infancy until he was eighteen years of age in a perfectly dark cage, without leaving it, and where he never saw a living creature or heard the voice of man. He was restricted from using his limbs, his voice, his hands, or senses; and his food consisted of bread and water only, which he found placed by him when wakening from his sleep. When exposed in Nuremberg, in 1828, he was consequently at eighteen years as if just come into the world, and as incapable of walking, discerning objects, or conveying his impressions, as a newly born infant. These faculties, however, he soon acquired; and he was placed under an able instructor, who has recorded his singular history. Darkness had been to him twilight. The light of day was at first insupportable, inflamed his eyes, and brought on spasms. Substances, the odour of which could not be perceived by others, produced severe effects upon him. The smell of a glass of wine, even at a distance, occasioned headache; of fresh meat, sickness; and of flowers, a painful sensation. Passing by a churchyard with Dr. Daumer, the smell of dead bodies, although altogether imperceptible to the doctor, affected the young man so powerfully as to occasion shudderings, followed by feverish heat, terminating in a violent perspiration. He retained a great aversion, owing to their disagreeable taste and smell, to all kinds of food excepting bread and water. When the north pole of a small magnet was held towards him, he described a drawing sensation proceeding outwards from the epigastrium, and _as if a current of air went from him_. The south pole affected him less, and he said it blew upon him. Professor Daumer and Hermann made several experiments of the kind, calculated to deceive him, and, even although the magnet was held at a considerable distance from him, his feelings always told him very correctly. These experiments always occasioned perspiration and a feeling of indisposition. He could detect metals placed under oil-cloths, paper, &c. by the sensation they occasioned. He described these sensations as a drawing, accompanied with a chill, which ascended, according to the metal, more or less up the arm, and attended with other distinctive feelings, the veins of the hand exposed to the metal becoming visibly swollen. The variety and multitude of objects which at once came rushing upon his attention when he thus suddenly came into existence, the unaccustomed impressions of light, free air, and sense, and his anxiety to comprehend them, were too much for his weak frame and acute senses: he became dejected and enfeebled, and his nervous system morbidly elevated. He was subject to spasms and tremors, so that partial exclusion from external excitements became for a time requisite. After he had learned regularly to eat meat, his mental activity was diminished; his eyes lost their brilliancy and expression; the intense application and activity of his mind gave way to absence or indifference, and the quickness of apprehension became diminished. It may be questioned whether this alteration proceeded from the change of diet, or the painful excess of excitement that had preceded it. Among the various doctrines regarding the creation of animals, that of _Panspermia_ was most ingenious and attractive. According to this theory, maintained by Anaxagoras and Heraclitus, all bodies contained the germ or the organic molecules necessary for their generation. Hippocrates favoured this idea, as plainly appears in his book _de Diætâ_; and in modern times Perrault, Gésik, Wollaston, Sturm, and other physiologists, have endeavoured to revive the doctrine, of which the organic molecules of Buffon and the living molecules of Ray were merely modifications. The expression in Genesis which sanctions the belief that the earth spontaneously germinated its productions, cannot be referred to the animal kingdom. Were this the case, similar animals would be found in every quarter of the globe. Spontaneous generation was also attributed to putrefaction; and Virgil describes the manner in which Aristæus drew forth a swarm of bees from the corrupted entrails of a heifer. Pliny admits the spontaneous creation of rats, mice, frogs, and other small tribes of animals. These errors, however, were soon dispelled by the light thrown on the subject by the microscopic experiments of Valisnéri, Swammerdam, Réaumur, and many other naturalists, who discovered sexual organs in all these supposed self-created individuals. This doctrine was the foundation of the classification of the generative principle into _equivocal_ and _univocal generations_,--the former the effect of putrefaction, but which in reality was _univocal_, since it was soon ascertained that this production arose from the incubation of numerous eggs deposited by various insects and animalculi in these corrupted bodies. The following experiment afforded a convincing proof of the fact: A piece of meat was placed in an open vessel, and another in a vase hermetically closed; so soon as these animal substances entered into decomposition, myriads of insects pullulated in the exposed meat, whereas that which was protected from external agency remained free from this invasion. It is a recognised fact that it is only through organized beings that organization can be transmitted; for how can corrupt substances, dead and deprived of vitality, give life to any organized matter? Generation is life; putrescence is death. By a law of nature, generation may be said ultimately to destroy the generative powers; a striking illustration of mortality, since life is transmitted at the expense of our very existence, and many individuals in the catenation of organized beings perish the very moment that they have tended to perpetuate their race. Death advances with rapid strides in the very ratio of the energies of life; and the surest method to attain longevity is to be sparing in the exercise of our exhausting faculties. Et quasi vitaï lampada tradunt. _Latent_ or insensible life, such as that of the seeds of plants, or the animal enveloped in its egg, may last for a number of years, so long as they are able to germinate; here vitality is not worn out by relative life. Various species of the snail, the wheel-polybe, the tile-eel, and divers animalcules, have been kept apparently dead, and in the form of dried preparations, withered and hardened, for months and even years, but have afterwards been restored to life by the agency of warmth, moisture, and other stimulants. Snails have been thus reanimated after a lapse of fifteen years; and Bauer revived the _Vibrio tritici_, after an apparent death of five years and eight months, by merely soaking it in water. Adders have been found in hard winters not only completely frozen but absolutely brittle, yet have been restored to life when thawed. A shower of fragments of ice has fallen at Leicester, containing the horsehair eel, with the nuclei of a greater number. Colonel Wilks found eggs in the solid rocks of St. Helena susceptible of being hatched. The vitality in the seeds of plants is truly amazing; barley taken out of the bodies of mummies, Indian corn discovered in the tomb of a Peruvian Inca, and the bulb of an onion found in the hand of a mummy 3000 years old have been sown and have thriven luxuriantly. The most intense heat cannot destroy the vital property. The seeds of roasted apples, the kernels of baked prunes and boiled elder-berries have germinated. Sir John Herschel found that the _Acacia Lophanta_ lived after having been steeped in boiling water for twelve hours, and Ludwig informs us that the seeds of a species of cedar only germinated after ebullition. Fresh-water shells have been found in the thermal waters of Gastein at a temperature of 117°, and Niebuhr found a conferva growing in water at 142°. Raspberry-seeds taken from the corpse of an ancient Briton, contemporaneous with the Druids, have produced fruit when recommitted to the earth. Some have endeavoured to explain the resurrection of the dead by these natural phenomena; forgetting that in these instances no corruption or actual disorganization had taken place. Stahl expresses himself in the following words when defining life: "Life is formally nothing more than the preservation of the body in mixture, corruptible indeed, but without the occurrence of corruption;" and in Junker we find, "What we call life is opposite to putridity." The next theory attributed the principle of life to a subtle _gas_ or _aura_. This doctrine constituted one of the principles of the Epicurean philosophy, and was illustrated by Lucretius in his poem on the Nature of Things: Nam penitùs prorsùm latet hæc natura, subestque; Nec magis hac infra quidquam est in corpore nostro; Atque anima est animæ proporrò totius ipsa. According to these notions, there existed a volatile principle that bore no specific name, but was diffused through every part of living bodies, more subtile than heat, air, or vapour. In later times this same gaseous agent received various appellations. Van Helmont designated it as the _aura vitalis_, while other philosophers called it the _aura seminalis_ and the _aura sanguinis_. The _archeus faber_ of Van Helmont, the _astrum internum_ of Crollius, the _principium energoumenon_ of Michael Alberti, the _substantia energetica naturæ_ of Glisson, may all be referred to this unseen but powerful agency. Hippocrates called it [Greek: physis], or nature, which he elsewhere denominates [Greek: enorônta]. It was also the [Greek: dynamis xôtikê] of Galen. This soul, or breath, or spirit, directed and preserved the whole economy; and Chrysippus asserts that it acted like salt upon pork. Modern chemistry has sought this principle in specific agents. Caloric, or the matter of heat; oxygen, or the vital part of atmospheric air, first discovered by Priestley, and explained by Lavoisier; and finally, the fluid collected by the Voltaic trough, were then considered as the principle of life. The experiments of Professor Galvani of Bologna, in which he produced the phenomena of life many hours after death, induced many physiologists to maintain that the identity that existed in galvanic electricity and the nervous influence, proved that this _aura_ was the creative agent in our economy. The late experiments of Mr. Crosse seemed to show that insects were produced in silicate of potash under a long-continued action of voltaic electricity. Now whether this be really the case or not, it is grievous in the present enlightened age, to see these experiments and the assertions that resulted from them, denominated the work of atheism, and the labour of another Frankenstein!--I do not suppose for one moment that Mr. Crosse pretended to have discovered the power of imparting life, but merely of having developed a vital principle in substances supposed to be inorganic. Every experimentalist who thus develops the vital principle may be said to bestow life, without being exposed to the absurd charge of impiety.--The man who brings forth chickens from the incubation of eggs, instead of eating them; the physiologist who rots a piece of meat to develop myriads of living beings in the putrid nidus, might just as well be called an atheist. While naturalists were thus groping in nature's dark labyrinth, endeavouring to account for the wonders of the _natura naturans_, that divinity of the Stoics that Lucan thus describes, Superos quid quærimus ultrà? Jupiter est quodcumque vides, Jovis omnia plena,-- other wise men fancied that they had actually discovered the seat of life, which, according to their fanciful speculations, they had lodged in certain organs. The nervous system, the spinal marrow, the brain, the heart, were all and each of them considered in turn as the head-quarters of vitality; while the workshop of alimentation, or much-abused stomach, did not pass unnoticed and unhonoured. The heart of a turtle, and of some reptiles, has been seen contracting and dilating hours after its extraction from the body; the stomach has been excited into an action bearing some analogy to vomiting, when separated from the trunk; but all these curious phenomena, explained and accounted for (in some measure, at least) by physiology, do not tend to prove that any one organ, or any chain of organs, is possessed of separate vitality independent of the general principle of life. The brain, which has been regarded as the chief seat of this principle, is not always essential to life; for although man perishes, or at least his vital functions cease to act, when he is decapitated,[30] yet various birds and reptiles continue to live for hours and days after the head has been severed from the body, while we actually behold a regeneration of the head in the earth-worm. Moreover, we have upon record many cases of _acephalous_ children, or born without any head; and _anencephalous_ children who lived (for a short time, it is true) without any brains. Fontana removed the entire brain of a turtle, yet it lived six months, and walked about as before. Sandiford had divided acephalous animals into three classes: the first, in which the head was wanting; the second, where other organs were also missing; and the third, where the foetus presented an unformed mass. In the acephalous twin described by Béclard, no liver, spleen, stomach, or oesophagus could be discovered, and the intestinal tube commenced at the superior extremity of the body. The infant had ten ribs on each side, and regular nerves arose from the spinal marrow. Although headless animals may not be gifted with intellectual faculties evident to our senses, yet they clearly live and feel. The zoophytes and polypes, without brains or heads, possess irritability and sensibility; they can seek their food, seize it, reject what is not edible, are susceptible of the powers of light and heat, can contract their fibres when touched or injured, and, in short, manifest various innate or instinctive powers. Gall has maintained that the passions resided in the brain, and, therefore, that brainless animals did not experience their influence. This is a bold assertion. Can he prove that worms, insects, zoophytes, that possess only what is called a ganglionic system, are strangers to instinctive fears and partialities? I apprehend that it will be found that passions belong to instinct much more than to our volition. It is nevertheless true that animals may be killed by wounding the spinal marrow, by the process commonly called "_pitting_." This practice may be traced to high antiquity; and Livy informs us that when the Carthaginian troops were routed, Asdrubal ordered their unmanageable elephants to be destroyed by driving the point of a knife between the junction of the head and spine. From these observations it will appear quite clear that life has no necessary connexion with sensation, although the latter cannot be experienced without the former. Vegetables are endowed with vitality; but we have no reason to suppose that they feel. It is also more than probable that, as the degree of intelligence decreases, the intensity of the corporeal feelings are also diminished. Did not this scale of sensibility exist, insects could not live under the supposed agonies that the entomologist daily inflicts. This supposition does not rest upon indefinite reasoning, for in our own race we observe that those parts which are gifted with a reproductive power are possessed of the smallest degrees of sensation; and the cuticle, the hair, the beard, and the nails will even grow after death. This fact may calm the apprehensions of those very humane persons who look upon experimental physiologists as very monsters of barbarity. Vaillant took out the intestines of a locust, and stuffed it with cotton, then fixed it down in his box with a pin, yet, five months after, the insect moved its feet and antennas. Spallanzani has shown that the snail can renew its head. All this confusion in theories and wandering of the imagination have arisen from our confounding the vital principle, of which we know nothing, with the phenomena of sensation, for which patient and calm investigation may account. That there does exist a principle of life that animates, vivifies, and preserves all living bodies, until its powers cease, no one can deny; although to find out its nature is a vain pursuit, as idle as our endeavours to penetrate into the _causes of causation_. As Richerand observes, "its _essence_ is not designed to preserve the aggregation of our constituent molecules, but to collect other molecules, which, by assimilating themselves to the organ that it _vivifies_, may replace those which daily losses carry off, and which are employed in repairing and augmenting them; the word _vital principle_ is therefore not designed to express a distinct being, but denotes the _totality of powers alone_ which animate living bodies, and distinguish them from inert matter, the _totality of properties_ and _laws_ which govern the animal economy." Of all the doctrines upon this abstruse subject (of which I have noticed the principal ones), that of the pre-existence of an organic germ appears the most plausible, or at any rate the easiest to conceive. It was from this conviction that the ancients held as an axiomatic principle _Omnia ex ovo_. It is upon this theory that Buffon rested his organic molecules, and Ray his vital globules. The primitive lineaments of organization may be traced in the egg, even before it is fecundated. The embryo that we find in its involucra is soft, flexible, ready to receive the plastic impression of the vivifying secretion,--the fecundating agency that imparts existence and all its wondrous attributes, to the pre-existing _ova_, the _ova subventanea_. It does not appear that the first organ of the embryo which exhibits the living principle is the heart, hence denominated in the foetus the _punctum saliens_; the principle of life has probably organized every molecule of the animal long before this supposed fountain of vitality had been seen to flow. It is more likely that the nervous system has received the first impressions imparted by the fecundating secretion, which the ancients supposed to have been a direct emanation from the brain, and bearing in its vivifying molecules the life of every part of the being it was about to organize; thus Valescus: "Sperma hominibus descendit ex omni corporis humore, qui fit ex subtiliori naturâ. Habet autem hoc sperma nervos et venas proprias attrahentes se à toto corpore ad testiculos--à membris disconditur principalibus--à corde, epate, cerebro mittuntur spiritus, ex quibus resultat spiritus informativus, et non aliter nisi cum spermate--ergo ab iis principaliter sperma disconditur." Such were the doctrines on this curious subject until the days of Fabricius d'Acquapendente and Harvey. Buffon, however, exerted all his eloquence to revive the theory. The following are the notions of this elegant writer, who unfortunately only studied natural history in books and cabinets. He maintains that there exist two sorts of matter,--the one living, the other dead: the first enjoying a permanent vitality; the second universally spread, passing from vegetables to animals through the channels of nutrition, and returning from animals to vegetables through the medium of putrefaction,--thus in a constant state of circulation to animate living beings. This vital matter exists in determined quantities in nature, and is composed of an infinity of organic molecules, primitive, living, active, incorruptible, and in relation, both as regards action and numbers, with the molecules of light, and enjoying an immutable existence, since the usual causes of destruction can only affect their adherence. It is these molecules which, being cast in regular moulds, constitute all the organized bodies that surround us. According to this doctrine, _development_ and _growth_ are only a change of form operated by the addition of organic molecules; _nutrition_, the preservation of this form by the accession of fresh molecules that replace those that are destroyed; _generation_, the combination of these particles; and _death_, their separation from cohesion and association. This ingenious system is not dissimilar to that of Maupertuis, who thought that the mysteries of generation could be explained by the usual laws of elective attraction. Various were the physical, metaphysical, and moral batteries raised against this visionary fabric. One single fact was sufficient to overthrow it. We constantly see parents deficient in a limb, or misshapen, producing perfect offspring; if each part of the economy was to transmit to its progeniture molecules similar to itself, the child would naturally be visited with the imperfection of the parent. Notwithstanding these fallacies, we cannot but admit that chemical and molecular attraction constitute the principle that harmonizes all organized bodies. Generation is simply a function of organization and life. Organized bodies alone can generate. The living only can impart life. Animals and plants transmit to their descendants their several properties; and the inheritance of organization departs with the vital spark. Life is the property of no one; it is a transmitted heir-loom that never perishes; it resembles a torch that communicates an eternal flame while consuming itself. Organized beings have justly been considered the fuel of the universal vital fire, and we all are the _daily bread_ of that monstrous animal called _the world_. All are ingulfed in that vortex which Beccher has called the "_circulus æterni motus_" Metempsychosis was simply an illustration of this fact recognised in all ages in the East, and taught in European schools by Pythagoras. Nothing perishes; and even combustion produces fresh combinations. Poetical philosophy has considered _Love_ as the source and arbiter of _life_, and the _Venus Generatrix_ the fount of our existence. Lucretius recognises this power in the following lines: Per te quoniam genus omne animantûm Concipitur, visitque exortum lumina solis. Then again, Omnibus incutiens blandum per pectora amorem, Efficis ut cupidè generatim sæcia propagent. Virey, a delightful French physiologist, seems to partake of this mythological opinion in the following passage: "L'amour est l'arbitre du monde organique; c'est lui qui débrouille le chaos de la matière, et qui l'impregne de vie. Il ouvre et ferme à son gré les portes de l'existence à tous les êtres que sa voix appelle du néant, et qu'il y replonge. L'attraction dans les matières brutes est une sorte d'amour ou d'amitie analogue à celle qui reproduit des êtres organisés. Ainsi la faculté générative est un phénomène général dans l'univers; elle est représentée par les attractions planétaires et chimiques dans les substances brutes, et par l'amour ou la vie dans les corps organisés." According to our amatory neighbours, the word _ame_, or soul, comes from _amor_ and _amare_, and _amare_ is derived from _animare_; hence _animation_ and _animal_ may be syllogistically referred to love. I know not how far this etymological disquisition may illustrate the history of their _enfans trouvés_, or our foundling hospitals, the inmates of which are generally uncommonly ill favoured by beauty. The offspring of the aforesaid Venus Generatrix must have been especially ungrateful; and if it be true that Julius Cæsar was her son, he certainly exerted his best endeavours to depopulate his mother's territories. OF THE HOMOEOPATHIC DOCTRINES. It is a matter worthy of remark, that, while the doctrines of homoeopathy have fixed the attention and become the study of many learned and experienced medical men in various parts of Europe, England is the only country where it has only been noticed to draw forth the most opprobrious invectives. It is certainly true that no one but an ardent proselyte of the visionary Hahnemann could for one moment become the advocate of all his absurd ideas; yet, while we reject his errors, great and important truths beam from the chaotic clouds that shroud his wanderings; and, however wild his theories may be, incontrovertible facts have been elicited from his apparently inefficacious practice. Before I enter into an examination of the practical views of the homoeopathists, I shall give a brief sketch of their doctrines and of their founder. Samuel Hahnemann was born in Meïssen in Saxony, on the 10th of April, 1755. His father was an humble porcelain manufacturer. The first rudiments of education that young Hahnemann received were gratuitous; and his master, pleased with the progress of his ambitious but needy scholar, strongly urged him to repair to Leipzig, where, at the age of twenty, he arrived, with exactly the same number of crowns in his pocket as he numbered years. At this university he zealously pursued his favourite studies of the natural sciences, supporting himself by translating French works, and giving lessons; and finally he graduated in the university of Eslan--in 1779. It was during his arduous studies that Hahnemann was struck with the conflicting systems and the deplorable controversies which for centuries divided in turn the medical schools of Europe, and were triumphant or overthrown by scholastic revolutions; each doctrine being doomed to obscurity and oblivion in the ratio of its ephemeral splendour. The result of his reflections and experiments was the system of homoeopathy. Its novelty, its apparent absurdity, soon exposed him not only to opposition, but to violent persecution. As is usual in all cases of oppression, whether justly or unjustly resorted to, proselytes as furious and as fanatical as his persecutors joined their chief. Despite the sanatary regulations of Saxony, which prohibited physicians from dispensing their medicines, Hahnemann prepared and supplied his homoeopathic remedies; and, being expelled from Leipzig, sought a refuge at Koethen, where, exasperated by the harsh treatment he had experienced, he fulminated his anathema on all past and present systems of medicine with no small degree of furious resentment, pronouncing his doctrine to be stamped with the seal of infallibility, and denouncing all others as the aberrations of ignorance and error, or the speculations of imposture and fraud. As might have been expected, few of his opponents thought it worth their while to study his system calmly and dispassionately; nor, indeed, was such an application necessary, for his doctrines needed no deep investigation on the part of his foes, so fraught were they with apparent errors and false deductions, not only from his own pretended experience, but the experience of ages. Finding that he could not enjoy a despotic sway over the schools, he was resolved at any rate to seek the palm of martyrdom, and had recourse to such violence in words and actions, that many of his enemies maintained he was a more fitting subject for a lunatic asylum than the _soi-disant_ founder of a rational doctrine; for he and his fanatical disciples set all ratiocination at nought, considering his _dixit_ as a fiat of condemnation passed on all who dared to doubt his infallibility, although at different periods their oracle was obliged to retract many erroneous assertions and contradict fallacious statements. In the short view of his doctrines which I am about to give, these fallacies will become evident. Hahnemann had observed in his studies and hospital practice that the prevalent systems of medicine were founded on the rational principle of combating effects by striking at morbid causes. Physicians sometimes endeavoured to attain this desirable end by producing in the system an artificial action differing from the nature of the malady, and founded their practice on the scholastic axiom of _contraria contrariis curantur_; at other times they raised or depressed the vital energies according to the prevalence of excitement or debility, or modified the character of the disease by revulsion and derivation, a practice which received the name of antagonistic, or _allopathic_,--a term used by Hahnemann in contradistinction to homoeopathy, and derived from [Greek: allos], _different_, and [Greek: pathos], _affection_. In his therapeutic pursuits Hahnemann had been forcibly struck with the long-acknowledged fact that medicinal substances supposed to possess a certain specific property in the treatment of diseases, were known in the healthy subject to produce phenomena bearing a close analogy to the symptoms of those identical diseases. Thus, mercurial preparations occasioned symptoms of syphilis, sulphur produced cutaneous irritation, and, in some instances, the exhibition of cinchona had been known to bring on febrile intermissions. In various works he found these observations established. For instance, amongst many others, he found in the publications of Beddoes, Scott, Blair, and various writers, that nitric acid, which was known to produce ptyalism, relieved salivation and ulceration in the mouth. Arsenic, which, according to Henreich, Knape, and Heinze, occasioned cancerous anomalies in healthy subjects, was stated by Fallopius, Bernharde, Roennow, and many other surgeons, to be efficacious in relieving, if not curing, similar disorders; preparations of copper were asserted by Tondi, Ramsay, Lazermi, and numerous practitioners, to have produced epileptic attacks; and Batty, Baumes, Cullen, Duncan, and several experienced medical practitioners, recommended similar remedies in epilepsy. In short, the illustrations of the power inherent in certain substances to produce accidents analogous to the symptoms of the various diseases in the treatment of which they had proved efficacious, induced Hahnemann to consider whether a treatment founded on _similia similibus curantur_ might not be found more effectual than the former practice based upon the _contraria contrariis_. He was of opinion that no medicine was possessed of any _curative property_, but solely acted by its _morbific power_ of producing a disordered condition in the system; and on this and other principles, which we shall shortly notice, he asserts that nature does not possess any curative power, totally denying the _vis medicatrix_ of the schools. He further maintained, that there does not exist any specific malady; but that which we consider to be a disease is nothing but a complexity of symptoms, and that a cure can only be effected when these complex symptoms are made to disappear. Impressed with these ideas, he and his disciples proceeded to try various medicinal substances upon themselves and others when in health, and, carefully recording the symptoms which these medicines produced, they drew up a statement of their various powers, that they might be afterwards resorted to, to relieve the same symptoms in a morbid state. Grounding this practice on the principle (in many instances correct) that two similar diseases cannot coexist, they conceived that if, to counteract a natural malady, one can produce by any medication an artificial derangement of the same nature, the artificial disorder will overcome the natural disease, and a radical cure be obtained. To explain more distinctly this idea, I shall quote the author's words. "The curative power of medicines is thus founded on the property they possess to give rise to symptoms similar to those of the disease, but of a more intense power. Hence no disease can be overcome or cured in a certain, radical, rapid, and lasting manner, but through the means of a medicine capable of provoking a group of symptoms similar to those of the disease, and at the same time possessed of a superior energetic power."[31] And further, "If two dissimilar maladies happen to be coexisting, possessed of an unequal force, or if the oldest disease is more energetic than the recent one, the latter will be expelled by the former. Thus, an individual labouring under a severe chronic disease will not be subject to the invasion of an autumnal dysentery, or any other slight epidemic. Larrey affirms that the districts of Egypt in which scurvy was prevalent were exempt from the plague. Jenner asserts that rachitis prevents the effect of vaccination; and Hildebrand assures us that phthysical patients never experience epidemic fevers unless of the most severe character."[32] "If a recent affection, dissimilar to a more ancient one be more powerful than the latter, then will the progress of the latter be suspended until the malady is either cured or has been expended in its career, and then the old one will reappear."[33] "But the result is totally different when two similar diseases meet in the organism; that is to say, when a pre-existing affection is complicated with one of the same nature, but possessed of more energy."[34] "Two maladies resembling each other in their manifestation and their effects, that is to say, in the symptoms which they determine, mutually destroy each other, the strongest conquering the weakest."[35] He further contends that the essential nature of every disease is unknown; that their existence is revealed by alterations and changes in the system perceptible to our senses, and constituting what are called _symptoms_, and it is the series of these symptoms which characterize the disease in its course and its development. According to his notions, the physician has only to follow and study the succession and the grouping of these symptoms; in short, the phases and the phenomena of diseases. Attack and destroy these symptoms, and you will have destroyed the malady. All classification of diseases, and their various denominations, he therefore deemed absurd, as, according to his doctrines, no one disease resembles another; so various were their modifications, that, with few exceptions, it was idle to give them a particular name, since disease was simply a derangement in our organization manifested by peculiar symptoms. We are also, according to Hahnemann, ignorant of the essential properties of medicines, and can only observe and record their effects by experimental observation. Like diseases, they also produce a derangement in our organism, manifested by peculiar symptoms, their sole action consisting in developing specific diseases. In conformity with these notions, to cure disease we have only to produce a similar affection; the primitive one would then give way to the secondary affection artificially produced, and in time the artificial one would cease to exist when the means that produced it were no longer brought into action. Homoeopathic medicines, he maintained, have the property of acting in a direct manner upon the affected part of the system; and this is proved when the disease, and the medicine given to relieve it, produce similar morbid manifestations: and he further contended that our vital organism was less susceptible of the action of natural affections than of those which are artificially produced. On this basis did the homoeopathic doctrinarians ground their practice; but a still more singular theory was broached by their leader; he maintained that medicinal substances, to prove efficacious, should be administered in an attenuated and diluted state, carried to such an extent as to become infinite in their division; he further asserts that this infinite division, far from diminishing their medicinal power and properties, imparts greater energy and certainty of action when these particles encounter in our organization an affinity of disposition, or a homogeny in action; that is to say, that these atomic attenuations act with greater power in those affections which manifest symptoms similar to those which these very medicines are known to produce when experimentally tried upon a healthy subject. Upon this principle the homoeopathist condemns all combinations of medicines as likely to neutralize each other's properties by their various affinities; therefore generally speaking, no fresh medicine should be given until the effects of the former have subsided; and to guide this practice, while they endeavoured to ascertain the symptoms produced by medicines, they also sought to ascribe certain limits to the duration of their action: thus, the influence of aconite lasts forty-eight hours, and that of crude antimony fifteen days. Dreading all substances that could tend to weaken or neutralize the effect of medicine, the homoeopathists made it their particular study to discover the peculiar action of all alimentary substances on the organism, and characterized as antidotes all such articles of food as they considered opposed to this supposed action: thus, wine and vegetable acids were deemed antidotes to aconite; coffee, to Angustura bark; vinegar, to asarum, &c. I have already stated that the homoeopathists conceive that the infinite dilution of their atoms of medicinal substances increase their energy; and this fact they so strenuously maintain, that they assert that accidents of a serious nature may arise when this division is carried too far; and these accidents are then to be met with the medicinal antidotes they pretend to have discovered: thus, camphor is an antidote to cocculus; opium, to the crocus sativus; camomile and camphor, to ignatia amara; and so on. The minuteness with which the specific actions of various medicinal substances on certain organs is detailed is scarcely credible; and the following extract from the homoeopathic materia medica will give a slight idea of their industrious labours. Taking as an example phosphorus, which they affirm produces-- Vertigo, determination of blood to the head, headache in the morning, fall of the hair, difficulty in opening the eyelids, burning sensation and ulceration of the internal canthus of the eye, when exposed to the open air, lachrymation and adhesion of the palpebræ; inflammation of the eyes, with the sensation of particles of sand having been introduced; sparks and spangles floating before the eyes, a dark tinge in objects that are looked on, diurnal cecity, the appearance of a gray veil drawn before the eyes, pulsation in the ears, epistaxis, mucous discharge from the nostrils, foulness of breath, tumefaction of the throat, whiteness of the tongue, ulceration of the mouth, expectoration of glairy mucus, dryness of the mouth by night and by day, spasmodic eructation, nausea, sense of hunger after eating, anxiety after meals; in short, twenty-four octavo pages are devoted to the innumerable effects of this substance on the organism. Of _magnesia artificialis_ three hundred and twelve symptoms are noted; six hundred and fifty of the _rhus radicans_; nine hundred and forty of _pulsatilla_; five hundred of _ignatia amara_; four hundred and sixty of _arsenic_: in short, volumes upon volumes are crowded with these observations, not only recording physical effects, but singular results on our moral faculties; such as serenity or moroseness, gaiety or sadness, a disposition to commit suicide or a fond partiality to life, courage or cowardice, a weak intellect or a vigorous conception. For instance,--common sea-salt occasions irascibility, lowness of spirits, taciturnity, melancholy, palpitation of heart, disposition to shed tears, pusillanimity, and despair; while potash gives rise to ill-temper without apparent cause at noon and in the evening, with violent paroxysms of rage in the morning, impetuous desires, furious passion, with gnashing of teeth, if all around does not yield to the patient's desires; while the vision of a bird hovering about the window produces loud shrieks of alarm, exaltation of the intellects, and a horror of the future. So innumerable, indeed, are all these singular effects attributed to various medicines thus experimented, that no memory, however retentive, could possibly bear them in recollection. The following are the directions laid down for conducting this curious inquiry: The person upon whom medicines are tried must be free from disease; but weak substances should be given to subjects of a delicate and sensitive constitution. The medicine is to be tried in its most pure and simple state, possessing all its energies, taking special care that it is not combined with any heterogeneous substances during the day it is exhibited, and the time while its action is supposed to last. The diet must be moderate; all spices and high-seasoned food to be avoided, as well as green vegetables, roots, salads, &c. which are known to possess medicinal properties. The dose of the medicine to be similar to that which is usually prescribed by practitioners. If, at the expiration of about two hours, no effect is observed, a stronger dose is to be given. Should the first dose operate powerfully at the commencement, but gradually lose its influence, the second will be given the following morning; and a still stronger one, four times the strength of the first, be administered on the third day. The result of these experiments being recorded, homoeopathic agents are selected to oppose morbid symptoms; and when the choice of remedies has been appropriate, an aggravation of the symptoms is observed. This aggravation is usually considered as an increase of the disorder, whereas it is solely the effect of the homoeopathic remedy. "For these phenomena," say the homoeopathists, "were frequently observed by physicians, who little thought at the time, that they were the result of the medicines they had given." Thus, when the pustules of itch became more rife after the exhibition of sulphur, it was thought that the increase of the eruption was merely the affection _coming out_ more freely; whereas, the aggravation was occasioned by sulphur. Leroy informs us that the heart's-ease, _viola tricolor_, increased an eruption in the face. Lyrons says that elm-bark aggravated cutaneous affections, which were cured by this remedy; but neither of them were aware of the nature of this homoeopathic development. For further information on this head, the Organon of Hahnemann must be consulted. Such were his doctrines for a period of about twenty years,--doctrines which he emphatically pronounced infallible, and founded on the immutable laws of homoeopathy. In 1828, however, convinced by numerous failures in the treatment of chronic diseases, that other causes than those which he acknowledged,--such as the improper preparation of the medicine, or dietetic neglect on the part of the patient,--contributed to these disappointments, he announced that he had discovered the hidden source of the obstacles he encountered; and that, after many years of experiments and meditation, he had come to the conclusion that almost all chronic diseases originated from constitutional miasmatic affections or predispositions, which he divided into _sycosis_, _syphilis_, and _psora_, or, in plain English, the itch. To this latter affection he attributes innumerable disorders. In diseases of a syphilitic character, he had found his mode of treatment infallible; and he therefore concluded that all obstinate and rebellious affections were the result of some other constitutional predisposing circumstances. He tells us that he laboured in profound secrecy to discover this great, this sublime desideratum: his very pupils knew it not; the world was to remain in ignorance of his pursuits until he could proclaim the most inestimable gift that Divinity bestowed upon mankind. This immortal discovery was neither more nor less than the itch; to which malady, according to his views, since the days of Moses, seven-eighths of the physical and moral miseries to which flesh is heir, were to be referred. Whether rendered evident by eruptions, or latent from our cradle, it was a curse transmitted to us, by the modification and degeneration of leprosy, through myriads of constitutions, and which only disappears from the surface to fester in malignity until it bursts forth again in the multifarious forms of innumerable diseases, amongst which we find scrofula, rachitis, phthisis, hysteria, hypochondriasis, dropsy, hydrocephalus, hæmorrhage, fistula, diseases of the head and liver, ruptures, cataracts, tic-douloureux, deafness, erysipelas, cancers, aneurisms, rheumatism, gout, apoplexy, epilepsy, palsy, convulsions, stone, St. Vitus's dance, nervous affections of every description, loss of sight, of smell, of taste, stupidity and imbecility.[36] In support of this doctrine, Hahnemann adduces ninety-five cases recorded by medical writers, in which the disappearance of the itch was followed by various acute and chronic maladies. The next miasmatic generator is _sycosis_, or the disposition to warty excrescences; but this source of disease Hahnemann does not consider so prolific as syphilis, or his favourite psora. Such are the principal features of the homoeopathic system. I have already stated that its followers consider the most minute particles of medicine more powerful than larger doses; they therefore have recourse to infinite trituration or dilution in three vehicles which they consider free from any medicinal property,--distilled water, spirits of wine, and sugar of milk; by these means they procure a decillionth or a quintillionth fraction of a grain. One drop of their solution is considered sufficient to saturate three hundred globules of sugar of milk; and three or four of these globules are deemed a powerful medicine. To give a better idea of Hahnemann's notions on this subject, I shall quote his own words: "By shaking a drop of medicinal liquid with one hundred drops of alcohol _once_, that is to say, by taking the phial in the hand which contains the whole, and imparting to it a rapid motion by a single stroke of the arm descending, I shall then obtain an exact mixture of them; but two or three, or ten such movements, would develop the medicinal virtues still further, making them more potent, and their action on the nerves much more penetrating. In the extenuation of powders, when it is requisite to mix one grain of a medicinal substance in one hundred grains of sugar of milk, it ought to be rubbed down with force during one hour _only_, in order that the power of the medicine may not be carried to too great an extent; medicinal substances acquiring at each division or dilution a new degree of power, as the rubbing or shaking they undergo develops that inherent virtue in medicines which was unknown until my time, and which is so energetic, that latterly I have been forced by experience to reduce the number of shakes to two." As a further illustration of this theory, he affirms that gold is without any action in our organism in its natural state; but that when one grain of this metal is triturated according to the above process until each grain of the last triturated preparation contains a quadrillionth part of the original grain of the mineral, it will be so powerful that it will be sufficient to place this single grain in a phial, to be inspired for a moment, to produce the most amazing results, and none more so than the faculty of restoring to a melancholy individual, disposed to commit suicide, his pristine partiality to life. Unfortunately for Hahnemann, many of these assertions are unsupported by facts or sound reasoning, and appear mere wanderings of an ardent imagination; and thus soaring in regions of fancy, he himself has struck many fatal blows to his own doctrines. For instance, what are the arguments he adduces to prove that in two similar diseases the strongest will overcome the weakest? "Why," he exclaims, "does the splendid Jupiter disappear during the twilight of morn to the eyes of the contemplator? It is because a similar power, but possessed of greater energies, the breaking day, acts upon our organs." This is a defective analogy. Hahnemann tells us that a stronger power banishes a weaker one in a permanent manner, whereas the bright planet he here alludes to will return with the night. Then again:-- "With what do we endeavour to relieve the olfactory nerves when offended by disagreeable odours? By snuff, which affects the nostrils in a similar but in a more powerful manner." This is not correct: when the action of snuff has ceased, the disagreeable effluvia become again offensive. In some instances his poetical vagaries are preposterous. "By what means," he adds, "do we endeavour to protect the ears of the compassionate from the lamentations of the poor wretched soldier condemned to be scourged? Is it not by the shrill notes of the fife united to the loud beat of the drum? How do we endeavour to drown the roar of distant artillery that causes terror in the heart of the soldier? By the roll of the double drum;--nor would this feeling of compassion, this sense of terror, have been checked by admonition or by splendid rewards. In the same manner our grief, our regret, subside, upon receiving the intelligence, true or false, that a more lively sorrow has affected another person." It would be idle to dwell upon the absurdity of such visions and erroneous statements. To support his doctrines, Hahnemann should have proved, 1st, that medicinal powers do produce an artificial malady similar to the natural affection; 2nd, that the organism only remains under the influence of the medicinal disease; 3rd, that this medicinal disease is of short duration; and 4th, that all these effects can only be produced by a medicine selected according to their similarity of symptoms. Our theorist has utterly failed in his endeavours to establish these facts; therefore have his doctrines been impugned by many of his most zealous disciples, amongst whom may be mentioned Griesselich, Rau, Schroen. The aggravation which he asserts takes place after the exhibition of a homoeopathic medicine is not only unsupported by proof, but positively denied by many of their practitioners; and Hartman plainly affirms that, after a homoeopathic dose, the patient frequently experiences a state of calm, a disposition to slumber, and often falls into a profound sleep more or less prolonged, in waking from which he finds himself much relieved, if not perfectly cured. Thus several physicians who have adopted his practical views reject many of the doctrines on which they are founded; and a homoeopathist has justly compared his works to a wild virgin forest, in which we meet with a number of valuable trees and plants in the midst of arid brushwood and parasitic weeds that would check the growth of the most useful productions. Yet, notwithstanding the many gratuitous assertions, and consequent erroneous inductions, we meet with in the _Organon_, it is probable that this system is destined to operate a gradual but material revolution in the _practice_ of medicine. As to theories, we must agree with Voltaire when he said "En fait de système, il faut toujours se reserver le droit de rire le lendemain de ses idées de la veille." Hippocrates laid down in his Aphorisms the incontrovertible fact, "Duobus doloribus simul obortis, non tandem eâdem in parte, vehementior alterum obscurat. A. 46." To a certain degree, it was upon this assertion, which the experience of ages has confirmed, that Hahnemann founded the principal and most important point of his doctrine; but, going much farther than the father of medicine, he affirms that similar diseases effectually remove each other. For centuries practitioners have been acting homoeopathically; the exhibition of specifics, in fact, being nothing else. As we have already shown, specifics are known to produce symptoms similar to the diseases they cure. Hitherto the number of such medicines has been confined to a very few agents; and perhaps with the exception of mercury, sulphur, and bark, with their several preparations, scarcely any article in the materia medica could have claimed this peculiar property. To extend these limits, which confined in so exiguous a compass our therapeutic agents, has been the laborious and singular study of Hahnemann and his disciples. Haller had first given the example, and they arduously applied themselves to discover by experiments on the healthy subject, both upon their own persons and others, what were the peculiar effects or symptoms produced by various medicinal substances. These observations are so numerous and confused, that, on reading them, we feel plunged in a chaotic labyrinth of symptoms, without any clue to extricate ourselves from its perplexing mazes. Still, from this multifarious catalogue much important information can be collected; and it cannot be denied that the homoeopathist has not only thrown a new light on the action of many medicines which we daily prescribe, but brought into practical consideration the necessity of attending to dietetic discipline, by an investigation of the several properties of our usual _ingesta_. It is obvious that any enthusiast who would blindly embrace the foregoing doctrines without serious and deep investigation, and boldly apply the wild theory to practice, would at once throw open the flood-gates of absurdity, and lend his aid in destroying, if possible, with one fell swoop, the result of ages of mature study and experience. Hahnemann, to fertilize the fields of science, had recourse to inundation instead of wise and cautious irrigation; and the fury with which he and his rash disciples maintained their opinions materially tended to retard their progress. Truth needeth not violence; its own lustre will beam through surrounding darkness, without being dragged into light. The objections to Hahnemann's doctrines are glaring. The art of healing, from the dawn of science until the present day, has been more or less founded on the faculties of reasoning. We are taught, in the first instance, to observe carefully the phenomena of disease, and, by referring effects to probable causes, endeavour, however difficult the task, to trace their catenation. Many of these causes are perhaps sealed for ever in the inscrutable book of our destinies; yet, if we cannot obtain a knowledge of the origin of these disorders, still when we take into mature consideration the complication of all accidental circumstances, and from visible effects seek invisible relations, guided by our experience in anatomy, physiology, and the revelations of pathology, we may find this pursuit less difficult than it may be imagined. But the homoeopathist despises and rejects as idle, all those collateral means of diving into nature's arcana. He bids us dwell only upon evident symptoms, or, in other words, look to the effects alone, and cast away all thoughts of discovering their causes. Nothing can be more illogical than this argument; for certainly we can scarcely hope to remove effects without striking, as far as in our power lies, at their cause. To deny the existence of any specific affection because we cannot account for its origin, is absurd. As well might we reject the use of medicines known to possess specific properties, from our utter ignorance of their _modus operandi_. The exclusive consideration of symptoms would lead us into lamentable error, since the same symptoms are observable in various diseases. Similar pains, for instance, may be the symptoms of rheumatism, nephritic affections, and calculus; headaches may arise from inflammation, and from various and well-known sympathies with distant organs: yet, without seeking to ascertain these relations, the mechanical and empirical homoeopathist will prescribe such medicines as are known to occasion pains in the loins, or headaches; only bearing in mind perceptible derangements, heedless of the phenomena of organization, the state of the secretions and excretions, the history, the rise and progress of the disorder, or the idiosyncrasy of the patient. The liver is diseased; the discovery is of no importance. We have only to attend to the pain extending up the clavicle and shoulder, or the uneasiness experienced in the right hypochondrium: the pulse, the respiration, the condition of the excretions, the temperature of the skin, the appearance of the tongue, are all regarded as minor considerations. It is not _hepatitis_ that we are called upon to cure; it is to relieve a pain in the shoulder and in the hypochondrium, or a difficulty of lying on the left side. No one will pretend to deny that our safest, perhaps our sole, guide in the study of disease is the group of symptoms, that become more and more perceptible during the course of our investigations. It was principally on the study of symptoms that the most learned practitioners of every age and country grounded their diagnosis and their prognosis; but they never viewed them either singly, or in their complexity, as unconnected with the particular diseases to which they were not only essentially united, but from which they originated, and of the existence of which they were to be considered the diagnostic signs. Therefore did the ancients classify them as principal and accessory, univocal and equivocal, characteristic or common, as they afforded more or less information in our pathological deduction; and in that light they were weighed with greater or less application, as our judgment could only be formed by the attentive consideration of the phenomena of the organism in health and in disease. But while the homoeopathist's attention is chiefly directed to the discovery of means that can enable him to produce symptoms analogous to those of the disorder, he seems to disregard the laws of sympathy, by which our organism appears to be ruled; a mysterious agency which can only be ascertained by observation and experiment, when, to use the words of a distinguished writer,[37] "by the former we may be said to listen to nature, by the latter to interrogate her." Health depends upon the due co-operation of all these associations; and one organ in the wonderful machinery cannot be deranged in its functions without influencing others, however distant and unconnected they may appear. In this co-ordination, these vital relations have been very properly divided into mechanical, functional, and sympathetic. Their study constitutes the groundwork of all rational induction. It is not by individual or complex symptoms that we can decide where the want of equilibrium is to be traced. Various have been the theories on this most important subject, and great have been the erroneous ideas dogmatically laid down. The illustrious Bichat himself erred when he maintained that sympathies were aberrations--morbid developments of our vital properties. Sympathies, on the contrary, may be considered as constant phenomena, essential and inseparable from our organism, whether in health or in sickness; and are, if I may be pardoned the expression, co-ordinated to co-operate with each other in their mechanical, their functional, and their sympathetic associations. An incarcerated hernia causes hiccup, nausea, vomiting. Will the homoeopathist tell us that we must seek in his catalogue of innumerable effects some substance which is known to produce similar symptoms? Surely the rupture must first call our attention. This example is adduced as referring to nearly every case in which it might be rashly attempted to separate causes from effects. The mammary glands are variously affected in uterine diseases; their impressions are reciprocal, yet the uterine affection must be the chief object of our solicitude. A peculiar pruritus is a symptom of calculus. Are we then to administer a homoeopathic dose of _cannabis_, or any other medicine which may give rise to a similar sensation? It may be objected to this observation that these are purely surgical cases, in which we need not be guided by symptoms to discover causes; but it has too frequently happened that nausea and vomiting have been attended to, while the hernia was overlooked, until fatal accidents were manifested. Moreover, a diseased liver, a diseased spleen or kidney, would be just as perceptible as hernia or calculus, if these parts could be brought into view or contact. It may be said that an erroneous notion of Hahnemann's doctrines on this subject has been taken; it is therefore necessary to quote his own words: "It may be easily conceived that the existence of a malady presupposes some alteration in the interior of the human organism; but our understanding can only lead us to suspect this alteration in a vague and deceitful manner, from the appearance of the morbid symptoms, the sole guide we can depend on except in surgical cases. The essence of the internal and invisible change is undiscoverable, nor have we any means of guarding against deceptive illusions."[38] "The invisible substance that has undergone a morbid alteration in the interior of the human body, and the perceptible changes, which are externally developed,--in other words, symptoms,--form by their union what is called disease; but the symptoms are the only points of the malady which are accessible to the physician, the sole indication whence he can derive any intuitive notion, and the principal objects with which he ought to become acquainted to effect a cure. From this incontestable truth there is nothing discoverable in disease beyond the totality of its symptoms to guide us in the selection of our curative means."[39] It is not to be supposed that an experienced physician, although a homoeopathist, will rest satisfied with this study of symptomatic medicine, without endeavouring to attach these effects to some cause, however occult it may appear; but such a doctrine becomes pernicious, since it bids us close the only book of truth that can reveal our errors,--_post mortem_ investigations. Surely, if a group of certain symptoms attend a disease which, when terminating fatally, shows disorganization in certain viscera, we are not only justifiable in giving to that disorganization a specific name in our scientific classification and categories, but in considering the symptoms of no other importance than as corroborative of those facts that morbid anatomy daily brings to light. It is generally admitted that most nosologies are imperfect, and may occasionally lead the young practitioner into error. This is easily accounted for when we consider the Protean forms that the same disease assumes in different individuals; yet, without this classification, the science of medicine could not be studied. A certain arrangement is necessary to simplify all our pursuits in natural science, and to seek a variety we must know the order and the genus. Had Hahnemann given a better system of nosology than those we possess, and with his truly praiseworthy zeal and industry enumerated the various symptoms of disease as minutely and as accurately as he has recorded the effects of medicinal substances, his labours might have proved a most valuable addition to our store of knowledge. Let us now direct our attention to the absurdities to which these opinions have led. Solely attentive to effects, and heedless of the disorganization of various important parts of the human economy which morbid anatomy detects, Hahnemann endeavours to discover the occult causes--the original source--the germ--of the malady, which most likely are beyond the reach of our researches; and he boldly affirms that all chronic diseases spring from syphilis, a disposition to warts and the itch. Now experience has proved that such an assumption is unfounded. The most healthy subjects, those who attain the finest old age, are more liable to this disgusting affection than the wealthy and cleanly part of the community. The Irish and Scotch peasantry from their infancy, and through life, are most subject to psora; and certainly our soldiers and sailors, amongst whom the disease is common, are not more predisposed to chronic diseases than any other classes of society, of course not taking into consideration the effects of unhealthy climates. Syphilis, it will be readily granted, has a considerable share in producing anomalous _sequelæ_, more especially when in combination with mercury. Warts, except of a syphilitic character, were never known to germinate diseases; indeed, they affect the most healthy and robust individuals. Yet to these three miasmatic causes does Hahnemann attribute nearly every disease that was ever known to afflict mankind; while he passes over in silence the predisposition to scrofula, gout, rheumatism, to which we can unfortunately trace with too much certainty the source of much human misery. That the itch is a disease of great antiquity is a matter of doubt. It has been maintained that it is the same eruptive disorder described by Celsus under the appellation of _scabies_; yet this writer does not allude to its contagious nature, and moreover says, that in some cases it disappears completely, whereas in others it is renewed at certain periods of the year. Celsus, moreover, includes other forms of pustular eruptions among the different species of scabies, not sufficiently distinguishing them from each other. The character of his scabies is more analogous to the lichen agrius of Willan. Nor did the ancients consider their _psora_ as our itch. It appears to have been the scaly tetter, which they sometimes denominated _psoriasis_, at others _lepra_, a synonymous affection; but neither pustular nor vesicular. Leprosy, indeed, is a malady totally distinct from the itch in all its characters. Hahnemann asserts that the species of leprosy that afflicted the Jews, and which is described by their legislator in the 13th chapter of Leviticus, was the itch; but any one who will peruse this description will perceive that it does not bear the slightest resemblance to that disorder. It appears, on the contrary, to have been that kind of leprosy called _leucé_ by the ancients. Nor was leprosy constantly attended with itching, one of the chief characteristics of the malady, and from which sensation it derives its very name. Hippocrates mentions a leprosy that usually occasioned a prurience before rain. There are no diseases in the classification of which more obscurity exists than in cutaneous affections; and Hahnemann's ideas would tend to increase this confusion, since he tells us that he considers the _framboesia_ of America, the _sibbens_ of Norway, the _pellagra_ of Lombardy, the _plica_ of Poland, the _pseudo-syphilis_ of the English, and the _asthenia Virginiensis_ of Virginia, complications of his three miasmatic principles; and he further informs us, no doubt on the faith of some idle tradition, that _psora_ lost its external deformity on the return of the Crusaders, who brought from the Holy Land the use of linen shirts, a cleanly and salutary precaution that eradicated the disease at a period when France had no less than two thousand hospitals for the reception of _itch_ patients,--a plain proof that he confounds leprosy with itch, since the hospitals he alludes to were distinctly considered leper-houses. It is certainly true that there does exist in our system a constant predisposition to eruptive affections of some kind or other. We are born heirs to certain exanthematic affections, such as the measles and smallpox; and it would be as difficult to find a being morally immaculate as an individual free from speck or blemish. Many of these eruptions are considered of a critical and salutary nature; and the ancients fancied that nature relieved herself by throwing upon the surface some "peccant humours." Hence their dread of the retrocession of any of these "breakings out;" and there is no doubt but that accidents frequently followed their sudden disappearance, in the same manner as drying up an issue or a blister established for some time, and become habitual, may occasion internal mischief; but to maintain that all chronic diseases arise from three eruptive principles is a most gratuitous and untenable assertion. Enthusiastically anxious to support his doctrines, Hahnemann is frequently led into erroneous assertions. Thus he tells us that life will suddenly cease if a little water, or the mildest liquid, is injected into a vein; whereas experience has proved, in the treatment of cholera, and various other instances, that the most stimulating solutions may be thus introduced, not only with impunity, but with salutary results. It is needless to enter more deeply into the ungracious business of pointing out errors, many of which were evident to Hahnemann himself; since, not only in the several editions of his Organon, but in various paragraphs in the same volume, he contradicts himself. A much more gratifying and important task is now undertaken, to prove, by the evidence of facts, supported by practical reasoning, that the art of healing is more indebted to the homoeopathic doctrines than to any system that has hitherto been delivered in our schools. That the all-bountiful Creator, in permitting, for purposes unknown to us, mankind to be visited by so many scourges, has also scattered around us means to counteract these evils, cannot be a matter of doubt. Instinct leads animals to find out these salutary agents, and various specifics have been discovered by man. The rudest savage is in possession of curative substances unknown to civilized man, and performs cures where learning and experience have proved of no avail. To extend the limits of specifics, must therefore be considered a most desirable step towards adding to our means of relieving disease; and in this pursuit it is impossible to bestow too much praise on the homoeopathic observer. Enthusiasm--predilection to a favourite but persecuted system--may induce an ardent proselyte not only to deceive others, but unwittingly to deceive himself. It is therefore not only possible, but probable, that in the experimental investigations of the effects of medicine, Fancy, in her multifarious colours, may have depicted, with apparent fidelity, a state of body and mind that only existed in an excited imagination; but when we behold various individuals, distant from each other, and totally unconnected, observing similar results from the exhibition of various medicinal substances, we have no right to call their assertions into doubt. These assertions, moreover, are not laid down dogmatically, but are earnestly recommended to be submitted to the test of experiment. For instance, the homoeopathist has found out that certain substances, by diminishing the energy of the heart and arteries, subdue inflammatory action as effectually as venesection. This is a fact daily witnessed, and of which any practitioner may convince himself. It is not asserted, that in cases of sudden determination of blood, which require immediate revulsion and abstraction of the vital fluid, homoeopathic remedies will be found possessed of sufficient activity to afford prompt relief; but experience has fully proved that in cases which can admit of a few hours' delay, these medicines very frequently supersede the necessity of debilitating the patient by a copious loss of blood. Dr. Paris, in his admirable work on Materia Medica, has justly observed, "that observation or experiment upon the effects of medicine is liable to a thousand fallacies, unless it be carefully repeated under the various circumstances of _health_ and _disease_, in different climates, and on different constitutions." This has been the main object of the homoeopathist; and a further quotation from the above distinguished writer will illustrate the importance of their labours. "It is impossible to cast our eyes over such multiplied groups (of medicinal substances) without being forcibly struck with the palpable absurdity of some, the disgusting and loathsome nature of others, the total want of activity in many, and the uncertain and precarious reputation of _all_, without feeling an eager curiosity to inquire, from the combination of what causes it can have happened that substances at one period in the highest esteem, and of generally acknowledged utility, have fallen into total neglect and disrepute. That such fluctuation in opinion and versatility in practice should have produced, even in the most candid and learned observer, an unfavourable impression with regard to the general efficacy of medicines can hardly excite our astonishment, much less our indignation; nor can we be surprised to find that another portion of mankind has at once arraigned physic as a fallacious art, or derided it as a composition of error and fraud. A late foreign writer, impressed with this sentiment, has given the following _flattering_ definition of our profession: _Physic is the art of amusing the patient, while Nature cures his disease_." With such a lamentable view of the practice of medicine, can we be too thankful to those observers who strenuously endeavour to rescue it from the dark trammels in which prejudice and interested motives have bound it? In no country more than in Great Britain is such an investigation desirable. We have become proverbial from our incessant abuse of a farrago of medicinal substances; and what is usually termed an _elegant prescription_ signifies an amalgam of various drugs and preparations, which most probably, by their affinities, neutralize the expected effects of each other; for, however great and flattering may have been the discoveries of modern chemistry, many of these affinities are unknown to us. Surely when our labours cannot detect any difference in the component parts of the purest Alpine atmosphere and the deleterious air of a loathsome dungeon, we cannot expect to form a correct idea of pharmaceutic combinations. The mere hopes of being able to relieve society from the curse of constant drugging, should lead us to hail with gratitude the homoeopathist's investigations. That many physicians, but especially apothecaries, who live by overwhelming their patients with useless and too frequently pernicious medicines, will warmly, nay furiously inveigh against any innovation of the kind, must be expected as the natural result of interested apprehension; and any man who aims at simplicity in practice will be denounced as guilty of medical heresy. Have we not seen inoculation and vaccination branded with the most opprobrious epithets, merely because their introduction tended to diminish professional lucre? In these remarks upon medicinal combinations, it is not meant to infer, that, because they are chemically incompatible, they are ineffectual,--experience has proved the contrary; but no one will contend that, if we can attain the same beneficial results from a single ingredient, administered in small quantities and at distant periods, as from the exhibition of repeated and nauseous doses of pills, powders, draughts, potions, &c. which hang over the bed of sickness, nay, of slight derangements, like the sword of Damocles, we have not effected a most salutary reform in the practice of physic. It is related of one of these ingenious and industrious practitioners, that, having seen a prescription, that only contained half a dozen medicines, he exclaimed, "What! nothing more?" To which the prescriber replied, "If you choose, sir, we'll step over to the apothecary, and see what else he has in his shop." Specifics may be divided into two classes; the one producing a peculiar effect upon particular organs, the other producing general results. Thus, the action of cantharides and digitalis on the urinary system, of emetics on the stomach, of certain purgatives on the small intestines, and of others on the large ones, are generally known; whereas the action of mercury and opium is still a matter of controversy. A study of these effects constitutes the chief object of the homoeopathist; and, having determined their peculiar action, these medicinal agents are given singly, and, as we have already observed, in the most minute doses. It is this division into infinite fractions that has drawn upon the homoeopathic practice the denunciation of the allopathic physicians, as it is considered utterly impossible that such imponderable particles can produce any beneficial or prejudicial effect; and the Academy of Medicine of Paris, when officially condemning the doctrine, asserts, in support of this argument, that great danger arises from it "in frequent and serious cases of disease, where the physician may do as much injury, and cause no less mischief, by ineffectual means as by those which are prejudicial." This is perhaps one of the most important points of the homoeopathic doctrine. If these fractional doses are inert, and yet the disease is cured, then must the successful treatment be solely ascribed to the dietetic regimen and the efforts of nature. However, experience has afforded abundant proofs that these infinite atoms do produce positive and evident effects. What appears to our feeble organs an atomic fraction may produce phenomena on the organism which we cannot comprehend, but should not therefore be denied. Let one grain of iodine be dissolved in one thousand five hundred and sixty grains of water, the solution will be limpid; let two grains of starch be dissolved in two ounces of water and added to the first solution, and the liquor will forthwith assume a blue tint. In this experiment the grain of iodine has been divided into 1/15360. Dissolve the four-hundredth part of one grain of arsenic in four hundred thousand parts of water, and the hydric-sulphite will bring it into evidence. Let a five-thousandth part of arseniate of ammonia be dissolved in five hundred thousand parts of water, and the addition of the smallest proportion of nitrate of silver will obtain a yellow precipitate. Numerous experiments of a similar nature may be daily resorted to, to prove that the most minute particles of two substances possessed of chemical affinities may be brought into action, although diluted _ad infinitum_. But the power that the smallest particle possesses in producing natural phenomena cannot be more evidently proved than by Spallanzani's experiments in fecundation. This physiologist having wrapped up a male frog in oil-silk, fecundation could not take place; but having collected on the point of a camel-hair pencil a particle of the fecundising fluid, he succeeded in vivifying thousands of eggs. Surprised at this result, he dissolved three grains of the secretion in a pound of water, and one globule of the solution was endowed with the same faculty. In this case the globule of water only contained 1/2994687500 part of one grain. This curious experiment has been tried with a similar result by Prevost and Dumas. How imponderable and impalpable must be the effluvium which enables the dog to track his master for miles! the particle of atter of roses that perfumes a whole chest of clothes! and what must the power of the aroma be which is preserved for thousands of years in some Egyptian mummies! Would the vulgar believe in the wonders of the solar and gaseous microscopes unless they were exposed to view? In these we behold in amazement myriads of individuals in one drop of fluid, each of them as perfect in organization as the mighty mammoth of old or the sagacious elephant of our days, endowed with distinct habits, destructive and reproductive propensities and faculties. It has been advanced by the opponents of homoeopathy that the insignificant dose of three or four medicinal globules cannot possess any power, since one might swallow a thousand of them with impunity. To this it is answered, that it is only under certain morbid conditions that these medicines act by their homoeopathic affinities. Moreover, it is well known that small doses of medicinal substances will frequently produce more powerful effects than larger quantities. Tartar-emetic, sugar of lead, calomel, afford daily instances of this fact; and it is also admitted that many substances act differently upon the healthy or the sick. An individual in health can take any food without apprehension; but when his functions are deranged, the slightest imprudence in regimen may lead to serious consequences. There are primordial and inscrutable peculiarities in our constitution that cannot be accounted for; and the medicine which relieves one patient will aggravate the sufferings of others. The exhalations of the American _rhus_ are deadly to some persons, but innocuous to others; and many poisons which cause instantaneous death to some animals may be given with safety to others. Whence has arisen the controversy regarding damp sheets, which many maintain are not dangerous, simply from the fact that a healthy person with a vigorous circulation may sleep in them with impunity, when a feeble and languid subject will be exposed to some dangerous determination of blood? A learned writer already quoted thus expresses himself on this matter:[40] "The virtues of medicines cannot be fairly nor beneficially ascertained by trying their effects on sound subjects, because the peculiar morbid condition which they are calculated to remove does not exist." It may be said that this observation militates against the homoeopathic experiments, and to a certain extent it evidently does; but it cannot be inferred that because a medicinal substance will occasionally act differently in health and in disease, that it may not frequently operate in a similar manner when the morbid condition does prevail, since it is generally admitted that medicines act in a relative manner according to the state of the system. Hence classifications of medicines are too frequently erroneous and imperfect. The doses of medicines determine their effects. Linnæus says, "Medicines differ from poisons, not in their nature, but in their dose;" and Pliny tells its aphoristically, "_Ubi virus, ibi virtus_." According to their doses, medicines will produce a general or a local effect; and Dr. Paris, whom I feel much gratification in quoting, lays down as a rule that "substances perfectly inert and useless in one dose may prove in another active and valuable." It would be foreign to my purpose to enter more fully into this most important subject; but the cases which shall be adduced will be deemed sufficient to convince the most incredulous, of the power of homoeopathic doses. Those who have denied this property have boldly attributed homoeopathic cures to dietetic means. Admitting this statement by way of argument, surely, if any observer, by ascertaining the peculiar action of our ingesta, can so regulate the regimen as to produce salutary effects without the aid of medicine, mankind would be most essentially benefited. How many persons do we not daily meet with, who have never taken any medicine since their childhood, when maternal care strove to destroy their digestive organs with apothecary's _stuff_, and who regulate their functions by mere attention to their mode of living. I know one gentleman, a physician, who relieves constipation by green chilies; another, with cold milk; a third, with warm milk: in some habits spinach and sorrel will act as a powerful and safe aperient; in others, cheese, or a hard egg, will operate in a contrary way. Fermented and spirituous liquors all possess specific properties. Some gouty persons cannot drink Claret without bringing on a paroxysm, and others dread a glass of Champagne or Burgundy. Nay, different wines have been known to bring on arthritic attacks in particular parts; and I have known Champagne to produce gout in the wrist, and Burgundy in the knee, in subjects who under other circumstances never experienced the disorder in those articulations. Our peculiar aversion, nay, our dread, of various alimentary substances are well known. The odour of cheese, of strawberries, have occasioned fainting and convulsions; and in certain constitutions, several articles of diet bring on indigestion. In short, the study of our ingesta is one of the greatest importance; and here again the homoeopathist is entitled to our best thanks. This investigation will moreover prompt physicians to be more attentive in inquiring into the various effects of alimentary and medicinal substances on their patients. Instead of hastily drawing out routine prescriptions for such and such a disorder, they will accurately ascertain the physical and moral condition of the subject, taking into due consideration previous habits, predispositions, and pursuits in life. Indeed, it would be desirable that practitioners followed the example of army medical men, who keep an exact register of every individual they attend, and in which is diligently recorded every circumstance connected with the disease and its treatment. Moral influence has also been called into aid in opposition to this practice, and cures have been attributed to the mere power of fancy and credulity. We have certainly known superstition and mental imbecility to be productive both of good and evil,--to have created some maladies, and cured others; but homoeopathy has succeeded when the patient was unaware of the treatment to which he was submitted. But, conceding the point, and admitting that inert substances, such as starch, (and this experiment was resorted to in Paris,) may have obtained singular beneficial results,--the results of a weak imagination, this circumstance alone would be illustrative of the power of moral agency; and who would not gladly wish for a mental relief in lieu of a nauseating and injurious course of medicine? Others will exclaim, although the homoeopathist disavows the _vis medicatrix naturæ_, that he solely succeeds by leaving the malady to the salutary efforts of the constitution. Here again we must admit, that, were we to leave many diseases to run their course, we might be more successful in obtaining a cure than by a rash and detrimental interference, founded on the principle that a physician "must order something." But the facts I am about to record,--facts which induced me, from having been one of the warmest opponents of this system, to investigate carefully and dispassionately its practical points,--will effectually contradict all these assertions regarding the inefficacy of the homoeopathic doses, the influence of diet, or the agency of the mind; for in the following cases in no one instance could such influences be brought into action. They were (with scarcely any exception) experiments made without the patient's knowledge, and where no time was allowed for any particular regimen. They may, moreover, be conscientiously relied upon, since they were made with a view to prove the fallacy of the homoeopathic practice. Their result, as may be perceived by the foregoing observations, by no means rendered me a convert to the absurdities of the doctrine, but fully convinced me by the most incontestable facts that the introduction of fractional doses will soon banish the farrago of nostrums that are now exhibited to the manifest prejudice both of the health and the purse of the sufferer. CASE I. A servant-maid received a blow of a stone upon the head. Severe headache, with dizziness and dimness of sight, followed. Various means were resorted to; but general blood-letting could alone relieve the distressing symptoms, local bleeding not having been found of any avail. The relief, however, was not of long duration, and the distressing accidents recurred periodically, when abstraction of blood became indispensable. Reduced by these frequent evacuations, I was resolved to try the boasted "bleeding globules" of the homoeopathist, when, to my great surprise, I obtained the same mitigation of symptoms which the loss of from twelve to sixteen ounces of blood had previously accomplished. Since the first experiment no venesection became necessary, and the returns of the violent headache were invariably relieved by the same means. CASE II. An elderly woman was subject to excruciating headache, with an evident determination of blood to the brain. Numerous leeches were constantly applied. The usual remedies indicated in similar affections were resorted to, but only afforded temporary relief. A homoeopathic dose of aconite was given, and the relief that followed was beyond all possible expectation. CASE III. My much-esteemed friend Dr. Grateloup of Bordeaux was subject to frequent sore-throats, which were only relieved by local blood-letting, cataplasms, &c., but generally lasted several days, during which deglutition became most difficult. I persuaded him to try a dose of the belladonna, neither of us having the slightest confidence in its expected effects. He took the globules at twelve o'clock, and at five P.M. the tumefaction of the tonsils, with their redness and sensibility, had subsided to such an extent that he was able to partake of some food at dinner. The following morning all the symptoms, excepting a slight swelling, had subsided. Since this period Dr. G. has repeatedly tried the same preparation in similar cases, and with equal success. In my own practice, I can record seven cases of cynanche tonsillaris which were thus relieved in the course of a few hours. CASE IV. H--, a young woman on the establishment of the Countess of --, was suffering under hemiplegia, and it was resolved by Dr. Brulatour and myself to try the effects of nux vomica. At this period the wonders of the homoeopathic practice had been extolled to the skies by its advocates, and we were resolved to give one of their supposed powerful preparations a fair trial. The girl was told that the powder she was about to take was simply a dose of calomel; and on calling upon her the following morning we did not expect that the slightest effect could have been obtained by this atomic dose, when, to our utter surprise, the patient told us that she had passed a miserable night, and described to us most minutely all the symptoms that usually follow the exhibition of a large dose of strychnine. It is but fair to mention that the homoeopathic treatment did not cure the disease; but the manifest operation of this fractional dose, that could not possibly be denied, is a fact of considerable importance. CASE V. Mrs. ---- of Brompton, Bow, had laboured under hectic fever for several months, and was so reduced by night perspirations, that she was on the very brink of the grave. Called into consultation, I frankly told her husband that every possible means known in the profession had been most judiciously employed, and that I saw no prospect of obtaining relief. At the same time I mentioned to him that the homoeopathic practitioners pretended that they had found the means of relieving these distressing symptoms, which he might submit to an experimental trial if he thought proper. He immediately expressed his wish that it should be adopted. I gave her a homoeopathic dose of phosphoric acid and stannum; and, to the surprise of all around her, the night sweats did not break out at their usual hour,--three o'clock in the morning. What renders this case still more interesting is the fact of these perspirations recurring so soon as the action of the medicine ceased; a circumstance so evidently ascertained, that the patient knew the very day when another dose became necessary. CASE VI. A daughter of the same lady was subject to deafness, which I attributed to a fulness of blood. This cause I clearly ascertained by the relief afforded by the application of a few leeches behind the ear. I was therefore induced, on a recurrence of the complaint, to endeavour to diminish vascular action by a dose of aconite. The effects were evident in the course of four hours, when the deafness and the other symptoms of local congestion had entirely disappeared. * * * * * I could record numerous instances of similar results, but they would of course be foreign to the nature of this work. I trust that the few cases I have related will afford a convincing proof of the injustice, if not the unjustifiable obstinacy, of those practitioners who, refusing to submit the homoeopathic practice to a fair trial, condemn it without investigation. That this practice will be adopted by quacks and needy adventurers, there is no doubt; but homoeopathy is a science on which numerous voluminous works have been written by enlightened practitioners, whose situation in life placed them far above the necessities of speculation. Their publications are not sealed volumes, and any medical man can also obtain the preparations they recommend. It is possible, nay, more than probable, that physicians cannot find time to commence a new course of studies, for such this investigation must prove. If this is the case, let them frankly avow their utter ignorance of the doctrine, and not denounce a practice of which they do not possess the slightest knowledge. Despite the persecution that _Hahnemannism_ (as this doctrine is ironically denominated) is at present enduring, every reflecting and unprejudiced person must feel convinced that, although its wild and untenable theories may not overthrow the established systems (if any one system can be called established), yet its study and application bid fair to operate an important revolution in medicine. The introduction of infinite small doses, when compared, at least, with the quantities formerly prescribed, is gradually creeping in. The history of medicine affords abundant proofs of the acrimony, nay, the fury, with which every new doctrine has been impugned and insulted. The same annals will also show that this spirit of intolerance has always been in the _ratio_ of the truths that these doctrines tended to bring into light. From the preceding observations, no one can accuse me of having become a blind bigot of homoeopathy; but I can only hope that its present vituperators will follow my example, and examine the matter calmly and dispassionately before they proceed to pass a judgment that their vanity may lead them to consider a final sentence. DOCTRINE OF SIGNATURES. One of the most absurd medical doctrines that ever prevailed in the dark æras of science was the firm belief that all medicinal substances displayed certain external characters that pointed out their specific virtues. This curious theory may be traced to the Magi and Chaldæans, who pretended that every sublunary body was under a planetary influence. To find the means of concentrating or fixing this stellary emanation became a cabalistic study, called by Paracelsus the "_ars signata_;" and talismans of various kinds were introduced by the professors of sideral science. The word talisman appears to be derived from the Chaldæan and Arabic _tilseman_ and _tilsem_, which mean characteristic figures or images. Paracelsus, Porta, Crollius, and many other philosophers and physicians, cherished this vision, which had been transmitted to them through the dense mists of superstition from more ancient authorities; amongst others, Dioscorides, Ælius, and Pliny. The _lapis ætites_, or eagle-stone, which was supposed to be found in the nests of this bird, but which, in fact, is nothing more than a variety of iron-ore, was said to prevent abortion if tied to the arm, and to accelerate parturition if affixed to the thigh. This conceit arose from the noise that seemed to arise from the centre of the stone when it was shaken: "Ætites lapis agitatus, sonitum edit, velut ex altero lapide prægnans." From this absurd hypothesis sprung the doctrine; and the very names of plants were supposed to indicate their specific qualities. For instance, the _euphrasia_, or eye-bright, exhibiting a dark spot in its corolla, resembling the pupil of the eye, was considered efficacious in affections of that organ. The blood-stone, the _heliotropum_, from its being marked with red specks, was employed to stop hæmorrhage; and is to this day resorted to in some countries, even in England, to stop a bleeding from the nose.[41] Nettle-tea was prescribed for the eruption called _nettle-rash_. The _semecarpus anacardium_, bearing the form of a heart, was recommended in the diseases of this viscus. The _cassuvium occidentale_, resembling the formation of a kidney, was prescribed in renal complaints; and the pulmonary lichen of the oak, the _sticta pulmonaria_, from its cellular structure, was esteemed a valuable substance in morbid affections of the lungs. Deductions still more absurd, if possible, are recorded: thus saxifrage, and other plants that grow in rocky places, embodied as if it were in calcareous beds, were advised to dissolve the stone; and the _echium_, bearing some faint resemblance to a viper, was deemed infallible in the sting inflicted by this reptile. The divers colours of substances supposed to be medicinal were also another _signature_. Red flowers were given for derangement in the sanguiferous system, and yellow ones for those of the bile. In Crollius's work, entitled "_De Signaturis Plantarum_," many curious observations may be found; and Sennert, Keuch, Dieterich, and other writers displayed great industry in the division of these signatures, which, by the ancients, were considered as something denoting no particular quality, and were then called [Greek: asêmoi charaktêroi]; or [Greek: sêmantikoi], when their virtues were evident. Amongst the various influences and indications that were attributed to colours, black was especially considered as the mark of melancholy. Baptista Porta affirms, that if a "black spot be over the spleen, or in the nails, it signifies much care, grief, contention, and melancholy." Cardan assures us that a little before his son's death he had a black spot, which appeared in one of his nails, and dilated itself as he approached his end. While nature was thus supposed to mark the virtues of her productions on their external configuration, man assumed the same authoritative power, and marked medicines with certain signs or seals. For this purpose, the ancient physicians carried signets or rings, frequently worn upon the thumb, and on which were engraved their own names, sometimes written backwards, or the denominations of the nostrums they vended. On one of these seals we find the word _aromaticu_, from _aromaticum_; on another, _melinu_, abbreviation of _melinum_,--a collyrium prepared with the alum of the island of Melos. A seal of this kind is described by Tôchon d'Annecy, bearing the words _psoricum crocodem_, an inscription that has puzzled medical antiquaries. The word _psoricum_ was applied to an eruptive affection of the eye; and Actuarius mentions a _collyrium psoricum_ of Ælius; while Marcellus Empiricus records the virtues of the _psoricum stratioticum_, which restored sight in twenty days to a patient who had been blind for twelve years; but, when it was applied, it was ineffectual, unless the words "_Te nunc resunco, bregan gresso_," were religiously pronounced. _Crocodem_ was also supposed to apply to _crocus_ or saffron, or to _crocodes_, a remedy for sore eyes, mentioned by Galen; while some learned men refer the word to the dejections of the crocodile, which were said to possess various virtues. The earth of Lemnos was sealed with the figure of Diana, and to this day the bolar argils, brought from Greece, bear various seals and characters; hence the _bolus Armeniæ_, and _bolus ruber_, are called _terra sigillata_. The influence of colours was supposed to have been so great, that in our own annals we find John de Gaddesden, mentioned by Chaucer, ordering the son of Edward I., when labouring under the small-pox, to be wrapped up in scarlet; and to the present day, flannel, died nine times blue, is supposed to be most efficacious in glandular swellings. Tourtelle, a French army physician, has made the following singular observation on this subject: "I observed that those soldiers of the Republic who were affected with diseases connected with transpiration were more severely indisposed, and not unfrequently exhibited symptoms of putrescency, when their wet clothes had left a blue tinge on the skin, than when they had been merely wetted by the rain." The explanation of this supposed phenomenon, is simply that those men who had been coloured by their uniforms, had, no doubt, been long wearing them, saturated by incessant rains, whereas the others had merely been exposed to occasional showers. From this observation, I do not pretend to affirm that any deleterious substances in a dye might not occasion a dangerous absorption; but the accidents that may result from such a circumstance could be easily explained without having recourse to any particular influence of colour. The colour of cloth, especially in army clothing, may also materially tend to influence cutaneous transpiration, as some colours are more powerful conductors of heat than others; and it is not impossible that the French soldiers, not belonging to fresh levies, and who had always been clad in white, might have experienced some difference of temperature when marching under intense heat in dark blue and green uniforms. Some of the terms used by the signature doctrinarians may puzzle the most learned. The Greeks called them [Greek: sêmantika]; and, in addition to the all-powerful _abracadabra_,--an infallible cure of ague, when suspended round the neck,--we find the magic terms of _sator_, _asebo_, _tenet_, _obera_, _rotas_, _abrac_, _khiriori_, _gibel_, engraved upon amulets. For the bite of a mad dog, _pax max_, and _adimax_, were irresistible; and for a fractured arm or a luxation, _araries_, _dandaries_, _denatas_, and _matas_, would have set at defiance the most experienced chirurgeons. I must refer the curious reader on this important subject to the work _De figuris Persarum Talismanicis_ of Guffarel, to the _Oedipus_ of Kircher, the book of Crollius _De signaturis internis rerum_, and _Isagoge physico-magico-medica_ of Elzer. The church vehemently denounced these abominations; and we find in the council of Laodicea an injunction forbidding the priesthood the study and practice of enchantment, mathematics, astrology, or the binding of soul by amulets. These incantations were dreaded in every age. Thus Lucan: Mens, hausti nullâ sanie polluta veneni, Incantata perit. Philosophers have justly observed that most of the diseases treated and supposed to have been cured by these mystic means, were of a nervous description, and therefore depending, in a great measure, upon moral influence. Here faith and hope assisted the physicians,--two great auxiliaries in every worldly turmoil and trouble. Therefore do we find most of these cures referred to epilepsy, paralysis, melancholy, hypochondriasis, hysteria, as well as to many periodical affections, the return of which is frequently arrested by mental impressions. A fright has checked the paroxysm of an intermittent fever; and many natural functions are impeded or brought on by a similar agency. The sight of a dentist has been often known to calm an excruciating toothache; and there is no complaint that has been cured by more singular means than this troublesome affection. In 1794, a tract was published in Florence by Dr. Ranieri Gerbi, a professor of mathematics in Pisa, entitled _Storia naturale di un nuovo insetto_, which he called _curculio anti-odontalgicus_, and which, being squeezed between the fingers, imparted to them, for the period of one year, the wonderful power of relieving toothache with the mere touch; and the author asserts that by this simple process he cured four hundred and one cases out of six hundred and twenty-nine. This may be considered a branch of magnetism, and has been treated by Schelhammar, in his book _De Odontalgiá tactu sedandâ_. This wonderful insect belonged to the _coleoptera_, and was simply the _curculio_ and the _coccinella septem-punctata_, well known to entomologists, and which, according to Cipriani Zuccagni, and more particularly Carradori, possessed these singular properties, which, however, subsequent experiments have fully disproved. While we find some _charms_ having sufficient power over our weak imagination to cure diseases, there were others considered sufficiently energetic to occasion death. Sometimes a wax figure was made, supposed to represent the devoted victim, and which was pierced with a pointed instrument, each stab being accompanied by a magic imprecation: Devovet absentes, simulacraque cerea fingit. These means the ancients called _carmina, incantationes, devotiones sortiariæ_. It is somewhat strange that this same ceremony of the waxen image to destroy the object of our hate was also employed to obtain love. The figure was on these occasions called by the name of the person, and afterwards placed near the fire, when, as the heat gradually melted it, the obdurate heart of the lover was simultaneously softened. At other times two images were thus exposed to heat, the one of clay, the other of wax; and, while the one melted, the other became more hardened:--a vindictive feeling, to render our own heart insensible, while we mollified that of an ingrate; or perhaps with a view to render that heart inflexible to others, while it propitiated the addresses of the supplicant. Thus Virgil: Limus ut hic durescit, et hæc ut cera liquescit, Uno eodemque igni; sic nostro Daphnis amore. Sparge molam, et fragiles incende bitumine lauros. Daphnis me malus urit, ego hanc in Daphnide laurum. The wishes of the ancients for those they loved were sometimes curious, and they often turned round a mystic wheel, praying that the object of their affections might fall down at their door and roll himself in the dirt. The ancients, who daily witnessed this influence of the imagination in causing and in curing disease, have left us many valuable injunctions on the subject; and Plato thus expresses himself: "The office of the physician extends equally to the purification of mind and body; to neglect the one is to expose the other to evident peril. It is not only the body that by its sound constitution strengthens the soul, but the well-regulated soul, by its authoritative power, maintains the body in perfect health." COFFEE. It is doubtful to whom we owe the introduction of this article of luxury into Europe. The plant is a native of that part of Arabia called _Yemen_, but we find no mention made of it until the sixteenth century; and it is believed that Leonhart Rauwolf, a German physician, was the first writer who spoke of it, in a work published in 1573. The plant was also described by Prosper Alpinus, in his treatise on Egyptian plants, published in 1591 and 1592. Pietro della Valle wrote from Constantinople in 1615 that he would teach Europe the manner in which the Turks made their _cahué_. This spelling was no doubt incorrect; for, in a pamphlet printed at Oxford in 1659, in Arabic and English, it is written _kauhi_, or _coffee_. Purchas, who was a contemporary of Della Valle, called it _coffa_; and Burton thus speaks of its use: "The Turks have a drink called _coffa_, so named of a berry as black as soot and as bitter, which they sip still of, and sup as warm as they can suffer. They spend much time in their coffa-houses, which are somewhat like our alehouses and taverns, and there they sit chatting and drinking to drive away the time and to be merry together, because they find by experience that kinde of drink so used helpeth digestion and procureth alacrity." The first coffee-house opened in London was in 1652. A Turkey merchant, of the name of Edwards, having brought with him from the Levant some coffee and a Greek servant, he allowed him to prepare and sell this beverage; when he established a house in St. Michael's Alley, Cornhill, on the spot where the Virginia Coffee-house now stands. Garraway's was the first coffee-house opened after the fire in 1666. It appears, however, that coffee was used in France in 1640; and a sale of it was opened at Marseilles in 1671. The introduction of this berry was furiously opposed; and it appears that in its native land it was treated with no less severity, since, in an Arabian MS. in the King of France's library, coffee-houses were suppressed in the East. In 1663 appeared a pamphlet against it, entitled "A Cup of Coffee, or Coffee in its Colours." In 1672 the following lines were to be found in another publication, "A Broadside against Coffee, or the Marriage of the Turk:" Confusion huddles all into one scene, Like Noah's ark, the clean and the unclean. For now, alas! the drench has credit got, And he's no gentleman who drinks it not. Then came "The Woman's Petition against Coffee," which appeared in 1674, in which we find the following complaint: "It made men as unfruitful as the deserts whence that unhappy berry is said to be brought, so much so, that the offspring of our mighty ancestors would dwindle into a succession of apes and pigmies; and on a domestic message a husband would stop by the way to drink a couple of cups of coffee." It was then sold in convenient pennyworths;--hence coffee-houses where wits, _quidnuncs_, and idlers resorted, were called "penny universities." While it had adversaries, coffee was not left without eloquent advocates. Sir Henry Blount, in his _Organon Salutis_, 1659, thus speaks of it: "This coffa-drink has caused a great sobriety among all nations. Formerly apprentices, clerks, &c. used to take their morning-draughts in ale, beer, or wine, which often made them unfit for business. Now they play the good-fellows in this wakeful and civil drink. The worthy gentleman, Sir James Muddiford, who introduced the practice hereof in London, deserves much respect of the whole nation." It appears, however, that the jealousy with which the use of coffee was viewed, even by the government, arose more from the nature of the conversations that took place in coffee-houses during moments of public excitement, than from the apprehension of any injury that its consumption might have caused to the public health. In the reign of Charles II. coffee-houses were shut up by a proclamation, issued in 1675, as the retailing of coffee "nourished sedition, spread lies, _scandalized great men_, and might therefore be considered a _common nuisance_." As a _nuisance_, its abolition was considered as not being an infringement of the constitution! Notwithstanding this Machiavellian torturing of the letter to serve the spirit, this arbitrary act occasioned loud and violent discontent; and permission was given to reopen coffee-houses, on condition that the landlords should not allow any scandalous papers containing scandalous reports against the government or _great men_ to be read on their premises! The use, or rather the abuse, of coffee is said to produce feverish heat, anxiety, palpitations, trembling, weakness of sight, and predisposition to apoplexy. Its effects in checking somnolence have been long known. However, the action of this berry differs according to its being roasted or raw. An infusion of torrefied coffee assists digestion, and frequently removes headaches resulting from derangement in the digestive functions. It also neutralizes the effect of narcotics, especially opium, and this power is increased by the addition of lemon juice. A similar mixture has been known to cure obstinate agues. Musgrave and Percival recommended its use in asthma: indeed, most persons who labour under this distressing malady seem to derive relief from its use. Taking into consideration all that has been advanced in regard to the inconveniences that may attend the use of coffee and tea, they must be considered as overruled by the moral results that have arisen from the introduction of these beverages; and a late writer has observed, that it has "led to the most wonderful change that ever took place in the diet of civilized nations,--a change highly important both in a moral and physical point of view. These beverages have the admirable advantage of affording stimulus without producing intoxication." Raynal observes, that the use of tea has contributed more to the sobriety of the Chinese than the severest laws, the most eloquent discourses, or the best treatises on morality. The quality and effects of coffee differ according to the manner in which it is roasted. Bernier states that when he was at Cairo there were only two persons in that great city who knew how to prepare it to perfection. If it be underdone, its virtues will not be imparted, and its infusion will load and oppress the stomach; if it be overdone, its properties will be destroyed, and it will heat the body, and act as an astringent. The best coffee is the _Mocha_, or that which is commonly called Turkey coffee. It should be chosen of a greenish, light, olive hue; the berries of a middling size, clean, and plump. The bad effects of coffee may in all likelihood be attributed both to its powerful and stimulating aroma and to its pungent acidity. According to Cadet, this acid is the _gallic_; while Grindel considers it the _kinic_, and Pfaff terms it the _caffeic_ acid. When strongly heated, it yields a _pyro-caffeic_ acid, from which may be obtained a most pungent vinegar, that has recently been thrown into trade, but, I believe, with little or no success. The principle of coffee is the _caffein_, discovered by Robiquet, in 1821; and it is to this active principle that its beneficial or baneful effects can be attributed. Recent experiments tend to show that it is possessed of powerful febrifuge virtues. To obtain this result, raw coffee has been used. It gives to water a greenish hue, and, thus saturated, it has been called the _citrine coffee_. Grindel has used this preparation in the treatment of intermittent fevers in the Russian hospital of Dorpat; he also administered the raw coffee in powder. In eighty cases of this fever scarcely any resisted the power of this medicine, given either in decoction, powder, or extract; but he seems to consider the latter form the most effectual. From this physician's observations, coffee may become a valuable addition to our _materia medica_; and the homoeopathic practitioners maintain that they have employed it with great success in various maladies. AQUA TOPHANIA. It was for a long time supposed that there actually did exist in Italy a secret poison, the effects of which were slow, and even unheeded, until a lingering malady had consumed the sufferer. No suspicions were excited; or, had they led to any _post mortem_ examination, no trace of the terrific preparation's effects could have been detected. It was towards the year 1659, during the pontificate of Alexander VII., that the existence of this baneful preparation was suspected. Many young women had been left widows; and many younger husbands, who might have ceased to please their wives, had died away. A certain society of young ladies had been observed to meet under the auspices of an elderly matron of rather a questionable character, who had been known in her horoscopic predictions to announce deaths that had but too truly taken place about the period she prophesied. One of the society, it appears, _peached_ against her companions, who were all apprehended and put to the torture; and the lady patroness, whose name was Spara, was executed with four of her pupils. This Spara was a Sicilian, who had obtained the fatal secret from Tofania at Naples. Hence the composition was named _aqua Tofania_, _aqua della Toffana_, and _acquetta di Napoli_. These deadly drops had been charitably distributed by Tofania to various uncomfortable ladies who wished to get rid of their lords, and were contained in small phials, bearing the inscription of "_Manna de San Nicolas de Bari_." This hag had lived to an old age, but was at length dragged from a monastery, in which she had sought a sanctuary, tortured, and duly strangled, after a confession of her crimes. Garelli, physician to Charles VI., thus wrote to Hoffmann on the subject: "Your elegant dissertation on the popular errors respecting poisons brought to my recollection a certain slow poison which that infamous poisoner, still alive in prison at Naples, employed to the destruction of upwards of six hundred persons. It was nothing else than crystallized arsenic dissolved in a large quantity of water by decoction, with the addition, but for what purpose I know not, of the herb _cymbalaria_ (_antirrhinum_). This was communicated to me by his Imperial Majesty himself, and confirmed by the confession of the criminal in the judicial procedure." Abbé Gagliani, however, gives a different account of the secret Neapolitan drug. "At Naples," he says, "the mixture of opium and cantharides is known to be a slow poison; the surest of all, and the most infallible, as one cannot mistrust it. At first, it is given in small doses, that its effects may be insensible. In Italy it is called _aqua di Tufinia_: no one can avoid its attacks, since the liquid is as limpid as water, and cannot be suspected. Most of the ladies of Naples have some of it lying carelessly on their toilet-tables with smelling-bottles; but they always can know the fatal phial when they need its contents." A curious observer has remarked on these two preparations, that the mixture of Garelli was, perhaps, intended for husbands, while that of Gagliani was for the use of lovers. This remark appears judicious, since the potion described by the Abbé was evidently intended as an amorous philter. Under that head I have related many curious circumstances. There is no doubt but that these preparations often contained deadly drugs, the perilous qualities of which were most probably unknown to those who made them up without any sinister motives. Plutarch and Cornelius Nepos inform us that Lucullus, the Roman General, lost his reason, and subsequently his life, from having taken one of these mixtures; and Caius Caligula was driven into a fit of insanity by a philter given to him by his wife Cæsonia, as described by Lucretius: Tamen hoc tolerabile, si non Et furere incipias, ut avunculus ille Neronis Cui totam tremuli frontem Cæsonia pulli Infudit. Virgil also alludes to the powerful and baneful nature of the plants employed in magical incantations: Has herbas, atque hæc Ponto mihi lecta venena Ipse dedit Moeris; nascuntur plurima Ponto. His ego sæpe lupum fieri, et se condere silvis Moerin, sæpe animas imis excire sepulchris, Atque satas alio vidi traducere messes. Female poisoners of a somewhat similar description were known amongst the ancients. Nero, when he resolved to destroy Britannicus, sent for one of those murderers, named Locusta, who, convicted of several assassinations, was pardoned, but kept by the emperor to execute his secret purposes. He wished that on this occasion the poison should produce immediate death. Locusta prepared a drug that destroyed a goat in a few minutes. This was not sufficiently active. The next preparation killed a hog in a few seconds. It was approved of. The ill-fated youth was seated at the imperial festive board--the potion poured into his goblet--and he died in epileptic convulsions. Nero, undisturbed, requested his guests to remain quiet--the youth he said was subject to similar attacks, which in general were but of short duration; but soon the black, the livid hue of the face betrayed the poison, which the imperial assassin sought to conceal, by ordering this tell-tale sign to be concealed with paint. Sir Henry Halford seems to think that Juvenal alludes to this circumstance in his first Satire. Instituit rudes melior Locusta propinquas Per famam et populum _nigros_ effere maritos. The poisons used by the ancients appear to have been of various kinds; some more slow in their action than others, to suit, most probably, the views of their employers. Socrates, it is supposed, drank the _cicuta_, the action of which must have been very slow and weak, since his gaoler informed him that if he could exert himself in a warm debate, the effects might be arrested. The philosopher, however, remained tranquil. He shortly after experienced a numbness in the legs, gradually became insensible, and expired in convulsions. These secret poisons were conveyed in the most stealthy manner. Hence it is related, that the poison prepared by Antipater, to destroy Alexander, had been conveyed in a mule's hoof, being of so corroding a nature, that no metallic vessel could contain it. This absurd story was credited by Plutarch and Quintus Curtius, whereas it appears more probable that poison was carried in an _onyx_, of which trinkets to contain precious ointments were frequently made, or under a human nail, also called _Unguis_, or [Greek: onux]. The latter case was the opinion of Dr. Heberden. Sir Henry Halford, in his learned and interesting essay on the deaths of illustrious persons of antiquity, has clearly proved that Alexander was not poisoned, but died of a lingering fever of a remittent type; a disease that was most probably endemic in the marshes surrounding the city of Babylon. Many absurd ideas regarding venenose substances prevailed in ancient days as well as in modern times. Hannibal and Themistocles were said to have been poisoned with bullocks' blood. Eastern nations fancy that a fascinating power is the gift of virtue. In the _Hitapadesa_ of _Vishnusannan_ we find the following aphorism: "As a charmer draweth a serpent from his hole, so a good wife, taking her husband from a place of torture, enjoyeth happiness with him." Possibly some receipt of this description may be found in the archives of Doctors' Commons. PLICA POLONICA AND HUMAN HAIR. Hair may be considered a vegetation from the surface of the body. In a state of health, hairs are insensible, and it is more than probable that they possess no nerves, and that the circulation is carried on in the same manner as in plants. In the bulb or root of the hair, however, the vessels that promote this circulation are numerous, and there we may trace the diseases that affect this beauteous ornament of mankind, more especially in the Caucasian race. Long hair, of course, requires more nutriment than scanty locks, and some physicians have been of opinion that their great length debilitates. Dr. Parr affirms that he has observed symptoms of plethoric congestion to arise after long hair had been suddenly cut off. Vauquelin has made curious experiments on this substance. A solution of black hair has deposited a black matter containing bitumen, sulphur, and iron; and alcohol extracted from the same coloured hair a whitish and a grayish-green oil. Red hair yielded whitish matter and a blood-red oil. White hair contained phosphate of magnesia, affording a proof of the disposition towards the formation of calcareous matter in old age. When hair becomes suddenly white under the shock of a severe moral impression, Vauquelin is of opinion that this phenomenon is to be attributed to the sudden extrication of some acid, as the oxymuriatic acid is found to whiten black hair. Parr thinks that this accident may be owing to an absorption of the oil of the hair by its sulphur, as in the operation of whitening woollen cloths. The _plica_ is a curious and disgusting malady, that has been considered a disease of the hair, which, according to vulgar report, secreted and shed blood. This affection is common and endemic in Poland; hence the term _Polonica_ that has been given to it. The invasion of this pestilence has been traced to the irruption of the Moguls, from 1241 to 1287, chiefly under the command of Cayuk, grandson of Yenghiz. The most absurd tales were then related of the manner in which this dreaded infection was propagated. Spondanus affirms that it arose from the waters having been poisoned by venomous plants. Pistorius and Pauli relate that these waters were corrupted by the great number of human hearts that the Moguls cast in rivers and in wells. This supposition arose from the unheard-of acts of barbarity perpetrated by the ferocious invaders on the wretched population of Prussia, Poland, Hungary, and Transylvania. Their refined cruelty has been depicted by Gebhardi, in his history of Hungary, in the most glowing language. Other historians assert that the plica originated in the East; such is the opinion of Stabel, Spreugel, and other writers. Rodrigo de Fonseca relates that the Indians, after drinking certain waters, were attacked with a disease in which the hair became agglomerated and matted in the most disgusting manner. Erndtel attributes the malady in Poland to the gluttonous consumption of horseflesh. However this may be, Poland has been ever considered the country most exposed to this visitation. This disease affords a convincing proof of the vascularity of the hair, since it tumefies, augments in capacity so as to allow an evident circulation of blood, as the hairs will often bleed when divided with the scissors. Dr. Kerckhoffs regards the malady as the mere result of the custom among the filthy Poles of letting the hair grow to an immense length, of never combing or cleaning it, and always keeping the head covered with a woollen or leathern cap. Hence he observes that the rich are generally exempt from the affection which particularly prevails amongst the Jews. With this view of the disorder, he thinks that cleanliness and the excision of the matted hair are sufficient to effect a cure. It is, however, more than probable that other causes occasion this horrible disease; and there is but little doubt that the system is affected by a particular virus. In many instances affections of the head complicate it; although it is likely that they may result from the constant irritation of the scalp, that sympathizes so powerfully with the membranes of the brain. The different names given to the _plica_ indicate more or less the ideas that prevail regarding its nature. The Poles call it _gwozdiec_ or _gwodziec_, which signifies a _nail_ that splits the wood into which it is driven. In the district of the Roxolans it is termed _koltun_, _a stake_. In Germany superstitious fancies have also given it various curious denominations. It is called _alpzopf_ and _schraitelzopf_, as being the result of the _malefices_ of vampires and incubi. By some it is asserted that the Moravians, natural enemies of the Poles, not having been able to conquer them by their arms, had recourse to magical art to inflict this scourge: hence they term it _mahrenflechten_, _mahrenwichtung_. To this day it is called _hexenzopf_ and _bichteln_, or unbaptized, alluding, no doubt, to the Jews, who were accused of having introduced the disorder in the deadly hate they bore the Christians; hence was it also known by the name of _Judenzopf_ (_Coma Judæorum_). Amongst the whimsical ideas to which the _plica_ has given rise, the most extraordinary effort of the imagination was that of Hercules Saxoniæ. He maintained that the fabulous description of the heads of the Gorgons and the Furies was derived from this affection: "_Caput Gorgoneum, caput Furiarum, vera humana capita fuisse, et fictitiis poetarum occasionem præbuisse_." There are instances on record of infants being born with this loathsome malady. Davidson attributes this circumstance to the mental impressions of the mother: "_Si ita matris ac nutricis superstitioni placere libuerit_." The length of the matted hair in plica is frequently considerable: Bachstrom relates the case of a Prussian woman whose hair extended beyond the sides of her bed, and she was in the habit of turning it over to make a quilt of it; Caligerus saw a man in Copenhagen whose clotted locks were six feet three inches in length; and Rzaczyinski gives an account of a woman whose hair measured six ells. In the museum of Dr. Meckel, at Halle, is to be seen a specimen of the disease eight feet long. The beard and the hair of other parts of the body are equally liable to these attacks; while the affection has been observed in horses, dogs, and other animals. A curious case is related on this subject by Dr. Schlegel: A drunken coachman was carried away by a pair of spirited young horses, who precipitated themselves, with the fragments of the broken carriage, into the Moskwa. One of the animals was drowned; but the other contrived to extricate itself, and swam ashore. It continued sick for a considerable time, and, on its convalescence the plica broke out in its entire coat. The assertion that the hairs become endowed with sensibility in this disorder is unfounded. The pain is experienced in the root or bulb; thus a painful sensation is occasionally felt when a lock of hair has been turned back under the nightcap. There is little doubt that the plica is to be attributed to a specific virus, which pervades the whole system unless successfully treated. The most serious accidents have arisen from neglecting it; and Starnigelio gives the following horrible account of its ravages. "Magno omnium malo magnoque cruciatu divagatur: infringit ossa, laxat artus, vertebras eorum infestat. Membra conglobat et retorquet; gibbos efficit, pediculos fundit, caputque aliis atque aliis succedentibus ita opplet, ut nequaquam purgari possit. Si cirri raduntur, humor ille et virus in corpus relabitur, et affectos, ut supra scriptum est, torquet; caput, manus, pedes, omnes artus, omnes juncturas, omnes corporis partes exagitat." Amongst the various specifics recommended for the cure of plica, is the _lycopodium_, hence called _herba plicaria_; the _vinca_, or _perventia_. The [Greek: daphnoeides] and [Greek: kamai daphnê] of the Greeks was also extolled, possibly from its supposed powers in cases of incantation, whence Apuleius calls it "_victoria, quod vinceret pervinceretque injuriam temporis_." This is the plant for which Rousseau felt such a predilection, that in after life he never beheld it without experiencing a delightful recollection of the pleasures of his boyhood. Its flowers are considered the symbol of virginity, and in Flanders are still called _Maegden-palm_. In Etruria maidens are crowned with a wreath of it on their funerals. The decay and fall of the hair is an accident of frequent occurrence. This unpleasant drawback on vanity has been termed _alopecia_, from the Greek word [Greek: alôpêx], _vulpes_, a _fox_; this animal and the wolf being said to lose their hair and become bald sooner than any other quadruped. The Arabian writers were impressed with the same belief, and named the affection _daustaleb_, literally the _wolf disease_. Baldness is more frequent in males than in females; and it has been observed, that emasculated subjects are exempt from its visitation. Amongst the singular anomalies that characterize our ideas, the respect in which hair (naturally unclean unless most carefully attended to) was held at various periods is as singular as the fond devotion with which it is treasured when having belonged to the objects of our affections. In ancient Rome neglected hair was the badge of bondage, and slaves were distinguished by the _capillum passum, fluxum, et intonsum_. Free men, on the contrary, took great care of it; and the term _cæsaries_ is said to be derived from the frequency of its cutting, while _coma_ alluded to the great attention paid to its ornamental appearance. The Gauls wore long hair, and their country was thence called _Gallia Comata_. The German chiefs, deprived of their rank and power, were shorn of their locks as a mark of degradation and loss of strength. Shaving the heads of criminals is to this day considered ignominious. Hair, most unquestionably, constitutes the proudest ornament of female beauty; and clustering locks, compared both by the ancients and the Oriental poets to the growth of grapes, has ever been considered a _desideratum_ at the female toilet, artificial means to curl it having been resorted to from time immemorial, even by men. We find Virgil speaking contemptuously of Æneas for the care he took of his locks: Vibratos calido ferro, myrrhaque madentes. The Romans called a man who thus frizzled himself, _homo calamistratus_. Crisp and curled ringlets were ever admired, and Petrarch thus describes them: Aura che quelle chiome bionde e _crespe_ Circondi, e movi, e se mossa de loro Soave mente, e spargi quel dolce oro E poi'l raccogli, e'n bei nodi _l'increspe_. Apuleius maintains, that if Venus were bald, though circled by the graces and the loves, she would not please even swarthy Vulcan. Petronius, in his description of Circe, describes her tresses naturally curling, and falling negligently over her shoulders, which they entirely covered. Apuleius praises her trailing locks, thick and long, and insensibly curling, dispersed over her divine neck, softly undulating with carelessness. Ovid notices those beauties who platted their braided hair like spiral shells. Petronius, to give an idea of a perfect beauty, says, that her forehead was small, and showed the roots of her hair raised upwards. This fashion, adopted by the Chinese, was not long ago a modish _coëffure_ in France. Lucian, however, makes Thais say of a rival courtezan, "Who can praise her person, unless he is blind? Does she not draw up her scanty hair on her large forehead?" The ancients also perfumed their hair, especially on festivals, with various ointments, composed of the spikenard and different balsams. They also occasionally painted it with a bright yellow. Unhappy must have been the poor slaves who had to attend a Roman lady's toilet; if a single ringlet was displaced, the scourge was applied, and the _cow-skin_ of our West Indian planters, the _Taurea_ ("_scutica de pene taurino_") brought into play; and not unfrequently the head of the offender was broken with the steel mirror that betrayed their negligence to the impatient fair one. As we are on the subject of female ingenuity in endeavouring to spread their nets more cunningly, it may be some comfort to our modern coquettes to know that antiquity seems to sanction the use of rouge, notwithstanding the fate of Jezabel. Plautus tells us that the Roman dames daubed their faces with the "_fucus_, compound of white lead and of vermilion:" hence were they called _fucatæ_, _cerusatæ_, and _minionatæ_. Various cosmetics were also employed, and, when at home, their faces were preserved with a coat of paste, the skin having been previously rubbed with a pumice-stone, and then washed with asses' milk. Poppæa, the wife of Nero, had five hundred asses milked every day for her baths; and when she was exiled, a reduction of her establishment to fifty asses was considered a severe chastisement. Patches were also worn, of various shapes and dimensions, even by men; and Pliny tells us of one Regulus, a lawyer, who put a patch upon his right or left eye as he was going to plead for plaintiff or defendant. The ancients also wore a certain hair-powder, a custom that was only revived in Europe in the seventeenth century, since it appears that this filthy fashion was brought in vogue at the fair of St. Germain, in 1614, by some beautiful ballad-singers. In ancient mythology, hair was the symbol of life. All dead persons were supposed to be under the jurisdiction of the infernal deities, and no man could resign his life until some of his hair was cut off. Euripides introduces Death going to cut off some of the hair of Alcestis, when doomed to die instead of her husband Admetus; and Virgil describes Dido unable to resign her life, from her hair having been cut off by Proserpine, until Iris was sent by Juno to perform the kind office: "Hunc ego Diti Sacrum jussa fero, teque isto corpore solvo." Sic ait, et dextra crinem secat; omnis et unà Dilapsus, calor, atque in ventos vita recessit. Locks of hair were suspended over the door of the deceased, to show that the family were in mourning. On these occasions, the hair was torn, cut off, or shaved. It was then sometimes strewed over the dead body, or cast on the funeral pile. On the demise of great men, whole cities and communities were shorn, while animals shared a similar fate. Admetus, on the death of Alcestis, ordered this operation to be performed on his chariot horses: and when Masistius was slain by the Athenians, the Persians shaved themselves, their horses, and their mules. Alexander, not satisfied with this testimony of grief, ordered the very battlements of a city to be knocked down, that the town might look bald and shorn of its beauty. While in some cases bald heads were expressive of affliction, in others long hair denoted grief; Joseph allowed his hair to grow during his captivity; and Mephibosheth did the same when David was banished from Jerusalem. Juvenal informs us that mariners, on their escape from shipwreck, shaved their heads; and Lycophron describes long and neglected hair as a sign of general lamentation. To be shaved by barbers was a proof of cheerfulness; but to cut off one's own hair denoted mourning. Hence Artemidorus informs us that for a man to dream of shaving himself was a presage of some calamity. However, this ceremony may, in its signification, be attributed to the customs of the various nations. Where the hair was generally worn short, its length indicated grief, and _vice versâ_. The filth of long and neglected hair might also have been considered a proper and respectful mark of tribulation; for the ancients fancied that rolling themselves in the dirt was a convincing proof of affection; and we see Oeneus besmearing himself with nastiness on the death of his son Meleager: Pulvere canitiem genitor, vultusque seniles Foedat humi fusos, spatiosumque increpat ævum. Shaving was also a nuptial ceremony, when virgins presented their hair to Venus, Juno, Minerva, Diana, and other propitious divinities. At Troezene virgins were obliged to sacrifice their hair to Hippolytus, the son of Theseus, who died for his chastity. The Megarensian maidens presented them to Sphinoe, daughter of Alcathous, who died a virgin. Statius records this ceremony, when speaking of Minerva's temple: Hic more parentum Insides, thalamis ubi casta adolescerat ætas, Virgineas libare comas; primosque solebant Excusare toros. ANIMAL MAGNETISM. Are we to give credit to the various observations that record the wonderful effects of animal magnetism; or should we reject them as the impostures of knaves, or the result of the credulity of fools? It is now nearly half a century since this method of relieving diseases has been introduced by modern practitioners. Thousands of disinterested and candid witnesses have corroborated their assertions, and testified to their veracity. How, then, are we authorized to treat this doctrine as visionary or fraudulent? The most learned bodies have not thought it derogatory to their dignity to investigate the matter; and, notwithstanding opposition, ridicule, and contempt, the practice obtains to the present day. It has, no doubt, been materially impeded in its progress by the invectives of occasional scepticism; but such will ever be the case with science, and those discoveries which accelerate its inevitable empire on the human understanding. Persecution may be considered as the harbinger of truth, or, at any rate, of that investigation which directs to it. Pythagoras was banished from Athens; Anaxagoras was immured in a dungeon; Democritus was considered a maniac, and Socrates condemned to death. An advanced and honourable old age did not protect Galileo against his barbarous persecutors. Varolius was decreed an infamous and execrable man for his anatomical discoveries, and our immortal Harvey was looked upon as a dangerous madman. Inoculation and vaccination were deemed impious attempts to interfere with the decrees of Providence. Magnetism may be defined as a reciprocal influence which is supposed to exist between individuals, arising from a state of relative harmony, and brought into action by the will, the imagination, or physical sensibility. This influence is said to exist in a peculiar fluid, transmissible from one body to another under certain conditions of each individual, without which the expected results are not manifest. Under these conditions, the effects of animal magnetism are obtained by manual application, by gestures, words, and even looks, more frequently, as may be easily conceived, with nervous, weak, and impressionable individuals. By these means magnetizers affirm that they can effect cures when all other remedial endeavours have been of no avail, either when the patient is awake or in a state of artificial somnambulism. The history of this doctrine is curious. The ancients fully admitted the power of sympathy in the cure of diseases; but generally attributed its action to the interference of Divinity, or the operation of sorcery and enchantment. A remarkable affinity can be traced between modern magnetism and its supposed phenomena, and the relations of the Pythian and Sibylline oracles, the wonders of the caverns of Trophonius and Esculapius, and the miraculous dreams and visions in the temples of the gods. Amongst the Hebrews, the Egyptians, the Greeks, and Romans, we constantly discover traces of this supposed power of manual apposition, friction, breathing, and the use of the charms of music and mystic amulets. The Egyptian priesthood were considered as possessing a divine attribute in healing diseases. Prosper Alpinus, in his treatise on the medicine of the Egyptians, informs us that mysterious frictions were one of their secret remedies. The patients were oftentimes wrapped in the skins of animals, and carried into the sanctuary of their temples to be assisted by visions, that appeared either to them or to their physicians, who pretended that Isis was the immortal source of these celestial inspirations. The same divine assistance was firmly believed by the Hebrews. It was intimated to Miriam and Aaron that the Lord would make himself known to them in a vision, and speak to them in a dream; and we find in Deuteronomy that the signs and the wonders of prophets and dreamers of dreams were to be considered as the abominations of idolaters, who were to be put to death without pity. This anathema on false prophets was not unfrequently rigorously carried into execution, and we read in the Book of Kings the destruction of all the worshippers of Baal. Ahab marched upon Ramoth-Gilead by the advice of his prophets. The sympathetic power of corporeal apposition was illustrated when Elisha, to revive the widow's child, stretched himself three times upon him and prayed to the Lord. When Elisha restored the child of the Shunamite to life he lay upon it, put his mouth upon his mouth, his eyes upon his eyes, and his hands upon his hands, and he stretched himself upon the child, and the child opened its eyes. Miracles were generally wrought by manual application or elevation. Naaman expected that Elisha would have stricken his hand over the place to cure his leprosy; and we find in the Scriptures that our SAVIOUR healed the sick upon whom he laid his hands. Amongst the Greeks we again see the same ceremonies performed on all wonderful recoveries. Plutarch tells us that Pyrrhus cured persons with diseased spleens by passing his hand over the seat of the malady. Ælianus informs us that the Psylli performed their cures by stretching themselves upon the patients, and making them swallow water with which they had rinsed their mouths; and he also mentions that those who approached these mysterious agents were seized with a sudden stupor, and deprived of their intellects until they had left them. Apollonius brought a young girl to life by touching her, and leaning over her as though he were whispering some magic words in her ear; and Origenes affirms that there were sages who dispensed health with their mere breath. Vespasian restored sight to the blind by rubbing their eyes and cheeks with his saliva, and cured a paralytic by merely touching him: the same emperor kept himself in perfect health by frequently rubbing his throat and his body. From a passage of Plautus, it appears that this manual application was resorted to in his days to procure sleep. Mercury is made to say, "Quid si ego illum tractem, tangam ut dormiat;" to which Sosia replies, "Servaveris, nam continuas has tres noctes pervigilavi." Pliny maintains that there exist persons whose bodies are endowed with medicinal properties; but he admits, at the same time, that imagination may produce these salutary emanations. Celsus informs us that Asclepiades by friction could calm a phrensy; and further states, that when these frictions were carried to too great an extent, they brought on a lethargic state. Cælius Aurelianus recommends manual frictions for the cure of pleurisy, lethargy, and various other maladies, describing the manner in which they are to be conducted: for instance, in epilepsy, the head and forehead are to be chafed, then the hand is to be carried gently over the neck and bosom; at other times, the extremities of the hands and feet are to be grasped, that "we may cure by the very act of holding the limb." That remedies were indicated in a state of somnambulism is affirmed by Tertullian, who thus speaks of one of the followers of Prisca and Maximilla, two women who foretold future events when they fell into an ecstatic swoon: "She conversed with angels, discovered the most hidden mysteries, prophesied, read the secrets of the heart, and pointed out remedies when she was consulted by the sick." He thus describes ecstasy in his treatise _De Anima_: "It is not sleep, for during sleep all reposes; whereas in ecstasy the body reposes, while the soul is actively employed. It is therefore a mixed state of sleep and ecstasy which constitutes the prophetic faculty, and it is then that we have revealed unto us, not only all that appertaineth to honour, to riches, but the means of curing our diseases." St. Stephen relates the case of a youth who was in such a lethargic state, that he was insensible to all painful agents, and could not be awakened; but when he recovered his senses, he declared that two persons, the one aged, the other young, had appeared to him and recommended sea-bathing. He complied with the instruction, and was cured. But the miracles of paganism were soon discredited, when the relics and tombs of saints were resorted to instead of the temples of the false gods; and priests assumed the power once held by their Chaldean and Egyptian predecessors, and the Druids of Gaul. The beatified were not only physicians during their life, but medicinal after death. St. Gregory of Tours tells us that St. Cosmus and St. Damian were not only able physicians during their blessed existence, but assisted all those who consulted them in their tombs, not unfrequently appearing to them in visions, and prescribing the proper remedies. A saint's breathing upon a veil, and then placing it on the head of a demoniac, infallibly cast out the evil one; and St. Bernard never failed in his exorcisms, by making the possessed swallow some water in which he had dipped his hands. St. Martin stopped the most fearful hemorrhage by merely touching the patient with his garment. The shrines of St. Litardus, St. Anthony, and various other saints, lulled to sleep, and inspired with miraculous visions those who sought their aid. However, as the progress of intellect dispelled the dark clouds that shrouded the middle ages in superstitious and credulous prejudices, philosophy endeavoured to investigate the nature of this mysterious agency, which priests had for so many centuries usurped as their special gift and property. Sceptic as to supernatural powers in the common occurrences of life, philosophers attributed these phenomena to some peculiar principle with which organized bodies were endowed, and hence arose the dawn of the doctrine of animal magnetism. So early as 1462, Pomponatius of Mantua maintained, in his work on incantation, that all the pretended arts of sorcery and witchcraft were the mere results of natural operations; he further gave it as his opinion, that it was not improbable but that external means, called into action by the soul, might relieve our sufferings; that there, moreover, did exist individuals endowed with salutary properties, and it might therefore easily be conceived that marvellous effects should be produced by the imagination, and by confidence, more especially when they are reciprocal between the patient and the person who assists his recovery; physicians and men of sense being well convinced that if the bones of any animal were substituted for those of a saint, the result would be the same. It need not be added that our author was violently persecuted for this heretical doctrine. Two years after, Agrippa, in Cologne, asserted that the soul, inflamed by a fervent imagination, could dispense health and disease, not only in the individual himself, but in other bodies. In 1493, Paracelsus expressed himself in the following language: "All doubt destroys work, and leaves it imperfect in the wise designs of nature. It is from faith that imagination draws its strength. It is by faith that it becomes complete and realized. He who believeth in nature, will obtain from nature to the extent of his faith. Let the object of this faith be real or imaginary, you nevertheless reap similar results; and hence the cause of superstition." Cardanus, Bacon, and Van Helmont pursued this study; and the latter physician, having cured several cases by magnetism, was considered a sorcerer, and was seized by the Inquisition. Magnetism, he observed, "is a universal agent, and only novel in its appellation, and paradoxical to those who ridicule every thing they do not comprehend, or attribute to Satan what they cannot understand. The name of magnetism is given to that occult influence which bodies possess on each other at various distances, either by attraction or by impulsion. The means or the vehicle of this influence is an ethereal spirit, pure, vital, (_magnale magnum_,) which penetrates all matter, and agitates the mass of the universe. This spirit is the moderator of the world, and establishes a correspondence between its several parts and the powers with which it is endowed. We can attach to a body the virtues that we possess, communicate to it certain properties, and use it as the intermediate means to operate salutary effects. I have hitherto withheld the revelation of this great mystery. There exists in man a certain energy, which can act beyond his own person according to his will or his imagination, and impart virtues and exercise a durable influence even in distant objects. Will is the first of powers." Van Helmont fully admitted the wonderful faculties that somnambulism seemed to develop, and informs us that it was chiefly during his sleep that he was inspired with his doctrines. One might have imagined that these philosophic researches would have put an effectual stop to the progress of superstition, or rather of persecution; yet their promulgation could not save Urbain Grandier, and many supposed sorcerers, from a barbarous death. It was in the beginning of the eighteenth century that various experiments were made with the loadstone in researches regarding electricity. In 1754, Lenoble had constructed magnets that could be used with facility in the treatment of various diseases. In 1774, Father Hell, a Jesuit and professor of astronomy at Vienna, having cured himself of a severe rheumatism by magnetism, related the result of his experiments to Mesmer. This physician was immediately struck with observations that illustrated his own theories respecting planetary influence. He forthwith proceeded to procure magnets of every form and description for the gratuitous treatment of all those that consulted him; and, while he widely diffused his doctrines, he sent his magnets in every direction to aid the experimental pursuits of others, and thus expressed himself on the subject in a memoir published in 1779: "I had maintained that the heavenly spheres possessed a direct power on all the constituent principles of animated bodies, particularly on the _nervous system_, by the agency of an all-penetrating fluid. I determined this action by the INTENSION and the REMISSION of the properties of matter and organized bodies, such as gravity, cohesion, elasticity, irritability, and electricity. I supported this doctrine by various examples of periodical revolutions; and I named that property of the animal matter, which renders it susceptible to the action of celestial and earthly bodies, ANIMAL MAGNETISM. A further consideration of the subject led me to the conviction that there does exist in nature an universal principle, which, independently of ourselves, performs all that we vaguely attribute to nature or to art." Mesmer, as might have been foreseen, became the object of persecution and of ridicule, and withdrew to Switzerland and Suabia. It was there that he met with a certain Gassner of Braz, who, having fancied that an exorcism had relieved him from a long and painful malady, took it into his head to exorcise others. He considered the greater part of the disorders, to which flesh is heir as the work of the devil, and he counteracted his baneful influence in the name of our SAVIOUR. He divided these diabolical visitations into _possessions_, _obsessions_, and _circumsessions_; the latter being trifling invasions. For the purpose of ascertaining whether his patients laboured under natural or infernal ailments, he conjured Satan to declare the truth. If, after three solemn interpellations, and signs of the cross, the devil did not answer, the disorder was considered as coming within the province of medicine; but if, on the contrary, the patient fell into convulsions, Gassner drew forth his stole and crucifix, and, in the name of the Redeemer, commenced rubbing and pinching, sometimes in the most indecorous manner, when females were submitted to his manipulations. When his attempts failed, he accused the patient of want of faith or of the commission of some deadly sin, which baffled his endeavours. His fame became so universal, that the Bishop of Ratisbon sent for him, and he exercised his art under his auspices. At one period, the town was so crowded with his patients, that ten thousand of them were obliged to encamp without the walls. It appears that this adventurer had the power of acting upon the pulse, and could increase or retard it, render it regular or intermittent, and was even reported to paralyze limbs and produce tears or laughter at will. It is scarcely credible, yet the celebrated De Haen, one of the most distinguished and learned practitioners in Germany, not only believed in the power of this Gassner, but actually attributed it to a paction with the devil. Mesmer was not so credulous, and explained the miraculous cures of Gassner by the doctrines of the animal magnetism which he advocated. From Suabia he returned to Vienna, whence he was expelled as a quack; and in 1778 arrived at Paris, a capital that had patronised Cagliostro and St. Germain, and was ever ready to be deceived by ingenious empiricism. In 1779 he published a paper on the subject, in which he maintained twenty-seven propositions to establish his supposed influence between the celestial bodies, the earth, and animated matter, produced by a fluid universal, subtile, susceptible of receiving, transmitting, and communicating its impressions, on mechanical principles, until then unknown, and producing alternate effects of flux and reflux. This powerful agent, he said, acted chiefly on the nervous system. The human body, moreover, according to his notions, possessed properties analogous to the loadstone, and presenting an opposed polarity, subject to various modifications, which either strengthened or weakened it. The action of animal magnetism, according to him, was not confined to animal matter, but could be equally communicated to inanimate bodies at various distances. Mirrors could reflect and increase its power like the rays of light, and sound could propagate and increase it. This magnetic property, he further stated, could be accumulated, concentrated, and transported at pleasure, although there did exist animated bodies possessed of properties so opposite as to render this powerful agent inefficient. He found that the loadstone was susceptible of animal magnetism, and of its opposite virtues, without any apparent influence on its power over iron and the needle; whence he concluded that there existed a wide difference between animal and mineral magnetism. Mesmer soon found a warm advocate of his doctrines in a Dr. D'Eslon, and animal magnetism became in fashionable vogue. Not only were men and animals subjected to their experiments, but this wondrous influence was communicated to trees and plants, and the celebrated elm-tree of Beaugency was magnetized by the Marquis de Puységur and his brother; while the enthusiastic D'Eslon absolutely went knocking from door to door to procure patients. Breteuil, who was then one of the ministers, offered Mesmer a yearly pension of thirty thousand francs, with a sum of three hundred thousand francs in cash, with the decoration of St. Michael, if he would consent to reveal the mysteries of his science to the medical faculty. This tempting offer our magnetizer indignantly rejected, and a secret society was instituted under the name of the Lodge and Order of Harmony. The charms and the power of youth and music were not neglected as auxiliaries to propagate the fashionable doctrine. Young men of elegant manners and athletic form were initiated in the practice of magnetizing, and the _salons_ of Paris consecrated to this worship (for such it might have been termed) were crowded with the most fascinating women that the gay metropolis of France could produce. Most of these females, impassioned by nervous excitability, as loose in their morals as to outward appearance they were fervent in their devotions, abandoned themselves without reserve to the delightful sensations that magnetism and its surrounding machinery were said to afford. In their ecstasies, their hysteric attacks, their spasms, Mesmer, the high-priest, fancifully dressed, but in the height of fashion, with his useful acolytes, endeavoured to soothe and calm the agitation of their enchanting patients by all the means that Mesmerism could devise. It soon became pretty evident that these phenomena were solely to be attributed to the influence of imagination; and Doppet, one of the most ardent disciples of the new creed, frankly avowed that "those who were initiated in the secrets of Mesmer entertained more doubts on the subject than those who were in thorough ignorance of them." Notwithstanding this evidence brought forward against Mesmer's fascinating practice, he was warmly eulogised even by high churchmen; and Hervier, a doctor of Sorbonne, did not hesitate to assert that the Golden Age was on the return; that man would be endowed with fresh vigour, live for the space of five generations, and only succumb to the exhaustion of age; that all the animal kingdom would enjoy a similar blessing; while magnetized trees would yield more abundant and delicious fruits. This belief of the good ecclesiastic arose, according to his own assertion, from his having been cured of some cruel disorder by magnetism, while all his intimate acquaintances insisted that he had never ceased to enjoy perfect health. Such were the circumstances that attended the introduction of animal magnetism, which to this day is defended and maintained by ardent proselytes. Sound philosophy can only attribute its wonderful phenomena, many of which cannot be denied, to the influence of the imagination, and the all-powerful deceptive agency of faith. It is an incontrovertible fact, that the nervous system may be so worked upon, thrown by various secret and physical means into such a morbid condition, that results bordering upon the miraculous in the eyes of the credulous may be easily obtained. Every circumstance that appears to differ from the usual course of nature is deemed miraculous by the ignorant; and the Greek proverb [Greek: thaumata môrois], plainly maintains that miracles are only for the simple. In fact, who are the persons who in our times cry out "miracle," but weak and timid men, worn out by excesses or age, labouring under the influence of terror; silly old women, who have not the power of reasoning; or nervous and enthusiastic females, who seek for some saving clauses in a pact between vice and virtue, depravity and religion. All the wonders of the creation are miraculous, if we are to consider those phenomena that are, and most probably will ever remain, beyond our humble and miserable comprehension to be such. The manifestations of the Creator's will are daily exhibited in stupendous forms that strike the ignorant with awe, while they lead the man of science to bow in grateful veneration to that Almighty power that has harmonized the creation for our wellbeing, if we would only obey the sublime dictates of his laws, without attempting to scrutinize their spirit by quibbling with their letter. There can be but little doubt that the wonders of magnetism may be referred to the imagination; yet some of the phenomena must excite our surprise, and may occasion some degree of hesitation in invariably attributing its results to fancy. The Academy of Medicine of Paris having appointed a commission of twelve members to examine and report upon it, their inferences were as follow: 1. The effects of magnetism were not evident in healthy persons, and in _some_ invalids. 2. They were _scarcely_ apparent in others. 3. They _often_ appeared to be the result of ennui, monotony, and the influence of imagination. 4. Lastly, _they are developed independently of these causes, very probably by the effects of magnetism alone_. The points of this report that I have printed in italics prove most clearly that the members of the commission, all of whom were decidedly adverse to the doctrine, were convinced, at least to a certain extent, by the experiments they had witnessed, of some singular powers residing in this mysterious science. Such must have been the case, since we find three members seceding from their associates, Laennec, Double, and Magendie, all well known as distinguished physiologists, somewhat inclined to pure materialism, and what may be termed _matter-of-fact_ men, who would hesitate in yielding their belief to any assertion that the scalpel could not demonstrate. Notwithstanding the protest of these gentlemen, the following were the conclusions of the commission: 1. Contact of the thumbs and magnetic movements are the means of relative influence employed to transmit magnetic action. 2. Magnetism acts on persons of different age and sex. 3. Many effects appear to depend on magnetism alone, and are not reproduced without it. 4. These effects are various. Sometimes magnetism agitates, at other times it calms. It generally causes acceleration of the pulse and respiration, slight convulsive movements, somnolency, and, in a few cases, somnambulism. 5. The existence of peculiar characters of somnambulism has not yet been proved. 6. It may, however, be inferred that this state of somnambulism prevails when we notice the development of new faculties, such as _clairvoyance_ and intuitive foresight, or when it produces changes in the physiological condition of the individual, such as insensibility, sudden increase of strength, since these effects cannot be attributed to any other cause. 7. When the effects of magnetism have been produced, there is no occasion on subsequent trials to have recourse to _passes_.[42] The look of the magnetizer and his will have the same influence. 8. Various changes are effected in the perceptions and faculties of those persons in whom somnambulism has been induced. 9. Somnambulists have distinguished with closed eyes objects placed before them. They have, then, read words, recognised colours, named cards, &c. 10. In two somnambulists we witnessed the faculty of foreseeing acts of the organism to take place at periods more or less distant. One announced the day, the hour, and the minute of the invasion and recurrence of an epileptic fit; the other foresaw the period of his recovery. Their anticipations were realized. 11. We have only seen one somnambulist who had described the symptoms of the diseases in three individuals presented to her. 12. In order to establish justly the relations of magnetism with therapeutics, one must have observed the effects on a number of individuals, and have made experiments on sick persons. Not having done this, the commissioners can only say, they have seen too few cases to enable them to form a decisive opinion. 13. Considered as an agent of physiological phenomena, or of therapeutics, magnetism should find a place in the range of medical science, and be either practised, or its employment superintended by a physician. 14. From the want of sufficient opportunities, the commission could not verify the existence of any other faculties in somnambulists; but its reports contain facts sufficiently important to conclude that the Academy ought to encourage researches in animal magnetism, as a curious fact of psychology and natural history. This report was impugned by Mr. Dubois, in what he calls his rational conclusions, which of course maintain that those of the commission were irrational. However, in this paper he merely affirms his own incredulity, without supporting it upon any grounds of experiment or observation; and therefore his observations must be considered an individual attempt to refute the assertions of a body of scientific men, who, after diligently and maturely weighing the arguments in favour of a doctrine that they were previously disposed to condemn as unworthy of research, came to the conclusions that we have seen. While the French Academy did not consider it beneath their dignity to investigate this doctrine, in other parts of Europe it attracted the attention both of the reigning monarchs and the most distinguished physicians. In Prussia, Hufeland, who had been one of the warmest opponents of magnetism, became a convert; and a clinical hospital was established in Berlin, by order of the government, to observe and record its phenomena. At Frankfort and Groningen, Drs. Passavant and Bosker published works on the subject; the latter having translated the critical history of Deleuze. At Petersburg, Dr. Stoffreghen, first physician of the Emperor, pronounced himself with several colleagues in its favour; and most of these distinguished men seemed to partake of the opinion of the justly celebrated Orfila, who certainly may be considered as an authority, and who thus expressed himself on the subject: "If there exists trickery and quackery in animal magnetism, its adversaries are too hasty in refusing to admit all that has been asserted in regard to its effects. The testimony of enlightened physicians should be considered as proofs. If the magnetic phenomena appear extraordinary, the phenomena of electricity appeared equally marvellous in its origin. Was Franklin to be considered a quack when he announced that with a pointed metal he could command thunder? Whether magnetism acts in good or in evil, it is clearly a therapeutic agent, and it behoves both the honour and the duty of the Academy to examine it." Such is the present state of this curious science. To what credit it may be entitled, and how far it may become a useful medical agent, experience alone can decide. At the same time, it would be unjust to assert, in our present ignorance, that all the learned and independent men who support it are either fools or knaves.[43] POISONOUS FISHES. The deleterious qualities of certain fishes have long been the subject of medical conjectures. It is somewhat singular, and most difficult to account for, that the same fish should be wholesome in some waters, and deadly in others, although under the same latitude, and when, to all appearance at least, no local cause can be discovered to which we might reasonably attribute this fatal property. So powerful and prompt moreover, it is in its action that rapid death will ensue whenever a small portion of the fish has been eaten. Such, for instance, is generally the case with the yellow-bill sprat, the _clypea thrissa_. Some naturalists attribute this poison to copper banks, on or near which the fish may feed. The absurdity of this opinion has been fully demonstrated; in the first instance, no such copper banks have been discovered in the West Indies, and these fish abound on the coasts of islands of coral formation. Moreover, it is not likely that this mineral should saturate the animal; and, even if it could produce this effect, the entire body would in all probability be affected, whereas the poison seems to lie in particular parts, chiefly in the intestines, the liver, the fat, &c. This is evident from the practice of fishermen, who can eat poisonous fish with impunity if they have taken the precaution to draw them carefully and salt them. In addition to these observations, the symptoms of the disease thus produced, by no means resemble those of mineral poisons. Dr. Chisholm, who pretends that copper banks do exist in the Windward Islands, is of this opinion. Admitting the facts, it may be asked, have the waters of these seas been impregnated by the copper? if they are not, how can its influence extend to its inhabitants? and why are particular fish only affected? Moreover, although it is well known that certain substances are deleterious to some animals and harmless to others, yet one might fancy that, if the coppery principal of an animal's flesh could poison, it is not irrational to think that the same deadly substance would also destroy the animal. The presence of this mineral has never been detected by any chemical test; and, if the poison consisted in copper, how could salting the fish destroy it? In opposition to these objections, it has been maintained that fish may be rendered poisonous by feeding on the marine plants that grow upon these deadly banks. Now, unless it could be proved that copper is not injurious to fish, these same lithophyta and zoophyta would no doubt poison them. However, it is more than probable that it is to a certain injurious food that these dangerous qualities are to be referred. Various plants that grow in these regions are of a poisonous nature to man, although, as I have just observed, they may not be so destructive to fish. The circumstance of the alimentary tube being more poisonous than any other part seems to warrant the conclusion; and I have observed in the West Indies, that the crabs that feed upon banks where the manchineel is to be found, frequently occasion serious, and sometimes fatal accidents. On the coast of Malabar, crabs are poisonous in the month of October, when the _blue tithymale_ abounds. Whatever may be the causes of this deadly principle, the effects are most rapid. When a large quantity has been taken, the patient soon dies in strong convulsions; but frequently, when the quantity and the nature of the poison have not been sufficient to occasion death, the body becomes emaciated, the cuticle peels off, particularly on the palms of the hands and the soles of the feet, the hair drops, acute pains shoot through every joint, and the sufferer not unfrequently sinks under a lingering disease. In these cases change of climate has been found the most effectual remedy, and a return to Europe becomes indispensable. The usual symptoms that denote the presence of the poison, are languor, heaviness, drowsiness, great restlessness, flushing of the face, nausea, griping, a burning sensation, at first experienced in the face and eyes, and then extending over the whole body; the pulse, at first hard and frequent, soon sinks, and becomes slow and feeble. In some cases the salivary glands become tumefied with a profuse salivation; and the body, and its perspiration, are as yellow as in the jaundice. These peculiar symptoms have frequently been known to arise after eating the _rock-fish_. The remedies that are usually resorted to are stimulants. Capsicum has been considered a powerful antidote; and the use of ardent spirits or cordials has also been strongly urged. It has been observed, that persons who had drunk freely, or who had taken a dram after eating fish that had disordered others, were, comparatively speaking, exempt from the severity of the disease. A decoction of the root of the _sour-sop_, and an infusion of the flowers of the _white cedar_ and the _sensitive plant_ have also been advised by several West India practitioners. The practice of putting a silver spoon in the water in which fish is boiled, to ascertain its salubrity, is a popular test that cannot be depended on. Fishermen have observed that fish that have no scales are more apt to prove injurious; and those of uncommon size are looked upon as the most dangerous. To ascertain whether the nature of the fishes' food could thus render them poisonous, Mr. Moreau de Jonnês had recourse to many curious experiments. He took portions of polypes found in the waters reputed dangerous, more particularly the _liriozoa Caribæa_, the _millepora polymorpha_, the _gorgonia pinnata_, the _actinia anemone_, &c., and, having enveloped them in paste, he fed fishes with them; but in no one instance was any prejudicial result observed. He tried in the same manner the _physalis pelagica_ of Lamark, which contains an acrid and caustic fluid; but the fish invariably refused it, nor would they touch fragments of the manchineel apple. Oysters have been known to produce various accidents; and, when they were of a green colour, it has been supposed that this peculiarity was also due to copper banks. This is an absurdity; the green tinge is as natural to some varieties as to the _esox belone_, whose bones are invariably of the same hue as verdigrise. Muscles frequently occasion feverish symptoms, attended with a red, and sometimes a copper-coloured, efflorescence over the whole body. These accidents appear to arise from some peculiar circumstances. In Boulogne I attended a family in which all the children who had eaten muscles were labouring under this affection, while not another instance of it was observed in the place. In the Bahama Islands I witnessed a fatal case in a young girl who had eaten crabs; she was the only sufferer, although every individual in the family had shared in the meal. The idea of the testaceous mollusca avoiding copper-bottomed vessels, while they are found in abundance on those that are not sheathed, is absurd; this circumstance can be easily explained by the greater facility these creatures find in adhering to wood. There is every reason to believe, that the supposed poisonous oysters found adhering to the copper bottom of a ship in the Virgin Isles, and the occasional accidents amongst the men that ate them, were only so in the observer's imagination, and that part of the ship's company were affected by some other causes. Another report, equally absurd, was that of the fish having gradually quitted the Thames and Medway since coppering ships' bottoms has been introduced! The following may be considered the fish that should be avoided: The Spanish mackerel, _Scomber cæruleo-argenteus_. The yellow-billed sprat, _Clupea thrissa_. The baracuta, _Esox baracuta_. Grey snapper, _Coracinus fuscus_. The porgie, _Sparus chrysops_. The king-fish, _Scomber maximus_. The hyne, _Coracinus minor_. Bottle-nosed cavallo, _Scomber_. Old wife, _Balistes monoceros_. Conger eel, _Muræna major_. Sword-fish, _Xiphias gladius_. Smooth bottle-fish, _Ostracion globellum_. Rock-fish, _Perca manna_. I have known accidents arise from the use of the dolphin on the high seas; and, while I was in the West Indies, a melancholy instance of the kind occurred, when the captain, mate, and three seamen of a trading vessel died from the poison; a passenger, his wife, and a boy, were the only survivors, and were fortunately picked up in the unmanageable vessel. The above catalogue of poisonous fishes is extracted from Dr. Dancer's "Jamaica Practice of Physic," and its correctness fell under my own observation in the Wrest Indies. The different systems and classifications of ichthyologists have produced much confusion, and may lead to fatal errors; I think it therefore advisable to submit to travellers, who may have to visit these unhealthy regions, the names of the _toxicophorous_ fishes according to the French momenclature. Le poisson armé, _Diodon orbicularis_. La lune, _Tetraodon mola_.--LINN. Le tétraodon ocellé, _T. ocellatus_. Le t. scélérat, _T. scelreatus_. La vieille, _Balistes vetula_. La petite vieille, { _B. monoceros_.--LINN. { _Alutus monoceros_.--CUVIER. Le coffre triangulaire, _Ostracion trigonus_.--BLOCH. La grande orphie, _Esox Brasiliensis_.--LINN. La petite orphie, _E. marginatus_.--LACEPEDE. Le congre, _Muræna conger_.--MINN. Le perroquet, _Sparus psittacus_.--LACEPEDE. Le capitaine, _S. erythrinus_.--BLOCH. La bécune, _Sphyræna becuna_. Le thon, _Scomber thynnus_.--LINN. La carangue, _Caranx carangus_. A work, in which a _synonymous_ catalogue of all the fishes supposed to be poisonous might be found, would be highly desirable, as they generally bear different popular and scientific names, thus producing a dangerous confusion even amongst naturalists; how much more dangerous amongst seafaring people and voyagers! I cannot conclude this article without noticing the singular properties of those electric fishes denominated the _torpedo-ray_ and the _gymnote_. They had been long known to naturalists, and the ancients attributed their destructive faculties to a magic power that Oppian had recorded in his _Alieuticon_, where he describes a fisherman palsied through the hook, the line, and the rod. This influence being voluntary on the part of the animal, seemed to warrant the belief in its mischievous nature, since it allows itself sometimes to be touched with impunity, while at others it burrows itself under the sand of the beach, when the tide has receded, and maliciously benumbs the astonished passenger who walks over it. This singular fish, which is common in the Mediterranean Sea, has been described both by the Greek and Roman writers; amongst others, by Aristotle and Athenæus: and Socrates, in his Dialogues, compares a powerful objection, to the influence of the torpedo. This voluntary faculty has been observed by Lacépède and Cloquet in the Mediterranean, and at La Rochelle. In torpedos kept in water for experimental purposes, Réaumur found that he handled them without experiencing any shock for some time, until they at last appeared to become impatient: he then experienced a stunning sensation along the arm, not easily to be described, but resembling that which is felt when a limb has been struck with a sudden blow. One of the experiments of this naturalist proved the extensive power of this faculty. He placed a torpedo and a duck in a vessel containing sea-water, covered with linen to prevent the duck from escaping, without impeding the bird's respiration. At the expiration of a few minutes the animal was found dead, having been killed by the electric shocks of its enemy. Redi was the first who demonstrated this faculty. Having laid hold of a torpedo recently caught, he had scarcely touched it, when he felt a creeping sensation shooting up to the shoulder, followed by an unpleasant tremor, with a lancinating pain in the elbow. These sensations he experienced as often as he touched the animal; but this faculty gradually decreased in strength as the animal became exhausted and dying. These experiments he related in a work entitled "_Esperienze intorno à diverse cose naturali_." Florence, 1671. In 1774, Walsh made some very interesting experiments at the Isle of Ré and La Rochelle, and clearly demonstrated this electric faculty in a paper _On the electric property of the torpedo_. In one of them he found that this fish could produce from forty to fifty shocks in the course of ninety minutes. The electrified individuals were isolated; and at each shock the animal gave, it appeared to labour under a sense of contraction, when its eyes sunk deep in their sockets. The _trichiurus electricus_ of Linnæus, the _rhinobatus electricus_ of Schneider, and the _gymnonotus electricus_ of _Surinam_, are the species of this singular fish with which experiments have chiefly been made. The _gymnonotus_ is a kind of eel, five or six feet in length, and its electric properties are so powerful that it can throw down men and horses. This animal is rendered more terrific from the velocity of his powers of natation, thus being able to discharge its thunder far and near. When touched with one hand the shock is slight; but when grasped with both, it is so violent that, according to the accounts of Collins Flag, the electric fluid can paralyze the arms of the imprudent experimentalist for several years. This electric action is analogous to that which is obtained by means of the fulminating plate, which is made of glass with metallic plates. Twenty-seven persons holding each other by the hands, and forming a chain, the extremities of which corresponded with the points of the fish's body, experienced a smart shock. These shocks are produced in quick succession, but become gradually weaker as the fluid appears to be exhausted. Humboldt informs us, that, to catch this fish, wild horses are driven into the water, and after having expended the fury and the vigour of the gymnonotus, fishermen step in and catch them either with nets or harpoons. Here we find that the irritable or sensorial power is exhausted through the medium of electricity. These phenomena may be attributed to an electric or Voltaic aura; and the organ of the animal that secretes the fluid resembles in its wonderful structure the Voltaic apparatus. Both the gymnote and the torpedo obey the laws of electricity, and their action is limited to the same conducting and non-conducting mediums. The electric sparks proceeding from the gymnote have been plainly seen in a dark chamber by Walsh, Pringle, Williamson, and others. The fish has four electric organs, two large and two small ones, extending on each side of the body from the abdomen to the end of the tail. These organs are of such a size that they constitute one third of the fish's bulk. Each of them is composed of a series of aponeurotic membranes, longitudinal, parallel, horizontal, and at about one line's distance from each other. Hunter counted thirty-four of these fasciculi in one of the largest. Other membranes or plates traverse these vertically, and nearly at a right angle; thus forming a plexus or net-work of numerous rhomboidal cells. Hunter found no less than two hundred and forty of these vertical plates in the space of eleven inches. This apparatus, analogous to the Voltaic pile, is brought into action by a system of nerves rising from the spinal marrow, each vertebra giving out a branch; other branches, rising from a large nerve, running from the basis of the cranium to the extremity of the tail. All these ramifications are spread and developed in the cells of the electric organs, to transmit its powerful fluid, and strike with stupor or with death every animal that comes within its reach. Lacépède has justly compared this wonderful mechanism to a battery formed of a multitude of folio-electric pieces. The electric organ of the _malapterus electricus_ is of a different formation. This fish, found in the Nile and in other rivers of Africa, is called by the Arabs _raash_ or thunder. In this animal the electric fluid extends all round the body, immediately under the integuments, and consists of a tissue of cellular fibres so dense, that it might be compared to a layer of bacon; but, when carefully examined, it consists of a series of fibres forming a complex net-work. These cells, like those in the gymnote, are lubricated with a mucous secretion. The nervous system of this intricate machinery is formed by the two long branches of the pneumo-gastric nerves, which in fishes usually run under each lateral line. Here, however, they approach each other on leaving the cranium, traversing the first vertebra. Linnæus had classed the torpedo in the genus _ray_, and hence called it _raia torpedo_. Later naturalists have restored to it its ancient name, as given by Pliny, and termed it _torpedo_, of which four species are described: the _T. narke_, or with five spots; the _T. unimaculata_, marked, as the name indicates, with one spot; the _T. marmorata_, and the _T. Galvanni_. The ancients placed much faith in the medicinal properties of these fishes. Hippocrates recommends its roasted flesh in dropsies that follow liver affections. Dioscorides prescribed its application in cases of obstinate headaches and rheumatisms. Galen and other physicians recommend the application of the living animal; and Scribonius Largus states that the freedman Anteroes was cured of the gout by this practice. To this day, in Abyssinia, fever patients are tied down on a table, and a torpedo is applied to various parts of the body. This operation, it is affirmed, causes great pain, but is an infallible remedy. MEMORY AND THE MENTAL FACULTIES. This noble faculty, the proudest attribute of mankind, justly called the mother of the Muses, is subject to be impaired by various physical and moral causes, while a similar agency can sometimes restore it to its pristine energy, or develope its powers when sluggish and defective. Memory may be considered as the history of the past chronicled in our minds, to be consulted and called upon whenever circumstances stances or the strange complication of human interests demand its powerful aid. Its powers and nature widely differ, and these varieties depend upon education, natural capacities, mode of living, and pursuits. Thus memory has been divided into that faculty that applies to facts, and to that more superficial quality that embraces a recollection of things, to which must be added the memory of localities and words: "Lucullus habuit divinam quamdam memoriam rerum, verborum majorem Hortensius," said Cicero. It is on this division that Aristotle founded his belief that the brute creation had not the faculty of reminiscence, although he allowed them to possess memory. According to his doctrine, reminiscence is the power of recollecting an object by means of a syllogistic chain of thought; an intellectual link with which animals do not seem to be gifted. Their memory appears solely to consist of the impressions received by the return of circumstances of a similar kind. Thus, a horse that has started on a certain part of a road will be apt to evince the same apprehension when passing the same spot. This is an instinctive fear, but not the result of calculation or the combination of former ideas. Reminiscence is the revival of memory by reflection; in short, the recovery or recollection of lost impressions. The recollection of things or facts can alone bring forth a sound judgment. It implies a regular co-ordination of ideas, a catenation of reflections, in which circumstances are linked with each other. The chain broken, no conclusion can be drawn. Newton was wont to lose the thread of an important conversation when his mind was in search of an idea. This is the reason why the society of the learned is seldom entertaining to the generality of men. They are considered absent, while their brain is busily employed in pursuits perhaps of great importance; they must therefore be anything but agreeable to those who generally think through the medium of other persons' brains. The brain is considered to be the seat of memory. When it is injured, remembrance is impaired; and, on the other hand, an accident has been known to improve the recollective faculties. A man remarkable for his bad memory fell from a considerable height upon his head; ever after he could recollect the most trifling circumstance. The effects of different maladies will also produce various results on this faculty. In some instances names of persons and things are completely forgotten or misapplied; at other times, words beginning with a vowel cannot be found. Sudden fright and cold have produced the same effects. An elderly man fell off his horse in crossing a ford in a winter's night; ever afterward he could not bring to his recollection the names of his wife and children, although he did not cease to recognise and love them as fondly as before the accident. Cold has been at all times considered injurious to memory; hence Paulus Æginus called Oblivion the child of Cold. In fevers, and a state of great debility, in a disordered condition of the digestive functions, and various affections of the head, we generally find that the attention cannot long be applied to any one subject or a continued train of thoughts; all past circumstances are readily forgotten, while passing occurrences are most acutely observed and felt, excepting in cases of delirium, when we have the perception of surrounding objects or receive an erroneous impression of their nature and agency. In many cases of this nature, we find that conversation produces great excitement and increases the evil, for the subject of such intercourse is generally misconceived and distorted through the medium of a morbid conception, while the past, the present, and the future are grouped in a confused and most heterogeneous and incoherent jumble. Philosophers have endeavoured to fix the seat of memory in various portions of the brain. The ancients fancied that it was lodged in the posterior part of the cranium; having observed that when persons endeavoured to recollect any thing, they usually scratched the back part of the head. The Arabian physicians entertained a similar belief. Gratarola maintained that a great protuberance of the occiput indicated a good memory. Gall places it above the orbitary cavity of the eye, and even behind it. It has long been thought that persons with protuberant eyes had quick recollections. The physical condition of the brain has also been considered as materially affecting memory. What physiologists have called a moist brain was looked upon as unfavourable to its development; and it was therefore owing to the soft and pulpy condition of the cerebral organs in young children that the difficulty of impressing anything upon their minds arose; the same stupidity being observed in cases where water was supposed to be lodged in the brain. While this humid state was considered as injurious to memory, dryness of the organ was also esteemed an obstacle of a similar nature; and in old age it is by this state of siccity that failure in memory was attempted to be explained. This failure of memory as age advances may, however, be explained in a much more rational manner. Old people will bear in lively recollection the events that attended their childhood, their youth, and manhood; it is only recent occurrences that shed a transient impression on their minds. The cause of this may be considered to arise from the extreme _impressionability_ that prevails in early life, when every organ is prompt in responding to each call upon its powers; when the charms of novelty tinge with a brighter, yet a more lasting lustre, all our pleasurable sensations; when grief had not yet wrung the young heart till its fibres became callous to future pangs, when perfidy and ingratitude have shown us that all is vanity, and calm philosophy has tutored our passions in the school of Adversity. Reason now sits upon the judgment-seat, and all that we then can wonder at that is, at any time we could have wondered at any thing. Why, then, are we to seek for a material theory of the mind, when our daily experience shows us that it is under the influence of so many moral agents? We have, moreover, convincing proof that the brain may be materially affected, without any deterioration of the mental faculties. Dr. Ferriar mentions a man in whom the whole of the right hemisphere, that is, one half of the brain, was found destroyed, but who retained all his faculties till the very moment of his death. Diemerbrook states another case where half a pound of matter was found in the substance of the brain. O'Hallaran relates the history of a man who had suffered such an injury of the head, that a large portion of his brain was removed on the right side; and extensive suppuration having taken place, an immense quantity of pus, mixed with large masses of the substance of the brain, was discharged at each dressing, through the opening. This went on for seventeen days, and it appears that nearly one half of the brain was thrown out, mixed with the matter, yet the man retained all his intellectual faculties to the very last moment of his dissolution, and through the whole course of the disease, his mind maintained uniform tranquillity. I attended a soldier at Braburne Lees, who had received a wound in the head during ball practice. The ball remained in the brain, and during three weeks large masses of brainular substance were brought away with pus. To the last day of his life he would relate, with every circumstantial particular, the neglect of the comrade by whom he had been wounded, and who fired while he was running to the target to mark the shots. It is somewhat singular, but suppuration of the brain is more offensive than the foulest ulcer, and it is with great difficulty that the pestilential effluvia can be tolerated. These cases plainly show that cerebral diseases have but little influence on the manifestations of the mind. Amongst the many curious doctrines that have been started, to account for the operations of memory, some philosophers have compared it to the art of engraving; pretending that on those subjects where it requires much time and trouble to work an impression it was more durable, while it was only traced in a superficial manner on those brains that were ever ready and soft to receive this plastic influence. These several faculties they therefore compared to bronze or marble, to butter and to wax. Descartes, following up the phantasy, compared recollection to etching, and said that the animal spirits, being passed over the lines previously traced, brought them more powerfully to the mind; thus comparing the brain to the varnished copper-plate over which the engraver passes his mordants. Malebranche endeavoured to establish another doctrine, and compared our cerebral organ to an instrument formed of a series of fibres, so arranged, that when any recent emotion agitated one of these chords the others would immediately be thrown into vibration, renewing a past chain of ideas. As these chords became less flexible in old age, of course these vibrations were more difficult to obtain. Recollection was also considered an attribute of each molecule of the brain; and Bonnet endeavoured to count how many hundred ideas each molecule was capable of holding during a long life. The controversies of learned psychologists on the relation of memory and judgment, indeed on the analogies that exist between our several mental faculties, have been as various as they are likely to prove interminable. Without offending these illustrious controversionalists, we may endeavour to enumerate these faculties, which, despite the ingenuity of theorists, appear in a practical point of view to exercise a wonderful influence upon each other. The first may be considered the faculty of _perception_, assisted by that of _attention_, to which we are indebted for our _ideas_. These are preserved and called into action from the rich stores of the mind by _memory_, justly called by Cicero the guardian of the other faculties. _Imagination_ is the faculty of the mind that represents the images of remembered objects as if they were actually present. _Abstraction_ forms general deductions from the foregoing faculties; while _judgment_ compares and examines the analogies and relations of the ideas of sense and of abstract notions. Finally, _reason_ draws inferences from the comparisons of judgment. It is from the combination and the workings of these wonderful powers that _appetency_, _desires_, _aversions_, and _volition_ arise. _Appetency_ occasions _desires_, and these, when disappointed or satiated, inevitably usher in aversions and antipathies; although, as we shall see in another article, our antipathies are frequently instinctive, and not arising from any combination of the faculties I have enumerated. Dr. Gall has considered these mental faculties as fundamental; and in this view he was certainly correct, since they may be considered the source whence all other distinct capacities are probably formed by particular habits of study and the nature of our pursuits, independently of those specific capacities which appear to be innate, and, according to the system of the phrenologists, organic. Every man possesses these fundamental faculties in a greater or less degree, according to the obtuseness or the energies of his mind; but it is absurd to conceive that specific capacities can be brought into action without the agency of those which are fundamental. Let us take the instinct to destroy life, the sentiment of property, metaphysical sagacity, or poetic talent,--in short, any one of Gall's various faculties; can we for one instant conceive that they are not under the influence of _perception_, _memory_, _imagination_, and _abstraction_, although they may not be properly ruled by _judgment_ and by _reason_? Instincts are equally under a similar influence, and are, according to circumstances, regulated by judgment in the various modes of life of animals. Phrenologists deny that instinct is a general faculty, and assert that it is an inherent disposition to activity possessed by every faculty, and that there are as many instincts as fundamental faculties. This is a postulation by no means clear. Instinct is an inherent disposition possessed by every animal, but not by every faculty. It is a disposition dependent upon the combination of all the mental faculties, according to the degree in which the animal may possess them: the reminiscences of animals prove it. We have instanced the horse, who endowed with the memory of locality, starts when passing by the same spot where he had started before. But here the memory of facts, _memoria realis_, and probably of words, _memoria verbalis_, are superadded to the _memoria localis_. The horse recollects the tree, the carrion, the object that startled him, whatever it might have been; but to this reminiscence are associated the chiding, the punishment he received from his rider. If this horse had possessed the faculties of _abstraction_, _judgment_, and _reason_, he would not have started, to avoid a reiteration of punishment; but he started under the impression of _perception_, _attention_, and _memory_. Wherever there does not exist a combination of the faculties, the intellectual ones may be considered imperfect. We certainly may have a greater perception and memory of one subject than of others. Thus, a man with a musical organisation will recollect any tune he may have heard, though it may not have attracted the _attention_ of one who "hath no music in his soul." We daily perceive different talents in children educated together. This is, no doubt, a strong corroboration of the doctrine of organic dispositions, which in reality no philosophic observer can deny; but to assert that these several dispositions are not regulated by what have been called the fundamental faculties, is, I apprehend, a position that cannot well be maintained; and we may be warranted in the conclusion that a particular faculty may be the result of the combined action of several faculties, if not of all; for, whether a man be a poet or a painter, a miser or a spendthrift, an affectionate father or an assassin, every one of the mental faculties that I have enumerated will to a certain extent be brought into action, however morbid that action may be. All these disquisitions, however attractive they may be, when decked out with the fascination of the fancy, are the mere wanderings of metaphysical speculation, that never can be proved or refuted until we attain a knowledge of the nature and quality of the perceptions which material objects produce in the mind through the medium of the external senses. But while some of these speculations are idle and harmless, others may be fraught with danger, and occasion much misery to society. Let us for one moment conceive the possibility of our resolves and actions being dictated by a supposed phrenological knowledge,--a knowledge earnestly recommended to statesmen, and indeed to mankind in general;--what would be the result? A diplomatic bungler would be sent on an embassy, because a minister, or a sovereign, with a phrenological map before him, may fancy that he displays the faculty of circumspection, or the sense of things; and a chancellor of the exchequer be found in some needy adventurer who possessed the organ of relation of numbers! I do not at all presume to invalidate the statements of Dr. Gall. The profession is highly indebted to him for his accurate description of the brain; and physiology must ever consider him as one of the brightest ornaments of science: but I do maintain, that to recommend his conclusions as a guide to society would be the most rash of visionary speculations; and, to my personal knowledge, no man was ever more mistaken in his estimate of the persons whom he met in society than the learned doctor himself. Of this I had frequent opportunities of convincing myself, when I met him in Paris in the circle of a Russian family which he daily visited. If I could admit, with a late ingenious writer, "that phrenology teaches the true nature of man, and that its importance in medicine, education, jurisprudence, and everything relating to society and conduct must be at once apparent," I should certainly agree with him in recommending its study to parents, judges, and juries; but for the present, I am inclined to believe that, although it may prove a most interesting and valuable pursuit to the physiologist, it is by no means calculated to be the _vade mecum_ of any liberal man. The memory of various persons is amazing, and has been remarked in ancient times with much surprise. Cyrus knew the name of every soldier in his army. Mithridates, who had troops of twenty-two nations serving under his banners, became a proficient in the language of each country. Cyneas, sent on a mission to Rome by Pyrrhus, made himself acquainted in two days with the names of all the senators and the principal citizens. Appius Claudius and the Emperor Hadrian, according to Seneca, could recite two thousand words in the order they had heard them, and afterwards repeat them from the end to the beginning. Portius Latro could deliver all the speeches he had hastily written without any study. Esdras is stated by historians to have restored the sacred Hebrew volumes by memory when they had been destroyed by the Chaldeans; and, according to Eusebius, it is to his sole recollection that we are indebted for that part of Holy Writ. St. Anthony, the Egyptian hermit, although he could not read, knew the whole Scripture by heart: and St. Jerome mentions one Neopolien, an illiterate soldier, who, anxious to enter into monastic orders, learned to recite the works of all the fathers, and obtained the name of the Living Dictionary of Christianity; while St. Antonius, the Florentine, at the age of sixteen, could repeat all the Papal Bulls, the Decrees of Councils, and the Canons of the Church, without missing a word. Pope Clement V. owed his prodigious memory to a fall on his head. This accident at first had impaired this faculty; but by dint of application he endeavoured to recover its powers, and he succeeded so completely, that Petrarch informs us he never forgot anything that he had read. John Pico de la Mirandola, justly considered a prodigy, could maintain a thesis on any subject,--_de omni re scibili_,--when a mere child; and when verses were read to him, he could repeat them backward. Joseph Scaliger learned his Homer in twenty-one days, and all the Latin poets in four months. Haller mentions a German scholar, of the name of Muller, who could speak twenty languages correctly. Our own literary annals record many instances of this wonderful faculty. To fortify this function when naturally weak, or to restore it to its pristine energy when enfeebled by any peculiar circumstances, has been long considered an essential study both by the philosopher and the physician. Reduced to an art, this pursuit has received the name of _Mnemonia_; and at various periods professors of it, more or less distinguished by their success, have appeared in the several capitals of Europe. It has been justly observed, that remembrance is to the past what our sensations are to the present, and our busy conjectures to futurity. Memory gives a lesson to mankind, by stripping past events of their _prestige_; thus enabling us to view what passes around us with a more calm and philosophic resignation, while at the same time it tends to protect us, in the career lying before us, against the many contingencies that are likely to impede our path. Although it might appear desirable that we could obliterate from the mind the painful scenes of our past life, yet the wisdom of the Creator has deemed this faculty as necessary to our happiness as our utter ignorance of our future destiny. For let us mistake not by a hasty glance on this most important subject; the remembrance of past sufferings is not always painful. On the contrary, there is that which is holy in our past sorrows, that tends to produce a calm, nay a pleasurable sensation of gratitude. St. Theresa beautifully expressed this hallowed feeling when she exclaimed, "Where are those blissful days when I felt so unhappy!" _Et olim meminisse juvabit._ Memory depends in a great measure on the vivacity with which these past scenes are retraced--I may say re-transmitted to the mind, in ideal forms "as palpable" as those that may be present. Therefore reminiscence may be said to result from a connexion between ideas and images recalled into being by a regular succession of expressive signs that the brute creation do not possess. Those characteristic signs and images that are generally circumstantial are co-ordained and classified in the mind, and tend materially in weak memories to produce an artificial mode of recollecting the past. This faculty is therefore matured by habit. A literary man, whose library is properly classed, will find the book he wants in the dark. The classification of his books is ever present to his mind. These circumstantial signs are always remembered by a sort of association in our ideas. Thus Descartes, who fondly loved a girl who squinted, was always affected with strabismus when speaking of her. When we first see a person in any particular costume, the individual is clad in the same apparel whenever brought to our minds, even after a lapse of many years, when fashion has banished even from general recollection the costume that memory thus retraces individually. From these observations it has been concluded that the most probable method of improving memory would be to regulate these associations by a proper classification. One link of this ideal chain will naturally lead to another. Many military men, to recollect any number, will associate it with that of a regiment, so far at least as the number of regiments extend; and the recollection of this particular regiment will not only bring to his mind the number of the house he seeks, but various other circumstances connected both with the regiment and the number. For instance, I wish to recollect No. 87 in a certain street. I had, when the number was mentioned to me, attached it to the 87th regiment; and instantly I not only recollect that the 87th regiment are the Irish Fusiliers, but that they took an eagle at Barossa, where they distinguished themselves, and that the figure of that eagle is borne upon all the appointments of the corps. At the same moment, with the rapidity of lightning I recollect all the circumstances of the battle of Barossa; the different conversations I may have had at various times with the officers of the 87th; the town, the camp, the bivouac where I last had met them. Thus are innumerable circumstances instantaneously converging in a mental focus while simply seeking for the lodgings of an individual. This may be called the memory of locality, since it is locality that revives the recollection of it. This train of thought has also been called the memory of association, and associations have been referred to three classes:-- I. Natural or philosophical associations. II. Local or incidental associations. III. Arbitrary or fictitious associations. Dr. Abercrombie has admirably treated this subject, and I refer the reader to his interesting work.[44] The poet Simonides is said to have been the founder of the mnemonic art. Cicero informs us, that, supping one night with a noble Thessalian, he was called out by two of his acquaintance, and while in conversation with them the roof of the house fell in, and crushed to death all the guests he had left at table. When the bodies were sought for, they were so disfigured by the accident that they could not be recognised even by their nearest friends; but Simonides identified them all, by merely recollecting the seats they had held at the banquet. Cicero and Quintilian adopted his system, connecting the ideas of a discourse with certain figures. The different parts of the hilt of a sword, for instance, might regulate the details of a battle; the different parts of a tree associate the relations of a journey. Other mnemonic teachers recommended the division of ideas to correspond with the distribution of a house; while some of them refreshed the memory by associations connected with the fingers and other parts of the hand. Cicero expresses himself plainly on this subject: "Qui multa voluerit meminisse, multa sibi loca comparet: oportet multos comparare locos, ut in multis locis multas imagines collocemus." The celebrated Feinagle who delivered lectures on memory had adopted the system of aiding the memory by dates, changing the figures in the dates into the letters of the alphabet corresponding to them in number. These letters were then formed into a word to be in some way associated with the date to be remembered--for instance--Henry IV., King of England, was born in the year 1366. This date changed into letters makes _mff_ which was very easily changed into the word _muff_--the method is not so obvious of establishing with this a relation to Henry IV., but Hen_ry_ IV., says Mr. Feinagle, means four hens, and we put them in a muff, one in each corner, and no one after hearing this is in any danger of forgetting the date of Henry IV.'s birth. Learning poetry by heart in infancy and youth is perhaps one of the best methods of improving memory, since it lays the early foundation of a classification of words and ideas. Virgil has justly said, "Numeros memini, si verba tenerem." To abridge, resume, and analyze what we have read or heard, is another practice highly beneficial; for, the more clearly we comprehend a subject, the deeper will it remain engraved in our memory. Reading what we wish to recollect before going to bed will materially assist the memory. We sleep over the impressions we have received, and dreams alone can weaken them. From this very reason we can write with more facility upon subjects that require much mental exertion in the morning, fasting, when the mind has not been disturbed by the events of the day, and when the functions of digestion have not drawn upon our faculties, too frequently with the lavishness of a spendthrift. It is somewhat singular, but, despite the interruption of dreams, our ideas are matured during our sleep. Quintilian expresses himself as follows on this subject: "Mirum dictu est quantum nox interposita adferat firmitatis, sivè quiescit labor ille cujus sibi ipsa fatigatio obstabat, sivè maturatur ac coquatur, seu firmissima ejus pars est recordatio. Quæ statim referri non poterant, contexuntur postero die, confirmatque memoriam idem illud tempus quod esse in causâ solet oblivionis." Memory is subject to be variously disturbed in certain maladies. There is an affection called _amnesia_, in which it utterly fails, and another termed _dysmnesia_, when it is defective. Failure of memory is generally more manifest on some subjects than on others. Salmuth relates the case of a man who had forgotten to pronounce words, although he could write them. Another person could only recollect the first syllables. An old man had forgotten all the past events of his life, unless recalled to his recollection by some occurrence; yet every night he regularly recollected some one particular circumstance of his early days. A curious anecdote is recorded of an elderly gentleman who had fallen into the meshes of an artful courtesan, and who frequently took his own wife for this insidious acquaintance, frequently saying to her, "Madam, I feel that I am doing wrong by devoting to you so much of my time, for, when a man has a wife and children, such conduct is unpardonable;" and, after this polite observation, he took up his hat, and would have walked off, had not his wife, wise enough not to manifest displeasure, contrived to undeceive him. Dietrich mentions a patient who remembered facts, but had totally forgotten words; while another could write, although he had lost the faculty of reading. Old men are frequently met with who confound substantives, and will call their snuff-box a cane, and their watch a hat. In other cases letters are transposed, and a musician has called his _flute_ a _tufle_. Dr. Abercrombie relates the case of a gentleman who uniformly called his snuff-box a hogshead. In Virginia he had been a trader in tobacco, so that the transition from snuff to tobacco, and from tobacco to a hogshead seemed to be natural. Another person, affected in a similar manner, always called for paper when he wanted coals, and coals when he needed paper. Others are known to invent names and unintelligible words. Some curious anagrams have been made by these irregularities. John Hunter was suddenly attacked with a loss of memory, which is thus related by Sir Everard Home: "He was at the time on a visit at the house of a friend. He did not know in what part of the house he was, not even the name of the street when he was told, nor where his own house was. He had not a conception of anything existing beyond the room in which he was, and yet he was perfectly conscious of the loss of memory. He was sensible of impressions of all kinds from the senses, and therefore looked out of the window, although rather dark, to see if he could be made sensible of the situation of the house. The loss of memory gradually went off, and in less than half an hour his memory was perfectly recovered." Such momentary accidents I have frequently observed in gouty patients; and for a second or two I have myself experienced the sensation, which was for the moment of a most alarming nature. Hunter was subject to arthritic attacks. Corvinus Messala lost his memory for two years, and in his old age could not remember his own name. This is an occurrence by no means uncommon; and I knew a person in perfect health who could only recollect his name by writing it. We frequently see individuals who, although they are generally correct orthographers, cannot sometimes spell a simple conjunction. An anecdote is related in the Psychological Magazine of a German statesman, who having called at a gentleman's house, the servants of which not knowing him, was asked for his name, which he had, however, so totally forgotten, that he was under the necessity of turning round to a friend and saying with great earnestness, "Pray tell me who I am, for I cannot recollect." Cases are recorded of the forgetfulness of a language constantly spoken, while one nearly forgotten from want of practice was recovered. A patient in St. Thomas's Hospital, who had been admitted with a brain-fever, on his recovery spoke an unknown language to his attendants. A Welsh milkman happened to be in the ward, and recognised his native dialect; although the patient had left Wales in early youth, had resided thirty years in England, and had nearly forgotten his native tongue. Boerhaave relates a curious case of a Spanish poet, author of several excellent tragedies, who had so completely lost his memory in consequence of an acute fever, that he not only had forgotten the languages he had formerly cultivated, but even the alphabet, and was obliged to begin again to learn to read. His own former productions were shown to him, but he could not recognise them. Afterwards, however, he began once more to compose verses, which bore so striking a resemblance to his former writings, that he at length became convinced of his having been the author of them. Dr. Abercrombie relates the case of an aged gentleman, who, in an attack of the head, had almost forgotten the English language, and expressed himself in a mixed dialect of French, Italian, Spanish, German, and Turkish. Having been some time afterwards severely burnt about the head, by setting fire to the curtains of his bed, he was observed to make use of some English words; this being followed by a course of blistering, he continued to speak more English, but only occasionally and in very short sentences. These were sometimes correctly applied, but at other times most erroneously; for instance, having been taken to see a small house, he observed, "it is very neat, but it is a very little child." Dr. Beattie mentions the case of a clergyman who, on his recovery from an apoplectic attack, had exactly forgotten a period of four years; and Dr. Abercrombie records a lady who had thus forgotten ten or twelve years of her life. Wepfer mentions a gentleman, who on recovery from an apoplectic attack, was found to know nobody and remember nothing. After several weeks he began to know his friends, to remember words, to repeat the Lord's Prayer, and to read a few words of Latin, rather than German, his native language. When urged to read more than a few words at a time, he said that he formerly understood those things, but now did not. After some time he began to pay more attention to what was passing around him, but while thus making slight and gradual progress, he was, after a few months, suddenly cut off by another attack of apoplexy. Dr. Beattie relates the case of a gentleman who, after a blow on the head, lost his knowledge of Greek, and did not appear to have lost any thing else. Loss of memory has been observed as a frequent occurrence after the prevalence of pestilential diseases. Thucydides relates, that after the plague of Athens several of the inhabitants forgot their own names and those of their parents and friends. After the disastrous retreat of the French army in Russia, and the disease which swept away so many of their troops at Wilna, many of the survivors had no recollection of country or of home. Injuries of the head appear to occasion different results. This circumstance was observed by the ancients. Valerius Maximus relates the case of an Athenian, who, being struck on the head with a stone, forgot all literary attainments, although he preserved the recollection of other matters. A man wounded with a sword in the eye completely forgot Greek and Latin, in which he had formerly been a proficient. A young man, having fallen off his horse and contused his head, lost his memory to such an extent, that he would repeat a question a hundred times over, although the very first interrogation had been answered. He had not the slightest recollection of his accident. Epileptic and paralytic attacks frequently usher in this melancholy result, which has also been often observed after child-birth. Dr. Abercrombie knew a lady who was seized with an apoplectic fit while engaged at cards; the attack took place on a Thursday evening--she lay in a state of stupor on Friday and Saturday, and recovered her consciousness rather suddenly on Sunday. The first words she then uttered were, "What is trump?" Dr. Conolly mentions a young clergyman who, when on the point of being married, suffered an injury of the head, by which his understanding became impaired. He lived in this condition to the advanced age of eighty, and to the last day of his existence, spoke of nothing but his approaching wedding, expressing impatience for the arrival of the happy day. A singular instance of forgetfulness is related of a lady who had been united to a man she loved, after much opposition on the part of her family, and who lost her memory after the birth of a child. She could not be made to recollect any circumstance that had occurred since her marriage; nor could she recognise her husband or her infant, both of whom she maintained were utter strangers to her. At first she repulsed them with apparent horror, but was at last, by the entreaties of her family, induced to believe that she was a wife and a mother; and although she yielded to their solicitations, yet for years she could not persuade herself that their assertions were correct, as she actually was convinced "against her will." In this instance disease not only destroyed memory, but affection. The case of Dr. Broussonnet was remarkable. An accident he had met with in the Pyrenees brought on an apoplectic attack. When he recovered, he could neither write nor pronounce correctly any substantives or personal names either in French or Latin, while adjectives and epithets crowded in his mind. Thus, when speaking of a person, he would describe his appearance, his qualities, and, without pronouncing the word "coat," would name its colour. In his botanical pursuits he could point out the form and colour of plants, but had not the power of naming them. A Parisian merchant, after severe losses, experienced such a failure in recollection, that he was constantly guilty of the most absurd anachronisms;--would talk of the battles of Louis the Fourteenth with Alexander the Great, and describe Charles the Twelfth ascending triumphantly Mount Valerian; and one night, after witnessing the performance of Talma, could not be persuaded that he had not applauded Lekain. Sudden fright has also obliterated this faculty. Artemidorus lost his memory from the terror inspired by treading on a crocodile. Bleeding has produced the same effects; while, on the other hand, blood-letting has restored an absent man to perfect recollection. Various venenose substances have also been said to produce amnesia. History records several instances of the kind. The soldiers of Anthony, on their return from the Parthian war, were attacked with loss of memory after eating some poisonous plants on their march. Bamba, king of the Goths, was suddenly deprived of all recollection after taking a draught presented to him by Eringius. Plater and Baldinger attributed a similar accident to the use of hemlock and arsenic. Narcotics, no doubt, may produce similar effects, but they will be of a transient nature; I do not know that this injurious power has been detected in any other productions, as the cases related by writers are not supported by sufficient authority to be entitled to unqualified belief. The cause of these affections will most probably ever be unknown. Equally futile have proved all the endeavours to ascertain in what part of the brain memory is seated, since we have found some physiologists lodging this wonderful faculty in the posterior, and others in the anterior portion of the cranium. I apprehend that we might torture the brute creation, from the elephant down to the lowest reptile, for centuries, without being able to ascertain this point; and even could we attain this information, _cui bono_? Would it protect this privileged quarter of the cerebral organ from the action of external agency, or restore it to its healthy functions when diseased? The mode in which our mental faculties are developed is an impenetrable mystery; and, instead of vainly endeavouring to raise the mystic veil to gratify our curiosity, or rather our vanity, let us endeavour to apply these functions to the use for which they were intended by the allwise Creator, and exert them for the purpose of increasing the prosperity, or at any rate in endeavouring to diminish the sum of sufferings of his creatures, whether they be our fellow-men or the divers races that are submitted to our capricious power. AFFECTIONS OF THE SIGHT. The different terms applied to the various morbid affections of vision have been frequently misconceived, and consequently have occasioned much confusion in their application. Those vitiated conditions which are usually noticed may be classed as follows: I. Night sight. II. Day sight. III. Long sight. IV. Short sight. V. Skew sight. VI. False sight. _Night sight_, specifically called _Lucifuga_, was also termed _Nyctalopia_, from [Greek: nyx], _night_, and [Greek: ôps], _eye_; it was also known as the _Noctem amans_. This affection was thus named in consequence of the person labouring under it being only able to see at night, or in a deep shade; hence the first name: while nyctalopia has been used by most modern writers in the opposite sense of _night-sight ache_, agreeably, according to Mason Good's observations, to the technical or implied meaning of _opia_, in which case it always applies to a diseased vision; whence nyctalopia has been made to import day sight, instead of night sight. This disease appears to be dependent upon a peculiar irritability of the retina, produced by two different causes,--a sudden exposure to a stronger light than the eye has been accustomed to bear, or a deficiency of the black pigment which lines the choroid tunic. If the iris be weak and torpid, it is enlarged; if strong and contracted, diminished. Thus, those who from peculiar circumstances reside in dark caverns and subterraneous abodes, or who have long been confined in obscure dungeons, labour under the first of these causes; instances of which were observed in two of the captives liberated from the Bastille in 1789. Ramazzini informs us that this affection is commonly observed among the Italian peasants, amongst whom he was not able to trace any other peculiarity than an enlargement of the pupil. This state of the vision, however, has been attributed to the peculiar brightness of the Italian sky, its clear atmosphere, and the relaxing warmth of the temperature. The Italian peasants are therefore constantly exposed to all those causes that tend to debilitate the iris, while they irritate the retina. We thus find these causes acting with renewed power at the season when the disease usually makes its attack,--the vernal equinox, when an increased flood of solar rays breaks on them. Such is the dimness that this brightness produces, that the peasantry frequently lose their way in the fields in the glare of day; but on the approach of night they can see distinctly. Hence are they obliged to remain for some weeks in the shade to recover their sight. A deficiency of the black pigment of the eye is occasionally found in persons of a very fair complexion and light hair. This affection is therefore common in the Albinoes. This circumstance arises from the whiteness of the eyelashes and hair, whereby the retina is deprived of the natural shade that softens the light in its descent. This debilitated race generally inhabit warm and damp regions; they are seldom long-lived, and frequently low-spirited and morose. The iris is of a pink colour, and this circumstance, added to the constant winking that the weakness of the organ occasions, gives them a distressing appearance. In horses, this want of the dark pigment constitutes what is called the _wall eye_. Acuteness in night vision is natural to most, if not to all, animals that prowl in the dark. In the feline genus we observe that the iris can be contracted much closer than in mankind, when exposed to a vivid glare; but they also expand to a much greater degree when obscurity sets in. Owls, bats, and many insects, possess a similar faculty. _Day sight_, the nyctalopia of some authors, is said to be endemic in some countries,--Poland, the West Indies, Brazil, and various intertropical regions. This affection arises from causes totally different from the former one. Here the eye is habitually exposed to too great a flood of light, whence the retina becomes torpid. It has been said to be endemic in some districts of France, particularly in the neighbourhood of Roche Guyon, on the banks of the Seine; but here the soil is of a dazzling white: and as it makes its attacks in the spring, and continues for three months, it is supposed to arise from the keenness of the reflected light, after the dreary winter months. This disease has also been commonly observed in Russia, especially in the summer, when the eye is exposed, with scarcely any intermission, to the constant action of light, as the sun dips but little below the horizon, and there is scarcely any interval of darkness. Hens are subject to this affection, and cannot see to pick up their food in the dusk of the evening. The complaint is, from this circumstance, called _hen blindness_. Dr. Heberden has communicated the following curious case of this species of affection: "A man about forty years old had in the spring a tertian fever, for which he took too small a quantity of bark, so that the returns of it were weakened without being removed. Three days after his last fit, being then employed on board a ship in the river, he observed at sun-setting that all objects began to look blue, which blueness gradually thickened into a cloud; and not long after he became so blind as hardly to perceive the light of a candle. The next morning about sunrising his sight was restored as perfectly as ever. When the next night came on, he lost his sight again in the same manner, and this continued for twelve days and nights. He then came ashore, where the disorder of his eyes gradually abated, and in three days was entirely gone. A month after he went on board another ship, and after three days' stay in it the night blindness returned as before, and lasted all the time of his remaining in the ship, which was nine nights. He then left the ship, and his blindness did not return while he was upon land. Some little time afterwards he went into another ship, in which he continued for ten days, during which time the blindness returned only two nights, and never afterwards." It appears, however, that this individual had previously laboured under an affection produced by the use of lead, which had left him in a state of much nervous debility. Notwithstanding this circumstance, this case clearly proves that the affection is liable to be increased and brought on by local influence. _Long sight._ In this species of vision the iris is habitually dilated, and not easily stimulated into contraction. Several varieties of this affection have been observed. Dr. Wells, in the Philosophical Transactions, relates the case of a young person who, from a permanent dilatation of the pupil, saw near objects with much difficulty and confusion, but remote bodies with singular accuracy. The power of moving the upper lid was completely lost. This dilatation of the pupil, which may be artificially produced by the application of belladonna, can be remedied by the use of convex glasses. _Short sight._ In this case the iris is contracted, and the cornea, which in long sight is too much flattened, is too convex or polarised; therefore spectacles of an opposite character, and with concave glasses, become necessary. Mice are said to be short-sighted; hence the affection has been termed myopia or myopiasis, literally "mouse-sight." _Skew sight_, or _sight askew_, is a condition of our vision only accurate when the object is placed obliquely, in consequence of some partial obfuscation of the cornea, frequently from slight scars, scarcely, if at all, observable. In this lateral vision the axis of the eye affected usually coincides with that of the sound eye. In squinting, on the contrary, the two axes do not coincide. In _false sight_, imaginary objects float before the sight; or, at other times, objects assume imaginary forms and qualities. The latter species has been divided in cases where the objects that are supposed to be seen have no real existence, and in cases where actual objects have assumed qualities that do not appertain to them. The first are termed ocular phantasms or spectres; the latter, ocular transmutations or illusions. These spectres sometimes form dark spots, called by physicians _muscæ volitantes_. In another species, a net-work seems to be spread before the eyes; hence called _visus reticularis_. In a third form sparks scintillate, and this appearance is experienced when the eye has been struck. The eye is also troubled with an imaginary sense of dazzling, constituting the _myrmaryge_ of the Greek writers; at other times, an iridescent appearance, exhibiting the colours of the rainbow, is experienced, although sometimes this impression is confined to a single colour. Dr. Heberden relates the case of a lady of advanced age, lodging on the eastern coast of Kent, in a house that looked immediately upon the sea, and exposed to the glare of the morning sun. The curtains of her room were white, a circumstance which added to the intensity of the light. When she had been there about ten days, she observed one evening, at the time of sunset, that first the fringes of the clouds appeared red, and soon after the same colour was diffused over all the objects around her, especially if they were white. This lasted the whole night, but in the morning her sight was again perfect. This alternation of morbid and sound sight prevailed the whole time the lady resided on the coast, which was three weeks; and for nearly as long after she left it, at which time it ceased suddenly of its own accord. There exists another variety of false sight, that Plenk has denominated _metamorphopsia_, and in which objects appear changed in their natural qualities, producing error of form, error of motion, error of number, and error of colour. I had a patient in Lisbon who fancied that all the horses he saw carried horns or extensive antlers. A young lady whom I attended beheld every one of a gigantic height. Dr. Priestley has given a curious case of error of colour in five brothers and two sisters, all adults. One of the brothers could form no idea whatever of colours, though he judged very accurately of the form and other qualities of objects; hence he thought stockings were sufficiently distinguished by the name of stockings, and could not conceive the necessity of calling them white or black. He could perceive cherries on a tree; but only distinguished them, even when red-ripe, from the surrounding leaves by their size and shape. One of the brothers appeared to have a faint sense of a few colours, but still a very imperfect notion; and, upon the whole, they did not seem to possess any other distinguishing power than that of light and shade, into which they resolved all the colours presented to them,--so that dove or straw colour were regarded as white; and green, crimson, and purple, as black or dark. On looking at a rainbow, one of them could distinguish that it consisted of stripes, but nothing more. Dr. Nicholl relates the case of a boy who confounded green with red; and called light red and pink, blue. His maternal grandfather and one uncle had the same imperfection. The latter was in the navy, and having a blue coat and waistcoat, purchased a pair of red breeches to match. The same physician knew a gentleman who could not distinguish green from red; a cucumber and a boiled lobster did not offer the least difference in colour. His brother and his niece laboured under a similar affection. Some philosophers are of opinion, that in the power of conceiving colours there is a striking difference in individuals, and are inclined to think that in many instances the supposed defects of sight ought to be ascribed to a defect in the power of conception, arising probably from some early habit of inattention. This theory is scarcely tenable. The utmost inattention and indifference regarding surrounding objects could never lead to a delusive view of any colour; also, it is more than probable that, in the case of a child in whom such a defective vision was observed, his attention would be incessantly called on by those around him, to correct, if possible, so strange a delusion. Moreover, this defect of vision, as we have seen, appears in some instances to be hereditary; and to prevail in families. Phrenologists of course are of opinion that the judgment of colours resides in a particular organ, remarkably full and prominent in painters distinguished by the perfection of their colouring. According to Gall, a local deficiency of brain is observable where the power of distinguishing colours is wanting. The sense of vision exhibits more variety in the different classes of animals than any of the others. In man, and the greater number of quadrupeds, this organ is guarded by an upper and a lower lid, both of which in man are fringed with lashes. This is not the case in most quadrupeds. In the elephant, opossum, seal, cats, other mammalia, birds, and all fishes, we find a third eyelid, or nictitating membrane, as it is called, arising from the internal angle of the eye, capable of covering and protecting the eye from danger, either wholly or in part. In the dog this membrane is narrow; in oxen and horses it extends half over the eyeball. It is by means of this veil that eagles are capable of fixing their eyes on the noon-day sun. The largest eyes in proportion to the size of the animal are found in birds,--nearly the smallest in whales; but the most diminutive are those of the shrew and mole, the latter's not exceeding the size of a pin's head. The situation of the organs of vision differs materially. In man and monkeys they are placed directly under the forehead; in some fishes, such as the turbot and flounder tribes, both eyes are placed in the same side of the head. In the snail they are situated on the horns; and in the spider, distributed over various points of the body, and in different arrangements. Eyes, however, are not indispensable to become sensible of the presence of light. Several zoophytes, that do not possess the organs of vision, are perfectly alive to its influence. A distinct organ is not always indispensable for a distinct sense. It is probable that in those animals that appear to be endowed with particular senses, without displaying particular organs relating to them, the senses are diffused like that of touch, over the whole surface. This subject has been admirably commented on by Cuvier. HELLEBORE. From time immemorial this substance has been considered an efficacious remedy in mania. The Greeks pretended that the daughters of Proetus, smitten with insanity by Bacchus, were restored to reason by the shepherd Melampus, who gave them some milk drawn from goats that had eaten hellebore. It is supposed that the use of purgatives arose from this fabulous tradition, whence this plant was called _melampodium_. The ancients described two varieties, the white and the black. The first, according to Theophrastus, was found on a part of Mount Oeta called Pyra, on which the body of Hercules was burnt. It is not certain whether they confounded our hellebore with our veratrum. Pinel supposes that the veratrum album was their hellebore, as it is not probable that the veratrum nigrum should have been thus confounded. Tournefort, in his travels in the Levant, fancied that he had discovered the root of the ancients in one that the Turks called _zopteme_, which answered in its character to the description recorded in older writers. Howbeit, it was considered a powerful purgative and emetic, especially indicated in the treatment of mental affections. Celsus forbade its exhibition in summer and during the winter, or whenever febrile symptoms were prevalent. This precaution, however, applied to all purgative medicines; and to this day, in several parts of the continent, similar injunctions are usual; and even in France practitioners of the old school prepare a patient several days before any opening medicine is given,--a learned precaution, that has but too frequently rendered every medicine useless. The exhibition of this drug was a matter of so much importance amongst the ancients, that it was specifically termed _helleborism_; and it was considered of so powerful a nature in mania, that the treatment of the malady was called _navigare Anticyras_, since it was near the town of Anticyras that the plant was generally gathered. If this process of helleborism proved efficacious, it is more than probable that its beneficial results proceeded from the violent evacuations that preceded it. The following was the mode adopted with the helleborised: The patient was first well fed for several days until the decline of the moon, when a powerful emetic was given to him; five days after a similar dose was prescribed, and then good living ordered for a month: at the expiration of this invigorating respite, emetics began again to work him every three days. After the last attack on his digestive head-quarters, he was bathed, fed again, and hellebore was given after he had been submitted to several hours' friction with olive oil. The emetics were invariably administered on a full stomach, which was cleared either by medicine or the excitement of the beard of a quill poked down the unfortunate patient's throat. At other times, (by way, no doubt, of variety,) rejection was excited by making the patient eat a pound or more of horseradish; after which he was walked about for some time; and then, after a short repose, the fingers or the quill were brought into action. After this operation he was lulled to sleep by a regular shampooing. It appears that, despite of all these practices, the stomachs of the ancients were sometimes so pertinaciously retentive, that more powerful means to _relieve_ them were adopted; and when the longest feather that could be plucked from a goose proved unavailing, gloves dipped in the oil of cyprus were put on, and the fingers thus inuncted replaced the feathers. When this failed, the obstinate sufferer was made to swallow a quart or two of honey and hot water, in which rue had been infused; and when this proved ineffectual, he was slung in a hammock to produce the sensation of sea-sickness. In some cases it appears that, despite this practice, the patient thought proper to faint. On such occasions little wedges of wood were driven between his obstinate and rebellious teeth clenched against medicine, so as to allow the introduction of the goose-quill, while cephalic snuff of the precious hellebore and euphorbia was blown up his nostrils to produce sneezing. The last trial to relieve him was tossing the ill-fated wight in a blanket. After this experiment the patient was left to nature or to his friends, if he _would_ not recover. These friends immediately proceeded to give him punches in the stomach, roll him about the floor, and endeavour to restore him to his senses by driving him out of them by every possible noise that could frighten him, if his _frightful_ condition was at all susceptible of any thing left in the arsenal of medicinal ingenuity.[45] Small doses of hellebore seem to have been taken not only with impunity, but were supposed to assist the mental faculties. According to Valerius Maximus and Aulus Gellius, orators were in the practice of using this stimulus before their disputations. Such, it is said, was the habit of Carneades, whose doctrines might well have been applied to this very day to many theories, since he denied that any thing in the world could be perceived or understood. Hellebore is to this day an ingredient in many of the fashionable pills vended by successful quacks. This introduction, at any rate, shows that their compounders have candour enough to think (although they may not acknowledge it) that the intellectual faculties of the purchasers of their nostrums do stand in need of some medicinal aid. SYMPATHIES AND ANTIPATHIES. The constant effects produced by causes which do not appear connected with them, are phenomena both of organic and inorganic nature which have long fixed the attention of philosophers, and have not yet been satisfactorily explained. This operation between distant bodies cannot be traced to any medium of communication. It arises from an attractive and a repulsive power that cannot be defined. Almost every substance evinces inclinations or antipathies; is attracted with more or less strength by one body, indifferent towards a second, and constantly avoiding a third; nay, bodies appear to act where they are not present, and where no communication can exist. We are as ignorant of the nature of these phenomena as of those of gravitation, magnetism, and electricity. Still, although this medium of communication is not evident, it must be admitted by inference that there must exist a connecting channel, although its nature be unknown. The ancients called sympathy _consensus_, and the moderns have also defined it a _consent of parts_; nor is this definition incorrect, since sympathy arises from the relative ties that mysteriously unite our several organs, however distant and unconnected they may appear; thus establishing a beauteous harmony between all the functions of the animal economy. Sympathies must therefore constitute the chief study of the physiologist: on this alone can the physician ground his investigation of the various disorders to which flesh is heir. Symptoms arise from sympathies: without a knowledge of the one we can never attain a clear insight in the other. Sympathies are of a physical or a moral nature. The first consist, as I have already stated, of a consent between the different parts of the organism; the latter of certain impressions, unaccountable, unconquerable, that harmonize in a multiplicity of phenomena various individuals, or that induce them, without their being able to assign any reason or motive to warrant the repugnance, to avoid each other, and not unfrequently to entertain a feeling of disgust or horror. A secret voice has spoken,--organism instinctively obeys. Moral sympathies have been defined as faculties that enabled us to partake of the ideas, the affections, or the dislike of others; although this sentiment is by no means reciprocal, and we often dislike those who fondly love us. So far sympathy is instinctive; yet, like many instincts, it is more or less under the control of our reason. We often acquire an artificial partiality to substances that we naturally disliked. Our senses may be considered the instruments of our sympathies; yet senses are regulated by education and habit. Oil, olives, tobacco, and various other substances, are naturally, one might say instinctively, unpleasant to most individuals; yet by custom they are not only relished, but ardently wished for when they cannot be obtained. It is the same with our relative partiality or aversion towards individuals; and indifference is often turned into affection, while the most ardent love is not far remote from hate, when vanity more especially, removes its boundaries. If we admit that our sympathies are lodged in certain specific organs, we must consider that we are the slaves of organism; whereas it is pretty positive that to a certain extent we are the slaves of habit. Even the most ardent and prevailing passions, the indulgence in which has become an absolute necessity, cease to be brought into action when they have long remained dormant. To associate our moral sympathies with physical consents of parts is to level man with the brute creation; although we hourly see the most decided instinctive dislikes in animals overcome by education. A mouse may be brought up with a cat, and a hawk with a sparrow; although a chicken has been known to dart at a fly the moment its head was out of the egg. Nor can we view in the same light the affinities of inorganic bodies. They are subject to chemical laws; each is endowed with specific qualities that seldom or never vary, and some other body must be interposed to check their attraction; and that body, in the relation of inorganic matter, may be compared to the influence of the mind in intellectual beings. In animals, the very laws of nature are not unfrequently unheeded; and in these instances natural instincts appear less powerful than the mechanical discrimination that we witness in vegetable life, where germs, and molecules, and fibrils not only select each other, according to nature's harmonic institutions, but actually attract each other from distant situations. This attractive power is beautifully illustrated in the mysterious vegetation of the _vallisneria spiralis_, an aquatic plant, in which the male and female are distinct individuals. The organization of the male qualifies it to adapt itself to the surface of the water, from the bottom of which the plant shoots forth, and to float in the middle of the deep and rapid tide. The female, on the contrary, is only found in shallow waters, or on shores where the tide exerts but little influence. Thus differently formed and situated, how does their union take place? It is a wonderful mystery. As soon as the male flower is perfect, the spinal stem dries away, and the flower thus separated sails away towards the shore in pursuit of the female, for the most part driven by a current of wind or the stream; yet as soon as it arrives near its destination it obeys a new influence, and is attracted towards the object of its pursuit, despite the powers of that wind and tide which until then directed it. No hypothesis, however ingenious, can explain this phenomenon. Notwithstanding the doctrines of various writers, I am of opinion that our passions are clearly instinctive, but fortunately more or less under the control of our mental faculties in well-regulated individuals, who do not yield to these instinctive feelings an unbridled course; and I doubt much if there does exist a single passion, however inordinate it may appear, that cannot be mastered. Both good and evil qualities are frequently artificial, and arise from peculiar moral and physical conditions. Self-preservation is an instinctive feeling; yet man will wantonly risk his existence from false views regarding his social position. Courage has been considered as differing in its quality (if I may use the term), and arises sometimes from a natural animal or brute propensity, at others from calculation and reflection; and the latter most unquestionably may temper the former. Duclos' distinction between what is called the courageous heart and the courageous mind, is by no means as objectionable as some of his opponents maintain. If courage is an instinctive faculty, residing in a certain organ, how comes it that this organism varies at different periods? How comes it, moreover, that this variety depends upon circumstances? I have seen a desperate duellist disgrace himself by a cowardly flight in the field of battle. I have known an arrant poltroon defend himself desperately against robbers; and a man, considered of undoubted courage, surrender his arms to a single footpad. In our instincts, our sympathies, we are to a certain extent the children of circumstances; and it would be as absurd to maintain that we cannot control our moral sympathies, as to excuse the commission of murder or of theft. Our physical sympathies are of a nature totally different. Here they are brought into action according to certain laws of the organization, as uncontrollable as chemical affinities; and I doubt much whether our unaccountable antipathies may not be considered as appertaining to this category: they seem to depend upon certain laws of attraction and repulsion. The channel of this communication, as I have already observed, will perhaps remain for ever in utter obscurity. To this day we know not in what manner certain articles of food and medical substances find a path to the kidneys with such a rapidity as to render it improbable that it was through the medium of the circulation. The nature of other physiological phenomena is equally unexplained. Through what channel of communication does the cat-hater know that one of these animals is in the room, although unseen by him? Yet these antipathies might be conquered. A man was wont to fall into fits at the sight of a spider; a waxen one was made, which equally terrified him. When he had recovered his faculties, his error was pointed out, the wax figure was put into his hand without inspiring dread, and shortly the living insect no longer disturbed him. Certain antipathies appear to depend upon a peculiarity of the senses. The horror inspired by the odour of certain flowers may be referred to this cause. Amatus Lusitanus relates the case of a monk who fainted when he beheld a rose, and never quitted his cell when that flower was blooming. Scaliger mentions one of his relations who experienced a similar horror when seeing a lily. In these instances it is not the agreeableness or the offensive nature of the aroma that inspires the repugnance; and Montaigne remarked on this subject, that there were men who dreaded an apple more than a musket-ball. Zimmerman tells us of a lady who could not endure the feeling of silk and satin, and shuddered when touching the velvety skin of a peach. Boyle records the case of a man who felt a natural abhorrence to honey. Without his knowledge, some honey was introduced in a plaster applied to his foot, and the accidents that resulted compelled his attendants to withdraw it. A young man was known to faint whenever he heard the servant sweeping. Hippocrates mentions one Nicanor who swooned whenever he heard a flute: our Shakspeare has alluded to the effects of the bagpipe. Julia, daughter of Frederick, king of Naples, could not taste meat without serious accidents. Boyle fainted when he heard the splashing of water; Scaliger turned pale at the sight of water-cresses; Erasmus experienced febrile symptoms when smelling fish; the Duke d'Epernon swooned on beholding a leveret, although a hare did not produce the same effect. Tycho Brahe fainted at the sight of a fox, Henry the Third of France at that of a cat, and Marshal d'Albert at a pig. The horror that whole families entertain of cheese is generally known. Many individuals cannot digest, or even retain certain substances, such as rice, wine, various fruits, and vegetables. There are also antipathies that border upon mental aberration. Such was the case with a clergyman who fainted whenever a certain verse in Jeremiah was read. I lately dined in company with a gentleman who was seized with symptoms of syncope whenever a surgical operation or an accident was spoken of. St. John Long's name happened to be mentioned, and he was carried out of the room. I have also known a person who experienced an alarming vertigo and dizziness whenever a great height or a dizzy precipice was described. A similar accident has been occasioned by Edgar's description of Dover Cliff in King Lear. All these sympathies may be looked upon as morbid affections, or rather peculiar idiosyncrasies, beyond the control of our reason or our volition, although it is not impossible that they might be gradually checked by habit. Our dislikes to individuals are often as unaccountable, when we are obliged to confess with the poet Martial: Non amo te, Sabidi, nec possum dicere quare; Hoc tantùm possum dicere, Non amo te. It is the same with our affections. The ancients, amongst others Empedocles, fancied that attraction and repulsion constituted the principal actions of life, and harmonized the universe. Hesiod dispels Chaos through the agency of Love. Aversions were attributed to the influence of an evil eye. To avoid its direful effects, strange practices were adopted, according to Tibullus; and to check the malefices of wicked crones, it was customary to spit three times in an infant's bosom, Despuit in molles et sibi quisque sinus; while the well-known amulet representing the god Fascinus, was suspended round the child's neck. Maidens were veiled to guard them against this noxious power, and secrecy and retirement were deemed the most effectual means of security. Latendum est dum vivimus, ut feliciter vivamus. In a preceding article I have given a sketch of the custom of administering love-philters. The singular sympathies that forewarn a future union between the sexes have in some instances been most surprising. The following example, that came within my knowledge, is perhaps one of the most singular: Mr. ----, a brother officer of mine, was a man of taciturn and retired habits, seldom frequenting public places of amusement, and, when there, felt any thing but gratification. One evening after dinner he was, however, prevailed upon to go to a ball. We had not been long in the room when, to my utter surprise, he expressed great admiration of a young lady who was dancing, and, what still more amazed us all, he engaged her to dance. Such an act of apparent levity on his part struck us as a singularity which might have been attributed to an unusual indulgence at table, had not the contrary been the case, for he was remarkably abstemious. The dance was scarcely over when he came to me, and told me with a look of deep despondency, that his lovely partner was a married woman. The tone of sadness in which he addressed me was truly ludicrous. A few minutes after he left the ball-room. The strangeness of his conduct led me to fear that his mind was not altogether in a sound state; but I was confirmed in my apprehension when he told me the following morning that he was convinced he should be married to the object of his admiration, whose husband was a young and healthy clergyman in the neighbourhood. Here matters rested, and we both went abroad. We did not meet until three years after, when, to my utter surprise, I found that his prediction had been verified. The lady's husband had died from a fall from his horse, and the parties were married. But what rendered this circumstance still more strange is, that a similar presentiment was experienced by the young lady herself who, on returning from the ball, mentioned to her sister with much emotion, that she had danced with a stranger, to whom she felt convinced that she was destined to be married. This conviction embittered every moment of her life, as, despite her most strenuous endeavours, she could not dismiss her partner from her constant thoughts, reluctantly yielding to the hope of seeing him again. The sympathetic power of fascination is another unaccountable phenomenon. It is well known that in regions infested with venomous snakes, there are persons endowed both by nature and by art with the power of disarming the reptiles of their poisonous capacities. The ancient Cyrenaica was overrun with poisonous serpents, and the Psylli were a tribe gifted with this faculty. When Cato pursued Juba over the Cyrenaica desert, he took some of these Psylli with him to cure the poisoned wounds that these reptiles might have inflicted on his soldiers. Bruce informs us that all the blacks in the kingdom of Sennaar are perfectly armed by nature against the bite of either scorpion or viper. They take the cerastes, or horned serpent, (one of the most venomous of all the viper tribe,) in their hands at all times, put them in their bosoms, and throw them to one another, as children do apples or balls; during which sport the serpents are seldom irritated to bite, and, when they do bite, no mischief ensues from the wound. It is said that this power is derived from the practice of chewing certain plants in their infancy. This is most probably the fact; these substances may impregnate the body with some quality obnoxious to the reptile. The same traveller has given an account of several of these roots. In South America a similar practice prevails, and a curious memoir on the subject was drawn out by Don Pedro d'Orbies y Vargas, detailing various experiments. He informs us that the plant thus employed is the _vejuco de guaco_, hence denominated from its having been observed that the bird of that name also called the serpent-hawk, usually sucked the juice of this plant before his attacks upon poisonous serpents. Prepared by drinking a small portion of this juice, inoculating themselves with it by rubbing it upon punctures in the skin, Don Pedro himself, and all his domestics, were accustomed to venture into the fields, and fearlessly seize the most venomous of these serpents. Acrell, in the _Amoenitates Academicæ_, informs us that the _senega_ possesses a similar power. The tantalus or ibis of Egypt, that derives its chief food from venomous animals, depends in a like manner on the protection of antidotes. This power of fascinating serpents is so great, that they remain totally torpid and inactive under its influence, and are not even able to offer any resistance when skinned from tail to head like an eel, and eaten alive. According to Bruce, they sicken the moment they are laid hold of, and are exhausted by this invincible power as though they had been struck by lightning or an electric battery, shutting their eyes the moment they are seized, and never attempting to turn their mouth towards the person that holds them. It has been asserted that the Hindoo jugglers render serpents innocuous by the extraction of their teeth, and although this may be the practice in some parts of India, it is not generally resorted to in other countries. Dr. Mead and Smith Barton of Philadelphia endeavour to explain this power by the influence of terror. This supposition, however, is not correct, since the serpent will injure one man and not another, if the latter is gifted with this faculty and the former one is not. Major Gordon of South Carolina attributes the fascinating power of reptiles to a vapour which they exhale and shed around them; and he mentions a negro who, from a peculiar acuteness of smell, could discover a rattlesnake at two hundred feet distance. That certain odours are overpowering there is not the least doubt; and trout and other fresh-water fishes are charmed and caught without resistance when the hand is smeared with asafoetida, marjoram, and other aromas. The fishes, delighted no doubt with this odour, or intoxicated by its power, will actually flock towards the fingers, and allow themselves to be laid hold of. Thieves and housebreakers have been known to possess the power of quieting watch-dogs, and keeping them silent during their depredations. Lindecrantz informs us that the Laplanders can instantly disarm the most furious dog, and oblige it to fly from them with every expression of terror. The strange faculty of taming the most unmanageable horses, possessed by an Irishman, hence called the _Whisperer_, is well known. Several horse-breakers have appeared at various periods possessing the same art, and they would make the wildest horse follow them as tamely as a dog, and lie down at their bidding. It has been affirmed that these whisperers introduce a globule of quicksilver, or some other substance, into the animal's ears. It is, however, more probable that these charmers derive their power of fascination from some natural or artificial emanation. The most singular power of fascination is perhaps that exhibited by the jugglers of Egypt, who, by merely pressing the serpent called _haje_ on the neck, stiffen the reptile to such a degree, that they can wave it like a wand. To explain this sympathetic influence that living beings exercise on each other, as I have already observed, has long been the study of philosophers. Their chief theories may be divided into those of the advocates of _pneumatism_ or _spiritualism_, who maintained that the nerves transmitted a subtle fluid susceptible of external transmission. Such were the disciples of Plato; and, amongst the moderns, the Arabian writers, Paracelsus, Van Helmont, Willis, Digby, Wirdig, and even Boerhave. The _mechanicians_ formed another class, refusing to admit the doctrine of influences, and submitting all sympathetic phenomena to the laws of mechanism and chemistry. Amongst these we find the Cartesians, Boyle, Hoffmann, and Haller. Their doctrine had already been established amongst the ancients by Asclepiades. The third system was that of the _organicians_, who attributed these effects to our organization, governed by a principle of free agency. In this school are recorded the names of Hippocrates, Galen, Stahl, Bordeu, and many illustrious writers of various ages. An investigation of these discrepancies would be foreign to these sketches. I can only observe, that none of them are tenable, and have only tended to display scholastic learning and ingenuity, without any practical beneficial results. Indeed, the only advantages that might possibly accrue from these pursuits would be the shedding of some faint light upon our systems of early education, by finding out the most judicious method of counteracting innate dispositions and peculiar idiosyncrasies. The life of man is a relative and external existence. He lives in communion with all around him, and before his ultimate dissolution he is doomed to die with every object of his affections that perishes before him. To these objects he has been united by the secret powers of sympathy. The organism of both appears to have been subject to mutual laws; and grief and joy, our pains and pleasures, are transmitted with the rapidity and power of the magnetic fluid. Nor time nor distance can affect these sympathies, which have been known to remain latent in our breasts till called into action by accidental circumstances. Thus, a man has never known how fondly he loved until he was suddenly deprived of the object of his sympathies, although until that moment this affection had been unknown even to himself. This circumstance clearly proves that these sympathies are not under the influence of our imagination. Although it is to this creative faculty that these reminiscences are attributed by Madame De Staël in the following exquisite words, "The creative talents of imagination, for some moments at least, satisfies all our desires and wishes,--it opens to us heavens of wealth; it offers to us crowns of glory; it raises before our eyes the pure and bright image of an ideal world: and so mighty sometimes is its power, that by it _we hear in our hearts the very voice and accents of one whom we have loved_." Sympathies might be denominated a moral contagion in mankind: in the brute creation they merely produce a physical impulse. Reid attributed to the nervous system an atmosphere of sensibility, influencing all that came within its range. Ernest Platner maintained that our soul could diffuse itself in mutual transmission; and in another paper I have shown that life may be prolonged by sacrificing the health of others, when the genial warmth of youth is surreptitiously communicated to decrepitude. What is then this invisible vital fluid, this electric principle, that the touch, the breath, the warmth, the very aroma of those we are fond of, communicates, when trembling, fluttering, breathless, we approach them? that enables us, even when surrounded with darkness, to recognise by the feel the hand of her we love? Nay, whence arises the feeling of respect and veneration that we experience in the presence of the great and the pre-eminently good? It may be said this is the result of our education; we have been taught to consider these individuals as belonging to a superior class of mortals. To a certain extent this may be true; yet there does exist an impressive contagion when we are brought into the presence, or placed under the guidance, of such truly privileged persons. Their courage, their eloquence, their energies, their fanaticism, thrill every fibre, like the vibration of the chord under the skilful harpist's hand. Actuated by this mystic influence the coward has boldly rushed into the battle, the timid dared imminent perils, and the humane been driven to deeds of blood. Fanatic contagion has produced both martyrs and heroes. Example stimulates and emulates, despite our reasoning faculties. _Regis ad exemplar totus componitur orbis._ Imitation is the principle of action, the nursery of good and great deeds. We either feel degraded by the ascendancy of others, when we fancy, however vainly, that we may attain their level; or devote ourselves to their cause and their service, when we tacitly recognize their mastery. It is more particularly in our devotion and in our love,--two sentiments more analogous than is generally believed,--that this _mutuality_ of sympathies prevails; and when Galigai was asked by his judges by what means he had obtained his influence over Mary of Medicis, his reply was similar to that of the Moor when describing his course of love,--the witchcraft he had used to win his Desdemona, when with a greedy ear devouring his discourse. There is no doubt that education, circumstances, our state of health, predisposes us more or less to the action of these sympathetic powers, for then our feelings are actually more or less morbid. Affliction, for instance, predisposes to tender sentiments. There is perhaps much psychological matter of fact in the old story of the Ephesian widow; and our immortal Shakspeare felt the truth not only of the contagion of grief, but of its consoling power when reciprocally felt, although no doubt the reciprocity has often been assumed to woo and win. Grief best is pleased with grief's society. True sorrow then is feelingly surprised, When with like feeling it is sympathized. Fortunately for our frail race, sympathies are liable to be worn out by their own exhausting powers. Attrition polishes but indurates at the same time: thus does social intercourse harden our gentle predispositions. The mathematical world dispels the illusions of our fervent youth, as chilling truth banishes fancy's flattering dreams. Experience is to man what rust is to iron; it corrodes, but at the same time protects the metal to a certain degree, from the magnet's mighty power. Although the nature of sympathies most probably will never be ascertained, their study is essential both to the moralist and the physician, and both may be materially aided in their vocations by the temperament of the pupil or the patient; for, as I shall endeavour to show in a subsequent sketch, our temperaments generally indicate individual characteristics. It is in vain that some philosophers may deny the power of innate faculties and dispositions. The very expression '_human nature_' implies their existence. To encourage their growth, or to check their developement, becomes the duty of those who are entrusted with the education of youth, when yielding to, or counteracting propensities, becomes as necessary as the care the horticulturist devotes to his plants. By the inclination that trees have taken, we can generally learn the prevalent winds of a district. The plastic hand of our early teachers may, in most instances, obtain a similar result; though in the vegetable kingdom, as well as in the animal kingdom, there will be constantly found stubborn trunks that will resist all influence. Were we to admit that our material organism cannot be counteracted, we should inevitably fall into many lamentable errors, and many a crime would be extenuated on the plea of fatalism. It is to be feared that some of our ingenious theorists have too frequently tortured organism on a Procrustean couch, to suit their favourite phantasies. We might reply to the visions of these enthusiasts in the words of Iago, "Our bodies are our gardens, to which our wills are gardeners--either to have it sterile with idleness, or manured with industry. The power and corrigible authority of this lies in our wills. If the balance of our lives had not one scale of reason to poise another of sensuality, the blood and baseness of our natures would conduct us to the most preposterous conclusions." THE ARCHEUS OF VAN HELMONT. One of the most ingenious fictions of those speculators who have endeavoured to explain the mysteries of our wonderful organization, was perhaps the Archeus of Van Helmont, a term derived from [Greek: archê], _origin_, _principle_, _authority_, _power_. According to the doctrines of this physician, the archeus was an internal agent that commanded and regulated all the vital functions. I cannot better describe it than by partly borrowing the language of the founder of the doctrine. The archeus and matter are the natural causes of all. The molecules of matter, essentially inert, receive from this principle their movements, their order, their distribution, their conformation: the archeus is the internal agent that penetrates them, the nucleus of their inspiration; it is the mould in which they are elaborated, brought into form by this plastic influence meeting in this material substance the requisite docility to realize its ideas of perfection. Thus the archeus is an active and an intelligent power, possessing the faculty of amalgamating and identifying itself with matter; penetrating its inmost recesses, it modifies and changes each particle of matter, producing that incomprehensible series of oscillations of spontaneousness and equilibrium, that catenation and marvellous automatism, that constitute the consciousness of our existence, and whence springs the only notion we can form of its causation. It is the archeus that presides over our sense of smelling, of tasting, and consequently the selection of our food; it is _he_ that dissolves it in our digestive organs, liquefies it, and prepares it for due assimilation; it is he that imparts a conservative action to the blood, and converts this vital fluid into bone and muscle. Should any particle of our aliments have escaped from this transforming power, these substances become foreign bodies, irritating by their presence this sovereign power, calling forth his energies and his activity, and exciting his indignation and wrath by their repeated provocations. His just fury stimulates and accelerates the vital functions; but, instead of wreaking its vengeance on external matter, it overwhelms all internal obstacles, whether diffused in the system or concentrated on any given point. It is this tumultuous confusion that constitutes maladies, which arise from two evident causes,--an alteration in matter and a reaction of the archeus. Of these two morbid elements, the first is susceptible of a thousand varieties both in nature and extent, and therefore produces as many modifications in the corrective power. Then does the archeus, threatened on different points in different manners, regulate his plans and operations both of defence and of attack, selecting his weapons according to the nature of his antagonists. In this mutual struggle our archeus wisely checks the impetuosity of his onset, husbands his forces, and merely detaches them from the main body according to the circumstances of the conflict; thus ever keeping a powerful reserve. It is this wisdom of conduct that ultimately restores tranquillity, and compels the rebellious molecules to submit to the laws of organization. For what constitutes the cure of a disease, whether obtained by nature or by art? Nothing more than the dignified repose of the mighty archeus, when the fire of his wrath has consumed his foes. Diseases, therefore, are simply the execution of vast and complex projects that inspire the archeus, and which he carries into execution as the statuary embodies on the marble the conceptions of his genius. When the morbid idea is in conformity with his plans, a favourable result will ensue; if, on the contrary, the archeus labours under a misconception, if he is thrown by erroneous impressions into disordinate steps, then may this power, excited without a just motive, or a determinate and proper object, turn its arms against itself, and destroy the ties that united it to matter. It is then that art, whose aim it is to meet the foe with his own weapons, must have recourse to medicine for the purpose of rousing the torpor of the archeus, reanimate his energies if he droops, overthrow him if he becomes unruly, and finally compel him to yield, by a salutary terror; forcibly bringing him back to that judicious equilibrium in action, when all the functions contribute in harmony and concert to the general welfare of the system. Such were the truly poetical ideas of Van Helmont, who might have written an epic on the government, revolutions, and battles, in the archean state, similar to the Holy War of our ingenious Bunyan; for, like the cobler poet, our theorist divided and subdivided his legions and their officers. The archeus is merely the sovereign commander, whose head-quarters and throne were in the stomach; all the other viscera have distinct commandants, receiving their orders from their chief, who employed the nerves of his _aides-de-camp_. Nor was it an easy matter to keep all these captains in a proper state of discipline. Their irregularities occasioned constant tumults; for the court of the archeus, like all other courts, was most depraved and capricious in its practices, and intriguing in all its machinations, and the archeus had great trouble in keeping his subordinates in a proper state. The most rebellious of his generals was the one who commanded the uterine district. There it was in vain that the articles of war were constantly read,--that solitary confinement and prison-diet were resorted to. Its constant mutinies not only demanded the utmost vigilance, but it was no easy matter to prevent its dangerous influence from contaminating the other branches of the service; and treasonable correspondences were not unfrequently discovered with the staff of the brain. This rebellious province, indeed, excited incessant apprehension, constantly agitated the entire commonwealth, and, on the plea of national welfare and liberty, it hoisted at times a standard of defiance, and precipitated the country in all the miseries of civil war; the more to be dreaded, as it always put forth the most specious pleas, destroying with words of peace. This whimsical doctrine is not unlike the Platonic theories, and resembles the _naturism_ or [Greek: enormon] of Hippocrates, and the autocracy of the soul, of Stahl. Van Helmont not only established his archei in animals, but in plants, and even in our food. The archeus of man he sometimes called _ens seminale_, _ens spirituale_, _impetum faciens_, _aura vitalis_. Well aware that the most powerful despot cannot reign without rival powers, Van Helmont admitted certain _imperia in imperio_: for instance, there was a troublesome minister in his own cabinet, whom the archeus frequently could not control,--one _pylorus rector_, or master of the ceremonies; then he had to apprehend the power of a secret faculty possessed by the stomach and spleen, which he called a _duumvirate_,--_jus duumvirat'_. The sensitive and immortal soul was another check on his sway; while the spirit of life residing in the blood was not easily managed. All these vexations occasioned frequent attacks of illness in the monarch, and Van Helmont has described these several affections; for, although he possessed the power of conceiving and executing plans of disease, like many physicians, he did not know how to cure himself. When we consider that systems similar to this absurd doctrine, if not more extravagant, have ruled the medical schools for centuries with a despotic sway, can we marvel that medicine should have incurred the invectives of scepticism, or the scurrility of wits? In the very ratio of their absurdity have these flitting systems been maintained with scholastic fury; their proselytes would have vied in excesses with monastic persecutors, had they been able to assume a religious mask. It is painful to observe that unbelief and impious ridicule in theologic matters may be referred to the same causes as medical scepticism,--the vain and presumptuous endeavour of man to explain that which the CREATOR has most probably willed to remain inexplicable. Instead of wisely referring all that is mysterious to the Almighty Power that knows no limit, man has sought to explain and comment upon human principles, nay upon human motives; and when they could no longer attribute evil to GOD, they crossed the _pons asinorum_ to call in the Devil. In like manner, when they proudly fancied that they had regulated all the functions of the animal economy in that harmonious manner that they were modest enough to call admirable and wondrous, they endeavoured to account for a derangement of this equilibrious condition, either by the introduction of some evil spirit, or the unmanageable rebellion of some organ, some principle, some agency, and for this purpose they gave individuality and specific vitality to those agents, each of the _dramatis personæ_ having a particular part to perform in bringing on a tragic catastrophe or a happy _denouement_ of the drama of life. Let not the learned doctors of modern schools exclaim, that these were the errors of former days and of dark ages. They themselves are grovelling and groping in the dark whenever they pretend to fly from the trammels of empiricism, and, like our forefathers, account for what is unaccountable. But, above all, let them be meek and modest (if they can) in passing judgment upon others, and inscribe upon the doors of their splendid libraries the saying of the olden sage, "All that we know is our own ignorance." MONSTERS. Philosophers have puzzled their brains to no purpose in endeavouring to account for the unnatural formation of animals. The ancients, amongst whom we may name Democritus and Epicurus, attributing all organization to an atomic aggregation, fancied that matter was endowed with an elective faculty and certain volition in attaining this organism; and considered monstruosities as mere experiments on the part of these atoms to produce some other species or races. This chimera was of a par with the archeus and his satellites of the preceding article. There is no doubt, however, that in the myriads of organized creatures various circumstances may tend to affect most materially the regularity of these developments, in the same manner as the properties and peculiar qualities of their organs may depend in a great measure upon similar influences. Conservation and reproduction are in the ratio of this perfection and imperfection. It is true, generally speaking, that the healthy and the best organized are less liable to engender an ill-conformed offspring; yet parents of this description have been known to produce monsters. Still the _fortes creantur fortibus_ of Horace has become a proverbial expression; and some fanciful wanderers in the mazes of imagination framed rules for their _megalanthropogenesy_, or the art of creating illustrious men and distinguished women by uniting the learned and the witty. Generation is a wondrous mystery. Many casual circumstances may check the mechanism of its action, (if I may be allowed the expression,) and affect its results. Any sudden physical or moral impression acting violently might produce this result; although, despite the theories and experiments of philosophers, it has not been proved that conception depends in the slightest degree upon the passions, being an act of nature totally independent of the control of mental emotions or bodily sufferings. This fact is clearly proved in cases of brutal violence. The ideas entertained by several naturalists, that organized beings were cast in a certain mould, were not altogether visionary, or unfounded in observation. The great resemblance between children, and their hereditary mal-conformation and defectuosities in whole families, would seem to a certain degree to warrant this conclusion; but it is more probable that imagination may have some influence in this irregularity, although at the time we may be unconscious of the relative action of moral agency on physical functions. The supporters of the existence of this plastic mould in which organized matter is cast, would then maintain that the mind having once influenced the conformation of the matrix, it would ever after preserve this deviation from nature's general laws. It is evident that different species of animals and vegetables have disappeared on the face of the earth, some within the memory of man. We neither know how these species have ceased to exist, nor whether all that possibly can be created has hitherto been brought into being; neither can we form any idea regarding the perpetuity of the races that surround us. Perpetuity and eternity (as far as regards this world) are conventional terms: races were supposed to be perpetuated by the successive evolutions of germs, as I have observed in a former article. To a certain extent this doctrine is correct, and is rendered evident in the evolutions of plants arising from their seed. Preternatural conditions are merely irregularities in this germination. The doctrine, that at each creation a true generation and gradual formation of a new conception from the formless genital matter takes place, does not appear to me reconcileable with sound physiology, nor supported by observation; for, were this the case, it is more than probable that preternatural formations would be more frequent. It was upon this doctrine that the learned Blumenbach founded his _nisus formativus_, an expression that he thus explains: "The word _nisus_ I have adopted chiefly to express an energy truly vital, and therefore to distinguish it as clearly as possible from powers merely mechanical, by which some physiologists formerly endeavoured to explain generation. The point upon which the whole of this doctrine respecting the _nisus formativus_ turns, and which is alone sufficient to distinguish it from the _vis plastica_ of the ancients, or the _vis essentialis_ of Wolff, and similar hypotheses, is _the union and intimate co-exertion of two distinct principles in the evolution of the nature of organized bodies_,--_of the_ PHYSICO-MECHANICAL _with the purely_ TELEOLOGICAL;--principles which have hitherto been adopted, but separately, by physiologists in framing theories of generation." The ingenuity of this hypothesis must be admitted, but it does not militate against the pre-existence of germs. Germs are visible in the ovum before fecundation; in these germs the very primordia of future organization can be distinguished. It is by no means necessary to allow these germs an exciting power, or a formative power, as has been objected: they are more or less profuse, and under the influence, as I have already said, of accidental circumstances. It has been maintained that monsters are more common in domesticated animals than in wild ones. This is by no means evident, since we have little opportunity of ascertaining the case in forests and in wildernesses; but, admitting the fact, it only tends to corroborate my opinion regarding the influence of accidental causes in physical development, since domestication must expose animals to many emotions unknown in their natural condition. It has been said that monsters are especially observed among sows. There perhaps is no animal under the subjection of man, excepting, perhaps, the unfortunate donkey, more exposed to physical injuries during gestation; and as the Portuguese maintain that a _cajado_ (a stick) springs from the earth whenever an ass is born, so our bumkins and malicious urchins fancy that every one owes a kick to a gravid sow. Howbeit, I doubt much whether the swinish multitude are more subject to bear monstruosities than other animals; and preternatural conformations are, I believe, as frequent in lambs, and calves, and chickens; and double-headed and double-legged specimens of these animals are more frequently exhibited than monstrous pigs. Monstruosities are of two kinds, and exhibit either an excess of parts or a defect. Thus, some children are born with more limbs than usual, whilst others are deprived of their natural proportions. It is not unlikely that in the former case twins were being developed; whereas, in the other, the proper nourishment of the parts that are either wanting or stunted in their growth had somehow or other been impeded in its assimilation. This opinion seems to be warranted by the facts observed in the artificial incubation of eggs, the different parts of the chick being more or less perfect where the heat had been more or less steadily applied; the produce of those eggs that had enjoyed more warmth being invariably the stronger. The same remark applies to plants. Eggs and seeds are in most respects ruled by similar laws in the phenomena of their germination: the arms and legs grow from the animal foetus, as the branches originate from the trunk of the tree. These ramifications are frequently as symmetrical as human limbs. When there are preternatural excesses in formation, it is probable that twins were intended: thus we see foetuses with double heads, or with two bodies. The same irregularity is observed in double and triple cherries, and other fruits. It is probable that this union took place when these bodies were in a soft state, and the vessels inosculated in their intricate ramifications with greater facility, until further development had consolidated the junction. If a proof were wanting that monstruosities do not arise in the original organization of the embryo, but from subsequent accidents during gestation, it might be sought in those preternatural appearances that arise from frights or longings, and constitute what are called _nævi materni_. Thus are infants born bearing the marks of some fruit the mother had desired, or some animal that had terrified her. This phenomenon plainly shows that there does exist a wonderful sympathy between external objects and the uterine system; yet this sympathy is not as surprising as that which is subsequently observed between these marks and the fruit they represent. It is a well-authenticated fact that they will assume a tinge of maturity when the fruit is ripening, and become gradually more pale as it is going out of season. The same observation has been made in regard to animal marks; for instance, these marks have displayed a deeper colour when the mouse or the rat that had occasioned them was mentioned. I know a lady who, during her pregnancy, was struck with the unpleasant view of leeches applied to a relative's foot. Her child was born with the mark of a leech coiled up in the act of suction on the identical spot. Mr. Bennett has published a remarkable instance of this uterine sympathy. A woman gave birth to a child with a large cluster of globular tumours growing from the tongue, and preventing the closure of the mouth, in colour, shape, and size exactly resembling our common grapes, and with a red excrescence from the chest, as exactly resembling in figure and appearance a turkey's wattles. On being questioned before the child was shown her, she answered that, while pregnant, she had seen some grapes, longed intensely for them, and constantly thought of them; and that she was also once attacked and much alarmed by a turkey-cock. Various writers have positively denied these facts. Gerard tells us that he had known three pregnant women whose minds had been constantly occupied with the unpleasant recollections of a cripple, of a dancing-dog fantastically dressed, and a basket of beautiful peaches; yet their offspring bore no marks of these objects. This is no argument. No rational person could imagine for a single moment that every impression thus received is to be transmitted. Buffon, who also doubts this influence, thus expresses himself: "We must not expect that we shall be able to convince women that the marks their children may bear have no analogy with ungratified longings. I have frequently asked them, before the birth of their infants, what had been their wishes, and consequently what would be the marks that they might expect? By this question I frequently gave unintentional offence." Now, with all due respect to this celebrated naturalist, this argument is by no means conclusive. We perfectly well know that pregnant women are frequently alarmed without such consequences, and the most fantastic phantasies may cross their idle brains, without any such result. It has been observed on this subject, "that when a circumstance may proceed from many causes, we do not universally reject any one because it is frequently alleged without reason." We have too many well-authenticated cases before us to doubt this strange effect of maternal impressions, so clearly observed and recorded in Holy Writ in the following passage of Genesis: "And Jacob took him rods of Green poplar, and of the hazel and chestnut tree, and pilled white strakes in them, and made the white appear which was in the rods. And he set the rods which he had pilled before the flocks in the gutters in the watering-troughs, when the flocks came to drink, that they should conceive when they came to drink. And the flocks conceived before the rods, and brought forth cattle ring-straked, speckled, and spotted." The sympathy that evidently exists between bodies separated from each other, but previously connected, has given rise to many absurd stories. It is told of Taliocotius, that having made a nose for a patient, cut out of a pig, the poor man's snout fell off the moment the hog was slaughtered. A similar belief prevails among horticulturists, who assert that the graft perishes when the parent tree decays. A very singular phenomenon is observed in wine countries, where the wine in wood enters into a state of slight effervescence, and even efflorescence, when the vines begin to throw out their blossoms. It therefore appears to me more than probable that monstruosities are by no means original mal-conformations, but arise, during gestation, from physical or moral influences that affect the mother, however unconscious she may be of their action. We have frequent instances of violence occasioning preternatural developements. Mr. Giron Buzareingues mentions that a violent blow was given to a gravid bitch, who produced eight pups, all of which excepting one, had the hind-legs wanting, malconformed, or weak. A further disquisition would lead me beyond the limits of a sketch. I shall therefore relate some curious cases of monstruosities, that would seem to set at nought our ideas regarding the _indispensability_ of certain organs to the functions of life. Various instances are recorded of the union of two or more foetuses. We have lately seen the Siamese twins, and such a preternatural formation is by no means uncommon. In the Journal de Verdun, 1709, a case is related of two twin female children who were united at the loins, with only one intestinal canal. They were seven years old, could walk about, embrace each other in the fondest manner, and both were proficient in several languages. Buffon gives the history of two Hungarian girls, who were also joined together in the lumbar region. Helena, who was the first-born, became tall and straight; Judith, her sister, was of a diminutive size, and slightly arched. At six years of age she was attacked with hemiplegia, and never recovered perfect health. Helena was sprightly and intelligent. With the exception of the smallpox and measles, under which they laboured at the same time, their ailments were always distinct. They lived until the age of twenty-two, when Judith was attacked with a fever, that shortly terminated her existence. The horror expressed by Helena in beholding her dead companion, with whom she had been identified in sisterly love for so many years, cannot be described; but her agonies were of short duration, for in three minutes she also had ceased to live. On their _post mortem_ examination each was found to have possessed distinct viscera. The aorta and vena cava were united above the origin of the iliac arteries, so that no severing operation could have been performed without destroying them both. Duverney relates the case of twins united at the lower part of the abdomen. They only lived six days; the strongest of the two died first, and was followed by his companion three hours after. Haller records upwards of thirty cases of a similar nature; and various skeletons of this description are to be seen in our museums. Munster saw two girls united by the forehead. They had then attained their tenth year, when one of them died. It therefore became indispensable to separate them, but the unfortunate creature did not survive the operation. Daubenton describes two children united at the back of the head. Such miserable junctions naturally suggested the idea of effecting a separation by surgical means; but I believe this operation was only once performed with a successful result. Two little girls were united from the xiphoid cartilage to the umbilicus. The uniting substance was an inch in thickness, six lines in breadth, and five inches in circumference. In the centre of the junction was the umbilical ring common to both. The umbilical vessels were separated and tied; the ligature fell at the expiration of nine days; and then Zwingler, the operator, proceeded to divide the remaining bonds. Various monsters have been seen with four arms and three legs, or four legs and two or three arms. The history of the double-headed infant of Oxford is curious. This creature had two heads diametrically opposite, four arms, one body and two lower extremities. These heads were doubly baptized; one by the name of Martha, and the other Mary. The features were different; Mary's was smiling, Martha's dejected. The latter died two days after her birth, and Mary expired a quarter of an hour after. A curious monster of a similar description is recorded to have lived at the court of James IV. of Scotland. It had been taught several languages, and music. One head was intelligent, the other remarkably stupid. This creature lived twenty-eight years, when one of the individuals died. The other survived several days, but gradually drooped as the body of his late companion was decomposing. In olden writers we have many curious cases. How far they may be entitled to credit I cannot say; although we have no reason to deny the fact, when we daily witness the most singular malconformations. Liceti relates the case of a child with two legs, but seven heads and seven arms. Bartholinus mentions one with three heads, each of which uttered the most horrible cries, and then expired. While these unfortunates were visited with several heads, instances have been known of heads that had attained a most enormous volume. In Tunis, there was a Moor of thirty years of age, whose head was so large, that crowds followed him in the streets; and his mouth was of such a capacity, that he could devour a large melon as easily as an apple. This man was an idiot. At Lucca, Benvenuti saw a lad, otherwise well-proportioned, whose head at the age of seven began to increase so rapidly, that when he was twenty-seven it measured thirty-seven inches eight lines in circumference, and his face was fifteen inches long. Singular monstruosities have been seen, where heads and bodies seemed actually to be growing from or hanging to individuals. Winslow knew an Italian child, of eight years of age, who carried a little head under the third left rib, and peeping out as if the body of the one had been concealed in that of the other. Both heads had been christened; the one James, the other Matthew. When the ear of little Matthew was pinched, his host James forthwith began to roar. The Bengal child, whose case is related by Valentin and Horne, is equally singular. Here one head was placed above the other, the superior one nearly as well conformed as the lower; both adhered intimately. The upper face assumed somewhat of an oblique direction. Each head had its distinct brain: sometimes one head was fast asleep while his neighbour was wide awake, and one head would cry most piteously if you pulled the hair of the other; but, what was still more singular, when the one was fed, its companion expressed its gratification, and water flowed from its mouth. This monster lived four years, and probably would have lived much longer, but for the bite of a venomous reptile. In a former article I alluded to encephalous and anencephalous cases, where there were either no heads or heads without brains. Of the first variety Béclard relates the following: A woman at Angers was delivered of twins, one of which not only was without a head, but only showed the inferior part of the body; without arms, a small stump-like excrescence growing from the upper part of the chest; the feet were turned inwards, and without toes. The creature was of the male sex. The body presented one cavity without any diaphragm; nor could any trace of liver, spleen, oesophagus, or stomach be detected: the intestinal tube commenced at the upper part of the body, but was impervious; the pancreas and kidneys were as usual; the umbilical vein arose from the cava, and the umbilical arteries from the hypogastric. There were ten ribs on each side, and the spinal marrow threw out its regular nerves. Brunel has recorded the case of a male infant born without brains. The frontal bone was thrown back, and flattened on the sphenoid in such a manner that the eyes appeared above his head. The parietal and the squamous portion of the temporal were wanting, although the organ of hearing was well conformed. Not a vestige of brain could be discovered; yet the carotid and vertebral arteries crossed the basis of the cranium. The spinal marrow arose from the fourth cervical vertebra. The organs of sight were perfect. Saviard describes an infant in which all the bones of the cranium were wanting, and, instead of a brain, the skin merely covered a cyst, containing a red pulpy substance resembling brain, whence arose several nerves. It is, no doubt, to these malconformations that we are to attribute the various stories of children with heads of monkeys, goats, pigs, &c., or of that child whose face represented the devil, and who was described as "Cacodæmonis picturæ quàm humanæ figuræ similius," &c. The idle tales of Cyclopes are also to be sought in such accidental preternatural appearances, and several instances are recorded of children born with a single eye in the forehead. It would be useless to dwell longer on this painful subject. Those who wish for more information may gratify their curiosity by consulting the works of Haller, Soemmering, and other writers, who have treated this matter _ex professo_. In conclusion, it appears to me that monstruosities are purely accidental, subject to no laws of nature, but deviations from them. We leave to theologasters the question of their being visitations of divine wrath. The only theories that can admit of discussion are the following: 1st, The imagination of the mother; 2nd, Accidental causes; and 3rd, An original monstrous germ. Maternal marks arising from longings and terror, as I have already observed, seemed to warrant the first conclusion; yet it is not tenable. What has imagination to do with the vegetable kingdom, which also presents monstrous conformations? Are we to attribute the same power of imagination to the brute creation? and, although we may fully admit the sympathy that exists between the uterine system and external objects, yet we cannot refer headless and double and triple embryos to this influence. The last hypothesis is also fraught with objections. We have every reason to believe that all germs or seed are perfect in themselves. Were there monstrous germs, there would ensue monstrous races. That germs may be accidentally vitiated and impaired there can be no doubt; but such an adventitious occurrence does not constitute an original monstruosity. Duverney and Winslow maintained that, in the case of a double monster, the monstruosity arose in the primitive germ. Lemery and other physiologists, on the contrary, insisted that double foetuses arise, as I have already stated, from a junction or fusion between two separate bodies, or, in short, the union of twins or triple conceptions, &c. Anatomical investigations confirmed this opinion, since in double-headed foetuses two distinct sets of organs are generally found. This subject has occupied the most ingenious philosophers for centuries; and the result of their experiments and debates seems to warrant the probability of these melancholy deviations from nature, foolishly denominated _lusi naturæ_, being purely accidental. The experiments of Jacobi seem to confirm this opinion, since he was able to produce preternatural fecundation in the eggs of fishes. This investigation may appear idle; yet, in a physiological point of view, it is fraught with interest as regarding the generation of animals and plants. Its study affords a lively illustration of those laws of attraction and repulsion that regulate the universe, and which seem to admit that every particle of matter should be endowed with a specific vitality, a specific individuality. This attraction is daily seen in the fecundation of the spawn of fish. Myriads of these eggs are accumulated in ponds and rivers; yet in this mass the fecundating principle solely selects and impregnates those that naturally claim its vivifying powers. Wonderful harmony, that man alone endeavours to destroy!--harmony so perfect, that Aristoxenus and Alcmæon maintained that it was an emanation of the diapason of celestial music between the planets, our globe, and our five senses, forming a diatonic series of seven tones; while Hippocrates justly denominated these organic laws the CONFLUXUS UNUS, CONSPIRATIO UNICA, CONSENTIENTIA OMNIA. LONGEVITY. The greater the complexity of a piece of machinery, and the more labour it is called upon to perform, the more rapid will be its wear and tear. This applies to human life as well as to mechanism. The derangement of its component parts--its springs and wheels, will also be in the ratio of their complication. Thus do we find that the brute creation are less subject to those affections that abridge their days than mankind. Their life is natural, except when under the sway of domestication: ours is artificial; and high civilization tends to render it still more unnatural than it would most probably have been in a simple and patriarchal existence. Endowed with more acuteness of sensibility than animals, we are rendered more susceptible of the extremes of pleasure and of pain; and our voluptuous enjoyments are perhaps more prejudicial than our sufferings. Had not the Creator wisely granted us the faculty of reasoning, we should have been the most wretched of all organized beings. The tenure of life depends upon the sum of vitality originally deposited, and the extent of our drafts upon this capital, which we too frequently exhaust by untimely expenses. Experience has proved that under ordinary circumstances, man can live six or seven times longer than the years required to attain puberty. This epoch is placed at our fourteenth year. This calculation would therefore yield from 84 to 98 years of age. Our own imprudences, and the disorders resulting from them, are more hostile in abridging this period than nature, all-wise and all-bountiful. Indeed, when we reflect on all the excesses to which we expose our frail and complicated being, as if we were resolved to try by every possible experiment how far it possesses the power of resisting destructive agents, we can only marvel in beholding so many instances of longevity. In this wasteful existence how many valuable hours do we not lose? how many real enjoyments have we not deprived ourselves of? When compared to the immensity of time, life is but an idle span. Let us deduct even from old age the years of infancy, the years of caducity, and the years of sleep,--alas! what remaineth of our many and our energetic days? Maupertuis calculated that in an ordinary life man could scarcely enjoy more than three years of happiness, mixed up with sixty or eighty years of misery or insipidity; and yet how miserable are we at the thought of quitting this short-leased tenement, though every wretchedness renders our abode a constant scene of uneasiness. It has been computed that out of about nine hundred millions of human beings that are scattered over the globe, it is more than probable that we could not find nine thousand individuals blessed with happiness, even taking happiness in its most limited sense--content. Were it not for the terrors of futurity, it is more than probable that our existence would lose much of its value. Socrates termed philosophy "the preparation for death;" the same may be said of our existence. Happily for man, life is a dream, all is illusion; sufferings alone are positive; Pandora's box is its best illustration. Could we have slept away our existence in constant visions, we should have lived as long as in a waking state. When we contemplate the flocks of human beings scattered like cattle on the face of the universe, with scarcely more intellect than the beasts of the same field, we might ask for what were they created? doomed to all the horrors of sickness or of war, victims of their own follies or the ambitious projects of others! As far as regards this life, it is worse than idle to seek a solution of the problem. In these inquiries we too often seek to guess that which we can never know, and to know that which we can never guess! We all complain and murmur like the woodman in the fable, yet are loath to accept the relief we loudly call for. The longevity of the first races, and the patriarchs, are records foreign to the investigations of natural history; we must seek for more recent examples. Haller had collected the cases of many centenaries, amounting to sixty-two who had reached from 100 to 120; twenty-nine from 120 to 130; and fifteen from 130 to 140. Few instances are authenticated beyond this period: yet we find one Eccleston, who lived 143 years; John Effingham, who attained his 144th; a Norwegian, who counted a century and a half; and our Thomas Parr would most probably have passed his 152nd year but for an excess. Henry Jenkins lived to 169; and we have on record the case of a Negress, aged 175. The Hungarian family of John Rovin were remarkable for their longevity: the father lived to 172, the wife to 164; they had been married 142 years, and their youngest child was 115; and such was the influence of habit and filial affection, that this _child_ was treated with all the severity of paternal rigidity, and did not dare to act without his _papa's_ and _mamma's_ permission. By the calculations of Sussmilch, out of one thousand individuals, only one attained 97; and not more than one lived to the age of 100, out of one hundred and fourteen thousand. In the census of Italy, taken under Vespasian, there were found fifty-four of 100, fifty-seven of 110, two of 125, four of 130, and three of 140. In China, under Kien Long, in 1784, there were only four individuals who had attained their 100th year. According to Larrey, there were at Cairo thirty-five persons who had exceeded their century. In Russia, in 1814, out of eight hundred and ninety-one thousand six hundred and fifty deaths, were three thousand five hundred and thirty-one from 100 to 132. In a register of deaths in Paris, taken in 1817, there were found in twenty-one thousand three hundred and ninety-two, nine from 95 to 100, and the general proportion of centenaries in that city is one to three thousand. What are the circumstances most favourable to longevity? This question is not easily answered; for we find in instances of advanced age that some individuals have led a most regular and abstemious life, while others have indulged in various excesses. These observations, however, are by no means calculated to form a conclusive opinion, as the constitutional vigour and peculiar idiosyncrasies of individuals differ widely. It is probable that a regular mode of living is the most likely to prolong our years, whatever may be that regularity in a comparative point of view. A sober man, who commits occasional excesses, is more likely to suffer than another man who gets drunk every night, provided that these excesses do not differ in regard to the quantity or quality of stimulus. In these melancholy instances the excitement is constant, and the indirect debility which it may produce has scarcely time to break down the system ere it is again wound up to its usual pitch, to use the vulgar expression, "by a hair of the same hound." The principal attribute of life that renovates for a while its moral and its physical exhaustion is _excitability_, and a constant _excitement_ is therefore indispensable, to serve as fuel to the consuming fire. This was to a certain degree the basis on which Brown founded his doctrine. He traced a scale of life like that of a thermometer,--health in the centre, death at each extremity: one scale ascending from health was graduated according to stimulating agency, the other to debilitating causes; and therefore the system was to be stimulated or lowered according to this gradation. It would be foreign to this work to point out the absurdity of this theory, although we must admit its ingenuity, and to a certain extent its correctness. The chief practical objection to it was the diversity of constitutions and idiosyncrasies, and the different action of stimulating or depressing agents in health and in disease; the effects of alimentary and medicinal substances being totally different in these several conditions. According to habit, a certain sum of stimulus is requisite to keep up the necessary excitement; and this sum cannot be immediately and suddenly withdrawn in weak subjects without some risk; in health, perhaps, the experiment may be safely made at all times, and under any circumstances, although it might be wiser to operate the change by degrees; and it must moreover be recollected, that an habitual drunkard is in a morbid condition, and must be treated accordingly. Six causes chiefly exert their influence upon life: 1. Climate and soil. 2. Difference of races. 3. Complexion and stature. 4. Period of development during gestation, and of subsequent growth. 5. Mode of living. 6. Moral emotions, occupations. Climates that are moderately cold are more favourable to long life. This observation equally applies to the vegetable kingdom; and trees that have scarcely attained their full growth in northern regions are drooping in the south. There also we find beasts and birds resisting the inclemency of the weather by the thickness of their coats and plumage, or a layer of grease; while many animals burrow in the earth to seek a state of torpor and insensibility, until restored to active life by a more genial temperature. Dryness of soil is another source of health and life; and the hardy mountaineer's existence is seldom abridged by the diseases that visit the inhabitants of damp and swampy regions. Steril plains are more salubrious than regions covered with a rank and exuberant vegetation, or highly cultivated grounds, from many obvious reasons. The humid earth is not turned up, and decayed vegetable substances are not acted upon in a deleterious manner by the solar heat. When we consider the various causes of disease that must abound in crowded and corrupt cities, we might imagine that mortality would be much greater than in the country; yet observation has not proved this difference to be as material as one might expect, at least as regards disease, the sad effects of poverty and starvation not being taken into account. Various reasons may be assigned for this apparent anomaly. In cities a more regular state of excitement prevails, and man's constant occupations scarcely give him time to attend to slight ailments, that, under other circumstances, might be aggravated. Moreover, intermittent fevers and visceral affections are more frequent in the country; and cottagers are exposed to more constant damp and severer revolutions in the atmospheric constitution than citizens. The mortality amongst men is greater in cities than in women; the latter do not enjoy so long a life in the country. March and April have been found the most fatal months. They are periods of atmospheric transition from cold to a higher temperature, and must therefore prove trying to the weak and the aged. The end of autumn is also deemed a sickly period; and the equinoxes have ever been considered critical, the solstices much less injurious. In Great Britain and the north-westerly regions of Europe, northerly and easterly winds are more prevalent in March, April, and May, owing, it is supposed, to the currents established to replace the warmer air, as it rises from the surface of the Atlantic and more southerly countries. These winds are generally dry and cold, followed by fogs, and give rise to catarrhs, bronchial and pulmonary affections. It is calculated that in our climes pulmonary affections carry off one-fifth of the population, or 191 in 1000. In regard to the variety of races, it has been observed that those people who sooner attain pubescence are the shortest-lived. Precocious excitement must bring on premature old age. Negroes seldom attain an advanced period of life; and the progress of years is more rapidly descried in their features and their form than in Europeans who have migrated to their clime. The negroes of Congo, Mozambique, and Zanguebar, seldom reach their fiftieth year. In northern latitudes longevity is more frequent: this is observed in Sweden, Russia, Poland, Norway. Some writers have looked upon the established religion of a country as influencing the duration of life; and Toaldo asserted that Christians are shorter-lived than Jews. To this observation it may be remarked, that Jews are in general a very sober, industrious, and active race, circumstances that must materially tend to prolong their days. Moreover, by their legislation they are very careful in the choice of the meat they consume. In Catholic countries fasting may be taken into calculation, not from the effects of abstemiousness, which would be more favourable to health than injurious, but the sudden return to feasting and gormandizing, by way of revenge, when the fast is over. Shrove Tuesday and Easter Sunday are noted in red letters in the gastronomic almanac; and the suppers that follow the midnight masses of Christmas generally require the apothecary's aid on the following morning.[46] In regard to conformation, very tall and spare subjects are seldom long-lived; and the same observation applies to the stunted and diminutive. A well-set body, with a broad and deep chest, a neck not over-long, with well-formed and firm muscles, generally hold forth a fair prospect of old age. Children born before the regular period of gestation, those who have been weaned too early, or given to nurses whose milk was not of a proper quality, are seldom strong. Too rapid a growth will also shorten the space of existence. Our avocations and pursuits materially affect health and the consequent duration of life; and the nature of the excitement man is submitted to produces a remarkable effect. It has been calculated in France that one hundred and fifty-two academicians, whose aggregate years were ten thousand five hundred and eleven, averaged sixty-nine years and two months. The following calculation of Madden will further illustrate this curious subject. AGES OF GREAT MEN. _Natural Philosophers._ Bacon 78 Buffon 81 Copernicus 70 Cuvier 64 Davy 51 Kepler 60 Laplace 77 Leibnitz 70 Newton 84 Whiston 95 Euler 76 Franklin 85 Galileo 78 Halley 86 Herschel 84 Lalande 75 Lewenhoeck 91 Linnæus 72 Tycho Brahe 75 Wollaston 62 _Poets._ Ariosto 59 Byron 37 Collins 56 Cowper 69 Dryden 70 Gray 57 Milton 66 Pope 56 Spenser 46 Thomson 48 Burns 38 Camoens 55 Cowley 49 Dante 56 Goldsmith 44 Metastasio 84 Petrarch 68 Shenstone 50 Tasso 52 Young 84 _Moral Philosophers._ Bacon 65 Berkeley 79 Condillac 65 Diderot 71 Fitche 52 Helvetius 57 Hume 65 Kaimes 86 Malebranche 77 Stewart 75 Bayle 59 Condorcet 51 Descartes 54 Ferguson 92 Hartley 52 Hobbes 91 Kant 80 Locke 72 Reid 86 St. Lambert 88 _Dramatists._ Alfieri 55 Goethe 82 Marlow 32 Racine 60 Shakspeare 52 Congreve 59 Crebillon 89 Farquhar 30 B. Jonson 63 Molière 53 Corneille 78 Massinger 55 Otway 34 Schiller 46 Voltaire 84 Colman 61 Cumberland 80 Goldoni 85 De Vega 73 Murphy 78 _Authors on Law and Jurisprudence._ Bentham 85 Butler 83 Erskine 73 Gifford 48 Hale 68 Littleton 75 Montesquieu 66 Romilly 61 Tenterden 78 Vatel 53 Blackstone 57 Coke 85 Filangieri 36 Grotius 63 Holt 68 Mansfield 88 Redesdale 82 Rolle 68 Thurlow 74 Wilmot 83 _Miscellaneous and Novel Writers._ Cervantes 70 Scott 62 Smollett 51 Defoe 70 Richardson 72 Johnson 75 Warton 78 Tickell 54 Bathurst 84 Hawkesworth 59 Le Sage 80 Fielding 47 Rabelais 70 Ratcliffe 60 Sterne 56 Addison 48 Steele 59 Montaigne 60 Thornton 44 Hazlitt 58 _Authors on Revealed Religion._ Baxter 76 J. Butler 60 Calvin 56 Doddridge 54 J. Knox 67 Luther 63 Melancthon 64 Porteus 77 Sherlock 67 Whitefield 56 Bellarmine 84 Bossuet 77 Chillingworth 43 G. Fox 67 Lowth 77 Massillon 79 Paley 63 Priestley 71 Wesley 88 Wycliffe 61 _Authors on Natural Religion._ Annet 55 Cardan 75 Sir W. Drummond 68 N. Freret 61 Lord Herbert 68 St. Pierre 77 Tindal 75 Vannini 34 Bolingbroke 79 Chubb 65 Dupuis 67 Gibbon 58 Spinosa 45 Shaftesbury 42 Toland 53 Volney 66 _Medical Authors._ J. Brown 54 Cullen 78 Fordyce 67 Gall 71 Harvey 81 J. Hoffman 83 W. Hunter 66 M. Good 64 Pinel 84 Tissot 70 Corvisart 66 Darwin 72 Fothergill 69 J. Gregory 48 Heberden 92 Hunter 65 Jenner 75 Paracelsus 43 Sydenham 66 T. Willis 54 _Philologists._ Bentley 81 Casaubon 55 Hartzheim 70 Heyne 84 Parr 80 Pighius 84 Raphelengius 59 J. J. Scaliger 69 H. Stephens 71 Vossius 73 Burton 64 Cheke 44 J. Harman 77 Lipsius 60 Pauw 61 Porson 50 Salmatius 66 Sigonius 60 Sylburgius 51 Wolfius 64 _Artists._ Bandinelle 72 Canova 65 Flaxman 71 Giotto 60 San Sovino 91 A. Caracci 49 David 76 Raphael 37 Salvator Rosa 58 P. Veronese 56 Bernini 82 Donatello 83 Ghiberti 64 M. Angelo 96 Verocchico 56 Claude 82 Guido 67 Reynolds 69 Titian 96 West 82 _Musical Composers._ Arne 68 Beethoven 57 Bull 41 Corelli 60 Greby 72 Haydn 77 Kerser 62 Mosart 36 Piccini 71 Scarlatti 78 Bach 66 Burney 88 Cimarosa 41 Gluck 75 Handel 75 Kalkbrenner 51 Martini 78 Paesiello 75 Porpore 78 Weber 40 To this list we may add the following instances of longevity from the late publication of Mr. Farren: Adling 93 Alcock 91 Bernabel 89 Celdara 90 Canpra 84 Casipini 90 Cervetti 101 Child 90 Creighton 97 Eichole 80 Genimani 96 Gibbons 93 Hasse 90 Hempel 86 Hesse 91 Leveridge 90 Lopez 103 Pittoni 90 Reike 100 Sala 99 Schell 87 Schramm 82 Telleman 86 F. Turner 99 W. Turner 88 Wagennell 98 In regard to the mortality of musicians, we give with much pleasure the following extract from the same work: "The ages of 468 persons at death, were all that could be obtained from a biography of musicians; of these, 109 born since the year 1740 are excluded, because some of their cotemporaries were yet living at the date of such biography, also 41 more are excluded as having died under 50 years of age. There remain then, the ages at death of 318 persons on which the present observation is made. "From the ages of 50 years to the end of life, the _apparent_ rate of mortality among musicians, appears very nearly with the lowest known rate, or that which prevails in villages, and it is scarcely probable that such rate should so agree without being the true one. For a musician to belong to the last class of human life, is very credible, when it is considered that eminence can only be attained by close mental devotion to an exalted science, and unremitting application to its practical acquirement, which abstraction would interrupt and intemperance destroy. "The mean age of musicians, born _since_ 1690, is 67-3/4 years, or two years greater than those born before 1690, from which it might be conveniently concluded, that the moderns were longer lived than the ancients. The case is precisely the reverse, at least for ages above 50, to which alone the materials are applicable. The expectation of life at the age of 60 of the ancients were nearly 15 years, of the modern musicians 13-1/2. The materials (limited as they are) from which these conclusions are drawn, support the doctrine, that the mortality of the moderns is less at middle, but greater at advanced age, than the mortality of the ancients." Dr. Caspar, of Berlin, in his late very interesting work on the duration of human life, has given the following conclusions: Medium longevity. Clergymen 65 Merchants 62 Clerks 61 Farmers 61 Military men 59 Lawyers 58 Artists 57 Medical men 56 The results of the other classes, with respect to their united ages, and the average of each, are-- Average. Moral philosophers united ages 1417 70 Sculptors and painters 1412 70 Authors on law and jurisprudence 1394 69 Medical authors united ages 1368 68 Authors on revealed religion 1350 67 Philologists 1323 66 Musical composers 1284 64 Novelists and miscellaneous authors 1257 62-1/2 Dramatists 1249 62 Authors on natural religion 1245 62 Poets 1144 57 This calculation was made most probably in Prussia. Dr. Caspar's view of longevity are not only highly interesting but, if correct, may lead to many important conclusions. He maintains that-- 1. The female sex enjoys, at every period or epoch of life, except at puberty, at which epoch the mortality is greater among young females--a greater longevity than the male sex. 2. Pregnancy and labour occasion, indeed, a considerable loss of life, but this loss disappears or is lost in the general mass. 3. The so-called climacteric periods of life do not seem to have any influence on the longevity of either sex. 4. The medium duration of life at this present time (1835), is in Russia, about 21 years; in Prussia, 29; in Switzerland, 34; in France, 35; in Belgium, 36; and in England, 38 years. 5. The medium duration of life has, in recent times, increased very greatly in most cities of Europe. 6. In reference to the influence of professional occupations in life, it seems that clergymen are on the whole, the longest, and medical men are the shortest livers. Military men are nearly between the two extremes, but yet, proportionably they more frequently than others reach very advanced years. 7. The mortality is very generally greater in manufacturing than in agricultural districts. 8. Marriage is decidedly favourable to longevity. 9. The mortality among the poor is always greater than among the wealthier classes. 10. The mortality in a population appears to be always proportionate to its fecundity--as the number of births increases, so does the number of deaths at the same time. * * * * * If this last assertion be correct, Malthus's doctrine must have been idle. It appears that in general more males are born than females--this difference has been attributed to the age of the parents; when the mother is older than the father the female offspring are more numerous--the same is observed when both parents have attained an advanced age--but when the father's age exceeds that of the mother's, sons are chiefly the result of their union, it has been also observed that widowers are most frequently blessed with daughters. Quetelet has very justly observed that the laws which preside over the development of man, and modify all his actions, are in general the result of his organization, of his years, his state of independence, the surrounding institutions, local influence, and an infinity of other causes, difficult to ascertain, and many of which, most probably, never can be known. Still if we admit the fact, our wellbeing, in a great measure, rests in our own hands, as the progress of our intellectual attainments may gradually enable us to improve our condition, in most of the points to which we have alluded; and Buffon has observed "that we know not to what extent man may perfect his nature, both in a moral and a physical point of view." Still the laws of our organization, and which regulate life, appear to be beyond human speculation; and it has been observed that, under ordinary circumstances, we are ruled by a harmonizing system tending to equalize society despite its institutions. Thus, births, marriages, and deaths, appear regulated on a certain scale in proportions singularly similar. This circumstance is rendered obvious by the following tables of nativity at Amsterdam. +-------+--------------------------------------------------+ | | Still-born. || Born alive. | | |-----------------------||-------------------------| | Years.| Boys. | Girls. |Total.|| Boys. | Girls. | Total. | |-------|-------|--------|------||-------|--------|--------| | 1821 | 288 | 246 | 534 || 3742 | 3600 | 7342 | | 1822 | 280 | 222 | 502 || 3887 | 3713 | 7600 | | 1823 | 268 | 198 | 466 || 3734 | 3448 | 7182 | | 1824 | 266 | 216 | 482 || 4011 | 3849 | 7860 | | 1825 | 207 | 173 | 404 || 3802 | 3559 | 7352 | | 1826 | 231 | 173 | 404 || 3803 | 3635 | 7438 | | 1827 | | | || 3524 | 3366 | 6890 | | 1828 | | | || 3699 | 3529 | 7208 | | 1829 | | | || 3785 | 3618 | 7403 | | 1830 | 241 | 169 | 410 || 3727 | 3579 | 7306 | | 1831 | 208 | 168 | 376 || 3843 | 3499 | 7342 | | 1832 | 210 | 151 | 361 || 3351 | 3101 | 6452 | +----------------------------------------------------------+ A statistical result much similar, was made also in Paris in the Bureau des Longitudes, as appears by the following return: +------------------------------------------------------------+ | | Still-born. | Born alive. | | |-------------------------|-------------------------| | Years. | Boys. | Girls. | Total. | Boys. | Girls. | Total. | |--------|-------|--------|--------|-------|--------|--------| | 1823 | 847 | 662 | 1509 | 13752 | 13318 | 27070 | | 1824 | 810 | 677 | 1487 | 14647 | 14647 | 28812 | | 1825 | 846 | 675 | 1521 | 14989 | 14264 | 29253 | | 1826 | 810 | 737 | 1547 | 15187 | 14783 | 29970 | | 1827 | 904 | 727 | 1631 | 15074 | 14732 | 29860 | | 1828 | 883 | 743 | 1626 | 15117 | 14484 | 29601 | | 1829 | 925 | 788 | 1713 | 14760 | 13961 | 28721 | | 1830 | 943 | 784 | 1727 | 14488 | 14099 | 28587 | | 1831 | 954 | 755 | 1709 | 15116 | 14414 | 29530 | | 1832 | 994 | 726 | 1720 | 13494 | 12789 | 26283 | +------------------------------------------------------------+ In these statements, of which many to the same effect might be produced, it is singular that the number of still-born infants bears such a regular proportion with the nativity of living ones. The proportion of deaths to births is also strangely regular, despite the difference of climate, and institutions, and the state of medical science in various countries, as will appear manifest by the following scales: +----------------------------------------------------------------+ | Cities. |Proportion of inhabitants|Proportion of inhabitants| | | to one death. | to one birth. | |------------|-------------------------|-------------------------| | London | 46 0} | 40 8} | | Glasgow | 46 8} 46 4 | 29 5} 35 2 | | Madrid | 36 0} | 26 0} | | Leghorn | 35 0} | 25 5} | | Lyons | 32 2} | 28 5} | | Moscow | 33 0} | 27 5} | | Palermo | 32 0} 32 3 | 24 5} 27 0 | | Paris | 31 4} | 27 0} | | Lisbon | 31 1} | 28 3} | | Copenhagen | 30 3} | 30 0} | | Hamburg | 30 0} | 25 5} | | Barcelona | 29 5} | 27 0} | | Berlin | 29 0} | 21 0} | | Bordeaux | 29 0} | 24 0} | | Naples | 28 6} | 23 8} | | Dresden | 27 7} 26 6 | 23 0} | | Amsterdam | 27 5} | 26 0} | | Brussels | 25 8} | 21 0} 24 2 | | Stockholm | 24 6} | 27 0} | | Prague | 24 5} | 23 3} | | Rome | 24 4} | 30 6} | | | | 20 0} | | | | 26 5} | | | | 20 0} | | Vienna | 22 5 | 20 0 | | Venice | 19 4} | 26 5} | | Bergamo | 18 0} 18 7 | 20 0} 23 2 | +----------------------------------------------------------------+ While such a regular proportion prevails in births and deaths, a still more singular law seems to regulate the commission of crimes, of which the following registers of the cases brought to trial in France is a proof. +------------------------------------------------------------------+ | | 1826 | 1827 | 1828 | 1829 | 1830 | 1831 | | |------|------|------|------|------|------+ |Murder in general | 241 | 234 | 227 | 231 | 205 | 266 | |With fire arms | 56 | 64 | 60 | 61 | 57 | 88 | |Swords, daggers, &c. | 15 | 7 | 8 | 7 | 12 | 30 | |Knives | 39 | 40 | 34 | 46 | 44 | 34 | |Sticks, bludgeons, &c. | 23 | 28 | 31 | 24 | 12 | 21 | |Stones, &c. | 20 | 20 | 21 | 21 | 11 | 9 | |Cutting and contusing | | | | | | | | instruments, tools, &c.| 35 | 40 | 42 | 45 | 46 | 49 | |Strangulation | 2 | 5 | 2 | 2 | 2 | 4 | |Drowning | 6 | 16 | 6 | 1 | 4 | 3 | |Kicks, and blows with | | | | | | | | the fist | 28 | 12 | 21 | 23 | 17 | 26 | |Fire | ... | 1 | ... | 1 | ... | ... | |Unknown means | 17 | 1 | 2 | ... | 2 | 2 | +------------------------------------------------------------------+ The criminal statistics of France have produced the following calculation: From 7000 to 7300 criminals are tried every year, out of which number 61 out of 100 are found guilty; 170,000 offenders are charged with minor offences and misdemeanors, of whom 85 in the 100 are condemned to various punishments, and the greatest annual calculation which Quetelet remarks in an annual budget, paid much more regularly than taxes, is as follows: Condemned to capital punishment 100 to 150 To hard labour for life 280 Hard labour for a period 1050 Imprisonment 1220 The following curious table has been drawn of the causes that excited to the commission of murder and the means resorted to: +------------------------------------------------------------------+ |Apparent motives, | | |Assassi- | | | |from 1826 to 1829.|Poison.|Murder.| nation.|Incendiary.| Total. | | | | | | | | |------------------|-------|-------|---------|-----------|---------| |Cupidity | 20 | 39 | 237 | 66 | 362 | |Adultery | 48 | 9 | 76 | ... | 133 | |Domestic broils | 48 | 120 | 131 | 84 | 333 | |Jealousy and | | | | | | | debauchery | 10 | 58 | 115 | 37 | 220 | |Revenge, hatred, | | | | | | | and other motives| 23 | 903 | 460 | 229 | 1615 | |------------------|-------|-------|---------|-----------|---------| | Total | 149 | 1129 | 1019 | 366 | 2663[47]| +------------------------------------------------------------------+ To what are we to attribute this apparent regularity in the scale of births, deaths, and the commission of crimes? Are we ruled by _certain_ laws that are only changed in the manifestations of Providence, by peculiar visitations, such as war, famine, and pestilential maladies? What a vast and curious field of research and reflection! what an argument for the fatalist! Man no doubt possesses a moral power that to a certain extent subjugates the creation to his influence and his will. Plants and animals seem to obey certain natural laws, that are only disturbed by perturbative agents; and it is difficult to point out what are the human actions that arise from natural impulses, or from accidental circumstances, although experience would tend to show that they bear a singular proportion in the similarity of their results; and one must come although reluctantly to the conclusion, that this perturbative power exercises but a slender influence on the laws of nature, which seem to set at defiance the destructive efforts of man. Thus have we seen of late years, that the most fearful and long-protracted wars, which one might have imagined would have devastated the fairest parts of Europe, have not checked a surprising increase in its population, and the destructive effects of the most fatal pestilence have vanished with a promptness that seemed to keep pace with the preceding havoc. Bigotry and fanaticism are the only scourges which appear to dare the benevolent views of Providence, and when we traverse the desolate fields of most Roman Catholic countries, one would imagine that Heaven has abandoned their inhabitants to their own blind wills and evil ways. Spain at this period and at many epochs of her bloody history, seems to corroborate the fable of the Titans who sought refuge in that ill-fated land from the anger of the gods.[48] To return: we find in the preceding _resumés_ of longevity that poets are the shortest-lived; next to them, authors on natural religion, dramatists, and novelists. May not this circumstance be attributed to the fervour of their imagination and to their unequal mode of living? A species of madness is the attribute of genius. Many authors on natural religion may come under the denomination of monomaniacs. The jealous irritability of poets and dramatists,--and next to them in the scale of vanity we find musicians,--may also contribute to wear them out, and bring on various chronic diseases, by digestive derangements; more especially as their habits of living are seldom regular, fits of sobriety alternating with bouts of merry-making. Moral philosophers, painters, and sculptors, whose average life appears the longest, follow more sedentary pursuits; and, although artists in general cannot boast of remarkable discretion in their mode of living, the nature of their profession requires much steadiness. It is moreover to be observed that, in the preceding calculation, historical painters have chiefly been noticed. Would the same calculation apply to the lighter branches of the art? It has been remarked that actors generally attain old age, notwithstanding the fatiguing and harassing nature of their profession. This may be attributed to the constant excitement of a similar nature to which they are subject, as well as to their continued exposure to the sudden transitions from heat to cold, which renders them less susceptible of the variations of temperature that affect those who can avoid these vicissitudes. Any person who would expose himself to the constant checked perspirations to which dancers are liable, would infallibly pay dear for the experiment; and those who have had occasion to witness the fatigues of their exercises, marvel at their not being constantly attacked with pulmonary inflammation, and the many maladies that result from similar exposures. On the very same principle, troops when engaged upon active service do not suffer from the inclemency of the weather, although saturated with wet by day, and sleeping under torrents of rain by night. So long as they are marching with an object in view, this excitement supports them, even against hunger; but the moment this excitement ceases, let them halt, in tranquil cantonments, or commence a retreat under unfavourable circumstances, that moment the invasion of disease is observed. The chief source of health and long life is an equilibrious state of the circulation. This condition a moderate mental excitement tends to maintain. Depression, on the contrary, will produce a languid flow of the vital stream, congestion, and chronic diseases. On the same principle, good temper and hilarity are also necessary to prolong life. Violent passions must tend to occasion dangerous determinations, while the inward gnawings of offended vanity and pride corrode every viscus, and lay the seeds of future mental and bodily sufferings. Apathy and insensibility are, unfortunately, the best sources of peace of mind, and as Fontenelle observed, a good stomach and a bad heart are essential to happiness. Perhaps the best maxim to prolong our days, and render them as tolerable as possible, is the "_Bene vivere et lætari_." I have just observed that conformation materially affects our existence; and this circumstance may in a great measure be referred to temper, and the wear and tear that it occasions in ill-conditioned individuals. Little people seldom attain the longevity of stronger individuals; and it is also a well-known fact that diminutive persons are generally spiteful and malicious. As Providence has bestowed destructive venoms on reptiles, so has it gifted these insignificant members of society with obnoxious qualities, to make amends for their want of physical power in the strategies of attack and defence. The same observation holds good with the deformed; but here we have a moral cause for this sourness of disposition. They too frequently are objects of ridicule, contempt, or pity, sentiments the most humiliating to mankind. In childhood they are not able to partake of the boisterous and active sports of their companions; they have not the power to resent an injury, and the more powerless we are, the greater is our thirst of revenge. Hence does tyranny degrade, and renders its victims cruel and vindictive. The deformed, moreover, find it necessary to improve their intellectual faculties, which in aftertimes fill their quivers with keen shafts of retaliation. In this study they also have more leisure, and they apply to their books while their comrades are at play. This very study adds to their sense of inferiority; they can never hope to share the warrior's laurels, or, what is perhaps still more painful, the myrtle of successful love. Their only chance of success in either of these careers is by kindling wars by their intrigues, or winning a woman's heart by intellectual superiority,--two very improbable events. Thus they gradually envy men who are looked upon by the world as their superiors, and hate women for the preference they show to those privileged individuals. In general we find these ill-shaped beings bitterly sarcastic whenever woman's name is mentioned. Pope, perhaps from these very reasons, was inexhaustible in his abuse of the sex: and Boileau abhorred them, since he had been emasculated by a turkey-cock. The intellectual superiority of hunchbacks has also been attributed to their physical condition; and it is generally believed that with them the circulation of blood in the brain is more rapid than in well-conformed subjects, and this increased action is supposed to contribute materially to the vivacity of the imagination, and the quickness of apprehension. Another circumstance is said to increase their mental powers, and that is, their continence, considered both by the ancients and the moderns as a source of intellectual energies. Minerva and the Muses were virgins; and in this and other fabulous traditions, we find the ancients illustrating in their mythologic allegories many physical facts and observations. Our Bacon had made the same remark; and Newton, and many other great men, considered the passion of love beneath the dignity of science. Continence and abstinence were deemed by Horace as indispensable privations in the cultivation of genius. In the deformed both are to a certain degree natural, or at least cannot be lost sight of without endangering life. The digestive powers of the deformed are generally weak; and this debility has ever been looked upon as a concomitant of superior intellects. Thus in Celsus, "_Imbecilli stomacho penè omnes cupidi litterarum sunt_;" while on the contrary, "_Obesus venter non parit subtilem intellectum_." The common expression of a child being too clever to live, is unfortunately founded on observation. Scrofulous and sickly children are in general remarkable for the quickness of their intellects; and Rousseau maintained that a man who could meditate was a depraved animal. It is a fact that the perfection of one faculty can seldom be attained but at the expense of others. The more our faculties are generally called into action, the less perfect will they be individually;--"_Pluribus intentus, minor est ad singula_." Thus, the singing of birds is improved by depriving them of sight. The influence of the mind upon our health is as evident as the influence of our health in the duration of existence. This corollary explains the shortness of life of the diminutive and the deformed, unconnected with such physical defects of organization as might impede the due exercise of their organs. The fable of Prometheus is a strong illustration of the pernicious effects of intemperance; and by Darwin, and other physiologists, has been considered as comparing the celestial fire that he purloined, to the artificial inspirations of excitement that ultimately preys upon the liver and the other viscera like a voracious vulture. A much deeper philosophy is concealed in this theogenic allegory. Prometheus was the son of Japetus; brother to Atlas, Menoetius, and Epimetheus, who all surpassed mankind in fraud and in guilt. Prometheus himself scoffed the gods, and violated their shrine. Heaven and Earth had formed his father, who had united his destinies with Clymene, one of the Oceanides. Thus Prometheus and Epimetheus arose from the very cradle of the universe; and their very names, [Greek: Promandanein] and [Greek: Epimandanein], signify foresight and improvidence,--_prædiscere et postea discere_,--the prevalent characteristics of all mortals, that either tend to promote or retard the progress of human reason and human happiness. Prometheus strove impiously to possess himself of Divine knowledge, and created man with a base amalgam of earth and the bones of animals, vivified by the celestial fire he had obtained. Jupiter, indignant at his audacity, commanded Vulcan to create a beauteous tempter in the form of woman, on whom every attractive gift might be conferred; and Pandora was sent upon earth with the fatal present of the father of the gods, the box that contained all the evils and distempers that were destined for mankind. The foresight of Prometheus resisted her charms; his improvident brother opened the dreaded casket. Have we not here an illustration of the vanity of science, that aims even at Divine attributes, and whose votaries, like Prometheus, would endeavour, if possible, to deprive wisdom of her power, and break down the boundaries of human intellects? His punishment describes in energetic language the endless and consuming studies of the learned, whose very viscera are corroded in lucubrations too often fruitless, and not unfrequently injurious to themselves and others. Hercules alone could relieve him from his torments:--and does not Hercules in this allegory typify the power of reason, that enables us to release the mind from the trammels both of ignorance and vanity, separated from each other by a gossamer partition? Prometheus, who could resist the most powerful of temptations,--beauty and talent combined,--dared Olympus to seek for that wisdom which would have doomed him to everlasting sufferings, had not strength of mind and the powers of reflection destroyed his merciless tormentor. Can we be surprised that the ancients consecrated games to this beautiful allegory?--games that are still carried on in our days; but, alas! where every vain competitor pretends that he has reached the goal with an unextinguished torch! CRETINISM. This singular disorder was first discovered and noticed by Plater, about the middle of the seventeenth century, among the poor inhabitants of Carinthia and the Valais, where, as in the valleys of the Lower Alps and the Pyrenees, it is also found to be an endemic affection. According to Sir George Staunton, it is also observed in Chinese Tartary. It has been erroneously confounded by some writers with bronchocele and rachitis, from both of which it is totally distinct. Cretinism presents various modifications in kind, and every intermediate grade between that extreme degree of physical and mental debasement which is characterized by the utmost deformity, and entire absence of mental manifestation, the organic and vegetative functions only being performed. There are certain circumstances that distinguish cretins from idiots; and their infirmities appear to depend upon endemic or local causes, regarding which much diversity of opinion has prevailed both amongst medical men and travellers. The cretins were also called _Cagots_ and _Capots_. In Navarre these unfortunates go by the name of _Gaffos_ and _Ganets_; and in various valleys of the Pyrenees they are called _Gézits_ or _Gezitains_. Near La Rochelle, some of them are also found, and there they are known by the appellation of _Coliberts_; and in Britanny _Cacons_ and _Cagneux_. The derivation of these names shows the contempt and disgust that they excited,--_Cagot_, according to Scaliger, being derived from _Canis Gottus_, or _Dog of a Goth_; _Colibert_ is traced to _quasi libertus_, or slave. The Spaniards call them _Gavachos_, a term of reproach, which they also applied to the French during the Peninsular struggle. The body of these poor creatures is stunted, their height not exceeding four feet. There is a total want of due proportion between it and the other parts, the height of the head with reference to the body being from one-fourth to one-fifth, instead of one-eighth, the natural proportion; the neck is strong, and bent downwards; the upper limbs reach below the knees, and the arm is shorter than the fore-arm; the chest narrow, the abdomen hemispherical, and of a length not exceeding the height of the head; the thighs, with the haunches, of greater width than the shoulders, and shorter than the legs, the calves of which are wanting; the feet and toes distorted. In the head, the masticating organs, the lower jaw, and the nose, preponderate considerably over the organs of sense and intelligence; the skull is depressed, and forms a lengthened and angular ellipsis; the receding forehead presents internally large frontal sinuses, to which the brain has yielded part of its place; the top of the head is flattened, instead of being vaulted; the occiput projects but slightly, and runs almost even with the nape of the neck, as in ruminating animals. The face is neither oval nor round, but spread out in width; the eyes are far apart, slightly diverging, small, and deep-seated in their orbits; the pupil contracted, and not very sensitive to light; the eyelids, except when morbidly swollen, are flaccid and pendent. Their look is an unmeaning stare, and turns with indifference from every thing that is not eatable. The elongated form of the lower jaw, the thick and puffed lips, give them a greater resemblance to ruminating creatures than to man. The tongue is rather cylindrical than flat, and the saliva is constantly running from the angles of their mouth. Enlargement of the thyroid glands generally prevails, sometimes to an enormous extent. Indeed, this appearance is commonly considered as a distinguishing sign of cretinism. The other glands of the throat are also obstructed. Many of these poor wretches are both deaf and dumb; yet do they appear unconscious of their miserable existence. Stretched out or gathered up under the solar rays, their head drooping in idiotic apathy, they are only roused from their torpor when food is presented to them. This endemic malady is supposed to arise from the use of snow-water, or of water impregnated with calcareous earth. Both of these opinions are without foundation. All the inhabitants of districts near the glaciers, drink snow and ice waters without being subject to the disorder; and the common waters of Switzerland, strongly impregnated with calcareous substances, are most salubrious. At Berne, the waters are extremely pure, yet Haller observed that swellings of the throat are not uncommon. De Saussure has assigned another cause, and refers the disorder to the physical features of the mountainous districts in which it prevails. The valleys, he tells us, are surrounded with very high mountains, sheltered from currents of fresh air, and exposed to the direct, and what is worse, the reflected rays of the sun. They are marshy, and hence the atmosphere is humid, close, and oppressive. When to these chorographical causes, he further says, we add the domestic ones, which are also well known to prevail among the poor of these regions,--such as innutritious food, indolence, and uncleanliness, with a predisposition to the disease from an hereditary taint of many generations,--we can sufficiently account for the prevalence of cretinism in such places, and for the most humiliating characters it is ever found to assume. This specious reasoning, however, is overthrown by observation. In the first instance, this character of the country does not affect its other inhabitants; and secondly, the _goître_ is found in warm latitudes, and Mungo Park observed it amongst the Africans of Bambara, on the banks of the Niger. Marsden has also seen it at Sumatra. Moreover, this affection is scarcely ever seen in the mountains, but principally prevails in the valleys. It is more than probable that these ill-favoured creatures belong to a particular race; for we must take care not to confound goître with cretinism, since goître is common where cretinism is prevalent. It has been remarked that the offspring of the natives of the Valais who intermarry with persons from the Italian side of the Alps, are more subject to goîtres than those born of native parents; and that females who have husbands from the higher Alps, seldom have children affected with this infirmity. It is pretty clear that in these observations, goître and cretinism are confounded. That these miserable cagots belong to a particular race of men, most probably accidentally degraded in their transmission from our primitive stock, appears most likely. We have sought the derivation of the several terms of contempt and disgust attached to them in different countries, to which migration may have led their parents. Some writers have traced their descent to the Goths and Vandals, thus chastised for their devastations. Gébelin, Belleforêt, and Ramont consider them as descendants of the Visigoths; while Marca, bishop of Cousérans, denounces them at once as Jews and Saracens; and other clerical writers have maintained that they are the miserable relicts of the heretic Albigenses who had escaped the holy massacres of 1215; although there did exist cagots in the year 1000, in the abbey of St. Luc, as they are described in a _for_ of Navarre, bearing date 1074, and issued by Ramirez. These helpless beings have also been considered as the offspring of Bohemians and gipsies. Bishop, or rather Senator Gregoire, maintained that they sprung from the hordes of northern barbarians who overran the south of Europe in the third and fourth centuries. Whatever might have been the origin of these poor creatures, they seem to share that ignominious destiny that has marked various races in different countries. The _Agotos_ of Navarre, the _Maragotos_ of Leon, the _Batuecos_ of Castile, the _Wendes_ of Silesia, are all held in as much contempt as the _Parias_ and the _Vaddahs_ of India. Even in Otaheite a degraded caste was found, from which victims were selected to appease Divine wrath, or propitiate their gods. The traditional contempt in which certain races are held, a contempt that seems to have affected their physical appearance, may perhaps be traced to the degradation of slavery, that seems to deprive man of all his proud attributes, both in a moral and physical point of view. The effects of tyranny, and the distinctions that oppression has created in the several castes and ranks of mankind, are every where evident. What a difference exists in Scotland between the chieftains and the humbler individuals of their clans!--between the naïres of India and their vassals! In France, said Buffon, you may distinguish by their aspect, not only the nobility from the peasantry, but the superior order of nobility from the inferior, these from the citizens, and citizens from the peasants. "The field-slaves in America," observes the enlightened Dr. Smith, "are badly clothed, fed, and lodged, live in small huts in the plantations, remote from the example and society of their superiors. Living by themselves they retain many of the customs and the manners of their ancestors. The domestic servants, on the other hand, who are kept near the persons or employed in the families of their masters, are treated with great lenity, their service is light, they are well fed and clothed. The field-slaves, in consequence of their condition, are slow in changing the aspect and figure of Africa; while the domestic servants have advanced far before them in acquiring the agreeable and regular features, and the expressive countenance, of civilized society. The former are frequently ill-shaped; they preserve in a great degree the African lips, and nose, and hair; their genius is dull, and their countenances sleepy and stupid. The latter are straight and well proportioned; their hair extends to three or four, sometimes even to six or eight inches; the size of their mouth is handsome, their features regular, their capacity good, and their looks animated." Dr. Prichard has also stated that similar changes become visible in the third and fourth generations in the West India islands; and I have seen several negresses in those colonies perfectly beautiful. In the Bahama islands I knew a female slave of the name of Leah, belonging to my late friend Mr. Commissary Brookes, as black as jet, and descended in the third generation from African parents, whose features would have vied in symmetry with the fairest specimen of the Caucasian race. Let us not, therefore, seek in snow-water or calcareous impregnations for the causes of deformity and degradation in any unfortunate castes of mankind. Their misery may more probably be traced to the iron rod of despotism, or the oppression of bigotry,--influences that mark out races as abject slaves, or objects of Divine wrath, that ought to be scorned by the wealthy and the powerful, and spurned and persecuted by the faithful and the elect; although, when it has served its purposes, priestcraft has held up the cagot, and the leper, and the idiot, as objects of veneration. When the tourist, in his Alpine and Pyrenean excursions, meets a wretched cagot, let him pause and contemplate the offspring of slavery, and reflect on what man is, and on what man might be,--nay, on what man _will_ be. TEMPERAMENTS. The different prevalent propensities in various individuals, the development of which appeared to be under the influence of a certain and constitutional organization, have received the name of temperaments; or, rather, this term applies to this peculiar organization of the constitution or idiosyncrasy. The Greek physiologists were the first to classify these peculiarities, or _temperamenta_,--the _naturæ_ of Hippocrates, the _mixturæ_ of Galen. They considered organized bodies as an assemblage of elements endowed with different properties, but combined in such manner that their union should constitute a whole, in which none of them should predominate in a healthy condition; but, on the contrary, they were to modify and _temper_ each other, their simultaneous action being directed and controlled by the spirit of life, _spiritus_. It was the due combination of these elements that constituted a perfect temperament; their aberrancy produced disease of body or of mind. The ancients divided these elements into cold and hot, dry and moist; from the combination of these principles they classified the fluids of the body. The blood was hot and moist, the bile hot and dry, the phlegm cold and damp, and the melancholy cold and dry. This division led to a further classification; and temperaments, according to the predominance of these elements, were divided into the _sanguineous_, the _bilious_, the _phlegmatic_, and the _melancholic_. These supposed radical fluids, influencing the whole animal frame, were dependent upon certain organs for their specific production. The blood was furnished by the heart, the phlegm by the head, the yellow bile by the gall-duct, and the black bile or atrabile,--the principle of melancholy,--by the spleen. Notwithstanding the many revolutions in the doctrine of physiology that have shaken the schools since the days of Hippocrates, this classification of his has remained to a certain degree to the present day, and has laid the foundation of all the systems of temperaments, constitutions, and natural characters, that have at various periods been advanced by philosophers; the only novel introduction in this ancient classification being the nervous temperament, which, after all, is only a modification of the four other categories. To illustrate the operations of these temperaments, it became necessary to adopt terms expressive of their combination, and _temper_ and _humour_ were adopted. Both are Latin terms; the first, in its original sense, imports mingling, modifying, tempering the four radical fluids, and producing that equilibrious condition of the frame, termed _constitution_. _Humour_ was derived from the Greek [Greek: chumos], _chumos_; and its radical sense imported moisture, or fluid of any kind. Hence _humid_ and _humidity_. This doctrine of fluidity is still applied to many functions that we cannot otherwise describe, and we talk, although in a figurative manner, of the nervous fluid, the vital fluid; and a good humour, a bad humour, a vein of humour, or a humorous vein, are illustrations of peculiar tempers and temperaments,--for temperaments are still distinguished by the same terms applied to them by the ancients, and we describe one man as _choleric_, or bilious, for _choler_ ([Greek: cholê]) means bile; another as being _melancholic_; a third of a _sanguine disposition_; and a fourth of a _phlegmatic habit_. The _sanguine_, that imports a predominance of the blood, indicated a warm and ardent exuberance of spirits; whereas the _phlegmatic_, denoting a thin and cold watery fluid, referred to a frigid and spiritless indolence. We thus see that modern physiology has scarcely advanced this branch of science, for the _nervous temperament_ may be considered as merely a modification of the other ones; and it is more than probable that the old classification will long prevail, notwithstanding the ingenuity of modern hypotheses. Husson divided the temperaments into those that referred to the vascular system, to the nervous system, and to the muscular system, with subdivisions applied to regions and to organs; all these temperaments being either natural and primitive, or acquired. Dr. Thomas, of Paris, has founded his arrangement according to the predominance of the head, chest, or abdomen,--or the mental, circulatory, or digestive organs,--and according to the relative bulk and predominance of these three regions will be the relative energy of the mental, muscular, or abdominal functions. Notwithstanding the ingenuity of these systems, the old arrangement, as I have already observed, is likely to prevail; and as Blumenbach observes, that although this division was founded on an imaginary depravation of the elements of the blood, if made to stand alone it will prove both natural and intelligible. This division I shall therefore endeavour to illustrate. In the _sanguineous temperament_ the heart and arteries possess a predominant energy; the pulse is strong, frequent and regular; the veins blue, full, and large; the complexion florid, the countenance animated, the stature erect, the muscular forms marked and firm; the hair of a yellow, auburn, or chestnut colour; the nervous impressions acute, the perception quick, the memory retentive, the imagination lively and luxuriant, the disposition passionate but not vindictive, and passion is easily appeased; amorous, and fond of conviviality and good cheer. In this temperament we find athletic strength and fortitude of mind in resisting the power of external agency, with mental tranquillity in the midst of danger; a calmness arising from a consciousness of power, and from less acuteness of external impressions and mental perceptions. Such a man, when roused to action, will endeavour to surmount every physical difficulty; but he will rarely attain pre-eminence in sciences and the fine arts, which require exquisite sensibility and mobility,--qualities seldom met with in such forms as those described by the poets in Hercules and Ajax. In the _choleric_ or _bilious_ temperament the liver and biliary organs are as redundant in their power as the sanguineous vessels, and, for the most part, at the expense of the excernent or cellulous and lymphatic system. The pulse is strong and hard, but more frequent than in the sanguineous; the veins superficial and projecting; the sensibility extremely acute and easily excited, with a capacity of pondering for a long time on the same object. The skin is sallow, with a tendency to a yellow tinge; the hair black or dark brown; the body moderately fleshy, the muscles firm and well marked, the figure expressive; the temper of the mind abrupt, impetuous, and violent,--bold in the conception of a project, inflexible in its pursuit, persevering and dauntless in its execution. These are the temperaments that have urged men both to noble and to execrable deeds. Such were Alexander, Brutus, Mahomet, Cromwell, Charles the Twelfth, Robespierre, Napoleon. All these celebrated characters evinced from their earliest youth the ambitious nature of their dispositions; and though circumstances might have checked the development of their predominant passions, it was also to adventitious circumstances that they owed their elevation, and the opportunities of displaying their good or evil qualities. Most of these men were irascible, vindictive, and cruel, and equally susceptible of ardent love and mortal hate. In these temperaments we find a mixed exuberance of blood and bile in a constant struggle for predominance. The _melancholy_ or _atrabilious_ temperament is of a different character. Here the biliary organs are brought into a constant and a morbid action, while the sanguineous system is weak and irregular. In these gloomy subjects the skin assumes a sallow, unearthly tinge, the pulse is hard and contracted, the digestive functions torpid and irregular, the imagination is gloomy and full of suspicion, and a dark gloom is shed on all around the morbid sufferer, for such he may be called, since the condition under which he labours may be considered one of disease. These subjects are prone to various monomanias; uncertain, fickle, and oftentimes capriciously cruel. Tiberius and Louis the Eleventh are quoted as examples of this temperament. Many melancholic individuals have displayed great genius, and at the same time great depth of thought. Richerand considers Tasso, Pascal, Zimmermann, and Rousseau as illustrating this unhappy disposition. The fourth temperament is the _phlegmatic_, _lymphatic_, _pituitous_, or _watery_, for all these terms used by different physiologists are synonymous. Here the proportion of fluids is too considerable for that of the solids; hence the body attains a considerable, unwholesome bulk. The muscles are soft and flaccid, the skin fair and transparent, the hair flaxen or sandy, the pulse weak and slow, all the vital actions are languid, the memory little tenacious, and the attention wavering; an insurmountable indolence prevails; and, averse to mental and corporeal exercise, the _far niente_ is their greatest enjoyment, and a nightcap is preferable to a diadem. These subjects are generally good, easy persons; susceptible of kindly feelings, but of a transient nature. Their mind is generally depraved by effeminacy, and their love is purely animal. They are not courageous; yet they show great tranquillity of mind in moments of danger, and would rather quietly sink than struggle with the waves. If their dwelling was on fire, they would calmly walk out of it, but not exert themselves to put down the conflagration; and, when hereditary power places them at the helm of a state, a wreck of the vessel may be speedily expected, unless the sceptre is wrested from their feeble hands by the choleric or the atrabilious enthusiast. The fifth, or _nervous_ temperament, as I have already stated, may be considered of a complex nature, as it influences the sanguineous as well as the choleric, the melancholy, and the phlegmatic. In this constitution the sentient system predominates, and there exists a great susceptibility to all external impressions. This temperament is generally acquired, and proceeds from a sedentary life, too great an enjoyment of sensual pleasures, and fanciful ideas brought on by romantic readings and romantic thoughts indulged in hours of idleness. The determination of such individuals is prompt, but uncertain; their affections warm for a while, are selfish and fickle; their sensations are vivid, but leave no impressions. Women, especially when educated in boarding-schools, essentially belong to this class, and are subject to hysterical and convulsive affections that render them a plague to others and a nuisance to themselves. In man the muscles are small, flabby, and wasted. The nervous may possess much vivacity of conception, but no depth of judgment; and, in general, their productions are as morbid as their mind. This condition frequently attends the melancholy temperament, "that wings the soul, and points her to the skies." Nervous excitability seldom prevails in the sanguineous constitution, where muscular masses are pronounced in athletic forms. Hence the sanguineous are not easily brought into action; but, when once roused, their energies are irresistible. This power is beautifully described by Virgil in the conflict between Entellus and Dares; still are these exertions governed by nervous influence, and the result of the excitability and contractibility of the muscular fibre, termed by Chaussier its _myotility_. Mason Good has very justly observed that these temperaments, or generic constitutions, are perpetually running into each other, and consequently that not one of them, perhaps, is to be found in a state of full perfection in any individual; he further aids this remark by the following illustration: "Strictly speaking, Mr. Pitt and Mr. Fox belonged equally, in the main, to the second temperament; there was the same ardour, genius and comprehensive judgment in both, with a considerable tendency to the sanguineous, and hence with more irritability, but more self-confidence, audacity, and sanguine expectation: the latter, while possessing the same general or bilious temperament, was at the same time more strongly inclined to the lymphatic, and hence his increased corporeal bulk, and with less bold and ardent expectation he possessed one of the sweetest and most benevolent dispositions to be met with in the history of the world. The first was formed to be revered, the second to be beloved; both to be admired and immortalized." I apprehend that a profound study of human temperaments and propensities may afford a more desirable guide in the education of youth, and the selection of men in the different concerns of life, than that of either physiognomy or phrenology; although the temperament must materially affect the general character of the countenance. Yet, from the apparent prevalence of any temperament we are not to form a rash and hasty judgment in regard to the future capacities or propensities of youth. As one temperament runs into another, and assumes a complex form, so can education regulate the one that naturally predominates, and modify it by a fusion with another. Thus, the restlessness of the bilious and choleric may be attuned to a phlegmatic state by the power of reason, and the brute courage and audacity of the sanguineous checked by inspiring sentiments of true valour. That every temperament, excepting perhaps the phlegmatic, is capable of displaying bravery, has been well described by Joanna Baillie in the following lines: The brave man is not he who feels no fear, For that were stupid and irrational; But he whose noble soul its fear subdues, And bravely dares the danger nature shrinks from. As for your youth, whom blood and blows delight, Away with them!--there is not in their crew One valiant spirit. SOLAR INFLUENCE. While both ancient and modern physiologists were of opinion that the various phenomena of organized bodies were influenced by lunar phases, the power of the solar rays was not less active in regulating our functions both in health and in disease. The name of Phoebus signified the torch of life, and Apollo was the father of medicine and the fine arts. The sun was considered as a deity in most countries, the Supreme Being,--the father of light, Diespiter,--Jupiter, Jehovah, the creator of all living matter,--the residence of the Most High--_In sole posuit tabernaculum suum_, said the Psalmist;--and in Egypt three hundred and sixty-five priests were ordained to watch its heavenly movements during the year, while many philosophers attributed the propagation of the human race to the union of man with the orb of day. The disciples of Plato and Pythagoras considered it as possessing a soul; and Origenus, in his Periarchon, maintained that it displayed both virtues and vices,--an heretical doctrine very properly condemned by the second Synod of Constantinople; and, although St. Augustin was of that opinion, it was warmly combated by St. Basil and St. Ambrose, and many other beatified divines. Anaxagoras, on the contrary, considered this luminary to be a burning stone; Plato called it a compact fire; Aristotle maintained that it was formed of one-fifth of the elements that constitute the planets; Epicurus, a mass of lava, or ignited pumice-stone; Xenophon asserted that it was fed by exhalations, and Zeno by watery vapours; Empedocles considered it a translucent body; Philolaus, a concave mirror, concentrating the rays of light from every part of the universe to reflect it upon nature. Kepler was of a similar opinion, and further insisted that the sun was composed of a limpid fluid upon which a luminous æther was reflected, whence its centre was blue, while the limbs were yellow. A modern philosopher, Woodward, attempts to show that the sun and fixed stars are masses of electric fluid, requiring no alimentation, yielding no smoke, and the light that emanates from them offers the bluish brilliancy of the electric spark. It has been justly observed, that if, like Eudoxus, we endeavoured to approach this luminary, the better to study and describe its nature, we should still remain in impenetrable darkness,--in which I must leave the matter, to confine myself to those influences which experience seems to show that the sun actually exercises on the animal economy. The genial and invigorating glow that moderate solar heat produces has ever been considered as tending to prolong our life. Hippocrates observed, that old men are double their age in winter, and younger in summer. To enjoy this reviving influence, the ancients had terraces on their house-tops called _solaria_, in which, to use their own expression, they took a solar air-bath. Pliny the younger, in speaking of his uncle, tells us, _Post cibum, æstate, si quid otii, jacebat in sole_. The ancients fancied that when the sun rose diseases declined, and _Levato sole levatur morbus_ became a medical axiom. Aristotle records the case of an innkeeper of Tarentum, who, although able to attend to his business by day, became insane so soon as the sun had set. The moderns relate many similar instances of derangement brought on by the absence of solar influence. Bouillon mentions a woman who lost her senses at sunset, but who recovered them at break of day. Other cases are recorded of a different nature, when maladies were aggravated by this influence. Sauvage tells us of a woman who became maniacal whenever the sun was at its zenith; an influence that could not be prevented even by various stratagems, such as keeping her in a dark room, and deceiving her in regard to the hour. Humboldt knew a Spanish lady in Madrid who lost her voice the moment the sun dipped in the horizon, but the paralysis of the nerves of the tongue ceased the following morning. A removal to Naples cured this singular affection. Parham relates the cases of several individuals who were deprived of vision when the sun had set. In a former paper I have alluded to the effects of a vivid flood of light upon the Italian peasantry, as observed by Ramazzini. Daily practice shows us that the paroxysms of fever and various maladies are under a similar influence; and the evening gun in our garrisons is often the signal of severe exacerbation in certain febrile cases, while the _reveillée_ develops acute aggravation in others. Sydenham and Floyer had observed that the gout and asthma were usually ushered in after our first sleep; and I have noticed that, during the prevalence of the cholera, the invasion of this fatal disorder generally occurred towards daybreak. The ancients divided their elementary predominance according to the diurnal cycle: thus, morning regulated the blood, noon the bile, evening the atrabile, and night the cold phlegmatic influence. Nor was this arrangement unnatural; we more or less observe it in a state of health, when man awakes refreshed and active at morn; towards noon his train of thoughts becomes more serious and busy; in the evening his mind is more gloomy and susceptible of unpleasant impressions; until night either sheds its poppies o'er his couch, or agitates his frame with its fearful dreams. The repose of night is ever more refreshing than that of day, however we may have changed the natural applications of our hours, and find, as Seneca said of Roman civilization, that _antipodes habemus in urbe_. The influence of night and day is equally observable in animals. Towards evening myriads of insects, who had shunned the solar heat, hum around us; while night calls forth its choristers; and as they cease to sing other creatures proclaim the dawn. Some animals, such as the _simia beelzebud_, and the _simia seniculus_, salute both the setting and the rising sun with fearful howls; and it may be considered as a law of nature, that we cannot turn night into day with impunity. Dr. Balfour's opinion on the influence of the heavenly bodies is of great weight: he conceives that the influence of the sun and moon when in a state of conjunction, which he names solar-lunar influence, produces paroxysms or exacerbations in continued fever, in all cases at least where paroxysms are observable. As this influence declines in consequence of the gradual separation of these luminaries from each other, and their getting into a state of opposition, a way is left open for a critical and beneficial change; in other words, that paroxysms and exacerbations in fever may be expected to take place at spring-tides, and crises at neap-tides. It has been observed in intermitting fevers, that paroxysms of the quotidian recur in the morning, the tertian at noon, and the quartan in the afternoon; in no instance do they take place at night. There can be no doubt that lunation, more especially in tropical climes, influences diseases; but the effects of insolation are every where observable. One of the most serious accidents resulting from this exposure is the _ictus solis_, the _coup de soleil_ of the French, and the [Greek: siriasis] of the Greeks, from the star _Sirius_, to whose influence they attributed the scorching heat of the dog-days. This attack is in general sudden, and the patient falls down as if struck with a blow on the head. Troops on a march, and labourers in the field, frequently are the victims of this solar power, which usually kills them on the spot. It has been known to destroy great numbers. In Pekin, from the 14th of July to the 25th, in the year 1743, it is related that eleven thousand persons were struck dead. On a hot day's march in Portugal, I lost six men in a brigade under my charge. They first reeled as if under the influence of liquor, and then fell dead with a slight convulsive struggle. One of them, the bâtman of the paymaster of the 3rd foot, or Buffs, was struck dead while speaking to me. A great number of greyhounds perished on the same march; but no other species of dog seemed to suffer, although we had many pointers and spaniels with us. Horses, mules, and cattle were also exempt from the attack, though it proved fatal to some weak donkeys who were following the troops. The shakos worn by our army are well calculated to preserve the soldier from these accidents, to which troops are constantly exposed during summer operations. SWEATING FEVER. This disastrous pestilence, which proved, if possible, more fatal and terrific than the cholera, made its first appearance in London, in 1480 or 1483, first showing itself in the army of Henry VII. on his landing at Milford Haven. In London it only broke out a year or two after, and visited that capital occasionally for upwards of forty years. It then spread to Holland, Germany, Belgium, Flanders, France, Denmark, and Norway, where it continued its ravages from 1525 to 1530; it then returned to England, and was observed for the last time in 1551. Dr. Caius calls it a pestilential fever of one day; and it prevailed, he says, with a mighty slaughter, and the description of it was as tremendous as that of the plague of Athens. Dr. Willis states that its malignity was so extreme, that as soon as it entered a city it made a daily attack on five or six hundred persons, of whom scarcely one in a hundred recovered. This malignant fever ran its course in a single paroxysm; and the cold fit and hot fit were equally fatal. If the patient was fortunate enough to reach the sweating stage, he was in general saved. It commenced its attack with a pain in the muscles of the neck, shoulders, legs, and arms, through which a warm aura seemed to creep; after these symptoms a profuse perspiration broke forth. The internal organs grew gradually hot and burning, the pungent heat extending to the extremities; with an intolerable thirst, sickness soon followed by jactitation, coma, and delirium. At Shrewsbury it raged for seven months, and carried off upwards of one thousand patients. The invasion of this terrific disorder was generally preceded by a thick noisome fog, especially in Shropshire. A dark cloud usually took the lead, and the distemper followed its course. It is somewhat singular, but most fatal contagions have been ushered in, both in ancient and modern times, by noxious fogs or mists, with clouds of various insects, either bending their course in innumerable bodies, covering vegetation, or falling in dead heaps upon the ground. The disease was generally supposed to arise from inclement seasons and injured grain; particularly wheat infested with the mildew or smut, or rye attacked with the spur. It was observed by Dr. Willan, that the contemporary inhabitants of Scotland and Wales, who fed on barley and oats, were not affected. One of the most singular features of this malady was its only attacking the English. Foreigners, and even the Scotch and Irish, in England, seemed to be exempted from this scourge, which attacked the monarch himself, and two Dukes of Suffolk, who sunk under its virulence. In Westminster the number of daily deaths averaged one hundred and twenty. It may be easily imagined that this special liability of Englishmen to contract the disease was attributed to Divine wrath for their manifold offences; and we find the following lines in Phemtophius: Coelestia numina nobis Nil sunt quàm nugæ, fabula, verba, jocus: Indè fames nobis, pestes, Mars; denique fontem Hinc etiam inclemens [Greek: idoônretos] habet, Sævum, horrendum, atrox genus immedicabile morbi, Nostræ perfidiæ debitum. Dr. Armstrong has also recorded this peculiar visitation in the following: Some, sad at home, and, in the desert, some, Abjur'd the fatal commerce of mankind. In vain: where'er they fled, the Fates pursued. Others, with hopes more specious, cross'd the main, To seek protection in far distant skies; But none they found. It seemed, the general air From pole to pole, from Atlas to the East, Was then at enmity with English blood; For, but the race of England, all were safe In foreign climes; nor did this Fury taste The foreign blood which England then contained. That the atmosphere was saturated by this disease was obvious from the circumstance of vast numbers of birds falling dead, when, upon examination, pestilential swellings were found under their wings. Schiller attributed the disease to sideral influence. England, however, was not the only country where the wrath of Heaven was considered as having fulminated this scourge! and at Marburg it had such an effect, that it actually put an end to the violent disputes between Luther and Zuingle concerning the Eucharist, and which were on the eve of kindling a religious war. A disease somewhat similar manifested itself in Picardy in 1773, having first appeared at Hardivilliers, five leagues from Beauvais; but, instead of terminating in a single day, it ran on to the third, fifth, and seventh: a fever of the same description was also observed in Gascony. But of all the maladies that affect cutaneous transpiration, _diapedesis_, or sweating of blood, is the most singular; so much so, indeed, that its existence has been doubted, although several well authenticated cases are on record, both in the ancient and modern annals of medicine. It is mentioned by Theophrastus and Aristotle, while Lucan thus describes it: Sic omnia membra Emisere simul rutilum pro sanguine virus. Sanguis erant lacrymæ; quacumque foramina novit Humor, ab his largus manat cruor: ora redundant, Et patulæ nares; sudor rubet; omnia plenis Membra fluunt venis: totum est pro vulnere corpus. The detestable Charles IX. of France sunk under this disorder, thus described by Mezeray: "La nature fit d'étranges efforts pendant les deux dernières semaines de la vie de ce Roi. Il s'agitait et se remuait sans cesse; le sang lui rejalliait par les pores et par tous les conduits de son corps. Après avoir longtems souffert, il tomba dans une extrème faiblesse et rendit l'ame." The same historian relates the case of a governor of a town taken by storm, who was condemned to die, but was seized with a profuse sweating of blood the moment he beheld the scaffold. Lombard mentions a general who was affected in a similar manner on losing a battle. The same writer tells us of a nun who was so terrified when falling into the hands of a ruthless banditti, that blood oozed from every pore. Henry ab Heer records the case of a man who not only laboured under diapedesis, but small worms accompanied the bloody secretion. In the Memoirs of the Society of Arts of Haarlem, we read of the case of a sailor, who, falling down during a storm, was raised from the deck streaming with blood. At first it was supposed that he had been wounded, but, on close examination, the blood was found to flow from the surface of the body. Fabricius de Hilden mentions a case that came under the observation of his friend Sporlinus, a physician of Bâle; the patient was a child of twelve years of age, who never drank any thing but water: having gone out into the fields to bring home his father's flocks, he stopped upon the road, and contrary to habit, drank freely of white wine. He shortly after was seized with fever. His gums first began to bleed, and soon after an hæmorrhage broke out from every part of the integuments, and from the nose. On the eighth day of the malady he was in a state of extreme debility, and the body was covered with livid and purple spots, while every part from whence the blood had exuded was stopped with clots. A case is also related of a widow of forty-five years of age, who had lost her only son. She one day fancied that she beheld his apparition beseeching her to relieve him from purgatory by her prayers, and by fasting every Friday. The following Friday, in the month of August, a perspiration tinged with blood broke out. For five successive Fridays the same phenomenon appeared, when a confirmed diapedesis appeared. The blood escaped from the upper part of the body, the back of the head, the temples, the eyes, nose, the breast, and the tips of the fingers. The disorder disappeared spontaneously on Friday the 8th of March of the following year. This affection was evidently occasioned by superstitious fears; and this appears the more probable from the periodicity of the attacks. The first invasion of the disease might have been purely accidental; but the regularity of its subsequent appearance on the stated day of the vision may be attributed to the influence of apprehension. Bartholinus mentions cases of bloody sweat taking place during vehement terror and the agonies of torture. The case of Catherine Merlin, of Chamberg, is well authenticated, and worthy of being recorded. She was a woman of forty-six years of age, strong and hale. She received a kick from a bullock in the epigastric region, that was followed by vomiting of blood: this discharge having been suddenly stopped by her medical attendants, the blood made its way through the pores of various parts of her body, every limb being affected in turn. The sanguineous discharge was invariably preceded by a prickly and itching sensation; frequently this itching exudation proceeded from the scalp. The discharge usually occurred twice in the twenty-four hours; and on pressing the skin, the flow of blood could be accelerated and increased. Dr. Fournier relates the case of a magistrate who was attacked with diapedesis after any excitement, whether of a pleasurable or a painful nature. A singular idiosyncrasy was transmitted to her male children by an American Female named Smith, occasioning a severe hæmorrhage wherever the skin was slightly pricked or scratched. This loss of blood would sometimes continue for several days. Several of her sons sunk under the affection, which was found at last to yield to the sulphate of soda. What is most singular, all her daughters were exempted from this fearful predisposition. It is probable that this strange disorder arises from a violent commotion of the nervous system, turning the streams of blood out of their natural course, and forcing the red particles into the cutaneous excretories. A mere relaxation of the fibres could not produce so powerful a revulsion. It may also arise in cases of extreme debility in connexion with a thinner condition of the blood. Curious cases are recorded of a sandy sweat, in which the perspiration becomes crystallized on the surface of the skin. Bartholinus, Schunig, and Mollenbroek have related several cases of the kind. It is probable, as Mason Good observes, that this morbid secretion may arise from an excess of uric acid, translated from the kidneys to the skin; this sand is generally of the same red colour as that of the renal secretions deposited in a lateritious sediment. Scented perspiration is another singular peculiarity. This odour, frequently unpleasant, has also been known to shed an agreeable aroma, compared to the perfume of violets, roses, and musk. This quality is common in various animals; in the _Simia jacchus_, hedgehogs, hares, serpents, and crocodiles. The _Viverra zibetha_ and _V. civetta_ yield this odour abundantly; and it has been observed in a faint degree in our domestic cat. Many insects exhale an agreeable odour; especially the _Cerambix moschatus_, the _Apis fragrans_, the _Tipula mochifera_. The _Cerambix suaveolens_ emits a delicious smell of roses, and the Petiolated sphex a highly fragrant balsamic ether. In the Memoirs of the Queen of Navarre, we read that Catherine de Medicis was a perfect nosegay; and Cujacius and Lord Herbert of Cherbury were equally distinguished by the suavity of their transpiration. The general perspiration of every man seems to be of a peculiar nature. Savages can distinguish their friends and foes by the scent. The boy born deaf and dumb, whose history is related by Dugald Stewart, distinguished persons by their odour; and the dealers in hair can ascertain by the smell the nation to which the hair belongs. The quantity of perspiration secreted by a well-grown adult weighing about one hundred and forty-six pounds, is at the rate of twenty-eight ounces in the twenty-four hours, sixteen ounces during the period usually allotted to waking, and twelve ounces during sleep.[49] It is not so much increased by moderate elevation of temperature as might be imagined; it appears increased after meals and during sleep. While the skin thus secretes so considerable a quantity of watery fluid, its powers of absorption are wonderful, and are frequently resorted to for medicinal purposes. This absorption evidently tends to assist in repairing the strength. A boy at Newcastle who had been greatly reduced for a race, gained thirty ounces in weight in the course of an hour, during which time he had only taken a glass of wine. Dr. Home, after going to bed much fatigued and supperless, gained two ounces before the morning. Keill says that one night he gained eighteen ounces in his sleep. Immersion in water and damp air materially increases this power. Frogs, toads, even lizards, increase in weight although only partially dipped in water; and remarkably so if previously deprived of part of their moisture by exposure to air. The power of absorbing medicinal substances when immersed in their solution has been demonstrated by Dr. Massy, an American physician, who found that if the body was immersed in a decoction of madder,[50] this substance immediately tinged the renal secretion. Dr. Rousseau made a similar experiment with rhubarb. It is now clearly demonstrated that friction is not necessary to produce absorption. The keenness of the deaf and dumb boy in ascertaining the effluvium of various individuals, to which I have alluded, induces me to give a short sketch of this curious individual. His name was James Mitchell; and having no other source by which he could discover or keep up a connexion with surrounding objects than those of smell, taste, and touch, he depended chiefly upon the first, like a domestic dog, in distinguishing persons and things. By this sense he identified his friends and relations; and conceived a sudden attachment or dislike to strangers. It was difficult, however, to ascertain at what distance he could thus exercise this faculty; but, from Mr. Wardrop's observations, it appears that he possessed it at a considerable distance. This was particularly striking when a person entered the room, as he seemed to be aware of this before he could derive any information from any sense than that of smell. When a stranger approached him, he eagerly began to touch some part of the body, commonly taking hold of his arm, which he held near his nose; and, after two or three strong inspirations through the nostrils, he appeared to form a decided opinion concerning him. If it were favourable, he showed a disposition to become more intimate, examined more minutely his dress, and expressed in his countenance more or less satisfaction; but if it happened to be unfavourable, he suddenly went off to a distance, with expressions of carelessness or disgust. SMALLPOX. The first description we have of this dreadful disease is to be found in the writings of Almansor of Rhazes, published about the end of the ninth or the beginning of the tenth century. He, however, quotes an Alexandrian physician of the name of Aaron, who had treated the same subject so early as the year 622. There is no substantial ground to warrant a belief that it was known to the Greeks or Romans. The opinion of Hahn, who considered it to have been their anthrax, is absurd. Had this pestilence prevailed amongst the ancients, and left the traces of its ravages,--which have marked most fearfully so many individuals,--it is probable that these impressions would have been attached to their names, as they were in the habit of designating many of their illustrious personages by their physical peculiarities, either natural or accidental. Hence we find Ovidius _Naso_, Tullius _Cicero_, Horatius _Cocles_, Scipio _Nasica_, Curius _Dentatus_. The term _variolæ_, which this disease bears, was first applied to a malady presenting the same symptoms, by Marius, bishop of Avanches, and appears to be derived from _varius_, spotted. Howbeit, to whatever region we may be indebted for this scourge, it appears that it existed in Asia, and especially in China, long before its introduction into Europe. About the middle of the sixth century, it was supposed to have been carried from India to Arabia by trading vessels, where no doubt the Arabian and Saracenic armies introduced it into the Levant, Spain, and Sicily. In 640, under the caliphate of Omar, the Saracens spread the contagion over Syria, Chaldæa, Mesopotamia, Egypt, and Persia. Its appearance in Europe may be referred to the eighth century. In the ninth century, as I have stated, we find it described by the Arabian physicians. In the tenth century we find it described by other Arabian writers, chiefly Avicenna and Hali Abbas. In 962, Count Baudouin of Flanders, died from its attack. It appears certain that it prevailed in Gaul long before; we find in the works of Marius, already mentioned, the following passage: "Hoc anno (570) morbus validus, cum profluvio ventris et _variolis_, Italiam Galliamque valdè afflixit." About the same period we find Dagobert and Clodobert, sons of Chilperic, falling victims to the disorder; and Austregilda, wife of Gontran King of Burgundy, died of it in 580, at the age of thirty-two, so enraged with her physicians, Nicholas and Donet, that she insisted that they should accompany her to the other world, to reward them for causing her untimely end. Her affectionate and disconsolate husband Gontran of course had both their throats cut upon her tomb. In the eleventh and twelfth centuries we find the smallpox in all the southern parts of Europe. The north was for a long time tolerably exempted from the scourge, until the Holy War introduced it into those regions; and it appears to have been the only trophy that the English and Germans brought home to commemorate their exploits in the Crusades. In the thirteenth century the Muscovites, Laplanders, and Norwegians were free from the disorder, the progress of which seemed to have been delayed by the cold; although at the same time, according to the relation of Gordon, it was most destructive all over France. Most physicians at this period partook of the opinion of the Arabians, who considered the disease as being in the blood, thrown by it into a state of ebullition, particularly in childhood and youth. According to the Arabian Auaron, or Ahron, it sometimes affected the same individual twice. This doctrine of the boiling up and bubbling forth of the blood to throw out its peccant qualities, tended not a little to increase the mortality and exasperate the disease; as the physicians, to encourage this concoction, were in the habit of wrapping up their patients in warm clothing, and keeping their apartments as hot as possible;--a fatal practice that subsequent experience has rejected as destructive. In 1517 the Spaniards carried it to St. Domingo, nearly depopulating the country. South America soon received this additional visitation, said to have been carried amongst them by a negro. So terrific were the ravages of this pestilence, that the Americans considered its invasion as one of the _data_ of their melancholy chronicles. The brother of the noble Montezuma was one of its earliest victims; worthy attendant on the Spanish banners, it accompanied their detested hordes in all their conquests. The northern districts of America were free from the contagion, when the English carried it with their commercial productions amongst the natives of Boston in 1649, and subsequently to Virginia and Carolina, and the remaining provinces. The Spaniards infected Nootka Sound, and the Russians desolated Kamtschatka about the same period. Inoculation appears nearly as ancient as the disease, if we can credit the missionaries, who were sent into China by the Church of Rome, and who, from their address and insinuation, gained access to the historical records: they have transmitted detailed accounts of the history of the Chinese, and of their knowledge in various branches of science. There is a memoir written on the smallpox by the missionaries at Pekin, the substance of which is extracted from Chinese medical books, and especially from a work published by the Imperial College of Medicine, for the instruction of the physicians of the empire. This book is entitled _Teou-tchin-fa_, or a treatise from the heart to the smallpox; which states that the disease was unknown in the very early ages, and did not appear until the dynasty of Tcheou, which was about 1122 years before Christ. The Chinese name for the malady is a singular one, _Tai-tou_, or venom from the mother's breast; and a description is given of the fever, the eruption of the pustules, their increase, flattening, and crusting. In the same Chinese book there is also an account of a species of inoculation discovered seven centuries previously; but, according to a tradition, it had been revealed in the dynasty of Long, that is, about 590 years before Christ. Father d'Entrecolles, the Jesuit, in his correspondence from China, gives some information respecting the smallpox, which confirms the material part of the above information; for he notices having read some Chinese work which mentions the smallpox as a disease of the earliest ages. He also describes a method of communicating the disease, which was called _sowing the smallpox_; this was generally performed by planting some of the crusts upon the nose,--an operation which was approved of by some but disapproved by others. Although the tradition of the smallpox being a disease originally transmitted to man by camels may be fanciful, yet the existence of the vaccine in cows might give some probability to its having been the case. Moore thus expresses himself on the subject: "This notion probably took its rise from the circumstance that land commerce from Egypt to India was only practicable by means of this animal. But such kind of traffic was tedious and difficult, and it is conjectured that no person known to have the smallpox would ever have been suffered to join himself to a caravan." Now this observation would rather confirm the fact than invalidate it; since, if no individual affected with the malady could have carried the contagion, the disease might have been spread by their camels. In regard to the antiquity of the practice of inoculation amongst the Chinese, I cannot do better than give Mr. Moore's own words on so very interesting a subject. "No account is handed down of the origin of this custom; but the reverence in which agriculture is held by the Chinese may have suggested the name (sowing of the smallpox) and the usual manner of performing the operation: for they took a few full dried smallpox crusts, as if they were seeds, and planted them in the nose; a bit of musk was added in order to correct the virulence of the poison, and the whole was wrapped up in a bit of cotton to prevent it dropping from the nostrils. The crusts employed were always taken from a healthy person who had had the smallpox favourably; and, with the vain hope of mitigating their acrimony, they were sometimes kept in close jars for years, and at other times fumigated with salutary plants. Some physicians beat these crusts into powder, and advised their patients to take a pinch of this snuff; and when they could not prevail upon them, they mixed it with water into a paste, and applied it in that form. In Hindostan, if tradition may be relied upon, inoculation has been practised from remote antiquity. The practice was in the hands of a particular tribe of Brahmins, who were delegated from various religious colleges, and who travelled through the provinces for this purpose. The natives were strictly enjoined to abstain during a preparatory month from milk and butter; and, when the Arabians and Portuguese appeared in that country, they were prohibited from taking animal food also. These were commonly inoculated on the arm; but the girls, not liking to have their arms disfigured, chose that it should be done low on the shoulder: and whatever part was fixed upon was well rubbed with a piece of cloth, which afterwards became a perquisite of the Brahmin. He then made a few slight scratches on the skin with a sharp instrument, and took a bit of cotton, which had been soaked the preceding year in variolous matter, moistened it with a drop or two of the holy water of the Ganges, and bound it upon the punctures. During the whole of this ceremony, the Brahmin always preserved a solemn countenance, and recited the prayers appointed in the _Attharna Veda_, to propitiate the goddess who superintended the smallpox. The Brahmin then gave his instructions, which were regularly observed. In six hours the bandage was to be taken off, and the pledget allowed to drop spontaneously. Early next morning, cold water was to be poured upon the patient's head and shoulders, and this was to be repeated until the fever came on. The ablution was then to be omitted; but, as soon as the eruption appeared, it was to be resumed and persevered in every morning and evening till the crusts should fall off. Confinement to the house was absolutely forbidden; the inoculated were to be freely exposed to every air that blew; but when the fever was upon them, they were sometimes permitted to lie on a mat at the door. Their regimen was to consist of the most refrigerating productions of the climate; as plantains, water-melons, thin gruel made of rice or poppy-seeds, cold water, and rice." While sowing the disease was thus prevalent in some countries, selling and buying it was adopted in others, when children bartered fruit in exchange for the infection. It does not appear that the faculty took any notice of inoculation until the year 1703, when Dr. Emmanuel Timoni Alpeck wrote an account of his observations in Constantinople, in a letter to Woodward: a Venetian physician, of the name of Pylamus, about the same time noticed the success of the practice in Turkey. Lady Mary Wortley Montagu pursued the inquiry in her voyage to that country, by causing her son Edward to be inoculated by Maitland, surgeon to the embassy, and, on her return to England in 1722, had the operation tried with successful results on her daughter. Still, although two of the princesses of the royal family had also been inoculated with equal benefit, inoculation was furiously opposed by the profession, and even from the pulpit; and so successful was this opposition, that it succeeded in bringing it into disuse both in England and throughout Europe, many cases of smallpox of a confluent character having made their appearance after inoculation, and in 1740 the practice had nearly fallen into disuse. In this virulent controversy, a singular circumstance was observed: while regular practitioners stated the practice to be unsuccessful, whenever it was adopted by quacks, monks, and old women, the result was invariably favourable; and the report that reached Europe of a Carmelite friar having inoculated thousands of Indians, an old woman being equally fortunate in Greece, while at the same time a planter in St. Christopher's inoculated three hundred persons without the loss of a single patient, the practice was again resumed, chiefly in our seaports, and gradually extended over the country. Mead materially assisted its progress by stating that the Circassian ladies chiefly owed their beauty to this salutary preservative. In the year 1763, Daniel Sutton, son of a surgeon in Suffolk, recommended the practice, modified, however, in the treatment of the malady, and brought inoculation into general repute. It appears, however, that inoculation was by no means a novel introduction even in England, as it had been long practised in Pembrokeshire and several parts of Wales. On the Continent it had been tried at Cleves. Bartholinus mentions it as adopted in Denmark; and traces of its adoption were evident in Auvergne and Perigord. Various modes of performing this operation were adopted. The Arabians inserted the virus with a pointed instrument between the thumb and the index; the Georgians on the fore-arm; and the Armenians on the thigh. The traveller Motraye mentions a Circassian old woman who used to inoculate with three pins tied together. It appears that this practice was generally prevalent in Turkey in 1673. Trinoni and Pilarini observed that the natural smallpox was generally fatal in Constantinople, while the disease produced artificially was most benign. Bruce relates that from time immemorial inoculation was practised in Nubia by old Negresses or Arabs. Strange to say, it was only in 1727 that inoculation became general in France; and its adoption was materially forwarded by Voltaire, who also took special care to acquaint the fair sex that it was to this practice that the Circassian and Georgian odalisks owed their beauty. The terrific mortality that attended this disease was much increased by the injudicious treatment to which patients were submitted. Instead of adopting the natural plan resorted to by eastern nations, and allowing the patients a free current of air, with a refrigerant diet, cordials and a hot regimen were enforced, under which the disorder soon assumed a destructive malignity. Cold affusion, which has also been extolled by modern physicians as a recent improvement in medical practice, we have seen, was also employed centuries ago. Sutton, who is generally, but erroneously, considered as being the introducer of inoculation, did nothing more, as I have already observed, than modify the treatment of the disorder. Thus do we daily see impudence and quackery receiving rewards for supposed discoveries, and the keepers of the public purse on such occasions seem much less careful of it than of their own. In our days, for instance, chain-cables have been decreed a discovery, and their inventor entitled to a national recompence, whereas we read the following passage in Cæsar's Commentaries, when speaking of the shipping of the Gauls,--"Anchoræ, pro funibus, ferreis catenis revinctæ:" any schoolboy could have given this information to our sapient legislators. The reappearance or supposed increased prevalence of the smallpox after vaccination, for the last few years, may call for some observation. Ever since the year 1804 a belief was entertained by many persons that the cowpox only afforded a temporary security. This doubt, however, never did rest upon any solid foundation. Dr. Jenner maintained in the most strenuous manner, that to render the cowpox efficient, it was absolutely necessary to attend most carefully to the character of the pustule, and the time and quality of the lymph taken from it; on the very same principle inoculation of the smallpox also failed. For it must be clearly understood, that Jenner considered the smallpox and the cowpox as identic maladies, and by no means dissimilar in their nature: on this important subject I feel much gratification in quoting a passage from a late valuable publication,[51] to which I refer the reader. "It was then clearly ascertained, that there were deviations from the usual course of smallpox, which were quite as common and infinitely more disastrous than those which took place in vaccination. These deviations regarded two apparently different states of the constitution. In the one the susceptibility of smallpox, was not taken away by previous infection, while, on the other hand some constitutions seem to be unsusceptible of smallpox infection altogether. It was found, that similar occurrences took place in the practice of vaccination, but as the security which the latter afforded was never more likely to be interfered with by slight causes than the former, it became absolutely necessary that great care should be shown in watching the progress and character of the pustule. Dr. Jenner had from the beginning felt the propriety of this watchfulness; and had distinctly announced that it was possible to propagate an infection by inoculation conveying different degrees of security, according as that affection approached to or receded from the full and perfect standard. He also clearly stated that the cause of the vaccine pustule might be so modified as to deprive it of its efficacy. That inoculation from such a source might communicate an inefficient protection, and that all those who were thus vaccinated were more or less liable to the subsequent smallpox." Dr. Bacon is of opinion that the cowpox is now what it was at the beginning. There are instances, in which it has passed from one human subject to another for more than thirty years, consequently through fifteen or sixteen hundred individuals, but yet in which no degeneration has taken place. He nevertheless admits that recent lymph from the cow should be preferred, when it can be procured; he is further of opinion that the occurrence of smallpox after inoculation does not exceed in number the cases of smallpox after smallpox. My own experience confirms these views. I was in practice in Bordeaux during the prevalence of what is called smallpox in vaccinated cases,--the cases were rare, doubtful, and very seldom fatal. There is little doubt that the smallpox would sweep away thousands of our dense population but for the protecting power of vaccination, the failure of which, ought more frequently to be attributed to the vaccinator, or the constitution of the patient, than to Jenner's immortal discovery. Dr. Severn has just published an essay on this most important subject, and it appears by his statistical tables, that such has been the decrease of mortality since the introduction of vaccination, that the number of patients admitted into the smallpox hospital from 1775 to 1800,--were 7017--the deaths 2277--whereas from the year 1800 to the year 1825, the number admitted was 3943, and the deaths 1118--not half the number, although the population of London had doubled during that period. Dr. Severn further calculates that the proportion of failures is 6 in 3000. We read with feelings of deep regret in his late bibliography, that the man at whose intercession the magic of his name obtained the liberation of Napoleon's prisoners, could not obtain an appointment for the members of his own family from the British Government; nay, the College of Physicians despite the exertions of Dr. Baillie, refused to admit him to a fellowship in their learned body. It was when reflecting on such national ingratitude, that he wrote to a friend, "Never aim, my friend at being a public character, if you love domestic peace." And not long before he terminated his invaluable career he made this remarkable expression: "I am not surprised that men are not thankful to me; but I wonder that they are not grateful to God for the good which he has made me the instrument of conveying to my fellow-creatures." It is in vain that France with her usual _jactance_ pretends that the first idea of vaccination arose in that country, they have no more claim to the discovery than their Marshals to Wellington's immortal glory. GENERATIVE ANIMALCULES. Microscopic experiments daily demonstrate the existence of myriads of animalcules in every substance. They have recently been discovered in the progress of certain crystallizations; and some philosophers maintain that most inorganic bodies are formed of the remains of organic substances. The existence of animalcules in the generative secretion was first noticed by Lewis Hamme, a young German student, and shown by him to Leeuwenhoeck, who published an account of them. Hartzoeken wrote upon the subject the following year, and asserted that he had seen these animalcules three years before they had been observed by Hamme. This curious subject soon attracted the notice, not only of physiologists, but of priests, artists, and even courtiers, for we find our Charles II. making curious inquiries on this investigation. Although many opticians could not discover these creatures, the eyes of courtiers were more keen than theirs, and to gratify their royal master's depravity, described them most minutely. Their length was 3/100000 of an inch, their bulk such as to admit the existence of 216,000 in a sphere whose diameter was the breadth of a hair, and their rate of travelling nine inches in the hour. They saw them in the seminal secretion of every animal; and, what was still more remarkable, they were of a similar size whatever might have been that of the animal: they saw them in the sprat and in the whale; they could distinguish the male from the female; and they all moved along in gregarious harmony like a flock of sheep: nay, more; Dalenpatius actually saw one of them, more impatient than his companions, burst from his ignoble shackles, and actually assume the human form. At other times they were discovered swimming in shoals to given points, turning back, separating, meeting again, and frisking about like golden fish in a pond. Kauw, Boerhaave, Maupertius, Lieuland, Ledermuller, Monro, Nicholas, Haller, and indeed most of the philosophers of Europe, were convinced of their existence. Buffon, however, and other naturalists, contended that these were not animalcules, but organic particles; and Linnæus imagined them to be inert molecules, thrown into agitation by the warmth of the fluid. Finally, to determine the question, Spallanzani began an assiduous course of observations and experiments. He found these animalcules in the human species to be of an oval form, with a tail tapering to a point. This appendage, by moving from side to side, propelled them forward. They were in constant motion in every direction. In about twenty-three minutes their movements became more languid, and in two or three hours they generally died. The duration of their life, however seemed to depend, in a great measure, on the temperature of the medium: at 2° (Reaumur) they died in three quarters of an hour; while at 7° they lived two hours, and at 12-1/2° three hours and three quarters. If the cold was not too intense, they recovered upon the temperature being raised; when only 3° or 4°, they recovered after a lethargy of fourteen hours; and according to the less intensity of the cold, they might be made to pass from the torpid to the active state more frequently. They were destroyed by river, ice, snow, and rain water; by sulphur, tobacco, camphor, and electricity; even the air was injurious to them: in close vessels their life was prolonged to some days, and their movements were not constant and hurried. They were of various sizes, and perfectly distinct from all species of animalcules found in vegetable infusions, &c. In short, Spallanzani completely confirmed the principal observations of Leeuwenhoeck, and satisfactorily explained the sources of the inaccuracies of other inquirers. Prevost and Dumas have recently confirmed the observations of the Italian physiologist. This doctrine of life being perpetuated by the transmission of animated particles, or animalcules, is by no means of modern date. We find this theory advanced by Hippocrates, and Aristotle, and Plato. Democritus described worms that assumed, in the progress of their development, the human form; and Lactantius thus refuted his ideas: "Erravit ergo Democritus, qui vermiculorum modo putavit homines effusos esse de terrâ, nullo auctore, nullâque ratione." Hippocrates plainly says, that the seminal secretion was full of animalcules, whose several parts were developed, and grew afresh; that nothing did exist that had not pre-existed; and that what we term birth was nothing more than that transition of these hitherto imperceptible animalcules from darkness to light. Gesner has endeavoured to prove that the word [Greek: psychê], so frequently found in the writings of Hippocrates, and translated _anima_, was synonymous with _insectum_, _animalculum_, _papilio_. Plato, when expressing himself on this curious subject, compares the matrix to a fertile field, in which animalcules are gradually developed, at first of such a small size that they are imperceptible, but, by taking the food prepared for them, grow in strength until they are brought to light in a state of perfect generation; and St. Augustine thus follows: "Hunc perfectionis modum sic habent omnes ut cum illo concipiantur atque nascuntur; sed habent in ratione, non in mole, sicut ipsa jam membra omnia sunt latenter in semine; cùm etiam natis nonnulla desint, sicut dentes, ac si quid ejusmodi." In the works of Seneca we also find the same notions: "In semine omnis futuri hominis ratio comprehensa est, et legem barbæ et canorum nondum natus infans habet; totius enim corporis, et sequentis ætatis, in parvo occultoque lineamenta sunt." It may be said that these opinions were similar to those of the _Ovarians_, who, as we have observed already, believed that every thing arose from the egg. Such were Aristotle, Empedocles, and other philosophers: "For the egg is the conception," said the first of these great men, "and after the same manner the animal is created;" but there was a manifest difference in their systems. Harvey, Haller, De Graef, were amongst the most warm advocates of this doctrine, which indeed prevails to the present day, as it would be difficult to find organized beings that did not spring from an original germ. It thus appears that, notwithstanding the absurd doctrines of generation being founded upon the existence of these animalcules, they clearly do exist. Modern microscopic experiments daily confirm the fact; not only in the generative secretion, but in the other fluids of the body: creatures of an inch to an inch and a quarter in length have been found to inhabit the mesenteric arteries of asses and horses. Mr. Hodgson found them in seven asses out of nine. They have also been found in the blood of female frogs, salamanders, and tadpoles. What wonders are perhaps in store for the microscopic observer and the physiologist! All living matter seems to be animated by particles, by atoms, equally possessed of life. Does the vitality of these constituent molecules hold any influence over our existence? Is their life necessary to the preservation of ours? Is any agency destructive to them injurious or destructive to us? In a former paper I have recorded recent observations, where animalcules of a peculiar description were found in the purulent secretion attending various affections. A morbid condition seems thus to produce a new series of animated beings, or this new series of living atoms perhaps have produced a morbid state. Many eruptive maladies are either caused by the presence of insects, or insects are subsequently developed in their pustules. Wichmann, and many other physicians, have maintained that the itch was produced by an insect of the genus _acarus_, or _tick_. Latreille has given a minute description of this creature in his _Genera crustaceorum et insectorum_, and calls this offensive species the _sarcoptes scabiei_. Linnæus classed it among the _aptera_, and termed it the _acarus scabiei_. This insect is nearly round, with eight legs; the four fore-legs terminated with a small head, the hind ones with a silky filament. The Arabian Avenzoar had long since observed them, and it was from his writings that Mouffet was induced to pursue the inquiry. Redi, an Italian physician, was the first propagator of this doctrine in modern times, and published, in 1685, a paper of Cestoni of Leghorn, who had frequently observed mendicants and galley-slaves extracting these insects from the pustules of itch with the point of a pin, in the same manner as _chigoes_ are extracted from their cyst in the West Indies. It was this communication of Cestoni that led to a further and more minute investigation. Curiosity was every where excited, and the most learned and intelligent naturalists and physicians, amongst whom we find the illustrious names of Borelli, Etmuller, Mead, Pringle, Pallas, Bonani, Linnæus, Morgagni, strove with incessant diligence to ascertain this important fact, which certainly was likely to shed a new light on our pathological speculations. The existence of the acarus was established. The most conclusive experiments on the subject were those of Galès, in 1812. The following is the account of them: "I placed under a microscope a watch-glass with a drop of distilled water, after having carefully ascertained that it did not contain any visible animalcules. I then extracted from an itch pustule a small portion of the virus, which I diluted in the water with the point of a lancet. I watched most attentively for upwards of ten minutes, without having been able to notice any animation. Two similar experiments were equally ineffectual. Disappointed in my expectations, I was about giving up the task, when an idea struck me of submitting the liquid of the first experiment to another trial. I had left it in the watch-glass, exposed to solar heat. I then was not a little surprised when I discovered a perfect insect struggling with its legs to extricate itself from the viscid fluid that confined it. Having succeeded in reaching a more limpid part of the liquor, its form was so distinct that Mr. Patrix, who was with me, was enabled to take an exact drawing of its configuration." This curious result naturally induced Galès to pursue his inquiries, and he discovered that this insect chiefly occupies the pustules that are filled with a thin serum, and avoids those that contain a thicker secretion. Hence the watery pimples in itch are invariably those that produce the most intolerable prurience. The next important question was to decide whether this insect was the cause of the disgusting disorder. For this purpose Galès placed several of them on the back of his hand. He then covered the part with a small watch-glass, kept in place with a bandage. Three hours after he awoke, experiencing a sensation of itching on the part. The following morning three itch pustules were evident, and convinced him that he had succeeded in inoculating himself with the loathsome complaint. This fact he communicated to Olivier, Duméril, Latreille, and Richerand. Experiments in the hospital were immediately directed to be made, and all produced a similar result; affording a convincing proof that these insects could produce the affection, which they had merely been thought to have complicated. Many writers, who, like Mason Good, had decided that "whenever these insects appear, they are not a cause but a consequence of the disease," opposed and contradicted the statement of Galès, and the numerous practitioners who had procured and witnessed facts, which are never "stubborn things" to speculative minds. These writers maintained that whenever any organ was weakened, or in a morbid condition, it was apt to become a nidus for some insects or worms to burrow in. Hence the numerous varieties of invermination in debility of the digestive organs. But it is needless to observe that their objections cannot stand against the imbodied evidence brought forward in proof of their error. Bosc, Huzard, Latreille, Duméril, and many other naturalists, subsequently found these acari in the eruptive diseases of many animals. I repeat it, this subject is replete with interest; and microscopic experiments may some time or other throw a material light on the practice of medicine. Those substances that are known to destroy the insect that produces the itch, cure the malady. May not this analogy lead to singular results? CIRCULATION OF THE BLOOD. The circulation of the blood was first taught by the unfortunate Servetus in 1553, who was burnt to death as a heretic; and, a century afterwards, demonstrated by our Harvey, who is justly considered as having discovered the wonderful mechanism of the motion of the vital fluid. There is no doubt, however, that the ancients had formed, if not a correct, at least an ingenious, idea of it. Hippocrates tells us "that all the veins communicate with each other, and flow from one vessel into others; and that all the veins that are spread over the body carry a flux and movement originating in a single vessel." He avows that he is ignorant of the principle whence it arises, or of its termination, it appearing to be a circle without beginning or end. He further states, that the heart is the source of the arteries, through which blood is carried over the body, communicating life and heat; and he adds, that they are so many rivulets that irrigate the system, and carry vitality into every part: the heart and veins are in constant motion; and he compares the circulation of blood to the course of rivers, that return to their source by extraordinary deviations. He therefore directs blood-letting to restore a free current of the blood and other spirits in apoplexies and other diseases of a similar nature, which he attributed to obstruction in the vessels intercepting the flow of their contents. He also observes, that when bile enters the blood, it deranges its consistence, and disturbs its ordinary course towards another point: and he compares the circulation to balls of thread, the threads of which return to each other in a circuitous manner, terminating at the point whence their motion arose. Plato thought that the heart was the source of the veins, and of the blood, that was rapidly borne to every part of the body. Aristotle tells us that the heart is the principle and source of the veins and of the blood. He considered that there were two veins proceeding from this organ, one from the left side, the other from the right; the first he termed _aorta_: and he further maintained that the arteries communicated with the veins, with which they were intimately connected. Julius Pollux taught, in his _Gnomasticon_, that the arteries are the channels through which the spirits circulate as the veins propel the blood; and he describes the heart as having two cavities, one communicating with the arteries, and the other with the veins. Apuleius tells his disciples that the heart propels the blood through the lungs, to be afterwards distributed over the system. In the writings of Nemesius, bishop of Emissa, we read that the movement observed in the pulse originates in the heart, chiefly from the artery of the left ventricle of the viscus. This artery is dilated, and then contracted, by a constant and powerful harmonious action. When dilated the vessel draws towards it the most subtile portions of the neighbouring blood, and the vapour or exhalation of this fluid, that feeds the animal spirits; but when it contracts, it exhales, through various channels of the body, all the vapours that it contains. Strange as it may appear, doubts were once entertained as to the actual situation of the heart, whether it was lodged in the right or the left side of the body. The question was finally settled by a professor of Heidelberg, who for the purpose killed a pig in the presence of the Margrave of Baden, Durlach, who then laboured under a supposed disease of that organ, which it was then clearly shown occupied the left side. The result of this experiment, however proved somewhat detrimental to his Highness's physician, who was dismissed, although he maintained with all becoming courtesy and respect, that the heart of his princely master could not _possibly be_ in the same position as that of a hog. Michael Servetus, in his work, _De Christianismi restitutione_, also in the 7th book, _De Trinitate Divinâ_, for which he was sentenced to the stake a very short time after its publication, gives us the following description of this important function: The blood, which is a vital spirit, is diffused all over the body by _anastomoses_, or inosculation of two vessels through their extremities. The air in the lungs contributes to the elaboration of the blood, which it draws for that purpose from the right ventricle of the heart through the pulmonary artery. This blood is prepared in the lungs by a movement of the air that agitates it, subtilizes it, and, finally, mingles it with that vital spirit which is afterwards retransmitted to the heart by the movement of the diastole, as a vital fluid proper to maintain life. This communication and preparation of the blood, he further states, is rendered evident by the union of the arteries and veins in this organ; and he concludes by affirming that the heart, having thus received the blood prepared by the lungs, transmits it through the artery of the left ventricle, or the aorta, to every part of the body. Great care was of course taken to destroy this abominable heretical publication, which was burnt by the common hangman in Geneva, Frankfort, and several provinces of France. The work thence became so scarce, that it is said only three or four copies of it are in existence. One of them was in the library of the Landgrave of Hesse-Cassel. John Leonicenus relates that the celebrated Paul Sarpi otherwise named Fra Paolo, had also discovered this circulation, and demonstrated the valves of the veins, which open to afford a free passage to the blood, and close to prevent its return. This discovery, it is pretended, was made known to Fabricius ab Aquapendente, professor of medicine in Padua in the sixteenth century, and successor of Fallopius, and who communicated the fact to Harvey, then a student in that university. Some time before Harvey's discovery, Cesalpinus had described with great precision the pulmonary circulation; and, on finding that veins swelled under a ligature, he attributed this enlargement to the warmth of the blood. This warmth, he says, proceeds from a spirit residing in the blood. The left ventricle is filled with blood of a spirituous nature; and one can trace the movement of the blood towards the superior parts, and its return (_retrocessus_) to the internal ones,--that is to say, a return by which it comes back from the extremities to the heart, when awake or sleeping, from every part of the body; for if you tie the vessels, or if they are obstructed, the current of the blood is stopped, and then their smaller ramifications tumefy towards their origin. The following are his words: "Sic non obscurus est ejusmodi motus in quâcumque corporis parte, si vinculum adhibeatur, aut aliâ ratione occludantur venæ: cùm enim tollitur permeatio, intumescunt rivuli quâ parte fluere solent." From these expressions it is clear that Cesalpinus suspected the great circulation, and had a fair idea of its nature; yet there is no doubt but that it was to our Harvey that the first demonstration of this wondrous function was reserved. DRUNKENNESS. At all periods this degrading vice appears to have been more or less prevalent. We find it frequently mentioned in the early history of the Jews. Tacitus informs us that it was common amongst the ancient Germans; and in Greece and Rome it was not only common, but frequently extolled as beneficial--as medicinal: Si nocturna tibi noceat potatio vini, Horâ matutinâ rebibas, et erit medicina. Socrates considered the indulgence in wine pardonable. Thus, C. Gallus: Hoc quoque virtutem quondam certamine, magnum Socratem palmam promeruisse ferunt. According to Horace, Cato the Censor had often recourse to its exhilarating virtues: Narratur et prisci Catonis Sæpe mero incaluisse virtus. Seneca informs us that even the Roman ladies frequently indulged in these potations. The drunkenness of the ancients bore all the disgusting character of the present day, and was thus admirably described by Lucretius: Cum vini penetravit-- Consequitur gravitas membrorum, præpediuntur Crura vacillanti, tardescit lingua, madet mens, Nant oculi; clamor, singultus, jurgia gliscunt. However, from the language of the ancients, we cannot come to the conclusion that Socrates, and other great men who were accused of inebriety, were habitual drunkards, or even that, under the influence of their potations, they were occasionally deprived of their reason. On the contrary, there is every reason to believe that the ancients both ate and drank a great deal during their repasts; and thus mingling their wine and their food, like most of the continental nations, they were less subject to the inconveniences that arose from their indulgence in liquor. Indeed, the term sobriety applies to a proper regulation of our ingesta, according to our constitution and our state of health. Extreme abstinence on some occasions may prove as prejudicial as intemperance; and there are peculiar idiosyncrasies where a certain quantity of stimulus is absolutely requisite to keep up the animal spirits, and at the same time assist assimilations which become languid under mental depression. No doubt, this necessity has arisen from habit,--most probably a very bad habit; still, when it does exist, physicians should be cautious in suddenly forbidding customary indulgences: we must also consider on such occasions the pursuits of different individuals. The laborious classes, who require more frequent refection, from the constant exhaustion to which their avocations expose them, can bear with impunity a moderate use of strong liquors. Such a practice would destroy the sedentary and the studious. Temperance is essentially requisite to perfect not only our intellectual faculties, but many of our physical functions. The senses both of man and the brute creation are rendered much more keen by abstinence. The scent of the dog, the vision of the hawk, are less acute after feeding; and this is one of the chief causes of the greater perspicuity in our ideas when fasting in the morning. The ancients had an axiom founded upon observation, "_if you wish to become robust, eat and labour; if you wish to become wise, fast and meditate_." The Greeks called sobriety, [Greek: sôphrosunê]; or, according to Aristotle, as though they said, [Greek: sôzousan tên phronêsin], it assisted our intellectuals. Plato tells us that Socrates termed this quality [Greek: sôtêrian tês psronêseôs], or the health of the mind. Xenophon maintained that it prevented men from spitting or blowing their noses, as we were not in need of superfluities when we decreased the consumption of what was necessary. The ancients looked upon sobriety as a bent bow, that required occasional relaxation. It is said, but I know not on what authority, that Hippocrates recommended an indulgence in potations once a month. Celsus recommends persons in perfect health not to be too rigorous in their diet; sometimes to fast, and at others to live more freely. In more modern times this supposed precept of Hippocrates has been advocated, and we find two theses on the subject, entitled "_Non ergo singulis mensibus repetita ebrietas salubris_," and "_Non ergo unquam ebrietas salubris_," by Hammet and Langlois. Zacchias, in his medical questions, asks if a physician can recommend such a departure from the laws of temperance without committing a sin. This query has been also debated by divines. Frederick Hoffmann maintained that poets required this indulgence, and attributes in a great measure the falling off of genius amongst the modern Greeks to the destruction of their vineyards by the Turks. In ancient Iconography we oftentimes find Bacchus placed near Minerva. The allusions of Heathen mythology to drunkenness, its effects, and the means of tempering its influence, are curious. Silenus, the preceptor of Bacchus, although represented as always intoxicated, was a philosopher, who accompanied his pupil in his Indian expedition, and aided him by the soundness of his judgment. Virgil makes him deliver the principles of the epicurean doctrines on the formation of the world, and the nature of things. Ælian gives us his conversation with Midas regarding the unknown world of Plato and other philosophers. He was also considered an able warrior and a wit. Ælian derives his name from _Sillainein_. The nymphs who follow his train were considered as typical of the water necessary to dilute his potations, and the influence of love in checking intemperance. Montaigne informs us that the celebrated Sylvius recommended an occasional debauch; and the late Dr. Gregory was of opinion than an occasional excess is, upon the whole, less injurious to the constitution than the practice of daily taking a moderate quantity of any fermented liquor or spirit. Experience, however, does not uphold the doctor's opinion; and, as I have observed in a preceding article, occasional excesses are far more injurious than habitual indulgences, under which, in the most unfavourable climates, men attain advanced years. An occasional excess actually brings on a state of sickness, which, in persons habitually sober, may not only last for several days, incapacitating them from any pursuit, but be frequently followed by serious accidents. Of course I am not alluding to a constant state of intoxication, which will often bring on delirium, tremor, apoplexy, and other destructive accidents. The appearances after death in drunkards exhibit great derangement in organic structure. The brain is generally firmer than usual. Serum is not unfrequently found effused in its cavities; and, what is singular, this watery fluid is often impregnated with the odour of the deceased's potations, such as rum, gin, or brandy. Schrader relates several instances of the kind. Æther has also been detected after the medicine had been freely exhibited. Dr. Ogston states that above four ounces of fluid were found in the ventricles of a drunkard's brain, that had all the physical qualities of alcohol. He thinks that this effusion takes place previously to the coma of intoxication, as he found it in considerable quantities in two cases of drowning in the stage of violent excitement from spirituous liquors. The mucous coats of the stomachs of drunkards, instead of being "worn out," according to the vulgar expression, are thickened, and sometimes softened; but in most cases they are found hardened. This condition is not likely to accelerate death; on the contrary, the stomach is less susceptible of the action of stimulating articles of diet, or excess in eating or drinking, than when in a healthy state of excitability. When drunkenness proves fatal, it appears that a portion of the spirituous part of the liquor is actually absorbed and carried into the circulation and the brain. Dr. Copeland has given the following very luminous and correct view of the pathology of drunkenness. "During the general nervous and vascular excitement consequent on the stimulus, increased determination to the head takes place, attended by excited vascular action, which soon terminates in congestion as the excitement becomes exhausted, and gives rise to drowsiness, sopor, and coma. With this state of the disorder effusion of serum takes place in the ventricles and between the membranes, heightening the sopor and coma. When the congestion or effusion amounts so high as to impede the functions of the organs at the basis of the encephalon and of the respiratory nerves, respiration becomes unfrequent and laborious, and consequently the changes produced by it on the blood insufficiently performed. In proportion as the blood is less perfectly changed in the lungs, the circulation through them is retarded, and the phenomena of asphyxy,--congestion of the lungs, right side of the head, brain, and liver; the circulation of unarterialized blood; the imperfect evolution of animal heat, and sedative effects upon the brain and nervous system generally,--follow in a more or less marked degree, according to the quantity of the intoxicating fluid that has been taken, and either gradually disappear after some time, or increase until life is extinguished. These phenomena are heightened by cold, which depresses the vital action in the extremities and surface to which it is applied, and increases the congestion in the above organs. The fatal consequences of intoxication are often averted by the occurrence of vomiting, the stomach thereby being relieved from a great part of the poison." Besides wine and spirituous liquors various other substances have been employed to bring on this supposed pleasurable state. The Syrian rue (_Peganum Harmala_), was constantly used by Sultan Solyman. The _Hibiscus Saldarissa_ of the Indians, which furnishes their _bangne_, is supposed to be the _Nepenthes_ of the ancients. The _Penang_ or Indian beetle, the _Hyosciamus Niger_. The _Belladonna_, the _Cocculus Indicus_, are drugs that have been resorted to by various nations. The last ingredient has made the fortune of many of our wealthy brewers, at the expense of public sobriety and health. In the accidents that follow intoxication, bleeding has frequently been resorted to. Nothing can be more hazardous than this practice, justly condemned by Darwin, Trotter, and most physicians, who have had frequent opportunities of witnessing the distressing train of symptoms that inebriety brings on. Coffee and green tea will be found the most efficacious antidotes, when no sickness prevails. Nausea is counteracted by effervescent and aromatic draughts, such as soda-water, (so highly appreciated by Byron, when accompanied by a sermon, after a night's conviviality,) spruce-beer, Seidlitz powders, &c. The ancients had recourse to various means to counteract the effects of wine, and amongst others we find olives and olive oil, wormwood, and saffron. The Greeks used a solution of salt, a common remedy among seafaring men to the present day; and the Romans surrounded their heads with wreaths of various refreshing plants. When Aristotle tells us that Dionysius of Syracuse remained in a state of intoxication for eighty days, we must suppose that he got drunk every morning. That the ancients were in the habit of diluting their wine with water, there cannot be a doubt. The Lacedæmonians accused those who drank it pure of acting like Scythians,--an expression introduced ever since Cleomenes the Spartan had learned to drink freely amongst them. The Thracians were also accused of this practice, which clearly proves that it was not general. Philochorus reports that Amphictyon, king of Athens, learned to mix wine and water from Bacchus himself, on which account he dedicated an altar to the god. According to Athenæus, this dilution was of various strength; sometimes in the proportion of one to two, at others of one to five. The Lacedæmonians used to boil their wine till the fifth part was consumed, under the impression that they thus deprived it of its spirituous qualities. Sometimes this boiled wine was laid by for four years. To add to the intoxicating power of wine various means were resorted to, and a mixture of myrrha was supposed to produce this effect. Such was the _murrhina_ of the Romans, mentioned in St. Mark's gospel, and which was given to malefactors before their execution. Notwithstanding the sobriety of the ancients, my fair readers may perhaps be glad to know that the ladies were allowed to indulge in an occasional stoup; and the Greek matrons and virgins were by no means restricted in a moderate use of the grape's delicious juice, as illustrated by Homer in Nausica and her companions. In the ancient entertainments the first libation was offered up to Vesta, as being, according to Cicero, _rerum custos intimarum_, or keeper of things most concealed; or, according to Aristocritus, for the services rendered by this goddess to Jupiter in his war against the Giants. However, without any erudite comments, it is very probable that even the poor Vestals were sometimes delighted when they could take a drop of wine to beguile their solitude. The phenomena of drunkenness have been so ably described by Macnish, that I most gladly transcribe the following passage from that author's excellent work, called the "Anatomy of Drunkenness." "First an unusual serenity prevails over the mind, and the soul of the votary is filled with a placid satisfaction. By degrees he is sensible of a soft and not unmusical humming in the ears, at every pause of the conversation. He seems, to himself, to wear his head lighter than usual upon his shoulders. Then a species of obscurity, thinner than the finest mist, passes before his eyes, and makes him see objects rather indistinctly. The lights begin to dance and appear double, a gaiety and warmth are felt at the same time about the heart. The imagination is expanded, and filled with a thousand delightful images. He becomes loquacious, and pours forth, in enthusiastic language, the thoughts, which are born, as it were, within him. "Now comes a spirit of universal contentment with himself and all the world. He thinks no more of misery: it is dissolved in the bliss of the moment. This is the acme of the fit--the ecstasy is now perfect. As yet the sensorium is in tolerable order, it is only shaken, but the capability of thinking with accuracy still remains. About this time the drunkard pours out all the secrets of his soul. His qualities, good or bad, come forth without reserve; and now, if at any time, the human heart may be seen into. In a short period, he is seized with a most inordinate propensity to talk nonsense, though he is perfectly conscious of doing so. He also commits many foolish things, knowing them to be foolish. The power of volition, that faculty which keeps the will subordinate to the judgment, seems totally weakened. The most delightful time seems to be that immediately before becoming very talkative. When this takes place a man turns ridiculous, and his mirth, though more boisterous, is not so exquisite. At first the intoxication partakes of sentiment, but, latterly, it becomes merely animal. "After this the scene thickens. The drunkard's imagination gets disordered with the most grotesque conceptions. Instead of moderating his drink, he pours it down more rapidly than ever, glass follows glass with reckless energy. His head becomes perfectly giddy. The candles burn blue, or green, or yellow, and when there are perhaps only three on the table, he sees a dozen. According to his temperament, he is amorous, or musical, or quarrelsome. Many possess a most extraordinary wit, and a great flow of spirits is generally attendant. In the latter stages, the speech is thick and the use of the tongue in a great measure lost. His mouth is half open, and idiotic in the expression; while his eyes are glazed, wavering and watery. He is apt to fancy that he has offended some one of the company, and is ridiculously profuse in his apologies. Frequently he mistakes one person for another, and imagines that some of those before him are individuals who are in reality absent or even dead. The muscular powers are all along much affected; this indeed happens before any great change takes place in the mind and goes on progressively increasing. He can no longer walk with steadiness, but totters from side to side. His limbs become powerless and inadequate to sustain his weight. He is, however, not always sensible of any deficiency in this respect, and while exciting mirth by his eccentric motions, imagines that he walks with the most perfect steadiness. In attempting to run, he conceives that he passes the ground with astonishing rapidity. In his distorted eyes all men and even inanimate nature itself, seem to be drunken, while he alone is sober. Houses reel from side to side, as if they had lost their balance; trees and steeples nod like tipsy bacchanals; and the very earth seems to slip under his feet and leave him walking and floundering in the air. "The last stage of drunkenness is total insensibility. The man tumbles, perhaps, beneath the table, and is carried off in a state of stupor to his couch _dead drunk_. "No sooner is his head laid upon the pillow, than it is seized with the strongest throbbing. His heart beats quick and hard against his ribs. A noise like the distant fall of a cascade, or rushing of a river is heard in his ears--rough--rough--rough--goes the sound. His senses now become more drowned and stupified. A dim recollection of his carousals, like a shadowy and indistinct dream, passes before the mind. He still hears, as in echo, the cries and laughter of his companions. Wild fantastic fancies accumulate thickly around the brain. His giddiness is greater than ever; and he feels as if in a ship tossed upon a heaving sea. At last he drops insensibly into a profound slumber. "In the morning he awakes in a high fever. The whole body is parched; the palms of the hands, in particular, are like leather. His head is often violently painful. He feels excessive thirst; while his tongue is white, dry, and stiff. The whole inside of the mouth is likewise hot and constricted, and the throat often sore. Then look at his eyes--how sickly, dull and languid! The fire which first lighted them up the evening before is all gone. A stupor like that of the last stage of drunkenness still clings about them, and they are disagreeably affected by the light. The complexion sustains as great a change: it is no longer flushed with gaiety and excitation, but pale and wayworn, indicating a profound mental and bodily exhaustion. There is probably sickness, and the appetite is totally gone. "Even yet the delirium of intoxication has not left him, for his head still rings, his heart still throbs violently, and if he attempt to get up, he stumbles with giddiness. The mind also is sadly depressed, and the proceedings of the previous night are painfully remembered. He is sorry for his conduct, promises solemnly never again so to commit himself, and calls impatiently for something to quench his thirst. "Persons of tender and compassionate minds are particularly subject, during intoxication, to be affected to tears at the sight of any distressing object, or even on hearing an affecting tale. Drunkenness, in most characters, may be said to melt the heart and open the fountain of sorrow. Their sympathy is often ridiculous, and aroused by the most trifling causes. Those who have a lively imagination, combined with this tenderness of heart, sometimes conceive fictitious cases of distress, and weep bitterly at the woes of their own creating. "There are also some persons on whom drunkenness calls forth a spirit of piety, or rather of religious hypocrisy, which is both ludicrous and disgusting. They become sentimental over their cups, and while in a state of debasement most offensive to God and man, they will weep at the wickedness of the human heart, entreat you to eschew swearing and profane company, and have a greater regard for the welfare of your immortal soul. These sanctimonious drunkards seem to consider ebriety as the most venial of offences!" Inebriety has sometimes a curious effect upon the memory. Actions committed during intoxication may be forgotten on a recovery from that state. Drunkenness differs materially according to the nature of the intoxicating potation. Wine in general may be considered as less injurious, and its effects more transient than spirituous liquors, that produce great excitement, followed by indirect debility and visceral obstruction. The inebriety produced by alcoholic preparations, moreover, is attended with a delirious state, furious and uncontrollable, or followed by congestion and torpor. Malt liquors render their victims heavy, stupid, and more obstinate than violent, and a long continuance in their use produces a state of imbecility, observed so early as Aristotle. Similar differences are observable in the effects of different liquors on the imagination. Wine most undoubtedly produces a greater vivacity of ideas and a more brilliant scintillation of wit and fancy. Hoffmann, indeed, considered the juice of the grape as indispensable to poetic inspiration, and it is very doubtful whether Pegasus was ever benefited by a draught of beer. But, alas! of what avail are the considerations regarding the effects of the pernicious habit of drinking? When once accustomed to the cheering stimulus of liquor, it matters not what the drunkard takes, and if Champagne or Burgundy are not at hand, gin or rum will prove a substitute, perhaps less grateful, but still not unwelcome. Drinking becomes the only refuge from those cares which owe their very origin to excesses, and they must be drowned in any bowl that can be filled to drive away the blue devils. Vina parant animos, faciuntque caloribus aptos, Cura fugit, multo diluiturque mero: Tunc veniunt risus, tunc pauper cornua sumit; Tunc dolor et curæ, rugaque frontis abit, Tunc aperit mentis ævo, rarissima nostro Simplicitas, artes excutiente Deo. DECAPITATION. As I have observed in a preceding article, much doubt exists whether decapitation puts an end to our sufferings, as it has not and most probably will never be ascertained, whether the body or the head are first deprived of sensation or vitality. Galvanic experiments had been resorted to, but were warmly opposed by Professor Ferry on the plea of humanity, as he maintained that unless we were certain that sensation had ceased, we had no right to submit the unfortunate culprits who had been decapitated to this trial. Guillotin (whose name was given to the terrific machine so closely connected in our recollection with the horrors of the French Revolution, which he introduced from the East and Germany) maintained that the moment the head was severed from the body all sensation ceased. Cabanis and Petit were of a similar opinion. Sue, Aldini, Mojon, Weicard, Liveling, Castel, and other physiologists, founded their belief in a contrary doctrine, upon numerous experiments on various animals. Sue grounded his arguments upon two chief points: first, the sudden effect produced by decapitation upon the two most powerful regulators of the functions of life, the brain and the heart; and secondly, on the consideration that the section of the neck was often uneven and jagged, splinters of bones irritating the bruised nerves, vessels, and spinal marrow. According to this view of the matter, existence was not immediately destroyed by decollation. Castel thought that this principle was extinguished in the head sooner than the body. Sue and Julia de Fontenelle were of a different opinion. Dubois of Amiens endeavoured to prove the non-existence of pain after decapitation, by showing that convulsive movements, epileptic and hysteric attacks, were not accompanied by any painful sensations. In decapitation, he thinks that the suddenness and violence of the blow must produce insensibility, for we cannot imagine that the section of the spinal marrow thus violently performed can occasion pain; and if any sensations were experienced in that awful moment, it is more than probable that the violent perturbation would render them obtuse. As to any feelings of the separated head, he does not think that any muscular convulsions observed in it can indicate the existence of pain. To these arguments of the Amiens physiologist, Julia de Fontenelle replied that it was never maintained that convulsive movements were expressive of pain, although it was not impossible that epileptic and hysterical patients may have experienced painful sensations during their attacks that might be forgotten upon their recovery, as somnambulists bear no recollection of what passed during their disturbed slumbers. The convulsive affections alluded to by Dubois were frequently expressive both of pleasure and of pain, or marked with a character of stupor or of indifference, whereas the convulsive movement observed in the features of the decapitated invariably expressed anguish; in support of his firm belief in the existence of the power of sensation after execution, he refers to the observations of Soemmering, Mojou, and Sue, who had remarked that when the head was turned towards the solar rays, the eyes instantly closed,--a phenomenon that could not take place if the eyes were dead. Dr. Montault jocosely observes that it is to be regretted that, to decide this controversy, recourse cannot be had to the experiments, recorded by Bacon, of an inquisitive person who hanged himself for the purpose of ascertaining if strangulation was a painful operation. One of his friends very fortunately cut him down ere it was too late, when the curious experimentalist was quite satisfied that hanging was by no means painful or unpleasant, and that the moment strangulation took place, he had been struck with a flickering light, that was instantly followed by utter darkness. Various cases are recorded of individuals thus cut down, when hanged by accident, or executed. In most instances they stated that they had experienced a pleasurable sensation as strangulation took place. I have already alluded to the curious fate of the well-known composer of the "Battle of the Prague." MUMMIES. Much doubt exists regarding the derivation of the word _mummy_. Bochard, Menage, Vossius, attributed it to the Arabic noun _mum_, meaning _wax_. Salmasius derives it from _mumia_, a body embalmed and aromatized. The Persian word _múmiyà_, means bitumen or mineral pitch. Abd-Allatif, an Arabian physician, describes mummy as a substance flowing from the tops of the mountains, and which mixing with the water that streamed down, coagulates like mineral pitch. Many are the opinions relating to the custom of embalming men and various animals in ancient Egypt. By some it has been considered a superstitious practice, by others the result of affection. To keep the remains of those we loved upon earth free from the destructive power of death, and preserving in some degree those forms that once flitted before us and around us in all the enjoyments of life, is a natural, one might almost say an instinctive, sentiment;--preserving those fond remains upon earth, exempted from the painful sight of beholding them committed to the earth--earth to earth--for ever! How different must have been the feelings of the relatives of the departed, when leaving the body reposing in the tomb, still preserving the form of its mortal coil--still in the world--where all we loved might be visited and spoken to in the language of affection and regret--how different must have been these feelings when compared to those that compress the respiration and check our utterance, after seeing that body separated from us, and leaving a chasm around us deeper still than the grave. We are, however, to seek in this practice other motives. The wisdom of the theocratic government of ancient Egypt was most admirable, and not founded upon mortal affections and dislikes. The sovereign priesthood had to attend to concerns of greater magnitude. The first inhabitants of Egypt, migrating most probably from the upper regions of Ethiopia, had to colonize an unhealthy region, to struggle with swamps and marshes, and destroy myriads of animals, whose decomposition added to the dangers they had to encounter when settling in such an unhealthy land. Pestilence, no doubt, as in after times, frequently desolated the infant kingdom. Their priests, in whose temples were recorded in mystic legends all the science of the age, must have applied their experience and their judgment to meet the evil, and surmount it, were it possible. The ideas of corruption are closely connected with those of putrescency; and putrescency has ever been considered the chief source and focus of pestilential maladies. To avoid corruption and putrescence, then, became one of the most important Hygienic studies; and, like Moses, who had received his early education in Egypt, its priesthood enforced salutary laws as the injunction of the Creator; nor was the task as difficult as it might have proved in a more extensive and more diversified region. The population resided in a land of no very great extent; their climate did not vary according to prominent topographical circumstances; and the produce of the soil, as regarded alimentary substances, admitted of little variety. Thus it became easy to establish salutary institutions to regulate the mode of living of the obedient people, who looked upon the commands of their sainted legislators as dictates from the eternal throne. Impressed with the conviction of the immortality of the soul, the Egyptian priesthood imagined, or, at any rate, endeavoured to persuade the multitude that the immortal part of our being was retained within its earthly house so long as the corporal form could be preserved entire, and if (which is most probable) they believed in the resurrection of the soul either in its human form or that of some other animal, this doctrine may be easily accounted for as founded upon reason, and grateful to the sensitive feelings. A belief in the transmigration of souls naturally led to the desire of retaining them as long as it was possible in their former abodes; and the lines of Virgil-- Animamque sepulchro, Condimus, would seem to warrant this belief amongst the ancients. St. Augustine clearly tells us that the Egyptians did believe in a resurrection. Amongst other prophylactic means to resist epidemic diseases the embalming of the dead must naturally have occurred to the sacred college as one of the most effectual means of checking or preventing contagion. Not only was man submitted to this process, but every animal, domestic or obnoxious, was equally preserved. It may be said, if destruction was rendered a prudent step, why were not these bodies consumed by fire? The reason appears to me obvious. It was necessary to check the consumption of animal food; therefore were various animals considered sacred, and not allowed to be immolated for the use of the multitude; other animals were considered noxious, and as such their use was forbidden. Religion thus stamped them with the irrevocable dye of holiness or corruption. Mystic characters were traced upon their remains. The sanctity of these animals sometimes varied in different districts, and the ibis was venerated where the serpent was disregarded. When we contemplate the thousands of crocodiles in the caverns of Samoun, the myriads of the ibis in the desert of Hermopolis, Antinoë, Memphis,--when we behold even the eggs that were destined to perpetuate their race thus preserved,--had not these animals been thus respected, they would have become the food of the inhabitants, and, both from their abundance and their unwholesome qualities, have added to the frequent scourges that desolated the land. Here again we find that this anomaly was unavoidable: those myriads of animals, from the nature of the climate and the soil would have increased to such numbers as to overrun the land. What was to be done? Had they been considered edible, most unquestionably they would have been devoured as food; it therefore became necessary to destroy and embalm them: this destruction was no doubt inculcated as a religious duty; otherwise, how should we find even to the present day, such numbers of these creatures, preserved through the lapse of ages, with their very eggs,--another proof that even their incubation was checked. Placed between the desolate desert and the sea, numerous must have been the races of animals who sought refuge in this wondrous region; and, as Lagasquie observes, in the Necropolis of Alexandria and Memphis, at Arsinoë, Charaounah, Achmin, Beni-Hacan, Samoun, Hermopolis, Thebes, and in innumerable hypogean monuments, we find the remains of thousands--nay of millions--of ibises, crocodiles, cats, rats, dogs, jackals, wolves, monkeys, serpents, nay, fishes of various kinds. Passalacqua found at Thebes numbers of birds, rats, mice, toads, adders, beetles and flies, all embalmed together. Nay, Herodotus informs us that the animals considered sacred in one city, were held in abhorrence in others, a difference of opinion that not unfrequently occasioned bitter hostilities. Thus the Ombites fought with the Tentyrites on account of the sparrowhawks, and the Cynopolitans waged war with the Oxyrhynchites from disputes about dogs and pikes. These schisms no doubt arose from priestly ambition, each temple claiming its especial shrine of adoration, for whatever might have been the original motive that led to those theological practices, there is no doubt but all these animals were to a certain degree typical of the good and evil propensities of the various deities, as manifested in their several habits, whence they were selected in the symbols and attributes of the sovereign powers. Abbé Banier endeavours to prove that the bull was the symbol of Osiris and Isis, and that these divinities were themselves symbolic of the sun and moon. Thus the worship of the bull, Mnévis and Apis. The inhabitants of Mendes adored the god Pan, and worshipped him under the figure of a goat, and Mercury is represented with the head of a dog, the most intelligent of animals. Thus in time people lost sight of the origin of the worship, and transferred their adoration to the symbols, as many Roman Catholics transfer their worship of the saints to their wooden images. The priesthood of Egypt sought not their power in terror, but in affection and gratitude. They strove to convince the people that they were their true friends and real benefactors; their sole study was their welfare, their greatest pride the nation's prosperity. Gratitude appears to be the sentiment they most sought to inculcate. The serpent was held in veneration, because it destroyed noxious vermin; the ibis was respected from the same motive; the crocodile for the protection it afforded their navigable waters; yet, by one of those strange anomalies that we find in most mythological _reveries_, animals were held sacred, although they constantly destroyed other sacred creatures; and while the crocodile was worshipped, the ichneumons that destroyed its eggs were also entitled to respect. Such was the value of the remains of departed relatives and friends, that their embalmed bodies were often pledged for large sums. The more readily advanced, since their redemption was considered a sacred duty. Thus do we find worldly regulations, bearing the sanctity of a theologic seal. Then again how mighty must have been the hierarchy from whose doctrines emanated the Pharaonic splendour of their stupendous monuments--works of art, that attracted the notice and the admiration of all the civilized part of the globe, whose travellers while they flocked to view their magnificence, were taught to cultivate the sciences and arts, which the priesthood professed, smatterings of which those visiters proudly carried back as a precious gift to their country. Moreover what occupation must have been afforded to the people and to their numerous captives, whom they continually dreaded, from the apprehension that in their constant wars, their prisoners might join their enemies--a circumstance fully proved in Holy Writ, where we find, in Exodus i. 10, that the Hebrews were oppressed, "lest when there falleth out any war, they join also unto our enemies and fight against us." This overwhelming power, most fortunately wise and humane, was maintained by every artifice that ingenuity could devise. Egypt has justly been denominated the _Alma Mater_ of superstition, since we have every reason to suppose, that with much less wisdom and learning, every successive hierarchy has sought by similar means to retain an equal sway. In Egypt this influence must have been amazing, they held the first rank after the sovereign, whom they assisted in the performance of all his public duties, were present in all his councils, and directed his judgment from the lessons which were laid down for his conduct in the sacred records. All the judges and principal officers of state were also selected in the priesthood; their number must also have been very considerable, since we find them classed as chief priests or pontiffs, and inferior priests of various grades belonging to the sacred deities, prophets, judges, hierophants, magistrates, hierogrammats, or sacred scribes; Basilico grammats, or royal scribes; Sphragistæ, whose office it was to examine the victims, and to put a seal of approbation on them before the sacrifice. Hierostoli, who had access to the Adytum, to clothe the statues of the gods; doctors, embalmers; hierophori, or the bearers of sacred emblems; pterophori, or bearers of the fans carried before the gods; præcones, or pastophori, bearers of the holy images, and keepers of the sacred animals; hierolaotomi, or masons of the priestly order, besides innumerable painters, sculptors, sprinklers of holy water, and flappers to drive away the flies. Kings were chiefly selected from the priestly order, and when they had been members of the military class, they were obliged to enter a sacerdotal college before they could ascend the throne; even then, they were only allowed to be attended by the children of families belonging to the priesthood. If such was the influence of priests, that of the priestesses were not the less powerful. The Pellices, or Pallacides of Amun, filled offices of the highest importance, and not unfrequently queens and princesses prided themselves in performing their duties. The subdivision of the female attendants of the temples was also sanctified, and they were chiefly selected in the families of priests. If we are to believe the Grecian accounts, these holy women were not remarkable for their chastity; their indiscretions, however, were confined to their own circle. These assertions, have been by no means general, nor is it probable that a class of men who affected so much purity, and observed such a rigid abstinence to obtain the character of sanctity to which their power was due, would have exposed themselves to the results of such an improvident mode of living. My view of the origin of embalming both men and animals is borne out by another striking circumstance. The moment the practice of embalming the bodies of men and animals ceased in Egypt, pestilence appeared. At the period when Christianity was introduced into Egypt, the new religion had to encounter many obstacles in overcoming the obstinate prejudices of the ancient creed. During the four first centuries of its propagation, the ancient customs were persevered in; at last the cross triumphed and was enthroned, and the practice of embalming was abolished. In 356, St. Anthony, upon his death-bed, anathematised it as sacrilegious; his last injunction according to St. Athanasius, his historian, had such an effect, that an injudicious zeal prevailed in Rome, in Constantinople, and other large cities, and led to the practice of inhuming bodies in churches and cemeteries, notwithstanding the prohibition of the magistracy. While the dead were interred in towns, or their vicinity, in dwelling houses and gardens, the remains of animals were scattered abroad to become part of the soil, and thus this most dangerous innovation hurried on the development of the most dangerous of diseases. In 1542, under Justinian, Egypt was avoided as the focus of pestilence. It would be difficult to point out the exact period when the custom of embalming fell into disuse; but it had ceased to be practised at the time when pestilence burst forth over the land in all its irresistible horrors. The coincidence was too remarkable not to have been noticed. It is certainly true that the plague had visited Egypt at former periods, recorded in holy writ, when we know not to what extent the preparation of mummies might have been carried, although we find that Jacob was embalmed by physicians; but when we consider the topography of Egypt presenting a vast plain exposed to a yearly inundation, its soil preserved for centuries from the admixture of animal substances, but of a sudden changed into a mass of corrupted bodies of men and animals, acted upon by heat and moisture,--when the inhumation of man was neglected, and the offals of beasts and reptiles accumulated in pestilential heaps,--we may easily imagine what a luxuriant field was submitted to the scythe of death. The Egyptians had, no doubt, introduced the practice of embalming the dead from Ethiopia, a country abounding in various gums, which served them to preserve the remains of their relatives. The transparency of these substances had induced some travellers to assert that the bodies were imbedded in glass, like insects found in amber. De Pau, and many other writers, have exposed the absurdity of such a report, since it is more than probable that glass was scarcely, if at all, known amongst them. The Persians enveloped their dead in wax; and the Scythians sewed them up in skins. While the foresight and wisdom of the Egyptian sacerdocy was thus distinguished by Hygienic institutions, their interests were not neglected; and the art of embalming, which they monopolized with every other branch of learning, tended not a little to add to their emoluments. Every dead body was their property. Herodotus tells us, that if the corpse of an Egyptian, or a stranger, was found in the Nile, or cast upon its banks, the priests alone had the power to touch it, and afford it a sepulture. This interesting, although not very veracious author, gives the following account of the process. There are in Egypt a particular class of people whose sole business consists in embalming bodies. When a corpse is shown them, they exhibit models of mummies depicted upon wood. These models are of three kinds, and vary in prices. The bargain being concluded, the embalmers commence their labours. The brains are first extracted through the nose with a crooked iron instrument; an incision is then made in the side of the body with a sharpened Ethiopian stone, through which the viscera are drawn. These are cleansed out, washed in palm wine, and then strewed with pulverized aromatic substances. The abdomen is stuffed with powdered myrrha, cinnamon, and other perfumes, but without incense. After these manipulations, the body is sewn up, and salted with natrum for seventy days. This period elapsed, the corpse is again washed, and swaddled up with rollers of linen, covered with gum, which the Egyptians commonly use instead of glue. The relations, after this operation, carry home the body, and place it in a wooden case resembling the human form; afterwards locking it up in chambers destined for the purpose, and placing it upright against the wall. This is the most expensive process. The next is more economical. Syringes are filled with an unctuous fluid, extracted from the cedar; this liquor is thrown into the body through an incision performed in the side, and is of such a nature that it gradually corrodes and destroys the viscera: after the body has been duly salted, nothing then remains but the bones and skin, which this substance does not affect. Diodorus Siculus gives an account somewhat similar, but adds some curious particulars. The first class of funerals cost a silver talent; the second twenty minæ; and the third scarcely any thing. The embalmers divide their labours into various offices. The first, or the scrivener, points out the part of the body on the left side where the incision is to be made. The next operator is the incisor, who uses for the purpose a sharp Ethiopian pebble; the viscera are then drawn out, with the exception of the heart and kidneys; and the body is then washed with palm wine and aromatics. The corpse is afterwards inuncted with the gum of cedar, and strewed with myrrha, cinnamon, and various spices. It is ultimately returned to the family of the deceased, in such preservation that the eyebrows and eyelids are uninjured, and the countenance preserves the character that distinguished it during life. Porphyrius informs us that the embalmers, after having extracted the intestines, exposed them to the sun, putting up a prayer to that luminary, and declaring that if the deceased had ever been guilty of any act of gluttony, the intestines alone were guilty, and they were therefore cast into the Nile. Plutarch alludes to a similar ceremony. The _incisor_ appears to have been considered a degraded being, for Diodorus tells us, that, after the operation, he was pursued by the relations of the defunct, and pelted with stones, as having polluted the remains of the dead. These accounts of the ancients have been warmly impugned by modern antiquaries, who maintained that the various substances stated to have been made use of in the process of embalming, did not possess the qualities attributed to them,--especially the liquor called _cedria_, drawn from the cedar-tree. Rouyer, a member of the Egyptian commission of sciences and arts, corroborates in a great measure the accounts of ancient historians; and, in a very interesting paper on the subject, we find that the bones of the nose are destroyed in some mummies, but left intact in others,--a circumstance that would lead us to think that on such occasions the brain was left in the cranium. The opening in the side did not appear to have been sewn up, but the lips of the incision merely brought into apposition. He divides mummies into those in which tanno-balsamic substances had been introduced, and those that had merely been salted. The first species were found stuffed either with aromatic resinous substances, or asphaltum and pure bitumen. These resinous substances emitted no odour, but, when cast into the fire, a thick smoke arose, and a strong aroma became evident. The mummies thus preserved were light, dry, and fragile; preserved their teeth, their hair, and eyebrows. Some of them had been gilded all over; in others, the gold had only been applied to the face, the hands, and the feet, and other parts. This practice of gilding was so general, that it does not warrant the belief that it was only the remains of the illustrious and wealthy that were thus ornamented. These mummies, so long as they were kept in a dry place, were unaltered; but were soon decomposed, and emitted an unpleasant effluvium, when exposed to atmospheric moisture. The mummies thus prepared were of an olive colour, while those preserved with bituminous substances were of a reddish tinge; the integuments hard and shining, as if varnished. The features were not altered, and the cavities were filled with a black, hard, and inodorous resinous substance. The ingredients thus employed were similar to the bitumen of Judea; most of them were gilded. Other mummies were found without any lateral incision, when, most probably, the intestines were drawn out through the rectum. These cavities were filled with the substance termed by historians _Pissasphaltos_. In the mummies merely cured with salt, when this ingredient is abundant, the features are obliterated, the surface of the body having been smeared with bitumen. These mummies which of course are the remains of the poorer classes, are the most common. They are heavy, hard, and black, and shed an unpleasant odour. They boast of no gilding; only the palms of the hands, the soles of the feet, and the nails, had frequently been decorated with a red tinge; most probably by the application of the _henne_. These were the mummies which were sold by the Arabs in former times for medicinal purposes. For a further description of the mode of enveloping the bodies and the history of embalming, I must refer to the valuable labours of Mr. Pettigrew.[52] The process of embalming appears to have consisted simply in extracting the viscera, or destroying them by some corrosive injection; dissolving the mucous and fatty matter by the long application of natrum; and, finally, in desiccating the corpse by exposure to air or stoving. Mummies have been also found in the Canary islands, where they were named by the Guanchi _xaxos_. They were light, dry, of a yellow colour, shedding a slight aroma, and carefully enclosed in goat-skins. The operation was also performed with a sharpened Ethiopian stone, called _tabona_. Humboldt found numerous mummies in Mexico, where desiccated bodies have not unfrequently been seen in the open air. Certain soils appear to possess a preservative quality, without any apparent preparation having been made use of. In the catacombs of Bordeaux and Toulouse, these dried bodies may be seen, the hair and eyebrows still intact; but they are dark and shrivelled, and it does not appear that the contents of the cavities had been extracted or heeded, the process of desiccation being general. The miraculous conservation of bodies recorded by Calmet in his History of Vampires was nothing more than instances of a similar preservation. Various experiments have proved that the progress of chemistry has been so great, that we might equal the Egyptians in the preparation of mummies, if ever such an absurd practice were introduced. In the sixteenth and seventeenth centuries mummies formed one of the ordinary drugs found in Apothecaries shops, and as considerable sums were expended in its purchase as had been laid out upon the _besoards_ of various rare animals. It became a lucrative branch of trade to the Jews. The demand not being easily supplied from the vigilance of the Egyptian Government, various frauds were introduced. So powerful were the supposed qualities of mummies, that Francis I. always carried a small parcel of it about him mixed with rhubarb. Lord Bacon tells us that mummy has great force in stanching of blood. Boyle assures us that it is one of the useful medicines commended and given for falls and bruises. The Arabs to this day make use of mummy powder mixed up with bitters. This preparation is called _mantey_, and is esteemed a sovereign remedy for bruises. HYDROPHOBIA. This term has been erroneously applied to the disease arising from the bite of a rabid animal, since many instances are recorded of mad dogs not only drinking freely of water and other fluids, but actually swimming across rivers; while, on the other hand, the horror of water has attended maladies totally unconnected with rabid injuries: Sauvages plainly expresses himself on this subject. "Apud Gallo-provincales, experientiâ, canes lubosque rabidos bibisse, munducasse, flumen transnasse, ut olim Maralogis et bis Forolivii observatum, adeoque nec potum aversari." Dr. James relates the case of a mad dog that drank both milk and water, and swam through a pond. Similar cases are recorded of mankind. This disease was known to the ancients, and the Greek term for rabies was _lyssa_, referred to several times by Homer, when Hector is compared to a mad dog by Teucer and Ulysses. It was also known by the name of _cynolisson_, _phobodipson_, and _hygrophobia_. According to Plutarch, the disease was first observed in the time of Asclepiades. Coelius Aurelianus is the most correct of the ancient writers on the subject. This disease, although it may appear in every climate, is far less common in hot regions than in those of a moderate temperature. In the West Indies it is unknown; nor has it been observed in South America. In Egypt and Syria it has never been seen. Mr. Barrow informs us that at the Cape of Good Hope, and amongst the Caffres, their dogs are exempt from the malady, although constantly fed upon putrid meat. Water-dread has been observed in various rheumatic and inflammatory affections, and frequently arises in a spontaneous manner; while many cases are recorded of the alarming symptoms being witnessed when no rabid bite has been inflicted. Violent passions, both in men and animals, seem to impart a peculiar acrimony to the saliva. Meekren, Wolff, Zacutus Lusitanus, mention fatal cases after the bite of a man in a passionate fit. Le Cat gives a case of death produced by the bite of an enraged duck. Thiermayer gives us two fatal cases of the bite of a hen and a goose, and Camararius has an instance of epilepsy produced by the bite of a horse. Of the cause of this disease we are utterly ignorant: thirst, without the means of quenching it,--the use of putrid food,--sultry weather, have been considered as producing the fearful disorder; but no one instance is recorded that can justify the opinion. The streets of Lisbon are crowded with dogs, feeding upon disgusting offal, under a burning sky, yet rabies is scarcely ever observed among them. It is more probable that certain mental emotions, such as anger and fear, have a peculiar influence on the animal. All the aggregate symptoms of the disease show that the nervous system is disturbed; and the singular effect of confidence in the treatment of persons bitten by a rabid animal, confirms the fact. This is further proved by many cases of hydrophobia unconnected with rabid bites. Marcel Donat relates the case of a woman who complained of pains in the neck and right arm, with constant trembling. In three days the pain ceased, but the tremor continued; a sense of suffocation followed, which was attended with a horror of water and every liquid, although the throat was burning. In five days she died in excruciating agonies, but preserving her senses until the last. Koehler saw a young soldier, who, having fallen asleep against a stove, was suddenly awakened with a sensation of intense thirst, which he quenched with a draught of cold water. Hydrophobia immediately ensued, and the next day terminated his existence. Selig relates the case of a man at Neukirchen, who was attacked with all the alarming symptoms of this malady after having laboured in the fields on a very hot day, and bathed in the river. The following day he was affected with violent rheumatic pains, which shortly ushered in an intolerance of fluids, and inability of swallowing. In the course of twenty-four hours he expired. It appeared upon inquiry that a year before he had purchased from the hangman of the town some dog's grease, to rub himself to relieve some troublesome affection; and it was stated that the dog had been killed by a gamekeeper, who suspected him of being mad. Cases of plague have been attended with water-dread. Lalius Diversus saw a woman labouring under the epidemic, who was thrown into agonies when she even saw other persons drinking. Sarcotius, in his history of the epidemic diseases of Naples, informs us that the fever was invariably attended with hydrophobic symptoms. The fever that prevailed at Breslau in 1719, presented the same peculiarity. Various venene substances have also been known to give rise to this disease. Professor Brera, of Pavia, witnessed it after the use of stramonium. Rancid oils have caused similar accidents. In regard to the causes that produced madness in dogs, numerous experiments have been made, particularly in the Veterinary School of Alfort: one dog was fed with salted meat, and totally restrained from drinking; another was allowed nothing but water; and the third was not allowed food or drink of any kind. The first died on the forty-first day; the second on the thirty-third; and the third on the twenty-fifth; not one of them evincing any symptoms of rabies. It appears that a peculiar predisposition renders some individuals more subject to the accidents that follow the bite of rabid animals than others. Mr. Hunter gives an instance in which, out of twenty persons who were bitten by the same dog, only one received the disease. It appears, however, that this virus is less volatile than most others, and is capable of remaining in a dormant state for a very long period; and if we are to give credence to many reports on the subject, it may linger in the system for several years. At other times, its destructive nature has proved immediately injurious. Heisler has given a case where a man was affected by merely putting into his mouth the cord by which the mad dog had been confined. Palmarius relates the case of a peasant, who, in the last stage of the disease, communicated it to his children by kissing them. It has, however, been clearly demonstrated, that inoculation of rabid saliva does not propagate the distemper. Experiments were made both by Magendie and Breschet in 1813. In 1800, when a dresser in the Hôtel Dieu of Paris, I witnessed several experiments of the kind, and with similar results. At the same period, I had occasion to observe the effect of imagination in many cases. Several persons had been bitten by a rabid dog in the Faubourg St. Antoine, and three of them had died in our wards; a report, however, was prevalent that we kept a mixture that would effectually prevent these accidents; no less than six applicants were served with a draught of coloured water, and in no one instance did any accident ensue. The period of the development of the accidents after the bite in animals is various. According to Meynall, the disease appears amongst dogs from ten days to eight months after the injury. In the hounds of Earl Fitzwilliam, who were bitten in June 1791, the intervals varied from six weeks to six months. Dr. James made a similar observation in Mr. Floyer's pack. No malady has been submitted to more curious and fearful modes of treatment than hydrophobia; and in many cases such has been the dread of the disease, that patients have been smothered or drowned. Dioscorides seared the wound with irons heated to whiteness; other practitioners first excised the wounded part, and then applied fire or caustic. While fire was resorted to by some practitioners, water was recommended by others, and submersion in a river or a pond has frequently been urged as an effectual remedy. In the time of Celsus, the miserable sufferer was thrown without any warning into a fishpond, alternately plunging his head under water and raising it: when the poor wretch could swim, he was forcibly kept immersed until filled with water. After this experiment, which Celsus terms the _unicum remedium_, for fear that the patient might be attacked with convulsions, he was taken out of the pond, and soused in warm oil. Van Helmont recommended that the poor devil should be kept under water while the psalm _Miserere_ was sung, and most probably the terrified choristers were not expeditious in their performance. Morin relates the case of a young woman, twenty years old, who was plunged in a tub of water, with a bushel of salt dissolved in it, and dipped repeatedly, until she became insensible; however, much to the surprise of the bystanders, who thought her dead, she recovered, and could not only look upon water, but was able to drink it. Bleeding nearly to death, mercury, cantharides, and various medicines, have been also called into aid; but none have appeared to prove effectual in curing this dreadful disorder. One of the most singular modes of treatment was the introduction of rabid blood into the system of the patient,--in fact, a homoeopathic plan of Dr. Rithmeister of Powlowsk, in Finland, who has recorded several cases to prove that the blood of a rabid animal, when drunk, is a specific against canine hydrophobia. The doctor communicates a letter from Dr. Stockmann, a Russian physician, stating this practice to be both common and effectual in White Russia. With a view of producing a fresh poisonous action that might neutralize the former one, it has also been proposed that a venomous serpent should be made to inflict a wound under the bite of the mad dog. I do not believe that this experiment has ever been tried; and, as Good observes, the claim of ingenuity is, most probably, the only one it will ever have to receive. This fatal disease is enveloped in so much darkness, both as regards its causes and its treatment, that it may well be considered one of the opprobriums of the profession. The experiments of my late friend Sir David Barry are, however, of great importance; and in many cases of poisonous wounds, the application of cupping-glasses has been followed by evident favourable results. To ascertain the existence of rabies in animals, more especially in dogs, is a matter of great importance, as being frequently the source of moral depression or of sanguine hope, that may tend to increase or diminish the severity of the accidents. One may apprehend madness in a dog when we see the animal dull, and seeking solitude and darkness, his sleep disturbed, and when awakened refusing food or drink. Its head droops, the tail hangs between the legs. The animal soon quits the abode of his master, the mouth secreting a viscid foam, the tongue pendulous and dry, the eyes bright and sparkling. His gait soon becomes uncertain; now precipitate, then slow and undecided. Impatient, and parched with a burning thirst, he cannot rest; and the sight of any fluid occasions an instinctive shudder. The rabid symptoms now become more violent; the animal will attack and bite other dogs, although much superior in strength. It is asserted that dogs avoid him with terror. On these occasions the fury of the animal is not to be controlled; all ties of attachment are dissolved; and his master is but too frequently the first victim of his indiscriminate rage. Hence the absurd popular notion that mad dogs inflict their first bite on those to whom they are attached,--a circumstance that simply can be attributed to the natural endeavours of a master to check the violence of a domestic creature whom he generally can control. Mad dogs seldom bark, but express their angry uneasiness with a growl, which gradually becomes weaker, until the animal staggers, droops, and dies. Yet as there may exist many maladies amongst animals in which these symptoms are observed, to destroy them, as is usually the case, is a most absurd practice, since the individuals whom they may have bitten will sink into a fatal despondency; whereas, by allowing them to live, if they recover, it is evident that the patient will be easily persuaded that the dog was not in a rabid state. The following cases, recorded by Dr. Perceval, are curious instances of the dormant state of this fearful virus, the effects of which are accidentally developed. A wine-porter was labouring under a low fever; after a time appeared some symptoms of hydrophobia, and much inquiry elicited the recollection of his having been slightly bitten by a dog six weeks before. In the interval he was convicted of some fraudulent practice in the cellar of his master, to whom he owed great obligation, and was dismissed with disgrace. Anxiety on this event seemed to produce the fever, which terminated in rabies. Lately an officer was bitten by a dog, whose madness being recognised, the bitten part was excised immediately: after an undisturbed interval of two months, he was advised to go to England to dissipate the recollection of the accident. There he exercised himself violently in hewing wood, felt pain in the hand which had been bitten, embarked for Ireland, had symptoms of hydrophobia on board the packet, and died soon after his arrival. From the varying period of attack, we might infer that the influence of occasional causes is very considerable. In the last patient, hydrophobia supervened exactly five weeks from the time of the bite: he lost one hundred and twenty ounces of blood in twelve hours, which sunk him much; violent perspiration, and at length delirium, attended the water-dread; during the last twenty-four hours he swallowed, and recovered his senses; and died slightly convulsed, whilst cutting an egg. These cases seem to point out agitation of mind and feverish excitation as powerful occasional causes. Herman Strahl has recently related the following case of rabies in which the dog that had bitten the patient was not mad. In the month of January, 1833, an innkeeper was taken ill. The doctor found him dressed, and stretched upon his bed. He did not complain of any particular ailment, but loathed all food. He at last admitted that he experienced some difficulty in swallowing; and his mother having offered him a cup of tea, he refused it with a sense of horror, and his countenance immediately assumed a character of ferocity that terrified the bystanders. An apple having been given to him, he ate it without repugnance. It was now discovered that, five weeks before, he had been bitten by a dog he was training; and the wound was slow in healing. The dog was sought, and did not show the slightest sign of disease,--barking, playing, and drinking freely. In the evening the patient's case was aggravated; and it was with the utmost difficulty that he was made to swallow a spoonful of ptisan. The next day he was seized with a violent attack of rabies: seeing one of his sisters drinking, he fell into a furious rage, dashed a looking-glass to pieces, and entreated his relatives to withdraw, as he otherwise would inevitably bite them. This outrageous paroxysm lasted half an hour; at its expiration he fell into a tranquil sleep. But at night he was seized with another attack; and he began to howl and imitate the barking of a dog, and commenced breaking every thing in the room of a shining appearance. His sisters fled in dismay; but he seized his mother, a woman of sixty-five years of age, cast her on the ground, and bit her in the cheek. After this desperate act, he seemed to be struck with a conviction of what he had done, and became more tranquil; but, half an hour after, on entering his chamber, he was found dead, his head under the bedclothes. His mother did not experience any accidents from the injury. It is singular that, in this miserable condition, the patients will frequently show singular partialities; and, although repulsing any fluid offered to them by some individuals, will take it from others, and attempt, however vainly, to drink. In the Hôtel Dieu of Paris, a young girl, affected with hydrophobia, would only take a cup of ptisan from me; but with looks of inexpressible anxiety returned it to me, after having struggled to moisten her burning lips. At Boulogne, a postilion, bitten by a mad dog, was violent with every one but one of my nephews: from him he also accepted drink, although unable to swallow it; before dying in excruciating agonies, he repeatedly asked for him, and begged that he might be sent for. He would not allow, even in his last moments, any other person to come near him;--another striking instance of that unknown power of sympathy to which I have frequently alluded in the preceding pages. ON THE RISE AND PROGRESS OF THE SCIENCE OF MEDICINE. In a former paper I have given a sketch of the progress of the Chirurgical profession, relating the many difficulties its members had to encounter in their endeavours to attain that degree of perfection to which surgery has risen; a perfection which we have every reason to believe will still continue to be improved by the daily discoveries of the Physiologist, whose labours may be considered the theoretical guide of the practitioner. The history of medicine is equally fraught with much interest, since its being a science more or less conjectural, it has opened a vast career to the speculative mind, and a wide field for the ambitious. Having been long considered a divine inspiration, priesthood in every age considered this science an attribute of their vocation, adding to their spiritual and temporal power. In a rude state of society it is more than probable that the art of curing diseases, as well as that of healing injuries, did not constitute a special profession, but was practised indiscriminately by all persons whose experience and position in the midst of their uncivilized kinsfolks, gave some weight and importance to their advice. Warriors attended their wounded companions in arms. Parents sought to relieve their offspring, and children endeavoured to alleviate the sufferings of their aged and infirm sires. Thus, I may say, was the art of healing instinctively taught, and not unfrequently the brute creation guided the efforts of humanity; when man contemplated the means animals resorted to when labouring under disease. Plutarch affirms that it is to these instinctive efforts of animals that we are indebted for the knowledge of the various properties of plants. The wild goats of Crete pointed out the use of the _Dictamus_ and vulnerary herbs--dogs when indisposed sought the _Triticum repens_, and the same animal taught to the Egyptians the use of purgatives constituting the treatment called _Syrmaïsm_. The hippopotamus introduced the practice of bleeding, and it is affirmed that the employment of enemata was shown by the ibis. Sheep with worms in their liver were seen seeking saline substances, and cattle affected with dropsy anxiously looked for chalybeate waters. This study might therefore have been called an instinctive school. Herodotus tells us that the Babylonians and Chaldeans had no physicians, and in cases of sickness the patient was carried out and exposed on the highway, that any persons passing by who had been affected in a similar manner, might give some information regarding the means that had afforded them relief. Shortly, these observations of cures were suspended in the temples of the gods, and we find that in Egypt the walls of their sanctuaries were covered with records of this description. The priests of these shrines soon considered these treasures as their property, and turned their possession to a good account. Amongst the Hebrews we find that the Levites were considered as the only persons who could cure leprosy, and the practice of medicine became their province. The priests of Greece adopted the same practice, and some of the tablets suspended in their temples are of a curious character which will illustrate the custom. The following votive memorials are given by Gurter: "Some days back, a certain Caius, who was blind, learned from an oracle, that he should repair to the temple, put up his fervent prayers, cross the sanctuary from right to left, place five fingers on the altar, then raise his hand and cover his eyes. He obeyed, and instantly his sight was restored amidst the loud acclamations of the multitude. These signs of the omnipotence of the gods were shown in the reign of Antoninus." "A blind soldier named Valerius Apes, having consulted the oracle, was informed that he should mix the blood of a white cock with honey, to make up an ointment to be applied to his eyes, for three consecutive days: he received his sight and returned public thanks to the gods." "Julian appeared lost beyond all hope, from a spitting of blood. The god ordered him to take from the altar some seeds of the pine, and to mix them with honey, of which mixture he was to eat for three days. He was saved, and came to thank the gods in presence of the people." The _Ex volos_ of modern times suspended at the altars of saints in Catholic churches, are similar testimonials of superstitious credulity, and priestly fraud, and constitute a lucrative branch of business, more particularly to waxchandlers, who fabricate simulacra of every organ or member of the body that may be diseased. Such was the study and practice of medicine, until the days of Hippocrates, justly named the father of medicine. But even this great man in his study of the problematic science, attributed to divine influence all that could not be comprehended and explained, giving the appellation of sacred, to that which appeared prodigious and inexplicable. This divine influence which was considered as invincible, setting at nought all human speculation and mortal efforts, he denominated the [Greek: to theion] the _Divinum quid_, he also fancied that the principle of fire was the source of all animation; for the which opinion, more modern writers pronounced him an atheist, amongst other bigots, who thus accused him, we find Gundling and Drelincourt, and even Mosheim; while on the other hand, Will Schmidt, Fabricius, and Bellunensi have sought to reconcile his doctrine with the scriptures; and so far from this accusation being founded, it is well known that Hippocrates had such an implicit belief in the power of the gods, that he got himself initiated in the Eleusinian mysteries at Athens. We find in his Prænotum the following singular passage: "Nevertheless, there does exist in all diseases something of a divine nature, and the physician who is able to foresee their results, must be admired for his judgment." This divine _something_, has been the subject of much research and angry disputation. Galen considered it to reside in the atmosphere. Fernel considered it the principle of putrefaction and disorganization. Mercuriali placed it in sideral influence, while Professor Martianus maintained that Hippocrates had a firm belief in demons and malevolent spirits. It would be endless to recount all the idle disquisitions on this matter, which have too frequently converted universities into Pandemoniums. The earliest teachers of medicine were the philosophers, amongst whom we must remark Pythagoras, who founded the school of Crotona, where assuming the sanctity of the priesthood he obtained such an authority over his disciples, that it gave rise to the common expression of _jurare in verba magistri_. This truly wonderful man had learnt in Egypt the secret symbolic mode of writing of the priests, and he certainly did apply his extensive acquirements to the welfare of his country and the benefit of mankind; according at least to his views of the subject, which we have every reason to believe were conscientious. From his youth, when he bore away the prize in the Olympic games, his lofty ambition, which scarcely knew any bounds, constantly urged him on in a career of perfection in every branch of learning, which ultimately placed him on the highest ground that ever philosopher attained. After Pythagoras, we find medicine taught by Anaxagoras, Democritus, Heraclitus; but Hippocrates was justly considered the father of medicine, and deserved the name of _great_--every line of his immortal works breathes a deep knowledge of the phenomena of nature, and an ardent desire to release the most important of all human sciences from the degrading trammels of ignorance and imposture. Nothing can afford a more convincing proof of the purity of his motives, and the integrity of his principles than the formula of the oath which he exacted from his disciples, and which runs as follows: "I swear by Apollo, by Esculapius, by Hygeia, and all the gods, to fulfil religiously the solemn promise which I now do make. "I will honour as my father, the master who shall teach me the art of healing, and convince him of my gratitude, by endeavouring to minister to all his necessities. I will consider his children as my own, and will gratuitously teach them my profession should they express a desire to follow it. "I shall act in a similar manner to all my brethren who are bound by a similar engagement, but shall not admit any other to my lessons, my discourses, or the exercises of my profession. "I shall prescribe to my patients, such a course of regimen as I may consider best suited to their condition, according to the best of my judgment and capacity, seeking to preserve them from any thing that might prove injurious. "No inducement shall ever lead me to administer poison, nor shall I ever give a criminal advice, or contribute to an abortion. "My sole end shall be to relieve and cure my patients, to render myself worthy of their confidence, and not to expose myself, even to the suspicion of having abused this influence, more especially when a woman is in the case. "I shall seek to maintain religiously both the integrity of my conduct, and the honour of my art. "I will not operate for the stone, but leave that operation to those who cultivate it. "To whatever dwelling I may be called, I shall cross its threshold with the sole view of succouring the sick, abstaining from all injurious views and corruption, especially from any immodest action. "If during my attendance, or even after a recovery, I happen to become acquainted with any circumstances of the patient's life which should not be revealed, I shall consider this knowledge a profound secret, and observe on the subject a religious silence. "May I as a rigid observer of this my oath, reap the fruit of my labours, enjoy a happy life, and obtain general esteem--should I become a perjurer, may the reverse be my lot." At this period the physician who founded a school taught every branch of the science, and after examining his disciples, gave them a permission to practise the profession when properly qualified. Hippocrates was succeeded by his sons Thessalus and Draco. The school of Hippocrates was followed by that of Plato who founded the dogmatic sect, but his speculative views were succeeded by the more sound doctrines of Aristotle, who was one of the first philosophers who applied himself to practical anatomy in the frequent dissections of various animals, and he struck out the important path which his successor Herophilus was fortunate enough to follow for the welfare of mankind, by submitting human bodies to the scrutinizing scalpel under the protection of Ptolemy Lagus, a protection which became the more necessary as he had been actually accused of having dissected living subjects. Tertullian affirms that he had thus sacrificed six hundred victims; but what faith can we place in such an absurd charge, which very probably arose from envy or prejudice; although his successor Erasistratus, was accused of a similar offence, and in more modern times Mondini, who was the first to reintroduce human dissections was exposed to a like charge. It was Herophilus who founded the celebrated school of Alexandria, where under the auspices of Ptolemy Philadelphus, Erasistratus succeeded him, followed by Strabo of Berytus, Strabo of Lampsacus, Lycon of Troas, Apollonius of Memphis, and many other distinguished philosophers. It was at this period that physicians began to practise surgery, which was first taught with great repute in the Alexandrian school, and where Ammonicus and Sostrates, surnamed the lythotomists, first distinguished themselves by this important operation. While the science of medicine thus flourished in Greece and Egypt it was scarcely known in Rome, where the first physician who ventured to practise was Archagathus from Peloponnesus. At first the bold adventurer was favourably received, but his operations having shocked a people who constantly glutted their eyes in scenes of horror, and who beheld the blood of gladiators flowing in their arena or streaming under the lictors axe! the imprudent practitioner was stoned to death by the populace, and a hundred and fifty years elapsed ere another physician could be induced to visit the ungrateful country, nor was it until the time of Pompey and of Cæsar that any medical men dared to visit the "eternal city." The first of these was Asclepiades, who commenced by giving lessons of rhetoric, which were succeeded by lectures on physic, in the first school of medicine which he founded in Rome. It was on these benches that Aufidius and Nico, Artonius and Niceratus were initiated in the art of healing, while Asclepiades formed his celebrated disciple Themison founder of the sect of the Methodists or Solidists. To this school are we also indebted for the learned Celsus justly called the _Cicero of medicine_. Under Trajan and Adrian the medical profession had attained great celebrity and splendour, and under M. Antoninus, and Marcus Aurelius the world became indebted to the glorious labours of Galen--but the bright days of the healing art were sinking with the star of Rome in the dark horizon of barbarism, and the works of these illustrious masters were sacrificed at the shrine of astrology, magic, and Eastern theosophy. From this period we find Eastern superstitions mingled with the early practices and creed of Christianity, when, to use the words of Sprengel, "An allegorical explanation of words and even of the scriptures, was carried so far by the Jews that it was considered the utmost perfection of human learning. The essence of every science, and the only method of obtaining, without laborious studies, and in a state of idle contemplation, a degree of wisdom beyond the reach of all other mortals. It is thus that during the first century of our era the science of Cabala arose, a tissue of all the chimeras of Zoroaster, Pythagoras, and the Jews, and which in time, to the shame of human intellect, invaded the domain of learning, and became closely connected with medicine." In the commencement of the second century of the church, Acibba published a work called _Jezirach_, and Cimeon-Ben-Ischai wrote his book entitled _Sohan_, in which their cabalistic labours sought to prove, that there existed a supreme being from whom emanated ten angels, who formed the first world, in which resided three personified abstractions--knowledge, intelligence, and wisdom.--Besides this first or primitive world, there existed three others moving in concentric circles--the world created, the world formed, and the world constructed! So united, so constructed, that whatever might happen in the last of these worlds had already existed in imagination in the first. From this theory it was maintained that the practice of physic was to call into action all the powers of the superior worlds; a problem that could only be solved by a cabalistic physician, who by his piety and contemplation had succeeded in rendering himself worthy of a communication with celestial agency. Facts and observations recorded by long experience were now considered useless and contemptible _data_, and all terrestrial knowledge despised. Anatomy was deemed worse than useless, and the established doctrines of various schools a dead letter. Chaldean, Phoenician, Hebrew words with mystic significations were introduced as symbolic illustrations of science: no language that could be understood, was deemed intelligible, and any system that could bear the test of reason was denounced as impious. Thus was the career opened to the craft of priests boundless. It had been believed that the apostles were gifted with the power of healing by the mere apposition of their hands, and their self-named descendants pretended to possess the same divine attributes--and not only beatified monks cured with various oils and ointments; but their very mortal remains, became precious in the hands of their monastic successors. When their mouldering bones had been sold wholesale and retail as precious relics, their very sepulchres and their shadows brought hosts of pilgrims to herd round their shrines. The study of medicine destroyed with the glories of Rome, was revived in Egypt, where Zeno of Cyprus delivered courses of lectures at Alexandria, a school which soon after dwindled into decay, sinking into obscurity with the once famed academies of Greece. The Roman empire dismembered, Persia became an asylum for fugitive philosophy, and the Nestorians founded a medical school at Edessa in Mesopotamia, while other sectarians equally oppressed by ostensible orthodoxy, sought a refuge in the city of Dschondi-Sabour, where numbers of Persian and Arabian students flocked to learn their doctrines, and thus we have the origin of the celebrated school of Bagdad under the protection of their caliphs. This regeneration of science was soon communicated to the shores of Europe, and the Caliph Alhakam founded a school at Cordova possessing upwards of 300,000 volumes, and Seville, Toledo, Saragossa, and Coimbra followed the bright example. Thus was a science, banished from Europe by bigoted and misguided Christians, restored to its former seat by Mohammedans. The progress of the science of medicine under the Moorish government was so rapid in Spain, that we find one hundred and fifty medical writers in the schools of Cordova, and sixty-two in Murcia. While the Moors thus encouraged these important studies, the priests in the western states kept the nations under their control in a state of dense ignorance, and the practice of medicine such as it was, was confined within the cloisters of monasteries and nunneries. There does still exist a treatise of medicine written by Hildegarde, Abbess of a convent at Rupertsberg. Monks opened medical schools in several cathedrals, and we find Gregory I. sending one of these medical propagators to Canterbury, where Theodore, one of its archbishops, practised the healing art. While the study of medicine had become a privilege of ignorant friars, it was destined to assume a semblance of learning in Italy, where some intelligent Benedictines founded a school at Salerno. Here the works of the Greeks, and Romans, and Arabian physicians were once more brought to light, and in the eighth century we find Salerno crowded with students, pilgrims, and invalids. In the eleventh century, this school had obtained a pre-eminence over every other medical institution, and at the period of the crusades its fame was universal--not that the ignorant and barbarous crusaders were capable of shedding any light on the improvement of their several countries from what they might have learned in Holy Land, but many of them who had happily returned to Europe, and been landed in the kingdom of Naples, were cured of their wounds and infirmities by these Benedictine doctors, who themselves owed much of their erudition to an African of the name of Constantine, who had studied at the school of Bagdad, and translated for the monks, who had offered him an asylum, Greek, Latin, and Arabian works, which to them were sealed volumes. Amongst the celebrated adventurers of rank who had escaped from the holy wars, was Robert, son of William the Conqueror, who was cured at Salerno of a supposed incurable wound in the arm. In this manner was the fame of the Salernian school spread far and nigh, and soon Ferdinand II. founded universities at Naples and Messina. The course of studies in the school of Salerno was three years of logic, and five years of medicine and surgery. At the expiration of these sessions, the student was admitted to examination, and after having passed, was still obliged to practise for another year under the immediate eye of an experienced physician. It was only upon his certificate as to his professional capacities, that a licence to practise was granted, upon his engaging himself by oaths, to observe the laws of the college, to attend the poor gratuitously, and to report to the magistracy all apothecaries that adulterated their drugs or neglected the proper preparation of medicines prescribed. The custom of granting academic dignities may be traced to the Nestorians and the Jewish professors in the East, where it was carried into the Moorish possessions in Spain. The school of Salerno was the first collegiate body that adopted it in the western Christian institutions. The degree they conferred was that of _Magister_. Previous to the granting of this distinction seven years study were required, and the candidate was to be upwards of one-and-twenty years of age. He had to explain in a public meeting the _Articella_ of Galen--a passage of the _Aphorisms_ of Hippocrates, and of the first book of Avicenna, after which he was examined in the works of Aristotle, he then received the degree of _Magister Artium et Physices_. It was only the professors who bore the title of Doctors. In this manner did the science of medicine struggle for several centuries with obstacles that appeared insurmountable--in turn practised and persecuted--anathematized by the clergy, and soon after becoming a lucrative privilege of the church--prejudice, superstition, and ignorance had closed anatomical theatres, and from the days when flourished the school of Herophilus until the fourteenth century, the dissection of animals was alone permitted, and it was only by stealth that the student sought some knowledge of the human structure, from mouldering bones purloined from the cemetery. A brighter era arose in the year 1315, when Mondini de Luzzi, Professor of Anatomy at Bologna, ventured to dissect human bodies--a bold attempt, as seventeen centuries had elapsed since this investigation of the book of nature, the only record where errors can be detected and truth sought for, had been prohibited. The example of Mondini, who had written a practical anatomical manual was followed in various other schools, but a barber was the person charged with the opening of the subjects, and with no other instrument then his razor he endeavoured to demonstrate the parts which Mondini's work described. From this period we may date the revival of medicine, although in the following century it made but little progress, still clogged by astrological absurdities and Arabic errors--and a Florentine physician, Marcillo Ficin, obtained a high repute by promulgating the doctrine that the vital spirits of man were similar to the ether which filled space and directed the planets; concluding that if man could obtain this ethereal principle he might prolong his days beyond human conception, he recommended the use of preparations of gold to obtain longevity and even advised the aged to drink youthful blood to prolong their precarious life. These absurdities were refuted by Chancellor Gerson, and the faculty of Paris condemned the Florentine's visions as diabolical and perilous--but what could have been the facilities offered at that time for the study of anatomy when we find Professor Montagnana, of Padua, boasting of having examined _fourteen_ subjects. However the fifteenth century was destined to witness a remarkable event in the annals of medical learning, Emmanuel Chrysolore, embassador of Emmanuel Paleologus, arrived in Italy, to solicit means from the Christian powers against the inroads of the Turks. Chrysolore, during a protracted residence at Venice, employed the leisure which his diplomatic occupations left him to deliver lectures on various branches of science, and not only did he encourage the study of the Greek language, but corrected the many errors that teamed in the Arabic translation of classic works. It was to this learned man that the succeeding century were indebted for their knowledge of the works of Hippocrates, and we find that his doctrine formed the groundwork of medical studies over Europe. But the study of the phenomena of nature founded on experience and observation was not sufficiently visionary and mystic, and soon we see cabalistic calculation and judicial astrology again subverting all doctrines that might lead to sound conclusions. Cornelius Agrippa of Cologne traversed the fairest cities of Europe, to expound the philosophy of Zamolxis and Abaris; maintaining that every Hebrew character had a natural signification, the Hebrew being, according to his ideas, not only the most ancient but a sacred language. He asserted that the language of demons was the Hebraic, and that all Hebrew letters being either favourable or hostile to these evil spirits, they might be conjured by a proper knowledge of their powers. This visionary not only fancied that letters possessed this influence, but that it was shared by numbers. Thus to cure a tertian fever he directs the use of Verbena, to be cut at the third articulation of the plant; but in the treatment of a quartern, the disease would only yield to the fourth joints. He added that every man was under the influence of three demons--a sacred demon (a divine gift)--an innate demon--and a professional demon, sent us by the constellations and the celestial intelligences. These reveries, however, were interrupted by the still greater absurdities of Paracelsus, a man whose ignorance could only be equalled by his vanity, since he maintained that as the genius of Greece had produced Hippocrates, the genius of Germany had created him for the salvation of mankind. He further assured his disciples that all the universities in the world had less knowledge than his beard, and that every hair of his head was more learned than all their writers. Paracelsus was perhaps one of the most singular enthusiasts that ever swayed the schools of medicine, or assumed a despotic stand in science. To superstition, credulity, and disreputable living, he certainly did add a certain degree of genius, but more particularly a _tact_ which established such a reputation, that, without much presumption, he might have claimed the title which he assumed, of "_Prince of Medicine_," to which he added the pompous appellation of _Aureolus, Philippus, Paracelsus Theophrastus Bombastus ab Hoppenheim_. This strange personage was born in 1493, at Einsidlen, a village near Zurich; he studied under Fugger Schwartz, a celebrated professor of what was then called the _Spagyristic_ school, or _Hermetic Medicine_, founded on a visionary doctrine that I shall shortly notice. He subsequently travelled over the greater part of Europe, chiefly courting a motley society of physicians, philosophers, old women, and barbers, culling all that he could from pretended science or unblushing ignorance. After having visited the German mines, where he became tainted with the superstition of the credulous workmen, he repaired to Russia, when he was made prisoner by a party of Tartars, who conducted him to their Cham. Taken into favour by their chief, he accompanied his son to Constantinople, where he pretended to have discovered the philosopher's stone. On his return to his native country, the magistrates of Bale appointed him to the chair of medicine; and in 1527 we find him delivering a course of lectures in the German tongue, being but an indifferent scholar. This sedentary life did not suit his roving habits; and being, moreover, likely to bring his ignorance into its proper light, he set out for Alsace with another enthusiast of the name of Oporinus, with whom however he shortly quarrelled. He continued to wander from town to town, scarcely ever sleeping, or changing his linen, clad in the most slovenly manner, and generally in a state of intoxication, until at Saltzburg in 1541 he was taken ill at a miserable inn and died in the 48th year of his busy life. He no doubt had obtained during his adventurous career much experience, having for a long time followed armies and attended at sieges, and during epidemic maladies; but he sought to disguise his want of a proper education by the assumption of a supernatural influence. One of his wildest flights of fancy was, perhaps, his receipt to make a man without conjunction. His doctrines were founded upon Judicial Astrology, Alchymy, Cabal, and Chemistry. Grossly ignorant in the last science, he pretended that all our diseases depended upon its combinations,--the combustion of sulphur, the effervescence of saline particles, and the coagulation and stagnation of mercury in our humours: all under the influence of the _Ens Astrorum_, the _Ens Deale_, the _Ens Spirituale_, the _Ens Veneni_, and the _Ens Naturale_. _Mercury_ was evacuated through the pores of the skin; _sulphur_ emanated from the nostrils; _deliquescent sulphur_ was discharged by the intestines; a _watery solution of sulphur_ arose from the eyes, while _arsenic_ oozed out of the ears. When these evacuations did not take place, the humour became putrid, and putrescency was _Localiter_ or _Emunctor labiter_--as the humours were either retained or excreted. This humoral doctrine of Paracelsus, strange to say, obtained for upwards of a century, and many were the learned men who distracted their brains and that of their disciples to multiply his errors, since we find Sanctorius calculates 90,000 morbid alterations in these peccant humours. In another part of this work, I have related the absurdities of Van Helmont, another visionary of the seventeenth century. Endless would be the task of recording the many systems and doctrines that have in turn ruled the schools of medicine, and been supported both by professors and disciples with a degree of virulent hostility as implacable as religious controversies; and still, while we read with contempt the absurd doctrines of our forefathers, and smile at the folly of their visions, we ourselves are advocating systems which, after a lapse of some few years, will appear just as ridiculous and preposterous to our successors in the doubtful career. One question naturally arises from all this controversial discrepance--has society benefited by the successive revolutions which have overthrown schools and doctrines, chairs and professors? have the advocates of Sangradian phlebotomy, and those who considered that the lancet has committed greater havoc than the sword--have the employers of antimony, and those who would have sent to the scaffold opponents who gave an antimonial preparation--have either of these enthusiasts diminished, in any sensible manner, the scale of mortality, or have they influenced the prevalence of disease? This is a most important question, and, however ungracious may be the task, I shall endeavour to consider it. It is but too true, that, with the exception of the introduction of inoculation and the cowpox, the bills of mortality do not appear, at any period, to have been influenced by the prevalence of any one medical system. This circumstance, however, cannot be admitted as invalidating the claims of medical men to a due consideration of their respective merits. I have endeavoured to show, in a preceding article, that the laws of nature appear to have regulated the equilibrium of life and death and the progress of disease with such harmony, indeed, that we might say that our existence was regulated with arithmetical accuracy. If this is admitted, it might be alleged, that if such be our fated tenure of life, recourse to medical aid becomes useless, and the efforts of physicians must prove effete. Such a deduction would be fatalism in its most absurd form; for, admitting that our days are thus numbered, the human frame may be assailed by many ailments, that may not prove fatal, but admit of relief, if they cannot be cured. It is, therefore, obvious, that the services of a physician are of great value, if he merely can alleviate our sufferings, and render a painful existence tolerable. Daily facts corroborate this assertion, and the most cruel pangs are constantly relieved by professional aid, although it is not equally evident that the same skill can prolong the patient's life, if "his hour is come;" but, as we know not when that fatal moment may strike, we must clearly seek to wind up the marvellous machinery, and keep it "going" as long as we can. We constantly behold individuals whose existence is most precarious, and yet who linger on for years, frequently to the disappointment of expectant heirs; for there is much truth in the old saying concerning those invalids who are considered to "have one foot in the grave," they find _that foot_ so very uncomfortable, that they hesitate for a long time ere they thrust in its fellow. There is little doubt but that much mischief has been done by ignorant men, yet, perhaps, if the truth were known, more vital injury has been inflicted on mankind by enthusiastic science--ignorance gropes its way, so long, at least, as modesty allows to doubt; but, so soon as presumption leads the way, then ignorance assumes dogmatic assurance, and places the hardy practitioner on the same line as presumptive science--or, at least, what is considered such. It is then that enthusiasm, combined with interested motives, seeks to maintain an acquired influence by experimental proofs of supremacy; and, as it has been truly said, "There is no writ of error in the grave," mother earth shrouds the fallacies, and every disease that the eminent practitioner cannot cure is deemed incurable. On the other hand, the Creator has gifted mankind with an innate and latent power of resisting noxious influence--a power called by the schools the _vis medicatrix naturæ_, and which is generally sufficient to throw off morbid attacks, when this principle is not exhausted, and the functions not impeded by organic derangement which involves the healthy equilibrium of life; then it is, that the prudent and experienced physician will carefully watch this precious faculty, and instead of counteracting the efforts of nature, assist her bounteous labours. This watchful practice, which may, however, be sometimes too inert, has been called _expectant medicine_--a slow and tardy process for the energetic practitioner, who, assuming the reins of life in his bold hands endeavours to goad and drive on nature in spite of herself; this practice has obtained the name of _active medicine_, of which our British practitioners are accused, by the _expectant_ continental physicians, who, to use a French expression, "_voient venir_," and the French themselves are so well aware of the imprudence of this hesitation in assisting nature, that they say "_Your physicians kill their patients, whereas ours let them die_." There is more truth in this remark than we perhaps are willing to believe. The power of nature in the cure of diseases has been acknowledged by the most experienced and wise physicians. Stahl, in his dissertation, "_De Medicina sine Medico_," perhaps exaggerated the influence of this faculty. Bordeu maintains that out of ten patients, two-thirds are cured without assistance, and come within the circle of all those minor ailments to which flesh is the constant heir. The illustrious Boerhaave doubted whether the successful practice of the small number of able physicians was a compensation for the evils that arose from the errors of the ignorant; and, in this sad calculation, he seems disposed to think that it would have been better for mankind that the science of medicine had never existed. All these deductions are both unjust and unwise; for, as I have already said, if physicians only possessed the means of affording relief, their mission upon earth is of the utmost importance. At the same time, while we watch the efforts of nature, it is our duty to rouse her energies when they become torpid, or to check inordinate action which would soon exhaust her power. Asclepiades very truly called the expectant practice of medicine "_a contemplation of death_." The powers of nature may be, and not inaptly, compared to those of the swimmer; however skilled in the art of natation, and able under ordinary circumstances to baffle an adverse tide, are we not to hasten to his succour, when we find that he is borne away by an inevitable current, or deprived by a cramp, of the power of stemming the stream? We are also willing to forget, that the turbulence of passions, the "wear and tear" of life, by excesses or irregularities, gradually tend to render the "medicinal power" of nature of little or no avail; and it has been truly said, that had we no cooks, we perhaps might not have needed physicians. Man in fact, in a high state of civilization, seems determined to counteract all the efforts both of nature and of art to relieve him from the manifold curses of intemperance; and it is fortunate that his own feelings of gradual decay prompt him more energetically to a reform in his habits, than the most persuasive language his physician could employ. In this illiberal view of the profession, how often do we lose sight of hereditary transmissions--heir-looms of disease--ingrafting misery on the variegated woof of our destinies--germs of fatal maladies which we bring into the world--a scourge on our posterity!--and yet, strange to say, our vain self-estimation blinds us in the contemplation of this doom--for the gratification of our desires, we bring forth a fearful generation--scrofulous, insane! Nay, we glory in the smiling offspring blooming around us--heedless, that the very roses we admire on their transparent cheeks, the coral hue that tinges their lips, are typical of flowers scattered on a grave, and the joyful beams of their bright yet languid looks are but the harbingers of the smile of death--the last kind look on earthly things.--And the physician is expected to arrest the hand of Providence--to eradicate germs struck before birth! It must also be observed, that many of our maladies are, in fact, reactions of nature, endeavouring to overcome other affections--a struggle for harmonious unity--for healthy equilibrium. Thus do we see a burning fever, tending to cast upon the surface exanthematic eruptions--a febrile reaction which we call critical, and which too often, like a political crisis, destroys in fruitless endeavours to save. "_Si natura non moveat, move, tu, motu ejus_" was an ancient axiom; but how often, in seeking to trim the expiring lamp of life, do we not extinguish the last vital spark! In regard to the influence of medicine on population, can it be expected, that when the most fatal pestilences do not thin it, the most erroneous medical practice can be more destructive? And, if nine-tenths of cholera, or pestiferated patients perish, on the other hand, nine-tenths of other cases of a less serious character are cured without medical intervention; and possibly, the chief study of a physician should be not to produce a more obstinate disease by the means he employs to cure an affection less formidable. Late years have proved that the effects of mercury were far more dreadful than the disease it was supposed to eradicate. In the animadversions that are accumulated upon the physician, an insidious comparison to his disadvantage, has been made with the utility of the surgeon--a utility which man is compelled, however reluctantly, to acknowledge, since it is evident to his most gross senses--an amputated limb--a reduced luxation--are before his eyes, while the favourable changes operated on a morbid condition of the body are not self-evident, and can only be recognised by sound and unbiassed judgment. In this illiberal view, it is forgotten that the mere operative surgeon is nothing more than a mechanical agent--a butcher could perform the same operation with his rude knives and saws as the chirurgeon with his refined and improved instruments; it is the judgment that we look to, and the skill in attending to the general health of the patient, to bring him to a perfect cure; in these functions, of much more importance than the dexterity of the hand, the surgeon clearly assumes the duties of the physician; and it is not possible for a man to excel in one part of the profession without being conversant with the other; a surgeon must be a sound anatomist, and an observant physiologist--without the knowledge of these fundamental sciences, a surgeon and a physician might be compared to the bungler who attempted to repair a watch, without a previous acquaintance with its intricate machinery. Let us hope that the mischievous distinction between surgery and medicine may soon become an obsolete prejudice, that was never founded upon reason, but simply based upon ambitious lucre. Let us hope that the graduate of an university will not conceive it beneath his dignity to save a fellow-creature's life by breathing a vein, and not esteem a vain and pompous piece of parchment an immunity from humane feelings and philanthropic duties. As good often results from apparent evil, the converse must also be frequently admitted. That much evil has occurred from errors in medical doctrine is unfortunately but too true, yet this evil has never attained the extent which is generally supposed. I have already alluded to the curative powers of nature, ever tending, while still enjoying a portion even of their energies, to repel obnoxious agents--this power has saved the lives of many; and indeed, when we daily witness the excesses committed by the sensualist and the drunkard with apparent impunity, although exposed to destructive agencies more powerful than the generality of medicinal substances, we must come to the conclusion that the kitchen and the cellar are, at least, as formidable as the officinal preparations of the pharmacopolist. That the physician, guided by experience and sound observation, is able, in very many cases to afford relief, must even be admitted by the most hostile depreciator of his science, who refuses to admit that he possesses the power of curing. This simple admission of daily facts, must entitle him to some degree of weight in our confidence, whatever may be our sceptical view of his doctrines. While the real merits of a physician are so frequently overlooked, we constantly see a blind confidence reposed in a quack. The cause is obvious. A man of real merit seldom extols his own good qualities, nor does he seek the fulsome adulation and praise of others. He rests upon his own deserts; but how seldom are they rewarded: when modesty places her light "under a bushel" who will bring it into view? Duclos has explained in some measure this apparent anomaly.--"The desire," he says "to obtain a high stand in the estimation of society, has given rise to reputation, celebrity, and renown,--the mainsprings of worldly action--arising from a similar principle, but showing different means and results. Both reputation and renown may be enjoyed at the same time and yet be widely different. The public is not unfrequently surprised at the reputations that it had itself created. It seeks to inquire into their origin, but not being able to discover a merit which never did exist, it gradually admires and respects a phantom of its own evocation. As society thus bestows a reputation in a capricious manner, quacks will usurp one by their intrigues or by a barefaced impudence, which cannot claim the comparatively honourable denomination of proper pride and dignity. They themselves proclaim their merit to the world--at first their impertinence becomes a subject of derision, but they repeat the assertion of their superior skill so frequently and confidently, that they end by imposing themselves upon society. People forget where, whence, and from whom they heard these flattering eulogies, to which at last they yield their credence, and an adventurer who thus resolves to establish a reputation, with perseverance and impudence seldom fails." It must also be remembered, that most medical men owe their success to woman's all-powerful aid. They are in general as blind and as pertinacious in their partialities as in their dislikes; seldom bestowing much judgment in either, but acting according to the impulses of their warm passions and flexibility. Females, from their situation in the world, stand in constant need of a friendly adviser, although they are rarely disposed to follow any advice, if their pleasures are marred by the suggestion, but when art and opportunity enable a man to turn their flexibility, their _impressionability_ to a good account, with the combined aid of vanity and weak nerves, he will in all probability succeed in obtaining a high estimation in the mind of a loquacious dame, who will blazon his fame far and near like the trumpeter of a mountebank. If this lady moves in an elevated and influencial sphere of life, to question her recommendation is to question her sense and power, both of which would be bold attempts; and thus have we seen an intriguing noble dame forcing a physician even upon royalty. Moreover, when we recollect that the wealthy send for a physician for every trifling real or supposed indisposition, which fashion or expediency may aggravate at will, to excite interest or carry a desirable point, it is manifest that the _cures_ of such a practitioner must be most numerous, since the attainment of any desire constitutes a _panacea_; and frequently we have seen a box at the opera, a check on a banker, a new carriage, or a diamond necklace, more efficacious than the most renowned nostrum, while the expulsion of an unpleasant plain-spoken acquaintance, or the kind reception of a dangerous and treacherous inmate, may produce more sudden recoveries than the most approved specific. The great science of such practitioners is to practise with equal success upon every branch of the family, to whom in return for their confidence, they can ensure peace and pleasure if they cannot bestow health. I cannot better conclude this article than by quoting the following passage of the sceptic Voltaire: It is true that regimen is preferable to physic. It is also true that for a long period of time, out of one hundred physicians were twenty-eight quacks, and it is also true, that Molière had very good reason to turn them into ridicule. It is also certain that nothing can be more absurd than to behold a crowd of silly women, and men, not less feminine in their habits, whenever they are satiated with eating, drinking, gambling, and late hours, calling in a physician for every trifling headache; consulting him as though he were a divinity, and praying for the miraculous gift of combined health and intemperance. It is nevertheless true, that a good physician in a hundred cases may preserve life and limb. A man falls down in an apoplectic fit, it will neither be a captain of infantry or a privy councillor that will relieve him. A cataract obscures my vision; my neighbouring gossips will not restore my sight; for here I make no distinction between the physician and the surgeon. For a long time the two professions have been inseparable. Men who would make it their study to restore health to their fellow-creatures on the sole grounds of humanity and benevolence, should be considered greater than the greatest man upon earth, and bordering upon divine attributes, for preservation and restoration stand next in rank to creation. The Romans were for upwards of five hundred years without physicians. Their people, continually employed in killing, thought but little of the preservation of life; what did they do when they were attacked with a putrid fever, a fistula, a hernia, or a pleurisy?--_They died._ MEDICINE OF THE CHINESE. This singular people possess works on medical science which they trace as far back as three thousand years, and chiefly written by two of their emperors, _Chin-nong_ and _Hoang-ti_. It has been asserted that they received the early elements of the science from the Egyptians, but it is more probable that they derived their information from their constant intercourse with the Bactrians, whose arts and sciences were flourishing at the period of Alexander's conquests, and the Chinese historians in support of this probability, state that several learned physicians came from Samarcand to establish themselves amongst them. Moreover, the doctrines of Erasistratus bear much resemblance to those of the Chinese. The superstitious regard shown to the bodies of the departed, must naturally have materially retarded the progress of anatomical pursuits, although this people assure us that 2706 years before our era they possessed a work on this subject, entitled _Nim Kin_. Howbeit it seems probable, from their extreme ignorance of the structure of the human body, that this important branch of the science of medicine has remained stationary ever since the publication of the aforesaid treatise. The Chinese physicians divide the body into a right and left portion, and three regions. The upper one, comprising the head and the chest, a middle one, extending from the lower part of the thorax to the umbilicus, and an inferior region, comprising the hypogaster and lower extremities. They admit twelve viscera as the sources of life, but they do not appear to have any distinct notion of the division, uses and conformation of the muscles, nerves, vessels, and the various tissues of the human economy. Their ignorance equally extends to the construction of animals. They consider that man is influenced by two principles, heat and humidity, the harmony of which constitutes life, which ceases when their equilibrious state is destroyed. Vital moisture resides in the heart, lungs, liver, spleen, and kidneys, while vital heat pervades the intestines, the stomach, the pericardium, the gall-bladder and the ureters. These two principles are transmitted through the medium of the vital spirits and the blood by twelve canals, one of which carries a fecundating moisture from the head to the hands; another from the liver to the feet; a third from the kidneys to the left side of the body; and a fourth from the lungs to the right division. In addition to these channels of vital transmission, they imagine that the state of our internal organs can be ascertained by the appearance of various parts of the head, which they consider as indicative sympathies of the action of the internal viscera. For instance, the head corresponds with the tongue, the lungs with the nostrils, the spleen with the mouth, the kidneys influence the ear, the liver acts upon the eyes, and thus they consider that they can form a correct idea of the nature of internal maladies by the complexion, the state of the eyes, the sound of the voice, the taste, and the smell of the patient. The Chinese physiologists also consider the human body as a harmonic instrument, of which the muscles, tendons, nerves, arteries, &c. are vibrating chords, producing various sounds and modulations, and the pulse their chief guide in ascertaining the nature of disease, is but the result of a modification of these sounds as the chords are more or less extended or relaxed. In addition to these singular views of the human economy, they imagine that the body is influenced by five elementary agents, earth, minerals, water, air, and fire. Fire prevails in the heart and the thoracic viscera, which bear an astronomic relation with the south. The liver and the gall-bladder are under the influence of air, which is in relation with the east, whence the winds arise, and it is towards spring that these organs are generally affected. The kidneys and ureters are ruled by water, astronomically associated with the north--hence winter is the usual season of the maladies in these parts. The stomach and spleen are regulated by earth, and are placed in connexion with the centre of the firmament, between the five cardinal points, and affections of these parts are observed in the third month of each quarter. Diseases are distinguished by their vicinity to or their distance from the central part of the body, the heart and lungs, and are usually occasioned by vicissitudes in the atmospheric constitution--varying with cold, heat, and moisture. The minuteness of their division of maladies is as great as the mechanical precision which all their labours exhibit: for instance, they admit no less than forty-two varieties of the smallpox; according to the shape, colour, situation of the pustules, which they compare to the cocoons of the silkworm--to strings of beads--chaplets of pearls--and lay equal stress on their being flat or round--black, red, or violet. This disease has, indeed, been described by them with much accuracy and judgment, as regards its benign or its confluent character; and there is no doubt that inoculation was practised among them from time immemorial, as I have already shown in the article on that head. Equally accurate have they been in detailing the various symptoms of gout, scurvy, elephantiasis, and syphilis, which also scourges the "Celestial empire." The chief guide, however, in their diagnosis and prognosis, is the state of the pulse, and a very curious work, called "The Secrets of the Pulse," and said to have been written two centuries before our era, by _Ouang-chou-hó_ or _Vam-xo-ho_. The pulse is divided into the external, the middle, and the deep--producing _nine_ different pulsations called _Heon_, and the arterial beats were formerly sought for in the joint of the big toe; this custom is now abandoned, but they still follow the strange practice of taking up the right wrist in women and the left in men. The external pulse, called _Piao_, is subdivided into several varieties. 1. The superficial P. in _Féou_, which yields to the slightest pressure. 2. The hollow P. _Kong_, which announces that the artery is empty when pressed upon. 3. The slippery P. _Hang_, which slides under the fingers, like the beads of a necklace. 4. The full P. _Ché_, striking against the fingers with a full caliber of blood. 5. The tremulous P. _Hien_, vibrating like the chord of a musical instrument. 6. The intermittent P. _Kin_, vibrating by starts, like the instrument called _Kin_. 7. The regurgitating P. _Hong_, the strong pulsation of a full and distended vessel. These seven characters are considered much more favourable than the eight which follow, and which, arising from a deeper action, require a more forcible pressure. 1. The deep P. _Tehin_, only discovered by a firm pressure. 2. The filiform P. _Ouei_, a threadlike pulsation. 3. The moderate P. _Ouan_, slow and languid. 4. The sharp P. _Soe_, producing the sensation of a cutting or sawing instrument. 5. The slow P. _Tehis_, when the pulsations follow each other with languid intervals. 6. The sinking P. _Fou_, when the pulse, although pressed hard, sinks under the finger. 7. The soft P. _Sin_, which feels like a drop of water one might press upon. 8. The weak P. _Yo_, which yields the sensation of feeling like a worn-out texture, and ceases to be observed when pressed upon for any time. To these are added nine other varieties, called _Tao_. 1. The long P. _Tehang_, full, smooth--feeling like a full tube. 2. The short P. _Toan_, presenting a pointed surface, that seems indivisible. 3. The empty P. _Hin_, insensible under moderate pressure. 4. The tight P. _Tsou_, which the finger feels with difficulty. 5. The embarrassed P. _Kié_, languid and occasionally stopping. 6. The intermittent P. _Tai_, when several pulsations appear to be missing. 7. The slender P. _Sié_, so slow and weak, that it feels like a hair. 8. The moving P. _Tong_, that one might compare to stones under water. 9. The tense P. _Ké_, feeling like a distended drum-head. But as many Chinese doctors were not satisfied with this confusion in the classification of pulses, and, like practitioners in other countries, sought to render darkness still more visible--they sought to strike out a new career by increasing the multiplication, and introduced the following _addenda_: 1. The strong pulse, _Ta_, filling the vessel, yet yielding to pressure. 2. The precipitate P. _Son_, in which the pulsation was rapid in succession. 3. The scattered P. _San_, soft, slow, and non-resisting. 4. The stray P. _Li-king_, strong--not pulsating three times in each inspiration. 5. The firm P. _Tun_, consistent and resisting. 6. The lively P. _Ki_, pulsation rapid in succession. 7. The skipping P. _Teng_, pulsation unequal, sudden, and frequent. In this minute attention to the many variations of the pulses, the Chinese aided their study, by attending to age, sex, stature, constitution, the seasons, the passions, and the comparative state of health and disease. In a person of high stature, the pulse was full--concentrated in diminished individuals--deep and embarrassed in fat subjects--long and superficial in the meager--soft in the phlegmatic temperament--tremulous in the lively and the active--slower in man than in woman, excepting when threatened with disease--full and firm in the adult--slow and feeble in old age--soft and vivacious in infancy. The rhythm of the pulse was affected by the passions, though chiefly in a transient manner:--moderately slow, in joy--short, in grief--deep, under the impression of fear--precipitate and regurgitating, in anger. In the spring, they maintained that the pulsation was tremulous--replete, in summer--spare and superficial, in autumn--dry and deep, in winter. Much mysterious ceremony was observed by the Chinese physicians in this investigation; they felt the pulse with four fingers, which they alternately raised or dropped on the vessel, as if playing on a musical instrument. In this profound study, they attributed to every disease a peculiar state of the pulse by which it could be recognised and ascertained, and at the same time it enabled them to form a favourable or unfavourable prognostic. Some of these rules are curious. If the pulses stop before fifty pulsations have been counted, disease is at hand; when an interruption in the course of the circulation takes place after forty pulsations, the patient has not more than four years to live; when an interruption takes place after the third pulsation, three or four days are the probable term of existence; but the patient may linger on for six or seven days more, when the interruption only succeeds the fourth pulsation. Idle as these speculations may appear, it is to be feared that while the Chinese paid such minute attention to the state of the circulation, more distinguished and learned schools do not consider this powerful indication of the strength or weakness of the vital functions with sufficient care and discrimination, and perhaps a translation of the works of _Ouang-chou-ho_, might not be altogether useless in the present enlightened age. I have no hesitation in saying that this important investigation is sadly neglected in medical education--so much so indeed, that the different appellations given to the varied state of the pulse, are neither well defined nor generally understood. The French physician Bordeu has given much valuable information on this subject, which occupied the ancients as much as it seems to have fixed the attention of the Chinese. We find that the Indians, in the time of Alexander, accurately studied this important point. Notwithstanding the assertion of Sprengel, Hippocrates was a most attentive observer of the state of the pulse. Thus we find him giving the name of [Greek: sphygmos] to that violent and spasmodic beating of the artery, which was not only sensible to the touch, but evident to the bystander's eye--in more than forty passages of his immortal works do we find important references to the pulse, which he also declared could enable us to detect the secret workings of the passions. Many were the ancient physicians who have minutely entered into these investigations, amongst them we may name Herophilus, Erasistratus, Zeno, Alexander Philalethes, Heraclides of Erythræ, Heraclides of Tarentum, Aristoxenes. Several of the doctrines founded on these observations were most absurd, attributing the various conditions of the circulation to the _Pneuma_ of the heart and arteries; such were the doctrines of Asclepiades, Agathinus, Galen, and many others; and amongst the Arabians we find _Thabeth Ebn Ibrahim_ asserting that by the state of the pulse he could ascertain what articles of food had been taken--in more modern times Baillou, Wierns, Boerhaave, Hoffmann, have sedulously applied themselves to this most essential study, and Schelhammenn asserts that the pulse never once deceived him. The effect of our passions on the circulation is much more powerful than is generally believed, and they are a more fertile source of our maladies than is commonly apprehended. We can readily conceive why the Spartan Chilo died through excess of joy whilst embracing his victorious son.[53] In the treatment of disease, the Chinese, so fond of classification, divide the medicinal substances they employ into heating, cooling, refreshing, and temperate; their _materia medica_ is contained in the work called the _Pen-tsaocang-mou_ in fifty-two large volumes, with an atlas of plates; most of our medicines are known to them and prescribed; the mineral waters, with which their country abounds, are also much resorted to; and their emperor, _Kang-Hi_, has given an accurate account of several thermal springs. Fire is a great agent, and the _moxa_ recommended in almost every ailment, while acupuncture is in general use both in China and Japan; bathing and _champooing_ are also frequently recommended, but blood-letting is seldom resorted to. China has also her animal magnetizers, practising the _Coug fou_, a mysterious manipulation taught by the bonzes, in which the adepts produce violent convulsions. The Chinese divide their prescriptions into seven categories. 1. The great prescription. 2. The little prescription. 3. The slow prescription. 4. The prompt prescription. 5. The odd prescription. 6. The even prescription. 7. The double prescription. Each of these receipts being applied to particular cases, and the ingredients that compose them being weighed with the most scrupulous accuracy. Medicine was taught in the imperial colleges of Pekin; but in every district, a physician, who had studied six years, is appointed to instruct the candidate for the profession, who was afterwards allowed to practise, without any further studies or examination; and it is said, that, in general, the physician only receives his fee when the patient is cured. This assertion, however, is very doubtful, as the country abounds in quacks, who, under such restrictions as to remuneration, would scarcely earn a livelihood. Another singular, but economical practice prevails amongst them--a physician never pays a second visit to a patient unless he is sent for. Whatever may be the merits of Chinese practitioners both in medicine and surgery, or their mode of receiving remuneration, it appears that they are as much subject to animadversion as in other countries:--a missionary having observed to a Chinese, that their medical men had constantly recourse to fire in the shape of moxa, redhot iron, and burning needles; he replied, "Alas! you Europeans are carved with steel, while we are martyrized with hot iron; and I fear that in neither country will the fashion subside, since the operators do not feel the anguish they inflict, and are equally paid to torment us or to cure us!" EXPERIMENTS ON LIVING ANIMALS. However ungrateful the discussion of this subject may be, since, in truth and justice, it must be considered with an unbiassed and unprejudiced mind, and elicit observations which may prove offensive to many, and absurd to some, it is one of such moment on the score of humanity, that I undertake the task without hesitation or reluctance. In support of the practice it has been urged, that mankind owes the most valuable discoveries in the science of medicine and its collateral branches to the vivisection of animals; that since the brute creation was intended for the use of our species, we could not apply them to a more important and justifiable purpose, than that of endeavouring to initiate ourselves in those wonderful functions of nature, a knowledge of which would give us a clearer insight of the mysterious machinery, and thereby the better enable us to remedy their derangement when in a morbid state. It has further been maintained, that when man to indulge his capricious appetites and his various amusements, tortures every creature that can minister to his depraved fancies or his unruly pleasures--he would be more excusable, if not fully justifiable even in the eyes of the most sentient philanthropist, in submitting these creatures to smaller or greater sufferings, if mankind could be ultimately benefited by this sacrifice of feeling. What, indeed, could be our commiseration when beholding the agonies of a mangled dog or a cat, if the throes of his sufferings, and the incalculable pangs he endured, could restore a beloved child to his disconsolate parents, or a sinking father to his helpless family. Moreover, is not man, from the very nature of his social position, created to suffer more than animals, not only from the many natural diseases to which flesh is heir, but to the torturing wounds received on the field of battle--the burning fevers of distant climes--the chances of war, pestilence, and famine--all of which are aggravated by that power of judgment, that reflection and consciousness derivating from the possession of an immortal soul, which makes the future more horrible than the present, however great its miseries may be. It has also been urged, that animals in their savage state, undomesticated by the _humane_ interference of man, inflict upon each other injuries under which they linger and die in excruciating pain; and, therefore, when we submit them to similar agonies, we only fill up the intended measure of their destined sufferings. It is painful to assert it, but all these allegations, I consider as not only unsupported by facts and experience, but grounded on speculative sophistry; for, in regard to the injuries which animals in their wild condition may inflict upon each other, they may be the result of the wise provisions of the CREATOR, with which man, however presumptuous he be, has nothing to do, and even were it in his power to check their furious and destructive propensities, it is more than likely, from what we daily witness, that he would turn them to a profitable or a pleasurable account, as most probably, the sight of a combat between a wild elephant and a rhinoceros (provided the spectators were perfectly secure), would attract a greater multitude, and _draw_ more money, than a dog-fight or a bull-bait--a tiger-hunt, were it not attended with some personal danger which requires courage, would prove more delectable than the pursuit of a timid hare. But I now come to a much more important consideration--the benefit to mankind that has occurred or that may be derived from such experiments. And here I must give as my most decided opinion, that if any such beneficial results did arise from the inquiries, they were not commensurate with the barbarity of the experiments; nay, I shall endeavour to show, that they are frequently more likely to deceive us, by propping up fallacious and tottering theories, than to shed any valuable light on the subject of investigation. I readily admit that there does exist much analogy in the structure of man and certain animals in the higher grades of the creation; that the functions of respiration, digestion, absorption, locomotion, are to a certain extent similar, and that experiments made to ascertain the mechanism of these functions (if I may so express myself), may tend, in some measure, to teach us that which the inanimate corpse of man cannot exhibit; but, admitting to the full extent of argumentation, the analogy of these functions, I do maintain that the phenomena of life differ widely between man and animals, and the very nervous influences which we seek to discover are, in life, of a nature totally different. Were it not so, would the senses of different animals, rendered more or less acute or obtuse according to their natural pursuits and protective habits, be so materially unequal? Indeed, the laws of nature that submit every creature to the immutable will of Providence are totally unlike; and each apparatus of life in divers beings seems to be especially calculated for the identical race: what is poison to the one is an aliment to another; and the vivid light which the eyes of one creature can bear, would produce blindness in another; the same effluvia which one animal would not notice, would guide another over trackless wastes in search of friend or foe. I therefore maintain, that the mere material examination of the living organs of animals can no more tend to illustrate their vital principle, than the keenest anatomical labours can enable us to attain a knowledge of the nature of our immortal and imperishable parts. I shall enter still more minutely into this subject. In the barbarous experiments to which I allude, animals bearing the strongest resemblance to man (at least in their conformation, for Heaven, in its mercy, did not gift them with what we call _mind_) are usually selected amongst such as possess a heart with four cavities, and double lungs. The dog--the natural companion of man, his most faithful friend in weal and woe, the guardian of his couch and property, the protector of his infants, the only mourner o'er the pauper's grave!--dogs, are in general selected for the scientific shambles; and this for obvious reasons,--they are more easily procured, and at a _cheaper rate_; moreover, they are more manageable and unresisting under the mangling scalpel. Well, thousands of these creatures have been starved to death with butter, sugar, and oil, to prove that they must die in all the aggravated pangs of hunger,--pangs producing ulcerated eyes, blindness, staggers, parched up organs, unless their food contains azote. Will any one maintain, that a similar nourishment would produce similar effects on man? Certainly not. The one was created by nature to consume animal substances highly azotized; the other, from the transition of life to which he is born to be exposed, is essentially polyphagous. Then, again, millions of animals have had their bones broken, scraped, bruised in every possible manner, to discover the process of the formation of bone, called _Osteogeny_: has a single fracture of a human limb been more rapidly consolidated by these experiments, which fill hundreds of pages in the works of Duhamel, Haller, Scarpa, and other physiologists? Animals will digest substances that would kill a human being--have the experiments in which their palpitating stomach and intestines have been torn from them, lacerated, pricked, cut, separated from their surrounding vessels and nerves, increased our means of relieving the dyspepsia of the sensualist, the surfeit of the glutton, or the nausea of the dissolute? On the other hand, the gin, the ardent spirits in which the drunkard wallows, would soon destroy what we think proper to call a _brute_! In many animals, moreover, there is a tenacity of life--highly convenient to the physiologist, since it enables him to prolong his experimental cruelties--which man does not possess; and we find the electric fluid acting much longer upon their muscles even after death, than on a human body or its severed limbs. Another point to be considered is the assertion of the advantages to be derived from contemplating the living viscera in a healthy state. Good God! a healthy state!--what a mockery, what a perversion of language! Behold the dog, stolen from his master--(for theft is encouraged to supply the man of science--and theft of the worst character, since it is of the most cruel nature;--our goods, our money, may be restored, replaced by industry, but what hand can restore the faithful companion of our solitude, whose looks seem to study our thoughts! left us perhaps by the lost one of our heart, symbol of that fidelity which death alone abridged!) the poor animal hungry, chained up for days and nights pining for his lost master, is led to the butchery. Still he looks up for compassion to man, his natural protector, licks the very hand that grasps him until his feeble limbs are lashed to the table! In vain he struggles--in vain he expresses his sufferings and his fears in piteous howls: a muzzle is buckled on to stifle his troublesome cries, and his concentrated groans heave his agonized breast in convulsive throes, until the scalpel is plunged in his helpless extended body! His blood flows in torrents, his very heart is exposed to the torturer's searching hand, and nerves which experience anguish from a mere breath of air, are lacerated with merciless ingenuity,--and this is a healthy state! The viscera exposed to atmospheric influence are already parched, and have lost their natural colour, and not a single function is performed in normal regularity. One only effort is natural until vital power is exhausted--a vain instinctive resistance against his butchers!--The heart sickens at such scenes, when cruelty that would bid defiance to the savage's vindictive barbarity, sacrifices thousands of harmless beings at the shrine of vanity. For let the matter not be mistaken--these experiments are mostly made to give an appearance of verisimilitude to the most absurd and visionary doctrines; and if a proof were required of this assertion, it can be easily obtained by reading the works of various physiologists at different periods, who all draw _different_ deductions from _similar_ facts. For when the mind labours under a certain impression, or a reputation is founded upon the support of a doctrine, these facts are distorted with Procrustean skill to suit the views of the experimentalist. Let us, for instance, consider the subject of digestion, to ascertain the nature of which, thousands--millions of animals have been ripped up alive. This practice has been attributed to _coction_, to _elixation_, to _fermentation_, to _putrefaction_, to _trituration_, to _maceration_, to _dissolution_, and to many other shades and shadows of similar theories; and were additional millions of living victims sacrificed in further scientific hecatombs, posterity may deem our present vain glorious physiologists as ignorant of the matter as they might consider their numerous predecessors in the same career of groping curiosity. Has the cruel extraction of the spleen from a thousand dogs to show that they could live without that viscous, explained the nature of its functions, or enabled us more successfully to control its obstinate diseases? We know nothing of the phenomena of life; all our functions are regulated by an allwise Power that sets at naught human presumption--and Hippocrates justly called this harmonic organization a _concensus_, or a circle, in which we could not discover the commencement or the end. There does however exist one course of experiments which probably might prove beneficial to mankind. The search of antidotes to various poisons that are too frequently administered by criminal hands; but here again experiments fall short of our expectations, for these substances act differently upon different animals, and even to some the prussic acid in large doses may be given with impunity. But I affirm, and can prove it, that in ninety-nine cases out of one hundred, in which such substances are given to animals, it is not with a view to discover antidotes, but to ascertain, according to the unfortunate creature's species, size, and condition, how long he can linger under the pangs of the poison, or what is the dose sufficient to occasion death. Of what benefit can it be to humanity to know that thirty drops of hydro-cyanic acid destroys dogs and cats in the space of six, twelve, or fifteen minutes; that twenty-six drops kill a rabbit in three minutes; that one drop introduced into the bill of a sparrow deprives it of life in eleven minutes; that a duck takes fifteen drops to put an end to its convulsive struggles; and that the exposing animals to the influence of hydro-cyanic acid gas destroys them in two, four, six, eight, and ten seconds? What benefit does society reap from the knowledge that, after the most excruciating suffering, a dog died in five hours after having taken half an ounce of tobacco, and that another ill-fated canine victim in whose limbs tobacco had been introduced, died of paralysis and in horrible convulsions in about an hour? Were antidotes sought in the thousands of similar cases that I could adduce? Certainly not--the experiments merely went to ascertain the power of the drug, and the only possible good that could have resulted from the barbarous trial, was the appearance of the viscera after death; a fact that one experiment could demonstrate as well as one thousand--but which could be more effectually exhibited in human creatures who died from the effects of deleterious substances. In short, these experiments are nothing more than cold calculations on the tenacity of life in various individuals. Every one knows that arsenic and prussic acid destroy life, and surely such an assertion on the part of a lecturer to his pupils should satisfy them on this head without having recourse to illustrations of the fact. In the case of supposed poison introduced into alimentary substances, and which are given to dogs to prove the criminal act, surely chemistry is not so little advanced in its boasted progress, not to be able to afford us a test of the presence of poison, without having recourse to so savage an expedient. Another most absurd argument has been upheld in favour of these experiments in the presence of pupils, that of hardening their feelings in the contemplation of acute sufferings. This assertion is worse than idle and absurd; many of our most able surgeons and anatomists have never practised these cruelties, and yet their nerves have not been unstrung during the most fearful operations. With hands imbrued in blood I have performed the arduous duties of my profession in fourteen battles, yet I never could _witness_ these heartless exhibitions without disgust, and I am sorry to say contempt. I am aware that these sentiments have been called _puling_ professions of humanity; nay, that there are men and women who would weep bitterly over the sufferings of a sick pet, while they would view accumulated human misery unmoved. These are painful anomalies arising too frequently in disappointed minds, when the cup of life has been imbittered by ingratitude, and the "milk of human kindness" curdled by deceit. These are not reasons to prevent us from censuring acts of cruelty, when they may be considered _useless_ in a scientific point of view, and _degrading_ to mankind in regard to private feelings. I can readily believe that the best and the most humane of men, may be induced by an ardent desire to elucidate obscure parts of physiologic inquiry, to try such experiments; but most undoubtedly--unless the object to be so attained was commensurate with the sacrifice and abnegation of humane sentiments, I should deeply lament their obduracy, and be inclined to doubt their benevolence towards their fellow-creatures. I would not enter on my list of friends (Though graced with polish'd manners, and fine sense, Yet wanting sensibility), the man Who needlessly sets foot upon a worm. An inadvertent step may crush the snail That crawls at evening in the public path; But he that hath humanity forewarned Will tread aside, and let the reptile live. In fine, whenever it is not evident that such practices can benefit mankind and increase our means of reducing the sum of human misery--it is a barbarous and criminal abuse of that power which the Creator has given us over the inferior grades of animated beings; and it is deeply to be lamented that no legislative measures can be adopted to restrain it, if it cannot be altogether prohibited. At any rate, professors alone should be allowed the "_indulgence_," but in no instance should such pseudo-scientific practices become a public exhibition or a student's pastime. Brought up in early life, amidst all the complicated horrors of a revolution, I have been sadly convinced that the contagion of CRUELTY is much more doubtless and active than that of PESTILENCE! THE END. WHITING, BEAUFORT HOUSE STRAND. FOOTNOTES: [1] During these ten years the following works appeared: Montesquieu--Esprit des Lois, 1748. ---- Défense de l'Esprit des Lois, 1750. Rousseau--Discours sur l'Influence des Sciences et des Lettres, 1750. ---- Discours sur l'Inégalité des Conditions, 1754. Voltaire--Essai sur les Moeurs et l'Esprit des nations, 1757. Condillac--Essai sur l'Origine des Connaissances Humaines, 1746. ---- Traité des Sensations, 1754. Helvétius--De l'Esprit, 1758. [2] The _Homo diluvii testis_, the skeleton of which was described by Scheuchzer, was considered by Cuvier to have belonged to a species of Salamander. [3] For the further illustration of this curious subject, Dr. Eliotson's valuable notes on Blumenbach may be consulted to advantage. [4] The dream of Ertucules seems to have been connected with similar phantasies. "I dreamed, venerable sir," said he to Edebales, "that the brightness of the moon did proceed from your bosom, and thence afterwards did pass into mine: when it was thither come, there sprung up a tree from my umbilic, which overshadowed at once many nations, mountains, and valleys. From the root of this tree there issued waters sufficient to irrigate vines and gardens; and then both my dream and my sleep forsook me." Edebales after some pause thus answered: "There will be born unto you, my good friend, a son whose name shall be Osman; he shall wage many wars, and shall acquire victory and glory; and my daughter must be married to your son Osman, and she is the brightness which you saw come from my bosom into yours, and from both sprung up the tree."--_Lips. Marsil._ [5] Vide the article "Enthusiasm." [6] The choenix contained a pint. [7] These lines afford a convincing proof of the minute attention the ancients paid to the phenomena of nature. Our poet had no doubt observed the frequent effect of the application of cold to the surface of the body producing a reaction in the circulation tending to overcome the noxious agent by a glow of heat, which in many instances of predisposition may assume a febrile character. [8] A Treatise on Insanity. [9] _Pallido il Sol_ and _Per quanto dolce amplasso_ of Hasse. [10] Much curious matter will be found in Mr. Nathan's valuable work upon music, entitled, "_Musurgia vocalis_." [11] That animals are more frequently guided by the sense of smelling than by sight, is evident in those plants that shed a cadaverous effluvia, especially the _arum dracunculus_ and the _stapelia variegata_ of the Cape, which attract various insects that usually deposit their eggs in a stercoraceous or corrupt nidus. Here these insects have been deceived by vision, and imagined in their illusion that they had safely lodged their progeny in carrion. [12] According to Ælian, the presence of this fish indicated the approaching overflow of the Nile. [13] The Irish, in their metaphorical language, give a corporeal form to foul effluvia, and one of them assured me that he had a terrier who would always cock up his tail and bark whenever he _saw_ a stink. [14] Diodorus, Strabo, and other ancient writers, state that the beer of the Egyptians called _Zythus_ was scarcely inferior to wine. This beer was made with barley, to which was added the lupin, the skirret, and the root of an Assyrian plant. We find the following in Columella: "Jam siser, Assyriaque venit quæ semine radix Sectaque præbetur madido satiata lupino, Ut Pelusiaci proviset pocula zythi." The vicinity of Pelusium was famed for this beverage and its lentils. [15] Diemerbrook states that, in the Plague of Nimeguen all those who were taken ill about new and full moon rarely escaped. [16] Dr. Desgenettes, physician to the French army, in order to inspire confidence among the troops, inoculated himself twice without experiencing any other consequence than a slight inflammation of the inoculated parts. Sonnini mentions a Russian surgeon, who was a prisoner in Constantinople with a number of his countrymen, and who took it into his head to inoculate his comrades, with a view of protecting them from the contagion; but, unfortunately, two hundred of them died, and, fortunately perhaps for the survivors, the operator himself died of his own treatment. [17] On this subject see what has been already said in the preceding article of _Food, its use and abuse_, in Dr. Beaumont's experiments. [18] Otway. [19] Shaftesbury. [20] Oil is, however, a useful application to wounds in warm climates. During the retreat of our troops after the battle of Talavera, I found the wounds of many of our men, that had not been dressed for three or four days, pullulating with maggots. This was not the case with the Spanish soldiers, who, to prevent this annoyance (which was more terrific than dangerous), had poured olive oil upon their dressings. I invariably resorted to the same practice when I subsequently had to remove the wounded in hot weather. [21] A Hebrew proverb originating from a tradition that Abraham wore a precious stone round his neck, which preserved him from disease, and which cured sickness when looked upon. When Abraham died, God placed this stone in the sun. [22] The ancients considered the spleen the seat of mirth, and the liver the organ of love; hence their old proverb. [23] _Cordia Sebestena_; according to some, the _C. Myxa L._, a species of Egyptian date. It was formerly employed as a demulcent. A viscid black glue was also prepared from it, and exported in considerable quantities from Alexandria. [24] Quod Cæretani totum orbem vano quodam ac turpi superstitionum genere ludificantes continuò peregrinantur, familia domi relicta. [25] Patin called it _l'impertinente nouveauté du siécle_. [26] The priesthood in thus stigmatizing the medical profession so soon as its practice ceased to be their exclusive privilege, displayed the same spirit of intolerance and thirst for omnipotent sway that characterized their anathemas on the drama when they no longer were the authors, actors, and managers of their own sacrilegious plays, which they called mysteries and moralities. Previously to the drama becoming the pursuit of laymen, the monkish exhibitions had been so holy, that one of the popes granted a pardon of one thousand days to every person who went to the plays performed in the Whitsun week, beginning with a piece called "The Creation," and ending the season with the performance of "The General Judgment." In these representations the performers belonged to various corporations, and acted under the direction of the clergy. "The Creation" was performed by the _Drapers_,--"The Deluge" by the _Dyers_,--"Abraham, Melchizedek, and Lot," by our friends the _Barbers_,--"The Purification" by the _Blacksmiths_,--"The Last Supper" by the _Bakers_,--"The Resurrection" by the _Skinners_,--and "The Ascension" by the _Tailors_. The following curious anecdotes are recorded in the description of a mystery performed at Veximel, near Metz, by the order of Conrad Bayer, bishop of the diocese. This play was called _The Passion_; and it appears that by some mismanagement a priest by the name of Jean de Nicey, curate of Métrange, who played Judas, was nigh meeting with an untimely end; for his neck had slipped and tightened the noose by which he was suspended to the tree, and, had he not been cut down, he would have performed the part most effectually. A play was acted in one of the principal cities in England by these clerical performers, representing the terrestrial Paradise, when Adam and Eve made their appearance entirely naked. [27] Mr. J. A. St. John. [28] As this worthy never took off his cuirass, it may be shrewdly suspected that his lashes were such as our old friend Sancho Pança inflicted on the tree. [29] The diseases to which the blood is subject was another ground upon which the vitality of this fluid was founded. The most remarkable kind of diseased blood is that which occurs in cholera, where it is dark, nearly black, even in the arteries. The cause of this phenomenon is by no means decided. Dr. Thomson attributes it to a diseased condition of the blood, which unfits it for being duly arterialised. Dr. O'Shaughnessy denies the assertion, and proves that choleric blood can be rendered florid by the absorption of oxygen. Dr. Stevens, in his treatise on the blood, attributes this dark appearance to the contagion of the malady, which throws the fluids into a morbid state, the effect of which is the diminution of the saline matter which the healthy blood contains. He observed that in cholera-hospitals the blood of all the persons residing in them was also dark. It is, however, more than probable that this morbid condition of the blood arises from the deranged state of the circulation, and may be attributed to a disease of the solids, which must invariably affect the fluids that they propel with more or less energy, flowing in a rapid current, or in a sluggish stream. I have fully illustrated this want of oxygen in the blood of cholera patients in a work I published in Bordeaux, in 1831, entitled _Observations sur la nature et le traitement du Cholera Morbus d'Europe et d'Asie_; and, from several experiments subsequently made on cholera patients, I feel convinced that the inspiration of oxygen gas will be ultimately found the most energetic and effective practice in combating this fearful disease. By the experiments lately made by Dr. Donné of Paris, it has been found that the globules of blood, when submitted to microscopic examination, varied in magnitude according to the description of animals from which it was drawn. In certain diseases, globules of pus have also been detected in the sanguiferous stream. They were larger than those of the blood, and, instead of being defined by a marginal line, were fringed on their circumference, and their centre was striated with interwoven lines. The same physiologist discovered animalcules in the pus of certain ulcers not dissimilar in appearance to the _vibrio lineola_ of Müller. Other animalcules, which he has named the _tricomonas vaginalis_, were also found in great number when the mucous membranes of the organ (whence the latter part of their denomination was derived) were in a state of inflammation. These animalculi could not be detected in healthy mucus. The knowledge of this influence of inflammation may lead to many important practical results. [30] During the horrors of the French Revolution, various experiments were made by Sue and other physiologists to ascertain if the bodies of the guillotined victims possessed sensibility. No conclusion, however, could be elicited from these inquiries, which gave rise to many absurd tales, such as that the face of Charlotte Corday blushed when the executioner slapped it, as he held it out to the enraptured Parisians. [31] Organon, xxxii. [32] Op. cit. xxxi. [33] Ibid. xxxiii. [34] Op. cit. xxxviii. [35] Organon, xl. This will be found to be the case in all diseases that are dissimilar; the stronger suspends the weaker, except in case of complication, which is a rare occurrence in acute diseases, but they never cure each other reciprocally. [36] On Chronic Diseases. Translation of Begel, p. 107. [37] Sir Gilbert Blane's Medical Logic. [38] Organon, v. [39] Ibid. vi. [40] Sir G. Blane. [41] The celebrated Boyle used to apply to his wrists for the same purpose, the moss that grew from a human skull. [42] The term that designated magnetic manipulation. [43] Since the first edition of this work was published, animal magnetism has become the subject of much controversy and animadversion in London and various parts of the empire. The utmost virulence has as usual been resorted to, not only to impugn the doctrine, but to stigmatize its supporters; while, on the other hand, the greatest ingenuity has been displayed to convince unbelievers, and to give to the many experiments practised for this purpose the semblance of undeniable facts. Baron Dupotet's labours and publications have been submitted to the test of a public investigation; while Dr. Elliotson and several other practitioners have aided the practice apparently with success. It would be foreign to the nature of this work to consider this matter more elaborately; it is now before the tribunal of public opinion, whose decision we must await. [44] Inquiries concerning the Intellectual Powers, &c. [45] That serious accidents might have resulted from the use of hellebore is most likely, since various plants resembling it have been mistaken for it; chiefly the _adonis vernalis_, _trollius Europæus_, _actæa spicata_, _astrantia major_, _veratrum album_, and the _aconitum neomontanum_, the last of which is a most virulent poison. [46] The advocates of fasting have calculated that in one hundred and fifty-two hermits who had lived eleven thousand five hundred and eighty-nine years, the average age was seventy three years and three months. [47] On this very curious subject the reader may consult the various statistical works of Quetelet. [48] It is somewhat strange, but in the mountains of the South of Spain, there does still exist a dance called _los Titanos_, in which the performers raise their hands in threatening attitude against the heavens! [49] The matter of insensible perspiration is calculated at being daily equal weight to one half of the food. [50] Madder, when given to animals tinges the surface of their bones with a red hue. [51] The life of J. E. Jenner, M.D. &c., by John Bacon, M.D. &c. [52] History of Egyptian Mummies, &c. &c., 1834. [53] In a work on the "Anatomy of the Passions," which I am about publishing, I have entered most minutely into this important sympathy. 
747	----	ANOMALIES and CURIOSITIES of MEDICINE Being an encyclopedic collection of rare and extraordinary cases, and of the most striking instances of abnormality in all branches of medicine and surgery, derived from an exhaustive research of medical literature from its origin to the present day, abstracted, classified, annotated, and indexed. by GEORGE M. GOULD, A.M., M.D. and WALTER L. PYLE, A.M., M.D. PREFATORY AND INTRODUCTORY. ---- Since the time when man's mind first busied itself with subjects beyond his own self-preservation and the satisfaction of his bodily appetites, the anomalous and curious have been of exceptional and persistent fascination to him; and especially is this true of the construction and functions of the human body. Possibly, indeed, it was the anomalous that was largely instrumental in arousing in the savage the attention, thought, and investigation that were finally to develop into the body of organized truth which we now call Science. As by the aid of collected experience and careful inference we to-day endeavor to pass our vision into the dim twilight whence has emerged our civilization, we find abundant hint and even evidence of this truth. To the highest type of philosophic minds it is the usual and the ordinary that demand investigation and explanation. But even to such, no less than to the most naive-minded, the strange and exceptional is of absorbing interest, and it is often through the extraordinary that the philosopher gets the most searching glimpses into the heart of the mystery of the ordinary. Truly it has been said, facts are stranger than fiction. In monstrosities and dermoid cysts, for example, we seem to catch forbidden sight of the secret work-room of Nature, and drag out into the light the evidences of her clumsiness, and proofs of her lapses of skill,--evidences and proofs, moreover, that tell us much of the methods and means used by the vital artisan of Life,--the loom, and even the silent weaver at work upon the mysterious garment of corporeality. "La premiere chose qui s'offre a l' Homme quand il se regarde, c'est son corps," says Pascal, and looking at the matter more closely we find that it was the strange and mysterious things of his body that occupied man's earliest as well as much of his later attention. In the beginning, the organs and functions of generation, the mysteries of sex, not the routine of digestion or of locomotion, stimulated his curiosity, and in them he recognized, as it were, an unseen hand reaching down into the world of matter and the workings of bodily organization, and reining them to impersonal service and far-off ends. All ethnologists and students of primitive religion well know the role that has been played in primitive society by the genetic instincts. Among the older naturalists, such as Pliny and Aristotle, and even in the older historians, whose scope included natural as well as civil and political history, the atypic and bizarre, and especially the aberrations of form or function of the generative organs, caught the eye most quickly. Judging from the records of early writers, when Medicine began to struggle toward self-consciousness, it was again the same order of facts that was singled out by the attention. The very names applied by the early anatomists to many structures so widely separated from the organs of generation as were those of the brain, give testimony of the state of mind that led to and dominated the practice of dissection. In the literature of the past centuries the predominance of the interest in the curious is exemplified in the almost ludicrously monotonous iteration of titles, in which the conspicuous words are curiosa, rara, monstruosa, memorabilia, prodigiosa, selecta, exotica, miraculi, lusibus naturae, occultis naturae, etc., etc. Even when medical science became more strict, it was largely the curious and rare that were thought worthy of chronicling, and not the establishment or illustration of the common, or of general principles. With all his sovereign sound sense, Ambrose Pare has loaded his book with references to impossibly strange, and even mythologic cases. In our day the taste seems to be insatiable, and hardly any medical journal is without its rare or "unique" case, or one noteworthy chiefly by reason of its anomalous features. A curious case is invariably reported, and the insertion of such a report is generally productive of correspondence and discussion with the object of finding a parallel for it. In view of all this it seems itself a curious fact that there has never been any systematic gathering of medical curiosities. It would have been most natural that numerous encyclopedias should spring into existence in response to such a persistently dominant interest. The forelying volume appears to be the first thorough attempt to classify and epitomize the literature of this nature. It has been our purpose to briefly summarize and to arrange in order the records of the most curious, bizarre, and abnormal cases that are found in medical literature of all ages and all languages--a thaumatographia medica. It will be readily seen that such a collection must have a function far beyond the satisfaction of mere curiosity, even if that be stigmatized with the word "idle." If, as we believe, reference may here be found to all such cases in the literature of Medicine (including Anatomy, Physiology, Surgery, Obstetrics, etc.) as show the most extreme and exceptional departures from the ordinary, it follows that the future clinician and investigator must have use for a handbook that decides whether his own strange case has already been paralleled or excelled. He will thus be aided in determining the truth of his statements and the accuracy of his diagnoses. Moreover, to know extremes gives directly some knowledge of means, and by implication and inference it frequently does more. Remarkable injuries illustrate to what extent tissues and organs may be damaged without resultant death, and thus the surgeon is encouraged to proceed to his operation with greater confidence and more definite knowledge as to the issue. If a mad cow may blindly play the part of a successful obstetrician with her horns, certainly a skilled surgeon may hazard entering the womb with his knife. If large portions of an organ,--the lung, a kidney, parts of the liver, or the brain itself,--may be lost by accident, and the patient still live, the physician is taught the lesson of nil desperandum, and that if possible to arrest disease of these organs before their total destruction, the prognosis and treatment thereby acquire new and more hopeful phases. Directly or indirectly many similar examples have also clear medicolegal bearings or suggestions; in fact, it must be acknowledged that much of the importance of medical jurisprudence lies in a thorough comprehension of the anomalous and rare cases in Medicine. Expert medical testimony has its chief value in showing the possibilities of the occurrence of alleged extreme cases, and extraordinary deviations from the natural. Every expert witness should be able to maintain his argument by a full citation of parallels to any remarkable theory or hypothesis advanced by his clients; and it is only by an exhaustive knowledge of extremes and anomalies that an authority on medical jurisprudence can hope to substantiate his testimony beyond question. In every poisoning case he is closely questioned as to the largest dose of the drug in question that has been taken with impunity, and the smallest dose that has killed, and he is expected to have the cases of reported idiosyncrasies and tolerance at his immediate command. A widow with a child of ten months' gestation may be saved the loss of reputation by mention of the authentic cases in which pregnancy has exceeded nine months' duration; the proof of the viability of a seven months' child may alter the disposition of an estate; the proof of death by a blow on the epigastrium without external marks of violence may convict a murderer; and so it is with many other cases of a medicolegal nature. It is noteworthy that in old-time medical literature--sadly and unjustly neglected in our rage for the new--should so often be found parallels of our most wonderful and peculiar modern cases. We wish, also, to enter a mild protest against the modern egotism that would set aside with a sneer as myth and fancy the testimonies and reports of philosophers and physicians, only because they lived hundreds of years ago. We are keenly appreciative of the power exercised by the myth-making faculty in the past, but as applied to early physicians, we suggest that the suspicion may easily be too active. When Pare, for example, pictures a monster, we may distrust his art, his artist, or his engraver, and make all due allowance for his primitive knowledge of teratology, coupled with the exaggerations and inventions of the wonder-lover; but when he describes in his own writing what he or his confreres have seen on the battle-field or in the dissecting room, we think, within moderate limits, we owe him credence. For the rest, we doubt not that the modern reporter is, to be mild, quite as much of a myth-maker as his elder brother, especially if we find modern instances that are essentially like the older cases reported in reputable journals or books, and by men presumably honest. In our collection we have endeavored, so far as possible, to cite similar cases from the older and from the more recent literature. This connection suggests the question of credibility in general. It need hardly be said that the lay-journalist and newspaper reporter have usually been ignored by us, simply because experience and investigation have many times proved that a scientific fact, by presentation in most lay-journals, becomes in some mysterious manner, ipso facto, a scientific caricature (or worse!), and if it is so with facts, what must be the effect upon reports based upon no fact whatsoever? It is manifestly impossible for us to guarantee the credibility of chronicles given. If we have been reasonably certain of unreliability, we may not even have mentioned the marvelous statement. Obviously, we could do no more with apparently credible cases, reported by reputable medical men, than to cite author and source and leave the matter there, where our responsibility must end. But where our proper responsibility seemed likely never to end was in carrying out the enormous labor requisite for a reasonable certainty that we had omitted no searching that might lead to undiscovered facts, ancient or modern. Choice in selection is always, of course, an affair de gustibus, and especially when, like the present, there is considerable embarrassment of riches, coupled with the purpose of compressing our results in one handy volume. In brief, it may be said that several years of exhaustive research have been spent by us in the great medical libraries of the United States and Europe in collecting the material herewith presented. If, despite of this, omissions and errors are to be found, we shall be grateful to have them pointed out. It must be remembered that limits of space have forbidden satisfactory discussion of the cases, and the prime object of the whole work has been to carefully collect and group the anomalies and curiosities, and allow the reader to form his own conclusions and make his own deductions. As the entire labor in the preparation of the forelying volume, from the inception of the idea to the completion of the index, has been exclusively the personal work of the authors, it is with full confidence of the authenticity of the reports quoted that the material is presented. Complete references are given to those facts that are comparatively unknown or unique, or that are worthy of particular interest or further investigation. To prevent unnecessary loading of the book with foot-notes, in those instances in which there are a number of cases of the same nature, and a description has not been thought necessary, mere citation being sufficient, references are but briefly given or omitted altogether. For the same reason a bibliographic index has been added at the end of the text. This contains the most important sources of information used, and each journal or book therein has its own number, which is used in its stead all through the book (thus, 476 signifies The Lancet, London; 597, the New York Medical Journal; etc.). These bibliographic numbers begin at 100. Notwithstanding that every effort has been made to conveniently and satisfactorily group the thousands of cases contained in the book (a labor of no small proportions in itself), a complete general index is a practical necessity for the full success of what is essentially a reference-volume, and consequently one has been added, in which may be found not only the subjects under consideration and numerous cross-references, but also the names of the authors of the most important reports. A table of contents follows this preface. We assume the responsibility for innovations in orthography, certain abbreviations, and the occasional substitution of figures for large numerals, fractions, and decimals, made necessary by limited space, and in some cases to more lucidly show tables and statistics. From the variety of the reports, uniformity of nomenclature and numeration is almost impossible. As we contemplate constantly increasing our data, we shall be glad to receive information of any unpublished anomalous or curious cases, either of the past or in the future. For many courtesies most generously extended in aiding our research-work we wish, among others, to acknowledge our especial gratitude and indebtedness to the officers and assistants of the Surgeon-General's Library at Washington, D.C., the Library of the Royal College of Surgeons of London, the Library of the British Museum, the Library of the British Medical Association, the Bibliotheque de Faculte de Medecine de Paris, the Bibliotheque Nationale, and the Library of the College of Physicians of Philadelphia. GEORGE M. GOULD. PHILADELPHIA, October, 1896. WALTER L. PYLE. TABLE OF CONTENTS. CHAPTER PAGES I. GENETIC ANOMALIES . . . . . . . . . . . . . . . . . 17-49 II. PRENATAL ANOMALIES . . . . . . . . . . . . . . . . 50-112 III. OBSTETRIC ANOMALIES . . . . . . . . . . . . . . . 113-143 IV. PROLIFICITY . . . . . . . . . . . . . . . . . . . 144-160 V. MAJOR TERATA . . . . . . . . . . . . . . . . . . . 161-212 VI. MINOR TERATA . . . . . . . . . . . . . . . . . . . 213-323 VII. ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT . . . 324-364 VIII. LONGEVITY . . . . . . . . . . . . . . . . . . . 365-382 IX. PHYSIOLOGIC AND FUNCTIONAL ANOMALIES . . . . . . . 383-526 X. SURGICAL ANOMALIES OF THE HEAD AND NECK . . . . . . 527-587 XI. SURGICAL ANOMALIES OF THE EXTREMITIES . . . . . . 588-605 XII. SURGICAL ANOMALIES OF THE THORAX AND ABDOMEN . . 606-666 XIII. SURGICAL ANOMALIES OF THE GENITOURINARY SYSTEM . 667-696 XIV. MISCELLANEOUS SURGICAL ANOMALIES . . . . . . . . 697-758 XV. ANOMALOUS TYPES AND INSTANCES OF DISEASE . . . . . 759-822 XVI. ANOMALOUS SKIN-DISEASES . . . . . . . . . . . . . 823-851 XVII. ANOMALOUS NERVOUS AND MENTAL DISEASES . . . . . 852-890 XVIII. HISTORIC EPIDEMICS . . . . . . . . . . . . . . 891-914 ANOMALIES AND CURIOSITIES OF MEDICINE. CHAPTER I. GENETIC ANOMALIES. Menstruation has always been of interest, not only to the student of medicine, but to the lay-observer as well. In olden times there were many opinions concerning its causation, all of which, until the era of physiologic investigation, were of superstitious derivation. Believing menstruation to be the natural means of exit of the feminine bodily impurities, the ancients always thought a menstruating woman was to be shunned; her very presence was deleterious to the whole animal economy, as, for instance, among the older writers we find that Pliny remarks: "On the approach of a woman in this state, must will become sour, seeds which are touched by her become sterile, grass withers away, garden plants are parched up, and the fruit will fall from the tree beneath which she sits." He also says that the menstruating women in Cappadocia were perambulated about the fields to preserve the vegetation from worms and caterpillars. According to Flemming, menstrual blood was believed to be so powerful that the mere touch of a menstruating woman would render vines and all kinds of fruit-trees sterile. Among the indigenous Australians, menstrual superstition was so intense that one of the native blacks, who discovered his wife lying on his blanket during her menstrual period, killed her, and died of terror himself in a fortnight. Hence, Australian women during this season are forbidden to touch anything that men use. Aristotle said that the very look of a menstruating woman would take the polish out of a mirror, and the next person looking in it would be bewitched. Frommann mentions a man who said he saw a tree in Goa which withered because a catamenial napkin was hung on it. Bourke remarks that the dread felt by the American Indians in this respect corresponds with the particulars recited by Pliny. Squaws at the time of menstrual purgation are obliged to seclude themselves, and in most instances to occupy isolated lodges, and in all tribes are forbidden to prepare food for anyone save themselves. It was believed that, were a menstruating woman to step astride a rifle, a bow, or a lance, the weapon would have no utility. Medicine men are in the habit of making a "protective" clause whenever they concoct a "medicine," which is to the effect that the "medicine" will be effective provided that no woman in this condition is allowed to approach the tent of the official in charge. Empiricism had doubtless taught the ancient husbands the dangers of sexual intercourse during this period, and the after-results of many such connections were looked upon as manifestations of the contagiousness of the evil excretions issuing at this period. Hence at one time menstruation was held in much awe and abhorrence. On the other hand, in some of the eastern countries menstruation was regarded as sacred, and the first menstrual discharge was considered so valuable that premenstrual marriages were inaugurated in order that the first ovum might not be wasted, but fertilized, because it was supposed to be the purest and best for the purpose. Such customs are extant at the present day in some parts of India, despite the efforts of the British Government to suppress them, and descriptions of child-marriages and their evil results have often been given by missionaries. As the advances of physiology enlightened the mind as to the true nature of the menstrual period, and the age of superstition gradually disappeared, the intense interest in menstruation vanished, and now, rather than being held in fear and awe, the physicians of to-day constantly see the results of copulation during this period. The uncontrollable desire of the husband and the mercenary aims of the prostitute furnish examples of modern disregard. The anomalies of menstruation must naturally have attracted much attention, and we find medical literature of all times replete with examples. While some are simply examples of vicarious or compensatory menstruation, and were so explained even by the older writers, there are many that are physiologic curiosities of considerable interest. Lheritier furnishes the oft-quoted history of the case of a young girl who suffered from suppression of menses, which, instead of flowing through the natural channels, issued periodically from vesicles on the leg for a period of six months, when the seat of the discharge changed to an eruption on the left arm, and continued in this location for one year; then the discharge shifted to a sore on the thumb, and at the end of another six months again changed, the next location being on the upper eyelid; here it continued for a period of two years. Brierre de Boismont and Meisner describe a case apparently identical with the foregoing, though not quoting the source. Haller, in a collection of physiologic curiosities covering a period of a century and a half, cites 18 instances of menstruation from the skin. Parrot has also mentioned several cases of this nature. Chambers speaks of bloody sweat occurring periodically in a woman of twenty-seven; the intervals, however, were occasionally but a week or a fortnight, and the exudation was not confined to any one locality. Van Swieten quotes the history of a case of suppression of the menstrual function in which there were convulsive contractions of the body, followed by paralysis of the right arm. Later on, the patient received a blow on the left eye causing amaurosis; swelling of this organ followed, and one month later blood issued from it, and subsequently blood oozed from the skin of the nose, and ran in jets from the skin of the fingers and from the nails. D'Andrade cites an account of a healthy Parsee lady, eighteen years of age, who menstruated regularly from thirteen to fifteen and a half years; the catamenia then became irregular and she suffered occasional hemorrhages from the gums and nose, together with attacks of hematemesis. The menstruation returned, but she never became pregnant, and, later, blood issued from the healthy skin of the left breast and right forearm, recurring every month or two, and finally additional dermal hemorrhage developed on the forehead. Microscopic examination of the exuded blood showed usual constituents present. There are two somewhat similar cases spoken of in French literature. The first was that of a young lady, who, after ten years' suppression of the menstrual discharge, exhibited the flow from a vesicular eruption on the finger. The other case was quite peculiar, the woman being a prostitute, who menstruated from time to time through spots, the size of a five-franc piece, developing on the breasts, buttocks, back, axilla, and epigastrium. Barham records a case similar to the foregoing, in which the menstruation assumed the character of periodic purpura. Duchesne mentions an instance of complete amenorrhea, in which the ordinary flow was replaced by periodic sweats. Parrot speaks of a woman who, when seven months old, suffered from strumous ulcers, which left cicatrices on the right hand, from whence, at the age of six years, issued a sanguineous discharge with associate convulsions. One day, while in violent grief, she shed bloody tears. She menstruated at the age of eleven, and was temporarily improved in her condition; but after any strong emotion the hemorrhages returned. The subsidence of the bleeding followed her first pregnancy, but subsequently on one occasion, when the menses were a few days in arrears, she exhibited a blood-like exudation from the forehead, eyelids, and scalp. As in the case under D'Andrade's observation, the exudation was found by microscopic examination to consist of the true constituents of blood. An additional element of complication in this case was the occurrence of occasional attacks of hematemesis. Menstruation from the Breasts.--Being in close sympathy with the generative function, we would naturally expect to find the female mammae involved in cases of anomalous menstruation, and the truth of this supposition is substantiated in the abundance of such cases on record. Schenck reports instances of menstruation from the nipple; and Richter, de Fontechia, Laurentius, Marcellus Donatus, Amatus Lusitanus, and Bierling are some of the older writers who have observed this anomaly. Pare says the wife of Pierre de Feure, an iron merchant, living at Chasteaudun, menstruated such quantities from the breasts each month that several serviettes were necessary to receive the discharge. Cazenave details the history of a case in which the mammary menstruation was associated with a similar exudation from the face, and Wolff saw an example associated with hemorrhage from the fauces. In the Lancet (1840-1841) is an instance of monthly discharge from beneath the left mamma. Finley also writes of an example of mammary hemorrhage simulating menstruation. Barnes saw a case in St. George's Hospital, London, 1876, in which the young girl menstruated vicariously from the nipple and stomach. In a London discussion there was mentioned the case of a healthy woman of fifty who never was pregnant, and whose menstruation had ceased two years previously, but who for twelve months had menstruated regularly from the nipples, the hemorrhage being so profuse as to require constant change of napkins. The mammae were large and painful, and the accompanying symptoms were those of ordinary menstruation. Boulger mentions an instance of periodic menstrual discharge from beneath the left mamma. Jacobson speaks of habitual menstruation by both breasts. Rouxeau describes amenorrhea in a girl of seventeen, who menstruated from the breast; and Teufard reports a case in which there was reestablishment of menstruation by the mammae at the age of fifty-six. Baker details in full the description of a case of vicarious menstruation from an ulcer on the right mamma of a woman of twenty. At the time he was called to see her she was suffering with what was called "green-sickness." The girl had never menstruated regularly or freely. The right mamma was quite well developed, flaccid, the nipple prominent, and the superficial veins larger and more tortuous than usual. The patient stated that the right mamma had always been larger than the left. The areola was large and well marked, and 1/4 inch from its outer edge, immediately under the nipple, there was an ulcer with slightly elevated edges measuring about 1 1/4 inches across the base, and having an opening in its center 1/4 inch in diameter, covered with a thin scab. By removing the scab and making pressure at the base of the ulcer, drops of thick, mucopurulent matter were made to exude. This discharge, however, was not offensive to the smell. On March 17, 1846, the breast became much enlarged and congested, as portrayed in Plate 1. The ulcer was much inflamed and painful, the veins corded and deep colored, and there was a free discharge of sanguineous yellowish matter. When the girl's general health improved and menstruation became more natural, the vicarious discharge diminished in proportion, and the ulcer healed shortly afterward. Every month this breast had enlarged, the ulcer became inflamed and discharged vicariously, continuing in this manner for a few days, with all the accompanying menstrual symptoms, and then dried up gradually. It was stated that the ulcer was the result of the girl's stooping over some bushes to take an egg from a hen's nest, when the point of a palmetto stuck in her breast and broke off. The ulcer subsequently formed, and ultimately discharged a piece of palmetto. This happened just at the time of the beginning of the menstrual epoch. The accompanying figures, Plate 1, show the breast in the ordinary state and at the time of the anomalous discharge. Hancock relates an instance of menstruation from the left breast in a large, otherwise healthy, Englishwoman of thirty-one, who one and a half years after the birth of the youngest child (now ten years old) commenced to have a discharge of fluid from the left breast three days before the time of the regular period. As the fluid escaped from the nipple it became changed in character, passing from a whitish to a bloody and to a yellowish color respectively, and suddenly terminating at the beginning of the real flow from the uterus, to reappear again at the breast at the close of the flow, and then lasting two or three days longer. Some pain of a lancinating type occurred in the breast at this time. The patient first discovered her peculiar condition by a stain of blood upon the night-gown on awakening in the morning, and this she traced to the breast. From an examination it appeared that a neglected lacerated cervix during the birth of the last child had given rise to endometritis, and for a year the patient had suffered from severe menorrhagia, for which she was subsequently treated. At this time the menses became scanty, and then supervened the discharge of bloody fluid from the left breast, as heretofore mentioned. The right breast remained always entirely passive. A remarkable feature of the case was that some escape of fluid occurred from the left breast during coitus. As a possible means of throwing light on this subject it may be added that the patient was unusually vigorous, and during the nursing of her two children she had more than the ordinary amount of milk (galactorrhea), which poured from the breast constantly. Since this time the breasts had been quite normal, except for the tendency manifested in the left one under the conditions given. Cases of menstruation through the eyes are frequently mentioned by the older writers. Bellini, Hellwig, and Dodonaeus all speak of menstruation from the eye. Jonston quotes an example of ocular menstruation in a young Saxon girl, and Bartholinus an instance associated with bloody discharge of the foot. Guepin has an example in a case of a girl of eighteen, who commenced to menstruate when three years old. The menstruation was tolerably regular, occurring every thirty-two or thirty-three days, and lasting from one to six days. At the cessation of the menstrual flow, she generally had a supplementary epistaxis, and on one occasion, when this was omitted, she suffered a sudden effusion into the anterior chamber of the eye. The discharge had only lasted two hours on this occasion. He also relates an example of hemorrhage into the vitreous humor in a case of amenorrhea. Conjunctival hemorrhage has been noticed as a manifestation of vicarious menstruation by several American observers. Liebreich found examples of retinal hemorrhage in suppressed menstruation, and Sir James Paget says that he has seen a young girl at Moorfields who had a small effusion of blood into the anterior chamber of the eye at the menstrual period, which became absorbed during the intervals of menstruation. Blair relates the history of a case of vicarious menstruation attended with conjunctivitis and opacity of the cornea. Law speaks of a plethoric woman of thirty who bled freely from the eyes, though menstruating regularly. Relative to menstruation from the ear, Spindler, Paullini, and Alibert furnish examples. In Paullini's case the discharge is spoken of as very foul, which makes it quite possible that this was a case of middle-ear disease associated with some menstrual disturbance, and not one of true vicarious menstruation. Alibert's case was consequent upon suppression of the menses. Law cites an instance in a woman of twenty-three, in whom the menstrual discharge was suspended several months. She experienced fulness of the head and bleeding (largely from the ears), which subsequently occurred periodically, being preceded by much throbbing; but the patient finally made a good recovery. Barnes, Stepanoff, and Field adduce examples of this anomaly. Jouilleton relates an instance of menstruation from the right ear for five years, following a miscarriage. Hemorrhage from the mouth of a vicarious nature has been frequently observed associated with menstrual disorders. The Ephemerides, Meibomius, and Rhodius mention instances. The case of Meibomius was that of an infant, and the case mentioned by Rhodius was associated with hemorrhages from the lungs, umbilicus, thigh, and tooth-cavity. Allport reports the history of a case in which there was recession of the gingival margins and alveolar processes, the consequence of amenorrhea. Caso has an instance of menstruation from the gums, and there is on record the description of a woman, aged thirty-two, who had bleeding from the throat preceding menstruation; later the menstruation ceased to be regular, and four years previously, after an unfortunate and violent connection, the menses ceased, and the woman soon developed hemorrhoids and hemoptysis. Henry speaks of a woman who menstruated from the mouth; at the necropsy 207 stones were found in the gall-bladder. Krishaber speaks of a case of lingual menstruation at the epoch of menstruation. Descriptions of menstruation from the extremities are quite numerous. Pechlin offers an example from the foot; Boerhaave from the skin of the hand; Ephemerides from the knee; Albertus from the foot; Zacutus Lusitanus from the left thumb; Bartholinus a curious instance from the hand; and the Ephemerides another during pregnancy from the ankle. Post speaks of a very peculiar case of edema of the arm alternating with the menstrual discharge. Sennert writes of menstruation from the groin associated with hemorrhage from the umbilicus and gums. Moses offers an example of hemorrhage from the umbilicus, doubtless vicarious. Verduc details the history of two cases from the top of the head, and Kerokring cites three similar instances, one of which was associated with hemorrhage from the hand. A peculiar mode is vicarious menstrual hemorrhage through old ulcers, wounds, or cicatrices, and many examples are on record, a few of which will be described. Calder gives an excellent account of menstruation at an ankle-ulcer, and Brincken says he has seen periodical bleeding from the cicatrix of a leprous ulcer. In the Lancet is an account of a case in the Vienna Hospital of simulated stigmata; the scar opened each month and a menstrual flow proceeded therefrom; but by placing a plaster-of-Paris bandage about the wound, sealing it so that tampering with the wound could be easily detected, healing soon ensued, and the imposture was thus exposed. Such would likely be the result of the investigation of most cases of "bleeding wounds" which are exhibited to the ignorant and superstitious for religious purposes. Hogg publishes a report describing a young lady who injured her leg with the broken steel of her crinoline. The wound healed nicely, but always burst out afresh the day preceding the regular period. Forster speaks of a menstrual ulcer of the face, and Moses two of the head. White, quoted by Barnes, cites an instance of vicarious hemorrhage from five deep fissures of the lips in a girl of fourteen; the hemorrhage was periodical and could not be checked. At the advent of each menstrual period the lips became much congested, and the recently-healed menstrual scars burst open anew. Knaggs relates an interesting account of a sequel to an operation for ovarian disease. Following the operation, there was a regular, painless menstruation every month, at which time the lower part of the wound re-opened, and blood issued forth during the three days of the catamenia. McGraw illustrates vicarious menstruation by an example, the discharge issuing from an ovariotomy-scar, and Hooper cites an instance in which the vicarious function was performed by a sloughing ulcer. Buchanan and Simpson describe "amenorrheal ulcers." Dupuytren speaks of denudation of the skin from a burn, with the subsequent development of vicarious catamenia from the seat of the injury. There are cases on record in which the menstruation occurs by the rectum or the urinary tract. Barbee illustrates this by a case in which cholera morbus occurred monthly in lieu of the regular menstrual discharge. Barrett speaks of a case of vicarious menstruation by the rectum. Astbury says he has seen a case of menstruation by the hemorrhoidal vessels, and instances of relief from plethora by vicarious menstruation in this manner are quite common. Rosenbladt cites an instance of menstruation by the bladder, and Salmuth speaks of a pregnant woman who had her monthly flow by the urinary tract. Ford illustrates this anomaly by the case of a woman of thirty-two, who began normal menstruation at fourteen; for quite a period she had vicarious menstruation from the urinary tract, which ceased after the birth of her last child. The coexistence of a floating kidney in this case may have been responsible for this hemorrhage, and in reading reports of so-called menstruation due consideration must be given to the existence of any other than menstrual derangement before we can accept the cases as true vicarious hemorrhage. Tarnier cites an instance of a girl without a uterus, in whom menstruation proceeded from the vagina. Zacutus Lusitanus relates the history of a case of uterine occlusion, with the flow from the lips of the cervix. There is mentioned an instance of menstruation from the labia. The occurrence of menstruation after removal of the uterus or ovaries is frequently reported. Storer, Clay, Tait, and the British and Foreign Medico-Chirurgical Review report cases in which menstruation took place with neither uterus nor ovary. Doubtless many authentic instances like the preceding could be found to-day. Menstruation after hysterectomy and ovariotomy has been attributed to the incomplete removal of the organs in question, yet upon postmortem examination of some cases no vestige of the functional organs in question has been found. Hematemesis is a means of anomalous menstruation, and several instances are recorded. Marcellus Donatus and Benivenius exemplify this with cases. Instances of vicarious and compensatory epistaxis and hemoptysis are so common that any examples would be superfluous. There is recorded an inexplicable case of menstruation from the region of the sternum, and among the curious anomalies of menstruation must be mentioned that reported by Parvin seen in a woman, who, at the menstrual epoch, suffered hemoptysis and oozing of blood from the lips and tongue. Occasionally there was a substitution of a great swelling of the tongue, rendering mastication and articulation very difficult for four or five days. Parvin gives portraits showing the venous congestion and discoloration of the lips. Instances of migratory menstruation, the flow moving periodically from the ordinary passage to the breasts and mammae, are found in the older writers. Salmuth speaks of a woman on whose hands appeared spots immediately before the establishment of the menses. Cases of semimonthly menstruation and many similar anomalies of periodicity are spoken of. The Ephemerides contains an instance of the simulation of menstruation after death, and Testa speaks of menstruation lasting through a long sleep. Instances of black menstruation are to be found, described in full, in the Ephemerides, by Paullini and by Schurig, and in some of the later works; it is possible that an excess of iron, administered for some menstrual disorder, may cause such an alteration in the color of the menstrual fluid. Suppression of menstruation is brought about in many peculiar ways, and sometimes by the slightest of causes, some authentic instances being so strange as to seem mythical. Through the Ephemerides we constantly read of such causes as contact with a corpse, the sight of a serpent or mouse, the sight of monsters, etc. Lightning stroke and curious neuroses have been reported as causes. Many of the older books on obstetric subjects are full of such instances, and modern illustrations are constantly reported. Menstruation in Man.--Periodic discharges of blood in man, constituting what is called "male menstruation," have been frequently noticed and are particularly interesting when the discharge is from the penis or urethra, furnishing a striking analogy to the female function of menstruation. The older authors quoted several such instances, and Mehliss says that in the ancient days certain writers remarked that catamenial lustration from the penis was inflicted on the Jews as a divine punishment. Bartholinus mentions a case in a youth; the Ephemerides several instances; Zacutus Lusitanus, Salmuth, Hngedorn, Fabricius Hildanus, Vesalius, Mead, and Acta Eruditorum all mention instances. Forel saw menstruation in a man. Gloninger tells of a man of thirty-six, who, since the age of seventeen years and five months, had had lunar manifestations of menstruation. Each attack was accompanied by pains in the back and hypogastric region, febrile disturbance, and a sanguineous discharge from the urethra, which resembled in color, consistency, etc., the menstrual flux. King relates that while attending a course of medical lectures at the University of Louisiana he formed the acquaintance of a young student who possessed the normal male generative organs, but in whom the simulated function of menstruation was periodically performed. The cause was inexplicable, and the unfortunate victim was the subject of deep chagrin, and was afflicted with melancholia. He had menstruated for three years in this manner: a fluid exuded from the sebaceous glands of the deep fossa behind the corona glandis; this fluid was of the same appearance as the menstrual flux. The quantity was from one to two ounces, and the discharge lasted from three to six days. At this time the student was twenty-two years of age, of a lymphatic temperament, not particularly lustful, and was never the victim of any venereal disease. The author gives no account of the after-life of this man, his whereabouts being, unfortunately, unknown or omitted. Vicarious Menstruation in the Male.--This simulation of menstruation by the male assumes a vicarious nature as well as in the female. Van Swieten, quoting from Benivenius, relates a case of a man who once a month sweated great quantities of blood from his right flank. Pinel mentions a case of a captain in the army (M. Regis), who was wounded by a bullet in the body and who afterward had a monthly discharge from the urethra. Pinel calls attention particularly to the analogy in this case by mentioning that if the captain were exposed to fatigue, privation, cold, etc., he exhibited the ordinary symptoms of amenorrhea or suppression. Fournier speaks of a man over thirty years old, who had been the subject of a menstrual evacuation since puberty, or shortly after his first sexual intercourse. He would experience pains of the premenstrual type, about twenty-four hours before the appearance of the flow, which subsided when the menstruation began. He was of an intensely voluptuous nature, and constantly gave himself up to sexual excesses. The flow was abundant on the first day, diminished on the second, and ceased on the third. Halliburton, Jouilleton, and Rayman also record male menstruation. Cases of menstruation during pregnancy and lactation are not rare. It is not uncommon to find pregnancy, lactation, and menstruation coexisting. No careful obstetrician will deny pregnancy solely on the regular occurrence of the menstrual periods, any more than he would make the diagnosis of pregnancy from the fact of the suppression of menses. Blake reports an instance of catamenia and mammary secretion during pregnancy. Denaux de Breyne mentions a similar case. The child was born by a face-presentation. De Saint-Moulin cites an instance of the persistence of menstruation during pregnancy in a woman of twenty-four, who had never been regular; the child was born at term. Gelly speaks of a case in which menstruation continued until the third month of pregnancy, when abortion occurred. Post, in describing the birth of a two-pound child, mentions that menstruation had persisted during the mother's pregnancy. Rousset reports a peculiar case in which menstruation appeared during the last four months of pregnancy. There are some cases on record of child-bearing after the menopause, as, for instance, that of Pearson, of a woman who had given birth to nine children up to September, 1836; after this the menses appeared only slightly until July, 1838, when they ceased entirely. A year and a half after this she was delivered of her tenth child. Other cases, somewhat similar, will be found under the discussion of late conception. Precocious menstruation is seen from birth to nine or ten years. Of course, menstruation before the third or fourth year is extremely rare, most of the cases reported before this age being merely accidental sanguineous discharges from the genitals, not regularly periodical, and not true catamenia. However, there are many authentic cases of infantile menstruation on record, which were generally associated with precocious development in other parts as well. Billard says that the source of infantile menstruation is the lining membrane of the uterus; but Camerer explains it as due to ligature of the umbilical cord before the circulation in the pulmonary vessels is thoroughly established. In the consideration of this subject, we must bear in mind the influence of climate and locality on the time of the appearance of menstruation. In the southern countries, girls arrive at maturity at an earlier age than their sisters of the north. Medical reports from India show early puberty of the females of that country. Campbell remarks that girls attain the age of puberty at twelve in Siam, while, on the contrary, some observers report the fact that menstruation does not appear in the Esquimaux women until the age of twenty-three, and then is very scanty, and is only present in the summer months. Cases of menstruation commencing within a few days after birth and exhibiting periodical recurrence are spoken of by Penada, Neues Hannoverisehes Magazin, Drummond, Buxtorf, Arnold, The Lancet, and the British Medical Journal. Cecil relates an instance of menstruation on the sixth day, continuing for five days, in which six or eight drams of blood were lost. Peeples cites an instance in Texas in an infant at the age of five days, which was associated with a remarkable development of the genital organs and breasts. Van Swieten offers an example at the first month; the British Medical Journal at the second month; Conarmond at the third month. Ysabel, a young slave girl belonging to Don Carlos Pedro of Havana, began to menstruate soon after birth, and at the first year was regular in this function. At birth her mamma were well developed and her axillae were slightly covered with hair. At the age of thirty-two months she was three feet ten inches tall, and her genitals and mammae resembled those of a girl of thirteen. Her voice was grave and sonorous; her moral inclinations were not known. Deever records an instance of a child two years and seven months old who, with the exception of three months only, had menstruated regularly since the fourth month. Harle speaks of a child, the youngest of three girls, who had a bloody discharge at the age of five months which lasted three days and recurred every month until the child was weaned at the tenth month. At the eleventh month it returned and continued periodically until death, occasioned by diarrhea at the fourteenth month. The necropsy showed a uterus 1 5/8 inches long, the lips of which were congested; the left ovary was twice the size of the right, but displayed nothing strikingly abnormal. Baillot and the British Medical Journal cite instances of menstruation at the fourth month. A case is on record of an infant who menstruated at the age of six months, and whose menses returned on the twenty-eighth day exactly. Clark, Wall, and the Lancet give descriptions of cases at the ninth month. Naegele has seen a case at the eighteenth month, and Schmidt and Colly in the second year. Another case is that of a child, nineteen months old, whose breasts and external genitals were fully developed, although the child had shown no sexual desire, and did not exceed other children of the same age in intellectual development. This prodigy was symmetrically formed and of pleasant appearance. Warner speaks of Sophie Gantz, of Jewish parentage, born in Cincinnati, July 27, 1865, whose menses began at the twenty-third month and had continued regularly up to the time of reporting. At the age of three years and six months she was 38 inches tall, 38 pounds in weight, and her girth at the hip was 33 1/2 inches. The pelvis was broad and well shaped, and measured 10 1/2 inches from the anterior surface of the spinous process of one ilium to that of the other, being a little more than the standard pelvis of Churchill, and, in consequence of this pelvic development, her legs were bowed. The mammae and labia had all the appearance of established puberty, and the pubes and axillae were covered with hair. She was lady-like and maidenly in her demeanor, without unnatural constraint or effrontery. A case somewhat similar, though the patient had the appearance of a little old woman, was a child of three whose breasts were as well developed as in a girl of twenty, and whose sexual organs resembled those of a girl at puberty. She had menstruated regularly since the age of two years. Woodruff describes a child who began to menstruate at two years of age and continued regularly thereafter. At the age of six years she was still menstruating, and exhibited beginning signs of puberty. She was 118 cm. tall, her breasts were developed, and she had hair on the mons veneris. Van der Veer mentions an infant who began menstruating at the early age of four months and had continued regularly for over two years. She had the features and development of a child ten or twelve years old. The external labia and the vulva in all its parts were well formed, and the mons veneris was covered with a full growth of hair. Sir Astley Cooper, Mandelshof, the Ephemerides, Rause, Geoffroy-Saint-Hilaire, and several others a report instances of menstruation occurring at three years of age. Le Beau describes an infant prodigy who was born with the mammae well formed and as much hair on the mons veneris as a girl of thirteen or fourteen. She menstruated at three and continued to do so regularly, the flow lasting four days and being copious. At the age of four years and five months she was 42 1/2 inches tall; her features were regular, the complexion rosy, the hair chestnut, the eyes blue-gray, her mamma the size of a large orange, and indications that she would be able to bear children at the age of eight. Prideaux cites a case at five, and Gaugirau Casals, a doctor of Agde, has seen a girl of six years who suffered abdominal colic, hemorrhage from the nose, migraine, and neuralgia, all periodically, which, with the association of pruritus of the genitals and engorged mammae, led him to suspect amenorrhea. He ordered baths, and shortly the menstruation appeared and became regular thereafter. Brierre de Boismont records cases of catamenia at five, seven, and eight years; and Skene mentions a girl who menstruated at ten years and five months. She was in the lowest grade of society, living with a drunken father in a tenement house, and was of wretched physical constitution, quite ignorant, and of low moral character, as evinced by her specific vaginitis. Occurring from nine years to the ordinary time of puberty, many cases are recorded. Instances of protracted menstruation are, as a rule, reliable, the individuals themselves being cognizant of the nature of true menstruation, and themselves furnishing the requisite information as to the nature and periodicity of the discharge in question. Such cases range even past the century-mark. Many elaborate statistics on this subject have been gathered by men of ability. Dr. Meyer of Berlin quotes the following:-- 28 at 50 years of age, 3 at 57 years of age, 18 " 51 " " " 3 " 58 " " " 18 " 52 " " " 1 " 59 " " " 11 " 53 " " " 4 " 60 " " " 13 " 54 " " " 4 " 62 " " " 5 " 55 " " " 3 " 63 " " " 4 " 56 " " " These statistics were from examination of 6000 cases of menstruating women. The last seven were found to be in women in the highest class of society. Mehliss has made the following collection of statistics of a somewhat similar nature-- Late Dentition. Late Late Male. Female. Lactation. Menstruation. Between 40 and 50 0 4 0 0 " 50 " 60 1 4 2 1 " 60 " 70 3 2 1 0 " 70 " 80 3 2 0 7 " 80 " 90 6 2 0 0 " 90 " 100 1 1 0 1 Above 100 ..... 6 1 0 1 -- -- -- -- 20 16 3 10 These statistics seem to have been made with the idea of illustrating the marvelous rather than to give the usual prolongation of these functions. It hardly seems possible that ordinary investigation would show no cases of menstruation between sixty and seventy, and seven cases between seventy and eighty; however, in searching literature for such a collection, we must bear in mind that the more extraordinary the instance, the more likely it is that it would be spoken of, as the natural tendency of medical men is to overlook the important ordinary and report the nonimportant extraordinary. Dewees mentions an example of menstruation at sixty-five, and others at fifty-four and fifty-five years. Motte speaks of a case at sixty-one; Ryan and others, at fifty-five, sixty, and sixty-five; Parry, from sixty-six to seventy seven; Desormeux, from sixty to seventy-five; Semple, at seventy and eighty seven; Higgins, at seventy-six; Whitehead, at seventy-seven; Bernstein, at seventy-eight; Beyrat, at eighty-seven; Haller, at one hundred; and highest of all is Blancardi's case, in which menstruation was present at one hundred and six years. In the London Medical and Surgical Journal, 1831, are reported cases at eighty and ninety-five years. In Good's System of Nosology there are instances occurring at seventy-one, eighty, and ninety years. There was a woman in Italy whose menstrual function continued from twenty-four to ninety years. Emmet cites an instance of menstruation at seventy, and Brierre de Boismont one of a woman who menstruated regularly from her twenty-fourth year to the time of her death at ninety-two. Strasberger of Beeskow describes a woman who ceased menstruating at forty-two, who remained in good health up to eighty, suffering slight attacks of rheumatism only, and at this late age was seized with abdominal pains, followed by menstruation, which continued for three years; the woman died the next year. This late menstruation had all the sensible characters of the early one. Kennard mentions a negress, aged ninety-one, who menstruated at fourteen, ceased at forty-nine, and at eighty-two commenced again, and was regular for four years, but had had no return since. On the return of her menstruation, believing that her procreative powers were returning, she married a vigorous negro of thirty-five and experienced little difficulty in satisfying his desires. Du Peyrou de Cheyssiole and Bonhoure speak of an aged peasant woman, past ninety-one years of age, who menstruated regularly. Petersen describes a woman of seventy-nine, who on March 26th was seized with uterine pains lasting a few days and terminating with hemorrhagic discharge. On April 23d she was seized again, and a discharge commenced on the 25th, continuing four days. Up to the time of the report, one year after, this menstruation had been regular. There is an instance on record of a female who menstruated every three months during the period from her fiftieth to her seventy-fourth year, the discharge, however, being very slight. Thomas cites an instance of a woman of sixty-nine who had had no menstruation since her forty-ninth year, but who commenced again the year he saw her. Her mother and sister were similarly affected at the age of sixty, in the first case attributable to grief over the death of a son, in the second ascribed to fright. It seemed to be a peculiar family idiosyncrasy. Velasquez of Tarentum says that the Abbess of Monvicaro at the very advanced age of one hundred had a recurrence of catamenia after a severe illness, and subsequently a new set of teeth and a new growth of hair. Late Establishment of Menstruation.--In some cases menstruation never appears until late in life, presenting the same phenomena as normal menstruation. Perfect relates the history of a woman who had been married many years, and whose menstruation did not appear until her forty-seventh year. She was a widow at the time, and had never been pregnant. Up to the time of her death, which was occasioned by a convulsive colic, in her fifty-seventh year, she had the usual prodromes of menstruation followed by the usual discharge. Rodsewitch speaks of a widow of a peasant who menstruated for the first time at the age of thirty-six. Her first coitus took place at the age of fifteen, before any signs of menstruation had appeared, and from this time all through her married life she was either pregnant or suckling. Her husband died when thirty-six years old, and ever since the catamenial flow had shown itself with great regularity. She had borne twins in her second, fourth, and eighth confinement, and altogether had 16 children. Holdefrund in 1836 mentions a case in which menstruation did not commence until the seventieth year, and Hoyer mentions one delayed to the seventy-sixth year. Marx of Krakau speaks of a woman, aged forty-eight, who had never menstruated; until forty-two years old she had felt no symptoms, but at this time pain began, and at forty-eight regular menstruation ensued. At the time of report, four years after, she was free from pain and amenorrhea, and her flow was regular, though scant. She had been married since she was twenty-eight years of age. A somewhat similar case is mentioned by Gregory of a mother of 7 children who had never had her menstrual flow. There are two instances of delayed menstruation quoted: the first, a woman of thirty, well formed, healthy, of good social position, and with all the signs of puberty except menstruation, which had never appeared; the second, a married woman of forty-two, who throughout a healthy connubial life had never menstruated. An instance is known to the authors of a woman of forty who has never menstruated, though she is of exceptional vigor and development. She has been married many years without pregnancy. The medical literature relative to precocious impregnation is full of marvelous instances. Individually, many of the cases would be beyond credibility, but when instance after instance is reported by reliable authorities we must accept the possibility of their occurrence, even if we doubt the statements of some of the authorities. No less a medical celebrity than the illustrious Sir Astley Cooper remarks that on one occasion he saw a girl in Scotland, seven years old, whose pelvis was so fully developed that he was sure she could easily give birth to a child; and Warner's case of the Jewish girl three and a half years old, with a pelvis of normal width, more than substantiates this supposition. Similar examples of precocious pelvic and sexual development are on record in abundance, and nearly every medical man of experience has seen cases of infantile masturbation. The ordinary period of female maturity is astonishingly late when compared with the lower animals of the same size, particularly when viewed with cases of animal precocity on record. Berthold speaks of a kid fourteen days old which was impregnated by an adult goat, and at the usual period of gestation bore a kid, which was mature but weak, to which it gave milk in abundance, and both the mother and kid grew up strong. Compared with the above, child-bearing by women of eight is not extraordinary. The earliest case of conception that has come to the authors' notice is a quotation in one of the last century books from von Mandelslo of impregnation at six; but a careful search in the British Museum failed to confirm this statement, and, for the present, we must accept the statement as hearsay and without authority available for reference-purposes. Molitor gives an instance of precocious pregnancy in a child of eight. It was probably the same case spoken of by Lefebvre and reported to the Belgium Academy: A girl, born in Luxemborg, well developed sexually, having hair on the pubis at birth, who menstruated at four, and at the age of eight was impregnated by a cousin of thirty-seven, who was sentenced to five years' imprisonment for seduction. The pregnancy terminated by the expulsion of a mole containing a well-characterized human embryo. Schmidt's case in 1779 was in a child who had menstruated at two, and bore a dead fetus when she was but eight years and ten months old. She had all the appearance and development of a girl of seventeen. Kussmaul gives an example of conception at eight. Dodd speaks of a child who menstruated early and continued up to the time of impregnation. She was a hard worker and did all her mother's washing. Her labor pains did not continue over six hours, from first to the last. The child was a large one, weighing 7 pounds, and afterward died in convulsions. The infant's left foot had but 3 toes. The young mother at the time of delivery was only nine years and eight months old, and consequently must have been impregnated before the age of nine. Meyer gives an astonishing instance of birth in a Swiss girl at nine. Carn describes a case of a child who menstruated at two, became pregnant at eight, and lived to an advanced age. Ruttel reports conception in a girl of nine, and as far north as St. Petersburg a girl has become a mother before nine years. The Journal de Scavans, 1684, contains the report of the case of a boy, who survived, being born to a mother of nine years. Beck has reported an instance of delivery in a girl a little over ten years of age. There are instances of fecundity at nine years recorded by Ephemerides, Wolffius, Savonarola, and others. Gleaves reports from Wytheville, Va., the history of what he calls the case of the youngest mother in Virginia--Annie H.--who was born in Bland County, July 15, 1885, and, on September 10, 1895, was delivered of a well-formed child weighing 5 pounds. The girl had not the development of a woman, although she had menstruated regularly since her fifth year. The labor was short and uneventful, and, two hours afterward, the child-mother wanted to arise and dress and would have done so had she been permitted. There were no developments of the mammae nor secretion of milk. The baby was nourished through its short existence (as it only lived a week) by its grandmother, who had a child only a few months old. The parents of this child were prosperous, intelligent, and worthy people, and there was no doubt of the child's age. "Annie is now well and plays about with the other children as if nothing had happened." Harris refers to a Kentucky woman, a mother at ten years, one in Massachusetts a mother at ten years, eight months, and seventeen days, and one in Philadelphia at eleven years and three months. The first case was one of infantile precocity, the other belonging to a much later period, the menstrual function having been established but a few months prior to conception. All these girls had well-developed pelves, large mammae, and the general marks of womanhood, and bore living children. It has been remarked of 3 very markedly precocious cases of pregnancy that one was the daughter of very humble parents, one born in an almshouse, and the other raised by her mother in a house of prostitution. The only significance of this statement is the greater amount of vice and opportunity for precocious sexual intercourse to which they were exposed; doubtless similar cases under more favorable conditions would never be recognized as such. The instance in the Journal decavans is reiterated in 1775, which is but such a repetition as is found all through medical literature--"new friends with old faces," as it were. Haller observed a case of impregnation in a girl of nine, who had menstruated several years, and others who had become pregnant at nine, ten, and twelve years respectively. Rowlett, whose case is mentioned by Harris, saw a child who had menstruated the first year and regularly thereafter, and gave birth to a child weighing 7 3/4 pounds when she was only ten years and thirteen days old. At the time of delivery she measured 4 feet 7 inches in height and weighed 100 pounds. Curtis, who is also quoted by Harris, relates the history of Elizabeth Drayton, who became pregnant before she was ten, and was delivered of a full-grown, living male child weighing 8 pounds. She had menstruated once or twice before conception, was fairly healthy during gestation, and had a rather lingering but natural labor. To complete the story, the father of this child was a boy of fifteen. One of the faculty of Montpellier has reported an instance at New Orleans of a young girl of eleven, who became impregnated by a youth who was not yet sixteen. Maygrier says that he knew a girl of twelve, living in the Faubourg Saint-Germain, who was confined. Harris relates the particulars of the case of a white girl who began to menstruate at eleven years and four months, and who gave birth to an over-sized male child on January 21, 1872, when she was twelve years and nine months old. She had an abundance of milk and nursed the child; the labor was of about eighteen hours' duration, and laceration was avoided. He also speaks of a mulatto girl, born in 1848, who began to menstruate at eleven years and nine months, and gave birth to a female child before she reached thirteen, and bore a second child when fourteen years and seven months old. The child's father was a white boy of seventeen. The following are some Indian statistics: 1 pregnancy at ten, 6 at eleven, 2 at eighteen, 1 at nineteen. Chevers speaks of a mother at ten and others at eleven and twelve; and Green, at Dacca, performed craniotomy upon the fetus of a girl of twelve. Wilson gives an account of a girl thirteen years old, who gave birth to a full-grown female child after three hours' labor. She made a speedy convalescence, but the child died four weeks afterward from bad nursing. The lad who acknowledged paternity was nineteen years old. King reports a well-verified case of confinement in a girl of eleven. Both the mother and child did well. Robertson of Manchester describes a girl, working in a cotton factory, who was a mother at twelve; de La Motte mentions pregnancy before twelve; Kilpatrick in a negress, at eleven years and six months; Fox, at twelve; Hall, at twelve; Kinney, at twelve years, ten months, and sixteen days; Herrick, at thirteen years and nine months; Murillo, at thirteen years; Philippart, at fourteen years; Stallcup, at eleven years and nine months; Stoakley, at thirteen years; Walker, at the age of twelve years and eight months; another case, at twelve years and six months; and Williams, at eleven. An editorial article in the Indian Medical Gazette of Sept., 1890, says:-- "The appearance of menstruation is held by the great majority of natives of India to be evidence and proof of marriageability, but among the Hindu community it is considered disgraceful that a girl should remain unmarried until this function is established. The consequence is that girls are married at the age of nine or ten years, but it is understood or professed that the consummation of the marriage is delayed until after the first menstrual period. There is, however, too much reason to believe that the earlier ceremony is very frequently, perhaps commonly, taken to warrant resort to sexual intercourse before the menstrual flux has occurred: it may be accepted as true that premenstrual copulation is largely practised under the cover of marriage in this country. "From this practice it results that girls become mothers at the earliest possible period of their lives. A native medical witness testified that in about 20 per cent of marriages children were born by wives of from twelve to thirteen years of age. Cases of death caused by the first act of sexual intercourse are by no means rare. They are naturally concealed, but ever and anon they come to light. Dr. Chevers mentioned some 14 cases of this sort in the last edition of his 'Handbook of Medical Jurisprudence for India,' and Dr. Harvey found 5 in the medicolegal returns submitted by the Civil Surgeons of the Bengal Presidency during the years 1870-71-72. "Reform must come from conviction and effort, as in every other case, but meantime the strong arm of the law should be put forth for the protection of female children from the degradation and hurt entailed by premature sexual intercourse. This can easily be done by raising the age of punishable intercourse, which is now fixed at the absurd limit of ten years. Menstruation very seldom appears in native girls before the completed age of twelve years, and if the 'age of consent' were raised to that limit, it would not interfere with the prejudices and customs which insist on marriage before menstruation." In 1816 some girls were admitted to the Paris Maternite as young as thirteen, and during the Revolution several at eleven, and even younger. Smith speaks of a legal case in which a girl, eleven years old, being safely delivered of a living child, charged her uncle with rape. Allen speaks of a girl who became pregnant at twelve years and nine months, and was delivered of a healthy, 9-pound boy before the physician's arrival; the placenta came away afterward, and the mother made a speedy recovery. She was thought to have had "dropsy of the abdomen," as the parents had lost a girl of about the same age who was tapped for ascites. The father of the child was a boy only fourteen years of age. Marvelous to relate, there are on record several cases of twins being born to a child mother. Kay reports a case of twins in a girl of thirteen; Montgomery, at fourteen; and Meigs reports the case of a young girl, of Spanish blood, at Maracaibo, who gave birth to a child before she was twelve and to twins before reaching fourteen years. In the older works, the following authors have reported cases of pregnancy before the appearance of menstruation: Ballonius, Vogel, Morgagni, the anatomist of the kidney, Schenck, Bartholinus, Bierling, Zacchias, Charleton, Mauriceau, Ephemerides, and Fabricius Hildanus. In some cases this precocity seems to be hereditary, being transmitted from mother to daughter, bringing about an almost incredible state of affairs, in which a girl is a grandmother about the ordinary age of maternity. Kay says that he had reported to him, on "pretty good" authority, an instance of a Damascus Jewess who became a grandmother at twenty-one years. In France they record a young grandmother of twenty-eight. Ketchum speaks of a negress, aged thirteen, who gave birth to a well-developed child which began to menstruate at ten years and nine months and at thirteen became pregnant; hence the negress was a grandmother at twenty-five years and nine months. She had a second child before she was sixteen, who began to menstruate at seven years and six months, thus proving the inheritance of this precocity, and leaving us at sea to figure what degree of grandmother she may be if she lives to an advanced age. Another interesting case of this nature is that of Mrs. C., born 1854, married in 1867, and who had a daughter ten months after. This daughter married in 1882, and in March, 1883, gave birth to a 9-pound boy. The youthful grandmother, not twenty-nine, was present at the birth. This case was remarkable, as the children were both legitimate. Fecundity in the old seems to have attracted fully as much attention among the older observers as precocity. Pliny speaks of Cornelia, of the family of Serpios, who bore a son at sixty, who was named Volusius Saturnius; and Marsa, a physician of Venice, was deceived in a pregnancy in a woman of sixty, his diagnosis being "dropsy." Tarenta records the history of the case of a woman who menstruated and bore children when past the age of sixty. Among the older reports are those of Blanchard of a woman who bore a child at sixty years; Fielitz, one at sixty; Ephemerides, one at sixty-two; Rush, one at sixty; Bernstein, one at sixty years; Schoepfer, at seventy years; and, almost beyond belief, Debes cites an instance as taking place at the very advanced age of one hundred and three. Wallace speaks of a woman in the Isle of Orkney bearing children when past the age of sixty. We would naturally expect to find the age of child-bearing prolonged in the northern countries where the age of maturity is later. Capuron cites an example of child-birth in a woman of sixty; Haller, cases at fifty-eight, sixty-three, and seventy; Dewees, at sixty-one; and Thibaut de Chauvalon, in a woman of Martinique aged ninety years. There was a woman delivered in Germany, in 1723, at the age of fifty-five; one at fifty-one in Kentucky; and one in Russia at fifty. Depasse speaks of a woman of fifty-nine years and five months old who was delivered of a healthy male child, which she suckled, weaning it on her sixtieth birthday. She had been a widow for twenty years, and had ceased to menstruate nearly ten years before. In St. Peter's Church, in East Oxford, is a monument bearing an inscription recording the death in child-birth of a woman sixty-two years old. Cachot relates the case of a woman of fifty-three, who was delivered of a living child by means of the forceps, and a year after bore a second child without instrumental interference. She had no milk in her breasts at the time and no signs of secretion. This aged mother had been married at fifty-two, five years after the cessation of her menstruation, and her husband was a young man, only twenty-four years old. Kennedy reports a delivery at sixty-two years, and the Cincinnati Enquirer, January, 1863, says: "Dr. W. McCarthy was in attendance on a lady of sixty-nine years, on Thursday night last, who gave birth to a fine boy. The father of the child is seventy-four years old, and the mother and child are doing well." Quite recently there died in Great Britain a Mrs. Henry of Gortree at the age of one hundred and twelve, leaving a daughter of nine years. Mayham saw a woman seventy-three years old who recovered after delivery of a child. A most peculiar case is that of a widow, seventy years old, a native of Garches. She had been in the habit of indulging freely in wine, and, during the last six months, to decided excess. After an unusually prolonged libation she found herself unable to walk home; she sat down by the roadside waiting until she could proceed, and was so found by a young man who knew her and who proposed helping her home. By the time her house was reached night was well advanced, and she invited him to stop over night; finding her more than affable, he stopped at her house over four nights, and the result of his visits was an ensuing pregnancy for Madame. Multiple births in the aged have been reported from authentic sources. The Lancet quotes a rather fabulous account of a lady over sixty-two years of age who gave birth to triplets, making her total number of children 13. Montgomery, Colomb, and Knehel, each, have recorded the birth of twins in women beyond the usual age of the menopause, and there is a case recorded of a woman of fifty-two who was delivered of twins. Impregnation without completion of the copulative act by reason of some malformation, such as occlusion of the vagina or uterus, fibrous and unruptured hymen, etc., has been a subject of discussion in the works of medical jurisprudence of all ages; and cases of conception without entrance of the penis are found in abundance throughout medical literature, and may have an important medicolegal bearing. There is little doubt of the possibility of spermatozoa deposited on the genitalia making progress to the seat of fertilization, as their power of motility and tenacity of life have been well demonstrated. Percy reports an instance in which semen was found issuing from the os uteri eight and one-half days after the last intercourse; and a microscopic examination of this semen revealed the presence of living as well as dead spermatozoa. We have occasional instances of impregnation by rectal coitus, the semen finding its way into an occluded vaginal canal by a fistulous communication. Guillemeau, the surgeon of the French king, tells of a girl of eighteen, who was brought before the French officials in Paris, in 1607, on the citation of her husband of her inability to allow him completion of the marital function. He alleged that he had made several unsuccessful attempts to enter her, and in doing so had caused paraphimosis. On examination by the surgeons she was found to have a dense membrane, of a fibrous nature, entirely occluding the vagina, which they incised. Immediately afterward the woman exhibited morning sickness and the usual signs of pregnancy, and was delivered in four months of a full-term child, the results of an impregnation occasioned by one of the unsuccessful attempts at entrance. Such instances are numerous in the older literature, and a mere citation of a few is considered sufficient here. Zacchias, Amand, Fabricius Hildanus, Graaf, the discoverer of the follicles that bear his name, Borellus, Blegny, Blanchard, Diemerbroeck, Duddell, Mauriceau, a Reyes, Riolan, Harvey, the discoverer of the circulation of the blood, Wolfius, Walther, Rongier, Ruysch, Forestus, Ephemerides, and Schurig all mention cases of conception with intact hymen, and in which there was no entrance of the penis. Tolberg has an example of hymen integrum after the birth of a fetus five months old, and there is recorded a case of tubal pregnancy in which the hymen was intact. Gilbert gives an account of a case of pregnancy in an unmarried woman, who successfully resisted an attempt at criminal connection and yet became impregnated and gave birth to a perfectly formed female child. The hymen was not ruptured, and the impregnation could not have preceded the birth more than thirty-six weeks. Unfortunately, this poor woman was infected with gonorrhea after the attempted assault. Simmons of St. Louis gives a curious peculiarity of conception, in which there was complete closure of the vagina, subsequent conception, and delivery at term. He made the patient's acquaintance from her application to him in regard to a malcondition of her sexual apparatus, causing much domestic infelicity. Lawson speaks of a woman of thirty-five, who had been married ten months, and whose husband could never effect an entrance; yet she became pregnant and had a normal labor, despite the fact that, in addition to a tough and unruptured hymen, she had an occluding vaginal cyst. Hickinbotham of Birmingham reports the history of two cases of labor at term in females whose hymens were immensely thickened. H. Grey Edwards has seen a case of imperforate hymen which had to be torn through in labor; yet one single act of copulation, even with this obstacle to entrance, sufficed to impregnate. Champion speaks of a woman who became pregnant although her hymen was intact. She had been in the habit of having coitus by the urethra, and all through her pregnancy continued this practice. Houghton speaks of a girl of twenty-five into whose vagina it was impossible to pass the tip of the first finger on account of the dense cicatricial membrane in the orifice, but who gave birth, with comparative ease, to a child at full term, the only interference necessary being a few slight incisions to permit the passage of the head. Tweedie saw an Irish girl of twenty-three, with an imperforate os uteri, who had menstruated only scantily since fourteen and not since her marriage. She became pregnant and went to term, and required some operative interference. He incised at the point of usual location of the os, and one of his incisions was followed by the flow of liquor amnii, and the head fell upon the artificial opening, the diameter of which proved to be one and a half or two inches; the birth then progressed promptly, the child being born alive. Guerard notes an instance in which the opening barely admitted a hair; yet the patient reached the third month of pregnancy, at which time she induced abortion in a manner that could not be ascertained. Roe gives a case of conception in an imperforate uterus, and Duncan relates the history of a case of pregnancy in an unruptured hymen, characterized by an extraordinary ascent of the uterus. Among many, the following modern observers have also reported instances of pregnancy with hymen integrum: Braun, 3 cases; Francis, Horton, Oakman, Brill, 2 cases; Burgess, Haig, Hay, and Smith. Instances in which the presence of an unruptured hymen has complicated or retarded actual labor are quite common, and until the membrane is ruptured by external means the labor is often effectually obstructed. Among others reporting cases of this nature are Beale, Carey, Davis, Emond Fetherston, Leisenring, Mackinlay, Martinelli, Palmer, Rousseau, Ware, and Yale. There are many cases of stricture or complete occlusion of the vagina, congenital or acquired from cicatricial contraction, obstructing delivery, and in some the impregnation seems more marvelous than cases in which the obstruction is only a thin membranous hymen. Often the obstruction is so dense as to require a large bistoury to divide it, and even that is not always sufficient, and the Cesarean operation only can terminate the obstructed delivery; we cannot surmise how conception could have been possible. Staples records a case of pregnancy and parturition with congenital stricture of the vagina. Maisonneuve mentions the successful practice of a Cesarean operation in a case of congenital occlusion of the vagina forming a complete obstruction to delivery. Verdile records an instance of imperforate vagina in which rectovaginal wall was divided and the delivery effected through the rectum and anus. Lombard mentions an observation of complete occlusion of the vagina in a woman, the mother of 4 living children and pregnant for the fifth time. Thus, almost incredible to relate, it is possible for a woman to become a mother of a living child and yet preserve all the vaginal evidences of virginity. Cole describes a woman of twenty-four who was delivered without the rupture of the hymen, and Meek remarks on a similar case. We can readily see that, in a case like that of Verdile, in which rectal delivery is effected, the hymen could be left intact and the product of conception be born alive. A natural sequence to the subject of impregnation without entrance is that of artificial impregnation. From being a matter of wonder and hearsay, it has been demonstrated as a practical and useful method in those cases in which, by reason of some unfortunate anatomic malformation on either the male or the female side, the marriage is unfruitful. There are many cases constantly occurring in which the birth of an heir is a most desirable thing in a person's life. The historic instance of Queen Mary of England, whose anxiety and efforts to bear a child were the subject of public comment and prayers, is but an example of a fact that is occurring every day, and doubtless some of these cases could be righted by the pursuance of some of the methods suggested. There have been rumors from the beginning of the century of women being impregnated in a bath, from contact with cloths containing semen, etc., and some authorities in medical jurisprudence have accepted the possibility of such an occurrence. It is not in the province of this work to speculate on what may be, but to give authoritative facts, from which the reader may draw his own deductions. Fertilization of plants has been thought to have been known in the oldest times, and there are some who believe that the library at Alexandria must have contained some information relative to it. The first authentic account that we have of artificial impregnation is that of Schwammerdam, who in 1680 attempted it without success by the fecundation of the eggs of fish. Roesel, his scholar, made an attempt in 1690, but also failed; and to Jacobi, in 1700, belongs the honor of success. In 1780, Abbe Spallanzani, following up the success of Jacobi, artificially impregnated a bitch, who brought forth in sixty-two days 3 puppies, all resembling the male. The illustrious John Hunter advised a man afflicted with hypospadias to impregnate his wife by vaginal injections of semen in water with an ordinary syringe, and, in spite of the simplicity of this method, the attempt was followed by a successful issue. Since this time, Nicholas of Nancy and Lesueur have practised the simple vaginal method; while Gigon, d'Angouleme (14 cases), Girault (10 cases), Marion Sims, Thomas, Salmon, Pajot, Gallard, Courty, Roubaud, Dehaut, and others have used the more modern uterine method with success. A dog-breeder, by syringing the uterus of a bitch, has succeeded in impregnating her. Those who are desirous of full information on this subject, as regards the modus operandi, etc., are referred to Girault; this author reports in full several examples. One case was that of a woman, aged twenty-five, afflicted with blenorrhea, who, chagrined at not having issue, made repeated forcible injections of semen in water for two months, and finally succeeded in impregnating herself, and was delivered of a living child. Another case was that of a female, aged twenty-three, who had an extra long vaginal canal, probably accounting for the absence of pregnancy. She made injections of semen, and was finally delivered of a child. He also reports the case of a distinguished musician who, by reason of hypospadias, had never impregnated his wife, and had resorted to injections of semen with a favorable result. This latter case seems hardly warranted when we consider that men afflicted with hypospadias and epispadias have become fathers. Percy gives the instance of a gentleman whom he had known for some time, whose urethra terminated a little below the frenum, as in other persons, but whose glans bulged quite prominently beyond it, rendering urination in the forward direction impossible. Despite the fact that this man could not perform the ejaculatory function, he was the father of three children, two of them inheriting his penile formation. The fundamental condition of fecundity being the union of a spermatozoid and an ovum, the object of artificial impregnation is to further this union by introducing semen directly to the fundus of the uterus. The operation is quite simple and as follows: The husband, having been found perfectly healthy, is directed to cohabit with his wife, using a condom. The semen ejaculated is sucked up by an intrauterine syringe which has been properly disinfected and kept warm. The os uteri is now exposed and wiped off with some cotton which has been dipped in an antiseptic fluid; introduced to the fundus of the uterus, and some drops of the fluid slowly expressed into the uterus. The woman is then kept in bed on her back. This operation is best carried out immediately before or immediately after the menstrual epoch, and if not successful at the first attempt should be repeated for several months. At the present day artificial impregnation in pisciculture is extensively used with great success. {footnote} The following extraordinary incident of accidental impregnation, quoted from the American Medical Weekly by the Lancet, is given in brief, not because it bears any semblance of possibility, but as a curious example from the realms of imagination in medicine. L. G. Capers of Vicksburg, Miss., relates an incident during the late Civil War, as follows: A matron and her two daughters, aged fifteen and seventeen years, filled with the enthusiasm of patriotism, stood ready to minister to the wounds of their countrymen in their fine residence near the scene of the battle of R----, May 12, 1863, between a portion of Grant's army and some Confederates. During the fray a gallant and noble young friend of the narrator staggered and fell to the earth; at the same time a piercing cry was heard in the house near by. Examination of the wounded soldier showed that a bullet had passed through the scrotum and carried away the left testicle. The same bullet had apparently penetrated the left side of the abdomen of the elder young lady, midway between the umbilicus and the anterior superior spinous process of the ilium, and had become lost in the abdomen. This daughter suffered an attack of peritonitis, but recovered in two months under the treatment administered. Marvelous to relate, just two hundred and seventy-eight days after the reception of the minie-ball, she was delivered of a fine boy, weighing 8 pounds, to the surprise of herself and the mortification of her parents and friends. The hymen was intact, and the young mother strenuously insisted on her virginity and innocence. About three weeks after this remarkable birth Dr. Capers was called to see the infant, and the grandmother insisted that there was something wrong with the child's genitals. Examination showed a rough, swollen, and sensitive scrotum, containing some hard substance. He operated, and extracted a smashed and battered minie-ball. The doctor, after some meditation, theorized in this manner: He concluded that this was the same ball that had carried away the testicle of his young friend, that had penetrated the ovary of the young lady, and, with some spermatozoa upon it, had impregnated her. With this conviction he approached the young man and told him the circumstances; the soldier appeared skeptical at first, but consented to visit the young mother; a friendship ensued which soon ripened into a happy marriage, and the pair had three children, none resembling, in the same degree as the first, the heroic pater familias. Interesting as are all the anomalies of conception, none are more so than those of unconscious impregnation; and some well-authenticated cases can be mentioned. Instances of violation in sleep, with subsequent pregnancy as a result, have been reported in the last century by Valentini, Genselius, and Schurig. Reports by modern authorities seem to be quite scarce, though there are several cases on record of rape during anesthesia, followed by impregnation. Capuron relates a curious instance of a woman who was raped during lethargy, and who subsequently became pregnant, though her condition was not ascertained until the fourth month, the peculiar abdominal sensation exciting suspicion of the true nature of the case, which had previously been thought impossible. There is a record of a case of a young girl of great moral purity who became pregnant without the slightest knowledge of the source; although, it might be remarked, such cases must be taken "cum grano salis." Cases of conception without the slightest sexual desire or pleasure, either from fright, as in rape, or naturally deficient constitution, have been recorded; as well as conception during intoxication and in a hypnotic trance, which latter has recently assumed a much mooted legal aspect. As far back as 1680, Duverney speaks of conception without the slightest sense of desire or pleasure on the part of the female. Conception with Deficient Organs.--Having spoken of conception with some obstructive interference, conception with some natural or acquired deficiency of the functional, organic, or genital apparatus must be considered. It is a well-known fact that women exhibiting rudimentary development of the uterus or vagina are still liable to become pregnant, and many such cases have been recorded; but the most peculiar cases are those in which pregnancy has appeared after removal of some of the sexual apparatus. Pregnancy going to term with a successful delivery frequently follows the performance of ovariotomy with astonishing rapidity. Olier cites an instance of ovariotomy with a pregnancy of twins three months afterward, and accouchement at term of two well-developed boys. Polaillon speaks of a pregnancy consecutive to ovariotomy, the accouchement being normal at term. Crouch reports a case of successful parturition in a patient who had previously undergone ovariotomy by a large incision. Parsons mentions a case of twin pregnancy two years after ovariotomy attended with abnormal development of one of the children. Cutter speaks of a case in which a woman bore a child one year after the performance of ovariotomy, and Pippingskold of two cases of pregnancy after ovariotomy in which the stump as well as the remaining ovary were cauterized. Brown relates a similar instance with successful delivery. Bixby, Harding, Walker (1878-9), and Mears all report cases, and others are not at all rare. In the cases following shortly after operation, it has been suggested that they may be explained by the long retention of the ova in the uterus, deposited them prior to operation. In the presence of such facts one can but wonder if artificial fecundation of an ovum derived from another woman may ever be brought about in the uterus of a sterile woman! Conception Soon After a Preceding Pregnancy.--Conception sometimes follows birth (or abortion) with astonishing rapidity, and some women seem for a period of their lives either always pregnant or with infants at their breasts. This prolificity is often alluded to, and is not confined to the lower classes, as often stated, but is common even among the nobility. Illustrative of this, we have examples in some of the reigning families in Europe to-day. A peculiar instance is given by Sparkman in which a woman conceived just forty hours after abortion. Rice mentions the case of a woman who was confined with her first child, a boy, on July 31, 1870, and was again delivered of another child on June 4, 1871. She had become pregnant twenty-eight days after delivery. He also mentions another case of a Mrs. C., who, at the age of twenty-three, gave birth to a child on September 13, 1880, and bore a second child on July 2, 1881. She must have become pregnant twenty-one days after the delivery of her first child. Superfetation has been known for many centuries; the Romans had laws prescribing the laws of succession in such cases, and many medical writers have mentioned it. Hippocrates and Aristotle wrote of it, the former at some length. Pliny speaks of a slave who bore two infants, one resembling the master, the other a man with whom she had intercourse, and cites the case as one of superfetation. Schenck relates instances, and Zacchias, Velchius, and Sinibaldus mention eases. Pare seemed to be well conversant with the possibility as well as the actuality of superfetation; and Harvey reports that a certain maid, gotten with child by her master, in order to hide her knavery came to London in September, where she lay in by stealth, and being recovered, returned home. In December of the same year she was unexpectedly delivered of another child, a product of superfetation, which proclaimed the crime that she had so cunningly concealed before. Marcellus Donatus, Goret, Schacher, and Mauriceau mention superfetation. In the Academie des Sciences, at Paris, in 1702, there was mentioned the case of a woman who was delivered of a boy; in the placenta was discovered a sort of bladder which was found to contain a female fetus of the age of from four to five months; and in 1729, before the same society, there was an instance in which two fetuses were born a day apart, one aged forty days and the other at full term. From the description, it does not seem possible that either of these were blighted twin pregnancies. Ruysch gives an account of a surgeon's wife at Amsterdam, in 1686, who was delivered of a strong child which survived, and, six hours after, of a small embryo, the funis of which was full of hydatids and the placenta as large and thick as one of three months. Ruysch accompanies his description with an illustrative figure. At Lyons, in 1782, Benoite Franquet was unexpectedly delivered of a child seven months old; three weeks later she experienced symptoms indicative of the existence of another fetus, and after five months and sixteen days she was delivered of a remarkably strong and healthy child. Baudeloque speaks of a case of superfetation observed by Desgranges in Lyons in 1780. After the birth of the first infant the lochia failed to flow, no milk appeared in the breasts, and the belly remained large. In about three weeks after the accouchement she had connection with her husband, and in a few days felt fetal movements. A second child was born at term, sixty-eight days after the first; and in 1782 both children were living. A woman of Arles was delivered on November 11, 1796, of a child at term; she had connection with her husband four days after; the lochia stopped, and the milk did not flow after this intercourse. About one and a half months after this she felt quickening again, and naturally supposed that she had become impregnated by the first intercourse after confinement; but five months after the first accouchement she was delivered of another child at term, the result of a superfetation. Milk in abundance made its appearance, and she was amply able to nourish both children from the breasts. Lachausse speaks of a woman of thirty who bore one child on April 30, 1748, and another on September 16th in the same year. Her breasts were full enough to nourish both of the children. It might be remarked in comment on this case that, according to a French authority, the woman died in 1755, and on dissection was found to have had a double uterus. A peculiar instance of superfetation was reported by Langmore in which there was an abortion of a fetus between the third and fourth months, apparently dead some time, and thirteen hours later a second fetus; an ovum of about four weeks and of perfect formation was found adherent near the fundus. Tyler Smith mentions a lady pregnant for the first time who miscarried at five months and some time afterward discharged a small clot containing a perfectly fresh and healthy ovum of about four weeks' formation. There was no sign of a double uterus, and the patient menstruated regularly during pregnancy, being unwell three weeks before the abortion. Harley and Tanner speak of a woman of thirty-eight who never had borne twins, and who aborted a fetus of four months' gestation; serious hemorrhage accompanied the removal of the placenta, and on placing the hand in the uterine cavity an embryo of five or six weeks was found inclosed in a sac and floating in clear liquor amnii. The patient was the mother of nine children, the youngest of which was three years old. Young speaks of a woman who three months previously had aborted a three months' fetus, but a tumor still remained in the abdomen, the auscultation of which gave evidence of a fetal heart-beat. Vaginal examination revealed a dilatation of the os uteri of at least one inch and a fetal head pressing out; subsequently a living fetus of about six months of age was delivered. Severe hemorrhage complicated the case, but was controlled, and convalescence speedily ensued. Huse cites an instance of a mother bearing a boy on November 4, 1834, and a girl on August 3, 1835. At birth the boy looked premature, about seven months old, which being the case, the girl must have been either a superfetation or a seven months' child also. Van Bibber of Baltimore says he met a young lady who was born five months after her sister, and who was still living. The most curious and convincing examples of superfetation are those in which children of different colors, either twins or near the same age, are born to the same woman,--similar to that exemplified in the case of the mare who was covered first by a stallion and a quarter of an hour later by an ass, and gave birth at one parturition to a horse and a mule. Parsons speaks of a case at Charleston, S.C., in 1714, of a white woman who gave birth to twins, one a mulatto and the other white. She confessed that after her husband left her a negro servant came to her and forced her to comply with his wishes by threatening her life. Smellie mentions the case of a black woman who had twins, one child black and the other almost white. She confessed having had intercourse with a white overseer immediately after her husband left her bed. Dewees reports a similar case. Newlin of Nashville speaks of a negress who bore twins, one distinctly black with the typical African features, while the other was a pretty mulatto exhibiting the distinct characters of the Caucasian race. Both the parents were perfect types of the black African negro. The mother, on being questioned, frankly acknowledged that shortly after being with her husband she had lain a night with a white man. In this case each child had its own distinct cord and placenta. Archer gives facts illustrating and observations showing: "that a white woman, by intercourse with a white man and negro, may conceive twins, one of which shall be white and the other a mulatto; and that, vice versa, a black woman, by intercourse with a negro and a white man, may conceive twins, one of which shall be a negro and the other a mulatto." Wight narrates that he was called to see a woman, the wife of an East Indian laborer on the Isle of Trinidad, who had been delivered of a fetus 6 inches long, about four months old, and having a cord of about 18 inches in length. He removed the placenta, and in about half an hour the woman was delivered of a full-term white female child. The first child was dark, like the mother and father, and the mother denied any possibility of its being a white man's child; but this was only natural on her part, as East Indian husbands are so intensely jealous that they would even kill an unfaithful wife. Both the mother and the mysterious white baby are doing well. Bouillon speaks of a negress in Guadeloupe who bore twins, one a negro and the other a mulatto. She had sexual congress with both a negro and a white man. Delmas, a surgeon of Rouen, tells of a woman of thirty-six who was delivered in the hospital of his city on February 26, 1806, of two children, one black and the other a mulatto. She had been pregnant eight months, and had had intercourse with a negro twice about her fourth month of pregnancy, though living with the white man who first impregnated her. Two placentae were expelled some time after the twins, and showed a membranous junction. The children died shortly after birth. Pregnancy often takes place in a unicorn or bicorn uterus, leading to similar anomalous conditions. Galle, Hoffman, Massen, and Sanger give interesting accounts of this occurrence, and Ross relates an instance of triple pregnancy in a double uterus. Cleveland describes a discharge of an anomalous deciduous membrane during pregnancy which was probably from the unimpregnated half of a double uterus. CHAPTER II. PRENATAL ANOMALIES. Extrauterine Pregnancy.--In the consideration of prenatal anomalies, the first to be discussed will be those of extrauterine pregnancy. This abnormalism has been known almost as long as there has been any real knowledge of obstetrics. In the writings of Albucasis, during the eleventh century, extrauterine pregnancy is discussed, and later the works of N. Polinus and Cordseus, about the sixteenth century, speak of it; in the case of Cordseus the fetus was converted into a lithopedion and carried in the abdomen twenty-eight years. Horstius in the sixteenth century relates the history of a woman who conceived for the third time in March, 1547, and in 1563 the remains of the fetus were still in the abdomen. Israel Spach, in an extensive gynecologic work published in 1557, figures a lithopedion drawn in situ in the case of a woman with her belly laid open. He dedicated to this calcified fetus, which he regarded as a reversion, the following curious epigram, in allusion to the classical myth that after the flood the world was repopulated by the two survivors, Deucalion and Pyrrha, who walked over the earth and cast stones behind them, which, on striking the ground, became people. Roughly translated from the Latin, this epigram read as follows: "Deucalion cast stones behind him and thus fashioned our tender race from the hard marble. How comes it that nowadays, by a reversal of things, the tender body of a little babe has limbs nearer akin to stone?" Many of the older writers mention this form of fetation as a curiosity, but offer no explanation as to its cause. Mauriceau and de Graaf discuss in full extrauterine pregnancy, and Salmuth, Hannseus, and Bartholinus describe it. From the beginning of the eighteenth century this subject always demanded the attention and interest of medical observers. In more modern times, Campbell and Geoffroy-Saint-Hilaire, who named it "Grossesse Pathologique," have carefully defined and classified the forms, and to-day every text-book on obstetrics gives a scientific discussion and classification of the different forms of extrauterine pregnancy. The site of the conception is generally the wall of the uterus, the Fallopian tube, or the ovary, although there are instances of pregnancy in the vagina, as for example when there is scirrhus of the uterus; and again, cases supposed to be only extrauterine have been instances simply of double uterus, with single or concurrent pregnancy. Ross speaks of a woman of thirty-three who had been married fourteen years, had borne six children, and who on July 16, 1870, miscarried with twins of about five months' development. After a week she declared that she was still pregnant with another child, but as the physician had placed his hand in the uterine cavity after the abortion, he knew the fetus must be elsewhere or that no pregnancy existed. We can readily see how this condition might lead to a diagnosis of extrauterine pregnancy, but as the patient insisted on a thorough examination, the doctor found by the stethoscope the presence of a beating fetal heart, and by vaginal examination a double uterus. On introducing a sound into the new aperture he discovered that it opened into another cavity; but as the woman was pregnant in this, he proceeded no further. On October 31st she was delivered of a female child of full growth. She had menstruated from this bipartite uterus three times during the period between the miscarriage of the twins and the birth of the child. Both the mother and child did well. In most cases there is rupture of the fetal sac into the abdominal cavity or the uterus, and the fetus is ejected into this location, from thence to be removed or carried therein many years; but there are instances in which the conception has been found in situ, as depicted in Figure 2. A sturdy woman of thirty was executed on January 16, 1735, for the murder of her child. It was ascertained that she had passed her catamenia about the first of the month, and thereafter had sexual intercourse with one of her fellow-prisoners. On dissection both Fallopian tubes were found distended, and the left ovary, which bore signs of conception, was twice as large as the right. Campbell quotes another such case in a woman of thirty-eight who for twenty years had practised her vocation as a Cyprian, and who unexpectedly conceived. At the third month of pregnancy a hard extrauterine tumor was found, which was gradually increasing in size and extending to the left side of the hypogastrium, the associate symptoms of pregnancy, sense of pressure, pain, tormina, and dysuria, being unusually severe. There was subsequently at attack of inflammatory fever, followed by tumefaction of the abdomen, convulsions, and death on the ninth day. The fetus had been contained in the peritoneal coat of the ovary until the fourth month, when one of the feet passed through the cyst and caused the fatal result. Signs of acute peritonitis were seen postmortem, the abdominal cavity was full of blood, and the ovary much lacerated. The termination of extrauterine pregnancy varies; in some cases the fetus is extracted by operation after rupture; in others the fetus has been delivered alive by abdominal section; it may be partially absorbed, or carried many years in the abdomen; or it may ulcerate through the confining walls, enter the bowels or bladder, and the remnants of the fetal body be discharged. The curious cases mentioned by older writers, and called abortion by the mouth, etc., are doubtless, in many instances, remnants of extrauterine pregnancies or dermoid cysts. Maroldus speaks in full of such cases; Bartholinus, Salmuth, and a Reyes speak of women vomiting remnants of fetuses. In Germany, in the seventeenth century, there lived a woman who on three different occasions is said to have vomited a fetus. The last miscarriage in this manner was of eight months' growth and was accompanied by its placenta. The older observers thought this woman must have had two orifices to her womb, one of which had some connection with the stomach, as they had records of the dissection of a female in whom was found a conformation similar to this. Discharge of the fetal bones or even the whole of an extrauterine fetus by the rectum is not uncommon. There are two early cases mentioned in which the bones of a fetus were discharged at stool, causing intense pain. Armstrong describes an anomalous case of pregnancy in a syphilitic patient who discharged fetal bones by the rectum. Bubendorf reports the spontaneous elimination of a fetal skeleton by the rectum after five years of retention, with recovery of the patient. Butcher speaks of delivery through the rectum at the fourth month, with recovery. Depaul mentions a similar expulsion after a pregnancy of about two months and a half. Jackson reports the dissection of an extrauterine sac which communicated freely with the large intestine. Peck has an example of spontaneous delivery of an extrauterine fetus by the rectum, with recovery of the mother. Skippon, in the early part of the last century, reports the discharge of the bones of a fetus through an "imposthume" in the groin. Other cases of anal discharge of the product of extrauterine conception are recorded by Winthrop, Woodbury, Tuttle, Atkinson, Browne, Weinlechner, Gibson, Littre, Magruder, Gilland, and many others. De Brun du Bois-Noir speaks of the expulsion of extrauterine remains by the anus after seven years, and Heyerdahl after thirteen years. Benham mentions the discharge of a fetus by the rectum; there was a stricture of the rectum associated with syphilitic patches, necessitating the performance of colotomy. Bartholinus and Rosseus speak of fetal bones being discharged from the urinary passages. Ebersbach, in the Ephemerides of 1717, describes a necropsy in which a human fetus was found contained in the bladder. In 1878 White reported an instance of the discharge of fetal remains through the bladder. Discharge of the Fetus through the Abdominal Walls.--Margaret Parry of Berkshire in 1668 voided the bones of a fetus through the flesh above the os pubis, and in 1684 she was alive and well, having had healthy children afterward. Brodie reports the history of a case in a negress who voided a fetus from an abscess at the navel about the seventeenth month of conception. Modern instances of the discharge of the extrauterine fetus from the walls of the abdomen are frequently reported. Algora speaks of an abdominal pregnancy in which there was spontaneous perforation of the anterior abdominal parietes, followed by death. Bouzal cites an extraordinary case of ectopic gestation in which there was natural expulsion of the fetus through abdominal walls, with subsequent intestinal strangulation. An artificial anus was established and the mother recovered. Brodie, Dunglison, Erich, Rodbard, Fox, and Wilson are among others reporting the expulsion of remnants of ectopic pregnancies through the abdominal parietes. Campbell quotes the case of a Polish woman, aged thirty-five, the mother of nine children, most of whom were stillborn, who conceived for the tenth time, the gestation being normal up to the lying-in period. She had pains followed by extraordinary effusion and some blood into the vagina. After various protracted complaints the abdominal tumor became painful and inflamed in the umbilical region. A breach in the walls soon formed, giving exit to purulent matter and all the bones of a fetus. During this process the patient received no medical treatment, and frequently no assistance in dressing the opening. She recovered, but had an artificial anus all her life. Sarah McKinna was married at sixteen and menstruated for the first time a month thereafter. Ten months after marriage she showed signs of pregnancy and was delivered at full term of a living child; the second child was born ten months after the first, and the second month after the second birth she again showed signs of pregnancy. At the close of nine months these symptoms, with the exception of the suppression of menses, subsided, and in this state she continued for six years. During the first four years she felt discomfort in the region of the umbilicus. About the seventh year she suffered tumefaction of the abdomen and thought she had conceived again. The abscess burst and an elbow of the fetus protruded from the wound. A butcher enlarged the wound and, fixing his finger under the jaw of the fetus, extracted the head. On looking into the abdomen he perceived a black object, whereupon he introduced his hand and extracted piecemeal an entire fetal skeleton and some decomposed animal-matter. The abdomen was bound up, and in six weeks the woman was enabled to superintend her domestic affairs; excepting a ventral hernia she had no bad after-results. Kimura, quoted by Whitney, speaks of a case of extrauterine pregnancy in a Japanese woman of forty-one similar to the foregoing, in which an arm protruded through the abdominal wall above the umbilicus and the remains of a fetus were removed through the aperture. The accompanying illustration shows the appearance of the arm in situ before extraction of the fetus and the location of the wound. Bodinier and Lusk report instances of the delivery of an extrauterine fetus by the vagina; and Mathieson relates the history of the delivery of a living ectopic child by the vagina, with recovery of the mother. Gordon speaks of a curious case in a negress, six months pregnant, in which an extrauterine fetus passed down from the posterior culdesac and occluded the uterus. It was removed through the vagina, and two days later labor-pains set in, and in two hours she was delivered of a uterine child. The placenta was left behind and drainage established through the vagina, and the woman made complete recovery. Combined Intrauterine and Extrauterine Gestation.--Many well-authenticated cases of combined pregnancy, in which one of the products of conception was intrauterine and the other of extrauterine gestation, have been recorded. Clark and Ramsbotham report instances of double conception, one fetus being born alive in the ordinary manner and the other located extrauterine. Chasser speaks of a case in which there was concurrent pregnancy in both the uterus and the Fallopian tube. Smith cites an instance of a woman of twenty-three who became pregnant in August, 1870. In the following December she passed fetal bones from the rectum, and a month later gave birth to an intrauterine fetus of six months' growth. McGee mentions the case of a woman of twenty-eight who became pregnant in July, 1872, and on October 20th and 21st passed several fetal bones by the rectum, and about four months later expelled some from the uterus. From this time she rapidly recovered her strength and health. Devergie quotes an instance of a woman of thirty who had several children, but who died suddenly, and being pregnant was opened. In the right iliac fossa was found a male child weighing 5 pounds and 5 ounces, 8 1/2 inches long, and of about five months' growth. The uterus also contained a male fetus of about three months' gestation. Figure 4 shows combined intrauterine and extrauterine gestation. Hodgen speaks of a woman of twenty-seven, who was regular until November, 1872; early in January, 1873, she had an attack of pain with peritonitis, shortly after which what was apparently an extrauterine pregnancy gradually diminished. On August 17, 1873, after a labor of eight hours, she gave birth to a healthy fetus. The hand in the uterus detected a tumor to the left, which wag reduced to about one-fourth the former size. In April, 1874, the woman still suffered pain and tenderness in the tumor. Hodgen believed this to have been originally a tubal pregnancy, which burst, causing much hemorrhage and the death of the fetus, together with a limited peritonitis. Beach has seen a twin compound pregnancy in which after connection there was a miscarriage in six weeks, and four years after delivery of an extrauterine fetus through the abdominal walls. Cooke cites an example of intrauterine and extrauterine pregnancy progressing simultaneously to full period of gestation, with resultant death. Rosset reports the case of a woman of twenty-seven, who menstruated last in November, 1878, and on August 5, 1879, was delivered of a well-developed dead female child weighing seven pounds. The uterine contractions were feeble, and the attached placenta was removed only with difficulty; there was considerable hemorrhage. The hemorrhage continued to occur at intervals of two weeks, and an extrauterine tumor remained. Two weeks later septicemia supervened and life was despaired of. On the 15th of October a portion of a fetus of five months' growth in an advanced stage of decomposition protruded from the vulva. After the escape of this putrid mass her health returned, and in four months she was again robust and healthy. Whinery speaks of a young woman who at the time of her second child-birth observed a tumor in the abdomen on her right side and felt motion in it. In about a month she was with severe pain which continued a week and then ceased. Health soon improved, and the woman afterward gave birth to a third child; subsequently she noticed that the tumor had enlarged since the first birth, and she had a recurrence of pain and a slight hemorrhage every three weeks, and distinctly felt motion in the tumor. This continued for eighteen months, when, after a most violent attack of pain, all movement ceased, and, as she expressed it, she knew the moment the child died. The tumor lost its natural consistence and felt flabby and dead. An incision was made through the linea alba, and the knife came in contact with a hard, gritty substance, three or four lines thick. The escape of several quarts of dark brown fluid followed the incision, and the operation had to be discontinued on account of the ensuing syncope. About six weeks afterward a bone presented at the orifice, which the woman extracted, and this was soon followed by a mass of bones, hair, and putrid matter. The discharge was small, and gradually grew less in quantity and offensiveness, soon ceasing altogether, and the wound closed. By December health was good and the menses had returned. Ahlfeld, Ambrosioni, Galabin, Packard, Thiernesse, Maxson, de Belamizaran, Dibot, and Chabert are among others recording the phenomenon of coexisting extrauterine and intrauterine pregnancy. Argles mentions simultaneous extrauterine fetation and superfetation. Sanger mentions a triple ectopic gestation, in which there was twin pregnancy in the wall of the uterus and a third ovum at the fimbriated end of the right tube. Careful examination showed this to be a case of intramural twin pregnancy at the point of entrance of the tube and the uterus, while at the abdominal end of the same tube there was another ovum,--the whole being an example of triple unilateral ectopic gestation. The instances of delivery of an extrauterine fetus, with viability of the child, from the abdomen of the mother would attract attention from their rarity alone, but when coupled with associations of additional interest they surely deserve a place in a work of this nature. Osiander speaks of an abdominal fetus being taken out alive, and there is a similar case on record in the early part of this century. The London Medical and Physical Journal, in one of its early numbers, contained an account of an abdominal fetus penetrating the walls of the bladder and being extracted from the walls of the hypogastrium; but Sennertus gives a case which far eclipses this, both mother and fetus surviving. He says that in this case the woman, while pregnant, received a blow on the lower part of her body, in consequence of which a small tumor appeared shortly after the accident. It so happened in this case that the peritoneum was extremely dilatable, and the uterus, with the child inside, made its way into the peritoneal sac. In his presence an incision was made and the fetus taken out alive. Jessop gives an example of extrauterine gestation in a woman of twenty-six, who had previously had normal delivery. In this case an incision was made and a fetus of about eight months' growth was found lying loose in the abdominal cavity in the midst of the intestines. Both the mother and child were saved. This is a very rare result. Campbell, in his celebrated monograph, in a total of 51 operations had only seen recorded the accounts of two children saved, and one of these was too marvelous to believe. Lawson Tait reports a case in which he saved the child, but lost the mother on the fourth day. Parvin describes a case in which death occurred on the third day. Browne quotes Parry as saying that there is one twin pregnancy in 23 extrauterine conceptions. He gives 24 cases of twin conception, one of which was uterine, the other extrauterine, and says that of 7 in the third month, with no operation, the mother died in 5. Of 6 cases of from four and a half to seven months' duration, 2 lived, and in 1 case at the fifth month there was an intrauterine fetus delivered which lived. Of 11 such cases at nine months, 6 mothers lived and 6 intrauterine fetuses lived. In 6 of these cases no operation was performed. In one case the mother died, but both the uterine and the extrauterine conceptions lived. In another the mother and intrauterine fetus died, and the extrauterine fetus lived. Wilson a gives an instance of a woman delivered of a healthy female child at eight months which lived. The after-birth came away without assistance, but the woman still presented every appearance of having another child within her, although examination by the vagina revealed none. Wilson called Chatard in consultation, and from the fetal heart-sounds and other symptoms they decided that there was another pregnancy wholly extrauterine. They allowed the case to go twenty-three days, until pains similar to those of labor occurred, and then decided on celiotomy. The operation was almost bloodless, and a living child weighing eight pounds was extracted. Unfortunately, the mother succumbed after ninety hours, and in a month the intrauterine child died from inanition, but the child of extrauterine gestation thrived. Sales gives the case of a negress of twenty-two, who said that she had been "tricked by a negro," and had a large snake in the abdomen, and could distinctly feel its movements. She stoutly denied any intercourse. It was decided to open the abdominal cyst; the incision was followed by a gush of blood and a placenta came into view, which was extracted with a living child. To the astonishment of the operators the uterus was distended, and it was decided to open it, when another living child was seen and extracted. The cyst and the uterus were cleansed of all clots and the wound closed. The mother died of septicemia, but the children both lived and were doing well six weeks after the operation. A curious case was seen in 1814 of a woman who at her fifth gestation suffered abdominal uneasiness at the third month, and this became intolerable at the ninth month. The head of the fetus could be felt through the abdomen; an incision was made through the parietes; a fully developed female child was delivered, but, unfortunately, the mother died of septic infection. The British Medical Journal quotes: "Pinard (Bull. de l'Acad. de Med., August 6, 1895) records the following, which he describes as an ideal case. The patient was aged thirty-six, had had no illness, and had been regular from the age of fourteen till July, 1894. During August of that year she had nausea and vomiting; on the 22d and 23d she lost a fluid, which was just pink. The symptoms continued during September, on the 22d and 23d of which month there was a similar loss. In October she was kept in bed for two days by abdominal pain, which reappeared in November, and was then associated with pain in micturition and defecation. From that time till February 26, 1895, when she came under Pinard's care, she was attended by several doctors, each of whom adopted a different diagnosis and treatment. One of them, thinking she had a fibroid, made her take in all about an ounce of savin powder, which did not, however, produce any ill effect. When admitted she looked ill and pinched. The left thigh and leg were painful and edematous. The abdomen looked like that of the sixth month of pregnancy. The abdominal wall was tense, smooth, and without lineae albicantes. Palpation revealed a cystic immobile tumor, extending 2 inches above the umbilicus and apparently fixed by deep adhesions. The fetal parts could only be made out with difficulty by deep palpation, but the heart-sounds were easily heard to the right of and below the umbilicus. By the right side of this tumor one could feel a small one, the size of a Tangerine orange, which hardened and softened under examination. When contracted the groove between it and the large tumor became evident. Vaginal examination showed that the cervix, which was slightly deflected forward and to the right and softened, as in uterine gestation, was continuous with the smaller tumor. Cephalic ballottement was obtained in the large tumor. No sound was passed into the uterus for fear of setting up reflex action; the diagnosis of extrauterine gestation at about six and a half months with a living child was established without requiring to be clinched by proving the uterus empty. The patient was kept absolutely at rest in bed and the edema of the left leg cured by position. On April 30th the fundus of the tumor was 35 cm. above the symphysis and the uterus 11 1/2 cm.; the cervix was soft as that of a primipara at term. Operation, May 2d: Uterus found empty, cavity 14 1/2 cm. long. Median incision in abdominal wall; cyst walls exposed; seen to be very slight and filled with enormous vessels, some greater than the little finger. On seizing the wall one of these vessels burst, and the hemorrhage was only rendered greater on attempting to secure it, so great was the friability of the walls. The cyst was therefore rapidly opened and the child extracted by the foot. Hemorrhage was restrained first by pressure of the hands, then by pressure-forceps and ligatures. The walls of the cyst were sewn to the margins of the abdominal wound, the edge of the placenta being included in the suture. A wound was thus formed 10 cm. in diameter, with the placenta for its base; it was filled with iodoform and salicylic gauze. The operation lasted an hour, and the child, a boy weighing 5 1/2 pounds, after a brief period of respiratory difficulties, was perfectly vigorous. There was at first a slight facial asymmetry and a depression on the left upper jaw caused by the point of the left shoulder, against which it had been pressed in the cyst; these soon disappeared, and on the nineteenth day the boy weighed 12 pounds. The maternal wound was not dressed till May 13th, when it was washed with biniodid, 1:4000. The placenta came away piecemeal between May 25th and June 2d. The wound healed up, and the patient got up on the forty-third day, having suckled her infant from the first day after its birth." Quite recently Werder has investigated the question of the ultimate fate of ectopic children delivered alive. He has been able to obtain the record of 40 cases. Of these, 18 died within a week after birth; 5 within a month; 1 died at six months of bronchopneumonia; 1 at seven months of diarrhea; 2 at eleven months, 1 from croup; 1 at eighteen months from cholera infantum--making a total of 26 deaths and leaving 14 children to be accounted for. Of these, 5 were reported as living and well after operation, with no subsequent report; 1 was strong and healthy after three weeks, but there has been no report since; 1 was well at six months, then was lost sight of; 1 was well at the Last report; 2 live and are well at one year; 2 are living and well at two years; 1 (Beisone's case) is well at seven years; and 1 (Tait's case) is well at fourteen and one-half years. The list given on pages 60 and 61 has been quoted by Hirst and Dorland. It contains data relative to 17 cases in which abdominal section has been successfully performed for advanced ectopic gestation with living children. Long Retention of Extrauterine Pregnancy.--The time of the retention of an extrauterine gestation is sometimes remarkable, and it is no uncommon occurrence for several pregnancies to successfully ensue during such retention. The Ephemerides contains examples of extrauterine pregnancy remaining in the abdomen forty-six years; Hannaeus mentioned an instance remaining ten years, the mother being pregnant in the meantime; Primperosius speaks of a similar instance; de Blegny, one of twenty-five years in the abdomen; Birch, a case of eighteen years in the abdomen, the woman bearing in the meantime; Bayle, one of twenty-six years, and the Ephemerides, another. In a woman of forty-six, the labor pains intervened without expulsion of the fetus. Impregnation ensued twice afterward, each followed by the birth of a living child. The woman lived to be ninety-four, and was persuaded that the fetus was still in the abdomen, and directed a postmortem examination to be made after her decease, which was done, and a large cyst containing an ossified fetus was discovered in the left side of the cavity. In 1716 a woman of Joigny when thirty years old, having been married four years, became pregnant, and three months later felt movements and found milk in her breasts. At the ninth month she had labor-pains, but the fetus failed to present; the pains ceased, but recurred in a month, still with a negative result. She fell into a most sickly condition and remained so for eighteen months, when the pains returned again, but soon ceased. Menstruation ceased and the milk in her breasts remained for thirty years. She died at sixty-one of peripneumonia, and on postmortem examination a tumor was found occupying part of the hypogastric and umbilical regions. It weighed eight pounds and consisted of a male fetus of full term with six teeth; it had no odor and its sac contained no liquid. The bones seemed better developed than ordinarily; the skin was thick, callous, and yellowish The chorion, amnion, and placenta were ossified and the cord dried up. Walther mentions the case of an infant which remained almost petrified in the belly of its mother for twenty-three years. No trace of the placenta, cord, or enveloping membrane could be found. Cordier publishes a paper on ectopic gestation, with particular reference to tubal pregnancy, and mentions that when there is rupture between the broad ligaments hemorrhage is greatly limited by the resistance of the surrounding structures, death rarely resulting from the primary rupture in this location. Cordier gives an instance in which he successfully removed a full-grown child, the result of an ectopic gestation which had ruptured intraligamentally and had been retained nearly two years. Lospichlerus gives an account of a mother carrying twins, extrauterine, for six years. Mounsey of Riga, physician to the army of the Czarina, sent to the Royal Society in 1748 the bones of a fetus that had been extracted from one of the fallopian tubes after a lodgment of thirteen years. Starkey Middleton read the report of a case of a child which had been taken out of the abdomen, having lain there nearly sixteen years, during which time the mother had borne four children. It was argued at this time that boys were conceived on the right side and girls on the left, and in commenting on this Middleton remarks that in this case the woman had three boys and one girl after the right fallopian tube had lost its function. Chester cites the instance of a fetus being retained fifty-two years, the mother not dying until her eightieth year. Margaret Mathew carried a child weighing eight pounds in her abdomen for twenty-six years, and which after death was extracted. Aubrey speaks of a woman aged seventy years unconsciously carrying an extrauterine fetus for many years, which was only discovered postmortem. She had ceased to menstruate at forty and had borne a child at twenty-seven. Watkins speaks of a fetus being retained forty-three years; James, others for twenty-five, thirty, forty-six, and fifty years; Murfee, fifty-five years; Cunningham, forty years; Johnson, forty-four years; Josephi, fifteen years (in the urinary bladder); Craddock, twenty-two years, and da Costa Simoes, twenty-six years. Long Retention of Uterine Pregnancy.--Cases of long retained intrauterine pregnancies are on record and deserve as much consideration as those that were extrauterine. Albosius speaks of a mother carrying a child in an ossified condition in the uterus for twenty-eight years. Cheselden speaks of a case in which a child was carried many years in the uterus, being converted into a clay-like substance, but preserving form and outline. Caldwell mentions the case of a woman who carried an ossified fetus in her uterus for sixty years. Camerer describes the retention of a fetus in the uterus for forty-six years; Stengel, one for ten years, and Storer and Buzzell, for twenty-two months. Hannaeus, in 1686, issued a paper on such a case under the title, "Mater, Infantis Mortui Vivum Sepulchrum," which may be found in French translation. Buchner speaks of a fetus being retained in the uterus for six years, and Horstius relates a similar case. Schmidt's Jahrbucher contain the report of a woman of forty-nine, who had borne two children. While threshing corn she felt violent pain like that of labor, and after an illness suffered a constant fetid discharge from the vagina for eleven years, fetal bones being discharged with occasional pain. This poor creature worked along for eleven years, at the end of which time she was forced to bed, and died of symptoms of purulent peritonitis. At the necropsy the uterus was found adherent to the anterior wall of the abdomen and containing remnants of a putrid fetus with its numerous bones. There is an instance recorded of the death of a fetus occurring near term, its retention and subsequent discharge being through a spontaneous opening in the abdominal wall one or two months after. Meigs cites the case of a woman who dated her pregnancy from March, 1848, and which proceeded normally for nine months, but no labor supervened at this time and the menses reappeared. In March, 1849, she passed a few fetal bones by the rectum, and in May, 1855, she died. At the necropsy the uterus was found to contain the remains of a fully developed fetus, minus the portions discharged through a fistulous connection between the uterine cavity and the rectum. In this case there had been retention of a fully developed fetus for nine years. Cox describes the case of a woman who was pregnant seven months, and who was seized with convulsions; the supposed labor-pains passed off, and after death the fetus was found in the womb, having lain there for five years. She had an early return of the menses, and these recurred regularly for four years. Dewees quotes two cases, in one of which the child was carried twenty months in the uterus; in the other, the mother was still living two years and five months after fecundation. Another case was in a woman of sixty, who had conceived at twenty-six, and whose fetus was found, partly ossified, in the uterus after death. There are many narratives of the long continuation of fetal movements, and during recent years, in the Southern States, there was quite a prevalence of this kind of imposters. Many instances of the exhibition of fetal movements in the bellies of old negro women have been noticed by the lay journals, but investigation proves them to have been nothing more than an exceptional control over the abdominal muscles, with the ability to simulate at will the supposed fetal jerks. One old woman went so far as to show the fetus dancing to the music of a banjo with rhythmical movements. Such imposters flourished best in the regions given to "voodooism." We can readily believe how easy the deception might be when we recall the exact simulation of the fetal movements in instances of pseudocyesis. The extraordinary diversity of reports concerning the duration of pregnancy has made this a much mooted question. Many opinions relative to the longest and shortest period of pregnancy, associated with viability of the issue, have been expressed by authors on medical jurisprudence. There is perhaps no information more unsatisfactory or uncertain. Mistakes are so easily made in the date of the occurrence of pregnancy, or in the date of conception, that in the remarkable cases we can hardly accept the propositions as worthy evidence unless associated with other and more convincing facts, such as the appearance and stage of development of the fetus, or circumstances making conception impossible before or after the time mentioned, etc. It will be our endeavor to cite the more seemingly reliable instances of the anomalies of the time or duration of pregnancy reported in reputable periodicals or books. Short Pregnancies.--Hasenet speaks of the possibility of a living birth at four months; Capuron relates the instance of Fortunio Liceti, who was said to have been born at the end of four and a half months and lived to complete his twenty-fourth year. In the case of the Marechal de Richelieu, the Parliament of Paris decreed that an infant of five months possessed that capability of living the ordinary period of existence, i.e., the "viabilite," which the law of France requires for the establishment of inheritance. In his seventh book Pliny gives examples of men who were born out of time. Jonston gives instances of births at five, six, seven, and eight months. Bonnar quotes 5 living births before the one hundred and fiftieth day; 1 of one hundred and twenty-five days; 1 of one hundred and twenty days; 1 of one hundred and thirty-three days, surviving to twenty-one months; and 1 of one hundred and thirty-five days' pregnancy surviving to eighty years. Maisonneuve describes a case in which abortion took place at four and a half months; he found the fetus in its membranes two hours after delivery, and, on laying the membranes open, saw that it was living. He applied warmth, and partly succeeded in restoring it; for a few minutes respiratory movements were performed regularly, but it died in six hours. Taylor quotes Carter concerning the case of a fetus of five months which cried directly after it was born, and in the half hour it lived it tried frequently to breathe. He also quotes Davies, mentioning an instance of a fetus of five months, which lived twelve hours, weighing 2 pounds, and measuring 12 inches, and which cried vigorously. The pupillary membrane was entire, the testes had not descended, and the head was well covered with hair. Usher speaks of a woman who in 1876 was delivered of 2 male children on the one hundred and thirty-ninth day; both lived for an hour; the first weighed 10 ounces 6 drams and measured 9 3/4 inches; the other 10 ounces 7 drams, with the same length as the first. Routh speaks of a Mrs. F----, aged thirty-eight, who had borne 9 children and had had 3 miscarriages, the last conception terminating as such. Her husband was away, and returned October 9, 1869. She did not again see her husband until the 3d or 4th of January. The date of quickening was not observed, and the child was born June 8, 1870. During gestation she was much frightened by a rat. The child was weak, the testes undescended, and it lived but eighteen days, dying of symptoms of atrophy. The parents were poor, of excellent character, and although, according to the evidence, this pregnancy lasted but twenty-two weeks and two days, there was absolutely no reason to suspect infidelity. Ruttel speaks of a child of five months who lived twenty-four hours; and he saw male twins born at the sixth month weighing 3 pounds each who were alive and healthy a year after. Barker cites the case of a female child born on the one hundred and fifty-eighth day that weighed 1 pound and was 11 inches long. It had rudimentary nails, very little hair on the head, its eyelids were closed, and the skin much shriveled; it did not suckle properly, and did not walk until nineteen months old. Three and a half years after, the child was healthy and thriving, but weighed only 29 1/2 pounds. At the time of birth it was wrapped up in a box and placed before the fire. Brouzet speaks of living births of from five to six months' pregnancy, and Kopp speaks of a six months' child which lived four days. The Ephemerides contains accounts of living premature births. Newinton describes a pregnancy of five months terminating with the birth of twins, one of whom lived twenty minutes and the other fifteen. The first was 11 1/2 inches long, and weighed 1 pound 3 1/2 ounces, and the other was 11 inches long, and weighed 1 pound. There is a recent instance of premature birth following a pregnancy of between five and a half and six months, the infant weighing 955 grams. One month after birth, through the good offices of the wet-nurse and M. Villemin, who attended the child and who invented a "couveuse" for the occasion, it measured 38 cm. long. Moore is accredited with the trustworthy report of the case of a woman who bore a child at the end of the fifth month weighing 1 1/2 pounds and measuring 9 inches. It was first nourished by dropping liquid food into its mouth; and at the age of fifteen months it was healthy and weighed 18 pounds. Eikam saw a case of abortion at the fifth month in which the fetus was 6 inches in length and weighed about 8 ounces. The head was sufficiently developed and the cranial bones considerably advanced in ossification. He tied the cord and placed the fetus in warm water. It drew up its feet and arms and turned its head from one side to the other, opening its mouth and trying to breathe. It continued in this wise for an hour, the action of the heart being visible ten minutes after the movements ceased. From its imperfectly developed genitals it was supposed to have been a female. Professor J. Muller, to whom it was shown, said that it was not more than four months old, and this coincided with the mother's calculation. Villemin before the Societe Obstetricale et Gynecologique reported the case of a two-year-old child, born in the sixth month of pregnancy. That the child had not had six months of intrauterine life he could vouch, the statement being borne out by the last menstrual period of the mother, the date of the first fetal movements, the child's weight, which was 30 1/2 ounces, and its appearance. Budin had had this infant under observation from the beginning and corroborated Villemin's statements. He had examined infants of six or seven months that had cried and lived a few days, and had found the alveolar cavities filled with epithelial cells, the lung sinking when placed in a vessel of water. Charpentier reported a case of premature birth in his practice, the child being not more than six and a half months and weighing 33 1/2 ounces. So sure was he that it would not live that he placed it in a basin while he attended to the mother. After this had been done, the child being still alive, he wrapped it in cotton and was surprised next day to find it alive. It was then placed in a small, well-heated room and fed with a spoon on human milk; on the twelfth day it could take the breast, since which time it thrived and grew. There is a case on record of a child viable at six months and twenty days. The mother had a miscarriage at the beginning of 1877, after which menstruation became regular, appearing last from July 3 to 9, 1877. On January 28, 1878, she gave birth to a male infant, which was wrapped in wadding and kept at an artificial temperature. Being unable to suckle, it was fed first on diluted cow's milk. It was so small at birth that the father passed his ring over the foot almost to the knee. On the thirteenth day it weighed 1250 grams, and at the end of a week it was taking the breast. In December, 1879, it had 16 teeth, weighed 10 kilograms, walked with agility, could pronounce some words, and was especially intelligent. Capuron relates an instance of a child born after a pregnancy of six and a half months and in excellent health at two years, and another living at ten years of the same age at birth. Tait speaks of a living female child, born on the one hundred and seventy-ninth day, with no nails on its fingers or toes, no hair, the extremities imperfectly developed, and the skin florid and thin. It was too feeble to grasp its mother's nipple, and was fed for three weeks by milk from the breast through a quill. At forty days it weighed 3 pounds and measured 13 inches. Before the expiration of three months it died of measles. Dodd describes a case in which the catamenia were on the 24th of June, 1838, and continued a week; the woman bore twins on January 11, 1839, one of which survived, the other dying a few minutes after birth. She was never irregular, prompt to the hour, and this fact, coupled with the diminutive size of the children, seemed to verify the duration of the pregnancy. In 1825, Baber of Buxur, India, spoke of a child born at six and a half months, who at the age of fifty days weighed 1 pound and 13 ounces and was 14 inches long. The longest circumference of the head was 10 inches and the shortest 9.1 inches. The child suckled freely and readily. In Spaeth's clinic there was a viable infant at six and a half months weighing 900 grams. Spaeth says that he has known a child of six months to surpass in eventual development its brothers born at full term. In some cases there seems to be a peculiarity in women which manifests itself by regular premature births. La Motte, van Swieten, and Fordere mention females who always brought forth their conceptions at the seventh month. The incubator seems destined to be the future means of preserving these premature births. Several successful cases have been noticed, and by means of an incubator Tarnier succeeded in raising infants which at the age of six months were above the average. A full description of the incubator may be found. The modified Auvard incubator is easily made; the accompanying illustrations (Figs. 5, 6, and 7) explain its mechanism. Several improved incubators have been described in recent years, but the Auvard appears to be the most satisfactory. The question of retardation of labor, like that of premature birth, is open to much discussion, and authorities differ as to the limit of protraction with viability. Aulus Gellius says that, after a long conversation with the physicians and wise men, the Emperor Adrian decided in a case before him, that of a woman of chaste manners and irreproachable character, the child born eleven months after her husband's death was legitimate. Under the Roman law the Decenviri established that a woman may bear a viable child at the tenth month of pregnancy. Paulus Zacchias, physician to Pope Innocent X, declared that birth may be retarded to the tenth month, and sometimes to a longer period. A case was decided in the Supreme Court of Friesland, a province in the northern part of the Netherlands, October, 1634, in which a child born three hundred and thirty-three days after the death of the husband was pronounced legitimate. The Parliament of Paris was gallant enough to come to the rescue of a widow and save her reputation by declaring that a child born after a fourteen months' gestation was legitimate. Bartholinus speaks of an unmarried woman of Leipzig who was delivered after a pregnancy of sixteen months. The civil code of France provides that three hundred days shall constitute the longest period of the legitimacy of an infant; the Scottish law, three hundred days; and the Prussian law, three hundred and one days. There are numerous cases recorded by the older writers. Amman has one of twelve months' duration; Enguin, one of twelve months'; Buchner, a case of twelve months'; Benedictus, one of fourteen months'; de Blegny, one of nineteen months'; Marteau, Osiander, and others of forty-two and forty-four weeks'; and Stark's Archives, one of forty-five weeks', living, and also another case of forty-four weeks'. An incredible case is recorded of an infant which lived after a three years' gestation. Instances of twelve months' duration are also recorded. Jonston quotes Paschal in relating an instance of birth after pregnancy of twenty-three months; Aventium, one after two years; and Mercurialis, a birth after a four years' gestation--which is, of course, beyond belief. Thormeau writes from Tours, 1580, of a case of gestation prolonged to the twenty-third month, and Santorini, at Venice, in 1721, describes a similar case, the child reaching adult life. Elvert records a case of late pregnancy, and Henschel one of forty-six weeks, but the fetus was dead. Schneider cites an instance of three hundred and eight days' duration. Campbell says that Simpson had cases of three hundred and nineteen, three hundred and thirty-two, and three hundred and thirty-six days'; Meigs had one of four hundred and twenty. James Reid, in a table of 500 mature births, gives 14 as being from three hundred and two to three hundred and fifteen days'. Not so long ago a jury rendered a verdict of guilty of fornication and bastardy when it was alleged that the child was born three hundred and seventeen days after intercourse. Taylor relates a case of pregnancy in which the wife of a laborer went to America three hundred and twenty-two days before the birth. Jaffe describes an instance of the prolongation of pregnancy for three hundred and sixty-five days, in which the developments and measurements corresponded to the length of protraction. Bryan speaks of a woman of twenty-five who became pregnant on February 10, 1876, and on June 17th felt motion. On July 28th she was threatened with miscarriage, and by his advice the woman weaned the child at the breast. She expected to be confined the middle of November, 1876, but the expected event did not occur until April 26, 1877, nine months after the quickening and four hundred and forty days from the time of conception. The boy was active and weighed nine pounds. The author cites Meigs' case, and also one of Atlee's, at three hundred and fifty-six days. Talcott, Superintendent of the State Homeopathic Asylum for the Insane, explained the pregnancy of an inmate who had been confined for four years in this institution as one of protracted labor. He said that many such cases have been reported, and that something less than two years before he had charge of a case in which the child was born. He made the report to the New York Senate Commission on Asylums for the Insane as one of three years' protraction. Tidd speaks of a woman who was delivered of a male child at term, and again in ten months delivered of a well-developed male child weighing 7 1/4 pounds; he relates the history of another case, in Clifton, W. Va., of a woman expecting confinement on June 1st going over to September 16th, the fetus being in the uterus over twelve months, and nine months after quickening was felt. Two extraordinary cases are mentioned, one in a woman of thirty-five, who expected to be confined April 24, 1883. In May she had a few labor-pains that passed away, and during the next six months she remained about as large as usual, and was several times thought to be in the early stages of labor. In September the os dilated until the first and second fingers could be passed directly to the head. This condition lasted about a month, but passed away. At times during the last nine months of pregnancy she was almost unable to endure the movements of the child. Finally, on the morning of November 6th, after a pregnancy of four hundred and seventy-six days, she was delivered of a male child weighing 13 pounds. Both the mother and child did well despite the use of chloroform and forceps. The other case was one lasting sixteen months and twenty days. In a rather loose argument, Carey reckons a case of three hundred and fifty days. Menzie gives an instance in a woman aged twenty-eight, the mother of one child, in whom a gestation was prolonged to the seventeenth month. The pregnancy was complicated by carcinoma of the uterus. Ballard describes the case of a girl of sixteen years and six months, whose pregnancy, the result of a single intercourse, lasted three hundred and sixty days. Her labor was short and easy for a primipara, and the child was of the average size. Mackenzie cites the instance of a woman aged thirty-two, a primipara, who had been married ten years and who always had been regular in menstruation. The menses ceased on April 28, 1888, and she felt the child for the first time in September. She had false pains in January, 1889, and labor did not begin until March 8th, lasting sixty-six hours. If all these statements are correct, the probable duration of this pregnancy was eleven months and ten days. Lundie relates an example of protracted gestation of eleven months, in which an anencephalous fetus was born; and Martin of Birmingham describes a similar case of ten and a half months' duration. Raux-Tripier has seen protraction to the thirteenth month. Enguin reports an observation of an accouchement of twins after a pregnancy that had been prolonged for eleven months. Resnikoff mentions a pregnancy of eleven months' duration in an anemic secundipara. The case had been under his observation from the beginning of pregnancy; the patient would not submit to artificial termination at term, which he advised. After a painful labor of twenty-four hours a macerated and decomposed child was born, together with a closely-adherent placenta. Tarnier reports an instance of partus serotinus in which the product of conception was carried in the uterus forty days after term. The fetus was macerated but not putrid, and the placenta had undergone fatty degeneration. At a recent meeting of the Chicago Gynecological Society, Dr. F. A. Stahl reported the case of a German-Bohemian woman in which the fifth pregnancy terminated three hundred and two days after the last menstruation. Twenty days before there had occurred pains similar to those of labor, but they gradually ceased. The sacral promontory was exaggerated, and the anteroposterior pelvic diameter of the inlet in consequence diminished. The fetus was large and occupied the first position. Version was with difficulty effected and the passage of the after-coming head through the superior strait required expression and traction, during which the child died. The mother suffered a deep laceration of the perineum involving an inch of the wall of the rectum. Among others reporting instances of protracted pregnancy are Collins, eleven months; Desbrest, eighteen months; Henderson, fifteen months; Jefferies, three hundred and fifty-eight days, and De la Vergne gives the history of a woman who carried an infant in her womb for twenty-nine months; this case may possibly belong under the head of fetus long retained in the uterus. Unconscious Pregnancy.--There are numerous instances of women who have had experience in pregnancy unconsciously going almost to the moment of delivery, yet experiencing none of the usual accompanying symptoms of this condition. Crowell speaks of a woman of good social position who had been married seven years, and who had made extensive preparations for a long journey, when she was seized with a "bilious colic," and, to her dismay and surprise, a child was born before the arrival of the doctor summoned on account of her sudden colic and her inability to retain her water. A peculiar feature of this case was the fact that mental disturbance set in immediately afterward, and the mother became morbid and had to be removed to an asylum, but recovered in a few months. Tanner saw a woman of forty-two who had been suffering with abdominal pains. She had been married three years and had never been pregnant. Her catamenia were very scant, but this was attributed to her change of life. She had conceived, had gone to the full term of gestation, and was in labor ten hours without any suspicion of pregnancy. She was successfully delivered of a girl, which occasioned much rejoicing in the household. Tasker of Kendall's Mills, Me., reports the case of a young married woman calling him for bilious colic. He found the stomach slightly distended and questioned her about the possibility of pregnancy. Both she and her husband informed him that such could not be the case, as her courses had been regular and her waist not enlarged, as she had worn a certain corset all the time. There were no signs of quickening, no change in the breasts, and, in fact, none of the usual signs of pregnancy present. He gave her an opiate, and to her surprise, in about six hours she was the mother of a boy weighing five pounds. Both the mother and child made a good recovery. Duke cites the instance of a woman who supposed that she was not pregnant up to the night of her miscarriage. She had menstruated and was suckling a child sixteen months old. During the night she was attacked with pains resembling those of labor and a fetus slipped into the vagina without any hemorrhage; the placenta came away directly afterward. In this peculiar case the woman was menstruating regularly, suckling a child, and at the same time was unconsciously pregnant. Isham speaks of a case of unconscious pregnancy in which extremely small twins were delivered at the eighth month. Fox cites an instance of a woman who had borne eight children, and yet unconscious of pregnancy. Merriman speaks of a woman forty years of age who had not borne a child for nine years, but who suddenly gave birth to a stout, healthy boy without being cognizant of pregnancy. Dayral tells of a woman who carried a child all through pregnancy, unconscious of her condition, and who was greatly surprised at its birth. Among the French observers speaking of pregnancy remaining unrecognized by the mother until the period of accouchement, Lozes and Rhades record peculiar cases; and Mouronval relates an instance in which a woman who had borne three children completely ignored the presence of pregnancy until the pains of labor were felt. Fleishman and Munzenthaler also record examples of unconscious pregnancy. Pseudocyesis.--On the other hand, instances of pregnancy with imaginary symptoms and preparations for birth are sometimes noticed, and many cases are on record. In fact, nearly every text-book on obstetrics gives some space to the subject of pseudocyesis. Suppression of the menses, enlargement of the abdomen, engorgement of the breasts, together with the symptoms produced by the imagination, such as nausea, spasmodic contraction of the abdomen, etc., are for the most part the origin of the cases of pseudocyesis. Of course, many of the cases are not examples of true pseudocyesis, with its interesting phenomena, but instances of malingering for mercenary or other purposes, and some are calculated to deceive the most expert obstetricians by their tricks. Weir Mitchell delineates an interesting case of pseudocyesis as follows: "A woman, young, or else, it may be, at or past the climacteric, eagerly desires a child or is horribly afraid of becoming pregnant. The menses become slight in amount, irregular, and at last cease or not. Meanwhile the abdomen and breasts enlarge, owing to a rapid taking on of fat, and this is far less visible elsewhere. There comes with this excess of fat the most profound conviction of the fact of pregnancy. By and by the child is felt, the physician takes it for granted, and this goes on until the great diagnostician, Time, corrects the delusion. Then the fat disappears with remarkable speed, and the reign of this singular simulation is at an end." In the same article, Dr. Mitchell cites the two following cases under his personal observation: "I was consulted by a lady in regard to a woman of thirty years of age, a nurse in whom she was interested. This person had been married some three years to a very old man possessed of a considerable estate. He died, leaving his wife her legal share and the rest to distant cousins, unless the wife had a child. For two months before he died the woman, who was very anemic, ceased to menstruate. She became sure that she was pregnant, and thereupon took on flesh at a rate and in a way which seemed to justify her belief. Her breasts and abdomen were the chief seats of this overgrowth. The menses did not return, her pallor increased; the child was felt, and every preparation made for delivery. At the eighth month a physician made an examination and assured her of the absence of pregnancy. A second medical opinion confirmed the first, and the tenth month found her of immense size and still positive as to her condition. At the twelfth month her menstrual flow returned, and she became sure it was the early sign of labor. When it passed over she became convinced of her error, and at once dropped weight at the rate of half a pound a day despite every effort to limit the rate of this remarkable loss. At the end of two months she had parted with fifty pounds and was, on the whole, less anemic. At this stage I was consulted by letter, as the woman had become exceedingly hysteric. This briefly stated case, which occurred many years ago, is a fair illustration of my thesis. "Another instance I saw when in general practice. A lady who had several children and suffered much in her pregnancies passed five years without becoming impregnated. Then she missed a period, and had, as usual, vomiting. She made some wild efforts to end her supposed pregnancy, and failing, acquiesced in her fate. The menses returned at the ninth month and were presumed to mean labor. Meanwhile she vomited, up to the eighth month, and ate little. Nevertheless, she took on fat so as to make the abdomen and breasts immense and to excite unusual attention. No physician examined her until the supposed labor began, when, of course, the truth came out. She was pleased not to have another child, and in her case, as in all the others known to me, the fat lessened as soon as the mind was satisfied as to the non-existence of pregnancy. As I now recall the facts, this woman was not more than two months in getting rid of the excess of adipose tissue. Dr. Hirst tells me he has met with cases of women taking on fat with cessation of the menses, and in which there was also a steady belief in the existence of pregnancy. He has not so followed up these cases as to know if in them the fat fell away with speed when once the patient was assured that no child existed within her." Hirst, in an article on the difficulties in the diagnosis of pregnancy, gives several excellent photographs showing the close resemblance between several pathologic conditions and the normal distention of the abdomen in pregnancy. A woman who had several children fell sick with a chest-affection, followed by an edema. For fifteen months she was confined to her bed, and had never had connection with her husband during that time. Her menses ceased; her mammae became engorged and discharged a serous lactescent fluid; her belly enlarged, and both she and her physician felt fetal movements in her abdomen. As in her previous pregnancies, she suffered nausea. Naturally, a suspicion as to her virtue came into her husband's mind, but when he considered that she had never left her bed for fifteen months he thought the pregnancy impossible. Still the wife insisted that she was pregnant and was confirmed in the belief by a midwife. The belly continued to increase, and about eleven months after the cessation of the menses she had the pains of labor. Three doctors and an accoucheur were present, and when they claimed that the fetal head presented the husband gave up in despair; but the supposed fetus was born shortly after, and proved to be only a mass of hydatids, with not the sign of a true pregnancy. Girard of Lyons speaks of a female who had been pregnant several times, but again experienced the signs of pregnancy. Her mammae were engorged with a lactescent fluid, and she felt belly-movements like those of a child; but during all this time she had regular menstruation. Her abdomen progressively increased in size, and between the tenth and eleventh months she suffered what she thought to be labor-pains. These false pains ceased upon taking a bath, and with the disappearance of the other signs was dissipated the fallacious idea of pregnancy. There is mentioned an instance of medicolegal interest of a young girl who showed all the signs of pregnancy and confessed to her parents that she had had commerce with a man. The parents immediately prosecuted the seducer by strenuous legal methods, but when her ninth month came, and after the use of six baths, all the signs of pregnancy vanished. Harvey cites several instances of pseudocyesis, and says we must not rashly determine of the the inordinate birth before the seventh or after the eleventh month. In 1646 a woman, after having laughed heartily at the jests of an ill-bred, covetous clown, was seized with various movements and motions in her belly like those of a child, and these continued for over a month, when the courses appeared again and the movements ceased. The woman was certain that she was pregnant. The most noteworthy historic case of pseudocyesis is that of Queen Mary of England, or "Bloody Mary," as she was called. To insure the succession of a Catholic heir, she was most desirous of having a son by her consort, Philip, and she constantly prayed and wished for pregnancy. Finally her menses stopped; the breasts began to enlarge and became discolored around the nipples. She had morning-sickness of a violent nature and her abdomen enlarged. On consultation with the ladies of her court, her opinion of pregnancy was strongly confirmed. Her favorite amusement then was to make baby-clothes and count on her fingers the months of pregnancy. When the end of the ninth month approached, the people were awakened one night by the joyous peals of the bells of London announcing the new heir. An ambassador had been sent to tell the Pope that Mary could feel the new life within her, and the people rushed to St. Paul's Cathedral to listen to the venerable Archbishop of Canterbury describe the baby-prince and give thanks for his deliverance. The spurious labor pains passed away, and after being assured that no real pregnancy existed in her case, Mary went into violent hysterics, and Philip, disgusted with the whole affair, deserted her; then commenced the persecution of the Protestants, which blighted the reign. Putnam cites the case of a healthy brunet, aged forty, the mother of three children. She had abrupt vertical abdominal movements, so strong as to cause her to plunge and sway from side to side. Her breasts were enlarged, the areolae dark, and the uterus contained an elastic tumor, heavy and rolling under the hand. Her abdomen progressively enlarged to the regular size of matured gestation; but the extrauterine pregnancy, which was supposed to have existed, was not seen at the autopsy, nothing more than an enlarged liver being found. The movement was due to spasmodic movements of the abdominal muscles, the causes being unknown. Madden gives the history of a primipara of twenty-eight, married one year, to whom he was called. On entering the room he was greeted by the midwife, who said she expected the child about 8 P.M. The woman was lying in the usual obstetric position, on the left side, groaning, crying loudly, and pulling hard at a strap fastened to the bed-post. She had a partial cessation of menses, and had complained of tumultuous movements of the child and overflow of milk from the breasts. Examination showed the cervix low down, the os small and circular, and no signs of pregnancy in the uterus. The abdomen was distended with tympanites and the rectum much dilated with accumulated feces. Dr. Madden left her, telling her that she was not pregnant, and when she reappeared at his office in a few days, he reassured her of the nonexistence of pregnancy; she became very indignant, triumphantly squeezed lactescent fluid from her breasts, and, insisting that she could feel fetal movements, left to seek a more sympathetic accoucheur. Underhill, in the words of Hamilton, describes a woman as "having acquired the most accurate description of the breeding symptoms, and with wonderful facility imagined that she had felt every one of them." He found the woman on a bed complaining of great labor-pains, biting a handkerchief, and pulling on a cloth attached to her bed. The finger on the abdomen or vulva elicited symptoms of great sensitiveness. He told her she was not pregnant, and the next day she was sitting up, though the discharge continued, but the simulated throes of labor, which she had so graphically pictured, had ceased. Haultain gives three examples of pseudocyesis, the first with no apparent cause, the second due to carcinoma of the uterus, while in the third there was a small fibroid in the anterior wall of the uterus. Some cases are of purely nervous origin, associated with a purely muscular distention of the abdomen. Clay reported a case due to ascites. Cases of pseudocyesis in women convicted of murder are not uncommon, though most of them are imposters hoping for an extra lease of life. Croon speaks of a child seven years old on whom he performed ovariotomy for a round-celled sarcoma. She had been well up to May, but since then she had several times been raped by a boy, in consequence of which she had constant uterine hemorrhage. Shortly after the first coitus her abdomen began to enlarge, the breasts to develop, and the areolae to darken. In seven months the abdomen presented the signs of pregnancy, but the cervix was soft and patulous; the sound entered three inches and was followed by some hemorrhage. The child was well developed, the mons was covered with hair, and all the associate symptoms tended to increase the deception. Sympathetic Male Nausea of Pregnancy.--Associated with pregnancy there are often present morning-nausea and vomiting as prominent and reliable symptoms. Vomiting is often so excessive as to be provocative of most serious issue and even warranting the induction of abortion. This fact is well known and has been thoroughly discussed, but with it is associated an interesting point, the occasional association of the same symptoms sympathetically in the husband. The belief has long been a superstition in parts of Great Britain, descending to America, and even exists at the present day. Sir Francis Bacon has written on this subject, the substance of his argument being that certain loving husbands so sympathize with their pregnant wives that they suffer morning-sickness in their own person. No less an authority than S. Weir Mitchell called attention to the interesting subject of sympathetic vomiting in the husband in his lectures on nervous maladies some years ago. He also quotes the following case associated with pseudocyesis:-- "A woman had given birth to two female children. Some years passed and her desire for a boy was ungratified. Then she missed her flow once, and had thrice after this, as always took place with her when pregnant, a very small but regular loss. At the second month morning-vomiting came on as usual with her. Meanwhile she became very fat, and as the growth was largely, in fact excessively, abdominal, she became easily sure of her condition. She was not my patient, but her husband consulted me as to his own morning-sickness, which came on with the first occurrence of this sign in his wife, as had been the case twice before in her former pregnancies. I advised him to leave home, and this proved effectual. I learned later that the woman continued to gain flesh and be sick every morning until the seventh month. Then menstruation returned, an examination was made, and when sure that there was no possibility of her being pregnant she began to lose flesh, and within a few months regained her usual size." Hamill reports an instance of morning-sickness in a husband two weeks after the appearance of menstruation in the wife for the last time. He had daily attacks, and it was not until the failure of the next menses that the woman had any other sign of pregnancy than her husband's nausea. His nausea continued for two months, and was the same as that which he had suffered during his wife's former pregnancies, although not until both he and his wife became aware of the existence of pregnancy. The Lancet describes a case in which the husband's nausea and vomiting, as well as that of the wife, began and ended simultaneously. Judkins cites an instance of a man who was sick in the morning while his wife was carrying a child. This occurred during every pregnancy, and the man related that his own father was similarly affected while his mother was in the early months of pregnancy with him, showing an hereditary predisposition. The perverted appetites and peculiar longings of pregnant women furnish curious matter for discussion. From the earliest times there are many such records. Borellus cites an instance, and there are many others, of pregnant women eating excrement with apparent relish. Tulpius, Sennert, Langius, van Swieten, a Castro, and several others report depraved appetites. Several writers have seen avidity for human flesh in such females. Fournier knew a woman with an appetite for the blood of her husband. She gently cut him while he lay asleep by her side and sucked blood from the wounds--a modern "Succubus." Pare mentions the perverted appetites of pregnant women, and says that they have been known to eat plaster, ashes, dirt, charcoal, flour, salt, spices, to drink pure vinegar, and to indulge in all forms of debauchery. Plot gives the case of a woman who would gnaw and eat all the linen off her bed. Hufeland's Journal records the history of a case of a woman of thirty-two, who had been married ten years, who acquired a strong taste for charcoal, and was ravenous for it. It seemed to cheer her and to cure a supposed dyspepsia. She devoured enormous quantities, preferring hard-wood charcoal. Bruyesinus speaks of a woman who had a most perverted appetite for her own milk, and constantly drained her breasts; Krafft-Ebing cites a similar case. Another case is that of a pregnant woman who had a desire for hot and pungent articles of food, and who in a short time devoured a pound of pepper. Scheidemantel cites a case in which the perverted appetite, originating in pregnancy, became permanent, but this is not the experience of most observers. The pregnant wife of a farmer in Hassfort-on-the-Main ate the excrement of her husband. Many instances could be quoted, some in which extreme cases of polydipsia and bulimia developed; these can be readily attributed to the increased call for liquids and food. Other cases of diverse new emotions can be recalled, such as lasciviousness, dirty habits, perverted thoughts, and, on the other hand, extreme piety, chastity, and purity of the mind. Some of the best-natured women are when pregnant extremely cross and irritable and many perversions of disposition are commonly noticed in pregnancy. There is often a longing for a particular kind of food or dish for which no noticeable desire had been displayed before. Maternal Impressions.--Another curious fact associated with pregnancy is the apparent influence of the emotions of the mother on the child in utero. Every one knows of the popular explanation of many birth-marks, their supposed resemblance to some animal or object seen by the mother during pregnancy, etc. The truth of maternal impressions, however, seems to be more firmly established by facts of a substantial nature. There is a natural desire to explain any abnormality or anomaly of the child as due to some incident during the period of the mother's pregnancy, and the truth is often distorted and the imagination heavily drawn upon to furnish the satisfactory explanation. It is the customary speech of the dime-museum lecturer to attribute the existence of some "freak" to an episode in the mother's pregnancy. The poor "Elephant-man" firmly believed his peculiarity was due to the fact that his mother while carrying him in utero was knocked down at the circus by an elephant. In some countries the exhibition of monstrosities is forbidden because of the supposed danger of maternal impression. The celebrated "Siamese Twins" for this reason were forbidden to exhibit themselves for quite a period in France. We shall cite only a few of the most interesting cases from medical literature. Hippocrates saved the honor of a princess, accused of adultery with a negro because she bore a black child, by citing it as a case of maternal impression, the husband of the princess having placed in her room a painting of a negro, to the view of which she was subjected during the whole of her pregnancy. Then, again, in the treatise "De Superfoetatione" there occurs the following distinct statement: "If a pregnant woman has a longing to eat earth or coals, and eats of them, the infant which is born carries on its head the mark of these things." This statement, however, occurs in a work which is not mentioned by any of the ancient authorities, and is rejected by practically all the modern ones; according to Ballantyne, there is, therefore, no absolute proof that Hippocrates was a believer in one of the most popular and long-persisting beliefs concerning fetal deformities. In the explanation of heredity, Hippocrates states "that the body of the male as well as that of the female furnishes the semen. That which is weak (unhealthy) is derived from weak (unhealthy) parts, that which is strong (healthy) from strong (healthy) parts, and the fetus will correspond to the quality of the semen. If the semen of one part come in greater quantity from the male than from the female, this part will resemble more closely the father; if, however, it comes more from the female, the part will rather resemble the mother. If it be true that the semen comes from both parents, then it is impossible for the whole body to resemble either the mother or the father, or neither the one nor the other in anything, but necessarily the child will resemble both the one and the other in something. The child will most resemble the one who contributes most to the formation of the parts." Such was the Hippocratic theory of generation and heredity, and it was ingeniously used to explain the hereditary nature of certain diseases and malformations. For instance, in speaking of the sacred disease (epilepsy), Hippocrates says: "Its origin is hereditary, like that of other diseases; for if a phlegmatic person be born of a phlegmatic, and a bilious of a bilious, and a phthisical of a phthisical, and one having spleen disease of another having disease of the spleen, what is to hinder it from happening that where the father and mother were subject to this disease certain of their offspring should be so affected also? As the semen comes from all parts of the body, healthy particles will come from healthy parts, and unhealthy from unhealthy parts." According to Pare, Damascene saw a girl with long hair like a bear, whose mother had constantly before her a picture of the hairy St. John. Pare also appends an illustration showing the supposed resemblance to a bear. Jonston quotes a case of Heliodorus; it was an Ethiopian, who by the effect of the imagination produced a white child. Pare describes this case more fully: "Heliodorus says that Persina, Queen of Ethiopia, being impregnated by Hydustes, also an Ethiopian, bore a daughter with a white skin, and the anomaly was ascribed to the admiration that a picture of Andromeda excited in Persina throughout the whole of the pregnancy." Van Helmont cites the case of a tailor's wife at Mechlin, who during a conflict outside her house, on seeing a soldier lose his hand at her door, gave birth to a daughter with one hand, the other hand being a bleeding stump; he also speaks of the case of the wife of a merchant at Antwerp, who after seeing a soldier's arm shot off at the siege of Ostend gave birth to a daughter with one arm. Plot speaks of a child bearing the figure of a mouse; when pregnant, the mother had been much frightened by one of these animals. Gassendus describes a fetus with the traces of a wound in the same location as one received by the mother. The Lancet speaks of several cases--one of a child with a face resembling a dog whose mother had been bitten; one of a child with one eye blue and the other black, whose mother during confinement had seen a person so marked; of an infant with fins as upper and lower extremities, the mother having seen such a monster; and another, a child born with its feet covered with scalds and burns, whose mother had been badly frightened by fireworks and a descending rocket. There is the history of a woman who while pregnant at seven months with her fifth child was bitten on the right calf by a dog. Ten weeks after, she bore a child with three marks corresponding in size and appearance to those caused by the dog's teeth on her leg. Kerr reports the case of a woman in her seventh month whose daughter fell on a cooking stove, shocking the mother, who suspected fatal burns. The woman was delivered two months later of an infant blistered about the mouth and extremities in a manner similar to the burns of her sister. This infant died on the third day, but another was born fourteen months later with the same blisters. Inflammation set in and nearly all the fingers and toes sloughed of. In a subsequent confinement, long after the mental agitation, a healthy unmarked infant was born. Hunt describes a case which has since become almost classic of a woman fatally burned, when pregnant eight months, by her clothes catching fire at the kitchen grate. The day after the burns labor began and was terminated by the birth of a well-formed dead female child, apparently blistered and burned in extent and in places corresponding almost exactly to the locations of the mother's injuries. The mother died on the fourth day. Webb reports the history of a negress who during a convulsion while pregnant fell into a fire, burning the whole front of the abdomen, the front and inside of the thighs to the knees, the external genitals, and the left arm. Artificial delivery was deemed necessary, and a dead child, seemingly burned much like its mother, except less intensely, was delivered. There was also one large blister near the inner canthus of the eye and some large blisters about the neck and throat which the mother did not show. There was no history of syphilis nor of any eruptive fever in the mother, who died on the tenth day with tetanus. Graham describes a woman of thirty-five, the mother of seven children, who while pregnant was feeding some rabbits, when one of the animals jumped at her with its eyes "glaring" upon her, causing a sudden fright. Her child was born hydrocephalic. Its mouth and face were small and rabbit-shaped. Instead of a nose, it had a fleshy growth 3/4 inch long by 1/4 inch broad, directed upward at an angle of 45 degrees. The space between this and the mouth was occupied by a body resembling an adult eye. Within this were two small, imperfect eyes which moved freely while life lasted (ten minutes). The child's integument was covered with dark, downy, short hair. The woman recovered and afterward bore two normal children. Parvin mentions an instance of the influence of maternal impression in the causation of a large, vivid, red mark or splotch on the face: "When the mother was in Ireland she was badly frightened by a fire in which some cattle were burned. Again, during the early months of her pregnancy she was frightened by seeing another woman suddenly light the fire with kerosene, and at that time became firmly impressed with the idea that her child would be marked." Parvin also pictures the "turtle-man," an individual with deformed extremities, who might be classed as an ectromelus, perhaps as a phocomelus, or seal-like monster. According to the story, when the mother was a few weeks pregnant her husband, a coarse, rough fisherman, fond of rude jokes, put a large live turtle in the cupboard. In the twilight the wife went to the cupboard and the huge turtle fell out, greatly startling her by its hideous appearance as it fell suddenly to the floor and began to move vigorously. Copeland mentions a curious case in which a woman was attacked by a rattlesnake when in her sixth month of pregnancy, and gave birth to a child whose arm exhibited the shape and action of a snake, and involuntarily went through snake-like movements. The face and mouth also markedly resembled the head of a snake. The teeth were situated like a serpent's fangs. The mere mention of a snake filled the child (a man of twenty-nine) with great horror and rage, "particularly in the snake season." Beale gives the history of a case of a child born with its left eye blackened as by a blow, whose mother was struck in a corresponding portion of the face eight hours before confinement. There is on record an account of a young man of twenty-one suffering from congenital deformities attributed to the fact that his mother was frightened by a guinea-pig having been thrust into her face during pregnancy. He also had congenital deformity of the right auricle. At the autopsy, all the skin, tissues, muscles, and bones were found involved. Owen speaks of a woman who was greatly excited ten months previously by a prurient curiosity to see what appearance the genitals of her brother presented after he had submitted to amputation of the penis on account of carcinoma. The whole penis had been removed. The woman stated that from the time she had thus satisfied herself, her mind was unceasingly engaged in reflecting and sympathizing on the forlorn condition of her brother. While in this mental state she gave birth to a son whose penis was entirely absent, but who was otherwise well and likely to live. The other portions of the genitals were perfect and well developed. The appearance of the nephew and the uncle was identical. A most peculiar case is stated by Clerc as occurring in the experience of Kuss of Strasburg. A woman had a negro paramour in America with whom she had had sexual intercourse several times. She was put in a convent on the Continent, where she stayed two years. On leaving the convent she married a white man, and nine months after she gave birth to a dark-skinned child. The supposition was that during her abode in the convent and the nine months subsequently she had the image of her black paramour constantly before her. Loin speaks of a woman who was greatly impressed by the actions of a clown at a circus, and who brought into the world a child that resembled the fantastic features of the clown in a most striking manner. Mackay describes five cases in which fright produced distinct marks on the fetus. There is a case mentioned in which a pregnant woman was informed that an intimate friend had been thrown from his horse; the immediate cause of death was fracture of the skull, produced by the corner of a dray against which the rider was thrown. The mother was profoundly impressed by the circumstance, which was minutely described to her by an eye-witness. Her child at birth presented a red and sensitive area upon the scalp corresponding in location with the fatal injury in the rider. The child is now an adult woman, and this area upon the scalp remains red and sensitive to pressure, and is almost devoid of hair. Mastin of Mobile, Alabama, reports a curious instance of maternal impression. During the sixth month of the pregnancy of the mother her husband was shot, the ball passing out through the left breast. The woman was naturally much shocked, and remarked to Dr. Mastin: "Doctor, my baby will be ruined, for when I saw the wound I put my hands over my face, and got it covered with blood, and I know my baby will have a bloody face." The child came to term without a bloody face. It had, however, a well-defined spot on the left breast just below the site of exit of the ball from its father's chest. The spot was about the size of a silver half-dollar, and had elevated edges of a bright red color, and was quite visible at the distance of one hundred feet. The authors have had personal communication with Dr. Mastin in regard to this case, which he considers the most positive evidence of a case of maternal impression that he has ever met. Paternal Impressions.--Strange as are the foregoing cases, those of paternal impression eclipse them. Several are on record, but none are of sufficient authenticity to warrant much discussion on the subject. Those below are given to illustrate the method of report. Stahl, quoted by Steinan, 1843, speaks of the case of a child, the father being a soldier who lost an eye in the war. The child was born with one of its eyes dried up in the orbit, in this respect presenting an appearance like that of the father. Schneider says a man whose wife was expecting confinement dreamt that his oldest son stood beside his bedside with his genitals much mutilated and bleeding. He awoke in a great state of agitation, and a few days later the wife was delivered of a child with exstrophy of the bladder. Hoare recites the curious story of a man who vowed that if his next child was a daughter he would never speak to it. The child proved to be a son, and during the whole of the father's life nothing could induce the son to speak to his father, nor, in fact, to any other male person, but after the father's death he talked fluently to both men and women. Clark reports the birth of a child whose father had a stiff knee-joint, and the child's knee was stiff and bent in exactly the same position as that of its father. Telegony.--The influence of the paternal seed on the physical and mental constitution of the child is well known. To designate this condition, Telegony is the word that was coined by Weismann in his "Das Keimplasma," and he defines it as "Infection of the Germ," and, at another time, as "Those doubtful instances in which the offspring is said to resemble, not the father, but an early mate of the mother,"--or, in other words, the alleged influence of a previous sire on the progeny produced by a subsequent one from the same mother. In a systematic discussion of telegony before the Royal Medical Society, Edinburgh, on March 1, 1895, Brunton Blaikie, as a means of making the definition of telegony plainer by practical example, prefaced his remarks by citing the classic example which first drew the attention of the modern scientific world to this phenomenon. The facts of this case were communicated in a letter from the Earl of Morton to the President of the Royal Society in 1821, and were as follows: In the year 1816 Lord Morton put a male quagga to a young chestnut mare of 7/8 Arabian blood, which had never before been bred from. The result was a female hybrid which resembled both parents. He now sold the mare to Sir Gore Ousley, who two years after she bore the hybrid put her to a black Arabian horse. During the two following years she had two foals which Lord Morton thus describes: "They have the character of the Arabian breed as decidedly as can be expected when 15/16 of the blood are Arabian, and they are fine specimens of the breed; but both in their color and in the hair of their manes they have a striking resemblance to the quagga. Their color is bay, marked more or less like the quagga in a darker tint. Both are distinguished by the dark line along the ridge of the back, the dark stripes across the forehand, and the dark bars across the back part of the legs." The President of the Royal Society saw the foals and verified Lord Morton's statement. "Herbert Spencer, in the Contemporary Review for May, 1893, gives several cases communicated to him by his friend Mr. Fookes, whom Spencer says is often appointed judge of animals at agricultural shows. After giving various examples he goes on to say: 'A friend of mine near this had a valuable Dachshund bitch, which most unfortunately had a litter by a stray sheep-dog. The next year the owner sent her on a visit to a pure Dachshund dog, but the produce took quite as much of the first father as the second, and the next year he sent her to another Dachshund, with the same result. Another case: A friend of mine in Devizes had a litter of puppies unsought for, by a setter from a favorite pointer bitch, and after this she never bred any true pointers, no matter what the paternity was.' "Lord Polwarth, whose very fine breed of Border Leicesters is famed throughout Britain, and whose knowledge on the subject of breeding is great, says that 'In sheep we always consider that if a ewe breeds to a Shrop ram, she is never safe to breed pure Leicesters from, as dun or colored legs are apt to come even when the sire is a pure Leicester. This has been proved in various instances, but is not invariable.'" Hon. Henry Scott says: "Dog-breeders know this theory well; and if a pure-bred bitch happens to breed to a dog of another breed, she is of little use for breeding pure-bred puppies afterward. Animals which produce large litters and go a short time pregnant show this throwing back to previous sires far more distinctly than others--I fancy dogs and pigs most of all, and probably horses least. The influence of previous sires may be carried into the second generation or further, as I have a cat now which appears to be half Persian (long hair). His dam has very long hair and every appearance of being a half Persian, whereas neither have really any Persian blood, as far as I know, but the grand-dam (a very smooth-haired cat) had several litters by a half-Persian tom-cat, and all her produce since have showed the influence retained. The Persian tom-cat died many years ago, and was the only one in the district, so, although I cannot be absolutely positive, still I think this case is really as stated." Breeders of Bedlington terriers wish to breed dogs with as powerful jaws as possible. In order to accomplish this they put the Bedlington terrier bitch first to a bull-terrier dog, and get a mongrel litter which they destroy. They now put the bitch to a Bedlington terrier dog and get a litter of puppies which are practically pure, but have much stronger jaws than they would otherwise have had, and also show much of the gameness of the bull-terrier, thus proving that physiologic as well as anatomic characters may be transmitted in this way. After citing the foregoing examples, Blaikie directs his attention to man, and makes the following interesting remarks:-- "We might expect from the foregoing account of telegony amongst animals that whenever a black woman had a child to a white man, and then married a black man, her subsequent children would not be entirely black. Dr. Robert Balfour of Surinam in 1851 wrote to Harvey that he was continually noticing amongst the colored population of Surinam 'that if a negress had a child or children by a white, and afterward fruitful intercourse with a negro, the latter offspring had generally a lighter color than the parents.' But, as far as I know, this is the only instance of this observation on record. Herbert Spencer has shown that when a pure-bred animal breeds with an animal of a mixed breed, the offspring resembles much more closely the parent of pure blood, and this may explain why the circumstance recorded by Balfour has been so seldom noted. For a negro, who is of very pure blood, will naturally have a stronger influence on the subsequent progeny than an Anglo-Saxon, who comes of a mixed stock. If this be the correct explanation, we should expect that when a white woman married first a black man, and then a white, the children by the white husband would be dark colored. Unfortunately for the proof of telegony, it is very rare that a white woman does marry a black man, and then have a white as second husband; nevertheless, we have a fair number of recorded instances of dark-colored children being born in the above way of white parents. "Dr. Harvey mentions a case in which 'a young woman, residing in Edinburgh, and born of white (Scottish) parents, but whose mother, some time previous to her marriage, had a natural (mulatto) child by a negro man-servant in Edinburgh, exhibits distinct traces of the negro. Dr. Simpson--afterward Sir James Simpson--whose patient the young woman at one time was, has had no recent opportunities of satisfying himself as to the precise extent to which the negro character prevails in her features; but he recollects being struck with the resemblance, and noticed particularly that the hair had the qualities characteristic of the negro.' Herbert Spencer got a letter from a 'distinguished correspondent' in the United States, who said that children by white parents had been 'repeatedly' observed to show traces of black blood when the women had had previous connection with (i.e., a child by) a negro. Dr. Youmans of New York interviewed several medical professors, who said the above was 'generally accepted as a fact.' Prof. Austin Flint, in 'A Text-book of Human Physiology,' mentioned this fact, and when asked about it said: 'He had never heard the statement questioned.' "But it is not only in relation to color that we find telegony to have been noticed in the human subject. Dr. Middleton Michel gives a most interesting case in the American Journal of the Medical Sciences for 1868: 'A black woman, mother of several negro children, none of whom were deformed in any particular, had illicit intercourse with a white man, by whom she became pregnant. During gestation she manifested great uneasiness of mind, lest the birth of a mulatto offspring should disclose her conduct.... It so happened that her negro husband possessed a sixth digit on each hand, but there was no peculiarity of any kind in the white man, yet when the mulatto child was born it actually presented the deformity of a supernumerary finger.' Taruffi, the celebrated Italian teratologist, in speaking of the subject, says: 'Our knowledge of this strange fact is by no means recent for Fienus, in 1608, said that most of the children born in adultery have a greater resemblance to the legal than to the real father'--an observation that was confirmed by the philosopher Vanini and by the naturalist Ambrosini. From these observations comes the proverb: 'Filium ex adultera excusare matrem a culpa.' Osiander has noted telegony in relation to moral qualities of children by a second marriage. Harvey said that it has long been known that the children by a second husband resemble the first husband in features mind, and disposition. He then gave a case in which this resemblance was very well marked. Orton, Burdach (Traite de Physiologie), and Dr. William Sedgwick have all remarked on this physical resemblance; and Dr. Metcalfe, in a dissertation delivered before this society in 1855, observed that in the cases of widows remarrying the children of the second marriage frequently resemble the first husband. "An observation probably having some bearing on this subject was made by Count de Stuzeleci (Harvey, loc. cit.). He noticed that when an aboriginal female had had a child by a European, she lost the power of conception by a male of her own race, but could produce children by a white man. He believed this to be the case with many aboriginal races; but it has been disproved, or at all events proved to be by no means a universal law, in every case except that of the aborigines of Australia and New Zealand. Dr. William Sedgwick thought it probable that the unfruitfulness of prostitutes might in some degree be due to the same cause as that of the Australian aborigines who have had children by white men. "It would seem as though the Israelites had had some knowledge of telegony, for in Deuteronomy we find that when a man died leaving no issue, his wife was commanded to marry her husband's brother, in order that he might 'raise up seed to his brother.'" We must omit the thorough inquiry into this subject that is offered by Mr. Blaikie. The explanations put forward have always been on one of three main lines:-- (1) The imagination-theory, or, to quote Harvey: "Due to mental causes so operating either on the mind of the female and so acting on her reproductive powers, or on the mind of the male parent, and so influencing the qualities of his semen, as to modify the nutrition and development of the offspring." (2) Due to a local influence on the reproductive organs of the mother. (3) Due to a general influence through the fetus on the mother. Antenatal Pathology.--We have next to deal with the diseases, accidents, and operations that affect the pregnant uterus and its contents; these are rich in anomalies and facts of curious interest, and have been recognized from the earliest times. In the various works usually grouped together under the general designation of "Hippocratic" are to be found the earliest opinions upon the subject of antenatal pathology which the medical literature of Greece has handed down to modern times. That there were medical writers before the time of Hippocrates cannot be doubted, and that the works ascribed to the "Father of Medicine" were immediately followed by those of other physicians, is likewise not to be questioned; but whilst nearly all the writings prior to and after Hippocrates have been long lost to the world, most of those that were written by the Coan physician and his followers have been almost miraculously preserved. As Littre puts it, "Les ecrits hippocratiques demeurent isoles au milieu des debris de l'antique litterature medicale."--(Ballantyne.) The first to be considered is the transmission of contagious disease to the fetus in utero. The first disease to attract attention was small-pox. Devilliers, Blot, and Depaul all speak of congenital small-pox, the child born dead and showing evidences of the typical small-pox pustulation, with a history of the mother having been infected during pregnancy. Watson reports two cases in which a child in utero had small-pox. In the first case the mother was infected in pregnancy; the other was nursing a patient when seven months pregnant; she did not take the disease, although she had been infected many months before. Mauriceau delivered a woman of a healthy child at full term after she had recovered from a severe attack of this disease during the fifth month of gestation. Mauriceau supposed the child to be immune after the delivery. Vidal reported to the French Academy of Medicine, May, 1871, the case of a woman who gave birth to a living child of about six and one-half months' maturation, which died some hours after birth covered with the pustules of seven or eight days' eruption. The pustules on the fetus were well umbilicated and typical, and could have been nothing but those of small-pox; besides, this disease was raging in the neighborhood at the time. The mother had never been infected before, and never was subsequently. Both parents were robust and neither of them had ever had syphilis. About the time of conception, the early part of December, 1870, the father had suffered from the semiconfluent type, but the mother, who had been vaccinated when a girl, had never been stricken either during or after her husband's sickness. Quirke relates a peculiar instance of a child born at midnight, whose mother was covered with the eruption eight hours after delivery. The child was healthy and showed no signs of the contagion, and was vaccinated at once. Although it remained with its mother all through the sickness, it continued well, with the exception of the ninth day, when a slight fever due to its vaccination appeared. The mother made a good recovery, and the author remarks that had the child been born a short time later, it would most likely have been infected. Ayer reports an instance of congenital variola in twins. Chantreuil speaks of a woman pregnant with twins who aborted at five and a half months. One of the fetuses showed distinct signs of congenital variola, although the mother and other fetus were free from any symptoms of the disease. In 1853 Charcot reported the birth of a premature fetus presenting numerous variolous pustules together with ulcerations of the derm and mucous membranes and stomach, although the mother had convalesced of the disease some time before. Mitchell describes a case of small-pox occurring three days after birth, the mother not having had the disease since childhood. Shertzer relates an instance of confluent small-pox in the eighth month of pregnancy. The child was born with the disease, and both mother and babe recovered. Among many others offering evidence of variola in utero are Degner, Derham, John Hunter, Blot, Bulkley, Welch, Wright, Digk, Forbes, Marinus, and Bouteiller. Varicella, Measles, Pneumonia, and even Malaria are reported as having been transmitted to the child in utero. Hubbard attended a woman on March 17, 1878, in her seventh accouchement. The child showed the rash of varicella twenty-four hours after birth, and passed through the regular coarse of chicken-pox of ten days' duration. The mother had no signs of the disease, but the children all about her were infected. Ordinarily the period of incubation is from three to four days, with a premonitory fever of from twenty-four to seventy-two hours' duration, when the rash appears; this case must therefore have been infected in utero. Lomer of Hamburg tells of the case of a woman, twenty-two years, unmarried, pregnant, who had measles in the eighth month, and who gave birth to an infant with measles. The mother was attacked with pneumonia on the fifth day of her puerperium, but recovered; the child died in four weeks of intestinal catarrh. Gautier found measles transmitted from the mother to the fetus in 6 out of 11 cases, there being 2 maternal deaths in the 11 cases. Netter has observed the case of transmission of pneumonia from a mother to a fetus, and has seen two cases in which the blood from the uterine vessels of patients with pneumonia contained the pneumococcus. Wallick collected a number of cases of pneumonia occurring during pregnancy, showing a fetal mortality of 80 per cent. Felkin relates two instances of fetal malaria in which the infection was probably transmitted by the male parent. In one case the father near term suffered severely from malaria; the mother had never had a chill. The violent fetal movements induced labor, and the spleen was so large as to retard it. After birth the child had seven malarial paroxysms but recovered, the splenic tumor disappearing. The modes of infection of the fetus by syphilis, and the infection of the mother, have been well discussed, and need no mention here. There has been much discussion on the effects on the fetus in utero of medicine administered to the pregnant mother, and the opinions as to the reliability of this medication are so varied that we are in doubt as to a satisfactory conclusion. The effects of drugs administered and eliminated by the mammary glands and transmitted to the child at the breast are well known, and have been witnessed by nearly every physician, and, as in cases of strong metallic purges, etc., need no other than the actual test. However, scientific experiments as to the efficacy of fetal therapeutics have been made from time to time with varying results. Gusserow of Strasbourg tested for iodin, chloroform, and salicylic acid in the blood and secretions of the fetus after maternal administration just before death. In 14 cases in which iodin had been administered, he examined the fetal urine of 11 cases; in 5, iodin was present, and in the others, absent. He made some similar experiments on the lower animals. Benicke reports having given salicylic acid just before birth in 25 cases, and in each case finding it in the urine of the child shortly after birth. At a discussion held in New York some years ago as to the real effect on the fetus of giving narcotics to the mother, Dr. Gaillard Thomas was almost alone in advocating that the effect was quite visible. Fordyce Barker was strongly on the negative side. Henning and Ahlfeld, two German observers, vouch for the opinion of Thomas, and Thornburn states that he has witnessed the effect of nux vomica and strychnin on the fetus shortly after birth. Over fifty years ago, in a memoir on "Placental Phthisis," Sir James Y. Simpson advanced a new idea in the recommendation of potassium chlorate during the latter stages of pregnancy. The efficacy of this suggestion is known, and whether, as Simpson said, it acts by supplying extra oxygen to the blood, or whether the salt itself is conveyed to the fetus, has never been definitely settled. McClintock, who has been a close observer on this subject, reports some interesting cases. In his first case he tried a mixture of iron perchlorid and potassium chlorate three times a day on a woman who had borne three dead children, with a most successful result. His second case failed, but in a third he was successful by the same medication with a woman who had before borne a dead child. In a fourth case of unsuccessful pregnancy for three consecutive births he was successful. His fifth case was extraordinary: It was that of a woman in her tenth pregnancy, who, with one exception, had always borne a dead child at the seventh or eighth month. The one exception lived a few hours only. Under this treatment he was successful in carrying the woman safely past her time for miscarriage, and had every indication for a normal birth at the time of report. Thornburn believes that the administration of a tonic like strychnin is of benefit to a fetus which, by its feeble heart-beats and movements, is thought to be unhealthy. Porak has recently investigated the passage of substances foreign to the organism through the placenta, and offers an excellent paper on this subject, which is quoted in brief in a contemporary number of Teratologia. In this important paper, Porak, after giving some historical notes, describes a long series of experiments performed on the guinea-pig in order to investigate the passage of arsenic, copper, lead, mercury, phosphorus, alizarin, atropin, and eserin through the placenta. The placenta shows a real affinity for some toxic substances; in it accumulate copper and mercury, but not lead, and it is therefore through it that the poison reaches the fetus; in addition to its pulmonary, intestinal, and renal functions, it fixes glycogen and acts as an accumulator of poisons, and so resembles in its action the liver; therefore the organs of the fetus possess only a potential activity. The storing up of poisons in the placenta is not so general as the accumulation of them in the liver of the mother. It may be asked if the placenta does not form a barrier to the passage of poisons into the circulation of the fetus; this would seem to be demonstrated by mercury, which was always found in the placenta and never in the fetal organs. In poisoning by lead and copper the accumulation of the poison in the fetal tissues is greater than in the maternal, perhaps from differences in assimilation and disassimilation or from greater diffusion. Whilst it is not an impermeable barrier to the passage of poisons, the placenta offers a varying degree of obstruction: it allows copper and lead to pass easily, arsenic with greater difficulty. The accumulation of toxic substances in the fetus does not follow the same law as in the adult. They diffuse more widely in the fetus. In the adult the liver is the chief accumulatory organ. Arsenic, which in the mother elects to accumulate in the liver, is in the fetus stored up in the skin; copper accumulates in the fetal liver, central nervous system, and sometimes in the skin; lead which is found specially in the maternal liver, but also in the skin, has been observed in the skin, liver, nervous centers, and elsewhere in the fetus. The frequent presence of poisons in the fetal skin demonstrates its physiologic importance. It has probably not a very marked influence on its health. On the contrary, accumulation in the placenta and nerve centers explains the pathogenesis of abortion and the birth of dead fetuses ("mortinatatite") Copper and lead did not cause abortion, but mercury did so in two out of six cases. Arsenic is a powerful abortive agent in the guinea-pig, probably on account of placental hemorrhages. An important deduction is that whilst the placenta is frequently and seriously affected in syphilis, it is also the special seat for the accumulation of mercury. May this not explain its therapeutic action in this disease? The marked accumulation of lead in the central nervous system of the fetus explains the frequency and serious character of saturnine encephalopathic lesions. The presence of arsenic in the fetal skin alone gives an explanation of the therapeutic results of the administration of this substance in skin diseases. Intrauterine amputations are of interest to the medical man, particularly those cases in which the accident has happened in early pregnancy and the child is born with a very satisfactory and clean stump. Montgomery, in an excellent paper, advances the theory, which is very plausible, that intrauterine amputations are caused by contraction of bands or membranes of organized lymph encircling the limb and producing amputation by the same process of disjunctive atrophy that the surgeons induce by ligature. Weinlechner speaks of a case in which a man devoid of all four extremities was exhibited before the Vienna Medical Society. The amputations were congenital, and on the right side there was a very small stump of the upper arm remaining, admitting the attachment of an artificial apparatus. He was twenty-seven years old, and able to write, to thread a needle, pour water out of a bottle, etc. Cook speaks of a female child born of Indian parents, the fourth birth of a mother twenty-six years old. The child weighed 5 1/2 pounds; the circumference of the head was 14 inches and that of the trunk 13 inches. The upper extremities consisted of perfect shoulder joints, but only 1/4 of each humerus was present. Both sides showed evidences of amputation, the cicatrix on the right side being 1 inch long and on the left 1/4 inch long. The right lower limb was merely a fleshy corpuscle 3/4 inch wide and 1/4 inch long; to the posterior edge was attached a body resembling the little toe of a newly-born infant. On the left side the limb was represented by a fleshy corpuscle 1 inch long and 1/4 inch in circumference, resembling the great toe of an infant. There was no history of shock or injury to the mother. The child presented by the breech, and by the absence of limbs caused much difficulty in diagnosis. The three stages of labor were one and one-half hours, forty-five minutes, and five minutes, respectively. The accompanying illustration shows the appearance of the limbs at the time of report. Figure 10 represents a negro boy, the victim of intrauterine amputation, who learned to utilize his toes for many purposes. The illustration shows his mode of holding his pen. There is an instance reported in which a child at full term was born with an amputated arm, and at the age of seventeen the stump was scarcely if at all smaller than the other. Blake speaks of a case of congenital amputation of both the upper extremities. Gillilam a mentions a case that shows the deleterious influence of even the weight of a fetal limb resting on a cord or band. His case was that of a fetus, the product of a miscarriage of traumatic origin; the soft tissues were almost cut through and the bone denuded by the limb resting on one of the two umbilical cords, not encircling it, but in a sling. The cord was deeply imbedded in the tissues. The coilings of the cord are not limited to compression about the extremities alone, but may even decapitate the head by being firmly wrapped several times about the neck. According to Ballantyne, there is in the treatise De Octimestri Partu, by Hippocrates, a reference to coiling of the umbilical cord round the neck of the fetus. This coiling was, indeed, regarded as one of the dangers of the eighth month, and even the mode of its production is described. It is said that if the cord he extended along one side of the uterus, and the fetus lie more to the other side, then when the culbute is performed the funis must necessarily form a loop round the neck or chest of the infant. If it remain in this position, it is further stated, the mother will suffer later and the fetus will either perish or be born with difficulty. If the Hippocratic writers knew that this coiling is sometimes quite innocuous, they did not in any place state the fact. The accompanying illustrations show the different ways in which the funis may be coiled, the coils sometimes being as many as 8. Bizzen mentions an instance in which from strangulation the head of a fetus was in a state of putrefaction, the funis being twice tightly bound around the neck. Cleveland, Cuthbert, and Germain report analogous instances. Matthyssens observed the twisting of the funis about the arm and neck of a fetus the body of which was markedly wasted. There was complete absence of amniotic fluid during labor. Blumenthal presented to the New York Pathological Society an ovum within which the fetus was under going intrauterine decapitation. Buchanan describes a case illustrative of the etiology of spontaneous amputation of limbs in utero Nebinger reports a case of abortion, showing commencing amputation of the left thigh from being encircled by the funis. The death of the fetus was probably due to compression of the cord. Owen mentions an instance in which the left arm and hand of a fetus were found in a state of putrescence from strangulation, the funis being tightly bound around at the upper part. Simpson published an article on spontaneous amputation of the forearm and rudimentary regeneration of the hand in the fetus. Among other contributors to this subject are Avery, Boncour, Brown, Ware, Wrangell, Young, Nettekoven, Martin, Macan, Leopold, Hecker, Gunther, and Friedinger. Wygodzky finds that the greatest number of coils of the umbilical cord ever found to encircle a fetus are 7 (Baudelocque), 8 (Crede), and 9 (Muller and Gray). His own case was observed this year in Wilna. The patient was a primipara aged twenty. The last period was seen on May 10, 1894. On February 19th the fetal movements suddenly ceased. On the 20th pains set in about two weeks before term. At noon turbid liquor amnii escaped. At 2 P.M., on examination, Wygodzky defined a dead fetus in left occipito-anterior presentation, very high in the inlet. The os was nearly completely dilated, the pains strong. By 4 P.M. the head was hardly engaged in the pelvic cavity. At 7 P.M. it neared the outlet at the height of each pain, but retracted immediately afterward. After 10 P.M. the pains grew weak. At midnight Wygodzky delivered the dead child by expression. Not till then was the cause of delay clear. The funis was very tense and coiled 7 times round the neck and once round the left shoulder; there was also a distinct knot. It measured over 65 inches in length. The fetus was a male, slightly macerated. It weighed over 5 pounds, and was easily delivered entire after division and unwinding of the funis. No marks remained on the neck. The placenta followed ten minutes later and, so far as naked-eye experience indicated, seemed healthy. Intrauterine fractures are occasionally seen, but are generally the results of traumatism or of some extraordinary muscular efforts on the part of the mother. A blow on the abdomen or a fall may cause them. The most interesting cases are those in which the fractures are multiple and the causes unknown. Spontaneous fetal fractures have been discussed thoroughly, and the reader is referred to any responsible text-book for the theories of causation. Atkinson, De Luna, and Keller report intrauterine fractures of the clavicle. Filippi contributes an extensive paper on the medicolegal aspect of a case of intrauterine fracture of the os cranium. Braun of Vienna reports a case of intrauterine fracture of the humerus and femur. Rodrigue describes a case of fracture and dislocation of the humerus of a fetus in utero. Gaultier reports an instance of fracture of both femora intrauterine. Stanley, Vanderveer, and Young cite instances of intrauterine fracture of the thigh; in the case of Stanley the fracture occurred during the last week of gestation, and there was rapid union of the fragments during lactation. Danyau, Proudfoot, and Smith mention intrauterine fracture of the tibia; in Proudfoot's case there was congenital talipes talus. Dolbeau describes an instance in which multiple fractures were found in a fetus, some of which were evidently postpartum, while others were assuredly antepartum. Hirschfeld describes a fetus showing congenital multiple fractures. Gross speaks of a wonderful case of Chaupier in which no less than 113 fractures were discovered in a child at birth. It survived twenty-four hours, and at the postmortem examination it was found that some were already solid, some uniting, whilst others were recent. It often happens that the intrauterine fracture is well united at birth. There seems to be a peculiar predisposition of the bones to fracture in the cases in which the fractures are multiple and the cause is not apparent. The results to the fetus of injuries to the pregnant mother are most diversified. In some instances the marvelous escape of any serious consequences of one or both is almost incredible, while in others the slightest injury is fatal. Guillemont cites the instance of a woman who was killed by a stroke of lightning, but whose fetus was saved; while Fabricius Hildanus describes a case in which there was perforation of the head, fracture of the skull, and a wound of the groin, due to sudden starting and agony of terror of the mother. Here there was not the slightest history of any external violence. It is a well-known fact that injuries to the pregnant mother show visible effects on the person of the fetus. The older writers kept a careful record of the anomalous and extraordinary injuries of this character and of their effects. Brendelius tells us of hemorrhage from the mouth and nose of the fetus occasioned by the fall of the mother; Buchner mentions a case of fracture of the cranium from fright of the mother; Reuther describes a contusion of the os sacrum and abdomen in the mother from a fall, with fracture of the arm and leg of the fetus from the same cause; Sachse speaks of a fractured tibia in a fetus, caused by a fall of the mother; Slevogt relates an instance of rupture of the abdomen of a fetus by a fall of the mother; the Ephemerides contains accounts of injuries to the fetus of this nature, and among others mentions a stake as having been thrust into a fetus in utero; Verduc offers several examples, one a dislocation of the fetal foot from a maternal fall; Plocquet gives an instance of fractured femur; Walther describes a case of dislocation of the vertebrae from a fall; and there is also a case of a fractured fetal vertebra from a maternal fall. There is recorded a fetal scalp injury, together with clotted blood in the hair, after a fall of the mother: Autenrieth describes a wound of the pregnant uterus, which had no fatal issue, and there is also another similar case on record. The modern records are much more interesting and wonderful on this subject than the older ones. Richardson speaks of a woman falling down a few weeks before her delivery. Her pelvis was roomy and the birth was easy; but the infant was found to have extensive wounds on the back, reaching from the 3d dorsal vertebra across the scapula, along the back of the humerus, to within a short distance of the elbow. Part of these wounds were cicatrized and part still granulating, which shows that the process of reparation is as active in utero as elsewhere. Injuries about the genitalia would naturally be expected to exercise some active influence on the uterine contents; but there are many instances reported in which the escape of injury is marvelous. Gibb speaks of a woman, about eight months pregnant, who fell across a chair, lacerating her genitals and causing an escape of liquor amnii. There was regeneration of this fluid and delivery beyond term. The labor was tedious and took place two and a half months after the accident. The mother and the female child did well. Purcell reports death in a pregnant woman from contused wound of the vulva. Morland relates an instance of a woman in the fifth month of her second pregnancy, who fell on the roof of a woodshed by slipping from one of the steps by which she ascended to the roof, in the act of hanging out some clothes to dry. She suffered a wound on the internal surface of the left nympha 1 1/2 inch long and 1/2 inch deep. She had lost about three quarts of blood, and had applied ashes to the vagina to stop the bleeding. She made a recovery by the twelfth day, and the fetal sounds were plainly audible. Cullingworth speaks of a woman who, during a quarrel with her husband, was pushed away and fell between two chairs, knocking one of them over, and causing a trivial wound one inch long in the vagina, close to the entrance. She screamed, there was a gush of blood, and she soon died. The uterus contained a fetus three or four months old, with the membranes intact, the maternal death being due to the varicosity of the pregnant pudenda, the slight injury being sufficient to produce fatal hemorrhage. Carhart describes the case of a pregnant woman, who, while in the stooping position, milking a cow, was impaled through the vagina by another cow. The child was born seven days later, with its skull crushed by the cow's horn. The horn had entered the vagina, carrying the clothing with it. There are some marvelous cases of recovery and noninterference with pregnancy after injuries from horns of cattle. Corey speaks of a woman of thirty-five, three months pregnant, weighing 135 pounds, who was horned by a cow through the abdominal parietes near the hypogastric region; she was lifted into the air, carried, and tossed on the ground by the infuriated animal. There was a wound consisting of a ragged rent from above the os pubis, extending obliquely to the left and upward, through which protruded the great omentum, the descending and transverse colon, most of the small intestines, as well as the pyloric extremity of the stomach. The great omentum was mangled and comminuted, and bore two lacerations of two inches each. The intestines and stomach were not injured, but there was considerable extravasation of blood into the abdominal cavity. The intestines were cleansed and an unsuccessful attempt was made to replace them. The intestines remained outside of the body for two hours, and the great omentum was carefully spread out over the chest to prevent interference with the efforts to return the intestines. The patient remained conscious and calm throughout; finally deep anesthesia was produced by ether and chloroform, three and a half hours after the accident, and in twenty minutes the intestines were all replaced in the abdominal cavity. The edges were pared, sutured, and the wound dressed. The woman was placed in bed, on the right side, and morphin was administered. The sutures were removed on the ninth day, and the wound had healed except at the point of penetration. The woman was discharged twenty days after, and, incredible to relate, was delivered of a well-developed, full-term child just two hundred and two days from the time of the accident. Both the mother and child did well. Luce speaks of a pregnant woman who was horned in the lower part of the abdomen by a cow, and had a subsequent protrusion of the intestines through the wound. After some minor complications, the wound healed fourteen weeks after the accident, and the woman was confined in natural labor of a healthy, vigorous child. In this case no blood was found on the cow's horn, and the clothing was not torn, so that the wound must have been made by the side of the horn striking the greatly distended abdomen. Richard, quoted also by Tiffany, speaks of a woman, twenty-two, who fell in a dark cellar with some empty bottles in her hand, suffering a wound in the abdomen 2 inches above the navel on the left side 8 cm. long. Through this wound a mass of intestines, the size of a man's head, protruded. Both the mother and the child made a good convalescence. Harris cites the instance of a woman of thirty, a multipara, six months pregnant, who was gored by a cow; her intestines and omentum protruded through the rip and the uterus was bruised. There was rapid recovery and delivery at term. Wetmore of Illinois saw a woman who in the summer of 1860, when about six months pregnant, was gored by a cow, and the large intestine and the omentum protruded through the wound. Three hours after the injury she was found swathed in rags wet with a compound solution of whiskey and camphor, with a decoction of tobacco. The intestines were cold to the touch and dirty, but were washed and replaced. The abdomen was sewed up with a darning needle and black linen thread; the woman recovered and bore a healthy child at the full maturity of her gestation. Crowdace speaks of a female pauper, six months pregnant, who was attacked by a buffalo, and suffered a wound about 1 1/2 inch long and 1/2 inch wide just above the umbilicus. Through this small opening 19 inches of intestine protruded. The woman recovered, and the fetal heart-beats could be readily auscultated. Major accidents in pregnant women are often followed by the happiest results. There seems to be no limit to what the pregnant uterus can successfully endure. Tiffany, who has collected some statistics on this subject, as well as on operations successfully performed during pregnancy, which will be considered later, quotes the account of a woman of twenty-seven, eight months pregnant, who was almost buried under a clay wall. She received terrible wounds about the head, 32 sutures being used in this location alone. Subsequently she was confined, easily bore a perfectly normal female child, and both did well. Sibois describes the case of a woman weighing 190 pounds, who fell on her head from the top of a wall from 10 to 12 feet high. For several hours she exhibited symptoms of fracture of the base of the skull, and the case was so diagnosed; fourteen hours after the accident she was perfectly conscious and suffered terrible pain about the head, neck, and shoulders. Two days later an ovum of about twenty days was expelled, and seven months after she was delivered of a healthy boy weighing 10 1/2 pounds. She had therefore lost after the accident one-half of a double conception. Verrier has collected the results of traumatism during pregnancy, and summarizes 61 cases. Prowzowsky cites the instance of a patient in the eighth month of her first pregnancy who was wounded by many pieces of lead pipe fired from a gun but a few feet distant. Neither the patient nor the child suffered materially from the accident, and gestation proceeded; the child died on the fourth day after birth without apparent cause. Milner records an instance of remarkable tolerance of injury in a pregnant woman. During her six months of pregnancy the patient was accidentally shot through the abdominal cavity and lower part of the thorax. The missile penetrated the central tendon of the diaphragm and lodged in the lung. The injury was limited by localized pneumonia and peritonitis, and the wound was drained through the lung by free expectoration. Recovery ensued, the patient giving birth to a healthy child sixteen weeks later. Belin mentions a stab-wound in a pregnant woman from which a considerable portion of the epiploon protruded. Sloughing ensued, but the patient made a good recovery, gestation not being interrupted. Fancon describes the case of a woman who had an injury to the knee requiring drainage. She was attacked by erysipelas, which spread over the whole body with the exception of the head and neck; yet her pregnancy was uninterrupted and recovery ensued. Fancon also speaks of a girl of nineteen, frightened by her lover, who threatened to stab her, who jumped from a second-story window. For three days after the fall she had a slight bloody flow from the vulva. Although she was six months pregnant there was no interruption of the normal course of gestation. Bancroft speaks of a woman who, being mistaken for a burglar, was shot by her husband with a 44-caliber bullet. The missile entered the second and third ribs an inch from the sternum, passed through the right lung, and escaped at the inferior angle of the scapula, about three inches below the spine; after leaving her body it went through a pine door. She suffered much hemorrhage and shock, but made a fair recovery at the end of four weeks, though pregnant with her first child at the seventh month. At full term she was delivered by foot-presentation of a healthy boy. The mother at the time of report was healthy and free from cough, and was nursing her babe, which was strong and bright. All the cases do not have as happy an issue as most of the foregoing ones, though in some the results are not so bad as might be expected. A German female, thirty-six, while in the sixth month of pregnancy, fell and struck her abdomen on a tub. She was delivered of a normal living child, with the exception that the helix of the left ear was pushed anteriorly, and had, in its middle, a deep incision, which also traversed the antihelix and the tragus, and continued over the cheek toward the nose, where it terminated. The external auditory meatus was obliterated. Gurlt speaks of a woman, seven months pregnant, who fell from the top of a ladder, subsequently losing some blood and water from the vagina. She had also persistent pains in the belly, but there was no deterioration of general health. At her confinement, which was normal, a strong boy was born, wanting the arm below the middle, at which point a white bone protruded. The wound healed and the separated arm came away after birth. Wainwright relates the instance of a woman of forty, who when six months pregnant was run over by railway cars. After a double amputation of the legs she miscarried and made a good recovery. Neugebauer reported the history of a case of a woman who, while near her term of pregnancy, committed suicide by jumping from a window. She ruptured her uterus, and a dead child with a fracture of the parietal bone was found in the abdominal cavity. Staples speaks of a Swede of twenty-eight, of Minnesota, who was accidentally shot by a young man riding by her side in a wagon. The ball entered the abdomen two inches above the crest of the right ilium, a little to the rear of the anterior superior spinous process, and took a downward and forward course. A little shock was felt but no serious symptoms followed. In forty hours there was delivery of a dead child with a bullet in its abdomen. Labor was normal and the internal recovery complete. Von Chelius, quoting the younger Naegele, gives a remarkable instance of a young peasant of thirty-five, the mother of four children, pregnant with the fifth child, who was struck on the belly violently by a blow from a wagon pole. She was thrown down, and felt a tearing pain which caused her to faint. It was found that the womb had been ruptured and the child killed, for in several days it was delivered in a putrid mass, partly through the natural passage and partly through an abscess opening in the abdominal wall. The woman made a good recovery. A curious accident of pregnancy is that of a woman of thirty-eight, advanced eight months in her ninth pregnancy, who after eating a hearty meal was seized by a violent pain in the region of the stomach and soon afterward with convulsions, supposed to have been puerperal. She died in a few hours, and at the autopsy it was found that labor had not begun, but that the pregnancy had caused a laceration of the spleen, from which had escaped four or five pints of blood. Edge speaks of a case of chorea in pregnancy in a woman of twenty-seven, not interrupting pregnancy or retarding safe delivery. This had continued for four pregnancies, but in the fourth abortion took place. Buzzard had a case of nervous tremor in a woman, following a fall at her fourth month of pregnancy, who at term gave birth to a male child that was idiotic. Beatty relates a curious accident to a fetus in utero. The woman was in her first confinement and was delivered of a small but healthy and strong boy. There was a small puncture in the abdominal parietes, through which the whole of the intestines protruded and were constricted. The opening was so small that he had to enlarge it with a bistoury to replace the bowel, which was dark and congested; he sutured the wound with silver wire, but the child subsequently died. Tiffany of Baltimore has collected excellent statistics of operations during pregnancy; and Mann of Buffalo has done the same work, limiting himself to operations on the pelvic organs, where interference is supposed to have been particularly contraindicated in pregnancy. Mann, after giving his individual cases, makes the following summary and conclusions:-- (1) Pregnancy is not a general bar to operations, as has been supposed. (2) Union of the denuded surfaces is the rule, and the cicatricial tissue, formed during the earlier months of pregnancy, is strong enough to resist the shock of labor at term. (3) Operations on the vulva are of little danger to mother or child. (4) Operations on the vagina are liable to cause severe hemorrhage, but otherwise are not dangerous. (5) Venereal vegetations or warts are best treated by removal. (6) Applications of silver nitrate or astringents may be safely made to the vagina. For such application, phenol or iodin should not be used, pure or in strong solution. (7) Operations on the bladder or urethra are not dangerous or liable to be followed by abortion. (8) Operations for vesicovaginal fistulae should not be done, as they are dangerous, and are liable to be followed by much hemorrhage and abortion. (9) Plastic operations may be done in the earlier months of pregnancy with fair prospects of a safe and successful issue. (10) Small polypi may be treated by torsion or astringents. If cut, there is likely to be a subsequent abortion. (11) Large polypi removed toward the close of pregnancy will cause hemorrhage. (12) Carcinoma of the cervix should be removed at once. A few of the examples on record of operations during pregnancy of special interest, will be given below. Polaillon speaks of a double ovariotomy on a woman pregnant at three months, with the subsequent birth of a living child at term. Gordon reports five successful ovariotomies during pregnancy, in Lebedeff's clinic. Of these cases, 1 aborted on the fifth day, 2 on the fifteenth, and the other 2 continued uninterrupted. He collected 204 cases with a mortality of only 3 per cent; 22 per cent aborted, and 69.4 per cent were delivered at full term. Kreutzman reports two cases in which ovarian tumors were successfully removed from pregnant subjects without the interruption of gestation. One of these women, a secundipara, had gone two weeks over time, and had a large ovarian cyst, the pedicle of which had become twisted, the fluid in the cyst being sanguineous. May describes an ovariotomy performed during pregnancy at Tottenham Hospital. The woman, aged twenty-two, was pale, diminutive in size, and showed an enormous abdomen, which measured 50 inches in circumference at the umbilicus and 27 inches from the ensiform cartilage to the pubes. At the operation, 36 pints of brown fluid were drawn off. Delivery took place twelve hours after the operation, the mother recovering, but the child was lost. Galabin had a case of ovariotomy performed on a woman in the sixth month of pregnancy without interruption of pregnancy; Potter had a case of double ovariotomy with safe delivery at term; and Storry had a similar case. Jacobson cites a case of vaginal lithotomy in a patient six and a half months pregnant, with normal delivery at full term. Tiffany quotes Keelan's description of a woman of thirty-five, in the eighth month of pregnancy, from whom he removed a stone weighing 12 1/2 ounces and measuring 2 by 2 1/2 inches, with subsequent recovery and continuation of pregnancy. Rydygier mentions a case of obstruction of the intestine during the sixth month of gestation, showing symptoms of strangulation for seven days, in which he performed abdominal section. Recovery of the woman without abortion ensued. The Revue de Chirurgien 1887, contains an account of a woman who suffered internal strangulation, on whom celiotomy was performed; she recovered in twenty-five days, and did not miscarry, which shows that severe injury to the intestine with operative interference does not necessarily interrupt pregnancy. Gilmore, without inducing abortion, extirpated the kidney of a negress, aged thirty-three, for severe and constant pain. Tiffany removed the kidney of a woman of twenty-seven, five months pregnant, without interruption of this or subsequent pregnancies. The child was living. He says that Fancon cites instances of operation without abortion. Lovort describes an enucleation of the eye in the second month of pregnancy. Pilcher cites the instance of a woman of fifty-eight, eight months in her fourth pregnancy, whose breast and axilla he removed without interruption of pregnancy. Robson, Polaillon, and Coen report similar instances. Rein speaks of the removal of an enormous echinococcus cyst of the omentum without interruption of pregnancy. Robson reports a multi-locular cyst of the ovary with extensive adhesions of the uterus, removed at the tenth week of pregnancy and ovariotomy performed without any interruption of the ordinary course of labor. Russell cites the instance of a woman who was successfully tapped at the sixth month of pregnancy. McLean speaks of a successful amputation during pregnancy; Napper, one of the arm; Nicod, one of the arm; Russell, an amputation through the shoulder joint for an injury during pregnancy, with delivery and recovery; and Vesey speaks of amputation for compound fracture of the arm, labor following ten hours afterward with recovery. Keen reports the successful performance of a hip-joint amputation for malignant disease of the femur during pregnancy. The patient, who was five months advanced in gestation, recovered without aborting. Robson reports a case of strangulated hernia in the third month of pregnancy with stercoraceous vomiting. He performed herniotomy in the femoral region, and there was a safe delivery at full term. In the second month of pregnancy he also rotated an ovarian tumor causing acute symptoms and afterward performed ovariotomy without interfering with pregnancy. Mann quotes Munde in speaking of an instance of removal of elephantiasis of the vulva without interrupting pregnancy, and says that there are many cases of the removal of venereal warts without any interference with gestation. Campbell of Georgia operated inadvertently at the second and third month in two cases of vesicovaginal fistula in pregnant women. The first case showed no interruption of pregnancy, but in the second case the woman nearly died and the fistula remained unhealed. Engelmann operated on a large rectovaginal fistula in the sixth month of pregnancy without any interruption of pregnancy, which is far from the general result. Cazin and Rey both produced abortion by forcible dilatation of the anus for fissure, but Gayet used both the fingers and a speculum in a case at five months and the woman went to term. By cystotomy Reamy removed a double hair-pin from a woman pregnant six and a half months, without interruption, and according to Mann again, McClintock extracted stones from the bladder by the urethra in the fourth month of pregnancy, and Phillips did the same in the seventh month. Hendenberg and Packard report the removal of a tumor weighing 8 3/4 pounds from a pregnant uterus without interrupting gestation. The following extract from the University Medical Magazine of Philadelphia illustrates the after-effects of abdominal hysteropasy on subsequent pregnancies:-- "Fraipont (Annales de la Societe Medico-Chirurgicale de Liege, 1894) reports four cases where pregnancy and labor were practically normal, though the uterus of each patient had been fixed to the abdominal walls. In two of the cases the hysteropexy had been performed over five years before the pregnancy occurred, and, although the bands of adhesion between the fundus and the parietes must have become very tough after so long a period, no special difficulty was encountered. In two of the cases the forceps was used, but not on account of uterine inertia; the fetal head was voluminous, and in one of the two cases internal rotation was delayed. The placenta was always expelled easily, and no serious postpartum hemorrhage occurred. Fraipont observed the progress of pregnancy in several of these cases. The uterus does not increase specially in its posterior part, but quite uniformly, so that, as might be expected, the fundus gradually detaches itself from the abdominal wall. Even if the adhesions were not broken down they would of necessity be so stretched as to be useless for their original purpose after delivery. Bands of adhesion could not share in the process of involution. As, however, the uterus undergoes perfect involution, it is restored to its original condition before the onset of the disease which rendered hysteropexy necessary." The coexistence of an extensive tumor of the uterus with pregnancy does not necessarily mean that the product of conception will be blighted. Brochin speaks of a case in which pregnancy was complicated with fibroma of the uterus, the accouchement being natural at term. Byrne mentions a case of pregnancy complicated with a large uterine fibroid. Delivery was effected at full term, and although there was considerable hemorrhage the mother recovered. Ingleby describes a case of fibrous tumor of the uterus terminating fatally, but not until three weeks after delivery. Lusk mentions a case of pregnancy with fibrocystic tumor of the uterus occluding the cervix. At the appearance of symptoms of eclampsia version was performed and delivery effected, followed by postpartum hemorrhage. The mother died from peritonitis and collapse, but the stillborn child was resuscitated. Roberts reports a case of pregnancy associated with a large fibrocellular polypus of the uterus. A living child was delivered at the seventh month, ecrasement was performed, and the mother recovered. Von Quast speaks of a fibromyoma removed five days after labor. Gervis reports the removal of a large polypus of the uterus on the fifth day after confinement. Davis describes the spontaneous expulsion of a large polypus two days after the delivery of a fine, healthy, male child. Deason mentions a case of anomalous tumor of the uterus during pregnancy which was expelled after the birth of the child; and Daly also speaks of a tumor expelled from the uterus after delivery. Cathell speaks of a case of pregnancy complicated with both uterine fibroids and measles. Other cases of a similar nature to the foregoing are too numerous to mention. Figure 13, taken from Spiegelberg, shows a large fibroid blocking the pelvis of a pregnant woman. There are several peculiar accidents and anomalies not previously mentioned which deserve a place here, viz., those of the membranes surrounding the fetus. Brown speaks of protrusion of the membranes from the vulva several weeks before confinement. Davies relates an instance in which there was a copious watery discharge during pregnancy not followed by labor. There is a case mentioned in which an accident and an inopportune dose of ergot at the fifth month of pregnancy were followed by rupture of the amniotic sac, and subsequently a constant flow of watery fluid continued for the remaining three months of pregnancy. The fetus died at the time, and was born in an advanced state of putrefaction, by version, three months after the accident. The mother died five months after of carcinoma of the uterus. Montgomery reports the instance of a woman who menstruated last on May 22, 1850, and quickened on September 26th, and continued well until the 11th of November. At this time, as she was retiring, she became conscious that there was a watery discharge from the vagina, which proved to be liquor amnii. Her health was good. The discharge continued, her size increased, and the motions of the child continued active. On the 18th of January a full-sized eight months' child was born. It had an incessant, wailing, low cry, always of evil augury in new-born infants. The child died shortly after. The daily discharge was about 5 ounces, and had lasted sixty-eight days, making 21 pints in all. The same accident of rupture of the membranes long before labor happened to the patient's mother. Bardt speaks of labor twenty-three days after the flow of the waters; and Cobleigh one of seventeen days; Bradley relates the history of a case of rupture of the membranes six weeks before delivery. Rains cites an instance in which gestation continued three months after rupture of the membranes, the labor-pains lasting thirty-six hours. Griffiths speaks of rupture of the amniotic sac at about the sixth month of pregnancy with no untoward interruption of the completion of gestation and with delivery of a living child. There is another observation of an accouchement terminating successfully twenty-three days after the loss of the amniotic fluid. Campbell mentions delivery of a living child twelve days after rupture of the membranes. Chesney relates the history of a double collection of waters. Wood reports a case in which there was expulsion of a bag of waters before the rupture of the membranes. Bailly, Chestnut, Bjering, Cowger, Duncan, and others also record premature rupture of the membranes without interruption of pregnancy. Harris gives an instance of the membranes being expelled from the uterus a few days before delivery at the full term. Chatard, Jr., mentions extrusion of the fetal membranes at the seventh month of pregnancy while the patient was taking a long afternoon walk, their subsequent retraction, and normal labor at term. Thurston tells of a case in which Nature had apparently effected the separation of the placenta without alarming hemorrhage, the ease being one of placenta praevia, terminating favorably by natural processes. Playfair speaks of the detachment of the uterine decidua without the interruption of pregnancy. Guerrant gives a unique example of normal birth at full term in which the placenta was found in the vagina, but not a vestige of the membranes was noticed. The patient had experienced nothing unusual until within three months of expected confinement, since which time there had been a daily loss of water from the uterus. She recovered and was doing her work. There was no possibility that this was a case of retained secundines. Anomalies of the Umbilical Cord.--Absence of the membranes has its counterpart in the deficiency of the umbilical cord, so frequently noticed in old reports. The Ephemerides, Osiander, Stark's Archives, Thiebault, van der Wiel, Chatton, and Schurig all speak of it, and it has been noticed since. Danthez speaks of the development of a fetus in spite of the absence of an umbilical cord. Stute reports an observation of total absence of the umbilical cord, with placental insertion near the cervix of the uterus. There is mentioned a bifid funis. The Ephemerides and van der Wiel speak of a duplex funis. Nolde reports a cord 38 inches long; and Werner cites the instance of a funis 51 inches long. There are modern instances in which the funis has been bifid or duplex, and there is also a case reported in which there were two cords in a twin pregnancy, each of them measuring five feet in length. The Lancet gives the account of a most peculiar pregnancy consisting of a placenta alone, the fetus wanting. What this "placenta" was will always be a matter of conjecture. Occasionally death of the fetus is caused by the formation of knots in the cord, shutting off the fetal circulation; Gery, Grieve, Mastin, Passot, Piogey, Woets, and others report instances of this nature. Newman reports a curious case of twins, in which the cord of one child was encircled by a knot on the cord of the other. Among others, Latimer and Motte report instances of the accidental tying of the bowel with the funis, causing an artificial anus. The diverse causes of abortion are too numerous to attempt giving them all, but some are so curious and anomalous that they deserve mention. Epidemics of abortion are spoken of by Fickius, Fischer, and the Ephemerides. Exposure to cold is spoken of as a cause, and the same is alluded to by the Ephemerides; while another case is given as due to exposure white nude. There are several cases among the older writers in which odors are said to have produced abortion, but as analogues are not to be found in modern literature, unless the odor is very poisonous or pungent, we can give them but little credence. The Ephemerides gives the odor of urine as provocative of abortion; Sulzberger, Meyer, and Albertus all mention odors; and Vesti gives as a plausible cause the odor of carbonic vapor. The Ephemerides mentions singultus as a cause of abortion. Mauriceau, Pelargus, and Valentini mention coughing. Hippocrates mentions the case of a woman who induced abortion by calling excessively loud to some one. Fabrieius Hildanus speaks of abortion following a kick in the region of the coccyx. Gullmannus speaks of an abortion which he attributes to the woman's constant neglect to answer the calls of nature, the rectum being at all times in a state of irritation from her negligence. Hawley mentions abortion at the fourth or fifth month due to the absorption of spirits of turpentine. Solingen speaks of abortion produced by sneezing. Osiander cites an instance in which a woman suddenly arose, and in doing so jolted herself so severely that she produced abortion. Hippocrates speaks of extreme hunger as a cause of abortion. Treuner speaks of great anger and wrath in a woman disturbing her to the extent of producing abortion. The causes that are observed every day, such tight lacing, excessive venery, fright, and emotions, are too well known to be discussed here. There has been reported a recent case of abortion following a viper-bite, and analogues may be found in the writings of Severinus and Oedman, who mention viper-bites as the cause; but there are so many associate conditions accompanying a snake-bite, such as fright, treatment, etc., any one of which could be a cause in itself, that this is by no means a reliable explanation. Information from India an this subject would be quite valuable. The Ephemerides speak of bloodless abortion, and there have been modern instances in which the hemorrhage has been hardly noticeable. Abortion in a twin pregnancy does not necessarily mean the abortion or death of both the products of conception. Chapman speaks of the case of the expulsion of a blighted fetus at the seventh month, the living child remaining to the full term, and being safely delivered, the placenta following. Crisp says of a case of labor that the head of the child was obstructed by a round body, the nature of which he was for some time unable to determine. He managed to push the obstructing body up and delivered a living, full-term child; this was soon followed by a blighted fetus, which was 11 inches long, weighed 12 ounces, with a placenta attached weighing 6 1/2 ounces. It is quite common for a blighted fetus to be retained and expelled at term with a living child, its twin. Bacon speaks of twin pregnancy, with the death of one fetus at the fourth month and the other delivered at term. Beall reports the conception of twins, with one fetus expelled and the other retained; Beauchamp cites a similar instance. Bothwell describes a twin labor at term, in which one child was living and the other dead at the fifth month and macerated. Belt reports an analogous case. Jameson gives the history of an extraordinary case of twins in which one (dead) child was retained in the womb for forty-nine weeks, the other having been born alive at the expiration of nine months. Hamilton describes a case of twins in which one fetus died from the effects of an injury between the fourth and fifth months and the second arrived at full period. Moore cites an instance in which one of the fetuses perished about the third month, but was not expelled until the seventh, and the other was carried to full term. Wilson speaks of a secondary or blighted fetus of the third month with fatty degeneration of the membranes retained and expelled with its living twin at the eighth month of uterogestation. There was a case at Riga in 1839 of a robust girl who conceived in February, and in consequence her menses ceased. In June she aborted, but, to her dismay, soon afterward the symptoms of advanced pregnancy appeared, and in November a full-grown child, doubtless the result of the same impregnation as the fetus, was expelled at the fourth month. In 1860 Schuh reported an instance before the Vienna Faculty of Medicine in which a fetus was discharged at the third month of pregnancy and the other twin retained until full term. The abortion was attended with much metrorrhagia, and ten weeks afterward the movements of the other child could be plainly felt and pregnancy continued its course uninterrupted. Bates mentions a twin pregnancy in which an abortion took place at the second month and was followed by a natural birth at full term. Hawkins gives a case of miscarriage, followed by a natural birth at full term; and Newnham cites a similar instance in which there was a miscarriage at the seventh month and a birth at full term. Worms in the Uterus.--Haines speaks of a most curious case--that of a woman who had had a miscarriage three days previous; she suffered intense pain and a fetid discharge. A number of maggots were seen in the vagina, and the next day a mass about the size of an orange came away from the uterus, riddled with holes, and which contained a number of dead maggots, killed by the carbolic acid injection given soon after the miscarriage. The fact seems inexplicable, but after their expulsion the symptoms immediately ameliorated. This case recalls a somewhat similar one given by the older writers, in which a fetus was eaten by a worm. Analogous are those cases spoken of by Bidel of lumbricoides found in the uterus; by Hole, in which maggots were found in the vagina and uterus; and Simpson, in which the abortion was caused by worms in the womb--if the associate symptoms were trustworthy. We can find fabulous parallels to all of these in some of the older writings. Pare mentions Lycosthenes' account of a woman in Cracovia in 1494 who bore a dead child which had attached to its back a live serpent, which had gnawed it to death. He gives an illustration showing the serpent in situ. He also quotes the case of a woman who conceived by a mariner, and who, after nine months, was delivered by a midwife of a shapeless mass, followed by an animal with a long neck, blazing eyes, and clawed feet. Ballantyne says that in the writings of Hippocrates there is in the work on "Diseases", which is not usually regarded as genuine, a some what curious statement with regard to worms in the fetus. It is affirmed that flat worms develop in the unborn infant, and the reason given is that the feces are expelled so soon after birth that there would not be sufficient time during extrauterine life for the formation of creatures of such a size. The same remark applies to round worms. The proof of these statements is to be found in the fact that many infants expel both these varieties of parasites with the first stool. It is difficult to know what to make of these opinions; for, with the exception of certain cases in some of the seventeenth and eighteenth century writers, there are no records in medicine of the occurrence of vermes in the infant at birth. It is possible that other things, such as dried pieces of mucus, may have been erroneously regarded as worms. CHAPTER III. OBSTETRIC ANOMALIES. General Considerations.--In discussing obstetric anomalies we shall first consider those strange instances in which stages of parturition are unconscious and for some curious reason the pains of labor absent. Some women are anatomically constituted in a manner favorable to child-birth, and pass through the experience in a comparatively easy manner; but to the great majority the throes of labor are anticipated with extreme dread, particularly by the victims of the present fashion of tight lacing. It seems strange that a physiologic process like parturition should be attended by so much pain and difficulty. Savages in their primitive and natural state seem to have difficulty in many cases, and even animals are not free from it. We read of the ancient wild Irish women breaking the pubic bones of their female children shortly after birth, and by some means preventing union subsequently, in order that these might have less trouble in child-birth--as it were, a modified and early form of symphysiotomy. In consequence of this custom the females of this race, to quote an old English authority, had a "waddling, lamish gesture in their going." These old writers said that for the same reason the women in some parts of Italy broke the coccyxes of their female children. This report is very likely not veracious, because this bone spontaneously repairs itself so quickly and easily. Rodet and Engelmunn, in their most extensive and interesting papers on the modes of accouchement among the primitive peoples, substantiate the fear, pain, and difficulty with which labor is attended, even in the lowest grades of society. In view of the usual occurrence of pain and difficulty with labor, it seems natural that exceptions to the general rule should in all ages have attracted the attention of medical men, and that literature should be replete with such instances. Pechlin and Muas record instances of painless births. The Ephemerides records a birth as having occurred during asphyxia, and also one during an epileptic attack. Storok also speaks of birth during unconsciousness in an epileptic attack; and Haen and others describe cases occurring during the coma attending apoplectic attacks. King reports the histories of two married women, fond mothers and anticipating the event, who gave birth to children, apparently unconsciously. In the first case, the appearance of the woman verified the assertion; in the second, a transient suspension of the menstrual influence accounted for it. After some months epilepsy developed in this case. Crawford speaks of a Mrs. D., who gave birth to twins in her first confinement at full term, and who two years after aborted at three months. In December, 1868, a year after the abortion, she was delivered of a healthy, living fetus of about five or six months' growth in the following manner: While at stool, she discovered something of a shining, bluish appearance protruding through the external labia, but she also found that when she lay down the tumor disappeared. This tumor proved to be the child, which had been expelled from the uterus four days before, with the waters and membranes intact, but which had not been recognized; it had passed through the os without pain or symptoms, and had remained alive in the vagina over four days, from whence it was delivered, presenting by the foot. The state of intoxication seems by record of several cases to render birth painless and unconscious, as well as serving as a means of anesthesia in the preanesthetic days. The feasibility of practising hypnotism in child-birth has been discussed, and Fanton reports 12 cases of parturition under the hypnotic influence. He says that none of the subjects suffered any pain or were aware of the birth, and offers the suggestion that to facilitate the state of hypnosis it should be commenced before strong uterine contractions have occurred. Instances of parturition or delivery during sleep, lethargies, trances, and similar conditions are by no means uncommon. Heister speaks of birth during a convulsive somnolence, and Osiander of a case during sleep. Montgomery relates the case of a lady, the mother of several children, who on one occasion was unconsciously delivered in sleep. Case relates the instance of a French woman residing in the town of Hopedale, who, though near confinement, attributed her symptoms to over-fatigue on the previous day. When summoned, the doctor found that she had severe lumbar pains, and that the os was dilated to the size of a half-dollar. At ten o'clock he suggested that everyone retire, and directed that if anything of import occurred he should be called. About 4 A.M. the husband of the girl, in great fright, summoned the physician, saying: "Monsieur le Medecin, il y a quelque chose entre les jambes de ma femme," and, to Dr. Case's surprise, he found the head of a child wholly expelled during a profound sleep of the mother. In twenty minutes the secundines followed. The patient, who was only twenty years old, said that she had dreamt that something was the matter with her, and awoke with a fright, at which instant, most probably, the head was expelled. She was afterward confined with the usual labor-pains. Palfrey speaks of a woman, pregnant at term, who fell into a sleep about eleven o'clock, and dreamed that she was in great pain and in labor, and that sometime after a fine child was crawling over the bed. After sleeping for about four hours she awoke and noticed a discharge from the vagina. Her husband started for a light, but before he obtained it a child was born by a head-presentation. In a few minutes the labor-pains returned and the feet of a second child presented, and the child was expelled in three pains, followed in ten minutes by the placenta. Here is an authentic case in which labor progressed to the second stage during sleep. Weill describes the case of a woman of twenty-three who gave birth to a robust boy on the 16th of June, 1877, and suckled him eleven months. This birth lasted one hour. She became pregnant again and was delivered under the following circumstances: She had been walking on the evening of September 5th and returned home about eleven o'clock to sleep. About 3 A.M. she awoke, feeling the necessity of passing urine. She arose and seated herself for the purpose. She at once uttered a cry and called her husband, telling him that a child was born and entreating him to send for a physician. Weill saw the woman in about ten minutes and she was in the same position, so he ordered her to be carried to bed. On examining the urinal he found a female child weighing 10 pounds. He tied the cord and cared for the child. The woman exhibited little hemorrhage and made a complete recovery. She had apparently slept soundly through the uterine contractions until the final strong pain, which awoke her, and which she imagined was a call for urination. Samelson says that in 1844 he was sent for in Zabelsdorf, some 30 miles from Berlin, to attend Hannah Rhode in a case of labor. She had passed easily through eight parturitions. At about ten o'clock in the morning, after a partially unconscious night, there was a sudden gush of blood and water from the vagina; she screamed and lapsed into an unconscious condition. At 10.35 the face presented, soon followed by the body, after which came a great flow of blood, welling out in several waves. The child was a male middle-sized, and was some little time in making himself heard. Only by degrees did the woman's consciousness return. She felt weary and inclined to sleep, but soon after she awoke and was much surprised to know what had happened. She had seven or eight pains in all. Schultze speaks of a woman who, arriving at the period for delivery, went into an extraordinary state of somnolence, and in this condition on the third day bore a living male child. Berthier in 1859 observed a case of melancholia with delirium which continued through pregnancy. The woman was apparently unconscious of her condition and was delivered without pain. Cripps mentions a case in which there was absence of pain in parturition. Depaul mentions a woman who fell in a public street and was delivered of a living child during a syncope which lasted four hours. Epley reports painless labor in a patient with paraplegia. Fahnestock speaks of the case of a woman who was delivered of a son while in a state of artificial somnambulism, without pain to herself or injury to the child. Among others mentioning painless or unconscious labor are Behrens (during profound sleep), Eger, Tempel, Panis, Agnoia, Blanckmeister, Whitehill, Gillette, Mattei, Murray, Lemoine, and Moglichkeit. Rapid Parturition Without Usual Symptoms.--Births unattended by symptoms that are the usual precursors of labor often lead to speedy deliveries in awkward places. According to Willoughby, in Darby, February 9, 1667, a poor fool, Mary Baker, while wandering in an open, windy, and cold place, was delivered by the sole assistance of Nature, Eve's midwife, and freed of her afterbirth. The poor idiot had leaned against a wall, and dropped the child on the cold boards, where it lay for more than a quarter of an hour with its funis separated from the placenta. She was only discovered by the cries of the infant. In "Carpenter's Physiology" is described a remarkable case of instinct in an idiotic girl in Paris, who had been seduced by some miscreant; the girl had gnawed the funis in two, in the same manner as is practised by the lower animals. From her mental imbecility it can hardly be imagined that she had any idea of the object of this separation, and it must have been instinct that impelled her to do it. Sermon says the wife of Thomas James was delivered of a lusty child while in a wood by herself. She put the child in an apron with some oak leaves, marched stoutly to her husband's uncle's house a half mile distant, and after two hours' rest went on her journey one mile farther to her own house; despite all her exertions she returned the next day to thank her uncle for the two hours' accommodation. There is related the history of a case of a woman who was delivered of a child on a mountain during a hurricane, who took off her gown and wrapped the child up in it, together with the afterbirth, and walked two miles to her cottage, the funis being unruptured. Harvey relates a case, which he learned from the President of Munster, Ireland, of a woman with child who followed her husband, a soldier in the army, in daily march. They were forced to a halt by reason of a river, and the woman, feeling the pains of labor approaching, retired to a thicket, and there alone brought forth twins. She carried them to the river, washed them herself, did them up in a cloth, tied them to her back, and that very day marched, barefooted, 12 miles with the soldiers, and was none the worse for her experience. The next day the Deputy of Ireland and the President of Munster, affected by the story, to repeat the words of Harvey, "did both vouchsafe to be godfathers of the infants." Willoughby relates the account of a woman who, having a cramp while in bed with her sister, went to an outhouse, as if to stool, and was there delivered of a child. She quickly returned to bed, her going and her return not being noticed by her sleeping sister. She buried the child, "and afterward confessed her wickedness, and was executed in the Stafford Gaol, March 31, 1670." A similar instance is related by the same author of a servant in Darby in 1647. Nobody suspected her, and when delivered she was lying in the same room with her mistress. She arose without awakening anyone, and took the recently delivered child to a remote place, and hid it at the bottom of a feather tub, covering it with feathers; she returned without any suspicion on the part of her mistress. It so happened that it was the habit of the Darby soldiers to peep in at night where they saw a light, to ascertain if everything was all right, and they thus discovered her secret doings, which led to her trial at the next sessions at Darby. Wagner relates the history of a case of great medicolegal interest. An unmarried servant, who was pregnant, persisted in denying it, and took every pains to conceal it. She slept in a room with two other maids, and, on examination, she stated that on the night in question she got up toward morning, thinking to relieve her bowels. For this purpose she secured a wooden tub in the room, and as she was sitting down the child passed rapidly into the empty vessel. It was only then that she became aware of the nature of her pains. She did not examine the child closely, but was certain it neither moved nor cried. The funis was no doubt torn, and she made an attempt to tie it. Regarding the event as a miscarriage, she took up the tub with its contents and carried it to a sand pit about 30 paces distant, and threw the child in a hole in the sand that she found already made. She covered it up with sand and packed it firmly so that the dogs could not get it. She returned to her bedroom, first calling up the man-servant at the stable. She awakened her fellow-servants, and feeling tired sat down on a stool. Seeing the blood on the floor, they asked her if she had made way with the child. She said: "Do you take me for an old sow?" But, having their suspicions aroused, they traced the blood spots to the sand pit. Fetching a spade, they dug up the child, which was about one foot below the surface. On the access of air, following the removal of the sand and turf, the child began to cry, and was immediately taken up and carried to its mother, who washed it and laid it on her bed and soon gave it the breast. The child was healthy with the exception of a club-foot, and must have been under ground at least fifteen minutes and no air could have reached it. It seems likely that the child was born asphyxiated and was buried in this state, and only began to assume independent vitality when for the second time exposed to the air. This curious case was verified to English correspondents by Dr. Wagner, and is of unquestionable authority; it became the subject of a thorough criminal investigation in Germany. During the funeral procession of Marshal MacMahon in Paris an enormous crowd was assembled to see the cortege pass, and in this crowd was a woman almost at the time of delivery; the jostling which she received in her endeavors to obtain a place of vantage was sufficient to excite contraction, and, in an upright position, she gave birth to a fetus, which fell at her feet. The crowd pushed back and made way for the ambulance officials, and mother and child were carried off, the mother apparently experiencing little embarrassment. Quoted by Taylor, Anderson speaks of a woman accused of child murder, who walked a distance of 28 miles on a single day with her two-days-old child on her back. There is also a case of a female servant named Jane May, who was frequently charged by her mistress with pregnancy but persistently denied it. On October 26th she was sent to market with some poultry. Returning home, she asked the boy who drove her to stop and allow her to get out. She went into a recess in a hedge. In five minutes she was seen to leave the hedge and follow the cart, walking home, a distance of a mile and a half. The following day she went to work as usual, and would not have been found out had not a boy, hearing feeble cries from the recess of the hedge, summoned a passer-by, but too late to save the child. At her trial she said she did not see her babe breathe nor cry, and she thought by the sudden birth that it must have been a still-born child. Shortt says that one day, while crossing the esplanade at Villaire, between seven and eight o'clock in the morning, he perceived three Hindoo women with large baskets of cakes of "bratties" on their heads, coming from a village about four miles distant. Suddenly one of the women stood still for a minute, stooped, and to his surprise dropped a fully developed male child to the ground. One of her companions ran into the town, about 100 yards distant, for a knife to divide the cord. A few of the female passers-by formed a screen about the mother with their clothes, and the cord was divided. The after-birth came away, and the woman was removed to the town. It was afterward discovered that she was the mother of two children, was twenty-eight years old, had not the slightest sign of approaching labor, and was not aware of parturition until she actually felt the child between her thighs. Smith of Madras, in 1862, says he was hastily summoned to see an English lady who had borne a child without the slightest warning. He found the child, which had been born ten minutes, lying close to the mother's body, with the funis uncut. The native female maid, at the lady's orders, had left the child untouched, lifting the bed-clothes to give it air. The lady said that she arose at 5.30 feeling well, and during the forenoon had walked down a long flight of steps across a walk to a small summer-house within the enclosure of her grounds. Feeling a little tired, she had lain down on her bed, and soon experienced a slight discomfort, and was under the impression that something solid and warm was lying in contact with her person. She directed the servant to look below the bed-clothes, and then a female child was discovered. Her other labors had extended over six hours, and were preceded by all the signs distinctive of childbirth, which fact attaches additional interest to the case. The ultimate fate of the child is not mentioned. Smith quotes Wilson, who said he was called to see a woman who was delivered without pain while walking about the house. He found the child on the floor with its umbilical cord torn across. Langston mentions the case of a woman, twenty-three, who, between 4 and 5 A.M., felt griping pains in the abdomen. Knowing her condition she suspected labor, and determined to go to a friend's house where she could be confined in safety. She had a distance of about 600 yards to go, and when she was about half way she was delivered in an upright position of a child, which fell on the pavement and ruptured its funis in the fall. Shortly after, the placenta was expelled, and she proceeded on her journey, carrying the child in her arms. At 5.50 the physician saw the woman in bed, looking well and free from pain, but complaining of being cold. The child, which was her first, was healthy, well nourished, and normal, with the exception of a slight ecchymosis of the parietal bone on the left side. The funis was lacerated transversely four inches from the umbilicus. Both mother and child progressed favorably. Doubtless the intense cold had so contracted the blood-vessels as to prevent fatal hemorrhage to mother and child. This case has a legal bearing in the supposition that the child had been killed in the fall. There is reported the case of a woman in Wales, who, while walking with her husband, was suddenly seized with pains, and would have been delivered by the wayside but for the timely help of Madame Patti, the celebrated diva, who was driving by, and who took the woman in her carriage to her palatial residence close by. It was to be christened in a few days with an appropriate name in remembrance of the occasion. Coleman met an instance in a married woman, who without the slightest warning was delivered of a child while standing near a window in her bedroom. The child fell to the floor and ruptured the cord about one inch from the umbilicus, but with speedy attention the happiest results were attained. Twitchell has an example in the case of a young woman of seventeen, who was suddenly delivered of a child while ironing some clothes. The cord in this case was also ruptured, but the child sustained no injury. Taylor quotes the description of a child who died from an injury to the head caused by dropping from the mother at an unexpected time, while she was in the erect position; he also speaks of a parallel case on record. Unusual Places of Birth.--Besides those mentioned, the other awkward positions in which a child may be born are so numerous and diversified that mention of only a few can be made here. Colton tells of a painless labor in an Irish girl of twenty-three, who felt a desire to urinate, and while seated on the chamber dropped a child. She never felt a labor-pain, and twelve days afterward rode 20 miles over a rough road to go to her baby's funeral. Leonhard describes the case of a mother of thirty-seven, who had borne six children alive, who was pregnant for the tenth time, and who had miscalculated her pregnancy. During pregnancy she had an attack of small-pox and suffered all through pregnancy with constipation. She had taken a laxative, and when returning to bed from stool was surprised to find herself attached to the stool by a band. The child in the vessel began to cry and was separated from the woman, who returned to bed and suddenly died one-half hour later. The mother was entirely unconscious of the delivery. Westphal mentions a delivery in a water-closet. Brown speaks of a woman of twenty-six who had a call of nature while in bed, and while sitting up she gave birth to a fine, full-grown child, which, falling on the floor, ruptured the funis. She took her child, lay down with it for some time, and feeling easier, hailed a cab, drove to a hospital with the child in her arms, and wanted to walk upstairs. She was put to bed and delivered of the placenta, there being but little hemorrhage from the cord; both she and her child made speedy recoveries. Thebault reports an instance of delivery in the erect position, with rupture of the funis at the placenta. There was recently a rumor, probably a newspaper fabrication, that a woman while at stool in a railway car gave birth to a child which was found alive on the track afterward. There is a curious instance on record in which a child was born in a hip-bath and narrowly escaped drowning. The mother was a European woman aged forty, who had borne two children, the last nine years before. She was supposed to have dropsy of the abdomen, and among other treatments was the use of a speculum and caustic applications for inflammation of the womb. The escape of watery fluid for two days was considered evidence of the rupture of an ovarian cyst. At the end of two days, severe pains set in, and a warm hip-bath and an opiate were ordered. While in the bath she bore a fully-matured, living, male child, to the great surprise of herself and her friends. The child might have been drowned had not assistance been close at hand. Birth by the Rectum.--In some cases in which there is some obstacle to the delivery of a child by the natural passages, the efforts of nature to expel the product of conception lead to an anomalous exit. There are some details of births by the rectum mentioned in the last century by Reta and others. Payne cites the instance of a woman of thirty-three, in labor thirty-six hours, in whom there was a congenital absence of the vaginal orifice. The finger, gliding along the perineum, arrived at a distended anus, just inside of which was felt a fetal head. He anesthetized the patient and delivered the child with forceps, and without perineal rupture. There was little hemorrhage, and the placenta was removed with slight difficulty. Five months later, Payne found an unaltered condition of the perineum and vicinity; there was absence of the vaginal orifice, and, on introducing the finger along the anterior wall of the rectum, a fistula was found, communicating with the vagina; above this point the arrangement and the situation of the parts were normal. The woman had given birth to three still-born children, and always menstruated easily. Coitus always seemed satisfactory, and no suspicion existed in the patient's mind, and had never been suggested to her, of her abnormality. Harrison saw a fetus delivered by the anus after rupture of the uterus; the membranes came away by the same route. In this case the neck of the uterus was cartilaginous and firmly adherent to the adjacent parts. In seven days after the accouchement the woman had completely regained her health. Vallisneri reports the instance of a woman who possessed two uteruses, one communicating with the vagina, the other with the rectum. She had permitted rectal copulation and had become impregnated in this manner. Louis, the celebrated French surgeon, created a furore by a pamphlet entitled "De partium externarum generationi inservientium in mulieribus naturali vitiosa et morbosa dispositione, etc.," for which he was punished by the Sorbonne, but absolved by the Pope. He described a young lady who had no vaginal opening, but who regularly menstruated by the rectum. She allowed her lover to have connection with her in the only possible way, by the rectum, which, however, sufficed for impregnation, and at term she bore by the rectum a well-formed child. Hunter speaks of a case of pregnancy in a woman with a double vagina, who was delivered at the seventh month by the rectum. Mekeln and Andrews give instances of parturition through the anus. Morisani describes a case of extrauterine pregnancy with tubal rupture and discharge into the culdesac, in which there was delivery by the rectum. After an attack of severe abdominal pain, followed by hemorrhage, the woman experienced an urgent desire to empty the rectum. The fetal movements ceased, and a recurrence of these symptoms led the patient to go to stool, at which she passed blood and a seromucoid fluid. She attempted manually to remove the offending substances from the rectum, and in consequence grasped the leg of a fetus. She was removed to a hospital, where a fetus nine inches long was removed from the rectum. The rectal opening gradually cicatrized, the sac became obliterated, and the woman left the hospital well. Birth Through Perineal Perforation.--Occasionally there is perineal perforation during labor, with birth of the child through the opening. Brown mentions a case of rupture of the perineum with birth of a child between the vaginal opening and the anus. Cassidy reports a case of child-birth through the perineum. A successful operation was performed fifteen days after the accident. Dupuytren speaks of the passage of an infant through a central opening of the perineum. Capuron, Gravis, and Lebrun all report accouchement through a perineal perforation, without alteration in the sphincter ani or the fourchet. In his "Diseases of Women" Simpson speaks of a fistula left by the passage of an infant through the perineum. Wilson, Toloshinoff, Stolz, Argles, Demarquay, Harley, Hernu, Martyn, Lamb, Morere, Pollock, and others record the birth of children through perineal perforations. Birth Through the Abdominal Wall.--Hollerius gives a very peculiar instance in which the abdominal walls gave way from the pressure exerted by the fetus, and the uterus ruptured, allowing the child to be extracted by the hand from the umbilicus; the mother made a speedy recovery. In such cases delivery is usually by means of operative interference (which will be spoken of later), but rarely, as here, spontaneously. Farquharson and Ill both mention rupture of the abdominal parietes during labor. There have been cases reported in which the recto-vaginal septum has been ruptured, as well as the perineum and the sphincter ani, giving all the appearance of a birth by the anus. There is an account of a female who had a tumor projecting between the vagina and rectum, which was incised through the intestine, and proved to be a dead child. Saviard reported what he considered a rather unique case, in which the uterus was ruptured by external violence, the fetus being thrown forward into the abdomen and afterward extracted from an umbilical abscess. Birth of the Fetus Enclosed in the Membranes.--Harvey says that an infant can rest in its membranes several hours after birth without loss of life. Schurig eventrated a pregnant bitch and her puppies lived in their membranes half an hour. Wrisberg cites three observations of infants born closed in their membranes; one lived seven minutes; the other two nine minutes; all breathed when the membranes were cut and air admitted. Willoughby recorded the history of a case which attracted much comment at the time. It was the birth of twins enclosed in their secundines. The sac was opened and, together with the afterbirth, was laid over some hot coals; there was, however, a happy issue, the children recovering and living. Since Willoughby's time several cases of similar interest have been noticed, one in a woman of forty, who had been married sixteen years, and who had had several pregnancies in her early married life and a recent abortion. Her last pregnancy lasted about twenty-eight or twenty-nine weeks, and terminated, after a short labor, by the expulsion of the ovum entire. The membranes had not been ruptured, and still enclosed the fetus and the liquor amnii. On breaking them, the fetus was seen floating on the waters, alive, and, though very diminutive, was perfectly formed. It continued to live, and a day afterward took the breast and began to cry feebly. At six weeks it weighed 2 pounds 2 ounces, and at ten months, 12 pounds, but was still very weak and ill-nourished. Evans has an instance of a fetus expelled enveloped in its membranes entire and unruptured. The membranes were opaque and preternaturally thickened, and were opened with a pair of scissors; strenuous efforts were made to save the child, but to no purpose. The mother, after a short convalescence, made a good recovery. Forman reports an instance of unruptured membranes at birth, the delivery following a single pain, in a woman of twenty-two, pregnant for a second time. Woodson speaks of a case of twins, one of which was born enveloped in its secundines. Van Bibber was called in great haste to see a patient in labor. He reached the house in about fifteen minutes, and was told by the midwife, a woman of experience, that she had summoned him because of the expulsion from the womb of something the like of which she had never seen before. She thought it must have been some variety of false conception, and had wrapped it up in some flannel. It proved to be a fetus enclosed in its sac, with the placenta, all having been expelled together and intact. He told the nurse to rupture the membranes, and the child, which had been in the unruptured sac for over twenty minutes, began to cry. The infant lived for over a month, but eventually died of bronchitis. Cowger reports labor at the end of the seventh month without rupture of the fetal sac. Macknus and Rootes speak of expulsion of the entire ovum at the full period of gestation. Roe mentions a case of parturition with unruptured membrane. Slusser describes the delivery of a full-grown fetus without rupture of the membrane. "Dry Births."--The reverse of the foregoing are those cases in which, by reason of the deficiency of the waters, the birth is dry. Numerous causes can be stated for such occurrences, and the reader is referred elsewhere for them, the subject being an old one. The Ephemerides speaks of it, and Rudolph discusses its occurrence exhaustively and tells of the difficulties of such a labor. Burrall mentions a case of labor without apparent liquor amnii, delivery being effected by the forceps. Strong records an unusual obstetric case in which there was prolongation of the pregnancy, with a large child, and entire absence of liquor amnii. The case was also complicated with interstitial and subserous fibroids and a contracted pelvis, combined with a posterior position of the occiput and nonrotation of the head. Lente mentions a case of labor without liquor amnii; and Townsend records delivery without any sanguineous discharge. Cosentino mentions a case of the absence of liquor amnii associated with a fetal monstrosity. Delivery After Death of the Mother.--Curious indeed are those anomalous cases in which the delivery is effected spontaneously after the death of the mother, or when, by manipulation, the child is saved after the maternal decease. Wegelin gives the account of a birth in which version was performed after death and the child successfully delivered. Bartholinus, Wolff, Schenck, Horstius, Hagendorn, Fabricius Hildanus, Valerius, Rolfinck, Cornarius, Boener, and other older writers cite cases of this kind. Pinard gives a most wonderful case. The patient was a woman of thirty-eight who had experienced five previous normal labors. On October 27th she fancied she had labor pains and went to the Lariboisiere Maternite, where, after a careful examination, three fetal poles were elicited, and she was told, to her surprise, of the probability of triplets. At 6 P.M., November 13th, the pains of labor commenced. Three hours later she was having great dyspnea with each pain. This soon assumed a fatal aspect and the midwife attempted to resuscitate the patient by artificial respiration, but failed in her efforts, and then she turned her attention to the fetuses, and, one by one, she extracted them in the short space of five minutes; the last one was born twelve minutes after the mother's death. They all lived (the first two being females), and they weighed from 4 1/4 to 6 1/2 pounds. Considerable attention has been directed to the advisability of accelerated and forced labor in the dying, in order that the child may be saved. Belluzzi has presented several papers on this subject. Csurgay of Budapest mentions saving the child by forced labor in the death agonies of the mother. Devilliers considers this question from both the obstetric and medicolegal points of view. Hyneaux mentions forcible accouchement practised on both the dead and the dying. Rogowicz advocates artificial delivery by the natural channel in place of Cesarian section in cases of pending or recent death, and Thevenot discussed this question at length at the International Medico-Legal Congress in 1878. Duer presented the question of postmortem delivery in this country. Kelly reports the history of a woman of forty who died in her eighth pregnancy, and who was delivered of a female child by version and artificial means. Artificial respiration was successfully practised on the child, although fifteen minutes had elapsed from the death of the mother to its extraction. Driver relates the history of a woman of thirty-five, who died in the eighth month of gestation, and who was delivered postmortem by the vagina, manual means only being used. The operator was about to perform Cesarean section when he heard the noise of the membranes rupturing. Thornton reports the extraction of a living child by version after the death of the mother. Aveling has compiled extensive statistics on all varieties of postmortem deliveries, collecting 44 cases of spontaneous expulsion of the fetus after death of the mother. Aveling states that in 1820 the Council of Cologne sanctioned the placing of a gag in the mouth of a dead pregnant woman, thereby hoping to prevent suffocation of the infant, and there are numerous such laws on record, although most of them pertain to the performance of Cesarean section immediately after death. Reiss records the death of a woman who was hastily buried while her husband was away, and on his return he ordered exhumation of her body, and on opening the coffin a child's cry was heard. The infant had evidently been born postmortem. It lived long afterward under the name of "Fils de la terre." Willoughby mentions the curious instance in which rumbling was heard from the coffin of a woman during her hasty burial. One of her neighbors returned to the grave, applied her ear to the ground, and was sure she heard a sighing noise. A soldier with her affirmed her tale, and together they went to a clergyman and a justice, begging that the grave be opened. When the coffin was opened it was found that a child had been born, which had descended to her knees. In Derbyshire, to this day, may be seen on the parish register: "April ye 20, 1650, was buried Emme, the wife of Thomas Toplace, who was found delivered of a child after she had lain two hours in the grave." Johannes Matthaeus relates the case of a buried woman, and that some time afterward a noise was heard in the tomb. The coffin was immediately opened, and a living female child rolled to the feet of the corpse. Hagendorn mentions the birth of a living child some hours after the death of the mother. Dethardingius mentions a healthy child born one-half hour after the mother's death. In the Gentleman's Magazine there is a record of an instance, in 1759, in which a midwife, after the death of a woman whom she had failed to deliver, imagined that she saw a movement under the shroud and found a child between its mother's legs. It died soon after. Valerius Maximus says that while the body of the mother of Gorgia Epirotas was being carried to the grave, a loud noise was heard to come from the coffin and on examination a live child was found between the thighs,--whence arose the proverb: "Gorgiam prius ad funus elatum, quam natum fuisse." Other cases of postmortem delivery are less successful, the delivery being delayed too late for the child to be viable. The first of Aveling's cases was that of a pregnant woman who was hanged by a Spanish Inquisitor in 1551 While still hanging, four hours later, two children were said to have dropped from her womb. The second case was of a woman of Madrid, who after death was shut in a sepulcher. Some months after, when the tomb was opened, a dead infant was found by the side of the corpse. Rolfinkius tells of a woman who died during parturition, and her body being placed in a cellar, five days later a dead boy and girl were found on the bier. Bartholinus is accredited with the following: Three midwives failing to deliver a woman, she died, and forty-eight hours after death her abdomen swelled to such an extent as to burst her grave-clothes, and a male child, dead, was seen issuing from the vagina. Bonet tells of a woman, who died in Brussels in 1633, who, undelivered, expired in convulsions on Thursday. On Friday abdominal movements in the corpse were seen, and on Sunday a dead child was found hanging between the thighs. According to Aveling, Herman of Berne reports the instance of a young lady whose body was far advanced in putrefaction, from which was expelled an unbroken ovum containing twins. Even the placenta showed signs of decomposition. Naumann relates the birth of a child on the second day after the death of the mother. Richter of Weissenfels, in 1861, reported the case of a woman who died in convulsions, and sixty hours after death an eight months' fetus came away. Stapedius writes to a friend of a fetus being found dead between the thighs of a woman who expired suddenly of an acute disease. Schenk mentions that of a woman, dying at 5 P.M., a child having two front teeth was born at 3 A.M. Veslingius tells of a woman dying of epilepsy on June 6, 1630, from whose body, two days later, issued a child. Wolfius relates the case of a woman dying in labor in 1677. Abdominal movements being seen six hours after death, Cesarean section was suggested, but its performance was delayed, and eighteen hours after a child was spontaneously born. Hoyer of Mulhausen tells of a child with its mouth open and tongue protruding, which was born while the mother was on the way to the grave. Bedford of Sydney, according to Aveling, relates the story of a case in which malpractice was suspected on a woman of thirty-seven, who died while pregnant with her seventh child. The body was exhumed, and a transverse rupture of the womb six inches long above the cervix was found, and the body of a dead male child lay between the thighs. In 1862, Lanigan tells of a woman who was laid out for funeral obsequies, and on removal of the covers for burial a child was found in bed with her. Swayne is credited with the description of the death of a woman whom a midwife failed to deliver. Desiring an inquest, the coroner had the body exhumed, when, on opening the coffin, a well-developed male infant was found parallel to and lying on the lower limbs, the cord and placenta being entirely unattached from the mother. Some time after her decease Harvey found between the thighs of a dead woman a dead infant which had been expelled postmortem. Mayer relates the history of a case of a woman of forty-five who felt the movement of her child for the fourth time in the middle of November. In the following March she had hemoptysis, and serious symptoms of inflammation in the right lung following, led to her apparent death on the 31st of the month. For two days previous to her death she had failed to perceive the fetal movements. She was kept on her back in a room, covered up and undisturbed, for thirty-six hours, the members of the family occasionally visiting her to sprinkle holy water on her face. There was no remembrance of cadaveric distortion of the features or any odor. When the undertakers were drawing the shroud on they noticed a half-round, bright-red, smooth-looking body between the genitals which they mistook for a prolapsed uterus. Early on April 2d, a few hours before interment, the men thought to examine the swelling they had seen the day before. A second look showed it to be a dead female child, now lying between the thighs and connected with the mother by the umbilical cord. The interment was stopped, and Mayer was called to examine the body, but with negative results, though the signs of death were not plainly visible for a woman dead fifty-eight hours. By its development the body of the fetus confirmed the mother's account of a pregnancy of twenty-one weeks. Mayer satisfies himself at least that the mother was in a trance at the time of delivery and died soon afterward. Moritz gives the instance of a woman dying in pregnancy, undelivered, who happened to be disinterred several days after burial. The body was in an advanced state of decomposition, and a fetus was found in the coffin. It was supposed that the pressure of gas in the mother's body had forced the fetus from the uterus. Ostmann speaks of a woman married five months, who was suddenly seized with rigors, headache, and vomiting. For a week she continued to do her daily work, and in addition was ill-treated by her husband. She died suddenly without having any abdominal pain or any symptoms indicative of abortion. The body was examined twenty-four hours after death and was seen to be dark, discolored, and the abdomen distended. There was no sanguineous discharge from the genitals, but at the time of raising the body to place it in the coffin, a fetus, with the umbilical cord, escaped from the vagina. There seemed to have been a rapid putrefaction in this ease, generating enough pressure of gas to expel the fetus as well as the uterus from the body. This at least is the view taken by Hoffman and others in the solution of these strange cases. Antepartum Crying of the Child.--There are on record fabulous cases of children crying in the uterus during pregnancy, and all sorts of unbelievable stories have been constructed from these reported occurrences. Quite possible, however, and worthy of belief are the cases in which the child has been heard to cry during the progress of parturition--that is, during delivery. Jonston speaks of infants crying in the womb, and attempts a scientific explanation of the fact. He also quotes the following lines in reference to this subject:-- "Mirandum foetus nlaterna clausus in alvo Dicitur insuetos ore dedisse sonos. Causa subest; doluit se angusta sede telleri Et cupiit magnae cernere moliis opus. Aut quia quaerendi studio vis fessa parentum Aucupii aptas innuit esse manus." The Ephemerides gives examples of the child hiccoughing in the uterus. Cases of crying before delivery, some in the vagina, some just before the complete expulsion of the head from the os uteri, are very numerous in the older writers; and it is quite possible that on auscultation of the pregnant abdomen fetal sounds may have been exaggerated into cries. Bartholinus, Borellus, Boyle, Buchner, Paullini, Mezger, Riolanus, Lentillus, Marcellus Donatus, and Wolff all speak of children crying before delivery; and Mazinus relates the instance of a puppy whose feeble cries could be heard before expulsion from the bitch. Osiander fully discusses the subject of infants crying during parturition. McLean describes a case in which he positively states that a child cried lustily in utero during application of the forceps. He compared the sound as though from a voice in the cellar. This child was in the uterus, not in the vagina, and continued the crying during the whole of the five minutes occupied by delivery. Cesarean Section.--Although the legendary history of Cesarean section is quite copious, it is very seldom that we find authentic records in the writings of the older medical observers. The works of Hippocrates, Aretxeus, Galen, Celsus, and Aetius contain nothing relative to records of successful Cesarean sections. However, Pliny says that Scipio Africanus was the first and Manlius the second of the Romans who owed their lives to the operation of Cesarean section; in his seventh book he says that Julius Caesar was born in this way, the fact giving origin to his name. Others deny this and say that his name came from the thick head of hair which he possessed. It is a frequent subject in old Roman sculpture, and there are many delineations of the birth of Bacchus by Cesarean section from the corpse of Semele. Greek mythology tells us of the birth of Bacchus in the following manner: After Zeus burnt the house of Semele, daughter of Cadmus, he sent Hermes in great haste with directions to take from the burnt body of the mother the fruit of seven months. This child, as we know, was Bacchus. Aesculapius, according to the legend of the Romans, had been excised from the belly of his dead mother, Corinis, who was already on the funeral pile, by his benefactor, Apollo; and from this legend all products of Cesarean sections were regarded as sacred to Apollo, and were thought to have been endowed with sagacity and bravery. Old records tell us that one of the kings of Navarre was delivered in this way, and we also have records of the birth of the celebrated Doge, Andreas Doria, by this method. Jane Seymour was supposed to have been delivered of Edward VI by Cesarean section, the father, after the consultation of the physicians was announced to him, replying: "Save the child by all means, for I shall be able to get mothers enough." Robert II of Scotland was supposed to have been delivered in this way after the death of his mother, Margery Bruce, who was killed by being thrown from a horse. Shakespere's immortal citation of Macduff, "who was from his mother's womb untimely ripped," must have been such a case, possibly crudely done, perchance by cattle-horn. Pope Gregory XIV was said to have been taken from his mother's belly after her death. The Philosophical Transactions, in the last century contain accounts of Cesarean section performed by an ignorant butcher and also by a midwife; and there are many records of the celebrated case performed by Jacob Nufer, a cattle gelder, at the beginning of the sixteenth century. By the advent of antisepsis and the improvements of Porro and others, Cesarean section has come to be a quite frequent event, and a record of the successful cases would hardly be considered a matter of extraordinary interest, and would be out of the province of this work, but a citation of anomalous cases will be given. Baldwin reports a case of Cesarean section on a typical rachitic dwarf of twenty-four, who weighed 100 pounds and was only 47 1/2 inches tall. It was the ninth American case, according to the calculation of Harris, only the third successful one, and the first successful one in Ohio. The woman had a uniformly contracted pelvis whose anteroposterior diameter was about 1 1/4 inches. The hygienic surroundings for the operation were not of the best, as the woman lived in a cellar. Tait's method of performing the operation was determined upon and successfully performed. Convalescence was prompt, and in three weeks the case was dismissed. The child was a female of 7 1/2 pounds which inherited the deformities of its mother. It thrived for nine and a half months, when it died of angina Ludovici. Figure 15 represents the mother and child. Harris gives an account of an operation upon a rachitic dwarf who was impregnated by a large man, a baby weighing 14 pounds and measuring 20 inches being delivered by the knife. St. Braun gives the account of a Porro-Cesarean operation in the case of a rachitic dwarf 3 feet 10 inches tall, in which both the mother and child recovered. Munde speaks of twins being delivered by Cesarean section. Franklin gives the instance of a woman delivered at full term of a living child by this means, in whom was also found a dead fetus. It lay behind the stump of the amputated cervix, in the culdesac of Douglas. The patient died of hemorrhage. Croston reports a case of Cesarean section on a primipara of twenty-four at full term, with the delivery of a double female monster weighing 12 1/2 pounds. This monster consisted of two females of about the same size, united from the sternal notch to the navel, having one cord and one placenta. It was stillborn. The diagnosis was made before operation by vaginal examination. In a communication to Croston, Harris remarked that this was the first successful Cesarean section for double monstrous conception in America, and added that in 1881 Collins and Leidy performed the same operation without success. Instances of repeated Cesarean section were quite numerous, and the pride of the operators noteworthy, before the uterus was removed at the first operation, as is now generally done. Bacque reports two sections in the same woman, and Bertrandi speaks of a case in which the operation was successfully executed many times in the same woman. Rosenberg reports three cases repeated successfully by Leopold of Dresden. Skutsch reports a case in which it was twice performed on a woman with a rachitic pelvis, and who the second time was pregnant with twins; the children and mother recovered. Zweifel cites an instance in which two Cesarean sections were performed on a patient, both of the children delivered being in vigorous health. Stolz relates a similar case. Beck gives an account of a Cesarean operation twice on the same woman; in the first the child perished, but in the second it survived. Merinar cites an instance of a woman thrice opened. Parravini gives a similar instance. Charlton gives an account of the performance carried out successfully four times in the same woman; Chisholm mentions a case in which it was twice performed. Michaelis of Kiel gives an instance in which he performed the same operation on a woman four times, with successful issues to both mother and children, despite the presence of peritonitis the last time. He had operated in 1826, 1830, 1832, and 1836. Coe and Gueniot both mention cases in which Cesarean section had been twice performed with successful terminations as regards both mothers and children. Rosenberg tabulates a number of similar cases from medical literature. Cases of Cesarean section by the patient herself are most curious, but may be readily believed if there is any truth in the reports of the operation being done in savage tribes. Felkin gives an account of a successful case performed in his presence, with preservation of the lives of both mother and child, by a native African in Kahura, Uganda Country. The young girl was operated on in the crudest manner, the hemorrhage being checked by a hot iron. The sutures were made by means of seven thin, hot iron spikes, resembling acupressure-needles, closing the peritoneum and skin. The wound healed in eleven days, and the mother made a complete recovery. Thomas Cowley describes the case of a negro woman who, being unable to bear the pains of labor any longer, took a sharp knife and made a deep incision in her belly--deep enough to wound the buttocks of her child, and extracted the child, placenta and all. A negro horse-doctor was called, who sewed the wound up in a manner similar to the way dead bodies are closed at the present time. Barker gives the instance of a woman who, on being abused by her husband after a previous tedious labor, resolved to free herself of the child, and slyly made an incision five inches long on the left side of the abdomen with a weaver's knife. When Barker arrived the patient was literally drenched with blood and to all appearance dead. He extracted a dead child from the abdomen and bandaged the mother, who lived only forty hours. In his discourses on Tropical Diseases Moseley speaks of a young negress in Jamaica who opened her uterus and extracted therefrom a child which lived six days; the woman recovered. Barker relates another case in Rensselaer County, N.Y., in which the incision was made with the razor, the woman likewise recovering. There is an interesting account of a poor woman at Prischtina, near the Servian frontier, who, suffering greatly from the pains of labor, resolved to open her abdomen and uterus. She summoned a neighbor to sew up the incision after she had extracted the child, and at the time of report, several months later, both the mother and child were doing well. Madigan cites the case of a woman of thirty-four, in her seventh confinement, who, while temporarily insane, laid open her abdomen with a razor, incised the uterus, and brought out a male child. The abdominal wound was five inches long, and extended from one inch above the umbilicus straight downward. There was little or no bleeding and the uterus was firmly contracted. She did not see a physician for three hours. The child was found dead and, with the placenta, was lying by her side. The neighbors were so frightened by the awful sight that they ran away, or possibly the child might have been saved by ligature of the funis. Not until the arrival of the clergyman was anything done, and death ultimately ensued. A most wonderful case of endurance of pain and heroism was one occurring in Italy, which attracted much European comment at the time. A young woman, illegitimately pregnant, at full term, on March 28th, at dawn, opened her own abdomen on the left side with a common knife such as is generally used in kitchens. The wound measured five inches, and was directed obliquely outward and downward. She opened the uterus in the same direction, and endeavored to extract the fetus. To expedite the extraction, she drew out an arm and amputated it, and finding the extraction still difficult, she cut off the head and completely emptied the womb, including the placenta. She bound a tight bandage around her body and hid the fetus in a straw mattress. She then dressed herself and attended to her domestic duties. She afterward mounted a cart and went into the city of Viterbo, where she showed her sister a cloth bathed in blood as menstrual proof that she was not pregnant. On returning home, having walked five hours, she was seized with an attack of vomiting and fainted. The parents called Drs. Serpieri and Baliva, who relate the case. Thirteen hours had elapsed from the infliction of the wound, through which the bulk of the intestines had been protruding for the past six hours. The abdomen was irrigated, the toilet made, and after the eighteenth day the process of healing was well progressed, and the woman made a recovery after her plucky efforts to hide her shame. Cases like the foregoing excite no more interest than those on record in which an abdominal section has been accidental, as, for instance, by cattle-horns, and the fetus born through the wound. Zuboldie speaks of a case in which a fetus was born from the wound made by a bull's horn in the mother's abdomen. Deneux describes a case in which the wound made by the horn was not sufficiently large to permit the child's escape, but it was subsequently brought through the opening. Pigne speaks of a woman of thirty-eight, who in the eighth month of her sixth pregnancy was gored by a bull, the horn effecting a transverse wound 27 inches long, running from one anterior spine to the other. The woman was found cold and insensible and with an imperceptible pulse. The small intestines were lying between the thighs and covered with coagulated blood. In the process of cleansing, a male child was expelled spontaneously through a rent in the uterus. The woman was treated with the usual precautions and was conscious at midday. In a month she was up. She lived twenty years without any inconvenience except that due to a slight hernia on the left side. The child died at the end of a fortnight. In a very exhaustive article Harris of Philadelphia has collected nearly all the remaining cases on record, and brief extracts from some of them will be given below. In Zaandam, Holland, 1647, a farmer's wife was tossed by a furious bull. Her abdomen was ripped open, and the child and membranes escaped. The child suffered no injuries except a bruised upper lip and lived nine months. The mother died within forty hours of her injuries. Figure 19 taken from an engraving dated 1647, represents an accouchement by a mad bull, possibly the same case. In Dillenberg, Germany, in 1779, a multipara was gored by an ox at her sixth month of pregnancy; the horn entered the right epigastric region, three inches from the linea alba, and perforated the uterus. The right arm of the fetus protruded; the wound was enlarged and the fetus and placenta delivered. Thatcher speaks of a woman who was gored by a cow in King's Park, and both mother and child were safely delivered and survived. In the Parish of Zecoytia, Spain, in 1785, Marie Gratien was gored by an ox in the superior portion of her epigastrium, making a wound eight inches long which wounded the uterus in the same direction. Dr. Antonio di Zubeldia and Don Martin Monaco were called to take charge of the case. While they were preparing to effect delivery by the vagina, the woman, in an attack of singultus, ruptured the line of laceration and expelled the fetus, dead. On the twenty-first day the patient was doing well. The wound closed at the end of the sixteenth week. The woman subsequently enjoyed excellent health and, although she had a small ventral hernia, bore and nursed two children. Marsh cites the instance of a woman of forty-two, the mother of eight children, who when eight months pregnant was horned by a cow. Her clothes were not torn, but she felt that the child had slipped out, and she caught it in her dress. She was seen by some neighbors twelve yards from the place of accident, and was assisted to her house. The bowels protruded and the child was separated from the funis. A physician saw the woman three-quarters of an hour afterward and found her pulseless and thoroughly exhausted. There was considerable but not excessive loss of blood, and several feet of intestine protruded through the wound. The womb was partially inverted through the wound, and the placenta was still attached to the inverted portion. The wound in the uterus was Y-shaped. The mother died in one and a half hours from the reception of her injuries, but the child was uninjured. Scott mentions the instance of a woman thirty-four years old who was gored by an infuriated ox while in the ninth month of her eighth pregnancy. The horn entered at the anterior superior spinous process of the ilium, involving the parietes and the uterus. The child was extruded through the wound about half an hour after the occurrence of the accident. The cord was cut and the child survived and thrived, though the mother soon died. Stalpart tells the almost incredible story of a soldier's wife who went to obtain water from a stream and was cut in two by a cannonball while stooping over. A passing soldier observed something to move in the water, which, on investigation, he found to be a living child in its membranes. It was christened by order of one Cordua and lived for some time after. Postmortem Cesarean Section.--The possibility of delivering a child by Cesarean section after the death of the mother has been known for a long time to the students of medicine. In the olden times there were laws making compulsory the opening of the dead bodies of pregnant women shortly after death. Numa Pompilius established the first law, which was called "les regia," and in later times there were many such ordinances. A full description of these laws is on record. Life was believed possible after a gestation of six months or over, and, as stated, some famous men were supposed to have been born in this manner. Francois de Civile, who on great occasions signed himself "trois fois enterre et trois fois par le grace de Dieu ressucite," saw the light of the world by a happy Cesarean operation on his exhumed mother. Fabricius Hildanus and Boarton report similar instances. Bourton cites among others the case of an infant who was found living twelve hours after the death of his mother. Dufour and Mauriceau are two older French medical writers who discuss this subject. Flajani speaks of a case in which a child was delivered at the death of its mother, and some of the older Italian writers discuss the advisability of the operation in the moribund state before death actually ensues. Heister writes of the delivery of the child after the death of the mother by opening the abdomen and uterus. Harris relates several interesting examples. In Peru in 1794 a Sambi woman was killed by lightning, and the next day the abdomen was opened by official command and a living child was extracted. The Princess von Swartzenberg, who was burned to death at a ball in Paris in 1810, was said to have had a living child removed from her body the next day. Like all similar instances, this was proved to be false, as her body was burned beyond the possibility of recognition, and, besides, she was only four months pregnant. Harris mentions another case of a young woman who threw herself from the Pont Neuf into the Seine. Her body was recovered, and a surgeon who was present seized a knife from a butcher standing by and extracted a living child in the presence of the curious spectators. Campbell discusses this subject most thoroughly, though he advances no new opinions upon it. Duer tabulates the successful results of a number of cases of Cesarean section after death as follows:-- Children extracted between 1 and 5 minutes after death of the mother, 21 " " 10 and 15 " " " " " " 13 " " 15 and 30 " " " " " " 2 " " 1 hour " " " " " " 2 " " 2 hours " " " " " " 2 Garezky of St. Petersburg collected reports of 379 cases of Cesarean section after death with the following results: 308 were extracted dead; 37 showed signs of life; 34 were born alive. Of the 34, only 5 lived for any length of time. He concludes that if extracted within five or six minutes after death, they may be born alive; if from six to ten minutes, they may still be born alive, though asphyxiated; if from ten to twenty-six minutes, they will be highly asphyxiated. In a great number of these cases the infant was asphyxiated or dead in one minute. Of course, if the death is sudden, as by apoplexy, accident, or suicide, the child's chances are better. These statistics seem conscientious and reliable, and we are safe in taking them as indicative of the usual result, which discountenances the old reports of death as taking place some time before extraction. Peuch is credited with statistics showing that in 453 operations 101 children gave signs of life, but only 45 survived. During the Commune of Paris, Tarnier, one night at the Maternite, was called to an inmate who, while lying in bed near the end of pregnancy, had been killed by a ball which fractured the base of the skull and entered the brain. He removed the child by Cesarean section and it lived for several days. In another case a pregnant woman fell from a window for a distance of more than 30 feet, instant death resulting; thirty minutes at least after the death of the mother an infant was removed, which, after some difficulty, was resuscitated and lived for thirteen years. Tarnier states that delivery may take place three-quarters of an hour or even an hour after the death of the mother, and he also quotes an extraordinary case by Hubert of a successful Cesarean operation two hours after the mother's death; the woman, who was eight months pregnant, was instantly killed while crossing a railroad track. Hoffman records the case of a successful Cesarean section done ten minutes after death. The patient was a woman of thirty-six, in her eighth month of pregnancy, who was suddenly seized with eclampsia, which terminated fatally in ten hours. Ten minutes after her last respiration the Cesarean section was performed and a living male child delivered. This infant was nourished with the aid of a spoon, but it died in twenty-five hours in consequence of its premature birth and enfeebled vitality. Green speaks of a woman, nine months pregnant, who was run over by a heavily laden stage-coach in the streets of Southwark. She died in about twenty minutes, and in about twenty minutes more a living child was extracted from her by Cesarean section. There was a similar case in the Hopital St. Louis, in Paris, in 1829; but in this case the child was born alive five minutes after death. Squire tells of a case in which the mother died of dilatation of the aorta, and in from twenty to thirty minutes the child was saved. In comment on this case Aveling is quoted as saying that he believed it possible to save a child one hour after the death of the mother. No less an authority than Playfair speaks of a case in which a child was born half an hour after the death of the mother. Beckman relates the history of a woman who died suddenly in convulsions. The incision was made about five minutes after death, and a male child about four pounds in weight was extracted. The child exhibited feeble heart-contractions and was despaired of. Happily, after numerous and persistent means of resuscitation, applied for about two and a half hours, regular respirations were established and the child eventually recovered. Walter reports a successful instance of removal of the child after the death of the mother from apoplexy. Cleveland gives an account of a woman of forty-seven which is of special interest. The mother had become impregnated five months after the cessation of menstruation, and a uterine sound had been used in ignorance of the impregnation at this late period. The mother died, and one hour later a living child was extracted by Cesarean section. There are two other recent cases recorded of extraction after an hour had expired from the death. One is cited by Veronden in which the extraction was two hours after death, a living child resulting, and the other by Blatner in which one hour had elapsed after death, when the child was taken out alive. Cases of rupture of the uterus during pregnancy from the pressure of the contents and delivery of the fetus by some unnatural passage are found in profusion through medical literature, and seem to have been of special interest to the older observers. Benivenius saw a case in which the uterus ruptured and the intestines protruded from the vulva. An instance similar to the one recorded by Benivenius is also found in the last century in Germany. Bouillon and Desbois, two French physicians of the last century, both record examples of the uterus rupturing in the last stages of pregnancy and the mother recovering. Schreiber gives an instance of rupture of the uterus occasioned by the presence of a 13-pound fetus, and there is recorded the account of a rupture caused by a 20-pound fetus that made its way into the abdomen. We find old accounts of cases of rupture of the uterus with birth by the umbilicus and the recovery of the woman. Vespre describes a case in which the uterus was ruptured by the feet of the fetus. Farquharson has an account of a singular case in midwifery in which abdomen ruptured from the pressure of the fetus; and quite recently Geoghegan illustrates the possibilities of uterine pressure in pregnancy by a postmortem examination after a fatal parturition, in which the stomach was found pushed through the diaphragm and lying under the left clavicle. Heywood Smith narrates the particulars of a case of premature labor at seven months in which rupture of the uterus occurred and, notwithstanding the fact that the case was complicated by placenta praevia, the patient recovered. Rupture of the uterus and recovery does not necessarily prevent subsequent successful pregnancy and delivery by the natural channels. Whinery relates an instance of a ruptured uterus in a healthy Irish woman of thirty-seven from whom a dead child was extracted by abdominal section and who was safely delivered of a healthy female child about one year afterward. Analogous to this case is that of Lawrence, who details the instance of a woman who had been delivered five times of dead children; she had a very narrow pelvis and labor was always induced at the eighth month to assure delivery. In her sixth pregnancy she had miscalculated her time, and, in consequence, her uterus ruptured in an unexpected parturition, but she recovered and had several subsequent pregnancies. Occasionally there is a spontaneous rupture of the vagina during the process of parturition, the uterus remaining intact. Wiltshire reports such a case in a woman who had a most prominent sacrum; the laceration was transverse and quite extensive, but the woman made a good recovery. Schauta pictures an exostosis on the promontory of the sacrum. Blenkinsop cites an instance in which the labor was neither protracted nor abnormally severe, yet the rupture of the vagina took place with the escape of the child into the abdomen of the mother, and was from thence extracted by Cesarean section. A peculiarity of this case was the easy expulsion from the uterus, no instrumental or other manual interference being attempted and the uterus remaining perfectly intact. In some cases there is extensive sloughing of the genitals after parturition with recovery far beyond expectation. Gooch mentions a case in which the whole vagina sloughed, yet to his surprise the patient recovered. Aetius and Benivenius speak of recovery in such cases after loss of the whole uterus. Cazenave of Bordeaux relates a most marvelous case in which a primipara suffered in labor from an impacted head. She was twenty-five, of very diminutive stature, and was in labor a long time. After labor, sloughing of the parts commenced and progressed to such an extent that in one month there were no traces of the labia, nymphae, vagina, perineum, or anus. There was simply a large opening extending from the meatus urinarius to the coccyx. The rectovaginal septum, the lower portion of the rectum, and the neck of the bladder were obliterated. The woman survived, although she always experienced great difficulty in urination and in entirely emptying the rectum. A similar instance is reported in a woman of thirty who was thirty-six hours in labor. The fundus of the uterus descended into the vagina and the whole uterine apparatus was removed. The lower part of the rectum depended between the labia; in the presence of the physician the nurse drew this out and it separated at the sphincter ani. On examining the parts a single opening was seen, as in the preceding case, from the pubes to the coccyx. Some time afterward the end of the intestine descended several inches and hung loosely on the concave surface of the rectum. A sponge was introduced to support the rectum and prevent access of air. The destruction of the parts was so complete and the opening so large as to bring into view the whole inner surface of the pelvis, in spite of which, after prolonged suppuration, the wound cicatrized from behind forward and health returned, except as regards the inconvenience of feces and urine. Milk-secretion appeared late and lasted two months without influencing the other functions. There are cases in which, through the ignorance of the midwife or the physician, prolapsed pelvic organs are mistaken for afterbirth and extracted. There have been instances in which the whole uterus and its appendages, not being recognized, have been dragged out. Walters cites the instance of a woman of twenty-two, who was in her third confinement. The midwife in attendance, finding the afterbirth did not come away, pulled at the funis, which broke at its attachment. She then introduced her hand and tore away what proved to be the whole of the uterus, with the right ovary and fallopian tube, a portion of the round ligament, and the left tube and ovarian ligament attached to it. A large quantity of omentum protruded from the vulva and upper part of the vagina, and an enormous rent was left. Walters saw the woman twenty-one hours afterward, and ligated and severed the protruding omentum. On the twenty-eighth day, after a marvelous recovery, she was able to drive to the Royal Berkshire Hospital, a distance of five miles. At the time of report, two years and six months after the mutilation, she was in perfect health. Walters looked into the statistics of such cases and found 36 accidental removals of the uterus in the puerperium with 14 recoveries. All but three of these were without a doubt attended by previous inversion of the uterus. A medical man was tried for manslaughter in 1878 because he made a similar mistake. He had delivered a woman by means of the forceps, and, after delivery, brought away what he thought a tumor. This "tumor" consisted of the uterus, with the placenta attached to the fundus, the funis, a portion of the lateral ligament, containing one ovary and about three inches of vagina. The uterus was not inverted. A horrible case, with similar results, happened in France, and was reported by Tardieu. A brutal peasant, whose wife was pregnant, dragged out a fetus of seven months, together with the uterus and the whole intestinal canal, from within 50 cm. of the pylorus to within 8 cm. of the ileocecal valve. The woman was seen three-quarters of an hour after the intestines had been found in the yard (where the brute had thrown them), still alive and reproaching her murderer. Hoffman cites an instance in which a midwife, in her anxiety to extract the afterbirth, made traction on the cord, brought out the uterus, ovaries, and tubes, and tore the vulva and perineum as far as the anus. Woodson tells the story of a negress who was four months pregnant, and who, on being seized with severe uterine pains in a bath, succeeded in seizing the fetus and dragging it out, but inverting the uterus in the operation. There is a case recorded of a girl of eighteen, near her labor, who, being driven from her house by her father, took refuge in a neighboring house, and soon felt the pains of child-birth. The accoucheur was summoned, pronounced them false pains, and went away. On his return he found the girl dying, with her uterus completely inverted and hanging between her legs. This unfortunate maiden had been delivered while standing upright, with her elbows on the back of a chair. The child suddenly escaped, bringing with it the uterus, but as the funis ruptured the child fell to the floor. Wagner pictures partial prolapse of the womb in labor. It would too much extend this chapter to include the many accidents incident to labor, and only a few of especial interest will be given. Cases like rupture of an aneurysm during labor, extensive hemorrhage, the entrance of air into the uterine veins and sinuses, and common lacerations will be omitted, together with complicated births like those of double monsters, etc., but there are several other cases that deserve mention. Eldridge gives an instance of separation of the symphysis pubis during labor,--a natural symphysiotomy. A separation of 3/4 inch could be discerned at the symphysis, and in addition the sacroiliac synchondrosis was also quite movable. The woman had not been able to walk in the latter part of her pregnancy. The child weighed 10 1/2 pounds and had a large head in a remarkably advanced stage of ossification, with the fontanelles nearly closed. Delivery was effected, though during the passage of the head the pubes separated to such an extent that Eldridge placed two fingers between them. The mother recovered, and had perfect union and normal locomotion. Sanders reports a case of the separation of the pubic bones in labor. Studley mentions a case of fracture of the pelvis during instrumental delivery. Humphreys cites a most curious instance. The patient, it appears, had a large exostosis on the body of the pubes which, during parturition, was forced through the walls of the uterus and bladder, resulting in death. Kilian reports four cases of death from perforation of the uterus in this manner. Schauta pictures such an exostosis. Chandler relates an instance in which there was laceration of the liver during parturition; and Hubbard records a case of rupture of the spleen after labor. Symphysiotomy is an operation consisting of division of the pubic symphysis in order to facilitate delivery in narrow pelves. This operation has undergone a most remarkable revival during the past two years. It originated in a suggestion by Pineau in his work on surgery in 1598, and in 1665 was first performed by La Courvee upon a dead body in order to save the child, and afterward by Plenk, in 1766, for the same purpose. In 1777 Sigault first proposed the operation on the living, and Ferrara was the one to carry out, practically, the proposition,--although Sigault is generally considered to be the first symphysiotormist, and the procedure is very generally known as the "Sigaultean operation." From Ferrara's time to 1858, when the operation had practically died out, it had been performed 85 times, with a recorded mortality of 33 per cent. In 1866 the Italians, under the leadership of Morisani of Naples, revived the operation, and in twenty years had performed it 70 times with a mortality of 24 per cent. Owing to rigid antiseptic technic, the last 38 of these operations (1886 to 1891) showed a mortality of only 50 per cent, while the infant-mortality was only 10 2/3 per cent. The modern history of this operation is quite interesting, and is very completely reviewed by Hirst and Dorland. In November, 1893, Hirst reported 212 operations since 1887, with a maternal mortality of 12.73 per cent and a fetal mortality of 28 per cent. In his later statistics Morisani gives 55 cases with 2 maternal deaths and 1 infantile death, while Zweifel reports 14 cases from the Leipzig clinic with no maternal death and 2 fetal deaths, 1 from asphyxia and 1 from pneumonia, two days after birth. All the modern statistics are correspondingly encouraging. Irwin reports a case in which the firm attachment of the fetal head to the uterine parietes rendered delivery without artificial aid impossible, and it was necessary to perform craniotomy. The right temporal region of the child adhered to the internal surface of the neck of the uterus, being connected by membranes. The woman was forty-four years old, and the child was her fourth. Delay in the Birth of the Second Twin.--In twin pregnancies there is sometimes a delay of many days in the birth of a second child, even to such an extent as to give suspicion of superfetation. Pignot speaks of one twin two months before the other. De Bosch speaks of a delay of seventeen days; and there were 2 cases on record in France in the last century, one of which was delayed ten days, and the other showed an interval of seven weeks between the delivery of the twins. There is an old case on record in which there was an interval of six weeks between deliveries; Jansen gives an account of three births in ten months; Pinart mentions a case with an interval of ten days; Thilenius, one of thirteen days; and Ephemerides, one of one week. Wildberg describes a case in which one twin was born two months after the other, and there was no secretion of milk until after the second birth. A full description of Wildberg's case is given in another journal in brief, as follows: A woman, eighteen months married, was in labor in the eighth month of pregnancy. She gave birth to a child, which, though not fully matured, lived. There was no milk-secretion in her breasts, and she could distinctly feel the movements of another child; her abdomen increased in size. After two months she had another labor, and a fully developed and strong child was born, much heavier than the first. On the third day after, the breasts became enlarged, and she experienced considerable fever. It was noticeable in this case that a placenta was discharged a quarter of an hour after the first birth. Irvine relates an instance of thirty-two days' delay; and Pfau one of seven days'. Carson cites the instance of a noblewoman of forty, the mother of four children, who was taken ill about two weeks before confinement was expected, and was easily delivered of a male child, which seemed well formed, with perfect nails, but weakly. After the birth the mother never became healthy or natural in appearance. She was supposed to be dying of dropsy, but after forty-four days the mystery was cleared by the birth of a fine, well-grown, and healthy daughter. Both mother and child did well. Addison describes the case of a woman who was delivered of a healthy male child, and everything was well until the evening of the fourth day, when intense labor-pains set in, and well-formed twins about the size of a pigeon's egg were born. In this strange case, possibly an example of superfetation, the patient made a good recovery and the first child lived. A similar case is reported by Lumby in which a woman was delivered on January 18th, by a midwife, of a full-grown and healthy female child. On the third day she came down-stairs and resumed her ordinary duties, which she continued until February 4th (seventeen days after). At this time she was delivered of twins, a boy and a girl, healthy and well-developed. The placenta was of the consistency of jelly and had to be scooped away with the hand. The mother and children did well. This woman was the mother of ten children besides the product of this conception, and at the latter occurrence had entire absence of pains and a very easy parturition. Pincott had a case with an interval of seven weeks between the births; Vale 1 of two months; Bush 1 of seventeen days; and Burke 1 with an interval of two months. Douglas cites an instance of twins being born four days apart. Bessems of Antwerp, in 1866, mentions a woman with a bicornate uterus who bore two twins at fifty-four days' interval. CHAPTER IV. PROLIFICITY. General Historic Observations.--Prolificity is a much discussed subject, for besides its medical and general interest it is of importance in social as well as in political economy. Superfluous population was a question that came to consciousness early; Aristotle spoke of legislation to prevent the increase of population and the physical and mental deterioration of the race,--he believed in a population fixed as regards numbers,--and later Lycurgus transformed these precepts into a terrible law. Strabonius reports that the inhabitants of Cathea brought their infants at the age of two months before a magistrate for inspection. The strong and promising were preserved and the weak destroyed. The founders of the Roman Empire followed a similar usage. With great indignation Seneca, Ovid, and Juvenal reproved this barbarity of the Romans. With the domination of Christianity this custom gradually diminished, and Constantine stopped it altogether, ordering succor to the people too poor to rear their own children. The old Celts were so jealous of their vigor that they placed their babes on a shield in the river, and regarded those that the waves respected as legitimate and worthy to become members of their clans. In many of the Oriental countries, where the population is often very excessive and poverty great, the girl babies of the lower classes were destroyed. At one time the crocodiles, held sacred in the Nile, were given the surplus infants. By destroying the females the breeding necessarily diminished, and the number of the weaker and dependent classes became less. In other countries persons having children beyond their ability to support were privileged to sell them to citizens, who contracted to raise them on condition that they became their slaves. General Law, and the Influence of War.--In the increase of the world's population, although circumstances may for the time alter it, a general average of prolificity has, in the long run, been maintained. In the history of every nation artificial circumstances, such as fashion, war, poverty, etc., at some period have temporarily lowered the average of prolificity; but a further search finds another period, under opposite circumstances, which will more than compensate for it. The effect of a long-continued war or wars on generation and prolificity has never been given proper consideration. In such times marriages become much less frequent; the husbands are separated from their wives for long periods; many women are left widows; the females become in excess of the males; the excitement of the times overtops the desire for sexual intercourse, or, if there is the same desire, the unprolific prostitute furnishes the satisfaction; and such facts as these, coupled with many similar ones, soon produce an astonishing effect upon the comparative birth-rate and death-rate of the country. The resources of a country, so far as concerns population, become less as the period of peace-disturbance is prolonged. Mayo-Smith quotes von Mayr in the following example of the influence of the war of 1870-71 on the birth-rate in Bavaria,--the figures for births are thrown back nine months, so as to show the time of conception: Before the war under normal conception the number of births was about 16,000 per month. During the war it sank to about 2000 per month. Immediately on the cessation of hostilities it arose to its former number, while the actual return of the troops brought an increase of 2000 per month. The maximum was reached in March, 1872, when it was 18,450. The war of 1866 seems to have passed over Germany without any great influence, the birth-rate in 1865 being 39.2; in 1866, 39.4; in 1867, 38.3; in 1868, 38.4. On the other hand, while the birth-rate in 1870 was 40.1, in 1871 it was only 35.9; in 1872 it recovered to 41.1, and remained above 41 down to 1878. Von Mayr believes the war had a depressing influence upon the rate apart from the mere absence of the men, as shown in the fact that immediately upon the cessation of hostilities it recovered in Bavaria, although it was several months before the return of the troops. Mayo-Smith, in remarking on the influence of war on the marriage-rate, says that in 1866 the Prussian rate fell from 18.2 to 15.6, while the Austrian rate fell from 15.5 to 13.0. In the war of 1870-71 the Prussian rate fell from 17.9 in 1869 to 14.9 in 1870 and 15.9 in 1871; but in the two years after peace was made it rose to 20.6 and 20.2, the highest rates ever recorded. In France the rate fell from 16.5 to 12.1 and 14.4, and then rose to 19.5 and 17.7, the highest rates ever recorded in France. Influence of Rural and Urban Life.--Rural districts are always very prolific, and when we hear the wails of writers on "Social Economy," bemoaning the small birth-rates of their large cities, we need have no fear for urban extinction, as emigration from the country by many ambitious sons and daughters, to avail themselves of the superior advantages that the city offers, will not only keep up but to a certain point increase the population, until the reaction of overcrowding, following the self-regulating law of compensation, starts a return emigration. The effect of climate and race on prolificity, though much spoken of, is not so great a factor as supposed. The inhabitants of Great Britain are surpassed by none in the point of prolificity; yet their location is quite northern. The Swedes have always been noted for their fecundity. Olaf Rudbeck says that from 8 to 12 was the usual family number, and some ran as high as 25 or 30. According to Lord Kames, in Iceland before the plague (about 1710) families of from 15 to 20 were quite common. The old settlers in cold North America were always blessed with large families, and Quebec is still noted for its prolificity. There is little difference in this respect among nations, woman being limited about the same everywhere, and the general average of the range of the productive function remaining nearly identical in all nations. Of course, exception must be made as to the extremes of north or south. Ancient and Modern Prolificity.--Nor is there much difference between ancient and modern times. We read in the writings of Aristotle, Pliny, and Albucasis of the wonderful fertility of the women of Egypt, Arabia, and other warm countries, from 3 to 6 children often being born at once and living to maturity; but from the wonder and surprise shown in the narration of these facts, they were doubtless exceptions, of which parallels may be found in the present day. The ancient Greek and Roman families were no larger than those of to-day, and were smaller in the zenith of Roman affluence, and continued small until the period of decadence. Legal Encouragement of Prolificity.--In Quebec Province, Canada, according to a Montreal authority, 100 acres of land are allotted to the father who has a dozen children by legitimate marriage. The same journal states that, stimulated by the premium offered, families of 20 or more are not rare, the results of patriotic efforts. In 1895, 1742 "chefs de famille" made their claim according to the conditions of the law, and one, Paul Bellanger, of the River du Loup, claimed 300 acres as his premium, based on the fact that he was the father of 36 children. Another claimant, Monsieur Thioret de Sainte Genevieve, had been presented by his wife, a woman not yet thirty years old, with 17 children. She had triplets twice in the space of five years and twins thrice in the mean time. It is a matter of conjecture what the effect would be of such a premium in countries with a lowering birth-rate, and a French medical journal, quoting the foregoing, regretfully wishes for some countrymen at home like their brothers in Quebec. Old Explanations of Prolificity.--The old explanation of the causation of the remarkable exceptions to the rules of prolificity was similar to that advanced by Empedocles, who says that the greater the quantity of semen, the greater the number of children at birth. Pare, later, uses a similar reason to explain the causation of monstrosities, grouping them into two classes, those due to deficiency of semen, such as the acephalous type, and those due to excess, such as the double monsters. Hippocrates, in his work on the "Nature of the Infant," tells us that twins are the result of a single coitus, and we are also informed that each infant has a chorion; so that both kinds of plural gestation (monochorionic and dichorionic) were known to the ancients. In this treatise it is further stated that the twins may be male or female, or both males or both females; the male is formed when the semen is thick and strong. The greatest number of children at a single birth that it is possible for a woman to have has never been definitely determined. Aristotle gives it as his opinion that one woman can bring forth no more than 5 children at a single birth, and discredits reports of multiplicity above this number; while Pliny, who is not held to be so trustworthy, positively states that there were authentic records of as many as 12 at a birth. Throughout the ages in which superstitious distortion of facts and unquestioning credulity was unchecked, all sorts of incredible accounts of prolificity are found. Martin Cromerus, a Polish historian, quoted by Pare, who has done some good work in statistical research on this subject, says a that Margaret, of a noble and ancient family near Cracovia, the wife of Count Virboslaus, brought forth 36 living children on January 20, 1296. The celebrated case of Countess Margaret, daughter of Florent IV, Earl of Holland, and spouse of Count Hermann of Henneberg, was supposed to have occurred just before this, on Good Friday, 1278. She was at this time forty-two years of age, and at one birth brought forth 365 infants, 182 males, 182 females, and 1 hermaphrodite. They were all baptized in two large brazen dishes by the Bishop of Treras, the males being called John, the females Elizabeth. During the last century the basins were still on exhibition in the village church of Losdun, and most of the visitors to Hague went out to see them, as they were reckoned one of the curiosities of Holland. The affliction was ascribed to the curse of a poor woman who, holding twins in her arms, approached the Countess for aid. She was not only denied alms, but was insulted by being told that her twins were by different fathers, whereupon the poor woman prayed God to send the Countess as many children as there were days in the year. There is room for much speculation as to what this case really was. There is a possibility that it was simply a case of hydatidiform or multiple molar pregnancy, elaborated by an exhaustive imagination and superstitious awe. As late as 1799 there was a woman of a town of Andalusia who was reported to have been delivered of 16 male infants, 7 of which were alive two months later. Mayo-Smith remarks that the proportion of multiple births is not more than 1 per cent of the total number of parturitions. The latest statistics, by Westergaard, give the following averages to number of cases of 100 births in which there were 2 or more at a birth:-- Sweden, 1.45 Germany, 1.24 Bavaria, 1.38 Denmark, 1.34 Holland, 1.30 Prussia, 1.26 Scotland, 1.22 Norway, 1.32 Saxony, 1.20 Italy, 1.21 Austria, 1.17 Switzerland, 1.16 France, 0.99 Belgium, 0.97 Spain, 0.85 In Prussia, from 1826 to 1880, there were 85 cases of quadruplets and 3 cases of 5 at a birth. The most extensive statistics in regard to multiple births are those of Veit, who reviews 13,000,000 births in Prussia. According to his deductions, twins occur once in 88 births; triplets, once in 7910; and quadruplets, once in 371,126. Recent statistics supplied by the Boards of Health of New York and Philadelphia place the frequency of twin births in these cities at 1 in every 120 births, while in Bohemia twins occur once in about 60 births, a proportion just twice as great. Of 150,000 twin pregnancies studied by Veit, in one-third both children were boys; in slightly less than one-third both were girls; in the remaining third both sexes were represented. Authentic records of 5 and 6 at a birth are extremely rare and infinitesimal in proportion. The reputed births in excess of 6 must be looked on with suspicion, and, in fact, in the great majority of reports are apochryphal. The examples of multiple births of a single pregnancy will be taken up under their respective numbers, several examples of each being given, together with the authorities. Many twin and triplet brothers have figured prominently in history, and, in fact, they seem especially favored. The instance of the Horatii and the Curatii, and their famous battle, on which hung the fate of Rome and Alba, is familiar to every one, their strength and wisdom being legendary with the Romans. Twins and triplets, being quite common, will not be considered here, although there are 2 cases of interest of the latter that deserve citation. Sperling reports 2 instances of triplets; in the first there was 1 placenta and chorion, 2 amnions, and the sex was the same; in the second case, in which the sexes were different, there were 3 placentas, 3 chorions, and 3 amnions. What significance this may have is only a matter of conjecture. Petty describes a case of triplets in which one child was born alive, the other 2 having lost their vitality three months before. Mirabeau has recently found that triple births are most common (1 to 6500) in multiparous women between thirty and thirty-four years of age. Heredity seems to be a factor, and duplex uteruses predispose to multiple births. Ross reports an instance of double uterus with triple pregnancy. Quadruplets are supposed to occur once in about every 400,000 births. There are 72 instances recorded in the Index Catalogue of the Surgeon General's Library, U. S. A., up to the time of compilation, not including the subsequent cases in the Index Medicus. At the Hotel-Dieu, in Paris, in 108,000 births, covering a period of sixty years, mostly in the last century, there was only one case of quadruplets. The following extract of an account of the birth of quadruplets is given by Dr. De Leon of Ingersoll, Texas:-- "I was called to see Mrs. E. T. Page, January 10, 1890, about 4 o'clock A.M.; found her in labor and at full time, although she assured me that her 'time' was six weeks ahead. At 8 o'clock A.M. I delivered her of a girl baby; I found there were triplets, and so informed her. At 11 A.M. I delivered her of the second girl, after having rectified presentation, which was singular, face, hands, and feet all presented; I placed in proper position and practised 'version.' This child was 'still-born,' and after considerable effort by artificial respiration it breathed and came around 'all right.' The third girl was born at 11.40 A.M. This was the smallest one of the four. In attempting to take away the placenta, to my astonishment I found the feet of another child. At 1 P.M. this one was born; the head of this child got firmly impacted at the lower strait, and it was with a great deal of difficulty and much patient effort that it was finally disengaged; it was blocked by a mass of placenta and cords. The first child had its own placenta; the second and third had their placenta; the fourth had also a placenta. They weighed at birth in the aggregate 19 1/2 pounds without clothing; the first weighed 6 pounds; the second 5 pounds; the third 4 1/2 pounds; the fourth 4 pounds. Mrs. Page is a blonde, about thirty-six years old, and has given birth to 14 children, twins three times before this, one pair by her first husband. She has been married to Page three years, and has had 8 children in that time. I have waited on her each time. Page is an Englishman, small, with dark hair, age about twenty-six, and weighs about 115 pounds. They are in St. Joseph, Mo., now, having contracted with Mr. Uffner of New York to travel and exhibit themselves in Denver, St. Joseph, Omaha, and Nebraska City, then on to Boston, Mass., where they will spend the summer." There is a report from Canada of the birth of 4 living children at one time. The mother, a woman of thirty-eight, of small stature, weighing 100 pounds, had 4 living children of the ages of twelve, ten, eight, and seven years, respectively. She had aborted at the second month, and at full term was delivered of 2 males, weighing, respectively, 4 pounds 9 1/4 ounces and 4 pounds 3 ounces; and of 2 females, weighing 4 pounds 3 ounces and 3 pounds 13 3/4 ounces, respectively. There was but one placenta, and no more exhaustion or hemorrhage than at a single birth. The father weighed 169 pounds, was forty-one years old, and was 5 feet 5 inches tall, healthy and robust. The Journal of St. Petersburg, a newspaper of the highest standard, stated that at the end of July, 1871, a Jewish woman residing in Courland gave birth to 4 girls, and again, in May, 1872, bore 2 boys and a girl; the mother and the 7 children, born within a period of ten months, were doing well at the time of the report. In the village of Iwokina, on May 26, 1854, the wife of a peasant bore 4 children at a birth, all surviving. Bousquet speaks of a primiparous mother, aged twenty-four, giving birth to 4 living infants, 3 by the breech and 1 by the vertex, apparently all in one bag of membranes. They were nourished by the help of 3 wet-nurses. Bedford speaks of 4 children at a birth, averaging 5 pounds each, and all nursing the mother. Quintuplets are quite rare, and the Index Catalogue of the Surgeon General's Library, U. S. A., gives only 19 cases, reports of a few of which will be given here, together with others not given in the Catalogue, and from less scientific though reliable sources. In the year 1731 there was one case of quintuplets in Upper Saxony and another near Prague, Bohemia. In both of these cases the children were all christened and had all lived to maturity. Garthshore speaks of a healthy woman, Margaret Waddington, giving birth to 5 girls, 2 of which lived; the 2 that lived weighed at birth 8 pounds 12 ounces and 9 pounds, respectively. He discusses the idea that woman was meant to bear more than one child at a birth, using as his argument the existence of the double nipple and mamma, to which might be added the not infrequent occurrence of polymazia. In March, 1736, in a dairy cellar in the Strand, London, a poor woman gave birth to 3 boys and 9 girls. In the same journal was reported the birth at Wells, Somersetshire, in 1739, of 4 boys and a girl, all of whom were christened and were healthy. Pare in 1549 gives several instances of 5 children at a birth, and Pliny reports that in the peninsula of Greece there was a woman who gave birth to quintuplets on four different occasions. Petritus, a Greek physician, speaks of the birth of quintuplets at the seventh month. Two males and one female were born dead, being attached to the same placenta; the others were united to a common placenta and lived three days. Chambon mentions an instance of 5 at a birth. Not far from Berne, Switzerland, the wife of John Gelinger, a preacher in the Lordship of Berne, brought forth twins, and within a year after she brought forth quintuplets, 3 sons and 2 daughters. There is a similar instance reported in 1827 of a woman of twenty-seven who, having been delivered of twins two years before, was brought to bed with 5 children, 3 boys and 2 girls. Their length was from 15 1/2 to 16 1/2 inches. Although regularly formed, they did not seem to have reached maturity. The mother was much exhausted, but recovered. The children appeared old-looking, had tremulous voices, and slept continually; during sleep their temperatures seemed very low. Kennedy showed before the Dublin Pathological Society 5 fetuses with the involucra, the product of an abortion at the third month. At Naples in 1839 Giuseppa Califani gave birth to 5 children; and about the same time Paddock reported the birth in Franklin County, Pa., of quintuplets. The Lancet relates an account of the birth of quintuplets, 2 boys and 3 girls, by the wife of a peasant on March 1, 1854. Moffitt records the birth at Monticello, Ill., of quintuplets. The woman was thirty-five years of age; examination showed a breech presentation; the second child was born by a foot-presentation, as was the third, but the last was by a head-presentation. The combined weight was something over 19 pounds, and of the 5, 3 were still-born, and the other 2 died soon after birth. The Elgin Courant (Scotland), 1858, speaks of a woman named Elspet Gordon, at Rothes, giving birth to 3 males and 2 females. Although they were six months' births, the boys all lived until the following morning. The girls were still-born. One of the boys had two front teeth when born. Dr. Dawson of Rothes is the obstetrician mentioned in this case. The following recent instance is given with full details to illustrate the difficulties attending the births of quintuplets. Stoker has reported the case of a healthy woman, thirty-five years old, 5 feet 1 inch high, and of slight build, whom he delivered of 5 fetuses in the seventh month of pregnancy, none of the children surviving. The patient's mother had on two occasions given birth to twins. The woman herself had been married for six years and had borne 4 children at full term, having no difficulty in labor. When she came under observation she computed that she had been pregnant for six months, and had had her attention attracted to the unusually large size of her abdomen. She complained of fixed pain in the left side of the abdomen on which side she thought she was larger. Pains set in with regularity and the labor lasted eight and three-quarter hours. After the rupture of the membranes the first child presented by the shoulder. Version was readily performed; the child was dead (recently). Examination after the birth of the first child disclosed the existence of more than one remaining fetus. The membranes protruded and became tense with each contraction. The presentation was a transverse one. In this case also there was little difficulty in effecting internal version. The child lived a couple of hours. The third fetus was also enclosed in a separate sac, which had to be ruptured. The child presented by the breech and was delivered naturally, and lived for an hour. In the fourth case the membranes had likewise to be ruptured, and alarming hemorrhage ensued. Version was at once practised, but the chin became locked with that of the remaining fetus. There was some difficulty and considerable delay in freeing the children, though the extent of locking was not at any time formidable. The child was dead (recently). The fifth fetus presented by the head and was delivered naturally. It lived for half an hour. The placenta was delivered about five minutes after the birth of the last child, and consisted of two portions united by a narrow isthmus. One, the smaller, had two cords attached centrally and close together; the other, and larger, had two cords attached in a similar way and one where it was joined to the isthmus. The organ appeared to be perfectly healthy. The cord of the fourth child was so short that it had to be ligated in the vagina. The children were all females and of about the same size, making a total weight of 8 pounds. The mother rallied quickly and got on well. Trustworthy records of sextuplets are, of course, extremely scarce. There are few catalogued at Washington, and but two authentic cases are on record in the United States. On December 30, 1831, a woman in Dropin was delivered of 6 daughters, all living, and only a little smaller than usual in size. The mother was not quite twenty years old, but was of strong constitution. The 6 lived long enough to be baptized, but died the evening of their births. There was a case a of sextuplets in Italy in 1844. In Maine, June 27, 1847, a woman was delivered of 6 children, 2 surviving and, together with the mother, doing well. In 1885 there was reported the birth of sextuplets in Lorca, Spain, of which only one survived. At Dallas, Texas, in 1888, Mrs. George Hirsh of Navarro County gave birth to 6 children, the mother and the children all doing well. There were 4 boys and 2 girls, and they were all perfect, well formed, but rather small. Valsalli gives an instance which is quoted by the Medical News without giving the authority. Valsalli's account, which differs slightly from the account in the Medical News, is briefly as follows: While straining at stool on the one hundred and fifteenth day of pregnancy the membranes ruptured and a foot prolapsed, no pain having been felt before the accident. A fetus was delivered by the midwife. Valsalli was summoned and found the woman with an enormously distended abdomen, within which were felt numerous fetal parts; but no fetal heart-sounds or movements were noticed. The cervix was only slightly dilated, and, as no pains were felt, it was agreed to wait. On the next day the membranes were ruptured and 4 more fetuses were delivered. Traction on the umbilical cord started hemorrhage, to check which the physician placed his hand in the uterine cavity. In this most arduous position he remained four hours until assistance from Lugano came. Then, in the presence of the three visiting physicians, a sixth amniotic sac was delivered with its fetus. The woman had a normal convalescence, and in the following year gave birth to healthy, living twins. The News says the children all moved vigorously at birth; there were 4 males and 2 females, and for the 6 there was only one placenta The mother, according to the same authority, was thirty-six years of age, and was in her second pregnancy. Multiple Births over Six.--When we pass sextuplets the records of multiple births are of the greatest rarity and in modern records there are almost none. There are several cases mentioned by the older writers whose statements are generally worthy of credence, which, however incredible, are of sufficient interest at least to find a place in this chapter. Albucasis affirms that he knew of the birth of seven children at one time; and d'Alechampius reports that Bonaventura, the slave of one Savelli, a gentleman of Siena, gave birth to 7 children, 4 of whom were baptized. At the Parish of San Ildefonso, Valladolid, Julianna, wife of Benito Quesada, gave birth to 3 children in one day, and during the following night to 4 more. Sigebert, in his Chronicles, says that the mother of the King of Lombardy had borne 7 children at a birth. Borellus says that in 1650 the lady of the then present Lord Darre gave birth to eight perfect children at one parturition and that it was the unusual event of the country. Mrs. Timothy Bradlee of Trumbull County, Ohio, in 1872 is reported to have given birth to 8 children at one time. They were healthy and living, but quite small. The mother was married six years previously and then weighed 273 pounds. She had given birth to 2 pairs of twins, and, with these 3 boys and 5 girls, she had borne 12 children in six years. She herself was a triplet and her father and her mother were of twin births and one of her grandmothers was the mother of 5 pairs of twins. This case was most celebrated and was much quoted, several British journals extracting it. Watering of Maregnac speaks of the simultaneous birth of 8 children at one time. When several months pregnant the woman was seized with colicky pains and thought them a call of nature. She went into a vineyard to answer it, and there, to her great astonishment, gave birth to 8 fetuses. Watering found them enclosed in a sac, and thought they probably had died from mutual pressure during growth. The mother made a good recovery. In 1755 Seignette of Dijon reports the simultaneous birth of nine children. Franciscus Picus Mirandulae, quoted by Pare, says that one Dorothea, an Italian, bore 20 children at 2 confinements, the first time bearing 9 and the second time eleven. He gives a picture of this marvel of prolificity, in which her belly is represented as hanging down to her knees, and supported by a girdle from the neck. In the Annals, History, and Guide to Leeds and York, according to Walford, there is mention of Ann Birch, who in 1781 was delivered of 10 children. One daughter, the sole survivor of the 10, married a market gardener named Platt, who was well known in Leeds. Jonston quotes Baytraff as saying that he knew of a case in which 9 children were born simultaneously; and also says that the Countess of Altdorf gave birth to twelve at one birth. Albucasis mentions a case of fifteen well-formed children at a birth. According to Le Brun, Gilles de Trazegines, who accompanied Saint Louis to Palestine, and who was made Constable of France, was one of thirteen infants at a simultaneous accouchement. The Marquise, his mother, was impregnated by her husband before his departure, and during his absence had 13 living children. She was suspected by the native people and thought to be an adulteress, and some of the children were supposed to be the result of superfetation. They condemned them all to be drowned, but the Marquis appeared upon the scene about this time and, moved by compassion, acknowledged all 13. They grew up and thrived, and took the name of Trazegines, meaning, in the old language, 13 drowned, although many commentaries say that "gines" was supposed to mean in the twelfth century "nes," or, in full, the interpretation would be "13 born." Cases in which there is a repetition of multiple births are quite numerous, and sometimes so often repeated as to produce a family the size of which is almost incredible. Aristotle is credited with saying that he knew the history of a woman who had quintuplets four times. Pliny's case of quintuplets four times repeated has been mentioned; and Pare, who may be believed when he quotes from his own experience, says that the wife of the last Lord de Maldemeure, who lived in the Parish of Seaux, was a marvel of prolificity. Within a year after her marriage she gave birth to twins; in the next year to triplets; in the third year to quadruplets; in the fourth year to quintuplets, and in the fifth year bore sextuplets; in this last labor she died. The then present Lord de Maldemeure, he says, was one of the final sextuplets. This case attracted great notice at the time, as the family was quite noble and very well known. Seaux, their home, was near Chambellay. Picus Mirandulae gathered from the ancient Egyptian inscriptions that the women of Egypt brought forth sometimes 8 children at a birth, and that one woman bore 30 children in 4 confinements. He also cites, from the history of a certain Bishop of Necomus, that a woman named Antonia, in the Territory of Mutina, Italy, now called Modena, had brought forth 40 sons before she was forty years of age, and that she had had 3 and 4 at a birth. At the auction of the San Donato collection of pictures a portrait of Dianora Frescobaldi, by one of the Bronzinos in the sixteenth century, sold for about $3000. At the bottom of this portrait was an inscription stating that she was the mother of 52 children. This remarkable woman never had less than 3 at a birth, and tradition gives her as many as 6. Merriman quotes a case of a woman, a shopkeeper named Blunet, who had 21 children in 7 successive births. They were all born alive, and 12 still survived and were healthy. As though to settle the question as to whom should be given the credit in this case, the father or the mother, the father experimented upon a female servant, who, notwithstanding her youth and delicateness, gave birth to 3 male children that lived three weeks. According to despatches from Lafayette, Indiana, investigation following the murder, on December 22, 1895, of Hester Curtis, an aged woman of that city, developed the rather remarkable fact that she had been the mother of 25 children, including 7 pairs of twins. According to a French authority the wife of a medical man at Fuentemajor, in Spain, forty-three years of age, was delivered of triplets 13 times. Puech read a paper before the French Academy in which he reports 1262 twin births in Nimes from 1790 to 1875, and states that of the whole number in 48 cases the twins were duplicated, and in 2 cases thrice repeated, and in one case 4 times repeated. Warren gives an instance of a lady, Mrs. M----, thirty-two years of age, married at fourteen, who, after the death of her first child, bore twins, one living a month and the other six weeks. Later she again bore twins, both of whom died. She then miscarried with triplets, and afterward gave birth to 12 living children, as follows: July 24, 1858, 1 child; June 30, 1859, 2 children; March 24, 1860, 2 children; March 1, 1861, 3 children; February 13, 1862, 4 children; making a total of 21 children in eighteen years, with remarkable prolificity in the later pregnancies. She was never confined to her bed more than three days, and the children were all healthy. A woman in Schlossberg, Germany, gave birth to twins; after a year, to triplets, and again, in another year, to 3 fairly strong boys. In the State Papers, Domestic Series, Charles I, according to Walford, appears an extract from a letter from George Garrard to Viscount Conway, which is as follows: "Sir John Melton, who entertained you at York, hath buried his wife, Curran's daughter. Within twelve months she brought him 4 sons and a daughter, 2 sons last summer, and at this birth 2 more and a daughter, all alive." Swan mentions a woman who gave birth to 6 children in seventeen months in 2 triple pregnancies. The first terminated prematurely, 2 children dying at once, the other in five weeks. The second was uneventful, the 3 children living at the time of the report. Rockwell gives the report of a case of a woman of twenty-eight, herself a twin, who gave birth to twins in January, 1879. They died after a few weeks, and in March, 1880, she again bore twins, one living three and the other nine weeks. On March 12, 1881, she gave birth to triplets. The first child, a male, weighed 7 pounds; the second, a female, 6 1/4 pounds; the third, a male, 5 1/2 pounds. The third child lived twenty days, the other two died of cholera infantum at the sixth month, attributable to the bottle-feeding. Banerjee gives the history of a case of a woman of thirty being delivered of her fourth pair of twins. Her mother was dead, but she had 3 sisters living, of one of which she was a twin, and the other 2 were twins. One of her sisters had 2 twin terms, 1 child surviving; like her own children, all were females. A second sister had a twin term, both males, 1 surviving. The other sister aborted female twins after a fall in the eighth month of pregnancy. The name of the patient was Mussamat Somni, and she was the wife of a respectable Indian carpenter. There are recorded the most wonderful accounts of prolificity, in which, by repeated multiple births, a woman is said to have borne children almost beyond belief. A Naples correspondent to a Paris Journal gives the following: "About 2 or 3 stations beyond Pompeii, in the City of Nocera, lives Maddalena Granata, aged forty-seven, who was married at twenty-eight, and has given birth to 52 living and dead children, 49 being males. Dr. de Sanctis, of Nocera, states that she has had triplets 15 times." Peasant Kirilow was presented to the Empress of Russia in 1853, at the age of seventy years. He had been twice married, and his first wife had presented him with 57 children, the fruits of 21 pregnancies. She had quadruplets four times, triplets seven times, and twins thrice. By his second wife he had 15 children, twins six times, and triplets once. This man, accordingly, was the father of 72 children, and, to magnify the wonder, all the children were alive at the time of presentation. Herman, in some Russian statistics, relates the instance of Fedor Vassilet, a peasant of the Moscow Jurisdiction, who in 1872, at the age of seventy-five years, was the father of 87 children. He had been twice married; his first wife bore him 69 children in 27 accouchements, having twins sixteen times, triplets seven times, and quadruplets four times, but never a single birth. His second wife bore him 18 children in 8 accouchements. In 1872, 83 of the 87 children were living. The author says this case is beyond all question, as the Imperial Academy of St. Petersburg, as well as the French Academy, have substantial proof of it. The family are still living in Russia, and are the object of governmental favors. The following fact is interesting from the point of exaggeration, if for nothing else: "The New York Medical Journal is accredited with publishing the following extract from the history of a journey to Saragossa, Barcelona, and Valencia, in the year 1585, by Philip II of Spain. The book was written by Henrique Cock, who accompanied Philip as his private secretary. On page 248 the following statements are to be found: At the age of eleven years, Margarita Goncalez, whose father was a Biscayian, and whose mother was French, was married to her first husband, who was forty years old. By him she had 78 boys and 7 girls. He died thirteen years after the marriage, and, after having remained a widow two years, the woman married again. By her second husband, Thomas Gchoa, she had 66 boys and 7 girls. These children were all born in Valencia, between the fifteenth and thirty-fifth year of the mother's age, and at the time when the account was written she was thirty-five years old and pregnant again. Of the children, 47 by the first husband and 52 by the second were baptized; the other births were still or premature. There were 33 confinements in all." Extreme Prolificity by Single Births.--The number of children a woman may bring forth is therefore not to be accurately stated; there seems to be almost no limit to it, and even when we exclude those cases in which remarkable multiplicity at each birth augments the number, there are still some almost incredible cases on record. The statistics of the St. Pancras Royal Dispensary, 1853, estimated the number of children one woman may bear as from 25 to 69. Eisenmenger relates the history of a case of a woman in the last century bearing 51 children, and there is another case in which a woman bore 44 children, all boys. Atkinson speaks of a lady married at sixteen, dying when she was sixty-four, who had borne 39 children, all at single births, by one husband, whom she survived. The children, 32 daughters and 7 sons, all attained their majority. There was a case of a woman in America who in twenty-six years gave birth to 22 children, all at single births. Thoresby in his "History of Leeds," 1715, mentions three remarkable cases--one the wife of Dr. Phineas Hudson, Chancellor of York, as having died in her thirty-ninth year of her twenty-fourth child; another of Mrs. Joseph Cooper, as dying of her twenty-sixth child, and, lastly, of Mrs. William Greenhill, of a village in Hertford, England, who gave birth to 39 children during her life. Brand, a writer of great repute, in his "History of Newcastle," quoted by Walford, mentions as a well attested fact the wife of a Scotch weaver who bore 62 children by one husband, all of whom lived to be baptized. A curious epitaph is to be seen at Conway, Carnarvonshire-- "Here lieth the body of Nicholas Hookes, of Conway, gentleman, who was one-and-fortieth child of his father, William Hookes, Esq., by Alice, his wife, and the father of 27 children. He died 20th of March, 1637." On November 21, 1768, Mrs. Shury, the wife of a cooper, in Vine Street, Westminster, was delivered of 2 boys, making 26 by the same husband. She had previously been confined with twins during the year. It would be the task of a mathematician to figure the possibilities of paternity in a man of extra long life who had married several prolific women during his prolonged period of virility. A man by the name of Pearsons of Lexton, Nottingham, at the time of the report had been married 4 times. By his first 3 wives he had 39 children and by his last 14, making a total of 53. He was 6 feet tall and lived to his ninety-sixth year. We have already mentioned the two Russian cases in which the paternity was 72 and 87 children respectively, and in "Notes and Queries," June 21, 1856, there is an account of David Wilson of Madison, Ind., who had died a few years previously at the age of one hundred and seven. He had been 5 times married and was the father of 47 children, 35 of whom were living at the time of his death. On a tomb in Ely, Cambridgeshire, there is an inscription saying that Richard Worster, buried there, died on May 11, 1856, the tomb being in memory of his 22 sons and 5 daughters. Artaxerxes was supposed to have had 106 children; Conrad, Duke of Moscow, 80; and in the polygamous countries the number seems incredible. Herotinus was said to have had 600; and Jonston also quotes instances of 225 and even of 650 in the Eastern countries. Recently there have been published accounts of the alleged experiments of Luigi Erba, an Italian gentleman of Perugia, whose results have been announced. About forty years of age and being quite wealthy, this bizarre philanthropist visited various quarters of the world, securing women of different races; having secured a number sufficient for his purposes, he retired with them to Polynesia, where he is accredited with maintaining a unique establishment with his household of females. In 1896, just seven years after the experiment commenced, the reports say he is the father of 370 children. The following is a report from Raleigh, N.C., on July 28, 1893, to the New York Evening Post:-- "The fecundity of the negro race has been the subject of much comment and discussion. A case has come to light in this State that is one of the most remarkable on record. Moses Williams, a negro farmer, lives in the eastern section of this State. He is sixty-five years old (as nearly as he can make out), but does not appear to be over fifty. He has been married twice, and by the two wives has had born to him 45 children. By the first wife he had 23 children, 20 of whom were girls and 3 were boys. By the second wife he had 22 children--20 girls and 2 boys. He also has about 50 grand-children. The case is well authenticated." We also quote the following, accredited to the "Annals of Hygiene:"-- "Were it not part of the records of the Berks County courts, we could hardly credit the history of John Heffner, who was accidentally killed some years ago at the age of sixty-nine. He was married first in 1840. In eight years his wife bore him 17 children. The first and second years of their marriage she gave birth to twins. For four successive years afterward she gave birth to triplets. In the seventh year she gave birth to one child and died soon afterward. Heffner engaged a young woman to look after his large brood of babies, and three months later she became the second Mrs. Heffner. She presented her husband with 2 children in the first two years of her wedded life. Five years later she had added 10 more to the family, having twins 5 times. Then for three years she added but 1 a year. At the time of the death of the second wife 12 of the 32 children had died. The 20 that were left did not appear to be any obstacle to a young widow with one child consenting to become the third wife of the jolly little man, for he was known as one of the happiest and most genial of men, although it kept him toiling like a slave to keep a score of mouths in bread. The third Mrs. Heffner became the mother of 9 children in ten years, and the contentment and happiness of the couple were proverbial. One day, in the fall of 1885, the father of the 41 children was crossing a railroad track and was run down by a locomotive and instantly killed. His widow and 24 of the 42 children are still living." Many Marriages.--In this connection it seems appropriate to mention a few examples of multimarriages on record, to give an idea of the possibilities of the extent of paternity. St. Jerome mentions a widow who married her twenty-second husband, who in his time had taken to himself 20 loving spouses. A gentleman living in Bordeaux in 1772 had been married 16 times. DeLongueville, a Frenchman, lived to be one hundred and ten years old, and had been joined in matrimony to 10 wives, his last wife bearing him a son in his one hundred and first year. Possible Descendants.--When we indulge ourselves as to the possible number of living descendants one person may have, we soon get extraordinary figures. The Madrid Estafette states that a gentleman, Senor Lucas Nequeiras Saez, who emigrated to America seventy years previously, recently returned to Spain in his own steamer, and brought with him his whole family, consisting of 197 persons. He had been thrice married, and by his first wife had 11 children at 7 births; by his second wife, 19 at 13 births, and by his third wife, 7 at 6 births. The youngest of the 37 was thirteen years old and the eldest seventy. This latter one had a son aged forty-seven and 16 children besides. He had 34 granddaughters, 45 grandsons, 45 great granddaughters, 39 great grandsons, all living. Senor Saez himself was ninety-three years old and in excellent health. At Litchfield, Conn., there is said to be the following inscription:-- "Here lies the body of Mrs. Mary, wife of Dr. John Bull, Esq. She died November 4, 1778, aetat. ninety, having had 13 children, 101 grandchildren, 274 great grandchildren, and 22 great-great grandchildren, a total of 410; surviving, 336." In Esher Church there is an inscription, scarcely legible, which records the death of the mother of Mrs. Mary Morton on April 18, 1634, and saying that she was the wonder of her sex and age, for she lived to see nearly 400 issued from her loins. The following is a communication to "Notes and Queries," March 21, 1891: "Mrs. Mary Honeywood was daughter and one of the coheiresses of Robert Waters, Esq., of Lenham, in Kent. She was born in 1527; married in February, 1543, at sixteen years of age, to her only husband, Robert Honeywood, Esq., of Charing, in Kent. She died in the ninety-third year of her age, in May, 1620. She had 16 children of her own body, 7 sons and 9 daughters, of whom one had no issue, 3 died young--the youngest was slain at Newport battle, June 20, 1600. Her grandchildren, in the second generation, were 114; in the third, 228, and in the fourth, 9; so that she could almost say the same as the distich doth of one of the Dalburg family of Basil: 'Rise up, daughter and go to thy daughter, for thy daughter's daughter hath a daughter.' "In Markshal Church, in Essex, on Mrs. Honeywood's tomb is the following inscription: 'Here lieth the body of Mary Waters, the daughter and coheir of Robert Waters, of Lenham, in Kent, wife of Robert Honeywood, of Charing, in Kent, her only husband, who had at her decease, lawfully descended from her, 367 children, 16 of her own body, 114 grandchildren, 228 in the third generation, and 9 in the fourth. She lived a most pious life and died at Markshal, in the ninety-third year of her age and the forty-fourth of her widowhood, May 11, 1620.' (From 'Curiosities for the Ingenious,' 1826.) S. S. R." Animal prolificity though not finding a place in this work, presents some wonderful anomalies. In illustration we may note the following: In the Illustrated London News, May 11, 1895, is a portrait of "Lady Millard," a fine St. Bernard bitch, the property of Mr. Thorp of Northwold, with her litter of 21 puppies, born on February 9, 1896, their sire being a magnificent dog--"Young York." There is quoted an incredible account of a cow, the property of J. N. Sawyer of Ohio, which gave birth to 56 calves, one of which was fully matured and lived, the others being about the size of kittens; these died, together with the mother. There was a cow in France, in 1871, delivered of 5 calves. CHAPTER V. MAJOR TERATA. Monstrosities have attracted notice from the earliest time, and many of the ancient philosophers made references to them. In mythology we read of Centaurs, impossible beings who had the body and extremities of a beast; the Cyclops, possessed of one enormous eye; or their parallels in Egyptian myths, the men with pectoral eyes,--the creatures "whose heads do beneath their shoulders grow;" and the Fauns, those sylvan deities whose lower extremities bore resemblance to those of a goat. Monsters possessed of two or more heads or double bodies are found in the legends and fairy tales of every nation. Hippocrates, his precursors, Empedocles and Democritus, and Pliny, Aristotle, and Galen, have all described monsters, although in extravagant and ridiculous language. Ballantyne remarks that the occasional occurrence of double monsters was a fact known to the Hippocratic school, and is indicated by a passage in De morbis muliebribus, in which it is said that labor is gravely interfered with when the infant is dead or apoplectic or double. There is also a reference to monochorionic twins (which are by modern teratologists regarded as monstrosities) in the treatise De Superfoetatione, in which it is stated that "a woman, pregnant with twins, gives birth to them both at the same time, just as she has conceived them; the two infants are in a single chorion." Ancient Explanations of Monstrosities.--From the time of Galen to the sixteenth century many incredible reports of monsters are seen in medical literature, but without a semblance of scientific truth. There has been little improvement in the mode of explanation of monstrous births until the present century, while in the Middle Ages the superstitions were more ludicrous and observers more ignorant than before the time of Galen. In his able article on the teratologic records of Chaldea, Ballantyne makes the following trite statements: "Credulity and superstition have never been the peculiar possession of the lower types of civilization only, and the special beliefs that have gathered round the occurrence of teratologic phenomena have been common to the cultured Greek and Roman of the past, the ignorant peasant of modern times, and the savage tribes of all ages. Classical writings, the literature of the Middle Ages, and the popular beliefs of the present day all contain views concerning teratologic subjects which so closely resemble those of the Chaldean magi as to be indistinguishable from them. Indeed, such works as those of Obsequens, Lycosthenes, Licetus, and Ambroise Pare only repeat, but with less accuracy of description and with greater freedom of imagination, the beliefs of ancient Babylon. Even at the present time the most impossible cases of so-called 'maternal impressions' are widely scattered through medical literature; and it is not very long since I received a letter from a distinguished member of the profession asking me whether, in my opinion, I thought it possible for a woman to give birth to a dog. Of course, I do not at all mean to infer that teratology has not made immense advances within recent times, nor do I suggest that on such subjects the knowledge of the magi can be compared with that of the average medical student of the present; but what I wish to emphasize is that, in the literature of ancient Babylonia, there are indications of an acquaintance with structural defects and malformations of the human body which will compare favorably with even the writings of the sixteenth century of the Christian era." Many reasons were given for the existence of monsters, and in the Middle Ages these were as faulty as the descriptions themselves. They were interpreted as divinations, and were cited as forebodings and examples of wrath, or even as glorifications of the Almighty. The semi-human creatures were invented or imagined, and cited as the results of bestiality and allied forms of sexual perversion prevalent in those times. We find minute descriptions and portraits of these impossible results of wicked practices in many of the older medical books. According to Pare there was born in 1493, as the result of illicit intercourse between a woman and a dog, a creature resembling in its upper extremities its mother, while its lower extremities were the exact counterpart of its canine father. This particular case was believed by Bateman and others to be a precursor to the murders and wickedness that followed in the time of Pope Alexander I. Volateranus, Cardani, and many others cite instances of this kind. Lycosthenes says that in the year 1110, in the bourg of Liege, there was found a creature with the head, visage, hands, and feet of a man, and the rest of the body like that of a pig. Pare quotes this case and gives an illustration. Rhodiginus mentions a shepherd of Cybare by the name of Cratain, who had connection with a female goat and impregnated her, so that she brought forth a beast with a head resembling that of the father, but with the lower extremities of a goat. He says that the likeness to the father was so marked that the head-goat of the herd recognized it, and accordingly slew the goatherd who had sinned so unnaturally. In the year 1547, at Cracovia, a very strange monster was born, which lived three days. It had a head shaped like that of a man; a nose long and hooked like an elephant's trunk; the hands and feet looking like the web-foot of a goose; and a tail with a hook on it. It was supposed to be a male, and was looked upon as a result of sodomy. Rueff says that the procreation of human beings and beasts is brought about-- (1) By the natural appetite; (2) By the provocation of nature by delight; (3) By the attractive virtue of the matrix, which in beasts and women is alike. Plutarch, in his "Lesser Parallels," says that Aristonymus Ephesius, son of Demonstratus, being tired of women, had carnal knowledge with an ass, which in the process of time brought forth a very beautiful child, who became the maid Onoscelin. He also speaks of the origin of the maiden Hippona, or as he calls her, Hippo, as being from the connection of a man with a mare. Aristotle mentions this in his paradoxes, and we know that the patron of horses was Hippona. In Helvetia was reported the existence of a colt (whose mother had been covered by a bull) that was half horse and half bull. One of the kings of France was supposed to have been presented with a colt with the hinder part of a hart, and which could outrun any horse in the kingdom. Its mother had been covered by a hart. Writing in 1557, Lycosthenes reports the mythical birth of a serpent by a woman. It is quite possible that some known and classified type of monstrosity was indicated here in vague terms. In 1726 Mary Toft, of Godalming, in Surrey, England, achieved considerable notoriety throughout Surrey, and even over all England, by her extensively circulated statements that she bore rabbits. Even at so late a day as this the credulity of the people was so great that many persons believed in her. The woman was closely watched, and being detected in her maneuvers confessed her fraud. To show the extent of discussion this case called forth, there are no less than nine pamphlets and books in the Surgeon-General's library at Washington devoted exclusively to this case of pretended rabbit-breeding. Hamilton in 1848, and Hard in 1884, both report the births in this country of fetal monstrosities with heads which showed marked resemblance to those of dogs. Doubtless many of the older cases of the supposed results of bestiality, if seen to-day, could be readily classified among some of our known forms of monsters. Modern investigation has shown us the sterile results of the connections between man and beast or between beasts of different species, and we can only wonder at the simple credulity and the imaginative minds of our ancestors. At one period certain phenomena of nature, such as an eclipse or comet, were thought to exercise their influence on monstrous births. Rueff mentions that in Sicily there happened a great eclipse of the sun, and that women immediately began to bring forth deformed and double-headed children. Before ending these preliminary remarks, there might be mentioned the marine monsters, such as mermaids, sea-serpents, and the like, which from time to time have been reported; even at the present day there are people who devoutly believe that they have seen horrible and impossible demons in the sea. Pare describes and pictures a monster, at Rome, on November 3, 1520, with the upper portion of a child apparently about five or six years old, and the lower part and ears of a fish-like animal. He also pictures a sea-devil in the same chapter, together with other gruesome examples of the power of imagination. Early Teratology.--Besides such cases as the foregoing, we find the medieval writers report likely instances of terata, as, for instance, Rhodiginus, who speaks of a monster in Italy with two heads and two bodies; Lycosthenes saw a double monster, both components of which slept at the same time; he also says this creature took its food and drink simultaneously in its two mouths. Even Saint Augustine says that he knew of a child born in the Orient who, from the belly up, was in all parts double. The first evidences of a step toward classification and definite reasoning in regard to the causation of monstrosities were evinced by Ambroise Pare in the sixteenth century, and though his ideas are crude and some of his phenomena impossible, yet many of his facts and arguments are worthy of consideration. Pare attributed the cause of anomalies of excess to an excessive quantity of semen, and anomalies of default to deficiency of the same fluid. He has collected many instances of double terata from reliable sources, but has interspersed his collection with accounts of some hideous and impossible creatures, such as are illustrated in the accompanying figure, which shows a creature that was born shortly after a battle of Louis XII, in 1512; it had the wings, crest, and lower extremity of a bird and a human head and trunk; besides, it was an hermaphrodite, and had an extra eye in the knee. Another illustration represents a monstrous head found in an egg, said to have been sent for examination to King Charles at Metz in 1569. It represented the face and visage of a man, with small living serpents taking the place of beard and hair. So credulous were people at this time that even a man so well informed as Pare believed in the possibility of these last two, or at least represented them as facts. At this time were also reported double hermaphroditic terata, seemingly without latter-day analogues. Rhodiginus speaks of a two-headed monster born in Ferrari, Italy, in 1540, well formed, and with two sets of genitals, one male and the other female. Pare gives a picture of twins, born near Heidelberg in 1486, which had double bodies joined back to back; one of the twins had the aspect of a female and the other of a male, though both had two sets of genitals. Scientific Teratology.--About the first half of the eighteenth century what might be called the positive period of teratology begins. Following the advent of this era come Mery, Duverney, Winslow, Lemery, and Littre. In their works true and concise descriptions are given and violent attacks are made against the ancient beliefs and prejudices. From the beginning of the second half of the last century to the present time may be termed the scientific epoch of teratology. We can almost with a certainty start this era with the names of Haller, Morgagni, Geoffroy-Saint-Hilaire, and Meckel, who adduced the explanations asked for by Harvey and Wolff. From the appearance of the treatise by Geoffroy-Saint-Hilaire, teratology has made enormous strides, and is to-day well on the road to becoming a science. Hand in hand with embryology it has been the subject of much investigation in this century, and to enumerate the workers of the present day who have helped to bring about scientific progress would be a task of many pages. Even in the artificial production of monsters much has been done, and a glance at the work of Dareste well repays the trouble. Essays on teratogenesis, with reference to batrachians, have been offered by Lombardini; and by Lereboullet and Knoch with reference to fishes. Foll and Warynski have reported their success in obtaining visceral inversion, and even this branch of the subject promises to become scientific. Terata are seen in the lower animals and always excite interest. Pare gives the history of a sheep with three heads, born in 1577; the central head was larger than the other two, as shown in the accompanying illustration. Many of the Museums of Natural History contain evidences of animal terata. At Hallae is a two-headed mouse; the Conant Museum in Maine contains the skeleton of an adult sheep with two heads; there was an account of a two-headed pigeon published in France in 1734; Leidy found a two-headed snake in a field near Philadelphia; Geoffroy Saint-Hilaire and Conant both found similar creatures, and there is one in the Museum at Harvard; Wyman saw a living double-headed snake in the Jardin des Plantes in Paris in 1853, and many parallel instances are on record. Classification.--We shall attempt no scientific discussion of the causation or embryologic derivation of the monster, contenting ourselves with simple history and description, adding any associate facts of interest that may be suggested. For further information, the reader is referred to the authors cited or to any of the standard treatises on teratology. Many classifications of terata have been offered, and each possesses some advantage. The modern reader is referred to the modification of the grouping of Geoffroy-Saint-Hilaire given by Hirst and Piersol, or those of Blanc and Guinard. For convenience, we have adopted the following classification, which will include only those monsters that have LIVED AFTER BIRTH, and who have attracted general notice or attained some fame in their time, as attested by accounts in contemporary literature. CLASS 1.--Union of several fetuses. CLASS 2.--Union of two distinct fetuses by a connecting band. CLASS 3.--Union of two distinct fetuses by an osseous junction of the cranial bones. CLASS 4.--Union of two distinct fetuses in which one or more parts are eliminated by the junction. CLASS 5.--Fusion of two fetuses by a bony union of the ischii. CLASS 6.--Fusion of two fetuses below the umbilicus into a common lower extremity. CLASS 7.--Bicephalic monsters. CLASS 8.--Parasitic monsters. CLASS 9.--Monsters with a single body and double lower extremities. CLASS 10.--Diphallic terata. CLASS 11.--Fetus in fetu, and dermoid cysts. CLASS 12.--Hermaphrodites. CLASS I.--Triple Monsters.--Haller and Meckel were of the opinion that no cases of triple monsters worthy of credence are on record, and since their time this has been the popular opinion. Surely none have ever lived. Licetus describes a human monster with two feet and seven heads and as many arms. Bartholinus speaks of a three-headed monster who after birth gave vent to horrible cries and expired. Borellus speaks of a three-headed dog, a veritable Cerberus. Blasius published an essay on triple monsters in 1677. Bordenave is quoted as mentioning a human monster formed of three fetuses, but his description proves clearly that it was only the union of two. Probably the best example of this anomaly that we have was described by Galvagni at Cattania in 1834. This monster had two necks, on one of which was a single head normal in dimensions. On the other neck were two heads, as seen in the accompanying illustration. Geoffroy-Saint-Hilaire mentions several cases, and Martin de Pedro publishes a description of a case in Madrid in 1879. There are also on record some cases of triple monster by inclusion which will be spoken of later. Instances in the lower animals have been seen, the three-headed sheep of Pare, already spoken of, being one. CLASS II.--Double Monsters.--A curious mode of junction, probably the most interesting, as it admits of longer life in these monstrosities, is that of a simple cartilaginous band extending between two absolutely distinct and different individuals. The band is generally in the sternal region. In 1752 there was described a remarkable monstrosity which consisted of conjoined twins, a perfect and an imperfect child, connected at their ensiform cartilages by a band 4 inches in circumference. The Hindoo sisters, described by Dr. Andrew Berry, lived to be seven years old; they stood face to face, with their chests 6 1/2 inches and their pubes 8 1/2 inches apart. Mitchell describes the full-grown female twins, born at Newport, Ky., called the Newport twins. The woman who gave birth to them became impregnated, it is said, immediately after seeing the famous Siamese twins, and the products of this pregnancy took the conformation of those celebrated exhibitionists. Perhaps the best known of all double monsters were the Siamese twins. They were exhibited all over the globe and had the additional benefit and advertisement of a much mooted discussion as to the advisability of their severance, in which opinions of the leading medical men of all nations were advanced. The literature on these famous brothers is simply stupendous. The amount of material in the Surgeon General's library at Washington would surprise an investigator. A curious volume in this library is a book containing clippings, advertisements, and divers portraits of the twins. It will be impossible to speak at all fully on this subject, but a short history and running review of their lives will be given: Eng and Chang were born in Siam about May, 1811. Their father was of Chinese extraction and had gone to Siam and there married a woman whose father was also a Chinaman. Hence, for the most part, they were of Chinese blood, which probably accounted for their dark color and Chinese features. Their mother was about thirty-five years old at the time of their birth and had borne 4 female children prior to Chang and Eng. She afterward had twins several times, having eventually 14 children in all. She gave no history of special significance of the pregnancy, although she averred that the head of one and the feet of the other were born at the same time. The twins were both feeble at birth, and Eng continued delicate, while Chang thrived. It was only with difficulty that their lives were saved, as Chowpahyi, the reigning king, had a superstition that such freaks of nature always presaged evil to the country. They were really discovered by Robert Hunter, a British merchant at Bangkok, who in 1824 saw them boating and stripped to the waist. He prevailed on the parents and King Chowpahyi to allow them to go away for exhibition. They were first taken out of the country by a certain Captain Coffin. The first scientific description of them was given by Professor J. C. Warren, who examined them in Boston, at the Harvard University, in 1829. At that time Eng was 5 feet 2 inches and Chang 5 feet 1 1/2 inches in height. They presented all the characteristics of Chinamen and wore long black queues coiled thrice around their heads, as shown by the accompanying illustration. After an eight-weeks' tour over the Eastern States they went to London, arriving at that port November 20, 1829. Their tour in France was forbidden on the same grounds as the objection to the exhibition of Ritta-Christina, namely, the possibility of causing the production of monsters by maternal impressions in pregnant women. After their European tour they returned to the United States and settled down as farmers in North Carolina, adopting the name of Bunker. When forty-four years of age they married two sisters, English women, twenty-six and twenty-eight years of age, respectively. Domestic infelicity soon compelled them to keep the wives at different houses, and they alternated weeks in visiting each wife. Chang had six children and Eng five, all healthy and strong. In 1869 they made another trip to Europe, ostensibly to consult the most celebrated surgeons of Great Britain and France on the advisability of being separated. It was stated that a feeling of antagonistic hatred after a quarrel prompted them to seek "surgical separation," but the real cause was most likely to replenish their depleted exchequer by renewed exhibition and advertisement. A most pathetic characteristic of these illustrious brothers was the affection and forbearance they showed for each other until shortly before their death. They bore each other's trials and petty maladies with the greatest sympathy, and in this manner rendered their lives far more agreeable than a casual observer would suppose possible. They both became Christians and members or attendants of the Baptist Church. Figure 31 is a representation of the Siamese twins in old age. On each side of them is a son. The original photograph is in the Mutter Museum, College of Physicians, Philadelphia. The feasibility of the operation of separating them was discussed by many of the leading men of America, and Thompson, Fergusson, Syme, Sir J. Y. Simpson, Nelaton, and many others in Europe, with various reports and opinions after examination. These opinions can be seen in full in nearly any large medical library. At this time they had diseased and atheromatous arteries, and Chang, who was quite intemperate, had marked spinal curvature, and shortly afterward became hemiplegic. They were both partially blind in their two anterior eyes, possibly from looking outward and obliquely. The point of junction was about the sterno-siphoid angle, a cartilaginous band extending from sternum to sternum. In 1869 Simpson measured this band and made the distance on the superior aspect from sternum to sternum 4 1/2 inches, though it is most likely that during the early period of exhibition it was not over 3 inches. The illustration shows very well the position of the joining band. The twins died on January 17, 1874, and a committee of surgeons from the College of Physicians of Philadelphia, consisting of Doctors Andrews, Allen, and Pancoast, went to North Carolina to perform an autopsy on the body, and, if possible, to secure it. They made a long and most interesting report on the results of their trip to the College. The arteries, as was anticipated, were found to have undergone calcareous degeneration. There was an hepatic connection through the band, and also some interlacing diaphragmatic fibers therein. There was slight vascular intercommunication of the livers and independence of the two peritoneal cavities and the intestines. The band itself was chiefly a coalescence of the xyphoid cartilages, surrounded by areolar tissue and skin. The "Orissa sisters," or Radica-Doddica, shown in Europe in 1893, were similar to the Siamese twins in conformation. They were born in Orissa, India, September, 1889, and were the result of the sixth pregnancy, the other five being normal. They were healthy girls, four years of age, and apparently perfect in every respect, except that, from the ensiform cartilage to the umbilicus, they were united by a band 4 inches long and 2 inches wide. The children when facing each other could draw their chests three or four inches apart, and the band was so flexible that they could sit on either side of the body. Up to the date mentioned it was not known whether the connecting band contained viscera. A portrait of these twins was shown at the World's Fair in Chicago. In the village of Arasoor, district of Bhavany, there was reported a monstrosity in the form of two female children, one 34 inches and the other 33 3/4 inches high, connected by the sternum. They were said to have had small-pox and to have recovered. They seemed to have had individual nervous systems, as when one was pinched the other did not feel it, and while one slept the other was awake. There must have been some vascular connection, as medicine given to one affected both. Fig. 36 shows a mode of cartilaginous junction by which each component of a double monster may be virtually independent. Operations on Conjoined Twins.--Swingler speaks of two girls joined at the xiphoid cartilage and the umbilicus, the band of union being 1 1/2 inches thick, and running below the middle of it was the umbilical cord, common to both. They first ligated the cord, which fell off in nine days, and then separated the twins with the bistoury. They each made early recovery and lived. In the Ephemerides of 1690 Konig gives a description of two Swiss sisters born in 1689 and united belly to belly, who were separated by means of a ligature and the operation afterward completed by an instrument. The constricting band was formed by a coalition of the xiphoid cartilages and the umbilical vessels, surrounded by areolar tissue and covered with skin. Le Beau says that under the Roman reign, A. D. 945, two male children were brought from Armenia to Constantinople for exhibition. They were well formed in every respect and united by their abdomens. After they had been for some time an object of great curiosity, they were removed by governmental order, being considered a presage of evil. They returned, however, at the commencement of the reign of Constantine VII, when one of them took sick and died. The surgeons undertook to preserve the other by separating him from the corpse of his brother, but he died on the third day after the operation. In 1866 Boehm gives an account of Guzenhausen's case of twins who were united sternum to sternum. An operation for separation was performed without accident, but one of the children, already very feeble, died three days after; the other survived. The last attempt at an operation like this was in 1881, when Biaudet and Buginon attempted to separate conjoined sisters (Marie-Adele) born in Switzerland on June 26th. Unhappily, they were very feeble and life was despaired of when the operation was performed, on October 29th. Adele died six hours afterward, and Marie died of peritonitis on the next day. CLASS III.--Those monsters joined by a fusion of some of the cranial bones are sometimes called craniopagi. A very ancient observation of this kind is cited by Geoffroy-Saint-Hilaire. These two girls were born in 1495, and lived to be ten years old. They were normal in every respect, except that they were joined at the forehead, causing them to stand face to face and belly to belly. When one walked forward, the other was compelled to walk backward; their noses almost touched, and their eyes were directed laterally. At the death of one an attempt to separate the other from the cadaver was made, but it was unsuccessful, the second soon dying; the operation necessitated opening the cranium and parting the meninges. Bateman said that in 1501 there was living an instance of double female twins, joined at the forehead. This case was said to have been caused in the following manner: Two women, one of whom was pregnant with the twins at the time, were engaged in an earnest conversation, when a third, coming up behind them, knocked their heads together with a sharp blow. Bateman describes the death of one of the twins and its excision from the other, who died subsequently, evidently of septic infection. There is a possibility that this is merely a duplication of the account of the preceding case with a slight anachronism as to the time of death. At a foundling hospital in St. Petersburg there were born two living girls, in good health, joined by the heads. They were so united that the nose of one, if prolonged, would strike the ear of the other; they had perfectly independent existences, but their vascular systems had evident connection. Through extra mobility of their necks they could really lie in a straight line, one sleeping on the side and the other on the back. There is a report a of two girls joined at their vertices, who survived their birth. With the exception of this junction they were well formed and independent in existence. There was no communication of the cranial cavities, but simply fusion of the cranial bones covered by superficial fascia and skin. Daubenton has seen a case of union at the occiput, but further details are not quoted. CLASS IV.--The next class to be considered is that in which the individuals are separate and well formed, except that the point of fusion is a common part, eliminating their individual components in this location. The pygopagous twins belong in this section. According to Bateman, twins were born in 1493 at Rome joined back to back, and survived their birth. The same authority speaks of a female child who was born with "2 bellies, 4 arms, 4 legs, 2 heads, and 2 sets of privates, and was exhibited throughout Italy for gain's sake." The "Biddenden Maids" were born in Biddenden, Kent, in 1100. Their names were Mary and Eliza Chulkhurst, and their parents were fairly well-to-do people. They were supposed to have been united at the hips and the shoulders, and lived until 1134. At the death of one it was proposed to separate them, but the remaining sister refused, saying, "As we came together, we will also go together," and, after about six hours of this Mezentian existence, they died. They bequeathed to the church-wardens of the parish and their successors land to the extent of 20 acres, at the present time bringing a rental of about $155.00 annually, with the instructions that the money was to be spent in the distribution of cakes (bearing the impression of their images, to be given away on each Easter Sunday to all strangers in Biddenden) and also 270 quartern loaves, with cheese in proportion, to all the poor in said parish. Ballantyne has accompanied his description of these sisters by illustrations, one of which shows the cake. Heaton gives a very good description of these maids; and a writer in "Notes and Queries" of March 27, 1875, gives the following information relative to the bequest:-- "On Easter Monday, at Biddenden, near Staplehurst, Kent, there is a distribution, according to ancient custom, of 'Biddenden Maids' cakes,' with bread and cheese, the cost of which is defrayed from the proceeds of some 20 acres of land, now yielding L35 per annum. and known as the 'Bread and Cheese Lands.' About the year 1100 there lived Eliza and Mary Chulkhurst, who were joined together after the manner of the Siamese twins, and who lived for thirty-four years, one dying, and then being followed by her sister within six hours. They left by their will the lands above alluded to and their memory is perpetuated by imprinting on the cakes their effigies 'in their habit as they lived.' The cakes, which are simple flour and water, are four inches long by two inches wide, and are much sought after as curiosities. These, which are given away, are distributed at the discretion of the church-wardens, and are nearly 300 in number. The bread and cheese amounts to 540 quartern loaves and 470 pounds of cheese. The distribution is made on land belonging to the charity, known as the Old Poorhouse. Formerly it used to take place in the Church, immediately after the service in the afternoon, but in consequence of the unseemly disturbance which used to ensue the practice was discontinued. The Church used to be filled with a congregation whose conduct was occasionally so reprehensible that sometimes the church-wardens had to use their wands for other purposes than symbols of office. The impressions of the maids 'on the cakes are of a primitive character, and are made by boxwood dies cut in 1814. They bear the date 1100, when Eliza and Mary Chulkhurst are supposed to have been born, and also their age at death, thirty-four years." Ballantyne has summed up about all there is to be said on this national monstrosity, and his discussion of the case from its historic as well as teratologic standpoint is so excellent that his conclusions will be quoted-- "It may be urged that the date fixed for the birth of the Biddenden Maids is so remote as to throw grave doubt upon the reality of the occurrence. The year 1100 was, it will be remembered, that in which William Rufus was found dead in the New Forest, 'with the arrow either of a hunter or an assassin in his breast.' According to the Anglo-Saxon Chronicle, several 'prodigies' preceded the death of this profligate and extravagant monarch. Thus it is recorded that 'at Pentecost blood was observed gushing from the earth at a certain town of Berkshire, even as many asserted who declared that they had seen it. And after this, on the morning after Lammas Day, King William was shot.' Now, it is just possible that the birth of the Biddenden Maids may have occurred later, but have been antedated by the popular tradition to the year above mentioned. For such a birth would, in the opinion of the times, be regarded undoubtedly as a most evident prodigy or omen of evil. Still, even admitting that the date 1100 must be allowed to stand, its remoteness from the present time is not a convincing argument against a belief in the real occurrence of the phenomenon; for of the dicephalic Scottish brothers, who lived in 1490, we have credible historic evidence. Further, Lycosthenes, in his "Chronicon Prodigiorum atque Ostentorum", published in 1557, states, upon what authority I know not, that in the year 1112 joined twins resembling the Biddenden phenomenon in all points save in sex were born in England. The passage is as follows: 'In Anglia natus est puer geminus a clune ad superiores partes ita divisus, ut duo haberet capita, duo corpora integra ad renes cum suis brachiis, qui baptizatus triduo supervixit.' It is just possible that in some way or other this case has been confounded with the story of Biddenden; at any rate, the occurrence of such a statement in Lycosthenes' work is of more than passing interest. Had there been no bequest of land in connection with the case of the Kentish Maids, the whole affair would probably soon have been forgotten. "There is, however, one real difficulty in accepting the story handed down to us as authentic,--the nature of the teratologic phenomenon itself. All the records agree in stating that the Maids were joined together at the shoulders and hips, and the impression on the cakes and the pictures on the 'broadsides' show this peculiar mode of union, and represent the bodies as quite separate in the space between the above-named points. The Maids are shown with four feet and two arms, the right and left respectively, whilst the other arms (left and right) are fused together at the shoulder according to one illustration, and a little above the elbow according to another. Now, although it is not safe to say that such an anomaly is impossible, I do not know of any case of this peculiar mode of union; but it may be that, as Prof. A. R. Simpson has suggested, the Maids had four separate arms, and were in the habit of going about with their contiguous arms round each other's necks, and that this gave rise to the notion that these limbs were united. If this be so, then the teratologic difficulty is removed, for the case becomes perfectly comparable with the well-known but rare type of double terata known as the pygopagous twins, which is placed by Taruffi with that of the ischiopagous twins in the group dicephalus lecanopagus. Similar instances, which are well known to students of teratology, are the Hungarian sisters (Helen and Judith), the North Carolina twins (Millie and Christine), and the Bohemian twins (Rosalie and Josepha Blazek). The interspace between the thoraces may, however, have simply been the addition of the first artist who portrayed the Maids (from imagination?); then it may be surmised that they were ectopagous twins. "Pygopagous twins are fetuses united together in the region of the nates and having each its own pelvis. In the recorded cases the union has been usually between the sacra and coccyges, and has been either osseous or (more rarely) ligamentous. Sometimes the point of junction was the middle line posteriorly, at other times it was rather a posterolateral union; and it is probable that in the Biddenden Maids it was of the latter kind; and it is likely, from the proposal made to separate the sisters after the death of one, that it was ligamentous in nature. "If it be granted that the Biddenden Maids were pygopagous twins, a study of the histories of other recorded cases of this monstrosity serves to demonstrate many common characters. Thus, of the 8 cases which Taruffi has collected, in 7 the twins were female; and if to these we add the sisters Rosalie and Josepha Blazek and the Maids, we have 10 cases, of which 9 were girls. Again, several of the pygopagous twins, of whom there are scientific records, survived birth and lived for a number of years, and thus resembled the Biddenden terata. Helen and Judith, for instance, were twenty-three years old at death; and the North Carolina twins, although born in 1851, are still alive. There is, therefore, nothing inherently improbable in the statement that the Biddenden Maids lived for thirty-four years. With regard also to the truth of the record that the one Maid survived her sister for six hours, there is confirmatory evidence from scientifically observed instances, for Joly and Peyrat (Bull. de l'Acad. Med., iii., pp. 51 and 383, 1874) state that in the case seen by them the one infant lived ten hours after the death of the other. It is impossible to make any statement with regard to the internal structure of the Maids or to the characters of their genital organs, for there is absolutely no information forthcoming upon these points. It may simply be said, in conclusion, that the phenomenon of Biddenden is interesting not only on account of the curious bequest which arose out of it, but also because it was an instance of a very rare teratologic type, occurring at a very early period in our national history." Possibly the most famous example of twins of this type were Helen and Judith, the Hungarian sisters, born in 1701 at Szony, in Hungary. They were the objects of great curiosity, and were shown successively in Holland, Germany, Italy, France, England, and Poland. At the age of nine they were placed in a convent, where they died almost simultaneously in their twenty-second year. During their travels all over Europe they were examined by many prominent physiologists, psychologists, and naturalists; Pope and several minor poets have celebrated their existence in verse; Buffon speaks of them in his "Natural History," and all the works on teratology for a century or more have mentioned them. A description of them can be best given by a quaint translation by Fisher of the Latin lines composed by a Hungarian physician and inscribed on a bronze statuette of them:-- Two sisters wonderful to behold, who have thus grown as one, That naught their bodies can divide, no power beneath the sun. The town of Szoenii gave them birth, hard by far-famed Komorn, Which noble fort may all the arts of Turkish sultans scorn. Lucina, woman's gentle friend, did Helen first receive; And Judith, when three hours had passed, her mother's womb did leave. One urine passage serves for both;--one anus, so they tell; The other parts their numbers keep, and serve their owners well. Their parents poor did send them forth, the world to travel through, That this great wonder of the age should not be hid from view. The inner parts concealed do lie hid from our eyes, alas! But all the body here you view erect in solid brass. They were joined back to back in the lumbar region, and had all their parts separate except the anus between the right thigh of Helen and the left of Judith and a single vulva. Helen was the larger, better looking, the more active, and the more intelligent. Judith at the age of six became hemiplegic, and afterward was rather delicate and depressed. They menstruated at sixteen and continued with regularity, although one began before the other. They had a mutual affection, and did all in their power to alleviate the circumstances of their sad position. Judith died of cerebral and pulmonary affections, and Helen, who previously enjoyed good health, soon after her sister's first indisposition suddenly sank into a state of collapse, although preserving her mental faculties, and expired almost immediately after her sister. They had measles and small-pox simultaneously, but were affected in different degree by the maladies. The emotions, inclinations, and appetites were not simultaneous. Eccardus, in a very interesting paper, discusses the physical, moral, and religious questions in reference to these wonderful sisters, such as the advisability of separation, the admissibility of matrimony, and, finally, whether on the last day they would rise as joined in life, or separated. There is an account of two united females, similar in conjunction to the "Hungarian sisters," who were born in Italy in 1700. They were killed at the age of four months by an attempt of a surgeon to separate them. In 1856 there was reported to have been born in Texas, twins after the manner of Helen and Judith, united back to back, who lived and attained some age. They were said to have been of different natures and dispositions, and inclined to quarrel very often. Pancoast gives an extensive report of Millie-Christine, who had been extensively exhibited in Europe and the United States. They were born of slave parents in Columbus County, N.C., July 11, 1851; the mother, who had borne 8 children before, was a stout negress of thirty-two, with a large pelvis. The presentation was first by the stomach and afterward by the breech. These twins were united at the sacra by a cartilaginous or possibly osseous union. They were exhibited in Paris in 1873, and provoked as much discussion there as in the United States. Physically, Millie was the weaker, but had the stronger will and the dominating spirit. They menstruated regularly from the age of thirteen. One from long habit yielded instinctively to the other's movements, thus preserving the necessary harmony. They ate separately, had distinct thoughts, and carried on distinct conversations at the same time. They experienced hunger and thirst generally simultaneously, and defecated and urinated nearly at the same times. One, in tranquil sleep, would be wakened by a call of nature of the other. Common sensibility was experienced near the location of union. They were intelligent and agreeable and of pleasant appearance, although slightly under size; they sang duets with pleasant voices and accompanied themselves with a guitar; they walked, ran, and danced with apparent ease and grace. Christine could bend over and lift Millie up by the bond of union. A recent example of the pygopagus type was Rosa-Josepha Blazek, born in Skerychov, in Bohemia, January 20, 1878. These twins had a broad bony union in the lower part of the lumbar region, the pelvis being obviously completely fused. They had a common urethral and anal aperture, but a double vaginal orifice, with a very apparent septum. The sensation was distinct in each, except where the pelves joined. They were exhibited in Paris in 1891, being then on an exhibition tour around the world. Rosa was the stronger, and when she walked or ran forward she drew her sister with her, who must naturally have reversed her steps. They had independent thoughts and separate minds; one could sleep while the other was awake. Many of their appetites were different, one preferring beer, the other wine; one relished salad, the other detested it, etc. Thirst and hunger were not simultaneous. Baudoin describes their anatomic construction, their mode of life, and their mannerisms and tastes in a quite recent article. Fig. 42 is a reproduction of an early photograph of the twins, and Fig. 43 represents a recent photograph of these "Bohemian twins," as they are now called. The latest record we have of this type of monstrosity is that given by Tynberg to the County Medical Society of New York, May 27, 1895. The mother was present with the remarkable twins in her arms, crying at the top of their voices. These two children were born at midnight on April 15th. Tynberg remarked that he believed them to be distinct and separate children, and not dependent on a common arterial system; he also expressed his intention of separating them, but did not believe the operation could be performed with safety before another year. Jacobi describes in full Tynberg's instance of pygopagus. He says the confinement was easy; the head of one was born first, soon followed by the feet and the rest of the twins. The placenta was single and the cord consisted of two branches. The twins were united below the third sacral vertebrae in such a manner that they could lie alongside of each other. They were females, and had two vaginae, two urethrae four labia minora, and two labia majora, one anus, but a double rectum divided by a septum. They micturated independently but defecated simultaneously. They virtually lived separate lives, as one might be asleep while the other cried, etc. CLASS V.--While instances of ischiopagi are quite numerous, few have attained any age, and, necessarily, little notoriety. Pare speaks of twins united at the pelves, who were born in Paris July 20, 1570. They were baptized, and named Louis and Louise. Their parents were well known in the rue des Gravelliers. According to Bateman, and also Rueff, in the year 1552 there were born, not far from Oxford, female twins, who, from the description given, were doubtless of the ischiopagus type. They seldom wept, and one was of a cheerful disposition, while the other was heavy and drowsy, sleeping continually. They only lived a short time, one expiring a day before the other. Licetus speaks of Mrs. John Waterman, a resident of Fishertown, near Salisbury, England, who gave birth to a double female monster on October 26, 1664, which evidently from the description was joined by the ischii. It did not nurse, but took food by both the mouths; all its actions were done in concert; it was possessed of one set of genitourinary organs; it only lived a short while. Many people in the region flocked to see the wonderful child, whom Licetus called "Monstrum Anglicum." It is said that at the same accouchement the birth of this monster was followed by the birth of a well-formed female child, who survived. Geoffroy-Saint-Hilaire quotes a description of twins who were born in France on October 7, 1838, symmetrically formed and united at their ischii. One was christened Marie-Louise, and the other Hortense-Honorine. Their avaricious parents took the children to Paris for exhibition, the exposures of which soon sacrificed their lives. In the year 1841 there was born in the island of Ceylon, of native parents, a monstrous child that was soon brought to Columbo, where it lived only two months. It had two heads and seemed to have duplication in all its parts except the anus and male generative organs. Montgomery speaks of a double child born in County Roscommon, Ireland, on the 24th of July, 1827. It had two heads, two chests with arms complete, two abdominal and pelvic cavities united end to end, and four legs, placed two on either side. It had only one anus, which was situated between the thighs. One of the twins was dark haired and was baptized Mary, while the other was a blonde and was named Catherine. These twins felt and acted independently of each other; they each in succession sucked from the breast or took milk from the spoon, and used their limbs vigorously. One vomited without affecting the other, but the feces were discharged through a common opening. Goodell speaks of Minna and Minnie Finley, who were born in Ohio and examined by him. They were fused together in a common longitudinal axis, having one pelvis, two heads, four legs, and four arms. One was weak and puny and the other robust and active; it is probable that they had but one rectum and one bladder. Goodell accompanies his description by the mention of several analogous cases. Ellis speaks of female twins, born in Millville, Tenn., and exhibited in New York in 1868, who were joined at the pelves in a longitudinal axis. Between the limbs on either side were to be seen well-developed female genitals, and the sisters had been known to urinate from both sides, beginning and ending at the same time. Huff details a description of the "Jones twins," born on June 24, 1889, in Tipton County, Indiana, whose spinal columns were in apposition at the lower end. The labor, of less than two hours' duration, was completed before the arrival of the physician. Lying on their mother's back, they could both nurse at the same time. Both sets of genitals and ani were on the same side of the line of union, but occupied normal positions with reference to the legs on either side. Their weight at birth was 12 pounds and their length 22 inches. Their mother was a medium-sized brunette of 19, and had one previous child then living at the age of two; their father was a finely formed man 5 feet 10 inches in height. The twins differed in complexion and color of the eyes and hair. They were publicly exhibited for some time, and died February 19 and 20, 1891, at St. John's Hotel, Buffalo, N.Y. Figure 45 shows their appearance several months after birth. CLASS VI.--In our sixth class, the first record we have is from the Commentaries of Sigbert, which contains a description of a monstrosity born in the reign of the Emperor Theodosius, who had two heads, two chests with four arms attached, but a single lower extremity. The emotions, affections, and appetites were different. One head might be crying while the other laughed, or one feeding while the other was sleeping. At times they quarreled and occasionally came to blows. This monster is said to have lived two years, one part dying four days before the other, which evinced symptoms of decay like its inseparable neighbor. Roger of Wendover says that in Lesser Brittany and Normandy, in 1062, there was seen a female monster, consisting of two women joined about the umbilicus and fused into a single lower extremity. They took their food by two mouths but expelled it at a single orifice. At one time, one of the women laughed, feasted, and talked, while the other wept, fasted, and kept a religious silence. The account relates how one of them died, and the survivor bore her dead sister about for three years before she was overcome by the oppression and stench of the cadaver. Batemen describes the birth of a boy in 1529, who had two heads, four ears, four arms, but only two thighs and two legs. Buchanan speaks at length of the famous "Scottish Brothers," who were the cynosure of the eyes of the Court of James III of Scotland. This monster consisted of two men, ordinary in appearance in the superior extremities, whose trunks fused into a single lower extremity. The King took diligent care of their education, and they became proficient in music, languages, and other court accomplishments. Between them they would carry on animated conversations, sometimes merging into curious debates, followed by blows. Above the point of union they had no synchronous sensations, while below, sensation was common to both. This monster lived twenty-eight years, surviving the royal patron, who died June, 1488. One of the brothers died some days before the other, and the survivor, after carrying about his dead brother, succumbed to "infection from putrescence." There was reported to have been born in Switzerland a double headed male monster, who in 1538, at the age of thirty, was possessed of a beard on each face, the two bodies fused at the umbilicus into a single lower extremity. These two twins resembled one another in contour and countenance. They were so joined that at rest they looked upon one another. They had a single wife, with whom they were said to have lived in harmony. In the Gentleman's Magazine about one hundred and fifty years since there was given the portrait and description of a double woman, who was exhibited all over the large cities of Europe. Little can be ascertained anatomically of her construction, with the exception that it was stated that she had two heads, two necks, four arms, two legs, one pelvis, and one set of pelvic organs. The most celebrated monster of this type was Ritta-Christina, who was born in Sassari, in Sardinia, March 23, 1829. These twins were the result of the ninth confinement of their mother, a woman of thirty-two. Their superior extremities were double, but they joined in a common trunk at a point a little below the mammae. Below this point they had a common trunk and single lower extremities. The right one, christened Ritta, was feeble and of a sad and melancholy countenance; the left, Christina, was vigorous and of a gay and happy aspect. They suckled at different times, and sensations in the upper extremities were distinct. They expelled urine and feces simultaneously, and had the indications in common. Their parents, who were very poor, brought them to Paris for the purpose of public exhibition, which at first was accomplished clandestinely, but finally interdicted by the public authorities, who feared that it would open a door for psychologic discussion and speculation. This failure of the parents to secure public patronage increased their poverty and hastened the death of the children by unavoidable exposure in a cold room. The nervous system of the twins had little in common except in the line of union, the anus, and the sexual organs, and Christina was in good health all through Ritta's sickness; when Ritta died, her sister, who was suckling at the mother's breast, suddenly relaxed hold and expired with a sigh. At the postmortem, which was secured with some difficulty on account of the authorities ordering the bodies to be burned, the pericardium was found single, covering both hearts. The digestive organs were double and separate as far as the lower third of the ilium, and the cecum was on the left side and single, in common with the lower bowel. The livers were fused and the uterus was double. The vertebral columns, which were entirely separate above, were joined below by a rudimentary os innorminatum. There was a junction between the manubrium of each. Sir Astley Cooper saw a monster in Paris in 1792 which, by his description, must have been very similar to Ritta-Christina. The Tocci brothers were born in 1877 in the province of Turin, Italy. They each had a well-formed head, perfect arms, and a perfect thorax to the sixth rib; they had a common abdomen, a single anus, two legs, two sacra, two vertebral columns, one penis, but three buttocks, the central one containing a rudimentary anus. The right boy was christened Giovanni-Batista, and the left Giacomo. Each individual had power over the corresponding leg on his side, but not over the other one. Walking was therefore impossible. All their sensations and emotions were distinctly individual and independent. At the time of the report, in 1882, they were in good health and showed every indication of attaining adult age. Figure 48 represents these twins as they were exhibited several years ago in Germany. McCallum saw two female children in Montreal in 1878 named Marie-Rosa Drouin. They formed a right angle with their single trunk, which commenced at the lower part of the thorax of each. They had a single genital fissure and the external organs of generation of a female. A little over three inches from the anus was a rudimentary limb with a movable articulation; it measured five inches in length and tapered to a fine point, being furnished with a distinct nail, and it contracted strongly to irritation. Marie, the left child, was of fair complexion and more strongly developed than Rosa. The sensations of hunger and thirst were not experienced at the same time, and one might be asleep while the other was crying. The pulsations and the respiratory movements were not synchronous. They were the products of the second gestation of a mother aged twenty-six, whose abdomen was of such preternatural size during pregnancy that she was ashamed to appear in public. The order of birth was as follows: one head and body, the lower extremity, and the second body and head. CLASS VII.--There are many instances of bicephalic monsters on record. Pare mentions and gives an illustration of a female apparently single in conformation, with the exception of having two heads and two necks. The Ephemerides, Haller, Schenck, and Archenholz cite examples, and there is an old account of a double-headed child, each of whose heads were baptized, one called Martha and the other Mary. One was of a gay and the other a sad visage, and both heads received nourishment; they only lived a couple of days. There is another similar record of a Milanese girl who had two heads, but was in all other respects single, with the exception that after death she was found to have had two stomachs. Besse mentions a Bavarian woman of twenty-six with two heads, one of which was comely and the other extremely ugly; Batemen quotes what is apparently the same case--a woman in Bavaria in 1541 with two heads, one of which was deformed, who begged from door to door, and who by reason of the influence of pregnant women was given her expenses to leave the country. A more common occurrence of this type is that in which there is fusion of the two heads. Moreau speaks of a monster in Spain which was shown from town to town. Its heads were fused; it had two mouths and two noses; in each face an eye well conformed and placed above the nose; there was a third eye in the middle of the forehead common to both heads; the third eye was of primitive development and had two pupils. Each face was well formed and had its own chin. Buffon mentions a cat, the exact analogue of Moreau's case. Sutton speaks of a photograph sent to Sir James Paget in 1856 by William Budd of Bristol. This portrays a living child with a supernumerary head, which had mouth, nose, eyes, and a brain of its own. The eyelids were abortive, and as there was no orbital cavity the eyes stood out in the form of naked globes on the forehead. When born, the corneas of both heads were transparent, but then became opaque from exposure. The brain of the supernumerary head was quite visible from without, and was covered by a membrane beginning to slough. On the right side of the head was a rudimentary external ear. The nurse said that when the child sucked some milk regurgitated through the supernumerary mouth. The great physiologic interest in this case lies in the fact that every movement and every act of the natural face was simultaneously repeated by the supernumerary face in a perfectly consensual manner, i.e., when the natural mouth sucked, the second mouth sucked; when the natural face cried, yawned, or sneezed, the second face did likewise; and the eyes of the two heads moved in unison. The fate of the child is not known. Home speaks of a child born in Bengal with a most peculiar fusion of the head. The ordinary head was nearly perfect and of usual volume, but fused with its vertex and reversed was a supernumerary head. Each head had its own separate vessels and brain, and each an individual sensibility, but if one had milk first the other had an abundance of saliva in its mouth. It narrowly escaped being burned to death at birth, as the midwife, greatly frightened by the monstrous appearance, threw it into the fire to destroy it, from whence it was rescued, although badly burned, the vicious conformation of the accessory head being possibly due to the accident. At the age of four it was bitten by a venomous serpent and, as a result, died. Its skull is in the possession of the Royal College of Surgeons in London. The following well-known story of Edward Mordake, though taken from lay sources, is of sufficient notoriety and interest to be mentioned here:-- "One of the weirdest as well as most melancholy stories of human deformity is that of Edward Mordake, said to have been heir to one of the noblest peerages in England. He never claimed the title, however, and committed suicide in his twenty-third year. He lived in complete seclusion, refusing the visits even of the members of his own family. He was a young man of fine attainments, a profound scholar, and a musician of rare ability. His figure was remarkable for its grace, and his face--that is to say, his natural face--was that of an Antinous. But upon the back of his head was another face, that of a beautiful girl, 'lovely as a dream, hideous as a devil.' The female face was a mere mask, 'occupying only a small portion of the posterior part of the skull, yet exhibiting every sign of intelligence, of a malignant sort, however.' It would be seen to smile and sneer while Mordake was weeping. The eyes would follow the movements of the spectator, and the lips would 'gibber without ceasing.' No voice was audible, but Mordake avers that he was kept from his rest at night by the hateful whispers of his 'devil twin,' as he called it, 'which never sleeps, but talks to me forever of such things as they only speak of in hell. No imagination can conceive the dreadful temptations it sets before me. For some unforgiven wickedness of my forefathers I am knit to this fiend--for a fiend it surely is. I beg and beseech you to crush it out of human semblance, even if I die for it.' Such were the words of the hapless Mordake to Manvers and Treadwell, his physicians. In spite of careful watching he managed to procure poison, whereof he died, leaving a letter requesting that the 'demon face' might be destroyed before his burial, 'lest it continues its dreadful whisperings in my grave.' At his own request he was interred in a waste place, without stone or legend to mark his grave." A most curious case was that of a Fellah woman who was delivered at Alexandria of a bicephalic monster of apparently eight months' pregnancy. This creature, which was born dead, had one head white and the other black the change of color commencing at the neck of the black head. The bizarre head was of negro conformation and fully developed, and the colored skin was found to be due to the existence of pigment similar to that found in the black race. The husband of the woman had a light brown skin, like an ordinary Fellah man, and it was ascertained that there were some negro laborers in port during the woman's pregnancy; but no definite information as to her relations with them could be established, and whether this was a case of maternal impression or superfetation can only be a matter of conjecture. Fantastic monsters, such as acephalon, paracephalon, cyclops, pseudencephalon, and the janiceps, prosopthoracopagus, disprosopus, etc., although full of interest, will not be discussed here, as none are ever viable for any length of time, and the declared intention of this chapter is to include only those beings who have lived. CLASS VIII.--The next class includes the parasitic terata, monsters that consist of one perfect body, complete in every respect, but from the neighborhood of whose umbilicus depends some important portion of a second body. Pare, Benivenius, and Columbus describe adults with acephalous monsters attached to them. Schenck mentions 13 cases, 3 of which were observed by him. Aldrovandus shows 3 illustrations under the name of "monstrum bicorpum monocephalon." Bustorf speaks of a case in which the nates and lower extremities of one body proceeded out of the abdomen of the other, which was otherwise perfect. Reichel and Anderson mention a living parasitic monster, the inferior trunk of one body proceeding from the pectoral region of the other. Pare says that there was a man in Paris in 1530, quite forty years of age, who carried about a parasite without a head, which hung pendant from his belly. This individual was exhibited and drew great crowds. Pare appends an illustration, which is, perhaps, one of the most familiar in all teratology. He also gives a portrait of a man who had a parasitic head proceeding from his epigastrium, and who was born in Germany the same year that peace was made with the Swiss by King Francis. This creature lived to manhood and both heads were utilized in alimentation. Bartholinus details a history of an individual named Lazarus-Joannes Baptista Colloredo, born in Genoa in 1617, who exhibited himself all over Europe. From his epigastrium hung an imperfectly developed twin that had one thigh, hands, body, arms, and a well-formed head covered with hair, which in the normal position hung lowest. There were signs of independent existence in the parasite, movements of respiration, etc., but its eyes were closed, and, although saliva constantly dribbled from its open mouth, nothing was ever ingested. The genitals were imperfect and the arms ended in badly formed hands. Bartholinus examined this monster at twenty-two, and has given the best report, although while in Scotland in 1642 he was again examined, and accredited with being married and the father of several children who were fully and admirably developed. Moreau quotes a case of an infant similar in conformation to the foregoing monster, who was born in Switzerland in 1764, and whose supernumerary parts were amputated by means of a ligature. Winslow reported before the Academie Royale des Sciences the history of a girl of twelve who died at the Hotel-Dieu in 1733. She was of ordinary height and of fair conformation, with the exception that hanging from the left flank was the inferior half of another girl of diminutive proportions. The supernumerary body was immovable, and hung so heavily that it was said to be supported by the hands or by a sling. Urine and feces were evacuated at intervals from the parasite, and received into a diaper constantly worn for this purpose. Sensibility in the two was common, an impression applied to the parasite being felt by the girl. Winslow gives an interesting report of the dissection of this monster, and mentions that he had seen an Italian child of eight who had a small head proceeding from under the cartilage of the third left rib. Sensibility was common, pinching the ear of the parasitic head causing the child with the perfect head to cry. Each of the two heads received baptism, one being named John and the other Matthew. A curious question arose in the instance of the girl, as to whether the extreme unction should be administered to the acephalous fetus as well as to the child. In 1742, during the Ambassadorship of the Marquis de l'Hopital at Naples, he saw in that city an aged man, well conformed, with the exception that, like the little girl of Winslow, he had the inferior extremities of a male child growing from his epigastric region. Haller and Meckel have also observed cases like this. Bordat described before the Royal Institute of France, August, 1826, a Chinaman, twenty-one years of age, who had an acephalous fetus attached to the surface of his breast (possibly "A-ke"). Dickinson describes a wonderful child five years old, who, by an extraordinary freak of nature, was an amalgamation of two children. From the body of an otherwise perfectly formed child was a supernumerary head protruding from a broad base attached to the lower lumbar and sacral region. This cephalic mass was covered with hair about four or five inches long, and showed the rudiments of an eye, nose, mouth, and chin. This child was on exhibition when Dickinson saw it. Montare and Reyes were commissioned by the Academy of Medicine of Havana to examine and report on a monstrous girl of seven months, living in Cuba. The girl was healthy and well developed, and from the middle line of her body between the xiphoid cartilage and the umbilicus, attached by a soft pedicle, was an accessory individual, irregular, of ovoid shape, the smaller end, representing the head, being upward. The parasite measured a little over 1 foot in length, 9 inches about the head, and 7 3/4 inches around the neck. The cranial bones were distinctly felt, and the top of the head was covered by a circlet of hair. There were two rudimentary eyebrows; the left eye was represented by a minute perforation encircled with hair; the right eye was traced by one end of a mucous groove which ran down to another transverse groove representing the mouth; the right third of this latter groove showed a primitive tongue and a triangular tooth, which appeared at the fifth month. There was a soft, imperforate nose, and the elements of the vertebral column could be distinguished beneath the skin; there were no legs; apparently no vascular sounds; there was separate sensation, as the parasite could be pinched without attracting the perfect infant's notice. The mouth of the parasite constantly dribbled saliva, but showed no indication of receiving aliment. Louise L., known as "La dame a quatre jambes," was born in 1869, and had attached to her pelvis another rudimentary pelvis and two atrophied legs of a parasite, weighing 8 kilos. The attachment was effected by means of a pedicle 33 cm. in diameter, having a bony basis, and being fixed without a joint. The attachment almost obliterated the vulva and the perineum was displaced far backward. At the insertion of the parasite were two rudimentary mammae, one larger than the other. No genitalia were seen on the parasite and it exhibited no active movements, the joints of both limbs being ankylosed. The woman could localize sensations in the parasite except those of the feet. She had been married five years, and bore, in the space of three years, two well-formed daughters. Quite recently there was exhibited in the museums of the United States an individual bearing the name "Laloo," who was born in Oudh, India, and was the second of four children. At the time of examination he was about nineteen years of age. The upper portion of a parasite was firmly attached to the lower right side of the sternum of the individual by a bony pedicle, and lower by a fleshy pedicle, and apparently contained intestines. The anus of the parasite was imperforate; a well-developed penis was found, but no testicles; there was a luxuriant growth of hair on the pubes. The penis of the parasite was said to show signs of erection at times, and urine passed through it without the knowledge of the boy. Perspiration and elevation of temperature seemed to occur simultaneously in both. To pander to the morbid curiosity of the curious, the "Dime Museum" managers at one time shrewdly clothed the parasite in female attire, calling the two brother and sister; but there is no doubt that all the traces of sex were of the male type. An analogous case was that of "A-Ke," a Chinaman, who was exhibited in London early in the century, and of whom and his parasite anatomic models are seen in our museums. Figure 58 represents an epignathus, a peculiar type parasitic monster, in which the parasite is united to the inferior maxillary bone of the autosite. CLASS IX.--Of "Lusus naturae" none is more curious than that of duplication of the lower extremities. Pare says that on January 9, 1529, there was living in Germany a male infant having four legs and four arms. In Paris, at the Academie des Sciences, on September 6, 1830, there was presented by Madame Hen, a midwife, a living male child with four legs, the anus being nearly below the middle of the third buttock; and the scrotum between the two left thighs, the testicles not yet descended. There was a well-formed and single pelvis, and the supernumerary legs were immovable. Aldrovandus mentions several similar instances, and gives the figure of one born in Rome; he also describes several quadruped birds. Bardsley speaks of a male child with one head, four arms, four legs, and double generative organs. He gives a portrait of the child when it was a little over a year old. Heschl published in Vienna in 1878 a description of a girl of seventeen, who instead of having a duplication of the superior body, as in "Millie-Christine, the two-headed nightingale," had double parts below the second lumbar vertebra. Her head and upper body resembled a comely, delicate girl of twelve. Wells a describes Mrs. B., aged twenty, still alive and healthy. The duplication in this case begins just above the waist, the spinal column dividing at the third lumbar vertebra, below this point everything being double. Micturition and defecation occur at different times, but menstruation occurs simultaneously. She was married at nineteen, and became pregnant a year later on the left side, but abortion was induced at the fourth month on account of persistent nausea and the expectation of impossible delivery. Whaley, in speaking of this case, said Mrs. B. utilized her outside legs for walking; he also remarks that when he informed her that she was pregnant on the left side she replied, "I think you are mistaken; if it had been on my right side I would come nearer believing it;"--and after further questioning he found, from the patient's observation, that her right genitals were almost invariably used for coitus. Bechlinger of Para, Brazil, describes a woman of twenty-five, a native of Martinique, whose father was French and mother a quadroon, who had a modified duplication of the lower body. There was a third leg attached to a continuation of the processus coceygeus of the sacrum, and in addition to well developed mammae regularly situated, there were two rudimentary ones close together above the pubes. There were two vaginae and two well-developed vulvae, both having equally developed sensations. The sexual appetite was markedly developed, and coitus was practised in both vaginae. A somewhat similar case, possibly the same, is that of Blanche Dumas, born in 1860. She had a very broad pelvis, two imperfectly developed legs, and a supernumerary limb attached to the symphysis, without a joint, but with slight passive movement. There was a duplication of bowel, bladder, and genitalia. At the junction of the rudimentary limb with the body, in front, were two rudimentary mammary glands, each containing a nipple. Other instances of supernumerary limbs will be found in Chapter VI. CLASS X.--The instances of diphallic terata, by their intense interest to the natural bent of the curious mind, have always elicited much discussion. To many of these cases have been attributed exaggerated function, notwithstanding the fact that modern observation almost invariably shows that the virile power diminishes in exact proportion to the extent of duplication. Taylor quotes a description of a monster, exhibited in London, with two distinct penises, but with only one distinct testicle on either side. He could exercise the function of either organ. Schenck, Schurig, Bartholinus, Loder, and Ollsner report instances of diphallic terata; the latter case a was in a soldier of Charles VI, twenty-two years old, who applied to the surgeon for a bubonic affection, and who declared that he passed urine from the orifice of the left glans and also said that he was incapable of true coitus. Valentini mentions an instance in a boy of four, in which the two penises were superimposed. Bucchettoni speaks of a man with two penises placed side by side. There was an anonymous case described of a man of ninety-three with a penis which was for more than half its length divided into two distinct members, the right being somewhat larger than the left. From the middle of the penis up to the symphysis only the lower wall of the urethra was split. Jenisch describes a diphallic infant, the offspring of a woman of twenty-five who had been married five years. Her first child was a well-formed female, and the second, the infant in question, cried much during the night, and several times vomited dark-green matter. In lieu of one penis there were two, situated near each other, the right one of natural size and the left larger, but not furnished with a prepuce. Each penis had its own urethra, from which dribbled urine and some meconium. There was a duplication of each scrotum, but only one testicle in each, and several other minor malformations. Gore, reported by Velpeau, has seen an infant of eight and one-half months with two penises and three lower extremities. The penises were 4 cm. apart and the scrotum divided, containing one testicle in each side. Each penis was provided with a urethra, urine being discharged from both simultaneously. In a similar case, spoken of by Geoffroy-Saint-Hilaire, the two organs were also separate, but urine and semen escaped sometimes from one, sometimes from both. The most celebrated of all the diphallic terata was Jean Baptista dos Santos, who when but six months old was spoken of by Acton. His father and mother were healthy and had two well-formed children. He was easily born after an uneventful pregnancy. He was good-looking, well proportioned, and had two distinct penises, each as large as that of a child of six months. Urination proceeded simultaneously from both penises; he had also two scrotums. Behind and between the legs there was another limb, or rather two, united throughout their length. It was connected to the pubis by a short stem 1/2 inch long and as large as the little finger, consisting of separate bones and cartilages. There was a patella in the supernumerary limb on the anal aspect, and a joint freely movable. This compound limb had no power of motion, but was endowed with sensibility. A journal in London, after quoting Acton's description, said that the child had been exhibited in Paris, and that the surgeons advised operation. Fisher, to whom we are indebted for an exhaustive work in Teratology, received a report from Havana in July, 1865, which detailed a description of Santos at twenty-two years of age, and said that he was possessed of extraordinary animal passion, the sight of a female alone being sufficient to excite him. He was said to use both penises, after finishing with one continuing with the other; but this account of him does not agree with later descriptions, in which no excessive sexual ability had been noticed. Hart describes the adult Santos in full, and accompanies his article with an illustration. At this time he was said to have developed double genitals, and possibly a double bladder communicating by an imperfect septum. At adulthood the anus was three inches anterior to the os coceygeus. In the sitting or lying posture the supernumerary limb rested on the front of the inner surface of the lower third of his left thigh. He was in the habit of wearing this limb in a sling, or bound firmly to the right thigh, to prevent its unseemly dangling when erect. The perineum proper was absent, the entire space between the anus and the posterior edge of the scrotum being occupied by the pedicle. Santos' mental and physical functions were developed above normal, and he impressed everybody with his accomplishments. Geoffroy-Saint-Hilaire records an instance in which the conformation was similar to that of Santos. There was a third lower extremity consisting of two limbs fused into one with a single foot containing ten distinct digits. He calls the case one of arrested twin development. Van Buren and Keyes describe a case in a man of forty-two, of good, healthy appearance. The two distinct penises of normal size were apparently well formed and were placed side by side, each attached at its root to the symphysis. Their covering of skin was common as far as the base of the glans; at this point they seemed distinct and perfect, but the meatus of the left was imperforate. The right meatus was normal, and through it most of the urine passed, though some always dribbled through an opening in the perineum at a point where the root of the scrotum should have been. On lifting the double-barreled penis this opening could be seen and was of sufficient size to admit the finger. On the right side of the aperture was an elongated and rounded prominence similar in outline to a labium majus. This prominence contained a testicle normal in shape and sensibility, but slightly undersized, and surrounded, as was evident from its mobility, by a tunica vaginalis. The left testicle lay on the tendon of the adductor longus in the left groin; it was not fully developed, but the patient had sexual desires, erections, and emissions. Both penises became erect simultaneously, the right more vigorously. The left leg was shorter than the right and congenitally smaller; the mammae were of normal dimensions. Sangalli speaks of a man of thirty-five who had a supernumerary penis, furnished with a prepuce and capable of erection. At the apex of the glans opened a canal about 12 cm. long, through which escaped monthly a serous fluid. Smith mentions a man who had two penises and two bladders, on one of which lithotomy was performed. According to Ballantyne, Taruffi, the scholarly observer of terata, mentions a child of forty-two months and height of 80 cm. who had two penises, each furnished with a urethra and well-formed scrotal sacs which were inserted in a fold of the groin. There were two testicles felt in the right scrotum and one in the left. Fecal evacuations escaped through two anal orifices. There is also another case mentioned similar to the foregoing in a man of forty; but here there was an osseous projection in the middle line behind the bladder. This patient said that erection was simultaneous in both penises, and that he had not married because of his chagrin over his deformity. Cole speaks of a child with two well-developed male organs, one to the left and the other to the right of the median line, and about 1/4 or 1/2 inch apart at birth. The urethra bifurcated in the perineal region and sent a branch to each penis, and urine passed from each meatus. The scrotum was divided into three compartments by two raphes, and each compartment contained a testicle. The anus at birth was imperforate, but the child was successfully operated on, and at its sixtieth day weighed 17 pounds. Lange says that an infant was brought to Karg for relief of anal atresia when fourteen days old. It was found to possess duplicate penises, which communicated each to its distinct half of the bladder as defined by a median fold. The scrotum was divided into three portions by two raphes, and each lateral compartment contained a fully formed testicle. This child died because of its anal malformation, which we notice is a frequent associate of malformations or duplicity of the penis. There is an example in an infant described in which there were two penises, each about 1/2 inch long, and a divided scrotal sac 21 inches long. Englisch speaks of a German of forty who possessed a double penis of the bifid type. Ballantyne and his associates define diphallic terata as individuals provided with two more or less well-formed and more or less separate penises, who may show also other malformations of the adjoining parts and organs (e.g., septate bladder), but who are not possessed of more than two lower limbs. This definition excludes, therefore, the cases in which in addition to a double penis there is a supernumerary lower extremity--such a case, for example, as that of Jean Baptista dos Santos, so frequently described by teratologists. It also excludes the more evident double terata, and, of course, the cases of duplication of the female genital organs (double clitoris, vulva, vagina, and uterus). Although Schurig, Meckel, Himly, Taruffi, and others give bibliographic lists of diphallic terata, even in them erroneous references are common, and there is evidence to show that many cases have been duplicated under different names. Ballantyne and Skirving have consulted all the older original references available and eliminated duplications of reports and, adhering to their original definition, have collected and described individually 20 cases; they offer the following conclusions:-- 1. Diphallus, or duplication of the penis in an otherwise apparently single individual, is a very rare anomaly, records of only 20 cases having been found in a fairly exhaustive search through teratologic literature. As a distinct and well-authenticated type it has only quite recently been recognized by teratologists. 2. It does not of itself interfere with intrauterine or extrauterine life; but the associated anomalies (e.g., atresia ani) may be sources of danger. If not noticed at birth, it is not usually discovered till adult life, and even then the discovery is commonly accidental. 3. With regard to the functions of the pelvic viscera, urine may be passed by both penises, by one only, or by neither. In the last instance it finds exit by an aperture in the perineum. There is reason to believe that semen may be passed in the same way; but in most of the recorded cases there has been sterility, if not inability to perform the sexual act. 4. All the degrees of duplication have been met with, from a fissure of the glans penis to the presence of two distinct penises inserted at some distance from each other in the inguinal regions. 5. The two penises are usually somewhat defective as regards prepuce, urethra, etc.; they may lie side by side, or more rarely may be situated anteroposteriorly; they may be equal in size, or less commonly one is distinctly larger than the other; and one or both may be perforate or imperforate. 6. The scrotum may be normal or split; the testicles, commonly two in number, may be normal or atrophic, descended or undescended; the prostate may be normal or imperfectly developed, as may also the vasa deferentia and vesiculae seminales. 7. The commonly associated defects are: More or less completely septate bladder, atresia ani, or more rarely double anus, double urethra, increased breadth of the bony pelvis with defect of the symphysis pubis, and possibly duplication of the lower end of the spine, and hernia of some of the abdominal contents into a perineal pouch. Much more rarely, duplication of the heart, lungs, stomach, and kidneys has been noted, and the lower limbs may be shorter than normal. CLASS XI.--Cases of fetus in fetu, those strange instances in which one might almost say that a man may be pregnant with his brother or sister, or in which an infant may carry its twin without the fact being apparent, will next be discussed. The older cases were cited as being only a repetition of the process by which Eve was born of Adam. Figure 63 represents an old engraving showing the birth of Eve. Bartholinus, the Ephemerides, Otto, Paullini, Schurig, and Plot speak of instances of fetus in fetu. Ruysch describes a tumor contained in the abdomen of a man which was composed of hair, molar teeth, and other evidences of a fetus. Huxham reported to the Royal Society in 1748 the history of a child which was born with a tumor near the anus larger than the whole body of the child; this tumor contained rudiments of an embryo. Young speaks of a fetus which lay encysted between the laminae of the transverse mesocolon, and Highmore published a report of a fetus in a cyst communicating with the duodenum. Dupuytren gives an example in a boy of thirteen, in whom was found a fetus. Gaetano-Nocito, cited by Philipeaux, has the history of a taken with a great pain in the right hypochondrium, and from which issued subsequently fetal bones and a mass of macerated embryo. His mother had had several double pregnancies, and from the length of the respective tibiae one of the fetuses seemed to be of two months' and the other of three months' intrauterine life. The man died five years after the abscess had burst spontaneously. Brodie speaks of a case in which fetal remains were taken from the abdomen of a girl of two and one-half years. Gaither describes a child of two years and nine months, supposed to be affected with ascites, who died three hours after the physician's arrival. In its abdomen was found a fetus weighing almost two pounds and connected to the child by a cord resembling an umbilical cord. This child was healthy for about nine months, and had a precocious longing for ardent spirits, and drank freely an hour before its death. Blundell says that he knew "a boy who was literally and without evasion with child, for the fetus was contained in a sac communicating with the abdomen and was connected to the side of the cyst by a short umbilical cord; nor did the fetus make its appearance until the boy was eight or ten years old, when after much enlargement of pregnancy and subsequent flooding the boy died." The fetus, removed after death, on the whole not very imperfectly formed, was of the size of about six or seven months' gestation. Bury cites an account of a child that had a second imperfectly developed fetus in its face and scalp. There was a boy by the name of Bissieu who from the earliest age had a pain in one of his left ribs; this rib was larger than the rest and seemed to have a tumor under it. He died of phthisis at fourteen, and after death there was found in a pocket lying against the transverse colon and communicating with it all the evidences of a fetus. At the Hopital de la Charite in Paris, Velpeau startled an audience of 500 students and many physicians by saying that he expected to find a rudimentary fetus in a scrotal tumor placed in his hands for operation. His diagnosis proved correct, and brought him resounding praise, and all wondered as to his reasons for expecting a fetal tumor. It appears that he had read with care a report by Fatti of an operation on the scrotum of a child which had increased in size as the child grew, and was found to contain the ribs, the vertebral column, the lower extremities as far as the knees, and the two orbits of a fetus; and also an account of a similar operation performed by Wendt of Breslau on a Silesian boy of seven. The left testicle in this case was so swollen that it hung almost to the knee, and the fetal remains removed weighed seven ounces. Sulikowski relates an instance of congenital fetation in the umbilicus of a girl of fourteen, who recovered after the removal of the anomaly. Aretaeos described to the members of the medical fraternity in Athens the case of a woman of twenty-two, who bore two children after a seven months' pregnancy. One was very rudimentary and only 21 inches long, and the other had an enormous head resembling a case of hydrocephalus. On opening the head of the second fetus, another, three inches long, was found in the medulla oblongata, and in the cranial cavity with it were two additional fetuses, neither of which was perfectly formed. Broca speaks of a fetal cyst being passed in the urine of a man of sixty-one; the cyst contained remnants of hair, bone, and cartilage. Atlee submits quite a remarkable case of congenital ventral gestation, the subject being a girl of six, who recovered after the discharge of the fetal mass from the abdomen. McIntyre speaks of a child of eleven, playing about and feeling well, but whose abdomen progressively increased in size 1 1/2 inches each day. After ten days there was a large fluctuating mass on the right side; the abdomen was opened and the mass enucleated; it was found to contain a fetal mass weighing nearly five pounds, and in addition ten pounds of fluid were removed. The child made an early recovery. Rogers mentions a fetus that was found in a man's bladder. Bouchacourt reports the successful extirpation of the remains of a fetus from the rectum of a child of six. Miner describes a successful excision of a congenital gestation. Modern literature is full of examples, and nearly every one of the foregoing instances could be paralleled from other sources. Rodriguez is quoted as reporting that in July, 1891, several newspapers in the city of Mexico published, under the head of "A Man-mother," a wonderful story, accompanied by wood-cuts, of a young man from whose body a great surgeon had extracted a "perfectly developed fetus." One of these wood-cuts represented a tumor at the back of a man opened and containing a crying baby. In commenting upon this, after reviewing several similar cases of endocymian monsters that came under his observation in Mexico, Rodriguez tells what the case which had been so grossly exaggerated by the lay journals really was: An Indian boy, aged twenty-two, presented a tumor in the sacrococcygeal region measuring 53 cm. in circumference at the base, having a vertical diameter of 17 cm. and a transverse diameter of 13 cm. It had no pedicle and was fixed, showing unequal consistency. At birth this tumor was about the size of a pigeon's egg. A diagnosis of dermoid cyst was made and two operations were performed on the boy, death following the second. The skeleton showed interesting conditions; the rectum and pelvic organs were natural, and the contents of the cyst verified the diagnosis. Quite similar to the cases of fetus in fetu are the instances of dermoid cysts. For many years they have been a mystery to physiologists, and their origin now is little more than hypothetic. At one time the fact of finding such a formation in the ovary of an unmarried woman was presumptive evidence that she was unchaste; but this idea was dissipated as soon as examples were reported in children, and to-day we have a well-defined difference between congenital and extrauterine pregnancy. Dermoid cysts of the ovary may consist only of a wall of connective tissue lined with epidermis and containing distinctly epidermic scales which, however, may be rolled up in firm masses of a more or less soapy consistency; this variety is called by Orth epidermoid cyst; or, according to Warren, a form of cyst made up of skin containing small and ill-defined papillae, but rich in hair follicles and sebaceous glands. Even the erector pili muscle and the sudoriparous gland are often found. The hair is partly free and rolled up into thick balls or is still attached to the walls. A large mass of sebaceous material is also found in these cysts. Thomson reports a case of dermoid cyst of the bladder containing hair, which cyst he removed. It was a pedunculated growth, and it was undoubtedly vesical and not expelled from some ovarian source through the urinary passage, as sometimes occurs. The simpler forms of the ordinary dermoid cysts contain bone and teeth. The complicated teratoma of this class may contain, in addition to the previously mentioned structures, cartilage and glands, mucous and serous membrane, muscle, nerves, and cerebral substance, portions of eyes, fingers with nails, mammae, etc. Figure 64 represents a cyst containing long red hair that was removed from a blonde woman aged forty-four years who had given birth to six children. Cullingworth reports the history of a woman in whom both ovaries were apparently involved by dermoids, who had given birth to 12 children and had three miscarriages--the last, three months before the removal of the growths. The accompanying illustration, taken from Baldy, pictures a dermoid cyst of the complicated variety laid open and exposing the contents in situ. Mears of Philadelphia reports a case of ovarian cyst removed from a girl of six and a half by Bradford of Kentucky in 1875. From this age on to adult life many similar cases are recorded. Nearly every medical museum has preserved specimens of dermoid cysts, and almost all physicians are well acquainted with their occurrence. The curious formations and contents and the bizarre shapes are of great variety. Graves mentions a dermoid cyst containing the left side of a human face, an eye, a molar tooth, and various bones. Dermoid cysts are found also in regions of the body quite remote from the ovary. The so-called "orbital wens" are true inclusion of the skin of a congenital origin, as are the nasal dermoids and some of the cysts of the neck. Weil reported the case of a man of twenty-two years who was born with what was supposed to be a spina bifida in the lower sacral region. According to Senn, the swelling never caused any pain or inconvenience until it inflamed, when it opened spontaneously and suppurated, discharging a large quantity of offensive pus, hair, and sebaceous material, thus proving it to have been a dermoid. The cyst was freely incised, and there were found numerous openings of sweat glands, from which drops of perspiration escaped when the patient was sweating. Dermoid cysts of the thorax are rare. Bramann reported a case in which a dermoid cyst of small size was situated over the sternum at the junction of the manubrium with the gladiolus, and a similar cyst in the neck near the left cornu of the hyoid bone. Chitten removed a dermoid from the sternum of a female of thirty-nine, the cyst containing 11 ounces of atheromatous material. In the Museum of St. Bartholomew's Hospital in London there is a congenital tumor which was removed from the anterior mediastinum of a woman of twenty one, and contained portions of skin, fat, sebaceous material, and two pieces of bone similar to the superior maxilla, and in which several teeth were found. Dermoids are found in the palate and pharynx, and open dermoids of the conjunctiva are classified by Sutton with the moles. According to Senn, Barker collected sixteen dermoid tumors of the tongue. Bryk successfully removed a tumor of this nature the size of a fist. Wellington Gray removed an enormous lingual dermoid from the mouth of a negro. It contained 40 ounces of atheromatous material. Dermoids of the rectum are reported. Duyse reports the history of a case of labor during which a rectal dermoid was expelled. The dermoid contained a cerebral vesicle, a rudimentary eye, a canine and a molar tooth, and a piece of bone. There is little doubt that many cases of fetus in fetu reported were really dermoids of the scrotum. Ward reports the successful removal of a dermoid cyst weighing 30 pounds from a woman of thirty-two, the mother of two children aged ten and twelve, respectively. The report is briefly as follows: "The patient has always been in good health until within the last year, during which time she has lost flesh and strength quite rapidly, and when brought to my hospital by her physician, Dr. James of Williamsburg, Kansas, was quite weak, although able to walk about the house. A tumor had been growing for a number of years, but its growth was so gradual that the patient had not considered her condition critical until quite recently. The tumor was diagnosed to be cystoma of the left ovary. Upon opening the sac with the trocar we were confronted by complications entirely unlooked for, and its use had to be abandoned entirely because the thick contents of the cyst would not flow freely, and the presence of sebaceous matter blocked the instrument. As much of the fluid as possible was removed, and the abdominal incision was enlarged to allow of the removal of the large tumor. An ovarian hematoma the size of a large orange was removed from the right side. We washed the intestines quite as one would wash linen, since some of the contents of the cyst had escaped into the abdominal cavity. The abdomen was closed without drainage, and the patient placed in bed without experiencing the least shock. Her recovery was rapid and uneventful. She returned to her home in four weeks after the operation. "The unusual feature in this case was the nature of the contents of the sac. There was a large quantity of long straight hair growing from the cyst wall and an equal amount of loose hair in short pieces floating through the tumor-contents, a portion of which formed nuclei for what were called 'moth-balls,' of which there were about 1 1/2 gallons. These balls, or marbles, varied from the size of moth-balls, as manufactured and sold by druggists, to that of small walnuts. They seemed to be composed of sebaceous matter, and were evidently formed around the short hairs by the motion of the fluid produced by walking or riding. There was some tissue resembling true skin attached to the inner wall of the sac." There are several cases of multiple dermoid cysts on record, and they may occur all over the body. Jamieson reports a case in which there were 250, and in Maclaren's case there were 132. According to Crocker, Hebra and Rayer also each had a case. In a case of Sangster, reported by Politzer, although most of the dermoids, as usual, were like fibroma-nodules and therefore the color of normal skin, those over the mastoid processes and clavicle were lemon-yellow, and were generally thought to be xanthoma until they were excised, and Politzer found they were typical dermoid cysts with the usual contents of degenerated epithelium and hair. Hermaphroditism.--Some writers claim that Adam was the first hermaphrodite and support this by Scriptural evidence. We find in some of the ancient poets traces of an Egyptian legend in which the goddess of the moon was considered to be both male and female. From mythology we learn that Hermaphroditus was the son of Hermes, or Mercury, and Venus Aphrodite, and had the powers both of a father and mother. In speaking of the foregoing Ausonius writes, "Cujus erat facies in qua paterque materque cognosci possint, nomen traxit ab illis." Ovid and Virgil both refer to legendary hermaphrodites, and the knowledge of their existence was prevalent in the olden times. The ancients considered the birth of hermaphrodites bad omens, and the Athenians threw them into the sea, the Romans, into the Tiber. Livy speaks of an hermaphrodite being put to death in Umbria, and another in Etruria. Cicero, Aristotle, Strabonius, and Pliny all speak concerning this subject. Martial and Tertullian noticed this anomaly among the Romans. Aetius and Paulus Aegineta speak of females in Egypt with prolonged clitorides which made them appear like hermaphrodites. Throughout the Middle Ages we frequently find accounts, naturally exaggerated, of double-sexed creatures. Harvey, Bartholinus, Paullini, Schenck, Wolff, Wrisberg, Zacchias, Marcellus Donatus, Haller, Hufeland, de Graff, and many others discuss hermaphroditism. Many classifications have been given, as, e.g., real and apparent; masculine, feminine, or neuter; horizontal and vertical; unilateral and bilateral, etc. The anomaly in most cases consists of a malformation of the external genitalia. A prolonged clitoris, prolapsed ovaries, grossness of figure, and hirsute appearance have been accountable for many supposed instances of hermaphrodites. On the other hand, a cleft scrotum, an ill-developed penis, perhaps hypospadias or epispadias, rotundity of the mammae, and feminine contour have also provoked accounts of similar instances. Some cases have been proved by dissection to have been true hermaphrodites, portions or even entire genitalia of both sexes having been found. Numerous accounts, many mythical, but always interesting, are given of these curious persons. They have been accredited with having performed the functions of both father and mother, notwithstanding the statements of some of the best authorities that they are always sterile. Observation has shown that the sexual appetite diminishes in proportion to the imperfections in the genitalia, and certainly many of these persons are sexually indifferent. We give descriptions of a few of the most famous or interesting instances of hermaphroditism. Pare speaks of a woman who, besides a vulva, from which she menstruated, had a penis, but without prepuce or signs of erectility. Haller alludes to several cases in which prolonged clitorides have been the cause of the anomaly. In commenting on this form of hermaphroditism Albucasiusus describes a necessary operation for the removal of the clitoris. Columbus relates the history of an Ethiopian woman who was evidently a spurious female hermaphrodite. The poor wretch entreated him to cut off her penis, an enlarged clitoris, which she said was an intolerable hindrance to her in coitus. De Graff and Riolan describe similar cases. There is an old record of a similar creature, supposing herself to be a male, who took a wife, but previously having had connection with a man, the outcome of which was pregnancy, was shortly after marriage delivered of a daughter. There is an account of a person in Germany who, for the first thirty years of life, was regarded as feminine, and being of loose morals became a mother. At a certain period she began to feel a change in her sexual inclinations; she married and became the father of a family. This is doubtless a distortion of the facts of the case of Catherine or Charles Hoffman, born in 1824, and who was considered a female until the age of forty. At puberty she had the instincts of a woman, and cohabitated with a male lover for twenty years. Her breasts were well formed and she menstruated at nineteen. At the age of forty-six her sexual desires changed, and she attempted coitus as a man, with such evident satisfaction that she married a woman soon afterward. Fitch speaks of a house-servant with masculine features and movements, aged twenty-eight, and 5 feet and 9 inches tall, who was arrested by the police for violating the laws governing prostitution. On examination, well-developed male and female organs of generation were found. The labia majora were normal and flattened on the anterior surface. The labia minora and hymen were absent. The vagina was spacious and the woman had a profuse leukorrhea. She stated that several years previously she gave birth to a normal child. In place of a clitoris she had a penis which, in erection, measured 5 1/4 inches long and 3 5/8 inches in circumference. The glans penis and the urethra were perfectly formed. The scrotum contained two testicles, each about an inch long; the mons veneris was sparsely covered with straight, black hair. She claimed functional ability with both sets of genitalia, and said she experienced equal sexual gratification with either. Semen issued from the penis, and every three weeks she had scanty menstruation, which lasted but two days. Beclard showed Marie-Madeline Lefort, nineteen years of age, 1 1/2 meters in height. Her mammae were well developed, her nipples erectile and surrounded by a brown areola, from which issued several hairs. Her feet were small, her pelvis large, and her thighs like those of a woman. Projecting from the vulva was a body looking like a penis 7 cm. long and slightly erectile at times; it was imperforate and had a mobile prepuce. She had a vulva with two well-shaped labia as shown by the accompanying illustration. She menstruated slightly and had an opening at the root of the clitoris. The parotid region showed signs of a beard and she had hair on her upper lip. On August 20, 1864, a person came into the Hotel-Dieu, asking treatment for chronic pleurisy. He said his age was sixty-five, and he pursued the calling of a mountebank, but remarked that in early life he had been taken for a woman. He had menstruated at eight and had been examined by doctors at sixteen. The menstruation continued until 1848, and at its cessation he experienced the feelings of a male. At this time he presented the venerable appearance of a long-bearded old man. At the autopsy, about two months later, all the essentials of a female were delineated. A Fallopian tube, ovaries, uterus, and round ligaments were found, and a drawing in cross-section of the parts was made. There is no doubt but that this individual was Marie-Madeline Lefort in age. Worbe speaks of a person who was supposed to be feminine for twenty-two years. At the age of sixteen she loved a farmer's son, but the union was delayed for some reason, and three years later her grace faded and she became masculine in her looks and tastes. It was only after lengthy discussion, in which the court took part, that it was definitely settled that this person was a male. Adelaide Preville, who was married as a female, and as such lived the last ten years of her life in France, was found on dissection at the Hotel-Dieu to be a man. A man was spoken of in both France and Germany a who passed for many years as a female. He had a cleft scrotum and hypospadias, which caused the deception. Sleeping with another servant for three years, he constantly had sexual congress with her during this period, and finally impregnated her. It was supposed in this case that the posterior wall of the vagina supplied the deficiency of the lower boundary of the urethra, forming a complete channel for the semen to proceed through. Long ago in Scotland a servant was condemned to death by burial alive for impregnating his master's daughter while in the guise and habit of a woman. He had always been considered a woman. We have heard of a recent trustworthy account of a pregnancy and delivery in a girl who had been impregnated by a bed-fellow who on examination proved to be a male pseudohermaphrodite. Fournier speaks of an individual in Lisbon in 1807 who was in the highest degree graceful, the voice feminine, the mammae well developed, The female genitalia were normal except the labia majora, which were rather diminutive. The thighs and the pelvis. were not so wide as those of a woman. There was some beard on the chin, but it was worn close. the male genitalia were of the size and appearance of a male adult and were covered with the usual hair. This person had been twice pregnant and aborted at the third and fifth month. During coitus the penis became erect, etc. Schrell describes a case in which, independent of the true penis and testicles, which were well formed, there existed a small vulva furnished with labia and nymphae, communicating with a rudimentary uterus provided with round ligaments and imperfectly developed ovaries. Schrell remarks that in this case we must notice that the female genitalia were imperfectly developed, and adds that perfect hermaphroditism is a physical impossibility without great alterations of the natural connections of the bones and other parts of the pelvis. Cooper describes a woman with an enormous development of the clitoris, an imperforate uterus, and absence of vagina; at first sight of the parts they appeared to be those of a man. In 1859 Hugier succeeded in restoring a vagina to a young girl of twenty who had an hypertrophied clitoris and no signs of a vagina. The accompanying illustrations show the conformation of the parts before operation with all the appearance of ill-developed male genitalia, and the appearance afterward with restitution of the vaginal opening. Virchow in 1872, Boddaert in 1875, and Marchand in 1883 report cases of duplication of the genitalia, and call their cases true hermaphrodites from an anatomic standpoint. There is a specimen in St. Bartholomew's Hospital in London from a man of forty-four, who died of cerebral hemorrhage. He was well formed and had a beard and a full-sized penis. He was married, and it was stated that his wife had two children. The bladder and the internal organs of generation were those of a man in whom neither testis had descended into the scrotum, and in whom the uterus masculinus and vagina were developed to an unusual degree. The uterus, nearly as large as in the adult female, lay between the bladder and rectum, and was enclosed between two layers of peritoneum, to which, on either side of the uterus, were attached the testes. There was also shown in London the pelvic organs from a case of complex or vertical hermaphroditism occurring in a child of nine months who died from the effects of an operation for the radical cure of a right inguinal hernia. The external organs were those of a male with undescended testes. The bladder was normal and its neck was surrounded by a prostate gland. Projecting backward were a vagina, uterus, and broad ligaments, round ligaments, and Fallopian tubes, with the testes in the position of the ovaries. There were no seminal vesicles. The child died eleven days after the operation. The family history states that the mother had had 14 children and eight miscarriages. Seven of the children were dead and showed no abnormalities. The fifth and sixth children were boys and had the same sexual arrangement. Barnes, Chalmers, Sippel, and Litten describe cases of spurious hermaphroditism due to elongation of the clitoris. In Litten's case a the clitoris was 3 1/2 inches long, and there was hydrocele of the processus vaginalis on both sides, making tumors in the labium on one side and the inguinal canal on the other, which had been diagnosed as testicles and again as ovaries. There was associate cystic ovarian disease. Plate 4 is taken from a case of false external bilateral hermaphroditism. Phillips mentions four cases of spurious hermaphroditism in one family, and recently Pozzi tells of a family of nine individuals in whom this anomaly was observed. The first was alive and had four children; the second was christened a female but was probably a male; the third, fourth, and fifth were normal but died young; the sixth daughter was choreic and feeble-minded, aged twenty-nine, and had one illegitimate child; the seventh, a boy, was healthy and married; the eighth was christened a female, but when seventeen was declared by the Faculty to be a male; the ninth was christened a female, but at eighteen the genitals were found to be those of a male, though the mammae were well developed. O'Neill speaks of a case in which the clitoris was five inches long and one inch thick, having a groove in its inferior surface reaching down to an oblique opening in the perineum. The scrotum contained two hard bodies thought to be testicles, and the general appearance was that of hypospadias. Postmortem a complete set of female genitalia was found, although the ovaries were very small. The right round ligament was exceedingly thick and reached down to the bottom of the false scrotum, where it was firmly attached. The hard bodies proved to be on one side an irreducible omental hernia, probably congenital, and on the other a hardened mass having no glandular structure. The patient was an adult. As we have seen, there seems to be a law of evolution in hermaphroditism which prevents perfection. If one set of genitalia are extraordinarily developed, the other set are correspondingly atrophied. In the case of extreme development of the clitoris and approximation to the male type we must expect to find imperfectly developed uterus or ovaries. This would answer for one of the causes of sterility in these cases. There is a type of hermaphroditism in which the sex cannot be definitely declared, and sometimes dissection does not definitely indicate the predominating sex. Such cases are classed under the head of neuter hermaphrodites, possibly an analogy of the "genus epicoenum" of Quintilian. Marie Dorothee, of the age of twenty-three, was examined and declared a girl by Hufeland and Mursina, while Stark, Raschig, and Martens maintained that she was a boy. This formidable array of talent on both sides provoked much discussion in contemporary publications, and the case attracted much notice. Marc saw her in 1803, at which time she carried contradicting certificates as to her sex. He found an imperforate penis, and on the inferior face near the root an opening for the passage of urine. No traces of nymphae, vagina, testicles, nor beard were seen. The stature was small, the form debilitated, and the voice effeminate. Marc came to the conclusion that it was impossible for any man to determine either one sex or the other. Everard Home dissected a dog with apparent external organs of the female, but discovered that neither sex was sufficiently pronounced to admit of classification. Home also saw at the Royal Marine Hospital at Plymouth, in 1779, a marine who some days after admission was reported to be a girl. On examination Home found him to possess a weak voice, soft skin, voluminous breasts, little beard, and the thighs and legs of a woman. There was fat on the pubis, the penis was short and small and incapable of erection, the testicles of fetal size; he had no venereal desires whatever, and as regards sex was virtually neuter. The legal aspect of hermaphroditism has always been much discussed. Many interesting questions arise, and extraordinary complications naturally occur. In Rome a hermaphrodite could be a witness to a testament, the exclusive privilege of a man, and the sex was settled by the predominance. If the male aspect and traits together with the generative organs of man were most pronounced, then the individual could call himself a man. "Hermaphroditus an ad testamentum adhiberi possit qualitas sesus incalescentis ostendit." There is a peculiar case on record in which the question of legal male inheritance was not settled until the individual had lived as a female for fifty-one years. This person was married when twenty-one, but finding coitus impossible, separated after ten years, and though dressing as a female had coitus with other women. She finally lived with her brother, with whom she eventually came to blows. She prosecuted him for assault, and the brother in return charged her with seducing his wife. Examination ensued, and at this ripe age she was declared to be a male. The literature on hermaphroditism is so extensive that it is impossible to select a proper representation of the interesting cases in this limited space, and the reader is referred to the modern French works on this subject, in which the material is exhaustive and the discussion thoroughly scientific. CHAPTER VI. MINOR TERATA. Ancient Ideas Relative to Minor Terata.--The ancients viewed with great interest the minor structural anomalies of man, and held them to be divine signs or warnings in much the same manner as they considered more pronounced monstrosities. In a most interesting and instructive article, Ballantyne quotes Ragozin in saying that the Chaldeo-Babylonians, in addition to their other numerous subdivisions of divination, drew presages and omens for good or evil from the appearance of the liver, bowels, and viscera of animals offered for sacrifice and opened for inspection, and from the natural defects or monstrosities of babies or the young of animals. Ballantyne names this latter subdivision of divination fetomancy or teratoscopy, and thus renders a special chapter as to omens derived from monstrous births, given by Lenormant:-- "The prognostics which the Chaldeans claimed to draw from monstrous births in man and the animals are worthy of forming a class by themselves, insomuch the more as it is the part of their divinatory science with which, up to the present time, we are best acquainted. The development that their astrology had given to 'genethliaque,' or the art of horoscopes of births, had led them early to attribute great importance to all the teratologic facts which were there produced. They claimed that an experience of 470,000 years of observations, all concordant, fully justified their system, and that in nothing was the influence of the stars marked in a more indubitable manner than in the fatal law which determined the destiny of each individual according to the state of the sky at the moment when he came into the world. Cicero, by the very terms which he uses to refute the Chaldeans, shows that the result of these ideas was to consider all infirmities and monstrosities that new-born infants exhibited as the inevitable and irremediable consequence of the action of these astral positions. This being granted, the observation of similar monstrosities gave, as it were, a reflection of the state of the sky; on which depended all terrestrial things; consequently, one might read in them the future with as much certainty as in the stars themselves. For this reason the greatest possible importance was attached to the teratologic auguries which occupy so much space in the fragments of the great treatise on terrestrial presages which have up to the present time been published." The rendering into English of the account of 62 teratologic cases in the human subject with the prophetic meanings attached to them by Chaldean diviners, after the translation of Opport, is given as follows by Ballantyne, some of the words being untranslatable:-- "When a woman gives birth to an infant-- (1) that has the ears of a lion, there will be a powerful king in the country; (2) that wants the right ear, the days of the master (king) will be prolonged (reach old age); (3) that wants both ears, there will be mourning in the country, and the country will be lessened (diminished); (4) whose right ear is small, the house of the man (in whose house the birth took place) will be destroyed; (5) whose ears are both small, the house of the man will be built of bricks; (6) whose right ear is mudissu tehaat (monstrous), there will be an androgyne in the house of the new-born (7) whose ears are both mudissu (deformed), the country will perish and the enemy rejoice; (8) whose right ear is round, there will be an androgyne in the house of the new-born; (9) whose right ear has a wound below, and tur re ut of the man, the house will be estroyed; (10) that has two ears on the right side and none on the left, the gods will bring about a stable reign, the country will flourish, and it will be a land of repose; (11) whose ears are both closed, sa a au; (12) that has a bird's beak, the country will be peaceful; (13) that has no mouth, the mistress of the house will die; (14) that has no right nostril, the people of the world will be injured; (15) whose nostrils are absent, the country will be in affliction, and the house of the man will be ruined; (16) whose jaws are absent, the days of the master (king) will be prolonged, but the house (where the infant is born) will be ruined. When a woman gives birth to an infant-- (17) that has no lower jaw, mut ta at mat, the name will not be effaced; (20) that has no nose, affliction will seize upon the country, and the master of the house will die; (21) that has neither nose nor virile member (penis), the army of the king will be strong, peace will be in the land, the men of the king will be sheltered from evil influences, and Lilit (a female demon) shall not have power over them; (22) whose upper lip overrides the lower, the people of the world will rejoice (or good augury for the troops); (23) that has no lips, affliction will seize upon the land, and the house of the man will be destroyed; (24) whose tongue is kuri aat, the man will be spared (?); (25) that has no right hand, the country will be convulsed by an earthquake; (26) that has no fingers, the town will have no births, the bar shall be lost; (27) that has no fingers on the right side, the master (king) will not pardon his adversary (or shall be humiliated by his enemies); (28) that has six fingers on the right side, the man will take the lukunu of the house; (29) that has six very small toes on both feet, he shall not go to the lukunu; (30) that has six toes on each foot, the people of the world will be injured (calamity to the troops); (31) that has the heart open and that has no skin, the country will suffer from calamities; (32) that has no penis, the master of the house will be enriched by the harvest of his field; (33) that wants the penis and the umbilicus, there will be ill-will in the house, the woman (wife) will have an overbearing eye (be haughty); but the male descent of the palace will be more extended. When a woman gives birth to an infant-- (34) that has no well-marked sex, calamity and affliction will seize upon the land; the master of the house shall have no happiness; (35) whose anus is closed, the country will suffer from want of nourishment; (36) whose right testicle (?) is absent, the country of the master (king) will perish; (37) whose right foot is absent, his house will be ruined and there will be abundance in that of the neighbor; (38) that has no feet, the canals of the country will be cut (intercepted) and the house ruined; (39) that has the right foot in the form of a fish's tail, the booty of the country of the humble will not be imas sa bir; (40) whose hands and feet are like four fishes' tails (fins), the master (king) shall perish (?) and his country shall be consumed; (41) whose feet are moved by his great hunger, the house of the su su shall be destroyed; (42) whose foot hangs to the tendons of the body, there will be great prosperity in the land; (43) that has three feet, two in their normal position (attached to the body) and the third between them, there will be great prosperity in the land; (44) whose legs are male and female, there will be rebellion; (45) that wants the right heel, the country of the master (king) will be destroyed. When a woman gives birth to an infant-- (46) that has many white hairs on the head, the days of the king will be prolonged; (47) that has much ipga on the head, the master of the house will die, the house will be destroyed; (48) that has much pinde on the head, joy shall go to meet the house (that has a head on the head, the good augury shall enter at its aspect into the house); (49) that has the head full of hali, there will be ill-will toward him and the master (king) of the town shall die; (50) that has the head full of siksi the king will repudiate his masters; (51) that has some pieces of flesh (skin) hanging on the head, there shall be ill-will; (52) that has some branches (?) (excrescences) of flesh (skin) hanging on the head, there shall be ill-will, the house will perish; (53) that has some formed fingers (horns?) on the head, the days of the king will be less and the years lengthened (in the duration of his old age); (54) that has some kali on the head, there will be a king of the land; (55) that has a ---- of a bird on the head, the master of the house shall not prosper; (56) that has some teeth already through (cut), the days of the king will arrive at old age, the country will show itself powerful over (against) strange (feeble) lands, but the house where the infant is born will be ruined; (57) that has the beard come out, there will be abundant rains; (58) that has some birta on the head, the country will be strengthened (reinforced); (59) that has on the head the mouth of an old man and that foams (slabbers), there will be great prosperity in the land, the god Bin will give a magnificent harvest (inundate the land with fertility), and abundance shall be in the land; (60) that has on one side of the head a thickened ear, the first-born of the men shall live a long time (?); (61) that has on the head two long and thick ears, there will be tranquility and the pacification of litigation (contests); (62) that has the figure in horn (like a horn?)..." As ancient and as obscure as are these records, Ballantyne has carefully gone over each, and gives the following lucid explanatory comments:-- "What 'ears like a lion' (No. 1) may have been it is difficult to determine; but doubtless the direction and shape of the auricles were so altered as to give them an animal appearance, and possibly the deformity was that called 'orechio ad ansa' by Lombroso. The absence of one or both ears (Nos. 2 and 3) has been noted in recent times by Virchow (Archiv fur path. Anat. xxx., p. 221), Gradenigo (Taruffi's 'Storia della Teratologia,' vi., p. 552), and others. Generally some cartilaginous remnant is found, but on this point the Chaldean record is silent. Variations in the size of the ears (Nos. 4 and 5) are well known at the present time, and have been discussed at length by Binder (Archiv fur Psychiatrie und Nervenkrankheiten, xx., 1887) and others. The exact malformation indicated in Nos. 6 and 7 is, of course, not to be determined, although further researches in Assyriology may clear up this point. The 'round ear' (No. 8) is one of Binder's types, and that with a 'wound below' (No. 9) probably refers to a case of fistula auris congenita (Toynbee, 'Diseases of the Ear,' 1860). The instance of an infant born with two ears on the right side (No. 10) was doubtless one of cervical auricle or preauricular appendage, whilst closure of the external auditory meatus (No. 11) is a well-known deformity. "The next thirteen cases (Nos. 12-24) were instances of anomalies of the mouth and nose. The 'bird's beak' (No. 12) may have been a markedly aquiline nose; No. 13 was a case of astoma; and Nos. 14 and 15 were instances of stenosis or atresia of the anterior nares. Fetuses with absence of the maxillae (Nos. 16 and 17) are in modern terminology called agnathous. Deformities like that existing in Nos. 20 and 21 have been observed in paracephalic and cyclopic fetuses. The coincident absence of nose and penis (No. 21) is interesting, especially when taken in conjunction with the popular belief that the size of the former organ varies with that of the latter. Enlargement of the upper lip (No. 22), called epimacrochelia by Taruffi, and absence of the lips (No. 23), known now under the name of brachychelia, have been not unfrequently noticed in recent times. The next six cases (Nos. 25-30) were instances of malformations of the upper limb: Nos. 25, 26. and 27 were probably instances of the so-called spontaneous or intrauterine amputation; and Nos. 28, 29, and 30 were examples of the comparatively common deformity known as polydactyly. No. 31 was probably a case of ectopia cordis. "Then follow five instances of genital abnormalities (Nos. 32-36), consisting of absence of the penis (epispadias?), absence of penis and umbilicus (epispadias and exomphalos?), hermaphroditism, imperforate anus, and nondescent of one testicle. The nine following cases (Nos. 37-45) were anomalies of the lower limbs: Nos. 37, 38, and 42 may have been spontaneous amputations; Nos. 39 and 40 were doubtless instances of webbed toes (syndactyly), and the deformity indicated in No. 45 was presumably talipes equinus. The infant born with three feet (No. 43) was possibly a case of parasitic monstrosity, several of which have been reported in recent teratologic literature; but what is meant by the statement concerning 'male and female legs' it is not easy to determine. "Certain of the ten following prodigies (Nos. 46-55) cannot in the present state of our knowledge be identified. The presence of congenital patches of white or gray hair on the scalp, as recorded in No. 46, is not an unknown occurrence at the present time; but what the Chaldeans meant by ipga, pinde, hali riksi, and kali on the head of the new-born infant it is impossible to tell. The guess may be hazarded that cephalhematoma, hydrocephalus, meningocele, nevi, or an excessive amount of vernix caseosa were the conditions indicated, but a wider acquaintance with the meaning of the cuneiform characters is necessary before any certain identification is possible. The 'pieces of skin hanging from the head' (No. 51) may have been fragments of the membranes; but there is nothing in the accompanying prediction to help us to trace the origin of the popular belief in the good luck following the baby born with a caul. If No. 53 was a case of congenital horns on the head, it must be regarded as a unique example, unless, indeed, a form of fetal ichthyosis be indicated. "The remaining observations (No. 56-62) refer to cases of congenital teeth (No. 56) to deformity of the ears (Nos. 60 and 61), and a horn (No. 62)." From these early times almost to the present day similar significance has been attached to minor structural anomalies. In the following pages the individual anomalies will be discussed separately and the most interesting examples of each will be cited. It is manifestly evident that the object of this chapter is to mention the most striking instances of abnormism and to give accompanying descriptions of associate points of interest, rather than to offer a scientific exposition of teratology, for which the reader is referred elsewhere. Congenital defect of the epidermis and true skin is a rarity in pathology. Pastorello speaks of a child which lived for two and a half hours whose hands and feet were entirely destitute of epidermis; the true skin of those parts looked like that of a dead and already putrefying child. Hanks cites the history of a case of antepartum desquamation of the skin in a living fetus. Hochstetter describes a full-term, living male fetus with cutaneous defect on both sides of the abdomen a little above the umbilicus. The placenta and membranes were normal, a fact indicating that the defect was not due to amniotic adhesions; the child had a club-foot on the left side. The mother had a fall three weeks before labor. Abnormal Elasticity of the Skin.--In some instances the skin is affixed so loosely to the underlying tissues and is possessed of so great elasticity that it can be stretched almost to the same extent as India rubber. There have been individuals who could take the skin of the forehead and pull it down over the nose, or raise the skin of the neck over the mouth. They also occasionally have an associate muscular development in the subcutaneous tissues similar to the panniculus adiposus of quadrupeds, giving them preternatural motile power over the skin. The man recently exhibited under the title of the "Elastic-Skin Man" was an example of this anomaly. The first of this class of exhibitionists was seen in Buda-Pesth some years since and possessed great elasticity in the skin of his whole body; even his nose could be stretched. Figure 70 represents a photograph of an exhibitionist named Felix Wehrle, who besides having the power to stretch his skin could readily bend his fingers backward and forward. The photograph was taken in January, 1888. In these congenital cases there is loose attachment of the skin without hypertrophy, to which the term dermatolysis is restricted by Crocker. Job van Meekren, the celebrated Dutch physician of the seventeenth century, states that in 1657 a Spaniard, Georgius Albes, is reported to have been able to draw the skin of the left pectoral region to the left ear, or the skin under the face over the chin to the vertex. The skin over the knee could be extended half a yard, and when it retracted to its normal position it was not in folds. Seiffert examined a case of this nature in a young man of nineteen, and, contrary to Kopp's supposition, found that in some skin from over the left second rib the elastic fibers were quite normal, but there was transformation of the connective tissue of the dermis into an unformed tissue like a myxoma, with total disappearance of the connective-tissue bundles. Laxity of the skin after distention is often seen in multipara, both in the breasts and in the abdominal walls, and also from obesity, but in all such cases the skin falls in folds, and does not have a normal appearance like that of the true "elastic-skin man." Occasionally abnormal development of the scalp is noticed. McDowall of twenty-two. On each side of the median line of the head there were five deep furrows, more curved and shorter as the distance from the median line increased. In the illustration the hair in the furrows is left longer than that on the rest of the head. The patient was distinctly microcephalic and the right side of the body was markedly wasted. The folds were due to hypertrophy of the muscles and scalp, and the same sort of furrowing is noticed when a dog "pricks his ears." This case may possibly be considered as an example of reversion to inferior types. Cowan records two cases of the foregoing nature in idiots. The first case was a paralytic idiot of thirty-nine, whose cranial development was small in proportion to the size of the face and body; the cranium was oxycephalic; the scalp was lax and redundant and the hair thin; there were 13 furrows, five on each side running anteroposteriorly, and three in the occipital region running transversely. The occipitofrontalis muscle had no action on them. The second case was that of an idiot of forty-four of a more degraded type than the previous one. The cranium was round and bullet-shaped and the hair generally thick. The scalp was not so lax as in the other case, but the furrows were more crooked. By tickling the scalp over the back of the neck the two median furrows involuntarily deepened. Impervious Skin.--There have been individuals who claimed that their skin was impervious to ordinary puncture, and from time to time these individuals have appeared in some of the larger medical clinics of the world for inspection. According to a recent number of the London Graphic, there is in Berlin a Singhalese who baffles all investigations by physicians by the impenetrability of his skin. The bronzed Easterner, a Hercules in shape, claims to have found an elixir which will render the human skin impervious to any metal point or sharpened edge of a knife or dagger, and calls himself the "Man with Iron Skin." He is now exhibiting himself, and his greatest feat is to pass with his entire body through a hoop the inside of which is hardly big enough to admit his body and is closely set with sharp knife-points, daggers, nails, and similar things. Through this hoop he squeezes his body with absolute impunity. The physicians do not agree as to his immunity, and some of them think that Rhannin, which is his name, is a fakir who has by long practice succeeded in hardening himself against the impressions of metal upon his skin. The professors of the Berlin clinic, however, considered it worth while to lecture about the man's skin, pronouncing it an inexplicable matter. This individual performed at the London Alhambra in the latter part of 1895. Besides climbing with bare feet a ladder whose rungs were sharp-edged swords, and lying on a bed of nail points with four men seated upon him, he curled himself up in a barrel, through whose inner edges nails projected, and was rolled about the stage at a rapid rate. Emerging from thence uninjured, he gracefully bows himself off the stage. Some individuals claim immunity from burns and show many interesting feats in handling fire. As they are nothing but skilful "fire jugglers" they deserve no mention here. The immunity of the participants in the savage fire ceremonies will be discussed in Chapter IX. Albinism is characterized by the absolute or relative absence of pigment of the skin, due to an arrest, insufficiency, or retardation of this pigment. Following Trelat and Guinard, we may divide albinism into two classes,--general and partial. As to the etiology of albinism, there is no known cause of the complete form. Heredity plays no part in the number of cases investigated by the authors. D'Aube, by his observations on white rabbits, believes that the influence of consanguinity is a marked factor in the production of albinism; there are, however, many instances of heredity in this anomaly on record, and this idea is possibly in harmony with the majority of observers. Geoffroy-Saint-Hilaire has noted that albinism can also be a consequence of a pathologic condition having its origin in adverse surroundings, the circumstances of the parents, such as the want of exercise, nourishment, light, etc. Lesser knew a family in which six out of seven were albinos, and in some tropical countries, such as Loango, Lower Guinea, it is said to be endemic. It is exceptional for the parents to be affected; but in a case of Schlegel, quoted by Crocker, the grandfather was an albino, and Marey describes the case of the Cape May albinos, in which the mother and father were "fair emblems of the African race," and of their children three were black and three were white, born in the following order: two consecutive black boys, two consecutive white girls, one black girl, one white boy. Sym of Edinburgh relates the history of a family of seven children, who were alternately white and black. All but the seventh were living and in good health and mentally without defect. The parents and other relatives were dark. Figure 73 portrays an albino family by the name of Cavalier who exhibited in Minneapolis in 1887. Examples of the total absence of pigment occur in all races, but particularly is it interesting when seen in negroes who are found absolutely white but preserving all the characteristics of their race, as, for instance, the kinky, woolly hair, flattened nose, thick lips, etc. Rene Claille, in his "Voyage a Tombouctou," says that he saw a white infant, the offspring of a negro and negress. Its hair was white, its eyes blue, and its lashes flaxen. Its pupils were of a reddish color, and its physiognomy that of a Mandingo. He says such cases are not at all uncommon; they are really negro albinos. Thomas Jefferson, in his "History of Virginia," has an excellent description of these negroes, with their tremulous and weak eyes; he remarks that they freckle easily. Buffon speaks of Ethiops with white twins, and says that albinos are quite common in Africa, being generally of delicate constitution, twinkling eyes, and of a low degree of intelligence; they are despised and ill-treated by the other negroes. Prichard, quoted by Sedgwick, speaks of a case of atavic transmission of albinism through the male line of the negro race. The grandfather and the grandchild were albinos, the father being black. There is a case of a brother and sister who were albinos, the parents being of ordinary color but the grandfather an albino. Coinde, quoted by Sedgwick, speaks of a man who, by two different wives, had three albino children. A description of the ordinary type of albino would be as follows: The skin and hair are deprived of pigment; the eyebrows and eyelashes are of a brilliant white or are yellowish; the iris and the choroid are nearly or entirely deprived of coloring material, and in looking at the eye we see a roseate zone and the ordinary pink pupil; from absence of pigment they necessarily keep their eyes three-quarters closed, being photophobic to a high degree. They are amblyopic, and this is due partially to a high degree of ametropia (caused by crushing of the eyeball in the endeavor to shut out light) and from retinal exhaustion and nystagmus. Many authors have claimed that they have little intelligence, but this opinion is not true. Ordinarily the reproductive functions are normal, and if we exclude the results of the union of two albinos we may say that these individuals are fecund. Partial albinism is seen. The parts most often affected are the genitals, the hair, the face, the top of the trunk, the nipple, the back of the hands and fingers. Folker reports the history of a case of an albino girl having pink eyes and red hair, the rest of the family having pink eyes and white hair. Partial albinism, necessarily congenital, presenting a piebald appearance, must not be confounded with leukoderma, which is rarely seen in the young and which will be described later. Albinism is found in the lower animals, and is exemplified ordinarily by rats, mice, crows, robins, etc. In the Zoologic Garden at Baltimore two years ago was a pair of pure albino opossums. The white elephant is celebrated in the religious history of Oriental nations, and is an object of veneration and worship in Siam. White monkeys and white roosters are also worshiped. In the Natural History Museum in London there are stuffed examples of albinism and melanism in the lower animals. Melanism is an anomaly, the exact contrary of the preceding. It is characterized by the presence in the tissues and skin of an excessive amount of pigment. True total melanism is unknown in man, in whom is only observed partial melanism, characterized simply by a pronounced coloration of part of the integument. Some curious instances have been related of an infant with a two-colored face, and of others with one side of the face white and the other black; whether they were cases of partial albinism or partial melanism cannot be ascertained from the descriptions. Such epidermic anomalies as ichthyosis, scleroderma, and molluscum simplex, sometimes appearing shortly after birth, but generally seen later in life, will be spoken of in the chapter on Anomalous Skin Diseases. Human horns are anomalous outgrowths from the skin and are far more frequent than ordinarily supposed. Nearly all the older writers cite examples. Aldrovandus, Amatus Lusitanus, Boerhaave, Dupre, Schenck, Riverius, Vallisneri, and many others mention horns on the head. In the ancient times horns were symbolic of wisdom and power. Michael Angelo in his famous sculpture of Moses has given the patriarch a pair of horns. Rhodius observed a Benedictine monk who had a pair of horns and who was addicted to rumination. Fabricius saw a man with horns on his head, whose son ruminated; the son considered that by virtue of his ruminating characteristics his father had transmitted to him the peculiar anomaly of the family. Fabricius Hildanus saw a patient with horns all over the body and another with horns on the forehead. Gastaher speaks of a horn from the left temple; Zacutus Lusitanus saw a horn from the heel; Wroe, one of considerable length from the scapula; Cosnard, one from the bregma; the Ephemerides, from the foot; Borellus, from the face and foot, and Ash, horns all over the body. Home, Cooper, and Treves have collected examples of horns, and there is one 11 inches long and 2 1/2 in circumference in a London museum. Lozes collected reports of 71 cases of horns,--37 in females, 31 in males, and three in infants. Of this number, 15 were on the head, eight on the face, 18 on the lower extremities, eight on the trunk, and three on the glans penis. Wilson collected reports of 90 cases,--44 females, 39 males, the sex not being mentioned in the remainder. Of these 48 were on the head, four on the face, four on the nose, 11 on the thigh, three on the leg and foot, six on the back, five on the glans penis, and nine on the trunk. Lebert's collection numbered 109 cases of cutaneous horns. The greater frequency among females is admitted by all authors. Old age is a predisposing cause. Several patients over seventy have been seen and one of ninety-seven. Instances of cutaneous horns, when seen and reported by the laity, give rise to most amusing exaggerations and descriptions. The following account is given in New South Wales, obviously embellished with apocryphal details by some facetious journalist: The child, five weeks old, was born with hair two inches long all over the body; his features were fiendish and his eyes shone like beads beneath his shaggy brows. He had a tail 18 inches long, horns from the skull, a full set of teeth, and claw-like hands; he snapped like a dog and crawled on all fours, and refused the natural sustenance of a normal child. The mother almost became an imbecile after the birth of the monster. The country people about Bomballa considered this devil-child a punishment for a rebuff that the mother gave to a Jewish peddler selling Crucifixion-pictures. Vexed by his persistence, she said she would sooner have a devil in her house than his picture. Lamprey has made a minute examination of the much-spoken-of "Horned Men of Africa." He found that this anomaly was caused by a congenital malformation and remarkable development of the infraorbital ridge of the maxillary bone. He described several cases, and through an interpreter found that they were congenital, followed no history of traumatism, caused little inconvenience, and were unassociated with disturbance of the sense of smell. He also learned that the deformity was quite rare in the Cape Coast region, and received no information tending to prove the conjecture that the tribes in West Africa used artificial means to produce the anomaly, although such custom is prevalent among many aborigines. Probably the most remarkable case of a horn was that of Paul Rodrigues, a Mexican porter, who, from the upper and lateral part of his head, had a horn 14 inches in circumference and divided into three shafts, which he concealed by constantly wearing a peculiarly shaped red cap. There is in Paris a wax model of a horn, eight or nine inches in length, removed from an old woman by the celebrated Souberbielle. Figure 75 is from a wax model supposed to have been taken from life, showing an enormous grayish-black horn proceeding from the forehead. Warren mentions a case under the care of Dubois, in a woman from whose forehead grew a horn six inches in diameter and six inches in height. It was hard at the summit and had a fetid odor. In 1696 there was an old woman in France who constantly shed long horns from her forehead, one of which was presented to the King. Bartholinus mentions a horn 12 inches long. Voigte cites the case of an old woman who had a horn branching into three portions, coming from her forehead. Sands speaks of a woman who had a horn 6 3/4 inches long, growing from her head. There is an account of the extirpation of a horn nearly ten inches in length from the forehead of a woman of eighty-two. Bejau describes a woman of forty from whom he excised an excrescence resembling a ram's horn, growing from the left parietal region. It curved forward and nearly reached the corresponding tuberosity. It was eight cm. long, two cm. broad at the base, and 1 1/2 cm. at the apex, and was quite mobile. It began to grow at the age of eleven and had constantly increased. Vidal presented before the Academie de Medecine in 1886 a twisted horn from the head of a woman. This excrescence was ten inches long, and at the time of presentation reproduction of it was taking place in the woman. Figure 76 shows a case of ichthyosis cornea pictured in the Lancet, 1850. There was a woman of seventy-five, living near York, who had a horny growth from the face which she broke off and which began to reproduce, the illustration representing the growth during twelve months. Lall mentions a horn from the cheek; Gregory reports one that measured 7 1/2 inches long that was removed from the temple of a woman in Edinburgh; Chariere of Barnstaple saw a horn that measured seven inches growing from the nape of a woman's neck; Kameya Iwa speaks of a dermal horn of the auricle; Saxton of New York has excised several horns from the tympanic membrane of the ear; Noyes speaks of one from the eyelid; Bigelow mentions one from the chin; Minot speaks of a horn from the lower lip, and Doran of one from the neck. Gould cites the instance of a horn growing from an epitheliomatous penis. The patient was fifty-two years of age and the victim of congenital phimosis. He was circumcised four years previously, and shortly after the wound healed there appeared a small wart, followed by a horn about the size of a marble. Jewett speaks of a penile horn 3 1/2 inches long and 3 3/4 inches in diameter; Pick mentions one 2 1/2 inches long. There is an account of a Russian peasant boy who had a horn on his penis from his earliest childhood. Johnson mentions a case of a horn from the scrotum, which was of sebaceous origin and was subsequently supplanted by an epithelioma. Ash reported the case of a girl named Annie Jackson, living in Waterford, Ireland, who had horny excrescences from her joints, arms, axillae, nipples, ears, and forehead. Locke speaks of a boy at the Hopital de la Charite in Paris, who had horny excrescences four inches long and 11 inches in circumference growing from his fingers and toes. Wagstaffe presents a horn which grew from the middle of the leg six inches below the knee in a woman of eighty. It was a flattened spiral of more than two turns, and during forty years' growth had reached the length of 14.3 inches. Its height was 3.8 inches, its skin-attachment 1.5 inches in diameter, and it ended in a blunt extremity of 0.5 inch in diameter. Stephens mentions a dermal horn on the buttocks at the seat of a carcinomatous cicatrix. Harris and Domonceau speak of horns from the leg. Cruveilhier saw a Mexican Indian who had a horn four inches long and eight inches in circumference growing from the left lumbar region. It had been sawed off twice by the patient's son and was finally extirpated by Faget. The length of the pieces was 12 inches. Bellamy saw a horn on the clitoris about the size of a tiger's claw in a its origin from beneath the preputium clitoridis. Horns are generally solitary but cases of multiple formation are known Lewin and Heller record a syphilitic case with eight cutaneous horns on the palms and soles. A female patient of Manzuroff had as many as 185 horns. Pancoast reports the case of a man whose nose, cheeks, forehead, and lips were covered with horny growths, which had apparently undergone epitheliomatous degeneration. The patient was a sea-captain of seventy-eight, and had been exposed to the winds all his life. He had suffered three attacks of erysipelas from prolonged exposure. When he consulted Pancoast the horns had nearly all fallen off and were brought to the physician for inspection; and the photograph was taken after the patient had tied the horns in situ on his face. Anomalies of the Hair.--Congenital alopecia is quite rare, and it is seldom that we see instances of individuals who have been totally destitute of hair from birth. Danz knew of two adult sons of a Jewish family who never had hair or teeth. Sedgwick quotes the case of a man of fifty-eight who ever since birth was totally devoid of hair and in whom sensible perspiration and tears were absent. A cousin on his mother's side, born a year before him, had precisely the same peculiarity. Buffon says that the Turks and some other people practised depilatory customs by the aid of ointments and pomades, principally about the genitals. Atkinson exhibited in Philadelphia a man of forty who never had any distinct growth of hair since birth, was edentulous, and destitute of the sense of smell and almost of that of taste. He had no apparent perspiration, and when working actively he was obliged to wet his clothes in order to moderate the heat of his body. He could sleep in wet clothes in a damp cellar without catching cold. There was some hair in the axillae and on the pubes, but only the slightest down on the scalp, and even that was absent on the skin. His maternal grandmother and uncle were similarly affected; he was the youngest of 21 children, had never been sick, and though not able to chew food in the ordinary manner, he had never suffered from dyspepsia in any form. He was married and had eight children. Of these, two girls lacked a number of teeth, but had the ordinary quantity of hair. Hill speaks of an aboriginal man in Queensland who was entirely devoid of hair on the head, face, and every part of the body. He had a sister, since dead, who was similarly hairless. Hill mentions the accounts given of another black tribe, about 500 miles west of Brisbane, that contained hairless members. This is very strange, as the Australian aboriginals are a very hairy race of people. Hutchinson mentions a boy of three and a half in whom there was congenital absence of hair and an atrophic condition of the skin and appendages. His mother was bald from the age of six, after alopecia areata. Schede reports two cases of congenitally bald children of a peasant woman (a boy of thirteen and a girl of six months). They had both been born quite bald, and had remained so. In addition there were neither eyebrows nor eyelashes and nowhere a trace of lanugo. The children were otherwise healthy and well formed. The parents and brothers were healthy and possessed a full growth of hair. Thurman reports a case of a man of fifty-eight, who was almost devoid of hair all his life and possessed only four teeth. His skin was very delicate and there was absence of sensible perspiration and tears. The skin was peculiar in thinness, softness, and absence of pigmentation. The hair on the crown of the head and back was very fine, short, and soft, and not more in quantity than that of an infant of three months. There was a similar peculiarity in his cousin-german. Williams mentions the case of a young lady of fifteen with scarcely any hair on the eyebrows or head and no eyelashes. She was edentulous and had never sensibly perspired. She improved under tonic treatment. Rayer quotes the case of Beauvais, who was a patient in the Hopital de la Charite in 1827. The skin of this man's cranium was apparently completely naked, although in examining it narrowly it was found to be beset with a quantity of very white and silky hair, similar to the down that covers the scalp of infants; here and there on the temples there were a few black specks, occasioned by the stumps of several hairs which the patient had shaved off. The eyebrows were merely indicated by a few fine and very short hairs; the free edges of the eyelids were without cilia, but the bulb of each of these was indicated by a small, whitish point. The beard was so thin and weak that Beauvais clipped it off only every three weeks. A few straggling hairs were observed on the breast and pubic region, as in young people on the approach of puberty. There was scarcely any under the axillae. It was rather more abundant on the inner parts of the legs. The voice was like that of a full-grown and well-constituted man. Beauvais was of an amorous disposition and had had syphilis twice. His mother and both sisters had good heads of hair, but his father presented the same defects as Beauvais. Instances are on record of women devoid of hair about the genital region. Riolan says that he examined the body of a female libertine who was totally hairless from the umbilical region down. Congenital alopecia is seen in animals. There is a species of dog, a native of China but now bred in Mexico and in the United States, which is distinguished for its congenital alopecia. The same fact has been observed occasionally in horses, cattle, and dogs. Heusner has seen a pigeon destitute of feathers, and which engendered a female which in her turn transmitted the same characteristic to two of her young. Sexualism and Hair Growth.--The growth or development of the hair may be accelerated by the state of the organs of generation. This is peculiarly noticeable in the pubic hairs and the beard, and is fully exemplified in the section on precocious development (Chapter VII); however, Moreau de la Sarthe showed a child to the Medical Faculty of Paris in whom precocious development of the testicles had influenced that of the hair to such a degree that, at the age of six, the chest of this boy was as thickly set with hair as is usually seen in adults. It is well known that eunuchs often lose a great part of their beards, and after removal of the ovaries women are seen to develop an extra quantity of hair. Gerberon tells of an infant with a beard, and Paullini and the Ephemerides mention similar instances. Bearded women are not at all infrequent. Hippocrates mentions a female who grew a beard shortly after menstruation had ceased. It is a well-recognized fact that after the menopause women become more hirsute, the same being the case after removal of any of the functional generative apparatus. Vicat saw a virgin who had a beard, and Joch speaks of "foeminis barbati." Leblond says that certain women of Ethiopia and South America have beards and little or no menstruation. He also says that sterility and excessive chastity are causes of female beards, and cites the case of Schott of a young widow who secluded herself in a cloister, and soon had a beard. Barbara Urster, who lived in the 16th century, had a beard to her girdle. The most celebrated "bearded woman" was Rosine-Marguerite Muller, who died in a hospital in Dresden in 1732, with a thick beard and heavy mustache. Julia Pastrana had her face covered with thick hair and had a full beard and mustache. She exhibited defective dentition in both jaws, and the teeth present were arranged in an irregular fashion. She had pronounced prognathism, which gave her a simian appearance. Ecker examined in 1876 a woman who died at Fribourg, whose face contained a full beard and a luxuriant mustache. Harris reports several cases of bearded women, inmates of the Coton Hill Lunatic Asylum. One of the patients was eighty-three years of age and had been insane forty-four years following a puerperal period. She would not permit the hair on her face to be cut, and the curly white hairs had attained a length of from eight to ten inches on the chin, while on the upper lip the hairs were scarcely an inch. This patient was quite womanly in all her sentiments. The second case was a woman of thirty-six, insane from emotional melancholia. She had tufts of thick, curly hair on the chin two inches long, light yellowish in color, and a few straggling hairs on the upper lip. The third case was that of a woman of sixty-four, who exhibited a strong passion for the male sex. Her menstruation had been regular until the menopause. She plaited her beard, and it was seven or eight inches long on the chin and one inch on the lip. This woman had extremely hairy legs. Another case was that of a woman of sixty-two, who, though bald, developed a beard before the climacteric. Her structural proportions were feminine in character, and it is said that her mother, who was sane, had a beard also. A curious case was that of a woman of twenty-three (Mrs. Viola M.), who from the age of three had a considerable quantity of hair on the side of the cheek which eventually became a full beard. She was quite feminine was free from excessive hair elsewhere, her nose and forehead being singularly bare. Her voice was very sweet; she was married at seventeen and a half, having two normal children, and nursed each for one month. "The bearded woman" of every circus side-show is an evidence of the curious interest in which these women are held. The accompanying illustration is a representation of a "bearded woman" born in Bracken County, Ky. Her beard measured 15 inches in length. There is a class of anomalies in which there is an exaggerated development of hair. We would naturally expect to find the primitive peoples, who are not provided with artificial protection against the wind, supplied with an extra quantity of hair or having a hairy coat like animals; but this is sometimes found among civilized people. This abnormal presence of hair on the human body has been known for many years; the description of Esau in the Bible is an early instance. Aldrovandus says that in the sixteenth century there came to the Canary Islands a family consisting of a father, son, and two daughters, who were covered all over their bodies by long hair, and their portrait, certainly reproduced from life, resembles the modern instances of "dog men." In 1883 there was shown in England and France, afterward in America, a girl of seven named "Krao," a native of Indo-China. The whole body of this child was covered with black hair. Her face was of the prognathic type, and this, with her extraordinary prehensile powers of feet and lips, gave her the title of "Darwin's missing link." In 1875 there was exhibited in Paris, under the name of "l'homme-chien" Adrien Jeftichew, a Russian peasant of fifty-five, whose face, head, back, and limbs were covered with a brown hairy coat looking like wool and several centimeters long. The other parts of the body were also covered with hair, but less abundantly. This individual had a son of three, Theodore, who was hairy like himself. A family living in Burmah (Shive-Maon, whose history is told by Crawford and Yule), consisting of a father, a daughter, and a granddaughter, were nearly covered with hair. Figure 84 represents a somewhat similar family who were exhibited in this country. Teresa Gambardella, a young girl of twelve, mentioned by Lombroso, was covered all over the body, with the exception of the hands and feet, by thick, bushy hair. This hypertrichosis was exemplified in this country only a few months since by a person who went the rounds of the dime museums under the euphonious name of "Jo-Jo, the dog-face boy." His face was truly that of a skye-terrier. Sometimes the hairy anomalies are but instances of naevus pilosus. The Indian ourang-outang woman examined at the office of the Lancet was an example of this kind. Hebra, Hildebrandt, Jablokoff, and Klein describe similar cases. Many of the older "wild men" were individuals bearing extensive hairy moles. Rayer remarks that he has seen a young man of sixteen who exhibited himself to the public under the name of a new species of wild man whose breast and back were covered with light brown hair of considerable length. The surface upon which it grew was of a brownish hue, different from the color of the surrounding integument. Almost the whole of the right arm was covered in the same manner. On the lower extremity several tufts of hair were observed implanted upon brown spots from seven to eight lines in diameter symmetrically disposed upon both legs. The hair was brown, of the same color as that of the head. Bichat informs us that he saw at Paris an unfortunate man who from his birth was afflicted with a hairy covering of his face like that of a wild boar, and he adds that the stories which were current among the vulgar of individuals with a boar's head, wolf's head, etc., undoubtedly referred to cases in which the face was covered to a greater or less degree with hair. Villerme saw a child of six at Poitiers in 1808 whose body, except the feet and hands, was covered with a great number of prominent brown spots of different dimensions, beset with hair shorter and not so strong as that of a boar, but bearing a certain resemblance to the bristles of that animal. These spots occupied about one-fifth of the surface of this child's skin. Campaignac in the early part of this century exhibited a case in which there was a large tuft of long black hair growing from the shoulder. Dufour has detailed a case of a young man of twenty whose sacral region contained a tuft of hair as long and black, thick and pliant, as that of the head, and, particularly remarkable in this case, the skin from which it grew was as fine and white as the integument of the rest of the body. There was a woman exhibited recently, under the advertisement of "the lady with a mane," who had growing from the center of her back between the shoulders a veritable mane of long, black hair, which doubtless proceeded from a form of naevus. Duyse reports a case of extensive hypertrichosis of the back in a girl aged nine years; her teeth were normal; there was pigmentation of the back and numerous pigmentary nevi on the face. Below each scapula there were tumors of the nature of fibroma molluscum. In addition to hairy nevi on the other parts of the body there was localized ichthyosis. Ziemssen figures an interesting case of naevus pilosus resembling "bathing tights". There were also present several benign tumors (fibroma molluscum) and numerous smaller nevi over the body. Schulz first observed the patient in 1878. This individual's name was Blake, and he stated that he was born with a large naevus spreading over the upper parts of the thighs and lower parts of the trunk, like bathing-tights, and resembling the pelt of an animal. The same was true of the small hairy parts and the larger and smaller tumors. Subsequently the altered portions of the skin had gradually become somewhat larger. The skin of the large hairy naevus, as well as that of the smaller ones, was stated by Schulz to have been in the main thickened, in part uneven, verrucose, from very light to intensely dark brown in color; the consistency of the larger mammiform and smaller tumors soft, doughy, and elastic. The case was really one of large congenital naevus pilosus and fibroma molluscum combined. A Peruvian boy was shown at the Westminster Aquarium with a dark, hairy mole situated in the lower part of the trunk and on the thighs in the position of bathing tights. Nevins Hyde records two similar cases with dermatolytic growths. A sister of the Peruvian boy referred to had a still larger growth, extending from the nucha all over the back. Both she and her brother had hundreds of smaller hairy growths of all sizes scattered irregularly over the face, trunk, and limbs. According to Crocker, a still more extraordinary case, with extensive dermatolytic growths all over the back and nevi of all sizes elsewhere, is described and engraved in "Lavater's Physiognomy," 1848. Baker describes an operation in which a large mole occupying half the forehead was removed by the knife. In some instances the hair and beard is of an enormous length. Erasmus Wilson of London saw a female of thirty-eight, whose hair measured 1.65 meters long. Leonard of Philadelphia speaks of a man in the interior of this country whose beard trailed on the ground when he stood upright, and measured 2.24 meters long. Not long ago there appeared the famous so-called "Seven Sutherland Sisters," whose hair touched the ground, and with whom nearly every one is familiar through a hair tonic which they extensively advertised. In Nature, January 9, 1892, is an account of a Percheron horse whose mane measured 13 feet and whose tail measured almost ten feet, probably the greatest example of excessive mane development on record. Figure 88 represents Miss Owens, an exhibitionist, whose hair measured eight feet three inches. In Leslie's Weekly, January 2, 1896, there is a portrait of an old negress named Nancy Garrison whose woolly hair was equally as long. The Ephemerides contains the account of a woman who had hair from the mons veneris which hung to the knees; it was affected with plica polonica, as was also the other hair of the body. Rayer saw a Piedmontese of twenty-eight, with an athletic build, who had but little beard or hair on the trunk, but whose scalp was covered with a most extraordinary crop. It was extremely fine and silky, was artificially frizzled, dark brown in color, and formed a mass nearly five feet in circumference. Certain pathologic conditions may give rise to accidental growths of hair. Boyer was accustomed to quote in his lectures the case of a man who, having an inflamed tumor in the thigh, perceived this part becoming covered in a short time with numerous long hairs. Rayer speaks of several instances of this kind. In one the part affected by a blister in a child of two became covered with hair. Another instance was that of a student of medicine, who after bathing in the sea for a length of time, and exposing himself to the hot sun, became affected with coppery patches, from which there sprang a growth of hair. Bricheteau, quoted by the same authority, speaks of a woman of twenty-four, having white skin and hair of deep black, who after a long illness occasioned by an affection analogous to marasmus became covered, especially on the back, breast, and abdomen, with a multitude of small elevations similar to those which appear on exposure to cold. These little elevations became brownish at the end of a few days, and short, fair, silky hair was observed on the summit of each, which grew so rapidly that the whole surface of the body with the exception of the hands and face became velvety. The hair thus evolved was afterward thrown out spontaneously and was not afterward reproduced. Anomalies of the Color of the Hair.--New-born infants sometimes have tufts of hair on their heads which are perfectly white in color. Schenck speaks of a young man whose beard from its first appearance grew white. Young men from eighteen to twenty occasionally become gray; and according to Rayer, paroxysms of rage, unexpected and unwelcome news, diseases of the scalp such as favus, wounds of the head, habitual headache, over-indulgence of the sexual appetite, mercurial courses too frequently repeated, too great anxiety, etc., have been known to blanch the hair prematurely. The well-accepted fact of the sudden changing of the color of the hair from violent emotions or other causes has always excited great interest, and many ingenious explanations have been devised to account for it. There is a record in the time of Charles V of a young man who was committed to prison in 1546 for seducing his girl companion, and while there was in great fear and grief, expecting a death-sentence from the Emperor the next day. When brought before his judge, his face was wan and pale and his hair and beard gray, the change having taken place in the night. His beard was filthy with drivel, and the Emperor, moved by his pitiful condition, pardoned him. There was a clergyman of Nottingham whose daughter at the age of thirteen experienced a change from jet-blackness of the hair to white in a single night, but this was confined to a spot on the back of the head 1 1/2 inches in length. Her hair soon became striped, and in seven years was totally white. The same article speaks of a girl in Bedfordshire, Maria Seeley, aged eight, whose face was swarthy, and whose hair was long and dark on one side and light and short on the other. One side of her body was also brown, while the other side was light and fair. She was seen by the faculty in London, but no cause could be established. Voigtel mentions the occurrence of canities almost suddenly. Bichat had a personal acquaintance whose hair became almost entirely gray in consequence of some distressing news that reached him. Cassan records a similar case. According to Rayer, a woman by the name of Perat, summoned before the Chamber of Peers to give evidence in the trial of the assassin Louvel, was so much affected that her hair became entirely white in a single night Byron makes mention of this peculiar anomaly in the opening stanzas of the "Prisoner of Chillon:"-- "My hair is gray, but not with years, Nor grew it white In a single night. As men's have grown from sudden fears." The commentators say that Byron had reference to Ludovico Sforza and others. The fact of the change is asserted of Marie Antoinette, the wife of Louis XVI, though in not quite so short a period, grief and not fear being the cause. Ziemssen cites Landois' case of a compositor of thirty-four who was admitted to a hospital July 9th with symptoms of delirium tremens; until improvement began to set in (July 13th) he was continually tormented by terrifying pictures of the imagination. In the night preceding the day last mentioned the hair of the head and beard of the patient, formerly blond, became gray. Accurate examination by Landois showed the pigment contents of the hair to be unchanged, and led him to believe that the white color was solely due to the excessive development of air-bubbles in the hair shaft. Popular belief brings the premature and especially the sudden whitening into connection with depressing mental emotions. We might quote the German expression--"Sich graue Haare etwas wachsen lassen" ("To worry one's self gray"). Brown-Sequard observed on several occasions in his own dark beard hairs which had turned white in a night and which he epileptoid. He closes his brief communication on the subject with the belief that it is quite possible for black hair to turn white in one night or even in a less time, although Hebra and Kaposi discredit sudden canities (Duhring). Raymond and Vulpian observed a lady of neurotic type whose hair during a severe paroxysm of neuralgia following a mental strain changed color in five hours over the entire scalp except on the back and sides; most of the hair changed from black to red, but some to quite white, and in two days all the red hair became white and a quantity fell off. The patient recovered her general health, but with almost total loss of hair, only a few red, white, and black hairs remaining on the occipital and temporal regions. Crocker cites the case of a Spanish cock which was nearly killed by some pigs. The morning after the adventure the feathers of the head had become completely white, and about half of those on the back of the neck were also changed. Dewees reports a case of puerperal convulsions in a patient under his care which was attended with sudden canities. From 10 A.M. to 4 P.M. 50 ounces of blood were taken. Between the time of Dr. Dewees' visits, not more than an hour, the hair anterior to the coronal suture turned white. The next day it was less light, and in four or five days was nearly its natural color. He also mentions two cases of sudden blanching from fright. Fowler mentions the case of a healthy girl of sixteen who found one morning while combing her hair, which was black, that a strip the whole length of the back hair was white, starting from a surface about two inches square around the occipital protuberance. Two weeks later she had patches of ephelis over the whole body. Prentiss, in Science, October 3, 1890, has collected numerous instances of sudden canities, several of which will be given:-- "In the Canada Journal of Medical Science, 1882, p. 113, is reported a case of sudden canities due to business-worry. The microscope showed a great many air-vesicles both in the medullary substance and between the medullary and cortical substance. "In the Boston Medical and Surgical Journal, 1851, is reported a case of a man thirty years old, whose hair 'was scared' white in a day by a grizzly bear. He was sick in a mining camp, was left alone, and fell asleep. On waking he found a grizzly bear standing over him. "A second case is that of a man of twenty-three years who was gambling in California. He placed his entire savings of $1100 on the turn of a card. He was under tremendous nervous excitement while the cards were being dealt. The next day his hair was perfectly white. "In the same article is the statement that the jet-black hair of the Pacific Islanders does not turn gray gradually, but when it does turn it is sudden, usually the result of fright or sudden emotions." D'Alben, quoted by Fournier, describes a young man of twenty-four, an officer in the regiment of Touraine in 1781, who spent the night in carnal dissipation with a mulatto, after which he had violent spasms, rendering flexion of the body impossible. His beard and hair on the right side of the body was found as white as snow, the left side being unchanged. He appeared before the Faculte de Montpelier, and though cured of his nervous symptoms his hair was still white, and no suggestion of relief was offered him. Louis of Bavaria, who died in 1294, on learning of the innocence of his wife, whom he had put to death on a suspicion of her infidelity, had a change of color in his hair, which became white almost immediately. Vauvilliers, the celebrated Hellenist, became white-haired almost immediately after a terrible dream, and Brizard, the comedian, experienced the same change after a narrow escape from drowning in the Rhone. The beard and the hair of the Duke of Brunswick whitened in twenty-four hours after hearing that his father had been mortally wounded at the battle of Auerstadt. De Schweinitz speaks of a well-formed and healthy brunette of eighteen in whom the middle portion of the cilia of the right upper eyelid and a number of the hairs of the lower lid turned white in a week. Both eyes were myopic, but no other cause could be assigned. Another similar case is cited by Hirshberg, and the authors have seen similar cases. Thornton of Margate records the case of a lady in whom the hair of the left eyebrow and eyelashes began to turn white after a fortnight of sudden grief, and within a week all the hair of these regions was quite white and remained so. No other part was affected nor was there any other symptom. After a traumatic ophthalmitis of the left and sympathetic inflammation of the right eye in a boy of nine, Schenck observed that a group of cilia of the right upper lid and nearly all the lashes of the upper lid of the left eye, which had been enucleated, turned silvery-white in a short time. Ludwig has known the eyelashes to become white after small-pox. Communications are also on record of local decolorization of the eyebrows and lashes in neuralgias of isolated branches of the trigeminus, especially of the supraorbital nerve. Temporary and Partial Canities.--Of special interest are those cases in which whiteness of the hair is only temporary. Thus, Compagne mentions a case in which the black hair of a woman of thirty-six began to fade on the twenty-third day of a malignant fever, and on the sixth day following was perfectly white, but on the seventh day the hairs became darker again, and on the fourteenth day after the change they had become as black as they were originally. Wilson records a case in which the hair lost its color in winter and regained it in summer. Sir John Forbes, according to Crocker, had gray hair for a long time, then suddenly it all turned white, and after remaining so for a year it returned to its original gray. Grayness of the hair is sometimes only partial. According to Crocker an adult whose hair was generally brown had a tuft of white hair over the temple, and several like cases are on record. Lorry tells us that grayness of one side only is sometimes occasioned by severe headache. Hagedorn has known the beard to be black in one place and white in another. Brandis mentions the hair becoming white on one side of the face while it continued of its former color on the other. Rayer quotes cases of canities of the whole of one side of the body. Richelot observed white mottling of hair in a girl sick with chlorosis. The whitening extended from the roots to a distance of two inches. The probable cause was a temporary alteration of the pigment-forming function. When the chlorosis was cured the natural color returned. Paullini and Riedlin, as well as the Ephemerides, speak of different colored hair in the same head, and it is not at all rare to see individuals with an anomalously colored patch of hair on the head. The members of the ancient house of Rohan were said to possess a tuft of white hair on the front of their heads. Michelson of Konigsberg describes a curious case in a barrister of twenty-three affected with partial canities. In the family of both parents there was stated to be congenital premature canities, and some white hairs had been observed even in childhood. In the fifteenth year, after a grave attack of scarlet fever, the hair to a great extent fell out. The succeeding growth of hair was stated to have been throughout lighter in tissue and color and fissured at the points. Soon after bunches of white hair appeared on the occiput, and in the succeeding years small patches of decolored hairs were observed also on the anterior and lateral portions of the scalp. In the spring of 1880 the patient exhibited signs of infiltration of the apex of the right lung, and afterward a violent headache came on. At the time of the report the patient presented the appearance shown in Figure 89. The complexion was delicate throughout, the eyelashes and eyelids dark brown, the moustache and whiskers blond, and in the latter were a few groups of white hair. The white patches were chiefly on the left side of the head. The hairs growing on them were unpigmented, but otherwise normal. The patient stated that his head never sweated. He was stout and exhibited no signs of internal disease, except at the apex of the right lung. Anomalous Color Changes of the Hair.--The hair is liable to undergo certain changes of color connected with some modification of that part of the bulb secreting its coloring-matter. Alibert, quoted by Rayer, gives us a report of the case of a young lady who, after a severe fever which followed a very difficult labor, lost a fine head of hair during a discharge of viscid fluid, which inundated the head in every part. He tells us, further, that the hair grew again of a deep black color after the recovery of the patient. The same writer tells of the case of James B--, born with brown hair, who, having lost it all during the course of a sickness, had it replaced with a crop of the brightest red. White and gray hair has also, under peculiar circumstances, been replaced by hair of the same color as the individual had in youth. We are even assured by Bruley that in 1798 the white hair of a woman sixty years of age changed to black a few days before her death. The bulbs in this case were found of great size, and appeared gorged with a substance from which the hair derived its color. The white hairs that remained, on the contrary, grew from shriveled bulbs much smaller than those producing the black. This patient died of phthisis. A very singular case, published early in the century, was that of a woman whose hair, naturally fair, assumed a tawny red color as often as she was affected with a certain fever, and returned to its natural hue as soon as the symptoms abated. Villerme alludes to the case of a young lady, sixteen years of age, who had never suffered except from trifling headaches, and who, in the winter of 1817, perceived that the hair began to fall out from several parts of her head, so that before six months were over she became entirely bald. In the beginning of January, 1819, her head became covered with a kind of black wool over those places that were first denuded, and light brown hair began to develop from the rest of the scalp. Some of this fell out again when it had grown from three to four inches; the rest changed color at different distances from its end and grew of a chestnut color from the roots. The hair, half black, half chestnut, had a very singular appearance. Alibert and Beigel relate cases of women with blond hair which all came off after a severe fever (typhus in one case), and when it grew again it was quite black. Alibert also saw a young man who lost his brown hair after an illness, and after restoration it became red. According to Crocker, in an idiotic girl of epileptic type (in an asylum at Edinburgh), with alternating phases of stupidity and excitement, the hair in the stupid phase was blond and in the excited condition red. The change of color took place in the course of two or three days, beginning first at the free ends, and remaining of the same tint for seven or eight days. The pale hairs had more air-spaces than the darker ones. There was much structural change in the brain and spinal cord. Smyly of Dublin reported a case of suppurative disease of the temporal bone, in which the hair changed from a mouse-color to a reddish-brown; and Squire records a congenital case in a deaf mute, in whom the hair on the left side was in light patches of true auburn and dark patches of dark brown like a tortoise-shell cap; on the other side the hair was a dark brown. Crocker mentions the changes which have occurred in rare instances after death from dark brown to red. Chemic colorations of various tints occur. Blue hair is seen in workers in cobalt mines and indigo works; green hair in copper smelters; deep red-brown hair in handlers of crude anilin; and the hair is dyed a purplish-brown whenever chrysarobin applications used on a scalp come in contact with an alkali, as when washed with soap. Among such cases in older literature Blanchard and Marcellus Donatus speak of green hair; Rosse saw two instances of the same, for one of which he could find no cause; the other patient worked in a brass foundry. Many curious causes are given for alopecia. Gilibert and Merlet mention sexual excess; Marcellus Donatus gives fear; the Ephemerides speaks of baldness from fright; and Leo Africanus, in his description of Barbary, describes endemic baldness. Neyronis makes the following observation: A man of seventy-three, convalescent from a fever, one morning, about six months after recovery perceived that he had lost all his hair, even his eyelashes, eyebrows, nostril-hairs, etc. Although his health continued good, the hair was never renewed. The principal anomalies of the nails observed are absence, hypertrophy, and displacement of these organs. Some persons are born with finger-nails and toe-nails either very rudimentary or entirely absent; in others they are of great length and thickness. The Chinese nobility allow their finger-nails to grow to a great length and spend much time in the care of these nails. Some savage tribes have long and thick nails resembling the claws of beasts, and use them in the same way as the lower animals. There is a description of a person with finger-nails that resembled the horns of a goat. Neuhof, in his books on Tartary and China, says that many Chinamen have two nails on the little toe, and other instances of double nails have been reported. The nails may be reversed or arise from anomalous positions. Bartholinus speaks of nails from the inner side of the digits; in another case, in which the fingers were wanting, he found the nails implanted on the stumps. Tulpius says he knew of a case in which nails came from the articulations of three digits; and many other curious arrangements of nails are to be found. Rouhuot sent a description and drawing of some monstrous nails to the Academie des Sciences de Paris. The largest of these was the left great toe-nail, which, from its extremity to its root, measured 4 3/4 inches; the laminae of which it consisted were placed one over the other, like the tiles on a roof, only reversed. This nail and several of the others were of unequal thickness and were variously curved, probably on account of the pressure of the shoe or the neighboring digits. Rayer mentions two nails sent to him by Bricheteau, physician of the Hopital Necker, belonging to an old woman who had lived in the Salpetriere. They were very thick and spirally twisted, like the horns of a ram. Saviard informs us that he saw a patient at the Hotel Dieu who had a horn like that of a ram, instead of a nail, on each great toe, the extremities of which were turned to the metatarsus and overlapped the whole of the other toes of each foot. The skeleton of Simore, preserved in Paris, is remarkable for the ankylosis of all the articulations and the considerable size of all the nails. The fingers and toes, spread out and ankylosed, ended in nails of great length and nearly of equal thickness. A woman by the name of Melin, living in the last century in Paris, was surnamed "the woman with nails;" according to the description given by Saillant in 1776 she presented another and not less curious instance of the excessive growth of the nails. Musaeus gives an account of the nails of a girl of twenty, which grew to such a size that some of those of the fingers were five inches in length. They were composed of several layers, whitish interiorly, reddish-gray on the exterior, and full of black points. These nails fell off at the end of four months and were succeeded by others. There were also horny laminae on the knees and shoulders and elbows which bore a resemblance to nails, or rather talons. They were sensitive only at the point of insertion into the skin. Various other parts of the body, particularly the backs of the hands, presented these horny productions. One of them was four inches in length. This horny growth appeared after small-pox. Ash, in the Philosophical Transactions, records a somewhat similar case in a girl of twelve. Anomalies of the Teeth.--Pliny, Colombus, van Swieten, Haller, Marcellus Donatus, Baudelocque, Soemmering, and Gardien all cite instances in which children have come into the world with several teeth already erupted. Haller has collected 19 cases of children born with teeth. Polydorus Virgilus describes an infant who was born with six teeth. Some celebrated men are supposed to have been born with teeth; Louis XIV was accredited with having two teeth at birth. Bigot, a physician and philosopher of the sixteenth century; Boyd, the poet; Valerian, Richard III, as well as some of the ancient Greeks and Romans, were reputed to have had this anomaly. The significance of the natal eruption of teeth is not always that of vigor, as many of the subjects succumb early in life. There were two cases typical of fetal dentition shown before the Academie de Medecine de Paris. One of the subjects had two middle incisors in the lower jaw and the other had one tooth well through. Levison saw a female born with two central incisors in the lower jaw. Thomas mentions a case of antenatal development of nine teeth. Puech, Mattei, Dumas, Belluzi, and others report the eruption of teeth in the newborn. In Dumas' case the teeth had to be extracted on account of ulceration of the tongue. Instances of triple dentition late in life are quite numerous, many occurring after a hundred years. Mentzelius speaks of a man of one hundred and ten who had nine new teeth. Lord Bacon cites the case of a Countess Desmond, who when over a century old had two new teeth; Hufeland saw an instance of dentition at one hundred and sixteen; Nitzsch speaks of one at one hundred, and the Ephemerides contain an account of a triple dentition at one hundred and twenty. There is an account of a country laborer who lost all his teeth by the time he arrived at his sixtieth year of age, but about a half year afterward a new set made their appearance. Bisset mentions an account of an old woman who acquired twelve molar teeth at the age of ninety-eight. Carre notes a case of dental eruption in an individual of eighty-five. Mazzoti speaks of a third dentition, and Ysabeau writes of dentition of a molar at the age of ninety-two. There is a record of a physician of the name of Slave who retained all his second teeth until the age of eighty, when they fell out; after five years another set appeared, which he retained until his death at one hundred. In the same report there is mentioned an old Scotchman who died at one hundred and ten, whose teeth were renewed at an advanced age after he had lost his second teeth. One of the older journals speaks of dentition at seventy, eighty-four, ninety, and one hundred and fourteen. The Philosophical Transactions of London contain accounts of dentition at seventy-five and eighty-one. Bassett tells of an old woman who had twelve molar teeth at the age of eighty-eight. In France there is recorded dentition at eighty-five and an account of an old man of seventy-three who had six new teeth. Von Helmont relates an instance of triple dentition at the same age. There is recorded in Germany an account of a woman of ninety who had dentition at forty-seven and sixty-seven, each time a new set of teeth appearing; Hunter and Petrequin have observed similar cases. Carter describes an example of third dentition. Lison makes a curious observation of a sixth dentition. Edentulousness.--We have already noticed the association of congenital alopecia with edentulousness, but, strange to say, Magitot has remarked that "l'homme-chien," was the subject of defective dentition. Borellus found atrophy of all the dental follicles in a woman of sixty who never had possessed any teeth. Fanton-Touvet saw a boy of nine who had never had teeth, and Fox a woman who had but four in both jaws; Tomes cites several similar instances. Hutchinson speaks of a child who was perfectly edentulous as to temporary teeth, but who had the permanent teeth duly and fully erupted. Guilford describes a man of forty-eight, who was edentulous from birth, who also totally lacked the sense of smell, and was almost without the sense of taste; the surface of his body was covered with fine hairs and he had never had visible perspiration. This is probably the same case quoted in the foregoing paragraph in regard to the anomalies of hair. Otto, quoted by Sedgwick, speaks of two brothers who were both totally edentulous. It might be interesting in this connection to note that Oudet found in a fetus at term all the dental follicles in a process of suppuration, leaving no doubt that, if the fetus had been born viable, it would have been edentulous. Giraldes mentions the absence of teeth in an infant of sixteen months. Bronzet describes a child of twelve, with only half its teeth, in whom the alveolar borders receded as in age. Baumes remarks that he had seen a man who never had any teeth. The anomalies of excessive dentition are of several varieties, those of simple supernumerary teeth, double or triple rows, and those in anomalous positions. Ibbetson saw a child with five incisors in the inferior maxillary bone, and Fanton-Touvet describes a young lady who possessed five large incisors of the first dentition in the superior maxilla. Rayer notes a case of dentition of four canines, which first made their appearance after pain for eight days in the jaws and associated with convulsions. In an Ethiopian Soemmering has seen one molar too many on each side and in each jaw. Ploucquet and Tesmer have seen five incisors and Fanchard six. Many persons have the supernumerary teeth parallel with their neighbors, anteriorly or posteriorly. Costa reports a case in which there were five canine teeth in the upper jaw, two placed laterally on either side, and one on the right side behind the other two. The patient was twenty-six years of age, well formed and in good health. In some cases there is fusion of the teeth. Pliny, Bartholinus, and Melanthon pretend to have seen the union of all the teeth, making a continuous mass. In the "Musee de l'ecole dentaire de Paris" there are several milk-teeth, both of the superior and inferior maxilla, which are fused together. Bloch cites a case in which there were two rows of teeth in the superior maxilla. Hellwig has observed three rows of teeth, and the Ephemerides contain an account of a similar anomaly. Extraoral Dentition.--Probably the most curious anomaly of teeth is that in which they are found in other than normal positions. Albinus speaks of teeth in the nose and orbit; Borellus, in the palate; Fabricius Hildanus, under the tongue; Schenck, from the palate; and there are many similar modern records. Heister in 1743 wrote a dissertation on extraoral teeth. The following is a recent quotation:-- "In the Norsk Magazin fur Laegevidenskaben, January, 1895, it is reported that Dr. Dave, at a meeting of the Medical Society in Christiania, showed a tooth removed from the nose of a woman aged fifty-three. The patient had consulted him for ear-trouble, and the tooth was found accidentally during the routine examination. It was easily removed, having been situated in a small depression at the junction of the floor and external wall of the nasal cavity, 22 mm. from the external nares. This patient had all her teeth; they were placed somewhat far from each other. The tooth resembled a milk canine; the end of the imperfect root was covered with a fold of mucous membrane, with stratified epithelium. The speaker suggested that part of the mucous membrane of the mouth with its tooth-germ had become impacted between the superior and premaxillary bones and thus cut off from the cavity of the mouth. Another speaker criticised this fetal dislocation and believed it to be due to an inversion--a development in the wrong direction--by which the tooth had grown upward into the nose. The same speaker also pointed out that the stratified epithelium of the mucous membrane did not prove a connection with the cavity of the mouth, as it is known that cylindric epithelium-cells after irritative processes are replaced by flat ones." Delpech saw a young man in 1829 who had an opening in the palatine vault occasioned by the extraction of a tooth. This opening communicated with the nasal fossa by a fracture of the palatine and maxillary bones; the employment of an obturator was necessary. It is not rare to see teeth, generally canine, make their eruption from the vault of the palate; and these teeth are not generally supernumerary, but examples of vice and deviation of position. Fanton-Touvet, however, gives an example of a supernumerary tooth implanted in the palatine arch. Branch a describes a little negro boy who had two large teeth in the nose; his dentition was otherwise normal, but a portion of the nose was destroyed by ulceration. Roy describes a Hindoo lad of fourteen who had a tooth in the nose, supposed to have been a tumor. It was of the canine type, and was covered with enamel to the junction with the root, which was deeply imbedded in the side and upper part of the antrum. The boy had a perfect set of permanent teeth and no deformity, swelling, or cystic formation of the jaw. This was clearly a case of extrafollicular development and eruption of the tooth in an anomalous position, the peculiarity being that while in other similar cases the crown of the tooth shows itself at the floor of the nasal cavity from below upward, in this instance the dental follicle was transposed, the eruption being from above downward. Hall cites an instance in which the right upper canine of a girl erupted in the nose. The subject showed marked evidence of hereditary syphilis. Carver describes a child who had a tooth growing from the lower right eyelid. The number of deciduous teeth was perfect; although this tooth was canine it had a somewhat bulbulous fang. Of anomalies of the head the first to be considered will be the anencephalous monsters who, strange to say, have been known to survive birth. Clericus cites an example of life for five days in a child without a cerebrum. Heysham records the birth of a child without a cerebrum and remarks that it was kept alive for six days. There was a child born alive in Italy in 1831 without a brain or a cerebellum--in fact, no cranial cavity--and yet it lived eleven hours. A somewhat similar case is recorded in the last century. In the Philosophical Transactions there is mentioned a child virtually born without a head who lived four days; and Le Duc records a case of a child born without brain, cerebellum, or medulla oblongata, and who lived half an hour. Brunet describes an anencephalous boy born at term who survived his birth. Saviard delivered an anencephalous child at term which died in thirty-six hours. Lawrence mentions a child with brain and cranium deficient that lived five days. Putnam speaks of a female nosencephalous monster that lived twenty-nine hours. Angell and Elsner in March, 1895, reported a case of anencephaly, or rather pseudencephaly, associated with double divergent strabismus and limbs in a state of constant spastic contraction. The infant lived eight days. Geoffroy-Saint-Hilaire cites an example of anencephaly which lived a quarter of an hour. Fauvel mentioned one that lived two hours, and Sue describes a similar instance in which life persisted for seven hours and distinct motions were noticed. Malacarne saw life in one for twelve hours, and Mery has given a description of a child born without brain that lived almost a full day and took nourishment. In the Hotel-Dieu in Paris in 1812 Serres saw a monster of this type which lived three days, and was fed on milk and sugared water, as no nurse could be found who was willing to suckle it. Fraser mentions a brother and sister, aged twenty and thirty, respectively, who from birth had exhibited signs of defective development of the cerebellum. They lacked power of coordination and walked with a drunken, staggering gait; they could not touch the nose with the finger when their eyes were shut, etc. The parents of these unfortunate persons were perfectly healthy, as were the rest of their family. Cruveilhier cites a case of a girl of eleven who had absolutely no cerebellum, with the same symptoms which are characteristic in such cases. There is also recorded the history of a man who was deficient in the corpus callosum; at the age of sixty-two, though of feeble intelligence, he presented no signs of nervous disorder. Claude Bernard made an autopsy on a woman who had no trace of olfactory lobes, and after a minute inquiry into her life he found that her sense of smell had been good despite her deficiency. Buhring relates the history of a case somewhat analogous to viability of anencephalous monsters. It was a bicephalous child that lived thirty-two hours after he had ligated one of its heads. {footnote} The argument that the brain is not the sole organ of the mind is in a measure substantiated by a wonderful case of a decapitated rooster, reported from Michigan. A stroke of the knife bad severed the larynx and removed the whole mass of the cerebrum, leaving the inner aspect and base of the skull exposed. The cerebrum was partly removed; the external auditory meatus was preserved. Immediately after the decapitation the rooster was left to its supposed death struggles, but it ran headless to the barn, where it was secured and subsequently fed by pushing corn down its esophagus, and allowing water to trickle into this tube from the spout of an oil-can. The phenomena exhibited by the rooster were quite interesting. It made all the motions of pecking, strutted about, flapped its wings, attempted to crow, but, of course, without making any sound. It exhibited no signs of incoordination, but did not seem to hear. A ludicrous exhibition was the absurd, sidelong pas seul made toward the hens. Ward mentions an instance of congenital absence of the corpora callosum. Paget and Henry mention cases in which the corpora callosum, the fornix, and septum lucidum were imperfectly formed. Maunoir reports congenital malformation of the brain, consisting of almost complete absence of the occipital lobe. The patient died at the twenty-eighth month. Combettes reports the case of a girl who died at the age of eleven who had complete absence of the cerebellum in addition to other minor structural defects; this was probably the case mentioned by Cruveilhier. Diminution in volume of the head is called microcephaly. Probably the most remarkable case on record is that mentioned by Lombroso. The individual was called "l'homme-oiseau," or the human bird, and his cranial capacity was only 390 c.c. Lombroso speaks of another individual called "l'homme-lapin," or man-rabbit, whose cranium was only slightly larger than that of the other, measuring 490 mm. in circumference. Castelli alludes to endemic microcephaly among some of the peoples of Asia. We also find it in the Caribbean Islands, and from the skulls and portraits of the ancient Aztecs we are led to believe that they were also microcephalic. Two creatures of celebrity were Maximo and Bartola, who for twenty-five years have been shown in America and in Europe under the name of the "Aztecs" or the "Aztec children". They were male and female and very short, with heads resembling closely the bas-reliefs on the ancient Aztec temples of Mexico. Their facial angle was about 45 degrees, and they had jutting lips and little or no chin. They wore their hair in an enormous bunch to magnify the deformity. These curiosities were born in Central America and were possibly half Indian and Negro. They were little better than idiots in point of intelligence. Figure 92 represents a microcephalic youth known as the "Mexican wild boy," who was shown with the Wallace circus. Virchow exhibited a girl of fourteen whose face was no larger than that of a new-born child, and whose head was scarcely as large as a man's fist. Magitot reported a case of a microcephalic woman of thirty who weighed 70 pounds. Hippocrates and Strabonius both speak of head-binding as a custom inducing artificial microcephaly, and some tribes of North American Indians still retain this custom. As a rule, microcephaly is attended with associate idiocy and arrested development of the rest of the body. Ossification of the fontanelles in a mature infant would necessarily prevent full development of the brain. Osiander and others have noticed this anomaly. There are cases on record in which the fontanelles have remained open until adulthood. Augmentation of the volume of the head is called macrocephaly, and there are a number of curious examples related. Benvenuti describes an individual, otherwise well formed, whose head began to enlarge at seven. At twenty-seven it measured over 37 inches in circumference and the man's face was 15 inches in height; no other portion of his body increased abnormally; his voice was normal and he was very intelligent. He died of apoplexy at the age of thirty. Fournier speaks of a cranium in the cabinet of the Natural History Museum of Marseilles of a man by the name of Borghini, who died in 1616. At the time he was described he was fifty years old, four feet in height; his head measured three feet in circumference and one foot in height. There was a proverb in Marseilles, "Apas mai de sen que Borghini," meaning in the local dialect, "Thou hast no more wit than Borghini." This man, whose fame became known all over France, was not able, as he grew older, to maintain the weight of his head, but carried a cushion on each shoulder to prop it up. Fournier also quotes the history of a man who died in the same city in 1807 at the age of sixty-seven. His head was enormous, and he never lay on a bed for thirty years, passing his nights in a chair, generally reading or writing. He only ate once in twenty-four or thirty hours, never warmed himself, and never used warm water. His knowledge was said to have been great and encyclopedic, and he pretended never to have heard the proverb of Borghini. There is related the account of a Moor, who was seen in Tunis early in this century, thirty-one years of age, of middle height, with a head so prodigious in dimensions that crowds flocked after him in the streets. His nose was quite long, and his mouth so large that he could eat a melon as others would an apple. He was an imbecile. William Thomas Andrews was a dwarf seventeen years old, whose head measured in circumference 35 inches; from one external auditory meatus to another, 27 1/4 inches; from the chin over the cranial summit to the suboccipital protuberance, 37 1/2 inches; the distance from the chin to the pubes was 20 inches; and from the pubes to the soles of the feet, 16; he was a monorchid. James Cardinal, who died in Guy's Hospital in 1825, and who was so celebrated for the size of his head, only measured 32 1/2 inches in head-circumference. The largest healthy brains on record, that is, of men of prominence, are those of Cuvier, weighing 64 1/3 ounces; of Daniel Webster, weighing 63 3/4 ounces (the circumference of whose head was 23 3/4 inches); of Abercrombie, weighing 63 ounces, and of Spurzheim, weighing 55 1/16 ounces. Byron and Cromwell had abnormally heavy brains, showing marked evidence of disease. A curious instance in this connection is that quoted by Pigne, who gives an account of a double brain found in an infant. Keen reports finding a fornix which, instead of being solid from side to side, consisted of two lateral halves with a triangular space between them. When the augmentation of the volume of the cranium is caused by an abundant quantity of serous fluid the anomaly is known as hydrocephaly. In this condition there is usually no change in the size of the brain-structure itself, but often the cranial bones are rent far asunder. Minot speaks of a hydrocephalic infant whose head measured 27 1/2 inches in circumference; Bright describes one whose head measured 32 inches; and Klein, one 43 inches. Figure 93 represents a child of six whose head circumference was 36 inches. Figure 94 shows a hydrocephalic adult who was exhibited through this country. There is a record of a curious monster born of healthy half-caste African parents. The deformity was caused by a deficiency of osseous material of the bones of the head. There was considerable arrest of development of the parietal, temporal, and superior maxillary bones, in consequence of which a very small amount of the cerebral substance could be protected by the membranous expansion of the cranial centers. The inferior maxilla and the frontal bone were both perfect; the ears were well developed and the tongue strong and active; the nostrils were imperforate and there was no roof to the mouth nor floor to the nares. The eyes were curiously free from eyelashes, eyelids, or brows. The cornea threatened to slough. There was double harelip on the left side; the second and third fingers of both hands were webbed for their whole length; the right foot wanted the distal phalanx of the great toe and the left foot was clubbed and drawn inward. The child swallowed when fed from a spoon, appeared to hear, but exhibited no sense of light. It died shortly after the accompanying sketch was made. Occasionally a deficiency in the osseous material of the cranium or an abnormal dilatation of the fontanelles gives rise to a hernia of the meninges, which, if accompanied by cerebrospinal fluid in any quantity, causes a large and peculiarly shaped tumor called meningocele. If there is a protrusion of brain-substance itself, a condition known as hernia cerebri results. Complete absence of the inferior maxilla is much rarer in man than in animals. Nicolas and Prenant have described a curious case of this anomaly in a sheep. Gurlt has named subjects presenting the total or partial absence of the inferior maxilla, agnathes or hemiagnathes. Simple atrophy of the inferior maxilla has been seen in man as well as in the lower animals, but is much less frequent than atrophy of the superior maxilla. Langenbeck reports the case of a young man who had the inferior maxilla so atrophied that in infancy it was impossible for him to take milk from the breast. He had also almost complete immobility of the jaws. Boullard reports a deformity of the visage, resulting in a deficiency of the condyles of the lower jaw. Maurice made an observation on a vice of conformation of the lower jaw which rendered lactation impossible, probably causing the death of the infant on this account. Tomes gives a description of a lower jaw the development of the left ramus of which had been arrested. Canton mentions arrest of development of the left perpendicular ramus of the lower jaw combined with malformation of the external ear. Exaggerated prominence of the maxillaries is called prognathism; that of the superior maxilla is seen in the North American Indians. Inferior prognathism is observed in man as well as in animals. The bull-dog, for example, displays this, but in this instance the deformity is really superior brachygnathism, the superior maxilla being arrested in development. Congenital absence of the nose is a very rare anomaly. Maisonneuve has seen an example in an individual in which, in place of the nasal appendix, there was a plane surface perforated by two small openings a little less than one mm. in diameter and three mm. apart. Exaggeration in volume of the nose is quite frequent. Ballonius speaks of a nose six times larger than ordinary. Viewing the Roman celebrities, we find that Numa, to whom was given the surname Pompilius, had a nose which measured six inches. Plutarch, Lyourgus, and Solon had a similar enlargement, as had all the kings of Italy except Tarquin the Superb. Early in the last century a man, Thomas Wedders (or Wadhouse), with a nose 7 1/2 inches long, was exhibited throughout Yorkshire. This man expired as he had lived, in a condition of mind best described as the most abject idiocy. The accompanying illustration is taken from a reproduction of an old print and is supposed to be a true likeness of this unfortunate individual. There are curious pathologic formations about the nose which increase its volume so enormously as to interfere with respiration and even with alimentation; but these will be spoken of in another chapter. There have been some celebrities whose noses were undersized. The Duc de Guise, the Dauphin d'Auvergne, and William of Orange, celebrated in the romances of chivalry, had extremely short noses. There are a few recorded cases of congenital division of the nose. Bartholinus, Borellus, and the Ephemerides speak of duplex noses. Thomas of Tours has observed congenital fissure of the nose. Rikere reports the case of an infant of three weeks who possessed a supernumerary nose on the right nasal bone near the inner canthus of the eye. It was pear-shaped, with its base down, and was the size of the natural nose of an infant of that age, and air passed through it. Hubbell, Ronaldson, and Luscha speak of congenital occlusion of the posterior nares. Smith and Jarvis record cases of congenital occlusion of the anterior nares. Anomalies in size of the mouth are not uncommon. Fournier quotes the history of a man who had a mouth so large that when he opened it all his back teeth could be seen. There is a history of a boy of seventeen who had a preternaturally-sized mouth, the transverse diameter being 6 1/2 inches. The mother claimed that the boy was born with his foot in his mouth and to this fact attributed his deformity. The negro races are noted for their large mouths and thick lips. A negro called "Black Diamond," recently exhibited in Philadelphia, could put both his fists in his mouth. Morgan reports two cases of congenital macrostoma accompanied by malformation of the auricles and by auricular appendages. Van Duyse mentions congenital macrostoma with preauricular tumors and a dermoid of the eye. Macrostoma is sometimes produced by lateral fissures. In other cases this malformation is unilateral and the fissure ascends, in which instance the fissure may be accompanied by a fistula of the duct of Stensen. Sometimes there is associated with these anomalies curious terminations of the salivary ducts, either through the cheek by means of a fistula or on the anterior part of the neck. Microstoma.--There are a few cases on record in which the mouth has been so small or ill-defined as not to admit of alimentation. Molliere knew an individual of forty whose mouth was the exact size of a ten-centime piece. Buchnerus records a case of congenital atresia of the mouth. Cayley, Smith, Sourrouille, and Stankiewiez of Warsaw discuss atresia of the mouth. Cancrum oris, scarlet fever, burns, scurvy, etc., are occasional causes that have been mentioned, the atresia in these instances taking place at any time of life. Anomalies of the Lips.--The aboriginal tribes are particularly noted for their large and thick lips, some of which people consider enormous lips signs of adornment. Elephantiasis or other pathologic hypertrophy of the labial tissues can produce revolting deformity, such as is seen in Figure 100, representing an individual who was exhibited several years ago in Philadelphia. We have in English the expression, "pulling a long lip." Its origin is said to date back to a semimythical hero of King Arthur's time, who, "when sad at heart and melancholic," would let one of his lips drop below his waist, while he turned the other up like a cap on his head. Blot records a case of monstrous congenital hypertrophy of the superior lip in an infant of eight months. Buck successfully treated by surgical operations a case of congenital hypertrophy of the under lip, and Detmold mentions a similar result in a young lady with hypertrophy of the lip and lower part of the nose. Murray reports an undescribed malformation of the lower lip occurring in one family. Hare-lip may be unilateral or double, and may or may not include the palatine arch. In the worst cases it extends in fissures on both sides to the orbit. In other cases the minimum degree of this deformity is seen. Congenital absence of the tongue does not necessarily make speech, taste, or deglutition impossible. Jussieu cites the case of a girl who was born without a tongue but who spoke very distinctly. Berdot describes a case in which the tongue was deficient, without apparent disturbance of any of the functions. Riolan mentions speech after loss of the tongue from small-pox. Boddington gives an account of Margaret Cutting, who spoke readily and intelligibly, although she had lost her tongue. Saulquin has an observation of a girl without a tongue who spoke, sang, and swallowed normally. Aurran, Bartholinus, Louis, Parsons, Tulpius, and others mention speech without the presence of a tongue. Philib reports a case in which mutism, almost simulating that of one congenitally deaf, was due to congenital adhesions of the tongue to the floor of the buccal cavity. Speech was established after removal of the abnormal adhesion. Routier speaks of ankylosis of the tongue of seventeen years' duration. Jurist records such abnormal mobility of the tongue that the patient was able to project the tongue into the nasopharynx. Wherry and Winslow record similar instances. There have been individuals with bifid tongues, after the normal type of serpents and saurians, and others who possessed a supernumerary tongue. Rev. Henry Wharton, Chaplain to Archbishop Sancroft, in his journal, written in the seventeenth century, says that he was born with two tongues and passed through life so, one, however, gradually atrophying. In the polyclinic of Schnitzer in Vienna in 1892 Hajek observed in a lad of twelve an accessory tongue 2.4 cm. in length and eight mm. in breadth, forming a tumor at the base of the normal tongue. It was removed by scissors, and on histologic examination proved to be a true tongue with the typical tissues and constituents. Borellus, Ephemerides, Eschenbach, Mortimer, Penada, and Schenck speak of double tongues, and Avicenna and Schenck have seen fissured tongues. Dolaeus records an instance of double tongue in a paper entitled "De puella bilingui," and Beaudry and Brothers speak of cleft tongue. Braine records a case in which there was a large hypertrophied fold of membrane coming from each side of the upper lip. In some cases there is marked augmentation of the volume of the tongue. Fournier has seen a juggler with a tongue so long that he could extrude it six inches from his mouth. He also refers to a woman in Berlin with a long tongue, but it was thinner than that of a cat. When she laughed it hung over her teeth like a curtain, and was always extremely cold to the touch. In the same article there is a description of a man with a very long neck who could touch his tongue to his chest without reclining his head. Congenital and acquired hypertrophy of the tongue will be discussed later. Amatus Lusitanus and Portal refer to the presence of hair on the tongue, and later there was an account of a medical student who complained of dyspepsia and a sticky sensation in the mouth. On examination a considerable growth of hair was found on the surface of the tongue. The hairs would be detached in vomiting but would grow again, and when he was last seen they were one inch long. Such are possibly nevoid in formation. The ordinary anomalies of the palate are the fissures, unilateral, bilateral, median, etc.: they are generally associated with hare-lip. The median fissure commencing between the middle incisors is quite rare. Many curious forms of obturator or artificial palate are employed to remedy congenital defects. Sercombe mentions a case in which destruction of the entire palate was successfully relieved by mechanical means. In some instances among the lower classes these obturators are simple pieces of wood, so fashioned as to fit into the palatine cleft, and not infrequently the obturator has been swallowed, causing obstruction of the air-passages or occluding the esophagus. Abnormalism of the Uvula.--Examples of double uvula are found in the older writers, and Hagendorn speaks of a man who was born without a uvula. The Ephemerides and Salmuth describe uvulae so defective as to be hardly noticeable. Bolster, Delius, Hodges, Mackenzie of Baltimore, Orr, Riedel, Schufeldt, and Tidyman are among observers reporting bifurcated and double uvula, and they are quite common. Ogle records instances of congenital absence of the uvula. Anomalies of the Epiglottis.--Morgagni mentions a man without an epiglottis who ate and spoke without difficulty. He thought the arytenoids were so strongly developed that they replaced the functions of the missing organ. Enos of Brooklyn in 1854 reported absence of the epiglottis without interference with deglutition. Manifold speaks of a case of bifurcated epiglottis. Debloisi records an instance of congenital web of the vocal bands. Mackenzie removed a congenital papillomatous web which had united the vocal cords until the age of twenty-three, thus establishing the voice. Poore also recorded a case of congenital web in the larynx. Elsberg and Scheff mention occlusion of the rima glottidis by a membrane. Instances of duplication of the epiglottis attended with a species of double voice possess great interest. French described a man of thirty, by occupation a singer and contortionist, who became possessed of an extra voice when he was sixteen. In high and falsetto tones he could run the scale from A to F in an upper and lower range. The compass of the low voice was so small that he could not reach the high notes of any song with it, and in singing he only used it to break in on the falsetto and produce a sensation. He was supposed to possess a double epiglottis. Roe describes a young lady who could whistle at will with the lower part of her throat and without the aid of her lips. Laryngeal examination showed that the fundamental tones were produced by vibrations of the edges of the vocal cords, and the modifications were effected by a minute adjustment of the ventricular bands, which regulated the laryngeal opening above the cord, and pressing firmly down closed the ventricle and acted as a damper preventing the vibrations of the cords except in their middle third. Morgan in the same journal mentions the case of a boy of nineteen, who seemed to be affected with laryngeal catarrh, and who exhibited distinct diphthongia. He was seen to have two glottic orifices with associate bands. The treatment was directed to the catarrh and consequent paresis of the posterior bands, and he soon lost his evidences of double voice. {footnote} The following is a description of the laryngeal formation of a singer who has recently acquired considerable notice by her ability to sing notes of the highest tones and to display the greatest compass of voice. It is extracted from a Cleveland, Ohio, newspaper: "She has unusual development of the larynx, which enables her to throw into vibration and with different degrees of rapidity the entire length of the vocal cords or only a part thereof. But of greatest interest is her remarkable control over the muscles which regulate the division and modification of the resonant cavities, the laryngeal, pharyngeal, oral, and nasal, and upon this depends the quality of her voice. The uvula is bifurcated, and the two divisions sometimes act independently. The epiglottis during the production of the highest notes rises upward and backward against the posterior pharyngeal wall in such a way as almost entirely to separate the pharyngeal cavities, at the same time that it gives an unusual conformation to those resonant chambers." Complete absence of the eyes is a very rare anomaly. Wordsworth describes a baby of seven weeks, otherwise well formed and healthy, which had congenital absence of both eyes. The parents of this child were in every respect healthy. There are some cases of monstrosities with closed, adherent eyelids and absence of eyes. Holmes reports a case of congenital absence of both eyes, the child otherwise being strong and perfect. The child died of cholera infantum. He also reports a case very similar in a female child of American parents. In a girl of eight, of German parents, he reports deficiency of the external walls of each orbit, in addition to great deformity of the side of the head. He also gives an instance of congenital paralysis of the levator palpebrae muscles in a child whose vision was perfect and who was otherwise perfect. Holmes also reports a case of enormous congenital exophthalmos, in which the right eye protruded from the orbit and was no longer covered by the cornea. Kinney has an account of a child born without eyeballs. The delivery was normal, and there was no history of any maternal impression; the child was otherwise healthy and well formed. Landes reports the case of an infant in which both eyes were absent. There were six fingers on each hand and six toes on each foot. The child lived a few weeks. In some instances of supposed absence of the eyeball the eye is present but diminutive and in the posterior portion of the orbit. There are instances of a single orbit with no eyes and also a single orbit containing two eyes. Again we may have two orbits with an absence of eyes but the presence of the lacrimal glands, or the eyes may be present or very imperfectly developed. Mackenzie mentions cases in which the orbit was more or less completely wanting and a mass of cellular tissue in each eye. Cases of living cyclopia, or individuals with one eye in the center of the forehead after the manner of the mythical Cyclops, are quite rare. Vallentini in 1884 reports a case of a male cyclopic infant which lived for seventy-three hours. There were median fissures of the upper lip, preauricular appendages, oral deformity, and absence of the olfactory proboscis The fetus was therefore a cyclops arrhynchus, or cyclocephalus. Blok describes a new-born infant which lived for six or seven hours, having but one eye and an extremely small mouth. The "Four-eyed Man of Cricklade" was a celebrated English monstrosity of whom little reliable information is obtainable. He was visited by W. Drury, who is accredited with reporting the following-- "'So wondrous a thing, such a lusus naturae, such a scorn and spite of nature I have never seen. It was a dreadful and shocking sight.' This unfortunate had four eyes placed in pairs, 'one eye above the other and all four of a dull brown, encircled with red, the pupils enormously large.' The vision in each organ appeared to be perfect. 'He could shut any particular eye, the other three remaining open, or, indeed, as many as he chose, each several eye seeming to be controlled by his will and acting independently of the remainder. He could also revolve each eye separately in its orbit, looking backward with one and forward with another, upward with one and downward with another simultaneously.' He was of a savage, malignant disposition, delighting in ugly tricks, teasing children, torturing helpless animals, uttering profane and blasphemous words, and acting altogether like the monster, mental and physical, that he was. 'He could play the fiddle, though in a silly sort, having his notes on the left side, while closing the right pair of eyes. He also sang, but in a rough, screeching voice not to be listened to without disgust.'" There is a recent report of a child born in Paris with its eyes in the top of its head. The infant seemed to be doing well and crowds of people have flocked to see it. Recent reports speak of a child born in Portland, Oregon, which had a median rudimentary eye between two normal eyes. Fournier describes an infant born with perfectly formed eyes, but with adherent eyelids and closed ocular aperture. Forlenze has seen the pupils adherent to the conjunctiva, and by dissection has given sight to the subject. Dubois cites an instance of supernumerary eyelid. At the external angle of the eyelid was a fold of conjunctiva which extended 0.5 cm. in front of the conjunctiva, to which it did not adhere, therefore constituting a fourth eyelid. Fano presents a similar case in a child of four months, in whom no other anomaly, either of organs or of vision, was observed. On the right side, in front of the external half of the sclerotic, was observed a semilunar fold with the concavity inward, and which projected much more when the lower lid was depressed. When the eyelid rolled inward the fold rolled with the globe, but never reached so far as the circumference of the cornea and did not interfere with vision. Total absence of both irides has been seen in a man of eighteen. Dixon reports a case of total aniridia with excellent sight in a woman of thirty-seven. In Guy's Hospital there was seen a case of complete congenital absence of the iris. Hentzschel speaks of a man with congenital absence of the iris who had five children, three of whom exhibited the same anomaly while the others were normal. Benson, Burnett, Demaux, Lawson, Morison, Reuling, Samelson, and others also report congenital deficiency of the irides in both eyes. Jeaffreson describes a female of thirty, living in India, who was affected with complete ossification of the iris. It was immovable and quite beautiful when seen through the transparent cornea; the sight was only slightly impaired. No cause was traceable. Multiple Pupils.--More than one pupil in the eye has often been noticed, and as many as six have been seen. They may be congenital or due to some pathologic disturbance after birth. Marcellus Donatus speaks of two pupils in one eye. Beer, Fritsche, and Heuermann are among the older writers who have noticed supernumerary pupils. Higgens in 1885 described a boy whose right iris was perforated by four pupils,--one above, one to the inner side, one below, and a fourth to the outer side. The first three were slit-shaped; the fourth was the largest and had the appearance as of the separation of the iris from its insertion. There were two pupils in the left eye, both to the outer side of the iris, one being slit-like and the other resembling the fourth pupil in the right eye. All six pupils commenced at the periphery, extended inward, and were of different sizes. The fundus could be clearly seen through all of the pupils, and there was no posterior staphyloma nor any choroidal changes. There was a rather high degree of myopia. This peculiarity was evidently congenital, and no traces of a central pupil nor marks of a past iritis could be found. Clinical Sketches a contains quite an extensive article on and several illustrations of congenital anomalies of the iris. Double crystalline lenses are sometimes seen. Fritsch and Valisneri have seen this anomaly and there are modern references to it. Wordsworth presented to the Medical Society of London six members of one family, all of whom had congenital displacement of the crystalline lens outward and upward. The family consisted of a woman of fifty, two sons, thirty-five and thirty-seven, and three grandchildren--a girl of ten and boys of five and seven. The irides were tremulous. Clark reports a case of congenital dislocation of both crystalline lenses. The lenses moved freely through the pupil into the anterior chambers. The condition remained unchanged for four years, when glaucoma supervened. Differences in Color of the Two Eyes.--It is not uncommon to see people with different colored eyes. Anastasius I had one black eye and the other blue, from whence he derived his name "Dicore," by which this Emperor of the Orient was generally known. Two distinct colors have been seen in an iris. Berry gives a colored illustration of such a case. The varieties of strabismus are so common that they will be passed without mention. Kuhn presents an exhaustive analysis of 73 cases of congenital defects of the movements of the eyes, considered clinically and didactically. Some or all of the muscles may be absent or two or more may be amalgamated, with anomalies of insertion, false, double, or degenerated, etc. The influence of heredity in the causation of congenital defects of the eye is strikingly illustrated by De Beck. In three generations twelve members of one family had either coloboma iridis or irideremia. He performed two operations for the cure of cataract in two brothers. The operations were attended with difficulty in all four eyes and followed by cyclitis. The result was good in one eye of each patient, the eye most recently blind. Posey had a case of coloboma in the macular region in a patient who had a supernumerary tooth. He believes the defects were inherited, as the patient's mother also had a supernumerary tooth. Nunnely reports cases of congenital malformation in three children of one family. The globes of two of them (a boy and a girl) were smaller than natural, and in the boy in addition were flattened by the action of the recti muscles and were soft; the sclera were very vascular and the cornea, conical, the irides dull, thin, and tremulous; the pupils were not in the axis of vision, but were to the nasal side. The elder sister had the same congenital condition, but to a lesser degree. The other boy in the family had a total absence of irides, but he could see fairly well with the left eye. Anomalies of the Ears.--Bilateral absence of the external ears is quite rare, although there is a species of sheep, native of China, called the "Yungti," in which this anomaly is constant. Bartholinus, Lycosthenes, Pare, Schenck, and Oberteuffer have remarked on deficient external ears. Guys, the celebrated Marseilles litterateur of the eighteenth century, was born with only one ear. Chantreuil mentions obliteration of the external auditory canal in the new-born. Bannofont reports a case of congenital imperforation of the left auditory canal existing near the tympanic membrane with total deafness in that ear. Lloyd described a fetus showing absence of the external auditory meatus on both sides. Munro reports a case of congenital absence of the external auditory meatus of the right ear; and Richardson speaks of congenital malformation of the external auditory apparatus of the right side. There is an instance of absence of the auditory canal with but partial loss of hearing. Mussey reports several cases of congenitally deficient or absent aural appendages. One case was that in which there was congenital absence of the external auditory meatus of both ears without much impairment of hearing. In neither ear of N. W. Goddard, aged twenty-seven, of Vermont, reported in 1834, was there a vestige of an opening or passage in the external ear, and not even an indentation. The Eustachian tube was closed. The integuments of the face and scalp were capable of receiving acoustic impressions and of transmitting them to the organs of hearing. The authors know of a student of a prominent New York University who is congenitally deficient in external ears, yet his hearing is acute. He hides his deformity by wearing his hair long and combed over his ears. The knowledge of anomalous auricles is lost in antiquity. Figure 103 represents the head of an aegipan in the British Museum showing a supernumerary auricle. As a rule, supernumerary auricles are preauricular appendages. Warner, in a report of the examination of 50,000 children, quoted by Ballantyne, describes 33 with supernumerary auricles, represented by sessile or pedunculated outgrowths in front of the tragus. They are more commonly unilateral, always congenital, and can be easily removed, giving rise to no unpleasant symptoms. They have a soft and elastic consistency, and are usually composed of a hyaline or reticular cartilaginous axis covered with connective or adipose tissue and skin bearing fine hairs; sometimes both cartilage and fat are absent. They are often associated with some form of defective audition--harelip, ocular disturbance, club-feet, congenital hernia, etc. These supernumerary members vary from one to five in number and are sometimes hereditary. Reverdin describes a man having a supernumerary nipple on the right side of his chest, of whose five children three had preauricular appendages. Figure 104 represents a girl with a supernumerary auricle in the neck, described in the Lancet, 1888. A little girl under Birkett's care in Guy's Hospital more than answered to Macbeth's requisition, "Had I three ears I'd hear thee!" since she possessed two superfluous ones at the sides of the neck, somewhat lower than the angle of the jaw, which were well developed as to their external contour and made up of fibrocartilage. There is mentioned the case of a boy of six months on the left side of whose neck, over the middle anterior border of the sternocleidomastoid muscle, was a nipple-like projection 1/2 inch in length; a rod of cartilage was prolonged into it from a thin plate, which was freely movable in the subcutaneous tissue, forming a striking analogue to an auricle. Moxhay cites the instance of a mother who was frightened by the sight of a boy with hideous contractions in the neck, and who gave birth to a child with two perfect ears and three rudimentary auricles on the right side, and on the left side two rudimentary auricles. In some people there is an excessive development of the auricular muscles, enabling them to move their ears in a manner similar to that of the lower animals. Of the celebrated instances the Abbe de Marolles, says Vigneul-Marville, bears witness in his "Memoires" that the Regent Crassot could easily move his ears. Saint Augustine mentions this anomaly. Double tympanitic membrane is spoken of by Loeseke. There is sometimes natural perforation of the tympanum in an otherwise perfect ear, which explains how some people can blow tobacco-smoke from the ear. Fournier has seen several Spaniards and Germans who could perform this feat, and knew one man who could smoke a whole cigar without losing any smoke, since he made it leave either by his mouth, his ears, or in both ways. Fournier in the same article mentions that he has seen a woman with ears over four inches long. Strange to say, there have been reports of cases in which the ossicles were deficient without causing any imperfection of hearing. Caldani mentions a case with the incus and malleus deficient, and Scarpa and Torreau quote instances of deficient ossicles. Thomka in 1895 reported a case of supernumerary tympanic ossicle, the nature of which was unknown, although it was neither an inflammatory product nor a remnant of Meckel's cartilage. Absence of the Limbs.--Those persons born without limbs are either the subjects of intrauterine amputation or of embryonic malformation. Probably the most celebrated of this class was Marc Cazotte, otherwise known as "Pepin," who died in Paris in the last century at the age of sixty-two of a chronic intestinal disorder. He had no arms, legs, or scrotum, but from very jutting shoulders on each side were well-formed hands. His abdomen ended in a flattened buttock with badly-formed feet attached. He was exhibited before the public and was celebrated for his dexterity. He performed nearly all the necessary actions, exhibited skilfulness in all his movements, and was credited with the ability of coitus. He was quite intellectual, being able to write in several languages. His skeleton is preserved in the Musee Dupuytren. Flachsland speaks of a woman who three times had borne children without arms and legs. Hastings describes a living child born without any traces of arms or legs. Garlick has seen a child with neither upper nor lower extremities. In place of them were short stumps three or four inches long, closely resembling the ordinary stumps after amputation. The head, chest, body, and male genitals were well formed, and the child survived. Hutchinson reports the history of a child born without extremities, probably the result of intrauterine amputation. The flaps were healed at the deltoid insertion and just below the groin. Pare says he saw in Paris a man without arms, who by means of his head and neck could crack a whip or hold an axe. He ate by means of his feet, dealt and played cards, and threw dice with the same members, exhibiting such dexterity that finally his companions refused to play with him. He was proved to be a thief and a murderer and was finally hanged at Gueldres. Pare also relates having seen a woman in Paris who sewed, embroidered, and did other things with her feet. Jansen speaks of a man in Spain, born without arms, who could use his feet as well as most people use their arms. Schenck and Lotichius give descriptions of armless people. Hulke describes a child of four whose upper limbs were absent, a small dimple only being in their place. He had free movement of the shoulders in every direction and could grasp objects between his cheeks and his acromian process; the prehensile power of the toes was well developed, as he could pick up a coin thrown to him. A monster of the same conformation was the celebrated painter, Ducornet, who was born at Lille on the 10th of January, 1806. He was completely deprived of arms, but the rest of the body was well formed with the exception of the feet, of which the second toe was faulty. The deformity of the feet, however, had the happiest result, as the space between the great toe and its neighbor was much larger than ordinary and the toes much more mobile. He became so skilful in his adopted profession that he finally painted a picture eleven feet in height (representing Mary Magdalene at the feet of Christ after the resurrection), which was purchased by the Government and given to the city of Lille. Broca describes James Leedgwood, who was deprived of his arms and had only one leg. He exhibited great dexterity with his single foot, wrote, discharged a pistol, etc.; he was said to have been able to pick up a sewing-needle on a slippery surface with his eyes blindfolded. Capitan described to the Societe d'anthropologie de Paris a young man without arms, who was said to play a violin and cornet with his feet. He was able to take a kerchief from his pocket and to blow his nose; he could make a cigarette, light it, and put it in his mouth, play cards, drink from a glass, and eat with a fork by the aid of his dexterous toes. There was a creature exhibited some time since in the principal cities of France, who was called the "l'homme tronc." He was totally deprived of all his members. Curran describes a Hindoo, a prostitute of forty, with congenital absence of both upper extremities. A slight fleshy protuberance depended from the cicatrix of the humerus and shoulder-joint of the left side, and until the age of ten there was one on the right side. She performed many tricks with her toes. Caldani speaks of a monster without arms, Davis mentions one, and Smith describes a boy of four with his upper limbs entirely absent. Breschet has seen a child of nine with only portions of the upper arms and deformity of lower extremities and pelvis. Pare says that he saw in Paris in 1573, at the gate of St. Andrew des Arts, a boy of nine, a native of a small village near Guise, who had no legs and whose left foot was represented by a fleshy body hanging from the trunk; he had but two fingers hanging on his right hand, and had between his legs what resembled a virile penis. Pare attributes this anomaly to a default in the quantity of semen. The figure and skeleton of Harvey Leach, called "Hervio Nono," is in the museum of the University College in London. The pelvis was comparatively weak, the femurs hardly to be recognized, and the right tibia and foot defective; the left foot was better developed, although far from being in due proportion to the trunk above. He was one of the most remarkable gymnasts of his day, and notwithstanding the distortion of his lower limbs had marvelous power and agility in them. As an arena-horseman, either standing or sitting, he was scarcely excelled. He walked and even ran quite well, and his power of leaping, partly with his feet and partly with his hands, was unusual. His lower limbs were so short that, erect, he touched the floor with his fingers, but he earned his livelihood as much with his lower as with his upper limbs. In his skeleton his left lower limb, between the hip and heel, measured 16 inches, while the right, between the same points, measured nine inches. Hare mentions a boy of five and a half whose head and trunk were the same as in any other child of like age. He was 22 1/2 inches high, had no spinal curvature, but was absolutely devoid of lower extremities. The right arm was two inches long and the left 2 1/4. Each contained the head and a small adjoining portion of the humerus. The legs were represented by masses of cellular tissue and fat covered by skin which projected about an inch. He was intelligent, had a good memory, and exhibited considerable activity. He seemed to have had more than usual mobility and power of flexion of the lower lumbar region. When on his back he was unable to rise up, but resting on the lower part of the pelvis he was able to maintain himself erect. He usually picked up objects with his teeth, and could hold a coin in the axilla as he rolled from place to place. His rolling was accomplished by a peculiar twisting of the thorax and bending of the pelvis. There was no history of maternal impression during pregnancy, no injury, and no hereditary disposition to anomalous members. Figure 112 represents a boy with congenital deficiency of the lower extremities who was exhibited a few years ago in Philadelphia. In Figure 113, which represents a similar case in a girl whose photograph is deposited in the Mutter Museum of the College of Physicians, Philadelphia, we see how cleverly the congenital defect may be remedied by mechanical contrivance. With her crutches and artificial legs this girl was said to have moved about easily. Parvin describes a "turtle-man" as an ectromelian, almost entering the class of phocomelians or seal-like monsters; the former term signifies abortive or imperfect formation of the members. The hands and feet were normally developed, but the arms, forearms, and legs are much shortened. The "turtle-woman" of Demerara was so called because her mother when pregnant was frightened by a turtle, and also from the child's fancied resemblance to a turtle. The femur was six inches long, the woman had a foot of six bones, four being toes, viz., the first and second phalanges of the first and second toes. She had an acetabulum, capsule, and ligamentum teres, but no tibia or fibula; she also had a defective right forearm. She was never the victim of rachitis or like disease, but died of syphilis in the Colonial Hospital. In her twenty-second year she was delivered of a full-grown child free of deformity. There was a woman living in Bavaria, under the observation of Buhl, who had congenital absence of both femurs and both fibulas. Almost all the muscles of the thigh existed, and the main attachment to the pelvis was by a large capsular articulation. Charpentier gives the portrait of a woman in whom there was a uniform diminution in the size of the limbs. Debout portrays a young man with almost complete absence of the thigh and leg, from whose right hip there depended a foot. Accrell describes a peasant of twenty-six, born without a hip, thigh, or leg on the right side. The external genital organs were in their usual place, but there was only one testicle in the scrotum. The man was virile. The rectum instead of opening outward and underneath was deflected to the right. Supernumerary Limbs.--Haller reports several cases of supernumerary extremities. Plancus speaks of an infant with a complete third leg, and Dumeril cites a similar instance. Geoffroy-Saint-Hilaire presented to the Academie des Sciences in 1830 a child with four legs and feet who was in good health. Amman saw a girl with a large thigh attached to her nates. Below the thigh was a single leg made by the fusion of two legs. No patella was found and the knee was anchylosed. One of the feet of the supernumerary limb had six toes, while the other, which was merely an outgrowth, had two toes on it. According to Jules Guerin, the child named Gustav Evrard was born with a thigh ending in two legs and two imperfect feet depending from the left nates. Tucker describes a baby born in the Sloane Maternity in New York, October 1, 1894, who had a third leg hanging from a bony and fleshy union attached to the dorsal spine. The supernumerary leg was well formed and had a left foot attached to it. Larkin and Jones mention the removal of a meningocele and a supernumerary limb from an infant of four months. This limb contained three fingers only, one of which did not have a bony skeleton. Pare says that on the day the Venetians and the Genevois made peace a monster was born in Italy which had four legs of equal proportions, and besides had two supernumerary arms from the elbows of the normal limbs. This creature lived and was baptized. Anomalies of the Feet.--Hatte has seen a woman who bore a child that had three feet. Bull gives a description of a female infant with the left foot double or cloven. There was only one heel, but the anterior portion consisted of an anterior and a posterior part. The anterior foot presented a great toe and four smaller ones, but deformed like an example of talipes equinovarus. Continuous with the outer edge of the anterior part and curving beneath it was a posterior part, looking not unlike a second foot, containing six well-formed toes situated directly beneath the other five. The eleven toes were all perfect and none of them were webbed. There is a class of monsters called "Sirens" on account of their resemblance to the fabulous creatures of mythology of that name. Under the influence of compression exercised in the uterus during the early period of gestation fusion of the inferior extremities is effected. The accompanying illustration shows the appearance of these monsters, which are thought to resemble the enchantresses celebrated by Homer. Anomalies of the Hand.--Blumenbach speaks of an officer who, having lost his right hand, was subsequently presented by his wife with infants of both sexes showing the same deformity. Murray cites the instance of a woman of thirty-eight, well developed, healthy, and the mother of normal children, who had a double hand. The left arm was abnormal, the flexion of the elbow imperfect, and the forearm terminated in a double hand with only rudimentary thumbs. In working as a charwoman she leaned on the back of the flexed carpus. The double hand could grasp firmly, though the maximum power was not so great as that of the right hand. Sensation was equally acute in all three of the hands. The middle and ring fingers of the supernumerary hand were webbed as far as the proximal joints, and the movements of this hand were stiff and imperfect. No single finger of the two hands could be extended while the other seven were flexed. Giraldes saw an infant in 1864 with somewhat the same deformity, but in which the disposition of the muscles and tendons permitted the ordinary movements. Absence of Digits.--Maygrier describes a woman of twenty-four who instead of having a hand on each arm had only one finger, and each foot had but two toes. She was delivered of two female children in 1827 and one in 1829, each having exactly the same deformities. Her mother was perfectly formed, but the father had but one toe on his foot and one finger on his left hand. Kohler gives photographs of quite a remarkable case of suppression and deformity of the digits of both the fingers and toes. Figure 123 shows a man who was recently exhibited in Philadelphia. He had but two fingers on each hand and two toes on each foot, and resembles Kohler's case in the anomalous digital conformation. Figure 124 represents an exhibitionist with congenital suppression of four digits on each hand. Tubby has seen a boy of three in whom the first, second, and third toes of each foot were suppressed, the great toe and the little toe being so overgrown that they could be opposed. In this family for four generations 15 individuals out of 22 presented this defect of the lower extremity. The patient's brothers and a sister had exactly the same deformity, which has been called "lobster-claw foot." Falla of Jedburgh speaks of an infant who was born without forearms or hands; at the elbow there was a single finger attached by a thin string of tissue. This was the sixth child, and it presented no other deformity. Falla also says that instances of intrauterine digital amputation are occasionally seen. According to Annandale, supernumerary digits may be classified as follows:-- (1) A deficient organ, loosely attached by a narrow pedicle to the hand or foot (or to another digit). (2) A more or less developed organ, free at its extremity, and articulating with the head or sides of a metacarpal, metatarsal, or phalangeal bone. (3) A fully developed separate digit. (4) A digit intimately united along its whole length with another digit, and having either an additional metacarpal or metatarsal bone of its own, or articulating with the head of one which is common to it and another digit. Superstitions relative to supernumerary fingers have long been prevalent. In the days of the ancient Chaldeans it was for those of royal birth especially that divinations relative to extra digits were cast. Among the ancients we also occasionally see illustrations emblematic of wisdom in an individual with many fingers, or rather double hands, on each arm. Hutchinson, in his comments on a short-limbed, polydactylous dwarf which was dissected by Ruysch, the celebrated Amsterdam anatomist, writes as follows.-- "This quaint figure is copied from Theodore Kerckring's 'Spicilegium Anatomicum,' published in Amsterdam in 1670. The description states that the body was that of an infant found drowned in the river on October 16, 1668. It was dissected by the renowned Ruysch. A detailed description of the skeleton is given. My reason for now reproducing the plate is that it offers an important item of evidence in reference to the development of short-limbed dwarfs. Although we must not place too much reliance on the accuracy of the draughtsman, since he has figured some superfluous lumbar vertebrae, yet there can be no doubt that the limbs are much too short for the trunk and head. This remark especially applies to the lower limbs and pelvis. These are exactly like those of the Norwich dwarf and of the skeleton in the Heidelberg Museum which I described in a recent number of the 'Archives.' The point of extreme interest in the present case is that this dwarfing of the limbs is associated with polydactylism. Both the hands have seven digits. The right foot has eight and the left nine. The conditions are not exactly symmetrical, since in some instances a metacarpal or metatarsal bone is wanting; or, to put it otherwise, two are welded together. It will be seen that the upper extremities are so short that the tips of the digits will only just touch the iliac crests. "This occurrence of short limbs with polydactylism seems to prove conclusively that the condition may be due to a modification of development of a totally different nature from rickets. It is probable that the infant was not at full term. Among the points which the author has noticed in his description are that the fontanelle was double its usual size; that the orbits were somewhat deformed; that the two halves of the lower jaw were already united; and that the ribs were short and badly formed. He also, of course, draws attention to the shortness of the limbs, the stoutness of the long bones, and the supernumerary digits. I find no statement that the skeleton was deposited in any museum, but it is very possible that it is still in existence in Amsterdam, and if so it is very desirable that it should be more exactly described." In Figure 126, A represents division of thumb after Guyot-Daubes, shows a typical case of supernumerary fingers, and C pictures Morand's case of duplication of several toes. Forster gives a sketch of a hand with nine fingers and a foot with nine toes. Voight records an instance of 13 fingers on each hand and 12 toes on each foot. Saviard saw an infant at the Hotel-Dieu in Paris in 1687 which had 40 digits, ten on each member. Annandale relates the history of a woman who had six fingers and two thumbs on each hand, and another who had eight toes on one foot. Meckel tells of a case in which a man had 12 fingers and 12 toes, all well formed, and whose children and grandchildren inherited the deformity. Mason has seen nine toes on the left foot. There is recorded the account of a child who had 12 toes and six fingers on each hand, one fractured. Braid describes talipes varus in a child of a few months who had ten toes. There is also on record a collection of cases of from seven to ten fingers on each hand and from seven to ten toes on each foot. Scherer gives an illustration of a female infant, otherwise normally formed, with seven fingers on each hand, all united and bearing claw-like nails. On each foot there was a double halux and five other digits, some of which were webbed. The influence of heredity on this anomaly is well demonstrated. Reaumur was one of the first to prove this, as shown by the Kelleia family of Malta, and there have been many corroboratory instances reported; it is shown to last for three, four, and even five generations; intermarriage with normal persons finally eradicates it. It is particularly in places where consanguineous marriages are prevalent that supernumerary digits persist in a family. The family of Foldi in the tribe of Hyabites living in Arabia are very numerous and confine their marriages to their tribe. They all have 24 digits, and infants born with the normal number are sacrificed as being the offspring of adultery. The inhabitants of the village of Eycaux in France, at the end of the last century, had nearly all supernumerary digits either on the hands or feet. Being isolated in an inaccessible and mountainous region, they had for many years intermarried and thus perpetuated the anomaly. Communication being opened, they emigrated or married strangers and the sexdigitism vanished. Maupertuis recalls the history of a family living in Berlin whose members had 24 digits for many generations. One of them being presented with a normal infant refused to acknowledge it. There is an instance in the Western United States in which supernumerary digits have lasted through five generations. Cameron speaks of two children in the same family who were polydactylic, though not having the same number of supernumerary fingers. Smith and Norwell report the case of a boy of fifteen both of whose hands showed webbing of the middle and ring fingers and accessory nodules of bone between the metacarpals, and six toes on each foot. The boy's father showed similar malformations, and in five generations 21 out of 28 individuals were thus malformed, ten females and 11 males. The deformity was especially transmitted in the female line. Instances of supernumerary thumbs are cited by Panaroli, Ephemerides, Munconys, as well as in numerous journals since. This anomaly is not confined to man alone; apes, dogs, and other lower animals possess it. Bucephalus, the celebrated horse of Alexander, and the horse of Caesar were said to have been cloven-hoofed. Hypertrophy of the digits is the result of many different processes, and true hypertrophy or gigantism must be differentiated from acromegaly, elephantiasis, leontiasis, and arthritis deformans, for which distinction the reader is referred to an article by Park. Park also calls attention to the difference between acquired gigantism, particularly of the finger and toes, and another condition of congenital gigantism, in which either after or before birth there is a relatively disproportionate, sometimes enormous, overgrowth of perhaps one finger or two, perhaps of a limited portion of a hand or foot, or possibly of a part of one of the limbs. The best collection of this kind of specimens is in the College of Surgeons in London. Curling quotes a most peculiar instance of hypertrophy of the fingers in a sickly girl. The middle and ring fingers of the right hand were of unusual size, the middle finger measuring 5 1/2 inches in length four inches in circumference. On the left hand the thumb and middle fingers were hypertrophied and the index finger was as long as the middle one of the right hand. The middle finger had a lateral curvature outward, due to a displacement of the extensor tendon. This affection resembled acromegaly. Curling cites similar cases, one in a Spanish gentleman, Governor of Luzon, in the Philippine Islands, in 1850, who had an extraordinary middle finger, which he concealed by carrying it in the breast of his coat. Hutchinson exhibited a photograph showing the absence of the radius and thumb, with shortening of the forearm. Conditions more or less approaching this had occurred in several members of the same family. In some they were associated with defects of development in the lower extremities also. The varieties of club-foot--talipes varus, valgus, equinus, equino-varus, etc.--are so well known that they will be passed with mention only of a few persons who have been noted for their activity despite their deformity. Tyrtee, Parini, Byron, and Scott are among the poets who were club-footed; some writers say that Shakespeare suffered in a slight degree from this deformity. Agesilas, Genserie, Robert II, Duke of Normandy, Henry II, Emperor of the West, Otto II, Duke of Brunswick, Charles II, King of Naples, and Tamerlane were victims of deformed feet. Mlle. Valliere, the mistress of Louis XIV, was supposed to have both club-foot and hip-disease. Genu valgum and genu varum are ordinary deformities and quite common in all classes. Transpositions of the character of the vertebrae are sometimes seen. In man the lumbar vertebrae have sometimes assumed the character of the sacral vertebrae, the sacral vertebrae presenting the aspect of lumbar vertebrae, etc. It is quite common to see the first lumbar vertebra presenting certain characteristics of the dorsal. Numerical anomalies of the vertebrae are quite common, generally in the lumbar and dorsal regions, being quite rare in the cervical, although there have been instances of six or eight cervical vertebrae. In the lower animals the vertebrae are prolonged into a tail, which, however, is sometimes absent, particularly when hereditary influence exists. It has been noticed in the class of dogs whose tails are habitually amputated to improve their appearance that the tail gradually decreases in length. Some breeders deny this fact. Human Tails.--The prolongation of the coccyx sometimes takes the shape of a caudal extremity in man. Broca and others claim that the sacrum and the coccyx represent the normal tail of man, but examples are not infrequent in which there has been a fleshy or bony tail appended to the coccygeal region. Traditions of tailed men are old and widespread, and tailed races were supposed to reside in almost every country. There was at one time an ancient belief that all Cornishmen had tails, and certain men of Kent were said to have been afflicted with tails in retribution for their insults to Thomas a Becket. Struys, a Dutch traveler in Formosa in the seventeenth century, describes a wild man caught and tied for execution who had a tail more than a foot long, which was covered with red hair like that of a cow. The Niam Niams of Central Africa are reported to have tails smooth and hairy and from two to ten inches long. Hubsch of Constantinople remarks that both men and women of this tribe have tails. Carpus, or Berengarius Carpensis, as he is called, in one of his Commentaries said that there were some people in Hibernia with long tails, but whether they were fleshy or cartilaginous could not be known, as the people could not be approached. Certain supposed tailed races which have been described by sea-captains and voyagers are really only examples of people who wear artificial appendages about the waists, such as palm-leaves and hair. A certain Wesleyan missionary, George Brown, in 1876 spoke of a formal breeding of a tailed race in Kali, off the coast of New Britain. Tailless children were slain at once, as they would be exposed to public ridicule. The tailed men of Borneo are people afflicted with hereditary malformation analogous to sexdigitism. A tailed race of princes have ruled Rajoopootana, and are fond of their ancestral mark. There are fabulous stories told of canoes in the East Indies which have holes in their benches made for the tails of the rowers. At one time in the East the presence of tails was taken as a sign of brute force. There was reported from Caracas the discovery of a tribe of Indians in Paraguay who were provided with tails. The narrative reads somewhat after this manner: One day a number of workmen belonging to Tacura Tuyn while engaged in cutting grass had their mules attacked by some Guayacuyan Indians. The workmen pursued the Indians but only succeeded in capturing a boy of eight. He was taken to the house of Senor Francisco Galeochoa at Posedas, and was there discovered to have a tail ten inches long. On interrogation the boy stated that he had a brother who had a tail as long as his own, and that all the tribe had tails. Aetius, Bartholinus, Falk, Harvey, Kolping, Hesse, Paulinus, Strauss, and Wolff give descriptions of tails. Blanchard says he saw a tail fully a span in length: and there is a description in 1690 of a man by the name of Emanuel Konig, a son of a doctor of laws who had a tail half a span long, which grew directly downward from the coccyx and was coiled on the perineum, causing much discomfort. Jacob describes a pouch of skin resembling a tail which hung from the tip of the coccyx to the length of six inches. It was removed and was found to be thicker than the thumb, consisted of distinctly jointed portions with synovial capsules. Gosselin saw at his clinic a caudal appendix in an infant which measured about ten cm. Lissner says that in 1872 he assisted in the delivery of a young girl who had a tail consisting of a coccyx prolonged and covered with skin, and in 1884 he saw the same girl, at this time the tail measuring nearly 13 cm. Virchow received for examination a tail three inches long amputated from a boy of eight weeks. Ornstein, chief physician of the Greek army, describes a Greek of twenty-six who had a hairless, conical tail, free only at the tip, two inches long and containing three vertebrae. He also remarks that other instances have been observed in recruits. Thirk of Broussa in 1820 described the tail of a Kurd of twenty-two which contained four vertebrae. Belinovski gives an account of a hip-joint amputation and extirpation of a fatty caudal extremity, the only one he had ever observed. Before the Berlin Anthropological Society there were presented two adult male Papuans, in good health and spirits, who had been brought from New Guinea; their coccygeal bones projected 1 1/2 inches. Oliver Wendell Holmes in the Atlantic Monthly, June, 1890, says that he saw in London a photograph of a boy with a considerable tail. The "Moi Boy" was a lad of twelve, who was found in Cochin China, with a tail a foot long which was simply a mass of flesh. Miller tells of a West Point student who had an elongation of the coccyx, forming a protuberance which bulged very visibly under the skin. Exercise at the riding school always gave him great distress, and the protuberance would often chafe until the skin was broken, the blood trickling into his boots. Bartels presents a very complete article in which he describes 21 persons born with tails, most of the tails being merely fleshy protuberances. Darwin speaks of a person with a fleshy tail and refers to a French article on human tails. Science contains a description of a negro child born near Louisville, eight weeks old, with a pedunculated tail 2 1/2 inches long, with a base 1 1/4 inches in circumference. The tail resembled in shape a pig's tail and had grown 1/4 inch since birth. It showed no signs of cartilage or bone, and had its origin from a point slightly to the left of the median line and about an inch above the end of the spinal column. Dickinson recently reported the birth of a child with a tail. It was a well-developed female between 5 1/2 and six pounds in weight. The coccyx was covered with the skin on both the anterior and posterior surfaces. It thus formed a tail of the size of the nail of the little finger, with a length of nearly 3/16 inch on the inner surface and 3/8 inch on the rear surface. This little tip could be raised from the body and it slowly sank back. In addition to the familiar caudal projection of the human fetus, Dickinson mentions a group of other vestigial remains of a former state of things. Briefly these are:-- (1) The plica semilunaris as a vestige of the nictitating membrane of certain birds. (2) The pointed ear, or the turned-down tip of the ears of many men. (3) The atrophied muscles, such as those that move the ear, that are well developed in certain people, or that shift the scalp, resembling the action of a horse in ridding itself of flies. (4) The supracondyloid foremen of the humerus. (5) The vermiform appendix. (6) The location and direction of the hair on the trunk and limbs. (7) The dwindling wisdom-teeth. (8) The feet of the fetus strongly deflected inward, as in the apes, and persisting in the early months of life, together with great mobility and a distinct projection of the great toe at an angle from the side of the foot. (9) The remarkable grasping power of the hand at birth and for a few weeks thereafter, that permits young babies to suspend their whole weight on a cane for a period varying from half a minute to two minutes. Horrocks ascribes to these anal tags a pathologic importance. He claims that they may be productive of fistula in ano, superficial ulcerations, fecal concretions, fissure in ano, and that they may hypertrophy and set up tenesmus and other troubles. The presence of human tails has given rise to discussion between friends and opponents of the Darwinian theory. By some it is considered a reversion to the lower species, while others deny this and claim it to be simply a pathologic appendix. Anomalies of the Spinal Canal and Contents.--When there is a default in the spinal column, the vice of conformation is called spina bifida. This is of two classes: first, a simple opening in the vertebral canal, and, second, a large cleft sufficient to allow the egress of spinal membranes and substance. Figure 130 represents a large congenital sacral tumor. Achard speaks of partial duplication of the central canal of the spinal cord. De Cecco reports a singular case of duplication of the lumbar segment of the spinal cord. Wagner speaks of duplication of a portion of the spinal cord. Foot records a case of amyelia, or absence of the spinal cord, in a fetus with hernia cerebri and complete fissure of the spinal column. Nicoll and Arnold describe an anencephalous fetus with absence of spinal marrow; and Smith also records the birth of an amyelitic fetus. In some persons there are exaggerated curvatures of the spine. The first of these curvatures is called kyphosis, in which the curvature is posterior; second, lordosis, in which the curvature is anterior; third, scoliosis, in which it is lateral, to the right or left. Kyphosis is the most common of the deviations in man and is most often found in the dorsal region, although it may be in the lumbar region. Congenital kyphosis is very rare in man, is generally seen in monsters, and when it does exist is usually accompanied by lordosis or spine bifida. We sometimes observe a condition of anterior curvature of the lumbar and sacral regions, which might be taken for a congenital lordosis, but this is really a deformity produced after birth by the physiologic weight of the body. Figure 131 represents a case of lordosis caused by paralysis of the spinal muscles. Analogous to this is what the accoucheurs call spondylolisthesis. Scoliosis may be a cervicodorsal, dorsolumbar, or lumbosacral curve, and the inclination of the vertebral column may be to the right or left. The pathologists divide scoliosis into a myopathic variety, in which the trouble is a physiologic antagonism of the muscles; or osteopathic, ordinarily associated with rachitis, which latter variety is generally accountable for congenital scoliosis. In some cases the diameter of the chest is shortened to an almost incredible degree, but may yet be compatible with life. Glover speaks of an extraordinary deformity of the chest with lateral curvature of the spine, in which the diameter from the pit of the stomach to the spinal integument was only 5 1/2 inches. Supernumerary ribs are not at all uncommon in man, nearly every medical museum having some examples. Cervical ribs are not rare. Gordon describes a young man of seventeen in whom there was a pair of supernumerary ribs attached to the cervical vertebrae. Bernhardt mentions an instance in which cervical ribs caused motor and sensory disturbances. Dumerin of Lyons showed an infant of eight days which had an arrested development of the 2d, 3d, 4th, and 5th ribs. Cases of deficient ribs are occasionally met. Wistar in 1818 gives an account of a person in whom one side of the thorax was at rest while the other performed the movements of breathing in the usual manner. In some cases we see fissure of the sternum, caused either by deficient union or absence of one of its constituent parts. In the most exaggerated cases these fissures permit the exit of the heart, and as a general rule ectopies of the heart are thus caused. Pavy has given a most remarkable case of sternal fissure in a young man of twenty-five, a native of Hamburg. He exhibited himself in one medical clinic after another all over Europe, and was always viewed with the greatest interest. In the median line, corresponding to the absence of sternum, was a longitudinal groove bounded on either side by a continuous hard ridge which articulated with the costal cartilages. The skin passed naturally over the chest from one side to another, but was raised at one part of the groove by a pulsatile swelling which occupied the position of the right auricle. The clavicle and the two margins of the sternum had no connections whatever, and below the groove was a hard substance corresponding to the ensiform cartilage, which, however, was very elastic, and allowed the patient, under the influence of the pectoral muscles, when the upper extremity was fixed, to open the groove to nearly the extent of three inches, which was more than twice its natural width. By approximating his arms he made the ends of his clavicles overlap. When he coughed, the right lung suddenly protruded from the chest through the groove and ascended a considerable distance above the clavicle into the neck. Between the clavicles another pulsatile swelling was easily felt but hardly seen, which was doubtless the arch of the aorta, as by putting the fingers on it one could feel a double shock, synchronous with distention and recoil of a vessel or opening and closing of the semilunar valves. Madden pictures (Figs. 134 and 135) a Swede of forty with congenital absence of osseous structure in the middle line of the sternum, leaving a fissure 5 3/8 X 1 3/16 X 2 inches, the longest diameter being vertical. Madden also mentions several analogous instances on record. Groux's case was in a person of forty-five, and the fissure had the vertical length of four inches. Hodgen of St. Louis reports a case in which there was exstrophy of the heart through the fissure. Slocum reports the occurrence of a sternal fissure 3 X 1 1/2 inches in an Irishman of twenty-five. Madden also cites the case of Abbott in an adult negress and a mother. Obermeier mentions several cases. Gibson and Malet describe a presternal fissure uncovering the base of the heart. Ziemssen, Wrany, and Williams also record congenital fissures of the sternum. Thomson has collected 86 cases of thoracic defects and summarizes his paper by saying that the structures deficient are generally the hair in the mammary and axillary regions, the subcutaneous fat over the muscles, nipples, and breasts, the pectorals and adjacent muscles, the costal cartilages and anterior ends of ribs, the hand and forearm; he also adds that there may be a hernia of the lung, not hereditary, but probably due to the pressure of the arm against the chest. De Marque gives a curious instance in which the chin and chest were congenitally fastened together. Muirhead cites an instance in which a firm, broad strip of cartilage resembling sternomastoid extended from below the left ear to the left upper corner of the sternum, being entirely separate from the jaw. Some preliminary knowledge of embryology is essential to understand the formation of branchial fissures, and we refer the reader to any of the standard works on embryology for this information. Dzondi was one of the first to recognize and classify congenital fistulas of the neck. The proper classification is into lateral and median fissures. In a case studied by Fevrier the exploration of a lateral pharyngeal fistula produced by the introduction of the sound violent reflex phenomena, such as pallor of the face and irregular, violent beating of the heart. The rarest of the lateral class is the preauricular fissure, which has been observed by Fevrier, Le Dentu, Marchand, Peyrot, and Routier. The median congenital fissures of the neck are probably caused by defective union of the branchial arches, although Arndt thinks that he sees in these median fistulas a persistence of the hypobranchial furrow which exists normally in the amphioxus. They are less frequent than the preceding variety. The most typical form of malformation of the esophagus is imperforation or obliteration. Van Cuyck of Brussels in 1824 delivered a child which died on the third day from malnutrition. Postmortem it was found that the inferior extremity of the esophagus to the extent of about two inches was converted into a ligamentous cord. Porro describes a case of congenital obliteration of the esophagus which ended in a cecal pouch about one inch below the inferior portion of the glottidean aperture and from this point to the stomach only measured an inch; there was also tracheal communication. The child was noticed to take to the breast with avidity, but after a little suckling it would cough, become livid, and reject most of the milk through the nose, in this way almost suffocating at each paroxysm; it died on the third day. In some cases the esophagus is divided, one portion opening into the bronchial or other thoracic organs. Brentano describes an infant dying ten days after birth whose esophagus was divided into two portions, one terminating in a culdesac, the other opening into the bronchi; the left kidney was also displaced downward. Blasius describes an anomalous case of duplication of the esophagus. Grashuys, and subsequently Vicq d'Azir, saw a dilatation of the esophagus resembling the crop of a bird. Anomalies of the Lungs.--Carper describes a fetus of thirty-seven weeks in whose thorax he found a very voluminous thymus gland but no lungs. These organs were simply represented by two little oval bodies having no lobes, with the color of the tissue of the liver. The heart had only one cavity but all the other organs were perfectly formed. This case seems to be unique. Tichomiroff records the case of a woman of twenty-four who died of pneumonia in whom the left lung was entirely missing. No traces of a left bronchus existed. The subject was very poorly developed physically. Tichomiroff finds four other cases in literature, in all of which the left lung was absent. Theremin and Tyson record cases of the absence of the left lung. Supplementary pulmonary lobes are occasionally seen in man and are taken by some authorities to be examples of retrogressive anomalies tending to prove that the derivation of the human race is from the quadrupeds which show analogous pulmonary malformation. Eckley reports an instance of supernumerary lobe of the right lung in close connection with the vena azygos major. Collins mentions a similar case. Bonnet and Edwards speak of instances of four lobes in the right lung. Testut and Marcondes report a description of a lung with six lobes. Anomalies of the Diaphragm.--Diemerbroeck is said to have dissected a human subject in whom the diaphragm and mediastinum were apparently missing, but such cases must be very rare, although we frequently find marked deficiency of this organ. Bouchand reports an instance of absence of the right half of the diaphragm in an infant born at term. Lawrence mentions congenital deficiency of the muscular fibers of the left half of the diaphragm with displacement of the stomach. The patient died of double pneumonia. Carruthers, McClintock, Polaillon, and van Geison also record instances of congenital deficiency of part of the diaphragm. Recently Dittel reported unilateral defect in the diaphragm of an infant that died soon after birth. The stomach, small intestines, and part of the large omentum lay in the left pleural cavity; both the phrenic nerves were normal. Many similar cases of diaphragmatic hernia have been observed. In such cases the opening may be large enough to allow a great part of the visceral constituents to pass into the thorax, sometimes seriously interfering with respiration and circulation by the pressure which ensues. Alderson reports a fatal case of diaphragmatic hernia with symptoms of pneumothorax. The stomach, spleen, omentum, and transverse colon were found lying in the left pleura. Berchon mentions double perforation of the diaphragm with hernia of the epiploon. The most extensive paper on this subject was contributed by Bodwitch, who, besides reporting an instance in the Massachusetts General Hospital, gives a numerical analysis of all the cases of this affection found recorded in the writings of medical authors between the years 1610 and 1846. Hillier speaks of an instance of congenital diaphragmatic hernia in which nearly all the small intestines and two-thirds of the large passed into the right side of the thorax. Macnab reports an instance in which three years after the cure of empyema the whole stomach constituted the hernia. Recently Joly described congenital hernia of the stomach in a man of thirty-seven, who died from collapse following lymphangitis, persistent vomiting, and diarrhea. At the postmortem there was found a defect in the diaphragm on the left side, permitting herniation of the stomach and first part of the duodenum into the left pleural cavity. There was no history of traumatism to account for strangulation. Longworth cites an instance of inversion of the diaphragm in a human subject. Bartholinus mentions coalition of the diaphragm and liver; and similar cases are spoken of by Morgagni and the Ephemerides. Hoffman describes diaphragmatic junction with the lung. Anomalies of the Stomach.--The Ephemerides contains the account of a dissection in which the stomach was found wanting, and also speaks of two instances of duplex stomach. Bartholinus, Heister, Hufeland, Morgagni, Riolan, and Sandifort cite examples of duplex stomach. Bonet speaks of a case of vomiting which was caused by a double stomach. Struthers reports two cases in which there were two cavities to the stomach. Struthers also mentions that Morgagni, Home, Monro, Palmer, Larry, Blasius, Hufeland, and Walther also record instances in which there was contraction in the middle of the stomach, accounting for their instances of duplex stomach. Musser reports an instance of hour-glass contraction of the stomach. Hart dissected the stomach of a woman of thirty which resembled the stomach of a predaceous bird, with patches of tendon on its surface. The right extremity instead of continuously contracting ended in a culdesac one-half as large as the greater end of the stomach. The duodenum proceeded from the depression marking the lesser arch of the organ midway between the cardiac orifice and the right extremity. Crooks speaks of a case in which the stomach of an infant terminated in a culdesac. Hernia of the stomach is not uncommon, especially in diaphragmatic or umbilical deficiency. There are many cases on record, some terminating fatally from strangulation or exposure to traumatism. Paterson reports a case of congenital hernia of the stomach into the left portion of the thoracic cavity. It was covered with fat and occupied the whole left half of the thoracic cavity. The spleen, pancreas, and transverse colon were also superior to the diaphragm. Death was caused by a well-defined round perforation at the cardiac curvature the size of a sixpence. Anomalies of the Intestines.--The Ephemerides contains the account of an example of double cecum, and Alexander speaks of a double colon, and there are other cases of duplication of the bowel recorded. There is an instance of coalition of the jejunum with the liver, and Treuner parallels this case. Aubery, Charrier Poelman, and others speak of congenital division of the intestinal canal. Congenital occlusion is quite frequently reported. Dilatation of the colon frequently occurs as a transient affection, and by its action in pushing up the diaphragm may so seriously interfere with the action of the heart and lungs as to occasionally cause heart-failure. Fenwick has mentioned an instance of this nature. According to Osler there is a chronic form of dilatation of the colon in which the gut may reach an enormous size. The coats may be hypertrophied without evidence of any special organic change in the mucosa. The most remarkable instance has been reported by Formad. The patient, known as the "balloon-man," aged twenty-three at the time of his death, had had a distended abdomen from infancy. Postmortem the colon was found as large as that of an ox, the circumference ranging from 15 to 30 inches. The weight of the contents was 47 pounds. Cases are not uncommon in children. Osler reports three well-marked cases under his care. Chapman mentions a case in which the liver was displaced by dilatation of the sigmoid flexure. Mya reports two cases of congenital dilatation and hypertrophy of the colon (megacolon congenito). Hirsohsprung, Genersich, Faralli, Walker, and Griffiths all record similar instances, and in all these cases the clinical features were obstinate constipation and marked meteorismus. Imperforate Anus.--Cases in which the anus is imperforate or the rectum ends in a blind pouch are occasionally seen. In some instances the rectum is entirely absent, the colon being the termination of the intestinal tract. There are cases on record in which the rectum communicated with the anus solely by a fibromuscular cord. Anorectal atresia is the ordinary imperforation of the anus, in which the rectum terminates in the middle of the sacral cavity. The rectum may be deficient from the superior third of the sacrum, and in this position is quite inaccessible for operation. A compensatory coalition of the bowel with the bladder or urethra is sometimes present, and in these cases the feces are voided by the urinary passages. Huxham mentions the fusion of the rectum and colon with the bladder, and similar instances are reported by Dumas and Baillie. Zacutus Lusitanus describes an infant with an imperforate membrane over its anus who voided feces through the urethra for three months. After puncture of the membrane, the discharge came through the natural passage and the child lived; Morgagni mentions a somewhat similar case in a little girl living in Bologna, and other modern instances have been reported. The rectum may terminate in the vagina. Masters has seen a child who lived nine days in whom the sigmoid flexure of the colon terminated in the fundus of the bladder. Guinard pictures a case in which there was communication between the rectum and the bladder. In Figure 140 a represents the rectum; b the bladder; c the point of communication; g shows the cellular tissue of the scrotum. There is a description of a girl of fourteen, otherwise well constituted and healthy, who had neither external genital organs nor anus. There was a plain dermal covering over the genital and anal region. She ate regularly, but every three days she experienced pain in the umbilicus and much intestinal irritation, followed by severe vomiting of stercoraceous matter; the pains then ceased and she cleansed her mouth with aromatic washes, remaining well until the following third day. Some of the urine was evacuated by the mammae. The examiners displayed much desire to see her after puberty to note the disposition of the menstrual flow, but no further observation of her case can be found. Fournier narrates that he was called by three students, who had been trying to deliver a woman for five days. He found a well-constituted woman of twenty-two in horrible agony, who they said had not had a passage of the bowels for eight days, so he prescribed an enema. The student who was directed to give the enema found to his surprise that there was no anus, but by putting his finger in the vagina he could discern the floating end of the rectum, which was full of feces. There was an opening in this suspended rectum about the size of an undistended anus. Lavage was practiced by a cannula introduced through the opening, and a great number of cherry stones agglutinated with feces followed the water, and labor was soon terminated. The woman afterward confessed that she was perfectly aware of her deformity, but was ashamed to disclose it before. There was an analogue of this case found by Mercurialis in a child of a Jew called Teutonicus. Gerster reports a rare form of imperforate anus, with malposition of the left ureter, obliteration of the ostia of both ureters, with consequent hydronephrosis of a confluent kidney. There was a minute opening into the bladder, which allowed the passage of meconium through the urethra. Burge mentions the case of what he calls "sexless child," in which there was an imperforate anus and no pubic arch; the ureters discharged upon a tumor the size of a teacup extending from the umbilicus to the pubes. A postmortem examination confirmed the diagnosis of sexless child. The Liver.--The Ephemerides, Frankenau, von Home, Molinetti, Schenok, and others speak of deficient or absent liver. Zacutus Lusitanus says that he once found a mass of flesh in place of the liver. Lieutaud is quoted as describing a postmortem examination of an adult who had died of hydropsy, in whom the liver and spleen were entirely missing. The portal vein discharged immediately into the vena cava; this case is probably unique, as no authentic parallel could be found. Laget reports an instance of supernumerary lobe in the liver. Van Buren describes a supernumerary liver. Sometimes there is rotation, real or apparent, caused by transposition of the characteristics of the liver. Handy mentions such a case. Kirmisson reports a singular anomaly of the liver which he calls double displacement by interversion and rotation on the vertical axis. Actual displacements of the liver as well as what is known as wandering liver are not uncommon. The operation for floating liver will be spoken of later. Hawkins reports a case of congenital obliteration of the ductus communis choledochus in a male infant which died at the age of four and a half months. Jaundice appeared on the eighth day and lasted through the short life. The hepatic and cystic ducts were pervious and the hepatic duct obliterated. There were signs of hepatic cirrhosis and in addition an inguinal hernia. The Gall-Bladder.--Harle mentions the case of a man of fifty, in whom he could find no gall-bladder; Patterson has seen a similar instance in a men of twenty-five. Purser describes a double gall-bladder. The spleen has been found deficient or wanting by Lebby, Ramsay, and others, but more frequently it is seen doubled. Cabrolius, Morgagni, and others have found two spleens in one subject; Cheselden and Fallopius report three; Fantoni mentions four found in one subject; Guy-Patin has seen five, none as large as the ordinary organ; Hollerius, Kerckringius, and others have remarked on multiple spleens. There is a possibility that in some of the cases of multiple spleens reported the organ is really single but divided into several lobes. Albrecht mentions a case shown at a meeting of the Vienna Medical Society of a very large number of spleens found in the mesogastrium, peritoneum, on the mesentery and transverse mesocolon, in Douglas' pouch, etc. There was a spleen "the size of a walnut" in the usual position, with the splenic artery and vein in their normal position. Every one of these spleens had a capsule, was covered by peritoneum, and exhibited the histologic appearance of splenic tissue. According to the review of this article, Toldt explains the case by assuming that other parts of the celomic epithelium, besides that of the mesogastrium, are capable of forming splenic tissue. Jameson reports a case of double spleen and kidneys. Bainbrigge mentions a case of supernumerary spleen causing death from the patient being placed in the supine position in consequence of fracture of the thigh. Peevor mentions an instance of second spleen. Beclard and Guy-Patin have seen the spleen congenitally misplaced on the right side and the liver on the left; Borellus and Bartholinus with others have observed misplacement of the spleen. The Pancreas.--Lieutaud has seen the pancreas missing and speaks of a double pancreatic duct that he found in a man who died from starvation; Bonet speaks of a case similar to this last. There are several cases of complete transposition of the viscera on record. This bizarre anomaly was probably observed first in 1650 by Riolanus, but the most celebrated case was that of Morand in 1660, and Mery described the instance later which was the subject of the following quatrain:-- "La nature, peu sage et sans douse en debauche Placa le foie au cote gauche, Et de meme, vice versa Le coeur a le droite placa." Young cites an example in a woman of eighty-five who died at Hammersmith, London. She was found dead in bed, and in a postmortem examination, ordered to discover if possible the cause of death, there was seen complete transposition of the viscera. The heart lay with its base toward the left, its apex toward the right, reaching the lower border of the 4th rib, under the right mamma. The vena cava was on the left side and passed into the pulmonary cavity of the heart, which was also on the left side, the aorta and systemic ventricle being on the right. The left splenic vein was lying on the superior vena cava, the liver under the left ribs, and the spleen on the right side underneath the heart. The esophagus was on the right of the aorta, and the location of the two ends of the stomach was reversed; the sigmoid flexure was on the right side. Davis describes a similar instance in a man. Herrick mentions transposition of viscera in a man of twenty-five. Barbieux cites a case of transposition of viscera in a man who was wounded in a duel. The liver was to the left and the spleen and heart to the right etc. Albers, Baron, Beclard, Boyer, Bull, Mackensie, Hutchinson, Hunt, Murray, Dareste, Curran, Duchesne, Musser, Sabatier, Shrady, Vulpian, Wilson, and Wehn are among others reporting instances of transposition and inversion of the viscera. Congenital extroversion or eventration is the result of some congenital deficiency in the abdominal wall; instances are not uncommon, and some patients live as long as do cases of umbilical hernia proper. Ramsey speaks of entire want of development of the abdominal parietes. Robertson, Rizzoli, Tait, Hamilton, Brodie, Denis, Dickie, Goyrand, and many others mention extroversion of viscera from parietal defects. The different forms of hernia will be considered in another chapter. There seem to be no authentic cases of complete absence of the kidney except in the lowest grades of monstrosities. Becker, Blasius, Rhodius, Baillie, Portal, Sandifort, Meckel, Schenck, and Stoll are among the older writers who have observed the absence of one kidney. In a recent paper Ballowitz has collected 213 cases, from which the following extract has been made by the British Medical Journal:-- "Ballowitz (Virchow's Archiv, August 5, 1895) has collected as far as possible all the recorded cases of congenital absence of one kidney. Excluding cases of fused kidney and of partial atrophy of one kidney, he finds 213 cases of complete absence of one kidney, upon which he bases the following conclusions: Such deficiency occurs almost twice as often in males as in females, a fact, however, which may be partly accounted for by the greater frequency of necropsies on males. As to age, 23 occurred in the fetus or newly born, most having some other congenital deformity, especially imperforate anus; the rest were about evenly distributed up to seventy years of age, after which only seven cases occurred. Taking all cases together, the deficiency is more common on the left than on the right side; but while in males the left kidney is far more commonly absent than the right, in females the two sides show the defect equally. The renal vessels were generally absent, as also the ureter, on the abnormal side (the latter in all except 15 cases); the suprarenal was missing in 31 cases. The solitary kidney was almost always normal in shape and position, but much enlarged. Microscopically the enlargement would seem to be due rather to hyperplasia than to hypertrophy. The bladder, except for absence of the opening of one ureter, was generally normal. In a large number of cases there were associated deformities of the organs of generation, especially of the female organs, and these were almost invariably on the side of the renal defect; they affected the conducting portion much more than the glandular portion--that is, uterus, vagina, and Fallopian tubes in the female, and vas deferens or vesiculae seminales in the male, rather than the ovaries or testicles. Finally, he points out the practical bearing of the subject--for example, the probability of calculus causing sudden suppression of urine in such cases--and also the danger of surgical interference, and suggests the possibility of diagnosing the condition by ascertaining the absence of the opening of one ureter in the bladder by means of the cystoscope, and also the likelihood of its occurring where any abnormality of the genital organs is found, especially if this be unilateral." Green reports the case of a female child in which the right kidney and right Fallopian tube and ovary were absent without any rudimentary structures in their place. Guiteras and Riesman have noted the absence of the right kidney, right ureter, and right adrenal in an old woman who had died of chronic nephritis. The left kidney although cirrhotic was very much enlarged. Tompsett describes a necropsy made on a coolie child of nearly twelve months, in which it was seen that in the place of a kidney there were two left organs connected at the apices by a prolongation of the cortical substance of each; the child had died of neglected malarial fever. Sandifort speaks of a case of double kidneys and double ureters, and cases of supernumerary kidney are not uncommon, generally being segmentation of one of the normal kidneys. Rayer has seen three kidneys united and formed like a horseshoe. We are quite familiar with the ordinary "horseshoe kidney," in which two normal kidneys are connected. There are several forms of displacement of the kidneys, the most common being the "floating kidney," which is sometimes successfully removed or fixed; Rayer has made an extensive study of this anomaly. The kidney may be displaced to the pelvis, and Guinard quotes an instance in which the left kidney was situated in the pelvis, to the left of the rectum and back of the bladder. The ureter of the left side was very short. The left renal artery came from the bifurcation of the aorta and the primitive iliacs. The right kidney was situated normally, and received from the aorta two arteries, whose volume did not surpass the two arteries supplying the left suprarenal capsule, which was in its ordinary place. Displacements of the kidney anteriorly are very rare. The ureters have been found multiple; Griffon reports the history of a male subject in whom the ureter on the left side was double throughout its whole length; there were two vesical orifices on the left side one above the other; and Morestin, in the same journal, mentions ureters double on both sides in a female subject. Molinetti speaks of six ureters in one person. Littre in 1705 described a case of coalition of the ureters. Allen describes an elongated kidney with two ureters. Coeyne mentions duplication of the ureters on both sides. Lediberder reports a case in which the ureter had double origin. Tyson cites an instance of four ureters in an infant. Penrose mentions the absence of the upper two-thirds of the left ureter, with a small cystic kidney, and there are parallel cases on record. The ureters sometimes have anomalous terminations either in the rectum, vagina, or directly in the urethra. This latter disposition is realized normally in a number of animals and causes the incessant flow of urine, resulting in a serious inconvenience. Flajani speaks of the termination of the ureters in the pelvis; Nebel has seen them appear just beneath the umbilicus; and Lieutaud describes a man who died at thirty-five, from another cause, whose ureters, as large as intestines, terminated in the urethral canal, causing him to urinate frequently; the bladder was absent. In the early part of this century there was a young girl examined in New York whose ureters emptied into a reddish carnosity on the mons veneris. The urine dribbled continuously, and if the child cried or made any exertion it came in jets. The genital organs participated but little in the deformity, and with the exception that the umbilicus was low and the anus more anterior than natural, the child was well formed and its health good. Colzi reports a case in which the left ureter opened externally at the left side of the hymen a little below the normal meatus urinarius. There is a case described of a man who evidently suffered from a patent urachus, as the urine passed in jets as if controlled by a sphincter from his umbilicus. Littre mentions a patent urachus in a boy of eighteen. Congenital dilatation of the ureters is occasionally seen in the new-born. Shattuck describes a male fetus showing reptilian characters in the sexual ducts. There was ectopia vesicae and prolapse of the intestine at the umbilicus; the right kidney was elongated; the right vas deferens opened into the ureter. There was persistence in a separate condition of the two Mullerian ducts which opened externally inferiorly, and there were two ducts near the openings which represented anal pouches. Both testicles were in the abdomen. Ord describes a man in whom one of the Mullerian ducts was persistent. Anomalies of the Bladder.--Blanchard, Blasius, Haller, Nebel, and Rhodius mention cases in which the bladder has been found absent and we have already mentioned some cases, but the instances in which the bladder has been duplex are much more frequent. Bourienne, Oberteuffer, Ruysch, Bartholinus, Morgagni, and Franck speak of vesical duplication. There is a description of a man who had two bladders, each receiving a ureter. Bussiere describes a triple bladder, and Scibelli of Naples mentions an instance in a subject who died at fifty-seven with symptoms of retention of urine. In the illustration, B represents the normal bladder, A and C the supplementary bladders, with D and E their respective points of entrance into B. As will be noticed, the ureters terminate in the supplementary bladders. Fantoni and Malgetti cite instances of quintuple bladders. The Ephemerides speaks of a case of coalition of the bladder with the os pubis and another case of coalition with the omentum. Prochaska mentions vesical fusion with the uterus, and we have already described union with the rectum and intestine. Exstrophy of the bladder is not rare, and is often associated with hypospadias, epispadias, and other malformations of the genitourinary tract. It consists of a deficiency of the abdominal wall in the hypogastric region, in which is seen the denuded bladder. It is remedied by many different and ingenious plastic operations. In an occasional instance in which there is occlusion at the umbilicus and again at the neck of the bladder this organ becomes so distended as to produce a most curious deformity in the fetus. Figure 143 shows such a case. The Heart.--Absence of the heart has never been recorded in human beings except in the case of monsters, as, for example, the omphalosites, although there was a case reported and firmly believed by the ancient authors,--a Roman soldier in whom Telasius said he could discover no vestige of a heart. The absence of one ventricle has been recorded. Schenck has seen the left ventricle deficient, and the Ephemerides, Behr, and Kerckring speak of a single ventricle only in the heart. Riolan mentions a heart in which both ventricles were absent. Jurgens reported in Berlin, February 1, 1882, an autopsy on a child who had lived some days after birth, in which the left ventricle of the heart was found completely absent. Playfair showed the heart of a child which had lived nine months in which one ventricle was absent. In King's College Hospital in London there is a heart of a boy of thirteen in which the cavities consist of a single ventricle and a single auricle. Duplication of the heart, notwithstanding the number of cases reported, has been admitted with the greatest reserve by Geoffroy-Saint-Hilaire and by a number of authors. Among the celebrated anatomists who describe duplex heart are Littre, Meckel, Collomb, Panum, Behr, Paullini, Rhodins, Winslow, and Zacutus Lusitanus. The Ephemerides cites an instance of triple heart, and Johnston has seen a triple heart in a goose. The phenomenon of "blue-disease," or congenital cyanosis, is due to the patency of the foremen ovale, which, instead of closing at birth, persists sometimes to adult life. Perhaps the most unique collection of congenital malformations of the heart from persons who have reached the age of puberty was to be seen in London in 1895. In this collection there was an adult heart in which the foremen ovale remained open until the age of thirty-seven; there were but two pulmonary valves; there was another heart showing a large patent foramen ovale from a man of forty-six; and there was a septum ventriculorum of an adult heart from a woman of sixty-three, who died of carcinoma of the breast, in which the foremen ovale was still open and would admit the fore-finger. This woman had shown no symptoms of the malformation. There were also hearts in which the interventricular septum was deficient, the ductus arteriosus patent, or some valvular malformation present. All these persons had reached puberty. Displacements of the heart are quite numerous. Deschamps of Laval made an autopsy on an old soldier which justified the expression, "He had a heart in his belly." This organ was found in the left lumbar region; it had, with its vessels, traversed an anomalous opening in the diaphragm. Franck observed in the Hospital of Colmar a woman with the heart in the epigastric region. Ramel and Vetter speak of the heart under the diaphragm. Inversion of the heart is quite frequent, and we often find reports of cases of this anomaly. Fournier describes a soldier of thirty years, of middle height, well proportioned and healthy, who was killed in a duel by receiving a wound in the abdomen; postmortem, the heart was found in the position of the right lung; the two lungs were joined and occupied the left chest. The anomalies of the vascular system are so numerous that we shall dismiss them with a slight mention. Malacarne in Torino in 1784 described a double aorta, and Hommelius mentions an analogous case. The following case is quite an interesting anatomic anomaly: A woman since infancy had difficulty in swallowing, which was augmented at the epoch of menstruation and after exercise; bleeding relieved her momentarily, but the difficulty always returned. At last deglutition became impossible and the patient died of malnutrition. A necropsy revealed the presence of the subclavicular artery passing between the tracheal artery and the esophagus, compressing this latter tube and opposing the passage of food. Anomalies of the Breasts.--The first of the anomalies of the generative apparatus to be discussed, although not distinctly belonging under this head, will be those of the mammae. Amazia, or complete absence of the breast, is seldom seen. Pilcher describes an individual who passed for a female, but who was really a male, in whom the breasts were absolutely wanting. Foerster, Froriep, and Ried cite instances associated with thoracic malformation. Greenhow reports a case in which the mammae were absent, although there were depressed rudimentary nipples and areolae. There were no ovaries and the uterus was congenitally imperfect. There was a negress spoken of in 1842 in whom the right breast was missing, and there are cases of but one breast, mentioned by King, Paull, and others. Scanzoni has observed absence of the left mamma with absence of the left ovary. Micromazia is not so rare, and is generally seen in females with associate genital troubles. Excessive development of the mammae, generally being a pathologic phenomenon, will be mentioned in another chapter. However, among some of the indigenous negroes the female breasts are naturally very large and pendulous. This is well shown in Figure 144, which represents a woman of the Bushman tribe nursing an infant. The breasts are sufficiently pendulous and loose to be easily thrown over the shoulder. Polymazia is of much more frequent occurrence than is supposed. Julia, the mother of Alexander Severus, was surnamed "Mammea" because she had supernumerary breasts. Anne Boleyn, the unfortunate wife of Henry VIII of England, was reputed to have had six toes, six fingers, and three breasts. Lynceus says that in his time there existed a Roman woman with four mammae, very beautiful in contour, arranged in two lines, regularly, one above the other, and all giving milk in abundance. Rubens has pictured a woman with four breasts; the painting may be seen in the Louvre in Paris. There was a young and wealthy heiress who addressed herself to the ancient faculty at Tubingen, asking, as she displayed four mammary, whether, should she marry, she would have three or four children at a birth. This was a belief with which some of her elder matron friends had inspired her, and which she held as a hindrance to marriage. Leichtenstern, who has collected 70 cases of polymazia in females and 22 in males, thinks that accessory breasts or nipples are due to atavism, and that our most remote inferiorly organized ancestors had many breasts, but that by constantly bearing but one child, from being polymastic, females have gradually become bimastic. Some of the older philosophers contended that by the presence of two breasts woman was originally intended to bear two children. Hirst says: "Supernumerary breasts and nipples are more common than is generally supposed. Bruce found 60 instances in 3956 persons examined (1.56 per cent). Leichtenstern places the frequency at one in 500. Both observers declare that men present the anomaly about twice as frequently as women. It is impossible to account for the accessory glands on the theory of reversion, as they occur with no regularity in situation, but may develop at odd places on the body. The most frequent position is on the pectoral surface below the true mammae and somewhat nearer the middle line, but an accessory gland has been observed on the left shoulder over the prominence of the deltoid, on the abdominal surface below the costal cartilages, above the umbilicus, in the axilla, in the groin, on the dorsal surface, on the labium majus, and on the outer aspect of the left thigh. Ahlfeld explains the presence of mammae on odd parts of the body by the theory that portions of the embryonal material entering into the composition of the mammary gland are carried to and implanted upon any portion of the exterior of the body by means of the amnion." Possibly the greatest number of accessory mammae reported is that of Neugebauer in 1886, who found ten in one person. Peuch in 1876 collected 77 cases, and since then Hamy, Quinqusud, Whiteford, Engstrom, and Mitchell Bruce have collected cases. Polymazia must have been known in the olden times, and we still have before us the old images of Diana, in which this goddess is portrayed with numerous breasts, indicating her ability to look after the growing child. Figure 145 shows an ancient Oriental statue of Artemisia or Diana now at Naples. Bartholinus has observed a Danish woman with three mammae, two ordinarily formed and a third forming a triangle with the others and resembling the breasts of a fat man. In the village of Phullendorf in Germany early in this century there was an old woman who sought alms from place to place, exhibiting to the curious four symmetrical breasts, arranged parallel. She was extremely ugly, and when on all fours, with her breasts pendulous, she resembled a beast. The authors have seen a man with six distinct nipples, arranged as regularly as those of a bitch or sow. The two lower were quite small. This man's body was covered with heavy, long hair, making him a very conspicuous object when seen naked during bathing. The hair was absent for a space of nearly an inch about the nipples. Borellus speaks of a woman with three mammae, two as ordinarily, the third to the left side, which gave milk, but not the same quantity as the others. Gardiner describes a mulatto woman who had four mammae, two of which were near the axillae, about four inches in circumference, with proportionate sized nipples. She became a mother at fourteen, and gave milk from all her breasts. In his "Dictionnaire Philosophique" Voltaire gives the history of a woman with four well-formed and symmetrically arranged breasts; she also exhibited an excrescence, covered with a nap-like hair, looking like a cow-tail. Percy thought the excrescence a prolongation of the coccyx, and said that similar instances were seen in savage men of Borneo. Percy says that among some prisoners taken in Austria was found a woman of Valachia, near Roumania, exceedingly fatigued, and suffering intensely from the cold. It was January, and the ground was covered with three feet of snow. She had been exposed with her two infants, who had been born twenty days, to this freezing temperature, and died on the next day. An examination of her body revealed five mammae, of which four projected as ordinarily, while the fifth was about the size of that of a girl at puberty. They all had an intense dark ring about them; the fifth was situated about five inches above the umbilicus. Percy injected the subject and dissected and described the mammary blood-supply. Hirst mentions a negress of nineteen who had nine mammae, all told, and as many nipples. The two normal glands were very large. Two accessory glands and nipples below them were small and did not excrete milk. All the other glands and nipples gave milk in large quantities. There were five nipples on the left and four on the right side. The patient's mother had an accessory mamma on the abdomen that secreted milk during the period of lactation. Charpentier has observed in his clinic a woman with two supplementary axillary mammae with nipples. They gave milk as the ordinary mammae. Robert saw a woman who nourished an infant by a mamma on the thigh. Until the time of pregnancy this mamma was taken for an ordinary nevus, but with pregnancy it began to develop and acquired the size of a citron. Figure 147 is from an old wood-cut showing a child suckling at a supernumerary mamma on its mother's thigh while its brother is at the natural breast. Jenner speaks of a breast on the outer side of the thigh four inches below the great trochanter. Hare describes a woman of thirty-seven who secreted normal milk from her axillae. Lee mentions a woman of thirty-five with four mammae and four nipples; she suckled with the pectoral and not the axillary breasts. McGillicudy describes a pair of rudimentary abdominal mammae, and there is another similar case recorded. Hartung mentions a woman of thirty who while suckling had a mamma on the left labium majus. It was excised, and microscopic examination showed its structure to be that of a rudimentary nipple and mammary gland. Leichtenstern cites a case of a mamma on the left shoulder nearly under the insertion of the deltoid, and Klob speaks of an acromial accessory mamma situated on the shoulder over the greatest prominence of the deltoid. Hall reports the case of a functionally active supernumerary mamma over the costal cartilage of the 8th rib. Jussieu speaks of a woman who had three breasts, one of which was situated on the groin and with which she occasionally suckled; her mother had three breasts, but they were all situated on the chest. Saunois details an account of a female who had two supernumerary breasts on the back. Bartholinus (quoted by Meckel) and Manget also mention mammae on the back, but Geoffroy-Saint-Hilaire questions their existence. Martin gives a very clear illustration of a woman with a supernumerary breast below the natural organ. Sneddon, who has collected quite a number of cases of polymazia, quotes the case of a woman who had two swellings in each axilla in which gland-structure was made out, but with no external openings, and which had no anatomic connection with the mammary glands proper. Shortly after birth they varied in size and proportion, as the breasts were full or empty, and in five weeks all traces of them were lost. Her only married sister had similar enlargements at her third confinement. Polymazia sometimes seems to be hereditary. Robert saw a daughter whose mother was polymastic, and Woodman saw a mother and eldest daughter who each had three nipples. Lousier mentions a woman wanting a mamma who transmitted this vice of conformation to her daughter. Handyside says he knew two brothers in both of whom breasts were wanting. Supernumerary nipples alone are also seen, as many as five having been found on the same breast. Neugebauer reports eight supernumerary nipples in one case. Hollerus has seen a woman who had two nipples on the same breast which gave milk with the same regularity and the same abundance as the single nipple. The Ephemerides contains a description of a triple nipple. Barth describes "mamma erratica" on the face in front of the right ear which enlarged during menstruation. Cases of deficiency of the nipples have been reported by the Ephemerides, Lentilius, Severinus, and Werckardus. Cases of functional male mammae will be discussed in Chapter IX. Complete absence of the hymen is very rare, if we may accept the statements of Devilliers, Tardieu, and Brouardel, as they have never seen an example in the numerous young girls they have examined from a medico-legal point of view. Duplication or biperforation of the hymen is also a very rare anomaly of this membrane. In this instance the hymen generally presents two lateral orifices, more or less irregular and separated by a membranous band, which gives the appearance of duplicity. Roze reported from Strasburg in 1866 a case of this kind, and Delens has observed two examples of biperforate hymen, which show very well that this disposition of the membrane is due to a vice of conformation. The first was in a girl of eleven, in which the membrane was of the usual size and thickness, but was duplicated on either side. In her sister of nine the hymen was normally conformed. The second case was in a girl under treatment by Cornil in 1876 for vaginitis. Her brother had accused a young man of eighteen of having violated her, and on examination the hymen showed a biperforate conformation; there were two oval orifices, their greatest diameter being in the vertical plane; the openings were situated on each side of the median line, about five mm. apart; the dividing band did not appear to be cicatricial, but presented the same roseate coloration as the rest of the hymen. Since this report quite a number of cases have been recorded. The different varieties of the hymen will be left to the works on obstetrics. As has already been observed, labor is frequently seriously complicated by a persistent and tough hymen. Deficient vulva may be caused by the persistence of a thick hymen, by congenital occlusion, or by absolute absence in vulvar structure. Bartholinus, Borellus, Ephemerides, Julius, Vallisneri, and Baux are among the older writers who mention this anomaly, but as it is generally associated with congenital occlusion, or complete absence of the vagina, the two will be considered together. Complete absence of the vagina is quite rare. Baux a reports a case of a girl of fourteen in whom "there was no trace of fundament or of genital organs." Oberteuffer speaks of a case of absent vagina. Vicq d'Azir is accredited with having seen two females who, not having a vagina, copulated all through life by the urethra, and Fournier sagely remarks that the extra large urethra may have been a special dispensation of nature. Bosquet describes a young girl of twenty with a triple vice of conformation--an obliterated vulva, closure of the vagina, and absence of the uterus. Menstrual hemorrhage took place from the gums. Clarke has studied a similar case which was authenticated by an autopsy. O'Ferral of Dublin, Gooch, Davies, Boyd, Tyler Smith, Hancock, Coste, Klayskens, Debrou, Braid, Watson, and others are quoted by Churchill as having mentioned the absence of the vagina. Amussat observed a German girl who did not have a trace of a vagina and who menstruated regularly. Griffith describes a specimen in the Museum of St. Bartholomew's Hospital, London, in which the ovaries lay on the surface of the pelvic peritoneum and there was neither uterus nor vagina; the pelvis had some of the characteristics of the male type. Matthews Duncan has observed a somewhat similar case, the vagina not measuring more than an inch in length. Ferguson describes a prostitute of eighteen who had never menstruated. The labia were found well developed, but there was no vagina, uterus, or ovaries. Coitus had been through the urethra, which was considerably distended, though not causing incontinence of urine. Hulke reports a case of congenital atresia of the vagina in a brunette of twenty, menstruation occurring through the urethra. He also mentions the instance of congenital atresia of the vagina with hernia of both ovaries into the left groin in a servant of twenty, and the case of an imperforate vagina in a girl of nineteen with an undeveloped uterus. Brodhurst reports an instance of absence of the vagina and uterus in a girl of sixteen who at four years of age showed signs of approaching puberty. At this early age the mons was covered with hair, and at ten the clitoris was three inches long and two inches in circumference. The mammae were well developed. The labia descended laterally and expanded into folds, resembling the scrotum. Azema reports an instance of complete absence of the vagina and impermeability and probable absence of the col uterinus. The deficiencies were remedied by operation. Berard mentions a similar deformity and operation in a girl of eighteen. Gooding cites an instance of absent vagina in a married woman, the uterus discharging the functions. Gosselin reports a case in which a voluminous tumor was formed by the retained menstrual fluid in a woman without a vagina. An artificial vagina was created, but the patient died from extravasation of blood into the peritoneal cavity. Carter, Polaillon, Martin, Curtis, Worthington, Hall, Hicks, Moliere, Patry, Dolbeau, Desormeaux, and Gratigny also record instances of absence of the vagina. There are some cases reported in extramedical literature which might be cited. Bussy Rabutin in his Memoires in 1639 speaks of an instance. The celebrated Madame Recamier was called by the younger Dumas an involuntary virgin; and in this connection could be cited the malicious and piquant sonnet-- Chateaubriand et Madame Recamier. "Juliette et Rene s'aimaient d'amour si tendre Que Dien, sans les punir, a pu leur pardonner: Il n'avait pas voulu que l'une put donner Ce que l'autre ne pouvait prendre." Duplex vagina has been observed by Bartholinus, Malacarne, Asch, Meckel, Osiander, Purcell, and other older writers. In more modern times reports of this anomaly are quite frequent. Hunter reports a case of labor at the seventh month in a woman with a double vagina, and delivery through the rectum. Atthill and Watts speak of double vagina with single uterus. Robb of Johns Hopkins Hospital reports a case of double vagina in a patient of twenty suffering from dyspareunia. The vaginal orifice was contracted; the urethra was dilated and had evidently been used for coitus. A membrane divided the vagina into two canals, the cervix lying in the right half; the septum was also divided. Both the thumbs of the patient were so short that their tips could scarcely meet those of the little fingers. Double vagina is also reported by Anway, Moulton, Freeman, Frazer, Haynes, Lemaistre, Boardman, Dickson, Dunoyer, and Rossignol. This anomaly is usually associated with bipartite or double uterus. Wilcox mentions a primipara, three months pregnant, with a double vagina and a bicornate uterus, who was safely delivered of several children. Haller and Borellus have seen double vagina, double uterus, and double ovarian supply; in the latter case there was also a double vulva. Sanger speaks of a supernumerary vagina connecting with the other vagina by a fistulous opening, and remarks that this was not a case of patent Gartner's duct. Cullingworth cites two cases in which there were transverse septa of the vagina. Stone reports five cases of transverse septa of the vagina. Three of the patients were young women who had never borne children or suffered injury. Pregnancy existed in each case. In the first the septum was about two inches from the introitus, and contained an opening about 1/2 inch in diameter which admitted the tip of the finger. The membrane was elastic and thin and showed no signs of inflammation. Menstruation had always been regular up to the time of pregnancy. The second was a duplicate of the first, excepting that a few bands extended from the cervix to the membranous septum. In the third the lumen of the vagina, about two inches from the introitus, was distinctly narrowed by a ridge of tissue. There was uterine displacement and some endocervicitis, but no history of injury or operation and no tendency to contraction. The two remaining cases occurred in patients seen by Dr. J. F. Scott. In one the septum was about 1 3/4 inches from the entrance to the vagina and contained an orifice large enough to admit a uterine probe. During labor the septum resisted the advance of the head for several hours, until it was slit in several directions. In the other, menstruation had always been irregular, intermissions being followed by a profuse flow of black and tarry blood, which lasted sometimes for fifteen days and was accompanied by severe pain. The septum was 1 1/2 inches from the vaginal orifice and contained an opening which admitted a uterine sound. It was very dense and tight and fully 1/8 inch in thickness. Mordie reported a case of congenital deficiency of the rectovaginal septum which was successfully remedied by operation. Anomalous Openings of the Vagina.--The vagina occasionally opens abnormally into the rectum, into the bladder, the urethra, or upon the abdominal parietes. Rossi reports from a hospital in Turin the case of a Piedmontese girl in whom there was an enormous tumor corresponding to the opening of the vaginal orifice; no traces of a vagina could be found. The tumor was incised and proved to be a living infant. The husband of the woman said that he had coitus without difficulty by the rectum, and examination showed that the vagina opened into the rectum, by which means impregnation had been accomplished. Bonnain and Payne have observed analogous cases of this abnormality of the vaginal opening and subsequent accouchement by the anus. Payne's case was of a woman of thirty-five, well formed, who had been in labor thirty-six hours, when the physician examined and looked in vain for a vaginal opening; the finger, gliding along the perineum, came in contact with the distended anus, in which was recognized the head of the fetus. The woman from prolongation of labor was in a complete state of prostration, which caused uterine inertia. Payne anesthetized the patient, applied the forceps, and extracted the fetus without further accident. The vulva of this woman five months afterward displayed all the characteristics of virginity, the vagina opened into the rectum, and menstruation had always been regular. This woman, as well as her husband, averred that they had no suspicion of the anomaly and that coitus (by the anus) had always been satisfactory. Opening of the vagina upon the parietes, of which Le Fort has collected a number of cases, has never been observed in connection with a viable fetus. Absence of the labia majora has been observed, especially by Pozzi, to the exclusion of all other anomalies. It is the rule in exstrophy of the bladder. Absence of the nymphae has also been observed, particularly by Auvard and by Perchaux, and is generally associated with imperfect development of the clitoris. Constantinedes reports absence of the external organs of generation, probably also of the uterus and its appendages, in a young lady. Van Haartman, LeFort, Magee, and Ogle cite cases of absence of the external female organs. Riolan in the early part of the seventeenth century reported a case of defective nymphae; Neubauer in 1774 offers a contrast to this case in an instance of triple nymphae. The nymphae are sometimes enormously enlarged by hypertrophy, by varicocele, or by elephantiasis, of which latter type Rigal de Gaillac has observed a most curious case. There is also a variety of enlargement of the clitoris which seems to be constant in some races; it may be a natural hypertrophy, or perhaps produced by artificial manipulation. The peculiar conditions under which the Chinese women are obliged to live, particularly their mode of sitting, is said to have the effect of causing unusual development of the mons veneris and the labia majora. On the other hand, some of the lower African races have been distinguished by the deficiency in development of the labia majora, mons veneris, and genital hair. In this respect they present an approximation to the genitals of the anthropoid apes, among whom the orang-outang alone shows any tendency to formation of the labia majora. The labial appendages of the Hottentot female have been celebrated for many years. Blumenbach and others of the earlier travelers found that the apron-like appearance of the genitals of the Hottentot women was due to abnormal hypertrophy of the labia and nymphae. According to John Knott, the French traveler, Le Vaillant, said that the more coquettish among the Hottentot girls are excited by extreme vanity to practice artificial elongation of the nympha and labia. They are said to pull and rub these parts, and even to stretch them by hanging weights to them. Some of them are said to spend several hours a day at this process, which is considered one of the important parts of the toilet of the Hottentot belle, this malformation being an attraction for the male members of the race. Merensky says that in Basutoland the elder women begin to practice labial manipulation on their female children shortly after infancy, and Adams has found this custom to prevail in Dahomey; he says that the King's seraglio includes 3000 members, the elect of his female subjects, all of whom have labia up to the standard of recognized length. Cameron found an analogous practice among the women of the shores of Lake Tanganyika. The females of this nation manipulated the skin of the lower part of the abdomens of the female children from infancy, and at puberty these women exhibit a cutaneous curtain over the genitals which reaches half-way down the thighs. A corresponding development of the preputian clitorides, attaining the length of 18 mm. or even more, has been observed among the females of Bechuanaland. The greatest elongation measured by Barrow was five inches, but it is quite probable that it was not possible for him to examine the longest, as the females so gifted generally occupied very high social positions. Morgagni describes a supernumerary left nympha, and Petit is accredited with seeing a case which exhibited neither nymphae, clitoris, nor urinary meatus. Mauriceau performed nymphotomy on a woman whose nymphae were so long as to render coitus difficult. Morand quotes a case of congenital malformation of the nymphae, to which he attributed impotency. There is sometimes coalition of the labia and nymphae, which may be so firm and extensive as to obliterate the vulva. Debout has reported a case of absence of the vulva in a woman of twenty upon whom he operated, which was the result of the fusion of the labia minora, and this with an enlarged clitoris gave the external appearance of an hermaphrodite. The absence of the clitoris coincides with epispadias in the male, and in atrophy of the vulva it is common to find the clitoris rudimentary; but a more frequent anomaly is hypertrophy of the clitoris. Among the older authorities quoting instances of enlarged clitorides are Bartholinus, Schenck, Hellwig, Rhodius, Riolanus, and Zacchias. Albucasis describes an operation for enlarged clitoris, Chabert ligated one, and Riedlin gives an instance of an enlarged clitoris, in which there appeared a tumor synchronous with the menstrual epoch. We learn from the classics that there were certain females inhabiting the borders of the Aegean Sea who had a sentimental attachment for one another which was called "Lesbian love," and which carried them to the highest degree of frenzy. The immortal effusions of Sappho contain references to this passion. The solution of this peculiar ardor is found in the fact that some of the females had enlarged clitorides, strong voices, robust figures, and imitated men. Their manner was imperative and authoritative to their sex, who worshiped them with perverted devotion. We find in Martial mention of this perverted love, and in the time of the dissolute Greeks and Romans ridiculous jealousies for unfaithfulness between these women prevailed. Aetius said that the Egyptians practiced amputation of the clitoris, so that enlargement of this organ must have been a common vice of conformation along the Nile. It was also said that the Egyptian women practiced circumcision on their females at the age of seven or eight, the time chosen being when the Nile was in flood. Bertherand cites examples of enlarged clitorides in Arab women; Bruce testifies to this circumstance in Abyssinia, and Mungo Park has observed it in the Mandingos and the Ibbos. Sonnini says that the women of Egypt had a natural excrescence, fleshy in consistency, quite thick and pendulous, coming from the skin of the mons veneris. Sonnini says that in a girl of eight he saw one of these caruncles which was 1/2 inch long, and another on a woman of twenty which was four inches long, and remarks that they seem peculiar only to women of distinct Egyptian origin. Duhouset says that in circumcision the Egyptian women not only remove a great part of the body of the clitoris with the prepuce, but also adjacent portions of the nymphae; Gallieni found a similar operation customary on the upper banks of the Niger. Otto at Breslau in 1824 reports seeing a negress with a clitoris 4 1/2 inches long and 1 1/2 inches in the transverse diameter; it projected from the vulva and when supine formed a complete covering for the vaginal orifice. The clitoris may at times become so large as to prevent coitus, and in France has constituted a legitimate cause for divorce. This organ is very sensitive, and it is said that in cases of supposed catalepsy a woman cannot bear titillation of the clitoris without some visible movement. Columbus cites an example of a clitoris as long as a little finger; Haller mentions one which measured seven inches, and there is a record of an enlarged clitoris which resembled the neck of a goose and which was 12 inches long. Bainbridge reports a case of enlarged clitoris in a woman of thirty-two who was confined with her first child. This organ was five inches in length and of about the diameter of a quiescent penis. Figure 149 shows a well-marked case of hypertrophy of the clitoris. Rogers describes a woman of twenty-five in a reduced state of health with an enormous clitoris and warts about the anus; there were also manifestations of tuberculosis. On questioning her, it was found that she had formerly masturbated; later she had sexual intercourse several times with a young man, but after his death she commenced self-abuse again, which brought on the present enlargement. The clitoris was ligated and came away without leaving disfigurement. Cassano and Pedretti of Naples reported an instance of monstrous clitoris in 1860 before the Academy of Medicine. In some cases ossification of the clitoris is observed Fournier speaks of a public woman in Venice who had an osseous clitoris; it was said that men having connection with her invariably suffered great pain, followed by inflammation of the penis. There are a few instances recorded of bifid clitoris, and Arnaud cites the history of a woman who had a double clitoris. Secretain speaks of a clitoris which was in a permanent state of erection. Complete absence of the ovaries is seldom seen, but there are instances in which one of the ovaries is missing. Hunter, Vidal, and Chaussier report in full cases of the absence of the ovaries, and Thudicum has collected 21 cases of this nature. Morgagni, Pears, and Cripps have published observations in which both ovaries were said to have been absent. Cripps speaks of a young girl of eighteen who had an infantile uterus and no ovaries; she neither menstruated nor had any signs of puberty. Lauth cites the case of a woman whose ovaries and uterus were rudimentary, and who exhibited none of the principal physiologic characteristics of her sex; on the other hand, Ruband describes a woman with only rudimentary ovaries who was very passionate and quite feminine in her aspect. At one time the existence of genuine supernumerary ovaries was vigorously disputed, and the older records contain no instances, but since the researches of Beigel, Puech, Thudicum, Winckler, de Sinety, and Paladino the presence of multiple ovaries is an incontestable fact. It was originally thought that supernumerary ovaries as well as supernumerary kidneys were simply segmentations of the normal organs and connected to them by portions of the proper substance; now, however, by the recent reports we are warranted in admitting these anomalous structures as distinct organs. It has even been suggested that it is the persistence of these ovaries that causes the menstruation of which we sometimes hear as taking place after ovariotomy. Sippel records an instance of third ovary; Mangiagalli has found a supernumerary ovary in the body of a still-born child, situated to the inner side of the normal organ. Winckel discovered a large supernumerary ovary connected to the uterus by its own ovarian ligament. Klebs found two ovaries on one side, both consisting of true ovarian tissue, and connected by a band 3/5 inch long. Doran divides supernumerary ovaries into three classes:-- (1) The ovarium succentauriatum of Beigel. (2) Those cases in which two masses of ovarian tissue are separated by ligamentous bands. (3) Entirely separate organs, as in Winckel's case. Prolapsus or displacement of the ovaries into the culdesac of Douglas, the vaginal wall, or into the rectum can be readily ascertained by the resulting sense of nausea, particularly in defecation or in coitus. Munde, Barnes, Lentz, Madden, and Heywood Smith report instances, and Cloquet describes an instance of inguinal hernia of the ovary in which the uterus as well as the Fallopian tube were found in the inguinal canal. Debierre mentions that Puech has gathered 88 instances of inguinal hernia of the ovary and 14 of the crural type, and also adds that Otte cites the only instance in which crural ovarian hernia has been found on both sides. Such a condition with other associate malformations of the genitalia might easily be mistaken for an instance of hermaphroditic testicles. The Fallopian tubes are rarely absent on either side, although Blasius reports an instance of deficient oviducts. Blot reports a case of atrophy, or rather rudimentary state of one of the ovaries, with absence of the tube on that side, in a woman of forty. Doran has an instance of multiple Fallopian tubes, and Richard, in 1861, says several varieties are noticed. These tubes are often found fused or adherent to the ovary or to the uterus; but Fabricius describes the symphysis of the Fallopian tube with the rectum. Absence of the uterus is frequently reported. Lieutaud and Richerand are each said to have dissected female subjects in whom neither the uterus nor its annexed organs were found. Many authors are accredited with mentioning instances of defective or deficient uteri, among them Bosquet, Boyer, Walther, Le Fort, Calori, Pozzi, Munde, and Strauch. Balade has reported a curious absence of the uterus and vagina in a girl of eighteen. Azem, Bastien, Bibb, Bovel, Warren, Ward, and many others report similar instances, and in several cases all the adnexa as well as the uterus and vagina were absent, and even the kidney and bladder malformed. Phillips speaks of two sisters, both married, with congenital absence of the uterus. In his masterly article on "Heredity," Sedgwick quotes an instance of total absence of the uterus in three out of five daughters of the same family; two of the three were twice married. Double uterus is so frequently reported that an enumeration of the cases would occupy several pages. Bicorn, bipartite, duplex, and double uteruses are so called according to the extent of the duplication. The varieties range all the way from slight increase to two distinct uteruses, with separate appendages and two vaginae. Meckel, Boehmer, and Callisen are among the older writers who have observed double uterus with associate double vagina. Figure 150 represents a transverse section of a bipartite uterus with a double vagina. The so-called uterus didelphus is really a duplex uterus, or a veritable double uterus, each segment having the appearance of a complete unicorn uterus more or less joined to its neighbor. Vallisneri relates the history of a woman who was poisoned by cantharides who had two uteruses, one opening into the vagina, the other into the rectum. Morand, Bartholinus, Tiedemann, Ollivier, Blundell, and many others relate instances of double uterus in which impregnation had occurred, the fetus being retained until the full term. Purcell of Dublin says that in the summer of 1773 he opened the body of a woman who died in the ninth month of pregnancy. He found a uterus of ordinary size and form as is usual at this period of gestation, which contained a full-grown fetus, but only one ovary attached to a single Fallopian tube. On the left side he found a second uterus, unimpregnated and of usual size, to which another ovary and tube were attached. Both of these uteruses were distinct and almost entirely separate. Pregnancy with Double Uterus.--Hollander describes the following anomaly of the uterus which he encountered during the performance of a celiotomy:-- "There were found two uteruses, the posterior one being a normal organ with its adnexa; connected with this uterus was another one, anterior to it. The two uteruses had a common cervix; the anterior of the two organs had no adnexa, though there were lateral peritoneal ligaments; it had become pregnant." Hollander explains the anomaly by stating that probably the Mullerian ducts or one of them had grown excessively, leading to a folding off of a portion which developed into the anterior uterus. Other cases of double uterus with pregnancy are mentioned on page 49. When there is simultaneous pregnancy in each portion of a double uterus a complication of circumstances arises. Debierre quotes an instance of a woman who bore one child on July 16, 1870, and another on October 31st of the same year, and both at full term. She had only had three menstrual periods between the confinements. The question as to whether a case like this would be one of superfetation in a normal uterus, or whether the uterus was double, would immediately arise. There would also be the possibility that one of the children was of protracted gestation or that the other was of premature birth. Article 312 of the Civil Code of France accords a minimum of one hundred and eighty and a maximum of three hundred days for the gestation of a viable child. (See Protracted Gestation.) Voight is accredited with having seen a triple uterus, and there are several older parallels on record. Thilow mentions a uterus which was divided into three small portions. Of the different anomalous positions of the uterus, most of which are acquired, the only one that will be mentioned is that of complete prolapse of the uterus. In this instance the organ may hang entirely out of the body and even forbid locomotion. Of 19 cases of hernia of the uterus quoted by Debierre 13 have been observed in the inguinal region, five on the right and seven on the left side. In the case of Roux in 1891 the hernia existed on both sides. The uterus has been found twice only in crural hernia and three times in umbilical hernia. There is one case recorded, according to Debierre, in which the uterus was one of the constituents of an obturator hernia. Sometimes its appendages are found with it. Doring, Ledesma, Rektorzick, and Scazoni have found the uterus in the sac of an inguinal hernia; Leotaud, Murray, and Hagner in an umbilical hernia. The accompanying illustration represents a hernia of the gravid womb through the linea alba. Absence of the penis is an extremely rare anomaly, although it has been noted by Schenck, Borellus, Bouteiller, Nelaton, and others. Fortunatus Fidelis and Revolat describe a newly born child with absence of external genitals, with spina bifida and umbilical hernia. Nelaton describes a child of two entirely without a penis, but both testicles were found in the scrotum; the boy urinated by the rectum. Ashby and Wright mention complete absence of the penis, the urethra opening at the margin of the anus outside the external sphincter; the scrotum and testicles were well developed. Murphy gives the description of a well-formed infant apparently without a penis; the child passed urine through an opening in the lower part of the abdomen just above the ordinary location of the penis; the scrotum was present. Incisions were made into a small swelling just below the urinary opening in the abdomen which brought into view the penis, the glans being normal but the body very small. The treatment consisted of pressing out the glans daily until the wound healed; the penis receded spontaneously. It is stated that the organ would doubtless be equal to any requirements demanded of it. Demarquay quotes a somewhat similar case in an infant, but it had no urinary opening until after operation. Among the older writers speaking of deficient or absent penis are Bartholinus, Bauhinus, Cattierus, the Ephemerides, Frank, Panaroli, van der Wiel, and others. Renauldin describes a man with a small penis and enormous mammae. Goschler, quoted by Jacobson, speaks of a well-developed man of twenty-two, with abundant hair on his chin and suprapubic region and the scrotum apparently perfect, with median rapine; a careful search failed to show any trace of a penis; on the anterior wall of the rectum four lines above the anus was an orifice which gave vent to urine; the right testicle and cord were normal, but there was an acute orchitis in the left. Starting from just in front of the anal orifice was a fold of skin 1 1/2 inches long and 3/4 inch high continuous with the rapine, which seemed to be formed of erectile tissue and which swelled under excitement, the enlargement lasting several minutes with usually an emission from the rectum. It was possible to pass a sound through the opening in the rectum to the bladder through a urethra 1 1/2 inches wide; the patient had control of the bladder and urinated from every three to five hours. Many instances of rudimentary development of the penis have been recorded, most of them complicated with cryptorchism or other abnormality of the sexual organs. In other instances the organ is present, but the infantile type is present all through life; sometimes the subjects are weak in intellect and in a condition similar to cretinism. Kaufmann quotes a case in a weakly boy of twelve whose penis was but 3/4 inch long, about as thick as a goose-quill, and feeling as limp as a mere tube of skin; the corpora cavernosa were not entirely absent, but ran only from the ischium to the junction of the fixed portion of the penis, suddenly terminating at this point. Nothing indicative of a prostate could be found. The testicles were at the entrance of the inguinal canal and the glans was only slightly developed. Binet speaks of a man of fifty-three whose external genitalia were of the size of those of a boy of nine. The penis was of about the size of the little finger, and contained on each side testicles not larger than a pea. There was no hair on the pubes or the face, giving the man the aspect of an old woman. The prostate was almost exterminated and the seminal vesicles were very primitive in conformation. Wilson was consulted by a gentleman of twenty-six as to his ability to perform the marital function. In size his penis and testicles hardly exceeded those of a boy of eight. He had never felt desire for sexual intercourse until he became acquainted with his intended wife, since when he had erections and nocturnal emissions. The patient married and became the father of a family; those parts which at twenty-six were so much smaller than usual had increased at twenty-eight to normal adult size. There are three cases on record in the older literature of penises extremely primitive in development. They are quoted by the Ephemerides, Plater, Schenck, and Zacchias. The result in these cases was impotency. In the Army and Medical Museum at Washington are two injected specimens of the male organ divested of skin. From the meatus to the pubis they measure 6 1/2 and 5 1/2 inches; from the extremity to the termination of either crus 9 3/4 and 8 3/4 inches, and the circumferences are 4 3/4 and 4 1/4 inches. Between these two we can strike an average of the size of the normal penis. In some instances the penis is so large as to forbid coitus and even inconvenience its possessor, measuring as much as ten or even more inches in length. Extraordinary cases of large penis are reported by Albinus (who mentions it as a cause for sterility), Bartholinus, Fabricius Hildanus, Paullini, Peyer, Plater, Schurig, Sinibaldus, and Zacchias. Several cases of enormous penises in the new-born have been observed by Wolff and others. The penis palme, or suture de la verge of the French, is the name given to those examples of single cutaneous envelope for both the testicles and penis; the penis is adherent to the scrotum by its inferior face; the glans only is free and erection is impossible. Chretien cites an instance in a man of twenty-five, and Schrumpf of Wesserling describes an example of this rare anomaly. The penis and testes were inclosed in a common sac, a slight projection not over 1/4 inch long being seen from the upper part of this curious scrotum. When the child was a year old a plastic operation was performed on this anomalous member with a very satisfactory result. Petit describes an instance in which the penis was slightly fused with the scrotum. There are many varieties of torsion of the penis. The glans itself may be inclined laterally, the curvature may be total, or there may be a veritable rotation, bringing the inferior face above and the superior face below. Gay describes a child with epispadias whose penis had undergone such torsion on its axis that its inferior surface looked upward to the left, and the child passed urine toward the left shoulder. Follin mentions a similar instance in a boy of twelve with complete epispadias, and Verneuil and Guerlin also record cases, both complicated with associate maldevelopment. Caddy mentions a youth of eighteen who had congenital torsion of the penis with out hypospadias or epispadias. There was a complete half-turn to the left, so that the slit-like urinary meatus was reversed and the frenum was above. Among the older writers who describe incurvation or torsion of the penis are Arantius, the Ephemerides, Haenel, Petit, Schurig, Tulpius, and Zacchias. Zacutus Lusitans speaks of torsion of the penis from freezing. Paullini mentions a case the result of masturbation, and Hunter speaks of torsion of the penis associated with arthritis. Ossification of the Penis.--MacClellann speaks of a man of fifty-two whose penis was curved and distorted in such a manner that urine could not be passed without pain and coitus was impossible. A bony mass was discovered in the septum between the corpora cavernosa; this was dissected out with much hemorrhage and the upward curvature was removed, but there resulted a slight inclination in the opposite direction. The formation of bone and cartilage in the penis is quite rare. Velpeau, Kauffmann, Lenhoseck, and Duploy are quoted by Jacobson as having seen this anomaly. There is an excellent preparation in Vienna figured by Demarquay, but no description is given. The Ephemerides and Paullini describe osseous penises. The complete absence of the frenum and prepuce has been observed in animals but is very rare in man. The incomplete or irregular development is more frequent, but most common is excessive development of the prepuce, constituting phimosis, when there is abnormal adherence with the glans. Instances of phimosis, being quite common, will be passed without special mention. Deficient or absent prepuce has been observed by Blasius, Marcellus Donatus, and Gilibert. Partial deficiency is described by Petit Severinus, and others. There may be imperforation or congenital occlusion of some portion of the urethra, causing enormous accumulation of urine in the bladder, but fortunately there is generally in such cases some anomalous opening of the urethra giving vent to the excretions. Tulpius mentions a case of deficient urethra. In the Ephemerides there is an account of a man who had a constant flow of semen from an abnormal opening in the abdomen. La Peyroma describes a case of impotence due to ejaculation of the spermatic ducts into the bladder instead of into the urethra, but remarks that there was a cicatrix of a wound of the neighboring parts. There are a number of instances in which the urethra has terminated in the rectum. Congenital dilatation of the urethral canal is very rare, and generally accompanied by other malformation. Duplication of the urethra or the existence of two permeable canals is not accepted by all the authors, some of whom contend that one of the canals either terminates in a culdesac or is not separate in itself. Verneuil has published an article clearly exposing a number of cases, showing that it is possible for the urethra to have two or more canals which are distinct and have separate functions. Fabricius Hildanus speaks of a double aperture to the urethra; Marcellus Donatus describes duplicity of the urethra, one of the apertures being in the testicle; and there is another case on record in which there was a urethral aperture in the groin. A case of double urethra in a man of twenty-five living in Styria who was under treatment for gonorrhea is described, the supernumerary urethra opening above the natural one and receiving a sound to the depth of 17 cm. There was purulent gonorrhea in both urethrae. Vesalius has an account of a double urethral aperture, one of which was supposed to give spermatic fluid and the other urine. Borellus, Testa, and Cruveilhier have reported similar instances. Instances of double penis have been discussed under the head of diphallic terata, page 194. Hypospadias and epispadias are names given to malformations of the urethra in which the wall of the canal is deficient either above or below. These anomalies are particularly interesting, as they are nearly always found in male hermaphrodites, the fissure giving the appearance of a vulva, as the scrotum is sometimes included, and even the perineum may be fissured in continuity with the other parts, thus exaggerating the deception. There seems to be an element of heredity in this malformation, and this allegation is exemplified by Sedgwick, who quotes a case from Heuremann in which a family of females had for generations given birth to males with hypospadias. Belloc mentions a man whose urethra terminated at the base of the frenum who had four sons with the same deformity. Picardat mentions a father and son, both of whom had double urethral orifices, one above the other, from one of which issued urine and from the other semen--a fact that shows the possibility of inheritance of this malformation. Patients in whom the urethra opens at the root of the penis, the meatus being imperforate, are not necessarily impotent; as, for instance, Fournier knew of a man whose urethra opened posteriorly who was the father of four children. Fournier supposed that the semen ejaculated vigorously and followed the fissure on the back of the penis to the uterus, the membrane of the vagina supplanting the deficient wall of the urethra. The penis was short, but about as thick as ordinary. Gray mentions a curious case in a man afflicted with hypospadias who, suffering with delusions, was confined in the insane asylum at Utica. When he determined to get married, fully appreciating his physical defect, he resolved to imitate nature, and being of a very ingenious turn of mind, he busied himself with the construction of an artificial penis. While so engaged he had seized every opportunity to study the conformation of this organ, and finally prepared a body formed of cotton, six inches in length, and shaped like a penis, minus a prepuce. He sheathed it in pig's gut and gave it a slight vermilion hue. To the touch it felt elastic, and its shape was maintained by a piece of gutta-percha tubing, around which the cotton was firmly wound. It was fastened to the waist-band by means of straps, a central and an upper one being so arranged that the penis could be thrown into an erect position and so maintained. He had constructed a flesh-colored covering which completely concealed the straps. With this artificial member he was enabled to deceive his wife for fifteen months, and was only discovered when; she undressed him while he was in a state of intoxication. To further the deception he had told his wife immediately after their marriage that it was quite indecent for a husband to undress in the presence of his wife, and therefore she had always retired first and turned out the light. Partly from fear that his virile power would be questioned and partly from ignorance, the duration of actual coitus would approach an hour. When the discovery was made, his wife hid the instrument with which he had perpetrated a most successful fraud upon her, and the patient subsequently attempted coitus by contact with unsuccessful results, although both parties had incomplete orgasms. Shortly afterward evidences of mental derangement appeared and the man became the subject of exalted delusions. His wife, at the time of report, had filed application for divorce. Haslam reports a case in which loss of the penis was compensated for by the use of an ivory succedaneum. Parallel instances of this kind have been recorded by Ammann and Jonston. Entire absence of the male sexual apparatus is extremely rare, but Blondin and Velpeau have reported cases. Complete absence of the testicles, or anorchism, is a comparatively rare anomaly, and it is very difficult to distinguish between anorchism and arrest of development, or simple atrophy, which is much more common. Fisher of Boston describes the case of a man of forty-five, who died of pneumonia. From the age of puberty to twenty-five, and even to the day of death, his voice had never changed and his manners were decidedly effeminate. He always sang soprano in concert with females. After the age of twenty-five, however, his voice became more grave and he could not accompany females with such ease. He had no beard, had never shaved, and had never exhibited amorous propensities or desire for female society. When about twenty-one he became associated with a gay company of men and was addicted to the cup, but would never visit houses of ill-fame. On dissection no trace of testicles could be found; the scrotum was soft and flabby. The cerebellum was the exact size of that of a female child. Individuals with one testicle are called monorchids, and may be divided into three varieties:-- (1) A solitary testicle divided in the middle by a deep fissure, the two lobes being each provided with a spermatic cord on the same side as the lobe. (2) Testicles of the same origin, but with coalescence more general. (3) A single testicle and two cords. Gruber of St. Petersburg held a postmortem on a man in January, 1867, in whom the right half of the scrotum, the right testicle, epididymis, and the scrotal and inguinal parts of the right vas deferens were absent. Gruber examined the literature for thirty years up to the time of his report, and found 30 recorded postmortem examinations in which there was absence of the testicle, and in eight of these both testicles were missing. As a rule, natural eunuchs have feeble bodies, are mentally dull, and live only a short time. The penis is ordinarily defective and there is sometimes another associate malformation. They are not always disinclined toward the opposite sex. Polyorchids are persons who have more than two testicles. For a long time the abnormality was not believed to exist, and some of the observers denied the proof by postmortem examination of any of the cases so diagnosed, but there is at present no doubt of the fact,--three, four, and five testicles having been found at autopsies. Russell, one of the older writers on the testicle, mentions a monk who was a triorchid, and was so salacious that his indomitable passion prevented him from keeping his vows of chastity. The amorous propensities and generative faculties of polyorchids have always been supposed greater than ordinary. Russell reports another case of a man with a similar peculiarity, who was prescribed a concubine as a reasonable allowance to a man thus endowed. Morgagni and Meckel say that they never discovered a third testicle in dissections of reputed triorchids, and though Haller has collected records of a great number of triorchids, he has never been able to verify the presence of the third testicle on dissection. Some authors, including Haller, have demonstrated heredity in examples of polyorchism. There is an old instance in which two testicles, one above the other, were found on the right side and one on the left. Macann describes a recruit of twenty, whose scrotum seemed to be much larger on the right than on the left side, although it was not pendulous. On dissection a right and left testicle were found in their normal positions, but situated on the right side between the groin and the normal testicle was a supernumerary organ, not in contact, and having a separate and short cord. Prankard also describes a man with three testicles. Three cases of triorchidism were found in recruits in the British Army. Lane reports a supernumerary testis found in the right half of the scrotum of a boy of fifteen. In a necropsy held on a man killed in battle, Hohlberg discovered three fully developed testicles, two on the right side placed one above the other. The London Medical Record of 1884 quotes Jdanoff of St. Petersburg in mentioning a soldier of twenty-one who had a supernumerary testicle erroneously diagnosed as inguinal hernia. Quoted by the same reference, Bulatoff mentions a soldier who had a third testicle, which diagnosis was confirmed by several of his confreres. They recommended dismissal of the man from the service, as the third testicle, usually resting in some portion of the inguinal canal, caused extra exposure to traumatic influence. Venette gives an instance of four testicles, and Scharff, in the Ephemerides, mentions five; Blasius mentions more than three testicles, and, without citing proof, Buffon admits the possibility of such occurrence and adds that such men are generally more vigorous. Russell mentions four, five, and even six testicles in one individual; all were not verified on dissection. He cites an instance of six testicles four of which were of usual size and two smaller than ordinary. Baillie, the Ephemerides, and Schurig mention fusion of the testicles, or synorchidism, somewhat after the manner of the normal disposition of the batrachians and also the kangaroos, in the former of which the fusion is abdominal and in the latter scrotal. Kerckring has a description of an individual in whom the scrotum was absent. In those cases in which the testicles are still in the abdominal cavity the individuals are termed cryptorchids. Johnson has collected the results of postmortem examinations of 89 supposed cryptorchids. In eight of this number no testicles were found postmortem, the number found in the abdomen was uncertain, but in 18 instances both testicles were found in the inguinal canal, and in eight only one was found in the inguinal canal, the other not appearing. The number in which the semen was examined microscopically was 16, and in three spermatozoa were found in the semen; one case was dubious, spermatozoa being found two weeks afterward on a boy's shirt. The number having children was ten. In one case a monorchid generated a cryptorchid child. Some of the cryptorchids were effeminate, although others were manly with good evidences of a beard. The morbid, hypochondriac, the voluptuous, and the imbecile all found a place in Johnson's statistics; and although there are evidences of the possession of the generative function, still, we are compelled to say that the chances are against fecundity of human cryptorchids. In this connection might be quoted the curious case mentioned by Geoffroy-Saint-Hilaire, of a soldier who was hung for rape. It was alleged that no traces of testicles were found externally or internally yet semen containing spermatozoa was found in the seminal vesicles. Spermatozoa have been found days and weeks after castration, and the individuals during this period were capable of impregnation, but in these cases the reservoirs were not empty, although the spring had ceased to flow. Beigel, in Virchow's Archives, mentions a cryptorchid of twenty-two who had nocturnal emissions containing spermatozoa and who indulged in sexual congress. Partridge describes a man of twenty-four who, notwithstanding his condition, gave evidences of virile seminal flow. In some cases there is anomalous position of the testicle. Hough mentions an instance in which, from the great pain and sudden appearance, a small tumor lying against the right pubic bone was supposed to be a strangulated hernia. There were two well-developed testicles in the scrotum, and the hernia proved to be a third. McElmail describes a soldier of twenty-nine, who two or three months before examination felt a pricking and slight burning pain near the internal aperture of the internal inguinal canal, succeeded by a swelling until the tumor passed into the scrotum. It was found in the upper part of the scrotum above the original testicle, but not in contact, and was about half the size of the normal testicle; its cord and epididymis could be distinctly felt and caused the same sensation as pressure on the other testicle did. Marshall mentions a boy of sixteen in whom the right half of the scrotum was empty, although the left was of normal size and contained a testicle. On close examination another testicle was found in the perineum; the boy said that while running he fell down, four years before, and on getting up suffered great pain in the groin, and this pain recurred after exertion. This testicle was removed successfully to the scrotum. Horsley collected 20 instances of operators who made a similar attempt, Annandale being the first one; his success was likely due to antisepsis, as previously the testicles had always sloughed. There is a record of a dog remarkable for its salacity who had two testicles in the scrotum and one in the abdomen; some of the older authors often indulged in playful humor on this subject. Brown describes a child with a swelling in the perineum both painful and elastic to the touch. The child cried if pressure was applied to the tumor and there was every evidence that the tumor was a testicle. Hutcheson, quoted by Russell, has given a curious case in an English seaman who, as was the custom at that time, was impressed into service by H.M.S. Druid in 1807 from a trading ship off the coast of Africa. The man said he had been examined by dozens of ship-surgeons, but was invariably rejected on account of rupture in both groins. The scrotum was found to be an empty bag, and close examination showed that the testicles occupied the seats of the supposed rupture. As soon as the discovery was made the man became unnerved and agitated, and on re-examining the parts the testicles were found in the scrotum. When he found that there was no chance for escape he acknowledged that he was an impostor and gave an exhibition in which, with incredible facility, he pulled both testes up from the bottom of the scrotum to the external abdominal ring. At the word of command he could pull up one testicle, then another, and let them drop simultaneously; he performed other like feats so rapidly that the movements could not be distinguished. In this connection Russell speaks of a man whose testicle was elevated every time the east wind blew, which caused him a sense of languor and relaxation; the same author describes a man whose testicles ascended into the inguinal canal every time he was in the company of women. Inversion of the testicle is of several varieties and quite rare, it has been recognized by Sir Astley Cooper, Boyer, Maisonneuve, Royet, and other writers. The anomalies of the vas deferens and seminal vesicles are of little interest and will be passed with mention of the case of Weber, who found the seminal vesicles double; a similar conformation has been seen in hermaphrodites. CHAPTER VII. ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT. Giants.--The fables of mythology contain accounts of horrible monsters, terrible in ferocity, whose mission was the destruction of the life of the individuals unfortunate enough to come into their domains. The ogres known as the Cyclops, and the fierce anthropophages, called Lestrygons, of Sicily, who were neighbors of the Cyclops, are pictured in detail in the "Odyssey" of Homer. Nearly all the nations of the earth have their fairy tales or superstitions of monstrous beings inhabiting some forest, mountain, or cave; and pages have been written in the heroic poems of all languages describing battles between these monsters and men with superhuman courage, in which the giant finally succumbs. The word giant is derived indirectly from the old English word "geant," which in its turn came from the French of the conquering Normans. It is of Greek derivation, "gigas", or the Latin, "gigas." The Hebrew parallel is "nophel," or plural, "nephilim." Ancient Giants.--We are told in the Bible a that the bedstead of Og, King of Basham, was 9 cubits long, which in English measure is 16 1/2 feet. Goliath of Gath, who was slain by David, stood 6 cubits and a span tall--about 11 feet. The body of Orestes, according to the Greeks, was 11 1/2 feet long. The mythical Titans, 45 in number, were a race of Giants who warred against the Gods, and their descendants were the Gigantes. The height attributed to these creatures was fabulous, and they were supposed to heap up mountains to scale the sky and to help them to wage their battles. Hercules, a man of incredible strength, but who is said to have been not over 7 feet high, was dispatched against the Gigantes. Pliny describes Gabbaras, who was brought to Rome by Claudius Caesar from Arabia and was between 9 and 10 feet in height, and adds that the remains of Posio and Secundilla, found in the reign of Augustus Caesar in the Sallustian Gardens, of which they were supposed to be the guardians, measured 10 feet 3 inches each. In common with Augustine, Pliny believed that the stature of man has degenerated, but from the remains of the ancients so far discovered it would appear that the modern stature is about the same as the ancient. The beautiful alabaster sarcophagus discovered near Thebes in 1817 and now in Sir John Soane's Museum in Lincoln's Inn Fields in London measures 9 feet 4 inches long. This unique example, the finest extant, is well worth inspection by visitors in London. Herodotus says the shoes of Perseus measured an equivalent of about 3 feet, English standard. Josephus tells of Eleazar, a Jew, among the hostages sent by the King of Persia to Rome, who was nearly 11 feet high. Saxo, the grammarian, mentions a giant 13 1/2 feet high and says he had 12 companions who were double his height. Ferragus, the monster supposed to have been slain by Roland, the nephew of Charlemagne, was said to have been nearly 11 feet high. It was said that there was a giant living in the twelfth century under the rule of King Eugene II of Scotland who was 11 1/2 feet high. There are fabulous stories told of the Emperor Maximilian. Some accounts say that he was between 8 1/2 and 9 feet high, and used his wife's bracelet for a finger-ring, and that he ate 40 pounds of flesh a day and drank six gallons of wine. He was also accredited with being a great runner, and in his earlier days was said to have conquered single-handed eight soldiers. The Emperors Charlemagne and Jovianus were also accredited with great height and strength. In the olden times there were extraordinary stories of the giants who lived in Patagonia. Some say that Magellan gave the name to this country because its inhabitants measured 5 cubits. The naturalist Turner says that on the river Plata near the Brazilian coast he saw naked savages 12 feet high; and in his description of America, Thevenot confirms this by saying that on the coast of Africa he saw on a boat the skeleton of an American giant who had died in 1559, and who was 11 feet 5 inches in height. He claims to have measured the bones himself. He says that the bones of the leg measured 3 feet 4 inches, and the skull was 3 feet and 1 inch, just about the size of the skull of Borghini, who, however, was only of ordinary height. In his account of a voyage to the Straits of Magellan, Jacob Lemaire says that on December 17, 1615, he found at Port Desire several graves covered with stones, and beneath the stones were skeletons of men which measured between 10 and 11 feet. The ancient idea of the Spaniards was that the men of Patagonia were so tall that the Spanish soldiers could pass under their arms held out straight; yet we know that the Patagonians exhibit no exaggeration of height--in fact, some of the inhabitants about Terra del Fuego are rather diminutive. This superstition of the voyagers was not limited to America; there were accounts of men in the neighborhood of the Peak of Teneriffe who had 80 teeth in their head and bodies 15 feet in height. Discoveries of "Giants' Bones."--Riolan, the celebrated anatomist, says that there was to be seen at one time in the suburbs of Saint Germain the tomb of the giant Isoret, who was reputed to be 20 feet tall; and that in 1509, in digging ditches at Rouen, near the Dominicans, they found a stone tomb containing a monstrous skeleton, the skull of which would hold a bushel of corn; the shin-bone measured about 4 feet, which, taken as a guide, would make his height over 17 feet. On the tomb was a copper plate which said that the tomb contained the remains of "the noble and puissant lord, the Chevalier Ricon de Vallemont." Plater, the famous physician, declares that he saw at Lucerne the true human bones of a subject that must have been at least 19 feet high. Valence in Dauphine boasted of possessing the bones of the giant Bucart, the tyrant of the Vivarias, who was slain by his vassal, Count de Cabillon. The Dominicans had the shin-bone and part of the knee-articulation, which, substantiated by the frescoes and inscriptions in their possession, showed him to be 22 1/2 feet high. They claimed to have an os frontis in the medical school of Leyden measuring 9.1 X 12.2 X .5 inches, which they deduce must have belonged to a man 11 or 12 feet high. It is said that while digging in France in 1613 there was disinterred the body of a giant bearing the title "Theutobochus Rex," and that the skeleton measured 25 feet long, 10 feet across the shoulders, and 5 feet from breast to back. The shin-bone was about 4 feet long, and the teeth as large as those of oxen. This is likely another version of the finding of the remains of Bucart. Near Mezarino in Sicily in 1516 there was found the skeleton of a giant whose height was at least 30 feet; his head was the size of a hogshead, and each tooth weighed 5 ounces; and in 1548 and in 1550 there were others found of the height of 30 feet. The Athenians found near their city skeletons measuring 34 and 36 feet in height. In Bohemia in 758 it is recorded that there was found a human skeleton 26 feet tall, and the leg-bones are still kept in a medieval castle in that country. In September, 1691, there was the skull of a giant found in Macedonia which held 210 pounds of corn. General Opinions.--All the accounts of giants originating in the finding of monstrous bones must of course be discredited, as the remains were likely those of some animal. Comparative anatomy has only lately obtained a hold in the public mind, and in the Middle Ages little was known of it. The pretended giants' remains have been those of mastodons, elephants, and other animals. From Suetonius we learn that Augustus Caesar pleased himself by adorning his palaces with so-called giants' bones of incredible size, preferring these to pictures or images. From their enormous size we must believe they were mastodon bones, as no contemporary animals show such measurements. Bartholinus describes a large tooth for many years exhibited as the canine of a giant which proved to be nothing but a tooth of a spermaceti whale (Cetus dentatus), quite a common fish. Hand described an alleged giant's skeleton shown in London early in the eighteenth century, and which was composed of the bones of the fore-fin of a small whale or of a porpoise. The celebrated Sir Hans Sloane, who treated this subject very learnedly, arrived at the conclusion that while in most instances the bones found were those of mastodons, elephants, whales, etc., in some instances accounts were given by connoisseurs who could not readily be deceived. However, modern scientists will be loath to believe that any men ever existed who measured over 9 feet; in fact, such cases with authentic references are extremely rare Quetelet considers that the tallest man whose stature is authentically recorded was the "Scottish Giant" of Frederick the Great's regiment of giants. This person was not quite 8 feet 3 inches tall. Buffon, ordinarily a reliable authority, comes to a loose conclusion that there is no doubt that men have lived who were 10, 12, and even 15 feet tall; but modern statisticians cannot accept this deduction from the references offered. From the original estimation of the height of Adam (Henrion once calculated that Adam's height was 123 feet and that of Eve 118) we gradually come to 10 feet, which seemed to be about the favorite height for giants in the Middle Ages. Approaching this century, we still have stories of men from 9 to 10 feet high, but no authentic cases. It was only in the latter part of the last century that we began to have absolutely authentic heights of giants, and to-day the men showing through the country as measuring 8 feet generally exaggerate their height several inches, and exact measurement would show that but few men commonly called giants are over 7 1/2 feet or weigh over 350 pounds. Dana says that the number of giants figuring as public characters since 1700 is not more than 100, and of these about 20 were advertised to be over 8 feet. If we confine ourselves to those accurately and scientifically measured the list is surprisingly small. Topinard measured the tallest man in the Austrian army and found that he was 8 feet 4 1/2 inches. The giant Winckelmeyer measured 8 feet 6 inches in height. Ranke measured Marianne Wehde, who was born in Germany in the present century, and found that she measured 8 feet 4 1/4 inches when only sixteen and a half years old. In giants, as a rule, the great stature is due to excessive growth of the lower extremities, the size of the head and that of the trunk being nearly the same as those of a man or boy of the same age. On the other hand, in a natural dwarf the proportions are fairly uniform, the head, however, being always larger in proportion to the body, just as we find in infants. Indeed, the proportions of "General Tom Thumb" were those of an ordinary infant of from thirteen to fifteen months old. Figure 156 shows a portrait of two well-known exhibitionists of about the same age, and illustrates the possible extremes of anomalies in stature. Recently, the association of acromegaly with gigantism has been noticed, and in these instances there seems to be an acquired uniform enlargement of all the bones of the body. Brissaud and Meige describe the case of a male of forty-seven who presented nothing unusual before the age of sixteen, when he began to grow larger, until, having reached his majority, he measured 7 feet 2 inches in height and weighed about 340 pounds. He remained well and very strong until the age of thirty-seven, when he overlifted, and following this he developed an extreme deformity of the spine and trunk, the latter "telescoping into itself" until the nipples were on a level with the anterior superior spines of the ilium. For two years he suffered with debility, fatigue, bronchitis, night-sweats, headache, and great thirst. Mentally he was dull; the bones of the face and extremities showed the hypertrophies characteristic of acromegaly, the soft parts not being involved. The circumference of the trunk at the nipples was 62 inches, and over the most prominent portion of the kyphosis and pigeon-breast, 74 inches. The authors agree with Dana and others that there is an intimate relation between acromegaly and gigantism, but they go further and compare both to the growth of the body. They call attention to the striking resemblance to acromegaly of the disproportionate growth of the boy at adolescence, which corresponds so well to Marie's terse description of this disease: "The disease manifests itself by preference in the bones of the extremities and in the extremities of the bones," and conclude with this rather striking and aphoristic proposition: "Acromegaly is gigantism of the adult; gigantism is acromegaly of adolescence." The many theories of the cause of gigantism will not be discussed here, the reader being referred to volumes exclusively devoted to this subject. Celebrated Giants.--Mention of some of the most famous giants will be made, together with any associate points of interest. Becanus, physician to Charles V, says that he saw a youth 9 feet high and a man and a woman almost 10 feet. Ainsworth says that in 1553 the Tower of London was guarded by three brothers claiming direct descent from Henry VIII, and surnamed Og, Gog, and Magog, all of whom were over 8 feet in height. In his "Chronicles of Holland" in 1557 Hadrianus Barlandus said that in the time of John, Earl of Holland, the giant Nicholas was so large that men could stand under his arms, and his shoe held 3 ordinary feet. Among the yeoman of the guard of John Frederick, Duke of Hanover, there was one Christopher Munster, 8 1/2 feet high, who died in 1676 in his forty-fifth year. The giant porter of the Duke of Wurtemberg was 7 1/2 feet high. "Big Sam," the porter at Carleton Palace, when George IV was Prince of Wales, was 8 feet high. The porter of Queen Elizabeth, of whom there is a picture in Hampton Court, painted by Zucchero, was 7 1/2 feet high; and Walter Parson, porter to James I, was about the same height. William Evans, who served Charles I, was nearly 8 feet; he carried a dwarf in his pocket. In the seventeenth century, in order to gratify the Empress of Austria, Guy-Patin made a congress of all the giants and dwarfs in the Germanic Empire. A peculiarity of this congress was that the giants complained to the authorities that the dwarfs teased them in such a manner as to make their lives miserable. Plater speaks of a girl in Basle, Switzerland, five years old, whose body was as large as that of a full-grown woman and who weighed when a year old as much as a bushel of wheat. He also mentions a man living in 1613, 9 feet high, whose hand was 1 foot 6 inches long. Peter van den Broecke speaks of a Congo negro in 1640 who was 8 feet high. Daniel, the porter of Cromwell, was 7 feet 6 inches high; he became a lunatic. Frazier speaks of Chilian giants 9 feet tall. There is a chronicle which says one of the Kings of Norway was 8 feet high. Merula says that in 1538 he saw in France a Flemish man over 9 feet. Keysler mentions seeing Hans Brau in Tyrol in 1550, and says that he was nearly 12 feet high. Jonston mentions a lad in Holland who was 8 feet tall. Pasumot mentions a giant of 8 feet. Edmund Mallone was said to have measured 7 feet 7 inches. Wierski, a Polander, presented to Maximilian II, was 8 feet high. At the age of thirty-two there died in 1798 a clerk of the Bank of England who was said to have been nearly 7 1/2 feet high. The Daily Advertiser for February 23, 1745, says that there was a young colossus exhibited opposite the Mansion House in London who was 7 feet high, although but fifteen years old. In the same paper on January 31, 1753, is an account of MacGrath, whose skeleton is still preserved in Dublin. In the reign of George I, during the time of the Bartholomew Fair at Smithfield, there was exhibited an English man seventeen years old who was 8 feet tall. Nicephorus tells of Antonius of Syria, in the reign of Theodosius, who died at the age of twenty-five with a height of 7 feet 7 inches. Artacaecas, in great favor with Xerxes, was the tallest Persian and measured 7 feet. John Middleton, born in 1752 at Hale, Lancashire, humorously called the "Child of Hale," and whose portrait is in Brasenose College, Oxford, measured 9 feet 3 inches tall. In his "History of Ripton," in Devonshire, 1854, Bigsby gives an account of a discovery in 1687 of a skeleton 9 feet long. In 1712 in a village in Holland there died a fisherman named Gerrit Bastiaansen who was 8 feet high and weighed 500 pounds. During Queen Anne's reign there was shown in London and other parts of England a most peculiar anomaly--a German giantess without hands or feet who threaded a needle, cut gloves, etc. About 1821 there was issued an engraving of Miss Angelina Melius, nineteen years of age and 7 feet high, attended by her page, Senor Don Santiago de los Santos, from the Island of Manilla, thirty-live years old and 2 feet 2 inches high. "The Annual Register" records the death of Peter Tuchan at Posen on June 18, 1825, of dropsy of the chest. He was twenty-nine years old and 8 feet 7 inches in height; he began to grow at the age of seven. This monster had no beard; his voice was soft; he was a moderate eater. There was a giant exhibited in St. Petersburg, June, 1829, 8 feet 8 inches in height, who was very thin and emaciated. Dr. Adam Clarke, who died in 1832, measured a man 8 feet 6 inches tall. Frank Buckland, in his "Curiosities of Natural History," says that Brice, the French giant, was 7 feet 7 inches. Early in 1837 there was exhibited at Parma a young man formerly in the service of the King of the Netherlands who was 8 feet 10 inches high and weighed 401 pounds. Robert Hale, the "Norfolk Giant," who died in Yarmouth in 1843 at the age of forty-three, was 7 feet 6 inches high and weighed 452 pounds. The skeleton of Cornelius McGrath, now preserved in the Trinity College Museum, Dublin, is a striking example of gigantism. At sixteen years he measured 7 feet 10 inches. O'Brien or Byrne, the Irish giant, was supposed to be 8 feet 4 inches in height at the time of his death in 1783 at the age of twenty-two. The story of his connection with the illustrious John Hunter is quite interesting. Hunter had vowed that he would have the skeleton of O'Brien, and O'Brien was equally averse to being boiled in the distinguished scientist's kettle. The giant was tormented all his life by the constant assertions of Hunter and by his persistence in locating him. Finally, when, following the usual early decline of his class of anomalies, O'Brien came to his death-bed, he bribed some fishermen to take his body after his death to the middle of the Irish Channel and sink it with leaden weights. Hunter, it is alleged, was informed of this and overbribed the prospective undertakers and thus secured the body. It has been estimated that it cost Hunter nearly 500 pounds sterling to gain possession of the skeleton of the "Irish Giant." The kettle in which the body was boiled, together with some interesting literature relative to the circumstances, are preserved in the Museum of the Royal College of Surgeons in London, and were exhibited at the meeting of the British Medical Association in 1895 with other Hunterian relics. The skeleton, which is now one of the features of the Museum, is reported to measure 92 3/4 inches in height, and is mounted alongside that of Caroline Crachami, the Sicilian dwarf, who was exhibited as an Italian princess in London in 1824. She did not grow after birth and died at the age of nine. Patrick Cotter, the successor of O'Brien, and who for awhile exhibited under this name, claiming that he was a lineal descendant of the famous Irish King, Brian Boru, who he declared was 9 feet in height, was born in 1761, and died in 1806 at the age of forty-five. His shoe was 17 inches long, and he was 8 feet 4 inches tall at his death. In the Museum of Madame Tussaud in London there is a wax figure of Loushkin, said to be the tallest man of his time. It measures 8 feet 5 inches, and is dressed in the military uniform of a drum-major of the Imperial Preobrajensky Regiment of Guards. To magnify his height there is a figure of the celebrated dwarf, "General Tom Thumb," in the palm of his hand. Figure 158 represents a well-known American giant, Ben Hicks who was called "the Denver Steeple." Buffon refers to a Swedish giantess who he affirms was 8 feet 6 inches tall. Chang, the "Chinese Giant," whose smiling face is familiar to nearly all the modern world, was said to be 8 feet tall. In 1865, at the age of nineteen, he measured 7 feet 8 inches. At Hawick, Scotland, in 1870, there was an Irishman 7 feet 8 inches in height, 52 inches around the chest, and who weighed 22 stone. Figure 159 shows an American giantess known as "Leah, the Giantess." At the age of nineteen she was 7 feet 2 inches tall and weighed 165 pounds. On June 17, 1871, there were married at Saint-Martins-in-the-Field in London Captain Martin Van Buren Bates of Kentucky and Miss Anna Swann of Nova Scotia, two celebrated exhibitionists, both of whom were over 7 feet. Captain Bates, familiarly known as the "Kentucky Giant," years ago was a familiar figure in many Northern cities, where he exhibited himself in company with his wife, the combined height of the two being greater than that of any couple known to history. Captain Bates was born in Whitesburg, Letcher County, Ky., on November 9, 1845. He enlisted in the Southern army in 1861, and though only sixteen years old was admitted to the service because of his size. At the close of the war Captain Bates had attained his great height of 7 feet 2 1/2 inches. His body was well proportioned and his weight increased until it reached 450 pounds. He traveled as a curiosity from 1866 to 1880, being connected with various amusement organizations. He visited nearly all the large cities and towns in the United States, Canada, Great Britain, France, Spain, Germany, Switzerland, Austria, and Russia. While in England in 1871 the Captain met Miss Anna H. Swann, known as the "Nova Scotia Giantess," who was two years the junior of her giant lover. Miss Swann was justly proud of her height, 7 feet 5 1/2 inches. The two were married soon afterward. Their combined height of 14 feet 8 inches marked them as the tallest married couple known to mankind. Captain Bates' parents were of medium size. His father, a native of Virginia, was 5 feet 10 inches high and weighed 160 pounds. His mother was 5 feet 3 inches tall and weighed 125 pounds. The height of the father of Mrs. Anna Swann Bates was 6 feet and her mother was 5 feet and 2 inches high, weighing but 100 pounds. A recent newspaper dispatch says: "Captain M. V. Bates, whose remarkable height at one time attracted the attention of the world, has recently retired from his conspicuous position and lives in comparative obscurity on his farm in Guilford, Medina County, O., half a mile east of Seville." In 1845 there was shown in Paris Joachim Eleiceigui, the Spanish giant, who weighed 195 kilograms (429 pounds) and whose hands were 42 cm. (16 1/2 inches) long and of great beauty. In 1882 at the Alhambra in London there was a giantess by the name of Miss Marian, called the "Queen of the Amazons," aged eighteen years, who measured 2.45 meters (96 1/2 inches). William Campbell, a Scotchman, died at Newcastle in May 1878. He was so large that the window of the room in which the deceased lay and the brick-work to the level of the floor had to be taken out, in order that the coffin might be lowered with block and tackle three stories to the ground. On January 27, 1887, a Greek, although a Turkish subject, recently died of phthisis in Simferopol. He was 7 feet 8 inches in height and slept on three beds laid close together. Giants of History.--A number of persons of great height, particularly sovereigns and warriors, are well-known characters of history, viz., William of Scotland, Edward III, Godefroy of Bouillon, Philip the Long, Fairfax, Moncey, Mortier, Kleber; there are others celebrated in modern times. Rochester, the favorite of Charles II; Pothier, the jurist; Bank, the English naturalist; Gall, Billat-Savarin, Benjamin Constant, the painter David, Bellart, the geographer Delamarche, and Care, the founder of the Gentleman's Magazine, were all men of extraordinary stature. Dwarfs.--The word "dwarf" is of Saxon origin (dwerg, dweorg) and corresponds to the "pumilio" or "nanus" of the Romans. The Greeks believed in the pygmy people of Thrace and Pliny speaks of the Spithamiens. In the "Iliad" Homer writes of the pygmies and Juvenal also describes them; but the fantasies of these poets have given these creatures such diminutive stature that they have deprived the traditions of credence. Herodotus relates that in the deserts of Lybia there were people of extreme shortness of stature. The Bible mentions that no dwarf can officiate at the altar. Aristotle and Philostratus speak of pygmy people descended from Pygmaeus, son of Dorus. In the seventeenth century van Helmont supposed that there were pygmies in the Canary Islands, and Abyssinia, Brazil, and Japan in the older times were repeatedly said to contain pygmy races. Relics of what must have been a pygmy race have been found in the Hebrides, and in this country in Kentucky and Tennessee. Dr. Schweinfurth, the distinguished African traveler, confirms the statements of Homer, Herodotus, and Aristotle that there was a race of pygmies near the source of the Nile. Schweinfurth says that they live south of the country occupied by the Niam-Niam, and that their stature varies from 4 feet to 4 feet 10 inches. These people are called the Akkas, and wonderful tales are told of their agility and cunning, characteristics that seem to compensate for their small stature. In 1860 Paul DuChaillu speaks of the existence of an African people called the Obongos, inhabiting the country of the Ashangos, a little to the south of the equator, who were about 1.4 meters in height. There have been people found in the Esquimaux region of very diminutive stature. Battel discovered another pygmy people near the Obongo who are called the Dongos. Kolle describes the Kenkobs, who are but 3 to 4 feet high, and another tribe called the Reebas, who vary from 3 to 5 feet in height. The Portuguese speak of a race of dwarfs whom they call the Bakka-bakka, and of the Yogas, who inhabit territory as far as the Loango. Nubia has a tribe of dwarfs called the Sukus, but little is known of them. Throughout India there are stories of dwarf tribes descended from the monkey-God, or Hoonuman of the mythologic poems. In the works of Humboldt and Burgoa there is allusion to the tradition of a race of pygmies in the unexplored region of Chiapas near the Isthmus of Tehuantepec in Central America. There is an expedition of anthropologists now on the way to discover this people. Professor Starr of Chicago on his return from this region reported many colonies of undersized people, but did not discover any pygmy tribes answering to the older legendary descriptions. Figure 160 represents two dwarf Cottas measuring 3 feet 6 inches in height. The African pygmies who were sent to the King of Italy and shown in Rome resembled the pygmy travelers of Akka that Schweinfurth saw at the court of King Munza at Monbuttu. These two pygmies at Rome were found in Central Africa and were respectively about ten and fifteen years old. They spoke a dialect of their own and different from any known African tongue; they were partly understood by an Egyptian sergeant, a native of Soudan, who accompanied them as the sole survivor of the escort with which their donor, Miani, penetrated Monbuttu. Miani, like Livingstone, lost his life in African travel. These dwarfs had grown rapidly in recent years and at the time of report, measured 1.15 and 1.02 meters. In 1874 they were under the care of the Royal Geographical Society of Italy. They were intelligent in their manner, but resented being lionized too much, and were prone to scratch ladies who attempted to kiss them. The "Aztec Children" in 1851, at the ages of seven and six years, another pair of alleged indigenous pygmies, measured 33 3/4 and 29 1/2 inches in height and weighed 20 3/4 and 17 pounds respectively. The circumference of their heads did not equal that of an ordinary infant at birth. It is known that at one time the ancients artificially produced dwarfs by giving them an insufficient alimentation when very young. They soon became rachitic from their deprivation of lime-salts and a great number perished, but those who survived were very highly prized by the Roman Emperors for their grotesque appearance. There were various recipes for dwarfing children. One of the most efficient in the olden times was said to have been anointing the backbone with the grease of bats, moles, dormice, and such animals; it was also said that puppies were dwarfed by frequently washing the feet and backbone, as the consequent drying and hardening of the parts were alleged to hinder their extension. To-day the growth of boys intended to be jockeys is kept down by excessive sweating. Ancient Popularity of Dwarfs.--At one time a dwarf was a necessary appendage of every noble family. The Roman Emperors all had their dwarfs. Julia, the niece of Augustus, had a couple of dwarfs, Conopas and Andromeda, each of whom was 2 feet 4 inches in height. It was the fashion at one time to have dwarfs noted for their wit and wisdom. Philos of Cos, tutor of Ptolemy Philadelphus, was a dwarf, as were Carachus, the friend of Saladin; Alypius of Alexandria, who was only 2 feet high; Lucinus Calvus, who was only 3 feet high, and aesop, the famous Greek fabulist. Later in the Middle Ages and even to the last century dwarfs were seen at every Court. Lady Montagu describes the dwarfs at the Viennese Court as "devils bedaubed with diamonds." They had succeeded the Court Jester and exercised some parts of this ancient office. At this time the English ladies kept monkeys for their amusement. The Court dwarfs were allowed unlimited freedom of speech, and in order to get at truths other men were afraid to utter one of the Kings of Denmark made one of his dwarfs Prime Minister. Charles IX in 1572 had nine dwarfs, of which four had been given to him by King Sigismund-Augustus of Poland and three by Maximilian II of Germany. Catherine de Medicis had three couples of dwarfs at one time, and in 1579 she had still five pygmies, named Merlin, Mandricart, Pelavine, Rodomont, and Majoski. Probably the last dwarf in the Court of France was Balthazar Simon, who died in 1662. Sometimes many dwarfs were present at great and noble gatherings. In Rome in 1566 the Cardinal Vitelli gave a sumptuous banquet at which the table-attendants were 34 dwarfs. Peter the Great of Russia had a passion for dwarfs, and in 1710 gave a great celebration in honor of the marriage of his favorite, Valakoff, with the dwarf of the Princess Prescovie Theodorovna. There were 72 dwarfs of both sexes present to form the bridal party. Subsequently, on account of dangerous and difficult labor, such marriages were forbidden in Russia. In England and in Spain the nobles had the portraits of their dwarfs painted by the celebrated artists of the day. Velasquez has represented Don Antonio el Ingles, a dwarf of fine appearance, with a large dog, probably to bring out the dwarf's inferior height. This artist also painted a great number of other dwarfs at the Court of Spain, and in one of his paintings he portrays the Infanta Marguerite accompanied by her male and female dwarfs. Reproductions of these portraits have been given by Garnier. In the pictures of Raphael, Paul Veronese, and Dominiquin, and in the "Triumph of Caesar" by Mantegna, representations of dwarfs are found, as well as in other earlier pictures representing Court events. At the present time only Russia and Turkey seem to have popular sympathy for dwarfs, and this in a limited degree. Intellectual Dwarfs.--It must be remarked, however, that many of the dwarfs before the public have been men of extraordinary-intelligence, possibly augmented by comparison. In a postmortem discussed at a meeting of the Natural History Society at Bonn in 1868 it was demonstrated by Schaufhausen that in a dwarf subject the brain weighed 1/19 of the body, in contradistinction to the average proportion of adults, from 1 to 30 to 1 to 44. The subject was a dwarf of sixty-one who died in Coblentz, and was said to have grown after his thirtieth year. His height was 2 feet 10 inches and his weight 45 pounds. The circumference of the head was 520 mm. and the brain weighed 1183.33 gm. and was well convoluted. This case was one of simple arrest of development, affecting all the organs of the body; he was not virile. He was a child of large parents; had two brothers and a sister of ordinary size and two brothers dwarfs, one 6 inches higher and the other his size. Several personages famous in history have been dwarfs. Attila, the historian Procopius, Gregory of Tours, Pepin le Bref, Charles III, King of Naples, and Albert the Grand were dwarfs. About the middle of the seventeenth century the French episcopacy possessed among its members a dwarf renowned for his intelligence. This diminutive man, called Godeau, made such a success in literature that by the grace of Richelieu he was named the Archbishop of Grasse. He died in 1672. The Dutch painter Doos, the English painter Gibson (who was about 3 feet in height and the father of nine infants by a wife of about the same height), Prince Eugene, and the Spanish Admiral Gravina were dwarfs. Fleury and Garry, the actors. Hay, a member of Parliament from Sussex in the last century; Hussein-Pasha, celebrated for his reforms under Selim III; the Danish antiquarian and voyager, Arendt, and Baron Denon were men far below the average size Varro says that there were two gentlemen of Rome who from their decorations must have belonged to an Equestrian Order, and who were but 2 Roman cubits (about 3 feet) high. Pliny also speaks of them as preserved in their coffins. It may be remarked that perhaps certain women are predisposed to give birth to dwarfs. Borwilaski had a brother and a sister who were dwarfs. In the middle of the seventeenth century a woman brought forth four dwarfs, and in the eighteenth century a dwarf named Hopkins had a sister as small as he was. Therese Souvray, the dwarf fiancee of Bebe, had a dwarf sister 41 inches high. Virey has examined a German dwarf of eight who was only 18 inches tall, i.e., about the length of a newly-born infant. The parents were of ordinary size, but had another child who was also a dwarf. There are two species of dwarfs, the first coming into the world under normal conditions, but who in their infancy become afflicted with a sudden arrest of development provoked by some malady; the second are born very small, develop little, and are really dwarfs from their birth; as a rule they are well conformed, robust, and intelligent. These two species can be distinguished by an important characteristic. The rachitic dwarfs of the first class are incapable of perpetuating their species, while those of the second category have proved more than once their virility. A certain number of dwarfs have married with women of normal height and have had several children, though this is not, it is true, an indisputable proof of their generative faculties; but we have instances in which dwarfs have married dwarfs and had a family sometimes quite numerous. Robert Skinner (25 inches) and Judith (26 inches), his wife, had 14 infants, well formed, robust, and of normal height. Celebrated Dwarfs.--Instances of some of the most celebrated dwarfs will be cited with a short descriptive mention of points of interest in their lives:-- Vladislas Cubitas, who was King of Poland in 1305, was a dwarf, and was noted for his intelligence, courage, and as a good soldier. Geoffrey Hudson, the most celebrated English dwarf, was born at Oakham in England in 1619. At the age of eight, when not much over a foot high, he was presented to Henriette Marie, wife of Charles I, in a pie; he afterward became her favorite. Until he was thirty he was said to be not more than 18 inches high, when he suddenly increased to about 45 inches. In his youth he fought several duels, one with a turkey cock, which is celebrated in the verse of Davenant. He became a popular and graceful courtier, and proved his bravery and allegiance to his sovereign by assuming command of a royalist company and doing good service therein. Both in moral and physical capacities he showed his superiority. At one time he was sent to France to secure a midwife for the Queen, who was a Frenchwoman. He afterward challenged a gentleman by the name of Croft to fight a duel, and would accept only deadly weapons; he shot his adversary in the chest; the quarrel grew out of his resentment of ridicule of his diminutive size. He was accused of participation in the Papist Plot and imprisoned by his political enemies in the Gate House at Westminster, where he died in 1682 at the advanced age of sixty-three. In Scott's "Peveril of the Peak" Hudson figures prominently. This author seemed fond of dwarfs. About the same epoch Charles I had a page in his court named Richard Gibson, who was remarkable for his diminutive size and his ability as a miniature painter. This little artist espoused another of his class, Anne Shepherd, a dwarf of Queen Henriette Marie, about his size (45 inches). Mistress Gibson bore nine children, five of whom arrived at adult age and were of ordinary proportions. She died at the age of eighty; her husband afterward became the drawing master of Princesses Mary and Anne, daughters of James II; he died July 23, 1690, aged seventy-five years. In 1730 there was born of poor fisher parents at Jelst a child named Wybrand Lokes. He became a very skilful jeweler, and though he was of diminutive stature he married a woman of medium height, by whom he had several children. He was one of the smallest men ever exhibited, measuring but 25 1/2 inches in height. To support his family better, he abandoned his trade and with great success exhibited himself throughout Holland and England. After having amassed a great fortune he returned to his country, where he died in 1800, aged seventy. He was very intelligent, and proved his power of paternity, especially by one son, who at twenty-three was 5 feet 3 inches tall, and robust. Another celebrated dwarf was Nicolas Ferry, otherwise known as Bebe. He was born at Plaine in the Vosges in 1741; he was but 22 cm. (8 1/2 inches) long, weighed 14 ounces at birth, and was carried on a plate to the church for baptism. At five Bebe was presented to King Stanislas of Poland. At fifteen he measured 29 inches. He was of good constitution, but was almost an idiot; for example, he did not recognize his mother after fifteen days' separation. He was quite lax in his morals, and exhibited no evidences of good nature except his lively attachment for his royal master, who was himself a detestable character. He died at twenty-two in a very decrepit condition, and his skeleton is preserved in the Museum of Natural History in Paris. Shortly before his death Bebe became engaged to a female dwarf named Therese Souvray, who at one time was exhibited in Paris at the Theatre Conti, together with an older sister. Therese lived to be seventy-three, and both she and her sister measured only 30 inches in height. She died in 1819. Aldrovandus gives a picture of a famous dwarf of the Duc de Crequi who was only 30 inches tall, though perfectly formed; he also speaks of some dwarfs who were not over 2 feet high. There was a Polish gentleman named Joseph Borwilaski, born in 1739 who was famed all over Europe. He became quite a scholar, speaking French and German fairly well. In 1860, at the age of twenty-two, and 28 inches in height, he married a woman of ordinary stature, who bore him two infants well conformed. He was exhibited in many countries, and finally settled at Durham, England, where he died in 1837 at the almost incredible age of ninety-eight, and is buried by the side of the Falstaffian Stephen Kemble. Mary Jones of Shropshire, a dwarf 32 inches tall and much deformed, died in 1773 at the age of one hundred. These two instances are striking examples of great age in dwarfs and are therefore of much interest. Borwilaski's parents were tall in stature and three of his brothers were small; three of the other children measured 5 feet 6 inches. Diderot has written a history of this family. Richeborg, a dwarf only 23 inches in height, died in Paris in 1858 aged ninety years. In childhood he had been a servant in the House of Orleans and afterward became their pensioner. During the Revolution he passed in and out of Paris as an infant in a nurse's arms, thus carrying dispatches memorized which might have proved dangerous to carry in any other manner. At St. Philip's, Birmingham, there is the following inscription on a tomb: "In memory of Mannetta Stocker, who quitted this life on the 4th day of May, 1819, at the age of thirty-nine years, the smallest woman in the kingdom, and one of the most accomplished." She was born in Krauma, in the north of Austria, under normal conditions. Her growth stopped at the age of four, when she was 33 inches tall. She was shown in many villages and cities over Europe and Great Britain; she was very gay, played well on the piano, and had divers other accomplishments. In 1742 there was shown in London a dwarf by the name of Robert Skinner, .63 meters in height, and his wife, Judith, who was a little larger. Their exhibition was a great success and they amassed a small fortune; during twenty-three years they had 14 robust and well-formed children. Judith died in 1763, and Robert grieved so much after her that he himself expired two years later. Figure 161 shows a female dwarf with her husband and child, all of whom were exhibited some years since in the Eastern United States. The likeness of the child to the mother is already noticeable. Buffon speaks of dwarfs 24, 21, and 18 inches high, and mentions one individual, aged thirty-seven, only 16 inches tall, whom he considers the smallest person on record. Virey in 1818 speaks of an English child of eight or nine who was but 18 inches tall. It had the intelligence of a child of three or four; its dentition was delayed until it was two years old and it did not walk until four. The parents of this child were of ordinary stature. At the "Cosmorama" in Regent Street in 1848 there was a Dutch boy of ten exhibited. He was said to be the son of an apothecary and at the time of his birth weighed nine pounds. He continued to grow for six months and at the expiration of that time weighed 12 pounds; since then, however, he had only increased four pounds. The arrest of development seemed to be connected with hydrocephalus; although the head was no larger than that of a child of two, the anterior fontanelle was widely open, indicating that there was pressure within. He was strong and muscular; grave and sedate in his manner; cheerful and affectionate; his manners were polite and engaging; he was expert in many kinds of handicraft; he possessed an ardent desire for knowledge and aptitude for education. Rawdon described a boy of five and a half, at the Liverpool Infirmary for Children, who weighed 10 1/2 pounds and whose height was 28 or 29 inches. He uttered no articulate sound, but evidently possessed the sense of hearing. His eyes were large and well formed, but he was apparently blind. He suckled, cut his teeth normally, but had tonic contractions of the spine and was an apparent idiot. Hardie mentions a girl of sixteen and a half whose height was 40 inches and weight 35 1/2 pounds, including her clothes. During intrauterine life her mother had good health and both her parents had always been healthy. She seemed to stop growing at her fourth year. Her intellect was on a par with the rest of her body. Sometimes she would talk and again she would preserve rigid silence for a long time. She had a shuffling walk with a tendency to move on her toes. Her temporary teeth were shed in the usual manner and had been replaced by canines and right first molar and incisors on the right side. There was no indication of puberty except a slight development of the hips. She was almost totally imbecile, but could tell her letters and spell short words. The circumference of the head was 19 inches, and Ross pointed out that the tendon-reflexes were well marked, as well as the ankle-clonus; he diagnosed the case as one of parencephalus. Figure 162 represents a most curious case of a dwarf named Carrie Akers, who, though only 34 inches tall, weighed 309 pounds. In recent years several dwarfs have commanded the popular attention, but none so much as "General Tom Thumb," the celebrated dwarf of Barnum's Circus. Charles Stratton, surnamed "Tom Thumb," was born at Bridgeport, Conn., on January 11, 1832; he was above the normal weight of the new-born. He ceased growing at about five months, when his height was less than 21 inches. Barnum, hearing of this phenomenon in his city, engaged him, and he was shown all over the world under his assumed name. He was presented to Queen Victoria in 1844, and in the following year he was received by the Royal Family in France. His success was wonderful, and even the most conservative journals described and commented on him. He gave concerts, in which he sang in a nasal voice; but his "drawing feat" was embracing the women who visited him. It is said that in England alone he kissed a million females; he prided himself on his success in this function, although his features were anything but inviting. After he had received numerous presents and had amassed a large fortune he returned to America in 1864, bringing with him three other dwarfs, the "Sisters Warren" and "Commodore Nutt." He married one of the Warrens, and by her had one child, Minnie, who died some months after birth of cerebral congestion. In 1883 Tom Thumb and his wife, Lavinia, were still living, but after that they dropped from public view and have since died. In 1895 the wife of a dwarf named Morris gave birth to twins at Blaenavon, North Wales. Morris is only 35 inches in height and his wife is even smaller. They were married at Bartholmey Church and have since been traveling through England under the name of "General and Mrs. Small," being the smallest married couple in the world. At the latest reports the mother and her twins were doing well. The Rossow Brothers have been recently exhibited to the public. These brothers, Franz and Carl, are twenty and eighteen years respectively. Franz is the eldest of 16 children and is said to weigh 24 pounds and measure 21 inches in height; Carl is said to weigh less than his brother but is 29 inches tall. They give a clever gymnastic exhibition and are apparently intelligent. They advertise that they were examined and still remain under the surveillance of the Faculty of Gottingen. Next to the success of "Tom Thumb" probably no like attraction has been so celebrated as the "Lilliputians," whose antics and wit so many Americans have in late years enjoyed. They were a troupe of singers and comedians composed entirely of dwarfs; they exhibited much talent in all their performances, which were given for several years and quite recently in all the large cities of the United States. They showed themselves to be worthy rivals for honors in the class of entertainments known as burlesques. As near as could be ascertained, partly from the fact that they all spoke German fluently and originally gave their performance entirely in German, they were collected from the German and Austrian Empires. The "Princess Topaze" was born near Paris in 1879. According to a recent report she is perfectly formed and is intelligent and vivacious. She is 23 1/2 inches tall and weighs 14 pounds. Her parents were of normal stature. Not long since the papers recorded the death of Lucia Zarete, a Mexican girl, whose exact proportions were never definitely known; but there is no doubt that she was the smallest midget ever exhibited In this country. Her exhibitor made a fortune with her and her salary was among the highest paid to modern "freaks." Miss H. Moritz, an American dwarf, at the age of twenty weighed 36 pounds and was only 22 inches tall. Precocious development is characterized by a hasty growth of the subject, who at an early period of life attains the dimensions of an adult. In some of these instances the anomaly is associated with precocious puberty, and after acquiring the adult growth at an early age there is an apparent cessation of the development. In adult life the individual shows no distinguishing characters. The first to be considered will be those cases, sometimes called "man-boys," characterized by early puberty and extraordinary development in infancy. Histories of remarkable children have been transmitted from the time of Vespasian. We read in the "Natural History" of Pliny that in Salamis, Euthimedes had a son who grew to 3 Roman cubits (4 1/2 feet) in three years; he was said to have little wit, a dull mind, and a slow and heavy gait; his voice was manly, and he died at three of general debility. Phlegon says that Craterus, the brother of King Antigonus, was an infant, a young man, a mature man, an old man, and married and begot children all in the space of seven years. It is said that King Louis II of Hungary was born so long before his time that he had no skin; in his second year he was crowned, in his tenth year he succeeded, in his fourteenth year he had a complete beard, in his fifteenth he was married, in his eighteenth he had gray hair, and in his twentieth he died. Rhodiginus speaks of a boy who when he was ten years impregnated a female. In 1741 there was a boy born at Willingham, near Cambridge, who had the external marks of puberty at twelve months, and at the time of his death at five years he had the appearance of an old man. He was called "prodigium Willinghamense." The Ephemerides and some of the older journals record instances of penile erection immediately after birth. It was said that Philip Howarth, who was born at Quebec Mews, Portman Square, London, February 21, 1806, lost his infantile rotundity of form and feature after the completion of his first year and became pale and extremely ugly, appearing like a growing boy. His penis and testes increased in size, his voice altered, and hair grew on the pubes. At the age of three he was 3 feet 4 1/2 inches tall and weighed 51 1/4 pounds. The length of his penis when erect was 4 1/2 inches and the circumference 4 inches; his thigh-measure was 13 1/2 inches, his waist-measure 24 inches, and his biceps 7 inches. He was reported to be clever, very strong, and muscular. An old chronicle says that in Wisnang Parish, village of Tellurge, near Tygure, in Lordship Kiburge, there was born on the 26th of May, 1548, a boy called Henry Walker, who at five years was of the height of a boy of fourteen and possessed the genitals of a man. He carried burdens, did men's work, and in every way assisted his parents, who were of usual size. There is a case cited by the older authors of a child born in the Jura region who at the age of four gave proof of his virility, at seven had a beard and the height of a man. The same journal also speaks of a boy of six, 1.62 meters tall, who was perfectly proportioned and had extraordinary strength. His beard and general appearance, together with the marks of puberty, gave him the appearance of a man of thirty. In 1806 Dupuytren presented to the Medical Society in Paris a child 3 1/2 feet high, weighing 57 pounds, who had attained puberty. There are on record six modern cases of early puberty in boys, one of whom died at five with the signs of premature senility; at one year he had shown signs of enlargement of the sexual organs. There was another who at three was 3 feet 6 3/4 inches high, weighed 50 pounds, and had seminal discharges. One of the cases was a child who at birth resembled an ordinary infant of five months. From four to fifteen months his penis enlarged, until at the age of three it measured when erect 3 inches. At this age he was 3 feet 7 inches high and weighed 64 pounds. The last case mentioned was an infant who experienced a change of voice at twelve months and showed hair on the pubes. At three years he was 3 feet 4 1/2 inches tall and weighed 51 1/4 pounds. Smith, in Brewster's Journal, 1829, records the case of a boy who at the age of four was well developed; at the age of six he was 4 feet 2 inches tall and weighed 74 pounds; his lower extremities were extremely short proportionally and his genitals were as well developed as those of an adult. He had a short, dark moustache but no hair on his chin, although his pubic hair was thick, black, and curly. Ruelle describes a child of three and a quarter years who was as strong and muscular as one at eight. He had full-sized male organs and long black hair on the pubes. Under excitement he discharged semen four or five times a day; he had a deep male voice, and dark, short hair on the cheek and upper lip. Stone gives an account of a boy of four who looked like a child of ten and exhibited the sexual organs of a man with a luxuriant growth of hair on the pubes. This child was said to have been of great beauty and a miniature model of an athlete. His height was 4 feet 1/4 inch and weight 70 pounds; the penis when semiflaccid was 4 1/4 inches long; he was intelligent and lively, and his back was covered with the acne of puberty. A peculiar fact as regards this case was the statement of the father that he himself had had sexual indulgence at eight. Stone parallels this case by several others that he has collected from medical literature. Breschet in 1821 reported the case of a boy born October 20, 1817, who at three years and one month was 3 feet 6 3/4 inches tall; his penis when flaccid measured 4 inches and when erect 5 1/4 inches, but the testicles were not developed in proportion. Lopez describes a mulatto boy of three years ten and a half months whose height was 4 feet 1/2 inch and weight 82 pounds; he measured about the chest 27 1/2 inches and about the waist 27 inches; his penis at rest was 4 inches long and had a circumference of 3 1/2 inches, although the testes were not descended. He had evidences of a beard and his axillae were very hairy; it is said he could with ease lift a man weighing 140 pounds. His body was covered with acne simplex and had a strong spermatic odor, but it was not known whether he had any venereal appetite. Johnson mentions a boy of seven with severe gonorrhea complicated with buboes which he had contracted from a servant girl with whom he slept. At the Hopital des Enfans Malades children at the breast have been observed to masturbate. Fournier and others assert having seen infantile masturbators, and cite a case of a girl of four who was habitually addicted to masturbation from her infancy but was not detected until her fourth year; she died shortly afterward in a frightful state of marasmus. Vogel alludes to a girl of three in whom repeated attacks of epilepsy occurred after six months' onanism. Van Bambeke mentions three children from ten to twenty months old, two of them females, who masturbated. Bidwell describes a boy of five years and two months who during the year previous had erections and seminal emissions. His voice had changed and he had a downy moustache on his upper lip and hair on the pubes; his height was 4 feet 3 1/2 inches and his weight was 82 1/2 pounds. His penis and testicles were as well developed as those of a boy of seventeen or eighteen, but from his facial aspect one would take him to be thirteen. He avoided the company of women and would not let his sisters nurse him when he was sick. Pryor speaks of a boy of three and a half who masturbated and who at five and a half had a penis of adult size, hair on the pubes, and was known to have had seminal emissions. Woods describes a boy of six years and seven months who had the appearance of a youth of eighteen. He was 4 feet 9 inches tall and was quite muscular. He first exhibited signs of precocious growth at the beginning of his second year and when three years old he had hair on the pubes. There is an instance in which a boy of thirteen had intercourse with a young woman at least a dozen times and succeeded in impregnating her. The same journal mentions an instance in which a boy of fourteen succeeded in impregnating a girl of the same age. Chevers speaks of a young boy in India who was sentenced to one year's imprisonment for raping a girl of three. Douglass describes a boy of four years and three months who was 3 feet 10 1/2 inches tall and weighed 54 pounds; his features were large and coarse, and his penis and testes were of the size of those of an adult. He was unusually dull, mentally, quite obstinate, and self-willed. It is said that he masturbated on all opportunities and had vigorous erections, although no spermatozoa were found in the semen issued. He showed no fondness for the opposite sex. The history of this rapid growth says that he was not unlike other children until the third year, when after wading in a small stream several hours he was taken with a violent chill, after which his voice began to change and his sexual organs to develop. Blanc quotes the case described by Cozanet in 1875 of Louis Beran, who was born on September 29, 1869, at Saint-Gervais, of normal size. At the age of six months his dimensions and weight increased in an extraordinary fashion. At the age of six years he was 1.28 meters high (4 feet 2 1/3 inches) and weighed 80 pounds. His puberty was completely manifested in every way; he eschewed the society of children and helped his parents in their labors. Campbell showed a lad of fourteen who had been under his observation for ten years. When fifteen months old this prodigy had hair on his pubes and his external genitals were abnormally larger end at the age of two years they were fully developed and had not materially changed in the following years. At times he manifested great sexual excitement. Between four and seven years he had seminal discharges, but it was not determined whether the semen contained spermatozoa. He had the muscular development of a man of twenty-five. He had shaved several years. The boy's education was defective from his failure to attend school. The accompanying illustration represents a boy of five years and three months of age whose height at this time was 4 feet and his physical development far beyond that usual at this age, his external genitals resembling those of a man of twenty. His upper lip was covered by a mustache, and the hirsute growth elsewhere was similarly precocious. The inscription on the tombstone of James Weir in the Parish of Carluke, Scotland, says that when only thirteen months old he measured 3 feet 4 inches in height and weighed 5 stone. He was pronounced by the faculty of Edinburgh and Glasgow to be the most extraordinary child of his age. Linnaeus saw a boy at the Amsterdam Fair who at the age of three weighed 98 pounds. In Paris, about 1822, there was shown an infant Hercules of seven who was more remarkable for obesity than general development. He was 3 feet 4 inches high, 4 feet 5 inches in circumference, and weighed 220 pounds. He had prominent eyebrows, black eyes, and his complexion resembled that of a fat cook in the heat. Borellus details a description of a giant child. There is quoted from Boston a the report of a boy of fifteen months weighing 92 pounds who died at Coney Island. He was said to have been of phenomenal size from infancy and was exhibited in several museums during his life. Desbois of Paris mentions an extraordinary instance of rapid growth in a boy of eleven who grew 6 inches in fifteen days. Large and Small New-born Infants.--There are many accounts of new-born infants who were characterized by their diminutive size. On page 66 we have mentioned Usher's instance of twins born at the one hundred and thirty-ninth day weighing each less than 11 ounces; Barker's case of a female child at the one hundred and fifty-eighth day weighing 1 pound; Newinton's case of twins at the fifth month, one weighing 1 pound and the other 1 pound 3 1/2 ounces; and on page 67 is an account of Eikam's five-months' child, weighing 8 ounces. Of full-term children Sir Everard Home, in his Croonian Oration in 1824, speaks of one borne by a woman who was traveling with the baggage of the Duke of Wellington's army. At her fourth month of pregnancy this woman was attacked and bitten by a monkey, but she went to term, and a living child was delivered which weighed but a pound and was between 7 and 8 inches long. It was brought to England and died at the age of nine, when 22 inches high. Baker mentions a child fifty days' old that weighed 1 pound 13 ounces and was 14 inches long. Mursick describes a living child who at birth weighed but 1 3/4 pounds. In June, 1896, a baby weighing 1 3/4 pounds was born at the Samaritan Hospital, Philadelphia. Scott has recorded the birth of a child weighing 2 1/2 pounds, and another 3 1/4 pounds. In the Chicago Inter-Ocean there is a letter dated June 20, 1874, which says that Mrs. J. B. McCrum of Kalamazoo, Michigan, gave birth to a boy and girl that could be held in the palm of the hand of the nurse. Their aggregate weight was 3 pounds 4 ounces, one weighing 1 pound 8 ounces, the other 1 pound 12 ounces. They were less than 8 inches long and perfectly formed; they were not only alive but extremely vivacious. There is an account of female twins born in 1858 before term. One weighed 22 1/2 ounces, and over its arm, forearm, and hand one could easily pass a wedding-ring. The other weighed 24 ounces. They both lived to adult life; the larger married and was the mother of two children, which she bore easily. The other did not marry, and although not a dwarf, was under-sized; she had her catamenia every third week. Post describes a 2-pound child. On the other hand, there have been infants characterized by their enormous size at birth. Among the older writers, Cranz describes an infant which at birth weighed 23 pounds; Fern mentions a fetus of 18 pounds; and Mittehauser speaks of a new-born child weighing 24 pounds. Von Siebold in his "Lucina" has recorded a fetus which weighed 22 1/2 pounds. It is worthy of comment that so great is the rarity of these instances that in 3600 cases, in the Rotunda Hospital, Dublin, only one child reached 11 pounds. There was a child born in Sussex in 1869 which weighed 13 1/2 pounds and measured 26 1/2 inches. Warren delivered a woman in Derbyshire of male twins, one weighing 17 pounds 8 ounces and the other 18 pounds. The placenta weighed 4 pounds, and there was an ordinary pailful of liquor amnii. Both the twins were muscular and well formed; the parents were of ordinary stature, and at last reports the mother was rapidly convalescing. Burgess mentions an 18-pound new-born child; end Meadows has seen a similar instance. Eddowes speaks of the birth of a child at Crewe, a male, which weighed 20 pounds 2 ounces and was 23 inches long. It was 14 1/2 inches about the chest, symmetrically developed, and likely to live. The mother, who was a schoolmistress of thirty-three, had borne two previous children, both of large size. In this instance the gestation had not been prolonged, the delivery was spontaneous, and there was no laceration of the parts. Chubb says that on Christmas Day, 1852, there was a child delivered weighing 21 pounds. The labor was not severe and the other children of the family were exceptionally large. Dickinson describes a woman, a tertipara, who had a most difficult labor and bore an extremely large child. She had been thirty-six hours in parturition, and by evisceration and craniotomy was delivered of a child weighing 16 pounds. Her first child weighed 9 pounds, her second 20, and her third, the one described, cost her her life soon after delivery. There is a history of a Swedish woman in Boston who was delivered by the forceps of her first child, which weighed 19 3/4 pounds and which was 25 3/4 inches long. The circumference of the head was 16 3/4 inches, of the neck 9 3/4, and of the thigh 10 3/4 inches. Rice speaks of a child weighing 20 1/4 pounds at birth. Johnston describes a male infant who was born on November 26, 1848, weighing 20 pounds, and Smith another of the same weight. Baldwin quotes the case of a woman who after having three miscarriages at last had a child that weighed 23 pounds. In the delivery there was extensive laceration of the anterior wall of the vagina; the cervix and perineum, together with an inch of the rectum, were completely destroyed. Beach describes a birth of a young giant weighing 23 3/4 pounds. Its mother was Mrs. Bates, formerly Anna Swann, the giantess who married Captain Bates. Labor was rather slow, but she was successfully delivered of a healthy child weighing 23 3/4 pounds and 30 inches long. The secundines weighed ten pounds and there were nine quarts of amniotic fluid. There is a recent record of a Cesarian section performed on a woman of forty in her twelfth pregnancy and one month beyond term. The fetus, which was almost exsanguinated by amputation, weighed 22 1/2 pounds. Bumm speaks of the birth of a premature male infant weighing 4320 gm. (9 1/2 pounds) and measuring 54 cm. long. Artificial labor had been induced at the thirty-fifth week in the hope of delivering a living child, the three preceding infants having all been still-born on account of their large size. Although the mother's pelvis was wide, the disposition to bear huge infants was so great as to render the woman virtually barren. Congenital asymmetry and hemihypertrophy of the body are most peculiar anomalies and must not be confounded with acromegaly or myxedema, in both of which there is similar lack of symmetric development. There seems to be no satisfactory clue to the causation of these abnormalisms. Most frequently the left side is the least developed, and there is a decided difference in the size of the extremities. Finlayson reports a case of a child affected with congenital unilateral hypertrophy associated with patches of cutaneous congestion. Logan mentions hypertrophy in the right half of the body in a child of four, first noticed shortly after birth; Langlet also speaks of a case of congenital hypertrophy of the right side. Broca and Trelat were among the first observers to discuss this anomaly. Tilanus of Munich in 1893 reported a case of hemihypertrophy in a girl of ten. The whole right half of the body was much smaller and better developed than the left, resulting in a limping gait. The electric reaction and the reflexes showed no abnormality. The asymmetry was first observed when the child was three. Mobius and Demme report similar cases. Adams reports an unusual case of hemihypertrophy in a boy of ten. There was nothing noteworthy in the family history, and the patient had suffered from none of the diseases of childhood. Deformity was noticeable at birth, but not to such a degree relatively as at a later period. The increased growth affected the entire right half of the body, including the face, but was most noticeable in the leg, thigh, and buttock. Numerous telangiectatic spots were scattered irregularly over the body, but most thickly on the right side, especially on the outer surface of the leg. The accompanying illustration represents the child's appearance at the time of report. Jacobson reports the history of a female child of three years with nearly universal giant growth (Riesenwuchs). At first this case was erroneously diagnosed as acromegaly. The hypertrophy affected the face, the genitals, the left side of the trunk, and all the limbs. Milne records a case of hemihypertrophy in a female child of one year. The only deviation from uniform excess of size of the right side was shown in the forefinger and thumb, which were of the same size as on the other hand; and the left side showed no overgrowth in any of its members except a little enlargement of the second toe. While hypertrophy of one side is the usual description of such cases, the author suggests that there may be a condition of defect upon the other side, and he is inclined to think that in this case the limb, hand, and foot of the left side seemed rather below the average of the child's age. In this case, as in others previously reported, there were numerous telangiectatic spots of congestion scattered irregularly over the body. Milne also reported later to the Sheffield Medico-Chirurgical Society an instance of unilateral hypertrophy in a female child of nineteen months. The right side was involved and the anomaly was believed to be due to a deficiency of growth of the left side as well as over-development of the right. There were six teeth on the right side and one on the left. Obesity.--The abnormality of the adipose system, causing in consequence an augmentation of the natural volume of the subject, should be described with other anomalies of size and stature. Obesity may be partial, as seen in the mammae or in the abdomen of both women and men, or it may be general; and it is of general obesity that we shall chiefly deal. Lipomata, being distinctly pathologic formations, will be left for another chapter. The cases of obesity in infancy and childhood are of considerable interest, and we sometimes see cases that have been termed examples of "congenital corpulency." Figure 167 represents a baby of thirteen months that weighed 75 pounds. Figure 168 shows another example of infantile obesity, known as "Baby Chambers." Elliotson describes a female infant not a year old which weighed 60 pounds. There is an instance on record of a girl of four who weighed 256 pounds Tulpius mentions a girl of five who weighed 150 pounds and had the strength of a man. He says that the acquisition of fat did not commence until some time after birth. Ebstein reports an instance given to him by Fisher of Moscow of a child in Pomerania who at the age of six weighed 137 pounds and was 46 inches tall; her girth was 46 inches and the circumference of her head was 24 inches. She was the offspring of ordinary-sized parents, and lived in narrow and sometimes needy circumstances. The child was intelligent and had an animated expression of countenance. Bartholinus mentions a girl of eleven who weighed over 200 pounds. There is an instance recorded of a young girl in Russia who weighed nearly 200 pounds when but twelve. Wulf, quoted by Ebstein, describes a child which died at birth weighing 295 ounces. It was well proportioned and looked like a child three months old, except that it had an enormous development of fatty tissue. The parents were not excessively large, and the mother stated that she had had children before of the same proportions. Grisolles mentions a child who was so fat at twelve months that there was constant danger of suffocation; but, marvelous to relate, it lost all its obesity when two and a half, and later was remarkable for its slender figure. Figure 169 shows a girl born in Carbon County, Pa., who weighed 201 pounds when nine years old. McNaughton describes Susanna Tripp, who at six years of age weighed 203 pounds and was 3 feet 6 inches tall and measured 4 feet 2 inches around the waist. Her younger sister, Deborah, weighed 119 pounds; neither of the two weighed over 7 pounds at birth and both began to grow at the fourth month. On October, 1788, there died at an inn in the city of York the surprising "Worcestershire Girl" at the age of five. She had an exceedingly beautiful face and was quite active. She was 4 feet in height and larger around the breast and waist; her thigh measured 18 inches and she weighed nearly 200 pounds. In February, 1814, Mr. S. Pauton was married to the only daughter of Thomas Allanty of Yorkshire; although she was but thirteen she was 13 stone weight (182 pounds). At seven years she had weighed 7 stone (98 pounds). Williams mentions several instances of fat children. The first was a German girl who at birth weighed 13 pounds; at six months, 42 pounds; at four years, 150 pounds; and at twenty years, 450 pounds. Isaac Butterfield, born near Leeds in 1781, weighed 100 pounds in 1782 and was 3 feet 13 inches tall. There was a child named Everitt, exhibited in London in 1780, who at eleven months was 3 feet 9 inches tall and measured around the loins over 3 feet. William Abernethy at the age of thirteen weighed 22 stone (308 pounds) and measured 57 inches around the waist. He was 5 feet 6 inches tall. There was a girl of ten who was 1.45 meters (4 feet 9 inches) high and weighed 175 pounds. Her manners were infantile and her intellectual development was much retarded. She spoke with difficulty in a deep voice; she had a most voracious appetite. At a meeting of the Physical Society of Vienna on December 4, 1894, there was shown a girl of five and a half who weighed 250 pounds. She was just shedding her first teeth; owing to the excess of fat on her short limbs she toddled like an infant. There was no tendency to obesity in her family. Up to the eleventh month she was nursed by her mother, and subsequently fed on cabbage, milk, and vegetable soup. This child, who was of Russian descent, was said never to perspire. Cameron describes a child who at birth weighed 14 pounds, at twelve months she weighed 69 pounds, and at seventeen months 98 pounds. She was not weaned until two years old and she then commenced to walk. The parents were not remarkably large. There is an instance of a boy of thirteen and a half who weighed 214 pounds. Kaestner speaks of a child of four who weighed 82 pounds, and Benzenberg noted a child of the same age who weighed 137. Hildman, quoted by Picat, speaks of an infant three years and ten months old who had a girth of 30 inches. Hillairet knew of a child of five which weighed 125 pounds. Botta cites several instances of preternaturally stout children. One child died at the age of three weighing 90 pounds, another at the age of five weighed 100 pounds, and a third at the age of two weighed 75 pounds. Figure 170 represents Miss "Millie Josephine" of Chicago, a recent exhibitionist, who at the reputed age of thirteen was 5 feet 6 inches tall and weighed 422 pounds. General Remarks.--It has been chiefly in Great Britain and in Holland that the most remarkable instances of obesity have been seen, especially in the former country colossal weights have been recorded. In some countries corpulency has been considered an adornment of the female sex. Hesse-Wartegg refers to the Jewesses of Tunis, who when scarcely ten years old are subjected to systematic treatment by confinement in narrow, dark rooms, where they are fed on farinaceous foods and the flesh of young puppies until they are almost a shapeless mass of fat. According to Ebstein, the Moorish women reach with astonishing rapidity the desired embonpoint on a diet of dates and a peculiar kind of meal. In some nations and families obesity is hereditary, and generations come and go without a change in the ordinary conformation of the representatives. In other people slenderness is equally persistent, and efforts to overcome this peculiarity of nature are without avail. Treatment of Obesity.--Many persons, the most famous of whom was Banting, have advanced theories to reduce corpulency and to improve slenderness; but they have been uniformly unreliable, and the whole subject of stature-development presents an almost unexplored field for investigation. Recently, Leichtenstein, observing in a case of myxedema treated with the thyroid gland that the subcutaneous fat disappeared with the continuance of the treatment, was led to adopt this treatment for obesity itself and reports striking results. The diet of the patient remained the same, and as the appetite was not diminished by the treatment the loss of weight was evidently due to other causes than altered alimentation. He holds that the observations in myxedema, in obesity, and psoriasis warrant the belief that the thyroid gland eliminates a material having a regulating influence upon the constitution of the panniculus adiposus and upon the nutrition of the skin in general. There were 25 patients in all; in 22 the effect was entirely satisfactory, the loss of weight amounting to as much as 9.5 kilos (21 pounds). Of the three cases in which the result was not satisfactory, one had nephritis with severe Graves' disease, and the third psoriasis. Charrin has used the injections of thyroid extract with decided benefit. So soon as the administration of the remedy was stopped the loss of weight ceased, but with the renewal of the remedy the loss of weight again ensued to a certain point, beyond which the extract seemed powerless to act. Ewald also reports good results from this treatment of obesity. Remarkable Instances of Obesity.--From time immemorial fat men and women have been the object of curiosity and the number who have exhibited themselves is incalculable. Nearly every circus and dime museum has its example, and some of the most famous have in this way been able to accumulate fortunes. Athenaeus has written quite a long discourse on persons of note who in the olden times were distinguished for their obesity. He quotes a description of Denys, the tyrant of Heraclea, who was so enormous that he was in constant danger of suffocation; most of the time he was in a stupor or asleep, a peculiarity of very fat people. His doctors had needles put in the back of his chairs to keep him from falling asleep when sitting up and thus incurring the danger of suffocation. In the same work Athenaeus speaks of several sovereigns noted for their obesity; among others he says that Ptolemy VII, son of Alexander, was so fat that, according to Posidonius, when he walked he had to be supported on both sides. Nevertheless, when he was excited at a repast, he would mount the highest couch and execute with agility his accustomed dance. According to old chronicles the cavaliers at Rome who grew fat were condemned to lose their horses and were placed in retirement. During the Middle Ages, according to Guillaume in his "Vie de Suger," obesity was considered a grace of God. Among the prominent people in the olden time noted for their embonpoint were Agesilas, the orator Licinius Calvus, who several times opposed Cicero, the actor Lucius, and others. Among men of more modern times we can mention William the Conqueror; Charles le Gros; Louis le Gros; Humbert II, Count of Maurienne; Henry I, King of Navarre; Henry III, Count of Champagne; Conan III, Duke of Brittany; Sancho I, King of Leon; Alphonse II, King of Portugal; the Italian poet Bruni, who died in 1635; Vivonne, a general under Louis XIV; the celebrated German botanist Dillenius; Haller; Frederick I, King of Wurtemberg, and Louis XVIII. Probably the most famous of all the fat men was Daniel Lambert, born March 13, 1770, in the parish of Saint Margaret, Leicester. He did not differ from other youths until fourteen. He started to learn the trade of a die-sinker and engraver in Birmingham. At about nineteen he began to believe he would be very heavy and developed great strength. He could lift 500 pounds with ease and could kick seven feet high while standing on one leg. In 1793 he weighed 448 pounds; at this time he became sensitive as to his appearance. In June, 1809, he weighed 52 stone 11 pounds (739 pounds), and measured over 3 yards around the body and over 1 yard around the leg. He had many visitors, and it is said that once, when the dwarf Borwilaski came to see him, he asked the little man how much cloth he needed for a suit. When told about 3/4 of a yard, he replied that one of his sleeves would be ample. Another famous fat man was Edward Bright, sometimes called "the fat man of Essex." He weighed 616 pounds. In the same journal that records Bright's weight is an account of a man exhibited in Holland who weighed 503 pounds. Wadd, a physician, himself an enormous man, wrote a treatise on obesity and used his own portrait for a frontispiece. He speaks of Doctor Beddoes, who was so uncomfortably fat that a lady of Clifton called him a "walking feather bed." He mentions Doctor Stafford, who was so enormous that this epitaph was ascribed to him:-- "Take heed, O good traveler! and do not tread hard, For here lies Dr. Stafford, in all this churchyard." Wadd has gathered some instances, a few of which will be cited. At Staunton, January 2, 1816, there died Samuel Sugars, Gent., who weighed with a single wood coffin 50 stone (700 pounds). Jacob Powell died in 1764, weighing 660 pounds. It took 16 men to carry him to his grave. Mr. Baker of Worcester, supposed to be larger than Bright, was interred in a coffin that was larger than an ordinary hearse. In 1797 there was buried Philip Hayes, a professor of music, who was as heavy as Bright (616 pounds). Mr. Spooner, an eminent farmer of Warwickshire, who died in 1775, aged fifty-seven, weighed 569 pounds and measured over 4 feet across the shoulders. The two brothers Stoneclift of Halifax, Yorkshire, together weighed 980 pounds. Keysler in his travels speaks of a corpulent Englishman who in passing through Savoy had to use 12 chairmen; he says that the man weighed 550 pounds. It is recorded on the tombstone of James Parsons, a fat man of Teddington, who died March 7, 1743, that he had often eaten a whole shoulder of mutton and a peck of hasty pudding. Keysler mentions a young Englishman living in Lincoln who was accustomed to eat 18 pounds of meat daily. He died in 1724 at the age of twenty-eight, weighing 530 pounds. In 1815 there died in Trenaw, in Cornwall, a person known as "Giant Chillcot." He measured at the breast 6 feet 9 inches and weighed 460 pounds. One of his stockings held 6 gallons of wheat. In 1822 there was reported to be a Cambridge student who could not go out in the daytime without exciting astonishment. The fat of his legs overhung his shoes like the fat in the legs of Lambert and Bright. Dr. Short mentions a lady who died of corpulency in her twenty-fifth year weighing over 50 stone (700 pounds). Catesby speaks of a man who weighed 500 pounds, and Coe mentions another who weighed 584 pounds. Fabricius and Godart speak of obesity so excessive as to cause death. There is a case reported from the French of a person who weighed 800 pounds. Smetius speaks of George Fredericus, an office-holder in Brandenburgh, who weighed 427 pounds. Dupuytren gives the history of Marie Francoise-Clay, who attained such celebrity for her obesity. She was born in poverty, reached puberty at thirteen, and married at twenty-five, at which age she was already the stoutest woman of her neighborhood notwithstanding her infirmity. She followed her husband, who was an old-clothes dealer, afoot from town to town. She bore six children, in whom nothing extraordinary was noticed. The last one was born when she was thirty-five years old. Neither the births, her travels, nor her poverty, which sometimes forced her to beg at church doors, arrested the progress of the obesity. At the age of forty she was 5 feet 1 inch high and one inch greater about the waist. Her head was small and her neck was entirely obliterated. Her breasts were over a yard in circumference and hung as low as the umbilicus. Her arms were elevated and kept from her body by the fat in her axillae. Her belly was enormous and was augmented by six pregnancies. Her thighs and haunches were in proportion to her general contour. At forty she ceased to menstruate and soon became afflicted with organic heart diseases. Fournier quotes an instance of a woman in Paris who at twenty-four, the time of her death, weighed 486 pounds. Not being able to mount any conveyance or carriage in the city, she walked from place to place, finding difficulty not in progression, but in keeping her equilibrium. Roger Byrne, who lived in Rosenalis, Queen's County, Ireland, died of excessive fatness at the age of fifty-four, weighing 52 stone. Percy and Laurent speak of a young German of twenty who weighed 450 pounds. At birth he weighed 13 pounds, at six months 42, and at four years 150 pounds. He was 5 feet 5 inches tall and the same in circumference. William Campbell, the landlord of the Duke of Wellington in Newcastle-on-Tyne, was 6 feet 4 inches tall and weighed 728 pounds. He measured 96 inches around the shoulders, 85 inches around the waist, and 35 inches around the calf. He was born at Glasgow in 1856, and was not quite twenty-two when last measured. To illustrate the rate of augmentation, he weighed 4 stone at nine months and at ten years 18 stone. He was one of a family of seven children. His appetite was not more than the average, and he was moderate as regards the use of liquors, but a great smoker Notwithstanding his corpulency, he was intelligent and affable. Miss Conley, a member of an American traveling circus, who weighed 479 pounds, was smothered in bed by rolling over on her face; she was unable to turn on her back without assistance. There was a girl who died at Plaisance near Paris in 1890 who weighed 470 pounds or more. In 1889 an impresario undertook to exhibit her; but eight men could not move her from her room, and as she could not pass through the door the idea was abandoned. There was a colored woman who died near Baltimore who weighed 850 pounds, exceeding the great Daniel Lambert by 120 pounds. The journal reporting this case quotes the Medical Record as saying that there was a man in North Carolina, who was born in 1798, who was 7 feet 8 inches tall and weighed over 1000 pounds, probably the largest man that ever lived. Hutchison says that he Saw in the Infirmary at Kensington, under Porter's care, a remarkable example of obesity. The woman was only just able to walk about and presented a close resemblance to Daniel Lambert. Obesity forced her to leave her occupation. The accumulation of fat on the abdomen, back, and thighs was enormous. According to a recent number of La Liberte, a young woman of Pennsylvania, although only sixteen years old, weighs 450 pounds. Her waist measures 61 inches in circumference and her neck 22 inches. The same paper says that on one of the quays of Paris may be seen a wine-shop keeper with whom this Pennsylvania girl could not compare. It is said that this curiosity of the Notre-Dame quarter uses three large chairs while sitting behind her specially constructed bar. There is another Paris report of a man living in Switzerland who weighs more than 40 stone (560 pounds) and eats five times as much as an ordinary person. When traveling he finds the greatest difficulty in entering an ordinary railway carriage, and as a rule contents himself in the luggage van. Figure 171 represents an extremely fat woman with a well-developed beard. To end this list of obese individuals, we mention an old gentleman living in San Francisco who, having previously been thin, gained 14 pounds in his seventieth year and 14 pounds each of seven succeeding years. Simulation of Obesity.--General dropsy, elephantiasis, lipomata, myxedema, and various other affections in which there is a hypertrophic change of the connective tissues may be mistaken for general obesity; on the other hand, a fatty, pendulous abdomen may simulate the appearances of pregnancy or even of ovarian cyst. Dercum of Philadelphia has described a variety of obesity which he has called "adiposis dolorosa," in which there is an enormous growth of fat, sometimes limited, sometimes spread all over the body, this condition differing from that of general lipomatosis in its rarity, in the mental symptoms, in the headache, and the generally painful condition complained of. In some of the cases examined by Dercum he found that the thyroid was indurated and infiltrated by calcareous deposits. The disease is not myxedema because there is no peculiar physiognomy, no spade-like hands nor infiltrated skin, no alteration of the speech, etc. Dercum considers it a connective-tissue dystrophy--a fatty metamorphosis of various stages, possibly a neuritis. The first of Dercum's cases was a widow of Irish birth, who died both alcoholic and syphilitic. When forty-eight or forty-nine her arms began to enlarge. In June, 1887, the enlargement affected the shoulders, arms, back, and sides of the chest. The parts affected were elastic, and there was no pitting. In some places the fat was lobulated, in others it appeared as though filled with bundles of worms. The skin was not thickened and the muscles were not involved. In the right arm there was unendurable pain to the touch, and this was present in a lesser degree in the left arm. Cutaneous sensibility was lessened. On June 13th a chill was followed by herpes over the left arm and chest, and later on the back and on the front of the chest. The temperature was normal. The second case was a married Englishwoman of sixty-four. The enlarged tissue was very unevenly distributed, and sensibility was the same as in the previous case. At the woman's death she weighed 300 pounds, and the fat over the abdomen was three inches thick. The third case was a German woman in whom were seen soft, fat-like masses in various situations over either biceps, over the outer and posterior aspect of either arm, and two large masses over the belly; there was excessive prominence of the mons veneris. At the autopsy the heart weighed 8 1/2 ounces, and the fat below the umbilicus was seven inches thick. Abnormal Leanness.--In contrast to the fat men are the so-called "living skeletons," or men who have attained notice by reason of absence of the normal adipose tissue. The semimythical poet Philotus was so thin that it was said that he fastened lead on his shoes to prevent his being blown away,--a condition the opposite of that of Dionysius of Heraclea, who, after choking to death from his fat, could hardly be moved to his grave. In March, 1754, there died in Glamorganshire of mere old age and gradual decay a little Welshman, Hopkin Hopkins, aged seventeen years. He had been recently exhibited in London as a natural curiosity; he had never weighed over 17 pounds, and for the last three years of his life never more than 12 pounds. His parents still had six children left, all of whom were normal and healthy except a girl of twelve, who only weighed 18 pounds and bore marks of old age. There was a "living skeleton" brought to England in 1825 by the name of Claude Seurat. He was born in 1798 and was in his twenty-seventh year. He usually ate in the course of a day a penny roll and drank a small quantity of wine. His skeleton was plainly visible, over which the skin was stretched tightly. The distance from the chest to the spine was less than 3 inches, and internally this distance was less. The pulsations of the heart were plainly visible. He was in good health and slept well. His voice was very weak and shrill. The circumference of this man's biceps was only 4 inches. The artist Cruikshank has made several drawings of Seurat. Calvin Edson was another living skeleton. In 1813 he was in the army at the battle of Plattsburg, and had lain down in the cold and become benumbed. At this time he weighed 125 pounds and was twenty-five years old. In 1830 he weighed but 60 pounds, though 5 feet 4 inches tall. He was in perfect health and could chop a cord of wood without fatigue; he was the father of four children. Salter speaks of a man in 1873 who was thirty-two years of age and only weighed 49 pounds. He was 4 feet 6 inches tall: his forehead measured in circumference 20 1/2 inches and his chest 27 inches. His genitals, both internal and external, were defectively developed. Figure 175 represents the well-known Ohio "living skeleton," J. W. Coffey, who has been exhibited all over the Continent. His good health and appetite were proverbial among his acquaintances. In some instances the so-called "living skeletons" are merely cases of extreme muscular atrophy. As a prominent example of this class the exhibitionist, Rosa Lee Plemons at the age of eighteen weighed only 27 pounds. Figure 177 shows another case of extraordinary atrophic condition of all the tissues of the body associated with nondevelopment. These persons are always sickly and exhibit all the symptoms of progressive muscular atrophy, and cannot therefore be classed with the true examples of thinness, in which the health is but slightly affected or possibly perfect health is enjoyed. CHAPTER VIII. LONGEVITY. Scope of the Present Article.--The limits of space in this work render impossible a scientific discussion upon the most interesting subject of longevity, and the reader is referred to some of the modern works devoted exclusively to this subject. In reviewing the examples of extreme age found in the human race it will be our object to lay before the reader the most remarkable instances of longevity that have been authentically recorded, to cite the source of the information, when possible to give explanatory details, and to report any relative points of value and interest. Throughout the article occasional facts will be given to show in what degree character, habit, and temperament influence longevity, and in what state of mind and body and under what circumstances man has obtained the highest age. General Opinions.--There have been many learned authorities who invariably discredit all accounts of extraordinary age, and contend that there has never been an instance of a man living beyond the century mark whose age has been substantiated by satisfactory proof. Such extremists as Sir G. Cornewall Lewis and Thoms contend that since the Christian era no person of royal or noble line mentioned in history whose birth was authentically recorded at its occurrence has reached one hundred years. They have taken the worst station in life in which to find longevity as their field of observation. Longevity is always most common in the middle and lower classes, in which we cannot expect to find the records preserved with historical correctness. The Testimony of Statistics.--Walford in his wonderful "Encyclopedia of Insurance" says that in England the "Royal Exchange" for a period of one hundred and thirty-five years had insured no life which survived ninety-six. The "London Assurance" for the same period had no clients who lived over ninety, and the "Equitable" had only one at ninety-six. In an English Tontine there was in 1693 a person who died at one hundred; and in Perth there lived a nominee at one hundred and twenty-two and another at one hundred and seven. On the other hand, a writer in the Strand Magazine points out that an insurance investigator some years ago gathered a list of 225 centenarians of almost every social rank and many nationalities, but the majority of them Britons or Russians. In reviewing Walford's statistics we must remember that it has only been in recent years that the middle and lower classes of people have taken insurance on their lives. Formerly only the wealthy and those exposed to early demise were in the habit of insuring. Dr. Ogle of the English Registrar-General's Department gives tables of expectancy that show that 82 males and 225 females out of 1,000,000 are alive at one hundred years. The figures are based on the death-rates of the years 1871-80. The researches of Hardy in the thirteenth, fourteenth, fifteenth, and sixteenth centuries are said to indicate that three-score-and-ten was considered old age; yet many old tombstones and monuments contain inscriptions recording age far beyond this, and even the pages of ordinary biographies disprove the alleged results of Hardy's research. In all statistical work of an individual type the histories of the lower classes are almost excluded; in the olden times only the lives and movements of the most prominent are thought worthy of record. The reliable parish register is too often monopolized by the gentry, inferior births not being thought worth recording. Many eminent scientists say that the natural term of the life of an animal is five times the period needed for its development. Taking twenty-one as the time of maturity in man, the natural term of human life would be one hundred and five. Sir Richard Owen fixes it at one hundred and three and a few months. Censuses of Centenarians.--Dr. Farr, the celebrated English Registrar-General, is credited with saying that out of every 1,000,000 people in England only 223 live to be one hundred years old, making an average of one to 4484. French says that during a period of ten years, from 1881 to 1890, in Massachusetts, there were 203 deaths of persons past the age of one hundred, making an average, with a population of 394,484, of one in 1928. Of French's centenarians 165 were between one hundred and one hundred and five; 35 were between one hundred and five and one hundred and ten; five were between one hundred and ten and one hundred and fifteen; and one was one hundred and eighteen. Of the 203, 153 were females and 50 males. There are 508 people in Iowa who are more than ninety years of age. There are 21 who are more than one hundred years old. One person is one hundred and fifteen years old, two are one hundred and fourteen, and the remaining 18 are from one hundred to one hundred and seven. In the British Medical Journal for 1886 there is an account of a report of centenarians. Fifty-two cases were analyzed. One who doubts the possibility of a man reaching one hundred would find this report of interest. The Paris correspondent to the London Telegraph is accredited with the following:-- "A census of centenarians has been taken in France, and the results, which have been published, show that there are now alive in this country 213 persons who are over one hundred years old. Of these 147 are women, the alleged stronger sex being thus only able to show 66 specimens who are managing to still "husband out life's taper" after the lapse of a century. The preponderance of centenarians of the supposed weaker sex has led to the revival of some amusing theories tending to explain this phenomenon. One cause of the longevity of women is stated to be, for instance, their propensity to talk much and to gossip, perpetual prattle being highly conducive, it is said, to the active circulation of the blood, while the body remains unfatigued and undamaged. More serious theorists or statisticians, while commenting on the subject of the relative longevity of the sexes, attribute the supremacy of woman in the matter to the well-known cause, namely, that in general she leads a more calm and unimpassioned existence than a man, whose life is so often one of toil, trouble, and excitement. Setting aside these theories, however, the census of French centenarians is not devoid of interest in some of its details. At Rocroi an old soldier who fought under the First Napoleon in Russia passed the century limit last year. A wearer of the St. Helena medal--a distinction awarded to survivors of the Napoleonic campaigns, and who lives at Grand Fayt, also in the Nord--is one hundred and three years old, and has been for the last sixty-eight years a sort of rural policeman in his native commune. It is a rather remarkable fact in connection with the examples of longevity cited that in almost every instance the centenarian is a person in the humblest rank of life. According to the compilers of these records, France can claim the honor of having possessed the oldest woman of modern times. This venerable dame, having attained one hundred and fifty years, died peacefully in a hamlet in the Haute Garonne, where she had spent her prolonged existence, subsisting during the closing decade of her life on goat's milk and cheese. The woman preserved all her mental faculties to the last, but her body became attenuated to an extraordinary degree, and her skin was like parchment." In the last ten years the St. James' Gazette has kept track of 378 centenarians, of whom 143 were men and 235 were women. A writer to the Strand Magazine tells of 14 centenarians living in Great Britain within the last half-dozen years. It may be interesting to review the statistics of Haller, who has collected the greatest number of instances of extreme longevity. He found:-- 1000 persons who lived from 100 to 110 15 persons who lived from 130 to 140 60 " " " " 110 to 120 6 " " " " 140 to 150 29 " " " " 120 to 130 1 person " " " to 169 Effect of Class-Influences, Occupation, etc.--Unfortunately for the sake of authenticity, all the instances of extreme age in this country have been from persons in the lower walks of life or from obscure parts of the country, where little else than hearsay could be procured to verify them. It must also be said that it is only among people of this class that we can expect to find parallels of the instances of extreme longevity of former times. The inhabitants of the higher stations of life, the population of thickly settled communities, are living in an age and under conditions almost incompatible with longevity. In fact, the strain of nervous energy made necessary by the changed conditions of business and mode of living really predisposes to premature decay. Those who object to the reliability of reports of postcentenarianism seem to lose sight of these facts, and because absolute proof and parallel cannot be obtained they deny the possibility without giving the subject full thought and reason. As tending to substantiate the multitude of instances are the opinions of such authorities as Hufeland, Buffon, Haller, and Flourens. Walter Savage Landor on being told that a man in Russia was living at one hundred and thirty-two replied that he was possibly older, as people when they get on in years are prone to remain silent as to the number of their years--a statement that can hardly be denied. One of the strongest disbelievers in extreme age almost disproved in his own life the statement that there were no centenarians. It is commonly believed that in the earliest periods of the world's history the lives of the inhabitants were more youthful and perfect; that these primitive men had gigantic size, incredible strength, and most astonishing duration of life. It is to this tendency that we are indebted for the origin of many romantic tales. Some have not hesitated to ascribe to our forefather Adam the height of 900 yards and the age of almost a thousand years; but according to Hufeland acute theologians have shown that the chronology of the early ages was not the same as that used in the present day. According to this same authority Hensler has proved that the year at the time of Abraham consisted of but three months, that it was afterward extended to eight, and finally in the time of Joseph to twelve. Certain Eastern nations, it is said, still reckon but three months to the year; this substantiates the opinion of Hensler, and, as Hufeland says, it would be inexplicable why the life of man should be shortened nearly one-half immediately after the flood. Accepting these conclusions as correct, the highest recorded age, that of Methuselah, nine hundred years, will be reduced to about two hundred, an age that can hardly be called impossible in the face of such an abundance of reports, to which some men of comparatively modern times have approached, and which such substantial authorities as Buffon, Hufeland, and Flourens believed possible. Alchemy and the "Elixir of Life."--The desire for long life and the acquisition of wealth have indirectly been the stimulus to medical and physical investigation, eventually evolving science as we have it now. The fundamental principles of nearly every branch of modern science were the gradual metamorphoses of the investigations of the old searchers after the "philosopher's stone" and "elixir of life." The long hours of study and experiment in the chase for this will-o'-the-wisp were of vast benefit to the coming generations; and to these deluded philosophers of the Middle Ages, and even of ancient times, we are doubtless indebted for much in this age of advancement. With a credulous people to work upon, many of the claimants of the discovery of the coveted secret of eternal life must be held as rank impostors claiming ridiculous ages for themselves. In the twelfth century Artephius claimed that by the means of his discovery he had attained one thousand and twenty-five years. Shortly after him came Alan de Lisle of Flanders with a reputed fabulous age. In 1244 Albertus Magnus announced himself as the discoverer. In 1655 the celebrated Doctor Dee appeared on the scene and had victims by the score. Then came the Rosicrucians. Count Saint-Germain claimed the secret of the "philosopher's stone" and declared to the Court of Louis XV that he was two thousand years old, and a precursor of the mythical "Wandering Jew," who has been immortalized in prose and rhyme and in whose existence a great mass of the people recently believed. The last of the charlatans who claimed possession of the secret of perpetual life was Joseph Balsamo, who called himself "Count of Cagliostro." He was born in Italy in 1743 and acquired a world-wide reputation for his alleged occult powers and acquisition of the "philosopher's stone." He died in 1795, and since then no one has generally inspired the superstitious with credence in this well-worn myth. The ill-fated Ponce de Leon when he discovered Florida, in spite of his superior education, announced his firm belief in the land of the "Fountain of Perpetual Youth," in the pursuit of which he had risked his fortune and life. We wish to emphasize that we by no means assume the responsibility of the authenticity of the cases to be quoted, but expressing belief in their possibility, we shall mention some of the extraordinary instances of longevity derived from an exhaustive research of the literature of all times. This venerable gallery of Nestors will include those of all periods and nations, but as the modern references are more available greater attention will be given to them. Turning first to the history of the earlier nations, we deduce from Jewish history that Abraham lived to one hundred and seventy-five; Isaac, likewise a tranquil, peaceful man, to one hundred and eighty; Jacob, who was crafty and cunning, to one hundred and forty-seven; Ishmael, a warrior, to one hundred and thirty-seven; and Joseph, to one hundred and ten. Moses, a man of extraordinary vigor, which, however, he exposed to great cares and fatigues, attained the advanced age of one hundred and twenty; and the warlike and ever-active Joshua lived to one hundred and ten. Lejoucourt gives the following striking parallels: John Glower lived to one hundred and seventy-two, and Abraham to one hundred and seventy-five; Susan, the wife of Gower, lived to one hundred and sixty-four, and Sarah, the wife of Abraham, to one hundred and twenty-seven. The eldest son of the Gower couple was one hundred and fifteen when last seen, and Isaac, the son of Abraham and Sarah, lived to one hundred and eighty. However replete with fables may be the history of the Kings of Egypt, none attained a remarkable age, and the record of the common people is incomplete or unavailable. If we judge from the accounts of Lucian we must form a high idea of the great age of the Seres, or ancient Chinese. Lucian ascribes this longevity to their habit of drinking excessive quantities of water. Among the Greeks we find several instances of great age in men of prominence. Hippocrates divided life into seven periods, living himself beyond the century mark. Aristotle made three divisions,--the growing period, the stationary period, and the period of decline. Solon made ten divisions of life, and Varro made five. Ovid ingeniously compares life to the four seasons. Epimenides of Crete is said to have lived one hundred and fifty-seven years, the last fifty-seven of which he slept in a cavern at night. Gorgias, a teacher, lived to one hundred and eight; Democritus, a naturalist, attained one hundred and nine; Zeno, the founder of the Stoics, lived to one hundred; and Diogenes, the frugal and slovenly, reached ninety years. Despite his life of exposure, Hippocrates lived to one hundred and nine; and Galen, the prince of physicians after him, who was naturally of a feeble constitution, lived past eighty, and few of the followers of his system of medicine, which stood for thirteen centuries, surpassed him in point of age. Among the Romans, Orbilis, Corvinus, Fabius, and Cato, the enemy of the physicians, approximated the century mark. A valuable collection relative to the duration of life in the time of the Emperor Vespasian has been preserved for us by Pliny from the records of a census, a perfectly reliable and creditable source. In 76 A. D. there were living in that part of Italy which lies between the Apennines and the Po 124 persons who had attained the age of one hundred and upward. There were 54 of one hundred; 57 of one hundred and ten; 2 of one hundred and twenty-five; 4 of one hundred and thirty; 4 of from one hundred and thirty-five to one hundred and thirty-seven, and 3 of one hundred and forty. In Placentia there was a man of one hundred and thirty and at Faventia a woman of one hundred and thirty-two. According to Hufeland, the bills of mortality of Ulpian agree in the most striking manner with those of our great modern cities. Among hermits and ecclesiastics, as would be the natural inference from their regular lives, many instances of longevity are recorded. John was supposed to be ninety-three; Paul the hermit was one hundred and thirteen; Saint Anthony lived to one hundred and five; James the hermit to one hundred and four; Saint Epithanius lived to one hundred and fifteen; Simeon Stylites to one hundred and twelve; Saint Mungo was accredited with one hundred and eighty-five years (Spottiswood), and Saint David attained one hundred and forty-six. Saint Polycarpe suffered martyrdom at over one hundred, and Simon Cleophas was Bishop of Jerusalem at one hundred and twenty. Brahmin priests of India are known to attain incredible age, and one of the secrets of the adepts of the Buddhist faith is doubtless the knowledge of the best means of attaining very old age. Unless cut off by violence or accident the priests invariably become venerable patriarchs. Influence of Mental Culture.--Men of thought have at all times been distinguished for their age. Among the venerable sages are Appolonius of Tyana, a follower of Pythagoras, who lived to over one hundred; Xenophilus, also a Pythagorean, was one hundred and six; Demonax, a Stoic, lived past one hundred; Isocrates was ninety-eight, and Solon, Sophocles, Pindar, Anacreon, and Xenophon were octogenarians. In more modern times we find men of science and literature who have attained advanced age. Kant, Buffon, Goethe, Fontenelle, and Newton were all over eighty. Michael Angelo and Titian lived to eighty-nine and ninety-nine respectively. Harvey, the discoverer of the circulation; Hans Sloane, the celebrated president of the Royal Society in London; Plater, the Swiss physician; Duverney, the anatomist, as well as his confrere, Tenon, lived to be octogenarians. Many men have displayed activity when past four score. Brougham at eighty-two and Lyndhurst at eighty-eight could pour forth words of eloquence and sagacity for hours at a time. Landor wrote his "Imaginary Conversations" when eighty-five, and Somerville his "Molecular Science" at eighty-eight; Isaac Walton was active with his pen at ninety; Hahnemann married at eighty and was working at ninety-one. J. B. Bailey has published a biography of "Modern Methusalehs," which includes histories of the lives of Cornaro, Titian, Pletho, Herschell, Montefiore, Routh, and others. Chevreul, the centenarian chemist, has only lately died. Gladstone, Bismarck, and von Moltke exemplify vigor in age In the Senate of the United States, Senators Edmunds, Sherman, Hoar, Morrill, and other elderly statesmen display as much vigor as their youthful colleagues. Instances of vigor in age could be cited in every profession and these few examples are only mentioned as typical. At a recent meeting of the Society of English Naturalists, Lord Kelvin announced that during the last year 26 members had died at an average age of seventy-six and a half years; one reached the age of ninety-nine years, another ninety-seven, a third ninety-five, etc. In commenting on the perfect compatibility of activity with longevity, the National Popular Review says:-- "Great men usually carry their full mental vigor and activity into old age. M. Chevreul, M. De Lesseps, Gladstone, and Bismarck are evidences of this anthropologic fact. Pius IX, although living in tempestuous times, reached a great age in full possession of all his faculties, and the dramatist Crebillon composed his last dramatic piece at ninety-four, while Michael Angelo was still painting his great canvases at ninety-eight, and Titian at ninety still worked with all the vigor of his earlier years. The Austrian General Melas was still in the saddle and active at eighty-nine, and would have probably won Marengo but for the inopportune arrival of Desaix. The Venetian Doge Henry Dandolo, born at the beginning of the eleventh century, who lost his eyesight when a young man, was nevertheless subsequently raised to the highest office in the republic, managed successfully to conduct various wars, and at the advanced age of eighty-three, in alliance with the French, besieged and captured Constantinople. Fontenelle was as gay-spirited at ninety-eight as in his fortieth year, and the philosopher Newton worked away at his tasks at the age of eighty-three with the same ardor that animated his middle age. Cornaro was as happy at ninety as at fifty, and in far better health at the age of ninety-five than he had enjoyed at thirty. "These cases all tend to show the value and benefits to be derived from an actively cultivated brain in making a long life one of comfort and of usefulness to its owner. The brain and spirits need never grow old, even if our bodies will insist on getting rickety and in falling by the wayside. But an abstemious life will drag even the old body along to centenarian limits in a tolerable state of preservation and usefulness. The foregoing list can be lengthened out with an indefinite number of names, but it is sufficiently long to show what good spirits and an active brain will do to lighten up the weight of old age. When we contemplate the Doge Dandolo at eighty-three animating his troops from the deck of his galley, and the brave old blind King of Bohemia falling in the thickest of the fray at Crecy, it would seem as it there was no excuse for either physical, mental, or moral decrepitude short of the age of four score and ten." Emperors and Kings, in short, the great ones of the earth, pay the penalty of their power by associate worriment and care. In ancient history we can only find a few rulers who attained four score, and this is equally the case in modern times. In the whole catalogue of the Roman and German Emperors, reckoning from Augustus to William I, only six have attained eighty years. Gordian, Valerian, Anastasius, and Justinian were octogenarians, Tiberius was eighty-eight at his death, and Augustus Caesar was eighty-six. Frederick the Great, in spite of his turbulent life, attained a rare age for a king, seventy-six. William I seems to be the only other exception. Of 300 Popes who may be counted, no more than five attained the age of eighty. Their mode of life, though conducive to longevity in the minor offices of the Church, seems to be overbalanced by the cares of the Pontificate. Personal Habits.--According to Hufeland and other authorities on longevity, sobriety, regular habits, labor in the open air, exercise short of fatigue, calmness of mind, moderate intellectual power, and a family life are among the chief aids to longevity. For this reason we find the extraordinary instances of longevity among those people who amidst bodily labor and in the open air lead a simple life, agreeable to nature. Such are farmers, gardeners, hunters, soldiers, and sailors. In these situations man may still maintain the age of one hundred and fifty or even one hundred and sixty. Possibly the most celebrated case of longevity on record is that of Henry Jenkins. This remarkable old man was born in Yorkshire in 1501 and died in 1670, aged one hundred and sixty-nine. He remembered the battle of Flodden Field in 1513, at which time he was twelve years old. It was proved from the registers of the Chancery and other courts that he had appeared in evidence one hundred and forty years before his death and had had an oath administered to him. In the office of the King's Remembrancer is a record of a deposition in which he appears as a witness at one hundred and fifty-seven. When above one hundred he was able to swim a rapid stream. Thomas Parr (or Parre), among Englishmen known as "old Parr," was a poor farmer's servant, born in 1483. He remained single until eighty. His first wife lived thirty-two years, and eight years after her death, at the age of one hundred and twenty, he married again. Until his one hundred and thirtieth year he performed his ordinary duties, and at this age was even accustomed to thresh. He was visited by Thomas, Earl of Arundel and Surrey, and was persuaded to visit the King in London. His intelligence and venerable demeanor impressed every one, and crowds thronged to see him and pay him homage. The journey to London, together with the excitement and change of mode of living, undoubtedly hastened his death, which occurred in less than a year. He was one hundred and fifty-two years and nine months old, and had lived under nine Kings of England. Harvey examined his body and at the necropsy his internal organs were found in a most perfect state. His cartilages were not even ossified, as is the case generally with the very aged. The slightest cause of death could not be discovered, and the general impression was that he died from being over-fed and too-well treated in London. His great-grandson was said to have died in this century in Cork at the age of one hundred and three. Parr is celebrated by a monument reared to his memory in Westminster Abbey. The author of the Dutch dictionary entitled "Het algemen historish Vanderbok" says that there was a peasant in Hungary named Jean Korin who was one hundred and seventy-two and his wife was one hundred and sixty-four; they had lived together one hundred and forty-eight years, and had a son at the time of their death who was one hundred and sixteen. Setrasch Czarten, or, as he is called by Baily, Petratsh Zartan, was also born in Hungary at a village four miles from Teneswaer in 1537. He lived for one hundred and eighty years in one village and died at the age of one hundred and eighty-seven, or, as another authority has it, one hundred and eighty-five. A few days before his death he had walked a mile to wait at the post-office for the arrival of travelers and to ask for succor, which, on account of his remarkable age, was rarely refused him. He had lost nearly all his teeth and his beard and hair were white. He was accustomed to eat a little cake the Hungarians call kalatschen, with which he drank milk. After each repast he took a glass of eau-de-vie. His son was living at ninety-seven and his descendants to the fifth generation embellished his old age. Shortly before his death Count Wallis had his portrait painted. Comparing his age with that of others, we find that he was five years older than the Patriarch Isaac, ten more than Abraham, thirty-seven more than Nahor, sixteen more than Henry Jenkins, and thirty-three more than "old Parr." Sundry Instances of Great Age.--In a churchyard near Cardiff, Glamorganshire, is the following inscription: "Here lieth the body of William Edwards, of Cacreg, who departed this life 24th February, Anno Domini 1668, anno aetatis suae one hundred and sixty-eight." Jonas Warren of Balydole died in 1787 aged one hundred and sixty-seven. He was called the "father of the fishermen" in his vicinity, as he had followed the trade for ninety-five years. The Journal de Madrid, 1775, contains the account of a South American negress living in Spanish possessions who was one hundred and seventy-four years of age. The description is written by a witness, who declares that she told of events which confirmed her age. This is possibly the oft-quoted case that was described in the London Chronicle, October 5, 1780, Louisa Truxo, who died in South America at the age of one hundred and seventy-five. Huteland speaks of Joseph Surrington, who died near Bergen, Norway, at the age of one hundred and sixty. Marvelous to relate, he had one living son of one hundred and three and another of nine. There has been recently reported from Vera Cruz, Mexico, in the town of Teluca, where the registers are carefully and efficiently kept, the death of a man one hundred and ninety-two years old--almost a modern version of Methuselah. Buffon describes a man who lived to be one hundred and sixty-five. Martin mentions a man of one hundred and eighty. There was a Polish peasant who reached one hundred and fifty-seven and had constantly labored up to his one hundred and forty-fifth year, always clad lightly, even in cold weather. Voigt admits the extreme age of one hundred and sixty. There was a woman living in Moscow in 1848 who was said to be one hundred and sixty-eight; she had been married five times and was one hundred and twenty-one at her last wedding. D'Azara records the age of one hundred and eighty, and Roequefort speaks of two cases at one hundred and fifty. There are stories of an Englishman who lived in the sixteenth century to be two hundred and seven, and there is a parallel case cited. Van Owen tabulates 331 cases of deaths between 110 and 120, 91 between 120 and 130, 37 between 130 and 140, 11 at 150, and 17 beyond this age. While not vouching for the authenticity in each case, he has always given the sources of information. Quite celebrated in English history by Raleigh and Bacon was the venerable Countess Desmond, who appeared at Court in 1614, being one hundred and forty years old and in full possession of all her powers, mental and physical. There are several portraits of her at this advanced age still to be seen. Lord Bacon also mentions a man named Marcus Appenius, living in Rimini, who was registered by a Vespasian tax-collector as being one hundred and fifty. There are records of Russians who have lived to one hundred and twenty-five, one hundred and thirty, one hundred and thirty-five, one hundred and forty-five, and one hundred and fifty. Nemnich speaks of Thomas Newman living in Bridlington at one hundred and fifty-three years. Nemnich is confirmed in his account of Thomas Newman by his tombstone in Yorkshire, dated 1542. In the chancel of the Honington Church, Wiltshire, is a black marble monument to the memory of G. Stanley, gent., who died in 1719, aged one hundred and fifty-one. There was a Dane named Draakenburg, born in 1623, who until his ninety-first year served as a seaman in the royal navy, and had spent fifteen years of his life in Turkey as a slave in the greatest misery. He was married at one hundred and ten to a woman of sixty, but outlived her a long time, in his one hundred and thirtieth year he again fell in love with a young country girl, who, as may well be supposed, rejected him. He died in 1772 in his one hundred and forty-sixth year. Jean Effingham died in Cornwall in 1757 in his one hundred and forty-fourth year. He was born in the reign of James I and was a soldier at the battle of Hochstadt; he never drank strong liquors and rarely ate meat; eight days before his death he walked three miles. Bridget Devine, the well-known inhabitant of Olean Street, Manchester died at the age of one hundred and forty-seven in 1845. On the register of the Cheshire Parish is a record of the death of Thomas Hough of Frodsam in 1591 at the age of one hundred and forty-one. Peter Garden of Auchterless died in 1775 at the age of one hundred and thirty-one. He had seen and talked with Henry Jenkins about the battle of Flodden Field, at which the latter was present when a boy of twelve. It seems almost incredible that a man could say that he had heard the story of an event which had happened two hundred and sixty-three years before related by the lips of an eye-witness to that event; nevertheless, in this case it was true. A remarkable instance of longevity in one family has recently been published in the St. Thomas's Hospital Gazette. Mrs. B., born in 1630 (five years after the accession of Charles I), died March 13, 1732. She was tended in her last illness by her great-granddaughter, Miss Jane C., born 1718, died 1807, and Miss Sarah C., born 1725, died 1811. A great-niece of one of these two ladies, Mrs. W., who remembers one of them, was born in 1803, and is at the present time alive and well. It will be seen from the above facts that there are three lives only to bridge over the long period between 1630 and 1896, and that there is at present living a lady who personally knew Miss C., who had nursed a relative born in 1630. The last lady of this remarkable trio is hale and hearty, and has just successfully undergone an operation for cataract. Similar to the case of the centenarian who had seen Henry Jenkins was that of James Horrocks, who was born in 1744 and died in 1844. His father was born in 1657, one year before the death of the Protector, and had issue in early life. He married again at eighty-four to a woman of twenty-six, of which marriage James was the offspring in 1744. In 1844 this man could with verity say that he had a brother born during the reign of Charles II, and that his father was a citizen of the Commonwealth. Among the Mission Indians of Southern California there are reported instances of longevity ranging from one hundred and twenty to one hundred and forty. Lieutenant Gibbons found in a village in Peru one hundred inhabitants who were past the century mark, and another credible explorer in the same territory records a case of longevity of one hundred and forty. This man was very temperate and always ate his food cold, partaking of meat only in the middle of the day. In the year of 1840 in the town of Banos, Ecuador, died "Old Morales," a carpenter, vigorous to his last days. He was an elderly man and steward of the Jesuits when they were expelled from their property near this location in 1767. In the year 1838 there was a witness in a judicial trial in South America who was born on the night of the great earthquake which destroyed the town of Ambato in 1698. How much longer this man who was cradled by an earthquake lived is not as yet reported. In the State of Vera Cruz, Mexico, as late as 1893 a man died at the age of one hundred and thirty-seven. The census of 1864 for the town of Pilaguin, Ecuador, lying 11,000 feet above the level of the sea and consisting of about 2000 inhabitants, gives 100 above seventy, 30 above ninety, five above one hundred, and one at one hundred and fifteen years. Francis Auge died in Maryland in 1767 at the age of one hundred and thirty-four. He remembered the execution of Charles I and had a son born to him after he was one hundred. There are several other instances in which men have displayed generative ability in old age. John Gilley, who died in Augusta, Maine, in 1813, was born in Ireland in 1690. He came to this country at the age of sixty, and continued in single blessedness until seventy-five, when he married a girl of eighteen, by whom he had eight children. His wife survived him and stated that he was virile until his one hundred and twentieth year. Baron Baravicino de Capelis died at Meran in 1770 at the age of one hundred and four, being the oldest man in Tyrol. His usual food was eggs, and he rarely tasted meat. He habitually drank tea and a well-sweetened cordial of his own recipe. He was married four times during his life, taking his fourth wife when he was eighty-four. By her he had seven children and at his death she was pregnant with the eighth child. Pliny mentions cases of men begetting sons when past the age of eighty and Plot speaks of John Best of the parish of Horton, who when one hundred and four married a woman of fifty-six and begat a son. There are also records of a man in Stockholm of one hundred who had several children by a wife of thirty. On August 7, 1776, Mary, the wife of Joseph Yates, at Lizard Common not far from London, was buried at the age of one hundred and twenty-seven. She had walked to London in 1666, and was hearty and strong at one hundred and twenty, and had married a third husband at ninety-two. A case without parallel, of long survival of a deaf mute, is found in Mrs. Gray of Northfleet, Kent, who died in 1770, one hundred and twenty-one years old. She was noted for her cheerful disposition, and apparently enjoyed life in spite of her infirmity, which lasted one hundred and twenty-one years. Macklin the actor was born in 1697 and died in 1797. Several years before his death he played "Shylock," displaying great vigor in the first act, but in the second his memory failed him, and with much grace and solemnity he advanced to the foot-lights and apologized for his inability to continue. It is worthy of remark that several instances of longevity in Roman actresses have been recorded. One Luceja, who came on the stage very young, performed a whole century, and even made her public appearance in her one hundred and twelfth year. Copiola was said to have danced before Augustus when past ninety. Influence of Stimulants, etc.--There have been men who have attributed their long lives to their excesses in stimulants. Thomas Wishart of Annandale, Dumfries, died in 1760 at one hundred and twenty-four. He had chewed tobacco one hundred and seventeen years, contracting the habit when a child; his father gave it to him to allay hunger while shepherding in the mountains. John de la Somet of Virginia died in 1766 aged one hundred and thirty. He was a great smoker, and according to Eaton the habit agreed with his constitution, and was not improbably the cause of his long health and longevity. William Riddell, who died at one hundred and sixteen carefully avoided water all his life and had a love for brandy. Possession of Faculties.--Eglebert Hoff was a lad driving a team in Norway when the news was brought that Charles I was beheaded. He died in Fishkill, N.Y., in 1764 at the age of one hundred and twenty-eight. He never used spectacles, read fluently, and his memory and senses were retained until his death, which was due to an accident. Nicolas Petours, curate of the parish of Baleene and afterward canon of the Cathedral of Constance, died at the age of one hundred and thirty-seven; he was always a healthy, vigorous man, and celebrated mass five days before his death. Mr. Evans of Spital Street, Spitalfields, London, died in 1780 aged one hundred and thirty-nine, having full possession of his mental faculties. Of interest to Americans is the case of David Kinnison, who, when one hundred and eleven, related to Lossing the historian the tale of the Boston Tea Party, of which he had been a member. He died in good mental condition at the age of one hundred and fifteen. Anthony Senish, a farmer of the village of Limoges, died in 1770 in his one hundred and eleventh year. He labored until two weeks before his death, had still his hair, and his sight had not failed him. His usual food was chestnuts and Turkish corn; he had never been bled or used any medicine. Not very long ago there was alive in Tacony, near Philadelphia, a shoemaker named R. Glen in his one hundred and fourteenth year. He had seen King William III, and all his faculties were perfectly retained; he enjoyed good health, walking weekly to Philadelphia to church. His third wife was but thirty years old. Longevity in Ireland.--Lord Bacon said that at one time there was not a village in all Ireland in which there was not a man living upward of eighty. In Dunsford, a small village, there were living at one time 80 persons above the age of four score. Colonel Thomas Winslow was supposed to have died in Ireland on August 26, 1766, aged one hundred and forty-six. There was a man by the name of Butler who died at Kilkenny in 1769 aged one hundred and thirty-three. He rode after the hounds while yet a centenarian. Mrs. Eckelston, a widow in Phillipstown, Kings County, Ireland, died in 1690 at one hundred and forty-three. There are a number of instances in which there is extraordinary renovation of the senses or even of the body in old age,--a new period of life, as it were, is begun. A remarkable instance is an old magistrate known to Hufeland, who lived at Rechingen and who died in 1791 aged one hundred and twenty. In 1787, long after he had lost all his teeth, eight new ones appeared, and at the end of six months they again dropped out, but their place was supplied by other new ones, and Nature, unwearied, continued this process until his death. All these teeth he had acquired and lost without pain, the whole number amounting to 150. Alice, a slave born in Philadelphia, and living in 1802 at the age of one hundred and sixteen, remembered William Penn and Thomas Story. Her faculties were well preserved, but she partially lost her eyesight at ninety-six, which, strange to say, returned in part at one hundred and two. There was a woman by the name of Helen Gray who died in her one hundred and fifth year, and who but a few years before her death had acquired a new set of teeth. In Wilson's "Healthy Skin" are mentioned several instances of very old persons in whom the natural color of the hair returned after they had been gray for years. One of them was John Weeks, whose hair became brown again at one hundred and fourteen. Sir John Sinclair a mentions a similar case in a Scotchman who lived to one hundred and ten. Susan Edmonds when in her ninety-fifth year recovered her black hair, but previously to her death at one hundred and five again became gray. There was a Dr. Slave who at the age of eighty had a renewal of rich brown hair, which he maintained until his death at one hundred. There was a man in Vienna, aged one hundred and five, who had black hair long after his hair had first become white This man is mentioned as a parallel to Dr. Slave. Similar examples are mentioned in Chapter VI. It is a remarkable fact that many persons who have reached an old age have lived on the smallest diet and the most frugal fare. Many of the instances of longevity were in people of Scotch origin who subsisted all their lives on porridges. Saint Anthony is said to have maintained life to one hundred and five on twelve ounces of bread daily. In 1792 in the Duchy of Holstein there was an industrious laborer named Stender who died at one hundred and three, his food for the most part of his life having been oatmeal and buttermilk. Throughout his life he had been particularly free from thirst, drinking little water and no spirits. Heredity.--There are some very interesting instances of successive longevity. Lister speaks of a son and a father, from a village called Dent, who were witnesses before a jury at York in 1664. The son was above one hundred and the father above one hundred and forty. John Moore died in 1805 aged one hundred and seven. His father died at one hundred and five and his grandfather at one hundred and fifteen, making a total of three hundred and twenty-seven years for the three generations. Recently, Wynter mentions four sisters,--of one hundred, one hundred and three, one hundred and five, and one hundred and seven years respectively. On the register of Bremhill 1696, is the following remarkable entry: "Buried, September 29th, Edith Goldie, Grace Young, and Elizabeth Wiltshire, their united ages making three hundred." As late as 1886 in the district of Campinos there was a strong active man named Joseph Joachim de Prado, of good family, who was one hundred and seven years old. His mother died by accident at one hundred and twelve, and his maternal grandmother died at one hundred and twenty-two. Longevity in Active Military Service.--One of the most remarkable proofs that under fickle fortune, constant danger, and the most destructive influences the life of man may be long preserved is exemplified in the case of an old soldier named Mittelstedt, who died in Prussia in 1792, aged one hundred and twelve. He was born at Fissalm in June, 1681. He entered the army, served under three Kings, Frederick I, Frederick William I, and Frederick II, and did active service in the Seven Years' War, in which his horse was shot under him and he was taken prisoner by the Russians. In his sixty-eight years of army service he participated in 17 general engagements, braved numerous dangers, and was wounded many times. After his turbulent life he married, and at last in 1790, in his one hundred and tenth year, he took a third wife. Until shortly before his death he walked every month to the pension office, a distance of two miles from his house. Longevity in Physicians.--It may be of interest to the members of our profession to learn of some instances of longevity among confreres. Dr. R. Baynes of Rockland, Maine, has been mentioned in the list of "grand old men" in medicine; following in the footsteps of Hippocrates and Galen, he was practicing at ninety-nine. He lives on Graham's diet, which is a form of vegetarianism; he does not eat potatoes, but does eat fruit. His drink is almost entirely water, milk, and chocolate, and he condemns the use of tea, coffee, liquors, and tobacco. He has almost a perfect set of natural teeth and his sight is excellent. Like most men who live to a great age, Dr. Baynes has a "fad," to which he attributes a chief part in prolonging his life. This is the avoidance of beds, and except when away from home he has not slept on a bed or even on a mattress for over fifty years. He has an iron reclining chair, over which he spreads a few blankets and rugs. The British Medical Journal speaks of Dr. Boisy of Havre, who is one hundred and three. It is said he goes his rounds every day, his practice being chiefly among the poor. At one time he practiced in India. He has taken alcoholic beverages and smoked tobacco since his youth, although in moderation. His father, it is added, died at the age of one hundred and eight. Mr. William R. Salmon, living near Cowbridge, Glamorganshire, recently celebrated his one hundred and sixth birthday. Mr. Salmon was born at Wickham Market in 1790, and became a member of the Royal College of Surgeons in 1809, the year in which Gladstone was born. He died April 11, 1896. In reference to this wonderful old physician the Journal of the American Medical Association, 1896, page 995, says-- "William Reynold Salmon, M.R.C.S., of Penllyn Court, Cowbridge, Glamorganshire, South Wales, completed his one hundred and sixth year on March 16th, and died on the 11th of the present month--at the time of his death the oldest known individual of indisputably authenticated age, the oldest physician, the oldest member of the Royal College of Surgeons, England, and the oldest Freemason in the world. His age does not rest upon tradition or repute. He was the son of a successful and esteemed practicing physician of Market Wickham, Suffolk, England, and there is in the possession of his two surviving relatives, who cared for his household for many years, his mother's diary, in which is inscribed in the handwriting of a lady of the eighteenth century, under the date, Tuesday, March 16, 1790, a prayer of thankfulness to God that she had passed her 'tryall,' and that a son was born, who she hoped 'would prosper, be a support to his parents, and make virtue his chief pursuit.' The Royal College of Surgeons verified this record many years ago, and it was subsequently again authenticated by the authorities of the Freemasons, who thereupon enshrined his portrait in their gallery as the oldest living Freemason. The Salmon family moved to Cowbridge in 1796, so that the doctor had lived exactly a century in the lovely and poetic Vale of Glamorgan, in the very heart of which Penllyn Court is situated. Here on his one hundred and sixth birthday--a man of over middle height, with still long, flowing hair, Druidical beard and mustache, and bushy eyebrows--Dr. Salmon was visited by one who writes:-- "'Seen a few days ago, the Patriarch of Penllyn Court was hale and hearty. He eats well and sleeps well and was feeling better than he had felt for the last five years. On that day he rose at noon, dined at six, and retired at nine. Drank two glasses of port with his dinner, but did not smoke. He abandoned his favorite weed at the age of ninety, and had to discontinue his drives over his beautiful estate in his one hundredth year. One day is much the same as another, for he gives his two relatives little trouble in attending upon his wants. Dr. Salmon has not discovered the elixir of life, for the shadows of life's evening are stealing slowly over him. He cannot move about, his hearing is dulled, and the light is almost shut out from the "windows of his soul." Let us think of this remarkable man waiting for death uncomplainingly in his old-fashioned mansion, surrounded by the beautiful foliage and the broad expanse of green fields that he loved so much to roam when a younger man, in that sylvan Sleepy Hollow in the Vale of Glamorgan.' "Eight weeks later he, who in youth had been 'the youngest surgeon in the army, died, the oldest physician in the world." Dr. William Hotchkiss, said to have reached the age of one hundred and forty years, died in St. Louis April 1, 1895. He went to St. Louis forty years ago, and has always been known as the "color doctor." In his peculiar practice of medicine he termed his patients members of his "circles," and claimed to treat them by a magnetic process. Dr. A. J. Buck says that his Masonic record has been traced back one hundred years, showing conclusively that he was one hundred and twenty-one years old. A letter received from his old home in Virginia, over a year ago, says that he was born there in 1755. It is comforting to the members of our profession, in which the average of life is usually so low, to be able to point out exceptions. It has been aptly said of physicians in general: "Aliis inserviendo consumuntur; aliis medendo moriuntur," or "In serving others they are consumed; in healing others they are destroyed." Recent Instances of Longevity.--There was a man who died in Spain at the advanced age of one hundred and fifty-one, which is the most extraordinary instance from that country. It is reported that quite recently a Chinese centenarian passed the examination for the highest place in the Academy of Mandarins. Chevreul, born in 1786, at Angers, has only recently died after an active life in chemical investigation. Sir Moses Montefiore is a recent example of an active centenarian. In the New York Herald of April 21, 1895, is a description and a portrait of Noah Raby of the Piscataway Poor Farm of New Jersey, to whom was ascribed one hundred and twenty-three years. He was discharged from active duty on the "Brandywine," U.S.N., eighty-three years ago. He relates having heard George Washington speak at Washington and at Portsmouth while his ship was in those places. The same journal also says that at Wichita, Kansas, there appeared at a municipal election an old negress named Mrs. Harriet McMurray, who gave her age as one hundred and fifteen. She had been a slave, and asserted that once on a visit to Alexandria with her master she had seen General Washington. From the Indian Medical Record we learn that Lieutenant Nicholas Lavin of the Grand Armee died several years ago at the age of one hundred and twenty-five, leaving a daughter of seventy-eight. He was born in Paris in 1768, served as a hussar in several campaigns, and was taken a prisoner during the retreat from Moscow. After his liberation he married and made his residence in Saratoff. CHAPTER IX. PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. In considering the anomalies of the secretions, it must be remembered that the ingestion of certain kinds of food and the administration of peculiar drugs in medicine have a marked influence in coloring secretions. Probably the most interesting of all these anomalies is the class in which, by a compensatory process, metastasis of the secretions is noticed. Colored Saliva.--Among the older writers the Ephemerides contains an account of blue saliva; Huxham speaks of green saliva; Marcellus Donatus of yellow, and Peterman relates the history of a case of yellow saliva. Dickinson describes a woman of sixty whose saliva was blue; besides this nothing was definitely the matter with her. It seemed however, that the color was due to some chemic-pencil poisoning rather than to a pathologic process. A piece of this aniline pencil was caught in the false teeth. Paget cites an instance of blue saliva due to staining the tongue in the same manner. Most cases of anomalous coloring of this kind can be subsequently traced to artificial substances unconsciously introduced. Crocker mentions a woman who on washing her hands constantly found that the water was stained blue, but this was subsequently traced to the accidental introduction of an orchid leaf. In another instance there was a woman whose linen was at every change stained brown; this, however, was found to be due to a hair-wash that she was in the habit of using. Among the older writers who have mentioned abnormal modes of exit of the urine is Baux, who mentions urine from the nipples; Paullini and the Ephemerides describe instances of urination from the eyes. Blancard, the Ephemerides, Sorbalt, and Vallisneri speak of urination by the mouth. Arnold relates the history of a case of dysuria in which urine was discharged from the nose, breasts, ears, and umbilicus; the woman was twenty-seven years old, and the dysuria was caused by a prolapsed uterus. There was an instance of anomalous discharge of urine from the body reported in Philadelphia many years ago which led to animated discussion. A case of dysuria in which the patient discharged urine from the stomach was reported early in this century from Germany. The patient could feel the accumulation of urine by burning pain in the epigastrium. Suddenly the pain would move to the soles of the feet, she would become nauseated, and large quantities of urine would soon be vomited. There was reported the case of an hysterical female who had convulsions and mania, alternating with anuria of a peculiar nature and lasting seven days. There was not a drop of urine passed during this time, but there were discharges through the mouth of alkaline waters with a strong ammoniacal odor. Senter reports in a young woman a singular case of ischuria which continued for more than three years; during this time if her urine was not drawn off with the catheter she frequently voided it by vomiting; for the last twenty months she passed much gravel by the catheter; when the use of the instrument was omitted or unsuccessfully applied the vomitus contained gravel. Carlisle mentions a case in which there was vomiting of a fluid containing urea and having the sensible properties of urine. Curious to relate, a cure was effected after ligature of the superior thyroid arteries and sloughing of the thyroid gland. Vomiting of urine is also mentioned by Coley, Domine, Liron, Malago, Zeviani, and Yeats. Marsden reports a case in which, following secondary papular syphilis and profuse spontaneous ptyalism, there was vicarious secretion of the urinary constituents from the skin. Instances of the anomalous exit of urine caused by congenital malformation or fistulous connections are mentioned in another chapter. Black urine is generally caused by the ingestion of pigmented food or drugs, such as carbolic acid and the anilines. Amatus Lusitanus, Bartholinus, and the Ephemerides speak of black urine after eating grapes or damson plums. The Ephemerides speaks of black urine being a precursor of death, but Piso, Rhodius, and Schenck say it is anomalous and seldom a sign of death. White urine, commonly known as chyluria, is frequently seen, and sometimes results from purulent cystitis. Though containing sediment, the urine looks as if full of milk. A case of this kind was seen in 1895 at the Jefferson Medical College Hospital, Philadelphia, in which the chyluria was due to a communication between the bladder and the thoracic duct. Ackerman has spoken of metastasis of the tears, and Dixon gives an instance in which crying was not attended by the visible shedding of tears. Salomon reports a case of congenital deficiency of tears. Blood-stained tears were frequently mentioned by the older writers. Recently Cross has written an article on this subject, and its analogy is seen in the next chapter under hemorrhages from the eyes through the lacrimal duct. The Semen.--The older writers spoke of metastasis of the seminal flow, the issue being by the skin (perspiration) and other routes. This was especially supposed to be the case in satyriasis, in which the preternatural exit was due to superabundance of semen, which could be recognized by its odor. There is no doubt that some people have a distinct seminal odor, a fact that will be considered in the section on "Human Odors." The Ephemerides, Schurig, and Hoffman report instances of what they call fetid semen (possibly a complication of urethral disease). Paaw speaks of black semen in a negro, and the Ephemerides and Schurig mention instances of dark semen. Blancard records an instance of preternatural exit of semen by the bowel. Heers mentions a similar case caused by urethral fistula. Ingham mentions the escape of semen through the testicle by means of a fistula. Demarquay is the authority on bloody semen. Andouard mentions an instance of blue bile in a woman, blue flakes being found in her vomit. There was no trace of copper to be found in this case. Andouard says that the older physicians frequently spoke of this occurrence. Rhodius speaks of the sweat being sweet after eating honey; the Ephemerides and Paullini also mention it. Chromidrosis, or colored sweat, is an interesting anomaly exemplified in numerous reports. Black sweat has been mentioned by Bartholinus, who remarked that the secretion resembled ink; in other cases Galeazzi and Zacutus Lusitanus said the perspiration resembled sooty water. Phosphorescent sweat has been recorded. Paullini and the Ephemerides mention perspiration which was of a leek-green color, and Borellus has observed deep green perspiration. Marcard mentions green perspiration of the feet, possibly due to stains from colored foot-gear. The Ephemerides and Paullini speak of violet perspiration, and Bartholinus has described perspiration which in taste resembled wine. Sir Benjamin Brodie has communicated the history of a case of a young girl of fifteen on whose face was a black secretion. On attempting to remove it by washing, much pain was caused. The quantity removed by soap and water at one time was sufficient to make four basins of water as black as if with India ink. It seemed to be physiologically analogous to melanosis. The cessation of the secretion on the forehead was followed by the ejection of a similar substance from the bowel, stomach, and kidney. The secretion was more abundant during the night, and at one time in its course an erysipelas-eruption made its appearance. A complete cure ultimately followed. Purdon describes an Irish married woman of forty, the subject of rheumatic fever, who occasionally had a blue serous discharge or perspiration that literally flowed from her legs and body, and accompanied by a miliary eruption. It was on the posterior portions, and twelve hours previous was usually preceded by a moldy smell and a prickly sensation. On the abdomen and the back of the neck there was a yellowish secretion. In place of catamenia there was a discharge reddish-green in color. The patient denied having taken any coloring matter or chemicals to influence the color of her perspiration, and no remedy relieved her cardiac or rheumatic symptoms. The first English case of chromidrosis, or colored sweat, was published by Yonge of Plymouth in 1709. In this affection the colored sweating appears symmetrically in various parts of the body, the parts commonly affected being the cheeks, forehead, side of the nose, whole face, chest, abdomen, backs of the hands, finger-tips, and the flexors, flexures at the axillae, groins, and popliteal spaces. Although the color is generally black, nearly every color has been recorded. Colcott Fox reported a genuine case, and Crocker speaks of a case at Shadwell in a woman of forty-seven of naturally dark complexion. The bowels were habitually sluggish, going three or four days at least without action, and latterly the woman had suffered from articular pains. The discolored sweat came out gradually, beginning at the sides of the face, then spreading to the cheeks and forehead. When seen, the upper half of the forehead, the temporal regions, and the skin between the ear and malar eminence were of a blackish-brown color, with slight hyperemia of the adjacent parts; the woman said the color had been almost black, but she had cleaned her face some. There was evidently much fat in the secretion; there was also seborrhea of the scalp. Washing with soap and water had very little effect upon it; but it was removed with ether, the skin still looking darker and redder than normal. After a week's treatment with saline purgatives the discoloration was much less, but the patient still had articular pains, for which alkalies were prescribed; she did not again attend. Crocker also quotes the case of a girl of twenty, originally under Mackay of Brighton. Her affection had lasted a year and was limited to the left cheek and eyebrow. Six months before the patch appeared she had a superficial burn which did not leave a distinct scar, but the surface was slightly granular. The deposit was distinctly fatty, evidently seborrheic and of a sepia-tint. The girl suffered from obstinate constipation, the bowels acting only once a week. The left side flushed more than the right In connection with this case may be mentioned one by White of Harvard, a case of unilateral yellow chromidrosis in a man. Demons gives the history of a case of yellow sweat in a patient with three intestinal calculi. Wilson says that cases of green, yellow, and blue perspiration have been seen, and Hebra, Rayer, and Fuchs mention instances. Conradi records a case of blue perspiration on one-half the scrotum. Chojnowski records a case in which the perspiration resembled milk. Hyperidrosis occurs as a symptom in many nervous diseases, organic and functional, and its presence is often difficult of explanation. The following are recent examples: Kustermann reports a case of acute myelitis in which there was profuse perspiration above the level of the girdle-sensation and none at all below. Sharkey reports a case of tumor of the pons varolii and left crus cerebri, in which for months there was excessive generalized perspiration; it finally disappeared without treatment. Hutchinson describes the case of a woman of sixty-four who for four years had been troubled by excessive sweating on the right side of the face and scalp. At times she was also troubled by an excessive flow of saliva, but she could not say if it was unilateral. There was great irritation of the right side of the tongue, and for two years taste was totally abolished. It was normal at the time of examination. The author offered no explanation of this case, but the patient gave a decidedly neurotic history, and the symptoms seem to point with some degree of probability to hysteria. Pope reports a peculiar case in which there were daily attacks of neuralgia preceded by sweating confined to a bald spot on the head. Rockwell reports a case of unilateral hyperidrosis in a feeble old man which he thought due to organic affection of the cervical sympathetic. Dupont has published an account of a curious case of chronic general hyperidrosis or profuse sweating which lasted upward of six years. The woman thus affected became pregnant during this time and was happily delivered of an infant, which she nursed herself. According to Dupont, this hyperidrosis was independent of any other affection, and after having been combated fruitlessly by various remedies, yielded at last to fluid extract of aconitin. Myrtle relates the case of a man of seventy-seven, who, after some flying pains and fever, began to sweat profusely and continued to do so until he died from exhaustion at the end of three months from the onset of the sweating. Richardson records another case of the same kind. Crocker quotes the case of a tailor of sixty-five in whom hyperidrosis had existed for thirty-five years. It was usually confined to the hands and feet, but when worst affected the whole body. It was absent as long as he preserved the horizontal posture, but came on directly when he rose; it was always increased in the summer months. At the height of the attack the man lost appetite and spirit, had a pricking sensation, and sometimes minute red papules appeared all over the hand. He had tried almost every variety of treatment, but sulphur did the most good, as it had kept the disease under for twelve months. Latterly, even that failed. Bachman reports the history of a case of hyperidrosis cured by hypnotism. Unilateral and localized sweating accompanies some forms of nervous disturbance. Mickle has discussed unilateral sweating in the general paralysis of the insane. Ramskill reports a case of sweating on one side of the face in a patient who was subject to epileptic convulsions. Takacs describes a case of unilateral sweating with proportionate nervous prostration. Bartholow and Bryan report unilateral sweating of the head. Cason speaks of unilateral sweating of the head, face, and neck. Elliotson mentions sweat from the left half of the body and the left extremities only. Lewis reports a case of unilateral perspiration with an excess of temperature of 3.5 degrees F. in the axilla of the perspiring side. Mills, White, Dow, and Duncan also cite instances of unilateral perspiration. Boquis describes a case of unilateral perspiration of the skin of the head and face, and instances of complete unilateral perspiration have been frequently recorded by the older writers,--Tebure, Marcellus Donatus, Paullini, and Hartmann discussing it. Hyperidrosis confined to the hands and feet is quite common. Instances of bloody sweat and "stigmata" have been known through the ages and are most interesting anomalies. In the olden times there were people who represented that in their own persons they realized at certain periods the agonies of Gethsemane, as portrayed in medieval art, e.g., by pictures of Christ wearing the crown of thorns in Pilate's judgment hall. Some of these instances were, perhaps, of the nature of compensatory hemorrhage, substituting the menses or periodic hemorrhoids, hemoptysis, epistaxis, etc., or possibly purpura. Extreme religious frenzy or deep emotions might have been the indirect cause of a number of these bleeding zealots. There are instances on record in which fear and other similar emotions have caused a sweating of blood, the expression "sweating blood" being not uncommon. Among the older writers, Ballonius, Marcolini, and Riedlin mention bloody sweat. The Ephemerides speaks of it in front of the hypochondrium. Paullini observed a sailor of thirty, who, falling speechless and faint during a storm on the deck of his ship, sweated a red perspiration from his entire body and which stained his clothes. He also mentions bloody sweat following coitus. Aristotle speaks of bloody sweat, and Pellison describes a scar which periodically opened and sweated blood. There were many cases like this, the scars being usually in the location of Christ's wounds. De Thou mentions an Italian officer who in 1552, during the war between Henry II of France and Emperor Charles V, was threatened with public execution; he became so agitated that he sweated blood from every portion of the body. A young Florentine about to be put to death by an order of Pope Sixtus V was so overcome with grief that he shed bloody tears and sweated blood. The Ephemerides contains many instances of bloody tears and sweat occasioned by extreme fear, more especially fear of death. Mezeray mentions that the detestable Charles IX of France, being under constant agitation and emotion, sank under a disorder which was accompanied by an exudation of blood from every pore of his body. This was taken as an attempt of nature to cure by bleeding according to the theory of the venesectionists. Fabricius Hildanus mentions a child who, as a rule, never drank anything but water, but once, contrary to her habit, drank freely of white wine, and this was soon followed by hemorrhage from the gums, nose, and skin. There is a case also related of a woman of forty-five who had lost her only son. One day she fancied she beheld him beseeching her to release his soul from purgatory by prayers and fasting every Friday. The following Friday, which was in the month of August, and for five succeeding Fridays she had a profuse bloody perspiration, the disorder disappearing on Friday, March 8th, of the following year. Pooley says that Maldonato, in his "Commentaries of Four Gospels," mentions a healthy and robust man who on hearing of his sentence of death sweated blood, and Zacchias noted a similar phenomenon in a young man condemned to the flames. Allusion may also be made to St. Luke, who said of Christ that in agony He prayed more earnestly, "and His sweat was, as it were, great drops of blood falling down to the ground." Pooley quotes the case of a young woman of indolent habit who in a religious fanatical trance sweated blood. The stigmatists were often imposters who artificially opened their scars, and set the example for the really peculiar cases of bloody sweat, which among ignorant people was considered evidence of sympathy with the agony of the Cross. Probably the best studied case on record is that of Louise Lateau of Bois d'Haine, which, according to Gray, occurred in 1869 in a village of Belgium when the girl was at the age of twenty-three; her previous life had offered nothing remarkable. The account is as follows: "One Friday Louise Lateau noticed that blood was flowing from one side of her chest, and this recurred every Friday. On each Thursday morning an oval surface about one inch in length on the back of each hand became pink in color and smooth, whilst a similar oval surface on the palm of each hand became of the same hue, and on the upper surface of each foot a pinkish-white square appeared. Examined under a magnifying glass, the epidermis appeared at first without solution of continuity and delicate. About noon on Thursday a vesicle formed on the pink surfaces containing clear serum. In the night between Thursday and Friday, usually between midnight and one o'clock, the flow of blood began, the vesicle first rupturing. The amount of blood lost during the so called stigmata varied, and some observers estimated it at about one and three-quarter pints. The blood itself was of a reddish color, inclining to violet, about the hue therefore, of capillary blood, coagulating in the usual way, and the white and red corpuscles being normal in character and relative proportion. The flow ceased on Saturdays. During the flow of the blood the patient was in a rapt, ecstatic condition. The facial expression was one of absorption and far-off contemplation, changing often to melancholy, terror, to an attitude of prayer or contrition. The patient herself stated that at the beginning of the ecstasy she imagined herself surrounded by a brilliant light; figures then passed before her, and the successive scenes of the crucifixion were panoramically progressive. She saw Christ in person--His clothing, His wounds, His crown of thorns, His cross--as well as the Apostles, the holy women, and the assembled Jews. During the ecstasy the circulation of the skin and heart was regular, although at times a sudden flash or pallor overspread the face, according with the play of the expression. From midday of Thursdays, when she took a frugal meal, until eight o'clock on Saturday mornings the girl took no nourishment, not even water, because it was said that she did not feel the want of it and could not retain anything upon her stomach. During this time the ordinary secretions were suspended." Fournier mentions a statesman of forty-five who, following great Cabinet labors during several years and after some worriment, found that the day after indulging in sexual indiscretions he would be in a febrile condition, with pains in the thighs, groins, legs, and penis. The veins of these parts became engorged, and subsequently blood oozed from them, the flow lasting several days. The penis was the part most affected. He was under observation for twenty months and presented the same phenomena periodically, except that during the last few months they were diminished in every respect. Fournier also mentions a curious case of diapedesis in a woman injured by a cow. The animal struck her in the epigastric region, she fell unconscious, and soon after vomited great quantities of blood, and continued with convulsive efforts of expulsion to eject blood periodically from every eight to fifteen days, losing possibly a pound at each paroxysm. There was no alteration of her menses. A physician gave her astringents, which partly suppressed the vomiting, but the hemorrhage changed to the skin, and every day she sweated blood from the chest, back of the thighs, feet, and the extremities of the fingers. When the blood ceased to flow from her skin she lost her appetite, became oppressed, and was confined to her bed for some days. Itching always preceded the appearance of a new flow. There was no dermal change that could be noticed. Fullerton mentions a girl of thirteen who had occasional oozing of blood from her brow, face, and the skin under the eyes. Sometimes a pound of clots was found about her face and pillow. The blood first appeared in a single clot, and, strange to say, lumps of fleshy substance and minute pieces of bone were discharged all day. This latter discharge became more infrequent, the bone being replaced by cartilaginous substance. There was no pain, discoloration, swelling, or soreness, and after this strange anomaly disappeared menstruation regularly commenced. Van Swieten mentions a young lady who from her twelfth year at her menstrual periods had hemorrhages from pustules in the skin, the pustules disappearing in the interval. Schmidt's Jahrbucher for 1836 gives an account of a woman who had diseased ovaries and a rectovesicovaginal fistula, and though sometimes catamenia appeared at the proper place it was generally arrested and hemorrhage appeared on the face. Chambers mentions a woman of twenty-seven who suffered from bloody sweat after the manner of the stigmatists, and Petrone mentions a young man of healthy antecedents, the sweat from whose axillae and pubes was red and very pungent. Petrone believes it was due to a chromogenic micrococcus, and relieved the patient by the use of a five per cent solution of caustic potash. Chloroform, ether, and phenol had been tried without success. Hebra mentions a young man in whom the blood spurted from the hand in a spiral jet corresponding to the direction of the duct of the sweat-gland. Wilson refers to five cases of bloody sweat. There is a record of a patient who once or twice a day was attacked with swelling of the scrotum, which at length acquired a deep red color and a stony hardness, at which time the blood would spring from a hundred points and flow in the finest streams until the scrotum was again empty. Hill describes a boy of four who during the sweating stage of malaria sweated blood from the head and neck. Two months later the skin-hemorrhages ceased and the boy died, vomiting blood and with bloody stools. Postmortem sweating is described in the Ephemerides and reported by Hasenest and Schneider. Bartholinus speaks of bloody sweat in a cadaver. In considering the anomalies of lactation we shall first discuss those of color and then the extraordinary places of secretion. Black milk is spoken of by the Ephemerides and Paullini. Red milk has been observed by Cramer and Viger. Green milk has been observed by Lanzonius, Riverius, and Paullini. The Ephemerides also contains an account of green milk. Yellow milk has been mentioned in the Ephemerides and its cause ascribed to eating rhubarb. It is a well-known fact that some cathartics administered to nursing mothers are taken from the breast by their infants, who, notwithstanding its indirect mode of administration, exhibit the effects of the original drug. The same is the case with some poisons, and instances of lead-poisoning and arsenic-poisoning have been seen in children who have obtained the toxic substance in the mother's milk. There is one singular case on record in which a child has been poisoned from the milk of its mother after she had been bitten by a serpent. Paullini and the Ephemerides give instances of milk appearing in the perspiration, and there are numerous varieties of milk-metastasis recorded Dolaeus and Nuck mention the appearance of milk in the saliva. Autenreith mentions metastasis of milk through an abdominal abscess to the thigh, and Balthazaar also mentions excretion of milk from the thigh. Bourdon mentions milk from the thigh, labia, and vulva. Klein speaks of the metastasis of the milk to the lochia. Gardane speaks of metastasis to the lungs, and there is another case on record in which this phenomenon caused asphyxia. Schenck describes excretion of milk from the bladder and uterus. Jaeger in 1770 at Tubingen describes the metastasis of milk to the umbilicus, Haen to the back, and Schurig to a wound in the foot. Knackstedt has seen an abscess of the thigh which contained eight pounds of milk. Hauser gives the history of a case in which the kidneys secreted milk vicariously. There is the history of a woman who suffered from metastasis of milk to the stomach, and who, with convulsive action of the chest and abdomen, vomited it daily. A peculiar instance of milk in a tumor is that of a Mrs. Reed, who, when pregnant with twins, developed an abdominal tumor from which 25 pounds of milk was drawn off. There is a French report of secretion of milk in the scrotum of a man of twenty-one. The scrotum was tumefied, and to the touch gave the sensation of a human breast, and the parts were pigmented similar to an engorged breast. Analysis showed the secretion to have been true human milk. Cases of lactation in the new-born are not infrequent. Bartholinus, Baricelli, Muraltus, Deusingius, Rhodius, Schenck, and Schurig mention instances of it. Cardanus describes an infant of one month whose breasts were swollen and gave milk copiously. Battersby cites a description of a male child three weeks old whose breasts were full of a fluid, analysis proving it to have been human milk; Darby, in the same journal, mentions a child of eight days whose breasts were so engorged that the nurse had to milk it. Faye gives an interesting paper in which he has collected many instances of milk in the breasts of the new-born. Jonston details a description of lactation in an infant. Variot mentions milk-secretion in the new-born and says that it generally takes place from the eighth to the fifteenth day and not in the first week. He also adds that probably mammary abscesses in the new-born could be avoided if the milk were squeezed out of the breasts in the first days. Variot says that out of 32 children of both sexes, aged from six to nine months, all but six showed the presence of milk in the breasts. Gibb mentions copious milk-secretion in an infant, and Sworder and Menard have seen young babes with abundant milk-secretion. Precocious Lactation.--Bochut says that he saw a child whose breasts were large and completely developed, offering a striking contrast to the slight development of the thorax. They were as large as a stout man's fist, pear-shaped, with a rosy areola, in the center of which was a nipple. These precocious breasts increased in size at the beginning of the menstrual epoch (which was also present) and remained enlarged while the menses lasted. The vulva was covered with thick hair and the external genitalia were well developed. The child was reticent, and with a doll was inclined to play the role of mother. Baudelocque mentions a girl of eight who suckled her brother with her extraordinarily developed breasts. In 1783 this child milked her breasts in the presence of the Royal Academy at Paris. Belloc spoke of a similar case. There is another of a young negress who was able to nourish an infant; and among the older writers we read accounts of young virgins who induced lactation by applying infants to their breasts. Bartholinus, Benedictus, Hippocrates, Lentilius, Salmuth, and Schenck mention lactation in virgins. De la Coide describes a case in which lactation was present, though menstruation had always been deficient. Dix, at the Derby Infirmary, has observed two females in whom there was continued lactation, although they had never been pregnant. The first was a chaste female of twenty-five, who for two years had abundant and spontaneous discharge of milk that wetted the linen; and the other was in a prostitute of twenty, who had never been pregnant, but who had, nevertheless, for several months an abundant secretion of healthy milk. Zoologists know that a nonpregnant bitch may secrete milk in abundance. Delafond and de Sinnety have cited instances. Lactation in the aged has been frequently noticed. Amatus Lusitanus and Schenck have observed lactation in old women; in recent years Dunglison has collected some instances. Semple relates the history of an elderly woman who took charge of an infant the mother of which had died of puerperal infection. As a means of soothing the child she allowed it to take the nipple, and, strange to say, in thirty-six hours milk appeared in her breasts, and soon she had a flow as copious as she had ever had in her early married life. The child thrived on this production of a sympathetic and spontaneous lactation. Sir Hans Sloane mentions a lady of sixty-eight who though not having borne a child for twenty years, nursed her grandchildren one after another. Montegre describes a woman in the Department of Charente who bore two male children in 1810. Not having enough milk for both, and being too poor to secure the assistance of a midwife, in her desperation she sought an old woman named Laverge, a widow of sixty-five, whose husband had been dead twenty-nine years. This old woman gave the breast to one of the children, and in a few days an abundant flow of milk was present. For twenty-two months she nursed the infant, and it thrived as well as its brother, who was nursed by their common mother--in fact, it was even the stronger of the two. Dargan tells of a case of remarkable rejuvenated lactation in a woman of sixty, who, in play, placed the child to her breast, and to her surprise after three weeks' nursing of this kind there appeared an abundant supply of milk, even exceeding in amount that of the young mother. Blanchard mentions milk in the breasts of a woman of sixty, and Krane cites a similar instance. In the Philosophical Transactions there is an instance of a woman of sixty-eight having abundant lactation. Warren, Boring, Buzzi, Stack, Durston, Egan, Scalzi, Fitzpatrick, and Gillespie mention rejuvenation and renewed lactation in aged women. Ford has collected several cases in which lactation was artificially induced by women who, though for some time not having been pregnant themselves, nursed for others. Prolonged lactation and galactorrhea may extend through several pregnancies. Green reports the case of a woman of forty-seven, the mother of four children, who after each weaning had so much milk constantly in her breasts that it had to be drawn until the next birth. At the time of report the milk was still secreting in abundance. A similar and oft-quoted case was that of Gomez Pamo, who described a woman in whom lactation seemed indefinitely prolonged; she married at sixteen, two years after the establishment of menstruation. She became pregnant shortly after marriage, and after delivery had continued lactation for a year without any sign of returning menstruation. Again becoming pregnant, she weaned her first child and nursed the other without delay or complication. This occurrence took place fourteen times. She nursed all 14 of her children up to the time that she found herself pregnant again, and during the pregnancies after the first the flow of milk never entirely ceased; always after the birth of an infant she was able to nurse it. The milk was of good quality and always abundant, and during the period between her first pregnancy to seven years after the birth of her last child the menses had never reappeared. She weaned her last child five years before the time of report, and since then the milk had still persisted in spite of all treatment. It was sometimes so abundant as to necessitate drawing it from the breast to relieve painful tension. Kennedy describes a woman of eighty-one who persistently menstruated through lactation, and for forty-seven years had uninterruptedly nursed many children, some of which were not her own. Three years of this time she was a widow. At the last reports she had a moderate but regular secretion of milk in her eighty-first year. In regard to profuse lacteal flow, Remy is quoted as having seen a young woman in Japan from whom was taken 12 1/2 pints of milk each day, which is possibly one of the most extreme instance of continued galactorrhea on record. Galen refers to gynecomastia or gynecomazia; Aristotle says he has seen men with mammae a which were as well developed as those of a woman, and Paulus aegineta recognized the fact in the ancient Greeks. Subsequently Albucasis discusses it in his writings. Bartholinus, Behr, Benedictus, Borellus, Bonet, the Ephemerides, Marcellus Donatus, Schenck, Vesalius, Schacher, Martineau, and Buffon all discuss the anomalous presence of milk in the male breast. Puech says that this condition is found in one out of 13,000 conscripts. To Bedor, a marine surgeon, we owe the first scientific exposition of this subject, and a little later Villeneuve published his article in the French dictionary. Since then many observations have been made on this subject, and quite recently Laurent has published a most exhaustive treatise upon it. Robert describes an old man who suckled a child, and Meyer discusses the case of a castrated man who was said to suckle children. It is said that a Bishop of Cork, who gave one-half crown to an old Frenchman of seventy, was rewarded by an exhibition of his breasts, which were larger than the Bishop had ever seen in a woman. Petrequin speaks of a male breast 18 inches long which he amputated, and Laurent gives the photograph of a man whose breasts measured 30 cm. in circumference at the base, and hung like those of a nursing woman. In some instances whole families with supernumerary breasts are seen. Handyside gives two instances of quadruple breasts in brothers. Blanchard speaks of a father who had a supernumerary nipple on each breast and his seven sons had the same deformities; it was not noticed in the daughters. The youngest son transmitted this anomaly to his four sons. Petrequin describes a man with three mammae, two on the left side, the third being beneath the others. He had three sons with accessory mammae on the right side and two daughters with the same anomaly on the left side. Savitzky reports a case of gynecomazia in a peasant of twenty-one whose father, elder brother, and a cousin were similarly endowed. The patient's breasts were 33 cm. in circumference and 15 cm. from the nipple to the base of the gland; they resembled normal female mammae in all respects. The penis and the other genitalia were normal, but the man had a female voice and absence of facial hair. There was an abundance of subcutaneous fat and a rather broad pelvis. Wiltshire said that he knew a gynecomast in the person of a distinguished naturalist who since the age of puberty observed activity in his breasts, accompanied with secretion of milky fluid which lasted for a period of six weeks and occurred every spring. This authority also mentions that the French call husbands who have well-developed mammae "la couvade;" the Germans call male supernumerary breasts "bauchwarze," or ventral nipples. Hutchinson describes several cases of gynecomazia, in which the external genital organs decreased in proportion to the size of the breast and the manners became effeminate. Cameron, quoted by Snedden, speaks of a fellow-student who had a supernumerary nipple, and also says he saw a case in a little boy who had an extra pair of nipples much wider than the ordinary ones. Ansiaux, surgeon of Liege, saw a conscript of thirteen whose left mamma was well developed like that of a woman, and whose nipple was surrounded by a large areola. He said that this breast had always been larger than the other, but since puberty had grown greatly; the genital organs were well formed. Morgan examined a seaman of twenty-one, admitted to the Royal Naval Hospital at Hong Kong, whose right mamma, in size and conformation, had the appearance of the well developed breast of a full-grown woman. It was lobulated and had a large, brown-colored areola; the nipple, however, was of the same size as that on the left breast. The man stated that he first observed the breast to enlarge at sixteen and a half years; since that time it had steadily increased, but there was no milk at any time from the nipple; the external genital organs were well and fully developed. He complained of no pain or uneasiness except when in drilling aloft his breast came in contact with the ropes. Gruger of St. Petersburg divides gynecomazia into three classes:-- (1) That in which the male generative organs are normal; (2) In which they are deformed; (3) In which the anomaly is spurious, the breast being a mass of fat or a new growth. The same journal quotes an instance (possibly Morgan's case) in a young man of twenty-one with a deep voice, excellent health, and genitals well developed, and who cohabited with his wife regularly. When sixteen his right breast began to enlarge, a fact that he attributed to the pressure of a rope. Glandular substance could be distinctly felt, but there was no milk-secretion. The left breast was normal. Schuchardt has collected 272 cases of gynecomazia. Instances of Men Suckling Infants.--These instances of gynecomazia are particularly interesting when the individuals display ability to suckle infants. Hunter refers to a man of fifty who shared equally with his wife the suckling of their children. There is an instance of a sailor who, having lost his wife, took his son to his own breast to quiet him, and after three or four days was able to nourish him. Humboldt describes a South American peasant of thirty-two who, when his wife fell sick immediately after delivery, sustained the child with his own milk, which came soon after the application to the breast; for five months the child took no other nourishment. In Franklin's "Voyages to the Polar Seas" he quotes the instance of an old Chippewa who, on losing his wife in childbirth, had put his infant to his breast and earnestly prayed that milk might flow; he was fortunate enough to eventually produce enough milk to rear the child. The left breast, with which he nursed, afterward retained its unusual size. According to Mehliss some missionaries in Brazil in the sixteenth century asserted that there was a whole Indian nation whose women had small and withered breasts, and whose children owed their nourishment entirely to the males. Hall exhibited to his class in Baltimore a negro of fifty-five who had suckled all his mistress' family. Dunglison reports this case in 1837, and says that the mammae projected seven inches from the chest, and that the external genital organs were well developed. Paullini and Schenck cite cases of men suckling infants, and Blumenbach has described a male-goat which, on account of the engorgement of the mammae, it was necessary to milk every other day of the year. Ford mentions the case of a captain who in order to soothe a child's cries put it to his breast, and who subsequently developed a full supply of milk. He also quotes an instance of a man suckling his own children, and mentions a negro boy of fourteen who secreted milk in one breast. Hornor and Pulido y Fernandez also mention similar instances of gynecomazia. Human Odors.--Curious as it may seem, each individual as well as each species is in life enveloped with an odor peculiarly its own, due to its exhaled breath, its excretions, and principally to its insensible perspiration. The faculty of recognizing an odor in different individuals, although more developed in savage tribes, is by no means unknown in civilized society. Fournier quotes the instance of a young man who, like a dog, could smell the enemy by scent, and who by smell alone recognized his own wife from other persons. Fournier also mentions a French woman, an inhabitant of Naples, who had an extreme supersensitiveness of smell. The slightest odor was to her intolerable; sometimes she could not tolerate the presence of certain individuals. She could tell in a numerous circle which women were menstruating. This woman could not sleep in a bed which any one else had made, and for this reason discharged her maid, preparing her own toilet and her sleeping apartments. Cadet de Gassieourt witnessed this peculiar instance, and in consultation with several of the physicians of Paris attributed this excessive sensitiveness to the climate. There is a tale told of a Hungarian monk who affirmed that he was able to decide the chastity of females by the sense of smell alone. It is well known that some savage tribes with their large, open nostrils not only recognize their enemies but also track game the same as hounds. Individual Odors.--Many individuals are said to have exhaled particularly strong odors, and history is full of such instances. We are told by Plutarch that Alexander the Great exhaled an odor similar to that of violet flowers, and his undergarments always smelled of this natural perfume. It is said that Cujas offered a particular analogy to this. On the contrary, there are certain persons spoken of who exhaled a sulphurous odor. Martial said that Thais was an example of the class of people whose odor was insupportable. Schmidt has inserted in the Ephemerides an account of a journeyman saddler, twenty-three years of age, of rather robust constitution, whose hands exhaled a smell of sulphur so powerful and penetrating as to rapidly fill any room in which he happened to be. Rayer was once consulted by a valet-de-chambre who could never keep a place in consequence of the odor he left behind him in the rooms in which he worked. Hammond is quoted with saying that when the blessed Venturni of Bergamons officiated at the altar people struggled to come near him in order to enjoy the odor he exhaled. It was said that St. Francis de Paul, after he had subjected himself to frequent disciplinary inflictions, including a fast of thirty-eight to forty days, exhaled a most sensible and delicious odor. Hammond attributes the peculiar odors of the saints of earlier days to neglect of washing and, in a measure, to affections of the nervous system. It may be added that these odors were augmented by aromatics, incense, etc., artificially applied. In more modern times Malherbe and Haller were said to diffuse from their bodies the agreeable odor of musk. These "human flowers," to use Goethe's expression, are more highly perfumed in Southern latitudes. Modifying Causes.--According to Brieude, sex, age, climate, habits, ailments, the passions, the emotions, and the occupations modify the difference in the humors exhaled, resulting in necessarily different odors. Nursing infants have a peculiar sourish smell, caused by the butyric acid of the milk, while bottle-fed children smell like strong butter. After being weaned the odors of the babies become less decided. Boys when they reach puberty exhibit peculiar odors which are similar to those of animals when in heat. These odors are leading symptoms of what Borden calls "seminal fever" and are more strongly marked in those of a voluptuous nature. They are said to be caused by the absorption of spermatic fluid into the circulation and its subsequent elimination by the skin. This peculiar circumstance, however, is not seen in girls, in whom menstruation is sometimes to be distinguished by an odor somewhat similar to that of leather. Old age produces an odor similar to that of dry leaves, and there have been persons who declared that they could tell approximately the age of individuals by the sense of smell. Certain tribes and races of people have characteristic odors. Negroes have a rank ammoniacal odor, unmitigated by cleanliness; according to Pruner-Bey it is due to a volatile oil set free by the sebaceous follicles. The Esquimaux and Greenlanders have the odors of their greasy and oily foods, and it is said that the Cossacks, who live much with their horses, and who are principally vegetarians, will leave the atmosphere charged with odors several hours after their passage in numbers through a neighborhood. The lower race of Chinamen are distinguished by a peculiar musty odor, which may be noticed in the laundry shops of this country. Some people, such as the low grade of Indians, have odors, not distinctive, and solely due to the filth of their persons. Food and drink, as have been mentioned, markedly influence the odor of an individual, and those perpetually addicted to a special diet or drink have a particular odor. Odor after Coitus.--Preismann in 1877 makes the statement that for six hours after coitus there is a peculiar odor noticeable in the breath, owing to a peculiar secretion of the buccal glands. He says that this odor is most perceptible in men of about thirty-five, and can be discerned at a distance of from four to six feet. He also adds that this fact would be of great medicolegal value in the early arrest of those charged with rape. In this connection the analogy of the breath immediately after coitus to the odor of chloroform has been mentioned. The same article states that after coitus naturally foul breath becomes sweet. The emotions are said to have a decided influence on the odor of an individual. Gambrini, quoted by Monin, mentions a young man, unfortunate in love and violently jealous, whose whole body exhaled a sickening, pernicious, and fetid odor. Orteschi met a young lady who, without any possibility of fraud, exhaled the strong odor of vanilla from the commissures of her fingers. Rayer speaks of a woman under his care at the Hopital de la Charite affected with chronic peritonitis, who some time before her death exhaled a very decided odor of musk. The smell had been noticed several days, but was thought to be due to a bag of musk put purposely into the bed to overpower other bad smells. The woman, however, gave full assurance that she had no kind of perfume about her and that her clothes had been frequently changed. The odor of musk in this case was very perceptible on the arms and other portions of the body, but did not become more powerful by friction. After continuing for about eight days it grew fainter and nearly vanished before the patient's death. Speranza relates a similar case. Complexion.--Pare states that persons of red hair and freckled complexion have a noxious exhalation; the odor of prussic acid is said to come from dark individuals, while blondes exhale a secretion resembling musk. Fat persons frequently have an oleaginous smell. The disorders of the nervous system are said to be associated with peculiar odors. Fevre says the odor of the sweat of lunatics resembles that of yellow deer or mice, and Knight remarks that the absence of this symptom would enable him to tell whether insanity was feigned or not. Burrows declares that in the absence of further evidence he would not hesitate to pronounce a person insane if he could perceive certain associate odors. Sir William Gull and others are credited with asserting that they could detect syphilis by smell. Weir Mitchell has observed that in lesions of nerves the corresponding cutaneous area exhaled the odor of stagnant water. Hammond refers to three cases under his notice in which specific odors were the results of affections of the nervous system. One of these cases was a young woman of hysterical tendencies who exhaled the odor of violets, which pervaded her apartments. This odor was given off the left half of the chest only and could be obtained concentrated by collecting the perspiration on a handkerchief, heating it with four ounces of spirit, and distilling the remaining mixture. The administration of the salicylate of soda modified in degree this violaceous odor. Hammond also speaks of a young lady subject to chorea whose insensible perspiration had an odor of pineapples; a hypochondriac gentleman under his care smelled of violets. In this connection he mentions a young woman who, when suffering from intense sick headache, exhaled an odor resembling that of Limburger cheese. Barbier met a case of disordered innervation in a captain of infantry, the upper half of whose body was subject to such offensive perspiration that despite all treatment he had to finally resign his commission. In lethargy and catalepsy the perspiration very often has a cadaverous odor, which has probably occasionally led to a mistaken diagnosis of death. Schaper and de Meara speak of persons having a cadaveric odor during their entire life. Various ingesta readily give evidence of themselves by their influence upon the breath. It has been remarked that the breath of individuals who have recently performed a prolonged necropsy smells for some hours of the odor of the cadaver. Such things as copaiba, cubebs, sandalwood, alcohol, coffee, etc., have their recognizable fragrance. There is an instance of a young woman taking Fowler's solution who had periodic offensive axillary sweats that ceased when the medicine was discontinued. Henry of Navarre was a victim of bromidrosis; proximity to him was insufferable to his courtiers and mistresses, who said that his odor was like that of carrion. Tallemant says that when his wife, Marie de Medicis, approached the bridal night with him she perfumed her apartments and her person with the essences of the flowers of her country in order that she might be spared the disgusting odor of her spouse. Some persons are afflicted with an excessive perspiration of the feet which often takes a disgusting odor. The inguinoscrotal and inguinovulvar perspirations have an aromatic odor like that of the genitals of either sex. During menstruation, hyperidrosis of the axillae diffuses an aromatic odor similar to that of acids or chloroform, and in suppression of menses, according to the Ephemerides, the odor is as of hops. Odors of Disease.--The various diseases have their own peculiar odors. The "hospital odor," so well known, is essentially variable in character and chiefly due to an aggregation of cutaneous exhalations. The wards containing women and children are perfumed with butyric acid, while those containing men are influenced by the presence of alkalies like ammonia. Gout, icterus, and even cholera (Drasch and Porker) have their own odors. Older observers, confirmed by Doppner, say that all the plague-patients at Vetlianka diffused an odor of honey. In diabetes there is a marked odor of apples. The sweat in dysentery unmistakably bears the odor of the dejecta. Behier calls the odor of typhoid that of the blood, and Berard says that it attracts flies even before death. Typhus has a mouse-like odor, and the following diseases have at different times been described as having peculiar odors,--measles, the smell of freshly plucked feathers; scarlatina, of bread hot from the oven; eczema and impetigo, the smell of mold; and rupia, a decidedly offensive odor. The hair has peculiar odors, differing in individuals. The hair of the Chinese is known to have the odor of musk, which cannot be washed away by the strongest of chemicals. Often the distinctive odor of a female is really due to the odor of great masses of hair. It is said that wig-makers simply by the sense of smell can tell whether hair has been cut from the living head or from combings, as hair loses its odor when it falls out. In the paroxysms of hysteroepilepsy the hair sometimes has a specific odor of ozone. Taenia favosa gives to the scalp an odor resembling that of cat's urine. Sexual Influence of Odors.--In this connection it may be mentioned that there is a peculiar form of sexual perversion, called by Binet "fetichism," in which the subject displays a perverted taste for the odors of handkerchiefs, shoes, underclothing, and other articles of raiment worn by the opposite sex. Binet maintains that these articles play the part of the "fetich" in early theology. It is said that the favors given by the ladies to the knights in the Middle Ages were not only tokens of remembrance and appreciation, but sexual excitants as well. In his remarkable "Osphresiologie," Cloquet calls attention to the sexual pleasure excited by the odors of flowers, and tells how Richelieu excited his sexual functions by living in an atmosphere loaded with these perfumes. In the Orient the harems are perfumed with intense extracts and flowers, in accordance with the strong belief in the aphrodisiac effect of odors. Krafft-Ebing quotes several interesting cases in which the connection between the olfactory and sexual functions is strikingly verified. "The case of Henry III shows that contact with a person's perspiration may be the exciting cause of passionate love. At the betrothal feast of the King of Navarre and Margaret of Valois he accidentally dried his face with a garment of Maria of Cleves which was moist with her perspiration. Although she was the bride of the Prince of Conde, Henry immediately conceived such a passion for her that he could not resist it, and, as history shows, made her very unhappy. An analogous instance is related of Henry IV, whose passion for the beautiful Gabrielle is said to have originated at the instant when, at a ball, he wiped his brow with her handkerchief." Krafft-Ebing also says that "one learns from reading the work of Ploss ('Das Weib') that attempts to attract a person of the opposite sex by means of the perspiration may be discerned in many forms in popular psychology. In reference to this a custom is remarkable which holds among the natives of the Philippine Islands when they become engaged. When it becomes necessary for the engaged pair to separate they exchange articles of wearing apparel, by means of which each becomes assured of faithfulness. These objects are carefully preserved, covered with kisses, and smelled." The love of perfumes by libertines and prostitutes, as well as sensual women of the higher classes, is quite marked. Heschl reported a case of a man of forty-five in whom absence of the olfactory sense was associated with imperfect development of the genitals; it is also well known that olfactory hallucinations are frequently associated with psychoses of an erotic type. Garnier has recently collected a number of observations of fetichism, in which he mentions individuals who have taken sexual satisfaction from the odors of shoes, night-dresses, bonnets, drawers, menstrual napkins, and other objects of the female toilet. He also mentions creatures who have gloated over the odors of the blood and excretions from the bodies of women, and gives instances of fetichism of persons who have been arrested in the streets of Paris for clipping the long hair from young girls. There are also on record instances of homosexual fetichism, a type of disgusting inversion of the sexual instinct, which, however, it is not in the province of this work to discuss. Among animals the influence of the olfactory perceptions on the sexual sense is unmistakable. According to Krafft Ebing, Althaus shows that animals of opposite sexes are drawn to each other by means of olfactory perceptions, and that almost all animals at the time of rutting emit a very strong odor from their genitals. It is said that the dog is attracted in this way to the bitch several miles away. An experiment by Schiff is confirmatory. He extirpated the olfactory nerves of puppies, and found that as they grew the male was unable to distinguish the female. Certain animals, such as the musk-ox, civet-cat, and beaver, possess glands on their sexual organs that secrete materials having a very strong odor. Musk, a substance possessing the most penetrating odor and used in therapeutics, is obtained from the preputial follicles of the musk-deer of Thibet; and castor, a substance less penetrating, is obtained from the preputial sacs of the beaver. Virgin moths (Bombyx) carried in boxes in the pockets of entomologists will on wide commons cause the appearance of males of the same species. Bulimia is excessive morbid hunger, also called canine appetite. While sometimes present in healthy people, it is most often seen in idiots and the insane, and is a symptom of diabetes mellitus. Mortimer mentions a boy of twelve who, while laboring under this affliction, in six days devoured food to the extent of 384 pounds and two ounces. He constantly vomited, but his craving for food was so insatiable that if not satisfied he would devour the flesh off his own bones. Martyn, Professor of Botany at Cambridge in the early part of the last century, tells of a boy ten years old whose appetite was enormous. He consumed in one week 373 pounds of food and drink. His urine and stools were voided in normal quantities, the excess being vomited. A pig was fed on what he vomited, and was sold in the market. The boy continued in this condition for a year, and at last reports was fast failing. Burroughs mentions a laborer at Stanton, near Bury, who ate an ordinary leg of veal at a meal, and fed at this extravagant rate for many days together. He would eat thistles and other similar herbs greedily. At times he would void worms as large as the shank of a clay-pipe, and then for a short period the bulimia would disappear. Johnston mentions a case of bulimia in a man who devoured large quantities of raw flesh. There is an instance on record of a case of canine appetite in which nearly 400 pounds of solid and fluid elements were taken into the body in six days and again ejected. A recovery was effected by giving very concentrated food, frequently repeated in small quantities. Mason mentions a woman in St. Bartholomew's Hospital in London in the early part of this century who was wretched unless she was always eating. Each day she consumed three quartern-loaves, three pounds of beef-steak, in addition to large quantities of vegetables, meal, etc., and water. Smith describes a boy of fourteen who ate continuously fifteen hours out of the twenty-four, and who had eight bowel movements each day. One year previous his weight was 105 pounds, but when last seen he weighed 284 pounds and was increasing a half pound daily. Despite his continuous eating, this boy constantly complained of hunger. Polydipsia is an abnormal thirst; it may be seen in persons otherwise normal, or it may be associated with diseases--such as diabetes mellitus or diabetes insipidus. Mackenzie quotes a case from Trousseau, in which an individual afflicted with diabetes insipidus passed 32 liters of urine daily and drank enormous quantities of water. This patient subjected himself to severe regimen for eight months,--although one day, in his agonies, he seized the chamber-pot and drank its contents at once. Mackenzie also mentions an infant of three who had polydipsia from birth and drank daily nearly two pailfuls of water. At the age of twenty-two she married a cobbler, unaware of her propensity, who found that his earnings did not suffice to keep her in water alone, and he was compelled to melt ice and snow for her. She drank four pailfuls a day, the price being 12 sous; water in the community was scarce and had to be bought. This woman bore 11 children. At the age of forty she appeared before a scientific commission and drank in their presence 14 quarts of water in ten hours and passed ten quarts of almost colorless urine. Dickinson mentions that he has had patients in his own practice who drank their own urine. Mackenzie also quotes Trousseau's history of a man who drank a liter of strong French brandy in two hours, and habitually drank the same quantity daily. He stated that he was free from the effects of alcohol; on several occasions on a wager he took 20 liters of wine, gaining his wager without visibly affecting his nervous system. There is an instance of a man of fifty-eight who could not live through the night without a pail of water, although his health was otherwise good. Atkinson in 1856 reported a young man who in childhood was a dirt-eater, though at that time complaining of nothing but excessive thirst. He was active, industrious, enjoyed good health, and was not addicted to alcoholics. His daily ration of water was from eight to twelve gallons. He always placed a tub of water by his bed at night, but this sometimes proved insufficient. He had frequently driven hogs from mudholes to slake his thirst with the water. He married in 1829 and moved into Western Tennessee, and in 1854 he was still drinking the accustomed amount; and at this time he had grown-up children. Ware mentions a young man of twenty who drank six gallons of water daily. He was tormented with thirst, and if he abstained he became weak, sick, and dizzy. Throughout a long life he continued his habit, sometimes drinking a gallon at one draught; he never used spirits. There are three cases of polydipsia reported from London in 1792. Field describes a boy with bilious remittent fever who would drink until his stomach was completely distended and then call for more. Emesis was followed by cries for more water. Becoming frantic, he would jump from his bed and struggle for the water bucket; failing in this, he ran to the kitchen and drank soapsuds, dish-water, and any other liquid he could find. He had swallowed a mass of mackerel which he had not properly masticated, a fact proved later by ejection of the whole mass. There is a case on record a in which there was intolerable thirst after retiring, lasting for a year. There was apparently no polydipsia during the daytime. The amount of water drunk by glass-blowers in a day is almost incredible. McElroy has made observations in the glass-factories in his neighborhood, and estimates that in the nine working hours of each day a glass-blower drinks from 50 to 60 pints of water. In addition to this many are addicted to the use of beer and spirits after working hours and at lunch-time. The excreta and urine never seem to be perceptibly increased. When not working these men do not drink more than three or four pints of water. Occasionally a man becomes what is termed "blown-up with water;" that is, the perspiration ceases, the man becomes utterly helpless, has to be carried out, and is disabled until the sweating process is restored by vigorously applied friction. There is little deleterious change noticed in these men; in fact, they are rarely invalids. Hydroadipsia is a lack of thirst or absence of the normal desire for water. In some of these cases there is a central lesion which accounts for the symptoms. McElroy, among other cases, speaks of one in a patient who was continually dull and listless, eating little, and complaining of much pain after the least food. This, too, will be mentioned under abstinence. Perverted appetites are of great variety and present many interesting as well as disgusting examples of anomalies. In some cases the tastes of people differ so that an article considered by one race as disgusting would be held as a delicacy by another class. The ancients used asafetida as a seasoning, and what we have called "stercus diaboli," the Asiatics have named the "food of the gods." The inhabitants of Greenland drink the oil of the whale with as much avidity as we would a delicate wine, and they eat blubber the mere smell of which nauseates an European. In some nations of the lower grade, insects, worms, serpents, etc., are considered edible. The inhabitants of the interior of Africa are said to relish the flesh of serpents and eat grubs and worms. The very earliest accounts of the Indians of Florida and Texas show that "for food, they dug roots, and that they ate spiders, ants' eggs, worms, lizards, salamanders, snakes, earth, wood, the dung of deer, and many other things." Gomara, in his "Historia de les Indias," says this loathsome diet was particular to one tribe, the Yagusces of Florida. It is said that a Russian peasant prefers a rotten egg to a fresh one; and there are persons who prefer game partly spoiled. Bourke recalls that the drinking of human urine has often been a religious rite, and describes the urine-dance of the Zunis of New Mexico, in which the participants drink freely of their urine; he draws an analogy to the Feast of the Fools, a religious custom of Pagan origin which did not disappear in Europe until the time of the Reformation. It is still a practice in some parts of the United States to give children fresh urine for certain diseases. It is said that the ordure of the Grand Lama of Thibet was at one time so venerated that it was collected and worn as amulets. The disgusting habit of eating human excrement is mentioned by Schurig, who gives numerous examples in epileptics, maniacs, chlorotic young women, pregnant women, children who have soiled their beds and, dreading detection, have swallowed their ejecta, and finally among men and women with abnormal appetites. The Indians of North America consider a broth made from the dung of the hare and caribou a dainty dish, and according to Abbe Domenech, as a means of imparting a flavor, the bands near Lake Superior mix their rice with the excrement of rabbits. De Bry mentions that the negroes of Guinea ate filthy, stinking elephant-meat and buffalo-flesh infested with thousands of maggots, and says that they ravenously devoured dogs' guts raw. Spencer, in his "Descriptive Sociology," describes a "Snake savage" of Australia who devoured the contents of entrails of an animal. Some authors have said that within the last century the Hottentots devoured the flesh and the entrails of wild beasts, uncleansed of their filth and excrement, and whether sound or rotten. In a personal letter to Captain Bourke, the Reverend J. Owen Dorsey reports that while among the Ponkas he saw a woman and child devour the entrails of a beef with their contents. Bourke also cites instances in which human ordure was eaten by East Indian fanatics. Numerous authorities are quoted by Bourke to prove the alleged use of ordure in food by the ancient Israelites. Pages of such reference are to be found in the works on Scatology, and for further reference the reader is referred to books on this subject, of which prominent in English literature is that of Bourke. Probably the most revolting of all the perverted tastes is that for human flesh. This is called anthropophagy or cannibalism, and is a time-honored custom among some of the tribes of Africa. This custom is often practised more in the spirit of vengeance than of real desire for food. Prisoners of war were killed and eaten, sometimes cooked, and among some tribes raw. In their religious frenzy the Aztecs ate the remains of the human beings who were sacrificed to their idols. At other times cannibalism has been a necessity. In a famine in Egypt, as pictured by the Arab Abdullatif, the putrefying debris of animals, as well as their excrement, was used as food, and finally the human dead were used; then infants were killed and devoured, so great was the distress. In many sieges, shipwrecks, etc., cannibalism has been practiced as a last resort for sustaining life. When supplies have given out several Arctic explorers have had to resort to eating the bodies of their comrades. In the famous Wiertz Museum in Brussels is a painting by this eccentric artist in which he has graphically portrayed a woman driven to insanity by hunger, who has actually destroyed her child with a view to cannibalism. At the siege of Rochelle it is related that, urged by starvation, a father and mother dug up the scarcely cold body of their daughter and ate it. At the siege of Paris by Henry IV the cemeteries furnished food for the starving. One mother in imitation of what occurred at the siege of Jerusalem roasted the limbs of her dead child and died of grief under this revolting nourishment. St. Jerome states that he saw Scotchmen in the Roman armies in Gaul whose regular diet was human flesh, and who had "double teeth all around." Cannibalism, according to a prominent New York journal, has been recently made a special study by the Bureau of Ethnology at Washington, D.C. Data on the subject have been gathered from all parts of the world, which are particularly interesting in view of discoveries pointing to the conclusion that this horrible practice is far more widespread than was imagined. Stanley claims that 30,000,000 cannibals dwell in the basin of the Congo to-day--people who relish human flesh above all other meat. Perah, the most peculiar form of cannibalism, is found in certain mountainous districts of northeast Burmah, where there are tribes that follow a life in all important respects like that of wild beasts. These people eat the congealed blood of their enemies. The blood is poured into bamboo reeds, and in the course of time, being corked up, it hardens. The filled reeds are hung under the roofs of the huts, and when a person desires to treat his friends very hospitably the reeds are broken and the contents devoured. "The black natives of Australia are all professed cannibals. Dr. Carl Lumholtz, a Norwegian scientist, spent many months in studying them in the wilds of the interior. He was alone among these savages, who are extremely treacherous. Wearing no clothing whatever, and living in nearly every respect as monkeys do, they know no such thing as gratitude, and have no feeling that can be properly termed human. Only fear of the traveler's weapons prevented them from slaying him, and more than once he had a narrow escape. One of the first of them whom he employed looked more like a brute than a man. 'When he talked,' says the doctor, 'he rubbed his belly with complacency, as if the sight of me made his mouth water.' This individual was regarded with much respect by his fellows because of his success in procuring human flesh to eat. These aborigines say that the white man's flesh is salt and occasions nausea. A Chinaman they consider as good for eating as a black man, his food being chiefly vegetable. "The most horrible development of cannibalism among the Australian blacks is the eating of defunct relatives. When a person dies there follows an elaborate ceremony, which terminates with the lowering of the corpse into the grave. In the grave is a man not related to the deceased, who proceeds to cut off the fat adhering to the muscles of the face, thighs, arms, and stomach, and passes it around to be swallowed by some of the near relatives. All those who have eaten of the cadaver have a black ring of charcoal powder and fat drawn around the mouth. The order in which the mourners partake of their dead relatives is duly prescribed. The mother eats of her children and the children of their mother. A man eats of his sister's husband and of his brother's wife. Mothers' brothers, mothers' sisters, sisters' children, mothers' parents, and daughters' children are also eaten by those to whom the deceased person stands in such relation. But the father does not eat of his children, nor the children of their sire. "The New Zealanders, up to very recent times, were probably the most anthropophagous race that ever existed. As many as 1000 prisoners have been slaughtered by them at one time after a successful battle, the bodies being baked in ovens underground. If the individual consumed had been a redoubtable enemy they dried his head as a trophy and made flutes of his thigh bones. "Among the Monbuttos of Africa human fat is commonly employed for a variety of purposes. The explorer Schweinfurth speaks of writing out in the evenings his memoranda respecting these people by the light of a little oil-lamp contrived by himself, which was supplied with some questionable-looking grease furnished by the natives. The smell of this grease, he says, could not fail to arouse one's worst suspicions against the negroes. According to his account the Monbuttos are the most confirmed cannibals in Africa. Surrounded as they are by a number of peoples who are blacker than themselves, and who, being inferior to them in culture, are held in contempt, they carry on expeditions of war and plunder which result in the acquisition of a booty especially coveted by them--namely, human flesh. The bodies of all foes who fall in battle are distributed on the field among the victors, and are prepared by drying for transportation. The savages drive their prisoners before them, and these are reserved for killing at a later time. During Schweinfurth's residence at the Court of Munza it was generally understood that nearly every day a little child was sacrificed to supply a meal for the ogre potentate. For centuries past the slave trade in the Congo Basin has been conducted largely for the purpose of furnishing human flesh to consumers. Slaves are sold and bought in great numbers for market, and are fattened for slaughter. "The Mundurucus of the Upper Amazon, who are exceedingly ferocious, have been accused of cannibalism. It is they who preserve human heads in such a remarkable way. When one of their warriors has killed an enemy he cuts off the head with his bamboo knife, removes the brain, soaks the head in a vegetable oil, takes out bones of the skull, and dries the remaining parts by putting hot pebbles inside of it. At the same time care is taken to preserve all the features and the hair intact. By repeating the process with the hot pebbles many times the head finally becomes shrunken to that of a small doll, though still retaining its human aspect, so that the effect produced is very weird and uncanny. Lastly, the head is decorated with brilliant feathers, and the lips are fastened together with a string, by which the head is suspended from the rafters of the council-house." Ancient Customs.--According to Herodotus the ancient Lydians and Medes, and according to Plato the islanders in the Atlantic, cemented friendship by drinking human blood. Tacitus speaks of Asian princes swearing allegiance with their own blood, which they drank. Juvenal says that the Scythians drank the blood of their enemies to quench their thirst. Occasionally a religious ceremony has given sanction to cannibalism. It is said that in the Island of Chios there was a rite by way of sacrifice to Dionysius in which a man was torn limb from limb, and Faber tells us that the Cretans had an annual festival in which they tore a living bull with their teeth. Spencer quotes that among the Bacchic orgies of many of the tribes of North America, at the inauguration of one of the Clallum chiefs on the northwest coast of British America, the chief seized a small dog and began to devour it alive, and also bit the shoulders of bystanders. In speaking of these ceremonies, Boas, quoted by Bourke, says that members of the tribes practicing Hamatsa ceremonies show remarkable scars produced by biting, and at certain festivals ritualistic cannibalism is practiced, it being the duty of the Hamatsa to bite portions of flesh out of the arms, legs, or breast of a man. Another cause of cannibalism, and the one which deserves discussion here, is genuine perversion or depravity of the appetite for human flesh among civilized persons,--the desire sometimes being so strong as to lead to actual murder. Several examples of this anomaly are on record. Gruner of Jena speaks of a man by the name of Goldschmidt, in the environs of Weimar, who developed a depraved appetite for human flesh. He was married at twenty-seven, and for twenty-eight years exercised his calling as a cow-herd. Nothing extraordinary was noticed in him, except his rudeness of manner and his choleric and gross disposition. In 1771, at the age of fifty-five, he met a young traveler in the woods, and accused him of frightening his cows; a discussion arose, and subsequently a quarrel, in which Goldschmidt killed his antagonist by a blow with a stick which he used. To avoid detection he dragged the body to the bushes, cut it up, and took it home in sections. He then washed, boiled, and ate each piece. Subsequently, he developed a further taste for human flesh, and was finally detected in eating a child which he had enticed into his house and killed. He acknowledged his appetite before his trial. Hector Boetius says that a Scotch brigand and his wife and children were condemned to death on proof that they killed and ate their prisoners. The extreme youth of one of the girls excused her from capital punishment; but at twelve years she was found guilty of the same crime as her father and suffered capital punishment. This child had been brought up in good surroundings, yet her inherited appetite developed. Gall tells of an individual who, instigated by an irresistible desire to eat human flesh, assassinated many persons; and his daughter, though educated away from him, yielded to the same graving. At Bicetre there was an individual who had a horribly depraved appetite for decaying human flesh. He would haunt the graveyards and eat the putrefying remains of the recently buried, preferring the intestines. Having regaled himself in a midnight prowl, he would fill his pockets for future use. When interrogated on the subject of his depravity he said it had existed since childhood. He acknowledged the greatest desire to devour children he would meet playing; but he did not possess the courage to kill them. Prochaska quotes the case of a woman of Milan who attracted children to her home in order that she might slay, salt, and eat them. About 1600, there is the record of a boy named Jean Granier, who had repeatedly killed and devoured several young children before he was discovered. Rodericus a Castro tells of a pregnant woman who so strongly desired to eat the shoulder of a baker that she killed him, salted his body, and devoured it at intervals. There is a record of a woman who in July, 1817, was discovered in cooking an amputated leg of her little child. Gorget in 1827 reported the celebrated case of Leger the vine dresser, who at the age of twenty-four wandered about a forest for eight days during an attack of depression. Coming across a girl of twelve, he violated her, and then mutilated her genitals, and tore out her heart, eating of it, and drinking the blood. He finally confessed his crime with calm indifference. After Leger's execution Esquirol found morbid adhesions between the brain and the cerebral membranes. Mascha relates a similar instance in a man of fifty-five who violated and killed a young girl, eating of her genitals and mammae. At the trial he begged for execution, saying that the inner impulse that led him to his crime constantly persecuted him. A modern example of lust-murder and anthropophagy is that of Menesclou, who was examined by Brouardel, Motet, and others, and declared to be mentally sound; he was convicted. This miscreant was arrested with the forearm of a missing child in his pocket, and in his stove were found the head and entrails in a half-burnt condition. Parts of the body were found in the water-closet, but the genitals were missing; he was executed, although he made no confession, saying the deed was an accident. Morbid changes were found in his brain. Krafft-Ebing cites the case of Alton, a clerk in England, who lured a child into a thicket, and after a time returned to his office, where he made an entry in his note-book: "Killed to-day a young girl; it was fine and hot." The child was missed, searched for, and found cut into pieces. Many parts, and among them the genitals, could not be found. Alton did not show the slightest trace of emotion, and gave no explanation of the motive or circumstances of his horrible deed; he was executed. D'Amador tells of persons who went into slaughter-houses and waste-places to dispute with wolves for the most revolting carrion. It is also mentioned that patients in hospitals have been detected in drinking the blood of patients after venesections, and in other instances frequenting dead-houses and sucking the blood of the recently deceased. Du Saulle quotes the case of a chlorotic girl of fourteen who eagerly drank human blood. She preferred that flowing fresh from a recent wound. Further Examples of Depraved Appetites.--Bijoux speaks of a porter or garcon at the Jardin des Plantes in Paris who was a prodigious glutton. He had eaten the body of a lion that had died of disease at the menagerie. He ate with avidity the most disgusting things to satiate his depraved appetite. He showed further signs of a perverted mind by classifying the animals of the menagerie according to the form of their excrement, of which he had a collection. He died of indigestion following a meal of eight pounds of hot bread. Percy saw the famous Tarrare, who died at Versailles, at about twenty-six years of age. At seventeen he weighed 100 pounds. He ate a quarter of beef in twenty-four hours. He was fond of the most revolting things. He particularly relished the flesh of serpents and would quickly devour the largest. In the presence of Lorenze he seized a live cat with his teeth, eventrated it, sucked its blood, and ate it, leaving the bare skeleton only. In about thirty minutes he rejected the hairs in the manner of birds of prey and carnivorous animals. He also ate dogs in the same manner. On one occasion it was said that he swallowed a living eel without chewing it; but he had first bitten off its head. He ate almost instantly a dinner that had been prepared for 15 vigorous workmen and drank the accompanying water and took their aggregate allowance of salt at the same time. After this meal his abdomen was so swollen that it resembled a balloon. He was seen by Courville, a surgeon-major in a military hospital, where he had swallowed a wooden box wrapped in plain white paper. This he passed the next day with the paper intact. The General-in-chief had seen him devour thirty pounds of raw liver and lungs. Nothing seemed to diminish his appetite. He waited around butcher-shops to eat what was discarded for the dogs. He drank the bleedings of the hospital and ate the dead from the dead-houses. He was suspected of eating a child of fourteen months, but no proof could be produced of this. He was of middle height and was always heated and sweating. He died of a purulent diarrhea, all his intestines and peritoneum being in a suppurating condition. Fulton mentions a girl of six who exhibited a marked taste for feeding on slugs, beetles, cockroaches, spiders, and repulsive insects. This child had been carefully brought up and was one of 13 children, none of whom displayed any similar depravity of appetite. The child was of good disposition and slightly below the normal mental standard for her age. At the age of fourteen her appetite became normal. In the older writings many curious instances of abnormal appetite are seen. Borellus speaks of individuals swallowing stones, horns, serpents, and toads. Plater mentions snail-eating and eel-eating, two customs still extant. Rhodius is accredited with seeing persons who swallowed spiders and scorpions. Jonston says that Avicenna, Rufus, and Gentilis relate instances of young girls who acquired a taste for poisonous animals and substances, who could ingest them with impunity. Colonia Agrippina was supposed to have eaten spiders with impunity. Van Woensel is said to have seen persons who devoured live eels. The habit of dirt eating or clay-eating, called pica, is well authenticated in many countries. The Ephemerides contains mention of it; Hunter speaks of the blacks who eat potters' clay; Bartholinus describes dirt-eating as does also a Castro. Properly speaking, dirt-eating should be called geophagism; it is common in the Antilles and South America, among the low classes, and is seen in the negroes and poorest classes of some portions of the Southern United States. It has also been reported from Java, China, Japan, and is said to have been seen in Spain and Portugal. Peat-eating or bog-eating is still seen in some parts of Ireland. There were a number of people in the sixteenth and seventeenth centuries who had formed the habit of eating small pebbles after each meal. They formed the habit from seeing birds swallowing gravel after eating. A number of such cases are on record. There is on record the account of a man living in Wurtemberg who with much voracity had eaten a suckling pig, and sometimes devoured an entire sheep. He swallowed dirt, clay, pebbles, and glass, and was addicted to intoxication by brandy. He lived sixty years in this manner and then he became abstemious; he died at seventy-nine. His omentum was very lean, but the liver covered all his abdominal viscera. His stomach was very large and thick, but the intestines were very narrow. Ely had a patient who was addicted to chalk-eating; this ha said invariably relieved his gastric irritation. In the twenty-five years of the habit he had used over 1/2 ton of chalk; but notwithstanding this he always enjoyed good health. The Ephemerides contains a similar instance, and Verzascha mentions a lime-eater. Adams mentions a child of three who had an instinctive desire to eat mortar. This baby was rickety and had carious teeth. It would pick its preferred diet out of the wall, and if prevented would cry loudly. When deprived of the mortar it would vomit its food until this substance was given to it again. At the time of report part of the routine duties of the sisters of this boy was to supply him with mortar containing a little sand. Lime-water was substituted, but he insisted so vigorously on the solid form of food that it had to be replaced in his diet. He suffered from small-pox; on waking up in the night with a fever, he always cried for a piece of mortar. The quantity consumed in twenty-four hours was about 1/2 teacupful. The child had never been weaned. Arsenic Eaters.--It has been frequently stated that the peasants of Styria are in the habit of taking from two to five grains of arsenious acid daily for the purpose of improving the health, avoiding infection, and raising the whole tone of the body. It is a well-substantiated fact that the quantities taken habitually are quite sufficient to produce immediate death ordinarily. But the same might be easily said of those addicted to opium and chloral, a subject that will be considered later. Perverted appetites during pregnancy have been discussed on pages 80 and 81. Glass-eaters, penknife-swallowers, and sword-swallowers, being exhibitionists and jugglers, and not individuals with perverted appetites, will be considered in Chapter XII. Fasting.--The length of time which a person can live with complete abstinence from food is quite variable. Hippocrates admits the possibility of fasting more than six days without a fatal issue; but Pliny and others allow a much longer time, and both the ancient and modern literature of medicine are replete with examples of abstinence to almost incredible lengths of time. Formerly, and particularly in the Middle Ages when religious frenzy was at its highest pitch, prolonged abstinence was prompted by a desire to do penance and to gain the approbation of Heaven. In many religions fasting has become a part of worship or religions ceremony, and from the earliest times certain sects have carried this custom to extremes. It is well known that some of the priests and anchorites of the East now subsist on the minimum amount of food, and from the earliest times before the advent of Christianity we find instances of prolonged fasting associated with religious worship. The Assyrians, the Hebrews, the Egyptians, and other Eastern nations, and also the Greeks and Romans, as well as feasting days, had their times of fasting, and some of these were quite prolonged. At the present day religious fervor accounts for but few of our remarkable instances of abstinence, most of them being due to some form of nervous disorder, varying from hysteria and melancholia to absolute insanity. The ability seen in the Middle Ages to live on the Holy Sacrament and to resist starvation may possibly have its analogy in some of the fasting girls of the present day. In the older times these persons were said to have been nourished by angels or devils; but according to Hammond many cases both of diabolical abstinence from food and of holy fasting exhibited manifest signs of hysteric symptoms. Hammond, in his exhaustive treatise on the subject of "Fasting Girls," also remarks that some of the chronicles detail the exact symptoms of hysteria and without hesitation ascribe them to a devilish agency. For instance, he speaks of a young girl in the valley of Calepino who had all her limbs twisted and contracted and had a sensation in her esophagus as if a ball was sometimes rising in her throat or falling into the stomach--a rather lay description of the characteristic hysteric "lump in the throat," a frequent sign of nervous abstinence. Abstinence, or rather anorexia, is naturally associated with numerous diseases, particularly of the febrile type; but in all of these the patient is maintained by the use of nutrient enemata or by other means, and the abstinence is never complete. A peculiar type of anorexia is that striking and remarkable digestive disturbance of hysteria which Sir William Gull has called anorexia nervosa. In this malady there is such annihilation of the appetite that in some cases it seems impossible ever to eat again. Out of it grows an antagonism to food which results at last, and in its worst forms, in spasm on the approach of food, and this in its turn gives rise to some of those remarkable cases of survival for long periods without food. As this goes on there may be an extreme degree of muscular restlessness, so that the patients wander about until exhausted. According to Osler, who reports a fatal case in a girl who, at her death, only weighed 49 pounds, nothing more pitiable is to be seen in medical practice than an advanced case of this malady. The emaciation and exhaustion are extreme, and the patient is as miserable as one with carcinoma of the esophagus, food either not being taken at all or only upon urgent compulsion. Gull mentions a girl of fourteen, of healthy, plump appearance, who in the beginning of February, 1887, without apparent cause evinced a great repugnance to food and soon afterward declined to take anything but a half cup of tea or coffee. Gull saw her in April, when she was much emaciated; she persisted in walking through the streets, where she was the object of remark of passers-by. At this time her height was five feet four inches, her weight 63 pounds, her temperature 97 degrees F., her pulse 46, and her respiration from 12 to 14. She had a persistent wish to be moving all the time, despite her emaciation and the exhaustion of the nutritive functions. There is another class of abstainers from food exemplified in the exhibitionists who either for notoriety or for wages demonstrate their ability to forego eating, and sometimes drinking, for long periods. Some have been clever frauds, who by means of artifices have carried on skilful deceptions; others have been really interesting physiologic anomalies. Older Instances.--Democritus in 323 B.C. is said to have lived forty days by simply smelling honey and hot bread. Hippocrates remarks that most of those who endeavored to abstain five days died within that period, and even if they were prevailed upon to eat and drink before the termination of their fast they still perished. There is a possibility that some of these cases of Hippocrates were instances of pyloric carcinoma or of stenosis of the pylorus. In the older writings there are instances reported in which the period of abstinence has varied from a short time to endurance beyond the bounds of credulity. Hufeland mentions total abstinence from food for seventeen days, and there is a contemporary case of abstinence for forty days in a maniac who subsisted solely on water and tobacco. Bolsot speaks of abstinence for fourteen months, and Consbruch mentions a girl who fasted eighteen months. Muller mentions an old man of forty-five who lived six weeks on cold water. There is an instance of a person living in a cave twenty-four days without food or drink, and another of a man who survived five weeks' burial under ruins. Ramazzini speaks of fasting sixty-six days; Willian, sixty days (resulting in death); von Wocher, thirty-seven days (associated with tetanus); Lantana, sixty days; Hobbes, forty days; Marcardier, six months; Cruikshank, two months; the Ephemerides, thirteen months; Gerard, sixty-nine days (resulting in death); and in 1722 there was recorded an instance of abstinence lasting twenty-five months. Desbarreaux-Bernard says that Guillaume Granie died in the prison of Toulouse in 1831, after a voluntary suicidal abstinence of sixty-three days. Haller cites a number of examples of long abstinence, but most extraordinary was that of a girl of Confolens, described by Citois of Poitiers, who published a history of the case in the beginning of the seventeenth century. This girl is said to have passed three entire years, from eleven to fourteen, without taking any kind of aliment. In the "Harleian Miscellanies" is a copy of a paper humbly offered to the Royal Society by John Reynolds, containing a discourse upon prodigious abstinence, occasioned by the twelve months' fasting of a woman named Martha Taylor, a damsel of Derbyshire. Plot gives a great variety of curious anecdotes of prolonged abstinence. Ames refers to "the true and admirable history of the maiden of Confolens," mentioned by Haller. In the Annual Register, vol. i., is an account of three persons who were buried five weeks in the snow; and in the same journal, in 1762, is the history of a girl who is said to have subsisted nearly four years on water. In 1684 four miners were buried in a coal-pit in Horstel, a half mile from Liege, Belgium, and lived twenty-four days without food, eventually making good recoveries. An analysis of the water used during their confinement showed an almost total absence of organic matter and only a slight residue of calcium salts. Joanna Crippen lay six days in the snow without nutriment, being overcome by the cold while on the way to her house; she recovered despite her exposure. Somis, physician to the King of Sardinia, gives an account of three women of Piedmont, Italy, who were saved from the ruins of a stable where they had been buried by an avalanche of snow, March 19, 1765. thirty-seven days before. Thirty houses and 22 inhabitants were buried in this catastrophe, and these three women, together with a child of two, were sheltered in a stable over which the snow lodged 42 feet deep. They were in a manger 20 inches broad and upheld by a strong arch. Their enforced position was with their backs to the wall and their knees to their faces. One woman had 15 chestnuts, and, fortunately, there were two goats near by, and within reach some hay, sufficient to feed them for a short time. By milking one of the goats which had a kid, they obtained about two pints daily, upon which they subsisted for a time. They quenched their thirst with melted snow liquefied by the heat of their hands. Their sufferings were greatly increased by the filth, extreme cold, and their uncomfortable positions; their clothes had rotted. When they were taken out their eyes were unable to endure the light and their stomachs at first rejected all food. While returning from Cambridge, February 2, 1799, Elizabeth Woodcock dismounted from her horse, which ran away, leaving her in a violent snowstorm. She was soon overwhelmed by an enormous drift six feet high. The sensation of hunger ceased after the first day and that of thirst predominated, which she quenched by sucking snow. She was discovered on the 10th of February, and although suffering from extensive gangrene of the toes, she recovered. Hamilton says that at a barracks near Oppido, celebrated for its earthquakes, there were rescued two girls, one sixteen and the other eleven; the former had remained under the ruins without food for eleven days. This poor creature had counted the days by a light coming through a small opening. The other girl remained six days under the ruin in a confined and distressing posture, her hands pressing her cheek until they had almost made a hole in it. Two persons were buried under earthquake ruins at Messina for twenty-three and twenty-two days each. Thomas Creaser gives the history of Joseph Lockier of Bath, who, while going through a woods between 6 and 7 P.M., on the 18th of August, was struck insensible by a violent thunderbolt. His senses gradually returned and he felt excessively cold. His clothes were wet, and his feet so swollen that the power of the lower extremities was totally gone and that of the arms was much impaired. For a long time he was unable to articulate or to summon assistance. Early in September he heard some persons in the wood and, having managed to summon them in a feeble voice, told them his story. They declared him to be an impostor and left him. On the evening of the same day his late master came to his assistance and removed him to Swan Inn. He affirmed that during his exposure in the woods he had nothing to eat; though distressing at first, hunger soon subsided and yielded to thirst, which he appeased by chewing grass having beads of water thereon. He slept during the warmth of the day, but the cold kept him awake at night. During his sleep he dreamt of eating and drinking. On November 17, 1806, several surgeons of Bath made an affidavit, in which they stated that this man was admitted to the Bath City Dispensary on September 15th, almost a month after his reputed stroke, in an extremely emaciated condition, with his legs and thighs shriveled as well as motionless. There were several livid spots on his legs and one toe was gangrenous. After some time they amputated the toe. The power in the lower extremities soon returned. In relating his travels in the Levant, Hasselquist mentions 1000 Abyssinians who became destitute of provisions while en route to Cairo, and who lived two months on gum arabic alone, arriving at their destination without any unusual sickness or mortality. Dr. Franklin lived on bread and water for a fortnight, at the rate of ten pounds per week, and maintained himself stout and healthy. Sir John Pringle knew a lady of ninety who lived on pure fat meat. Glower of Chelmsford had a patient who lived ten years on a pint of tea daily, only now or then chewing a half dozen raisins or almonds, but not swallowing them. Once in long intervals she took a little bread. Brassavolus describes a younger daughter of Frederick King of Naples who lived entirely without meat, and could not endure even the taste of it, as often as she put any in her mouth she fell fainting. The monks of Monte Santo (Mount Athos) never touched animal food, but lived on vegetables, olives, end cheese. In 1806 one of them at the age of one hundred and twenty was healthy. Sometimes in the older writings we find records of incredible abstinence. Jonston speaks of a man in 1460 who, after an unfortunate matrimonial experience, lived alone for fifteen years, taking neither food nor drink. Petrus Aponensis cites the instance of a girl fasting for eight years. According to Jonston, Hermolus lived forty years on air alone. This same author has also collected cases of abstinence lasting eleven, twenty-two, and thirty years and cites Aristotle as an authority in substantiating his instances of fasting girls. Wadd, the celebrated authority on corpulence, quotes Pennant in mentioning a woman in Rosshire who lived one and three-quarters years without meat or drink. Granger had under observation a woman by the name of Ann Moore, fifty-eight years of age, who fasted for two years. Fabricius Hildanus relates of Apollonia Schreiera that she lived three years without meat or drink. He also tells of Eva Flegen, who began to fast in 1596, and from that time on for sixteen years, lived without meat or drink. According to the Rev. Thos. Steill, Janet Young fasted sixteen years and partially prolonged her abstinence for fifty years. The Edinburgh Medical and Surgical Journal, which contains a mention of the foregoing case, also describes the case of Janet Macleod, who fasted for four years, showing no signs of emaciation. Benjamin Rush speaks of a case mentioned in a letter to St. George Tucker, from J. A. Stuart, of a man who, after receiving no benefit from a year's treatment for hemiplegia, resolved to starve himself to death. He totally abstained from food for sixty days, living on water and chewing apples, but spitting out the pulp; at the expiration of this time he died. Eccles relates the history of a beautiful young woman of sixteen, who upon the death of a most indulgent father refused food for thirty-four days, and soon afterward for fifty-four days, losing all her senses but that of touch. There is an account of a French adventurer, the Chevalier de Saint-Lubin, who had a loathing for food and abstained from every kind of meat and drink for fifty-eight days. Saint-Sauver, at that time Lieutenant of the Bastille, put a close watch on this man and certified to the verity of the fast. The European Magazine in 1783 contained an account of the Calabria earthquake, at which time a girl of eighteen was buried under ruins for six days. The edge of a barrel fell on her ankle and partly separated it, the dust and mortar effectually stopping the hemorrhage. The foot dropped off and the wound healed without medical assistance, the girl making a complete recovery. There is an account taken from a document in the Vatican of a man living in 1306, in the reign of Pope Clement V, who fasted for two years. McNaughton mentions Rubin Kelsey, a medical student afflicted with melancholia, who voluntarily fasted for fifty-three days, drinking copiously and greedily of water. For the first six weeks he walked about, and was strong to the day of his death. Hammond has proved many of the reports of "fasting girls" to have been untrustworthy. The case of Miss Faucher of Brooklyn, who was supposed to have taken no food for fourteen years, was fraudulent. He says that Ann Moore was fed by her daughter in several ways; when washing her mother's face she used towels wet with gravy, milk, or strong arrow-root meal. She also conveyed food to her mother by means of kisses. One of the "fasting girls," Margaret Weiss, although only ten years old, had such powers of deception that after being watched by the priest of the parish, Dr. Bucoldianus, she was considered free from juggling, and, to everybody's astonishment, she grew, walked, and talked like other children of her age, still maintaining that she used neither food nor drink. In several other cases reported all attempts to discover imposture failed. As we approach more modern times the detection is more frequent. Sarah Jacobs, the Welsh fasting girl who attained such celebrity among the laity, was taken to Guy's Hospital on December 9, 1869, and after being watched by eight experienced nurses for eight days she died of starvation. A postmortem examination of Anna Garbero of Racconis, in Piedmont, who died on May 19, 1828, after having endured a supposed fast of two years, eight months, and eleven days, revealed remarkable intestinal changes. The serous membranes were all callous and thickened, and the canal of the sigmoid flexure was totally obliterated. The mucous membranes were all soft and friable, and presented the appearance of incipient gangrene. Modern Cases.--Turning now to modern literature, we have cases of marvelous abstinence well substantiated by authoritative evidence. Dickson describes a man of sixty-two, suffering from monomania, who refused food for four months, but made a successful recovery. Richardson mentions a case, happening in 1848, of a man of thirty-three who voluntarily fasted for fifty-five days. His reason for fasting, which it was impossible to combat, was that he had no gastric juice and that it was utterly useless for him to take any nutrition, as he had no means of digesting it. He lived on water until the day of his death. Richardson gives an interesting account of the changes noticed at the necropsy. There is an account of a religious mendicant of the Jain caste who as a means of penance fasted for ninety-one days. The previous year he had fasted eighty-six days. He had spent his life in strict asceticism, and during his fasting he was always engrossed in prayer. Collins describes a maiden lady of eighty, always a moderate eater, who was attacked by bronchitis, during which she took food as usual. Two days after her recovery, without any known cause, she refused all food and continued to do so for thirty-three days, when she died. She was delirious throughout this fast and slept daily seven or eight hours. As a rule, she drank about a wineglassful of water each day and her urine was scanty and almost of the consistency of her feces. There is a remarkable case of a girl of seventeen who, suffering with typhoid fever associated with engorgement of the abdomen and suppression of the functions of assimilation, fasted for four months without visible diminution in weight. Pierce reports the history of a woman of twenty-six who fasted for three months and made an excellent recovery. Grant describes the "Market Harborough fasting-girl," a maiden of nineteen, who abstained from food from April, 1874, until December, 1877, although continually using morphia. Throughout her fast she had periodic convulsions, and voided no urine or feces for twelve months before her death. There was a middle-aged woman in England in 1860 who for two years lived on opium, gin, and water. Her chief symptoms were almost daily sickness and epileptic fits three times a week. She was absolutely constipated, and at her death her abdomen was so distended as to present the appearance of ascites. After death, the distention of the abdomen was found to be due to a coating of fat, four inches thick, in the parietes. There was no obstruction to the intestinal canal and no fecal or other accumulation within it. Christina Marshall, a girl of fourteen, went fifteen and one-half months without taking solid nourishment. She slept very little, seldom spoke, but occasionally asked the time of day. She took sweets and water, with beef tea at intervals, and occasionally a small piece of orange. She died April 18, 1882, after having been confined to her bed for a long while. King, a surgeon, U.S.A., gives an account of the deprivation of a squad of cavalry numbering 40. While scouting for Indians on the plains they went for eighty-six hours without water; when relieved their mouths and throats were so dry that even brown sugar would not dissolve on their tongues. Many were delirious, and all had drawn fresh blood from their horses. Despite repeated vomiting, some drank their own urine. They were nearly all suffering from overpowering dyspnea, two were dead, and two were missing. The suffering was increased by the acrid atmosphere of the dry plains; the slightest exercise in this climate provoked a thirst. MacLoughlin, the surgeon in charge of the S.S. City of Chester, speaks of a young stowaway found by the stevedores in an insensible condition after a voyage of eleven days. The man was brought on deck and revived sufficiently to be sent to St. Vincent's Hospital, N.Y., about one and one-half hours after discovery, in an extremely emaciated, cold, and nearly pulseless condition. He gave his name as John Donnelly, aged twenty, of Dumbarton, Scotland. On the whole voyage he had nothing to eat or drink. He had found some salt, of which he ate two handfuls, and he had in his pocket a small flask, empty. Into this flask he voided his urine, and afterward drank it. Until the second day he was intensely hungry, but after that time was consumed by a burning thirst; he shouted four or five hours every day, hoping that he might be heard. After this he became insensible and remembered nothing until he awakened in the hospital where, under careful treatment, he finally recovered. Fodere mentions some workmen who were buried alive fourteen days in a cold, damp cavern under a ruin, and yet all lived. There is a modern instance of a person being buried thirty-two days beneath snow, without food. The Lancet notes that a pig fell off Dover Cliff and was picked up alive one hundred and sixty days after, having been partially imbedded in debris. It was so surrounded by the chalk of the cliff that little motion was possible, and warmth was secured by the enclosing material. This animal had therefore lived on its own fat during the entire period. Among the modern exhibitionists may be mentioned Merlatti, the fasting Italian, and Succi, both of whom fasted in Paris; Alexander Jacques, who fasted fifty days; and the American, Dr. Tanner, who achieved great notoriety by a fast of forty days, during which time he exhibited progressive emaciation. Merlatti, who fasted in Paris in 1886, lost 22 pounds in a month; during his fast of fifty days he drank only pure filtered water. Prior to the fast his farewell meal consisted of a whole fat goose, including the bones, two pounds of roast beef, vegetables for two, and a plate of walnuts, the latter eaten whole. Alexander Jacques fasted fifty days and Succi fasted forty days. Jacques lost 28 pounds and 4 ounces (from 142 pounds, 8 ounces to 114 pounds, 4 ounces), while Succi's loss was 34 pounds and 3 ounces. Succi diminished in height from 65 3/4 to 64 1/2 inches, while Jacques increased from 64 1/2 to 65 1/2 inches. Jacques smoked cigarettes incessantly, using 700 in the fifty days, although, by professional advice, he stopped the habit on the forty-second day. Three or four times a day he took a powder made of herbs to which he naturally attributed his power of prolonging life without food. Succi remained in a room in which he kept the temperature at a very high point. In speaking of Succi's latest feat a recent report says: "It has come to light in his latest attempt to go for fifty days without food that he privately regaled himself on soup, beefsteak, chocolate, and eggs. It was also discovered that one of the 'committee,' who were supposed to watch and see that the experiment was conducted in a bona fide manner, 'stood in' with the faster and helped him deceive the others. The result of the Vienna experiment is bound to cast suspicion on all previous fasting accomplishments of Signor Succi, if not upon those of his predecessors." Although all these modern fasters have been accused of being jugglers and deceivers, throughout their fasts they showed constant decrease in weight, and inspection by visitors was welcomed at all times. They invariably invited medical attention, and some were under the closest surveillance; although we may not implicitly believe that the fasts were in every respect bona fide, yet we must acknowledge that these men displayed great endurance in their apparent indifference for food, the deprivation of which in a normal individual for one day only causes intense suffering. Anomalies of Temperature.--In reviewing the reports of the highest recorded temperatures of the human body, it must be remembered that no matter how good the evidence or how authentic the reference there is always chance for malingering. It is possible to send the index of an ordinary thermometer up to the top in ten or fifteen seconds by rubbing it between the slightly moistened thumb and the finger, exerting considerable pressure at the time. There are several other means of artificially producing enormous temperatures with little risk of detection, and as the sensitiveness of the thermometer becomes greater the easier is the deception. Mackenzie reports the temperature-range of a woman of forty-two who suffered with erysipelatous inflammation of a stump of the leg. Throughout a somewhat protracted illness, lasting from February 20 to April 22, 1879, the temperature many times registered between 108 degrees and 111 degrees F. About a year later she was again troubled with the stump, and this time the temperature reached as high as 114 degrees. Although under the circumstances, as any rational physician would, Mackenzie suspected fraud, he could not detect any method of deception. Finally the woman confessed that she had produced the temperature artificially by means of hot-water bottles, poultices, etc. MacNab records a case of rheumatic fever in which the temperature was 111.4 degrees F. as indicated by two thermometers, one in the axilla and the other in the groin. This high degree of temperature was maintained after death. Before the Clinical Society of London, Teale reported a case in which, at different times, there were recorded temperatures from 110 degrees to 120 degrees F. in the mouth, rectum, and axilla. According to a comment in the Lancet, there was no way that the patient could have artificially produced this temperature, and during convalescence the thermometer used registered normal as well as subnormal temperatures. Caesar speaks of a girl of fifteen with enteric fever, whose temperature, on two occasions 110 degrees F., reached the limit of the mercury in the thermometer. There have been instances mentioned in which, in order to escape duties, prisoners have artificially produced high temperatures, and the same has occasionally been observed among conscripts in the army or navy. There is an account of a habit of prisoners of introducing tobacco into the rectum, thereby reducing the pulse to an alarming degree and insuring their exemption from labor. In the Adelaide Hospital in Dublin there was a case in which the temperature in the vagina and groin registered from 120 degrees to 130 degrees, and one day it reached 130.8 degrees F.; the patient recovered. Ormerod mentions a nervous and hysteric woman of thirty-two, a sufferer with acute rheumatism, whose temperature rose to 115.8 degrees F. She insisted on leaving the hospital when her temperature was still 104 degrees. Wunderlich mentions a case of tetanus in which the temperature rose to 46.40 degrees C. (115.5 degrees F.), and before death it was as high as 44.75 degrees C. Obernier mentions 108 degrees F. in typhoid fever. Kartulus speaks of a child of five, with typhoid fever, who at different times had temperatures of 107 degrees, 108 degrees, and 108.2 degrees F.; it finally recovered. He also quotes a case of pyemia in a boy of seven, whose temperature rose to 107.6 degrees F. He also speaks of Wunderlich's case of remittent fever, in which the temperature reached 107.8 degrees F. Wilson Fox, in mentioning a case of rheumatic fever, says the temperature reached 110 degrees F. Philipson gives an account of a female servant of twenty-three who suffered from a neurosis which influenced the vasomotor nervous system, and caused hysteria associated with abnormal temperatures. On the evening of July 9th her temperature was 112 degrees F.; on the 16th, it was 111 degrees; on the 18th, 112 degrees; on the 24th, 117 degrees (axilla); on the 28th, in the left axilla it was 117 degrees, in the right axilla, 114 degrees, and in the mouth, 112 degrees; on the 29th, it was 115 degrees in the right axilla, 110 degrees in the left axilla, and 116 degrees in the mouth The patient was discharged the following September. Steel of Manchester speaks of a hysteric female of twenty, whose temperature was 116.4 degrees. Mahomed mentions a hysteric woman of twenty-two at Guy's Hospital, London, with phthisis of the left lung, associated with marked hectic fevers. Having registered the limit of the ordinary thermometers, the physicians procured one with a scale reaching to 130 degrees F. She objected to using the large thermometers, saying they were "horse thermometers." On October 15, 1879, however, they succeeded in obtaining a temperature of 128 degrees F. with the large thermometer. In March of the following year she died, and the necropsy revealed nothing indicative of a cause for these enormous temperatures. She was suspected of fraud, and was closely watched in Guy's Hospital, but never, in the slightest way, was she detected in using artificial means to elevate the temperature record. In cases of insolation it is not at all unusual to see a patient whose temperature cannot be registered by an ordinary thermometer. Any one who has been resident at a hospital in which heat-cases are received in the summer will substantiate this. At the Emergency Hospital in Washington, during recent years, several cases have been brought in which the temperatures were above the ordinary registering point of the hospital thermometers, and one of the most extraordinary cases recovered. At a meeting of the Association of American Physicians in 1895, Jacobi of New York reported a case of hyperthermy reaching 148 degrees F. This instance occurred in a profoundly hysteric fireman, who suffered a rather severe injury as the result of a fall between the revolving rods of some machinery, and was rendered unconscious for four days. Thereafter he complained of various pains, bloody expectoration, and had convulsions at varying intervals, with loss of consciousness, rapid respiration, unaccelerated pulse, and excessively high temperature, the last on one occasion reaching the height of 148 degrees F. The temperature was taken carefully in the presence of a number of persons, and all possible precautions were observed to prevent deception. The thermometer was variously placed in the mouth, anus, axilla, popliteal space, groin, urethra, and different instruments were from time to time employed. The behavior of the patient was much influenced by attention and by suggestion. For a period of five days the temperature averaged continuously between 120 degrees and 125 degrees F. In the discussion of the foregoing case, Welch of Baltimore referred to a case that had been reported in which it was said that the temperature reached as high as 171 degrees F. These extraordinary elevations of temperature, he said, appear physically impossible when they are long continued, as they are fatal to the life of the animal cell. In the same connection Shattuck of Boston added that he had observed a temperature of 117 degrees F.; every precaution had been taken to prevent fraud or deception. The patient was a hysteric young woman. Jacobi closed the discussion by insisting that his observations had been made with the greatest care and precautions and under many different circumstances. He had at first viewed the case with skepticism, but he could not doubt the results of his observation. He added, that although we cannot explain anomalies of this kind, this constitutes no reason why we should deny their occurrence. Duffy records one of the lowest temperatures on record in a negress of thirty-five who, after an abortion, showed only 84 degrees F. in the mouth and axillae. She died the next day. The amount of external heat that a human being can endure is sometimes remarkable, and the range of temperature compatible with life is none the less extraordinary. The Esquimaux and the inhabitants of the extreme north at times endure a temperature of--60 degrees F., while some of the people living in equatorial regions are apparently healthy at a temperature as high as 130 degrees F., and work in the sun, where the temperature is far higher. In the engine-rooms of some steamers plying in tropical waters temperatures as high as 150 degrees F. have been registered, yet the engineers and the stokers become habituated to this heat and labor in it without apparent suffering. In Turkish baths, by progressively exposing themselves to graduated temperatures, persons have been able to endure a heat considerably above the boiling point, though having to protect their persons from the furniture and floors and walls of the rooms. The hot air in these rooms is intensely dry, provoking profuse perspiration. Sir Joseph Banks remained some time in a room the temperature of which was 211 degrees F., and his own temperature never mounted above normal. There have been exhibitionists who claimed particular ability to endure intense heats without any visible disadvantage. These men are generally styled "human salamanders," and must not be confounded with the "fire-eaters," who, as a rule, are simply jugglers. Martinez, the so-called "French Salamander," was born in Havana. As a baker he had exposed himself from boyhood to very high temperatures, and he subsequently gave public exhibitions of his extraordinary ability to endure heat. He remained in an oven erected in the middle of the Gardens of Tivoli for fourteen minutes when the temperature in the oven was 338 degrees F. His pulse on entering was 76 and on coming out 130. He often duplicated this feat before vast assemblages, though hardly ever attaining the same degree of temperature, the thermometer generally varying from 250 degrees F. upward. Chamouni was the celebrated "Russian Salamander," assuming the title of "The Incombustible." His great feat was to enter an oven with a raw leg of mutton, not retiring until the meat was well baked. This person eventually lost his life in the performance of this feat; his ashes were conveyed to his native town, where a monument was erected over them. Since the time of these two contemporaneous salamanders there have been many others, but probably none have attained the same notoriety. In this connection Tillet speaks of some servant girls to a baker who for fifteen minutes supported a temperature of 270 degrees F.; for ten minutes, 279 degrees F.; and for several minutes, 364 degrees F., thus surpassing Martinez. In the Glasgow Medical Journal, 1859, there is an account of a baker's daughter who remained twelve minutes in an oven at 274 degrees F. Chantrey, the sculptor, and his workman are said to have entered with impunity a furnace of over 320 degrees F. In some of the savage ceremonies of fire worship the degree of heat endured by the participants is really remarkable, and even if the rites are performed by skilful juggling, nevertheless, the ability to endure intense heat is worthy of comment. A recent report says:-- "The most remarkable ceremonial of fire worship that survives in this country is practiced by the Navajos. They believe in purification by fire, and to this end they literally wash themselves in it. The feats they perform with it far exceed the most wonderful acts of fire-eating and fire-handling accomplished by civilized jugglers. In preparation for the festival a gigantic heap of dry wood is gathered from the desert. At the appointed moment the great pile of inflammable brush is lighted and in a few moments the whole of it is ablaze. Storms of sparks fly 100 feet or more into the air, and ashes fall about like a shower of snow. The ceremony always takes place at night and the effect of it is both weird and impressive. "Just when the fire is raging at its hottest a whistle is heard from the outer darkness and a dozen warriors, lithe and lean, dressed simply in narrow white breech-cloths and moccasins and daubed with white earth so as to look like so many living statues, come bounding through the entrance to the corral that incloses the flaming heap. Yelping like wolves, they move slowly toward the fire, bearing aloft slender wands tipped with balls of eagle-down. Rushing around the fire, always to the left, they begin thrusting their wands toward the fire, trying to burn off the down from the tips. Owing to the intensity of the heat this is difficult to accomplish. One warrior dashes wildly toward the fire and retreats; another lies as close to the ground as a frightened lizard, endeavoring to wriggle himself up to the fire; others seek to catch on their wands the sparks that fly in the air. At last one by one they all succeed in burning the downy balls from the wands. The test of endurance is very severe, the heat of the fire being so great. "The remarkable feats, however, are performed in connection with another dance that follows. This is heralded by a tremendous blowing of horns. The noise grows louder and louder until suddenly ten or more men run into the corral, each of them carrying two thick bundles of shredded cedar bark. "Four times they run around the fire waving the bundles, which are then lighted. Now begins a wild race around the fire, the rapid running causing the brands to throw out long streamers of flames over the hands and arms of the dancers. The latter apply the brands to their own nude bodies and to the bodies of their comrades in front. A warrior will seize the flaming mass as if it were a sponge, and, keeping close to the man he is pursuing, will rub his back with it as if bathing him. The sufferer in turn catches up with the man in front of him and bathes him in flame. From time to time the dancers sponge their own backs with the flaming brands. When a brand is so far consumed that it can no longer be held it is dropped and the dancers disappear from the corral. The spectators pick up the flaming bunches thus dropped and bathe their own hands in the fire. "No satisfactory explanation seems to be obtainable as to the means by which the dancers in this extraordinary performance are able to escape injury. Apparently they do not suffer from any burns. Doubtless some protection is afforded by the earth that is applied to their bodies." Spontaneous combustion of the human body, although doubted by the medical men of this day, has for many years been the subject of much discussion; only a few years ago, among the writers on this subject, there were as many credulous as there were skeptics. There is, however, no reliable evidence to support the belief in the spontaneous combustion of the body. A few apochryphal cases only have been recorded. The opinion that the tissues of drunkards might be so saturated with alcohol as to render the body combustible is disproved by the simple experiment of placing flesh in spirits for a long time and then trying to burn it. Liebig and others found that flesh soaked in alcohol would burn only until the alcohol was consumed. That various substances ignite spontaneously is explained by chemic phenomena, the conditions of which do not exist in the human frame. Watkins in speaking of the inflammability of the human body remarks that on one occasion he tried to consume the body of a pirate given to him by a U. S. Marshal. He built a rousing fire and piled wood on all night, and had not got the body consumed by the forenoon of the following day. Quite a feasible reason for supposed spontaneous human combustion is to be found in several cases quoted by Taylor, in which persons falling asleep, possibly near a fire, have been accidentally ignited, and becoming first stupefied by the smoke, and then suffocated, have been burned to charcoal without awaking. Drunkenness or great exhaustion may also explain certain cases. In substantiation of the possibility of Taylor's instances several prominent physiologists have remarked that persons have endured severe burns during sleep and have never wakened. There is an account of a man who lay down on the top of a lime kiln, which was fired during his sleep, and one leg was burned entirely off without awaking the man, a fact explained by the very slow and gradual increase of temperature. The theories advanced by the advocates of spontaneous human combustion are very ingenious and deserve mention here. An old authority has said: "Our blood is of such a nature, as also our lymph and bile: all of which, when dried by art, flame like spirit of wine at the approach of the least fire and burn away to ashes." Lord Bacon mentions spontaneous combustion, and Marcellus Donatus says that in the time of Godefroy of Bouillon there were people of a certain locality who supposed themselves to have been burning of an invisible fire in their entrails, and he adds that some cut off a hand or a foot when the burning began, that it should go no further. What may have been the malady with which these people suffered must be a matter of conjecture. Overton, in a paper on this subject, remarks that in the "Memoirs of the Royal Society of Paris," 1751, there is related an account of a butcher who, opening a diseased beef, was burned by a flame which issued from the maw of the animal; there was first an explosion which rose to a height of five feet and continued to blaze several minutes with a highly offensive odor. Morton saw a flame emanate from beneath the skin of a hog at the instant of making an incision through it. Ruysch, the famous Dutch physician, remarks that he introduced a hollow bougie into a woman's stomach he had just opened, and he observed a vapor issuing from the mouth of the tube, and this lit on contact with the atmosphere. This is probably an exaggeration of the properties of the hydrogen sulphid found in the stomach. There is an account of a man of forty-three, a gross feeder, who was particularly fond of fats and a victim of psoriasis palmaria, who on going to bed one night, after extinguishing the light in the room, was surprised to find himself enveloped in a phosphorescent halo; this continued for several days and recurred after further indiscretions in diet. It is well known that there are insects and other creatures of the lower animal kingdom which possess the peculiar quality of phosphorescence. There are numerous cases of spontaneous combustion of the human body reported by the older writers. Bartholinus mentions an instance after the person had drunk too much wine. Fouquet mentions a person ignited by lightning. Schrader speaks of a person from whose mouth and fauces after a debauch issued fire. Schurig tells of flames issuing from the vulva, and Moscati records the same occurrence in parturition, Sinibaldust, Borellus, and Bierling have also written on this subject, and the Ephemerides contains a number of instances. In 1763 Bianchini, Prebendary of Verona, published an account of the death of Countess Cornelia Bandi of Cesena, who in her sixty-second year was consumed by a fire kindled in her own body. In explanation Bianchini said that the fire was caused in the entrails by the inflamed effluvia of the blood, by the juices and fermentation in the stomach, and, lastly, by fiery evaporations which exhaled from the spirits of wine, brandy, etc. In the Gentleman's Magazine, 1763, there is recorded an account of three noblemen who, in emulation, drank great quantities of strong liquor, and two of them died scorched and suffocated by a flame forcing itself from the stomach. There is an account of a poor woman in Paris in the last century who drank plentifully of spirits, for three years taking virtually nothing else. Her body became so combustible that one night while lying on a straw couch she was spontaneously burned to ashes and smoke. The evident cause of this combustion is too plain to be commented on. In the Lancet, 1845, there are two cases reported in which shortly before death luminous breath has been seen to issue from the mouth. There is an instance reported of a professor of mathematics of thirty-five years of age and temperate, who, feeling a pain in his left leg, discovered a pale flame about the size of a ten-cent piece issuing therefrom. As recent as March, 1850, in a Court of Assizes in Darmstadt during the trial of John Stauff, accused of the murder of the Countess Goerlitz, the counsel for the defense advanced the theory of spontaneous human combustion, and such eminent doctors as von Siebold, Graff, von Liebig, and other prominent members of the Hessian medical fraternity were called to comment on its possibility; principally on their testimony a conviction and life-imprisonment was secured. In 1870 there was a woman of thirty-seven, addicted to alcoholic liquors, who was found in her room with her viscera and part of her limbs consumed by fire, but the hair and clothes intact. According to Walford, in the Scientific American for 1870, there was a case reported by Flowers of Louisiana of a man a hard drinker, who was sitting by a fire surrounded by his Christmas guests, when suddenly flames of a bluish tint burst from his mouth and nostrils and he was soon a corpse. Flowers states that the body remained extremely warm for a much longer period than usual. Statistics.--From an examination of 28 cases of spontaneous combustion, Jacobs makes the following summary:-- (1) It has always occurred in the human living body. (2) The subjects were generally old persons. (3) It was noticed more frequently in women than in men. (4) All the persons were alone at the time of occurrence. (5) They all led an idle life. (6) They were all corpulent or intemperate. (7) Most frequently at the time of occurrence there was a light and some ignitible substance in the room. (8) The combustion was rapid and was finished in from one to seven hours. (9) The room where the combustion took place was generally filled with a thick vapor and the walls covered with a thick, carbonaceous substance. (10) The trunk was usually the part most frequently destroyed; some part of the head and extremities remained. (11) With but two exceptions, the combustion occurred in winter and in the northern regions. Magnetic, Phosphorescent, and Electric Anomalies.--There have been certain persons who have appeared before the public under such names as the "human magnet," the "electric lady," etc. There is no doubt that some persons are supercharged with magnetism and electricity. For instance, it is quite possible for many persons by drawing a rubber comb through the hair to produce a crackling noise, and even produce sparks in the dark. Some exhibitionists have been genuine curiosities of this sort, while others by skilfully arranged electric apparatus are enabled to perform their feats. A curious case was reported in this country many years ago, which apparently emanates from an authoritative source. On the 25th of January, 1837, a certain lady became suddenly and unconsciously charged with electricity. Her newly acquired power was first exhibited when passing her hand over the face of her brother; to the astonishment of both, vivid electric sparks passed from the ends of each finger. This power continued with augmented force from the 25th of January to the last of February, but finally became extinct about the middle of May of the same year. Schneider mentions a strong, healthy, dark-haired Capuchin monk, the removal of whose head-dress always induced a number of shining, crackling sparks from his hair or scalp. Bartholinus observed a similar peculiarity in Gonzaga, Duke of Mantua. In another case luminous sparks were given out whenever the patient passed urine. Marsh relates two cases of phthisis in which the heads of the patients were surrounded by phosphorescent lights. Kaster mentions an instance in which light was seen in the perspiration and on the body linen after violent exertion. After exertion Jurine, Guyton, and Driessen observed luminous urine passed by healthy persons, and Nasse mentions the same phenomenon in a phthisical patient. Percy and Stokes have observed phosphorescence in a carcinomatous ulcer. There is a description of a Zulu boy exhibited in Edinburgh in 1882 whose body was so charged with electricity that he could impart a shock to any of his patrons. He was about six-and-a-half years of age, bright, happy, and spoke English thoroughly well. From infancy he had been distinguished for this faculty, variable with the state of the atmosphere. As a rule, the act of shaking hands was generally attended by a quivering sensation like that produced by an electric current, and contact with his tongue gave a still sharper shock. Sir Charles Bell has made extensive investigation of the subject of human magnetism and is probably the best authority on the subject, but many celebrated scientists have studied it thoroughly. In the Pittsburg Medical Review there is a description of a girl of three and a half, a blonde, and extremely womanly for her age, who possessed a wonderful magnetic power. Metal spoons would adhere to her finger-tips, nose, or chin. The child, however, could not pick up a steel needle, an article generally very sensitive to the magnet; nor would a penny stick to any portion of her body. Only recently there was exhibited through this country a woman named Annie May Abbott, who styled herself the "Georgia Electric Lady." This person gave exhibitions of wonderful magnetic power, and invited the inspection and discussion of medical men. Besides her chief accomplishment she possessed wonderful strength and was a skilled equilibrist. By placing her hands on the sides of a chair upon which a heavy man was seated, she would raise it without apparent effort. She defied the strongest person in the audience to take from her hand a stick which she had once grasped. Recent reports say that Miss Abbott is amusing herself now with the strong men of China and Japan. The Japanese wrestlers, whose physical strength is celebrated the world over, were unable to raise Miss Abbott from the floor, while with the tips of her fingers she neutralized their most strenuous efforts to lift even light objects, such as a cane, from a table. The possibilities, in this advanced era of electric mechanism, make fraud and deception so easy that it is extremely difficult to pronounce on the genuineness of any of the modern exhibitions of human electricity. The Effects of Cold.--Gmelin, the famous scientist and investigator of this subject, says that man has lived where the temperature falls as low as -157 degrees F. Habit is a marked factor in this endurance. In Russia men and women work with their breasts and arms uncovered in a temperature many degrees below zero and without attention to the fact. In the most rigorous winter the inhabitants of the Alps work with bare breasts and the children sport about in the snow. Wrapping himself in his pelisse the Russian sleeps in the snow. This influence of habit is seen in the inability of intruders in northern lands to endure the cold, which has no effect on the indigenous people. On their way to besiege a Norwegian stronghold in 1719, 7000 Swedes perished in the snows and cold of their neighboring country. On the retreat from Prague in 1742, the French army, under the rigorous sky of Bohemia, lost 4000 men in ten days. It is needless to speak of the thousands lost in Napoleon's campaign in Russia in 1812. Pinel has remarked that the insane are less liable to the effects of cold than their normal fellows, and mentions the escape of a naked maniac, who, without any visible after-effect, in January, even, when the temperature was -4 degrees F., ran into the snow and gleefully rubbed his body with ice. In the French journals in 1814 there is the record of the rescue of a naked crazy woman who was found in the Pyrenees, and who had apparently suffered none of the ordinary effects of cold. Psychologic Effects of Cold.--Lambert says that the mind acts more quickly in cold weather, and that there has been a notion advanced that the emotion of hatred is much stronger in cold weather, a theory exemplified by the assassination of Paul of Russia, the execution of Charles of England, and that of Louis of France. Emotions, such as love, bravery, patriotism, etc., together with diverse forms of excitement, seem to augment the ability of the human body to endure cold. Cold seems to have little effect on the generative function. In both Sweden, Norway, and other Northern countries the families are as large, if not larger, than in other countries. Cold undoubtedly imparts vigor, and, according to DeThou, Henry III lost his effeminacy and love of pleasure in winter and reacquired a spirit of progress and reformation. Zimmerman has remarked that in a rigorous winter the lubberly Hollander is like the gayest Frenchman. Cold increases appetite, and Plutarch says Brutus experienced intense bulimia while in the mountains, barely escaping perishing. With full rations the Greek soldiers under Xenophon suffered intense hunger as they traversed the snow-clad mountains of Armenia. Beaupre remarks that those who have the misfortune to be buried under the snow perish less quickly than those who are exposed to the open air, his observations having been made during the retreat of the French army from Moscow. In Russia it is curious to see fish frozen stiff, which, after transportation for great distances, return to life when plunged into cold water. Sudden death from cold baths and cold drinks has been known for many centuries. Mauriceau mentions death from cold baptism on the head, and Graseccus, Scaliger, Rush, Schenck, and Velschius mention deaths from cold drinks. Aventii, Fabricius Hildanus, the Ephemerides, and Curry relate instances of a fatal issue following the ingestion of cold water by an individual in a superheated condition. Cridland describes a case of sudden insensibility following the drinking of a cold fluid. It is said that Alexander the Great narrowly escaped death from a constrictive spasm, due to the fact that while in a copious sweat he plunged into the river Cydnus. Tissot gives an instance of a man dying at a fountain after a long draught on a hot day. Hippocrates mentions a similar fact, and there are many modern instances. The ordinary effects of cold on the skin locally and the system generally will not be mentioned here, except to add the remark of Captain Wood that in Greenland, among his party, could be seen ulcerations, blisters, and other painful lesions of the skin. In Siberia the Russian soldiers cover their noses and ears with greased paper to protect them against the cold. The Laplanders and Samoiedes, to avoid the dermal lesions caused by cold (possibly augmented by the friction of the wind and beating of snow), anoint their skins with rancid fish oil, and are able to endure temperatures as low as -40 degrees F. In the retreat of the 10,000 Xenophon ordered all his soldiers to grease the parts exposed to the air. Effects of Working in Compressed Air.--According to a writer in Cassier's Magazine, the highest working pressures recorded have been close to 50 pounds per square inch, but with extreme care in the selection of men, and corresponding care on the part of the men, it is very probable that this limit may be considerably exceeded. Under average conditions the top limit may be placed at about 45 pounds, the time of working, according to conditions, varying from four to six hours per shift. In the cases in which higher pressures might be used, the shifts for the men should be restricted to two of two hours each, separated by a considerable interval. As an example of heavy pressure work under favorable conditions as to ventilation, without very bad effects on the men, Messrs. Sooysmith & Company had an experience with a work on which men were engaged in six-hour shifts, separated into two parts by half-hour intervals for lunch. This work was excavation in open, seamy rock, carried on for several weeks under about 45 pounds pressure. The character of the material through which the caisson is being sunk or upon which it may be resting at any time bears quite largely upon the ability of the men to stand the pressure necessary to hold back the water at that point. If the material be so porous as to permit a considerable leakage of air through it, there will naturally result a continuous change of air in the working chamber, and a corresponding relief of the men from the deleterious effects which are nearly always produced by over-used air. From Strasburg in 1861 Bucuoy reports that during the building of a bridge at Kehl laborers had to work in compressed air, and it was found that the respirations lost their regularity; there were sometimes intense pains in the ears, which after a while ceased. It required a great effort to speak at 2 1/2 atmospheres, and it was impossible to whistle. Perspiration was very profuse. Those who had to work a long time lost their appetites, became emaciated, and congestion of the lung and brain was observed. The movements of the limbs were easier than in normal air, though afterward muscular and rheumatic pains were often observed. The peculiar and extraordinary development of the remaining special senses when one of the number is lost has always been a matter of great interest. Deaf people have always been remarkable for their acuteness of vision, touch, and smell. Blind persons, again, almost invariably have the sense of hearing, touch, and what might be called the senses of location and temperature exquisitely developed. This substitution of the senses is but; an example of the great law of compensation which we find throughout nature. Jonston quotes a case in the seventeenth century of a blind man who, it is said, could tell black from white by touch alone; several other instances are mentioned in a chapter entitled "De compensatione naturae monstris facta." It must, however, be held impossible that blind people can thus distinguish colors in any proper sense of the words. Different colored yarns, for example, may have other differences of texture, etc., that would be manifest to the sense of touch. We know of one case in which the different colors were accurately distinguished by a blind girl, but only when located in customary and definite positions. Le Cat speaks of a blind organist, a native of Holland, who still played the organ as well as ever. He could distinguish money by touch, and it is also said that he made himself familiar with colors. He was fond of playing cards, but became such a dangerous opponent, because in shuffling he could tell what cards and hands had been dealt, that he was never allowed to handle any but his own cards. It is not only in those who are congenitally deficient in any of the senses that the remarkable examples of compensation are seen, but sometimes late in life these are developed. The celebrated sculptor, Daniel de Volterre, became blind after he had obtained fame, and notwithstanding the deprivation of his chief sense he could, by touch alone, make a statue in clay after a model. Le Cat also mentions a woman, perfectly deaf, who without any instruction had learned to comprehend anything said to her by the movements of the lips alone. It was not necessary to articulate any sound, but only to give the labial movements. When tried in a foreign language she was at a loss to understand a single word. Since the establishment of the modern high standard of blind asylums and deaf-and-dumb institutions, where so many ingenious methods have been developed and are practiced in the education of their inmates, feats which were formerly considered marvelous are within the reach of all those under tuition To-day, those born deaf-mutes are taught to speak and to understand by the movements of the lips alone, and the blind read, become expert workmen, musicians, and even draughtsmen. D. D. Wood of Philadelphia, although one of the finest organists in the country, has been totally blind for years. It is said that he acquires new compositions with almost as great facility as one not afflicted with his infirmity. "Blind Tom," a semi-idiot and blind negro achieved world-wide notoriety by his skill upon the piano. In some extraordinary cases in which both sight and hearing, and sometimes even taste and smell, are wanting, the individuals in a most wonderful way have developed the sense of touch to such a degree that it almost replaces the absent senses. The extent of this compensation is most beautifully illustrated in the cases of Laura Bridgman and Helen Keller. No better examples could be found of the compensatory ability of differentiated organs to replace absent or disabled ones. Laura Dewey Bridgman was born December 21, 1829, at Hanover, N.H. Her parents were farmers and healthy people. They were of average height, regular habits, slender build, and of rather nervous dispositions. Laura inherited the physical characteristics of her mother. In her infancy she was subject to convulsions, but at twenty months had improved, and at this time had learned to speak several words. At the age of two years, in common with two of the other children of the family, she had an attack of severe scarlet fever. Her sisters died, and she only recovered after both eyes and ears had suppurated; taste and smell were also markedly impaired. Sight in the left eye was entirely abolished, but she had some sensation for large, bright objects in the right eye up to her eighth year; after that time she became totally blind. After her recovery it was two years before she could sit up all day, and not until she was five years old had she entirely regained her strength. Hearing being lost, she naturally never developed any speech; however, she was taught to sew, knit, braid, and perform several other minor household duties. In 1837 Dr. S. W. Howe, the Director of the Massachusetts Asylum for the Blind, took Laura in charge, and with her commenced the ordinary deaf-mute education. At this time she was seven years and ten months old. Two years later she had made such wonderful progress and shown such ability to learn that, notwithstanding her infirmities, she surpassed any of the pupils of her class. Her advancement was particularly noticed immediately after her realization that an idea could be expressed by a succession of raised letters. In fact, so rapid was her progress, that it was deemed advisable by the authorities to hold her back. By her peculiar sensibility to vibration she could distinguish the difference between a whole and a half note in music, and she struck the notes on the piano quite correctly. During the first years of her education she could not smell at all, but later she could locate the kitchen by this sense. Taste had developed to such an extent that at this time she could distinguish the different degrees of acidity. The sense of touch, however, was exceedingly delicate and acute. As to her moral habits, cleanliness was the most marked. The slightest dirt or rent in her clothes caused her much embarrassment and shame, and her sense of order, neatness, and propriety was remarkable. She seemed quite at home and enjoyed the society of her own sex, but was uncomfortable and distant in the society of males. She quickly comprehended the intellectual capacity of those with whom she was associated, and soon showed an affiliation for the more intelligent of her friends. She was quite jealous of any extra attention shown to her fellow scholars, possibly arising from the fact that she had always been a favorite. She cried only from grief, and partially ameliorated bodily pain by jumping and by other excessive muscular movements. Like most mutes, she articulated a number of noises,--50 or more, all monosyllabic; she laughed heartily, and was quite noisy in her play. At this time it was thought that she had been heard to utter the words doctor, pin, ship, and others. She attached great importance to orientation, and seemed quite ill at ease in finding her way about when not absolutely sure of directions. She was always timid in the presence of animals, and by no persuasion could she be induced to caress a domestic animal. In common with most maidens, at sixteen she became more sedate, reserved and thoughtful; at twenty she had finished her education. In 1878 she was seen by G. Stanley Hall, who found that she located the approach and departure of people through sensation in her feet, and seemed to have substituted the cutaneous sense of vibration for that of hearing. At this time she could distinguish the odors of various fragrant flowers and had greater susceptibility to taste, particularly to sweet and salty substances. She had written a journal for ten years, and had also composed three autobiographic sketches, was the authoress of several poems, and some remarkably clever letters. She died at the Perkins Institute, May 24, 1889, after a life of sixty years, burdened with infirmities such as few ever endure, and which, by her superior development of the remnants of the original senses left her, she had overcome in a degree nothing less than marvelous. According to a well-known observer, in speaking of her mental development, although she was eccentric she was not defective. She necessarily lacked certain data of thought, but even this feet was not very marked, and was almost counterbalanced by her exceptional power of using what remained. In the present day there is a girl as remarkable as Laura Bridgman, and who bids fair to attain even greater fame by her superior development. This girl, Helen Keller, is both deaf and blind; she has been seen in all the principal cities of the United States, has been examined by thousands of persons, and is famous for her victories over infirmities. On account of her wonderful power of comprehension special efforts have been made to educate Helen Keller, and for this reason her mind is far more finely developed than in most girls of her age. It is true that she has the advantage over Laura Bridgman in having the senses of taste and smell, both of which she has developed to a most marvelous degree of acuteness. It is said that by odor alone she is always conscious of the presence of another person, no matter how noiseless his entrance into the room in which she may be. She cannot be persuaded to take food which she dislikes, and is never deceived in the taste. It is, however, by the means of what might be called "touch-sight" that the most miraculous of her feats are performed. By placing her hands on the face of a visitor she is able to detect shades of emotion which the normal human eye fails to distinguish, or, in the words of one of her lay observers, "her sense of touch is developed to such an exquisite extent as to form a better eye for her than are yours or mine for us; and what is more, she forms judgments of character by this sight." According to a recent report of a conversation with one of the principals of the school in which her education is being completed, it is said that since the girl has been under his care he has been teaching her to sing with great success. Placing the fingers of her hands on the throat of a singer, she is able to follow notes covering two octaves with her own voice, and sings synchronously with her instructor. The only difference between her voice and that of a normal person is in its resonant qualities. So acute has this sense become, that by placing her hand upon the frame of a piano she can distinguish two notes not more than half a tone apart. Helen is expected to enter the preparatory school for Radcliffe College in the fall of 1896. At a meeting of the American Association to Promote the Teaching of Speech to the Deaf, in Philadelphia, July, 1896, this child appeared, and in a well-chosen and distinct speech told the interesting story of her own progress. Miss Sarah Fuller, principal of the Horace Mann School for the Deaf, Boston, is credited with the history of Helen Keller, as follows:-- "Helen Keller's home is in Tuscumbia, Ala. At the age of nineteen months she became deaf, dumb, and blind after convulsions lasting three days. Up to the age of seven years she had received no instruction. Her parents engaged Miss Sullivan of the Perkins Institute for the Blind, South Boston, to go to Alabama as her teacher. She was familiar with methods of teaching the blind, but knew nothing about instructing deaf children. Miss Sullivan called upon Miss Fuller for some instruction on the subject. Miss Fuller was at that time experimenting with two little deaf girls to make them speak as hearing children do, and called Miss Sullivan's attention to it. Miss Sullivan left for her charge, and from time to time made reports to Dr. Anagnos the principal of the Perkins School, which mentioned the remarkable mind which she found this little Alabama child possessed. The following year Miss Sullivan brought the child, then eight years old, to Boston, and Mrs. Keller came with her. They visited Miss Fuller's school. Miss Sullivan had taught the child the manual alphabet, and she had obtained much information by means of it. Miss Fuller noticed how quickly she appreciated the ideas given to her in that way. "It is interesting to note that before any attempt had been made to teach the child to speak or there had been any thought of it, her own quickness of thought had suggested it to her as she talked by hand alphabet to Miss Fuller. Her mother, however, did not approve Miss Fuller's suggestion that an attempt should be made to teach her speech. She remained at the Perkins School, under Miss Sullivan's charge, another year, when the matter was brought up again, this time by little Helen herself, who said she must speak. Miss Sullivan brought her to Miss Fuller's school one day and she received her first lesson, of about two hours' length. "The child's hand was first passed over Miss Fuller's face, mouth, and neck, then into her mouth, touching the tongue, teeth, lips, and hard palate, to give her an idea of the organs of speech. Miss Fuller then arranged her mouth, tongue, and teeth for the sound of i as in it. She took the child's finger and placed it upon the windpipe so that she might feel the vibration there, put her finger between her teeth to show her how wide apart they were, and one finger in the mouth to feel the tongue, and then sounded the vowel. The child grasped the idea at once. Her fingers flew to her own mouth and throat, and she produced the sound so nearly accurate that it sounded like an echo. Next the sound of ah was made by dropping the jaw a little and letting the child feel that the tongue was soft and lying in the bed of the jaw with the teeth more widely separated. She in the same way arranged her own, but was not so successful as at first, but soon produced the sound perfectly." "Eleven such lessons were given, at intervals of three or four days, until she had acquired all the elements of speech, Miss Sullivan in the meantime practicing with the child on the lessons received. The first word spoken was arm, which was at once associated with her arm; this gave her great delight. She soon learned to pronounce words by herself, combining the elements she had learned, and used them to communicate her simple wants. The first connected language she used was a description she gave Miss Fuller of a visit she had made to Dr. Oliver Wendell Holmes, in all over 200 words. They were, all but two or three, pronounced correctly. She now, six years afterward, converses quite fluently with people who know nothing of the manual alphabet by placing a couple of fingers on the speaker's lips, her countenance showing great intentness and brightening as she catches the meaning. Anybody can understand her answers." In a beautiful eulogy of Helen Keller in a recent number of Harper's Magazine, Charles Dudley Warner expresses the opinion that she is the purest-minded girl of her age in the world. Edith Thomas, a little inmate of the Perkins Institute for the Blind, at South Boston, is not only deaf and dumb but also blind. She was a fellow-pupil with Helen Keller, and in a measure duplicated the rapid progress of her former playmate. In commenting on progress in learning to talk the Boston Herald says: "And as the teacher said the word 'Kitty' once or twice she placed the finger-tips of one hand upon the teacher's lips and with the other hand clasped tightly the teacher's throat; then, guided by the muscular action of the throat and the position of the teeth, tongue, and lips, as interpreted by that marvelous and delicate touch of hers, she said the word 'Kitty' over and over again distinctly in a very pretty way. She can be called dumb no longer, and before the summer vacation comes she will have mastered quite a number of words, and such is her intelligence and patience, in spite of the loss of three senses, she may yet speak quite readily. "Her history is very interesting. She was born in Maplewood, and up to the time of contracting diphtheria and scarlet fever, which occurred when she was four years old, had been a very healthy child of more than ordinary quickness and ability. She had attained a greater command of language than most children of her age. What a contrast between these 'other days,' as she calls them, and the days which followed, when hearing and sight were completely gone, and gradually the senses of speech and smell went, too! After the varied instruction of the blind school the little girl had advanced so far as to make the rest of her study comparatively easy. The extent of her vocabulary is not definitely known, but it numbers at least 700 words. Reading, which was once an irksome task, has become a pleasure to her. Her ideas of locality and the independence of movement are remarkable, and her industry and patience are more noticeable from day to day. She has great ability, and is in every respect a very wonderful child." According to recent reports, in the vicinity of Rothesay, on the Clyde, there resides a lady totally deaf and dumb, who, in point of intelligence, scholarship, and skill in various ways, far excels many who have all their faculties. Having been educated partly in Paris, she is a good French scholar, and her general composition is really wonderful. She has a shorthand system of her own, and when writing letters, etc., she uses a peculiar machine, somewhat of the nature of a typewriter. Among the deaf persons who have acquired fame in literature and the arts have been Dibil Alkoffay, an Arabian poet of the eighth century; the tactician, Folard; the German poet, Engelshall; Le Sage; La Condamine, who composed an epigram on his own infirmity; and Beethoven, the famous musician. Fernandez, a Spanish painter of the sixteenth century, was a deaf-mute. All the world pities the blind, but despite their infirmities many have achieved the highest glory in every profession. Since Homer there have been numerous blind poets. Milton lost none of his poetic power after he had become blind. The Argovienne, Louise Egloff, and Daniel Leopold, who died in 1753, were blind from infancy. Blacklock, Avisse, Koslov, and La Mott-Houdart are among other blind poets. Asconius Pedianus, a grammarian of the first century; Didyme, the celebrated doctor of Alexandria; the Florentine, Bandolini, so well versed in Latin poetry; the celebrated Italian grammarian, Pontanus; the German, Griesinger, who spoke seven languages; the philologist, Grassi, who died in 1831, and many others have become blind at an age more or less advanced in their working lives. Probably the most remarkable of the blind scientists was the Englishman, Saunderson, who in 1683, in his first year, was deprived of sight after an attack of small-pox. In spite of his complete blindness he assiduously studied the sciences, and graduated with honor at the University of Cambridge in mathematics and optics. His sense of touch was remarkable. He had a collection of old Roman medals, all of which, without mistake, he could distinguish by their impressions. He also seemed to have the ability to judge distance, and was said to have known how far he had walked, and by the velocity he could even tell the distance traversed in a vehicle. Among other blind mathematicians was the Dutchman, Borghes (died in 1652); the French astronomer, the Count de Pagan, who died in 1655; Galileo; the astronomer, Cassini, and Berard, who became blind at twenty-three years, and was for a long time Professor of Mathematics at the College of Briancon. In the seventeenth century the sculptor, Jean Gonnelli, born in Tuscany, became blind at twenty years; but in spite of his infirmity he afterward executed what were regarded as his masterpieces. It is said that he modeled a portrait of Pope Urban VIII, using as a guide his hand, passed from time to time over the features. Lomazzo, the Italian painter of the eighteenth century, is said to have continued his work after becoming blind. Several men distinguished for their bravery and ability in the art of war have been blind. Jean de Troczow, most commonly known by the name of Ziska, in 1420 lost his one remaining eye, and was afterward known as the "old blind dog," but, nevertheless, led his troops to many victories. Froissart beautifully describes the glorious death of the blind King of Bohemia at the battle of Crecy in 1346. Louis III, King of Provence; Boleslas III, Duke of Bohemia; Magnus IV, King of Norway, and Bela II, King of Hungary, were blind. Nathaniel Price, a librarian of Norwich in the last century, lost his sight in a voyage to America, which, however, did not interfere in any degree with his duties, for his books were in as good condition and their location as directly under his knowledge, during his blindness as they were in his earlier days. At the present day in New York there is a blind billiard expert who occasionally gives exhibitions of his prowess. Feats of Memory.--From time to time there have been individuals, principally children, who gave wonderful exhibitions of memory, some for dates, others for names, and some for rapid mental calculation. Before the Anthropological Society in 1880 Broca exhibited a lad of eleven, a Piedmontese, named Jacques Inaudi. This boy, with a trick monkey, had been found earning his livelihood by begging and by solving mentally in a few minutes the most difficult problems in arithmetic. A gentleman residing in Marseilles had seen him while soliciting alms perform most astonishing feats of memory, and brought him to Paris. In the presence of the Society Broca gave him verbally a task in multiplication, composed of some trillions to be multiplied by billions. In the presence of all the members he accomplished his task in less than ten minutes, and without the aid of pencil and paper, solving the whole problem mentally. Although not looking intelligent, and not being able to read or write, he perhaps could surpass any one in the world in his particular feat. It was stated that he proceeded from left to right in his calculations, instead of from right to left in the usual manner. In his personal appearance the only thing indicative of his wonderful abilities was his high forehead. An infant prodigy named Oscar Moore was exhibited to the physicians of Chicago at the Central Music Hall in 1888, and excited considerable comment at the time. The child was born of mulatto parents at Waco, Texas, on August 19, 1885, and when only thirteen months old manifested remarkable mental ability and precocity. S. V. Clevenger, a physician of Chicago, has described the child as follows:-- "Oscar was born blind and, as frequently occurs in such cases, the touch-sense compensatingly developed extraordinarily. It was observed that after touching a person once or twice with his stubby baby fingers, he could thereafter unfailingly recognize and call by name the one whose hand he again felt. The optic sense is the only one defective, for tests reveal that his hearing, taste, and smell are acute, and the tactile development surpasses in refinement. But his memory is the most remarkable peculiarity, for when his sister conned her lessons at home, baby Oscar, less than two years old, would recite all he heard her read. Unlike some idiot savants, in which category he is not to be included, who repeat parrot-like what they have once heard, baby Oscar seems to digest what he hears, and requires at least more than one repetition of what he is trying to remember, after which he possesses the information imparted and is able to yield it at once when questioned. It is not necessary for him to commence at the beginning, as the possessors of some notable memories were compelled to do, but he skips about to any required part of his repertoire. "He sings a number of songs and counts in different languages, but it is not supposable that he understands every word he utters. If, however, his understanding develops as it promises to do, he will become a decided polyglot. He has mastered an appalling array of statistics, such as the areas in square miles of hundreds of countries, the population of the world's principal cities, the birthdays of all the Presidents, the names of all the cities of the United States of over 10,000 inhabitants, and a lot of mathematical data. He is greatly attracted by music, and this leads to the expectation that when more mature he may rival Blind Tom. "In disposition he is very amiable, but rather grave beyond his years. He shows great affection for his father, and is as playful and as happy as the ordinary child. He sleeps soundly, has a good childish appetite, and appears to be in perfect health. His motions are quick but not nervous, and are as well coordinated as in a child of ten. In fact, he impresses one as having the intelligence of a much older child than three years (now five years), but his height, dentition, and general appearance indicate the truthfulness of the age assigned. An evidence of his symmetrical mental development appears in his extreme inquisitiveness. He wants to understand the meaning of what he is taught, and some kind of an explanation must be given him for what he learns. Were his memory alone abnormally great and other faculties defective, this would hardly be the case; but if so, it cannot at present be determined. "His complexion is yellow, with African features, flat nose, thick lips but not prognathous, superciliary ridges undeveloped, causing the forehead to protrude a little. His head measures 19 inches in circumference, on a line with the upper ear-tips, the forehead being much narrower than the occipitoparietal portion, which is noticeably very wide. The occiput protrudes backward, causing a forward sweep of the back of the neck. From the nose-root to the nucha over the head he measures 13 1/2 inches, and between upper ear-tips across and over the head 11 inches, which is so close to the eight-and ten-inch standard that he may be called mesocephalic. The bulging in the vicinity of the parietal region accords remarkably with speculations upon the location of the auditory memory in that region, such as those in the American Naturalist, July, 1888, and the fact that injury of that part of the brain may cause loss of memory of the meaning of words. It may be that the premature death of the mother's children has some significance in connection with Oscar's phenomenal development. There is certainly a hypernutrition of the parietal brain with atrophy of the optic tract, both of which conditions could arise from abnormal vascular causes, or the extra growth of the auditory memory region may have deprived of nutrition, by pressure, the adjacent optic centers in the occipital brain. The otherwise normal motion of the eyes indicates the nystagmus to be functional. "Sudden exaltation of the memory is often the consequence of grave brain disease, and in children this symptom is most frequent. Pritchard, Rush, and other writers upon mental disorders record interesting instances of remarkable memory-increase before death, mainly in adults, and during fever and insanity. In simple mania the memory is often very acute. Romberg tells of a young girl who lost her sight after an attack of small-pox, but acquired an extraordinary memory. He calls attention to the fact that the scrofulous and rachitic diatheses in childhood are sometimes accompanied by this disorder. Winslow notes that in the incipient state of the brain disease of early life connected with fevers, disturbed conditions of the cerebral circulation and vessels, and in affections of advanced life, there is often witnessed a remarkable exaltation of the memory, which may herald death by apoplexy. "Not only has the institution of intelligence in idiots dated from falls upon the head, but extra mentality has been conferred by such an event Pritchard tells of three idiot brothers, one of whom, after a severe head injury, brightened up and became a barrister, while his brothers remained idiotic. 'Father Mabillon,' says Winslow, 'is said to have been an idiot until twenty-six years of age, when he fractured his skull against a stone staircase. He was trepanned. After recovering, his intellect fully developed itself in a mind endowed with a lively imagination, an amazing memory, and a zeal for study rarely equaled.' Such instances can be accounted for by the brain having previously been poorly nourished by a defective blood supply, which defect was remedied by the increased circulation afforded by the head-injury. "It is a commonly known fact that activity of the brain is attended with a greater head-circulation than when the mind is dull, within certain limits. Anomalous development of the brain through blood-vessels, affording an extra nutritive supply to the mental apparatus, can readily be conceived as occurring before birth, just as aberrant nutrition elsewhere produces giants from parents of ordinary size. "There is but one sense-defect in the child Oscar, his eyesight-absence, and that is atoned for by his hearing and touch-acuteness, as it generally is in the blind. Spitzka and others demonstrate that in such cases other parts of the brain enlarge to compensate for the atrophic portion which is connected with the functionless nerves. This, considered with his apparently perfect, mental and physical health, leaves no reason to suppose that Oscar's extravagant memory depends upon disease any more than we can suspect all giants of being sickly, though the anomaly is doubtless due to pathologic conditions. Of course, there is no predicting what may develop later in his life, but in any event science will be benefited. "It is a popular idea that great vigor of memory is often associated with low-grade intelligence, and cases such as Blind Tom and other 'idiot savants,' who could repeat the contents of a newspaper after a single reading, justify the supposition. Fearon, on 'Mental Vigor,' tells of a man who could remember the day that every person had been buried in the parish for thirty-five years, and could repeat with unvarying accuracy the name and age of the deceased and the mourners at the funeral. But he was a complete fool. Out of the line of burials he had not one idea, could not give an intelligible reply to a single question, nor be trusted even to feed himself. While memory-development is thus apparent in some otherwise defective intellects, it has probably as often or oftener been observed to occur in connection with full or great intelligence. Edmund Burke, Clarendon, John Locke, Archbishop Tillotson, and Dr. Johnson were all distinguished for having great strength of memory. Sir W. Hamilton observed that Grotius, Pascal, Leibnitz, and Euler were not less celebrated for their intelligence than for their memory. Ben Jonson could repeat all that he had written and whole books he had read. Themistocles could call by name the 20,000 citizens of Athens. Cyrus is said to have known the name of every soldier in his army. Hortensius, a great Roman orator, and Seneca had also great memories. Niebuhr, the Danish historian, was remarkable for his acuteness of memory. Sir James Mackintosh, Dugald Stewart, and Dr. Gregory had similar reputations. "Nor does great mental endowment entail physical enfeeblement; for, with temperance, literary men have reached extreme old age, as in the cases of Klopstock, Goethe, Chaucer, and the average age attained by all the signers of the American Declaration of Independence was sixty-four years, many of them being highly gifted men intellectually. Thus, in the case of the phenomenal Oscar it cannot be predicted that he will not develop, as he now promises to do, equal and extraordinary powers of mind, even though it would be rare in one of his racial descent, and in the face of the fact that precocity gives no assurance of adult brightness, for it can be urged that John Stuart Mill read Greek when four years of age. "The child is strumous, however, and may die young. His exhibitors, who are coining him into money, should seek the best medical care for him and avoid surcharging his memory with rubbish. Proper cultivation of his special senses, especially the tactile, by competent teachers, will give Oscar the best chance of developing intellectually and acquiring an education in the proper sense of the word." By long custom many men of letters have developed wonderful feats of memory; and among illiterate persons, by means of points of association, the power of memory has been little short of marvelous. At a large hotel in Saratoga there was at one time a negro whose duty was to take charge of the hats and coats of the guests as they entered the dining-room and return to each his hat after the meal. It was said that, without checks or the assistance of the owners, he invariably returned the right articles to the right persons on request, and no matter how large the crowd, his limit of memory never seemed to be reached. Many persons have seen expert players at draughts and chess who, blindfolded, could carry on numerous games with many competitors and win most of the matches. To realize what a wonderful feat of memory this performance is, one need only see the absolute exhaustion of one of these men after a match. In whist, some experts have been able to detail the succession of the play of the cards so many hands back that their competitors had long since forgotten it. There is reported to be in Johnson County, Missouri, a mathematical wonder by the name of Rube Fields. At the present day he is between forty and fifty years of age, and his external appearance indicates poverty as well as indifference. His temperament is most sluggish; he rarely speaks unless spoken to, and his replies are erratic. The boyhood of this strange character was that of an overgrown country lout with boorish manners and silly mind. He did not and would not go to school, and he asserts now that if he had done so he "would have become as big a fool as other people." A shiftless fellow, left to his own devices, he performed some wonderful feats, and among the many stories connected with this period of his life is one which describes how he actually ate up a good-sized patch of sugar cane, simply because he found it good to his taste. Yet from this clouded, illiterate mind a wonderful mathematical gift shines. Just when he began to assert his powers is not known; but his feats have been remembered for twenty years by his neighbors. A report says:-- "Give Rube Fields the distance by rail between any two points, and the dimensions of a car-wheel, and almost as soon as the statement has left your lips he will tell you the number of revolutions the wheel will make in traveling over the track. Call four or five or any number of columns of figures down a page, and when you have reached the bottom he will announce the sum. Given the number of yards or pounds of articles and the price, and at once he will return the total cost--and this he will do all day long, without apparent effort or fatigue. "A gentleman relates an instance of Fields' knowledge of figures. After having called several columns of figures for addition, he went back to the first column, saying that it was wrong, and repeating it, purposely miscalling the next to the last figure. At once Fields threw up his hand, exclaiming: 'You didn't call it that way before.' "Fields' answers come quick and sharp, seemingly by intuition. Calculations which would require hours to perform are made in less time than it takes to state the question. The size of the computations seems to offer no bar to their rapid solution, and answers in which long lines of figures are reeled off come with perfect ease. In watching the effort put forth in reaching an answer, there would seem to be some process going on in the mind, and an incoherent mumbling is often indulged in, but it is highly probable that Fields does not himself know how he derives his answers. Certain it is that he is unable to explain the process, nor has any one ever been able to draw from him anything concerning it. Almost the only thing he knows about the power is that he possesses it, and, while he is not altogether averse to receiving money for his work, he has steadily refused to allow himself to be exhibited." In reviewing the peculiar endowment of Fields, the Chicago Record says:-- "How this feat is performed is as much a mystery as the process by which he solves a problem in arithmetic. He answers no questions. Rapid mathematicians, men of study, who by intense application and short methods have become expert, have sought to probe these two mysteries, but without results. Indeed, the man's intelligence is of so low an order as to prevent him from aiding those who seek to know. With age, too, he grows more surly. Of what vast value this 'gift' might be to the world of science, if coupled with average intelligence, is readily imagined. That it will ever be understood is unlikely. As it is, the power staggers belief and makes modern psychology, with its study of brain-cells, stand aghast. As to poor Fields himself, he excites only sympathy. Homeless, unkempt, and uncouth, traveling aimlessly on a journey which he does not understand, he hugs to his heart a marvelous power, which he declares to be a gift from God. To his weak mind it lifts him above his fellow-men, and yet it is as useless to the world as a diamond in a dead man's hand." Wolf-Children.--It is interesting to know to what degree a human being will resemble a beast when deprived of the association with man. We seem to get some insight to this question in the investigation of so called cases of "wolf-children." Saxo Grammaticus speaks of a bear that kidnapped a child and kept it a long time in his den. The tale of the Roman she-wolf is well known, and may have been something more than a myth, as there have been several apparently authentic cases reported in which a child has been rescued from its associations with a wolf who had stolen it some time previously. Most of the stories of wolf-children come from India. According to Oswald in Ball's "Jungle Life in India," there is the following curious account of two children in the Orphanage of Sekandra, near Agra, who had been discovered among wolves: "A trooper sent by a native Governor of Chandaur to demand payment of some revenue was passing along the bank of the river about noon when he saw a large female wolf leave her den, followed by three whelps and a little boy. The boy went on all-fours, and when the trooper tried to catch him he ran as fast as the whelps, and kept up with the old one. They all entered the den, but were dug out by the people and the boy was secured. He struggled hard to rush into every hole or gully they came near. When he saw a grown-up person he became alarmed, but tried to fly at children and bite them. He rejected cooked meat with disgust, but delighted in raw flesh and bones, putting them under his paws like a dog." The other case occurred at Chupra, in the Presidency of Bengal. In March, 1843, a Hindoo mother went out to help her husband in the field, and while she was cutting rice her little boy was carried off by a wolf. About a year afterward a wolf, followed by several cubs and a strange, ape-like creature, was seen about ten miles from Chupra. After a lively chase the nondescript was caught and recognized (by the mark of a burn on his knee) as the Hindoo boy that had disappeared in the rice-field. This boy would not eat anything but raw flesh, and could never be taught to speak, but expressed his emotions in an inarticulate mutter. His elbows and the pans of his knees had become horny from going on all-fours with his foster mother. In the winter of 1850 this boy made several attempts to regain his freedom, and in the following spring he escaped for good and disappeared in the jungle-forest of Bhangapore. The Zoologist for March, 1888, reproduced a remarkable pamphlet printed at Plymouth in 1852, which had been epitomized in the Lancet. This interesting paper gives an account of wolves nurturing small children in their dens. Six cases are given of boys who have been rescued from the maternal care of wolves. In one instance the lad was traced from the moment of his being carried off by a lurking wolf while his parents were working in the field, to the time when, after having been recovered by his mother six years later, he escaped from her into the jungle. In all these cases certain marked features reappear. In the first, the boy was very inoffensive, except when teased, and then he growled surlily. He would eat anything thrown to him, but preferred meat, which he devoured with canine voracity. He drank a pitcher of buttermilk at one gulp, and could not be induced to wear clothing even in the coldest weather. He showed the greatest fondness for bones, and gnawed them contentedly, after the manner of his adopted parents. This child had coarse features, a repulsive countenance, was filthy in his habits, and could not articulate a word. In another case the child was kidnapped at three and recovered at nine. He muttered, but could not articulate. As in the other case, he could not be enticed to wear clothes. From constantly being on all-fours the front of this child's knees and his elbows had become hardened. In the third case the father identified a son who had been carried away at the age of six, and was found four years afterward. The intellectual deterioration was not so marked. The boy understood signs, and his hearing was exceedingly acute; when directed by movements of the hands to assist the cultivators in turning out cattle, he readily comprehended what was asked of him; yet this lad, whose vulpine career was so short, could neither talk nor utter any decidedly articulate sound. The author of the pamphlet expressed some surprise that there was no case on record in which a grown man had been found in such association. This curious collection of cases of wolf-children is attributed to Colonel Sleeman, a well-known officer, who is known to have been greatly interested in the subject, and who for a long time resided in the forests of India. A copy, now a rarity, is in the South Kensington Museum. An interesting case of a wolf-child was reported many years ago in Chambers' Journal. In the Etwah district, near the banks of the river Jumna, a boy was captured from the wolves. After a time this child was restored to his parents, who, however, "found him very difficult to manage, for he was most fractious and troublesome--in fact, just a caged wild beast. Often during the night for hours together he would give vent to most unearthly yells and moans, destroying the rest and irritating the tempers of his neighbors and generally making night hideous. On one occasion his people chained him by the waist to a tree on the outskirts of the village. Then a rather curious incident occurred. It was a bright moonlight night, and two wolf cubs (undoubtedly those in whose companionship he had been captured), attracted by his cries while on the prowl, came to him, and were distinctly seen to gambol around him with as much familiarity and affection as if they considered him quite one of themselves. They only left him on the approach of morning, when movement and stir again arose in the village. This boy did not survive long. He never spoke, nor did a single ray of human intelligence ever shed its refining light over his debased features." Recently a writer in the Badmington Magazine, in speaking of the authenticity of wolf-children, says:-- "A jemidar told me that when he was a lad he remembered going, with others, to see a wolf-child which had been netted. Some time after this, while staying at an up-country place called Shaporeooundie, in East Bengal, it was my fortune to meet an Anglo-Indian gentleman who had been in the Indian civil service for upward of thirty years, and had traveled about during most of that time; from him I learned all I wanted to know of wolf-children, for he not only knew of several cases, but had actually seen and examined, near Agra, a child which had been recovered from the wolves. The story of Romulus and Remus, which all schoolboys and the vast majority of grown people regard as a myth, appears in a different light when one studies the question of wolf-children, and ascertains how it comes to pass that boys are found living on the very best terms with such treacherous and rapacious animals as wolves, sleeping with them in their dens, sharing the raw flesh of deer and kids which the she-wolf provides, and, in fact, leading in all essentials the actual life of a wolf. "A young she-wolf has a litter of cubs, and after a time her instinct tells her that they will require fresh food. She steals out at night in quest of prey. Soon she espies a weak place in the fence (generally constructed of thatching grass and bamboos) which encloses the compound, or 'unguah,' of a poor villager. She enters, doubtless, in the hope of securing a kid; and while prowling about inside looks into a hut where a woman and infant are soundly sleeping. In a moment she has pounced on the child, and is out of reach before its cries can attract the villagers. Arriving safely at her den under the rocks, she drops the little one among her cubs. At this critical time the fate of the child hangs in the balance. Either it will be immediately torn to pieces and devoured, or in a most wonderful way remain in the cave unharmed. In the event of escape, the fact may be accounted for in several ways. Perhaps the cubs are already gorged when the child is thrown before them, or are being supplied with solid food before their carnivorous instinct is awakened, so they amuse themselves by simply licking the sleek, oily body (Hindoo mothers daily rub their boy babies with some native vegetable oil) of the infant, and thus it lies in the nest, by degrees getting the odor of the wolf cubs, after which the mother wolf will not molest it. In a little time the infant begins to feel the pangs of hunger, and hearing the cubs sucking, soon follows their example. Now the adoption is complete, all fear of harm to the child from wolves has gone, and the foster-mother will guard and protect it as though it were of her own flesh and blood. "The mode of progression of these children is on all fours--not, as a rule, on the hands and feet, but on the knees and elbows. The reason the knees are used is to be accounted for by the fact that, owing to the great length of the human leg and thigh in proportion to the length of the arm, the knee would naturally be brought to the ground, and the instep and top of the toes would be used instead of the sole and heel of the almost inflexible foot. Why the elbow should be employed instead of the hand is less easy to understand, but probably it is better suited to give support to the head and fore-part of the body. "Some of these poor waifs have been recovered after spending ten or more years in the fellowship of wolves, and, though wild and savage at first, have in time become tractable in some degree. They are rarely seen to stand upright, unless to look around, and they gnaw bones in the manner of a dog, holding one end between the forearms and hands, while snarling and snapping at everybody who approaches too near. The wolf-child has little except his outward form to show that it is a human being with a soul. It is a fearful and terrible thing, and hard to understand, that the mere fact of a child's complete isolation from its own kind should bring it to such a state of absolute degradation. Of course, they speak no language, though some, in time, have learned to make known their wants by signs. When first taken they fear the approach of adults, and, if possible, will slink out of sight; but should a child of their own size, or smaller, come near, they will growl, and even snap and bite at it. On the other hand, the close proximity of "pariah" dogs or jackals is unresented, in some cases welcomed; for I have heard of them sharing their food with these animals, and even petting and fondling them. They have in time been brought to a cooked-meat diet, but would always prefer raw flesh. Some have been kept alive after being reclaimed for as long as two years, but for some reason or other they all sicken and die, generally long before that time. One would think, however, that, having undoubtedly robust constitutions, they might be saved if treated in a scientific manner and properly managed." Rudyard Kipling, possibly inspired by accounts of these wolf-children in India, has ingeniously constructed an interesting series of fabulous stories of a child who was brought up by the beasts of the jungles and taught their habits and their mode of communication. The ingenious way in which the author has woven the facts together and interspersed them with his intimate knowledge of animal-life commends his "Jungle-Book" as a legitimate source of recreation to the scientific observer. Among observers mentioned in the "Index Catalogue" who have studied this subject are Giglioli, Mitra, and Ornstein. The artificial manufacture of "wild men" or "wild boys" in the Chinese Empire is shown by recent reports. Macgowan says the traders kidnap a boy and skin him alive bit by bit, transplanting on the denuded surfaces the hide of a bear or dog. This process is most tedious and is by no means complete when the hide is completely transplanted, as the subject must be rendered mute by destruction of the vocal cords, made to use all fours in walking, and submitted to such degradation as to completely blight all reason. It is said that the process is so severe that only one in five survive. A "wild boy" exhibited in Kiangse had the entire skin of a dog substituted and walked on all fours. It was found that he had been kidnapped. His proprietor was decapitated on the spot. Macgowan says that parasitic monsters are manufactured in China by a similar process of transplantation. He adds that the deprivation of light for several years renders the child a great curiosity, if in conjunction its growth is dwarfed by means of food and drugs, and its vocal apparatus destroyed. A certain priest subjected a kidnapped boy to this treatment and exhibited him as a sacred deity. Macgowan mentions that the child looked like wax, as though continually fed on lardaceous substances. He squatted with his palms together and was a driveling idiot. The monk was discovered and escaped, but his temple was razed. Equilibrists.--Many individuals have cultivated their senses so acutely that by the eye and particularly by touch they are able to perform almost incredible feats of maintaining equilibrium under the most difficult circumstances Professional rope-walkers have been known in all times. The Greeks had a particular passion for equilibrists, and called them "neurobates," "oribates," and "staenobates." Blondin would have been one of the latter. Antique medals showing equilibrists making the ascent of an inclined cord have been found. The Romans had walkers both of the slack-rope and tight-rope Many of the Fathers of the Church have pronounced against the dangers of these exercises. Among others, St. John Chrysostom speaks of men who execute movements on inclined ropes at unheard-of heights. In the ruins of Herculaneum there is still visible a picture representing an equilibrist executing several different exercises, especially one in which he dances on a rope to the tune of a double flute, played by himself. The Romans particularly liked to witness ascensions on inclined ropes, and sometimes these were attached to the summits of high hills, and while mounting them the acrobats performed different pantomimes. It is said that under Charles VI a Genoese acrobat, on the occasion of the arrival of the Queen of France, carried in each hand an illuminated torch while descending a rope stretched from the summit of the towers of Notre Dame to a house on the Pont au Change. According to Guyot-Daubes, a similar performance was seen in London in 1547. In this instance the rope was attached to the highest pinnacle of St. Paul's Cathedral. Under Louis XII an acrobat named Georges Menustre, during a passage of the King through Macon, executed several performances on a rope stretched from the grand tower of the Chateau and the clock of the Jacobins, at a height of 156 feet. A similar performance was given at Milan before the French Ambassadors, and at Venice under the Doges and the Senate on each St. Mark's Day, rope-walkers performed at high altitudes. In 1649 a man attempted to traverse the Seine on a rope placed between the Tour de Nesles and the Tour du Grand-Prevost. The performance, however, was interrupted by the fall of the mountebank into the Seine. At subsequent fairs in France other acrobats have appeared. At the commencement of this century there was a person named Madame Saqui who astonished the public with her nimbleness and extraordinary skill in rope walking. Her specialty was military maneuvers. On a cord 20 meters from the ground she executed all sorts of military pantomimes without assistance, shooting off pistols, rockets, and various colored fires. Napoleon awarded her the title of the first acrobat of France. She gave a performance as late as 1861 at the Hippodrome of Paris. In 1814 there was a woman called "La Malaga," who, in the presence of the allied sovereigns at Versailles, made an ascension on a rope 200 feet above the Swiss Lake. In the present generation probably the most famous of all the equilibrists was Blondin. This person, whose real name was Emile Gravelet, acquired a universal reputation; about 1860 he traversed the Niagara Falls on a cable at an elevation of nearly 200 feet. Blondin introduced many novelties in his performances. Sometimes he would carry a man over on his shoulders; again he would eat a meal while on his wire; cook and eat an omelet, using a table and ordinary cooking utensils, all of which he kept balanced. In France Blondin was almost the patron saint of the rope-walkers; and at the present day the performers imitate his feats, but never with the same grace and perfection. In 1882 an acrobat bearing the natural name of Arsens Blondin traversed one river after another in France on a wire stretched at high altitudes. With the aid of a balancing-rod he walked the rope blindfolded; with baskets on his feet; sometimes he wheeled persons over in a wheelbarrow. He was a man of about thirty, short, but wonderfully muscled and extremely supple. It is said that a negro equilibrist named Malcom several times traversed the Meuse at Sedan on a wire at about a height of 100 feet. Once while attempting this feat, with his hands and feet shackled with iron chains, allowing little movement, the support on one side fell, after the cable had parted, and landed on the spectators, killing a young girl and wounding many others. Malcom was precipitated into the river, but with wonderful presence of mind and remarkable strength he broke his bands and swam to the shore, none the worse for his high fall; he immediately helped in attention to his wounded spectators. A close inspection of all the exhibitionists of this class will show that they are of superior physique and calm courage. They only acquire their ability after long gymnastic exercise, as well as actual practice on the rope. Most of these persons used means of balancing themselves, generally a long and heavy pole; but some used nothing but their outstretched arms. In 1895, at the Royal Aquarium in London, there was an individual who slowly mounted a long wire reaching to the top of this huge structure, and, after having made the ascent, without the aid of any means of balancing but his arms, slid the whole length of the wire, landing with enormous velocity into an outstretched net. The equilibrists mentioned thus far have invariably used a tightly stretched rope or wire; but there are a number of persons who perform feats, of course not of such magnitude, on a slack wire, in which they have to defy not only the force of gravity, but the to-and-fro motion of the cable as well. It is particularly with the Oriental performers that we see this exhibition. Some use open parasols, which, with their Chinese or Japanese costumes, render the performance more picturesque; while others seem to do equally well without such adjuncts. There have been performers of this class who play with sharp daggers while maintaining themselves on thin and swinging wires. Another class of equilibrists are those who maintain the upright position resting on their heads with their feet in the air. At the Hippodrome in Paris some years since there was a man who remained in this position seven minutes and ate a meal during the interval. There were two clowns at the Cirque Franconi who duplicated this feat, and the program called their dinner "Un dejouner en tete-a-tete." Some other persons perform wonderful feats of a similar nature on an oscillating trapeze, and many similar performances have been witnessed by the spectators of our large circuses. The "human pyramids" are interesting, combining, as they do, wonderful power of maintaining equilibrium with agility and strength. The rapidity with which they are formed and are tumbled to pieces is marvelous they sometimes include as many as 16 persons men, women, and children. The exhibitions given by the class of persons commonly designated as "jugglers" exemplify the perfect control that by continual practice one may obtain over his various senses and muscles. The most wonderful feats of dexterity are thus reduced into mere automatic movements. Either standing, sitting, mounted on a horse, or even on a wire, they are able to keep three four, five, and even six balls in continual motion in the air. They use articles of the greatest difference in specific gravity in the same manner. A juggler called "Kara," appearing in London and Paris in the summer of 1895, juggled with an open umbrella, an eye-glass, and a traveling satchel, and received each after its course in the air with unerring precision. Another man called "Paul Cinquevalli," well known in this country, does not hesitate to juggle with lighted lamps or pointed knives. The tricks of the clowns with their traditional pointed felt hats are well known. Recently there appeared in Philadelphia a man who received six such hats on his head, one on top of the other, thrown by his partner from the rear of the first balcony of the theater. Others will place a number of rings on their fingers, and with a swift and dexterous movement toss them all in the air, catching them again all on one finger. Without resorting to the fabulous method of Columbus, they balance eggs on a table, and in extraordinary ways defy all the powers of gravity. In India and China we see the most marvelous of the knife-jugglers. With unerring skill they keep in motion many pointed knives, always receiving them at their fall by the handles. They throw their implements with such precision that one often sees men, who, placing their partner against a soft board, will stand at some distance and so pen him in with daggers that he cannot move until some are withdrawn, marking a silhouette of his form on the board,--yet never once does one as much as graze the skin. With these same people the foot-jugglers are most common. These persons, both made and female, will with their feet juggle substances and articles that it requires several assistants to raise. A curious trick is given by Rousselet in his magnificent work entitled "L'Inde des Rajahs," and quoted by Guyot-Daubes. It is called in India the "dance of the eggs." The dancer, dressed in a rather short skirt, places on her head a large wheel made of light wood, and at regular intervals having hanging from it pieces of thread, at the ends of which are running knots kept open by beads of glass. She then brings forth a basket of eggs, and passes them around for inspection to assure her spectators of their genuineness. The monotonous music commences and the dancer sets the wheel on her head in rapid motion; then, taking an egg, with a quick movement she puts it on one of the running knots and increases the velocity of the revolution of the wheel by gyrations until the centrifugal force makes each cord stand out in an almost horizontal line with the circumference of the wheel. Then one after another she places the eggs on the knots of the cord, until all are flying about her head in an almost horizontal position. At this moment the dance begins, and it is almost impossible to distinguish the features of the dancer. She continues her dance, apparently indifferent to the revolving eggs. At the velocity with which they revolve the slightest false movement would cause them to knock against one another and surely break. Finally, with the same lightning-like movements, she removes them one by one, certainly the most delicate part of the trick, until they are all safely laid away in the basket from which they came, and then she suddenly brings the wheel to a stop; after this wonderful performance, lasting possibly thirty minutes, she bows herself out. A unique Japanese feat is to tear pieces of paper into the form of butterflies and launch them into the air about a vase full of flowers; then with a fan to keep them in motion, making them light on the flowers, fly away, and return, after the manner of several living butterflies, without allowing one to fall to the ground. Marksmen.--It would be an incomplete paper on the acute development of the senses that did not pay tribute to the men who exhibit marvelous skill with firearms. In the old frontier days in the Territories, the woodsmen far eclipsed Tell with his bow or Robin Hood's famed band by their unerring aim with their rifles. It is only lately that there disappeared in this country the last of many woodsmen, who, though standing many paces away and without the aid of the improved sights of modern guns, could by means of a rifle-ball, with marvelous precision, drive a nail "home" that had been placed partly in a board. The experts who shoot at glass balls rarely miss, and when we consider the number used each year, the proportion of inaccurate shots is surprisingly small. Ira Paine, Doctor Carver, and others have been seen in their marvelous performances by many people of the present generation. The records made by many of the competitors of the modern army-shooting matches are none the less wonderful, exemplifying as they do the degree of precision that the eye may attain and the control which may be developed over the nerves and muscles. The authors know of a countryman who successfully hunted squirrels and small game by means of pebbles thrown with his hand. Physiologic wonders are to be found in all our modern sports and games. In billiards, base-ball, cricket, tennis, etc., there are experts who are really physiologic curiosities. In the trades and arts we see development of the special senses that is little less than marvelous. It is said that there are workmen in Krupp's gun factory in Germany who have such control over the enormous trip hammers that they can place a watch under one and let the hammer fall, stopping it with unerring precision just on the crystal. An expert tool juggler in one of the great English needle factories, in a recent test of skill, performed one of the most delicate mechanical feats imaginable. He took a common sewing needle of medium size (length 1 5/8 inches) and drilled a hole through its entire length from eye to point--the opening being just large enough to admit the passage of a very fine hair. Another workman in a watch-factory of the United States drilled a hole through a hair of his beard and ran a fiber of silk through it. Ventriloquists, or "two-voiced men," are interesting anomalies of the present day; it is common to see a person who possesses the power of speaking with a voice apparently from the epigastrium. Some acquire this faculty, while with others it is due to a natural resonance, formed, according to Dupont, in the space between the third and fourth ribs and their cartilaginous union and the middle of the first portion of the sternum. Examination of many of these cases proves that the vibration is greatest here. It is certain that ventriloquists have existed for many centuries. It is quite possible that some of the old Pagan oracles were simply the deceptions of priests by means of ventriloquism. Dupont, Surgeon-in-chief of the French Army about a century since, examined minutely an individual professing to be a ventriloquist. With a stuffed fox on his lap near his epigastrium, he imitated a conversation with the fox. By lying on his belly, and calling to some one supposed to be below the surface of the ground, he would imitate an answer seeming to come from the depths of the earth. With his belly on the ground he not only made the illusion more complete, but in this way he smothered "the epigastric voice." He was always noticed to place the inanimate objects with which he held conversations near his umbilicus. Ventriloquists must not be confounded with persons who by means of skilful mechanisms, creatures with movable fauces, etc., imitate ventriloquism. The latter class are in no sense of the word true ventriloquists, but simulate the anomaly by quickly changing the tones of their voice in rapid succession, and thus seem to make their puppets talk in many different voices. After having acquired the ability to suddenly change the tone of their voice, they practice imitations of the voices of the aged, of children, dialects, and feminine tones, and, with a set of mechanical puppets, are ready to appear as ventriloquists. By contraction of the pharyngeal and laryngeal muscles they also imitate tones from a distance. Some give their performance with little labial movement, but close inspection of the ordinary performer of this class shows visible movements of his lips. The true ventriloquist pretends only to speak from the belly and needs no mechanical assistance. The wonderful powers of mimicry displayed by expert ventriloquists are marvelous; they not only imitate individuals and animals, but do not hesitate to imitate a conglomeration of familiar sounds and noises in such a manner as to deceive their listeners into believing that they hear the discussions of an assemblage of people. The following description of an imitation of a domestic riot by a Chinese ventriloquist is given by the author of "The Chinaman at Home" and well illustrates the extent of their abilities: "The ventriloquist was seated behind a screen, where there were only a chair, a table, a fan, and a ruler. With this ruler he rapped on the table to enforce silence, and when everybody had ceased speaking there was suddenly heard the barking of a dog. Then we heard the movements of a woman. She had been waked by the dog and was shaking her husband. We were just expecting to hear the man and wife talking together when a child began to cry. To pacify it the mother gave it food; we could hear it drinking and crying at the same time. The mother spoke to it soothingly and then rose to change its clothes. Meanwhile another child had wakened and was beginning to make a noise. The father scolded it, while the baby continued crying. By-and-by the whole family went back to bed and fell asleep. The patter of a mouse was heard. It climbed up some vase and upset it. We heard the clatter of the vase as it fell. The woman coughed in her sleep. Then cries of "Fire! fire!" were heard. The mouse had upset the lamp; the bed curtains were on fire. The husband and wife waked up, shouted, and screamed, the children cried, people came running and shouting. Children cried, dogs barked, squibs and crackers exploded. The fire brigade came racing up. Water was pumped up in torrents and hissed in the flames. The representation was so true to life that every one rose to his feet and was starting away when a second blow of the ruler on the table commanded silence. We rushed behind the screen, but there was nothing there except the ventriloquist, his table, his chair, and his ruler." Athletic Feats.--The ancients called athletes those who were noted for their extraordinary agility, force, and endurance. The history of athletics is not foreign to that of medicine, but, on the contrary, the two are in many ways intimately blended. The instances of feats of agility and endurance are in every sense of the word examples of physiologic and functional anomalies, and have in all times excited the interest and investigation of capable physicians. The Greeks were famous for their love of athletic pastimes; and classical study serves powerfully to strengthen the belief that no institution exercised greater influence than the public contests of Greece in molding national character and producing that admirable type of personal and intellectual beauty that we see reflected in her art and literature. These contests were held at four national festivals, the Olympian, the Pythian, the Nemean, and the Isthmean games. On these occasions every one stopped labor, truce was declared between the States, and the whole country paid tribute to the contestants for the highly-prized laurels of these games. Perhaps the enthusiasm shown in athletics and interest in physical development among the Greeks has never been equaled by any other people. Herodotus and all the Greek writers to Plutarch have elaborated on the glories of the Greek athlete, and tell us of the honors rendered to the victors by the spectators and the vanquished, dwelling with complacency on the fact that in accepting the laurel they cared for nothing but honor. The Romans in "ludi publici," as they called their games, were from first to last only spectators; but in Greece every eligible person was an active participant. In the regimen of diet and training the physicians from the time of Hippocrates, and even before, have been the originators and professional advisers of the athlete. The change in the manner of living of athletes, if we can judge from the writings of Hippocrates, was anterior to his time; for in Book V of the "Epidemics" we read of Bias, who, "suapte nature vorax, in choleram-morbum incidit ex carnium esu, praecipueque suillarum crudarum, etc." From the time of the well-known fable of the hero who, by practicing daily from his birth, was able to lift a full-grown bull, thus gradually accustoming himself to the increased weight, physiologists and scientists have collaborated with the athlete in evolving the present ideas and system of training. In his aphorisms Hippocrates bears witness to the dangers of over-exercise and superabundant training, and Galen is particularly averse to an art which so preternaturally develops the constitution and nature of man; many subsequent medical authorities believed that excessive development of the human frame was necessarily followed by a compensatory shortening of life. The foot-race was the oldest of the Greek institutions, and in the first of the Olympiads the "dromos," a course of about 200 yards, was the only contest; but gradually the "dialos," in which the course was double that of the dromos, was introduced, and, finally, tests of endurance as well as speed were instituted in the long-distance races and the contests of racing in heavy armor, which were so highly commended by Plato as preparation for the arduous duties of a soldier. Among the Greeks we read of Lasthenes the Theban, who vanquished a horse in the course; of Polymnestor, who chased and caught a hare; and Philonides, the courier of Alexander the Great, who in nine hours traversed the distance between the Greek cities Sicyone and Elis, a distance of over 150 miles. We read of the famous soldier of Marathon, who ran to announce the victory to the Magistrates of Athens and fell dead at their feet. In the Olympian games at Athens in 1896 this distance (about 26 miles) was traversed in less than three hours. It is said of Euchidas, who carried the fire necessary for the sacrifices which were to replace those which the Persians had spoiled, that he ran a thousand stadia (about 125 miles) and fell dead at the end of his mission. The Roman historians have also recited the extraordinary feats of the couriers of their times. Pliny speaks of an athlete who ran 235 kilometers (almost 150 miles) without once stopping. He also mentions a child who ran almost half this distance. In the Middle Ages the Turks had couriers of almost supernatural agility and endurance. It is said that the distance some of them would traverse in twenty-four hours was 120 miles, and that it was common for them to make the round trip from Constantinople to Adrianople, a distance of 80 leagues, in two days. They were dressed very lightly, and by constant usage the soles of their feet were transformed into a leathery consistency. In the last century in the houses of the rich there were couriers who preceded the carriages and were known as "Basques," who could run for a very long time without apparent fatigue. In France there is a common proverb, "Courir comme un Basque." Rabelais says: "Grand-Gousier depeche le Basque son laquais pour querir Gargantua en toute hate." In the olden times the English nobility maintained running footmen who, living under special regimen and training, were enabled to traverse unusual distances without apparent fatigue. There is an anecdote of a nobleman living in a castle not far from Edinburgh, who one evening charged his courier to carry a letter to that city. The next morning when he arose he found this valet sleeping in his antechamber. The nobleman waxed wroth, but the courier gave him a response to the letter. He had traveled 70 miles during the night. It is said that one of the noblemen under Charles II in preparing for a great dinner perceived that one of the indispensable pieces of his service was missing. His courier was dispatched in great haste to another house in his domain, 15 miles distant, and returned in two hours with the necessary article, having traversed a distance of over 30 miles. It is also said that a courier carrying a letter to a London physician returned with the potion prescribed within twenty-four hours, having traversed 148 miles. There is little doubt of the ability of these couriers to tire out any horse. The couriers who accompany the diligences in Spain often fatigue the animals who draw the vehicles. At the present time in this country the Indians furnish examples of marvelous feats of running. The Tauri-Mauri Indians, who live in the heart of the Sierra Madre Mountains, are probably the most wonderful long-distance runners in the world. Their name in the language of the mountain Mexicans means foot-runners; and there is little doubt that they perform athletic feats which equal the best in the days of the Olympian games. They are possibly the remnants of the wonderful runners among the Indian tribes in the beginning of this century. There is an account of one of the Tauri-Mauri who was mail carrier between Guarichic and San Jose de los Cruces, a distance of 50 miles of as rough, mountainous road as ever tried a mountaineer's lungs and limbs. Bareheaded and barelegged, with almost no clothing, this man made this trip each day, and, carrying on his back a mail-pouch weighing 40 pounds, moved gracefully and easily over his path, from time to time increasing his speed as though practicing, and then again more slowly to smoke a cigarette. The Tauri-Mauri are long-limbed and slender, giving the impression of being above the average height. There is scarcely any flesh on their puny arms, but their legs are as muscular as those of a greyhound. In short running they have the genuine professional stride, something rarely seen in other Indian racers. In traversing long distances they leap and bound like deer. "Deerfoot," the famous Indian long-distance runner, died on the Cattaraugus Reservation in January, 1896. His proper name was Louis Bennett, the name "Deerfoot" having been given to him for his prowess in running. He was born on the reservation in 1828. In 1861 he went to England, where he defeated the English champion runners. In April, 1863, he ran 11 miles in London in fifty-six minutes fifty-two seconds, and 12 miles in one hour two minutes and two and one-half seconds, both of which have stood as world's records ever since. In Japan, at the present day, the popular method of conveyance, both in cities and in rural districts, is the two-wheeled vehicle, looking like a baby-carriage, known to foreigners as the jinrickisha, and to the natives as the kuruma. In the city of Tokio there is estimated to be 38,000 of these little carriages in use. They are drawn by coolies, of whose endurance remarkable stories are told. These men wear light cotton breeches and a blue cotton jacket bearing the license number, and the indispensable umbrella hat. In the course of a journey in hot weather the jinrickisha man will gradually remove most of his raiment and stuff it into the carriage. In the rural sections he is covered with only two strips of cloth, one wrapped about his head and the other about his loins. It is said that when the roadway is good, these "human horses" prefer to travel bare-footed; when working in the mud they wrap a piece of straw about each big toe, to prevent slipping and to give them a firmer grip. For any of these men a five-mile spurt on a good road without a breathing spell is a small affair. A pair of them will roll a jinrickisha along a country road at the rate of four miles an hour, and they will do this eight hours a day. The general average of the distance traversed in a day is 25 miles. Cockerill, who has recently described these men, says that the majority of them die early. The terrible physical strain brings on hypertrophy and valvular diseases of the heart, and many of them suffer from hernia. Occasionally one sees a veteran jinrickisha man, and it is interesting to note how tenderly he is helped by his confreres. They give him preference as regards wages, help push his vehicle up heavy grades, and show him all manner of consideration. Figure 180 represents two Japanese porters and their usual load, which is much more difficult to transport than a jinrickisha carriage. In other Eastern countries, palanquins and other means of conveyance are still borne on the shoulders of couriers, and it is not so long since our ancestors made their calls in Sedan-chairs borne by sturdy porters. Some of the letter-carriers of India make a daily journey of 30 miles. They carry in one hand a stick, at the extremity of which is a ring containing several little plates of iron, which, agitated during the course, produce a loud noise designed to keep off ferocious beasts and serpents. In the other hand they carry a wet cloth, with which they frequently refresh themselves by wiping the countenance. It is said that a regular Hindustanee carrier, with a weight of 80 pounds on his shoulder,--carried, of course, in two divisions, hung on his neck by a yoke,--will, if properly paid, lope along over 100 miles in twenty-four hours--a feat which would exhaust any but the best trained runners. The "go-as-you-please" pedestrians, whose powers during the past years have been exhibited in this country and in England, have given us marvelous examples of endurance, over 600 miles having been accomplished in a six-days' contest. Hazael, the professional pedestrian, has run over 450 miles in ninety-nine hours, and Albert has traveled over 500 miles in one hundred and ten hours. Rowell, Hughes, and Fitzgerald have astonishingly high records for long-distance running, comparing favorably with the older, and presumably mythical, feats of this nature. In California, C. A. Harriman of Truckee in April, 1883, walked twenty-six hours without once resting, traversing 122 miles. For the purpose of comparison we give the best modern records for running:-- 100 Yards.--9 3/5 seconds, made by Edward Donavan, at Natick, Mass., September 2, 1895. 220 Yards.--21 3/5 seconds, made by Harry Jewett, at Montreal, September 24, 1892. Quarter-Mile.--47 3/4 seconds, made by W. Baker, at Boston, Mass., July 1, 1886. Half-Mile.--1 minute 53 2/3 seconds, made by C. J. Kirkpatrick, at Manhattan Field, New York, September 21, 1895. 1 Mile.--4 minutes 12 3/4 seconds, made by W. G. George, at London, England, August 23, 1886. 5 Miles.--24 minutes 40 seconds, made by J. White, in England, May 11, 1863. 10 Miles.--51 minutes 6 3/5 seconds, made by William Cummings, at London, England, September 18,1895. 25 Miles.--2 hours 33 minutes 44 seconds, made by G. A. Dunning, at London, England, December 26, 1881. 50 Miles.--5 hours 55 minutes 4 1/2 seconds, made by George Cartwright, at London, England, February 21, 1887. 75 Miles.--8 hours 48 minutes 30 seconds, made by George Littlewood, at London, England, November 24, 1884. 100 Miles.--13 hours 26 minutes 30 seconds, made by Charles Rowell at New York, February 27, 1882. In instances of long-distance traversing, rapidity is only a secondary consideration, the remarkable fact being in the endurance of fatigue and the continuity of the exercise. William Gale walked 1500 miles in a thousand consecutive hours, and then walked 60 miles every twenty-four hours for six weeks on the Lillie Bridge cinder path. He was five feet five inches tall, forty-nine years of age, and weighed 121 pounds, and was but little developed muscularly. He was in good health during his feat; his diet for the twenty-four hours was 16 pounds of meat, five or six eggs, some cocoa, two quarts of milk, a quart of tea, and occasionally a glass of bitter ale, but never wine nor spirits. Strange to say, he suffered from constipation, and took daily a compound rhubarb pill. He was examined at the end of his feat by Gant. His pulse was 75, strong, regular, and his heart was normal. His temperature was 97.25 degrees F., and his hands and feet warm; respirations were deep and averaged 15 a minute. He suffered from frontal headache and was drowsy. During the six weeks he had lost only seven pounds, and his appetite maintained its normal state. Zeuner of Cincinnati refers to John Snyder of Dunkirk, whose walking-feats were marvelous. He was not an impostor. During forty-eight hours he was watched by the students of the Ohio Medical College, who stated that he walked constantly; he assured them that it did not rest him to sit down, but made him uncomfortable. The celebrated Weston walked 5000 miles in one hundred days, but Snyder was said to have traveled 25,000 miles in five hundred days and was apparently no more tired than when he began. Recently there was a person who pushed a wheelbarrow from San Francisco to New York in one hundred and eighteen days. In 1809 the celebrated Captain Barclay wagered that he could walk 1000 miles in one thousand consecutive hours, and gained his bet with some hours to spare. In 1834 Ernest Mensen astonished all Europe by his pedestrian exploits. He was a Norwegian sailor, who wagered that he could walk from Paris to Moscow in fifteen days. On June 25, 1834, at ten o'clock A.M., he entered the Kremlin, after having traversed 2500 kilometers (1550 miles) in fourteen days and eighteen hours. His performances all over Europe were so marvelous as to be almost incredible. In 1836, in the service of the East India Company, he was dispatched from Calcutta to Constantinople, across Central Asia. He traversed the distance in fifty-nine days, accomplishing 9000 kilometers (5580 miles) in one-third less time than the most rapid caravan. He died while attempting to discover the source of the Nile, having reached the village of Syang. A most marvelous feat of endurance is recorded in England in the first part of this century. It is said that on a wager Sir Andrew Leith Hay and Lord Kennedy walked two days and a night under pouring rain, over the Grampian range of mountains, wading all one day in a bog. The distance traversed was from a village called Banchory on the river Dee to Inverness. This feat was accomplished without any previous preparation, both men starting shortly after the time of the wager. Riders.--The feats of endurance accomplished by the couriers who ride great distances with many changes of horses are noteworthy. According to a contemporary medical journal there is, in the Friend of India, an account of the Thibetan couriers who ride for three weeks with intervals of only half an hour to eat and change horses. It is the duty of the officials at the Dak bungalows to see that the courier makes no delay, and even if dying he is tied to his horse and sent to the next station. The celebrated English huntsman, "Squire" Osbaldistone, on a wager rode 200 miles in seven hours ten minutes and four seconds. He used 28 horses; and as one hour twenty-two minutes and fifty-six seconds were allowed for stoppages, the whole time, changes and all, occupied in accomplishing this wonderful feat was eight hours and forty-two minutes. The race was ridden at the Newmarket Houghton Meeting over a four-mile course. It is said that a Captain Horne of the Madras Horse Artillery rode 200 miles on Arab horses in less than ten hours along the road between Madras and Bangalore. When we consider the slower speed of the Arab horses and the roads and climate of India, this performance equals the 200 miles in the shorter time about an English race track and on thoroughbreds. It is said that this wonderful horseman lost his life in riding a horse named "Jumping Jenny" 100 miles a day for eight days. The heat was excessive, and although the horse was none the worse for the performance, the Captain died from the exposure he encountered. There is a record of a Mr. Bacon of the Bombay Civil Service, who rode one camel from Bombay to Allygur (perhaps 800 miles) in eight days. As regards the physiology of the runners and walkers, it is quite interesting to follow the effects of training on the respiration, whereby in a measure is explained the ability of these persons to maintain their respiratory function, although excessively exercising. A curious discussion, persisted in since antiquity, is as to the supposed influence of the spleen on the ability of couriers. For ages runners have believed that the spleen was a hindrance to their vocation, and that its reduction was followed by greater agility on the course. With some, this opinion is perpetuated to the present day. In France there is a proverb, "Courir comme un derate." To reduce the size of the spleen, the Greek athletes used certain beverages, the composition of which was not generally known; the Romans had a similar belief and habit Pliny speaks of a plant called equisetum, a decoction of which taken for three days after a fast of twenty-four hours would effect absorption of the spleen. The modern pharmacopeia does not possess any substance having a similar virtue, although quinin has been noticed to diminish the size of the spleen when engorged in malarial fevers. Strictly speaking, however, the facts are not analogous. Hippocrates advises a moxa of mushrooms applied over the spleen for melting or dissolving it. Godefroy Moebius is said to have seen in the village of Halberstadt a courier whose spleen had been cauterized after incision; and about the same epoch (seventeenth century) some men pretended to be able to successfully extirpate the spleen for those who desired to be couriers. This operation we know to be one of the most delicate in modern surgery, and as we are progressing with our physiologic knowledge of the spleen we see nothing to justify the old theory in regard to its relations to agility and coursing. Swimming.--The instances of endurance that we see in the aquatic sports are equally as remarkable as those that we find among the runners and walkers. In the ancient days the Greeks, living on their various islands and being in a mild climate, were celebrated for their prowess as swimmers. Socrates relates the feats of swimming among the inhabitants of Delos. The journeys of Leander across the Hellespont are well celebrated in verse and prose, but this feat has been easily accomplished many times since, and is hardly to be classed as extraordinary. Herodotus says that the Macedonians were skilful swimmers; and all the savage tribes about the borders of waterways are found possessed of remarkable dexterity and endurance in swimming. In 1875 the celebrated Captain Webb swam from Dover to Calais. On landing he felt extremely cold, but his body was as warm as when he started. He was exhausted and very sleepy, falling in deep slumber on his way to the hotel. On getting into bed his temperature was 98 degrees F. and his pulse normal. In five hours he was feverish, his temperature rising to 101 degrees F. During the passage he was blinded from the salt water in his eyes and the spray beating against his face. He strongly denied the newspaper reports that he was delirious, and after a good rest was apparently none the worse for the task. In 1876 he again traversed this passage with the happiest issue. In 1883 he was engaged by speculators to swim the rapids at Niagara, and in attempting this was overcome by the powerful currents, and his body was not recovered for some days after. The passage from Dover to Calais has been duplicated. In 1877 Cavill, another Englishman, swam from Cape Griz-Nez to South Forland in less than thirteen hours. In 1880 Webb swam and floated at Scarborough for seventy-four consecutive hours--of course, having no current to contend with and no point to reach. This was merely a feat of staying in the water. In London in 1881, Beckwith, swimming ten hours a day over a 32-lap course for six days, traversed 94 miles. Since the time of Captain Webb, who was the pioneer of modern long-distance swimming, many men have attempted and some have duplicated his feats; but these foolhardy performances have in late years been diminishing, and many of the older feats are forbidden by law. Jumpers and acrobatic tumblers have been popular from the earliest time. By the aid of springing boards and weights in their hands, the old jumpers covered great distances. Phayllus of Croton is accredited with jumping the incredible distance of 55 feet, and we have the authority of Eustache and Tzetzes that this jump is genuine. In the writings of many Greek and Roman historians are chronicled jumps of about 50 feet by the athletes; if they are true, the modern jumpers have greatly degenerated. A jump of over 20 feet to-day is considered very clever, the record being 29 feet seven inches with weights, and 23 feet eight inches without weights, although much greater distances have been jumped with the aid of apparatus, but never an approximation to 50 feet. The most surprising of all these athletes are the tumblers, who turn somersaults over several animals arranged in a row. Such feats are not only the most amusing sights of a modern circus, but also the most interesting as well. The agility of these men is marvelous, and the force with which they throw themselves in the air apparently enables them to defy gravity. In London, Paris, or New York one may see these wonderful tumblers and marvel at the capabilities of human physical development. In September, 1895, M. F. Sweeney, an American amateur, at Manhattan Field in New York jumped six feet 5 5/8 inches high in the running high jump without weights. With weights, J. H. Fitzpatrick at Oak Island, Mass., jumped six feet six inches high. The record for the running high kick is nine feet eight inches, a marvelous performance, made by C. C. Lee at New Haven, Conn., March 19, 1887. Extraordinary physical development and strength has been a grand means of natural selection in the human species. As Guyot-Daubes remarks, in prehistoric times, when our ancestors had to battle against hunger, savage beasts, and their neighbors, and when the struggle for existence was so extremely hard, the strong man alone resisted and the weak succumbed. This natural selection has been perpetuated almost to our day; during the long succession of centuries, the chief or the master was selected on account of his being the strongest, or the most valiant in the combat. Originally, the cavaliers, the members of the nobility, were those who were noted for their courage and strength, and to them were given the lands of the vanquished. Even in times other than those of war, disputes of succession were settled by jousts and tourneys. This fact is seen in the present day among the lower animals, who in their natural state live in tribes; the leader is usually the strongest, the wisest, and the most courageous. The strong men of all times have excited the admiration of their fellows and have always been objects of popular interest. The Bible celebrates the exploits of Samson of the tribe of Dan. During his youth he, single handed, strangled a lion; with the jaw-bone of an ass he is said to have killed 1000 Philistines and put the rest to flight. At another time during the night he transported from the village of Gaza enormous burdens and placed them on the top of a mountain. Betrayed by Delilah, he was delivered into the hands of his enemies and employed in the most servile labors. When old and blind he was attached to the columns of an edifice to serve as an object of public ridicule; with a violent effort he overturned the columns, destroying himself and 3000 Philistines. In the Greek mythology we find a great number of heroes, celebrated for their feats of strength and endurance. Many of them have received the name of Hercules; but the most common of these is the hero who was supposed to be the son of Jupiter and Alemena. He was endowed with prodigious strength by his father, and was pursued with unrelenting hatred by Juno. In his infancy he killed with his hands the serpents which were sent to devour him. The legends about him are innumerable. He was said to have been armed with a massive club, which only he was able to carry. The most famous of his feats were the twelve labors, with which all readers of mythology are familiar. Hercules, personified, meant to the Greeks physical force as well as strength, generosity, and bravery, and was equivalent to the Assyrian Hercules. The Gauls had a Hercules-Pantopage, who, in addition to the ordinary qualities attributed to Hercules, had an enormous appetite. As late as the sixteenth century, and in a most amusing and picturesque manner, Rabelais has given us the history of Gargantua, and even to this day, in some regions, there are groups of stones which are believed by ignorant people to have been thrown about by Gargantua in his play. In their citations the older authors often speak of battles, and in epic ballads of heroes with marvelous strength. In the army of Charlemagne, after Camerarius, and quoted by Guyot-Daubes (who has made an extensive collection of the literature on this subject and to whom the authors are indebted for much information), there was found a giant named Oenother, a native of a village in Suabia, who performed marvelous feats of strength. In his history of Bavaria Aventin speaks of this monster. To Roland, the nephew of Charlemagne, the legends attributed prodigious strength; and, dying in the valley of Roncesveaux, he broke his good sword "Durandal" by striking it against a rock, making a breach, which is stilled called the "Breche de Roland." Three years before his death, on his return from Palestine, Christopher, Duke of Bavaria, was said to have lifted to his shoulders a stone which weighed more than 340 pounds. Louis de Boufflers, surnamed the "Robust," who lived in 1534, was noted for his strength and agility. When he placed his feet together, one against the other, he could find no one able to disturb them. He could easily bend and break a horseshoe with his hands, and could seize an ox by the tail and drag it against its will. More than once he was said to have carried a horse on his shoulders. According to Guyot-Daubes there was, in the last century, a Major Barsaba who could seize the limb of a horse and fracture its bone. There was a tale of his lifting an iron anvil, in a blacksmith's forge, and placing it under his coat. To the Emperor Maximilian I was ascribed enormous strength; even in his youth, when but a simple patriot, he vanquished, at the games given by Severus, 16 of the most vigorous wrestlers, and accomplished this feat without stopping for breath. It is said that this feat was the origin of his fortune. Among other celebrated persons in history endowed with uncommon strength were Edmund "Ironsides," King of England; the Caliph Mostasem-Billah; Baudouin, "Bras-de-Fer," Count of Flanders; William IV, called by the French "Fier-a-Bras," Duke of Aquitaine; Christopher, son of Albert the Pious, Duke of Bavaria; Godefroy of Bouillon; the Emperor Charles IV; Scanderbeg; Leonardo da Vinci; Marshal Saxe; and the recently deceased Czar of Russia, Alexander III. Turning now to the authentic modern Hercules, we have a man by the name of Eckeberg, born in Anhalt, and who traveled under the name of "Samson." He was exhibited in London, and performed remarkable feats of strength. He was observed by the celebrated Desaguliers (a pupil of Newton) in the commencement of the last century, who at that time was interested in the physiologic experiments of strength and agility. Desaguliers believed that the feats of this new Samson were more due to agility than strength. One day, accompanied by two of his confreres, although a man of ordinary strength, he duplicated some of Samson's feats, and followed his performance by a communication to the Royal Society. One of his tricks was to resist the strength of five or six men or of two horses. Desaguliers claimed that this was entirely due to the position taken. This person would lift a man by one foot, and bear a heavy weight on his chest when resting with his head and two feet on two chairs. By supporting himself with his arms he could lift a piece of cannon attached to his feet. A little later Desaguliers studied an individual in London named Thomas Topham, who used no ruse in his feats and was not the skilful equilibrist that the German Samson was, his performances being merely the results of abnormal physical force. He was about thirty years old, five feet ten inches in height and well proportioned, and his muscles well developed, the strong ligaments showing under the skin. He ignored entirely the art of appearing supernaturally strong, and some of his feats were rendered difficult by disadvantageous positions. In the feat of the German--resisting the force of several men or horses--Topham exhibited no knowledge of the principles of physics, like that of his predecessor, but, seated on the ground and putting his feet against two stirrups, he was able to resist the traction of a single horse; when he attempted the same feat against two horses he was severely strained and wounded about the knees. According to Desaguliers, if Topham had taken the advantageous positions of the German Samson, he could have resisted not only two, but four horses. On another occasion, with the aid of a bridle passed about his neck, he lifted three hogsheads full of water, weighing 1386 pounds. If he had utilized the force of his limbs and his loins, like the German, he would have been able to perform far more difficult feats. With his teeth he could lift and maintain in a horizontal position a table over six feet long, at the extremity of which he would put some weight. Two of the feet of the table he rested on his knees. He broke a cord five cm. in diameter, one part of which was attached to a post and the other to a strap passed under his shoulder. He was able to carry in his hands a rolling-pin weighing 800 pounds, about twice the weight a strong man is considered able to lift. Tom Johnson was another strong man who lived in London in the last century, but he was not an exhibitionist, like his predecessors. He was a porter on the banks of the Thames, his duty being to carry sacks of wheat and corn from the wharves to the warehouses. It was said that when one of his comrades was ill, and could not provide support for his wife and children, Johnson assumed double duty, carrying twice the load. He could seize a sack of wheat, and with it execute the movements of a club-swinger, and with as great facility. He became quite a celebrated boxer, and, besides his strength, he soon demonstrated his powers of endurance, never seeming fatigued after a lively bout. The porters of Paris were accustomed to lift and carry on their shoulders bags of flour weighing 159 kilograms (350 pounds) and to mount stairs with them. Johnson, on hearing this, duplicated the feat with three sacks, and on one occasion attempted to carry four, and resisted this load some little time. These four sacks weighed 1400 pounds. Some years since there was a female Hercules who would get on her hands and knees under a carriage containing six people, and, forming an arch with her body, she would lift it off the ground, an attendant turning the wheels while in the air to prove that they were clear from the ground. Guyot-Daubes considers that one of the most remarkable of all the men noted for their strength was a butcher living in the mountains of Margeride, known as Lapiada (the extraordinary). This man, whose strength was legendary in the neighboring country, one day seized a mad bull that had escaped from his stall and held him by the horns until his attendants could bind him. For amusement he would lie on his belly and allow several men to get on his back; with this human load he would rise to the erect position. One of Lapiada's great feats was to get under a cart loaded with hay and, forming an arch with his body, raise it from the ground, then little by little he would mount to his haunches, still holding the cart and hay. Lapiada terminated his Herculean existence in attempting a mighty effort. Having charged himself alone with the task of placing a heavy tree-trunk in a cart, he seized it, his muscles stiffened, but the blood gushed from his mouth and nostrils, and he fell, overcome at last. The end of Lapiada presents an analogue to that of the celebrated athlete, Polydamas, who was equally the victim of too great confidence in his muscular force, and who died crushed by the force that he hoped to maintain. Figures 181 and 183 portray the muscular development of an individual noted for his feats of strength, and who exhibited not long since. In recent years we have had Sebastian Miller, whose specialty was wrestling and stone-breaking; Samson, a recent English exhibitionist, Louis Cyr, and Sandow, who, in addition to his remarkable strength and control over his muscles, is a very clever gymnast. Sandow gives an excellent exposition of the so-called "checkerboard" arrangement of the muscular fibers of the lower thoracic and abdominal regions, and in a brilliant light demonstrates his extraordinary power over his muscles, contracting muscles ordinarily involuntary in time with music, a feat really more remarkable than his exhibition of strength. Figures 182 and 184 show the beautiful muscular development of this remarkable man. Joseph Pospischilli, a convict recently imprisoned in the Austrian fortress of Olen, surprised the whole Empire by his wonderful feats of strength. One of his tricks was to add a fifth leg to a common table (placing the useless addition in the exact center) and then balance it with his teeth while two full-grown gipsies danced on it, the music being furnished by a violinist seated in the middle of the well-balanced platform. One day when the prison in which this Hercules was confined was undergoing repairs, he picked up a large carpenter's bench with his teeth and held it balanced aloft for nearly a minute. Since being released from the Olen prison, Pospischilli and his cousin, another local "strong man" named Martenstine, have formed a combination and are now starring Southern Europe, performing all kinds of startling feats of strength. Among other things they have had a 30-foot bridge made of strong timbers, which is used in one of their great muscle acts. This bridge has two living piers--Pospischilli acting as one and Martenstine the other. Besides supporting this monstrous structure (weight, 1866 pounds) upon their shoulders, these freaks of superhuman strength allow a team of horses and a wagon loaded with a ton of cobble-stones to be driven across it. It is said that Selig Whitman, known as "Ajax," a New York policeman, has lifted 2000 pounds with his hands and has maintained 450 pounds with his teeth. This man is five feet 8 1/2 inches tall and weighs 162 pounds. His chest measurement is 40 inches, the biceps 17 inches, that of his neck 16 1/2 inches, the forearm 11, the wrist 9 1/2, the thigh 23, and the calf 17. One of the strongest of the "strong women" is Madame Elise, a Frenchwoman, who performs with her husband. Her greatest feat is the lifting of eight men weighing altogether about 1700 pounds. At her performances she supports across her shoulders a 700-pound dumb-bell, on each side of which a person is suspended. Miss Darnett, the "singing strong lady," extends herself upon her hands and feet, face uppermost, while a stout platform, with a semicircular groove for her neck, is fixed upon her chest, abdomen, and thighs by means of a waist-belt which passes through brass receivers on the under side of the board. An ordinary upright piano is then placed on the platform by four men; a performer mounts the platform and plays while the "strong lady" sings a love song while supporting possibly half a ton. Strength of the Jaws.--There are some persons who exhibit extraordinary power of the jaw. In the curious experiments of Regnard and Blanchard at the Sorbonne, it was found that a crocodile weighing about 120 pounds exerted a force between its jaws at a point corresponding to the insertion of the masseter muscles of 1540 pounds; a dog of 44 pounds exerted a similar force of 363 pounds. It is quite possible that in animals like the tiger and lion the force would equal 1700 or 1800 pounds. The anthropoid apes can easily break a cocoanut with their teeth, and Guyot-Daubes thinks that possibly a gorilla has a jaw-force of 200 pounds. A human adult is said to exert a force of from 45 to 65 pounds between his teeth, and some individuals exceed this average as much as 100 pounds. In Buffon's experiments he once found a Frenchman who could exert a force of 534 pounds with his jaws. In several American circuses there have been seen women who hold themselves by a strap between their teeth while they are being hauled up to a trapeze some distance from the ground. A young mulatto girl by the name of "Miss Kerra" exhibited in the Winter Circus in Paris; suspended from a trapeze, she supported a man at the end of a strap held between her teeth, and even permitted herself to be turned round and round. She also held a cannon in her teeth while it was fired. This feat has been done by several others. According to Guyot-Daubes, at Epernay in 1882, while a man named Bucholtz, called "the human cannon," was performing this feat, the cannon, which was over a yard long and weighed nearly 200 pounds, burst and wounded several of the spectators. There was another Hercules in Paris, who with his teeth lifted and held a heavy cask of water on which was seated a man and varying weights, according to the size of his audience, at the same time keeping his hands occupied with other weights. Figure 185 represents a well-known modern exhibitionist lifting with his teeth a cask on which are seated four men. The celebrated Mlle. Gauthier, an actress of the Comedie-Francais, had marvelous power of her hands, bending coins, rolling up silver plate, and performing divers other feats. Major Barsaba had enormous powers of hand and fingers. He could roll a silver plate into the shape of a goblet. Being challenged by a Gascon, he seized the hand of his unsuspecting adversary in the ordinary manner of salutation and crushed all the bones of the fingers, thus rendering unnecessary any further trial of strength. It is said that Marshal Saxe once visited a blacksmith ostensibly to have his horse shod, and seeing no shoe ready he took a bar of iron, and with his hands fashioned it into a horseshoe. There are Japanese dentists who extract teeth with their wonderfully developed fingers. There are stories of a man living in the village of Cantal who received the sobriquet of "La Coupia" (The Brutal). He would exercise his function as a butcher by strangling with his fingers the calves and sheep, instead of killing them in the ordinary manner. It is said that one day, by placing his hands on the shoulders of the strong man of a local fair, he made him faint by the pressure exerted by his fingers. Manual strangulation is a well-known crime and is quite popular in some countries. The Thugs of India sometimes murdered their victims in this way. Often such force is exerted by the murderer's fingers as to completely fracture the cricoid cartilage. In viewing the feats of strength of the exhibitionist we must bear in consideration the numerous frauds perpetrated. A man of extraordinary strength sometimes finds peculiar stone, so stratified that he is able to break it with the force he can exert by a blow from the hand alone, although a man of ordinary strength would try in vain. In most of these instances, if one were to take a piece of the exhibitionist's stone, he would find that a slight tap of the hammer would break it. Again, there are many instances in which the stone has been found already separated and fixed quite firmly together, placing it out of the power of an ordinary man to break, but which the exhibitionist finds within his ability. This has been the solution of the feats of many of the individuals who invite persons to send them marked stones to use at their performances. By skilfully arranging stout twine on the hands, it is surprising how easily it is broken, and there are many devices and tricks to deceive the public, all of which are more or less used by "strong men." The recent officially recorded feats of strength that stand unequaled in the last decade are as follows:-- Weight-lifting.--Hands alone 1571 1/4 pounds, done by C. G. Jefferson, an amateur, at Clinton, Mass December 10, 1890; with harness, 3239 pounds, by W B. Curtis, at New York December 20 1868; Louis Cyr, at Berthierville, Can., October 1, 1888, pushed up 3536 pounds of pig-iron with his back, arms, and legs. Dumb-bells.--H. Pennock, in New York, 1870, put up a 10-pound dumb-bell 8431 times in four hours thirty-four minutes; by using both hands to raise it to the shoulder, and then using one hand alone, R. A. Pennell, in New York, January 31, 1874, managed to put up a bell weighing 201 pounds 5 ounces; and Eugene Sandow, at London, February 11, 1891, surpassed this feat with a 250-pound bell. Throwing 16-pound hammer.--J. S. Mitchell, at Travers Island, N. Y., October 8, 1892, made a record-throw of 145 feet 3/4 inch. Putting 16-pound Shot.--George R. Gray, at Chicago, September 16, 1893, made the record of 47 feet. Throwing 50-pound Weight.--J. S. Mitchell, at New York, September 22, 1894, made the distance record of 35 feet 10 inches; and at Chicago, September 16, 1893, made the height record of 15 feet 4 1/2 inches. The class of people commonly known as contortionists by the laxity of their muscles and ligaments are able to dislocate or preternaturally bend their joints. In entertainments of an arena type and even in what are now called "variety performances" are to be seen individuals of this class. These persons can completely straddle two chairs, and do what they call "the split;" they can place their foot about their neck while maintaining the upright position; they can bend almost double at the waist in such a manner that the back of the head will touch the calves, while the legs are perpendicular with the ground; they can bring the popliteal region over their shoulders and in this position walk on their hands; they can put themselves in a narrow barrel; eat with a fork attached to a heel while standing on their hands, and perform divers other remarkable and almost incredible feats. Their performances are genuine, and they are real physiologic curiosities. Plate 6 represents two well-known contortionists in their favorite feats. Wentworth, the oldest living contortionist, is about seventy years of age, but seems to have lost none of his earlier sinuosity. His chief feat is to stow himself away in a box 23 X 29 X 16 inches. When inside, six dozen wooden bottles of the same size and shape as those which ordinarily contain English soda water are carefully stowed away, packed in with him, and the lid slammed down. He bestows upon this act the curious and suggestive name of "Packanatomicalization." Another class of individuals are those who can either partially or completely dislocate the major articulations of the body. Many persons exhibit this capacity in their fingers. Persons vulgarly called "double jointed" are quite common. Charles Warren, an American contortionist, has been examined by several medical men of prominence and descriptions of him have appeared from time to time in prominent medical journals. When he was but a child he was constantly tumbling down, due to the heads of the femurs slipping from the acetabula, but reduction was always easy. When eight years old he joined a company of acrobats and strolling performers, and was called by the euphonious title of "the Yankee dish-rag." His muscular system was well-developed, and, like Sandow, he could make muscles act in concert or separately. He could throw into energetic single action the biceps, the supinator longus, the radial extensors, the platysma myoides, and many other muscles. When he "strings," as he called it, the sartorius, that ribbon muscle shows itself as a tight cord, extending from the front of the iliac spine to the inner side of the knee. Another trick was to leave flaccid that part of the serratus magnus which is attached to the inferior angle of the scapula whilst he roused energetic contraction in the rhomboids. He could displace his muscles so that the lower angles of the scapulae projected and presented the appearance historically attributed to luxation of the scapula. Warren was well informed on surgical landmarks and had evidently been a close student of Sir Astley Cooper's classical illustrations of dislocations. He was able so to contract his abdominal muscles that the aorta could be distinctly felt with the fingers. In this feat nearly all the abdominal contents were crowded beneath the diaphragm. On the other hand, he could produce a phantom abdominal tumor by driving the coils of the intestine within a peculiar grasp of the rectus and oblique muscles. The "growth" was rounded, dull on percussion, and looked as if an exploratory incision or puncture would be advisable for diagnosis. By extraordinary muscular power and extreme laxity of his ligaments, he simulated all the dislocations about the hip joint. Sometimes he produced actual dislocation, but usually he said he could so distort his muscles as to imitate in the closest degree the dislocations. He could imitate the various forms of talipes, in such a way as to deceive an expert. He dislocated nearly every joint in the body with great facility. It was said that he could contract at will both pillars of the fauces. He could contract his chest to 34 inches and expand it to 41 inches. Warren weighed 150 pounds, was a total abstainer, and was the father of two children, both of whom could readily dislocate their hips. In France in 1886 there was shown a man who was called "l'homme protee," or protean man. He had an exceptional power over his muscles. Even those muscles ordinarily involuntary he could exercise at will. He could produce such rigidity of stature that a blow by a hammer on his body fell as though on a block of stone. By his power over his abdominal muscles he could give himself different shapes, from the portly alderman to the lean and haggard student, and he was even accredited with assuming the shape of a "living skeleton." Quatrefages, the celebrated French scientist, examined him, and said that he could shut off the blood from the right side and then from the left side of the body, which feat he ascribed to unilateral muscular action. In 1893 there appeared in Washington, giving exhibitions at the colleges there and at the Emergency Hospital, a man named Fitzgerald, claiming to reside in Harrisburg, Pa., who made his living by exhibiting at medical colleges over the country. He simulated all the dislocations, claiming that they were complete, using manual force to produce and reduce them. He exhibited a thorough knowledge of the pathology of dislocations and of the anatomy of the articulations. He produced the different forms of talipes, as well as all the major hip-dislocations. When interrogated as to the cause of his enormous saphenous veins, which stood out like huge twisted cords under the skin and were associated with venous varicosity on the leg, he said he presumed they were caused by his constantly compressing the saphenous vein at the hip in giving his exhibitions, which in some large cities were repeated several times a day. Endurance of Pain.--The question of the endurance of pain is, necessarily, one of comparison. There is little doubt that in the lower classes the sensation of pain is felt in a much less degree than in those of a highly intellectual and nervous temperament. If we eliminate the element of fear, which always predominates in the lower classes, the result of general hospital observation will show this distinction. There are many circumstances which have a marked influence on pain. Patriotism, enthusiasm, and general excitement, together with pride and natural obstinacy, prove the power of the mind over the body. The tortures endured by prisoners of war, religious martyrs and victims, exemplify the power of a strong will excited by deep emotion over the sensation of pain. The flagellants, persons who expiated their sins by voluntarily flaying themselves to the point of exhaustion, are modern examples of persons who in religious enthusiasm inflict pain on themselves. In the ancient times in India the frenzied zealots struggled for positions from which they could throw themselves under the car of the Juggernaut, and their intense emotions turned the pains of their wounds into a pleasure. According to the reports of her Majesty's surgeons, there are at the present time in India native Brahmins who hang themselves on sharp hooks placed in the flesh between the scapulae, and remain in this position without the least visible show of pain. In a similar manner they pierce the lips and cheeks with long pins and bore the tongue with a hot iron. From a reliable source the authors have an account of a man in Northern India who as a means of self-inflicted penance held his arm aloft for the greater part of each day, bending the fingers tightly on the palms. After a considerable time the nails had grown or been forced through the palms of the hands, making their exit on the dorsal surfaces. There are many savage rites and ceremonies calling for the severe infliction of pain on the participants which have been described from time to time by travelers. The Aztecs willingly sacrificed even their lives in the worship of their Sun-god. By means of singing and dancing the Aissaoui, in the Algerian town of Constantine, throw themselves into an ecstatic state in which their bodies seem to be insensible even to severe wounds. Hellwald says they run sharp-pointed irons into their heads, eyes, necks, and breasts without apparent pain or injury to themselves. Some observers claim they are rendered insensible to pain by self-induced hypnotism. An account by Carpenter of the Algerian Aissaoui contained the following lucid description of the performances of these people:-- "The center of the court was given up to the Aissaoui. These were 12 hollow-checked men, some old and some young, who sat cross-legged in an irregular semicircle on the floor. Six of them had immense flat drums or tambours, which they presently began to beat noisily. In front of them a charcoal fire burned in a brazier, and into it one of them from time to time threw bits of some sort of incense, which gradually filled the place with a thin smoke and a mildly pungent odor. "For a long time--it seemed a long time--this went on with nothing to break the silence but the rhythmical beat of the drums. Gradually, however, this had become quicker, and now grew wild and almost deafening, and the men began a monotonous chant which soon was increased to shouting. Suddenly one of the men threw himself with a howl to the ground, when he was seized by another, who stripped him of part of his garments and led him in front of the fire. Here, while the pounding of the drums and the shouts of the men became more and more frantic, he stood swaying his body backward and forward, almost touching the ground in his fearful contortions, and wagging his head until it seemed as if he must dislocate it from his shoulders. All at once he drew from the fire a red-hot bar of iron, and with a yell of horror, which sent a shiver down one's back, held it up before his eyes. More violently than ever he swayed his body and wagged his head, until he had worked himself up to a climax of excitement, when he passed the glowing iron several times over the palm of each hand and then licked it repeatedly with his tongue. He next took a burning coal from the fire, and, placing it between his teeth, fanned it by his breath into a white heat. He ended his part of the performance by treading on red-hot coals scattered on the floor after which he resumed his place with the rest. Then the next performer with a yell as before, suddenly sprang to his feet and began again the same frantic contortions, in the midst of which he snatched from the fire an iron rod with a ball on one end, and after winding one of his eyelids around it until the eyeball was completely exposed, he thrust its point in behind the eye, which was forced far out on his cheek. It was held there for a moment when it was withdrawn, the eye released, and then rubbed vigorously a few times with the balled end of the rod. "The drums all the time had been beaten lustily, and the men had kept up their chant, which still went unceasingly on. Again a man sprang to his feet and went through the same horrid motions. This time the performer took from the fire a sharp nail and, with a piece of the sandy limestone common to this region, proceeded with a series of blood-curdling howls to hammer it down into the top of his head, where it presently stuck upright, while he tottered dizzily around until it was pulled out with apparent effort and with a hollow snap by one of the other men. "The performance had now fairly begun, and, with short intervals and always in the same manner, the frenzied contortions first, another ate up a glass lamp-chimney, which he first broke in pieces in his hands and then crunched loudly with his teeth. He then produced from a tin box a live scorpion, which ran across the floor with tail erect, and was then allowed to attach itself to the back of his hand and his face, and was finally taken into his mouth, where it hung suspended from the inside of his cheek and was finally chewed and swallowed. A sword was next produced, and after the usual preliminaries it was drawn by the same man who had just given the scorpion such unusual opportunities several times back and forth across his throat and neck, apparently deeply imbedded in the flesh. Not content with this, he bared his body at his waist, and while one man held the sword, edge upward, by the hilt and another by the point, about which a turban had been wrapped, he first stood upon it with his bare feet and then balanced himself across it on his naked stomach, while still another of the performers stood upon his back, whither he had sprung without any attempt to mollify the violence of the action. With more yells and genuflections, another now drew from the fire several iron skewers, some of which he thrust into the inner side of his cheeks and others into his throat at the larynx, where they were left for a while to hang. "The last of the actors in this singular entertainment was a stout man with a careworn face, who apparently regarded his share as a melancholy duty which he was bound to perform, and the last part of it, I have no doubt, was particularly painful. He first took a handful of hay, and, having bared the whole upper part of his body, lighted the wisp at the brazier and then passed the blazing mass across his chest and body and over his arms and face. This was but a preliminary, and presently he began to sway backward and forward until one grew dazed with watching him. The drums grew noisier and noisier and the chant louder and wilder. The man himself had become maudlin, his tongue hung from his mouth, and now and then he ejaculated a sound like the inarticulate cry of an animal. He could only totter to the fire, out of which he snatched the balled instrument already described, which he thereupon thrust with a vicious stab into the pit of his stomach, where it was left to hang. A moment after he pulled it out again, and, picking up the piece of stone used before, he drove it with a series of resounding blows into a new place, where it hung, drawing the skin downward with its weight, until a companion pulled it out and the man fell in a heap on the floor." To-day it is only through the intervention of the United States troops that some of the barbarous ceremonies of the North American Indians are suppressed. The episode of the "Ghost-dance" is fresh in every mind. Instances of self-mutilation, although illustrating this subject, will be discussed at length in Chapter XIV. Malingerers often endure without flinching the most arduous tests. Supraorbital pressure is generally of little avail, and pinching, pricking, and even incision are useless with these hospital impostors. It is reported that in the City Hospital of St. Louis a negro submitted to the ammonia-test, inhaling this vapor for several hours without showing any signs of sensibility, and made his escape the moment his guard was absent. A contemporary journal says:-- "The obstinacy of resolute impostors seems, indeed, capable of emulating the torture-proof perseverance of religious enthusiasts and such martyrs of patriotism as Mueius Scaevola or Grand Master Ruediger of the Teutonic Knights, who refused to reveal the hiding place of his companion even when his captors belabored him with red-hot irons. "One Basil Rohatzek, suspected of fraudulent enlistment (bounty-jumping, as our volunteers called it), pretended to have been thrown by his horse and to have been permanently disabled by a paralysis of the lower extremities. He dragged himself along in a pitiful manner, and his knees looked somewhat bruised, but he was known to have boasted his ability to procure his discharge somehow or other. One of his tent mates had also seen him fling himself violently and repeatedly on his knees (to procure those questionable bruises), and on the whole there seemed little doubt that the fellow was shamming. All the surgeons who had examined him concurred in that view, and the case was finally referred to his commanding officer, General Colloredo. The impostor was carried to a field hospital in a little Bohemian border town and watched for a couple of weeks, during which he had been twice seen moving his feet in his sleep. Still, the witnesses were not prepared to swear that those changes of position might not have been effected by a movement of the whole body. The suspect stuck to his assertion, and Colloredo, in a fit of irritation, finally summoned a surgeon, who actually placed the feet of the professed paralytic in "aqua fortis," but even this rigorous method availed the cruel surgeon nothing, and he was compelled to advise dismissal from the service. "The martyrdom of Rohatzek, however, was a mere trifle compared with the ordeal by which the tribunal of Paris tried in vain to extort a confession of the would-be regicide, Damiens. Robert Damiens, a native of Arras, had been exiled as an habitual criminal, and returning in disguise made an attempt upon the life of Louis XV, January 5, 1757. His dagger pierced the mantle of the King, but merely grazed his neck. Damiens, who had stumbled, was instantly seized and dragged to prison, where a convocation of expert torturers exhausted their ingenuity in the attempt to extort a confession implicating the Jesuits, a conspiracy of Huguenots, etc. But Damiens refused to speak. He could have pleaded his inability to name accomplices who did not exist, but he stuck to his resolution of absolute silence. They singed off his skin by shreds, they wrenched out his teeth and finger-joints, they dragged him about at the end of a rope hitched to a team of stout horses, they sprinkled him from head to foot with acids and seething oil, but Damiens never uttered a sound till his dying groan announced the conclusion of the tragedy." The apparent indifference to the pain of a major operation is sometimes marvelous, and there are many interesting instances on record. When at the battle of Dresden in 1813 Moreau, seated beside the Emperor Alexander, had both limbs shattered by a French cannon-ball, he did not utter a groan, but asked for a cigar and smoked leisurely while a surgeon amputated one of his members. In a short time his medical attendants expressed the danger and questionability of saving his other limb, and consulted him. In the calmest way the heroic General instructed them to amputate it, again remaining unmoved throughout the operation. Crompton records a case in which during an amputation of the leg not a sound escaped from the patient's lips, and in three weeks, when it was found necessary to amputate the other leg, the patient endured the operation without an anesthetic, making no show of pain, and only remarking that he thought the saw did not cut well. Crompton quotes another case, in which the patient held a candle with one hand while the operator amputated his other arm at the shoulder-joint. Several instances of self-performed major operations are mentioned in Chapter XIV. Supersensitiveness to Pain.--Quite opposite to the foregoing instances are those cases in which such influences as expectation, naturally inherited nervousness, and genuine supersensitiveness make the slightest pain almost unendurable. In many of these instances the state of the mind and occasionally the time of day have a marked influence. Men noted for their sagacity and courage have been prostrated by fear of pain. Sir Robert Peel, a man of acknowledged superior physical and intellectual power, could not even bear the touch of Brodie's finger to his fractured clavicle. The authors know of an instance of a pugilist who had elicited admiration by his ability to stand punishment and his indomitable courage in his combats, but who fainted from the puncture of a small boil on his neck. The relation of pain to shock has been noticed by many writers. Before the days of anesthesia, such cases as the following, reported by Sir Astley Cooper, seem to have been not unusual: A brewer's servant, a man of middle age and robust frame, suffered much agony for several days from a thecal abscess, occasioned by a splinter of wood beneath the thumb. A few seconds after the matter was discharged by an incision, the man raised himself by a convulsive effort from his bed and instantly expired. It is a well-known fact that powerful nerve-irritation, such as produces shock, is painless, and this accounts for the fact that wounds received during battle are not painful. Leyden of Berlin showed to his class at the Charite Hospital a number of hysteric women with a morbid desire for operation without an anesthetic. Such persons do not seem to experience pain, and, on the contrary, appear to have genuine pleasure in pain. In illustration, Leyden showed a young lady who during a hysteric paroxysm had suffered a serious fracture of the jaw, injuring the facial artery, and necessitating quite an extensive operation. The facial and carotid arteries had to be ligated and part of the inferior maxilla removed, but the patient insisted upon having the operations performed without an anesthetic, and afterward informed the operator that she had experienced great pleasure throughout the whole procedure. Pain as a Means of Sexual Enjoyment.--There is a form of sexual perversion in which the pervert takes delight in being subjected to degrading, humiliating, and cruel acts on the part of his or her associate. It was named masochism from Sacher-Masoch, an Austrian novelist, whose works describe this form of perversion. The victims are said to experience peculiar pleasure at the sight of a rival who has obtained the favor of their mistress, and will even receive blows and lashes from the rival with a voluptuous mixture of pain and pleasure. Masochism corresponds to the passivism of Stefanowski, and is the opposite of sadism, in which the pleasure is derived from inflicting pain on the object of affection. Krafft-Ebing cites several instances of masochism. Although the enjoyment and frenzy of flagellation are well known, its pleasures are not derived from the pain but by the undoubted stimulation offered to the sexual centers by the castigation. The delight of the heroines of flagellation, Maria Magdalena of Pazzi and Elizabeth of Genton, in being whipped on the naked loins, and thus calling up sensual and lascivious fancies, clearly shows the significance of flagellation as a sexual excitant. It is said that when Elizabeth of Genton was being whipped she believed herself united with her ideal and would cry out in the loudest tones of the joys of love. There is undoubtedly a sympathetic communication between the ramifying nerves of the skin of the loins and the lower portion of the spinal cord which contains the sexual centers. Recently, in cases of dysmenorrhea, amenorrhea dysmenorrhagia, and like sexual disorders, massage or gentle flagellation of the parts contiguous with the genitalia and pelvic viscera has been recommended. Taxil is the authority for the statement that just before the sexual act rakes sometimes have themselves flagellated or pricked until the blood flows in order to stimulate their diminished sexual power. Rhodiginus, Bartholinus, and other older physicians mention individuals in whom severe castigation was a prerequisite of copulation. As a ritual custom flagellation is preserved to the present day by some sects. Before leaving the subject of flagellation it should be stated that among the serious after-results of this practice as a disciplinary means, fatal emphysema, severe hemorrhage, and shock have been noticed. There are many cases of death from corporal punishment by flogging. Ballingal records the death of a soldier from flogging; Davidson has reported a similar case, and there is a death from the same cause cited in the Edinburgh Medical and Surgical Journal for 1846. Idiosyncrasy is a peculiarity of constitution whereby an individual is affected by external agents in a different manner from others. Begin defines idiosyncrasy as the predominance of an organ, of a viscus, or a system of organs. This definition does not entirely grasp the subject. An idiosyncrasy is something inherent in the organization of the individual, of which we only see the manifestation when proper causes are set in action. We do not attempt to explain the susceptibility of certain persons to certain foods and certain exposures. We know that such is the fact. According to Begin's idea, there is scarcely any separation between idiosyncrasy and temperament, whereas from what would appear to be sound reasoning, based on the physiology of the subject, a very material difference exists. Idiosyncrasies may be congenital, hereditary, or acquired, and, if acquired, may be only temporary. Some, purely of mental origin, are often readily cured. One individual may synchronously possess an idiosyncrasy of the digestive, circulatory, and nervous systems. Striking examples of transitory or temporary idiosyncrasies are seen in pregnant women. There are certain so-called antipathies that in reality are idiosyncrasies, and which are due to peculiarities of the ideal and emotional centers. The organ of sense in question and the center that takes cognizance of the image brought to it are in no way disordered. In some cases the antipathy or the idiosyncrasy develops to such an extent as to be in itself a species of monomania. The fear-maladies, or "phobias," as they are called, are examples of this class, and, belonging properly under temporary mental derangements, the same as hallucinations or delusions, will be spoken of in another chapter. Possibly the most satisfactory divisions under which to group the material on this subject collected from literature are into examples of idiosyncrasies in which, although the effect is a mystery, the sense is perceptible and the cause distinctly defined and known, and those in which sensibility is latent. The former class includes all the peculiar antipathies which are brought about through the special senses, while the latter groups all those strange instances in which, without the slightest antipathy on the part of the subject, a certain food or drug, after ingestion, produces an untoward effect. The first examples of idiosyncrasies to be noticed will be those manifested through the sense of smell. On the authority of Spigelius, whose name still survives in the nomenclature of the anatomy of the liver, Mackeuzie quotes an extraordinary case in a Roman Cardinal, Oliver Caraffa, who could not endure the smell of a rose. This is confirmed from personal observation by another writer, Pierius, who adds that the Cardinal was obliged every year to shut himself up during the rose season, and guards were stationed at the gates of his palace to stop any visitors who might be wearing the dreadful flower. It is, of course, possible that in this case the rose may not have caused the disturbance, and as it is distinctly stated that it was the smell to which the Cardinal objected, we may fairly conclude that what annoyed him was simply a manifestation of rose-fever excited by the pollen. There is also an instance of a noble Venetian who was always confined to his palace during the rose season. However, in this connection Sir Kenelm Digby relates that so obnoxious was a rose to Lady Heneage, that she blistered her cheek while accidentally lying on one while she slept. Ledelius records the description of a woman who fainted before a red rose, although she was accustomed to wear white ones in her hair. Cremer describes a Bishop who died of the smell of a rose from what might be called "aromatic pain." The organ of smell is in intimate relation with the brain and the organs of taste and sight; and its action may thus disturb that of the esophagus, the stomach, the diaphragm, the intestines, the organs of generation, etc. Odorous substances have occasioned syncope, stupor, nausea, vomiting, and sometimes death. It is said that the Hindoos, and some classes who eat nothing but vegetables, are intensely nauseated by the odors of European tables, and for this reason they are incapable of serving as dining-room servants. Fabricius Hildanus mentions a person who fainted from the odor of vinegar. The Ephemerides contains an instance of a soldier who fell insensible from the odor of a peony. Wagner knew a man who was made ill by the odor of bouillon of crabs. The odors of blood, meat, and fat are repugnant to herbivorous animals. It is a well-known fact that horses detest the odor of blood. Schneider, the father of rhinology, mentions a woman in whom the odor of orange-flowers produced syncope. Odier has known a woman who was affected with aphonia whenever exposed to the odor of musk, but who immediately recovered after taking a cold bath. Dejean has mentioned a man who could not tolerate an atmosphere of cherries. Highmore knew a man in whom the slightest smell of musk caused headache followed by epistaxis. Lanzonius gives an account of a valiant soldier who could neither bear the sight nor smell of an ordinary pink. There is an instance on record in which the odor coming from a walnut tree excited epilepsy. It is said that one of the secretaries of Francis I was forced to stop his nostrils with bread if apples were on the table. He would faint if one was held near his nose Schenck says that the noble family of Fystates in Aquitaine had a similar peculiarity--an innate hatred of apples. Bruyerinus knew a girl of sixteen who could not bear the smell of bread, the slightest particle of which she would detect by its odor. She lived almost entirely on milk. Bierling mentions an antipathy to the smell of musk, and there is a case on record in which it caused convulsions. Boerhaave bears witness that the odor of cheese caused nasal hemorrhage. Whytt mentions an instance in which tobacco became repugnant to a woman each time she conceived, but after delivery this aversion changed to almost an appetite for tobacco fumes. Panaroli mentions an instance of sickness caused by the smell of sassafras, and there is also a record of a person who fell helpless at the smell of cinnamon. Wagner had a patient who detested the odor of citron. Ignorant of this repugnance, he prescribed a potion in which there was water of balm-mint, of an odor resembling citron. As soon as the patient took the first dose he became greatly agitated and much nauseated, and this did not cease until Wagner repressed the balm-mint. There is reported the case of a young woman, rather robust, otherwise normal, who always experienced a desire to go to stool after being subjected to any nasal irritation sufficient to excite sneezing. It has already been remarked that individuals and animals have their special odors, certain of which are very agreeable to some people and extremely unpleasant to others. Many persons are not able to endure the emanations from cats, rats, mice, etc., and the mere fact of one of these animals being in their vicinity is enough to provoke distressing symptoms. Mlle. Contat, the celebrated French actress, was not able to endure the odor of a hare. Stanislaus, King of Poland and Duke of Lorraine, found it impossible to tolerate the smell of a cat. The Ephemerides mentions the odor of a little garden-frog as causing epilepsy. Ab Heers mentions a similar anomaly, fainting caused by the smell of eels. Habit had rendered Haller insensible to the odor of putrefying cadavers, but according to Zimmerman the odor of the perspiration of old people, not perceptible to others, was intolerable to him at a distance of ten or twelve paces. He also had an extreme aversion for cheese. According to Dejan, Gaubius knew a man who was unable to remain in a room with women, having a great repugnance to the female odor. Strange as it may seem, some individuals are incapable of appreciating certain odors. Blumenbach mentions an Englishman whose sense of smell was otherwise very acute, but he was unable to perceive the perfume of the mignonette. The impressions which come to us through the sense of hearing cause sensations agreeable or disagreeable, but even in this sense we see marked examples of idiosyncrasies and antipathies to various sounds and tones. In some individuals the sensations in one ear differ from those of the other. Everard Home has cited several examples, and Heidmann of Vienna has treated two musicians, one of whom always perceived in the affected ear, during damp weather, tones an octave lower than in the other ear. The other musician perceived tones an octave higher in the affected ear. Cheyne is quoted as mentioning a case in which, when the subject heard the noise of a drum, blood jetted from the veins with considerable force. Sauvages has seen a young man in whom intense headache and febrile paroxysm were only relieved by the noise from a beaten drum. Esparron has mentioned an infant in whom an ataxic fever was established by the noise of this instrument. Ephemerides contains an account of a young man who became nervous and had the sense of suffocation when he heard the noise made by sweeping. Zimmerman speaks of a young girl who had convulsions when she heard the rustling of oiled silk. Boyle, the father of chemistry, could not conquer an aversion he had to the sound of water running through pipes. A gentleman of the Court of the Emperor Ferdinand suffered epistaxis when he heard a cat mew. La Mothe Le Vayer could not endure the sounds of musical instruments, although he experienced pleasurable sensations when he heard a clap of thunder. It is said that a chaplain in England always had a sensation of cold at the top of his head when he read the 53d chapter of Isaiah and certain verses of the Kings. There was an unhappy wight who could not hear his own name pronounced without being thrown into convulsions. Marguerite of Valois, sister of Francis I, could never utter the words "mort" or "petite verole," such a horrible aversion had she to death and small-pox. According to Campani, the Chevalier Alcantara could never say "lana," or words pertaining to woolen clothing. Hippocrates says that a certain Nicanor had the greatest horror of the sound of the flute at night, although it delighted him in the daytime. Rousseau reports a Gascon in whom incontinence of urine was produced by the sound of a bagpipe. Frisch, Managetta, and Rousse speak of a man in whom the same effect was produced by the sound of a hurdy-gurdy. Even Shakespeare alludes to the effects of the sound of bagpipes. Tissot mentions a case in which music caused epileptic convulsions, and Forestus mentions a beggar who had convulsions at the sound of a wooden trumpet similar to those used by children in play. Rousseau mentions music as causing convulsive laughter in a woman. Bayle mentions a woman who fainted at the sound of a bell. Paullini cites an instance of vomiting caused by music, and Marcellus Donatus mentions swooning from the same cause. Many people are unable to bear the noise caused by the grating of a pencil on a slate, the filing of a saw, the squeak of a wheel turning about an axle, the rubbing of pieces of paper together, and certain similar sounds. Some persons find the tones of music very disagreeable, and some animals, particularly dogs, are unable to endure it. In Albinus the younger the slightest perceptible tones were sufficient to produce an inexplicable anxiety. There was a certain woman of fifty who was fond of the music of the clarionet and flute, but was not able to listen to the sound of a bell or tambourine. Frank knew a man who ran out of church at the beginning of the sounds of an organ, not being able to tolerate them. Pope could not imagine music producing any pleasure. The harmonica has been noticed to produce fainting in females. Fischer says that music provokes sexual frenzy in elephants. Gutfeldt speaks of a peculiar idiosyncrasy of sleep produced by hearing music. Delisle mentions a young person who during a whole year passed pieces of ascarides and tenia, during which time he could not endure music. Autenreith mentions the vibrations of a loud noise tickling the fauces to such an extent as to provoke vomiting. There are some emotional people who are particularly susceptible to certain expressions. The widow of Jean Calas always fell in a faint when she heard the words of the death-decree sounded on the street. There was a Hanoverian officer in the Indian war against Typoo-Saib, a good and brave soldier, who would feel sick if he heard the word "tiger" pronounced. It was said that he had experienced the ravages of this beast. The therapeutic value of music has long been known. For ages warriors have been led to battle to the sounds of martial strains. David charmed away Saul's evil spirit with his harp. Horace in his 32d Ode Book 1, concludes his address to the lyre:-- "O laborum Dulce lenimen mihicumque calve, Rite vocanti;" Or, as Kiessling of Berlin interprets:-- "O laborum, Dulce lenimen medieumque, salve, Rite vocanti." --"O, of our troubles the sweet, the healing sedative, etc." Homer, Plutarch, Theophrastus, and Galen say that music cures rheumatism, the pests, and stings of reptiles, etc. Diemerbroeck, Bonet, Baglivi, Kercher, and Desault mention the efficacy of melody in phthisis, gout, hydrophobia, the bites of venomous reptiles, etc. There is a case in the Lancet of a patient in convulsions who was cured in the paroxysm by hearing the tones of music. Before the French Academy of Sciences in 1708, and again in 1718, there was an instance of a dancing-master stricken with violent fever and in a condition of delirium, who recovered his senses and health on hearing melodious music. There is little doubt of the therapeutic value of music, but particularly do we find its value in instances of neuroses. The inspiration offered by music is well-known, and it is doubtless a stimulant to the intellectual work. Bacon, Milton, Warburton, and Alfieri needed music to stimulate them in their labors, and it is said that Bourdaloue always played an air on the violin before preparing to write. According to the American Medico-Surgical Bulletin, "Professor Tarchanoff of Saint Petersburg has been investigating the influence of music upon man and other animals. The subject is by no means a new one. In recent times Dagiel and Fere have investigated the effect of music upon the respirations, the pulse, and the muscular system in man. Professor Tarchanoff made use of the ergograph of Mosso, and found that if the fingers were completely fatigued, either by voluntary efforts or by electric excitation, to the point of being incapable of making any mark except a straight line on the registering cylinder, music had the power of making the fatigue disappear, and the finger placed in the ergograph again commenced to mark lines of different heights, according to the amount of excitation. It was also found that music of a sad and lugubrious character had the opposite effect, and could check or entirely inhibit the contractions. Professor Tarchanoff does not profess to give any positive explanation of these facts, but he inclines to the view that 'the voluntary muscles, being furnished with excitomotor and depressant fibers, act in relation to the music similarly to the heart--that is to say, that joyful music resounds along the excitomotor fibers, and sad music along the depressant or inhibitory fibers.' Experiments on dogs showed that music was capable of increasing the elimination of carbonic acid by 16.7 per cent, and of increasing the consumption of oxygen by 20.1 per cent. It was also found that music increased the functional activity of the skin. Professor Tarchanoff claims as the result of these experiments that music may fairly be regarded as a serious therapeutic agent, and that it exercises a genuine and considerable influence over the functions of the body. Facts of this kind are in no way surprising, and are chiefly of interest as presenting some physiologic basis for phenomena that are sufficiently obvious. The influence of the war-chant upon the warrior is known even to savage tribes. We are accustomed to regard this influence simply as an ordinary case of psychic stimuli producing physiologic effects. "Professor Tarchanoff evidently prefers to regard the phenomena as being all upon the same plane, namely, that of physiology; and until we know the difference between mind and body, and the principles of their interaction, it is obviously impossible to controvert this view successfully. From the immediately practical point of view we should not ignore the possible value of music in some states of disease. In melancholia and hysteria it is probably capable of being used with benefit, and it is worth bearing in mind in dealing with insomnia. Classical scholars will not forget that the singing of birds was tried as a remedy to overcome the insomnia of Maecenas. Music is certainly a good antidote to the pernicious habit of introspection and self-analysis, which is often a curse both of the hysteric and of the highly cultured. It would seem obviously preferable to have recourse to music of a lively and cheerful character." Idiosyncrasies of the visual organs are generally quite rare. It is well-known that among some of the lower animals, e.g., the turkey-cocks, buffaloes, and elephants, the color red is unendurable. Buchner and Tissot mention a young boy who had a paroxysm if he viewed anything red. Certain individuals become nauseated when they look for a long time on irregular lines or curves, as, for examples, in caricatures. Many of the older examples of idiosyncrasies of color are nothing more than instances of color-blindness, which in those times was unrecognized. Prochaska knew a woman who in her youth became unconscious at the sight of beet-root, although in her later years she managed to conquer this antipathy, but was never able to eat the vegetable in question. One of the most remarkable forms of idiosyncrasy on record is that of a student who was deprived of his senses by the very sight of an old woman. On one occasion he was carried out from a party in a dying state, caused, presumably, by the abhorred aspect of the chaperons The Count of Caylus was always horror-stricken at the sight of a Capuchin friar. He cured himself by a wooden image dressed in the costume of this order placed in his room and constantly before his view. It is common to see persons who faint at the sight of blood. Analogous are the individuals who feel nausea in an hospital ward. All Robert Boyle's philosophy could not make him endure the sight of a spider, although he had no such aversion to toads, venomous snakes, etc. Pare mentions a man who fainted at the sight of an eel, and another who had convulsions at the sight of a carp. There is a record of a young lady in France who fainted on seeing a boiled lobster. Millingen cites the case of a man who fell into convulsions whenever he saw a spider. A waxen one was made, which equally terrified him. When he recovered, his error was pointed out to him, and the wax figure was placed in his hand without causing dread, and henceforth the living insect no longer disturbed him. Amatus Lusitanus relates the case of a monk who fainted when he beheld a rose, and never quitted his cell when that flower was in bloom. Scaliger, the great scholar, who had been a soldier a considerable portion of his life, confesses that he could not look on a water-cress without shuddering, and remarks: "I, who despise not only iron, but even thunderbolts, who in two sieges (in one of which I commanded) was the only one who did not complain of the food as unfit and horrible to eat, am seized with such a shuddering horror at the sight of a water-cress that I am forced to go away." One of his children was in the same plight as regards the inoffensive vegetable, cabbage. Scaliger also speaks of one of his kinsmen who fainted at the sight of a lily. Vaughheim, a great huntsman of Hanover, would faint at the sight of a roasted pig. Some individuals have been disgusted at the sight of eggs. There is an account of a sensible man who was terrified at the sight of a hedgehog, and for two years was tormented by a sensation as though one was gnawing at his bowels. According to Boyle, Lord Barrymore, a veteran warrior and a person of strong mind, swooned at the sight of tansy. The Duke d'Epernon swooned on beholding a leveret, although a hare did not produce the same effect. Schenck tells of a man who swooned at the sight of pork. The Ephemerides contains an account of a person who lost his voice at the sight of a crab, and also cites cases of antipathy to partridges, a white hen, to a serpent, and to a toad. Lehman speaks of an antipathy to horses; and in his observations Lyser has noticed aversion to the color purple. It is a strange fact that the three greatest generals of recent years, Wellington, Napoleon, and Roberts, could never tolerate the sight of a cat, and Henry III of France could not bear this animal in his room. We learn of a Dane of herculean frame who had a horror of cats. He was asked to a supper at which, by way of a practical joke, a live cat was put on the table in a covered dish. The man began to sweat and shudder without knowing why, and when the cat was shown he killed his host in a paroxysm of terror. Another man could not even see the hated form even in a picture without breaking into a cold sweat and feeling a sense of oppression about the heart. Quercetanus and Smetius mention fainting at the sight of cats. Marshal d'Abret was supposed to be in violent fear of a pig. As to idiosyncrasies of the sense of touch, it is well known that some people cannot handle velvet or touch the velvety skin of a peach without having disagreeable and chilly sensations come over them. Prochaska knew a man who vomited the moment he touched a peach, and many people, otherwise very fond of this fruit, are unable to touch it. The Ephemerides speaks of a peculiar idiosyncrasy of skin in the axilla of a certain person, which if tickled would provoke vomiting. It is occasionally stated in the older writings that some persons have an idiosyncrasy as regards the phases of the sun and moon. Baillou speaks of a woman who fell unconscious at sunset and did not recover till it reappeared on the horizon. The celebrated Chancellor Bacon, according to Mead, was very delicate, and was accustomed to fall into a state of great feebleness at every moon-set without any other imaginable cause. He never recovered from his swooning until the moon reappeared. Nothing is more common than the idiosyncrasy which certain people display for certain foods. The trite proverb, "What is one man's meat is another man's poison," is a genuine truth, and is exemplified by hundreds of instances. Many people are unable to eat fish without subsequent disagreeable symptoms. Prominent among the causes of urticaria are oysters, crabs, and other shell fish, strawberries, raspberries, and other fruits. The abundance of literature on this subject makes an exhaustive collection of data impossible, and only a few of the prominent and striking instances can be reported. Amatus Lusitanus speaks of vomiting and diarrhea occurring each time a certain Spaniard ate meat. Haller knew a person who was purged violently by syrup of roses. The son of one of the friends of Wagner would vomit immediately after the ingestion of any substance containing honey. Bayle has mentioned a person so susceptible to honey that by a plaster of this substance placed upon the skin this untoward effect was produced. Whytt knew a woman who was made sick by the slightest bit of nutmeg. Tissot observed vomiting in one of his friends after the ingestion of the slightest amount of sugar. Ritte mentions a similar instance. Roose has seen vomiting produced in a woman by the slightest dose of distilled water of linden. There is also mentioned a person in whom orange-flower water produced the same effect. Dejean cites a case in which honey taken internally or applied externally acted like poison. It is said that the celebrated Haen would always have convulsions after eating half a dozen strawberries. Earle and Halifax attended a child for kidney-irritation produced by strawberries, and this was the invariable result of the ingestion of this fruit. The authors personally know of a family the male members of which for several generations could not eat strawberries without symptoms of poisoning. The female members were exempt from the idiosyncrasy. A little boy of this family was killed by eating a single berry. Whytt mentions a woman of delicate constitution and great sensibility of the digestive tract in whom foods difficult of digestion provoked spasms, which were often followed by syncopes. Bayle describes a man who vomited violently after taking coffee. Wagner mentions a person in whom a most insignificant dose of manna had the same effect. Preslin speaks of a woman who invariably had a hemorrhage after swallowing a small quantity of vinegar. According to Zimmerman, some people are unable to wash their faces on account of untoward symptoms. According to Ganbius, the juice of a citron applied to the skin of one of his acquaintances produced violent rigors. Brasavolus says that Julia, wife of Frederick, King of Naples, had such an aversion to meat that she could not carry it to her mouth without fainting. The anatomist Gavard was not able to eat apples without convulsions and vomiting. It is said that Erasmus was made ill by the ingestion of fish; but this same philosopher, who was cured of a malady by laughter, expressed his appreciation by an elegy on the folly. There is a record of a person who could not eat almonds without a scarlet rash immediately appearing upon the face. Marcellus Donatus knew a young man who could not eat an egg without his lips swelling and purple spots appearing on his face. Smetius mentions a person in whom the ingestion of fried eggs was often followed by syncope. Brunton has seen a case of violent vomiting and purging after the slightest bit of egg. On one occasion this person was induced to eat a small morsel of cake on the statement that it contained no egg, and, although fully believing the words of his host, he subsequently developed prominent symptoms, due to the trace of egg that was really in the cake. A letter from a distinguished litterateur to Sir Morell Mackenzie gives a striking example of the idiosyncrasy to eggs transmitted through four generations. Being from such a reliable source, it has been deemed advisable to quote the account in full: "My daughter tells me that you are interested in the ill-effects which the eating of eggs has upon her, upon me, and upon my father before us. I believe my grandfather, as well as my father, could not eat eggs with impunity. As to my father himself, he is nearly eighty years old; he has not touched an egg since he was a young man; he can, therefore, give no precise or reliable account of the symptoms the eating of eggs produce in him. But it was not the mere 'stomach-ache' that ensued, but much more immediate and alarming disturbances. As for me, the peculiarity was discovered when I was a spoon-fed child. On several occasions it was noticed (that is my mother's account) that I felt ill without apparent cause; afterward it was recollected that a small part of a yolk of an egg had been given to me. Eclaircissement came immediately after taking a single spoonful of egg. I fell into such an alarming state that the doctor was sent for. The effect seems to have been just the same that it produces upon my daughter now,--something that suggested brain-congestion and convulsions. From time to time, as a boy and a young man, I have eaten an egg by way of trying it again, but always with the same result--a feeling that I had been poisoned; and yet all the while I liked eggs. Then I never touched them for years. Later I tried again, and I find the ill-effects are gradually wearing off. With my daughter it is different; she, I think, becomes more susceptible as time goes on, and the effect upon her is more violent than in my case at any time. Sometimes an egg has been put with coffee unknown to her, and she has been seen immediately afterward with her face alarmingly changed--eyes swollen and wild, the face crimson, the look of apoplexy. This is her own account: 'An egg in any form causes within a few minutes great uneasiness and restlessness, the throat becomes contracted and painful, the face crimson, and the veins swollen. These symptoms have been so severe as to suggest that serious consequences might follow.' To this I may add that in her experience and my own, the newer the egg, the worse the consequences." Hutchinson speaks of a Member of Parliament who had an idiosyncrasy as regards parsley. After the ingestion of this herb in food he always had alarming attacks of sickness and pain in the abdomen, attended by swelling of the tongue and lips and lividity of the face. This same man could not take the smallest quantity of honey, and certain kinds of fruit always poisoned him. There was a collection of instances of idiosyncrasy in the British Medical Journal, 1859, which will be briefly given in the following lines: One patient could not eat rice in any shape without extreme distress. From the description given of his symptoms, spasmodic asthma seemed to be the cause of his discomfort. On one occasion when at a dinner-party he felt the symptoms of rice-poisoning come on, and, although he had partaken of no dish ostensibly containing rice, was, as usual, obliged to retire from the table. Upon investigation it appeared that some white soup with which he had commenced his meal had been thickened with ground rice. As in the preceding case there was another gentleman who could not eat rice without a sense of suffocation. On one occasion he took lunch with a friend in chambers, partaking only of simple bread and cheese and bottled beer. On being seized with the usual symptoms of rice-poisoning he informed his friend of his peculiarity of constitution, and the symptoms were explained by the fact that a few grains of rice had been put into each bottle of beer for the purpose of exciting a secondary fermentation. The same author speaks of a gentleman under treatment for stricture who could not eat figs without experiencing the most unpleasant formication of the palate and fauces. The fine dust from split peas caused the same sensation, accompanied with running at the nose; it was found that the father of the patient suffered from hay-fever in certain seasons. He also says a certain young lady after eating eggs suffered from swelling of the tongue and throat, accompanied by "alarming illness," and there is recorded in the same paragraph a history of another young girl in whom the ingestion of honey, and especially honey-comb, produced swelling of the tongue, frothing of the mouth, and blueness of the fingers. The authors know of a gentleman in whom sneezing is provoked on the ingestion of chocolate in any form. There was another instance--in a member of the medical profession--who suffered from urticaria after eating veal. Veal has the reputation of being particularly indigestible, and the foregoing instance of the production of urticaria from its use is doubtless not an uncommon one. Overton cites a striking case of constitutional peculiarity or idiosyncrasy in which wheat flour in any form, the staff of life, an article hourly prayed for by all Christian nations as the first and most indispensable of earthly blessings, proved to one unfortunate individual a prompt and dreadful poison. The patient's name was David Waller, and he was born in Pittsylvania County, Va., about the year 1780. He was the eighth child of his parents, and, together with all his brothers and sisters, was stout and healthy. At the time of observation Waller was about fifty years of age. He had dark hair, gray eyes, dark complexion, was of bilious and irascible temperament, well formed, muscular and strong, and in all respects healthy as any man, with the single exception of his peculiar idiosyncrasy. He had been the subject of but few diseases, although he was attacked by the epidemic of 1816. From the history of his parents and an inquiry into the health of his ancestry, nothing could be found which could establish the fact of heredity in his peculiar disposition. Despite every advantage of stature, constitution, and heredity, David Waller was through life, from his cradle to his grave, the victim of what is possibly a unique idiosyncrasy of constitution. In his own words he declared: "Of two equal quantities of tartar and wheat flour, not more than a dose of the former, he would rather swallow the tartar than the wheat flour." If he ate flour in any form or however combined, in the smallest quantity, in two minutes or less he would have painful itching over the whole body, accompanied by severe colic and tormina in the bowels, great sickness in the stomach, and continued vomiting, which he declared was ten times as distressing as the symptoms caused by the ingestion of tartar emetic. In about ten minutes after eating the flour the itching would be greatly intensified, especially about the head, face, and eyes, but tormenting all parts of the body, and not to be appeased. These symptoms continued for two days with intolerable violence, and only declined on the third day and ceased on the tenth. In the convalescence, the lungs were affected, he coughed, and in expectoration raised great quantities of phlegm, and really resembled a phthisical patient. At this time he was confined to his room with great weakness, similar to that of a person recovering from an asthmatic attack. The mere smell of wheat produced distressing symptoms in a minor degree, and for this reason he could not, without suffering, go into a mill or house where the smallest quantity of wheat flour was kept. His condition was the same from the earliest times, and he was laid out for dead when an infant at the breast, after being fed with "pap" thickened with wheat flour. Overton remarks that a case of constitutional peculiarity so little in harmony with the condition of other men could not be received upon vague or feeble evidence, and it is therefore stated that Waller was known to the society in which he lived as an honest and truthful man. One of his female neighbors, not believing in his infirmity, but considering it only a whim, put a small quantity of flour in the soup which she gave him to eat at her table, stating that it contained no flour, and as a consequence of the deception he was bed-ridden for ten days with his usual symptoms. It was also stated that Waller was never subjected to militia duty because it was found on full examination of his infirmity that he could not live upon the rations of a soldier, into which wheat flour enters as a necessary ingredient. In explanation of this strange departure from the condition of other men, Waller himself gave a reason which was deemed equivalent in value to any of the others offered. It was as follows: His father being a man in humble circumstances in life, at the time of his birth had no wheat with which to make flour, although his mother during gestation "longed" for wheat-bread. The father, being a kind husband and responsive to the duty imposed by the condition of his wife, procured from one of his opulent neighbors a bag of wheat and sent it to the mill to be ground. The mother was given much uneasiness by an unexpected delay at the mill, and by the time the flour arrived her strong appetite for wheat-bread had in a great degree subsided. Notwithstanding this, she caused some flour to be immediately baked into bread and ate it, but not so freely as she had expected The bread thus taken caused intense vomiting and made her violently and painfully ill, after which for a considerable time she loathed bread. These facts have been ascribed as the cause of the lamentable infirmity under which the man labored, as no other peculiarity or impression in her gestation was noticed. In addition it may be stated that for the purpose of avoiding the smell of flour Waller was in the habit of carrying camphor in his pocket and using snuff, for if he did not smell the flour, however much might be near him, it was as harmless to him as to other men. The authors know of a case in which the eating of any raw fruit would produce in a lady symptoms of asthma; cooked fruit had no such effect. Food-Superstitions.--The superstitious abhorrence and antipathy to various articles of food that have been prevalent from time to time in the history of the human race are of considerable interest and well deserve some mention here. A writer in a prominent journal has studied this subject with the following result:-- "From the days of Adam and Eve to the present time there has been not only forbidden fruit, but forbidden meats and vegetables. For one reason or another people have resolutely refused to eat any and all kinds of flesh, fish, fowl, fruits, and plants. Thus, the apple, the pear, the strawberry, the quince, the bean, the onion, the leek, the asparagus, the woodpecker, the pigeon, the goose, the deer, the bear, the turtle, and the eel--these, to name only a few eatables, have been avoided as if unwholesome or positively injurious to health and digestion. "As we all know, the Jews have long had an hereditary antipathy to pork. On the other hand, swine's flesh was highly esteemed by the ancient Greeks and Romans. This fact is revealed by the many references to pig as a dainty bit of food. At the great festival held annually in honor of Demeter, roast pig was the piece de resistance in the bill of fare, because the pig was the sacred animal of Demeter. Aristophanes in 'The Frogs' makes one of the characters hint that some of the others 'smell of roast pig.' These people undoubtedly had been at the festival (known as the Thesmophoria) and had eaten freely of roast pig, Those who took part in another Greek mystery or festival (known as the Eleusinia) abstained from certain food, and above all from beans. "Again, as we all know, mice are esteemed in China and in some parts of India. But the ancient Egyptians, Greeks, and Jews abhorred mice and would not touch mouse-meat. Rats and field-mice were sacred in Old Egypt, and were not to be eaten on this account. So, too, in some parts of Greece, the mouse was the sacred animal of Apollo, and mice were fed in his temples. The chosen people were forbidden to eat 'the weasel, and the mouse, and the tortoise after his kind.' These came under the designation of unclean animals, which were to be avoided. "But people have abstained from eating kinds of flesh which could not be called unclean. For example, the people of Thebes, as Herodotus tells us, abstained from sheep. Then, the ancients used to abstain from certain vegetables. In his 'Roman Questions' Plutarch asks: 'Why do the Latins abstain strictly from the flesh of the woodpecker?' In order to answer Plutarch's question correctly it is necessary to have some idea of the peculiar custom and belief called 'totemism.' There is a stage of society in which people claim descent from and kinship with beasts, birds, vegetables, and other objects. This object, which is a 'totem,' or family mark, they religiously abstain from eating. The members of the tribe are divided into clans or stocks, each of which takes the name of some animal, plant, or object, as the bear, the buffalo, the woodpecker, the asparagus, and so forth. No member of the bear family would dare to eat bear-meat, but he has no objection to eating buffalo steak. Even the marriage law is based on this belief, and no man whose family name is Wolf may marry a woman whose family name is also Wolf. "In a general way it may be said that almost all our food prohibitions spring from the extraordinary custom generally called totemism. Mr. Swan, who was missionary for many years in the Congo Free State, thus describes the custom: 'If I were to ask the Yeke people why they do not eat zebra flesh, they would reply, 'Chijila,' i.e., 'It is a thing to which we have an antipathy;' or better, 'It is one of the things which our fathers taught us not to eat.' So it seems the word 'Bashilang' means 'the people who have an antipathy to the leopard;' the 'Bashilamba,' 'those who have an antipathy to the dog,' and the 'Bashilanzefu,' 'those who have an antipathy to the elephant.' In other words, the members of these stocks refuse to eat their totems, the zebra, the leopard, or the elephant, from which they take their names. "The survival of antipathy to certain foods was found among people as highly civilized as the Egyptians, the Greeks, and the Romans. Quite a list of animals whose flesh was forbidden might be drawn up. For example, in Old Egypt the sheep could not be eaten in Thebes, nor the goat in Mendes, nor the cat in Bubastis, nor the crocodile at Ombos, nor the rat, which was sacred to Ra, the sun-god. However, the people of one place had no scruples about eating the forbidden food of another place. And this often led to religious disputes. "Among the vegetables avoided as food by the Egyptians may be mentioned the onion, the garlic, and the leek. Lucian says that the inhabitants of Pelusium adored the onion. According to Pliny the Egyptians relished the leek and the onion. Juvenal exclaims: 'Surely a very religious nation, and a blessed place, where every garden is overrun with gods!' The survivals of totemism among the ancient Greeks are very interesting. Families named after animals and plants were not uncommon. One Athenian gens, the Ioxidae, had for its ancestral plant the asparagus. One Roman gens, the Piceni, took a woodpecker for its totem, and every member of this family refused, of course, to eat the flesh of the woodpecker. In the same way as the nations of the Congo Free State, the Latins had an antipathy to certain kinds of food. However, an animal or plant forbidden in one place was eaten without any compunction in another place. 'These local rites in Roman times,' says Mr. Lang, 'caused civil brawls, for the customs of one town naturally seemed blasphemous to neighbors with a different sacred animal. Thus when the people of dog-town were feeding on the fish called oxyrrhyncus, the citizens of the town which revered the oxyrrhyncus began to eat dogs. Hence arose a riot.' The antipathy of the Jews to pork has given rise to quite different explanations. The custom is probably a relic of totemistic belief. That the unclean animals--animals not to be eaten--such as the pig, the mouse, and the weasel, were originally totems of the children of Israel, Professor Robertson Smith believes is shown by various passages in the Old Testament. "When animals and plants ceased to be held sacred they were endowed with sundry magical or mystic properties. The apple has been supposed to possess peculiar virtues, especially in the way of health. 'The relation of the apple to health,' says Mr. Conway, 'is traceable to Arabia. Sometimes it is regarded as a bane. In Hessia it is said an apple must not be eaten on New Year's Day, as it will produce an abscess. But generally it is curative. In Pomerania it is eaten on Easter morning against fevers; in Westphalia (mixed with saffron) against jaundice; while in Silesia an apple is scraped from top to stalk to cure diarrhea, and upward to cure costiveness.' According to an old English fancy, if any one who is suffering from a wound in the head should eat strawberries it will lead to fatal results. In the South of England the folk say that the devil puts his cloven foot upon the blackberries on Michaelmas Day, and hence none should be gathered or eaten after that day. On the other hand, in Scotland the peasants say that the devil throws his cloak over the blackberries and makes them unwholesome after that day, while in Ireland he is said to stamp on the berries. Even that humble plant, the cabbage, has been invested with some mystery. It was said that the fairies were fond of its leaves, and rode to their midnight dances on cabbage-stalks. The German women used to say that 'Babies come out of the cabbage-heads.' The Irish peasant ties a cabbage-leaf around the neck for sore throat. According to Gerarde, the Spartans ate watercress with their bread, firmly believing that it increased their wit and wisdom. The old proverb is, 'Eat cress to learn more wit.' "There is another phase to food-superstitions, and that is the theory that the qualities of the eaten pass into the eater. Mr. Tylor refers to the habit of the Dyak young men in abstaining from deer-meat lest it should make them timid, while the warriors of some South American tribes eat the meat of tigers, stags, and boars for courage and speed. He mentions the story of an English gentleman at Shanghai who at the time of the Taeping attack met his Chinese servant carrying home the heart of a rebel, which he intended to eat to make him brave. There is a certain amount of truth in the theory that the quality of food does affect the mind and body. Buckle in his 'History of Civilization' took this view, and tried to prove that the character of a people depends on their diet." Idiosyncrasies to Drugs.--In the absorption and the assimilation of drugs idiosyncrasies are often noted; in fact, they are so common that we can almost say that no one drug acts in the same degree or manner on different individuals. In some instances the untoward action assumes such a serious aspect as to render extreme caution necessary in the administration of the most inert substances. A medicine ordinarily so bland as cod-liver oil may give rise to disagreeable eruptions. Christison speaks of a boy ten years old who was said to have been killed by the ingestion of two ounces of Epsom salts without inducing purgation; yet this common purge is universally used without the slightest fear or caution. On the other hand, the extreme tolerance exhibited by certain individuals to certain drugs offers a new phase of this subject. There are well-authenticated cases on record in which death has been caused in children by the ingestion of a small fraction of a grain of opium. While exhibiting especial tolerance from peculiar disposition and long habit, Thomas De Quincey, the celebrated English litterateur, makes a statement in his "Confessions" that with impunity he took as much as 320 grains of opium a day, and was accustomed at one period of his life to call every day for "a glass of laudanum negus, warm, and without sugar," to use his own expression, after the manner a toper would call for a "hot-Scotch." The individuality noted in the assimilation and the ingestion of drugs is functional as well as anatomic. Numerous cases have been seen by all physicians. The severe toxic symptoms from a whiff of cocain-spray, the acute distress from the tenth of a grain of morphin, the gastric crises and profuse urticarial eruptions following a single dose of quinin,--all are proofs of it. The "personal equation" is one of the most important factors in therapeutics, reminding us of the old rule, "Treat the patient, not the disease." The idiosyncrasy may be either temporary or permanent, and there are many conditions that influence it. The time and place of administration; the degree of pathologic lesion in the subject; the difference in the physiologic capability of individual organs of similar nature in the same body; the degree of human vitality influencing absorption and resistance; the peculiar epochs of life; the element of habituation, and the grade and strength of the drug, influencing its virtue,--all have an important bearing on untoward action and tolerance of poisons. It is not in the province of this work to discuss at length the explanations offered for these individual idiosyncrasies. Many authors have done so, and Lewin has devoted a whole volume to this subject, of which, fortunately, an English translation has been made by Mulheron, and to these the interested reader is referred for further information. In the following lines examples of idiosyncrasy to the most common remedial substances will be cited, taking the drugs up alphabetically. Acids.--Ordinarily speaking, the effect of boric acid in medicinal doses on the human system is nil, an exceptionally large quantity causing diuresis. Binswanger, according to Lewin, took eight gm. in two doses within an hour, which was followed by nausea, vomiting, and a feeling of pressure and fulness of the stomach which continued several hours. Molodenkow mentions two fatal cases from the external employment of boric acid as an antiseptic. In one case the pleural cavity was washed out with a five per cent solution of boric acid and was followed by distressing symptoms, vomiting, weak pulse, erythema, and death on the third day. In the second case, in a youth of sixteen, death occurred after washing out a deep abscess of the nates with the same solution. The autopsy revealed no change or signs indicative of the cause of death. Hogner mentions two instances of death from the employment of 2 1/2 per cent solution of boric acid in washing out a dilated stomach The symptoms were quite similar to those mentioned by Molodenkow. In recent years the medical profession has become well aware that in its application to wounds it is possible for carbolic acid or phenol to exercise exceedingly deleterious and even fatal consequences. In the earlier days of antisepsis, when operators and patients were exposed for some time to an atmosphere saturated with carbolic spray, toxic symptoms were occasionally noticed. Von Langenbeck spoke of severe carbolic-acid intoxication in a boy in whom carbolic paste had been used in the treatment of abscesses. The same author reports two instances of death following the employment of dry carbolized dressings after slight operations. Kohler mentions the death of a man suffering from scabies who had applied externally a solution containing about a half ounce of phenol. Rose spoke of gangrene of the finger after the application of carbolized cotton to a wound thereon. In some cases phenol acts with a rapidity equal to any poison. Taylor speaks of a man who fell unconscious ten seconds after an ounce of phenol had been ingested, and in three minutes was dead. There is recorded an account of a man of sixty-four who was killed by a solution containing slightly over a dram of phenol. A half ounce has frequently caused death; smaller quantities have been followed by distressing symptoms, such as intoxication (which Olshausen has noticed to follow irrigation of the uterus), delirium, singultus, nausea, rigors, cephalalgia, tinnitus aurium, and anasarca. Hind mentions recovery after the ingestion of nearly six ounces of crude phenol of 14 per cent strength. There was a case at the Liverpool Northern Hospital in which recovery took place after the ingestion with suicidal intent of four ounces of crude carbolic acid. Quoted by Lewin, Busch accurately describes a case which may be mentioned as characteristic of the symptoms of carbolism. A boy, suffering from abscess under the trochanter, was operated on for its relief. During the few minutes occupied by the operation he was kept under a two per cent carbolic spray, and the wound was afterward dressed with carbolic gauze. The day following the operation he was seized with vomiting, which was attributed to the chloroform used as an anesthetic. On the following morning the bandages were removed under the carbolic spray; during the day there was nausea, in the evening there was collapse, and carbolic acid was detected in the urine. The pulse became small and frequent and the temperature sank to 35.5 degrees C. The frequent vomiting made it impossible to administer remedies by the stomach, and, in spite of hypodermic injections and external application of analeptics, the boy died fifty hours after operation. Recovery has followed the ingestion of an ounce of officinal hydrochloric acid. Black mentions a man of thirty-nine who recovered after swallowing 1 1/2 ounces of commercial hydrochloric acid. Johnson reports a case of poisoning from a dram of hydrochloric acid. Tracheotomy was performed, but death resulted. Burman mentions recovery after the ingestion of a dram of dilute hydrocyanic acid of Scheele's strength (2.4 am. of the acid). In this instance insensibility did not ensue until two minutes after taking the poison, the retarded digestion being the means of saving life. Quoting Taafe, in 1862 Taylor speaks of the case of a man who swallowed the greater part of a solution containing an ounce of potassium cyanid. In a few minutes the man was found insensible in the street, breathing stertorously, and in ten minutes after the ingestion of the drug the stomach-pump was applied. In two hours vomiting began, and thereafter recovery was rapid. Mitscherlich speaks of erosion of the gums and tongue with hemorrhage at the slightest provocation, following the long administration of dilute nitric acid. This was possibly due to the local action. According to Taylor, the smallest quantity of oxalic acid causing death is one dram. Ellis describes a woman of fifty who swallowed an ounce of oxalic acid in beer. In thirty minutes she complained of a burning pain in the stomach and was rolling about in agony. Chalk and water was immediately given to her and she recovered. Woodman reports recovery after taking 1/2 ounce of oxalic acid. Salicylic acid in medicinal doses frequently causes untoward symptoms, such as dizziness, transient delirium, diminution of vision, headache, and profuse perspiration; petechial eruptions and intense gastric symptoms have also been noticed. Sulphuric acid causes death from its corrosive action, and when taken in excessive quantities it produces great gastric disturbance; however, there are persons addicted to taking oil of vitriol without any apparent untoward effect. There is mentioned a boot-maker who constantly took 1/2 ounce of the strong acid in a tumbler of water, saying that it relieved his dyspepsia and kept his bowels open. Antimony.--It is recorded that 3/4 grain of tartar emetic has caused death in a child and two grains in an adult. Falot reports three cases in which after small doses of tartar emetic there occurred vomiting, delirium, spasms, and such depression of vitality that only the energetic use of stimulants saved life. Beau mentions death following the administration of two doses of 1 1/2 gr. of tartar emetic. Preparations of antimony in an ointment applied locally have caused necrosis, particularly of the cranium, and Hebra has long since denounced the use of tartar emetic ointment in affections of the scalp. Carpenter mentions recovery after ingestion of two drams of tartar emetic. Behrends describes a case of catalepsy with mania, in which a dose of 40 gr. of tartar emetic was tolerated, and Morgagni speaks of a man who swallowed two drams, immediately vomited, and recovered. Instances like the last, in which an excessive amount of a poison by its sudden emetic action induces vomiting before there is absorption of a sufficient quantity to cause death, are sometimes noticed. McCreery mentions a case of accidental poisoning with half an ounce of tartar emetic successfully treated with green tea and tannin. Mason reports recovery after taking 80 gr. of tartar emetic. Arsenic.--The sources of arsenical poisoning are so curious as to deserve mention. Confectionery, wall-paper, dyes, and the like are examples. In other cases we note money-counting, the colored candles of a Christmas tree, paper collars, ball-wreaths of artificial flowers, ball-dresses made of green tarlatan, playing cards, hat-lining, and fly-papers. Bazin has reported a case in which erythematous pustules appeared after the exhibition during fifteen days of the 5/6 gr. of arsenic. Macnal speaks of an eruption similar to that of measles in a patient to whom he had given but three drops of Fowler's solution for the short period of three days. Pareira says that in a gouty patient for whom he prescribed 1/6 gr. of potassium arseniate daily, on the third day there appeared a bright red eruption of the face, neck, upper part of the trunk and flexor surfaces of the joints, and an edematous condition of the eyelids. The symptoms were preceded by restlessness, headache, and heat of the skin, and subsided gradually after the second or third day, desquamation continuing for nearly two months. After they had subsided entirely, the exhibition of arsenic again aroused them, and this time they were accompanied by salivation. Charcot and other French authors have noticed the frequent occurrence of suspension of the sexual instinct during the administration of Fowler's solution. Jackson speaks of recovery after the ingestion of two ounces of arsenic by the early employment of an emetic. Walsh reports a case in which 600 gr. of arsenic were taken without injury. The remarkable tolerance of arsenic eaters is well known. Taylor asserts that the smallest lethal dose of arsenic has been two gr., but Tardieu mentions an instance in which ten cgm. (1 1/2 gr.) has caused death. Mackenzie speaks of a man who swallowed a large quantity of arsenic in lumps, and received no treatment for sixteen hours, but recovered. It is added that from two masses passed by the anus 105 gr. of arsenic were obtained. In speaking of the tolerance of belladonna, in 1859 Fuller mentioned a child of fourteen who in eighteen days took 37 grains of atropin; a child of ten who took seven grains of extract of belladonna daily, or more than two ounces in twenty-six days; and a man who took 64 grains of the extract of belladonna daily, and from whose urine enough atropin was extracted to kill two white mice and to narcotize two others. Bader has observed grave symptoms following the employment of a vaginal suppository containing three grains of the extract of belladonna. The dermal manifestations, such as urticaria and eruptions resembling the exanthem of scarlatina, are too well known to need mention here. An enema containing 80 grains of belladonna root has been followed in five hours by death, and Taylor has mentioned recovery after the ingestion of three drams of belladonna. In 1864 Chambers reported to the Lancet the recovery of a child of four years who took a solution containing 1/2 grain of the alkaloid. In some cases the idiosyncrasy to belladonna is so marked that violent symptoms follow the application of the ordinary belladonna plaster. Maddox describes a ease of poisoning in a music teacher by the belladonna plaster of a reputable maker. She had obscure eye-symptoms, and her color-sensations were abnormal. Locomotor equilibration was also affected. Golden mentions two cases in which the application of belladonna ointment to the breasts caused suppression of the secretion of milk. Goodwin relates the history of a case in which an infant was poisoned by a belladonna plaster applied to its mother's breast and died within twenty-four hours after the first application of the plaster. In 1881 Betancourt spoke of an instance of inherited susceptibility to belladonna, in which the external application of the ointment produced all the symptoms of belladonna poisoning. Cooper mentions the symptoms of poisoning following the application of extract of belladonna to the scrotum. Davison reports poisoning by the application of belladonna liniment. Jenner and Lyman also record belladonna poisoning from external applications. Rosenthal reports a rare case of poisoning in a child eighteen months old who had swallowed about a teaspoonful of benzin. Fifteen minutes later the child became unconscious. The stomach-contents, which were promptly removed, contained flakes of bloody mucus. At the end of an hour the radial pulse was scarcely perceptible, respiration was somewhat increased in frequency and accompanied with a rasping sound. The breath smelt of benzin. The child lay in quiet narcosis, occasionally throwing itself about as if in pain. The pulse gradually improved, profuse perspiration occurred, and normal sleep intervened. Six hours after the poisoning the child was still stupefied. The urine was free from albumin and sugar, and the next morning the little one had perfectly recovered. There is an instance mentioned of a robust youth of twenty who by a mistake took a half ounce of cantharides. He was almost immediately seized with violent heat in the throat and stomach, pain in the head, and intense burning on urination. These symptoms progressively increased, were followed by intense sickness and almost continual vomiting. In the evening he passed great quantities of blood from the urethra with excessive pain in the urinary tract. On the third day all the symptoms were less violent and the vomiting had ceased. Recovery was complete on the fifteenth day. Digitalis has been frequently observed to produce dizziness, fainting, disturbances of vision, vomiting, diarrhea, weakness of the pulse, and depression of temperature. These phenomena, however, are generally noticed after continued administration in repeated doses, the result being doubtless due to cumulative action caused by abnormally slow elimination by the kidneys. Traube observed the presence of skin-affection after the use of digitalis in a case of pericarditis. Tardieu has seen a fluid-dram of the tincture of digitalis cause alarming symptoms in a young woman who was pregnant. He also quotes cases of death on the tenth day from ingestion of 20 grains of the extract, and on the fifth day from 21 grams of the infusion. Kohuhorn mentions a death from what might be called chronic digitalis poisoning. There is a deleterious practice of some of the Irish peasantry connected with their belief in fairies, which consists of giving a cachetic or rachitic child large doses of a preparation of fox-glove (Irish--luss-more, or great herb), to drive out or kill the fairy in the child. It was supposed to kill an unhallowed child and cure a hallowed one. In the Hebrides, likewise, there were many cases of similar poisoning. Epidemics of ergotism have been recorded from time to time since the days of Galen, and were due to poverty, wretchedness, and famine, resulting in the feeding upon ergotized bread. According to Wood, gangrenous ergotism, or "Ignis Sacer" of the Middle Ages, killed 40,000 persons in Southwestern France in 922 A. D., and in 1128-29, in Paris alone, 14,000 persons perished from this malady. It is described as commencing with itchings and formications in the feet, severe pain in the back, contractions in the muscles, nausea, giddiness, apathy, with abortion in pregnant women, in suckling women drying of milk, and in maidens with amenorrhea. After some time, deep, heavy aching in the limbs, intense feeling of coldness, with real coldness of the surfaces, profound apathy, and a sense of utter weariness develop; then a dark spot appears on the nose or one of the extremities, all sensibility is lost in the affected part, the skin assumes a livid red hue, and adynamic symptoms in severe cases deepen as the gangrene spreads, until finally death ensues. Very generally the appetite and digestion are preserved to the last, and not rarely there is a most ferocious hunger. Wood also mentions a species of ergotism characterized by epileptic paroxysms, which he calls "spasmodic ergotism." Prentiss mentions a brunette of forty-two, under the influence of ergot, who exhibited a peculiar depression of spirits with hysteric phenomena, although deriving much benefit from the administration of the drug from the hemorrhage caused by uterine fibroids. After taking ergot for three days she felt like crying all the time, became irritable, and stayed in bed, being all day in tears. The natural disposition of the patient was entirely opposed to these manifestations, as she was even-tempered and exceptionally pleasant. In addition to the instance of the fatal ingestion of a dose of Epsom salts already quoted, Lang mentions a woman of thirty-five who took four ounces of this purge. She experienced burning pain in the stomach and bowels, together with a sense of asphyxiation. There was no purging or vomiting, but she became paralyzed and entered a state of coma, dying fifteen minutes after ingestion. Iodin Preparations.--The eruptions following the administration of small doses of potassium iodid are frequently noticed, and at the same time large quantities of albumin have been seen in the urine. Potassium iodid, although generally spoken of as a poisonous drug, by gradually increasing the dose can be given in such enormous quantities as to be almost beyond the bounds of credence, several drams being given at a dose. On the other hand, eight grains have produced alarming symptoms. In the extensive use of iodoform as a dressing instances of untoward effects, and even fatal ones, have been noticed, the majority of them being due to careless and injudicious application. In a French journal there is mentioned the history of a man of twenty-five, suspected of urethral ulceration, who submitted to the local application of one gram of iodoform. Deep narcosis and anesthesia were induced, and two hours after awakening his breath smelled strongly of iodoform. There are two similar instances recorded in England. Pope mentions two fatal cases of lead-poisoning from diachylon plaster, self-administered for the purpose of producing abortion. Lead water-pipes, the use of cosmetics and hair-dyes, coloring matter in confectionery and in pastry, habitual biting of silk threads, imperfectly burnt pottery, and cooking bread with painted wood have been mentioned as causes of chronic lead-poisoning. Mercury.--Armstrong mentions recovery after ingestion of 1 1/2 drams of corrosive sublimate, and Lodge speaks of recovery after a dose containing 100 grains of the salt. It is said that a man swallowed 80 grains of mercuric chlorid in whiskey and water, and vomited violently about ten minutes afterward. A mixture of albumin and milk was given to him, and in about twenty-five minutes a bolus of gold-leaf and reduced iron; in eight days he perfectly recovered. Severe and even fatal poisoning may result from the external application of mercury. Meeres mentions a case in which a solution (two grains to the fluid-ounce) applied to the head of a child of nine for the relief of tinea tonsurans caused diarrhea, profuse salivation, marked prostration, and finally death. Washing out the vagina with a solution of corrosive sublimate, 1:2000, has caused severe and even fatal poisoning. Bonet mentions death after the inunction of a mercurial ointment, and instances of distressing salivation from such medication are quite common. There are various dermal affections which sometimes follow the exhibition of mercury and assume an erythematous type. The susceptibility of some persons to calomel, the slightest dose causing profuse salivation and painful oral symptoms, is so common that few physicians administer mercury to their patients without some knowledge of their susceptibility to this drug. Blundel relates a curious case occurring in the times when mercury was given in great quantities, in which to relieve obstinate constipation a half ounce of crude mercury was administered and repeated in twelve hours. Scores of globules of mercury soon appeared over a vesicated surface, the result of a previous blister applied to the epigastric region. Blundel, not satisfied with the actuality of the phenomena, submitted his case to Dr. Lister, who, after careful examination, pronounced the globules metallic. Oils.--Mauvezin tells of the ingestion of three drams of croton oil by a child of six, followed by vomiting and rapid recovery. There was no diarrhea in this case. Wood quotes Cowan in mentioning the case of a child of four, who in two days recovered from a teaspoonful of croton oil taken on a full stomach. Adams saw recovery in an adult after ingestion of the same amount. There is recorded an instance of a woman who took about an ounce, and, emesis being produced three-quarters of an hour afterward by mustard, she finally recovered. There is a record in which so small a dose as three minims is supposed to have killed a child of thirteen months. According to Wood, Giacomini mentions a case in which 24 grains of the drug proved fatal in as many hours. Castor oil is usually considered a harmless drug, but the castor bean, from which it is derived, contains a poisonous acrid principle, three such beans having sufficed to produce death in a man. Doubtless some of the instances in which castor oil has produced symptoms similar to cholera are the results of the administration of contaminated oil. The untoward effects of opium and its derivatives are quite numerous Gaubius treated an old woman in whom, after three days, a single grain of opium produced a general desquamation of the epidermis; this peculiarity was not accidental, as it was verified on several other occasions. Hargens speaks of a woman in whom the slightest bit of opium in any form produced considerable salivation. Gastric disturbances are quite common, severe vomiting being produced by minimum doses; not infrequently, intense mental confusion, vertigo, and headache, lasting hours and even days, sometimes referable to the frontal region and sometimes to the occipital, are seen in certain nervous individuals after a dose of from 1/4 to 5/6 gr. of opium. These symptoms were familiar to the ancient physicians, and, according to Lewin, Tralles reports an observation with reference to this in a man, and says regarding it in rather unclassical Latin: "... per multos dies ponderosissimum caput circumgestasse." Convulsions are said to be observed after medicinal doses of opium. Albers states that twitching in the tendons tremors of the hands, and even paralysis, have been noticed after the ingestion of opium in even ordinary doses. The "pruritus opii," so familiar to physicians, is spoken of in the older writings. Dioscorides, Paulus Aegineta, and nearly all the writers of the last century describe this symptom as an annoying and unbearable affection. In some instances the ingestion of opium provokes an eruption in the form of small, isolated red spots, which, in their general character, resemble roseola. Rieken remarks that when these spots spread over all the body they present a scarlatiniform appearance, and he adds that even the mucous membranes of the mouth and throat may be attacked with erethematous inflammation. Behrend observed an opium exanthem, which was attended by intolerable itching, after the exhibition of a quarter of a grain. It was seen on the chest, on the inner surfaces of the arms, on the flexor surfaces of the forearms and wrists, on the thighs, and posterior and inner surfaces of the legs, terminating at the ankles in a stripe-like discoloration about the breadth of three fingers. It consisted of closely disposed papules of the size of a pin-head, and several days after the disappearance of the eruption a fine, bran-like desquamation of the epidermis ensued. Brand has also seen an eruption on the trunk and flexor surfaces, accompanied with fever, from the ingestion of opium. Billroth mentions the case of a lady in whom appeared a feeling of anxiety, nausea, and vomiting after ingestion of a small fraction of a grain of opium; she would rather endure her intense pain than suffer the untoward action of the drug. According to Lewin, Brochin reported a case in which the idiosyncrasy to morphin was so great that 1/25 of a grain of the drug administered hypodermically caused irregularity of the respiration, suspension of the heart-beat, and profound narcosis. According to the same authority, Wernich has called attention to paresthesia of the sense of taste after the employment of morphin, which, according to his observation, is particularly prone to supervene in patients who are much reduced and in persons otherwise healthy who have suffered from prolonged inanition. These effects are probably due to a central excitation of a similar nature to that produced by santonin. Persons thus attacked complain, shortly after the injection, of an intensely sour or bitter taste, which for the most part ceases after elimination of the morphin. Von Graefe and Sommerfrodt speak of a spasm of accommodation occurring after ingestion of medicinal doses of morphin. There are several cases on record in which death has been produced in an adult by the use of 1/2 to 1/6 grain of morphin. According to Wood, the maximum doses from which recovery has occurred without emesis are 55 grains of solid opium, and six ounces of laudanum. According to the same authority, in 1854 there was a case in which a babe one day old was killed by one minim of laudanum, and in another case a few drops of paregoric proved fatal to a child of nine months. Doubtful instances of death from opium are given, one in an adult female after 30 grains of Dover's powder given in divided doses, and another after a dose of 1/4 grain of morphin. Yavorski cites a rather remarkable instance of morphin-poisoning with recovery: a female took 30 grains of acetate of morphin, and as it did not act quickly enough she took an additional dose of 1/2 ounce of laudanum. After this she slept a few hours, and awoke complaining of being ill. Yavorski saw her about an hour later, and by producing emesis, and giving coffee, atropin, and tincture of musk, he saved her life. Pyle describes a pugilist of twenty-two who, in a fit of despondency after a debauch (in which he had taken repeated doses of morphin sulphate), took with suicidal intent three teaspoonfuls of morphin; after rigorous treatment he revived and was discharged on the next day perfectly well. Potassium permanganate was used in this case. Chaffee speaks of recovery after the ingestion of 18 grains of morphin without vomiting. In chronic opium eating the amount of this drug which can be ingested with safety assumes astounding proportions. In his "Confessions" De Quincey remarks: "Strange as it may sound, I had a little before this time descended suddenly and without considerable effort from 320 grains of opium (8000 drops of laudanum) per day to 40 grains, or 1/8 part. Instantaneously, and as if by magic, the cloud of profoundest melancholy which rested on my brain, like some black vapors that I have seen roll away from the summits of the mountains, drew off in one day,--passed off with its murky banners as simultaneously as a ship that has been stranded and is floated off by a spring-tide-- 'That moveth altogether if it move at all.' Now, then, I was again happy; I took only a thousand drops of Laudanum per day, and what was that? A latter spring had come to close up the season of youth; my brain performed its functions as healthily as ever before; I read Kant again, and again I understood him, or fancied that I did." There have been many authors who, in condemning De Quincey for unjustly throwing about the opium habit a halo of literary beauty which has tempted many to destruction, absolutely deny the truth of his statements. No one has any stable reason on which to found denial of De Quincey's statements as to the magnitude of the doses he was able to take; and his frankness and truthfulness is equal to that of any of his detractors. William Rosse Cobbe, in a volume entitled "Dr. Judas, or Portrayal of the Opium Habit," gives with great frankness of confession and considerable purity of diction a record of his own experiences with the drug. One entire chapter of Mr. Cobb's book and several portions of other chapters are devoted to showing that De Quincey was wrong in some of his statements, but notwithstanding his criticism of De Quincey, Mr. Cobbe seems to have experienced the same adventures in his dreams, showing, after all, that De Quincey knew the effects of opium even if he seemed to idealize it. According to Mr. Cobbe, there are in the United States upward of two millions of victims of enslaving drugs entirely exclusive of alcohol. Cobbe mentions several instances in which De Quincey's dose of 320 grains of opium daily has been surpassed. One man, a resident of Southern Illinois, consumed 1072 grains a day; another in the same State contented himself with 1685 grains daily; and still another is given whose daily consumption amounted to 2345 grains per day. In all cases of laudanum-takers it is probable that analysis of the commercial laudanum taken would show the amount of opium to be greatly below that of the official proportion, and little faith can be put in the records of large amounts of opium taken when the deduction has been made from the laudanum used. Dealers soon begin to know opium victims, and find them ready dupes for adulteration. According to Lewin, Samter mentions a case of morphin-habit which was continued for three years, during which, in a period of about three, hundred and twenty-three days, upward of 2 1/2 ounces of morphin was taken daily. According to the same authority, Eder reports still larger doses. In the case observed by him the patient took laudanum for six years in increasing doses up to one ounce per day; for eighteen months, pure opium, commencing with 15 grains and increasing to 2 1/4 drams daily; and for eighteen months morphin, in commencing quantities of six grains, which were later increased to 40 grains a day. When deprived of their accustomed dose of morphin the sufferings which these patients experience are terrific, and they pursue all sorts of deceptions to enable them to get their enslaving drug. Patients have been known to conceal tubes in their mouths, and even swallow them, and the authors know of a fatal instance in which a tube of hypodermic tablets of the drug was found concealed in the rectum. The administration of such an inert substance as the infusion of orange-peel has been sufficient to invariably produce nervous excitement in a patient afflicted with carcinoma. Sonnenschein refers to a case of an infant of five weeks who died from the effects of one phosphorous match head containing only 1/100 grain of phosphorus. There are certain people who by reason of a special susceptibility cannot tolerate phosphorus, and the exhibition of it causes in them nausea, oppression, and a feeling of pain in the epigastric region, tormina and tenesmus, accompanied with diarrhea, and in rare cases jaundice, sometimes lasting several months. In such persons 1/30 grain is capable of causing the foregoing symptoms. In 1882 a man was admitted to Guy's Hospital, London, after he had taken half of a sixpenny pot of phosphorous paste in whiskey, and was subsequently discharged completely recovered. A peculiar feature of phosphorus-poisoning is necrosis of the jaw. This affection was first noticed in 1838, soon after the introduction of the manufacture of phosphorous matches. In late years, owing to the introduction of precautions in their manufacture, the disease has become much less common. The tipping of the match sticks is accomplished by dipping their ends in a warm solution of a composition of phosphorus, chlorate of potassium, with particles of ground flint to assist friction, some coloring agent, and Irish glue. From the contents of the dipping-pans fumes constantly arise into the faces of the workmen and dippers, and in cutting the sticks and packing the matches the hands are constantly in contact with phosphorus. The region chiefly affected in this poisoning is the jaw-bone, but the inflammation may spread to the adjoining bones and involve the vomer, the zygoma, the body of the spheroid bone, and the basilar process of the occipital bone. It is supposed that conditions in which the periosteum is exposed are favorable to the progress of the disease, and, according to Hirt, workmen with diseased teeth are affected three times as readily as those with healthy teeth, and are therefore carefully excluded from some of the factories in America. Prentiss of Washington, D.C., in 1881 reported a remarkable case of pilocarpin idiosyncrasy in a blonde of twenty-five. He was consulted by the patient for constipation. Later on symptoms of cystitis developed, and an ultimate diagnosis of pyelitis of the right kidney was made. Uremic symptoms were avoided by the constant use of pilocarpin. Between December 16, 1880, and February 22, 1881, the patient had 22 sweats from pilocarpin. The action usually lasted from two to six hours, and quite a large dose was at length necessary. The idiosyncrasy noted was found in the hair, which at first was quite light, afterward chestnut-brown, and May 1, 1881, almost pure black. The growth of the hair became more vigorous and thicker than formerly, and as its color darkened it became coarser in proportion. In March, 1889, Prentiss saw his patient, and at that time her hair was dark brown, having returned to that color from black. Prentiss also reported the following case a as adding another to the evidence that jaborandi will produce the effect mentioned under favorable circumstances: Mrs. L., aged seventy-two years, was suffering from Bright's disease (contracted kidney). Her hair and eyebrows had been snow-white for twenty years. She suffered greatly from itching of the skin, due to the uremia of the kidney-disease; the skin was harsh and dry. For this symptom fluid extract of jaborandi was prescribed with the effect of relieving the itching. It was taken in doses of 20 or 30 drops several times a day, from October, 1886, to February, 1888. During the fall of 1887 it was noticed by the nurse that the eyebrows were growing darker, and that the hair of the head was darker in patches. These patches and the eyebrows continued to become darker, until at the time of her death they were quite black, the black tufts on the head presenting a very curious appearance among the silver-white hairs surrounding them. Quinin being such a universally used drug, numerous instances of idiosyncrasy and intolerance have been recorded. Chevalier mentions that through contact of the drug workmen in the manufacture of quinin are liable to an affection of the skin which manifests itself in a vesicular, papular, or pustular eruption on different parts of the body. Vepan mentions a lady who took 1 1/2 grains and afterward 2 1/2 grains of quinin for neuralgia, and two days afterward her body was covered with purpuric spots, which disappeared in the course of nine days but reappeared after the administration of the drug was resumed. Lewin says that in this case the severity of the eruption was in accordance with the size of the dose, and during its existence there was bleeding at the gums; he adds that Gouchet also noticed an eruption of this kind in a lady who after taking quinin expectorated blood. The petechiae were profusely spread over the entire body, and they disappeared after the suspension of the drug. Dauboeuf, Garraway, Hemming, Skinner, and Cobner mention roseola and scarlatiniform erythema after minute doses of quinin. In nearly all these cases the accompanying symptoms were different. Heusinger speaks of a lady who, after taking 1/2 grain of quinin, experienced headache, nausea, intense burning, and edema, together with nodular erythema on the eyelids, cheeks, and portion of the forehead. At another time 1 1/2 grains of the drug gave rise to herpetic vesicles on the cheeks, followed by branny desquamation on elimination of the drug. In other patients intense itching is experienced after the ingestion of quinin. Peters cites an instance of a woman of sixty-five who, after taking one grain of quinin, invariably exhibited after an hour a temperature of from 104 degrees to 105 degrees F., accelerated pulse, rigors, slight delirium, thirst, and all the appearances of ill-defined fever, which would pass off in from twelve to twenty-four hours. Peters witnessed this idiosyncrasy several times and believed it to be permanent. The most unpleasant of the untoward symptoms of quinin exhibition are the disturbances of the organs of special sense. Photophobia, and even transient amblyopia, have been observed to follow small doses. In the examination of cases of the untoward effects of quinin upon the eye, Knapp of New York found the power of sight diminished in various degrees, and rarely amaurosis and immobility of the pupils. According to Lewin, the perceptions of color and light are always diminished, and although the disorder may last for some time the prognosis is favorable. The varieties of the disturbances of the functions of the ear range from tinnitus aurium to congestion causing complete deafness. The gastro-intestinal and genito-urinary tracts are especially disposed to untoward action by quinin. There is a case recorded in which, after the slightest dose of quinin, tingling and burning at the meatus urinarius were experienced. According to Lewin, there is mentioned in the case reported by Gauchet a symptom quite unique in the literature of quinin, viz., hemoptysis. Simon de Ronchard first noted the occurrence of several cases of hemoptysis following the administration of doses of eight grains daily. In the persons thus attacked the lungs and heart were healthy. Hemoptysis promptly ceased with the suspension of the drug. When it was renewed, blood again appeared in the sputa. Taussig mentions a curious mistake, in which an ounce of quinin sulphate was administered to a patient at one dose; the only symptoms noticed were a stuporous condition and complete deafness. No antidote was given, and the patient perfectly recovered in a week. In malarious countries, and particularly in the malarial fevers of the late war, enormous quantities of quinin were frequently given. In fact, at the present day in some parts of the South quinin is constantly kept on the table as a prophylactic constituent of the diet. Skinner noticed the occurrence of a scarlatiniform eruption in a woman after the dose of 1/165 grain of strychnin, which, however, disappeared with the discontinuance of the drug. There was a man in London in 1865 who died in twenty minute's after the ingestion of 1/2 grain of strychnin. Wood speaks of a case in which the administration of 1/100 grain killed a child three and one-half months old. Gray speaks of a man who took 22 grains and was not seen for about an hour. He had vomited some of it immediately after taking the dose, and was successfully treated with chloral hydrate. A curious case is mentioned in which three mustard plasters, one on the throat, one on the back of the neck, and another on the left shoulder of a woman, produced symptoms similar to strychnin poisoning. They remained in position for about thirty minutes, and about thirty hours afterward a painful stinging sensation commenced in the back of the neck, followed by violent twitching of the muscles of the face, arms, and legs, which continued in regular succession through the whole of the night, but after twelve hours yielded to hot fomentations of poppy-heads applied to the back of the neck. It could not be ascertained whether any medicine containing strychnin had been taken, but surely, from the symptoms, such must have been the case. Tobacco.--O'Neill a gives the history of a farmer's wife, aged forty, who wounded her leg against a sewing-machine, and by lay advice applied a handful of chopped wet tobacco to it, from which procedure, strange to say, serious nicotin-poisoning ensued. The pupils were dilated, there were dimness of vision, confusion of thought, and extreme prostration. The pulse was scarcely apparent, the skin was white and wet with clammy perspiration. Happily, strychnin was given in time to effect recovery, and without early medical assistance she would undoubtedly have succumbed. There are several similar cases on record. Although not immediately related to the subject of idiosyncrasy, the following case may be mentioned here: Ramadge speaks of a young Frenchman, suffering from an obstinate case of gonorrhea, who was said to have been completely cured by living in a newly painted house in which he inhaled the odors or vapors of turpentine. White speaks of a case of exanthematous eruption similar to that of ivy-poison in mother and child, which was apparently caused by playing with and burning the toy called "Pharaoh's serpent egg." The idiosyncrasies noticed in some persons during coitus are quite interesting. The Ephemerides mentions a person in whom coitus habitually caused vomiting, and another in whom excessive sexual indulgence provoked singultus. Sometimes exaggerated tremors or convulsions, particularly at the moment of orgasm, are noticed. Females especially are subject to this phenomenon, and it is seen sometimes in birds. Winn reports the case of a man who, when prompted to indulge in sexual intercourse, was immediately prior to the act seized with a fit of sneezing. Even the thought of sexual pleasure with a female was sufficient to provoke this peculiar idiosyncrasy. Sullivan mentions a bride of four weeks, who called at the doctor's office, saying that in coitus her partner had no difficulty until the point of culmination or orgasm, when he was seized with complete numbness and lost all pleasurable sensation in the penis. The numbness was followed by a sensation of pain, which was intensified on the slightest motion, and which was at times so excruciating as to forbid separation for upward of an hour, or until the penis had become flaccid. The woman asked for advice for her unfortunate husband's relief, and the case was reported as a means of obtaining suggestions from the physicians over the country. In response, one theory was advanced that this man had been in the habit of masturbating and had a stricture of the membranous portion of the urethra, associated with an ulcer of the prostate involving the ejaculatory ducts, or an inflammatory condition of all the tissues compressed by the ejaculatory muscles. Hendrichsen quotes a case in which a spasmodic contraction of the levator ani occurred during coitus, and the penis could not be withdrawn while this condition lasted; and in support of this circumstance Hendrichsen mentions that Marion Sims, Beigel, and Budin describe spasmodic contractions of the levator and, constricting the vagina; he also cites an instance under his personal observation in which this spasm was excited by both vaginal and rectal examination, although on the following day no such condition could be produced. In this connection, among the older writers, Borellus gives the history of a man who before coitus rubbed his virile member with musk, and, similar to the connection of a dog and bitch, was held fast in his wife's vagina; it was only after the injection of great quantities of water to soften the parts that separation was obtained. Diemerbroeck confirms this singular property of musk by an analogous observation, in which the ludicrous method of throwing cold water on the persons was practised. Schurig also relates the history of a similar instance. Among the peculiar effects of coitus is its deteriorating effect on the healing process of wounds. Boerhaave, Pare, and Fabricius Hildanus all speak of this untoward effect of venery, and in modern times Poncet has made observations at a hospital in Lyons which prove that during the process of healing wounds are unduly and harmfully influenced by coitus, and cites confirmatory instances. Poncet also remarks that he found on nine occasions, by placing a thermometer in the rectum, that the temperature was about 1 degrees F. lower just before than after coitus, and that during the act the temperature gradually rose above normal. There are many associate conditions which, under the exciting influence of coitus, provoke harmful effects and even a fatal issue. Deguise mentions a man who had coitus 18 times in ten hours with most disastrous effects. Cabrolius speaks of a man who took a potion of aphrodisiac properties, in which, among other things, he put an enormous dose of cantharides. The anticipation of the effect of his dose, that is, the mental influence, in addition to the actual therapeutic effect, greatly distressed and excited him. Almost beyond belief, it is said that he approached his wife eighty-seven times during the night, spilling much sperm on the sleeping-bed. Cabrolius was called to see this man in the morning, and found him in a most exhausted condition, but still having the supposed consecutive ejaculations. Exhaustion progressed rapidly, and death soon terminated this erotic crisis. Lawson is accredited with saying that among the Marquesan tribe he knew of a woman who during a single night had intercourse with 103 men. Among the older writers there are instances reported in which erection and ejaculation took place without the slightest pleasurable sensation. Claudius exemplifies this fact in his report of a Venetian merchant who had vigorous erections and ejaculations of thick and abundant semen without either tingling or pleasure. Attila, King of the Huns, and one of the most celebrated leaders of the German hosts which overran the Roman Empire in its decline, and whose enormous army and name inspired such terror that he was called the "Scourge of God," was supposed to have died in coitus. Apoplexy, organic heart disorders, aneurysms, and other like disorders are in such cases generally the direct cause of death, coitus causing the death indirectly by the excitement and exertion accompanying the act. Bartholinus, Benedictus, Borellus, Pliny, Morgagni, Plater, a Castro, Forestus, Marcellus Donatus, Schurig, Sinibaldus, Schenck, the Ephemerides, and many others mention death during coitus; the older writers in some cases attributed the fatal issue to excessive sexual indulgence, not considering the possibility of the associate direct cause, which most likely would have been found in case of a necropsy. Suspended Animation.--Various opinions have been expressed as to the length of time compatible with life during which a person can stay under water. Recoveries from drowning furnish interesting examples of the suspension of animation for a protracted period, but are hardly ever reliable, as the subject at short intervals almost invariably rises to the surface of the water, allowing occasional respiration. Taylor mentions a child of two who recovered after ten minutes' submersion; in another case a man recovered after fourteen minutes' submersion. There is a case reported in this country of a woman who was said to have been submerged twenty minutes. Guerard quotes a case happening in 1774, in which there was submersion for an hour with subsequent recovery; but there hardly seems sufficient evidence of this. Green mentions submersion for fifteen minutes; Douglass, for fourteen minutes; Laub, for fifteen minutes; Povall gives a description of three persons who recovered after a submersion of twenty-five minutes. There is a case in French literature, apparently well authenticated, in which submersion for six minutes was followed by subsequent recovery. There have been individuals who gave exhibitions of prolonged submersion in large glass aquariums, placed in full view of the audience. Taylor remarks that the person known some years ago in London as "Lurline" could stay under water for three minutes. There have been several exhibitionists of this sort. Some of the more enterprising seat themselves on an artificial coral, and surrounded by fishes of divers hues complacently eat a meal while thus submerged. It is said that quite recently in Detroit there was a performer who accomplished the feat of remaining under water four minutes and eight seconds in full view of the audience. Miss Lurline swam about in her aquarium, which was brilliantly illuminated, ate, reclined, and appeared to be taking a short nap during her short immersion. In Paris, some years since, there was exhibited a creature called "l'homme-poisson," who performed feats similar to Lurline, including the smoking of a cigarette held entirely in his mouth. In all these exhibitions all sorts of artificial means are used to make the submersion appear long. Great ceremony, music, and the counting of the seconds in a loud voice from the stage, all tend to make the time appear much longer than it really is. However, James Finney in London, April 7, 1886, stayed under water four minutes, twenty-nine and one-fourth seconds, and one of his feats was to pick up 70 or 80 gold-plated half-pennies with his mouth, his hands being securely tied behind his back, and never emerging from his tank until his feat was fully accomplished. In company with his sister he played a game of "nap" under water, using porcelain cards and turning them to the view of the audience. "Professor Enochs" recently stayed under water at Lowell, Mass., for four minutes, forty-six and one-fifth seconds. The best previous record was four minutes, thirty-five seconds, made by "Professor Beaumont" at Melbourne on December 16, 1893. For the most satisfactory examples of prolonged submersion we must look to the divers, particularly the natives who trade in coral, and the pearl fishers. Diving is an ancient custom, and even legendary exploits of this nature are recorded. Homer compares the fall of Hector's chariot to the action of a diver; and specially trained men were employed at the Siege of Syracuse, their mission being to laboriously scuttle the enemy's vessels. Many of the old historians mention diving, and Herodotus speaks of a diver by the name of Scyllias who was engaged by Xerxes to recover some articles of value which had been sunk on some Persian vessels in a tempest. Egyptian divers are mentioned by Plutarch, who says that Anthony was deceived by Cleopatra in a fishing contest by securing expert divers to place the fish upon the hooks. There was a historical or rather legendary character by the name of Didion, who was noted for his exploits in the river Meuse. He had the ability to stay under water a considerable length of time, and even to catch fish while submerged. There was a famous diver in Sicily at the end of the fifteenth century whose feats are recorded in the writings of Alexander ab Alexandro, Pontanus, and Father Kircher, the Jesuit savant. This man's name was Nicolas, born of poor parents at Catania. From his infancy he showed an extraordinary power of diving and swimming, and from his compatriots soon acquired various names indicative of his capacity. He became very well known throughout Sicily, and for his patron had Frederick, King of Naples. In the present day, the sponge-fishers and pearl-fishers in the West Indies, the Mediterranean, the Indian Seas, and the Gulf of Mexico invite the attention of those interested in the anomalies of suspended animation. There are many marvelous tales of their ability to remain under water for long periods. It is probable that none remain submerged over two minutes, but, what is more remarkable, they are supposed to dive to extraordinary depths, some as much as 150 to 200 feet. Ordinarily they remain under water from a minute to one and a half minutes. Remaining longer, the face becomes congested, the eyes injected; the sputum bloody, due to rupture of some of the minute vessels in the lung. It is said by those who have observed them carefully that few of these divers live to an advanced age. Many of them suffer apoplectic attacks, and some of them become blind from congestion of the ocular vessels. The Syrian divers are supposed to carry weights of considerable size in their hands in order to facilitate the depth and duration of submersion. It is also said that the divers of Oceanica use heavy stones. According to Guyot-Daubes, in the Philippine Isles the native pearl-fishers teach their children to dive to the depth of 25 meters. The Tahitians, who excited the admiration of Cook, are noted for their extraordinary diving. Speaking of the inhabitants of the island of Fakaraya, near Tahiti, de la Quesnerie says that the pearl-fishers do not hesitate to dive to the depth even of 100 feet after their coveted prizes. On the Ceylon coast the mother-of-pearl fishers are under the direction of the English Government, which limits the duration and the practice of this occupation. These divers are generally Cingalese, who practice the exercise from infancy. As many as 500 small boats can be seen about the field of operation, each equipped with divers. A single diver makes about ten voyages under the water, and then rests in the bottom of the boat, when his comrade takes his place. Among other native divers are the Arabs of Algeria and some of the inhabitants of the Mexican coast. It might be well to mention here the divers who work by means of apparatus. The ancients had knowledge of contrivances whereby they could stay under water some time. Aristotle speaks of an instrument by which divers could rest under water in communication with the air, and compares it with the trunk of an elephant wading a stream deeper than his height. In the presence of Charles V diving bells were used by the Greeks in 1540. In 1660 some of the cannon of the sunken ships of the Spanish Armada were raised by divers in diving bells. Since then various improvements in submarine armor have been made, gradually evolving into the present perfected diving apparatus of to-day, by which men work in the holds of vessels sunk in from 120 to 200 feet of water. The enormous pressure of the water at these great depths makes it necessary to have suits strong enough to resist it. Lambert, a celebrated English diver, recovered L90,000 in specie from the steamer Alphonso XII, a Spanish mail boat belonging to the Lopez line, which sank off Point Gando, Grand Canary, in 26 1/2 fathoms of water. For nearly six months the salvage party, despatched by the underwriters in May, 1885, persevered in the operations; two divers lost their lives, the golden bait being in the treasure-room beneath the three decks, but Lambert finished the task successfully. Deep-sea divers only acquire proficiency after long training. It is said that as a rule divers are indisposed to taking apprentices, as they are afraid of their vocation being crowded and their present ample remuneration diminished. At present there are several schools. At Chatham, England, there is a school of submarine mining, in which men are trained to lay torpedoes and complete harbor defense. Most of these divers can work six hours at a time in from 35 to 50 feet of water. Divers for the Royal Navy are trained at Sheerness. When sufficiently trained to work at the depth of 150 feet seamen-divers are fully qualified, and are drafted to the various ships. They are connected with an air-pump in charge of trustworthy men; they signal for their tools and material, as well as air, by means of a special line for this purpose. At some distance below the water the extraordinary weight of the suits cannot be felt, and the divers work as well in armor as in ordinary laboring clothes. One famous diver says that the only unpleasant experience he ever had in his career as a diver, not excepting the occasion of his first dive, was a drumming in the ears, as a consequence of which, after remaining under water at a certain work for nine hours, he completely lost the use of one ear for three months, during which time he suffered agony with the earache. These men exhibit absolute indifference to the dangers attached to their calling, and some have been known to sleep many fathoms beneath the surface. Both by means of their signal lines and by writing on a slate they keep their associates informed of the progress of their work. Suspension of the Pulse.--In some cases the pulse is not apparent for many days before actual death, and there have been instances in which, although the pulse ceased for an extended period, the patient made an ultimate recovery. In reviewing the older literature we find that Ballonius mentions an instance in which the pulse was not apparent for fourteen days before complete asphyxia. Ramazzini describes a case of cessation of the pulse four days before death. Schenck details the history of a case in which the pulse ceased for three days and asphyxia was almost total, but the patient eventually recovered. There is a noteworthy observation, in which there was cessation of the pulse for nine days without a fatal issue. Some persons seem to have a preternatural control over their circulatory system, apparently enabling them to produce suspension of cardiac movement at will. Cheyne speaks of a Colonel Townshend who appeared to possess the power of dying, as it were, at will,--that is, so suspending the heart's action that no pulsation could be detected. After lying in this state of lifelessness for a short period, life would become slowly established without any consciousness or volition on the man's part. The longest period in which he remained in this death-like condition was about thirty minutes. A postmortem examination of this person was awaited with great interest; but after his death nothing was found to explain the power he possessed over his heart. Saint Augustin knew of a priest named Rutilut who had the power of voluntarily simulating death. Both the pulsation and respiration was apparently abolished when he was in his lifeless condition. Burning and pricking left visible effects on the skin after his recovery, but had no apparent effect on his lethargy. Chaille reports an instance of voluntary suspension of the pulse. Relative to hibernation, it is well-known that mice, snakes, and some reptiles, as well as bees, sometimes seem to entirely suspend animation for an extended period, and especially in the cold weather. In Russia fish are transported frozen stiff, but return to life after being plunged into cold water. A curious tale is told by Harley, from Sir John Lubbock, of a snail brought from Egypt and thought to be dead. It was placed on a card and put in position on a shelf in the British Museum in March, 1845. In March, 1850 after having been gummed to a label for five years, it was noticed to have an apparent growth on its mouth and was taken out and placed in water, when it soon showed signs of life and ate cabbage leaves offered to it. It has been said, we think with credible evidence, that cereal seeds found in the tombs with mummies have grown when planted, and Harley quotes an instance of a gentleman who took some berries, possibly the remnants of Pharaoh's daughter's last meal, coming as they did from her mummified stomach after lying dormant in an Egyptian tomb many centuries, and planted them in his garden, where they soon grew, and he shortly had a bush as flourishing as any of those emanating from fresh seeds. Human hibernation is an extremely rare anomaly. Only the fakirs of India seem to have developed this power, and even the gifted ones there are seldom seen. Many theories have been advanced to explain this ability of the fakirs, and many persons have discredited all the stories relative to their powers; on the other hand, all who have witnessed their exhibitions are convinced of their genuineness. Furthermore, these persons are extremely scarce and are indifferent to money; none has been enticed out of his own country to give exhibitions. When one dies in a community, his place is never filled--proving that he had no accomplices who knew any fraudulent secret practices, otherwise the accomplice would soon step out to take his place. These men have undoubtedly some extraordinary mode of sending themselves into a long trance, during which the functions of life are almost entirely suspended. We can readily believe in their ability to fast during their periods of burial, as we have already related authentic instances of fasting for a great length of time, during which the individual exercised his normal functions. To the fakir, who neither visibly breathes nor shows circulatory movements, and who never moves from his place of confinement, fasting should be comparatively easy, when we consider the number of men whose minds were actively at work during their fasts, and who also exercised much physical power. Harley says that the fakirs begin their performances by taking a large dose of the powerfully stupefying "bang," thus becoming narcotized. In this state they are lowered into a cool, quiet tomb, which still further favors the prolongation of the artificially induced vital lethargy; in this condition they rest for from six to eight weeks. When resurrected they are only by degrees restored to life, and present a wan, haggard, debilitated, and wasted appearance. Braid is credited, on the authority of Sir Claude Wade, with stating that a fakir was buried in an unconscious state at Lahore in 1837, and when dug up, six weeks later, he presented all the appearances of a dead person. The legs and arms were shrunken and stiff, and the head reclined on the shoulder in a manner frequently seen in a corpse. There was no pulsation of the heart or arteries of the arm or temple--in fact, no really visible signs of life. By degrees this person was restored to life. Every precaution had been taken in this case to prevent the possibility of fraud, and during the period of interment the grave was guarded night and day by soldiers of the regiment stationed at Lahore. Honigberger, a German physician in the employ of Runjeet Singh, has an account of a fakir of Punjaub who allowed himself to be buried in a well-secured vault for such a long time that grain sown in the soil above the vault sprouted into leaf before he was exhumed. Honigberger affirms that the time of burial was over 40 days, and that on being submitted to certain processes the man recovered and lived many years after. Sir Henry Lawrence verified the foregoing statements. The chest in which the fakir was buried was sealed with the Runjeet stamp on it, and when the man was brought up he was cold and apparently lifeless. Honigberger also states that this man, whose name was Haridas, was four months in a grave in the mountains; to prove the absolute suspension of animation, the chin was shaved before burial, and at exhumation this part was as smooth as on the day of interment. This latter statement naturally calls forth comment when we consider the instances that are on record of the growth of beard and hair after death. There is another account of a person of the same class who had the power of suspending animation, and who would not allow his coffin to touch the earth for fear of worms and insects, from which he is said to have suffered at a previous burial. It has been stated that the fakirs are either eunuchs or hermaphrodites, social outcasts, having nothing in common with the women or men of their neighborhood; but Honigberger mentions one who disproved this ridiculous theory by eloping to the mountains with his neighbor's wife. Instances of recovery after asphyxia from hanging are to be found, particularly among the older references of a time when hanging was more common than it is to-day. Bartholinus, Blegny, Camerarius, Morgagni, Pechlin, Schenck, Stoll, and Wepfer all mention recovery after hanging. Forestus describes a case in which a man was rescued by provoking vomiting with vinegar, pepper, and mustard seed. There is a case on record in which a person was saved after hanging nineteen minutes. There was a case of a man brought into the Hopital Saint-Louis asphyxiated by strangulation, having been hung for some time. His rectal temperature was only 93.3 degrees F., but six hours after it rose to 101.6 degrees F., and he subsequently recovered. Taylor cites the instance of a stout woman of forty-four who recovered from hanging. When the woman was found by her husband she was hanging from the top of a door, having been driven to suicide on account of his abuse and intemperance. When first seen by Taylor she was comatose, her mouth was surrounded by white froth, and the swollen tongue protruded from it. Her face was bloated, her lips of a darkened hue, and her neck of a brown parchment-color. About the level of the larynx, the epidermis was distinctly abraded, indicating where the rope had been. The conjunctiva was insensible and there was no contractile response of the pupil to the light of a candle. The reflexes of the soles of the feet were tested, but were quite in abeyance. There was no respiratory movement and only slight cardiac pulsation. After vigorous measures the woman ultimately recovered. Recovery is quite rare when the asphyxiation has gone so far, the patients generally succumbing shortly after being cut down or on the following day. Chevers mentions a most curious case, in which cerebral congestion from the asphyxiation of strangling was accidentally relieved by an additional cut across the throat. The patient was a man who was set upon by a band of Thugs in India, who, pursuant to their usual custom, strangled him and his fellow-traveler. Not being satisfied that he was quite dead, one of the band returned and made several gashes across his throat. This latter action effectually relieved the congestion caused by the strangulation and undoubtedly saved his life, while his unmutilated companion was found dead. After the wounds in his throat had healed this victim of the Thugs gave such a good description of the murderous band that their apprehension and execution soon followed. Premature Burial.--In some instances simulation of death has been so exact that it has led to premature interment. There are many such cases on record, and it is a popular superstition of the laity that all the gruesome tales are true of persons buried alive and returning to life, only to find themselves hopelessly lost in a narrow coffin many feet below the surface of the earth. Among the lower classes the dread of being buried before life is extinct is quite generally felt, and for generations the medical profession have been denounced for their inability to discover an infallible sign of death. Most of the instances on record, and particularly those from lay journals, are vivid exaggerations, drawn from possibly such a trivial sign as a corpse found with the fist tightly clenched or the face distorted, which are the inspiration of the horrible details of the dying struggles of the person in the coffin. In the works of Fontenelle there are 46 cases recorded of the premature interment of the living, in which apparent has been mistaken for real death. None of these cases, however, are sufficiently authentic to be reliable. Moreover, in all modern methods of burial, even if life were not extinct, there could be no possibility of consciousness or of struggling. Absolute asphyxiation would soon follow the closing of the coffin lid. We must admit, however, that the mistake has been made, particularly in instances of catalepsy or trance, and during epidemics of malignant fevers or plagues, in which there is an absolute necessity of hasty burial for the prevention of contagion. In a few instances on the battle-field sudden syncope, or apparent death, has possibly led to premature interment; but in the present day this is surely a very rare occurrence. There is also a danger of mistake from cases of asphyxiation, drowning, and similar sudden suspensions of the vital functions. It is said that in the eighty-fourth Olympiad, Empedocles restored to life a woman who was about to be buried, and that this circumstance induced the Greeks, for the future protection of the supposed dead, to establish laws which enacted that no person should be interred until the sixth or seventh day. But even this extension of time did not give satisfaction, and we read that when Hephestion, at whose funeral obsequies Alexander the Great was present, was to be buried his funeral was delayed until the tenth day. There is also a legend that when Acilius Aviola fell a victim to disease he was burned alive, and although he cried out, it was too late to save him, as the fire had become so widespread before life returned. While returning to his country house Asclepiades, a physician denominated the "God of Physic," and said to have been a descendant of aesculapius, saw during the time of Pompey the Great a crowd of mourners about to start a fire on a funeral pile. It is said that by his superior knowledge he perceived indications of life in the corpse and ordered the pile destroyed, subsequently restoring the supposed deceased to life. These examples and several others of a similar nature induced the Romans to delay their funeral rites, and laws were enacted to prevent haste in burning, as well as in interment. It was not until the eighth day that the final rites were performed, the days immediately subsequent to death having their own special ceremonies. The Turks were also fearful of premature interment and subjected the defunct to every test; among others, one was to examine the contractility of the sphincter and, which shows their keen observation of a well-known modern medical fact. According to the Memoirs of Amelot de la Houssaye, Cardinal Espinola, Prime Minister to Philip II, put his hand to the embalmer's knife with which he was about to be opened; It is said that Vesalius, sometimes called the "Father of Anatomy," having been sent for to perform an autopsy on a woman subject to hysteric convulsions, and who was supposed to be dead, on making the first incision perceived by her motion and cries that she was still alive. This circumstance, becoming known, rendered him so odious that he had to leave the community in which he practiced, and it is believed that he never entirely recovered from the shock it gave him. The Abbe Prevost, so well known by his works and the singularities of his life, was seized by apoplexy in the Forest of Chantilly on October 23, 1763. His body was carried to the nearest village, and the officers of justice proceeded to open it, when a cry he sent forth frightened all the assistants and convinced the surgeon in charge that the Abbe was not dead; but it was too late to save him, as he had already received a mortal wound. Massien speaks of a woman living in Cologne in 1571 who was interred living, but was not awakened from her lethargy until a grave-digger opened her grave to steal a valuable ring which she wore. This instance has been cited in nearly every language. There is another more recent instance, coming from Poitiers, of the wife of a goldsmith named Mernache who was buried with all her jewels. During the night a beggar attempted to steal her jewelry, and made such exertion in extracting one ring that the woman recovered and was saved. After this resurrection she is said to have had several children. This case is also often quoted. Zacchias mentions an instance which, from all appearances, is authentic. It was that of a young man, pest-stricken and thought to be dead, who was placed with the other dead for burial. He exhibited signs of life, and was taken back to the pest-hospital. Two days later he entered a lethargic condition simulating death, and was again on his way to the sepulcher, when he once more recovered. It is said that when the body of William, Earl of Pembroke, who died April 10, 1630, was opened to be embalmed, the hand raised when the first incision was made. There is a story of an occurrence which happened on a return voyage from India. The wife of one of the passengers, an officer in the army, to all appearances died. They were about to resort to sea-burial, when, through the interposition of the husband, who was anxious to take her home, the ship-carpenters started to construct a coffin suitable for a long voyage, a process which took several days, during which time she lay in her berth, swathed in robes and ready for interment. When the coffin was at last ready the husband went to take his last farewell, and removed the wedding-ring, which was quite tightly on her finger. In the effort to do this she was aroused, recovered, and arrived in England perfectly well. It is said that when a daughter of Henry Laurens, the first President of the American Congress, died of small-pox, she was laid out as dead, and the windows of the room were opened for ventilation. While left alone in this manner she recovered. This circumstance so impressed her illustrious father that he left explicit directions that in case of his death he should be burned. The same journal also contains the case of a maid-servant who recovered thrice on her way to the grave, and who, when really dead, was kept a preposterous length of time before burial. The literature on this subject is very exhaustive, volumes having been written on the uncertainty of the signs of death, with hundreds of examples cited illustrative of the danger of premature interment. The foregoing instances have been given as indicative of the general style of narration; for further information the reader is referred to the plethora of material on this subject. Postmortem Anomalies.--Among the older writers startling movements of a corpse have given rise to much discussion, and possibly often led to suspicion of premature burial. Bartholinus describes motion in a cadaver. Barlow says that movements were noticed after death in the victims of Asiatic cholera. The bodies were cold and expressions were death-like, but there were movements simulating natural life. The most common was flexion of the right leg, which would also be drawn up toward the body and resting on the left leg. In some cases the hand was moved, and in one or two instances a substance was grasped as if by reflex action. Some observers have stated that reflex movements of the face were quite noticeable. These movements continued sometimes for upward of an hour, occurring mostly in muscular subjects who died very suddenly, and in whom the muscular irritability or nervous stimulus or both had not become exhausted at the moment of dissolution. Richardson doubts the existence of postmortem movements of respiration. Snow is accredited with having seen a girl in Soho who, dying of scarlet fever, turned dark at the moment of death, but in a few hours presented such a life-line appearance and color as to almost denote the return of life. The center of the cheeks became colored in a natural fashion, and the rest of the body resumed the natural flesh color. The parents refused to believe that death had ensued. Richardson remarks that he had seen two similar cases, and states that he believes the change is due to oxidation of the blood surcharged with carbon dioxid. The moist tissues suffuse carbonized blood, and there occurs an osmotic interchange between the carbon dioxid and the oxygen of the air resulting in an oxygenation of the blood, and modification of the color from dark venous to arterial red. A peculiar postmortem anomaly is erection of the penis. The Ephemerides and Morgagni discuss postmortem erection, and Guyon mentions that on one occasion he saw 14 negroes hanged, and states that at the moment of suspension erection of the penis occurred in each; in nine of these blacks traces of this erectile state were perceived an hour after death. Cadaveric perspiration has been observed and described by several authors, and Paullini has stated that he has seen tears flow from the eyes of a corpse. The retardation of putrefaction of the body after death sometimes presents interesting changes. Petrifaction or mummification of the body are quite well known, and not being in the province of this work, will be referred to collateral books on this subject; but sometimes an unaccountable preservation takes place. In a tomb recently opened at Canterbury Cathedral, a for the purpose of discovering what Archbishop's body it contained, the corpse was of an extremely offensive and sickening odor, unmistakably that of putrefaction. The body was that of Hubert Walter, who died in 1204 A.D., and the decomposition had been retarded, and was actually still in progress, several hundred years after burial. Retardation of the putrefactive process has been noticed in bodies some years under water. Konig of Hermannstadt mentions a man who, forty years previous to the time of report, had fallen under the waters of Echoschacht, and who was found in a complete state of preservation. Postmortem Growth of Hair and Nails.--The hair and beard may grow after death, and even change color. Bartholinus recalls a case of a man who had short, black hair and beard at the time of interment, but who, some time after death, was found to possess long and yellowish hair. Aristotle discusses postmortem growth of the hair, and Garmanus cites an instance in which the beard and hair were cut several times from the cadaver. We occasionally see evidences of this in the dissecting-rooms. Caldwell mentions a body buried four years, the hair from which protruded at the points where the joints of the coffin had given away. The hair of the head measured 18 inches, that of the beard eight inches, and that on the breast from four to six inches. Rosse of Washington mentions an instance in which after burial the hair turned from dark brown to red, and also cites a case in a Washington cemetery of a girl, twelve or thirteen years old, who when exhumed was found to have a new growth of hair all over her body. The Ephemerides contains an account of hair suddenly turning gray after death. Nails sometimes grow several inches after death, and there is on record the account of an idiot who had an idiosyncrasy for long nails, and after death the nails were found to have grown to such an extent that they curled up under the palms and soles. The untoward effects of the emotions on the vital functions are quite well exemplified in medical literature. There is an abundance of cases reported in which joy, fear, pride, and grief have produced a fatal issue. In history we have the old story of the Lacedemonian woman who for some time had believed her son was dead, and who from the sudden joy occasioned by seeing him alive, herself fell lifeless. There is a similar instance in Roman history. Aristotle, Pliny, Livy, Cicero, and others cite instances of death from sudden or excessive joy. Fouquet died of excessive joy on being released from prison. A niece of the celebrated Leibnitz immediately fell dead on seeing a casket of gold left to her by her deceased uncle. Galen mentions death from joy, and in comment upon it he says that the emotion of joy is much more dangerous than that of anger. In discussing this subject, Haller says that the blood is probably sent with such violence to the brain as to cause apoplexy. There is one case on record in which after a death from sudden joy the pericardium was found full of blood. The Ephemerides, Marcellus Donatus, Martini, and Struthius all mention death from joy. Death from violent laughter has been recorded, but in this instance it is very probable that death was not due to the emotion itself, but to the extreme convulsion and exertion used in the laughter. The Ephemerides mentions a death from laughter, and also describes the death of a pregnant woman from violent mirth. Roy, Swinger, and Camerarius have recorded instances of death from laughter. Strange as it may seem, Saint-Foix says that the Moravian brothers, a sect of Anabaptists having great horror of bloodshed, executed their condemned brethren by tickling them to death. Powerfully depressing emotions, which are called by Kant "asthenic," such as great and sudden sorrow, grief, or fright, have a pronounced effect on the vital functions, at times even causing death. Throughout literature and history we have examples of this anomaly. In Shakespeare's "Pericles," Thaisa, the daughter to Simonides and wife of Pericles, frightened when pregnant by a threatened shipwreck, dies in premature childbirth. In Scott's "Guy Mannering," Mrs. Bertram, on suddenly learning of the death of her little boy, is thrown into premature labor, followed by death. Various theories are advanced in explanation of this anomaly. A very plausible one is, that the cardiac palsy is caused by energetic and persistent excitement of the inhibitory cardiac nerves. Strand is accredited with saying that agony of the mind produces rupture of the heart. It is quite common to hear the expression, "Died of a broken heart;" and, strange to say, in some cases postmortem examination has proved the actual truth of the saying. Bartholinus, Fabricius Hildanus, Pliny, Rhodius, Schenck, Marcellus Donatus, Riedlin, and Garengeot speak of death from fright and fear, and the Ephemerides describes a death the direct cause of which was intense shame. Deleau, a celebrated doctor of Paris, while embracing his favorite daughter, who was in the last throes of consumption, was so overcome by intense grief that he fell over her corpse and died, and both were buried together. The fear of child-birth has been frequently cited as a cause of death McClintock quotes a case from Travers of a young lady, happily married; who entertained a fear of death in child-birth; although she had been safely delivered, she suddenly and without apparent cause died in six hours. Every region of the body was examined with minutest care by an eminent physician, but no signs indicative of the cause of death were found. Mordret cites a similar instance of death from fear of labor. Morgagni mentions a woman who died from the disappointment of bearing a girl baby when she was extremely desirous of a boy. The following case, quoted from Lauder Brunton, shows the extent of shock which may be produced by fear: Many years ago a janitor of a college had rendered himself obnoxious to the students, and they determined to punish him. Accordingly they prepared a block and an axe, which they conveyed to a lonely place, and having appropriately dressed themselves, some of them prepared to act as judges, and sent others of their company to bring him before them. He first affected to treat the whole affair as a joke, but was solemnly assured by the students that they meant it in real earnest. He was told to prepare for immediate death. The trembling janitor looked all around in the vain hope of seeing some indication that nothing was really meant, but stern looks met him everywhere. He was blindfolded, and made to kneel before the block. The executioner's axe was raised, but, instead of the sharp edge, a wet towel was brought sharply down on the back of the neck. The bandage was now removed from the culprit's eyes, but to the horror and astonishment of the students they found that he was dead. Such a case may be due to heart-failure from fear or excitement. It is not uncommon that death ensues from the shock alone following blows that cause no visible injury, but administered to vital parts. This is particularly true of blows about the external genital region, or epigastrium, where the solar plexus is an active factor in inhibition. Ivanhoff of Bulgaria in 1886 speaks of a man of forty-five who was dealt a blow on the testicle in a violent street fight, and staggering, he fell insensible. Despite vigorous medical efforts he never regained consciousness and died in forty-five minutes. Postmortem examination revealed everything normal, and death must have been caused by syncope following violent pain. Watkins cites an instance occurring in South Africa. A native shearing sheep for a farmer provoked his master's ire by calling him by some nickname. While the man was in a squatting posture the farmer struck him in the epigastrium. He followed this up by a kick in the side and a blow on the head, neither of which, however, was as severe as the first blow. The man fell unconscious and died. At the autopsy there were no signs indicative of death, which must have been due to the shock following the blow on the epigastrium. As illustrative of the sensitiveness of the epigastric region, Vincent relates the following case: "A man received a blow by a stick upon the epigastrium. He had an anxious expression and suffered from oppression. Irregular heart-action and shivering were symptoms that gradually disappeared during the day. In the evening his appetite returned and he felt well; during the night he died without a struggle, and at the autopsy there was absolutely nothing abnormal to be found." Blows upon the neck often produce sudden collapse. Prize-fighters are well aware of the effects of a blow on the jugular vein. Maschka, quoted by Warren, reports the case of a boy of twelve, who was struck on the anterior portion of the larynx by a stone. He fell lifeless to the ground, and at autopsy no local lesion was found nor any lesion elsewhere. The sudden death may be attributed in this case partly to shock and partly to cerebral anemia. Soldiers have been seen to drop lifeless on the battle-field without apparent injury or organic derangement; in the olden times this death was attributed to fear and fright, and later was supposed to be caused by what is called "the wind of a cannon-ball." Tolifree has written an article on this cause of sudden death and others have discussed it. By some it is maintained that the momentum acquired by a cannon-ball generates enough force in the neighboring air to prostrate a person in the immediate vicinity of its path of flight. CHAPTER X. SURGICAL ANOMALIES OF THE HEAD AND NECK. Injuries of such a delicate organ as the eye, in which the slightest accident can produce such disastrous consequences, naturally elicit the interest of all. Examples of exophthalmos, or protrusion of the eye from the orbit from bizarre causes, are of particular interest. Among the older writers we find Ficker and the Ephemerides giving instances of exophthalmos from vomiting. Fabricius Hildanus mentions a similar instance. Salmuth, Verduc, and others mention extrusion of the eyeball from the socket, due to excessive coughing. Ab Heers and Sennert mention instances in which after replacement the sight was uninjured. Tyler relates the case of a man who, after arising in the morning, blew his nose violently, and to his horror his left eye extruded from the orbit. With the assistance of his wife it was immediately replaced and a bandage placed over it. When Tyler saw him the upper lid was slightly swollen and discolored, but there was no hemorrhage. Hutchinson describes extrusion of the eyeball from the orbit caused by a thrust with a stick. There was paraphymotic strangulation of the globe, entirely preventing replacement and necessitating excision. Reyssie speaks of a patient who, during a fire, was struck in the right eye by a stream of water from a hose, violently thrusting the eye backward. Contracting under the double influence of shock and cold, the surrounding tissues forced the eyeball from the orbit, and an hour later Reyssie saw the patient with the eye hanging by the optic nerve and muscles. Its reduction was easy, and after some minor treatment vision was perfectly restored in the injured organ. Thirty months after the accident the patient had perfect vision, and the eye had never in the slightest way discommoded him. Bodkin mentions the case of a woman of sixty who fell on the key in a door and completely avulsed her eye. In von Graefe's Archiv there is a record of a man of seventy-five who suffered complete avulsion of the eye by a cart-wheel passing over his head. Verhaeghe records complete avulsion of the eye caused by a man falling against the ring of a sharp-worn key. Hamill describes the case of a young girl whose conjunctiva was pierced by one of the rests of an ordinary gas-bracket. Being hooked at one of its extremities the iron became entangled in either the inferior oblique or external rectus muscles, and completely avulsed the eyeball upon the cheek. The real damage could not be estimated, as the patient never returned after the muscle was clipped off close to its conjunctival insertion. Calhoun mentions an instance of a little Esquimaux dog whose head was seized between the jaws of a large Newfoundland with such force as to press the left eyeball from the socket. The ball rested on the cheek, held by the taut optic nerve; the cornea was opaque. The ball was carefully and gently replaced, and sight soon returned to the eye. In former days there was an old-fashioned manner of fighting called "gouging." In this brutal contest the combatant was successful who could, with his thumb, press his opponent's eyeball out. Strange to say, little serious or permanently bad results followed such inhuman treatment of the eye. Von Langenbeck of Berlin mentions an instance of fracture of the superior maxilla, in which the eyeball was so much displaced as to lodge in the antrum of Highmore. Von Becker of Heidelberg reports the history of a case in which a blow from the horn of a cow dislocated the eye so far back in the orbit as to present the appearance of enucleation. The conjunctiva hid the organ from view, but when it was pulled aside the eyeball was exposed, and in its remote position still possessed the power of vision. In some cases in which exophthalmos has been seemingly spontaneous, extreme laxity of the lids may serve as an explanation. There is an instance on record in which a Polish dew appeared in a Continental hospital, saying that while turning in bed, without any apparent cause, his eyeball was completely extruded. There have been people who prided themselves on their ability to produce partial exophthalmos. Rupture of the Eyeball.--Jessop mentions the case of a child of eight who suffered a blow on the eye from a fall against a bedpost, followed by compound rupture of the organ. The wound in the sclerotic was three or four lines in length, and the rent in the conjunctiva was so large that it required three sutures. The chief interest in this case was the rapid and complete recovery of vision. Adler reports a case of fracture of the superior maxillary in which the dislocated bone-fragment of the lower orbital border, through pressure on the inferior maxillary and counter pressure on the skull, caused rupture of the conjunctiva of the left eye. Serious Sequelae of Orbital Injuries.--In some instances injuries primarily to the orbit either by extension or implication of the cerebral contents provoke the most serious issues. Pointed instruments thrust into the orbital cavity may by this route reach the brain. There is a record of death caused by a wound of a cavernous sinus through the orbit by the stem of a tobacco-pipe. Bower saw a woman at the Gloucester Infirmary who had been stabbed in the eye by the end of an umbrella. There was profuse hemorrhage from the nostrils and left eye, but no signs indicative of its origin. Death shortly ensued, and at the necropsy a fracture through the roof of the orbit was revealed, the umbrella point having completely severed the optic nerve and divided the ophthalmic artery. The internal carotid artery was wounded in one-half of its circumference at its bend, just before it passes up between the anterior clinoid process and the optic nerve. The cavernous sinus was also opened. In this rare injury, although there was a considerable quantity of clotted blood at the base of the brain, there was no wound to the eyeball nor to the brain itself. Pepper records a case in which a knife was thrust through the spheroidal fissure, wounding a large meningeal vein, causing death from intracranial hemorrhage. Nelaton describes an instance in which the point of an umbrella wounded the cavernous sinus and internal carotid artery of the opposite side, causing the formation of an arteriovenous aneurysm which ultimately burst, and death ensued. Polaillon saw a boy of eighteen who was found in a state of coma. It was stated that an umbrella stick had been thrust up through the roof of the orbit and had been withdrawn with much difficulty. The anterior lobe of the brain was evidently much wounded; an incision was made in the forehead and a portion of the frontal bone chiseled away entrance being thus effected, the aura was incised, and some blood and cerebrospinal fluid escaped. Five splinters were removed and a portion of the damaged brain-substance, and a small artery was tied with catgut. The debris of the eyeball was enucleated and a drain was placed in the frontal wound, coming out through the orbit. The patient soon regained consciousness and experienced no bad symptoms afterward. The drains were gradually withdrawn, the process of healing advanced rapidly, and recovery soon ensued. Annandale mentions an instance in which a knitting-needle penetrated the brain through the orbit. Hewett speaks of perforation of the roof of the orbit and injury to the brain by a lead-pencil. Gunshot Injuries of the Orbit.--Barkan recites the case in which a leaden ball 32/100 inch in diameter was thrown from a sling into the left orbital cavity, penetrating between the eyeball and osseous wall of the orbit without rupturing the tunics of the eye or breaking the bony wall of the cavity. It remained lodged two weeks without causing any pain or symptoms, and subsequently worked itself forward, contained in a perfect conjunctival sac, in which it was freely movable. Buchanan recites the case of a private in the army who was shot at a distance of three feet away, the ball entering the inner canthus of the right eye and lodging under the skin of the opposite side. The eye was not lost, and opacity of the lower part of the cornea alone resulted. Cold water and purging constituted the treatment. It is said a that an old soldier of one of Napoleon's armies had a musket-ball removed from his left orbit after twenty-four years' lodgment. He was struck in the orbit by a musket-ball, but as at the same time a companion fell dead at his side he inferred that the bullet rebounded from his orbit and killed his comrade. For twenty-four years he had suffered from cephalalgia and pains and partial exophthalmos of the left eye. After removal of the ball the eye partially atrophied. Warren reports a case of a man of thirty-five whose eyeball was destroyed by the explosion of a gun, the breech-pin flying off and penetrating the head. The orbit was crushed; fourteen months afterward the man complained of soreness on the hard palate, and the whole breech-pin, with screw attached, was extracted. The removal of the pin was followed by fissure of the hard palate, which, however, was relieved by operation. The following is an extract of a report by Wenyon of Fatshan, South China:-- "Tang Shan, Chinese farmer, thirty-one years of age, was injured in the face by the bursting of a shot-gun. After being for upward of two months under the treatment of native practitioners, he came to me on December 4, 1891. I observed a cicatrix on the right side of his nose, and above this a sinus, still unhealed, the orifice of which involved the inner canthus of the right eye, and extended downward and inward for about a centimeter. The sight of the right eye was entirely lost, and the anterior surface of the globe was so uniformly red that the cornea could hardly be distinguished from the surrounding conjunctiva. There was no perceptible enlargement or protrusion of the eyeball, and it did not appear to have sustained any mechanical injury or loss of tissue. The ophthalmia and keratitis were possibly caused by the irritating substances applied to the wound by the Chinese doctors. The sinus on the side of the nose gave exit to a continuous discharge of slightly putrid pus, and the patient complained of continuous headache and occasional dizziness, which interfered with his work. The pain was referred to the right frontal and temporal regions, and the skin on this part of the head had a slight blush, but there was no superficial tenderness. The patient had been told by his native doctors, and he believed it himself, that there was no foreign body in the wound; but on probing it I easily recognized the lower edge of a hard metallic substance at a depth of about one inch posteriorly from the orifice of the sinus. Being unable to obtain any reliable information as to the probable size or shape of the object, I cautiously made several attempts to remove it through a slightly enlarged opening, but without success. I therefore continued the incision along the side of the nose to the nostril, thus laying open the right nasal cavity; then, seizing the foreign body with a pair of strong forceps, I with difficulty removed the complete breech-pin of a Chinese gun. Its size and shape are accurately represented by the accompanying drawing. The breech-pin measures a little over three inches in length, and weighs 21 ounces, or 75.6 grams. It had evidently lain at the back of the orbit, inclined upward and slightly backward from its point of entrance, at an angle of about 45 degrees. On its removal the headache was at once relieved and did not return. In ten days the wound was perfectly healed and the patient went back to his work. A somewhat similar case, but which terminated fatally, is recorded in the American Journal of the Medical Sciences of July, 1882." The extent of permanent injury done by foreign bodies in the orbit is variable. In some instances the most extensive wound is followed by the happiest result, while in others vision is entirely destroyed by a minor injury. Carter reports a case in which a hat-peg 3 3/10 inches long and about 1/4 inch in diameter (upon one end of which was a knob nearly 1/2 inch in diameter) was impacted in the orbit for from ten to twenty days, and during this time the patient was not aware of the fact. Recovery followed its extraction, the vision and movements of the eye being unimpaired. According to the Philosophical Transactions a laborer thrust a long lath with great violence into the inner canthus of the left eye of his fellow workman, Edward Roberts. The lath broke off short, leaving a piece two inches long, 1/2 inch wide, and 1/4 inch thick, in situ. Roberts rode about a mile to the surgery of Mr. Justinian Morse, who extracted it with much difficulty; recovery followed, together with restoration of the sight and muscular action. The lath was supposed to have passed behind the eyeball. Collette speaks of an instance in which 186 pieces of glass were extracted from the left orbit, the whole mass weighing 186 Belgian grains. They were blown in by a gust of wind that broke a pane of glass; after extraction no affection of the brain or eye occurred. Watson speaks of a case in which a chip of steel 3/8 inch long was imbedded in cellular tissue of the orbit for four days, and was removed without injury to the eye. Wordsworth reports a case in which a foreign body was deeply imbedded in the orbit for six weeks, and was removed with subsequent recovery. Chisholm has seen a case in which for five weeks a fly was imbedded in the culdesac between the lower lid and the eyeball. Foreign bodies are sometimes contained in the eyeball for many years. There is an instance on record in which a wooden splinter, five mm. long and two mm. broad, remained in the eye forty-seven years. It was extracted, with the lens in which it was lodged, to relieve pain and other distressing symptoms. Snell reports a case in which a piece of steel was imbedded and encapsulated in the ciliary process twenty-nine years without producing sympathetic irritation of its fellow, but causing such pain as to warrant enucleation of this eye. Gunning speaks of a piece of thorn 5/8 inch long, imbedded in the left eyeball of an old man for six years, causing total loss of vision; he adds that, after its removal, some improvement was noticed. Williams mentions a stone-cutter whose left eye was put out by a piece of stone. Shortly after this his right eye was wounded by a knife, causing traumatic cataract, which was extracted by Sir William Wilde, giving the man good sight for twelve years, after which iritis attacked the right eye and produced a false membrane over the pupil so that the man could not work. It was in this condition that he consulted Williams, fourteen years after the loss of the left eye. The eye was atrophied, and on examination a piece of stone was seen projecting from it directly between the lids. The visible portion was 1/4 inch long, and the end in the shrunken eye was evidently longer than the end protruding. The sclera was incised, and, after fourteen years' duration in the eye, the stone was removed. Taylor reports the removal of a piece of bone which had remained quiescent in the eye for fourteen years; after the removal of the eye the bone was found adherent to the inner tunics. It resembled the lens in size and shape. Williams mentions continual tolerance of foreign bodies in the eyeball for fifteen and twenty-two years; and Chisholm reports the lodgment of a fragment of metal in the iris for twenty-three years. Liebreich extracted a piece of steel from the interior of the eye where it had been lodged twenty-two years. Barkar speaks of a piece of steel which penetrated through the cornea and lens, and which, five months later, was successfully removed by the extraction of the cataractous lens. Critchett gives an instance of a foreign body being loose in the anterior chamber for sixteen years. Rider speaks of the lodgment of a fragment of a copper percussion cap in the left eye, back of the inner ciliary margin of the iris, for thirty-five years; and Bartholinus mentions a thorn in the canthus for thirty years. Jacob reports a case in which a chip of iron remained in the eyeball twenty-eight years without giving indications for removal. It was clearly visible, protruding into the anterior surface of the iris, and although it was rusted by its long lodgment, sight in the eye was fairly good, and there was no sign of irritation. Snell gives an instance in which a piece of steel was imbedded close to the optic disc with retention of sight. It was plainly visible by the opthalmoscope eighteen months after the accident, when as yet no diminution of sight was apparent. Smyly speaks of a portion of a tobacco pipe which was successfully removed from the anterior chamber by an incision through the cornea. Clark mentions a case in which molten lead in the eye caused no permanent injury; and there are several cases mentioned in confirmation of the statement that the eye seems to be remarkably free from disastrous effects after this injury. Williamson mentions eyelashes in the anterior chamber of the eye, the result of a stab wound of this organ. Contusion of the eyeball may cause dislocation of the lens into the anterior chamber, and several instances have been recorded. We regret our inability to give the reference or authority for a report that we have seen, stating that by one kick of a horse the lenses of both eyes of a man were synchronously knocked through the eyeballs by the calkins of the horseshoe. Oliver mentions extraction of a lens by a thrust of a cow's horn. Lowe speaks of rupture of the anterior capsule of the lens from violent sneezing, with subsequent absorption of the lenticular substance and restoration of vision. Trioen mentions a curious case of expulsion of the crystalline lens from the eye in ophthalmia, through the formation of a corneal fissure. The authors have personal knowledge of a case of spontaneous extrusion of the lens through a corneal ulcer, in a case of ophthalmia of the new-born. Injury of the Eyeball by Birds.--There are several instances in which birds have pierced the eyeball with their bills, completely destroying vision. Not long since a prominent taxidermist winged a crane, picked it up, and started to examine it, when it made one thrust with its bill and totally destroyed his eyeball. In another instance a man was going from the railroad station to his hotel in a gale of wind, when, as he turned the corner of the street, an English sparrow was blown into his face. Its bill penetrated his eyeball and completely ruined his sight. There are several instances on record in which game fowls have destroyed the eyes of their owners. In one case a game cock almost completed the enucleation of the eye of his handler by striking him with his gaff while preparing in a cock-pit. Moorehead explains a rare accident to an eye as follows:-- "Mr. S. B. A., while attending to his bees, was stung by one upon the right upper eyelid near its center. An employee, who was assisting in the work, immediately discovered the sting driven in the lid and cautiously extracted it, stating that he made sufficient traction to lift the lid well away from the globe. In a few hours the lid became much swollen, but the pain experienced at first had disappeared. Before retiring for the night he began gentle massage of the lid, stroking it horizontally with his finger. The edematous condition was by this means much reduced in a short time. While thus engaged in stroking the lid he suddenly experienced intense pain in the eye as if it had been pierced by a sharp instrument. The suffering was very severe, and he passed a wretched night, constantly feeling 'something in his eye.' "The next morning, the trouble continuing, he came to me for relief. Upon examination of the lid, no opening could be made out where the sting had penetrated, and a minute inspection of the conjunctival surface with a good glass failed to reveal any foreign substance. Cleansing the lid thoroughly, and carefully inspecting with a lens under strong light, a minute dark point was made out about the center of the lid. Feeling that this might be the point of the sting, I had recourse to several expedients for its removal, but without success. Finally, with a fine knife, I succeeded in cutting down by the side of the body and tilting it out. Examination with a 1/5 inch objective confirmed my opinion that it was the point of the bee-sting. "The barbed formation of the point explains how, under the stroking with the finger, it was forced through the dense tarsal cartilage and against the cornea of the eye." There is a story told in La Medecine Moderne of a seamstress of Berlin who was in the habit of allowing her dog to lick her face. She was attacked with a severe inflammation of the right eye, which had to be enucleated, and was found full of tenia echinococcus, evidently derived from the dog's tongue. Gabb mentions a case of epistaxis in which the blood welled up through the lacrimal ducts and suffused into the eye so that it was constantly necessary to wipe the lower eyelid, and the discharge ceased only when the nose stopped bleeding. A brief editorial note on epistaxis through the eyes, referring to a case in the Medical News of November 30, 1895, provoked further reports from numerous correspondents. Among others, the following:-- "Dr. T. L. Wilson of Bellwood, Pa., relates the case of an old lady of seventy-eight whom he found with the blood gushing from the nostrils. After plugging the nares thoroughly with absorbent cotton dusted with tannic acid he was surprised to see the blood ooze out around the eyelids and trickle down the cheeks. This oozing continued for the greater part of an hour, being controlled by applications of ice to both sides of the nose." "Dr. F. L. Donlon of New York City reports the case of a married woman, about fifty years old, in whom epistaxis set in suddenly at 11 P.M., and had continued for several hours, when the anterior nares were plugged. In a short time the woman complained that she could scarcely see, owing to the welling up of blood in the eyes and trickling down her face. The bleeding only ceased when the posterior nares also were plugged." "Dr. T. G. Wright of Plainville, Conn., narrates the case of a young man whom he found in the night, bleeding profusely, and having already lost a large amount of blood. Shortly after plugging both anterior and posterior nares the blood found its way through the lacrimal ducts to the eyes and trickled down the cheeks." "Dr. Charles W. Crumb cites the case of a man, sixty-five years old, with chronic nephritis, in whom a slight bruise of the nose was followed by epistaxis lasting twenty-four hours. When the nares were plugged blood escaped freely from the eyes. A cone-shaped bit of sponge, saturated with ferrous sulphate, was passed into each anterior naris, and another piece of sponge, similarly medicated, into either posterior naris. The patient had been taking various preparations of potassium, and it was thought that his blood contained a deficiency of fibrin. Upon removal of the nasal plugs a catarrhal inflammation developed which lasted a long time and was attended with considerable purulent discharge." Late Restoration of Sight.--There are some marvelous cases on record in which, after many years of blindness, the surgeon has been able, by operation, to restore the sight. McKeown gives the history of a blind fiddler of sixty-three, who, when one and a half years old, had lost the sight of both eyes after an attack of small-pox. Iridectomy was performed, and after over sixty years of total blindness his sight was restored; color-perception was good. Berncastle mentions a case of extraction of double cataract and double iridectomy for occluded pupils, which, after thirty years of blindness, resulted in the recovery of good sight. The patient was a blind beggar of Sydney. To those interested in this subject, Jauffret has a most interesting description of a man by the name of Garin, who was born blind, who talked at eight or nine months, showed great intelligence, and who was educated at a blind asylum. At the age of twenty-four he entered the hospital of Forlenze, to be operated upon by that famous oculist. Garin had never seen, but could distinguish night or darkness by one eye only, and recognized orange and red when placed close to that eye. He could tell at once the sex and age of a person approximately by the voice and tread, and formed his conclusions more rapidly in regard to females than males. Forlenze diagnosed cataract, and, in the presence of a distinguished gathering, operated with the happiest result. The description that follows, which is quoted by Fournier and is readily accessible to any one, is well worth reading, as it contains an account of the first sensations of light, objects, distance, etc., and minor analogous thoughts, of an educated and matured mind experiencing its first sensations of sight. Hansell and Clark say that the perplexities of learning to see after twenty-six years of blindness from congenital disease, as described by a patient of Franke, remind one of the experience of Shelley's Frankenstein. Franke's patient was successfully operated on for congenital double cataract, at twenty-six years of age. The author describes the difficulties the patient had of recognizing by means of vision the objects he had hitherto known through his other senses, and his slowness in learning to estimate distances and the comparative size of objects. Sight is popularly supposed to be occasionally restored without the aid of art, after long years of blindness. Benjamin Rush saw a man of forty-five who, twelve years before, became blind without ascertainable cause, and recovered his sight equally without reason. St. Clair mentions Marshal Vivian, who at the age of one hundred regained sight that for nearly forty years had gradually been failing almost to blindness, and preserved this new sight to the time of his death. There are many superstitions prevalent among uneducated people as to "second sight," recovery of vision, etc., which render their reports of such things untrustworthy. The real explanations of such cases are too varied for discussion here. Nyctalopia etymologically means night blindness, but the general usage, making the term mean night-vision, is so strongly intrenched that it is useless and confusing to attempt any reinstatement of the old significance. The condition in which one sees better by night, relatively speaking, than by day is due to some lesion of the macular region, rendering it blind. At night the pupil dilates more than in the day-time, and hence vision with the extramacular or peripheral portions of the retina is correspondingly better. It is, therefore, a symptom of serious retinal disease. All night-prowling animals have widely dilatable pupils, and in addition to this they have in the retina a special organ called the tapetum lucidum, the function of which is to reflect to a focus in front of them the relatively few rays of light that enter the widely-dilated pupil and thus enable them the better to see their way. Hence the luminous appearance of the eyes of such animals in the dark. Hemeralopia (etymologically day-blindness, but by common usage meaning day-vision or night-blindness) is a symptom of a peculiar degenerative disease of the retina, called retinitis pigmentosa. It also occurs in some cases of extreme denutrition, numerous cases having been reported among those who make the prolonged fasts customary in the Russian church. In retinitis pigmentosa the peripheral or extramacular portions of the retina are subject to a pigmentary degeneration that renders them insensitive to light, and patients so afflicted are consequently incapable of seeing at night as well as others. They stumble and run against objects easily seen by the normal eye. Snow-blindness occurs from prolonged exposure of the eyes to snow upon which the sun is shining. Some years ago, some seventy laborers, who were clearing away snow-drifts in the Caucasus, were seized, and thirty of them could not find their way home, so great was the photophobia, conjunctivitis, and lacrimation. Graddy reports six cases, and many others are constantly occurring. Other forms of retinal injury from too great or too prolonged exposure to light are "moon-blindness," due to sleeping with the eyes exposed to bright moonlight, and that due to lightning--a case, e.g., being reported by Knies. Silex also reports such a case and reviews the reported cases, 25 in number, in ten of which cataract ensued. In the Annual of the Universal Medical Sciences, 1888, there is a report of seven cases of retinal injury with central scotoma, amblyopia, etc., in Japanese medical students, caused by observation of the sun in eclipse. In discussing the question of electric-light injuries of the eyes Gould reviews the literature of the subject and epitomizes the cases reported up to that time. They numbered 23. No patient was seriously or permanently injured, and none was in a person who used the electric light in a proper manner as an illuminant. All were in scientific investigators or workmen about the light, who approached it too closely or gazed at it too long and without the colored protecting spectacles now found necessary by such workers. Injuries to the Ear.--The folly of the practice of boxing children's ears, and the possible disastrous results subsequent to this punishment, are well exemplified throughout medical literature. Stewart quotes four cases of rupture of the tympanum from boxing the ears, and there is an instance of a boy of eight, who was boxed on the ear at school, in whom subsequent brain-disease developed early, and death followed. Roosa of New York mentions the loss of hearing following a kiss on the ear. Dalby, in a paper citing many different causes of rupture of the tympanic membrane, mentions the following: A blow in sparring; violent sneezing; blowing the nose; forcible dilatation of the Eustachian canal; a thorn or twig of a tree accidentally thrust into the head; picking the ear with a toothpick. In time of battle soldiers sometimes have their tympanums ruptured by the concussion caused by the firing of cannon. Dalby mentions an instance of an officer who was discharged for deafness acquired in this manner during the Crimean War. He was standing beside a mortar which, unexpectedly to him, was fired, causing rupture of the tympanic membrane, followed by hemorrhage from the ear. Similar cases were reported in the recent naval engagements between the Chinese and Japanese. Wilson reports two cases of rupture of the membrane tympani caused by diving. Roosa divides the causes into traumatic, hemorrhagic, and inflammatory, and primary lesions of the labyrinth, exemplifying each by numerous instances. Under traumatic causes he mentions severe falls, blows about the head or face, constant listening to a telegraphic instrument, cannonading, and finally eight cases of boiler-makers' deafness. Roosa cites a curious case of sudden and profound deafness in a young man in perfect health, while calling upon the parents of his lady-love to ask her hand in marriage. Strange to say that after he had had a favorable reply he gradually recovered his hearing! In the same paper there is an instance of a case of deafness due to the sudden cessation of perspiration, and an instance of tinnitus due to the excessive use of tobacco; Roosa also mentions a case of deafness due to excessive mental employment. Perforation of the Tympanum.--Kealy relates an instance in which a pin was introduced into the left ear to relieve an intolerable itching. It perforated the tympanum, and before the expiration of twenty-four hours was coughed up from the throat with a small quantity of blood. The pin was bent at an angle of about 120 degrees. Another similar case was that of a girl of twenty-two who, while pricking her ear with a hair-pin, was jerked or struck on the arm by a child, and the pin forced into the ear; great pain and deafness followed, together with the loss of taste on the same side of the tongue; after treatment both of the disturbed senses were restored. A man of twenty was pricked in the ear by a needle entering the meatus. He uttered a cry, fell senseless, and so continued until the fourth day when he died. The whole auditory meatus was destroyed by suppuration. Gamgee tells of a constable who was stabbed in the left ear, severing the middle meningeal artery, death ensuing. In this instance, after digital compression, ligature of the common carotid was practiced as a last resort. There is an account of a provision-dealer's agent who fell asleep at a public house at Tottenham. In sport an attendant tickled his ear with a wooden article used as a pipe light. A quick, unconscious movement forced the wooden point through the tympanum, causing cerebral inflammation and subsequent death. There is a record of death, in a child of nine, caused by the passage of a knitting-needle into the auditory meatus. Kauffmann reports a case of what he calls objective tinnitus aurium, in which the noise originating in the patient's ears was distinctly audible by others. The patient was a boy of fourteen, who had fallen on the back of his head and had remained unconscious for nearly two weeks. The noises were bilateral, but more distinct on the left than on the right side. The sounds were described as crackling, and seemed to depend on movements of the arch of the palate. Kauffmann expresses the opinion that the noises were due to clonic spasm of the tensor velum palati, and states that under appropriate treatment the tinnitus gradually subsided. The introduction of foreign bodies in the ear is usually accidental, although in children we often find it as a result of sport or curiosity. There is an instance on record of a man who was accustomed to catch flies and put them in his ear, deriving from them a pleasurable sensation from the tickling which ensued. There have been cases in which children, and even adults, have held grasshoppers, crickets, or lady-birds to their ears in order to more attentively listen to the noise, and while in this position the insects have escaped and penetrated the auditory canal. Insects often enter the ears of persons reposing in the fields with the ear to the ground. Fabricius Hildanus speaks of a cricket penetrating the ear during sleep. Calhoun mentions an instance of disease of the ear which he found was due to the presence of several living maggots in the interior of the ear. The patient had been sleeping in a horse stall in which were found maggots similar to those extracted from his ear. An analogous instance was seen in a negro in the Emergency Hospital, Washington, D.C., in the summer of 1894; and many others are recorded. The insects are frequently removed only after a prolonged lodgment. D'Aguanno gives an account of two instances of living larvae of the musca sarcophaga in the ears of children. In one of the cases the larvae entered the drum-cavity through a rupture in the tympanic membrane. In both cases the maggots were removed by forceps. Haug has observed a tic (ixodes ricinus) in the ear of a lad of seventeen. The creature was killed by a mercuric-chlorid solution, and removed with a probe. There is a common superstition that centipedes have the faculty of entering the ear and penetrating the brain, causing death. The authors have knowledge of an instance in which three small centipedes were taken from the ear of a policeman after remaining there three days; during this time they caused excruciating pain, but there was no permanent injury. The Ephemerides contains instances in which, while yet living, worms, crickets, ants, and beetles have all been taken from the ear. In one case the entrance of a cricket in the auditory canal was the cause of death. Martin gives an instance in which larvae were deposited in the ear. Stalpart van der Wiel relates an instance of the lodgment of a living spider in the ear. Far more common than insects are inanimate objects as foreign bodies in the ear, and numerous examples are to be found in literature. Fabricius Hildanus tells of a glass ball introduced into the auditory canal of a girl of ten, followed by headache, numbness on the left side, and after four or five years epileptic seizures, and atrophy of the arm. He extracted it and the symptoms immediately ceased. Sabatier speaks of an abscess of the brain caused by a ball of paper in the ear; and it is quite common for persons in the habit of using a tampon of cotton in the meatus to mistake the deep entrance of this substance for functional derangement, and many cases of temporary deafness are simply due to forgetfulness of the cause. A strange case is reported in a girl of fourteen, who lost her tympanum from a profuse otorrhea, and who substituted an artificial tympanum which was, in its turn, lost by deep penetration, causing augmentation of the symptoms, of the cause of which the patient herself seemed unaware. Sometimes artificial otoliths are produced by the insufflation of various powders which become agglutinated, and are veritable foreign bodies. Holman tells of a negro, aged thirty-five, whose wife poured molten pewter in his ear while asleep. It was removed, but total deafness was the result. Alley mentions a New Orleans wharf laborer, in whose ear was poured some molten lead; seventeen months afterward the lead was still occupying the external auditory meatus. It is quite remarkable that the lead should have remained such a length of time without causing meningeal inflammation. There was deafness and palsy of that side of the face. A fungous growth occupied the external portion of the ear; the man suffered pain and discharge from the ear, and had also great difficulty in closing his right eyelid. Morrison mentions an alcoholic patient of forty who, on June 6, 1833, had nitric acid poured in her right ear. There were no headache, febrile symptoms, stupor, or vertigo. Debility alone was present. Two weeks after the injury paralysis began on the right side, and six weeks from the injury the patient died. This case is interesting from the novel mode of death, the perfect paralysis of the arm, paralysis agitans of the body (occurring as hemorrhage from the ear came on, and subsiding with it), and extensive caries of the petrous bone, without sensation of pain or any indicative symptoms. There is an instance in a young girl in which a piece of pencil remained in the right ear for seven years. Haug speaks of two beads lying in the auditory canal for twenty-eight years without causing any harm. A boy of six introduced a carob-nut kernel into each ear. On the next day incompetent persons attempted to extract the kernel from the left side, but only caused pain and hemorrhage. The nut issued spontaneously from the right side. In the afternoon the auditory canal was found excoriated and red, and deep in the meatus the kernel was found, covered with blood. The patient had been so excited and pained by the bungling attempts at extraction that the employment of instruments was impossible; prolonged employment of injections was substituted. Discharge from the ear commenced, intense fever and delirium ensued, and the patient had to be chloroformed to facilitate the operation of extraction. The nut, when taken out, was found to have a consistency much larger than originally, caused by the agglutination of wax and blood. Unfortunately the symptoms of meningitis increased; three days after the operation coma followed, and on the next day death ensued. In 75 cases collected by Mayer, and cited by Poulet (whose work on "Foreign Bodies" is the most extensive in existence), death as a consequence of meningitis was found in three. Fleury de Clermont mentions a woman of twenty-five who consulted him for removal of a pin which was in her right ear. Vain attempts by some of her lay-friends to extract the pin had only made matters worse. The pin was directed transversely, and its middle part touched the membrane tympanum. The mere touching of the pin caused the woman intense pain; even after etherization it was necessary to construct a special instrument to extract it. She suffered intense cephalalgia and other signs of meningitis; despite vigorous treatment she lost consciousness and died shortly after the operation. Winterbotham reports an instance in which a cherry-stone was removed from the meatus auditorius after lodgment of upward of sixty years. Marchal de Calvi mentions intermittent deafness for forty years, caused by the lodgment of a small foreign body in the auditory canal. There is an instance in which a carious molar tooth has been tolerated in the same location for forty years. Albucasius, Fabricius Hildanus, Pare, and others, have mentioned the fact that seeds and beans have been frequently seen to increase in volume while lodged in the auditory canal. Tulpius speaks of an infant, playing with his comrades, who put a cherry-seed in his ear which he was not able to extract. The seed increased in volume to such an extent that it was only by surgical interference that it could be extracted, and then such serious consequences followed that death resulted. Albers reports an instance in which a pin introduced into the ear issued from the pharynx. Confusion of diagnosis is occasionally noticed in terrified or hysteric persons. Lowenberg was called to see a child of five who had introduced a button into his left ear. When he saw the child it complained of all the pain in the right ear, and he naturally examined this ear first but found nothing to indicate the presence of a foreign body. He examined the ear supposed to be healthy and there found the button lying against the tympanum. This was explained by the fact that the child was so pained and terrified by the previous explorations of the affected ear that rather than undergo them again he presented the well ear for examination. In the British Medical Journal for 1877 is an account of an unjustified exploration of an ear for a foreign body by an incompetent physician, who spent a half hour in exploration and manipulation, and whose efforts resulted in the extraction of several pieces of bone. The child died in one and a half hours afterward from extreme hemorrhage, and the medical bungler was compelled to appear before a coroner's jury in explanation of his ignorance. In the external ear of a child Tansley observed a diamond which he removed under chloroform. The mother of the child had pushed the body further inward in her endeavors to remove it and had wounded the canal. Schmiegelow reports a foreign body forced into the drum-cavity, followed by rough extraction, great irritation, tetanus, and death; and there are on record several cases of fatal meningitis, induced by rough endeavors to extract a body from the external ear. In the Therapeutic Gazette, August 15, 1896, there is a translation of the report of a case by Voss, in which a child of five pushed a dry pea in his ear. Four doctors spent several days endeavoring to extract it, but only succeeded in pushing it in further. It was removed by operation on the fifth day, but suppuration of the tympanic cavity caused death on the ninth day. Barclay reports a rare case of ensnared aural foreign body in a lady, aged about forty years, who, while "picking" her left ear with a so-called "invisible hair-pin" several hours before the consultation, had heard a sudden "twang" in the ear, as if the hair-pin had broken. And so, indeed, it had; for on the instant she had attempted to jerk it quickly from the ear the sharp extremity of the inner portion of its lower prong sprang away from its fellow, penetrated the soft tissues of the floor of the external auditory canal, and remained imbedded there, the separated end of this prong only coming away in her grasp. Every attempt on her part to remove the hair-pin by traction on its projecting prong--she durst not force it INWARD for fear of wounding the drumhead--had served but to bury the point of the broken prong more deeply into the flesh of the canal, thereby increasing her suffering. Advised by her family physician not to delay, she forthwith sought advice and aid. On examination, it was found that the lower prong of the "invisible hair-pin" had broken at the outer end of its wavy portion, and seemed firmly imbedded in the floor of the auditory canal, now quite inflamed, at a point about one-third of its depth from the outlet of the canal. The loop or turn of the hair-pin was about 1/2 inch from the flaccid portion of the drumhead, and, together with the unbroken prong, it lay closely against the roof of the canal. Projecting from the meatus there was enough of this prong to be easily grasped between one's thumb and finger. Removal of the hair-pin was effected by first inserting within the meatus a Gruber speculum, encircling the unbroken projecting prong, and then raising the end of the broken one with a long-shanked aural hook, when the hair-pin was readily withdrawn. The wound of the canal-floor promptly healed. In the severest forms of scalp-injuries, such as avulsion of the scalp from the entangling of the hair in machinery, skin-grafting or replantation is of particular value. Ashhurst reports a case which he considers the severest case of scalp-wound that he had ever seen, followed by recovery. The patient was a girl of fifteen, an operative in a cotton-mill, who was caught by her hair between two rollers which were revolving in opposite directions; her scalp being thus, as it were, squeezed off from her head, forming a large horseshoe flap. The linear extent of the wound was 14 inches, the distance between the two extremities being but four inches. This large flap was thrown backward, like the lid of a box, the skull being denuded of its pericranium for the space of 2 1/2 by one inch in extent. The anterior temporal artery was divided and bled profusely, and when admitted to the hospital the patient was extremely depressed by shock and hemorrhage. A ligature was applied to the bleeding vessel, and after it had been gently but carefully cleansed the flap was replaced and held in place with gauze and collodion dressing. A large compress soaked in warm olive oil was then placed over the scalp, covered with oiled silk and with a recurrent bandage. A considerable portion of the wound healed by adhesions, and the patient was discharged, cured, in fifty-four days. No exfoliation of bone occurred. Reverdin, a relative of the discoverer of transplantation of skin, reported the case of a girl of twenty-one whose entire scalp was detached by her hair being caught in machinery, leaving a wound measuring 35 cm. from the root of the nose to the nape of the neck, 28 cm. from one ear to the other, and 57 cm. in circumference. Grafts from the rabbit and dog failed, and the skin from the amputated stump of a boy was employed, and the patient was able to leave the hospital in seven months. Cowley speaks of a girl of fourteen whose hair was caught in the revolving shaft of a steam-engine, which resulted in the tearing off of her whole scalp. A triangular portion of the skin was hanging over her face, the apex of the triangle containing short hair, from which the long hair had been detached. Both ears were hanging down the neck, having been detached above. The right pinna was entire, and the upper half of the left pinna had disappeared. The whole of the head and back of the neck was denuded of skin. One of the temporal arteries was ligated, and the scalp cleansed and reapplied. The hanging ears and the skin of the forehead were successfully restored to their proper position. The patient had no bad symptoms and little pain, and the shock was slight. Where the periosteum had sloughed the bone was granulating, and at the time of the report skin-grafting was shortly to be tried. Schaeffer has presented quite an extensive article on scalp-injuries in which grafting and transplantation has been used, and besides reporting his own he mentions several other cases. One was that of a young lady of twenty-four. While at work under a revolving shaft in a laundry the wind blew her hair and it was caught in the shaft. The entire skull was laid bare from the margin of the eyelids to the neck. The nasal bones were uncovered and broken, exposing the superior nasal meatus. The skin of the eyelids was removed from within three mm. of their edges. The lower margin of the wound was traceable from the lower portion of the left external process of the frontal bone, downward and backward below the left ear (which was entirely removed), thence across the neck, five cm. below the superior curved line of the occipital bone, and forward through the lower one-third of the right auricle to the right external angular process of the frontal bone and margin of the right upper eyelid, across the lid, nose, and left eyelid, to the point of commencement. Every vessel and nerve supplying the scalp was destroyed, and the pericranium was torn off in three places, one of the denuded spots measuring five by seven cm. and another five by six cm. The neck flap of the wound fell away from the muscular structures beneath it, exposing the trapezius muscle almost one-half the distance to the shoulder blade. The right ear was torn across in its lower third, and hung by the side of the neck by a piece of skin less than five mm. wide. The exposed surface of the wound measured 40 cm. from before back, and 34 cm. in width near the temporal portion. The cranial sutures were distinctly seen in several places, and only a few muscular fibers of the temporal were left on each side. Hemorrhage was profuse from the temporal, occipital, and posterior auricular arteries, which were tied. The patient was seen three-quarters of an hour after the injury, and the mangled scalp was thoroughly washed in warm carbolized water, and stitched back in position, after the hair was cut from the outer surface. Six weeks after the injury suppuration was still free, and skin-grafting was commenced. In all, 4800 grafts were used, the patient supplying at different times 1800 small grafts. Her own skin invariably did better than foreign grafts. In ten months she had almost completely recovered, and sight and hearing had returned. Figure 191 shows the extent of the injury, and the ultimate results of the treatment. Schaeffer also reports the case of a woman working in a button factory at Union City, Conn., in 1871, who placed her head under a swiftly turning shaft to pick up a button, when her hair caught in the shaft, taking off her scalp from the nape of the neck to the eyebrows. The scalp was cleansed by her physician, Dr. Bartlett, and placed on her head about two hours after the accident, but it did not stay in position. Then the head was covered twice by skin-grafts, but each time the grafts were lost; but the third time a successful grafting was performed and she was enabled to work after a period of two years. The same authority also quotes Wilson and Way of Bristol, Conn., in an account of a complete avulsion of the scalp, together with tearing of the eyelid and ear. The result of the skin-grafting was not given. Powell of Chicago gives an account of a girl of nineteen who lost her scalp while working in the Elgin Watch Factory at Elgin, Illinois. The wound extended across the forehead above the eyebrows, but the ears were untouched. Skin-grafting was tried in this case but with no result, and the woman afterward lost an eye by exposure, from retraction of the eyelid. In some cases extensive wounds of the scalp heal without artificial aid by simply cicatrizing over. Gross mentions such a case in a young lady, who, in 1869, lost her scalp in a factory. There is reported an account of a conductor on the Union Pacific Railroad, who, near Cheyenne, in 1869, was scalped by Sioux Indians. He suffered an elliptic wound, ten by eight cm., a portion of the outer table of the cranium being removed, yet the wound healed over. Cerebral Injuries.--The recent advances in brain-surgery have, in a measure, diminished the interest and wonder of some of the older instances of major injuries of the cerebral contents with unimportant after-results, and in reviewing the older cases we must remember that the recoveries were made under the most unfavorable conditions, and without the slightest knowledge of all important asepsis and antisepsis. Penetration or even complete transfixion of the brain is not always attended with serious symptoms. Dubrisay is accredited with the description of a man of forty-four, who, with suicidal intent, drove a dagger ten cm. long and one cm. wide into his brain. He had deliberately held the dagger in his left hand, and with a mallet in his right hand struck the steel several blows. When seen two hours later he claimed that he experienced no pain, and the dagger was sticking out of his head. For half an hour efforts at extraction were made, but with no avail. He was placed on the ground and held by two persons while traction was made with carpenter's pliers. This failing, he was taken to a coppersmith's, where he was fastened by rings to the ground, and strong pinchers were placed over the dagger and attached to a chain which was fastened to a cylinder revolved by steam force. At the second turn of the cylinder the dagger came out. During all the efforts at extraction the patient remained perfectly cool and complained of no pain. A few drops of blood escaped from the wound after the removal of the dagger, and in a few minutes the man walked to a hospital where he remained a few days without fever or pain. The wound healed, and he soon returned to work. By experiments on the cadaver Dubrisay found that the difficulty in extraction was due to rust on the steel, and by the serrated edges of the wound in the bone. Warren describes a case of epilepsy of seven months' standing, from depression of the skull caused by a red hot poker thrown at the subject's head. Striking the frontal bone just above the orbit, it entered three inches into the cerebral substance. Kesteven reports the history of a boy of thirteen who, while holding a fork in his hand, fell from the top of a load of straw. One of the prongs entered the head one inch behind and on a line with the lobe of the left ear and passed upward and slightly backward to almost its entire length. With some difficulty it was withdrawn by a fellow workman; the point was bent on itself to the extent of two inches. The patient lived nine days. Abel and Colman have reported a case of puncture of the brain with loss of memory, of which the following extract is an epitome: "A railway-fireman, thirty-six years old, while carrying an oil-feeder in his hand, slipped and fell forward, the spout of the can being driven forcibly into his face. There was transitory loss of consciousness, followed by twitching and jerking movements of the limbs, most marked on the left side, the legs being drawn up and the body bent forward. There was no hemorrhage from mouth, nose, or ears. The metallic spout of the oil-can was firmly fixed in the base of the skull, and was only removed from the grasp of the bone by firm traction with forceps. It had passed upward and toward the middle line, with its concavity directed from the middle line. Its end was firmly plugged by bone from the base of the skull. No hemorrhage followed its removal. The wound was cleansed and a simple iodoform-dressing applied. The violent jerking movements were replaced by a few occasional twitchings. It was now found that the left side of the face and the left arm were paralyzed, with inability to close the left eye completely. The man became drowsy and confused, and was unable to give replies to any but the simplest questions. The temperature rose to 102 degrees; the pupils became contracted, the right in a greater degree than the left; both reacted to light. The left leg began to lose power. There was complete anesthesia of the right eyebrow and of both eyelids and of the right cheek for an uncertain distance below the lower eyelid. The conjunctiva of the right eye became congested, and a small ulcer formed on the right cornea, which healed without much trouble. In the course of a few days power began to return, first in the left leg and afterward, though to a much less extent, in the left arm. For two weeks there was drowsiness, and the man slept considerably. He was apathetic, and for many days passed urine in bed. He could not recognize his wife or old comrades, and had also difficulty in recognizing common objects and their uses. The most remarkable feature was the loss of all memory of his life for twenty years before the accident. As time went on, the period included in this loss of memory was reduced to five years preceding the accident. The hemiplegia persisted, although the man was able to get about. Sensibility was lost to all forms of stimuli in the right upper eyelid, forehead, and anterior part of the scalp, corresponding with the distribution of the supraorbital and nasal nerves. The cornea was completely anesthetic, and the right cheek, an inch and a half external to the angle of the nose, presented a small patch of anesthesia. There was undue emotional mobility, the patient laughing or crying on slight provocation. The condition of mind-blindness remained. It is believed that the spout of the oil-can must have passed under the zygoma to the base of the skull, perforating the great wing of the spheroid bone and penetrating the centrum ovale, injuring the anterior fibers of the motor tract in the internal capsule near the genu." Figures 192 and 193 show the outline and probable course of the spout. Beaumont reports the history of an injury in a man of forty-five, who, standing but 12 yards away, was struck in the orbit by a rocket, which penetrated through the spheroidal fissure into the middle and posterior lobes of the left hemisphere. He did not fall at the time he was struck, and fifteen minutes after the stick was removed he arose without help and walked away. Apparently no extensive cerebral lesion had been caused, and the man suffered no subsequent cerebral symptoms except, three years afterward, impairment of memory. There is an account given by Chelius of an extraordinary wound caused by a ramrod. The rod was accidentally discharged while being employed in loading, and struck a person a few paces away. It entered the head near the root of the zygomatic arch, about a finger's breadth from the outer corner of the right eye, passed through the head, emerging at the posterior superior angle of the parietal bone, a finger's breadth from the sagittal suture, and about the same distance above the superior angle of the occipital bone. The wounded man attempted to pull the ramrod out, but all his efforts were ineffectual. After the tolerance of this foreign body for some time, one of his companions managed to extract it, and when it was brought out it was as straight as the day it left the maker's shop. Little blood was lost, and the wound healed rapidly and completely; in spite of this major injury the patient recovered. Carpenter reports the curious case of an insane man who deliberately bored holes through his skull, and at different times, at a point above the ear, he inserted into his brain five pieces of No. 20 broom wire from 2 1/16 to 6 3/4 inches in length, a fourpenny nail 2 1/4 inches long, and a needle 1 5/8 inches long. Despite these desperate attempts at suicide he lived several months, finally accomplishing his purpose by taking an overdose of morphin. MacQueen has given the history of a man of thirty-five, who drove one three-inch nail into his forehead, another close to his occiput, and a third into his vertex an inch in front and 1/4 inch to the left of the middle line. He had used a hammer to effect complete penetration, hoping that death would result from his injuries. He failed in this, as about five weeks later he was discharged from the Princess Alice Hospital at Eastbourne, perfectly recovered. There is a record of a man by the name of Bulkley who was found, by a police officer in Philadelphia, staggering along the streets, and was taken to the inebriate ward of the Blockley Hospital, where he subsequently sank and died, after having been transferred from ward to ward, his symptoms appearing inexplicable. A postmortem examination revealed the fact that an ordinary knife-blade had been driven into his brain on the right side, just above the ear, and was completely hidden by the skin. It had evidently become loosened from the handle when the patient was stabbed, and had remained in the brain several days. No clue to the assailant was found. Thudicum mentions the case of a man who walked from Strafford to Newcastle, and from Newcastle to London, where he died, and in his brain was found the breech-pin of a gun. Neiman describes a severe gunshot wound of the frontal region, in which the iron breech-block of an old-fashioned muzzle-loading gun was driven into the substance of the brain, requiring great force for its extraction. The patient, a young man of twenty-eight, was unconscious but a short time, and happily made a good recovery. A few pieces of bone came away, and the wound healed with only a slight depression of the forehead. Wilson speaks of a child who fell on an upright copper paper-file, which penetrated the right side of the occipital bone, below the external orifice of the ear, and entered the brain for more than three inches; and yet the child made a speedy recovery. Baron Larrey knew of a man whose head was completely transfixed by a ramrod, which extended from the middle of the forehead to the left side of the nape of the neck; despite this serious injury the man lived two days. Jewett records the case of an Irish drayman who, without treatment, worked for forty-seven days after receiving a penetrating wound of the skull 1/4 inch in diameter and four inches deep. Recovery ensued in spite of the delay in treatment. Gunshot Injuries.--Swain mentions a patient who stood before a looking glass, and, turning his head far around to the left, fired a pistol shot into his brain behind the right ear. The bullet passed into his mouth, and he spat it out. Some bleeding occurred from both the internal and external wounds; the man soon began to suffer with a troublesome cough, with bloody expectoration; his tongue was coated and drawn to the right; he became slightly deaf in his right ear and dragged his left leg in walking. These symptoms, together with those of congestion of the lung, continued for about a week, when he died, apparently from his pulmonary trouble. Ford quotes the case of a lad of fifteen who was shot in the head, 3/4 inch anterior to the summit of the right ear, the ball escaping through the left os frontis, 1 1/4 inch above the center of the brow. Recovery ensued, with a cicatrix on the forehead, through which the pulsations of the brain could be distinctly seen. The senses were not at all deteriorated. Richardson tells of a soldier who was struck by a Minie ball on the left temporal bone; the missile passed out through the left frontal bone 1/2 inch to the left of the middle of the forehead. He was only stunned, and twenty-four hours later his intellect was undisturbed. There was no operation; free suppuration with discharges of fragments of skull and broken-down substance ensued for four weeks, when the wounds closed kindly, and recovery followed. Angle records the case of a cowboy who was shot by a comrade in mistake. The ball entered the skull beneath the left mastoid process and passed out of the right eye. The man recovered. Rice describes the case of a boy of fourteen who was shot in the head, the ball directly traversing the brain substance, some of which protruded from the wound. The boy recovered. The ball entered one inch above and in front of the right ear and made its exit through the lambdoidal suture posteriorly. Hall of Denver, Col., in an interesting study of gunshot wounds of the brain, writes as follows:-- "It is in regard to injuries involving the brain that the question of the production of immediate unconsciousness assumes the greatest interest. We may state broadly that if the medulla or the great centers at the base of the brain are wounded by a bullet, instant unconsciousness must result; with any other wounds involving the brain-substance it will, with very great probability, result. But there is a very broad area of uncertainty. Many instances have been recorded in which the entrance of a small bullet into the anterior part of the brain has not prevented the firing of a second shot on the part of the suicide. Personally, I have not observed such a case, however. But, aside from the injuries by the smallest missiles in the anterior parts of the brain, we may speak with almost absolute certainty with regard to the production of unconsciousness, for the jar to the brain from the blow of the bullet upon the skull would produce such a result even if the damage to the brain were not sufficient to do so. "Many injuries to the brain from bullets of moderate size and low velocity do not cause more than a temporary loss of consciousness, and the subjects are seen by the surgeon, after the lapse of half an hour or more, apparently sound of mind. These are the cases in which the ball has lost its momentum in passing through the skull, and has consequently done little damage to the brain-substance, excepting to make a passage for itself for a short distance into the brain. It is apparently well established that, in the case of the rifle-bullet of high velocity, and especially if fired from the modern military weapons using nitro-powders, and giving an enormous initial velocity to the bullet, the transmission of the force from the displaced particles of brain (and this rule applies to any other of the soft organs as well) to the adjacent parts is such as to disorganize much of the tissue surrounding the original track of the missile. Under these circumstances a much slighter wound would be necessary to produce unconsciousness or death than in the case of a bullet of low velocity, especially if it were light in weight. Thus I have recorded elsewhere an instance of instant death in a grizzly bear, an animal certainly as tenacious of life as any we have, from a mere furrow, less than a quarter of an inch in depth, through the cortex of the brain, without injury of the skull excepting the removal of the bone necessary for the production of this furrow. The jar to the brain from a bullet of great velocity, as in this case, was alone sufficient to injure the organ irreparably. In a similar manner I have known a deer to be killed by the impact of a heavy rifle-ball against one horn, although there was no evidence of fracture of the skull. On the other hand, game animals often escape after such injuries not directly involving the brain, although temporarily rendered unconscious, as I have observed in several instances, the diagnosis undoubtedly being concussion of the brain. "Slight injury to the brain, and especially if it be unilateral, then, may not produce unconsciousness. It is not very uncommon for a missile from a heavy weapon to strike the skull, and be deflected without the production of such a state. Near the town in which I formerly practiced, the town-marshal shot at a negro, who resisted arrest, at a distance of only a few feet, with a 44-caliber revolver, striking the culprit on the side of the head. The wound showed that the ball struck the skull and plowed along under the scalp for several inches before emerging, but it did not even knock the negro down, and no unconsciousness followed later. I once examined an express-messenger who had been shot in the occipital region by a weapon of similar size, while seated at his desk in the car. The blow was a very glancing one and did not produce unconsciousness, and probably, as in the case of the negro, because it did not strike with sufficient directness." Head Injuries with Loss of Cerebral Substance.--The brain and its membranes may be severely wounded, portions of the cranium or cerebral substance destroyed or lost, and yet recovery ensue. Possibly the most noted injury of this class was that reported by Harlow and commonly known as "Bigelow's Case" or the "American Crow-bar Case." Phineas P. Gage, aged twenty-five, a foreman on the Rutland and Burlington Railroad, was employed September 13, 1847, in charging a hole with powder preparatory to blasting. A premature explosion drove a tamping-iron, three feet seven inches long, 1 1/4 inches in diameter, weighing 13 1/4 pounds, completely through the man's head. The iron was round and comparatively smooth; the pointed end entered first. The iron struck against the left side of the face, immediately anterior to the inferior maxillary and passed under the zygomatic arch, fracturing portions of the spheroid bone and the floor of the left orbit; it then passed through the left anterior lobe of the cerebrum, and, in the median line, made its exit at the junction of the coronal and sagittal sutures, lacerating the longitudinal sinus, fracturing the parietal and frontal bones, and breaking up considerable of the brain; the globe of the left eye protruded nearly one-half of its diameter. The patient was thrown backward and gave a few convulsive movements of the extremities. He was taken to a hotel 3/4 mile distant, and during the transportation seemed slightly dazed, but not at all unconscious. Upon arriving at the hotel he dismounted from the conveyance, and without assistance walked up a long flight of stairs to the hall where his wound was to be dressed. Harlow saw him at about six o'clock in the evening, and from his condition could hardly credit the story of his injury, although his person and his bed were drenched with blood. His scalp was shaved, the coagula and debris removed, and among other portions of bone was a piece of the anterior superior angle of each parietal bone and a semicircular piece of the frontal bone, leaving an opening 3 1/2 inches in diameter. At 10 P.M. on the day of the injury Gage was perfectly rational and asked about his work and after his friends. After a while delirium set in for a few days, and on the eleventh day he lost the vision in the left eye. His convalescence was rapid and uneventful. It was said that he discharged pieces of bone and cerebral substance from his mouth for a few days. The iron when found was smeared with blood and cerebral substance. As was most natural such a wonderful case of cerebral injury attracted much notice. Not only was the case remarkable in the apparent innocuous loss of cerebral substance, but in the singular chance which exempted the brain from either concussion or compression, and subsequent inflammation. Professor Bigelow examined the patient in January, 1850, and made a most excellent report of the case, and it is due to his efforts that the case attained world-wide notoriety. Bigelow found the patient quite recovered in his faculties of body and mind, except that he had lost the sight of the injured eye. He exhibited a linear cicatrix one inch long near the angle of the ramus of the left lower jaw. His left eyelid was involuntarily closed and he had no power to overcome his ptosis. Upon the head, well covered by the hair, was a large unequal depression and elevation. In order to ascertain how far it might be possible for a bar of the size causing the injury to traverse the skull in the track assigned to it, Bigelow procured a common skull in which the zygomatic arches were barely visible from above, and having entered a drill near the left angle of the inferior maxilla, he passed it obliquely upward to the median line of the cranium just in front of the junction of the sagittal and coronal sutures. This aperture was then enlarged until it allowed the passage of the bar in question, and the loss of substance strikingly corresponded with the lesion said to have been received by the patient. From the coronoid process of the inferior maxilla there was removed a fragment measuring about 3/4 inch in length. This fragment, in the patient's case, might have been fractured and subsequently reunited. The iron bar, together with a cast of the patient's head, was placed in the Museum of the Massachusetts Medical College. Bigelow appends an engraving to his paper. In the illustration the parts are as follows:-- (1) Lateral view of a prepared cranium representing the iron bar traversing its cavity. (2) Front view of same. (3) Plan of the base seen from within. In these three figures the optic foramina are seen to be intact and are occupied by small white rods. (4) Cast taken from the shaved head of the patient representing the appearance of the fracture in 1850, the anterior fragment being considerably elevated in the profile view. (5) The iron bar with length and diameter in proportion to the size of the other figures. Heaton reports a case in which, by an explosion, a tamping-iron was driven through the chin of a man into the cerebrum. Although there was loss of brain-substance, the man recovered with his mental faculties unimpaired. A second case was that of a man who, during an explosion, was wounded in the skull. There was visible a triangular depression, from which, possibly, an ounce of brain-substance issued. This man also recovered. Jewett mentions a case in which an injury somewhat similar to that in Bigelow's case was produced by a gas-pipe. Among older writers, speaking of loss of brain-substance with subsequent recovery, Brasavolus saw as much brain evacuated as would fill an egg shell; the patient afterward had an impediment of speech and grew stupid. Franciscus Arcaeus gives the narrative of a workman who was struck on the head by a stone weighing 24 pounds falling from a height. The skull was fractured; fragments of bone were driven into the brain. For three days the patient was unconscious and almost lifeless. After the eighth day a cranial abscess spontaneously opened, from the sinciput to the occiput, and a large quantity of "corruption" was evacuated. Speech returned soon after, the eyes opened, and in twenty days the man could distinguish objects. In four months recovery was entire. Bontius relates a singular accident to a sailor, whose head was crushed between a ship and a small boat; the greater part of the occipital bone was taken away in fragments, the injury extending almost to the foremen magnum. Bontius asserts that the patient was perfectly cured by another surgeon and himself. Galen mentions an injury to a youth in Smyrna, in whom the brain was so seriously wounded that the anterior ventricles were opened; and vet the patient recovered. Glandorp mentions a case of fracture of the skull out of which his father took large portions of brain and some fragments of bone. He adds that the man was afterward paralyzed an the opposite side and became singularly irritable. In his "Chirurgical Observations," Job van Meek'ren tells the story of a Russian nobleman who lost part of his skull, and a dog's skull was supplied in its place. The bigoted divines of the country excommunicated the man, and would not annul his sentence until he submitted to have the bit of foreign bone removed. Mendenhall reports the history of an injury to a laborer nineteen years old. While sitting on a log a few feet from a comrade who was chopping wood, the axe glanced and, slipping from the woodman's grasp, struck him just above the ear, burying the "bit" of the axe in his skull. Two hours afterward he was seen almost pulseless, and his clothing drenched with blood which was still oozing from the wound with mixed brain-substance and fragments of bone. The cut was horizontal on a level with the orbit, 5 1/2 inches long externally, and, owing to the convex shape of the axe, a little less internally. Small spicules of bone were removed, and a cloth was placed on the battered skull to receive the discharges for the inspection of the surgeon, who on his arrival saw at least two tablespoonfuls of cerebral substance on this cloth. Contrary to all expectation this man recovered, but, strangely, he had a marked and peculiar change of voice, and this was permanent. From the time of the reception of the injury his whole mental and moral nature had undergone a pronounced change. Before the injury, the patient was considered a quiet, unassuming, and stupid boy, but universally regarded as honest. Afterward he became noisy, self-asserting, sharp, and seemingly devoid of moral sense or honesty. These new traits developed immediately, and more strikingly so soon as convalescence was established. Bergtold quotes a case reported in 1857 of extreme injury to the cranium and its contents. While sleeping on the deck of a canal boat, a man at Highspire was seriously injured by striking his head against a bridge. When seen by the surgeon his hair was matted and his clothes saturated with blood. There was a terrible gap in the scalp from the superciliary ridge to the occipital bone, and, though full of clots, the wound was still oozing. In a cloth on a bench opposite were rolled up a portion of the malar bone, some fragments of the os frontis, one entire right parietal bone, detached from its fellow along the sagittel suture, and from the occipital along the lambdoidal suture, perhaps taking with it some of the occipital bone together with some of the squamous portion of the temporal bone. This bone was as clean of soft parts as if it had been removed from a dead subject with a scalpel and saw. No sight of the membranes or of the substance of the brain was obtained. The piece of cranium removed was 6 3/4 inches in the longitudinal diameter, and 5 3/4 inches in the short oval diameter. The dressing occupied an hour, at the end of which the patient arose to his feet and changed his clothes as though nothing had happened. Twenty-six years after the accident there was slight unsteadiness of gait, and gradual paralysis of the left leg and arm and the opposite side of the face, but otherwise the man was in good condition. In place of the parietal bone the head presented a marked deficiency as though a slice of the skull were cut out. The depressed area measured five by six inches. In 1887 the man left the hospital in Buffalo with the paralysis improved, but his mental equilibrium could be easily disturbed. He became hysteric and sobbed when scolded. Buchanan mentions the history of a case in a woman of twenty-one, who, while working in a mill, was struck by a bolt. Her skull was fractured and driven into the brain comminuted. Hanging from the wound was a bit of brain-substance, the size of a finger, composed of convolution as well as white matter. The wound healed, there was no hernia, and at the time of report the girl was conscious of no disturbance, not even a headache. There was nothing indicative of the reception of the injury except a scar near the edge of the hair on the upper part of the right side of the forehead. Steele, in a school-boy of eight, mentions a case of very severe injury to the bones of the face and head, with escape of cerebral substance, and recovery. The injury was caused by falling into machinery. There was a seaman aboard of the U.S.S. "Constellation," who fell through a hatchway from the masthead, landing on the vertex of the head. There was copious bleeding from the ears, 50 to 60 fluid-ounces of blood oozing in a few hours, mingled with small fragments of brain-tissue. The next day the discharge became watery, and in it were found small pieces of true brain-substance. In five weeks the man returned to duty complaining only of giddiness and of a "stuffed-up" head. In 1846 there is a record of a man of forty who fell from a scaffold, erected at a height of 20 feet, striking on his head. He was at first stunned, but on admission to the hospital recovered consciousness. A small wound was found over the right eyebrow, protruding from which was a portion of brain-substance. There was slight hemorrhage from the right nostril, and some pain in the head, but the pulse and respiration were undisturbed. On the following day a fragment of the cerebral substance, about the size of a hazel-nut, together with some brood-clots, escaped from the right nostril. In this case the inner wall of the frontal sinus was broken, affording exit for the lacerated brain. Cooke and Laycock mention a case of intracranial injury with extensive destruction of brain-substance around the Rolandic area; there was recovery but with loss of the so called muscular sense. The patient, a workman of twenty-nine, while cutting down a gum-tree, was struck by a branch as thick as a man's arm, which fell from 100 feet overhead, inflicting a compound comminuted fracture of the cranium. The right eye was contused but the pupils equal; the vertex-wound was full of brain-substance and pieces of bone, ten of which were removed, leaving an oval opening four by three inches. The base of the skull was fractured behind the orbits; a fissure 1/4 inch wide was discernible, and the right frontal bone could be easily moved. The lacerated and contused brain-substance was removed. Consciousness returned six days after the operation. The accompanying illustrations (Figs. 196 and 197) show the extent of the injury. The lower half of the ascending frontal convolution, the greater half of the sigmoid gyrus, the posterior third of the lower and middle frontal convolutions, the base and posterior end of the upper convolution, and the base of the corresponding portion of the falciform lobe were involved. The sensory and motor functions of the arm were retained in a relative degree. There was power of simple movements, but complex movements were awkward. The tactile localization was almost lost. Morton mentions a patient of forty-seven, who was injured in a railroad accident near Phoenixville, Pa.; there was a compound comminuted fracture of the skull involving the left temporal, spheroid, and superior maxillary bones. The side of the head and the ear were considerably lacerated; several teeth were broken, and besides this there was injury to the aura and cerebral substance. There was profound coma for ten days and paralysis of the 1st, 2d, 3d, 4th, 6th, and 7th cranial nerves, particularly affecting the left side of the face. There was scarcely enough blood-supply left to the orbit to maintain life in the globe. The man primarily recovered, but ninety-one days from the injury he died of cerebral abscess. There is the record of a curious brain-injury in a man of twenty-two, who was struck on the skull by a circular saw. The saw cut directly down into the brain, severing the superior longitudinal sinus, besides tearing a branch of the meningeal artery. The wound was filled with sawdust left by the saw while it was tearing through the parts. After ordinary treatment the man recovered. Bird reports a compound comminuted fracture of the left temporal region, with loss of bone, together with six drams of brain-substance, which, however, was followed by recovery. Tagert gives an instance of compound depressed fracture of the skull, with loss of brain-substance, in which recovery was effected without operative interference. Ballou, Bartlett, Buckner, Capon, Carmichael, Corban, Maunder and many others, cite instances of cranial fracture and loss of brain-substance, with subsequent recovery. Halsted reports the history of a boy of seventeen, who, while out fowling, had the breech-pin of a shot-gun blown out, the sharp point striking the forehead in the frontal suture, crushing the os frontis, destroying 1 3/4 inches of the longitudinal sinus, and causing severe hemorrhage from both the longitudinal and frontal sinuses. The pin was pulled out by the boy, who washed his own face, and lay down; he soon became semi-comatose, in which condition he remained for some days; but, after operation, he made complete recovery. Loss of Brain-substance from Cerebral Tumor.--Koser is accredited with reporting results of a postmortem held on a young man of twenty who suffered from a cerebral tumor of considerable duration. It was stated that, although there was a cavity in the brain at least five inches in length, the patient, almost up to the time of death, was possessed of the senses of touch, taste, hearing, and smell, showed considerable control over his locomotor muscles, and could talk. In fact, he was practically discommoded in no other way than by loss of vision, caused by pressure on the optic centers. It was also stated that the retention of memory was remarkable, and, up to within two weeks of his death, the patient was able to memorize poems. The amount of involvement discovered postmortem in cases similar to the preceding is astonishing. At a recent pathologic display in London several remarkable specimens were shown. Extensive Fractures of the Skull. Jennings mentions an instance of extensive fracture of the skull, 14 pieces of the cranium being found. The patient lived five weeks and two days after the injury, the immediate cause of death being edema of the lungs. His language was incoherent and full of oaths. Belloste, in his "Hospital Surgeon," states that he had under has care a most dreadful case of a girl of eleven or twelve years, who received 18 or 19 cutlass wounds of the head, each so violent as to chip out pieces of bone; but, notwithstanding her severe injuries, she made recovery. At the Emergency Hospital in Washington, D.C., there was received a negress with at least six gaping wounds of the head, in some cases denuding the periosteum and cutting the cranium. During a debauch the night before she had been engaged in a quarrel with a negro with whom she lived, and was struck by him several times on the head with an axe. She lay all night unconscious, and was discovered the next morning with her hair and clothes and the floor on which she lay drenched with blood. The ambulance was summoned to take her to the morgue, but on the arrival of the police it was seen that feeble signs of life still existed. On admission to the hospital she was semi-comatose, almost pulseless, cold, and exhibiting all the signs of extreme hemorrhage and shock. Her head was cleaned up, but her condition would not permit of any other treatment than a corrosive-sublimate compress and a bandage of Scultetus. She was taken to the hospital ward, where warmth and stimulants were applied, after which she completely reacted. She progressed so well that it was not deemed advisable to remove the head-bandage until the fourth day, when it was seen that the wounds had almost entirely healed and suppuration was virtually absent. The patient rapidly and completely recovered, and her neighbors, on her return home, could hardly believe that she was the same woman whom, a few days before, they were preparing to take to the morgue. A serious injury, which is not at all infrequent, is that caused by diving into shallow water, or into a bath from which water has been withdrawn. Curran mentions a British officer in India who, being overheated, stopped at a station bath in which the previous night he had had a plunge, and without examining, took a violent "header" into the tank, confidently expecting to strike from eight to ten feet of water. He dashed his head against the concrete bottom 12 feet below (the water two hours previously having been withdrawn) and crushed his brain and skull into an indistinguishable mass. There are many cases on record in which an injury, particularly a gunshot wound of the skull, though showing no external wound, has caused death by producing a fracture of the internal table of the cranium. Pare gives details of the case of a nobleman whose head was guarded by a helmet and who was struck by a ball, leaving no external sign of injury, but it was subsequently found that there was an internal fracture of the cranium. Tulpius and Scultetus are among the older writers reporting somewhat similar instances, and there are several analogous cases reported as having occurred during the War of the Rebellion. Boling reports a case in which the internal table was splintered to a much greater extent than the external. Fracture of the base of the skull is ordinarily spoken of as a fatal injury, reported instances of recovery being extremely rare, but Battle, in a paper on this subject, has collected numerous statistics of nonfatal fracture of the base of the brain, viz.:-- Male. Female. Anterior fossa, . . . . . . . . . . . 16 5 Middle fossa, . . . . . . . . . . . . 50 6 Posterior fossa,. . . . . . . . . . . 10 1 Middle and anterior fossae, . . . . . 15 5 Middle and posterior fossae,. . . . . 4 1 Anterior, middle, and posterior fossae, 1 0 ------ ------ 96 18 Total, 114. In a paper on nonmortal fractures of the base of the skull, Lidell gives an account of 135 cases. MacCormac reports a case of a boy of nine who was run over by a carriage drawn by a pair of horses. He suffered fracture of the base of the skull, of the bones of the face, and of the left ulna, and although suppuration at the points of fracture ensued, followed by an optic neuritis, an ultimate recovery was effected. Ball, an Irish surgeon, has collected several instances in which the base of the skull has been driven in and the condyle of the jaw impacted in the opening by force transmitted through the lower maxilla. The tolerance of foreign bodies in the brain is most marvelous. In the ancient chronicles of Koenigsberg there is recorded the history of a man who for fourteen years carried in his head a piece of iron as large as his finger. After its long lodgment, during which the subject was little discommoded, it finally came out by the palatine arch. There is also an old record of a ball lodging near the sella turcica for over a year, the patient dying suddenly of an entirely different accident. Fabricius Hildanus relates the history of an injury, in which, without causing any uncomfortable symptoms, a ball rested between the skull and dura for six months. Amatus Lusitanus speaks of a drunken courtesan who was wounded in a fray with a long, sharp-pointed knife which was driven into the head. No apparent injury resulted, and death from fever took place eight years after the reception of the injury. On opening the head a large piece of knife was found between the skull and dura. It is said that Benedictus mentions a Greek who was wounded, at the siege of Colchis, in the right temple by a dart and taken captive by the Turks; he lived for twenty years in slavery, the wound having completely healed. Obtaining his liberty, he came to Sidon, and five years after, as he was washing his face, he was seized by a violent fit of sneezing, and discharged from one of his nostrils a piece of the dart having an iron point of considerable length. In about 1884 there died in the Vienna Hospital a bookbinder of forty-five, who had always passed as an intelligent man, but who had at irregular intervals suffered from epileptic convulsions. An iron nail covered with rust was discovered in his brain; from the history of his life and from the appearances of the nail it had evidently been lodged in the cerebrum since childhood. Slee mentions a case in which, after the death of a man from septic peritonitis following a bullet-wound of the intestines, he found postmortem a knife-blade 5/16 inch in width projecting into the brain to the depth of one inch. The blade was ensheathed in a strong fibrous capsule 1/2 inch thick, and the adjacent brain-structure was apparently normal. The blade was black and corroded, and had evidently passed between the sutures during boyhood as there was no depression or displacement of the cranial bones. The weapon had broken off just on a level with the skull, and had remained in situ until the time of death without causing any indicative symptoms. Slee does not state the man's age, but remarks that he was a married man and a father at the time of his death, and had enjoyed the best of health up to the time he was shot in the abdomen. Callaghan, quoted in Erichsen's "Surgery," remarks that he knew of an officer who lived seven years with a portion of a gun-breech weighing three ounces lodged in his brain. Lawson mentions the impaction of a portion of a breech of a gun in the forehead of a man for twelve years, with subsequent removal and recovery. Waldon speaks of a similar case in which a fragment of the breech weighing three ounces penetrated the cranium, and was lodged in the brain for two months previous to the death of the patient. Huppert tells of the lodgment of a slate-pencil three inches long in the brain during lifetime, death ultimately being caused by a slight head-injury. Larry mentions a person who for some time carried a six ounce ball in the brain and ultimately recovered. Peter removed a musket-ball from the frontal sinus after six years' lodgment, with successful issue. Mastin has given an instance in which the blade of a pen-knife remained in the brain six months, recovery following its removal. Camden reports a case in which a ball received in a gunshot wound of the brain remained in situ for thirteen years; Cronyn mentions a similar case in which a bullet rested in the brain for eight years. Doyle successfully removed an ounce Minie ball from the brain after a fifteen years' lodgment. Pipe-stems, wires, shot, and other foreign bodies, are from time to time recorded as remaining in the brain for some time. Wharton has compiled elaborate statistics on this subject, commenting on 316 cases in which foreign bodies were lodged in the brain, and furnishing all the necessary information to persons interested in this subject. Injuries of the nose, with marked deformity, are in a measure combated by devices invented for restoring the missing portions of the injured member. Taliacotius, the distinguished Italian surgeon of the sixteenth century, devised an operation which now bears his name, and consists in fashioning a nose from the fleshy tissues of the arm. The arm is approximated to the head and held in this position by an apparatus or system of bandages for about ten days, at which time it is supposed that it can be severed, and further trimming and paring of the nose is then practiced. A column is subsequently made from the upper lip. In the olden days there was a timorous legend representing Taliacotius making noses for his patients from the gluteal regions of other persons, which statement, needless to say, is not founded on fact. Various modifications and improvements on the a Talicotian method have been made; but in recent years the Indian method, introduced by Carpue into England in 1816, is generally preferred. Syme of Edinburgh, Wood, and Ollier have devised methods of restoring the nose, which bear their names. Ohmann-Dumesnil reports a case of rhinophyma in a man of seventy-two, an alcoholic, who was originally affected with acne rosacea, on whom he performed a most successful operation for restoration. The accompanying illustration shows the original deformity--a growth weighing two pounds--and also pictures the appearance shortly after the operation. This case is illustrative of the possibilities of plastic surgery in the hands of a skilful and ingenious operator. About 1892 Dr. J. P. Parker then of Kansas City, Mo., restored the missing bridge of a patient's nose by laying the sunken part open in two long flaps, denuding the distal extremity of the little finger of the patient's right hand of nail, flesh, tendons, etc., and binding it into the wound of the nose until firm union had taken place. The finger was then amputated at the second joint and the plastic operation completed, with a result pleasing both to patient and operator. There is a case quoted of a young man who, when first seen by his medical attendant, had all the soft parts of the nose gone, except one-third of the left ala and a thin flap of the septum which was lying on the upper lip. The missing member was ferreted out and cleansed, and after an hour's separation sutured on. The nostrils were daily syringed with a corrosive sublimate solution, and on the tenth day the dressing was removed; the nose was found active and well, with the single exception of a triangular notch on the right side, which was too greatly bruised by the violence of the blow to recover. When we consider the varicosity of this organ we can readily believe the possibility of the foregoing facts, and there is little doubt that more precaution in suturing severed portions of the nose would render the operation of nose making a very rare one. Maxwell mentions a curious case of attempted suicide in which the ball, passing through the palatine process of the superior maxillary bone, crushing the vomer to the extent of its own diameter, fell back through the right nostril into the pharynx, was swallowed, and discharged from the anus. Deformities of the nose causing enormous development, or the condition called "double-nose" by Bartholinus, Borellus, Bidault, and others, are ordinarily results of a pathologic development of the sebaceous glands. In some cases tumors develop from the root of the nose, forming what appears to be a second nose. In other cases monstrous vegetations divide the nose into many tumors. In the early portion of this century much was heard about a man who was a daily habitue of the Palais-Royal Gardens. His nose was divided into unequally sized tumors, covering nearly his entire face. Similar instances have been observed in recent years. Hey mentions a case in which the tumor extended to the lower part of the under lip, which compressed the patient's mouth and nostrils to such an extent that while sleeping, in order to insure sufficient respiration, he had to insert a tin-tube into one of his nostrils. Imbert de Lannes is quoted as operating on a former Mayor of Angouleme. This gentleman's nose was divided into five lobes by sarcomatous tumors weighing two pounds, occupying the external surface of the face, adherent to the buccinator muscles to which they extended, and covering the chin. In the upright position the tumors sealed the nostrils and mouth, and the man had to bend his head before and after respiration. In eating, this unfortunate: person had to lift his tumors away from his mouth, and during sleep the monstrous growths were supported in a sling attached to his night cap. He presented such a hideous aspect that he was virtually ostracized from society The growth had been in progress for twelve years, but during twenty-two months' confinement in Revolutionary prisons the enlargement had been very rapid. Fournier says that the most beautiful result followed the operation which was considered quite hazardous. Foreign bodies in the nose present phenomena as interesting as wounds of this organ. Among the living objects which have been found in the nose may be mentioned flies, maggots, worms, leeches, centipedes, and even lizards. Zacutus Lusitanus tells of a person who died in two days from the effects of a leech which was inadvertently introduced into the nasal fossa, and there is a somewhat similar case of a military pharmacist, a member of the French army in Spain, who drank some water from a pitcher and exhibited, about a half hour afterward, a persistent hemorrhage from the nose. Emaciation progressively continued, although his appetite was normal. Three doctors, called in consultation, prescribed bleeding, which, however, proved of no avail. Three weeks afterward he carried in his nostril a tampon of lint, wet with an astringent solution, and, on the next day, on blowing his nose, there fell from the right nostril a body which he recognized as a leech. Healey gives the history of four cases in which medicinal leeches were removed from the mouth and posterior nares of persons who had, for some days previously, been drinking turbid water. Sinclair mentions the removal of a leech from the posterior nares. In some regions, more particularly tropical ones, there are certain flies that crawl into the nostrils of the inhabitants and deposit eggs, in the cavities. The larvae develop and multiply with great rapidity, and sometimes gain admission into the frontal sinus, causing intense cephalalgia, and even death. Dempster reports an instance of the lodgment of numerous live maggots within the cavity of the nose, causing sloughing of the palate and other complications. Nicholson mentions a case of ulceration and abscess of the nostrils and face from which maggots were discharged. Jarvis gives the history of a strange and repeated hemorrhage from the nose and adjacent parts that was found to be due to maggots from the ova of a fly, which had been deposited in the nose while the patient was asleep. Tomlinson gives a case in which maggots traversed the Eustachian tube, some being picked out of the nostrils, while others were coughed up. Packard records the accidental entrance of a centipede into the nostril. There is an account of a native who was admitted to the Madras General Hospital, saying that a small lizard had crawled up his nose. The urine of these animals is very irritating, blistering any surface it touches. Despite vigorous treatment the patient died in consequence of the entrance of this little creature. There have been instances among the older writers in which a pea has remained in the nose for such a length of time as to present evidences of sprouting. The Ephemerides renders an instance of this kind, and Breschet cites the history of a young boy, who, in 1718, introduced a pea into his nostril; in three days it had swollen to such an extent as to fill the whole passage. It could not be extracted by an instrument, so tobacco snuff was used, which excited sneezing, and the pea was ejected. Vidal and the Ephemerides report several instances of tolerance of foreign bodies in the nasal cavities for from twenty to twenty-five years. Wiesman, in 1893, reported a rhinolith, which was composed of a cherry-stone enveloped in chalk, that had been removed after a sojourn of sixty years, with intense ozena as a consequence of its lodgment. Waring mentions the case of a housemaid who carried a rhinolith, with a cherry-stone for a nucleus, which had been introduced twenty-seven years before, and which for twenty-five years had caused no symptoms. Grove describes a necrosed inferior turbinated bone, to which was attached a coffee-grain which had been retained in the nostril for twenty years., Hickman gives an instance of a steel ring which for thirteen and a half years had been impacted in the nasopharyngeal fossa of a child. It was detected by the rhinoscope and was removed. Parker speaks of a gunbreech bolt which was removed from the nose after five years' lodgment. Major mentions the removal of a foreign body from the nose seven years after its introduction. Howard removed a large thimble from the posterior nares, although it had remained in its position for some time undetected. Eve reports a case in which a thimble was impacted in the right posterior nares. Gazdar speaks, of a case of persistent neuralgia of one-half of the face, caused by a foreign body in the nose. The obstruction was removed after seven years' lodgment and the neuralgia disappeared. Molinier has an observation on the extraction of a fragment of a knife-blade which had rested four years in the nasal fossae, where the blade had broken off during a quarrel. A peculiar habit, sometimes seen in nervous individuals, is that of "swallowing the tongue." Cohen claims that in some cases of supposed laryngeal spasm the tongue is swallowed, occluding the larynx, and sometimes with fatal consequences. There are possibly a half score of cases recorded, but this anomaly is very rare, and Major is possibly the only one who has to a certainty demonstrated the fact by a laryngoscopic examination. By the laryngoscope he was enabled to observe a paroxysm in a woman, in which the tongue retracted and impinged on the epiglottis, but quickly recovered its position. Pettit mentions suffocation from "tongue swallowing," both with and without section of the frenum. Schobinger cites a similar instance, due to loosening of the frenum. Analogous to the foregoing phenomenon is the habit of "tongue sucking." Morris mentions a young lady of fifteen who spontaneously dislocated her jaw, owing indirectly to this habit. Morris says that from infancy the patient was addicted to this habit, which was so audible as to be heard in all parts of the room. The continued action of the pterygoid muscles had so preternaturally loosened the ligaments and muscular structures supporting the joint as to render them unable to resist the violent action of "tongue sucking" even during sleep. Injuries to the Tongue.--Hobbs describes a man of twenty-three who, while working, had a habit of protruding his tongue. One day he was hit under the chin by the chain of a crane on a pier, his upper teeth inflicting a wound two inches deep, three inches from the tip, and dividing the entire structure of the tongue except the arteries. The edges of the wound were brought into apposition by sutures, and after the removal of the latter perfect union and complete restoration of the sensation of taste ensued. Franck mentions regeneration of a severed tongue; and Van Wy has seen union of almost entirely severed parts of the tongue. De Fuisseaux reports reunion of the tongue by suture after almost complete transverse division. There is an account of a German soldier who, May 2, 1813, was wounded at the battle of Gross-Gorschen by a musket ball which penetrated the left cheek, carrying away the last four molars of the upper jaw and passing through the tongue, making exit on the left side, and forcing out several teeth of the left lower jaw. To his surprise, thirty years afterward, one of the teeth was removed from an abscess of the tongue. Baker speaks of a boy of thirteen who was shot at three yards distance. The bullet knocked out two teeth and passed through the tongue, although it produced no wound of the pharynx, and was passed from the anus on the sixth day. Stevenson mentions a case of an organist who fell forward when stooping with a pipe in his mouth, driving its stem into the roof of the pharynx. He complained of a sore throat for several days, and, after explanation, Stevenson removed from the soft palate a piece of clay pipe nearly 1 1/4 inches long. Herbert tells of a case resembling carcinoma of the tongue, which was really due to the lodgment of a piece of tooth in that organ. Articulation Without the Tongue.--Total or partial destruction of the tongue does not necessarily make articulation impossible. Banon mentions a man who had nothing in his mouth representing a tongue. When he was young, he was attacked by an ulceration destroying every vestige of this member. The epiglottis, larynx, and pharynx, in fact the surrounding structures were normal, and articulation, which was at first lost, became fairly distinct, and deglutition was never interfered with. Pare gives a description of a man whose tongue was completely severed, in consequence of which he lost speech for three years, but was afterward able to make himself understood by an ingenious bit of mechanism. He inserted under the stump of the tongue a small piece of wood, in a most marvelous way replacing the missing member. Articulation with the absence of some constituent of the vocal apparatus has been spoken of on page 254. Hypertrophy of the Tongue.--It sometimes happens that the tongue is so large that it is rendered not only useless but a decided hindrance to the performance of the ordinary functions into which it always enters. Ehrlich, Ficker, Klein, Rodforffer, and the Ephemerides, all record instances in which a large tongue was removed either by ligation or amputation. Von Siebold records an instance in which death was caused by the ligature of an abnormally sized tongue. There is a modern record of three cases of enormous tongues, the result of simple hypertrophy. In one case the tongue measured 6 1/4 inches from the angle of the mouth about the sides and tip to the opposite angle, necessitating amputation of the protruding portion. Carnochan reports a case in which hypertrophy of the tongue was reduced to nearly the normal size by first tying the external carotid, and six weeks later the common carotid artery. Chalk mentions partial dislocation of the lower jaw from an enlarged tongue. Lyford speaks of enlargement of the tongue causing death. The above conditions are known as macroglossia, which is a congenital hypertrophy of the tongue analogous to elephantiasis. It is of slow growth, and as the organ enlarges it interferes with deglutition and speech. It may protrude over the chin and reach even as far down as the sternum. The great enlargement may cause deformities of the teeth and lower jaw, and even present itself as an enormous tumor in the neck. The protruding tongue itself may ulcerate, possibly bleed, and there is constant dribbling of saliva. The disease is probably due to congenital defect aggravated by frequent attacks of glossitis, and the treatment consists in the removal of the protruding portions by the knife, ligation, the cautery, or ecraseur. Living Fish in the Pharynx.--Probably the most interesting cases of foreign bodies are those in which living fish enter the pharynx and esophagus. Chevers has collected five cases in which death was caused by living fish entering the mouth and occluding the air-passages. He has mentioned a case in which a large catfish jumped into the mouth of a Madras bheestie. An operation on the esophagus was immediately commenced, but abandoned, and an attempt made to push the fish down with a probang, which was, in a measure, successful. However, the patient gave a convulsive struggle, and, to all appearances, died. The trachea was immediately opened, and respiration was restored. During the course of the night the man vomited up pieces of fish bone softened by decomposition. In 1863 White mentions that the foregoing accident is not uncommon among the natives of India, who are in the habit of swimming with their mouths open in tanks abounding with fish. There is a case in which a fisherman, having both hands engaged in drawing a net, and seeing a sole-fish about eight inches long trying to escape through the meshes of the net, seized it with his teeth. A sudden convulsive effort of the fish enabled it to enter the fisherman's throat, and he was asphyxiated before his boat reached the shore. After death the fish was found in the cardiac end of the stomach. There is another case of a man named Durand, who held a mullet between his teeth while rebaiting his hook. The fish, in the convulsive struggles of death, slipped down the throat, and because of the arrangement of its scales it could be pushed down but not up; asphyxiation, however, ensued. Stewart has extensively described the case of a native "Puckally" of Ceylon who was the victim of the most distressing symptoms from the impaction of a living fish in his throat. The native had caught the fish, and in order to extract it placed its head between his teeth, holding the body with the left hand and the hook with the right. He had hardly extracted the hook, when the fish pricked his palm with his long and sharp dorsal fin, causing him suddenly to release his grasp on the fish and voluntarily open his mouth at the same time. The fish quickly bolted into his mouth, and, although he grasped the tail with his right hand, and squeezed his pharynx with his left, besides coughing violently, the fish found its way into the esophagus. Further attempts at extraction were dangerous and quite likely to fail; his symptoms were distressing, he could not hold his head erect without the most agonizing pain and he was almost prostrated from fright and asphyxia; it was thought advisable to push the fish into the stomach, and after an impaction of sixteen hours the symptoms were relieved. The fish in this instance was the Anabas scandens or "walking perch" of Ceylon, which derives its name from its power of locomotion on land and its ability to live out of water for some time. It is from four to five inches long and has a dorsal fin as sharp as a knife and directed toward the tail, and pectoral fins following the same direction; these would admit of entrance, but would interfere with extraction. MacLauren reports the history of a young man who, after catching a fish, placed it between his teeth. The fish, three inches long, by a sudden movement, entered the pharynx. Immediately ensued suffocation, nausea, vomiting, together with the expectoration of blood and mucus. There was emphysema of the face, neck, and chest. The fish could be easily felt impacted in the tissues, but, after swallowing much water and vinegar, together with other efforts at extraction, the fins were loosened--about twenty-four hours after the accident. By this time the emphysema had extended to the scrotum. There was much expectoration of muco-purulent fluid, and on the third day complete aphonia, but the symptoms gradually disappeared, and recovery was complete in eight days. Dantra is accredited with describing asphyxiation, accompanied by great agony, in a man who, while swimming, had partially swallowed a live fish. The fish was about three inches in length and one in breadth, and was found lying on the dorsum of his tongue and, together with numerous clots of blood, filled his mouth. Futile attempts to extract the fish by forceps were made. Examination showed that the fish had firmly grasped the patient's uvula, which it was induced to relinquish when its head was seized by the forceps and pressed from side to side. After this it was easily extracted and lived for some time. There was little hemorrhage after the removal of the offending object, and the blood had evidently come from the injuries to the sides of the mouth, caused by the fins. The uvula was bitten, not torn. There is an interesting account of a native of India, who, while fishing in a stream, caught a flat eel-like fish from fifteen to sixteen inches long. After the fashion of his fellows he attempted to kill the eel by biting off its head; in the attempt the fish slipped into his gullet, and owing to its sharp fins could not be withdrawn. The man died one hour later in the greatest agony; so firmly was the eel impacted that even after death it could not be extracted, and the man was buried with it protruding from his mouth. A Leech in the Pharynx.--Granger, a surgeon in Her Majesty's Indian Service, writes:--"Several days ago I received a note from the political sirdar, asking me if I would see a man who said he had a leech in his throat which he was unable to get rid of. I was somewhat sceptical, and thought that possibly the man might be laboring under a delusion. On going outside the fort to see the case, I found an old Pathan graybeard waiting for me. On seeing me, he at once spat out a large quantity of dark, half-clotted blood to assure me of the serious nature of his complaint. His history--mostly made out with the aid of interpreters--was that eleven days ago he was drinking from a rain-water tank and felt something stick in his throat, which he could not reject. He felt this thing moving, and it caused difficulty in swallowing, and occasionally vomiting. On the following day he began to spit up blood, and this continued until he saw me. He stated that he once vomited blood, and that he frequently felt that he was going to choke. "On examining his throat, a large clot of blood was found to be adherent to the posterior wall of the pharynx. On removing this clot of blood, no signs of the presence of a leech could be detected. However, on account of the symptoms complained of by the patient I introduced a polypus forceps into the lower part of the pharynx and toward the esophagus, where a body, distinctly moving, was felt. This body I seized with the forceps, and with considerable force managed to remove it. It was a leech between 2 1/2 and three inches in length, and with a body of the size of a Lee-Metford bullet. No doubt during the eleven days it had remained in the man's throat the leech had increased in size. Nevertheless it must have been an animal of considerable size when the man attempted to swallow it. I send this case as a typical example of the carelessness of natives of the class from which we enlist our Sepoys, as to the nature of the water they drink. This man had drunk the pea-soup like water of a tank dug in the side of the hill, rather than go a few hundred yards to a spring where the water is perfectly clear and pure. Though I have not met with another case of leeches being taken with drinking water, I am assured that such cases are occasionally met with about Agra and other towns in the North-West Provinces. This great carelessness as to the purity or impurity of their drinking water shows the difficulty medical officers must experience in their endeavors to prevent the Sepoys of a regiment from drinking water from condemned or doubtful sources during a cholera or typhoid epidemic." Foreign Bodies in the Pharynx and Esophagus.--Aylesbury mentions a boy who swallowed a fish-hook while eating gooseberries. He tried to pull it up, but it was firmly fastened, and a surgeon was called. By ingeniously passing a leaden bullet along the line, the weight of the lead loosened the hook, and both bullet and hook were easily drawn up. Babbit and Battle report an ingenious method of removing a piece of meat occluding the esophagus--the application of trypsin. Henry speaks of a German officer who accidentally swallowed a piece of beer bottle, 3/8 x 1/8 inch, which subsequently penetrated the esophagus, and in its course irritated the recurrent laryngeal and vagi, giving rise to the most serious phlegmonous inflammation and distressing respiratory symptoms. A peculiar case is that of the man who died after a fire at the Eddystone Lighthouse. He was endeavoring to extinguish the flames which were at a considerable distance above his head, and was looking up with his mouth open, when the lead of a melting lantern dropped down in such quantities as not only to cover his face and enter his mouth, but run over his clothes. The esophagus and tunica in the lower part of the stomach were burned, and a great piece of lead, weighing over 7 1/2 ounces, was taken from the stomach after death. Evans relates the history of a girl of twenty-one who swallowed four artificial teeth, together with their gold plate; two years and eight days afterward she ejected them after a violent attack of retching. Gauthier speaks of a young girl who, while eating soup, swallowed a fragment of bone. For a long time she had symptoms simulating phthisis, but fourteen years afterward the bone was dislodged, and, although the young woman was considered in the last stages of phthisis, she completely recovered in six weeks. Gastellier has reported the case of a young man of sixteen who swallowed a crown piece, which became lodged in the middle portion of the esophagus and could not be removed. For ten months the piece of money remained in this position, during which the young man was never without acute pain and often had convulsions. He vomited material, sometimes alimentary, sometimes mucus, pus, or blood, and went into the last stage of marasmus. At last, after this long-continued suffering, following a strong convulsion and syncope, the coin descended to the stomach, and the young man expectorated great quantities of pus. After thirty-five years, the coin had not been passed by the rectum. Instances of migration of foreign bodies from the esophagus are repeatedly recorded. There is an instance of a needle which was swallowed and lodged in the esophagus, but twenty-one months afterward was extracted by an incision at a point behind the right ear. Kerckring speaks of a girl who swallowed a needle which was ultimately extracted from the muscles of her neck. Poulet remarks that Vigla has collected the most interesting of these cases of migration of foreign bodies. Hevin mentions several cases of grains of wheat abstracted from abscesses of the thoracic parietes, from thirteen to fifteen days after ingestion. Bonnet and Helmontius have reported similar facts. Volgnarius has seen a grain of wheat make its exit from the axilla, and Polisius mentions an abscess of the back from which was extracted a grain of wheat three months after ingestion. Bally reports a somewhat similar instance, in which, three months after ingestion, during an attack of peripneumonia, a foreign body was extracted from an abscess of the thorax, between the 2d and 3d ribs. Ambrose found a needle encysted in the heart of a negress. She distinctly stated that she had swallowed it at a time calculated to have been nine years before her death. Planque speaks of a small bone perforating the esophagus and extracted through the skin. Abscess or ulceration, consequent upon periesophagitis, caused by the lodgment of foreign bodies in the esophagus, often leads to the most serious results. There is an instance of a soldier who swallowed a bone while eating soup, who died on the thirty-first day from the rupture internally of an esophageal abscess. Grellois has reported the history of a case of a child twenty-two months old, who suffered for some time with impaction of a small bone in the esophagus. Less than three months afterward the patient died with all the symptoms of marasmus, due to difficult deglutition, and at the autopsy an abscess was seen in the posterior wall of the pharynx, opposite the 3d cervical vertebra; extensive caries was also noticed in the bodies of the 2d, 3d, and 4th cervical vertebrae. Guattani mentions a curious instance in which a man playing with a chestnut threw it in the air, catching it in his mouth. The chestnut became lodged in the throat and caused death on the nineteenth day. At the autopsy it was found that an abscess communicating with the trachea had been formed in the pharynx and esophagus. A peculiarly fatal accident in this connection is that in which a foreign body in the esophagus ulcerates, and penetrates one of the neighboring major vessels. Colles mentions a man of fifty-six who, while eating, perceived a sensation as of a rent in the chest. The pain was augmented during deglutition, and almost immediately afterward he commenced to expectorate great quantities of blood. On the following day he vomited a bone about an inch long and died on the same day. At the autopsy it was found that there was a rent in the posterior wall of the esophagus, about 1/2 inch long, and a corresponding wound of the aorta. There was blood in the pleura, pericardium, stomach, and intestines. There is one case in which a man of forty-seven suddenly died, after vomiting blood, and at the autopsy it was demonstrated that a needle had perforated the posterior wall of the esophagus and wounded the aorta. Poulet has collected 31 cases in which ulceration caused by foreign bodies in the esophagus has resulted in perforation of the walls of some of the neighboring vessels. The order of frequency was as follows: aorta, 17; carotids, four; vena cava, two; and one case each of perforation of the inferior thyroid artery, right coronary vein, demi-azygos vein, the right subclavicular artery (abnormal), and the esophageal artery. In three of the cases collected there was no autopsy and the vessel affected was not known. In a child of three years that had swallowed a half-penny, Atkins reports rupture of the innominate artery. No symptoms developed, but six weeks later, the child had an attack of ulcerative stomatitis, from which it seemed to be recovering nicely, when suddenly it ejected two ounces of bright red blood in clots, and became collapsed out of proportion to the loss of blood. Under treatment, it rallied somewhat, but soon afterward it ejected four ounces more of blood and died in a few minutes. At the autopsy 3/4 pint of blood was found in the stomach, and a perforation was discovered on the right side of the esophagus, leading into a cavity, in which a blackened half-penny was found. A probe passed along the aorta into the innominate protruded into the same cavity about the bifurcation of the vessel. Denonvilliers has described a perforation of the esophagus and aorta by a five-franc piece. A preserved preparation of this case, showing the coin in situ, is in the Musee Dupuytren. Blaxland relates the instance of a woman of forty-five who swallowed a fish bone, was seized with violent hematemesis, and died in eight hours. The necropsy revealed a penetration of the aorta through the thoracic portion of the esophagus. There is also in the Musee Dupuytren a preparation described by Bousquet, in which the aorta and the esophagus were perforated by a very irregular piece of bone. Mackenzie mentions an instance of death from perforation of the aorta by a fish-bone. In some cases penetration of the esophagus allows the further penetration of some neighboring membrane or organ in the same manner as the foregoing cases. Dudley mentions a case in which fatal hemorrhage was caused by penetration of the esophagus and lung by a chicken-bone. Buist speaks of a patient who swallowed two artificial teeth. On the following day there was pain in the epigastrium, and by the fourth day the pain extended to the vertebrae, with vomiting, delirium, and death on the fifth day. At the autopsy it was found that a foreign body, seven cm. long had perforated the pericardium, causing a suppurative pericarditis. Dagron reports a unique instance of death by purulent infection arising from perforation of the esophagus by a pin. The patient was a man of forty-two, and, some six weeks before he presented himself for treatment, before swallowing had experienced a severe pain low down in the neck. Five days before admission he had had a severe chill, followed by sweating and delirium. He died of a supraclavicular abscess on the fifth day; a black steel pin was found against the esophagus and trachea. In connection with foreign bodies in the esophagus, it might be interesting to remark that Ashhurst has collected 129 cases of esophagotomy for the removal of foreign bodies, resulting in 95 recoveries and 34 deaths. Gaudolphe collected 142 cases with 110 recoveries. Injuries of the neck are usually inflicted with suicidal intent or in battle. Cornelius Nepos says that while fighting against the Lacedemonians, Epaminondas was sensible of having received a mortal wound, and apprehending that the lance was stopping a wound in an important vessel, remarked that he would die when it was withdrawn. When he was told that the Boeotians had conquered, exclaiming "I die unconquered," he drew out the lance and perished. Petrus de Largenta speaks of a man with an arrow in one of his carotids, who was but slightly affected before its extraction, but who died immediately after the removal of the arrow. Among the remarkable recoveries from injuries of the neck is that mentioned by Boerhaave, of a young man who lived nine or ten days after receiving a sword-thrust through the neck between the 4th and 5th vertebrae, dividing the vertebral artery. Benedictus, Bonacursius, and Monroe, all mention recovery after cases of cut-throat in which the esophagus as well as the trachea was wounded, and food protruded from the external cut. Warren relates the history of a case in which the vertebral artery was wounded by the discharge of a pistol loaded with pebbles. The hemorrhage was checked by compression and packing, and after the discharge of a pebble and a piece of bone from the wound, the man was seen a month afterward in perfect health. Corson of Norristown, Pa., has reported the case of a quarryman who was stabbed in the neck with a shoemaker's knife, severing the left carotid one inch below its division. He was seen thirty minutes later in an apparently lifeless condition, but efforts at resuscitation were successfully made. The hemorrhage ceased spontaneously, and at the time of report, the man presented the symptoms of one who had had his carotid ligated (facial atrophy on one side, no pulse, etc.). Baron Larrey mentions a case of gunshot wound in which the carotid artery was open at its division into internal and external branches, and says that the wound was plugged by an artilleryman until ligation, and in this primitive manner the patient was saved. Sale reports the case of a girl of nineteen, who fell on a china bowl that she had shattered, and wounded both the right common carotid artery and internal jugular vein. There was profuse and continuous hemorrhage for a time, and subsequently a false aneurysm developed, which ruptured in about three months, giving rise to enormous momentary hemorrhage; notwithstanding the severity of the injury and the extent of the hemorrhage, complete recovery ensued. Amos relates the instance of a woman named Mary Green who, after complete division of all the vessels of the neck, walked 23 yards and climbed over an ordinary bar-gate nearly four feet high. Cholmeley reports the instance of a Captain of the First Madras Fusileers, who was wounded at Pegu by a musket-ball penetrating his neck. The common carotid was divided and for five minutes there was profuse hemorrhage which, however, strange to say, spontaneously ceased. The patient died in thirty-eight hours, supposedly from spinal concussion or shock. Relative to ligature of the common carotid artery, Ashhurst mentions the fact that the artery has been ligated in 228 instances, with 94 recoveries. Ellis mentions ligature of both carotids in four and a half days, as a treatment for a gunshot wound, with subsequent recovery. Lewtas reports a case of ligation of the innominate and carotid arteries for traumatic aneurysm (likely a hematoma due to a gunshot injury of the subclavian artery). The patient was in profound collapse, but steadily reacted and was discharged cured on the forty-fifth day, with no perceptible pulse at the wrist and only a feeble beat in the pulmonary artery. Garengeot, Wirth, Fine, and Evers, all mention perforating wounds of the trachea and esophagus with recoveries. Van Swieten and Hiester mention cases in which part of the trachea was carried away by a ball, with recovery. Monro, Tulpius, Bartholinus, and Pare report severance of the trachea with the absence of oral breathing, in which the divided portions were sutured, with successful results. In his "Theatro Naturae," Bodinus says that William, Prince of Orange, lost the sense of taste after receiving a wound of the larynx; according to an old authority, a French soldier became mute after a similar accident. Davies-Colley mentions a boy of eighteen who fell on a stick about the thickness of the index finger, transfixing his neck from right to left; he walked to a doctor's house, 250 yards away, with the stick in situ. In about two weeks he was discharged completely well. During treatment he had no hemorrhage of any importance, and his voice was not affected, but for a while he had slight dysphagia. Barker gives a full account of a barber who was admitted to a hospital two and a half hours after cutting his throat. He had a deep wound running transversely across the neck, from one angle of the jaw to the other, cutting open the floor of the mouth and extending from the inner border of the sternocleido-mastoid to the other, leaving the large vessels of the neck untouched. The razor had passed through the glosso-epiglottidean fold, a tip of the epiglottis, and through the pharynx down to the spinal column. There was little hemorrhage, but the man could neither swallow nor speak. The wound was sutured, tracheotomy done, and the head kept fixed on the chest by a copper splint. He was ingeniously fed by esophageal tubes and rectal enemata; in three weeks speech and deglutition were restored. Shortly afterward the esophageal tube was removed and recovery was virtually complete. Little mentions an extraordinary case of a woman of thirty-six who was discharged from Garland's asylum, where she had been an inmate for three months. This unfortunate woman had attempted suicide by self-decapitation from behind forward. She was found, knife in hand, with a huge wound in the back of the neck and her head bobbing about in a ghastly manner. The incision had severed the skin, subcutaneous tissues and muscles, the ligaments and bone, opening the spinal canal, but not cutting the cord. The instrument used to effect this major injury was a blunt potato-peeling knife. Despite this terrible wound the patient lived to the sixth day. Hislop records a case of cut-throat in a man of seventy-four. He had a huge gaping wound of the neck, extending to within a half inch of the carotids on each side. The trachea was almost completely severed, the band left was not more than 1/4 inch wide. Hislop tied four arteries, brought the ends of the trachea together with four strong silk sutures, and, as the operation was in the country, he washed the big cavity of the wound out with cold spring-water. He brought the superficial surfaces together with ten interrupted sutures, and, notwithstanding the patient's age, the man speedily recovered. This emphasizes the fact that the old theory of leaving wounds of this nature open was erroneous. Solly reports the case of a tailor of twenty-two who attempted suicide by cutting through the larynx, entirely severing the epiglottis and three-fourths of the pharynx. No bleeding point was found, and recovery ensued. Cowles describes the case of a soldier of thirty-five who, while escaping from the patrols, was shot by the Officer of the Day with a small bullet from a pistol. The ball entered the right shoulder, immediately over the suprascapular notch, passed superficially upward and forward into the neck, wounding the esophagus posteriorly at a point opposite the thyroid cartilage, and lodged in the left side of the neck. The patient had little hemorrhage, but had expectorated and swallowed much blood. He had a constant desire to swallow, which continued several days. The treatment was expectant; and in less than three weeks the soldier was returned to duty. From the same authority there is a condensation of five reports of gunshot wounds of the neck, from all of which the patients recovered and returned to duty. Braman describes the case of a man on whom several injuries were inflicted by a drunken companion. The first wound was slight; the second a deep flesh-wound over the trapezius muscle; the third extended from the right sterno-cleido-mastoid midway upward to the middle of the jaw and down to the rapine of the trachea. The external jugular, the external thyroid, and the facial arteries were severed. Braman did not find it necessary to ligate, but was able to check the hemorrhage with lint and persulphate of iron, in powder, with pressure. After fourteen hours the wound was closed; the patient recovered, and was returned to duty in a short time. Thomas has reported the case of a man sixty-five years old who in an attempt at suicide with a penknife, had made a deep wound in the left side of the neck. The sternohyoid and omohyoid muscles were divided; the internal jugular vein was cut through, and its cut ends were collapsed and 3/4 inch apart; the common carotid artery was cut into, but not divided; the thyroid cartilage was notched, and the external and anterior jugular veins were severed. Clamp-forceps were immediately applied to the cut vessels and one on each side the aperture in the common carotid from which a small spurt of blood, certainly not half a teaspoonful, came out. The left median basilic vein was exposed by an incision, and 20 ounces of warm saline solution were slowly perfused, an ordinary glass syringe with a capacity of five ounces, with an India-rubber tubing attached to a canula in the vein being employed. After seven ounces of fluid had been injected, the man made a short, distinct inspiration; at ten ounces a deeper one (the radial pulse could now be felt beating feebly); at 15 ounces the breathing became regular and deep; at 18 ounces the man opened his eyes, but did not appear to be conscious. The clamped vessels were now tied with catgut and the wound cleansed with phenol lotion and dressed with cyanid-gauze. The man was surrounded by hot-water bottles and the foot of the bed elevated 18 inches. In the course of an hour the patient had recovered sufficiently to answer in a squeaky voice to his name when called loudly. Improvement proceeded rapidly until the twenty-second day, when violent hemorrhage occurred, preceded a few hours previously by a small trickle, easily controlled by pressure. The wound was at once opened and blood found oozing from the distal extremities of the carotid artery and jugular vein, which were promptly clamped. The common carotid artery was not sound, so that ligatures were applied to the internal and external carotids and to the internal jugular with a small branch entering into it. The patient was in great collapse, but quickly rallied, only to suffer renewed hemorrhage from the internal carotid nine days later. This was controlled by pressure with sponges, and a quart of hot water was injected into the rectum. From this time on the patient made a slow recovery, a small sinus in the lower part of the neck disappearing on the removal of the catgut ligature. Adams describes the case of a woman who attempted suicide with a common table-knife, severing the thyroid, cricoid, and first three rings of the trachea, and lacerating the sternohyoid and thyroid arteries; she finally recovered. There is a curious case of suicide of a woman who, while under the effects of opium, forced the handle of a mirror into her mouth. From all appearances, the handle had broken off near the junction and she had evidently fallen forward with the remaining part in her mouth, driving it forcibly against the spine, and causing the point of the handle to run downward in front of the cervical vertebrae. On postmortem examination, a sharp piece of wood about two inches long, corresponding to the missing portion of the broken mirror handle, was found lying between the posterior wall of the esophagus and the spine. Hennig mentions a case of gunshot wound of the neck in which the musket ball was lodged in the posterior portion of the neck and was subsequently discharged by the anus. Injuries of the cervical vertebrae, while extremely grave, and declared by some authors to be inevitably fatal, are, however, not always followed by death or permanently bad results. Barwell mentions a man of sixty-three who, in a fit of despondency, threw himself from a window, having fastened a rope to his neck and to the window-sill. He fell 11 or 12 feet, and in doing so suffered a subluxation of the 4th cervical vertebra. It slowly resumed the normal position by the elasticity of the intervertebral fibrocartilage, and there was complete recovery in ten days. Lazzaretto reports the history of the case of a seaman whose atlas was dislocated by a blow from a falling sail-yard. The dislocation was reduced and held by adhesive strips, and the man made a good recovery. Vanderpool of Bellevue Hospital, N.Y., describes a fracture of the odontoid process caused by a fall on the back of the head; death, however, did not ensue until six months later. According to Ashhurst, Philips, the elder Cline, Willard Parker, Bayard, Stephen Smith, May, and several other surgeons, have recorded complete recovery after fracture of the atlas and axis. The same author also adds that statistic investigation shows that as large a proportion as 18 per cent of injuries of the cervical vertebrae occurring in civil practice, recover. However, the chances of a fatal issue in injuries of the vertebrae vary inversely with the distance of the point of injury from the brain. Keen has recorded a case in which a conoidal ball lodged in the body of the third cervical vertebra, from which it was extracted six weeks later. The paralysis, which, up to the time of extraction, had affected all four limbs, rapidly diminished. In about five weeks after the removal of the bullet nearly the entire body of the 3d cervical vertebra, including the anterior half of the transverse process and vertebral foremen, was spontaneously discharged. Nearly eight years afterward Keen saw the man still living, but with his right shoulder and arm diminished in size and partly paralyzed. Doyle reports a case of dislocated neck with recovery. During a runaway the patient was thrown from his wagon, and was soon after found on the roadside apparently dead. Physicians who were quickly summoned from the immediate neighborhood detected faint signs of life; they also found a deformity of the neck, which led them to suspect dislocation. An ambulance was called, and without any effort being made to relieve the deformity the man was placed in it and driven to his home about a mile distant. The jolting over the rough roads greatly aggravated his condition. When Doyle saw the patient, his general appearance presented a hopeless condition, but being satisfied that a dislocation existed, Doyle immediately prepared to reduce it. Two men were told to grasp the feet and two more the head, and were directed to make careful but strong extension. At the same time the physician placed his right hand against the neck just over the pomum Adami, and his left against the occiput, and, while extension was being made, he flexed the head forward until the chin nearly touched the breast, after which the head was returned to its normal position. The manipulation was accompanied by a clicking sensation, caused by the replacement of the dislocated vertebra. The patient immediately showed signs of relief and improved rapidly. Perceptible but feeble movements were made by all the limbs except the right arm. The patient remained in a comatose condition for eight or nine days, during which he had enuresis and intestinal torpor. He suffered from severe concussion of the brain, which accounted for his prolonged coma. Delirium was present, but he was carefully watched and not allowed to injure himself. His recovery was tedious and was delayed by several relapses. His first complaint after consciousness returned (on the tenth day) was of a sense of constriction about the neck, us if he were being choked. This gradually passed off, and his improvement went on without development of any serious symptoms. At the time of report he appeared in the best of health and was quite able to attend to his daily avocations. Doyle appends to his report the statement that among 394 cases embraced in Ashhurst's statistics, in treatment of dislocations in the cervical region, the mortality has been nearly four times greater when constitutional or general treatment has been relied on exclusively than when attempts had been made to reduce the dislocation by extension, rotation, etc. Doyle strongly advocates attempts at reduction in such cases. Figure 205 represents a photograph of Barney Baldwin, a switchman of the Louisville and Nashville Railroad, who, after recovery from cervical dislocation, exhibited himself about the country, never appearing without his suspensory apparatus. Acheson records a case of luxation of the cervical spine with recovery after the use of a jury-mast. The patient was a man of fifty-five, by trade a train-conductor. On July 10, 1889, he fell backward in front of a train, his head striking between the ties; the brake-body caught his body, pushing it forward on his head, and turned him completely over. Three trucks passed over him. When dragged from beneath the train, his upper extremities were paralyzed. At noon the next day, nineteen hours after the accident, examination revealed bruises over the body, and he suffered intense pain at the back of the neck and base of the skull. Posteriorly, the neck presented a natural appearance; but anteriorly, to use the author's description, his neck resembled a combined case of mumps and goiter. The sternomastoid muscle bulged at the angle of the jaw, and was flaccid, and his "Adam's apple" was on a level with the chin. Sensation in the upper extremities was partially restored, and, although numb, he now had power of movement in the arms and hands, but could not rotate his neck. A diagnosis of cervical dislocation was made, and violent extension, with oscillation forward and backward, was practiced, and the abnormal appearance subsided at once. No crepitus was noticed. On the fourth day there was slight hemorrhage from the mouth, which was more severe on the fifth and sixth days. The lower jaw had been forced past the upper, until the first molar had penetrated the tissues beneath the tongue. A plaster-of-Paris apparatus was applied, and in two months was exchanged for one of sole-leather. In rising from the recumbent position the man had to lift his head with his hands. Fifty days after the accident he suffered excruciating pain at the change of the weather, and at the approach of a storm the joints, as well as the neck, were involved. It was believed (one hundred and seven days after the accident) that both fracture and luxation existed. His voice had become guttural, but examination of the fauces was negative. The only evidence of paralysis was in the fingers, which, when applied to anything, experienced the sensation of touching gravel. The mottling of the tissues of the neck, which appeared about the fiftieth day, had entirely disappeared. According to Thorburn, Hilton had a patient who lived fourteen years with paraplegia due to fracture of the 5th, 6th, and 7th cervical vertebrae. Shaw is accredited with a case in which the patient lived fifteen months, the fracture being above the 4th cervical vertebra. In speaking of foreign bodies in the larynx and trachea, the first to be considered will be liquids. There is a case on record of an infant who was eating some coal, and being discovered by its mother was forced to rapidly swallow some water. In the excitement, part of the fluid swallowed fell into the trachea, and death rapidly ensued. It is hardly necessary to mention the instances in which pus or blood from ruptured abscesses entered the trachea and caused subsequent asphyxiation. A curious instance is reported by Gaujot of Val-de-Grace of a soldier who was wounded in the Franco-Prussian war, and into whose wound an injection of the tincture of iodin was made. The wound was of such an extent as to communicate with a bronchus, and by this means the iodin entered the respiratory tract, causing suffocation. According to Poulet, Vidal de Cassis mentions an inmate of the Charite Hospital, in Paris, who, full of wine, had started to vomit; he perceived Corvisart, and knew he would be questioned, therefore he quickly closed his mouth to hide the proofs of his forbidden ingestion. The materials in his mouth were forced into the larynx, and he was immediately asphyxiated. Laennec, Merat, and many other writers have mentioned death caused by the entrance of vomited materials into the air-passages. Parrot has observed a child who died by the penetration of chyme into the air-passages. The bronchial mucous and underlying membrane were already in a process of digestion. Behrend, Piegu, and others cite analogous instances. The presence of a foreign body in the larynx is at all times the cause of distressing symptoms, and, sometimes, a substance of the smallest size will cause death. There is a curious accident recorded that happened to a young man of twenty-three, who was anesthetized in order to extract a tooth. A cork had been placed between the teeth to keep the mouth open. The tooth was extracted but slipped from the forceps, and, together with the cork, fell into the pharynx. The tooth was ejected in an effort at vomiting, but the cork entered the larynx, and, after violent struggles, asphyxiation caused death in an hour. The autopsy demonstrated the presence of the cork in the larynx. A somewhat analogous case, though not ending fatally, was reported by Hertz of a woman of twenty-six, who was anesthetized for the extraction of the right second inferior molar. The crown broke off during the operation, and immediately after the extraction she had a fit of coughing. About fifteen days later she experienced pain in the lungs. Her symptoms increased to the fifth week, when she became so feeble as to be confined to her bed. A body seemed to be moving in the trachea, synchronously with respiration. At the end of the fifth week the missing crown of the tooth was expelled after a violent fit of coughing; the symptoms immediately ameliorated, and recovery was rapid thereafter. Aronsohn speaks of a child who was playing with a toy wind-instrument, and in his efforts to forcibly aspirate air through it, the child drew the detached reed into the respiratory passages, causing asphyxiation. At the autopsy the foreign body was found at the superior portion of the left bronchus. There are other cases in which, while sucking oranges or lemons, seeds have been aspirated; and there is a case in which, in a like manner, the claw of a crab was drawn into the air-passages. There are two cases mentioned in which children playing with toy balloons, which they inflated with their breath, have, by inspiration, reversed them and drawn the rubber of the balloon into the opening of the glottis, causing death. Aronsohn, who has already been quoted, and whose collection of instances of this nature is probably the most extensive, speaks of a child in the street who was eating an almond; a carriage threw the child down and he suddenly inspired the nut into the air-passages, causing immediate asphyxia The same author also mentions a soldier walking in the street eating a plum, who, on being struck by a horse, suddenly started and swallowed the seed of the fruit. After the accident he had little pain or oppression, and no coughing, but twelve hours afterward he rejected the seed in coughing. A curious accident is that in which a foreign body thrown into the air and caught in the mouth has caused immediate asphyxiation. Suetonius transmits the history of a young man, a son of the Emperor Claudius, who, in sport, threw a small pear into the air and caught it in his mouth, and, as a consequence, was suffocated. Guattani cites a similar instance of a man who threw up a chestnut, which, on being received in the mouth, lodged in the air-passages; the man died on the nineteenth day. Brodie reported the classic observation of the celebrated engineer, Brunel, who swallowed a piece of money thrown into the air and caught in his mouth. It fell into the open larynx, was inspired, causing asphyxiation, but was removed by inversion of the man's body. Sennert says that Pope Adrian IV died from the entrance of a fly into his respiratory passages; and Remy and Gautier record instances of the penetration of small fish into the trachea. There are, again, instances of leeches in this location. Occasionally the impaction of artificial teeth in the neighborhood of the larynx has been unrecognized for many years. Lennox Browne reports the history of a woman who was supposed to have either laryngeal carcinoma or phthisis, but in whom he found, impacted in the larynx, a plate with artificial teeth attached, which had remained in this position twenty-two months unrecognized and unknown. The patient, when questioned, remembered having been awakened in the night by a violent attack of vomiting, and finding her teeth were missing assumed they were thrown away with the ejections. From that time on she had suffered pain and distress in breathing and swallowing, and became the subject of progressive emaciation. After the removal of the impacted plate and teeth she soon regained her health. Paget speaks of a gentleman who for three months, unconsciously, carried at the base of the tongue and epiglottis, very closely fitted to all the surface on which it rested, a full set of lost teeth and gold palate-plate. From the symptoms and history it was suspected that he had swallowed his set of false teeth, but, in order to prevent his worrying, he was never informed of this suspicion, and he never once suspected the causes of his symptoms. Wrench mentions a case illustrative of the extent to which imagination may produce symptoms simulating those ordinarily caused by the swallowing of false teeth. This man awoke one morning with his nose and throat full of blood, and noticed that his false teeth, which he seldom removed at night, were missing. He rapidly developed great pain and tumor in the larynx, together with difficulty in deglutition and speech. After a fruitless search, with instrumental and laryngoscopic aid, the missing teeth were found--in a chest of drawers; the symptoms immediately subsided when the mental illusion was relieved. There is a curious case of a man drowned near Portsmouth. After the recovery of his body it was seen that his false teeth were impacted at the anterior opening of the glottis, and it was presumed that the shock caused by the plunge into the cold water had induced a violent and deep inspiration which carried the teeth to the place of impaction. Perrin reports a case of an old man of eighty-two who lost his life from the impaction of a small piece of meat in the trachea and glottis. In the Musee Valde-Grace is a prepared specimen of this case showing the foreign body in situ. In the same museum Perrin has also deposited a preparation from the body of a man of sixty-two, who died from the entrance of a morsel of beef into the respiratory passages. At the postmortem a mobile mass of food about the size of a hazel-nut was found at the base of the larynx at the glossoepiglottic fossa. About the 5th ring of the trachea the caliber of this organ was obstructed by a cylindric alimentary bolus about six inches long, extending almost to the bronchial division. Ashhurst shows a fibrinous cast, similar to that found in croup, caused by a foreign body removed by Wharton, together with a shawl-pin, from a patient at the Children's Hospital seven hours after the performance of tracheotomy. Search for the foreign body at the time of the operation was prevented by profuse hemorrhage. The ordinary instances of foreign bodies in the larynx and trachea are so common that they will not be mentioned here. Their variety is innumerable and it is quite possible for more than two to be in the same location simultaneously. In his treatise on this subject Gross says that he has seen two, three, and even four substances simultaneously or successively penetrate the same location. Berard presented a stick of wood extracted from the vocal cords of a child of ten, and a few other similar instances are recorded. The Medical Press and Circular finds in an Indian contemporary some curious instances of misapplied ingenuity on the part of certain habitual criminals in that country. The discovery on a prisoner of a heavy leaden bullet about 3/4 inch in diameter led to an inquiry as to the object to which it was applied. It was ascertained that it served to aid in the formation of a pouch-like recess at the base of the epiglottis. The ball is allowed to slide down to the desired position, and it is retained there for about half an hour at a time. This operation is repeated many times daily until a pouch the desired size results, in which criminals contrive to secrete jewels, money, etc., in such a way as to defy the most careful search, and without interfering in any way with speech or respiration. Upward of 20 prisoners at Calcutta were found to be provided with this pouch-formation. The resources of the professional malingerer are exceedingly varied, and testify to no small amount of cunning. The taking of internal irritants is very common, but would-be in-patients very frequently overshoot the mark and render recovery impossible. Castor-oil seeds, croton beans, and sundry other agents are employed with this object in view, and the medical officers of Indian prisons have to be continually on the lookout for artificially induced diseases that baffle diagnosis and resist treatment. Army surgeons are not altogether unfamiliar with these tricks, but compared with the artful Hindoos the British soldier is a mere child in such matters. Excision of the larynx has found its chief indication in carcinoma, but has been employed in sarcoma, polyps, tuberculosis, enchondroma, stenosis, and necrosis. Whatever the procedure chosen for the operation, preliminary tracheotomy is a prerequisite. It should be made well below the isthmus of the thyroid gland, and from three to fifteen days before the laryngectomy. This affords time for the lungs to become accustomed to the new manner of breathing, and the trachea becomes fixed to the anterior wall of the neck. Powers and White have gathered 69 cases of either total or partial extirpation of the larynx, to which the 240 cases collected and analyzed by Eugene Kraus, in 1890, have been added. The histories of six new cases are given. Of the 309 operations, 101, or 32 per cent of the patients, died within the first eight weeks from shock, hemorrhage, pneumonia, septic infection, or exhaustion. The cases collected by these authors show a decrease in the death ratio in the total excision,--29 per cent as against 36 per cent in the Kraus tables. The mortality in the partial operation is increased, being 38 per cent as opposed to 25 per cent. Cases reported as free from the disease before the lapse of three years are of little value, except in that they diminish, by so much, the operative death-rate. Of 180 laryngectomies for carcinoma prior to January 1, 1892, 72, or 40 per cent, died as a result of the operation; 51 of the remaining 108 had recurrence during the first year, and 11, or ten per cent of the survivors, were free from relapse three or more years after operation. In 77 cases of partial laryngectomy for cancer, 26, or 33 per cent, died during the first two months; of the remaining 51, seven cases, or 13 per cent, are reported as free from the disease three or more years after the operation. Injuries destroying great portions of the face or jaw, but not causing death, are seldom seen, except on the battle-field, and it is to military surgery that we must look for the most striking instances of this kind. Ribes mentions a man of thirty-three who, in the Spanish campaign in 1811, received an injury which carried away the entire body of the lower jaw, half of each ramus, and also mangled in a great degree the neighboring soft parts. He was transported from the field of battle, and, despite enormous hemorrhage and suppuration, in two months recovered. At the time of report the wounded man presented no trace of the inferior maxillary bone, but by carrying the finger along the side of the pharynx in the direction of the superior dental arch the coronoid apophyses could be recognized, and about six lines nearer the temporal extremity the ramus could be discovered. The tongue was missing for about one-third its length, and was thicker than natural and retracted on the hyoid bone. The sublingual glands were adherent to the under part of the tongue and were red and over-developed. The inferior parts of the cheeks were cicatrized with the lateral and superior regions of the neck, and with the base of the tongue and the hyoid bone. The tongue was free under and in front of the larynx. The patient used a gilded silver plate to fix the tongue so that deglutition could be carried on. He was not able to articulate sounds, but made himself understood through the intervention of this plate, which was fixed to a silver chin. The chin he used to maintain the tongue-plate, to diminish the deformity, and to retain the saliva, which was constantly dribbling on the neck. The same author quotes the instance of a man of fifty, who, during the siege of Alexandria in 1801, was struck in the middle of his face, obliquely, by a cannonball, from below upward and from right to left. A part of the right malar bone, the two superior maxillary bones, the nasal bones, the cartilage, the vomer, the middle lamina of the ethmoid, the left maxillary bone, a portion of the left zygomatic arch, and a great portion of the inferior maxilla were carried away, or comminuted, and all the soft parts correspondingly lacerated. Several hours afterward this soldier was counted among the number of dead, but Larrey, the surgeon-in-chief of the army, with his typical vigilance and humanity, remarked that the patient gave signs of life, and that, despite the magnitude of his wound, he did not despair of his recovery. Those portions in which attrition was very great were removed, and the splinters of bone taken out, showing an enormous wound. Three months were necessary for cicatrization, but it was not until the capitulation of Marabou, at which place he was wounded, that the patient was returned to France. At this time he presented a hideous aspect. There were no signs of nose, nor cartilage separating the entrance of the nostrils, and the vault of the nasal fossa could be easily seen. There was a part of the posterior region of the right superior maxilla, but the left was entirely gone--in fact, the man presented an enormous triangular opening in the center of the face, as shown by the accompanying illustration. The tongue and larynx were severely involved, and the sight in the left eye was lost. This patient continually wore a gilded silver mask, which covered his deformity and rendered articulation a little less difficult. The saliva continually dribbled from the mouth and from the inferior internal portion of his mask, compelling him to carry some substance to receive the dribblings. Whymper mentions an analogous instance of a gunner who had his whole lower jaw torn away by a shell, but who recovered and used an ingenious contrivance in the shape of a silver mask for remedying the loss of the parts. Steiner mentions a wound from a cannon-ball, which carried away the left half of the inferior maxilla, stripping the soft parts as high as the malar, and on the left side of the neck to within 1 1/2 inches of the clavicle, laying bare the transverse processes of the 2d and 3d vertebrae, end exposing the external carotid and most of its branches. It sometimes happens that a foreign body, such as the breech of a gun, may be imbedded for some time in the face, with subsequent safe removal. Keith mentions an instance of the successful removal of the breech of a fowling-piece from the face, at the root of the nose, after a lodgment of four months; and Fraser cites an analogous instance in which the breech was imbedded in the bones of the face for eight years Smith records an instance in which a broken piece of tobacco-pipe penetrated the cheek, remained there for seven months, but was successfully extracted. Before leaving accidents to the head and neck, a most curious case, cited by O'Neill, will be briefly reviewed. A boy of twelve was entrusted to carry a new iron pot to the destination of its purchaser. Probably to facilitate transportation, the boy removed his hat and placed the pot obliquely on the back part of his head, but a sudden movement caused it to slip forward and downward over the head. Unavailing efforts were made at the time and after he reached home, to remove the pot from his head, but in vain, and he continued all the night greatly prostrated by fright, hunger, and thirst, together with the efforts at removal. The next morning he was taken to a neighboring blacksmith, who, by greasing one of his fingers, managed to insinuate it between the head and pot. Placing the other side of the pot against an anvil he struck over the location of his finger a quick, heavy tap with a hammer, and the pot fell to pieces. The little patient was much exhausted by all his treatment and want of sleep, and, in fact, could hardly have endured his situation much longer. CHAPTER XI. SURGICAL ANOMALIES OF THE EXTREMITIES. Reunion of Digits.--An interesting phenomenon noticed in relation to severed digits is their wonderful capacity for reunion. Restitution of a severed part, particularly if one of considerable function, naturally excited the interest of the older writers. Locher has cited an instance of avulsion of the finger with restitution of the avulsed portion; and Brulet, Van Esh, Farmer, Ponteau, Regnault, and Rosenberg cite instances of reunion of a digit after amputation or severance. Eve's "Remarkable Cases in Surgery" contains many instances of reunion of both fingers and thumbs, and in more recent years several other similar cases have been reported. At the Emergency Hospital in Washington, D.C., there was a boy brought in who had completely severed one of his digits by a sharp bread-cutter. The amputated finger was wrapped up in a piece of brown paper, and, being apparently healthy and the wound absolutely clean, it was fixed in the normal position on the stump, and covered by a bichlorid dressing. In a short time complete function was restored. In this instance no joint was involved, the amputation being in the middle of the 2d phalanx. Staton has described a case in which the hand was severed from the arm by an accidental blow from an axe. The wound extended from the styloid process directly across to the trapezium, dividing all the muscles and blood-vessels, cutting through bones. A small portion of the skin below the articulation, with the ulna, remained intact. After an unavoidable delay of an hour, Staton proceeded to replace the hand with silver sutures, adhesive plaster, and splints. On the third day pulsation was plainly felt in the hand, and on the fourteenth day the sutures were removed. After some time the patient was able to extend the fingers of the wounded member, and finally to grasp with all her wonted strength. The reproduction or accidental production of nails after the original part has been torn away by violence or destroyed by disease, is quite interesting. Sometimes when the whole last phalanx has been removed, the nail regrows at the tip of the remaining stump. Tulpius seems to have met with this remarkable condition. Marechal de Rougeres, Voigtel, and Ormancey have related instances of similar growths on the 2d phalanx after the loss of the 1st. For several months a woman had suffered from an ulcer of the middle finger of the right hand, in consequence of a whitlow; there was loss of the 3d phalanx, and the whole of the articular surface and part of the compact bony structure of the 2d. On examining the sore, Ormangey saw a bony sequestrum which appeared to keep it open. He extracted this, and, until cicatrization was complete, he dressed the stump with saturnine cerate. Some months afterward Ormangey saw with astonishment that the nail had been reproduced; instead of following the ordinary direction, however, it lay directly over the face of the stump, growing from the back toward the palmer aspect of the stump digit, as if to cover and protect the stump. Blandin has observed a case of the same description. A third occurred at the Hopital de la Charite, in a woman, who, in consequence of a whitlow, had lost the whole of the 3d phalanx of one of the forefingers. The soft and fleshy cushion which here covered the 2d phalanx was terminated by a small, blackish nail, like a grain of spur rye. It is probable that in these cases the soft parts of the 3d phalanx, and especially the ungual matrix, had not been wholly destroyed. In his lectures Chevalier speaks of analogous cases. In some instances avulsion of a finger is effected in a peculiar manner. In 1886 Anche reported to his confreres in Bordeaux a rare accident of this nature that occurred to a carpenter. The man's finger was caught between a rope and the block of a pulley. By a sudden and violent movement on his part he disengaged the hand but left the 3d finger attached to the pulley. At first examination the wound looked like that of an ordinary amputation by the usual oval incision; from the center of the wound the proximal fragment of the 1st phalanx projected. Polaillon has collected 42 similar instances, in none of which, however, was the severance complete. It occasionally happens that in avulsion of the finger an entire tendon is stripped up and torn off with the detached member. Vogel describes an instance of this nature, in which the long flexor of the thumb was torn off with that digit. In the Surgical Museum at Edinburgh there is preserved a thumb and part of the flexor longus pollicis attached, which were avulsed simultaneously. Nunnely has seen the little finger together with the tendon and body of the longer flexor muscle avulsed by machinery. Stone details the description of the case of a boy named Lowry, whose left thumb was caught between rapidly twisting strands of a rope, and the last phalanx, the neighboring soft parts, and also the entire tendon of the flexor longus pollicis were instantly torn away. There was included even the tendinous portion of that small slip of muscle taking its origin from the anterior aspect of the head and upper portion of the ulna, and which is so delicate and insignificant as to be generally overlooked by anatomists. There was great pain along the course of the tract of abstraction of the tendon. Pinkerton describes a carter of thirty-one who was bitten on the thumb by a donkey. The man pulled violently in one direction, and the donkey, who had seized the thumb firmly with his teeth, pulled forcibly in the other direction until the tissues gave way and the man ran off, leaving his thumb in the donkey's mouth. The animal at once dropped the thumb, and it was picked up by a companion who accompanied the man to the hospital. On examination the detached portion was found to include the terminal phalanx of the thumb, together with the tendon of the flexor longus pollicis measuring ten inches, about half of which length had a fringe of muscular tissue hanging from the free borders, indicating the extent and the penniform arrangement of the fibers attached to it. Meyer cites a case in which the index finger was torn off and the flexor muscle twisted from its origin. The authors know of an unreported case in which a man running in the street touched his hand to a hitching block he was passing; a ring on one of his fingers caught in the hook of the block, and tore off the finger with the attached tendon and muscle. There is a similar instance of a Scotch gentleman who slipped, and, to prevent falling, he put out his hand to catch the railing. A ring on one of his fingers became entangled in the railing and the force of the fall tore off the soft parts of the finger together with the ring. The older writers mentioned as a curious fact that avulsion of the arm, unaccompanied by hemorrhage, had been noticed. Belchier, Carmichael, and Clough report instances of this nature, and, in the latter case, the progress of healing was unaccompanied by any uncomfortable symptoms. In the last century Hunezoysky observed complete avulsion of the arm by a cannon-ball, without the slightest hemorrhage. The Ephemerides contains an account of the avulsion of the hand without any bleeding, and Woolcomb has observed a huge wound of the arm from which hemorrhage was similarly absent. Later observations have shown that in this accident absence of hemorrhage is the rule and not the exception. The wound is generally lacerated and contused and the mouths of the vessels do not gape, but are twisted and crushed. The skin usually separates at the highest point and the muscles protrude, appearing to be tightly embraced and almost strangulated by the skin, and also by the tendons, vessels, and nerves which, crushed and twisted with the fragments of bone, form a conical stump. Cheselden reports the history of a case, which has since become classic, that he observed in St. Thomas' Hospital in London, in 1837. A miller had carelessly thrown a slip-knot of rope about his wrist, which became caught in a revolving cog, drawing him from the ground and violently throwing his body against a beam. The force exerted by the cog drawing on the rope was sufficient to avulse his whole arm and shoulder-blade. There was comparatively little hemorrhage and the man was insensible to pain; being so dazed and surprised he really was unconscious of the nature of his injury until he saw his arm in the wheel. According to Billroth the avulsion of an arm is usually followed by fatal shock. Fischer, however, relates the case of a lion-tamer whose whole left arm was torn from the shoulder by a lion; the loss of blood being very slight and the patient so little affected by shock that he was able to walk to the hospital. Mussey describes a boy of sixteen who had his left arm and shoulder-blade completely torn from his body by machinery. The patient became so involved in the bands that his body was securely fastened to a drum, while his legs hung dangling. In this position he made about 15 revolutions around the drum before the motion of the machinery could be effectually stopped by cutting off the water to the great wheel. When he was disentangled from the bands and taken down from the drum a huge wound was seen at the shoulder, but there was not more than a pint of blood lost. The collar-bone projected from the wound about half an inch, and hanging from the wound were two large nerves (probably the median and ulnar) more than 20 inches long. He was able to stand on his feet and actually walked a few steps; as his frock was opened, his arm, with a clot of blood, dropped to the floor. This boy made an excellent recovery. The space between the plastered ceiling and the drum in which the revolutions of the body had taken place was scarcely 7 1/2 inches wide. Horsbeck's case was of a negro of thirty-five who, while pounding resin on a 12-inch leather band, had his hand caught between the wheel and band. His hand, forearm, arm, etc., were rapidly drawn in, and he was carried around until his shoulder came to a large beam, where the body was stopped by resistance against the beam, fell to the floor, and the arm and scapula were completely avulsed and carried on beyond the beam. In this case, also, the man experienced little pain, and there was comparatively little hemorrhage. Maclean reports the history of an accident to a man of twenty-three who had both arms caught between a belt and the shaft while working in a woolen factory, and while the machinery was in full operation. He was carried around the shaft with great velocity until his arms were torn off at a point about four inches below the shoulder-joint on each side. The patient landed on his feet, the blood spurting from each brachial artery in a large stream. His fellow-workmen, without delay, wound a piece of rope around each bleeding member, and the man recovered after primary amputation of each stump. Will gives an excellent instance of avulsion of the right arm and scapula in a girl of eighteen, who was caught in flax-spinning machinery. The axillary artery was seen lying in the wound, pulsating feebly, but had been efficiently closed by the torsion of the machinery. The girl recovered. Additional cases of avulsion of the upper extremity are reported by Aubinais, Bleynie, Charles, George, James, Jones, Marcano, Belchier, Braithwaite, and Hendry. Avulsion of the Lower Extremity.--The symptoms following avulsion of the upper extremity are seen as well in similar accidents to the leg and thigh, although the latter are possibly the more fatal. Horlbeck quotes Benomont's description of a small boy who had his leg torn off at the knee by a carriage in motion; the child experienced no pain, and was more concerned about the punishment he expected to receive at home for disobedience than about the loss of his leg. Carter speaks of a boy of twelve who incautiously put the great toe of his left foot against a pinion wheel of a mill in motion. The toe was fastened and drawn into the mill, the leg following almost to the thigh. The whole left leg and thigh, together with the left side of the scrotum, were torn off; the boy died as a result of his injuries. Ashurst reported to the Pathological Society of Philadelphia the case of a child of nine who had its right leg caught in the spokes of a carriage wheel. The child was picked up unconscious, with its thigh entirely severed, and the bone broken off about the middle third; about three inches higher the muscles were torn from the sheaths and appeared as if cut with a knife. The great sciatic nerve was found hanging 15 inches from the stump, having given way from its division in the popliteal space. The child died in twelve hours. One of the most interesting features of the case was the rapid cooling of the body after the accident and prolongation of the coolness with slight variations until death ensued. Ashurst remarks that while the cutaneous surface of the stump was acutely sensitive to the touch, there was no manifestation of pain evinced upon handling the exposed nerve. With reference to injuries to the sciatic nerve, Kuster mentions the case of a strong man of thirty, who in walking slipped and fell on his back. Immediately after rising to his feet he felt severe pain in the right leg and numbness in the foot. He was unable to stand, and was carried to his house, where Kuster found him suffering great pain. The diagnosis had been fracture of the neck of the femur, but as there was no crepitation and passive movements caused but little pain, Kuster suspected rupture of the sciatic nerve. The subsequent history of the case confirmed this diagnosis. The patient was confined to bed six weeks, and it was five months afterward before he was able to go about, and then only with a crutch and a stick. Park mentions an instance of rupture of the sciatic nerve caused by a patient giving a violent lurch during an operation at the hip-joint. The instances occasionally observed of recovery of an injured leg after extensive severance and loss of substance are most marvelous. Morton mentions a boy of sixteen, who was struck by one of the blades of a reaping machine, and had his left leg cut through about 1 1/4 inches above the ankle-joint. The foot was hanging by the portion of skin corresponding to the posterior quarter of the circumference of the leg, together with the posterior tibial vessels and nerves. These were the only structures escaping division, although the ankle-joint itself was intact. There was comparatively little hemorrhage and no shock; a ligature was applied to the vessels, the edges of the wound were drawn together by wire sutures, and the cut surfaces of the tibia were placed in as good apposition as possible, although the lower fragment projected slightly in front of the upper. The wound was dressed and healing progressed favorably; in three months the wound had filled up to such an extent that the man was allowed to go on crutches. The patient was discharged in five months, able to walk very well, but owing to the loss of the function of the extensor tendons the toes dragged. Washington reports in full the case of a boy of eleven, who, in handing a fowling piece across a ditch, was accidentally shot. The contents of the gun were discharged through the leg above the ankle, carrying away five-sixths of the structure--at the time of the explosion the muzzle of the gun was only two feet away from his leg. The portions removed were more than one inch of the tibia and fibula (irregular fractures of the ends above and below), a corresponding portion of the posterior tibial muscle, and the long flexors of the great and small toes, as well as the tissue interposed between them and the Achilles tendon. The anterior tibial artery was fortunately uninjured. The remaining portions consisted of a strip of skin two inches in breadth in front of the wound, the muscles which it covered back of the wound, the Achilles tendon, and another piece of skin, barely enough to cover the tendon. The wound was treated by a bran-dressing, and the limb was saved with a shortening of but 1 1/2 inches. There are several anomalous injuries which deserve mention. Markoe observed a patient of seventy-two, who ruptured both the quadriceps tendons of each patella by slipping on a piece of ice, one tendon first giving way, and followed almost immediately by the other. There was the usual depression immediately above the upper margin of the patella, and the other distinctive signs of the accident. In three months both tendons had united to such an extent that the patient was able to walk slowly. Gibney records a case in which the issue was not so successful, his patient being a man who, in a fall ten years previously, had ruptured the right quadriceps tendon, and four years later had suffered the same accident on the opposite side. As a result of his injuries, at the time Gibney saw him, he had completely lost all power of extending the knee-joint. Partridge mentions an instance, in a strong and healthy man, of rupture of the tendon of the left triceps cubiti, caused by a fall on the pavement. There are numerous cases in which the tendo Achillis has recovered after rupture,--in fact, it is unhesitatingly severed when necessity demands it, sufficient union always being anticipated. None of these cases of rupture of the tendon are unique, parallel instances existing in medical literature in abundance. Marshall had under his observation a case in which the femoral artery was ruptured by a cart wheel passing over the thigh, and death ensued although there were scarcely any external signs of contusion and positively no fracture. Boerhaave cites a curious instance in which a surgeon attempted to stop hemorrhage from a wounded radial artery by the application of a caustic, but the material applied made such inroads as to destroy the median artery and thus brought about a fatal hemorrhage. Spontaneous fractures are occasionally seen, but generally in advanced age, although muscular action may be the cause. There are several cases on record in which the muscular exertion in throwing a stone or ball, or in violently kicking the leg, has fractured one or both of the bones of an extremity. In old persons intracapsular fracture may be caused by such a trivial thing as turning in bed, and even a sudden twist of the ankle has been sufficient to produce this injury. In a boy of thirteen Storrs has reported fracture of the femur within the acetabulum. In addition to the causes enumerated, inflammation of osseous tissue, or osteoid carcinoma, has been found at the seat of a spontaneous fracture. One of the most interesting subjects in the history of surgery is the gradual evolution of the rational treatment of dislocations. Possibly no portion of the whole science was so backward as this. Thirty-five centuries ago Darius, son of Hydaspis, suffered a simple luxation of the foot; it was not diagnosed in this land of Apis and of the deified discoverer of medicine. Among the wise men of Egypt, then in her acme of civilization, there was not one to reduce the simple luxation which any student of the present day would easily diagnose and successfully treat. Throughout the dark ages and down to the present century, the hideous and unnecessary apparatus employed, each decade bringing forth new types, is abundantly pictured in the older books on surgery; in some almost recent works there are pictures of windlasses and of individuals making superhuman efforts to pull the luxated member back--all of which were given to the student as advisable means of treatment. Relative to anomalous dislocations the field is too large to be discussed here, but there are two recent ones worthy of mention. Bradley relates an instance of death following a subluxation of the right humerus backward on the scapula It could not be reduced because the tendon of the biceps lay between the head of the humerus and a piece of the bone which was chipped off. Baxter-Tyrie reports a dislocation of the shoulder-joint, of unusual origin, in a man who was riding a horse that ran away up a steep hill. After going a few hundred yards the animal abated its speed, when the rider raised his hand to strike. Catching sight of the whip, the horse sprang forward, while the man felt an acute pain and a sense of something having given way at his shoulder. He did not fall off, but rode a little further and was helped to dismount. On examination a subcoracoid dislocation of the head of the humerus was found. The explanation is that as the weight of the whip was inconsiderable (four ounces) the inertia of the arm converted it into a lever of the first order. Instead of fulfilling its normal function of preventing displacement, the coraco-acromial arch acted as a fulcrum. The limb from the fingers to that point acted as the "long arm," and the head and part of the neck of the humerus served as the "short arm." The inertia of the arm, left behind as it were, supplied the power, while the ruptured capsular ligament and displacement of the head of the bone would represent the work done. Congenital Dislocations.--The extent and accuracy of the knowledge possessed by Hippocrates on the subject of congenital dislocations have excited the admiration of modern writers, and until a comparatively recent time examples of certain of the luxations described by him had not been recorded. With regard, for instance, to congenital dislocations at the shoulder-joint, little or nothing was known save what was contained in the writings of Hippocrates, till R. M. Smith and Guerin discussed the lesion in their works. Among congenital dislocations, those of the hips are most common--in fact, 90 per cent of all. They are sometimes not recognizable until after the lapse of months and sometimes for years, but their causes--faulty developments of the joint, paralysis, etc.--are supposed to have existed at birth. One or both joints may be involved, and according to the amount of involvement the gait is peculiar. As to the reduction of such a dislocation, the most that can be done is to diminish the deformity and functional disability by traction and palliative measures with apparatus. The normal structure of the joint does not exist, and therefore the dislocation admits of no reduction. Congenital dislocations of the shoulder are also seen, owing to faulty development of the glenoid fossa; and at the knee, the leg generally being in extreme hyperextension, the foot sometimes resting on the abdomen. Congenital luxation of the femora, when it appears in adult women is a prominent factor in dystocia. There is a dislocation found at birth, or occurring shortly after, due to dropsy of the joint in utero; and another form due to succeeding paralysis of groups of muscles about the joint. The interesting instances of major amputations are so numerous and so well known as to need no comment here. Amputation of the hip with recovery is fast becoming an ordinary operation; at Westminster Hospital in London, there is preserved the right humerus and scapula, presenting an enormous bulk, which was removed by amputation at the shoulder-joint, for a large lymphosarcoma growing just above the clavicle. The patient was a man of twenty-two, and made a good recovery. Another similar preparation is to be seen in London at St. Bartholomew's Hospital. Simultaneous, synchronous, or consecutive amputations of all the limbs have been repeatedly performed. Champeuois reports the case of a Sumatra boy of seven, who was injured to such an extent by an explosion as to necessitate the amputation of all his extremities, and, despite his tender age and the extent of his injuries, the boy completely recovered. Jackson, quoted by Ashhurst, had a patient from whom he simultaneously amputated all four limbs for frost-bite. Muller reports a case of amputation of all four limbs for frost-bite, with recovery. The patient, aged twenty-six, while traveling to his home in Northern Minnesota, was overtaken by a severe snow storm, which continued for three days; on December 13th he was obliged to leave the stage in a snow-drift on the prairie, about 110 miles distant from his destination. He wandered over the prairie that day and night, and the following four days, through the storm, freezing his limbs, nose, ears, and cheeks, taking no food or water until, on December 16th, he was found in a dying condition by Indian scouts, and taken to a station-house on the road. He did not reach the hospital at Fort Ridgely until the night of December 24th--eleven days after his first exposure. He was almost completely exhausted, and, after thawing the ice from his clothes, stockings, and boots,--which had not been removed since December 13th,--it was found that both hands and forearms were completely mortified up to the middle third, and both feet and legs as far as the upper third; both knees over and around the patellae, and the alae and tip of the nose all presented a dark bluish appearance and fairly circumscribed swelling. No evacuation of the bowels had taken place for over two weeks, and as the patient suffered from singultus and constant pain over the epigastric region, a light cathartic was given, which, in twenty-four hours, gave relief. The four frozen limbs were enveloped in a solution of zinc chlorid. The frozen ears and cheeks healed in due time, and the gangrenous parts of the nose separated and soon healed, with the loss of the tip and parts of the alae, leaving the septum somewhat exposed. On January 10th the lines of demarcation were distinct and deep on all four limbs, though the patient, seconded by his wife, at first obstinately opposed operative interference; on January 13th, after a little hesitancy, the man consented to an amputation of the arms. This was successfully carried out on both forearms, at the middle third, the patient losing hardly any blood and complaining of little pain. The great relief afforded by this operation so changed his aversion to being operated upon that on the next day he begged to have both legs amputated in the same manner, which was done, three days afterward, with the same favorable result. After some minor complications the patient left for his home, perfectly recovered, June 9, 1866. Begg of Dundee successfully performed quadruple amputation on a woman, the victim of idiopathic gangrene. With artificial limbs she was able to earn a livelihood by selling fancy articles which she made herself. This woman died in 1885, and the four limbs, mounted on a lay figure, were placed in the Royal College of Surgeons, in London. Wallace, of Rock Rapids, Iowa, has successfully removed both forearms, one leg, and half of the remaining foot, for frost-bite. Allen describes the case of a boy of eight who was run over by a locomotive, crushing his right leg, left foot, and left forearm to such an extent as to necessitate primary triple amputation at the left elbow, left foot, and right leg, the boy recovering. Ashhurst remarks that Luckie, Alexander, Koehler, Lowman, and Armstrong have successfully removed both legs and one arm simultaneously for frost-bite, all the patients making excellent recoveries in spite of their mutilations; he adds that he himself has successfully resorted to synchronous amputation of the right hip-joint and left leg for a railroad injury occurring in a lad of fifteen, and has twice synchronously amputated three limbs from the same patient, one case recovering. Wharton reports a case of triple major amputation on a negro of twenty-one, who was run over by a train. His right leg was crushed at the knee, and the left leg crushed and torn off in the middle third; the right forearm and hand were crushed. In order to avoid chill and exposure, he was operated on in his old clothes, and while one limb was being amputated the other was being prepared. The most injured member was removed first. Recovery was uninterrupted. There are two cases of spontaneous amputation worthy of record. Boerhaave mentions a peasant near Leyden, whose axillary artery was divided with a knife, causing great effusion of blood, and the patient fainted. The mouth of the vessel was retracted so far as to render ligature impossible, and the poor man was abandoned to what was considered an inevitable fate by his unenlightened attendants. Expecting to die every moment, he continued several days in a languid state, but the hemorrhage ceased spontaneously, and the arm decayed, shrunk, and dried into a mummified stump, which he carried about for quite a while. Rooker speaks of a fracture of the forearm, near the lower part of the middle third, in a patient aged fourteen. Incipient gangrene below the seat of fracture, with associate inflammation, developed; but on account of the increasing gangrene it was determined to amputate. On the fifth day the line of demarcation extended to the spine of the scapula, laying bare the bone and exposing the acromion process and involving the pectoral muscles. It was again decided to let Nature continue her work. The bones exfoliated, the spine and the acromial end of the scapula came away, and a good stump was formed. Figure 212 represents the patient at the age of twenty-eight. By ingenious mechanical contrivances persons who have lost an extremity are enabled to perform the ordinary functions of the missing member with but slight deterioration. Artificial arms, hands, and legs have been developed to such a degree of perfection that the modern mechanisms of this nature are very unlike the cumbersome and intricate contrivances formerly used. Le Progres Medical contains an interesting account of a curious contest held between dismembered athletes at Nogent-Sur-Marne, a small town in the Department of the Seine, in France. Responding to a general invitation, no less than seven individuals who had lost either leg or thigh, competed in running races for prizes. The enterprising cripples were divided into two classes: the cuissards, or those who had lost a thigh, and jambards, or those who had lost a leg; and, contrary to what might have been expected, the grand champion came from the former class. The distance in each race was 200 meters. M. Roullin, whose thigh, in consequence of an accident, was amputated in 1887, succeeded in traversing the course in the remarkable time of thirty seconds (about 219 yards); whereas M. Florrant, the speediest jambard, required thirty-six seconds to run the same distance; and was, moreover, defeated by two other cuissards besides the champion. The junior race was won in thirty-five seconds, and this curious day's sport was ended by a course de consolation, which was carried off in thirty-three seconds by M. Mausire, but whether he was a cuissard or a jambard was not stated. On several occasions in England, cricket matches have been organized between armless and legless men. In Charles Dickens' paper, "All the Year Round," October 5, 1861, there is a reference to a cricket match between a one-armed eleven and a one-legged eleven. There is a recent report from De Kalb, Illinois, of a boy of thirteen who had lost both legs and one arm, but who was nevertheless enabled to ride a bicycle specially constructed for him by a neighboring manufacturer. With one hand he guided the handle bar, and bars of steel attached to his stumps served as legs. He experienced no trouble in balancing the wheel; it is said that he has learned to dismount, and soon expects to be able to mount alone; although riding only three weeks, he has been able to traverse one-half a mile in two minutes and ten seconds. While the foregoing instance is an exception, it is not extraordinary in the present day to see persons with artificial limbs riding bicycles, and even in Philadelphia, May 30, 1896, there was a special bicycle race for one-legged contestants. The instances of interesting cases of foreign bodies in the extremities are not numerous. In some cases the foreign body is tolerated many years in this location. There are to-day many veterans who have bullets in their extremities. Girdwood speaks of the removal of a foreign body after twenty-five years' presence in the forearm. Pike mentions a man in India, who, at the age of twenty-two, after killing a wounded hare in the usual manner by striking it on the back of the neck with the side of the hand, noticed a slight cut on the hand which soon healed but left a lump under the skin. It gave him no trouble until two months before the time of report, when he asked to have the lump removed, thinking it was a stone. It was cut down upon and removed, and proved to be the spinous process of the vertebra of a hare. The bone was living and healthy and had formed a sort of arthrodial joint on the base of the phalanx of the little finger and had remained in this position for nearly twenty-two years. White has described a case in which a nail broken off in the foot, separated into 26 splinters, which, after intense suffering, were successfully removed. There was a case recently reported of a man admitted to the Bellevue Hospital, New York, whose arm was supposed to have been fractured by an explosion, but instead of which 11 feet of lead wire were found in it by the surgeons. The man was a machinist in the employ of the East River Lead Co., and had charge of a machine which converted molten lead into wire. This machine consists of a steel box into which the lead is forced, being pressed through an aperture 1/8 inch in diameter by hydraulic pressure of 600 tons. Reaching the air, the lead becomes hard and is wound on a large wheel in the form of wire. Just before the accident this small aperture had become clogged, and the patient seized the projecting wire in his hand, intending to free the action of the machine, as he had previously done on many occasions, by a sharp, strong pull; but in so doing an explosion occurred, and he was hurled to the floor unconscious. While on the way to the hospital in the ambulance, he became conscious and complained of but little pain except soreness of the left arm about the elbow. The swelling, which had developed very rapidly, made it impossible for the surgeons to make an examination, but on the following day, when the inflammation had subsided sufficiently, a diagnosis of fracture of the bones of the arm was made. There was no external injury of the skin of any magnitude, and the surgeons decided to cut down on the trifling contusion, and remove what appeared to be a fragment of bone, lodged slightly above the wrist. An anesthetic was administered, and an incision made, but to the amazement of the operators, instead of bone, a piece of wire one inch in length and 1/8 inch in diameter was removed. On further exploration piece after piece of the wire was taken out until finally the total length thus removed aggregated 11 feet, the longest piece measuring two feet and the shortest 1/4 inch. The wire was found imbedded under the muscles of the arm, and some of it had become wedged between the bones of the forearm. Probably the most remarkable feature of this curious accident was the fact that there was no fracture or injury to the bone, and it was thought possible that the function of the arm would be but little impaired. Tousey reports a case of foreign body in the axilla that was taken for a necrotic fragment of the clavicle. The patient was a boy of sixteen, who climbed up a lamp-post to get a light for his bicycle lamp; his feet slipped off the ornamental ledge which passed horizontally around the post about four feet from the ground, and he fell. In the fall a lead pencil in his waistcoat pocket caught on the ledge and was driven into the axilla, breaking off out of sight. This was supposed to be a piece of the clavicle, and was only discovered to be a pencil when it was removed six weeks after. There are several diseases of the bone having direct bearing on the anomalies of the extremities which should have mention here. Osteomalacia is a disease of the bones in adult life, occurring most frequently in puerperal women, but also seen in women not in the puerperal state, and in men. It is characterized by a progressive softening of the bone-substance, from a gradual absorption of the lime salts, and gives rise to considerable deformity, and occasionally to spontaneous fracture. Rachitis or rickets is not a disease of adult life, but of infancy and childhood, and never occurs after the age of puberty. It seldom begins before six months or after three years. There are several theories as to its causation, one being that it is due to an abnormal development of acids. There is little doubt that defective nutrition and bad hygienic surroundings are prominent factors in its production. The principal pathologic change is seen in the epiphyseal lines of long bones and beneath the periosteum. Figure 213 shows the appearance during life of a patient with the highest grade of rachitis, and it can be easily understood what a barrier to natural child-birth it would produce. In rachitis epiphyseal swellings are seen at the wrists and ankle-joints, and in superior cases at the ends of the phalanges of the fingers and toes. When the shaft of a long bone is affected, not only deformity, but even fracture may occur. Under these circumstances the humerus and femur appear to be the bones most likely to break; there is an associate deformity of the head, known as "craniotabes," together with pigeon-breast and various spinal curvature. The accompanying illustration is from a drawing of a skeleton in the Warren Museum in Boston. The subject was an Indian, twenty-one years of age, one of the Six Nations. His mode of locomotion was by a large wooden bowl, in which he sat and moved forward by advancing first one side of the bowl and then the other, by means of his hands. The nodules or "adventitious joints" were the result of imperfect ossification, or, in other words, of motion before ossification was completed. Analogous to rachitis is achondroplasia, or the so called fetal rickets--a disease in which deformity results from an arrest, absence, or perversion of the normal process of enchondral ossification. It is decidedly an intrauterine affection, and the great majority of fetuses die in utero. Thomson reports three living cases of achondroplasia. The first was a child five months of age, of pale complexion, bright and intelligent, its head measuring 23 inches in length. There was a narrow thorax showing the distinct beads of rickets; the upper and lower limbs were very short, but improved under antirachitic treatment. The child died of pneumonia. The other two cases were in adults, one thirty-nine and the other thirty-six. The men were the same height, 49 inches, and resembled each other in all particulars. They both enjoyed good health, and, though somewhat dwarfed, were of considerable intelligence. Neither had married. Both the upper and; lower limbs showed exaggerations of the normal curves; the hands and feet were broad and short; the gait of both of these little men was waddling, the hunk swaying when they attempted to make any rapid progress. Osteitis deformans is a hyperplasia of bone described by Paget in 1856. Paget's patient was a gentleman of forty-six who had always enjoyed good health; without assignable cause he began to be subject to aching pains in the thighs and legs. The bones of the left leg began to increase in size, and a year or two later the left femur; also enlarged considerably. During a period of twenty years these changes were followed by a growth of other bones. The spine became firm and; rigid, the head increased 5 1/4 inches in circumference. The bones of the face were not affected. When standing, the patient had a peculiar bowed condition of the legs, with marked flexure at the knees. He finally died of osteosarcoma, originating in the left radius, Paget collected eight cases, five of whom died of malignant disease. The postmortem of Paget's case showed extreme thickening in the bones affected, the femur and cranium particularly showing osteoclerosis. Several cases have been recorded in this country; according to Warren, Thieberge analyzed 43 cases; 21 were men, 22 women; the disease appeared usually after forty. Acromegaly is distinguished from osteitis deformans in that it is limited to hypertrophy of the hands, feet, and face, and it usually begins earlier. In gigantism the so-called "giant growth of bones" is often congenital in character, and is unaccompanied by inflammatory symptoms. The deformities of the articulations may be congenital but in most cases are acquired. When these are of extreme degree, locomotion is effected in most curious ways. Ankylosis at unnatural angles and even complete reversion of the joints has been noticed. Pare gives a case of reversion, and of crooked hands and feet; and Barlow speaks of a child of two and three-quarter years with kyphosis, but mobility of the lumbar region, which walked on its elbows and knees. The pathology of this deformity is obscure, but there might have been malposition in utero. Wilson presented a similar case before the Clinical Society of London, in 1888. The "Camel-boy," exhibited some years ago throughout the United States, had reversion of the joints, which resembled those of quadrupeds. He walked on all fours, the mode of progression resembling that of a camel. Figure 216 represents Orloff, "the transparent man," an exhibitionist, showing curious deformity of the long bones and atrophy of the extremities. He derived his name from the remarkable transparency of his deformed members to electric light, due to porosity of the bones and deficiency of the overlying tissues. Figure 217, taken from Hutchinson's "Archives of Surgery," represents an extreme case of deformity of the knee-joints in a boy of seven, the result of severe osteoarthritis. The knees and elbows were completely ankylosed. Infantile spinal paralysis is often the cause of distressing deformities, forbidding locomotion in the ordinary manner. In a paper on the surgical and mechanical treatment of such deformities Willard mentions a boy of fourteen, the victim of infantile paralysis, who at the age of eleven had never walked, but dragged his legs along. His legs were greatly twisted, and there was flexion at right angles at the hips and knees. There was equinovarus in the left foot and equinovalgus in the right. By an operation of subcutaneous section at the hips, knees, and feet, with application of plaster-of-Paris and extension, this hopeless cripple walked with crutches in two months, and with an apparatus consisting of elastic straps over the quadriceps femoris, peroneals, and weakened muscles, the valgus-foot being supported beneath the sole. In six months he was walking long distances; in one year he moved speedily on crutches. Willard also mentions another case of a girl of eleven who was totally unable to support the body in the erect position, but could move on all fours, as shown in figure 219. There was equinovarus in the right foot and valgus in the left. The left hip was greatly distorted, not only in the direction of flexion, but there was also twisting of the femoral neck, simulating dislocation. This patient was also operated on in the same manner as the preceding one. Relative to anomalous increase or hypertrophy of the bones of the extremities, Fischer shows that an increase in the length of bone may follow slight injuries. He mentions a boy of twelve, who was run over by a wagon and suffered a contusion of the bones of the right leg. In the course of a year this leg became 4 1/2 cm. longer than the other, and the bones were also much thicker than in the other. Fischer also reports several cases of abnormal growth of bone following necrosis. A case of shortening 3 3/4 cm., after a fracture, was reduced to one cm. by compensatory growth. Elongation of the bone is also mentioned as the result of the inflammation of the joint. Warren also quotes Taylor's case of a lady who fell, injuring, but not fracturing, the thigh. Gradual enlargement, with an outward curving of the bone, afterward took place. CHAPTER XII. SURGICAL ANOMALIES OF THE THORAX AND ABDOMEN. Injuries of the lung or bronchus are always serious, but contrary to the general idea, recovery after extensive wound of the lung is quite a common occurrence. Even the older writers report many instances of remarkable recoveries from lung-injuries, despite the primitive and dirty methods of treatment. A review of the literature previous to this century shows the names of Arcaeus, Brunner, Collomb, Fabricius Hildanus, Vogel, Rhodius, Petit, Guerin, Koler, Peters, Flebbe, and Stalpart, as authorities for instances of this nature. In one of the journals there is a description of a man who was wounded by a broad-sword thrust in the mediastinum. After death it was found that none of the viscera were wounded, and death was attributed to the fact that the in-rush of air counterbalancing the pressure within the lungs left them to their own contractile force, with resultant collapse, obstruction to the circulation, and death. It is said that Vesalius demonstrated this condition on the thorax of a pig. Gooch gives an instance of a boy of thirteen who fell from the top of a barn upon the sharp prow of a plough, inflicting an oblique wound from the axilla to below the sternum, slightly above the insertion of the diaphragm. Several ribs were severed, and the left thoracic cavity was wholly exposed to view, showing the lungs, diaphragm, and pericardium all in motion. The lungs soon became gangrenous, and in this horrible state the patient lived twelve days. One of the curious facts noticed by the ancient writers was the amelioration of the symptoms caused by thoracic wounds after hemorrhage from other locations; and naturally, in the treatment of such injuries, this circumstance was used in advocacy of depletion. Monro speaks of a gentleman who was wounded in a duel, and who had all the symptoms of hemothorax; his condition was immediately relieved by the evacuation of a considerable quantity of bloody matter with the urine. Swammerdam records a similar case, and Fabricius ab Aquapendente noticed a case in which the opening in the thorax showed immediate signs of improvement after the patient voided large quantities of bloody urine. Glandorp also calls attention to the foregoing facts. Nicolaus Novocomensis narrates the details of the case of one of his friends, suffering from a penetrating wound of the thorax, who was relieved and ultimately cured by a bloody evacuation with the stool. There is an extraordinary recovery reported in a boy of fifteen who, by falling into the machinery of an elevator, was severely injured about the chest. There were six extensive lacerations, five through the skin about six inches long, and one through the chest about eight inches long. The 3d, 4th, 5th, and 6th ribs were fractured and torn apart, and about an inch of the substance of the 4th rib was lost. Several jagged fragments were removed; a portion of the pleura, two by four inches, had been torn away, exposing the pericardium and the left lung, and showing the former to have been penetrated and the latter torn. The lung collapsed completely, and for three or four months no air seemed to enter it, but respiration gradually returned. The lacerated integument could only be closed approximately by sutures. It is worthy of remark that, although extremely pale, the patient complained of but little pain, and exhibited only slight symptoms of shock. The pleural cavity subsequently filled with a dirty serum, but even this did not interfere with the healing of the wound and the restoration of the lung; the patient recovered without lateral curvature. Bartholf reports a case of rapid recovery after perforating wound of the lung. The pistol-ball entered the back 1 1/2 inches to the right of the spinous process of the 6th dorsal vertebra, and passed upward and very slightly inward toward the median line. Its track could be followed only 1 1/4 inches. Emphysema appeared fifteen minutes after the reception of the wound, and soon became pronounced throughout the front and side of the neck, a little over the edge of the lower jaw, and on the chest two inches below the sternum and one inch below the clavicle. In four hours respiration became very frequent, short, and gasping, the thoracic walls and the abdomen scarcely moving. The man continued to improve rapidly, the emphysema disappeared on the seventh day, and eighteen days after the reception of the wound he was discharged. There was slight hemorrhage from the wound at the time, but the clot dried and closed the wound, and remained there until it was removed on the morning of his discharge, leaving a small, dry, white cicatrix. Loss of Lung-tissue.--The old Amsterdam authority, Tulpius, has recorded a case in which a piece of lung of about three fingers' breadth protruded through a large wound of the lung under the left nipple. This wound received no medical attention for forty-eight hours, when the protruding portion of lung was thought to be dead, and was ligated and cut off; it weighed about three ounces. In about two weeks the wound healed with the lung adherent to it and this condition was found six years later at the necropsy of this individual. Tulpius quoted Celaus and Hippocrates as authorities for the surgical treatment of this case. In 1787 Bell gave an account of a case in which a large portion of the lung protruded and was strangulated by the edges of the thoracic wound, yet the patient made a good recovery. Fabricius Hildanus and Ruysch record instances of recovery in which large pieces of lung have been cut off; and it is said that with General Wolfe at Quebec there was another officer who was shot through the thorax and who recovered after the removal of a portion of the lung. In a letter to one of his medical friends Roscius says that he succeeded in cutting off part of a protruding, livid, and gangrenous lung, after a penetrating wound of the chest, with a successful result. Hale reports a case of a penetrating stab-wound in which a piece of lung was removed from a man of twenty-five. Tait claims that surgical treatment, as exemplified by Biondi's experiment in removing portions of lung from animals, such as dogs, sheep, cats, etc., is not practical; he adds that his deductions are misleading, as the operation was done on healthy tissue and in deep and narrow-chested animals. Excision of diseased portions of the lung has been practised by Kronlein (three cases), Ruggi of Bologna (two cases), Block, Milton, Weinlechner; one of Kronlein's patients recovered and Milton's survived four months, but the others promptly succumbed after the operation. Tuffier is quoted as showing a patient, aged twenty-nine, upon whom, for beginning tuberculosis, he had performed pneumonectomy four years before. At the operation he had removed the diseased area at the apex of the right lung, together with sound tissue for two cm. in every direction. Tuffier stated that the result of his operation had been perfectly successful and the patient had shown no suspicious symptoms since. Rupture of the Lung Without Fracture.--It is quite possible for the lung to be ruptured by external violence without fracture of the ribs; there are several such cases on record. The mechanism of this rare and fatal form of injury has been very aptly described by Gosselin as due to a sudden pressure exerted on the thoracic wall at the moment of full inspiration, there being a spasm of the glottis or obstruction of the larynx, in consequence of which the lung bursts. An extravasation of air occurs, resulting in the development of emphysema, pneumothorax, etc. Subsequently pleurisy, pneumonia, or even pus in the pleural cavity often result. Hemoptysis is a possible, but not a marked symptom. The mechanism is identical with that of the bursting of an inflated paper bag when struck by the hand. Other observers discard this theory of M. Gosselin and claim that the rupture is due to direct pressure, as in the cases in which the heart is ruptured without fracture of the ribs. The theory of Gosselin would not explain these cardiac ruptures from external violence on the thoracic walls, and, therefore, was rejected by some. Pare, Morgagni, Portal, Hewson Smith, Dupuytren, Laennec, and others mention this injury. Gosselin reports two cases terminating in recovery. Ashurst reports having seen three cases, all of which terminated fatally before the fifth day; he has collected the histories of 39 cases, of which 12 recovered. Otis has collected reports of 25 cases of this form of injury from military practice exclusively. These were generally caused by a blow on the chest, by a piece of shell, or other like missile. Among the 25 cases there were 11 recoveries. As Ashhurst very justly remarks, this injury appears more fatal in civil than in military life. Pyle reports a case successfully treated, as follows:-- "Lewis W., ten years old, white, born in Maryland, and living now in the District of Columbia, was brought in by the Emergency Hospital ambulance, on the afternoon of November 10th, with a history of having been run over by a hose-cart of the District Fire Department. The boy was in a state of extreme shock, having a weak, almost imperceptible pulse; his respirations were shallow and rapid, and his temperature subnormal. There were no signs of external injury about his thoracic cavity and no fracture of the ribs could be detected, although carefully searched for; there was marked emphysema; the neck and side of the face were enormously swollen with the extravasated air; the tissues of the left arm were greatly infiltrated with air, which enabled us to elicit the familiar crepitus of such infiltration when an attempt at the determination of the radial pulse was made. Consciousness was never lost. There were several injuries to the face and scalp; and there was hemorrhage from the nose and mouth, which was attributed to the fact that the patient had fallen on his face, striking both nose and lip. This was confirmed subsequently by the absence of any evidences of hemoptysis during the whole period of convalescence. The saliva was not even blood-streaked; therefore, it can be said with verity that there was no hemoptysis. Shortly after admission the patient reacted to the stimulating treatment, his pulse became stronger, and all evidences of threatened collapse disappeared. He rested well the first night and complained of no pain, then or subsequently. The improvement was continuous. The temperature remained normal until the evening of the fifth day, when it rose to 102.2 degrees, end again, on the evening of the sixth, to 102.3 degrees. This rise was apparently without significance as the patient at no time seemed disturbed by it. On the eighth day the temperature again reached the normal and has since remained there. The boy is apparently well now, suffers no inconvenience, and has left the hospital, safe from danger and apparently free from any pulmonary embarrassment. He uses well-developed diaphragmatic breathing which is fully sufficient." Pollock reports the case of a boy of seven, whose lung was ruptured by a four-wheeled cab which ran over him. He was discharged well in thirty-two days. Bouilly speaks of recovery in a boy of seventeen, after a rupture of the lung without fracture. There are several other interesting cases of recovery on record. There are instances of spontaneous rupture of the lung, from severe cough. Hicks speaks of a child of ten months suffering with a severe cough resembling pertussis, whose lung ruptured about two weeks after the beginning of the cough, causing death on the second day. Ferrari relates a curious case of rupture of the lung from deep inspiration. Complete penetration or transfixion of the thoracic cavity is not necessarily fatal, and some marvelous instances of recovery after injuries of this nature, are recorded. Eve remarks that General Shields was shot through the body by a discharge of a cannon at Cerro Gordo, and was given up as certain to die. The General himself thought it was grape-shot that traversed his chest. He showed no signs of hemoptysis, and although in great pain, was able to give commands after reception of the wound. In this case, the ball had evidently entered within the right nipple, had passed between the lungs, through the mediastinum, emerging slightly to the right of the spine. Guthrie has mentioned a parallel instance of a ball traversing the thoracic cavity, the patient completely recovering after treatment. Girard, Weeds, Meacham, Bacon, Fryer and others report cases of perforating gunshot wounds of the chest with recovery. Sewell describes a case of transfixion of the chest in a youth of eighteen. After mowing and while carrying his scythe home, the patient accidentally fell on the blade; the point passed under the right axilla, between the 3d and 4th right ribs, horizontally through the chest, and came out through corresponding ribs of the opposite side, making a small opening. He fell to the ground and lay still until his brother came to his assistance; the latter with great forethought and caution carefully calculated the curvature of the scythe blade, and thus regulating his direction of tension, successfully withdrew the instrument. There was but little hemoptysis and the patient soon recovered. Chelius records an instance of penetration of the chest by a carriage shaft, with subsequent recovery. Hoyland mentions a man of twenty-five who was discharging bar-iron from the hold of a ship; in a stooping position, preparatory to hoisting a bundle on deck, he was struck by one of the bars which pinned him to the floor of the hold, penetrating the thorax, and going into the wood of the flooring to the extent of three inches, requiring the combined efforts of three men to extract it. The bar had entered posteriorly between the 9th and 10th ribs of the left side, and had traversed the thorax in an upward and outward direction, coming out anteriorly between the 5th and 6th ribs, about an inch below and slightly external to the nipple. There was little constitutional disturbance, and the man was soon discharged cured. Brown records a case of impalement in a boy of fourteen. While running to a fire, he struck the point of the shaft of a carriage, which passed through his left chest, below the nipple. There was, strangely, no hemorrhage, and no symptoms of so severe an injury; the boy recovered. There is deposited in the Museum of the Royal College of Surgeons in London, a mast-pivot, 15 inches in length and weighing between seven and eight pounds, which had passed obliquely through the body of a sailor. The specimen is accompanied by a colored picture of the sufferer himself in two positions. The name of the sailor was Taylor, and the accident occurred aboard a brig lying in the London docks. One of Taylor's mates was guiding the pivot of the try-sail into the main boom, when a tackle gave way. The pivot instantly left the man's hand, shot through the air point downward striking Taylor above the heart, passing out lower down posteriorly, and then imbedded itself in the deck. The unfortunate subject was carried at once to the London Hospital, and notwithstanding his transfixion by so formidable an instrument, in five months Taylor had recovered sufficiently to walk, and ultimately returned to his duties as a seaman. In the same museum, near to this spike, is the portion of a shaft of the carriage which passed through the body of a gentleman who happened to be standing near the vehicle when the horse plunged violently forward, with the result that the off shaft penetrated his body under the left arm, and came out from under the right arm, pinning the unfortunate man to the stable door. Immediately after the accident the patient walked upstairs and got in bed; his recovery progressed uninterruptedly, and his wounds were practically healed at the end of nine weeks; he is reported to have lived eleven years after this terrible accident. In the Indian Medical Gazette there is an account of a private of thirty-five, who was thrown forward and off his horse while endeavoring to mount. He fell on a lance which penetrated his chest and came out through the scapula. The horse ran for about 100 yards, the man hanging on and trying to stop him. After the extraction of the lance the patient recovered. Longmore gives an instance of complete transfixion by a lance of the right side of the chest and lung, the patient recovering. Ruddock mentions cases of penetrating wounds of both lungs with recovery. There is a most remarkable instance of recovery after major thoracic wounds recorded by Brokaw. In a brawl, a shipping clerk received a thoracic wound extending from the 3d rib to within an inch of the navel, 13 1/2 inches long, completely severing all the muscular and cartilaginous structures, including the cartilages of the ribs from the 4th to the 9th, and wounding the pleura and lung. In addition there was an abdominal wound 6 1/2 inches long, extending from the navel to about two inches above Poupart's ligament, causing almost complete intestinal evisceration. The lung was partially collapsed. The cartilages were ligated with heavy silk, and the hemorrhage checked by ligature and by packing gauze in the inter-chondral spaces. The patient speedily recovered, and was discharged in a little over a month, the only disastrous result of his extraordinary injuries being a small ventral hernia. In wounds of the diaphragm, particularly those from stabs and gunshot injuries, death is generally due to accompanying lesions rather than to injury. Hollerius, and Alexander Benedictus, made a favorable diagnosis of wounds made in the fleshy portions of the diaphragm, but despaired of those in the tendinous portions. Bertrand, Fabricius Hildanus, la Motte, Ravaton, Valentini, and Glandorp, record instances of recovery from wounds of the diaphragm. There are some peculiar causes of diaphragmatic injuries on record, laughter, prolonged vomiting, excessive eating, etc., being mentioned. On the other hand, in his "Essay on Laughter (du Ris)," Joubert quotes a case in which involuntary laughter was caused by a wound of the diaphragm; the laughter mentioned in this instance was probably caused by convulsive movements of the diaphragm, due to some unknown irritation of the phrenic nerve. Bremuse gives an account of a man who literally split his diaphragm in two by the ingestion of four plates of potato soup, numerous cups of tea and milk, followed by a large dose of sodium bicarbonate to aid digestion. After this meal his stomach swelled to an enormous extent and tore the diaphragm on the right side, causing immediate death. The diaphragm may be ruptured by external violence (a fall on the chest or abdomen), or by violent squeezing (railroad accidents, etc.), or according to Ashhurst, by spasmodic contraction of the part itself. If the injury is unaccompanied by lesion of the abdominal or thoracic viscera, the prognosis is not so unfavorable as might be supposed. Unless the laceration is extremely small, protrusion of the stomach or some other viscera into the thoracic cavity will almost invariably result, constituting the condition known as internal or diaphragmatic hernia. Pare relates the case of a Captain who was shot through the fleshy portion of the diaphragm, and though the wound was apparently healed, the patient complained of a colicky pain. Eight months afterward the patient died in a violent paroxysm of this pain. At the postmortem by Guillemeau, a man of great eminence and a pupil of Pare, a part of the colon was found in the thorax, having passed through a wound in the diaphragm. Gooch saw a similar case, but no history of the injury could be obtained. Bausch mentions a case in which the omentum, stomach, and pancreas were found in the thoracic cavity, having protruded through an extensive opening in the diaphragm. Muys, Bonnet, Blancard, Schenck, Sennert, Fantoni, and Godefroy record instances in which, after rupture of the diaphragm, the viscera have been found in the thorax; there are many modern cases on record. Internal hernia through the diaphragm is mentioned by Cooper, Bowles, Fothergill, Monro, Ballonius, Derrecagiax, and Schmidt. Sir Astley Cooper mentioned a case of hernia ventriculi from external violence, wherein the diaphragm was lacerated without any fracture of the ribs. The man was aged twenty-seven, and being an outside passenger on a coach (and also intoxicated), when it broke down he was projected some distance, striking the ground with considerable force. He died on the next day, and the diagnosis was verified at the necropsy, the opening in the diaphragm causing stricture of the bowel. Postempski successfully treated a wound of the diaphragm complicated with a wound of the omentum, which protruded between the external opening between the 10th and 11th ribs; he enlarged the wound, forced the ribs apart, ligated and cut off part of the omentum, returned its stump to the abdomen, and finally closed both the wound in the diaphragm and the external wound with sutures. Quoted by Ashhurst, Hunter recorded a case of gunshot wound, in which, after penetrating the stomach, bowels, and diaphragm the ball lodged in the thoracic cavity, causing no difficulty in breathing until shortly before death, and even then the dyspnea was mechanical--from gaseous distention of the intestines. Peritonitis in the thoracic cavity is a curious condition which may be brought about by a penetrating wound of the diaphragm. In 1872 Sargent communicated to the Boston Society for Medical Improvement an account of a postmortem examination of a woman of thirty-seven, in whom he had observed major injuries twenty years before. At that time, while sliding down some hay from a loft, she was impaled on the handle of a pitchfork which entered the vagina, penetrated 22 inches, and was arrested by an upper left rib, which it fractured; further penetration was possibly prevented by the woman's feet striking the floor. Happily there was no injury to the bladder, uterus, or intestines. The principal symptoms were hemorrhage from the vagina and intense pain near the fractured rib, followed by emphysema. The pitchfork-handle was withdrawn, and was afterward placed in the museum of the Society, the abrupt bloody stain, 22 inches from the rounded end, being plainly shown. During twenty years the woman could never lie on her right side or on her back, and for half of this time she spent most of the night in the sitting position. Her last illness attracted little attention because her life had been one of suffering. After death it was found that the cavity in the left side of the chest was entirely filled with abdominal viscera. The opening in the diaphragm was four inches in diameter, and through it had passed the stomach, transverse colon, a few inches of the descending colon, and a considerable portion of the small intestines. The heart was crowded to the right of the sternum and was perfectly healthy, as was also the right lung. The left lung was compressed to the size of a hand. There were marked signs of peritonitis, and in the absence of sufficient other symptoms, it could be said that this woman had died of peritonitis in the left thoracic cavity. Extended tolerance of foreign bodies loose in the thoracic cavity has been noticed. Tulpins mentions a person who had a sponge shut up in his thoracic cavity for six weeks; it was then voided by the mouth, and the man recovered. Fabricius Hildanus relates a similar instance in which a sponge-tent was expelled by coughing. Arnot reports a case in which a piece of iron was found in a cyst in the thorax, where it had remained for fourteen years. Leach gives a case in which a bullet was impacted in the chest for forty-two years. Snyder speaks of a fragment of knife-blade which was lodged in the chest twelve years and finally coughed up. Foreign Bodies in the Bronchi.--Walnut kernels, coins, seeds, beans, corks, and even sponges have been removed from the bronchi. In the presence of Sir Morrell Mackenzie, Johnston of Baltimore removed a toy locomotive from the subglottic cavity by tracheotomy and thyreotomy. The child had gone to sleep with the toy in his mouth and had subsequently swallowed it. Eldredge presented a hopeless consumptive, who as a child of five had swallowed an umbrella ferrule while whistling through it, and who expelled it in a fit of coughing twenty-three years after. Eve of Nashville mentions a boy who placed a fourpenny nail in a spool to make a whistle, and, by a violent inspiration, drew the nail deep into the left bronchus. It was removed by tracheotomy. Liston removed a large piece of bone from the right bronchus of a woman, and Houston tells of a case in which a molar tooth was lodged in a bronchus causing death on the eleventh day. Warren mentions spontaneous expulsion of a horse-shoe nail from the bronchus of a boy of two and one-half years. From Dublin, in 1844, Houston reports the case of a girl of sixteen who inhaled the wooden peg of a small fiddle and in a fit of coughing three months afterward expelled it from the lungs. In 1849 Solly communicated the case of a man who inhaled a pebble placed on his tongue to relieve thirst. On removal this pebble weighed 144 grains. Watson of Murfreesboro removed a portion of an umbrella rib from a trachea, but as he failed to locate or remove the ferrule, the case terminated fatally. Brigham mentions a child of five who was seized with a fit of coughing while she had a small brass nail in her mouth; pulmonary phthisis ensued, and in one year she died. At the postmortem examination the nail was found near the bifurcation of the right bronchus, and, although colored black, was not corroded. Marcacci reported an observation of the removal of a bean from the bronchus of a child of three and a half years. The child swallowed the bean while playing, immediately cried, and became hoarse. No one having noticed the accident, a diagnosis of croup was made and four leeches were applied to the neck. The dyspnea augmented during the night, and there was a whistling sound with each respiratory movement. On the next day the medical attendants suggested the possibility of a foreign body in the larynx. Tracheotomy was performed but the dyspnea continued, showing that the foreign body was lodged below the incision. The blood of one of the cut vessels entered the trachea and caused an extra paroxysm of dyspnea, but the clots of blood were removed by curved forceps. Marcacci fils practised suction, and placed the child on its head, but in vain. A feather was then introduced in the wound with the hope that it would clean the trachea and provoke respiration; when the feather was withdrawn the bean followed. The child was much asphyxiated, however, and five or six minutes elapsed before the first deep inspiration. The wound was closed, the child recovered its voice, and was well four days afterward. Annandale saw a little patient who had swallowed a bead of glass, which had lodged in the bronchus. He introduced the handle of a scalpel into the trachea, producing sufficient irritation to provoke a brusque expiration, and at the second attempt the foreign body was expelled. Hulke records the case of a woman, the victim of a peculiar accident happening during the performance of tracheotomy, for an affection of the larynx. The internal canule of the tracheotomy-tube fell into the right bronchus, but was removed by an ingenious instrument extemporaneously devised from silver wire. A few years ago in this country there was much public excitement and newspaper discussion over the daily reports which came from the bedside of a gentleman who had swallowed a cork, and which had become lodged in a bronchus. Tracheotomy was performed and a special corkscrew devised to extract it, but unfortunately the patient died of slow asphyxiation and exhaustion. Herrick mentions the case of a boy of fourteen months who swallowed a shawl-pin two inches long, which remained in the lungs four years, during which time there was a constant dry and spasmodic cough, and corresponding depression and emaciation. When it was ultimately coughed up it appeared in one large piece and several smaller ones, and was so corroded as to be very brittle. After dislodgment of the pin there was subsidence of the cough and rapid recovery. Lapeyre mentions an elderly gentleman who received a sudden slap on the back while smoking a cigarette, causing him to start and take a very deep inspiration. The cigarette was drawn into the right bronchus, where it remained for two months without causing symptoms or revealing its presence. It then set up a circumscribed pneumonia and cardiac dropsy which continued two months longer, at which time, during a violent fit of coughing, the cigarette was expelled enveloped in a waxy, mucus-like matter. Louis relates the case of a man who carried a louis-d'or in his lung for six and a half years. There is a case on record of a man who received a gunshot wound, the ball entering behind the left clavicle and passing downward and across to the right clavicle. Sometime afterward this patient expectorated two pieces of bone and a piece of gum blanket in which he was enveloped at the time of the injury. Carpenter describes a case of fatal pleuritis, apparently due to the presence of four artificial teeth which had been swallowed thirteen years before. Cardiac Injuries.--For ages it has been the common opinion relative to injuries of the heart that they are necessarily fatal and that, as a rule, death immediately follows their reception. Notwithstanding this current belief a careful examination of the literature of medicine presents an astounding number of cases in which the heart has been positively wounded, and the patients have lived days, months, and even recovered; postmortem examination, by revealing the presence of cicatrices in the heart, confirming the original diagnosis. This question is one of great interest as, in recent years, there has been constant agitation of the possibility of surgical procedures in cardiac as well as cerebral injuries. Del Vecchio has reported a series of experiments on dogs with the conclusion that in case of wounds in human beings suture of the heart is a possible operation. In this connection he proposes the following operative procedure: Two longitudinal incisions to be made from the lower border of the 3d rib to the upper border of the 7th rib, one running along the inner margin of the sternum, the other about ten mm. inside the nipple-line. These incisions are joined by a horizontal cut made in the fourth intercostal space. The 4th, 5th, and 6th ribs and cartilages are divided and the outer cutaneous flaps turned up; pushing aside the pleura with the finger, expose the pericardium and incise it longitudinally; suture the heart-wound by interrupted sutures. Del Vecchio adds that Fischer has collected records of 376 cases of wounds of the heart with a mortality two to three minutes after the injury of 20 per cent. Death may occur from a few seconds to nine months after the accident. Keen and Da Costa quote Del Vecchio, and, in comment on his observations, remark that death in cases of wound of the heart is due to pressure of effused blood in the pericardial sac, and, because this pressure is itself a cheek to further hemorrhage, there seems, as far as hemorrhage is concerned, to be rather a question whether operative interference may not be itself more harmful than beneficial. It might be added that the shock to the cardiac action might be sufficient to check it, and at present we would have no sure means of starting pulsation if once stopped. In heart-injuries, paracentesis, followed, if necessary, by incision of the pericardium, is advised by some surgeons. Realizing the fatality of injuries of the heart, in consequence of which almost any chance by operation should be quickly seized by surgeons rather than trust the lives of patients to the infinitesimal chance of recovery, it would seem that the profession should carefully consider and discuss the feasibility of any procedure in this direction, no matter how hypothetic. Hall states that his experience in the study of cardiac wounds, chiefly on game-animals, would lead him to the conclusion that transverse wounds the lower portions of the heart, giving rise to punctures rather than extensive lacerations, do not commonly cause cessation of life for a time varying from some considerable fraction of a minute to many minutes or even hours, and especially if the puncture be valvular in character, so as to prevent the loss of much blood. However, if the wound involve the base of the organ, with extensive laceration of the surrounding parts, death is practically instantaneous. It would seem that injury to the muscular walls of the heart is much less efficient in the production of immediate death than destruction of the cardiac nervous mechanism, serious irritation of the latter producing almost instantaneous death from shock. In addition, Hall cites several of the instances on which he based his conclusions. He mentions two wild geese which flew respectively 1/4 and 3/4 of a mile after having been shot through the heart, each with a pellet of BB shot, the base in each instance being uninjured; in several instances antelope and deer ran several rods after being shot with a rifle ball in a similar manner; on the other hand, death was practically instantaneous in several of these animals in which the base of the heart was extensively lacerated. Again, death may result instantaneously from wounds of the precordial region, or according to Erichsen, if held directly over the heart, from the discharge of a pistol containing powder alone, a result occasionally seen after a blow on the precordial region. It is well, however, to state that in times of excitement, one may receive an injury which will shortly prove fatal, and yet not be aware of the fact for some time, perhaps even for several minutes. It would appear that the nervous system is so highly tuned at such times, that it does not respond to reflex irritations as readily as in the absence of excitement. Instances of Survival after Cardiac Injuries.--We briefly cite the principal interesting instances of cardiac injuries in which death has been delayed for some time, or from which the patient ultimately recovered. Pare relates the case of a soldier who received a blow from a halberd, penetrating the left ventricle, and who walked to the surgeon's tent to have his wound dressed and then to his own tent 260 yards away. Diemerbroeck mentions two instances of long survival after cardiac injuries, in one of which the patient ran 60 paces after receiving the wound, had complete composure of mind, and survived nine days. There is an instance in which a man ran 400 paces after penetration of the left ventricle, and lived for five hours. Morand gives an instance of survival for five days after wound of the right ventricle. Saucerotte speaks of survival for three days after injury to the heart. Babington speaks of a case of heart-injury, caused by transfixion by a bayonet, in which the patient survived nine hours. Other older cases are as follows: l'Ecluse, seven days; the Ephemerides, four and six days; Col de Vilars, twelve days; Marcucci, eighteen days; Bartholinus, five days; Durande, five days; Boyer, five days; Capelle, twenty six hours; Fahner, eleven days; Marigues, thirteen days; Morgagni, eight days; la Motte, twelve hours; Rhodius, Riedlin, two days; Saviard, eleven days; Sennert, three days; Triller, fourteen days; and Tulpius, two and fifteen days; and Zittman, eight days. The Duc de Berri, heir to the French throne, who was assassinated in 1826, lived several hours with one of his ventricles opened. His surgeon, Dupuytren, was reprimanded for keeping the wound open with a probe introduced every two hours, but this procedure has its advocates at the present day. Randall mentions a gunshot wound of the right ventricle which did not cause death until the sixty-seventh day. Grant describes a wound in which a ball from a revolver entered a little to the right of the sternum, between the cartilages of the 5th and 6th ribs, and then entered the right ventricle about an inch from the apex. It emerged from the lower part, passed through the diaphragm, the cardiac end of the stomach, and lodged in the left kidney. The patient remained in a state of collapse fifteen hours after being shot, and with little or no nourishment lived twenty-six days. At the postmortem examination the wounds in the organs were found to be healed, but the cicatrices were quite evident. Bowling gives a case of gunshot wound of the shoulder in which death resulted eleven weeks after, the bullet being found in the left ventricle of the heart. Thompson has reported a bayonet wound of the heart, after the reception of which the patient lived four days. The bayonet entered the ventricle about 1 1/2 inches from the left apex, traversing the left wall obliquely, and making exit close to the septum ventriculorum. Roberts mentions a man who ran 60 yards and lived one hour after being shot through both lungs and the right auricle. Curran mentions the case of a soldier who, in 1809, was wounded by a bullet which entered his body to the left of the sternum, between the 2d and 3d ribs. He was insensible a half hour, and was carried aboard a fighting ship crowded with sailors. There was little hemorrhage from his wound, and he survived fourteen days. At the postmortem examination some interesting facts were revealed. It was found that the right ventricle was transversely opened for about an inch, the ball having penetrated its anterior surface, near the origin of the pulmonary artery. The ball was found loose in the pericardium, where it had fallen during the necropsy. There was a circular lacerated opening in the tricuspid valve, and the ball must have been in the right auricle during the fourteen days in which the man lived. Vite mentions an example of remarkable tenacity of life after reception of a cardiac wound, the subject living four days after a knife-wound penetrating the chest into the pericardial sac and passing through the left ventricle of the heart into the opposite wall. Boone speaks of a gunshot wound in which death was postponed until the thirteenth day. Bullock mentions a case of gunshot wound in which the ball was found lodged in the cavity of the ventricle four days and eighteen hours after infliction of the wound. Carnochan describes a penetrating wound of the heart in a subject in whom life had been protracted eleven days. After death the bullet was found buried and encysted in the heart. Holly reports a case of pistol-shot wound through the right ventricle, septum, and aorta, with the ball in the left ventricle. There was apparent recovery in fourteen days and sudden death on the fifty-fifth day. Hamilton gives an instance of a shoemaker sixty-three years old who, while carrying a bundle, fell with rupture of the heart and lived several minutes. On postmortem examination an opening in the heart was found large enough to admit a blowpipe. Noble speaks of duration of life for five and a half days after rupture of the heart; and there are instances on record in which life has been prolonged for thirteen hours and for fifty-three hours after a similar injury. Glazebrook reports the case of a colored man of thirty, of powerful physique, who was admitted to the Freedmen's Hospital, Washington, D.C., at 12.30 A.M., on February 5, 1895. Upon examination by the surgeons, an incised wound was discovered one inch above the left nipple, 3 1/4 inches to the left of the median line, the incision being 2 1/4 inches in length and its direction parallel with the 3d rib. The man's general condition was fairly good, and the wound was examined. It was impossible to trace its depth further than the 3d rib, although probing was resorted to; it was therefore considered a simple wound, and dressed accordingly. Twelve hours later symptoms of internal hemorrhage were noticed, and at 8 A.M., February 6th, the man died after surviving his injury thirty-two hours. A necropsy was held three hours after death, and an oblique incision 3/4 inch in length was found through the cartilage-end of the 3d rib. A similar wound was next found in the pericardium, and upon examining the heart there was seen a clean, incised wound 1/2 inch in length, directly into the right ventricle, the endocardial wound being 3/8 inch long. Both the pericardium and left pleura were distended with fresh blood and large clots. Church reports a case of gunshot wound of the heart in a man of sixty-seven who survived three hours. The wound had been made by a pistol bullet (32 caliber), was situated 1 1/4 inches below the mammary line, and slightly to the left of the center of the sternum; through it considerable blood had escaped. The postmortem examination showed that the ball had pierced the sternum just above the xiphoid cartilage, and had entered the pericardium to the right and at the lower part. The sac was filled with blood, both fresh and clotted. There was a ragged wound in the anterior wall 1/2 inch in diameter. The wound of exit was 5/8 inch in diameter. After traversing the heart the ball had penetrated the diaphragm, wounded the omentum in several places, and become lodged under the skin posteriorly between the 9th and 10th ribs. Church adds that the "Index Catalogue of the Surgeon-General's Library" at Washington contains 22 cases of direct injury to the heart, all of which lived longer than his case: 17 lived over three days; eight lived over ten days; two lived over twenty-five days; one died on the fifty-fifth day, and there were three well-authenticated recoveries. Purple tabulates a list of 42 cases of heart-injury which survived from thirty minutes to seventy days. Fourteen instances of gunshot wounds of the heart have been collected from U.S. Army reports, in all of which death followed very promptly, except in one instance in which the patient survived fifty hours. In another case the patient lived twenty-six hours after reception of the injury, the conical pistol-ball passing through the anterior margin of the right lobe of the lung into the pericardium, through the right auricle, and again entered the right pleural cavity, passing through the posterior margin of the lower lobe of the right lung; at the autopsy it was found in the right pleural cavity. The left lung and cavity were perfectly normal. The right lung was engorged and somewhat compressed by the blood in the pleural cavity. The pericardium was much distended and contained from six to eight ounces of partially coagulated blood. There was a fibrinous clot in the left ventricle. Nonfatal Cardiac Injuries.--Wounds of the heart are not necessarily fatal. Of 401 cases of cardiac injury collected by Fischer there were as many as 50 recoveries, the diagnosis being confirmed in 33 instances by an autopsy in which there were found distinct signs of the cardiac injury. By a peculiar arrangement of the fibers of the heart, a wound transverse to one layer of fibers is in the direction of another layer, and to a certain extent, therefore, valvular in function; it is probably from this fact that punctured wounds of the heart are often attended with little or no bleeding. Among the older writers, several instances of nonfatal injuries to the heart are recorded. Before the present century scientists had observed game-animals that had been wounded in the heart in the course of their lives, and after their ultimate death such direct evidence as the presence of a bullet or an arrow in their hearts was found. Rodericus a Veiga tells the story of a deer that was killed in hunting, and in whose heart was fixed a piece of arrow that appeared to have been there some time. Glandorp experimentally produced a nonfatal wound in the heart of a rabbit. Wounds of the heart, not lethal, have been reported by Benivenius, Marcellus Donatus, Schott, Stalpart van der Wiel, and Wolff. Ollenrot reports an additional instance of recovery from heart-injury, but in his case the wound was only superficial. There is a recent case of a boy of fourteen, who was wounded in the heart by a pen-knife stab. The boy was discharged cured from the Middlesex Hospital, but three months after the reception of the injury he was taken ill and died. A postmortem examination showed that the right ventricle had been penetrated in a slanting direction; the cause of death was apoplexy, produced by the weakening and thinning of the heart's walls, the effect of the wound. Tillaux reports the case of a man of sixty-five, the victim of general paralysis, who passed into his chest a blade 16 cm. long and 2 mm. broad. The wound of puncture was 5 cm. below the nipple and 2 cm. to the outside. The left side of the chest was emphysematous and ecchymosed. The heart-sounds were regular, and the elevation of the skin by the blade coincided with the ventricular systole. The blade was removed on the following day, and the patient gradually improved. Some thirteen months after he had expectoration of blood and pus and soon died. At the necropsy it was seen that the wound had involved both lungs; the posterior wall of the ventricle and the inferior lobe of the right lung were traversed from before backward, and from left to right, but the ventricular cavity was not penetrated. Strange to say, the blade had passed between the vertebral column and the esophagus, and to the right of the aorta, but had wounded neither of these organs. O'Connor mentions a graduate of a British University who, with suicidal intent, transfixed his heart with a darning-needle. It was extracted by a pair of watchmaker's pliers. In five days the symptoms had all abated, and the would-be suicide was well enough to start for the Continent. Muhlig was consulted by a mason who, ten years before, had received a blow from a stiletto near the left side of the sternum. The cicatrix was plainly visible, but the man said he had been able to perform his daily labors, although at the present time suffering from intense dyspnea and anasarca. A loud bellows-sound could be heard, which the man said had been audible since the time of reception of the injury. This was a double bruit accompanying systole, and entirely obscuring the physical signs. From this time the man speedily failed, and after his death there were cicatricial signs found, particularly on the wall of the left ventricle, together with patency of the interventricular septum, with signs of cicatrization about this rent. At the side of the left ventricle the rent was twice as large and lined with cicutricial tissue. Stelzner mentions a young student who attempted suicide by thrusting a darning-needle into his heart. He complained of pain and dyspnea; in twenty-four hours his symptoms increased to such an extent that operation was deemed advisable on account of collapse. The 5th rib was resected and the pleural cavity opened. When the pericardial sac was incised, a teaspoonful of turbid fluid oozed out, and the needle was felt in an oblique position in the right ventricle. By pressure of a finger passed under the heart, the eye of the needle was pressed through the anterior wall and fixed on the operator's finger-nail. An attempt to remove by the forceps failed, as the violent movements of the heart drew the needle back into the cavity. About this stage of the operation an unfortunate accident happened--the iodoform tampon, which protected the exposed pleural cavity, was drawn into this cavity during a deep inspiration, and could not be found. Notwithstanding subsequent pneumothorax and extensive pleuritic effusion, the patient made a good recovery at the end of the fourth week and at the time of report it was still uncertain whether the needle remained in the heart or had wandered into the mediastinum. During the discussion which followed the report of this case, Hahn showed a portion of a knitting-needle which had been removed from the heart of a girl during life. The extraction was very slow in order to allow of coagulation along the course of the wound in the heart, and to guard against hemorrhage into the pericardial sac, which is so often the cause of death in punctured wounds of this organ. Hahn remarked that the pulse, which before the removal had been very rapid, sank to 90. Marks reports the case of a stab-wound penetrating the left 9th intercostal space, the diaphragm, pleura, pericardium, and apex of the heart. It was necessary to enlarge the wound, and, under an anesthetic, after removing one and one-half inches of the 9th and 10th ribs, the wound was thoroughly packed with iodoform gauze and in twenty-one days the patient recovered. Lavender mentions an incised wound of the heart penetrating the right ventricle, from which the patient recovered. Purple gives, an account of a recovery from a wound penetrating both ventricles. The diagnosis was confirmed by a necropsy nine years thereafter. Stoll records a nonfatal injury to the heart. Mastin reports the case of a man of thirty-two who was shot by a 38-caliber Winchester, from an ambush, at a distance of 110 yards. The ball entered near the chest posteriorly on the left side just below and to the outer angle of the scapula, passed between the 7th and 8th ribs, and made its exit from the intercostal space of the 4th and 5th ribs, 2 1/4 inches from the nipple. A line drawn from the wound of entrance to that of exit would pass exactly through the right ventricle. After receiving the wound the man walked about twenty steps, and then, feeling very weak from profuse hemorrhage from the front of the wound, he sat down. With little or no treatment the wound closed and steady improvement set in; the patient was discharged in three weeks. As the man was still living at last reports, the exact amount of damage done in the track of the bullet is not known, although Mastin's supposition is that the heart was penetrated. Mellichamp speaks of a gunshot wound of the heart with recovery, and Ford records an instance in which a wound of the heart by a buckshot was followed by recovery. O'Connor reports a case under his observation in which a pistol-ball passed through three of the four cavities of the heart and lodged in the root of the right lung. The patient, a boy of fifteen, died of the effects of cardiac disease three years and two months later. Bell mentions a case in which, six years after the receipt of a gunshot wound of the chest, a ball was found in the right ventricle. Christison speaks of an instance in which a bullet was found in the heart of a soldier in Bermuda, with no apparent signs of an opening to account for its entrance. There is a case on record of a boy of fourteen who was shot in the right shoulder, the bullet entering through the right upper border of the trapezius, two inches from the acromion process. Those who examined him supposed the ball was lodged near the sternal end of the clavicle, four or five inches from where it entered. In about six weeks the boy was at his labors. Five years later he was attacked with severe pneumonia and then first noticed tumultuous action of the heart which continued to increase after his recovery. Afterward the pulsation could be heard ten or 12 feet away. He died of another attack of pneumonia fifteen years later and the heart was found to be two or three times its natural size, soft and flabby, and, on opening the right ventricle, a bullet was discovered embedded in its walls. There was no scar of entrance discernible, though the pericardium was adherent. Biffi of Milan describes the case of a lunatic who died in consequence of gangrene of the tongue from a bite in a paroxysm of mania. At the necropsy a needle, six cm. in length, was found transfixing the heart, with which the relatives of the deceased said he had stabbed himself twenty-two months prior to his death. There is a collection of cases in which bullets have been lodged in the heart from twenty to thirty years. Balch reports a case in which a leaden bullet remained twenty years in the walls of the heart. Hamilton mentions an instance of gunshot wound of the heart, in which for twenty years a ball was embedded in the wall of the right ventricle, death ultimately being caused by pneumonia. Needles have quite frequently been found in the heart after death; Graves, Leaming, Martin, Neill, Piorry, Ryerson, and others record such cases. Callender mentions recovery of the patient after removal of a needle from the heart. Garangeot mentions an aged Jesuit of seventy-two, who had in the substance of his heart a bone 4 1/2 inches long and possibly an inch thick. This case is probably one of ossification of the cardiac muscle; in the same connection Battolini says that the heart of Pope Urban VII contained a bone shaped like the Arab T. Among the older writers we frequently read of hairs, worms, and snakes being found in the cavities of the heart. The Ephemerides, Zacutus Lusitanus, Pare, Swinger, Riverius, and Senac are among the authorities who mention this circumstance. The deception was possibly due to the presence of loose and shaggy membrane attached to the endocardial lining of the heart, or in some cases to echinococci or trichine. A strange case of foreign body in the heart was reported some time since in England. The patient had swallowed a thorn of the Prunus spinosa (Linn.), which had penetrated the esophagus and the pericardium and entered the heart. A postmortem examination one year afterward confirmed this, as a contracted cicatrix was plainly visible on the posterior surface of the heart about an inch above the apex, through which the thorn had penetrated the right ventricle and lodged in the tricuspid valve. The supposition was that the thorn had been swallowed while eating radishes. Buck mentions a case of hydatid cysts in the wall of the left ventricle, with rupture of the cysts and sudden death. It is surprising the extent of injury to the pericardium Nature will tolerate. In his "Comment on the Aphorisms of Hippocrates," Cardanus says that he witnessed the excision of a portion of the pericardium with the subsequent cure of the patient. According to Galen, Marulus, the son of Mimographus, recovered after a similar operation. Galen also adds, that upon one occasion he removed a portion of carious sternum and found the pericardium in a putrid state, leaving a portion of the heart naked. It is said that in the presence of Leucatel and several theologians, Francois Botta opened the body of a man who died after an extended illness and found the pericardium putrefied and a great portion of the heart destroyed, but the remaining portion still slightly palpitating. In this connection Young mentions a patient of sixty-five who in January, 1860, injured his right thumb and lost the last joint by swelling and necrosis. Chloroform was administered to excise a portion of the necrosed bone and death ensued. Postmortem examination revealed gangrene of the heart and a remarkable tendency to gangrene elsewhere (omentum, small intestines, skin, etc.). Recently, Dalton records a remarkable case of stab-wound of the pericardium with division of the intercostal artery, upon which he operated. An incision eight inches long was made over the 4th rib, six inches of the rib were resected, the bleeding intercostal artery was ligated, the blood was turned out of the pericardial cavity, this cavity being irrigated with hot water. The wound in the pericardium, which was two inches long, was sutured and the external wound was closed. Recovery followed. Harris gives an instance of a man who was injured by a bar of iron falling on his shoulder, producing a compound fracture of the ribs as low as the 7th, and laying the heart and lungs bare without seriously injuring the pericardium. Rupture of the heart from contusion of the chest is not always instantly fatal. According to Ashhurst, Gamgee has collected 28 cases of rupture of this viscus, including one observed by himself. In nine of these cases there was no fracture, and either no bruise of the parietes or a very slight one. The pericardium was intact in at least half of the cases, and in 22 in which the precise seat of lesion was noticed the right ventricle was ruptured in eight, the left in three, the left auricle in seven, the right in four. The longest period during which any patient survived the injury was fourteen hours. Among the older writers who note this traumatic injury are Fine, who mentions concussion rupturing the right ventricle, and Ludwig, who reports a similar accident. Johnson mentions rupture of the left ventricle in a paroxysm of epilepsy. There is another species of rupture of the heart which is not traumatic, in which the rupture occurs spontaneously, the predisposing cause being fatty degeneration, dilatation, or some other pathologic process in the cardiac substance. It is quite possible that the older instances of what was known as "broken-heart," which is still a by-word, were really cases in which violent emotion had produced rupture of a degenerated cardiac wall. Wright gives a case of spontaneous rupture of the heart in which death did not occur for forty-eight hours. Barth has collected 24 cases of spontaneous rupture of the heart, and in every instance the seat of lesion was in the left ventricle. It was noticed that in some of these cases the rupture did not take place all at once, but by repeated minor lacerations, death not ensuing in some instances for from two to eleven days after the first manifestation of serious symptoms. A more recent analysis is given by Meyer of cases reported since 1870: Meyer collects 25 cases of rupture of the left ventricle seven of the right ventricle, and four of the right auricle. Within the last year Collings has reported a case of idiopathic rupture of the heart in a man of fifty-three, who had always lived a temperate life, and whose only trouble had been dyspepsia and a weak heart. There was no history of rheumatism or rheumatic fever. The man's father had died suddenly of heart disease. After feeling out of sorts for a time, the man experienced severe pain in the precordium and felt too ill to leave his bed. He gradually became worse and sick after taking food. Speech became thick, the mouth was drawn to the right, and the right eye was partially closed. The left arm became paralyzed, then the right leg. The tongue deviated to the right on protrusion. The sphincters were unaffected. The heart sounds were faint and without added sounds. The man was moved to a water-bed, his body and head being kept horizontal, and great care being taken to avoid sudden movement. Later, when his pelvis was raised to allow the introduction of a bed-pan, almost instantaneous death ensued. Upon postmortem examination prolonged and careful search failed to reveal any microscopic change in the brain, its vessels, or the meninges. On opening the pericardium it was found to be filled with blood-clot, and on washing this away a laceration about 1 1/2 inches in length was found in the left ventricle; the aperture was closed by a recent clot. The cavities of the heart were dilated, the walls thin and in advanced stage of fatty degeneration. There was no valvular disease. The aorta and its main branches were atheromatous. Both lungs contained calcifying tubercle; the abdomen was loaded with fat; the spleen was soft; the kidneys were engorged, but otherwise healthy. Stokes gives the case of a man who was severely crushed between the arms of a water-wheel of great size and the embankment on which the axle of the wheel was supported; a peculiar factor of the injury being that his heart was displaced from left to right. At the time of report, after recovery from the injury, the patient exhibited remarkable tolerance of great doses of digitalis. When not taking digitalis, his pulse was 100 to 120, regular, and never intermittent. Hypertrophy of the Heart.--The heart of a man of ordinary size weighs nine ounces, and that of a woman eight; in cases of hypertrophy, these weights may be doubled, although weights above 25 ounces are rare. According to Osler, Beverly Robinson describes a heart weighing 53 ounces, and Dulles has reported one weighing 48 ounces. Among other modern records are the following: Fifty and one-half ounces, 57 ounces, and one weighing four pounds and six ounces. The Ephemerides contains an incredible account of a heart that weighed 14 pounds. Favell describes a heart that only weighed 3 1/2 ounces. Wounds of the aorta are almost invariably fatal, although cases are recorded by Pelletan, Heil, Legouest, and others, in which patients survived such wounds for from two months to several years. Green mentions a case of stab-wound in the suprasternal fossa. The patient died one month after of another cause, and at the postmortem examination the aorta was shown to have been opened; the wound in its walls was covered with a spheric, indurated coagulum. No attempt at union had been made. Zillner observed a penetrating wound of the aorta after which the patient lived sixteen days, finally dying of pericarditis. Zillner attributed this circumstance to the small size of the wound, atheroma and degeneration of the aorta and slight retraction of the inner coat, together with a possible plugging of the pericardial opening. In 1880 Chiari said that while dissecting the body of a man who died of phthisis, he found a false aneurysm of the ascending aorta with a transverse rupture of the vessel by the side of it, which had completely cicatrized. Hill reports the case of a soldier who was stabbed with a bowie-knife nine inches long and three inches wide. The blade passed through the diaphragm, cut off a portion of the liver, and severed the descending aorta at a point about the 7th dorsal vertebra; the soldier lived over three hours after complete division of this important vessel. Heil reports the case of a man of thirty-two, a soldier in the Bavarian army, who, in a quarrel in 1812, received a stab in the right side. The instrument used was a common table-knife, which was passed between the 5th and 6th ribs, entering the left lung, and causing copious hemorrhage. The patient recovered in four months, but suffered from amaurosis which had commenced at the time of the stab. Some months afterward he contracted pneumonia and was readmitted to the hospital, dying in 1813. At the postmortem the cicatrix in the chest was plainly visible, and in the ascending aorta there was seen a wound, directly in the track of the knife, which was of irregular border and was occupied by a firm coagulum of blood. The vessel had been completely penetrated, as, by laying it open, an internal cicatrix was found corresponding to the other. Fatal hemorrhage had been avoided in this case by the formation of coagulum in the wound during the syncope immediately following the stab, possibly aided by extended exposure to cold. Sundry Cases.--Sandifort mentions a curious case of coalescence of the esophagus and aorta, with ulceration and consequent rupture of the aorta, the hemorrhage proceeding from the stomach at the moment of rupture. Heath had a case of injury to the external iliac artery from external violence, with subsequent obliteration of the vessel. When the patient was discharged no pulse could be found in the leg. Dismukes reports a case in which the patient had received 13 wounds, completely severing the subclavian artery, and, without any medical or surgical aid, survived the injury two hours. Illustrative of the degree of hemorrhage which may follow an injury so slight as that of falling on a needle we cite an instance, reported by a French authority, of a child who picked up a needle, and, while running with it to its mother, stumbled and fell, the needle penetrating the 4th intercostal space, the broadened end of it remaining outside of the wound. The mother seized the needle between her teeth and withdrew it, but the child died, before medical aid could be summoned, from internal hemorrhage, causing pulmonary pressure and dyspnea. Rupture of the esophagus is attributable to many causes. Dryden mentions vomiting as a cause, and Guersant reports the case of a little girl of seven, who, during an attack of fever, ruptured her esophagus by vomiting. In 1837 Heyfelder reported the case of a drunkard, who, in a convulsion, ruptured his esophagus and died. Williams mentions a case in which not only the gullet, but also the diaphragm, was ruptured in vomiting. In this country, Bailey and Fitz have recorded cases of rupture of the esophagus. Brewer relates a parallel instance of rupture from vomiting. All the foregoing cases were linear ruptures, but there is a unique case given by Boerhaave in 1724, in which the rent was transverse. Ziemssen and Mackenzie have both translated from the Latin the report of this case which is briefly as follows: The patient, Baron de Wassenaer, was fifty years of age, and, with the exception that he had a sense of fulness after taking moderate meals, he was in perfect health. To relieve this disagreeable feeling he was in the habit of taking a copious draught of an infusion of "blessed thistle" and ipecacuanha. One day, about 10.30 in the evening, when he had taken no supper, but had eaten a rather hearty dinner, he was bothered by a peculiar sensation in his stomach, and to relieve this he swallowed about three tumbler-fuls of his usual infusion, but to no avail. He then tried to excite vomiting by tickling the fauces, when, in retching, he suddenly felt a violent pain; he diagnosed his own case by saying that it was "the bursting of something near the pit of the stomach." He became prostrated and died in eighteen and one-half hours; at the necropsy it was seen that without any previously existing signs of disease the esophagus had been completely rent across in a transverse direction. Schmidtmuller mentions separation of the esophagus from the stomach; and Flint reports the history of a boy of seven who died after being treated for worms and cerebral symptoms. After death the contents of the stomach were found in the abdominal cavity, and the esophagus was completely separated from the stomach. Flint believed the separation was postmortem, and was possibly due to the softening of the stomach by the action of the gastric acids. In this connection may be mentioned the case reported by Hanford of a man of twenty-three who had an attack of hematemesis and melanema two years before death. A postmortem was made five hours after death, and there was so much destruction of the stomach by a process resembling digestion that only the pyloric and cardiac orifices were visible. Hanford suggests that this was an instance of antemortem digestion of the stomach which physiologists claim is impossible. Nearly all cases of rupture of the stomach are due to carcinoma, ulcer, or some similar condition, although there have been instances of rupture from pressure and distention. Wunschheim reports the case of a man of fifty-two who for six months presented symptoms of gastric derangement, and who finally sustained spontaneous rupture of the posterior border of the stomach due to overdistention. There was a tear two inches long, beginning near the cardiac end and running parallel to the lesser curvature. The margin of the tear showed no evidence of digestion. There were obstructing esophageal neoplasms about 10 1/3 inches from the teeth, which prevented vomiting. In reviewing the literature Wunschheim found only six cases of spontaneous rupture of the stomach. Arton reports the case of a negro of fifty who suffered from tympanites. He was a hard drinker and had been aspirated several times, gas heavily laden with odors of the milk of asafetida being discharged with a violent rush. The man finally died of his malady, and at postmortem it was found that his stomach had burst, showing a slit four inches long. The gall bladder contained two quarts of inspissated bile. Fulton mentions a case of rupture of the esophageal end of a stomach in a child. The colon was enormously distended and the walls thickened. When three months old it was necessary to puncture the bowel for distention. Collins describes spontaneous rupture of the stomach in a woman of seventy-four, the subject of lateral curvature of the spine, who had frequent attacks of indigestion and tympanites. On the day of death there was considerable distention, and a gentle purgative and antispasmodic were given. Just before death a sudden explosive sound was heard, followed by collapse. A necropsy showed a rupture two inches long and two inches from the pyloric end. Lallemand mentions an instance of the rupture of the coats of the stomach by the act of vomiting. The patient was a woman who had suffered with indigestion five or six months, but had been relieved by strict regimen. After indulging her appetite to a greater extent than usual, she experienced nausea, and made violent and ineffectual efforts to discharge the contents of the stomach. While suffering great agony she experienced a sensation as if something was tearing in the lower part of her belly. The woman uttered several screams, fell unconscious, and died that night. Postmortem examination showed that the anterior and middle part of the stomach were torn obliquely to the extent of five inches. The tear extended from the smaller toward the greater curvature. The edges were thin and irregular and presented no marks of disease. The cavity of the peritoneum was full of half-digested food. The records of St. Bartholomew's Hospital, London, contain the account of a man of thirty-four who for two years had been the subject of paroxysmal pain in the stomach. The pains usually continued for several hours and subsided with vomiting. At St. Bartholomew's he had an attack of vomiting after a debauch. On the following day he was seized with vomiting accompanied by nausea and flatus, and after a sudden attack of pain at the pit of the stomach which continued for two hours, he died. A ragged opening at the esophageal orifice, on the anterior surface of the stomach was found. This tear extended from below the lesser curvature to its extremity, and was four inches long. There were no signs of gastric carcinoma or ulcer. Clarke reports the case of a Hindoo of twenty-two, under treatment for ague, who, without pain or vomiting, suddenly fell into collapse and died twenty-three hours later. He also mentions a case of rupture of the stomach of a woman of uncertain history, who was supposed to have died of cholera. The examination of the bodies of both cases showed true rupture of the stomach and not mere perforation. In both cases, at the time of rupture, the stomach was empty, and the gastric juice had digested off the capsules of the spleens, thus allowing the escape of blood into the abdominal cavities. The seats of rupture were on the anterior walls. In the first case the coats of the stomach were atrophied and thin. In the second the coats were healthy and not even softened. There was absence of softening, erosion, or rupture on the posterior walls. As illustrative of the amount of paralytic distention that is possible, Bamberger mentions a case in which 70 pounds of fluid filled the stomach. Voluntary Vomiting.--It is an interesting fact that some persons exhibit the power of contracting the stomach at will and expelling its contents without nausea. Montegre mentions a distinguished member of the Faculty of Paris, who, by his own volition and without nausea or any violent efforts, could vomit the contents of his stomach. In his translation of "Spallanzani's Experiments on Digestion" Sennebier reports a similar instance in Geneva, in which the vomiting was brought about by swallowing air. In discussing wounds and other injuries of the stomach no chapter would be complete without a description of the celebrated case of Alexis St. Martin, whose accident has been the means of contributing so much to the knowledge of the physiology of digestion. This man was a French Canadian of good constitution, robust and healthy, and was employed as a voyageur by the American Fur Company. On June 16, 1822, when about eighteen years of age, he was accidentally wounded by a discharge from a musket. The contents of the weapon, consisting of powder and duck-shot, entered his left side from a distance of not more than a yard off. The charge was directed obliquely forward and inward, literally blowing off the integument and muscles for a space about the size of a man's hand, carrying away the anterior half of the 6th rib, fracturing the 5th rib, lacerating the lower portion of the lowest lobe of the left lung, and perforating the diaphragm and the stomach. The whole mass of the discharge together with fragments of clothing were driven into the muscles and cavity of the chest. When first seen by Dr. Beaumont about a half hour after the accident, a portion of the lung, as large as a turkey's egg was found protruding through the external wound. The protruding lung was lacerated and burnt. Immediately below this was another protrusion, which proved to be a portion of the stomach, lacerated through all its coats. Through an orifice, large enough to admit a fore-finger, oozed the remnants of the food he had taken for breakfast. His injuries were dressed; extensive sloughing commenced, and the wound became considerably enlarged. Portions of the lung, cartilages, ribs, and of the ensiform process of the sternum came away. In a year from the time of the accident, the wound, with the exception of a fistulous aperture of the stomach and side, had completely cicatrized. This aperture was about 2 1/2 inches in circumference, and through it food and drink constantly extruded unless prevented by a tent-compress and bandage. The man had so far recovered as to be able to walk and do light work, his digestion and appetite being normal. Some months later a small fold or doubling of the stomachal coats slightly protruded until the whole aperture was filled, so as to supersede the necessity of a compress, the protruding coats acting as a valve when the stomach was filled. This valvular protrusion was easily depressed by the finger. St. Martin suffered little pain except from the depression of the skin. He took his food and drink like any healthy person, and for eleven years remained under Dr. Beaumont's own care in the Doctor's house as a servant. During this time were performed the experiments on digestion which are so well known. St. Martin was at all times willing to lend himself in the interest of physiologic science. In August, 1879, The Detroit Lancet contains advices that St. Martin was living at that time at St. Thomas, Joliette County, Province of Quebec, Canada. At the age of seventy-nine he was comparatively strong and well, and had always been a hard worker. At this time the opening in the stomach was nearly an inch in diameter, and in spite of its persistence his digestion had never failed him. Spizharny relates a remarkable case of gastric fistula in the loin, and collects 61 cases of gastric fistula, none of which opened in the loin. The patient was a girl of eighteen, who had previously had perityphlitis, followed by abscesses about the navel and lumbar region. Two fistulae were found in the right loin, and were laid open into one canal, which, after partial resection of the 12th rib, was dilated and traced inward and upward, and found to be in connection with the stomach. Food was frequently found on the dressings, but with the careful use of tampons a cure was effected. In the olden times wounds of the stomach were not always fatal. The celebrated anatomist, Fallopius, successfully treated two cases in which the stomach was penetrated so that food passed through the wound. Jacobus Orthaeus tells us that in the city of Fuldana there was a soldier who received a wound of the stomach, through which food passed immediately after being swallowed; he adds that two judicious surgeons stitched the edges of the wound to the integuments, thereby effecting a cure. There is another old record of a gastric fistula through which some aliment passed during the period of eleven years. Archer tells of a man who was stabbed by a negro, the knife entering the cartilages of the 4th rib on the right side, and penetrating the stomach to the extent of two inches at a point about two inches below the xiphoid cartilage. The stomachal contents, consisting of bacon, cabbage, and cider, were evacuated. Shortly after the reception of the injury, an old soldier sewed up the wound with an awl, needle, and wax-thread; Archer did not see the patient until forty-eight hours afterward, at which time he cleansed and dressed the wound. After a somewhat protracted illness the patient recovered, notwithstanding the extent of injury and the primitive mode of treatment. Travers mentions the case of a woman of fifty-three who, with suicidal intent, divided her abdominal parietes below the navel with a razor, wounding the stomach in two places. Through the wound protruded the greater part of the larger curvature of the stomach; the arch of the colon and the entire greater omentum were both strangulated. A small portion of the coats of the stomach, including the wound, was nipped up, a silk ligature tied about it, and the entrails replaced. Two months afterward the patient had quite recovered, though the ligature of the stomach had not been seen in the stool. Clements mentions a robust German of twenty-two who was stabbed in the abdomen with a dirk, producing an incised wound of the stomach. The patient recovered and was returned to duty the following month. There are many cases on record in which injury of the stomach has been due to some mistake or accident in the juggling process of knife-swallowing or sword-swallowing. The records of injuries of this nature extend back many hundred years, and even in the earlier days the delicate operation of gastrotomy, sometimes with a successful issue, was performed upon persons who had swallowed knives. Gross mentions that in 1502 Florian Mathias of Bradenberg removed a knife nine inches long from the stomach of a man of thirty-six, followed by a successful recovery. Glandorp, from whom, possibly, Gross derived his information, relates this memorable case as being under the direction of Florianus Matthaesius of Bradenburg. The patient, a native of Prague, had swallowed a knife eight or nine inches long, which lay pointing at the superior portion of the stomach. After it had been lodged in this position for seven weeks and two days gastrotomy was performed, and the knife extracted; the patient recovered. In 1613 Crollius reports the case of a Bohemian peasant who had concealed a knife in his mouth, thinking no one would suspect he possessed the weapon; while he was excited it slipped into the stomach, from whence it subsequently penetrated through to the skin; the man recovered. There is another old case of a man at Prague who swallowed a knife which some few weeks afterward made its exit from an abdominal abscess. Gooch quotes the case of a man, belonging to the Court of Paris, who, nine months after swallowing a knife, voided it at the groin. In the sixteenth century Laurentius Joubert relates a similar case, the knife having remained in the body two years. De Diemerbroeck mentions the fact that a knife ten inches long was extracted by gastrotomy, and placed among the rarities in the anatomic chamber of the University at Leyden. The operation was done in 1635 at Koenigsberg, by Schwaben, who for his surgical prowess was appointed surgeon to the King of Poland. The patient lived eight years after the operation. It is said that in 1691, while playing tricks with a knife 6 1/2 inches long, a country lad of Saxony swallowed it, point first. He came under the care of Weserern, physician to the Elector of Brandenburgh, who successfully extracted it, two years and seven months afterward, from the pit of the lad's stomach. The horn haft of the knife was considerably digested. In 1720 Hubner of Rastembourg operated on a woman who had swallowed an open knife. After the incision it was found that the knife had almost pierced the stomach and had excited a slight suppuration. After the operation recovery was very prompt. Bell of Davenport, Iowa, performed gastrotomy on a man, who, while attempting a feat of legerdemain, allowed a bar of lead, 10 1/8 inches long, 1 1/2 inches wide, and 9 1/2 ounces in weight, to slip into his stomach. The bar was removed and the patient recovered. Gussenbauer gives an account of a juggler who turned his head to bow an acknowledgment of applause while swallowing a sword; he thus brought his upper incisors against the sword, which broke off and slipped into his stomach. To relieve suffocation the sword was pushed further down. Gastrotomy was performed, and the piece of sword 11 inches long was extracted; as there was perforation of the stomach before the operation, the patient died of peritonitis. An hour after ingestion, Bernays of St. Louis successfully removed a knife 9 1/2 inches long. By means of an army-bullet forceps the knife was extracted easily through an incision 5/8 inch long in the walls of the stomach. Gross speaks of a man of thirty who was in the habit of giving exhibitions of sword-swallowing in public houses, and who injured his esophagus to such an extent as to cause abscess and death. In the Journal of the American Medical Association, March 1, 1896, there is an extensive list of gastrotomies performed for the removal of knives and other foreign bodies, from the seventeenth century to the present time. The physiologic explanation of sword-swallowing is quite interesting. We know that when we introduce the finger, a spoon, brush, etc., into the throat of a patient, we cause extremely disagreeable symptoms. There is nausea, gagging, and considerable hindrance with the function of respiration. It therefore seems remarkable that there are people whose physiologic construction is such that, without apparent difficulty, they are enabled to swallow a sword many inches long. Many of the exhibitionists allow the visitors to touch the stomach and outline the point of the sabre through the skin. The sabre used is usually very blunt and of rounded edges, or if sharp, a guiding tube of thin metal is previously swallowed. The explanation of these exhibitions is as follows: The instrument enters the mouth and pharynx, then the esophagus, traverses the cardiac end of the stomach, and enters the latter as far as the antrum of the pylorus, the small culdesac of the stomach. In their normal state in the adult these organs are not in a straight line, but are so placed by the passage of the sword. In the first place the head is thrown back, so that the mouth is in the direction of the esophagus, the curves of which disappear or become less as the sword proceeds; the angle that the esophagus makes with the stomach is obliterated, and finally the stomach is distended in the vertical diameter and its internal curve disappears, thus permitting the blade to traverse the greater diameter of the stomach. According to Guyot-Daubes, these organs, in a straight line, extend a distance of from 55 to 62 cm., and consequently the performer is enabled to swallow an instrument of this length. The length is divided as follows:-- Mouth and pharynx, . . . . . . . . . . . . 10 to 12 cm. Esophagus, . . . . . . . . . . . . . . . . 25 to 28 cm. Distended stomach, . . . . . . . . . . . . 20 to 22 cm. ------------- 55 to 62 cm. These acrobats with the sword have rendered important service to medicine. It was through the good offices of a sword-swallower that the Scotch physician, Stevens, was enabled to make his experiments on digestion. He caused this assistant to swallow small metallic tubes pierced with holes. They were filled, according to Reaumur's method, with pieces of meat. After a certain length of time he would have the acrobat disgorge the tubes, and in this way he observed to what degree the process of digestion had taken place. It was also probably the sword-swallower who showed the physicians to what extent the pharynx could be habituated to contact, and from this resulted the invention of the tube of Faucher, the esophageal sound, ravage of the stomach, and illumination of this organ by electric light. Some of these individuals also have the faculty of swallowing several pebbles, as large even as hen's eggs, and of disgorging them one by one by simple contractions of the stomach. From time to time individuals are seen who possess the power of swallowing pebbles, knives, bits of broken glass, etc., and, in fact, there have been recent tricky exhibitionists who claimed to be able to swallow poisons, in large quantities, with impunity. Henrion, called "Casaandra," a celebrated example of this class, was born at Metz in 1761. Early in life he taught himself to swallow pebbles, sometimes whole and sometimes after breaking them with his teeth. He passed himself off as an American savage; he swallowed as many as 30 or 40 large pebbles a day, demonstrating the fact by percussion on the epigastric region. With the aid of salts he would pass the pebbles and make them do duty the next day. He would also swallow live mice and crabs with their claws cut. It was said that when the mice were introduced into his mouth, they threw themselves into the pharynx where they were immediately suffocated and then swallowed. The next morning they would be passed by the rectum flayed and covered with a mucous substance. Henrion continued his calling until 1820, when, for a moderate sum, he was induced to swallow some nails and a plated iron spoon 5 1/2 inches long and one inch in breadth. He died seven days later. According to Bonet, there was a man by the name of Pichard who swallowed a razor and two knives in the presence of King Charles II of England, the King himself placing the articles into the man's mouth. In 1810 Babbington and Curry are accredited with citing the history of an American sailor in Guy's Hospital, London, who frequently swallowed penknives for the amusement of his audiences. At first he swallowed four, and three days later passed them by the anus; on another occasion he swallowed 14 of different sizes with the same result. Finally he attempted to gorge himself with 17 penknives, but this performance was followed by horrible pains and alarming abdominal symptoms. His excrement was black from iron. After death the cadaver was opened and 14 corroded knives were found in the stomach, some of the handles being partly digested; two were found in the pelvis and one in the abdominal cavity. Pare recalls the instance of a shepherd who suffered distressing symptoms after gulping a knife six inches long. Afterward the knife was abstracted from his groin. Fabricius Hildanus cites a somewhat similar case. Early in the century there was a man known as the "Yankee knife-swallower," whose name was John Cummings, an American sailor, who had performed his feats in nearly all the ports of the world. One of his chief performances was swallowing a billiard ball. Poland mentions a man (possibly Cummings) who, in 1807, was admitted to Guy's Hospital with dyspeptic symptoms which he attributed to knife-swallowing. His story was discredited at first; but after his death, in March, 1809, there were 30 or 40 fragments of knives found in his stomach. One of the back-springs on a knife had transfixed the colon and rectum. In the Edinburgh Philosophical Journal for 1825 there is an account of a juggler who swallowed a knife which remained in his stomach and caused such intense symptoms that gastrotomy was advised; the patient, however, refused operation. Drake reports a curious instance of polyphagia. The person described was a man of twenty-seven who pursued the vocation of a "sword-swallower." He had swallowed a gold watch and chain with a seal and key attached; at another time he swallowed 34 bullets and voided them by the anus. At Poughkeepsie, N.Y., in August, 1819, in one day and night he swallowed 19 pocket-knives and 41 copper cents. This man had commenced when a lad of fifteen by swallowing marbles, and soon afterward a small penknife. After his death his esophagus was found normal, but his stomach was so distended as to reach almost to the spine of the ilium, and knives were found in the stomach weighing one pound or more. In his exhibitions he allowed his spectators to hear the click of the knives and feel them as low down as the anterior superior spine of the ilium. The present chief of the dangerous "profession" of sword-swallowing is Chevalier Cliquot, a French Canadian by birth, whose major trick is to swallow a real bayonet sword, weighted with a cross-bar and two 18-pound dumbbells. He can swallow without difficulty a 22-inch cavalry sword; formerly, in New York, he gave exhibitions of swallowing fourteen 19-inch bayonet swords at once. A negro, by the name of Jones, exhibiting not long since in Philadelphia, gave hourly exhibitions of his ability to swallow with impunity pieces of broken glass and china. Foreign Bodies in the Alimentary Canal.--In the discussion of the foreign bodies that have been taken into the stomach and intestinal tract possibly the most interesting cases, although the least authentic, are those relating to living animals, such as fish, insects, or reptiles. It is particularly among the older writers that we find accounts of this nature. In the Ephemerides we read of a man who vomited a serpent that had crept into his mouth, and of another person who ejected a beetle that had gained entrance in a similar manner. From the same authority we find instances of the vomiting of live fish, mice, toads, and also of the passage by the anus of live snails and snakes. Frogs vomited are mentioned by Bartholinus, Dolaeus, Hellwigius, Lentilus, Salmuth, and others. Vege mentions a man who swallowed a young chicken whole. Paullini speaks of a person who, after great pain, vomited a mouse which he had swallowed. Borellus, Bartholinus, Thoner, and Viridet, are among the older authorities mentioning persons who swallowed toads. Hippocrates speaks of asphyxia from a serpent which had crawled into the mouth. Borellus states that he knew a case of a person who vomited a salamander. Plater reports the swallowing of eels and snails. Rhodius mentions persons who have eaten scorpions and spiders with impunity. Planchon writes of an instance in which a live spider was ejected from the bowel; and Colini reports the passage of a live lizard which had been swallowed two days before, and there is another similar case on record. Marcellus Donatus records an instance in which a viper, which had previously crawled into the mouth, had been passed by the anus. There are also recorded instances in French literature in which persons affected with pediculosis, have, during sleep, unconsciously swallowed lice which were afterward found in the stools. There is an abundance of cases in which leeches have been accidentally swallowed. Pliny, Aetius, Dioscorides, Scribonius-Largus, Celsus, Oribasius, Paulus Aegineta, and others, describe such cases. Bartholinus speaks of a Neapolitan prince who, while hunting, quenched his thirst in a brook, putting his mouth in the running water. In this way he swallowed a leech, which subsequently caused annoying hemorrhage from the mouth. Timaeus mentions a child of five who swallowed several leeches, and who died of abdominal pains, hemorrhage, and convulsions. Rhodius, Riverius, and Zwinger make similar observations. According to Baron Larrey the French soldiers in Napoleon's Egyptian campaign occasionally swallowed leeches. Grandchamp and Duval have commented on curious observations of leeches in the digestive tract. Dumas and Marques also speak of the swallowing of leeches. Colter reports a case in which beetles were vomited. Wright remarks on Banon's case of fresh-water shrimps passed from the human intestine. Dalton, Dickman, and others, have discussed the possibility of a slug living in the stomach of man. Pichells speaks of a case in which beetles were expelled from the stomach; and Pigault gives an account of a living lizard expelled by vomiting. Fontaine, Gaspard, Vetillart, Ribert, MacAlister, and Waters record cases in which living caterpillars have been swallowed. Sundry Cases.--The variety of foreign bodies that have been swallowed either accidentally or for exhibitional or suicidal purposes is enormous. Nearly every imaginable article from the minutest to the most incredible size has been reported. To begin to epitomize the literature on this subject would in itself consume a volume, and only a few instances can be given here, chosen in such a way as to show the variety, the effects, and the possibilities of their passage through the intestinal canal. Chopart says that in 1774 the belly of a ravenous galley-slave was opened, and in the stomach were found 52 foreign bodies, including a barrel-hoop 19 inches long, nails, pieces of pipe, spoons, buckles, seeds, glass, and a knife. In the intestines of a person Agnew found a pair of suspenders, a mass of straw, and three roller-bandages, an inch in width and diameter. Velpeau mentions a fork which was passed from the anus twenty months after it was swallowed. Wilson mentions an instance of gastrotomy which was performed for the extraction of a fork swallowed sixteen years before. There is an interesting case in which, in a delirium of typhoid fever, a girl of twenty-two swallowed two iron forks, which were subsequently expelled through an abdominal abscess. A French woman of thirty-five, with suicidal intent, swallowed a four-pronged fork, which was removed four years afterward from the thigh. For two years she had suffered intense pain in both thighs. In the Royal College of Surgeons in London there is a steel button-hook 3 1/2 inches in length which was accidentally swallowed, and was passed three weeks later by the anus, without having given rise to any symptom. Among the insane a favorite trait seems to be swallowing nails. In the Philosophical Transactions is an account of the contents of the stomach of an idiot who died at thirty-three. In this organ were found nine cart-wheel nails, six screws, two pairs of compasses, a key, an iron pin, a ring, a brass pommel weighing nine ounces, and many other articles. The celebrated Dr. Lettsom, in 1802, spoke of an idiot who swallowed four pounds of old nails and a pair of compasses. A lunatic in England e swallowed ten ounces of screws and bits of crockery, all of which were passed by the anus. Boardman gives an account of a child affected with hernia who swallowed a nail 2 1/2 inches long. In a few days the nail was felt in the hernia, but in due time it was passed by the rectum. Blower reports an account of a nail passing safely through the alimentary canal of a baby. Armstrong mentions an insane hair-dresser of twenty-three, in whose stomach after death were found 30 or more spoon handles, 30 nails, and other minor articles. Closmadenc reported a remarkable case which was extensively quoted. The patient was an hysteric young girl, an inmate of a convent, to whom he was called to relieve a supposed fit of epilepsy. He found her half-asphyxiated, and believed that she had swallowed a foreign body. He was told that under the influence of exaggerated religious scruples this girl inflicted penance upon herself by swallowing earth and holy medals. At the first dose of the emetic, the patient made a strong effort to vomit, whereupon a cross seven cm. long appeared between her teeth. This was taken out of her mouth, and with it an enormous rosary 220 cm. long, and having seven medals attached to it. Hunt recites a case occurring in a pointer dog, which swallowed its collar and chain, only imperfectly masticating the collar. The chain and collar were immediately missed and search made for them. For several days the dog was ill and refused food. Finally the gamekeeper saw the end of the chain hanging from the dog's anus, and taking hold of it, he drew out a yard of chain with links one inch long, with a cross bar at the end two inches in length; the dog soon recovered. The collar was never found, and had apparently been digested or previously passed. Fear of robbery has often led to the swallowing of money or jewelry. Vaillant, the celebrated doctor and antiquarian, after a captivity of four months in Algiers, was pursued by Tunis pirates, and swallowed 15 medals of gold; shortly after arriving at Lyons he passed them all at stool. Fournier and Duret published the history of a galley slave at Brest in whose stomach were found 52 pieces of money, their combined weight being one pound, 10 1/4 ounces. On receiving a sentence of three years' imprisonment, an Englishman, to prevent them being taken from him, swallowed seven half-crowns. He suffered no bad effects, and the coins not appearing the affair was forgotten. While at stool some twenty months afterward, having taken a purgative for intense abdominal pain, the seven coins fell clattering into the chamber. Hevin mentions the case of a man who, on being captured by Barbary pirates, swallowed all the money he had on his person. It is said that a certain Italian swallowed 100 louis d'ors at a time. It occasionally happens that false teeth are accidentally swallowed, and even passed through the intestinal tract. Easton mentions a young man who accidentally swallowed some artificial teeth the previous night, and, to further their passage through the bowel, he took a dose of castor oil. When seen he was suffering with pain in the stomach, and was advised to eat much heavy food and avoid aperients. The following day after several free movements he felt a sharp pain in the lower part of his back. A large enema was given and the teeth and plate came away. The teeth were cleansed and put back in his mouth, and the patient walked out. Nine years later the same accident again happened to the man but in spite of treatment nothing was seen of the teeth for a month afterward, when a body appeared in the rectum which proved to be a gold plate with the teeth in it. In The Lancet of December 10, 1881, there is an account of a vulcanite tooth-plate which was swallowed and passed forty-two hours later. Billroth mentions an instance of gastrotomy for the removal of swallowed artificial teeth, with recovery; and another case in which a successful esophagotomy was performed. Gardiner mentions a woman of thirty-three who swallowed two false teeth while supping soup. A sharp angle of the broken plate had caught in a fold of the cardiac end of the stomach and had caused violent hematemesis. Death occurred seventeen hours after the first urgent symptoms. In the Museum of the Royal College of Surgeons in London there is an intestinal concretion weighing 470 grains, which was passed by a woman of seventy who had suffered from constipation for many years. Sixteen years before the concretion was passed she was known to have swallowed a tooth. At one side of the concretion a piece had been broken off exposing an incisor tooth which represented the nucleus of the formation. Manasse recently reported the case of a man of forty-four whose stomach contained a stone weighing 75 grams. He was a joiner and, it was supposed, habitually drank some alcoholic solution of shellac used in his trade. Quite likely the shellac had been precipitated in the stomach and gave rise to the calculus. Berwick mentions a child of eight months who was playing with a detached organ-handle, and put it in its mouth. Seeing this the mother attempted to secure the handle, but it was pushed into the esophagus. A physician was called, but nothing was done, and the patient seemed to suffer little inconvenience. Three days later the handle was expelled from the anus. Teakle reports the successful passage through the alimentary canal of the handle of a music-box. Hashimoto, Surgeon-General of the Imperial Japanese Army, tells of a woman of forty-nine who was in the habit of inducing vomiting by irritating her fauces and pharynx with a Japanese toothbrush--a wooden instrument six or seven inches long with bristles at one end. In May, 1872, she accidentally swallowed this brush. Many minor symptoms developed, and in eleven months there appeared in the epigastric region a fluctuating swelling, which finally burst, and from it extended the end of the brush. After vainly attempting to extract the brush the attending physician contented himself with cutting off the projecting portion. The opening subsequently healed; and not until thirteen years later did the pain and swelling return. On admission to the hospital in October, 1888, two fistulous openings were seen in the epigastric region, and the foreign body was located by probing. Finally, on November 19, 1888, the patient was anesthetized, one of the openings enlarged, and the brush extracted. Five weeks later the openings had all healed and the patient was restored to health. Garcia reports an interesting instance of foreign body in a man between forty-five and fifty. This man was afflicted with a syphilitic affection of the mouth, and he constructed a swab ten inches long with which to cleanse his fauces. While making the application alone one day, a spasmodic movement caused him to relinquish his grasp on the handle, and the swab disappeared. He was almost suffocated, and a physician was summoned; but before his arrival the swab had descended into the esophagus. Two weeks later, gastro-peritoneal symptoms presented, and as the stick was located, gastrotomy was proposed; the patient, however, would not consent to an operation. On the twenty-sixth day an abscess formed on the left side below the nipple, and from it was discharged a large quantity of pus and blood. Four days after this, believing himself to be better, the man began to redress the wound, and from it he saw the end of a stick protruding. A physician was called, and by traction the stick was withdrawn from between the 3d and 4th ribs; forty-nine days after the accident the wound had healed completely. Two years afterward the patient had an attack of cholera, but in the fifteen subsequent years he lived an active life of labor. Occasionally an enormous mass of hair has been removed from the stomach. A girl of twenty a with a large abdominal swelling was admitted to a hospital. Her illness began five years previously, with frequent attacks of vomiting, and on three occasions it was noticed that she became quite bald. Abdominal section was performed, the stomach opened, and from it was removed a mass of hair which weighed five pounds and three ounces. A good recovery ensued. In the Museum of St. George's Hospital, London, are masses of hair and string taken from the stomach and duodenum of a girl of ten. It is said that from the age of three the patient had been in the habit of eating these articles. There is a record in the last century of a boy of sixteen who ate all the hair he could find; after death his stomach and intestines were almost completely lined with hairy masses. In the Journal of the American Medical Association, March 1, 1896, there is a report of a case of hair-swallowing. Foreign Bodies in the Intestines.--White relates the history of a case in which a silver spoon was swallowed and successfully excised from the intestinal canal. Houston mentions a maniac who swallowed a rusty iron spoon 11 inches long. Fatal peritonitis ensued and the spoon was found impacted in the last acute turn of the duodenum. In 1895, in London, there was exhibited a specimen, including the end of the ileum with the adjacent end of the colon, showing a dessert spoon which was impacted in the latter. The spoon was seven inches long, and its bowl measured 1 1/2 inches across. There was much ulceration of the mucous membrane. This spoon had been swallowed by a lunatic of twenty-two, who had made two previous ineffectual attempts at suicide. Mason describes the case of a man of sixty-five who, after death by strangulated hernia, was opened, and two inches from the ileocecal valve was found an earthen egg-cup which he had swallowed. Mason also relates the instance of a man who swallowed metal balls 2 1/2 inches in diameter; and the case of a Frenchman who, to prevent the enemy from finding them, swallowed a box containing despatches from Napoleon. He was kept prisoner until the despatches were passed from his bowels. Denby discovered a large egg-cup in the ileum of a man. Fillion mentions an instance of recovery following the perforation of the jejunum by a piece of horn which had been swallowed. Madden tells of a person, dying of intestinal obstruction, in whose intestines were found several ounces of crude mercury and a plum-stone. The mercury had evidently been taken for purgative effect. Rodenbaugh mentions a most interesting case of beans sprouting while in the bowel. Harrison relates a curious case in which the swallowed lower epiphysis of the femur of a rabbit made its way from the bowel to the bladder, and was discharged thence by the urethra. In cases of appendicitis foreign bodies have been found lodged in or about the vermiform appendix so often that it is quite a common lay idea that appendicitis is invariably the result of the lodgment of some foreign body accidentally swallowed. In recent years the literature of this subject proves that a great variety of foreign bodies may be present. A few of the interesting cases will be cited in the following lines:-- In the New England Medical Journal, 1843, is an account of a vermiform appendix which was taken from the body of a man of eighty-eight who had died of pneumothorax. During life there were no symptoms of disease of the appendix, and after death no adhesions were found, but this organ was remarkably long, and in it were found 122 robin-shot. The old gentleman had been excessively fond of birds all his life, and was accustomed to bolt the meat of small birds without properly chewing it; to this fact was attributed the presence of these shot in the appendix. A somewhat similar case was that of a man who died in the Hotel-Dieu in 1833. The ileum of this man contained 92 shot and 120 plum stones. Buckler reports a case of appendicitis in a child of twelve, in which a common-sized bird-shot was found in the appendix. Packard presented a case of appendicitis in which two pieces of rusty and crooked wire, one 2 1/2 and the other 1 1/2 inches long, were found in the omentum, having escaped from the appendix. Howe describes a case in which a double oat, with a hard envelope, was found in the vermiform appendix of a boy of four years and one month of age. Prescott reports a case of what he calls fatal colic from the lodgment of a chocolate-nut in the appendix; and Noyes relates an instance of death in a man of thirty-one attributed to the presence of a raisin-seed in the vermiform appendix. Needles, pins, peanuts, fruit-stones, peas, grape-seeds, and many similar objects have been found in both normal and suppurative vermiform appendices. Intestinal Injuries.--The degree of injury that the intestinal tract may sustain, and after recovery perform its functions as usual, is most extraordinary; and even when the injury is of such an extent as to be mortal, the persistence of life is remarkable. It is a well known fact that in bull-fights, after mortal injuries of the abdomen and bowels, horses are seen to struggle on almost until the sport is finished. Fontaine reports a case of a Welsh quarryman who was run over by a heavy four-horse vehicle. The stump of a glass bottle was crushed into the intestinal cavity, and the bowels protruded and were bruised by the wheels of the wagon. The grit was so firmly ground into the bowel that it was impossible to remove it; yet the man made a complete recovery. Nicolls has the case of a man of sixty-nine, a workhouse maniac, who on August 20th attempted suicide by running a red-hot poker into his abdomen. His wound was dressed and he was recovering, but on September 11th he tore the cast off his abdomen, and pulled out of the wound the omentum and 32 inches of colon, which he tore off and threw between his pallet and the wall. Strange to say he did not die until eight days after this horrible injury. Tardieu relates the case of a chemist who removed a large part of the mesentery with a knife, and yet recovered. Delmas of Montpellier reports the history of a wagoner with complete rupture of the intestines and rupture of the diaphragm, and who yet finished his journey, not dying until eighteen hours after. Successful Intestinal Resection.--In 1755 Nedham of Norfolk reported the case of a boy of thirteen who was run over and eviscerated. It was found necessary to remove 57 inches of the protruding bowel, but the boy made a subsequent recovery. Koebererle of Strasburg performed an operation on a woman of twenty-two for the relief of intestinal obstruction. On account of numerous strictures it was found necessary to remove over two yards of the small intestine; the patient recovered without pain or trouble of any kind. In his dissertation on "Ruptures" Arnaud remarks that he cut away more than seven feet of gangrenous bowel, his patient surviving. Beehe reports recovery after the removal of 48 inches of intestine. The case was one of strangulation of an umbilical hernia. Sloughing of the Intestine Following Intussusception.--Lobstein mentions a peasant woman of about thirty who was suddenly seized with an attack of intussusception of the bowel, and was apparently in a moribund condition when she had a copious stool, in which she evacuated three feet of bowel with the mesentery attached. The woman recovered, but died five months later from a second attack of intussusception, the ileum rupturing and peritonitis ensuing. There is a record in this country of a woman of forty-five who discharged 44 inches of intestine, and who survived for forty-two days. The autopsy showed the sigmoid flexure gone, and from the caput ceci to the termination the colon only measured 14 inches. Vater gives a history of a penetrating abdominal wound in which a portion of the colon hung from the wound during fourteen years, forming an artificial anus. Among others mentioning considerable sloughing of intestine following intussusception, and usually with complete subsequent recovery, are Bare, 13 inches of the ileum; Blackton, nine inches; Bower, 14 inches; Dawson, 29 inches; Sheldon, 4 1/2 feet; Stanley, three feet; Tremaine, 17 inches; and Grossoli, 40 cm. Rupture of the Intestines.--It is quite possible for the intestine to be ruptured by external violence, and cases of rupture of all parts of the bowel have been recorded. Titorier gives the history of a case in which the colon was completely separated from the rectum by external violence. Hinder reports the rupture of the duodenum by a violent kick. Eccles, Ely, and Pollock also mention cases of rupture of the duodenum. Zimmerman, Atwell, and Allan report cases of rupture of the colon. Operations upon the gastrointestinal tract have been so improved in the modern era of antisepsis that at the present day they are quite common. There are so many successful cases on record that the whole subject deserves mention here. Gastrostomy is an operation for establishing a fistulous opening in the stomach through the anterior wall. Many operations have been devised, but the results of this maneuver in malignant disease have not thus far been very satisfactory. It is quite possible that, being an operation of a serious nature, it is never performed early enough, the patient being fatally weakened by inanition. Gross and Zesas have collected, respectively, 207 and 162 cases with surprisingly different rates of mortality: that of Gross being only 29.47 per cent, while that of Zesas was for cicatricial stenoses 60 per cent, and for malignant cases 84 per cent. It is possible that in Zesas's statistics the subjects were so far advanced that death would have resulted in a short time without operation. Gastrotomy we have already spoken of. Pyloroplasty is an operation devised by Heineke and Mikulicz, and is designed to remove the mechanic obstruction in cicatricial stenoses of the pylorus, at the same time creating a new pylorus. Gastroenterostomy and pylorectomy are operations devised for the relief of malignant disease of the pylorus, the diseased portions being removed and the parts resected. Gastrectomy or extirpation of the stomach is considered by most surgeons entirely unjustifiable, as there is seldom hope of cure or prospect of amelioration. La Tribune Medicale for January 16, 1895, gives an abstract of Langenbuch's contribution upon total extirpation of the stomach. Three patients were treated, of whom two died. In the first case, on opening the abdominal cavity the stomach was found very much contracted, presenting extensive carcinomatous infiltration on its posterior surface. After division of the epiploon section was made at the pylorus and at the cardiac extremities; the portions removed represented seven-eighths of the stomach. The pylorus was stitched to the remains of the cardiac orifice, making a cavity about the size of a hen's egg. In this case a cure was accomplished in three weeks. The second case was that of a man in whom almost the entire stomach was removed, and the pyloric and cardiac ends were stitched together in the wound of the parietes. The third case was that of a man of sixty-two with carcinoma of the pylorus. After pylorectomy, the line of suture was confined with iodoform-gauze packing. Unfortunately the patient suffered with bronchitis, and coughing caused the sutures to give way; the patient died of inanition on the twenty-third day. Enterostomy, or the formation of a fecal fistula above the ileocecal valve, was performed for the first time by Nelaton in 1840, but the mortality since 1840 has been so great that in most cases it is deemed inadmissible. Colostomy, an operation designed to make a fistulous opening in any portion of the rectum, was first practiced by Littre. In early times the mortality of inguinal colostomy was about five per cent, but has been gradually reduced until Konig reports 20 cases with only one death from peritonitis, and Cripps 26 cases with only one death. This will always retain its place in operative surgery as a palliative and life-saving operation for carcinomatous stenosis of the lower part of the colon, and in cases of carcinoma of the rectum in which operation is not feasible. Intestinal anastomosis, whereby two portions of a severed or resected bowel can be intimately joined, excluding from fecal circulation the portion of bowel which has become obstructed, was originally suggested by Maisonneuve, and was studied experimentally by von Hacken. Billroth resorted to it, and Senn modified it by substituting decalcified bone-plates for sutures. Since that time, Abbe, Matas, Davis, Brokaw, Robinson, Stamm, Baracz, and Dawburn, have modified the material of the plates used, substituting catgut rings, untanned leather, cartilage, raw turnips, potatoes, etc. Recently Murphy of Chicago has invented a button, which has been extensively used all over the world, in place of sutures and rings, as a means of anastomosis. Hardly any subject has had more discussion in recent literature than the merits of this ingenious contrivance. Foreign Bodies in the Rectum.--Probably the most celebrated case of foreign body introduced into the rectum is the classic one mentioned by Hevin. Some students introduced the frozen tail of a pig in the anus of a French prostitute. The bristles were cut short, and having prepared the passage with oil, they introduced the tail with great force into the rectum, allowing a portion to protrude. Great pain and violent symptoms followed; there was distressing vomiting, obstinate constipation, and fever. Despite the efforts to withdraw the tail, the arrangement of the bristles which allowed entrance, prevented removal. On the sixth day, in great agony, the woman applied to Marchettis, who ingeniously adopted the simple procedure of taking a long hollow reed, and preparing one of its extremities so that it could be introduced into the rectum, he was enabled to pass the reed entirely around the tail and to withdraw both. Relief was prompt, and the removal of the foreign body was followed by the issue of stercoraceous matter which had accumulated the six days it had remained in situ. Tuffet is quoted as mentioning a farmer of forty-six who, in masturbation, introduced a barley-head into his urethra. It was found necessary to cut the foreign body out of the side of the glans. A year later he put in his anus a cylindric snuff-box of large size, and this had to be removed by surgical methods. Finally, a drinking goblet was used, but this resulted in death, after much suffering and lay treatment. In his memoirs of the old Academy of Surgery in Paris, Morand speaks of a monk who, to cure a violent colic, introduced into his fundament a bottle of l'eau de la reine de Hongrie, with a small opening in its mouth, by which the contents, drop by drop, could enter the intestine. He found he could not remove the bottle, and violent inflammation ensued. It was at last necessary to secure a boy with a small hand to extract the bottle. There is a record of a case in which a tin cup or tumbler was pushed up the rectum and then passed into the colon where it caused gangrene and death. It was found to measure 3 1/2 by 3 1/2 by two inches. There is a French case in which a preserve-pot three inches in diameter was introduced into the rectum, and had to be broken and extracted piece by piece. Cloquet had a patient who put into his rectum a beer glass and a preserving pot. Montanari removed from the rectum of a man a mortar pestle 30 cm. long, and Poulet mentions a pederast who accidentally killed himself by introducing a similar instrument, 55 cm. long, which perforated his intestine. Studsgaard mentions that in the pathologic collection at Copenhagen there is a long, smooth stone, 17 cm. long, weighing 900 gm., which a peasant had introduced into his rectum to relieve prolapsus. The stone was extracted in 1756 by a surgeon named Frantz Dyhr. Jeffreys speaks of a person who, to stop diarrhea, introduced into his rectum a piece of wood measuring seven inches. There is a remarkable case recorded of a stick in the anus of a man of sixty, the superior extremity in the right hypochondrium, the inferior in the concavity of the sacrum. The stick measured 32 cm. in length; the man recovered. It is impossible to comprehend this extent of straightening of the intestine without great twisting of the mesocolon. Tompsett mentions that he was called to see a workman of sixty-five, suffering from extreme rectal hemorrhage. He found the man very feeble, without pulse, pale, and livid. By digital examination he found a hard body in the rectum, which he was sure was not feces. This body he removed with a polyp-forceps, and found it to be a cylindric candle-box, which measured six inches in circumference, 2 1/2 in length, and 1 1/2 in diameter. The removal was followed by a veritable flood of fecal material, and the man recovered. Lane reports perforation of the rectum by the introduction of two large pieces of soap; there was coincident strangulated hernia. Hunter mentions a native Indian, a resident of Coorla, who had introduced a bullock's horn high up into his abdomen, which neither he nor his friends could extract. He was chloroformed and placed in the lithotomy position, his buttocks brought to the edge of the bed, and after dilatation of the sphincter, by traction with the fingers and tooth-forceps, the horn was extracted. It measured 11 inches long. The young imbecile had picked it up on the road, where it had been rendered extremely rough by exposure, and this caused the difficulty in extraction. In Nelson's Northern Lancet, 1852, there is the record of a case of a man at stool, who slipped on a cow's horn, which entered the rectum and lodged beyond the sphincter. It was only removed with great difficulty. A convict at Brest put up his rectum a box of tools. Symptoms of vomiting, meteorism, etc., began, and became more violent until the seventh day, when he died. After death, there was found in the transverse colon, a cylindric or conic box, made of sheet iron, covered with skin to protect the rectum and, doubtless, to aid expulsion. It was six inches long and five inches broad and weighed 22 ounces. It contained a piece of gunbarrel four inches long, a mother-screw steel, a screw-driver, a saw of steel for cutting wood four inches long, another saw for cutting metal, a boring syringe, a prismatic file, a half-franc piece and four one-franc pieces tied together with thread, a piece of thread, and a piece of tallow, the latter presumably for greasing the instruments. On investigation it was found that these conic cases were of common use, and were always thrust up the rectum base first. In excitement this prisoner had pushed the conic end up first, thus rendering expulsion almost impossible. Ogle gives an interesting case of foreign body in the rectum of a boy of seventeen. The boy was supposed to be suffering with an abdominal tumor about the size of a pigeon's egg under the right cartilages; it had been noticed four months before. On admission to the hospital the lad was suffering with pain and jaundice; sixteen days later he passed a stick ten inches long, which he reluctantly confessed that he had introduced into the anus. During all his treatment he was conscious of the nature of his trouble, but he suffered rather than confess. Studsgaard mentions a man of thirty-five who, for the purpose of stopping diarrhea, introduced into his rectum a preserve-bottle nearly seven inches long with the open end uppermost. The next morning he had violent pain in the abdomen, and the bottle could be felt through the abdominal wall. It was necessary to perform abdominal section through the linea alba, divide the sigmoid flexure, and thus remove the bottle. The intestine was sutured and the patient recovered. The bottle measured 17 cm. long, five cm. in diameter at its lower end, and three cm. at its upper end. Briggs reports a case in which a wine glass was introduced into the rectum, and although removed twenty-four hours afterward, death ensued. Hockenhull extracted 402 stones from the rectum of a boy of seven. Landerer speaks of a curious case in which the absorptive power of the rectum was utilized in the murder of a boy of fifteen. In order to come into the possession of a large inheritance the murderess poisoned the boy by introducing the ends of some phosphorous matches into his rectum, causing death that night; there was intense inflammation of the rectum. The woman was speedily apprehended, and committed suicide when her crime was known. Complete transfixion of the abdomen does not always have a fatal issue. In fact, two older writers, Wisemann and Muys, testify that it is quite possible for a person to be transfixed without having any portion of the intestines or viscera wounded. In some nations in olden times, the extremest degree of punishment was transfixion by a stake. In his voyages and travels, in describing the death of the King of Demaa at the hands of his page, Mendez Pinto says that instead of being reserved for torture, as were his successors Ravaillac, and Gerard, the slayer of William the Silent, the assassin was impaled alive with a long stake which was thrust in at his fundament and came out at the nape of his neck. There is a record of a man of twenty-five, a soldier in the Chinese war of 1860, who, in falling from his horse, was accidentally transfixed by a bayonet. The steel entered his back two inches to the left of the last dorsal vertebra, and reappeared two inches to the left and below the umbilicus; as there was no symptom of visceral wound there were apparently no injuries except perforation of the parietes and the peritoneum. The man recovered promptly. Ross reports a case of transfixion in a young male aborigine, a native of New South Wales, who had received a spear-wound in the epigastrium during a quarrel; extraction was impossible because of the sharp-pointed barbs; the spear was, therefore, sawed off, and was removed posteriorly by means of a small incision. The edges of the wound were cleansed, stitched, and a compress and bandage applied. During the night the patient escaped and joined his comrades in the camp, and on the second day was suffering with radiating pains and distention. The following day it was found that the stitches and plaster had been removed, and the anterior wound was gaping and contained an ichorous discharge. The patient was bathing the wound with a decoction of the leaves of the red-gum tree. Notwithstanding that the spear measured seven inches, and the interference of treatment, the abdominal wound closed on the sixth day, and recovery was uninterrupted. Gilkrist mentions an instance in which a ramrod was fired into a soldier's abdomen, its extremity lodging in the spinal column, without causing the slightest evidence of wounds of the intestines or viscera. A minute postmortem examination was held some time afterward, the soldier having died by drowning, but the results were absolutely negative as regards any injury done by the passage of the ramrod. Humphreys says that a boy of eleven, while "playing soldier" with another boy, accidentally fell on a rick-stake. The stake was slightly curved at its upper part, being 43 inches long and three inches in circumference, and sharp-pointed at its extremity. As much as 17 1/2 inches entered the body of the lad. The stake entered just in front of the right spermatic cord, passed beneath Poupart's ligament into the cavity of the abdomen, traversed the whole cavity across to the left side; it then entered the thorax by perforating the diaphragm, displaced the heart by pushing it to the right of the sternum, and pierced the left lung. It then passed anteriorly under the muscles and integument in the axillary space, along the upper third of the humerus, which was extended beyond the head, the external skin not being ruptured. The stick remained in situ for four hours before attempts at extraction were made. On account of the displacement of the heart it was decided not to give chloroform. The boy was held down by four men, and Humphreys and his assistant made all the traction in their power. After removal not more than a teaspoonful of blood followed. The heart still remained displaced, and a lump of intestine about the size of an orange protruded from the wound and was replaced. The boy made a slow and uninterrupted recovery, and in six weeks was able to sit up. The testicle sloughed, but five months later, when the boy was examined, he was free from pain and able to walk. There was a slight enlargement of the abdomen and a cicatrix of the wound in the right groin. The right testicle was absent, and the apex of the heart was displaced about an inch. Woodbury reports the case of a girl of fourteen, who fell seven or eight feet directly upon an erect stake in a cart; the tuberosity was first struck, and then the stake passed into the anus, up the rectum for two inches, thence through the rectal wall, and through the body in an obliquely upward direction. Striking the ribs near the left nipple it fractured three, and made its exit. The stake was three inches in circumference, and 27 inches of its length passed into the body, six or seven inches emerging from the chest. This girl recovered so rapidly that she was able to attend school six weeks afterward. In a case reported by Bailey a middle-aged woman, while sliding down a hay-stack, struck directly upon a pitchfork handle which entered the vagina; the whole weight of the woman was successfully maintained by the cellular tissue of the uterovaginal culdesac. Minot speaks of the passage of one prong of a pitchfork through the body of a man of twenty-one, from the perineum to the umbilicus; the man recovered. Hamilton reports a case of laceration of the perineum with penetration of the pelvic cavity to the depth of ten inches by a stick 3/4 inch thick. Prowse mentions the history of a case of impalement in a man of thirty-four, who, coming down a hay-stack, alighted on the handle of a pitchfork which struck him in the middle of the scrotum, and passed up between the skin and fascia to the 10th rib. Recovery was prompt. There are several cases on record in which extensive wounds of the abdominal parietes with protrusion and injury to the intestine have not been followed by death. Injuries to the intestines themselves have already been spoken of, but there are several cases of evisceration worthy of record. Doughty says that at midnight on June 7, 1868, he was called to see a man who had been stabbed in a street altercation with a negro. When first seen in the street, the patient was lying on his back with his abdomen exposed, from which protruded an enormous mass of intestines, which were covered with sand and grit; the small intestine (ileum) was incised at one point and scratched at another by the passing knife. The incision, about an inch in length, was closed with a single stitch of silk thread, and after thorough cleansing the whole mass was returned to the abdominal cavity. In this hernial protrusion were recognized four or five feet of the ileum, the cecum with its appendix, part of the ascending colon with corresponding portions of the mesentery; the distribution of the superior mesentery, made more apparent by its living pulsation, was more beautifully displayed in its succession of arches than in any dissection that Doughty had ever witnessed. Notwithstanding the extent of his injuries the patient recovered, and at last reports was doing finely. Barnes reports the history of a negro of twenty-five who was admitted to the Freedmen's Hospital, New Orleans, May 15, 1867, suffering from an incised wound of the abdomen, from which protruded eight inches of colon, all of the stomach, and nearly the whole of the small intestines. About 2 1/2 feet of the small intestine, having a whitish color, appeared to be filled with food and had much of the characteristic feeling of a sausage. The rest of the small intestine had a dark-brown color, and the stomach and colon, distended with gas, were leaden-colored. The viscera had been exposed to the atmosphere for over an hour. Having nothing but cold Mississippi water to wash them with, Barnes preferred returning the intestines without any attempt at removing blood and dirt further than wiping with a cambric handkerchief and the stripping they would naturally be subjected to in being returned through the opening. In ten minutes they were returned; they were carefully examined inch by inch for any wound, but none was found. Three silver sutures were passed through the skin, and a firm compress applied. The patient went to sleep shortly after his wound was dressed, and never had a single subsequent bad symptom; he was discharged on May 24th, the wound being entirely healed, with the exception of a cartilage of a rib which had not reunited. Rogers mentions the case of a carpenter of thirty-six who was struck by a missile thrown by a circular saw, making a wound two inches above the umbilicus and to the left. Through the opening a mass of intestines and a portion of the liver, attached by a pedicle, protruded. A portion of the liver was detached, and the liver, as well as the intestines, were replaced, and the man recovered. Baillie, Bhadoory, Barker, Edmundson, Johnson, and others, record instances of abdominal wounds accompanied by extensive protrusion of the intestines, and recovery. Shah mentions an abdominal wound with protrusion of three feet of small intestine. By treatment with ice, phenol, and opium, recovery was effected without peritonitis. Among nonfatal perforating gunshot wounds of the abdomen, Loring: reports the case of a private in the First Artillery who recovered after a double gunshot perforation of the abdomen. One of the balls entered 5 1/2 inches to the left of the umbilicus, and two inches above the crest of the ilium, making its exit two inches above the crest of the ilium, on a line with and two inches from the 4th lumbar vertebra. The other ball entered four inches below and to the rear of the left nipple, making its exit four inches directly below the point of entrance. In their passages these balls did not wound any of the viscera, and with the exception of traumatic fever there was no disturbance of the health of the patient. Schell records the case of a soldier who was wounded July 3, 1867, by a conoid ball from a Remington revolver of the Army pattern. The ball entered on the left side of the abdomen, its lower edge grazing the center of Poupart's ligament, and passing backward, inward, and slightly upward, emerged one inch to the left of the spinous process of the sacrum. On July 6th all the symptoms of peritonitis made their appearance. On July 11th there was free discharge of fecal matter from both anterior and posterior wounds. This discharge continued for three days and then ceased. By August 12th both wounds were entirely healed. Mineer reports a case of a wound from a revolver-ball entering the abdomen, passing through the colon, and extracted just above the right ilium. Under simple treatment the patient recovered and was returned to duty about ten weeks afterward. There are a number of cases on record in which a bullet entering the abdominal cavity is subsequently voided either by the bladder or by the bowel. Ducachet mentions two cases at the Georgetown Seminary Hospital during the late war in which Minie balls entering the abdominal wall were voided by the anus in a much battered condition. Bartlett reports the case of a young man who was accidentally shot in the abdomen with a Colt's revolver. Immediately after the accident he complained of constant and pressing desire to void his urine. While urinating on the evening of the third day, the ball escaped from the urethra and fell with a click into the chamber. After the discharge of the ball the intolerable symptoms improved, and in two or three weeks there was complete recovery. Hoag mentions a man who was wounded by a round musket-ball weighing 400 grains. It had evidently passed through the lung and diaphragm and entered the alimentary canal; it was voided by the rectum five days after the injury. Lenox mentions the fact of a bullet entering the abdominal wall and subsequently being passed from the rectum. Day and Judkins report similar cases. Rundle speaks of the lodgment of a bullet, and its escape, after a period of seven and one-half years, into the alimentary canal, causing internal strangulation and death. Wounds of the liver often end very happily, and there are many cases on record in which such injuries have been followed by recovery, even when associated with considerable loss of liver-substance. In the older records, Glandorp and Scultetus mention cures after large wounds of the liver. Fabricius Hildanus reports a case that ended happily, in which a piece of liver was found in the wound, having been separated by a sword-thrust. There is a remarkable example of recovery after multiple visceral wounds, self-inflicted by a lunatic. This man had 18 wounds, 14 having penetrated the abdomen, the liver, colon, and the jejunum being injured; by frequent bleeding, strict regimen, dressing, etc., he recovered his health and senses, but relapsing a year and a half later, he again attempted suicide, which gave the opportunity for a postmortem to learn the extent of the original injuries. Plater, Schenck, Cabrolius, the Ephemerides, and Nolleson mention recovery after wounds of the liver. Salmuth and the Ephemerides report questionable instances in which portions of the liver were ejected in violent vomiting. Macpherson describes a wound of the liver occurring in a Hindoo of sixty who had been struck by a spear. A portion of the liver was protruding, and a piece weighing 1 1/4 ounces was removed, complete recovery following. Postempski mentions a case of suture of the liver after a stab-wound. Six sutures of chromicized cat-gut were carefully tightened and fastened with a single loop. The patient left his bed on the sixth day and completely recovered. Gann reports a case of harpoon-wound of the liver. While in a dory spearing fish in the Rio Nuevo, after a sudden lurch of the boat, a young man of twenty-eight fell on the sharp point of a harpoon, which penetrated his abdomen. About one inch of the harpoon was seen protruding from below the tip of the ensiform cartilage; the harpoon was seven inches long. It was found that the instrument had penetrated the right lobe of the liver; on passing the hand backward along the inferior surface of the liver, the point could be felt projecting through its posterior border. On account of two sharp barbs on the spear-point, it was necessary to push the harpoon further in to disengage the barbs, after which it was easily removed. Recovery followed, and the patient was discharged in twenty-one days. Romme discusses the subject of punctured wounds of the liver, as a special text using the case of the late President Carnot. He says that in 543 cases of traumatism of the liver collected by Elder, 65 were caused by cutting or sharp-pointed instruments. Of this group, 23 recovered and 42 died. The chief causes of death were hemorrhage and peritonitis. The principal symptoms of wounds of the liver, such as traumatic shock, collapse, local and radiating pains, nausea, vomiting, and respiratory disturbances were all present in the case of President Carnot. From an experience gained in the case of the President, Romme strongly recommends exploratory celiotomy in all penetrating wounds of the liver. Zeidler reports three cases of wound of the liver in which recovery ensued. The hemorrhage in one case was arrested by the tampon, and in the other by the Pacquelin cautery. McMillan describes a man of twenty who was kicked by a horse over the liver and rupturing that organ. A large quantity of offensive fluid was drawn off from the liver, and the man recovered. Frazer reports a case of rupture of liver and kidney in a boy of thirteen who was squeezed between the tire and driving chain of a mill, but who recovered despite his serious symptoms. Allen mentions recovery after an extensive incised wound of the abdomen, liver, and lung. Massie cites an instance of gunshot wound of the right hypochondrium, with penetration and protrusion of the liver. The patient, a boy of seven, recovered after excision of a small part of the protruding liver. Lawson Tait has incised the liver to the extent of three inches, evacuated two gallons of hydatids, and obtained successful recovery in ten weeks. There are several cases of wound of the liver followed by recovery reported by surgeons of the United States Army. Whitehead mentions a man of twenty-two who on June 3, 1867, was shot in the liver by a slug from a pistol. At the time of the injury he bled freely from the wound of entrance continuing to lose blood and bile until daylight the next morning, when the hemorrhage ceased, but the flow of bile kept on. By June 10th there was considerable improvement, but the wound discharged blood-clots, bile, and serum. When the patient left the hospital on July 15th the wound was healthy, discharging less than 1 1/2 ounces during the twenty-four hours, of a mixture of free bile, and bile mixed with thick material. When last heard from--July 27, 1867--the patient was improving finely in flesh and strength. McKee mentions a commissary-sergeant stationed at Santa Fe, New Mexico, who recovered after a gunshot wound of the liver. Hassig reports the case of a private of twenty-six who was wounded in a fray near Paducah, Kentucky, by a conoid ball, which passed through the liver. The ball was cut out the same day. The patient recovered and was returned to duty in May, 1868. Patzki mentioned a private in the Sixth Cavalry, aged twenty-five, who recovered from a gunshot wound of the abdomen, penetrating the right lobe of the liver and the gall-bladder. Resection of the Liver.--It is remarkable to what extent portions of the liver may be resected by the knife, cautery, or ligature, and the patient recover. Langenbuch records a case in which he successfully removed the greater portion of the left lobe of a woman of thirty. The lobe had been extensively deformed by tight lacing, and caused serious inconvenience. There was considerable hemorrhage, but the vessels were secured, and the woman made a good recovery. McWhinnie, in The Lancet, records a case of dislodgment of an enlarged liver from tight lacing. Terrilon mentions an instance in which a portion of the liver was removed by ligature after celiotomy. The ligature was removed in seven days, and the sphacelated portion of the liver came off with it. A cicatrix was completed at the end of six weeks, and the patient, a woman of fifty-three, made an excellent recovery. Bastianelli discusses those cases in which portions of the liver, having been constricted from the general body of the organ and remaining attached by a pedicle, give rise to movable tumors of the abdomen. He records such a case in a woman of thirty-seven who had five children. A piece of liver weighing 500 grams was removed, and with it the gall-bladder, and the patient made an uninterrupted recovery. Tricomi reports a case in which it was found necessary to remove the left lobe of the liver. An attempt had been made to remove a liver-tumor the size of a fist by constricting the base with an elastic ligature. This attempt was a failure, and cure was also unsuccessfully attempted by wire ligature and the thermocautery. The growth was cut away, bleeding was arrested by the thermocautery and by iron-solution, the wound entirely healed, and the patient recovered. Valerian von Meister has proved that the liver has marvelous powers of regeneration, and that in rabbits, cats, and dogs, even three-fourths of the organ may be reproduced in from forty-five to sixty-five days. This regeneration is brought about chiefly by hypertrophy of the lobules. Floating liver is a rare malady in which the liver forms an abdominal prominence that may be moved about, and which changes its situation as the patient shifts the attitude. The condition usually arises from a lax abdominal wall following repeated pregnancies. The accompanying illustration exhibits a typical case verified by postmortem examination. Hypertrophy of the Liver.--The average weight of the normal liver is from 50 to 55 ounces, but as noted by Powell, it may become so hypertrophic as to weigh as much as 40 pounds. Bonet describes a liver weighing 18 pounds; and in his "Medical and Surgical Observations," Gooch speaks of a liver weighing 28 pounds. Vieussens, the celebrated anatomist, reports an instance in which the liver weighed 20 pounds, and in his "Aphorisms," Vetter cites a similar instance. In 1811 Kraus of Germany describes a liver weighing 25 pounds; modern instances of enlarged liver are too numerous to be quoted here. Rupture of the gall-bladder, although generally followed by death, is not always fatal. In such cases bile is usually found in the abdominal cavity. Fergus mentions a case in which, after this accident, the patient was considered convalescent and was walking about, when, on the seventh day, peritonitis suddenly developed and proved fatal in two days. Several cases of this accident have been reported as treated successfully by incision and drainage (Lane) or by inspiration (Bell). In these cases large quantities of bile escaped into the abdominal cavity. Peritonitis does not necessarily follow. Cholecystotomy for the relief of the distention of the gall-bladder from obstruction of the common or cystic duct and for the removal of gall-stones was first performed in 1867 by Bobbs of Indianapolis, but it is to Marion Sims, in 1878, that perfection of the operation is due. It has been gradually improved and developed, until today it is a most successful operation. Tait reports 54 cases with 52 perfect recoveries. Cholyecystectomy, or excision of the gall-bladder, was first practiced in 1880 by Langenbuch of Berlin, and is used in cases in which gall-stones are repeatedly forming. Ashhurst's statistics show only four deaths in 28 cases. At St. Bartholomew's Hospital, in London, is a preserved specimen of a gall-bladder which had formed the contents of a hernial sac, and which, near the fundus, shows a constriction caused by the femoral ring. It was taken from a woman of forty-five who was admitted into the hospital with a strangulated femoral hernia. The sac was opened and its contents were returned. The woman died in a few days from peritonitis. The gall-bladder was found close to the femoral ring, and showed a marked constriction. The liver was misshapen from tight lacing, elongated and drawn downward toward the ring. There was no evidence that any portion of intestine or other structure besides the gall-bladder had passed through the ring. The fatality of rupture of the spleen is quite high. Out of 83 cases of injury to this organ collected by Elder, and quoted by MacCormac, only 11 recovered; but the mortality is less in punctured or incised wounds of this organ, the same authorities mentioning 29 recoveries out of 35 cases. In his "Surgery" Gooch says that at the battle of Dettingen one of Sir Robert Rich's Dragoons was left all night on the field, weltering in his blood, his spleen hanging out of his body in a gangrenous state. The next morning he was carried to the surgeons who ligated the large vessels, and extirpated the spleen; the man recovered and was soon able to do duty. In the Philosophical Transactions there is a report of a man who was wounded in the spleen by a large hunting-knife. Fergusson found the spleen hanging from the wound and ligated it. It separated in ten days and the patient recovered. Williams reports a stab-wound of the spleen in a negro of twenty-one. The spleen protruded, and the protruding part was ligated by a silver wire, one-half of the organ sloughing off; the patient recovered. Sir Astley Cooper mentions a curious case, in which, after vomiting, during which the spleen was torn from its attachments, this organ produced a swelling in the groin which was supposed to be a hernia. The vomiting continued, and at the end of a week the woman died; it was then found that the spleen had been turned half round on its axis, and detached from the diaphragm; it had become enlarged; the twist interrupted the return of the blood. Portal speaks of a rupture of the spleen simply from engorgement. There was no history of a fall, contusion, or other injury. Tait describes a case of rupture of the spleen in a woman who, in attempting to avoid her husband's kick, fell on the edge of the table. There were no signs of external violence, but she died the third day afterward. The abdomen was found full of blood, and the spleen and peritoneal covering was ruptured for three inches. Splenectomy, excision of the spleen, has been performed a number of times, with varying results, but is more successful when performed for injury than when for disease. Ashhurst has tabulated a total of 109 operations, 27 having been for traumatic causes, and all but five having terminated successfully; of 82 operations for disease, only 32 recovered. Vulpius has collected 117 cases of splenectomy, with a death-rate of 50 per cent. If, however, from these cases we deduct those suffering with leukocythemia and lardaceous spleen, in which the operation should not be performed, the mortality in the remaining 85 cases is reduced to 33 per cent. Terrier speaks of splenectomy for torsion or twisting of the pedicle, and such is mentioned by Sir Astley Cooper, who has found records of only four such cases. Conklin reports a successful case of splenectomy for malarial spleen, and in reviewing the subject he says that the records of the past decade in operations for simple hypertrophy, including malaria, show 20 recoveries and eight deaths. He also adds that extirpation in cases of floating or displaced spleen was attended with brilliant results. Zuccarelli is accredited with reporting two cases of splenectomy for malarial spleen, both of which recovered early. He gives a table of splenectomies performed in Italy, in which there were nine cases of movable spleen, with two deaths; eight cases of simple hypertrophy, with three deaths; 12 cases of malarial spleen, with three deaths; four cases of leukemia and pseudoleukemia, with two deaths. In his experiments on rabbits it was proved by Tizzoni, and in his experiments on dogs, by Crede, that an individual could live without a spleen; but these observations were only confirmatory of what had long been known, for, in 1867, Pean successfully removed a spleen from a woman of twenty. Tricomi reports eight cases in which he had extirpated the spleen for various morbid conditions, with a fortunate issue in all but one. In one case he ligated the splenic artery. In The Lancet there is an account of three recent excisions of the spleen for injury at St. Thomas Hospital in London, and it is added that they are among the first of this kind in Great Britain. Abnormalities of Size of the Spleen.--The spleen may be extremely small. Storck mentions a spleen that barely weighed an ounce; Schenck speaks of one in the last century that weighed as much as 20 pounds. Frank describes a spleen that weighed 16 pounds; there is another record of one weighing 15 pounds. Elliot mentions a spleen weighing 11 pounds; Burrows one, 11 pounds; Blasius, four pounds; Osiander, nine pounds; Blanchard, 31 pounds; Richardson, 3 1/2 pounds; and Hare, 93 ounces. The thoracic duct, although so much protected by its anatomical position, under exceptional circumstances has been ruptured or wounded. Kirchner has collected 17 cases of this nature, two of which were due to contusions of the chest, one each to a puncture, a cut, and a shot-wound, and three to erosion from suppuration. In the remaining cases the account fails to assign a definite cause. Chylothorax, or chylous ascites, is generally a result of this injury. Krabbel mentions a patient who was run over by an empty coal car, and who died on the fifth day from suffocation due to an effusion into the right pleural cavity. On postmortem examination it was found that the effusion was chyle, the thoracic duct being torn just opposite the 9th dorsal vertebra, which had been transversely fractured. In one of Kirchner's cases a girl of nine had been violently pushed against a window-sill, striking the front of her chest in front of the 3d rib. She suffered from pleural effusion, which, on aspiration, proved to be chyle. She ultimately recovered her health. In 1891 Eyer reported a case of rupture of the thoracic duct, causing death on the thirty-eighth day. The young man had been caught between a railroad car and an engine, and no bones were broken. Manley reports a case of rupture of the thoracic duct in a man of thirty-five, who was struck by the pole of a brewery wagon; he was knocked down on his back, the wheel passing squarely over his abdomen. There was subsequent bulging low down in the right iliac fossa, caused by the presence of a fluid, which chemic and microscopic examination proved was chyle. From five to eight ounces a day of this fluid were discharged, until the tenth day, when the bulging was opened and drained. On the fifteenth day the wound was healed and the man left the hospital quite restored to health. Keen has reported four instances of accidental injury to the thoracic duct, near its termination at the base of the left side of the neck; the wounding was in the course of removals for deep-seated growths in this region. Three of the cases recovered, having sustained no detriment from the injury to the thoracic duct. One died; but the fatal influence was not specially connected with the wound of the duct. Possibly the boldest operation in the history of surgery is that for ligation of the abdominal aorta for inguinal aneurysm. It was first practiced by Sir Astley Cooper in 1817, and has since been performed several times with a uniformly fatal result, although Monteiro's patient survived until the tenth day, and there is a record in which ligature of the abdominal aorta did not cause death until the eleventh day. Loreta of Bologna is accredited with operating on December 18, 1885, for the relief of a sailor who was suffering from an abdominal aneurysm caused by a blow. An incision was made from the ensiform cartilage to the umbilicus, the aneurysm exposed, and its cavity filled up with two meters of silver-plated wire. Twenty days after no evidence of pulsation remained in the sac, and three months later the sailor was well and able to resume his duties. Ligation of the common iliac artery, which, in a case of gunshot injury, was first practiced by Gibson of Philadelphia in 1812, is, happily, not always fatal. Of 82 cases collected by Ashhurst, 23 terminated successfully. Foreign bodies loose in the abdominal cavity are sometimes voided at stool, or may suppurate externally. Fabricius Hildanus gives us a history of a person wounded with a sword-thrust into the abdomen, the point breaking off. The sword remained one year in the belly and was voided at stool. Erichsen mentions an instance in which a cedar lead-pencil stayed for eight months in the abdominal cavity. Desgranges gives a case of a fish-spine in the abdominal cavity, and ten years afterward it ulcerated through an abscess in the abdominal wall. Keetley speaks of a man who was shot when a boy; at the time of the accident the boy had a small spelling-book in his pocket. It was not until adult life that from an abscess of the groin was expelled what remained of the spelling-book that had been driven into the abdomen during boyhood. Kyle speaks of the removal of a corn-straw 33 inches in length by an incision ten inches long, at a point about equidistant from the umbilicus to the anterior spinous process of the right ilium. There are several instances on record of tolerance of foreign bodies in the skin and muscles of the back for an extended period. Gay speaks of a curious case in which the point of a sheath-knife remained in the back of an individual for nine years. Bush reported to Sir Astley Cooper the history of a man who, as he supposed, received a wound in the back by canister shot while serving on a Tartar privateer in 1779. There was no ship-surgeon on board, and in about a month the wound healed without surgical assistance. The man suffered little inconvenience and performed his duties as a seaman, and was impressed into the Royal Navy. In August, 1810, he complained of pain in the lumbar region. He was submitted to an examination, and a cicatrix of this region was noticed, and an extraneous body about 1/2 inch under the integument was felt. An incision was made down it, and a rusty blade of a seaman's clasp-knife extracted from near the 3d lumbar vertebra. The man had carried this knife for thirty years. The wound healed in a few days and there was no more inconvenience. Fracture of the lower part of the spine is not always fatal, and notwithstanding the lay-idea that a broken back means certain death, patients with well-authenticated cases of vertebral fracture have recovered. Warren records the case of a woman of sixty who, while carrying a clothes-basket, made a misstep and fell 14 feet, the basket of wet clothes striking the right shoulder, chest, and neck. There was fracture of the 4th dorsal vertebra at the transverse processes. By seizing the spinous process it could be bent backward and forward, with the peculiar crepitus of fractured bone. The clavicle was fractured two inches from the acromial end, and the sternal end was driven high up into the muscles of the neck. The arm and hand were paralyzed, and the woman suffered great dyspnea. There was at first a grave emphysematous condition due to the laceration of several broken ribs. There was also suffusion and ecchymosis about the neck and shoulder. Although complicated with tertiary syphilis, the woman made a fair recovery, and eight weeks later she walked into a doctor's office. Many similar and equally wonderful injuries to the spine are on record. The results sometimes following the operation of laminectomy for fracture of the vertebrae are often marvelous. One of the most successful on record is that reported by Dundore. The patient was a single man who lived in Mahanoy, Pa., and was admitted to the State Hospital for Injured Persons, Ashland, Pa., June 17, 1889, suffering from a partial dislocation of the 9th dorsal vertebra. The report is as follows--"He had been a laborer in the mines, and while working was injured March 18, 1889, by a fall of top rock, and from this date to that of his admission had been under the care of a local physician without any sign of improvement. At the time of his admission he weighed but 98 pounds, his weight previous to the injury being 145. He exhibited entire loss of motion in the lower extremities, with the exception of very slight movement in the toes of the left foot; sensation was almost nil up to the hips, above which it was normal; he had complete retention of urine, with a severe cystitis. His tongue was heavily coated, the bowels constipated, and there was marked anorexia, with considerable anemia. His temperature varied from 99 degrees to 100 degrees in the morning, and from 101 degrees to 103 degrees in the evening. The time which had elapsed since the accident precluded any attempt at reduction, and his anemic condition would not warrant a more radical method. "He was put on light, nourishing diet, iron and strychnin were given internally, and electricity was applied to the lower extremities every other day; the cystitis was treated by irrigating the bladder each day with Thiersch's solution. By August his appetite and general condition were much improved, and his weight had increased to 125 pounds, his temperature being 99 degrees or less each morning, and seldom as high as 100 degrees at night. The cystitis had entirely disappeared, and he was able, with some effort, to pass his urine without the aid of a catheter. Sensation in both extremities had slightly improved, and he was able to slightly move the toes of the right foot. This being his condition, an operation was proposed as the only means of further and permanent improvement, and to this he eagerly consented, and, accordingly, on the 25th of August, the 9th dorsal vertebra was trephined. "The cord was found to be compressed and greatly congested, but there was no evidence of laceration. The laminae and spinous processes of the 8th and 9th dorsal vertebrae were cut away, thus relieving all pressure on the cord; the wound was drained and sutured, and a plaster-of-Paris jacket applied, a hole being cut out over the wound for the purpose of changing the dressing when necessary. By September 1st union was perfect, and for the next month the patient remained in excellent condition, but without any sign of improvement as to sensation and motion. Early in October he was able to slightly move both legs, and had full control of urination; from this time on his paralysis rapidly improved; the battery was applied daily, with massage morning and evening; and in November the plaster-of-Paris jacket was removed, and he propelled himself about the ward in a rolling chair, and shortly after was able to get about slowly on crutches. He was discharged December 23d, and when I saw him six months later he walked very well and without effort; he carried a cane, but this seemed more from habit than from necessity. At present date he weighs 150 pounds, and drives a huckster wagon for a living, showing very little loss of motion in his lower extremities." Although few cases show such wonderful improvement as this one, statistics prove that the results of this operation are sometimes most advantageous. Thorburn collects statistics of 50 operations from 1814 to 1885, undertaken for relief of injuries of the spinal cord. Lloyd has compiled what is possibly the most extensive collection of cases of spinal surgery, his cases including operations for both disease and injury. White has collected 37 cases of recent date; and Chipault reports two cases, and collected 33 cases. Quite a tribute to the modern treatment by antisepsis is shown in the results of laminectomy. Of his non-antiseptic cases Lloyd reports a mortality of 65 per cent; those surviving the operation are distributed as follows: Cured, one; partially cured, seven; unknown, two; no improvement, five. Of those cases operated upon under modern antiseptic principles, the mortality was 50 per cent; those surviving were distributed as follows: Cured, four; partially cured, 15; no improvement, 11. The mortality in White's cases, which were all done under antiseptic precautions, was 38 per cent. Of those surviving, there were six complete recoveries, six with benefit, and 11 without marked benefit. Pyle collects 52 cases of spinal disease and injury, in which laminectomy was performed. All the cases were operated upon since 1890. Of the 52 cases there were 15 deaths (a mortality of 29.4 per cent), 26 recoveries with benefit, and five recoveries in which the ultimate result has not been observed. It must be mentioned that several of the fatal cases reported were those of cervical fracture, which is by far the most fatal variety. Injury to the spinal cord does not necessarily cause immediate death. Mills and O'Hara, both of Philadelphia, have recorded instances of recovery after penetrating wound of the spinal marrow. Eve reports three cases of gunshot wound in which the balls lodged in the vertebral canal, two of the patients recovering. He adds some remarks on the division of the spinal cord without immediate death. Ford mentions a gunshot wound of the spinal cord, the patient living ten days; after death the ball was found in the ascending aorta. Henley speaks of a mulatto of twenty-four who was stabbed in the back with a knife. The blade entered the body of the 6th dorsal vertebra, and was so firmly embedded that the patient could be raised entirely clear of the bed by the knife alone. An ultimate recovery ensued. Although the word hernia can be construed to mean the protrusion of any viscus from its natural cavity through normal or artificial openings in the surrounding structures, the usual meaning of the word is protrusion of the abdominal contents through the parietes--what is commonly spoken of as rupture. Hernia may be congenital or acquired, or may be single or multiple--as many as five having been seen in one individual. More than two-thirds of cases of rupture suffer from inguinal hernia In the oblique form of inguinal hernia the abdominal contents descend along the inguinal canal to the outer side of the epigastric artery, and enter the scrotum in the male, and the labium majus in the female. In this form of hernia the size of the sac is sometimes enormous, the accompanying illustration showing extreme cases of both scrotal and labial hernia. Umbilical hernia may be classed under three heads: congenital, infantile, and adult. Congenital umbilical hernia occurs most frequently in children, and is brought about by the failure of the abdominal walls to close. When of large size it may contain not only the intestines, but various other organs, such as the spleen, liver, etc. In some monsters all the abdominal contents are contained in the hernia. Infantile umbilical hernia is common, and appears after the separation of the umbilical cord; it is caused by the yielding of the cicatrix in this situation. It never reaches a large size, and shows a tendency to spontaneous cure. Adult umbilical hernia rarely commences in infancy. It is most commonly seen in persons with pendulous bellies, and is sometimes of enormous size, in addition to the ordinary abdominal contents, containing even the stomach and uterus. A few years since there was a man in Philadelphia past middle age, the victim of adult umbilical hernia so pendulous that while walking he had to support it with his arms and hands. It was said that this hernia did not enlarge until after his service as a soldier in the late war. Abbott recites the case of an Irish woman of thirty-five who applied to know if she was pregnant. No history of a hernia could be elicited. No pregnancy existed, but there was found a ventral hernia of the abdominal viscera through an opening which extended the entire length of the linea alba, and which was four inches wide in the middle of the abdomen. Pim saw a colored woman of twenty-four who, on December 29, 1858, was delivered normally of her first child, and who died in bed at 3 A.M. on February 12, 1859. The postmortem showed a tumor from the ensiform cartilage to the symphysis pubis, which contained the omentum, liver (left lobe), small intestines, and colon. It rested upon the abdominal muscles of the right side. The pelvic viscera were normally placed and there was no inguinal nor femoral hernia. Hulke reports a case remarkable for the immense size of the rupture which protruded from a spot weakened by a former abscess. There was a partial absence of the peritoneal sac, and the obstruction readily yielded to a clyster and laxative. The rupture had a transverse diameter of 14 1/2 inches, with a vertical diameter of 11 1/2 inches. The opening was in the abdominal walls outside of the internal inguinal ring. The writhings of the intestines were very conspicuous through the walls of the pouch. Dade reports a case of prodigious umbilical hernia. The patient was a widow of fifty-eight, a native of Ireland. Her family history was good, and she had never borne any children. The present dimensions of the tumor, which for fifteen years had been accompanied with pain, and had progressively increased in size, are as follows: Circumference at the base, 19 1/2 inches; circumference at the extremity, 11 1/4 inches; distance of extremity from abdominal wall, 12 3/4 inches. Inspection showed a large lobulated tumor protruding from the abdominal wall at the umbilicus. The veins covering it were prominent and distended. The circulation of the skin was defective, giving it a blue appearance. Vermicular contractions of the small intestines could be seen at the distance of ten feet. The tumor was soft and velvety to the touch, and could only partially be reduced. Borborygmus could be easily heard. On percussion the note over the bulk was tympanitic, and dull at the base. The distal extremity contained a portion of the small intestine instead of the colon, which Wood considered the most frequent occupant. The umbilicus was completely obliterated. Dade believed that this hernia was caused by the weakening of the abdominal walls from a blow, and considered that the protrusion came from an aperture near the umbilicus and not through it, in this manner differing from congenital umbilical hernia. A peculiar form of hernia is spontaneous rupture of the abdominal walls, which, however, is very rare. There is an account of such a case in a woman of seventy-two living in Pittsburg, who, after a spasmodic cough, had a spontaneous rupture of the parietes. The rent was four inches in length and extended along the linea alba, and through it protruded a mass of omentum about the size of a child's head. It was successfully treated and the woman recovered. Wallace reports a case of spontaneous rupture of the abdominal wall, following a fit of coughing. The skin was torn and a large coil of ileum protruded, uncovered by peritoneum. After protracted exposure of the bowel it was replaced, the rent was closed, and the patient recovered. CHAPTER XIII. SURGICAL ANOMALIES OF THE GENITO-URINARY SYSTEM. Wounds of the kidney may be very severe without causing death, and even one entire kidney may be lost without interfering with the functions of life. Marvand, the Surgeon-Major of an Algerian regiment, reports the case of a young Arab woman who had been severely injured in the right lumbar region by a weapon called a "yataghan," an instrument which has only one cutting edge. On withdrawing this instrument the right kidney was extruded, became strangulated between the lips of the wound, and caused considerable hemorrhage. A ligature was put around the base of the organ, and after some weeks the mass separated. The patient continued in good health the whole time, and her urinary secretion was normal. She was discharged in two months completely recovered. Price mentions the case of a groom who was kicked over the kidney by a horse, and eighteen months later died of dropsy. Postmortem examination showed traces of a line of rupture through the substance of the gland; the preparation was deposited in St. George's Hospital Museum in London. The case is singular in that this man, with granular degeneration of the kidney, recovered from so extensive a lesion, and, moreover, that he remained in perfect health for over a year with his kidney in a state of destructive disease. Borthwick mentions a dragoon of thirty who was stabbed by a sword-thrust on the left side under the short rib, the sword penetrating the pelvis and wounding the kidney. There was no hemorrhage from the external wound, nor pain in the spermatic cord or testicle. Under expectant treatment the man recovered. Castellanos mentions a case of recovery from punctured wound of the kidney by a knife that penetrated the tubular and cortical substance, and entered the pelvis of the organ. The case was peculiar in the absence of two symptoms, viz., the escape of urine from the wound, and retraction of the corresponding testicle. Dusenbury reports the case of a corporal in the army who was wounded on April 6, 1865, the bullet entering both the liver and kidney. Though there was injury to both these important organs, there was no impairment of the patient's health, and he recovered. Bryant reports four cases of wound of the kidney, with recovery. All of these cases were probably extraperitoneal lacerations or ruptures. Cock found a curious anomaly in a necropsy on the body of a boy of eighteen, who had died after a fall from some height. There was a compound, transverse rupture of the left kidney, which was twice as large as usual, the ureter also being of abnormal size. Further search showed that the right kidney was rudimentary, and had no vein or artery. Ward mentions a case of ruptured kidney, caused by a fall of seven feet, the man recovering after appropriate treatment. Vernon reports a case of serious injury to the kidney, resulting in recovery in nine weeks. The patient fell 40 feet, landing on some rubbish and old iron, and received a wound measuring six inches over the right iliac crest, through which the lower end of the right kidney protruded; a piece of the kidney was lost. The case was remarkable because of the slight amount of hemorrhage. Nephrorrhaphy is an operation in which a movable or floating kidney is fixed by suture through its capsule, including a portion of kidney-substance, and then through the adjacent lumbar fascia and muscles. The ultimate results of this operation have been most successful. Nephrolithotomy is an operation for the removal of stone from the kidney. The operation may be a very difficult one, owing to the adhesions and thickening of all the perinephric tissues, or to the small size or remote location of the stone. There was a recent exhibition in London, in which were shown the results of a number of recent operations on the kidney. There was one-half of a kidney that had been removed on account of a rapidly-growing sarcoma from a young man of nineteen, who had known of the tumor for six months; there was a good recovery, and the man was quite well in eighteen months afterward. Another specimen was a right kidney removed at St. Bartholomew's Hospital. It was much dilated, and only a small amount of the kidney-substance remained. A calculus blocked the ureter at its commencement. The patient was a woman of thirty-one, and made a good recovery. From the Middlesex Hospital was a kidney containing a uric acid calculus which was successfully removed from a man of thirty-five. From the Cancer Hospital at Brompton there were two kidneys which had been removed from a man and a woman respectively, both of whom made a good recovery. From the King's College Hospital there was a kidney with its pelvis enlarged and occupied by a large calculus, and containing little secreting substance, which was removed from a man of forty-nine, who recovered. These are only a few of the examples of this most interesting collection. Large calculi of the kidney are mentioned in Chapter XV. Rupture of the ureter is a very rare injury. Poland has collected the histories of four cases, one of which ended in recovery after the evacuation by puncture, at intervals, of about two gallons of fluid resembling urine. The other cases terminated in death during the first, fourth, and tenth weeks respectively. Peritonitis was apparently not present in any of the cases, the urinary extravasation having occurred into the cellular tissue behind the peritoneum. There are a few recorded cases of uncomplicated wounds of the ureters. The only well authenticated case in which the ureter alone was divided is the historic injury of the Archbishop of Paris, who was wounded during the Revolution of 1848, by a ball entering the upper part of the lumbar region close to the spine. Unsuccessful attempts were made to extract the ball, and as there was no urine in the bladder, but a quantity escaping from the wound, a diagnosis of divided ureter was made. The Archbishop died in eighteen hours, and the autopsy showed that the ball had fractured the transverse process of the 3d lumbar vertebra, and divided the cauda equina just below its origin; it had then changed direction and passed up toward the left kidney, dividing the ureter near the pelvis, and finally lodged in the psoas muscle. It occasionally happens that the ureter is wounded in the removal of uterine, ovarian, or other abdominal tumors. In such event, if it is impossible to transplant to the bladder, the divided or torn end should be brought to the surface of the loin or vagina, and sutured there. In cases of malignant growth, the ureter has been purposely divided and transplanted into the bladder. Penrose, assisted by Baldy, has performed this operation after excision of an inch of the left ureter for carcinomatous involvement. The distal end of the ureter was ligated, and the proximal end implanted in the bladder according to Van Hook's method, which consists in tying the lowered end of the ureter, then making a slit into it, and invaginating the upper end into the lower through this slit. A perfect cure followed. Similar cases have been reported by Kelly, Krug, and Bache Emmet. Reed reports a most interesting series in which he has successfully transplanted ureters into the rectum. Ureterovaginal fistulae following total extirpation of the uterus, opening of pelvic abscesses, or ulcerations from foreign bodies, are repaired by an operation termed by Bazy of Paris ureterocystoneostomy, and suggested by him as a substitute for nephrectomy in those cases in which the renal organs are unaffected. In the repair of such a case after a vaginal hysterectomy Mayo reports a successful reimplantation of the ureter into the bladder. Stricture of the ureter is also a very rare occurrence except as a result of compression of abdominal or pelvic new growths. Watson has, however, reported two cases of stricture, in both of which a ureter was nearly or quite obliterated by a dense mass of connective tissue. In one case there was a history of the passage of a renal calculus years previously. In both instances the condition was associated with pyonephrosis. Watson has collected the reports of four other cases from medical literature. A remarkable procedure recently developed by gynecologists, particularly by Kelly of Baltimore, is catheterization and sounding of the ureters. McClellan records a case of penetration of the ureter by the careless use of a catheter. Injuries of the Bladder.--Rupture of the bladder may result from violence without any external wound (such as a fall or kick) applied to the abdomen. Jones reports a fatal case of rupture of the bladder by a horse falling on its rider. In this case there was but little extravasation of urine, as the vesical aperture was closed by omentum and bowel. Assmuth reports two cases of rupture of the bladder from muscular action. Morris cites the history of a case in which the bladder was twice ruptured: the first time by an injury, and the second time by the giving way of the cicatrix. The patient was a man of thirty-six who received a blow in the abdomen during a fight in a public house on June 6, 1879. At the hospital his condition was diagnosed and treated expectantly, but he recovered perfectly and left the hospital July 10, 1879. He was readmitted on August 4, 1886, over seven years later, with symptoms of rupture of the bladder, and died on the 6th. The postmortem showed a cicatrix of the bladder which had given way and caused the patient's death. Rupture of the bladder is only likely to happen when the organ is distended, as when empty it sinks behind the pubic arch and is thus protected from external injury. The rupture usually occurs on the posterior wall, involving the peritoneal coat and allowing extravasation of urine into the peritoneal cavity, a condition that is almost inevitably fatal unless an operation is performed. Bartels collected the data of 98 such cases, only four recovering. When the rent is confined to the anterior wall of the bladder the urine escapes into the pelvic tissues, and the prognosis is much more favorable. Bartels collected 54 such cases, 12 terminating favorably. When celiotomy is performed for ruptured bladder, in a manner suggested by the elder Gross, the mortality is much less. Ashhurst collected the reports of 28 cases thus treated, ten of which recovered--a mortality of 64.2 per cent. Ashhurst remarks that he has seen an extraperitoneal rupture of the anterior wall of the bladder caused by improper use of instruments, in the case of retention of urine due to the presence of a tight urethral stricture. There are a few cases on record in which the bladder has been ruptured by distention from the accumulation of urine, but the accident is a rare one, the urethra generally giving way first. Coats reports two cases of uncomplicated rupture of the bladder. In neither case was a history of injury obtainable. The first patient was a maniac; the second had been intoxicated previous to his admission to the hospital, with symptoms of acute peritonitis. The diagnosis was not made. The first patient died in five days and the second in two days after the onset of the illness. At the autopsies the rent was found to be in both instances in the posterior wall of the bladder a short distance from the fundus; the peritoneum was not inflamed, and there was absolutely no inflammatory reaction in the vesical wound. From the statistics of Ferraton and Rivington it seems that rupture of the bladder is more common in intoxicated persons than in others--a fact that is probably explained by a tendency to over-distention of the bladder which alcoholic liquors bring about. The liquor imbibed increases the amount of urine, and the state of blunted consciousness makes the call to empty the bladder less appreciated. The intoxicated person is also liable to falls, and is not so likely to protect himself in falling as a sober person. Gunshot Wounds of the Bladder.--Jackson relates the remarkable recovery of a private in the 17th Tennessee Regiment who was shot in the pelvis at the battle of Mill Springs or Fishing Creek, Ky. He was left supposedly mortally wounded on the field, but was eventually picked up, and before receiving any treatment hauled 164 miles, over mountainous roads in the midst of winter and in a wagon without springs. His urine and excretions passed out through the wounds for several weeks and several pieces of bone came away. The two openings eventually healed, but for twenty-two months he passed pieces of bone by the natural channels. Eve records the case of a private in the Fifth Tennessee Cavalry who was shot in the right gluteal region, the bullet penetrating the bladder and making its exit through the pubis. He rode 30 miles, during which the urine passed through the wound. Urine was afterward voided through the left pubic opening, and spicules of bone were discharged for two years afterward; ultimate recovery ensued. Barkesdale relates the history of the case of a Confederate soldier who was shot at Fredericksburg in the median line of the body, 1 1/2 inches above the symphysis, the wound of exit being in the median line at the back, 1/2 inch lower down. Urine escaped from both wounds and through the urethra. There were no bad symptoms, and the wounds healed in four weeks. The bladder is not always injured by penetration of the abdominal wall, but may be wounded by penetration through the anus or vagina, or even by an instrument entering the buttocks and passing through the smaller sacrosciatic notch. Camper records the case of a sailor who fell from a mast and struck upon some fragments of wood, one of which entered the anus and penetrated the bladder, the result being a rectovesical fistula. About a year later the man consulted Camper, who unsuccessfully attempted to extract the piece of wood; but by incising the fistula it was found that two calculi had formed about the wooden pieces, and when these were extracted the patient recovered. Perrin gives the history of a man of forty who, while adjusting curtains, fell and struck an overturned chair; one of the chair-legs penetrated the anus. Its extraction was followed by a gush of urine, and for several days the man suffered from incontinence of urine and feces. By the tenth day he was passing urine from the urethra, and on the twenty-fifth day there was a complete cicatrix of the parts; fifteen days later he suffered from an attack of retention of urine lasting five days; this was completely relieved after the expulsion of a small piece of trouser-cloth which had been pushed into the bladder at the time of the accident. Post reports the case of a young man who, in jumping over a broomstick, was impaled upon it, the stick entering the anus without causing any external wound, and penetrating the bladder, thus allowing the escape of urine through the anus. A peculiar sequela was that the man suffered from a calculus, the nucleus of which was a piece of the seat of his pantaloons which the stick had carried in. Couper reports a fatal case of stab-wound of the buttocks, in which the knife passed through the lesser sacrosciatic notch and entered the bladder close to the trigone. The patient was a man of twenty-three, a seaman, and in a quarrel had been stabbed in the buttocks with a long sailor's knife, with resultant symptoms of peritonitis which proved fatal. At the autopsy it was found that the knife had passed through the gluteal muscles and divided part of the great sacrosciatic ligament. It then passed through the small sacrosciatic notch, completely dividing the pudic artery and nerve, and one vein, each end being closed by a clot. The knife entered the bladder close to the trigone, making an opening large enough to admit the index finger. There were well-marked evidences of peritonitis and cellulitis. Old-time surgeons had considerable difficulty in extracting arrow-heads from persons who had received their injuries while on horseback. Conrad Gesner records an ingenious device of an old surgeon who succeeded in extracting an arrow which had resisted all previous attempts, by placing the subject in the very position in which he was at the time of reception of the wound. The following noteworthy case shows that the bladder may be penetrated by an arrow or bullet entering the buttocks of a person on horseback. Forwood describes the removal of a vesical calculus, the nucleus of which was an iron arrow-head, as follows: "Sitimore, a wild Indian, Chief of the Kiowas, aged forty-two, applied to me at Fort Sill, Indian Territory, August, 1869, with symptoms of stone in the bladder. The following history was elicited: In the fall of 1862 he led a band of Kiowas against the Pawnee Indians, and was wounded in a fight near Fort Larned, Kansas. Being mounted and leaning over his horse, a Pawnee, on foot and within a few paces, drove an arrow deep into his right buttock. The stick was withdrawn by his companions, but the iron point remained in his body. He passed bloody urine immediately after the injury, but the wound soon healed, and in a few weeks he was able to hunt the buffalo without inconvenience. For more than six years he continued at the head of his band, and traveled on horseback, from camp to camp, over hundreds of miles every summer. A long time after the injury he began to feel distress in micturating, which steadily increased until he was forced to reveal this sacred secret (as it is regarded by these Indians), and to apply for medical aid. His urine had often stopped for hours, at which times he had learned to obtain relief by elevating his hips, or lying in different positions. The urine was loaded with blood and mucus and with a few pus globules, and the introduction of a sound indicated a large, hard calculus in the bladder. The Indians advised me approximately of the depth to which the shaft had penetrated and the direction it took, and judging from the situation of the cicatrix and all the circumstances it was apparent that the arrow-head had passed through the glutei muscles and the obturator foremen and entered the cavity of the bladder, where it remained and formed the nucleus of a stone. Stone in the bladder is extremely rare among the wild Indians, owing, no doubt, to their almost exclusive meat diet and the very healthy condition of their digestive organs, and this fact, in connection with the age of the patient and the unobstructed condition of his urethra, went very far to sustain this conclusion. On August 23d I removed the stone without difficulty by the lateral operation through the perineum. The lobe of the prostate was enlarged, which seemed to favor the extent of the incision beyond what would otherwise have been safe. The perineum was deep and the tuberosities of the ischii unnaturally approximated. The calculus of the mixed ammoniaco-magnesian variety was egg-shaped, and weighed 19 drams. The arrow-point was completely covered and imbedded near the center of the stone. It was of iron, and had been originally about 2 1/2 inches long, by 7/8 inch at its widest part, somewhat reduced at the point and edges by oxidation. The removal of the stone was facilitated by the use of two pairs of forceps,--one with broad blades, by which I succeeded in bringing the small end of the stone to the opening in the prostate, while the other, long and narrow, seized and held it until the former was withdrawn. In this way the forceps did not occupy a part of the opening while the large end of the stone was passing through it. The capacity of the bladder was reduced, and its inner walls were in a state of chronic inflammation. The patient quickly recovered from the effects of the chloroform and felt great relief, both in body and mind, after the operation, and up to the eighth day did not present a single unfavorable symptom. The urine began to pass by the natural channel by the third day, and continued more or less until, on the seventh day, it had nearly ceased to flow at the wound. But the restless spirit of the patient's friends could no longer be restrained. Open hostility with the whites was expected to begin at every moment, and they insisted on his removal. He needed purgative medicine on the eighth day, which they refused to allow him to take. They assumed entire charge of the case, and the following day started with him to their camps 60 miles away. Nineteen days after he is reported to have died; but his immediate relatives have since assured me that his wound was well and that no trouble arose from it. They described his symptoms as those of bilious remittent fever, a severe epidemic of which was prevailing at the time, and from which several white men and many Indians died in that vicinity." The calculus was deposited in the Army Medical Museum at Washington, and is represented in the accompanying photograph, showing a cross-section of the calculus with the arrow-head in situ. As quoted by Chelius, both Hennen and Cline relate cases in which men have been shot through the skirts of the jacket, the ball penetrating the abdomen above the tuberosity of the ischium, and entering the bladder, and the men have afterward urinated pieces of clothing, threads, etc., taken in by the ball. In similar cases the bullet itself may remain in the bladder and cause the formation of a calculus about itself as a nucleus, as in three cases mentioned by McGuire of Richmond, or the remnants of cloth or spicules of bone may give rise to similar formation. McGuire mentions the case of a man of twenty-three who was wounded at the Battle of McDowell, May 8, 1862. The ball struck him on the horizontal ramus of the left pubic bone, about an inch from the symphysis, passed through the bladder and rectum, and came out just below the right sacrosciatic notch, near the sacrum. The day after the battle the man was sent to the general hospital at Staunton, Va., where he remained under treatment for four months. During the first month urine passed freely through the wounds made by the entrance and exit of the ball, and was generally mixed with pus and blood. Fecal matter was frequently discharged through the posterior wound. Some time during the third week he passed several small pieces of bone by the rectum. At the end of the fifth week the wound of exit healed, and for the first time after his injury urine was discharged through the urethra. The wound of entrance gradually closed after five months, but opened again in a few weeks and continued, at varying intervals, alternately closed and open until September, 1865. At this time, on sounding the man, it was found that he had stone; this was removed by lateral operation, and was found to weigh 2 1/4 ounces, having for its nucleus a piece of bone about 1/2 inch long. Dougherty reports the operation of lithotomy, in which the calculus removed was formed by incrustations about an iron bullet. In cases in which there is a fistula of the bladder the subject may live for some time, in some cases passing excrement through the urethra, in others, urine by the anus. These cases seem to have been of particular interest to the older writers, and we find the literature of the last century full of examples. Benivenius, Borellus, the Ephemerides, Tulpius, Zacutus Lusitanus, and others speak of excrement passing through the penis; and there are many cases of vaginal anus recorded. Langlet cites an instance in which the intestine terminated in the bladder. Arand mentions recovery after atresia of the anus with passage of excrement from the vulva. Bartholinus, the Ephemerides, Fothergill, de la Croix, Riedlin, Weber, and Zacutus Lusitanus mention instances in which gas was passed by the penis and urethra. Camper records such a case from ulcer of the neighboring or connecting intestine; Frank, from cohesion and suppuration of the rectum; Marcellus Donatus, from penetrating ulcer of the rectum; and Petit, from communication of the rectum and bladder in which a cure was effected by the continued use of the catheter for the evacuation of urine. Flatus through the vagina, vulva, and from the uterus is mentioned by Bartholinus, the Ephemerides, Meckel, Mauriceau, Paullini, Riedlin, Trnka, and many others in the older literature. Dickinson mentions a Burmese male child, four years old, who had an imperforate anus and urethra, but who passed feces and urine successfully through an opening at the base of the glans penis. Dickinson eventually performed a successful operation on this case. Modern literature has many similar instances. In the older literature it was not uncommon to find accounts of persons passing worms from the bladder, no explanations being given to account for their presence in this organ. Some of these cases were doubtless instances of echinococcus, trichinae, or the result of rectovesical fistula, but Riverius mentions an instance in which, after drinking water containing worms, a person passed worms in the urine. In the old Journal de physique de Rozier is an account of a man of forty-five who enjoyed good health, but who periodically urinated small worms from the bladder. They were described as being about 1 1/2 lines long, and caused no inconvenience. There is also mentioned the case of a woman who voided worms from the bladder. Tupper describes a curious case of a woman of sixty-nine who complained of a severe, stinging pain that completely overcame her after micturition. An ulceration of the neck of the bladder was suspected, and the usual remedies were applied, but without effect. An examination of the urine was negative. On recommendation of her friends the patient, before going to bed, steeped and drank a decoction of knot-grass. During the night she urinated freely, and claimed that she had passed a worm about ten inches long and of the size of a knitting-needle. It exhibited motions like those of a snake, and was quite lively, living five or six days in water. The case seems quite unaccountable, but there is, of course, a possibility that the animal had already been in the chamber, or that it was passed by the bowel. A rectovaginal or vesical fistula could account for the presence of this worm had it been voided from the bowel; nevertheless the woman adhered to her statement that she had urinated the worm, and, as confirmatory evidence, never complained of pain after passing the animal. Foreign bodies in the bladder, other than calculi (which will be spoken of in Chapter XV), generally gain entrance through one of the natural passages, as a rule being introduced, either in curiosity or for perverted satisfaction, through the urethra. Morand mentions an instance in which a long wax taper was introduced into the bladder through the urethra by a man. At the University Hospital, Philadelphia, White has extracted, by median cystotomy, a long wax taper which had been used in masturbation. The cystoscopic examination in this case was negative, and the man's statements were disbelieved, but the operation was performed, and the taper was found curled up and covered by mucus and folds of the bladder. It is not uncommon for needles, hair-pins, and the like to form nuclei for incrustations. Gross found three caudal vertebrae of a squirrel in the center of a vesical calculus taken from the bladder of a man of thirty-five. It was afterward elicited that the patient had practiced urethral masturbation with the tail of this animal. Morand relates the history of a man of sixty-two who introduced a sprig of wheat into his urethra for a supposed therapeutic purpose. It slipped into the bladder and there formed the nucleus of a cluster calculus. Dayot reports a similar formation from the introduction of the stem of a plant. Terrilon describes the case of a man of fifty-four who introduced a pencil into his urethra. The body rested fifteen days in this canal, and then passed into the bladder. On the twenty-eighth day he had a chill, and during two days made successive attempts to break the pencil. Following each attempt he had a violent chill and intense evening fever. On the thirty-third day Terrilon removed the pencil by operation. Symptoms of perivesical abscess were present, and seventeen days after the operation, and fifty days after the introduction of the pencil, the patient died. Caudmont mentions a man of twenty-six who introduced a pencil-case into his urethra, from whence it passed into his bladder. It rested about four years in this organ before violent symptoms developed. Perforation of the bladder took place, and the patient died. Poulet mentions the case of a man of seventy-eight, in whose bladder a metallic sound was broken off. The fractured piece of sound, which measured 17 cm. in length, made its exit from the anus, and the patient recovered. Wheeler reports the case of a man of twenty-one who passed a button-hook into his anus, from whence it escaped into his bladder. The hook, which was subsequently spontaneously passed, measured 2 1/2 inches in length and 1/2 inch in diameter. Among females, whose urethrae are short and dilatable, foreign bodies are often found in the bladder, and it is quite common for smaller articles of the toilet, such as hair-pins, to be introduced into the bladder, and there form calculi. Whiteside describes a case in which a foreign body introduced into the bladder was mistaken for pregnancy, and giving rise to corresponding symptoms. The patient was a young girl of seventeen who had several times missed her menstruation, and who was considered pregnant. The abdomen was more developed than usual in a young woman. The breasts were voluminous, and the nipples surrounded by a somber areola. At certain periods after the cessation of menstruation, she had incontinence of urine, and had also repeatedly vomited. The urine was of high specific gravity, albuminous, alkaline, and exhaled a disagreeable odor. In spite of the signs of pregnancy already noted, palpitation and percussion did not show any augmentation in the size of the uterus, but the introduction of a catheter into the bladder showed the existence of a large calculus. Under chloroform the calculus and its nucleus were disengaged, and proved to be the handle of a tooth-brush, the exact size of which is represented in the accompanying illustration. The handle was covered with calcareous deposits, and was tightly fixed in the bladder. At first the young woman would give no explanation for its presence, but afterward explained that she had several times used this instrument for relief in retention of urine, and one day it had fallen into the bladder. A short time after the operation menstruation returned for the first time in seven months, and was afterward normal. Bigelow reports the case of a woman who habitually introduced hair-pins and common pins into her bladder. She acquired this mania after an attempt at dilatation of the urethra in the relief of an obstinate case of strangury. Rode reports the case of a woman who had introduced a hog's penis into her urethra. It was removed by an incision into this canal, but the patient died in five days of septicemia. There is a curious case quoted of a young domestic of fourteen who was first seen suffering with pain in the sides of the genital organs, retention of urine, and violent tenesmus. She was examined by a midwife who found nothing, but on the following day the patient felt it necessary to go to bed. Her general symptoms persisted, and meanwhile the bladder became much distended. The patient had made allusion to the loss of a hair-pin, a circumstance which corresponded with the beginning of her trouble. Examination showed the orifice of the urethra to be swollen and painful to the touch, and from its canal a hair-pin 6.5 cm. long was extracted. The patient was unable to urinate, and it was necessary to resort to catheterization. By evening the general symptoms had disappeared, and the next day the patient urinated as usual. There are peculiar cases of hair in the bladder, in which all history as to the method of entrance is denied, and which leave as the only explanation the possibility that the bladder was in communication with some dermoid cyst. Hamelin mentions a case of this nature. It is said that all his life Sir William Elliot was annoyed by passing hairs in urination. They would lodge in the urethra and cause constant irritation. At his death a stone was taken from the bladder, covered with scurf and hair. Hall relates the case of a woman of sixty, from whose bladder, by dilatation of the urethra, was removed a bundle of hairs two inches long, which, Hall says, without a doubt had grown from the vesical walls. Retention of Foreign Bodies in the Pelvis.--It is a peculiar fact that foreign bodies which once gain entrance to the pelvis may be tolerated in this location for many years. Baxter describes a man who suffered an injury from a piece of white board which entered his pelvis, and remained in position for sixteen and a half years; at this time a piece of wood 7 1/2 inches long was discharged at stool, and the patient recovered. Jones speaks of a case in which splinters of wood were retained in the neighborhood of the rectum and vagina for sixteen years, and spontaneously discharged. Barwell mentions a case in which a gum elastic catheter that had been passed into the vagina for the purpose of producing abortion became impacted in the pelvis for twenty months, and was then removed. Rupture of the Male Urethra.--The male urethra is occasionally ruptured in violent coitus. Frank and the Philosophical Transactions are among the older authorities mentioning this accident. In Frank's case there was hemorrhage from the penis to the extent of five pounds. Colles mentions a man of thirty-eight, prone to obesity, and who had been married two months, who said that in sexual congress he had hurt himself by pushing his penis against the pubic bone, and added that he had a pain that felt as though something had broken in his organ. The integuments of the penis became livid and swollen and were extremely painful. His urine had to be drawn by a catheter, and by the fifth day his condition was so bad that an incision was made into the tumor, and pus, blood, urine, and air issued. The patient suffered intense rigors, his abdomen became tympanitic, and he died. Postmortem examination revealed the presence of a ruptured urethra. Watson relates an instance of coitus performed en postillon by a man while drunk, with rupture of the urethra and fracture of the corpus spongiosum only. Loughlin mentions a rupture of the corpus spongiosum during coitus. Frank cites a curious case of hemorrhage from a fall while the penis was erect. It is not unusual to find ruptured urethrae following traumatism, and various explanations are given for it in the standard works on surgery. Fracture of the Penis.--A peculiar accident to the penis is fracture, which sometimes occurs in coitus. This accident consists in the laceration of the corpora cavernosa, followed by extensive extravasation of blood into the erectile tissue. It has also occurred from injury inflicted accidentally or maliciously, but always happening when the organ was erect. An annoying sequel following this accident is the tendency to curvature in erection, which is sometimes so marked as to interfere with coitus, and even render the patient permanently impotent. There is an account of a laborer of twenty-seven who, in attempting to micturate with his penis erect, pressed it downward with considerable force and fractured the corpora cavernosa. Veazie relates a case of fracture of the corpora cavernosa occurring in coitus. During the act the female suddenly withdrew, and the male, following, violently struck the pubes, with the resultant injury. Recovery ensued. M'Clellan speaks of removing the cavernous septum from a man of fifty-two, in whom this part had become infiltrated with lime-salts and resembled a long, narrow bone. When the penis was erect it was bent in the form of a semicircular bow. The Transactions of the South Carolina Medical Association contain an account of a negro of sixty who had urethral stricture from gonorrhea and who had been treated for fifteen years by caustics. The penis was seven inches in circumference around the glans, and but little less near the scrotum. The glans was riddled with holes, and numerous fistulae existed on the inferior surface of the urethra, the meatus being impermeable. So great was the weight and hypertrophy that amputation was necessary. John Hunter speaks of six strictures existing in one urethra at one time; Lallemand of seven; Bolot of eight; Ducamp of five; Boyer thought three could never exist together; Leroy D'Etoilles found 11, and Rokitansky met with four. Sundry Injuries to the Penis.--Fabricius Hildanus mentions a curious case of paraphimosis caused by violent coitus with a virgin who had an extremely narrow vagina. Joyce relates a history of a stout man who awoke with a vigorous erection, and feeling much irritation, he scratched himself violently. He soon bled copiously, his shirt and underlying sheets and blankets being soaked through. On examination the penis was found swollen, and on drawing back the foreskin a small jet of blood spurted from a small rupture in the frenum. The authors have knowledge of a case in which hemorrhage from the frenum proved fatal. The patient, in a drunken wager, attempted to circumcise himself with a piece of tin, and bled to death before medical aid could be summoned. It sometimes happens that the virile member is amputated by an animal bite. Paullini and Celliez mention amputation of the penis by a dog-bite. Morgan describes a boy of thirteen who was feeding a donkey which suddenly made a snap at him, unfortunately catching him by the trousers and including the penis in one of the folds. By the violence of the bite the boy was thrown to the ground, and his entire prepuce was stripped off to the root as if it had been done by a knife. There was little hemorrhage, and the prepuce was found in the trousers, looking exactly like the finger of a glove. Morgan stated that this was the third case of the kind of which he had knowledge. Bookey records a case in which an artilleryman was seized by the penis by an infuriated horse, and the two crura were pulled out entire. Amputation of the penis is not always followed by loss of the sexual power and instinct, but sometimes has the mental effect of temporarily increasing the desire. Haslam reports the case of a man who slipped on the greasy deck of a whaler, and falling forward with great violence upon a large knife used to cut blubber, completely severed his penis, beside inflicting a wound in the abdomen through which the intestines protruded. After recovery there was a distinct increase of sexual desire and frequent nocturnal emissions. In the same report there is recorded the history of a man who had entirely lost his penis, but had supplied himself with an ivory succedaneum. This fellow finally became so libidinous that it was necessary to exclude him from the workhouse, of which he was an inmate. Norris gives an account of a private who received a gunshot wound of the penis while it was partly erect. The wound was acquired at the second battle of Fredericksburg. The ball entered near the center of the glans penis, and taking a slightly oblique direction, it passed out of the right side of the penis 1 1/2 inches beyond the glans; it then entered the scrotum, and after striking the pelvis near the symphysis, glanced off around the innominate bone, and finally made its exit two inches above the anus. The after-effects of this injury were incontinence of urine, and inability to assume the erect position. Bookey cites the case of six wounds from one bullet with recovery. The bullet entered the sole and emerged from the dorsum of the foot. It then went through the right buttock and came out of the groin, only to penetrate the dorsum of the penis and emerge at the upper part of the glans. Rose speaks of a case in which a man had his clothes caught in machinery, drawing in the external genital organs. The testicles were found to be uninjured, but the penis was doubled out of sight and embedded in the scrotum, from whence it was restored to its natural position and the man recovered. Nelaton describes a case of luxation of the penis in a lad of six who fell from a cart. Nelaton found the missing member in the scrotum, where it had been for nine days. He introduced Sir Astley Cooper's instrument for tying deeply-seated arteries through a cutaneous tube, and conducting the hook under the corporus cavernosum, seized this crosswise, and by a to-and-fro movement succeeded in replacing the organ. Moldenhauer describes the case of a farmer of fifty-seven who was injured in a runaway accident, a wheel passing over his body close to the abdomen. The glans penis could not be recognized, since the penis in toto had been torn from its sheath at the corona, and had slipped or been driven into the inguinal region. This author quotes Stromeyer's case, which was that of a boy of four and a half years who was kicked by a horse in the external genital region. The sheath was found empty of the penis, which had been driven into the perineum. Raven mentions a case of spontaneous retraction of the penis in a man of twenty-seven. While in bed he felt a sensation of coldness in the penis, and on examination he found the organ (a normal-sized one) rapidly retracting or shrinking. He hastily summoned a physician, who found that the penis had, in fact, almost disappeared, the glans being just perceptible under the pubic arch, and the skin alone visible. The next day the normal condition was restored, but the patient was weak and nervous for several days after his fright. In a similar case, mentioned by Ivanhoff, the penis of a peasant of twenty-three, a married man, bodily disappeared, and was only captured by repeated effort. The patient was six days under treatment, and he finally became so distrustful of his virile member that, to be assured of its constancy, he tied a string about it above the glans. Injuries of the penis and testicles self-inflicted are grouped together and discussed in Chapter XIV. As a rule, spontaneous gangrene of the penis has its origin in some intense fever. Partridge describes a man of forty who had been the victim of typhus fever, and whose penis mortified and dried up, becoming black and like the empty finger of a cast-off glove; in a few days it dropped off. Boyer cites a case of edema of the prepuce, noticed on the fifteenth day of the fever, and which was followed by gangrene of the penis. Rostan mentions gangrene of the penis from small-pox. Intermittent fever has been cited as a cause. Koehler reports a fatal instance of gangrene of the penis, caused by a prostatic abscess following gonorrhea. In this case there was thrombosis of the pelvic veins. Hutchinson mentions a man who, thirty years before, after six days' exposure on a raft, had lost both legs by gangrene. At the age of sixty-six he was confined to bed by subacute bronchitis, and during this period his whole penis became gangrenous and sloughed off. This is quite unusual, as gangrene is usually associated with fever; it is more than likely that the gangrene of the leg was not connected with that of the penis, but that the latter was a distinct after-result. Possibly the prolonged exposure at the time he lost his legs produced permanent injury to the blood-vessels and nerves of the penis. There is a case on record in which, in a man of thirty-seven, gangrene of the penis followed delirium tremens, and was attributed to alcoholism. Quoted by Jacobson, Troisfontaines records a case of gangrene of the skin and body of the penis in a young man, and without any apparent cause. Schutz speaks of regeneration of the penis after gangrenous destruction. Gangrene of the penis does not necessarily hinder the performance of marital functions. Chance mentions a man whose penis sloughed off, leaving only a nipple-like remnant. However, he married four years later, and always lived in harmony with his wife. At the time of his death he was the father of a child, subsequent to whose birth his wife had miscarried, and at the time of report she was daily expecting to be again confined. Willett relates the instance of a horseman of thirty-three who, after using a combination of refuse oils to protect his horse from gnats, was prompted to urinate, and, in so doing, accidentally touched his penis with the mixture. Sloughing phagedena rapidly ensued, but under medical treatment he eventually recovered. Priapism is sometimes seen as a curious symptom of lesion of the spinal cord. In such cases it is totally unconnected with any voluptuous sensation and is only found accompanied by motor paralysis. It may occur spontaneously immediately after accident involving the cord, and is then probably due to undue excitement of the portion of the cord below the lesion, which is deprived of the regulating influence of the brain. Priapism may also develop spontaneously at a later period, and is then due to central irritation from extravasation into the substance of the cord, or to some reflex cause. It may also occur from simple concussion, as shown by a case reported by Le Gros Clark. Pressure on the cerebellum is supposed to account for cases of priapism observed in executions and suicides by hanging. There is an instance recorded of an Italian "castrate" who said he provoked sexual pleasure by partially hanging himself. He accidentally ended his life in pursuance of this peculiar habit. The facts were elicited by testimony at the inquest. There are, however, in literature, records of long continued priapism in which either the cause is due to excessive stimulation of the sexual center or in which the cause is obscure or unknown. There may or may not be accompanying voluptuous feelings. The older records contain instances of continued infantile priapism caused by the constant irritation of ascarides and also records of prolonged priapism associated with intense agony and spasmodic cramps. Zacutus Lusitanus speaks of a Viceroy of India who had a long attack of stubborn priapism without any voluptuous feeling. Gross refers to prolonged priapism, and remarks that the majority of cases seem to be due to excessive coitus. Moore reports a case in a man of forty who had been married fifteen years, and who suffered spasmodic contractions of the muscles of the penis after an incomplete coitus. This pseudopriapism continued for twenty-three days, during which time he had unsuccessfully resorted to the application of cold, bleeding, and other treatment; but on the twenty-sixth day, after the use of bladders filled with cold water, there was a discharge from the urethra of a glairy mucus, similar in nature to that in seminal debility. There was then complete relaxation of the organ. During all this time the man slept very little, only occasionally dozing. Donne describes an athletic laborer of twenty-five who received a wound from a rifle-ball penetrating the cranial parietes immediately in the posterior superior angle of the parietal bone, and a few lines from the lambdoid suture. The ball did not make egress, but passed posteriorly downward. Reaction was established on the third day, but the inflammatory symptoms influenced the genitalia. Priapism began on the fifth day, at which time the patient became affected with a salacious appetite, and was rational upon every subject except that pertaining to venery. He grew worse on the sixth day, and his medical adviser was obliged to prohibit a female attendant. Priapism continued, but the man went into a soporose condition, with occasional intervals of satyriasis. In this condition he survived nine days; there was not the slightest abatement of the priapism until a few moments before his death. Tripe relates the history of a seaman of twenty-five, in perfect health, who, arriving from Calcutta on April 12, 1884, lodged with a female until the 26th. At this time he experienced an unusually fierce desire, with intense erection of the penis which, with pain, lasted throughout the night. Though coitus was frequently resorted to, these symptoms continued. He sought aid at the London Hospital, but the priapism was persistent, and when he left, on May 10th, the penis formed an acute angle with the pubes, and he again had free intercourse with the same female. At the time of leaving England the penis made an angle of about 45 degrees with the pubes, and this condition, he affirmed, lasted three months. On his return to England his penis was flaccid, and his symptoms had disappeared. Salzer presents an interesting paper on priapism which was quoted in The Practitioner of London. Salzer describes one patient of forty-six who awoke one morning with a strong erection that could not be reduced by any means. Urine was voided by jerks and with difficulty, and only when the subject was placed in the knee and elbow position. Despite all treatment this condition continued for seven weeks. At this time the patient's spleen was noticed to be enormously enlarged. The man died about a year after the attack, but a necropsy was unfortunately refused. Salzer, in discussing the theories of priapism, mentions eight cases previously reported, and concludes, that such cases are attributable to leukemia. Kremine believes that continued priapism is produced by effusion of blood into the corpora cavernosa, which is impeded on its return. He thinks it corresponds to bleeding at the nose and rectum, which often occurs in perfectly healthy persons. Longuet regards the condition of the blood in leukemia as the cause of such priapism, and considers that the circulation of the blood is retarded in the smaller vessels, while, owing to the great increase in the number of white corpuscles, thrombi are formed. Neidhart and Matthias conclude that the origin of this condition might be sought for in the disturbance of the nerve-centers. After reviewing all these theories, Salzer states that in his case the patient was previously healthy and never had suffered the slightest hemorrhage in any part, and he therefore rejects the theory of extravasation. He is inclined to suppose that the priapism was due to the stimulation of the nervi erigentes, brought about either by anatomic change in the nerves themselves, or by pressure upon them by enlarged lumbar glands, an associate condition of leukemia. Burchard reports a most interesting case of prolonged priapism in an English gentleman of fifty-three. When he was called to see the man on July 15th he found him suffering with intense pain in the penis, and in a state of extreme exhaustion after an erection which had lasted five hours uninterruptedly, during the whole of which time the organ was in a state of violent and continuous spasm. The paroxysm was controlled by 3/4 grain morphin and 1/50 grain atropin. Five hours later, after a troubled sleep, there was another erection, which was again relieved by hypodermic medication. During the day he had two other paroxysms, one lasting forty-five minutes; and another, three hours later, lasting eighteen minutes. Both these were controlled by morphin. There was no loss of semen, but after the paroxysms a small quantity of glairy mucus escaped from the meatus. The rigidity was remarkable, simulating the spasms of tetanus. No language could adequately describe the suffering of the patient. Burchard elicited the history that the man had suffered from nocturnal emissions and erotic dreams of the most lascivious nature, sometimes having three in one night. During the day he would have eight or ten erections, unaccompanied by any voluptuous emotions. In these there would rarely be any emission, but occasionally a small mucous discharge. This state of affairs had continued three years up to the time Burchard saw him, and, chagrined by pain and his malady, the patient had become despondent. After a course of careful treatment, in which diet, sponging, application of ice-bags, and ergot were features, this unfortunate man recovered. Bruce mentions the case of an Irishman of fifty-five who, without apparent cause, was affected with a painful priapism which lasted six weeks, and did not subside even under chloroform. Booth mentions a case of priapism in a married seaman of fifty-five, due to local inflammation about the muscles, constricting the bulb of the penis. The affection lasted five weeks, and was extremely painful. There was a similar case of priapism which lasted for three weeks, and was associated with hydrocele in a man of forty-eight. Injuries of the testicle and scrotum may be productive of most serious issue. It is a well-known surgical fact that a major degree of shock accompanies a contusion of this portion of the body. In fact, Chevers states that the sensitiveness of the testicles is so well known in India, that there are cases on record in which premeditated murder has been effected by Cossiah women, by violently squeezing the testicles of their husbands. He also mentions another case in which, in frustrating an attempt at rape, death was caused in a similar manner. Stalkartt describes the case of a young man who, after drinking to excess with his paramour, was either unable, or indifferent in gratifying her sexual desire. The woman became so enraged that she seized the scrotum and wrenched it from its attachments, exposing the testicles. The left testicle was completely denuded, and was hanging by the vas deferens and the spermatic vessels. There was little hemorrhage, and the wound was healed by granulation. Avulsion of the male external genitalia is not always accompanied by serious consequences, and even in some cases the sexual power is preserved. Knoll described a case in 1781, occurring in a peasant of thirty-six who fell from a horse under the wheels of a carriage. He was first caught in the revolving wheels by his apron, which drew him up until his breeches were entangled, and finally his genitals were torn off. Not feeling much pain at the time, he mounted his horse and went to his house. On examination it was found that the injury was accompanied with considerable hemorrhage. The wound extended from the superior part of the pubes almost to the anus; the canal of the urethra was torn away, and the penis up to the neck of the bladder. There was no vestige of either the right scrotum or testicle. The left testicle was hanging by its cord, enveloped in its tunica vaginalis. The cord was swollen and resembled a penis stripped of its integument. The prostate was considerably contused. After two months of suffering the patient recovered, being able to evacuate his urine through a fistulous opening that had formed. In ten weeks cicatrization was perfect. In his "Memoirs of the Campaign of 1811," Larrey describes a soldier who, while standing with his legs apart, was struck from behind by a bullet. The margin of the sphincter and, the skin of the perineum, the bulbous portion of the urethra, some of the skin of the scrotum, and the right testicle were destroyed. The spermatic cord was divided close to the skin, and the skin of the penis and prepuce was torn. The soldier was left as dead on the field, but after four months' treatment he recovered. Madden mentions a man of fifty who fell under the feet of a pair of horses, and suffered avulsion of the testicles through the scrotum. The organs were mangled, the spermatic cord was torn and hung over the anus, and the penis was lacerated from the frenum down. The man lost his testicles, but otherwise completely recovered. Brugh reports an instance of injury to the genitalia in a boy of eighteen who was caught in a threshing-machine. The skin of the penis and scrotum, and the tissue from the pubes and inguinal region were torn from the body. Cicatrization and recovery were complete. Brigham cites an analogous case in a youth of seventeen who was similarly caught in threshing machinery. The skin of the penis and the scrotum was entirely torn away; both sphincters of the anus were lacerated, and the perineum was divested of its skin for a space 2 1/2 inches wide. Recovery ensued, leaving a penis which measured, when flaccid, three inches long and 1 1/2 inches in diameter. There is a case reported of a man who had his testicles caught in machinery while ginning cotton. The skin of the penis was stripped off to its root, the scrotum torn off from its base, and the testicles were contused and lacerated, and yet good recovery ensued. A peculiarity of this case was the persistent erection of the penis when cold was not applied. Gibbs mentions a case in which the entire scrotum and the perineum, together with an entire testicle and its cord attached, and nearly all the integument of the penis were torn off, yet the patient recovered with preservation of sexual powers. The patient was a negro of twenty-two who, while adjusting a belt, had his coat (closely buttoned) caught in the shafting, and his clothes and external genitals torn off. On examination it was found that the whole scrotum was wrenched off, and also the skin and cellular tissue, from 2 1/2 inches above the spine of the pubes down to the edge of the sphincter ani, including all the breadth of the perineum, together with the left testicle with five inches of its cord attached, and all the integument and cellular covering of the penis except a rim nearly half an inch wide at the extremity and continuous with the mucous membrane of the prepuce. The right testicle was hanging by its denuded cord, and was apparently covered only by the tunica vaginalis as high up as the abdominal ring, where the elastic feeling of the intestines was distinctly perceptible. There was not more than half an ounce of blood lost. The raw surface was dressed, the gap in the perineum brought together, and the patient made complete recovery, with preservation of his sexual powers. Other cases of injuries to the external genital organs (self-inflicted) will be found in the next chapter. The preservation of the sexual power after injuries of this kind is not uncommon. There is a case reported of a man whose testicles were completely torn away, and the perineal urethra so much injured that micturition took place through the wound. After a tedious process the wound healed and the man was discharged, but he returned in ten days with gonorrhea, stating that he had neither lost sexual desire nor power of satisfaction. Robbins mentions a man of thirty-eight who, in 1874, had his left testicle removed. In the following year his right testicle became affected and was also removed. The patient stated that since the removal of the second gland he had regular sexual desire and coitus, apparently not differing from that in which he indulged before castration. For a few months previous to the time of report the cord on the left side, which had not been completely extirpated, became extremely painful and was also removed. Atrophy of the testicle may follow venereal excess, and according to Larrey, deep wounds of the neck may produce the same result, with the loss of the features of virility. Guthrie mentions a case of spontaneous absorption of the testicle. According to Larrey, on the return of the French Army from the Egyptian expedition the soldiers complained of atrophy and disappearance of the testicle, without any venereal affection. The testicle would lose its sensibility, become soft, and gradually diminish in size. One testicle at a time was attacked, and when both were involved the patient was deprived of the power of procreation, of which he was apprised by the lack of desire and laxity of the penis. In this peculiar condition the general health seemed to fail, and the subjects occasionally became mentally deranged. Atrophy of the testicles has been known to follow an attack of mumps. In his description of the diseases of Barbadoes Hendy mentions several peculiar cases under his observation in which the scrotum sloughed, leaving the testicles denuded. Alix and Richter mention a singular modification of rheumatic inflammation of the testicle, in which the affection flitted from one testicle to the other, and alternated with rheumatic pains elsewhere. There is a case of retraction of the testicle reported in a young soldier of twenty-one who, when first seen, complained of a swelling in the right groin. He stated that while riding bareback his horse suddenly plunged and threw him on the withers. He at once felt a sickening pain in the groin and became so ill that he had to dismount. On inspection an oval tumor was seen in the groin, tender to the touch and showing no impulse on coughing. The left testicle was in its usual position, but the right was absent. The patient stated positively that both testicles were in situ before the accident. An attempt at reduction was made, but the pain was so severe that manipulation could not be endured. A warm bath and laudanum were ordered, but unfortunately, as the patient at stool gave a sudden bend to the left, his testicle slipped up into the abdomen and was completely lost to palpation. Orchitis threatened, but the symptoms subsided; the patient was kept under observation for some weeks, and then as a tentative measure, discharged to duty. Shortly afterward he returned, saying that he was ill, and that while lifting a sack of corn his testicle came partly down, causing him great pain. At the time of report his left testicle was in position, but the right could not be felt. The scrotum on that side had retracted until it had almost disappeared; the right external ring was very patent, and the finger could be passed up in the inguinal canal; there was no impulse on coughing and no tendency to hernia. A unique case of ectopia of the testicle in a man of twenty-four is given by Popoff. The scrotum was normally developed, and the right testicle in situ. The left half of the scrotum was empty, and at the root of the penis there was a swelling the size of a walnut, covered with normal skin, and containing an oval body about four-fifths the size of the testicle, but softer in constituency. The patient claimed that this swelling had been present since childhood. His sexual power had been normal, but for the past six months he had been impotent. In childhood the patient had a small inguinal hernia, and Popoff thought this caused the displacement of the testicle. A somewhat similar case occurred in the Hotel-Dieu, Paris. Through the agency of compression one of the testes was forced along the corpus cavernosum under the skin as far as the glans penis. It was easily reduced, and at a subsequent autopsy it was found that it had not been separated from the cord. Gluiteras a cites a parallel case of dislocation of the testicle into the penis. It was the result of traumatism--a fall upon the wheel of a cart. It was reduced under anesthesia, after two incisions had been made, the adhesions broken up, and the shrunken sac enlarged by stretching. Rupture of the spermatic arteries and veins has caused sudden death. Schleiser is accredited with describing an instance in which a healthy man was engaged in a fray in the dark, and, suddenly crying out, fell into convulsions and died in five minutes. On examination the only injury found was the rupture of both spermatic arteries at the internal ring, produced by a violent pull on the scrotum and testicles by one of his antagonists. Shock was evidently a strong factor in this case. Fabricius Hildanus gives a case of impotency due to lesions of the spermatic vessels following a burn. There is an old record of an aged man who, on marrying, found that he had erections but no ejaculations. He died of ague, and at the autopsy it was found that the verumontanum was hard and of the size of a walnut and that the ejaculatory ducts contained calculi about the size and shape of peas. Hydrocele is a condition in which there is an abnormal quantity of fluid in the tunica vaginalis. It is generally caused by traumatism, violent muscular efforts, or straining, and is much more frequent in tropic countries than elsewhere. It sometimes attains an enormous size. Leigh mentions a hydrocele weighing 120 pounds, and there are records of hydroceles weighing 40 and 60 pounds. Larrey speaks of a sarcocele in the coverings of the testicle which weighed 100 pounds. Mursinna describes a hydrocele which measured 27 inches in its longest and 17 in its transverse axis. Tedford gives a curious case of separation of the ovary in a woman of twenty-eight. After suffering from invagination of the bowel and inflammation of the ovarian tissue, an ovary was discharged through an opening in the sigmoid flexure, and thence expelled from the anus. In discussing injuries of the vagina, the first to be mentioned will be a remarkable case reported by Curran. The subject was an Irish girl of twenty. While carrying a bundle of clothes that prevented her from seeing objects in front of her, she started to pass over a stile, just opposite to which a goat was lying. The woman wore no underclothing, and in the ascent her body was partially exposed, and, while in this enforced attitude, the goat, frightened by her approach, suddenly started up, and in so doing thrust his horn forcibly into her anus and about two or three inches up her rectum. The horn then passed through the bowel and its coverings, just above the hymen, and was then withdrawn as she flinched and fell back. The resultant wound included the lower part of the vagina and rectum, the sphincter and, the fourchet, and perineum. Hemorrhage was profuse, and the wound caused excruciating pain. The subject fainted on the spot from hemorrhage and shock. Her modesty forbade her summoning medical aid for three days, during which time the wound was undergoing most primitive treatment. After suturing, cicatrization followed without delay. Trompert mentions a case of rupture of the vagina by the horn of a bull. There is a case recorded in the Pennsylvania Hospital Reports of a girl of nineteen who jumped out of a second-story window. On reaching the ground, her foot turned under her as she fell. The high heel of a French boot was driven through the perineum one inch from the median line, midway between the anus and the posterior commissure of the labia majora. The wound extended into the vagina above the external opening, in which the heel, now separated from the boot, projected, and whence it was removed without difficulty. This wound was the only injury sustained by the fall. Beckett records a case of impalement in a woman of forty-five who, while attempting to obtain water from a hogshead, fell with one limb inside the cistern, striking a projecting stave three inches wide and 1/2 inch thick. The external labia were divided, the left crus of the clitoris separated, the nymphae lacerated, and the vaginal wall penetrated to the extent of five inches; the patient recovered by the fourth week. Homans reports recovery from extensive wounds acquired by a negress who fell from a roof, striking astride an upright barrel. There was a wound of the perineum, and penetration of the posterior wall of the vagina, with complete separation of the soft parts from the symphysis pubis, and extrusion of the bladder. Howe reports a case of impalement with recovery in a girl of fifteen who slid down a hay-stack, striking a hay-hook which penetrated her perineum and passed into her body, emerging two inches below the umbilicus and one inch to the right of the median line. Injuries of the vagina may be so extensive as to allow protrusion of the intestines, and some horrible cases of this nature are recorded. In The Lancet for 1873 there is reported a murder or suicide of this description. The woman was found with a wound in the vagina, through which the intestines, with clean-cut ends, protruded. Over 7 1/2 feet of the intestines had been cut off in three pieces. The cuts were all clean and carefully separated from the mesentery. The woman survived her injuries a whole week, finally succumbing to loss of blood and peritonitis. Her husband was tried for murder, but was acquitted by a Glasgow jury. Taylor mentions similar cases of two women murdered in Edinburgh some years since, the wounds having been produced by razor slashes in the vagina. Taylor remarks that this crime seems to be quite common in Scotland. Starkey reports an instance in which the body of an old colored woman was found, with evidences of vomiting, and her clothing stained with blood that had evidently come from her vagina. A postmortem showed the abdominal cavity to be full of blood; at Douglas' culdesac there was a tear large enough to admit a man's hand, through which protruded a portion of the omentum; this was at first taken for the membranes of an abortion. There were distinct signs of acute peritonitis. After investigation it was proved that a drunken glass-blower had been seen leaving her house with his hand and arm stained with blood. In his drunken frenzy this man had thrust his hand into the vagina, and through the junction of its posterior wall with the uterus, up into the abdominal cavity, and grasped the uterus, trying to drag it out. Outside of obstetric practice the injury is quite a rare one. There is a case of death from a ruptured clitoris reported by Gutteridge. The woman was kicked while in a stooping position and succumbed to a profuse hemorrhage, estimated to be between three and four pounds, and proceeding from a rupture of the clitoris. Discharge of Vaginal Parietes.--Longhi describes the case of a woman of twenty-seven, an epileptic, with metritis and copious catamenia twice a month. She was immoderately addicted to drink and sexual indulgence, and in February, 1835, her menses ceased. On May 8th she was admitted to the hospital with a severe epileptic convulsion, and until the 18th remained in a febrile condition, with abdominal tenderness, etc. On the 21st, while straining as if to discharge the contents of the rectum, she felt a voluminous body pass through the vagina, and fancied it was the expected fetus. After washing this mass it was found to be a portion of the vaginal parietes and the fleshy body of the neck of the uterus. The woman believed she had miscarried, and still persisted in refusing medicine. Cicatrization was somewhat delayed; immediately on leaving the hospital she returned to her old habits, but the pain and hemorrhage attending copulation was so great that she had finally to desist. The vagina, however, gradually yielding, ceased to interfere with the gratification of her desires. Toward the end of June the menses reappeared and flowed with the greatest regularity. The portions discharged are preserved in the Milan Hospital. The injuries received during coitus have been classified by Spaeth as follows: Deep tears of the hymen with profuse hemorrhage; tears of the clitoris and of the urethra (in cases of atresia hymenis); vesicovaginal fistula; laceration of the vaginal fornices, posteriorly or laterally; laceration of the septum of a duplex vagina; injuries following coitus after perineorrhaphy. In the last century Plazzoni reports a case of vaginal rupture occurring during coitus. Green of Boston; Mann of Buffalo; Sinclair and Munro of Boston, all mention lacerations occurring during coitus. There is an instance recorded of extensive laceration of the vagina in a woman, the result of coitus with a large dog. Haddon and Ross both mention cases of rupture of the vagina in coitus; and Martin reports a similar case resulting in a young girl's death. Spaeth speaks of a woman of thirty-one who, a few days after marriage, felt violent pain in coitus, and four days later she noticed that fecal matter escaped from the vagina during stool. Examination showed that the columns of the posterior wall were torn from their attachment, and that there was a rectovaginal fistula admitting the little finger. Hofmokl cites an instance in which a powerful young man, in coitus with a widow of fifty-eight, caused a tear of her fornix, followed by violent hemorrhage. In another case by the same author, coitus in a sitting posture produced a rupture of the posterior fornix, involving the peritoneum; although the patient lost much blood, she finally recovered. In a third instance, a young girl, whose lover had violent connection with her while she was in an exaggerated lithotomy position, suffered a large tear of the right vaginal wall. Hofmokl also describes the case of a young girl with an undeveloped vagina, absence of the uterus and adnexa, who during a forcible and unsuccessful attempt at coitus, had her left labium majus torn from the vaginal wall. The tear extended into the mons veneris and down to the rectum, and the finger could be introduced into the vaginal wound to the depth of two inches. The patient recovered in four weeks, but was still anemic from the loss of blood. Crandall cites instances in which hemorrhage, immediately after coitus of the marriage-night, was so active as to almost cause death. One of his patients was married three weeks previously, and was rapidly becoming exhausted from a constant flowing which started immediately after her first coitus. Examination showed this to be a case of active intrauterine hemorrhage excited by coitus soon after the menstrual flow had ceased and while the uterus and ovaries were highly congested. In another case the patient commenced flooding while at the dinner table in the Metropolitan Hotel in New York, and from the same cause an almost fatal hemorrhage ensued. Hirst of Philadelphia has remarked that brides have been found on their marital beds completely covered with blood, and that the hemorrhage may have been so profuse as to soak through the bed and fall on the floor. Lacerations of the urethra from urethral coitus in instances of vaginal atresia or imperforate hymen may also excite serious hemorrhage. Foreign Bodies in the Vagina.--The elasticity of the vagina allows the presence in this passage of the most voluminous foreign bodies. When we consider the passage of a fetal head through the vagina the ordinary foreign bodies, none of which ever approximate this size, seem quite reasonable. Goblets, hair-pins, needles, bottles, beer glasses, compasses, bobbins, pessaries, and many other articles have been found in the vagina. It is quite possible for a phosphatic incrustation to be found about a foreign body tolerated in this location for some time. Hubbauer speaks of a young girl of nineteen in whose vagina there was a glass fixed by incrustations which held it solidly in place. It had been there for six months and was only removed with great difficulty. Holmes cites a peculiar case in which the neck of a bottle was found in the vagina of a woman. One point of the glass had penetrated the bladder and a calculus had formed on this as well as on the vaginal end. When a foreign body remains in the vagina for a long time and if it is composed of material other than glass, it becomes influenced by the corrosive action of the vaginal secretion. For instance, Cloquet removed a foreign body which was incrusted in the vagina, and found the cork pessary which had formed its nucleus completely rotted. A similar instrument found by Gosselin had remained in the vagina thirty-six years, and was incrustated with calcareous salts. Metal is always attacked by the vaginal secretions in the most marked manner. Cloquet mentions that at an autopsy of a woman who had a pewter goblet in her vagina, lead oxid was found in the gangrenous debris. Long Retention of Pessaries, etc.--The length of time during which pessaries may remain in the vagina is sometimes astonishing. The accompanying illustration shows the phosphatic deposits and incrustations around a pessary after a long sojourn in the vagina. The specimen is in the Musee Dupoytren. Pinet mentions a pessary that remained in situ for twenty-five years. Gerould of Massilon, Ohio, reports a case in which a pessary had been worn by a German woman of eighty-four for more than fifty years. She had forgotten its existence until reminded of it by irritation some years before death. It was remarkable that when the pessary was removed it was found to have largely retained its original wax covering. Hurxthal mentions the removal of a pessary which had been in the pelvis for forty-one years. Jackson speaks of a glove-pessary remaining in the vagina thirty-five years. Mackey reports the removal of a glass pessary after fifty-five years' incarceration. There is an account of a young girl addicted to onanism who died from the presence of a pewter cup in her vagina; it had been there fourteen months. Shame had led her to conceal her condition for all the period during which she suffered pain in the hypogastrium, and diarrhea. She had steadily refused examination. Bazzanella of Innsbruck removed a drinking glass from the vagina by means of a pair of small obstetric forceps. The glass had been placed there ten years previously by the woman's husband. Szigethy reports the case of a woman of seventy-five who, some thirty years before, introduced into her vagina a ball of string previously dipped in wax. The ball was effectual in relieving a prolapsed uterus, and was worn with so little discomfort that she entirely forgot it until it was forced out of place by a violent effort. The ball was seven inches in circumference, and covered with mucus, but otherwise unchanged. Breisky is accredited with the report of a case of a woman suffering with dysmenorrhea, in whose vagina was found a cotton reel which had been introduced seven years before. The woman made a good recovery. Pearse mentions a woman of thirty-six who had suffered menorrhagia for ten days, and was in a state of great prostration and suffering from strong colicky pains. On examination he found a silk-bobbin about an inch from the entrance, which the patient had introduced fourteen years before. She had already had attacks of peritonitis and hemorrhage, and a urethrovaginal fistula was found. The bobbin itself was black. This patient had been married twice, and had been cared for by physicians, but the existence of a body 3/4 inch long had never been noticed. Poulet quotes two curious cases: in one a pregnant woman was examined by a doctor who diagnosticated carcinomatous degeneration of the neck of the uterus. Capuron, who was consulted relative to the case, did not believe that the state of the woman's health warranted the diagnosis, and on further examination the growth was found to have been a sponge which had previously been introduced by the woman into the vagina. The other case, reported by Guyon, exemplified another error in diagnosis. The patient was a woman who suffered from continuous vaginal hemorrhage, and had been given extensive treatment without success. Finally, when the woman was in extreme exhaustion, an injection of vinegar-water was ordered, the use of which was followed by the expulsion from the vagina of a live leech of a species very abundant in the country. The hemorrhage immediately ceased and health returned. There is a record of a woman of twenty-eight who was suddenly surprised by some one entering her chamber at the moment she was introducing a cedar pencil into her vagina. With the purpose of covering up her act and dissembling the woman sat down, and the shank of the wood was pushed through the posterior wall of the vagina into the peritoneal cavity. The intestine was, without doubt, pierced in two of its curves, which was demonstrated later by an autopsy. A plastic exudation had evidently agglutinated the intestine at the points of penetration, and prevented an immediate fatal issue. Erichsen practiced extraction eight months after the accident, and a pencil 5 1/2 inches long, having a strong fecal odor, was brought out. The patient died the fourth day after the operation, from peritonitis, and an autopsy showed the perforation and agglutination of the two intestinal curvatures. Getchell relates the description of a calculus in the vagina, formed about a hair-pin as a nucleus. It is reported that a country girl came to the Hotel-Dieu to consult Dupoytren, and stated that several years before she had been violated by some soldiers, who had introduced an unknown foreign body into her vagina, which she never could extract. Dupuytren found this to be a small metallic pot, two inches in diameter, with its concavity toward the uterus. It contained a solid black substance of a most fetid odor. Foreign bodies are generally introduced in the uterus either accidentally in vaginal applications, or for the purpose of producing abortion. Zuhmeister describes a case of a woman who shortly after the first manifestations of pregnancy used a twig of a tree to penetrate the matrix. She thrust it so strongly into the uterus that the wall was perforated, and the twig became planted in the region of the kidneys. Although six inches long and of the volume of a goose feather, this branch remained five months in the pelvis without causing any particular inconvenience, and was finally discharged by the rectum. Brignatelli mentions the case of a woman who, in culpable practices, introduced the stalk of a reed into her uterus. She suffered no inconvenience until the next menstrual epoch which was accompanied by violent pains. She presented the appearance of one in the pains of labor. The matrix had augmented in volume, and the orifice of the uterine cervix was closed, but there was hypertrophy as if in the second or third month of pregnancy. After examination a piece of reed three cm. long was extracted from the uterus, its external face being incrusted with hard calcareous material. Meschede of Schwetz, Germany, mentions death from a hair-pin in the uterine cavity. Crouzit was called to see a young girl who had attempted criminal abortion by a darning-needle. When he arrived a fetus of about three months had already been expelled, and had been wounded by the instrument. It was impossible to remove the needle, and the placenta was not expelled for two days. Eleven days afterward the girl commenced to have pains in the inguinal region, and by the thirty-fifth day an elevation was formed, and the pains increased in violence. On the seventy-ninth day a needle six inches long was expelled from the swelling in the groin, and the patient recovered. Lisfranc extracted from the uterus of a woman who supposed herself to be pregnant at the third month, a fragment of a large gum-elastic sound which during illicit maneuvers had broken off within five cm. of its extremity, and penetrated the organ. Lisfranc found there was not the slightest sign of pregnancy, despite the woman's belief that she was with child. CHAPTER XIV. MISCELLANEOUS SURGICAL ANOMALIES. Marvelous Recoveries from Multiple Injuries.--There are injuries so numerous or so great in extent, and so marvelous in their recovery, that they are worthy of record in a section by themselves. They are found particularly in military surgery. In the Medical and Philosophical Commentaries for 1779 is the report of the case of a lieutenant who was wounded through the lungs, liver, and stomach, and in whose armpit lodged a ball. It was said that when the wound in his back was injected, the fluid would immediately be coughed up from his lungs. Food would pass through the wound of the stomach. The man was greatly prostrated, but after eleven months of convalescence he recovered. In the brutal capture of Fort Griswold, Connecticut, in 1781, in which the brave occupants were massacred by the British, Lieutenant Avery had an eye shot out, his skull fractured, the brain-substance scattering on the ground, was stabbed in the side, and left for dead; yet he recovered and lived to narrate the horrors of the day forty years after. A French invalid-artillery soldier, from his injuries and a peculiar mask he used to hide them, was known as "L'homme a la tete de cire." The Lancet gives his history briefly as follows: During the Franco-Prussian War, he was horribly wounded by the bursting of a Prussian shell. His whole face, including his two eyes, were literally blown away, some scanty remnants of the osseous and muscular systems, and the skull covered with hair being left. His wounds healed, giving him such a hideous and ghastly appearance that he was virtually ostracized from the sight of his fellows. For his relief a dentist by the name of Delalain constructed a mask which included a false palate and a set of false teeth. This apparatus was so perfect that the functions of respiration and mastication were almost completely restored to their former condition, and the man was able to speak distinctly, and even to play the flute. His sense of smell also returned. He wore two false eyes simply to fill up the cavities of the orbits, for the parts representing the eyes were closed. The mask was so well-adapted to what remained of the real face, that it was considered by all one of the finest specimens of the prothetic art that could be devised. This soldier, whose name was Moreau, was living and in perfect health at the time of the report, his bizarre face, without expression, and his sobriquet, as mentioned, making him an object of great curiosity. He wore the Cross of Honor, and nothing delighted him more than to talk about the war. To augment his meager pension he sold a pamphlet containing in detail an account of his injuries and a description of the skilfully devised apparatus by which his declining life was made endurable. A somewhat similar case is mentioned on page 585. A most remarkable case of a soldier suffering numerous and almost incredible injuries and recovering and pursuing his vocation with undampened ardor is that of Jacques Roellinger, Company B, 47th New York Volunteers. He appeared before a pension board in New York, June 29, 1865, with the following history: In 1862 he suffered a sabre-cut across the quadriceps extensor of the left thigh, and a sabre-thrust between the bones of the forearm at the middle third. Soon afterward at Williamsburg, Va., he was shot in the thigh, the ball passing through the middle third external to the femur. At Fort Wagner, 1863, he had a sword-cut, severing the spinal muscles and overlying tissue for a distance of six inches. Subsequently he was captured by guerillas in Missouri and tortured by burning splinters of wood, the cicatrices of which he exhibited; he escaped to Florida, where he was struck by a fragment of an exploding shell, which passed from without inward, behind the hamstring on the right leg, and remained embedded and could be plainly felt. When struck he fell and was fired on by the retiring enemy. A ball entered between the 6th and 7th ribs just beneath the apex of the heart, traversed the lungs and issued at the right 9th rib. He fired his revolver on reception of this shot, and was soon bayonetted by his own comrades by mistake, this wound also penetrating the body. He showed a depressed triangular cicatrix on the margin of the epigastrium. If the scars are at all indicative, the bayonet must have passed through the left lobe of the liver and border of the diaphragm. Finally he was struck by a pistol-ball at the lower angle of the left lower jaw, this bullet issuing on the other side of the neck. As exemplary of the easy manner in which he bore his many injuries during a somewhat protracted convalescence, it may be added that he amused his comrades by blowing jets of water through the apertures on both sides of his neck. Beside the foregoing injuries he received many minor ones, which he did not deem worthy of record or remembrance. The greatest disability he suffered at the time of applying for a pension resulted from an ankylosed knee. Not satisfied with his experience in our war, he stated to the pension examiners that he was on his way to join Garibaldi's army. This case is marvelous when we consider the proximity of several of the wounds to a vital part; the slightest deviation of position would surely have resulted in a fatal issue for this apparently charmed life. The following table shows the man's injuries in the order of their reception:-- (1) Sabre-cut across the quadriceps femoris of right leg, dividing the tendinous and muscular structures. (2) Sabre-thrust between the bones in the middle third of the right forearm. (3) Shot in the right thigh, the ball passing through the middle third. (4) A sword-cut across the spinal muscles covering the lower dorsal vertebrae. (5) Tortured by guerillas in Indian fashion by having burning splinters of wood applied to the surface of his right thorax. (6) An exploded shell passed through the hamstring muscles of the right thigh and embedded itself in the ligamentous tissues of the internal condyle of the femur. (7) Shot by a ball between the 6th and 7th ribs of the left side. (8) Bayonetted through the body, the steel passing through the left lobe of the liver and penetrating the posterior border of the diaphragm. (9) Pistol-ball shot through the sternocleido muscle of one side of the neck, emerging through the corresponding muscle of the other side of the neck. (10) Sabre-thrust between the bones of the left forearm. (11) Pistol-shot through the left pectoralis major and left deltoid muscles. (12) Deep cut dividing the commissure between the left thumb and forefinger down to the carpal bones. Somewhat analogous to the foregoing is a case reported in 1834 by McCosh from Calcutta. The patient was a native who had been dreadfully butchered in the Chooar campaign. One of his hands was cut off above the wrist. The remaining stump was nearly amputated by a second blow. A third blow penetrated the shoulder-joint. Beside these and several other slashes, he had a cut across the abdomen extending from the umbilicus to the spine. This cut divided the parietes and severed one of the coats of the colon. The intestines escaped and lay by his side. He was then left on the ground as dead. On arrival at the hospital his wounds were dressed and he speedily convalesced, but the injured colon ruptured and an artificial anus was formed and part of the feces were discharged through the wound. This man was subsequently seen at Midnapore healthy and lusty although his body was bent to one side in consequence of a large cicatrix; a small portion of the feces occasionally passed through the open wound. There is an account of a private soldier, aged twenty-seven, who suffered a gunshot wound of the skull, causing compound fracture of the cranium, and who also received compound fractures of both bones of the leg. He did not present himself for treatment until ten days later. At this time the head-injury caused him no inconvenience, but it was necessary to amputate the leg and remove the necrosed bones from the cranial wounds; the patient recovered. Recovery After Injuries by Machinery, with Multiple Fractures, etc.--Persons accidentally caught in some portions of powerful machinery usually suffer several major injuries, any one of which might have been fatal, yet there are marvelous instances of recovery after wounds of this nature. Phares records the case of a boy of nine who, while playing in the saw-gate of a cotton-press, was struck by the lever in revolution, the blow fracturing both bones of the leg about the middle. At the second revolution his shoulder was crushed; the third passed over him, and the fourth, with maximum momentum struck his head, carrying away a large part of the integument, including one eyebrow, portions of the skull, membranes, and brain-substance. A piece of cranial bone was found sticking in the lever, and there were stains of brain on all the 24 posts around the circumference of the hole. Possibly from 1 1/2 to two ounces of cerebral substance were lost. A physician was called, but thinking the case hopeless he declined to offer surgical interference. Undaunted, the father of the injured lad straightened the leg, adjusted the various fractures, and administered calomel and salts. The boy progressively recovered, and in a few weeks his shoulder and legs were well. About this time a loosened fragment of the skull was removed almost the size and shape of a dessert spoon, with the handle attached, leaving a circular opening directly over the eye as large as a Mexican dollar, through which cerebral pulsation was visible. A peculiar feature of this case was that the boy never lost consciousness, and while one of his playmates ran for assistance he got out of the hole himself, and moved to a spot ten feet distant before any help arrived, and even then he declined proffered aid from a man he disliked. This boy stated that he remembered each revolution of the lever and the individual injuries that each inflicted. Three years after his injury he was in every respect well. Fraser mentions an instance of a boy of fifteen who was caught in the crank of a balance-wheel in a shingle-mill, and was taken up insensible. His skull was fractured at the parietal eminence and the pericranium stripped off, leaving a bloody tumor near the base of the fracture about two inches in diameter. The right humerus was fractured at the external condyle; there was a fracture of the coronoid process of the ulna, and a backward dislocation at the elbow. The annular ligament was ruptured, and the radius was separated from the ulna. On the left side there was a fracture of the anatomic neck of the humerus, and a dislocation downward. The boy was trephined, and the comminuted fragments removed; in about six weeks recovery was nearly complete. Gibson reports the history of a girl of eight who was caught by her clothing in a perpendicular shaft in motion, and carried around at a rate of 150 or 200 times a minute until the machinery could be stopped. Although she was found in a state of shock, she was anesthetized, in order that immediate attention could be given to her injuries, which were found to be as follows:-- (1) An oblique fracture of the middle third of the right femur. (2) A transverse fracture of the middle third of the left femur. (3) A slightly comminuted transverse fracture of the middle third of the left tibia and fibula. (4) A transverse fracture of the lower third of the right humerus. (5) A fracture of the lower third of the right radius. (6) A partial radiocarpal dislocation. (7) Considerable injuries of the soft parts at the seats of fracture, and contusions and abrasions all over the body. During convalescence the little patient suffered an attack of measles, but after careful treatment it was found by the seventy-eighth day that she had recovered without bony deformity, and that there was bony union in all the fractures. There was slight tilting upward in the left femur, in which the fracture had been transverse, but there was no perceptible shortening. Hulke describes a silver-polisher of thirty-six who, while standing near a machine, had his sleeve caught by a rapidly-turning wheel, which drew him in and whirled him round and round, his legs striking against the ceiling and floor of the room. It was thought the wheel had made 50 revolutions before the machinery was stopped. After his removal it was found that his left humerus was fractured at its lower third, and apparently comminuted. There was no pulse in the wrist in either the radial or ulnar arteries, but there was pulsation in the brachial as low as the ecchymosed swelling. Those parts of the hand and fingers supplied by the median and radial nerves were insensible. The right humerus was broken at the middle, the end of the upper fragment piercing the triceps, and almost protruding through the skin. One or more of the middle ribs on the right side were broken near the angle, and there was a large transverse rent in the quadriceps extensor. Despite this terrible accident the man made a perfect recovery, with the single exception of limitation of flexion in the left elbow-joint. Dewey details a description of a girl of six who was carried around the upright shaft of a flour mill in which her clothes became entangled. Some part of the body struck the bags or stones with each revolution. She sustained a fracture of the left humerus near the insertion of the deltoid, a fracture of the middle third of the left femur, a compound fracture of the left femur in the upper third, with protrusion of the upper fragment and considerable venous hemorrhage, and fracture of the right tibia and fibula at the upper third. When taken from the shafting the child was in a moribund state, with scarcely perceptible pulse, and all the accompanying symptoms of shock. Her injuries were dressed, the fractures reduced, and starch bandages applied; in about six weeks there was perfect union, the right leg being slightly shortened. Six months later she was playing about, with only a slight halt in her gait. Miscellaneous Multiple Fractures.--Westmoreland speaks of a man who was pressed between two cars, and sustained a fracture of both collar-bones and of the sternum; in addition, six or eight ribs were fractured, driven into and lacerating the lung. The heart was displaced. In spite of these terrible injuries, the man was rational when picked up, and lived nearly half a day. In comment on this case Battey mentions an instance in which a mill-sawyer was run over by 20 or 30 logs, which produced innumerable fractures of his body, constituting him a surgical curiosity. He afterward completely recovered, and, as a consequence of his miraculous escape, became a soothsayer in his region. West reports a remarkable recovery after a compound fracture of the femur, fracture of the jaw, and of the radius, and possibly injury to the base of the skull, and injury to the spine. There is on record an account of a woman of forty-three who, by muscular action in lifting a stone, fractured her pubes, external to the spine, on the left side. Not realizing her injury she continued hard work all that day, but fell exhausted on the next. She recovered in about a month, and was able to walk as well as ever. Vinnedge reports recovery after concussion of the brain and extreme shock, associated with fracture of the left femur, and comminuted fractures of the left tibia and fibula. Tufnell mentions recovery after compound comminuted fracture of the leg, with simple fracture of both collar-bones, and dislocation of the thumb. Nankivell speaks of a remarkable recovery in an individual who suffered compound comminuted fracture of both legs, and fracture of the skull. It was found necessary to amputate the right thigh and left leg. Erichsen effected recovery by rest alone, in an individual whose ribs and both clavicles were fractured by being squeezed. Gilman records recovery after injuries consisting of fracture of the frontal bone near the junction with the right parietal; fracture of the right radius and ulna at the middle third and at the wrist; and compound fracture of the left radius and ulna, 1 1/4 inches above the wrist. Boulting reports a case of an individual who suffered compound fractures of the skull and humerus, together with extensive laceration of the thigh and chest, and yet recovered. Barwell mentions recovery after amputation of the shoulder-joint, in an individual who had suffered fracture of the base of the skull, fracture of the jaw, and compound fracture of the right humerus. There was high delirium followed by imbecility in this case. Bonnet reports a case of fracture of both thighs, two right ribs, luxation of the clavicle, and accidental club-foot with tenotomy, with good recovery from all the complications. Beach speaks of an individual who suffered fracture of both thighs, and compound comminuted fracture of the tibia, fibula, and tarsal bones into the ankle-joint, necessitating amputation of the leg. The patient not only survived the operation, but recovered with good union in both thighs. As illustrative of the numerous fractures a person may sustain at one time, the London Medical Gazette mentions an injury to a girl of fourteen, which resulted in 31 fractures. Remarkable Falls.--In this connection it is of interest to note from how great a height a person may fall without sustaining serious injury. A remarkable fall of a miner down 100 meters of shaft (about 333 feet) without being killed is recorded by M. Reumeaux in the Bulletin de l'Industrie Minerale. Working with his brother in a gallery which issued on the shaft, he forgot the direction in which he was pushing a truck; so it went over, and he after it, falling into some mud with about three inches of water. As stated in Nature, he seems neither to have struck any of the wood debris, nor the sides of the shaft, and he showed no contusions when he was helped out by his brother after about ten minutes. He could not, however, recall any of his impressions during the fall. The velocity on reaching the bottom would be about 140 feet, and time of fall 4.12 seconds; but it is thought he must have taken longer. It appears strange that he should have escaped simple suffocation and loss of consciousness during a time sufficient for the water to have drowned him. While intoxicated Private Gough of the 42d Royal Highlanders attempted to escape from the castle at Edinburgh. He fell almost perpendicularly 170 feet, fracturing the right frontal sinus, the left clavicle, tibia, and fibula. In five months he had so far recovered as to be put on duty again, and he served as an efficient soldier. There is an account of recovery after a fall of 192 feet, from a cliff in County Antrim, Ireland. Manzini mentions a man who fell from the dome of the Invalides in Paris, without sustaining any serious accident, and there is a record from Madrid of a much higher fall than this without serious consequence. In 1792 a bricklayer fell from the fourth story of a high house in Paris, landing with his feet on the dirt and his body on stone. He bled from the nose, and lost consciousness for about forty-five minutes; he was carried to the Hotel-Dieu where it was found that he had considerable difficulty in breathing; the regions about the external malleoli were contused and swollen, but by the eighth day the patient had recovered. In the recent reparation of the Hotel Raleigh in Washington, D.C., a man fell from the top of the building, which is above the average height, fracturing several ribs and rupturing his lung. He was taken to the Emergency Hospital where he was put to bed, and persistent treatment for shock was pursued; little hope of the man's recovery was entertained. His friends were told of his apparently hopeless condition. There were no external signs of the injury with the exception of the emphysema following rupture of the lung. Respiration was limited and thoracic movement diminished by adhesive straps and a binder; under careful treatment the man recovered. Kartulus mentions an English boy of eight who, on June 1, 1879, while playing on the terrace in the third story of a house in Alexandria, in attempting to fly a kite in company with an Arab servant, slipped and fell 71 feet to a granite pavement below. He was picked up conscious, but both legs were fractured about the middle. He had so far recovered by the 24th of July that he could hobble about on crutches. On the 15th of November of the same year he was seen by Kartulus racing across the playground with some other boys; as he came in third in the race he had evidently lost little of his agility. Parrott reports the history of a man of fifty, weighing 196 pounds, who fell 110 feet from the steeple of a church. In his descent he broke a scaffold pole in two, and fell through the wooden roof of an engine-house below, breaking several planks and two strong joists, and landing upon some sacks of cement inside the house. When picked up he was unconscious, but regained his senses in a short time, and it was found that his injuries were not serious. The left metacarpal bones were dislocated from the carpal bones, the left tibia was fractured, and there were contusions about the back and hips. Twelve days later he left for home with his leg in plaster. Farber and McCassy report a case in which a man fell 50 feet perpendicularly through an elevator shaft, fracturing the skull. Pieces of bone at the superior angle of the occipital bone were removed, leaving the aura exposed for a space one by four inches. The man was unconscious for four days, but entirely recovered in eighteen days, with only a slightly subnormal hearing as an after-effect of his fall. For many years there have been persons who have given exhibitions of high jumps, either landing in a net or in the water. Some of these hazardous individuals do not hesitate to dive from enormous heights, being satisfied to strike head first or to turn a somersault in their descent. Nearly all the noted bridges in this country have had their "divers." The death of Odlum in his attempt to jump from Brooklyn bridge is well known. Since then it has been claimed that the feat has been accomplished without any serious injury. It is reported that on June 20, 1896, a youth of nineteen made a headlong dive from the top of the Eads bridge at St. Louis, Mo., a distance of 125 feet. He is said to have swum 250 feet to a waiting tug, and was taken on board without having been hurt. Probably the most interesting exhibition of this kind that was ever seen was at the Royal Aquarium, London, in the summer of 1895. A part of the regular nightly performance at this Hall, which is familiar on account of its immensity, was the jump of an individual from the rafters of the large arched roof into a tank of water about 15 by 20 feet, and from eight to ten feet deep, sunken in the floor of the hall. Another performer, dressed in his ordinary street clothes, was tied up in a bag and jumped about two-thirds of this height into the same tank, breaking open the bag and undressing himself before coming to the surface. In the same performance a female acrobat made a backward dive from the topmost point of the building into a net stretched about ten feet above the floor. Nearly every large acrobatic entertainment has one of these individuals who seem to experience no difficulty in duplicating their feats night after night. It is a common belief that people falling from great heights die in the act of descent. An interview with the sailor who fell from the top-gallant of an East Indiaman, a height of 120 feet, into the water, elicited the fact that during the descent in the air, sensation entirely disappeared, but returned in a slight degree when he reached the water, but he was still unable to strike out when rising to the surface. By personal observation this man stated that he believed that if he had struck a hard substance his death would have been painless, as he was sure that he was entirely insensible during the fall. A writer in the Pall Mall Gazette, in speaking of the accidents which had happened in connection with the Forth Bridge, tells of a man who trusted himself to work at the height of 120 feet above the waters of the Firth, simply grasping a rope. His hands became numb with cold, his grasp relaxed, and he fell backward down into the water, but was brought out alive. In another instance a spanner fell a distance of 300 feet, knocked off a man's cap, and broke its way through a four-inch plank. Again, another spanner fell from a great height, actually tearing off a man's clothes, from his waistcoat to his ankle, but leaving him uninjured. On another occasion a staging with a number of workmen thereon gave way. Two of the men were killed outright by striking some portion of the work in their descent; two others fell clear of the girders, and were rescued from the Firth little worse for their great fall. Resistance of Children to Injuries.--It is a remarkable fact that young children, whose bones, cartilages, and tissues are remarkably elastic, are sometimes able to sustain the passage over their bodies of vehicles of great weight without apparent injury. There is a record early in this century of a child of five who was run over across the epigastrium by a heavy two-wheeled cart, but recovered without any bad symptoms. The treatment in this case is quite interesting, and was as follows: venesection to faintness, castor oil in infusion of senna until there was a free evacuation of the bowels, 12 leeches to the abdomen and spine, and a saline mixture every two hours! Such depleting therapeutics would in themselves seem almost sufficient to provoke a fatal issue, and were given in good faith as the means of effecting a recovery in such a case. In a similar instances a wagon weighing 1200 pounds passed over a child of five, with no apparent injury other than a bruise near the ear made by the wheel. Infant-vitality is sometimes quite remarkable, a newly-born child sometimes surviving extreme exposure and major injuries. There was a remarkable instance of this kind brought to light in the Mullings vs. Mullings divorce-case, recorded in The Lancet. It appeared that Mrs. Mullings, a few hours after her confinement at Torquay, packed her newly-born infant boy in a portmanteau, and started for London. She had telegraphed Dr. J. S. Tulloch to meet her at Paddington, where he found his patient apparently in good condition, and not weak, as he expected in a woman shortly to be confined. On the way to her apartments, which had been provided by Dr. Tulloch, Mrs. Mullings remarked to the Doctor that she had already borne her child. Dr. Tulloch was greatly surprised, and immediately inquired what she had done with the baby. She replied that it was in a box on top of the cab. When the box was opened the child was found alive. The Lancet comments on the remarkable fact that, shortly after confinement, a woman can travel six or seven hours in a railroad train, and her newly-born babe conveyed the same distance in a portmanteau, without apparent injury, and without attracting attention. Booth reports a remarkable case of vitality of a newly-born child which came under his observation in October, 1894. An illegitimate child, abandoned by its mother, was left at the bottom of a cesspool vault; she claimed that ten hours before Booth's visit it had been accidentally dropped during an attempt to micturate. The infant lived despite the following facts: Its delivery from an ignorant, inexperienced, unattended negress; its cord not tied; its fall of 12 feet down the pit; its ten hours' exposure in the cesspool; its smothering by foul air, also by a heavy covering of rags, paper, and straw; its pounding by three bricks which fell in directly from eight feet above (some loose bricks were accidentally dislodged from the sides of the vault, in the maneuvers to extricate the infant); its lowered temperature previous to the application of hot bottles, blankets, and the administration of cardiac stimulants. Booth adds that the morning after its discovery the child appeared perfectly well, and some two months afterward was brought into court as evidence in the case. A remarkable case of infant vitality is given on page 117. Operations in the Young and Old.--It might be of interest to mention that such a major operation as ovariotomy has been successfully performed in an infant. In a paper on infant ovariotomy, several instances of this nature are mentioned. Roemer successfully performed ovariotomy on a child one year and eight months old; Swartz, on a child of four; Barker, on a child of four; Knowsley Thornton, on a child of seven, and Spencer Wells Cupples, and Chenoweth, on children of eight. Rein performed ovariotomy on a girl of six, suffering from a multilocular cyst of the left ovary. He expresses his belief that childhood and infancy are favorable to laparotomy. Kidd removed a dermoid from a child of two years and eleven months; Hooks performed the same operation on a child of thirty months. Chiene extirpated an ovary from a child of three; Neville duplicated this operation in a child one month younger; and Alcock performed ovariotomy on a child of three. Successful ovariotomies are infrequent in the extremely aged. Bennett mentions an instance in a woman of seventy-five, and Davies records a similar instance. Borsini and Terrier cite instances of successful ovariotomy in patients of seventy-seven. Carmichael performed the operation at seventy-four. Owens mentions it at eighty; and Homans at eighty-two years and four months. Dewees records a successful case of ovariotomy in a woman over sixty-seven; McNutt reports a successful instance in a patient of sixty-seven years and six months; the tumor weighed 60 pounds, and there were extensive adhesions. Maury removed a monocystic ovarian tumor from a woman of seventy-four, his patient recovering. Pippingskold mentions an ovariotomy at eighty. Terrier describes double ovariotomy for fibromata in a woman of seventy-seven. Aron speaks of an operation for pilous dermoid of the ovary in a woman of seventy-five. Shepherd reports a case of recurrent proliferous cyst in a woman of sixty-three, on whom successful ovariotomy was performed twice within nine months. Wells mentions an ovarian cyst in a woman of sixty-five, from which 72 pints of fluid were removed. Hawkins describes the case of a musician, M. Rochard, who at the age of one hundred and seven was successfully operated on for strangulated hernia of upward of thirty hours' duration. The wound healed by first intention, and the man was well in two weeks. Fowler operated successfully for strangulated umbilical hernia on a patient of sixty-eight. Repeated Operations.--Franzolini speaks of a woman of fifty on whom he performed six celiotomies between June, 1879, and April, 1887. The first operation was for fibrocystic disease of the uterus. Since the last operation the woman had had remarkably good health, and there was every indication that well-merited recovery had been effected. The Ephemerides contains an account of a case in which cystotomy was repeated four times, and there is another record of this operation having been done five times on a man. Instances of repeated Cesarean section are mentioned on page 130. Before leaving this subject, we mention a marvelous operation performed by Billroth on a married woman of twenty-nine, after her sixth pregnancy. This noted operator performed, synchronously, double ovariotomy and resections of portions of the bladder and ileum, for a large medullary carcinomatous growth of the ovary, with surrounding involvement. Menstruation returned three months after the operation, and in fifteen months the patient was in good health in every way, with no apparent danger of recurrence of the disease. Self-performed Surgical Operations.--There have been instances in which surgeons and even laymen have performed considerable operations upon themselves. On the battlefield men have amputated one of their own limbs that had been shattered. In such cases there would be little pain, and premeditation would not be brought into play in the same degree as in the case of M. Clever de Maldigny, a surgeon in the Royal Guards of France, who successfully performed a lithotomy on himself before a mirror. He says that after the operation was completed the urine flowed in abundance; he dressed the wound with lint dipped in an emollient solution, and, being perfectly relieved from pain, fell into a sound sleep. On the following day, M. Maldigny says, he was as tranquil and cheerful as if he had never been a sufferer. A Dutch blacksmith and a German cooper each performed lithotomy on themselves for the intense pain caused by a stone in the bladder. Tulpius, Walther, and the Ephemerides each report an instance of self-performed cystotomy. The following case is probably the only instance in which the patient, suffering from vesical calculus, tried to crush and break the stone himself. J. B., a retired draper, born in 1828, while a youth of seventeen, sustained a fracture of the leg, rupture of the urethra, and laceration of the perineum, by a fall down a well, landing astride an iron bar. A permanent perineal fistula was established, but the patient was averse to any operative remedial measure. In the year 1852 he became aware of the presence of a calculus, but not until 1872 did he ask for medical assistance. He explained that he had introduced a chisel through his perineal fistula to the stone, and attempted to comminute it himself and thus remove it, and by so doing had removed about an ounce of the calculus. The physician started home for his forceps, but during the interval, while walking about in great pain, the man was relieved by the stone bursting through the perineum, falling to the floor, and breaking in two. Including the ounce already chiselled off, the stone weighed 14 1/2 ounces, and was 10 5/8 inches in its long circumference. B. recovered and lived to December, 1883, still believing that he had another piece of stone in his bladder. In Holden's "Landmarks" we are told that the operation of dividing the Achilles tendon was first performed by an unfortunate upon himself, by means of a razor. According to Patterson, the late Mr. Symes told of a patient in North Scotland who, for incipient hip-disease, had the cautery applied at the Edinburgh Infirmary with resultant great relief. After returning home to the country he experienced considerable pain, and despite his vigorous efforts he was unable to induce any of the men to use the cautery upon him; they termed it "barbarous treatment." In desperation and fully believing in the efficacy of this treatment as the best means of permanently alleviating his pain, the crippled Scotchman heated a poker and applied the cautery himself. We have already mentioned the marvelous instances of Cesarean sections self-performed, and in the literature of obstetric operations many of the minor type have been done by the patient herself. In the foregoing cases it is to be understood that the operations have been performed solely from the inability to secure surgical assistance or from the incapacity to endure the pain any longer. These operations were not the self-mutilations of maniacs, but were performed by rational persons, driven to desperation by pain. Possibly the most remarkable instances of extensive loss of blood, with recoveries, are to be found in the older records of venesection. The chronicles of excessive bleeding in the olden days are well known to everybody. Perhaps no similar practice was so universally indulged in. Both in sickness and in health, depletion was indicated, and it is no exaggeration to say that about the hospital rooms at times the floors were covered with blood. The reckless way in which venesection was resorted to, led to its disuse, until to-day it has so vanished from medical practice that even its benefits are overlooked, and depletion is brought about in some other manner. Turning to the older writers, we find Burton describing a patient from whom he took 122 ounces of blood in four days. Dover speaks of the removal of 111 and 190 ounces; Galen, of six pounds; and Haen, of 114 ounces. Taylor relates the history of a case of asphyxia in which he produced a successful issue by extracting one gallon of blood from his patient during twelve hours. Lucas speaks of 50 venesections being practiced during one pregnancy. Van der Wiel performed venesection 49 times during a single pregnancy. Balmes mentions a case in which 500 venesections were performed in twenty-five years. Laugier mentions 300 venesections in twenty-six months. Osiander speaks of 8000 ounces of blood being taken away in thirty-five years. Pechlin reports 155 venesections in one person in sixteen years, and there is a record of 1020 repeated venesections. The loss of blood through spontaneous hemorrhage is sometimes remarkable. Fabricius Hildanus reports the loss of 27 pounds of blood in a few days; and there is an older record of 40 pounds being lost in four days. Horstius, Fabricius Hildanus, and Schenck, all record instances of death from hemorrhage of the gums. Tulpius speaks of hemoptysis lasting chronically for thirty years, and there is a similar record of forty years' duration in the Ephemerides. Chapman gives several instances of extreme hemorrhage from epistaxis. He remarks that Bartholinus has recorded the loss of 48 pounds of blood from the nose; and Rhodius, 18 pounds in thirty-six hours. The Ephemerides contains an account of epistaxis without cessation for six weeks. Another writer in an old journal speaks of 75 pounds of blood from epistaxis in ten days. Chapman also mentions a case in which, by intestinal hemorrhage, eight gallons of blood were lost in a fortnight, the patient recovering. In another case a pint of blood was lost daily for fourteen days, with recovery. The loss of eight quarts in three days caused death in another case; and Chapman, again, refers to the loss of three gallons of blood from the bowel in twenty-four hours. In the case of Michelotti, recorded in the Transactions of the Royal Society, a young man suffering from enlargement of the spleen vomited 12 pounds of blood in two hours, and recovered. In hemorrhoidal hemorrhages, Lieutaud speaks of six quarts being lost in two days; Hoffman, of 20 pounds in less than twenty-four hours, and Panaroli, of the loss of one pint daily for two years. Arrow-Wounds.--According to Otis the illustrious Baron Percy was wont to declare that military surgery had its origin in the treatment of wounds inflicted by darts and arrows; he used to quote Book XI of the Iliad in behalf of his belief, and to cite the cases of the patients of Chiron and Machaon, Menelaus and Philoctetes, and Eurypiles, treated by Patroclus; he was even tempted to believe with Sextus that the name iatros, medicus, was derived from ios, which in the older times signified "sagitta," and that the earliest function of our professional ancestors was the extraction of arrows and darts. An instrument called beluleum was invented during the long Peloponnesian War, over four hundred years before the Christian era. It was a rude extracting-forceps, and was used by Hippocrates in the many campaigns in which he served. His immediate successor, Diocles, invented a complicated instrument for extracting foreign bodies, called graphiscos, which consisted of a canula with hooks. Otis states that it was not until the wars of Augustus that Heras of Cappadocia designed the famous duck-bill forceps which, with every conceivable modification, has continued in use until our time. Celsus instructs that in extracting arrow-heads the entrance-wound should be dilated, the barb of the arrow-head crushed by strong pliers, or protected between the edges of a split reed, and thus withdrawn without laceration of the soft parts. According to the same authority, Paulus Aegineta also treated fully of wounds by arrow-heads, and described a method used in his time to remove firmly-impacted arrows. Albucasius and others of the Arabian school did little or nothing toward aiding our knowledge of the means of extracting foreign bodies. After the fourteenth century the attention of surgeons was directed to wounds from projectiles impelled by gunpowder. In the sixteenth century arrows were still considerably used in warfare, and we find Pare a delineating the treatment of this class of injuries with the sovereign good sense that characterized his writings. As the use of firearms became prevalent the literature of wounds from arrows became meager, and the report of an instance in the present day is very rare. Bill has collected statistics and thoroughly discussed this subject, remarking upon the rapidity with which American Indians discharge their arrows, and states that it is exceptional to meet with only a single wound. It is commonly believed that the Indian tribes make use of poisoned arrows, but from the reports of Bill and others, this must be a very rare custom. Ashhurst states that he was informed by Dr. Schell, who was stationed for some time at Fort Laramie, that it is the universal custom to dip the arrows in blood, which is allowed to dry on them; it is not, therefore, improbable that septic material may thus be inoculated through a wound. Many savage tribes still make use of the poisonous arrow. The Dyak uses a sumpitan, or blow-tube, which is about seven feet long, and having a bore of about half an inch. Through this he blows his long, thin dart, anointed on the head with some vegetable poison. Braidwood speaks of the physiologic action of Dajaksch, an arrow-poison used in Borneo. Arnott has made observations relative to a substance produced near Aden, which is said to be used by the Somalies to poison their arrows. Messer of the British Navy has made inquiries into the reputed poisonous nature of the arrows of the South Sea Islanders. Otis has collected reports of arrow-wounds from surgical cases occurring in the U. S. Army. Of the multiple arrow-wounds, six out of the seven cases were fatal. In five in which the cranial cavity was wounded, four patients perished. There were two remarkable instances of recovery after penetration of the pleural cavity by arrows. The great fatality of arrow-wounds of the abdomen is well known, and, according to Bill, the Indians always aim at the umbilicus; when fighting Indians, the Mexicans are accustomed to envelop the abdomen, as the most vulnerable part, in many folds of a blanket. Of the arrow-wounds reported, nine were fatal, with one exception, in which the lesion implicated the soft parts only. The regions injured were the scalp, face, and neck, in three instances; the parietes of the chest in six; the long muscles of the back in two; the abdominal muscles in two; the hip or buttocks in three; the testis in one; the shoulder or arm in 13; forearm or hand in six; the thigh or leg in seven. The force with which arrows are projected by Indians is so great that it has been estimated that the initial velocity nearly equals that of a musket-ball. At a short distance an arrow will perforate the larger bones without comminuting them, causing a slight fissure only, and resembling the effect of a pistol-ball fired through a window-glass a few yards off. Among extraordinary cases of recovery from arrow-wounds, several of the most striking will be recorded. Tremaine mentions a sergeant of thirty-four who, in a fray with some hostile Indians, received seven arrow-wounds: two on the anterior surface of the right arm; one in the right axilla; one on the right side of the chest near the axillary border; two on the posterior surface of the left arm near the elbow-joint, and one on the left temple. On June 1st he was admitted to the Post Hospital at Fort Dodge, Kan. The wound on the right arm near the deltoid discharged, and there was slight exfoliation of the humerus. The patient was treated with simple dressings, and was returned to duty in July, 1870. Goddard mentions an arrow-wound by which the body was transfixed. The patient was a cutler's helper at Fort Rice, Dakota Territory. He was accidentally wounded in February, 1868, by an arrow which entered the back three inches to the right of the 5th lumbar vertebra, and emerged about two inches to the right of the ensiform cartilage. During the following evening the patient lost about eight ounces of blood externally, with a small amount internally. He was confined to his bed some two weeks, suffering from circumscribed peritonitis with irritative fever. In four weeks he was walking about, and by July 1st was actively employed. The arrow was deposited in the Army Medical Museum. Muller gives a report of an arrow-wound of the lung which was productive of pleurisy but which was followed by recovery. Kugler recites the description of the case of an arrow-wound of the thorax, complicated by frightful dyspnea and blood in the pleural cavity and in the bronchi, with recovery. Smart extracted a hoop-iron arrow-head, 1 3/4 inches long and 1/2 inch in breadth, from the brain of a private, about a month after its entrance. About a dram of pus followed the exit of the arrow-head. After the operation the right side was observed to be paralyzed, and the man could not remember his name. He continued in a varying condition for a month, but died on May 13, 1866, fifty-two days after the injury. At the postmortem it was found that the brain-tissue, to the extent of 3/4 inch around the track of the arrow as a center, was softened and disorganized. The track itself was filled with thick pus which extended into the ventricles. Peabody reports a most remarkable case of recovery from multiple arrow-wounds. In a skirmish with some Indians on June 3, 1863, the patient had been wounded by eight distinct arrows which entered different parts of the body. They were all extracted with the exception of one, which had entered at the outer and lower margin of the right scapula, and had passed inward and upward through the upper lobe of the right lung or trachea. The hemorrhage at this time was so great that all hope was abandoned. The patient, however, rallied, but continued to experience great pain on swallowing, and occasionally spat blood. In July, 1866, more than three years after the injury, he called on Dr. Peabody to undergo an examination with a view of applying for a pension, stating that his health was affected from the presence of an arrow-head. He was much emaciated, and expressed himself as tired of life. Upon probing through a small fistulous opening just above the superior end of the sternum, the point of the arrow was found resting against the bone, about 1 1/2 inches below, the head lying against the trachea and esophagus, with the carotid artery, jugular vein, and nerves overlying. After some little difficulty the point of the arrow was raised above the sternum, and it was extracted without the loss of an ounce of blood. The edge grazed against the sheath of the innominate artery during the operation. The missile measured an inch at the base, and was four inches long. The health of the patient underwent remarkable improvement immediately after the operation. Serious Insect-stings.--Although in this country the stings of insects are seldom productive of serious consequences, in the tropic climates death not unfrequently results from them. Wounds inflicted by large spiders, centipedes, tarantulae, and scorpions have proved fatal. Even in our country deaths, preceded by gangrene, have sometimes followed the bite of a mosquito or a bee, the location of the bite and the idiosyncrasy of the individual probably influencing the fatal issue. In some cases, possibly, some vegetable poison is introduced with the sting. Hulse, U.S.N., reports the case of a man who was bitten on the penis by a spider, and who subsequently exhibited violent symptoms simulating spinal meningitis, but ultimately recovered. Kunst mentions a man of thirty-six who received several bee-stings while taking some honey from a tree, fell from the tree unconscious, and for some time afterward exhibited signs of cerebral congestion. Chaumeton mentions a young man who did not perceive a wasp in a glass of sweet wine, and swallowed the insect. He was stung in the throat, followed by such intense inflammation that the man died asphyxiated in the presence of his friends, who could do nothing to relieve him. In connection with this case there is mentioned an English agriculturist who saved the life of one of his friends who had inadvertently swallowed a wasp with a glass of beer. Alarming symptoms manifested themselves at the moment of the sting. The farmer made a kind of paste from a solution of common salt in as little water as possible, which he gave to the young man, and, after several swallows of the potion, the symptoms disappeared as if by enchantment. There is a recent account from Bridgeport, Conn., of a woman who, while eating a pear, swallowed a hornet that had alighted on the fruit. In going down the throat the insect stung her on the tonsil. Great pain and inflammation followed, and in a short time there was complete deprivation of the power of speech. Mease relates the case of a corpulent farmer who, in July, 1835, was stung upon the temple by a common bee. He walked to a fence a short distance away, thence to his house, 20 yards distant, lay down, and expired in ten minutes. A second case, which occurred in June, 1811, is also mentioned by Mease. A vigorous man was stung in the septum of the nose by a bee. Supported by a friend he walked to his house, a few steps distant, and lay down. He rose immediately to go to the well, stepped a few paces, fell, and expired. It was thirty minutes from the time of the accident to the man's death. A third case is reported by the same author from Kentucky. A man of thirty-five was stung on the right superior palpebrum, and died in twenty minutes. Mease reports a fourth ease from Connecticut, in which a man of twenty-six was stung by a bee on the tip of the nose. He recovered after treatment with ten-grain doses of Dover's Powder, and persistent application of plantain leaves. A fifth case was that of a farmer in Pennsylvania who was stung in the left side of the throat by a wasp which he had swallowed in drinking cider. Notwithstanding medical treatment, death ensued twenty-seven hours afterward. A sixth case, which occurred in October, 1834, is given by the same author. A middle-aged man was stung by a yellow wasp on the middle finger of the right hand, and died in less than twenty minutes after having received his wound. A seventh case was that of a New York farmer who, while hoeing, was bitten on the foot by a spider. Notwithstanding medical treatment, principally bleeding, the man soon expired. Desbrest mentions the sting of a bee above the eyebrow followed by death. Zacutus saw a bee-sting which was followed by gangrene. Delaistre mentions death from a hornet-sting in the palate. Nivison relates the case of a farmer of fifty who was stung in the neck by a bee. The usual swelling and discoloration did not follow, but notwithstanding vigorous medical treatment the man died in six days. Thompson relates three cases of bee-sting, in all of which death supervened within fifteen minutes,--one in a farmer of fifty-eight who was stung in the neck below the right ear; a second in an inn-keeper of fifty who was stung in the neck, and a third of a woman of sixty-four who was stung on the left brow. "Chirurgus" recalls the details of a case of a wasp-sting in the middle finger of the right hand of a man of forty, depriving him of all sense and of muscular power. Ten minutes after receiving it he was unconscious, his heart-beats were feeble, and his pulse only perceptible. Syphilis from a Flea-bite.--Jonathan Hutchinson, in the October, 1895, number of his unique and valuable Archives of Surgery, reports a primary lesion of most unusual origin. An elderly member of the profession presented himself entirely covered with an evident syphilitic eruption, which rapidly disappeared under the use of mercury. The only interest about the case was the question as to how the disease had been acquired. The doctor was evidently anxious to give all the information in his power, but was positive that he had never been exposed to any sexual risk, and as he had retired from practice, no possibility of infection in that manner existed. He willingly stripped, and a careful examination of his entire body surface revealed no trace of lesion whatever on the genitals, or at any point, except a dusky spot on one leg, which looked like the remains of a boil. This, the doctor stated, had been due to a small sore, the dates of the appearance and duration of which were found to fit exactly with those of a primary lesion. There had also been some enlargement of the femoral glands. He had never thought of the sore in this connection, but remembered most distinctly that it followed a flea-bite in an omnibus, and had been caused, as he supposed, by his scratching the place, though he could not understand why it lasted so long. Mr. Hutchinson concludes that all the evidence tends to show that the disease had probably been communicated from the blood of an infected person through the bite of the insect. It thus appears that even the proverbially trivial fleabite may at times prove a serious injury. Snake-bites.--A writer in an Indian paper asserts that the traditional immunity of Indian snake-charmers is due to the fact that having been accidentally bitten by poisonous serpents or insects more than once, and having survived the first attack, they are subsequently immune. His assertion is based on personal acquaintance with Madari Yogis and Fakirs, and an actual experiment made with a Mohammedan Fakir who was immune to the bites of scorpions provided by the writer. The animals were from five to seven inches long and had lobster-like claws. Each bite drew blood, but the Fakir was none the worse. The venom of poisonous snakes may be considered the most typical of animal poisons, being unrivaled in the fatality and rapidity of its action. Fortunately in our country there are few snake-bites, but in the tropic countries, particularly India, the mortality from this cause is frightful. Not only are there numerous serpents in that country, but the natives are lightly dressed and unshod, thus being exposed to the bites of the reptiles. It is estimated by capable authorities that the deaths in India each year from snake-bites exceed 20,000. It is stated that there were 2893 human beings killed by tigers, leopards, hyenas, and panthers in India during the year 1894, and in the same year the same species of beasts, aided by snakes, killed 97,371 head of cattle. The number of human lives destroyed by snakes in India in 1894 was 21,538. The number of wild beasts killed in the same year was 13,447, and the number of snakes killed was 102,210. Yarrow of Washington, who has been a close student of this subject, has found in this country no less than 27 species of poisonous snakes, belonging to four genera. The first genus is the Crotalus, or rattlesnake proper; the second is the Caudisona, or ground-rattlesnake; the third is the Ancistrodon, or moccasin, one of the species of which is a water-snake; and the fourth is the Elaps, or harlequin snake. There is some dispute over the exact degree of the toxic qualities of the venom of the Heloderma suspectum, or Gila monster. In India the cobra is the most deadly snake. It grows to the length of 5 1/2 feet, and is most active at night. The Ophiophagus, or hooded cobra, is one of the largest of venomous snakes, sometimes attaining a length of 15 feet; it is both powerful, active, and aggressive. The common snakes of the deadly variety in the United States are the rattlesnake, the "copperhead," and the moccasin; and it is from the bites of one of these varieties that the great majority of reported deaths are caused. But in looking over medical literature one is struck with the scarcity of reports of fatal snake-bites. This is most likely attributable to the fact that, except a few army-surgeons, physicians rarely see the cases. The natural abode of the serpents is in the wild and uninhabited regions. The venom is delivered to the victim through the medium of a long fang which is connected with a gland in which the poison is stored. The supply may be readily exhausted; for a time the bite would then be harmless. Contrary to the general impression, snake-venom when swallowed is a deadly poison, as proved by the experiments of Fayrer, Mitchell, and Reichert. Death is most likely caused by paralysis of the vital centers through the circulation. In this country the wounds invariably are on the extremities, while in India the cobra sometimes strikes on the shoulder or neck. If called on to describe accurately the symptoms of snake-venom poisoning, few medical men could respond correctly. In most cases the wound is painful, sometimes exaggerated by the mental condition, which is wrought up to a pitch rarely seen in other equally fatal injuries. It is often difficult to discern the exact point of puncture, so minute is it. There is swelling due to effusion of blood, active inflammation, and increasing pain. If the poison has gained full entrance into the system, in a short time the swelling extends, vesicles soon form, and the disorganization of the tissues is so rapid that gangrene is liable to intervene before the fatal issue. The patient becomes prostrated immediately after the infliction of the wound, and his condition strongly indicates the use of stimulants, even if the medical attendant were unfamiliar with the history of the snake-bite. There may be a slight delirium; the expression becomes anxious, the pulse rapid and feeble, the respiration labored, and the patient complains of a sense of suffocation. Coma follows, and the respirations become slower and slower until death results. If the patient lives long enough, the discoloration of the extremity and the swelling may spread to the neck, chest and back. Loss of speech after snake-bite is discussed in Chapter XVII, under the head of Aphasia. A peculiar complication is a distressing inflammation of the mouth of individuals that have sucked the wounds containing venom. This custom is still quite common, and is preferred by the laity to the surer and much wiser method of immediate cauterization by fire. There is a curious case reported of a young man who was bitten on the ankle by a viper; he had not sucked the wound, but he presented such an enormous swelling of the tongue as to be almost provocative of a fatal issue. In this case the lingual swelling was a local effect of the general constitutional disturbance. Cases of Snake-bite.--The following case illustrative of the tenacity of virulence of snake-venom was reported by Mr. Temple, Chief Justice of Honduras, and quoted by a London authority. While working at some wood-cutting a man was struck on a heavy boot by a snake, which he killed with an axe. He imagined that he had been efficiently protected by the boot, and he thought little of the incident. Shortly afterward he began to feel ill, sank into a stupor, and succumbed. His boots were sold after his death, as they were quite well made and a luxury in that country. In a few hours the purchaser of the boots was a corpse, and every one attributed his death to apoplexy or some similar cause. The boots were again sold, and the next unfortunate owner died in an equally short time. It was then thought wise to examine the boots, and in one of them was found, firmly embedded, the fang of the serpent. It was supposed that in pulling on the boots each of the subsequent owners had scratched himself and became fatally inoculated with the venom, which was unsuspected and not combated. The case is so strange as to appear hypothetic, but the authority seems reliable. The following are three cases of snake-bite reported by surgeons of the United States Army, two followed by recovery, and the other by death: Middleton mentions a private in the Fourth Cavalry, aged twenty-nine, who was bitten by a rattlesnake at Fort Concho, Texas, June 27, 1866. The bite opened the phalangeal joint of the left thumb, causing violent inflammation, and resulted in the destruction of the joint. Three years afterward the joint swelled and became extremely painful, and it was necessary to amputate the thumb. Campbell reports the case of a private of the Thirteenth Infantry who was bitten in the throat by a large rattlesnake. The wound was immediately sucked by a comrade, and the man reported at the Post Hospital, at Camp Cooke, Montana, three hours after the accident. The only noticeable appearance was a slightly wild look about the eyes, although the man did not seem to be the least alarmed. The region of the wound was hard and somewhat painful, probably from having been bruised by the teeth of the man who sucked the wound; it remained so for about three hours. The throat was bound up in rancid olive oil (the only kind at hand) and no internal remedy was administered. There were no other bad consequences, and the patient soon returned to duty. Le Carpentier sends the report of a fatal case of rattlesnake-bite: A private, aged thirty-seven, remarkable for the singularity of his conduct, was known in his Company as a snake-charmer, as he had many times, without injury, handled poisonous snakes. On the morning of July 13, 1869, he was detailed as guard with the herd at Fort Cummings, New Mexico, when, in the presence of the herders, he succeeded in catching a rattlesnake and proving his power as a sorcerer. The performance being over and the snake killed, he caught sight of another of the same class, and tried to duplicate his previous feat; but his dexterity failed, and he was bitten in the middle finger of the right hand. He was immediately admitted to the Post Hospital, complaining only of a little pain, such as might follow the sting of a bee or wasp. A ligature was applied above the wound; the two injuries made by the fangs were enlarged by a bistoury; ammonia and the actual cautery were applied; large doses of whiskey were repeated frequently, the constitution of the patient being broken and poor. Vomiting soon came on but was stopped without trouble, and there were doubts from the beginning as to his recovery. The swelling of the hand and arm gradually increased, showing the particular livid and yellowish tint following the bites of poisonous snakes. A blister was applied to the bitten finger, tincture of iodin used, and two ounces of whiskey given every two hours until inebriety was induced. The pulse, which was very much reduced at first, gained gradually under the influence of stimulants; two grains of opium were given at night, the patient slept well, and on the next day complained only of numbness in the arm. The swelling had extended as far as the shoulder-joint, and the blood, which was very fluid, was incessantly running from the wound. Carbolic acid and cerate were applied to the arm, with stimulants internally. On the 15th his condition was good, the swelling had somewhat augmented, there was not so much lividity, but the yellowish hue had increased. On the 16th the man complained of pain in the neck, on the side of the affected limb, but his general condition was good. Examining his genitals, an iron ring 3/4 inch in diameter was discovered, imbedded in the soft tissues of the penis, constricting it to such a degree as to have produced enormous enlargement of the parts. Upon inquiry it seemed that the ring had been kept on the parts very long, as a means of preservation of chastity; but under the influence of the snake's venom the swelling had increased, and the patient having much trouble in passing water was obliged to complain. The ring was filed off with some difficulty. Gangrene destroyed the extremity of the bitten finger. From this date until the 30th the man's condition improved somewhat. The progress of the gangrene was stopped, and the injured finger was disarticulated at the metacarpal articulation. Anesthesia was readily obtained, but the appearance of the second stage was hardly perceptible. Le Carpentier was called early on the next morning, the patient having been observed to be sinking; there was stertorous respiration, the pulse was weak and slow, and the man was only partly conscious. Electricity was applied to the spine, and brandy and potassium bromid were given, but death occurred about noon. A necropsy was made one hour after death. There was general softening of the tissues, particularly on the affected side. The blood was black and very fluid,--not coagulable. The ventricles of the brain were filled with a large amount of serum; the brain was somewhat congested. The lungs were healthy, with the exception of a few crude tubercles of recent formation on the left side. The right ventricle of the heart was empty, and the left filled with dark blood, which had coagulated. The liver and kidneys were healthy, and the gall-bladder very much distended with bile. The intestines presented a few livid patches on the outside. Hydrophobia.--The bite of an enraged animal is always of great danger to man, and death has followed a wound inflicted by domestic animals or even fowls; a human bite has also caused a fatal issue. Rabies is frequently observed in herbivorous animals, such as the ox, cow, or sheep, but is most commonly found in the carnivore, such as the dog, wolf, fox, jackal, hyena, and cat and other members of the feline tribe. Fox reports several cases of death from symptoms resembling those of hydrophobia in persons who were bitten by skunks. Swine, birds, and even domestic poultry have caused hydrophobia by their bites. Le Cat speaks of the bite of an enraged duck causing death, and Thiermeyer mentions death shortly following the bite of a goose, as well as death in three days from a chicken-bite. Camerarius describes a case of epilepsy which he attributed to a horse-bite. Among the older writers speaking of death following the bite of an enraged man, are van Meek'ren, Wolff, Zacutus Lusitanus, and Glandorp. The Ephemerides contains an account of hydrophobia caused by a human bite. Jones reports a case of syphilitic inoculation from a human bite on the hand. Hydrophobia may not necessarily be from a bite; a previously-existing wound may be inoculated by the saliva alone, conveyed by licking. Pliny, and some subsequent writers, attributed rabies to a worm under the animal's tongue which they called "lytta." There is said to be a superstition in India that, shortly after being bitten by a mad dog, the victim conceives pups in his belly; at about three months these move rapidly up and down the patient's intestines, and being mad like their progenitor, they bite and bark incessantly, until they finally kill the unfortunate victim. The natives of Nepaul firmly believe this theory. All sorts of curious remedies have been suggested for the cure of hydrophobia. Crabs-claws, Spanish fly, and dragon roots, given three mornings before the new or full moon, was suggested as a specific by Sir Robert Gordon. Theodore De Vaux remarks that the person bitten should immediately pluck the feathers from the breech of an old cock and apply them bare to the bites. If the dog was mad the cock was supposed to swell and die. If the dog was not mad the cock would not swell; in either case the person so treated was immune. Mad-stones, as well as snake-stones, are believed in by some persons at the present day. According to Curran, at one time in Ireland the fear of hydrophobia was so great that any person supposed to be suffering from it could be legally smothered. According to French statistics, hydrophobia is an extremely fatal disease, although the proportion of people bitten and escaping without infection is overwhelmingly greater than those who acquire the disease. The mortality of genuine hydrophobia is from 30 to 80 per cent, influenced by efficient and early cauterization and scientific treatment. There is little doubt that many of the cases reported as hydrophobia are merely examples of general systemic infection from a local focus of sepsis, made possible by some primitive and uncleanly treatment of the original wound. There is much superstition relative to hydrophobia; the majority of wounds seen are filled with the hair of the dog, soot, ham-fat, and also with particles of decayed food and saliva from the mouth of some person who has practiced sucking the wound. Ordinarily, the period of incubation of hydrophobia in man is before the end of the second month, although rarely cases are seen as many as six months from the reception of the bite. The first symptoms of the disease are melancholia, insomnia, loss of appetite, and occasionally shooting pains, radiating from the wound. There may be severe pain at the back of the head and in the neck. Difficulty in swallowing soon becomes a marked symptom. The speech assumes a sobbing tone, and occasionally the expression of the face is wild and haggard. As regards the crucial diagnostic test of a glass of water, the following account of a patient's attempt to drink is given by Curtis and quoted by Warren: "A glass of water was offered the patient, which he refused to take, saying that he could not stand so much as that, but would take it from a teaspoon. On taking the water from the spoon he evinced some discomfort and agitation, but continued to raise the spoon. As it came within a foot of his lips, he gagged and began to gasp violently, his features worked, and his head shook. He finally almost tossed the water into his mouth, losing the greater part of it, and staggered about the room gasping and groaning. At this moment the respirations seemed wholly costal, and were performed with great effort, the elbows being jerked upward with every inspiration. The paroxysm lasted about half a minute. The act of swallowing did not appear to cause distress, for he could go through the motions of deglutition without any trouble. The approach of liquid toward the mouth would, however, cause distress." It is to be remarked that the spasm affects the mechanism of the respiratory apparatus, the muscles of mastication and deglutition being only secondarily contracted. Pasteur discovered that the virulence of the virus of rabies could be attenuated in passing it through different species of animals, and also that inoculation of this attenuated virus had a decided prophylactic effect on the disease; hence, by cutting the spinal cord of inoculated animals into fragments a few centimeters long, and drying them, an emulsion could be made containing the virus. The patients are first inoculated with a cord fourteen days old, and the inoculation is repeated for nine days, each time with a cord one day fresher. The intensive method consists in omitting the weakest cords and giving the inoculations at shorter intervals. As a curious coincidence, Pliny and Pasteur, the ancient and modern, both discuss the particular virulence of saliva during fasting. There is much discussion over the extent of injury a shark-bite can produce. In fact some persons deny the reliability of any of the so-called cases of shark-bites. Ensor reports an interesting case occurring at Port Elizabeth, South Africa. While bathing, an expert swimmer felt a sharp pain in the thigh, and before he could cry out, felt a horrid crunch and was dragged below the surface of the water. He struggled for a minute, was twisted about, shaken, and then set free, and by a supreme effort, reached the landing stairs of the jetty, where, to his surprise, he found that a monstrous shark had bitten his leg off. The leg had been seized obliquely, and the teeth had gone across the joints, wounding the condyles of the femur. There were three marks on the left side showing where the fish had first caught him. The amputation was completed at once, and the man recovered. Macgrigor reports the case of a man at a fishery, near Manaar, who was bitten by a shark. The upper jaw of the animal was fixed in the left side of the belly, forming a semicircular wound of which a point one inch to the left of the umbilicus was the upper boundary, and the lower part of the upper third of the thigh, the lower boundary. The abdominal and lumbar muscles were divided and turned up, exposing the colon in its passage across the belly. Several convolutions of the small intestines were also laid bare, as were also the three lowest ribs. The gluteal muscles were lacerated and torn, the tendons about the trochanter divided, laying the bone bare, and the vastus externus and part of the rectus of the thigh were cut across. The wound was 19 inches in length and four or five inches in breadth. When Dr. Kennedy first saw the patient he had been carried in a boat and then in a palanquin for over five miles, and at this time, three hours after the reception of the wound, Kennedy freed the abdominal cavity of salt water and blood, thoroughly cleansed the wound of the hair and the clots, and closed it with adhesive strips. By the sixteenth day the abdominal wound had perfectly closed, the lacerations granulated healthily, and the man did well. Boyle reports recovery from extensive lacerated wounds from the bite of a shark. Both arms were amputated as a consequence of the injuries. Fayrer mentions shark-bites in the Hooghley. Leprosy from a Fish-bite.--Ashmead records the curious case of a man that had lived many years in a leprous country, and while dressing a fish had received a wound of the thumb from the fin of the fish. Swelling of the arm followed, and soon after bullae upon the chest, head, and face. In a few months the blotches left from this eruption became leprous tubercles, and other well-marked signs of the malady followed. The author asked if in this case we have to do with a latent leprosy which was evoked by the wound, or if it were a case of inoculation from the fish? Cutliffe records recovery after amputation at the elbow-joint, as a consequence of an alligator-bite nine days before admission to the hospital. The patient exhibited a compound comminuted fracture of the right radius and ulna in their lower thirds, compound comminuted fractures of the bones of the carpus and metacarpus, with great laceration of the soft parts, laying bare the wrist-joint, besides several penetrating wounds of the arm and fore-arm. Mourray gives some notes on a case of crocodile-bite with removal of a large portion of omentum. Sircar speaks of recovery from a crocodile-bite. Dudgeon reports two cases of animal-bites, both fatal, one by a bear, and the other by a camel. There is mention of a compound dislocation of the wrist-joint from a horse-bite. Fayrer speaks of a wolf-bite of the forearm, followed by necrosis and hemorrhage, necessitating ligature of the brachial artery and subsequent excision of the elbow-joint. Injuries from Lightning.--The subject of lightning-stroke, with its diverse range of injuries, is of considerable interest, and, though not uncommon, the matter is surrounded by a veil of superstition and mystery. It is well known that instantaneous or temporary unconsciousness may result from lightning-stroke. Sometimes superficial or deep burns may be the sole result, and again paralysis of the general nerves, such as those of sensation and motion, may be occasioned. For many years the therapeutic effect of a lightning-stroke has been believed to be a possibility, and numerous instances are on record. The object of this article will be to record a sufficient number of cases of lightning-stroke to enable the reader to judge of its various effects, and form his own opinion of the good or evil of the injury. It must be mentioned here that half a century ago Le Conte wrote a most extensive article on this subject, which, to the present time, has hardly been improved upon. The first cases to be recorded are those in which there has been complete and rapid recovery from lightning-stroke. Crawford mentions a woman who, while sitting in front of her fireplace on the first floor of a two-story frame building, heard a crash about her, and realized that the house had been struck by lightning. The lightning had torn all the weather-boarding off the house, and had also followed a spouting which terminated in a wooden trough in a pig-sty, ten feet back of the house, and killed a pig. Another branch of the fluid passed through the inside of the building and, running along the upper floor to directly over where Mrs. F. was sitting, passed through the floor and descended upon the top of her left shoulder. Her left arm was lying across her abdomen at the time, the points of the fingers resting on the crests of the ilium. There was a rent in the dress at the top of the shoulder, and a red line half an inch wide running from thence along the inside of the arm and fore-arm. In some places there was complete vesication, and on its palmer surface the hand lying on the abdomen was completely denuded. The abdomen, for a space of four inches in length and eight inches in breadth, was also blistered. The fluid then passed from the fingers to the crest of the ilium, and down the outside of the leg, bursting open the shoes, and passing then through the floor. Again a red line half an inch wide could be traced from the ilium to the toes. The clothing was not scorched, but only slightly rent at the point of the shoulder and where the fingers rested. This woman was neither knocked off her chair nor stunned, and she felt no shock at the time. After ordinary treatment for her burns she made rapid and complete recovery. Halton reports the history of a case of a woman of sixty-five who, about thirty-five minutes before he saw her, had been struck by lightning. While she was sitting in an outbuilding a stroke of lightning struck and shattered a tree about a foot distant. Then, leaving the tree about seven feet from the ground, it penetrated the wall of the building, which was of unplastered frame, and struck Mrs. P. on the back of the head, at a point where her hair was done up in a knot and fastened by two ordinary hair-pins. The hair was much scorched, and under the knot the skin of the scalp was severely burned. The fluid crossed, burning her right ear, in which was a gold ear-ring, and then passed over her throat and down the left sternum, leaving a burn three inches wide, covered by a blister. There was another burn, 12 inches long and three inches wide, passing from just above the crest of the ilium forward and downward to the symphysis pubis. The next burn began at the patella of the right knee, extending to the bottom of the heel, upon reaching which it wound around the inner side of the leg. About four inches below the knee a sound strip of cuticle, about 1 1/2 inches, was left intact. The lightning passed off the heel of the foot, bursting open the heel of a strongly sewed gaiter-boot. The woman was rendered unconscious but subsequently recovered. A remarkable feature of a lightning-stroke is the fact that it very often strips the affected part of its raiment, as in the previous case in which the shoe was burst open. In a discussion before the Clinical Society of London, October 24 1879, there were several instances mentioned in which clothes had been stripped off by lightning. In one case mentioned by Sir James Paget, the clothes were wet and the man's skin was reeking with perspiration. In its course the lightning traveled down the clothes, tearing them posteriorly, and completely stripping the patient. The boots were split up behind and the laces torn out. This patient, however, made a good recovery. Beatson mentions an instance in which an explosion of a shell completely tore off the left leg of a sergeant instructor, midway between the knee and ankle. It was found that the foot and lower third of the leg had been completely denuded of a boot and woolen stocking, without any apparent abrasion or injury to the skin. The stocking was found in the battery and the boot struck a person some distance off. The stocking was much torn, and the boot had the heel missing, and in one part the sole was separated from the upper. The laces in the upper holes were broken but were still present in the lower holes. The explanation offered in this case is similar to that in analogous cases of lightning-stroke, that is, that the gas generated by the explosion found its way between the limb and the stocking and boot and stripped them off. There is a curious collection of relics, consisting of the clothes of a man struck by lightning, artistically hung in a glass case in the Museum of the Royal College of Surgeons, London, and the history of the injury, of which these remnants are the result, is given by Professor Stewart, the curator, as follows: At half past four on June 8, 1878, James Orman and others were at work near Snave, in Romney Marsh, about eight miles from Ashford. The men were engaged in lopping willows, when the violence of the rain compelled them to take refuge under a hedge. Three of the men entered a shed near by, but Orman remained by the willow, close to the window of the shed. Scarcely were the three inside when a lightning-stroke entered the door, crossed the shed, and passed out the window, which it blew before it into the field. The men noticed that the tree under which Orman stood was stripped of its bark. Their companion's boots stood close to the foot of the tree, while the man himself lay almost perfectly naked a few yards further on, calling for help. When they left him a few moments previously, he was completely clad in a cotton shirt, cotton jacket, flannel vest, and cotton trousers, secured at the waist with leather straps and buckles. Orman also wore a pair of stout hobnail boots, and had a watch and chain. After the lightning-stroke, however, all he had on him was the left arm of his flannel vest. The field was strewn for some distance with fragments of the unfortunate man's clothing. Orman was thrown down, his eyebrows burned off, and his whiskers and beard much scorched. His chest was covered with superficial burns, and he had sustained a fracture of the leg. His strong boots were torn from his feet, and his watch had a hole burned right through it, as if a soldering iron had been used. The watch-chain was almost completely destroyed, only a few links remaining. Together with some fused coins, these were found close by, and are deposited in a closed box in the Museum. According to Orman's account of the affair, he first felt a violent blow on the chest and shoulders, and then he was involved in a blinding light and hurled into the air. He said he never lost consciousness; but when at the hospital he seemed very deaf and stupid. He was discharged perfectly cured twenty weeks after the occurrence. The scientific explanation of this amazing escape from this most eccentric vagary of the electric fluid is given,--the fact that the wet condition of the man's clothing increased its power of conduction, and in this way saved his life. It is said that the electric current passed down the side of Orman's body, causing everywhere a sudden production of steam, which by its expansion tore the clothing off and hurled it away. It is a curious fact that where the flannel covered the man's skin the burns were merely superficial, whereas in those parts touched by the cotton trousers they were very much deeper. This case is also quoted and described by Dr. Wilks. There was a curious case of lightning-stroke reported at Cole Harbor, Halifax. A diver, while at work far under the surface of the water, was seriously injured by the transmission of a lightning-stroke, which first struck the communicating air pump to which the diver was attached. The man was brought to the surface insensible, but he afterward recovered. Permanent Effect of Lightning on the Nervous System.--MacDonald mentions a woman of seventy-eight who, some forty-two years previous, while ironing a cap with an Italian iron, was stunned by an extremely vivid flash of lightning and fell back unconscious into a chair. On regaining consciousness she found that the cap which she had left on the table, remote from the iron, was reduced to cinders. Her clothes were not burned nor were there any marks on the skin. After the stroke she felt a creeping sensation and numbness, particularly in the arm which was next to the table. She stated positively that in consequence of this feeling she could predict with the greatest certainty when the atmosphere was highly charged with electricity, as the numbness increased on these occasions. The woman averred that shortly before or during a thunder storm she always became nauseated. MacDonald offers as a physiologic explanation of this case that probably the impression produced forty-two years before implicated the right brachial plexus and the afferent branches of the pneumogastric, and to some degree the vomiting center in the medulla; hence, when the atmosphere was highly charged with electricity the structures affected became more readily impressed. Camby relates the case of a neuropathic woman of thirty-eight, two of whose children were killed by lightning in her presence. She herself was unconscious for four days, and when she recovered consciousness, she was found to be hemiplegic and hemianesthetic on the left side. She fully recovered in three weeks. Two years later, during a thunder storm, when there was no evidence of a lightning-stroke, she had a second attack, and three years later a third attack under similar circumstances. There are some ocular injuries from lightning on record. In these cases the lesions have consisted of detachment of the retina, optic atrophy, cataract, hemorrhages into the retina, and rupture of the choroid, paralysis of the oculomotor muscles, and paralysis of the optic nerve. According to Buller of Montreal, such injuries may arise from the mechanic violence sustained by the patient rather than by the thermal or chemic action of the current. Buller describes a case of lightning-stroke in which the external ocular muscles, the crystalline lens, and the optic nerve were involved. Godfrey reports the case of Daniel Brown, a seaman on H.M.S. Cambrian. While at sea on February 21, 1799, he was struck both dumb and blind by a lightning-stroke. There was evidently paralysis of the optic nerve and of the oculomotor muscles; and the muscles of the glottis were also in some manner deprived of motion. That an amputation can be perfectly performed by a lightning-stroke is exemplified in the case of Sycyanko of Cracow, Poland. The patient was a boy of twelve, whose right knee was ankylosed. While riding in a field in a violent storm, a loud peal of thunder caused the horse to run away, and the child fell stunned to the ground. On coming to his senses the boy found that his right leg was missing, the parts having been divided at the upper end of the tibia. The wound was perfectly round and the patella and femur were intact. There were other signs of burns about the body, but the boy recovered. Some days after the injury the missing leg was found near the place where he was first thrown from the horse. The therapeutic effect of lightning-stroke is verified by a number of cases, a few of which will be given. Tilesius mentions a peculiar case which was extensively quoted in London. Two brothers, one of whom was deaf, were struck by lightning. It was found that the inner part of the right ear near the tragus and anti-helix of one of the individuals was scratched, and on the following day his hearing returned. Olmstead quotes the history of a man in Carteret County, N.C., who was seized with a paralytic affection of the face and eyes, and was quite unable to close his lids. While in his bedroom, he was struck senseless by lightning, and did not recover until the next day, when it was found that the paralysis had disappeared, and during the fourteen years which he afterward lived his affection never returned. There is a record of a young collier in the north of England who lost his sight by an explosion of gunpowder, utterly destroying the right eye and fracturing the frontal bone. The vision of the left eye was lost without any serious damage to the organ, and this was attributed to shock. On returning from Ettingshall in a severe thunder storm, he remarked to his brother that he had seen light through his spectacles, and had immediately afterward experienced a piercing sensation which had passed through the eye to the back of the head. The pain was brief, and he was then able to see objects distinctly. From this occasion he steadily improved until he was able to walk about without a guide. Le Conte mentions the case of a negress who was struck by lightning August 19, 1842, on a plantation in Georgia. For years before the reception of the shock her health had been very bad, and she seemed to be suffering from a progressive emaciation and feebleness akin to chlorosis. The difficulty had probably followed a protracted amenorrhea, subsequent to labor and a retained placenta In the course of a week she had recovered from the effects of lightning and soon experienced complete restoration to health; and for two years had been a remarkably healthy and vigorous laborer. Le Conte quotes five similar cases, and mentions one in which a lightning-shock to a woman of twenty-nine produced amenorrhea, whereas she had previously suffered from profuse menstruation, and also mentions another case of a woman of seventy who was struck unconscious; the catamenial discharge which had ceased twenty years before, was now permanently reestablished, and the shrunken mammae again resumed their full contour. A peculiar feature or superstition as to lightning-stroke is its photographic properties. In this connection Stricker of Frankfort quotes the case of Raspail of a man of twenty-two who, while climbing a tree to a bird's nest, was struck by lightning, and afterward showed upon his breast a picture of the tree, with the nest upon one of its branches. Although in the majority of cases the photographs resembled trees, there was one case in which it resembled a horse-shoe; another, a cow; a third, a piece of furniture; a fourth, the whole surrounding landscape. This theory of lightning-photographs of neighboring objects on the skin has probably arisen from the resemblance of the burns due to the ramifications of the blood-vessels as conductors, or to peculiar electric movements which can be demonstrated by positive charges on lycopodium powder. A lightning-stroke does not exhaust its force on a few individuals or objects, but sometimes produces serious manifestations over a large area, or on a great number of people. It is said that a church in the village of Chateauneuf, in the Department of the Lower Alps, in France, was struck by three successive lightning strokes on July 11, 1819, during the installation of a new pastor. The company were all thrown down, nine were killed and 82 wounded. The priest, who was celebrating mass, was not affected, it is believed, on account of his silken robe acting as an insulator. Bryant of Charlestown, Mass., has communicated the particulars of a stroke of lightning on June 20, 1829, which shocked several hundred persons. The effect of this discharge was felt over an area of 172,500 square feet with nearly the same degree of intensity. Happily, there was no permanent injury recorded. Le Conte reports that a person may be killed when some distance--even as far as 20 miles away from the storm--by what Lord Mahon calls the "returning stroke." Skin-grafting is a subject which has long been more or less familiar to medical men, but which has only recently been developed to a practically successful operation. The older surgeons knew that it was possible to reunite a resected nose or an amputated finger, and in Hunter's time tooth-replantation was quite well known. Smellie has recorded an instance in which, after avulsion of a nipple in suckling, restitution was effected. It is not alone to the skin that grafting is applicable; it is used in the cornea, nerves, muscles, bones, tendons, and teeth. Wolfer has been successful in transplanting the mucous membranes of frogs, rabbits, and pigeons to a portion of mucous membrane previously occupied by cicatricial tissue, and was the first to show that on mucous surfaces, mucous membrane remains mucous membrane, but when transplanted to skin, it becomes skin. Attempts have been made to transplant a button of clear cornea of a dog, rabbit, or cat to the cornea of a human being, opaque as the result of ophthalmia, and von Hippel has devised a special method of doing this. Recently Fuchs has reported his experience in cornea-grafting in sections, as a substitute for von Hippel's method, in parenchymatous keratitis and corneal staphyloma, and though not eminently successful himself, he considers the operation worthy of trial in cases that are without help, and doomed to blindness. John Hunter was the first to perform the implantation of teeth; and Younger the first to transplant the teeth of man in the jaws of man; the initial operation should be called replantation, as it was merely the replacement of a tooth in a socket from which it had accidentally or intentionally been removed. Hunter drilled a hole in a cock's comb and inserted a tooth, and held it by a ligature. Younger drilled a hole in a man's jaw and implanted a tooth, and proved that it was not necessary to use a fresh tooth. Ottolengni mentions the case of a man who was struck by a ruffian and had his two central incisors knocked out. He searched for them, washed them in warm water, carefully washed the teeth-sockets, and gently placed the teeth back in their position, where they remained firmly attached. At the time of report, six years after the accident, they were still firmly in position. Pettyjohn reports a successful case of tooth-replantation in his young daughter of two, who fell on the cellar stairs, completely excising the central incisors. The alveolar process of the right jaw was fractured, and the gum lacerated to the entire length of the root. The teeth were placed in a tepid normal saline solution, and the child chloroformed, narcosis being induced in sleep; the gums were cleaned antiseptically, and 3 1/2 hours afterward the child had the teeth firmly in place. They had been out of the mouth fully an hour. Four weeks afterward they were as firm as ever. By their experiments Gluck and Magnus prove that there is a return of activity after transplantation of muscle. After excision of malignant tumors of muscles, Helferich of Munich, and Lange of New York, have filled the gap left by the excision of the muscle affected by the tumor with transplanted muscles from dogs. Gluck has induced reproduction of lost tendons by grafting them with cat-gut, and according to Ashhurst, Peyrot has filled the gaps in retracted tendons by transplanting tendons, taken in one case from a dog, and in another from a cat. Nerve-grafting, as a supplementary operation to neurectomy, has been practiced, and Gersung has transplanted the nerves of lower animals to the nerve stumps of man. Bone-grafting is quite frequently practiced, portions from a recently amputated limb, or portions removed from living animals, or bone-chips, may be used. Senn proposed decalcified bone-plates to be used to fill in the gaps. Shifting of the bone has been done, e.g., by dividing a strip of the hard palate covered with its soft parts, parallel to the fissure in cleft palate, but leaving unsevered the bony attachments in front, and partially fracturing the pedicle, drawing the bony flaps together with sutures; or, when forming a new nose, by turning down with the skin and periosteum the outer table of the frontal bone, split off with a chisel, after cutting around the part to be removed. Trueheart reports a case of partial excision of the clavicle, successfully followed by the grafting of periosteal and osseous material taken from a dog. Robson and Hayes of Rochester, N.Y., have successfully supplemented excision of spina bifida by the transplantation of a strip of periosteum from a rabbit. Poncet hastened a cure in a case of necrosis with partial destruction of the periosteum by inserting grafts taken from the bones of a dead infant and from a kid. Ricketts speaks of bone-grafting and the use of ivory, and remarks that Poncet of Lyons restored a tibia in nine months by grafting to the superior articular surface. Recently amalgam fillings have been used in bone-cavities to supplant grafting. In destructive injuries of the skin, various materials were formerly used in grafting, none of which, however, have produced the same good effect as the use of skin by the Thiersch Method, which will be described later. Rodgers, U.S.N., reports the case of a white man of thirty-eight who suffered from gangrene of the skin of the buttocks caused by sitting in a pan of caustic potash. When seen the man was intoxicated, and there was a gangrenous patch four by six inches on his buttocks. Rodgers used grafts from the under wing of a young fowl, as suggested by Redard, with good result. Vanmeter of Colorado describes a boy of fourteen with a severe extensive burn; a portion beneath the chin and lower jaw, and the right arm from the elbow to the fingers, formed a granulating surface which would not heal, and grafting was resorted to. The neck-grafts were supplied by the skin of the father and brother, but the arm-grafts were taken from two young puppies of the Mexican hairless breed, whose soft, white, hairless skin seemed to offer itself for the purpose with good prospect of a successful result. The outcome was all that could be desired. The puppy-grafts took faster and proved themselves to be superior to the skin-grafts. There is a case reported in which the skin of a greyhound seven days old, taken from the abdominal wall and even from the tail, was used with most satisfactory results in grafting an extensive ulcer following a burn on the left leg of a boy of ten. Masterman has grafted with the inner membrane of a hen's egg, and a Mexican surgeon, Altramirano, used the gills of a cock. Fowler of Brooklyn has grafted with the skin from the back and abdomen of a large frog. The patient was a colored boy of sixteen, who was extensively burned by a kerosene lamp. The burns were on the legs, thighs, buttocks, and right ankle, and the estimated area of burnt surface was 247.95 square inches. The frog skin was transferred to the left buttocks, and on the right buttocks eight long strips of white skin were transferred after the manner of Thiersch. A strip of human skin was placed in one section over the frog skin, but became necrotic in four days, not being attached to the granulating surface. The man was discharged cured in six months. The frog skin was soft, pliable, and of a reddish hue, while the human white skin was firm and rapidly becoming pigmented. Leale cites the successful use of common warts in a case of grafting on a man of twenty who was burned on the foot by a stream of molten metal. Leale remarks that as common warts of the skin are collections of vascular papillae, admitting of separation without injury to their exceptionally thick layer of epidermis, they are probably better for the purposes of skin-grafting than ordinary skin of less vitality or vascularity. Ricketts has succeeded in grafting the skin of a frog to that of a tortoise, and also grafting frog skin to human skin. Ricketts remarks that the prepuce of a boy is remarkably good material for grafting. Sponge-grafts are often used to hasten cicatrization of integumental wounds. There is recorded an instance in which the breast of a crow and the back of a rat were grafted together and grew fast. The crow dragged the rat along, and the two did not seem to care to part company. Relative to skin-grafting proper, Bartens succeeded in grafting the skin of a dead man of seventy on a boy of fourteen. Symonds reports cases of skin-grafting of large flaps from amputated limbs, and says this method is particularly available in large hospitals where they have amputations and grafts on the same day. Martin has shown that, after many hours of exposure in the open air at a temperature of nearly 32 degrees F., grafts could be successfully applied, but in such temperatures as 82 degrees F., exposure of from six to seven hours destroyed their vitality, so that if kept cool, the limb of a healthy individual amputated for some accident, may be utilized for grafting purposes. Reverdin originated the procedure of epidermic grafting. Small grafts the size of a pin-head doing quite as well as large ones. Unfortunately but little diminution of the cicatricial contraction is effected by Reverdin's method. Thiersch contends that healing of a granulated surface results first from a conversion of the soft, vascular granulation-papillae, by contraction of some of their elements into young connective-tissue cells, into "dry, cicatricial papillae," actually approximating the surrounding tissues, thus diminishing the area to be covered by epidermis; and, secondly, by the covering of these papillae by epidermic cells. Thiersch therefore recommends that for the prevention of cicatricial contraction, the grafting be performed with large strips of skin. Harte gives illustrations of a case of extensive skin-grafting on the thigh from six inches above the great trochanter well over the median line anteriorly and over the buttock. This extent is shown in Figure 228, taken five months after the accident, when the granulations had grown over the edge about an inch. Figure 229 shows the surface of the wound, six and one-half months after the accident and three months after the applications of numerous skin-grafts. Cases of self-mutilation may be divided into three classes:--those in which the injuries are inflicted in a moment of temporary insanity from hallucinations or melancholia; with suicidal intent; and in religious frenzy or emotion. Self-mutilation is seen in the lower animals, and Kennedy, in mentioning the case of a hydrocephalic child who ate off its entire under lip, speaks also of a dog, of cats, and of a lioness who ate off their tails. Kennedy mentions the habit in young children of biting the finger-nails as an evidence of infantile trend toward self-mutilation. In the same discussion Collins states that he knew of an instance in India in which a horse lay down, deliberately exposing his anus, and allowing the crows to pick and eat his whole rectum. In temporary insanity, in fury, or in grief, the lower animals have been noticed by naturalists to mutilate themselves. Self-mutilation in man is almost invariably the result of meditation over the generative function, and the great majority of cases of this nature are avulsions or amputations of some parts of the genitalia. The older records are full of such instances. Benivenius, Blanchard, Knackstedt, and Schenck cite cases. Smetius mentions castration which was effected by using the finger-nails, and there is an old record in which a man avulsed his own genitals. Scott mentions an instance in which a man amputated his genitals and recovered without subsequent symptoms. Gockelius speaks of self-castration in a ruptured man, and Golding, Guyon, Louis, Laugier, the Ephemerides, Alix, Marstral, and others, record instances of self-castration. In his Essays Montaigne mentions an instance of complete castration performed by the individual himself. Thiersch mentions a case of a man who circumcised himself when eighteen. He married in 1870, and upon being told that he was a father he slit up the hypogastrium from the symphysis pubis to the umbilicus, so that the omentum protruded; he said his object was to obtain a view of the interior. Although the knife was dirty and blunt, the wound healed after the removal of the extruding omentum. A year later he laid open one side of the scrotum. The prolapsed testicle was replaced, and the wound healed without serious effect. He again laid open his abdomen in 1880, the wound again healing notwithstanding the prolapse of the omentum. In May of the same year he removed the right testicle, and sewed the wound up himself. Four days later the left was treated the same way. The spermatic cord however escaped, and a hematoma, the size of a child's head, formed on account of which he had to go to the hospital. This man acted under an uncontrollable impulse to mutilate himself, and claimed that until he castrated himself he had no peace of mind. There is a similar report in an Italian journal which was quoted in London. It described a student at law, of delicate complexion, who at the age of fourteen gave himself up to masturbation. He continually studied until the age of nineteen, when he fell into a state of dulness, and complained that his head felt as if compressed by a circle of fire. He said that a voice kept muttering to him that his generative organs were abnormally deformed or the seat of disease. After that, he imagined that he heard a cry of "amputation! amputation!" Driven by this hallucination, he made his first attempt at self-mutilation ten days later. He was placed in an Asylum at Astino where, though closely watched, he took advantage of the first opportunity and cut off two-thirds of his penis, when the delirium subsided. Camp describes a stout German of thirty-five who, while suffering from delirium tremens, fancied that his enemies were trying to steal his genitals, and seizing a sharp knife he amputated his penis close to the pubes. He threw the severed organ violently at his imaginary pursuers. The hemorrhage was profuse, but ceased spontaneously by the formation of coagulum over the mouth of the divided vessels. The wound was quite healed in six weeks, and he was discharged from the hospital, rational and apparently content with his surgical feat. Richards reports the case of a Brahman boy of sixteen who had contracted syphilis, and convinced, no doubt, that "nocit empta dolore voluptus," he had taken effective means of avoiding injury in the future by completely amputating his penis at the root. Some days after his admission to the hospital he asked to be castrated, stating that he intended to become an ascetic, and the loss of his testes as well as of his penis appeared to him to be an imperative condition to the attainment of that happy consummation. Chevers mentions a somewhat similar case occurring in India. Sands speaks of a single man of thirty who amputated his penis. He gave an incomplete history of syphilis. After connection with a woman he became a confirmed syphilophobe and greatly depressed. While laboring under the hallucination that he was possessed of two bodies he tied a string around the penis and amputated the organ one inch below the glans. On loosening the string, three hours afterward, to enable him to urinate, he lost three pints of blood, but he eventually recovered. In the Pennsylvania Hospital Reports there is an account of a married man who, after drinking several weeks, developed mania a potu, and was found in his room covered with blood. His penis was completely cut off near the pubes, and the skin of the scrotum was so freely incised that the testicles were entirely denuded, but not injured. A small silver cap was made to cover the sensitive urethra on a line with the abdominal wall. There is a record of a tall, powerfully-built Russian peasant of twenty-nine, of morose disposition, who on April 3d, while reading his favorite book, without uttering a cry, suddenly and with a single pull tore away his scrotum together with his testes. He then arose from the bank where he had been sitting, and quietly handed the avulsed parts to his mother who was sitting near by, saying to her: "Take that; I do not want it any more." To all questions from his relatives he asked pardon and exemption from blame, but gave no reason for his act. This patient made a good recovery at the hospital. Alexeef, another Russian, speaks of a similar injury occurring during an attack of delirium tremens. Black details the history of a young man of nineteen who went to his bath-room and deliberately placing his scrotum on the edge of the tub he cut it crossways down to the wood. He besought Black to remove his testicle, and as the spermatic cord was cut and much injured, and hemorrhage could only be arrested by ligature, the testicle was removed. The reason assigned for this act of mutilation was that he had so frequent nocturnal emissions that he became greatly disgusted and depressed in spirit thereby. He had practiced self-abuse for two years and ascribed his emissions to this cause. Although his act was that of a maniac, the man was perfectly rational. Since the injury he had had normal and frequent emissions and erections. Orwin mentions the case of a laborer of forty who, in a fit of remorse after being several days with a prostitute, atoned for his unfaithfulness to his wife by opening his scrotum and cutting away his left testicle with a pocket knife. The missing organ was found about six yards away covered with dirt. At the time of infliction of this injury the man was calm and perfectly rational. Warrington relates the strange case of Isaac Brooks, an unmarried farmer of twenty-nine, who was found December 5, 1879, with extensive mutilations of the scrotum; he said that he had been attacked and injured by three men. He swore to the identity of two out of the three, and these were transported to ten years' penal servitude. On February 13, 1881, he was again found with mutilation of the external genitals, and again said he had been set upon by four men who had inflicted his injury, but as he wished it kept quiet he asked that there be no prosecution. Just before his death on December 31, 1881, he confessed that he had perjured himself, and that the mutilations were self-performed. He was not aware of any morbid ideas as to his sexual organs, and although he had an attack of gonorrhea ten years before he seemed to worry very little over it. There is an account of a Scotch boy who wished to lead a "holy life," and on two occasions sought the late Mr. Liston's skilful aid in pursuance of this idea. He returned for a third time, having himself unsuccessfully performed castration. A case of self-mutilation by a soldier who was confined in the guard-house for drunkenness is related by Beck. The man borrowed a knife from a comrade and cut off the whole external genital apparatus, remarking as he flung the parts into a corner: "Any----fool can cut his throat, but it takes a soldier to cut his privates off!" Under treatment he recovered, and then he regretted his action. Sinclair describes an Irishman of twenty-five who, maniacal from intemperance, first cut off one testicle with a wire nail, and then the second with a trouser-buckle. Not satisfied with the extent of his injuries he drove a nail into his temple, first through the skin by striking it with his hand, and then by butting it against the wall,--the latter maneuver causing his death. There is on record the history of an insane medical student in Dublin who extirpated both eyes and threw them on the grass. He was in a state of acute mania, and the explanation offered was that as a "grinder" before examination he had been diligently studying the surgery of the eye, and particularly that relating to enucleation. Another Dublin case quoted by the same authority was that of a young girl who, upon being arrested and committed to a police-cell in a state of furious drunkenness, tore out both her eyes. In such cases, as a rule, the finger-nails are the only instrument used. There is a French case also quoted of a woman of thirty-nine who had borne children in rapid succession. While suckling a child three months old she became much excited, and even fanatical, in reading the Bible. Coming to the passage, "If thy right eye offend thee, pluck it out, etc.," she was so impressed with the necessity of obeying the divine injunction that she enucleated her eye with a meat-hook. There is mentioned the case of a young woman who cut off her right hand and cast it into the fire, and attempted to enucleate her eyes, and also to hold her remaining hand in the fire. Haslam reports the history of a female who mutilated herself by grinding glass between her teeth. Channing gives an account of the case of Helen Miller, a German Jewess of thirty, who was admitted to the Asylum for Insane Criminals at Auburn, N.Y., in October, 1872, and readmitted in June, 1875, suffering from simulation of hematemesis. On September 25th she cut her left wrist and right hand; in three weeks she became again "discouraged" because she was refused opium, and again cut her arms below the elbows, cleanly severing the skin and fascia, and completely hacking the muscles in every direction. Six weeks later she repeated the latter feat over the seat of the recently healed cicatrices. The right arm healed, but the left showed erysipelatous inflammation, culminating in edema, which affected the glottis to such an extent that tracheotomy was performed to save her life. Five weeks after convalescence, during which her conduct was exemplary, she again cut her arms in the same place. In the following April, for the merest trifle, she again repeated the mutilation, but this time leaving pieces of glass in the wounds. Six months later she inflicted a wound seven inches in length, in which she inserted 30 pieces of glass, seven long splinters, and five shoe-nails. In June, 1877, she cut herself for the last time. The following articles were taken from her arms and preserved: Ninety-four pieces of glass, 34 splinters, two tacks, five shoe-nails, one pin, and one needle, besides other things which were lost,--making altogether about 150 articles. "Needle-girls," etc.--A peculiar type of self-mutilation is the habit sometimes seen in hysteric persons of piercing their flesh with numerous needles or pins. Herbolt of Copenhagen tells of a young Jewess from whose body, in the course of eighteen months, were extracted 217 needles. Sometime after 100 more came from a tumor on the shoulder. As all the symptoms in this case were abdominal, it was supposed that during an epileptic seizure this girl had swallowed the needles; but as she was of an hysteric nature it seems more likely they had entered the body through the skin. There is an instance in which 132 needles were extracted from a young lady's person. Caen describes a woman of twenty-six, while in prison awaiting trial, succeeding in committing suicide by introducing about 30 pins and needles in the chest region, over the heart. Her method was to gently introduce them, and then to press them deeper with a prayer-book. An autopsy showed that some of the pins had reached the lungs, some were in the mediastinum, on the back part of the right auricle; the descending vena cave was perforated, the anterior portion of the left ventricle was transfixed by a needle, and several of the articles were found in the liver. Andrews removed 300 needles from the body of an insane female. The Lancet records an account of a suicide by the penetration of a darning-needle in the epigastrium. There were nine punctures in this region, and in the last the needle was left in situ and fixed by worsted. In 1851 the same journal spoke of an instance in which 30 pins were removed from the limbs of a servant girl. It was said that while hanging clothes, with her mouth full of pins, she was slapped on the shoulder, causing her to start and swallow the pins. There is another report of a woman who swallowed great numbers of pins. On her death one pound and nine ounces of pins were found in her stomach and duodenum. There are individuals known as "human pin-cushions," who publicly introduce pins and needles into their bodies for gain's sake. The wanderings of pins and needles in the body are quite well known. Schenck records the finding of a swallowed pin in the liver. Haller mentions one that made its way to the hand. Silvy speaks of a case in which a quantity of swallowed pins escaped through the muscles, the bladder, and vagina; there is another record in which the pins escaped many years afterward from the thigh. The Philosophical Transactions contain a record of the escape of a pin from the skin of the arm after it had entered by the mouth. Gooch, Ruysch, Purmann, and Hoffman speak of needle-wanderings. Stephenson gives an account of a pin which was finally voided by the bladder after forty-two years' sojourn in a lady's body. On November 15, 1802, the celebrated Dr. Lettsom spoke of an old lady who sat on a needle while riding in a hackney coach; it passed from the injured leg to the other one, whence it was extracted. Deckers tells of a gentleman who was wounded in the right hypochondrium, the ball being taken thirty years afterward from the knee. Borellus gives an account of a thorn entering the digit and passing out of the body by the anus. Strange as it may seem, a prick of a pin not entering a vital center or organ has been the indirect cause of death. Augenius writes of a tailor who died in consequence of a prick of a needle between the nail and flesh of the end of the thumb. Amatus Lusitanus mentions a similar instance in an old woman, although, from the symptoms given, the direct cause was probably tetanus. In modern times Cunninghame, Boring, and Hobart mention instances in which death has followed the prick of a pin: in Boring's case the death occurred on the fifth day. Manufacture of Crippled Beggars.--Knowing the sympathy of the world in general for a cripple, in some countries low in the moral scale, voluntary mutilation is sometimes practiced by those who prefer begging to toiling. In the same manner artificial monstrosities have been manufactured solely for gain's sake. We quite often read of these instances in lay-journals, but it is seldom that a case comes under the immediate observation of a thoroughly scientific mind. There is, however, on record a remarkable instance accredited to Jamieson of Shanghai who presented to the Royal College of Surgeons a pair of feet with the following history: Some months previously a Chinese beggar had excited much pity and made a good business by showing the mutilated stumps of his legs, and the feet that had belonged to them slung about his neck. While one day scrambling out of the way of a constable who had forbidden this gruesome spectacle, he was knocked down by a carriage in the streets of Shanghai, and was taken to the hospital, where he was questioned about the accident which deprived him of his feet. After selling the medical attendant his feet he admitted that he had purposely performed the amputations himself, starting about a year previously. He had fastened cords about his ankles, drawing them as tightly as he could bear them, and increasing the pressure every two or three days. For a fortnight his pain was extreme, but when the bones were bared his pains ceased. At the end of a month and a half he was able to entirely remove his feet by partly snapping and partly cutting the dry bone. Such cases appear to be quite common in China, and by investigation many parallels could elsewhere be found. The Chinese custom of foot-binding is a curious instance of self-mutilation. In a paper quoted in the Philadelphia Medical Times, January 31, 1880, a most minute account of the modus operandi, the duration, and the suffering attendant on this process are given. Strapping of the foot by means of tight bandages requires a period of two or three years' continuance before the desired effect is produced. There is a varying degree of pain, which is most severe during the first year and gradually diminishes after the binding of all the joints is completed. During the binding the girl at night lies across the bed, putting her legs on the edge of the bed-stead in such a manner as to make pressure under the knees, thus benumbing the parts below and avoiding the major degree of pain. In this position, swinging their legs backward and forward, the poor Chinese girls pass many a weary night. During this period the feet are unbound once a month only. The operation is begun by placing the end of a long, narrow bandage on the inside of the instep and carrying it over the four smaller toes, securing them under the foot. After several turns the bandage is reversed so as to compress the foot longitudinally. The young girl is then left for a month, and when the bandage is removed the foot is often found gangrenous and ulcerated, one or two toes not infrequently being lost. If the foot is thus bound for two years it becomes virtually dead and painless. By this time the calf disappears from lack of exercise, the bones are attenuated, and all the parts are dry and shrivelled. In after-life the leg frequently regains its muscles and adipose tissue, but the foot always remains small. The binding process is said to exert a markedly depressing influence upon the emotional character of the subject, which lasts through life, and is very characteristic. To show how minute some of the feet of the Chinese women are, Figure I of the accompanying plate, taken from a paper by Kenthughes on the "Feet of Chinese Ladies" is from a photograph of a shoe that measured only 3 1/4 inches anteroposteriorly. The foot which it was intended to fill must have been smaller still, for the bandage would take up a certain amount of space. Figure II is a reproduction of a photograph of a foot measuring 5 1/2 inches anteroposteriorly, the wrinkled appearance of the skin being due to prolonged immersion in spirit. This photograph shows well the characteristics of the Chinese foot--the prominent and vertically placed heel, which is raised generally about an inch from the level of the great toe; the sharp artificial cavus, produced by the altered position of the os calcis, and the downward deflection of the foot in front of the mediotarsal joint; the straight and downward pointing great toe, and the infolding of the smaller toes underneath the great toe. In Figure III we have a photograph of the skeleton of a Chinese lady's foot about five inches in anteroposterior diameter. The mesial axis of the os calcis is almost directly vertical, with a slight forward inclination, forming a right angle with the bones in front of the mediotarsal joint. The upper three-quarters of the anterior articular surface of the calcis is not in contact with the cuboid, the latter being depressed obliquely forward and downward, the lower portion of the posterior facet on the cuboid articulating with a new surface on the under portion of the bone. The general shape of the bone closely resembles that of a normal one--a marked contrast to its wasted condition and tapering extremity in paralytic calcaneus. Extension and flexion at the ankle are only limited by the shortness of the ligaments; there is no opposition from the conformation of the bones. The astragalus is almost of normal shape; the trochlea is slightly prolonged anteriorly, especially on the inner side, from contact with the tibial articular surface. The cartilage on the exposed posterior portion of the trochlea seems healthy. The head of the astragalus is very prominent on the outer side, the scaphoid being depressed downward and inward away from it. The anterior articular surface is prolonged in the direction of the displaced scaphoid. The scaphoid, in addition to its displacement, is much compressed on the planter surface, being little more than one-half the width of the dorsal surface. The cuboid is displaced obliquely downward and forward, so that the upper part of the posterior articular surface is not in contact with the calcis. A professional leg-breaker is described in the Weekly Medical Review of St. Louis, April, 1890. This person's name was E. L. Landers, and he was accredited with earning his living by breaking or pretending to break his leg in order to collect damages for the supposed injury. Moreover, this individual had but one leg, and was compelled to use crutches. At the time of report he had succeeded in obtaining damages in Wichita, Kansas, for a supposed fracture. The Review quotes a newspaper account of this operation as follows.-- "According to the Wichita Dispatch he represented himself as a telegraph operator who was to have charge of the postal telegraph office in that city as soon as the line reached there. He remained about town for a month until he found an inviting piece of defective sidewalk, suitable for his purpose, when he stuck his crutch through the hole and fell screaming to the ground, declaring that he had broken his leg. He was carried to a hospital, and after a week's time, during which he negotiated a compromise with the city authorities and collected $1000 damages, a confederate, claiming to be his nephew, appeared and took the wounded man away on a stretcher, saying that he was going to St. Louis. Before the train was fairly out of Wichita, Landers was laughing and boasting over his successful scheme to beat the town. The Wichita story is in exact accord with the artistic methods of a one-legged sharper who about 1878 stuck his crutch through a coal-hole here, and, falling heels over head, claimed to have sustained injuries for which he succeeded in collecting something like $1500 from the city. He is described as a fine-looking fellow, well dressed, and wearing a silk hat. He lost one leg in a railroad accident, and having collected a good round sum in damages for it, adopted the profession of leg-breaking in order to earn a livelihood. He probably argued that as he had made more money in that line than in any other he was especially fitted by natural talents to achieve distinction in this direction. But as it would be rather awkward to lose his remaining leg altogether he modified the idea and contents himself with collecting the smaller amounts which ordinary fractures of the hip-joint entitle such an expert 'fine worker' to receive. "He first appeared here in 1874 and succeeded, it is alleged, in beating the Life Association of America. After remaining for some time in the hospital he was removed on a stretcher to an Illinois village, from which point the negotiations for damages were conducted by correspondence, until finally a point of agreement was reached and an agent of the company was sent to pay him the money. This being accomplished the agent returned to the depot to take the train back to St. Louis when he was surprised to see the supposed sufferer stumping around on his crutches on the depot platform, laughing and jesting over the ease with which he had beaten the corporation. "He afterward fell off a Wabash train at Edwardsville and claimed to have sustained serious injuries, but in this case the company's attorneys beat him and proved him to be an impostor. In 1879 he stumbled into the telegraph office at the Union Depot here, when Henry C. Mahoney, the superintendent, catching sight of him, put him out, with the curt remark that he didn't want him to stick that crutch into a cuspidor and fall down, as it was too expensive a performance for the company to stand. He beat the Missouri Pacific and several other railroads and municipalities at different times, it is claimed, and manages to get enough at each successful venture to carry him along for a year or eighteen months, by which time the memory of his trick fades out of the public mind, when he again bobs up serenely." Anomalous Suicides.--The literature on suicide affords many instances of self-mutilations and ingenious modes of producing death. In the Dublin Medical Press for 1854 there is an extraordinary case of suicide, in which the patient thrust a red-hot poker into his abdomen and subsequently pulled it out, detaching portions of the omentum and 32 inches of the colon. Another suicide in Great Britain swallowed a red-hot poker. In commenting on suicides, in 1835, Arntzenius speaks of an ambitious Frenchman who was desirous of leaving the world in a distinguished manner, and who attached himself to a rocket of enormous size which he had built for the purpose, and setting fire to it, ended his life. On September 28, 1895, according to the Gaulois and the New York Herald (Paris edition) of that date, there was admitted to the Hopital St. Louis a clerk, aged twenty-five, whom family troubles had rendered desperate and who had determined to seek death as a relief from his misery. Reviewing the various methods of committing suicide he found none to his taste, and resolved on something new. Being familiar with the constituents of explosives, he resolved to convert his body into a bomb, load it with explosives, and thus blow himself to pieces. He procured some powdered sulphur and potassium chlorate, and placing each in a separate wafer he swallowed both with the aid of water. He then lay down on his bed, dressed in his best clothes, expecting that as soon as the two explosive materials came into contact he would burst like a bomb and his troubles would be over. Instead of the anticipated result the most violent collicky pains ensued, which finally became so great that he had to summon his neighbors, who took him to the hospital, where, after vigorous application with the stomach-pump, it was hoped that his life would be saved. Sankey mentions an epileptic who was found dead in his bed in the Oxford County Asylum; the man had accomplished his end by placing a round pebble in each nostril, and thoroughly impacting in his throat a strip of flannel done up in a roll. In his "Institutes of Surgery" Sir Charles Bell remarks that his predecessor at the Middlesex Hospital entered into a conversation with his barber over an attempt at suicide in the neighborhood, during which the surgeon called the "would-be suicide" a fool, explaining to the barber how clumsy his attempts had been at the same time giving him an extempore lecture on the anatomic construction of the neck, and showing him how a successful suicide in this region should be performed. At the close of the conversation the unfortunate barber retired into the back area of his shop, and following minutely the surgeon's directions, cut his throat in such a manner that there was no hope of saving him. It is supposed that one could commit suicide by completely gilding or varnishing the body, thus eliminating the excretory functions of the skin. There is an old story of an infant who was gilded to appear at a Papal ceremony who died shortly afterward from the suppression of the skin-function. The fact is one well established among animals, but after a full series of actual experiments, Tecontjeff of St. Petersburg concludes that in this respect man differs from animals. This authority states that in man no tangible risk is entailed by this process, at least for any length of time required for therapeutic purposes. "Tarred and feathered" persons rarely die of the coating of tar they receive. For other instances of peculiar forms of suicide reference may be made to numerous volumes on this subject, prominent among which is that by Brierre de Boismont, which, though somewhat old, has always been found trustworthy, and also to the chapters on this subject written by various authors on medical jurisprudence. Religious and Ceremonial Mutilations.--Turning now to the subject of self-mutilation and self-destruction from the peculiar customs or religious beliefs of people, we find pages of information at our disposal. It is not only among the savage or uncivilized tribes that such ideas have prevailed, but from the earliest times they have had their influence upon educated minds. In the East, particularly in India, the doctrines of Buddhism, that the soul should be without fear, that it could not be destroyed, and that the flesh was only its resting-place, the soul several times being reincarnated, brought about great indifference to bodily injuries and death. In the history of the Brahmans there was a sect of philosophers called the Gymnosophists, who had the extremest indifference to life. To them incarnation was a positive fact, and death was simply a change of residence. One of these philosophers, Calanus, was burned in the presence of Alexander; and, according to Plutarch, three centuries later another Gymnosophist named Jarmenochegra, was similarly burned before Augustus. Since this time, according to Brierre de Boismont, the suicides from indifference to life in this mystic country are counted by the thousands. Penetrating Japan the same sentiment, according to report, made it common in the earlier history of that country to see ships on its coasts, filled with fanatics who, by voluntary dismantling, submerged the vessels little by little, the whole multitude sinking into the sea while chanting praises to their idols. The same doctrines produced the same result in China. According to Brucker it is well known that among the 500 philosophers of the college of Confucius, there were many who disdained to survive the loss of their books (burned by order of the savage Emperor Chi-Koung-ti), and throwing themselves into the sea, they disappeared under the waves. According to Brierre de Boismont, voluntary mutilation or death was very rare among the Chaldeans, the Persians, or the Hebrews, their precepts being different from those mentioned. The Hebrews in particular had an aversion to self-murder, and during a period in their history of 4000 years there were only eight or ten suicides recorded. Josephus shows what a marked influence on suicides the invasion of the Romans among the Hebrews had. In Africa, as in India, there were Gymnosophists. In Egypt Sesostris, the grandest king of the country, having lost his eyesight in his old age, calmly and deliberately killed himself. About the time of Mark Anthony and Cleopatra, particularly after the battle of Actium, suicide was in great favor in Egypt. In fact a great number of persons formed an academy called The Synapothanoumenes, who had for their object the idea of dying together. In Western Europe, as shown in the ceremonies of the Druids, we find among the Celts a propensity for suicide and an indifference to self-torture. The Gauls were similarly minded, believing in the dogma of immortality and eternal repose. They thought little of bodily cares and ills. In Greece and Rome there was always an apology for suicide and death in the books of the philosophers. "Nil igitur mors est, ad nos neque pertinet hilum; quando quidem natura animi mortalis habetur!" cries Lucretius. With the advent of Christianity, condemning as it did the barbarous customs of self-mutilation and self-murder, these practices seem to disappear gradually; but stoicism and indifference to pain were exhibited in martyrdom. Toward the middle ages, when fanaticism was at its height and the mental malady of demoniacal possession was prevalent, there was something of a reversion to the old customs. In the East the Juggernaut procession was still in vogue, but this was suppressed by civilized authorities; outside of a few minor customs still prevalent among our own people we must to-day look to the savage tribes for the perpetuation of such practices. In an excellent article on the evolution of ceremonial institutions Herbert Spencer mentions the Fuegians, Veddahs, Andamanese, Dyaks, Todas, Gonds, Santals, Bodos, and Dhimals, Mishmis, Kamchadales, and Snake Indians, as among people who form societies to practice simple mutilations in slight forms. Mutilations in somewhat graver forms, but still in moderation, are practiced by the Tasmanians, Tamaese, the people of New Guinea, Karens, Nagas, Ostiaks, Eskimos, Chinooks, Comanches, and Chippewas. What might be called mixed or compound mutilations are practiced by the New Zealanders, East Africans, Kondes, Kukas, and Calmucks. Among those practising simple but severe mutilations are the New Caledonians, the Bushmen, and some indigenous Australians. Those tribes having for their customs the practice of compound major mutilations are the Fiji Islanders, Sandwich Islanders, Tahitians, Tongans, Samoans, Javanese, Sumatrans, natives of Malagasy, Hottentots, Damaras, Bechuanas, Kaffirs, the Congo people, the Coast Negroes, Inland Negroes, Dahomeans, Ashantees, Fulahs, Abyssinians, Arabs, and Dakotas. Spencer has evidently made a most extensive and comprehensive study of this subject, and his paper is a most valuable contribution to the subject. In the preparation of this section we have frequently quoted from it. The practice of self-bleeding has its origin in other mutilations, although the Aztecs shed human blood in the worship of the sun. The Samoiedes have a custom of drinking the blood of warm animals. Those of the Fijians who were cannibals drank the warm blood of their victims. Among the Amaponda Kaffirs there are horrible accounts of kindred savage customs. Spencer quotes:--"It is usual for the ruling chief on his accession to be washed in the blood of a near relative, generally a brother, who is put to death for the occasion." During a Samoan marriage-ceremony the friends of the bride "took up stones and beat themselves until their heads were bruised and bleeding." In Australia a novitiate at the ceremony of manhood drank a mouthful of blood from the veins of the warrior who was to be his sponsor. At the death of their kings the Lacedemonians met in large numbers and tore the flesh from their foreheads with pins and needles. It is said that when Odin was near his death he ordered himself to be marked with a spear; and Niort, one of his successors, followed the example of his predecessor. Shakespeare speaks of "such as boast and show their scars." In the olden times it was not uncommon for a noble soldier to make public exhibition of his scars with the greatest pride; in fact, on the battlefield they invited the reception of superficial disfiguring injuries, and to-day some students of the learned universities of Germany seem prouder of the possession of scars received in a duel of honor than in awards for scholastic attainments. Lichtenstein tells of priests among the Bechuanas who made long cuts from the thigh to the knee of each warrior who slew an enemy in battle. Among some tribes of the Kaffirs a kindred custom was practiced; and among the Damaras, for every wild animal a young man destroyed his father made four incisions on the front of his son's body. Speaking of certain Congo people, Tuckey says that they scar themselves principally with the idea of rendering themselves agreeable to the women of their tribe. Among the Itzaex Indians of Yucatan, a race with particularly handsome features, some are marked with scarred lines, inflicted as signs of courage. Cosmetic Mutilations.--In modern times there have been individuals expert in removing facial deformities, and by operations of various kinds producing pleasing dimples or other artificial signs of beauty. We have seen an apparatus advertised to be worn on the nose during the night for the purpose of correcting a disagreeable contour of this organ. A medical description of the artificial manufacture of dimples is as follows:--"The modus operandi was to make a puncture in the skin where the dimple was required, which would not be noticed when healed, and, with a very delicate instrument, remove a portion of the muscle. Inflammation was then excited in the skin over the subcutaneous pit, and in a few days the wound, if such it may be called, was healed, and a charming dimple was the result." It is quite possible that some of our modern operators have overstepped the bounds of necessity, and performed unjustifiable plastic operations to satisfy the vanity of their patients. Dobrizhoffer says of the Abipones that boys of seven pierce their little arms in imitation of their parents. Among some of the indigenous Australians it is quite customary for ridged and linear scars to be self-inflicted. In Tanna the people produce elevated scars on the arms and chests. Bancroft recites that family-marks of this nature existed among the Cuebas of Central America, refusal being tantamount to rebellion. Schomburgk tells that among the Arawaks, after a Mariquawi dance, so great is their zeal for honorable scars, the blood will run down their swollen calves, and strips of skin and muscle hang from the mangled limbs. Similar practices rendered it necessary for the United States Government to stop some of the ceremonial dances of the Indians under their surveillance. A peculiar custom among savages is the amputation of a finger as a sacrifice to a deity. In the tribe of the Dakotas the relatives of a dead chief pacified his spirit by amputating a finger. In a similar way, during his initiation, the young Mandan warrior, "holding up the little finger of his left hand to the Great Spirit," ... "expresses his willingness to give it as a sacrifice, and he lays it on the dried buffalo skull, when another chops it off near the hand with a blow of the hatchet." According to Mariner the natives of Tonga cut off a portion of the little finger as a sacrifice to the gods for the recovery of a superior sick relative. The Australians have a custom of cutting off the last joint of the little finger of females as a token of submission to powerful beings alive and dead. A Hottentot widow who marries a second time must have the distal joint of her little finger cut off; another joint is removed each time she remarries. Among the mutilations submitted to on the death of a king or chief in the Sandwich Islands, Cook mentions in his "Voyages" the custom of knocking out from one to four front teeth. Among the Australian tribes the age of virility and the transition into manhood is celebrated by ceremonial customs, in which the novices are subjected to minor mutilations. A sharp bone is used for lancing their gums, while the throw-stick is used for knocking out a tooth. Sometimes, in addition to this crude dentistry, the youth is required to submit to cruel gashes cut upon his back and shoulders, and should he flinch or utter any cry of pain he is always thereafter classed with women. Haygarth writes of a semi-domesticated Australian who said one day, with a look of importance, that he must go away for a few days, as he had grown to man's estate, and it was high time he had his teeth knocked out. It is an obligatory rite among various African tribes to lose two or more of their front teeth. A tradition among certain Peruvians was that the Conqueror Huayna Coapae made a law that they and their descendants should have three front teeth pulled out in each jaw. Cieza speaks of another tradition requiring the extraction of the teeth of children by their fathers as a very acceptable service to their gods. The Damaras knock out a wedge-shaped gap between two of their front teeth; and the natives of Sierra Leone file or chip their teeth after the same fashion. Depilatory customs are very ancient, and although minor in extent are still to be considered under the heading of mutilations. The giving of hair to the dead as a custom, has been perpetuated through many tribes and nations. In Euripides we find Electra admonishing Helen for sparing her locks, and thereby defrauding the dead. Alexander the Great shaved his locks in mourning for his friend, Hephaestion, and it was supposed that his death was hastened by the sun's heat on his bare head after his hat blew off at Babylon. Both the Dakota Indians and the Caribs maintain the custom of sacrificing hair to the dead. In Peru the custom was varied by pulling out eyelashes and eyebrows and presenting them to the sun, the hills, etc. It is said this custom is still in continuance. When Clovis was visited by the Bishop of Toulouse he gave him a hair from his beard and was imitated by his followers. In the Arthurian legends we find "Then went Arthur to Caerleon; and thither came messages from King Ryons who said, 'even kings have done me homage, and with their beards I have trimmed a mantle. Send me now thy beard, for there lacks yet one to the finishing of the mantle.'" The association between short hair and slavery arose from the custom of taking hair from the slain. It existed among the Greeks and Romans, and was well known among the indigenous tribes of this continent. Among the Shoshones he who took the most scalps gained the most glory. In speaking of the prisoners of the Chicimecs Bancroft says they were often scalped while yet alive, and the bloody trophies placed on the heads of their tormentors. In this manner we readily see that long hair among the indigenous tribes and various Orientals, Ottomans, Greeks, Franks, Goths, etc., was considered a sign of respect and honor. The respect and preservation of the Chinese queue is well known in the present day. Wishing to divide their brother's kingdom, Clothair and Childebert consulted whether to cut off the hair of their nephews, the rightful successors, so as to reduce them to the rank of subjects, or to kill them. The gods of various people, especially the greater gods, were distinguished by their long beards and flowing locks. In all pictures Thor and Samson were both given long hair, and the belief in strength and honor from long hair is proverbial. Hercules is always pictured with curls. According to Goldzhier, long locks of hair and a long beard are mythologic attributes of the sun. The sun's rays are compared to long locks or hairs on the face of the sun. When the sun sets and leaves his place to the darkness, or when the powerful summer sun is succeeded by the weak rays of the winter sun, then Samson's long locks, through which alone his strength remains, are cut off by the treachery of his deceitful concubine Delilah (the languishing, according to the meaning of the name). The beaming Apollo was, moreover, called the "Unshaven;" and Minos cannot conquer the solar hero, Nisos, until the latter loses his golden hair. In Arabic "Shams-on" means the sun, and Samson had seven locks of hair, the number of the planetary bodies. In view of the foregoing facts it seems quite possible that the majority of depilatory processes on the scalp originated in sun-worship, and through various phases and changes in religions were perpetuated to the Middle Ages. Charles Martel sent Pepin, his son, to Luithprand, king of the Lombards, that he might cut his first locks, and by this ceremony hold for the future the place of his illustrious father. To make peace with Alaric, Clovis became his adopted son by offering his beard to be cut. Among the Caribs the hair constituted their chief pride, and it was considered unequivocal proof of the sincerity of their sorrow, when on the death of a relative they cut their hair short. Among the Hebrews shaving of the head was a funeral rite, and among the Greeks and Romans the hair was cut short in mourning, either for a relative or for a celebrated personage. According to Krehl the Arabs also had such customs. Spencer mentions that during an eruption in Hawaii, "King Kamahameha cut off part of his own hair" ... "and threw it into the torrent (of lava)." The Tonga regarded the pubic hairs as under the special care of the devil, and with great ceremony made haste to remove them. The female inhabitants of some portions of the coast of Guinea remove the pubic hairs as fast as they appear. A curious custom of Mohammedan ladies after marriage is to rid themselves of the hirsute appendages of the pubes. Depilatory ointments are employed, consisting of equal parts of slaked lime and arsenic made into a paste with rose-water. It is said that this important ceremony is not essential in virgins. One of the ceremonies of assuming the toga virilis among the indigenous Australians consists in submitting to having each particular hair plucked singly from the body, the candidate being required not to display evidences of pain during the operation. Formerly the Japanese women at marriage blackened their teeth and shaved or pulled out their eyebrows. The custom of boring the ear is very old, mention of it being made in Exodus xxi., 5 and 6, in which we find that if a Hebrew servant served for six years, his freedom was optional, but if he plainly said that he loved his master, and his wife and children, and did not desire to leave their house, the master should bring him before the judges; and according to the passage in Exodus, "he shall also bring him to the door or unto the doorpost, and his master shall bore his ear through with an awl; and he shall serve him forever." All the Burmese, says Sangermano, without exception, have the custom of boring their ears. The days when the operations were performed were kept as festivals. The ludicrous custom of piercing the ears for the wearing of ornaments, typical of savagery and found in all indigenous African tribes, is universally prevalent among our own people. The extremists in this custom are the Botocudos, who represent the most cruel and ferocious of the Brazilian tribes, and who especially cherish a love for cannibalism. They have a fondness for disfiguring themselves by inserting in the lower parts of their ears and in their under lips variously shaped pieces of wood ornaments called peleles, causing enormous protrusion of the under lip and a repulsive wide mouth, as shown in Figure 230. Tattooing is a peculiar custom originating in various ways. The materials used are vermilion, indigo, carbon, or gunpowder. At one time this custom was used in the East to indicate caste and citizenship. Both sexes of the Sandwich Islanders have a peculiar tattooed mark indicative of their tribe or district. Among the Uapes, one tribe, the Tucanoes, have three vertical blue lines. Among other people tattooed marks indicated servility, and Boyle says the Kyans, Pakatans, and Kermowits alone, among the Borneo people, practised tattooing, and adds that these races are the least esteemed for bravery. Of the Fijians the women alone are tattooed, possibly as a method of adornment. The tattooing of the people of Otaheite, seen by Cook, was surmised by him to have a religious significance, as it presented in many instances "squares, circles, crescents, and ill-designed representations of men and dogs." Every one of these people was tattooed upon reaching majority. According to Carl Bock, among the Dyaks of Borneo all of the married women were tattooed on the hands and feet, and sometimes on the thighs. The decoration is one of the privileges of matrimony, and is not permitted to unmarried girls. Andrew Lang says of the Australian tribes that the Wingong or the Totem of each man is indicated by a tattooed representation of it on his flesh. The celebrated American traveler, Carpenter, remarks that on his visit to a great prison in Burmah, which contains more than 3000 men, he saw 6000 tattooed legs. The origin of the custom he was unable to find out, but in Burmah tattooing was a sign of manhood, and professional tattooers go about with books of designs, each design warding off some danger. Bourke quotes that among the Apaches-Yumas of Arizona the married women are distinguished by several blue lines running from the lower lip to the chin; and he remarks that when a young woman of this tribe is anxious to become a mother she tattoos the figure of a child on her forehead. After they marry Mojave girls tattoo the chin with vertical blue lines; and when an Eskimo wife has her face tattooed with lamp-black she is regarded as a matron in society. The Polynesians have carried this dermal art to an extent which is unequaled by any other people, and it is universally practiced among them. Quoted by Burke, Sullivan states that the custom of tattooing continued in England and Ireland down to the seventh century. This was the tattooing with the woad. Fletcher remarks that at one time, about the famous shrine of Our Lady of Loretto, were seen professional tattooers, who for a small sum of money would produce a design commemorative of the pilgrim's visit to the shrine. A like profitable industry is pursued in Jerusalem. Universal tattooing in some of the Eastern countries is used as a means of criminal punishment, the survival of the persecuted individual being immaterial to the torturers, as he would be branded for life and ostracized if he recovered. Illustrative of this O'Connell tells of a case in Hebra's clinic. The patient, a man five feet nine inches in height, was completely tattooed from head to foot with all sorts of devices, such as elephants, birds, lions, etc., and across his forehead, dragons. Not a square of even a quarter inch had been exempt from the process. According to his tale this man had been a leader of a band of Greek robbers, organized to invade Chinese Tartary, and, together with an American and a Spaniard, was ordered by the ruler of the invaded province to be branded in this manner as a criminal. It took three months' continuous work to carry out this sentence, during which his comrades succumbed to the terrible agonies. During the entire day for this extended period indigo was pricked in this unfortunate man's skin. Accounts such as this have been appropriated by exhibitionists, who have caused themselves to be tattooed merely for mercenary purposes. The accompanying illustration represents the appearance of a "tattooed man" who exhibited himself. He claimed that his tattooing was done by electricity. The design showing on his back is a copy of a picture of the Virgin Mary surrounded by 31 angels. The custom of tattooing the arms, chest, or back is quite prevalent, and particularly among sailors and soldiers. The sequences of this custom are sometimes quite serious. Syphilis has been frequently contracted in this manner, and Maury and Dulles have collected 15 cases of syphilis acquired in tattooing. Cheinisse reports the case of a young blacksmith who had the emblems of his trade tattooed upon his right forearm. At the end of forty days small, red, scaly elevations appeared at five different points in the tattooed area. These broke down and formed ulcers. When examined these ulcers presented the peculiarities of chancres, and there was upon the body of the patient a well-marked syphilitic roseola. It was ascertained that during the tattooing the operator had moistened the ink with his own saliva. Hutchinson exhibited drawings and photographs showing the condition of the arms of two boys suffering from tuberculosis of the skin, who had been inoculated in the process of tattooing. The tattooing was done by the brother of one of the lads who was in the last stages of phthisis, and who used his own saliva to mix the pigment. The cases were under the care of Murray of Tottenham, by whom they had been previously reported. Williams has reported the case of a militiamen of seventeen who, three days after an extensive tattooing of the left forearm, complained of pain, swelling, and tenderness of the left wrist. A day later acute left-sided pneumonia developed, but rapidly subsided. The left shoulder, knee, and ankle were successively involved in the inflammation, and a cardiac bruit developed. Finally chorea developed as a complication, limited for a time to the left side, but shortly spreading to the right, where rheumatic inflammation was attacking the joints. The last, however, quickly subsided, leaving a general, though mild chorea and a permanently damaged heart. Infibulation of the male and female external genital organs for the prevention of sexual congress is a very ancient custom. The Romans infibulated their singers to prevent coitus, and consequent change in the voice, and pursued the same practice with their actors and dancers. According to Celsus, Mercurialis, and others, the gladiators were infibulated to guard against the loss of vigor by sexual excesses. In an old Italian work there is a figure of an infibulated musician--a little bronze statue representing a lean individual tortured or deformed by carrying an enormous ring through the end of the penis. In one of his pleasantries Martial says of these infibulated singers that they sometimes break their rings and fail to place them back--"et cujus refibulavit turgidum faber peruem." Heinsius considers Agamemnon cautious when he left Demodocus near Clytemnestra, as he remarks that Demodocus was infibulated. For such purposes as the foregoing infibulation offered a more humane method than castration. Infibulation by a ring in the prepuce was used to prevent premature copulation, and was in time to be removed, but in some cases its function was the preservation of perpetual chastity. Among some of the religious mendicants in India there were some who were condemned to a life of chastity, and, in the hotter climates, where nudity was the custom, these persons traveled about exposing an enormous preputial ring, which was looked upon with adoration by devout women. It is said these holy persons were in some places so venerated that people came on their knees, and bowing below the ring, asked forgiveness--possibly for sexual excesses. Rhodius mentions the usage of infibulation in antiquity, and Fabricius d'Aquapendente remarks that infibulation was usually practiced in females for the preservation of chastity. No Roman maiden was able to preserve her virginity during participation in the celebrations in the Temples of Venus, the debauches of Venus and Mars, etc., wherein vice was authorized by divine injunction; for this reason the lips of the vagina were closed by rings of iron, copper, or silver, so joined as to hinder coitus, but not prevent evacuation. Different sized rings were used for those of different ages. Although this device provided against the coitus, the maiden was not free from the assaults of the Lesbians. During the Middle Ages, in place of infibulation, chastity-girdles were used, and in the Italian girdles, such as the one exhibited in the Musee Cluny in Paris, both the anus and vulva were protected by a steel covering perforated for the evacuations. In the Orient, particularly in India and Persia, according to old travelers, the labia were sewed together, allowing but a small opening for excretions. Buffon and Brown mention infibulation in Abyssinia, the parts being separated by a bistoury at the time of marriage. In Circassia the women were protected by a copper girdle or a corset of hide and skin which, according to custom, only the husband could undo. Peney speaks of infibulation for the preservation of chastity, as observed by him in the Soudan. Among the Nubians this operation was performed at about the age of eight with great ceremony, and when the time for marriage approached the vulva had to be opened by incision. Sir Richard Buxton, a distinguished traveler, also speaks of infibulation, and, according to him, at the time of the marriage ceremony the male tries to prove his manhood by using only Nature's method and weapon to consummate the marriage, but if he failed he was allowed artificial aid to effect entrance. Sir Samuel Baker is accredited in The Lancet with giving an account in Latin text of the modus operandi of a practice among the Nubian women of removing the clitoris and nymphae in the young girl, and abrading the adjacent walls of the external labia so that they would adhere and leave only a urethral aperture. This ancient custom of infibulation is occasionally seen at the present day in civilized countries, and some cases of infibulation from jealousy are on record. There is mentioned, as from the Leicester Assizes, the trial of George Baggerly for execution of a villainous design on his wife. In jealousy he "had sewed up her private parts." Recently, before the New York Academy of Medicine, Collier reported a case of pregnancy in a woman presenting nympha-infibulation. The patient sought the physician's advice in the summer of 1894, while suffering from uterine disease, and being five weeks pregnant. She was a German woman of twenty-eight, had been married several years, and was the mother of several children. Collier examined her and observed two holes in the nymphae. When he asked her concerning these, she reluctantly told him that she had been compelled by her husband to wear a lock in this region. Her mother, prior to their marriage, sent her over to the care of her future husband (he having left Germany some months before). On her arrival he perforated the labia minora, causing her to be ill several weeks; after she had sufficiently recovered he put on a padlock, and for many years he had practiced the habit of locking her up after each intercourse. Strange to relate, no physician, except Collier, had ever inquired about the openings. In this connection the celebrated Harvey mentions a mare with infibulated genitals, but these did not prevent successful labor. Occasionally infibulation has been used as a means of preventing masturbation. De la Fontaine has mentioned this fact, and there is a case in this country in which acute dementia from masturbation was cured by infibulation. In this instance the prepuce was perforated in two opposite places by a trocar, and two pewter sounds (No. 2) were introduced into the wounds and twisted like rings. On the eleventh day one of the rings was removed, and a fresh one introduced in a new place. A cure was effected in eight weeks. There is recent mention made of a method of preventing masturbation by a cage fastened over the genitals by straps and locks. In cases of children the key was to be kept by the parents, but in adults to be put in some part of the house remote from the sleeping apartment, the theory being that the desire would leave before the key could be obtained. Among some peoples the urethra was slit up as a means of preventing conception, making a meatus near the base of the penis. Herodotus remarks that the women of a certain portion of Egypt stood up while they urinated, while the men squatted. Investigation has shown that the women were obliged to stand up on account of elongated nymphae and labia, while the men sought a sitting posture on account of the termination of the urethra being on the inferior side of the base of the penis, artificially formed there in order to prevent conception. In the Australian Medical Gazette, May, 1883, there is an account of some of the methods of the Central Australians of preventing conception. One was to make an opening into the male urethra just anterior to the scrotum, and another was to slit up the entire urethra so far as to make but a single canal from the scrotum to the glans penis. Bourke quotes Palmer in mentioning that it is a custom to split the urethra of the male of the Kalkadoon tribe, near Cloncurry, Queensland, Australia Mayer of Vienna describes an operation of perforation of the penis among the Malays; and Jagor and Micklucho-Maclay report similar customs among the Dyaks and other natives of Borneo, Java, and Phillipine Islands. Circumcision is a rite of great antiquity. The Bible furnishes frequent records of this subject, and the bas-reliefs on some of the old Egyptian ruins represent circumcised children. Labat has found traces of circumcision and excision of nymphae in mummies. Herodotus remarks that the Egyptians practiced circumcision rather as a sanitary measure than as a rite. Voltaire stated that the Hebrews borrowed circumcision from the Egyptians; but the Jews claimed that the Phoenicians borrowed this rite from the Israelites. Spencer and others say that in the early history of the Christian religion, St. Paul and his Disciples did not believe in circumcision, while St. Peter and his followers practiced it. Spencer mentions that the Abyssinians take a phallic trophy by circumcision from the enemy's dead body. In his "History of Circumcision," Remondino says that among the modern Berbers it is not unusual for a warrior to exhibit virile members of persons he has slain; he also says that, according to Bergman, the Israelites practiced preputial mutilations; David brought 200 prepuces of the Philistines to Saul. Circumcision is practiced in nearly every portion of the world, and by various races, sometimes being a civil as well as a religious custom. Its use in surgery is too well known to be discussed here. It might be mentioned, however, that Rake of Trinidad, has performed circumcision 16 times, usually for phimosis due to leprous tuberculation of the prepuce. Circumcision, as practiced on the clitoris in the female, is mentioned on page 308. Ceremonial Ovariotomy.--In the writings of Strabonius and Alexander ab Alexandro, allusion is made to the liberties taken with the bodies of females by the ancient Egyptians and Lydians. Knott says that ablation of the ovaries is a time-honored custom in India, and that he had the opportunity of physically examining some of the women who had been operated on in early life. At twenty-five he found them strong and muscular, their mammary glands wholly undeveloped, and the normal growth of pubic hairs absent. The pubic arch was narrow, and the vaginal orifice practically obliterated. The menses had never appeared, and there seemed to be no sexual desire. Micklucho-Maclay found that one of the most primitive of all existing races--the New Hollanders--practiced ovariotomy for the utilitarian purpose of creating a supply of prostitutes, without the danger of burdening the population by unnecessary increase. MacGillibray found a native ovariotomized female at Cape York who had been subjected to the operation because, having been born dumb, she would be prevented from bearing dumb children,--a wise, though primitive, method of preventing social dependents. Castration has long been practiced, either for the production of eunuchs, or castrata, through vengeance or jealousy, for excessive cupidity, as a punishment for crime, in fanaticism, in ignorance, and as a surgical therapeutic measure (recently, for the relief of hypertrophied prostate). The custom is essentially Oriental in origin, and was particularly used in polygamous countries, where the mission of eunuchs was to guard the females of the harem. They were generally large, stout men, and were noted for their vigorous health. The history of eunuchism is lost in antiquity. The ancient Book of Job speaks of eunuchs, and they were in vogue before the time of Semiramis; the King of Lydia, Andramytis, is said to have sanctioned castration of both male and female for social reasons. Negro eunuchs were common among the Romans. All the great emperors and conquerors had their eunuchs. Alexander the Great had his celebrated eunuch, Bagoas, and Nero, his Sporus, etc. Chevers says that the manufacture of eunuchs still takes place in the cities of Delhi, Lucknow, and Rajpootana. So skilful are the traveling eunuch-makers that their mortality is a small fraction of one per cent. Their method of operation is to encircle the external genital organs with a tight ligature, and then sweep them off at one stroke. He also remarks that those who retain their penises are of but little value or trusted. He divided the Indian eunuchs into three classes: those born so, those with a penis but no testicles, and those minus both testicles and penis. Curran describes the traveling eunuch-makers in Central India, and remarks upon the absence of death after the operation, and invites the attention of gynecologists and operators to the successful, though crude, methods used. Curran says that, except those who are degraded by practices of sexual perversions, these individuals are vigorous bodily, shrewd, and sagacious, thus proving the ancient descriptions of them. Jamieson recites a description of the barbarous methods of making eunuchs in China. The operators follow a trade of eunuch-making, and keep it in their families from generation to generation; they receive the monetary equivalent of about $8.64 for the operation. The patient is grasped in a semi-prone position by an assistant, while two others hold the legs. After excision the wounded parts are bathed three times with a hot decoction of pepper-pods, the wound is covered with paper soaked in cold water, and bandages applied. Supported by two men the patient is kept walking for two or three hours and then tied down. For three days he is allowed nothing to drink, and is not allowed to pass his urine, the urethra being filled with a pewter plug. It generally takes about one hundred days for the wound to heal, and two per cent of the cases are fatal. There is nocturnal incontinence of urine for a long time after the operation. Examples of castration because of excessive cupidity, etc.,--a most unwarranted operation,--are quite rare and are usually found among ecclesiastics. The author of "Faustin, or le Siecle Philosophique," remarked that there were more than 4000 castrated individuals among the ecclesiastics and others of Italy. The virtuous Pope Clement XIV forbade this practice, and describes it as a terrible abuse; but in spite of the declaration of the Pope the cities of Italy, for some time, still continued to contain great numbers of these victims. In France an article was inserted into the penal code providing severe punishment for such mutilations. Fortunately castration for the production of "castrata," or tenor singers, has almost fallen into disuse. Among the ancient Egyptians and Persians amputation of the virile member was inflicted for certain crimes of the nature of rape. Castration as a religious rite has played a considerable role. With all their might the Emperors Constantine and Justinian opposed the delirious religion of the priests of Cybele, and rendered their offence equivalent to homicide. At the annual festivals of the Phrygian Goddess Amma (Agdistis) it was the custom of young men to make eunuchs of themselves with sharp shells, and a similar rite was recorded among Phoenicians. Brinton names severe self-mutilators of this nature among the ancient Mexican priests. Some of the Hottentots and indigenous Australians enforced semicastration about the age of eight or nine. The Skoptzies, religious castrators in Russia, are possibly the most famous of the people of this description. The Russian government has condemned members of this heresy to hard labor in Siberia, but has been unable to extinguish the sect. Pelikan, Privy Counsel of the government, has exhaustively considered this subject. Articles have appeared in Le Progres Medical, December. 1876. and there is an account in the St. Louis Clinical Record, 1877-78. The name Skoptzy means "the castrated," and they call themselves the "White Doves." They arose about 1757 from the Khlish or flagellants. Paul I caused Sseliwanow, the true founder, to return from Siberia, and after seeing him had him confined in an insane asylum. After an interview, Alexander I transferred him to a hospital. Later the Councillor of State, Jelansky, converted by Sseliwanow, set the man free and soon the Skoptzies were all through Russia and even at the Court. The principal argument of these people is the nonconformity of orthodox believers, especially the priests, to the doctrines professed, and they contrast the lax morals of these persons with the chaste lives, the abstinence from liquor, and the continual fasts of the "White Doves." For the purpose of convincing novices of the Scriptural foundation of their rites and belief they are referred to Matthew xix., 12: "and there be eunuchs which have made themselves for the kingdom of Heaven's sake," etc.; and Mark ix., 43-47; Luke xxiii., 29: "blessed are the barren," etc., and others of this nature. As to the operation itself, pain is represented as voluntary martyrdom, and persecution as the struggle of the spirit of darkness with that of light. They got persons to join the order by monetary offers. Another method was to take into service young boys, who soon became lost to society, and lied with effrontery and obstinacy. They had secret methods of communicating with one another, and exhibited a passion for riches, a fact that possibly accounts for their extended influence. The most perfect were those "worthy of mounting the white horse," the "bearers of the Imperial seal," who were deprived of the testicles, penis, and scrotum. The operation of castration among these people was performed at one stroke or at two different times, in the former case one cicatrix being left, and in the latter two. The greater number--those who had submitted to the "first purification," conferring upon them the "lesser seal"--had lost testicles and scrotum. These people are said to have lost the "keys of hell," but to retain the "key of the abyss" (female genitals). As instruments of excision the hot iron, pieces of glass, old wire, sharpened bone, and old razors are used. Only nine fatal cases resulting from the operation are known. At St. Petersburg Liprandi knew a rich Skoptzy who constantly kept girls--mostly Germans--for his own gratification, soon after having entered into the "first purification." Few of them were able to remain with him over a year, and they always returned to their homes with health irretrievably lost. Women members of the order do not have their ovaries removed, but mutilation is practiced upon the external genitals, the mammae, and nipples. The first ablation is obtained by applying fire or caustics to the nipples, the second by amputation of the breasts, one or both, the third by diverse gashes, chiefly across the breast, and the fourth by resection of the nymphae or of the nymphae and clitoris, and the superior major labia, the cicatrices of which would deform the vulva. Figure 232 represents the appearance of the external genital organs of a male Skoptzy after mutilation; Figure 233 those of a female. Battey speaks of Skoptzies in Roumania who numbered at the time of report 533 persons. They came from Russia and practiced the same ceremonies as the heretics there. CHAPTER XV. ANOMALOUS TYPES AND INSTANCES OF DISEASE. Tumors.--In discussing tumors and similar growths no attempt will be made to describe in detail the various types. Only the anomalous instances or examples, curious for their size and extent of involvement, will be mentioned. It would be a difficult matter to decide which was the largest tumor ever reported. In reviewing literature so many enormous growths are recorded that but few can be given here. Some of the large cystic formations have already been mentioned; these are among the largest tumors. Scrotal tumors are recorded that weighed over 200 pounds; and a limb affected with elephantiasis may attain an astonishing size. Delamater is accredited with a report of a tumor that weighed 275 pounds, the patient only weighing 100 pounds at death. Benign tumors will be considered first. Pure adenoma of the breast is a rare growth. Gross was able to collect but 18 examples; but closely allied to this condition is what is known as diffuse hypertrophy of the breast. In some parts of the world, particularly in India and Africa, long, dependent breasts are signs of beauty. On the other hand we learn from Juvenal and Martial that, like ourselves, the Greeks detested pendant and bulky breasts, the signs of beauty being elevation, smallness, and regularity of contour. In the Grecian images of Venus the breasts are never pictured as engorged or enlarged. The celebrated traveler Chardin says that the Circassian and Georgian women have the most beautiful breasts in the world; in fact the Georgians are so jealous of the regular contour and wide interval of separation of their breasts that they refuse to nourish their children in the natural manner. The amount of hypertrophy which is sometimes seen in the mammae is extraordinary. Borellus remarks that he knew of a woman of ordinary size, each of whose mammae weighed about 30 pounds, and she supported them in bags hung about her neck. Durston reports a case of sudden onset of hypertrophy of the breast causing death. At the postmortem it was found that the left breast weighed 64 pounds and the right 40 pounds. Boyer successfully removed two breasts at an interval of twenty-six days between the two operations. The mass excised was one-third of the total body-weight. Schaeffer speaks of hypertrophied mammae in a girl of fourteen, the right breast weighing 3900 grams (136 1/2 oz.) and the right 3500 grams (122 1/2 oz.). Hamilton reports a case of hypertrophied glands in a woman of thirty-two, which, within the short space of a year, reached the combined weight of 52 pounds. They were successfully excised. Velpeau, Billroth, and Labarracque have reported instances of the removal of enormously hypertrophied mammae. In 1886 Speth of Munich described a hypertrophy of the right breast which increased after every pregnancy. At the age of twenty-six the woman had been five times pregnant in the space of a little over five years, and at this time the right breast hung down to the anterior superior spine of the ilium. It weighed 20 pounds, and its greatest circumference was 25 inches. There was no milk in this breast, although the left was in perfect lactation. This case was one of pure hypertrophy and not an example of fibro-adenoma, as illustrated by Billroth. Warren figures a case of diffused hypertrophy of the breast which was operated on by Porter. The right breast in its largest circumference measured 38 inches and from the chest-wall to the nipple was 17 inches long, the circumference at the base being 23 inches; the largest circumference of the left breast was 28 inches; its length from the chest-wall to the nipple was 14 inches, and its circumference at the base 23 inches. The skin was edematous and thickened. Throughout both breasts were to be felt hardened movable masses, the size of oranges. Microscopic examination showed the growth to be a diffused intracanalicular fibroma. A peculiar case was presented before the Faculty at Montpellier. The patient was a young girl of fifteen and a half years. After a cold bath, just as the menses were appearing, it was found that the breasts were rapidly increasing in size; she was subsequently obliged to leave service on account of their increased size, and finally the deformity was so great as to compel her to keep from the public view. The circumference of the right breast was 94 cm. and of the left 105 cm.; the pedicle of the former measured 67 cm. and of the latter 69 cm.; only the slightest vestige of a nipple remained. Removal was advocated, as applications of iodin had failed; but she would not consent to operation. For eight years the hypertrophy remained constant, but, despite this fact, she found a husband. After marriage the breasts diminished, but she was unable to suckle either of her three children, the breasts becoming turgid but never lactescent. The hypertrophy diminished to such a degree that, at the age of thirty-two, when again pregnant, the circumference of the right breast was only 27 cm. and of the left 33 cm. Even thus reduced the breasts descended almost to the navel. When the woman was not pregnant they were still less voluminous and seemed to consist of an immense mass of wrinkled, flaccid skin, traversed by enormous dilated and varicose blood-vessels, the mammary glands themselves being almost entirely absent. Diffuse hypertrophy of the breast is occasionally seen in the male subject. In one case reported from the Westminster Hospital in London, a man of sixty, after a violent fall on the chest, suffered enormous enlargement of the mammae, and afterward atrophy of the testicle and loss of sexual desire. The names goiter, struma, and bronchocele are applied indiscriminately to all tumors of the thyroid gland; there are, however, several distinct varieties among them that are true adenoma, which, therefore, deserves a place here. According to Warren, Wolfler gives the following classification of thyroid tumors: 1. Hypertrophy of the thyroid gland, which is a comparatively rare disease; 2. Fetal adenoma, which is a formation of gland tissue from the remains of fetal structures in the gland; 3. Gelatinous or interacinous adenoma, which consists in an enlargement of the acini by an accumulation of colloid material, and an increase in the interacinous tissue by a growth of round cells. It is this latter form in which cysts are frequently found. The accompanying illustration pictures an extreme ease of cystic goiter shown by Warren. A strange feature of tumors of the thyroid is that pressure-atrophy and flattening of the trachea do not take place in proportion to the size of the tumor. A small tumor of the middle lobe of the gland, not larger that a hen's egg, will do more damage to the trachea than will a large tumor, such as that shown by Senn, after Bruns. When a tumor has attained this size, pressure-symptoms are often relieved by the weight of the tumor making traction away from the trachea. Goiter is endemic in some countries, particularly in Switzerland and Austria, and appears particularly at the age of childhood or of puberty. Some communities in this country using water containing an excess of calcium salt show distinct evidences of endemic goiter. Extirpation of the thyroid gland has in recent years been successfully practiced. Warren has extirpated one lobe of the thyroid after preliminary ligation of the common carotid on the same side. Green practiced rapid removal of the tumor and ligated the bleeding vessels later. Rose tied each vessel before cutting, proceeding slowly. Senn remarks that in 1878 he witnessed one of Rose's operations which lasted for four hours. Although the operatic technic of removal of the thyroid gland for tumor has been greatly perfected by Billroth, Lucke, Julliard, Reverdin, Socin, Kocher, and others, the current opinion at the present day seems to be that complete extirpation of the thyroid gland, except for malignant disease, is unjustifiable. Partial extirpation of the thyroid gland is still practiced; and Wolfler has revived the operation of ligating the thyroid arteries in the treatment of tumors of the thyroid gland. Fibromata.--One of the commonest seats of fibroma is the skin. Multiple fibromata of the skin sometimes occur in enormous numbers and cover the whole surface of the body; they are often accompanied by pendulous tumors of enormous size. Virchow called such tumors fibroma molluscum. Figure 237 represents a case of multiple fibromata of the skin shown by Octerlony. Pode mentions a somewhat similar case in a man of fifty-six, under the care of Thom. The man was pale and emaciated, with anxious expression, complaining of a tumor which he described as a "wishing-mark." On examination he was found to be covered with a number of small tumors, ranging in size from that of a small orange to that of a pin's head; from the thoracic wall over the lower true ribs of the right side was situated a large pendulous tumor, which hung down as far as the upper third of the thigh. He said that it had always been as long as this, but had lately become thicker, and two months previously the skin over the lower part of the tumor had ulcerated. This large tumor was successfully removed; it consisted of fibrous tissue, with large veins running in its substance. The excised mass weighed 51 pounds. The patient made an early recovery. Keloids are fibromata of the true skin, which may develop spontaneously or in a scar. Although the distinction of true and false keloid has been made, it is generally discarded. According to Hebra a true typical keloid is found once in every 2000 cases of skin-disease. It is, however, particularly the false keloid, or keloid arising from cicatrices, with which we have mostly to deal. This tumor may arise from a scar in any portion of the body, and at any age. There seems to be a disposition in certain families and individuals to keloid-formations, and among negroes keloids are quite common, and often of remarkable size and conformation. The form of injury causing the cicatrix is no factor in the production of keloid, the sting of an insect, the prick of a needle, and even the wearing of ear-rings having been frequent causes of keloid-formations among the negro race. Collins describes a negress of ninety, born of African parents, who exhibited multiple keloids produced by diverse injuries. At fourteen she was burned over her breasts by running against a shovelful of hot coals, and several months later small tumors appeared, which never suppurated. When a young girl a tumor was removed from the front of her neck by operation, and cicatricial tumors then spread like a band encircling one-half her neck. There were keloids over her scapulae, which followed the application of blisters. On her back, over, and following the direction of the ribs, were growths attributed to the wounds caused by a flogging. This case was quite remarkable for the predisposition shown to keloid at an early age, and the variety of factors in causation. About 1867 Duhring had under his observation at the Philadelphia Hospital a negro whose neck was encircled by enormous keloids, which, although black, otherwise resembled tomatoes. A photograph of this remarkable case was published in Philadelphia in 1870. A lipoma is a tumor consisting of adipose tissue. When there is much fibrous tissue in the tumor it is much firmer, and is known as a fibro-lipoma. Brander describes a young native of Manchuria, North China, from whom he removed a fibro-lipoma weighing 50 pounds. The growth had progressively enlarged for eleven years, and at the time of extirpation hung as an enormous mass from beneath the left scapula. In operating the tumor had to be swung on a beam. The hemorrhage was slight and the patient was discharged in five days. The true lipoma must be distinguished from diffuse accumulations of fat in different parts of the body in the same way that fibroma is distinguished from elephantiasis. Circumscribed lipoma appears as a lobulated soft tumor, more or less movable, lying beneath the skin. It sometimes reaches enormous size and assumes the shape of a pendulous tumor. Diffuse lipoma, occurring in the neck, often gives the patient a grotesque and peculiar appearance. It is generally found in men addicted to the use of alcohol, and occurs between thirty-five and forty-five years of age; in no case has general obesity been described. In one of Madelung's cases a large lobe extended downward over the clavicle. The growth has been found between the larynx and the pharynx. Black reports a remarkable case of fatty tumor in a child one year and five months old which filled the whole abdominal cavity, weighing nine pounds and two ounces. Chipault mentions a case of lipoma of the parietal region, observed by Rotter. This monstrous growth was three feet three inches long, descending to the knees. It had its origin in the left parietal region, and was covered by the skin of the whole left side of the face and forehead. The left ear was plainly visible in the upper third of the growth. Chondroma, or enchondroma, is a cartilaginous tumor occurring principally where cartilage is normally found, but sometimes in regions containing no cartilage. Enchondroma may be composed of osteoid tissue, such as is found in the ossifying callous between the bone and the periosteum, and, according to Virchow, then takes the name of osteochondroma. Virchow has divided chondromata into two forms--those which he calls ecchondromata, which grow from cartilage, and those that grow independently from cartilage, or the enchondromata, which latter are in the great majority. Enchondroma is often found on the long bones, and very frequently upon the bones of the hands or on the metatarsal bones. Figure 244 represents an enchondroma of the thumb. Multiple enchondromata are most peculiar, and may attain enormous sizes. Whittaker describes a farmer of forty who exhibited peculiar tumors of the fingers, which he calls multiple osteoecchondromata. His family history was negative. He stated that at an early age he received a stroke of lightning, which rendered him unconscious for some time. He knows of nothing else that could be in possible relation with his present condition. Nine months after this accident there was noticed an enlargement of the middle joint of the little finger, and about the same time an enlargement on the middle finger. Gradually all the joints of the right hand became involved. The enlargement increased so that at the age of twelve they were of the size of walnuts, and at this time the patient began to notice the same process developing in the left hand. The growths continued to develop, new nodules appearing, until the fingers presented the appearance of nodulated potatoes. One of the most frequent of the fibro-cartilaginous tumors is the "mixed cartilaginous" tumor of Paget, which grows in the interstitial tissues of the parotid gland, and sometimes attains enormous size. Matas presented the photograph of a negress having an enormous fibroma growing from the left parotid region; and there is a photograph of a similar case in the Mutter Museum of the College of Physicians, Philadelphia. The hyaline enchondroma is of slow growth, but may at times assume immense proportions, as is shown in the accompanying illustration, given by Warren, of a patient in whom the growth was in the scapula. In 1824 there is quoted the description of a peculiar growth which, though not definitely described, may be spoken of here. It was an enormous encysted tumor, springing from the clavicle of a Veronese nobleman. Contrary to general expectations it was successfully removed by Portalupi, a surgeon of Venice. It weighed 57 pounds, being 20 1/2 inches long and 30 inches in circumference. It is said this tumor followed the reception of a wound. Among the benign bone tumors are exostoses--homologous outgrowths differing from hypertrophies, as they only involve a limited part of the circumference. When developmental, originating in childhood, the outgrowths may be found on any part of the skeleton, and upon many and generally symmetric parts at the same time, as is shown in Figure 248. Barwell had a case of a girl with 38 exostoses. Erichsen mentions a young man of twenty-one with 15 groups of symmetric exostoses in various portions of the body; they were spongy or cancellous in nature. Hartmann shows two cases of multiple exostoses, both in males, and universally distributed over the body. Macland of the French navy describes an affection of the bones of the face known as anakhre or goundron (gros-nez). It is so common that about one per cent of the natives of certain villages on the Ivory Coast, West Africa, are subject to it. As a rule the earliest symptoms in childhood are: more or less persistent headache, particularly frontal, sanguineous and purulent discharge from the nostrils, and the formation of symmetric swellings the size of an almond in the region of the nasal processes of the superior maxilla. The cartilage does not seem to be involved, and, although it is not so stated, the nasal duct appears to remain intact. The headache and discharge continue for a year, and the swelling continually increases through life, although the symptoms gradually disappear, the skin not becoming involved, and no pain being present. It has been noticed in young chimpanzees. The illustration represents a man of forty who suffered from the disease since puberty. Pressure on the eyeball had started and the native said he expected that in two years he would lose his sight. Figure 251 shows an analogous condition, called by Hutchinson symmetric osteomata of the nasal processes of the maxilla. His patient was a native of Great Britain. Among neuromata, multiple neurofibroma is of considerable interest, chiefly for the extent of general involvement. According to Senn, Heusinger records the case of a sailor of twenty-three in whom all the nerves were affected by numerous nodular enlargements. Not a nerve in the entire body was found normal. The enlargement was caused by increase in the connective tissue, the axis-cylinders being normal. In this case there was neither pain nor tenderness. Prudden reports the case of a girl of twenty-five who, during convalescence from variola, became paraplegic, and during this time multiple neuromata appeared. At the postmortem more than a thousand tumors were found affecting not only the peripheral branches and the sympathetic, but also the cranial nerves and the pneumogastric. Under the microscope these tumors showed an increase in the interfascicular as well as perivascular fibers, but the nerve-fibers were not increased in size or number. Virchow collected 30 cases of multiple neurofibromata. In one case he found 500, in another from 800 to 1000 tumors. Plexiform neuroma is always congenital, and is found most frequently in the temporal region, the neck, and the sides of the face, but almost any part of the body may be affected. Christot reports two cases in which the tumors were located upon the cheek and the neck. Czerny observed a case in which the tumor involved the lumbar plexus. Quoted by Senn, Campbell de Morgan met with a plexiform neuroma of the musculo-spiral nerve and its branches. The patient was a young lady, and the tumor, which was not painful, had undergone myxomatous degeneration. Neuroma of the vulva is a pathologic curiosity. Simpson reports a case in which the tumor was a painful nodule situated near the urinary meatus. Kennedy mentions an instance in which the tumor appeared as extremely tender tubercles. Tietze describes a woman of twenty-seven who exhibited a marked type of plexiform neurofibroma. The growth was simply excised and recovery was promptly effected. Carcinomatous growths, if left to themselves, make formidable devastations of the parts which they affect. Warren pictures a case of noli-me-tangere, a destructive type of epithelial carcinoma. The patient suffered no enlargement of the lymphatic glands. The same absence of glandular involvement was observed in another individual, in whom there was extensive ulceration. The disease had in this case originated in the scar of a gunshot wound received during the Civil War, and had destroyed the side of the nose, the eye, the ear, the cheek, including the corresponding half of the upper and lower lips. Harlan reports a most extraordinary epithelioma of the orbit in a boy of about five years. It followed enucleation, and attained the size depicted in a few months. Sarcomata, if allowed full progress, may attain great size. Plate 10 shows an enormous sarcoma of the buttocks in an adult negro. Fascial sarcomata are often seen of immense size. Senn shows a tumor of this variety which was situated between the scapulae. Schwimmer records a curious case of universal small sarcomata over the whole body of a teacher of the age of twenty-one, in the Hungarian lowlands. The author called the disease sarcomata pigmentosum diffusum multiplex. The bones are a common seat of sarcomatous growths, the tumor in this instance being called osteosarcoma. It may affect any bone, but rarely involves an articulation; at times it skips the joint and goes to the neighboring bone. A case of nasal sarcoma is shown by Moore. The tumor was located in the nasal septum, and caused a frightful deformity. In this case pain was absent, the sense of smell was lost, and the sight of the right eye impaired. Moore attempted to remove the tumor, but in consequence of some interference of respiration the patient died on the table. Tiffany reports several interesting instances of sarcoma, one in a white female of nineteen following a contusion of tibia. The growth had all the clinical history of an osteosarcoma of the tibia, and was amputated and photographed after removal. In another case, in a white male of thirty, the same author successfully performed a hip-amputation for a large sarcoma of the left femur. The removed member was sent entire to the Army Medical Museum at Washington. The fatality and incurability of malignant growths has done much to stimulate daring and marvelous operations in surgery. The utter hopelessness of the case justifies almost any means of relief, and many of the visceral operations, resections of functional organs, and extraordinary amputations that were never dreamed of in the early history of medicine are to-day not only feasible and justifiable, but even peremptorily demanded. Varicose veins sometimes become so enlarged and distorted as to simulate the appearance of one varicose tumor. Adams describes a curious case of congenital dilatation of the arteries and veins in the right lower limb, accompanied by an anastomosis with the interior of the os calcis. The affected thigh exceeded the other in size by one-third, all the veins being immensely swelled and distorted. The arteries were also distorted and could be felt pulsating all over the limb. The patient died at thirty from rupture of the aneurysm. Abbe shows a peculiar aneurysmal varix of the finger in a boy of nine. When a babe the patient had, on the dorsum of the little finger, a small nevus, which was quiescent for many years. He received a deep cut at the base of the thumb, and immediately after this accident the nevus began to enlarge rapidly. But for the local aneurysmal thrill at the point of the scar the condition would have been diagnosed as angioma, but as a bruit could be heard over the entire mass it was called an aneurysmal varix, because it was believed there was a connection between a rather large artery and a vein close to the mass. There is a curious case reported of cirsoid tumor of the ear of a boy of thirteen. Figure 259 shows the appearance before and after operation. Jessop records a remarkable case of multiple aneurysm. This case was particularly interesting as it was accompanied by a postmortem examination. Pye-Smith reports an extremely interesting case in which death occurred from traumatic aneurysm of an aberrant subclavian artery. The patient fell from a height of 28 feet, lost consciousness for a few minutes, but soon recovered it. There was no evidence of any fracture, but the man suffered greatly from dyspnea, pain between the shoulders, and collapse. The breath-sounds on auscultation and the difficulty in swallowing led to the belief that one of the bronchi was blocked by the pressure of a hematoma. Dyspnea continued to increase, and eighteen days after admission the man was in great distress, very little air entering the chest. He had no pulse at the right wrist, and Pye-Smith was unable to feel either the temporal or carotid beats on the right side, although these vessels were felt pulsating on the left side. Laryngotomy was done with the hope of removing a foreign body, but the man died on the tenth day. A postmortem examination disclosed the existence of an aberrant right subclavian artery in the posterior mediastinum, and this was the seat of a traumatic aneurysm that had ruptured into the esophagus. Relative to the size of an aneurysm, Warren reported a case of the abdominal aorta which commenced at the origin of the celiac axis and passed on to the surfaces of the psoas and iliac muscles, descending to the middle of the thigh The total length of the aneurysm was 19 inches, and it measured 18 inches in circumference. A peculiar sequence of an aortic aneurysm is perforation of the sternum or rib. Webb mentions an Irish woman who died of aneurysm of the aorta, which had perforated the sternum, the orifice being plugged by a large clot. He quotes 17 similar cases which he has collected as occurring from 1749 to 1874, and notes that one of the patients lived seven weeks after the rupture of the aneurysmal sac. Large Uterine Tumors.--Before the meeting of the American Medical Association held in Washington, D.C., 1891, McIntyre a reported a case of great interest. The patient, a woman of thirty-eight, five feet 5 1/2 inches in height, coarse, with masculine features, having hair on her upper lip and chin, and weighing 199 1/2 pounds, was found in a poor-house in Trenton, Missouri, on November 26, 1890, suffering from a colossal growth of the abdomen. The accompanying illustration is from a photograph which was taken at the time of the first interview. The measurements made at the time were as follows: circumference at the largest part, just below the umbilicus, 50 inches; circumference just below the mammae, 35 inches; from the xiphoid cartilage to the symphysis pubis, 32 inches, not including the appendum, which is shown in the picture. Percussion suggested a fluid within a sac. The uterus was drawn up to the extent of from 12 to 14 inches. The woman walked with great difficulty and with a waddling gait, bending far backward the better to keep "the center of gravity within the base," and to enable her to sustain the enormous weight of the abdomen. She was compelled to pass her urine while standing. Attempts had been made six and two years before to tap this woman, but only a few drops of blood followed several thrusts of a large trocar. A diagnosis was made of multilocular ovarian cyst or edematous myoma of the uterus, and on the morning of December 7, 1890, an operation was performed. An incision 14 inches in length was first made in the linea alba, below the umbilicus, and afterward extended up to the xiphoid cartilage. The hemorrhage from the abdominal wall was very free, and the enormously distended vessels required the application of a large number of pressure-forceps. Adhesions were found almost everywhere the most difficult to manage being those of the liver and diaphragm. The broad ligaments and Fallopian tubes were ligated on either side, the tumor turned out, the thick, heavy pedicle transfixed and ligated, and the enormous growth cut away. After operation the woman was immediately placed on platform scales, and it was found that she had lost 93 1/2 pounds. Unfortunately the patient developed symptoms of septicemia and died on the fifth day. In looking over the literature on this subject McIntyre found no mention of any solid tumor of this size having been removed. On April 18, 1881, Keith, late of Edinburgh, now of London, successfully removed an edematous myoma, together with the uterus, which was 42 pounds in weight. In a recent work Tait remarks that the largest uterine myoma which he ever removed weighed 68 pounds, and adds that it grew after the menopause. McIntyre believes that his tumor, weighing 93 1/2 pounds, is the largest yet reported. Eastman reports the removal of a fibroid tumor of the uterus weighing 60 pounds. The patient recovered from the operation. It is quite possible for a fibrocyst of the uterus to attain an enormous size, equaling the ovarian cysts. Stockard describes an instance of this nature in a negress of fifty, the mother of several children. About twelve years before a cyst in the right iliac region was tapped. The woman presented the following appearance: The navel hung below her knees, and the skin near the umbilicus resembled that of an elephant. The abdomen in its largest circumference measured 68 inches, and 27 inches from the ensiform cartilage to the umbilicus. The umbilicus was five inches in diameter and three inches in length. Eight gallons and seven pints of fluid were removed by tapping, much remaining. The whole tumor weighed 135 pounds. Death from exhaustion followed on the sixth day after the tapping. Ovarian cysts, of which by far the greater number are of the glandular variety, form extremely large tumors; ovarian dropsies of enormous dimensions are recorded repeatedly throughout medical literature. Among the older writers Ford mentions an instance of ovarian dropsy from which, by repeated operations, 2786 pints of water were drawn. Martineau describes a remarkable case of twenty-five years' duration, in which 80 paracenteses were performed and 6630 pints of fluid were withdrawn. In one year alone 495 pints were withdrawn. Tozzetti mentions an ovarian tumor weighing 150 pounds. Morand speaks of an ovarian cyst from which, in ten months, 427 pounds of fluid were withdrawn. There are old records of tubal cysts weighing over 100 pounds. Normand speaks of an ovary degenerating into a scirrhous mass weighing 55 pounds. Among recent operations Briddon describes the removal of an ovarian cyst which weighed 152 pounds, death resulting. Helmuth mentions an ovarian cyst from which, in 12 tappings, 559 pounds of fluid were withdrawn. Delivery was effected by instrumental aid. The tumor of 70 pounds was removed and death followed. McGillicuddy mentions a case of ovarian cyst containing 132 pounds of fluid. The patient was a woman of twenty-eight whose abdomen at the umbilicus measured 69 inches in circumference and 47 inches from the sternum to the pubes. Before the operation the great tumor hung down as far as the knees, the abdominal wall chafing the thighs. Figure 263 shows the appearance of a large ovarian cyst weighing 149 pounds. The emaciation of the subject is particularly noticeable. Reifsnyder describes a native Chinese woman affected with an ovarian tumor seen at the Margaret Williamson Hospital at Shanghai. She was four feet eight inches in height, and twenty-five years of age. The tumor had been growing for six years until the circumference at the umbilicus measured five feet 7 3/4 inches; 88 quarts of fluid were drawn off and the woman recovered. In the College of Physicians, Philadelphia, there are photographs of this case, with an inscription saying that the patient was a young Chinese woman who measured but four feet eight inches in height, while her girth was increased by an ovarian cyst to five feet 9 1/8 inches. The tumor was removed and weighed 182 1/2 pounds; it contained 22 gallons of fluid. Figure 265 shows the appearance of the woman two months after the operation, when the girth was reduced to normal. Stone performed ovariotomy on a girl of fifteen, removing a tumor weighing 81 1/2 pounds. Ranney speaks of the successful removal of a unilocular tumor weighing 95 pounds; and Wall tells of a death after removal of an ovarian tumor of the same weight. Rodenstein portrays the appearance of a patient of forty-five after death from an enormous glandular ovarian cystoma. The tumor was three feet high, covered the breasts, extended to the knees, and weighed 146 pounds. Kelly speaks of a cyst weighing 116 pounds; Keith one of 89 1/2 pounds; Gregory, 80 pounds; Boerstler, 65 pounds; Bixby, 70 pounds; and Alston a tumor of 70 pounds removed in the second operation of ovariotomy. Dayot reports the removal of an enormous ovarian cyst from a girl of seventeen. The tumor had been present three years, but the patient and her family refused an operation until the size of the tumor alarmed them. Its largest circumference was five feet 11 inches. The distance from the xiphoid to the symphysis pubis was three feet. The tumor was covered with veins the size of the little finger. The apex of the heart was pushed to the 3d interspace and the umbilicus had disappeared. There were 65 quarts of a thick, brown fluid in the tumor. The patient recovered in twenty-five days. Cullingworth of St. Thomas Hospital, London, successfully removed from a girl of sixteen an ovarian cyst weighing over 80 pounds. The patient was admitted to the hospital April 30, 1895. She gave a history of a single menstruation, which took place in March or April, 1893, and said that in the latter month she noticed that she was growing large. She was tapped at Christmas, 1893, when a large quantity of fluid was removed, and again in February, 1894, and a third time in May, 1894, but without useful results. For the previous six months she had been almost entirely bedridden because of the great size of the tumor. There were no symptoms referring to the bladder and rectum. At the time she entered the hospital she was much emaciated, the eyes were sunken, and her cheeks had a livid hue. The chest was thin and the lower ribs were everted; dulness began at the lower border of the 3d cartilage, and the apex-beat was best felt in the third space. Liver-dulness began at the 4th rib cartilage in the nipple line. The abdomen was enormously distended, and covered by large veins running from below upward to the thorax. About 3 1/2 inches above the umbilicus there was a sulcus with its convexity downward. There was dulness over the whole abdomen, except at the sides parallel with the lumbar spines, and a resonant band over the stomach. The greatest girth was 54 1/2 inches. By vaginal examination the cervix was found to be pulled up and obliterated; the anterior vaginal wall was bulged downward by the tumor. On May 3d abdominal section was performed. An incision eight inches long was made in the mid-line of the abdomen. A cystic tumor, formed of small cysts in its upper part and of somewhat larger ones in the lower part, was revealed. It was adherent to the abdominal wall, liver, spleen, and omentum. The adhesions were separated and the cyst tapped with a large trocar, and then the septa between the cysts were broken down with the fingers. The pedicle was rather small and was tied in the usual way, and the tumor was removed. Its seat of origin was the left ovary. The right ovary and the uterus were healthy, but poorly developed. The tumor weighed between 80 and 90 pounds,--the patient having weighed 170 pounds on the night before the operation and 79 1/2 pounds a week after the operation. Alarming symptoms of collapse were present during the night after the operation, but the patient responded to stimulation by hypodermic injections of 1/20 grain of strychnin and of brandy, and after the first twenty-four hours the recovery was uninterrupted. Cullingworth thinks that the most interesting points in the case are: the age of the patient, the enormous size of the tumor, and the advice given by the surgeon who first attended the patient (insisting that no operation should be performed). This case shows anew the uselessness of tapping ovarian cysts. In the records of enormous dropsies much material of interest is to be found, and a few of the most interesting cases on record will be cited. In the older times, when the knowledge of the etiology and pathology of dropsies was obscure, we find the records of the most extraordinary cases. Before the Royal Society, in 1746, Glass of Oxford read the report of a case of preternatural size of the abdomen, and stated that the dropsy was due to the absence of one kidney. The circumference of the abdomen was six feet four inches, and the distance from the xiphoid to the os pubis measured four feet 1/2 inch. In this remarkable case 30 gallons of fluid were drawn off from the abdomen after death. Bartholinus mentions a dropsy of 120 pounds; and Gockelius one of 180 pounds; there is recorded an instance of a dropsy of 149 pounds. There is an old record of a woman of fifty who had suffered from ascites for thirty years. She had been punctured 154 times, and each time about 20 pints were drawn off. During each of two pregnancies she was punctured three or four times; one of her children was still living. It has been said that there was a case in Paris of a person who was punctured 300 times for ascites. Scott reports a case of ascites in which 928 pints of water were drawn off in 24 successive tappings, from February, 1777, to May, 1778. Quoted by Hufeland, Van Wy mentions 1256 pounds of fluid being drawn from the abdomen of a woman in five years. Kaltschmid describes a case of ascites in which, in 12 paracenteses, 500 pounds of fluid were removed. In 1721 Morand reported two cases of ascites in one of which, by the means of 57 paracenteses, 970 pounds of fluid were drawn off in twenty-two months. In the other case 1708 pounds of fluid issued in ten months. There is a record of 484 pounds of "pus" being discharged during a dropsy. The Philosophical Transactions contain the account of a case of hydronephrosis in which there were 240 pounds of water in the sac. There are several cases on record in which ovarian dropsies have weighed over 100 pounds; and Blanchard mentions a uterine dropsy of 80 pounds. The Ephemerides contains an account of a case of hydrocephalus in which there were 24 pounds of fluid, and similar cases have been noted. Elliotson reports what he calls the largest quantity of pus from the liver on record. His patient was a man of thirty-eight, a victim of hydatid disease of the liver, from whom he withdrew one gallon of offensive material. Lieutaud cites a case, reported by Blanchard, in which, in a case of hydatid disease, the stomach contained 90 pounds of fluid. Ankylosis of the articulations, a rare and curious anomaly, has been seen in the human fetus by Richaud, Joulin, Bird, and Becourt. Ankylosis of all the joints, with muscular atrophy, gives rise to a condition that has been popularly termed "ossified man." A case of this nature is described, the patient being a raftsman, aged seventeen, who suffered with inflammatory symptoms of the right great toe, which were followed in the next ten years by progressive involvement of all the joints of the extremities, and of the vertebrae and temporo-maxillary articulations, with accompanying signs of acute articular rheumatism. At the age of thirty-one the pains had subsided, leaving him completely disabled. All the joints except the fingers and toes had become ankylosed, and from nonusage the muscles had atrophied. There were no dislocations, anesthesia, or bedsores, and the viscera were normal; there were apparently no gouty deposits, as an examination of the urine was negative. J. R. Bass, the well-known "ossified man" of the dime museums, has been examined by many physicians, and was quite intelligent and cheerful in spite of his complete ankylosis. Figure 269 represents his appearance in 1887. Percy speaks of a man named Simoore, born in 1752, who at the age of fifteen was afflicted with ankylosis of all the joints, and at different angles He was unable to move even his jaw, and his teeth had to be extracted in order to supply him with nourishment. Even his ribs were ankylosed; his chest puffed up, and the breathing was entirely abdominal. In spite of his infirmities, after his pains had ceased he lived a comparatively comfortable life. His digestion was good, and his excretory functions were sufficient. The urine always showed phosphates, and never the slightest sign of free phosphoric acid. He still retained his sexual feeling, and occasionally had erections. This man died in 1802 at the age of fifty, asphyxia being the precursor of death. His skeleton was deposited in the Museum of the ecole de Medecine de Paris. In the same Museum there was another similar skeleton, but in this subject there was motion of the head upon the first vertebra, the lower jaw was intact, and the clavicle, arms, and some of the digits of the right hand were movable. An ossified man has been recently found and exhibited to the Paris Academy of Medicine. He is a Roumanian Jew of thirty who began to ossify twelve years ago, first up the right side of his back, then down the left side. He has hardened now to the nape of the neck, his head is turned to the left, and the jaws are ankylosed. He can still move his arms and legs a little with great difficulty. Akin to the foregoing condition is what is known as petrifaction or ossification of portions of the living human body other than the articulations. Of the older writers Hellwigius, Horstius, and Schurig speak of petrifaction of the arm. In the Philosophical Transactions there was a case recorded in which the muscles and ligaments were so extensively converted into bone that all the joints were fixed, even including the vertebrae, head, and lower jaw. In a short time this man was, as it were, one single bone from his head to his knees, the only joints movable being the right wrist and knee. For over a century there has been in the Trinity College at Dublin the skeleton of a man who died about 20 miles from the city of Cork. The muscles about the scapula, and the dorsum of the ilium (the glutei) were converted into great masses of bone, equal to the original muscles in thickness and bulk. Half of the muscles of the hips and thighs were converted into bone, and for a long time this specimen was the leading curiosity of the Dublin Museum. In the Isle of Man, some years ago, there was a case of ossification which continued progressively for many years. Before death this man was reduced to almost a solid mass of bony substance. With the exception of one or two toes his entire frame was solidified. He was buried in Kirk Andreas Churchyard, and his grave was strictly guarded against medical men by his friends, but the body was finally secured and taken to Dublin by Dr. McCartney. Calculi.--In reviewing the statistics of vesical calculi, the strangest anomalies in their size and weight have been noticed. Among the older writers the largest weights have been found. Le Cat speaks of a calculus weighing over three pounds, and Morand is accredited with having seen a calculus which weighed six pounds. In his statistics in 1883 Cross collected reports on 704 stones, and remarked that only nine of these weighed above four ounces, and only two above six, and that with the last two the patient succumbed. Of those removed successfully Harmer of Norwich reports one of 15 ounces; Kline, one of 13 ounces 30 grains; Mayo of Winchester, 14 ounces two drams; Cheselden, 12 ounces; and Pare in 1570 removed a calculus weighing nine ounces. Sir Astley Cooper remarks that the largest stone he ever saw weighed four ounces, and that the patient died within four hours after its removal. Before the Royal Society of London in 1684 Birch reported an account of a calculus weighing five ounces. Fabricius Hildanus mentions calculi weighing 20 and 21 ounces; Camper, 13 ounces; Foschini, 19 ounces six drams; Garmannus, 25 ounces; Greenfield, 19 ounces; Heberden, 32 ounces; Wrisberg, 20 ounces; Launai, 51 ounces; Lemery, 27 ounces; Paget, in Kuhn's Journal, 27 ounces (from a woman); Pauli, 19 ounces; Rudolphi, 28 ounces; Tozzetti, 39 ounces; Threpland, 35 ounces; and there is a record of a calculus weighing over six pounds. There is preserved in Trinity College, Cambridge, a stone weighing 34 ounces taken from the bladder of the wife of Thomas Raisin, by Gutteridge, a surgeon of Norwich. This stone was afterward sent to King Charles II for inspection. In his "Journey to Paris" Dr. Lister said that he saw a stone which weighed 51 ounces; it had been taken from one of the religious brothers in June, 1690, and placed in the Hopital de la Charite. It was said that the monk died after the operation. There is a record of a calculus taken from the bladder of an individual living in Aberdeen. This stone weighed two pounds, three ounces, and six drams. In the Hunterian Museum in London there is a stone weighing 44 ounces, and measuring 16 inches in circumference. By suprapubic operation Duguise removed a stone weighing 31 ounces from a patient who survived six days. A Belgian surgeon by the name of Uytterhoeven, by the suprapubic method extracted a concretion weighing two pounds and measuring 6 1/2 inches long and four wide. Frere Come performed a high operation on a patient who died the next day after the removal of a 24-ounce calculus. Verduc mentions a calculus weighing three pounds three ounces. It was said that a vesical calculus was seen in a dead boy at St. Edmund's which was as large as the head of a new-born child. It has been remarked that Thomas Adams, Lord Mayor of London, who died at the age of eighty-two, had in his bladder at the time of his death a stone which filled the whole cavity, and which was grooved from the ureters to the urethral opening, thus allowing the passage of urine. Recent records of large calculi are offered: by Holmes, 25 ounces; Hunter, 25 ounces; Cayley, 29 ounces; Humphrys, 33 ounces; Eve, 44 ounces; and Janeway, 51 ounces. Kirby has collected reports ol a number of large vesical calculi. Barton speaks of stone in the bladder in very young children. There is a record of a stone at one month, and another at three years. Todd describes a stone in the bladder of a child of sixteen months. May removed an enormous stone from a young girl, which had its nucleus in a brass penholder over three inches long. Multiple Vesical Calculi.--Usually the bladder contains a single calculus, but in a few instances a large number of stones have been found to coexist. According to Ashhurst, the most remarkable case on record is that of the aged Chief Justice Marshal, from whose bladder Dr. Physick of Philadelphia is said to have successfully removed by lateral lithotomy more than 1000 calculi. Macgregor mentions a case in which 520 small calculi coexisted with a large one weighing 51 ounces. There is an old record of 32 stones having been removed from a man of eighty-one, a native of Dantzic, 16 of which were as large as a pigeon's egg. Kelly speaks of 228 calculi in the bladder of a man of seventy-three, 12 being removed before death. The largest weighed 111 grains. Goodrich took 96 small stones from the bladder of a lad. Among the older records of numerous calculi Burnett mentions 70; Desault, over 200; the Ephemerides, 120; Weickman, over 100; Fabricius Hildanus, 2000 in two years; and there is a remarkable case of 10,000 in all issuing from a young girl. Greenhow mentions 60 stones removed from the bladder. An older issue of The Lancet contains an account of lithotrity performed on the same patient 48 times. Occasionally the calculi are discharged spontaneously. Trioen mentions the issue of a calculus through a perineal aperture, and there are many similar cases on record. There is an old record of a stone weighing five ounces being passed by the penis. Schenck mentions a calculus perforating the bladder and lodging in the groin. Simmons reports a case in which a calculus passed through a fistulous sore in the loins without any concomitant passage of urine through the same passage. Vosberg mentions a calculus in a patent urachus; and calculi have occasionally been known to pass from the umbilicus. Gourges mentions the spontaneous excretion of a five-ounce calculus; and Thompson speaks of the discharge of two calculi of enormous size. Of the extravesical calculi some are true calculi, while others are simply the result of calcareous or osseous degeneration. Renal and biliary calculi are too common to need mention here. There are some extraordinary calculi taken from a patient at St. Bartholomew's Hospital and deposited in the museum of that institution. The patient was a man of thirty-eight. In the right kidney were found a calculus weighing 36 1/2 ounces, about 1000 small calculi, and a quantity of calcareous dust. In the left kidney there was a calculus weighing 9 3/4 ounces, besides a quantity of calcareous dust. The calculi in this case consisted chiefly of phosphate of magnesium and ammonium. Cordier of Kansas City, Mo., successfully removed a renal calculus weighing over three ounces from a woman of forty-two. The accompanying illustration shows the actual size of the calculus. At the University College Hospital, London, there are exhibited 485 gall-stones that were found postmortem in a gall-bladder. Vanzetti reports the removal of a preputial calculus weighing 224 grams. Phillipe mentions the removal of a calculus weighing 50 grams from the prepuce of an Arab boy of seven. Croft gives an account of some preputial calculi removed from two natives of the Solomon Islands by an emigrant medical officer in Fiji. In one case 22 small stones were removed, and in the other a single calculus weighing one ounce 110 grains. Congenital phimosis is said to be very common among the natives of Solomon Islands. In September, 1695, Bernard removed two stones from the meatus urinarius of a man, after a lodgment of twenty years. Block mentions a similar case, in which the lodgment had lasted twenty-eight years. Walton speaks of a urethral calculus gradually increasing in size for fifty years. Ashburn shows what he considers the largest calculus ever removed from the urethra. It was 2 1/8 inches long, and 1 1/4 inches in diameter; it was white on the outside, very hard, and was shaped and looked much like a potato. Its dry weight was 660 grains. At one end was a polished surface that corresponded with a similar surface on a smaller stone that lay against it; the latter calculus was shaped like a lima bean, and weighed 60 grains. Hunt speaks of eight calculi removed from the urethra of a boy of five. Herman and the Ephemerides mention cases of calculi in the seminal vesicles. Calcareous degeneration is seen in the ovary, and Peterman speaks of a stone in the ovary. Uterine calculi are described by Cuevas and Harlow; the latter mentions that the calculus he saw was egg-shaped. There is an old chronicle of a stone taken from the womb of a woman near Trent, Somersetshire, at Easter, 1666, that weighed four ounces. The Ephemerides speaks of a calculus coming away with the menstrual fluid. Stones in the heart are mentioned by medical writers, and it is said that two stones as large as almonds were found in the heart of the Earl of Balcarres. Morand speaks of a calculus ejected from the mouth by a woman. An old record says that stones in the brain sometimes are the cause of convulsions. D'Hericourt reports the case of a girl who died after six months' suffering, whose pineal gland was found petrified, and the incredible size of a chicken's egg. Blasius, Diemerbroeck, and the Ephemerides, speak of stones in the location of the pineal gland. Salivary calculi are well known; they may lodge in any of the buccal ducts. There is a record of the case of a man of thirty-seven who suffered great pain and profuse salivation. It was found that he had a stone as large as a pigeon's egg under his tongue. Umbilical calculi are sometimes seen, and Deani reports such a case. There is a French record of a case of exstrophy of the umbilicus, attended with abnormal concretions. Aetius, Marcellus Donatus, Scaliger, and Schenck mention calculi of the eyelids. There are some extraordinary cases of retention and suppression of urine on record. Actual retention of urine, that is, urinary secretion passed into the bladder, but retention in the latter viscus by inanition, stricture, or other obstruction, naturally cannot continue any great length of time without mechanically rupturing the vesical walls; but suppression of urine or absolute anuria may last an astonishingly extended period. Of the cases of retention of urine, Fereol mentions that of a man of forty-nine who suffered absolute retention of urine for eight days, caused by the obstruction of a uric acid calculus. Cunyghame reports a ease of mechanic obstruction of the flow of urine for eleven days. Trapenard speaks of retention of urine for seven days. Among the older writers Bartholinus mentions ischuria lasting fourteen days; Cornarius, fourteen days; Rhoclius, fifteen days; the Ephemerides, ten, eleven, and twelve days. Croom notes a case of retention of urine from laceration of the vagina during first coitus. Foucard reports a case of retention of urine in a young girl of nineteen, due to accumulation of the menstrual fluid behind an imperforate hymen. The accumulation of urine in cases of ischuria is sometimes quite excessive. De Vilde speaks of 16 pints being drawn off. Mazoni cites a case in which 15 pounds of urine were retained; and Wilson mentions 16 pounds of urine being drawn off. Frank reports instances in which both 12 and 30 pounds of urine were evacuated. There is a record at the beginning of this century in which it is stated that 31 pounds of urine were evacuated in a case of ischuria. Following some toxic or thermic disturbance, or in diseased kidneys, suppression of urine is quite frequently noticed. The older writers report some remarkable instances: Haller mentions a case lasting twenty-two weeks; Domonceau, six months; and Marcellus Donatus, six months. Whitelaw describes a boy of eight who, after an attack of scarlet fever, did not pass a single drop of urine from December 7th to December 20th when two ounces issued, after vesication over the kidneys. On January 2d two ounces more were evacuated, and no more was passed until the bowel acted regularly. On January 5th a whole pint of urine passed; after that the kidneys acted normally and the boy recovered. It would be no exaggeration to state that this case lasted from December 5th to January 5th, for the evacuations during this period were so slight as to be hardly worthy of mention. Lemery reports observation of a monk who during eight years vomited periodically instead of urinating in a natural way. Five hours before vomiting he experienced a strong pain in the kidneys. The vomitus was of dark-red color, and had the odor of urine. He ate little, but drank wine copiously, and stated that the vomiting was salutary to him, as he suffered more when he missed it. Bryce records a case of anuria of seventeen days' standing. Butler speaks of an individual with a single kidney who suffered suppression of urine for thirteen days, caused by occlusion of the ureter by an inspissated thrombus. Dubuc observed a case of anuria which continued for seventeen days before the fatal issue. Fontaine reports a case of suppression of urine for twenty-five days. Nunneley showed the kidneys of a woman who did not secrete any urine for a period of twelve days, and during this time she had not exhibited any of the usual symptoms of uremia. Peebles mentions a case of suspension of the functions of the kidneys more than once for five weeks, the patient exhibiting neither coma, stupor, nor vomiting. Oke speaks of total suppression of urine during seven days, with complete recovery; and Paxon mentions a case in a child that recovered after five days' suppression. Russell reports a case of complete obstructive suppression for twenty days followed by complete recovery. Scott and Shroff mention recovery after nine days' suppression. The most persistent constipation may exist for weeks, or even months, with fair health. The fact seemed to be a subject of much interest to the older writers. De Cabalis mentions constipation lasting thirty-seven days; Caldani, sixty-five days; Lecheverel, thirty-four days; and Pomma, eight months; Sylvaticus, thirty months; Baillie, fifteen weeks; Blanchard, six weeks; Smetius, five mouths; Trioen, three months; Devilliers, two years; and Gignony, seven years. Riverius mentions death following constipation of one month, and says that the intestines were completely filled. Moosman mentions death from the same cause in sixty days. Frank speaks of constipation from intestinal obstructions lasting for three weeks, and Manget mentions a similar case lasting three months. Early in the century Revolat reported in Marseilles an observation of an eminently nervous subject addicted to frequent abuse as regards diet, who had not had the slightest evacuation from the bowel for six months. A cure was effected in this case by tonics, temperance, regulation of the diet, etc. In Tome xv of the Commentaries of Leipzig there is an account of a man who always had his stercoral evacuations on Wednesdays, and who suffered no evil consequences from this abnormality. This state of affairs had existed from childhood, and, as the evacuations were abundant and connected, no morbific change or malformation seemed present. The other excretions were slightly in excess of the ordinary amount. There are many cases of constipation on record lasting longer than this, but none with the same periodicity and without change in the excrement. Tommassini records the history of a man of thirty, living an ordinary life, who became each year more constipated. Between the ages of twenty and twenty-four the evacuations were gradually reduced to one in eight or ten days, and at the age of twenty-six, to one every twenty-two days. His leanness increased in proportion to his constipation, and at thirty his appetite was so good that he ate as much as two men. His thirst was intense, but he secreted urine natural in quantity and quality. Nothing seemed to benefit him, and purgatives only augmented his trouble. His feces came in small, hard balls. His tongue was always in good condition, the abdomen not enlarged, the pulse and temperature normal. Emily Plumley was born on June 11,1850, with an imperforate anus, and lived one hundred and two days without an evacuation. During the whole period there was little nausea and occasional regurgitation of the mother's milk, due to over-feeding. Cripps mentions a man of forty-two with stricture of the rectum, who suffered complete intestinal obstruction for two months, during which time he vomited only once or twice. His appetite was good, but he avoided solid food. He recovered after the performance of proctotomy. Fleck reports the case of a Dutchman who, during the last two years, by some peculiar innervation of the intestine, had only five or six bowel movements a year. In the intervals the patient passed small quantities of hard feces once in eight or ten days, but the amount was so small that they constituted no more than the feces of one meal. Two or three days before the principal evacuation began the patient became ill and felt uncomfortable in the back; after sharp attacks of colic he would pass hard and large quantities of offensive feces. He would then feel better for two or three hours, when there would be a repetition of the symptoms, and so on until he had four or five motions that day. The following day he would have a slight diarrhea and then the bowels would return to the former condition. The principal fecal accumulations were in the ascending and transverse colon and not only could be felt but seen through the abdominal wall. The patient was well nourished and had tried every remedy without success. Finally he went to Marienbad where he drank freely of the waters and took the baths until the bowel movements occurred once in two or three days. There is a record of a man who stated that for two years he had not passed his stool by the anus, but that at six o'clock each evening he voided feces by the mouth. His statement was corroborated by observation. At times the evacuation took place without effort, but was occasionally attended with slight pain in the esophagus and slight convulsions. Several hours before the evacuation the abdomen was hard and distended, which appearance vanished in the evening. In this case there was a history of an injury in the upper iliac region. The first accurate ideas in reference to elephantiasis arabum are given by Rhazes, Haly-Abas, and Avicenna, and it is possibly on this account that the disease received the name elephantiasis arabum. The disease was afterward noticed by Forestus, Mercurialis, Kaempfer, Ludoff, and others. In 1719 Prosper Alpinus wrote of it in Egypt, and the medical officers of the French army that invaded Egypt became familiar with it; since then the disease has been well known. Alard relates as a case of elephantiasis that of a lady of Berlin, mentioned in the Ephemerides of 1694, who had an abdominal tumor the lower part of which reached to the knees. In this case the tumor was situated in the skin and no vestige of disease was found in the abdominal cavity and no sensible alteration had taken place in the veins. Delpech quotes a similar case of elephantiasis in the walls of the abdomen in a young woman of twenty-four, born at Toulouse. Lymphedema, or elephantiasis arabum, is a condition in which, in the substance of a limb or a part, there is diffused dilatation of the lymphatics, with lymphostasis. Such a condition results when there is obstruction of so large a number of the ducts converging to the root of the extremity or part that but little relief through collateral trunks is possible. The affected part becomes swollen and hardened, and sometimes attains an enormous size. It is neither reducible by position nor pressure. There is a corresponding dilatation and multiplication of the blood-vessels with the connective-tissue hypertrophy. The muscles waste, the skin becomes coarse and hypertrophied. The swollen limb presents immense lobulated masses, heaped up at different parts, separated from one another by deep sulci, which are especially marked at the flexures of the joints. Although elephantiasis is met with in all climates, it is more common in the tropics, and its occurrence has been repeatedly demonstrated in these localities to be dependent on the presence in the lymphatics of the filaria sanguinis hominis. The accompanying illustration shows the condition of the limb of a girl of twenty-one, the subject of lymphedema, five years after the inception of the disease. The changes in the limb were as yet moderate. The photograph from which the cut was made was taken in 1875 At the present time (seventeen years later) the case presents the typical condition of the worst form of elephantiasis. Repeated attacks of lymphangitis have occurred during this period, each producing an aggravation of the previous condition. The leg below the knee has become enormously deformed by the production of the elephantoid masses; the outer side of the thigh remains healthy, but the skin of the inner side has developed so as to form a very large and pendant lobulated mass. A similar condition has begun to develop in the other leg, which is row about in the condition of the first, as shown in the figure. Figure 273 represents this disease in its most aggravated form, a condition rarely observed in this country. As an example of the change in the weight of a person after the inception of this disease, we cite a case reported by Griffiths. The patient was a woman of fifty-two who, five years previous, weighed 148 pounds. The elephantoid change was below the waist, yet at the time of report the woman weighed 387 pounds. There was little thickening of the skin. The circumference of the calf was 28 inches; of the thigh, 38 inches; and of the abdomen, 80 inches; while that of the arm was only 15 inches. The condition commonly known as "Barbadoes leg" is a form of elephantiasis deriving its name from its relative frequency in Barbadoes. Figure 275 represents a well-known exhibitionist who, from all appearances, is suffering from an elephantoid hypertrophy of the lower extremities, due to a lymphedema. Quite a number of similar exhibitionists have been shown in recent years, the most celebrated of whom was Falmy Mills, one of whose feet alone was extensively involved, and was perhaps the largest foot ever seen. Elephantiasis seldom attacks the upper extremities. Of the older cases Rayer reports four collected by Alard. In one case the hard and permanent swelling of the arm occurred after the application of a blister; in another the arm increased so that it weighed more than 200 Genoese pounds, 40 of which consisted of serum. The swellings of the arm and forearm resembled a distended bladder. The arteries, veins, and nerves had not undergone any alteration, but the lymphatics were very much dilated and loaded with lymph. The third case was from Fabricius Hildanus, and the fourth from Hendy. Figure 276 represents a remarkable elephantoid change in the hand of an elderly German woman. Unfortunately there is no medical description of the case on record, but the photograph is deemed worthy of reproduction. Terry describes a French mulatto girl of eleven whose left hand was enormously increased in weight and consistency, the chief enlargement being in the middle finger, which was 6 1/2 inches long, and 5 1/2 inches about the nail, and 8 1/2 around the base of the finger. The index finger was two inches thick and four inches long, twisted and drawn, while the other fingers were dwarfed. The elephantiasis in this case slowly and gradually increased in size until the hand weighed 3 1/2 pounds. The skin of the affected finger, contrary to the general appearance of a part affected with elephantiasis, was of normal color, smooth, shiny, showed no sensibility, and the muscles had undergone fatty degeneration. It was successfully amputated in August, 1894. The accompanying illustration shows a dorsal view of the affected hand. Magalhaes of Rio Janeiro reports a very interesting case of elephantiasis of the scalp, representing dermatolysis, in which the fold of hypertrophied skin fell over the face like the hide of an elephant, somewhat similar in appearance to the "elephant-man." Figure 279 represents a somewhat similar hypertrophic condition of the scalp and face reported in the Photographic Review of Medicine and Surgery, 1870. Elephantiasis of the face sometimes only attacks it on one side. Such a case was reported by Alard, in which the elephantiasis seems to have been complicated with eczema of the ear. Willier, also quoted by Alard, describes a remarkable case of elephantiasis of the face. After a debauch this patient experienced violent pain in the left cheek below the zygomatic arch; this soon extended under the chin, and the submaxillary glands enlarged and became painful; the face swelled and became erythematous, and the patient experienced nausea and slight chills. At the end of six months there was another attack, after which the patient perceived that the face continued puffed. This attack was followed by several others, the face growing larger and larger. In similar cases tumefaction assumes enormous proportions, and Schenck speaks of a man whose head exceeded that of an ox in size, the lower part of the face being entirely covered with the nose, which had to be raised to enable its unhappy owner to breathe. Rayer cites two instances in which elephantiasis of the breast enlarged these organs to such a degree that they hung to the knees. Salmuth speaks of a woman whose breasts increased to such a size that they hung down to her knees. At the same time she had in both axillae glandular tumors as large as the head of a fetus. Borellus also quotes the case of a woman whose breasts became so large that it was necessary to support them by straps, which passed over the shoulders and neck. Elephantiasis is occasionally seen in the genital regions of the female, but more often in the scrotum of the male, in which location it produces enormous tumors, which sometimes reach to the ground and become so heavy as to prevent locomotion. This condition is curious in the fact that these immense tumors have been successfully removed, the testicles and penis, which had long since ceased to be distinguished, saved, and their function restored. Alibert mentions a patient who was operated upon by Clot-Bey, whose scrotum when removed weighed 110 pounds; the man had two children after the disease had continued for thirteen years, but before it had obtained its monstrous development--a proof that the functions of the testicles had not been affected by the disease. There are several old accounts of scrotal tumors which have evidently been elephantoid in conformation. In the Ephemerides in 1692 there was mentioned a tumor of the scrotum weighing 200 pounds. In the West Indies it was reported that rats have been known to feed on these enormous tumors, while the deserted subjects lay in a most helpless condition. Larrey mentioned a case of elephantiasis of the scrotum in which the tumor weighed over 200 pounds. Sir Astley Cooper removed a tumor of 56 pounds weight from a Chinese laborer. It extended from beneath the umbilicus to the anterior border of the anus; it had begun in the prepuce ten years previously. Clot-Bey removed an elephantoid tumor of the scrotum weighing 80 pounds, performing castration at the same time. Alleyne reports a case of elephantiasis, in which he successfully removed a tumor of the integuments of the scrotum and penis weighing 134 pounds. Bicet mentions a curious instance of elephantiasis of the penis and scrotum which had existed for five years. The subject was in great mental misery and alarm at his unsightly condition. The parts of generation were completely buried in the huge mass. An operation was performed in which all of the diseased structures that had totally unmanned him were removed, the true organs of generation escaping inviolate. Thebaud mentions a tumor of the scrotum, the result of elephantiasis, which weighed 63 1/2 pounds. The weight was ascertained by placing the tumor on the scales, and directing the patient to squat over them without resting any weight of the body on the scales. This man could readily feel his penis, although his surgeons could not do so. The bladder was under perfect control, the urine flowing over a channel on the exterior of the scrotum, extending 18 inches from the meatus. Despite his infirmity this patient had perfect sexual desire, and occasional erections and emissions. A very interesting operation was performed with a good recovery. Partridge reports an enormous scrotal tumor which was removed from a Hindoo of fifty-five, with subsequent recovery of the subject. The tumor weighed 111 1/2 pounds. The ingenious technic of this operation is well worth perusal by those interested. Goodman successfully removed an elephantiasis of the scrotum from a native Fiji of forty-five. The tumor weighed 42 pounds, without taking into consideration the weight of the fluid which escaped in abundance during the operation and also after the operation, but before it was weighed. Van Buren and Keyes mention a tumor of the scrotum of this nature weighing 165 pounds. Quoted by Russell, Hendy describes the case of a negro who had successive attacks of glandular swelling of the scrotum, until finally the scrotum was two feet long and six feet in circumference. It is mentioned that mortification of the part caused this patient's ultimate death. Figure 281 is taken from a photograph loaned to the authors by Dr. James Thorington. The patient was a native of Fiji, and was successfully operated on, with preservation of the testes. The tumor, on removal, weighed 120 pounds. W. R. Browne, Surgeon-General, reports from the Madras General Hospital an operation on a patient of thirty-five with elephantoid scrotum of six years' duration. The proportions of the scrotum were as follows: Horizontally the circumference was six feet 6 1/2 inches, and vertically the circumference was six feet ten inches. The penis was wholly hidden, and the urine passed from an opening two feet 5 1/2 inches from the pubis. The man had complete control of his bladder, but was unable to walk. The operation for removal occupied one hour and twenty minutes, and the tumor removed weighed 124 3/4 pounds. Little blood was lost on account of an elastic cord tied about the neck of the tumor, and secured by successful removal of a scrotal tumor weighing 56 pounds. Fenger describes a case of the foregoing nature in a German of twenty-three, a resident of Chicago. The growth had commenced eight years previously, and had progressively increased. There was no pain or active inflammation, and although the patient had to have especially constructed trousers he never ceased his occupation as a driver. The scrotum was represented by a hairless tumor weighing 22 pounds, and hanging one inch below the knees. No testicles or penis could be made out. Fenger removed the tumor, and the man was greatly improved in health. There was still swelling of the inguinal glands on both sides, but otherwise the operation was very successful. The man's mental condition also greatly improved. Fenger also calls especial attention to the importance of preserving the penis and testes in the operation, as although these parts may apparently be obliterated their functions are undisturbed. The statistics of this major operation show a surprisingly small mortality. Fayrer operated on 28 patients with 22 recoveries and six deaths, one from shock and five from pyemia The same surgeon collected 193 cases, and found the general mortality to be 18 per cent. According to Ashhurst, Turner, who practiced as a medical missionary in the Samoan Islands, claims to have operated 136 times with only two deaths. McLeod, Fayrer's successor in India, reported 129 cases with 23 deaths. Early in this century Rayer described a case of elephantiasis in a boy of seventeen who, after several attacks of erysipelas, showed marked diminution of the elephantoid change; the fact shows the antagonism of the streptococcus erysipelatis to hypertrophic and malignant processes. Acromegaly is a term introduced by Marie, and signifies large extremities. It is characterized by an abnormally large development of the extremities and of the features of the face,--the bony as well as the soft parts. In a well-marked case the hands and feet are greatly enlarged, but not otherwise deformed, and the normal functions are not disturbed. The hypertrophy involves all the tissues, giving a curious spade-like appearance to the hands. The feet are similarly enlarged, although the big toe may be relatively much larger. The nails also become broad and large. The face increases in volume and becomes elongated, in consequence of the hypertrophy of the superior and inferior maxillary bones. The latter often projects beyond the upper teeth. The teeth become separated, and the soft parts increase in size. The nose is large and broad, and the skin of the eyelids and ears is enormously hypertrophied. The tongue is greatly hypertrophied. The disease is of long duration, and late in the history the bones of the spine and thorax may acquire great deformity. As we know little of the influences and sources governing nutrition, the pathology and etiology of acromegaly are obscure. Marie regards the disease as a systemic dystrophy analogous to myxedema, due to a morbid condition of the pituitary body, just as myxedema is due to disease of the thyroid. In several of the cases reported the squint and optic atrophy and the amblyopia have pointed to the pituitary body as the seat of a new growth of hypertrophy. Pershing shows a case of this nature. The enlargement of the face and extremities was characteristic, and the cerebral and ocular symptoms pointed to the pituitary body as the seat of the lesion. Unverricht, Thomas, and Ransom report cases in which the ocular lesions, indicative of pituitary trouble, were quite prominent. Of 22 cases collected by Tamburini 19 showed some change in the pituitary body, and in the remaining three cases either the diagnosis was uncertain or the disease was of very short duration. Linsmayer reported a case in which there was a softened adenoma in the pituitary body, and the thymus was absent. Hersman reports an interesting case of progressive enlargement of the hands in a clergyman of fifty. Since youth he had suffered with pains in the joints. About three years before the time of report he noticed enlargement of the phalangeal joint of the third finger of the right hand. A short time later the whole hand became gradually involved and the skin assumed a darker hue. Sensation and temperature remained normal in both hands; acromegaly was excluded on account of the absence of similar changes elsewhere. Hersman remarks that the change was probably due to increase in growth of the fibrous elements of the subcutaneous lesions about the tendons, caused by rheumatic poison. Figure 283 shows the palmer and dorsal surfaces of both hands. Chiromegaly is a term that has been applied by Charcot and Brissaud to the pseudoacromegaly that sometimes occurs in syringomyelia. Most of the cases that have been reported as a combination of these two diseases are now thought to be only a syringomyelia. A recent case is reported by Marie. In this connection it is interesting to notice a case of what might be called acute symptomatic transitory pseudoacromegaly, reported by Potovski: In an insane woman, and without ascertainable cause, there appeared an enlargement of the ankles, wrists, and shoulders, and later of the muscles, with superficial trophic disturbances that gradually disappeared. The author excludes syphilis, tuberculosis, rheumatism, gout, hemophilia, etc., and considers it to have been a trophic affection of cerebral origin. Cases of pneumonia osteoarthropathy simulating acromegaly have been reported by Korn and Murray. Megalocephaly, or as it was called by Virchow, leontiasis ossea, is due to a hypertrophic process in the bones of the cranium. The cases studied by Virchow were diffuse hyperostoses of the cranium. Starr describes what he supposes to be a case of this disease, and proposes the title megalocephaly as preferable to Virchow's term, because the soft parts are also included in the hypertrophic process. A woman of fifty-two, married but having no children, and of negative family history, six years before the time of report showed the first symptoms of the affection, which began with formication in the finger-tips. This gradually extended to the shoulders, and was attended with some uncertainty of tactile sense and clumsiness of movement, but actual anesthesia had never been demonstrated. This numbness had not invaded the trunk or lower extremities, although there was slight uncertainty in the gait. There had been a slowly progressing enlargement of the head, face, and neck, affecting the bone, skin, and subcutaneous tissues, the first to the greatest degree. The circumference of the neck was 16 inches; the horizontal circumference of the head was 24 inches; from ear to ear, over the vertex, 16 inches; and from the root of the nose to the occipital protuberance, 16 inches. The cervical vertebrae were involved, and the woman had lost five inches in height. It may be mentioned here that Brissaud and Meige noticed the same loss in height, only more pronounced, in a case of gigantism, the loss being more than 15 inches. In Starr's case the tongue was normal and there was no swelling of the thyroid. Cretinism is an endemic disease among mountainous people who drink largely of lime water, and is characterized by a condition of physical, physiologic, and mental degeneracy and nondevelopment, and possibly goiter. The subjects of this disease seldom reach five feet in height, and usually not more than four. The word cretin is derived from the Latin creatura. They are found all over the world. In Switzerland it is estimated that in some cantons there is one cretin to every 25 inhabitants. In Styria, the Tyrol, and along the Rhine cretins are quite common, and not long since cases existed in Derbyshire. These creatures have been allowed to marry and generate, and thus extend their species. In "Le Medicin de Campagne," Balzac has given a vivid picture of the awe and respect in which they were held and the way in which they were allowed to propagate. Speaking of the endemic cretins, Beaupre says: "I see a head of unusual form and size, a squat and bloated figure, a stupid look, bleared, hollow, and heavy eyes, thick, projecting eyelids, and a flat nose. His face is of a leaden hue, his skin dirty, flabby, covered with tetters, and his thick tongue hangs down over his moist, livid lips; his mouth, always open and full of saliva, shows teeth going to decay. His chest is narrow, his back curved, his breath asthmatic, his limbs short, misshapen, without power. The knees are thick and inclined inward, the feet flat. The large head droops listlessly on the breast; the abdomen is like a bag." The cretin is generally deaf and dumb, or only able to give a hoarse cry. He is indifferent to heat and cold, and even to the most revolting odors. The general opinion has always been that the sexual desire and genital organs are fully developed. A quotation under our observation credits Colonel Sykes with the following statistics of cretinism, which show how in some locations it may be a decided factor of population. In December, 1845, in a population of 2,558,349 souls (the locality not mentioned), there were 18,462 people with simple goiter. Of the cretins without goiter there were 2089. Of cretins with goiter there were 3909; and cretins in which goiter was not stated 962, making a total of 6960. Of these 2185 had mere animal instincts; 3531 possessed very small intellectual faculties; 196 were almost without any; 1048 not classified. Of this number 2483 were born of healthy and sane fathers; 2285 from healthy mothers; 961 from goitrous fathers; 1267 from goitrous mothers; 49 from cretin fathers; 41 from cretin mothers; 106 from cretin fathers with goiter; 66 from cretin mothers with goiter; 438 fathers and 405 mothers were not specified. Sporadic cretinism, or congenital myzedema, is characterized by a congenital absence of the thyroid, diminutiveness of size, thickness of neck, shortness of arms and legs, prominence of the abdomen, large size of the face, thickness of the lips, large and protruding tongue, and imbecility or idiocy. It is popularly believed that coitus during intoxication is the cause of this condition. Osler was able to collect 11 or 12 cases in this country. The diagnosis is all-important, as the treatment by the thyroid extract produces the most noteworthy results. There are several remarkable recoveries on record, but possibly the most wonderful is the case of J. P. West of Bellaire, Ohio, the portraits of which are reproduced in Plate 11. At seventeen months the child presented the typical appearance of a sporadic cretin. The astonishing results of six months' treatment with thyroid extract are shown in the second figure. After a year's treatment the child presents the appearance of a healthy and well-nourished little girl. Myxedema proper is a constitutional condition due to the loss of the function of the thyroid gland. The disease was first described by Sir William Gull as a cretinoid change, and later by William Ord of London, who suggested the name. It is characterized clinically by a myxedematous condition of the subcutaneous tissues and mental failure, and anatomically by atrophy of the thyroid gland. The symptoms of myxedema, as given by Ord, are marked increase in the general bulk of the body, a firm, inelastic swelling of the skin, which does not pit on pressure; dryness and roughness which tend, with swelling, to obliterate the lines of expression in the face; imperfect nutrition of the hair; local tumefaction of the skin and subcutaneous tissues, particularly in the supraclavicular region. The physiognomy is remarkably altered; the features are coarse and broad, the lips thick, the nostrils broad and thick, and the mouth enlarged. There is a striking slowness of thought and of movement; the memory fails, and conditions leading to incipient dementia intervene. The functions of the thoracic and abdominal organs seem to be normal, and death is generally due to some intercurrent disease, possibly tuberculosis. A condition akin to myxedema occurs after operative removal of the thyroid gland. In a most interesting lecture Brissaud shows the intimate relation between myxedema, endemic cretinism, sporadic cretinism, or myxedematous idiocy, and infantilism. He considers that they are all dependent upon an inherited or acquired deficiency or disease of the thyroid gland, and he presents cases illustrating each affection. Figure 285 shows a case of myxedema, one of myxedema in a case of arrested development--a transition case between myxedema of the adult and sporadic cretinism--and a typical case of sporadic cretinism. Cagots are an outcast race or clan of dwarfs in the region of the Pyrenees, and formerly in Brittany, whose existence has been a scientific problem since the sixteenth century, at which period they were known as Cagots, Gahets, Gafets, Agotacs, in France; Agotes or Gafos, in Spain; and Cacous, in Lower Brittany. Cagot meant the dog of a Goth; they were of supposed Gothic origin by some, and of Tartar origin by others. These people were formerly supposed to have been the descendants of lepers, or to have been the victims of leprosy themselves. From the descriptions there is a decided difference between the Cagots and the cretins. In a recent issue of Cosmos a writer describes Cagots as follows:-- "They inhabit the valley of the Ribas in the northwestern part of the Spanish province now called Gerona. They never exceed 51 1/2 inches in height, and have short, ill-formed legs, great bellies, small eyes, flat noses, and pale, unwholesome complexions. They are usually stupid, often to the verge of idiocy, and much subject to goiter and scrofulous affections. The chief town of the Ribas Valley is Ribas, a place of 1500 inhabitants, about 800 feet above sea-level. The mountains rise about the town to a height of from 6000 to 8000 feet, and command an amazingly beautiful panorama of mountain, plain, and river, with Spanish cities visible upon the one side and French upon the other. The region is rich, both agriculturally and minerally, and is famous for its medicinal springs. In this paradise dwell the dwarfs, perhaps as degraded a race of men and women as may be found in any civilized community. They are almost without education, and inhabit wretched huts when they have any shelter. The most intelligent are employed as shepherds, and in summer they live for months at an elevation of more than 6000 feet without shelter. Here they see no human creature save some of their own kind, often idiots, who are sent up every fifteen or twenty days with a supply of food. "It is said that formal marriage is almost unknown among them. The women in some instances are employed in the village of Ribas as nurses for children, and as such are found tender and faithful. Before communication throughout the region was as easy as it is now, it was thought lucky to have one of these dwarfs in a family, and the dwarfs were hired out and even sold to be used in beggary in neighboring cities. There are somewhat similar dwarfs in other valleys of the Pyrenees, but the number is decreasing, and those of the Ribas Valley are reduced to a few individuals." Hiccough is a symptom due to intermittent, sudden contraction of the diaphragm. Obstinate cases are most peculiar, and sometimes exhaust the physician's skill. Symes divides these cases into four groups:-- (1) Inflammatory, seen particularly in inflammatory diseases of the viscera or abdominal membranes, and in severe cases of typhoid fever. (2) Irritative, as in direct stimulus of the diaphragm in swallowing some very hot substance; local disease of the esophagus near the diaphragm, and in many conditions of gastric and intestinal disorder, more particularly those associated with flatus. (3) Specific or idiopathic, in which there are no evident causes present; it is sometimes seen in cases of nephritis and diabetes. (4) Neurotic, in which the primary cause is in the nervous system,--hysteria, epilepsy, shock, or cerebral tumors. The obstinacy of continued hiccough has long been discussed. Osler calls to mind that in Plato's "Symposium" the physician, Eryximachus, recommended to Aristophanes, who had hiccough from eating too much, either to hold his breath or to gargle with a little water; but if it still continued, "tickle your nose with something and sneeze, and if you sneeze once or twice even the most violent hiccough is sure to go." The attack must have been a severe one, as it is stated subsequently that the hiccough did not disappear until Aristophanes had excited the sneezing. Among the older medical writers Weber speaks of singultus lasting for five days; Tulpius, for twelve days; Eller and Schenck, for three months; Taranget, for eight months; and Bartholinus, for four years. At the present day it is not uncommon to read in the newspapers accounts of prolonged hiccoughing. These cases are not mythical, and are paralleled by a number of instances in reliable medical literature. The cause is not always discernible, and cases sometimes resist all treatment. Holston reports a case of chronic singultus of seven years' standing. It had followed an attack of whooping-cough, and was finally cured apparently by the administration of strychnin. Cowan speaks of a shoemaker of twenty-two who experienced an attack of constant singultus for a week, and then intermittent attacks for six years. Cowan also mentions instances of prolonged hiccough related by Heberden, Good, Hoffman, and Wartmouth. Barrett is accredited with reporting a case of persistent hiccough in a man of thirty-five. Rowland speaks of a man of thirty-five who hiccoughed for twelve years. The paroxysms were almost constant, and occurred once or twice a minute during the hours when the man was not sleeping. There was no noise with the cough. There is another case related in the same journal of a man who died on the fourth day of an attack of singultus, probably due to abscess of the diaphragm, which no remedy would relieve. Moore records a case of a child, injured when young, who hiccoughed until about twenty years of age (the age at the time of report). Foot mentions a lad of fifteen who, except when asleep, hiccoughed incessantly for twenty-two weeks, and who suffered two similar, but less severe, attacks in the summer of 1879, and again in 1880. The disease was supposed to be due to the habit of pressing the chest against the desk when at school. Dexter reports a case of long-continued singultus in an Irish girl of eighteen, ascribed to habitual masturbation. There was no intermission in the paroxysm, which increased in force until general convulsions ensued. The patient said that the paroxysm could be stopped by firm pressure on the upper part of the external genital organs. Dexter applied firm pressure on her clitoris, and the convulsions subsided, and the patient fell asleep. They could be excited by firm pressure on the lower vertebrae. Corson speaks of a man of fifty-seven who, after exposure to cold, suffered exhausting hiccough for nine days; and also records the case of an Irish servant who suffered hiccough for four months; the cause was ascribed to fright. Stevenson cites a fatal instance of hiccough in a stone-mason of forty-four who suffered continuously from May 14th to May 28th. The only remedy that seemed to have any effect in this case was castor-oil in strong purgative doses. Willard speaks of a man of thirty-four who began to hiccough after an attack of pneumonia, and continued for eighty-six hours. The treatment consisted of the application of belladonna and cantharides plasters, bismuth, and lime-water, camphor, and salts of white hellebore inhaled through the nose in finest powder. Two other cases are mentioned by the same author. Gapper describes the case of a young man who was seized with loud and distressing hiccough that never ceased for a minute during eighty hours. Two ounces of laudanum were administered in the three days without any decided effect, producing only slight languor. Ranney reports the case of an unmarried woman of forty-four who suffered from paroxysms of hiccough that persisted for four years. A peculiarity of this attack was that it invariably followed movements of the upper extremities. Tenderness and hyperesthesia over the spinous processes of the 4th, 5th, and 6th cervical vertebrae led to the application of the thermocautery, which, in conjunction with the administration of ergot and bromide, was attended with marked benefit, though not by complete cure. Barlow mentions a man with a rheumatic affection of the shoulder who hiccoughed when he moved his joints. Barlow also recites a case of hiccough which was caused by pressure on the cicatrix of a wound in the left hand. Beilby reports a peculiar case in a girl of seventeen who suffered an anomalous affection of the respiratory muscle, producing a sound like a cough, but shriller, almost resembling a howl. It was repeated every five or six seconds during the whole of the waking moments, and subsided during sleep. Under rest and free purgation the patient recovered, but the paroxysms continued during prolonged intervals, and in the last six years they only lasted from twenty-four to forty-eight hours. Parker reports four rebellious cases of singultus successfully treated by dry cups applied to the abdomen. In each case it was necessary to repeat the operation after two hours, but recovery was then rapid. Tatevosoff reports a brilliant cure in a patient with chronic chest trouble, by the use of common snuff, enough being given several times to induce lively sneezing. Griswold records a successful treatment of one case in a man of fifty, occurring after a debauch, by the administration of glonoin, 1/150 of a grain every three hours. Heidenhain records a very severe and prolonged case caused, as shown later at the operation and postmortem examination, by carcinoma of the pancreas. The spasms were greatly relieved by cocain administered by the mouth, as much as 15 grains being given in twelve hours. Laborde and Lepine report the case of a young girl who was relieved of an obstinate case of hiccough lasting four days by traction on her tongue. After the tongue had been held out of the mouth for a few minutes the hiccoughs ceased. Laborde referred to two cases of a similar character reported by Viand. Anomalous Sneezing.--In the olden times sneezing was considered a good omen, and was regarded as a sacred sign by nearly all of the ancient peoples. This feeling of reverence was already ancient in the days of Homer. Aristotle inquired into the nature and origin of the superstition, somewhat profanely wondering why sneezing had been deified rather than coughing. The Greeks traced the origin of the sacred regard for sneezing to the days of Prometheus, who blessed his man of clay when he sneezed. According to Seguin the rabbinical account says that only through Jacob's struggle with the angel did sneezing cease to be an act fatal to man. Not only in Greece and Rome was sneezing revered, but also by races in Asia and Africa, and even by the Mexicans of remote times. Xenophon speaks of the reverence as to sneezing, in the court of the King of Persia. In Mesopotamia and some of the African towns the populace rejoiced when the monarch sneezed. In the present day we frequently hear "God bless you" addressed to persons who have just sneezed, a perpetuation of a custom quite universal in the time of Gregory the Great, in whose time, at a certain season, the air was filled with an unwholesome vapor or malaria which so affected the people that those who sneezed were at once stricken with death-agonies. In this strait the pontiff is said to have devised a form of prayer to be uttered when the paroxysm was seen to be coming on, and which, it was hoped, would avert the stroke of the death-angel. There are some curious cases of anomalous sneezing on record, some of which are possibly due to affections akin to our present "hay fever," while others are due to causes beyond our comprehension. The Ephemerides records a paroxysm of continual sneezing lasting thirty days. Bonet, Lancisi, Fabricius Hildanus, and other older observers speak of sneezing to death. Morgagni mentions death from congestion of the vasa cerebri caused by sneezing. The Ephemerides records an instance of prolonged sneezing which was distinctly hereditary. Ellison makes an inquiry for treatment of a case of sneezing in a white child of ten. The sneezing started without apparent cause and would continue 20 or 30 times, or until the child was exhausted, and then stop for a half or one minute, only to relapse again. Beilby speaks of a boy of thirteen who suffered constant sneezing (from one to six times a minute) for one month. Only during sleep was there any relief. The patient recovered under treatment consisting of active leeching, purgation, and blisters applied behind the ear, together with the application of olive oil to the nostrils. Lee reports a remarkable case of yawning followed by sneezing in a girl of fifteen who, just before, had a tooth removed without difficulty. Half an hour afterward yawning began and continued for five weeks continuously. There was no pain, no illness, and she seemed amused at her condition. There was no derangement of the sexual or other organs and no account of an hysteric spasm. Potassium bromid and belladonna were administered for a few days with negative results, when the attacks of yawning suddenly turned to sneezing. One paroxysm followed another with scarcely an interval for speech. She was chloroformed once and the sneezing ceased, but was more violent on recovery therefrom. Ammonium bromid in half-drachm doses, with rest in bed for psychologic reasons, checked the sneezing. Woakes presented a paper on what he designated "ear-sneezing," due to the caking of cerumen in one ear. Irritation of the auricular branch of the vagus was produced, whence an impression was propagated to the lungs through the pulmonary branches of the vagus. Yawning was caused through implication of the third division of the 5th nerve, sneezing following from reflex implication of the spinal nerves of respiration, the lungs being full of air at the time of yawning. Woakes also speaks of "ear-giddiness" and offers a new associate symptom--superficial congestion of the hands and forearm. A case of anomalous sneezing immediately prior to sexual intercourse is mentioned on page 511. Hemophilia is an hereditary, constitutional fault, characterized by a tendency to uncontrollable bleeding, either spontaneous or from slight wounds. It is sometimes associated with a form of arthritis (Ogler). This hemorrhagic diathesis has been known for many years; and the fact that there were some persons who showed a peculiar tendency to bleed after wounds of a trifling nature is recorded in some of the earliest medical literature. Only recently, however, through the writings of Buel, Otto, Hay, Coates, and others, has the hereditary nature of the malady and its curious mode of transmission through the female line been known. As a rule the mother of a hemophile is not a "bleeder" herself, but is the daughter of one. The daughters of a hemophile, though healthy and free from any tendency themselves, are almost certain to transmit the disposition to the male offspring. The condition generally appears after some slight injury in the first two years of life; but must be distinguished from the hemorrhagic affections of the new-born, which will be discussed later. The social condition of the family does not alter the predisposition; the old Duke of Albany was a "bleeder"; and bleeder families are numerous, healthy looking, and have fine, soft skins. The duration of this tendency, and its perpetuation in a family, is remarkable. The Appleton-Swain family of Reading, Mass., has shown examples for two centuries. Osler has been advised of instances already occurring in the seventh generation. Kolster has investigated hemophilia in women, and reports a case of bleeding in the daughter of a hemophilic woman. He also analyzes 50 genealogic trees of hemophilic families, and remarks that Nasse's law of transmission does not hold true. In 14 cases the transmission was direct from the father to the child, and in 11 cases it was direct from the mother to the infant. The hemorrhagic symptoms of bleeders may be divided into external bleedings, either spontaneous or traumatic; interstitial bleedings, petechiae, and ecchymoses; and the joint-affections. The external bleedings are seldom spontaneous, and generally follow cuts, bruises, scratches, and often result seriously. A minor operation on a hemophile may end in death; so slight an operation as drawing a tooth has been followed by the most disastrous consequences. Armstrong, Blagden, and Roberts, have seen fatal hemorrhage after the extraction of teeth. MacCormac observed five bleeders at St. Thomas Hospital, London, and remarks that one of these persons bled twelve days after a tooth-extraction. Buchanan and Clay cite similar instances. Cousins mentions an individual of hemorrhagic diathesis who succumbed to extensive extravasation of blood at the base of the brain, following a slight fall during an epileptic convulsion. Dunlape reports a case of hemorrhagic diathesis, following suppression of the catamenia, attended by vicarious hemorrhage from the gums, which terminated fatally. Erichsenf cites an instance of extravasation of blood into the calf of the leg of an individual of hemophilic tendencies. A cavity was opened, which extended from above the knee to the heel; the clots were removed, and cautery applied to check the bleeding. There was extension of the blood-cavity to the thigh, with edema and incipient gangrene, necessitating amputation of the thigh, with a fatal termination. Mackenzie reports an instance of hemophilic purpura of the retina, followed by death. Harkin gives an account of vicarious bleeding from the under lip in a woman of thirty-eight. The hemorrhage occurred at every meal and lasted ten minutes. There is no evidence that the woman was of hemophilic descent. Of 334 cases of bleeding in hemophilia collected by Grandidier, 169 were from the nose, 43 from the mouth, 15 from the stomach, 36 from the bowels, 16 from the urethra, 17 from the lungs, and a few from the skin of the head, eyelids, scrotum, navel, tongue, finger-tips, vulva, and external ear. Osler remarks that Professor Agnew knew of a case of a bleeder who had always bled from cuts and bruises above the neck, never from those below. The joint-affections closely resemble acute rheumatism. Bleeders do not necessarily die of their early bleedings, some living to old age. Oliver Appleton, the first reported American bleeder, died at an advanced age, owing to hemorrhage from a bed-sore and from the urethra. Fortunately the functions of menstruation and parturition are not seriously interfered with in hemophilia. Menstruation is never so excessive as to be fatal. Grandidier states that of 152 boy subjects 81 died before the termination of the seventh year. Hemophilia is rarely fatal in the first year. Of the hemorrhagic diseases of the new-born three are worthy of note. In syphilis haemorrhagica neonatorum the child may be born healthy, or just after birth there may appear extensive cutaneous extravasations with bleeding from the mucous surfaces and from the navel; the child may become deeply jaundiced. Postmortem examination shows extensive extravasations into the internal viscera, and also organic syphilitic lesions. Winckel's disease, or epidemic hemoglobinuria, is a very fatal affection, sometimes epidemic in lying-in institutions; it develops about the fourth day after birth. The principal symptom is hematogenous icterus with cyanosis,--the urine contains blood and blood-coloring matter. Some cases have shown in a marked degree acute fatty degeneration of the internal organs--Buhl's disease. Apart from the common visceral hemorrhages, the results of injuries at birth, bleeding from one or more of the surfaces is a not uncommon event in the new-born, particularly in hospital-practice. According to Osler Townsend reports 45 cases in 6700 deliveries, the hemorrhage being both general and from the navel alone. Bleeding also occurs from the bowels, stomach, and mouth, generally beginning in the first week, but in rare instances it is delayed to the second or third. Out of 50 cases collected by Townsend 31 died and 19 recovered. The nature of the disease is unknown, and postmortem examination reveals no pathologic changes, although the general and not local nature of the affection, its self-limited character, the presence of fever, and the greater prevalence of the disease in hospitals, suggest an infectious origin (Townsend). Kent a speaks of a new-born infant dying of spontaneous hemorrhage from about the hips. Infantile scurvy, or Barlow's disease, has lately attracted marked attention, and is interesting for the numerous extravasations and spontaneous hemorrhages which are associated with it. A most interesting collection of specimens taken from the victims of Barlow's disease were shown in London in 1895. In an article on the successful preventive treatment of tetanus neonatorum, or the "scourge of St. Kilda," of the new-born, Turner says the first mention of trismus nascentium or tetanus neonatorum was made by Rev. Kenneth Macaulay in 1764, after a visit to the island of St. Kilda in 1758. This gentleman states that the infants of this island give up nursing on the fourth or fifth day after birth; on the seventh day their gums are so clinched together that it is impossible to get anything down their throats; soon after this they are seized with convulsive fits and die on the eighth day. So general was this trouble on the island of St. Kilda that the mothers never thought of making any preparation for the coming baby, and it was wrapped in a dirty piece of blanket till the ninth or tenth day, when, if the child survived, the affection of the mother asserted itself. This lax method of caring for the infant, the neglect to dress the cord, and the unsanitary condition of the dwellings, make it extremely probable that the infection was through the umbilical cord. All cases in which treatment was properly carried out by competent nurses have survived. This treatment consisted in dressing the cord with iodoform powder and antiseptic wool, the breast-feeding of the baby from the first, and the administration of one-grain doses of potassium bromid at short intervals. The infant death-rate on the island of St. Kilda has, consequently, been much reduced. The author suggests the use of a new iodin-preparation called loretin for dressing the cord. The powder is free from odor and is nonpoisonous. Human Parasites.--Worms in the human body are of interest on account of the immense length some species attain, the anomalous symptoms which they cause, or because of their anomalous location and issue. According to modern writers the famous Viennese collection of helminths contains chains of tenia saginata 24 feet long. The older reports, according to which the taenia solium (i.e., generally the taenia saginata) grew to such lengths as 40, 50, 60, and even as much as 800 yards, are generally regarded as erroneous. The observers have apparently taken the total of all the fragments of the worm or worms evacuated at any time and added them, thus obtaining results so colossal that it would be impossible for such an immense mass to be contained in any human intestine. The name solium has no relation to the Latin solus, or solium. It is quite possible for a number of tapeworms to exist simultaneously in the human body. Palm mentions the fact of four tapeworms existing in one person; and Mongeal has made observations of a number of cases in which several teniae existed simultaneously in the stomach. David speaks of the expulsion of five teniae by the ingestion of a quantity of sweet wine. Cobbold reports the case of four simultaneous tapeworms; and Aguiel describes the case of a man of twenty-four who expelled a mass weighing a kilogram, 34.5 meters long, consisting of several different worms. Garfinkel mentions a case which has been extensively quoted, of a peasant who voided 238 feet of tapeworms, 12 heads being found. Laveran reports a case in which 23 teniae were expelled in the same day. Greenhow mentions the occurrence of two teniae mediocanellata. The size of a tapeworm in a small child is sometimes quite surprising. Even the new-born have exhibited signs of teniae, and Haussmann has discussed this subject. Armor speaks of a fully-matured tapeworm being expelled from a child five days old. Kennedy reports cases in which tapeworms have been expelled from infants five, and five and one-half months old. Heisberg gives an account of a tapeworm eight feet in length which came from a child of two. Twiggs describes a case in which a tapeworm 36 feet long was expelled from a child of four; and Fabre mentions the expulsion of eight teniae from a child. Occasionally the tapeworm is expelled from the mouth. Such cases are mentioned by Hitch and Martel. White speaks of a tapeworm which was discharged from the stomach after the use of an emetic. Lile mentions the removal of a tapeworm which had been in the bowel twenty-four years. The peculiar effects of a tapeworm are exaggerated appetite and thirst, nausea, headaches, vertigo, ocular symptoms, cardiac palpitation, and Mursinna has even observed a case of trismus, or lockjaw, due to taenia solium. Fereol speaks of a case of vertigo, accompanied with epileptic convulsions, which was caused by teniae. On the administration of kousso three heads were expelled simultaneously. There is a record of an instance of cardiac pulsation rising to 240 per minute, which ceased upon the expulsion of a large tapeworm. It is quite possible for the presence of a tapeworm to indirectly produce death. Garroway describes a case in which death was apparently imminent from the presence of a tapeworm. Kisel has recorded a fatal case of anemia, in a child of six, dependent on teniae. The number of ascarides or round-worms in one subject is sometimes enormous. Victor speaks of 129 round-worms being discharged from a child in the short space of five days. Pole mentions the expulsion of 441 lumbricoid worms in thirty-four days, and Fauconneau-Dufresne has reported a most remarkable case in which 5000 ascarides were discharged in less than three years, mostly by vomiting. The patient made an ultimate recovery. There are many instances in which the lumbricoid worms have pierced the intestinal tract and made their way to other viscera, sometimes leading to an anomalous exit. There are several cases on record in which the lumbricoid worms have been found in the bladder. Pare speaks of a case of this kind during a long illness; and there is mention of a man who voided a worm half a yard long from his bladder after suppression of urine. The Ephemerides contains a curious case in which a stone was formed in the bladder, having for its nucleus a worm. Fontanelle presented to the Royal Academy of Medicine of Paris several yards of tapeworm passed from the urethra of a man of fifty-three. The following is a quotation from the British Medical Journal: "I have at present a patient passing in his urine a worm-like body, not unlike a tapeworm as far as the segments and general appearance are concerned, the length of each segment being about 1/4 inch, the breadth rather less; sometimes 1 1/2 segments are joined together. The worm is serrated on the one side, each segment having 1 1/2 cusps. The urine pale, faintly acid at first, within the last week became almost neutral. There was considerable vesical irritation for the first week, with abundant mucus in the urine, specific gravity was 1010; there were no albumin nor tube-casts nor uric acid in the urinary sediments. Later there were pus-cells and abundant pus. Tenderness existed behind the prostate and along the course of left ureter. Temperature of patient oscillated from 97.5 degrees to 103.2 degrees F. There was no history at any time of recto-vesical fistula. Can anyone suggest the name, etc., of this helminth?" Other cases of worms in the bladder are mentioned in Chapter XIII Mitra speaks of the passage of round-worms through the umbilicus of an adult; and there is a case mentioned in which round-worms about seven inches long were voided from the navel of a young child. Borgeois speaks of a lumbricoid worm found in the biliary passages, and another in the air passages. Turnbull has recorded two cases of perforation of the tympanic membrane from lumbricoides. Dagan speaks of the issue of a lumbricoid from the external auditory meatus. Laughton reports an instance of lumbricoid in the nose. Rake speaks of asphyxia from a round-worm. Morland mentions the ejection of numerous lumbricoid worms from the mouth. Worms have been found in the heart; and it is quite possible that in cases of trichinosis, specimens of the trichinae may be discovered anywhere in the line of cardiac or lymphatic circulation. Quoted by Fournier, Lapeyronnie has seen worms in the pericardial sac, and also in the ventricle. There is an old record of a person dying of intestinal worms, one of which was found in the left ventricle. Castro and Vidal speak of worms in the aorta. Rake reports a case of sudden death from round-worm; and Brown has noted a similar instance. The echinococcus is a tiny cestode which is the factor in the production of the well-known hydatid cysts which may be found in any part of the body. Delafield and Prudden report the only instance of multilocular echinococcus seen in this country. Their patient was a German who had been in this country five years. There are only about 100 of these cases on record, most of them being in Bavaria and Switzerland. The filaria sanguinis hominis is a small worm of the nematode species, the adult form of which lives in the lymphatics, and either the adult or the prematurely discharged ova (Manson) block the lymph-channels, producing the conditions of hematochyluria, elephantiasis, and lymph-scrotum. The Dracunculus medinensis or Guinea-worm is a widely-spread parasite in parts of Africa and the West Indies. According to Osler several cases have occurred in the United States. Jarvis reports a case in a post-chaplain who had lived at Fortress Monroe, Va., for thirty years. Van Harlingen's patient, a man of forty-seven, had never lived out of Philadelphia, so that the worm must be included among the parasites infesting this country. In February, 1896, Henry of Philadelphia showed microscopic slides containing blood which was infested with numbers of living and active filaria embryos. The blood was taken from a colored woman at the Woman's Hospital, who developed hematochyluria after labor. Henry believed that the woman had contracted the disease during her residence in the Southern States. Curran gives quite an exhaustive article on the disease called in olden times "eaten of worms,"--a most loathsome malady. Herod the Great, the Emperor Galerius, and Philip II of Spain perished from it. In speaking of the Emperor Galerius, Dean Milman, in his "History of Latin Christianity," says, "a deep and fetid ulcer preyed on the lower parts of his body and ate them away into a mass of living corruption." Gibbon, in his "Decline and Fall," also says that "his (Galerius's) death was caused by a very painful and lingering disorder. His body, swelled by an intemperate course of life to an unwieldy corpulence, was covered with ulcers and devoured by immense swarms of those insects who have given their names to this most loathsome disease." It is also said that the African Vandal King, the Arian Huneric, died of the disease. Antiochus, surnamed the "Madman," was also afflicted with it; and Josephus makes mention of it as afflicting the body of Herod the Great. The so-called "King Pym" died of this "morbus pedicularis," but as prejudice and passion militated against him during his life and after his death, this fact is probably more rumor than verity. A case is spoken of by Curran, which was seen by an army-surgeon in a very aged woman in the remote parts of Ireland, and another in a female in a dissecting-room in Dublin. The tissues were permeated with lice which emerged through rents and fissures in the body. Instances of the larvae of the estrus or the bot-fly in the skin are not uncommon. In this country Allen removed such larvae from the skin of the neck, head, and arm of a boy of twelve. Bethune, Delavigne, Howship, Jacobs, Jannuzzi and others, report similar cases. These flesh-flies are called creophilae, and the condition they produce is called myiosis. According to Osler, in parts of Central America, the eggs of a bot-fly, called the dermatobia, are not infrequently deposited in the skin, and produce a swelling very like the ordinary boil. Matas has described a case in which the estrus larvae were found in the gluteal region. Finlayson of Glasgow has recently reported an interesting case in a physician who, after protracted constipation and pain in the back and sides, passed large numbers of the larvae of the flower-fly, anthomyia canicularis, and there are other instances of myiosis interna from swallowing the larvae of the common house-fly. There are forms of nasal disorder caused by larvae, which some native surgeons in India regard as a chronic and malignant ulceration of the mucous membranes of the nose and adjacent sinuses in the debilitated and the scrofulous. Worms lodging in the cribriform plate of the ethmoid feed on the soft tissues of that region. Eventually their ravages destroy the olfactory nerves, with subsequent loss of the sense of smell, and they finally eat away the bridge of the nose. The head of the victim droops, and he complains of crawling of worms in the interior of the nose. The eyelids swell so that the patient cannot see, and a deformity arises which exceeds that produced by syphilis. Lyons says that it is one of the most loathsome diseases that comes under the observation of medical men. He describes the disease as "essentially a scrofulous inflammation of the Schneiderian membrane, ... which finally attacks the bones." Flies deposit their ova in the nasal discharges, and from their infection maggots eventually arise. In Sanskrit peenash signifies disease of the nose, and is the Indian term for the disease caused by the deposition of larvae in the nose. It is supposed to be more common in South America than in India. CHAPTER XVI. ANOMALOUS SKIN-DISEASES. Ichthyosis is a disease of the skin characterized by a morbid development of the papillae and thickening of the epidermic lamellae; according as the skin is affected over a larger or smaller area, or only the epithelial lining of the follicles, it is known as ichthyosis diffusa, or ichthyosis follicularis. The hardened masses of epithelium develop in excess, the epidermal layer loses in integrity, and the surface becomes scaled like that of a fish. Ichthyosis may be congenital, and over sixty years ago Steinhausen described a fetal monster in the anatomic collection in Berlin, the whole surface of whose body was covered with a thick layer of epidermis, the skin being so thick as to form a covering like a coat-of-mail. According to Rayer the celebrated "porcupine-man" who exhibited himself in England in 1710 was an example of a rare form of ichthyosis. This man's body, except the face, the palms of the hands, and the soles of the feet, was covered with small excrescences in the form of prickles. These appendages were of a reddish-brown color, and so hard and elastic that they rustled and made a noise when the hand was passed over their surfaces. They appeared two months after birth and fell off every winter, to reappear each summer. In other respects the man was in very good health. He had six children, all of whom were covered with excrescences like himself. The hands of one of these children has been represented by Edwards in his "Gleanings of Natural History." A picture of the hand of the father is shown in the fifty-ninth volume of the Philosophical Transactions. Pettigrew mentions a man with warty elongations encasing his whole body. At the parts where friction occurred the points of the elongations were worn off. This man was called "the biped armadillo." His great grandfather was found by a whaler in a wild state in Davis's Straits, and for four generations the male members of the family had been so encased. The females had normal skins. All the members of the well-known family of Lambert had the body covered with spines. Two members, brothers, aged twenty-two and fourteen, were examined by Geoffroy-Saint-Hilaire. This thickening of the epidermis and hair was the effect of some morbid predisposition which was transmitted from father to son, the daughters not being affected. Five generations could be reckoned which had been affected in the manner described. The "porcupine-man" seen by Baker contracted small-pox, and his skin was temporarily freed from the squamae, but these reappeared shortly afterward. There are several older records of prickly men or porcupine-men. Ascanius mentions a porcupine-man, as do Buffon and Schreber. Autenreith speaks of a porcupine-man who was covered with innumerable verrucae. Martin described a remarkable variety of ichthyosis in which the skin was covered with strong hairs like the bristles of a boar. When numerous and thick the scales sometimes assumed a greenish-black hue. An example of this condition was the individual who exhibited under the name of the "alligator-boy." Figure 286 represents an "alligator-boy" exhibited by C. T. Taylor. The skin affected in this case resembled in color and consistency that of a young alligator. It was remarked that his olfactory sense was intact. The harlequin fetus, of which there are specimens in Guy's Hospital, London Hospital, and the Royal College of Surgeons Museum, is the result of ichthyosis congenita. According to Crocker either after the removal of the vernix caseosa, which may be thick, or as the skin dries it is noticeably red, smooth, shiny, and in the more severe cases covered with actual plates. In the harlequin fetus the whole surface of the body is thickly covered with fatty epidermic plates, about 1/16 inch in thickness, which are broken up by horizontal and vertical fissures, and arranged transversely to the surface of the body like a loosely-built stone wall. After birth these fissures may extend down into the corium, and on movement produce much pain. The skin is so stiff and contracted that the eyes cannot be completely opened or shut, the lips are too stiff to permit of sucking, and are often inverted; the nose and ears are atrophied, the toes are contracted and cramped, and, if not born dead, the child soon dies from starvation and loss of heat. When the disease is less severe the child may survive some time. Crocker had a patient, a male child one month old, who survived three months. Hallopeau and Elliot also report similar cases. Contagious follicular keratosis is an extremely rare affection in which there are peculiar, spine-like outgrowths, consisting in exudations of the mouths of the sebaceous glands. Leloir and Vidal shorten the name to acne cornee. Erasmus Wilson speaks of it as ichthyosis sebacea cornea. H. G. Brooke describes a case in a girl of six. The first sign had been an eruption of little black spots on the nape of the neck. These spots gradually developed into papules, and the whole skin took on a dirty yellow color. Soon afterward the same appearances occurred on both shoulders, and, in the same order, spread gradually down the outer sides of the arms--first black specks, then papules, and lastly pigmentation. The black specks soon began to project, and comedo-like plugs and small, spine-like growths were produced. Both the spines and plugs were very hard and firmly-rooted. They resisted firm pressure with the forceps, and when placed on sheets of paper rattled like scraps of metal. A direct history of contagion was traced from this case to others. Mibelli describes an uncommon form of keratodermia (porokeratosis). The patient was a man of twenty-one, and exhibited the following changes in his skin: On the left side of the neck, beyond a few centimeters below the lobe of the ear, there were about ten small warty patches, irregularly scattered, yellowish-brown in color, irregular in outline, and varying in size from a lentil to a half-franc piece, or rather more. Similar patches were seen on other portions of the face. Patches of varying size and form, sharply limited by a kind of small, peripheral "dike," sinuous but uninterrupted, of a color varying from red to whitish-red, dirty white, and to a hue but little different from that of the healthy skin. Similar patches were seen on the right hand, and again on the back of the right hand was a wide space, prolonged upward in the form of a broad band on the posterior surface of the forearm to just below the olecranon, where the skin was a little smoother and thinner than the surrounding skin, and altogether bare of hairs. The disease was noticed at the age of two, and gradually progressed. The patient always enjoyed the most perfect health, but had contracted syphilis three years before. A brother of the patient, aged twenty-four, for sixteen years has had the same skin-affection as this patient, on the back of the hand, and the sister and father had noticed similar lesions. Diffuse symmetric scleroderma, or hide-bound disease, is quite rare, and presents itself in two phases: that of infiltration (more properly called hypertrophy) and atrophy, caused by shrinkage. The whole body may be involved, and each joint may be fixed as the skin over it becomes rigid. The muscles may be implicated independently of the skin, or simultaneously, and they give the resemblance of rigor mortis. The whole skin is so hard as to suggest the idea of a frozen corpse, without the coldness, the temperature being only slightly subnormal. The skin can neither be pitted nor pinched. As Crocker has well put it, when the face is affected it is gorgonized, so to speak, both to the eye and to the touch. The mouth cannot be opened; the lids usually escape, but if involved they are half closed, and in either case immovable. The effect of the disease on the chest-walls is to seriously interfere with the respiration and to flatten and almost obliterate the breasts; as to the limbs, from the shortening of the distended skin the joints are fixed in a more or less rigid position. The mucous membranes may be affected, and the secretion of both sweat and sebum is diminished in proportion to the degree of the affection, and may be quite absent. The atrophic type of scleroderma is preceded by an edema, and from pressure-atrophy of the fat and muscles the skin of the face is strained over the bones; the lips are shortened, the gums shrink from the teeth and lead to caries, and the nostrils are compressed. The strained skin and the emotionless features (relieved only by telangiectatic striae) give the countenance a ghastly, corpse-like aspect. The etiology and pathology of this disease are quite obscure. Happily the prognosis is good, as there is a tendency to spontaneous recovery, although the convalescence may be extended. Although regarded by many as a disease distinct from scleroderma, morphea is best described as a circumscribed scleroderma, and presents itself in two clinical aspects: patches and bands, the patches being the more common. Scleroderma neonatorum is an induration of the skin, congenital and occurring soon after birth, and is invariably fatal. A disease somewhat analogous is edema neonatorum, which is a subcutaneous edema with induration affecting the new-born. If complete it is invariably fatal, but in a few cases in which the process has been incomplete recovery has occurred. Gerard reports recovery from a case of sclerema neonatorum in an infant five weeks old, which seemed in perfect health but for this skin-affection. The back presented a remarkable induration which involved the entire dorsal aspect, including the deltoid regions, the upper arms, the buttocks, and the thighs, down to and involving the popliteal spaces. The edges of the indurated skin were sharply defined, irregular, and map-like. The affected skin was stretched, but not shiny, and exhibited a pink mottling; it could not be pinched between the fingers; pressure produced no pitting, but rendered the surface pale for a time. The induration upon the buttocks had been noticed immediately after birth, and the region was at first of a deep pink color. During the first nine days the trouble had extended to the thighs, but only shortly before the examination had it attacked the arms. Inunctions of codliver oil were at first used, but with little improvement. Blue ointment was substituted, and improvement commenced. As the induration cleared up, outlying patches of the affected skin were left surrounded by normal integument. No pitting could be produced even after the tension of the skin had decreased during recovery. The lowest rectal temperature was 98 degrees F. In a little more than four months the skin became normal. The treatment with mercurial ointment was stopped some time before recovery. Possibly the most interesting of the examples of skin-anomaly was the "elephant-man" of London. His real name was Merrick. He was born at Leicester, and gave an elaborate account of shock experienced by his mother shortly before his birth, when she was knocked down by an elephant at a circus; to this circumstance he attributed his unfortunate condition. He derived his name from a proboscis-like projection of his nose and lips, together with a peculiar deformity of the forehead. He was victimized by showmen during his early life, and for a time was shown in Whitechapel Road, where his exhibition was stopped by the police. He was afterward shown in Belgium, and was there plundered of all his savings. The gruesome spectacle he presented ostracized him from the pleasures of friendship and society, and sometimes interfered with his travels. On one occasion a steamboat captain refused to take him as a passenger. Treves exhibited him twice before the Pathological Society of London. His affection was not elephantiasis, but a complication of congenital hypertrophy of certain bones and pachydermatocele and papilloma of the skin. From his youth he suffered from a disease of the left hip-joint. The papillary masses developed on the skin of the back, buttock, and occiput. In the right pectoral and posterior aspect of the right axillary region, and over the buttocks, the affected skin hung in heavy pendulous flaps. His left arm was free from disease. His head grew so heavy that at length he had great difficulty in holding it up. He slept in a sitting or crouching position, with his hands clasped over his legs, and his head on his knees. If he lay down flat, the heavy head showed a tendency to fall back and produce a sense of suffocation. For a long time he was an inmate of the London Hospital, where special quarters were provided for him, and it was there that he was found dead, April 11, 1890; while in bed his ponderous head had fallen backward and dislocated his neck. Ainhum may be defined as a pathologic process, the ultimate result of which is a spontaneous amputation of the little toe. It is confined almost exclusively to negroes, chiefly males, and of African descent. In Brazil it is called "ainham" or "quigila." "Ainham" literally means to saw, and is doubtless a colloquial name derived from a supposed slow, sawing process. The Hindoo name for it is "sukha pakla," meaning dry suppuration. In 1866 da Silva Lima of Bahia, at the Misericordia Hospital, gave the first reports of this curious disease, and for quite a period it was supposed to be confined to Brazilian territory. Since then, however, it has been reported from nearly every quarter of the globe. Relative to its geographic distribution, Pyle states that da Silva Lima and Seixas of Bahia have reported numerous cases in Brazil, as have Figueredo, Pereira, Pirovano, Alpin, and Guimares. Toppin reports it in Pernambuco. Mr. Milton reports a case from Cairo, and Dr. Creswell at Suez, both in slaves. E. A. G. Doyle reports several cases at the Fernando Hospital, Trinidad. Digby reports its prevalence on the west coast of Africa, particularly among a race of negroes called Krumens. Messum reports it in the South African Republic, and speaks of its prevalence among the Kaffirs. Eyles reports it on the Gold Coast. It has also been seen in Algiers and Madagascar. Through the able efforts of Her Majesty's surgeons in India the presence of ainhum has been shown in India, and considerable investigation made as to its etiology, pathologic histology, etc. Wise at Dacca, Smyth and Crombie at Calcutta, Henderson at Bombay, and Warden, Sen, Crawford, and Cooper in other portions of Southern India have all rendered assistance in the investigation of ainhum. In China a case has been seen, and British surgeons speak of it as occurring in Ceylon. Von Winckler presents an admirable report of 20 cases at Georgetown, British Guiana. Dr. Potoppidan sends a report of a case in a negress on St. Thomas Island. The disease has several times been observed in Polynesia. Dr. Hornaday reports a case in a negress from North Carolina, and, curious to relate, Horwitz of Philadelphia and Shepherd of Canada found cases in negroes both of North Carolina antecedents. Dr. James Evans reports a case in a negro seventy-four years of age, at Darlington, S.C. Dr. R. H. Days of Baton Rouge, La., had a case in a negress, and Dr. J. L. Deslates, also of Louisiana, reports four cases in St. James Parish. Pyle has seen a case in a negress aged fifty years, at the Emergency Hospital in Washington. So prevalent is the disease in India that Crawford found a case in every 2500 surgical cases at the Indian hospitals. The absence of pain or inconvenience in many instances doubtless keeps the number of cases reported few, and again we must take into consideration the fact that the class of persons afflicted with ainhum are seldom brought in contact with medical men. The disease usually affects the 5th phalanx at the interphalangeal joint. Cases of the 4th and other phalanges have been reported. Cooper speaks of a young Brahman who lost his left great toe by this process. Crombie speaks of a simultaneous amputation of both fourth toes. Potoppidan reports a similar case in a negress on St. Thomas Island. Sen reports a case in a supernumerary digit in a child, whose father, a Hindoo, lost a toe by ainhum. Eyles reports a case in a negro in whom the second finger was affected. Mirault, at Angiers, speaks of a case in which two fingers were lost in fifteen days, a fact which makes his diagnosis dubious. Beranger-Ferraud has seen all the toes amputated, and there is a wax model by Baretta, Paris, in the Army Medical Museum at Washington, in which all the toes of the right foot have been amputated, and the process is fast making progress at the middle third of the leg. Ainhum is much more common in males than in females; it is, in fact, distinctly rare in the latter. Of von Winckler's 20 cases all were males. It may occur at any age, but is most common between thirty and thirty-five. It has been reported in utero by Guyot, and was seen to extend up to the thigh, a statement that is most likely fallacious. However, there are well-authenticated cases in infants, and again in persons over seventy years of age. In some few cases the metatarso-phalangeal joint is affected; but no case has been seen at the base of the ungual phalanx. The duration of the disease is between two and four years, but Dr. Evans's case had been in progress fifty years. It rarely runs its full course before a year. Ainhum begins as a small furrow or crack, such as soldiers often experience, at the digito-plantar fold, seen first on the inner side. This process of furrowing never advances in soldiers, and has been given a name more expressive than elegant. In ainhum the toe will swell in a few days, and a pain, burning or shooting in nature, may be experienced in the foot and leg affected. Pain, however, is not constant. There may be an erythematous eruption accompanying the swelling. The furrow increases laterally and in depth, and meets on the dorsal aspect of the toe, giving the toe the appearance of being constricted by a piece of fine cord. As the furrow deepens the distal end of the toe becomes ovoid, and soon an appearance as of a marble attached to the toe by a fibrous pedicle presents itself. By this time the swelling, if any, has subsided. The distal end of the toe bends under the foot, and becomes twisted when walking, and causes inconvenience, and, unfortunately, says Eyles, it is in this last stage only that the Fanti presents himself. There is in the majority of cases a small ulcer in or near the digito-plantar fold, which causes most of the pain, particularly when pressed upon. This ulcer does not occur early, and is not constant. The case under Pyle's observation showed no ulceration, and was absolutely painless, the negress applying for diagnosis rather than treatment. The furrow deepens until spontaneous amputation takes place, which rarely occurs, the patient generally hastening the process by his own operation, or by seeking surgical treatment. A dry scab forms at the furrow, and when picked and repicked constantly re-forms, being composed of horny desquamation or necrosis. The histology of ainhum shows it to be a direct ingrowth of epithelium, with a corresponding depression of surface due to a rapid hyperplasia that pushes down and strangles the papillae, thus cutting off the blood supply from the epithelial cells, causing them to undergo a horny change. The disease is not usually symmetric, as formerly stated, nor is it simultaneous in different toes. There are no associated constitutional symptoms, no tendency to similar morbid changes in other parts, and no infiltration elsewhere. There is little or no edema with ainhum. In ainhum there is, first, simple hypertrophy, then active hyperplasia The papillae degenerate when deprived of blood supply, and become horny. Meanwhile the pressure thus exerted on the nervi vasorum sets up vascular changes which bring about epithelial changes in more distant areas, the process advancing anteriorly, that is, in the direction of the arteries. This makes the cause, according to Eyles, an inflammatory and trophic phenomenon due mainly to changes following pressure on the vasomotor nerves. Etiology.--The theories of the causation of ainhum are quite numerous. The first cause is the admirable location for a furrow in the digito-plantar fold, and the excellent situation of the furrow for the entrance of sand or other particles to make the irritation constant, thus causing chronic inflammatory changes, which are followed subsequently by the changes peculiar to ainhum. The cause has been ascribed to the practice of wearing rings on the toes; but von Winckler says that in his locality (British Guinea) this practice is confined to the coolie women, and in not one of his 20 cases had a ring been previously worn on the toe; in fact all of the patients were males. Digby says, however, that the Krumens, among whom the disease is common, have long worn brass or copper rings on the fifth toe. Again the natives of India, who are among those most frequently afflicted, have no such custom. Injury, such as stone-bruise, has been attributed as the initial cause, and well-authenticated cases have been reported in which traumatism is distinctly remembered; but Smyth, Weber, and several other observers deny that habits, accidents, or work, are a feature in causation. Von During reports a curious case which he calls sclerodactylia annularis ainhumoides. The patient was a boy about twelve years old, born in Erzeroum, brought for treatment for scabies, and not for the affection about to be described. A very defective history led to the belief that a similar affection had not been observed in the family. When he was six years old it began on the terminal phalanges of the middle fingers. A myxomatous swelling attacked the phalanges and effected a complete absorption of the terminal phalanx. It did not advance as far as gangrene or exfoliation of bone. At the time of report the whole ten fingers were involved; the bones seemed to be thickened, the soft parts being indurated or sclerosed. In the right index finger a completely sclerosed ring passed around the middle phalanx. The nails on the absorbed phalanges had become small and considerably thickened plates. No analogous changes were found elsewhere, and sensation was perfectly normal in the affected parts. There were no signs whatever of a multiple neuritis nor of a leprous condition. There is a rare and curious condition known as "deciduous skin" or keratolysis, in which the owners possess a skin, which, like that of a serpent, is periodically cast off, that of the limbs coming off like the finger of a glove. Preston of Canterbury, New Zealand, mentions the case of a woman who had thus shed her skin every few weeks from the age of seven or even earlier. The woman was sixty-seven years of age; the skin in every part of the body came away in casts and cuticles which separated entire and sometimes in one unbroken piece like a glove or stocking. Before each paroxysm she had an associate symptom of malaise. Even the skin of the nose and ears came off complete. None of the patient's large family showed this idiosyncrasy, and she said that she had been told by a medical man that it had been due to catching cold after an attack of small-pox. Frank mentions a case in which there was periodic and complete shedding of the cuticle and nails of the hands and feet, which was repeated for thirty-three consecutive years on July 24th of each year, and between the hours of 3 P.M. and 9 P.M. The patient remembered shedding for the first time while a child at play. The paroxysms always commenced abruptly, constitutional febrile symptoms were first experienced, and the skin became dry and hot. The acute symptoms subsided in three or four hours and were entirely gone in twelve hours, with the exception of the redness of the skin, which did not disappear for thirty-six hours more. The patient had been delirious during this period. The cuticle began to shed some time between the third and twelfth day, in large sheets, as pictured in the accompanying illustrations. The nails were shed in about four weeks after the acute stage. Crocker had an instance of this nature in a man with tylosis palmae, in which the skin was cast off every autumn, but the process lasted two months. Lang observed a case in which the fingers alone were affected. There is a case of general and habitual desquamation of the skin in the Ephemerides of 1686; and Newell records a case which recovered under the use of Cheltenham water for several seasons. Latham describes a man of fifty who was first seized about ten years previously with a singular kind of fever, and this returned many times afterward, even twice in the course of the same year, attended with the same symptoms and circumstances, and appearing to be brought on by obstructed perspiration, in consequence of catching cold. Besides the common febrile symptoms, upon the invasion of the disease his skin universally itched, more especially at the joints, and the itching was followed by many little red spots, with a small degree of swelling. Soon after this his fingers became stiff; hard, and painful at the ends, and at the roots of the nails. In about twenty-four hours the cuticle began to separate from the cutis, and in ten or twelve days this separation was general from head to foot, during which time he completely turned the cuticle off from the wrists to the fingers' ends like a glove, and in like manner on the legs to the toes, after which his nails shot gradually from their roots, at first with exquisite pain, which abated as the separation of the cuticle advanced, and the old nails were generally thrown off by new ones in about six months. The cuticle rose in the palms and soles like blisters, having, however, no fluid beneath, and when it came off it left the underlying cutis exposed for a few days. Sometimes, upon catching cold, before quite free from feverish symptoms, a second separation of the cuticle from the cutis occurred, but it appeared so thin as to be like scurf, demonstrating the quick renewal of the parts. There is a similar case in the Philosophical Transactions in a miller of thirty-five who was exposed to great heat and clouds of dust. On the first cold a fever attacked him, and once or twice a year, chiefly in the autumn, this again occurred, attended with a loosening and detachment of the cuticle. The disorder began with violent fever, attended with pains in the head, back, limbs, retching, vomiting, dry skin, furred tongue, urgent thirst, constipation, and high-colored urine. Usually the whole surface of the body then became yellow. It afterward became florid like a rash, and then great uneasiness was felt for several days, with general numbness and tingling; the urine then began to deposit a thick sediment. About the third week from the first attack the cuticle appeared elevated in many places, and in eight or ten days afterward became so loose as to admit of its easy removal in large flakes. The cuticle of the hands, from the wrists to the fingers' ends, came off like a glove. The patient was never disposed to sweat, and when it was attempted to force perspiration he grew worse; nor was he much at ease until his urine deposited a sediment, after which he felt little inconvenience but from the rigidity of the skin. The nails were not detached as in the previous case. It is quite natural that such cases as this should attract the attention of the laity, and often find report in newspapers. The following is a lay-report of a "snake-boy" in Shepardstown, Va.:-- "Jim Twyman, a colored boy living with his foster-parents ten miles from this place, is a wonder. He is popularly known as the "snake-boy." Mentally he is as bright as any child of his age, and he is popular with his playmates, but his physical peculiarities are probably unparalleled. His entire skin, except the face and hands, is covered with the scales and markings of a snake. These exceptions are kept so by the constant use of Castile soap, but on the balance of his body the scales grow abundantly. The child sheds his skin every year. It causes him no pain or illness. From the limbs it can be pulled in perfect shape, but off the body it comes in pieces. His feet and hands are always cold and clammy. He is an inordinate eater, sometimes spending an hour at a meal, eating voraciously all the time, if permitted to do so. After these gorgings he sometimes sleeps two days. There is a strange suggestion of a snake in his face, and he can manipulate his tongue, accompanied by hideous hisses, as viciously as a serpent." Under the name of dermatitis exfoliativa neonatorum, Ritter has described an eruption which he observed in the foundling asylum at Prague, where nearly 300 cases occurred in ten years. According to Crocker it begins in the second or third week of life, and occasionally as late as the fifth week, with diffuse and universal scaling, which may be branny or in laminae like pityriasis rubra, and either dry or with suffusion beneath the epidermis. Sometimes it presents flaccid bullae like pemphigus foliaceus, and then there are crusts as well as scales, with rhagades on the mouth, anus, etc.; there is a total absence of fever or other general symptoms. About 50 per cent die of marasmus and loss of heat, with or without diarrhea. In those who recover the surface gradually becomes pale and the desquamation ceases. Opinions differ regarding it, some considering it of septic origin, while others believe it to be nothing but pemphigus foliaceus. Kaposi regards it as an aggravation of the physiologic exfoliation of the new-born. Elliott of New York reports two cases with a review of the subject, but none have been reported in England. Cases on the Continent have been described by Billard, von Baer, Caspary, those already mentioned, and others. The name epidemic exfoliative dermatitis has been given to an epidemic skin-disease which made its appearance in 1891 in England; 425 cases were collected in six institutions, besides sporadic cases in private houses. In 1895, in London, some photographs and sketches were exhibited that were taken from several of the 163 cases which occurred in the Paddington Infirmary and Workhouse, under the care of Dr. Savill, from whose negatives they were prepared. They were arranged in order to illustrate the successive stages of the disorder. The eruption starts usually with discrete papules, often in stellate groups, and generally arranged symmetrically when on the limbs. These become fused into crimson, slightly raised maculae, which in severe cases become further fused into red thickened patches, in which the papules can still be felt and sometimes seen. Vesicles form, and exudation occurs in only about one-third of the cases. Desquamation of the epidermis is the invariable feature of all cases, and it usually commences between the fourth and eighth days. In severe cases successive layers of the epidermis are shed, in larger or smaller scales, throughout the whole course of the malady. One-half of the epidermis shed from the hand of a patient is exhibited in this collection. Of sphaceloderma, or gangrene of the skin, probably the most interesting is Raynaud's disease of symmetric gangrene, a vascular disorder, which is seen in three grades of intensity: there is local syncope, producing the condition known as dead-fingers or dead-toes, and analogous to that produced by intense cold; and local asphyxia, which usually follows local syncope, or may develop independently. Chilblains are the mildest manifestation of this condition. The fingers, toes, and ears, are the parts usually affected. In the most extreme degree the parts are swollen, stiff, and livid, and the capillary circulation is almost stagnant; this is local or symmetric gangrene, the mildest form of which follows asphyxia. Small areas of necrosis appear on the pads of the fingers and of the toes; also at the edges of the ears and tip of the nose. Occasional symmetric patches appear on the limbs and trunk, and in extensive cases terminate in gangrene. Raynaud suggested that the local syncope was produced by contraction of the vessels; the asphyxia is probably caused by a dilatation of the capillaries and venules, with persistence of the spasm of the arterioles. According to Osler two forms of congestion occur, which may be seen in adjacent fingers, one of which may be swollen, intensely red, and extremely hot; the other swollen, cyanotic, and intensely cold. Sometimes all four extremities are involved, as in Southey's case, in a girl of two and a half in whom the process began on the calves, after a slight feverish attack, and then numerous patches rapidly becoming gangrenous appeared on the backs of the legs, thighs, buttocks, and upper arms, worse where there was pressure; the child died thirty-two hours after the onset. The whole phenomenon may be unilateral, as in Smith's case, quoted by Crocker,--in a girl of three years in whom the left hand was cold and livid, while on the right there was lividity, progressing to gangrene of the fingers and of the thumb up to the first knuckles, where complete separation occurred. A considerable number of cases of apparently spontaneous gangrene of the skin have been recorded in medical literature as occurring generally in hysteric young women. Crocker remarks that they are generally classified as erythema gangraenosum, and are always to be regarded with grave suspicion of being self-induced. Ehrl records an interesting case of this nature with an accompanying illustration. The patient was a girl of eighteen whose face, left breast, anus, legs, and feet became affected every autumn since her sixth year, after an attack of measles. At first the skin became red, then water-blisters formed, the size of a grain of corn, and in three days reaching the size of a hazel-nut; these burst and healed, leaving no scars. The menses appeared at the fifteenth year, lasted eight days, with great loss of blood, but there was no subsequent menstruation, and no vicarious hemorrhage. Afterward the right half of the face became red for three or four weeks, with a disturbance of the sensibility of this part, including the right half of the mucosa of the mouth and the conjunctive of the right eye. At the seventeenth year the patient began to have a left-sided headache and increased sweating of the right half of the body. In 1892 the periodically-appearing skin-affection became worse. Instead of healing, the broken vessels became blackish and healed slowly, leaving ulcers, granulations, and scars, and the gangrenous tendency of the skin increased. Disturbance of the sight shortly intervened, associated with aphonia. The sensibility of the whole body, with the exception of the face, was greatly impaired, and there was true gangrene of the corium. A younger sister of the patient was similarly affected with symptoms of hysteria, hemianesthesia, etc. Neuroses of the skin consist in augmentation of sensibility or hyperesthesia and diminution of sensibility or anesthesia. There are some curious old cases of loss of sensation. Ferdinandus mentions a case of a young man of twenty-four who, after having been seized with insensibility of the whole body with the exception of the head, was cured by purgatives and other remedies. Bartholinus cites the case of a young man who lost the senses of taste and feeling; and also the case of a young girl who could permit the skin of her forehead to be pricked and the skin of her neck to be burned without experiencing any pain. In his "Surgery" Lamothe mentions a case of insensibility of the hands and feet in consequence of a horse-kick in the head without the infliction of any external wound. In the "Memoires de l'Academie des Sciences" for the year 1743, we read an account of a soldier who, after having accidentally lost all sensation in his left arm, continued to go through the whole of the manual exercise with the same facility as ever. It was also known that La Condamine was able to use his hands for many years after they had lost their sensation. Rayer gives a case of paralysis of the skin of the left side of the trunk without any affection of the muscles, in a man of forty-three of apoplectic constitution. The paralysis extended from the left mammary region to the haunch, and from the vertebrae to the linea alba. Throughout this whole extent the skin was insensible and could be pinched or even punctured without the patient being aware that he was even touched. The parts did not present any perceptible alteration in texture or in color. The patient was free from fever and made no complaint except a slight headache. Rayer quotes another case in a man of sixty who had been bitten three years previously by a dog that was not mad. He was greatly frightened by the accident and every time he saw a dog he trembled violently, and on one occasion he suffered a convulsive attack for one and a half hours. The convulsions increased in number and frequency, he lost his memory, and exhibited other signs of incipient dementia. He was admitted to the hospital with two small wounds upon the head, one above the left eyebrow and the other on the scalp, occasioned by a fall on his entrance into the hospital. For several days a great degree of insensibility of the skin of the whole body was observed without any implication of the power of voluntary motion. He was entirely cured in eighteen days. Duhring reports a very rare form of disease of the skin, which may be designated neuroma cutis dolorosum, or painful neuroma of the skin. The patient was a boiler-maker of seventy who had no family history bearing on the disease. Ten years previously a few cutaneous tubercles the size and shape of a split-pea were noticed on the left shoulder, attended with decided itching but not with pain. The latter symptom did not come on until three years later. In the course of a year or two the lesions increased in number, so that in four years the shoulder and arm were thickly studded with them. During the next five years no particular changes occurred either in lesions or in the degree of pain. The region affected simply looked like a solid sheet of variously-sized, closely-packed, confluent tubercles, hard and dense. The tubercles were at all times painful to the touch, and even the contact of air was sufficient to cause great suffering. During the paroxysms, which occurred usually at several short intervals every day, the skin changed color frequently and rapidly, passing through various reddish and violet tints, at times becoming purplish. As a paroxysm came on the man was in the habit of gently pressing and holding the arm closely to his body. At one time he endured the attack in a standing posture, walking the floor, but usually he seated himself very near a hot stove, in a doubled-up, cramped position, utterly unmindful of all surroundings, until the worst pain had ceased. Frequently he was unable to control himself, calling out piteously and vehemently and beseeching that his life be terminated by any means. In desperation he often lay and writhed on the floor in agony. The intense suffering lasted, as a rule, for about a half hour, but he was never without pain of the neuralgic type. He was freer of pain in summer than in winter. Exsection of the brachial plexus was performed, but gave only temporary relief. The man died in his eighty-fourth year of senile debility. According to Osler the tubercula dolorosa or true fascicular neuroma is not always made up of nerve-fibers, but, as shown by Hoggan, may be an adenomatous growth of the sweat-glands. Yaws may be defined as an endemic, specific, and contagious disease, characterized by raspberry-like nodules with or without constitutional disturbance. Its synonym, frambesia, is from the French, framboise, a raspberry. Yaws is derived from a Carib word, the meaning of which is doubtful. It is a disease confined chiefly to tropical climates, and is found on the west coast of Africa for about ten degrees on each side of the equator, and also on the east coast in the central regions, but rarely in the north. It is also found in Madagascar, Mozambique, Ceylon, Hindoostan, and nearly all the tropical islands of the world. Crocker believes it probable that the button-scurvy of Ireland, now extinct, but described by various writers of 1823 to 1857 as a contagious disease which was prevalent in the south and in the interior of the island, was closely allied to yaws, if not identical with it. The first mention of the yaws disease is by Oviedo, in 1535, who met with it in San Domingo. Although Sauvages at the end of the last century was the first to give an accurate description of this disease, many physicians had observed it before. Frambesia or yaws was observed in Brazil as early as 1643, and in America later by Lebat in 1722. In the last century Winterbottom and Hume describe yaws in Africa, Hume calling it the African distemper. In 1769 in an essay on the "Natural History of Guiana," Bancroft mentions yaws; and Thomson speaks of it in Jamaica. Hillary in 1759 describes yaws in Barbadoes; and Bajou in Domingo and Cayenne in 1777, Dazille having already observed it in San Domingo in 1742. Crocker takes his account of yaws from Numa Rat of the Leeward Islands, who divides the case into four stages: incubation, primary, secondary, and tertiary. The incubation stage is taken from the date of infection to the first appearance of the local lesion at the sight of inoculation. It varies from three to ten weeks. The symptoms are vague, possibly palpitation, vertigo, edema of the limbs and eyelids. The primary stage begins with the initial lesion, which consists of a papule which may be found most anywhere on the body. This papule ulcerates. The secondary stage commences about a fortnight after the papule has healed. There is intermittent fever, headache, backache, and shooting pains in the limbs and intercostal spaces, like those of dengue, with nocturnal exacerbations. An eruption of minute red spots appears first on the face, and gradually extends so that the whole body is covered at the end of three days. By the seventh day the apex of the papule is of a pale yellow color, and the black skin has the appearance of being dotted over with yellow wax. The papule then develops into nodules of cylindric shape, with a dome-shaped, thick, yellow crust. It is only with the crust off that there is any resemblance to a raspberry. During the month following the raspberry appearance the skin is covered with scabs which, falling off, leave a pale macula; in dark races the macula becomes darker than normal, but in pale races it becomes paler than the natural skin, and in neither case is it scarcely ever obliterated. Intense itching is almost always present, and anemia is also a constant symptom. The disease is essentially contagious and occurs at all ages and among all sexes, to a lesser degree in whites and hybrids, and is never congenital. It seems to have a tendency to undergo spontaneous recovery. Furunculus orientalis, or its synonyms, Oriental boil, Aleppo boil, Delhi boil, Biskra button, etc., is a local disease occurring chiefly on the face and other uncovered spots, endemic in limited districts in hot climates, characterized by the formation of a papule, a nodule, and a scab, and beneath the last a sharply punched-out ulcer. Its different names indicate the districts in which it is common, nearly always in tropical or subtropical climates. It differs from yaws in the absence of febrile symptoms, in its unity, its occurrence often on the feet and the backs of the hands, its duration, and the deep scar which it leaves. A fatal issue is rare, but disfiguring and disabling cicatrices may be left unless great care is employed. Pigmentary Processes.--Friction, pressure, or scratching, if long continued, may produce extensive and permanent pigmentation. This is seen in its highest degree in itching diseases like prurigo and pityriasis. Greenhow has published instances of this kind under the name of "vagabond's disease," a disease simulating morbus addisonii, and particularly found in tramps and vagrants. In aged people this condition is the pityriasis nigra of Willan. According to Crocker in two cases reported by Thibierge, the oral mucous membrane was also stained. Carrington and Crocker both record cases of permanent pigmentation following exposure to great cold. Gautier is accredited with recording in 1890 the case of a boy of six in whom pigmented patches from sepia to almost black began to form at the age of two, and were distributed all over the body. Precocious maturity of the genital organs preceded and accompanied the pigmentation, but the hair was illy developed. Chloasma uterinum presents some interesting anomalies. Swayne records a singular variety in a woman in whom, during the last three months of three successive pregnancies, the face, arms, hands, and legs were spotted like a leopard, and remained so until after her confinement. Crocker speaks of a lady of thirty whose skin during each pregnancy became at first bronze, as if it had been exposed to a tropical sun, and then in spots almost black. Kaposi knew a woman with a pigmented mole two inches square on the side of the neck, which became quite black at each pregnancy, and which was the first recognizable sign of her condition. It is quite possible that the black disease of the Garo Hills in Assam is due to extreme and acute development of a pernicious form of malaria. In chronic malaria the skin may be yellowish, from a chestnut-brown to a black color, after long exposure to the influence of the fever. Various fungi, such as tinea versicolor and the Mexican "Caraati," may produce discoloration on the skin. Acanthosis Nigricans may be defined as a general pigmentation with papillary mole-like growths. In the "International Atlas of Rare Skin Diseases" there are two cases pictured, one by Politzer in a woman of sixty-two, and the other by Janovsky in a man of forty-two. The regions affected were mostly of a dirty-brown color, but in patches of a bluish-gray. The disease began suddenly in the woman, but gradually in the man. Crocker has reported a case somewhat similar to these two, under the head of general bronzing without constitutional symptoms, in a Swedish sailor of twenty-two, with rapid onset of pigmentation. Xeroderma pigmentosum, first described by Kaposi in 1870, is a very rare disease, but owing to its striking peculiarities is easily recognized. Crocker saw the first three cases in England, and describes one as a type. The patient was a girl of twelve, whose general health and nutrition were good. The disease began when she was between twelve and eighteen months old, without any premonitory symptom. The disease occupied the parts habitually uncovered in childhood. The whole of these areas was more or less densely speckled with pigmented, freckle-like spots, varying in tint from a light, raw umber to a deep sepia, and in size from a pin's head to a bean, and of a roundish and irregular shape. Interspersed among the pigment-spots, but not so numerous, were white atrophic spots, which in some parts coalesced, forming white, shining, cicatrix-like areas. The skin upon this was finely wrinkled, and either smooth or shiny, or covered with thin, white scales. On these white areas bright red spots were conspicuous, due to telangiectasis, and there were also some stellate vascular spots and strife interspersed among the pigment. Small warts were seen springing up from some of the pigment spots. These warts ulcerated and gave rise to numerous superficial ulcerations, covered with yellow crusts, irregularly scattered over the face, mostly on the right side. The pus coming from these ulcers was apparently innocuous. The patient complained neither of itching nor of pain. Archambault has collected 60 cases, and gives a good resume to date. Amiscis reports two cases of brothers, in one of whom the disease began at eight months, and in the other at a year, and concludes that it is not a lesion due to external stimuli or known parasitic elements, but must be regarded as a specific, congenital dystrophy of the skin, of unknown pathogenesis. However, observations have shown that it may occur at forty-three years (Riehl), and sixty-four years (Kaposi). Crocker believes that the disease is an atrophic degeneration of the skin, dependent on a primary neurosis, to which there is a congenital predisposition. Nigrities is a name given by the older writers to certain black blotches occurring on the skin of a white person--in other words, it is a synonym of melasma. According to Rayer it is not uncommon to see the scrotum and the skin of the penis of adults almost black, so as to form a marked contrast with the pubes and the upper part of the thighs. Haller met with a woman in whom the skin of the pubic region was as black as that of a negress. During nursing the nipples assume a deep black color which disappears after weaning. Le Cat speaks of a woman of thirty years, whose forehead assumed a dusky hue of the color of iron rust when she was pregnant about the seventh month. By degrees the whole face became black except the eyes and the edges of the lips, which retained their natural color. On some days this hue was deeper than on others; the woman being naturally of a very fair complexion had the appearance of an alabaster figure with a black marble head. Her hair, which was naturally exceedingly dark, appeared coarser and blacker. She did not suffer from headache, and her appetite was good. After becoming black, the face was very tender to the touch. The black color disappeared two days after her accouchement, and following a profuse perspiration by which the sheets were stained black. Her child was of a natural color. In the following pregnancy, and even in the third, the same phenomenon reappeared in the course of the seventh month; in the eighth month it disappeared, but in the ninth month this woman became the subject of convulsions, of which she had one each day. The existence of accidental nigrities rests on well-established facts which are distinctly different from the pigmentation of purpura, icterus, or that produced by metallic salts. Chomel quotes the case of a very apathic old soldier, whose skin, without any appreciable cause, became as brown as that of a negro in some parts, and a yellowish-brown in others. Rustin has published the case of a woman of seventy who became as black as a negress in a single night. Goodwin relates the case of an old maiden lady whose complexion up to the age of twenty-one was of ordinary whiteness, but then became as black as that of an African. Wells and Rayer have also published accounts of cases of accidental nigrities. One of the latter cases was a sailor of sixty-three who suffered from general nigrities, and the other was in a woman of thirty, appearing after weaning and amenorrhea. Mitchell Bruce has described an anomalous discoloration of the skin and mucous membranes resembling that produced by silver or cyanosis. The patient, a harness-maker of forty-seven, was affected generally over the body, but particularly in the face, hands, and feet. The conjunctival, nasal, and aural mucosa were all involved. The skin felt warm, and pressure did not influence the discoloration. The pains complained of were of an intermittent, burning, shooting character, chiefly in the epigastric and left lumbar regions. The general health was good, and motion and sensation were normal. Nothing abnormal was discovered in connection with the abdominal and thoracic examinations. The pains and discoloration had commenced two years before his admission, since which time the skin had been deepening in tint. He remained under observation for three months without obvious change in his symptoms. There was nothing in the patient's occupation to account for the discoloration. A year and a half previously he had taken medicine for his pains, but its nature could not be discovered. He had had syphilis. Galtier mentions congenital and bronze spots of the skin. A man born in Switzerland the latter part of the last century, calling himself Joseph Galart, attracted the attention of the curious by exhibiting himself under the name of the "Living Angel." He presented the following appearance: The skin of the whole posterior part of the trunk, from the nape of the neck to the loins, was of a bronze color. This color extended over the shoulders and the sides of the neck, and this part was covered with hairs of great fineness and growing very thick; the skin of the rest of the body was of the usual whiteness. Those parts were the darkest which were the most covered with hair; on the back there was a space of an inch in diameter, which had preserved its whiteness, and where the hairs were fewer in number, darker at their bases, and surrounded by a very small black circle; the hair was thinner at the sides of the neck; there were a great many individual hairs surrounded by circles of coloring matter; but there were also many which presented nothing of this colored areola. In some places the general dark color of the skin blended with the areola surrounding the roots of the hair, so that one uniform black surface resulted. In many places the dark color changed into black. The irides were brown. The man was of very unstable character, extremely undecided in all his undertakings, and had a lively but silly expression of countenance. A distinct smell, as of mice, with a mixture of a garlicky odor, was emitted from those parts where the excessive secretion of the coloring matter took place. In those places the heat was also greater than natural. Rayer recites the case of a young man whom he saw, whose eyelids and adjacent parts of the cheeks were of a bluish tint, similar to that which is produced on the skin by the explosion of gunpowder. Billard has published an extraordinary case of blue discoloration of the skin in a young laundress of sixteen. Her neck, face, and upper part of the chest showed a beautiful blue tint, principally spreading over the forehead, the alae, and the mouth. When these parts were rubbed with a white towel the blue parts of the skin were detached on the towel, coloring it, and leaving the skin white. The girl's lips were red, the pulse was regular and natural, and her strength and appetite like that of a person in health. The only morbid symptom was a dry cough, but without mucous rattle or any deficiency of the sound of the chest or alteration of the natural beat of the heart. The catamenia had never failed. She had been engaged as a laundress for the past two years. From the time she began this occupation she perceived a blueness around her eyes, which disappeared however on going into the air. The phenomenon reappeared more particularly when irons were heated by a bright charcoal fire, or when she worked in a hot and confined place. The blueness spread, and her breast and abdomen became shaded with an azure blue, which appeared deeper or paler as the circulation was accelerated or retarded. When the patient's face should have blushed, the face became blue instead of red. The changes exhibited were like the sudden transition of shades presented by the chameleon. The posterior part of the trunk, the axillae, the sclerotic coats of the eyes, the nails, and the skin of the head remained in their natural state and preserved their natural color. The linen of the patient was stained blue. Chemical analysis seemed to throw no light on this case, and the patient improved on alkaline treatment. She vomited blood, which contained sufficient of the blue matter to stain the sides of the vessel. She also stated that in hemorrhage from the nose she had seen blue drops among the drops of blood. One cannot but suspect indigo as a factor in the causation of this anomalous coloration. Artificial discolorations of the skin are generally produced by tattooing, by silver nitrate, mercury, bismuth, or some other metallic salt. Melasma has been designated as an accidental and temporary blackish discoloration of the skin. There are several varieties: that called Addison's disease, that due to uterine disease, etc. In this affection the skin assumes a dark and even black hue. Leukoderma is a pathologic process, the result of which is a deficiency in the normal pigmentation of the skin, and possibly its appendages. Its synonyms are leukopathia, vitiligo, achroma, leukasmus, and chloasma album. In India the disease is called sufaid-korh, meaning white leprosy. It has numerous colloquial appellations, such as chumba or phoolyree (Hindoo), buras (Urdu), cabbore (Singalese), kuttam (Taneil), dhabul (Bengal). It differs from albinism in being an acquired deficiency of pigment, not universal and not affecting the eye. Albinism is congenital, and the hair and eyes are affected as well as the skin. The disease is of universal distribution, but is naturally more noticeable in the dark-skinned races. It is much more common in this country among the negroes than is generally supposed. The "leopard-boy of Africa," so extensively advertised by dime museums over the country, was a well-defined case of leukoderma in a young mulatto, a fitting parallel for the case of ichthyosis styled the "alligator-boy." Figure 293 represents a family of three children, all the subjects of leukoderma. Leukoderma is more common among females. It is rarely seen in children, being particularly a disease of middle age. Bissell reports a case in an Indian ninety years of age, subsequent to an attack of rheumatism thirty years previous. It is of varying duration, nearly every case giving a different length of time. It may be associated with most any disease, and is directly attributable to none. In a number of cases collected rheumatism has been a marked feature. It has been noticed following typhoid fever and pregnancy. In white persons there are spots or blotches of pale, lustreless appearance either irregular or symmetric, scattered over the body. In the negro and other dark-skinned races a mottled appearance is seen. If the process goes to completion, the whole surface changes to white. The hair, though rarely affected, may present a mottled appearance. There seems to be no constitutional disturbances, no radical change in the skin, no pain--in fact, no disturbance worthy of note. The eye is not affected; but in a negro the sclerotic generally appears muddy. It appears first in small spots, either on the lips, nose, eyelids, soles, palms, or forehead, and increases peripherally--the several spots fusing together. The skin is peculiarly thin and easily irritated. Exposure to the sun readily blisters it, and after the slightest abrasion it bleeds freely. Several cases have been reported in which the specific gravity of the urine was extremely high, due to an excess of urea. Wood calls attention to the wave-like course of leukoderma, receding on one side, increasing on the other. The fading is gradual, and the margins may be abrupt or diffuse. The mucous membranes are rosy. The functions of the swell-glands are unimpaired. The theory of the absence of pigment causing a loss of the olfactory sense, spoken of by Wallace, is not borne out by several observations of Wood and others. Wilson says: "Leukasma is a neurosis, the result of weakened innervation of the skin, the cause being commonly referable to the organs of assimilation or reproduction." It is not a dermatitis, as a dermatitis usually causes deposition of pigment. The rays of the sun bronze the skin; mustard, cantharides, and many like irritants cause a dermatitis, which is accompanied by a deposition of pigment. Leukoderma is as common in housemaids as in field-laborers, and is in no way attributable to exposure of sun or wind. True leukodermic patches show no vascular changes, no infiltration, but a partial obliteration of the rete mucosum. It has been ascribed to syphilis; but syphilitic leukoderma is generally the result of cicatrices following syphilitic ulceration. Many observers have noticed that negroes become several degrees lighter after syphilization; but no definite relation between syphilis and leukoderma has yet been demonstrated in this race. Postmortem examinations of leukodermic persons show no change in the suprarenal capsule, a supposed organ of pigmentation. Climate has no influence. It is seen in the Indians of the Isthmus of Darien, the Hottentots, and the Icelanders. Why the cells of the rete mucosum should have the function in some races of manufacturing or attracting pigment in excess of those of other races, is in itself a mystery. By his experiments on the pigment-cells of a frog Lister has established the relation existing between these elements and innervation, which formerly had been supposititious. Doubtless a solution of the central control of pigmentation would confirm the best theory of the cause of leukoderma--i.e., faulty innervation of the skin. At present, whether the fault is in the cell proper, the conducting media, or the central center, we are unable to say. It is certainly not due to any vascular disturbances, as the skin shows no vascular changes. White spots on the nails are quite common, especially on young people. The mechanic cause is the presence of air between the lamellae of the affected parts, but their origin is unknown. According to Crocker in some cases they can be shown to be a part of trophic changes. Bielschowsky records the case of a man with peripheral neuritis, in whom white spots appeared at the lower part of the finger-nails, grew rapidly, and in three weeks coalesced into a band across each nail a millimeter wide. The toes were not affected. Shoemaker mentions a patient who suffered from relapsing fever and bore an additional band for each relapse. Crocker quotes a case reported by Morison of Baltimore, in which transverse bars of white, alternating with the normal color, appeared without ascertainable cause on the finger-nails of a young lady and remained unchanged. Giovannini describes a case of canities unguium in a patient of twenty-nine, following an attack of typhoid fever. On examining the hands of this patient the nails showed in their entire extent a white, opaque, almost ivory color. An abnormal quantity of air found in the interior of the nails explains in this particular case their impaired appearance. It is certain that the nails, in order to have admitted such a large quantity of air into their interior must have altered in their intimate structure; and Giovannini suggests that they were subject to an abnormal process of keratinization. Unna describes a similar case, which, however, he calls leukonychia. Plica polonica, or, as it was known in Cracow--weicselzopf, is a disease peculiar to Poland, or to those of Polish antecedents, characterized by the agglutination, tangling, and anomalous development of the hair, or by an alteration of the nails, which become spongy and blackish. In older days the disease was well known and occupied a prominent place in books on skin-diseases. Hercules de Saxonia and Thomas Minadous, in 1610, speak of plica as a disease already long known. The greater number of writers fix the date of its appearance in Poland at about the year 1285, under the reign of Lezekle-Noir. Lafontaine stated that in the provinces of Cracow and Sandomir plica formerly attacked the peasantry, beggars, and Jews in the proportion of 1 1/2 in 20; and the nobility and burghers in the proportion of two in 30 or 40. In Warsaw and surrounding districts the disease attacked the first classes in the proportion of one to ten, and in the second classes one to 30. In Lithuania the same proportions were observed as in Warsaw; but the disease has gradually grown rarer and rarer to the present day, although occasional cases are seen even in the United States. Plica has always been more frequent on the banks of the Vistula and Borysthenes, in damp and marshy situations, than in other parts of Poland. The custom formerly prevailing in Poland of shaving the heads of children, neglect of cleanliness, the heat of the head-dress, and the exposure of the skin to cold seem to favor the production of this disease. Plica began after an attack of acute fever, with pains like those of acute rheumatism in the head and extremities, and possibly vertigo, tinnitus aurium, ophthalmia, or coryza. Sometimes a kind of redness was observed on the thighs, and there was an alteration of the nails, which became black and rough, and again, there was clammy sweat. When the scalp was affected the head was sore to the touch and excessively itchy. A clammy and agglutinating sweat then occurred over the cranium, the hair became unctuous, stuck together, and appeared distended with an adhesive matter of reddish-brown color, believed by many observers to be sanguineous. The hair was so acutely sensitive that the slightest touch occasioned severe pain at the roots. A viscid matter of a very offensive smell, like that of spoiled vinegar, or according to Rayer like that of mice or garlic, exuded from the whole surface of each affected hair. This matter glued the hairs together, at first from their exit at the skin, and then along the entire length; it appeared to be secreted from the whole surface of the scalp and afterward dried into an incrustation. If there was no exudation the disease was called plica sicca. The hair was matted and stuck together in a variety of ways, so as to resemble ropes (plica multiformis). Sometimes these masses united together and formed one single thick club like the tail of a horse (plica caudiformis). Again, and particularly in females, the hair would become matted and glued together into one uniform intricate mass of various magnitudes. The hair of the whole body was likely to be attacked with this disease. Kalschmidt of Jena possessed the pubes of a woman dead of plica, the hair of which was of such length that it must have easily gone around the body. There was formerly a superstition that it was dangerous to cut the hair until the discharge diminished. Lafontaine, Schlegel, and Hartman all assure us that the section of the affected masses before this time has been known to be followed by amaurosis, convulsions, apoplexy, epilepsy, and even death. Alarmed or taught by such occurrences, the common people often went about all their lives with the plica gradually dropping off. Formerly there was much theorizing and discussion regarding the etiology and pathology of plica, but since this mysterious affection has been proved to be nothing more than the product of neglect, and the matting due to the inflammatory exudation, excited by innumerable pediculi, agglutinating the hair together, the term is now scarcely mentioned in dermatologic works. Crocker speaks of a rare form which he entitles neuropathic plica, and cites two cases, one reported by Le Page whose specimen is in the Royal College of Surgeons Museum; and the other was in a Hindoo described by Pestonji. Both occurred in young women, and in both it came on after washing the hair in warm water, one in a few minutes, and the other in a few hours. The hair was drawn up into a hard tangled lump, impossible to unravel, limited to the right side in Le Page's patient, who had very long hair, and in Pestonji's case to the back of the head, where on each side was an elongated mass, very hard and firm, like a rope and about the size of the fist. There was no reason to believe that it was ascribable to imposture; the Hindoo woman cut the lumps off herself and threw them away. Le Page found the most contracted hairs flattened. Stellwagon reports a case of plica in a woman. It occupied a dollar-sized area above the nape of the neck, and in twelve years reached the length of 12 feet. There was no history of its manner of onset. Tinea nodosa is a name given by Morris and Cheadle to a case of nodular growth on the beard and whiskers of a young man. In a case noticed by Crocker this disease affected the left side of the mustache of a medical man, who complained that the hair, if twisted up, stuck together. When disintegrated the secretion in this case seemed to be composed of fungous spores. Epithelium fragments, probably portions of the internal root-sheath, sometimes adhere to the shaft of the hair as it grows up, and look like concretions. Crocker states that he is informed by White of Boston that this disease is common in America in association with alopecia furfuracea, and is erroneously thought to be the cause of the loss of hair, hence the popular name, "hair-eaters." Thomson describes a case of mycosis fungoides in a young girl of the age of fourteen, whom he saw in Brussels toward the end of October, 1893. She was the third of a family of 13 children of whom only five survived. Of the children born subsequently to the patient, the first were either premature or died a few days after their births. The seventh was under treatment for interstitial keratitis and tuberculous ulceration of the lips and throat. The disease in the patient made its appearance about seven months previously, as a small raised spot in the middle of the back just above the buttocks. Many of the patches coalesced. At the time of report the lumbar region was the seat of the disease, the affection here presenting a most peculiar appearance, looking as if an enormous butterfly had alighted on the patient's back, with its dark blue wings covered with silvery scales, widely expanded. The patient was not anemic and appeared to be in the best of health. None of the glands were affected. According to Thomson there is little doubt that this disease is caused by non-pyogenic bacteria gaining access to the sweat-glands. The irritation produced by their presence gives rise to proliferation of the connective-tissue corpuscles. Jamieson reports a case of mycosis in a native of Aberdeenshire aged thirty-eight. There was no history of any previous illness. The disease began three years previous to his application for treatment, as a red, itching, small spot on the cheek. Two years later lumps presented themselves, at first upon his shoulders. The first thing to strike an observer was the offensive odor about the patient. In the hospital wards it made all the occupants sick. The various stages of the disease were marked upon the different parts of the body. On the chest and abdomen it resembled an eczema, on the shoulders there were brown, pinkish-red areas. On the scalp the hair was scanty, the eye-brows denuded, and the eyelashes absent. The forehead was leonine in aspect. From between the various nodosities a continual discharge exuded, the nodosities being markedly irregular over the limbs. The backs of the hands, the dorsums of the feet, the wrists and ankles, had closely approximating growths upon them, while under the thick epidermis of the palms of the hands were blisters. Itching was intense. The patient became emaciated and died thirteen days after his admission into the hospital. A histologic examination showed the sarcomatous nature of the various growths. The disease differed from "button-scurvy." Mycosis fungoides approximates, clinically and histologically, granulomata and sarcomata. Morris described an interesting case of universal dermatitis, probably a rare variety of mycosis fungoides. The patient had for many years a disease which had first appeared on the arms and legs, and which was usually regarded by the physicians who saw the case as eczema. At times the disease would entirely disappear, but it relapsed, especially during visits to India. At the time the patient came under the care of Morris, his general health seemed unaffected. The skin of the whole body, except the face, the scalp, and the front of the chest, was of a mahogany color. The skin of the lips was so thickened that it could not be pinched into folds, and was of a mottled appearance, due to hemorrhagic spots. All over the thickened and reddened surface were scattered crops of vesicles and boils. The nails were deformed, and the toes beyond the nails were tense with a serous accumulation. The glands in the right axilla and the groin were much enlarged. The hair on the pubes had disappeared. The abdomen was in a condition similar to that upon the limbs, but less in degree. The front of the chest below the nipples was covered with dark papules the size of a pin's head. The back, the buttocks, the face, and the scalp presented similar lesions. The most striking lesions were three ulcers--one on the back of the right hand, one on the right temple, and the other on the left cheek. The largest was the size of a florin, and had elevated borders, somewhat infiltrated; they were covered with a brown, dry scab. The patient suffered from itching at night so that he could not sleep. He was kept under observation, and in spite of treatment the malady advanced in a periodic manner, each exacerbation being preceded by a feeling of tension in the parts, after which a crop of vesicles would appear. Sometimes, especially on the feet, bullae formed. The patient finally left the hospital and died of an intercurrent attack of pneumonia. A microscopic examination revealed a condition which might be found with a number of the chronic affections of the skin, but, in addition, there were certain cell-inclusions which were thought to represent psorosperms. Morris thought this case corresponded more to mycosis fungoides than any other malady. CHAPTER XVII. ANOMALOUS NERVOUS AND MENTAL DISEASES. Epilepsy has been professionally recognized as a distinct type of disease since the time of Hippocrates, but in earlier times, and popularly throughout later times, it was illy defined. The knowledge of the clinical symptoms has become definite only since the era of cerebral local anatomy and localization. Examination of the older records of epilepsy shows curious forms recorded. The Ephemerides speaks of epilepsy manifested only on the birthday. Testa mentions epilepsy recurring at the festival of St. John, and Bartholinus reports a case in which the convulsions corresponded with the moon's phases. Paullini describes epilepsy which occurred during the blowing of wind from the south, and also speaks of epilepsy during the paroxysms of which the individual barked. Fabricius and the Ephemerides record dancing epilepsy. Bartholinus and Hagendorn mention cases during which various splendors appeared before the eyes during the paroxysm. Godart Portius, and Salmuth speak of visions occurring before and after epileptic paroxysms. The Ephemerides contains records of epilepsy in which blindness preceded the paroxysm, in which there was singing during it, and a case in which the paroxysm was attended with singultus. Various older writers mention cases of epilepsy in which curious spots appeared on the face; and the kinds of aura mentioned are too numerous to transcribe. Baly mentions a case of epilepsy occasioned by irritation in the socket of a tooth. Webber reports a case of epilepsy due to phimosis and to irritation from a tooth. Beardsley speaks of an attempt at strangulation that produced epilepsy. Brown-Sequard records an instance produced by injury to the sciatic nerve. Doyle gives an account of the production of epilepsy from protracted bathing in a pond. Duncan cites an instance of epilepsy connected with vesical calculus that was cured by lithotomy. Museroft mentions an analogous case. Greenhow speaks of epilepsy arising from an injury to the thumb. Garmannus, early in the eighteenth century, describes epilepsy arising from fright and terror. Bristowe in 1880, and Farre speak of similar instances. In Farre's case the disease was temporarily cured by an attack of acute rheumatism. Thorington of Philadelphia has seen a paroxysm of epilepsy induced by the instillation of atropia in the eye of a child nearly cured of the malady. It was supposed that the child was terrified on awakening and finding its vision suddenly diminished, and that the convulsions were directly due to the emotional disturbance. Orwin describes epilepsy from prolonged lactation, and instances of ovarian and uterine epilepsy are quite common. There is a peculiar case of running epilepsy recorded. The patient was a workman who would be suddenly seized with a paroxysm, and unconsciously run some distance at full speed. On one occasion he ran from Peterborough to Whittlesey, where he was stopped and brought back. Once he ran into a pit containing six feet of water, from which he was rescued. Yeo says that sexual intercourse occasionally induces epilepsy, and relates a case in which a severe epileptic fit terminated fatally three days after the seizure, which occurred on the nuptial night. Drake reports the case of a man who was wounded in the War of 1812, near Baltimore, the ball passing along the left ear and temple so close as to graze the skin. Eighteen years after the accident he suffered with pain in the left ear and temple, accompanied by epileptic fits and partial amnesia, together with an entire loss of power of remembering proper names and applying them to the objects to which they belonged. He would, for instance, invariably write Kentucky for Louisville. Beirne records the case of a dangerous lunatic, an epileptic, who was attacked by a fellow-inmate and sustained an extensive fracture of the right parietal bone, with great hemorrhage, followed by coma. Strange to say, after the accident he recovered his intellect, and was cured of his epileptic attacks, but for six years he was a paralytic from the hips down. The Dancing Mania.--Chorea has appeared in various epidemic forms under the names of St. Vitus's dance, St. Guy's dance, St. Anthony's dance, choromania, tanzplage, orchestromania, dance of St. Modesti or St. John, the dancing mania, etc.; although these various functional phenomena of the nervous system have been called chorea, they bear very little resemblance to what, at the present day, is called by this name. The epidemic form appeared about 1374, although Hecker claims that, at that time, it was no new thing. Assemblages of men and women were seen at Aix-la-Chapelle who, impelled by a common delusion, would form circles, hand in hand, and dance in wild delirium until they fell to the ground exhausted, somewhat after the manner of the Ghost-Dance or Messiah-Dance of our North American Indians. In their Bacchantic leaps they were apparently haunted by visions and hallucinations, the fancy conjuring up spirits whose names they shrieked out. Some of them afterward stated that they appeared to be immersed in a stream of blood which obliged them to leap so high. Others saw the heavens open and disclose the Saviour enthroned with the Virgin Mary. The participants seemed to suffer greatly from tympanites which was generally relieved by compression or thumping on the abdomen. A few months after this dancing malady had made its appearance at Aix-la-Chapelle it broke out at Cologne, and about the same time at Metz, the streets of which were said to have been filled with 1100 dancers. This rich city became the scene of the most ruinous disorder. Peasants left their plows, mechanics their shops, servants their masters, children their homes; and beggars and idle vagabonds, who understood how to imitate the convulsions, roved from place to place, inducing all sorts of crime and vice among the afflicted. Strasburg was visited by the dancing plague in 1418, and it was here that the plague assumed the name of St. Vitus's dance. St. Vitus was a Sicilian youth who, just at the time he was about to undergo martyrdom by order of Diocletian, in the year 303, is said to have prayed to God that He might protect all those who would solemnize the day of his commemoration and fast upon its eve. The people were taught that a voice from heaven was then heard saying, "Vitus, thy prayer is accepted." Paracelsus called this malady (Chorus sancti viti) the lascivious dance, and says that persons stricken with it were helpless until relieved by either recovery or death. The malady spread rapidly through France and Holland, and before the close of the century was introduced into England. In his "Anatomy of Melancholy" Burton refers to it, and speaks of the idiosyncrasies of the individuals afflicted. It is said they could not abide one in red clothes, and that they loved music above all things, and also that the magistrates in Germany hired musicians to give them music, and provided them with sturdy companions to dance with. Their endurance was marvelous. Plater speaks of a woman in Basle whom he saw, that danced for a month. In Strasburg many of them ate nothing for days and nights until their mania subsided. Paracelsus, in the beginning of the sixteenth century, was the first to make a study of this disease. He outlined the severest treatment for it, and boasted that he cured many of the victims. Hecker conjectures that probably the wild revels of St. John's day, 1374, gave rise to this mental plague, which thenceforth visited so many thousands with incurable aberrations of mind and disgusting distortions of the body. Almost simultaneous with the dance of "St. With," there appeared in Italy and Arabia a mania very similar in character which was called "tarantism," which was supposed to originate in the bite of the tarantula. The only effective remedy was music in some form. In the Tigre country, Abyssinia, this disease appeared under the name of "Tigretier." The disease, fortunately, rapidly declined, and very little of it seems to have been known in the sixteenth century, but in the early part of the eighteenth century a peculiar sect called the "Convulsionnaires" arose in France; and throughout England among the Methodist sect, insane convulsions of this nature were witnessed; and even to the present day in some of the primitive religious meetings of our people, something not unlike this mania of the Middle Ages is perpetuated. Paracelsus divided the sufferers of St. Vitus's dance into three classes .-- (1) Those in which the affliction arose from imagination (chorea imaginativa). (2) Those which had their origin in sexual desires depending on the will. (3) Those arising from corporeal causes (chorea naturalis). This last case, according to a strange notion of his own he explained by maintaining that in certain vessels which are susceptible of an internal pruriency, and thence produced laughter, the blood is set into commotion in consequence of an alteration in the vital spirits, whereby are occasioned involuntary fits of intoxicating joy, and a propensity to dance. The great physician Sydenham gave the first accurate description of what is to-day called chorea, and hence the disease has been named "Sydenham's chorea." So true to life was his portrayal of the disease that it has never been surpassed by modern observers. The disease variously named palmus, the jumpers, the twitchers, lata, miryachit, or, as it is sometimes called, the emeryaki of Siberia, and the tic-convulsif of La Tourette, has been very well described by Gray who says that the French authors had their attention directed to the subject by the descriptions of two American authors--those of Beard upon "The Jumpers of Maine," published in 1880, and that of Hammond upon "Miryachit," a similar disease of the far Orient. Beard found that the jumpers of Maine did unhesitatingly whatever they were told to do. Thus, one who was sitting in a chair was told to throw a knife that he had in his hand, and he obeyed so quickly that the weapon stuck in a house opposite; at the same time he repeated the command given him, with a cry of alarm not unlike that of hysteria or epilepsy. When he was suddenly clapped upon the shoulder he threw away his pipe, which he had been filling with tobacco. The first parts of Virgil's aeneid and Homer's Iliad were recited to one of these illiterate jumpers, and he repeated the words as they came to him in a sharp voice, at the same time jumping or throwing whatever he had in his hand, or raising his shoulder, or making some other violent motion. It is related by O'Brien, an Irishman serving on an English naval vessel, that an elderly and respectable Malay woman, with whom he was conversing in an entirely unsuspecting manner, suddenly began to undress herself, and showed a most ominous and determined intention of stripping herself completely, and all because a by-standing friend had suddenly taken off his coat; at the same time she manifested the most violent anger at what she deemed this outrage to her sex, calling the astonished friend an abandoned hog, and begging O'Brien to kill him. O'Brien, furthermore, tells of a cook who was carrying his child in his arms over the bridge of a river, while at the same time a sailor carried a log of wood in like manner; the sailor threw his log of wood on an awning, amusing himself by causing it to roll over the cloth, and finally letting it fall to the bridge; the cook repeated every motion with his little boy, and killed him on the spot. This miryachit was observed in Malaysia, Bengal, among the Sikhs and the Nubians, and in Siberia, whilst Beard has observed it in Michigan as well as in Maine. Crichton speaks of a leaping ague in Angusshire, Scotland. Gray has seen only one case of acute palmus, and records it as follows: "It was in a boy of six, whose heredity, so far as I could ascertain from the statements of his mother, was not neurotic. He had had trouble some six months before coming to me. He had been labeled with a number of interesting diagnoses, such as chorea, epilepsy, myotonia, hysteria, and neurasthenia. His palmodic movements were very curious. When standing near a table looking at something, the chin would suddenly come down with a thump that would leave a black-and-blue mark, or his head would be thrown violently to one side, perhaps coming in contact with some adjacent hard object with equal force, or, while standing quietly, his legs would give a sudden twitch, and he would be thrown violently to the ground, and this even happened several times when he was seated on the edge of a stool. The child was under my care for two weeks, and, probably because of an intercurrent attack of diarrhea, grew steadily worse during that time, in spite of the full doses of arsenic which were administered to him. He was literally covered with bruises from the sudden and violent contacts with articles of furniture, the floor, and the walls. At last, in despair at his condition, I ordered him to be undressed and put to bed, and steadily pushed the Fowler's solution of arsenic until he was taking ten drops three times a day, when, to my great surprise, he began to improve rapidly, and at the end of six weeks was perfectly well. Keeping him under observation for two weeks longer I finally sent him to his home in the West, and am informed that he has since remained perfectly well. It has seemed to me that many of the cases recorded as paramyoclonus multiples have been really acute palmus." Gray mentions two cases of general palmus with pseudomelancholia, and describes them in the following words:-- "The muscular movements are of the usual sudden, shock-like type, and of the same extent as in what I have ventured to call the general form. With them, however, there is associated a curious pseudomelancholia, consisting of certain fixed melancholy suspicious delusions, without, however, any of the suicidal tendencies and abnormal sensations up and down the back of the head, neck, or spine, or the sleeplessness, which are characteristic of most cases of true melancholia. In both of my cases the palmus had existed for a long period, the exact limits of which, however, I could not determine, because the patient scouted the idea that he had had any trouble of the kind, but which the testimony of friends and relatives seemed to vouch for. They were both men, one thirty-six and one thirty-eight years of age. The pseudomelancholia, however, had only existed in one case for about a year, and in the other for six months. One case passed away from my observation, and I know nothing of its further course. The other case recovered in nine months' treatment, and during the three years that have since elapsed he has been an active business man, although I have not seen him myself during that period, as he took a great dislike to me because I was forced to take strong measures to keep him under treatment, so persistent were his suspicions." Athetosis was first described by Hammond in 1871, who gave it the name because it was mainly characterized by an inability to retain the fingers and toes in any position in which they might be planed, as well as by their continuous motion. According to Drewry "athetosis is a cerebral affection, presenting a combination of symptoms characterized chiefly by a more or less constant mobility of the extremities and an inability to retain them in any fixed position. These morbid, grotesque, involuntary movements are slow and wavy, somewhat regular and rigid, are not jerky, spasmodic, nor tremulous. The movements of the digits are quite different from those attending any other disease, impossible to imitate even by the most skilful malingerer, and, if once seen, are not likely to be forgotten. In an athetoid hand, says Starr, the interossei and lumbricales, which flex the metacarpo-phalangeal and extend the phalangeal joints, are affected; rarely are the long extensors and the long flexors affected. Therefore the hand is usually in the so-called interosseal position, with flexion of the proximal and extension of the middle and distal phalanges. The athetoid movements of the toes correspond to those of the fingers in point of action. In a great majority of cases the disease is confined to one side (hemiathetosis), and is a sequel of hemiplegia. The differential diagnosis of athetosis is generally easily made. The only nervous affections with which it could possibly be confounded are chorea and paralysis agitans. Attention to the twitching, spasmodic, fibrillary movements, having a quick beginning and a quick ending, which is characteristic in Sydenham's chorea, would at once exclude that disease. These jerky movements peculiar to St. Vitus's dance may be easily detected in a few or many muscles, if moderate care and patience be exercised on the part of the examiner. This form of chorea is almost always a disease of childhood. So-called post-hemiplegic chorea is, in the opinion of both Hammond and Gray, simply athetosis. The silly, dancing, posturing, wiry movements, and the facial distortion observed in Huntington's chorea would hardly be mistaken by a careful observer for athetosis. The two diseases, however, are somewhat alike. Paralysis agitans (shaking palsy), with its coarse tremor, peculiar facies, immobility, shuffling gait, the 'bread-crumbling' attitude of the fingers, and deliberate speech, would be readily eliminated even by a novice. It is, too, a disease of advanced life, usually. Charcot, Gray, Ringer, Bernhardt, Shaw, Eulenberg, Grassel; Kinnicutt, Sinkler, and others have written on this affection." The following is the report of a case by Drewry, of double (or, more strictly speaking, quadruple) athetosis, associated with epilepsy and insanity: "The patient was a negro woman, twenty-six years old when she was admitted into this, the Central State (Va.) Hospital, in April, 1886. She had had epilepsy of the grand mal type for a number of years, was the mother of one child, and earned her living as a domestic. A careful physical examination revealed nothing of importance as an etiologic factor. Following in the footsteps of many of those unfortunates afflicted with epilepsy, she degenerated into a state of almost absolute imbecility. "Some degree of mental deficiency seems usually to accompany athetosis, even when uncomplicated by any other degenerating neurosis. Athetoid symptoms of an aggravated character, involving both upper and both lower extremities, had developed previous to her admission into this hospital, but it was impossible to find out when and how they began. She had never had, to the knowledge of her friends, an attack of 'apoplexy,' nor of paralysis. The head was symmetric, and without scars thereon. The pedal extremities involuntarily assumed various distorted positions and were constantly in motion. The toes were usually in a state of tonic spasm,--contracted, and drawn downward or extended, pointing upward, and slightly separated. Irregular alternate extension and flexion of the toes were marked. The feet were moved upon the ankles in a stiff and awkward manner. During these 'complex involuntary movements,' the muscles of the calf became hard and rigid. The act of walking was accomplished with considerable difficulty, on account of contractures, and because the feet were not exactly under the control of the will. The unnatural movements of the hands corresponded to those of the lower extremities, though they were more constant and active. The fingers, including the thumbs, were usually widely separated and extended, though they were sometimes slightly flexed. The hands were continually in slow, methodic, quasi-rhythmic motion, never remaining long in the same attitude. In grasping an object the palm of the hand was used, it being difficult to approximate the digits. The wrist-joints were also implicated, there being alternate flexion and extension. In fact these odd contortions affected the entire limb from the shoulder to the digital extremities. When standing or walking the arms were held out horizontally, as if to maintain the equilibrium of the body. The patient's general physical health was fairly good. She frequently complained of headache, and when she was exceedingly irritable and violent all the athetoid movements would be intensified. Speech was jerky and disordered, which gave it a distinctive character. The special senses seemed to be unimpaired, and the pupils were normal, except when an epileptic attack came on. Death occurred in January, 1895, after an obstinate attack of status epilepticus." Paramyoclonus multiplex is a condition of chronic muscular spasm affecting the trunk, occasionally the muscles of the face, abdomen, or diaphragm. The muscles affected are usually in the trunk and in the limbs, and not in the toes and hand; occasionally the movements are tonic as well as clonic; the degree of spasm varies greatly, and according to Gray may sometimes be so violent as to throw the patient down or out of the chair. Saltatoric spasm is an extremely rare condition, first observed by Bamberger in 1859. The calf, hip, knee, and back-muscles are affected by clonic spasm, causing springing or jumping movements when the patient attempts to stand. The disease is transient, and there are no mental symptoms. Progressive muscular atrophy has been observed as far back as Hippocrates, but it is only in recent times that we have had any definite knowledge of the subject. It is divided into four types, the hand type (causing the griffin-or claw-hand, or the ape-hand); the juvenile type (generally in the muscles of the shoulder and arm); the facial type; and the peroneal type. Generalized progressive atrophy leads to a condition that simulates the appearance of a "living skeleton." Facial hemiatrophy is an incurable disease, as yet of unknown pathology. It consists of wasting of the bones, subcutaneous tissues, and muscles of one-half of the face or head, the muscles suffering but slightly. The accompanying illustration shows a case in which there was osseous depression of the cranium and a localized alopecia. The disease is very rare, only about 100 cases having been reported. Of five cases seen by Dana, three were in females and two in males; in all the cases that could be found the origin was between the tenth and twentieth years. It is a chronic affection, usually beginning in early life, increasing slowly for years, and then becoming stationary. It is distinguished from one-sided muscular atrophy by the electric reaction, which is not lost in the facial muscles in facial hemiatrophy, and there is no atrophy of other muscles of the body. Burr contributes an exhaustive paper on hemiatrophy of the tongue with report of a case as follows: "L. B., female, mulatto, thirty-one years old, married, came to the Medico-Chirurgical Hospital, Philadelphia, September 23, 1895, complaining that her 'tongue was crooked.' Save that she had had syphilis, her personal history is negative. In February, 1895, she began to suffer from headache, usually behind the left ear, and often preventing sleep. At times there is quite severe vertigo. Several weeks after the onset, headache persisting, she awoke in the night and found the left side of the tongue swollen, black, and painless. For some hours she could neither speak nor chew, but breathing was not interfered with. After a few days all symptoms passed away except headache, and she thought no more of the matter until recently, as stated above, she noticed by accident that her tongue was deformed. She is a spare, poorly-fed, muddy-skinned mulatto girl. The left half of the tongue is only about one-half as large as the right. The upper surface is irregularly depressed and elevated. There are no scars. When protruded it turns sharply to the left. Fibrillary twitching is not present. The mucous membrane is normal. Common sensation and taste are preserved. The pharyngeal reflex is present. The palate moves well. There is no palsy or wasting of the face. The pupils are of normal size and react well to light and with accommodation. Station and gait are normal. There is no incoordination of movement in the arms or legs. The knee-jerks are much increased. There is an attempt at, but no true, clonus; that is, passive flexion of the foot causes two or three jerky movements. There is no glandular swelling or tumor about the jaw or in the neck. Touch and pain-sense are normal in the face and hands, but she complains of numbness in the hands as if she had on tight gloves. There is no trouble in speaking, chewing, or swallowing. There is no pain or rigidity in the neck muscles. Examination of the pharynx reveals no disease of the bones. Under specific treatment the patient improved." Astasia-abasia was named by Blocq, who collected 11 cases. According to Knapp, four cases have been reported in America. The disease consists in an inability to stand erect or walk normally, although there is no impairment of sensation, of muscular strength, or of the coordination of other muscles in walking than the lower extremities. In attempting to walk the legs become spasmodic; there are rapid flexions and extensions of the legs on the thighs, and of the thighs on the pelvis. The steps are short, and the feet drag; the body may make great oscillations if the patient stands, walks, or sits, and the head and arms make rhythmical movements; walking may become impossible, the patient appearing to leap up on one foot and then up on the other, the body and head oscillating as he advances; he may be able to walk cross-legged, or by raising the legs high; or to walk on his hands and feet; he may be able to walk at certain times and not at others; or to hop with both feet together; he may succeed with great strides and with the arms extended; or finally he may be able to use his legs perfectly if suspended (Gray). There are various types which have been called the paralytic, the choreic, and the saltatory. A tendency to go backward or retropulsion has been observed, according to Gray, as has also a tendency to go forward or propulsion. A curious phenomenon in this disease is that the patient can use the legs perfectly well lying in bed. The prognosis seems to be favorable. Meniere's disease is a disease probably of the semicircular canals, characterized by nausea, vomiting, vertigo, deafness, tinnitus aurium, and various other phenomena. It is also called aural or auditory vertigo. The salient symptom is vertigo, and this varies somewhat in degree according to the portions of the ear affected. If the disease is in the labyrinth, the patient is supposed to stagger to one side, and the vertigo is paroxysmal, varying to such a degree as to cause simple reeling, or falling as if shot. Gray reports the history of a patient with this sensational record: He had been a peasant in Ireland, and one day crossing one of the wide moors in a dog-cart, he was suddenly, as he thought, struck a violent blow from behind, so that he believed that he lost consciousness for some time. At all events, when he was able to get up he found his horse and cart some distance off, and, of course, not a soul in sight. Under the belief that he had been struck by some enemy he went quietly home and said nothing about it. Some time afterward, however, in crossing another lonely place he had a similar experience, and as he came to the conclusion that nobody could have been near him, he made up his mind that it was some malevolent stroke of the devil and he consulted a priest who agreed with him in his belief, and gave him an amulet to wear. A series of similar attacks occurred and puzzled as to whether there was some diabolical agency at work, or whether he was the victim of some conspiracy, he emigrated to America; for several months he had no attacks. A new paroxysm occurring he consulted Gray, who found indubitable evidence of labyrinthine disease. The paroxysms of this disease are usually accompanied by nausea and vomiting, and on account of the paleness of the face, and the cold, clammy perspiration, attacks have frequently been mistaken for apoplexy. In disease of the middle ear the attacks are continuous rather than paroxysmal. If the disease is in the middle or internal ears, loud noises are generally heard, but if the disease is in the external ear, the noises are generally absent, and the vertigo of less degree but continuous. The prognosis varies with the location of the disease, but is always serious. Human rumination has been known for many years. Bartholinus, Paullinus, Blanchard, Bonet, the Ephemerides, Fabricius Hildanus, Horstius, Morgagni, Peyer, Rhodius, Vogel, Salmuth, Percy, Laurent, and others describe it. Fabricius d'Aquapendente personally knew a victim of rumination, or, as it is generally called, merycism. The dissection by Bartholinus of a merycol showed nothing extraordinary in the cadaver. Winthier knew a Swede of thirty-five, in Germany, apparently healthy, but who was obliged when leaving the table to retire to some remote place where he might eject his food into his mouth again, saying that it gave him the sensation of sweetest honey. The patient related that from his infancy he had been the subject of acid eructations, and at the age of thirty he commenced rumination as a means of relief. To those who are interested in the older records of these cases Percy and Laurent offer the descriptions of a number of cases. In a recent discussion before the American Neurological Association Hammond defined merycism as the functions of remastication and rumination in the human subject. He referred to several cases, among them that of the distinguished physiologist, Brown-Sequard, who acquired the habit as a result of experiments performed upon himself. Hammond reported a case of a young man who was the subject of merycism, and whose mental condition was also impaired. No special treatment was undertaken, but the patient was trephined, with the purpose of improving his mental condition. There were no unusual features connected with the operation, but it was noticed that there were no ruminations with the meals he took until the fifth day, when a slight rumination occurred. Eight days later a similar button was removed from the corresponding side of the left skull, and from that time (about six months) to the time of report, there had been no regurgitation. Whether the cure of the merycism in this case was directly due to the operations on the cranium, or the result of the mental improvement, is a question for discussion. Hammond added that, when acquired, merycism was almost invariably the result of over-eating and loading the esophagus, or the result of fast eating. In remarks upon Hammond's paper Knapp said that two cases had come to his knowledge, both in physicians, but one of them he knew of only by hearsay. The other man, now over thirty, had regurgitated his food from early childhood, and he did not know that he had anything very unusual the matter with him until he began some investigations upon the functions and diseases of the stomach. This man was not nervous, and was certainly not an idiot. He had done active work as a physician, and called himself in perfect health. He was something of an epicure, and never suffered from indigestion. After a hearty meal the regurgitation was more marked. Food had been regurgitated, tasting as good as when first eaten, several hours after the eating. If he attempted to check the regurgitation he sometimes had a slight feeling of fulness in the stomach. Lloyd said that these cases were forms of neuroses, and were types of hysteric vomiting. There was no gustatory satisfaction connected with any form of hysteric vomiting that he had seen. In some of these cases of hysteric vomiting the food does not appear to enter the stomach, but is rejected by a sort of spasm of the esophagus. This has been called "esophagismus," and is apparently closely allied to this neurosis, which some have called "merycism." The President of the Association said that this would seem to be an affection common among physicians. A student friend of his who had been affected in this way, had written an elaborate monograph on the subject. He was disgusted with the habit, and finally overcame it by the exercise of his will-power. Runge discusses three cases of hereditary rumination. These patients belonged to three generations in the male line. The author subjected the contents of the stomach of one patient to quite an extensive analysis, without finding any abnormality of secretion. Wakefulness.--Generally speaking, the length of time a person can go without sleep is the same as that during which he can survive without food. Persons, particularly those of an hysteric nature, are prone to make statements that they have not slept for many days, or that they never sleep at all, but a careful examination and watch during the night over these patients show that they have at least been in a drowsy, somnolent condition, which is in a measure physiologically equivalent to sleep. Accounts of long periods of wakefulness arise from time to time, but a careful examination would doubtless disprove them. As typical of these accounts, we quote one from Anderson, Indiana, December 11, 1895:-- "David Jones of this city, who attracted the attention of the entire medical profession two years ago by a sleepless spell of ninety-three days, and last year by another spell which extended over one hundred and thirty-one days, is beginning on another which he fears will be more serious than the preceding ones. He was put on the circuit jury three weeks ago, and counting to-day has not slept for twenty days and nights. He eats and talks as well as usual, and is full of business and activity. He does not experience any bad effects whatever from the spell, nor did he during his one hundred and thirty-one days. During that spell he attended to all of his farm business. He says now that he feels as though he never will sleep again. He does not seem to bother himself about the prospects of a long and tedious wake. He cannot attribute it to any one thing, but thinks that it was probably superinduced by his use of tobacco while young." Somnambulism, or, as it has been called, noctambulation, is a curious phase of nocturnal cerebration analogous to the hypnotic state, or double consciousness occasionally observed in epileptics. Both Hippocrates and Aristotle discuss somnambulism, and it is said that the physician Galen was a victim of this habit. Horstius, ab Heers, and many others of the older writers recorded interesting examples of this phenomenon. Schenck remarks on the particular way in which somnambulists seem to escape injury. Haller, Hoffmann, Gassendi, Caelius Rhodiginus, Pinel, Hechler, Bohn, Richter,--in fact nearly all the ancient physiologists and anatomists have written on this subject. The marvelous manifestations of somnambulism are still among the more surprising phenomena with which science has to deal. That a person deeply immersed in thought should walk and talk while apparently unconscious, excites no surprise, but that anyone should when fast asleep perform a series of complicated actions which undoubtedly demand the assistance of the senses is marvelous indeed. Often he will rise in the night, walk from room to room, go out on porticoes, and in some cases on steep roofs, where he would not dare to venture while awake. Frequently he will wander for hours through streets and fields, returning home and to bed without knowledge of anything having transpired. The state of the eyes during somnambulism varies considerably. They are sometimes closed, sometimes half-closed, and frequently quite open; the pupil is sometimes widely dilated, sometimes contracted, sometimes natural, and for the most part insensible to light. Somnambulism seems to be hereditary. Willis cites an example in which the father and the children were somnambulists, and in other cases several individuals in the same family have been afflicted. Horstius gives a history of three young brothers who became somnambulistic at the same epoch. A remarkable instance of somnambulism was the case of a lad of sixteen and a half years who, in an attack of somnambulism, went to the stable, saddled his horse, asked for his whip, and disputed with the toll-keeper about his fare, and when he awoke had no recollection whatever of his acts, having been altogether an hour in his trance. Marville quotes the case of an Italian of thirty, melancholic, and a deep thinker, who was observed one evening in his bed. It was seen that he slept with his eyes open but fixed and immovable. His hands were cold, and his pulse extremely slow. At midnight he brusquely tore the curtains of his bed aside, dressed himself, went to his stable, and mounted a horse. Finding the gate of the court yard closed he opened it with the aid of a large stone. Soon he dismounted, went to a billiard room, and simulated all the movements of one playing. In another room he struck with his empty hands a harpsichord, and finally returned to his bed. He appeared to be irritated when anybody made a noise, but a light placed under his nose was apparently unnoticed. He awoke if his feet were tickled, or if a horn was blown in his ear. Tissot transmits to us the example of a medical student who arose in the night, pursued his studies, and returned to bed without awaking; and there is another record of an ecclesiastic who finished his sermon in his sleep. The Archbishop of Bordeaux attests the case of a young ecclesiastic who was in the habit of getting up during the night in a state of somnambulism, taking pen, ink, and paper, and composing and writing sermons. When he had finished a page he would read aloud what he had written and correct it. In order to ascertain whether the somnambulist made any use of his eyes the Archbishop held a piece of cardboard under his chin to prevent his seeing the paper upon which he was writing. He continued to write without being in the slightest degree incommoded. In this state he also copied out pieces of music, and when it happened that the words were written in too large characters and did not stand over the corresponding notes he perceived his error, blotted them out, and wrote them over again with great exactness. Negretti, a sleep-walker, sometimes carried a candle about with him as if to furnish him light in his employment, but when a bottle was substituted he carried it, fancying that he had the candle. Another somnambulist, Castelli, was found by Dr. Sloane translating Italian and French and looking out words in his dictionary. His candle was purposely extinguished, whereupon he immediately began groping about, as if in the dark, and, although other lighted candles were in the room, he did not resume his occupation until he had relighted his candle at the fire. He was insensible to the light of every candle excepting the one upon which his attention was fixed. Tuke tells of a school-boy who being unable to master a school-problem in geometry retired to bed still thinking of the subject; he was found late at night by his instructor on his knees pointing from spot to spot as though he were at the blackboard. He was so absorbed that he paid no attention to the light of the candle, nor to the speech addressed to him. The next morning the teacher asked him if he had finished his problem, and he replied that he had, having dreamt it and remembered the dream. There are many such stories on record. Quoted by Gray, Mesnet speaks of a suicidal attempt made in his presence by a somnambulistic woman. She made a noose of her apron, fastened one end to a chair and the other to the top of a window. She then kneeled down in prayer, made the sign of the cross, mounted a stool, and tried to hang herself. Mesnet, scientific to the utmost, allowed her to hang as long as he dared, and then stopped the performance. At another time she attempted to kill herself by violently throwing herself on the floor after having failed to fling herself out of the window. At still another time she tried poison, filling a glass with water, putting several coins into it, and hiding it after bidding farewell to her family in writing; the next night, when she was again somnambulistic, she changed her mind once more, writing to her family explaining her change of purpose. Mesnet relates some interesting experiments made upon a French sergeant in a condition of somnambulism, demonstrating the excitation of ideas in the mind through the sense of touch in the extremities. This soldier touched a table, passed his hands over it, and finding nothing on it, opened the drawer, took out a pen, found paper and an inkstand, and taking a chair he sat down and wrote to his commanding officer speaking of his bravery, and asking for a medal. A thick metallic plate was then placed before his eyes so as to completely intercept vision. After a few minutes, during which he wrote a few words with a jumbled stroke, he stopped, but without any petulance. The plate was removed and he went on writing. Somnambulism may assume such a serious phase as to result in the commission of murder. There is a case of a man of twenty-seven, of steady habits, who killed his child when in a state of somnambulism. He was put on trial for murder, and some of the most remarkable facts of his somnambulistic feats were elicited in the evidence. It is said that once when a boy he arose at night while asleep, dressed himself; took a pitcher and went for milk to a neighboring farm, as was his custom. At another time he worked in a lumber-yard in a rain-storm while asleep. Again, when about twenty-one, he was seen in a mill-pond wading about attempting to save his sister who he imagined was drowning. The worst phase of his somnambulism was the impending fears and terrible visions to which he was subjected. Sometimes he would imagine that the house was on fire and the walls about to fall upon him, or that a wild beast was attacking his wife and child; and he would fight, screaming inarticulately all the while. He would chase the imaginary beast about the room, and in fact had grasped one of his companions, apparently believing he was in a struggle with a wild beast. He had often injured himself in these struggles, and had often attacked his father, his wife, sister, fellow-lodgers, and while confined in jail he attacked one of his fellow-prisoners. His eyes would always be wide open and staring; he was always able to avoid pieces of furniture which were in his way, and he occasionally threw them at his visionary enemies. At the time of the murder of his child, in a somnambulistic attack, he imagined that he saw a wild beast rise up from the floor and fly at his child, a babe of eighteen months. He sprang at the beast and dashed it to the ground, and when awakened, to his horror and overwhelming grief he found that he had killed his beloved baby. A similar record has been reported of a student who attempted during the night to stab his teacher; the man was disarmed and locked up in another portion of the building; but he had not the slightest remembrance of the events of the night. Yellowlees speaks of homicide by a somnambulist. According to a prominent New York paper, one of the most singular and at the same time sad cases of somnambulism occurred a few years ago near Bakersville, N.C. A young man there named Garland had been in the habit of walking in his sleep since childhood. Like most other sleep-walkers when unmolested, his ramblings had been without harm to himself or others. Consequently his wife paid little attention to them. But finally he began to stay away from the house longer than usual and always returned soaking wet. His wife followed him one night. Leaving his home he followed the highway until he came to a rough, narrow pig-trail leading to the Tow River. His wife followed with difficulty, as he picked his way through the tangled forest, over stones and fallen trees and along the sides of precipitous cliffs. For more than a mile the sleeper trudged on until he came to a large poplar tree, which had fallen with its topmost branches far out in the river. Walking on the log until he came to a large limb extending over the water, he got down on his hands and knees and began crawling out on it. The frightened wife screamed, calling to him to wake up and come back. He was awakened by the cries, fell into the river, and was drowned. Each night for weeks he had been taking that perilous trip, crawling out on the limb, leaping from it into the river, swimming to the shore, and returning home unconscious of anything having happened. Dreams, nightmare, and night terrors form too extensive a subject and one too well known to be discussed at length here, but it might be well to mention that sometimes dreams are said to be pathognomonic or prodromal of approaching disease. Cerebral hemorrhage has often been preceded by dreams of frightful calamities, and intermittent fever is often announced by persistent and terrifying dreams. Hammond has collected a large number of these prodromic dreams, seeming to indicate that before the recognizable symptoms of disease present themselves a variety of morbid dreams may occur. According to Dana, Albers says: "Frightful dreams are signs of cerebral congestion. Dreams about fire are, in women, signs of impending hemorrhage. Dreams about blood and red objects are signs of inflammatory conditions. Dreams of distorted forms are frequently a sign of abdominal obstruction and diseases of the liver." Catalepsy, trance, and lethargy, lasting for days or weeks, are really examples of spontaneously developed mesmeric sleep in hysteric patients or subjects of incipient insanity. If the phenomenon in these cases takes the form of catalepsy there is a waxy-like rigidity of the muscles which will allow the limbs to be placed in various positions, and maintain them so for minutes or even hours. In lethargy or trance-states the patient may be plunged into a deep and prolonged unconsciousness lasting from a few hours to several years. It is in this condition that the lay journals find argument for their stories of premature burial, and from the same source the fabulous "sleeping girls" of the newspapers arise. Dana says that some persons are in the habit of going into a mesmeric sleep spontaneously. In these states there may be a lowering of bodily temperature, a retarding of the respiration and heart-action, and excessive sluggishness of the action of the bowels. The patients can hear and may respond to suggestions, though apparently insensible to painful impressions, and do not appear to smell, taste, or see; the eyes are closed, turned upward, and the pupils contracted as in normal sleep. This subject has been investigated by such authorities as Weir Mitchell and Hammond, and medical literature is full of interesting cases, many differing in the physiologic phenomena exhibited; some of the most striking of these will be quoted. Van Kasthoven of Leyden reports a strange case of a peasant of Wolkwig who, it is alleged, fell asleep on June 29, 1706, awakening on January 11, 1707, only to fall asleep again until March 15th of the same year. Tuke has resurrected the remarkable case reported by Arnold of Leicester, early in this century. The patient's name was John Engelbrecht. This man passed into a condition of catalepsy in which he heard everything about him distinctly, but in his imagination he seemed to have passed away to another world, this condition coming on with a suddenness which he describes as with "far more swiftness than any arrow can fly when discharged from a cross-bow." He also lost his sensation from the head downward, and recovered it in the opposite direction. At Bologna there was observed the case of a young female who after a profound grief had for forty-two successive days a state of catalepsy lasting from midday to midnight. Muller of Lowenburg records a case of lethargy in a young female, following a sudden fright in her fourteenth year, and abrupt suppression of menstruation. This girl was really in a sleep for four years. In the first year she was awake from one minute to six hours during the day. In the second and third years she averaged four hours wakefulness in ninety-six hours. She took very little nourishment and sometimes had no bowel-movement for sixteen days. Scull reports the history of a man of twenty-seven suffering with incipient phthisis, who remained bedridden and in a state of unconsciousness for fifteen months. One day while being fed he spoke out and asked for a glass of water in his usual manner, and so frightened his sister that she ran from the room. The man had remembered nothing that had occurred during the fifteen months, and asked who was president and seemed eager for news. One curious fact was that he remembered a field of oats which was just sprouting about the time he fell in the trance. The same field was now standing in corn knee-high. After his recovery from the trance he rapidly became worse and died in eighteen months. There is a record of a man near Rochester, N.Y., who slept for five years, never waking for more than sixteen hours at a time, and then only at intervals of six weeks or over. When seized with his trance he weighed 160, but he dwindled down to 90 pounds. He passed urine once or twice a day, and had a stool once in from six to twenty days. Even such severe treatment as counter-irritation proved of no avail. Gunson mentions a man of forty-four, a healthy farmer, who, after being very wet and not changing his clothes, contracted a severe cold and entered into a long and deep sleep lasting for twelve hours at a time, during which it was impossible to waken him. This attack lasted eight or nine months, but in 1848 there was a recurrence accompanied by a slight trismus which lasted over eighteen months, and again in 1860 he was subjected to periods of sleep lasting over twenty-four hours at a time. Blaudet describes a young woman of eighteen who slept forty days, and again after her marriage in her twentieth year she slept for fifty days; it was necessary to draw a tooth to feed her. Four years later, on Easter day, 1862, she became insensible for twelve months, with the exception of the eighth day, when she awoke and ate at the table, but fell asleep in the chair. Her sleep was so deep that nothing seemed to disturb her; her pulse was slow, the respirations scarcely perceptible, and there were apparently no evacuations. Weir Mitchell collected 18 cases of protracted sleep, the longest continuing uninterruptedly for six months. Chilton's case lasted seventeen weeks. Six of the 18 cases passed a large part of each day in sleep, one case twenty-one hours, and another twenty-three hours. The patients were below middle life; ten were females, seven males, and one was a child whose sex was not given. Eight of the 18 recovered easily and completely, two recovered with loss of intellect, one fell a victim to apoplexy four months after awakening, one recovered with insomnia as a sequel, and four died in sleep. One recovered suddenly after six months' sleep and began to talk, resuming the train of thought where it had been interrupted by slumber. Mitchell reports a case in an unmarried woman of forty-five. She was a seamstress of dark complexion and never had any previous symptoms. On July 20, 1865, she became seasick in a gale of wind on the Hudson, and this was followed by an occasional loss of sight and by giddiness. Finally, in November she slept from Wednesday night to Monday at noon, and died a few days later. Jones of New Orleans relates the case of a girl of twenty-seven who had been asleep for the last eighteen years, only waking at certain intervals, and then remaining awake from seven to ten minutes. The sleep commenced at the age of nine, after repeated large doses of quinin and morphin. Periods of consciousness were regular, waking at 6 A.M. and every hour thereafter until noon, then at 3 P.M., again at sunset, and at 9 P.M., and once or twice before morning. The sleep was deep, and nothing seemed to arouse her. Gairdner mentions the case of a woman who, for one hundred and sixty days, remained in a lethargic stupor, being only a mindless automaton. Her life was maintained by means of the stomach tube. The Revue d'Hypnotisme contains the report of a young woman of twenty-five, who was completing the fourth year of an uninterrupted trance. She began May 30, 1883, after a fright, and on the same day, after several convulsive attacks, she fell into a profound sleep, during which she was kept alive by small quantities of liquid food, which she swallowed automatically. The excretions were greatly diminished, and menstruation was suppressed. There is a case reported of a Spanish soldier of twenty-two, confined in the Military Hospital of San Ambrosio, Cuba, who had been in a cataleptic state for fourteen months. His body would remain in any position in which it was placed; defecation and micturition were normal; he occasionally sneezed or coughed, and is reported to have uttered some words at night. The strange feature of this case was that the man was regularly nourished and increased in weight ten pounds. It was noted that, some months before, this patient was injured and had suffered extreme depression, which was attributed to nostalgia, after which he began to have intermittent and temporary attacks, which culminated as related. Camuset and Planes in January, 1896, mention a man who began to have grand hallucinations in 1883. In March, 1884, he exhibited the first signs of sleep, and on March 10th it was necessary to put him to bed, where he remained, more or less continuously for three months, awakening gradually, and regaining his normal condition by the middle of June. He was fed by hand three times daily, was placed on a night-chair, and with one exception never evacuated in bed. Five months afterward he showed no signs of relapse. The latest report of a "sleeping girl" is that of the young Dutch maiden, Maria Cvetskens, of Stevenswerth, who on December 5, 1895, had been asleep for two hundred and twenty days. She had been visited by a number of men of good professional standing who, although differing as to the cause of her prolonged sleep, universally agreed that there was no deception in the case. Her parents were of excellent repute, and it had never occurred to them to make any financial profit out of the unnatural state of their daughter. Hypnotism.--The phenomenon of hypnotism was doubtless known to the Oriental nations, and even to the Greeks, Romans, and Egyptians, as well as to other nations since the downfall of the Roman Empire. "The fakirs of India, the musicians of Persia, the oracles of Greece, the seers of Rome, the priests and priestesses of Egypt, the monastic recluses of the Middle Ages, the ecstatics of the seventeenth and early part of the eighteenth century exhibited many symptoms that were, and are still, attributed by religious enthusiasts to supernatural agencies, but which are explainable by what we know of hypnotism. The Hesychasts of Mount Athos who remained motionless for days with their gaze directed steadily to the navel; the Taskodrugites who remained statuesque for a long period with the finger applied to the nose; the Jogins who could hibernate at will; the Dandins of India who became cataleptoid by 12,000 repetitions of the sacred word Om; St. Simeon Stylites who, perched on a lofty pillar, preserved an attitude of saint-like withdrawal from earthly things for days; and even Socrates, of whom it was said that he would stand for hours motionless and wordless--all these are probable instances of autohypnotism." (Gray.) Hypnotism is spoken of as a morbid mental state artificially produced, and characterized by perversion or suspension of consciousness, and abeyance of volition; a condition of suggestibility leads the patient to yield readily to commands of external sense-impressions, and there is intense concentration of the mental faculties upon some idea or feeling. There are several methods of inducing hypnosis, one of which is to give particular direction to the subject's imagination by concentrating the attention upon an arbitrary point, or by raising an image of the hypnotic state in the patient's mind. The latter is most readily induced by speech. Faria formerly strained the attention of the subject as much as possible, and suddenly called out, "Sleep!" This method has been used by others. Physical methods consist of certain stimuli of sight, hearing, and touch. Taste and smell have generally given negative results. Fixation of the gaze has been the most successful, but the ticking of a watch has been used. According to Moll, among uncivilized races particular instruments are used to produce similar states, for example, the magic drum's sound among the Lapps, or among other races the monotony of rhythm in song, etc. Instead of these continuous, monotonous, weak stimulations of the senses, we find also that sudden and violent ones are made use of--for example in the Salpetriere, the field of Charcot's work, the loud noise of a gong, or a sudden ray of light; however, it is more than doubtful whether these sudden, strong, physical stimuli, without any mental stimuli, can induce hypnosis. Perhaps we have to do here with states not far removed from paralysis from fright. The sense of touch is also brought into play in hypnosis; Richet set great value on the so-called mesmeric strokes or passes. It is often stated that touches on the forehead induce a sleepy state in many persons. Hypnotism is practiced by stimulation of the muscular sense, such as cradle-rocking, used to send little children to sleep. Similar states are said to be produced among uncivilized people by violent whirling or dancing movements; the movements are, however, accompanied by music and other mental excitations. Hypnosis is spoken of by Huc and Hellwald of the Buddhist convents in Thibet; and Sperling, who has had a particularly wide experience in the field of hypnotism, and whose opinion is of particular value, says that he has seen dervishes in Constantinople who, from the expression of their eyes and their whole appearance, as well as from peculiar postures they maintain for a long time, impressed him as being in a hypnotic state. The state may have been induced by singing and uniform whirling motions. Hildebrandt, Jacolliot, Fischer, Hellwald, and other trustworthy witnesses and authors tell us strange things about the fakirs of India, which set any attempt at explanation on the basis of our present scientific knowledge at defiance--that is, if we decline to accept them as mere juggler's tricks. Hypnotism seems to be the only explanation. It is a well known fact that both wild and domestic beasts can be hypnotized and the success of some of the animal-tamers is due to this fact. In hypnotism we see a probable explanation for the faith-cures which have extended over many centuries, and have their analogy in the supposed therapeutic powers of the Saints. The medicolegal aspect of hypnotism may be called in to answer whether crime may be committed at suggestion. Such examples have already been before the public in the recent trial of the Parisian strangler, Eyraud. It was claimed that his accomplice in the crime, Gabrielle Bompard, had been hypnotized. Bernheim narrates a case of outrage effected in the hypnotic condition, which was brought to light by a trial in the South of France. As to the therapeutic value of hypnotism, with the exception of some minor benefits in hysteric cases and in insomnia, the authors must confess that its use in Medicine seems very limited. African sleep-sickness is a peculiar disorder, apparently infectious in character, which occurs among the negroes of the western coast of Africa. It has been transported to other regions but is endemic in Africa. According to Dana it begins gradually with malaise and headache. Soon there is drowsiness after meals which increases until the patient is nearly all the time in a stupor. When awake he is dull and apathetic. There is no fever; the temperature may be subnormal. The pulse, too, is not rapid, the skin is dry, the tongue moist but coated, the bowels regular. The eyes become congested and prominent. The cervical glands enlarge. The disease ends in coma and death. Recovery rarely occurs. Sometimes the disease is more violent, and toward the end there are epileptic convulsions and muscular tremors. Autopsies have revealed no pathologic changes. Recently Forbes contributes an interesting paper on the sleeping sickness of Africa. The disease may occur in either sex and at any age, though it is most frequent from the twelfth to the twentieth years, and in the male sex. It begins with enlargement of the cervical glands, and drowsiness and sleep at unusual hours. At first the patient may be aroused, but later sinks into a heavy stupor or coma. Death occurs in from three to twelve months, and is due to starvation. Forbes reports 11 fatal cases, and two that passed from observation. At the autopsy are found hyperemia of the arachnoid, and slight chronic leptomeningitis and pachymeningitis. There is also anemia of the brain-substance. In one of his cases the spleen was enlarged. He was inclined to regard the disease as a neurosis. Aphasia is a disease of the faculty of language, that is, a disturbance of the processes by which we see, hear, and at the same time appreciate the meaning of symbols. It includes also the faculty of expressing our ideas to others by means of the voice, gesture, writing, etc. The trouble may be central or in the conducting media. The varieties of aphasia are:-- (1) Amnesia of speech. (2) Amnesia of speech and written language. (3) Amnesia of speech, written language, and gesture. In most cases there is no paralysis of the tongue or speech-forming organs. As a rule the intellect is unaffected, the patient has the ideas, but lacks the power to give them proper expression through words, written language, or gesture. If the patient is enable to write, the condition is known as agraphia. Word-blindness, word-deafness, etc., are terms of different forms of aphasia. What was probably a case of incomplete aphasia is mentioned by Pliny, that of Messala Corvinus who was unable to tell his own name; and many instances of persons forgetting their names are really nothing but cases of temporary or incomplete aphasia. In some cases of incomplete and in nearly all cases of complete aphasia, involuntary sentences are ejaculated. According to Seguin a reverend old gentleman affected with amnesia of words was forced to utter after the sentence, "Our Father who art in heaven," the words "let Him stay there." A lady seen by Trousseau would rise on the coming of a visitor to receive him with a pleased and amiable expression of countenance, and show him to a chair, at the same time addressing to him the words, "cochon, animal, fichue bete," French words hardly allowable in drawing-room usage. She was totally aphasic but not paralyzed. Women often use semi-religious expressions like "Oh dear," or "Oh Lord." Men of the lower classes retain their favorite oaths remarkably. Sometimes the phrases ejaculated are meaningless, as in Broca's celebrated case. Aphasia may be the result of sudden strong emotions, in such cases being usually temporary; it may be traumatic; it may be the result of either primary or secondary malnutrition or degeneration. There are some cases on record in which the sudden loss and the sudden return of the voice are quite marvelous. Habershon reports the case of a woman who on seeing one of her children scalded fell unconscious and motionless, and remained without food for three days. It was then found that she suffered from complete aphasia. Five weeks after the incident she could articulate only in a very limited vocabulary. In the Philosophical Transactions Archdeacon Squire tells of the case of Henry Axford, who lost the power of articulation for four years; after a horrible dream following a debauch he immediately regained his voice, and thereafter he was able to articulate without difficulty. Ball records a curious case of what he calls hysteric aphonia. The patient was a young lady who for several months could neither sing nor speak, but on hearing her sister sing a favorite song, she began to sing herself; but, although she could sing, speech did not return for several weeks. Ball remarks that during sleep such patients may cry out loudly in the natural voice. Wadham reports the case of a boy of eighteen who was admitted to his ward suffering with hemiplegia of the left side. Aphasia developed several days after admission and continued complete for three months. The boy gradually but imperfectly recovered his speech. Over six months after the original admission he was readmitted with necrosis of the jaw, for which he underwent operation, and was discharged a month later. From this time on he became progressively emaciated until his death, twelve months after Wadham first saw him. A postmortem examination showed nearly total destruction of the Island of Reil, popularly called the speech-center. Jackson mentions a hemiplegic patient with aphasia who could only utter the words "come on to me," "come on," and "yes" and "no." Bristowe cites the history of a sailor of thirty-six, a patient of St. Thomas Hospital, London, who suffered from aphasia for nine months. His case was carefully explained to him and he nodded assent to all the explanations of the process of speech as though he understood all thoroughly. He was gradually educated to speak again by practicing the various sounds. It may be worth while to state that after restoration of speech he spoke with his original American accent. Ogle quotes six cases of loss of speech after bites of venomous snakes. Two of the patients recovered. According to Russ this strange symptom is sometimes instantaneous and in other instances it only appears after an interval of several hours. In those who survive the effects of the venom it lasts for an indefinite period. One man seen by Russ had not only lost his speech in consequence of the bite of a fer-de-lance snake, but had become, and still remained, hemiplegic. In the rest of Russ's cases speech alone was abolished. Russ remarks that the intelligence was altogether intact, and sensibility and power of motion were unaffected. One woman who had been thus condemned to silence, suddenly under the influence of a strong excitement recovered her speech, but when the emotion passed away speech again left her. Ogle accounts for this peculiar manifestation of aphasia by supposing that the poison produces spasm of the middle cerebral arteries, and when the symptom remains a permanent defect the continuance of the aphasia is probably due to thrombosis of arteries above the temporary constriction. Anosmia, or loss of smell, is the most common disorder of olfaction; it may be caused by cortical lesions, olfactory nerve-changes, congenital absence, or over-stimulation of the nerves, or it may be a symptom of hysteria. Ogle, after mentioning several cases of traumatic anosmia, suggests that a blow on the occiput is generally the cause. Legg reports a confirmatory case, but of six cases mentioned by Notta two were caused by a blow on the crown of the head, and two on the right ear. The prognosis in traumatic anosmia is generally bad, although there is a record of a man who fell while working on a wharf, striking his head and producing anosmia with partial loss of hearing and sight, and who for several weeks neither smelt nor tasted, but gradually recovered. Mitchell reports a case of a woman of forty who, after an injury to her nose from a fall, suffered persistent headache and loss of smell. Two years later, at bedtime, or on going to sleep, she had a sense of horrible odors, which were fecal or animal, and most intense in nature. The case terminated in melancholia, with delirium of persecution, during which the disturbance of smell passed away. Anosmia has been noticed in leukoderma and allied disturbances of pigmentation. Ogle mentions a negro boy in Kentucky whose sense of smell decreased as the leukoderma extended. Influenza, causing adhesions of the posterior pillars of the fauces, has given rise to anosmia. Occasionally overstimulation of the olfactory system may lead to anosmia. Graves mentions a captain of the yeomanry corps who while investigating the report that 500 pikes were concealed at the bottom of a cesspool in one of the city markets superintended the emptying of the cesspool, at the bottom of which the arms were found. He suffered greatly from the abominable effluvia, and for thirty-six years afterward he remained completely deprived of the sense of smell. In a discussion upon anosmia before the Medico-Chirurgical Association of London, January 25, 1870, there was an anosmic patient mentioned who was very fond of the bouquet of moselle, and Carter mentioned that he knew a man who had lost both the senses of taste and smell, but who claimed that he enjoyed putrescent meat. Leared spoke of a case in an epileptic affected with loss of taste and smell, and whose paroxysms were always preceded by an odor of peach-blossoms. Hyperosmia is an increase in the perception of smell, which rarely occurs in persons other than the hysteric and insane. It may be cultivated as a compensatory process, as in the blind, or those engaged in particular pursuits, such as tea-tasting. Parosmia is a rare condition, most often a symptom of hysteria or neurasthenia, in which everything smells of a similar, peculiar, offensive odor. Hallucinations of odor are sometimes noticed in the insane. They form most obstinate cases, when the hallucination gives rise to imaginary disagreeable, personal odors. Perversion of the tactile sense, or wrong reference to the sensation of pain, has occasionally been noticed. The Ephemerides records a case in which there was the sense of two objects from a single touch on the hypochondrium. Weir Mitchell remarks that soldiers often misplace the location of pain after injuries in battle. He also mentions several cases of wrong reference of the sensation of pain. These instances cannot be called reflex disturbances, and are most interesting. In one case the patient felt the pain from a urethral injection in gonorrhea, on the top of the head. In another an individual let an omnibus-window fall on his finger, causing but brief pain in the finger, but violent pains in the face and neck of that side. Mitchell also mentions a naturalist of distinction who had a small mole on one leg which, if roughly rubbed or pinched, invariably seemed to cause a sharp pain in the chin. Nostalgia is the name generally given to that variety of melancholia in which there is an intense longing for home or country. This subject has apparently been overlooked in recent years, but in the olden times it was extensively discussed. Swinger, Harderus, Tackius, Guerbois, Hueber, Therrin, Castellanau, Pauquet, and others have written extensively upon this theme. It is said that the inhabitants of cold countries, such as the Laplanders and the Danes, are the most susceptible to this malady. For a long time many writers spoke of the frequency and intensity of nostalgia among the Swiss. Numerous cases of suicide from this affliction have been noticed among these hardy mountaineers, particularly on hearing the mountain-song of their homes, "Ranz des vaches." This statement, which is an established fact, is possibly due to the social constitution of the Swiss mountaineers, who are brought up to a solitary home life, and who universally exhibit great attachment to and dependence upon their parents and immediate family. In the European armies nostalgia has always been a factor in mortality. In the Army of the Moselle, and in Napoleon's Alpine Army, the terrible ravages of suicide among the young Bretons affected with nostalgia have been recorded; it is among the French people that most of the investigation on this subject has been done. Moreau speaks of a young soldier in a foreign country and army who fell into a most profound melancholy when, by accident, he heard his native tongue. According to Swinger and Sauvages women are less subject to nostalgia than men. Nostalgia has been frequently recorded in hospital wards. Percy and Laurent have discussed this subject very thoroughly, and cite several interesting cases among emigrants, soldiers, marines, etc. Hamilton speaks of a recruit who became prostrated by longing for his home in Wales. He continually raved, but recovered from his delirium when assured by the hospital authorities of his forthcoming furlough. Taylor records two cases of fatal nostalgia. One of the victims was a Union refugee who went to Kentucky from his home in Tennessee. He died talking about and pining for his home. The second patient was a member of a regiment of colored infantry; he died after repeatedly pining for his old home. Animals are sometimes subject to nostalgia, and instances are on record in which purchasers have been compelled to return them to the old home on account of their literal home-sickness. Oswald tells of a bear who, in the presence of food, committed suicide by starvation. Hypochondria consists of a mild form of insanity in which there is a tendency to exaggerate the various sensations of the body and their importance, their exaggeration being at times so great as to amount to actual delusion. All sorts of symptoms are dwelt upon, and the doctor is pestered to the extreme by the morbid fears of the patient. Morbid fears or impulses, called by the Germans Zwangsvorstellungen, or Zwangshandlungen, and by the French, peurs maladies, have only been quite recently studied, and form most interesting cases of minor insanity. Gelineau has made extensive investigations in this subject, and free reference has been made to his work in the preparation of the following material. Aichmophobia is a name given by the French to the fear of the sight of any sharp-pointed instrument, such as a pin, needle, fish-spine, or naked sword. An illustrious sufferer of this 'phobia was James I of England, who could never tolerate the appearance of a drawn sword. Gelineau reports an interesting case of a female who contracted this malady after the fatigue of lactation of two children. She could not tolerate knives, forks, or any pointed instruments on the table, and was apparently rendered helpless in needle-work on account of her inability to look at the pointed needle. Agoraphobia is dread of an open space, and is sometimes called Kenophobia. The celebrated philosopher Pascal was supposed to have been affected with this fear. In agoraphobia the patient dreads to go across a street or into a field, is seized with an intense feeling of fright, and has to run to a wall or fall down, being quite unable to proceed. There is violent palpitation, and a feeling of constriction is experienced. According to Suckling, pallor and profuse perspiration are usually present, but there is no vertigo, confusion of mind, or loss of consciousness. The patient is quite conscious of the foolishness of the fears, but is unable to overcome them. The will is in abeyance and is quite subservient to the violent emotional disturbances. Gray mentions a patient who could not go over the Brooklyn Bridge or indeed over any bridge without terror. Roussel speaks of a married woman who had never had any children, and who was apparently healthy, but who for the past six months had not been able to put her head out of the window or go upon a balcony. When she descended into the street she was unable to traverse the open spaces. Chazarin mentions a case in a woman of fifty, without any other apparent symptom of diathesis. Gelineau quotes a case of agoraphobia, secondary to rheumatism, in a woman of thirty-nine. There is a corresponding fear of high places often noticed, called acrophobia; so that many people dare not trust themselves on high buildings or other eminences. Thalassophobia is the fear of the view of immense spaces or uninterrupted expanses. The Emperor Heraclius, at the age of fifty-nine, had an insurmountable fear of the view of the sea; and it is said that when he crossed the Bosphorus a bridge of boats was formed, garnished on both sides with plants and trees, obscuring all view of the water over which the Emperor peacefully traversed on horseback. The moralist Nicole, was equally a thalassophobe, and always had to close his eyes at the sight of a large sheet of water, when he was seized with trembling in all his limbs. Occasionally some accident in youth has led to an aversion to traversing large sheets of water, and there have been instances in which persons who have fallen into the water in childhood have all their lives had a terror of crossing bridges. Claustrophobia is the antithesis of agoraphobia. Raggi describes a case of such a mental condition in a patient who could not endure being within an enclosure or small space. Suckling mentions a patient of fifty-six who suffered from palpitation when shut in a railway carriage or in a small room. She could only travel by rail or go into a small room so long as the doors were not locked, and on the railroad she had to bribe the guard to leave the doors unlocked. The attacks were purely mental, for the woman could be deceived into believing that the door to a railroad carriage was unlocked, and then the attack would immediately subside. Suckling also mentions a young woman brought to him at Queen's Hospital who had a great fear of death on getting into a tram car, and was seized with palpitation and trembling on merely seeing the car. This patient had been in an asylum. The case was possibly due more to fear of an accident than to true claustrophobia. Gorodoichze mentions a case of claustrophobia in a woman of thirty-eight, in whose family there was a history of hereditary insanity. Ball speaks of a case in a woman who was overcome with terror half way in the ascension of the Tour Saint-Jacques, when she believed the door below was closed. Gelineau quotes the case of a brave young soldier who was believed to be afraid of nothing, but who was unable to sleep in a room of which the door was closed. Astrophobia or astropaphobia is a morbid fear of being struck by lightning. It was first recognized by Bruck of Westphalia, who knew a priest who was always in terror when on a country road with an unobstructed view of the sky, but who was reassured when he was under the shelter of trees. He was advised by an old physician always to use an umbrella to obstruct his view of the heavens, and in this way his journeys were made tranquil. Beard knew an old woman who had suffered all her life from astrophobia. Her grandmother had presented the same susceptibility and the same fears. Sometimes she could tell the approach of a storm by her nervous symptoms. Caligula, Augustus, Henry III, and other celebrated personages, were overcome with fear during a storm. Mysophobia is a mild form of insanity characterized by a dread of the contact of dirt. It was named by Hammond, whose patient washed her hands innumerable times a day, so great was the fear of contamination. These patients make the closest inspection of their toilet, their eating and drinking utensils, and all their lives are intensely worried by fear of dirt. Hematophobia is a horror of blood, which seems to be an instinctive sentiment in civilized man, but which is unknown among savages. When the horror is aggravated to such an extent as to cause distressing symptoms or unconsciousness, it takes the name of hematophobia. There are many cases on record and nearly every physician has seen one or more, possibly among his colleagues. Necrophobia and thanatophobia are allied maladies, one being the fear of dead bodies and the other the fear of death itself. Anthropophobia is a symptom of mental disease consisting in fear of society. Beard, Mitchell, Baillarger, and others have made observations on this disease. The antithesis of this disease is called monophobia. Patients are not able to remain by themselves for even the shortest length of time. This morbid dread of being alone is sometimes so great that even the presence of an infant is an alleviation. Gelineau cites an instance in a man of forty-five which was complicated with agoraphobia. Bacillophobia is the result of abnormal pondering over bacteriology. Huchard's case was in a woman of thirty-eight who, out of curiosity, had secretly read the works of Pasteur, and who seemed to take particular pleasure in conning over the causes of death in the health-reports. Goyard mentions an instance in a Swiss veterinary surgeon. Kleptophobia, examples of which have been cited by Cullere, is the fear of stealing objects in view, and is often the prelude of kleptomania. The latter disease has gained notoriety in this country, and nearly every large store has agents to watch the apparently growing number of kleptomaniacs. These unfortunate persons, not seldom from the highest classes of society, are unable to combat an intense desire to purloin articles. Legal proceedings have been instituted against many, and specialists have been called into court to speak on this question. Relatives and friends have been known to notify the large stores of the thieving propensities of such patients. Le Grande du Saulle has given to the disease in which there is a morbid doubt about everything done, the name folie de doute. Gray mentions a case in a patient who would go out of a door, close it, and then come back, uncertain as to whether he had closed it, close it again, go off a little way, again feel uncertain as to whether he had closed it properly, go back again, and so on for many times. Hammond relates the history of a case in an intelligent man who in undressing for bed would spend an hour or two determining whether he should first take off his coat or his shoes. In the morning he would sit for an hour with his stockings in his hands, unable to determine which he should put on first. Syphilophobia is morbid fear of syphilis. Lyssophobia is a fear of hydrophobia which sometimes assumes all the symptoms of the major disease, and even produces death. Gelineau, Colin, Berillon, and others have studied cases. In Berillon's case the patient was an artist, a woman of brunet complexion, who for six years had been tormented with the fear of becoming mad, and in whom the symptoms became so intense as to constitute pseudobydrophobia. At their subsidence she was the victim of numerous hallucinations which almost drove her to the point of suicide. Spermatophobia has been noticed among the ignorant, caused or increased by inspection of sensational literature, treatises on the subject of spermatorrhea, etc. Ferre mentions a woman of thirty-six, of intense religious scruples, who was married at eighteen, and lost her husband six years afterward. She had a proposition of marriage which she refused, and was prostrated by the humid touch of the proposer who had kissed her hand, imagining that the humidity was due to semen. She was several times overcome by contact with men in public conveyances, her fear of contamination being so great. Zoophobia, or dread of certain animals, has been mentioned under another chapter under the head of idiosyncrasies. Pantophobia is a general state of fear of everything and everybody. Phobophobia, the fear of being afraid, is another coinage of the wordmakers. The minor 'phobias, such as pyrophobia, or fear of fire; stasophobia, or inability to arise and walk, the victims spending all their time in bed; toxicophobia or fear of poison, etc., will be left to the reader's inspection in special works on this subject. Demonomania is a form of madness in which a person imagines himself possessed of the devil. Ancient records of this disease are frequent, and in this century Lapointe reports the history of demonomania in father, mother, three sons, and two daughters, the whole family, with the exception of one son, who was a soldier, being attacked. They imagined themselves poisoned by a sorceress, saw devils, and had all sorts of hallucinations, which necessitated the confinement of the whole family in an asylum for over a month. They continued free from the hallucinations for two years, when first the mother, and then gradually all the other members of the family, again became afflicted with demonomania and were again sent to the asylum, when, after a residence therein of five months, they were all sufficiently cured to return home. Particular aversions may be temporary only, that is, due to an existing condition of the organism, which, though morbid, is of a transitory character. Such, for instance, are those due to dentition, the commencement or cessation of the menstrual function, pregnancy, etc. These cases are frequently of a serious character, and may lead to derangement of the mind. Millington relates the history of a lady who, at the beginning of her first pregnancy, acquired an overpowering aversion to a half-breed Indian woman who was employed in the house as a servant. Whenever this woman came near her she was at once seized with violent trembling; this ended in a few minutes with vomiting and great mental and physical prostration lasting several hours. Her husband would have sent the woman away, but Mrs. X insisted on her remaining, as she was a good servant, in order that she might overcome what she regarded as an unreasonable prejudice. The effort was, however, too great, for upon one occasion when the woman entered Mrs. X's apartment rather unexpectedly, the latter became greatly excited, and, jumping from an open window in her fright, broke her arm, and otherwise injured herself so severely that she was confined to her bed for several weeks. During this period, and for some time afterward, she was almost constantly subject to hallucinations, in which the Indian woman played a prominent part. Even after her recovery the mere thought of the woman would sometimes bring on a paroxysm of trembling, and it was not till after her confinement that the antipathy disappeared. Circular or periodic insanity is a rare psychosis. According to Drewry reports of very few cases have appeared in the medical journals. "Some systematic writers," says Drewry, "regard it as a mere subdivision of periodic insanity (Spitzka). A distinguished alienist and author of Scotland however has given us an admirable lecture on the subject. He says: 'I have had under my care altogether about 40 cases of typical folie circulaire.' In the asylum at Morningside there were, says Dr. Clouston, in 800 patients 16 cases of this peculiar form of mental disease. Dr. Spitzka, who was the first American to describe it, found in 2300 cases of pauper insane four per cent to be periodic, and its sub-group, circular, insanity. Dr. Stearns states that less than one-fourth of one per cent of cases in the Hartford (Conn.) Retreat classed as mania and melancholia have proved to be folie circulaire. Upon examination of the annual reports of the superintendents of hospitals for the insane in this country, in only a few are references made to this as a distinct form of insanity. In the New York State hospitals there is a regular uniform classification of mental diseases in which 'circular (alternating) insanity' occupies a place. In the report of the Buffalo Hospital for 1892, in statistical table No. 4, 'showing forms of insanity in those admitted, etc., since 1888,' out of 1428 cases, only one was 'alternating (circular) insanity.' In the St. Lawrence Hospital only one case in 992 was credited to this special class. In the institution in Philadelphia, of which Dr. Chapin is the superintendent, 10,379 patients have been treated, only three of whom were diagnosed cases of manie circulaire. Of the 900 cases of insanity in the State Hospital at Danville, Pa., less than four per cent were put in this special class. There are in the Central (Va.) State Hospital (which is exclusively for the colored insane) 775 patients, three of whom are genuine cases of circular insanity, but they are included in 'periodic insanity.' This same custom evidently prevails in many of the other hospitals for the insane." Drewry reports three cases of circular insanity, one of which was as follows:-- "William F., a negro, thirty-six years old, of fair education, steady, sober habits, was seized with gloomy depression a few weeks prior to his admission to this hospital, in September, 1886. This condition came on after a period of fever. He was a stranger in the vicinity and scarcely any information could be obtained regarding his antecedents. When admitted he was in a state of melancholic hypochondriasis; he was the very picture of abject misery. Many imaginary ills troubled his peace of mind. He spoke of committing suicide, but evidently for the purpose of attracting attention and sympathy. On one occasion he said he intended to kill himself, but when the means to do so were placed at his command, he said he would do the deed at another time. The most trivial physical disturbances were exaggerated into very serious diseases. From this state of morbid depression he slowly emerged, grew brighter, more energetic, neater in personal appearance, etc. During this period of slow transition or partial sanity he was taken out on the farm where he proved to be a careful and industrious laborer. He escaped, and when brought back to the hospital a few weeks subsequently he was in a condition of great excitement and hilarity. His expression was animated, and he was, as it were, overflowing with superabundance of spirit, very loquacious, and incessantly moving. He bore an air of great importance and self-satisfaction; said he felt perfectly well and happy, but abused the officers for keeping him 'confined unjustly in a lunatic asylum.' It was his habit almost daily, if not interfered with, to deliver a long harangue to his fellow-patients, during which he would become very excited and noisy. He showed evidences of having a remarkable memory, particularly regarding names and dates. (Unusual memory is frequently observed in this type of insanity, says Stearns.) He was sometimes disposed to be somewhat destructive to furniture, etc., was neat in person, but would frequently dress rather 'gorgeously,' wearing feathers and the like in his hat, etc. He was not often noisy and sleepless at night, and then only for a short time. His physical health was good. This 'mental intoxication,' as it were, lasted nearly a year. After this long exacerbation of excitement there was a short remission and then depression again set in, which lasted about fifteen months. At this time this patient is in the depressed stage or period of the third circle. So, thus the cycles have continuously repeated their weary rounds, and in all probability they will keep this up 'until the final capitation in the battle of life has taken place.'" Katatonia, according to Gray, is a cerebral disease of cyclic symptoms, ranging in succession from primary melancholia to mania, confusion, and dementia, one or more of these stages being occasionally absent, while convulsive and epileptoid symptoms accompany the mental changes. It is manifestly impossible to enter into the manifold forms and instances of insanity in this volume, but there is one case, seldom quoted, which may be of interest. It appeared under the title, "A Modern Pygmalion." It recorded a history of a man named Justin, who died in the Bicetre Insane Asylum. He had been an exhibitor of wax works at Montrouge, and became deeply impressed with the beautiful proportions of the statue of a girl in his collection, and ultimately became intensely enamored with her. He would spend hours in contemplation of the inanimate object of his affections, and finally had the illusion that the figure, by movements of features, actually responded to his devotions. Nemesis as usual at last arrived, and the wife of Justin, irritated by his long neglect, in a fit of jealousy destroyed the wax figure, and this resulted in a murderous attack on his wife by Justin who resented the demolition of his love. He was finally secured and lodged in Bicetre, where he lived for five years under the influence of his lost love. An interesting condition, which has been studied more in France than elsewhere, is double consciousness, dual personality, or, as it is called by the Germans, Doppelwahrnehmungen. In these peculiar cases an individual at different times seems to lead absolutely different existences. The idea from a moralist's view is inculcated in Stevenson's "Dr. Jekyl and Mr. Hyde." In an article on this subject Weir Mitchell illustrated his paper by examples, two of which will be quoted. The first was the case of Mary Reynolds who, when eighteen years of age, became subject to hysteric attacks, and on one occasion she continued blind and deaf for a period of five or six weeks. Her hearing returned suddenly, and her sight gradually. About three months afterward she was discovered in a profound sleep. Her memory had fled, and she was apparently a new-born individual. When she awoke it became apparent that she had totally forgotten her previous existence, her parents, her country, and the house where she lived. She might be compared to an immature child. It was necessary to recommence her education. She was taught to write, and wrote from right to left, as in the Semitic languages. She had only five or six words at her command--mere reflexes of articulation which were to her devoid of meaning. The labor of re-education, conducted methodically, lasted from seven to eight weeks. Her character had experienced as great a change as her memory; timid to excess in the first state, she became gay, unreserved, boisterous, daring, even to rashness. She strolled through the woods and the mountains, attracted by the dangers of the wild country in which she lived. Then she had a fresh attack of sleep, and returned to her first condition; she recalled all the memories and again assumed a melancholy character, which seemed to be aggravated. No conscious memory of the second state existed. A new attack brought back the second state, with the phenomenon of consciousness which accompanied it the first time. The patient passed successively a great many times from one of these states to the other. These repeated changes stretched over a period of sixteen years. At the end of that time the variations ceased. The patient was then thirty-six years of age; she lived in a mixed state, but more closely resembling the second than the first; her character was neither sad nor boisterous, but more reasonable. She died at the age of sixty-five years. The second case was that of an itinerant Methodist minister named Bourne, living in Rhode Island, who one day left his home and found himself, or rather his second self, in Norristown, Pennsylvania. Having a little money, he bought a small stock in trade, and instead of being a minister of the gospel under the Methodist persuasion, he kept a candy shop under the name of A. J. Brown, paid his rent regularly, and acted like other people. At last, in the middle of the night, he awoke to his former consciousness, and finding himself in a strange place, supposed he had made a mistake and might be taken for a burglar. He was found in a state of great alarm by his neighbors, to whom he stated that he was a minister, and that his home was in Rhode Island. His friends were sent for and recognized him, and he returned to his home after an absence of two years of absolutely foreign existence. A most careful investigation of the case was made on behalf of the London Society for Psychical Research. An exhaustive paper on this subject, written by Richard Hodgson in the proceedings of the Society for Psychical Research, states that Mr. Bourne had in early life shown a tendency to abnormal psychic conditions; but he had never before engaged in trade, and nothing could be remembered which would explain why he had assumed the name A. J. Brown, under which he did business. He had, however, been hypnotized when young and made to assume various characters on the stage, and it is possible that the name A. J. Brown was then suggested to him, the name resting in his memory, to be revived and resumed when he again went into a hypnotic trance. Alfred Binet describes a case somewhat similar to that of Mary Reynolds: "Felida, a seamstress, from 1858 up to the present time (she is still living) has been under the care of a physician named Azam in Bordeaux. Her normal, or at least her usual, disposition when he first met her was one of melancholy and disinclination to talk, conjoined with eagerness for work. Nevertheless her actions and her answers to all questions were found to be perfectly rational. Almost every day she passed into a second state. Suddenly and without the slightest premonition save a violent pain in the temples she would fall into a profound slumber-like languor, from which she would awake in a few moments a totally different being. She was now as gay and cheery as she had formerly been morose. Her imagination was over-excited. Instead of being indifferent to everything, she had become alive to excess. In this state she remembered everything that had happened in the other similar states that had preceded it, and also during her normal life. But when at the end of an hour or two the languor reappeared, and she returned to her normal melancholy state, she could not recall anything that had happened in her second, or joyous, stage. One day, just after passing into the second stage, she attended the funeral of an acquaintance. Returning in a cab she felt the period coming on which she calls her crisis (normal state). She dozed several seconds, without attracting the attention of the ladies who were in the cab, and awoke in the other state, absolutely at a loss to know why she was in a mourning carriage with people who, according to custom, were praising the qualities of a deceased person whose name she did not even know. Accustomed to such positions, she waited; by adroit questions she managed to understand the situation, and no one suspected what had happened. Once when in her abnormal condition she discovered that her husband had a mistress, and was so overcome that she sought to commit suicide. Yet in her normal mind she meets the woman with perfect equilibrium and forgetfulness of any cause for quarrel. It is only in her abnormal state that the jealousy recurs. As the years went on the second state became her usual condition. That which was at first accidental and abnormal now constitutes the regular center of her psychic life. It is rather satisfactory to chronicle that as between the two egos which alternately possess her, the more cheerful has finally reached the ascendant." Jackson reports the history of the case of a young dry-goods clerk who was seized with convulsions of a violent nature during which he became unconscious. In the course of twenty-four hours his convulsions abated, and about the third day he imagined himself in New York paying court to a lady, and having a rival for her favors; an imaginary quarrel and duel ensued. For a half-hour on each of three days he would start exactly where he had left off on the previous day. His eyes were open and to all appearances he was awake during this peculiar delirium. When asked what he had been doing he would assert that he had been asleep. His language assumed a refinement above his ordinary discourse. In proportion as his nervous system became composed, and his strength improved, this unnatural manifestation of consciousness disappeared, and he ultimately regained his health. A further example of this psychologic phenomenon was furnished quite meetly at a meeting of the Clinical Society of London, where a well known physician exhibited a girl of twelve, belonging to a family of good standing, who displayed in the most complete and indubitable form this condition of dual existence. A description of the case is as follows:-- "Last year, after a severe illness which was diagnosed to be meningitis, she became subject to temporary attacks of unconsciousness, on awakening from which she appeared in an entirely different character. In her normal condition she could read and write and speak fluently, and with comparative correctness. In the altered mental condition following the attack she loses all memory for ordinary events, though she can recall things that have taken place during previous attacks. So complete is this alteration of memory, that at first she was unable to remember her own name or to identify herself or her parents. By patient training in the abnormal condition she has been enabled to give things their names, though she still preserves a baby-fashion of pronouncing. She sometimes remains in the abnormal condition for days together and the change to her real self takes place suddenly, without exciting surprise or dismay, and she forthwith resumes possession of her memory for events of her ordinary life. During the last month or two she appears to have entered on a new phase, for after a mental blank of a fortnight's duration she awakened completely oblivious of all that had happened since June, 1895, and she alludes to events that took place just anterior to that date as though they were of recent occurrence; in fact she is living mentally in July, 1895. These cases, though rare, are of course not infrequently met with, and they have been carefully studied, especially in France, where women appear more prone to neurotic manifestations. The hypothesis that finds most favor is that the two halves of the brain do not work in unison; in other words, that there has been some interference with the connections which in the ordinary normal being make of a wonderful composite organ like the brain one organic whole." Proust tells a story of a Parisian barrister of thirty-three. His father was a heavy drinker, his mother subject to nervous attacks, his younger brother mentally deficient, and the patient himself was very impressionable. It was said that a judge in a court, by fixing his gaze on him, could send him into an abnormal state. On one occasion, while looking into a mirror in a cafe, he suddenly fell into a sleep, and was taken to the Charite where he was awakened. He suffered occasional loss of memory for considerable lengths of time, and underwent a change of personality during these times. Though wide awake in such conditions he could remember nothing of his past life, and when returned to his original state he could remember nothing that occurred during his secondary state, having virtually two distinct memories. On September 23, 1888, he quarreled with his stepfather in Paris and became his second self for three weeks. He found himself in a village 100 miles from Paris, remembering nothing about his journey thereto; but on inquiry he found that he had paid a visit to the priest of the village who thought his conduct odd, and he had previously stayed with an uncle, a bishop, in whose house he had broken furniture, torn up letters, and had even had sentence passed upon him by a police court for misdemeanor. During these three weeks he had spent the equivalent of $100, but he could not recall a single item of expenditure. Davies cites a remarkable case of sudden loss of memory in a man who, while on his way to Australia, was found by the police in an exhausted condition and who was confined in the Kent County Insane Asylum. He suffered absolute loss of all memory with the exception of the names of two men not close acquaintances, both of whom failed to recognize him in his changed condition in confinement. Four months later his memory returned and his identity was established. In the Revue Philosophique for 1885 there are the details of a case of a young man who seemed able to assume six states of what might be fairly called different personalities. The memories attached to each of these states were very different, though only one was completely exclusive of the others. The handwriting varied from complete competence to complete incompetence. His character varied between childish timidity, courteous reserve, and reckless arrogance; and to four of his conditions there was a form of hysteric paralysis attached. Mere suggestion would not only induce any one of these varied forms of paralysis, but also the memories, capacities, and characters habitually accompanying it. A young man named Spencer, an inmate of the Philadelphia Hospital, was exhibited before the American Neurological Society in June, 1896, as an example of dual personality. At the time of writing he is and has been in apparently perfect health, with no evidence of having been in any other condition. His faculties seem perfect, his education manifests itself in his intelligent performance of the cleric duties assigned to him at the hospital, yet the thread of continuous recollection which connects the present moment with its predecessors--consciousness and memory--has evidently been snapped at some point of time prior to March 3d and after January 19th, the last date at which he wrote to his parents, and as if in a dream, he is now living another life. The hospital staff generally believe that the man is not "shamming," as many circumstances seem to preclude that theory. His memory is perfect as to everything back to March 3d. The theory of hypnotism was advanced in explanation of this case. The morbid sympathy of twin brothers, illustrated in Dumas's "Corsican Brothers," has been discussed by Sedgwick, Elliotson, Trousseau, Laycock, Cagentre, and others. Marshall Hall relates what would seem to verify the Corsican myth, the history of twin brothers nine months of age, who always became simultaneously affected with restlessness, whooping and crowing in breathing three weeks previous to simultaneous convulsions, etc. Rush describes a case of twin brothers dwelling in entirely different places, who had the same impulse at the same time, and who eventually committed suicide synchronously. Baunir describes a similar development of suicidal tendency in twin brothers. A peculiar case of this kind was that of the twin brothers Laustand who were nurses in a hospital at Bordeaux; they invariably became ill at the same time, and suffered cataract of the lens together. Automatism has been noticed as a sequel to cranial injuries, and Huxley quotes a remarkable case reported by Mesnet. The patient was a young man whose parietal bone was partially destroyed by a ball. He exhibited signs of hemiplegia on the right side, but these soon disappeared and he became subject to periodic attacks lasting from twenty-four to forty-eight hours, during which he was a mere automaton. In these attacks he walked continually, incessantly moving his jaw, but not uttering a word. He was insensible to pain, electric shock, or pin-prick. If a pen was placed in his hand he would write a good letter, speaking sensibly about current topics. When a cigarette-paper was placed in his hand he sought his tobacco box, and adroitly rolled a cigarette and lighted it. If the light went out he procured another, but would not allow another to substitute a match. He allowed his mustache to be burned without resistance, but would not allow a light to be presented to him. If chopped charpie was put in his pocket instead of tobacco he knew no difference. While in his periods of automatism he was in the habit of stealing everything within his grasp. He had been a concert singer, and a peculiar fact was that if given white gloves he would carefully put them on and commence a pantomime of the actions of a singer, looking over his music, bowing, assuming his position, and then singing. It is particularly in hypnotic subjects that manifestations of automatism are most marked. At the suggestion of battle an imaginary struggle at once begins, or if some person present is suggested as an enemy the fight is continued, the hypnotic taking care not to strike the person in question. Moll conceded that this looked like simulation, but repetition of such experiments forced him to conclude that these were real, typical hypnoses, in which, in spite of the sense-delusions, there was a dim, dreamy consciousness existing, which influenced the actions of the subject, and which prevented him from striking at a human being, although hitting at an imaginary object. Many may regard this behavior of hypnotics as pure automatism; and Moll adds that, as when walking in the street while reading we automatically avoid knocking passers-by, so the hypnotic avoids hitting another person, although he is dimly or not at all aware of his existence. Gibbs reports a curious case of lack of integrity of the will in a man of fifty-five. When he had once started on a certain labor he seemed to have no power to stop the muscular exercise that the task called forth. If he went to the barn to throw down a forkful of hay, he would never stop until the hay was exhausted or someone came to his rescue. If sent to the wood-pile for a handful of wood, he would continue to bring in wood until the pile was exhausted or the room was full. On all occasions his automatic movements could only be stopped by force. At a meeting in Breslau Meschede rendered an account of a man who suffered from simple misdirection of movement without any mental derangement. If from his own desire, or by direction of others, he wanted to attempt any muscular movement, his muscles performed the exact opposite to his inclinations. If he desired to look to the right, his eyes involuntarily moved to the left. In this case the movement was not involuntary, as the muscles were quiet except when called to action by the will, and then they moved to the opposite. Presentiment, or divination of approaching death, appearing to be a hypothetic allegation, has been established as a strong factor in the production of a fatal issue in many cases in which there was every hope for a recovery. In fact several physicians have mentioned with dread the peculiar obstinacy of such presentiment. Hippocrates, Romanus, Moller, Richter, Jordani, and other older writers speak of it. Montgomery reports a remarkable case of a woman suffering from carcinoma of the uterus. He saw her on October 6, 1847, when she told him she had a strong presentiment of death on October 28th. She stated that she had been born on that day, her first husband had died on October 28th, and she had married her second husband on that day. On October 27th her pulse began to fail, she fell into a state of extreme prostration, and at noon on the 28th she died. In substantiation of the possibility of the influence of presentiment Montgomery cites another case in which he was called at an early hour to visit a lady, the mother of several children. He found her apparently much agitated and distressed, and in great nervous excitement over a dream she had had, in which she saw a handsome monument erected by some children to their mother. She had awakened and became dreadfully apprehensive, she could not tell as to what. The uneasiness and depression continued, her pulse continued to grow weak, and she died at twelve that night without a struggle. Andrews has made several observations on this subject, and concludes that presentiment of death is a dangerous symptom, and one which should never be overlooked. One of his cases was in a man with a fractured leg in the Mercy Hospital at Pittsburg. The patient was in good health, but one day he became possessed of a cool, quiet, and perfectly clear impression that he was about to die. Struck with his conviction, Andrews examined his pulse and general condition minutely, and assured the patient there was not the slightest ground for apprehension. But he persisted, and was attacked by pneumonia three days later which brought him to the verge of the grave, although he ultimately recovered. In another instance a young man of ruddy complexion and apparent good health, after an operation for varicocele, had a very clear impression that he would die. Careful examination showed no reason for apprehension. After five or six days of encouragement and assurance, he appeared to be convinced that his reasoning was foolish, and he gave up the idea of death. About the ninth day the wound presented a healthy, rosy appearance, and as the patient was cheerful he was allowed to leave his bed. After a few hours the nurse heard the noise of labored breathing, and on investigation found the patient apparently in a dying condition. He was given stimulants and regained consciousness, but again relapsed, and died in a few moments. At the necropsy the heart was found healthy, but there were two or three spots of extravasated blood in the brain, and evidences of cerebral congestion. Vos remarks that he remembers a case he had when dressing for Mr. Holden at St. Bartholomew's Hospital: "A man who had been intemperate was rolling a sod of grass, and got some grit into his left palm. It inflamed; he put on hot cow-dung poultices by the advice of some country friends. He was admitted with a dreadfully swollen hand. It was opened, but the phlegmonous process spread up to the shoulder, and it was opened in many places, and at last, under chloroform, the limb was amputated below the joint. The stump sloughed, and pus pointing at the back of the neck, an opening was again made. He became in such a weak state that chloroform could not be administered, and one morning he had such a dread of more incisions that, saying to us all standing round his bed, 'I can bear it no more, I must now die,' he actually did die in a few minutes in our presence. His was the last arm that Mr. Holden ever amputated at St. Bartholomew's." CHAPTER XVIII. HISTORIC EPIDEMICS. A short history of the principal epidemics, including as it does the description of anomalous diseases, many of which are now extinct, and the valuable knowledge which finally led to their extinction, the extraordinary mortalities which these epidemics caused, and many other associate points of interest would seem fitting to close the observations gathered in this volume. As the illustrious Hecker says, in the history of every epidemic, from the earliest times, the spirit of inquiry was always aroused to learn the machinery of such stupendous engines of destruction; and even in the earliest times there was neither deficiency in courage nor in zeal for investigation. "When the glandular plague first made its appearance as a universal epidemic, whilst the more pusillanimous, haunted by visionary fears, shut themselves up in their closets, some physicians at Constantinople, astonished at the phenomena opened the boils of the deceased. The like has occurred both in ancient and modern times, not without favorable results for Science; nay, more mature views excited an eager desire to become acquainted with similar or still greater visitations among the ancients, but, as later ages have always been fond of referring to Grecian antiquity, the learned of those times, from a partial and meagre predilection, were contented with the descriptions of Thucydides, even where nature had revealed, in infinite diversity, the workings of her powers." There cannot but be a natural interest in every medical mind to-day in the few descriptions given of the awful ravages of the epidemics which, fortunately, in our enlightened sanitary era, have entirely disappeared. In the history of such epidemics the name of Hecker stands out so prominently that any remarks on this subject must necessarily, in some measure, find their origin in his writings, which include exhaustive histories of the black death, the dancing mania, and the sweating sickness. Few historians have considered worthy of more than a passing note an event of such magnitude as the black death, which destroyed millions of the human race in the fourteenth century and was particularly dreadful in England. Hume has given but a single paragraph to it and others have been equally brief. Defoe has given us a journal of the plague, but it is not written in a true scientific spirit; and Caius, in 1562, gave us a primitive treatise on the sweating sickness. It is due to the translation of Hecker's "Epidemics of the Middle Ages" by Babbington, made possible through the good offices of the Sydenham Society, that a major part of the knowledge on this subject of the English-reading populace has been derived. The Black Death, or, as it has been known, the Oriental plague, the bubonic plague, or in England, simply the plague, and in Italy, "la Mortalega" (the great mortality) derived its name from the Orient; its inflammatory boils, tumors of the glands, and black spots, indicative of putrid decomposition, were such as have been seen in no other febrile disease. All the symptoms were not found in every case, and in many cases one symptom alone preceded death. Although afflicted with all the manifestations of the plague, some patients recovered. According to Hecker the symptoms of cephalic affliction were seen; many patients were stupefied and fell into a deep sleep, or became speechless from palsy of the tongue, while others remained sleepless and without rest. The fauces and tongue were black and as if suffused with blood; no beverage could assuage the burning thirst, so that suffering continued without alleviation until death, which many in their despair accelerated with their own hands. Contagion was evident, for attendants caught the disease from their parents and friends, and many houses were emptied of their inhabitants. In the fourteenth century this affection caused still deeper sufferings, such as had not been hitherto experienced. The organs of respiration became the seats of a putrid inflammation, blood was expectorated, and the breath possessed a pestiferous odor. In the West an ardent fever, accompanied by an evacuation of blood, proved fatal in the first three days. It appears that buboes and inflammatory boils did not at first appear, but the disease in the form of carbuncular affection of the lungs (anthrax artigen) caused the fatal issue before the other symptoms developed. Later on in the history of the plague the inflammatory boils and buboes in the groins and axillae were recognized at once as prognosticating a fatal issue. The history of this plague extends almost to prehistoric times. There was a pest in Athens in the fifth century before Christ. There was another in the second century, A.D., under the reign of Marcus Aurelius, and again in the third century, under the reign of the Gauls; following this was the terrible epidemic of the sixth century, which, after having ravaged the territory of the Gauls, extended westward. In 542 a Greek historian, Procopius, born about the year 500, gives a good description of this plague in a work, "Pestilentia Gravissima," so called in the Latin translation. Dupouy in "Le Moyen Age Medical," says that it commenced in the village of Peleuse, in Egypt, and followed a double course, one branch going to Alexandria and the other to Palestine. It reached Constantinople in the Spring of 543, and produced the greatest devastation wherever it appeared. In the course of the succeeding half century this epidemic became pandemic and spread over all the inhabited earth. The epidemic lasted four months in Constantinople, from 5000 to 10,000 people dying each day. In his "History of France," from 417 to 591, Gregorius speaks of a malady under the name inguinale which depopulated the Province of Arles. In another passage this illustrious historian of Tours says that the town of Narbonne was devastated by a maladie des aines. We have records of epidemics in France from 567 to 590, in which bubonic symptoms were a prominent feature. About the middle of the fourteenth century the bubonic plague made another incursion from the East. In 1333, fifteen years before the plague appeared in Europe, there were terrible droughts in China followed by enormous floods in which thousands of people perished. There are traditions of a plague in Tche in 1334, following a drought, which is said to have carried off about 5,000,000 people. During the fifteen years before the appearance of the plague in Europe there were peculiar atmospheric phenomena all over the world, besides numerous earthquakes. From the description of the stinking atmosphere of Europe itself at this time it is quite possible that part of the disease came, not from China, but originated in Southern Europe itself. From China the route of caravans ran to the north of the Caspian Sea, through Asia, to Tauris. Here ships were ready to take the produce of the East to Constantinople, the capital of commerce, and the medium of communication between Europe, Asia, and Africa. Other caravans went from Europe to Asia Minor and touched at the cities south of the Caspian Sea, and lastly there were others from Bagdad through Arabia to Egypt; the maritime communication on the Red Sea to Arabia and Egypt was also not inconsiderable. In all these directions contagion found its way, though doubtless Constantinople and the harbors of Asia Minor were the chief foci of infection, whence it radiated to the most distant seaports and islands. As early as 1347 the Mediterranean shores were visited by the plague, and in January, 1348, it appeared in the south of France, the north of Italy, and also in Spain. Place after place was attacked throughout the year, and after ravishing the whole of France and Germany, the plague appeared in England, a period of three months elapsing before it reached London. The northern kingdoms were attacked in 1349, but in Russia it did not make its appearance before 1351. As to the mortality of this fearful epidemic Dupony considers that in the space of four years more than 75,000,000 fell victims, that is, about half of the population of the countries visited. Hecker estimates that from 1347 to 1351, 25,000,000 people died, or one-quarter of the total population of Europe. It was reported to Pope Clement that throughout the East, probably with the exception of China, nearly 24,000,000 people had fallen victims to the plague. Thirteen millions are said to have died in China alone. Constantinople lost two-thirds of its population. When the plague was at its greatest violence Cairo lost daily from 10,000 to 15,000, as many as modern plagues have carried off during their whole course. India was depopulated. Tartary, Mesopotamia, Syria, Armenia, and Arabia were covered with dead bodies. In this latter country Arabian historians mention that Maara el nooman, Schisur, and Harem in some unaccountable manner remained free. The shores of the Mediterranean were ravaged and ships were seen on the high seas without sailors. In "The Decameron" Boccaccio gives a most graphic description of the plague and states that in Florence, in four months, 100,000 perished; before the calamity it was hardly supposed to contain so many inhabitants. According to Hecker, Venice lost 100,000; London, 100,000; Paris, 50,000; Siena, 70,000; Avignon, 60,000; Strasburg, 16,000; Norwich, 51,100. Dupony says that in one month there were 56,000 victims in Marseilles, and at Montpellier three-quarters of the population and all the physicians were stricken with the epidemic. Johanna of Burgundy, wife of King Philip VI of Valois; Johanna II, Queen of Navarre, granddaughter of Philippe le Bel; Alphonse XI of Castile, and other notable persons perished. All the cities of England suffered incredible losses. Germany seems to have been particularly spared; according to a probable calculation, only about 1,250,000 dying. Italy was most severely visited, and was said to have lost most of its inhabitants. In the north of Europe two of the brothers of Magnus, King of Sweden, died; and in Westgothland alone 466 priests died. The plague showed no decrease in the northern climates of Iceland and Greenland, and caused great havoc in those countries. The moral effect of such a great pandemic plague can be readily surmised. The mental shock sustained by all nations during the prevalence of the black plague is beyond parallel and description. An awful sense of contrition and repentance seized Christians of every community. They resolved to forsake their vices, and to make restitution for past offenses; hence extreme religious fanaticism held full sway throughout Europe. The zeal of the penitents stopped at nothing. The so-called Brotherhood of the Cross, otherwise known as the Order of Flagellants, which had arisen in the thirteenth century, but was suppressed by the mandates and strenuous efforts of the Church, was revived during the plague, and numbers of these advocates of self-chastisement roamed through the various countries on their great pilgrimages. Their power increased to such an extent that the Church was in considerable danger, for these religious enthusiasts gained more credit among the people, and operated more strongly on their minds than the priests from whom they so entirely withdrew that they even absolved each other. Their strength grew with such rapidity, and their numbers increased to such an extent daily, that the State and the Church were forced to combine for their suppression. Degeneracy, however, soon crept in, crimes were committed, and they went beyond their strength in attempting the performance of miracles. One of the most fearful consequences of this frenzy was the persecution of the Jews. This alien race was given up to the merciless fury and cruelty of the populace. The persecution of the Jews commenced in September and October, 1348, at Chillon on Lake Geneva, where criminal proceedings were instituted against them on the mythic charge of poisoning the public wells. These persecuted people were summoned before sanguinary tribunals, beheaded and burned in the most fearful manner. At Strasburg 2000 Jews were burned alive in their own burial-ground, where a large scaffold had been erected, their wealth being divided among the people. In Mayence 12,000 Jews were said to have been put to a cruel death. At Eslingen the whole Jewish community burned themselves in their synagogue, and mothers were often seen throwing their children on the pile, to prevent them from being baptized, and then precipitating themselves into the flames. The cruel and avaricious desires of the monarchs against these thrifty and industrious people added fuel to the flames of the popular passion, and even a fanatic zeal arose among the Jews to perish as martyrs to their ancient religion. When we sum up the actual effects as well as the after effects of the black death, we are appalled at the magnitude of such a calamity, the like of which the world had never seen before. In the fifteenth and sixteenth centuries the plague was generally diffused throughout Europe, and in the latter half of the seventeenth century a final Occidental incursion of the plague took place. From 1603 to 1604 over 30,000 people perished in London from the plague, and in 1625 the mortality in that city amounted to 35,417 persons. But the great plague of London did not begin until 1664. In this plague the patient at first became sensible of great weariness and fatigue, had slight chills, nausea, vomiting, vertigo, and pains in the loins. The mental disturbance rapidly increased, and stupor and delirium ensued. The face was alternately flushed and pallid, and a sense of constriction was experienced in the region of the heart. Darting pains were felt all over the body, soon followed by the enlargement of the lymphatic glands, or by the formation of carbuncles in various parts of the body. About the third day the tongue became dry and brown, and the gums, tongue, and teeth were covered with a dark fur, and the excretions became offensive; paralysis intervened; ecchymosed patches or stripes due to extravasation appeared on the skin; finally the pulse sank, the body grew cold and clammy, delirium or coma seized the victim, and in five or six days, sometimes in two or three, the painful struggle was at an end. It was supposed that the disease originated in the Orient and was brought to London from Holland. In his "Journal of the Plague in London" Defoe describes its horrors, and tells of the dead-cart which went through the streets gathering the victims. A few extracts from Pepys's "Diary," the evidence of an eye-witness and a contemporary, show the ghastly aspects of this terrible visitation. On August 31st he writes: "In the City, this week, died 7496, and of them 6102 died of the plague. But it is found that the true number of the dead this week is nearer 10,000; partly from the poor who cannot be taken care of through the greatness of the number, and partly from the Quakers and others that will not have any bell rung for them." According to Adams, John Evelyn noted in his "Kalendarium":--"Sept. 7th.--Near 10,000 now died weekly; however, I went all along the City and suburbs from Kent street to St. James's, a dismal passage, and dangerous to see so many coffins exposed in the streets; the streets thin of people, the shops shut up, and all in silence, no one knowing whose turn might be next." As the cold weather came on the plague diminished in intensity and the people regained their confidence and returned to the city. According to Adams, in the first week of March, 1666, deaths by the plague had decreased to 42; and by the end of the month it was nearly extinct after carrying off about 100,000 victims. In our days we can hardly comprehend the filthy hygienic conditions under which the people in the cities lived, and it was probably to this fact that the growth and perpetuation of this plague was due. As to the bubonic plague recently raging in Camptown, China, Mary Niles says that it was the same disease as the great London plague, and was characterized mainly by glandular enlargement. It had not appeared in the Canton district for forty years or more, though it was endemic in Yunnan. In some places it began in the winter; and as early as January she herself found the first case in Canton in an infected house. In no case was direct contagiousness found to exist. The glands enlarged twelve hours after the fever began, and sometimes suppurated in nonfatal cases in a short time. Kitasato has recently announced the discovery of the specific cause of the bubonic plague. Sweating Sickness.--According to Hecker, very shortly after Henry's triumphant march from Bosworth Field, and his entry into the capital on August 8, 1485, the sweating sickness began its ravages among the people of the densely populated city. According to Lord Bacon the disease began about September 21st, and lasted to the end of October, 1485. The physicians could do little or nothing for the people, and seemed to take no account of the clinical history of the disease,--in this respect not unlike the Greek physicians who for four hundred years paid no attention to small-pox because they could find no description of it in the immortal works of Galen. The causes seemed to be uncleanliness, gluttony, immoderate drinking, and also severe inundations leaving decaying vegetation. Richmond's army has been considered a factor in the germination of the seeds of pestilent disorder which broke out soon after in the camps of Litchfield, and on the banks of the Severn. Sweating sickness was an inflammatory rheumatic fever, with great disorder of the nervous system, and was characterized by a profuse and injurious perspiration. In the English epidemic the brain, meninges, and the nerves were affected in a peculiar manner. The functions of the pneumogastric nerves were violently disordered in this disease, as was shown by the oppressed respiration and extreme anxiety, with nausea and vomiting,--symptoms to which modern physicians attach much importance. The stupor and profound lethargy show that there was an injury to the brain, to which, in all probability, was added a stagnation of black blood in the torpid veins. Probably decomposing blood gave rise to the offensive odor of the person. The function of the lungs was considerably impaired. The petechial fever in Italy in 1505 was a form of the sweating sickness. There were visitations in 1506 and in 1515 in England. In 1517 the disease lasted full six months and reached its greatest height about six weeks after its appearance, but was apparently limited to England. Meningeal symptoms were characteristic of the third visitation of the disease. In 1528 and 1529 there was a fourth visitation which resulted in the destruction of the French Army before Naples. It is said that in 1524 a petechial fever carried off 50,000 people in Milan, and possibly this was the same disease. In 1529 the disease had spread all over Europe, attended with great mortality. Germany, France, and Italy were visited equally. The famine in Germany, at this time, is described by authorities in a tone of deep sympathy. Swabia, Lorraine, Alsace, and provinces on the border of the lower Rhine, were frightfully affected, so that the disease reached the same heights there as in France. In England Henry VIII endeavored to avoid the epidemic by continual traveling, until at last he grew tired of so unsettled a life and determined to await his destiny at Tytynhangar. It was not the inhabitants of the land alone who were affected, but even fish and the fowls of the air sickened. According to Schiller, in the neighborhood of Freiburg in Breisgau, dead birds were found scattered under the trees with boils as large as peas under their wings,--indicating among them a disease, and this extended far beyond the southern districts of the Rhine. The disease was undoubtedly of a miasmatic infectious nature, as was proved by its rapid spread and the occasional absence of a history of contagion. It was particularly favored in its development by high temperature and humidity. The moral effect of the sweating sickness, similar to that of the black plague, was again to increase religious fanaticism and recreate the zeal of persecution. On the 15th of April, 1551, there was an outbreak of the fifth and last epidemic of sweating fever in Shrewsbury, on the Severn. With stinking mists it gradually spread all over England, and on the 9th of July it reached London. The mortality was very considerable. The English residents were particularly susceptible, foreigners being comparatively exempt. The epidemic terminated about the 30th of September. Since that time the sweating sickness has never reappeared in England; but in the beginning of the eighteenth century a disease very similar in symptoms and course broke out in Picardy, in Northern France. Toward the end of the century it spread to the South of France, and since that time has appeared epidemically, 195 distinct outbreaks having been observed in the course of one hundred and sixty-nine years, from 1618 to 1787. The disease has frequently appeared in Italy since 1755, and in various parts of Germany since 1801. In Belgium it has been observed in a few places within the present century (Rohe). Chronologic Table of the Principal Plagues.--In December, 1880, H. P. Potter, F.R.C.S., published a chronologic table of some of the principal plagues on record. In comments on his table, Potter says that he has doubtless included mention of many plagues which, although described under that name, are probably a dissimilar disease, writers having applied the terms pestilential and pestilent in a generic sense to diseases specifically different. It must also be remembered that, in some cases, death must have been due to famine, want, and privation, which are so frequently coexistent with pestilence. Following the idea of Hecker, the dancing manias have been included in this table. {table omitted} Small-pox.--From certain Chinese records it appears that small-pox, or a disease with similar symptoms, was known in China before the Christian era, and it was supposed to have been known at a very early period in India. Most likely it was introduced into Europe in the second century by a Roman army returning from Asia. Before the sixth century, the terrible century of the great plague, there seem to be no records of small-pox or other eruptive fevers. Neither Hippocrates, Galen, nor the Greek physicians who practiced at Rome, mention small-pox, although it is now believed that the Emperor Marcus Aurelius died of this disease. According to Dupony, the first document mentioning variola was in 570 A.D., by Marius, a scholar of Avenches, in Switzerland. ("Anno 570, morbus validus cum profluvio ventris, et variola, Italiam Galliamque valde affecit.") Ten years later Gregory of Tours describes an epidemic with all the symptoms of small-pox in the fifth reign of King Childebert (580); it started in the region of Auvergne, which was inundated by a great flood; he also describes a similar epidemic in Touraine in 582. Rhazes, or as the Arabs call him, Abu Beer Mohammed Ibn Zacariya Ar-Razi, in the latter part of the ninth century wrote a most celebrated work on small-pox and measles, which is the earliest accurate description of these diseases, although Rhazes himself mentions several writers who had previously described them, and who had formulated rules for their cure. He explained these diseases by the theory of fermentation, and recommended the cooling treatment. Adams remarks that although it is probable that small-pox existed for ages in Hindoostan and China, being completely isolated in those countries from the European world, it was not introduced into the West until the close of the seventh century. Imported into Egypt by the Arabians, it followed in the tracks of their conquests, and was in this way propagated over Europe. The foregoing statement disagrees with Dupony and others. It is well known that small-pox was prevalent in Europe before Rhazes's description of it, and after the Crusades it spread over Central and Western Europe, but did not extend to the northern countries until some years later. In 1507 the Spaniards introduced it into San Domingo, and in 1510 into Mexico, where it proved a more fatal scourge than the swords of Cortez and his followers, for according to Robertson it swept away in Mexico three millions and a half of people. In 1707 it appeared in Iceland, and carried off more than one-fourth of its inhabitants; in 1733, according to Collinson, it almost depopulated Greenland. The Samoyeds, Ostiaks, and other natives of Eastern Siberia, have frequently suffered from devastating epidemics. In Kamchatka the disease was introduced in 1767, and many villages were completely depopulated. According to Moore, at the beginning of the eighteenth century nearly one-fourteenth of the population died from small-pox in England, and at the end of the century the number of the victims had increased to one-tenth. In the last century the statement was made in England that one person in every three was badly pock-marked. The mortality of the disease at the latter half of the eighteenth century was about three to every thousand inhabitants annually. India has always been a fertile ground for the development of small-pox, and according to Rohe the mortality from small-pox has been exceedingly great for the past twenty years. From 1866 to 1869, 140,000 persons died in the Presidencies of Bombay and Calcutta, and several years later, from 1873 to 1876, 700,000 died from this disease. China, Japan, and the neighboring countries are frequently visited with small-pox, and nearly all the inhabitants of Corea are said to bear evidences of the disease. In the Marquesas Islands one-fourth of the inhabitants had fallen victims to the disease since 1863. It was first introduced into the Sandwich Islands in 1853, and it then carried off eight per cent of the natives. Australia, Tasmania, New Zealand, and the Fiji Archipelago have to the present day remained exempt from small-pox; although it has been carried to Australia in vessels, rigorous quarantine methods have promptly checked it. On the American continent it was believed that small-pox was unknown until the conquest of Mexico. It has been spread through various channels to nearly all the Indian tribes of both North and South America, and among these primitive people, unprotected by inoculation or vaccination, its ravages have been frightful. That small-pox a disease so general and so fatal at one time--has, through the ingenuity of man, in civilized communities at least, become almost extinct, is one of the greatest triumphs of medicine. Inoculation was known in Europe about 1700, and in 1717 the famous letter of Lady Montagu from Adrianople was issued, containing in part the following statements:-- "The small-pox, so fatal and so general amongst us, is here entirely harmless, by the invention of ingrafting, which is the term they give it. There is a set of old women who make it their business to perform the operation every autumn in the month of September, when the great heat is abated. People send to one another to know if any of their family has a mind to have the small-pox; they make parties for this purpose, and when they are met, the old woman comes with a nut-shell full of the matter of the best sort of small-pox, and asks what vein you please to have opened. She immediately rips open that you offer her with a large needle, and puts into the vein as much matter as can lie upon the head of her needle, and after that binds up the little wound with a hollow shell, and in this manner opens four or five veins." Soon after this letter Lady Montagu had her son inoculated in Turkey, and four years later her daughter was to be the first subject inoculated in England. She made rapid progress notwithstanding the opposition of the medical profession, and the ignorance and credulity of the public. The clergy vituperated her for the impiety of seeking to control the designs of Providence. Preaching in 1722, the Rev. Edward Massey, for example, affirmed that Job's distemper was confluent small-pox, and that he had been inoculated by the Devil. Lady Montagu, however, gained many supporters among the higher classes. In 1721 Mead was requested by the Prince of Wales to superintend the inoculation of some condemned criminals, the Prince intending afterward to continue the practice in his own family; the experiment was entirely successful, and the individuals on whom it was made afterward received their liberty (Adams). According to Rohe, inoculation was introduced into this country in 1721 by Dr. Zabdiel Boylston of Boston, who had his attention directed to the practice by Cotton Mather, the eminent divine. During 1721 and 1722 286 persons were inoculated by Boylston and others in Massachusetts, and six died. These fatal results rendered the practice unpopular, and at one time the inoculation hospital in Boston was closed by order of the Legislature. Toward the end of the century an inoculating hospital was again opened in that city. Early in the eighteenth century inoculation was extensively practiced by Dr. Adam Thomson of Maryland, who was instrumental in spreading a knowledge of the practice throughout the Middle States. Despite inoculation, as we have already seen, during the eighteenth century the mortality from small-pox increased. The disadvantage of inoculation was that the person inoculated was affected with a mild form of small-pox, which however, was contagious, and led to a virulent form in uninoculated persons. As universal inoculation was manifestly impracticable, any half-way measure was decidedly disadvantageous, and it was not until vaccination from cow-pox was instituted that the first decided check on the ravages of small-pox was made. Vaccination was almost solely due to the persistent efforts of Dr. Edward Jenner, a pupil of the celebrated John Hunter, born May 17, 1749. In his comments on the life of Edward Jenner, Adams, in "The Healing Art," has graphically described his first efforts to institute vaccination, as follows: "To the ravages of small-pox, and the possibility of finding some preventive Jenner had long given his attention. It is likely enough that his thoughts were inclined in this direction by the remembrance of the sufferings inflicted upon himself by the process of inoculation. Through six weeks that process lingered. He was bled, purged, and put on a low diet, until 'this barbarism of human veterinary practice' had reduced him to a skeleton. He was then exposed to the contagion of the small-pox. Happily, he had but a mild attack; yet the disease itself and the inoculating operations, were probably the causes of the excessive sensitiveness which afflicted him through life. "When Jenner was acting as a surgeon's articled pupil at Sudbury, a young countrywoman applied to him for advice. In her presence some chance allusion was made to the universal disease, on which she remarked: 'I shall never take it, for I have had the cow-pox.' The remark induced him to make inquiries; and he found that a pustular eruption, derived from infection, appeared on the hands of milkers, communicated from the teats of cows similarly disordered; this eruption was regarded as a safeguard against small-pox. The subject occupied his mind so much that he frequently mentioned it to John Hunter and the great surgeon occasionally alluded to it in his lectures, but never seems to have adopted Jenner's idea that it might suggest some efficacious substitute for inoculation. Jenner, however, continued his inquiries, and in 1780 he confided to his friend, Edward Gardner, his hope and prayer that it might be his work in life to extirpate smallpox by the mode of treatment now so familiar under the name of vaccination. "At the meetings of the Alveston and Radborough Medical Clubs, of both of which Jenner was a member, he so frequently enlarged upon his favorite theme, and so repeatedly insisted upon the value of cow-pox as a prophylactic, that he was denounced as a nuisance, and in a jest it was even proposed that if the orator further sinned, he should then and there be expelled. Nowhere could the prophet find a disciple and enforce the lesson upon the ignorant; like most benefactors of mankind he had to do his work unaided. Patiently and perseveringly he pushed forward his investigations. The aim he had in view was too great for ridicule to daunt, or indifference to discourage him. When he surveyed the mental and physical agony inflicted by the disease, and the thought occurred to him that he was on the point of finding a sure and certain remedy, his benevolent heart overflowed with unselfish gladness. No feeling of personal ambition, no hope or desire of fame, sullied the purity of his noble philanthropy. 'While the vaccine discovery was progressive,' he writes, 'the joy at the prospect before me of being the instrument destined to take away from the world one of its greatest calamities, blended with the fond hope of enjoying independence, and domestic peace and happiness, were often so excessive, that, in pursuing my favorite subject among the meadows, I have sometimes found myself in a kind of reverie. It is pleasant to recollect that those reflections always ended in devout acknowledgments to that Being from whom this and all other blessings flow.' At last an opportunity occurred of putting his theory to the test. On the 14th day of May, 1796,--the day marks an epoch in the Healing Art, and is not less worthy of being kept as a national thanksgiving than the day of Waterloo--the cow-pox matter or pus was taken from the hand of one Sarah Holmes, who had been infected from her master's cows, and was inserted by two superficial incisions into the arms of James Phipps, a healthy boy of about eight years of age. The cow-pox ran its ordinary course without any injurious effect, and the boy was afterward inoculated for the small-pox,--happily in vain. The protection was complete; and Jenner thenceforward pursued his experiments with redoubled ardor. His first summary of them, after having been examined and approved by several friends, appeared under the title of 'An Inquiry into the Causes and Effects of the Variolae Vaccinae,' in June, 1798. In this important work he announced the security against the small-pox afforded by the true cow-pox, and proceeded to trace the origin of that disease in the cow to a similar affection of the horse's heel." This publication produced a great sensation in the medical world, and vaccination spread so rapidly that in the following summer Jenner had the indorsement of the majority of the leading surgeons of London. Vaccination was soon introduced into France, where Napoleon gave another proof of his far-reaching sagacity by his immediate recognition of the importance of vaccination. It was then spread all over the continent; and in 1800 Dr. Benjamin Waterhouse of Boston introduced it into America; in 1801, with his sons-in-law, President Jefferson vaccinated in their own families and those of their friends nearly 200 persons. Quinan has shown that vaccination was introduced into Maryland at least simultaneously with its introduction into Massachusetts. De Curco introduced vaccination into Vienna, where its beneficial results were displayed on a striking scale; previously the average annual mortality had been about 835; the number now fell to 164 in 1801, 61 in 1802, and 27 in 1803. After the introduction of vaccination in England the mortality was reduced from nearly 3000 per million inhabitants annually to 310 per million annually. During the small-pox epidemic in London in 1863, Seaton and Buchanan examined over 50,000 school children, and among every thousand without evidences of vaccination they found 360 with the scars of small-pox, while of every thousand presenting some evidence of vaccination, only 1.78 had any such traces of small-pox to exhibit. Where vaccination has been rendered compulsory, the results are surprising. In 1874 a law was established in Prussia that every child that had not already had small-pox must be vaccinated in the first year of its life, and every pupil in a private or public institution must be revaccinated during the year in which his or her twelfth birthday occurs. This law virtually stamped small-pox out of existence; and according to Frolich not a single death from small-pox occurred in the German army between 1874 and 1882. Notwithstanding the arguments advanced in this latter day against vaccination, the remembrance of a few important statistic facts is all that is necessary to fully appreciate the blessing which Jenner conferred upon humanity. In the last century, besides the enormous mortality of small-pox (it was computed that, in the middle of the last century, 2,000,000 victims perished in Russia from small-pox), the marks of affliction, blindness, deafness, etc., were plain in at least one member of every family. Asiatic cholera probably originated centuries ago in India, where it is now endemic and rages to such an extent as to destroy 750,000 inhabitants in the space of five years. There is questionable evidence of the existence of cholera to be found in the writings of some of the classic Grecian and Indian authors, almost as far back as the beginning of the Christian era. In the sixteenth and seventeenth centuries travelers in the East gave accounts of this disease. Sonnerat, a French traveler, describes a pestilence having all the characteristics of Asiatic cholera which prevailed in the neighborhood of Pondicherry and the Coromandel coast from 1768 to 1769, and which, within a year, carried off 60,000 of those attacked. According to Rohe, Jasper Correa, an officer in Vasco da Gama's expedition to Calicut, states that Zamorin, the chief of Calicut, lost 20,000 troops by the disease. Although cholera has frequently extended to Europe and America, its ravages have never been nearly as extensive as in the Oriental outbreaks. An excellent short historic sketch of the epidemics of the cholera observed beyond the borders of India has been given by Rohe. In 1817 cholera crossed the boundaries of India, advancing southeasterly to Ceylon, and westerly to Mauritius, reaching the African coast in 1820. In the following two years it devastated the Chinese Empire and invaded Japan, appearing at the port of Nagasaki in 1822. It advanced into Asiatic Russia, and appeared as far east as St. Petersburg in 1830, from whence it spread north to Finland. In 1831 it passed through Germany, invading France and the western borders of Europe, entering the British Isles in 1832, and crossing the Atlantic Ocean for the first time, appeared in Canada, having been carried thence by some Irish emigrants. From Canada it directly made its way to the United States by way of Detroit. In the same year (1832) it appeared in New York and rapidly spread along the Atlantic coast. "During the winter of 1832 it appeared at New Orleans, and passed thence up the Mississippi Valley. Extending into the Indian country, causing sad havoc among the aborigines, it advanced westward until its further progress was stayed by the shores of the Pacific Ocean. In 1834 it reappeared on the east coast of the United States, but did not gain much headway, and in the following year New Orleans was again invaded by way of Cuba. It was again imported into Mexico in 1833. In 1835 it appeared for the first time in South America, being restricted, however, to a mild epidemic on the Guiana coast. "In 1846 the disease again advanced beyond its natural confines, reaching Europe by way of Turkey, in 1848. In the autumn of this year it also appeared in Great Britain, Belgium, the Netherlands, Sweden, and the United States, entering by way of New York and New Orleans. In the succeeding two years the entire extent of country east of the Rocky Mountains was invaded. During 1851 and 1852 the disease was frequently imported by emigrants, who were annually arriving in great numbers from the various infected countries of Europe. In 1853 and 1854 cholera again prevailed extensively in this country, being, however, traceable to renewed importation of infected material from abroad. In the following two years it also broke out in numerous South American States, where it prevailed at intervals until 1863. Hardly had this third great pandemic come to an end before the disease again advanced from the Ganges, spreading throughout India, and extending to China, Japan, and the East Indian Archipelago, during the years 1863 to 1865. In the latter year it reached Europe by way of Malta and Marseilles. It rapidly spread over the Continent, and in 1866 was imported into this country by way of Halifax, New York, and New Orleans. This epidemic prevailed extensively in the Western States, but produced only slight ravages on the Atlantic Coast, being kept in check by appropriate sanitary measures. In the same year (1866) the disease was also carried to South America, and invaded for the first time the states bordering on the Rio de la Plata and the Pacific coast of the Continent. "Cholera never entirely disappeared in Russia during the latter half of the sixth decade, and in 1870 it again broke out with violence, carrying off a quarter of a million of the inhabitants before dying out in 1873. It spread from Russia into Germany and France and was imported, in 1873, into this country, entering by way of New Orleans and extending up the Mississippi Valley. None of the Atlantic coast cities suffered from this epidemic in 1873, and since that year the United States has been entirely free from the disease, with the exception of a few imported cases in New York harbor in 1887" (and in 1893). In 1883 an epidemic of cholera raged in Egypt and spread to many of the Mediterranean ports, and reappeared in 1885 with renewed violence. In Spain alone during this latter epidemic the total number of cases was over one-third of a million, with nearly 120,000 deaths. In 1886 cholera caused at least 100,000 deaths in Japan. In the latter part of 1886 cholera was carried from Genoa to Buenos Ayres, and crossing the Andean range invaded the Pacific coast for a second time. In Chili alone there were over 10,000 deaths from cholera in the first six months of 1887. Since then the entire Western hemisphere has been virtually free from the disease. In 1889 there was an epidemic of cholera in the Orient; and in 1892 and 1893 it broke out along the shores of the Mediterranean, invading all the lines of commerce of Europe, Hamburg in the North and Marseilles in the South being especially affected. In the summer of 1893 a few cases appeared in New York Bay and several in New York city, but rigorous quarantine methods prevented any further spread. Typhus fever is now a rare disease, and epidemics are quite infrequent. It has long been known under the names of hospital-fever, spotted-fever, jail-fever, camp-fever, and ship-fever, and has been the regular associate of such social disturbances as overcrowding, excesses, famine, and war. For the past eight centuries epidemics of typhus have from time to time been noticed, but invariably can be traced to some social derangement. Yellow Fever is a disease prevailing endemically in the West Indies and certain sections of what was formerly known as the Spanish Main. Guiteras recognizes three areas of infection:-- (1) The focal zone from which the disease is never absent, including Havana, Vera Cruz, Rio, and the other various Spanish-American points. (2) The perifocal zone, or regions of periodic epidemics, including the ports of the tropical Atlantic and Africa. (3) The zone of accidental epidemics, between the parallels of 45 degrees north and 35 degrees south latitude. In the seventeenth century Guadaloupe, Dominica, Martinique, and Barbadoes suffered from epidemics of yellow fever. After the first half of the seventeenth century the disease was prevalent all through the West Indies. It first appeared in the United States at the principal ports of Boston, Philadelphia, and Charleston, in 1693, and in 1699 it reappeared in Philadelphia and Charleston, and since that time many invasions have occurred, chiefly in the Southern States. The epidemic of 1793 in Philadelphia, so graphically described by Matthew Carey, was, according to Osler, the most serious that has ever prevailed in any city of the Middle States. Although the population of the city was only 40,000, during the months of August, September, October, and November the mortality, as given by Carey, was 4041, of whom 3435 died in the months of September and October. During the following ten years epidemics of a lesser degree occurred along the coast of the United States, and in 1853 the disease raged throughout the Southern States, there being a mortality in New Orleans alone of nearly 8000. In the epidemic of 1878 in the Southern States the mortality was nearly 16,000. South America was invaded for the first time in 1740, and since 1849 the disease has been endemic in Brazil. Peru and the Argentine Republic have also received severe visitations of yellow fever since 1854. In Cuba the disease is epidemic during June, July, and August, and it appears with such certainty that the Revolutionists at the present time count more on the agency of yellow fever in the destruction of the unacclimated Spanish soldiers than on their own efforts. Leprosy is distinctly a malady of Oriental origin, and existed in prehistoric times in Egypt and Judea. It was supposed to have been brought into Europe by a Roman army commanded by Pompey, after an expedition into Palestine. Leprosy was mentioned by several authors in the Christian era. France was invaded about the second century, and from that time on to the Crusades the disease gradually increased. At this epoch, the number of lepers or ladres becoming so large, they were obliged to confine themselves to certain portions of the country, and they took for their patron St. Lazare, and small hospitals were built and dedicated to this saint. Under Louis VIII 2000 of these hospitals were counted, and later, according to Dupony, there were 19,000 in the French kingdom. Various laws and regulations were made to prevent the spread of the contagion. In 1540 it was said that there were as many as 660 lepers in one hospital in Paris. No mention is made in the Hippocratic writings of elephantiasis graecorum, which was really a type of leprosy, and is now considered synonymous with it. According to Rayer, some writers insist that the affection then existed under the name of the Phoenician disease. Before the time of Celsus, the poet Lucretius first speaks of elephantiasis graecorum, and assigns Egypt as the country where it occurs. Celsus gives the principal characteristics, and adds that the disease is scarcely known in Italy, but is very common in certain other countries. Galen supplies us with several particular but imperfect cases--histories of elephantiasis graecorum, with a view to demonstrate the value of the flesh of the viper, and in another review he adds that the disease is common in Alexandria. Aretaeus has left a very accurate picture of the symptoms of elephantiasis graecorum; and Pliny recapitulates the principal features and tells us that the disease is indigenous in Egypt. The opinion of the contagiousness of elephantiasis graecorum which we find announced in Herodotus and Galen is more strongly insisted upon by Caelius Aurelianus who recommends isolation of those affected. Paulus aegenita discusses the disease. The Arabian writers have described elephantiasis graecorum under the name of juzam, which their translators have rendered by the word lepra. Later, Hensler, Fernel Pare, Vesalius, Horstius, Forestus, and others have discussed it. The statistics of leprosy in Europe pale before the numbers affected in the East. The extent of its former ravages is unknown, but it is estimated that at the present day there are over 250,000 lepers in India, and the number in China is possibly beyond computation. According to Morrow, in 1889 in the Sandwich Islands there were 1100 lepers in the settlement at Molokai. Berger states that there were 100 cases at Key West; and Blanc found 40 cases at New Orleans. Cases of leprosy are not infrequently found among the Chinese on the Pacific coast, and an occasional case is seen in the large cities of this country. At the present day in Europe, where leprosy was once so well known, it is never found except in Norway and the far East. Possibly few diseases have caused so much misery and suffering as leprosy. The banishment from all friends and relatives, the confiscation of property and seclusion from the world, coupled with poverty and brutality of treatment,--all emphasize its physical horror a thousandfold. As to the leper himself, no more graphic description can be given than that printed in The Ninteenth Century, August, 1884: "But leprosy! Were I to describe it no one would follow me. More cruel than the clumsy torturing weapons of old, it distorts, and scars, and hacks, and maims, and destroys its victim inch by inch, feature by feature, member by member, joint by joint, sense by sense, leaving him to cumber the earth and tell the horrid tale of a living death, till there is nothing left of him. Eyes, voice, nose, toes, fingers, feet, hands, one after the other are slowly deformed and rot away, until at the end of ten, fifteen, twenty years, it may be, the wretched leper, afflicted in every sense himself, and hateful to the sight, smell, hearing, and touch of others, dies, despised and the most abject of men." Syphilis.--Heretofore the best evidence has seemed to prove that syphilis had its origin in 1494, during the siege of Naples by Charles VIII of France; but in later days many investigators, prominent among them Buret, have stated that there is distinct evidence of the existence of syphilis in prehistoric times. Buret finds evidence of traces of syphilis among the Chinese five thousand years ago, among the Egyptians at the time of the Pharaohs, among the Hebrews and Hindoos in biblic times, and among the Greeks and Romans after Christ. Some American writers claim to have found evidences of syphilitic disease in the skulls and other bones of the prehistoric Indian mounds, thus giving further evidence to the advocates of the American origin of syphilis. The Spaniards claimed that, returning from America in 1493, Columbus brought with him syphilis. Friend says: "One thing is remarkable; the Spaniards, upon their first expedition to America, brought home from thence this contagious disorder, and soon after carried another affection thither, the small-pox, of which the Indian Prince Montezuma died." The first descriptions of syphilis are given under the name of morbus gallicus, while the French in return called it morbus neapolitanus or mal d'Italie. The name of syphilis was said to have been first given to it by a physician of Verona, in a poem describing the disease. Inspired by heroic epics Fracastor places before us the divinities of paganism, and supposes that a shepherd, whom he called Syphilus, had addressed words offensive to Apollo, and had deserted his altars. To punish him the God sent him a disease of the genitals, which the inhabitants of the country called the disease of Syphilus. "Syphilidemque ab eo labem dixere coloni." Buret traces the origin of the word syphilis from sun, with, and filia, love, the companion of love; which means in plain language that the pox is a disease transmitted more especially by venereal relations. The first great epidemic of syphilis occurred between 1493 and 1496, and attacked all ranks, neither the Church nor the Crown being spared. The ravages of this disease were increased by the treatment with mercury which soon afterward was found in proper doses to be a specific in this disease. It is possible that the terrible manifestations of syphilis of which we read in the older writers were in a great measure due to the enormous doses of mercury. At the present day syphilis is universally prevalent. In his excellent monograph Sturgis estimated in New York, in 1873, that one out of 18 suffered from it; and White of Philadelphia pronounces the opinion that "not less than 50,000 people in that city are affected with syphilis." According to Rohe, on this basis Gihon estimates the number of syphilitics in the United States at one time as 2,000,000. To-day no disease, except possibly tuberculosis, is a greater agency in augmenting the general mortality and furthering sickness than syphilis. Its hereditary features, the numerous ways in which it may be communicated outside of the performance of the sexual act, and the careful way in which it is kept from the sanitary authorities render it a scourge which, at the present day, we seem to have no method of successfully repressing. Modern Mortality from Infectious Diseases.--As to the direct influence on the mortality of the most common infectious diseases of the present day, tuberculosis, universally prevalent, is invariably in the lead. No race or geographic situation is exempt from it. Osler mentions that in the Blood Indian Reserve of the Canadian Northwest Territories, during six years, among a population of about 2000 there were 127 deaths from pulmonary consumption. This enormous death-rate, it is to be remembered, occurred in a tribe occupying one of the finest climates of the world, among the foothills of the Rocky Mountains, a region in which consumption is extremely rare among the white population, and in which cases of tuberculosis from the Eastern provinces do remarkably well. Mayo-Smith quotes a table illustrating the annual deaths (based on the returns from 1887 to 1891) from certain infectious diseases per 10,000 European inhabitants. The figures for each disease give a rough measure of its prevalence in different countries. The large figures as to small-pox show the absence in Italy and "Hieronymi Fracastorii," Veronae, 1530. Statistics and Sociology, New York, 1885. Austria of vaccination; diphtheria seems to be very fatal in Germany and Austria; Italy has a large rate for typhoid fever, and the same is true of the other fevers; France, Germany, and Austria show a very large rate for tuberculosis, while Italy has a small rate. DEATHS FROM CERTAIN DISEASES PER 10,000 INHABITANTS. Small- Scarlet Diphtheria Typhoid Tuber- COUNTRY. pox. Measles. fever fever. culosis Italy, . . . . . 3.86 6.17 2.99 6.08 7.49 13.61 France (cities). 2.3 5.18 3.1 6.66 5.32 33. England, . . . . 0.11 4.68 2.31 1.74 1.9 16.09 Ireland, . . . . 0.01 2.01 1.22 0.76 2.33 21.15 Germany (cities). 0.04 2.8 2.15 10.21 2.11 31.29 Prussia, . . . . 0.03 3.2 2.46 14.17 2.26 28.06 Austria, . . . . 4.43 5.36 5.57 13.2 5.42 37.2 Switzerland, . . 0.06 1.53 1.22 3.53 1.47 21.07 Belgium, . . . . 1.52 6.2 1.62 5.77 3.83 19.87 Holland, . . . . 0.02 3.93 0.38 1.45 2.5 19.21 Sweden, . . . . . 0.01 2.3 3.69 3.89 2.22 0. Based upon the Tenth Census Reports, we figure that of every 10,000 inhabitants of the United States the number of deaths for the census year from similar diseases was as follows:-- Rural. Cities. Measles, . . . . . . . 1.62 1.54 Scarlet Fever, . . . . 2.84 5.54 Diphtheria, . . . . . 7.53 8. Croup, . . . . . . . . 3.51 4.08 Typhoid Fever, . . . . 4.75 3.46 Tuberculosis, . . . . 16.29 28.55 The general average of deaths from small-pox was about 0.14.